Mussarrat Hussain

A Prospective Study of Fractional Scanned Nonsequential Carbon Dioxide Laser Resurfacing: A Clinical and Histopathologic Evaluation

BACKGROUND Although unparalleled in its efficacy, carbon dioxide (CO2) laser resurfacing has a high risk:benefit ratio. A modified device uses a novel handpiece and software to deliver nonsequential fractional ablative CO2 laser exposures. OBJECTIVE To evaluate the safety and efficacy of this fractional ablative, scanned, nonsequential CO2 laser in the treatment of photo‐damaged skin and to evaluate histologic and ultrastructural changes after the treatment. MATERIALS AND METHODS Ten subjects with Fitzpatrick skin types I to III with photo‐damaged facial skin underwent a single CO2 ablative laser treatment using a scanning handpiece in a nonsequential fractional mode. Clinical improvement and histologic and ultrastructrural changes were assessed. RESULTS All subjects completed the study with no serious or long‐term complications. Blinded evaluator and subject assessment documented improvement in cutaneous photoaging. Light microscopy revealed changes consistent with a wound repair mechanism, and electron microscopy confirmed evidence of new collagen deposition. CONCLUSION Nonsequential scanned fractional CO2 laser resurfacing can lead to improvement in photo‐damaged skin, accompanied by histologic and ultrastructural evidence of wound repair and subsequent new collagen formation. The study was supported in part by a grant from Lumenis Inc.

Treatment of terminal and vellus non-pigmented hairs with an optical/ bipolar radiofrequency energy source—with and without pre-treatment using topical aminolevulinic acid

Objective. The present study compares the 6‐month hair removal efficacy of a combined pulsed light bipolar radiofrequency device with and without pre‐treatment using topical aminolevulinic acid. Materials and methods. Fifteen adult females, skin phenotypes II–IV were entered into the study. Ten subjects were determined to have white terminal hairs; an additional five females presented with fine facial vellus hairs. Unwanted facial hair was treated twice at 4–6 week intervals with a combined optical bipolar radiofrequency source. At each treatment half of the treatment area was pre‐treated with topical aminolevulinic acid; the other half was not. Follow‐up visits were undertaken at 6 months after the second treatment. Hair counts were obtained before treatment and 6 months after the final treatment. Results. An average terminal white hair removal of 35% was observed at 6 months after treatment with the combined pulsed light bipolar radiofrequency device. When pre‐treatment with topical aminolevulinic acid was provided the average hair removal of terminal white hairs was found to be 48%. None of the five subjects with vellus hair were noted to respond to either treatment. Conclusions. Combined radiofrequency and optical light treatment leads to effective hair removal of terminal white hairs. This improvement is increased with pre‐treatment use of topical aminolevulinic acid. Vellus nonpigmented hairs did not respond to treatment

Treatment of skin laxity of the lower face and neck in older individuals with a broad‐spectrum infrared light device

Background: Non‐ablative approaches with infrared and radiofrequency energy sources have been shown to reduce skin laxity, but studies have focused on individuals with early‐stage, mild‐to‐moderate degenerative dermal changes. Objective: The purpose of this prospective study was to evaluate the safety and efficacy of an infrared light device for the treatment of skin laxity in patients with soft tissue ptosis of the lower face and neck characteristic of the sixth decade of life and beyond. Materials and methods: Thirteen females, aged 58–83 years old (average: 64 years), were treated with a filtered 1100–1800 nm infrared light‐based device. All individuals presented with ptotic soft tissue, but varied in the extent of skin laxity from no visible laxity to having pendulous excess skin. Two treatment sessions were provided at monthly intervals. The individuals returned for follow‐up visits at 1, 3 and 6 months after the second treatment. Twelve of the individuals completed the study. Results: Changes were dramatic for those individuals in whom the skin envelope appeared to drape separately from deeper soft tissue. No treatment complications were noted. Conclusion: Infrared light source‐induced skin tightening may be induced even in older individuals.

Acne scar correction using calcium hydroxylapatite in a carrier‐based gel

Objectives: This study sought to determine the efficacy and safety profile of calcium hydroxylapatite filler in the treatment of acne scars. Methods: Ten subjects with a variety of acne scars were treated with calcium hydroxylapatite filler. Results: Saucerized acne scars responded to treatment; ice‐pick scars did not. Results lasted, at least to some degree, for 12 months after treatment. No significant treatment complications were noted. Conclusions: Calcium hydroxylapatite is a safe and effective long‐term filler for the treatment of saucerized acne scars.

Laser lipolysis of the arm, with and without suction aspiration: Clinical and histologic changes

Abstract Background and objective: Liposuction has become increasingly popular over the past several decades. However, liposuction is a relatively traumatic procedure with known risks, which include skin redundancy. Laser lipolysis has the potential of producing similar clinical results to those seen with liposuction while providing the additional benefit of tissue tightening. In this study, we evaluated the efficacy, safety, and histologic changes induced by 1064-nm Nd:YAG laser lipolysis. Furthermore, we investigated the benefit of suction aspiration after laser lipolysis. Methods: Twenty female subjects, aged 44–66 years, underwent a single laser lipolysis treatment of the extensor arm fat pads. Treatment was undertaken after infusion of tumescent anesthesia. Lipolysis was undertaken with a 10-Watt 1064-nm Nd:YAG laser (SmartLipo™ Cynosure Lasers, Chelmsford, MA, USA), delivered via a 300-μm fiber encased in 1-mm micro-cannula introduced through a 1-mm incision. The liquefied fat was removed via standard liposuction aspiration in 50% of patients. Subjects were evaluated at 6 months after laser lipolysis for reduction of unwanted fat and any associated complications. Post-procedure histologic changes were also evaluated. Results: Clinical improvement in both unwanted fat and associated skin tightening was noted in most subjects. Results at 6 months were greater than those seen at 1 month. The clinical observations were substantiated by measurements showing an average reduction in the arm circumference following treatment. No significant treatment-induced complications were noted. Treatment with and without post-laser lipolysis suction aspiration produced similar results. Histologic changes showed disruption of adipocytes and evidence of connective tissue thermal injury. Conclusion: Laser lipolysis using the 1064-nm Nd:YAG represents a safe and effective option for removal of unwanted fat of the upper arm. Results were identical whether or not post-laser suction aspiration was undertaken.

A Split-Face Comparison of Two Ablative Fractional Carbon Dioxide Lasers for the Treatment of Photodamaged Facial Skin

OBJECTIVE To compare the safety and efficacy of two fractional carbon dioxide (CO(2)) laser devices for the treatment of photodamaged facial skin. METHODS Eight healthy subjects underwent full-face resurfacing for photodamaged skin with two fractionated CO(2) laser devices using manufacturer-recommended settings for facial rejuvenation. For each subject, one device with a rolling handpiece was used on one side and a second device with a stamping handpiece was used on the other. Patients were evaluated 3 months postoperatively and photographed. A blinded physician investigator assessed the photographs and rated each side for improvement in four categories (wrinkles, pigmentation, skin laxity, and overall appearance). Patient ratings for overall improvement for each side were also recorded. RESULTS All patients had improved on the basis of photographic and clinical assessments at 3 months. No significant differences in patient ratings of overall improvement and physician-measured parameters of clinical improvement were found, although intraoperative times and pain ratings were greater with the laser with the stamping handpiece. No complications were experienced with either device. CONCLUSIONS Both fractionated CO(2) resurfacing devices used in the study were safe and effective for the treatment of photodamaged facial skin, but the modality using a stamping handpiece was associated with longer operative times and greater intraoperative pain. The authors have indicated no significant interest with commercial supporters.

Clinical, histologic, and ultrastructural changes after use of human growth factor and cytokine skin cream for the treatment of skin rejuvenation

The present study reports the clinical, histologic, and ultrastructural changes observed after the 6‐month application of a novel skin cream containing a mixture of human growth factors and cytokines. Participants were asked to apply the human growth factor and cytokine skin cream twice daily to their entire face over a period of 6 months. A 3‐mm punch biopsy was taken from the preauricular skin area before and after the treatment period. Further evaluations included photographic and clinical assessment of facial skin for wrinkles. After the treatment period, improved clinical appearance of periorbital and perioral wrinkles by 33% and 25% on average, respectively, was demonstrated. Histologic evaluation indicated moderate changes in the epidermal thickness as well as an increased fibroblast density in the superficial dermis at the end of the 6‐month treatment period. Ultrastructural changes consistent with new collagen formation were shown by electron microscopy. This study, together with earlier studies, corroborates that topical application of growth factors and cytokines are beneficial in reducing signs of facial skin aging.

Evaluation of histologic and electron microscopic changes after novel treatment using combined microdermabrasion and ultrasound‐induced phonophoresis of human skin

Background: Mechanical exfoliation using microdermabrasion has been used as a minimally invasive treatment of photodamage, as well as to improve absorption of topical agents. Phonophoresis, a method of electrically assisted percutaneous delivery of macromolecules, relies on ultrasonic waves producing alterations within the stratum corneum that result in increased absorption. Objective: To determine the effects on photodamaged facial skin that resulted from the ultrasound‐enhanced delivery of a combined hyaluronic acid, retinol, and peptide‐containing complex following microdermabrasion. Methods: Seven individuals, aged 40–65, with Fitzpatrick skin types I–III and class I–III rhytids, underwent eight weekly aluminum oxide crystal microdermabrasion procedures (Parisian Peel®; Aesthetic Technologies, Golden, CO, USA), followed by administration of a topical combined hyaluronic acid, retinol, and peptide‐containing complex, propelled through ultrasound phonophoresis. The participants continued manual twice‐daily application of the topical complex between treatments. Clinical evaluation included digital photography, and patient and investigator assessment of changes in skin dryness, texture, brightness, tone, and rhytids. The 3‐month post‐treatment histologic evaluation consisted of pre‐ and post‐treatment biopsies evaluated for microscopic and ultrastructural changes. Results: An overall mild clinical improvement in the skin was noted. A slight increase in vascularity within the papillary dermis, increased reticulin stain (type III collagen), and ultrastuctural evidence of increased type I collagen indicate dermal injury with resulting new collagen formation. Conclusion: Microdermabrasion followed by ultrasonic phonophoretic application of topical products represents a novel dermal delivery approach to photorejuvenation.

Evaluation of clinical, microscopic, and ultrastructural changes after treatment with a novel Q‐switched Nd:YAG laser

Background: The Q‐switched Nd:YAG laser was among the first non‐ablative lasers to be used. High‐fluence photoacoustic Q‐switched laser treatments were shown to produce results akin to those seen with some ablative lasers. Previous low‐fluence, non‐thermal, Q‐switched Nd:YAG lasers produced almost no results. Objective: The purpose of this study was to evaluate a new combined photoacoustic/photothermal low‐fluence Q‐switched Nd:YAG laser in the treatment of facial photodamage. Methods: Ten individuals with photodamaged facial skin were enrolled in the study. Participants underwent six bi‐weekly full‐face treatments using a Q‐switched Nd:YAG laser (RevLite, HOYA ConBio, Freemont, CA, USA) at 1064 nm, with an 8‐mm spot size and fluence of 3.2 J/cm2. Clinical improvement was evaluated through blinded investigator assessment of photographs obtained before and 3 months after the last treatment. Pre‐auricular biopsies, performed before and 3 months following the last treatment, were processed for light and electron microscopy and analyzed for evidence of treatment‐related changes. Results: Eight individuals completed the study with no serious or long‐term complications. Blinded evaluator assessment documented improvement in a variety of different aspects of photodamaged skin. Biopsy specimens revealed changes consistent with wound repair under light microscopy, while electron microscopy confirmed new collagen deposition. Conclusion: A novel combined photoacoustic/photothermal Q‐switched Nd:YAG laser can be used for non‐ablative photorejuvenation. In addition to clinical improvement, histological and ultrastructural changes consistent with new collagen deposition were noted.

308-nm Excimer laser treatment of palmoplantar psoriasis

Abstract Psoriasis is a chronic inflammatory condition affecting 1–3% of the population. The incidence of palmoplantar involvement has been estimated to be between 2.8% and 40.9%. Significant psychosocial distress and difficulty performing activities of daily living can result. Treatment is often challenging. Traditional treatments include topical steroids, anthralin, calcipotriene, PUVA, methotrexate, cyclosporine, retinoids and biologics. In this case series, we report our success with the 308-nm excimer laser in the treatment of palmoplantar psoriasis.