COLD ABLATIVE FIBRE LASER A New Solution for Photoageing in All Skin Types

Michael Gold, MD, describes his success using the UltraClear™ system in his aesthetic practice

THE USE OF LASERS TO IMPROVE THE appearance in signs of photodamage and ageing, such as wrinkles, pigment, and loss of tone and texture, has been a popular procedure in cosmetic practices for decades.

Promising results using a fully ablative infrared 10,600 nm carbon dioxide (CO2) laser were first reported by Fitzpatrick et al1, but carried drawbacks such as a long downtime after treatment and significant side effects, including patient discomfort, scarring, and hyperpigmentation2,3. It was later demonstrated that more rapid healing with fewer and less severe side effects could be achieved with the introduction of fractional lasers years later by Manstein et al4, using either ablative or, more recently, non-ablative lasers. However, other practical issues for incorporating these into an aesthetic practice remained. Application of topical anaesthesia was typically required up to 60 minutes before each treatment. The procedure itself could require up to 60 minutes, and the downtime following the procedure could last weeks, significantly affecting the acceptance of these procedures in many patients. Furthermore, many patients of darker skin types were contraindicated due to a higher risk of developing long-term hyperpigmentation.

A new cold ablative 2910 nm fibre laser is showing promise to eliminate most, if not all, of these concerns and provide a much-needed solution for treating patients.

Technology

We have recently begun exploring the use of a new midinfrared 2910 nm, cold ablative, fractional fibre laser (UltraClear™, Acclaro Corporation, Smithfield, RI) for general facial photo rejuvenation. The UltraClear is a firstof-its-kind mid-infrared fractional laser that can be customised to produce coagulative effects, delivered as fractional arrays of rings, ablative effects as highly uniform microbeams, or as a combination of both for the treatment of general facial photodamage. Representative beam array patterns from the UltraClear are shown in Figure 1

Among the advantages of this new technology in clinical practice is fullface treatments can be performed in under 20 minutes. In addition, healing times are rapid, typically lasting only a few days, as can be seen in the day-today time sequence of photos shown in Figure 2

Furthermore, the controlled superficial effects of this new laser device are beginning to show in separate early studies. The versatility of the various 3DMIRACL, Clear, Clear+, Ultra, and UltraClear modes provide choices ranging from lunchtime treatments with depth settings as soft as 10 microns, to three-dimensional deep collagen remodelling at 1500 micron depths.

Even skin of colour, including Fitzpatrick skin types IV, V, and VI, can be safely treated with a much lower risk of post-inflammatory hyperpigmentation. The flexibility for practitioners to treat patients of all skin types underscores the excellent return on investment.

Another distinct benefit is that these quick treatments can be safely delegated to physician extenders.

Clinical results

Our patients were treated using the fractional cold ablation ULTRA mode customised using the 15 mm square and rectangular patterns, 2.0% coverage and a depth setting of 500 microns with high coagulation.

A 65-year-old female with Fitzpatrick skin type III presented with a history of facial photodamage, including mild to moderate fine lines and wrinkles and diffuse pigmentation. She received a single, full-face treatment with UltraClear. Figure 3 illustrates her results from before and four weeks after one treatment.

Figure 4 shows another 58-year-old patient with very positive pigment clearance on the forehead.

Discussion

To date, the fractional 2910 nm fibre laser used in our practice produces clinically beneficial results after a single treatment. Discomfort during treatment was

A B C D minimal without the need for topical anaesthesia application. Initial mild erythema was common but treated skin generally returned to a healthy normal appearance within three days with noticeable clearance of benign lentigines.

The short downtime following treatments due to rapid healing provides a desirable outcome for all patients. In our practice, patients were pleased to be able to resume normal social functions or return to work very quickly. This represents a distinct advantage for dermatologists and aesthetic doctors to meet many of the most common patient demands.

From a practical standpoint, the fact that no topical anaesthesia was used or required made the treatment sessions an attractive offering for our cosmetic laser practice and has resulted in the adoption of over 100 of these novel devices in just under one year since the company launched the product into the market. US Food and Drug Administration (FDA) clearance was achieved in December 2021 for not only the general skin resurfacing procedures presented in this article but also wrinkles, scar revision (including acne scars), telangiectasia, and spider veins. Many other indications are currently being studied in clinical trials.

The system’s autoclavable tips offer the distinct benefit of not requiring per-patient consumables for treatments, which substantially reduces the usage costs for the practitioner. Further, the first-of-its-kind fibre laser design dramatically reduces service costs, when needed, up to 70%, as compared to other infrared lasers that utilise articulated arm technology. In addition, the shortened time required to complete the treatment is another key benefit for both the patient and practitioner, resulting in a procedure that is cost-effective and fits well within any practice’s business model.

Good results were seen after as little as a single treatment session; however, we now recommend a series of two or three treatments spaced approximately four weeks apart. Maintenance treatments can be performed on an as needed basis.

The combination of an effective, fractional, low downtime procedure offered by the novel 2910 nm fractional fibre laser should find considerable utility, filling a need in general dermatologic and cosmetic laser practices as identified in previous works5,6

References

1. Fitzpatrick RE, Goldman MP, Satur NM, Tope WD. Pulsed carbon dioxide laser resurfacing of photoaged facial skin. Arch Dermatol 1996;132:395-402

2. Ross EV, Grossman MC, Duke D, Grevelink JM. Long-term results after CO2 laser skin resurfacing: a comparison of scanned and pulsed systems. J Am Acad Dermatol 1997;37:709-718.

3. Nanni CA, Alster TS. Complications of carbon dioxide concept for

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