title: An in vivo histopathological comparison of single and double pulsed modes of a fractionated CO(2)  laser.
abstract: BACKGROUND
  Studies examining the histopathological changes that occur in human skin following fractional laser treatment have been performed mainly in animals or abdominal tissue prior to abdominoplasty. This study looks at the effect of double pulse fractional CO(2) laser compared to single pulse treatments to assess differences in tissue injury in the face and abdomen.
  
  
  METHODS
  Twelve healthy subjects randomized into two groups, had two 1 cm(2) areas (infraumbilical and forehead) treated with the fractional CO(2) laser (Deep Fx, Lumenis). Settings used were 15 mJ double pulse, and 30 mJ single pulse, 300 Hz, 10% density and compared to the historic control of 15 patients treated at 15 mJ single pulse [Bailey et al. (2011), Lasers Surg Med 43: 99-107]. Treated sites were biopsied and analyzed with H&E and TUNEL staining to measure width and depth of the microthermal zones (MTZ) of ablation.
  
  
  RESULTS
  When comparing 15 mJ double pulse to single pulse there were significant differences both in depth (abdominal skin, P = 0.002 and facial skin, P = 0.001) and width (facial skin, P = 0.0002) of MTZ. When comparing double pulsing at 15 mJ with single pulsing at 30 mJ there were significant differences between MTZ depths in the abdomen (P < 0.01) but not in either the MTZ depth (P = 0.69) or the width in the face (P = 0.502).
  
  
  CONCLUSIONS
  This study demonstrates the differences between histopathological laser injury patterns in the face compared to the abdomen when single pulsing is used. It also demonstrates that double pulsing at 15 mJ is statistically similar to single pulsing at 30 mJ in the face. We think this could have ramifications for clinical practice where by double pulsing at lower energies may result in better clinical outcomes than increasing energies or using multiple passes at single pulse. Clinical studies needs to be performed to investigate this further.
authors.affiliation: Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9132, USA.
authors.forename: Georgette
authors.initials: G
authors.lastname: Oni
authors.forename: Daniel
authors.initials: D
authors.lastname: Robbins
authors.forename: Steven
authors.initials: S
authors.lastname: Bailey
authors.forename: Spencer A
authors.initials: SA
authors.lastname: Brown
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Kenkel
mesh_terms: D000005:Abdomen / Q000473:pathology / Q000528:radiation effects; D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D020405:Dermis / Q000473:pathology* / Q000528:radiation effects*; D019583:Dose Fractionation, Radiation; D004307:Dose-Response Relationship, Radiation; D005145:Face / Q000473:pathology / Q000528:radiation effects; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D020287:In Situ Nick-End Labeling; D054020:Lasers, Gas; D028022:Low-Level Light Therapy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011829:Radiation Dosage; D012016:Reference Values; D018570:Risk Assessment; D055815:Young Adult