Improvement in the appearance of cellulite and skin laxity resulting from a single treatment with acoustic subcision: Findings from a multicenter pivotal clinical trial.

INTRODUCTION AND OBJECTIVES: Surface depressions and skin laxity together play a role in the appearance of cellulite. Cellulite depressions can be improved through disruption of the subcutaneous fibrous structures. Some currently utilized approaches accomplish this through invasive techniques requiring local anesthesia and potential down time. Skin laxity can exacerbate the appearance of cellulite, however current invasive approaches do little to improve skin laxity. The objective of this study was to evaluate a noninvasive approach to improving both cellulite depressions and skin laxity through the use of rapid acoustic pulses (acoustic subcision). Safety, efficacy, tolerability, and participant satisfaction results were measured. METHODS: Women (n = 56) with moderate to severe cellulite were treated in a single acoustic subcision treatment session without anesthesia. Posttreatment adverse events (AEs) and tolerability were recorded. At 12-weeks cellulite outcomes were assessed using a 6-point simplified Cellulite Severity Scale (CSS), Global Aesthetic Improvement Scale (GAIS), and a participant satisfaction questionnaire. Additionally, laxity improvement was measured using a 4-point Laxity Score (LS) and GAIS. RESULTS: Improvement in cellulite appearance measured at 12-weeks showed that participants (n = 56) had a mean CSS reduction of 1.01 (a 29.5% reduction from baseline). The posttreatment photograph was correctly identified by blinded independent reviewers from randomized pairs of pre/posttreatment photographs for 96.4% of participants. Cellulite was graded as improved, much improved or very much improved using the GAIS at 90.9% of treated locations. Finally, 92.9% of participants reported positive satisfaction responses. Scoring for improvement in skin laxity appearance at 12-weeks showed a mean LS reduction of 0.57 (a 27.9% reduction from baseline). GAIS for laxity was graded as improved, much improved or very much improved in 67.3% of treated areas. No unexpected or serious AEs were noted at treatment or follow-up. Overall average pain score during treatment was 2.4 (0-10 pain scale) and 0.3 immediately posttreatment. CONCLUSION: A single noninvasive acoustic subcision session can safely provide meaningful improvement in the appearance of cellulite in terms of depressions, as well as skin laxity, with minimal treatment pain and no posttreatment down time. Further improvement in appearance is expected with multiple treatments over time. Additional trials to verify this are planned.

Noninvasive approach to treatment of submental fullness.

A recent survey done by the American Society for Dermatologic Surgery indicated that 67% of respondents were bothered by "excess fat under the chin/neck." Accumulation of fat in the preplatysmal compartment of the neck is a common cause for fullness in the submental area. In the past, surgical liposuction was the only option to remove fat in the submental area. Although effective, liposuction does have risks and downtime. Recently, noninvasive options for treatment of submental fat have been introduced. These include treatment with deoxycholic acid, known as Kybella®, and cryolipolysis using the CoolMini™ handpiece. Both of these treatments offer less downtime fewer potential risks than the surgical counterpart. This article summarizes these two procedures and describes noninvasive approaches to treatment of submental fat.

Multicenter prospective cohort study of the incidence of adverse events associated with cosmetic dermatologic procedures: lasers, energy devices, and injectable neurotoxins and fillers.

IMPORTANCE: Common noninvasive to minimally invasive cosmetic dermatologic procedures are widely believed to be safe given the low incidence of reported adverse events, but reliable incidence data regarding adverse event rates are unavailable to date. OBJECTIVE: To assess the incidence of adverse events associated with noninvasive to minimally invasive cosmetic dermatologic procedures, including those involving laser and energy devices, as well as injectable neurotoxins and fillers. DESIGN, SETTING, AND PARTICIPANTS: A multicenter prospective cohort study (March 28, 2011, to December 30, 2011) of procedures performed using laser and energy devices, as well as injectable neurotoxins and soft-tissue augmentation materials, among 8 geographically dispersed US private and institutional dermatology outpatient clinical practices focused on cosmetic dermatology, with a total of 23 dermatologists. Participants represented a consecutive sample of 20 399 cosmetic procedures. Data acquisition was for 3 months (13 weeks) per center, with staggered start dates to account for seasonal variation. EXPOSURES: Web-based data collection daily at each center to record relevant procedures, by category type and subtype. Adverse events were detected by (1) initial observation by participating physicians or staff; (2) active ascertainment from patients, who were encouraged to self-report after their procedure; and (3) follow-up postprocedural phone calls to patients by staff, if appropriate. When adverse events were not observed by physicians but were suspected, follow-up visits were scheduled within 24 hours to characterize these events. Detailed information regarding each adverse event was entered into an online form. MAIN OUTCOMES AND MEASURES: The main outcome was the total incidence of procedure-related adverse events (total adverse events divided by total procedures performed), as verified by clinical examination. RESULTS: Forty-eight adverse events were reported, for a rate of 0.24% (95% CI, 0.18%-0.31%). Overall, 36 procedures resulted in at least 1 adverse event, for a rate of 0.18% (95% CI, 0.13%-0.25%). No serious adverse events were reported. Adverse events were infrequently associated with known risk factors. CONCLUSIONS AND RELEVANCE: Noninvasive to minimally invasive cosmetic dermatologic procedures, including energy, neurotoxin, and filler procedures, are safe when performed by experienced board-certified dermatologists. Adverse events occur in less than 1% of patients, and most of these are minor and transient.

Microfocused ultrasound for skin tightening.

The demand for noninvasive skin tightening procedures is increasing as patients seek safe and effective alternatives to aesthetic surgical procedures of the face, neck, and body. Over the past decade, radiofrequency and infrared laser devices have been popularized owing to their ability to deliver controlled heat to the dermis, stimulate neocollagenesis, and effect modest tissue tightening with minimal recovery. However, these less invasive approaches are historically associated with inferior efficacy so that surgery still remains the treatment of choice to address moderate to severe tissue laxity. Microfocused ultrasound was recently introduced as a novel energy modality for transcutaneous heat delivery that reaches the deeper subdermal connective tissue in tightly focused zones at consistent programmed depths. The goal is to produce a deeper wound healing response at multiple levels with robust collagen remodeling and a more durable clinical response. The Ulthera device (Ulthera, Inc, Meza, AZ), with refined microfocused ultrasound technology, has been adapted specifically for skin tightening and lifting with little recovery or risk of complications since its introduction in 2009. As clinical parameters are studied and optimized, enhanced efficacy and consistency of clinical improvement is expected.

Noninvasive lifting of arm, thigh, and knee skin with transcutaneous intense focused ultrasound.

BACKGROUND: Transcutaneous intense focused ultrasound is a novel Food and Drug Administration-approved technology for noninvasive skin tightening of the face and neck. No studies have reported on its safety and effectiveness on nonfacial areas. MATERIALS AND METHODS: Eighteen paired areas (6 each) on the upper arms, medial thighs, and extensor knees were randomly treated with two different transducers (4.0 MHz, 4.5-mm focal depth and 7.0 MHz, 3.0-mm focal depth). One side was randomly assigned to receive a single pass (single plane) of microthermal coagulation zones over the involved area with the 4.0 MHz, 4.5-mm-depth transducer, and the contralateral side was assigned to receive consecutive single passes (dual plane) using both transducers (4.0 MHz, 4.5-mm depth followed by 7.0 MHz, 3.0-mm depth). Two independent masked assessors determined clinical improvement scores using comparative standardized photographs obtained at baseline and 3 and 6 months after treatment. Subjective assessments of clinical improvement and side effects of treatment were obtained. RESULTS: Global assessment scores revealed significant improvement in all treated areas, with the upper arms and knees demonstrating more skin lifting and tightening than the thighs. Areas receiving dual-plane treatment had slightly better clinical scores than those receiving single-plane treatment in all three sites. Clinical scores from single-plane and dual-plane treated areas continued to improve between 3 and 6 months after treatment. Side effects were mild and transient and included erythema, warmth, and skin tenderness. Rare focal bruising was noted in two patients on the upper arms that resolved within 7 days. No other side effects were reported or observed. CONCLUSIONS: Transcutaneous intense focused ultrasound can be safely and effectively used to improve the clinical appearance (texture and contour) of the upper arms, extensor knees, and medial thighs.

Combined 595-nm and 1,064-nm laser irradiation of recalcitrant and hypertrophic port-wine stains in children and adults.

PURPOSE: Although pulsed dye laser (PDL) treatment of port-wine stain (PWS) has long been proven safe and effective, incomplete clearance of these vascular malformations can be problematic. In addition, advanced PWS with deeper coloration and tissue hypertrophy can be particularly difficult to treat because of the superficial dermal penetration of 585- to 595-nm light. The purpose of this study was to evaluate the safety and efficacy of a novel device that delivers sequential pulses of 595- and 1,064-nm wavelengths in the treatment of recalcitrant and hypertrophic PWS. METHODS: Twenty-five children and adults (skin phototypes I-III) with recalcitrant or hypertrophic PWS showing incomplete clearance after 10 prior PDL treatments were included in the study. Successive treatments using a 595-nm PDL and a 1,064-nm neodymium-doped yttrium-aluminum-garnet (Nd:YAG) laser were delivered at 6- to 8-week intervals. Two masked assessors determined clinical improvement of treatment areas using independent evaluation of comparative photographs at baseline and 3 months after treatment using a standard quartile grading scale. RESULTS: The use of dual 595-/1,064-nm wavelengths provided continued improvement of PWS that were previously recalcitrant to ongoing PDL therapy. Side effects were limited to transient erythema, edema, and mild purpura. Rare vesicle formation was observed, with no subsequent scarring or undesirable pigmentary changes. CONCLUSION: The novel dual 595-nm PDL and 1,064-nm Nd:YAG laser is an effective treatment for PWS that are recalcitrant to PDL therapy alone.

Effect of a novel low-energy pulsed-light device for home-use hair removal.

BACKGROUND: Removal of unwanted hair is the most popular skin treatment worldwide. Over the past decade, various lasers and light sources for epilation have been advocated for use in an office setting, although most people continue to treat unwanted hair with a variety of temporary physical methods (e.g., waxing, shaving) in a home setting, presumably due to cost and convenience factors. OBJECTIVES: To evaluate the safety and efficacy of a low-energy pulsed-light device intended for home-use hair removal. MATERIALS AND METHODS: Twenty women (skin phototypes I-IV) with dark terminal hair in nonfacial sites (axilla, forearms, inguinal region, legs) self-administered three treatments at 2-week intervals using a handheld intense-pulsed-light device. Matched untreated skin sites were also studied. Hair counts and clinical photographs were obtained pretreatment and at 1, 3, and 6 months after the third treatment. Side effects and patient satisfaction scores were recorded. RESULTS: All patients showed a positive clinical response to treatment, with reduction of unwanted hair. No reduction of hair was noted in untreated matched areas. Hair counts were reduced 37.8% to 53.6% 6 months after the three treatments. Skin region influenced clinical response, with lower legs exhibiting greater hair reduction than arms and inguinal and axillary areas. Mild erythema was experienced in 25% of patients, but no other side effects or complications were encountered. Patient satisfaction scores were high, with all patients stating that they would purchase the device for future home use. CONCLUSIONS Low-energy pulsed light can be applied safely and effectively for at-home hair removal in a variety of nonfacial locations and skin phototypes I-IV.

Fraxel laser indications and long-term follow-up.

Fractional photothermolysis, based on creating spatially precise microscopic thermal wounds, is performed using a 1550-nm erbium fiber laser that targets water-containing tissue to effect the photocoagulation of narrow, sharply defined columns of skin known as microscopic thermal zones. According to the authors, Fraxel resurfacing has been shown to be both safe and effective for facial and nonfacial photodamage, atrophic acne scars, hypopigmented scars, and dyspigmentation. Because only a fraction of the skin is treated during a single session, a series (typically 3 to 6 treatments) of fractional resurfacing at 2- to 4-week intervals is required for the best clinical improvement. It is the authors' experience that a series of Fraxel treatments can achieve a similar clinical result for atrophic scars compared with traditional ablative laser skin resurfacing. However, the improvement seen after a series of Fraxel treatments for perioral laxity and rhytides often falls short of the impressive results that can be achieved with ablative laser skin resurfacing.

Side effects and complications of fractional laser photothermolysis: experience with 961 treatments.

BACKGROUND: A novel 1,550-nm erbium-doped laser (Fraxel, Reliant Technologies Inc.) has been shown to be effective in the treatment of photodamaged skin and scars with minimal postoperative recovery; however, studies evaluating its side effects and complication rates have been limited. PURPOSE: The purpose was to determine the frequency and range of side effects and complications associated with fractional photothermolysis treatment. METHODS: A retrospective evaluation of 961 successive 1,550-nm erbium-doped laser treatments in patients of various skin phototypes (I-V) was conducted in a single center. Side effects and complications of treatment, including time of onset and duration, were identified and tabulated. Patient demographics and laser parameters were also assessed. RESULTS: Seventy-three treatments (7.6%) resulted in development of complications. The most frequent complications were acneiform eruptions (1.87%) and herpes simplex virus outbreaks (1.77%). Side effects and complications were equally distributed across different ages, skin types, body locations, laser parameters, and underlying skin conditions, except for postinflammatory hyperpigmentation, which occurred with increased frequency in patients with darker skin phototypes. CONCLUSIONS: Fractional laser skin treatment is associated with a relatively low complication rate. Side effects and complications observed in this study were temporary and did not result in long-term or significantly severe sequelae (e.g., scarring).

The use of fractional laser photothermolysis for the treatment of atrophic scars.

BACKGROUND: Patients with atrophic scars commonly seek treatment for their removal but are often concerned about the prolonged recovery, short-lived results, and/or ineffectiveness of available therapies. A novel treatment using a 1,550-nm erbium-doped fiber laser to induce fractional photothermolysis of treated skin has been used to resurface photodamaged skin but has not been studied previously in patients with atrophic scars to determine its effectiveness for this condition. PURPOSE: To determine the effectiveness and safety of 1,550-nm erbium-doped fiber laser treatment on atrophic scars. METHODS: Fifty-three patients (skin phototypes I-V) with mild to moderate atrophic facial acne scars received monthly treatment with a 1,550-nm erbium-doped fiber laser (Fraxel, Reliant Technologies Inc., San Diego, CA). Clinical response to treatment was determined at each treatment visit and 6 months after the final treatment session by two independent assessors using a quartile grading scale. Side effects and patient satisfaction were monitored at each follow-up visit. RESULTS: Clinical improvement averaged 51% to 75% in nearly 90% of patients after three monthly laser treatments. Mean improvement scores increased proportionately with each successive laser session. Clinical response rates were independent of age, gender, or skin phototype. Side effects included transient erythema and edema in most patients, but no dyspigmentation, ulceration, or scarring. CONCLUSIONS: Atrophic scars can be effectively and safely reduced with 1,550-nm erbium-doped fiber laser treatment.

Fractional photothermolysis: treatment of facial and nonfacial cutaneous photodamage with a 1,550-nm erbium-doped fiber laser.

PURPOSE: To evaluate the safety and effectiveness of a novel nonablative 1,550 nm erbium-doped fiber laser in the treatment of facial and non-facial photodamaged skin. METHODS: 50 patients with mild to moderate cutaneous photodamage, rhytides, and dyspigmentation received 3 successive treatments at 3-4 week intervals with a 1,550 nm erbium-doped fiber laser (Fraxel, Reliant Technologies Inc., San Diego, CA). Clinical improvement of treatment areas was independently determined by two masked assessors' evaluations of comparative photographs at baseline and 3, 6, and 9 months post-treatment using a quartile grading scale. Patient satisfaction surveys were also obtained at each follow-up visit. RESULTS: Mean clinical improvement at 3 months for the face was 2.23 and 1.85 for non-facial skin (p<0.001). Mean improvement at 6 months was 2.10 for the face and 1.81 for non-facial skin (p<0.001). Mean improvement at 9 months was 1.96 for the face and 1.70 for non-facial skin (p<0.001). At least 51% to 75% improvement in photodamage at the 9-month follow-up was achieved in 73 and 55% of facial and non-facial treated skin, respectively. Side effects were limited to transient erythema and edema in the majority of patients. No prolonged pigmentary changes or scarring were observed. Patient satisfaction surveys mirrored the observed clinical effects. CONCLUSION: The nonablative 1,550 nm erbium-doped fiber laser is an effective treatment for facial and non-facial photodamage, rhytides, and dyspigmentation with a favorable recovery and side effect profile.

Improving patient retention after botulinum toxin type A treatment.

BACKGROUND: Botulinum toxin treatments have been associated with consistently high patient satisfaction rates, but calculation of patient retention rates is not routinely performed. Retention measurements serve as critical indicators of clinical performance and can be optimized by evaluation of current office policies and implementation of strategies to improve patient retention. PURPOSE: To investigate the reasons patients discontinue botulinum toxin treatments and to evaluate the effect of a single intervention intended to improve patient retention. METHODS: A retrospective chart review was performed of all patients who received botulinum toxin injections in a private cosmetic dermatology practice over a 2-year time period to determine the patient retention rate. Patients who had discontinued botulinum toxin treatment after a single session were surveyed to discern their reasons for terminating treatment. A change in office policy was instituted wherein all patients who received their first botulinum toxin treatment were required to undergo a 2-week post-treatment evaluation to determine treatment effect and to receive touch-up treatment as necessary. Retention rates were calculated over the 1-year period immediately after initiation of the new policy. RESULTS: The initial patient retention rate was 55%. The most common reasons cited for discontinuance of botulinum toxin treatments were procedural cost, patient failure to re-schedule, perceived lack of product longevity, and clinical effect falling short of expectations. After initiation of the mandatory 2-week post-treatment office evaluation, a 67% patient retention rate was achieved. CONCLUSIONS: Managing patient expectations of botulinum toxin treatments and mandatory post-treatment appointments for evaluation of the initial procedure increase the patient retention rate.

Photorejuvenation of facial skin with topical 20% 5-aminolevulinic acid and intense pulsed light treatment: a split-face comparison study.

BACKGROUND: Photorejuvenation of facial skin has been reported after intense pulsed light (IPL) therapy alone and in conjunction with topical 5-aminolevulinic acid (5-ALA), but no comparative studies between these regimens have been performed. OBJECTIVE: To evaluate the safety and effectiveness of combination topical 5-ALA and IPL compared to IPL treatment alone. METHODS: Ten patients with mild to moderate photodamage were randomly assigned treatment with 5-ALA + IPL on one facial half and IPL alone on the contralateral side. Two treatments were delivered at 4-week intervals. Clinical improvement scores were determined by masked evaluations of digital photographs obtained at baseline, prior to each treatment session, and at 1, 3, and 6 months after the final treatment. RESULTS: Higher clinical improvement scores were noted on the combination 5-ALA + IPL treated areas. Mild edema, erythema, and desquamation were observed on the facial halves where 5-ALA was applied. No scarring or unwanted pigmentary alteration was seen. CONCLUSIONS: Photodynamic therapy with combination topical 5-ALA + IPL is safe and more effective for facial rejuvenation than IPL treatment alone.

Cellulite treatment using a novel combination radiofrequency, infrared light, and mechanical tissue manipulation device.

BACKGROUND: Most post-pubertal women exhibit cellulite, particularly in the thigh and buttock regions. The prevalence of cellulite has led to many attempts at treatment, including a variety of topical solutions, massage-based therapies, and surgical techniques--most with suboptimal clinical effects. The purpose of this controlled study was to evaluate a novel combination device involving radiofrequency, infrared light, and mechanical tissue manipulation for the treatment of cellulite. METHODS: Twenty adult women (ages 25-57 years) of various skin phototypes (I-V), and with moderate bilateral thigh and buttock cellulite, received eight biweekly treatments to a randomly selected side (the contralateral side serving as a non-treated control). A combined bipolar radiofrequency, infrared light, and mechanical suction-based massage device was applied at 20 watts RF, 20 watts IR (700-1500 nm) light, and 200 millibar vacuum (750 mmHg negative pressure). Patients were evaluated using standardized digital photography and circumferential leg measurements at baseline, prior to each treatment session, and at one, three, and six months after the final treatment. Clinical improvement scores of comparable photographs using a quartile grading scale (0 = or < 25%, 1 = 25%-50%, 2 = 51%-75%, 3 = or >75% improvement) were made independently by two masked medical assessors after the series of treatments. Final post-treatment body weight and patients' subjective evaluations were recorded. RESULTS: Ninety per cent (18/20) of patients noticed overall clinical improvement, and 17 of these 18 patients reported that they would pursue treatment of the contralateral thigh. Side effects were limited to transient erythema in most patients, and bruising was observed in 2/20 patients after the first couple of treatment sessions, but not as the treatment series progressed. Clinical improvement scores averaged 1.82 (corresponding to approximately 50% improvement) after the series of treatments. Circumferential thigh measurements were reduced by 0.8 cm on the treatment side. CONCLUSIONS: Cellulite can be significantly and safely reduced with the use of a noninvasive device that combines bipolar RF, infrared light, and mechanical massage. The effects of treatment appear to be prolonged, but maintenance treatments may be necessary to further enhance the clinical results achieved.

Comparison of a 1450-nm diode laser and a 1320-nm Nd:YAG laser in the treatment of atrophic facial scars: a prospective clinical and histologic study.

BACKGROUND: Atrophic scar revision techniques, although numerous, have been hampered by inadequate clinical responses and prolonged postoperative recovery periods. Nonablative laser treatment has been shown to effect significant dermal collagen remodeling with minimal posttreatment sequelae. Although many studies have been published regarding the effectiveness of these nonablative lasers on rhytides, there are limited data demonstrating their specific effects on atrophic scars. OBJECTIVE: To evaluate and compare the efficacy and safety of long-pulsed 1320-nm Nd:YAG and 1450-nm diode lasers in the treatment of atrophic facial scarring. METHODS: A series of 20 patients (skin phototypes I-V) with mild to moderate atrophic facial acne scars randomly received three successive monthly treatments with a long-pulsed 1320-nm Nd:YAG laser on one facial half and a long-pulsed 1450-nm diode laser on the contralateral facial half. Patients were evaluated using digital photography and three-dimensional in vivo microtopography measurements at each treatment visit and at 1, 3, 6, and 12 months postoperatively. Histologic evaluations of cutaneous biopsies obtained before treatment, immediately after the first treatment, and at 1, 3, 6, and 12 months after the third treatment were performed. Clinical assessment scores were determined at each treatment session and follow-up visit. Patient satisfaction surveys were obtained at the end of the study. RESULTS: Mild to moderate clinical improvement was observed after the series of three treatments in the majority of patients studied. Patient satisfaction scores and in vivo microtopography measurements paralleled the photographic and histopathologic changes seen. Side effects of treatment were limited to mild transient erythema, edema, and hyperpigmentation. No scarring or adverse textural changes resulted from the use of either laser system. CONCLUSIONS: Nonablative long-pulsed 1320-nm Nd:YAG and 1450-nm diode lasers each offer clinical improvement for patients with atrophic scarring without significant side effects or complications. The 1450-nm diode laser showed greater clinical scar response at the parameters studied. The use of nonablative laser systems is a good treatment alternative for patients with atrophic scarring who are unable or unwilling to endure the prolonged postoperative recovery process associated with ablative laser skin resurfacing procedures.

Cutaneous laser surgery in darker skin phototypes.

Effective laser surgery in patients with darker skin phototypes can be achieved despite a greater inherent risk of side effects. Although the incidence of undesirable postoperative sequelae has decreased with the development of advanced laser technology and individualized treatment parameters, the risks may never be eliminated completely. Therefore, thorough patient preoperative preparation and education regarding the risks of cutaneous laser surgery will remain an essential aspect of treatment in patients with darker skin tones. As more refined laser techniques evolve, the ability to safely and effectively treat these patients will continue to improve.

Long-pulsed 1064-nm Nd:YAG laser-assisted hair removal in all skin types.

BACKGROUND: Although there are several different laser systems available for the reduction of unwanted hair, no single system has been shown to be superior in providing safe and effective hair removal in every skin type. The purpose of this study was to evaluate the safety and efficacy of a high-energy, long-pulsed, 1064-nm Nd:YAG laser with a contact cooling device for hair removal in skin phototypes I-VI. METHODS: Thirty-six adult patients (skin phototypes I-VI) with dark terminal facial or nonfacial hair were treated with a long-pulsed Nd:YAG laser (1064 nm, 10-mm spot size, fluence of 30 to 60 J/cm2). The selected pulse duration was dependent on the skin type of the patient: Skin types I/II, III/IV, and V/VI received 10, 20, and 30 ms, respectively. Three consecutive laser treatments were delivered to 36 skin sites at 4- to 6-week intervals. Hair counts and photographic evaluations of skin sites were obtained at baseline, immediately before each treatment session, and at 1, 3, and 6 months after the final laser treatment. RESULTS: Peak hair reduction was observed 1 month after the series of laser treatments with a mean hair reduction ranging from 58% to 62% on facial sites and 66% to 69% on nonfacial sites. At 6 months after a series of three long-pulsed Nd:YAG laser treatments, a mean hair reduction of 41% to 46% on the face and 48% to 53% on the body was found depending on the skin phototype. Adverse reactions included mild to moderate treatment pain, short-term erythema, and rare occurrences of transient pigmentary alteration without scarring. CONCLUSION: The long-pulsed 1064-nm Nd:YAG laser with contact cooling is a safe and effective method of hair reduction in patients of all skin types. Side effects were limited and transient.

Laser surgery in dark skin.

Although challenging, effective laser surgery in patients with darker skin tones can be achieved despite a higher inherent risk of untoward side effects. While the incidence of undesirable postoperative sequelae has decreased with the development of advanced laser technology and individualized treatment parameters, these risks may never be eliminated completely. Consequently, thorough patient preoperative preparation and education regarding the risks of cutaneous laser therapy will remain an essential component of treatment in darkly pigmented patients. In the future, as more refined laser techniques evolve, the ability to safely and effectively treat these patients will improve.

Lasers in dermatology: four decades of progress.

Advances in laser technology have progressed so rapidly during the past decade that successful treatment of many cutaneous concerns and congenital defects, including vascular and pigmented lesions, tattoos, scars, and unwanted hair-can be achieved. The demand for laser surgery has increased substantially by patients and dermatologists alike as a result of the relative ease with which many of these lesions can be removed, combined with a low incidence of adverse postoperative sequelae. Refinements in laser technology and technique have provided patients and practitioners with more therapeutic choices and improved clinical results. In this review, the currently available laser systems with cutaneous applications are outlined, with primary focus placed on recent advancements and modifications in laser technology that have greatly expanded the cutaneous laser surgeon's armamentarium and improved overall treatment efficacy and safety.