PEER-REVIEW | DERMATOLOGY | Patient histology
SmartXide DOT (14306/07) immediately post-procedure
POWER 30 W, DOT mode spacing 400 µm, dwell time 500 µs
LASER PENETRATION DEPTH 113 nm
requiring the deeper penetrating ‘harder’ MaxFX (also
from Lumenis) rather than the ‘softer’ ActiveFX, and it is apparent that Lumenis are presently working on a combination therapy to address this. The mean pain sensation felt during the treatment was 2.7, in keeping with other studies1
. The author noted
that most patients do not feel much pain with the ActiveFX if the topical anaesthetic is applied 1 hour before treatment, or until the settings are above 100 mJ. Some patients required ice-packs owing to a mild ‘burning’ effect after the procedure, but none required analgesia to take home. Post-inflammatory hyperpigmentation (PIH) was not
SmartXide DOT (S14304/07) immediately post-procedure
POWER 30 W, DOT mode spacing 300 µm, dwell time 500 µs
LASER PENETRATION DEPTH 113 nm
SmartXide (S14304/07) 3 months post-procedure
POWER 30 W, DOT mode spacing 300 µm, dwell time 500 µs
LASER PENETRATION DEPTH 113 nm
noted in any of the patients. Seventeen patients were classified as Fitzpatrick skin types I and the remaining four as type II. Two patients sustained a global facial herpetic infection. No patient experienced any adverse reaction to laser skin resurfacing outside herpetic infection, and 92% of patients were satisfied with their final aesthetic outcome. The mean patient age was 53 years (range 43–74 years). A small number of patients (< 3%) received full facial herpes. A similar study in 2007 showed levels of < 12%, especially with the ActiveFX. This number fell dramatically after changing prophylactic anti-viral protocol from Famvir 750 mg daily to Valaciclovir 500 mg twice daily for 1 week. All skin biopsies in this study show the effect of
ActiveFX (S479/08) immediately post-procedure
ENERGY 100 mJ 9.4 J/cm2
rate 125 Hz 18.8 W, CPG 3/5/2.
LASER PENETRATION DEPTH reported at 85 mm and some new collagen formation seen at this level
Active FX (S479/08) 3 months post-procedure
ENERGY 125 mJ 9.4 J/cm2
rate 125 Hz 18.8 W, CPG 3/5/2.
LASER PENETRATION DEPTH reported as deep as 700 mm and marked new collagen formation seen at this level
Slides reviewed by Professor Kieran Sheahan and Dr Tom Crotty, of the Pathology Department, St Vincent’s University Hospital, Dublin, Ireland.
All skin biopsies in this study show the effect of thermal
treatment with thermal coagulation of epidermis and superficial dermis in a depth ranging 85–700 µm.
58 ❚ October 2013 |
prime-journal.com , ,
thermal treatment with thermal coagulation of epidermis and superficial dermis in a depth ranging 85–700 µm. This was especially seen with the ActiveFX going below 700 µm. A number of studies show that the zone of residual thermal (coagulative) damage can extend a further 20–120 µm, depending on the particular laser variables used14–16
. This was particularly evident in image
C, in which the SmartXide thermal effect appears to be more diffuse than focal. As CO2
lasers differ in their
biophysical properties, their documented depth of histological ablation and thermal effects vary15, 16
. Limiting the depth of penetration also decreases the
risk of scarring and permanent pigmentary alteration. However, during the period of the study, the author became quite comfortable using the SmartXide with longer dwell time, reduced spacing and selective use of double passes, particularly in the upper lip and lateral periorbital areas of some patients outside the study to achieve better aesthetic effect. The longer dwell time, albeit with reduced spacing, could achieve deeper collagen stimulation to increase the rejuvenative effect. These parameters are for Fitzpatrick skin types I–III. In general, thinner periorbital skin usually requires fewer laser passes, but the author felt comfortable enough to double pass patients with the SmartXide in this area.
Conclusions Laser resurfacing technology is continually changing and the type of laser purchased and the settings used by the operator is dependent on financial considerations, skin type, patient age, and thickness of epidermis and dermis to be treated. This means that an experienced operator can adapt the depth of penetration and
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