Laser treatments deserve second look in how they interact with one another

Hyaluronic acid (HA) fillers and laser treatments: They're part of the armamentarium of countless cosmetic physicians. And for good reason — they work.

Dr. Khoury

A study conducted by Jordan P. Farkas, M.D., James A. Richardson, D.V.M., Ph.D., Spencer Brown, Ph.D., John E. Hoopman, and Jeffrey M. Kenkel, M.D., researchers at the University of Texas, Southwestern, set out to take a deeper look at how subsequent laser application affected previously injected HA in a porcine model.

BEYOND THE SURFACE For the study, "The abdomens of six Yorkshire pigs were injected with three different HAFs: Restylane (Medicis), Perlane (Medicis) and Juvéderm (Allergan Medical)." Two weeks later, the researchers treated the injection sites with one of seven common laser/light ablative or nonablative devices.

After the laser treatment, they obtained 8-mm punch biopsies from the treated tissue, and fixed the samples for histopathologic evaluation, staining them with hematoxylin-eosin and alcian blue stains for identification of the pre-injected HAF.

So, does the use of lasers on skin previously treated with HAF have any influence on the latter? Put succinctly: It depends.

The researchers concluded, "Injected HAFs were unaffected by the nonablative laser/light and superficial ablative treatments. The more aggressive deeper laser treatments demonstrated laser-filler interaction and may have a clinical effect on the longevity of the filler and/or efficacy of laser treatments. Novel ablative fractional lasers have the capability of deep dermal penetration, and this should be taken into consideration when planning to use them in combination with soft tissue fillers for noninvasive facial rejuvenation."

CONSIDERATIONS IN PRACTICE Jane G. Khoury, M.D., private practitioner at The Dermatology Center at Ladera, Ladera Ranch, Calif., reviewed these findings and tells Cosmetic Surgery Times that the study addresses an important topic.

"Combination therapy is an expanding area of cosmetic surgery and as fillers, nonablative and ablative resurfacing become more popular, this issue becomes an important practical consideration," she says.

This study takes steps to definitively determine what happens to the skin — and below the skin's surface — when laser is used subsequent to HA. "The effects of the laser were, in general, above the placement of the filler, although as [the researchers] mentioned, this is very technique-dependent," Dr. Khoury observed. "On the deeper ablative lasers such as DeepFx or Profractional, even though the microablation columns approached the placement of the HA fillers, no denaturation of the filler was seen."

Dr. Khoury says that she is unaware of any other ongoing or completed research on HA fillers and laser treatments, "although there have been anecdotal reports of extrusion of filler with laser resurfacing, as well as reports of no extrusion of superficially placed filler with DeepFx treatment over the nasolabial fold."