The pinhole method using an erbium: YAG laser for the treatment of papular acne scars.

Papular acne scars are skin-colored or hypopigmented, soft and elevated lesions of the chin and trunk. Papular scars are one of the most difficult acne scars to treat. Herein, we reported two patients with papular acne scars on the chin that were successfully treated by the pinhole method using an Erbium (ER):YAG laser. Good cosmetic results were achieved in both patients. The side effects included mild, intra-, and post-procedural pain and erythema that resolved spontaneously within 2 weeks. The pinhole method with an Er:YAG laser could potentially be used as a safe and effective treatment for papular acne scars.

Treatment of hesitation marks on the forearm by the pinhole method.

Scars from self-inflicted wounds, referred to as "hesitation marks," are usually linear, flat, poorly oriented, white in color, and often located on the forearm. Many patients do not undergo treatment for these due to limited available modalities. The aim of this study was to evaluate the efficacy and safety of the pinhole method using a 10,600 nm carbon dioxide (CO2) laser for treating hesitation marks on the forearm. We conducted a retrospective chart review of patients with hesitation marks treated by the pinhole method from March 2010 to April 2014. Eleven patients with hesitation marks (mean age 37.8 years; range, 23-67 years) were treated with the pinhole method over the 4-year study period. Subjects were treated via the pinhole method in one to six treatment sessions at 4- to 8-week intervals. Two blinded observers evaluated photographs taken at baseline and 3 months after the final treatment and assessed improvement using a quartile grading scale. Compared with baseline, there was mild to moderate improvement in all patients (mean score 3.0). The patient satisfaction survey revealed a mean improvement score of 2.82. The pinhole method using a CO2 laser may be an effective treatment option in patients with hesitation marks on the forearm.

Sequential treatment with intradermal incision (intracision) and 2,940-nm Er:YAG laser for chicken pox scars.

Boxcar scars, such as chicken pox scars, are round to oval depressions with sharply defined vertical edges. Subcision is a simple and safe procedure for treatment of atrophic and depressed scars, but boxcar scars are generally not eliminated by subcision. Intradermal incision technique (intracision) can treat chicken pox scars by untethering fibrotic strands, raising collagen synthesis, and having additional intradermal blood pocket formation. We have found that chicken pox scars further improve when intracision is followed by laser skin resurfacing.

Treatment of hypertrophic burn scars by combination laser-cision and pinhole method using a carbon dioxide laser.

BACKGROUND: Hypertrophic burn scars induce cosmetic and functional complications. Although there are various treatment modalities, an ideal method has not yet been found. Recently, numerous laser treatment modalities have been introduced with encouraging results. OBJECTIVE: To assess the efficacy and safety of combination therapy with laser-cision and pinhole method using a carbon dioxide (CO2 ) laser. METHODS: We conducted retrospective chart review of patients with hypertrophic burn scars treated by combination laser-cision and pinhole method from January 2007 to December 2012. RESULTS: Nine patients with hypertrophic burn scars (mean age 31.2 years; range, 13-52 years) were treated with combination therapy over the past 6 years. Subjects were treated with one to three treatment sessions at 1-year intervals by laser-cision and five to eight treatment sessions at 2- to 3-month intervals by pinhole method. Two blinded observers evaluated photographs taken at baseline and 6 months after the final treatment. Compared with baseline, there was a mild to moderate improvement in all the patients (Grades 1-4; mean score: 2.89). The patient satisfaction survey revealed a mean improvement score of 3.11. CONCLUSION: Combination laser-cision and pinhole method using a CO2 laser may be a new effective treatment option for patients with hypertrophic burn scars.

Ablative non-fractional lasers for atrophic facial acne scars: a new modality of erbium:YAG laser resurfacing in Asians.

Atrophic facial scars which commonly occur after inflammatory acne vulgaris can be extremely disturbing to patients both physically and psychologically. Treatment with fractional laser devices has become increasingly popular, but there has been disappointment in terms of effectiveness. The objective of this study was to assess the safety and efficacy of ablative full-face resurfacing on atrophic acne scars in the Korean population. A total of 22 patients, aged 25-44 years, underwent a new modality of resurfacing combining both short-pulsed and dual-mode erbium:yttrium-aluminum garnet (Er:YAG) laser. The patients had Fitzpatrick skin types ranging from III to V. Photographs were taken before and up to 6 months after treatment. Results were evaluated for the degree of clinical improvement and any adverse events. Degree of improvement was graded using a four-point scale: poor (1) = <25%, fair (2) = 25-50%, good (3) = 51-75%, and excellent (4) = >75%. Based on the blinded photo assessments by two independent reviewers, clinically and statistically significant mean improvement of 3.41 was observed (one-sample Wilcoxon signed rank test, P < 0.001). Complete wound healing occurred between 6 and 9 days. Erythema occurred in all patients and lasted longer than 3 months in two patients (9.1%). Postinflammatory hyperpigmentation occurred in ten patients (45.5%) and lasted longer than 3 months in one patient (4.5%). One patient experienced mild hypopigmentation (4.5%). Mild to moderate acne flare-up occurred in five patients (22.7%). No other adverse effects were observed. A new modality of Er:YAG laser resurfacing combining short-pulsed and dual-mode Er:YAG laser is a safe and very effective treatment modality for atrophic facial acne scars in Asians with darker skin tones.

Combination of 595-nm pulsed dye laser, long-pulsed 755-nm alexandrite laser, and microdermabrasion treatment for keratosis pilaris: retrospective analysis of 26 Korean patients.

Keratosis pilaris (KP) has beenpresented as small keratotic follicular papules with or without surrounding erythema. Various treatments with laser or light therapy have been used for the management of KP with various clinical outcomes. In the present study, we investigated the efficacy and safety of a combination therapy for KP. A total of 29 anatomical sites with KP in 26 patients were treated using a 595-nm pulsed dye laser (PDL) with nonpurpuragenic fluences, a long-pulsed 755-nm alexandrite laser, and microdermabrasion. Clinical improvement was assessed by comparing preand posttreatment clinical photographs and patient satisfaction rates. Evaluation of the clinical results three months after the treatments showed that 12 of the 29 anatomical sites (41.4%) demonstrated Grade 3 clinical improvement, ten (34.5%) had Grade 2 clinical improvement, four (13.8%) showed Grade 1 improvement, and three (10.3%) showed Grade 4 improvement. We observed that KP lesions improved not only in erythema and skin texture, but also in brownish dyschromias. Potential adverse events were not observed, except prolonged posttherapy scaling. Our observations demonstrate that combination therapy using a 595-nm PDL, a long-pulsed 755-nm alexandrite laser, and microdermabrasion can have a positive therapeutic effect on KP.

Use of fractionated microneedle radiofrequency for the treatment of inflammatory acne vulgaris in 18 Korean patients.

BACKGROUND: Nonablative radiofrequency (RF) devices have been shown to be clinically effective for the treatment of moderate to severe acne lesions. OBJECTIVE: To evaluate the efficacy and safety of a fractionated microneedle RF device in the treatment of inflammatory acne vulgaris. METHODS: Eighteen patients (15 male, 3 female; mean age 27, range: 19-33; Fitzpatrick skin type IV) with moderate to severe acne vulgaris who were treated with two sessions of fractionated microneedle RF at 1-month intervals were enrolled in this study. RESULTS: Evaluation of improvement, which took into account number of inflammatory acne lesions, showed that two of the 18 patients had grade 4 clinical improvement, eight had grade 3 improvement, and six had grade 2 improvement. Improvement scores in terms of lesion severity were also evaluated. One of the 18 patients had grade 4 clinical improvement, eight grade 3, and seven grade 2. No patient had worsening of inflammatory acne lesions. CONCLUSION: Fractionated microneedle RF can have a positive therapeutic effect on inflammatory acne vulgaris and related scars. In addition, this technique does not worsen active acne lesions.

Treatment of syringoma using an ablative 10,600-nm carbon dioxide fractional laser: a prospective analysis of 35 patients.

BACKGROUND: Treatment of syringoma aims to destroy the dermal tumor using methods that can include surgical excision, electrodessication, cryosurgery, chemical peeling, and laser ablation, but complete removal of syringomas is often unsuccessful, and recurrence occurs frequently. OBJECTIVE: To investigate the therapeutic efficacy of an ablative 10,600-nm carbon dioxide fractional laser system (CO(2) FS) for the treatment of periorbital syringomas. METHODS: Thirty-five patients with periorbital syringomas were treated with two sessions of CO(2) FS at 1-month intervals. Laser fluences were delivered in two or three passes over the lower eyelids, using a pulse energy of 100 mJ and a density of 100 spots/cm(2) . Clinical improvement was assessed by comparing pre- and post-treatment clinical photographs and patient satisfaction rates. We examined the histological features of human periorbital syringomas treated with CO(2) FS. RESULTS: Evaluation of clinical results 2 months after treatment showed that 15 of the 35 patients (42.9%) demonstrated marked (51-75%) clinical improvement, 12 (34.3%) had moderate (26-50%) clinical improvement, five (14.3%) showed minimal (0-25%) improvement, and three (8.6%) showed near total (≥75%) improvement. Clinical improvement scores were less 4 months after the second CO(2) FS treatment (not statistically significant). The mean maximal depth of the necrotic column was 1,236.3 µm. A specimen obtained from the infraorbital area immediately after treatment showed formation of necrotic columns on the interfollicular skin. CONCLUSION: The use of CO(2) FS can have a positive therapeutic effect on periorbital syringomas.

Treatment of striae distensae using an ablative 10,600-nm carbon dioxide fractional laser: a retrospective review of 27 participants.

BACKGROUND: Late-stage striae distensae is a type of scar characterized by a loss of collagen and elastic fibers in the dermis. Ablative 10,600-nm carbon dioxide fractional laser systems (CO2 FS) have been used successfully for the treatment of various types of scars. OBJECTIVE: To investigate the therapeutic efficacy of using CO2 FS for the treatment of striae distensae. METHODS: Twenty-seven women with striae distensae were treated in a single session with a CO2 FS. Deep FX mode with a pulse energy of 10 mJ and a density of 2 (percent coverage of 10%) was used. Clinical improvement was assessed by comparing pre- and post-treatment clinical photographs and participant satisfaction rates. RESULTS: The evaluation of clinical results 3 months after treatment showed that two of the 27 participants (7.4%) had grade clinical 4 improvement, 14 (51.9%) had grade 3 improvement, nine (33.3%) had grade 2 improvement, and two (7.4%) had grade 1 improvement. None of the participants showed worsening of their striae distensae. Mean clinical improvement score was 2.6. Surveys evaluating overall participant satisfaction administered after the treatment was completed showed that six of the 27 participants (22.2%) were very satisfied, 14 (51.9%) were satisfied, five (18.1%) were slightly satisfied, and two (7.4%) were unsatisfied. CONCLUSION: Our observations demonstrated that the use of CO2 FS can have a positive therapeutic effect on late-stage striae distensae.

Treatment of burn scar using a carbon dioxide fractional laser.

In Asian patients, ablative laser therapies are seldom used to treat burn scars due to posttreatment dyschromia, especially when nonfacial areas are treated. The non-ablative 1550-nm erbium-doped fractional photothermolysis system, although effective, requires multiple treatment sessions. In the authors hands, a 34-year-old Korean woman achieved improved atrophy, contracture, texture and color of a burn scar on her chest after two treatments spaced six weeks apart with an ablative 10,600 nm CO2 fractional laser system (Ultrapulse Encore Laser, Lumenis Inc., Santa Clara, CA).

The efficacy and safety of 10,600-nm carbon dioxide fractional laser for acne scars in Asian patients.

BACKGROUND: The nonablative 1,550-nm erbium-doped fractional photothermolysis system (FPS) has been effectively used for scar treatments, but it seems that several sessions of treatment must be delivered to achieve satisfactory improvement. OBJECTIVES: To evaluate the efficacy and safety of the combined use of two treatment modes of an ablative 10,600-nm carbon dioxide fractional laser system (CO(2) FS) on acne scars. METHODS: Twenty Korean patients with atrophic acne scars treated with a single session of Ultrapulse Encore laser (Lumenis Inc., Santa Clara, CA) were enrolled. The laser fluences were delivered to the scars using the Deep FX mode. Additional treatment using the Active FX mode was performed throughout the entire face. RESULTS: Follow-up results revealed that one patient had clinical improvement of 76% to 100%, nine had improvements of 51% to 75%, seven had moderate improvements of 26% to 50%, and three had minimal to no improvements. The mean duration of post-therapy crusting or scaling was 6.3+/-3.0 days, and post-therapy erythema lasted 2.8+/-4.6 days. CONCLUSION: We suggest that CO(2) FS used with a combination of two different treatment modes may provide a new treatment algorithm for acne scars in Asians.

Scar characteristics and treatment expectations: a survey of 589 patients.

BACKGROUND: Scar tissue formation by skin injury is common and patients need treatments for cosmetic or functional improvement. OBJECTIVE: To determine the relationship between various characteristics of scars and patients' treatment expectations. METHODS: The subjects were patients who had one or more scars regardless of their intention for treatment between August 2007 and February 2008. The survey was conducted using paper forms on patients' first visits. RESULTS: A total of 589 patients (mean age 29 years) with various types of scars participated in this survey. Of the causes described by the patients, trauma was the most common (681 answers), followed by cutaneous diseases (189), and surgery (133). The treatment history of scars was recorded in 233 patients (39.6%), namely topical agents in 146 (62.7%), laser therapies in 79 (33.9%), and skin grafts or surgical scar revisions in eight (3.4%). Patients with a treatment history showed a more prominent expectation for the next treatment outcome (p < 0.05) and were willing to spend more time on scar treatment (p < 0.05). CONCLUSION: Although it could not play a major role in choosing treatment modalities, treatment expectations can be significant as a part of a healthy doctor-patient relationship, of which the ultimate goal is always the best outcome for the patient.

Burn scars treated by pinhole method using a carbon dioxide laser.

Many patients with burn injuries have various complications and emotional problems due to scars. Although various modalities to improve burn scars have been attempted, such as excision of scars, skin grafts, laser abrasion and silicone product usage, the cosmetic outcomes have not been satisfactory for a large portion of patients. Herein, we describe two cases which showed satisfactory cosmetic results after treatment of burns scars with the pinhole method using a carbon dioxide (CO(2)) laser that allowed us to make deep, closely set holes reaching down to the upper dermis. A 20-year-old female patient with a scar on her neck and a 25-year-old female patient with a scar on her right forearm after burn injuries are presented. As early as only a few weeks after the treatment, the scars showed relaxation of contracture, reduction of wrinkles and improvement of texture and color compared to before the treatment. Treatment of burn scars with the pinhole method can be easily performed and results in dramatic improvement in scar quality with only a few side-effects.

Combination of Q-switched and quasi long-pulsed 1064-nm Nd:YAG laser, non-ablative 1450-nm diode laser, and ablative 10 600-nm carbon dioxide fractional laser for enlarged pores.

Currently, there is no gold standard for the treatment of enlarged facial pores. In this report, we describe a patient with enlarged nasal pores which were treated with a combination of a non-ablative 1450-nm diode laser, a Q-switched and quasi long-pulsed 1064-nm Nd:YAG laser, and an ablative 10 600-nm carbon dioxide fractional laser system. Four months after the final treatment, the condition of the patient's pores had markedly improved, and the patient was satisfied with the results.