title: Nd:YAG laser combined with IPL treatment improves clinical results in non-ablative photorejuvenation.
abstract: BACKGROUND
  Intense pulsed light (IPL) sources have been reported in non-ablative photorejuvenation, but the excellent histological findings do not always coincide with the clinical results and patient satisfaction index (SI).
  
  
  METHODS
  Ten female patients (two forehead, four periocular and four perioral), ages ranging from 28 to 46 years, skin types II-IV, wrinkle types I-III, participated in the study. The IPL system was applied with the yellow (570 nm) cut-off filter, 30 J/cm(2), single pulse, followed by the Nd:YAG at 120 J/cm(2), double pulse (7 ms per shot with 20 ms between pulses) on the wrinkled areas only. Three sessions were given at monthly intervals, and an assessment was made 1 and 6 months after the third session. Biopsies were taken from four consenting patients as a cross-section before the first treatment and then 1 and 6 months after the third session. For clinical control and contrast of tissue results, a group of 10 patients (two forehead, four periocular and four perioral; ages ranging from 27 to 47 years, skin types II-IV, wrinkle types I-III) was treated only with IPL, using the same parameters and sessions. Histologies were taken from four consenting patients.
  
  
  RESULTS
  The histology showed thickening of the epidermis with good dermal collagen organization in both groups. However, the combined treatment showed more dramatic changes in histological tissue condition, and ectatic blood vessels were seen in the deeper dermis. The patient SI values, related to the results, were lower when IPL was used alone. All patients completed the study. In the combined treatment group, overall SIs of 8 (80%) and 8 (80%) were obtained at the control points of 1 and 6 months, respectively, after session 3, compared with SIs of 6 (60%) and 4 (40%) scored by patients in the IPL group at the same points. Discomfort and side effects were minimal in both groups.
  
  
  CONCLUSIONS
  The addition of the Nd:YAG laser to the IPL regimen in non-ablative skin rejuvenation gave very good histological results, which were echoed by stronger patient satisfaction than in the control group treated only with IPL. Visible improvement in the skin condition of both groups was achieved, but was better in the combined treatment group.
authors.affiliation: Instituto Médico Vilafortuny/Antoni de Gimbernat Foundation, Av. Vilafirtuny 31, ES-43850 Cambrils, Spain. imv@laser-spain.com
authors.forename: Mario
authors.initials: M
authors.lastname: Trelles
authors.forename: Inés
authors.initials: I
authors.lastname: Allones
authors.forename: Mariano
authors.initials: M
authors.lastname: Vélez
authors.forename: Serge
authors.initials: S
authors.lastname: Mordon
mesh_terms: D000328:Adult; D005145:Face; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D008875:Middle Aged; D017060:Patient Satisfaction; D010789:Phototherapy / Q000379:methods*; D015595:Skin Aging / Q000528:radiation effects*; D016896:Treatment Outcome