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Li D, Li Y, Yang Z, Chen J, Yang D, Wang J, Xiong H. Efficacy of fractional radiofrequency in the treatment of erythematous capillary rosacea: A split-face study. J Cosmet Dermatol 2024; 23:2895-2904. [PMID: 38943266 DOI: 10.1111/jocd.16354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 04/02/2024] [Indexed: 07/01/2024]
Abstract
OBJECTIVE To assess the effectiveness and safety of treating erythematotelangiectatic rosacea using fractional radiofrequency (FRF). METHODS Twenty patients with a confirmed diagnosis of erythema capillaris rosacea were selected, and one side of each patient's face was randomly assigned to receive FRF treatments for three to six times, with an interval of 2 weeks between each treatment. VISIA, dermoscopy, and the Clinician's Erythema Evaluation Scale (CEA) were applied to evaluate the efficacy of the treatment before and after the treatment, to record the VAS scores and adverse reactions, and to conduct a patient satisfaction survey. RESULTS The characteristic counts and scores of red zone and porphyrin as assessed by VISIA test were significantly decreased, and the difference between the treated side and the pretreatment side was statistically significant (p < 0.05), and the efficacy of the treatment was statistically insignificant compared with the control side, except for the red zone and porphyrin which were statistically significant before and after the treatment (p > 0.05). By CEA score, the difference between the treated side after treatment and the control side was statistically significant (p < 0.05), and the difference between the treated side before and after treatment was statistically significant (p < 0.05); the difference between the control side before and after treatment was not statistically significant (p > 0.05). Dermatoscopic observation showed reduction in pore size, reduction of yellowish-white and black horn plugs within the pores, lightening of the red background and thinning and blurring of the capillary structure on the treated side of the skin compared to the control side, and the skin on the treated side showed the above mentioned changes before and after the treatment as well. The mean pain score of the subjects was obtained by VAS score 3.67 ± 0.90. Adverse effects included mild edema, erythema, and microscopic crusting; no long-term adverse effects were seen in all patients. The efficacy of FRF treatment was evaluated 1 month after the final treatment, and 85% of the subjects rated it as satisfactory, very satisfactory, and very satisfactory. CONCLUSION FRF for the treatment of erythematous capillary dilatation rosacea is effective, safe, and suitable for clinical promotion.
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Affiliation(s)
- Dongqing Li
- Department of Dermatology, Qujing Hospital, Kunming Medical University, Qujing, Yunnan, China
| | - Yujing Li
- Department of Dermatology, The First Affiliated Hospital, Kunming Medical University, Kunming, Yunnan, China
| | - Zhi Yang
- Department of Dermatology, The First Affiliated Hospital, Kunming Medical University, Kunming, Yunnan, China
| | - Jiaoyu Chen
- Department of Dermatology, The First Affiliated Hospital, Kunming Medical University, Kunming, Yunnan, China
| | - Dengrong Yang
- Department of Dermatology, The First Affiliated Hospital, Kunming Medical University, Kunming, Yunnan, China
| | - Jinlai Wang
- Department of Dermatology, The First Affiliated Hospital, Kunming Medical University, Kunming, Yunnan, China
| | - Haojun Xiong
- Department of Dermatology, The First Affiliated Hospital, Kunming Medical University, Kunming, Yunnan, China
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Radiofrequency and Radiofrequency Microneedling in Skin of Color: A Review of Usage, Safety, and Efficacy. Dermatol Surg 2023; 49:489-493. [PMID: 36826381 DOI: 10.1097/dss.0000000000003733] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
BACKGROUND Radiofrequency (RF) and radiofrequency microneedling (RFM) for rhytides, scarring, and skin rejuvenation are believed to have a lower risk of postprocedural dyspigmentation in darker skin types. OBJECTIVE To explore the safety and efficacy of RF and RFM in Fitzpatrick skin Types III to VI. METHODS AND MATERIALS A systematic review of PubMed/MEDLINE databases from 2000 to 2021 using combinations of the terms radiofrequency, microneedling, skin of color, and Fitzpatrick was performed. Exclusion criteria included non-Fitzpatrick skin Types III-VI patient population, nonprimary articles, nonskin radiofrequency, and nonhuman studies. RESULTS Thirty-five articles addressing the use of RF or RFM in skin of color were identified-22 for skin rejuvenation, 7 for acne scars, 4 for nonacne scars, 1 for hyperpigmentation, and 1 for acne treatment. Seven studies noted transient postinflammatory hyperpigmentation, 1 observed mild prolonged hyperpigmentation, and only 1 study reported permanent scarring. CONCLUSION Radiofrequency and RFM seem to have a low risk of scarring or hyperpigmentation in skin of color. This review demonstrates that these procedures have been successfully used primarily for rhytides, acne scarring, and skin rejuvenation. However, a large proportion of the studies lack strong quality evidence.
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Li J, Duan F, Kuang J. Meta-analysis of fractional radiofrequency treatment for acne and/or acne scars. J Cosmet Dermatol 2022; 21:6754-6766. [PMID: 36062400 DOI: 10.1111/jocd.15348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/20/2022] [Accepted: 08/30/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Fractional radiofrequency (FRF) is increasingly used for acne scars. The common coexistence of acne scars and active acne is a challenge in the timely management of acne scarring. AIMS We conducted a systematic review and meta-analysis to compare the efficacy and safety of FRF treatment with the lasers for acne and/or acne scars. METHODS A systematic search was performed on PubMed, Embase, Ovid, Cochrane Library, and Web of Science. Compared with the lasers, a meta-analysis was conducted to assess the clinical improvement and adverse events after FRF treatment. RESULTS Eight randomized controlled trials were included. FRF group was more effective than the laser group in patient-evaluated acne improvement (RR = 1.35, 95% CI: 1.01 ∼ 1.80). Regardless of observer assessment or patient evaluation, the FRF group was as effective as the laser group in treating atrophic acne scars (RR = 0.92, 95% CI: 0.78 ∼ 1.08; RR =1.15, 95% CI: 0.99 ∼ 1.34). Although there was no difference in pain level and crusting time between the two groups (SMD =0.20, 95% CI: -0.72 ∼ 1.12; SMD = -0.93, 95% CI: -2.38 ∼ 0.52), PIH incidence of FRF was significantly lower than that of the laser group (RR = 0.12, 95% CI: 0.04 ∼ 0.35). The duration of erythema after FRF treatment was also obviously shorter than that after the laser treatment (SMD = -0.78, 95% CI: -1.37 ∼ -0.18). Subgroup analysis showed that at least a 12-week follow-up was required to observe the full effects of FRF. CONCLUSIONS FRF could be a better choice for atrophic acne scar patients with active acne. FRF is superior in treating atrophic acne scar patients prone to pigmentation.
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Affiliation(s)
- Jing Li
- Department of Dermatology, Beijing Jishuitan Hospital, Beijing, China.,Fourth Medical College of Peking University, Beijing, China
| | - Fangfang Duan
- Fourth Medical College of Peking University, Beijing, China.,Clinical Epidemiology Research Center, Beijing Jishuitan Hospital, Beijing, China
| | - Jie Kuang
- Department of Dermatology, Beijing Jishuitan Hospital, Beijing, China.,Fourth Medical College of Peking University, Beijing, China
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Ren K, Liu H, Li B, Zhou B. Fractional microneedle radiofrequency treatment for enlarged facial pores: A real-world retrospective observational study on 75 patients. J Cosmet Dermatol 2022; 21:6742-6753. [PMID: 36038248 DOI: 10.1111/jocd.15339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/10/2022] [Accepted: 08/26/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVE This study aimed to analyze the clinical results and influencing factors of the fractional microneedle radiofrequency (FMR) treatment for enlarged facial pores on different facial sites. METHODS The clinical data of patients with enlarged facial pores who underwent FMR treatment from January 2019 to December 2020 were collected. The efficacy and complications of FMR for enlarged pores in different facial areas were retrospectively analyzed. Univariate and multivariate logistic regression analyses were used to explore the clinical factors related to the efficacy of FMR after the first treatment session. RESULTS Totally, 75 patients with enlarged facial pores were included (full-face FMR for 45, nasal FMR for 58, frontal FMR for 45, and cheek FMR for 72 patients). All patients received more than one treatment session, two patients received five treatment sessions, and the mean number of FMR session was 1.7. The moderate to excellent improvement rates in patients with nasal, frontal and cheek enlarged pores after the first session were 13.8%, 8.9%, and 11.1%, respectively. The improvement rate rose with the increasing number of treatment sessions. Multivariate logistic regression analysis revealed that long pulse-width (300 ms) was positively associated with clinical efficacy after the first session (OR = 22.4, 95% CI [2.0-250.4], p = 0.012), compared with the short pulse-width group (100-200 ms). The main adverse effects after FMR were transient pain, erythema, and edema. A minority of patients developed acneiform eruption. CONCLUSION This study confirms that FMR is safe and effective in improving enlarged facial pores. The pulse width is associated with the improvement of nasal enlarged pores.
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Affiliation(s)
- Kehui Ren
- Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Houfang Liu
- Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.,Department of Dermatology, The Fourth people's Hospital of Zhenjiang, Zhenjiang, China
| | - Bingyan Li
- Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.,Department of cosmetic dermatology, Friendship Plastic Surgery Hospital, Nanjing Medical University, Nanjing, China
| | - Bingrong Zhou
- Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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5
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Cucu C, Butacu AI, Niculae BD, Tiplica GS. Benefits of fractional radiofrequency treatment in patients with atrophic acne scars - Literature review. J Cosmet Dermatol 2020; 20:381-385. [PMID: 33355993 DOI: 10.1111/jocd.13900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/23/2020] [Accepted: 11/30/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Acne scars carry a huge physical and psychological impact on people. This article aims to evaluate the role of fractional radiotherapy in treatment of atrophic acne scars. The main objective includes providing an up-to-date review of existing literature, presenting the most significant studies conducted in this field. METHODS In order to study the impact of fractional radiotherapy on the appearance of atrophic acne scars, we conducted a search on Pubmed using the keywords "fractional radiotherapy", combined with/or "acne", "atrophic acne scars" and "acne scars" and found 75 papers, from which we selected 39. RESULTS There are several therapeutic approaches for the improvement of acne scars with variable results and possible side effects. Fractional radiofrequency system has been used widely in the last years, as it turned out to be an effective treatment method, either in combination with other modalities, or alone. CONCLUSION There are no generalized clinical guidelines adopted to standardize atrophic acne scar treatment. The multiple therapeutic options available create a dilemma in choosing the proper method in order to enhance its efficacy and to minimize its risks. The accumulated experience in nonablative collagen stimulating devices like fractional radiofrequency has proven that thickening of interstitial fibers in the dermis is possible with a controlled thermal injury, without epidermal damage and development of side effects.
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Affiliation(s)
| | - Alexandra-Irina Butacu
- Department of Dermatology, Colentina Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | | | - George-Sorin Tiplica
- Department of Dermatology, Colentina Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
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Manuskiatti W, Punyaratabandhu P, Tantrapornpong P, Yan C, Cembrano KAG. Objective and Long-Term Evaluation of the Efficacy and Safety of a 1064-nm Picosecond Laser With Fractionated Microlens Array for the Treatment of Atrophic Acne Scar in Asians. Lasers Surg Med 2020; 53:899-905. [PMID: 33326626 DOI: 10.1002/lsm.23368] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/12/2020] [Accepted: 11/29/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND OBJECTIVE Fractional 1064-nm picosecond-domain laser has recently been utilized for the treatment of atrophic acne scars and showed promising results. However, data on the safety and efficacy of this procedure in dark-skinned patients are limited. This prospective, self-controlled study was conducted to objectively evaluate the safety and efficacy of a 1064-nm picosecond laser coupled with a microlens array (MLA) for the treatment of atrophic acne scars on Asian skin. STUDY DESIGN/MATERIALS AND METHODS Twenty-six subjects of Fitzpatrick skin types (FSTs) III and IV with atrophic acne scars were enrolled. All subjects were treated with a 1064-nm picosecond laser (spot size of 8 mm, fluence of 1.0 J/cm2 , a repetition rate of 10 Hz) in combination with the MLA handpiece for an average of three passes, for 6 monthly sessions. Objective (measurement of scar volume using three-dimensional (3D) photography and skin roughness analysis using ultraviolet A-light video camera) and subjective (clinical evaluation by two blinded dermatologists) assessments were obtained at baseline and at 1, 3, and 6 months after the final treatment. RESULTS Statistically significant reduction of the scar volume from baseline at 1, 3, and 6 months after the final treatment were observed by 3D photography and ultraviolet A-light video camera. At the 6-month follow-up, 50% (13 of 26) of the subjects were rated as having at least 50% improvement of the scars. The rate of improvement significantly increased from the 1-month follow-up to the 6-month follow-up (P = 0.013). Similarly, at the 6-month follow-up, the scar volume (P = 0.024) and skin roughness (P = 0.001) also significantly improved, in comparison with the baseline. Mild postinflammatory hyperpigmentation (PIH) was observed to develop in approximately 18% of all the treatment sessions. All cases of PIH were temporary and resolved within 4 weeks on average. CONCLUSIONS The 1064-nm picosecond laser with MLA is a safe therapeutic alternative for the treatment of atrophic acne scars in dark-skinned individuals. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.
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Affiliation(s)
- Woraphong Manuskiatti
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Preawphan Punyaratabandhu
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Ploypailin Tantrapornpong
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Chadakan Yan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Kathryn Anne G Cembrano
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
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7
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Nitayavardhana S, Wanitphakdeedecha R, Ng JNC, Eimpunth S, Manuskiatti W. The efficacy and safety of fractional radiofrequency nanoneedle system in the treatment of atrophic acne scars in Asians. J Cosmet Dermatol 2020; 19:1636-1641. [PMID: 32416635 PMCID: PMC8246773 DOI: 10.1111/jocd.13484] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 05/06/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Multiple treatment modalities have been developed to treat atrophic acne scars with varying degrees of success. Post-inflammatory hyperpigmentation (PIH) after acne scar treatments remain a major concern in Asian patients. Fractional radiofrequency (FRF) has been used in many dermatological skin conditions including acne scars. AIMS To determine the efficacy and safety of FRF nanoneedle system in the treatment of acne scars in Asians. METHODS This is a prospective, evaluator-blinded study with 25 subjects diagnosed with moderate to severe acne scarring. All subjects received 3 monthly treatments of the FRF nanoneedle system on both cheeks. Primary outcome was the clinical improvement of acne scars graded by 2 blinded dermatologists at baseline, 1-, 3-, and 6-month follow-ups. Objective scar volume analysis was done using ultraviolet A (UVA) light video camera. Subjects' self-assessment, pain score, and adverse events were also recorded. RESULTS Twenty-three out of 25 subjects completed the study and attended all follow-up. Clinical improvement of acne scars was observed as early as 1-month follow-up. Objective evaluation of acne scar volume decreased significantly on all follow-up compared to baseline (P < .005). Majority of the subjects (48%) reported marked improvement in their acne scars. Adverse events such as pain, erythema, burning sensation, edema, scab formation, and PIH were mild and temporary. CONCLUSIONS FRF nanoneedle system is a safe and effective treatment for acne scars in Asians. However, despite the significant changes in the scar volume, caution should be used to avoid excessive coagulation resulting in PIH.
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Affiliation(s)
- Sunatra Nitayavardhana
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Janice Natasha C Ng
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sasima Eimpunth
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Woraphong Manuskiatti
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Vachiramon V, Iamsumang W, Chanasumon N, Thadanipon K, Triyangkulsri K. A study of efficacy and safety of high‐intensity focused ultrasound for the treatment of melasma in Asians: A single‐blinded, randomized, split‐face, pilot study. J Cosmet Dermatol 2019; 19:375-381. [DOI: 10.1111/jocd.13044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/28/2019] [Accepted: 05/21/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Vasanop Vachiramon
- Division of Dermatology, Faculty of Medicine Ramathibodi Hospital Mahidol University Bangkok Thailand
| | - Wimolsiri Iamsumang
- Division of Dermatology, Faculty of Medicine Ramathibodi Hospital Mahidol University Bangkok Thailand
| | - Nongsak Chanasumon
- Division of Dermatology, Faculty of Medicine Ramathibodi Hospital Mahidol University Bangkok Thailand
| | - Kunlawat Thadanipon
- Division of Dermatology, Faculty of Medicine Ramathibodi Hospital Mahidol University Bangkok Thailand
- Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital Mahidol University Bangkok Thailand
| | - Korn Triyangkulsri
- Division of Dermatology, Faculty of Medicine Ramathibodi Hospital Mahidol University Bangkok Thailand
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Weiner SF. Radiofrequency Microneedling: Overview of Technology, Advantages, Differences in Devices, Studies, and Indications. Facial Plast Surg Clin North Am 2019; 27:291-303. [PMID: 31280844 DOI: 10.1016/j.fsc.2019.03.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Radiofrequency (RF) skin rejuvenation is improved using RF microneedling (RFM) devices. More aggressive treatments are performed safely with minimal downtime than previous RF devices. Optimizing treatment parameters is essential for safety and efficacy. Multiple RFM studies support minimal risks even in dark skin types. RFM has been used to treat acne scarring successfully as well as skin laxity and hyperhidrosis.
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Affiliation(s)
- Steven F Weiner
- 2050 West County Highway 30A, Suite 114, Santa Rosa Beach, FL 32459, USA.
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10
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Comparison of Moderate and High Energy of a Nano-Fractional Radiofrequency Treatment on a Photoaging Hairless Mice Model. Dermatol Surg 2018; 44:569-575. [PMID: 29053534 DOI: 10.1097/dss.0000000000001362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Fractional radiofrequency (FRF) has been widely used in skin rejuvenation. To explore optimal settings, it is important to compare different treatment parameters. OBJECTIVE This study was designed to compare the effect of moderate-energy and high-energy FRF treatment on a hairless mice model. METHODS Fifteen photoaged hairless mice were assigned to 3 groups: control, moderate energy, and high energy. Two treatment sessions (T × 1 and T × 2) were performed at 1-month interval. Transepidermal water loss was measured at baseline, immediately, 1, 2, and 4 weeks after T × 1. Skin samples were harvested before each treatment, 1 and 2 months after T × 2. Neocollagenesis was evaluated by hematoxylin and eosin staining, Masson staining, and immunohistochemistry analysis. RESULTS Transepidermal water loss of high-energy group was significantly higher than the moderate-energy group (p = .008) immediately after T × 1. Remarkable fibroblast proliferation was observed at 1 month after T × 1, followed by significant dermal thickening, and increase of Type I collagen and Type III collagen. There was no significant difference between 2 energy groups in fibroblast proliferation, dermal thickness, and collagen density. CONCLUSION The effect of moderate-energy treatment was comparable with that of high energy in neocollagenesis, whereas moderate energy yielded less damage to skin barrier function.
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Casabona G. Combined use of microfocused ultrasound and a calcium hydroxylapatite dermal filler for treating atrophic acne scars: A pilot study. J COSMET LASER THER 2018; 20:301-306. [DOI: 10.1080/14764172.2017.1406606] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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12
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Kravvas G, Al-Niaimi F. A systematic review of treatments for acne scarring. Part 2: Energy-based techniques. Scars Burn Heal 2018; 4:2059513118793420. [PMID: 30627441 PMCID: PMC6305948 DOI: 10.1177/2059513118793420] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Acne scarring is a very common problem, which can be extensive, and may lead to significant psychosocial morbidity. Multiple types of treatments are used to ameliorate atrophic scars with varying degrees of success. This paper provides an overview of the various energy-based modalities that are commonly employed against acne scarring. OBJECTIVES AND METHODS A comprehensive literature search of papers published since 2008 was performed in order to determine the efficacy and adverse reactions of commonly used energy-based treatments against post-acne scarring. RESULTS A total of 59 relevant articles were identified covering a multitude of different devices. DISCUSSION Ablative lasers seem to achieve the highest degree of efficacy, albeit this is associated with significant pain and downtime, and the risk for long-term pigmentary changes. Non-ablative fractional photothermolysis (FP) has a much safer profile but cannot achieve as good cosmetic results. The efficacies of fractional radiofrequency microneedling and radiofrequency are slightly inferior to that of FP but offer an even safer adverse profile. Little evidence is available on the remaining devices, with larger studies required in order to reach more solid conclusions. CONCLUSION Multiple devices have been used with varying levels of efficacy and very different safety profiles. There is an overall lack of high-quality evidence about the effects of different interventions. Furthermore, no standardised scale is available for acne scarring, leading to variability in evaluation and interpretation of data in different studies.
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Affiliation(s)
| | - Firas Al-Niaimi
- Department of Dermatological Surgery and Lasers, St John’s Institute of Dermatology, London, UK
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Thanasarnaksorn W, Siramangkhalanon V, Duncan DI, Belenky I. Fractional ablative and nonablative radiofrequency for skin resurfacing and rejuvenation of Thai patients. J Cosmet Dermatol 2017; 17:184-192. [DOI: 10.1111/jocd.12413] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Wilai Thanasarnaksorn
- Division of Dermatology; Faculty of Medicine; Ramathibodi Hospital, Mahidol University; Bangkok Thailand
- Doctor Younger Clinic; Bangkok Thailand
| | | | | | - Inna Belenky
- Clinical Department; Viora Inc.; New York NY USA
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14
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Albornoz-Cabello M, Ibáñez-Vera AJ, De la Cruz-Torres B. Efficacy of monopolar dielectric transmission radio frequency in panniculus adiposus and cellulite reduction. J COSMET LASER THER 2017; 19:422-426. [DOI: 10.1080/14764172.2017.1342041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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15
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Kim H, Yoo KH, Zheng Z, Cho SB. Pressure- and dose-controlled transcutaneous pneumatic injection of hypertonic glucose solution for the treatment of atrophic skin disorders. J COSMET LASER THER 2017; 19:479-484. [PMID: 28665146 DOI: 10.1080/14764172.2017.1343950] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Needleless transcutaneous pneumatic injections (TPIs) are a minimally invasive way to deliver the solution into the skin for therapeutic purposes. The suggested action mechanisms of TPI therapy include mechanical stimulation, immediate tissue shrinkage and late wound healing. METHODS Thirteen Korean patients were treated with TPI for atrophic skin disorders, including acne scars, striae albae, post-furuncle, or carbuncle scars, and horizontal wrinkles with lipoatrophy. At each TPI treatment session, a single pass was made along with the atrophic skin lesions without overlapping. Thereafter, two dermatologists objectively evaluated the clinical improvement in the lesions in the photographs via the global aesthetic improvement scale (GAIS). RESULTS One month after the final treatment, the overall mean GAIS score was 2.3 ± 0.8. Six of the 13 (46.2%) patients exhibited clinical improvement of grade 3, five (38.5%) patients grade 2 and two (15.4%) patients grade 1. The overall mean subjective satisfaction score with the TPI treatment was 2.3 ± 0.9. Six of the 13 (46.2%) patients achieved subjective satisfaction of grade 3, six (46.2%) patients grade 2 and one (7.7%) patient grade 0. CONCLUSIONS The present study demonstrated that the TPI treatment is effective and safe for treating atrophic skin disorders of varying causes in Korean patients.
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Affiliation(s)
- Heesu Kim
- a Department of Dermatology and Cutaneous Biology Research Center, International St. Mary's Hospital , Catholic Kwandong University, College of Medicine , Incheon , Republic of Korea
| | - Kwang Ho Yoo
- a Department of Dermatology and Cutaneous Biology Research Center, International St. Mary's Hospital , Catholic Kwandong University, College of Medicine , Incheon , Republic of Korea
| | - Zhenlong Zheng
- a Department of Dermatology and Cutaneous Biology Research Center, International St. Mary's Hospital , Catholic Kwandong University, College of Medicine , Incheon , Republic of Korea.,b Department of Dermatology , Yanbian University Hospital , Yanji , China
| | - Sung Bin Cho
- a Department of Dermatology and Cutaneous Biology Research Center, International St. Mary's Hospital , Catholic Kwandong University, College of Medicine , Incheon , Republic of Korea.,c Kangskin Sillim Dermatology Clinic , Seoul , Republic of Korea
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Tenna S, Cogliandro A, Barone M, Panasiti V, Tirindelli M, Nobile C, Persichetti P. Comparative Study Using Autologous Fat Grafts Plus Platelet-Rich Plasma With or Without Fractional CO 2 Laser Resurfacing in Treatment of Acne Scars: Analysis of Outcomes and Satisfaction With FACE-Q. Aesthetic Plast Surg 2017; 41:661-666. [PMID: 28127660 DOI: 10.1007/s00266-017-0777-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 12/31/2016] [Indexed: 01/24/2023]
Abstract
BACKGROUND A multitude of options are traditionally used for the treatment of acne scars; however, newer treatment modalities are emerging to decrease the propensity for post-inflammatory hyperpigmentation and upregulate new collagen production. The aim of this study was to evaluate the efficacy of nanofat and platelet-rich plasma (PRP) infiltration alone and combined with fractional CO2 laser resurfacing to improve atrophic scars of the face. METHODS From March 2014 to June 2015, 30 patients with atrophic acne scars on the cheeks were selected for this study. Patients were evaluated pre- and postoperatively by physical examination, photographs and ultrasound with a 22-MHz probe to measure subcutaneous tissue thickness. All patients were treated with infiltration of nanofat plus PRP. The production of PRP was achieved using the RegenLab THT tube® method. In 15 randomly chosen patients, a fractional CO2 laser resurfacing at 15 W was also performed right after the infiltration. An Italian version of the FACE-Q postoperative module was administered to analyze each patient's satisfaction and aesthetic perception of the result. RESULTS The average preoperative thickness of subcutaneous tissue of patients from group A was 0.532 cm, while the average preoperative thickness of subcutaneous tissue of patients from group B was 0.737 cm. The average postoperative thickness of subcutaneous tissue was 1.201 cm in group A and 1.367 cm in group B. The improvement of thickness of subcutaneous tissue was 0.668 cm in group A and 0.63 cm in group B. We applied a t test on unpaired data, comparing the difference in thickness obtained with the treatment in both group A and in group B, with a p value =0.7289 (not significant). All patients in both groups had a treatment benefit, confirmed with FACE-Q postoperative module, but without a significant difference between the two groups. CONCLUSIONS Subcutaneous infiltration with nanofat and PRP seems to be effective to improve atrophic scars, either alone or combined with fractional CO2 laser resurfacing. The FACE-Q module confirmed the impact of treatment of facial acne scars in social life and relationships. LEVEL OF EVIDENCE III 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 .
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Affiliation(s)
- S Tenna
- Unit of Plastic Reconstructive and Aesthetic Surgery and Dermatology, Campus Bio-Medico University of Rome, Via Alvaro Del Portillo 200, Rome, Italy
| | - A Cogliandro
- Unit of Plastic Reconstructive and Aesthetic Surgery and Dermatology, Campus Bio-Medico University of Rome, Via Alvaro Del Portillo 200, Rome, Italy
| | - M Barone
- Unit of Plastic Reconstructive and Aesthetic Surgery and Dermatology, Campus Bio-Medico University of Rome, Via Alvaro Del Portillo 200, Rome, Italy.
| | - Vincenzo Panasiti
- Unit of Plastic Reconstructive and Aesthetic Surgery and Dermatology, Campus Bio-Medico University of Rome, Via Alvaro Del Portillo 200, Rome, Italy
| | - M Tirindelli
- Department of Ematology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Carolina Nobile
- Department of Ematology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Paolo Persichetti
- Unit of Plastic Reconstructive and Aesthetic Surgery and Dermatology, Campus Bio-Medico University of Rome, Via Alvaro Del Portillo 200, Rome, Italy
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Ibrahim ZA, El-Ashmawy AA, Shora OA. Therapeutic effect of microneedling and autologous platelet-rich plasma in the treatment of atrophic scars: A randomized study. J Cosmet Dermatol 2017; 16:388-399. [DOI: 10.1111/jocd.12356] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2017] [Indexed: 01/26/2023]
Affiliation(s)
- Zeinab A. Ibrahim
- Department of Dermatology & Venereology; Faculty of Medicine; Tanta University; Tanta Egypt
| | - Amal A. El-Ashmawy
- Department of Dermatology & Venereology; Faculty of Medicine; Tanta University; Tanta Egypt
| | - Ola A. Shora
- Department of Clinical Pathology; Faculty of Medicine; Tanta University; Tanta Egypt
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18
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19
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Suh DH, Byun EJ, Lee SJ, Song KY, Kim HS. Clinical efficacy and safety evaluation of a novel fractional unipolar radiofrequency device on facial tightening: A preliminary report. J Cosmet Dermatol 2017; 16:199-204. [PMID: 28191716 DOI: 10.1111/jocd.12321] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Previous studies have shown that radiofrequency (RF) energy is safe and effective for improving skin laxity. Unlike monopolar and bipolar devices, little has been studied with the unipolar hand piece. OBJECTIVES We sought to evaluate the safety and efficacy of a novel fractional unipolar RF device on facial tightening. PATIENTS AND METHODS This was a retrospective, single-center study of 14 subjects with age-related facial laxity who underwent five sessions of fractional unipolar RF at an interval of 2 weeks, and then followed-up for 3 months. Standardized photos were taken at baseline and at 3-months follow-up, and were assessed by two independent dermatologists using a 4-point scale (0=no improvement, 1=mild improvement, 2=moderate improvement, 3=significant improvement). Punch biopsies (2 mm) were performed and a questionnaire was used to evaluate the patient's satisfaction and the incidence of adverse reactions. RESULTS Fourteen subjects with mild to moderate age-related facial laxity were included in the study. The mean age of the subjects was 49.7 years (range 32-80). 35.7% of the subjects showed significant improvement, 50% moderate improvement, and 14.3% slight improvement of facial laxity in their follow-up photos. About 85.7% of the patients replied that they were either greatly satisfied or satisfied with the results at 3-months follow-up. Skin biopsies revealed an increase in collagen in the dermis. None of the subjects experienced any serious adverse events during or after the procedure. CONCLUSION Our findings suggest that fractional Unipolar RF can be safely performed on the face and is effective in skin tightening. It has a great advantage over other forms of RF by being entirely painless.
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Affiliation(s)
| | - Eun Jung Byun
- Department of Dermatology, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Korea
| | | | - Kye Yong Song
- Department of Pathology, Chung-Ang University, Seoul, Korea
| | - Hei Sung Kim
- Department of Dermatology, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Korea
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20
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Wat H, Wu DC, Chan HHL. Fractional resurfacing in the Asian patient: Current state of the art. Lasers Surg Med 2016; 49:45-59. [PMID: 27605303 DOI: 10.1002/lsm.22579] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND OBJECTIVE Fractionated photothermolysis (FP) has revolutionized modern laser technology. By creating selective columns of microthermal damage, fractionated devices allows for greater treatment depths to be achieved without the prolonged downtime and risk of complications seen in traditional fully ablative laser resurfacing. Fractional resurfacing is a proven method to treat a variety of cutaneous conditions. In the Caucasian patient, a wide range of devices and treatment settings can be utilized safely and effectively. However, ethnic skin requires special consideration due to its unique pigmentary characteristics and clinical presentations. In this review article, we detail the current indications and strategies to optimize results and mitigate complications when utilizing fractional resurfacing for the Asian patient. METHODS A review of the MEDLINE English literature was conducted on fractionated laser devices studied in the Asian population. Articles included describe non-ablative devices including fractionated erbium glass, thulium fiber, diode, and radiofrequency devices; and ablative devices including fractionated carbon dioxide (CO2 ) laser, erbium yttrium aluminum garnet and yttrium scandium gallium garnet (YSGG) laser. These data were integrated with the expert opinion of the authors. CONCLUSION Taking into account the unique characteristics and cosmetic concerns of the Asian population, fractional resurfacing can be considered a safe and effective option for the treatment of atrophic and hypertrophic scarring, and photorejuvenation in ethnic skin types. Select cases of melasma may be treated with fractionated non-ablative devices, but utilized with caution. The predominant complication associated with fractional resurfacing for these conditions is post-inflammatory hyperpigmentation (PIH) and rebound worsening of melasma. A greater number of treatments at lower density settings and wider treatment intervals typically produce the lowest risks of PIH without compromising treatment efficacy. Lasers Surg. Med. 49:45-59, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Heidi Wat
- Division of Dermatology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada, T6G 2G3
| | - Douglas C Wu
- Goldman, Butterwick, Groff, Fabi, and Wu Cosmetic Laser Dermatology, San Diego, California, 92121
| | - Henry Hin Lee Chan
- Division of Dermatology, Department of Medicine, University of Hong Kong, Hong Kong, SAR, China.,Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Abstract
This article reviews minimally invasive radiofrequency options for skin tightening, focusing on describing their mechanism of action and clinical profile in terms of safety and efficacy and presenting peer-reviewed articles associated with the specific technologies. Treatments offered by minimally invasive radiofrequency devices (fractional, microneedling, temperature-controlled) are increasing in popularity due to the dramatic effects they can have without requiring skin excision, downtime, or even extreme financial burden from the patient's perspective. Clinical applications thus far have yielded impressive results in treating signs of the aging face and neck, either as stand-alone or as postoperative maintenance treatments.
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Affiliation(s)
- Neil Sadick
- Department of Dermatology, Weill Medical College of Cornell University, 911 Park Avenue, New York, NY 10075, USA.
| | - Kenneth O Rothaus
- Division of Plastic Surgery, Department of Surgery, New York Presbyterian - Weill Cornell Medical Center, New York, NY, USA
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