Notes

New Technologies Supporting Cutaneous Laser Treatment

Fractional resurfacing C02 and Er:YAG lasers have traditionally been found in ablative resurfacing procedures. They target tissue water and non-specifically ablate layers of skin to varying depths. Significant improvements can be obtained with your lasers inside the management of scars (including those from acne vulgaris), cutaneous growths and photodamaged skin. However, recovery may be protracted and several negative effects are recognized, including dyspigmentation, scarring and prolonged erythema. A new laser technology, fractional photothermolysis, has recently been brought to specifically overcome the drawbacks of conventional resurfacing. Instead of producing one beam that creates uniform thermal problems for tissue in its path (just like conventional resurfacing lasers), the output from fractional resurfacing devices is made up of thousands of microscopic columns, which each produce thermal harm to a little number of tissue).

As ablation is non-confluent, potential risk of scarring is reduced and recovery is rapid, with epidermal healing taking only 24 hours by means of keratinocyte migration.

Side effects last 24 to a couple of days, and consist mainly of erythema and oedema. The procedure might be performed under topical anaesthesia with slight discomfort.

Although published here , fraxel treatments remains in the infancy and optimum treatment frequency and parameters remain to be defined. The original fractionated laser Fraxel (Reliant Technologies, Mountain View, CA, USA) would have been a non ablative technique, interest is increasing in the delivery of ablative wavelengths this way with fractionated Er:YAG and CO2 laser sources.

Pneumatic suction devices

Pneumatic suction devices are a current enhancement to existing lasers and IPLs. A negative pressure is applied for the skin prior to light pulse is delivered. This gently pulls and stretches skin to be able to thin the epidermis, lessen the density of epidermal melanin and bring the dermis closer towards the light source. As a result, lower energies are essential, and there's theoretically a reduced propensity for side effects. The vacuum also activates sensory fibres, thereby reducing the transmission of pain and treatment becomes more comfortable. Negative pressure could also increase the number of dermal vessels.

Expanded vessels concentrate laser energy better while they contain more blood this might be of assistance for treating therapy resistant lesions including PWS. Pneumatic suction devices could be built-into the laser or IPL handpiece (e.g. Aesthera PPx, Pleasanton, CA, USA) or like a separate attachment that can be used with existing systems (e.g. Inolase, Candela Corp, Boston, USA). Investigative clinical uses include techniques, acne and analgesia in various procedures.

Optical clearing agents

A significant proportion of the light emitted by lasers is scattered through the epidermis.

Non-human and laboratory data show that hyperosmotic chemicals including glycerol and propylene glycol enhance penetration of light to dermal targets by reducing scattering in the epidermis. This has the potential of enhancing the efficacy of lasers and reducing unwanted epidermal injury. Optical clearing agents are presently impractical to make use of in the clinical context, and refinements inside the epidermal delivery mechanism of these agents are awaited. 

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