Mariano Vélez

Non-ablative facial skin photorejuvenation with an intense pulsed light system and adjunctive epidermal care

AbstractLaser skin resurfacing is popular, but the appearance of the face during healing is unpleasant. Non-ablative photorejuvenation with intense pulsed light (IPL) has been reported as being successful but with varied results. In this study we sought the possibility of enhancing the clinical effects with adjunctive epidermal care. Twenty-five women aged from 32 to 68, skin types I–IV, with a variety of wrinkle types and other conditions associated with photoaged skin, were treated with IPL according to our parameters over six sessions coupled with an adjunctive pretreatment micropeel and applications of nutritive and antipigmenting creams. Macroscopic and histological assessments were performed. At weeks 4 and 8 fair to good satisfaction was noted in 17 and 19 patients, and poor satisfaction in 8 and 6 patients, respectively. The histology showed good dermal collagen remodelling in all cases, with a reduction in elastosis. The results of IPL photorejuvenation can be enhanced, as our trials showed. The good patient satisfaction obtained was clearly demonstrated in the histologies and evaluations throughout the study.

Correlation of Histological Findings of Single Session Er:YAG Skin Fractional Resurfacing With Various Passes and Energies and the Possible Clinical Implications

Ablative fractional resurfacing shows promise for skin resurfacing and tightening and also to improve treatment of epidermal and dermal pigmentary disorders. This study aimed at determining any correlation between epidermal ablation and effects on the dermis when using an Er:YAG laser in ablative fractional resurfacing mode.

Nd:YAG laser combined with IPL treatment improves clinical results in non‐ablative photorejuvenation

BACKGROUND: Intense pulsed light (IPL) sources have been reported in non‐ablative photorejuvenation, but the excellent histological findings do not always coincide with the clinical results and patient satisfaction index (SI). METHODS: Ten female patients (two forehead, four periocular and four perioral), ages ranging from 28 to 46 years, skin types II–IV, wrinkle types I–III, participated in the study. The IPL system was applied with the yellow (570 nm) cut‐off filter, 30 J/cm2, single pulse, followed by the Nd:YAG at 120 J/cm2, double pulse (7 ms per shot with 20 ms between pulses) on the wrinkled areas only. Three sessions were given at monthly intervals, and an assessment was made 1 and 6 months after the third session. Biopsies were taken from four consenting patients as a cross‐section before the first treatment and then 1 and 6 months after the third session. For clinical control and contrast of tissue results, a group of 10 patients (two forehead, four periocular and four perioral; ages ranging from 27 to 47 years, skin types II–IV, wrinkle types I–III) was treated only with IPL, using the same parameters and sessions. Histologies were taken from four consenting patients. RESULTS: The histology showed thickening of the epidermis with good dermal collagen organization in both groups. However, the combined treatment showed more dramatic changes in histological tissue condition, and ectatic blood vessels were seen in the deeper dermis. The patient SI values, related to the results, were lower when IPL was used alone. All patients completed the study. In the combined treatment group, overall SIs of 8 (80%) and 8 (80%) were obtained at the control points of 1 and 6 months, respectively, after session 3, compared with SIs of 6 (60%) and 4 (40%) scored by patients in the IPL group at the same points. Discomfort and side effects were minimal in both groups. CONCLUSIONS: The addition of the Nd:YAG laser to the IPL regimen in non‐ablative skin rejuvenation gave very good histological results, which were echoed by stronger patient satisfaction than in the control group treated only with IPL. Visible improvement in the skin condition of both groups was achieved, but was better in the combined treatment group.

Treatment of leg veins with combined pulsed dye and Nd:YAG lasers: 60 patients assessed at 6 months

Leg telangiectasias have been reported to have been treated with a variety of lasers. This study was designed to measure response to treatment of leg telangiectasias with a unique coupled 585 nm and 1064 nm pulse.

Electron microscopy comparison of CO2 laser flash scanning and pulse technology one year after skin resurfacing

Background The recent adaptation of laser technology in plastic and dermatologic surgery has provided a means to reduce efficiently the irregularities of the surface of the skin. Previous studies have analyzed the short‐ and medium‐term clinical and histologic results of two laser systems: the Sharplan 40C SilkTouchTM and the 5000C Coherent Ultrapulse® with Computer Pattern Generator® (CPG). This paper contains the long‐term ultrastructural findings observed with the aid of transmission electron microscopy (TEM).

Hair removal evaluated with a filterless flashlamp‐based system: a preliminary study in 10 patients

BACKGROUND: A relatively inexpensive, portable epilation system based on unfiltered flashlamp technology (Spa Touch®, Epilast, Paris, France) was macroscopically and histologically evaluated for efficacy and duration of hair removal. PATIENTS AND METHODS: Ten patients participated (eight female, two male, aged 22–62 years, skin types I–V). The system delivers a 35 ms pulse of 6–7.5 J/cm2 of broadband infrared visible light through a large treatment window in the handpiece, held in light contact with the target skin, without skin cooling or anaesthesia. The skin was shaved before the first treatment, and the subsequent frequency of application over a further four sessions was done every month. RESULTS: Histology revealed the destruction of most of the hair shaft, with regrowth of finer and lighter hair approximately 4 weeks after the final treatment, depending on the area treated. Patients were satisfied with results if epilation was maintained on a monthly basis. A delay in treatment allows hair to grow back. An interesting observation was recorded on white and vellous hair. Nine of the 10 patients noted better skin condition in the treated area. CONCLUSIONS: This system retards hair regrowth and acts as a ‘light razor’ that can be implemented for speedy epilation at a reasonable cost.

The search for a youthful upper lip via laser resurfacing.

Generally, the upper lip resembles a bow of harmonious shape, characteristic of youthfulness. At the lip, noticeable wrinkles develop with aging, and these wrinkles can be successfully treated with laser resurfacing. Ideally, the aim of the treatment should include not only the wrinkles but the recovery of the whole aesthetic configuration of the upper lip. The study includes 236 patients treated for wrinkles of the upper lip either with the Coherent 5000C pulsed CO2 technology (300 mJ, density 6) or with the Flashscanning continuous wave emission, also CO2 technology (Sharplan FeatherTouch 36 W). Once resurfacing was done, passing the laser three times over the whole surface to recover the upper lip from the aging appearance of wrinkles, three more passes (same laser parameters) were performed at the area of the philtrum to reshape the Cupid’s bow. Biopsies were taken to examine possible particular implications of tissue behavior and the role in the recovery of the anatomy and aesthetics of young lip characteristics after resurfacing, using the proposed technique. Laser resurfacing, done with a few more passes at the philtrum area, reshapes the anatomic-aesthetic youthful appearance of the upper lip and fully recovers the appearance of the Cupid’s bow. Results proved to be about the same when using the Coherent or the Sharplan laser. The sum of “very good” (e.g., equal to >80 percent clinical improvement and >60 percent improvement for “good” results, for both systems) was as follows: (1) Sharplan, rate of success 52 percent “very good” and 35 percent “good,” and (2) Coherent, rate of success 40 percent “very good” and 50 percent “good” against a group of 118 patients treated with each laser. No bad results were scored. Histologic samples after laser resurfacing showed effects down to the reticular dermis, which, anatomically, is closely related to muscle layer because of the nonexistence of a subcutaneous fat layer. Two months later, tissue showed signs that typically appear after laser resurfacing, that is to say, there was a rich broad band of compacted collagen present immediately below the epidermis-dermis junction. This band could be very well distinguished from collagen before laser treatment, which was lax and presented clear signs of elastosis. The orbicular, the main muscle surrounding the mouth, is attached to the dermis with practically no layer of fat in between. Thus, when the technique is used as described, extra laser passes will promote a more compacted rich band of collagen that efficiently stretches the fibers of the mirtiform muscle which lies in direct connection with the philtrum and its physiognomy. Extra pulling on this particular location, related to the philtrum, will result in reshaping the anatomic and aesthetic lip configuration. Laser resurfacing offers possibilities of enhancing the results of lip rejuvenation by improving the vermilion appearance and the aesthetic pattern with little risk of complications.

1064-nm Nd: YAG laser-assisted cartilage reshaping for treating ear protrusions.

Correction of prominent ears is a common plastic surgical procedure. The laser‐assisted cartilage reshaping (LACR) technique for protruding ears was developed at the French National Institute of Health and Medical Research in Lille, France, using both the 1064‐ and 1540‐nm wavelengths, with a view to simplifying the surgical procedure. Herein we report our results with the 1064‐nm wavelength.

Letter: Photodynamic Therapy with Methyl Aminolevulinate Induces Phototoxic Reactions on Areas of the Nose Adjacent to Basal Cell Carcinomas and Actinic Keratoses

Topical photodynamic therapy (PDT) with 5-aminolevulinic acid (ALA) or methyl aminolevulinate (MAL) is an effective and generally well-tolerated therapeutic tool for actinic keratoses (AK), Bowen’s disease, and superficial and thin nodular basal cell carcinomas (sBCC). Since ALA and MAL are selectively taken up by skin malignant cells, there is usually little damage to surrounding normal tissue. MAL is more lipophilic than ALA, apparently resulting in increased tumor penetration after topical application and inducing fewer side effects in normal tissue. We have recently observed severe phototoxic reactions in four patients undergoing MAL-PDT for nasal skin lesions.

Clinical and histologic effects of facial skin rejuvenation with pulsed- and continuous-wave flash-scanned CO2 lasers

LEARNING OBJECTIVES The reader is presumed to have some understanding of the use of lasers in skin resurfacing. After studying the article, the participant should be able to: Physicians may earn 1 hour of Category 1 CME credit by successfully completing the examination based on material covered in this article. The examination begins on page 409. BACKGROUND The selection of the ideal laser for facial resurfacing is debatable. OBJECTIVE The purpose of the study was to determine whether any clinical and histologic differences existed in short- and long-term results after treatment with the Coherent UltraPulse 5000G laser (a pulsed laser; PL) and the Sharplan Silk Touch laser (a continuous-wave laser [CWL] with a flash scanner). METHODS Eight patients underwent facial resurfacing treatment on different areas. In each case, one side was treated with the PL and the other with the CWL. The condition of the patients and the treated tissue were monitored periodically after treatment. Histologic assessment of punch biopsies was performed 3 months and 1 year after treatment with hematoxylin-eosin, Masson trichromic, and Verhoeffs stains. RESULTS The areas treated with the PL achieved earlier epithelialization with a good appearance. Longer-lasting erythema was observed on the side treated with the CWL. On a histologic level, although the PL-treated tissue epithelialized more quickly, at 3 months and 1 year the collagen was better compacted and better aligned in the CWL-treated tissue, and the macroscopic appearance of the CWL-treated areas was more enhanced. CONCLUSIONS The more active vascularization seen in the CWL-treated tissue, associated with the longer-lasting erythema and possibly greater collateral thermal injury, is possibly the reason for the better collagenization and remodeling of collagen and elastin fibers as compared with the results with the PL-treated tissue. This may explain the longer effect associated with CWL treatment. The clinician would do well to bear in mind the histologic findings as well as the macroscopic clinical results when assessing the long-term effects of laser skin resurfacing. (Aesthetic Surg J 2001;21:399-411.).