Comprehensive Non-ablative Laser Skin Rejuvenation Using a Novel 650 microsecond Pulsed Nd:YAG
1064nm Laser
Kevin S. Pinski, MD, Kayla Mannausa
Pinski Dermatology and Cosmetic Surgery, Chicago, IL
Presented at the American Society for Laser Medicine & Surgery Annual Conference 2017

Abstract
Background: A variety of energy-based devices have been used to treat acne.
However, all studies have been subjective and have not involved double-blind and
randomized controlled studies.
Aims: We undertook a randomized controlled study evaluating the use of a 650 usec
1064 nm Nd:YAG laser compared with a sham in the treatment of acne.

Background: Laser procedures for acne and acne scars have traditionally been postponed for at least 6 to 8 months after the end of
systemic isotretinoin therapy. Lower dosages with more modern laser devices having unique energy parameters of high power in

Affecting up to 50 million Americans annually, acne is the most common skin condition in the United States, according to the American Academy of Dermatology.
Acne is associated with physical and emotional scars and has
been linked to poor quality of life, depression, and anxiety.
More than 5.1 million people seek medical treatment for
acne, but satisfaction rates with therapy remain low. Topical
therapy, including retinoids and benzoyl peroxide, is often
first-line therapy for acne, but topical drugs can be ineffective,
take many weeks to start working and are associated with
side effects such as sun sensitivity, skin dryness and irritation.

OBJECTIVES To evaluate the safety and efficacy of a microsecond 1,064-nm neodymium-doped yttrium
aluminum garnet (Nd:YAG) laser for the treatment of facial telangiectasias.
METHODS Subjects ages 35–70 with Fitzpatrick skin types I to III and facial telangiectasias underwent two
treatments with a micropulse (0.65 ms) 1,064-nm Nd:YAG laser. Treatments were spaced 30 days apart, with a
final evaluation 60 days after the second treatment. Evaluation included digital photography and an
assessment of the degree of improvement on a scale from 1 to 5 by the subject and a nontreating investigator.

Abstract Background and objective: This study was conducted to evaluate the clinical efficacy of laser hair removal using a novel 650-microsecond pulsed Nd:YAG 1064 nm laser. Materials and Methods: Patients seeking laser hair removal with no prior laser hair removal treatment in the past one year were recruited from a dermatology clinic. A total of 298 adult subjects with skin types II-IV, received an average of 6 treatments at four-week intervals in various body locations including the facial, axillary, back, neck, arms, legs and bikini areas. At each four-week follow up and at six months post final treatment, an analysis of the clinical improvement as defined by percent hair reduction was performed.

Abstract Background and objective: This study was conducted to evaluate the clinical efficacy of laser hair removal using a novel 650-microsecond pulsed Nd:YAG 1064 nm laser. Materials and Methods: Patients seeking laser hair removal with no prior laser hair removal treatment in the past one year were recruited from a dermatology clinic. A total of 298 adult subjects with skin types II-IV, received an average of 6 treatments at four-week intervals in various body locations including the facial, axillary, back, neck, arms, legs and bikini areas. At each four-week follow up and at six months post final treatment, an analysis of the clinical improvement as defined by percent hair reduction was performed.

Summary
The treatment of acne, especially severe acne, remains a challenge to dermatolo-
gists. Therapies include retinoids, antibiotics, hormones, lights, lasers, and various
combinations of these modalities. Acne is currently considered a chronic rather than
an adolescent condition. The appropriate treatment depends on the patient and the
severity of disease. The purpose of this study was to review current therapies for
acne of all severities and to introduce the 650-ls 1064-nm laser for the treatment
of acne.

Individuals with skin of color are a rapidly growing portion of the cosmetic procedures market. There are unique challenges to treating
skin conditions in skin of color patients. This article and roundtable discussion focus on the use of energy-based modalities, particu-
larly a 650-microsecond 1064nm laser that delivers energy in a collimated beam. Alone or in combination with other therapies, the
650-microsecond 1064nm laser has been used successfully to treat melasma, acne, postinflammatory hyperpigmentation, pseudofol-
liculitis barbae, hair removal, acne keloidalis nuchae, and aging skin in skin of color.

Onychomycosis is a common disorder of the nails. Treatment modalities include oral and topical antifungals, surgical treat-
ment or a combination of these therapies. Cure rates remain low with relatively high relapse rates seen after successful
treatment. The purpose of this study was to evaluate the treatment of onychomycosis using a novel 0.65-millisecond (ms)
pulsed 1064-nm laser. Eight subjects were treated over two to three sessions spaced at least 3 weeks apart. Of the eight
subjects evaluated, seven had negative post-treatment cultures after the second or third session. Treatments were well toler-
ated by all subjects. These data suggest that treatment of onychomycosis with a 0.65-ms pulsed Nd:YAG 1064-nm laser
should be studied further to determine the long-term clinical and microbiologic effect. The optimal number of treatment
sessions for each patient needs to be determined.

Pseudofolliculitis barbae
(Pfb) is a chronic foreign body
inflammatory reaction to the
hair shaft, predominantly seen in
individuals with coarse, curled hair
who shave regularly. black persons
are genetically predisposed to curly
hair and curved hair follicles which
confer a much higher risk of Pfb.
an additional genetic risk factor
has been identified as an ala12thr
polymorphism in the 1a alpha-
helical segment of keratin K6hf.1 the
prevalence rates of Pfb in the united
states range from 10% to 83%

Background: Phototherapy is a safe and effective modality for the treatment of mild to moderate psoriasis.
Objectives: To compare the efficacy and safety of the 650-microsecond, 1064-nm pulsed YAG laser with the excimer laser for the treat-
ment of mild to moderate psoriasis vulgaris of the arms and legs.
Methods: Eligible subjects (n=15) aged 54.3 ± 11.7 years enrolled in a randomized, investigator-blinded study. Psoriatic plaques on one
side of the body were treated with the 650-microsecond laser and plaques on the other side were treated with the 308-nm excimer
laser. Subjects made up to 15 visits, twice weekly, or fewer if full clearance was achieved. Efficacy and tolerance were evaluated by the
mPASI scores and local skin reactions, respectively.

Psoriasis is a chronic immune-mediated inflammatory
disease that can significantly affect a person's quality of
life and may be associated with serious comorbidities.
Affecting more than 8 million Americans, psoriasis is charac-
terized by erythematous papules and plaques covered with
silvery scales. Multiple factors contribute to its etiology and
pathogenesis, including genetics. It has been hypothesized that
the disease starts with the activation of T cells by an unknown
antigen, which leads to secretion of an array of cytokines,
inflammatory cells, and keratinocytes.

Background and objective: The erbium:YAG laser is a popular modality for laser skin resurfacing (LSR). This study was
performed to evaluate the safety and efficacy of a new portable Er:YAG laser in the treatment of photo-damaged skin.
Methods: Nine patients with skin types I–IV were treated for rhytides, large pores, pigmented lesions, lentigines and photo-
damage.

Laser resurfacing of facial rhytids has become
a popular treatment option for many patients
who have wrinkles, photodamage, and acne scar-
ring. Laser wavelength, pulse duration, and newer
techniques continue to shorten the healing phase
associated with laser skin resurfacing while main-
taining clinical efficacy [1–9]. Erbium:YAG laser re-
surfacing has emerged as one of the safer, more
effective methods of facial rejuvenation compared
with other modalities, such as carbon dioxide laser,
with shorter recovery time and better treatment out-
come [1].
Author's

The Nd:YAG 1064 nm has become the gold standard la-
ser modality for safely treating all skin types and specif-
ically skin of color. The 1064 nm laser technologies with
ultra long pulse durations generally require anesthetics as well
as skin cooling in order for patients to tolerate the treatment.
The use of anesthetics and gels can involve considerable time,
cost and mess.

Individuals with skin of color are the majority in California, New Mexico, and Texas and will soon will be the majority in Arizona, Nevada, Georgia, New York, and Florida. By 2050,
more than 50 percent of the US population will have skin of
color, according to the Skin of Color Society.1

A 39-year-old, healthy Caucasian female
presented to the dermatology o!ce with a
non-itchy, painless bump on her "nger that
had been increasing in size for the past few
months. Physical examination revealed a
2 mm, #esh-colored, "rm, hyperkeratotic,
verrucous papule with disruption of normal
skin markings and display of small black
dots on the right middle "nger, close to the
nail. A clinical diagnosis of verruca vulgaris
was made, and the patient received multiple
treatment sessions using liquid nitrogen for
wart destruction.

Objective: The objective of this paper is to present observational data to support the premise of using a 650-microsecond
Nd:YAG 1064 nm laser for wound healing.

Acne is one of the most common and challenging skin diseases
for patients and skincare specialists. Treatment typically requires
a multi-modal approach involving the use of topical and oral
medications to help reduce breakouts and prevent long-term
scarring. As the healthcare industry as a whole works to expand
antibiotic stewardship programs and isotretinoin—the most
effective non-antibiotic oral medication for acne patients—
remains heavily regulated, laser and light sources are again
generating interest as alternative acne treatment tools.