Ablative Resurfacing with the Confluent 2,790 nm Erbium:YSGG Laser: A Pilot Study on Safety and Efficacy

Susan E. Walgrave, MD, David Kist, HTL, Peter M.H. Cham, MD, and Brian D. Zelickson, MD, Minneapolis, MN

This study investigated the safety and efficacy of the confluent 2,790 nm Erbium:YSGG (PearlTM, Cutera) laser for facial rejuvenation. The 2,790 nm Er:YSGG wavelength has a lower water absorption coefficient than the 2,940 nm Er:YAG wavelength, allowing for minimally ablative resurfacing and coagulation, which may increase clinical efficacy while reducing patient downtime.

Eleven subjects (mean age 50, skin types I–III) with mild to moderate photodamage and wrinkles had two facial treatments with the 2,790 nm Er:YSGG laser using a fluence level of 3.5 J/cm2 and pulse duration of 0.4 ms, with 20% overlap. Treatments were performed 6 weeks apart. Pre–auricular biopsies from five subjects were evaluated at baseline and 6 weeks after the final treatment. Data from blinded physician photo evaluations (quartile scale of improvement) and subjects’ self–assessment of improvement (none, mild, significant, dramatic) were analyzed.

Histologically, 80% of subjects had new collagen formation in the dermal grenz zone. Increased epidermal thickness was also seen in 60% of subjects. Based on the blinded photo evaluations, 89% of subjects showed visible improvement in dyschromia, tone/texture, and fine lines. Similarly, 55% displayed visible improvement in wrinkles. Evaluators were substantially consistent (agreement between evaluators, kappa of 0.71) and accurate (agreement between evaluators versus gold standard, kappa of 0.78) about their identification of before and after photos. Subjects’ self–assessment indicated “significant” to “dramatic” improvement in dyschromia (91%), tone/texture (82%), and fine lines (64%). No serious adverse events were reported. Moderate treatment discomfort was noted with a mean pain score of 5.5 on a 10–point scale.

The minimally ablative resurfacing treatments with the 2,790 nm Er:YSGG laser demonstrated good tolerability with minimal downtime. Blinded physician evaluations indicated visible improvement in the majority of subjects with strong agreement between evaluators. Subjects were highly satisfied with their clinical improvement, especially with respect to dyschromia and tone/texture.

 

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Results of New Study on Nonsurgical Facial Skin Tightening Published in Dermatologic Surgery

Dr. Brian Zelickson, medical director for Zel Skin & Laser Specialists, a cosmetic skin care clinic, and Dr. Jeffrey Dover, SkinCare Physicians, Chestnut Hill, Mass., are the lead authors of a study on nonsurgical facial skin tightening published in the August 2007 issue of the journal Dermatologic Surgery.

To date, this is the largest study in the world evaluating the effects of non–invasive tissue tightening procedures. In the study, 5,700 patients were surveyed to determine the optimal treatment methods and protocol for nonsurgical facial skin tightening, medically known as monopolar radiofrequency therapy.

Monopolar radiofrequency therapy is a non–ablative procedure that delivers heat to the deeper layers of the skin (dermis) while leaving the surface layer (epidermis) relatively unaffected and intact. The heating action causes collagen fibers, the material that supports the skin’s structure, to immediately tighten and also stimulates the gradual growth of new collagen, which further plumps up and tightens the skin.

Results of the study indicate that a new treatment protocol of using larger device tips at lower energy levels and multiple passes offers patients better results and satisfaction. The study results also show that patient feedback on the heat sensation is the preferred method for optimal energy selection based on an extensive questionnaire given to the 5,700 patients by 13 dermatologists, plastic surgeons and cosmetic facial surgeons across the United States and one in Hong Kong.

First cleared by the Food and Drug Administration for the treatment of wrinkles around the eyes in November 2002, radiofrequency therapy was cleared for treating the rest of the face in June 2004 and for skin treatment on the rest of the body in December 2005. Zel Skin & Laser Specialists offers several state–of–the–art radiofrequency technologies, with treatment options tailored to individual needs and desired outcomes.

A graduate of the University of Colorado and the Mayo Medical School in Rochester, Minn., Dr. Zelickson completed his post–graduate medical training at Hennepin County Medical Center and the Mayo Clinic Graduate School of Medicine. In 1990, he received special training at the University of North Carolina, Chapel Hill. He is a member of the faculty at the University of Minnesota Medical School’s Department of Dermatology and a director of the department’s Electron Microscopy Laboratory. Although he has extensive training in all aspects of dermatology, he is nationally recognized for his contributions to laser medicine and surgery. He has published more than 50 medical journal articles in the field and currently serves as the Government Liaison/Blue Ribbon Committee for the American Society for Laser Medicine and Surgery. In addition, he has completed specialized training in electron microscopy of the skin, cutaneous light and laser interactions, laser therapy, Botox and Restylane.

Susan E. Walgrave, MD, of Zel Skin & Laser Specialists, presents findings at ASLMS conference

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