title: Fractional versus ablative erbium:yttrium-aluminum-garnet laser resurfacing for facial rejuvenation: an objective evaluation.
abstract: BACKGROUND
  Laser is one of the main tools for skin resurfacing. Erbium:yttrium-aluminum-garnet (Er:YAG) was the second ablative laser, after carbon dioxide, emitting wavelength of 2940 nm. Fractional laser resurfacing has been developed to overcome the drawbacks of ablative lasers.
  
  
  OBJECTIVE
  We aimed to objectively evaluate the histopathological and immunohistochemical effects of Er:YAG 2940-nm laser for facial rejuvenation (multiple sessions of fractional vs single session of ablative Er:YAG laser).
  
  
  METHODS
  Facial resurfacing with single-session ablative Er:YAG laser was performed on 6 volunteers. Another 6 were resurfaced using fractional Er:YAG laser (4 sessions). Histopathological (hematoxylin-eosin, orcein, Masson trichrome, and picrosirius red stains) and immunohistochemical assessment for skin biopsy specimens were done before laser resurfacing and after 1 and 6 months. Histometry for epidermal thickness and quantitative assessment for neocollagen formation; collagen I, III, and VII; elastin; and tropoelastin were done for all skin biopsy specimens.
  
  
  RESULTS
  Both lasers resulted in increased epidermal thickness. Dermal collagen showed increased neocollagen formation with increased concentration of collagen types I, III, and VII. Dermal elastic tissue studies revealed decreased elastin whereas tropoelastin concentration increased after laser resurfacing. Neither laser showed significant difference between their effects clinically and on dermal collagen. Changes in epidermal thickness, elastin, and tropoelastin were significantly more marked after ablative laser.
  
  
  CONCLUSIONS
  The small number of patients is a limitation, yet the results show significant improvement.
  
  
  CONCLUSIONS
  Multiple sessions of fractional laser have comparable effects to a single session of ablative Er:YAG laser on dermal collagen but ablative laser has more effect on elastic tissue and epidermis.
authors.affiliation: Department of Dermatology, Faculty of Medicine, Al-Minya University, Al-Minya, Egypt. moetazeldomyati@yahoo.com
authors.forename: Moetaz
authors.initials: M
authors.lastname: El-Domyati
authors.forename: Talal
authors.initials: T
authors.lastname: Abd-El-Raheem
authors.forename: Hossam
authors.initials: H
authors.lastname: Abdel-Wahab
authors.forename: Walid
authors.initials: W
authors.lastname: Medhat
authors.forename: Wael
authors.initials: W
authors.lastname: Hosam
authors.forename: Hasan
authors.initials: H
authors.lastname: El-Fakahany
authors.forename: Mustafa
authors.initials: M
authors.lastname: Al Anwer
mesh_terms: D000328:Adult; D000368:Aged; D024042:Collagen Type I / Q000096:biosynthesis; D024061:Collagen Type III / Q000096:biosynthesis; D024143:Collagen Type VII / Q000096:biosynthesis; D062109:Dermatologic Surgical Procedures; D004549:Elastin / Q000096:biosynthesis; D004890:Erythema / Q000209:etiology; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D053685:Laser Therapy / Q000009:adverse effects / Q000379:methods*; D053844:Lasers, Solid-State / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012060:Rejuvenation; D012867:Skin / Q000033:anatomy & histology* / Q000378:metabolism*; D014333:Tropoelastin / Q000096:biosynthesis
chemical_list: D024042:Collagen Type I; D024061:Collagen Type III; D024143:Collagen Type VII; D014333:Tropoelastin; D004549:Elastin