Nonablative Remodeling: Clinical, Histologic, Ultrasound Imaging, and Profilometric Evaluation of a 1540 nm Er:Glass Laser

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Abstract
Background. Nonablative remodeling has been recently proposed as an alternative to CO2 and Er:YAG resurfacing. Objective. To evaluate the efficacy and safety of a 1540 nm Er:glass laser with contact cooling in nonablative skin remodeling, focused on perioral and periorbital rhytides. Methods. Sixty patients (mean age 47 years), Fitzpatrick skin types I–IV were treated four times over 6‐week intervals. Patients were evaluated using digital photographs, histology, ultrasound imaging, and profilometry with silicone imprints in order to quantitate the degree of clinical improvement. Results. All subjects reported subjective improvement in the quality and visual aspect of their skin. This was confirmed by a 40.2% reduction of anisotropy (P < .001) 6 weeks after the fourth treatment. Ultrasound imaging demonstrated a 17% increase of dermis thickness (P < .005). Biopsy specimens showed evidence of new collagen formation. Conclusion. This study has clearly demonstrated that irradiation with 1540 nm Er:glass laser can lead to new collagen formation, dermis thickening, reduction of anisotropy of the skin, and clinical improvements. The lack of adverse effects confirmed that this 1540 nm laser emitting in a pulsed mode coupled with an efficient cooling system is safe.