10.5826/dpc.1304a219
Background: Carbon solution-assisted Nd:YAG lasers were previously used in enlarged pores; hair removal; acne and acne scars; and facial rejuvenation.
Objective:The aim of this study is to determine the patient satisfaction for different treatment indications of carbon solution-assisted 1064 nm Nd:YAG lasers.
Patients and Method: This is a retrospective study that included the patients who were treated with carbon solution-assisted 1064 nm Nd:YAG laser with any indication in a private dermatology practice. A pre-prepared carbon solution was applied 30 minutes before the laser treatment with the following parameters: a spot size of 8mm, fluence of 1.3 J/cm2 and a frequency of 8Hz. Patient satisfaction was assesed with GAIS.
Results: A total of 272 patients were included; of these 70 patients had acne lesions, 135 patients had melasma, 27 patients had post-inflammatory hyperpigmentation, 17 patients had ephelides and 23 patients had solar lentigines. The mean patient satisfaction for solar lentigo patients (4.35/5) was greater than for that of acne patients (4.26/5) which was greater than that of ephelide patients (3.94/5) which was greater than that of melasma patients (3.67/5) which was greater than that of post inflammatory hyperpigmentation patients (2.30/5)
Conclusion: This study revealed that carbon solution-assisted 1064 nm Nd:YAG laser therapy is effective in the treatment of solar lentigo, acne vulgaris, ephelides and melasma. However, it fails to provide therapeutic efficacy in post inlammatory hyperpigmentation.
text/xml
2160-9381
3186
en
Zekayi Kutlubay
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
laser
Treatment Indications of Carbon Solution-Assisted Nd:YAG Laser According to Patient Satisfaction: A Retrospective Study
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Original Article
2023-10-31
2023-01-30
2023-10-31
2024-01-15
e2023219
Dermatol Pract Concept
Background: Carbon solution-assisted Nd:YAG lasers were previously used in enlarged pores; hair removal; acne and acne scars; and facial rejuvenation.
Objective:The aim of this study is to determine the patient satisfaction for different treatment indications of carbon solution-assisted 1064 nm Nd:YAG lasers.
Patients and Method: This is a retrospective study that included the patients who were treated with carbon solution-assisted 1064 nm Nd:YAG laser with any indication in a private dermatology practice. A pre-prepared carbon solution was applied 30 minutes before the laser treatment with the following parameters: a spot size of 8mm, fluence of 1.3 J/cm2 and a frequency of 8Hz. Patient satisfaction was assesed with GAIS.
Results: A total of 272 patients were included; of these 70 patients had acne lesions, 135 patients had melasma, 27 patients had post-inflammatory hyperpigmentation, 17 patients had ephelides and 23 patients had solar lentigines. The mean patient satisfaction for solar lentigo patients (4.35/5) was greater than for that of acne patients (4.26/5) which was greater than that of ephelide patients (3.94/5) which was greater than that of melasma patients (3.67/5) which was greater than that of post inflammatory hyperpigmentation patients (2.30/5)
Conclusion: This study revealed that carbon solution-assisted 1064 nm Nd:YAG laser therapy is effective in the treatment of solar lentigo, acne vulgaris, ephelides and melasma. However, it fails to provide therapeutic efficacy in post inlammatory hyperpigmentation.
Zekayi Kutlubay
2023/10/31
10.5826/dpc.1304a219
e2023219
Department of Dermatology and Venerology, Medical Faculty, İstanbul University-Cerrahpaşa, Cerrahpaşa, Turkey
2160-9381
laser
en
e2023219
Feng J, Huang L. Treatment of permanent post-inflammatory hyperpigmentation with medium-fluence medium-spot-size setting in Q-switched Nd: YAG 1064 nm laser: A novel treatment parameters setting strategy. J Cosmet Dermatol. 2021.
Treatment Indications of Carbon Solution-Assisted Nd:YAG Laser According to Patient Satisfaction: A Retrospective Study
https://dpcj.org/index.php/dpc/article/download/3186/2355
 Treatment Indications of Carbon Solution-Assisted
  Nd: YAG Laser According to Patient Satisfaction:
              A Retrospective Study
                     Hüray Hügül1, Defne Özkoca2, Murat Kirişci3, Zekayi Kutlubay2


1 Free Dermatologist, Antalya, Turkey
2 Department of Dermatology and Venerology, Medical Faculty, İstanbul University-Cerrahpaşa, Cerrahpaşa, Turkey
3 Department of Biostatistics, Cerrahpaşa Medical Faculty, İstanbul University-Cerrahpaşa, Turkey



Key words: acne, carbon, Nd:YAG, laser
Citation: Hügül H, Özkoca D, Kirişci M, Kutlubay Z. Treatment Indications of Carbon Solution-Assisted Nd: YAG Laser According to
Patient Satisfaction: a Retrospective Study. Dermatol Pract Concept. 2023;13(4):e2023219. DOI: https://doi.org/10.5826/dpc.1304a219
Accepted: April 8, 2023; Published: October 2023
Copyright: ©2023 Hügül et al. This is an open-access article distributed under the terms of the Creative Commons
Attribution-NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted
noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing Interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding Author: Defne Özkoca, MD, Cerrahpaşa Mah. Kocamustafapaşa Cad. No:34/E Fatih/İstanbul, Turkey.
Phone: 00905366561000 E-mail: defneozkoca@yahoo.com




  ABSTRACT             Introduction: Carbon solution-assisted Nd:YAG lasers were previously used in enlarged pores; hair
                       removal; acne and acne scars; and facial rejuvenation.
                       Objectives: The aim of this study is to determine the patient satisfaction for different treatment indi-
                       cations of carbon solution-assisted 1064 nm Nd:YAG lasers.
                       Methods: This is a retrospective study that included the patients who were treated with carbon
                       solution-assisted 1064 nm Nd:YAG laser with any indication in a private dermatology practice. A
                       pre-prepared carbon solution was applied 30 minutes before the laser treatment with the following
                       parameters: a spot size of 8mm, fluence of 1.3 J/cm2 and a frequency of 8Hz. Patient satisfaction was
                       assessed with GAIS.
                       Results: A total of 272 patients were included; of these 70 patients had acne lesions, 135 patients had
                       melasma, 27 patients had post-inflammatory hyperpigmentation, 17 patients had ephelides and 23 pa-
                       tients had solar lentigines. The mean patient satisfaction for solar lentigo patients (4.35/5) was greater
                       than for that of acne patients (4.26/5) which was greater than that of ephelide patients (3.94/5) which
                       was greater than that of melasma patients (3.67/5) which was greater than that of post inflammatory
                       hyperpigmentation patients (2.30/5)




Original Article | Dermatol Pract Concept. 2023;13(4):e2023219                                                                        1
                       Conclusions: This study revealed that carbon solution-assisted 1064 nm Nd:YAG laser therapy is
                       effective in the treatment of solar lentigo, acne vulgaris, ephelides and melasma. However, it fails to
                       provide therapeutic efficacy in post inflammatory hyperpigmentation.




Introduction                                                          laser (Fotona; Qxmax-M031-3A/2,R28 head-piece) treat-
                                                                      ment was initiated 30 minutes after the application of the
The Q-switched neodymium doped-yittrium (Nd:YAG) la-                  solution The treatment parameters were as follows: a spot
sers are used in cosmetic dermatology in order to improve             size of 8mm, a fluence of 1.3 J/cm2 and a frequency of 8Hz.
skin texture, decrease wrinkling and for an overall skin re-          Treatment sessions were continued until the complete regres-
juvenation. Nd:YAG lasers have a wavelength of 1064 nm                sion of the lesions in acne vulgaris, solar lentigo, melasma
which can penetrate deep into the dermis; however, the                and ephelide patients. For patients with post-inflammatory
longer wavelength limits its efficacy in targeting epidermal          hyperpigmentation and for those who also applied for re-
melanin and hemoglobulin [1]. The application of a topical            juvenation, further sessions were planned according to the
carbon solution before the laser treatment was initially pre-         financial capacity of the patient and the necessity according
sented as a necessary procedure because it acts as an exoge-          to the operating physician.
nous chromophore in increasing the heat damage; however,
previous studies in the literature contradict in the additional       Assessment
benefit of the adjuvant carbon solution [1-5]. The previously         Patient satisfaction was evaluated with the Global Aesthetic
researched application areas of carbon solution-assisted              Evaluation Scale (GAIS) as 1 for exceptional improvement, 2
Nd:YAG lasers are enlarged pores; hair removal; acne and              for marked improvement, 3 for minimal improvement com-
acne scars; and facial rejuvenation [1-7].                            pared to the beginning, 4 for same as the beginning and 5 for
    Carbon solution-assisted Nd:YAG lasers are used fre-              worse than the beginning [8].
quently in the daily cosmetic dermatology practice even
though the results regarding the benefit of the addition of           Statistical Analysis
a carbon solution contradict in the literature [(1-7]. With
                                                                      SPSS version 21 was used for the statistical analyses. T-test
this study, we aim to determine the utilization areas of car-
                                                                      was used to analyze the relationship between gender and pa-
bon solution-assisted Nd:YAG lasers, the frequency for each
                                                                      tient satisfaction. Pearson correlation was used to analyze
area, number of sessions needed per area, patient satisfaction
                                                                      the patient satisfaction according to age. ANOVA was used
and gender prevalence of the patient population.
                                                                      to determine the relationship between the treatment indica-
                                                                      tions and patient satisfaction.
Methods                                                                  The approval of İstanbul University-Cerrahpaşa Faculty
                                                                      of Medicine, Medical Faculty Ethics Committee was taken
Patient Selection                                                     before initiating the study. The informed consent of each pa-
The patients who applied to a private cosmetic dermatology            tient was taken.
practice with any cosmetic concern that was treatable with car-
bon solution-assisted Nd:YAG lasers and have received at least
one treatment session of carbon solution-assisted Nd:YAG laser
                                                                      Results
were included in this retrospective study. All of the patients were   A total of 272 patients were included in this retrospective
Turkish with Fitzpatrick skin types of 3 or 4. Patients with the      study. Of these patients, 43 were male and 229 were female.
following characterestics were excluded from this study: pho-         The mean age of the patients was 34.1 years with a standard
tosensitivity, immunosupression, pregnancy, lactation, active or      deviation of 9.9 years. The youngest patient was 15 years old
previous malignancy and active infection. For each patient, the       and the oldest patient was 80 years old. Seventy patients re-
gender, age, diagnosis for which treatment was applied and the        ceived treatment for acne lesions, 135 patients for melasma
number of treatment sessions received were noted.                     27 patients for post-inflammatory hyperpigmentation,
                                                                      17 patients for ephelides and 23 patients for solar lentigo.
Treatment Procedure                                                      Independent t-test was used in order to analyze the rela-
The pre-prepared carbon solution (Brand: Taygete) was topi-           tionship between patient satisfaction and gender. We failed
cally applied on the face of each patient. Q-switched Nd:YAG          to find a statistically significant difference between gender



2                                                                         Original Article | Dermatol Pract Concept. 2023;13(4):e2023219
                  Figure 1. The relationship between patient satisfaction and treatment indication.




                   Figure 2. (A) Melasma patient before treatment. (B) Melasma patient after 3 sessions of monthly
                   carbon solution-assisted Nd:YAG laser treatments.

and patient satisfaction. Thus, the treatment efficacy is inde-        patients were the fourth group in terms of patient satisfaction
pendent of gender.                                                     with a mean satisfaction of 3.67. The least satisfied group
    The Pearson correlation was used to determine the rela-            was the post inflammatory hyperpigmentation group with a
tionship between patient satisfaction and age. The Pearson             mean satisfaction of 2.30 out of 5. In short, the treatment ef-
correlation coefficient was calculated as -0.071; meaning              ficacy can be listed as follows: solar lentigo more than acne,
that treatment efficacy is independent of age.                         acne more than ephelide, ephelide more than melasma and
    ANOVA was used to determine the relationship between               melasma more than post inflammatory hyperpigmentation.
patient satisfaction and treatment indications. The compara-           These differences were statistically significant (P = 0.0000).
tive statistical analyses revealed that the patient satisfaction       Figure 1 visualizes the relationship between patient satisfac-
was the highest in solar lentigo patients with a mean satisfac-        tion and treatment indications.
tion of 4.35. The second most satisfied group was the acne                 Figures 2 and 3 show a melasma and an acne patient
patients with a mean satisfaction of 4.26. Third group was             who have benefited from monthly sessions of carbon
ephelide patients with a mean satisfaction of 3.94. Melasma            solution-assisted Nd:YAG laser treatment.



Original Article | Dermatol Pract Concept. 2023;13(4):e2023219                                                                      3
              Figure 3. (A) Acne patient before treatment. (B) Acne patient after 4 sessions of monthly carbon solution-
              assisted Nd:YAG laser treatments.




    There were not any major adverse events. The most com-           further studies should be performed in order to compare its
mon complaint of the patients was post-treatment mild ery-           efficacy to Q-switched Nd:YAG laser alone and other treat-
thema, which subsided within hours.                                  ment modalities.
                                                                         The second patient group that benefited the most from

Conclusions                                                          carbon solution-assisted Nd:YAG laser therapy was the acne
                                                                     group. Topically applied carbon suspension distributes itself
Our study revealed that the patient satisfaction for carbon          within the stratum corneum and can penetrate into the hair
solution-assisted Nd:YAG laser therapy was the highest in            follicles. Carbon serves as an exogenous chromophore and
patients with solar lentigo. Solar lentigo are observed as a         the rapid increase in temperature damages the hair follicles
result of the photo damage and lesions show melanocytic              and the surrounding sebaceous glands. With the destruction
proliferation histopathologically [9]. There is a wide spec-         of the pilosebaceous unit, one of the key pathogenetic steps
trum of treatment modalities available for solar lentigo;            of acne vulgaris, hyper-seborrhea, is prevented. Previously,
these modalities can be categorized into two broad groups            Yung et al reported that carbon assisted 1064 nm Nd:YAG
as the physical and topical therapies. Cryotherapy, laser            laser therapy is safe and effective in the treatment of both in-
therapy and chemical peels are grouped under the physi-              flammatory and non-inflammatory acne vulgaris lesions [6].
cal modalities group [10]. Since the absorption spectrum             Likewise, Chun and Calderhead reported a patient with se-
of melanocytes lie between 351 to 1064 nm, different laser           vere acne vulgaris who achieved 90 percent clearance with
devices with differing wavelengths can be used in the treat-         six treatments of carbon solution-assisted Nd:YAG laser
ment of solar lentigo [11]. The use of Pulse-dye laser, copper       treatment with two weeks intervals [14]. Recently, Conforti
vapor laser, krypton laser, Nd:YAG laser, frequency doubled          et al. reported that the carbon solution assisted Nd:YAG la-
Nd:YAG laser (KTP), Q-switched ruby laser, Q-switched                ser treatment is effective, without any major side effects, in
alexandrite laser, Q-switched Nd:YAG laser, carbon dioxed            the treatment of inflammatory acne lesions, enlarged pores
laser and argon diode laser have been published in the lit-          and skin texture [15]. In alliance with the previous literature,
erature [10]. Several studies have previously assessed the           we also report that carbon solution-assisted Nd:YAG laser
efficacy of Q-switched Nd:YAG lasers in the treatment of             therapy is an effective treatment modality for acne vulgaris
solar lentigo; and their efficacy was found to be inferior to        with a high patient satisfaction rate.
KTP but superior to carbon dioxide laser [12,13]. Our study              The third and fourth groups to benefit from carbon as-
revealed a high patient satisfaction for the use of carbon           sisted Nd:YAG laser treatment were ephelides and melasma,
solution-assisted Q-switched Nd:YAG laser in the treatment           respectively. Similar to solar lentigo, the target chromophore
of solar lentigo. Among all the treatment indications stud-          is melanin in ephelides and melasma as well. The wavelength
ied in this article, solar lentigines were the most to benefit       of Q-switched Nd:YAG lasers (1064 nm) lies within the ab-
from the carbon solution assisted Nd:YAG laser therapy. Yet,         sorption spectrum of melanin and therefore can be used in



4                                                                         Original Article | Dermatol Pract Concept. 2023;13(4):e2023219
the treatment of epidermal and dermal pigmented lesions               2. Lee MC, Hu S, Chen MC, Shih YC, Huang YL, Lee SH. Skin
[11,16]. Previously the 532 nm KTP laser was found to be                 rejuvenation with 1,064-nm Q-switched Nd:YAG laser in Asian
                                                                         patients. Dermatol Surg. 2009; (6):929-932. DOI: 10.1111/j
effective in the treatment of ephelides and the Q-switched
                                                                         .1524-4725.2009.01157.x. PMID: 19397646.
Nd:YAG laser has been proven to be safe and effective in the
                                                                      3. Zheng Z, Kim J, Choi MJ, Goo B, Chun SI, Cho SB. Histometric
treatment of melasma [17,18]. Our results show that the use              changes and epidermal FGF9 expression in carbon photoenhancer-
of carbon solution-assisted Nd:YAG laser treatment is effec-             assisted Nd:YAG laser treatment. J Dermatolog Treat. 2014;
tive for the treatment of ephelides and melasma, with patient            25(4):278-282. DOI: 10.3109/09546634.2012.723121. PMID:
satisfactions of 3.94 and 3.67 respectively.                             22905667.
                                                                      4. Chung H, Goo B, Lee H, Roh M, Chung K. Enlarged pores
    The patient group to benefit the least was the post-
                                                                         treated with a combination of Q-switched and micropulsed
inflammatory hyperpigmentation patients with a mean
                                                                         1064 nm Nd:YAG laser with and without topical carbon sus-
patient satisfaction of 2.30. Post-inflammatory hyperpigmenta-           pension: A simultaneous split-face trial. Laser Ther. 2011;20
tion is a treatment challenge for many physicians and there are          (3):181-188. DOI: 10.5978/islsm.20.181. PMID: 24155527.
many topical or physical treatment alternatives. Laser therapy           PMCID: PMC3799029.
is one of these modalities; however, the destruction induced by       5. Roh MR, Chung HJ, Chung KY. Effects of various parameters
                                                                         of the 1064 nm Nd:YAG laser for the treatment of enlarged
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                                                                         facial pores. J Dermatolog Treat. 2009;20(4):223-228. DOI:
increase the pigmentation, which is referred to as rebound hy-
                                                                         10.1080/09546630802647244. PMID: 19125363.
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pigmentation previously. Although some therapeutic efficacy              study of acne vulgaris treated with dual mode of quasi-long
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ists and therefore lower doses are recommended. The use of
                                                                         2012;66(4):626-633. DOI: 10.1016/j.jaad.2011.08.031. PMID:
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that the use of carbon solution-assisted Nd:YAG laser in the             suspension-assisted Q-switched Nd:YAG laser hair removal.
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                                                                          of Melasma and Solar Lentigenes in Asians: Prospective, Ran-
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                                                                          domized, and Split-Face Comparative Study. Dermatol Surg.
Nd:YAG laser therapy is effective in the treatment of solar
                                                                          2017;43(9):1120-1133. DOI: 10.1097/DSS.0000000000001120.
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                                                                      12. Bohnert K, Dorizas A, Sadick N. A prospective, randomized,
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6                                                                            Original Article | Dermatol Pract Concept. 2023;13(4):e2023219
