Newest diode-pumped thulium laser effective in anti-aging, aesthetic arena

Key Points

With the introduction of the diode pumped fiber lasers in the last decade, new laser wavelengths are now hitting the market. Laser resurfacing has seen resurgence over the past five years with the introduction of new wavelengths and fractional delivery systems. Introduced last year, the newest of the fiber lasers is the diode-pumped thulium laser, which emits a wavelength of 1,927 nm (Fraxel re:store, Solta Medical).

Thulium is a metal element similar in value and rarity to gold. It is soft and pliable, making it almost useless for most indications. In fact, its most common use is for production of laser light.

The thulium laser is new to the aesthetic market, but has been in use in other medical fields for many years. It has found its place in surgical procedures such as prostate resection, polyp removal, laser lithotripsy, airway disease, tissue welding and urinary tract abnormalities. Its introduction to the aesthetic market was made in 2009, and it is currently approved for dermatologic procedures requiring the coagulation of soft tissue. There are currently no peer-reviewed publications with the 1,927 nm thulium for skin resurfacing, but several studies are currently in progress.

Though likened to a superficial traditional CO₂ treatment, the thulium has several unique properties that set it apart. Histologically, the thulium treatment demonstrates more tissue coagulation than ablation. With treatment of the epidermis at 1,927 nm, the stratum corneum remains intact. This is similar to the nonablative lasers and has been shown to decrease the incidence of infection and downtime. Traditional superficial ablative devices completely vaporize the epidermis. Depth of the thulium depends on the energy used, but ranges between 150 to 250 microns. Coagulation of the epidermis can be seen extending to the superficial dermis. Clinically, this would be beneficial for treatment of superficial conditions, including, but not limited to, pigmentation, photodamage, fine textural abnormalities and actinic damage.

Using the device

As compared to the nonablative fractional resurfacing devices, the 1,927 nm thulium laser can be employed to treat more superficial conditions such as dyspigmentation and photodamage. Treatment with the thulium device is performed under topical anesthesia.

Preparations of combination tetracaine and lidocaine (7 percent/7 percent) or higher concentrations of lidocaine (30 percent) can be used without occlusion for one hour. Additional nerve blocks are usually not required. Analgesics such as Toradol (ketorolac tromethamine, Syntex) or extra strength Tylenol (acetaminophen, McNeil-PPC) can be offered for additional pain control. A forced air-cooling device and ice to nearby anatomic areas can also be used to diminish discomfort during the treatment session.

Treatment of the entire face can be performed in approximately 15 minutes with sequential overlapping passes. The patient may experience a slightly more prolonged course of post-procedural crusting when compared to the other fractional nonablative resurfacing devices, with superficial crusting lasting approximately four to five days after treatment.

Unlike results of collagen remodeling and textural improvement, however, which may take several months to appreciate clinically, patients often notice immediate improvement in dyspigmentation and superficial textural irregularities. Care must be taken to completely avoid sun exposure, and pre- and post-treatment with topical hydroquinone may be helpful to prevent recrudescence of dyspigmentation.