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Evaluation of the Aura 532nm laser and the Lyra
1064nm laser for non-invasive skin rejuvenation and
Min-Wei Christine Lee, M. D., M. P. H.
Director, The East Bay Laser & Skin Care CenterWalnut Creek, California Background
Non-invasive techniques for skin rejuvenation are being quickly established as a new standard in the treatment of mild rhytids and
overall skin toning. Multiple laser wavelengths and modalities have been tried for this procedure with varying degrees of success.
These lasers include 532nm, 585nm, 1064nm and 1320nm wavelengths.
The goal of this clinical trial was to evaluate a long pulse KTP laser and a long pulse Nd:YAG laser both separately and combined,
for non-invasive skin rejuvenation and toning and to establish efficacy and degree of success.
A total of 150 patients were treated with the Aura and the Lyra lasers both separately and combined. Patients included skin types I
through IV. The fluences varied between 7 and 15 J/cm2 at 7 to 20 msec pulse duration with a 2mm handpiece and 6 to 9 J/cm2
and 30 msec with a 4mm handpiece for KTP. The Lyra fluences were set at 24 J/cm2 for a 10mm handpiece and 30 J/cm2 for a
SmartScan Plus scanner. These energies were delivered at 30 msec pulse durations. All subjects were treated at least 3 times and
at most 6 times and were observed between 3 and 6 months following the last treatment.
All 150 patients exhibited a mild to moderate degree of improvement in the appearance of rhytids, moderate degree of
improvement in skin toning and texture and great improvement in redness and pigmentation at the last follow-up observation.
varies as well and is intricately dependent onthe Laser skin resurfacing procedures are divided into aggressiveness of the treatment. The healing two categories – invasive and non-invasive.
process triggered by the amount of injuryinflicted results in remodeled smoother collagen Invasive procedures are being done with laser and a newer, rejuvenated epidermis. The major wavelengths whose primary chromophore is water drawback of the invasive procedure is a long Erbium:Yittrium-Aluminum-Garnet (Er:YAG @ anywhere between 2 weeks and 2 months. In 2940nm). Since human skin consists of 70% spite of the great results, the number of invasive water, laser energy applied to the skin immediately skin resurfacing procedures have dropped in the vaporizes the epidermis and papillary dermis.
procedures in 1996 to 33% in 1998 according to duration (microseconds vs. several milliseconds), amount of applied energy and number of passes,the depth of penetration and consecutive thermal An Erbium:YAG laser procedure may also be damage into the dermis vary. The final result performed in a much lighter technique. Theshallow tissue penetration and very low applied to the skin simply slough off the stratum Materials and Methods
corneum inflicting no additional damage to therest of the epidermis or dermis. Certain new The lasers used for these procedures were the Aura generation Er:YAG lasers can achieve similar from Laserscope (San Jose, CA). A total of 150 Er:YAG lasers, however, are capable of only very patients were treated and the group was divided superficial laser abrasion. It has typically been used into equal parts, where 50 patients were treated to achieve a more even look of the skin with with the 532nm alone, 50 patients were treated correction of fine wrinkles in younger patients.
with 1064nm alone, and 50 patients were treatedwith both lasers together. Patients of Fitzpatrick Non-invasive procedures also inflict thermal skin types I through IV were enrolled in this damage to the papillary dermis; however, the evaluation for the first and third groups and I mechanism involves the laser passing through the through V for the second group. The limitation in epidermis without any significant or damagingimpact, with energy deposition in the lower layersof dermis. Wavelengths utilized for this procedureinclude those whose main chromophore is water(Nd:YAG @ 1320nm), hemoglobin (KTP @532nm, Dye @ 585nm), and oxyhemoglobin(Nd:YAG @ 1064nm) but whose depth ofpenetration is much deeper than that of either CO2or Er:YAG. In addition to the depth of penetrationdifference, the upper layers of skin are generallyprotected with superficial cooling. Each laser hasits own modality and its own method of applicationbut, as stated above, the general idea is to impactthe lower layers of skin inducing injury and thusencouraging the healing process of the collagen, The ultimate solution for this treatment is yet to befound. Although the non-invasive treatments do nothave the downtime of the invasive technique, theyare not as effective either. The main drawbacksinclude multiple treatments, comparatively minorimprovement of wrinkles and overall skin quality.
The goal of this study was to evaluate two differentwavelengths for non-invasive skin rejuvenation,both separately and in combination and compare all Typical result following just one treatment three types of treatments. The theory behind usingtwo wavelengths is to insure both epidermal qualitychanges as well as the changes to papillary dermal skin types in the first and third groups was collagen. In order to achieve this, shorter (532nm) mainly due to the KTP laser, which is well and longer (1064nm) wavelengths were utilized.
absorbed in melanin and cannot be used in darkerskin types. The longer wavelength – Nd:YAG –alone could safely be applied to skin types V andVI.
There were three to six treatments applied in treated with the SmartScan Plus scanner which each group with 4-6 weeks between individual is based on a 5mm spot applied to the skin in a zigzag manner. The laser was set at 30 msec based on the patient satisfaction level. All and 30 J/cm2. The laser energy was deposited patients were asked to fill out a ‘Severity through a contact cooling window set at 5°C.
rhytids, skin tone/tightness, texture and patient available and the rest of the patients received satisfaction were noted before the treatment delivering 30 msec and 24 J/cm2. Both the pigmentation and rhytids were also evaluated scanner and the handpiece were used over the using the same scale by the physician and entire face in a “brush stroke” manner.
The third group was treated with the The first group of patients treated with the combination of the two lasers. This group KTP laser alone was first evaluated for sun included 25 patients of skin types I and II and damage, telangiectatic vessels and other skin 25 patients of skin types III and IV. Patients inconsistencies. There were 25 patients with with skin type V or VI were excluded. First skin types I and II and 25 patients with skin all patients were treated with KTP exactly per types III and IV. The laser was first used for the protocol of the first group, immediately “clearing up the skin”, i.e., erasing any described in the protocol for the second group.
telangiectasias, using a 2mm handpiece. Thelaser parameters were set at 15-20 msec and10-15 J/cm2 for telangiectasia and 7-10 msec and 7-10 J/cm2 for lentigos. Once individualdiscolorations were cleared to satisfaction, a All patients filled out the “Severity Scale” 4mm handpiece with contact cooling was used form where on a scale of 0 to 10 they had to at 30 msec and 6-9 J/cm2 in a “brushing” or evaluate redness, pigmentation, rhytids, skin “sweeping” manner over the entire face. This tone/tightening, skin texture and overall was done to even out the skin color of the patient satisfaction before the first treatment and at the 3-6 months follow up after the final treatment Elocon ointment was applied to the treated areas followed by ice packs placed onthese areas for 15 to 20 minutes.
The results for the first group were as follows: The final follow up took place at 3 monthsfollowing the last treatment. Several patients First Group Average improvement (%)
The second group of patients was treated with discolorations and were mainly interested in included 25 patients of skin types I and II, 20 patients of skin types III and IV, and 5 patients of skin type V. The first several patients were Patients treated with KTP had minimal erythemaand scabbing of lentigos, which sloughed offafter 5 days. These patients could wear make upimmediately after treatments.
The results for the second group are depicted loss of telangiectatic vessels. However, it is rather obvious that the application of thelonger wavelength brought its benefits as well Second Group Average Improvement (%)
as it increased skin tightening and improvedtoning and appearance of mild rhytids.
Although this treatment has not yet overcome one of the drawbacks of non-invasive skin rejuvenation – multiple treatments – the impressive. Both lasers could be used for this procedure separately, however, much moreimpressive results were observed with thecombination treatment. It was also very The results for the third group are exhibited in impressive to have observed no side effects or discomfort during or after any of thetreatments, except for minor erythema andsloughing off of lentigos after KTP treatment.
Third Group Average Im provem ent (%)
Longer follow up will be needed to observe any additional changes to the skin and any studies will need to be done to confirm the References
Goldberg DJ. Non-ablative subsurface remodeling: Discussion and Conclusion
Clinical and histologic evaluation of a 1320nm Nd:YAGlaser. J. Cutan Laser Ther 1999; 1: 153-7Zelickson BD, Kilmer SL, et al. Pulsed Dye Laser It was rather obvious that the best results have Therapy for Sun Damaged Skin. Lasers in Surgery and predicted before the clinical trial, the treatment Sumian C, et al: Laser Skin Resurfacing Using a Frequency Doubled Nd:YAG laser after TopicalApplication of an Exogenous Chromophore. Lasers in delivered the best clinical outcome. Both Surgery and Medicine 1999; 25:43-50.
Goldberg DJ. New Collagen Formation After Dermal within the dermal papillae and dermis, with Remodeling With an Intense Pulsed Light Source. J.
KTP mainly targeting more superficial and smaller vessels and Nd:YAG absorbed indeeper layers. This absorption in bloodincreases the temperature around the vesselstransferring thermal damage to thesurrounding tissue, and in turn inducing ahealing effect to the collagen within the skin.
There is also some non-specific thermaldamage from the scattering effect from bothlasers which has been seen inseveral biopsies taken during this evaluation.
Patient satisfaction was much higher with theKTP laser due to the more visual effects of theskin changes, such as more even coloration or


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