Sequential facial skin rejuvenation with intense pulsed light and non-ablative fractionated laser resurfacing in fitzpatrick skin type II-IV patients: A prospective multicenter analysis

J Matthew Knight, Gerd Kautz, J Matthew Knight, Gerd Kautz

Abstract

Background: While skin aging is triggered by multiple factors and typically presents with multiple manifestations, conventional treatment regimens deploy a single treatment modality. Typical approaches exploit ablative techniques, which involve considerable patient discomfort and downtime and can induce adverse events. Non-ablative fractionated laser (NAFL) resurfacing promotes neocollagenesis, with significantly fewer complications and discomfort. At the same time, intense pulsed light (IPL) therapies have a marked impact on skin tone, with an effect on collagen deposition. This study evaluated the combined effect of same-day, sequential IPL-NAFL treatment on photoaging of the face.

Design: In this prospective study, 30 patients presenting Fitzpatrick skin types II-IV, elastosis scores 3-6 and mild to moderate pigmentation, underwent three sessions, of full-face IPL therapy, followed immediately by NAFL treatment, conducted at 4-6 weeks intervals. Wrinkle/elastosis and skin qualities were scored at 1, 3, and 6 months after the last treatment session. Immediate responses were evaluated up to 30 min following treatment and adverse events were monitored throughout the study period.

Results: Wrinkle/elastosis scores gradually improved over the treatment period, with 59% of patients presenting a ≥1-point improvement in FES scores by the 1-month follow-up session, which persisted also at the 6 months follow-up visit. Good to excellent pigmentation responses were recorded for ≥63% and improvements in texture, brightness, and tightness were recorded for ≥80% of patients throughout the follow-up period. Over 90% of the treated patients exhibited improved or much improved overall appearance. Patient scorings and satisfaction level reflected physician assessments. Treatments were well tolerated and the social downtime observed was of 1.5 ± 0.25 days.

Conclusion: The same-day combined IPL-NAFL regimen proved safe and elicited a significant skin rejuvenating effect, in a similar manner to that shown in other same-day combined therapies, without prolonging downtime of each individual modality. Lasers Surg. Med. 51:141-149, 2019. © 2018 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.

Trial registration: ClinicalTrials.gov NCT02032771.

Keywords: IPL; cosmteic; fractionated laser; intense pulsed light; laser; non ablative; pigmentation; resurfacing; skin rejuvenation; wrinkles.

© 2018 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.

Figures

Figure 1
Figure 1
Investigator‐assessed improvement in various parameters (texture, tightness, brightness, pigmentation) and overall improvement (0, worse; 1, no change; 2, improved; 3, much improved; 4, very much improved) at 1, 3, and 6 months following three treatments with IPL followed by NAFL treatment. At 1 month, 3 months, and 6 months following last treatment, overall improvement was “improved” or “much improved” in majority of the subjects.
Figure 2
Figure 2
Patient‐assessed improvement in various parameters (texture, tightness, brightness, pigmentation) and overall improvement (0, worse; 1, no change; 2, improved; 3, much improved; 4, very much improved) at 1, 3, and 6 months following three treatments with IPL followed by NAFL treatment. At 1 month, 3 months, and 6 months following last treatment, overall improvement was “improved” or “much improved” in majority of the patients.
Figure 3
Figure 3
Patient‐assessed satisfaction (0 = none, 1 = slight, 2 = moderate, 3 = good, 4 = very good) at 1, 3, and 6‐month follow‐up visits. At the 6 months follow up, most patients rated their improvement and satisfaction as “good” or “very good.”
Figure 4
Figure 4
Clinical results of the combination therapy. Patient's face before (A) and 1 month after (B) the third combined treatment session. Treatment settings for IPL: filter 560 nm, fluence 11–12 J/cm2, 2‐3 pulses, pulse duration of 3 and 20 ms pulse delay. Treatment settings for NAFL treatment: Energy 20 mJ and Density 250–350 spots/cm2.
Figure 5
Figure 5
Clinical results of the combination therapy. Patient's face before and 1 month after the third combined treatment session. Treatment settings for IPL: filter 560 nm, fluence 13 J/cm2, 3 pulses, pulse duration of 3 and 20 ms pulse delay. Treatment settings for NAFL treatment: Energy 30 mJ and Density 300 spots/cm2.
Figure 6
Figure 6
Clinical results of the combination therapy. Patient's face before (A), 3 months (B), and 6 months (C) after the third combined treatment session. Treatment settings for IPL: filter 560 nm, fluence 12–13 J/cm2, 3 pulses, pulse duration of 3 and 20 ms pulse delay. Treatment settings for NAFL treatment: Energy 25–30 mJ and Density 250–300 spots/cm2.
Figure 7
Figure 7
Clinical results of the combination therapy. Patient's face before (A), and 3 months (B) after the third combined treatment session. Treatment settings for IPL: filter 560 nm, fluence 15–16 J/cm2, 2 pulses, pulse duration of 4 and 30 ms pulse delay. Treatment settings for NAFL treatment: Energy 15–35 mJ and Density 250–350 spots/cm2.
Figure 8
Figure 8
Clinical results of the combination therapy. Patient's face before (A), 3 months (B), and 6 months (C) after the third combined treatment session. Treatment settings for IPL: filter 560 nm, fluence 14–15 J/cm2, 2 pulses, pulse duration of 4 and 20 ms pulse delay. Treatment settings for NAFL treatment: Energy 20–35 mJ and Density 200–350 spots/cm2.

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