In his quest to find the optimal skin resurfacing device and post-treatment regimen for patients, Las Vegas, Nev., facial plastic and cosmetic surgeon Robert J. Troell, M.D., studied more than 250 patients over 10 years. He shared some of his findings yesterday at the American Academy of Cosmetic Surgery’s (AACS’s) 2017 annual scientific meeting in San Diego, Calif.
During his presentation, “Fractional CO2 Laser Skin Resurfacing: Treatment Results Comparing Platelet Rich Plasma and Alastin to Standard Post-Treatment," Dr. Troell compared devices and tested posttreatments to answer burning questions about what works best. These are the questions he asked and answered. Also, don't miss the Laser Skin Resurfacting Treatment Protocol he provided.
Q: What energy-based system is best in treating facial wrinkles and acne scarring?
A: CO2 laser
“I have compared radiofrequency devices, fractional erbium-YAG lasers and carbon dioxide (CO2) lasers for wrinkle and acne scarring treatment. These procedures were performed alone or adding topical platelet-rich plasma (also adding dermal needling with radiofrequency),” he says. “The carbon dioxide laser outcomes were superior for wrinkle and acne scarring indications.”
Dr. Troell cites this study, published 2009 in the Journal of Drugs in Dermatology (JDD), which helps to confirm the superior results with the CO2 laser.
“[Waibel J, Beer K, Naruker V, Alster T] showed that an Erbium:YAG laser (2940 nm wavelength) is superior for improving hyperpigmentation and revealed that the Erbium:YAG and carbon dioxide lasers are comparable regarding improving texture and skin tightening,” he says.
However, Dr. Troell says, he has found that in patients with Fitzpatrick classification V and VII skin types, the preferred options were radiofrequency devices, such a Venus Viva [Venus Concept], Matrix RF [Syneron] or Fractora [Invasix], to minimize the risk of post-treatment hyperpigmentation.
Q: Does the specific CO2 laser produced by different manufacturers make a difference?
“DEKA [Implant Direct], Equinox [Eclipse Aesthetics] and Lutronic [Lutronic Aesthetics] CO2 lasers were compared concerning aesthetic outcome, length and severity of recovery and discomfort during treatment,” Dr. Troell says. “The DEKA laser revealed less discomfort during the treatment, more rapid recovery and better aesthetic overall results. All these study variables were followed by the Equinox and lastly the Lutronic CO2 laser.”
The JDD study confirms the DEKA laser’s superiority for texture, rhytid improvement and overall appearance, over the other studied CO2 and Erbium:YAG lasers, according to Dr. Troell.
Q: Does topical PRP application immediately post-laser treatment alter the studied variables?
PRP post-laser treatment shortened the duration and severity of erythema during recovery, resulted in less (observed) hyperpigmentation and improved subjective and objective aesthetic outcomes, according to Dr. Troell.
“The objective outcomes were assessed by using Enhanced Image Pro system. It revealed 10% to 15% less wrinkles, compared to conventional post-treatment occlusive treatments and moisturizers alone,” Dr. Troell says.
He cites this study published in April 2011 in Dermatologic Surgery, which showed PRP applied on one arm but not the other after carbon dioxide lase treatment resulted in faster recovery, less erythema index, less melanin index (hyperpigmentation), as well as induced angiogenesis and increased collagen production by biopsies.
Q: Is there any benefit to adding Alastin (Alastin Skincare), as an extracellular matrix modulator, to the PRP and post-treatment skincare regimen after CO2 laser skin resurfacing?
“The addition of autologous platelet rich plasma (PRP) along with the Alastin tripeptide and hexapeptide extracellular matrix modulator system shortens the severity and length of the recovery period, lowers the incidence of hyperpigmentation, and improves the overall post-treatment result, Dr. Troell says. “The Alastin Skin Nectar is a unique product of an anhydrous formulation of a tripeptide and hexapeptide, with histological demonstration of [extracellular matrix] recycling with increased production of elastin and collagen.”
The addition of human stem cell protein cytokines (Stemulation Facial Serum by Stemulation or Regenica Dual Serum by Suneva Medical) appears to further hasten healing and yield improved aesthetic outcomes, he says, but further testing is needed.
“…we do not currently have enough patient numbers, length of time post-treatment, and objective testing to determine the amount and type of improvement using human stem cell protein cytokines topically after energy-based systems treatment,” he says.