Determination of Optimal Parameters for Laser for Nonablative Remodeling with a 1.54 μm Er

BACKGROUND Nonablative subsurface heating is a challenge for medical laser companies. Among the different lasers proposed today, the erbium-glass (Er:glass) laser combined with contact cooling could be an alternative for nonablative remodeling. OBJECTIVE To investigate the risk of side effects according to the quality of cooling and number of pulses. METHODS A clinical evaluation was performed on 10 patients using an Er:glass laser (1.54 μm) with contact sapphire cooling handpiece (+5°C). Periorbital and perioral areas were treated with a number of pulses increasing gradually from three to eight for a total energy of 24–64 J/cm2. The presence or absence of swelling, crust, blister, and erythema were graded at 7 days. At 3 months postoperatively, hypopigmentation, hyperpigmentation, textural changes, and scars were evaluated clinically. RESULTS Periorbital and perioral areas respond differently to the number of pulses defining a "safe" clinical threshold. The periorbital site is very sensitive to dermal heating and efficacy of contact cooling; the anatomic features of this body location may explain these differences. CONCLUSION Selective dermal heating can be achieved with an Er:glass laser coupled with a contact cooling handpiece. The quality of the contact cooling and the number of pulses appear to be important parameters for safety and reproducible clinical results.