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Effectiveness of the Nd:YAG Laser in Combating Photoaging

When photoaging occurs, skin becomes lax and starts to sag. Excessive skin laxity in the face has traditionally been corrected by rhytidectomy, a surgical lifting procedure under a general anaesthetic. Intense Pulsed Light (IPL) or lasers at various wavelengths now offer easier alternatives.

When the long-pulse 1064 nm Nd:YAG laser is used, the epidermis is cooled to prevent injury while the near-infrared laser energy penetrates deeply enough to injure the dermis. This stimulates collagen production and improved skin quality. The absorption coefficient of melanin for 1064 nm radiation is lower than for shorter wavelengths. This means patients with dark skin can be treated with little risk of pigmentation abnormalities.

In 2006 Taylor and Prokopenko conducted a clinical study into the relative effectiveness of the long pulse 1064 nm Nd:YAG laser compared to radiofrequency (RF) in treating wrinkles, pores, skin texture, skin laxity and pigmentation. The research was carried out at the Gateway Aesthetic Institute and Laser Center, Salt Lake City, USA. All subjects were over 30 years old and had mild to moderate sagging skin. Most had wrinkles, abnormal pigmentation, large pores and skin texture problems.

The left sides of their faces were treated with long-pulse 1064 nm Nd:YAG laser radiation and the right sides with RF energy. Improvements in wrinkles, texture, pores, laxity and pigmentation were independently evaluated by six observers from digital photographs. They were presented with a pair of photographs – one taken before treatment and the other after – not knowing which was which. They then estimated the amount of improvement for each skin parameter. The results showed a greater improvement on the laser side of the face for wrinkles and laxity. Improvements in wrinkles and skin laxity were up to 46% for individual patients and the median for patients as a group was 30%. Both sides of the face saw a 15% median improvement for texture, pores and pigmentation.

No adverse effects occurred with either treatment type. Pigmentation actually improved on both sides for some patients. They were generally satisfied with the outcomes and none expressed disappointment.

Other Studies of the Nd:YAG laser

Dayan and colleagues treated 34 patients at least seven times, taking photographs before the first and after the final treatment. Photographs were evaluated by three ‘blinded’ physicians. The results showed a reduction of 11.9% for coarse wrinkles, an improvement of 17.3% for skin laxity and a 20% overall improvement.

Lee treated 150 patients with the long-pulsed KTP 532 nm laser, a long-pulsed 1064 nm Nd:YAG laser, or both lasers. With the long-pulsed 1064 nm laser, Lee reported an improvement of 10–20% in redness, 0–10% in pigmentation, 10–30% in skin tone/tightening, 20– 30% in skin texture, and 10–30% in rhytids.

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