PEER-REVIEW | DERMATOLOGY |
Table 1 Patient treatment (positive) scoring chart GLOBAL SCORE AR x2
0 Fine lines Touch
problems Facial veins Coarse lines Complexion
AR x0 None
Pigmentation None Even
None None Pink
1
AR x1 Rare
Patchy Rare
Rare Rare Pale
2 Several
Moderate Mild
Several Several Grey
3 AR x3
Moderate Heavy
Moderate Moderate
Moderate Suggestion
yellow–grey 4
AR x4 Many
Marked Severe
Severe Many
Distinct yellow–grey AR=area of roughness
Table 2 Patient treatment (negative) scoring chart 0
1
Erythema Infection* Crusting Pain
None None None None
Improvement None
Rare Rare Rare Mild
2
Several Several Several
Tolerable Minimal Fair
Table 3 Deka treatment protocols for SmartXide DOT
Phototype I Phototype II Phototype III
DWELL TIME 1.0 ms 0.5 ms 0.2 ms
PASSES DOWN TIME 4 3 3
7 days 7 days 7 days
30 Watt Spacing; 500 µm natural bandage. This allows the skin to heal faster
than if the whole area was treated, as the surrounding ‘healthy’, untreated tissue helps to fill damaged areas with new cells. Downtime is also reduced and erythema moderate, allowing patients to apply cosmetics 5 days after treatment27
. Fractionalised C02 lasers are extremely versatile as
they can be used for the treatment of facial rhytides, acne scars, surgical scars, melasma, and photodamaged skin.
3
Moderate Moderate Moderate Moderate Good
4
Severe Severe Severe Severe
Excellent *Herpes/acne
Fractionalised C02
lasers are extremely
versatile as they can be used for
the treatment of facial rhytides, acne scars,
surgical scars, melasma, and
photodamaged skin.
There are currently a number of high-energy, fractionalised CO2
lasers available for cutaneous
resurfacing. Although each laser system adheres to the same basic principles, there are significant differences with regard to tissue dwell time, energy output, and laser beam profile. These differences may result in variable clinical and histological tissue effects. The purpose of this study was to compare the in vivo clinical and
histopathologic effects of two fractionalised CO2 resurfacing lasers: the 30 W SmartXide DOT™ (DEKA S.r.l., Florence, Italy) and the UltraPulse® ActiveFX™ (Lumenis Ltd., Yokneam, Israel). The ActiveFX (although technically the name of a set of parameters) is an upgrade of the UltraPulse Encore with a smaller spot size and a new computer pattern generator (CPG), giving a random pattern and thus reducing the possibility of adjacent spots with resultant heat accumulation. The SmartXide DOT adopts a lightweight titanium articulated arm in conjunction with a user-friendly colour touch screen control panel to display the settings. The SmartXide DOT requires an external plume device.
Patients and methods A prospective randomised split-face study using two different fractionalised CO2
resurfacing lasers (Lumenis
ActiveFX and DEKA SmartXide) was performed on 23 Caucasian subjects (17 women) with visible evidence of cutaneous photoageing to compare the clinical efficacy of each device. All subjects were given a physical examination and their medical histories reviewed. Subjects were instructed to avoid sun exposure and apply SPF 50 daily for 1 week after the study period. The study evaluated post-procedural aesthetic results, length of downtime, adverse side-effects, and new collagen formation for the ActiveFX and SmartXide during ablative treatment for photodamaged facial skin. Each patient was randomly assigned to receive
48 ❚
Figure 1 Perioral split-face study showing the different skin eschar results from the fractionalised lasers (computer pattern generators) immediately after treatment. Left: Lumenis Active FX. Right: DEKA SmartXide
October 2013 |
prime-journal.com
treatment on one half of their face with one of the devices. The ActiveFX patients were treated at an energy of 100–125 mJ, rate 125 Hz, CPG 3/6/1-3/9/4, repeat delay 0.5 s, depending on the area of the face being treated. This is approximately 19 W. This was dropped to 14 W for the neck area owing to the possibility of poor healing as a result of reduced epidermal rete pegs that project into the underlying connective tissue in this area compared to the face (rate 125 Hz, CPG 3/6/1-2, repeat delay 0.5–1 s; SmartXide at 10–15 W, 500 µm pitch, 500 ms dwell time). The SmartXide DOT patients were treated at a power of 30 W, DOT mode on, spacing 300–500 µm, dwell time 800–2000 µs, stack of 2 or 3. These levels were relatively arbitrary and not based on specific conversion tables, but the author was hoping to achieve an ablation depth of approximately 80 mm and a depth of the residual thermal damage of 200 mm28–30
. All patients underwent an ‘active’ single-session,
single-pass and full-face fractional ablative treatment. Fifteen patients received a double-pass treatment of the periorbital region and 12 to the perioral area, and in these cases the effect was repeated bilaterally. Significant differences (P<0.05) between baseline and at 1 and
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