Oct 15, 2016 Global Academy for Medical Education

Facial Rejuvenation Turns 40

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By Dr. Christopher Zachary

For decades, devices and peels have been used for facial rejuvenation and the treatment of skin damage. In recent years, new laser systems have been developed, including fractionated ablative and non-ablative lasers which, while not as effective as the traditional laser resurfacing, can provide nice results with reduced side effects. While fractionated hybrid systems, picosecond lasers, and daylight photodynamic therapy have all been rolled out for clinicians to assess their efficacy, future technology, including TRASER (total reflection amplification of spontaneous emission of radiation) technology, should be just around the corner. These technologies offer new potential applications, efficacy, and recovery periods.

Laser Skin Resurfacing
Laser skin resurfacing remains a major therapeutic tool for facial rejuvenation and the treatment of acne scars and other skin damage. The technologies work by altering the epidermis and dermis, either by full field treatment or fractionated delivery of coagulative or ablative injury, thereby inducing regrowth of new epidermis and growth of new collagen and elastin in the dermis. The first lasers introduced to dermatology were ablative lasers, such as the CO2 and erbium: YAG (yttrium-aluminumgarnet) lasers, both of which target water. Although traditional laser resurfacing techniques are still considered the gold standard by many dermatologists, a variety of new laser systems have become available, with each device inducing different patterns of focal injury and subsequent outcomes.

Fractionated Non-Ablative and Ablative Lasers
Scars, facial photodamage, and normal photoaging have all been well treated in the past with chemical peels, dermabrasion, and traditional laser resurfacing techniques. Various non-ablative heating technologies such as the CoolTouch® (1320 nm) laser were developed in the hope that this would improve acne scarring, skin tightness, and aging changes, but early results were mixed.1 Rox Anderson and Dieter Manstein first considered the concept of fractionation as a method to create universal benefit by inducing myriad tiny areas of injury, much akin to the lawn aerator benefit for a lawn. The first device manufactured by Reliant delivered multiple microbeams using a computer-controlled scanner.1,2 These are characterized by having normal unaffected epidermis and dermis between the areas of laser-treated skin, preserving a reservoir of healthy cells that expedite healing.3 Subsequently, Reliant developed an ablative device with similar characteristics, though instead of inducing a thermal injury, this device vaporized the tissue, leaving relatively deep but narrow channels into the dermis. Although the original fractionated devices induced injuries of 150 μm or less, many useful devices create injuries of up to 400-500 μm, which are still small enough to allow the intervening skin cells to promote healing.

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