Stretching fractional laser indications

July 1, 2007

Fractional photothermolysis provides a safe and effective option for treating striae distensae - particularly older, white striae that don't respond to other modalities, says a leading Brazilian cosmetic surgeon.

Key Points

"Patients commonly ask what they can do about striae. I haven't seen results in other modalities of treatment," says Otavio Macedo, M.D., a cosmetic surgeon in private practice in São Paulo, Brazil.

More specifically, he says existing ablative and nonablative approaches are either limited by postoperative morbidity (namely pigmentary alterations) or offer minimal degrees of improvement. However, he says his success in treating acne scars with fractional photothermolysis inspired him to consider using this modality for striae, another form of scarring.

To test this modality, Dr. Macedo says he initiated a study involving 15 female patients of skin types I through V, ages 15 through 50, with a variety of striae.

He and several colleagues gave each patient five successive treatments at two-week intervals with a 1,550 nm erbium-doped fiber laser (Fraxel SR Laser, Reliant Technologies). Treatment sites included the abdomen, lateral thighs, breasts, back and waist, all treated with the same protocol that would be used for acne scars, that is, 12 to 22 millijoules/microthermal zone (MTZ) and a final density of 2,000 MTZs per cm2, Dr. Macedo tells Dermatology Times.

In this trial, patients used no topical treatments for their striae one month before treatment, as well as during or for one month after, he adds. However, researchers did give patients topical anesthetic ointment one hour before treatment and used a dynamic cooling air device during each session to minimize patients' discomfort. Physicians prescribed sunscreen during the treatment phase.

To evaluate results, nontreating physicians analyzed clinical photos taken before and after each treatment. Additionally, Dr. Macedo says patients filled out satisfaction surveys at each follow-up visit.

All 15 patients completed the full five sessions, after which the appearance of their striae generally improved, although results were best in fresher and more superficial striae, Dr. Macedo says.

EVEN SOME OLDER STRIAE IMPROVE

Based on photographic analysis and patient surveys, 20 percent of patients showed "very good" overall improvement in the clinical appearance and texture (size, width and elasticity) of their striae, while 30 percent achieved "good" improvements and 40 percent achieved "regular" improvements, Dr. Macedo says.

Only 10 percent of patients - those with very old striae and significant skin flaccidity - got poor results, he adds.

Overall, he says, "We saw good results not only in young people, but also in patients over 40."

Dr. Macedo says he did not expect the "amazing" improvements observed in old, white striae, which can be difficult to treat.

Conversely, he says that with red striae, "We've gotten results with retinoic acid and other lasers."

ADDITIONAL ADVANTAGES

Another advantage of fractional photothermolysis is its lack of downtime, which allowed patients to return to work and social activities almost immediately, Dr. Macedo adds.