What is Nonablative Photorejuvenation of Human Skin?

Nonablative photorejuvenation has become an integral procedure in the emerging discipline of laser dermatologic surgery. The objective is to confine selectively, without any epidermal damage, thermal injury to the papillary, and upper reticular dermis leading to fibroblast activation and synthesis of new collagen and extracellular matrix material. The procedure results in minimal patient morbidity, no interference with lifestyle, and a low risk of complications, while providing a satisfying degree of rhytides reduction. Multiple devices have been studied and marketed for nonablative photorejuvenation of human skin. However, currently, nonablative photorejuvenation should not be considered an alternative to laser skin resurfacing. The skin surface is not removed or modified. What really occurs may be more accurately referred to as dermal "remodeling" or "toning" as a wound healing response is initiated and collagen regenerated. The narrow "therapeutic window" of laser-induced dermal heating and epidermal cooling must still be optimized so that effective treatments can be obtained routinely. Clinical verification of effective treatment parameters (irradiation wavelength, pulse structure, radiant exposure, cooling time) will be obtained through further human studies. Most importantly, understanding the relationship between the degree of dermal thermal injury and synthesis of new collagen and extracellular matrix material will be fundamental to predicting the clinical efficacy and limitations of nonablative photorejuvenation.