Mario A. Trelles

Nonablative Wrinkle Treatment of the Face and Neck Using a Combined Diode Laser and Radiofrequency Technology

Background Nonablative laser systems that integrate optical and conducted radiofrequency (RF) energies are a novel technology for the treatment of wrinkles. Objective This two-center study investigated the safety and effectiveness of combination diode laser (900 nm) and RF for the treatment of wrinkles and skin texture. Methods Patients with grade II to IV wrinkling on the face, according to the Glogau classification system, were treated with a combination diode laser and RF using a fluence of 30 to 50 J/cm2 and RF energy of 80 to 100 J/cm3. Patients received up to three treatment sessions at 2- to 3-week time intervals. Wrinkle assessments using the Glogau scale were conducted at baseline and at 3 months following the last treatment. In addition, patients and physicians graded the level of improvement using pre- and post-treatment photographs. Results Twenty-three subjects completed all three treatment sessions. Of these participants, more than 50% had a greater than 50% improvement in the appearance of wrinkles. All subjects reported a noticeable improvement in skin smoothness and texture. Conclusion This preliminary study demonstrates that the combination of diode laser and RF energies decreases the appearance of wrinkles and improves skin texture.

Treatment of wrinkles with the nonablative 1,320-nm Nd:YAG laser.

Ablative laser resurfacing with the CO2 and Er:YAG lasers has become a well-accepted and well-reported modality for skin rejuvenation of photoaged and photodamaged skin. However, the side effects associated with these lasers, such as exudation and crusting followed by prolonged erythema, are often socially disturbing for the patient. A nonablative 1,320-nm pulsed Nd:YAG system has been developed that controls dermal collagen damage while preserving the epidermis. Thirteen patients are presented on whom periocular wrinkle treatment was carried out during two sessions 1 month apart. Side effects were minimal. Histology showed improvement in the previously typical sun-damaged dermis. However, although physician assessment noted a trend toward macroscopic improvement, almost all patients failed to see any improvement. The authors conclude that further studies of the ideal parameters are required before the 1,320-nm Nd:YAG laser can be indicated successfully in stand-alone, nonablative wrinkle removal. In addition, patients should be selected carefully, and a complementary minimally aggressive technique should be used to restore a youthful appearance to the epidermis.

The origin and role of erythema after carbon dioxide laser resurfacing. A clinical and histological study.

background. Transient erythema, which can last up to 3 months after carbon dioxide (CO2) laser skin resurfacing, is a usual side effect with pulsed or rapidly scanned CO2 lasers. objective. We evaluated the cause of erythema in the clinical setting and by histology in order to determine if and how we may decrease it, or even eliminate it. methods. Ten patients who underwent resurfacing were recruited to this study. Skin punch biopsies were taken at 0, 7, 21, and 90 days and analyzed by light microscopy. results. Erythema was noticed from about day 8, when the crusting on the skin surface was exfoliated. It reached its maximum intensity after 14 days, and had disappeared by 60–90 days. Histology showed an early inflammatory response, with an immature neoepithelium, and rich vascularization. The normal epidermis had returned by 90 days, and during this period there was reduced optical scattering and absorption in melanin. conclusion. Although the erythema is an unwanted side effect in the patients eyes, it is to be expected and thus represents the effects of a combination of epidermal immaturity, reduced melanin absorption of light, reduced dermal optical scattering, and increased blood flow secondary to the surgically induced inflammatory response.

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.

A multicenter study of cellulite treatment with a variable emission radio frequency system

Radio frequency (RF) systems have been reported as producing electrothermally mediated and subcutaneous effects. The present study evaluates a new approach to treat cellulite with a bipolar RF device. The buttocks of 50 patients were treated, 10 from each of five multinational centers with a novel bipolar RF technology set at 6 J/cm3, which changes its frequency between 0.6 and 2.4 MHz according to impedance of tissue. Twelve weekly sessions were given for 12 minutes on each buttock, with a treatment end point of 42°C external skin temperature. Cellulite changes and tissue condition were assessed before and immediately after the first session, before the final 12th session, and 2 months thereafter. The patient Satisfaction Index was recorded. Objective evaluation involved clinical photography, three‐dimensional optical skin surface measurement, and histological findings. Almost all patients noted improvement of cellulite and body silhouette at the final session, which slightly decreased at the 2‐month assessment. Improved skin appearance was objectively detected. Histological findings following the first session showed reactive edema and lysis of adipocyte membranes, possibly implicated in the final effects achieved. The RF technology used in the present multicenter study improved the general aspect of skin and cellulite, with high patient Satisfaction Index. Maintenance sessions might lead to even better and longer‐lasting results.

Red light‐emitting diode (LED) therapy accelerates wound healing post‐blepharoplasty and periocular laser ablative resurfacing

Background and aims. Blepharoplasties can be associated with sequelae‐related patient downtime, often extended or reinforced by periocular laser ablative resurfacing. The present controlled study examined the effects of a new‐generation LED phototherapy system on enhancing wound healing following such combination surgery. Methods. Two males and eight females participated in the trial, with ages ranging from 44 to 59 years (average 52.3 years). Following blepharoplasty and Er:YAG/CO2 laser ablative resurfacing, one‐half of each subjects face was treated with the red LED therapy (20 min, 96 J/cm2, 633 nm), the contralateral half being the unirradiated control. Patients reported subjectively on pain levels and resolution. Resolution of erythema, edema, bruising and days to healing were independently evaluated from the clinical photography. All findings were compared between the treated and untreated sides. Results. In all instances, the LED therapy‐treated side was statistically significantly superior to the unirradiated control by a factor of two to three. Conclusions. In this small series of 10 patients, red LED phototherapy after blepharoplasty and laser ablative resurfacing cut the time to resolution of side effects and the healing time by one‐half to one‐third compared with contralateral unirradiated controls. Further studies are warranted with larger populations to confirm these findings.

A clinical and histological comparison of flashscanning versus pulsed technology in carbon dioxide laser facial skin resurfacing.

background. Two different carbon dioxide (CO2) laser systems are currently in use for skin resurfacing. The vast majority of lasers use a pulsed beam, like the Coherent 5000C, but Shar‐plan uses scanning technology. objective. We describe a clinical and histological comparison of these two laser technologies in order to determine if there are differences in the outcome. methods. Twenty‐two female patients underwent facial skin resurfacing using the Coherent 5000C UltraPulse CPG on one side of the face and the Sharplan Silk Touch on the contralateral side of the face. The clinical appearances were assessed periodically after treatment and punch biopsies were taken preoperatively and after 7, 21, and 90 days. Tissue was stained with Hematoxylin‐Eosin, Masson Trichrom, and with the Verhoeff technique. Histological evaluation was performed on randomized samples taken from the same patient. Epidermis/dermis expression, collagen compaction, and elastin fiber quantity were compared to evaluate if any differences existed. results. The side treated by Coherent healed more rapidly and with excellent cosmesis. Greater erythema was observed on the Sharplan side, but had disappeared at the 90‐day evaluation. At this time the quality of the results was similar with no particular difference between the sides treated by the Coherent or the Sharplan lasers. At the histological level, although tissue recovered faster on the Coherent side at the 7‐day control, at 90 days the collagen was better compacted and organized on the Sharplan side. Similarly, the quantity of the elastin was significantly more enhanced on the Sharplan side. conclusion. Irradiated laser energy density in relation to time, and the way that it is delivered, should play an important role at the moment of producing collagen shrinkage. The SilkTouch delivers laser energy more aggressively, thereby producing a more intense inflammatory tissue reaction, which results in slower recovery of tissue, compared with the Coherent CPG. More active enhancement of vascularization found in the Sharplan is likely to be the reason for a more effective collagen proliferation and compaction. These changes, together with the increase in elastin in the dermis, may produce longer lasting effects in skin resurfacing.

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.

Effects of cellulite treatment with RF, IR light, mechanical massage and suction treating one buttock with the contralateral as a control

Background and objectives: A system that combines bipolar radio frequency (RF) and intense infrared light (IR) together with mechanical massage and suction has recently been reported as being efficient for cellulite treatment. The present split study was designed to evaluate the efficacy of such a system through various treatments of cellulite located on the buttocks. Methods: Ten patients were enrolled for 12 sessions of 30 minutes each performed over one buttock, the other buttock serving as an untreated control. Sessions were conducted twice a week for a period of 12 weeks. Clinical photography and profilometry were carried out to assess textural changes before (baseline) and 2 months after the final treatment. Histopathology was performed at baseline, 2 hours after the first session, and just before the 12th session and 2 months thereafter. Results: All patients noted improvement in the treated buttock before the final session, which was maintained at the 2‐month assessment. Improved skin appearance was noticed after the first session and was maintained throughout the study. All patients were satisfied with the results and requested further treatment in order to balance the results in both buttocks. Random histological analyses suggested dermal firmness, fibre compaction and tightening of skin layers, including the subcutis, as possible reasons for the effects achieved. The authors recognize that the small number of participants limits the statistical power of the study. Conclusions: Treatment sessions with the combined RF, IR light and mechanical massage and suction system were complication free, produced improvements in the overall cellulite appearance and skin condition, suggesting that further treatment sessions for maintenance could sustain patient satisfaction index (SI) and lead to lasting results. Based on the good results in the limited trial population, further studies with larger patient populations are warranted.

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.