Neck rejuvenation: Fractional CO2 laser is valuable tool

Orlando

- Ablative fractional CO

₂

laser resurfacing offers an effective technique for neck rejuvenation with a very low risk of adverse events, according to Lori Brightman, M.D., at the annual meeting of the American Society for Dermatologic Surgery.

"Signs of aging and photodamage of neck skin, including laxity, redundancy, and mottling, is a common cosmetic concern, but can be a challenge to treat. Ablative lasers cannot be used off the face, and alternative approaches, including chemical peels and treatment with radiofrequency energy, have their own complications and limited benefit," says Dr. Brightman, who is in private practice at the Laser & Skin Surgery Center of New York.

"We have found that ablative fractional CO₂ laser resurfacing can restore a more youthful appearance to neck skin with a combination of consistently good results and a favorable safety profile that was unobtainable using previously available techniques.

"However, achieving these outcomes and patient satisfaction requires use of the laser by skilled hands, proper patient selection, and establishing reasonable patient expectations," she says.

Dr. Brightman and colleagues evaluated neck rejuvenation with a proprietary fractional CO₂ laser (Fraxel re:pair, Reliant Technologies) in a clinical trial enrolling 13 patients with mild to moderate photodamage and laxity of the neck skin.

‘Useful adjunct’

"This procedure is not a replacement for incisional surgery in patients with more advanced photodamage or skin laxity. However, the resurfacing can be a useful adjunct to a neck lift for improving the crepe-like skin and pigmentary changes that are not addressed by that surgical procedure," Dr. Brightman tells Dermatology Times.

All patients underwent two CO₂ fractional resurfacing procedures at about one to three months apart. The laser was used with the following parameters: 15 mm spot size, 200 microthermal zones/cm², 50 to 70 J/cm² fluence. Two passes were applied, and the procedure was performed using topical anesthesia and/or mild sedation.

"Settings for treatment with this laser vary, and should be selected based on a variety of factors, including skin type, anatomic location, indication, and severity of the condition," Dr. Brightman says.

Evaluation

Outcomes were assessed by evaluation of standard photographs taken pretreatment and at three months after the second procedure.

Three blinded physician observers performed the photographic assessment and graded changes in rhytids, crepe-like skin, neck tightening, and pigmentation using a five-point scale where 0 = no improvement, 1 = 25 percent improvement 2 = 25-50 percent improvement, 3 = 50-75 percent improvement and 4 = >75 percent improvement.All patients obtained at least 25 percent degree improvement in each of the outcome parameters. The greatest improvement was seen in pigmentation (overall improvement score ~3), while the mean improvement score for each of the other clinical parameters was about 2.6.

Adverse effects

All patients experienced post-treatment erythema and edema that generally lasted for five to 14 days, but there were no cases of scarring or pigmentary changes, including up to one year of follow-up.

"This procedure involves a recovery period, but it is significantly shorter than after ablative CO₂ resurfacing and its overall safety appears to be better. Patients can expect oozing and some pinpoint bleeding for the first 24 to 36 hours after the treatment, and it can take up to seven days for the skin to re-epithelialize.

"When that occurs, patients can apply make-up, but the skin will still be red for an average of another one to two weeks and remain pink for a few weeks after that," Dr. Brightman says.

She noted that follow-up for some of the initially treated patients extends to more than one year. The majority of the treatment benefit appears to be persisting, and importantly, there is no evidence of delayed hypopigmentation, as has been reported after traditional CO₂ laser resurfacing procedures of facial skin.

"Patients need to be counseled that this treatment sets back the clock but does not stop the aging process. The importance of good skincare, including protection against sun exposure and smoking cessation if relevant, must be emphasized," Dr. Brightman says. DT

Disclosure: Dr. Brightman reports no relevant financial disclosures.