"One of the things I noticed with PSR is that with low-energy treatment, one feels almost nothing while the treatment is going on. But afterwards, there's a tremendous feeling of warmth and erythema," says Eric F. Bernstein, M.D., director of Laser Surgery and Cosmetic Dermatology Centers in Bryn Mawr, Pa., and New Jersey, and clinical associate professor of dermatology, University of Pennsylvania. He also performed the study.
To test his hypotheses — and to investigate whether very low-energy PSR treatments can provide quantifiable improvement in photodamage with no downtime — Dr. Bernstein performed a study at half of the lowest energy level that was then available with the device.
"The machine went from 1 to 4 joules (J), but I treated at 0.5 J, because my opinion is that less can be more. So, I performed multiple treatments at a lower energy level," Dr. Bernstein tells Dermatology Times.
Twelve female patients with cutaneous photodamage participated in the study, which took place in a single site under Institutional Review Board approval. Patients' ages ranged from 44 to 68 years (mean: 55).
Before each treatment, Dr. Bernstein applied topical anesthesia (L.M.X. 4, lidocaine; Ferndale Laboratories) for one hour. Afterward, he treated patients' entire faces using 0.5 J per pulse. Patients underwent a total of three treatments, spaced three weeks apart.
Dr. Bernstein conducted follow-up visits on the fourth day after each session, as well as one and three months after patients' third treatment. During these visits, he and the subjects rated results in terms of texture, wrinkle severity and overall improvement on a five-point scale.
Patients also rated discomfort the procedure produced, and their own satisfaction after their final treatments.
All subjects tolerated the treatment well, Dr. Bernstein says. In fact, subject-assigned discomfort scores averaged 0.65 (range: zero to 2.5). Equally important, he says most subjects were able to apply makeup or shave within one day of treatment, while patients' average time of flaking/peeling was one day.
"Nobody experienced any downtime," Dr. Bernstein says, "and patients were pleased with the results."
Specifically, subjects rated their skin to be 48 percent (mean) improved three months after their final treatment. Regarding texture, patients' mean scores on the five-point scale climbed from 2.42 before treatment to 2.63 three months after, actually peaking at 3.04 on day 30.
Ninety days post-treatment, subjects rated their satisfaction level at 2.38 (moderately satisfied to satisfied). And 11 of 12 subjects said they'd recommend the procedure to a friend.
Similarly, physician-assigned average wrinkle severity scores improved by 32.54 percent during the course of the study. They declined from 4.25 (on a nine-point scale) before treatment to 3.08 one month after final treatment and 2.92 at day 90.
The above results proved encouraging enough that at press time, Dr. Bernstein had almost finished a second study incorporating three-dimensional topographical imaging (Primos, Canfield) to help gauge treatment efficacy.
"Primos topographic imaging should best measure potential changes in rhytids, which are three-dimensional but do not vary in color from surrounding skin.
"This system is one of the best ways to measure improvement in rhytids," he says.