12/7/2014. Dr.Mohammad Alshami associate professor of dermatology Sana a university Yemen

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1 Dr.Mohammad Alshami associate professor of dermatology Sana a university Yemen 1

2 2

3 Types of resurfacing lasers A. Classical ablative lasers -CO nm -Erbium-YAG 2400nm B. Non ablative lasers -Nd-YAG 1064nm Background Carbon dioxide (CO2) and erbium yttrium aluminum garnet (ErYAG)lasers are the gold standards in ablative skin resurfacing. Neodymium-doped yttrium aluminum garnet (Nd-YAG) laser is considered a nonablative skin resurfacing laser whose usage is limited due to its high cost. 3

4 Aim To assess the efficacy and safety of Nd-YAG as an ablative resurfacing laser. To compare the results with those previously published for CO2 and Erbium-YAG lasers. Patients/Methods A total of 296 patients (251 female and 45 male) with Fitzpatrick skin types III-IV and dermatological conditions amenable to ablative skin resurfacing participated in this study. 4

5 Patients/Methods Nd-YAG laser parameters assessed were wavelength (1064 nm), pulse duration (5 ms), fluence (10 J/cm2), and spot size (8 10 mm). Efficacy of Nd-YAG laser was assessed by comparing pre- and posttreatment photographs. Results An improvement of 30 80% was observed in treated patients. The degree of improvement correlated positively with the number of laser sessions. 5

6 Results The most common side effect was hyperpigmentation. Other side effects were less common and mild in intensity compared with published results for gold standard ablative lasers. Conclusion Nd-YAG laser wasfound to be as effective as Er-YAG and CO2 lasers. Treated patients also had shorter recovery and treatment times, and at lower cost. 6

7 Is used mainly for hair removal in dark skinned individuals, because it is poorly absorbed by melanin, and therefor can penetrate deep to the hair follicles. Nd-YAG 1064nmLASER It is also used for treatment of leg veins, and as a Nonablative resurfacing tool for treatment of acne scars. 7

8 Nd-YAG 1064nmLASER Black colored ink can absorb all wavelengths including 1064 Nd-YAG. Table 1: Frequency of skin conditions among the different treatment groups. Male(n) Female(n) Total (n) Total(%) scars dyspigmentation Acne Dermal atrophy Benign growth others Surface irregularity total

9 Table 2: Extent of improvement (number and percentage of patients) among subjects with different skin conditions. Acne scars Wrinkles Striae Acne P.B. Scars Trichostasis spinolusa Enlarged pores Slight improvement (0 25%) 20 (33%) 6 (29%) 6 (55%) 4 (13%) 16 (42%) 0 0 Moderate improvement (26 50%) Marked improvement (51 75%) Excellent improvement (>75%) Total 20 (33%) 5 (24%) 2 (18%) 10 (31%) 10 (26%) (18%) 5 (24%) 2 (18%) 4 (13%) 6 (16%) 2 (22%) 5 (71%) 10 (16%) 5 (24%) 1 (9%) 4 (13%) 6 (16%) 7 (78%) 2 (29%) Table 3: Correlation of number of the Nd-YAG laser treatment sessions on extent of improvement in skin conditions of male and female patients, as determined by Pearson s correlation test Group male female total % Overall improvement (%) I (one treatment) 18 (16.7%) 90 (83.3%) % 15 30% II (3 treatments) 15 (15.2%) 84 (84.8%) % 40 60% III (5 treatments) 12 (13.5%) 77 (86.5%) % 65 85% 9

10 Table 4: Interaction between patients level of satisfaction and number of the neodymium-doped yttrium aluminum garnet laser treatment sessions. Grade of satisfaction Group I Group II Group III 0 (Not satisfied) 0% 0% 0% I (Slightly satisfied) 80% 20% 0% II (Satisfied) 20% 60% 40% III (Very satisfied) 0% 20% 40% IV (extremely satisfied) 0% 0% 20% Table 5: Frequency of side effects observed after neodymium-doped yttrium aluminum garnet laser treatments. Side effect Count % Post inflammatory hyperpigmentation % Acneiform eruption % Secondary bacterial infections 6 2% Herpes simplex reactivation 2 0.6% Scarring 1 0.3% Total 39 13% 10

11 The treatment stages of the novel method: (a) skin before laser treatment, (b) skin after applying black-colored film, (c) immediately after Nd-YAG laser treatment, and (d) 7 days after the procedure, showing the difference between treated youthful skin and nontreated dull skin Postoperative changes of acne scars prior to treatment (a), after applying the fusidic acid/betamethasone cream (b), and 4 days after the procedure (c). The pink skin with the adherent crusts represents the dead ablated epidermis. The enlarged pores are markedly reduced. 11

12 Ice pick acne scars and periocular rhytids prior to treatment (a), immediately after the Nd-YAG laser treatment (b), and 7 weeks after one treatment session (c). The acne scars and the rhytids are markedly reduced. Rolling acne scars on the face of a 20-year-old female patient prior to treatment (a), 6 weeks after one session of Nd-YAG laser treatment and flattened scars (b). 12

13 Moderate striae on the abdomen of a 30-year-old female patient (a) prior to treatment, (b) 2 weeks after one treatment session,and (c) 3 days after 2 treatment sessions. The striae are diminished and the skin is tightened Steroid-induced severe striae on the abdomen of a 20-year-old female patient (a) prior to treatment and (b) 5 months after 5 treatment sessions. The size of the striae is definitely reduced and the color is improved. 13

14 Depth of the epidermal ablation, along with the residual thermal effects created by the Nd-YAG laser on a skin punch biopsy taken from the preauricular area of a 30-year-old female patient with acne scars. (a) Prior to treatment and (b) immediately after the Nd-YAG laser treatment with the epidermis almost completely ablated. The basal cells are necrotic and swollen at many places of the biopsy section, and the papillary dermis shows mild necrosis as a result of the residual thermal effect. H&E stain 40 (a) and 100 (b). 14

15 THANK YOU 15

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