Download PDF
Facial Plast Surg 2005; 21(2): 99-109
DOI: 10.1055/s-2005-872410
Copyright © 2005 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001 USA.

Laser Treatment of Photodamaged Skin

Elizabeth F. Rostan1
  • 1Dermatology and Cosmetic Surgery Center of Charlotte, Charlotte, North Carolina
Further Information

Publication History

Publication Date:
28 July 2005 (online)

Also available at
    Permissions and Reprints

ABSTRACT

The market for skin rejuvenation has grown vastly during the last decade. Many new laser technologies are now available to the practitioner for the treatment of sundamage. Ablative laser techniques, while currently less popular because of associated protracted healing times and greater risk of scarring and pigmentary change, remain the gold standard in the treatment of severe sundamage, rhytides, and dermatoheliosis. Newer nonablative techniques have increased in popularity and are an effective method of skin rejuvenation for mild to moderate sundamage; however, they are of limited benefit in the treatment of more severe sundamage. New fractional photothermolysis laser technology is a promising method of rejuvenation that combines much of the efficacy of the ablative procedures with the convenience and safety of the nonablative laser procedures.

KEYWORDS

Nonablative - laser - skin rejuvenation - fractional photothermolysis - review

REFERENCES

  • 1 Lavker R. Cutaneous aging: chronologic versus photoaging. In: Gilchrest BA Photoaging. Cambridge, MA; Blackwell Science 1995: 123-135
    Google Scholar
  • 2 Uitto J, Bernstein E F. Molecular mechanisms of cutaneous aging: connective tissue alterations in the dermis.  J Investig Dermatol Symp Proc. 1998;  3 41-44
    PubMedGoogle Scholar
  • 3 Uitto J, Fazio M J, Olsen D R. Molecular mechanisms of cutaneous aging. Age-associated connective tissue alterations in the dermis.  J Am Acad Dermatol. 1989;  21 614-622
    PubMedGoogle Scholar
  • 4 Yaar M, Gilchrest B A. Cellular and molecular mechanisms of cutaneous aging.  J Dermatol Surg Oncol. 1990;  16 915-922
    PubMedGoogle Scholar
  • 5 Fisher G J, Wang Z Q, Datta S C, Varani J, Kang S, Voorhees J J. Pathophysiology of premature skin aging induced by ultraviolet light.  N Engl J Med. 1997;  337 1419-1428
    CrossrefPubMedGoogle Scholar
  • 6 Lent W M, David L M. Laser resurfacing: a safe and predictable method of skin resurfacing.  J Cutan Laser Ther. 1999;  1 87-94
    CrossrefPubMedGoogle Scholar
  • 7 Dover J S, Hruza G J. Laser skin resurfacing.  Semin Cutan Med Surg. 1996;  15 177-188
    CrossrefPubMedGoogle Scholar
  • 8 Fitzpatrick R E, Goldman M P, Satur N M, Tope W D. Pulsed carbon dioxide laser resurfacing of photo-aged facial skin.  Arch Dermatol. 1996;  132 395-402
    CrossrefPubMedGoogle Scholar
  • 9 Lowe N J, Lask G, Griffin M E, Maxwell A, Lowe P, Quilada F. Skin resurfacing with the Ultrapulse carbon dioxide laser. Observations on 100 patients.  Dermatol Surg. 1995;  21 1025-1029
    CrossrefPubMedGoogle Scholar
  • 10 Hamilton M M. Carbon dioxide laser resurfacing.  Facial Plast Surg Clin North Am. 2004;  12 289-295 v
    PubMedGoogle Scholar
  • 11 Weinstein C. Computerized scanning erbium:YAG laser for skin resurfacing.  Dermatol Surg. 1998;  24 83-89
    CrossrefPubMedGoogle Scholar
  • 12 Trelles M A, David L M, Rigau J. Penetration depth of ultrapulse carbon dioxide laser in human skin.  Dermatol Surg. 1996;  22 863-865
    PubMedGoogle Scholar
  • 13 Rubach B W, Schoenrock L D. Histological and clinical evaluation of facial resurfacing using a carbon dioxide laser with the computer pattern generator.  Arch Otolaryngol Head Neck Surg. 1997;  123 929-934
    PubMedGoogle Scholar
  • 14 Ross E V, Domankevitz Y, Skrobal M, Anderson R R. Effects of CO2 laser pulse duration in ablation and residual thermal damage: implications for skin resurfacing.  Lasers Surg Med. 1996;  19 123-129
    CrossrefPubMedGoogle Scholar
  • 15 Moy R L, Bucalo B, Lee M H et al.. Skin resurfacing of facial rhytides and scars with the 90-microsecond short pulse CO2 laser. Comparison to the 900-microsecond dwell time CO2 lasers and clinical experience.  Dermatol Surg. 1998;  24 1390-1396
    CrossrefPubMedGoogle Scholar
  • 16 Fitzpatrick R E, Smith S R, Sriprachya-anunt S. Depth of vaporization and the effect of pulse stacking with a high-energy, pulsed carbon dioxide laser.  J Am Acad Dermatol. 1999;  40 615-622
    PubMedGoogle Scholar
  • 17 Kauvar A N, Geronemus R G. Histology of laser resurfacing.  Dermatol Clin. 1997;  15 459-467
    PubMedGoogle Scholar
  • 18 Fitzpatrick R E. CO2 laser resurfacing.  Dermatol Clin. 2001;  19 443-451
    PubMedGoogle Scholar
  • 19 Fulton Jr J E. Complications of laser resurfacing. Methods of prevention and management.  Dermatol Surg. 1998;  24 91-99
    CrossrefPubMedGoogle Scholar
  • 20 Caniglia Jr R J. Erbium:YAG laser skin resurfacing.  Facial Plast Surg Clin North Am. 2004;  12 373-377
    PubMedGoogle Scholar
  • 21 Teikemeier G, Goldberg D J. Skin resurfacing with the erbium:YAG laser.  Dermatol Surg. 1997;  23 685-687
    CrossrefPubMedGoogle Scholar
  • 22 Goldman M P, Roberts 3rd T L, Skover G, Lettieri J T, Fitzpatrick R E. Optimizing wound healing in the face after laser abrasion.  J Am Acad Dermatol. 2002;  46 399-407
    CrossrefPubMedGoogle Scholar
  • 23 Collawn S S. Combination therapy: utilization of CO2 and erbium:YAG lasers for skin resurfacing.  Ann Plast Surg. 1999;  42 21-26
    PubMedGoogle Scholar
  • 24 Fitzpatrick R E, Goldman M P. Skin resurfacing with carbon dioxide and erbium lasers. In: Fitzpatrick RE Cutaneous Laser Surgery. Mosby; St. Louis, MO 1999: 413-417
    Google Scholar
  • 25 Tanzi E L, Lupton J R, Alster T S. Lasers in dermatology: four decades of progress.  J Am Acad Dermatol. 2003;  49 1-31
    CrossrefPubMedGoogle Scholar
  • 26 Pozner J M, Goldberg D J. Histologic effect of a variable pulsed Er:YAG laser.  Dermatol Surg. 2000;  26 733-736
    CrossrefPubMedGoogle Scholar
  • 27 Ross E V, McKinlay J R, Sajben F P et al.. Use of a novel erbium laser in a Yucatan minipig: a study of residual thermal damage, ablation, and wound healing as a function of pulse duration.  Lasers Surg Med. 2002;  30 93-100
    CrossrefPubMedGoogle Scholar
  • 28 Hill R A, Stern D, Lesiecki M L, Hsia J, Berns M W. Effects of pulse width on erbium:YAG laser photothermal trabecular ablation (LTA).  Lasers Surg Med. 1993;  13 440-446
    PubMedGoogle Scholar
  • 29 Price C R, Carniol P J, Glaser D A. Skin resurfacing with the erbium:YAG laser.  Facial Plast Surg Clin North Am. 2001;  9 291-302
    PubMedGoogle Scholar
  • 30 Zachary C B. Modulating the Er:YAG laser.  Lasers Surg Med. 2000;  26 223-226
    CrossrefPubMedGoogle Scholar
  • 31 Rostan E F, Fitzpatrick R E, Goldman M P. Laser resurfacing with a long pulse erbium:YAG laser compared to the 950 ms pulsed CO(2) laser.  Lasers Surg Med. 2001;  29 136-141
    CrossrefPubMedGoogle Scholar
  • 32 Tanzi E L, Alster T S. Side effects and complications of variable-pulsed erbium:yttrium-aluminum-garnet laser skin resurfacing: extended experience with 50 patients.  Plast Reconstr Surg. 2003;  111 1524-1532
    PubMedGoogle Scholar
  • 33 Newman J B, Lord J L, Ash K, McDaniel D H. Variable pulse erbium:YAG laser skin resurfacing of perioral rhytides and side-by-side comparison with carbon dioxide laser.  Lasers Surg Med. 2000;  26 208-214
    CrossrefPubMedGoogle Scholar
  • 34 Adrian R M. Pulsed carbon dioxide and long pulse 10-ms erbium-YAG laser resurfacing: a comparative clinical and histologic study.  J Cutan Laser Ther. 1999;  1 197-202
    CrossrefPubMedGoogle Scholar
  • 35 Khosh M M, Larrabee W F, Smoller B. Safety and efficacy of high fluence CO2 laser skin resurfacing with a single pass.  J Cutan Laser Ther. 1999;  1 37-40
    CrossrefPubMedGoogle Scholar
  • 36 Tanzi E L, Alster T S. Single-pass carbon dioxide versus multiple-pass Er:YAG laser skin resurfacing: a comparison of postoperative wound healing and side-effect rates.  Dermatol Surg. 2003;  29 80-84
    CrossrefPubMedGoogle Scholar
  • 37 Kelly K M, Nelson J S, Lask G P, Geronemus R G, Bernstein L J. Cryogen spray cooling in combination with nonablative laser treatment of facial rhytides.  Arch Dermatol. 1999;  135 691-694
    CrossrefPubMedGoogle Scholar
  • 38 Goldberg D J. Non-ablative subsurface remodeling: clinical and histologic evaluation of a 1320-nm Nd:YAG laser.  J Cutan Laser Ther. 1999;  1 153-157
    CrossrefPubMedGoogle Scholar
  • 39 Goldberg D J. Full-face nonablative dermal remodeling with a 1320 nm Nd:YAG laser.  Dermatol Surg. 2000;  26 915-918
    CrossrefPubMedGoogle Scholar
  • 40 Fatemi A, Weiss M A, Weiss R A. Short-term histologic effects of nonablative resurfacing: results with a dynamically cooled millisecond-domain 1320 nm Nd:YAG laser.  Dermatol Surg. 2002;  28 172-176
    CrossrefPubMedGoogle Scholar
  • 41 Paithankar D Y, Clifford J M, Saleh B A, Ross E V, Hardaway C A, Barnette D. Subsurface skin renewal by treatment with a 1450-nm laser in combination with dynamic cooling.  J Biomed Opt. 2003;  8 545-551
    CrossrefPubMedGoogle Scholar
  • 42 Goldberg D J, Rogachefsky A S, Silapunt S. Non-ablative laser treatment of facial rhytides: a comparison of 1450-nm diode laser treatment with dynamic cooling as opposed to treatment with dynamic cooling alone.  Lasers Surg Med. 2002;  30 79-81
    CrossrefPubMedGoogle Scholar
  • 43 Trelles M A, Allones I, Levy J L, Calderhead R G, Moreno-Arias G A. Combined nonablative skin rejuvenation with the 595- and 1450-nm lasers.  Dermatol Surg. 2004;  30 1292-1298
    CrossrefPubMedGoogle Scholar
  • 44 Goldberg D, Metzler C. Skin resurfacing utilizing a low-fluence Nd:YAG laser.  J Cutan Laser Ther. 1999;  1 23-27
    CrossrefPubMedGoogle Scholar
  • 45 Goldberg D J, Silapunt S. Q-switched Nd:YAG laser: rhytid improvement by non-ablative dermal remodeling.  J Cutan Laser Ther. 2000;  2 157-160
    CrossrefPubMedGoogle Scholar
  • 46 Dayan S H, Vartanian A J, Menaker G, Mobley S R, Dayan A N. Nonablative laser resurfacing using the long-pulse (1064-nm) Nd:YAG laser.  Arch Facial Plast Surg. 2003;  5 310-315
    CrossrefPubMedGoogle Scholar
  • 47 Lee M W. Combination 532-nm and 1064-nm lasers for noninvasive skin rejuvenation and toning.  Arch Dermatol. 2003;  139 1265-1276
    CrossrefPubMedGoogle Scholar
  • 48 Lee M W. Combination visible and infrared lasers for skin rejuvenation.  Semin Cutan Med Surg. 2002;  21 288-300
    PubMedGoogle Scholar
  • 49 Zelickson B D, Kilmer S L, Bernstein E et al.. Pulsed dye laser therapy for sun damaged skin.  Lasers Surg Med. 1999;  25 229-236
    CrossrefPubMedGoogle Scholar
  • 50 Reynolds N, Thomas K, Baker L, Adams C, Kenealy J. Pulsed dye laser and non-ablative wrinkle reduction.  Lasers Surg Med. 2004;  34 109-113
    CrossrefPubMedGoogle Scholar
  • 51 Goldberg D J, Sarradet D, Hussain M, Krishtul A, Phelps R. Clinical, histologic, and ultrastructural changes after nonablative treatment with a 595-nm flashlamp-pumped pulsed dye laser: comparison of varying settings.  Dermatol Surg. 2004;  30 979-982
    CrossrefPubMedGoogle Scholar
  • 52 Rostan E, Bowes L E, Iyer S, Fitzpatrick R E. A double-blind, side-by-side comparison study of low fluence long pulse dye laser to coolant treatment for wrinkling of the cheeks.  J Cosmet Laser Ther. 2001;  3 129-136
    PubMedGoogle Scholar
  • 53 Moody B R, McCarthy J E, Hruza G J. Collagen remodeling after 585-nm pulsed dye laser irradiation: an ultrasonographic analysis.  Dermatol Surg. 2003;  29 997-1000
    CrossrefPubMedGoogle Scholar
  • 54 Ashinoff R, Geronemus R G. Q-switched ruby laser treatment of labial lentigos.  J Am Acad Dermatol. 1992;  27 809-811
    PubMedGoogle Scholar
  • 55 DePadova-Elder S M, Milgraum S S. Q-switched ruby laser treatment of labial lentigines in Peutz-Jeghers syndrome.  J Dermatol Surg Oncol. 1994;  20 830-832
    PubMedGoogle Scholar
  • 56 Goldberg D J. Benign pigmented lesions of the skin. Treatment with the Q-switched ruby laser.  J Dermatol Surg Oncol. 1993;  19 376-379
    PubMedGoogle Scholar
  • 57 Gupta G, MacKay I R, MacKie R M. Q-switched ruby laser in the treatment of labial melanotic macules.  Lasers Surg Med. 1999;  25 219-222
    CrossrefPubMedGoogle Scholar
  • 58 Jang K A, Chung E C, Choi J H, Sung K J, Moon K C, Koh J K. Successful removal of freckles in Asian skin with a Q-switched alexandrite laser.  Dermatol Surg. 2000;  26 231-234
    CrossrefPubMedGoogle Scholar
  • 59 Kopera D, Hohenleutner U. Ruby laser treatment of melasma and postinflammatory hyperpigmentation.  Dermatol Surg. 1995;  21 994
    CrossrefPubMedGoogle Scholar
  • 60 Kopera D, Hohenleutner U, Landthaler M. Quality-switched ruby laser treatment of solar lentigines and Becker's nevus: a histopathological and immunohistochemical study.  Dermatology. 1997;  194 338-343
    CrossrefPubMedGoogle Scholar
  • 61 Taylor C R, Anderson R R. Treatment of benign pigmented epidermal lesions by Q-switched ruby laser.  Int J Dermatol. 1993;  32 908-912
    PubMedGoogle Scholar
  • 62 Tse Y, Levine V J, McClain S A, Ashinoff R. The removal of cutaneous pigmented lesions with the Q-switched ruby laser and the Q-switched neodymium: yttrium-aluminum-garnet laser. A comparative study.  J Dermatol Surg Oncol. 1994;  20 795-800
    CrossrefPubMedGoogle Scholar
  • 63 Kilmer S L, Wheeland R G, Goldberg D J, Anderson R R. Treatment of epidermal pigmented lesions with the frequency-doubled Q-switched Nd:YAG laser. A controlled, single-impact, dose-response, multicenter trial.  Arch Dermatol. 1994;  130 1515-1519
    CrossrefPubMedGoogle Scholar
  • 64 Chan H H, Ying S Y, Ho W S, Kono T, King W W. An in vivo trial comparing the use of different types of 532 nm Nd:YAG lasers in the treatment of facial lentigines in Oriental patients.  Dermatol Surg. 2000;  26 743-749
    CrossrefPubMedGoogle Scholar
  • 65 Li Y T, Yang K C. Comparison of the frequency-doubled Q-switched Nd:YAG laser and 35% trichloroacetic acid for the treatment of face lentigines.  Dermatol Surg. 1999;  25 202-204
    CrossrefPubMedGoogle Scholar
  • 66 Rashid T, Hussain I, Haider M, Haroon T S. Laser therapy of freckles and lentigines with quasi-continuous, frequency-doubled, Nd:YAG (532 nm) laser in Fitzpatrick skin type IV: a 24-month follow-up.  J Cosmet Laser Ther. 2002;  4 81-85
    PubMedGoogle Scholar
  • 67 Rosenbach A, Lee S J, Johr R H. Treatment of medium-brown solar lentigines using an alexandrite laser designed for hair reduction.  Arch Dermatol. 2002;  138 547-548
    CrossrefPubMedGoogle Scholar
  • 68 Bitter P H. Noninvasive rejuvenation of photodamaged skin using serial, full-face intense pulsed light treatments.  Dermatol Surg. 2000;  26 835-843
    CrossrefPubMedGoogle Scholar
  • 69 Avram D K, Goldman M P. Effectiveness and safety of ALA-IPL in treating actinic keratoses and photodamage.  J Drugs Dermatol. 2004;  3(1 suppl) S36-S39
    PubMedGoogle Scholar
  • 70 Manstein D, Herron G S, Sink R K, Tanner H, Anderson R R. Fractional photothermolysis: a new concept for cutaneous remodeling using microscopic patterns of thermal injury.  Lasers Surg Med. 2004;  34 426-438
    CrossrefPubMedGoogle Scholar
  • 71 Carruthers J, Carruthers A. The adjunctive usage of botulinum toxin.  Dermatol Surg. 1998;  24 1244-1247
    CrossrefPubMedGoogle Scholar
  • 72 West T B, Alster T S. Effect of botulinum toxin type A on movement-associated rhytides following CO2 laser resurfacing.  Dermatol Surg. 1999;  25 259-261
    CrossrefPubMedGoogle Scholar
  • 73 Yamauchi P, Lask G, Lowe N. Botulinum toxin type A gives adjunctive benefit to periorbital laser resurfacing.  J Cosmet Laser Ther. 2004;  6 145-148
    CrossrefPubMedGoogle Scholar
  • 74 Zimbler M S, Holds J B, Kokoska M S et al.. Effect of botulinum toxin pretreatment on laser resurfacing results: a prospective, randomized, blinded trial.  Arch Facial Plast Surg. 2001;  3 165-169
    CrossrefPubMedGoogle Scholar

Elizabeth F RostanM.D. 

1918 Randolph Road, Suite 580, Charlotte, NC 28207