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We receive many questions regarding the use of fractional lasers for treatment of non-facial areas such as the hand. Few clinical studies have been reported in the literature documenting the efficacy of non-ablative modalities in the treatment of hands with visible photoaging conditions (search in Research).

Laser treatment for photoaging of the hands should ideally address pigmentary alteration as well as associated skin roughness and wrinkling. Fractional non-ablative resurfacing has been previously shown to effectively treat facial rhytids and dyschromia and are currently widely used by medical practitioners and aesthetic clinics.

About fractional non-ablative resurfacing

Non-ablative fractional photothermolysis (nFP) produces specific thermal injury areas called microthermal treatment zones (MTZ) at specific depths in the skin. The surrounding tissue of the MTZ and the stratum corneum of the epidermis remain intact during treatment, leading to rapid healing of the injured tissue. Macroscopic wounding is not apparent. Mild to moderate erythema and edema are usually apparent for several days post-treatment, therefore there is only minimal downtime for the patient. Several treatment courses are required, which is typical of any other non-ablative laser procedures. The most commonly used is the 1,550-nm diode-pumped erbium fiber laser by Solta Medical, formerly Reliant Technologies.

About clinical trials

Trials are conducted by medical doctors, proficient in the laser photothermolysis field, and sponsored by grants by laser manufacturers, Solta Medical in the reviewed cases. Patients (Fitzpatrick skin phototypes I to IV) with with bilateral moderate hand photodamage were randomized to receive 5-6 treatments with the 1,550-nm diode erbium fiber laser on either the right or left hand. Treatments were performed at settings of 8 to 9 mJ/microscopic treatment zone (MTZ) and density of 2,500 microscopic treatment zones/cm2. Subjective assessments by the patients and investigator were performed for skin roughness, wrinkling, pigmentation, skin texture and overall photodamage using an improvement scale. Skin biopsies were taken at baseline and at 1 and 3 months. In addition, some histological analyses (H&E) were carried out on several individuals.

Reported results

The subjective assessment and physician clinical assessment at 1 and 3 months revealed a mean 51% to 75% improvement in skin pigmentation and 25% to 50% improvement in skin roughness and wrinkling. Biopsies of the skin showed increased density of dermal collagen. Patients experienced transient erythema and edema and none had scarring or other adverse effects. Histologic evaluation showed a reduction in atypical keratinocytes, improvement in rete ridge formations, increased collagen density and a reduction in solar elastosis at 6 months post-treatment.

Fractional non-ablative resurfacing appears to be an effective and safe treatment modality for correcting both the pigmentary and the textural aspects of photoaging of non-facial anatomic areas such as the dorsum of the hands.

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  • Filed under: LT | fractional, New Lasers, Research
  • Fractional CO2 laser ablation has become very popular among cosmetic dermatologists and plastic surgeons.

    Below is a list of tips from our medical panel.

    Cosmetic conditions

    1. Vertical lip (smokers) lines, deep wrinkles and acne scars require deep penetration to stimulates more collagen and ablate more tissue for better skin tightening.
    2. Superficial pigment and surface textural problems will require less penetration and a mild ablation.
    3. For Stria (Stretch Marks): mild penetration of 80-100 mj, deeper penetration may cause adverse effect.
    4. Melasma: medical experts are not sure it will work and do not recommend treating Malasma at this time.
    5. For Tattoo Removal: deep penetration might be good for resistant tattoos, results will vary as always with tattoos.

    Pre / post-treatment tips for fractional CO2 laser treatments:

    1. Mild moisturizers to avoid acne flare-ups
    2. No aquaphor or vasoline. Beware of the Lanolin in the Aquaphor. Mild moisturizers are good enough.
    3. Aveeno Water Gel may get your patient one less day of downtime.
    4. Frequent saline soaks are good.
    5. Cold ice packs or chilled air cooler for 30-45 min after treatment are good.
    6. Valtrex for all patients! Acyclovir (cheaper) will also work.
    7. No pain medications after treatment! Prolonged pain suggests infection: bacterial, viral, fungal. Follow up with your patients!
    8. Pliaglis can be mixed with Cetaphil cleanser or moisturizer. 90% Pliaglis and 10% cleanser or moisturizer in the mix.
    9. Experts worry about possible Lidocaine toxicity so excercise care. Compounded Lidocaine works as well or better than Pliaglis. Pliaglis costs $60 per treatment. Compounded Lidocaine costs about $6 per treatment.
    10. Do not routinely use oral antibiotics unless indicated for acne outbreak prevention: Keflex 500 mg TID, Doxycycline 100 mg BID, Erythromycin can be used to prevent acne outbreak.
    11. Sunscreens: every day and stay out of sun until the skin is healed up completely, and use good UVA blockers for further protection.

    Fractional C02 lasers are not perfect but can produce great results if used correctly. Especially in a combination of treatments.

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  • Filed under: Laser Clinics, LT | fractional
  • Fractional photothermolysis, based on creating spatially precise microscopic thermal wounds, is performed using a 1550-nm erbium fiber laser that targets water-containing tissue to effect the photocoagulation of narrow, sharply defined columns of skin known as microscopic thermal zones.

    Fraxel resurfacing has been shown to be both safe and effective for facial and nonfacial photodamage, atrophic acne scars, hypopigmented scars, and dyspigmentation. Because only a fraction of the skin is treated during a single session, a series (typically 3 to 6 treatments) of fractional resurfacing at 2- to 4-week intervals is required for the best clinical improvement.

    Many physicians have reported that a series of Fraxel treatments can achieve a similar clinical result for atrophic scars compared with traditional ablative laser skin resurfacing with either CO2 or Er:YAG 2940-nm lasers. However, the improvement seen after a series of Fraxel treatments for perioral laxity and rhytides often falls short of the impressive results that can be achieved with ablative laser skin resurfacing.

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  • Filed under: CURRENT NEWS, LT | fractional, LT | skin resurfacing
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