Energy Delivery Devices for Cutaneous RemodelingLasers, Lights, and Radio Waves

Evaluation of pulsed light and radiofrequency combined for the treatment of acne vulgaris with histologic analysis of facial skin biopsies

BACKGROUND

Light and radiofrequency (RF) devices have recently been used to treat acne in selected patients.

OBJECTIVE

To investigate the safety and efficacy of a combination of pulsed light and RF energy for the treatment of acne. Materials and methods. Thirty-two patients with moderate acne were treated twice weekly for four weeks with the Aurora AC (Syneron Medical Ltd, Yokneam, Israel), a combination of pulsed light and RF energy. Twenty-five patients completed the study. In four patients, the number of hair follicles showing perifolliculitis, the diameters of hair follicles, the diameters of sebaceous glands, and expressions of heat shock protein 70 and procollagen-1 were evaluated before and after treatment.

RESULTS

The mean lesion count was reduced by 47% (p < 0.05) after eight treatments. Adverse effects-erythema, tingling, and burning-were mild and temporary. The percentage of follicles with perifolliculitis decreased from 58% to 33%, sebaceous gland areas decreased from 0.092 mm2 to 0.07 mm2, and heat shock protein 70 and procollagen-1 expressions did not change.

CONCLUSION

The combination of optical and RF energies may be an alternative nonablative modality for the treatment of moderate acne. Clinical improvement may be partly due to reductions in both perifollicular inflammation and sebaceous gland areas.

The spectrum of laser skin resurfacing: nonablative, fractional, and ablative laser resurfacing

The drive to attain cosmetic facial enhancement with minimal risk and rapid recovery has inspired the field of nonsurgical skin rejuvenation. Laser resurfacing was introduced in the 1980s with continuous wave carbon dioxide (CO(2)) lasers; however, because of a high rate of side effects, including scarring, short-pulse, high-peak power, and rapidly scanned, focused-beam CO(2) lasers and normal-mode erbium-doped yttrium aluminium garnet lasers were developed, which remove skin in a precisely controlled manner. The prolonged 2-week recovery time and small but significant complication risk prompted the development of non-ablative and, more recently, fractional resurfacing in order to minimize risk and shorten recovery times. Nonablative resurfacing produces dermal thermal injury to improve rhytides and photodamage while preserving the epidermis. Fractional resurfacing thermally ablates microscopic columns of epidermal and dermal tissue in regularly spaced arrays over a fraction of the skin surface. This intermediate approach increases efficacy as compared to nonablative resurfacing, but with faster recovery as compared to ablative resurfacing. Neither nonablative nor fractional resurfacing produces results comparable to ablative laser skin resurfacing, but both have become much more popular than the latter because the risks of treatment are limited in the face of acceptable improvement.

LEARNING OBJECTIVES

At the completion of this learning activity, participants should be familiar with the spectrum of lasers and light technologies available for skin resurfacing, published studies of safety and efficacy, indications, methodologies, side effects, complications, and management.

Nonablative tissue remodeling and photorejuvenation

Nonablative facial resurfacing is a noninvasive approach to tissue remodeling and skin rejuvenation. These procedures are considered an alternative to the more traditional laser resurfacing with less dramatic effects, but also with significantly less downtime. Results vary based on the lasers and light sources used. In general, the infrared lasers improve texture, visible light lasers somewhat improve texture but greatly reduce redness and telangiectasias, and intense pulsed light devices improve both red targets and brown discoloration, as well as skin texture. Lastly, low-energy devices may improve redness and texture modestly. Patient selection, as well as device selection, is based on the outcome desired. Side effects are uncommon and preventable.

The Use of Hybrid Radiofrequency Device for the Treatment of Rhytides and Lax Skin

BACKGROUND

Recently, radiofrequency (RF) devices have been introduced and commercialized for nonablative procedures in dermatology and plastic surgery for the treatment of age-related rhytides and lax skin.

OBJECTIVE

The objective was to assess the efficacy and safety of a novel RF device (Accent, Alma Lasers, Ltd, Caesarea, Israel) for the treatment of rhytides and lax skin.

METHODS AND MATERIALS

Sixteen female patients (age range, 29-66 years; mean, 47+/-6 years; skin phototypes II to IV) were treated with Accent system. Patients were treated on the chin (n=5), forehead (n=8), cheeks (n=12), jowl lines (n=9), periorbital area (n=7), marionette line (n=3), and nasolabial folds (n=6) for wrinkles (n=27 cases) and skin laxity (n=23 cases). Patients received two to six treatments (mean, 4.3+/-1.1), with the time interval of 2 to 3 weeks. Photographs were assessed 1 month after the last treatment. RESULTS For wrinkles and skin laxity, in 5 patients (42%), the cheeks (n=12) scored 51% to 75% (significant improvement), and 2 patients (17%), 76% to 100% (excellent improvement). For the jowl lines (n=9), 4 patients (44%) scored 51% to 75% (significant improvement), and 1 patient scored 76% to 100% (excellent improvement) for lax skin. For wrinkles on the periorbital (n=7) and forehead areas (n=8), three patients (37%) scored 51% to 75% (significant improvement).

CONCLUSION

The Accent system is an effective and safe modality for the improvement of age-related rhytides and lax skin.

Adverse Events Associated With Nonablative Cutaneous Laser, Radiofrequency, and Light-Based Devices

Medical and esthetic indications and demand for nonablative laser and light-based treatments are increasing. Although these are generally safe procedures, laser practitioners should be aware of potential complications that may be associated with therapy. An adverse event may be defined as any undesirable effect, even if expected, that occurs with laser treatment. These adverse events can be related to patient factors, professional errors, common side effects, and more serious complications. A variety of providers, including nondermatologists, perform laser treatments and must be aware of therapeutic outcomes as well as potential complications after laser surgery. Clinical indications for nonablative laser treatments, common side effects, and more serious adverse events will be reviewed in addition to treatment and prevention of these potential complications.

Complications of laser dermatologic surgery

BACKGROUND AND OBJECTIVE

Innovations in lasers, light and radiofrequency devices have allowed for improved therapeutic efficacy and safety and the ability to treat patients with an ever-increasing number of medical and aesthetic indications. Safety remains a primary concern and the timely communication of complications and their management is vital to insure that treatments be as safe as possible. The purpose of this report on the Proceedings of the First International Laser Surgery Morbidity Meeting is to provide laser experts the opportunity to present and discuss complications that their patients have experienced and how they were successfully managed.

METHODS

Laser experts were invited to present complications of laser, light, and radiofrequency treatments that their patients have experienced and to discuss the potential mechanisms leading to the complications their management and final outcomes.

RESULTS

Nineteen unique cases are presented and the clinical management of each case discussed. Eighteen sets of pre- and post-operative photos are presented.

CONCLUSION

This report shows that even experts, with extensive experience using light-based therapies, can and do have patients who develop complications. Sound clinical judgment, and knowing how to avoid complications and their timely post-operative management, is essential to insure optimal therapeutic outcome.

Review of photorejuvenation: devices, cosmeceuticals, or both?

BACKGROUND

Both the public and the medical profession have placed a lot of attention on reversal of signs of aging and photodamage, resulting in numerous cosmeceutical products and nonablative laser techniques designed to achieve these results.

OBJECTIVE

The purpose of this report is to briefly review both the cosmeceutical products and nonablative laser techniques that appear to be most promising based on published studies. After this review, recommendations for potential enhancement of benefits by combining cosmeceuticals and laser treatments will be explored.

RESULTS

Pulsed dye lasers targeting microvessels, intense pulsed light targeting both melanin and microvessels, and midinfrared lasers targeting dermal water and collagen all appear to have some ability to improve skin texture, color, and wrinkling. Retinoids, vitamin C, alpha-hydroxy acids, and topical growth factors may also stimulate repair mechanisms that result in similar improvements in photodamaged skin.

CONCLUSION

Although supported only by theoretic considerations and anecdotal reports, it seems logical that the concurrent use of appropriate cosmeceuticals with nonablative laser photorejuvenation should result in enhanced benefits.

Nonablative skin rejuvenation

Laser resurfacing of photodamaged or scarred skin has traditionally involved the use of ablative lasers with their associated limitations and side effects. Nonablative skin rejuvenation is a relatively new concept in facial rejuvenation, which aims to induce dermal remodeling without visible epidermal disruption. A number of laser devices and light sources, emitting at various wavelengths, have been shown to effectively enhance the appearance of facial skin through nonablative mechanisms. Among the conditions that can be treated with this novel modality are erythema, telangiectasia, pigmentation, lentigines, and textural imperfections ranging from fine and moderate rhytides to other surface irregularities such as acne scarring. A major attraction of nonablative laser therapy is the very limited downtime after each treatment, making it an ideal method for patients seeking a minimally invasive procedure with an excellent safety profile.

Using light in dermatology: an update on lasers, ultraviolet phototherapy, and photodynamic therapy

Indications for light-based treatments, such as lasers, UV phototherapy, and photodynamic therapy, are rapidly increasing within the arena of skin disorders. Physicians can remain current in their understanding of these modalities if they understand a few basic principles outlined in this article. Once these concepts are understood, all the rapid advances can be kept in perspective and physicians can apply the most appropriate technology to the care of their patients while informing them about the limitations of overmarketed but poorly proved strategies.

Cutaneous oncologic and cosmetic surgery in geriatric patients

A wide array of surgical procedures is available to geriatric patients. These interventions can enhance the appearance of patients and facilitate the removal of skin cancers. Pre-existing medical conditions of geriatric patients must be considered comprehensively when selecting and performing cutaneous surgical procedures. Many older patients suffer from a variety of diseases and take a variety of medications and herbal supplements to ameliorate the consequences of such diseases. In general, skin surgery can be performed safely on even very old patients, provided precautions are followed. The biopsychosocial well-being and essence of patients must also be addressed when performing dermatologic surgery. If patients are treated holistically and comprehensively, their surgical experience can be enhanced and their health and appearance improved.