Cryo is a skin cooling system designed for superficial laser skin procedures. The Cryo 6 cold air device is intended to minimize pain and thermal injury during laser and dermatological treatments and for temporary topical anesthetic relief for injections. Unlike other cooling methods, such as contact cooling, cryogen spray or ice packs, the Cryo 6 can cool the epidermis before, during and after the laser energy has been applied, without interfering with the laser beam.
Background and Objectives
Cold air cooling is widely used in dermatological laser therapy. We investigated the influence of cold air cooling at different skin temperatures on therapeutic outcome and side effects of pulsed dye laser treatment of facial telangiectasia.
Study Design / Materials and Methods
From September 2002 to February 2003, 17 patients with previously untreated facial telangiectasia underwent a single treatment session with flash-lamp pulsed dye laser (3.5 J / cm2, 585 nm, 0.45 milliseconds pulse length, 10 mm beam diameter, Cynosure1 V). The treatment area was divided into three sub-areas: no cooling, cold air cooling to 20°C and to 17°C skin temperature. The skin temperature was monitored by a prototype infrared sensor system which controlled the temperature of the cold air stream (Cryo 5). In a prospective study, we collected data on purpura, pain, clearance, and patient satisfaction on numerical analog scales (NAS) from 0 (meaning »no«) to 3 (meaning »high«).
Without cooling, purpura (2.53), pain (2.41), and clearance (2.35) were rated medium to high. Cooling to 20°C reduced purpura (1.12) and pain (1.06), whereas the clearance (2.12) was only slightly affected. Cooling to 17°C reduced purpura (0.76) and pain (0.88) even more, the clearance (2.06) was lowered marginally. Most patients preferred cooling to 20°C skin temperature.
In dermatological laser therapy of facial telangiectasia, the use of cold air cooling can significantly reduce side effects and increase patient satisfaction while only slightly affecting clearance. Cooling to 20°C skin temperature proved to be a well-balanced middle course. For the practical use of cold air cooling, we thus recommend cooling to a level which the patient can tolerate without problems and to try to increase the energy.
Material and method
The treatment with and without cold air application was conducted in halfside comparison. The force of the air current corresponded with level 5 of the instrument Cryo 6 by the company Zimmer MedizinSysteme (scale of levels 0-9). Each patient served as his/her own monitoring, as the intervention took place symmetrically on both body halves, the cold air treatment however only on one half. Measured was the subjectively declared pain by means of a visual analog scale of 1-10, whereby 1 indicated no pain and 10 the most servere imaginable. As pain occurence was applied the prick with the injection needle, either to inject BTX, Hyaluronic acid or a local anesthetica.
The cold air was applied to the patients during the interventions. The fan level 5 of the instrument Cryo 6 (company Zimmer MedizinSysteme, Neu Ulm) was used. The cooling was applied during the complete duration of the injection (approximately 1 – 2 minutes). Used was an exact cool air nozzle opening of 5 mm. The distance between the cool air nozzle opening and the skin surface was 3 cm. Used were Hyaluronic acid products of the company Zimmer MedizinSysteme Z Fill refresh for subdermal injection and Z Fill deep for intradermal injection.
All patient groups had significantly less pain after the treatment with cold air than without cold air. This also corresponds with the well studied pain reduction effect of cold air. Cold air relieves pain reliably in cosmetical interventions. Especially significant was the pain relief during the non-surgical treatments with injections of Botulinumtoxin and Hyaluronic acid-fillers. Cold air reliably reduces the pain of the pre-treatment of cosmetical interventions by allowing a painless injection of BTX, Hyaluronic acid or a local anaesthetica.
Lasers in Surgery and Medicine 9999:1–5 (2004)