title: Correlation of histological findings of single session Er:YAG skin fractional resurfacing with various passes and energies and the possible clinical implications.
abstract: OBJECTIVE
  Ablative fractional resurfacing shows promise for skin resurfacing and tightening and also to improve treatment of epidermal and dermal pigmentary disorders. This study aimed at determining any correlation between epidermal ablation and effects on the dermis when using an Er:YAG laser in ablative fractional resurfacing mode.
  
  
  METHODS
  Ten female subjects participated in the study, mean age 52 years, Skin phototypes: 1 Fitzpatrick type II; 8 type III and 1 type IV. The degree of wrinkles (Glogau scale II or III) was similar in all cases. The laser used was the Pixel Er:YAG system (Alma Lasertrade mark, Israel) which delivers the laser beam via a hand-piece equipped with a beam splitter to divide the 2,940 nm beam into various microbeams of 850 microm in diameter in an 11 mmx11 mm treatment area. Using a constant energy of 1,400 mJ/cm(2), on a test area of 4 cmx2 cm. Two, 4, 6, and 8 passes on the preauricular area of the face were evaluated immediately after treatment. In all cases, the handpiece was kept in the same position, and rotated slightly around its perpendicular axis between passes, then moved on to the next spot. Biopsies were performed and tissue samples were routinely processed and stained with hematoxylin and eosin (H&E).
  
  
  RESULTS
  No patient reported any noticeable discomfort, even at 8 passes. The histological findings revealed that, independent of the degree of the wrinkles, more laser passes produced more ablative removal of the epidermis. Residual thermal damage (RTD) with 2 laser passes was not observed but with 4 and 6 passes increased thermal effects and vacuole formation in the epidermal cells were noticed. With 8 laser passes, total epidermal removal was seen together with frank RTD-related changes in the upper part of the papillary dermis.
  
  
  CONCLUSIONS
  In this study, we have demonstrated that high density fractional Er:YAG laser energy in a single session with multiple passes targeted not only the skin surface with elimination of the epidermis, but could also achieve heat deposition in the upper dermis. When performing ablative fractional resurfacing with an Er:YAG laser, treatment of varying degrees of damage could be achieved by varying the number of passes.
authors: Instituto Medico Vilafortuny, FUNDACION ANTONI DE GIMBERNAT, Cambrils, Spain.
authors: Mario A
authors: MA
authors: Trelles
authors: Mariano
authors: M
authors: Vélez
authors: Serge
authors: S
authors: Mordon
mesh_terms: D020405:Dermis / Q000473:pathology / Q000528:radiation effects; D019583:Dose Fractionation, Radiation; D004817:Epidermis / Q000473:pathology / Q000528:radiation effects; D004867:Equipment Design; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D008875:Middle Aged; D015595:Skin Aging / Q000473:pathology* / Q000528:radiation effects*; D016896:Treatment Outcome