Gary Lask

Skin resurfacing with the Ultrapulse carbon dioxide laser. Observations on 100 patients.

background The Ultrapulse carbon dioxide (CO2) laser has been shown to be a highly effective treatment for photodamaged skin including improvement of rhytides, precancerous and benign skin lesions, as well as superficial benign pigmented lesions. objective We describe our experiences using the Ultrapulse CO2 laser in treating 100 patients with different severities of photodamaged skin. methods All patients had moderately or severely photodamaged skin and were selected for treatment with the Ultrapulse CO2 laser to evaluate the efficacy and toxicity of this treatment. The patients were placed on a pretreatment regimen for 2–6 weeks prior to receiving treatment with the Ultrapulse CO2 laser. Patients were evaluated for pre‐ and posttreatment severity of photodamage. In addition, skin surface replicas were obtained in selected patients and evaluated by computer image analysis technology. results At 1 month post‐laser treatment, 68 patients received a moderate improvement, five patients achieved a marked improvement, and the remaining 27 patients showed minimal improvement. By 2 months post‐laser treatment, 20 of the 27 patients who at 1 month showed only minimal improvement revealed a moderate to marked improvement from baseline. All the patients studied developed a transient erythema that lasted up to 6 weeks, and many of these patients showed a transient hyperpigmentation that persisted for up to 4 months. conclusion The Ultrapulse CO2 laser is confirmed as an effective treatment for skin resurfacing of photodamaged skin.

Laser Skin Resurfacing with the Silk Touch Flashscanner for Facial Rhytides

background Effective treatment of facial rhytides has been reported using carbon dioxide (CO2) lasers with high peak power and short exposure time which creates char‐free ablation. Char‐free ablation can also be created using a Silktouch Flashscanner attached to n conventional CO2 laser. objective The purpose of this study is to evaluate the effectiveness of the SilkTouch Flashscanner in skin resurfacing. methods The SilkTouch Flashscanner attached to one of two continuous wave CO2 lasers was used to treat facial rhytides on 40 patients. Histopathology to evaluate the depth of penetration of the scanner on both CO2 lasers was performed on preauricular skin prior to excision during facelift surgery. Silicone surface replicas were obtained pre‐ and 2 months post‐laser treatment on two patients and evaluated by optical micrometry. Clinical evaluation of all patients pre‐ and post‐laser treatment was performed. results Clinical evaluation showed significant improvement of facial rhytides. Optical micrometry revealed a decrease in rhytide volume, indicating rhytide improvement. conclusion The Silktouch flashscanner is effective for the treatment of facial rhytides.

Laser Resurfacing in Pigmented Skin

background Laser skin resurfacing is a very promising new treatment for solar elastosis and acne scars. The Ultrapulse carbon dioxide (CO2) laser and the Silk Touch flashscanner allow precise depth control and char‐free ablation. Earlier studies have been done mainly on Caucasian skin types I and II, but very little data were available on pigmented skin. objective The purpose of this study is to assess the efficacy and safety of laser skin resurfacing in skin types III and IV. methods Thirty Asian and Hispanic patients were treated for facial rhytides and acne scars. All patients were instructed to use tretinoin cream 0.05%, hydroquinone 5%, and desonide 0.1% cream nightly for 2–4 weeks prior to the laser treatment. The Ultrapulse 5000C CO2 laser with the Truespot 3‐mm collimated handpiece at the setting of 250–450 mJ per pulse, or the Silk‐Touch flashscanner at the setting of 5–7 W, 0.2‐second pulse duration, and 4‐mm (M) spot size, was used. Patients were evaluated clinically, and global response was assessed by both clinicians and patients. results The facial rhytides and acne scars improved 25–50% in all patients after one laser treatment. The most common side effects were persistent erythema that resolved on the average of 6 weeks. Hyperpigmentation occurred, but was reduced with regular use of tretinoin, hydroquinone, and desonide cream both pre‐ and postoperatively along with use of broad spectrum sunscreen after treatments. conclusion Laser skin resurfacing can be used to treat facial rhytides and acne scars in skin phototypes III and IV. When proper pre‐ and postoperative management is implemented, the risk of dyspigmentation can be reduced.

Laser-assisted Hair Removal by Selective Photothermolysis Preliminary Results

background Laser‐assisted hair removal with the long pulsed ruby laser is a promising new technique based on selectively targeting melanin in hair follicles. objective The purpose of this study was to evaluate the efficacy and safety of the long pulsed ruby laser (EpiTouch) for hair removal. methods The Epitouch laser was used for hair removal of the arms of 20 patients. The areas were evaluated immediately post‐treatment, and at 1, 4, 8, and 12 weeks, for efficacy and complications. results Postoperative results showed 40–80% regrowth after 12 weeks. conclusion Selective melanin‐based photothermolysis with a free running pulsed ruby laser seems to be a promising, noninvasive technique for long‐term hair removal. More than one treatment is necessary since only anagen hair will be affected.

Consensus Recommendations on the Use of an Erbium‐Doped 1,550‐nm Fractionated Laser and Its Applications in Dermatologic Laser Surgery

BACKGROUND Nonablative fractional photothermolysis has revolutionized the way we treat a number of common skin conditions with laser technology. OBJECTIVE A comprehensive guide is needed for clinicians using this technology to treat specific skin conditions in various skin types. MATERIALS AND METHODS Recommendations were made from a recent round table discussion among experienced physicians and a review of recent literature findings. RESULTS Optimal laser parameters are dependent on patient skin type and condition. We recommended guidelines for the successful treatment of several common skin conditions on and off the face using nonablative fractional photothermolysis. Specific conditions were dyschromia, rhytides, acne scars, surgical scars, melasma, and striae distensae. CONCLUSIONS We developed reproducible guidelines to most effectively treat a variety of skin types and conditions using nonablative fractional photothermolysis. Future large, multicenter trials are indicated for further optimization of treatment parameters. Reliant Technologies paid travel expenses and honorariums to all authors.

Botulinum toxins types A and B for brow furrows: preliminary experiences with type B toxin dosing

BACKGROUND : Facial lines resulting from hyperactivity can be misleading manifestations of negative emotions, fatigue and stress. They may also contribute to a perception of facial aging. A well established treatment is botulinum toxin type A (BTX-A). Recently, botulinum toxin type B (BTX-B) has become available for the treatment of cervical dystonia. There has been little comparison on the efficacy of the two different types of botulinum toxins, nor is there information on appropriate dosing of BTX-B for facial muscles. OBJECTIVES : The purpose of this pilot study was to observe the effects of BTX-B in comparison to BTX-A, on patients with brow furrows assessing initial efficacy and duration of effect. METHODS : Patients were injected with BTX-B in two different dose conversions against BTX-A to the corrugator-procerus complex. Some patients received a conversion of 50 units of BTX-B (total of 1000 units) to one unit of BTX-A while others received a conversion of 100 units of BTX-B (total of 2000 units) to one unit of BTX-A. The patients treated with BTX-A received a total of 20 units. These patients were clinically assessed prior to treatment and 3 days, 1 week, 4 weeks, 12 weeks and 16 weeks after treatment. RESULTS : Both types of botulinum toxin were effective at improving glabellar frown lines. The onset of actions occurred slightly sooner (2-3 days) with BTX-B than with BTX-A (3-7 days). Duration of effect with BTX-A was at least 16 weeks. With 1000 units of BTX-B, dose duration was 6-8 weeks and with 2000 units of BTX-B, duration was 10-12 weeks. SUMMARY : Both types of botulinum toxin are effective at correcting deep glabellar furrows. At least with the doses used, BTX-B has a quicker onset of action and BTX-A has longer benefit for glabellar wrinkles. These data strongly suggest that further dose ranging studies of BTX-B are necessary and indicated in controlled double blind studies in a larger patient population.

Treatment of spider veins with the 595 nm pulsed-dye laser☆☆☆★

BACKGROUND Previous attempts to treat spider veins with the conventional 585 nm pulsed-dye laser with a 0.5-ms pulse duration have been relatively ineffective. Recently, a new pulsed-dye laser that is tunable from 585 to 600 nm with a pulse duration 3 times longer than previously available lasers has preliminarily been shown to be effective for treatment of spider veins. OBJECTIVE Our purpose was to evaluate the effectiveness of multiple treatments with the tunable long-pulse dye laser in treatment of spider veins of the lower extremity. METHODS Ten female volunteers were treated in two separate areas containing blue or red linear spider veins less than 1.5 mm in diameter. Treatments were administered with the pulsed-dye laser with a 1.5-ms pulse duration and 595-nm light at fluences of 15 and 20 J/cm2, and each subject received a total of 3 treatments at each site, administered at 6-week intervals. Photographs were taken before and 6 weeks after the last treatment. RESULTS Computer-based image analysis showed clearing of more than three fourths of veins after 3 treatments with 15 or 20 J/cm2. Side effects were minimal and the treatments were well tolerated. CONCLUSION The 595 nm, 1.5 ms pulse duration, pulsed-dye laser is safe and effective for treating blue or red spider veins of the lower extremities less than 1.5 mm in diameter in nontanned patients with Fitzpatrick skin types I and II. Multiple treatments improve on the results obtained after a single treatment.

Skin closure by Nd: YAG laser welding

Skin incisions 6 mm in length were made on the backs of hairless mice. Control wounds were closed with interrupted 5-0 Prolene sutures, and experimental wounds were approximated and closed by laser welding using a Nd:YAG laser. The wounds were examined daily, and specimens were excised at weekly intervals for histopathologic study, transmission electron microscopy, tensile strength determination, and type I collagen-specific messenger ribonucleic acid measurements. The laser-welded wounds demonstrated rapid healing. Histologic study showed a functional scar tissue at day 7 and a minimal residue of the original wound at day 14. Tensile strength of the control and experimental wounds was similar at all time points. The levels of collagen-specific messenger ribonucleic acid were significantly higher in the sutured group in comparison with the laser group or with normal control skin. This study suggests that laser welding might have advantages over suturing, since the former is sterile and nontactile, does not require introduction of foreign material into the wound, and provides subjectively improved cosmetic results.

The role of pulsed light and heat energy (LHETM) in acne clearance

BACKGROUND: Propionibacterium acnes synthesize and store a large amount of porphyrins. Once the porphyrin is exposed to visible light it becomes chemically active and transfers to an excited state, resulting in the formation of singlet oxygen, which combines with cell membranes to destroy the P. acnes. This process is dependent on the rate of production of excited porphyrin molecules, which is influenced by the concentration of porphyrins, the concentration of photons, the temperature, and the wavelength of the photons. METHODS: Nineteen patients with mild to moderate acne underwent bi‐weekly treatments for 4 weeks using the ClearTouchTM system. During each treatment, pulses of light and heat were applied. Each pulse used an average energy density of 3.5 J/cm2, a pulse width of 35 ms, and a wavelength between 430 and 1100 nm. RESULTS: At the end of the eighth treatment, acne clearance for the non‐inflammatory and inflammatory lesions was 63±21% and 50±32%, respectively. One month after the last treatment, the acne clearance for non‐inflammatory and inflammatory lesions was 79±22% and 74±20%, respectively, with further improvement in acne clearance at 2 months after the last treatment (85±17% and 87±25%, respectively). CONCLUSION: ClearTouch pulsed light and heat energy (LHETM) technology is effective and safe for the treatment of acne vulgaris.

The role of laser and intense light sources in photo-epilation: a comparative evaluation.

The method for laser and light assisted hair removal is based on the theory of selective photothermolysis. Selective absorption of hair chromophores from lasers and broad band light sources results in destruction of hair follicles while leaving the skin undamaged. A discussion of the basic principles of selective photothermolysis as it applies to hair removal by lasers and light sources is presented, followed by a comparative review of three melanin target based systems: Ruby laser, Alexandrite laser, and a broad band intense pulsed light. These systems are efficient and safe with proper patient selection. Multiple treatments are necessary due to the nature of the hair growth cycle.