medicina
Brief Report
Carbon Peeling Laser Treatment to Improve Skin Texture, Pores
and Acne Lesions: A Retrospective Study
Claudio Conforti 1, * , Stefania Guida 2 , Caterina Dianzani 3 , Piergiorgio Turco 4 , Vito Cazzato 5 ,
Iris Zalaudek 1 and Domenico Piccolo 6
1 Dermatology Clinic, University of Trieste, Maggiore Hospital, Piazza Ospitale 1, 34125 Trieste, Italy
2 Dermatology Clinic, Vita-Salute San Raffaele University, 20132 Milan, Italy
3 Plastic and Reconstructive Surgery Unit, Campus Biomedico University of Rome, 00128 Rome, Italy
4 Department of Plastic and Reconstructive Surgery, Università Degli Studi di Napoli Federico II, Via Pansini 5,
80131 Napoli, Italy
5 Plastic and Reconstructive Surgery Unit, Department of Medical, Surgical and Health Sciences, University of
Trieste, 34127 Trieste, Italy
6 Skin Center Avezzano, Private Practice, Avezzano, L’Aquila, Via Saragat 51, 67051 Avezzano, Italy
* Correspondence: claudioconforti@[Link]
Abstract: Carbon peel laser treatment has been described for the improvement of skin texture, with
pore reduction and acne lesion treatment. The technique consists of applying a carbon mask to
the face for about ten minutes followed by laser irradiation with a Q-switched 1064 nm laser. This
mechanism of action seems to be related to small carbon molecules binding both the corneocytes
and serum within the hair follicles; the effect of the laser eliminates carbon bound to skin particles
and the high temperature generated reduces sebum production by sebaceous glands and inhibits
Cutibacterium acnes replication. Although this method was described 20 years ago, scientific data
supporting its efficacy and safety have only recently been reported in small case series. For this
Citation: Conforti, C.; Guida, S.;
reason, we performed a retrospective study including patients treated from January to May 2022
Dianzani, C.; Turco, P.; Cazzato, V.;
in the context of a private practice. Even if this study is limited by the low number of patients and
Zalaudek, I.; Piccolo, D. Carbon
Peeling Laser Treatment to Improve
its retrospective nature, this is the first research to show that carbon peel laser, performed with a
Skin Texture, Pores and Acne Lesions: standardized technique, is an effective and safe treatment for patients with acne lesions, showing
A Retrospective Study. Medicina 2022, pores and wrinkles, and is able to improve the overall skin aspect.
58, 1668. [Link]
medicina58111668 Keywords: laser; carbon peel; acne; wrinkles; rejuvenation
Academic Editor: Mauro Salvatore
Alessandro Alaibac
Received: 20 October 2022 Carbon peel laser treatment has been described for the improvement of skin texture,
Accepted: 15 November 2022 with pore reduction and treatment of acne lesions. The technique consists of applying
Published: 18 November 2022 a carbon mask to the face for about ten minutes followed by laser irradiation with a
Publisher’s Note: MDPI stays neutral Q-switched 1064 nm laser (Quanta System Pico by Deka [Link], Samarate, Italy). This
with regard to jurisdictional claims in mechanism of action seems to be related to small carbon molecules binding both the
published maps and institutional affil- corneocytes and serum within the hair follicles; the effect of the laser eliminates carbon
iations. bound to skin particles and the high temperature generated reduces sebum production by
sebaceous glands and inhibits Cutibacterium acnes replication. Although this method was
described 20 years ago, scientific data supporting its efficacy and safety have only recently
been reported in small case series [1].
Copyright: © 2022 by the authors. We performed a retrospective study including patients treated from January to May
Licensee MDPI, Basel, Switzerland. 2022 in the context of a private practice. All patients signed an informed consent before the
This article is an open access article procedure, authorizing data analysis.
distributed under the terms and
After cleaning the skin of each patient, a carbon mask (NaturaPeel, Quanta System,
conditions of the Creative Commons
Deka, Italy) was applied to the face for 10 minutes. After that, a Q-switched laser (DEKA
Attribution (CC BY) license (https://
Srl) was employed, using 5 mm spot and 1 J/cm2 fluence. A total of three carbon peel
[Link]/licenses/by/
laser sessions were performed, each one month apart from the other. It was decided to also
4.0/).
Medicina 2022, 58, 1668. [Link] [Link]
After cleaning the skin of each patient, a carbon mask (NaturaPeel, Quanta System,
Deka, Italy) was applied to the face for 10 minutes. After that, a Q-switched laser (DEKA
Medicina 2022, 58, 1668 Srl) was employed, using 5 mm spot and 1 J/cm2 fluence. A total of three carbon peel laser 2 of 4
sessions were performed, each one month apart from the other. It was decided to also
evaluate, as a secondary parameter, the improvement of thin wrinkles. In fact, stimulation
of the dermis
evaluate, induced byparameter,
as a secondary laser-irradiated carbon shock
the improvement of waves can result
thin wrinkles. in improvement
In fact, stimulation
of
of the dermis induced
wrinkles. by laser-irradiated
Its efficacy was estimated carbon shockthe
through waves can result
validated in improvement
Fitzpatrick Wrinkle of
wrinkles.
Assessment Its Scale
efficacy was estimated
(FWAS) through the
for the assessment of validated
thin/deepFitzpatrick
lines on theWrinkle
face (from Assessment
0 absence
Scale (FWAS)
of wrinkles to 6for theand
deep assessment of thin/deep
diffuse wrinkles) lines
[2], the on the face
Physician (from
Global 0 absenceImprovement
Aesthetic of wrinkles to
deep(GAIS)
6Scale and diffuse wrinkles) [2], the Physician Global Aesthetic Improvement
to express overall improvement (from 1 exceptional improvement to 5 worsened Scale (GAIS)
to express overall improvement (from 1 exceptional improvement to 5 worsened
patient) [3], a photographic scale for the pore assessment (score system from 1 no obvious patient) [3], a
photographic scalepores)
pores to 6 enlarged for the[4]
pore
andassessment (score system
the Investigator from 1 no obvious
Global Assessment pores(IGA)
of Acne to 6 enlarged
for the
pores) [4] and the
classification Investigator
of acne lesions Global
(from Assessment of Acne lesions
0 no inflammatory (IGA) forto the
3 manyclassification
comedones, of
acne lesions (from
inflammatory no inflammatory
lesions0and lesionsassessments
nodules) [5]. These to 3 many comedones,
were performedinflammatory
1 month lesions
afterand
the
nodules) [5]. These
last treatment assessments
session were performed
(T1), comparing 1 month
these scores to after the last treatment
the baseline session
(T0), employing
(T1), comparing these scores to the baseline (T0), employing Student’s
Student’s t-test (p < 0.05 was considered as a cut-off for significance). Main results t-test (p < 0.05 was
considered as a cut-off for significance). Main results achieved
achieved are shown in Figure 1. Additionally, safety was assessed based on major or are shown in Figure 1.
Additionally, safety was assessed based on major or minor adverse events,
minor adverse events, respectively, requiring medical intervention or not, after each laser respectively,
requiring
session. medical intervention or not, after each laser session.
Figure 1.
Figure 1. Mild
Mildacne
acnebefore
before(a)
(a)and
andafter
after(d)(d)the carbon
the peel
carbon laser
peel treatment;
laser skinskin
treatment; pores (b) (b)
pores of the
of
nasolabial fold reduced after the protocol (e); deep wrinkles of the periocular area (c)
the nasolabial fold reduced after the protocol (e); deep wrinkles of the periocular area (c) and and (f)
improvement of thin and deep wrinkles of the face after the entire protocol.
(f) improvement of thin and deep wrinkles of the face after the entire protocol.
A total
A total of
of 32
32 patients
patients (13
(13 females;
females; 19
19 males)
males) aged
aged 26
26±± 66 years
years old
old were
were included
included in
in
present study.
the present study. Inclusion
Inclusion criteria
criteria were:
were: older than 18 years old,
old, mild
mild oror moderate
moderate acneacne
with poor
with poor response
response toto conventional
conventionaltreatments
treatments(antibiotics
(antibiotics±± retinoids), enlarged pores of
the face
face and
and fine
fine wrinkles;
wrinkles; exclusion
exclusion criteria
criteria were
were patients
patients on
on oral
oral isotretinoin
isotretinoin treatment
treatment
with an
or with an ongoing
ongoing autoimmune
autoimmune skin disease, pregnancy,
pregnancy, breastfeeding
breastfeeding and and absence
absence of
of
informed consent.
informed consent. Baseline characteristics of patients are reported
reported inin Table
Table 1.
1. Interestingly,
Interestingly,
at T1, a significant reduction of FWAS, IGA and pores scores were observed, as compared to
T0. In detail, an improvement of the mid-depth wrinkles was observed in six patients, with
a reduction of the FWAS score by one point (p < 0.01). Furthermore, 18 patients showed a
reduction of one-point on the IGA scale, especially patients with mild-to-moderate acne
severity (p < 0.01). Additionally, the photographic analysis of pore severity showed that
Medicina 2022, 58, 1668 3 of 4
88% of patients had minimal pores or complete absence at T1, as compared to T0 (p < 0.01).
Strikingly, an overall skin improvement, as assessed by the GAIS scale, was observed
in 100% of patients. This finding represents a strength for this technique, which can be
effective for overall skin improvement. After each laser session, only minor adverse events,
including temporary erythema, was observed in 6 subjects.
Table 1. Characteristics of patients treated with carbon peeling laser technique.
Baseline Characteristics Patients N = 32 n (%)
Sex:
Females 13 (40)
Males 19 (60)
Phototype:
1 3 (9)
2 6 (19)
3 15 (47)
4 8 (25)
Scores Before treatment n (%) After treatment n (%) p§
FWAS *:
1 4 (12) 6 (18)
2 16 (50) 16 (50) 0.012
3 10 (32) 10 (32)
4 2 (6) 0
Pores:
No obvious pores 0 6 (18)
Minimal pores 4 (12) 22 (70) <0.01
Mild pores 18 (57) 4 (12)
Moderate pores 10 (31) 0
IGA # :
Few comedons and <1 small inflammatory lesion 0 14 (44)
<0.01
Dozens of comedons and several inflammatory lesions 26 (81) 16 (50)
Many comedons, several inflammatory lesions and <1 nodule 6 (19) 2 (6)
GAIS ◦ :
exceptional improvement 2 (6)
very improved 14 (44)
improved 16 (50)
unaltered 0
worsened 0
§ p-value according to Student’s t-test for paired samples; * FWAS = Fitzpatrick Wrinkle Assessment Scale;
# IGA = Investigator Global Assessment of Acne; ◦ GAIS = Global Assessment Investigator Scale.
Even if this study is limited by the low number of patients and its retrospective nature,
this is the first research to show that carbon peel laser, performed with a standardized
technique, is an effective and safe treatment for patients with acne lesions, showing pores
and wrinkles, and one that is able to improve the overall skin aspect.
Author Contributions: Conceptualization, C.C. and D.P.; methodology, I.Z.; formal analysis, S.G.
and C.D.; data curation, P.T. and V.C.; writing—original draft preparation, C.C.; writing—review
and editing, C.C., S.G. and P.T.; supervision, I.Z. and C.D. All authors have read and agreed to the
published version of the manuscript.
Funding: This research received no external funding.
Institutional Review Board Statement: The study was conducted in accordance with the Declaration
of Helsinki and all patients signed an informed consent before each treatment. Ethical review and
approval were waived for this study due to its retrospective nature.
Medicina 2022, 58, 1668 4 of 4
Informed Consent Statement: Written informed consent has been obtained from the patient(s) to
publish this paper.
Data Availability Statement: The data that support the findings of this study are available on request
from the corresponding author, CC.
Conflicts of Interest: The authors declare no conflict of interest.
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tool for nasolabial wrinkle severity assessment. Dermatol. Surg. 2008, 34 (Suppl. 1), S85–S91. [CrossRef] [PubMed]
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