施留杰 張?jiān)扑?/p>
[摘 要] 面部皮膚年輕化是當(dāng)今臨床實(shí)踐和美容領(lǐng)域的熱點(diǎn)話題,鑒于手術(shù)治療存在一定創(chuàng)傷,多種非手術(shù)治療方法受到廣泛關(guān)注。其中點(diǎn)陣激光屬于激光療法的一種,可分為剝脫性點(diǎn)陣激光和非剝脫性點(diǎn)陣激光。點(diǎn)陣激光單獨(dú)應(yīng)用或與其他治療方式聯(lián)合應(yīng)用的療效確切,具有良好的應(yīng)用前景。本文就不同類(lèi)型的點(diǎn)陣激光療法應(yīng)用于面部皮膚年輕化的相關(guān)研究進(jìn)展作一綜述,以期為面部皮膚年輕化需求患者提供更為全面、有效地醫(yī)療美容服務(wù)。
[關(guān)鍵詞] 面部皮膚年輕化;點(diǎn)陣激光;剝脫性點(diǎn)陣激光;非剝脫性點(diǎn)陣激光
[中圖分類(lèi)號(hào)] R622 [文獻(xiàn)標(biāo)識(shí)碼] A [文章編號(hào)] 1004-4949(2024)10-0025-03
Research Progress of Fractional Laser in Facial Skin Rejuvenation
SHI Liu-jie, ZHANG Yun-song
(Department of Plastic and Cosmetic, Guangdong Second Provincial General Hospital of Jinan University, Guangzhou 510317, Guangdong, China)
[Abstract] Facial skin rejuvenation is a hot topic in the field of clinical practice and cosmetology. In view of the trauma of surgical treatment, a variety of non-surgical treatment methods have received extensive attention. Among them, fractional laser is a kind of laser therapy, which can be divided into ablative fractional laser and nonablative fractional laser. The application of fractional laser alone or in combination with other treatment methods is effective and has a good application prospect. This article reviews the research progress of different types of fractional laser therapy in facial skin rejuvenation, in order to provide more comprehensive and effective medical cosmetic services for patients with the demand of facial skin rejuvenation.
[Key words] Facial skin rejuvenation; Fractional laser; Ablative fractional laser; Nonablative fractional laser
隨著社會(huì)的發(fā)展,人們審美水平逐漸提高,對(duì)面部年輕化的追求也越來(lái)普遍。鑒于手術(shù)治療存在創(chuàng)傷大、恢復(fù)周期長(zhǎng)、副作用多等弊端,非手術(shù)治療方法如:外用維甲酸類(lèi)藥物、局部注射肉毒桿菌毒素、射頻、超聲、微針、激光療法等應(yīng)用更加廣泛[1]。其中點(diǎn)陣激光單獨(dú)或聯(lián)合其他光電或藥物治療,可有效改善皮膚老化,成為臨床治療面部年輕化的主要方式。近年來(lái),眾多學(xué)者驗(yàn)證了點(diǎn)陣激光技術(shù)治療面部年輕化的有效性、安全性,并探索其作用機(jī)制及與其他療法聯(lián)合應(yīng)用效果。本文主要回顧近年來(lái)的相關(guān)研究,分析點(diǎn)陣激光技術(shù)在面部年輕化中的研究進(jìn)展,以期為臨床應(yīng)用提供一定參考。
面部皮膚老化主要表現(xiàn)為皮膚松弛粗糙、皺紋、毛孔粗大、色素斑形成等,依據(jù)影響因素不同分為外源性老化和內(nèi)源性老化。外源性老化以光老化最常見(jiàn),會(huì)出現(xiàn)皮膚色沉、深大皺紋;內(nèi)源性老化是隨年齡增長(zhǎng)而發(fā)生的皮膚生理性衰老,受內(nèi)分泌因素和遺傳因素雙重影響,表現(xiàn)為皮膚萎縮、干燥、細(xì)小皺紋[2]。面部皮膚老化給愛(ài)美人士帶來(lái)了嚴(yán)重的心理壓力,而手術(shù)治療具有創(chuàng)傷大、恢復(fù)周期長(zhǎng)等局限性。近年來(lái),光電治療因其微創(chuàng)、安全性高、停工期短等優(yōu)勢(shì)逐漸廣泛應(yīng)用于面部年輕化治療中。
點(diǎn)陣激光技術(shù)是激光療法在醫(yī)學(xué)領(lǐng)域新的巨大突破,其作用原理是局灶光熱理論,由Anderson RR等[3]學(xué)者提出,該技術(shù)通過(guò)將精確的激光微束傳遞到皮膚下層,在治療區(qū)域產(chǎn)生熱效應(yīng)改變部分皮膚組織,即形成微熱損傷區(qū)(microthermal zone,MTZ),由于被周?chē)】到M織包圍,促進(jìn)了組織快速新生,減少停工期。根據(jù)熱損傷強(qiáng)度不同,點(diǎn)陣激光又分為剝脫性點(diǎn)陣激光(ablative fractional laser,AFL)和非剝脫性點(diǎn)陣激光(nonablative fractional laser,NAFL)。
2.1 剝脫性點(diǎn)陣激光
2.1.1概述及作用機(jī)制 剝脫性點(diǎn)陣激光是一種有創(chuàng)性激光,通過(guò)對(duì)表皮和真皮乳頭層的汽化及熱消融,形成點(diǎn)陣狀不完全剝脫創(chuàng)面,在愈合階段,由輕微創(chuàng)傷刺激膠原蛋白再生與重塑,從而達(dá)到除皺、緊致皮膚的顯著療效。臨床常用的主要有CO2點(diǎn)陣激光(波長(zhǎng)10 600 nm)和Er:YAG激光(波長(zhǎng)2940 nm)[4]。
2.1.2臨床應(yīng)用 剝脫性點(diǎn)陣激光形成微熱損傷區(qū),促進(jìn)皮膚Ⅰ、Ⅲ型膠原蛋白新生和重塑。治療參數(shù)方面,有研究提出[5],低能量低密度CO2點(diǎn)陣激光是一種安全有效的面部年輕化選擇,點(diǎn)陣激光往往會(huì)增加了深膚色患者出現(xiàn)炎癥后色素沉著并發(fā)癥的可能。Andrade GB等[6]給予705例拉丁美洲患者CO2點(diǎn)陣激光治療,證實(shí)了CO2點(diǎn)陣激光在各膚色人群中的廣泛適用性。剝脫性點(diǎn)陣激光術(shù)后常見(jiàn)并發(fā)癥有皮膚紅斑、腫痛、瘙癢等,皮膚剝脫后皰疹病毒的爆發(fā)是最常見(jiàn)的感染方式。
2.2 非剝脫性點(diǎn)陣激光
2.2.1概述及作用機(jī)制 非剝脫性點(diǎn)陣激光的工作原理是加熱皮膚而不產(chǎn)生皮膚剝脫。通過(guò)熱量刺激膠原蛋白損傷后再生,新生的膠原蛋白填補(bǔ)了皺紋和局部皮膚凹陷,同時(shí)也增強(qiáng)了皮膚結(jié)構(gòu)并減輕色素沉著等皮膚老化問(wèn)題[7]。非剝脫性點(diǎn)陣激光治療比剝脫性點(diǎn)陣激光侵入性更小,恢復(fù)時(shí)間也更少。
2.2.2臨床應(yīng)用 剝脫性點(diǎn)陣激光在面部皮膚年輕化治療中的應(yīng)用效果在臨床實(shí)踐中已得到肯定,但其有創(chuàng)性降低了患者耐受性,因此非剝脫性點(diǎn)陣激光的應(yīng)用隨之增加。有研究表明[8],1540 nm點(diǎn)陣鉺玻璃激光治療后面部皺紋外觀有顯著改善。治療參數(shù)方面,Kirsanova L等[9]分別使用1064 nm激光的低能量模式(1.1 J/cm2)和高能量模式(2.1 J/cm2),結(jié)果顯示高能量模式下作用效果顯著優(yōu)于低能量模式,Ⅲ型膠原蛋白表達(dá)量也高于低能量組。黃褐斑是一種嚴(yán)重影響外觀的色素沉著病變,有研究發(fā)現(xiàn)[10],對(duì)黃褐斑患者進(jìn)行多達(dá)9次的非剝脫性1064 nm點(diǎn)陣激光治療,療效顯著,皮損改善效果良好。此外,非剝脫性點(diǎn)陣激光治療后并發(fā)癥低于剝脫性點(diǎn)陣激光,但仍不可忽視,其中色素沉著是非剝脫性點(diǎn)陣激光治療后最常見(jiàn)并發(fā)癥[11]。
3.1 點(diǎn)陣激光聯(lián)合其他光電療法 隨著各類(lèi)新型光電器械問(wèn)世,臨床工作者傾向于采用多種光電療法聯(lián)合治療以提升療效。高強(qiáng)度聚焦超聲在真皮網(wǎng)狀層至SMAS層產(chǎn)生小的微熱病變,而CO2點(diǎn)陣激光則主要針對(duì)表皮及真皮乳頭層,Kang HY等[12]聯(lián)合使用CO2點(diǎn)陣激光及高強(qiáng)度聚焦超聲實(shí)現(xiàn)多層次治療面部皮膚老化。此外,有研究表明[13],CO2點(diǎn)陣激光聯(lián)合強(qiáng)脈沖光改善面部老化的效果良好。也有研究發(fā)現(xiàn)[14],點(diǎn)陣微針射頻聯(lián)合非剝脫性1927 nm點(diǎn)陣激光治療后面部皮膚更加緊致年輕。由此可見(jiàn),點(diǎn)陣激光與多種光電療法聯(lián)合應(yīng)用起到了協(xié)同作用,在提高療效及減少并發(fā)癥方面均優(yōu)于單一療法。
3.2 點(diǎn)陣激光聯(lián)合外用藥物 激光輔助皮膚藥物遞送技術(shù)(laser-assisted drug delivery,LADD)是聯(lián)合應(yīng)用激光與外用藥物,皮膚屏障限制了經(jīng)皮藥物的生物利用率,而點(diǎn)陣激光的光熱解作用可以提高藥物療效,外用藥物也能促進(jìn)激光術(shù)后恢復(fù),起到相輔相成的效果[15,16]。富血小板血漿含有豐富的生長(zhǎng)因子[17],聯(lián)合點(diǎn)陣激光治療后,對(duì)皮膚色澤、毛孔擴(kuò)張程度等有明顯改善[18,19]。由于眶周解剖位置特殊,眶周年輕化治療往往難度較大。有研究顯示[20],剝脫性CO2點(diǎn)陣激光聯(lián)合重組人膠原蛋白治療眼周老化可顯著改善眼周皺紋及皮膚松弛,還能增加眼瞼皮膚厚度。激光治療不僅能提高藥物的滲透性,抗衰藥物也能促進(jìn)激光后損傷修復(fù),減少不良反應(yīng),實(shí)現(xiàn)療效最大化。
近年來(lái),點(diǎn)陣激光在內(nèi)的光電聲技術(shù)發(fā)展尤為迅速,且經(jīng)臨床試驗(yàn)證實(shí),點(diǎn)陣激光可以單獨(dú)或與其他光電技術(shù)、外用藥物等聯(lián)合用于改善面部皮膚老化。隨著社會(huì)生活水平的提高和人們的抗衰意識(shí)增強(qiáng),對(duì)于早期抗衰治療的需求日益增加,需要針對(duì)不同年齡段人群的皮膚衰老狀況提供更加個(gè)體化的診療方案,使點(diǎn)陣激光治療面部皮膚老化方面發(fā)揮出更優(yōu)效果。
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收稿日期:2024-3-22 編輯:扶田