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Reprinted by permission of Lasers Surg Med. 2016; 48(6):577-583.

Lasers in Surgery and Medicine 48:577–583 (2016)

Facial Rejuvenation Via the Sequential Combined Use of Multiple Laser Modalities: Safety and Efficacy Douglas C. Wu, MD, PhD and Richard E. Fitzpatrick, MD † Goldman, Butterwick, Groff, Fabi, and Wu, Cosmetic Laser Dermatology, 9339 Genesee Avenue, Suite 300, San Diego, California 92121

Background and Objectives: Multi-modal combination treatments for facial rejuvenation offer the potential to achieve superior results in a single treatment session. In this study, we evaluate the safety and efficacy of combining multiple laser modalities in a single treatment session. Methods: Fifty patients underwent a multi-modal facial laser resurfacing procedure consisting of the sequential use of 595 nm pulsed dye laser, 755 nm alexandrite laser, superficial fractionated and fully ablative CO 2 laser, superficial fully ablative erbium-YAG laser, and deep fractionated ablative CO 2 laser in a single treatment session. Improvements in dyspigmentation, rhytides, telangiectasia, and skin texture were assessed. Patient satisfaction, healing times, and tolerability of procedure was also evaluated. Results: Highly significant improvements in all clinical parameters were demonstrated at both short- and long- term follow-up evaluations. Patients reported a high satisfaction rate. Conclusion: Mega-combination treatment utilizing a variety of laser devices in a single treatment session is safe and highly effective at achieving facial rejuvenation. This approach represents an efficient use of both patient and physician time and resources. Lasers Surg. Med. 48:577–583, 2016. 2016 Wiley Periodicals, Inc. Key words: laser resurfacing; alexandrite; CO 2 pulsed dye laser; facial rejuvenation; combination treatment laser; INTRODUCTION Facial rejuvenation via ablative resurfacing has the potential to achieve excellent outcomes [1,2], but adverse events and downtime can be significant [3]. Conversely, the side effect profile of non-ablative modalities is considerably less, but the clinical efficacy is often also substantially reduced [4]. Over the past decade, frac- tional photothermolysis—first non-ablative, then abla- tive—has represented a compromise between achieving satisfactory clinical results while also minimizing associ- ated adverse reactions [5,6]. The above modalities are often used in isolation to treat the entire face, and sometimes require several treatment sessions to achieve optimal outcomes. However, photoaging of facial skin is a complex process that

manifests clinically in a large variety of ways including dyspigmentation, telangiectasia, textural and laxity changes, and rhytides of varying depths. Additionally, different anatomical units of the face feature unique clinical characteristics. A single treatment modality may therefore be suboptimal to address these multifaceted components. Combination laser treatments have been previously reported, but typically consist of milder treatment options such as pulsed light and non-ablative fractional lasers [7–12]. The safety and efficacy of aggressively combining multiple ablative laser modalities has yet to be fully explored, although experimental evidence suggests benefits in the induction of neocollagenesis [13]. In this study, we present an aggressive sequential multi-modal laser protocol that safely and selectively targets specific components of the photoaging process while simultaneously producing significant global facial rejuvenation in a single treatment session. A retrospective chart review was performed of patients receiving combination sequential multi-modal laser rejuvenation of the face at our center between January 1, 2010 and January 1, 2013. Fifty patients treated by two independent physicians were selected at random for further analysis. Combination Sequential Multi-Modal Laser Rejuvenation Patients were prepared with the application of a topical anesthetic cream consisting of 7% lidocaine and 7% † Posthumous author. Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported. Correspondence to: Douglas C. Wu, MD, PhD, Goldman, Butterwick, Groff, Fabi, and Wu, Cosmetic Laser Dermatology, 9339 Genesee Avenue, Suite 300, San Diego, CA 92121. E-mail: dwu@clderm.com Accepted 12 March 2016 Published online 6 April 2016 in Wiley Online Library MATERIALS AND METHODS Patient Selection

(wileyonlinelibrary.com). DOI 10.1002/lsm.22514

2016 Wiley Periodicals, Inc.

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