David E. Bank, M.D. Director, Center for Dermatology, Cosmetic and Laser Surgery Mt. Kisco, New York, USA

 

Abstract

Case history showing laser resurfacing with a specific method of pulsed dye laser with dynamic cooling.

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Introduction

Since the beginning of time, both men and women have strived to look younger. In the past 10 years, there have been multiple breakthroughs in the treatment of photo-aged skin, whose symptoms include pigmented lesions (both red and brown), wrinkles, and alterations of the skin’s texture.

During the 1980' and early 1990', the most commonly used rejuvenation method was laser resurfacing, archieved with CO₂ and/or erbium lasers. While this procedure did archieve a dramatic rejuvenation of the face (10+ years), the drawback was the post-treatment side effects and necessary downtime. Indeed, a full face resurfacing requires seven to 10 days of social eviction, and then up to three months of makeup to cover the excessive epidermal redness.

In more recent years, both physicians and patients have been searching for less aggressive ways of archieving facial rejuvenation. This interest in so-called nonablative skin rejuvenation has led to a variety of lasers being used for the reduction of wrinkles, including Nd:YAG lasers (1320 nm), diode lasers (1450 nm), and short-pulsed-dye lasers (585 nm). Longer pulsed-dye lasers, such as the Vbeam, offer an additional option for both physicians and their patients. Used at below-purpura thresholds, the Vbeam creates a small wound in the dermis, leading to an activation of collagen and thus to a reduction in wrinkle appearance. While the results are not as dramatic as those archieved with a laser resurfacing, this procedure is better accepted by patients due to the lack of side effects and necessary downtime.

 

Method

After signing an informed consent form for pulsed-dye laser treatment, patient were treated with the Vbeam at subpurpuric thresholds. In most cases, this involved the 10 ms pulse duration, the 10mm spot, and a fluence of 7,5 J/cm², with the DCD^TM setting of 30ms spray and 30 ms delay. In the case of the patient photographed, the DCD setting was set at 40 ms spray and 40 ms delay, due to her darker skin type (Type IV). The periocular area was treated as follows: three passes to paintbrush the area, once horizontally again. On average, the treatment involved multiple overlapping (approximately 30%). The number of pulses involved depended on the size of the area of involvement. Patients were treated a total number of one or two times on average, at six to 12 week intervals.

Nothing was used either pre- or post- treatment.

 

Results

According to both the patient and the physician, there was significant clinical improvement in all 50 patients treated.

Figure 1: Pre-treatment	Figure 2: After 8 months and 1 treatment

There was no post-operative purpura at the settings used. There were no side effects noted in any of these patients aside from rare anh short-lived (24 hours) edema.

 

Discussion

Rejuvenation of the skin is archievable by a number of treatments, including everything in between the extremes of topical creams and laser resurfacing.

Treatment with the Vbeam laser offers a particularly appealing compromise between therapeutic efficacy and lack of side effects. As per the photographs, the results are definitely apparent. And with no downtime, patients are able to go back to their responsibilities immediately after the treatment. The Vbeam has put the treatment of wrinkles in the “lunchtime treatment“ category, which represents a quantum jump in technology.

In addition, treatment of wrinkles with the Vbeam is an excellent option when more aggressive rejuvenation procedures are not recommended. In the case of the patient photographed here, her darker skin type (Type IV) and predisposition to melasma made the risk of pigmentary change following a laser resurfacing unacceptably high. The Vbeam procedure was both soft enough to cause no side effects and efficacious enough for the patient to be pleased with the results.