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Clinical experiences in Asian skin with new technology of
ablative fractional Er:YAG Laser
Clinical experiences inClinical experiences in Asian skinAsian skin with new technology ofwith new technology of
ablative fractional ablative fractional Er:YAGEr:YAG LaserLaser
2011.05.20 SLOVENIA
Ming-Li Tseng, MD
Dr. Tseng Skin and Beauty Clinic, Taipei, Taiwan
Lynton N
d:YA
G
FidelisEr:YA
G
StarLux
IPL
Y+G
, cryo6
•CO2 •Dye •Ruby •Q-AlexQ-Nd:YAG•Er:YAG
CoolTouchIPL
TC C6Sciton Fraxel
CoolLipoFr.Co2
Dev
elop
‘92 ‘97 ‘99 ’03 ’05 ’06 ‘07
C6
StarLux
IPL
1064, IR H
P
Lux1540
M2 N
d:YA
G
Fr. Fr. Er:YAGEr:YAG
Development of Dr. TsengDevelopment of Dr. Tseng’’s Clinics Clinic
Development of Aesthetic Laser in Taiwan Development of Aesthetic Laser in Taiwan
QSRL PIH
QSRL BLISTER
IPL Burn
QSRL HYPO
QSNd:YAG
PIH
SCAR POST CO2 LASER FOR TATTO
ErythemaPIH or
HYPO
Edema Bulla Crusting Scar Pitting
Scar
Infecti on
Ulcer
IPL
Pigment
Hair Removal Vascular
Invasive
Thermage
Fractional
Laser & IPL Side Effects
5
Search for Ideal SR Treatment
Ablative High Efficacy -
Long Downtime
Non-Ablative Low Efficacy -
Short Downtime
7
Fractional Story –
Wound Healing Mechanism
Re-epithelization of micro treatment zones (MZT) is quicker due to:-
Enough healthy cells
(epidermal stem cells and transient amplifying cells)-
Short migration paths of keratinocytes
(quick arrival to wounded sites)
Islands of healthy skin are helping in would healing mechanism
Search for Ideal SR Treatment
What is “ fractional” ?What is What is ““ fractionalfractional”” ??
Safe, Effective and Short DowntimeSafe, Effective and Short Downtime
FDA-Cleared IndicationsFDA-Cleared Indications
November 10, 2003
Dermatological procedures requiring the coagulation of soft tissue
June 15, 2004
Treatment of periorbital
wrinkles
Photocoagulation of pigmented lesions including lentigos
(age spots), solar lentigos
(sun spots), and dyschromia
Resurfacing
-
the only non-ablative device cleared for resurfacing! (3/10/05)
Melasma
- the only device cleared for melasma! (7/5/05)
Acne scars and surgical scars!
(3/20/06)
Fraxel®
SR 1500
(3/29/06)
Can be used on all skin types anywhere on the body!
R. Rox
Anderson, M.D
Transepidermal
Elimination Avenue
11Photo-Acoustic Effects
Microspot
Histology Comparison
Ablative Fr.CO2
Non‐ablative
Fr. Er‐Glass
AblativeFr.Er‐YAG
Lasers in Surgery and Medicine 41:179–184 (2009)
雷
Long downtimeLong downtime
Hig
h Ef
ficac
yH
igh
Effic
acy
AblativeAblative
Short downtimeShort downtime
Low
Effi
cacy
Low
Effi
cacy Fractional ErGlass
NdYAG
Fractional ErYAG
CO2 Laser
IdealIdeal
Search for Ideal SR Treatment
FracFrac. . AblativeAblative
FracFrac. Non. Non-- AblativeAblative
NonNon-- AblativeAblative
15
Ablative Fr. Er-Yag
ApplicationsSkin Rejuvenation Indications for Ablative Fractional Treatments
●
Hyperpigmentations (Post-Inflamatory Hyperpigmentation -
PIH, Melasma,
Dyshromia)
●
Photoaged (photodamaged) skin (freckles, age spots, vascular lesions, skin texture…)
●
Wrinkles (moderate to severe rhytides)
●
Scars (acne scars, surgical scars, traumatic scars, burn scars)
●
Stretch marks
●
Skin tightening.. (some new and exciting applications)
Dr. Tseng’s RegimeDr. TsengDr. Tseng’’s Regimes Regime
•
I ALWAYS include the Fr. Er-Yag
Laser as part of the regime
•
General Parameters of Treatment: ‧Skin Rejuvenation
5 %, 3-14 mJ, MSP, 50HZ
‧Acne Scar
5-10%,14-Turbo 6-120mj, MSP-XLP•
Remember:
Once the pigment has reduced to a satisfactory level, continue with the philosophy of “Preventing Pigment Gain”
SR, 38y/o, F,2-5% ,6mj-turb3, MSP, 50Hz , 3 Sessions
before
after
SR, 56 y/o, F, 2-5% , 6mj-turb3 ,MSP, 50Hz , 3 Sessions
before
after
SR, 44 y/o, F, 2-5% , 7mj-turb2 ,MSP, 50Hz , 2 Sessions
before
after
SR, 35 y/o, F, 2-5% , 3mj-turb3 ,MSP, 50Hz , 3 Sessions
before
after
SR, 55 y/o, F, 2-5% , 8mj-turb3 ,MSP, 50Hz , 2 Sessions
before
after
Acne+SR, 41y/o, F,2%, 3mj-trub3, MSP,50Hz, 3 Sessions
before
after
Acne Scar 34y/o, M, 10%, 14mj-trub3, SP,40Hz, 2 Sessions
before
after
Acne Scar 34y/o, M, 10%, 14mj-trub3, SP,40Hz, 2 Sessions
before
after
Ota Nevus 75y/o, F, 5%, 14mJ-Trubo2, MSP,50Hz, 8 Sessions
before
after
Evaluation of Improvement AfterAblative Fractional ER YAG laser for Skin Rejuvenation
Improvement Assessment
by the
physician (%)
Assessment by
the patient(%)
Excellent (≥75%) 10(4.1) 8(3.1)
Good (50-75%) 134(51.9) 130(50.6)
Fair (25-50%) 99 (38.9) 103(39.7)
Poor (≤25%) 15(5.1) 17(6.6)
Rejuvenation efficacy of Fractional ErYAGRejuvenation efficacy of Fractional ErYAG
Facial Skin Rejuvenation (258 patients)
0%10%20%30%40%50%60%
Poor Fair Good Excellent
Improvement
Patie
nts
PhysiciansPatients
Fig.2 Results of fractional Skin rejuvenation.
(2‐5% of coverage, energy 6 mJ
with Turbo 4 and MSP pulse duration)
Improvement Assessment by the
physician (%)
Assessment by the
patient(%)
Excellent (≥75%) 3(7.1) 1(2.3)
Good (50-75%) 25(59.5) 28(66.9)
Fair (25-50%) 13(30.9) 12(28.5)
Poor (≤25%) 1(2.5) 1(2.3)
Evaluation of Improvement AfterAblative Fractional ER YAG laser for Acne Scar
Acne Scar efficacy of Fractional ErYAGAcne Scar efficacy of Fractional ErYAG
Acne Scars (42 patients)
0%10%20%30%40%50%60%70%80%
Poor Fair Good Excellent
Improvement
Patie
nts
PhysiciansPatients
Fig.1 Results of fractional ErYAG
treatment of Acne scars.
(5‐10% of coverage, 14 mJ, Turbo 6, MSP – LP pulse duration)
Side Effects
After Ablative Fr. ER YAG laser
for Skin RejuvenationSide effects n(%) Mean Duration,
Days
Erythema 258(100) 2.8
Edema 258(100) 0.9
Mild crusting 241(93.7) 4.1
Acneiform
eruption 9(3.8) 6.7
Postinflammatoryhyperpigmentation 0(0) 0
Side Effects
After Ablative Fractional ER YAG
laser for Acne ScarSide effects n(%) Mean Duration,
Days
Erythema 42(100) 5.6
Edema 42(100) 1.6
Mild crusting 40(95.2) 5.1
Acneiform
eruption 2(4.8) 6.7
Postinflammatoryhyperpigmentation 1(2.4) 14
ConclusionsConclusionsConclusions•
Fractional Er-Yag
represents an
Alternative treatment of several dermatologic conditions without the adverse effects of classic ablative laser devices despite of darker skin patients.
•
Ablative Fractional treatments are less effective than full ablative ones, but are offering shorter down time
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