Introduction

Q Switch Lasers are an alternative therapeutic modality for patients failing to respond to or unable to tolerate conventional acne treatments. The therapeutic mechanism of Q switch lasers is associated with its wavelength, total energy, power, and pulse duration. Q-switched 1064-nm Nd:YAG laser is commonly used for pigmentation and tattoo removal. 1064-nm Q-switched Nd:YAG laser combined with topical carbon suspension provides good improvement in periocular and perioral rhytides(fine wrinkles).

Topical carbon suspension combined with q switch laser treatment (carbon facial) improves post-acne scarring and facial wrinkles. The Q-switched 1064-nm Nd:YAG laser together with an exogenous artificial chromophore (topical carbon lotion serving as a photoenhancer) is associated with significant improvements in acne.1064-nm Nd:YAG laser used for treatment with quasi-long pulse and the Q-switched pulse.The absorption characteristics of carbon at 1064 nm are capable of producing biological phenomenon effective for treatment of inflammatory acne.

Procedure

• The patient’s face is washed with a bi-phasic cleanser. The topical carbon lotion is applied evenly over face and allowed to penetrate the skin and hair follicles for 20 minutes.
• From a dual pulsed Q-switched Nd:YAG laser, the laser energy is delivered with a 8-10 mm diameter spot-sized handpiece at a frequency of 10 Hz. Single pass with minimal overlapping is carried on face with a quasi long-pulse of 300 microseconds. Overlap is minimised during the first pass as multiple overlapping passes can induce too much of a thermal effect can damage skin.
• Second pass is done in Q-switched mode, with a pulse width of 5 nanoseconds. All the areas to be treated are covered in 3 passes (horizontal, vertical, and diagonal) with 30% overlapping until the popping sound of carbon is no longer heard. The immediate post-treatment end point is an even mild erythema over the entire face.

Mechanism of Action

The topical carbon suspension containing purified carbon particles serves as an exogenous artificial chromophore. The 1064-nm Nd:YAG laser light is strongly more absorbed by carbon as compared to melanin. Carbon suspension particles are distributed into the stratum corneum, and some penetrate into the hair follicles. When activated by the laser light, the carbon undergoes a rapid temperature increase, thereby heating and damaging the follicles and surrounding structures such as sebaceous gland. 1064 nm-Nd:YAG laser system with  a 300-microsecond quasi-long pulse width and 5-nanosecond pulse width is used for carbon (hollywood) facial.

The first pass is a quasi long pulse of 300 microseconds that heats the applied carbon particles.  It alters immunobiological response to the P acnes in skin of acne patients. It controls the dermal inflammation associated with the inflammatory acne lesions. Sebaceous glands are thermally ablated, and it reduces the non-inflammatory acne lesions and sebum output. Thermal injury to the dermis affects the vasculature and fibroblastic proliferation and dermal matrix rearrangement induction. It helps skin tightening and reduces the appearance of superficial acne scars.

The second pass is delivered at a Q-switched pulse width of 5 nanoseconds. The stratum corneum is superficially ablated. The peeling effect cleans off the skin surface and the plugged pores and improves comedones. The Q-switched 1064-nm Nd:YAG laser increases collagen synthesis similar to the first pass. The sebaceous gland size, number and sebum output is decreased and many patients reported a sensation of dryness. The peeling effect of the Q-switched mode phase corrects the hypercornification of follicular epithelium.

The dual toning effect of the quasi-long pulse and Q-switched Nd:YAG laser treatment assisted with a topically applied carbon suspension acts quickly, and is effective for treating not only inflammatory but noninflammatory acne lesions on face.

Sebum output reduction caused by sebaceous gland destruction, inflammatory cell and cytokine reductions, and decrease of perifollicular stratum corneum and epithelium. No serious side effects are observed. The dual mode of the quasi-long pulse and Q-switched Nd:YAG laser treatment assisted with a topically applied carbon suspension is a novel approach that is safe and effective for the acne and is popularly known as Hollywood (carbon) facial.