1
|
Wang JV, Bajaj S, Himeles JR, Geronemus RG. Clinical and Optical Coherence Tomography Correlation of Vascular Conditions Treated With a Novel, Variable-Sequenced, Long-Pulsed, 532 and 1,064 nm Laser With Cryogen Spray Cooling. Dermatol Surg 2024; 50:277-281. [PMID: 38085090 PMCID: PMC10903995 DOI: 10.1097/dss.0000000000004057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
BACKGROUND Patients frequently seek laser treatment for vascular conditions. More recently, a novel 532 and 1,064 nm laser was developed to offer greater flexibility. OBJECTIVE A prospective clinical trial evaluated the safety and efficacy of a novel, variable-sequenced, long-pulsed, 532 and 1,064 nm laser with cryogen spray cooling (DermaV, Lutronic, South Korea). MATERIALS AND METHODS Subjects with vascular conditions were enrolled for laser treatments. Clinical evaluations and optical coherence tomography (OCT) imaging were performed. RESULTS Thirteen subjects were enrolled. The mean age was 51.3 years, and 92.3% were women. Fitzpatrick skin types I-IV were included. Treatment indications included broken blood vessels, rosacea, port-wine birthmark, and spider angioma. For physician investigator grading, all subjects were graded as improved at both 30-day and 90-day follow-up. Blinded photographic review by 3 independent, blinded physicians had a mean of 89.7% of cases selected correctly with at least 2 of 3 in agreement for 100.0% of cases. Optical coherence tomography imaging showed significant reductions in vessel density ( p = .018) and diameter ( p = .003) of the superficial vascular plexus. No serious adverse events occurred. CONCLUSION A novel, variable-sequenced, long-pulsed, 532 and 1,064 nm laser with cryogen spray cooling can safely and effectively improve vascular conditions and lesions as determined by both clinical and OCT evaluation.
Collapse
Affiliation(s)
- Jordan V. Wang
- Laser & Skin Surgery Center of New York, New York, New York
| | - Shirin Bajaj
- Laser & Skin Surgery Center of New York, New York, New York
| | - Jaclyn R. Himeles
- The Ronald O. Perelman Department of Dermatology, NYU Langone Health, New York, New York
| | - Roy G. Geronemus
- Laser & Skin Surgery Center of New York, New York, New York
- The Ronald O. Perelman Department of Dermatology, NYU Langone Health, New York, New York
| |
Collapse
|
2
|
Cervantes J, Chang YF, Dover JS, Hernandez Alvarez A, Chung HJ. Laser-Assisted and Device-Assisted Filler Delivery: A Histologic Evaluation. Dermatol Surg 2023; 49:865-870. [PMID: 37389474 DOI: 10.1097/dss.0000000000003870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
BACKGROUND Lasers and devices are used to enhance transcutaneous delivery of fillers. However, little has been published on the histologic findings of this form of laser/device-assisted delivery to determine the optimal devices and fillers. OBJECTIVE To objectively evaluate the histological effects of laser-assisted and device-assisted filler delivery. METHODS Ex vivo human abdominoplasty skin samples were treated with fractional CO 2 laser (ECO 2 , 120 μm tip, 120 mJ), fractional radiofrequency microneedling (FRMN, Genius, 1.5 mm, 20 mJ/pin), and microneedling (2.0 mm). Immediately after poly- l -lactic acid (PLLA), hyaluronic acid gel, calcium hydroxylapatite, and black tissue marking dye were topically applied. After treatment, biopsies were collected for histologic evaluation. RESULTS Histology revealed that PLLA and black dye were found in greatest abundance, hyaluronic acid was found to a lesser extent, and calcium hydroxylapatite was least found within channels created by fractional CO 2 laser. Microneedling was effective only at delivering black dye, whereas FRMN failed to show significant channel formation or delivery of the studied products. CONCLUSION Among the devices and fillers studied, fractional CO 2 laser and PLLA proved to be the most effective combination for laser/device-assisted filler delivery. Neither microneedling nor FRMN was effective as devices to enhance filler delivery.
Collapse
Affiliation(s)
- Jessica Cervantes
- Harvard Combined Dermatology Residency Training Program, Boston, Massachusetts
| | - Yu-Feng Chang
- Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Jeffrey S Dover
- SkinCare Physicians, Chestnut Hill, Massachusetts
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | | | - Hye Jin Chung
- Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| |
Collapse
|
3
|
Wang JV, Bajaj S, Steuer A, Orbuch D, Geronemus RG. Prospective Evaluation of the Safety and Efficacy of Thermomechanical Fractional Injury for Perioral Rhytides. Dermatol Surg 2023; 49:566-569. [PMID: 36946689 DOI: 10.1097/dss.0000000000003762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND Perioral rhytides can be treated with laser and energy-based devices. More recently, a novel fractional thermomechanical skin rejuvenation system was developed to cause controlled thermal injury through direct heat transfer. OBJECTIVE A prospective clinical trial evaluated the safety and efficacy of a thermomechanical fractional injury device (Tixel 2, Novoxel, Netanya, Israel) for perioral rhytides. MATERIALS AND METHODS Subjects with moderate-to-severe perioral rhytides were enrolled and underwent 4 monthly treatments. RESULTS Twenty-three subjects were enrolled and completed all study visits. Mean age was 62.5 years, and 100.0% were women. Fitzpatrick Skin Types I-IV were included. For Fitzpatrick Wrinkle Classification System (FWCS), mean baseline score was 6.9. Per investigator, there was a mean 1.9-grade improvement in FWCS at 3-month follow-up ( p < .0001). At 3-month follow-up, 8.7% (n = 2) of subjects had a 3-grade improvement, 69.6% (n = 16) had a 2-grade improvement, and 21.7% (n = 5) had a 1-grade improvement. For physician Global Aesthetics Improvement Scale at 3-month follow-up, 69.6% (n = 16) had 76% to 100% improvement, 13.0% (n = 3) had 51% to 75% improvement, and 17.4% (n = 4) had 26% to 50% improvement. There were no severe adverse events, and subjects experienced minimal pain. CONCLUSION A novel device using thermomechanical fractional injury was demonstrated to be safe and effective in the treatment of perioral rhytides.
Collapse
Affiliation(s)
- Jordan V Wang
- Laser & Skin Surgery Center of New York, New York, New York
| | - Shirin Bajaj
- Laser & Skin Surgery Center of New York, New York, New York
| | - Alexa Steuer
- The Ronald O Perelman Department of Dermatology, New York University Langone Health, New York, New York
| | - David Orbuch
- Laser & Skin Surgery Center of New York, New York, New York
| | - Roy G Geronemus
- Laser & Skin Surgery Center of New York, New York, New York
- The Ronald O Perelman Department of Dermatology, New York University Langone Health, New York, New York
| |
Collapse
|
5
|
Wang JV, Friedman PM, Rodeberg D, Konda A, Parker C, Geronemus RG. Enhancing Skin Uptake of Topical Antioxidants With 1,440-nm Nonablative Fractional Diode Laser Pretreatment. Dermatol Surg 2022; 48:927-931. [PMID: 36054044 DOI: 10.1097/dss.0000000000003531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Energy-based devices, such as nonablative lasers, are a promising method to enhance the delivery and absorption of topically applied molecules. OBJECTIVE To characterize ex vivo uptake of common antioxidant topicals after pretreatment with a nonablative laser wavelength. MATERIALS AND METHODS Using donor human skin tissue, uptake of 3 topical antioxidants was analyzed (C E Ferulic with 15% l-ascorbic acid [15% vitamin C serum], Phloretin CF with ferulic acid [10% vitamin C serum], and Phyto+ [botanical serum]; SkinCeuticals, Dallas, TX; 2010 formulations) after pretreatment with a 1,440-nm nonablative fractional diode laser. RESULTS Pretreatment with the 1,440-nm laser enhanced uptake of 15% and 10% vitamin C serums by approximately 10 and 21 times, respectively, compared to controls. Laser pretreatment also enhanced uptake of botanical serum by approximately 6 times relative to controls. Permeation of vitamin C and botanical serums was also enhanced through laser pretreatment. CONCLUSION Nonablative laser pretreatment increased uptake and permeation of topical antioxidants. Optimizing treatment requires consideration of the device and treatment parameters as well as the properties of the topical formulation.
Collapse
Affiliation(s)
- Jordan V Wang
- Laser & Skin Surgery Center of New York, New York, New York
| | - Paul M Friedman
- Laser & Skin Surgery Center of New York, New York, New York
- Dermatology & Laser Surgery Center, Houston, Texas
| | | | | | | | | |
Collapse
|
6
|
Labadie JG, Ibrahim SA, Worley B, Kang BY, Rakita U, Rigali S, Arndt KA, Bernstein E, Brauer JA, Chandra S, Didwania A, DiGiorgio C, Donelan M, Dover JS, Galadari H, Geronemus RG, Goldman MP, Haedersdal M, Hruza G, Ibrahimi OA, Kauvar A, Kelly KM, Krakowski AC, Miest R, Orringer JS, Ozog DM, Ross EV, Shumaker PR, Sobanko JF, Suozzi K, Taylor MB, Teng JMC, Uebelhoer NS, Waibel J, Wanner M, Ratchev I, Christensen RE, Poon E, Miller CH, Alam M. Evidence-Based Clinical Practice Guidelines for Laser-Assisted Drug Delivery. JAMA Dermatol 2022; 158:1193-1201. [PMID: 35976634 DOI: 10.1001/jamadermatol.2022.3234] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Laser-assisted drug delivery (LADD) is used for various medical and cosmetic applications. However, there is insufficient evidence-based guidance to assist clinicians performing LADD. Objective To develop recommendations for the safe and effective use of LADD. Evidence Review A systematic literature review of Cochrane Central Register of Controlled Trials, Embase, and MEDLINE was conducted in December 2019 to identify publications reporting research on LADD. A multidisciplinary panel was convened to draft recommendations informed by the systematic review; they were refined through 2 rounds of Delphi survey, 2 consensus meetings, and iterative review by all panelists until unanimous consensus was achieved. Findings Of the 48 published studies of ablative fractional LADD that met inclusion criteria, 4 were cosmetic studies; 21, oncologic; and 23, medical (not cosmetic/oncologic), and 6 publications of nonablative fractional LADD were included at the request of the expert panel, producing a total of 54 studies. Thirty-four studies (63.0%) were deemed to have low risk of bias, 17 studies (31.5%) had moderate risk, and 3 (5.5%) had serious risk. The key findings that informed the guidelines developed by the expert panel were as follows: LADD is safe in adults and adolescents (≥12 years) with all Fitzpatrick skin types and in patients with immunosuppression; it is an effective treatment for actinic keratosis, cutaneous squamous cell carcinoma in situ, actinic cheilitis, hypertrophic scars, and keloids; it is useful for epidermal and dermal analgesia; drug delivery may be increased through the application of heat, pressure, or occlusion, or by using an aqueous drug solution; laser settings should be selected to ensure that channel diameter is greater than the delivered molecule; antibiotic prophylaxis is not recommended, except with impaired wound healing; antiviral prophylaxis is recommended when treating the face and genitalia; and antifungal prophylaxis is not recommended. The guideline's 15 recommendations address 5 areas of LADD use: (I) indications and contraindications; (II) parameters to report; (III) optimization of drug delivery; (IV) safety considerations; and (V) prophylaxis for bacterial, viral, and fungal infections. Conclusions and Relevance This systematic review and Delphi consensus approach culminated in an evidence-based clinical practice guideline for safe and effective use of LADD in a variety of applications. Future research will further improve our understanding of this novel treatment technique.
Collapse
Affiliation(s)
- Jessica G Labadie
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Sarah A Ibrahim
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Brandon Worley
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Bianca Y Kang
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Uros Rakita
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois
| | - Sarah Rigali
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois
| | - Kenneth A Arndt
- SkinCare Physicians, Chestnut Hill, Massachusetts.,Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Eric Bernstein
- Main Line Center for Laser Surgery, Ardmore, Pennsylvania
| | - Jeremy A Brauer
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York
| | - Sunandana Chandra
- Division of Hematology and Oncology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Aashish Didwania
- Department of Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Mattias Donelan
- Shriners Hospital for Children-Boston, Harvard Medical School, Boston, Massachusetts.,Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jeffrey S Dover
- SkinCare Physicians, Chestnut Hill, Massachusetts.,Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island.,Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | - Hassan Galadari
- College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | | | - Mitchel P Goldman
- Cosmetic Laser Dermatology, West Dermatology Company, San Diego, California
| | - Merete Haedersdal
- Department of Dermatology, Bispebjerg University Hospital, Copenhagen, Denmark.,Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - George Hruza
- Departments of Dermatology and Otolaryngology, St Louis University-Laser and Dermatologic Surgery Center, St Louis, Missouri
| | | | - Arielle Kauvar
- New York Laser & Skin Care, New York.,New York University Grossman School of Medicine, New York, New York
| | - Kristen M Kelly
- Department of Dermatology, University of California Irvine School of Medicine, Irvine
| | - Andrew C Krakowski
- Department of Dermatology, St. Luke's University Health Network, Easton, Pennsylvania
| | - Rachel Miest
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Jeffrey S Orringer
- Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor
| | - David M Ozog
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | | | - Peter R Shumaker
- Veterans Affairs San Diego Healthcare System and University of California, San Diego, California
| | - Joseph F Sobanko
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kathleen Suozzi
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | - Mark B Taylor
- Gateway Aesthetic Institute & Laser Center, Salt Lake City, Utah
| | - Joyce M C Teng
- Department of Dermatology, School of Medicine, Stanford University, Stanford, California
| | | | - Jill Waibel
- Miami Dermatology and Laser Institute, Miami, Florida
| | - Molly Wanner
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Ina Ratchev
- Section of Cutaneous Surgery, Northwestern Medical Group, Chicago, Illinois
| | - Rachel E Christensen
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Emily Poon
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Corinne H Miller
- Galter Health Sciences Library & Learning Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Murad Alam
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Department of Otolaryngology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| |
Collapse
|