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Liu B, Sood R, Wang F, Zhang F, Sun L, Qiu X, Zhao D, Lineaweaver WC. Principles and clinical applications of transcutaneous laser-assisted drug delivery: A narrative review. Scars Burn Heal 2024; 10:20595131241234715. [PMID: 38505821 PMCID: PMC10949547 DOI: 10.1177/20595131241234715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024] Open
Abstract
Introduction Transcutaneous laser-assisted drug delivery (LADD) is recognized as a developing therapy for skin disorders. Method Current literature was reviewed to summarize current applications for LADD. Discussion 12 clinical applications for this therapy are currently reported. Conclusion LADD has potential for wide application in skin disorder treatment. Lay Summary Laser assisted drug delivery improves drug bioavailability for treatment of skin disorders. This technique is being assessed clinically in disorders ranging from skin cancers to alopecia.
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Affiliation(s)
- Baoyi Liu
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
| | - Rajiv Sood
- Burn and Reconstruction Centers of America Augusta, Augusta, GA, USA
| | - Fuyang Wang
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
| | - Feng Zhang
- Burn and Reconstruction Centers of America Augusta, Augusta, GA, USA
| | - Lu Sun
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
| | - Xing Qiu
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
| | - Dewei Zhao
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
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Sullivan DA, da Costa AX, Del Duca E, Doll T, Grupcheva CN, Lazreg S, Liu SH, McGee SR, Murthy R, Narang P, Ng A, Nistico S, O'Dell L, Roos J, Shen J, Markoulli M. TFOS Lifestyle: Impact of cosmetics on the ocular surface. Ocul Surf 2023; 29:77-130. [PMID: 37061220 PMCID: PMC11246752 DOI: 10.1016/j.jtos.2023.04.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 04/17/2023]
Abstract
In this report the use of eye cosmetic products and procedures and how this represents a lifestyle challenge that may exacerbate or promote the development of ocular surface and adnexal disease is discussed. Multiple aspects of eye cosmetics are addressed, including their history and market value, psychological and social impacts, possible problems associated with cosmetic ingredients, products, and procedures, and regulations for eye cosmetic use. In addition, a systematic review that critically appraises randomized controlled trial evidence concerning the ocular effects of eyelash growth products is included. The findings of this systematic review highlight the evidence gaps and indicate future directions for research to focus on ocular surface outcomes associated with eyelash growth products.
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Affiliation(s)
| | | | - Ester Del Duca
- Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | | | | | - Sihem Lazreg
- Lazreg Cornea and Ocular Surface Center, Blida, Algeria
| | - Su-Hsun Liu
- University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | | | | | | | - Alison Ng
- Centre for Ocular Research & Education, School of Optometry and Vision Science, University of Waterloo, Waterloo, Canada
| | - Steven Nistico
- Department of Dermatology, University Magna Graecia, Catanzaro, Italy
| | | | | | - Joanne Shen
- Department of Ophthalmology, Mayo Clinic in Arizona, Scottsdale, AZ, USA
| | - Maria Markoulli
- School of Optometry and Vision Science, UNSW Sydney, NSW, Australia
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3
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Scarcella G, Pieri L, Fusco I. Skin Fractional Scar Treatment with a New Carbon Dioxide Scanner: Histological and Clinical Evaluation. Photobiomodul Photomed Laser Surg 2022; 40:424-432. [DOI: 10.1089/photob.2021.0165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Giuseppe Scarcella
- General Secretary and National Head of Laser Department of ISPLAD, International-Italian Society of Plastic-Regenerative and Oncologic Dermatology, Verona, Italy
| | | | - Irene Fusco
- Department of Pharmacology, University of Florence, Florence, Italy
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de Filippi Sartori J, Osaki TH, Osaki MH, de Souza RB, Allemann N. "Split-Face" Evaluation of Collagen Changes Induced by Periorbital Fractional CO2 Laser Resurfacing. Aesthet Surg J 2022; 42:239-248. [PMID: 34618888 DOI: 10.1093/asj/sjab357] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Periorbital fractional CO2 laser resurfacing has been employed for facial rejuvenation purposes. However, to the best of our knowledge, no study has objectively assessed periorbital neoformation and remodeling of local cutaneous collagen, in a split-face model, from skin samples obtained during upper blepharoplasty. OBJECTIVES The authors sought to objectively evaluate neoformation and remodeling of local cutaneous collagen after periorbital skin fractional CO2 laser resurfacing. METHODS Sixteen female patients presenting with dermatochalasis and periorbital rhytids were evaluated in a prospective and comparative study. All patients underwent unilateral periorbital fractional CO2 laser resurfacing 30 days before upper blepharoplasty. Quantification of types I and III collagen from laser-treated and untreated eyelid skin samples obtained during upper blepharoplasty was assessed with histochemical analysis (Picrosirius Red staining). Laser resurfacing treatment was applied to the untreated side immediately after the upper blepharoplasty. Two blinded, independent physicians evaluated clinical improvement in pretreatment and 1- and 6-month posttreatment digital images. RESULTS Histochemical analysis showed significantly higher intensity in collagen types I (treated: 158.7 ± 5.3, untreated: 139.2 ± 5.0; P < 0.0001) and III (treated: 105.1 ± 7.7, untreated: 104.1 ± 7.1; P < 0.0001) in the fractional CO2 laser treatment samples; a greater difference was detected in collagen type I. A significant improvement in periorbital rhytidosis was observed 1 month after laser resurfacing (23%); a greater improvement in the periorbital region was observed 6 months after laser resurfacing and upper blepharoplasty (43.67%). CONCLUSIONS Periorbital fractional CO2 laser resurfacing was an effective method to improve palpebral skin, with histochemical evidence of increase in collagen types I and III. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Juliana de Filippi Sartori
- Division of Ophthalmic Plastic and Reconstructive Surgery, Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo (EPM/ UNIFESP), São Paulo, SP, Brazil
| | - Tammy Hentona Osaki
- Division of Ophthalmic Plastic and Reconstructive Surgery, Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo (EPM/ UNIFESP), São Paulo, SP, Brazil
| | - Midori Hentona Osaki
- Periorbital Aesthetics Sector, Division of Ophthalmic Plastic and Reconstructive Surgery, Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo (EPM/UNIFESP), São Paulo, SP, Brazil
| | - Rodrigo Barbosa de Souza
- Department of Genetics and Evolutionary Biology, Institute of Biosciences, University of São Paulo, São Paulo, SP, Brazil
| | - Norma Allemann
- Division of Ocular Imaging, Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo (UNIFESP/ EPM), São Paulo, SP, Brazil
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5
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Jordão JM, Stoliar MFF, Melo SS, de Campos GLM, de Forville Mesquita LA, Skare TL. Low-fluence and low-density CO2 laser: histological analysis of collagen fiber changes in skin and its clinical repercussions in photorejuvenation. Lasers Med Sci 2021; 37:905-911. [PMID: 34009520 DOI: 10.1007/s10103-021-03330-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 05/03/2021] [Indexed: 10/21/2022]
Abstract
This study refers to clinical and histologic analysis of effects on photorejuvenation after one single treatment of fractional CO2 laser with low fluence and low density. To analyze histologically the quantitative variation of collagen fibers type I and III, elastic fibers, and epidermal thickness on D84, besides clinical evaluation of amount, length, thickness, and depth of periocular wrinkles during the same period. This is an open, prospective, interventional study. There were 40 healthy female with age between 35 and 65 years. Twenty-six participants were randomly selected for D0 and D84 biopsy. A single session of fractional CO2 laser was done in the hole face, using a 800-µm tip, 5% density, and 10 mJ fluence with a single pass. On D0, D42, and D84, a clinical comparative analysis of amount, length, depth, and thickness of periocular wrinkles has been done. On histological analysis, a comparative quantitative evaluation of collagen fibers type I and III, elastic fibers, and epidermal thickness has been done on D0 and D84. The results of this study denoted a significant clinical improvement of amount (- 32.17%; p < 0.0001), thickness (- 33%; p < 0.0001), lenght (- 35.84%; p < 0.0001), and depth of periocular wrinkles (- 32.46%; p < 0.0001). A significant increase in the amount of collagen fibers type III was observed on D84 (+ 60.67%; p = 0.0013). Collagen fibers type I and elastic fibers did not have the same result, with a nonsignificant increase (+ 8.31%; p = 0.3820) and a decrease (- 12.4%; p = 0.0585) respectively. Epidermal thickness has a tendency to significant variation (p = 0.05553). The results demonstrate that fractional CO2 laser with low fluence and low density is a safe and efficient option for photorejuvenation of the face.
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Affiliation(s)
- Juliana Merheb Jordão
- Head of Laser Therapy Dermatology Department, Hospital Universitário Evangélico Mackenzie, Curitiba, PR, Brazil.
| | | | - Sarah Sanches Melo
- Dermatology Department, Hospital Universitário Evangélico Mackenzie, Curitiba, PR, Brazil
| | | | | | - Thelma Larocca Skare
- Rheumatology Department, Hospital Universitário Evangélico Mackenzie, Curitiba, PR, Brazil
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6
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Motta MM, Stelini RF, Calderoni DR, Gilioli R, Damiani GV, César CL, Kharmandayan P. Effects of the lower energy and pulse stacking in carbon dioxide laser skin treatment: an objective analysis using second harmonic generation. Acta Cir Bras 2021; 36:e360304. [PMID: 33978061 PMCID: PMC8112111 DOI: 10.1590/acb360304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/11/2021] [Indexed: 01/31/2023] Open
Abstract
PURPOSE To evaluate the effect of fractional carbon dioxide (CO2) laser treatment using lower power associated with pulse stacking within collagen fibers, using second harmonic generation microscopy and computerized image analysis. METHODS Twenty male Wistar rats aging eight weeks were used. Each treatment area received a single-pass CO2 fractional laser with different parameters. The 20 animals were divided into two groups and euthanized after 30 and 60 days. Second harmonic generation images were obtained and program ImageJ was utilized to evaluate the collagen organization within all areas. Collagen anisotropy, entropy and optical density were quantified. RESULTS Increased anisotropy over time was observed in all four areas, but only reached statistical significance (p = 0.0305) when the mildest parameters were used (area four). Entropy decreased over time in all areas, but without significance(p = 0.1779) in area four. Density showed an overtime increase only in area four, but no statistical significance was reached (p = 0.6534). CONCLUSIONS When combined, the results obtained in this study regarding anisotropy, entropy and density tend to demonstrate that it is possible to achieve collagen remodeling with the use of lower power levels associated with stacked pulses.
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7
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Nistico SP, Silvestri M, Zingoni T, Tamburi F, Bennardo L, Cannarozzo G. Combination of Fractional CO 2 Laser and Rhodamine-Intense Pulsed Light in Facial Rejuvenation: A Randomized Controlled Trial. PHOTOBIOMODULATION PHOTOMEDICINE AND LASER SURGERY 2021; 39:113-117. [PMID: 33449867 DOI: 10.1089/photob.2020.4876] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective: This randomized controlled trial aims to verify the efficacy of a combined fractional CO2 laser and rhodamine-intense pulsed-light (r-IPL) protocol in the photoaging therapy. Background: Skin aging is related to multiple environmental and genetic factors that give rise to different manifestations. In recent years many techniques have been proposed for the rejuvenation of the skin of the face such as ablative and nonablative procedures. Combination of laser or light sources with different wavelengths represents a safe and effective treatment method. r-IPL is a new pulsed-light technique capable to generate wavelengths varying from 550 to 650 nm proposed in nonablative photorejuvenation with a good efficacy and safety profile. Methods: Twenty-two patients (skin phototypes II-III, aged 46-67 years) were randomly allocated into two groups: group A was treated only with a therapeutic standard dose of the fractional CO2 laser, whereas group B was treated with a combined therapy of r-IPL and fractional CO2 laser. All patients were treated up to three times at a 2-month interval. Efficacy of the procedures was assessed thanks to the Fitzpatrick Wrinkle Severity Scale (scores 1-9) before treatment and at a 4-month follow-up from the last treatment. Results: Patients treated with the combination of r-IPL and fractional CO2 laser showed better results in terms of wrinkle reduction according to the Fitzpatrick Wrinkle Severity score (2.82 ± 0.87 vs. 3.09 ± 1.14), with a statistically significant reduction in healing times (7.82 ± 0.75 vs. 13.82 ± 1.94 days, p ≤ 0.001) and duration of post-treatment erythema (3.55 ± 0.93 vs. 8.18 ± 1.47 days, p ≤ 0.001). Patient satisfaction was higher after combined fractional CO2 laser and r-IPL treatment. Conclusions: Our data suggest that combined use of fractional CO2 laser and r-IPL may lead to excellent results in terms of skin rejuvenation with a simple post-treatment management and an optimal tolerability.
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Affiliation(s)
| | - Martina Silvestri
- Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
| | - Tiziano Zingoni
- Unit of Dermatology, University of Rome, Tor Vergata, Rome, Italy
| | - Federica Tamburi
- Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
| | - Luigi Bennardo
- Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
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8
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Scarano A, Carinci F, Festa F, Candotto V, Amore R, Lorusso F. Periauricular wrinkles removed with voltaic arc dermabrasion (Atmospheric Plasma technique). J Cosmet Dermatol 2019; 19:1709-1714. [DOI: 10.1111/jocd.13204] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 08/22/2019] [Accepted: 10/07/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Antonio Scarano
- Department of Medical, Oral and Biotechnological Sciences University of Chieti‐Pescara Chieti Italy
- Master Program in Aesthetic Medicine University of Chieti‐Pescara Chieti Italy
| | - Francesco Carinci
- Master Program in Aesthetic Medicine University of Chieti‐Pescara Chieti Italy
| | - Felice Festa
- Department of Medical, Oral and Biotechnological Sciences University of Chieti‐Pescara Chieti Italy
| | - Valentina Candotto
- Medical‑Surgical Sciences of Communication and Behavior, Section of Maxillofacial and Plastic Surgery University of Ferrara Ferrara Italy
- Department of Biomedical, Surgical and Dental Sciences University of Milan Milan Italy
| | - Roberto Amore
- Master of Techniques of Aesthetic Medicine and Wellness University of Palermo Palermo Italy
| | - Felice Lorusso
- Department of Medical, Oral and Biotechnological Sciences University of Chieti‐Pescara Chieti Italy
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Abstract
The aging to the upper eyelid complex includes skin laxity, resulting in rhytids, orbicularis oculi hypertrophy, and pseudohermitian of orbital fat and nowadays a high number of patients seeking cosmetic surgery. Excess and laxity of upper eyelid skin affect more than 90% of women, the impact of these problems on the patient's self-esteem can become important enough to affect quality of life in psychological and sociocultural terms.The aim of the study was to evaluate the clinical efficacy of blepharoplasty with an electrosurgical technology for treatment of skin laxity of upper eyelid, which produced a lid retraction and an elevation of the upper lid without complications.This retrospective evaluation was conducted from October 2008 to July 2015, where 80 patients (56 female and 24 male) were treated for excess and laxity of upper eyelid skin with voltaic arc dermabrasion.The outcome was that all patients displayed some aspects of tissue contraction that stretched the lax skin of the upper eyelids, resulting in cosmetic improvement.In conclusion this technique was predictable and useful to remove the laxity of upper eyelid skin minimal recurrence rates, and acceptable aesthetics.
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10
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Evaluation Effectiveness of the Voltaic Arc Dermabrasion in Perioral Rhytides Eradication. J Craniofac Surg 2017; 27:1205-8. [PMID: 27300456 DOI: 10.1097/scs.0000000000002714] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Perioral rhytides affect more than 90% of women, the impact of these problems on the patient's self-esteem can become important enough to affect quality of life in psychological and sociocultural terms. Basic science shows that skin rhytides are related to loss in quantity and function of dermal collagen fibers. An electrosurgical technology was used in this study for treatment of perioral rhytides. The authors treated 34 patients (26 women and 8 men) for perioral rhytides with voltaic arc dermabrasion technique. Patient ages ranged between 30 and 65 years and the majority (90%) of these perioral areas had class II and III wrinkle scores. Voltaic arc dermabrasion was used to remove the keratinized layer for point perioral area. Treatments are minimally painful and in the authors' experience require no anesthesia. No discomfort should be expected once the voltaic arc dermabrasion treatment is concluded. The perioral dermis appears as a pale, erythematous, dull surface. Bleeding is not seen unless excessive abrading occurs with the saline-moistened gauze. No hyperpigmentation, hypopigmentation, erythema, ecchymosis, pain, itching, outbreaks of herpes, infectious processes, and scarring were observed. All patients monitored for fine perioral rhytides showed a reduction in the treated area. Since skin-specific quality of life was significantly improved after "voltaic arc" treatment, this therapy can be recommended for patients with perioral rhytides skin wishing to improve their appearance.
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11
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Motta MM, Stelini RF, Calderoni DR, Gilioli R, Kharmandayan P. Lower energy and pulse stacking. A safer alternative for skin tightening using fractional CO2 laser. Acta Cir Bras 2016; 31:28-35. [PMID: 26840353 DOI: 10.1590/s0102-865020160010000005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 12/23/2015] [Indexed: 01/09/2023] Open
Abstract
PURPOSE To evaluate the effect of different energies and stacking in skin shrinkage. METHODS Three decreasing settings of a fractional CO2 laser were applied to the abdomen of Twenty five Wistar rats divided into three groups. Group I (n=5) was histologically evaluated for microthermal zones dimensions. Groups II and III (n=10 each) were macroscopic evaluated with freeware ImageJ for area contraction immediately and after 30 and 60 days. RESULTS No statistical significance was found within microthermal zone histological dimensions (Group I) in all settings studied. (Ablation depth: 76.90 to 97.18µm; Coagulation depth: 186.01 to 219.84 µm). In Group II, macroscopic evaluation showed that all settings cause significant immediate skin contraction. The highest setting cause significant more intense tightening effect initially, contracting skin area from 258.65 to 179.09 mm2. The same pattern was observed in Group III. At 30 and 60 days, the lowest setting significantly sustained contraction. CONCLUSION Lower fractional CO2 laser energies associated to pulse stacking could cause consistent and long lasting tissue contraction in rats.
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12
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Non-ablative fractional laser assists cutaneous delivery of small- and macro-molecules with minimal bacterial infection risk. Eur J Pharm Sci 2016; 92:1-10. [DOI: 10.1016/j.ejps.2016.06.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 06/20/2016] [Accepted: 06/20/2016] [Indexed: 12/26/2022]
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Hersant B, Abbou R, SidAhmed-Mezi M, Meningaud JP. Assessment Tools for Facial Rejuvenation Treatment: A Review. Aesthetic Plast Surg 2016; 40:556-65. [PMID: 27178571 DOI: 10.1007/s00266-016-0640-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 04/15/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND In the field of cosmetic medicine, patient satisfaction is an important and common indicator used to measure the efficacy of the treatment. However, it is insufficient to prove objectively that the benefit of the specific factors involved in the cosmetic outcomes. The practitioner should be aware of these assessment tools, in particular in case of demanding or litigious patients. OBJECTIVE The aim of this review was to establish a list and discuss the subjective and objective methods used to assess facial aesthetic rejuvenation treatments. METHODS A systematic literature search was performed using the Pubmed search engine. Studies published over the last 5 years, i.e. between January 2010 and January 2015 were considered for review. The following keywords were used: "aesthetic treatment", "facial rejuvenation", and "subjective evaluation" or "objective evaluation". RESULTS Of the 446 articles identified by the search strategy, 47 articles focused specifically on facial rejuvenation and on the efficacy of aesthetic medical treatments were retrieved for review. Thirty-seven articles used quantitative methods to assess aesthetic treatment outcomes and only 12 used subjective methods. The different assessment methods were listed according to the tools used and treatment indications. CONCLUSION This review will help in choosing adequate methods to assess facial rejuvenation medical treatment. It is important to combine these tools adequately to improve the assessment. There is no current consensus on assess facial rejuvenation treatments but we noted that objective assessment methods seem helpful. NO LEVEL ASSIGNED This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- B Hersant
- Department of Maxillofacial and Plastic & Reconstructive Surgery, Henri Mondor Hospital, 51 avenue du Maréchal de Lattre de Tassigny, Créteil, 94010, France.
| | - R Abbou
- Department of Maxillofacial and Plastic & Reconstructive Surgery, Henri Mondor Hospital, 51 avenue du Maréchal de Lattre de Tassigny, Créteil, 94010, France
| | - M SidAhmed-Mezi
- Department of Maxillofacial and Plastic & Reconstructive Surgery, Henri Mondor Hospital, 51 avenue du Maréchal de Lattre de Tassigny, Créteil, 94010, France
| | - J P Meningaud
- Department of Maxillofacial and Plastic & Reconstructive Surgery, Henri Mondor Hospital, 51 avenue du Maréchal de Lattre de Tassigny, Créteil, 94010, France
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The Efficacy and Safety of Fractional CO₂ Laser Combined with Topical Type A Botulinum Toxin for Facial Rejuvenation: A Randomized Controlled Split-Face Study. BIOMED RESEARCH INTERNATIONAL 2016; 2016:3853754. [PMID: 26998485 PMCID: PMC4779842 DOI: 10.1155/2016/3853754] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 01/27/2016] [Indexed: 01/31/2023]
Abstract
Objective. We evaluated synergistic efficacy and safety of combined topical application of Botulinum Toxin Type A (BTX-A) with fractional CO2 laser for facial rejuvenation. Methods. Twenty female subjects were included for this split-face comparative study. One side of each subject's cheek was treated with fractional CO2 plus saline solution, and the other side was treated with fractional CO2 laser plus topical application of BTX-A. Patients received one session of treatment and evaluations were done at baseline, one, four, and twelve weeks after treatment. The outcome assessments included subjective satisfaction scale; blinded clinical assessment; and the biophysical parameters of roughness, elasticity, skin hydration, transepidermal water loss (TEWL), and the erythema and melanin index. Results. BTX-A combined with fractional CO2 laser sides showed higher physician's global assessment score, subject satisfaction score, roughness, skin hydration, and skin elasticity compared to that of fractional CO2 plus saline solution side at 12 weeks after treatment. TEWL and erythema and melanin index showed no significant differences between two sides at baseline, one, four, and twelve weeks after treatment. Conclusion. Topical application of BTX-A could enhance the rejuvenation effect of fractional CO2 laser.
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15
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Cannarozzo G, Sannino M, Tamburi F, Chiricozzi A, Saraceno R, Morini C, Nisticò S. Deep pulse fractional CO2 laser combined with a radiofrequency system: results of a case series. Photomed Laser Surg 2016; 32:409-12. [PMID: 24992275 DOI: 10.1089/pho.2014.3733] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The purpose of this study was evaluation of the safety and efficacy of this new combined technology that adds deep ablation to thermal stimulation. BACKGROUND DATA Minimally ablative or subablative lasers, such as fractional CO2 lasers, have been developed in an attempt to achieve the same clinical results observed with traditional ablative lasers, but with fewer side effects. Despite being an ablative laser, the system used in this study is able to produce a fractional supply of the beam of light. Fractional ablation of skin is performed through the development of microscopic vertical columns surrounded by spared areas of epidermis and dermis, ensuring rapid wound healing and minimum down time. Simultaneous synchronized delivery of a radiofrequency (RF) current to the deeper layers of the skin completes the therapeutic scenario, ensuring an effective skin tightening effect over the entire treated area. METHODS Nine adult patients were treated for wrinkles and acne scars using this new laser technology. An independent observer evaluated the improvement using a five point scale. RESULTS All patients had good results in terms of improvement of skin texture, with mild and transitory side effects. CONCLUSIONS This novel combined system produced improvement in wrinkles and acne scars, with progressive enhancement of skin tone and elasticity.
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16
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Borges J, Cuzzi T, Mandarim-de-Lacerda CA, Manela-Azulay M. Fractional Erbium laser in the treatment of photoaging: randomized comparative, clinical and histopathological study of ablative (2940nm) vs. non-ablative (1540nm) methods after 3 months. An Bras Dermatol 2014; 89:250-8. [PMID: 24770501 PMCID: PMC4008055 DOI: 10.1590/abd1806-4841.20142370] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 03/08/2013] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Fractional non-ablative lasers keep the epidermis intact, while fractional ablative lasers remove it, making them theoretically more effective. OBJECTIVES To evaluate the clinical and histological alterations induced by fractional photothermolysis for treating photoaging, comparing the possible equivalence of multiple sessions of 1540nm Erbium, to one session of 2940nm Erbium. METHODS Eighteen patients (mean age 55.9) completed the treatment with three sessions of 1540nm fractional Erbium laser on one side of the face (50 mJ/mB, 15ms, 2 passes), and one session of 2940nm on the other side (5mJ/mB, 0.25ms, 2 passes). Biopsies were performed before and 3 months after treatment. Clinical, histological and morphometric evaluations were carried out. RESULTS All patients presented clinical improvement with no statistically significant difference (p> 0.05) between the treated sides. Histopathology revealed a new organization of collagen and elastic fibers, accompanied by edema, which was more evident with the 2940nm laser. This finding was confirmed by morphometry, which showed a decrease in collagen density for both treatments, with a statistical significance for the 2940nm laser (p > 0.001). CONCLUSIONS Three 1540nm sessions were clinically equivalent to one 2940nm session. The edema probably contributed to the positive results after three months, togheter with the new collagen and elastic fibers organization. The greater edema after the 2940nm session indicates that dermal remodeling takes longer than with 1540nm. It is possible that this histological superiority relates to a more prolonged effect, but a cohort longer than three months is needed to confirm that supposition.
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Affiliation(s)
- Juliano Borges
- Santa Casa de Misericórdia do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Tullia Cuzzi
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Lin CH, Aljuffali IA, Fang JY. Lasers as an approach for promoting drug delivery via skin. Expert Opin Drug Deliv 2014; 11:599-614. [PMID: 24490743 DOI: 10.1517/17425247.2014.885501] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Using lasers can be an effective drug permeation-enhancement approach for facilitating drug delivery into or across the skin. The controlled disruption and ablation of the stratum corneum (SC), the predominant barrier for drug delivery, is achieved by the use of lasers. The possible mechanisms of laser-assisted drug permeation are the direct ablation of the skin barrier, optical breakdown by a photomechanical wave and a photothermal effect. It has been demonstrated that ablative approaches for enhancing drug transport provide some advantages, including increased bioavailability, fast treatment time, quick recovery of SC integrity and the fact that skin surface contact is not needed. In recent years, the concept of using laser techniques to treat the skin has attracted increasing attention. AREAS COVERED This review describes recent developments in using nonablative and ablative lasers for drug absorption enhancement. This review systematically introduces the concepts and enhancement mechanisms of lasers, highlighting the potential of this technique for greatly increasing drug absorption via the skin. Lasers with different wavelengths and types are employed to increase drug permeation. These include the ruby laser, the erbium:yttrium-gallium-garnet laser, the neodymium-doped yttrium-aluminum-garnet laser and the CO2 laser. Fractional modality is a novel concept for promoting topical/transdermal drug delivery. The laser is useful in enhancing the permeation of a wide variety of permeants, such as small-molecule drugs, macromolecules and nanoparticles. EXPERT OPINION This potential use of the laser affords a new treatment for topical/transdermal application with significant efficacy. Further studies using a large group of humans or patients are needed to confirm and clarify the findings in animal studies. Although the laser fluence or output energy used for enhancing drug absorption is much lower than for treatment of skin disorders and rejuvenation, the safety of using lasers is still an issue. Caution should be used in optimizing the feasible conditions of the lasers in balancing the effectiveness of permeation enhancement and skin damage.
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Affiliation(s)
- Chih-Hung Lin
- Chang Gung University of Science and Technology, Center for General Education, Chronic Diseases and Health Promotion Research Center, Kweishan, Taoyuan, Taiwan
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Skin ablation by physical techniques for enhancing dermal/transdermal drug delivery. J Drug Deliv Sci Technol 2014. [DOI: 10.1016/s1773-2247(14)50046-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Noninvasive delivery of siRNA and plasmid DNA into skin by fractional ablation: erbium:YAG laser versus CO₂ laser. Eur J Pharm Biopharm 2013; 86:315-23. [PMID: 23962771 DOI: 10.1016/j.ejpb.2013.08.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 07/31/2013] [Accepted: 08/05/2013] [Indexed: 12/21/2022]
Abstract
The present study was conducted to evaluate the impacts of fractional erbium (Er):YAG and CO2 lasers on skin permeation of small interfering (si)RNA and plasmid (p)DNA vectors. In vitro skin delivery was determined with a Franz diffusion cell. In vivo absorption was investigated by observing fluorescence and confocal microscopic imaging. Fractional laser-mediated ablation of the skin resulted in significant enhancement of dextran and siRNA penetration. Respective fluxes of dextran (10 kDa) and siRNA, which had similar molecular size, with Er:YAG laser irradiation at 5 J/cm(2) were 56- and 11-fold superior to that of intact skin. The respective permeation extents of dextran and siRNA by the CO2 laser at 4 mJ/400 spots were 42- and 12-fold greater than that of untreated skin. Fluorescence and confocal images showed increased fluorescence intensities and penetration depths of siRNA and pDNA delivery. According to an examination of the follicular permeant amount and fluorescence microscopy, hair follicles were important deposition areas for fractional laser-assisted delivery, with the Er:YAG modality revealing higher follicular siRNA selectivity than the CO2 modality. This is the first report of siRNA and pDNA penetrating the skin with a sufficient amount and depth with the assistance of fractional lasers.
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Campolmi P, Bonan P, Cannarozzo G, Bruscino N, Moretti S. Efficacy and safety evaluation of an innovative CO2 laser/radiofrequency device in dermatology. J Eur Acad Dermatol Venereol 2012; 27:1481-90. [PMID: 23176105 DOI: 10.1111/jdv.12029] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND CO2 laser has not only become the most widely used laser in dermatological surgical practice, but it has also proved to be highly effective in treating aesthetic imperfections. OBJECTIVE To examine the efficacy and safety of a novel fractional CO2 laser combined with a radiofrequency device in different dermatological, surgical and aesthetic fields. METHODS A total of 79 patients were treated in our Outpatient Service with a novel fractional CO2 laser combined with a bipolar radiofrequency device for a maximum of 5 months. Group A consisted of 39 patients with lesions requiring complete excision, whereas Group B consisted of 40 subjects seeking to enhance aesthetic facial imperfections. The results were assessed by three 'blind' investigators using photographs and clinical observations; in addition, the patients had to give their own subjective assessment of the results. RESULTS At the 6-month follow-up, the lesions of the Group A patients had been completely removed, except for one case of a large sebaceous nevus on the scalp. All the Group B patients showed global improvement in skin tightening, removal of fine lines and rhytides and correction of dilated pores and hyperpigmentation, with no significant side-effects and short downtimes. CONCLUSION This kind of laser meets the needs of the majority of dermatologists requiring a unique, versatile tool to remove cutaneous lesions and at the same time, safely and effectively treat skin imperfections.
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Affiliation(s)
- P Campolmi
- Department of Dermatology II, University of Florence, Florence, Italy
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