Fractional Laser Tx Found Effective for Hands

PHOENIX — Nonablative fractional laser therapy applied at conservative settings achieved moderate global improvement in photodamaged hands in a pilot study.

Six months following their last treatment session, 8 of the 10 patients in the study showed a 26%-50% improvement in wrinkles, pigmentation, and skin texture, based on a formal investigator-rated scoring system, Dr. Neil S. Sadick reported at the annual meeting of the American Academy of Cosmetic Surgery. Patient assessments correlated well with the investigators' ratings.

"What you can expect is moderate, intermediate-level global improvement. But it's hard to achieve these global changes with any other type of technology," said Dr. Sadick, a dermatologist at Cornell University, New York, and immediate past president of the Cosmetic Surgery Foundation.

As is the case with other skin remodeling technologies, the results improved from 1 month post treatment to the 6-month follow-up mark, he noted.

The treatment sessions were well tolerated, side effects were mild and self-limited, and return to daily activities was immediate. "In our no-downtime world, this is what our patients are looking for in a nonsurgical venue," Dr. Sadick said.

The 10 patients (mean age, 57 years) were Fitzpatrick skin types I-III. Their bilateral photodamage on the dorsum of the hands was treated with a fractional 1,550-nm erbium-doped fiber laser, the first-generation Fraxel laser marketed by Reliant Technologies Inc.

Patients underwent five or six treatment sessions 3–4 weeks apart, with topical anesthesia. The laser energy setting was 6 mJ at the first session, increasing as tolerated by 2 mJ at each subsequent session. The total microthermal zone density was 1,000–2,000/cm

The technique used in treating the hands was the same as with Fraxel therapy on the face, with three or four passes per session being done, depending on the degree of photoaging.

All patients had immediate posttreatment erythema. Unlike on the face, where it resolves within a day or two, the erythema on the hands lasted for as long as 4 weeks.

"This is something that you need to tell your patients if you're going to use this modality," Dr. Sadick said.

Half of the patients developed mild edema. This was most prominent after the first treatment session, but it occasionally occurred after others as well.

No scarring or long-term inflammatory dyschromia occurred. Patients reported that the discomfort associated with treatment was mild but increased slightly with increasing laser energy.

Three patients underwent biopsies at baseline and again 3 and 6 months after their last session. Histologic evaluation using hematoxylin and eosin and elastin tissue stains showed a treatment-related decrease in atypical keratinocytes, increased rete ridge formation in the epidermis, enhanced collagen density in the epidermis and papillary and reticular dermis, improvement in the baseline irregular dermal architecture, and reduced solar elastosis. Consistent with clinical findings, there was no histologic evidence of scarring or inflammatory changes.

Dr. Sadick said he plans to study whether fractional laser therapy at greater energy densities will result in even better outcomes in fewer treatment sessions than in this initial study. "We're presently doing a study using a CO₂ Fraxel laser with just two treatment sessions. The results appear to be even better than in this pilot study," he said.

He disclosed that he performed his pilot study for Reliant in return for discounted equipment. He is on the speakers bureaus for laser and medical device manufacturers Cynosure, Palomar Medical Technologies Inc., Syneron Medical Ltd., and Cutera Inc.

The image at left shows a hand before treatment with a nonablative fractional laser at conservative settings. At right, the same hand is shown 6 months after the last of six treatment sessions. PHOTOS COURTESY DR. NEIL S. SADICK

PHOENIX — Nonablative fractional laser therapy applied at conservative settings achieved moderate global improvement in photodamaged hands in a pilot study.

Six months following their last treatment session, 8 of the 10 patients in the study showed a 26%-50% improvement in wrinkles, pigmentation, and skin texture, based on a formal investigator-rated scoring system, Dr. Neil S. Sadick reported at the annual meeting of the American Academy of Cosmetic Surgery. Patient assessments correlated well with the investigators' ratings.

"What you can expect is moderate, intermediate-level global improvement. But it's hard to achieve these global changes with any other type of technology," said Dr. Sadick, a dermatologist at Cornell University, New York, and immediate past president of the Cosmetic Surgery Foundation.

As is the case with other skin remodeling technologies, the results improved from 1 month post treatment to the 6-month follow-up mark, he noted.

The treatment sessions were well tolerated, side effects were mild and self-limited, and return to daily activities was immediate. "In our no-downtime world, this is what our patients are looking for in a nonsurgical venue," Dr. Sadick said.

The 10 patients (mean age, 57 years) were Fitzpatrick skin types I-III. Their bilateral photodamage on the dorsum of the hands was treated with a fractional 1,550-nm erbium-doped fiber laser, the first-generation Fraxel laser marketed by Reliant Technologies Inc.

Patients underwent five or six treatment sessions 3–4 weeks apart, with topical anesthesia. The laser energy setting was 6 mJ at the first session, increasing as tolerated by 2 mJ at each subsequent session. The total microthermal zone density was 1,000–2,000/cm

The technique used in treating the hands was the same as with Fraxel therapy on the face, with three or four passes per session being done, depending on the degree of photoaging.

All patients had immediate posttreatment erythema. Unlike on the face, where it resolves within a day or two, the erythema on the hands lasted for as long as 4 weeks.

"This is something that you need to tell your patients if you're going to use this modality," Dr. Sadick said.

Half of the patients developed mild edema. This was most prominent after the first treatment session, but it occasionally occurred after others as well.

No scarring or long-term inflammatory dyschromia occurred. Patients reported that the discomfort associated with treatment was mild but increased slightly with increasing laser energy.

Three patients underwent biopsies at baseline and again 3 and 6 months after their last session. Histologic evaluation using hematoxylin and eosin and elastin tissue stains showed a treatment-related decrease in atypical keratinocytes, increased rete ridge formation in the epidermis, enhanced collagen density in the epidermis and papillary and reticular dermis, improvement in the baseline irregular dermal architecture, and reduced solar elastosis. Consistent with clinical findings, there was no histologic evidence of scarring or inflammatory changes.

Dr. Sadick said he plans to study whether fractional laser therapy at greater energy densities will result in even better outcomes in fewer treatment sessions than in this initial study. "We're presently doing a study using a CO₂ Fraxel laser with just two treatment sessions. The results appear to be even better than in this pilot study," he said.

He disclosed that he performed his pilot study for Reliant in return for discounted equipment. He is on the speakers bureaus for laser and medical device manufacturers Cynosure, Palomar Medical Technologies Inc., Syneron Medical Ltd., and Cutera Inc.

The image at left shows a hand before treatment with a nonablative fractional laser at conservative settings. At right, the same hand is shown 6 months after the last of six treatment sessions. PHOTOS COURTESY DR. NEIL S. SADICK

PHOENIX — Nonablative fractional laser therapy applied at conservative settings achieved moderate global improvement in photodamaged hands in a pilot study.

Six months following their last treatment session, 8 of the 10 patients in the study showed a 26%-50% improvement in wrinkles, pigmentation, and skin texture, based on a formal investigator-rated scoring system, Dr. Neil S. Sadick reported at the annual meeting of the American Academy of Cosmetic Surgery. Patient assessments correlated well with the investigators' ratings.

"What you can expect is moderate, intermediate-level global improvement. But it's hard to achieve these global changes with any other type of technology," said Dr. Sadick, a dermatologist at Cornell University, New York, and immediate past president of the Cosmetic Surgery Foundation.

As is the case with other skin remodeling technologies, the results improved from 1 month post treatment to the 6-month follow-up mark, he noted.

The treatment sessions were well tolerated, side effects were mild and self-limited, and return to daily activities was immediate. "In our no-downtime world, this is what our patients are looking for in a nonsurgical venue," Dr. Sadick said.

The 10 patients (mean age, 57 years) were Fitzpatrick skin types I-III. Their bilateral photodamage on the dorsum of the hands was treated with a fractional 1,550-nm erbium-doped fiber laser, the first-generation Fraxel laser marketed by Reliant Technologies Inc.

Patients underwent five or six treatment sessions 3–4 weeks apart, with topical anesthesia. The laser energy setting was 6 mJ at the first session, increasing as tolerated by 2 mJ at each subsequent session. The total microthermal zone density was 1,000–2,000/cm

The technique used in treating the hands was the same as with Fraxel therapy on the face, with three or four passes per session being done, depending on the degree of photoaging.

All patients had immediate posttreatment erythema. Unlike on the face, where it resolves within a day or two, the erythema on the hands lasted for as long as 4 weeks.

"This is something that you need to tell your patients if you're going to use this modality," Dr. Sadick said.

Half of the patients developed mild edema. This was most prominent after the first treatment session, but it occasionally occurred after others as well.

No scarring or long-term inflammatory dyschromia occurred. Patients reported that the discomfort associated with treatment was mild but increased slightly with increasing laser energy.

Three patients underwent biopsies at baseline and again 3 and 6 months after their last session. Histologic evaluation using hematoxylin and eosin and elastin tissue stains showed a treatment-related decrease in atypical keratinocytes, increased rete ridge formation in the epidermis, enhanced collagen density in the epidermis and papillary and reticular dermis, improvement in the baseline irregular dermal architecture, and reduced solar elastosis. Consistent with clinical findings, there was no histologic evidence of scarring or inflammatory changes.

Dr. Sadick said he plans to study whether fractional laser therapy at greater energy densities will result in even better outcomes in fewer treatment sessions than in this initial study. "We're presently doing a study using a CO₂ Fraxel laser with just two treatment sessions. The results appear to be even better than in this pilot study," he said.

He disclosed that he performed his pilot study for Reliant in return for discounted equipment. He is on the speakers bureaus for laser and medical device manufacturers Cynosure, Palomar Medical Technologies Inc., Syneron Medical Ltd., and Cutera Inc.

The image at left shows a hand before treatment with a nonablative fractional laser at conservative settings. At right, the same hand is shown 6 months after the last of six treatment sessions. PHOTOS COURTESY DR. NEIL S. SADICK