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Aesthetic Dermatology Laser
Table 2: Commonly Used Ablative and Non-ablative re-epithelialisation compared with its non-fractional predecessors,
Fractional Devices on the Market
whether powered by erbium or CO
2
lasers. In vivo studies are in
progress to test the clinical response of the AFR on different skin
Device Company Type
conditions. Table 2 shows a number of commonly used and available
Affirm™ Cynosure Nd:YAG
ablative and non-AFR in the market. In their recent study, Gotkin et al.
Affirm CO
2
™ Cynosure CO
2
demonstrated that laser skin resurfacing with the microablative CO
Lux 1,540™ Palomar IPL-powered laser
2
laser has been shown to be both safe and effective in the treatment
LuxIR Fractional™ Palomar IPL-powered infrared
Lux 2,940 Palomar IPL Er:Yag
of wrinkles, scars, pigment and solar elastosis associated with sun-
Active FX™ Lumenis CO
damaged skin.
13
2
Mosaic™ Lutronic CO
2
Er: Glass A novel, FRAC3
®
non-ablative 3D fractional laser method that
ProFractional™ Sciton Er:YAG produces a self-induced fractional thermal damage matrix within the
Pixel™ Alma Lasers Er:YAG
skin tissues is undergoing randomised trials.
14
The method utilises
Pixel CO
2
OMNIFIT™ Alma Lasers CO
2 short-pulse/high peak-power density of Nd:YAG Aceelera mode laser
Mixto SX™ Lasering USA CO
2
pulses. The FRAC3 fractional thermal damage structure forms around
SmartXide Dot™ DEKA, Calenzano CO
2
the existing skin imperfections and inhomogeneities, and is not
Fraxel re:store™ Reliant Erbium fibre
arbitrarily imposed on the skin by the external optics. This makes the
(former SR 1,550)
method very effective and minimally invasive. Additional advantage of
Fraxel re:fine™ Reliant Erbium fibre
Fraxel re:pair™ Reliant Microablative CO
the FRAC3 approach compared with the standard fractional
2
techniques is that the resulting fractional damage islands are not
IPL = intense pulsed light; Nd: YAG = neodymium-doped yttrium–aluminium–garnet;
Er: YAG = erbium: yttrium–aluminium–garnet. limited to the 2D column matrix, but are distributed in a 3D manner
throughout the skin volume. In addition, no special optical device is
A recent concept in dermal remodelling is ablative FR (AFR) using needed, thus leading to enhanced cost-effectiveness of the skin
ablative lasers such as a focused CO
2
laser or Er:YAG laser. This new rejuvenation procedure as well. The new FRAC3 laser method is the
concept for dermal remodelling combines the theories of ablative next step in improved laser skin rejuvenation procedures, with its
resurfacing and non-ablative FR.
10
A focused CO
2
laser was used on efficacy, selectiveness, short healing time and cost-effectiveness.
15
post mortem human skin with a focused 0.2mm hand-piece in
combination with x-y micrometer stage with well-defined distances of The frontier for AFR treatments is very promising. The appeal of these
1mm. Single pulses of 100–500mJ with a constant pulse duration of treatments will depend on the willingness of patients to accept the
1ms resulted in cylindrically shaped channels with a depth of up to trade-off of a single treatment with downtime to achieve substantial
4mm and a cross-sectional diameter OF up to 500mm. The efficacy. The alternative is non-ablative multitreatment regimens with
surrounding thermal damage zone was found to be up to 350mm, little to no downtime but modest efficacy. Other non-facial applications
with sparing of areas between individual lesions. This resulted in such as treatment of the neck, chest and arms are promising based on
immediate skin shrinkage of approximately 15%.
11
Subsequently, preliminary findings. ■
Pandolfino et al.
1
tested the clinical response of the AFR. Eleven
subjects with tattoos received a single treatment with half of the
Keyvan Nouri is a Professor of Dermatology and Otolaryngology, Director of
tattoo treated with Q-switched, neodymium: yttrium–aluminum–
MOHS, Dermatological and Laser Surgery and Director of Surgical Training in
garnet (QSNd:YAG) (1,064nm, 5–6.5J/cm
2
, 4mm spot size) and the the Department of Dermatology and Cutaneous Surgery at the University of
second half treated with QS Nd:YAG followed by CO
Miami Miller School of Medicine. He is an internationally renowned dermatologist
2
laser
and has lectured around the world. Dr Nouri is a member of a large number
(300–450mJ, 0.2mm spot size). Healing of the skin was rapidly
of international dermatology organisations and a board member of many
achieved within one to two days. At two-month follow-up, there was dermatology associations.
no evidence of appreciable scarring, textural changes, hyper- or
Mohamed L ElSaie is a Lecturer in Dermatology and Cutaneous Surgery at the
hypopigmentation, persistent erythema, edema or exudate with National Research Centre (NRC) Cairo, Egypt, and a Clinical Fellow of Dermatology,
variable response in improvement of tattoo pigment.
Lasers and Cutaneous Surgery at the University of Miami Miller School of Medicine.
He completed a post-doctoral fellowship in cosmetic dermatology in Miami, a
post-doctoral fellowship in infectious disease at Memorial Sloan-Kettering
Recently, Hantash et al.
12
reported the ex vivo histological Cancer Center (MSKCC) in New York and is undertaking a fellowship in
characterisation of a novel prototype ablative carbon dioxide laser FR
dermatological surgery.
device. Interestingly, ablative FR demonstrated much more rapid
1. Anderson RR, Manstein D, et al., Selective 7. Vasily DB, Treatment OF MELASMA USING THE 11. Groff WF, Fitzpatrick RE, Uebelhoer NS, Fractional Carbon
photothermolysis of lipid-rich tissues: a free electron laser STARLUX1540NM FRACTIONAL HANDPIECE, Lasers Surg Dioxide Laser and Plasmakinetic Skin Resurfacing, Semin
study, Lasers Surg Med, 2006;38:913–19. Med, 2007;19:23. Cutan Med Surg, 2008;27(4):239–51.
2. Walgrave S, Zelickson B, Childs J, et al., Pilot investigation 8. Alexiades-Armenakas MR, Dover JS, Arndt KA, The 12. Hantash BM, Bedi VP, Chan KF, Zachary CB, Ex vivo
of the correlation between histological and clinical effects spectrum of laser skin resurfacing: Non-ablative, histological characterization of a novel ablative fractional
of infrared fractional resurfacing lasers, Dermatol Surg, fractional, and ablative laser resurfacing, JAAD, resurfacing device, Lasers Surg Med, 2007;39(2):87–95.
2008;34(11):1443–53. 2008;58(5):719–37. 13. Gotkin RH, Sanoff DS, Cannarozo G, et al., Ablative skin
3. Rinaldi F, Laser: a review, Clin Dermatol, 2008;26(6):590–601. 9. Graber E, Tanzi EL, Alster TS, Side effects and resurfacing with a novel microablative CO2 laser, J Drugs
4. Bogle MA, Fractionated Mid-infrared Resurfacing, Sem Cut complications of fractional laser photothermolysis: Dermatol, 2009;8:138–44.
Med Surg, 2008;27(4):252–8. experience with 961 treatments, Dermatol Surg, 2008;34. 14 Gorjan M, Grad L, Lukac M, 3D Fractional Laser Skin
5. Jih MH, Kimyai-Asadi A, Fractional photothermolysis: a 10. Alexiades-Armenakas MR, Dover JS, Arndt KA, The Rejuvenation, IMCAS, 2008;28.
review and update, Semin Cutan Med Surg, 2008;27(1):63–71. spectrum of laser skin resurfacing: non-ablative, 15. Lukac M, Zabkar J, Gorjan M, Sult T, FRAC3: Three
6. Christine Lee MW, Gear up for new fractional procedures, fractional, and ablative laser resurfacing, J Am Acad Dimensional Non-Ablative Fractional Laser, Skin Rejuvenation
Practical Dermatol, 2008;6:51–6. Dermatol, 2008;58(5):719–37. J Laser Health Acad, 2008;5:1.
64 EUROPEAN DERMATOLOGY
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