Cutaneous photoaging treated with a combined 595/1064 nm laser.
The pulsed dye laser (PDL) has been used for a variety of vascular changes associated with photoaging. The Nd:YAG laser has been shown to be effective in the treatment of deeper facial vessels, as well as to stimulate new dermal collagen deposition. This study was undertaken to evaluate the safety and efficacy of sequential dual-wavelength PDL and Nd:YAG laser treatment of photoaged facial skin. Fifteen individuals, between the ages of 38 and 66 years old, with various stigmata of facial photoaging, were entered into the study. Five sequential combined PDL/Nd:YAG (Cynergy, Cynosure Inc., Westford, MA, USA) treatments were performed using a 10-mm handpiece at monthly intervals. PDL parameters included a 10-ms pulse duration and a fluence set at 1 J/cm2 below the purpura threshold. Nd:YAG parameters were set at a 50-ms pulse duration with fluences varying between 35 and 50 J/cm2, depending on patient comfort. Improvement was determined by evaluation of photographs taken before the first treatment and at 1 and 3 months following the last treatment, as well as the individual's self-assessment. Individuals tolerated treatments well with no serious, long-term, or permanent adverse effects. Improvement was most pronounced in telangiectasias and diffuse erythema, followed by epidermal dyspigmentation and lentigines. Some individuals were also noted to have improved smoothness, radiance, or pore size. The improvement was generally maintained at the 3-month follow-up. In addition, the average self-reported improvement was 1.7 (on a 0-4 scale) at 1 month and 2.4 at 3 months following the last treatment. A novel combined sequential PDL/Nd:YAG laser can be used to treat a variety of cutaneous changes associated with photoaging. Further studies may determine the relative impact of each laser and whether the total effect is simply additive or synergistic