title: In vivo wound healing and dermal matrix remodelling in response to fractional CO(2) laser intervention: clinicopathological correlation in non-facial skin.
abstract: OBJECTIVE
  Ablative fractional photothermolysis is a new concept for treatment of aged skin. Despite the low frequency of side effects there are now several reports about scarring, especially in non-facial regions like the neck. Our study aimed to investigate the in vivo wound healing process and remodelling in an area prone to scarring using a fractional ablative CO(2) laser with three different energy protocols.
  
  
  METHODS
  Six patients with photo-damaged skin received a single fractional ablative treatment using a 250-µm scanning CO(2) laser. Three areas on the neck were treated with 50, 100 and 300 mJ/microbeam at densities of 200, 150 and 100/cm(2), respectively. Biopsies were taken from untreated skin (control) and 10 minutes, 3 days, 14 days, 21 days and 28 days post-intervention.
  
  
  RESULTS
  Fractional ablation with higher energies resulted in increased total thermal damage. Overall, 50 mJ was effective up to the superficial dermis, 100 mJ up to the mid-dermis, and 300 mJ resulted in deep dermal ablation. The intensity of lymphocytic inflammation and dermal remodelling correlated with the total amount of thermal damage. At 300 mJ, granuloma was present and persisted for at least 4 weeks as opposed to clinical healing, which was completed < 2 weeks.
  
  
  CONCLUSIONS
  With the above-mentioned low and medium parameter settings, ablative fractional photothermolysis is safe and effective in non-facial skin. However, dermal remodelling continues for up to 4 weeks, which should be the minimum space between treatment sessions. Higher energies may induce granuloma formation, possibly a sign of an overstrained remodelling capacity.
authors.affiliation: Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Abteilung Laser und Kosmetik, Universitätsklinikum Leipzig AöR, Germany.
authors.forename: Sonja
authors.initials: S
authors.lastname: Grunewald
authors.forename: Marc
authors.initials: M
authors.lastname: Bodendorf
authors.forename: Monica
authors.initials: M
authors.lastname: Illes
authors.forename: Michael
authors.initials: M
authors.lastname: Kendler
authors.forename: Jan C
authors.initials: JC
authors.lastname: Simon
authors.forename: Uwe
authors.initials: U
authors.lastname: Paasch
mesh_terms: D000328:Adult; D000368:Aged; D062109:Dermatologic Surgical Procedures; D005260:Female; D006099:Granuloma / Q000209:etiology / Q000473:pathology; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects; D054020:Lasers, Gas / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012867:Skin / Q000293:injuries / Q000473:pathology; D015595:Skin Aging / Q000473:pathology; D014945:Wound Healing