One-pass PDL effective for facial rejuvenation

A pulsed dye laser developed for the treatment of vascular and pigmented lesions of the face, has been shown to be effective for facial rejuvenation on just one pass treatment, a pilot study shows.

Compared to existing technologies, the 595nm pulsed dye laser enjoys a larger spot size range, longer dye life, options for cryogen spray or contact cooling, and an option for radiofrequency energy deployment just before the laser pulse.

The laser was used on a total of 13 patents (12 Caucasians and one Hispanic; 9 females and 4 males), aged 51-74 years, with Fitzpatrick Skin type I-III (I n=1; II n=9; III n=3) to treat 16 facial lesions. The lesions included diffuse redness (n=3), photodamaged (n=10) and telangiectasia (n=3) colored red and/or brown. All patients received two treatment sessions, and one patient had 3 sessions.

The spot size range used was 5-12mm, and fluences ranged from 8-18 J/cm2, with smaller fluences applied for general rejuvenation with the larger 12mm spot (mean 9 J/cm2). The smaller spot was used for focal low contrast pigmented lesions and vessels that persisted after overall facial treatment with the larger spot. The minimum fluence that achieved vessel closure and/or slight immediate pigment darkening, was applied based on test spots performed just before treatment to the entire face, and treatment was mainly without radiofrequency energy deployment.

Lidocaine cream (5 percent) was applied 30-60 minutes before all treatments. During treatment sapphire contact cooling was applied at 10°C, but cryogen spray cooling was not applied in full treatment sessions as it tended to overcool the epidermal pigmented lesions in test areas.

E. Victor Ross, M.D., director of the Laser Cosmetic Dermatology Centre at Scripps Clinic in San Diego, said that use of the Dynamic Cooling Device (DCD), which sprays the skin with a burst of cryogen milliseconds before the laser pulse, is “probably the best epidermal protection but sometimes it’s too much” as treatment would then require two or three passes. “If you’re a busy dermatologist you like to do things preferably in one pass,” he said.

Photographs of 13 lesions taken at baseline and three months after treatment were assessed by two blinded dermatologists who ranked clearance response using a five-point scale, where zero represented no change and four 76-100 percent clearance. All lesions had at least 50 percent clearance, 77 percent had 50-75 percent clearance and 23 percent had 76-100 percent clearance.

The application of radiofrequency energy did not affect the outcomes. Subject satisfaction rate was 91 percent, and at the same rate patients reported they would recommend this procedure.

Mean discomfort reported by patients during treatment was 4.7±2.3 on a zero to 10 scale, where zero represented no discomfort and 10 intolerable pain). All patients experienced mild to moderate erythema (100 percent) immediately after treatment, and 89 percent mild edema, 33 percent mild purpura and 8 percent and mild hyper-pigmentation. 

“We really found this laser to be better than what we had before,” Ross concluded. “The key features were increased energy over the old device and increased maximum spot size up to 15 mm.”

REFERENCE
“Novel pulsed dye laser for facial rejuvenation,” Victor Ross. American Society for Laser Medicine and Surgery annual conference, April 13, Dallas.