Enhancement of visible laser and light-based photorejuvenation can be accomplished with photodynamic therapy (PDT). Photodynamic therapy was originally introduced with overnight incubation of 5 amino-levulanic acid, followed by activation with a 420 nm blue light for the treatment of actinic keratosis. This approach did not gain momentum due to significant discomfort and recovery time. Photodynamic therapy has undergone a dermatologic renaissance with the use of a short contact incubation of 5 amino-levulanic acid of 1-3 hours, followed by activation by a variety of lasers and light sources including vascular lasers (532 nm, 585 nm, 595 nm), pulsed light sources, blue light, and combination devices.
Fewer photofacial treatments are necessary and more advanced photodamage can be treated. There is some evidence that there is more consistent improvement of skin texture, and possibly fine rhytids with this approach (Fig. 13.1).