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Erbium:YAG laser skin ablation shows promise in wound healing

Paris — Laser technology can be used not only to rejuvenate skin to eliminate wrinkles, but it also has shown promise in animal studies as a means of promoting wound healing, according to research presented at the International Academy of Cosmetic Dermatology here.

"The laser (erbium:yttrium-aluminum-garnet) allows us to eliminate the epidermis, but not the dermis," explains Jean-Michel Lagarde, a physicist-engineer and head of the skin imaging and bioengineering unit at the Pierre-Fabre Institute.

"This technique is less invasive than using conventional suture. There are very few techniques available to study the cicatrisation or reconstruction of the skin."

He and fellow researchers have completed the first year of a three-year study looking at the use of the 2,940 nm erbium:YAG laser for skin ablation and wound healing. Mr. Lagarde says the technology would permit the clinician greater control of the wound's depth than would a suction blister.

"We can perform ablation of the epidermis with very good control," Mr. Lagarde tells Cosmetic Surgery Times.

"The suction blister is not a very precise method to standardize the depth of the wound and the surface of it. It's also important that the technique that we use does not provoke inflammation. Because the laser is employed very quickly, that minimizes the risk of inflammation. If the dermis is affected, this may aggravate the wound."

Nonablative remodeling

Mr. Lagarde and colleagues published a study in the Journal of Cosmetic Laser Therapy in 2004 which looked at the long-term benefits of nonablative remodeling using a 1,540 nm erbium glass laser to eliminate perioral and periorbital wrinkles. The role of maintenance treatments was also investigated.

The study of 11 patients found the percentage of anisotropy reduction, meaning an increase in skin's smoothness and firmness, was 41 percent at six months, 52 percent at 14 months and 30 percent at 35 months. No adverse events were reported. Patient satisfaction was high. Researchers concluded that treatment of wrinkles with the nonablative 1,540 nm erbium glass laser system can produce benefits that last more than two years.

Scar treatment

One study that looked at the use of the erbium:YAG laser to treat scars found that in a series of 78 patients, there was a reported 70 percent to 90 percent improvement in acne scarring.

In 2004, more than 164,450 laser-resurfacing procedures were performed by plastic surgeons, a 4 percent increase over the number performed in 2000.

Serge Mordon, Ph.D., a co-investigator with Mr. Lagarde, conducted earlier research in wound healing in 25 rats using the 815 nm diode laser system. Laser-assisted skin closure (LASC) was found to be four times faster to process than conventional suture. The scar that resulted in subjects where LASC was employed was less discernible than in wounds where the conventional suture was employed.

Conventional suture carries limitations such as inflammatory body reaction and hypertrophic scars, according to Dr. Mordon, a biophysicist who acts as research director at INSERM (the French National Institute for Health and Medical Research) in France.

Knowledge is key

Dr. Mordon says knowledge of the biological process in wound closure is key in developing accelerated healing of wounds and minimizing the resulting scar. Laser irradiation appears to modify the growth factor synthesis.

"We need to better understand the nerve growth factors that are involved in the process," Dr. Mordon says.

"We know that we want to decrease the amount of TGF-beta 1 and increase the amount of TGF-beta 3 in the healing process. We also know that we want to stimulate fibroblasts so that new collagen develops."

Advances in laser technology reduce the possibility of thermal damage and burn injury, Dr. Mordon notes. Indeed, the initial studies using lasers for skin welding resulted in thermal damage and detracted from effective wound healing.

Not contraindicated

Dr. Mordon adds that the use of the laser for wound healing is not contraindicated in any potential patient.


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