| guest editorial
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Professor Leonardo Marini sdcthe skin doctors’ centre, trieste, italy
priMe journal editorial board Board MeMBer Dr Wilmar Accursio Dr Ashraf Badawi
SpecialiSM
Dr Claude Dalle Dr Pierre Andre
Dr Janethy Balakrishnan Dr Lakhdar Belhaouari Dr Philippe Berros Dr Dario Bertossi
Dr Jean Christophe Bichet
Anti-ageing & aesth. medicine France Endocrinologist Dermatology Dermatology Dermatology Plastic surgery
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Oculoplastic surgery Maxillofacial surgery Plastic surgery
Dr Philippe Blanchemaison Phlebology Dr Pierre Bouhanna Dr Fahd Benslimane Prof Wayne Carey
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Prof Andreas Katsambas
Dermatology – Hair surgery Plastic Surgeon Dermatology
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Dermatology
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Board MeMBer Dr Mario Krause
Dr Ching Lai
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prime-journal.com | May 2011 ❚ 5
Romania Spain
M
odern laser derMatology really began when strategies to control intra-tissue heat production by photothermal effects were proposed. dermatology has come a long way since the original concept of selective photothermolysis, with the development of innovative concepts such as thermokinetic tissue selectivity, extended selective photothermolysis and finally, the presently used fractional photothermolysis.
the aim of laser research has always been to confine heat diffusion to avoid non-selective tissue heating,
which is difficult to predict. heat can either destroy or stimulate cellular activity according to temperature and time of application. when properly applied, it can effectively stimulate neo-collagen production, eliminate damaged, fragmented collagen fibres, coagulate unwanted dermal ectatic vessels, correct skin pigmentation, and eliminate superficial neoplasms typical of ageing skin. skin rejuvenation is an appealing concept, popular among many of the world’s ageing population; but the
majority of patients looking for effective treatments are not willing to face a prolonged postoperative down- time, and intense intraoperative and postoperative discomfort. ageing varies among different races and sub- races and has a progressive evolution, so treatment strategies need to be personalised. there is no way to stop ageing, but we can slow it down. Present trends feature procedures strategically distributed along each patient pathway, with the aim of inducing ‘subtle’ improvements. Most patients do not desire dramatic changes, but prefer to always be at their ‘credible’ best. therefore, modulating photothermal effects is crucial. light tissue interactions opened previously impossible therapeutic scenarios and offer an incredible
variety of treatment options based on different wavelengths, characterising tissue penetration depths and identifying specific light-absorbing biological targets. considering these fundamental properties and patient desire, we can either treat variable amounts of tissue, spacing vertical microthermal columns according to the fractional technique, or sequentially combine similar or different laser wavelengths, layering them horizontally to obtain highly specific clinical results perfectly tailored to patient need. it has been widely accepted that combination treatments offer much better clinical results than single
treatments alone, minimising side-effects particular to each procedure. laser layering allows highly selective photothermal effects targeting wavelength-specific chromophores, naturally located at different depths into the skin, without reaching unwanted bulk heating tissue levels. Fractional and non-fractional techniques can be combined one after the other, allowing tissue to cool between subsequent passes, tailoring laser wavelengths and pulse-widths to thermally-induced variations of tissue water (oedema) and chromophores (oxyhaemoglobin — metahaemoglobin). the laser layering technique is very interesting, but putting it into practice
requires perfect knowledge of the skin combined with experience of every laser or light source used. the future of laser dermatology is also stimulating and will give dermatologists endless treatment options when different light sources are properly and sequentially combined.
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