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PEER-REVIEW | DERMATOLOGY |


Post-procedure care For the areas treated with the ActiveFX, subjects were instructed to maintain a barrier coating of Vaseline (petroleum jelly) using a tongue depressor and to continue doing this every few hours to prevent direct contact between the treated tissue and air during healing. They were also instructed to wash the treated area with cool water, 2% dilute vinegar, or Cetaphil if required. All patients received Omnilux 633 nm light. In patient CM (Figure 4) the author used dilute vinegar


soaks (one teaspoon of distilled white vinegar to two cups water) applied over a layer of Vaseline every few hours postoperatively, but only because the patient requested multiple passes. The patients were shown demonstration photographs of other patients to explain that the treated facial areas will be pink–red for the first 2 days post-treatment, before turning a darker red to purple colour. They were also warned about the possibility of a herpetic outbreak on the third day, and shown photographs of how this would appear. The patients were reviewed at 7–10 days


postoperatively, during which time the treated areas of the face had mostly returned to normal, although the neck sometimes remained erythematous. Outbreaks of herpetic infection were reviewed on an almost daily basis, and patients were prescribed Famvir 750 mg three times per day during this period. A topical steroid (1% Hydrocortisone) was applied to two patients for continual itch, possibly a result of Vaseline sensitivity.


Skin biopsies and histology Skin biopsies were obtained from five of the patients intraoperatively from each side, after one laser pass, and at 3 months postoperatively. Lesion penetrative dimensions were assessed histologically using haematoxylin and eosin. Blinded histological examination of laser-treated halves was performed to determine the amount of tissue ablation, residual thermal damage, inflammation, and new collagen synthesis. The patients received a single fractional ablative CO2


pattern (number 3) with the largest spot size available


for the pre-selected energy density used. For the SmartXide the author used at 30 W, DOT mode spacing 200–400 µm, scanning dwell time 500 µs–1 ms. These setting are much faster to use. The cheek and perioral (under regional anaesthesia)


areas were treated first in order that the patient could acclimatise to the laser. The periorbital area was treated next, finally extending down onto the neck. When treating the neck area, the parameters were modified to use the lowest energy density possible (ActiveFX density 1). The Cool Scan was always used, with a repeat delay of 0.5–1 ms. Care was taken in the inferior regions of the neck to feather in the posterior border. In general, the patients experienced no pain post-procedurally, and the author placed them under a 633 nm Omnilux Revive™ (Photo Therapeutics, Ltd., A Photomedex® Company, London, UK) to biomodulate fibroblast activity, thereby leading to faster and more efficient collagen synthesis32


54 ❚ . October 2013 | prime-journal.com


Figure 4 The patient was a 53-year-old Caucasian male with bilateral periorbital rhytides. Left eye treated with SmartXide — 30 W, DOT mode, spacing 200 µm, dwell time 500 µs. Two passes were given under the left eye, with an obvious reduction in rhytides. The right eye was treated with the Lumenis ActiveFX — 100 mJ, 125 Hz, CPG 3/5/2. (A) SmartXide before treatment (eye open); (B) SmartXide before treatment (eye partially closed); (C) SmartXide on day 4; (D) SmartXide on day 14; (E) SmartXide on day 30; (F) ActiveFX before treatment; (G) ActiveFX day 4; (H) ActiveFX day 30


treatment with the ActiveFX device on one side of the face, and the DEKA SmartXide DOT device on the other. Micrographic analysis showed a 30% increase in new collagen on the CO2


treated side and a 15% increase of


new collagen on the other side. These slides were reviewed by dedicated skin


histopathologists Professor Kieran Sheahan and Dr Tom Crotty, Consultant Histopathologists, St Vincent’s University Hospital, Dublin, Ireland.


Case studies Photoageing In Figure 2, the patient was a 59-year-old Caucasian female with a ‘normal’ level of photoageing. She had a history of herpes simplex and was prescribed Famvir 750 mg once daily. The left side of her face was treated with the ActiveFX:


energy 125 mJ, rate 125 Hz, CPG 3/5/4. The right side was treated with the SmartXide: power 30 W, DOT mode


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