Optimizing Outcomes With the 1550/1927 nm Dual Wavelength Non-Ablative Fractional Laser: Experienced User Recommendations

November 2021 | Volume 20 | Issue 11 | Original Article | 1150 | Copyright © November 2021


Published online November 1, 2021

doi:10.36849/JDD.6181

Paul M. Friedman MD,a Anne Chapas MD,b Suzanne L. Kilmer MD,c Zakia Rahman MD,d Wendy Roberts MD,e E. Victor Ross MD,f Jill S. Waibel MD,g Jeffrey S. Dover MD FRCPCh

aDermatology and Laser Surgery Center, Houston, TX
bUnion Square Laser Dermatology, New York, NY
cLaser & Skin Surgery Center of Northern California, Sacramento, CA
dStanford University, Stanford, CA
eRancho Mirage, CA
fLaser and Cosmetic Dermatology Center, Scripps Clinic, San Diego, CA
gMiami Dermatology and Laser Institute, Miami FL
hSkinCare Physicians, Chestnut Hill, MA

Abstract
Background: Fractional laser treatment was introduced in 2004 as a non-invasive technique to treat sun-damaged and aging skin. Since then, numerous ablative and non-ablative photothermolysis technologies and devices have been introduced, increasing the options for clinicians and patients but also increasing the complexity regarding which system to use and the techniques to optimize outcomes. No two devices are the same and the user-manuals preset dosimetry does not address many clinical situations, which can create confusion for new and inexperienced users.
Methods: An online survey addressing use of a 1550 nm /1927 nm dual wavelength, non-ablative, fractional laser was sent to eight (8) US board certified dermatologists with extensive experience in the use of the device. The survey included 39 questions, addressing experience, best practices and recommendations for use.
Results: The survey data suggests that the device can be used to treat patients of all ages and skin types for indications including photoaging and photodamage, periorbital wrinkles, freckles, (ephelides), solar lentigines, poikiloderma, scarring due to acne or surgery. It can be used on both facial and non-facial areas, including neck, chest, hands, arms, abdomen, legs, and buttocks. Unexpected and adverse effects were rarely reported and those that did were mild and transient.
Conclusions: This position paper provides practical real-world guidelines resulting from a small survey of experienced users, for new and early uses of the novel 1550 nm /1927 nm dual wavelength, non-ablative, fractional laser.

J Drugs Dermatol. 2021;20(11):1150-1157. doi:10.36849/JDD.6181

INTRODUCTION

Skin resurfacing with laser devices has become a popular non-surgical rejuvenation option for photodamaged skin. Dermatologic lasers in common use include ablative and non-ablative devices in both fractionated and unfractionated forms as well as radiofrequency technologies. This article presents results of an online survey highlighting the best practices of physicians with collective experience of approximately 50,000 treatment procedures, using the fractionated, non-ablative dual wavelength 1550 nm erbium doped glass fiber/ 1927 nm thulium fiber laser (Fraxel Dual®, Solta Medical, Hayward, CA). Although the safety and efficacy of this device has been demonstrated in clinical studies2-8 and in routine clinical practice since 2009, the multiple treatment setting options can be complex for new users.

These recommendations aim to simplify and provide realworld guidance in order to achieve optimal aesthetic outcomes.

Although we suggest how to optimize use of the 1550 nm/ 1927 nm dual wavelength, non-ablative, fractional laser, the recommendations should not replace an in-depth understanding of laser-tissue interactions, the technical user manual and hands-on training. Furthermore, the recommended techniques are applicable to the majority of patients, but each patient deserves customized treatment settings.

MATERIALS AND METHODS

The recommendations were developed from the results of a 39-question survey tool developed by Solta Medical and reviewed by the authors. Questions covered topics ranging
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