Fractional Laser Santi Devina Pembimbing : dr. Lynda Hariani, Sp. BP-RE Textbook Reading 12 Februari 2016

Light Amplification by the Stimulated Emission of Radiation DEFINISI Light Amplification by the Stimulated Emission of Radiation ~ Perangkat yang memancarkan cahaya melalui proses amplifikasi optik berdasarkan stimulasi emisi dari radiasi elektromagnetik

KARAKTERISTIK LASER Monochromaticity Directionality Coherence

Grabb & Smith Plastic Surgery, ed 7

ELEMEN DASAR PADA LASER

MEDIUM LASER

Ablative CO2 Laser ~ Gold Standard??? Prolonged healing time Intensive follow-up Significant complication risks High incidence of residual hypopigmentation Unimpressive results for acne scars Counterindication of use for darker skin types Limitations of use for the face only

TIPE LASER

Thermal Injury Zone

Microscopic-sized Thermal Injury Zones

KEUNGGULAN FRACTIONAL LASER Heals in 24 hours Ideal for acne scars Improve skin texture and tightness Appliable for neck, chest, back, extremities Appliable in higher Fitzpatrick skin types Less pain Lower incidence of hypo/ hyperpigmentation

FRACTIONAL LASER, APA SAJA? Infrared-wavelength lasers (1,540–1,550 nm) Er:YAG 2,940 nm CO2 lasers 10,600 nm Nd: YAG Er:glass 1,550 nm Erbium fiber Radiofrequency wavelength

Energy (mJ) = Power (W) x Pulse width (ms) LASER SETTING Spot size >>  Penetrasi ke dalam >>  Nyeri >> Untuk mengurangi nyeri bisa dengan menurunkan Pulse width  less coagulation and crusting  less thermal effect  less effective for skin tightening and superficial lines Energy (mJ) = Power (W) x Pulse width (ms)

IDEAL FRACTIONAL LASER Minimal power 30 W Offer both a smaller and a larger spot size Offer operator-adjusted pulse Widths up to at least 2 ms Offer adjustable treatment densities

INDIKASI Photodamage Rhytids Acne scars Surgical scars Traumatic scars Melasma Striae

FITZPATRICK SKIN TYPE

Palomar 1540 nm

Fraxel Erbium doped 1550 nm

Er:YAG 2940 nm

CO2 Fractional Laser 10,600 nm

KOMPARASI ANTAR LASER

Komplikasi Perdarahan bintik Krusta Nyeri (minimal) Infeksi Hypertrophic scar

KESIMPULAN Fractional Laser merupakan jenis laser yang memiliki keuntungan lebih cepat masa penyembuhannya dan dapat dipalikasikan lebih luas dibanding laser ablatif. Fractional Laser memiliki respons yang baik terhadap kulit dengan penuaan dan kerutan, bekas luka, dll.

Referensi Eremia, S. Cosmetic Application of Light, Radiofrequency, and Ultrasound Energy, Part 4 of Office-based Cosmetic Procedures and Techniques. 2010. New York : Cambridge University Press. Low DW, Percec I. Laser in Plastic Surgery, Chapter 18 of Grabb and Smith Plastic Surgery ed 7. 2014. Philadelphia : Lippincott-William and Wilkins. Saryazdi S, Mohebbi A. Evaluation of Fractional CO2 Laser Efficacy in Acne Scar. Journal of Lasers in Medical Sciences Volume 3 Number 2. 2012. Cassuto DA et al. An Innovative Device for Fractional CO2 Laser Resurfacing: A Preliminary Clinical Study. The American Journal of Cosmetic Surgery Vol. 25, No. 2. 2008. Avram MM et al. Hypertrophic Scarring of the Neck Following Ablative Fractional Carbon Dioxide Laser Resurfacing. Lasers Surg Med. 41(3): 185–188. 2009. Wolfenson M, Filho FCN. Scar Treatment with Fractional Laser. Journal of Plastic and Reconstructive Surgery. 2012.