Notes

New Technologies Supporting Cutaneous Laser Treatment

Fractional resurfacing C02 and Er:YAG lasers have traditionally been employed in ablative resurfacing procedures. They target tissue water and non-specifically ablate layers of skin to varying depths. Significant improvements can be purchased with your lasers in the treatment of scars (including those from acne vulgaris), cutaneous growths and photodamaged skin. However, recovery could be protracted and many side effects are recognized, including dyspigmentation, scarring and prolonged erythema. A new laser technology, fractional photothermolysis, has been unveiled in specifically overcome the drawbacks of conventional resurfacing. Instead of producing one beam that produces uniform thermal problems for tissue in its path (just like conventional resurfacing lasers), the output from fractional resurfacing devices consists of thousands of microscopic columns, which each produce thermal damage to a smaller level of tissue).

As More Help is non-confluent, the potential risk of scarring is reduced and recovery is rapid, with epidermal healing taking only 24 hours through keratinocyte migration.

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

Although promising, fractional treatments remains to be rolling around in its infancy and optimum treatment frequency and parameters remain to be defined. The original fractionated laser Fraxel (Reliant Technologies, Mountain View, CA, USA) was a non ablative technique, interest is increasing inside delivery of ablative wavelengths in this way with fractionated Er:YAG and CO2 laser sources.

Pneumatic suction devices

Pneumatic suction tools are a newly released enhancement to existing lasers and IPLs. A negative pressure is applied on the skin prior to the light pulse is delivered. This gently pulls and stretches your skin layer to be able to thin the epidermis, slow up the density of epidermal melanin and bring the dermis closer to the light source. As a result, lower energies are essential, as there are theoretically a lesser propensity for side effects. The vacuum also activates sensory fibres, thereby lowering the transmission of pain and treatment grows more comfortable. Negative pressure may also increase the level of dermal vessels.

Expanded vessels concentrate laser energy better as they contain more blood this might be of assistance in treating therapy resistant lesions for example PWS. Pneumatic suction devices might be incorporated into the laser or IPL handpiece (e.g. Aesthera PPx, Pleasanton, CA, USA) or being a separate attachment that may 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 sunlight emitted by lasers is scattered by the epidermis.

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

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