Fractional CO2 Laser Skin Resurfacing: Wrinkle & Acne Scarring Improvement

Fractional CO2 Laser Skin Resurfacing:

Results Comparing Platelet Rich Plasma, Alastin, & Human Stem Cell Protein Cytokines to Conventional Post-Treatment (Presented at the American Academy of Cosmetic Surgery annual meeting 2017)

Robert J Troell, MD, FACS Beauty by Design, Las Vegas NV. Stanford University Medical Center, Facial Plastic & Cosmetic Surgeon, Diplomate of six medical specialty boards

This clinical study was examining the goal of most aesthetic treatments:

1. cosmetic results
2. severity & length of the recovery period
3. side effects & possible complications.

Study Hypothesis:

Can the topical application of autologous platelet rich plasma (PRP) improve the result from Carbon Dioxide (CO₂) Facial Skin Resurfacing?

Can PRP reduce the severity and length of the recovery period with comparable laser energy settings?

Can the PRP reduce the incidence of side effects and complications, specifically scarring and hyperpigmentation?

Can adding Alastin and a Human Stem Cell protein cytokine product to the post-treatment skin regimen affect the result, recovery and complications?

This comprehensive laser clinical study evaluated of over 250 patients and has been evolving over the past ten years. I have been searching for the best skin resurfacing device and post-treatment regimen.

Dr Troell performing CO2 laser skin resurfacing using the DEKA Smartxide Fractional Laser followed by Platelet Rich Plasma topical application & Alastin Tripeptide & Hexapeptide Pos-Treatment application

Background:

What currently available medical device is best in treating facial wrinkles and acne scarring?

Carbon Dioxide (CO₂) laser.

I have compared radiofrequency devices, fractional erbium-YAG lasers, and Carbon Dioxide (CO₂) lasers for wrinkle and acne scarring treatment. These procedures were performed alone or adding topical platelet rich plasma (also adding dermal needling with radiofrequency).

The Carbon Dioxide laser outcomes were superior for wrinkle and acne scarring indications. Another study has confirmed the superior results with the CO₂ laser. They showed that an Erbium:YAG  laser (2940 nm) is superior for improving hyperpigmentation and revealed that these lasers are comparable regarding skin tightening (Preliminary Observations on Fractional Ablative Resurfacing Devices: Clinical Impressions: J Waibel, K Beer, V Narurkar, T Alster. J Drugs Derm, 2009, Vol 8(5), 481-485).

However, in patients with Fitzpatrick Classification type V and VII were preferably treated with a radiofrequency device (either Venus Viva, Matrix RF, or Fractora) to minimize the risk of post-treatment hyperpigmentation.

Does the specific CO₂ laser produced by different manufactured make a difference?

Yes.

The DEKA laser revealed less discomfort during the treatment, more rapid recovery, and better aesthetic overall results.

DEKA, Equinox and Lutronic CO₂ lasers were compared concerning aesthetic outcome, length and severity of recovery, and discomfort during treatment. All these study variables were followed by the Equinox and lastly the Lutronic CO₂ laser.

Dr Troell now exclusively uses the DEKA Smartxide CO₂ laser. From a previous conversation, according to the president of DEKA North America, Dr Troell has the largest clinical study in the United States with over 200 patients treated with the DEKA laser for skin resurfacing for solar damage creating wrinkles as well as acne scarring.

Another study confirmed the superiority of the DEKA laser for texture, rhytid improvement and overall appearance over all other studied CO₂ and Erbium-YAG lasers (Preliminary Observations on Fractional Ablative Resurfacing Devices: Clinical Impressions: J Waibel, K Beer, V Narurkar, T Alster. J Drugs Derm, 2009, Vol 8(5), 481-485).

Current Study Findings:

Does the topical application of autologous platelet rich plasma (PRP) immediately post-laser treatment alter the studied variables?

Yes.

The advantages of PRP include:

1. the duration and severity of erythema of the recovery process was shortened
2. less skin hyperpigmentation was noted
3. subjective and objective outcomes revealed better aesthetic outcomes (less wrinkles & much improved acne scarring). The objective outcomes were assessed by using Enhanced Image Pro system. It revealed 10-15% less wrinkles compared to conventional post-treatment occlusive treatments and moisturizers alone.

A previous study showed Platelet Rich Plasma (PRP) taken from each patient’s own blood applied after Carbon dioxide treatment resulted in:

1. Faster recovery
2. Less erythema index
3. Less melanin index (hyperpigmentation)
4. Induced more blood vessel formation (angiogenesis)
5. Increased collagen production by biopsies.

(Rapid Healing and Reduced Erythema after Ablative Fractional Carbon Dioxide Laser Resurfacing Combined with the Application of Autologous Platelet-Rich Plasma, Jung-IM, NA, Jee-Qoong C, Hye-Ryung C, Jeong-Bok, J, et al. Dermatologic Surgery, 2011).

Is there any benefit adding Alastin as an extracellular matrix modulator to the platelet rich plasma (PRP) and post-treatment skin care regimen after CO₂ laser skin resurfacing?

Yes.

The advantages combining the Alastin cream to the PRP after laser treatments:

1. subjective improvement in aesthetic outcome
2. shorter duration of the recovery period
3. less erythema observed during the recovery period        The Alastin Skin nectar is a unique product of an anhydrous formulation of a tripeptide and hexapeptide with histological demonstration of ECM recycling with increased production of elastin and collagen.

Alastin Extracellular Matrix Modulator Proposed tissue mechanism:

The peptides and synergistic additional ingredients have been shown to recycle the extracellular matrix (ECM) and support skin structure and elasticity. They support the skin’s natural ability to produce new, healthy elastin and collagen.

The specific observations on skin biopsy from Alastin treatment include:

• More organized, younger collagen fibers replacing mature older fibers
• Increases in pro-collagen and collagen
• Thickening of the outer skin layer (epidermis)
• More functional cells observed in the skin (at dermo-epidermal junction)
• Increases in elastin fibers

The laser tissue trauma produces fragments of collagen amorphous elastin agglutination and abnormal cross-linkages between collagen fibers. This tissue reaction impedes some of the extracellular matrix’s (ECM) normal complex repair processes. The tripeptide and hexapeptides incorporated in Alastin Skin nectar are designed to target ECM modulation. The stress induced oxidation, proteasome dysfunction, and non-enzymatic cross linkages involved in glycation end products are combated by peptides, known as “matrikines”. The Tripeptide is a “matrikine” which specifically activates the production of metalloproteinase and anti-proteases that remove damaged proteins from the ECM. The end result is upregulated neocollagenesis and elastin production. The Hexapeptide is a signal transduction cytokine that stimulates the generation of elastin.

Summary:

Carbon dioxide laser skin resurfacing yields the most optimal skin resurfacing results in patients with wrinkles and acne scarring. The DEKA CO₂ laser appears to be the best currently available aesthetic laser studied for these indications. The addition of autologous platelet rich plasma (PRP) along with the Alastin tripeptide and hexapeptide extracellular matrix modulator system shortens the severity and length of the recovery period, lowers the incidence of hyperpigmentation, and improves the overall post-treatment result. Continued testing with the addition of Human Stem Cell protein cytokines (Stemulation Facial Serum by Stemulation or Regenica Dual Serums by Suneva Medical, Inc.) appears to further hasten healing and yield improved aesthetic outcomes.