Multiple fractional erbium: yttrium-aluminum-garnet laser sessions for upper facial rejuvenation: clinical and histological implications and expectations

Summary Background Fractional photothermolysis is a modern resurfacing technique, in which microscopic zones of thermal injury are created, stimulating turnover of both epidermis and dermis. Fractional laser rejuvenation has been developed to overcome the drawbacks of traditional ablative laser. Objectives To objectively evaluate the effectiveness of multiple sessions of fractional Er:YAG laser rejuvenation for aging upper face clinically, histologically and immunohistochemically. Patients/Methods Ten volunteers asking for facial rejuvenation were subjected to multiple sessions (3–5) of fractional Er:YAG laser. Clinical evaluation with both histopathological and immunohistochemical assessment for skin biopsies was carried out before, after 1 month and 6 months of laser resurfacing. Histometry for epidermal thickness and quantitative assessment for neocollagen formation, collagen I, III, and VII, elastin and tropoelastin were carried out for all skin biopsies. Results Comparing before, after 1 month and 6 months of fractional Er:YAG laser resurfacing resulted in improved clinical appearance with increased epidermal thickness (P