What is the proper protocol for performing a carbon peel with a Neodymium-doped Yttrium Aluminum Garnet (Nd:YAG) laser?

Carbon Peel Protocol with Nd:YAG Laser

The carbon peel procedure involves applying a topical carbon lotion to the face for approximately 10 minutes, followed by Q-switched Nd:YAG laser irradiation at 1064 nm using specific dual-mode parameters for optimal results. 1, 2

Pre-Treatment Preparation

• Apply topical local anesthesia to the treatment area before beginning the procedure 2
• Apply a topical carbon lotion/suspension evenly across the entire face and allow it to dry for approximately 10 minutes 1, 2, 3
• The carbon molecules bind to corneocytes and penetrate hair follicles, creating targets for laser absorption 1

Laser Treatment Parameters

Dual-Mode Technique (Most Effective)

First Pass - Micropulsed/Quasi-Long Pulsed Mode:

• Pulse width: 300 microseconds 2, 3
• Fluence: 1.1-1.5 J/cm² (can increase to 2.3 J/cm² based on tolerance) 2, 3
• Spot size: 7-mm handpiece 2
• Deliver a single pass across the entire treatment area 3

Second Pass - Q-Switched Mode:

• Pulse width: 5 nanoseconds 2, 3
• Fluence: 1.5-2.0 J/cm² (can increase to 2.5 J/cm²) 2, 3
• Spot size: 7-mm handpiece 2
• Deliver multiple passes until achieving the clinical endpoint 3

Clinical Endpoint

• Target delayed post-treatment perifollicular erythema and/or edema as the indicator of adequate energy delivery 4
• This endpoint confirms effective follicular destruction without excessive tissue damage 4

Treatment Protocol

• Treatment sessions: 3-6 sessions total 1, 2
• Interval between sessions: 2-3 weeks 2, 3
• The procedure is well-tolerated with minimal patient downtime 2

Mechanism of Action

• Carbon particles absorb laser energy and generate high temperatures that:
  • Remove bound corneocytes and debris from skin surface 1
  • Reduce sebum production by thermal effect on sebaceous glands 1
  • Inhibit Cutibacterium acnes replication through heat generation 1
  • Cause controlled thermal injury to stimulate collagen remodeling 1

Expected Outcomes

• Acne lesions: Significant improvement by the 4th treatment, with >90% clearance of inflammatory lesions by the 6th treatment 2
• Pore size reduction: 75% of patients show improvement when using carbon photoenhancer, 67% without carbon 3
• Skin texture improvement: Notable enhancement in overall skin appearance, including reduction in wrinkles and sebum 1, 2
• Long-lasting results: Improvements maintained at 2-month follow-up after final treatment 2

Safety Considerations

• No significant adverse effects reported in clinical studies 1, 3
• The technique is minimally invasive with excellent tolerability 2
• Appropriate for various skin types when parameters are adjusted accordingly 1

Important Caveats

• The carbon photoenhancer appears to enhance efficacy, though treatment can be performed without it with slightly reduced results 3
• This technique differs from Nd:YAG laser hair removal protocols, which use different parameters (10-mm spot size, 10-ms pulse duration, 35-50 J/cm² for skin types I-III) 5
• While evidence supports efficacy, most published data comes from small case series and retrospective studies rather than large randomized controlled trials 1