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greycel
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So I made this as a reply to @BrahminBoss, and to help OP who wanted to remove Scarring or Acne Vulgaris (Acne).
OP didn't even react to my post jfl
Fuck you @shizuku11111
Anyways I think this will help a lot of you out. Information spans from around 30+ studies.. but I will be particularly focusing on two very special ones.
Both comparing the Fractional Co2 Laser and Nd-YAG Laser. Enjoy!
_______________________________________________________________________________________________________________________________________________
OP didn't even react to my post jfl
Fuck you @shizuku11111
Anyways I think this will help a lot of you out. Information spans from around 30+ studies.. but I will be particularly focusing on two very special ones.
Both comparing the Fractional Co2 Laser and Nd-YAG Laser. Enjoy!
_______________________________________________________________________________________________________________________________________________
Non-Ablative resurfacing devices improve photodamaged skin, but they don't do any epidermal damage, that Ablative resurfacing does. That's because they penetrate deeper. This damage done deeper, damages dermal tissue to occur wound responses. This leads to formation of new dermal collagen, also repairing any pre-existing tissue defects due to photoaging.
Now, as there is not much epidermal damage, there are less side effects with non-ablative resurfacing lasers.
Ablative Lasers (recommended for over 65):
- Fully Ablative CO2 lasers
- Er:YAG
Non-Ablative Lasers:
- 1,064-nm Q switched Nd:YAG laser
- 1,320-nm Nd:YAG laser
- Pulsed-dye lasers (585nm-595nm)
- many more ...
The Ablative lasers used to be very common, but down time is anywhere from 3-4 weeks to 3-4 months!!! They also DESTROY outer layers of skin.
So Fractional lasers were introduced, such as the Fractional CO2 laser. Downtime reduced to 1-2 weeks.
This is a fractional ablative laser.
A fractional non-ablative:
- Non-Ablative Erbium laser
- 1927 nm fractional thulium fiber laser (FTL)
I may make a thread about the differences between these two, in more detail, covering Fractional photothermolysis (FP), Microscopic Treatment Zones (MTZ), Stratum Corneum. You can use these two articles to learn a lot: Study 1, Study 2
Now, as there is not much epidermal damage, there are less side effects with non-ablative resurfacing lasers.
Ablative Lasers (recommended for over 65):
- Fully Ablative CO2 lasers
- Er:YAG
Non-Ablative Lasers:
- 1,064-nm Q switched Nd:YAG laser
- 1,320-nm Nd:YAG laser
- Pulsed-dye lasers (585nm-595nm)
- many more ...
The Ablative lasers used to be very common, but down time is anywhere from 3-4 weeks to 3-4 months!!! They also DESTROY outer layers of skin.
So Fractional lasers were introduced, such as the Fractional CO2 laser. Downtime reduced to 1-2 weeks.
This is a fractional ablative laser.
A fractional non-ablative:
- Non-Ablative Erbium laser
- 1927 nm fractional thulium fiber laser (FTL)
I may make a thread about the differences between these two, in more detail, covering Fractional photothermolysis (FP), Microscopic Treatment Zones (MTZ), Stratum Corneum. You can use these two articles to learn a lot: Study 1, Study 2
Study 1 for Acne Vulgaris was the first study to compare a fractional CO2 laser with Nd:YAG laser in acne vulgaris.
Test 1 was Count of lesions both Inflammatory and Non-inflammatory.
Test 2 used the Global Acne Severity Scale (0-5):
Test 3 used Goodman and Baron's Qualitative and Quantitative Acne scarring grading system (I-IV):
Test 1 was Count of lesions both Inflammatory and Non-inflammatory.
Test 1:
Post-1 month values of both Inflammatory and Non-inflammatory count for CO2 Fractional mog Post-3 month counts for Nd-YAG! Here it is in % Improvement:
Post-1 month values of both Inflammatory and Non-inflammatory count for CO2 Fractional mog Post-3 month counts for Nd-YAG! Here it is in % Improvement:
Test 2 used the Global Acne Severity Scale (0-5):
Test 2:
Same stuff as above obviously, but check out the range for this (it is more important). The Fractional Side has 0-2 range, and the Nd-YAG has 0-3 range (even after 3 months), which means one person at least has 3 - moderate:
Guess which side is Fractional Co2 and which is Nd-Yag:
i)
ii)
iii)
iv)
v)
vi)
vii)
viii)
Same stuff as above obviously, but check out the range for this (it is more important). The Fractional Side has 0-2 range, and the Nd-YAG has 0-3 range (even after 3 months), which means one person at least has 3 - moderate:
Guess which side is Fractional Co2 and which is Nd-Yag:
i)
ii)
iii)
iv)
v)
vi)
vii)
viii)
i) Fractional 4->1->0
ii) Nd-YAG 4->2->2
Disagree with ii) tbh would say 3->2->1. Still i) is better
iii) Nd-YAG 4->3->3
iv) Fractional 4->3->3
I don't get this btw, they said Fractional side range was 0-2 in tables, but this one is noted as 3.. I figure this was the cause of range 0-3 for the Nd-YAG though.
v) Fractional (prior not mentioned, would guess 4)->0->0
vi) Nd-YAG 3->0->0
vii) Fractional 5->1->1
viii) Nd-YAG 5->1->2, got worse 3months after
ii) Nd-YAG 4->2->2
Disagree with ii) tbh would say 3->2->1. Still i) is better
iii) Nd-YAG 4->3->3
iv) Fractional 4->3->3
I don't get this btw, they said Fractional side range was 0-2 in tables, but this one is noted as 3.. I figure this was the cause of range 0-3 for the Nd-YAG though.
v) Fractional (prior not mentioned, would guess 4)->0->0
vi) Nd-YAG 3->0->0
vii) Fractional 5->1->1
viii) Nd-YAG 5->1->2, got worse 3months after
Test 3 used Goodman and Baron's Qualitative and Quantitative Acne scarring grading system (I-IV):
Test 3:
For Acne scarring what OP wants improvement in @shizuku11111 , the results:
Qualitative: 6 people using Fractional reported good (1 of which excellent) compared to 2 for Nd-YAG, 3 months after.
Quantitative: Approx 70% Improvement (Fractional) compared to approx 40% Improvement (Nd-YAG).
For Acne scarring what OP wants improvement in @shizuku11111 , the results:
Qualitative: 6 people using Fractional reported good (1 of which excellent) compared to 2 for Nd-YAG, 3 months after.
Quantitative: Approx 70% Improvement (Fractional) compared to approx 40% Improvement (Nd-YAG).
Study 2 the first study to compare a fractional CO2 laser with Nd:YAG laser for Scar Atrophy, due to Acne Vulgaris. Group A recieved Nd-YAG laser and Group B recieved Fractional CO2 laser.
Mean percent of scar improvement at 6 months follow up was 31.9% in group A and was 46.6% in group B.
Some hyperpigmentation was noted, all of which was resolved.
Mean percent of scar improvement at 6 months follow up was 31.9% in group A and was 46.6% in group B.
Some hyperpigmentation was noted, all of which was resolved.
Only downside with CO2 Fractional Lasers would be that the recovery is longer and its slightly more painful, but it's worth it imo.
Study 2 burning sensation only lasted a few hours.
What is more permanent in nature is Hypopigmentation. In 2013 a study came out using Narrowband Ultraviolet B Targeted Phototherapy to repigment the affected areas of a dude who used laser to remove Black tattoo. I saw results, most of it is gone but looks like shit still. Dude was Fitzpatrick 5 and this was a result from Nd-YAG laser too.
But, in general, the Nd-YAG laser saw in a study, that hypertrophic scarring existed for only 3/1041 patients (following laser tatoo removal), with 4 others unsure of how they got it.
6.6% of Blacks (probably Fitzpatrick V-VI) got scarring (entire study opting laser initially for tattoo removal however).
Study 2 burning sensation only lasted a few hours.
Also they may cause Hyperpigmentation if you Fitzpatrick III (20-30% of the time) and definitely Fitzpatrick IV+ (100% of the time):
BUT, the Post Inflammatory Hyperpigmentation in Study 2 only lasted 3 weeks at maximum, and in ONLY 31.2% of cases. Most of the time Hyperpigmentation is chill, just stay indoors and away from UV rays. For other studies:
Why you thought Nd-YAG was the best?
Someone probably told you that therere is no dyspigmentation for Nd-YAG lasers. This study mentions that there were 0% cases of dyspigmentation. But, all 11 cases were Fitzpatrick I-III.
Don't get me wrong they look good and slightly better (from 39.2% improvement in a roughness analysis, 6months in), but I saw one of the pictures and the dude's scarring is still visible (albeit better skin smoothness). The guy is also white.
Someone probably told you that therere is no dyspigmentation for Nd-YAG lasers. This study mentions that there were 0% cases of dyspigmentation. But, all 11 cases were Fitzpatrick I-III.
Don't get me wrong they look good and slightly better (from 39.2% improvement in a roughness analysis, 6months in), but I saw one of the pictures and the dude's scarring is still visible (albeit better skin smoothness). The guy is also white.
BUT, the Post Inflammatory Hyperpigmentation in Study 2 only lasted 3 weeks at maximum, and in ONLY 31.2% of cases. Most of the time Hyperpigmentation is chill, just stay indoors and away from UV rays. For other studies:
- 55.5% and 11.1% at 1 and 6 months after treatment (PIH) for Fitzpatrick III to IV
- 92% of people developed PIH after treatment too. Completely resolved in approx 5 weeks. Fitzpatrick IV
- Mild PIH for 13 asians seen in 92% subjects, resolved fully in average 5 weeks
- 1 case of persistent hyperpigmentation in Encore treatment, fixed 4 months later
If you want to cure PIH, you can use Clobetasol propionate 0.05% or Fusidic acid cream. Results: 39% and 53.3%, respectively. The study that mentioed this also said: "The Fitzpatrick-skinphenotype did not appear to influence the risk of PIH". So take that as you will..
Other ways to prevent PIH after Fractional Laser:
. Keep in mind the patients were Asain (Fitzpatrick III-IV mostly).
Other ways to prevent PIH after Fractional Laser:
- Use of Petrolatum and topical corticosteroids: reduced incidence fo PIH (40%) compared to just Petrolatum (75%)
- Use of plateletpoor plasma gel in combination with fractional CO(2) laser (for Stretch Marks though)
- Use of Fusidic Acid Cream application after Beifuxin Gel after Laser (twice a day, 7 days after laser, wash crusty face day 7)
- Use of recombinant epidermal growth factor at concentration of 1ug/g (conflict of interest)
- Hydroquinone (for up to 6 months after)
- Tazarotene 0.1% cream
- 0.02% TA cream
- Azelaic acid
- Kojic Acid and Licorice Extract
- N-acetyl glucosamine
- Chemical peels are not really advised, but check out them with GA or salicylic acid (SA), that help dark-skinned acne patients with PIH
- and more
. Keep in mind the patients were Asain (Fitzpatrick III-IV mostly).What is more permanent in nature is Hypopigmentation. In 2013 a study came out using Narrowband Ultraviolet B Targeted Phototherapy to repigment the affected areas of a dude who used laser to remove Black tattoo. I saw results, most of it is gone but looks like shit still. Dude was Fitzpatrick 5 and this was a result from Nd-YAG laser too.
But, in general, the Nd-YAG laser saw in a study, that hypertrophic scarring existed for only 3/1041 patients (following laser tatoo removal), with 4 others unsure of how they got it.
6.6% of Blacks (probably Fitzpatrick V-VI) got scarring (entire study opting laser initially for tattoo removal however).
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