An Innovative Device for Fractional CO2 Laser Resurfacing:Medical fiber Application

Keywords:medical, fibers, application,  Time:25-02-2016

The lesser depth of immediate tissue necrosis, in comparison with the mid-infrared wavelengths, together with the possibility of further heat deposition in the dermis, significantly reduces the pain caused by the procedure without decreasing its efficacy. A new CO2 laser medical fibers (10600 nm, Active FX, Lumenis Inc., Yokneam,Israel) with less penetration was shown to be more tolerable, but the 1.3-mm spot still makes some local anesthesia and\or cooling necessary. The spot distribution is uniform as with the mid-infrared devices. A more recent CO2 laser system (Slim Evolution, Lasering, Modena, Italy) with a microspot system (300 l) fractional modality (Mixto SX) has been developed with a new scanning algorithm that keeps the longest possible interval between 2 adjacent spots, in order to minimize the heat accumulation around the treated areas. This is supposed to significantly reduce the pain during the procedure. An overview of the characteristics of several fractional devices is shown in Table 1.

Objective A new CO2 laser system (Slim Evolution, Lasering) with a unique fractional modality (Mixto SX) added to a high-speed scanner was tested as a tool for skin rejuvenation. It will be tested to evaluate its efficacy and tolerability as a tool for skin rejuvenation without any form of anesthesia or cooling.

Materials and Methods The Mixto SX system (Lasering) is a fractional CO2 laser equipped with a new generation computerized pattern generator. Its recently developed algorithm allows the 300-lm beam to be delivered at intervals that greatly increase its tolerability. The pattern results in a precise beam delivery over the treated area. The operator can choose to be selectively more aggressive in treating areas that are particularly scarred or sundamaged areas as needed. The laser can perform traditional and fractional resurfacing at depths ranging from 20 to 500 lm, treating 20% or 100% of the scanned area. The traditional single beam is also available for vaporizing solid lesions or cutting purposes. A series of 24 consecutive patients (Fitzpatrick skin types II–IV) were treated with one pass of the aforementioned fractional CO2 laser (11 faces, 5 necks, 8 hands). No anesthesia or skin cooling were used. The power used was between 8 and 10 W, with SX index values of 6 to 8, according to the indication and to patient tolerance. A single pass was done over the whole area. Postoperative management included a thermal waterbased cream (Cicalfate, Ave`ne, France) and makeup provided free of charge. Pain tolerance was measured with a 0–5 score (Table 2). Digital clinical microphotography was used before and 3 months after laser fibers treatment. An independent evaluator assessed the results according to the scale shown in Table 3. All patients completed satisfaction questionnaires stating how strongly they would recommend the treatment to their friends. To eliminate the bias in satisfaction questionnaires (Table 4) all patients were charged for the treatments.

Results

All patients showed significant improvement in skin texture and color after one treatment. All patients tolerated the treatment sessions. The mean pain score was 1.8 (a score of 2 5 easily tolerated). The average improvement score given by the independent evaluator was 3.83. Postoperative undesired effects were immediate erythema and swelling that subsided within 24 hours.