Clinical experiences in Asian skin with new technology of

ablative fractional Er:YAG Laser

Clinical experiences inClinical experiences in Asian skinAsian skin with new technology ofwith new technology of

ablative fractional ablative fractional Er:YAGEr:YAG LaserLaser

2011.05.20 SLOVENIA

Ming-Li Tseng, MD

Dr. Tseng Skin and Beauty Clinic, Taipei, Taiwan

Lynton N

d:YA

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FidelisEr:YA

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StarLux

IPL

Y+G

, cryo6

•CO2 •Dye •Ruby •Q-AlexQ-Nd:YAG•Er:YAG

CoolTouchIPL

TC C6Sciton Fraxel

CoolLipoFr.Co2

Dev

elop

‘92 ‘97 ‘99 ’03 ’05 ’06 ‘07

C6

StarLux

IPL

1064, IR H

P

Lux1540

M2 N

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Fr. Fr. Er:YAGEr:YAG

Development of Dr. TsengDevelopment of Dr. Tseng’’s Clinics Clinic

Development of Aesthetic Laser in Taiwan Development of Aesthetic Laser in Taiwan

QSRL PIH

QSRL BLISTER

IPL Burn

QSRL HYPO

QSNd:YAG

PIH

SCAR POST CO2 LASER FOR TATTO

ErythemaPIH or

HYPO

Edema Bulla Crusting Scar Pitting

Scar

Infecti on

Ulcer

IPL

Pigment

Hair Removal Vascular

Invasive

Thermage

Fractional

Laser & IPL Side Effects

5

Search for Ideal SR Treatment

Ablative High Efficacy -

Long Downtime

Non-Ablative Low Efficacy -

Short Downtime

7

Fractional Story –

Wound Healing Mechanism

Re-epithelization of micro treatment zones (MZT) is quicker due to:-

Enough healthy cells

(epidermal stem cells and transient amplifying cells)-

Short migration paths of keratinocytes

(quick arrival to wounded sites)

Islands of healthy skin are helping in would healing mechanism

Search for Ideal SR Treatment

What is “ fractional” ?What is What is ““ fractionalfractional”” ??

Safe, Effective and Short DowntimeSafe, Effective and Short Downtime

FDA-Cleared IndicationsFDA-Cleared Indications

November 10, 2003

Dermatological procedures requiring the coagulation of soft tissue

June 15, 2004

Treatment of periorbital

wrinkles

Photocoagulation of pigmented lesions including lentigos

(age spots), solar lentigos

(sun spots), and dyschromia

Resurfacing

-

the only non-ablative device cleared for resurfacing! (3/10/05)

Melasma

- the only device cleared for melasma! (7/5/05)

Acne scars and surgical scars!

(3/20/06)

Fraxel®

SR 1500

(3/29/06)

Can  be used on all skin types anywhere on the body!

R. Rox

Anderson, M.D

Transepidermal

Elimination Avenue

11Photo-Acoustic Effects

Microspot

Histology Comparison

Ablative Fr.CO2

Non‐ablative

Fr. Er‐Glass 

AblativeFr.Er‐YAG

Lasers in Surgery and Medicine 41:179–184 (2009)

雷

Long downtimeLong downtime

Hig

h Ef

ficac

yH

igh

Effic

acy

AblativeAblative

Short downtimeShort downtime

Low

Effi

cacy

Low

Effi

cacy Fractional ErGlass

NdYAG

Fractional ErYAG

CO2 Laser

IdealIdeal

Search for Ideal SR Treatment

FracFrac. . AblativeAblative

FracFrac. Non. Non-- AblativeAblative

NonNon-- AblativeAblative

15

Ablative Fr. Er-Yag

ApplicationsSkin Rejuvenation Indications for Ablative Fractional Treatments

●

Hyperpigmentations (Post-Inflamatory Hyperpigmentation -

PIH, Melasma,

Dyshromia)

●

Photoaged (photodamaged) skin (freckles, age spots, vascular lesions, skin texture…)

●

Wrinkles (moderate to severe rhytides)

●

Scars (acne scars, surgical scars, traumatic scars, burn scars)

●

Stretch marks

●

Skin tightening.. (some new and exciting applications)

Dr. Tseng’s RegimeDr. TsengDr. Tseng’’s Regimes Regime

•

I ALWAYS include the Fr. Er-Yag

Laser as part of the regime

•

General Parameters of Treatment: ‧Skin Rejuvenation

5 %, 3-14 mJ, MSP, 50HZ

‧Acne Scar

5-10%,14-Turbo 6-120mj, MSP-XLP•

Remember:

Once the pigment has reduced to a satisfactory level, continue with the philosophy of “Preventing Pigment Gain”

SR, 38y/o, F,2-5% ,6mj-turb3, MSP, 50Hz , 3 Sessions

before

after

SR, 56 y/o, F, 2-5% , 6mj-turb3 ,MSP, 50Hz , 3 Sessions

before

after

SR, 44 y/o, F, 2-5% , 7mj-turb2 ,MSP, 50Hz , 2 Sessions

before

after

SR, 35 y/o, F, 2-5% , 3mj-turb3 ,MSP, 50Hz , 3 Sessions

before

after

SR, 55 y/o, F, 2-5% , 8mj-turb3 ,MSP, 50Hz , 2 Sessions

before

after

Acne+SR, 41y/o, F,2%, 3mj-trub3, MSP,50Hz, 3 Sessions

before

after

Acne Scar 34y/o, M, 10%, 14mj-trub3, SP,40Hz, 2 Sessions

before

after

Acne Scar 34y/o, M, 10%, 14mj-trub3, SP,40Hz, 2 Sessions

before

after

Ota Nevus 75y/o, F, 5%, 14mJ-Trubo2, MSP,50Hz, 8 Sessions

before

after

Evaluation of Improvement AfterAblative Fractional ER YAG laser for Skin Rejuvenation

Improvement Assessment

by the

physician (%)

Assessment by

the patient(%)

Excellent (≥75%) 10(4.1) 8(3.1)

Good (50-75%) 134(51.9) 130(50.6)

Fair (25-50%) 99 (38.9) 103(39.7)

Poor (≤25%) 15(5.1) 17(6.6)

Rejuvenation efficacy of Fractional ErYAGRejuvenation efficacy of Fractional ErYAG

Facial Skin Rejuvenation (258 patients)

0%10%20%30%40%50%60%

Poor Fair Good Excellent

Improvement

Patie

nts

PhysiciansPatients

Fig.2 Results of fractional Skin rejuvenation. 

(2‐5% of coverage, energy 6 mJ

with Turbo 4 and MSP pulse duration)

Improvement Assessment by the

physician (%)

Assessment by the

patient(%)

Excellent (≥75%) 3(7.1) 1(2.3)

Good (50-75%) 25(59.5) 28(66.9)

Fair (25-50%) 13(30.9) 12(28.5)

Poor (≤25%) 1(2.5) 1(2.3)

Evaluation of Improvement AfterAblative Fractional ER YAG laser for Acne Scar

Acne Scar efficacy of Fractional ErYAGAcne Scar efficacy of Fractional ErYAG

Acne Scars (42 patients)

0%10%20%30%40%50%60%70%80%

Poor Fair Good Excellent

Improvement

Patie

nts

PhysiciansPatients

Fig.1 Results of fractional ErYAG

treatment of Acne scars. 

(5‐10% of coverage, 14 mJ, Turbo 6, MSP – LP pulse duration)

Side Effects

After Ablative Fr. ER YAG laser

for Skin RejuvenationSide effects n(%) Mean Duration,

Days

Erythema 258(100) 2.8

Edema 258(100) 0.9

Mild crusting 241(93.7) 4.1

Acneiform

eruption 9(3.8) 6.7

Postinflammatoryhyperpigmentation 0(0) 0

Side Effects

After Ablative Fractional ER YAG

laser for Acne ScarSide effects n(%) Mean Duration,

Days

Erythema 42(100) 5.6

Edema 42(100) 1.6

Mild crusting 40(95.2) 5.1

Acneiform

eruption 2(4.8) 6.7

Postinflammatoryhyperpigmentation 1(2.4) 14

ConclusionsConclusionsConclusions•

Fractional Er-Yag

represents an

Alternative treatment of several dermatologic conditions without the adverse effects of classic ablative laser devices despite of darker skin patients.

•

Ablative Fractional treatments are less effective than full ablative ones, but are offering shorter down time

Thank You

for Your Attention~

TThank Youhank You

for Your Attention~for Your Attention~