Alberto Goldman

Subdermal Nd‐YAG Laser for Axillary Hyperhidrosis

BACKGROUND Axillary hyperhidrosis is a common but difficult-to-treat condition with major social, labor, and emotional consequences. OBJECTIVE The aim of this study is to present the Nd-YAG laser as a safe and effective option for the treatment of axillary hyperhidrosis. MATERIALS AND METHODS From January 2002 to April 2007, 17 patients (15 women and 2 men) with axillary hyperhidrosis were treated using a subdermal 1,064-nm Nd-YAG laser. The results were evaluated by the patients as well as by the physician. The objective evaluation was realized by Minors iodine starch test combined with planimetry. Histology was performed in axillary skin after the laser treatment. RESULTS The subdermal laser-assisted axillary hyperhidrosis treatment using a 1,064-nm Nd-YAG laser resulted in significant clinical improvement. CONCLUSIONS The treatment of axillary hyperhidrosis using the 1,064-nm Nd-YAG laser has the advantage of a minor invasive procedure without leaving large scars and causing temporary impairment. The laser proved to be effective and safe. Although the laser treatment has shown promising results in this pilot trial, further studies are necessary for final conclusions.

Esthetic and cosmetic dermatology.

ABSTRACT:  The field of esthetic and cosmetic dermatology has gained remarkable interest all over the world. The major advantage of recent years is the high scientific levels of the most significant new developments in techniques and pharmacotherapy and other nonsurgical approaches. The present paper reviews selected fields of interest under this view. Sexual hormones are involved in the aging process of men and women. Skin function, in particular the epidermal barrier, is affected by a loss of endocrine activity. Hormone replacement therapy has only recently been introduced in treatment of aging males. This is an area of gender‐medicine in dermatology with a strong well‐aging attempt. Botulinum toxin therapy for hyperfunctional lines has become not only well‐established but evidence‐based medicine on its highest level. Recent advantages were gained in objective evaluation and monitoring the effect. Digital imaging techniques with various facets have been introduced to assess the achievements of treatment in the most objective way. This may become an example for other techniques as peeling, laser therapy, or radiofrequency in esthetic and cosmetic dermatology. Botulinum toxin has become a valuable tool for brow lifts. Details of the technique are discussed. Cellulite is a strongly female gender‐related condition. During the past decades numerous treatments had been recommended but only recently a more critical scientific approach led to improvements in therapy of this common and disfiguring condition. Three major approaches are developed: (a) skin loosing with techniques such as subcision, (b) skin tightening with radiofrequency and other approaches, and (c) improving circulation in blood and lymphatic microvasculature using both physical treatments and pharmacotherapy. The last two chapters are devoted to body sculpturing by lipotransfer and lipolysis. Lipotransfer for facial or body sculpturing has a history of about 100 years. Nevertheless, recently the role of adult stem cells in adipose tissue has gained much interest. By optimizing the harvesting, storage, and transplantation of adipose tissue, remarkable long‐standing results have been obtained. Here the present authors will focus on midface contouring, where lipotransfer competes with dermal fillers. Lipolysis is another effective tool in body sculpturing. The present authors will focus on recent advances in laser‐assisted lipolysis for delicate body sculpturing in the submental region but also for gynecomastia abdominal region, flanks, and hips. In conclusion, esthetic and cosmetic dermatology has become a scientific‐based subspeciality of dermatology with evidence‐based treatments and a great variety of high‐tech approaches to provide more effective, more selective, and safer therapeutic options.

Facial rejuvenation for middle-aged women: a combined approach with minimally invasive procedures.

Facial rejuvenation is a significant process involved in restoring youthfulness. The introduction of less invasive procedures has increased acceptance of such procedures. Often a combination of different techniques allows individualized treatment with optimal outcomes. Furthermore, this leads to a natural look without a significant downtime. We report herein the use of such a combined approach in middle-aged women with particular emphasis on botulinum toxin type A, dermal fillers, and chemical peels.

Elevation of the corner of the mouth using Botulinum toxin type A

Indications for botulinum toxin type A have been constantly evolving, and it can currently be used in virtually any area of the face and neck. The authors present their experience with this neurotoxin in treating the platysmal bands and depressor anguli oris muscle with the purpose of cosmetically improving the anterior neck and lifting the oral commissure.

Hyaluronic Acid Dermal Fillers: Safety and Efficacy for the Treatment of Wrinkles, Aging Skin, Body Sculpturing and Medical Conditions

Hyaluronic acid (HA) is a linear naturally occurring polysaccharide formed from repeating disaccharide units of N-acetyl-D-glucosamine and D-glucuronate. HA is omnipresent in the human body but highest amounts are found in soft connective tissues. HA is involved in several key processes, including wound repair, regeneration, and matrix organization. To increase stability, modifications of HA like various crosslinking substances and technologies have been developed. In recent years, most HA-fillers are of bacterial origin which ensures very low protein contaminations. HA fillers are temporary fillers, which can easily be digested by hyaluronidase, usually lasting for 6 to 9 months. They are safe for volumizing procedures when used with the appropriate technique and indications. Various types of clinical application are discussed. Best data are available for facial rejuvenation, in particular for nasolabial folds and the periocular region. Combining HA dermal fillers with other techniques allows an individualized treatment. In addition, HA fillers are useful to improve medical conditions such as scars and HIV-associated lipodystrophy as well. This review will provide an overview on the potential of this class of filler substances.

ATX-101 for reduction of submental fat

Introduction: Facial esthetics are important for self-esteem. Undesired submental fat (SMF) deposits lead to an unappealing submental profile associated with aging and overweight. Compound ATX-101 is a proprietary formulation of purified synthetic deoxycholic acid for pharmacological submental contouring. Review areas covered: This reviews covers anatomy of SMF, biochemistry of deoxycholic acid related to adipose tissue and tissue response to injection of ATX-101. Data from clinical trials were analyzed for efficacy and safety. Methodology: Published studies using PubMed© database 2000 – 2014 have been analyzed. The terms ‘deoxycholate’, ‘deoxycholic acid’, ‘ATX-101’ and ‘injection lipolysis’ were used. Results: Deoxycholic acid causes adipocyte breakdown and an inflammatory tissue reaction leading to fat cell reduction and limited fibrosis. Four large clinical Phase III trials demonstrated efficacy of ATX-101 in reduction of SMF measured by validated scales and objective measurements. Patients reported improved psychological features and feeling. Adverse effects were mild and temporary. Expert opinion: Adipocytolysis of SMF by ATX-101 is an important step forward to the development of approved drugs for reduction of localized fat pads. This could become a growing market.

Dermal fillers: facts and controversies.

Dermal fillers have been used for decades in soft tissue augmentation. Currently, filler implementation is among the most common minimally invasive procedures for rejuvenation and body sculpturing. There is a broad variety of filler materials and products. Despite immense experience, a number of controversies in this topic exist. Some of these controversies are addressed in this review, for example, who should perform filler injections, the difference between permanent and nonpermanent fillers, the off-label use of liquid silicone, and the role of pain reduction. Implementation of guidelines and restriction of filler use by trained physicians can improve safety for patients.

Evaluation of Tissue Tightening by the Subdermal Nd: YAG Laser- Assisted Liposuction Versus Liposuction Alone

Background: Skin tightening is a desirable outcome for skin flaccidity. Objective: We evaluated the applicability, safety, capacity and intensity of skin tightening with the subdermal 1,064 nm Nd: YAG laser application to the upper arms, and compared the results with liposuction. Materials and Methods: Patients with lipodystrophy and mild-to-severe skin laxity of the arms were included (n=28). In half of patients, a single treatment with a subcutaneous laser and liposuction was performed, while the other 14 had a regular liposuction. Treatment parameters, adverse effects and photographic documentation were recorded. Results: Aesthetic improvement and skin retraction was superior by laser lipolysis. The procedure was well tolerated without significant complications. Conclusions: The subdermal laser-assisted liposuction using a 1,064 nm Nd: YAG laser achieves improved skin tightening.

Lipoma treatment with a subdermal Nd:YAG laser technique

Background  Lipoma is the most common benign mesenchymal tumor composed of mature fat cells. The standard treatment for lipoma is excision. Many treatments have been described in order to minimize the scars produced by surgical excision. The treatment of lipoma using a subdermal laser produces an effective disruption of fat cells and results in a small scar.

Severe unexpected adverse effects after permanent eye makeup and their management by Q-switched Nd:YAG laser

Permanent makeup is a cosmetic tattoo that is used to enhance one’s appearance, and which has become more popular among middle-aged and elderly women. A couple of benefits seem to be associated with permanent tattoos in the elderly: saving time (wake up with makeup); poor eyesight (difficult to apply makeup); and saving money. On the other hand, cosmetic tattoos bear the same risks as other tattoo procedures. We report on fading and unintended hyperpigmentation after tattooing on eyebrows and eyelids, and discuss the scientific and anatomical background behind the possible cause. Dermatochalasis may be a possible risk factor for excessive unwanted discolorations. Q-switched neodymium-doped yttrium aluminum garnet laser is an appropriate and safe therapeutic tool that can manage such adverse effects. Consumer protection warrants better information and education of the risks of cosmetic tattoos – in particular, for elderly women.