Edward Victor Ross

In Vitro Spectral Analysis of Tattoo Pigments

BACKGROUND Absorption spectra of common tattoo pigments, their reaction to irradiation at 532 and 752 nm, and correlation with their titanium and iron component are important to the selection of an optimal laser device. OBJECTIVE The objectives were (1) to establish the absorption spectra of common tattoo pigments and India ink and (2) to determine their response to laser irradiation at 532 and 752 nm and correlate this to their composition. MATERIALS AND METHODS Samples of 28 tattoo pigments and India ink were mixed in agar and analyzed with a spectrophotometer. These agar plates were irradiated with Q-switched wavelengths of 532 and 752 nm. RESULTS The highest absorbance of red was in the complementary spectrum, while blue, yellow, and orange had peaks in the adjacent portion of the visible light spectrum. There is great variability in the absorbance of green tattoo material. Pigment darkening was noted at both wavelengths in all iron-containing pigments except black. It was variable in those containing titanium. Pigments tested responded with either clearance or darkening at 532 nm; however, response at 752 nm was more limited. CONCLUSION (1) Tattoo pigment absorption spectra can explain why some colors are more resistant to removal. (2) Pigment darkening is a complex process.

Split-Face Treatment of Facial Dyschromia: Pulsed Dye Laser with a Compression Handpiece versus Intense Pulsed Light

BACKGROUND Many visible light lasers and intense pulsed light (IPL) devices are available to treat photodamaged skin. OBJECTIVES The objective was to perform a multiple-treatment split-face comparison evaluating a pulsed dye laser (PDL) with a compression handpiece versus IPL for photorejuvenation. METHODS Ten subjects were treated three times at 3- to 4-week intervals. One side of the face was treated with the PDL with compression handpiece, and the other with IPL. One month after final treatment, blinded evaluation assessed for improvements in dyschromias and texture. Patients provided self-assessment of improvement in dyschromias and texture. Time to complete final treatments and pain during all treatments were recorded for each device. RESULTS Improvement of the PDL was (mean) 86.5, 65, 85, 38, and 40% for dark lentigines, light lentigines, vessels <0.6 mm, vessels >0.6 mm, and texture, respectively, versus 82, 62.5, 78.5, 32.5, and 32%, respectively, for the IPL side. Patient-evaluated difference in improvement for vascular lesions significantly favored the PDL (p=.011). Mean third treatment times were 7.7 minutes for PDL versus 4.6 minutes for the IPL (p=.005). Mean pain ratings were 5.8 for the PDL and 3.1 for the IPL (p=.007). Purpura-free procedures depended on proper technical use of the compression handpiece when treating lentigines with the PDL. CONCLUSIONS The PDL with compression handpiece and IPL are highly effective for photorejuvenation.

Pulsed Dye Laser and Pulsed Dye Laser–Mediated Photodynamic Therapy in the Treatment of Dermatologic Disorders

Background The pulsed dye laser (PDL) is used for treating cutaneous vascular disorders. Recent reports have also shown its effectiveness in conditions of other etiologies, although the precise mechanisms of action are unknown. PDL has also been used in photodynamic therapy (PDT) for many dermatologic conditions. We review the broad array of disorders that can be effectively managed using the PDL. Objectives and Methods A review of the literature on the application of the PDL and PDL‐mediated PDT in dermatologic disorders. A literature‐based search was performed using PubMed from 1997 to 2010. Search terms included: “pulsed dye laser,” “pulsed dye laser photodynamic therapy,” and “pulsed dye laser indications.” Results The PDL was initially designed for cutaneous vascular disorders. Recent investigations have demonstrated successful results when treating malignant, inflammatory, viral, and collagenous conditions. Side effects, including pain, purpura, edema, and postinflammatory hyperpigmentation, were mild, well tolerated, and transient. Conclusions PDL is accepted as first‐line therapy for vascular disorders including port‐wine stains, telangiectasias, and hemangiomas. PDL causes selective photothermolysis of dermal vasculature. This mechanism also allows it to be applicable for disorders of other etiologies. Recent studies suggest that the PDL may induce cytokine expression and collagen formation, further increasing its applicability in dermatology.

Evaluation of the vacuum-assisted handpiece compared with the sapphire-cooled handpiece of the 800-nm diode laser system for the use of hair removal and reduction.

Abstract Background: A handpiece with a 35 × 22-mm treatment window that uses vacuum technology has been designed for the diode laser system. Vacuum suction stretches the skin and brings the hair follicle closer to the surface with the intent to damage the hair follicle at a lower surface fluence. The objective of this study was to compare the degree of follicular thermal damage between the sapphire-cooled smaller handpiece at a higher fluence versus the larger vacuum-assisted handpiece at a lower fluence. Methods: Five male patients with Fitzpatrick skin types I–IV were enrolled in the study. Three test spots on the right back were treated with the vacuum-assisted laser handpiece at a setting of 10–12 J/cm2, and 61-ms pulse duration. Three test spots on the left back were treated with the sapphire-cooled handpiece with a setting of 30–34 J/cm2 and a pulse duration of 14–16 ms. A punch biopsy was obtained from one treated area for each handpiece type. The biopsies were sectioned horizontally and examined for the degree of thermal damage to the hair follicle at the level of the isthmus and the bulb. Immediate treatment response, pain score, and total treatment time were recorded. Results: Biopsies from the skin treated with the sapphire-cooled handpiece and the vacuum-assisted handpiece showed the mean hair follicle diameter was 258.3 µm (SE [standard error] 41.7) and 225.1 µm (SE 17.1), respectively. The mean thermal damage diameter to hair diameter ratio was 0.91 (SE 0.10) and 0.72 (SE 0.12), respectively. The mean immediate treatment response, the mean pain severity, and the mean total treatment time were all lower for the vacuum-assisted handpiece. Conclusion: Treatment with the vacuum-assisted handpiece is faster and has a tendency to be more comfortable. Thermal damage to the hair follicle was greater with the sapphire-cooled handpiece.

A Pulsed Dye Laser with a 10-mm Beam Diameter and a Pigmented Lesion Window for Purpura-Free Photorejuvenation

BACKGROUND AND OBJECTIVES In traditional pulsed dye lasers (PDLs), power limitations and pulse characteristics have compromised purpura-free procedures. This study evaluated a new PDL with a modified pulse structure and a 10-mm beam diameter for purpura-free photorejuvenation. A compression handpiece was used for targeting lentigines. MATERIALS AND METHODS Twenty patients with skin types I to III were treated three times at 3- to 4-week intervals. The first pass was delivered through a 10-mm compression handpiece to target pigment dyschromias using fluences between 6.5 and 8.0 J/cm2 with a 1.5-ms pulse duration. A second pass was then performed with a 10-mm spot with fluences between 9.5 and 10 J/cm2, a 20-ms pulse duration, and cryogen spray enabled. Improvement was evaluated by comparing pre- and posttreatment photographs and live subjects 1 month after the third treatment. RESULTS In the majority of patients, >90% reduction of fine telangiectasias (<0.6 mm) and dark lentigines was achieved. Pigmented dyschromias improved proportional to the degree of pigment at presentation. Avoidance of purpura with the compression handpiece was dependent on obtaining proper compression before laser emission. Mean textural improvement was 34%. CONCLUSIONS The new 595-nm PDL is highly effective for two-pass purpura-free improvement of telangiectases, pigment dyschromias, and texture.

Consensus statement regarding storage and reuse of previously reconstituted neuromodulators.

BACKGROUND Legacy recommendations suggest that vials of botulinum toxin be used within 24 hours of reconstitution and in a single patient. Current standard of care is consistent with storage after reconstitution and use of a single vial for several patients. OBJECTIVE To develop expert consensus regarding the effectiveness and safety of storage and reuse of botulinum toxin. MATERIALS AND METHODS The American Society for Dermatologic Surgery authorized a task force of content experts to review the literature and provide guidance. Data extraction was followed by clinical question review, a consensus Delphi process, and validation of the results by peer review. RESULTS After 2 rounds of Delphi process, the task force concluded by unanimous consensus and with the highest level of confidence that a vial of toxin reconstituted appropriately can, for facial muscle indications, be (1) refrigerated or refrozen for at least 4 weeks before injection without significant risk for contamination or decreased effectiveness and (2) used to treat multiple patients, assuming appropriate handling. CONCLUSION The standard of care, which allows for use of botulinum toxin more than 24 hours after reconstitution and in more than 1 patient per vial, is appropriate and consistent with the safe and effective practice of medicine.

Cutaneous siderosis secondary to intramuscular iron dextran treated with 755 nm Q‐switched alexandrite laser: A case report

Cutaneous siderosis is accumulation of iron in the dermis and the subcutaneous tissue secondary to extravasation of an intramuscular or intravascular iron injection. It presents as varying shades of brown macules with no distinct contours. The hyperpigmentation is permanent without treatment.

Treatment of acral persistent papular mucinosis using an Erbium‐YAG laser

Acral persistent papular mucinosis (APPM) is a rare condition with persistent flesh colored papules on the hands and extensor wrists. The authors aim to present a novel treatment option for this condition.

Subsurface wrinkle removal by laser treatment in combination with dynamic cooling

Compared to traditional CO2 or Er:YAG laser resurfacing, sub-surface thermal injury to stimulate skin remodeling for the removal of wrinkles is attractive due to the lower morbidity associated with epidermal preservation. We have developed a technique that thermally damages dermal collagen while preserving the epidermis by a combination of infra-red laser irradiation and dynamic cooling of skin. Wound healing response to the thermal denaturation of collagen may trigger synthesis of fresh collagen and result in restoration of a more youthful appearance. The laser wavelength is chosen so as to thermally injure dermis in a narrow band at depths of 150 to 500 microns from the surface of the skin. The epidermis is preserved by a Candela dynamic cooling device (DCDTM) cryogen spray. Three-dimensional Monte Carlo calculations have been done to calculate the light distribution within tissue while taking into account light absorption and scattering. This light distribution has been used to calculate heat generation within tissue. Heat transfer calculations have been done while taking into consideration the cryogen cooling. The resulting temperature profiles have been used to suggest heating and cooling parameters. Freshly excised ex vivo pig skin was irradiated with laser and DCD at these heating and cooling parameters. Histological evaluation of the biopsies has shown that it is possible to spare the epidermis while thermally denaturing the dermal collagen. The modeling and histology results are discussed.

Airborne particulate concentration during laser hair removal: A comparison between cold sapphire with aqueous gel and cryogen skin cooling: AIRBORNE PARTICULATE CONCENTRATION DURING LASER HAIR REMOVAL

High concentrations of sub‐micron nanoparticles have been shown to be released during laser hair removal (LHR) procedures. These emissions pose a potential biohazard to healthcare workers that have prolonged exposure to LHR plume.