Nonsurgical Facial Rejuvenation Procedures in Patients Under 50 Prior to Undergoing Facelift: Habits, Costs, and Results

Background

Facial rejuvenation in patients younger than 50 years of age has experienced an unprecedented growth with multimodality nonsurgical and less invasive rhytidectomy techniques.

Objectives

To analyze the nonsurgical treatment habits of patients prior to undergoing rhytidectomy at <50 years of age.

Methods

Retrospective study to enlist patients who underwent primary rhytidectomy at age <50 years between January 1, 2003 and December 31, 2013 by the senior author (AAJ) to complete a survey.

Results

One hundred and fifty-seven patients were surveyed. Patients had nonsurgical rejuvenation starting at an average age of 37 years and rhytidectomy at an average age of 44 years. Thirty-two percent of responders had injectable treatments prior to their facelift, reporting a mean of 7 rounds of injectable treatments prior to pursuing rhytidectomy. Sixteen percent of responders had laser skin resurfacing undergoing 4 separate treatments prior to rhytidectomy, and 10% had energy-based facial tightening treatments one time prior to their rhytidectomy. Average expenditure on nonsurgical treatments prior to rhytidectomy was $7000 cumulatively. Fifty-nine percent of patients who went on to rhytidectomy did not report regret over this cost expenditure. Patients reported that they appeared 4 years younger after nonsurgical intervention, and 8 years younger after their facelift, a statistically significant difference (P = .048).

Conclusions

Patients undergoing rhytidectomy <50 years old begin less invasive facial rejuvenation treatments at an even earlier age. The majority of these patients did not regret the costs associated with noninvasive treatments, even though they saw that rhytidectomy provided a greater rejuvenation effect. Rhytidectomy surgeons should incorporate nonsurgical techniques into their practice to best serve the needs of the modern aging face patient.

Laser Surgeon, Client Education, and Satisfaction with Tattoo Removal

Studies of satisfaction with tattoo removal outcomes by laser, rated by clients themselves, including qualitative aspects, are sparse. We studied long-term results and client satisfaction with tattoo removal by Q-switched YAG laser. Client satisfaction is influenced by numerous factors: pretreatment expectations, objective observations, pretreatment information, laser treatment procedures, and outcome, including subjective experiences such as pain. Client-surgeon interaction during the full laser treatment course is a major determinant of client satisfaction. The client is in a dynamic state of mind and undergoes a change of opinion during a laser treatment course as a result of his/her experiences. In this continuous process of learning, expectations are changed from a state of high expectation before treatment to a more realistic state with acceptance of outcome. The laser surgeon shall be aware of his/her role as a tutor and prepare the client for a situation, where outcomes can be acceptable albeit not ideal.

Patient Tolerance of In-Office Pulsed Dye Laser Treatments to the Upper Aerodigestive Tract

INTRODUCTION: Recent advances in technology have facilitated a movement toward unsedated in-office treatment of laryngeal, tracheal, and esophageal lesions. The objective of this study was to determine patient tolerance of inoffice pulsed-dye laser (PDL) treatment of upper aerodigestive tract pathoses via the transnasal esophagoscope.

METHODS: Three hundred twenty-eight unsedated in-office PDL cases were performed at a university-based tertiary referral center in 131 patients. These procedures were performed for various upper aerodigestive pathoses, including recurrent respiratory papillomatosis, chronic granulomas, and recurrent leukoplakia. Eighty-nine subjects completed a phone survey concerning their discomfort level after the PDL procedure. They were also asked specific questions about recovery time, pain medication, and preference of operating room versus inoffice procedures.

RESULTS: The average comfort score was 7.4 (10 being minimal discomfort). Eighty-four percent did not use any pain medication; 87% stated that, if possible, they would prefer to undergo unsedated inoffice procedures rather than surgeries under general anesthesia for further treatment of their upper aerodigestive tract pathosis.

CONCLUSIONS: Unsedated transnasal treatment of upper aerodigestive tract pathoses is readily accepted and well-tolerated by otolaryngology patients. Patients overwhelmingly prefer the inoffice PDL over surgeries under general anesthesia.

Role of psychological intervention in fetoscopic laser surgery of twin-to-twin transfusion syndrome

OBJECTIVE

This study aims to investigate the influence of application of psychological intervention in fetoscopic laser surgery of twin-to-twin transfusion syndrome (TTTS) on perinatal outcome.

MATERIALS AND METHODS

A total of ten cases of pregnant women diagnosed with TTTS from January 2007 to December 2009 in the present hospital were selected. Their gestational weeks ranged from 16 to 29 weeks. Under the location of B ultrasound, the method of intra-amniotic fetoscopic laser occlusion of chorioangiopagous vessels (FLOC) plus amnioreduction was conducted for treatment. Contemporarily, psychological intervention was also carried out.

RESULTS

Preoperative, intraoperative, and postoperative behavior controls of all pregnant women were good, and all operations were successfully completed to achieve the desired purpose of rehabilitation discharge.

CONCLUSION

Fetoscopic laser surgery is an effective treatment for TTTS and competent psychological intervention is one of important measures for successful operation and pregnant woman rehabilitation discharge.

Effects of laserneedle acupuncture on olfactory sensitivity of healthy human subjects: a placebo-controlled, double-blinded, randomized trial

The aims of the present study were to investigate the influence of laserneedle acupuncture on olfactory sensitivity and to examine whether the attitude towards laserneedle acupuncture affects the outcome. Olfaction was tested repeatedly on two days using the olfactory detection threshold subtest of the Sniffin' Sticks test battery in sixty-four healthy subjects of which 32 showed a positive attitude towards the effects of laserneedle acupuncture and 32 were sceptic about its effects. Testing was accomplished three times on day one (T1 = 0 min, T2 = 35 min, T3 = 105 min) without laserneedle acupuncture and on day two (T1* = 0 min, T2* = 35 min, T3* = 105 min) when the subjects were randomized in a non-stimulation (placebo) and a stimulation (laserneedle acupuncture) group. Stimulation or non-stimulation was conducted in a double-blinded design. Following laserneedle acupuncture a significant decrease in olfactory detection thresholds was observed at both, T2* and T3*, whereas no significant changes were found in the baseline or placebo group. Effects of laserneedle acupuncture on the olfactory detection threshold did not differ between sceptic and non-sceptic subjects. In conclusion, laserneedle acupuncture is an effective method to improve olfactory sensitivity after one session of stimulation for at least one hour, independently of the attitude of subjects towards the stimulation method.

Perception of, and anxiety levels induced by, laser treatment in patients with sight-threatening diabetic retinopathy. A multicentre study

AIMS

To investigate how laser treatment is perceived, in terms of anxiety and awareness, by diabetic patients attending four centres in Northern Italy with specific interest and expertise in diabetic retinopathy, where work settings and flow are organized differently.

METHODS

The Hospital Anxiety and Depression Scale (HADS), Family Apgar-List of Threatening Experiences (FA-LTE), State-Trait Anxiety Inventories 1 and 2 (STAI-1 and STAI-2) questionnaires were completed by 259 patients, 131 waiting for laser treatment and 128 control subejcts awaiting non-intervention visits. Open questions were also asked on whether patients had ever heard the word 'laser' and whether they could describe laser treatment.

RESULTS

High scores were detected by HADS, STAI-1 and STAI-2 among patients waiting for photocoagulation. Anxiety was greater in women and people with poor schooling. After controlling for centres, gender, previous laser treatment and schooling, HADS and STAI-1 remained significantly lower among persons waiting for non-intervention visits. Having received photocoagulation previously did not modify anxiety. Anxiety was lower in those centres where facilities and resources were more patient-oriented. Most patients could neither describe photocoagulation nor explain why they were about to receive it, but had a negative perception and some described it with words evoking cruelty and pain.

CONCLUSIONS

These data suggest that laser treatment is experienced as an event that causes anxiety. Preoperative education and counselling may help to reduce fear and patients' avoidance of treatment.

Management of epistaxis in hereditary hemorrhagic telangiectasia by Nd:YAG laser and quality of life assessment using the HR-QoL questionnaire

The purpose of this study was to describe the results of Nd:YAG laser application in hereditary hemorrhagic telangiectasia (HHT) patients and to measure the Health-Related Quality of Life (HR-QoL) in patients with HHT before and after Nd:YAG laser application in a prospective, clinical trial at a university hospital. Twenty-seven consecutive patients with HHT and mild to moderate degrees of epistaxis were followed-up for 2 years after Nd:YAG laser treatments. Recurrence of epistaxis after Nd:YAG laser application and measurement of HR-QoL using the International Quality of Life Assessment questionnaire, version 1.1 (IQOLA 1.1), was found. Eight patients (30%) received only one Nd:YAG laser treatment, 15 (56%) had a recurrence and received a second treatment and 4 (14%) had two recurrences and received three Nd:YAG laser treatments. HR-QoL was improved 2 years after the first Nd:YAG laser application in both its Physical Health Dimension (47.5+/-2.9 vs. 38.1+/-2.3 before treatment, P <0.05) and Mental Health Dimension (45.1+/-2.7 vs. 39.6+/-2.4 before treatment, P <0.05). Although no curative treatment for HHT exists, Nd:YAG laser treatment seems to constitute a simple and efficient method of epistaxis control, resulting in a significant improvement in quality of life.

Phonomicrosurgery in singers and performing artists: treatment outcomes, management theories, and future directions

Phonomicrosurgery in performing artists has historically been approached with great trepidation, and vocal outcome data are sparse. The vocal liability of surgically disturbing the superficial lamina propria (SLP) and epithelium must be balanced with the inherent detrimental vocal effect of the lesion(s). A prospective investigation was performed on 185 performing artists who underwent phonomicrosurgical resection of 365 lesions: 201 nodules, 71 polyps, 66 varices and ectasias, 13 cysts, 8 keratotic lesions, 2 granulomas, 2 Reinke's edema, and 2 papillomas. Nearly all patients with SLP lesions reported improvement in their postsurgical vocal function. This subjective result was supported by objective acoustic and aerodynamic measures. All postsurgical objective vocal function measures fell within normal limits, including a few that displayed presurgical abnormalities. However, given the relative insensitivity of standard objective measures to assess higher-level vocal performance-related factors, it is even more noteworthy that 8 of 24 objective measures displayed statistically significant postsurgical improvements in vocal function. Such changes in objective measures mostly reflect overall enhancement in the efficiency of voice production. Phonomicrosurgical resection of vocal fold lesions in performing artists is enjoying an expanding role because of a variety of improvements in diagnostic assessment, surgical instrumentation and techniques, and specialized rehabilitation. Most of these lesions are the result of phonotrauma and arise within the SLP. Successful management depends on prudent patient selection and counseling, ultraprecise technique, and vigorqus vocal rehabilitation. Furthermore, an understanding of the vocal function and dysfunction of this high-performance population provides all otolaryngologists who manage laryngeal problems with valuable information that they can extrapolate for use in their practices.

[Preoperative expectations and clinical outcome of transmyocardial laser treatment in patients with angina pectoris]

BACKGROUND

The aims of this study were to evaluate the effect of transmyocardial laser treatment on quality of life and to assess the correlation between preoperative expectations and clinical improvement after one year.

MATERIAL AND METHODS

13 patients (median age 56 years) with disabling angina pectoris were subjected to transmyocardial holmium: YAG laser. Quality of life was assessed preoperatively and at three and 12 months by Hospital Anxiety and Depression Scale (HAD), Physical Symptom Distress Index (PSDI) and Life Satisfaction Index (LSI). Expectations were evaluated by Leedham's scale.

RESULTS

A significant improvement in Canadian Cardiovascular Society Score (CCS) from 3.4 +/- 0.5 (mean +/- SD) preoperatively to 1.6 +/- 1.0 and 1.7 +/- 0.8 three and 12 months after treatment was observed (p < 0.01). Quality of life (PSDI and LSI) improved. No significant changes in ejection fraction or exercise performance were found. Preoperative expectations were generally high, but did not correlate significantly with improvements in CCS or quality of life.

INTERPRETATION

Although no changes in objective parameters were found, the lack of significant correlations between preoperative expectation and subjective clinical improvement indicate that the improvement of angina pectoris only partly can be explained by placebo effects.

Patients' answers to a postoperative questionnaire related to laser resurfacing

To date there is no information that evaluates, from the patient's point of view, the experience of undergoing CO(2) laser skin resurfacing. This article investigates the outcome of laser resurfacing for various cutaneous problems with respect to the patient's expectations and experiences and the surgeon's opinions. Patients were entered into the study prospectively and presented with a questionnaire, at 12 months after treatment, to evaluate the patient's skin resurfacing experience. All patients received standardized preoperative counseling and underwent a standardized surgical protocol, conducted by the same surgeon. Eighty-eight percent of patients considered the result of the laser resurfacing to be very good, and 97% indicated that they had experienced little pain or discomfort. Nevertheless, 77% of patients stated that they would be unwilling to undergo another resurfacing procedure. This discrepancy is most likely the result of the patients' experiences in relation to the degree of erythema afterward. Most patients stated a desire to have more information regarding the procedure, particularly with respect to their experiences concerning postoperative erythema and exudates in the treated area. From the study it can be concluded that patients require extensive preoperative counseling, including a full explanation of all possible sequelae of these procedures to improve the patient's experience.

[Quality of life after treatment of laryngeal carcinoma: surgery versus radiotherapy]

Radiotherapy and surgery for laryngeal cancer achieve comparable results in patient survival. Therefore, the expected quality of life is increasingly influencing the choice of treatment. The aim of this study was to compare the quality of life of patients after surgery or radiotherapy for laryngeal carcinoma. To evaluate quality of life, we used the validated European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and the EORTC Head and Neck module (EORTC QLQ-H&N35). 65 patients who were treated with either radiotherapy or surgery for laryngeal cancer between January 1990 and December 1995, and who were alive and free of tumour in January 1999, were included in this study. In the first group with small tumours (T1/T2), 40 patients were treated by CO2-laser surgery and 16 by primary radiotherapy. In the second group with more advanced tumours (T3/T4), 5 patients underwent total laryngectomy and 4 primary radiotherapy. In the first group there was good global quality of life with no significant difference between the two treatment modalities. Surgically treated patients scored significantly better than the irradiated patients in questions about swallowing of solid food, xerostomia and dental problems. No other significant differences were found: hoarseness in particular was rated equally after both treatments. In the second group there was also good global quality of life with no significant difference between the two treatment modalities. The laryngectomized patients scored equally on questions about voice function, talking on the phone and social behaviour. As far as quality of life is concerned we can recommend both treatment modalities for patients with laryngeal cancer of all stages.

Randomised trial comparing hysterectomy with endometrial ablation for dysfunctional uterine bleeding: psychiatric and psychosocial aspects

OBJECTIVE

To compare in psychiatric and psychosocial terms the outcome of hysterectomy and endometrial ablation for the treatment of dysfunctional uterine bleeding.

DESIGN

Prospective randomised controlled trial. SETTING--Obstetrics and gynaecology department of a large teaching hospital.

SUBJECTS

204 women with dysfunctional bleeding for whom hysterectomy would have been the preferred treatment were recruited over 24 months and randomly allocated to hysterectomy (99 women) or to hysteroscopic surgery (transcervical resection (52 women) or laser ablation (53 women).

MAIN OUTCOME MEASURES

Mental state, martial relationship, psychosocial and sexual adjustment in assessments conducted before the operation and one month, six months, and 12 months later.

RESULTS

Both treatments significantly reduced the anxiety and depression present before the operation, and there were no differences in mental health between the groups at 12 months. Hysterectomy did not lead to postoperative psychiatric illness. Sexual interest after the operation did not vary with treatment. Overall, 46 out of 185 (25%) women reported a loss sexual interest and 50 out of 185 (27%) reported increased sexual interest. Marital relationships were unaffected by surgery. Personality and duration of dysfunctional uterine bleeding played no significant part in determining outcome.

CONCLUSIONS

Hysteroscopic surgery and hysterectomy have a similar effect on psychiatric and psychosocial outcomes. There is no evidence that hysterectomy leads to postoperative psychiatric illness.

Laser endometrial ablation: an alternative to hysterectomy

Laser endometrial ablation has been approved by the U.S. Food and Drug Administration as an alternative to hysterectomy for the treatment of chronic menorrhagia. The purpose of the present study was to document women's feelings and outcomes after having the procedure. In-depth interviews were conducted with 65 women who were among the first to undergo this surgery in the United States. For these women, laser endometrial ablation resulted in the end of enduring unpleasant symptoms without the need for a hysterectomy. Nearly all (91%) of the women considered the ablation a success, and all would recommend ablation to another woman. Access to laser endometrial ablation for all women is one method of decreasing the number of hysterectomies performed.

Who finds cervical laser therapy painful?

To identify women who find outpatient laser cervical surgery painful we designed a prospective observational study correlating surgical pain with multiple variables. The pain scoring systems were validated by comparing the subjective linear analogue score with an objective scoring method. The pain of surgery was compared with age, parity, acute anxiety scores, psychological state, premenstrual syndrome scores, phase of the menstrual cycle, contraceptive use, menstrual history, nature of the lesion, and intraoperative bleeding. Anxious women with no children suffered most. Nulliparity, acute preoperative anxiety, and a history of dysmenorrhea independently predict high pain scores. Young women and those using the combined oral contraceptive pill also find laser surgery more painful but this is because they are less likely to have delivered children and more likely to suffer from dysmenorrhea. Psychological state, premenstrual syndrome score, phase of the menstrual cycle, type of surgery, and perioperative bleeding have no predictive value. We suggest that nulliparous women and dysmenorrhea sufferers who are anxious about outpatient surgery but ambivalent about hospital admission should be offered cervical surgery under general anesthesia. Parous women who do not suffer from dysmenorrhea can be reassured that outpatient laser treatment should be tolerable.

Assessing patient pain during dental laser treatment

Patients reported little or no pain during or after treatment with a dental laser. With many people reporting fear of pain as their chief reason for not seeking dental care, lasers may offer a more acceptable treatment technique.

[Acceptance of ambulatory laser conization under local anesthesia by Danish women]

The aim of the study was to evaluate the acceptability of CO2 laser excisional conization for cervical intraepithelial neoplasia under local anaesthesia in an outpatient setting. Seventy-seven patients, who underwent this procedure, were interviewed three months later concerning pain during treatment, pain and bleeding in the immediate postoperative period, and their general opinion about this procedure. The median duration of surgery was 11 minutes. The postoperative median observation time was 90 minutes. Seventy-one women experienced no discomfort during treatment. Thirty-one patients needed mild analgesics for an average of three days. Bleeding continued for a mean of 7.7 days after treatment and 73% experienced the bleeding as less, 8% as more as compared to menstrual bleeding. Ninety-two percent of the women would prefer this procedure if they had to undergo conization once again. In conclusion, we found a high acceptability in women treated with CO2 laser excisional conization under local anaesthesia in an outpatient setting.

Complications of treatment of recurrent laryngeal papillomatosis with the carbon dioxide laser in children

A retrospective study of the complications of treatment with the carbon dioxide (CO2) laser of 17 patients diagnosed to be suffering from recurrent laryngeal papillomatosis is presented. No immediate complications occurred except one case of laryngospasm and failure to intubate during anaesthesia leading to hypoxic encephalopathy. Three patients were completely free from disease and complications. Another patient was free from laryngeal lesions but developed a papilloma in the right tonsillar pillar. Five other patients showed one or more multiple sites of involvement in addition to the larynx. Laryngeal scarring developed in ten patients. Six patients (35.29 per cent) developed scarring as anterior glottic webs while in two scarring (11.7 per cent) occurred as posterior glottic webs. One developed scarring in the supraglottic region. The remaining one had scarring in both the glottic and supraglottic regions. One patient developed tracheal scarring necessitating laryngo-tracheal separation. Two patients were psychologically disturbed during treatment requiring psychiatric consultation and therapy.

Laser education, laser usage, and surgical attitudes: a challenge for the future

The results of a questionnaire distributed to enrollees at laser training programs at the Rochester General Hospital between 1986 and 1989 were compared with the results of a previous survey and current patterns of laser utilization and acceptance among surgical house staff. Laser utilization has improved slightly. However, both house staff and attending surgeons prefer, and are most comfortable with, nonlaser technology. Continued efforts to enhance the utilization of laser technology and the availability of laser education at teaching hospitals are key for the future.

Laser surgery of Neurofibromatosis 1 (NF 1)

Over six years of experience, the technique of treating NF 1 by laser surgery has been developed and has become a standardized treatment protocol. Whole-body therapy is undertaken over several sessions, during which a distinctive LPLL technique is applied to radically remove every NF fibroma, success being assured by nothing less than total extirpation of the tumors present. Either the argon or the carbon dioxide laser is employed, depending on the stage of the tumors. In 58 sessions of approximately 150 laser hours 21 patients have been treated. There have been no recurrences. A radically removed tumor diminishes the total number of programmed tumors by one. This is the basis underlying the therapy described. Psychosocial care of NF 1 patients remains a factor of great importance. In itself, however, it is not sufficient to achieve emotional recovery and physicocosmetic well-being.

Ergonomics of medical lasers: operator's viewpoint

Lasers are instruments that may enhance the surgeon's ability to perform surgery. Many medical lasers sit unused. Lack of use is associated with "user unfriendliness." Nurses and surgeons often cite factors such as complexity, location, and types of controls, and content of displays. Other factors such as culture-ethnology and its relationship to command words and symbols, affect understandability of controls, displays, and user friendliness. Laser designers and engineers must analyze the interaction between laser users and products. Laser design and operation must coincide with specific needs and expectations of the nurses and physicians. Poor design and engineering compromises result in nonuse of expensive instrumentation, products which are ineffective for clinical use, and could potentially increase the risk of possible injury to patients and staff. This discussion of the design and operation of medical laser systems, presents the advantages and disadvantages of several laser systems. User interfaces for controls: color, function, touch activation, labels and size, sound cues, laser activation, type and amount of feedback information during operation; design of storage for accessories, and need for features such as pulsing, and milliwatts will be discussed. We will present what we consider to be an ideal laser system.

Assessment of psychiatric morbidity in patients attending a colposcopy clinic situated in a genitourinary medicine clinic

OBJECTIVE

To determine the adverse psychological implications of referral for colposcopic screening within a genitourinary medicine clinic.

DESIGN

Cross sectional survey.

SETTING

A colposcopy clinic held within a genitourinary medicine clinic.

SUBJECTS

160 consecutive women referred to the clinic were assessed for psychiatric morbidity using the General Health Questionnaire (GHQ-28). Women were referred to the colposcopy clinic because of one or more of the following: abnormal cervical cytology, condylomata acuminata, HIV antibody positivity. A history of prior local ablative therapy to the cervix was also included in the analysis.

RESULTS

There was no difference in psychiatric morbidity, as detected by the GHQ-28, in women referred to the clinic because of abnormal cervical cytology or condylomata acuminata. The total GHQ-28 scores indicated a significant increase in psychiatric morbidity, with increased sub-scores indicating social dysfunction, anxiety and somatic symptoms, in women who had had prior laser therapy to the cervix. Women with HIV infection attending the clinic were noted to have an increase in GHQ-28 sub-scores indicating social dysfunction and depression.

CONCLUSIONS

Women who have undergone laser therapy to the cervix may benefit from psychological evaluation and supportive measures if they develop further genital lesions which require colposcopic evaluation. Women with HIV infection need further psychological evaluation prior to planning intervention and preventative strategies.

Patient acceptability of laser and cold coagulation therapy for pre-malignant disease of the uterine cervix

OBJECTIVE

To determine patient acceptability of cold coagulation and laser treatment for cervical intraepithelial neoplasia (CIN).

DESIGN

A prospective study with alternate allocation.

SETTING

Teaching hospital in London.

SUBJECTS

155 women requiring treatment for CIN.

MAIN OUTCOME MEASURES

Time taken to complete the treatment; visual analogue scores for pain experienced, anxiety felt and acceptability of the procedure; post treatment bleeding and discharge, and follow-up smear.

RESULTS

Cold coagulation treatment was found to be quicker and less painful than laser treatment, there were no other significant differences between the two methods of treatment.

CONCLUSION

Cold coagulation is a more acceptable form of treatment for CIN than laser.