Surgical and acne scars: new approach with fractional photothermolysis
Macedo O.; Fujimura M.; Wippel C.; Bussade M.; Salgado A.
Objectives:
Fractional photothermolysis (FP) is a novel concept of resurfacing for facial acne and surgical scars treatment, which creates precise microscopic thermal wounds, using a 1550-nm erbium fiber laser that targets water-containing tissue resulting in photocoagulation of narrow, sharply defined columns of skin (microscopic thermal zones). Surgical scars and post acne scarring is a challenging condition, and despite the several currently available technologies, no study showed significant advantage of a treatment over the others. The aim of this poster is to evaluate the efficacy of Fraxel Laser® (Relyant Technologies, Ca, USA), a 1550nm erbium-doped laser for scars treatment.
Materials and Method:
Twenty patients (aged 20 to 50 years), Fitzpatrick skin types I to IV with moderate to severe facial acne scars and post surgical scars on breasts, abdomen, and forehead, were submitted to four to five sessions of Fraxel Laser® (Relyant Technologies, Ca, USA) performed 2 to 4 weeks apart. Fluences ranged from 35 to 45 mJ/microthermal zone. Treatment levels varied from 4 to 7. Patients were evaluated (improvements in texture, atrophy, and overall satisfaction with appearance) by two blinded dermatologists using standardized digital photography (Canfield Visia CR System) prior to first treatment session and one month after the final treatment. Clinical improvement scores comparable photographs using a grading scale (0=<25%, 1=25% to 50%, 2=51% to 75%, 3=>75% improvement) were made independently after treatment.
Results:
FP improved appearance of scars after 4 to 5 sessions of treatment. Clinical improvements were noted in the overall texture of the treated skin. Medical assessed degrees of improvement were as follow: 40% of patients on grading 3, 50% on grading 2 and 10% on grading 1. The patients’ degree of satisfaction paralleled the physicians’s assessment. Clinical response rates were independent of age, gender, or skin phototype. Adverse events were limited to transient pain, erythema and edema, and no evidence of dyspigmentation, ulceration or scarring occurred. One patient developed herpes simplex virus outbreaks on lips.
Patient assessment was an excellent improvement in 70%, significant improvement in 20% and 10% moderate improvement. The improvement was persistent at 3 and 6 months follow-up.
Discussion:
Acneiform scarring after severe episodes of acne and surgical scars are a common cosmetic concern, treatable by a variety of modalities with varying degrees of success. Ablative CO² laser resurfacing, while effective, is associated with an undesirable side effects profile, lengthy recovery period, and risk of infection as well as edema, prolonged erythema, scarring and and potential pigmentary alterations. Newer modalities using the principles of fractional photothermolysis (FP) create patterns of tiny microscopic wounds surrounded by undamaged tissue beneath the skin with an erbium-doped 1,550 nm laser. These devices produce more modest results in many cases than traditional carbon dioxide CO² lasers but with fewer side effects and shorter recovery periods.
Nowadays patient wants skin improvement but no downtime recovery. The FP is diferent of the ablative lasers (CO² and Erbium YAG) or non ablative techniques such as Intense Pulsed Lights, Radiofrequency or Nd Yag 1320nm. The FP causes a minimal thermical damage at epidermis and dermis, time recovery is quick and easy and results are significant. Fractional photothermolysis provides a new modality for the treatment of challenging conditions in cosmetic and surgical dermatology such as melasma, surgical scars, striae and photoaging. It is safe and effective treatment for facial an non-facial photodamaged skin. The nonablative 1,550 nm erbium-doped fiber laser can provide a safe and effective reduction in the appearance of photoaged skin with a favorable recovery and side effect profile. Fractional laser skin treatment is associated with a relatively low complication rate. Side effects and complications are temporary and did not result in long-term or significantly severe sequelae (e.g., scarring).
Conclusion:
Ablative laser resurfacing is an effective treatment for acne scars, however edema and prolonged erythema, scarring and hyperpigmentation are often induced.
Fractional photothermolysis offers a safe and effective option treatment of all types of acne and surgical scars, and is associated with significant patient satisfaction with minimal downtime and low risk of complications. No adverse effects were noted, including in patients with Fitzpatrick Skin Types III to V.
Biiblliiogrraphy
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