title: Multifractional microablative laser combined with spacially modulated ablative (SMA) technology for facial skin rejuvenation.
abstract: Due to the increasing demand for aesthetic procedures, especially facial aesthetic surgery, a new laser technology has been developed for facial skin rejuvenation and wrinkle treatment. The aim of this study was to objectively and subjectively assess the clinical efficacy and safety of Erbium:YAG laser combined with Spatially Modulated Ablation (Er:YAG + SMA) on facial skin rejuvenation.
  
  
  
  Patients with Fitzpatrick skin type's I-IV were prospectively included. Inclusion criteria consisted of having wrinkles and irregular skin texture. All patients underwent two Er:YAG + SMA sessions (1 month apart) to stimulate tissue regeneration. Er:YAG laser emits wavelength at 2,940 nm and when combined with SMA, a resonance effect is produced in the dermis to promote tissue regeneration. Facial skin elasticity and firmness were objectively assessed by Cutometer at baseline and month 6 (M6). Aesthetic improvement was qualitatively assessed using digital photographs. Patient satisfaction with regard to their facial appearance was self-assessed using the validated FACE-Q scale and the patient-perceived age VAS scale at baseline, M1, and M6. Side effects were investigated after each session.
  
  
  
  Thirty-four patients were included, 50% (18 patients) had Fitzpatrick skin type III and 41% (14 patients) were smokers. Skin elasticity indices were significantly improved: from 0.335 ± 0.015 at baseline to 0.387 ± 0.021 at M6 (P = 0.05*) for R5 (net elasticity). Skin firmness was assessed through R7 (biological elasticity) and R6 (viscoelastic ratio) at baseline and M6: a significant increase from 0.235 ± 0.01 to 0.2709 ± 0.009 (P < 0.03**) and decrease from 0.486 ± 0.022 to 0.3918 ± 0.023 (P < 0.006***) were respectively observed. A negative value for R6 corresponded to an improved skin condition. The FACE-Q scores were significantly increased from 39.4 ± 6.7 at baseline to 45.4 ± 9.1 at M1 (P < 0.006***) and 50.4 ± 9.8 at M6 (P < 0.0001***), reflecting wrinkle reduction and enhanced rejuvenation. According to the age appraisal VAS scale, results showed that patients felt younger by -2.92 years at M1 (P < 0.0001***) and -4.13 years (P < 0.0001***) at M6. No adverse reaction was reported.
  
  
  
  The Er:YAG + SMA technology offers an effective and safe treatment alternative for facial skin rejuvenation. It reduces the recovery time compared to conventional lasers such as carbon dioxide laser. Lasers Surg. Med. 49:78-83, 2017. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of Plastic and Cosmetic Reconstructive Surgery and Maxillo Facial Surgery, Henri Mondor Hospital, 51 Avenue du Maréchal de Lattre de Tassigny, Créteil, 94010, France.
authors.forename: Barbara
authors.initials: B
authors.lastname: Hersant
authors.affiliation: Department of Plastic and Cosmetic Reconstructive Surgery and Maxillo Facial Surgery, Henri Mondor Hospital, 51 Avenue du Maréchal de Lattre de Tassigny, Créteil, 94010, France.
authors.forename: Mounia
authors.initials: M
authors.lastname: SidAhmed-Mezi
authors.affiliation: Department of Plastic and Cosmetic Reconstructive Surgery and Maxillo Facial Surgery, Henri Mondor Hospital, 51 Avenue du Maréchal de Lattre de Tassigny, Créteil, 94010, France.
authors.forename: Adrien
authors.initials: A
authors.lastname: Chossat
authors.affiliation: Department of Plastic and Cosmetic Reconstructive Surgery and Maxillo Facial Surgery, Henri Mondor Hospital, 51 Avenue du Maréchal de Lattre de Tassigny, Créteil, 94010, France.
authors.forename: Jean Paul
authors.initials: JP
authors.lastname: Meningaud
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003131:Combined Modality Therapy; D004954:Esthetics; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D054020:Lasers, Gas / Q000627:therapeutic use*; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D028022:Low-Level Light Therapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012060:Rejuvenation; D018570:Risk Assessment; D015595:Skin Aging / Q000528:radiation effects*; D016896:Treatment Outcome
keywords: Er:YAG; laser; microablative; skin rejuvenation; wrinkle treatment