{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T18:23:49Z","timestamp":1781634229260,"version":"3.54.5"},"reference-count":74,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2021,4,1]],"date-time":"2021-04-01T00:00:00Z","timestamp":1617235200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Lasers Surg Med"],"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:sec><jats:title>Background and Objectives<\/jats:title><jats:p>Recently, several minimally invasive gynecological, ENT and esthetic procedures have been introduced that are based on delivering \u201csmooth\u201d sequences of Er:YAG laser pulses to cutaneous or mucosal tissue at moderate cumulative fluences that are not only below the ablation threshold\u00a0but typically also do not require local anesthesia. \u00a0To explain the observed clinical results using \u201csmooth\u2010resurfacing,\u201d\u00a0it has been suggested that in addition to the direct heat injury to deeper\u2010lying connective tissues, there is an additional mechanism based on indirect triggering of tissue regeneration through short\u2010exposure, intense heat shocking of epithelia. The goal of this study is to improve understanding of the complex dynamics of the exposure of tissues to a series of short Er:YAG laser pulses, during which the thermal exposure times transition from extremely short to long durations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design\/Materials and Methods<\/jats:title><jats:p>A physical model of laser\u2010tissue interaction was used to calculate the temperature evolution at the irradiated surface and deeper within the tissue, in combination with a chemical model of tissue response based on the recently introduced variable heat shock (VHS) model, which assumes that the tissue damage represents a combined effect of two limiting Arrhenius\u2032 processes, defining cell viability at extremely long and short exposure times. Superficial tissue temperature evolution was measured during smooth\u2010resurfacing of cutaneous and mucosal tissue, and compared with the model. Two modalities of non\u2010ablative resurfacing were explored: a standard \u201csub\u2010resurfacing\u201d modality with cumulative fluences near the ablation threshold, and the \u201csmooth\u2010resurfacing\u201d modality with fluences below the patient\u2032s pain threshold. An exemplary skin tightening clinical situation was explored by measuring pain tolerance threshold fluences for treatments on abdominal skin with and without topical anesthesia. The obtained temperature data and pain thresholds were then used to study the influence of Er:YAG laser sequence parameters on the superficial (triggering) and deep (coagulative) tissue response.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The simulations show that for the sub\u2010resurfacing modality, the parameter range where no excessive damage to the tissue will occur is very narrow. On the other hand, using pain tolerance as an indicator, the smooth\u2010resurfacing treatments can be performed more safely and without sacrificing the treatment efficacy. Two preferred smooth\u2010resurfacing treatment modalities were identified. One involves using optimally long pulse sequence durations (\u22481\u20133 seconds) with an optimal number of pulses (<jats:italic>N<\/jats:italic>\u2009\u2248\u200910\u201330), resulting in a maximal short\u2010exposure superficial tissue response and moderate coagulation depths. And for deeper coagulation, without significant superficial heat shocking, very long pulse sequences (&gt;5 seconds) with a large number of delivered pulses are to be used in combination with topical anesthesia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>A comparison of the simulations with the established smooth\u2010resurfacing clinical protocols in gynecology, ENT, and esthetics suggests that, through clinical experience, the clinical protocols have been optimized for the maximal superficial heat shock triggering effect. Further research is needed to gain a better understanding of the proposed role of heat shock triggering in the clinically observed regeneration of cutaneous, vaginal, and oral tissues following Er:YAG laser smooth\u2010resurfacing. Lasers Surg. Med. \u00a9 2021 The Authors. <jats:italic>Lasers in Surgery and Medicine<\/jats:italic> published by Wiley Periodicals LLC.<\/jats:p><\/jats:sec>","DOI":"10.1002\/lsm.23402","type":"journal-article","created":{"date-parts":[[2021,4,1]],"date-time":"2021-04-01T14:28:54Z","timestamp":1617287334000},"page":"1266-1278","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Characteristics of Non\u2010Ablative Resurfacing of Soft Tissues by Repetitive Er:YAG Laser Pulse Irradiation"],"prefix":"10.1002","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9059-9923","authenticated-orcid":false,"given":"Matjaz","family":"Lukac","sequence":"first","affiliation":[{"name":"Institut Jozef Stefan  Jamova 39 SI\u20101000 Ljubljana Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anze","family":"Zorman","sequence":"additional","affiliation":[{"name":"Medilase Dermatology &amp; Laser Center  Tbilisijska 59 SI\u20101000 Ljubljana Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nejc","family":"Lukac","sequence":"additional","affiliation":[{"name":"Faculty of Mechanical Engineering University of Ljubljana  Askerceva 6 SI\u20101000 Ljubljana Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tadej","family":"Perhavec","sequence":"additional","affiliation":[{"name":"Fotona, d.o.o.  Stegne 7 SI\u20101000 Ljubljana Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Blaz","family":"Tasic","sequence":"additional","affiliation":[{"name":"Faculty of Mechanical Engineering University of Ljubljana  Askerceva 6 SI\u20101000 Ljubljana Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,4]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1096-9101(1999)24:2<87::AID-LSM3>3.0.CO;2-P"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/archderm.135.4.391"},{"issue":"1","key":"e_1_2_7_4_1","first-page":"1","article-title":"New options and treatment strategies with the VSP erbium YAG aesthetics lasers","volume":"2007","author":"Lukac M","year":"2007","journal-title":"J\u00a0Laser Health Acad"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10103-007-0509-z"},{"issue":"1","key":"e_1_2_7_6_1","first-page":"56","article-title":"Ablation and thermal depths in VSP Er:YAG laser skin resurfacing","volume":"2010","author":"Lukac M","year":"2010","journal-title":"J Laser Health Acad"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s003400050423"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s003400050772"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/archderm.1996.03890280047007"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1524-4725.2002.01087.x"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1524-4725.1998.tb04161.x"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1096-9101(2000)26:2<215::AID-LSM13>3.0.CO;2-O"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/lsm.1026"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/lsm.1027"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/lsm.20380"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/lsm.20080"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/lsm.10030"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2008.01.003"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/lsm.10172"},{"issue":"1","key":"e_1_2_7_20_1","first-page":"126","article-title":"TightSculpting\u00ae: A complete minimally invasive body contouring solution; Part II: Tightening with FotonaSmooth\u00ae technology","volume":"2018","author":"Lukac M","year":"2018","journal-title":"J Laser Health Acad"},{"issue":"1","key":"e_1_2_7_21_1","first-page":"1","article-title":"Dual tissue regeneration: Non\u2010ablative resurfacing of soft tissues with FotonaSmooth\u00ae mode Er:YAG laser","volume":"2018","author":"Lukac M","year":"2018","journal-title":"J Laser Health Acad"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10103-016-1884-0"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10103-017-2170-5"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.3109\/13697137.2015.1078668"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/lsm.22416"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.esxm.2020.01.001"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2018.03.038"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1080\/14764172.2018.1439964"},{"issue":"1","key":"e_1_2_7_29_1","first-page":"56","article-title":"The effect of intraoral 2,940nm nonablative Erbium:YAG laser on the rejuvenation of the upper lip: A pilot study","volume":"9","author":"Quezada Ga\u00f3n N","year":"2017","journal-title":"Surg Cosmet Dermatol"},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10103-018-2436-6"},{"issue":"1","key":"e_1_2_7_31_1","first-page":"39","article-title":"NightLase\u00ae: Minimally invasive laser\u2010assisted uvulopalatoplasty","volume":"2018","author":"Shiffman H","year":"2018","journal-title":"J Laser Health Acad"},{"key":"e_1_2_7_32_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10103-020-02987-3"},{"key":"e_1_2_7_33_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10103-019-02731-6"},{"key":"e_1_2_7_34_1","doi-asserted-by":"publisher","DOI":"10.1002\/lsm.20048"},{"key":"e_1_2_7_35_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1524-4725.2009.01258.x"},{"issue":"1","key":"e_1_2_7_36_1","first-page":"1","article-title":"Non\u2010ablative resurfacing of mucosal tissue by SMOOTH\u2010mode Er:YAG laser.\u00a03rd LA&HA Super Symposium 2020","volume":"2020","author":"Gaspar A","year":"2020","journal-title":"J Laser Health Acad"},{"key":"e_1_2_7_37_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-020-04452-9"},{"key":"e_1_2_7_38_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10103-018-02704-1"},{"key":"e_1_2_7_39_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajpcell.1997.272.6.C1988"},{"key":"e_1_2_7_40_1","doi-asserted-by":"publisher","DOI":"10.2165\/00128071-200304010-00001"},{"key":"e_1_2_7_41_1","doi-asserted-by":"publisher","DOI":"10.1117\/1.3600013"},{"key":"e_1_2_7_42_1","doi-asserted-by":"publisher","DOI":"10.3109\/14764172.2011.552614"},{"key":"e_1_2_7_43_1","doi-asserted-by":"publisher","DOI":"10.3109\/02656736.2011.580822"},{"key":"e_1_2_7_44_1","doi-asserted-by":"publisher","DOI":"10.1115\/1.1553974"},{"key":"e_1_2_7_45_1","first-page":"531","article-title":"Studies of thermal injury, 1. The conduction of heat to and through skin and the temperature attained therein.\u00a0A theoretical and an experimental investigation","volume":"23","author":"Henriques FC","year":"1947","journal-title":"Am J Pathol"},{"key":"e_1_2_7_46_1","first-page":"695","article-title":"Studies of thermal injury, 2.\u00a0The relative importance of time and surface temperature in the causation of burns","volume":"23","author":"Moritz AR","year":"1947","journal-title":"Am J Pathol"},{"key":"e_1_2_7_47_1","doi-asserted-by":"publisher","DOI":"10.1103\/PhysRevE.74.011915"},{"key":"e_1_2_7_48_1","doi-asserted-by":"crossref","unstructured":"SimanovskiiD SarkarM IraniA et al.\u00a0Cellular tolerance to pulsed heating. Proc. of SPIE 5695.\u00a02005. pp254\u2013259.https:\/\/doi.org\/10.1117\/12.601774","DOI":"10.1117\/12.601774"},{"key":"e_1_2_7_49_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10103-010-0841-6"},{"issue":"1","key":"e_1_2_7_50_1","first-page":"1","article-title":"High\u2010temperature triggering of soft tissue regeneration by Er:YAG laser.\u00a03rd LA&HA Super Symposium 2020","volume":"2020","author":"Lukac N","year":"2020","journal-title":"J Laser Health Acad"},{"key":"e_1_2_7_51_1","doi-asserted-by":"publisher","DOI":"10.1097\/00004032-199311000-00008"},{"key":"e_1_2_7_52_1","doi-asserted-by":"publisher","DOI":"10.1097\/HP.0000000000000121"},{"key":"e_1_2_7_53_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.ajp.0000154048.68273.d8"},{"key":"e_1_2_7_54_1","doi-asserted-by":"publisher","DOI":"10.1016\/0304-3959(94)00132-X"},{"key":"e_1_2_7_55_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awf055"},{"key":"e_1_2_7_56_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neucli.2003.10.005"},{"key":"e_1_2_7_57_1","doi-asserted-by":"publisher","DOI":"10.3758\/BF03198847"},{"key":"e_1_2_7_58_1","doi-asserted-by":"publisher","DOI":"10.3390\/safety4030038"},{"key":"e_1_2_7_59_1","first-page":"96891R","article-title":"Laser treatment of female stress urinary incontinence: Optical, thermal, and tissue damage simulations","volume":"9689","author":"Hardy LA","year":"2016","journal-title":"Proc SPIE Int Soc Opt Eng"},{"key":"e_1_2_7_60_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijpara.2014.11.002"},{"key":"e_1_2_7_61_1","doi-asserted-by":"publisher","DOI":"10.1089\/wound.2013.0473"},{"key":"e_1_2_7_62_1","doi-asserted-by":"publisher","DOI":"10.1111\/wrr.12154"},{"key":"e_1_2_7_63_1","doi-asserted-by":"publisher","DOI":"10.1089\/pho.2005.23.369"},{"key":"e_1_2_7_64_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9610(03)00211-3"},{"key":"e_1_2_7_65_1","doi-asserted-by":"publisher","DOI":"10.1007\/PL00012511"},{"key":"e_1_2_7_66_1","doi-asserted-by":"publisher","DOI":"10.1016\/0891-5849(94)00198-S"},{"key":"e_1_2_7_67_1","doi-asserted-by":"publisher","DOI":"10.3109\/10715769509065268"},{"key":"e_1_2_7_68_1","doi-asserted-by":"publisher","DOI":"10.1038\/jid.2015.248"},{"key":"e_1_2_7_69_1","doi-asserted-by":"publisher","DOI":"10.4161\/derm.22804"},{"key":"e_1_2_7_70_1","doi-asserted-by":"publisher","DOI":"10.1089\/acu.2014.1057"},{"key":"e_1_2_7_71_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jccw.2012.11.001"},{"issue":"11","key":"e_1_2_7_72_1","first-page":"1","article-title":"Anatomic distribution of nerves and microvascular density in the human anterior vaginal wall: Prospective study","volume":"9","author":"Ting Li T","year":"2004","journal-title":"PLOS One"},{"key":"e_1_2_7_73_1","doi-asserted-by":"publisher","DOI":"10.1002\/lsm.23124"},{"key":"e_1_2_7_74_1","doi-asserted-by":"publisher","DOI":"10.1097\/00004032-198012000-00007"},{"key":"e_1_2_7_75_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0846.2009.00410.x"}],"container-title":["Lasers in Surgery and Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/lsm.23402","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/lsm.23402","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/lsm.23402","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,29]],"date-time":"2023-08-29T21:45:49Z","timestamp":1693345549000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/lsm.23402"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4]]},"references-count":74,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2021,11]]}},"alternative-id":["10.1002\/lsm.23402"],"URL":"https:\/\/doi.org\/10.1002\/lsm.23402","archive":["Portico"],"relation":{},"ISSN":["0196-8092","1096-9101"],"issn-type":[{"value":"0196-8092","type":"print"},{"value":"1096-9101","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4]]},"assertion":[{"value":"2020-12-08","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-03-14","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-04-01","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}