DERMATOLOGY AND AESTHETIC SURGERY

The Er: YAG laser is of special interest in dermatology and aesthetic surgery since it ablates and cuts tissue with surgical precision with minimal collateral thermal damage.
This is due to the wavelenght of the Er: YAG radiation (2940 nm) which is strongly absorbed by liquid water in tissue.
In our clinical applications the erbium laser has been used to treat various benign skin disorders, scars and wrinkles.
Over 100 patients were treated with the Er: YAG laser at the University Medical Centre of Ljubljana.
No special pre-treatment therapy was performed, except in skin-resurfacing cases.
Optimal laser parameters for treating various skin disorders, hypertrophic scars as well as for skin resurfacing were established.
The reported patient discomfort was mild, and recovery period relatively short.
No complications were observed.
We found the erbium laser as a perfect option for effective use in dermatology and aesthetic surgery.
This brochure is a report on the on-going clinical work with the Er:YAG laser system, which is being carried out at the University Clinical Centre of Ljubljana 1-6.
Pre-clinical experiments started in September 1994. In vitro experiments were first carried out on pig skin, afterwards also on dead human skin excised from different parts of the body, and finally on vital human skin, intended to be excised due to prior pathological observation. All samples were examined histologically. The influence of different laser parameters (energy and spot size of the laser beam, as well as the repetition rate) on skin was observed. The excised parts were stored in 10% formalin. The effect and influence of laser operation on skin organels was evaluated after histopathological observation of the excised skin.
Light microscopy of histological specimen (carried out by the Institute of Pathology, Ljubljana) revealed normal skin around the sharp laser "excision" of the tissue, with little thermal damage, which is extending less than 150 um from the excision border. Thermal damage around the excision was observed as coagulative necrosis of epidermal ceratinocytes, and denaturation of the extracellular organic material, like bundels of collagen and elastic fibers beneath the epidermis. Staining on special trichrom revealed opac-red "necrotic-like" degenerated material, clearly demarcated from the rest of the skin tissue. The depth of the penetration depends on the applied laser energy, and ranges from 30 um to 150 um.
Other changes were expressed as dilitation of involved vessels with limited intraluminal coagulative effect of blood serum and fluid extravasation with local "hyalinisation" of the tissue.
The clinical cases, presented in this brochure, are the result of 18-month experience with the Skinlight laser system at the University Eye Clinic of Ljubljana. By today, the Er:YAG laser has proven to be a very effective and precise tool for superficial skin ablation on a layer basis, with minimal and controllable thermal influence to the surrounding tissue. In addition, the laser offers the physician, by properly choosing the laser parameters, the unique ability to select between pure skin ablation and thermally induced coagulation.

1. Drnovsek - Olup B., Vedlin B. "The Use of Er:YAG Laser in Ophthalmoplastic Surgery", Lasers and Light in Ophthalmology, International Journal on Laser Applications in Ophthalmology, Kugler Publications Amsterdam/New York. (accepted for publication)
2. Drnovsek - Olup B., Vedlin B., Bartenjev I. "The Use of Er: YAG Laser for Benign Epithelial Skin Disorders", Lasers in Surg. and Medicine. (accepted for publication)
3. Bartenjev I., Drnovsek - Olup B., Vedlin B., Marincek M. " The Use of Er: YAG Laser for Different Benign Epithelial Skin Disorders", Proceedings of the 2nd International Symposium on Lasers in Dermatology, Ulm, Oct.1995; 24
4. Drnovsek - Olup B., Vedlin B. "The Use of Er: YAG Laser in Ophthalmoplastic Surgery", Abstract Book of the 14th Meeting of E.S.O.P.R.S., Utrecht, June 1996; 27
5. Drnovsek - Olup B., Vedlin B. "Er:YAG Laser in Ophthalmoplastic Surgery", Abstracts of the 5th International Congress on Laser Technology in Ophthalmology, Lugano, June 1996; 22.
6. Drnovsek - Olup B., Vedlin B., Bartenjev I. "The Use of Er: YAG Laser in Dermatology and Plastic Surgery", Proceedings of the International Laser Congress on Lasers at the Dawn of the third Millenium, Athens, Sept. 1996. (being printed)

CLINICAL APPLICATIONS Er:YAG LASER

NAEVUS EPIDERMALIS
HYDRADENOMATA PALPEBRARUM
MILIA PALPEBRARUM
VERRUCA SEBORRHOIC KERATOSIS
FIBROEPITHELIAL PAPILLOMATA
CHLOASMA LIKE PIGMENTATION
XANTHELASMAE
KERATOSIS ACTINICA
HYPERTROPHIC SCARS
ACNE SCARS
PERILABIAL WRINKLES
PERIOCULAR WRINKLES
TATTOOS

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