Over the past ten years, the industry has seen significant growth in developing unique energy-emitting devices that allow the professional to treat patients for fine lines and wrinkles without disrupting the barrier and intact layers the skin. This has been driven both by (1) the need to develop efficacious approaches with reduced negative side effects and long recovery periods for the patient and (2) reapplications from advancements in the aeronautic and military industries for harnessing light as a controlled source of energy. Since ablative techniques cause significant damage to the photodamaged epidermis, the skin responds by undergoing a dramatic wound-healing repair process, yielding a restored epidermis and underlying dermis that is significantly closer in histological and biochemical responsiveness to a younger state. In contrast, nonablative techniques spare the epidermis and underlying dermis by utilizing relatively low fluencies and/or a cooling of the epidermis. As with ablative, nonablative techniques are hypothesized to mechanistically stimulate a woundhealing response via controlled thermal elevation or stimulation of pseudo-chromophores via select wavelengths. While one of the significant advantages of nonablative techniques over ablative is that they allow the professional to treat patients and provide noticeable benefits without the associated significant negatives, and the clinical results from nonablative techniques are not as dramatic as those by the ablative techniques, this has still not precluded the growth and usage of nonablative procedures in the professional’s offices. For further information on the market relative to aesthetic devices, excellent summaries and references can be obtained at www. miinews. com.
A classification system for the types of nonablative procedures has been proposed, based partly on the specific endpoints that they impact [43]. Type I has been ascribed to the treatment of pigmentation, and Type II for the treatment of wrinkles and skin tone. In this chapter, the focus will be upon Type II modalities.