Evaluation of the Affirm CO2 Micro Ablative Laser for the Treatment of Photoaging

Bruce Katz, MDShari Marchbein, MD

JUVA Skin & Laser CenterNew York, NY

Introduction:Chronic sun exposure can lead to skin changes, especially in the face. Photodamage presents as

excess blood vessels on the cheeks, chin, and nose, as well as hyperpigmentation, wrinkles, enlarged pores, and sagging skin. Lasers have been used to successfully repair sun-damaged skin for many years. Ablative solutions, such as with carbone dioxide (CO2) and Erbium (Er:YAG) have been known to create the most significant improvements as they ablate the surface of the skin resulting in improvement of the dermal extra cellular matrix and epidermal changes.

Although the CO2 laser is considered the gold standard device for ablative resurfacing, treatments with this technology are also associated with long periods of downtime, thermal damage, cell death and scarring, especially when pulses are overlapped.1 Other complications include prolonged erythema, hyperpigmentation, acne flares, milia formation, and dermatitis.2

In an attempt to leverage the performance of CO2 technology while minimizing downtime, micro ablative lasers were developed. Micro ablative technology removes only a fraction of the photodamaged skin at any one treatment session, leaving intact skin in between the zones of damage. Since only a portion of the skin is treated, the therapy leads to excellent outcomes.

A novel micro ablative CO2 laser, Affirm CO2 (Cynosure, Inc.), now offers versatile options for the treatment of signs of photoaging. The Affirm CO2 selectable parameters are: • Power (up to 30 Watts): Accounts for the depth of

ablation of approximately 300 μm.

• Dwell time (200 – 2,000 μs in micro ablative mode; 200 – 20,000 μs in standard mode): Influences the amount of thermal injury surrounding the ablative pulse, stimulating neo-collagenesis.

• Spot pitch (0.0 – 2,000 μm): Determines the distance between each micro ablative spots. At 0.0 mm, the Affirm CO2 is set in “standard mode” where 100% of the treated surface is ablated.

Affirm CO2’s unique pulse configuration combines high peak power to affect the depth of ablation with a long pulse width that creates lateral thermal injury for collagen rejuvenation.

The objective of this study was to evaluate the performance of the Affirm CO2 micro-ablative laser in the treatment of photoaging including wrinkles, pigmentation and skin laxity.

Methods:Five subjects with skin types I-III seeking improvements in wrinkles, skin tone and/or skin laxity received 1-4 facial treatments; 2 passes each at 2-3 week intervals. The initial treatment was performed using a power ranging from 15–20 Watts, a dwell time of 500-750 ms and spot pitch of 500–600 μm. Topical anesthetic (Lidocaine 30%) was applied on the area to be treated 20-30 minutes prior to the treatment. Patient’s skin was cooled during the procedure to enhance comfort with the SmartCool (Cynosure, Inc.) and afterward with ice. Aquafor was applied to keep the treated surface moist.

A typical case report: A 57 year old female with skin type II presented with photoaged skin that included rhytides, enlarged pores, pigmentation and skin laxity. Prior to the treatment, the skin was cleaned to remove any make up or skin lotion. Lidocaine 30% anesthetic cream was applied on the face for 20-30 minutes prior to the treatment. Treatment was administered using a power of 15 Watts, dwell time of 500 microseconds and spot pitch of 500 microns. The SmartCool air cooling system was also used at a speed of 3. Post treatment, Aquaphor was applied to the treated area and ice packs were used for 10-20 minutes post procedure. The patient was advised to gently clean the area and reapply Aquaphor 3-4 times for the first 24 hours. Erythema was present for the first 2-3 days post-treatment, but the patient was able to apply make-up and resume her normal activities after only one day.

Figure 1: Before treatment. (Photo courtesy of B. Katz, MD) Figure 2: After 3 weeks post second treatment. Improvement of Rhytides, skin laxity and pigmentation. (Photo courtesy of B. Katz, MD)

Cynosure, Inc. | 5 Carlisle Road, Westford, MA 01886 | 800.886.2966 | www.cynosure.com p/n: 921-0120-000

Results: Treatment was well tolerated by all five subjects. Initial treatments administered at lower energies yielded to less downtime for patients. However, additional treatments were required to achieve desired aesthetic results.

Common adverse effects were limited to mild erythema and edema, which dissipated within 24 -36 hours. Patients treated at higher settings reported mild weeping and crusting. There was no incidence of scars or dyschromia (hyperpigmentation or hypopigmentation). The study showed a positive correlation between energy level and downtime.

Conclusion:The Affirm CO2 micro ablative system provides significant improvement for the treatment of wrinkles, skin texture and skin laxity. The versatility of the settings, including power, dwell time and spot pitch along with the scanner’s flexibility allow for customized outcomes. In particular, the adjustable dwell time application shows promises and warrants further investigation. Additional clinical applications are being investigated to include treatment of a variety of scars, and pigmentation. The Affirm CO2 combines the performance of the CO2 technology with the benefits of minimal downtime. References:1. Ross EV, Barnette DJ, Glatter RD, et al. Effects of overlap and

pass number in CO2 laser skin resurfacing: a study of residual thermal damage, cell death, and wound healing. Lasers Surg Med 1999;24:103-112.

2. Nanni CA, Alster TS. Complications of carbon dioxide laser resurfacing. An evaluation of 500 patients. Dermatol Surg 1998;24:315-320.