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PEER-REVIEW | DERMATOLOGY |


(Table 1). In the original Dover Scale, patients and blinded investigators assessed pain during treatment and post-treatment improvement in photoageing with lasers by measuring rhytides, lentigines, texture, and pore size using a five-point scale. In this study the author included facial veins and complexion rather than pore size. A total global score was recorded for each patient


based on the addition of points obtained from six variables of photodamage: fine lines, coarse wrinkles, hypo/hyperpigmentation, sallow complexion, tactile roughness, and telangiectasia. The author felt that this method would allow individual photoageing parameter response to be recognised, while also allowing any differences in the laser effect to be exaggerated in the overall higher global totals. The positive results related to overall aesthetic outcome for treatment of photoaged skin, while the negative (Table 2) were more a reflection of patient satisfaction to the type of laser device that performed the treatment. A small number of patients (< 3%) received full facial


herpes. This figure is well below the number of herpetic infections noted in other CO2


ablative laser studies30 . Both


lasers were considered comparatively similar with regard to downtime, erythema and overall aesthetic effect in this form of ‘soft’ resurfacing. However, histopathologic penetrative effect and adverse side-effects were considered higher with the ActiveFX than the SmartXide, although this may be owing to non-comparable device settings.


The devices The ActiveFX is not a new laser, but rather a particular protocol of settings applied in conjunction to an improved CPG to the ultrapulsed CO2


laser (UltraPulse 3 months post-treatment were observed for fine lines


and wrinkles, although the best improvements were noted at regions in which the practitioner thought the patient required a double-pass. Patients who received second overlapping passes in the periorbital and perioral areas received them for deeper rhytides. The author went slightly above the recognised Lumenis ‘soft’ protocol for ActiveFX — energy 90–100 mJ, rate 100 Hz, CPG 3/5/2-3/5/5, repeat delay 0.5s — as previous experience showed these parameters to be less preferable in aesthetic effect. The protocols for the SmartXide included treatments that required multiple passes, so the above parameters were agreed with the company to be comparatively similar. A clinical assessment of each patient was made at


2 weeks, 1 month and 3 months postoperatively in the presence of two physicians. Scoring was based on re-epithelialisation rate, reduction of rhytides, reduction of tactile roughness, and reduction of hyperpigmentation and telangiectasia. The prolongation and severity of erythema, as well as the presence of negative side-effects (e.g. herpes were also recorded by both patient and doctor). The degree of photoageing and the efficacy of treatment were evaluated using a variation of the five-point scale originally suggested by Dover et al30


50 ❚ October 2013 | prime-journal.com


Figure 2 Each half face was randomly assigned to receive


treatment with one of the CO2 lasers. (A) Split-face study day 1; (B) split-face study day 3; (C) patient on day 5 with full facial herpes; (D) satellite herpetic lesions


Encore). Technical differences exist between this upgraded non-sequential fractional device and the older ultrapulsed CO2


. These include the device leaving intact


tissue bridges between spots, which results in faster healing time and less thermal damage to the basal cell membrane. The device also has a smaller spot size (1300 mm instead of 2500 mm), resulting in less post-procedure erythema as a result of reduced heat build-up in the tissues. The CPG lays a random series of spots rather than a sequential arrangement, resulting in greater thermal relaxation time (τr


A small number of patients (< 3%)


received full facial herpes. This figure is well below the number of herpetic


infections noted in other CO2


ablative laser studies.


) and less overheating


of the treated tissue. The application of random rather than sequential beams is termed ‘Cool Scan’ and this feature was used for every patient in the study. The SmartXide DOT is a 30 W fractional CO2


laser with


computerised scanner, which allows the user to deliver a customised pattern with adjustable power, pattern density and dwell time. With DOT (Dermal Optical Thermolysis) technology, the physician is able to deliver a superficial ‘soft’ treatment with no downtime, a moderate treatment requiring a few days of downtime, or a fully ablative laser resurfacing treatment. The author wished to see whether there was also a single treatment schedule comparable to the ActiveFX settings. The SmartXide was used at the following parameters


(Table 3):


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