INTRODUCTION
A new Erbium:YAG laser employing micro-ablative
technology provides a decrease in
fine lines and wrinkles in the peri-orbital
area in addition to a reduction in
the appearance of acne scarring after
one treatment. Skin appears brighter,
fresher and more rejuvenated after
just one treatment.
OBJECTIVE
The purpose of this study is to determine
the safety and efficacy of a low
energy Erbium YAG laser based upon
clinical and histologic analysis.
MATERIALS AND METHODS
Ten subjects (8 female and 2 male)
age 18 or older (mean age 33) were
randomized into two groups and were
treated with the laser on the medium
or high setting. Subjects were monitored
immediately post-treatment, 5 days
and 10 days after treatment. Improvement
was measured by the participant, the
principal investigator and a blinded
investigator 10 days after the treatment
session based on the following scale:
no improvement, 0-25% improvement,
26-50% improvement, 51-75% improvement,
and 76-100% improvement (see table
below). Five participants elected
to participate in the biopsy group,
four subjects had a biopsy pre-treatment
and immediately after treatment and
one subject had a biopsy pretreatment,
immediately after treatment and 5
days after treatment. Subjects were
also asked to measure their brownness,
redness, swelling, crusting and pain.
| Improvements |
Participant |
Blinded
Investigator |
Principal
Investigator |
0% |
10% |
40% |
0% |
0-25% |
40% |
30% |
60%
|
26-50% |
10% |
20% |
10%
|
51-75% |
20% |
10% |
0%
|
76-100% |
20% |
0% |
30%
|
|
RESULTS
Subjects most commonly reported burning,
erythema and mild edema in the treated
area. The burning sensation ceased
within a few hours after treatment.
Mild edema and erythema subsided over
the next 48 hours. Patients were instructed
to use make-up for the erythema. Desquamation
occurred up to 10 days with the majority
of subjects achieving complete re-epithelialization
within 7 days.
Subjects indicated that their skin
felt “tighter”, “smoother”, and “brighter”
after just one treatment. Biopsies
taken pre-treatment, immediately post
treatment with the device and five
days post-treatment revealed that
immediately post-treatment the cells
of the spinous and granular layers
in the epidermis were ablated. Five
days post-treatment revealed an alteration
in the elastic tissue and a thickening
of collagen bundles in the papillary
dermis consistent with early dermal
remodeling were noted.
CONCLUSION
In conclusion, epidermal ablation
and mild alteration of the dermal
matrix consistent with early remodeling
are noted after a single treatment
with this novel low energy Er:YAG
technology. This technology, as confirmed
by the histology, is helpful for skin
turnover as well as potentiating new
collagen leading to plumper, smoother,
and more uniform healthy skin. Dermal
remodeling can lead to a decreased
appearance of fine lines and wrinkles.
(Figure 2) We would recommend this
treatment as a “Friday peel” for patients
as they can resume normal activities
the same day however most subjects
indicated they would feel most comfortable
having a weekend rest period. Post-treatment
patients are to avoid sun exposure
and use a bland moisturizer and a
sunscreen. Based upon this study protocol
and the results, a series of 3 to
5 treatments every 1-2 months is recommended.
This treatment series can be customized
to suit the individual patient based
upon the degree of photoaging. Because
the device employs multiple energy
levels, each treatment in the series
can be tailored to the patient’s needs
and desired outcome.
Subjects were asked to rate brownness,
redness, swelling, blistering, crusting,
and pain that they experienced over
the day period of the study. Subjects
rated this on a scale of 1 to 10 where
1=none and 10=terrible.
The table below represents the averages
based upon the subject’s responses.
| Brownness |
Redness |
Swelling
|
Blistering |
Crusting |
Pain
|
5.0 |
8.1 |
4.2 |
2.2 |
3.5 |
5.4 |
|
 Figure
1.
A 2mm punch biopsy performed five
days post-treatment on the high setting.
Tissue was fixed in formalin and paraffin
embedded prior to staining for elastic
fibers. Black lines are decreased
elastic fibers that are surrounded
by collagen bundles. This is consistent
with dermal remodeling.
Figure 2.
A) Pre-Treatment.
B) 10 days post-treatment on the high
setting. The post-treatment photo
shows a decrease in the appearance
of fines lines and wrinkles in the
peri-orbital area.
- Neil Sadick M.D., F.A.C.P., F.A.A.C.S
Sadick Aesthetic Surgery and Dermatology
Clinical professor of dermatology
at Cornell University Medical College
in New York City
October 17, 2005
Aesthetic
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