Presentation on theme: "LASER Applications for Skin Rejuvenation"— Presentation transcript:
1LASER Applications for Skin Rejuvenation Dr. Tzermias ChristopherAthensGreece
2LASER Applications for Skin Rejuvenation Traditional rejuvenation techniques(CO2, Er:YAG) characterizedby top–to–bottom injuries,sacrifice epidermis to achieve subsequent dermal remodeling.
3Ablative LASERs Produce: Epidermal Ablation:Improvement in skin surface textureand dyspigmentation butProlonged healing timeHigh incidence of complicationsDermal Injury Thermal Contraction:Immediate collagen denaturation and shrinkageCollagen remodelingWrinkle improvement
4Ablative LASERs for Skin Rejuvenation The primary mechanism for wrinkle reduction after laser resurfasing appears to be a dermal wound and new collagen formation.Therefore, is epidermal ablation really necessary for skin rejuvenation?Theoretically, techniques that induce a dermal wound should lead to cosmetic improvement.
5Non – Ablative LASERs For Skin Rejuvenation “Selective dermal remodeling”theoretically can be accomplished by:Deeply penetrating laser beamDermal HeatingNew Collagen ProductionCosmetic EnhancementSurface – Cooling DeviceEpidermal Preservation
6Non – Ablative “Subsurface Remodeling” has been reported to be induced by:Pulsed – Dye Laser(P.Bjerriug et al, J. Cutaneous laser therapy,2000,2:9-15)1320 nm - Nd : Yag Laser(D.J. Goldberg, Dermatol. Surg. 2000, 26 : )1450 nm - Diode Laser(D.J. Goldberg, Lasers in Syrg and Med, 2000, 26: )Intense Pulsed Light(D.J. Goldberg, K.B. Culter, Lasers in Surg. And Med, 2000,26: )
7Non- Ablative LASER for Skin Rejuvenation Pulsed-Dye LaserWavelength 585 nm selectively targets hemoglobin and melaninPulse duration: 0,35 millisecond(shorter than traditional 0,45 msec 585 PDLaser)Low fluence range: 2-4 J/cm2 in order to insult but not injure the microrasculacture.
8Histologic Evaluation Pulsed – Dye LaserHistologic EvaluationStatistically significant increase in the production of type III procollagen.Hypothesis:Endothelial cells insulted by laser, releaseinflammatory mediators that trigger fibroblasts.Clinical EvaluationLack of purpura, no side effectsStatistically significant wrinkle improvement greater in Class II and III.
9Non- Ablative LASER for Skin Rejuvenation 1320 nm Nd:Yag LASERWavelength with significantscattering properties.Approximately 20-millisecond macropulse(train of three 300-microsecond pulses)Coupled with a cryogen – spraycooling system of epidermisThermal sensor built into the handpiece to accurately document the temprature rise after pulse and aid the physician in choosing an optimal treatment fluence.
10Histologic evaluation 1320 nm Nd :Yag LASERHistologic evaluationNew collagen formation in all subjects at6 months after the fourth treatmentClinical EvaluationIn general terms, mild clinical improvement and in few subjects lack of improvementHistologic changes are not necessarily correlate with wrinkle reductionAbsence or minimal side effects.
111450 nm Diode LaserTissue scattering properties similar to 1320nm Nd: YagLow-power system: longer exposures ( msecs) are required to achieve sufficient fluences for selective dermal heatingDynamic Cooling Device :(pre–, intermediate-, and post-laser cryogen cooling)Clinical Endpoint: Small edematous papules vs1320 nm Nd :Yag post treatment erythema.Clinical Evaluation: Subjective and objective wrinkle improvement seem to be modest and comparable to 1320 nm Nd :Yag laser.
12Advantages of Non – Ablative LASERs Absence of post - operative healing period:Ideal for the working individualMinimal adverse effectsHelpful in maintaining the rejuvenating effect of ablative laser systemsAdjuctive method to laser treatment for face telangiectasia and age spotsNo need for anesthesiaNo need for post - operative topical agent administration.
13Disadvantages Of Non – Ablative LASERs Definately more subtle wrinkle improvementthan those seen with ablative laser.Delayed clinical improvement.(subsequent collagen deposition occurs orer a period of several months)Microscopic changes are not always associated with cosmetic enhancement.Abseuce of improvement in skin surface texture and dyspigmentation (midinfrared lasers)Multiple treatment sessionsHigher cost than other resurfacing modalities that also provide mild improvement such as microdermabrasion and superficial chemical peels.
14LASERLINE CLINICS “Non –Ablative LASERs and complementary techniques for skin rejuvenation” C. Tzermias, C. Gintzou, T. AnthopoulosObjective:Clinical evaluation of wrinkle improvement and patient satisfaction using non- ablative lasers alone and in combination with microdermabrasion for skin rejuvenationMaterial:Total cases: 50 / Age range yearsSkin types: I – III / Solar and age – related wrinkles
15All subjects were treated 3 times over a period of MethodsAll subjects were treated 3 times over a period of12-14 weeks with non- ablative midinfrared lasers:1450 nm Diode laserFluence range: J/Cm21320 nm Nd :Yag laserFluence range: J/Cm2Half of subjects were simultaneously submitted to seven microdernabration facial treatments at 15 days internalClinical and photographic assessments were recorded monthlyFinal evaluation: one month after the third laser treatment
16“Non–Ablative LASERs and complementary techniques for skin rejuvenation” ResultsNeither 1450nm Diode nor 1320nm Nd :Yag laser induced statistically significant macroscopic wrinkle improvement.Similar disappointing rates of clinical wrinkle improvement in both groups:Group A: Non-Ablative laser treatment aloneGroup B: Non-Ablative laser combined with microdermabrasion.
17ResultsConsiderably higher satisfaction score in group treated with non – ablative laser and microdermabrationWe propose the use of a complementary minimally aggressive technique such as microdermabrasion in order to restore a youthful appearance to the epidermis and increase patient satisfaction.
18In conclusionNon – ablative lasers is a safe treatment, suitable for patients with realistic expectations and who are unwilling or unable to undergo an ablative skin resurfacing laser procedure.In combination with microdermabration can achieve non-invasively an overall skin improvement (clearer, smoother, brighter, younger-appearing).Complementary method to vascular and pigmented laser treatments.