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Periorbital skin resurfacing using high energy erbium:YAG laser: results in 50 patients
R A Weiss1, A C Harrington, R C Pfau
1Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Objective:
To evaluate Erbium:YAG regional periorbital laser resurfacing clinically and histologically.
Study Design/Materials And Methods:
Photographic evaluation before and after Erbium:YAG resurfacing with histologic evaluation of depth of injury.
Setting:
Group private single specialty practice.
Patients:
Fifty patients in the age range of 35-62 years, Fitzpatrick skin types I-III were treated using Erbium:YAG for regional resurfacing of periorbital rhytides.
Outcome Measures:
Patients were seen at days 1, 2, 3, 7, 14, 28, and at six months and one year. Photographs were obtained prior to application of topical anesthesia and were utilized to judge improvement of rhytides at all time intervals. Additional photographs were taken at each follow-up visit and the results judged by an independent investigator. Results were graded into five categories at all treatment intervals: no improvement, mild (grade 1: up to 25%), moderate (grade 2: 25-50%), good (grade 3: 50-75%, or excellent (grade 4: 75-100%). For histologic evaluation of depth of ablation and thermal injury one, two, and three passes at 21.2 J/cm2 were performed on four patients.
Results:
Re-epithelization in the periorbital region was rapid with a mean duration of 2.65 days. Erythema ranged from a longest of six weeks to the shortest of seven days with a mean duration of 15.4 days. Evaluation of clinical results revealed that at two weeks mean improvement was 2.15 (between moderate and good). At four weeks further improvement was noted with a mean of 2.62. By six months, mean improvement score increased to 2.94. Minimal further improvement was noted between six months and one year with a mean improvement score of 3.02 (good to excellent). Histology revealed complete removal of the epidermis with one to three passes. Dermal ablation of 5-10 microns accompanied by small increases (5-10 microns) in dermal thermal injury occurred with each subsequent pass.
Conclusions:
We conclude that high energy Erbium:YAG periorbital resurfacing is a safe and effective modality which achieves substantial therapeutic effect. Most patients achieve approximately 75% improvement. Erythema fades quickly, reepithelization is rapid and side effects are minimal.