Opinion article
21st-Century Alternatives to Classic Resurfacing Techniques
Nuevas técnicas alternativas al resurfacing clásico en el siglo xxi
B. Pérez-García
Servicio de Dermatología, Hospital Ramón y Cajal, Madrid, Spain
Leído
7266
Vecesse ha leído el artículo
2264
Total PDF
5002
Total HTML
Compartir estadísticas
array:23 [ "pii" => "S1578219013000024" "issn" => "15782190" "doi" => "10.1016/j.adengl.2012.09.019" "estado" => "S300" "fechaPublicacion" => "2013-03-01" "aid" => "727" "copyright" => "Elsevier España, S.L. and AEDV" "copyrightAnyo" => "2012" "documento" => "article" "crossmark" => 0 "subdocumento" => "sco" "cita" => "Actas Dermosifiliogr. 2013;104:96-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2235 "formatos" => array:3 [ "EPUB" => 48 "HTML" => 1582 "PDF" => 605 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0001731012004449" "issn" => "00017310" "doi" => "10.1016/j.ad.2012.09.003" "estado" => "S300" "fechaPublicacion" => "2013-03-01" "aid" => "727" "copyright" => "Elsevier España, S.L. and AEDV" "documento" => "article" "crossmark" => 0 "subdocumento" => "sco" "cita" => "Actas Dermosifiliogr. 2013;104:96-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4501 "formatos" => array:3 [ "EPUB" => 3 "HTML" => 3210 "PDF" => 1288 ] ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Artículo de opinión</span>" "titulo" => "Nuevas técnicas alternativas al <span class="elsevierStyleItalic">resurfacing</span> clásico en el siglo <span class="elsevierStyleSmallCaps">xxi</span>" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "96" "paginaFinal" => "98" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "21st-Century Alternatives to Classic Resurfacing Techniques" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "B. Pérez García" "autores" => array:1 [ 0 => array:2 [ "nombre" => "B." "apellidos" => "Pérez García" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1578219013000024" "doi" => "10.1016/j.adengl.2012.09.019" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219013000024?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731012004449?idApp=UINPBA000044" "url" => "/00017310/0000010400000002/v1_201304241237/S0001731012004449/v1_201304241237/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1578219013000036" "issn" => "15782190" "doi" => "10.1016/j.adengl.2012.02.005" "estado" => "S300" "fechaPublicacion" => "2013-03-01" "aid" => "668" "copyright" => "Elsevier España, S.L. and AEDV" "documento" => "article" "crossmark" => 0 "subdocumento" => "ssu" "cita" => "Actas Dermosifiliogr. 2013;104:99-127" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 16692 "formatos" => array:3 [ "EPUB" => 43 "HTML" => 14325 "PDF" => 2324 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review</span>" "titulo" => "Immunohistochemistry in Dermatopathology: A Review of the Most Commonly Used Antibodies (Part I)" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "99" "paginaFinal" => "127" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Inmunohistoquímica en dermatopatología: revisión de los anticuerpos utilizados con mayor frecuencia (parte <span class="elsevierStyleSmallCaps">i</span>)" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0085" "etiqueta" => "Figure 17" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr17.jpeg" "Alto" => 1648 "Ancho" => 2195 "Tamanyo" => 706045 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Cutaneous glomangioma. A, Low-power magnification (x10). B, High-power magnification of neoplastic cells around the vascular lumen, with round monomorphous nuclei and scant cytoplasm (×400). C, The same sample studied immunohistochemically with α-SMA (smooth muscle actin) (×10). D, Detail of α-SMA-positive neoplastic cells (×400).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "L. Fuertes, C. Santonja, H. Kutzner, L. Requena" "autores" => array:4 [ 0 => array:2 [ "nombre" => "L." "apellidos" => "Fuertes" ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Santonja" ] 2 => array:2 [ "nombre" => "H." "apellidos" => "Kutzner" ] 3 => array:2 [ "nombre" => "L." "apellidos" => "Requena" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731012002773" "doi" => "10.1016/j.ad.2012.02.015" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731012002773?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219013000036?idApp=UINPBA000044" "url" => "/15782190/0000010400000002/v1_201304241618/S1578219013000036/v1_201304241618/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Opinion article</span>" "titulo" => "21st-Century Alternatives to Classic Resurfacing Techniques" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "96" "paginaFinal" => "98" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "B. Pérez-García" "autores" => array:1 [ 0 => array:3 [ "nombre" => "B." "apellidos" => "Pérez-García" "email" => array:1 [ 0 => "bibianapg@telefonica.net" ] ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Dermatología, Hospital Ramón y Cajal, Madrid, Spain" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Nuevas técnicas alternativas al <span class="elsevierStyleItalic">resurfacing</span> clásico en el siglo <span class="elsevierStyleSmallCaps">xxi</span>" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Conventional resurfacing with carbon dioxide (CO<span class="elsevierStyleInf">2</span>) laser therapy is highly effective for reversing the signs of skin photoaging. Improvements can be appreciated and are often spectacular even after a single session. They are also long-lasting,<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> as can be demonstrated on the basis of both clinical and histologic criteria.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> However, after the initial boom of the mid-1990s many dermatologists and plastic surgeons began to lose their enthusiasm for this technique as they became aware of the considerable associated morbidity, the long recovery times, need for meticulous postprocedural care, and non-negligible risk of adverse effects. Fewer and fewer patients are willing to accept prolonged periods away from work and social life or to assume the discomfort and risk that accompany CO<span class="elsevierStyleInf">2</span> laser therapy. As a result, other rejuvenation techniques have been developed. They sacrifice some degree of efficacy in the interest of safety and convenience but are at present generally better accepted by most patients. Grouped together under the heading of evolving approaches to therapies to reverse photoaging, these alternative treatments combine several techniques and are applied in a series of sessions for treatment and maintenance. Adverse effects are minimal and the improvements are more subtle, without sudden changes in the patient's appearance.</p><p id="par0010" class="elsevierStylePara elsevierViewall">These gentler approaches to treating the signs of aging—such as changes in coloring and texture or the formation of wrinkles—are based on 2 concepts.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The first is the use of nonablative mechanisms that act on the dermis without damaging the epidermis, thus lowering the risk of adverse effects and minimizing the time until the patient can resume normal activity. The second is the use of fractional therapy, through which microscopic treatment zones are distributed in columns separated from each other by intact tissue; this system encourages rapid recovery and lowers risk.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Experiments have shown that conventional nonablative lasers like those traditionally used to treat vascular lesions (pulsed dye, Nd:YAG [neodymium:yttrium aluminum garnet], and KTP [potassium-titanyl-phosphate] lasers) and infrared lasers with a wavelength of 1320 or 1450<span class="elsevierStyleHsp" style=""></span>nm are able to enhance collagen synthesis and decrease oxidative stress<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a>; however, their clinical rejuvenating effect is minimal and they are little used for this purpose. My opinion is that these tools could be useful to complement other antiaging treatments, such as the injection of botulinum toxin or fillers because they act on erythema and telangiectasia and attenuate color differences. Pulsed light therapy is particularly useful for such complementary purposes, especially when treating the neck and upper part of the chest, where it improves texture while also attenuating telangiectasis and pigmentation changes.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> However, the effect on wrinkles is practically nil, so we cannot think of these techniques by themselves as true alternatives to classic resurfacing even when sessions are given in series.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Nonablative fractional laser therapy for photoaging is a step forward. The effect on wrinkles and changes in pigmentation and texture is moderate in this modality, in which the density of columns of thermal damage can be controlled and their depth adjusted according to the energy administered. Treatments are well tolerated and time away from work or social life is minimal. They are also safe, with minimal risk of adverse effects. Although appreciable results require several sessions (usually 3 to 6) and the improvement is not as great as that achieved with classic resurfacing, many patients prefer this alternative, which does not interfere with their routine and offers a high degree of safety. Another option that has proven useful is the combination of pulsed light and fractional nonablative laser at a wavelength of 1550<span class="elsevierStyleHsp" style=""></span>nm in the same session. When applied together, the effect of each treatment is enhanced, yet there is no increase in recovery time or adverse effects.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In 2007, reports of the results of fractional ablative laser treatment began to appear. Initially CO<span class="elsevierStyleInf">2</span> lasers were being used at a wavelength of 10 600<span class="elsevierStyleHsp" style=""></span>nm. Later, devices giving an Er:YAG (erbium-doped YAG) beam at a wavelength of 2940<span class="elsevierStyleHsp" style=""></span>nm were developed. The aim of these modalities was to approximate as closely as possible the response to traditional “confluent” ablative lasers (classic resurfacing) while significantly reducing recovery time, postprocedural discomfort, and the risk of adverse effects. In fractional techniques, a high percentage of skin remains intact, encouraging rapid recovery and lowering risk. Many studies have shown that the fractional ablative lasers are more effective than nonablative techniques,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> in spite of higher associated morbidity. The new systems can probably be considered the true heirs of classic resurfacing, given that outcomes can even be equivalent to those achieved with traditional CO<span class="elsevierStyleInf">2</span> laser therapy and, for patients willing to take a certain amount of time off to recover, the fractional ablative approach offers a powerful tool for obtaining clearly appreciable results in a single session.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The tolerability and efficacy of other approaches to resurfacing have also recently come under study. These methods include minimally ablative resurfacing using Er:YSGG (erbium:yttrium, scandium, gallium, and garnet) laser light at a wavelength of 2790<span class="elsevierStyleHsp" style=""></span>nm. This modality has a water absorption coefficient of 5000/cm<span class="elsevierStyleSup">2</span>, which falls between the coefficients of the Er:YAG (12 500/cm<span class="elsevierStyleSup">2</span>) and CO<span class="elsevierStyleInf">2</span> (1000/cm<span class="elsevierStyleSup">2</span>) lasers. The ER:YSGG laser provides thermal stimulation and coagulation that cannot be achieved with the ER:YAG device without causing collateral damage and exudation—with the consequent need for a recovery time similar to that required after CO<span class="elsevierStyleInf">2</span> laser therapy.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Another approach that has been described is the combination of fractional and continuous laser treatments in the same session. This approach achieves complete vaporization of the superficial epidermis with coagulation of the deep epidermis and fractional coagulation of the deep dermis; improvement is evident within an average of 6 days, when make-up can again be applied and routine social life can be resumed.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Nonlaser modalities have also been used to rejuvenate photoaged skin. The latest radiofrequency devices not only encourage collagen contraction and remodelling—tightening the skin—but they also produce subtle improvements in texture. Some of these devices incorporate a laser beam or pulsed light to work more broadly on diverse effects of photoaging. More recently, the so-called fractional radiofrequency devices have begun to appear, offering both fractional ablative treatment and deep volumetric heat delivered to the dermis. Promising results have been reported for these devices in treating the effects of photoaging<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> and in correcting acne scars.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> The effect on collagen has been confirmed histologically. Fractional radiofrequency therapy has also been combined with ultrasound to enhance percutaneous penetration of the active principles in treatments for photoaging and other conditions. All these systems carry minimal risk of adverse effects and recovery is nearly immediate. As the beneficial effects are moderate, several sessions must be given before benefits become noticeable.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Laser and radiofrequency are not the only modalities used to apply thermal energy at doses that are sufficient for achieving collagen remodelling. Another option, plasma skin regeneration technology, is based on the ionization of nitrogen gas by means of radiofrequency stimulation. In this system the nitrogen gas is converted to plasma—the fourth state of matter, in which electrons have been separated from atoms to form an electromagnetically unstable ionized gas able to transmit energy directly to the skin in pulses. As the local heating by plasma bursts does not require a chromophore, energy is delivered uniformly to the skin. This technology is nonablative, recovery is rapid, and the effects have been compared favorably to those of classic rejuvenation therapy with ablative confluent lasers.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14,15</span></a> Although this technique is little known and hardly used in Spain, it was approved by the US Food and Drug Administration for the treatment of facial wrinkles some years ago and the literature contains reports of beneficial effects on skin tone, texture, and coloring.</p><p id="par0045" class="elsevierStylePara elsevierViewall">In spite of the vast literature on a great variety of skin rejuvenation techniques, it is not easy to draw conclusions as to the superiority of one over another. If we subscribe to the evidence-based practice of medicine, we must take note that few high-quality randomized controlled trials are available to help us decide which procedure is the safest and most effective. A 2009 Cochrane review on interventions for photodamaged skin found only limited evidence for the superiority of phenol peeling over CO<span class="elsevierStyleInf">2</span> laser treatment of photoaged skin of the upper lip, although postprocedural discomfort was greater with the phenol treatment.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> That review did not bring clear evidence to light to support the superiority of CO<span class="elsevierStyleInf">2</span> laser therapy over Er:YAG laser therapy; nor did it consider the new techniques discussed above. General review articles on the subject nonetheless express the opinion that ablative laser therapy achieves superior results, even though nonablative and fractional technologies have become much more popular because they give acceptable results with fewer adverse effects.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Practically speaking, our adoption of one type of treatment over another for routine use will be influenced by both the availability of the technology and the patient's expectations and willingness to undertake whatever skin rejuvenation option we might propose. Less aggressive techniques will be preferable for patients who cannot accept a recovery period of inactivity that can be fairly long and involve meticulous care of the treated skin. Patients who seek an easier recovery must be able to commit to multiple sessions at intervals of several weeks, however, as less aggressive approaches are delivered in series to achieve an effect that can be evaluated. The most useful therapies in these cases will probably be those that combine the application of light or radiofrequency energy along with neurotoxin treatment of expression wrinkles or fillers to replace loss of volume. Naturally, although such rejuvenating programs are highly effective and fairly well tolerated and safe, they are expensive. It will therefore be preferable to prioritize and treat only the aspect that concerns the patient most, in accordance with an acceptable risk of adverse effects.</p><p id="par0055" class="elsevierStylePara elsevierViewall">In summary, we can conclude that fractional lasers (particularly ablative modalities), the new radiofrequency devices (combined or not with pulsed light or nonablative lasers), and the less-known plasma skin regeneration systems are techniques that offer effective and safe alternatives to confluent CO<span class="elsevierStyleInf">2</span> laser rejuvenation therapy. We should not forget, however, that classic resurfacing will continue to be the best choice for some patients. For classic resurfacing, the patient should be referred to one of the increasingly scarce specialists that still perform this procedure routinely, given that experience is the key to achieving an acceptable result.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Pérez García B. Nuevas técnicas alternativas al resurfacing clásico en el siglo XXI. Actas Dermo-sifiliogr. 2013;104:96–8.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:17 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term results of carbon dioxide laser resurfacing of the face" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "P.D. Ward" 1 => "S.R. Baker" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archfaci.10.4.238" "Revista" => array:6 [ "tituloSerie" => "Arch Facial Plast Surg" "fecha" => "2008" "volumen" => "10" "paginaInicial" => "238" "paginaFinal" => "243" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18645090" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Full-face carbon dioxide laser resurfacing: a 10-year follow-up descriptive study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Prado" 1 => "P. Andrades" 2 => "S. Danilla" 3 => "S. Benitez" 4 => "S. Reyes" 5 => "G. Valenzuela" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.prs.0000299380.83221.a8" "Revista" => array:6 [ "tituloSerie" => "Plast Reconstr Surg" "fecha" => "2008" "volumen" => "121" "paginaInicial" => "983" "paginaFinal" => "993" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18317147" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term effectiveness and side effects of carbon dioxide laser resurfacing for photoaged facial skin" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "W. Manuskiatti" 1 => "R.E. Fitzpatrick" 2 => "M.P. Goldman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "1999" "volumen" => "40" "paginaInicial" => "401" "paginaFinal" => "411" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10071310" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fractional photothermolysis: a new concept for cutaneous remodeling using microscopic patterns of thermal injury" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "D. Manstein" 1 => "G.S. Herron" 2 => "R.K. Sink" 3 => "H. Tanner" 4 => "R.R. Anderson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/lsm.20048" "Revista" => array:6 [ "tituloSerie" => "Lasers Surg Med" "fecha" => "2004" "volumen" => "34" "paginaInicial" => "426" "paginaFinal" => "438" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15216537" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Investigation of irradiation by different nonablative lasers on primary cultured skin fibroblasts" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "Y. Weng" 1 => "Y. Dang" 2 => "X. Ye" 3 => "N. Liu" 4 => "Z. Zhang" 5 => "Q. Ren" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2230.2011.04043.x" "Revista" => array:7 [ "tituloSerie" => "Clin Exp Dermatol" "fecha" => "2011" "volumen" => "36" "paginaInicial" => "655" "paginaFinal" => "660" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21457156" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0161642010003118" "estado" => "S300" "issn" => "01616420" ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Exploring the role of a nonablative laser (1320<span class="elsevierStyleHsp" style=""></span>nm cooltouch laser) in skin photorejuvenation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Z. Zhenxiao" 1 => "X. Aie" 2 => "J. Yuzhi" 3 => "W. Xiaodong" 4 => "J. Xianqiang" 5 => "S. Jing" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1600-0846.2011.00525.x" "Revista" => array:7 [ "tituloSerie" => "Skin Res Technol" "fecha" => "2011" "volumen" => "17" "paginaInicial" => "505" "paginaFinal" => "509" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21707764" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0002939412006824" "estado" => "S300" "issn" => "00029394" ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-pulsed dye laser versus intense pulsed light for photodamaged skin: a randomized split-face trial with blinded response evaluation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G.F. Jorgensen" 1 => "L. Hedelund" 2 => "M. Haedersdal" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/lsm.20634" "Revista" => array:6 [ "tituloSerie" => "Lasers Surg Med" "fecha" => "2008" "volumen" => "40" "paginaInicial" => "293" "paginaFinal" => "299" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18563775" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Single-session combination treatment with intense pulsed light and nonablative fractional photothermolysis: a split-face study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C. Kearney" 1 => "D. Brew" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Dermatol Surg" "fecha" => "2012" "paginaInicial" => "1" "paginaFinal" => "8" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Review of fractional photothermolysis: treatment indications and efficacy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E.P. Tierney" 1 => "D.J. Kouba" 2 => "W. Hanke" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1524-4725.2009.01258.x" "Revista" => array:7 [ "tituloSerie" => "Dermatol Surg" "fecha" => "2009" "volumen" => "35" "paginaInicial" => "1445" "paginaFinal" => "1461" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19686366" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0002939411002509" "estado" => "S300" "issn" => "00029394" ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Minimally ablative resurfacing with the confluent 2,790<span class="elsevierStyleHsp" style=""></span>nm erbium:YSGG laser: a pilot study on safety and efficacy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S.E. Walgrave" 1 => "D.A. Kist" 2 => "A. Noyaner-Turley" 3 => "B.D. Zelickson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/lsm.21124" "Revista" => array:6 [ "tituloSerie" => "Lasers Surg Med" "fecha" => "2012" "volumen" => "44" "paginaInicial" => "103" "paginaFinal" => "111" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22302749" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Combining confluent and fractionally ablative modalities of a novel 2790<span class="elsevierStyleHsp" style=""></span>nm YSGG laser for facial resurfacing" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "G.S. Munavalli" 1 => "A. Turley" 2 => "S. Silapunt" 3 => "B. Biesman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/lsm.21059" "Revista" => array:6 [ "tituloSerie" => "Lasers Surg Med" "fecha" => "2011" "volumen" => "43" "paginaInicial" => "273" "paginaFinal" => "282" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21500221" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fractional rejuvenation using a novel bipolar radiofrequency system in Asian skin" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H.S. Lee" 1 => "D.H. Lee" 2 => "C.H. Won" 3 => "H.W. Chang" 4 => "H.H. Kwon" 5 => "K.H. Kim" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1524-4725.2011.02134.x" "Revista" => array:7 [ "tituloSerie" => "Dermatol Surg" "fecha" => "2011" "volumen" => "37" "paginaInicial" => "1611" "paginaFinal" => "1619" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21883650" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S016164201200070X" "estado" => "S300" "issn" => "01616420" ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of acne scars of skin types <span class="elsevierStyleSmallCaps">ii</span> to <span class="elsevierStyleSmallCaps">v</span> by sublative fractional bipolar radiofrequency and bipolar radiofrequency combined with diode laser" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A.F. Taub" 1 => "C.B. Garretson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "J Clin Aesthet Dermatol" "fecha" => "2011" "volumen" => "4" "paginaInicial" => "18" "paginaFinal" => "27" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22191004" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0161642009010653" "estado" => "S300" "issn" => "01616420" ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A pilot study on the use of a plasma skin regeneration device (Portrait PSR3) in full facial rejuvenation procedures" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S. Kilmer" 1 => "N. Semchyshyn" 2 => "G. Shah" 3 => "R. Fitzpatrick" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10103-006-0431-9" "Revista" => array:6 [ "tituloSerie" => "Lasers Med Sci" "fecha" => "2007" "volumen" => "22" "paginaInicial" => "101" "paginaFinal" => "109" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17342383" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A histopathologic evaluation of the Plasma Skin Regeneration System (PSR) versus a standard carbon dioxide resurfacing laser in an animal model" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R. Fitzpatrick" 1 => "E. Bernstein" 2 => "S. Iyer" 3 => "D. Brown" 4 => "P. Andrews" 5 => "K. Penny" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/lsm.20547" "Revista" => array:6 [ "tituloSerie" => "Lasers Surg Med" "fecha" => "2008" "volumen" => "40" "paginaInicial" => "93" "paginaFinal" => "99" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18306159" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Interventions for photodamaged skin" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Samuel" 1 => "R.C. Brooke" 2 => "S. Hollis" 3 => "G.E. Griffiths" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "The Cochrane Library" "fecha" => "2009" "paginaInicial" => "3" "itemHostRev" => array:3 [ "pii" => "S0161642010001867" "estado" => "S300" "issn" => "01616420" ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The spectrum of laser skin resurfacing: nonablative, fractional and ablative laser resurfacing" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.R. Alexiades-Armenakas" 1 => "J.S. Dover" 2 => "K.A. Arndt" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2008.01.003" "Revista" => array:7 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2008" "volumen" => "58" "paginaInicial" => "719" "paginaFinal" => "737" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18423256" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0002939412004369" "estado" => "S300" "issn" => "00029394" ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010400000002/v1_201304241618/S1578219013000024/v1_201304241618/en/main.assets" "Apartado" => array:4 [ "identificador" => "6152" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Opinion Article" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010400000002/v1_201304241618/S1578219013000024/v1_201304241618/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219013000024?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 22 | 8 | 30 |
| 2024 Octubre | 190 | 35 | 225 |
| 2024 Septiembre | 177 | 26 | 203 |
| 2024 Agosto | 202 | 59 | 261 |
| 2024 Julio | 181 | 25 | 206 |
| 2024 Junio | 155 | 29 | 184 |
| 2024 Mayo | 140 | 29 | 169 |
| 2024 Abril | 124 | 29 | 153 |
| 2024 Marzo | 134 | 21 | 155 |
| 2024 Febrero | 127 | 28 | 155 |
| 2024 Enero | 116 | 33 | 149 |
| 2023 Diciembre | 88 | 22 | 110 |
| 2023 Noviembre | 86 | 37 | 123 |
| 2023 Octubre | 60 | 40 | 100 |
| 2023 Septiembre | 44 | 37 | 81 |
| 2023 Agosto | 36 | 10 | 46 |
| 2023 Julio | 43 | 30 | 73 |
| 2023 Junio | 42 | 29 | 71 |
| 2023 Mayo | 45 | 20 | 65 |
| 2023 Abril | 37 | 33 | 70 |
| 2023 Marzo | 44 | 21 | 65 |
| 2023 Febrero | 27 | 30 | 57 |
| 2023 Enero | 24 | 24 | 48 |
| 2022 Diciembre | 47 | 42 | 89 |
| 2022 Noviembre | 32 | 27 | 59 |
| 2022 Octubre | 27 | 21 | 48 |
| 2022 Septiembre | 22 | 37 | 59 |
| 2022 Agosto | 21 | 39 | 60 |
| 2022 Julio | 26 | 26 | 52 |
| 2022 Junio | 21 | 28 | 49 |
| 2022 Mayo | 37 | 34 | 71 |
| 2022 Abril | 50 | 39 | 89 |
| 2022 Marzo | 45 | 46 | 91 |
| 2022 Febrero | 35 | 35 | 70 |
| 2022 Enero | 32 | 32 | 64 |
| 2021 Diciembre | 41 | 45 | 86 |
| 2021 Noviembre | 29 | 34 | 63 |
| 2021 Octubre | 52 | 57 | 109 |
| 2021 Septiembre | 41 | 41 | 82 |
| 2021 Agosto | 35 | 33 | 68 |
| 2021 Julio | 30 | 35 | 65 |
| 2021 Junio | 50 | 34 | 84 |
| 2021 Mayo | 60 | 42 | 102 |
| 2021 Abril | 95 | 47 | 142 |
| 2021 Marzo | 47 | 29 | 76 |
| 2021 Febrero | 47 | 29 | 76 |
| 2021 Enero | 37 | 24 | 61 |
| 2020 Diciembre | 29 | 8 | 37 |
| 2020 Noviembre | 36 | 14 | 50 |
| 2020 Octubre | 17 | 15 | 32 |
| 2020 Septiembre | 35 | 6 | 41 |
| 2020 Agosto | 25 | 26 | 51 |
| 2020 Julio | 30 | 3 | 33 |
| 2020 Junio | 32 | 20 | 52 |
| 2020 Mayo | 31 | 17 | 48 |
| 2020 Abril | 39 | 21 | 60 |
| 2020 Marzo | 37 | 18 | 55 |
| 2020 Febrero | 8 | 2 | 10 |
| 2020 Enero | 3 | 3 | 6 |
| 2019 Diciembre | 5 | 5 | 10 |
| 2019 Noviembre | 4 | 1 | 5 |
| 2019 Octubre | 0 | 1 | 1 |
| 2019 Septiembre | 4 | 0 | 4 |
| 2019 Agosto | 4 | 0 | 4 |
| 2019 Julio | 1 | 5 | 6 |
| 2019 Junio | 6 | 15 | 21 |
| 2019 Mayo | 5 | 26 | 31 |
| 2019 Abril | 3 | 7 | 10 |
| 2019 Marzo | 4 | 9 | 13 |
| 2019 Febrero | 0 | 6 | 6 |
| 2019 Enero | 3 | 0 | 3 |
| 2018 Diciembre | 4 | 2 | 6 |
| 2018 Noviembre | 0 | 2 | 2 |
| 2018 Octubre | 5 | 1 | 6 |
| 2018 Septiembre | 3 | 0 | 3 |
| 2018 Mayo | 0 | 7 | 7 |
| 2018 Abril | 0 | 1 | 1 |
| 2018 Marzo | 0 | 3 | 3 |
| 2018 Febrero | 29 | 2 | 31 |
| 2018 Enero | 26 | 6 | 32 |
| 2017 Diciembre | 33 | 5 | 38 |
| 2017 Noviembre | 29 | 5 | 34 |
| 2017 Octubre | 29 | 4 | 33 |
| 2017 Septiembre | 27 | 3 | 30 |
| 2017 Agosto | 43 | 7 | 50 |
| 2017 Julio | 32 | 5 | 37 |
| 2017 Junio | 45 | 24 | 69 |
| 2017 Mayo | 27 | 12 | 39 |
| 2017 Abril | 27 | 5 | 32 |
| 2017 Marzo | 31 | 5 | 36 |
| 2017 Febrero | 26 | 9 | 35 |
| 2017 Enero | 24 | 11 | 35 |
| 2016 Diciembre | 43 | 8 | 51 |
| 2016 Noviembre | 43 | 3 | 46 |
| 2016 Octubre | 44 | 6 | 50 |
| 2016 Septiembre | 46 | 14 | 60 |
| 2016 Agosto | 44 | 4 | 48 |
| 2016 Julio | 42 | 7 | 49 |
| 2016 Junio | 12 | 11 | 23 |
| 2016 Mayo | 8 | 9 | 17 |
| 2016 Abril | 5 | 14 | 19 |
| 2016 Marzo | 4 | 15 | 19 |
| 2016 Febrero | 6 | 18 | 24 |
| 2016 Enero | 10 | 16 | 26 |
| 2015 Diciembre | 13 | 15 | 28 |
| 2015 Noviembre | 15 | 18 | 33 |
| 2015 Octubre | 10 | 10 | 20 |
| 2015 Septiembre | 10 | 9 | 19 |
| 2015 Agosto | 15 | 3 | 18 |
| 2015 Julio | 53 | 10 | 63 |
| 2015 Junio | 60 | 10 | 70 |
| 2015 Mayo | 120 | 10 | 130 |
| 2015 Abril | 67 | 13 | 80 |
| 2015 Marzo | 52 | 4 | 56 |
| 2015 Febrero | 32 | 5 | 37 |
| 2015 Enero | 17 | 0 | 17 |
| 2014 Diciembre | 26 | 4 | 30 |
| 2014 Noviembre | 13 | 7 | 20 |
| 2014 Octubre | 22 | 8 | 30 |
| 2014 Septiembre | 6 | 5 | 11 |
| 2014 Agosto | 11 | 5 | 16 |
| 2014 Julio | 13 | 4 | 17 |
| 2014 Junio | 28 | 6 | 34 |
| 2014 Mayo | 19 | 5 | 24 |
| 2014 Abril | 15 | 5 | 20 |
| 2014 Marzo | 27 | 12 | 39 |
| 2014 Febrero | 28 | 10 | 38 |
| 2014 Enero | 21 | 12 | 33 |
| 2013 Diciembre | 26 | 7 | 33 |
| 2013 Noviembre | 10 | 5 | 15 |
| 2013 Octubre | 14 | 2 | 16 |
| 2013 Septiembre | 5 | 16 | 21 |
| 2013 Agosto | 7 | 2 | 9 |
| 2013 Julio | 9 | 24 | 33 |
| 2013 Junio | 3 | 6 | 9 |
| 2013 Mayo | 11 | 10 | 21 |
| 2013 Abril | 5 | 13 | 18 |
| 2013 Marzo | 8 | 6 | 14 |
Mostrar todo
