Jin-Soo Kang

Non-ablative 1550-nm erbium-glass and ablative 10 600-nm carbon dioxide fractional lasers for acne scars: a randomized split-face study with blinded response evaluation

Background  Non‐ablative 1550‐nm erbium‐doped fractional photothermolysis systems (FPS) and 10 600‐nm carbon dioxide fractional laser systems (CO2 FS) have been effectively used to treat scars.

Therapeutic efficacy of autologous platelet‐rich plasma and polydeoxyribonucleotide on female pattern hair loss

Autologous platelet‐rich plasma (PRP) exerts positive therapeutic effects on hair thickness and density in patients with pattern hair loss. The aim of our study was to evaluate the efficacy of intra‐perifollicular autologous PRP and polydeoxyribonucleotide (PDRN) injections in treating female pattern hair loss (FPHL). Twenty FPHL patients were treated with a single session of PRP injection, followed by 12 sessions of PDRN intra‐perifollicular injection, along the scalp at weekly intervals. Additionally, another 20 FPHL patients were treated with 12 sessions of PDRN injection only. Meanwhile, one half of the backs of two rabbits was injected with the PRP preparation, while the other half was injected with phosphate buffered saline as a control. Tissue samples from the rabbits were analyzed by real‐time polymerase chain reaction and Western blotting. Compared with baseline values, patients treated with PRP and PDRN injections exhibited clinical improvement in mean hair counts (23.2 ± 15.5%; p < 0.001) and mean hair thickness (16.8 ± 10.8%; p < 0.001). In addition, patients treated with the 12 sessions of intra‐perifollicular PDRN injection alone also showed clinical improvement in mean hair counts (17.9 ± 13.2%; p < 0.001) and mean hair thickness (13.5 ± 10.7%; p < 0.001). Comparison analyses between the two groups revealed that combined therapy with PRP and PDRN induces greater improvement in hair thickness than treatment with PDRN therapy alone (p = 0.031), but not in hair counts (p > 0.05). The pilot animal study revealed significant up‐regulation of WNT, platelet‐derived growth factor, and fibroblast growth factor expression in rabbit skin treated with the PRP preparation, compared with control skin. In conclusion, intra‐perifollicular injections of autologous PRP and/or PDRN generate improvements in hair thickness and density in FPHL patients.

Histometric analysis of skin-radiofrequency interaction using a fractionated microneedle delivery system.

BACKGROUND Fractionated microneedle radiofrequency (RF) devices have been reported to be effective in treatment of various dermatologic disorders. OBJECTIVES To analyze histometric changes in skin‐RF interactions using a fractionated microneedle delivery system. MATERIALS AND METHODS RF energies were delivered using a fractionated microneedle device to an in vivo minipig model with penetration depths of 0.5, 1.0, 1.5, 2.0, 2.5, and 3.5 mm; RF conduction times of 20, 50, 100, and 1,000 ms; and energy levels of 5.0, 10.0, 20.0, 25.0, 37.5, and 50.0 V. RESULTS Immediately after treatment, skin samples showed that the RF‐induced coagulated columns in the dermis formed a cocoon‐shaped zone of sublative thermal injury. Four days after the treatment, skin specimens demonstrated reepithelialization, and the dermal RF‐induced coagulated columns showed mixed cellular infiltration, neovascularization, and granulation tissue formation. Microneedle depth and RF conduction times, but not energy level, significantly affected histometric values of RF‐induced dermal coagulation. Microneedle RF treatment affected adnexal structures by coagulating follicular epithelium and perifollicular structures. CONCLUSIONS Our data may be of use as an essential reference for choosing RF parameters in treatment of various skin conditions.

Electromagnetic Initiation and Propagation of Bipolar Radiofrequency Tissue Reactions via Invasive Non-Insulated Microneedle Electrodes.

Radiofrequency (RF) energy can be emitted into the skin, either non- or invasively, via a monopolar mode that utilizes an active electrode and a grounded electrode or via a bipolar mode that employs two active electrodes. In this experimental study of RF tissue reactions, bipolar RF energy was emitted in vivo to micropig skin at varying microneedle penetration depths, signal amplitudes, and conduction times. Immediately after RF treatment, skin samples exhibited RF-induced coagulation columns of thermal injury, separately generated around each microneedle in the dermis. In ex vivo bovine liver tissue, the thermal coagulation columns were found to be concentrated maximally around the pointed tips of each electrode. After a RF conduction time of 2 seconds, the individual areas of thermal coagulation began to converge with neighboring RF-induced coagulation columns; the convergence of coagulation columns was found to start from the tips of neighboring electrodes.

Facilitated scalp measuring using phototrichogram with a headband and tapeline.

We measured the scalp hair using a simple device, a plastic headband connected with a tapeline at the center of headband by a snap (Figure 1) and four reference points to promote reproducibility. The reference points were ‘‘P’’, ‘‘V’’, ‘‘Fr’’, and ‘‘Fl’’ points. ‘‘P’’ is the point of intersection between the posterior midsagittal line and the horizontal line connecting the upper ear roots (Figure 2A). ‘‘V’’ (Kang’s point) is the point of intersection between the midsagittal line and the coronal line connecting the tips of the tragus (Figure 2B, dashed line). By using a plastic headband and a tapeline, ‘‘V’’ can be measured conveniently because the headband presents the coronal line connecting the roots of the ear vagus, and the attached tapeline easily shows the midsagittal line (Figure 2B). We measure ‘‘V,’’ which is located roughly 1 to 1.3 cm in front of the anterior margin of the headband and record the distance from the headband to the midpoint of the line connecting the lower margins of the eyebrows for reproducibility. ‘‘Fr’’ is the point of intersection between the right frontal hairline and the tapeline extending from the pole of the headband to the highest point of the right eyebrow (Figure 2C). ‘‘Fl’’ is the point of intersection between the left frontal hairline and the tapeline extending from the pole of the headband to the highest point of the left eyebrow (Figure 2D). We record the distance from the headband to the highest points of the eyebrows for reproducibility.

Treatment of early-stage erythematotelangiectatic rosacea with a Q-switched 595-nm Nd:YAG laser

Abstract Erythematotelangiectatic rosacea presents as persistent erythema and telangiectasia with frequent flushing and blushing on the facial and extrafacial skin. Additionally, papulopustular rosacea shows acneiform papules, pustules, and nodules with persistent plaque-form edema. Despite garnering only grade-C or -D level recommendations, a 585-nm or 595-nm flashlamp-pumped pulsed-dye laser can be considered as an effective therapeutic modality for the treatment of rosacea in patients who are refractory to topical and/or systemic treatments. In this report, treatment with a Q-switched 595-nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser with low non-purpuragenic fluence proved to be safe and effective in treating early-stage erythematotelangiectatic rosacea in two female Korean patients. Laser treatment for rosacea was delivered with the settings of pulse energy of 0.4–0.5 J/cm2, pulse duration of 5–10 ns, 5-mm spot size, 5 Hz, and 500 shots. Additionally, we found that remarkable therapeutic effects were achieved for both rosacea and melasma by combining Q-switched quick pulse-to-pulse 1,064-nm Nd:YAG and Q-switched 595-nm Nd:YAG laser treatments, which required only the changing of handpieces equipped with solid dye. In conclusion, we suggest that treatment with a Q-switched 595-nm Nd:YAG laser with low fluence may provide an additional therapeutic option for treating early-stage erythematotelangiectatic rosacea.

Therapeutic Efficacy of 1,927-nm Fractionated Thulium Laser Energy and Polydeoxyribonucleotide on Pattern Hair Loss

Results One week after the final treatment session, patients treated with the thulium laser and PDRN showed clinical improvements in mean hair counts (20.4 ± 15.7%; p=0.005) and mean hair thickness (53.1 ± 31.1%; p<0.001), compared to baseline values. Patients treated with mesotherapy and PDRN also showed clinical improvements in mean hair counts (9.7 ± 7.4%; p=0.007) and mean hair thickness (16.1 ± 25%; p>0.05). Further statistical analysis showed that combined treatment with the thulium laser and PDRN injections resulted in greater improvement in hair thickness (p=0.029) than combined application of mesotherapy and PDRN, but not in hair counts (p>0.05).

A Pilot Split-face Comparison of Q-switched (QS) Single Pulse versus QS Quick Pulse-to-pulse 1,064-nm Nd:YAG Laser Treatment in a Patient with Melasma

Melasma is a common disorder that clinically presents as symmetric illdefined hyperpigmented macules and patches on the face. In the current split-face, evaluator-blinded study, we treated a female patient with eight sessions of 1,064-nm Nd:YAG laser treatment at one-week intervals. Utilizing the Q-switched (QS) quick pulse-to-pulse (Q-PTP) mode, in reference to the laser settings, 1,064-nm Nd:YAG laser energy can be irradiated at split fluences and at a dual-pulse interval of 80-μsec. On the right side of the face, 1,064-nm QS single pulse Nd:YAG laser treatment was administered with the settings of 1.6 J/cm2, a spot size of 7-mm, and 1200 shots. On the left side, 1,064-nm QS Q-PTP Nd:YAG laser treatment was administered with the settings of 1.6 J/cm2 irradiated at dual pulses of 0.8 J/cm2 at 80-μsec intervals, a spot size of 7-mm, and 1,200 shots. Results of objective clinical assessment showed better clinical outcomes with less treatment-associated pain with QS Q-PTP-treatment than with QS single-pulse-treatment. However, clinical outcomes were subjectively indistinguishable between QS single pulseand QS Q-PTP-treatments. Transient or persistent post-treatment erythema and newly developed punctate leukoderma lesions were not reported for either side of the face. Pre-existing punctate leukoderma lesions became obscure, especially on the QS Q-PTP-treated side, with improvement of the melasma lesions. We suggest that the QS Q-PTP mode may be of use in treatment of melasma, particularly on the relatively thin skin of the periorbital regions and in pain-sensitive and erythema-prone patients.

Combination of 1064-nm Q-switched neodymium: yttrium–aluminum–garnet laser with low fluence and 578-/511-nm copper bromide laser for nipple–areolar hyperpigmentation

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Therapeutic efficacy and safety of a 1927-nm fractionated thulium laser on pattern hair loss: an evaluator-blinded, split-scalp study

Laser- or light-assisted therapies have been used to improve the perifollicular environment by upregulating the expression of growth factors and signaling molecules for hair restoration. The aim of our study was to preclinically and clinically evaluate the therapeutic efficacy and safety of a 1927-nm fractionated thulium laser on pattern hair loss (PHL). An in vivo hairless mouse study and an in vivo human skin environmental scanning electron microscopy (ESEM) study were performed with different power and energy settings. Thereafter, an evaluator-blinded, split-scalp study was conducted to evaluate hair thickness and density in 10 PHL patients treated with 12 sessions of fractionated thulium laser treatment with or without post-laser treatment application of a growth factor-containing (GF) solution. In in vivo hairless mouse skin, inverted cone-shaped zones of thulium laser-induced tissue coagulation (LITC) were noted immediately after treatment in the epidermis and upper to mid-dermis without remarkable ablative tissue injury. The ESEM study revealed round to oval-shaped zones of non-ablative LITC on the surface of the stratum corneum of a human subject immediately after laser irradiation. In PHL patients, 12 sessions of thulium laser monotherapy at 1-week intervals resulted in significantly increased hair density and thickness. Post-laser treatment application of GF solution offered additional therapeutic efficacy by improving hair density and thickness on the split scalp. The use of a fractionated thulium laser with or without post-laser therapy application of GF solution to treat PHL elicited remarkable improvements in hair thickness and hair counts.