有朋友問起，究竟什麼是靚顏光？為什麼其它醫師使用的是淨顏/淨膚雷射？
這部份其實有很重的「技術成份」在內—或者說，智慧財產權？
極緻皮膚專科診所2005年引進淨膚雷射技術後，經過三千多次的治療經驗之後，發現臺灣人（特別是臺北人）的膚質有些特異處—相較於淨膚雷射技術的發源地新加坡，臺北的氣候更加冷熱明顯，四季乾濕分明；肌膚於淨膚雷射術後照顧其實有些困難。如果完全以傳統淨膚雷射手法治療，效果不足將導致治療次數增加。如果加強治療，可能導致肌膚過度乾燥，或者出現「色素不均」的現象。
因此我們根據皮膚生理學與雷射光電組織學原理，將532奈米、1064奈米與2940奈米三種不同雷射波長混合使用於所謂「淨膚雷射」治療中，使得治療效果更好，肌膚刺激卻更溫和。
532奈米的國外治療經驗顯示，黃種肌膚接受532奈米治療，褪黑/紅效果甚快，但容易術後反黑；2940奈米肌膚緊緻效果一流，還是有反黑疑慮。經過特殊設計的532+1064+2940奈米雷射療程，可以減少約30%的治療劑量，因此不曾產生反黑案例；效果卻比原先淨膚雷射更好許多。「極緻靚顏光療法」因此產生；「靚顏光」是一種使用Q-開關銣雅各雷射的特殊技巧，一種方法，而非一種機種。
目前靚顏光療法已經治療超過四年多的時間，加上上述的「淨膚雷射時代」經驗，總案例實在非常之多。我們對於淨膚雷射/靚顏光的掌握已經十分純熟，多次受邀於醫學會演講，與其它醫師交流。對於受術者來說，純熟的技術十分重要，可以減少副作用的發作機會與程度，確保治療效果必然出現。
我知道這個部落格友 許多的 醫師同儕在看，對於淨膚/淨顏雷射的使用經驗與副作用，我們總是在國內外各個醫學會的演講中大聲疾呼；這些經驗總結於Q-開關銣雅各雷射應用於華人二萬例效果與副作用報告與淨膚雷射的美麗與哀愁=臺北奇摩宋奉宜醫師部落格文章引用二文中，有興趣的朋友還請自行參閱。
靚顏光的學理依據大約如下：
***********************
第一篇文章：Non-ablative facial remodeling: erythema reduction and histologic evidence of new collagen formation using a 300-microsecond 1064-nm Nd:YAG laser.（非傷害性臉部重建：以300微秒1064奈米波長銣雅鉻雷射降低肌膚紅腫，並促進膠原蛋白新生的組織學證據）
Schmults CD, Phelps R, Goldberg DJ.
Arch Dermatol. 2004 Nov;140(11):1373-6
BACKGROUND: A variety of non-ablative lasers have been used to improve skin color and toning. Evidence of new collagen has been seen. Using blinded observer analysis of electron microscopic changes, we have documented the effect of a non-ablative Nd:YAG laser on collagen production and its relationship to patient age.（背景：目前有許多種雷射都應用於肌膚緊緻與膚色改善。本文報告運用非傷害性銣雅鉻雷射，發現在電子顯微鏡下檢測受術者膠原蛋白增生現象，與受術者年齡之相互關係。）
OBSERVATIONS: Ultra-structural analysis of 9 patients showed a decrease in overall collagen fiber diameter in the papillary dermis at 1 month and 3 months after 3 treatment sessions. This is consistent with the formation of new collagen. Younger patients had a greater decrease in collagen fiber diameter compared with older patients. The change in collagen fiber diameter with time as well as the relationship between that change and the patient's age were statistically significant (P<.001). Photographic evaluation showed that those patients with preexisting erythema showed improvement in erythema along with an associated improvement in skin quality. There were no adverse events.（觀 察：電子顯微分析顯示九位受術者於第三次治療的一個月與 三個月後，真皮均出現膠原纖維直徑變細情形，顯示出明顯膠原纖維新生現象。年紀愈輕的受術者膠原纖維細化現象更明顯，表示膠原纖維再生效果更佳；此事可經 統計驗證。整個療程無副作用出現，受術者照片顯示肌膚品質改善，即使原先有發炎現象亦獲緩解。）
CONCLUSIONS: Microsecond Nd:YAG lasers appear to be safe for non-ablative laser remodeling. Our study indicates that microsecond Nd:YAG lasers can produce new collagen formation in the papillary dermis. In addition, the condition of patients with erythema may be improved. Younger patients may form more new collagen compared with older patients with photodamage.（結論：該雷射機種用於無傷口式雷射緊緻效果良好，淺真皮部位確有膠原纖維增生現象。愈年輕受術者效果愈明顯。）
PMID: 15545547 [PubMed - indexed for MEDLINE]
***********************
第二篇文章：Combination 532-nm and 1064-nm lasers for noninvasive skin rejuvenation and toning. （同時運用532奈米與1064奈米雙波長雷射作為非侵入性肌膚回春治療）
Lee MW.
The East Bay Laser & Skin Care Center , Walnut Creek , CA 94598 , USA . eastbaylaser@aol.com
Arch Dermatol. 2004 May;140(5):625.
BACKGROUND: Noninvasive techniques for skin rejuvenation are quickly becoming standard in the treatment of mild rhytids and overall skin toning. Multiple laser wavelengths and modalities have been used with varying degrees of success, including 532-nm, 585-nm, 1064-nm, 1320-nm, 1450-nm, and 1540-nm wavelengths.（背景：非侵入性治療觀念已成為改善淺皺紋與肌膚色調不均現象的主流治療。目前有許多種治療波長/機種與治療設計均為非侵入性治療。）
OBJECTIVES: To evaluate a combination technique using a long-pulsed, 532-nm potassium titanyl phosphate (KTP) laser and a long-pulsed 1064-nm Nd:YAG laser, separately and combined, for noninvasive photorejuvenation and skin toning and collagen enhancement and to establish efficacy and degree of success.（目的：評估長波532奈米與1064奈米雷射分別與合併治療成果。）
DESIGN: Prospective nonrandomized study with longitudinal follow-up.（設計：前瞻式非亂數追蹤評估法。）
SETTING: Private dermatologic surgery and laser practice.（場地：於皮膚科醫師處。）
METHODS: A total of 150 patients, with skin types I through V, were treated with long-pulsed KTP 532-nm and long-pulsed Nd:YAG 1064-nm lasers, separately and combined. For the KTP 532-nm laser, the fluences varied between 7 to 15 J/cm2 at 7- to 20-millisecond pulse durations with a 2-mm handpiece and 6 to 15 J/cm2 at 30- to 50-millisecond pulses with a 4-mm handpiece. The 1064-nm Nd:YAG laser fluences were set at 24 to 30 J/cm2 for a 10-mm handpiece. These energies were delivered at 30- to 65-millisecond pulse durations. All subjects were treated at least 3 times and at most 6 times, depending on patient satisfaction level, at monthly intervals and were observed for up to 18 months after the last treatment.（方法：150位受術者，肌膚分類為特白至黃種；使用532奈米與1064奈米雷射…所有受術者依病個人需求每月一次，接受三至六次治療。術後追蹤十八個月。）
MAIN OUTCOME MEASURES: All patients were asked to fill out a "severity scale" on which redness, pigmentation, rhytids, skin tone/tightness, texture, and patient satisfaction were noted before and after each treatment. Redness, pigmentation, rhytids, skin tone/tightness, and texture were also evaluated by the physician and another observer.（觀察條件：所有受術者都要填寫包括紅腫、色素、皺紋、膚色均勻、緊緻、毛孔等內容在內的自我評估文件。醫師與第三觀察者亦填寫相同文件。）
RESULTS: After 3 to 6 treatments, 50 patients treated with the 532-nm KTP laser alone showed improvement of 70% to 80% in redness and pigmentation, 30% to 50% in skin tone/tightening, 30% to 40% in skin texture, and 20% to 30% in rhytids. Another 50 patients treated with the 1064-nm Nd:YAG laser alone showed improvement of 10% to 20% in redness, 0% to 10% in pigmentation, 10% to 30% in skin tone/tightening, 20% to 30% in skin texture, and 10% to 30% in rhytids. The third group of 50 patients treated with both KTP and Nd:YAG lasers showed improvement of 70% to 80% in redness and pigmentation, 40% to 60% in skin tone/tightening, 40% to 60% in skin texture, and 30% to 40% in rhytids. Skin biopsy specimens taken at 1-, 2-, 3-, and 6-month intervals demonstrated new collagen formation.（結果：三至六次治療後，單獨使用532奈米治療的五十位受術者中，紅腫與色素改善約70~80%，緊緻部分為30~50%，毛孔30~40%以及皺紋20~30%。單獨使用1064奈米治療的五十位受術者中，紅腫與色素改善約10~20%，緊緻部分為10~30%，毛孔20~30%以及皺紋10~30%。使用雙波長複合治療的五十位受術者，紅腫與色素改善約70~80%，緊緻部分為40~60%，毛孔40~60%以及皺紋30~40%。術後四次切片均顯示膠原纖維新生。）
CONCLUSIONS: All 150 patients exhibited mild to moderate improvement in the appearance of rhytids, moderate improvement in skin toning and texture, and great improvement in the reduction of redness and pigmentation. The KTP laser used alone produced results superior to those of the Nd:YAG laser. Results from combination treatment with both KTP and Nd:YAG lasers were slightly superior to those achieved with either laser alone.（結果：所有人的狀況都有改善，532奈米效果較1064奈米佳；複合式治療尤佳。）
PMID: 14568830 [PubMed - indexed for MEDLINE]
***********************
第三篇文章：Combination visible and infrared lasers for skin rejuvenation.（以可見光與紅外線區域雷射合併治療處理肌膚回春。）
Lee MW
Department of Dermatologic Surgery, University of California , San Francisco , CA 94598 , USA . eastbaylaser@aol.com
Semin Cutan Med Surg. 2002 Dec;21(4):288-300
Noninvasive techniques for skin rejuvenation are quickly being established as a new standard in the treatment of mild rhytides and overall skin toning. Multiple laser wavelengths and modalities have been tried for this procedure with varying degrees of success. These lasers include 532 nm, 585 nm, 1064 nm, 1320 nm, 1450 nm, and 1540 nm wavelengths. This study evaluates a combination technique by using a long-pulsed 532 nm potassium titanyl phosphate (KTP) laser and a long-pulsed 1064 nm Neodynium:yttrium aluminum garnet (Nd:YAG) laser, both separately and combined, for noninvasive photorejuvenation and skin toning/collagen enhancement, and establishes efficacy and degree of success. A total of 150 patients were treated with the long-pulsed KTP 532 nm (Aura; Laserscope, San Jose , CA ) and long-pulsed Nd:YAG 1064 nm (Lyra; Laserscope) lasers both separately and combined. Patients included skin types I through V. The fluences varied between 7 and 15 J/cm2 at 7 to 20 ms pulse duration with a 2-mm handpiece, and 6 to 15 J/cm2 and 30 to 50 ms with a 4-mm handpiece for KTP. The Nd:YAG fluences were set at 24 to 30 J/cm2 for a 10-mm handpiece and 30 J/cm2 for a SmartScan Plus scanner (Laserscope, San Jose , CA ). These energies were delivered at 30 to 65 ms pulse durations. All patients were treated at least 3 times and at most 6 times at monthly intervals, and were observed for up to 18 months after the last treatment. All 150 patients exhibited a mild to moderate degree of improvement in the appearance of rhytides, moderate degree of improvement in skin toning and texture, and great improvement in the reduction of redness and pigmentation. The KTP used alone was superior to the Nd:YAG laser in terms of results. The KTP and Nd:YAG laser combination was superior to either laser used alone.
（這是第二篇的前作…）
PMID: 12512652 [PubMed - indexed for MEDLINE]
***********************
第四篇文章：What is non-ablative photorejuvenation of human skin?（什麼是無傷口式雷射回春術？）
Nelson JS, Majaron B, Kelly KM.
Department of Surgery, Beckman Laser Institute and Medical Clinic, University of California , Irvine , CA 92612 , USA . snelson@laser.bli.uci.edu
Semin Cutan Med Surg. 2002 Dec;21(4):238-50
Nonablative photorejuvenation has become an integral procedure in the emerging discipline of laser dermatologic surgery. The objective is to confine selectively, without any epidermal damage, thermal injury to the papillary, and upper reticular dermis leading to fibroblast activation and synthesis of new collagen and extracellular matrix material. The procedure results in minimal patient morbidity, no interference with lifestyle, and a low risk of complications, while providing a satisfying degree of rhytides reduction. Multiple devices have been studied and marketed for nonablative photorejuvenation of human skin. However, currently, nonablative photorejuvenation should not be considered an alternative to laser skin resurfacing. The skin surface is not removed or modified. What really occurs may be more accurately referred to as dermal "remodeling" or "toning" as a wound healing response is initiated and collagen regenerated. The narrow "therapeutic window" of laser-induced dermal heating and epidermal cooling must still be optimized so that effective treatments can be obtained routinely. Clinical verification of effective treatment parameters (irradiation wavelength, pulse structure, radiant exposure, cooling time) will be obtained through further human studies. Most importantly, understanding the relationship between the degree of dermal thermal injury and synthesis of new collagen and extracellular matrix material will be fundamental to predicting the clinical efficacy and limitations of nonablative photorejuvenation.
（這篇2002年的文章，大概解釋了「無傷口式雷射回春術」的概念。）
PMID: 12512647 [PubMed - indexed for MEDLINE]
留言列表
