Introduction
Acne scars are a common problem that dermatologists are consulted on regularly. Numerous treatments have been used in the past with variable success. Treatment modalities typically include punch elevation, subcision, chemical peels, injection of permanent and temporary filler agents, ablative and non-ablative laser treatments and, more recently, fractional laser resurfacing.
The fractional technology used in this case was the Lux 1540 handpiece (Palomar Medical Technologies, Inc.), a non-ablative laser that delivers 1540-nm light in fractionated columns. This wavelength in the near-infrared region of the electromagnetic spectrum is preferentially absorbed by dermal water, resulting in discrete thermal zones of collagen coagulation and subsequent dermal remodeling with wound healing. Epidermal protection is afforded by contact cooling available on the 10-mm tip. This allows for deeper penetration of the laser beam without ablation of the superficial layers.
Treatment for Our Patient
This patient underwent three treatment sessions using the Lux 1540 fractional handpiece spaced 3 to 4 weeks apart. A 10-mm spot size, delivering 100 microbeams per cm2, was utilized with a pulse width of 15 ms and fluences ranging from 50 to 55 J/cm2.
Technique
With this procedure, topical anesthesia is not always necessary, but may be used if preferred by patients. In either case, we typically use a Cryo 5 (Zimmer Medizin Systeme) cooling device during the procedure to help with tolerability.
For those patients with a strong history of recurrent herpes labialis, we generally premedicate with oral anti-viral agents when treating the perioral skin. Prior to treatment, we have patients wash their faces to completely remove all makeup, moisturizers and sunscreen products. Subsequently, pre-procedure digital photographs are taken for documentation in order to facilitate evaluation of improvement over time. Tangential lighting can sometimes be utilized because the depth of acne scars may not be evident with conventional illumination.
Settings for this unit are generally determined based on the depth of the acne lesion, location and patient skin type. For skin types up to Fitzpatrick Skin Type IV, cheeks can generally be treated using settings of 45 to 60 mJ per microbeam. Thinner skin, such as on the neck, usually requires a reduction to 35 to 50 mJ, depending on the degree of individual patient discomfort. For darker skin types, we generally decrease the settings by 10% to 15%.
During treatment, the handpiece is brought into complete contact with the skin and a laser pulse is then delivered. Although pulse stacking should be avoided, treatment of the areas particularly affected by scarring is recommended prior to background treatment because the resulting swelling may diminish efficacy. Several passes, usually three to five, are delivered to each cosmetic unit before moving on to the next one. Treatment course typically consists of four to five sessions administered 3 to 6 weeks apart.
Post-procedure skin care generally consists of moisturizers and sunscreen, while makeup is usually not applied until the day following the treatment. Patients should expect mild to moderate swelling and a varying amount of erythema. These issues typically resolve by 2 to 3 days post-treatment. Blistering is uncommon and may be related to pulse stacking or excessive fluences.
Tips
1. Adjust fluence according to treatment location and patient comfort level.
2. Complete multiple passes over a cosmetic unit before moving on to the next one.
3. For some patients with extensive lentigines, we often will perform pulsed light or alexandrite laser treatments on the same day but prior to the fractional resurfacing, so that the lesions are not obscured by the post-fractional erythema.
4. For patients desiring botulinum toxin type A therapy, injections are generally scheduled for another day out of theoretic concern that migration of the neurotoxin may be induced by the post-resurfacing swelling.
5. Patients should be clearly advised that the process of dermal remodeling and subsequent improvement in acne scars is gradual and will continue for several months after the completion of the treatment course.
6. Traditional modalities, such as subcision and/or filler agents, can have a synergistic effect and may still be useful on residual or recalcitrant scars.
Points to Remember
Fractional non-ablative resurfacing is a promising novel approach to treating acne scars. Although good to very good results may be obtained with this type of technology, future studies, especially in skin of color, will be important to determine its most predictable efficacy, settings and number of treatment sessions.
Introduction
Acne scars are a common problem that dermatologists are consulted on regularly. Numerous treatments have been used in the past with variable success. Treatment modalities typically include punch elevation, subcision, chemical peels, injection of permanent and temporary filler agents, ablative and non-ablative laser treatments and, more recently, fractional laser resurfacing.
The fractional technology used in this case was the Lux 1540 handpiece (Palomar Medical Technologies, Inc.), a non-ablative laser that delivers 1540-nm light in fractionated columns. This wavelength in the near-infrared region of the electromagnetic spectrum is preferentially absorbed by dermal water, resulting in discrete thermal zones of collagen coagulation and subsequent dermal remodeling with wound healing. Epidermal protection is afforded by contact cooling available on the 10-mm tip. This allows for deeper penetration of the laser beam without ablation of the superficial layers.
Treatment for Our Patient
This patient underwent three treatment sessions using the Lux 1540 fractional handpiece spaced 3 to 4 weeks apart. A 10-mm spot size, delivering 100 microbeams per cm2, was utilized with a pulse width of 15 ms and fluences ranging from 50 to 55 J/cm2.
Technique
With this procedure, topical anesthesia is not always necessary, but may be used if preferred by patients. In either case, we typically use a Cryo 5 (Zimmer Medizin Systeme) cooling device during the procedure to help with tolerability.
For those patients with a strong history of recurrent herpes labialis, we generally premedicate with oral anti-viral agents when treating the perioral skin. Prior to treatment, we have patients wash their faces to completely remove all makeup, moisturizers and sunscreen products. Subsequently, pre-procedure digital photographs are taken for documentation in order to facilitate evaluation of improvement over time. Tangential lighting can sometimes be utilized because the depth of acne scars may not be evident with conventional illumination.
Settings for this unit are generally determined based on the depth of the acne lesion, location and patient skin type. For skin types up to Fitzpatrick Skin Type IV, cheeks can generally be treated using settings of 45 to 60 mJ per microbeam. Thinner skin, such as on the neck, usually requires a reduction to 35 to 50 mJ, depending on the degree of individual patient discomfort. For darker skin types, we generally decrease the settings by 10% to 15%.
During treatment, the handpiece is brought into complete contact with the skin and a laser pulse is then delivered. Although pulse stacking should be avoided, treatment of the areas particularly affected by scarring is recommended prior to background treatment because the resulting swelling may diminish efficacy. Several passes, usually three to five, are delivered to each cosmetic unit before moving on to the next one. Treatment course typically consists of four to five sessions administered 3 to 6 weeks apart.
Post-procedure skin care generally consists of moisturizers and sunscreen, while makeup is usually not applied until the day following the treatment. Patients should expect mild to moderate swelling and a varying amount of erythema. These issues typically resolve by 2 to 3 days post-treatment. Blistering is uncommon and may be related to pulse stacking or excessive fluences.
Tips
1. Adjust fluence according to treatment location and patient comfort level.
2. Complete multiple passes over a cosmetic unit before moving on to the next one.
3. For some patients with extensive lentigines, we often will perform pulsed light or alexandrite laser treatments on the same day but prior to the fractional resurfacing, so that the lesions are not obscured by the post-fractional erythema.
4. For patients desiring botulinum toxin type A therapy, injections are generally scheduled for another day out of theoretic concern that migration of the neurotoxin may be induced by the post-resurfacing swelling.
5. Patients should be clearly advised that the process of dermal remodeling and subsequent improvement in acne scars is gradual and will continue for several months after the completion of the treatment course.
6. Traditional modalities, such as subcision and/or filler agents, can have a synergistic effect and may still be useful on residual or recalcitrant scars.
Points to Remember
Fractional non-ablative resurfacing is a promising novel approach to treating acne scars. Although good to very good results may be obtained with this type of technology, future studies, especially in skin of color, will be important to determine its most predictable efficacy, settings and number of treatment sessions.
Introduction
Acne scars are a common problem that dermatologists are consulted on regularly. Numerous treatments have been used in the past with variable success. Treatment modalities typically include punch elevation, subcision, chemical peels, injection of permanent and temporary filler agents, ablative and non-ablative laser treatments and, more recently, fractional laser resurfacing.
The fractional technology used in this case was the Lux 1540 handpiece (Palomar Medical Technologies, Inc.), a non-ablative laser that delivers 1540-nm light in fractionated columns. This wavelength in the near-infrared region of the electromagnetic spectrum is preferentially absorbed by dermal water, resulting in discrete thermal zones of collagen coagulation and subsequent dermal remodeling with wound healing. Epidermal protection is afforded by contact cooling available on the 10-mm tip. This allows for deeper penetration of the laser beam without ablation of the superficial layers.
Treatment for Our Patient
This patient underwent three treatment sessions using the Lux 1540 fractional handpiece spaced 3 to 4 weeks apart. A 10-mm spot size, delivering 100 microbeams per cm2, was utilized with a pulse width of 15 ms and fluences ranging from 50 to 55 J/cm2.
Technique
With this procedure, topical anesthesia is not always necessary, but may be used if preferred by patients. In either case, we typically use a Cryo 5 (Zimmer Medizin Systeme) cooling device during the procedure to help with tolerability.
For those patients with a strong history of recurrent herpes labialis, we generally premedicate with oral anti-viral agents when treating the perioral skin. Prior to treatment, we have patients wash their faces to completely remove all makeup, moisturizers and sunscreen products. Subsequently, pre-procedure digital photographs are taken for documentation in order to facilitate evaluation of improvement over time. Tangential lighting can sometimes be utilized because the depth of acne scars may not be evident with conventional illumination.
Settings for this unit are generally determined based on the depth of the acne lesion, location and patient skin type. For skin types up to Fitzpatrick Skin Type IV, cheeks can generally be treated using settings of 45 to 60 mJ per microbeam. Thinner skin, such as on the neck, usually requires a reduction to 35 to 50 mJ, depending on the degree of individual patient discomfort. For darker skin types, we generally decrease the settings by 10% to 15%.
During treatment, the handpiece is brought into complete contact with the skin and a laser pulse is then delivered. Although pulse stacking should be avoided, treatment of the areas particularly affected by scarring is recommended prior to background treatment because the resulting swelling may diminish efficacy. Several passes, usually three to five, are delivered to each cosmetic unit before moving on to the next one. Treatment course typically consists of four to five sessions administered 3 to 6 weeks apart.
Post-procedure skin care generally consists of moisturizers and sunscreen, while makeup is usually not applied until the day following the treatment. Patients should expect mild to moderate swelling and a varying amount of erythema. These issues typically resolve by 2 to 3 days post-treatment. Blistering is uncommon and may be related to pulse stacking or excessive fluences.
Tips
1. Adjust fluence according to treatment location and patient comfort level.
2. Complete multiple passes over a cosmetic unit before moving on to the next one.
3. For some patients with extensive lentigines, we often will perform pulsed light or alexandrite laser treatments on the same day but prior to the fractional resurfacing, so that the lesions are not obscured by the post-fractional erythema.
4. For patients desiring botulinum toxin type A therapy, injections are generally scheduled for another day out of theoretic concern that migration of the neurotoxin may be induced by the post-resurfacing swelling.
5. Patients should be clearly advised that the process of dermal remodeling and subsequent improvement in acne scars is gradual and will continue for several months after the completion of the treatment course.
6. Traditional modalities, such as subcision and/or filler agents, can have a synergistic effect and may still be useful on residual or recalcitrant scars.
Points to Remember
Fractional non-ablative resurfacing is a promising novel approach to treating acne scars. Although good to very good results may be obtained with this type of technology, future studies, especially in skin of color, will be important to determine its most predictable efficacy, settings and number of treatment sessions.
