Clinical Efficacy and Safety of a Monopolar Radiofrequency Device With Comfort Pulse Technology for the Treatment of Facial and Neck Laxity in Men.

The objective of this study was to demonstrate the efficacy and safety of a monopolar radiofrequency treatment for facial and neck laxity in men. Twelve men received one treatment of the face and upper portion of the neck using an RF system with comfort pulsed technology. Standardized photographs were taken at baseline and at 1, 3, and 6 months of follow-up. Study investigators evaluated facial and neck laxity at baseline and all follow-up visits using the Fasil Laxity Scale. Patents and investigators assessed skin texture and overall appearance using the Quartile Improvement Scale. Average improvement in treated areas was statistically significant at 1-month (P<.01), 3-month (P=.02), and 6-month (P=.05) follow-up visits compared with baseline. Investigators rated greatest improvement in skin texture and overall appearance (mild to moderate) at the 3-month follow-up. Patient assessments demonstrated moderate improvement in skin laxity, skin texture, and overall appearance maintained out to 6 months after treatment. A total of 64% of patients were satisfied to very satisfied with treatment at the 6-month follow-up. One RF treatment of the face and neck yielded 20% reduction in facial laxity 1 month after treatment, with maintained improvement out to 6 months (15% reduction).

A randomized, split-face clinical trial of low-fluence Q-switched neodymium-doped yttrium aluminum garnet (1,064 nm) laser versus low-fluence Q-switched alexandrite laser (755 nm) for the treatment of facial melasma.

BACKGROUND: Melasma is distressing for patients and challenging for physicians to treat. Clinical data from controlled comparative studies is lacking to support the efficacy, longevity, and safety of laser treatments for melasma. OBJECTIVE: Compare the efficacy and safety of low fluence Q-switched neodymium-doped yttrium aluminum garnet (1,064 nm) laser (Nd:YAG) versus low-fluence Q-switched alexandrite laser (755 nm) (QSAL) for the treatment of facial melasma. METHODS: Twenty male and female subjects with moderate to severe mixed-type melasma on both sides of the face were randomized to six, weekly treatments with the low-fluence Q-switched Nd:YAG laser on one side and the low-fluence QSAL to the other side. Two independent investigators conducted Modified Melasma Area and Severity Index (MMASI) evaluations and subjects completed self-assessment questionnaires at baseline, after three treatments and each follow-up visit 2, 12, and 24 weeks after the last treatment. Standardized digital photographs were taken at baseline and at each subsequent follow-up visit. RESULTS: One male and fifteen females, mean age of 43.4 (range 32-64) years, completed the 29-week study. Both laser treated sides showed a significant improvement in MMASI evaluations after two treatments (22% improvement on the QS-Nd:YAG, 17% QSAL) and each follow-up visit 2 (36% QS-Nd:YAG; 44% QSAL), 12 (27% QS-Nd:YAG; and 24% QSAL), and 24 weeks (27% QS-Nd:YAG; and 19% QSAL) after the last treatment, but no significant difference was seen between study groups at any visit. There was also no significant difference in subject evaluation of improvement between both treatment sides at any visit. Both laser treated sides were tolerated well, and no serious adverse events were noted. Only one subject was taken out of the study due to development of post-inflammatory hyperpigmentation bilaterally. CONCLUSION: Both low-fluence Q-switched Nd:YAG and low-fluence QSAL were equally effective at improving moderate to severe mixed-type facial melasma. LIMITATIONS: This was a single-center trial and patients were not able to use complimentary lightening agents during the study.

Evaluation of microfocused ultrasound with visualization for lifting, tightening, and wrinkle reduction of the décolletage.

BACKGROUND: Laxity and rhytides are manifestations of photodamage on the chest. OBJECTIVE: We sought to evaluate efficacy and safety of microfocused ultrasound with visualization treatment of décolletage laxity and rhytides. METHODS: In all, 24 subjects with moderate to severe rhytides, as measured by a validated 5-point photonumeric scale (Fabi/Bolton Chest Wrinkle Scale), received microfocused ultrasound with visualization treatment. Efficacy was measured at 90 and 180 days by the Fabi/Bolton Chest Wrinkle Scale, mid-clavicular to nipple distance, masked assessment, Physician and Subject Global Aesthetic Improvement Scales, and patient satisfaction. Adverse events were recorded. RESULTS: Rhytides improved over time (P < .0001), with 46% and 62% of subjects showing a 1- to 2-point improvement at days 90 and 180, respectively. Mean (SD) mid-clavicular to nipple distance decreased (P < .0001), from 20.9 (1.57) cm to 19.8 (1.50) cm and 19.5 (1.59) cm, at days 90 and 180, respectively. At day 90, 100% were improved by Subject Global Aesthetic Improvement Scale score (P < .0001) and 96% were improved by Physician Global Aesthetic Improvement Scale score (P < .0001), with similar findings at day 180. All subjects were satisfied or very satisfied at day 90, with similar results at day 180. Improvement by masked assessment at day 90 was 71%. LIMITATIONS: Single-center study, small sample size, and only Fitzpatrick skin types I and II enrolled were limitations. CONCLUSION: There was appreciable efficacy and patient satisfaction after a single microfocused ultrasound with visualization treatment in wrinkle reduction and lifting of the décolletage.

Treatment of melasma with the 1,927-nm fractional thulium fiber laser: a retrospective analysis of 20 cases with long-term follow-up.

BACKGROUND: Melasma is a common acquired symmetrical hyperpigmentation that is often recurrent and refractory. OBJECTIVES: To investigate the efficacy and safety of a single administration of high-density fractional thulium fiber laser (1,927 nm) for the treatment of refractory melasma in 20 patients. MATERIALS AND METHODS: A retrospective chart and photographs review of 20 women (Fitzpatrick skin type II-IV) with clinical diagnosis of melasma treated with the 1,927-nm fractionated thulium laser at 10 or 20 mJ/cm(2) , with 60-70% surface area coverage. Four investigators independently evaluated Melasma Area Severity Index (MASI) scores before, 4 weeks, 3-6 months, and 6-12 months after treatment. RESULTS: Mean MASI scores decreased dramatically from 13.2 ± 5.4 before treatment to 8.5 ± 3.5 at 4 weeks after laser treatment (P = 0.004). Patient assessment revealed that 12 of the 20 subjects had more than 50% clearance of their melasma. Recurrence was reported by 7 out of 15 patients who were successfully followed-up (mean 10.2 months). Two patients developed postinflammatory hyperpigmentation that subsided with topical bleaching after 3 months. CONCLUSION: High-density coverage fractional 1,927-nm thulium laser proved to be safe and effective for melasma with long-term remission.

Endoluminal laser delivery mode and wavelength effects on varicose veins in an ex vivo model.

BACKGROUND AND OBJECTIVES: Endovenous laser ablation (EVLA) has been shown to be effective for the elimination of saphenous veins and associated reflux. Mechanism is known to be heat related, but precise way in which heat causes vein ablation is not completely known. This study aimed to determine the effects of various endovenous laser wavelengths and delivery modes on ex vivo human vein both macroscopically and microscopically. We also evaluated whether protected-tip fibers, consisting of prototype silica fibers with a metal tube over the distal end, reduced vein wall perforations compared with non-protected-tip fibers. MATERIALS AND METHODS: An ex vivo EVLA model with human veins harvested during ambulatory phlebectomy procedures was used. Six laser fiber combinations were tested: 810 nm continuous wave (CW) diode laser with a flat tip fiber, 810 CW diode laser with a protected tip fiber, 1,320 nm pulsed Nd:YAG laser, 1,310 nm CW diode laser, 1,470 nm CW diode laser, and 2,100 nm pulsed Ho:YAG laser. RESULTS: Perforation or full thickness necrosis of a portion of the vein wall was observed in 5/11 (45%), 0/11 (0%), 3/22 (14%), 7/11 (64%), 4/6 (67%), and 5/10 (50%) of cross-sections of veins treated with the 810 nm CW diode laser with a flat tip fiber, the 810 CW diode laser with a protected tip fiber, the 1,320 nm pulsed Nd:YAG laser, the 1,310 nm CW diode laser, the 1,470 nm CW diode laser, and the 2,100 nm pulsed Ho:YAG laser, respectively. CONCLUSION: Our results have shown that the delivery mode, pulsed Nd:YAG versus CW, may be just as important as the wavelength. Therefore, the 1,310 nm CW laser may not be equivalent to the 1,320 nm pulsed laser. In addition, protected 810 nm fibers may be less likely to yield wall perforations than their non-protected counterparts.

Clinical efficacy and safety evaluation of a monopolar radiofrequency device with a new vibration handpiece for the treatment of facial skin laxity: a 10-month experience with 64 patients.

BACKGROUND: Although ablative laser technology and surgical treatment are considered to be the criterion standard for the rejuvenation of aging skin, the demand for procedures with less down time and risk, such as nonablative laser and radiofrequency (RF) treatments, has increased over the last several decades. OBJECTIVES: To investigate the efficacy and safety of the newest generation of monopolar RF (mRF) devices by evaluating our patients after treatment. METHODS AND MATERIALS: Sixty-four patients with mild to moderate facial skin laxity were treated using the new mRF with vibration handpiece. Patients were surveyed between 1-10 months after treatment to determine degree of improvement, satisfaction, and presence of side effects. RESULTS: With the new system, 80% (n = 51) reported at least mild correction of skin laxity, 55% (n = 35) noticed skin texture improvement, average pain level was 6.06 (0-10 scale), 9% (n = 6) found the procedure too painful, and 43% (n = 28) would have the procedure again. CONCLUSION: The new mRF system was safely tolerated and efficacious for most patients for facial treatment sites.

Repigmentation of hypopigmented scars using an erbium-doped 1,550-nm fractionated laser and topical bimatoprost.

BACKGROUND: Hypopigmented scarring is a challenging condition to treat, with current treatments showing limited efficacy and temporary results. Nonablative fractional resurfacing has been demonstrated to be an effective and safe modality in the treatment of hypopigmented scars. OBJECTIVES: To demonstrate the efficacy and safety of combining fractional resurfacing with topical bimatoprost and topical tretinoin or pimecrolimus for the treatment of hypopigmented scars. MATERIALS AND METHODS: Fourteen patients with hypopigmented scars were treated with a mean of 4.5 sessions of a fractionated 1,550-nm erbium-doped laser at 4- to 8-week intervals and subsequently started topical bimatoprost and tretinoin or pimecrolimus. An independent physician evaluated digital photographs taken before and 4 weeks after the last laser treatment using a quartile grading scale (grade 1, ≤25% improvement; grade 2, 26-50% improvement; grade 3, 51-75% improvement; grade 4, >75% improvement). RESULTS: Five patients had >75% improvement in hypopigmentation, and 12 had >50% improvement. After a mean follow-up of 20.1 months, all patients demonstrated prolonged results. Side effects were limited to transitory post-treatment edema and erythema. CONCLUSION: The combination of fractional resurfacing, topical bimatoprost, and tretinoin or pimecrolimus is a potential effective resource for the treatment of hypopigmented scars, with long-lasting results.