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(Figure 1) [4]. It is a treatment modality that has been shown to provide increased rates of skin rejuvenation and wound healing with great efficacy, while also reducing post-operative pain, edema and several types of inflammation making it highly desirable tool. Early studies by Abergel et al. [5] and Yu et al. [6] reported an increase in production of pro-collagen, collagen, basic fibroblast growth factors (bFGF) and proliferation of fibroblasts after exposure to low-energy laser irradiation in vitro and in vivo animal models. Lee et al. conducted a study to investigate the histological and ultrastructural alterations that followed a series of phototherapies utilizing combinations of light emitting diodes (LEDs) of 830 nm, 55 mW/cm2, 66 J/ cm2 and 633 nm, 105 mW/ cm2, 126 J/ cm2. They observed alteration in the status of MMPs and tissue inhibitors of metalloproteinases (TIMPs) [7]The study also showed increased mRNA levels of interleukin-1 beta (IL-1ß), tumor necrosis factor alpha (TNF-α), intercellular adhesion molecule 1 (ICAM-1), and connexin 43 (Cx43) following LED phototherapy whereas IL-6 levels were decreased [7]. Subsequently the study also demonstrated a well-marked increase in the amount of collagen in the post-treatment specimens [7]. It is thought that the deliberate development of photothermally-mediated wounds is responsible for the recruitment of pro-inflammatory cytokines IL-1ß and TNF-α in order cause wound repair. The generation of such a wound healing cascade thus contributes to new collagen synthesis [7]. LLLT may induce this wound healing process through athermal and atraumatic induction of a subclinical ‘quasi-wound’, even without any actual wounding created by thermal damage which can possibly cause complications as in some other laser treatments [7]. MMP activities are known to be inhibited by TIMPs, suggesting the possibility of other mechanisms for increased collagen synthesis through induction of TIMPs. Collectively viewing these findings, they are suggestive of the idea that an increased production of IL-1ß and TNF-α might be responsible for induction of MMP activity as an early response to light treatment, which might possibly contribute to the removal of photodamaged collagen fragments in order to facilitate collagen biosynthesis of new fragments. Furthermore, as a consequence of the therapy there may be increased concentrations of TIMPs that most likely play a role in the protection of the newly synthesized collagen, from proteolytic degradation by MMPs [7]. Subsequently, heightened expression of Cx43 may possibly enhance cell-cell communication between dermal components, especially between fibroblasts, allowing for greater synchrony between cellular responses, following the effects of photobiostimulation from LLLT in order to promote synthesis of new collagen in a greater area including even the regions that did not receive light irradiation [7]. A clinical study conducted by Weiss et al. demonstrated the benefits of LLLT over traditional thermal-based rejuvenation modalities. A group of 300 patients were administered LLLT (590 nm, 0.10 J/cm2) alone, and another group of 600 patients received a combination of LLLT with a thermal-based photorejuvenation procedure. Of the patients who received just the light treatment, 90% reported an observed softening of skin textures as well as a reduction in skin coarseness and fine lines that ranged from small alterations to significant changes [8].It was observed that patients who received a form of LLLT (n = 152) reported a noticeable reduction in post-treatment erythema and an overall impression of increased efficacy versus patients that received treatment through a thermal photorejuvenation laser or light source lacking any sort of LLLT photomodulation [8, 9]. Reduction in post-treatment erythema can most likely be attributed to the anti-inflammatory effects of LLLT. [10]. Utilizing different pulsing sequence parameters, a multicenter clinical trial was conducted, wherein 90 patients received 8 LLLT treatments over 4 weeks [11-14]. The study presented desirable results with more than 90% of patients improving by at least one Fitzpatrick photoaging category and 65% of the patients displaying global improvement in facial texture, fine lines, background erythema and pigmentation with results peaking at 4 to 6 months following completion of the 8 treatments. Noticeable increases in papillary dermal collagen and reductions in MMP-1 were generally observed. A study conducted by Barolet et al. also proved to be consistent with the aforementioned studies. The study used a 3-D model of tissue-engineered Human Reconstructed Skin (HRS) to investigate the potential of LLLT (660 nm, 50 mW/cm, 4 J/cm2) in collagen and MMP-1 modulation. The results showed up-regulation of collagen and down-regulation MMP-1 in vitro [10]. A split-face, single-blinded clinical study was then carried out to assess the results of this light treatment on skin texture and appearance of individuals LLLT sources with wavelengths of 633 nm/830 nm is most common in cases of clinical application involving wound healing and skin rejuvenation. LLLT is now used for the healing of even non healing wounds through restoration of collagenesis/collagenase imbalances and allows for rapid and enhanced wound healing in general. Proc. of SPIE Vol. 8932 89320X-2 Implementation ofPDF Image | Low-level light therapy (LLLT) for cosmetics and dermatology
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