ORIGINAL ARTICLE Efficacy of long pulse Nd:YAG laser versus fractional Er:YAG laser in the treatment of hand wrinkles Reza M. Robati 1 & Elmira Asadi 1 & Anoosh Shafiee 1 & Nastaran Namazi 1 & Atefeh Talebi 2 Received: 6 August 2017 /Accepted: 1 October 2017 # Springer-Verlag London Ltd. 2017 Abstract There are different modalities for hand rejuvenation. Fractional Er:YAG laser and long pulse Nd:YAG laser were introduced for treating hand wrinkles. We plan to compare fractional Er:YAG laser and long pulse Nd:YAG laser in a randomized controlled double-blind design with multiple ses- sions and larger sample size in comparison with previous stud- ies. Thirty-three participants with hand wrinkles entered this study. They were randomly allocated to undergo three monthly laser treatments on each hand, one with a fractional Er:YAG laser and the other with a long pulse Nd:YAG laser. The eval- uations included assessment of clinical improvement deter- mined by two independent dermatologists not enrolled in the treatment along with measuring skin biomechanical property of hands using a sensitive biometrologic device with the assess- ment of cutaneous resonance running time (CRRT). Moreover, potential side effects and patients’ satisfaction have been docu- mented at baseline, 1 month after each treatment, and 3 months after the final treatment session. Clinical evaluation revealed both modalities significantly reduce hand wrinkles (p val- ue < 0.05), with no significant difference between two lasers. Mean CRRT values also decreased significantly after the laser treatment compared to those of the baseline in both laser groups. There was no serious persistent side effect after both laser treatments. Both fractional Er:YAG and long pulse Nd:YAG lasers show substantial clinical improvement of hand skin wrinkles with no serious side effects. However, combina- tion treatment by these lasers along with the other modalities such as fat transfer could lead to better outcomes in hand reju- venation. Trial registration: IRCT2016032020468N4 Keywords Erbium:YAG laser . Handrejuvenation . ND:YAG laser . Skin aging Introduction Hand rejuvenation is intended to restoring soft tissue volume, decreasing skin laxity, and reversing extrinsic aging [1]. For the appearance of the hand, the dorsum is the most frequently viewed non-clothed body part. In patients who have had facial rejuvenation treatments, an inconsistency between a youthful face and aged hands often becomes relevant and proves a pa- tient’ s true age [2]. Common findings in the aged hand include atrophy with prominent bones, tendons, and inter-metacarpal spaces as well as large, visible veins and rhytides, solar lentigines, actinic keratosis, and seborrheic keratosis [3]. Hand rejuvenation can be achieved using a variety of tech- niques, including ablative dermabrasion, chemical peels, and ablative laser resurfacing, intense pulsed light, radiofrequency, and photodynamic therapy, autologous fat transfer, hyaluronic acid, calcium hydroxylapatite, and poly-L-lactic acid injections [2–4]. Laser technology is widely used for cosmetic surgery. Tissue ablation and thermal coagulation of the dermis stimu- late dermal remodeling. The effect of laser resurfacing is more powerful with the ablative fractional laser than with non- ablative laser devices, although there has been growing de- mand for the short downtime and minimal side effects associ- ated with ablative lasers, which has incited development of non-ablative lasers. When handling non-facial locations, there * Reza M. Robati rezarobati@sbmu.ac.ir 1 Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2 Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran Lasers Med Sci https://doi.org/10.1007/s10103-017-2351-2