Yale dermatology professor compares skin resurfacing techniques

February 4, 2008, San Antonio, TX--Speaking at the 66th Annual Meeting of the American Academy of Dermatology, Jeffrey Dover, MD, FAAD, associate clinical professor of dermatology at Yale University Medical School (New Haven, CT), shared his professional experience with three of the newer laser skin resurfacing procedures being used to treat fine lines, wrinkles, photodamage, and uneven skin pigmentation.

February 4, 2008, San Antonio, TX--Speaking at the 66th Annual Meeting of the American Academy of Dermatology, Jeffrey Dover, MD, FAAD, associate clinical professor of dermatology at Yale University Medical School (New Haven, CT), shared his professional experience with three of the newer laser skin resurfacing procedures being used to treat fine lines, wrinkles, photodamage, and uneven skin pigmentation.

"The search for safe and effective treatments to improve and rejuvenate the tone, color and texture of the aging face is never ending," said Dr. Dover. "Today, patients are interested in gentler skin rejuvenation options than those used previously, such as the CO2 laser, and will trade less dramatic results for less downtime and few, if any, side effects."

One of the most versatile new laser technologies being used to treat aging skin is fractional laser skin resurfacing. Numerous clinical studies have shown this technology to be safe and effective in treating patients of all skin types, including skin of color, for fine lines, wrinkles, uneven skin tone and even acne scars.

Fractional laser resurfacing works by targeting damaged skin in columns of microscopic treatment zones, which include the outermost and underlying layers of skin known as the epidermis and the dermis. Fractional laser resurfacing thermally damages the tiny columns of skin while the surrounding healthy skin is left intact.

"One of the main benefits of fractional laser resurfacing is that it stimulates the production of new collagen during the body's natural healing process," said Dr. Dover. "Not only does the treated skin look better after a series of three to six treatments, but it also improves gradually as the new collagen forms - with optimal results clearly noticeable in about four to six months. Patients really prefer this treatment over more invasive procedures, as they can usually get results comparable to a treatment that would have required weeks of healing time and longer-lasting side effects."

Another new technology that shows promise in improving photodamaged skin in initial studies is plasma skin resurfacing. Rather than using light or radiofrequency that are common in other laser resurfacing procedures, plasma resurfacing uses a nitrogen gas to generate plasma energy - which is delivered to the targeted epidermis and dermis in either multiple, low-energy or single, high-energy millisecond pulses. Over a period of three to 10 days, depending on the level of energy used, the outermost layer of skin remains intact and acts as a "biological dressing" to protect the new epidermis and dermis forming underneath.

In a study published in the February 2007 issue of the Archives of Dermatology, Dr. Dover and his colleagues evaluated the effectiveness of multiple, low-energy, full-face plasma skin resurfacing treatments compared to a single, high-energy treatment. While single, high-energy plasma resurfacing treatments have been demonstrated to achieve successful results, patients typically require a week or more of healing time. Dr. Dover explained that his study was conducted to determine if comparable results could be achieved with less downtime by using multiple treatments at a lower energy.

"In the eight patients we studied that underwent full-face treatments every three weeks for a total of three treatments, we found a 37 percent reduction in wrinkles three months after treatment, with study participants noting a 68 percent improvement in overall facial appearance," said Dr. Dover. "We concluded that plasma skin resurfacing using the multiple low-energy treatment technique delivers significant improvement comparable to a single high-energy treatment, but with less healing time."

One of the most widely used lasers for skin resurfacing, the Er:YAG laser produces energy in varying wavelengths that penetrates the skin and is quickly absorbed by water, scattering the heat generated from the light of the laser. While patients with moderate to more severe wrinkles and photodamage are the best candidates for this laser treatment, the high amount of energy needed to improve aging skin requires the removal of part of the epidermis and the deeper tissues of the dermis. This more invasive procedure also requires a long healing time, as redness and swelling could last for several weeks.

Now, a modified version of this technology known as superficial Er:YAG laser resurfacing uses short-pulsed wavelengths to create a gentler treatment with fewer side effects and decreased downtime. Dr. Dover noted that this superficial laser procedure works well for patients with less extensive skin damage, such as mild wrinkles and slight skin discoloration, and the resulting mild redness and swelling generally only last for two to three days.

"The advantage of superficial Er:YAG laser resurfacing is that we can easily vary the amount of energy delivered to the skin to produce the desired effect," said Dr. Dover. "This technology has a proven track record, and it is a great option for patients who want noticeable results but a shorter healing time than the traditional high-powered procedure."

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