1. LASER Applications for Skin Rejuvenation
Dr. Tzermias Christopher
Athens
Greece

2. LASER Applications for Skin Rejuvenation
Traditional rejuvenation techniques
(CO2, Er:YAG) characterized
by top–to–bottom injuries,
sacrifice epidermis to achieve subsequent dermal remodeling.

3. Ablative LASERs Produce:
Epidermal Ablation:
Improvement in skin surface texture
and dyspigmentation but
Prolonged healing time
High incidence of complications
Dermal Injury Thermal Contraction:
Immediate collagen denaturation and shrinkage
Collagen remodeling
Wrinkle improvement

4. Ablative 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.

5. Non – Ablative LASERs For Skin Rejuvenation
“Selective dermal remodeling”
theoretically can be accomplished by:
Deeply penetrating laser beam
Dermal Heating
New Collagen Production
Cosmetic Enhancement
Surface – Cooling Device
Epidermal Preservation

6. Non – 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: )

7. Non- Ablative LASER for Skin Rejuvenation
Pulsed-Dye Laser
Wavelength 585 nm selectively targets hemoglobin and melanin
Pulse 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.

8. Histologic Evaluation
Pulsed – Dye Laser
Histologic Evaluation
Statistically significant increase in the production of type III procollagen.
Hypothesis:
Endothelial cells insulted by laser, release
inflammatory mediators that trigger fibroblasts.
Clinical Evaluation
Lack of purpura, no side effects
Statistically significant wrinkle improvement greater in Class II and III.

9. Non- Ablative LASER for Skin Rejuvenation
1320 nm Nd:Yag LASER
Wavelength with significant
scattering properties.
Approximately 20-millisecond macropulse
(train of three 300-microsecond pulses)
Coupled with a cryogen – spray
cooling system of epidermis
Thermal sensor built into the handpiece to accurately document the temprature rise after pulse and aid the physician in choosing an optimal treatment fluence.

10. Histologic evaluation
1320 nm Nd :Yag LASER
Histologic evaluation
New collagen formation in all subjects at
6 months after the fourth treatment
Clinical Evaluation
In general terms, mild clinical improvement and in few subjects lack of improvement
Histologic changes are not necessarily correlate with wrinkle reduction
Absence or minimal side effects.

11. 1450 nm Diode Laser
Tissue scattering properties similar to 1320nm Nd: Yag
Low-power system: longer exposures ( msecs) are required to achieve sufficient fluences for selective dermal heating
Dynamic Cooling Device :
(pre–, intermediate-, and post-laser cryogen cooling)
Clinical Endpoint: Small edematous papules vs
1320 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.

12. Advantages of Non – Ablative LASERs
Absence of post - operative healing period:
Ideal for the working individual
Minimal adverse effects
Helpful in maintaining the rejuvenating effect of ablative laser systems
Adjuctive method to laser treatment for face telangiectasia and age spots
No need for anesthesia
No need for post - operative topical agent administration.

13. Disadvantages Of Non – Ablative LASERs
Definately more subtle wrinkle improvement
than 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 sessions
Higher cost than other resurfacing modalities that also provide mild improvement such as microdermabrasion and superficial chemical peels.

14. LASERLINE CLINICS “Non –Ablative LASERs and complementary techniques for skin rejuvenation” C. Tzermias, C. Gintzou, T. Anthopoulos
Objective:
Clinical evaluation of wrinkle improvement and patient satisfaction using non- ablative lasers alone and in combination with microdermabrasion for skin rejuvenation
Material:
Total cases: 50 / Age range years
Skin types: I – III / Solar and age – related wrinkles

15. All subjects were treated 3 times over a period of
Methods
All subjects were treated 3 times over a period of
12-14 weeks with non- ablative midinfrared lasers:
1450 nm Diode laser
Fluence range: J/Cm2
1320 nm Nd :Yag laser
Fluence range: J/Cm2
Half of subjects were simultaneously submitted to seven microdernabration facial treatments at 15 days internal
Clinical and photographic assessments were recorded monthly
Final evaluation: one month after the third laser treatment

16. “Non–Ablative LASERs and complementary techniques for skin rejuvenation”
Results
Neither 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 alone
Group B: Non-Ablative laser combined with microdermabrasion.

17. Results
Considerably higher satisfaction score in group treated with non – ablative laser and microdermabration
We 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.

18. In conclusion
Non – 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.