Hsiao Francis C, Bock Gerald N, Eisen Daniel B
Department of Dermatology, University of California , Davis Medical Center, Sacramento, California.
California Skin and Laser Center , Stockton, California.
Adv Wound Care (New Rochelle). 2012 Oct;1(5):207-212. doi: 10.1089/wound.2011.0323.
Laser plays an increasingly prominent role in skin rejuvenation. The advent of fractional photothermolysis revolutionizes its application. Microcolumns of skin are focally injured, leaving intervening normal skin to facilitate rapid wound healing and orderly tissue remodeling.
Even with the popularity of fractional laser devices, we still have limited knowledge about the ideal treatment parameters and postlaser wound care.
BASIC/CLINICAL SCIENCE ADVANCES: Many clinicians believe that higher microbream energy in fractional laser devices results in better clinical outcome. Two recent studies argue against this assumption. One article demonstrates that lower fluence can induce comparable molecular changes with fewer side effects. Another study corroborates this by showing that lower-density settings produce similar clinical outcome in scar remodeling as higher-density ones, but with fewer side effects. To shed light on the optimal post-treatment wound care regimen from fractional ablative resurfacing, another paper shows that platelet-rich plasma (PRP) can reduce transepidermal water loss and skin color changes within 1 month after treatment.
For fractional nonablative resurfacing, lower settings in fluence or density may produce similar dermal remodeling as higher settings and with a better side-effect profile. Moreover, autologous PRP appears to expedite wound healing after fractional ablative resurfacing.
Lower microbeam energy in fractional laser resurfacing produces similar molecular changes and clinical outcome with fewer side effects. The findings might portend a shift in the paradigm of treatment parameters. Autologous PRP can facilitate better wound healing, albeit modestly. Long-term follow-ups and larger studies are necessary to confirm these findings.
激光在皮肤年轻化方面发挥着越来越重要的作用。点阵式光热解技术的出现彻底改变了其应用方式。皮肤微柱受到局部损伤，而其间的正常皮肤得以保留，从而促进伤口快速愈合和组织有序重塑。
尽管点阵激光设备广受欢迎，但我们对于理想的治疗参数和激光术后伤口护理的了解仍然有限。
基础/临床科学进展：许多临床医生认为，点阵激光设备中较高的微束能量会带来更好的临床效果。最近的两项研究对此假设提出了反对意见。一篇文章表明，较低的能量密度可诱导类似的分子变化，且副作用更少。另一项研究通过显示低密度设置在瘢痕重塑中产生的临床效果与高密度设置相似，但副作用更少，从而证实了这一点。为了阐明点阵剥脱性皮肤重建术后的最佳伤口护理方案，另一篇论文表明，富含血小板血浆（PRP）可在治疗后1个月内减少经表皮水分流失和皮肤颜色变化。
对于非剥脱性点阵皮肤重建，较低的能量密度设置可能与较高设置产生相似的真皮重塑效果，且副作用更小。此外，自体PRP似乎可加快点阵剥脱性皮肤重建术后的伤口愈合。
点阵激光皮肤重建中较低的微束能量可产生类似的分子变化和临床效果，且副作用更少。这些发现可能预示着治疗参数范式的转变。自体PRP虽作用有限，但可促进更好的伤口愈合。需要进行长期随访和更大规模的研究来证实这些发现。
