Introduction
Capsule Summary
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Various minimally invasive treatments enhance the skin's appearance, but little is known about the associated molecular changes.
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Intraepidermal Er:YAG laser resurfacing resulted in molecular alterations associated with an improved appearance of photodamaged skin.
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Although microablation was confined to the uppermost epidermis, marked changes in epidermal and dermal structure and function were demonstrated. This suggests that enhanced appearance may be achieved via superficially acting treatments.
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These results may have significant implications for future device/procedure development.
In recent years, there has been intense interest in developing increasingly less invasive techniques to improve the clinical signs of photoaging. Many nonablative laser systems have been utilized with these goals in mind.1, 2, 3 Although nonablative lasers have an impressive safety profile because the epidermis of treated skin generally remains intact, clinical results have been modest in terms of textural improvement. Alternatively, while traditional ablative laser resurfacing is, in many respects, the gold standard for facial rejuvenation, the procedure is fraught with the risk of significant complications and results in substantial down time.4, 5, 6
To mitigate against the potential drawbacks of procedures that result in complete epidermal ablation, lower powered ablative erbium:yttrium-aluminium-garnet (Er:YAG) lasers have recently been used in an attempt to improve the appearance of human skin while largely preserving epidermal integrity. Superficial Er:YAG laser resurfacing employs technology with a long track record of efficacy now modified to produce a minimally invasive treatment. With respect to improving the uniformity of skin texture, this strategy theoretically relies on the ability of an intervention that acts primarily through intraepidermal injury to drive dermal extracellular matrix changes. To date, no study has produced detailed quantification of the dermal alterations that may result from such intraepidermal damage. Demonstration that controlled, superficial cutaneous injury results in significant dermal changes could result in the development of a paradigm shift in treatment strategies for photoaging. We thus sought to assess and quantify whether minimally invasive Er:YAG laser resurfacing has the ability to stimulate dermal matrix remodeling.