Photodamage

Long-term clinical improvement of facial and nonfacial photodamaged skin has been seen up to nine months after treatment with the 1550 nm Fraxel laser. Wanner et al. [23] exam­ined fifty patients (skin types I-III) who underwent three treatments (8 mJ, 2000 MTZ/cm2 for facial areas; 8 mJ, 1,500-2000 MTZ/cm2 for nonfacial areas) three to four weeks apart. Nine months after treatment, 51-75% improvement in photodamage was observed in 73 and 55% of facial and nonfacial treated skin, respectively. Transient erythema and edema were seen in the majority of patients; however, no protracted pigmentary changes or scar­ring were observed [23].

In Asian patients with photodamaged skin, pigmentary problems are often more of a concern than rhytids [25,31]. Postinflammatory hyperpigmentation (PIH) is a common complication in these and other dark-skinned patients who attempt laser resurfacing [25,32-34]. Fractional resurfacing, however, can be effective in Asian patients when appro­priate parameters are used, and caution is exercised to prevent complications such as hyper­pigmentation. Initial studies have shown that there is a lower incidence of PIH when lower microthermal zone densities are used [24,25]. Chan et al. [25] found that Asian patients who received a high-energy, low-density treatment with the Fraxel (average fluence 16.3 mJ, total density 1000 MTZ/cm2) had a lower prevalence of PIH than those who received a low – energy, high-density treatment (average fluence 8.2 mJ, total density 2000 MTZ/cm 2). Similarly, Kono et al. [24] found that the use of higher densities (even with lower fluences) was associated with an increased risk of developing hyperpigmentation. Patients also expe­rienced more pain, erythema, and swelling when higher densities and increased fluences were used. Overall, the clinical efficacy and patient satisfaction were significantly higher with high-fluence, low-density treatments.

Updated: September 21, 2015 — 9:42 am