Pulsed dye laser therapy for sun damaged skin

Correction of Infraorbital Dark Circles Using Autologous Adipose-Derived Collagen Filler: A Novel Regenerative Option

BACKGROUND

Numerous intrinsic and extrinsic factors, notably the aging process, contribute to the development of infraorbital dark circles. These features, commonly associated with old age and fatigue, are caused by a disruption of dermal melanin and impairment of skin barrier function. Common aesthetic concerns affecting patients with infraorbital dark circles are primarily owing to lean and translucent lower eyelid skin overlying the orbicularis oculi muscle. This study aimed to present a novel technique for correcting infraorbital dark circles utilizing an adipose-derived extracellular matrix concentrate-adipose collagen fragment (ACF)-to correct infraorbital dark circles.

METHODS

Female patients (n = 94) aged 20-38 who presented infraorbital dark circles were enrolled to assess the efficacy of this technique for an eight-month follow-up. Following intradermal injections with ACF filler, the clinical outcome was determined by responses to GAIS and patient satisfaction surveys. Statistical analysis was performed with the one-way ANOVA test, and a p value of < 0.05 was considered statistically significant.

RESULTS

Patients (n = 92) completed a single treatment session and underwent an eight-month follow-up. Eighty patients (86%) reported being "highly satisfied" or "satisfied" with the outcome and responded that the technique resulted in brighter, tighter, and smoother infraorbital skin. Over 97% of patients were rated as "improved," "much improved" and "Very much improved" throughout the follow-up on GAIS by three independent surgeons (p < 0.05). The statistical analyses demonstrated the percentage differences among groups are highly significant (p < 0.0001). No irregularity or lump was observed during the follow-up. Two patients were excluded from the study due to having undergone cosmetic eyelid surgery.

CONCLUSION

Intradermal ACF filler represents a novel approach to addressing infraorbital dark circles and yields significantly high patient satisfaction. ACF fillers provide a degree of bio-stimulation, and adipose-derived concentrate is a natural filler with regenerative effects used in periorbital rejuvenation.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Nonsurgical Light and Energy-Based Devices: Utility in Eyelid and Periorbital Surgery

Periorbital rejuvenation is a common reason for patients to seek cosmetic treatment. There are several nonsurgical light and energy-based devices available to treat various aspects of periorbital rejuvenation without risks of an invasive, surgical procedure. Although ablative laser resurfacing appears to offer the most impressive clinical improvements, nonablative devices result in noticeable cosmetic improvement with more favorable side-effect profiles and shorter recovery times. The specific modality selected for periorbital rejuvenation should be tailored to patients' individual characteristics, preferences, and aesthetic goals. With continued advancements, additional nonsurgical light and energy-based devices will become available in the future for periorbital rejuvenation.

Pulsed dye laser versus ablative fractional CO2 laser in treatment of old hypertrophic scars: Clinicopathological study

There is a continuous need to find out the best treatment for old hypertrophic scars (OHSs). Thirty patients with OHSs were included. Each scar was divided into right half treated with PDL (handpiece with a 7-mm spot, pulse duration of 1.5 ms and fluence of 6 J/cm² ) and left half treated with FrCo2 laser (15 W, spacing 800 μm, dwelling time 600 μs and stack 3) once every month for three sessions. Scars were assessed before and after treatment clinically by Vancouver Scar Scale (VSS) and histologically using hematoxylin and eosin (H&E), Masson trichrome and orcein stains. Both halves showed statistically significant improvement after treatment. However, there was no statistically significant difference in VSS between them (P = 0.176). FrCo2 laser showed more significant improvement in pliability and height (P^p = 0.017, P^h = 0,011), while, PDL showed more significant improvement in vascularity (P = 0.039) of OHSs. Both PDL and ablative FrCo2 laser were effective in the treatment of OHSs, however, FrCo2 laser was more effective in improving OHSs pliability, and height which are the main concern in OHSs.

Histological investigation of picosecond laser-toning and fractional laser therapy

Background and Aims

Rejuvenation therapy using picosecond pulse laser and picosecond pulsed fractional therapy with a fractional lens have been performed with clinical effects evaluated. However, no histological analysis of effects on photoaged skin exists. In this study, influence of laser-toning and fractional therapy using picosecond pulse laser on photoaging was histologically investigated.

Subjects and Methods

The flexor side forearm of a male, age 61, with photoaging was divided into three 20 cm² areas and irradiated with approximately 400 shots of 10-Hz laser, 8 mm spot size, and nine passes at an output of 0.7, 0.9, and 1.1 J/cm² using picosecond laser-toning therapy six times, every two weeks. Two weeks post final irradiation, 2 mm punch biopsies were taken from the irradiation fields. Fractional therapy using Micro Lens Array (MLA) attached picosecond fractional therapy was applied to the medial crural skin with marked photoaging of a male, age 63. Irradiation was applied at 0.5 and 0.7 J/cm² through two passes, with 3 mm punch biopsies taken from each irradiation field immediately after and again two months post-irradiation. Samples were subjected to hematoxylin and eosin (HE) and Elastica van Gieson staining and compared.

Results

In the picosecond laser-toning therapy sample, photoaging-induced dermis reconstruction occurred. The picosecond fractional therapy sample showed both epidermis and dermis reconstruction, with intrinsic aging and photoaging improvements.

Conclusions

Recovery of dermal and epidermal age related atrophy by picosecond laser-toning and picosecond fractional therapy was histologically confirmed. Picosecond fractional therapy demonstrated superior improvement.

Comparing the effectiveness of fractional CO2 laser and the combination therapy with micro-needling and topical 10% trichloroacetic acid to remove infra-orbital dark circles in Tehran women

BACKGROUND

Infra orbital dark circles are now recognized as being a cosmetic problem that should be considered in treatment issue. The present study aimed to assess and compare the clinical efficiency of the combination of micro-needling and 10% trichloroacetic acid (TCA) cream as well as carbon dioxide laser in the management of infra-orbital dark circles.

METHODS

This randomized clinical trial was performed on women aged 28-62 years who complained of infra-orbital dark circles. The patients were randomly assigned to be treated with micro-needling combined with 10% TCA cream topically or CO₂ laser. The treatment period in each group included three sessions with an interval of one month between sessions. The assessment was based on both subjective and objective methods.

RESULTS

the mean of ΔE (the difference in the intensity of darkening at infra-orbital points and other points of the face) was significantly higher in the laser group than in the other group in all sessions. The patients who were treated with laser were found to have a higher level of satisfaction in the fifth visit when compared to those who received the other treatment method.

CONCLUSION

Regarding clinical effectiveness and the patients' compliance, fractional CO₂ laser was more preferred in the combination therapy with micro-needling and topical TCA for removing infra-orbital dark circles.

Moisture-Responsive Wrinkling Surfaces with Tunable Dynamics

The wrinkle dynamics (such as reversibility and stability) of human skin are affected by the external stimuli, as well as the skin's structure and mechanical properties. Inspired by these tunable responses, three types of moisture-responsive wrinkle dynamics are achieved, for the first time, through a single film-substrate system. These dynamics include: (1) completely reversible wrinkles formation; (2) irreversible wrinkles formation I: the initially formed wrinkles can be permanently erased and never reappear; and (3) irreversible wrinkles formation II: once the wrinkles form, they can no longer be erased. The key to success is to control the stiffness and thickness ratios of the film and the substrate, and tailor the crosslink degree/gradient of the film to allow for moisture-dependent changes of modulus and swelling degree. These unique responsive dynamics motivate the invention of a series of optical devices triggered by moisture, including anticounterfeit tabs, encryption devices, water indicators, light diffusors, and antiglare films. This study also paves the road for further understanding of the skin wrinkling dynamics and manipulation.

Noninvasive Wrinkle Reduction with the Nlite Laser: A Study of 50 Consecutive Patients

Introduction:

Selective nonablative wrinkle reduction by laser is an exciting and appealing concept. The Nlite laser is a 585-nm pulsed dye laser that works on the concept that mild laser light injury of microvessels in the skin induces production of new collagen and may cause reduction in depth and visibility of wrinkles. This study reports on the author's experience with this new technology and the 6-month evaluation of 50 consecutive patients in his practice.

Materials and Methods:

Fifty consecutive patients were treated with the Nlite laser according to the parameters suggested by the manufacturer. All patients had preoperative photographs taken and their wrinkles graded according to the Fitzpatrick and Glogau score. Three observers performed postoperative evaluation of 37 patients at 6- to 9-month intervals using photographs. Patient survey of 42 patients was completed with statistical analysis of the results.

Results:

Three observers were asked to evaluate pretreatment and posttreatment photographs and to determine if any detectable improvement had occurred after treatment. A total of 54%, 27%, and 37% of patients were found to have detectable improvement, respectively, for the periorbital, forehead, and perioral areas (marionette and lip lines). Patients surveyed on their results indicated detectable improvement in 70%, 62%, and 70% of patients, respectively, for the periorbital, forehead, and perioral areas. Most patients and observers graded the improvement as 0–25%.

Discussion:

The Nlite laser is a noninvasive treatment that improves skin wrinkles in some patients as noted by observer evaluation of pretreatment and posttreatment photographs and by patients as perceived by patient survey. The degree of improvement does not appear to be as great as that claimed by the laser manufacturer.

Multiple sequential light and laser sources to activate aminolevulinic acid in the treatment of photodamage: A retrospective study

INTRODUCTION

The aim of this study was to retrospectively evaluate photodynamic therapy (PDT) with aminolevulinic acid (ALA) for cutaneous photorejuvenation using blue light sequentially with red light, pulsed-dye laser (PDL), and/or intense pulsed light (IPL).

MATERIALS AND METHODS

Ninety-six patients (121 treatments) had photodamage treated with field-directed ALA-PDT from 2001 to 2010 in this single-center study. Treatments were performed with blue light + PDL, blue light + IPL, blue light + PDL + IPL, or blue light + red light + PDL + IPL. Outcome measures were obtained via telephone questionnaire and graded on a four-point scale.

RESULTS

There were no significant differences in patient-reported improvement in photodamage, overall skin quality, and postprocedure adverse events between treatment arms. However, number of patients in the blue light + red light + PDL + IPL group was markedly smaller (n = 2) than that in the other groups (n = 14-46).

DISCUSSION

Although results showed a trend toward greater efficacy with similar tolerability using multiple, sequential light and laser sources with ALA-PDT for photorejuvenation, the potential for recall bias and widely disparate number of patients between treatment groups and follow-up times between patients severely limit this retrospective study. Nevertheless, despite these major statistical flaws, the results may provide valuable information regarding the safety of multiple modalities with PDT of photodamage in a single session.

Integrated cooling-vacuum-assisted 1540-nm erbium:glass laser is effective in treating mild-to-moderate acne vulgaris

Acne treatment by a mid-infrared laser may be unsatisfactory due to deeply situated acne-affected sebaceous glands which serve as its target. Skin manipulation by vacuum and contact cooling may improve laser-skin interaction, reduce pain sensation, and increase overall safety and efficacy. To evaluate the safety and efficacy of acne treatment using an integrated cooling-vacuum-assisted 1540-nm erbium:glass laser, a prospective interventional study was conducted. It included 12 patients (seven men and five women) suffering from mild-to-moderate acne vulgaris. The device utilizes a mid-infrared 1540-nm laser (Alma Lasers Ltd. Caesarea, Israel), which is integrated with combined cooling-vacuum-assisted technology. An acne lesion is initially manipulated upon contact by a vacuum-cooling-assisted tip, followed by three to four stacked laser pulses (500-600 mJ, 4 mm spot size, and frequency of 2 Hz). Patients underwent four to six treatment sessions with a 2-week interval and were followed-up 1 and 3 months after the last treatment. Clinical photographs were taken by high-resolution digital camera before and after treatment. Clinical evaluation was performed by two independent dermatologists, and results were graded on a scale of 0 (exacerbation) to 4 (76-100 % improvement). Patients' and physicians' satisfaction was also recorded. Pain perception and adverse effects were evaluated as well. All patients demonstrated a moderate to significant improvement (average score of 3.6 and 2.0 within 1 and 3 months, respectively, following last treatment session). No side effects, besides a transient erythema, were observed. Cooling-vacuum-assisted 1540-nm laser is safe and effective for the treatment of acne vulgaris.

Anetoderma treated with combined 595-nm pulsed-dye laser and 1550-nm non-ablative fractionated laser

Anetoderma is a skin disorder characterized by a focal loss of dermal elastic tissue whereby patients present with soft, depressible lesions. We postulated that a series of combination treatment using the 595-nm pulsed dye laser (PDL) and the 1550-nm non-ablative fractionated laser (NAFL) would improve the anetoderma lesions. Our patient with biopsy proven anetoderma received 3 treatments with a combination of 595-nm PDL and 1550-nm NAFL spaced 3 weeks apart. Skin biopsies were performed at baseline and immediately prior to the third treatment. Stains for hematoxylin and eosin and Verhoeff Van Gieson (VVG) were performed. Improvement in lesion color, texture, and overall appearance was noted after the second treatment and continued following the third treatment. Post-treatment VVG staining demonstrated an increase in dermal elastin fibers and a decrease in elastin fiber fragmentation. Thus, the combination of 595-nm PDL and 1550-nm NAFL should be considered as a treatment modality for anetoderma.

Imaging directed photothermolysis through two-photon absorption demonstrated on mouse skin - a potential novel tool for highly targeted skin treatment

One-photon absorption based traditional laser treatment may not necessarily be selective at the microscopic level, thus could result in un-intended tissue damage. Our objective is to test whether two-photon absorption (TPA) could provide highly targeted tissue alteration of specific region of interest without damaging surrounding tissues. TPA based laser treatments (785 nm, 140 fs pulse width, 90 MHz) were performed on ex vivo mouse skin using different average power levels and irradiation times. Reflectance confocal microscopy (RCM) and combined second-harmonic-generation (SHG) and two-photon fluorescence (TPF) imaging channels were used to image before, during, and after each laser treatment. The skin was fixed, sectioned and H & E stained after each experiment for histological assessment of tissue alterations and for comparison with the non-invasive imaging assessments. Localized destruction of dermal fibers was observed without discernible epidermal damage on both RCM and SHG + TPF images for all the experiments. RCM and SHG + TPF images correlated well with conventional histological examination. This work demonstrated that TPA-based light treatment provides highly localized intradermal tissue alteration. With further studies on optimizing laser treatment parameters, this two-photon absorption photothermolysis method could potentially be applied in clinical dermatology.

Will nonablative rejuvenation replace ablative lasers? Facts and controversies

Since the early 1980s, the field of skin rejuvenation has evolved rapidly. Traditional ablative resurfacing with carbon dioxide and Er:YAG lasers offered dramatic improvement of the skin tone and texture, but prolonged postoperative period and an increased risk for side effects and complications were unacceptable for the majority of patients. It prompted the development of nonablative lasers and non-laser systems, which stimulate dermal neocollagenesis without epidermal disruption, and therefore, produce less adverse effects with little or no healing time. Recently, fractional nonablative and ablative lasers have been introduced, employing a completely new concept of fractional photothermolysis, which ensures high efficacy and fewer risks. Ablative laser resurfacing still remains the gold standard for treating advanced and severe photoaging providing excellent results in experienced hands. Alternatively, ablative fractional resurfacing can be used, with the results, which are comparable to fully ablative lasers with better standard of safety. Nonablative resurfacing is ideal for patients under the age of 50 years with minimal facial sagging, and for those who are unwilling to undergo expensive and demanding ablative procedures. It can be concluded that the key of therapeutic success is in proper patient selection, setting appropriate expectations and combining different rejuvenation technologies with other therapeutic modalities, such as botulinum toxin and fillers.

Skin anti-aging strategies

Skin aging is a complex biological process influenced by a combination of endogenous or intrinsic and exogenous or extrinsic factors. Because of the fact that skin health and beauty is considered one of the principal factors representing overall "well-being" and the perception of "health" in humans, several anti-aging strategies have been developed during the last years. It is the intention of this article to review the most important anti-aging strategies that dermatologists have nowadays in hand, including including preventive measurements, cosmetological strategies, topical and systemic therapeutic agents and invasive procedures.

Effects of long-pulsed 1,064-nm neodymium-doped yttrium aluminum garnet laser on dermal collagen remodeling in hairless mice

BACKGROUND

Nonablative lasers are used for dermal collagen remodeling. Although clinical improvements have been reported using various laser devices, the mechanism of dermal collagen remodeling remains unknown.

OBJECTIVE

To investigate the effects of energy fluences of the long-pulsed neodymium-doped yttrium aluminum garnet (Nd:YAG) nonablative laser on dermal collagen remodeling and evaluate the dermal collagen remodeling mechanism.

MATERIALS AND METHODS

Hairless mice were pretreated with ultraviolet B irradiation to produce photo-damage. The laser treatment used a long-pulse 1,064-nm Nd:YAG laser at energy fluences of 20, 40, and 60 J/cm(2) . The amount of dermal collagen and expressions of transforming growth factor beta (TGF-β), matrix metalloproteinase-1 (MMP-1), and tissue inhibitor of metalloproteinase-1 (TIMP-1) of laser treated skin were compared with those of nontreated control skin.

RESULTS

The long-pulse Nd:YAG laser treatment increased dermal collagen and significantly increased TGF-β expression. The expression of MMP-1 decreased with low energy fluence. The expression of TIMP-1 was not significantly different.

CONCLUSION

Long-pulsed 1,064-nm Nd:YAG laser increases the dermal collagen in association with the increased expression of TGF-β.

Effect of intense pulsed light on rat skin

BACKGROUND

Intense pulsed light (IPL) is widely used in treating skin conditions and has been reported to increase collagen and elastic fibers without damaging the epidermis.

OBJECTIVE

To evaluate the effect of variation in the number of passes and intervals of IPL treatments on photorejuvenation in rats.

MATERIALS AND METHODS

Groups of two rats each were exposed to two or four passes of an IPL source using a fluence of 30 J/cm(2) and a cut-off filter of 560 nm at 1- or 3-week intervals. The collagen and elastic fiber content in stained tissue biopsies and the thickness of the collagen fibers of IPL-irradiated and unexposed skin regions were compared.

RESULTS

Collagen distribution and collagen fiber diameter was in IPL-irradiated than in control regions. The number of passes did not significantly affect the collagen fiber thickness, but the collagen fibers from the 3-week-interval groups were thicker than those of the 1-week-interval groups (p < .001).

CONCLUSION

IPL increased dermal collagen fibers and collagen fiber diameter, suggesting efficacy in photorejuvenation and wrinkle reduction.

Molecular mechanisms of nonablative fractionated laser resurfacing

BACKGROUND

Nonablative fractionated laser resurfacing improves the texture of treated skin, but little is known about the molecular mechanisms that underlie clinical improvements.

OBJECTIVES

We sought to examine and quantify the time course and magnitude of dermal matrix changes that occur in response to nonablative fractionated laser resurfacing, with the dual goals of better understanding the molecular mechanisms that underlie clinical improvements and of gaining knowledge that will enable evidence-based treatment parameter optimization.

METHODS

Twenty patients (mean age 58 years) with photodamaged skin were focally treated on dorsal forearms with a nonablative fractionated laser. Serial skin samples were obtained at baseline and at various times after treatment. Biopsies were examined with real-time polymerase chain reaction technology and immunohistochemical techniques.

RESULTS

Laser treatment resulted in an initial inflammatory response as indicated by statistically significant induction of proinflammatory cytokines (interleukin-1β and tumour necrosis factor-α). This was followed by substantial increases in levels of several matrix metalloproteinases and later by significant induction of type I collagen. Dermal remodelling was noted with both low and high microbeam energy treatment parameters.

CONCLUSIONS

Nonablative fractionated laser resurfacing induces a well-organized wound-healing response that leads to substantial dermal remodelling and collagen induction. Surprisingly, only minimal differences were observed between lower and higher microbeam energy settings. These data suggest that lower microbeam energy/higher microbeam density treatment parameters, which are generally better tolerated by patients, may yield dermal changes similar to those that result from higher microbeam energy/lower microbeam density treatment parameters.

Intraepidermal erbium:YAG laser resurfacing: impact on the dermal matrix

BACKGROUND

Various minimally invasive treatments enhance the skin's appearance. Little is known about the molecular mechanisms whereby treatments working at the epidermal level might alter the dermis.

OBJECTIVE

We sought to quantify the molecular changes that result from erbium:yttrium-aluminium-garnet (Er:YAG) laser microablative resurfacing.

METHODS

We performed biochemical analyses after intraepidermal Er:YAG laser resurfacing of 10 patients. Immunohistochemical analysis and polymerase chain reaction technology were utilized to measure key biomarkers.

RESULTS

The basement membrane remained intact after intraepidermal microablation, as demonstrated by laminin γ2 immunostaining. Epidermal injury was demonstrated with acute up-regulation of keratin 16. An inflammatory response ensued as indicated by increases in cytokines interleukin 1 beta (IL-1β) and IL-8 as well as a substantial neutrophil infiltrate. Levels of cJun and JunB proteins, components of the transcription factor AP-1 complex, were also elevated. Up-regulation of extracellular matrix degrading proteinases matrix metalloproteinase 1 (MMP-1), MMP-3, and MMP-9 was noted. A transient increase in keratinocyte proliferation, as indicated by staining for Ki67, was observed. Increased expression of type I and type III procollagen was demonstrated.

LIMITATIONS

The data presented are those that resulted from a single treatment session.

CONCLUSIONS

Although microablation was confined to the uppermost epidermis, marked changes in epidermal and dermal structure and function were demonstrated after Er:YAG laser microablative resurfacing. We demonstrated substantial dermal matrix remodeling, including a degree of collagen production that compares favorably with some more invasive interventions. Dermal remodeling and stimulation of collagen production are associated with wrinkle reduction. Thus these results suggest that the skin's appearance may be enhanced by creating dermal changes through the use of superficially acting treatments.

Nonablative skin rejuvenation devices and the role of heat shock protein 70: results of a human skin explant model

Nonablative thermal laser therapy with a 1,540-nm laser induces controlled, spatially determined thermal damage, allowing subsequent collagen remodeling while preserving the epidermis. A photorejuvenation effect using nonthermal nonablative stimulation of cells with low energy and narrow band light has been termed photomodulation. Light emitting diodes (LEDs) are narrow band emitters that lead to photomodulation via stimulation of mitochondrial cell organelles. In a previous study, we demonstrated in a human skin explant model that heat shock protein 70 (HSP70) plays a pivotal role in the initiation of skin remodeling after ablative fractional photothermolysis. To test its importance in nonablative laser therapy and photomodulation, the spatio-temporal expression of HSP70 is investigated in response to a 1540-nm laser treatment and six different LED therapies. An Er:glass laser is used with a 1-Hz repetition rate, 30-J/cm(2) fluence, and a hand piece with a 2-mm spot size. Nonthermal nonablative treatment is performed using two LED (LEDA SCR red light: 635 nm, 40 to 120 W/cm(2), 40 to 120 J/cm(2); LEDA SCR yellow light: 585 nm, 16 to 35 W/cm(2), 20 to 100 J/cm(2); spot size 16 x 10 cm). Immediate responses as well as responses 1, 3, or 7 days postprocedure are studied; untreated skin explants serve as control. Immunohistochemical investigation (HSP70) is performed in all native, nontreated, and Er:glass laser- or LED-treated samples (n=175). Nonablative laser therapy leads to a clear time-dependent induction of epidermally expressed HSP70, peaking between one to three days post-treatment. In contrast, none of the various LED treatments up-regulated the HSP70 expression in our skin explant model. HSP70 is up-regulated by nonablative but thermal laser devices, but does not seem to play a significant role in the induction of skin remodeling induced by photomodulation. The maximum of HSP70 expression is reached later after Er:glass laser intervention compared to ablative fractional (AFP) treatment.

Treatment of superficial infantile hemangiomas of the eyelid using the 595-nm pulsed dye laser

BACKGROUND

Despite the proven effectiveness of the 595-nm pulsed dye laser (PDL) in treating superficial infantile hemangiomas, many physicians are reluctant to treat such lesions involving the eyelid. OBJECTIVE To examine the safety and efficacy of the 595-nm PDL for the treatment of superficial infantile hemangiomas of the eyelid.

MATERIALS & METHODS

Records were reviewed for patients with superficial infantile hemangiomas of the eyelid treated with 595-nm PDL. Pre- and post-treatment photographs were compared. Reviewers rated the degree of improvement of the hemangioma as excellent (76-100%), good (51-75%), moderate (26-50%), or poor (0-25%) and indicated whether the hemangioma was 100% clear. Side effects of scarring, atrophy, hyperpigmentation, and hypopigmentation were assessed.

RESULTS

Twenty-two patients met the study criteria. Eight (36.4%) demonstrated complete clearance of their hemangioma, 17 (77.3%) received an improvement rating of excellent, and five (22.7%) received a rating of good. No scarring, atrophy, or hypopigmentation was noted. Two patients (9.1%) were noted to have hyperpigmentation in the treated area.

CONCLUSION

Early treatment with the 595-nm PDL can safely and effectively diminish proliferative growth and hasten resolution of superficial infantile hemangiomas of the eyelid.

Q-switched Nd:YAG laser: rhytid improvement by non-ablative dermal remodeling

BACKGROUND

The Q-switched Nd:YAG laser has been used for a variety of dermatologic indications including tattoo and hair removal, as well as vascular and pigmented lesion treatment. Previous studies have suggested that this laser may also be safe and effective in the non-ablative treatment of rhytids.

OBJECTIVES

The purpose of this study was to evaluate the safety and efficacy of the Q-switched Nd:YAG laser in the non-ablative dermal remodeling of facial rhytids.

METHODS

Eight subjects were treated at 3 monthly intervals with a Q-switched Nd:YAG laser. Two passes with fluences of 7 J/cm2 and a 3-mm spot size were utilized. Clinical improvement and adverse effects were assessed 3 months after the last treatment.

RESULTS

Six of the eight subjects showed clinical improvement as assessed by an independent observer. No pigmentary changes, erythema, or scarring were observed at the end of the study.

CONCLUSION

The Q-switched Nd:YAG laser may be used for the non-ablative treatment of facial rhytids.

Evaluation of procollagen I deposition after intense pulsed light treatments at varying parameters in a porcine model

Several lasers and light sources have been reported to induce dermal collagen remodeling without damaging the epidermis. The intense pulsed light (IPL) system, which emits polychromatic light of wavelengths between 560 and 1200 nm belongs to this group of increasingly popular non-ablative skin rejuvenation devices. Various IPL treatment parameters can be adjusted to achieve optimal dermal remodeling and clinical improvement. The aim of this study was to evaluate variations in IPL treatment parameters and the effect on procollagen I deposition. Marked areas of a live Yorkshire pig's flank skin were irradiated with a single or double pass of an IPL source using a fluence of 30 or 40 J/cm2 and a cut-off wavelength filter of 590 nm. Skin biopsies were performed on postoperative days 1, 7, 14, 21, and 42. A statistically significant increase in procollagen I in treated versus untreated sites was found on postoperative days 21 and 42, but not earlier. There was a uniformly significant increase in procollagen I on day 42 using the 590 nm filter at both 30 and 40 J/cm2 with either a single or double pass. The increase in procollagen was greater with a fluence of 40 J/cm2 compared with 30 J/cm2.

Long pulsed dye laser treatment of facial wrinkles

BACKGROUND

The flashlamp pulsed dye laser has been used in the treatment of rhytids.

OBJECTIVE

To evaluate the efficacy of the long pulsed dye laser in the treatment of mild to moderate wrinkles in Asian patients.

METHODS

Wrinkles on one half of the face in 10 subjects were treated with the long pulsed dye laser (595 nm, 10 mm spot size, 10 ms, 7 J/cm2, 40 ms spray, 40 ms delay, single-pass, 30% overlap) with the other side serving as a control. A total of three treatments were given at 2 monthly intervals. The following sites were treated: periorbital area, six patients; forehead, two patients; cheek, two patients. No preoperative anesthesia or postoperative treatment were used. Clinical photographs were taken before and after each treatment, and analysis was undertaken through photographic evaluation by non-treating physicians.

RESULTS

At 2 months after the last treatment, the clinical improvement of rhytids was noted in all patients compared with baseline. Four subjects had mild improvement (< or = 25%), five had moderate improvement (26-50%) and one had marked improvement (51-75%). The periorbital area was more responsive to treatment compared with the other sites. No clinical changes were noted in the control areas. No adverse effects were reported except for transient mild erythema in two patients which lasted for up to an hour. Nine patients were somewhat satisfied with the treatment and one was highly satisfied. All wanted the other half of the face to be treated.

CONCLUSION

Treatment with a non-ablative 595 nm flashlamp pulsed dye laser can lead to mild to moderate clinical improvement in class I-II rhytids with minimal to no side effects in patients with darker skin types.

Infraorbital dark circles: definition, causes, and treatment options

BACKGROUND

Infraorbital dark circles refer to the conditions that present with darkness of the infraorbital eyelids. Although it is not a medical concern, it can be a cosmetic concern for a large number of individuals. Moreover, clear definition and possible causes have not been elucidated.

OBJECTIVE

To review the possible causes and treatment options for infraorbital dark circles.

METHODS

The article is based on a review of the medical literature and the author's clinical experience in treating infraorbital dark circles.

CONCLUSION

Possible causative factors of infraorbital dark circles include excessive pigmentation, thin and translucent lower eyelid skin overlying the orbicularis oculi muscle, and shadowing due to skin laxity and tear trough, but because multiple factors cause infraorbital dark circles in the majority of patients, it is essential to identify the cause and choose the appropriate treatment according to the cause.

Lasers and optical technologies in facial plastic surgery

Lasers and optical technologies play a significant role in aesthetic and reconstructive surgery. The unique ability of optical technologies to target specific structures and layers in tissues to effect chemical, mechanical, or thermal changes makes them a powerful tool in cutaneous rejuvenation, hair removal, fat removal, and treatment of vascular lesions such as port-wine stains, among many other procedures. With the development of adjunct techniques such as epidermal cooling, lasers and optical technologies have become more versatile and safe. The constant improvement of existing applications and the emergence of novel applications such as photodynamic therapy, nanoparticles, spectroscopy, and noninvasive imaging continue to revolutionize aesthetic medicine by offering a minimally invasive alternative to traditional surgery. In the future, therapies will be based on individualized, maximum, safe radiant exposure to deliver optimal dosimetry. Lasers and optical technologies are headed toward safer, easier, more quantifiable, and more individualized therapy.

Retinoids, 585-nm laser, and carbon dioxide laser: a numeric comparison of neocollagen formation in photoaged hairless mouse skin

BACKGROUND

A variety of new methods for treating photoaging have been recently introduced. There has been increasing interest in comparing the relative efficacy of multiple methods for photoaging. However, the efficacy of a single method is difficult to assess from the data reported in the literature.

METHODS

Photoaged hairless mice were randomly divided into seven treatment groups: control, retinoids (tretinoin and adapalene), lasers (585 nm and CO(2)), and combination groups (585 nm + adapalene and CO(2 )+ adapalene). Biopsies were taken from the treated regions, and the results were analyzed based on the repair zone. The repair zones of the various methods for photoaging were compared.

RESULTS

Retinoids produced a wider repair zone than the control condition. The 585-nm and CO(2) laser resurfacing produced a result equivalent to that of the control condition. A combination of these lasers with adapalene produced a wider repair zone than the lasers alone, but the combination produced a result equivalent to that of adapalene alone.

CONCLUSION

Retinoids are potent stimuli for neocollagen formation. The 585-nm or CO(2) laser alone did not induce more neocollagen than the control condition. In addition, no synergistic effect was observed with the combination treatments. The repair zone of the combination treatment is mainly attributable to adapalene.

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.

Laser induced collagen remodeling: a comparative study in vivo on mouse model

BACKGROUND AND OBJECTIVE

Many lasers have claimed the clinical efficacy on skin rejuvenation. In this study, the mechanisms of laser induced collagen remodeling were explored systematically on a Kunming (KM) mouse model in vivo by comparing the different non-ablative laser effects using four different laser treatment modalities.

MATERIALS AND METHODS

The dorsal skin of KM mice was exposed by depilation before the laser treatments. Four laser treatment modalities were used: the 595-nm pulsed dye laser (PDL) (10 ms), 1,320-nm neodymium-yttrium-aluminum garnet (Nd:YAG) laser (0.35 ms), 1,064-nm Nd:YAG laser with Q-switched (5 ns), and long-pulsed (0.3 ms) mode. Each modality exposed one side of the mouse dorsal skin leaving the other side as the contralateral control. Then skin histology, fibroblast number, and the genesis of collagen type I and III were studied by comparing the treatment site and control site at 1 hour, 1 day, 1 week, 3 weeks, 4 weeks, and 8 weeks after laser treatment. Hydroxyproline content of the skin tissue was measured 4 weeks and 8 weeks after laser exposure.

RESULTS

All laser treatments led to marked improvements in dermal layer thickness and collagen fiber density, and the increase in fibroblast number and hydroxyproline content compared with their own controls. Collagen synthesis and remodeling induced by the Q-switched 1,064-nm laser was most effective 4 weeks after treatment, while there was no significant difference among the other three modalities. Among the new collagen genesis after the different laser treatments, collagen type III increased sharply after the Q-switched 1,064-nm laser treatment whereas more collagen type I was elicited by the other laser treatment modalities.

CONCLUSIONS

The efficacy of photo-mechanical effects in promoting more effectively the synthesis of collagen type III, whereas the photo-thermal effect favored more the formation of collagen type I.

Laser surgery in dark skin

Although challenging, effective laser surgery in patients with darker skin tones can be achieved despite a higher inherent risk of side effects. Although the incidence of undesirable postoperative sequelae has decreased with the development of advanced laser technology and individualized treatment parameters, these risks may never be eliminated completely. Consequently, thorough patient preoperative preparation and education regarding the risks of cutaneous laser therapy will remain an essential component of treatment in darkly pigmented patients. In the future, as more refined laser techniques evolve, the ability to safely and effectively treat these patients will improve.

Masers to magic bullets: an updated history of lasers in dermatology

Laser therapy is one of the fastest expanding and most exciting fields in dermatology. From its theoretical beginnings in Einstein's imagination, lasers have come to be used in treatments for conditions ranging from skin malignancy and acne to hirsutism and photoaging. We will briefly review the evolution of laser treatment, with a focus on the recent developments surrounding the new millennium.

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.