There are multiple laser and light source treatments for photoaging. These treatments range in efficacy and side effects. Typically, there is a trade-off between clinical improvement and a concomitant increase in side effects and downtime from work and social activities. Other chapters have focused on such treatments as nonablative fractional resurfacing, ablative fractional resurfacing, and traditional resurfacing. This chapter examines non-ablative laser resurfacing and, in particular, the use of mid-infrared lasers. Other devices such as intense pulsed light, nonablative fractional resurfacing lasers, and vascular lasers also achieve nonablative benefits, and are addressed in detail in other chapters.
Photoaging encompasses all the changes produced by exposure to ultraviolet (UV) radiation, including telangiectasias, rhytides, poor skin texture, and tone as well as skin laxity (see Dermatoheliosis chapter). Nonablative rejuvenation treats sun-damaged skin by heating dermal collagen with the aim of stimulating new collagen growth. It is also effective in the treatment of acne scars. Epidermal cooling is provided to ensure that thermal heating is targeting the dermis, and not the epidermis. The best advantage of nonablative treatments is that they require little, if any, downtime from work and social activities. This is in contrast to ablative and fractional ablative treatments. In skilled hands, side effects are typically mild and temporary (Fig. 6.1).
Vesicles appeared 1 day after treatment with a 1450-nm diode laser with a Fitzpatrick skin type 1 patient. These vesicles completely cleared without sequelae 3 days later
Often, they produce subtle or mild benefits, even after multiple treatments. Unfortunately, the predictability of improvement is uncertain. Some patients do not experience any discernible benefit even after multiple treatments. In the past few years, nonablative fractional lasers have produced enhanced results from other forms of nonablative resurfacing, with multiple treatments. These lasers have also proven to be safe in skilled hands. With the advent of nonablative fractional lasers, traditional nonablative laser resurfacing has declined in popularity.
In addition to intense pulsed light sources and vascular lasers, there are many nonablative devices that utilize visible, near-infrared, and mid-infrared wavelengths with epidermal skin cooling. These wavelengths target the water that is abundant in dermal tissue. The skin cooling protects against epidermal damage. These lasers produce deeper dermal penetration, greater absorption, and dermal thermal injury than vascular lasers. Further, there is significantly decreased risk of pigmentary changes in darker skin phototypes at these wavelengths. While the best candidates for treatment are those with mild to moderate static rhytides, the degree of improvement after treatment is difficult to quantify.
Subtle improvement of rhytides, particularly when compared to ablative devices
Requires multiple treatments to provide mild improvement of skin texture, tone, and rhytides
Little to no postoperative downtime ...