title: The erbium micropeel: a prospective, randomized trial of the effects of two fluence settings on facial photoaging.
abstract: BACKGROUND
  Recent studies have suggested that a series of low-energy, single-pass ablative laser resurfacing micropeels can reduce photoaging with decreased downtime. This randomized, prospective single-blinded trial sought to determine the ideal settings of sequential erbium:yttrium-aluminum-garnet (Er:YAG) laser treatments that maximize efficacy and patient satisfaction.
  
  
  METHODS
  Forty-six subjects with mild-to-moderate facial dyschromia and rhytides were evenly randomized to two Er:YAG treatment arms. Patients in the lower fluence (LF) (2.5 J/cm2) and higher fluence (HF) (3.8 J/cm2) groups each received three one-pass, full-face treatments one month apart. Patient and investigator assessments of rhytides, dyschromia and global appearance were performed at baseline and at four, eight and 20 weeks using a nominal scale from 1–4. Adverse events and patient satisfaction were also evaluated.
  
  
  RESULTS
  Patient scores showed rhytid improvement only with HF treatments. Investigator scores at three months post-treatment showed dyschromia was significantly improved in both study arms, with a 24 and 36 percent reduction for the LF and HF groups, respectively. Global appearance scores improved by 25 and 32 percent, respectively. A trend towards greater post-procedure erythema and time-to-erythema resolution was observed in the HF group. Mild peeling was the most common adverse event. Individuals who underwent LF treatments were more likely to pursue future treatments.
  
  
  CONCLUSIONS
  Both settings resulted in moderate but significant improvement in dyschromia, although only HF treatment improved rhytides. The decreased downtime of LF treatments made this the preferred choice of patients.
authors.affiliation: Department of Dermatology, Stanford University School of Medicine, Stanford, CA 94063, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Somoano
authors.forename: Basil M
authors.initials: BM
authors.lastname: Hantash
authors.forename: Edgar F
authors.initials: EF
authors.lastname: Fincher
authors.forename: Peggy
authors.initials: P
authors.lastname: Wu
authors.forename: Hayes B
authors.initials: HB
authors.lastname: Gladstone
mesh_terms: D000328:Adult; D000368:Aged; D004890:Erythema / Q000209:etiology; D005145:Face / Q000473:pathology; D005260:Female; D006801:Humans; D053844:Lasers, Solid-State / Q000009:adverse effects / Q000627:therapeutic use*; D028022:Low-Level Light Therapy; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D016037:Single-Blind Method; D015595:Skin Aging; D012880:Skin Pigmentation; D016896:Treatment Outcome