A split-face comparison study of pulsed 532-nm KTP laser and 595-nm pulsed dye laser in the treatment of facial telangiectasias and diffuse telangiectatic facial erythema.

BACKGROUND AND OBJECTIVES: Pulsed 595 nm and 532 nm lasers can effectively diminish or eliminate facial telangiectasia. We performed a split-face, single-blind, controlled, comparison study in an effort to determine their individual and comparative efficacy. STUDY DESIGN/MATERIALS AND METHODS: Fifteen patients were treated using a 595-nm PDL on one side of the face and a pulsed 532-nm potassium-titanyl-phosphate (KTP) laser on the other. Each subject was evaluated at 3 weeks after three treatments. RESULTS: Both devices improved telangiectasia. The 532-nm device, however, was at least as effective or more effective than the 595-nm laser in all subjects. On average, the KTP laser achieved 62% clearing after the first treatment and 85% clearing 3 weeks after the third treatment, compared to 49% and 75% for the PDL, respectively. Seventy-nine percent of KTP laser-treated patients continued to have swelling for greater than 1 day versus 71% of PDL-treated patients. Of those patients who noted persistent erythema for at least 1 day after treatment, 58% noted more erythema on the KTP laser-treated side compared to 8% on the PDL-treated side. CONCLUSIONS: Both the 595-nm and the 532-nm pulsed lasers are highly effective in the treatment of facial telangiectasia and redness. The 532-nm KTP laser appears to be more effective but causes more swelling and erythema.

Patient satisfaction and reported long-term therapeutic efficacy associated with 1,320 nm Nd:YAG laser treatment of acne scarring and photoaging.

BACKGROUND AND OBJECTIVE: Nonablative laser treatments have become increasingly used for the treatment of acne scarring and photoaging. While nonablative laser treatments are more convenient and relatively safer than ablative laser resurfacing, efficacy and patient satisfaction with the level of improvement of textural abnormalities in acne scarring and rhytids associated with photoaging needs further study. DESIGN/MATERIALS AND METHODS: Structured interviews were performed with 34 patients from a referral-based academic practice who each previously received a series of 6 monthly treatments with a 1,320 nm neodymium:yttrium-aluminum-garnet (Nd:YAG) laser for treatment of acne scarring or photoaging. Topical anesthesia was applied 1 hour before each treatment. Patients were interviewed at least 3 months after cessation of treatment (range 3-12 months). RESULTS: Patients tolerated the treatments well. Combined results for acne scarring and photoaging patients were as follows: (a) patient satisfaction with treatment was rated at 62%, and (b) textural improvement was reported at 31% at the end of the six treatments, and 30% at the date of interview. When results were stratified by diagnosis, patient satisfaction was slightly higher for treatment of acne scarring than for photoaging. Overall degree of improvement on a 1-10 scale was 5.4 for acne scarring and 3.8 for wrinkling. CONCLUSION: Nonablative treatment with the 1,320 nm Nd:YAG laser induced significant patient-reported improvement in both acne scarring and photoaging. The majority of patients reported satisfaction with the degree of improvement.

Topical 5-aminolevulinic acid combined with intense pulsed light in the treatment of photoaging.

BACKGROUND: The adjunctive use of 5-aminolevulinic acid (5-ALA) with intense pulsed-light (IPL) treatments has been suggested to increase the benefit of IPL for photoaging; however, to our knowledge, no controlled trials have been performed. DESIGN: A prospective, randomized, controlled, split-face study was designed. Twenty subjects participated in a series of 3 split-face treatments 3 weeks apart in which half of the face was pretreated with 5-ALA followed by IPL treatment while the other half was treated with IPL alone. Two additional full-face treatments (with IPL alone) were then delivered 3 weeks apart. Assessment of global photodamage, fine lines, mottled pigmentation, tactile roughness, and sallowness (on a scale of 0-4) was performed by a blinded investigator before each treatment and 4 weeks after the final treatment. Patients also completed an assessment at the conclusion of the study comparing their results with pretreatment photographs. RESULTS: All 20 volunteers completed the study. Pretreatment with 5-ALA resulted in more improvement in the global score for photoaging (16 [80%] subjects vs 9 [45%] subjects; P = .008) and mottled pigmentation (19 [95%] subjects vs 12 [60%] subjects; P = .008) than IPL treatment alone. More successful results were achieved on the side pretreated with 5-ALA compared with the side treated with IPL alone for fine lines (12 [60%] subjects vs 5 [25%] subjects; P = .008) and mottled pigmentation (17 [85%] subjects vs 4 [20%] subjects; P < .001). While there was noticeable improvement over baseline scores with respect to tactile roughness and sallowness, pretreatment with 5-ALA did not seem to enhance the results of the IPL treatment. The final investigator cosmetic evaluations (P=.0002) and subject satisfaction scores (P=.005) were significantly better for the 5-ALA-pretreated side. Both treatments were well tolerated, with little difference in the incidence or profile of adverse effects with or without 5-ALA pretreatment. CONCLUSIONS: The adjunctive use of 5-ALA in the treatment of facial photoaging with IPL provides significantly greater improvement in global photodamage, mottled pigmentation, and fine lines than treatment with IPL alone, without a significant increase in adverse effects. This combination treatment enhances the results of photorejuvenation and improves patient satisfaction.

Clinical evaluation of enhanced nonablative skin rejuvenation using a combination of a 532 and a 1,064 nm laser.

BACKGROUND AND OBJECTIVES: Improvements in the physical signs of photoaging can be achieved by non-invasive laser resurfacing procedures. To evaluate the effectiveness and safety of the Nd:YAG 1,064 nm and KTP 532 nm lasers for non-invasive skin rejuvenation. STUDY DESIGN/PATIENTS AND METHODS: Subjects requesting non-invasive skin rejuvenation underwent two treatments with the 532 nm laser to one side of the face and with both lasers to the other side, followed by three treatments with the 1,064 nm laser to both sides. Skin characteristics were evaluated before, during, and up to 4 months after treatment. RESULTS: A >25% improvement in overall skin condition was observed for >30% of subjects at the 1 month follow-up and >40% of subjects at the 4 month follow-up. The greatest improvements were observed for visual dryness, roughness, and uneven pigmentation. No adverse events were reported. There was a trend for greater improvement in patients who received more 1,064 nm treatments but this was not statistically significant. CONCLUSIONS: The 532 nm KTP and 1,064 nm Nd: YAG lasers can be effectively and safely used for non-invasive skin rejuvenation.

Reduction in injection pain with botulinum toxin type B further diluted using saline with preservative: a double-blind, randomized controlled trial.

BACKGROUND: Injection with botulinum A exotoxin reconstituted with preserved saline has been shown to be less uncomfortable than injection with the same toxin reconstituted with preservative-free saline. OBJECTIVE: We sought to determine whether injection with botulinum toxin type B is similarly less painful when preservative-containing saline is used to further dilute the product. METHODS: We conducted a double-blind, randomized controlled trial. A total of 15 consecutive adult patients presenting for treatment of upper face dynamic lines received treatment to one side (left or right) of the face with toxin type B further diluted with preservative-containing saline, and to the other side with toxin type B further diluted with preservative-free saline. RESULTS: Of 15 patients, 13 (87%) reported less pain in the halves of their faces treated with the preservative-containing saline (P =.0006). Pain on the preservative-containing side was on average 32% less among patients as a whole, and 39% less among patients noting some reduction. The 95% confidence interval for pain reduction associated with preservative-containing injection was -46.9% to -16.1%. Neither investigators nor patients observed any difference in clinical efficacy between the 2 treatment sides. CONCLUSIONS: Use of preservative-containing saline to further dilute botulinum toxin type B can significantly decrease patient discomfort on injection.