Geraghty Laurel Naversen, Biesman Brian
Department of Ophthalmology, Otolaryngology, Dermatology, Vanderbilt University Medical Center Laser and Facial Surgery, 345 23rd Ave., N. Suite 416, Nashville, Tennessee 37203, USA.
Lasers Surg Med. 2009 Aug;41(6):408-16. doi: 10.1002/lsm.20784.
Nonablative fractional lasers are well recognized for rejuvenating photoaged skin. We previously reported favorable outcomes with short follow-up after the use of 1,440-nm Nd:YAG laser energy used alone or in combination with a 1,320-nm laser to effect rejuvenation and wrinkle reduction. We now report longer follow-up data.
STUDY DESIGN/MATERIALS AND METHODS: Nineteen Caucasian subjects (average age 47+/-8.4; range 33-62) exhibiting mild-to-moderate photoaging of the face and neck were treated four times (average interval 18.1+/- 4.1 days; range 11-37 days) with the 1,440-nm Nd:YAG fractional laser (average fluence 3.7+/-0.3 J/cm(2)) or the 1,320/1,440-nm multiplex Nd:YAG fractional laser (1,320-nm average fluence 8.4+/-0.4 J/cm(2); 1,440-nm average fluence 2.3+/-0.2 J/cm(2)). Outcomes were assessed by subjects and the treating physician using a quartile scale to evaluate skin tightening, surface texture, rhytids, dyschromia, erythema, and global appearance after 1, 3, and 6 months. Retroauricular punch biopsies from three patients were used to evaluate wound healing. Three patients withdrew from the study prior to evaluation, one missed the 1-month evaluation, and one missed the 6-month evaluation.
Assessment by subjects and the treating physician revealed clinical improvement for all outcomes after 1, 3, and 6 months. The differences between the treatment groups were not statistically significant. Subjects demonstrated the greatest average 6-month improvements in surface texture and global skin appearance. Subjects treated with the multiplex laser reported more skin tightening than the group treated only with the 1,440-nm laser. Histological evaluation revealed wound healing within 10 days and significant neocollagenesis at 3 months. No adverse events were reported in any subject.
The 1,440-nm Nd:YAG and 1,320/1,440-nm multiplex Nd:YAG lasers safely and effectively produced improved surface texture, rhytids, dyschromia, erythema, global skin appearance, and skin tightening. Histopathologic findings correlated with clinical observations.
非剥脱性分次激光在改善光老化皮肤方面已得到广泛认可。我们之前曾报道，单独使用1440纳米钕钇铝石榴石（Nd:YAG）激光能量或联合1320纳米激光进行嫩肤和减少皱纹治疗后，短期随访结果良好。我们现在报告更长时间的随访数据。
研究设计/材料与方法：19名白种人受试者（平均年龄47±8.4岁；范围33 - 62岁），面部和颈部呈现轻度至中度光老化，接受了4次1440纳米Nd:YAG分次激光（平均能量密度3.7±0.3 J/cm²）或1320/1440纳米多波长Nd:YAG分次激光（1320纳米平均能量密度8.4±0.4 J/cm²；1440纳米平均能量密度2.3±0.2 J/cm²）治疗（平均间隔18.1±4.1天；范围11 - 37天）。在1、3和6个月后，由受试者和治疗医生使用四分位量表评估皮肤紧致度、表面质地、皱纹、色素沉着、红斑和整体外观等结果。取3名患者耳后打孔活检组织评估伤口愈合情况。3名患者在评估前退出研究，1名错过1个月评估，1名错过6个月评估。
受试者和治疗医生的评估显示，在1、3和6个月后所有评估指标均有临床改善。治疗组之间的差异无统计学意义。受试者在6个月时表面质地和整体皮肤外观的平均改善最为显著。接受多波长激光治疗的受试者报告皮肤紧致度改善比仅接受1440纳米激光治疗的组更明显。组织学评估显示10天内伤口愈合，3个月时有明显的新胶原形成。所有受试者均未报告不良事件。
1440纳米Nd:YAG激光和1320/1440纳米多波长Nd:YAG激光安全有效地改善了皮肤表面质地、皱纹、色素沉着、红斑、整体皮肤外观和皮肤紧致度。组织病理学结果与临床观察结果相关。
