Multiple pass ultrasound tightening of skin laxity of the lower face and neck.

BACKGROUND: Skin laxity is a common complaint of patients who request skin rejuvenation. Radiofrequency and infrared light are widely used for nonablative treatment of skin laxity. Intense focused ultrasound (IFUS) has been investigated as a tool for the treatment of solid benign and malignant tumors for many decades but is only now beginning to emerge as a potential noninvasive alternative to conventional nonablative therapy. OBJECTIVES: To evaluate the efficacy of IFUS for the treatment of face and neck laxity. METHODS: Twelve female volunteers were enrolled in the study, and 10 were ultimately evaluated. The device under investigation was an IFUS. Areas treated included the face and neck. For treatment, the 4-MHz, 4.5-mm probe was used first, followed by the 7-MHz, 3.0-mm probe. Two blinded, experienced clinicians evaluated paired pretreatment and post-treatment (day 90) photographs. Patient self-assessments were also obtained. RESULTS: On the first primary outcome measure, two blinded clinicians felt that 8 of 10 subjects (80%) showed clinical improvement 90 days after treatment. Nine of 10 subjects (90%) reported subjective improvement. CONCLUSIONS: IFUS has many advantages for skin tightening.

Fractional rejuvenation using a novel bipolar radiofrequency system in Asian skin.

BACKGROUND: Fractional photothermolysis (FP) constitutes an effective modality of skin resurfacing by delivering thermal energy into multiple arrays of microscopic treatment zones. Radiofrequency (RF) can induce volumetric heating of dermis depending on electrical properties of target tissue. OBJECTIVES: To evaluate the efficacy and safety of a novel bipolar RF-based fractional device for the treatment of photoaged Asian faces. METHODS: Twenty-six Korean women (mean age 56, skin phototype III-IV) received three consecutive fractional RF treatments at 4- to 6-week intervals. Outcome assessments included standardized photography physician evaluation of fine lines, pores, smoothness and tightness, brightness, and overall appearance; degree of elastosis; subjective improvement scale; and patient satisfaction. RESULTS: Fractional RF treatments produced moderate (26-50%) and incremental improvements in each category of physician evaluation. In particular, degree of smoothness and tightness, brightness, and overall appearance improved significantly 6 weeks after the third session from before the third session. The degree of elastosis was 5.46 at baseline, which decreased significantly to 4.05 at 6-week follow-up. Patient self-assessment paralleled the physician assessment. Adverse events were limited to mild erythema, swelling, and scabs, which usually shed 3.9 days after treatment. CONCLUSION: Fractional bipolar RF treatment is an effective treatment for facial photodamage in Asians, with a favorable safety profile.

Treatment of melasma in Asian skin using a fractional 1,550-nm laser: an open clinical study.

BACKGROUND: Melasma is a common hyperpigmentation disorder that can cause refractory cosmetic disfigurement, especially in Asians. Fractional photothermolysis (FP) has been reported to be effective for the treatment of melasma, despite small study populations and short follow-up periods. OBJECTIVE: To evaluate the efficacy and safety of FP for the treatment of melasma in Asians. PATIENTS AND METHODS: Twenty-five patients with melasma received four monthly FP sessions and were followed up to 24 weeks after treatment completion. Efficacy was evaluated using objective and subjective ratings, Melasma Area and Severity Index (MASI), melanin index tracking, and skin elasticity measurements. RESULTS: Investigators observed clinical improvements in 60% and patients in 44% at 4 weeks after treatment, but the figures decreased to 52% and 35%, respectively, at 24 weeks after treatment. Mean MASI scores decreased significantly from 7.6 to 6.2. Mean melanin index decreased significantly after the first two sessions, but it relapsed slightly in subsequent follow-ups. The treatment did not alter skin elasticity. Hyperpigmentation was observed in three of 23 subjects (13%). CONCLUSION: Treatment of melasma with FP led to some clinical improvements, but it was not as efficacious as previously reported at 6-month follow-up. We recommend judicious use of FP for the treatment of melasma in Asian skin because of its limited efficacy.

Fractional photothermolysis for the treatment of acne scars: a report of 27 Korean patients.

OBJECTIVES: Atrophic post-acne scarring remains a therapeutically challenging condition despite various currently available technologies. Fractional photothermolysis (FP) is a novel concept of cutaneous resurfacing which induces non-contiguous microscopic thermal injury. The aim of this study is to evaluate the safety and efficacy of FP in the treatment of acne scars in Asian patients. METHODS: A total of 27 Korean patients (Fitzpatrick skin types IV or V) with moderate to severe facial acne scars received three to five sessions of FP treatment (Fraxel Laser; Reliant Technologies, CA, USA), each spaced 3-4 weeks apart. Standardized digital photographs were obtained before each treatment and 3 months after the final treatment. In addition, the patients' perceived degrees of improvement were assessed 3 months after the final treatment using a five-point grading scale. RESULTS: FP led to marked improvement in the appearance of acne scars at 3 months post-treatment. Patients' self-assessed degrees of improvement were as follows: excellent improvement in eight patients (30%), significant improvement in 16 patients (59%), and moderate improvement in three patients (11%). Adverse events were limited to transient pain, erythema and edema. CONCLUSIONS: The 1550-nm erbium-doped FP is associated with significant patient-reported improvement in the appearance of acne scars, with minimal downtime.

Minimal heating dose: a novel biological unit to measure infrared irradiation.

BACKGROUND AND OBJECTIVE: Infrared (IR) rays, which comprise approximately 40% of the solar radiation which reaches the earth's surface, have received relatively scant attention. As no standard method has yet been agreed upon for the biological evaluation of IR irradiation, the objective of this study is to suggest a new unit for IR irradiation. METHODS: The skin temperature of 38 Korean volunteers was measured after IR irradiation with varying irradiance. RESULTS: Skin temperature after IR irradiation at an irradiance of 2.02 W/cm2 remained unchanged after 652+/-22 s (mean+/-standard error), which corresponds, in this case, to a total radiation dose of IR 1317.3+/-44.84 J/cm2. This quantity was designated as the minimal heating dose (MHD). We also demonstrated that MHD increased with increasing IR irradiance at lower IR irradiance (1.17 and 2.02 W/cm2), whereas it became constant at higher irradiance (2.87 and 3.22 W/cm2). No statistically significant correlations were detected between MHD and volunteers' ages, erythema index, or melanin index. CONCLUSION: We propose 'MHD' as a biological unit for the measurement of IR irradiation.