Effificacy of autologous platelet-rich plasma combined with fractional ablative carbon dioxide resurfacing laser in treatment of facial atrophic acne scars: A split-face randomized clinical trial.

Background: Autologous platelet-rich plasma has recently attracted signifi cant attention throughout the medical fi eld for its wound-healing ability. Aims: This study was conducted to investigate the potential of platelet-rich plasma combined with fractional laser therapy in the treatment of acne scarring. Methods: Sixteen patients (12 women and 4 men) who underwent split-face therapy were analyzed in this study. They received ablative fractional carbon dioxide laser combined with intradermal platelet-rich plasma treatment on one half of their face and ablative fractional carbon dioxide laser with intradermal normal saline on the other half. The injections were administered immediately after laser therapy. The treatment sessions were repeated after an interval of one month. The clinical response was assessed based on patient satisfaction and the objective evaluation of serial photographs by two blinded dermatologists at baseline, 1 month after the fi rst treatment session and 4 months after the second. The adverse effects including erythema and edema were scored by participants on days 0, 2, 4, 6, 8, 15 and 30 after each session. Results: Overall clinical improvement of acne scars was higher on the platelet-rich plasma-fractional carbon dioxide laser treated side but the difference was not statistically signifi cant either 1 month after the fi rst treatment session (P = 0.15) or 4 months after the second (P = 0.23). In addition, adverse effects (erythema and edema) on the platelet-rich plasma-fractional carbon dioxide laser-treated side were more severe and of longer duration. Limitations: Small sample size, absence of all skin phototypes within the study group and lack of objective methods for the evaluation of response to treatment and adverse effects were the limitations. Conclusion: This study demonstrated that adding platelet-rich plasma to fractional carbon dioxide laser treatment did not produce any statistically signifi cant synergistic effects and also resulted in more severe side effects and longer downtime.

Hypopigmentation Occurred After Er: YAG Laser Resurfacing / 대한피부과학회지

BACKGROUND: Hypopigmentation is one of the complications developed after laser resurfacing. There have been few data about hypopigmentation developed after Er: YAG laser resurfacing, especially in darker skin. OBJECTIVE: The objective of this study was to assess the clinical and histopathologic features of hypopigmentation developed after Er: YAG laser resurfacing. METHODS: One hundred and ninety patients have been included in this study. Ninety seven patients were treated with short pulsed Er: YAG laser, 2mm spot sized handpiece at the setting of 12.5-15.0J/cm2. Fifty two patients were treated with variable pulsed Er: YAG laser, 5mm spot sized handpiece at the setting of 7.0-7.5J/cm2 and 7msec pulse duration. Forty one patients were treated with dual mode Er: YAG laser, 4mm spot sized scanner at the setting of 17.5J/cm2 ablation mode and 3.15J/cm2 coagulation mode. Incidence, time of onset, duration of hypopigmentation were evaluated throughout the medical charts and serially checked photographs. Skin biopsy was performed in four patients at the hypopigmentation site for histopathologic and electron microscopic examinations with informed consents. RESULTS: Hypopigmentation was observed in twenty six patients; eight in short pulsed Er: YAG laser, eight in variable pulsed Er: YAG laser, ten in dual mode Er: YAG laser. According to the time of onset of hypopigmentation, twelve patients developed hypopigmentation within one month, five patients in two months, three patients within three months, three patients within four months, two patients within five months, and one patient within six months. Twenty out of twenty six patients recovered skin coloration within six months, and two patients within twelve months. On the other hand, four patients had persisted hypopigmentation for more than one year. Melanosome appeared to be decreased but melanocytes appeared to be present in normal numbers on the histopathologic and electron microscopic examinations. CONCLUSION: Although hypopigmentation is one of the frequent complicaions of Er: YAG laser resurfacing, it is temporary in most cases. Thermal damage due to long pulse duration of laser seems to be a very important factor in inducing hypopigmentation.

Treatment of Five Cases of Hypertrophic Scar Developed after Laser Resurfacing / 대한피부과학회지

At times several complications can be encountered after laser resurfacing, even with careful preoperative screening and patient preparation as well as meticulous intraoperative technique. Hypertrophic scar is rare but the most severe complication, which exerts a bad influence on patient"s postoperative satisfaction and doctor-patient relationship. We report five patients who had hypertrophic scar after laser resurfacing. They were treated with several modalities including intralesional steroid injection, high potency topical steroid, tranilast oral medication, and Er: YAG laser ablation using lower energy.

A Effect of Pretreatment Period on CO2 Laser Resurfacing in Guinea Pig Skin: A Comparative, Histologic Study

For the pre-treatment prior to laser resurfacing, materials such as glycolic acid, tretinoin, and/or hydroquinone have been widely used. However, the optimal duration of pretreatment is still controversial. The authors chose guinea pig skin which is similar to human skin, pre-treated it with tretinoin and hydroquinone with different duration, and examined gross and histologic changes after performing laser resurfacing in an attempt to study the effect of pre-treatment period on CO2 laser resurfacing. Sixteen guinea pigs were divided into four groups, and the dorsal skin was pre-treated with 0.05% tretinoin cream and 4% hydroquinone for 4, 8, and 12 weeks respectively while groupI underwent no pre-treatment as control. During the pre-treatment period, the authors observed gross skin reactions, and also examined the number of epithelial layers, thickness changes, the extent of epithelial regeneration, and collagen tissue change within dermis layer with skin tissue samples before and after laser resurfacing. Compared to group I(control) which received no pre- treatment, pre-treatment groups showed rapid epithelial hyperplasia and increase in the number and thickness of squamous epithelial cells and granular cell layer. However, there was no statistically significant difference in epithelial regeneration and number and thickness of epithelial cell layer between the 4-weeks, 8-weeks, 12- weeks pretreated groups. Pre-treatment with tretinoin and hydroquinone prior to laser resurfacing helped epithelial regeneration after resurfacing, but as to the benefit of long-term pre-treatment more than 4 weeks was not necessary.

Combined Facial Rejuvenation Using Endoscopic Face Lift and Laser Resurfacing

Facial aging is a complex process of gravity-induced soft tissue ptosis and photoaging. In the standpoint of ideal rejuvenation, face lifting combined with laser resurfacing offers significant improvement in aesthetic outcome unachievable by either procedure alone and has many advantages. Neverthless, the simultaneous combination has never been popularized due to the non-specific thermal effects of the laser and risks of skin necrosis in Korea. This report documents the safety and effectivness of combined procedures when using systematic consideration and modified techniques in orientals. This study included 26 Fitzpatrick type III, IV orientals who didn't complaint lower face aging. A dramatic rejuvenation in soft tissue reposition and skin quality was produced in combined endoscopic forehead and midface lift with laser resurfacing cases. The standard forehead lift using endoscopic subperiosteal deep plane seldom interfere flap resurfacing. An endoscopic subperiosteal and subcutaneous midface lift repositions the midface tissue effectively without preauricular incision. Newer variable pulse Er:YAG lasers allow precise ablation and coagulation separately. The minimal excessive thermal injury from variable Er:YAG lasers, modified techniques for flap and skin care program would make it possible to safely perform laser resurfacing with surgical facial rejuvenations on non smokers. There were no incidents of persistent erythema or pigmentation abnormality, scar, full thickness flap necrosis. By following the considerations suggested in this report, the combination of controlled skin resurfacing with face lifting may be safe and effective in orientals.

Wound Dressing after CO2 Laser Resurfacing using a New Dressing Material: Medifoam(R)

CO2 laser resurfacing procedure on the face is an increasingly popular and highly effective for patients with facial rhytids and scarring. And there is a variety of dressing materials available for wound care after CO2 laser resurfacing. Among the dressing method, the authors have been used the Medifoam(R) (Il Dong Pharmaceutical Ltd. and Biopol Ltd.,Seoul, Korea; a hydrocelluar semi-permeable dressing material) after CO2 laser resurfacing. A total of 20 patients were treated for scar face and wrinkles (mainly scar face including small pox scar face) with ultra-pulsed CO2 lasers (Coherent, Palo Alto, USA). No pretreatment was done. The basic protocol of laser resurfacing was that, first pass was 300mJ on the shoulder of scar, second pass with 250-200mJ, and feathering with 150mJ. Immediately after the procedure, the wound must be cleansed and dried well so that the Medifoam(R) sticks better and early contamination is avoided. Medifoam(R) was fixed to wound surface using surgical tape or surgi-net. First dressing change was done after 24-48hours according to the amount of exudates. Because of the high absorption ability of the Medifoam(R), dressing change was not necessarily needed on postoperative day 1. Another dressing changes were done on days 3, 6, 9 postoperatively for evaluating wound healing and observation. The epithelialization was usually completed within 9 days in all cases. During the dressing change, there were no exudates outside, less crust, and less thin layer of gel formation on the wound surface than any other dressing materials. Also there was no detachment of reepithelialized layer on removing the dressing materials. The use of the Medifoam(R) after CO2 laser resurfacing accelerates the healing time, reduces the pain and anxiety of the patients due to exudation, reduces the inconvenience of the patients and surgeons by less dressing changes, and reduces the cost.

Chemical Peeling and Laser Resurfacing

The chemical peeling is the process that involves the application of one or more exfoliating agents to the skin, resulting in the destruction of portions of the epidermis and/or dermis with subsequent regeneration. These techniques produce a controlled wound with instant vascular coagulation resulting in skin rejuvenenation with reduction or disappearance of actinic keratoses and changes, pigmentary dyschromias, rhytides, and selected superficial depressed scar. We herein introduce brief skin resurfacing techniques, indications, effectiveness, side effects of chemical peeling, dermabrasion, laser resurfacing.