Anne M. Chapas

Successful treatment of acneiform scarring with CO2 ablative fractional resurfacing

Acneiform scarring after severe episodes of acne is a common cosmetic concern, treatable by a variety of modalities with varying degrees of success. Ablative CO2 laser resurfacing, while effective, is associated with an undesirable side effects profile, lengthy recovery period, and risk of infection as well as potential pigmentary alterations. Newer modalities using the principles of fractional photothermolysis (FP) create patterns of tiny microscopic wounds surrounded by undamaged tissue beneath the skin with an erbium‐doped 1,550 nm laser. These devices produce more modest results in many cases than traditional carbon dioxide (CO2) lasers but with fewer side effects and shorter recovery periods. A novel ablative 30 W CO2 laser device uses a technique called ablative fractional resurfacing (AFR), combines CO2 ablation with a FP system.

Outcomes of Childhood Hemangiomas Treated with the Pulsed-Dye Laser with Dynamic Cooling: A Retrospective Chart Analysis

BACKGROUND Laser treatment of childhood hemangiomas remains controversial. Previous studies have used outdated technology, resulting in a potential overrepresentation of adverse outcomes. OBJECTIVE To evaluate outcomes of hemangiomas treated with the most current laser technology. METHODS A retrospective chart analysis of 90 patients with a median age of 3.0 months and a total of 105 hemangiomas were enrolled over a 2.5‐year period. All were treated with the 595‐nm long‐pulse pulsed‐dye laser (LP‐PDL) with dynamic epidermal cooling at 2‐ to 8‐week intervals depending on the stage of growth. Exclusion criteria were previous laser, surgical, or corticosteroid treatment. Three reviewers assessed outcomes. RESULTS Near‐complete or complete clearance in color were achieved for 85 (81%) and in thickness for 67 (64%) hemangiomas. There was no scarring or atrophy. Ulceration occurred in one case and resolved during treatment. Hyperpigmentation and hypopigmentation occurred in 4% and 14% of hemangiomas, respectively. CONCLUSION Early treatment of childhood hemangiomas with the 595‐nm LP‐PDL with dynamic cooling may reduce the proliferative phase and result in excellent rates of clearing and few adverse events. Dr. Geronemus serves on the Advisory Board for Candela Corporation.

Successful Treatment of Atrophic Postoperative and Traumatic Scarring With Carbon Dioxide Ablative Fractional Resurfacing Quantitative Volumetric Scar Improvement

OBJECTIVE To assess the safety and efficacy of ablative fractional resurfacing (AFR) for nonacne atrophic scarring. DESIGN In this before-and-after trial, each scar received 3 AFR treatments and 6 months of follow-up. SETTING Private academic practice. PATIENTS Fifteen women with Fitzpatrick skin types I to IV, aged 21 to 66 years, presented with 22 nonacne atrophic scars between June 1 and November 30, 2007. Three patients (3 scars) were excluded from the study after receiving 1 AFR treatment and not returning for follow-up visits. The remaining 12 patients (19 scars) completed all 3 treatments and 6 months of follow-up. INTERVENTIONS Each scar received 3 AFR treatments at 1- to 4-month intervals. MAIN OUTCOME MEASURES Erythema, edema, petechiae, scarring, crusting, and dyschromia were graded after treatment and through 6 months of follow-up. Skin texture, pigmentation, atrophy, and overall appearance were evaluated after treatment and through 6 months of follow-up by the patient and a nonblinded investigator. A 3-dimensional optical profiling system generated high-resolution topographic representations of atrophic scars for objective measurement of changes in scar volume and depth. RESULTS Adverse effects of treatment were mild to moderate, and no scarring or delayed-onset hypopigmentation was observed. At the 6-month follow-up visit, patient and investigator scores demonstrated improvements in skin texture for all scars (patient range, 1-4 [mean, 2.79]; investigator range, 2-4 [mean, 2.95]), pigmentation for all scars (patient range, 1-4 [mean, 2.32]; investigator range, 1-4 [mean, 2.21]), atrophy for all scars (patient range, 1-4 [mean, 2.26]; investigator range, 2-4 [mean, 2.95]), and overall scar appearance for all scars (patient range, 2-4 [mean, 2.89]; investigator range, 2-4 [mean, 3.05]). Image analysis revealed a 38.0% mean reduction of volume and 35.6% mean reduction of maximum scar depth. CONCLUSION The AFR treatments represent a safe, effective treatment modality for improving atrophic scarring due to surgery or trauma.

Ablative and Fractional Ablative Lasers

The field of nonsurgical laser resurfacing for aesthetic enhancement continues to improve with new research and technological advances. Since its beginnings in the 1980s, the laser-resurfacing industry has produced a multitude of devices employing ablative, nonablative, and fractional ablative technologies. The three approaches largely differ in their method of thermal damage, weighing degrees of efficacy, downtime, and side effect profiles against each other. Nonablative technologies generate some interest, although only for those patient populations seeking mild improvements. Fractional technologies, however, have gained dramatic ground on fully ablative resurfacing. Fractional laser resurfacing, while exhibiting results that fall just short of the ideal outcomes of fully ablative treatments, is an increasingly attractive alternative because of its far more favorable side effect profile, reduced recovery time, and significant clinical outcome.

Improvement in Arm and Post-Partum Abdominal and Flank Subcutaneous Fat Deposits and Skin Laxity Using a Bipolar Radiofrequency, Infrared, Vacuum and Mechanical Massage Device

Skin laxity of the body is a growing cosmetic concern. Laxity can result from chronological or photoaging and changes in body dimensions during pregnancy or weight loss. The end result is loose, sagging skin, and localized fat deposits. Liposuction and abdominoplasty or brachioplasty are established approaches to these issues. Patient desire for alternatives to surgical correction has spawned the development of non‐invasive body contouring devices. The combination of infrared light (IR), bipolar radiofrequency (RF), vacuum and mechanical massage (Velashape, Syneron Medical Ltd, Israel) has demonstrated efficacy in improving skin appearance and circumference of the thighs [Goldberg et al., Derm Surg 2008; 34:204–209; Fisher et al., Derm Surg 2005; 31:1237–1241; Arnoczky and Aksan, J Am Acad Orthop Surg 2000; 8:305–313; Alster and Tanzi, J Cosmetic Laser Therapy 2005; 7:81–85; Wanitphakdeedecha and Manuskiatti, J Cosmet Dermatol 2006; 5:284–288; Nootheti et al., Lasers Surg Med 2006; 38: 908–912], but only anecdotal evidence has supported its use on other anatomic locations. This study was designed to evaluate the efficacy and safety of Velashape on additional body sites and more rigorously examine the technologys impact on upper arm as well as abdominal and flank circumference.

Radiofrequency devices for body shaping: a review and study of 12 patients.

Radiofrequency (RF) devices such as ThermaCool TC (Solta Medical Inc., Hayward, CA) offer a nonablative and noninvasive treatment option for unwanted skin concerns of the head, neck, and body. Relatively fewer studies address RF treatment on the body when compared with the head and neck. The purpose of this report is to investigate the use of the ThermaCool TC system with the novel Thermage Multiplex Tip for the enhancement of body shape. Additionally, this report will review the literature of RF technology with a concentration on body shaping. Twelve subjects underwent ThermaCool TC treatments using the Thermage Multiplex Tip. Waist circumference, standardized photographs, skin laxity score, global aesthetic improvement score, and patient satisfaction surveys were assessed at baseline and several follow-up visits after treatment. Average waist circumference and skin laxity scores decreased after ThermaCool TC treatment, using the Thermage Multiplex Tip at follow-up visits held at 1, 2, 4, and 6 months after treatment. Global aesthetic improvement score and patient satisfaction surveys reflected these objective clinical improvements. RF devices, such as the ThermaCool TC offer a nonablative and noninvasive treatment option for unwanted skin findings of the head, neck, and body.

Eyelid Tightening and Improved Eyelid Aperture through Nonablative Fractional Resurfacing

BACKGROUND AND OBJECTIVE The effects of fractional resurfacing on eyelid tightening and aperture are unknown. Our purpose was to retrospectively examine the potential for eyelid tightening and eye-aperture opening in patients treated with nonablative fractional resurfacing for facial photorejuvenation. STUDY DESIGN/MATERIALS AND METHODS Fractional laser treatments using a 1,550-nm erbium-doped fiber laser system on the upper and lower eyelids were given at a pulse energy of 17 to 20 mJ at 125 micro-thermal zones (MTZ)/cm2 to a final density of 500 to 750 MTZ/cm2. Each patient had 3 to 7 treatments. Standard pre- and post-treatment photographs were taken at each visit. Physicians who graded 31 preselected patient photographs using a 4-point scale evaluated eyelid tightening. Increase in eyelid aperture was also evaluated. RESULTS All patients had some degree of eyelid tightening; 19% achieved 1% to 25% tightening, 26% achieved 25% to 50%, 26% achieved 50% to 75%, and 29% achieved 75% to 100%. Increase in eyelid aperture was seen in 55.9% of patients. Postoperative wounding, hypopigmentation, hyperpigmentation, persistent erythema, and scarring were not observed. All patients experienced mild or no edema for a few days after treatment. CONCLUSION Fractional resurfacing tightens and increases eyelid aperture without wounding, downtime, or long-term complications.

Three‐dimensional surface imaging for clinical trials: Improved precision and reproducibility in circumference measurements of thighs and abdomens

Numerous body contouring and laser‐assisted liposuction devices have recently obtained or are seeking FDA clearance, and assessment of efficacy of these devices is largely based upon qualitative comparisons of before and after photographs and measurable changes in patient circumference. The current standard for measuring body circumference in clinical trials involves the use of a standard measuring tape. These manual measurements introduce human error and may incorrectly support or refute a device or procedures efficacy. A promising alternative to manual measurements is three‐dimensional (3D) photography. This technology allows circumference measurements to be performed on 3D digital models. Our objective is to compare the precision and reproducibility of manual versus 3D photographic measurement of body circumference.

Physiologic changes in vascular birthmarks during early infancy: Mechanisms and clinical implications

albinos, with an incidence estimated at 50%. Most of these were SCCs. We observed about 75 patients with vitiligo; some had had vitiligo for as many as 20 years. Several had marked solar elastosis, indicating dermal damage but no epidermal damage. None had skin cancers of any type ( personal observation). Phototherapy—particularly psoralen plus ultraviolet A light phototherapy (PUVA), a known carcinogen in patients with psoriasis—was the treatment of choice for vitiligo for many decades. The authors note that there is a scarcity of reports of skin cancers in depigmented, vitiliginous skin treated with all modalities, including PUVA. The mystery is why skin cancer is not more common in vitiligo skin compared to normally pigmented skin. Why is NMSC not as common in vitiligo patients as in albinos? Because all vitiligo skin is the same color, why do peoples of any ethnic background not get NMSC in the white skin? The answers to these questions will, I believe, provide us a breakthrough in understanding skin cancers and their pathogenesis.

Reduction of thickened flap using fractional carbon dioxide laser.

The paramedian forehead flap is an excellent choice when repairing a large nasal defect. However, even when carefully thinned, the flap may develop a bulky appearance, an ill‐fitting contour, or trap door deformity. When on the face, these suboptimal results can be quite distressing. Surgical and non‐surgical options for improvement exist. Surgical options include additional debulking and reorientation of the flap. Non‐surgical options include intralesional corticosteroids or 5‐flourouracil, dermabrasion, and ablative and non‐ablative laser resurfacing. Each option has limited benefit as well potential side effects.