April 2020 HSC Section 4 - Plastic and Reconstructive Problems
Clinical Review & Education Review
Energy-Based Facial Rejuvenation—Advances in Diagnosis and Treatment
Table 2. Selected Source Articles for Major Therapies Available
Sample Size and Characteristics
Fitzgerald Skin Type
Source by Category
Energy Used
Adverse Effects
Bottom Line
Laser Ablative
Triana et al, 5 2015
High satisfaction rate, but significant complications
III-V
Hyperpigmentation (30.4%), prolonged recovery
Carbon dioxide
665 Patient, retrospective, 80% full-face ablative resurfacing primarily for rhytids, single treatment 45 Patient, prospective single-blinded, 2-3 full-face treatments 9 Patients, prospective, full face, 1-2 treatments 58 Patients, retrospective, acne scarring
Fractionated ablative Tierney et al, 9 2011
I-III
None significant, erythema <7 d
Significant improvements in photoaging, minimal adverse effects Improvements in photoaging greater with 2 treatments 3 Treatments with AFL as effective as a single treatment with resurfacing lasers
Carbon dioxide
Khatri et al, 13 2012
Erbium:YAG
I-IV
3-4 d Downtime, moderate discomfort
You et al, 44 2016
IV
Increased downtime, erythema, and dyschromia in ablative group, more with carbon dioxide laser
Carbon dioxide, erbium:YAG, NAFL, and AFL
Fractionated nonablative Hong et al, 15 2015
III-IV
Mild pain, minimal downtime
Mild/moderate improvement in mild rhytids
LPND
20 Patient, prospective, split-faced study, 3 treatments 20 Patient, prospective, randomized, control is triple topical therapy
Kroon et al, 52 2011
II-IV
Mild erythema, burning sensation, edema, pain
Significant improvement compared with control in melasma, high recurrence
NAFL
Combination
Cohen et al, 19 2013
Improved, equivalent results in both groups; lower adverse effect profile in combined FLs There is a small risk of dyschromia with IPL use in patients with prior dyschromia Improvement in melasma vs bleaching cream alone, poor response in frontal and malar melasma
Reduced adverse effects, downtime in combined laser
Combined FL
8 Patients, prospective, split-face control is fractional ablative carbon dioxide laser
Intense pulsed light Fang et al, 24 2014
IPL
675 Patients, retrospective, 1-5 treatments
III-IV
Hyperpigmentation in 2.96% of patients, all had pigmentation issues before treatment Significant response to IPL therapy based on MASI vs control
II-V
62 Patients, prospective, randomized, control is triple-topical therapy alone, single-session, melasma 43 Patients, prospective, photodamage, 29 patients IPL/NAFL full-face, 14 patients split-face IPL/NAFL and IPL or NAFL alone, 4 wk later completion treatment 113 Patients, prospective, full-face combination, split-face combination vs IPL alone 14 Patients, prospective, single blinded, 4-6 treatments 17 Patients, prospective, 6 total treatments for 6 mo
Figueiredo Souza et al, 51 2012
IPL/triple combination treatment
Combination Kearney
Statistically superior results in combined IPL/NAFL group
NA
Combined group: 10% persistent erythema (≤10 d), 10% superficial pustule formation, 14% pruritus
IPL/NAFL
and Brew, 28 2012
Tao et al, 29 2015
Combination therapy statistically superior to IPL alone
III-IV
AFL: 3-5 d for reepithelialization, erythema for 1-2 d, 3.6% experienced hyperpigmentation
IPL/AFL/ Near infrared
Radiofrequency Nelson et al, 39 2015
NA
Minimal, transient erythema and edema
All experienced some improvement, no long-term data, weekly treatments Improvement out to 1 year that was mild and diminished from 6 mo
Bipolar RF
Taub et al, 41 2012
Monopolar RF
NA
Minimal, mild discomfort
Ultrasonography Fabi and Goldman, 37 2014
MFU Retrospective, most had mild improvement in appearance out to 6 mo, no longer-term data Abbreviations: AFL, ablative fractionated laser; erbium:YAG, erbium yttrium aluminum garnet; FL, fractionated laser; IPL, intense pulse light; LPND, long-pulsed Nd:YAG; MASI, melasma area and severity index; MFU, microfocused ultrasonography; RF, radiofrequency. 48 Patients, retrospective, face and upper neck skin laxity treated I-IV 1 Small pustule at treatment site, no permanent
were compared in several studies showing high recurrence rates with fractional therapy and a higher incidence in PIH. 60,61 Melasma continues to be a difficult problem, with frequent recurrence, but refinements in techniques are helping identify the optimal treat- ment to improve pigmentation without hypopigmentation or worsening PIH.
Ethnic Skin Darker skin types, Fitzpatrick type V and VI, have thicker and more compact skin layers with thicker collagen bundles, which increase the epidermal barrier and reduce skin sensitivity in addition to a higher density of larger melanosomes. 62-64 Ablative nonfraction- ated lasers, including the carbon dioxide and the erbium:YAG, can
JAMA Facial Plastic Surgery January/February 2017 Volume 19, Number 1 (Reprinted)
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