Results from ex vivo and in vivo studies combined with clinical outcomes indicate that new compression tip technology (XD Optic, Palomar Medical) is fulfilling its design objectives of safely enabling nonablative fractional treatment to increased tissue depth, according to research presented by Christine Dierickx, M.D., at the 30th annual meeting of the American Society for Laser Medicine and Surgery.
The advanced compression tip is available for use with both the Palomar Lux1540 and Lux1440 lasers. It consists of a sapphire crystal with an array of multiple optical pins and is used to press against the skin prior to delivery of the laser beam.
The compressive force displaces water and blood from underlying tissue, reduces tissue thickness and lowers the scattering of light in the skin by flattening collagen fibers. Together, these effects allow for deeper penetration of the delivered energy with increased safety."The physical effects of the compression result in preservation of the dermal-epidermal junction while enabling induction of high-aspect columns that allow increased dermal treatment volume over a given area of coverage," says Dr. Dierickx, director, Skin and Laser Centre, Boom, Belgium. "XD stands for extra deep, and our studies show this advanced compression tip technology is living up to its name, as it can deliver subablative dermal damage up to a depth of 2 mm with minimal side effects and less pain."
COMPRESSION, TRANSMITTANCE Describing the results from an in vivo study evaluating the effects of skin compression with the new tip on optical transmittance dynamics, Dr. Dierickx reported a rapid increase in transmission of light through the skin in the first seconds after compression relative to measurements made performing the same treatment without compression. Thereafter, there was further increase of light transmission due to the displacement of extracellular water.
"The findings of the study suggest that 3 to 5 seconds is the optimal compression time," Dr. Dierickx says.
The histological effects of treatment with the compression tip were determined in an ex vivo study in which Yucatan black porcine skin was treated with the 1,440 nm and 1,540 nm lasers with and without compression. The results indicated that treatment using the compression tip was associated with less damage to the dermal-epidermal junction, but increased depth of denatured collagen. Comparing treatments performed using various settings and the two lasers showed that the column depth could be increased to almost 2 mm when treatment was performed with pulse stacking and the longer wavelength device.
"The greater depth of penetration with the 1,540 nm laser can be explained by lower absorption of water of this wavelength," Dr. Dierickx says.
CLINICAL OUTCOMES Dr. Dierickx demonstrated clinical outcomes achieved using the compression tip in a series of pre- and post-treatment standardized photographs from cases encompassing various types of scars, such as hyperpigmented, hypertrophic and keloidal, as well as deeper periorbital rhytids and striae, and tightening of sagging/lax skin on the lower third of the face and the abdomen.
"The compression tip is intended for deep targeting in small treatment areas, but it can also be combined with traditional nonablative treatment in a larger procedure," she says.
Despite the increased treatment depth achieved using the compression tip, pain is minimal, because the compressive force blocks nerve conduction. Therefore, the procedures can be performed without anesthesia. Post-treatment morbidity is minimal, as well, Dr. Dierickx says.
"An imprint from the compression tip is seen on the skin immediately after the treatment, but dissipates within a few minutes, and there is also transient erythema, which persists for just a few hours. However, there is no crusting or oozing, and this procedure does not necessitate any downtime," Dr. Dierickx says. "Therefore, treatments with the compression tip targeting pathology and aging skin changes with deeper dermal components have no detrimental impact on a patient's social or professional life."