Evaluating the efficacy in improving facial photodamage with a mixture of topical antioxidants.

This study evaluates the efficacy and tolerability of an investigational study cream composed of 3 ingredients (green and white teas, mangosteen, and pomegranate extract), Vitaphenol Skin Cream (La Jolla Spa MD, La Jolla CA), as compared to a placebo cream in rejuvenating facial skin. Twenty healthy females between the ages of 35 and 65 with demonstrable facial wrinkling, achieving a Rao-Goldman wrinkle scale score of 2 or above, applied either Vitaphenol Skin Cream or placebo cream to a randomized half of their face twice daily for 60 days and returned for follow-up after 2 weeks. Twice as many subjects indicated an enhancement of skin texture (eg, reduction in pore size, roughness, and touch) with the usage of Vitaphenol versus placebo. In all, 41% of the study subjects preferred the half of their face that had been receiving Vitaphenol, while only 0.06% of the subjects favored the placebo side. PRIMOS images from periorbital skin treated with Vitaphenol demonstrated an average improvement in skin smoothness of 1 mm3, whereas skin treated with placebo showed an average decrease in smoothness or an increase in skin roughness of 0.9 mm3. The addition of 3 antioxidants, green and white teas, mangosteen, and pomegranate, have an additive effect to enhance the improvement of age-related changes in the skin.

Treatment of atrophic facial acne scars with the 1064-nm Q-switched Nd:YAG laser: six-month follow-up study.

OBJECTIVES: To quantitatively assess improvement in acne scarring after a series of nonablative laser treatments and to determine efficacy at 1-, 3-, and 6-month follow-up after treatment. DESIGN: Before-after trial of consecutively selected patients. SETTING: Private practice at the Laser and Skin Surgery Center of New York, New York. PATIENTS: Eleven patients with mild to moderate atrophic acne scarring were treated. INTERVENTIONS: A 3-dimensional optical profiling imaging system was used to assess skin topography before, during, and after treatment. Patients were treated with a 1064-nm Q-switched Nd:YAG laser and reassessed after 3 treatment sessions and at 1, 3, and 6 months after the fifth treatment session. MAIN OUTCOME MEASURES: The skin roughness analysis was quantified at baseline and at each follow-up interval. Pain, erythema, and petechiae formation were assessed on 3-point scales. RESULTS: At midtreatment (1 month after the third treatment session), an 8.9% improvement in roughness analysis was seen. This improvement increased to 23.3%, 31.6%, and 39.2% at 1, 3, and 6 months after the fifth treatment, respectively. Patients reported mild to moderate pain with treatment. The only adverse effects noted were transient erythema and mild pinpoint petechiae. CONCLUSIONS: Treatment with the nonablative 1064-nm Q-switched Nd:YAG laser results in significant quantitative improvements in skin topography in patients with mild to moderate atrophic acne scars. Continued incremental improvements were noted at 1-, 3-, and 6-month follow-up, indicating ongoing dermal collagen remodeling after the treatment.

Quantitative evaluation of nonablative laser technology.

A new method for treating facial rhytides and acne scars with nonablative laser and light source techniques has recently been introduced. Given the inherent limitations of photographic and clinical evaluation to assess subtle changes in rhytides and surface topography, new noninvasive, objective instruments were used to accurately assess the outcome of these procedures. This study measures and objectively quantifies facial skin by using 2 novel, noninvasive measuring systems after 3 to 5 treatment sessions with the 1,064 nm QS Nd:YAG laser in patients with photodamage and acne scarring. One system measures the skin surface topography and the other characterizes the biomechanical properties of the skin. Patients undergoing facial rejuvenation procedures were analyzed before and after therapy with a 32 x 32 mm in vivo three-dimensional microtopography imaging system (PRIMOS, GFM, Teltow, Germany). The imaging system projects light on to a specific surface of the skin with a Digital Micromirror Device (DMD; Texas Instruments, Irving, TX) and records the image with a CCD camera. Skin Surface microtopography is reconstructed using temporal phase shift algorithms to generate three-dimensional images. Measurements were taken at baseline, at various times during the treatment protocol, and then at 3 and 6 month follow-up visits. Silicone skin replicas (FLEXICO, Herts, England) were also made before and after the laser treatment protocol for comparison to in vivo acquisition. Skin stiffness and compliance were measured with the BTC-2000 (BTC 2000, S.R.L.I. Inc. Nashville, TN). This instrument measures the response of the skin during dynamic stress created by suction. An infrared targeting laser measures the vertical displacement of the skin during the cycle. Pressure and deformation are graphically displayed on the monitor and embedded biomechanical algorithms determine the aforementioned parameters based on the average of 3 repetitive cycles. Four sites on the face were analyzed and compared including the right and left cheek and the right and left forehead. Measurements were taken at baseline and then at 1-, 3- and 6-month follow-up visits. Skin roughness decreased 11% from baseline in the patient with photodamaged skin, while the patients with acne scarring showed a 33% improvement from baseline after 3 treatment sessions. Six-months after the fifth treatment session, a 26% improvement in skin smoothness was documented in the patients with photodamaged skin, while a 61% improvement was recorded in the subject with acne scarring. Biomechanical analysis of the skin showed a 23% decrease in skin stiffness and a 30% increase in skin compliance at the 6-month follow-up in the patients with photodamage. Alternatively, the patient with acne scarring showed a 50% increase in skin stiffness, and a 30% decrease in skin compliance at the 6-month follow-up. Three-dimensional in vivo optical skin imaging provided a rapid and quantitative assessment of surface topography and facial fine lines after multiple treatment sessions with a 1064-nm QS Nd:YAG laser, correlating with clinical and subjective responses. Biomechanical analysis provided technical understanding of structural changes in photodamaged skin and acne scarring following nonablative laser treatment. Future applications of these devices may include comparison of nonablative laser technology, optimization of treatment regimens, and objective evaluation of other aesthetic procedures performed by dermatologists.

Optimizing wound healing in the face after laser abrasion.

BACKGROUND: Laser resurfacing is a popular procedure to improve the physical signs of photoaging. In addition to improvements in treatment modalities, optimizing posttreatment regimens will enhance patient care. OBJECTIVE: Our purpose was to evaluate the efficacy of two forms of wound care for the face after laser abrasion. METHODS: Forty-two patients received full-face laser resurfacing at two clinics by using either the UltraPulse carbon dioxide (CO(2)) laser (Coherent Laser Corp, Palo Alto, Calif) alone or followed by an erbium:YAG laser (Derma-20, ESC Sharplan, Inc, Needham, Mass) and/or a blended CO(2)/Er:YAG laser (Derma-K, ESC Sharplan) or a variable pulse erbium:YAG laser (Contour, Sciton Laser Corp, Palo Alto). Twenty-one patients were randomly assigned to a postoperative regimen including Silon-TSR (Bio Med Sciences, Inc, Allentown, Pa) for the first 2 to 3 days after laser resurfacing, followed by Aquaphor ointment (Beiersdorf, Charlotte, NC) to complete the first 2 weeks. The other 21 patients received the resurfacing recovery system (RRS, Neutrogena, Los Angeles, Calif) following a specific regimen. The system includes Fibracol wound dressing (Johnson & Johnson, Skillman, NJ) for 2 days, followed by a hydrogel dressing for 1 to 2 days, followed by an ointment to complete the first 2 weeks. Patients were evaluated for wound healing on days 2, 3, 6-10, 14-16, and 28-30. The skin was swabbed for colonization at every visit to determine the quantity of bacteria throughout the healing process. RESULTS: Ninety percent of patients in both groups experienced either "no pain" or "minimal pain" during the first 3 days. Total bacterial counts peaked on days 3 and 6 in the patients managed with the RRS and the Silon-TSR/Aquaphor regimen, respectively. The average day at which patients did not require a dressing was 3.0 days in the group managed with the RRS and 3.7 days in the group managed with the Silon-TSR/Aquaphor dressing regimen (P < or =.05). The average day of complete epithelial regeneration was significantly shorter at 6.3 days using the RRS compared with 7.4 days for patients using the Silon-TSR/Aquaphor regimen (P < or =.02). There was no difference in infection, adverse sequelae, exudate management, or pain in either group. CONCLUSION: Healing was optimized in patients using the RRS after laser resurfacing.

3D in-vivo optical skin imaging for topographical quantitative assessment of non-ablative laser technology.

BACKGROUND: A new method for treating facial rhytides and acne scars with nonablative laser and light source techniques has recently been introduced. Given the inherent limitations of photographic and clinical evaluation to assess subtle changes in rhytides and surface topography, a new noninvasive objective assessment is required to accurately assess the outcomes of these procedures. OBJECTIVE: The purpose of this study was to measure and objectively quantify facial skin using a novel, noninvasive, In-vivo method for assessing three-dimensional topography. This device was used to quantify the efficacy of five treatment sessions with the 1064 nm QS Nd:YAG laser for rhytides and acne scarring, for up to six months following laser treatment. METHODS: Two subjects undergoing facial rejuvenation procedures were analyzed before and after therapy using a 30-mm, three-dimensional microtopography imaging system (PRIMOS, GFM, Teltow, Germany). The imaging system projects light on to a specific surface of the skin using a Digital Micromirror Device (DMD Texas Instruments, Irving, TX) and records the image with a CCD camera. Skin Surface microtopography is reconstructed using temporal phase shift algorithms to generate three-dimensional images. Measurements were taken at baseline, at various times during the treatment protocol, and then at three and six-month follow-up visits. Silicone skin replicas (FLEXICO, Herts, England) were also made before and after the laser treatment protocol for comparison to In-vivo acquisition. RESULTS: Skin roughness decreased by 11% from baseline after three treatment sessions in the wrinkles subject, while a 26% improvement of skin roughness was recorded by 3D In-vivo assessment six months following the fifth treatment session. The subject with acne scarring demonstrated a 33% decrease in roughness analysis after three treatment sessions by 3D In-vivo assessment. A 61% improvement in surface topography was recorded 3-months following the fifth treatment session, which was maintained at the 6-month follow-up. CONCLUSION: Three-dimensional In-vivo optical skin imaging provided a rapid and quantitative assessment of surface topography and facial fine lines following multiple treatment sessions with a 1064-nm QS Nd:YAG laser, correlating with clinical and subjective responses. This imaging technique provided objective verification and technical understanding of nonablative laser technology. Wrinkle depth and skin roughness decreased at the three and six-month follow-up evaluations by 3D In-vivo assessment, indicating ongoing dermal collagen remodeling after the laser treatment protocol. Future applications may include comparison of nonablative laser technology, optimization of treatment regimens, and objective evaluation of other aesthetic procedures performed by dermatologists.