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Zhang Y, Yan M, Mi J, Zeng Y, Lin H, Yao M, Dong J, Wang S. Clinical efficacy and safety of a focused-radiofrequency device on middle and lower face rejuvenation: a retrospective clinical study. J COSMET LASER THER 2022; 23:176-183. [PMID: 35244511 DOI: 10.1080/14764172.2022.2048672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The aim of the present study was to evaluate the efficacy and safety of a unipolar focused-RF device used to rejuvenate the middle and lower face and to create an assessment system. This retrospective study comprised 52 patients with mild-to-moderate skin laxity and wrinkles who received 1-3 treatments 1 month apart and were followed up for 1-7 months. At baseline and post-treatment, three blinded observers measured facial contour and lines, analyzed VISIA scores, and assessed the results using Alexiades Comprehensive Grading Scale (ACGS) and Global Aesthetic Improvement Scale (GAIS). Significant improvements were observed (P < .05) in facial width (left 5.95%, right 5.66%), nasolabial folds (left 18.98%, right 20.56%), marionette lines (left 18.88%, right 25.80%), and cheek lines (left 3.35%, right 3.05%) and in the scores of wrinkles (15.37%), texture (13.67%), pores (6.48%), and red areas (6.57%) using VISIA. There was an obvious reduction in wrinkles, laxity, erythema/telangiectasia based on ACGS, and 75% improved and 5.8% much improved using GAIS. There was no severe side effect. We suggest that the unipolar focused-RF device is an effective and safe technique for middle and lower face rejuvenation and provides a series of comprehensive assessment methods based on standardized photos using VISIA.
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Affiliation(s)
- Yiqiu Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University of Medicine, Shanghai, China
| | - Min Yan
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University of Medicine, Shanghai, China
| | - Jing Mi
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University of Medicine, Shanghai, China
| | - Ying Zeng
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University of Medicine, Shanghai, China
| | - Huyan Lin
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University of Medicine, Shanghai, China
| | - Min Yao
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University of Medicine, Shanghai, China
| | - Jiying Dong
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University of Medicine, Shanghai, China
| | - Shen Wang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University of Medicine, Shanghai, China
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Dunlop N, Abramowicz S, Fisher E. Pharmacology of Aesthetic Medicines. Oral Maxillofac Surg Clin North Am 2021; 34:189-200. [PMID: 34711465 DOI: 10.1016/j.coms.2021.08.017] [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] [Indexed: 11/18/2022]
Abstract
The realm of aesthetic medicine is broad, and there are countless medications and topical agents used in the practice of aesthetic medicine. The most commonly used injectable medicines include botulinum toxin for mimetic lines and hyaluronic acid fillers for deeper facial rhytids and volume rejuvenation. Topical aesthetic medicines are useful adjuncts for facial rejuvenation and commonly include tretinoin, hydroquinone, growth factors, and vitamin C, as well as a wide range of chemical peels.
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Affiliation(s)
- Natalie Dunlop
- Oral and Maxillofacial Surgery, Division of Craniofacial and Surgical Care, University of North Carolina at Chapel Hill, 149 Brauer Hall, CB #7450, Chapel Hill, NC 27599, USA
| | - Shelly Abramowicz
- Division of Oral and Maxillofacial Surgery, Section of Oral and Maxillofacial Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Emory University, 1365 Clifton Road, Northeast, Building B, Suite 2300, Atlanta, GA 30322, USA
| | - Elda Fisher
- Division of Craniofacial and Surgical Care, Residency Program in Oral and Maxillofacial Surgery, University of North Carolina at Chapel Hill, 149 Brauer Hall, CB #7450, Chapel Hill, NC 27599, USA.
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Chen Y, Huang Y, Deng X. A Review of External Cervical Resorption. J Endod 2021; 47:883-894. [PMID: 33745945 DOI: 10.1016/j.joen.2021.03.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 03/08/2021] [Accepted: 03/08/2021] [Indexed: 12/21/2022]
Abstract
External cervical resorption (ECR) is a relatively uncommon yet aggressive form of dental hard tissue destruction. It is initiated at the cervical aspect of the root surface and extends apicocoronally and circumferentially inside the dentin. Despite the large number of case reports and clinical studies that have investigated ECR, its etiology remains unclear. Recent advancements in clinical assessment measures, such as the use of cone-beam computed tomographic imaging, have provided additional insights into the nature of this lesion. This has facilitated the continued development and improvement of treatment methods for this condition. In this article, we provide an overview of the latest research pertaining to the etiology, histopathology, predisposing factors, diagnosis, classification, and treatment of ECR. Furthermore, we provide a summary of the different classification schemes for ECR and highlight the relevant therapeutic principles.
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Affiliation(s)
- Yiming Chen
- Department of Geriatric Dentistry, National Medical Products Administration Key Laboratory for Dental Materials, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Laboratory of Biomedical Materials, Peking University School and Hospital of Stomatology, Beijing, China
| | - Ying Huang
- Department of Geriatric Dentistry, National Medical Products Administration Key Laboratory for Dental Materials, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Laboratory of Biomedical Materials, Peking University School and Hospital of Stomatology, Beijing, China.
| | - Xuliang Deng
- Department of Geriatric Dentistry, National Medical Products Administration Key Laboratory for Dental Materials, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Laboratory of Biomedical Materials, Peking University School and Hospital of Stomatology, Beijing, China.
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Robati RM, Hamedani B, Namazi N, Niknejad N, Gheisari M. Efficacy of microneedling versus fractional Er:YAG laser in facial rejuvenation. J Cosmet Dermatol 2020; 19:1333-1340. [PMID: 32359018 DOI: 10.1111/jocd.13440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/31/2020] [Accepted: 04/08/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Microneedling and fractional lasers have been used in facial rejuvenation with acceptable results and low adverse effects. AIMS To compare the efficacy of microneedling with fractional Er:YAG in facial skin rejuvenation. PATIENTS/METHODS This study was planned as a split-face clinical trial. Volunteers were randomly allocated to receive three monthly treatments on each side of the face, one with fractional Er:YAG laser and one with microneedling. The assessments included investigating clinical outcomes by two blinded dermatologists accompanied by measuring skin biophysical characteristics including cutaneous resonance running time (CRRT) and transepidermal water loss (TEWL). Moreover, possible adverse effects, downtime, and patients' satisfaction were recorded at baseline, 1 month after each treatment, and 3 months after the last treatment session. The protocol was approved by the Iranian Registry of Clinical Trials (IRCT20160820029436N3). RESULTS Of the 32 selected volunteers, 24 subjects completed the study. The clinical assessment showed a significant improvement of the face appearance along with a significant reduction in dyschromia, and periorbital wrinkling (P-value < .05), with both procedures without any considerable difference between two methods. Moreover, the patients showed substantial satisfaction with both modalities with no statistically significant difference. Mean TEWL and CRRT values also decreased significantly in both groups with no considerable difference. The downtime was significantly shorter in the microneedling-treated side. There were no long-lasting or severe adverse effects after treatment with both methods. CONCLUSION Microneedling and fractional Er:YAG laser have comparable efficacy in facial rejuvenation, but little downtime of the former makes it preferable for many patients.
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Affiliation(s)
- Reza M Robati
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Dermatology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behnaz Hamedani
- Department of Dermatology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nastaran Namazi
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Dermatology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nasim Niknejad
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Gheisari
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Dermatology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Borelli C, Ursin F, Steger F. The rise of Chemical Peeling in 19th-century European Dermatology: emergence of agents, formulations and treatments. J Eur Acad Dermatol Venereol 2020; 34:1890-1899. [PMID: 32080904 DOI: 10.1111/jdv.16307] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 01/31/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Considering the increasing number of chemical peeling applications, also the interest in the history of chemical peelings and agents, has grown in dermatology. Research ascribes the first use of phenol as a chemical peeling agent to William Tilbury Fox (1836-1879) in 1871. Furthermore, Ferdinand von Hebra (1847-1902) is said to describe the properties of various peeling agents in 1874, and Paul Gerson Unna (1850-1929) adds resorcinol and trichloroacetic acid in 1882. OBJECTIVE To identify the first mentions of chemical peeling applications and agents in 19th-century dermatology. METHODS Nineteenth-century dermatologists were identified by an examination of literature of the last 30 years on the history of chemical peeling. Systematic examination of the medical textbooks of Hebra, Fox and Unna was conducted. It was proved whether the mentioned agents were used for chemical peeling applications. RESULTS The skin peeling property of phenol was already discovered by its first describer, the chemist Friedlieb Ferdinand Runge (1795-1867) in 1834. The Viennese dermatologist Hebra described phenol as a chemical peeling agent in 1860. Hebra and his associate Moriz Kaposi (1837-1902) stated that 'Lotio carbolica' was already used in London. Fox used phenol mostly as a disinfectant and not for chemical peelings since 1869. Unna described the chemical peeling property of salicylic acid in 1882 and gave the most comprehensive account of chemical peels of the 19th century in 1899. Unna also introduced the Gutta-percha plaster with salicylic acid and phenol. Around 1900, Unna was famous for his peeling paste with resorcinol in Germany. CONCLUSIONS A new chronology of the introduction of chemical peeling in dermatology can be drawn from the results. The German-speaking dermatology pioneered the treatment of skin diseases with chemical peelings as well as for aesthetical purposes 21 years earlier than hitherto known.
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Affiliation(s)
- C Borelli
- Unit of Aesthetic Dermatology and Laser, Department of Dermatology, University of Tuebingen, Tuebingen, Germany
| | - F Ursin
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, Ulm, Germany
| | - F Steger
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, Ulm, Germany
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Jessner's Solution with Trichloroacetic Acid Chemical Peel: Optimizing Outcomes and Safety. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2250. [PMID: 31333972 PMCID: PMC6571353 DOI: 10.1097/gox.0000000000002250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 03/15/2019] [Indexed: 11/26/2022]
Abstract
Trichloroacetic acid (TCA) is a versatile agent, efficacious in treating a spectrum of facial rhytids and dyschrommias at varying concentrations. TCA is commonly used in a 30%-35% concentration to achieve a medium-depth peel into the upper reticular dermis. The addition of Jessner's solution before the TCA peel application leads to partial removal of epidermis, allowing for deeper penetration of the TCA. This combination is beneficial, as lower concentrations of TCA can be used for the same depth of peel, minimizing complications such as scarring.
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Dadkhahfar S, Fadakar K, Robati RM. Efficacy and safety of long pulse Nd:YAG laser versus fractional erbium:YAG laser in the treatment of facial skin wrinkles. Lasers Med Sci 2018; 34:457-464. [PMID: 30117052 DOI: 10.1007/s10103-018-2614-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 08/07/2018] [Indexed: 12/28/2022]
Abstract
Fractional lasers such erbium:YAG (Er:YAG) are among popular options for facial rejuvenation. Lasers with infrared wavelength ranges such as long pulse Nd:YAG have been used in nonablative rejuvenation of skin with variable outcomes. In this study, we plan to compare safety and efficacy of fractional Er:YAG and long pulse Nd:YAG for facial rejuvenation applying objective and subjective measurements. Twenty-five patients with Glogau photo aging scale of II to IV were recruited in this randomized face-split double-blind controlled trial. Individuals received three monthly treatments on two sides of the face; one side was treated by fractional Er:YAG laser and the other side by long pulse Nd:YAG laser. Outcomes were evaluated by two blinded dermatologists, patient satisfaction reports and objective measurements of cutaneous resonance running time (CRRT). Both modalities significantly improved periorbital wrinkling, nasolabial folds, dyschromia and skin laxity, and sagging of jowls (p value < 0.05), with no noticeable difference between two lasers. Mean CRRT values decreased significantly after treatment with both lasers. The downtime was significantly lower for the Nd:YAG-treated side. Fractional Er:YAG laser and long pulse Nd:YAG has comparable effects in facial rejuvenation but little to no downtime of the latter makes it popular for many patients. ClinicalTrials.gov Identifier: IRCT2015120320468N3.
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Affiliation(s)
- Sahar Dadkhahfar
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kaveh Fadakar
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza M Robati
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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El-Domyati M, Abdel-Wahab H, Hossam A. Combining microneedling with other minimally invasive procedures for facial rejuvenation: a split-face comparative study. Int J Dermatol 2018; 57:1324-1334. [PMID: 30105816 DOI: 10.1111/ijd.14172] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 07/16/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND The introduction of minimally invasive procedures has increased acceptance due to their efficacy, safety, and relatively long-lasting and natural results. At least two different and unrelated modalities are employed to consider a combination treatment. OBJECTIVES This study aims to evaluate and compare the use and effectiveness of combined microneedling with platelet-rich plasma (PRP) or trichloroacetic acid (TCA) peeling for facial rejuvenation. PATIENTS/METHODS Twenty-four volunteers with photoaging were randomly divided into three equal groups according to performed procedure on each side of the face (microneedling by dermaroller alone or combined with PRP or TCA 15% peeling). They had received one session every 2 weeks for six sessions of treatment. Photography and punch biopsies were performed before and after 3 months of treatment for clinical, histometrical, and histological evaluation. RESULTS Combined treatment of dermaroller and PRP or dermaroller and TCA showed significant improvement when compared with dermaroller alone. Significant increase in epidermal thickness was apparent in studied groups, especially after combined treatment with TCA. Organized collagen bundles with newly formed collagen formation and markedly decreased abnormal elastic fibers were noticed in the three studied groups. However, improvement of dermal structures was better demonstrated after combined treatment of Dermaroller and PRP than Dermaroller and TCA 15%. CONCLUSIONS Most volunteers showed significant clinical improvement after treatment supported by the histometrical and histochemical evaluation; however, the combined use of dermaroller with PRP is apparently more beneficial for facial rejuvenation.
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Affiliation(s)
- Moetaz El-Domyati
- Department of Dermatology, Faculty of Medicine, Minia University, Al-Minya, Egypt
| | - Hossam Abdel-Wahab
- Department of Dermatology, Faculty of Medicine, Minia University, Al-Minya, Egypt
| | - Aliaa Hossam
- Department of Dermatology, Faculty of Medicine, Minia University, Al-Minya, Egypt
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Shemesh A, Ben Itzhak J, Solomonov M. Minimally Invasive Treatment of Class 4 Invasive Cervical Resorption with Internal Approach: A Case Series. J Endod 2017; 43:1901-1908. [DOI: 10.1016/j.joen.2017.04.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 04/21/2017] [Accepted: 04/24/2017] [Indexed: 12/21/2022]
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10
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Ahn SK, Jun M, Bak H, Park BD, Hong SP, Lee SH, Kim SJ, Kim HJ, Song DH, Min PK, Goo JW, Kim TH, Oh CK, Chun SH, Lee S, Sung YO, Sohn IB, Ahn HJ, Park K. Baumann Skin Type in the Korean Female Population. Ann Dermatol 2017; 29:586-596. [PMID: 28966515 PMCID: PMC5597652 DOI: 10.5021/ad.2017.29.5.586] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 12/30/2016] [Accepted: 02/08/2017] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND To meet the need for a subspecialized skin type system, the Baumann skin type (BST) system was proposed. OBJECTIVE To evaluate the distribution of BST types and influencing factors among Korean women. METHODS BST questionnaires were administered to 1,000 Korean women. The possible responses were as follows: oily (O) or dry (D), sensitive (S) or resistant (R), pigmented (P) or non-pigmented (N), and wrinkled (W) or tight (T). The correlations of the BST with the subjects' age, location, ultraviolet (UV) ray exposure, drinking and smoking habits, and blood type were assessed. RESULTS The OSNT, DSNT, DRNT, and OSNW skin types were the most common skin types (55.3%). The O, S, P, and W types accounted for 46.6%, 68.8%, 23.2%, and 31.9%, respectively. The proportion of the O and S type was the highest in Gyeongsangbuk-do (55.0%) and Seoul (77.2%). The proportion of the P and W type was the highest in Gyeongsangbuk-do (33.0%) and Chungcheong-do (39.0%). The O type decreased in the higher age group, whereas the P and W type showed a reversed tendency. In smokers, the proportion of W type was significantly higher than in the non-smokers (66.3% vs. 24.1%, p<0.05). CONCLUSION The 4 most common BST types were OSNT, DSNT, DRNT, and OSNW. In the comparison across the 4 BST parameters according to the age, region, smoking and drinking habits, occupation, blood type, and UV exposure, significant differences were observed. Individualized and customized skin care is required according to the personal skin type.
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Affiliation(s)
- Sung Ku Ahn
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Myungsoo Jun
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Hana Bak
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | | | - Seung Phil Hong
- Department of Dermatology, Dankook University Medical College, Cheonan, Korea
| | - Sang-Hoon Lee
- Department of Dermatology, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Seong-Jin Kim
- Department of Dermatology, Chonnam National University Medical School, Gwangju, Korea
| | - Hyung Joo Kim
- Department of Dermatology, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Hoon Song
- Department of Dermatology, Yonsei University College of Medicine, Seoul, Korea
| | - Pok Kee Min
- Department of Dermatology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Ja Woong Goo
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Tae-Hyun Kim
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Chang-Keun Oh
- Department of Dermatology, Pusan National University School of Medicine, Busan, Korea
| | - Seung Hyun Chun
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Sewon Lee
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Yeol Oh Sung
- Department of Dermatology, Kyungpook National University School of Medicine, Daegu, Korea
| | - In-Bum Sohn
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Hyung Jin Ahn
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Kun Park
- Department of Dermatology, Wonkwang University School of Medicine, Iksan, Korea
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Costa IMC, Damasceno PS, Costa MC, Gomes KGP. Review in peeling complications. J Cosmet Dermatol 2017; 16:319-326. [DOI: 10.1111/jocd.12329] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2017] [Indexed: 11/28/2022]
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12
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Affiliation(s)
- Harold J. Brody
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia, USA
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14
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El-Domyati M, Attia SK, El-Sawy AE, Moftah NH, Nasif GA, Medhat W, Marwan B. The use of Botulinum toxin-a injection for facial wrinkles: a histological and immunohistochemical evaluation. J Cosmet Dermatol 2015; 14:140-4. [PMID: 25916463 DOI: 10.1111/jocd.12144] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2014] [Indexed: 01/04/2023]
Abstract
Botulinum toxin (BTX)-A has been used for years in the reduction of facial wrinkles; however, histological and immunohistochemical changes after its use were not previously investigated. To evaluate histological and immunohistochemical changes after BTX-A injection for facial wrinkles, sixteen volunteers, with wrinkles on the upper third of the face, were subjected to single injection of BTX-A. Skin biopsy specimens were obtained from peri-orbital wrinkle site (crow's feet area) before and after 3 months of BTX-A injection. Using histological and immunohistochemical evaluation coupled with computerized morphometric analysis, measurement of epidermal thickness, wrinkle depth and width as well as quantitative evaluation of collagen types I and III and elastin was performed for skin biopsies. After BTX-A injections, there were significant increase in wrinkle width and granular layer thickness (P < 0.001), while the other histometrical measures as well as the immunohistochemical expression of collagen types I and III and elastin showed no significant difference (P > 0.05). However, collagen fibers showed better organization and orientation after BTX-A injection. The histological changes observed after BTX-A injection for facial wrinkles may help in better understanding of its mechanism of action.
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Affiliation(s)
- Moetaz El-Domyati
- Department of Dermatology, STD's and Andrology, Al-Minya University, Al-Minya, Egypt
| | - Sameh K Attia
- Department of Dermatology, STD's and Andrology, Al-Minya University, Al-Minya, Egypt
| | - Ashraf E El-Sawy
- Department of Dermatology, STD's and Andrology, Al-Minya University, Al-Minya, Egypt
| | - Noha H Moftah
- Department of Dermatology, STD's and Andrology, Al-Minya University, Al-Minya, Egypt
| | - Ghada A Nasif
- Department of Dermatology, STD's and Andrology, Al-Minya University, Al-Minya, Egypt
| | - Walid Medhat
- Department of Dermatology, STD's and Andrology, Al-Minya University, Al-Minya, Egypt
| | - Belkais Marwan
- Department of Dermatology, STD's and Andrology, Al-Minya University, Al-Minya, Egypt
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15
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El-Domyati M, Medhat W, Abdel-Wahab HM, Moftah NH, Nasif GA, Hosam W. Forehead wrinkles: a histological and immunohistochemical evaluation. J Cosmet Dermatol 2014; 13:188-94. [DOI: 10.1111/jocd.12097] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2013] [Indexed: 12/17/2022]
Affiliation(s)
- Moetaz El-Domyati
- Department of Dermatology; STD's and Andrology; Al-Minya University; Al-Minya Egypt
| | - Walid Medhat
- Department of Dermatology; STD's and Andrology; Al-Minya University; Al-Minya Egypt
| | - Hossam M Abdel-Wahab
- Department of Dermatology; STD's and Andrology; Al-Minya University; Al-Minya Egypt
| | - Noha H Moftah
- Department of Dermatology; STD's and Andrology; Al-Minya University; Al-Minya Egypt
| | - Ghada A Nasif
- Department of Dermatology; STD's and Andrology; Al-Minya University; Al-Minya Egypt
| | - Wael Hosam
- Department of Dermatology; STD's and Andrology; Al-Minya University; Al-Minya Egypt
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Nilforoushzadeh MA, Jaffary F, Derakhshan R, Haftbaradaran E. Comparison Between Intralesional Meglumine Antimoniate and Combination of Trichloroacetic Acid 50% and Intralesional Meglumine Antimoniate in the Treatment of Acute Cutaneous Leishmaniasis: A Randomized Clinical Trial. ACTA ACUST UNITED AC 2014. [DOI: 10.17795/jssc16633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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17
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Brauer JA, Patel U, Hale EK. Laser Skin Resurfacing, Chemical Peels, and Other Cutaneous Treatments of the Brow and Upper Lid. Clin Plast Surg 2013. [DOI: 10.1016/j.cps.2012.08.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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18
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Han SH, Kim HJ, Kim SY, Kim YC, Choi GS, Shin JH. Skin rejuvenating effects of chemical peeling: a study in photoaged hairless mice. Int J Dermatol 2011; 50:1075-82. [DOI: 10.1111/j.1365-4632.2010.04712.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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el-Domyati M, el-Ammawi TS, Medhat W, Moawad O, Brennan D, Mahoney MG, Uitto J. Radiofrequency facial rejuvenation: evidence-based effect. J Am Acad Dermatol 2011; 64:524-35. [PMID: 21315951 DOI: 10.1016/j.jaad.2010.06.045] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Revised: 05/12/2010] [Accepted: 06/08/2010] [Indexed: 11/30/2022]
Abstract
BACKGROUND Multiple therapies involving ablative and nonablative techniques have been developed for rejuvenation of photodamaged skin. Monopolar radiofrequency (RF) is emerging as a gentler, nonablative skin-tightening device that delivers uniform heat to the dermis at a controlled depth. OBJECTIVE We evaluated the clinical effects and objectively quantified the histologic changes of the nonablative RF device in the treatment of photoaging. METHODS Six individuals of Fitzpatrick skin type III to IV and Glogau class I to II wrinkles were subjected to 3 months of treatment (6 sessions at 2-week intervals). Standard photographs and skin biopsy specimens were obtained at baseline, and at 3 and 6 months after the start of treatment. We performed quantitative evaluation of total elastin, collagen types I and III, and newly synthesized collagen using computerized histometric and immunohistochemical techniques. Blinded photographs were independently scored for wrinkle improvement. RESULTS RF produced noticeable clinical results, with high satisfaction and corresponding facial skin improvement. Compared with the baseline, there was a statistically significant increase in the mean of collagen types I and III, and newly synthesized collagen, while the mean of total elastin was significantly decreased, at the end of treatment and 3 months posttreatment. LIMITATIONS A limitation of this study is the small number of patients, yet the results show a significant improvement. CONCLUSIONS Although the results may not be as impressive as those obtained by ablative treatments, RF is a promising treatment option for photoaging with fewer side effects and downtime.
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Ali NM, Fariba J, Elaheh H, Ali N. The efficacy of 5% trichloroacetic acid cream in the treatment of cutaneous leishmaniasis lesions. J DERMATOL TREAT 2010; 23:136-9. [PMID: 21034291 DOI: 10.3109/09546634.2010.500322] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Cutaneous Leishmaniasis (CL) is an endemic disease in Iran. Based on the results of our previous study, this study was designed as a pilot trial to evaluate the effect of 5% trichloroacetic acid (TCA) cream in the treatment of leishmaniasis lesions. METHODS 16 patients with positive smear for leishmaniasis were randomly selected for treatment with 5% TCA cream, twice a day for 8 weeks or up to complete healing of the lesions. Scar size was measured 6 months after complete epithelization of the lesions. RESULTS Mean area of the lesions was 38.81+ 81.9 mm(2) before treatment and 3.6 + 9.1 mm(2) at 6 month follow up period. Complete cure was achieved in 1 patient (6.3%) at week 2, 13 patients (86.7%) at week 7, and in all patients at week 8. There was no serious adverse reaction in none of the patients. CONCLUSION Decreasing the scar size and the low cost are two promising aspects in introducing 5% TCA cream as a potential alternative for intralesional glucantime in the treatment of CL. Considering the self limiting nature of the disease, this effect should be assessed further through a double blind randomized controlled trial.
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Affiliation(s)
- Nilforoushzadeh Mohammad Ali
- Research Center & Training of Leprosy and Skin Diseases, Department of Dermatology, Tehran University of Medical Sciences, Tehran, Iran
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Combination Jessner’s Solution and Trichloroacetic Acid Chemical Peel: Technique and Outcomes. Plast Reconstr Surg 2009; 124:955-964. [DOI: 10.1097/prs.0b013e3181addcf5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Levy JL, Trelles M, Servant JJ, Agopian L. Non‐ablative skin remodeling: an 8‐month clinical and 3D in vivo profilometric study with an 810 nm diode laser. J COSMET LASER THER 2009; 6:11-5. [PMID: 15370407 DOI: 10.1080/14764170410030750] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Non-ablative remodeling has recently been proposed as a new anti-aging treatment with no downtime. OBJECTIVE This study aimed to evaluate objectively, with a three-dimensional (3D) in vivo profilometric study, the efficacy and safety of non-ablative skin remodeling with an 810 nm diode laser on periorbital wrinkles with an 8-month follow-up. METHODS Ten female patients (mean age: 55 years) were treated three times at 1-month intervals and then evaluated 5 months after the last treatment. Patients were evaluated using clinical data, standardized photographs and 3D in vivo profilometry in order to quantify the degree of improvement. This objective method evaluates the general degree of roughness (anisotropy) and the depth of the wrinkles. RESULTS An observer independent from the study showed slight improvement in the quality of the skin and visual aspect of the wrinkles at 3 months. Eight months later this was confirmed to a lesser degree by clinical and 3D profilometry. No immediate or late adverse effects were noted at any stage of the procedure. CONCLUSION This study demonstrated that irradiation with a 810 nm laser emitting in a pulsed mode and connected to a cooling system reduced anisotropy of the skin and improved the clinical aspects of the wrinkles. Results appear quickly at 3 months and are stable at 8 months.
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Abstract
Upper eye lid blepharoplasty is one of the most commonly practiced surgical treatments in aesthetic medicine. Careful patient selection, thorough preoperative planing, and exact surgical treatment lead to optimal results. CO(2) laser assisted surgery provides a dry and clear surgical field, allowing precise tissue control. On the other hand CO(2) laser subsurfacing leads due to thermal effect to a shrinking of the lax orbital septum, and reduces the need for orbital fat resection or even allows one to avoid fat resection. Periorbital combination treatments in most cases allow smaller or less invasive procedures, reducing risk factors. Additionally they adapt to individual anatomic structures, different needs in outcome and show synergistic effects. Aesthetic dermatology incorporates many conservative and invasive approaches, so that upper eyelid blepharoplasty in dermatologic surgery is widely accepted and well-established.
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Affiliation(s)
- W Prager
- Dermatologikum Hamburg, Stephansplatz 5, 20354 Hamburg.
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Abstract
Superficial chemical peeling (SCP) involves the application of a peeling agent to the skin, resulting in destruction of part or all of the epidermis. SCP is mainly recommended for facial rejuvenation, photoaging and superficial rhytides, pigmentary dyschromias and acne. It can be used on all Fitzpatrick skin types, no sedation is needed, and the desquamation is usually well accepted. Overpeel and complications are very rare. The most commonly used SCP agents are glycolic acid 20-70%, trichloroacetic acid 10-35%, Jessner's solution, salicylic acid, pyruvic acid, resorcinol 30-50% preparations, and solid carbon dioxide. The careful selection of patients is critical for the outcome of a SCP and contraindications must be seriously considered. The peel procedure is generally common for all SCP agents but a good knowledge of the specific characters of each agent is of great importance in order to decide which to use for each individual patient.
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Affiliation(s)
- N Zakopoulou
- 2nd Department of Dermatology, A. Sygros Hospital, Athens, Greece.
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. MN, . FJ, . MR. Comparative Effect of Topical Trichloroacetic Acid and Intralesional Meglumine Antimoniate in the Treatment of Acute Cutaneous Leishmaniasis. INT J PHARMACOL 2006. [DOI: 10.3923/ijp.2006.633.636] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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El-Domyati MBM, Attia SK, Saleh FY, Ahmad HM, Uitto JJ. Trichloroacetic acid peeling versus dermabrasion: a histometric, immunohistochemical, and ultrastructural comparison. Dermatol Surg 2004; 30:179-88. [PMID: 14756647 DOI: 10.1111/j.1524-4725.2004.30061.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Trichloroacetic acid (TCA) chemical peel and dermabrasion are beneficial methods for treatment of photoaged skin. OBJECTIVE In this study, we evaluated the changes induced by these therapies on various structures of facial skin of nine dark-skinned patients (Fitzpatrick types IV-V; TCA, five patients; dermabrasion, four patients) demonstrating different degrees of photodamage. METHODS Routine histopathology coupled with histometric computer-assisted image analysis was used to assess epidermal changes. Alcian blue stain was used to evaluate changes in glycosaminoglycans. Immunoperoxidase techniques with antibodies against types I and III collagen and elastin were used to evaluate quantitatively changes in collagen and elastic fibers, and their ultrastructure was examined by transmission electron microscopy. RESULTS Similar histologic, immunohistochemical, as well as ultrastructural changes were observed in the two groups, including epidermal and dermal rejuvenation with new collagen deposition and normalization of the elastic tissue. However, these changes were more prominent in patients treated with dermabrasion than those treated with TCA. CONCLUSION The results of this study suggest that beneficial effects of such modalities on facial skin were accomplished primarily by increasing the amounts of collagen I and collagen III and improving the morphologic appearance of collagen and elastic fibers.
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Affiliation(s)
- Moetaz B M El-Domyati
- Department of Dermatology, Faculty of Medicine, Al-Minya University, Al-Minya, Egypt
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Oppel T, Korting HC. Actinic Keratosis: The Key Event in the Evolution from Photoaged Skin to Squamous Cell Carcinoma. Skin Pharmacol Physiol 2004; 17:67-76. [PMID: 14976383 DOI: 10.1159/000076016] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2003] [Accepted: 08/14/2003] [Indexed: 11/19/2022]
Abstract
Skin aging is the result of intrinsic and extrinsic factors. Extrinsic aging, also called photoaging, is mainly caused by ultraviolet radiation from the sun and leads to a state which has been termed dermatoheliosis. The aim of this article is to provide an overview of photoaged skin addressing actinic keratoses (AKs) in particular. This review will describe the clinical features of photoaged skin and briefly summarize the underlying histological, photobiochemical and molecular mechanisms responsible for photoaging. The concept of the disease continuum from AK to squamous cell carcinoma will also be presented. A special focus will be on established and new therapeutic approaches to undo photoinduced skin damage.
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Affiliation(s)
- T Oppel
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany.
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Trichloroacetic Acid Peeling Versus Dermabrasion. Dermatol Surg 2004. [DOI: 10.1097/00042728-200402000-00014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Velasco MVR, Okubo FR, Ribeiro ME, Steiner D, Bedin V. Rejuvenescimento da pele por peeling químico: enfoque no peeling de fenol. An Bras Dermatol 2004. [DOI: 10.1590/s0365-05962004000100011] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O envelhecimento da pele é um processo que preocupa muitos indivíduos, que buscam a ajuda especializada do médico para minimizar seus sinais. Um dos recursos para melhorar a qualidade da pele são os peelings químicos, utilizando várias substâncias ativas, como ácido glicólico, retinóico, tricloroacético e o fenol, entre outros, que proporcionam a esfoliação cutânea e posterior renovação celular. Dependendo da concentração e do valor de pH em que são empregados nas formulações, desencadeiam o peeling superficial, médio e profundo. O fenol tem sido utilizado como peeling profundo tanto isoladamente como em associação com outros componentes da fórmula que atuam como promotores de penetração e permeação. A utilização desses produtos resulta no processo de renovação celular intenso, normalizando a pigmentação da pele, atenuando marcas e minimizando as rugas. Devido a sua toxicidade e contra-indicações, o fenol deve ser aplicado cuidadosamente segundo a técnica recomendada, e o paciente deve ser monitorado para se obter a máxima eficácia do peeling e também minimizar os efeitos sistêmicos.
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Abstract
One of the most distressing side effects of acne vulgaris is the development of acne scars. In this article, the authors discuss the history of and current modalities in use for the treatment of acne scars. The discussion includes resurfacing, dermabrasion, laser surgery, peels, punch excisions, and the use of fillers.
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Affiliation(s)
- R J Hirsch
- Department of Dermatology, State University of New York Health Science Center at Brooklyn 11203, USA
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Affiliation(s)
- M Ramos-e-Silva
- Sector of Dermatology, HUCFF-UFRJ and School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
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Bitter PH. Noninvasive rejuvenation of photodamaged skin using serial, full-face intense pulsed light treatments. Dermatol Surg 2000; 26:835-42; discussion 843. [PMID: 10971556 DOI: 10.1046/j.1524-4725.2000.00085.x] [Citation(s) in RCA: 230] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Photodamaged skin is characterized not only by rhytides, but also by epidermal and dermal atrophy, rough skin texture, irregular pigmentation, telangiectasias, laxity, and enlarged pores. There is growing interest in the development of noninvasive methods to treat photodamaged skin. Skin photorejuvenation is the visible improvement of photodamaged skin using a laser or other light source. A noncoherent, broadband, pulsed light source is effective in the treatment of vascular and pigmented lesions of the skin. This study evaluates the role of intense pulsed light in the rejuvenation of photo aged skin. OBJECTIVE The purpose of this study was to evaluate and quantify the degree of visible improvement in photodamaged skin following a series of full-face, intense pulsed light treatments. METHODS Forty-nine subjects with varying degrees of photo-damage were treated with a series of four or more full-face treatments at 3-week intervals using a nonablative, nonlaser intense pulsed visible light source. Fluences varied from 30 to 50 J/cm2. Subject evaluation and skin biopsies were used to assess treatment results. RESULTS All aspects of photodamage including wrinkling, skin coarseness, irregular pigmentation, pore size, and telangiectasias showed visible improvement in more than 90% of subjects with minimal downtime and no scarring. Eighty-eight percent of subjects were satisfied with the overall results of their treatments. CONCLUSION Treatment of photodamaged facial skin using a series of full-face treatments with intense pulsed light is a new and effective noninvasive method of skin rejuvenation with minimal risk and no patient downtime.
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Vossen M, Hage JJ, Karim RB. Formulation of trichloroacetic acid peeling solution: a bibliometric analysis. Plast Reconstr Surg 2000; 105:1088-94; discussion 1095-6. [PMID: 10724271 DOI: 10.1097/00006534-200003000-00038] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Since the beginning of this century, trichloroacetic acid solutions of various concentrations have been used for chemical exfoliation. These solutions have been prepared by using four different formulas. To prepare a 50% solution, for instance, water may be added to 50 g of trichloroacetic acid crystals until 100 ml of solution is obtained (weight-to-volume solution). Alternatively, 50 g of water may be added to 50 g of trichloroacetic acid crystals (weight-to-weight solution), or 50 g of trichloroacetic acid crystals may be solved in 100 ml of water (weight-plus-volume solution). Finally, a saturated trichloroacetic acid solution (or "100% solution") may be diluted by an equal volume of water (dilution). Depending on the method used, these so-called 50% solutions contain 40 to 71 weight-to-volume percentages of trichloroacetic acid. From a review of 120 publications on trichloroacetic acid peeling that have appeared since 1926, it was concluded that the authors of 87 of these publications (73 percent) did not report their formula for the trichloroacetic acid solution. Any one of the four methods was reported to have been used by the 33 authors who did report their formula. Eight of 10 internationally reputed pharmacopeias were found not to include the formula of a trichloroacetic acid solution. Proper evaluation of results and prevention of complications of trichloroacetic acid chemexfoliation is only feasible if both the concentration and the formula of trichloroacetic acid solution are reported by the author. Practitioners who use a trichloroacetic acid solution need to establish that the concentration of the solution they apply corresponds with that of the solution reported in the literature.
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Affiliation(s)
- M Vossen
- Department of Plastic and Reconstructive Surgery at the Academisch Ziekenhuis Vrije Universiteit, Amsterdam, The Netherlands
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35
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Gladstone HB. The art but not the science... Dermatol Surg 2000; 26:173. [PMID: 10691960 DOI: 10.1046/j.1524-4725.2000.02622.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Benedetto AV. Carbon dioxide laser resurfacing of the aged face. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 1999; 455:483-90. [PMID: 10599386 DOI: 10.1007/978-1-4615-4857-7_71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Affiliation(s)
- A V Benedetto
- Department of Dermatology, Allegheny University of the Health Sciences, Philadelphia, Pennsylvania, USA
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Burns RL, Carruthers A, Langtry JA, Trotter MJ. Electrosurgical skin resurfacing: a new bipolar instrument. Dermatol Surg 1999; 25:582-6. [PMID: 10469119 DOI: 10.1046/j.1524-4725.1999.98239.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Numerous modalities may be used for skin resurfacing, including chemical peels, dermabrasion, and lasers. Each of these methods is associated with significant disadvantages. OBJECTIVE The purpose of these initial studies was to determine the efficacy and safety of a new electrosurgical resurfacing system. Depth of cutaneous injury was also evaluated. METHODS Postoperative scar resurfacing was performed on six patients in the initial feasibility study. Patients were evaluated with questionnaires, physician observations, and photographs. The histologic investigation evaluated depth of injury after resurfacing at various power settings and number of passes. RESULTS Appearance of postoperative scars in all 6 patients was improved by electrosurgical resurfacing. The overall injury, residual thermal damage plus ablation, for all power levels and passes was 114.1 micrometer (mean) with a standard deviation of 60.7 micrometer. CONCLUSION Electrosurgical resurfacing may become an effective and safe alternative to current resurfacing modalities.
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Affiliation(s)
- R L Burns
- Division of Dermatology, Department of Pathology, University of British Columbia, Vancouver, Canada
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38
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Abstract
BACKGROUND The periorbital region serves as a barometer of chronologic and environmental age and, as such, patients often seek its cosmetic rejuvenation. OBJECTIVE The purpose of this article was to review the dermatologic treatments available for periorbital skin rejuvenation. METHODS Topical retinoic and glycolic acid preparations, chemical peels, botulinum and collagen injections, dermabrasion, and laser resurfacing procedures for periorbital skin rejuvenation were reviewed. The relative benefits and risks of each treatment were detailed. RESULTS Minimal photodamage with mild rhytides should be responsible to topical acid therapy and superficial peels, whereas moderate wrinkling and photodamage generally require medium-depth peels, collagen injections, or erbium:YAG laser resurfacing. Deeper rhytides and more extensive cutaneous photo-damage usually necessitate CO2 laser resurfacing and botulinum injections. CONCLUSIONS Proper patient selection and assessment of aging severity are critical to determine the best therapeutic option.
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Affiliation(s)
- R M Manaloto
- Washington Institute of Dermatologic Laser Surgery, Washington, DC, USA
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BISACCIA EMIL, SEQUEIRA MARIO, MAGIDSON JORY, SCARBOROUGH DWIGHT. Surgical Intervention for the Aging Face. Dermatol Surg 1998. [DOI: 10.1111/j.1524-4725.1998.tb04258.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Laws RA, Finley EM, McCollough ML, Grabski WJ. Alabaster skin after carbon dioxide laser resurfacing with histologic correlation. Dermatol Surg 1998; 24:633-6. [PMID: 9648570 DOI: 10.1111/j.1524-4725.1998.tb04220.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Carbon dioxide laser resurfacing has gained popularity as a relatively safe and effective method of facial rejuvenation. Original reports describe mostly reversible side effects and a low incidence of scarring. Only very recently have reports of delayed hypopigmentation surfaced. This effect is not visible until several months after resurfacing, and most likely represents a permanent change. OBJECTIVE To provide an additional clinical description of the complication of delayed hypopigmentation along with the first published histologic correlation. METHODS Clinical records along with a preprocedure and 7-month postprocedure full-thickness skin biopsy were used for this report. RESULTS This patient experienced a striking leukoderma 6 months after a full facial carbon dioxide laser resurfacing procedure done for widespread actinic keratoses. There was a zone of dermal fibrosis extending approximately 0.4 mm on the postprocedure biopsy. Comparison of the preprocedure and postprocedure biopsies revealed no difference in the number of melanocytes by MART-1 immunohistochemical staining, but there was a significant decrease in epidermal melanin as determined by Fontana-Mason staining. CONCLUSION This patient experienced a profound expression of an increasingly recognized and reported complication of carbon dioxide laser resurfacing. Histologic correlation is similar to the results previously reported after phenol chemical peels, demonstrating a normal number of melanocytes but a decrease in epidermal melanin.
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Affiliation(s)
- R A Laws
- Department of Dermatology, Brooke Army Medical Center, Fort Sam Houston, TX 78234-6200, USA
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42
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Duffy DM. Alpha hydroxy acids/trichloroacetic acids risk/benefit, strategies. A photographic review. Dermatol Surg 1998; 24:181-9; quiz 190-1. [PMID: 9491112 DOI: 10.1111/j.1524-4725.1998.tb04135.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- D M Duffy
- Department of Dermatology, University of California, Los Angeles, USA
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43
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Rubach BW. Comparison of chemical peel and dermabrasion to carbon dioxide (CO2) laser resufacing. ACTA ACUST UNITED AC 1997. [DOI: 10.1016/s1043-1810(97)81003-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Niederman R, Zhang J, Kashket S. Short-chain carboxylic-acid-stimulated, PMN-mediated gingival inflammation. CRITICAL REVIEWS IN ORAL BIOLOGY AND MEDICINE : AN OFFICIAL PUBLICATION OF THE AMERICAN ASSOCIATION OF ORAL BIOLOGISTS 1997; 8:269-90. [PMID: 9260044 DOI: 10.1177/10454411970080030301] [Citation(s) in RCA: 101] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This communication reviews the effects of short-chain carboxylic acids on human cells of importance to the periodontium. The central hypothesis is that these acids can alter both cell function and gene expression, and thus contribute to the initiation and prolongation of gingival inflammation. Short-chain carboxylic acids [CH3-(CH2)x-COOH, x < 3] are metabolic intermediates with a broad range of apparently paradoxical biological effects. For example, lactic acid (CH3-CHOH-COOH), a 3-carbon alpha-hydroxy-substituted acid, is widely recognized for its cariogenicity. Lactic acid, however, also occurs in tropical fruits, and is the active ingredient in a variety of anti-wrinkle creams developed by dermatologists. In marked contrast, the unsubstituted 3-carbon propionic acid (CH3-CH2-COOH) is used as a food preservative and is the active principle for one class of non-steroidal anti-inflammatory agents. Interestingly, the addition of one carbon to propionic acid dramatically changes the biological effects. The unsubstituted 4-carbon butyric acid (CH3-CH2-CH2-COOH) is used by hematologists as a de-differentiating agent for the treatment of sickle cell anemia, but by oncologists as a differentiating agent for cancer chemotherapy. Finally, acting either individually or in concert, these acids can increase vascular dilation. Clearly, these acids, while metabolically derived, have a number of very divergent activities which are cell-type-specific (Fig. 1). It may be telling that periodontal bacteria produce these acids in millimolar concentrations, and that these bacteria can be characterized by their acid production profiles. It is no less interesting that these acids occur in the gingival crevices of human subjects with severe periodontal disease at millimolar levels which are > 10-fold higher than those found in mildly diseased subjects, and are undetectable in healthy subjects. Further, when applied directly to healthy human gingiva, short-chain carboxylic acids stimulate a gingival inflammatory response and inflammatory cytokine release. At the cellular level, these acids inhibit proliferation of gingival epithelial and endothelial cells, and inhibit leukocyte apoptosis and function, but can stimulate leukocyte cytokine release. At the molecular level, these acids can stimulate neutrophil gene transcription, translation, and protein expression. Thus, the likelihood is high that these acids, in addition to their cariogenic activity, can promote and prolong gingival inflammation. Our challenge will be to identify the cell or cells of the periodontium which respond to short-chain carboxylic acids, to delineate their responses and the molecular mechanism(s) of these effects, and to categorize the aspects of the inflammatory components which damage and those which protect the host. With this information, it may be possible to begin to rationally identify and test pharmaceutical agents which diminish the harmful aspects, while enhancing the beneficial components, of the inflammatory response.
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Affiliation(s)
- R Niederman
- Department of Periodontology, Harvard School of Dental Medicine, Boston, Massachusetts 02115, USA
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45
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Abstract
Facial skin wrinkling and sagging are concerns that often compel patients to seek counsel on rejuvenative procedures. Facial plasty procedures will alleviate many of these concerns. However, deep chemical peels, in conjunction with surgery or alone, can often significantly improve both the ravages of excess sun exposure and the stigmata of aging.
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Affiliation(s)
- S L Matarasso
- Department of Dermatology, University of California School of Medicine, San Francisco
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46
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Abstract
Skin resurfacing procedures with the carbon dioxide (CO2) laser, chemical peels, and dermabrasion have similar complication profiles. The most frequent complications are pigmentary disturbances, erythema, infection, and scarring. Patients should be well advised of the potential untoward side effects. Proper preoperative skin preparation, postoperative wound care, adequate physician training, and physician alertness will reduce the frequency and severity of these complications.
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Affiliation(s)
- H P Ragland
- Department of Dermatology, Louisiana State University Medical Center, Tulane University Medical Center, New Orleans, USA
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Waldorf HA, Kauvar AN, Geronemus RG. Skin resurfacing of fine to deep rhytides using a char-free carbon dioxide laser in 47 patients. Dermatol Surg 1995; 21:940-6. [PMID: 7582831 DOI: 10.1111/j.1524-4725.1995.tb00530.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Recent advances in carbon dioxide (CO2) laser technology have resulted in the development of lasers that can precisely remove thin layers of skin with minimal thermal damage to the surrounding tissue. These lasers rely on rapid pulsing or scanning of the laser beam. The effects of these lasers are predictable and reproducible, making them ideal for skin resurfacing. Clinical results have been promising, however, to date, no published series exist. OBJECTIVE To evaluate the effectiveness and side effect profile of laser resurfacing utilizing a CO2 laser with a scanning device, and make recommendations for patient selection and treatment protocol. METHODS Patients with perioral, periorbital, and glabellar rhytides were treated with a CO2 laser with a scanning device. Utilizing chart review and photographic evaluation, patients treated between November 1994 and April 1995 were retrospectively evaluated for effectiveness of therapy, healing time, and complication rates. RESULTS A total of 47 patients were evaluated. Photographic evaluation or chart review revealed good to excellent cosmetic results in all anatomic areas studied. All patients experienced posttreatment erythema lasting 1-6 months. Other minor complications were limited to contact dermatitis to topical preparations, transient postinflammatory hyperpigmentation, and milia formation. One patient experienced a primary herpes simplex virus infection during reepithelialization and required intravenous therapy. Minor focal atrophy was seen in one patient. No hypertrophic scarring or permanent pigmentation changes were seen. CONCLUSIONS A CO2 laser system with a scanning beam can effectively and safely improve or remove glabellar, perioral, and periorbital rhytides.
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Affiliation(s)
- H A Waldorf
- Laser and Skin Surgery Center of New York, NY 10016, USA
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