Rejuvenation of photoaged skin: 5 years results with intense pulsed light of the face, neck, and chest

Clinical application of 675 nm laser therapy for dorsal hand skin hyperpigmentation

BACKGROUND

Noninvasive skin rejuvenation treatment is growing in recognition to aesthetic medicine.

AIM

The objective of the study was to assess the efficacy and the safety of the 675-nm laser source treatment of photodamaged hands.

MATERIALS AND METHODS

The study included 21 patients (6 males and 15 females) with a mean age of 63 (± 9) years. Patients were treated with -two to three sessions of the 675-nm laser with a 1-month interval between sessions. Photos of each patient were collected at baseline, and 3 months after the last laser session. The 5-point Global Aesthetic Improvement Scale (GAIS) was recorded with their final assessment session (3 months).

RESULTS

The total GAIS scores showed satisfactory results: 15 patients (71%) experienced 4 score (excellent improvement) changes and 6 patients (29%) experienced 3 score (good improvement) changes. Clinical images showed good efficacy and visible aesthetic results for the management of photodamaged skin. No serious adverse effects were recorded.

CONCLUSION

This study demonstrates the safety and efficacy of for the aesthetic improvement of skin pigmentation and texture for photodamaged hands.

Therapeutic effect of concentrated growth factor preparation on skin photoaging in a mouse model

OBJECTIVE

To establish a nude mouse model of photoaging and study the therapeutic effect of a concentrated growth factor preparation (CGF) on skin photoaging.

METHODS

CGF was prepared from blood from Sprague-Dawley rats. A skin photoaging nude mouse model was developed using UV irradiation combined with the photosensitizer, 8-methoxypsoralen. Mice were divided randomly into seven groups (n = 6 per group): normal control, photoaging, mock treatment, saline treatment, CGF treatment, Filoca 135HA treatment, and plasma skin regeneration system irradiation (the latter two were positive controls). Body weight and skin appearance were observed and pathological changes were determined by hematoxylin and eosin staining. Fiber elasticity was evaluated by Weigert staining. Expression levels of proliferating cell nuclear antigen (PCNA) and matrix metalloproteinase 1 (MMP1) were determined by immunohistochemistry.

RESULTS

A mouse model with typical features of photoaging skin was successfully developed. CGF significantly improved the skin appearance, wrinkle scores, pathological changes, and fiber elasticity, and increased PCNA and decreased MMP1 expression levels in photoaging mice, comparable to the two positive controls.

CONCLUSION

CGF can improve the symptoms of skin photoaging in mice, suggesting that it may have applications in the treatment of skin aging in humans.

Ablative fractional carbon dioxide laser combined with intense pulsed light for the treatment of photoaging skin in Chinese population: A split-face study

Intense pulsed light (IPL) is effective for the treatment of lentigines, telangiectasia, and generalized erythema, but is less effective in the removal of skin wrinkles. Fractional laser is effective on skin wrinkles and textural irregularities, but can induce postinflammatory hyperpigmentation (PIH), especially in Asians. This study evaluated the safety and efficacy of ablative fractional laser (AFL) in combination with IPL in the treatment of photoaging skin in Asians.This study included 28 Chinese women with Fitzpatrick skin type III and IV. The side of the face to be treated with IPL alone (3 times) or AFL in combination with IPL (2 IPL treatments and 1 AFL treatment) was randomly selected. Skin conditions including hydration, transepidermal water loss, elasticity, spots, ultraviolet spots, brown spots, wrinkle, texture, pore size and red areas, as well as adverse effects were evaluated before the treatment and at 30 days after the treatment.Compared with IPL treatment alone, AFL in combination with IPL significantly increased elasticity, decreased pore size, reduced skin wrinkles, and improved skin texture (P = .004, P = .039, P = .015, and P = .035, respectively). Both treatment protocols produced similar effects in relation to the improvement of photoaging-induced pigmentation. The combined therapy did not impair epidermal barrier function. No postoperative infection, hypopigmentation, or scarring occurred after IPL and AFL treatments. PIH occurred at 1 month after AFL treatment and disappeared at 30 days after completion of the combined therapy.AFL in combination with IPL is safe and effective for photoaging skin in Asians.

Clinical evaluation of the efficacy and safety of combined bipolar radiofrequency and optical energies vs. optical energy alone for the treatment of aging hands

Different treatment modalities are used for the treatment and esthetic improvement of aging hands. This study evaluated the efficacy and safety of a novel technology, which combines bipolar radio frequency (RF) and optical energies for the cosmetic treatment of aging hands. The objective of the study was to assess the efficacy, safety, tolerability, and patient satisfaction of combined bipolar radiofrequency and optical energies vs. optical energy alone for the treatment of aging hands. Thirteen female patients with solar lentigines on the back of the hands were enrolled. Participants received three treatments: combined RF and intense pulsed light (IPL) on one hand and IPL treatment alone on the other. Standardized clinical photographs were taken, and patient and investigator improvement assessment (Global Esthetic Improvement (GAI) scale), patient satisfaction, and tolerability were evaluated. At the 1 and 3 months follow-up, skin laxity and pigmentation, investigator and patient improvement assessments, and satisfaction were significantly better in the hand treated with combined bipolar RF and IPL. This study demonstrates the safety and efficacy of combining RF and optical energies for the esthetic improvement of aging hands. Combined RF and IPL treatment was more efficient than IPL alone in improving skin pigmentation, skin laxity, and texture.

Photoepilation and Skin Photorejuvenation: An Update

The effectiveness of intense pulsed light (IPL) and laser devices is widely accepted in aesthetic dermatology for unwanted hair removal and treatment of a variety of cutaneous conditions. Overall, most comparative trials have demonstrated similar effectiveness for IPL and laser devices. Literature studies alternatively favor the IPL and laser concepts, but the incidence of severe local pain and side effects were generally lower with IPL. IPL phototherapy, already established as a sound option in photoepilation and treatment of photoaging, hyperpigmentation and other skin conditions, is also considered first choice in the phototherapy of skin vascular malformations. When treating large areas, as often required in photoepilation and many aesthetic dermatology indications, IPL technologies show advantages over laser-based devices because of their high skin coverage rate. Compared to lasers, the wide range of selectable treatment settings, though a strong advantage of IPL, may also imply some more risk of local thermal side effects, but almost only in the hands of poorly trained operators. Overall, the strongest advantages of the IPL technologies are robust technology, versatility, lower purchase price, and the negligible risk of serious adverse effects in the hands of skilled and experienced operators.

Rosacea: Molecular Mechanisms and Management of a Chronic Cutaneous Inflammatory Condition

Rosacea is a chronic cutaneous inflammatory disease that affects the facial skin. Clinically, rosacea can be categorized into papulopustular, erythematotelangiectatic, ocular, and phymatous rosacea. However, the phenotypic presentations of rosacea are more heterogeneous. Although the pathophysiology of rosacea remains to be elucidated, immunologic alterations and neurovascular dysregulation are thought to have important roles in initiating and strengthening the clinical manifestations of rosacea. In this article, we present the possible molecular mechanisms of rosacea based on recent laboratory and clinical studies. We describe the genetic predisposition for rosacea along with its associated diseases, triggering factors, and suggested management options in detail based on the underlying molecular biology. Understanding the molecular pathomechanisms of rosacea will likely aid toward better comprehending its complex pathogenesis.

Hand rejuvenation using standard Intense Pulsed Light (IPL) in Asian patients

BACKGROUND

In recent years, facial rejuvenation using Intense Pulsed Light (IPL) is in demand and there have been many reports. However, hand rejuvenation, which aims to treat lentigines on the dorsal hand and wrinkles, is in demand but with few reports. In this study, hand rejuvenation was attempted using two wavelengths of a standard IPL system. It focuses mainly on improvement of lentigines, and efficacy on wrinkles on the dorsal hand will be discussed as well.

SUBJECTS AND METHODS

The subjects were 128 Japanese patients (average age 58.1) who had lentigines and wrinkles on the dorsa of both hands, and the wavelength spectra of 560 - 1200 nm and 515 - 1200 nm were applied. In general, the number of treatments was not fixed, and further treatments beyond the first treatment were added only when asked for by the patient. Lentigines were assessed on 4 levels and wrinkles on 3 levels.

RESULTS

The results in lentigines were graded "Excellent" in 45.3%, "Good" in 14.8%, "Unchanged" in 37.5% and "Bad" in 2.3% of the patients. Dark-toned lentigines in particular improved after one treatment. On the other hand, the results in wrinkles were graded as "Effective" in 25.0%, "Hard to tell" in 39.1% and "Ineffective" in 35.9% of the patients after the first treatment, but there was increased improvement in some cases after multiple treatments.

CONCLUSIONS

By using appropriate IPL parameters with specific cut-off filters, dark-toned and flat senile lentigines could be treated effectively with a small number of treatments. On the other hand, improvement of fine dorsal wrinkles was noticed but more finesse is needed as to how to apply IPL and to decide on the number of treatments. Further study is necessary, but overall it can be said that IPL is an effective choice for hand rejuvenation.

Safety and efficacy of 2,790-nm laser resurfacing for chest photoaging

Chest photodamage is a common cosmetic complaint. Laser treatment of the chest may be higher risk than other areas. The objective of this study was to assess the safety and efficacy of 2,790-nm chest resurfacing for photodamage. Twelve patients with Fitzpatrick skin types I-III were enrolled in this university IRB-approved study. Photo documentation was obtained at baseline and each visit. A test spot with the 2,790-nm resurfacing laser was performed on the chest. Patients who did not have adverse effects from the test spot went on to have a full chest resurfacing procedure. Patients were instructed on standardized aftercare, including sunscreen. A 5-point healing and photodamage improvement scale was used to rate improvement by both investigators and the patients and was obtained at 2 weeks, 1 month, 2 months, and 3 months. One pass chest treatment with the 2,790-nm resurfacing laser at fluences greater than or equal to 3.0 mJ with 10% overlap leads to unacceptable rates of hyperpigmentation. Double pass chest treatment at fluences less than or equal to 2.5 mJ with 10% overlap leads to mild improvement in chest photodamage parameters without significant or persistent adverse effects. Laser treatment of aging/photodamaged chest skin remains a challenge due to the delicacy of chest skin. Mild improvement may be obtained with double pass resurfacing with the 2,790-nm wavelength.

Will nonablative rejuvenation replace ablative lasers? Facts and controversies

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

Neck skin rejuvenation

The author of this article uses the pulsed ablative CO2 laser for resurfacing of the neck and face, based on the gold standard status of the CO2 laser and a novel post-treatment plan that greatly reduces adverse effects traditionally associated with fully ablative resurfacing. The croton oil peel is an inexpensive and effective modality for rejuvenating neck skin. The use of either technique as an adjunct to neck lift surgery, with or without facelift surgery, permits surgeons to fulfill the expectations of patients who want the skin of their face and neck to be homogeneous and more attractive.

Dermaplaning, topical oxygen, and photodynamic therapy: a systematic review of the literature

BACKGROUND

Noninvasive procedures for facial rejuvenation are becoming an increasingly popular component of a comprehensive skin care regimen. Concurrently, many new treatment methods are now available to both the plastic surgeon and the aesthetician. Because these techniques have become an integral part of many cosmetic practices, this study aimed to assess the existing evidence-based literature as to their clinical efficacy; to provide an objective overview of some of the most popular noninvasive rejuvenation strategies such as dermaplaning, oxygen therapy, and light therapy; to discuss recent pertinent scientific evidence-based literature; and to provide treatment recommendations based on these findings.

METHODS

A systematic review was performed in August 2009 using PubMed and the following keywords: "dermaplaning," "oxygen therapy," and "light therapy." All peer-reviewed articles then were screened independently by three plastic surgeons.

RESULTS

The search identified 42 English-written, peer-reviewed manuscripts. The overall amount of scientific data supporting these methods was found to be scarce, anecdotal, and not well documented. Nevertheless, all three noninvasive therapies have become increasingly popular in the cosmetic market because many patients and physicians or surgeons report being pleased with their results.

CONCLUSION

Although the evidence supporting these nonsurgical methods is suboptimal, their uses continue to expand. As with any plastic surgery procedure, providing patients with realistic expectations is essential to achieving optimal outcomes and patient satisfaction. Therefore, critical investigation is warranted. In addition, these methods are most effective when included within a comprehensive skin care regimen consisting of sunscreen, vitamin therapy, and lifestyle modification.

Technology approaches to the medical spa: art plus science equal rejuvenation

Medical spas are the fasting growing segment of the 15-billion dollar spa industry. Although medical spas have been in existence since ancient times to treat a wide variety of ailments such as gout, arthritis, and diabetes, our modern concept of the medical spa combines relaxation with medical rejuvenative procedures. This article focuses on the more recent technologic advancements in rejuvenation.

Facial Skin Rejuvenation in the Asian Patient

Asian skin exhibits increased dermal thickness, collagen, and melanin content when compared with Caucasian skin. As a result of these features, the stigmata of aging skin in Asians is characterized more by pigmentation changes rather than fine, facial wrinkles, and it has an increased tendency toward pigmentary dyschromia after treatment. All facial skin rejuvenation techniques may not be applicable toward this selected population. This article highlights the various skin rejuvenation techniques that balance safety and efficacy and are most suitable toward treating the aging Asian face.

"Multi Light and Drugs": a new technique to treat face photoaging. Comparative study with photorejuvenation

Nonablative skin rejuvenation using laser, intense pulsed lights (IPLs), or radiofrequency techniques are becoming increasingly popular. In this paper, a novel protocol that integrates IPL sessions, low intense light and vitamin C, low-weight hyaluronic acid, betaglucan dermal injection versus IPL photorejuvenation as monotherapy is compared. A group of 100 patients, all women, with ages ranging from 35 to 65 years old (median age 56.3) with different degrees of photodamage was considered. A blinded control study was done. The patients were divided not randomly into two groups. These groups are similar for ages, skin types, and degrees of photoaging distribution. A first group of 40 patients had monotherapy consisting of seven sessions of IPL only. A second group of 60 patients had triple therapy consisting of seven sessions of IPL as well as nine sessions of low intense diode light and also biostimulation by drugs. Considering only the improvement in hyperpigmentations and teleangectasias, the monotherapy and the triple therapy show good results with no significant statistical difference between the two groups. Considering the improvement in skin texture and firmness in the group treated only with monotherapy, 30% (12 patients) had positive results, and 70% (28 patients) had poor results. In the group treated with triple therapy, 70% (42 patients) had positive results, and 30% (18 patients) had poor results, with the main differences in skin silicone negative imprints. On the basis of the data presented, the new technique of IPL, low intensity diode light, and multidrugs biostimulation seems to be a safe and effective method for skin rejuvenation and upgrades the effects of IPL in the fibroblasts' stimulation.

Near [corrected] painless, nonablative, immediate skin contraction induced by low-fluence irradiation with new infrared device: a report of 25 patients

BACKGROUND

Nonablative radiofrequency (NARF) has been the only method for producing noninvasive skin tightening. Nevertheless, significant pain during the procedure is an important downside of this technology. A new nonablative medical device, Titan (Cutera, Inc., Brisbane, CA, USA), capable of fluences much lower than those possible with NARF, was tested as a less painful alternative.

OBJECTIVES

To produce skin contraction leading to lifting of eyebrows and/or improvement of lower face and neck skin laxity using fluences below pain levels.

PATIENTS AND METHODS

Twenty-five patients were treated. Standardized photographs were obtained preoperatively, after a few days, a few weeks, and up to 12 months after the procedure.

RESULTS

Immediate changes were obtained in 22 of 25 patients. Examination of photographs revealed that the initial improvement was maintained throughout the follow-up period.

CONCLUSION

Immediate true skin contraction persisting through the immediate, intermediate, and long-term follow-up was found in the vast majority of patients in this group. Edema as an artifact simulating immediate improvement was excluded by serial photographs taken during the follow-up period. Skin contraction occurred at low fluences, below the threshold of pain. This, to the best of our knowledge, has not been previously described in the medical literature.

Visible light treatment of photoaging

Recently, a number of new devices have been developed specifically to improve the visible signs of aging in a noninvasive way. These include visible or near-infrared lasers, intense pulsed light sources (IPL), light-emitting diode (LED), and radiofrequency devices. This paper reviews the use of visible light sources and examines the attributes of specific systems for noninvasive skin rejuvenation.

Nonablative skin rejuvenation

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

Neck rejuvenation

The neck has long been neglected when it comes to facial rejuvenation. More often than not the neck is left untreated, leaving the patient with a line of demarcation along the mandible separating a rejuvenated face from an aged neck. Neck rejuvenation involves targeting all of the layers of tissue that are affected by the aging process. Neck rejuvenation is usually performed in conjunction with facial rejuvenation, but can be an isolated procedure. Neck rejuvenation can be nonsurgical or surgical, with many options for combined approaches and modalities.

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

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

Rosacea: II. Therapy

Despite an incomplete understanding of the pathogenesis of rosacea, therapeutic modalities continue to expand. The principal subtypes of rosacea include erythematotelangiectatic rosacea, papulopustular rosacea, phymatous rosacea, and ocular rosacea. These phenotypic expressions are probably caused by divergent pathogenic factors and consequently respond to different therapeutic regimens. A subtype-directed approach to therapy is discussed in part II of this review. We provide an overview of the available topical, oral, laser, and light therapies in the context of these cutaneous subtypes, review the evidence that supports their use, and outline their therapeutic approach. Suggestions for future areas of study also are provided. Learning objective At the completion of this learning activity, participants should be familiar with the subtype-directed approach to therapy for rosacea including available topical, oral, laser, and light therapies.

Intense pulsed light treatment of photoaged facial skin

BACKGROUND

It has been reported that intense pulsed light is efficacious for rejuvenation of photoaged skin, specifically the improvement of appearance of telangiectases and solar lentigines.

OBJECTIVE

The objective was to define the treatment variables for photodamaged facial skin using a newer intense pulsed light system.

METHODS

Twenty-three female subjects received three treatments using double-stacked pulses with fluences of 24 and 30 J/cm2. Response to treatment was evaluated using digital photography. Three signs of photoaging were evaluated: surface texture/roughness, mottled hyperpigmentation, and erythema/telangiectases.

RESULTS

There was a shift in clinical grading from more to less severe on all three measures of photoaging.

CONCLUSION

Intense pulsed light therapy was efficacious in ameliorating the clinical signs of photoaging. The device was well tolerated with minimal side effects.

Review of nonablative laser resurfacing modalities

Because of considerable morbidities and recovery time associated with CO2 laser resurfacing,many efforts are being made to discover a less ablative resurfacing modality. A thorough review of the literature demonstrates promising but less than ideal results for all of the currently used lasers. The clinical efficacy does not appear to be as significant as the histologic results that have been documented. Our review of the literature also demonstrates that not all of the modalities are equal.

Study of the Incidence and Nature of "Very Subtle Epidermal Melasma" in Relation to Intense Pulsed Light Treatment

BACKGROUND

Skin rejuvenation with intense pulsed light (IPL) is effective for clearing epidermal pigment disorders. Complications are mild and limited to epidermal burns caused by excessive settings. Some patients, however, experience IPL-induced melasma-like hyperpigmentation despite the appearance of normal skin. These patients seem to have very subtle epidermal melasma not visible to the naked eye. Ultraviolet photography has been useful in identifying these patients and preventing complications.

OBJECTIVE

The study investigated the incidence of very subtle melasma in patients using UV photography, and assessed this tool in identifying high-risk patients.

SUBJECTS AND METHODS

223 Japanese women, 30-69 years old, participated in the study. Very subtle melasma invisible to the naked eye under normal light was diagnosed by UV photography by two physicians, and any relationship among the disease incidence, age, and regular sunscreen use was examined.

RESULTS

Sixty-three cases of very subtle melasma (28.3%) were identified among the 223 subjects, with a significantly lower incidence in sunscreen users.

CONCLUSIONS

Patients diagnosed with subtle epidermal melasma and treated with mild IPL parameters did not suffer induced secondary hyperpigmentaion. To help avoid complications after treatment, IPL users should be aware of the age and sunscreen-related incidence of this phenomenon in Asian patients.

Treatment of Neck Lines and Forehead Rhytids with a Nonablative 1540-nm Er:Glass Laser: A Controlled Clinical Study Combined with the Measurement of the Thickness and the Mechanical Properties of the Skin

BACKGROUND

Nonablative remodeling has been recently proposed as a new, no-down-time, anti-aging treatment. Objective. The objective was to evaluate the efficacy and safety of nonablative skin remodeling with a 1540-nm Er:Glass laser on neck lines and forehead rhytids.

METHODS

Twenty female patients (mean age 45 years) were enrolled. Skin thickness and mechanical properties were measured before the first treatment, 1 month after the third treatment, 1 month after the fifth treatment, and 3 months after the fifth treatment.

RESULTS

All patients reported an improvement in both skin tone and texture. Using ultrasound imaging, dermal thickness of neck and forehead increased, respectively, by 70+/-13 microm (p<0.001) and 110+/-19 microm (p<0.003). A dramatic increase of initial stress of the forehead skin (firmness) was obtained, from 7.62+/-3.68 before treatment to 16.68+/-7.44 3 months after the fifth treatment (p<0.0002). No immediate or late adverse effects were noted throughout the treatment regimen.

CONCLUSION

This study demonstrates that irradiation with a 1540-nm Er:Glass laser emitting in a pulsed mode and coupled with an efficient contact cooling system increases dermal thickness and firmness, leading to a clinical improvement of neck lines and forehead rhydits.

A cosmetic approach to cutaneous defects

The options available to cosmetic surgeons for the treatment of the aging face are expanding at a rapid pace. Although any one modality may help, often a combination of approaches provides the most dramatic results. Whereas some of these techniques represent refinements of old tools, others represent entirely new modalities (Box 1). To tailor the most effective treatment plan appropriately, the limitations and strengths of these various tools must be understood by the patient and physician. During the preoperative consultation, assessment of a patient's expectations is critical when suggesting a treatment plan. By performing an assessment, the physician and patient can experience increased satisfaction because more optimal results are achieved.

Using silicone gel sheet for the treatment of facial telangiectasias with sclerotherapy

BACKGROUND

Telangiectasias are superficial cutaneous vessels that are visible to human eye and are present as a dilated venule, capillary, or arteriole. They are a common cause of concern, especially when located in face. Sclerotherapy is among the treatment alternatives, but facial telangiectasias are less responsive than those located on the leg.

OBJECTIVE

To show the effectiveness of silicone gel sheet in improving the results obtained by sclerotherapy in facial telangiectasias.

METHODS

Between 1998 and 2003, 32 patients were treated with sclerotherapy and silicone gel sheet (group 1). Twenty-six patients were treated with sclerotherapy and cotton ball (group 2), and 30 patients were treated only sclerotherapy (group 3). Patients were evaluated for 12 weeks for the degree of improvement and side effects. All complications, side effects, and number of sessions were also recorded at each follow-up visit. The number of sessions is limited to six. After the final follow-up visit, the photographs taken of each treatment site at baseline and at final visit were reviewed in a double-blinded manner based on a 0 to 4 scale by two physicians.

RESULTS

Fifty one of the 88 patients showed improvement totally. In the silicone sheet-sclerotherapy group, 22 of the 36 patients showed improvement. In the sclerotherapy-cotton ball group, 14 of the 26 patients showed improvement, and in the sclerotherapy-only group, 15 of the 30 patients showed improvement completely within the 12 weeks. The patients treated with sclerotherapy-silicone gel sheet (group 1) had more improvement than the other groups.

CONCLUSION

Combining silicone gel sheeting to sclerotherapy increases the success rate in treating facial telangiectasias, especially facial subunits, which have bone support.

Comparison of a 1450-nm Diode Laser and a 1320-nm Nd:YAG Laser in the Treatment of Atrophic Facial Scars: A Prospective Clinical and Histologic Study

BACKGROUND

Atrophic scar revision techniques, although numerous, have been hampered by inadequate clinical responses and prolonged postoperative recovery periods. Nonablative laser treatment has been shown to effect significant dermal collagen remodeling with minimal posttreatment sequelae. Although many studies have been published regarding the effectiveness of these nonablative lasers on rhytides, there are limited data demonstrating their specific effects on atrophic scars.

OBJECTIVE

To evaluate and compare the efficacy and safety of long-pulsed 1320-nm Nd:YAG and 1450-nm diode lasers in the treatment of atrophic facial scarring.

METHODS

A series of 20 patients (skin phototypes I-V) with mild to moderate atrophic facial acne scars randomly received three successive monthly treatments with a long-pulsed 1320-nm Nd:YAG laser on one facial half and a long-pulsed 1450-nm diode laser on the contralateral facial half. Patients were evaluated using digital photography and three-dimensional in vivo microtopography measurements at each treatment visit and at 1, 3, 6, and 12 months postoperatively. Histologic evaluations of cutaneous biopsies obtained before treatment, immediately after the first treatment, and at 1, 3, 6, and 12 months after the third treatment were performed. Clinical assessment scores were determined at each treatment session and follow-up visit. Patient satisfaction surveys were obtained at the end of the study.

RESULTS

Mild to moderate clinical improvement was observed after the series of three treatments in the majority of patients studied. Patient satisfaction scores and in vivo microtopography measurements paralleled the photographic and histopathologic changes seen. Side effects of treatment were limited to mild transient erythema, edema, and hyperpigmentation. No scarring or adverse textural changes resulted from the use of either laser system.

CONCLUSIONS

Nonablative long-pulsed 1320-nm Nd:YAG and 1450-nm diode lasers each offer clinical improvement for patients with atrophic scarring without significant side effects or complications. The 1450-nm diode laser showed greater clinical scar response at the parameters studied. The use of nonablative laser systems is a good treatment alternative for patients with atrophic scarring who are unable or unwilling to endure the prolonged postoperative recovery process associated with ablative laser skin resurfacing procedures.

Review of nonablative photorejuvenation: reversal of the aging effects of the sun and environmental damage using laser and light sources

This review article outlines all the latest light or electromagnetic radiation based technologies used for nonablative skin rejuvenation. While many technologies have been available for a number of years, emerging technologies are also discussed, which may play a role in treatment of photoaged skin in the very near future. The principles behind these technologies are discussed in detail.