Study Shows Faster Recovery, Less Pain With 2910-nm Laser

BALTIMORE — A 2910-nm erbium-doped fluoride glass fiber laser, approved 2 years ago by the US Food and Drug Administration, has demonstrated a high degree of improvement for facial photoaging and rhytides along with relatively high rates of patient satisfaction — while causing less discomfort and downtime compared with conventional fractional lasers, a small single-center study showed.

The study enrolled 15 patients who had three treatment sessions with the 2910-nm laser. “It’s highly customizable,” the study’s lead author, Taryn Murray, MD, a dermatologist at Cleveland Clinic, Cleveland, Ohio, told Medscape Dermatology. “It has a really fast time in healing compared to traditional abatable lasers; the healing time is five to seven days vs several weeks.” Murray presented the results at the annual meeting of the American Society for Laser Medicine and Surgery.

The Technology Behind the Laser

The 2910-nm erbium-doped fluoride glass fiber laser is a mid-infrared ablative fractional device that operates at peak water absorption. It’s designed to cause minimal residual thermal damage, resulting in less discomfort, shorter downtime, and potentially fewer side effects than conventional ablative lasers, Murray said.

Because of the way the pulses are delivered, “it’s far less painful than traditional fractional ablative lasers, so you can use mainly topical numbing; you don’t need nerve blocks, you don’t have to infiltrate lidocaine, you don’t have to put the patient under anesthesia,” she said.

“Because of the wavelength, how pulses are delivered and how customizable the settings are, it’s safer to use in darker skin types,” and the density, depth, and the amount of coagulation applied into the skin are customizable, Murray added.

The laser also delivers pulses in a different way than the conventional 2940-nm erbium and CO 2 lasers, she explained. “Traditional lasers do it all in one pulse. This laser uses micropulses with relaxation time in between pulses, so the body interprets it as less painful and allows pressure and steam to escape out of the channel, which results in faster healing.”

The study patients had topical anesthetic cream applied to their faces 45-60 minutes before the procedure. Multiple passes were made using both superficial and deep laser modes. The average patient age was 65.7 years, and Fitzpatrick skin types included I (n = 3), II (n = 3), III (n = 7) and IV (n = 2). On a scale of 0-10, the average level of discomfort was 4.9, and the average patient satisfaction after three treatments was 4.8, Murray said.

For cosmetic improvement, the study used the 5-point Global Aesthetic Improvement Scale (GAIS). Blinded reviewers evaluated digital images and determined an average GAIS score of 3.2 for overall appearance, 2.9 for wrinkles, 3.6 for pigment, 3.1 for skin texture, and 2.6 for skin laxity.

When the patients themselves reviewed the digital images, the average GAIS score was 3.8 for overall appearance.

Side effects, said Murray, were transient, with edema and soft-tissue crusting lasting 3-5 days and erythema resolving in 1-2 weeks on average. One case of postinflammatory hyperpigmentation (PIH) did arise, which was linked to allergic contact dermatitis from the healing ointment. That patient stayed in the study and had complete resolution of the PIH.

Study Stands Out

A number of studies of the 2910-nm erbium-doped fluoride glass fiver laser have emerged over the past half year, Ritu Swali, MD, who was an American Society of Dermatologic Surgery fellow at a practice in Houston, Texas, said in an interview at the meeting. But this one stands out because of the evidence surrounding its use.

Most people are using this laser for facial resurfacing, “and we want to know that we have a technology…with shorter downtime and easier wound care and just more comfort,” she said.

She noted that with conventional lasers, most patients get nerve blocks and some even opt for general anesthesia. “To be able to do the levels of facial resurfacing [Murray] is doing without having to do all of that pain management is pretty amazing,” Swali added.

The speed of the procedure and the relatively short downtime are also noteworthy, she said. “The huge advantage is having so much less pain from the procedure itself, so you’re able to do it faster because they’re tolerating it so well and you’re not having to take breaks,” she said.

As for downtime, Swali added, “these patients are coming in on a Thursday and they are back up and running by Monday,” as opposed to weeks that is typical with a conventional laser. This laser platform also avoids the pigmentation problems that can come with continuing and aggressive treatment with conventional lasers, she said.

Murray disclosed relationships with Acclaro Medical, the manufacturer of the laser. Swali has no relationships to disclose.

Richard Mark Kirkner is a medical journalist based in the Philadelphia area.

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