Fractional Photothermolysis of a Replanted Nose: A Case Report

Although several cases of successful reconstruction of complete nasal amputations have been reported, reconstruction of a traumatic amputated nose remains a challenge both aesthetically and functionally. Even if replantation of the nasal tip is successful, the scar on the nose may develop an irregular appearance, an ill-fitting contour, a trap door deformity, or discoloration. In the predominant nasal tip, these suboptimal results are very stressful for patient. There are no guidelines for both management and postoperative care of traumatic nasal amputation. At the completion of laser scar revision after successful replantation, we present an excellent aesthetic outcome using the 1,550-nm fractional erbium-glass laser (MOSAIC(R), Lutronic Co. Ltd, Seoul, Korea). Based on our experience, a microvascular replantation followed by fractional non-ablative laser therapy was not harmful and was available to maximize the aesthetic outcomes.

The Consideration of Dermoscopic Findings during Atrophic Acne Scar Treatment: a Pilot Study / 대한피부과학회지

BACKGROUND: Dermoscopy has been suggested as a useful tool for diagnosing various skin diseases. Recently, the possibility of using dermoscopy to predict the response to treatment has emerged. OBJECTIVE: The purpose of this study was to determine whether dermoscopic findings corresponded to clinical acne scar types. This study also aimed to discover which dermoscopic findings predict the response to acne scar treatment. METHODS: The dermoscopic findings of 39 participants undergoing atrophic acne scar treatment with fractional photothermolysis were evaluated. Patients were divided into two groups according to the duration of acne scar persistence. RESULTS: Patients with a relatively short duration of acne scar persistence usually achieved better treatment outcomes. Dermoscopic findings showed no obvious differences according to clinical acne scar type. But high hair follicle density can be considered a predictive factor of treatment effects. CONCLUSION: Our study indicated that acne scar improvements can be predicted by dermoscopically observing hair follicle density.

The Origin, Principles of Intense Pulsed Light and Its Proper Application in Clinical Practice / 대한피부과학회지

Intense pulsed light (IPL) is a high-intensity polychromatic incoherent light of a determined wavelength spectrum, fluence, and pulse duration. Clinicians can combine these variable factors of IPL for the purpose of selective destruction of target chromophores. Due to these properties, IPL has been widely used for numerous indications including hair removal and treatment of vascular or pigmented lesions. For skilled and experienced clinicians, IPL is a great treatment modality; however it can be a source of serious adverse effects when performed by untrained clinicians. Thus, to promote the proper and safe use of IPL, we summarized the origin, history, basic principles, and clinical application of IPL and discussed qualification factors needed for clinicians who use IPL.

Treatment of Acne Scars and Wrinkles in Asian Patients Using Carbon-Dioxide Fractional Laser Resurfacing: Its Effects on Skin Biophysical Profiles

BACKGROUND: Although ablative fractional resurfacing is known to be effective against photoaging and acne scars, studies on its efficacy, safety and changes in the skin characteristics of Asians are limited. OBJECTIVE: The aim of this study is to assess the efficacy and safety of carbon dioxide fractional laser (CO2FL) in Koreans treated for wrinkles and acne scars, and to define the changes in skin characteristics during recovery period. METHODS: We administered one session of CO2FL on 10 acne scar patients and 14 wrinkles patients with skin types IV and V. The surveillance of efficacy and side effects along with the measurement of biophysical properties was carried out before 1 day, 1 week, 1 month and 3 months after treatment. RESULTS: Using a non-invasive method, skin barrier damage, erythema and bronzing of skin during the recovery period were assessed, and all of the items eventually returned to the pre-treatment level. Skin elasticity was measured in the wrinkle group, and the statistically significant effect was sustained throughout the next three months. The outcome of treatment was found to be better than 'moderate improvement' in both the acne scar and wrinkle groups. Further, there were no serious side effects three months post-procedure. CONCLUSION: CO2 FL is thought to be an effective and safe method for treating moderate to severe acne scars and wrinkles in Asians.

Effect of 2790 nm YSGG fractional laser on facial atrophic acne scars / 中华医学美学美容杂志

Objective To evaluate the effect of resurfacing facial atrophic acne scars with 2790 nm YSGG fractional laser.Methods 38 patients with facial atrophic acne scars were treated with the 2790 nm YSGG fractional laser.All patients were randomly divided into two groups:group A using the combination with ablative and non-ablative mode of treatment; group B only using the non-ablative mode throughout the entire face,four treatment sessions for each patient,6 weeks interval.Comparative photographs were taken by using VISIA.Specific complexion analysis was used to identify and quantify depressed scars and texture,and patient satisfaction was graded with a 4-point scale.Results All of facial atrophic acne scars obtained different degree of improvement were treated by 4 times.In groups A and B,cure rate achieved 56.0 ％ and 30.8 ％,respectively.All the 38 patients had a chieved efficacy (81.6 ％),and they were satisfied with the results (84.2 ％).No severe side effect was observed.Conclusions 2790 nm YSGG laser is easy to manipulate and is more exactly than other lasers.It is especially effective in enhancing the clinical outcomes of scar revision with less complications and pigmentation,and thereby 2790 nm YSGG fractional laser can provide the patients with superficial scar in face as an additional therapeutic option.

Fractional lasers in dermatology - Current status and recommendations.

Introduction: Fractional laser technology is a new emerging technology to improve scars, fine lines, dyspigmentation, striae and wrinkles. The technique is easy, safe to use and has been used effectively for several clinical and cosmetic indications in Indian skin. Devices: Different fractional laser machines, with different wavelengths, both ablative and non-ablative, are now available in India. A detailed understanding of the device being used is recommended. Indications: Common indications include resurfacing for acne, chickenpox and surgical scars, periorbital and perioral wrinkles, photoageing changes, facial dyschromias. The use of fractional lasers in stretch marks, melasma and other pigmentary conditions, dermatological conditions such as granuloma annulare has been reported. But further data are needed before adopting them for routine use in such conditions. Physician qualification: Any qualified dermatologist may administer fractional laser treatment. He/ she should possess a Master's degree or diploma in dermatology and should have had specific hands-on training in lasers, either during postgraduation or later at a facility which routinely performs laser procedures under a competent dermatologist or plastic surgeon with experience and training in using lasers. Since parameters may vary with different systems, specific training tailored towards the concerned device at either the manufacturer's facility or at another center using the machine is recommended. Facility: Fractional lasers can be used in the dermatologist's minor procedure room for the above indications. Preoperative counseling and Informed consent: Detailed counseling with respect to the treatment, desired effects and possible postoperative complications should be provided to the patient. The patient should be provided brochures to study and also adequate opportunity to seek information. A detailed consent form needs to be completed by the patient. Consent form should include information on the machine, possible postoperative course expected and postoperative complications. Preoperative photography should be carried out in all cases of resurfacing. A close-up front and 45-degree lateral photographs of both sides must be taken. Laser parameters: There are different machines based on different technologies available. Choice parameters depend on the type of machine, location and type of lesion, and skin color. Physician needs to be familiar with these requirements before using the machine. Anesthesia: Fractional laser treatment can be carried out under topical anesthesia with eutectic mixture of lidocaine and prilocaine. Some machines can be used without any anesthesia or only with topical cooling or cryospray. But for maximal patient comfort, a topical anesthetic prior to the procedure is recommended. Postoperative care: Proper postoperative care is important in avoiding complications. Post-treatment edema and redness settle in a few hours to a few days. A sunscreen is mandatory, and emollients may be prescribed for the dryness and peeling that could occur.

Skin Characteristics after Fractional Photothermolysis

BACKGROUND: Fractional photothermolysis makes thousands of minute areas called microthermal treatment zones on the skin surface and transmits thermal injury to facilitate heat shock protein formation around the dermis. Potential side effects include acneiform eruption, herpes simplex virus outbreak, erythema, and post-inflammatory hyperpigmentation. OBJECTIVE: To investigate and compare the changes in the skin of Asian patients after two different fractional photothermolysis systems (FPS) on a split face. METHODS: A half-split face study was performed with 10,600 nm carbon dioxide FPS on the left and 1,550 nm erbium-doped FPS on the right side of the face. Only one session of laser irradiation and several biophysical measurements were done. RESULTS: Although both FPS proved to be effective in treating acne scar and wrinkle patients, a slightly higher satisfaction rating was seen with the 10,600 nm FPS treatment. Both types of FPS showed a significant increase in transepidermal water loss which decreased gradually after treatment and returned to pre-treatment level after 1 week. A decreased reviscometer score was sustained for a longer period in wrinkle areas treated with 10,600 nm FPS. CONCLUSION: Even though the changes in skin varied according to different FPS wave-length, adverse outcomes, such as increased erythema and TEWL were entirely subdued within 3 months of treatment.

Effect of fractional Er:YAG laser on skin collag en proliferation / 中华皮肤科杂志

Objective To investigate the histological changes of normal human skin after fixed irradiation with multiple-pulse fractional Er:YAG laser.Methods After hair removal,the upper arms of 7 healthy volunteers were consecutively irradiated with multiple-pulse fractional Er:YAG laser.Tissue samples were resected from the irradiated skin at 1,24,48,72 hours,on day 5,7,15,and 30 after the irradiation.Hematoxylin and eosin(HE)staining and Masson staining were performed to observe the histological changes and collagen proliferation respectively.Immunohistochemical staining was used to detect the expression of heat shock protein(HSP)70 and 47.Results The consecutive irradiation with multi-pulse fractional Er:YAG laser generated an array of tapering microscopic treatment zones(MTZs)of gasification and ablation in the upper arm skin.After the irradiation,inflammation developed in the microscopic lesions with the epithelization of epidermal cells within 7 days; local dermal collagen was renewed and remodelled during the 7th to 30th day.HSP70 expression peaked as early as 48 hours after the treatment and maintained until the 7th day,while the high expression of HSP47 persisted from the 15th to 30th day after irradiation.Conclusion The fixed,multiplepulse and fractional Er:YAG laser irradiation can reach the deep dermis,and induce the local proliferation of dermal collagen.

The Principles of Intense Pulsed Light and Its Clinical Application / 대한피부과학회지

Intense pulsed light (IPL) is a high-intensity pulsed light source emitting polychromatic, non-coherent, and defocused light with a broad wavelength spectrum. However, IPL can similarly work as a conventional laser with the help of variable cut-off filters. It enables selective destruction of target chromophores based upon the theory of selective photothermolysis. Clinicians can combine variable factors including wavelengths, pulse durations, and fluences in IPL systems, which allow great versatility in treating wide ranges of dermatologic diseases and flexibility in optimizing individual treatment parameters according to different skin types or indications. These properties are of great advantage for skilled and experienced clinicians but can be a source of unwanted serious adverse effects for untrained ones at the same time. Therefore, we summarized the basic principles and clinical application of IPL devices to provide the practical guidance. In addition, critical diagnostics, a great deal of experience, and a thorough knowledge of skin pathology and physiology are required for an effective and safe IPL treatment.

Fractional Laser Photothermolysis for Treatment of Facial Wrinkles in Asians

PURPOSE: To evaluate the safety and efficacy of fractional photothermolysis (FP) in the treatment of facial wrinkles in Asians. METHODS: A total of 27 Korean patients (Fitzpatrick type III or IV) received 2-3 FP treatment sessions (Sellas; Dinona Inc., Seoul, Korea) spaced two weeks apart. Treatments were performed at settings of 7 to 9 mJ/microthermal treatment zone (MTZ) and a density of 1000 MTZ/cm2. Standardized digital photographs were obtained before each treatment and three months after the final treatment. The evaluations of clinical photographs were performed by three physicians blinded to the study subjects using a five-point grading scale. In addition, the patients' perceived degree of improvement was assessed three months after the final treatment using a five-point grading scale. Side effects were monitored at each follow-up visit. RESULTS: The physicians' assessed degrees of improvement were excellent in three patients (12%), significant in ten (40%), and moderate in seven (28%). The patients' self-assessed degrees of improvement were excellent in five patients (20%), significant in 11 (44%), and moderate in six (24%). Adverse events were limited to transient pain, erythema and edema, except in one case of transient postinflammatory hyperpigmentation. CONCLUSIONS: FP is an effective treatment modality for reducing facial wrinkles with minimal side effects in Asian patients.

New Melasma Treatment by Collimated Low Fluence Q-switched Nd : YAG Laser / 대한피부과학회지

BACKGROUND: Laser treatment in melasma has previously failed because of the resulting inflammation and consequent pigmentation and excessive thermal damage caused by the use of high fluence. OBJECTIVE: This study is aimed at establishing the concept of the collimated low fluence Q-switched Nd : YAG laser as a treatment for melasma by investigating its therapeutic effects clinically as well as histopathologically. METHODS: 27 patients were treated weekly with Q-switched Nd : YAG laser (1,064 nm wavelength, 7 mm spot size, 1.6~2.5 J/cm2 fluence) for 8 weeks. The results were evaluated based on standardized clinical images that used Robo skin analyzer, spectrophotometer, MASI score and general severity. RESULTS: 17 (58.8%) patients showed "GOOD" (50~75% improvement) and no case of full recurrence was examined and partial recurrence was detected in 12/17 patients. Common adverse effects include pain, erythema, and temporary edema. Rarely partial hypopigmented macules and diffuse hyperpigmentation appeared. Additional studies, such as immunohistochemical examination and electron microscopic examination, are also currently in progress. CONCLUSION: The collimated low fluence Q-switched Nd : YAG Laser is effective in melasma treatment. This treatment method is a new concept that can be described as selective photothermolysis with minimal thermal damage and inflammation reaction to affected tissues by pigmentation. We consider this treatment method should be regarded as Minimized Selective Photothermolysis (MSP) that will provide a new effective treatment for melasma.

Lasers in Dermatology / 대한피부과학회지

The basic concept of the laser was first described by Einstein in 1917. Laser is an acronym for "Light Amplification by Stimulated Emission of Radiation". The applications of laser light to the field of medicine were begun in 1960s. Since that time there has been a great increase in the development of laser technology and in the understanding of laser-target tissue interactions. The theory of selective photothermolysis mans that a chromophore can be selectively damaged with a laser light of an appropriate wavelength and of a suitably short pulse duration that is shorter than the thermal relaxation time of the chromophore. The introduction of pulsed tunable dye lasers has considerably improved the treatment of vascular lesions, particularly light pink nevus flammeus in children. The argon pumped dye laser and copper vapor laser may be better for telangiectatic and the hypertrophic nevus flammeus often seen in adults. Since the Q-switched and pused green light lasers are capable of selective photothermolysis of melanosomes and tattoo dyes, their efficacy has been under investigation for the treatment of pigmented lesions. The automated delivery systems such as Hexascan produce a superior cosmetic result when compared with manual delivery of laser light and the risk of scarring is reduced. Further comparative study is needed to determine which lesions respond best to each laser system, and which treatment techniques are optimal. Treatment combining more than one of these laser systems may prove superior to any of them used alone.