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Novel Fractional Treatments with VSP Er:YAG Aesthetic Lasers
Clinical Experience conditions, avoiding some of the adverse effects of fully ablative
Clinical observations and histological findings demonstrate that laser procedures while improving the limited efficacy of non-
fractional ablative treatments with the Er:YAG laser are a safe ablative treatments. The combination of the latest Fotona smooth,
and effective alternative to more aggressive, fullly ablative laser PST and turbo techniques provides 11 basic treatment modalities
treatments.
2–4,20–25
Typical treatment parameters for skin rejuvenation and 11 fractional treatment modalities.
procedures are around 1–5J/cm
2
in one to three passes using a
combination of varying pulsewidths. Shorter (0.2–0.3 milliseconds) These innovations and advances in Fotona’s VSP Er:YAG technology
VSP Er:YAG pulses are used during the first few passes, and longer enables the practitioner to fully adjust and tune the laser treatment
pulses (1–2 milliseconds) during the last, or last few passes.
20,25
modality to the patient type, the treated indication and the desired
treatment outcome. There is no other laser wavelength or
Photographic evaluations show significant improvement in skin technology that allows similar levels of treatment control and
quality (see Figure 4).
20
No side effects apart from transient precision while at the same time providing the extent of treatment
erythema have been reported. Mild erythema was markedly modalities presented in this article. ■
reduced after one to two days, and totally disappeared after
one week.
Matjaz Lukac is a Research Associate at the Josef
Stefan Institute and has held a senior managerial
For the treatment of moderate to severe rhytides (peri-oral, position at Fotona since 1989. His main areas of
peri-orbital) with minimal patient downtime, deeper Er:YAG
interest in research are the physics of laser sources,
the interaction of laser light with biological tissues
fractional ablation and thicker coagulation is needed. Treatment
and fundamental research into new clinical
parameters can vary from 3 to 60J/cm
2
, where higher fluences are applications. Consequently, he is a widely published
achieved in a stacked (turbo) mode with three to five stacked
author or co-author of research papers and
studies in these areas.
pulses.
2,3,21
Areas are treated with several passes in one session.
Substantial improvements in peri-oral and peri-orbital wrinkles
Zdenko Vizintin is Aesthetic Laser Programme
have been observed with more aggressive treatments (four more Director at Fotona and is actively involved in new
passes). Compared with full-surface ablative skin resurfacing,
medical laser application development and validation
fractionated VSP Er:YAG laser treatments provide rapid
through clinical studies. He is the author and co-
author of numerous laser engineering papers and
re-epithelisation with limited side effects (mild post-inflammatory studies of the applications of laser in medicine.
erythema at three months or less depending on coagulation
Throughout his professional career, Mr Vizintin
thickness), and reduces patient downtime to four days or less.
has been deeply involved in the research and
development and the production of laser systems
for various industries.
PST fractional modalities have been successfully used in the
reduction of stretch marks. Significant improvements in stretch Tom Sult is Medical Director of Laser Aesthetics, Inc.
mark size, colour and texture have been reported
22,23
using
and works in a private practice in Minnesota. He is
actively involved in laser clinical research and
treatment protocols consisting of a combination of VSP Er:YAG PST
protocol development. In addition, he is a frequent
fractional and non-fractional modalities.
24
presenter at laser and aesthetic conferences. He is a
faculty member of the Institute for Functional
Conclusion
Medicine and Aesthetic Lasers, Inc., and is a member
of the American Society for Lasers Medicine and
In conclusion, Er:YAG fractional photothermolysis with Fotona’s PST Surgery (ASLMS).
provides an additional option in the treatment of various skin
1. C. C. Dierickx, et al., Micro-Fractional Ablative Skin 10 .Pozner JN, Goldberg DJ, Superficial erbium:YAG laser 18. Drnovsek-Olup B, Beltram M, ER:YAG dual-mode skin
Resurfacing with Two Novel Erbium Laser Systems, resurfacing of photodamaged skin, J Cosmet Laser Ther, resurfacing long-term follow-up, Lasers Surg Med,
Lasers Surg Med, 2008;40:113–23. 2006;8(2):89–91. 2002;1–9.
2. Pozner JN, Glanz S, Goldberg DJ, Fractional erbium 11. Beltram M, Drnovsek-Olup B, Quantitative analysis of 19. Drnovsek-Olup B, Beltram M, Er:Yag laser skin
resurfacing : Histologic and early clinical experience, new collagen synthesis after Er:YAG laser skin resurfacing long term follow-up, Lasers Surg Med,
Lasers Surg Med, 2007;39:S19. resurfacing with biomolecular technicque, Lasers Surg 2002(Suppl. 14):66–7.
3. Lapidoth M, Odo MEY, Odo LM, Novel Use of Erbium Med, 2008;(Suppl. 20):35. 20. L.Volovec, Skin Rejuvenation with Fractionated Ablative
(2,940nm) Laser for Fractional Ablative Photothermolysis 12. Drnovsek-Olup B, Beltram M, ER:YAG dual-mode skin Er:YAG Laser, 7th Croatian Congress of Plastic,
in the Treatment of Photodamaged Facial Skin: A Pilot resurfacing long-term follow-up, Lasers Surg Med, 2002; Reconstructive Aesthetic Surg, Book of abstracts, 2008.
Study, Dermatology Surgery, 2008:34:2–6. 1–9. 21. Trelles MA, Velez M, Mordon S, Correlation of
4. Diaci J, Laser Profilometry for the Characterization of 13. Beltram M, Drnovsek-Olup B, In situ hybridization Histological Findings of Single Session Er:YAG Skin
Craters Produced in Hard Dental Tissue by Er:YAG and analysis of type 1 collagen gene expression after Er:YAG Fractional Resurfacing With Various Passes and Energies
Er,Cr:YSGG Lsaers, J Laser Health Acad, 2008;2. laser skin resurfacing, Lasers Surg Med, 2003;(Suppl.15):8. and the Possible Clinical Implications, Lasers Surg Med,
5. Perhavec T, Diaci J, J Oral Laser Appl, 2008;8:84–87. 14. Drnovsek-Olup B, Beltram M, Pizem J, Repetitive Er:YAG 2008;40:174–7.
6. Variable Square Pulse (VSP) is a Fotona dd proprietary laser irradiation of human skin: a histological evaluation. 22. Vizintin Z, Fractional Laser Technologies - Overview, 7th
technology for the generation and control of laser Lasers Surg Med, 2004;35:146–51. Croatian Congress of Plastic, Reconstructive Aesthetic Surg,
pulses, 2008. Available at: www.fotona.com. 15. Drnovsek-Olup B, Beltram M, Long-term evaluation of Book of abstracts, 2008.
7. Lukac M, Sult T, Sult R, New Options and Treatment periocular Er:Yag laser skin resurfacing combined with 23. Kozarev J, Treatment of Stretch marks with fractional
Strategies with the VSP Er:YAG Aesthetic Lasers, J Laser blepharoplasty. V: ESOPRS Meeting. Abstracts. Münster ablative Er:YAG laser, 2008; in press.
and Health Acad, 2007;1. Universitäte-Hauptgebäude, 2002. 24. Pidal C, Estria Roja con Fractional Smooth ErYAG laser,
8. Lukac M, New Options and Treatment Strategies with 16. Drnovsek-Olup B, Beltram M, Histological comparison VIII Curso Internacional de Procedimientos Estéticos
VSP Er:YAG Aesthetic Lasers, J Cosmetic Laser Therapy, between different modes of Er:YAG laser skin Minimamente Invasivos, Avances en Medicina Estética y
2007;9:4. resurfacing-ablative, dual mode and smooth mode Cirugía Minimamente Invasiva, 2008.
9. Majaron B, Sustersic D, Lukac M, et al., Heat Diffusion resurfacing, Lasers Surg Med, 2005(Suppl. 17):9. 25. Massoud K, Fractional Laser Skin Resurfacing,
and Debris Screening in Er:YAG Laser Ablation of Hard 17. Drnovsek Olup B, Vedlin B, Use of Er:YAG laser for International Aesthetic Laser Seminar, 2007.
Biological Tissues, Appl Phys, 1998;66:1–9. benign skin disorders, Lasers Surg Med, 1997;21:13–19.
EUROPEAN DERMATOLOGY 61
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