Currently, the devices which are available in the field of nonablative resurfacing can be divided into two main types: those with a vascular target that initiate a cascade of events by wounding dermal microvasculature and those that target water to deposit heat into the dermis. The first group includes pulsed dye lasers (PDL) and intense pulsed light (IPL) sources, as well as one IPL device used in conjunction with radiofre-quency (RF) energy. The pulsed dye lasers are
in the 585- to 595-nm range and have pulse widths which vary from 350-450 ms to 1.5, 3, 6, 10, 20, and 40 ms. IPL sources utilize a broad band of light with cutoff filters in the 550- to 690-nm range which are used to eliminate the shorter, undesirable wavelengths. A recently developed device uses a combination of IPL and RF and has a similar cutoff filter-IPL system with the addition of up to 25 J/cm3 RF energy. The 1064-nm laser in the millisecond and microsecond domain has been used for nonablative rejuvenation as well. Finally, a combina-
Fig. 5.6. 48-year-old man with dermatosis papulosa nigra, photodamage and acne scarring, pre (a) and post (b) CO2 resurfacing
Fig. 5.6. 48-year-old man with dermatosis papulosa nigra, photodamage and acne scarring, pre (a) and post (b) CO2 resurfacing tion treatment with 1064-nm and 532-nm lasers has proven beneficial for fine lines and pigmentary and vascular changes.
There are several mid-infrared lasers that target water to effect dermal heat deposition. The 1320-nm Nd:YAG laser was the original system to use this approach in nonablative resurfacing in conjunction with a spray cooling device to protect the epidermis. Subsequently, the 1450-nm diode laser was shown to have even greater water absorption resulting in more superficial heat deposition. Most recently, the 1540-nm erbium:glass laser system, which has been more widely available in Europe, has emerged as an effective nonablative laser. These devices do not improve vascular or pigmentary changes. However, their histological and clinical improvement of wrinkles is well documented (Fournier et al. 2001; Goldberg et al. 2002; Hard-away 2002; Lupton 2002).
A unique high-powered monopolar RF device has recently been shown to deposit heat deeper in the dermis and possibly into subcutaneous tissue including fascia and fat. This effect can lead to more dramatic tissue tightening as well as traditional nonablative benefits. Additionally, acne scars as well as fine lines and surface changes have been noted to improve (Zelickson 2004).
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