David B. Apfelberg

Histology of port wine stains following argon laser treatment

Abstract The argon laser has now been firmly established as an effective treatment of certain port wine stain haemangiomas (Apfelberget al., 1977; Goldman and Dreffer, 1977) and we have studied the histological changes which occur following treatment.

Argon laser treatment of cutaneous vascular abnormalities: progress report.

One hundred six cutaneous vascular abnormalities were treated over a 3-year period by the argon laser. Absorption of light energy causes heat coagulation of the hemangioma with sparing of the overlying skin and secondary skin appendages. Patients with port wine hemangiomas, capillary/cavernous hemangiomas, and telangiectasia showed good response to argon laser treatment. Superficial varicosities of the lower extremity proved to be relatively insensitive to laser treatment. The argon laser shows promise as an effective clinical tool in the treatment of hemangiomas: however, further clinical and laboratory investigation will be necessary to establish the laser as the modality of choice in the treatment of such lesions.

UltraPulse carbon dioxide laser with CPG scanner for full-face resurfacing for rhytids, photoaging, and acne scars

&NA; Eleven female patients are reported who underwent full‐face resurfacing. Three patients were treated for cosmetic rhytids, five for residual acne scarring, and three for photoaging. There were no complications or side effects in this group of patients. Reepithelialization was achieved in an average of 9.3 days, and erythema disappeared in an average of 8.9 weeks. The UltraPulse carbon dioxide laser with computerized pattern generator (CPG) scanner allows a rapid, uniform laserbrasion. The sequence of the procedure involves close application of adjacent squares at 60 W, 200 to 300 mJ, at moderate density. Skin preparation with Retin‐A and bleaching agents is important for best wound healing. Postoperative wound care includes maintenance of a moist environment and Zovirax for herpes prophylaxis. (Plast. Reconstr. Surg. 99: 1817, 1997.)

Breast reconstruction following mastectomy: a comparison of submuscular and subcutaneous techniques.

An analysis of the benefits of submuscular versus subcutaneous implantation was made on mastectomy patients. Ninety-one breast were reconstructed following mastectomy. In 30 breasts, the implants were placed subcutaneously; in 19, subpectorally, and in 42, beneath both the pectoralis and the serratus. The follow-up averaged 2 to 3 years, and recent cases included postoperative tonometry measurements to quantitate the degree of capsular contraction. In addition, 12 cadaver dissections were done to delineate muscle insertion and origins. Results indicate that (1) submuscular implants are clearly superior to subcutaneous ones; (2) subpectoral implantation requires complete detachment of the muscular origin from the ribs; (3) subserratus implantation provides extra muscular coverage, but dissection is more difficult owing to its firm rib attachment; and (4) the subserratus technique provided the lowest incidence of capsular contracture, although the breast was slightly flatter initially, but improved with time.

A Critical Appraisal of High-Energy Pulsed Carbon Dioxide Laser Facial Resurfacing for Acne Scars

Thirteen patients with mild and severe acne scarring have been treated with the Ultra Pulse carbon dioxide laser over a 24-month period. Nine patients had full-face and 4 patients had regional resurfacing. All patients were pretreated with a Retin-A preparation. The patients healed in an average of 7.3 days and erythema was gone in an average of 7.6 weeks. Eight patients with mild acne experienced a good (1 patient) or excellent (7 patients) result. Of the 5 patients with severe acne characterized by marked irregularity, deep defects, and atrophy, 2 patients experienced fair results and 2 experienced good results (1 patient was lost to follow-up). Thus, laser resurfacing for severe atrophic acne achieves only moderate results, while treatment for mild acne can provide excellent results.

Benefits of the CO2 laser in oral hemangioma excision.

Twenty-one patients with small localized oral cavity hemangiomas of the lips, tongue, and buccal mucosa are reported in this series. Although the lesions were not massive or high-flow/high-pressure vascular tumors, the simultaneous cutting and coagulation capabilities of the CO2 laser were demonstrated, rendering such excisional surgery more precisely and easily accomplished with a great deal less bleeding and a marked reduction in postoperative pain and edema. Many of the patients in this series were done as outpatients under local anesthesia. Results were acceptable and complications were minimal. Thus this laser is recommended both for the patient care and comfort aspects and the ability to render oral cavity hemangioma excisional surgery much more safely and easily done with a significant decrease in hospital utilization and overall medical expenses.

The ultrapulse carbon dioxide laser with computer pattern generator automatic scanner for facial cosmetic surgery and resurfacing.

The ultrapulse carbon dioxide laser has been used in 110 patients for resurfacing and 50 patients for facelift, eyelid, and forehead surgery. Skin resurfacing is able to remove layers of skin of 100 μm without bleeding. Use of the computer pattern generator automatic scanning device allows a very rapid, uniform treatment in a variety of geometric patterns, sizes, and densities. Hemostatic incision is possible for cosmetic surgery. Sequence of the laserbrasion procedure as well as patient preparation, selection for surgery, and postoperative care are detailed. Laser lower blepharoplasty through the transconjunctival approach is commonly done concurrently with skin resurfacing to smooth out fine rhytides and extra skin.

Argon laser treatment of decorative tattoos

The argon laser shows promise as an effective clinical method for the treatment of tattoos. Although clinical follow-up has been limited to 3 years and less in a series of 30 patients, the preliminary results are sufficiently optimistic to recommend further clinical use of the argon laser for such treatment.

Comparison of Argon and Carbon Dioxide Laser Treatment of Decorative Tattoos: A Preliminary Report

Seven patients with either homemade or professional decorative tattoos have been treated with both the argon and CO2 lasers and studied clinically as well as histologically. The argon laser is absorbed by dermal pigment and vaporizes this pigment out of the skin. The CO2 laser vaporizes tissue layer by layer and must be accompanied by mechanical debridement. Results and complications of treatment with the two lasers were markedly similar, as were histological studies.

Intralesional Laser Photocoagulation—Steroids as an Adjunct to Surgery for Massive Hemangiomas and Vascular Malformations

Massive hemangiomas and vascular malformations have been treated with lasers and adjunctive measures. Intralesional laser photocoagulation involves the direct penetration of a tumor by a yttrium-aluminum-garnet laser fiber with photocoagulation at various depths and levels to produce thromboses and controlled coagulation necrosis, thus shrinking and blanching the malformation. Seven children have benefited from intralesional laser photocoagulation as well as steroids, embolization, and excisional surgery. Intralesional laser photocoagulation has contributed to the initial shrinkage and fibrosis of these massive vascular tumors in preparation for surgery or as the only treatment in some cases.