Quantitative Evaluation of
Nonablative Laser Technology
Paul M. Friedman, MD,*1: Greg R. Skover, PhD,t Greg Payonk, PhD,T and
Roy G. Geronemus, MD1:
A new method for treating facial rhytides a n d
a c n e scars with n o n a b l a t i v e laser and light source
techniques has recently been introduced. Given
the inherent limitations of p h o t o g r a p h i c and clini-
cal e v a l u a t i o n to assess subtle changes in rhyt-
ides and surface topography, new noninvasive,
objective instruments were used to a c c u r a t e l y as-
sess the o u t c o m e of these procedures. This study
measures and objectively quantifies facial skin by
using 2 novel, noninvasive measuring systems af-
ter 3 to 5 treatment sessions with the 1,064 nm QS
Nd:YAG laser in patients with p h o t o d a m a g e a n d
a c n e scarring. One system measures the skin sur-
f a c e t o p o g r a p h y a n d the other characterizes the
b i o m e c h a n i c a l properties of the skin. Patients un-
dergoing facial rejuvenation procedures were an-
alyzed before and after therapy with a 32 x 32 mm
in viva three-dimensional m i c r o t o p o g r a p h y imag-
ing system (PRIMOS, GFM, Teltow, Germany). The
i m a g i n g system projects light an to a specific sur-
f a c e of the skin with a Digital Micromirror Device
(DMD; Texas Instruments, Irving, TX) and records
the i m a g e with a CCD camera. Skin Surface mi-
c r o t o p o g r a p h y is reconstructed using t e m p o r a l
phase shift algorithms to generate three-dimen-
sional images. Measurements were taken at base-
line, at various times during the treatment proto-
col, and then at 3 and 6 month follow-up visits.
Silicone skin replicas (FLEXICO, Herts, England)
were also m a d e before and after the laser treat-
ment protocol for comparison to in viva acquisi-
tion. Skin stiffness and compliance were m e a -
sured with the BTC-2000 (BTC 2000, S.R.L.I. Inc.
Nashville, TN). This instrument measures the re-
sponse of the skin during dynamic stress created
by suction. An infrared targeting laser measures
the vertical d i s p l a c e m e n t of the skin during the
cycle. Pressure a n d deformation are g r a p h i c a l l y
displayed on the monitor and e m b e d d e d biome-
c h a n i c a l algorithms determine the aforemen-
tioned parameters based on the a v e r a g e of 3
*DermSurgery Laser Center, Houston, TX; "f'Shin Research
Center, Johnson andJohnson Consumer Companies, Skillman, NJ;
and ~Laser & Skin Surgery Center of New York, New York, NY.
Address reprint requests to Paul M. Friedman, MD, Director of
Laser Surgery, DermSurgery Laser Center, 7515 Main, Suite 21 O,
Houston, TX 77030; e-mail: pmfriedman@dermsurgery.org.
Copyright 2002, Elsevier Science (USA). All rights reserved.
1085-5629/02/2104-0004535.00/0
doi:10.1053/sder.2002.36768
266 Seminars in Cutaneous Medicine and Surgery, Vol 21, No 4 (December), 2002: pp 266-273
repetitive cycles. Four sites on the face were ana-
lyzed and c o m p a r e d including the right a n d left
cheek and the right and left forehead. Measure-
ments were taken at baseline a n d then at 1-, S-
and 6-month follow-up visits. Skin roughness de-
creased 11% from baseline in the patient with
p h o t o d a m a g e d skin, while the patients with a c n e
scarring showed a 33% improvement from base-
line after 3 treatment sessions. Six-months after the
fifth treatment session, a 26% improvement in skin
smoothness was d o c u m e n t e d in the patients with
p h o t o d a m a g e d skin, while a 61% improvement
was recorded in the subject with a c n e scarring.
B i o m e c h a n i c a l analysis of the skin showed a 23%
decrease in skin stiffness and a 30% increase in
skin c o m p l i a n c e at the 6-month follow-up in the
patients with p h a t o d a m a g e . Alternatively, the pa-
tient with a c n e scarring showed a 50% increase in
skin stiffness, and a 30% decrease in skin compli-
a n c e at the 6-month follow-up. Three-dimensional
in viva optical skin i m a g i n g p r o v i d e d a rapid and
quantitative assessment of surface t o p o g r a p h y
and facial fine lines after multiple treatment ses-
sions with a 1064-nm QS Nd:YAG laser, correlating
with clinical and subjective responses. Biome-
c h a n i c a l analysis p r o v i d e d technical understand-
ing of structural changes in p h o t o d a m a g e d skin
and a c n e scarring following n o n a b l a t i v e laser
treatment. Future a p p l i c a t i o n s of these devices
m a y include comparison of n o n a b l a t i v e laser
technology, optimization of treatment regimens,
a n d objective e v a l u a t i o n of other aesthetic proce-
dures performed by dermatologists.
Copyright 2002, Elsevier Science (USA). All rights
reserved.
A variety of methods have been used to treat
facial rhytides associated with photoaging
including dermabrasion, chemical peels, and ab-
lative laser resurfacing. 1-r Nonablative laser and
light source techniques have recently been intro-
duced as a treatment that selectively heats the
upper dermis, inducing a wound healing response
in the papillary and upper reticular dermis with-
out epidermal ablation. 8-t2 Histologic studies have
shown that new collagen production and deposi-
tion results from such procedures, and that re-
moval of the epidermis and portions of the dermis
are not required for neocollagenesis and collagen
QUANTITATIVE EVALUATION OF NONABLATIVE T E C H N O L O G Y
Fig 1, Patient with pho-
todamage before treat-
ment. (A) High resolution
camera image (B) three-
dimensional wiremesh re-
constructed surface.
remodeling, s,~~Improved skin texture and turgor
have been reported by patients and physicians,
but has been difficult to quantify given the inher-
ent limitation of photographic and clinical evalu-
ation.
A novel noninvasive, in vivo method for quan-
tifying facial skin has emerged enabling clinicians
to objectively quantify results obtained with
nonablative laser technology. This three-dimen-
sional microtopography imaging system has been
shown to detect subtle changes in skin topogra-
phy and structure (Fig 1), corresponding to clin-
ical and subjective evaluation. 13,s4
The PRIMOS optical three-dimensional in vivo
skin measurement device (PRIMOS, GFM~ Tet-
low, Germany) used in this study deploys a paral-
lel stripe pattern imaging technique that is pro-
jected onto the skin surface and depicted on the
charged coupled device (CCD) chip of a high res-
olution camera. Light patterns are created by a
digital micromirror projector (Texas Instruments,
Irving TX). The use of micromirror-based digital
light projectors is advantageous when applied to
optical three-dimensional in vivo skin measure-
ment because the light intensity is high~ exposure
time is short, and the light can be controlled point
and/or pixelwise. ~5 The 3D effect is achieved by
means of minute elevation differences on the skin
surface deflecting the parallel projection stripes to
produce a qualitative and quantitative measure-
ment of the skin's profile. Images are digitized and
transferred for computer-assisted quantitative
evaluation and measurement. Mathematical algo-
rithms embedded in the analytical software recon-
struct the data into a highly precise three-dimen-
sional profile of the skin surface.
To acquire an exact three-dimensional impres-
267
sion of skin microtopography the technique used
must achieve high lateral resolution with minimal
vertical interference, or noise, enabling accurate
reconstruction of images. Images must be ac-
quired rapidly without altering the surface. The
system must be abIe to 1) adapt to highly con-
toured surfaces without losing resolution, 2) cal-
ibrate with ease and ensure accurate measurement
of reconstructed images, and 3) identify suitable
landmarks permitting comparative image assess-
ment.
The vertical and lateral resolution of a stripe
projection measurement device such as the PRI-
MOS optical system are essentially determined by
the field of view (FOV) used, the number of pixels
of the recording camera and the accuracy of the
determination of the smallest stripe deflections
that can be processed. A highly precise area recov-
ery was developed for the PRIMOS device that
makes it possible to realize the measurement po-
sition on the skin surface with a precision of 1/10
pixel. Therefore, for the measurement field of
30 • 24 mm, using a 640 X 480 pixel CCD,
positioning precision of 3/xm can be attained.
This in vivo technique has been shown to be
superior to silicone rubber replicas to capture and
determine changes in the skin's surface topogra-
phy. 1~ Direct three-dimensional in vivo skin im-
aging and analysis can minimize inherent artifacts
associated with the capture and processing of rep-
licas. The improved standardization of subject po-
sitioning for climcal photographs are directly ap-
plicable to three-dimensional image capture.
Furthermore, multiple instruments can be stan-
dardized at different locations. Therefore when
similar methods are used to capture and process
268
images, the data can be compared directly, mini-
mizing variability among sites.
The ability to measure the response of the skin
in a noninvasive manner following treatment is
progressing beyond photographic, microscopic
and spectroscopic analysis. Optical methods
freeze a moment in time rather than evaluating the
properties of a living, dynamic tissue. The BTC-
2000 Dynamic Skin Analyzer (SRLI, Nashville,
TN) is an instrument designed to measure the
elastic deformation of skin during dynamic stress.
It has been used to assess changes in skin structure
caused by inflammatory disease affecting collagen
synthesis, lr inherent differences in skin struc-
ture, ss and changes in response to cosmetic pro-
cedures. 19 A measuring chamber is attached to the
skin with an adhesive ring, 1 cm in diameter, that
isolates a specific area of skin and minimizes skin
creep during analysis. The instrument applies a
linear negative pressure, at a predetermined rate
until a maximum pressure is achieved for a spec-
ified number of cycles. An infrared targeting laser
detects the vertical deformation of the skin en-
abling the instrument to automatically calculate
and display pressure and deformation in real time.
Biomechanical properties of the skin including
ultimate deformation, laxity, elasticity, stiffness,
and energy absorption are calculated with embed-
ded biomechanical algorithms by averaging the
data collected from the predetermined repetitive
cycles.
The elastic deformation of the skin is the max-
imum amount of displacement obtained at the
maximum pressure. Stiffness and energy absorp-
tion are 2 important biomechanical characteristics
used to describe the stiffness and compliance of a
material. Stiffness is the slope of the stress/strain
curve, and energy absorption is the area under-
neath the curve generated between the minimum
to the maximum point on the curve. As the slope
increases so does the stiffness of the material. The
compliance of a material describes its softness or
firmness. As energy absorption increases so does
the softness of the material. The more resistant a
material is to stress the greater is its perceived
hardness. In the case of skin, a tighter skin has a
greater slope and a higher stiffness. Tight skin
would also have a low compliance and be consid-
ered hard or firm. However, these biomechanical
definitions may not translate into the applied con-
notations of skin tone and are used to here to
FRIEDMAN ET AL
describe the structure of the skin and not its aes-
thetics.
MATERIALS AND METHODS
The study protocol conformed to the ethical
guidelines of the 1975 Declaration of Helsinki and
approved as a prospective clinical trial by the Es-
sex Institutional Review Board, Inc, Lebanon, NJ.
Two subjects were evaluated by three-dimen-
sional microtopography and biomechanical skin
analysis to show how quantitatively measurable
changes in the skin could be assessed following
nonablative laser treatments. Patient 1, a woman
with class III rhytides and skin phototype II, was
evaluated before treatment, after 3 treatment ses-
sions, and at 3 and 6 months after completion of
the fifth treatment session.
Patient 2 was a man with mild atrophic acne
scarring and skin phototype II. Three-dimen-
sional in vivo microtopography and silicone rub-
ber impressions were taken before treatment, after
3 treatment sessions, and at 3 and 6 months after
the completion of the fifth treatment session.
LASER TREATMENT
The patients were treated 5 times at 2- to
3-week intervals. A topical anesthetic (EMLA
cream, Astra USA, Westborough, MA) was ap-
plied under occlusion for 1 hour prior to each
treatment. Immediately before treatment, the
EMLA was washed off the treatment area and fol-
lowed by gentle cleansing with alcohol. The Q-
Switched Nd:YAG laser (Medlite IV, Continuum,
Santa Clara, CA) ()t = 1064 nm) was used with a
spot size 6 mm, fluence 3-3.5 J/cm 2. Multiple
passes with the laser were performed to the peri-
orbital and perioral regions until a clinical end
point of erythema was obtained. The patient with
acne scarring received multiple laser passes to
both cheeks, extending from the nasolabial fold to
the preauricular area and jawline until a clinical
end point of erythema was obtained. The patients
applied a sunscreen of SPF30 or higher daily to the
treatment areas.
CLINICAL PHOTOGRAPHY
Photographs were taken before and after the
procedure with a Nikon N6006 camera Nikkor 60
m m F2.8 lens (Melville, NY) and CSI Twin Flash
(Canfield Scientific, Fairfield, NJ) using KODAK
Kodachrome film (Rochester, NY). Replicate pho-
QUANTITMIVE EVALUATION OF NONABLATtVETECHNOLOGY
tographs were taken from 0 ~ 45 ~ (right), and 45 ~
(left) using a standardized reproduction ratio of
1:6 (f/16) for full facial photographs and 1:3 (f/22)
for close-up photographs. The patient was posi-
tioned in a CSI head restraint enabling compara-
tive photographs to be taken throughout the study
(Canfield Scientific, Fairfield, NJ). Pre- and post-
treatment photographs were assessed by 2 physi-
cians and graded on a four-point scale (0% change
from baseline was graded as no improvement, 1%-
25% change graded as mild improvement, 26-75%
change graded as a moderate improvement, 75%-
100% a marked improvement).
SKIN SURFACE TOPOGRAPHY
Patients were positioned in front of the light
projector and the head position fixed and re-
corded using a head restraint. Three-dimensional
microtopography was performed with the PRI-
MOS 32 • 32 m m imaging system (PRIMOS Im-
aging System, G.F.M. Tehow, Germany). A digital
micro mirror device (Texas Instruments, Irving
TX) creates a parallel stripe pattern imaging tech-
nique that is projected onto the skin surface and
depicted on the CCD chip of a high-resolution
camera. Images are digitized and transferred for
computer assisted quantitative evaluation and
measurement. Mathematical algorithms embed-
ded in the analytical software reconstruct the data
into a highly precise three-dimensional profile of
the skin surface.
Algorithms contained in the evaluation soft-
ware permit Star Roughness to be calculated from
the acquired surface profile. The average of 16
profile lines arranged in a radial array were used to
assess the surface. Two different roughness equa-
tions were used to analyze the data. Roughness
(R~) is the arithmetic average of the absolute val-
ues of all points of the profile. In other words, R~ is
the height of the rectangle with the same length
and surface as the profile encloses in the specified
sector. The value yields an impression of surface
smoothness therefore was used to analyze surface
images taken from subjects with acne scarring. On
the other hand, Roughness (Rz) is the mean peak
to valley height and is the arithmetic average of
the maximum peak to valley height of the rough-
ness values Y1 to Y5 of 5 consecutive sampling
sections over the filtered profile. Alternatively,
this value yields an impression of the prominence
of wrinkles that are the greatest contributors el-
269
fecting the surface deflection in the crow's feet
area of patients with photodamage. 2~
Silicone Impressions
Silicone skin replicas (FLEXICO, Herts, En-
gland) were made before and after the laser treat-
ment protocol to measure surface texture and
topography. Impressions were taken from repre-
sentative areas on the cheek from patient 2 with
acne scarring. Analysis was performed with the
PRIMOS 32 • 32 m m imaging system. The light
projector was rotated 90 ~ perpendicular to
mounting stand stage. The replica was positioned
underneath the light source and the image ac-
quired in a similar manner to the in vivo acquisi-
tion. 2~
BIOMECHANICAL SKIN CHARACTERIZATION
Skin stiffness, and compliance were measured
with the BTC-2000 (BTC 2000, S.R.L.I. Inc. Nash-
ville, TN). The instrument was set to apply a linear
negative pressure at a rate of 10 m m Hg/s; over 1
cm of skin until 150 m m Hg was achieved. An
infrared targeting laser measured the vertical dis-
placement of the skin during the cycle. Pressure
and deformation are graphically displayed on the
monitor and embedded biomechanical algorithms
determine the aforementioned parameters. Four
sites on the face were analyzed and compared in-
cluding the right and left cheek and the right and
left forehead. Measurements were taken at base-
line, and then at 1-, 3- and 6-month follow-up
visits.
RESULTS
In the patient with photodamaged skin, a re-
duction of 11% was observed in the Rz value from
baseline after 3 treatment sessions, while a 26%
reduction in skin roughness was recorded 6
months after the fifth treatment session (Fig 2).
The patient with acne scarring showed a decrease
in Ra at each follow-up visit by in vivo assessment.
Ra decreased by 33% after 3 treatment sessions. A
61% improvement was recorded 3-months after
the fifth treatment session, which was maintained
at the 6-month follow-up (Fig 3).
Evaluation of the biomechanical properties of
photodamaged skin following the laser treatment
protocol showed a continuous increase in skin
compliance, with an inverse change in skin stiff-
ness up to 3 months after the laser treatment pro-
270
Fig 2. IVlicrotopography of facial skin in a
woman with p h o t o d a m a g e after nonablative la-
ser remodeling. Three-dimensional microtopogra-
phy was performed with the PRIMOS 3 2 * 3 2 mm
imaging system (PRIMOS Imaging System, G.F.M.
Teltow, Germany). Patients were positioned in
front of the light projector and the head position
fixed and recorded using a head restraint. Skin
roughness (R, urn) was calculated from phase-
shift algorhythms e m b e d d e d in the software.
Roughness (Rz) is the mean peak to valley height
and is the arithmetic average of the maximum
peak to valley height of the roughness values Y1 to
Y5 of 5 consecutive sampling sections over the
filtered profile. Sixteen profile lines arranged in a
radial display were used to compute the a v e r a g e
surface roughness. Time points: Baseline: pretreat-
ment, Mid Tx: measurement before the fourth laser
treatment, 6 mo FU: six months after 5 laser treat-
ments. Solid black line indicates a linear, best-fit
line through the roughness points.
tocol. The right side of the forehead demonstrated
a greater change than the left side (Fig 4). Evalu-
ation of acne-scarred skin demonstrated an op-
posing phenomenon. Skin compliance decreased
by 34% with a reciprocal increase in skin stiffness
one-month following the laser treatment proto-
col, and results were similar in both the right and
left cheek. The decrease was not sustained at the
3- and 6-month time points on both cheeks
(Fig 5).
Comparison of in vivo versus replica impres-
sion Ra acquisition was performed with the PRI-
MOS imaging device. The surface data acquired
from the silicone replicas corroborated findings
from the in vivo images; however, they did not
show the accuracy or resolution determined by
the in vivo method. Both correlated with the clin-
ical assessment and subjective responses of a 25%
to 50% improvement after 3 treatment sessions,
and a greater than 50% improvement at the 3- and
6-months follow-up.
FRIEDMAN ET AL
The high-resolution camera images obtained
with the PRIMOS camera before and after treat-
ment (Figs 6A and 7A) clearly shows the improve-
ment of surface topography in patient 2. Color
coded height display of surface topography show
smoother skin texture 3-months after the 5 treat-
ment sessions by the evenness in color distribu-
tion with greater amount of color closer to the 0
height after the laser treatments (Figs 6B and 7B).
CONCLUSION
The study of nonablative laser technology for
facial fine lines and acne scarring is a new area of
clinical research for which appropriate evaluation
criteria are being determined. Three-dimensional
in vivo imaging provided a real time, quantitative
analysis of the skin surface, enabling a dimension
of objectivity for the evaluation of nonablative
laser technology to improve these conditions.
Likewise the BTC-2000 calculated the anisotropy
of skin in response to a vertical displacement force
Fig 3. Microtopography of facial skin in a man
with a c n e scarring after nonablative laser remod-
eling. Three-dimensional microtopography was
performed with the PRIMOS 3 2 * 3 2 mm imaging
system (PRIMOS Imaging System, G.F.M. Teltow,
Germany). Patients were positioned in front of the
light projector and the head position fixed a n d
recorded using a head restraint. Skin roughness
(No urn) was calculated from phase-shift algo-
rhythms e m b e d d e d in the software. Roughness
(No) is the height of the rectangle with the same
length and surface as the profile encloses in the
specified sector. Sixteen profile lines arranged in
a radial display were used to compute the aver-
a g e surface roughness. Time points: Baseline: pre-
treatment, Mid Tx: measurement before the fourth
laser treatment, 3 and 6 mo FU: three a n d six
months after five laser treatments. Dashed black
line indicates a linear, best-fit line through the
roughness points.
QUANTITATIVE EVALUATION OF NONABLATIVE TECHNOLOGY
100,0
80.0
8
60,0
ca
-~
40.0
20.0
0.0
Fig 4. B i o m e c h a n i c a l characterization of facial
skin in a w o m a n with p h o t o d a m a g e after n o n a b -
lative laser remodeling. Skin stiffness ( b l a c k a n d
striped bars), a n d c o m p l i a n c e (open d i a m o n d
a n d circle) were measured with the BTC-2000
(BTC 2000, S.R.LI. Inc. Nashville, TN) using a linear
negative pressure at a rate of I 0 m m H g l s e c ; over
I cm of skin until 150 m m H g was a c h i e v e d . Data
represents one m e a s u r e m e n t cycle, on unstressed
skin, performed on the right and left forehead at
baseline, 1, 3, a n d 6 months after five treatments
with the 1,064 nm QS Nd:YAG laser. Solid b l a c k
a n d gray lines indicate a third order polynominal,
best-fit line through the skin c o m p l i a n c e points.
Dashed black and gray lines indicate a linear,
best-fit line through the skin stiffness points.
in a relatively easy and reproducible manner. Both
methods allowed for the rapid evaluation of the
surface and dermal structure of the skin, provid-
ing a better understanding of photodamaged skin
and acne scarring, and a technical understanding
of structural changes in the skin after this evolving
technique.
After 3 to 5 treatment sessions with a QS Nd:
YAG laser, we quantified improvement of surface
topography using three-dimensional in vivo skin
imaging in patients with acne scarring and facial
fine lines. Surface topography and facial fine lines
were effectively captured by the PRIMOS imaging
system at baseline, during the treatment sequence
and months after therapy. Evaluation of succes-
sive images suggests that the method provides
rapid and reliable data that can document out-
comes throughout the rejuvenation process. Pa-
tients were assessed over 10 months, with photog-
raphy, skin replicas, and three-dimensional in
vivo imaging. The subjects showed successive im-
provement in surface topography at the end of the
treatment sequence continuing through the sub-
271
sequent evaluation time points, suggesting ongo-
ing dermal collagen remodeling. The greatest per-
centage improvement was observed with in vivo
imaging at 3 months after the treatment protocol.
The improvement plateaued and held constant at
the final 6-month evaluation.
Three-dimensional in vivo optical imaging pro-
vided higher resolution of skin topography than
analysis by clinical photography or skin replicas
changes, and were in agreement with clinical as-
sessment and patient subjective responses. This
data corroborates results presented by Bowes et
a114 showing a substantial correlation between
subjective clinical assessment and obj ective three-
dimensional in vivo imaging after nonablative la-
ser procedures. These results suggest that three-
dimensional in vivo skin imaging provides a rapid
and accurate method to quantify measurable
changes in subjects with acne scarring and photo-
damage. This imaging technique has also proven
useful for quantitative assessment of nonablative
laser technology in a larger series of patients
treated for acne scarring. =
Results from the biomechanical assessment are
more perplexing and may require more rigorous
250 - - 80
- 70
200
- 6D
8
150 so ._~9
r O
100 30
20
50-
10
0 0
roLlCheek Stiffness
toRtCheekSUfflle~
OLtCheekCompr~en~
~ n c e
Fig 5. B i o m e c h a n i c a l characterization of facial
skin in a m a n with a c h e scarring following nonab-
lative laser remodeling. Skin stiffness ( b l a c k a n d
striped bars), and c o m p l i a n c e (open d i a m o n d
a n d circle) was measured with the BTC-2000 (BTC
2000, S.R.L.I. Inc. Nashville, TN) using a linear neg-
ative pressure at a rate of 10 mml-lglsec; over I
cm of skin until 150 m m H g was a c h i e v e d . Data
represents one m e a s u r e m e n t cycle, on unstressed
skin, performed on the right and left c h e e k over
the m a l a r process at baseline, 1, 3, a n d 6 months
after five treatments with the 1,064 nm QS Nd:YAG
laser. Solid a n d dotted lines are a best-fit linear
line through the skin c o m p l i a n c e points.
272
evaluation. The 51-year-old woman with photo-
damage showed an increase in skin compliance,
whereas the 40-year-old man with acne scarring
showed a decrease in skin compliance however,
both showed improvement. The increase in skin
compliance is similar to the changes observed by
Tan et al ~9 after microdermabrasion. The decrease
in skin compliance may be unique to skin with
acne scarring or could be the due to gender and
hormonal differences. In a larger series of subjects
evaluated with this modality, the average skin
compliance measured at baseline was 76.8 m m Hg
• m m for men, whereas it was 47.7 m m Hg • m m
for women. 23 Results from this study further
showed that subtle changes induced via energy-
matrix interactions are detectable with the BTC-
2000, similar to results obtained from patients
with systemic sclerosis ~ and normal patients with
and without cellulite, ts
These instruments enabled the elucidation of
novel properties of the skin, allowing correlation
Fig 7. Patient with a c n e
scarring three months af-
ter the end of five treat-
ments. (A) High resolution
c a m e r a image (B) color
coded surface topogra-
phy image (Ra = 37.0
#M).
FRIEDMAN ET AL
Fig 6. Patient with a c n e
scarring before treatment.
(A) High resolution cam-
era image (B) color c o d e d
surface topography im-
a g e (Ra = 90.4/~M).
with subjective end-points obtained with nonab-
lative laser technology. Future applications may
include comparison of nonablative laser technol-
ogy, optimization of treatment regimens, and ob-
jective evaluation of other aesthetic procedures
performed by dermatologists. These devices may
also allow for the evaluation of other cosmetic
procedures such as alternative energy sources,
soft tissue augmentation, BOTOX injections, and
topical anti-aging medications.
ACKNOWLEDGMENT
The authors express our sincere appreciation to
Marisol Edward, Judy Dulberg, Alexis Moreno,
and Michelle Turnbull of the Laser (~ Skin Sur-
gery Center of New York Research Department for
their clinical assistance. Furthermore, to Dick
Jackson, D-Jackson Software Consulting Calgary,
Canada, for his invaluable expertise in developing
the software for the three-dimensional image pro-
cessing and analysis.
QUANTITATIVE EVALUATION OF NONABLATIVE TECHNOLOGY
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