Joop M. Grevelink

Long-term results after CO 2 laser skin resurfacing: a comparison of scanned and pulsed systems

BACKGROUND New laser technology permits the use of high-energy pulsed and continuous-wave carbon dioxide (CO2) lasers with flashscanners to treat rhytides. OBJECTIVE We compared the efficacy and side effects of the two leading CO2 lasers used in skin resurfacing. METHODS A total of 28 patients with facial rhytides were treated with either the UltraPulse or SilkTouch laser systems; in five additional patients, contralateral cosmetic units were treated with one system or the other in a direct comparison of the lasers. RESULTS We compared photographs taken before and after treatment, and a lessening of facial wrinkling was noted in all subjects. In some subjects improvement was confirmed by optical profilometry methods. Biopsy specimens in representative patients showed that immediate thermal damage was limited to 180 microns. Long-term postoperative specimens showed changes in the papillary dermis consistent with new collagen deposition and reduction of pretreatment solar elastosis. Posttreatment facial erythema was noted in half the patients for up to 2 months; transient hyperpigmentation was observed in one third of the treated areas. CONCLUSION Although the SilkTouch system produced more immediate thermal damage, there were no significant differences in efficacy or adverse effects between the lasers. Our results suggest that both laser systems, used with appropriate settings, are capable of safely smoothing the skin surface.

Comparison of carbon dioxide laser, erbium:YAG laser, dermabrasion, and dermatome: A study of thermal damage, wound contraction, and wound healing in a live pig model: Implications for skin resurfacing

BACKGROUND Advances in laser technology allow for precise tissue removal and minimal thermal damage. However, mechanisms for cosmetic improvement have not been determined. Investigators have suggested that ablation, collagen shrinkage, and new collagen deposition all contribute to the clinical outcome. OBJECTIVE In a live farm pig, we examined gross and microscopic effects of thermal and mechanical ablation devices to characterize immediate and long-term mechanisms in skin rejuvenation. METHODS Two CO(2) lasers, an erbium:YAG laser, a dermabrader, and a dermatome were used to treat flank skin in a farm pig. There were 14 different treatment groups based on device type and working parameters. One to five sites were treated for each group. Wound surface areas were measured before treatment, immediately after treatment, and 7, 17, 23, 30, and 60 days thereafter. Biopsies were performed immediately after irradiation and 2, 7, 17, and 60 days after treatment. RESULTS For the CO(2) laser-induced wounds, surface area measurements showed that immediate and final wound contraction tended to increase with initial residual thermal damage (RTD) for a range of values, above which immediate contraction remained relatively constant. Although there was no immediate wound contraction with mechanical ablation devices, long-term wound contraction in the dermatome and dermabrasion sites increased with depth of ablation. The erbium:YAG laser sites healed in a manner similar to that of mechanically induced wounds. Wound contraction profiles over time were dependent on depth of RTD and depth of ablation. Sixty days postoperatively, histologic examination showed varying degrees of fibroplasia. Overall, there was greater compaction and horizontal orientation of collagen fibers in those wounds with more than 70 microm of dermal RTD. Grossly, all wounds were similar after 60 days, with the exception of the deep dermabrasion sites, at which clinical scarring was observed. CONCLUSION Our results show that CO(2) laser resurfacing produces short- and long-term wound contraction that is greater than that induced by purely ablative methods for the same total depth of injury. The erbium laser produced wound contraction profiles similar to those produced by mechanical wounding. The data suggest that initial collagen contraction and thermal damage modulate wound healing.

Laser treatment of tattoos in darkly pigmented patients: Efficacy and side effects

BACKGROUND Many modalities for the treatment of tattoos and pigmented lesions produce a greater risk of complications in Fitzpatrick types V and VI skin because of an increased incidence of adverse pigmentary changes and keloidal scarring. In fair-skinned persons Q-switched lasers have proved effective in removing pigmented lesions and tattoos without scarring. OBJECTIVE This study was conducted to determine the efficacy and effects of Q-switched lasers on a small series of darkly pigmented patients with tattoos. METHODS Four patients of Ethiopian origin with facial and neck tribal tattoos were treated with both the Q-switched ruby and Nd:YAG lasers. One black woman with a multicolored tattoo on the mid chest was treated with the Q-switched ruby laser. RESULTS Clearing of all lesions was seen. The treatments did not result in scarring or permanent pigment changes other than the ones intended. CONCLUSION Our results indicate that in darkly pigmented patients, Q-switched laser treatment of tattoos can be performed successfully. The longer wavelength Q-switched Nd:YAG laser is recommended when removing tattoos in darker complected persons. A test treatment is advised before treatment of large skin areas.

Treatment of pyogenic granulomas with the 585 nm pulsed dye laser

BACKGROUND Current therapeutic alternatives for pyogenic granulomas include surgical excision, electrodesiccation and curettage, cryotherapy, and ablation with CO2 or continuous-wave vascular lasers. OBJECTIVE Our purpose was to investigate the use of the 585 nm flashlamp-pumped pulsed dye laser (585 nm PDL) for the treatment of pyogenic granulomas in terms of efficacy, advantages in technique, and side effects. METHODS Eighteen patients with symptomatic pyogenic granulomas in a variety of locations were treated with the 585 nm PDL and examined. RESULTS Sixteen of 18 treated patients demonstrated both symptomatic and clinical clearing of the lesions with excellent cosmetic results after treatment. The two patients who dropped out after one to two 585 nm PDL treatments were eventually treated successfully with electrodesiccation and curettage. No postoperative complications and no persistent pigmentary changes or scarring were observed. The procedure required no anesthesia, and postoperative care was limited to the application of a topical antibiotic ointment. CONCLUSION Our experience suggests that treatment of pyogenic granulomas with the 585 nm PDL is a safe, effective, and reasonable alternative to conventional therapy.

Treatment of Nevus Spilus with the Q-switched Ruby Laser

BACKGROUND Q‐switched lasers have shown to be effective in the removal of unwanted cutaneous pigmentation. Benign cutaneous pigmented lesions represent a heterogeneous group. Nevus spilus is a relatively uncommon pigmented lesion characterized by dark, hyperpigmented dots scattered over a tan‐colored macule. OBJECTIVE A cohort of patients with nevus spilus was studied to determine the effects of Q‐switched ruby and Q‐switched Nd:YAG laser treatment on clearance of pigment and to evaluate potential side effects. METHODS Sir patients with nevus spilus were treated with the Q‐switched ruby laser (QSR). In addition, three lesions received a test treatment with the Q‐switched Nd:YAG (QSYAG) laser at 532 or 1064 nm. The results of treatment were documented during follow up visits. RESULTS Most lesions showed a near‐complete or complete response to laser treatment. In one case partial hyperpigmentation occurred after treatment and in one case no follow‐up could be obtained. In the three cases that received both QSR and QSYAG laser treatment, the QSR laser was shown to be the most effective in removing pigment. CONCLUSION Nevus spilus can be treated effectively with the Q‐switched ruby laser.

Effects of overlap and pass number in CO2 laser skin resurfacing: a study of residual thermal damage, cell death, and wound healing.

Newer CO2 laser systems incorporating short pulse and scanning technology have been used effectively to resurface the skin. As the number of resurfacing cases has increased, hypertrophic scarring has been reported more commonly. Previous dermabrasion and continuous wave CO2 studies have suggested that depth of injury and thermal damage are important predictors of scarring for a given anatomic region. To determine whether rapid overlapping of laser pulses/scans significantly altered wound healing, we examined residual thermal damage, cell death, and histologic and clinical wound healing in a farm pig.

Treatment of small nevomelanocytic nevi with a Q-switched ruby laser

BACKGROUND Small nevomelanocytic nevi are common and some are of cosmetic concern. Conventional therapy may cause a scar or permanent hypopigmentation. OBJECTIVE Our purpose was to determine whether selective photothermolysis of pigmented cells by Q-switched ruby laser treatment removes small nevomelanocytic nevi in a nonscarring fashion. METHODS Twelve patients with 18 small nevomelanocytic nevi were treated with a Q-switched ruby laser (694 nm, 28 nsec) at fluences of 8 J/cm2. Biopsy specimens were obtained after treatment at varying time intervals. RESULTS Twelve lesions (67%) showed a complete response and six lesions (33%) had a partial response. The only adverse sequela observed was mild fibrosis of the papillary dermis, without loss of papillary architecture. CONCLUSION The Q-switched ruby laser is effective in removing small melanocytic nevi. However, some might recur depending on the depth of the nevomelanocytic nests.

Pulsed laser treatment in children and the use of anesthesia

BACKGROUND The rationale for choosing certain anesthetic options in children when they are being treated with pulsed lasers is unclear. OBJECTIVE Our purpose was to assess the safety and side effects of general anesthesia in the treatment of vascular lesions and to compare this to treatment outcome in the office setting. METHODS We carried out a retrospective chart review of 179 patients, with an age range of 5 weeks to 18 years, who received laser treatment and underwent different anesthetic modalities. The age of the patient and the size, location, and severity of the vascular lesion were also noted. RESULTS The factors determining the type of anesthesia to use included (1) the age of the patient, (2) the number of treatments, and (3) the size and location of the lesion. Our data showed minimal risk and sequelae of general anesthesia in the treatment of vascular lesions in children. CONCLUSION Proper selection of anesthesia is a key factor in dealing with children. Office surgery can be performed safely when small lesions are treated. The use of general anesthesia in the treatment of port-wine stains in children does not appear to be accompanied by increased risk.

Laser treatment of pigmented lesions in children.

A variety of lasers can be used to effectively treat cutaneous pigmentation in children. Furthermore, using the principle of selective photothermolysis, several pigment-specific lasers can be used to achieve significant clinical improvement if not complete removal of pigmented lesions with greatly reduced risks of scarring, textural or pigmentary changes. A summary of laser treatments for pigmented lesions that commonly present in children including café-au-lait macules, nevus of Ota and other dermal melanocytosis, congenital melanocytic nevus, nevus spilus, lentigines, epidermal nevus, Beckers nevus, and tattoos is presented. Overall, laser treatment is a very safe, effective treatment option that could offer distinct advantages compared with other conventional modalities.

Care before and after Laser Skin Resurfacing. A Survey and Review of the Literature

background. The extent of the wound healing period and the final outcome of cutaneous laser resurfacing are influenced not only by the treatment protocol and type of laser used but also on care of the skin before and after the procedure. objective. This project was conducted to determine the pre‐ and postresurfacing care protocols currently in practice and to research the literature in an effort to clarify which interventions can accelerate wound healing and improve efficacy of the treatment. methods. Three hundred thirty‐nine questionnaires were mailed to all dermatology and plastic surgery members of the American Society for Laser Medicine and Surgery (ASLMS). Questionnaires were completed anonymously to decrease respondent bias. Statistical analysis included calculation of percentages and means of the data. results. Survey results are discussed and compared with data from the literature for the following interventions: tretinoin cream, glycolic acid cream, hydroquinone, oral prophylactic antibiotics, oral prophylactic antivirals, hydrogel dressings, semiocclusive ointments, topical antibiotics, topical corticosteroids, oral corticosteroids, and dilute acetic acid soaks. conclusions. Many options are appropriate, based on data from past studies, for pre‐ and postresurfacing skin care. Approximately 73% of the results of the survey correlate with information from the literature. Past studies do provide information to help us select interventions that can improve wound healing and the final cosmetic outcome. Further studies involving resurfacing patients may clarify some of the more complex wound care issues, such as oral prophylactic antibiotics, hydroquinone, and topical vitamins C and E.