Post Filler Ecchymosis Resolution With Intense Pulsed Light

Bruising after dermal filler and neuromodulator injections is a common side effect and can have durations of 1 to 2 weeks. While it ultimately resolves, faster resolution can produce better outcomes for patients and also make patients more likely to return for future treatments. We report the successful reduction in bruising following injections of fillers with an intense pulsed light source. We also documented the onset of action of bruising resolution with serial photographs. Resolution started within the first hour of treatment and continued rapidly over 48 hours. This is the first-time reported study of resolution of bruising from injectables with intense pulsed light. Patient satisfaction is improved when such adverse events are minimized.

Rheological Properties and In Vivo Performance Characteristics of Soft Tissue Fillers.

BACKGROUND: Physicochemical properties and performance in nonclinical animal models can provide insights into soft tissue filler performance. OBJECTIVE: To evaluate the in vivo performance of fillers with different compositions and physicochemical properties. MATERIALS AND METHODS: Physicochemical properties were measured in vitro. Rat models were developed and used to compare lift capacity, resistance to deformation, and tissue integration. Four homogeneous hyaluronic acid (HA) fillers, 2 nonanimal stabilized HA (NASHA) fillers, and 1 calcium hydroxylapatite/carboxymethyl cellulose (CaHA/CMC) filler were evaluated. RESULTS: Filler lift capacity correlated better with filler composition/type (homogeneous > NASHA > CaHA/CMC) than with specific rheological properties. The CaHA/CMC filler had high initial resistance to deformation relative to other groups; all HA fillers exhibited lower initial resistance to deformation, which increased over time. Homogeneous HA fillers were integrated with surrounding tissue, whereas integration within particle-based fillers (NASHA and CaHA/CMC) was variable, with some areas void of tissue. CONCLUSION: The animal models provide a platform to make comparative evaluations among fillers. The results indicated that biological interaction plays an important role in how the filler performs. Rheology alone was not sufficient to understand filler performance but was most useful when comparing within fillers of similar composition.

An open-label trial examining the efficacy and safety of a pre- and postprocedure topical five-product system (Clinique Medical Optimizing Regimen) specifically formulated to complement laser/light-based facial cosmetic procedures.

BACKGROUND: Specialized skin care regimens may help to minimize adverse events (AEs) following non-ablative facial procedures. METHODS: A 14-week, open-label, three-center study evaluated the efficacy and safety of a topical five-product system (Clinique Medical Optimizing Regimen; Allergan, Inc., Irvine, CA, USA) for minimizing localized AEs during two 6-week procedure cycles with fractionated laser (FL) or intense pulsed light (IPL). The skin care regimen consisted of a 2-week preprocedure phase, a 1-week postprocedure phase, and a 3-week maintenance phase. Investigators and patients rated the presence and severity of erythema, itching, stinging/burning, edema, pain, pruritus, swelling, crusts/erosion, and photodamage. RESULTS: Two days after the FL/IPL treatment (IPL: n = 27; FL: n = 21), most assessments, including erythema, were near baseline values; at 4 weeks postprocedure, all investigator scores were comparable to baseline. Patients missed work or avoided social situations a mean of only 0.8 days. Mean subject ratings for itching, stinging/burning, pain, swelling, and redness for 2 weeks postprocedure were 'none' to 'mild'. Treatment-related AEs (acne, facial rash) occurred in four patients. All investigators stated they would recommend this topical over-the-counter regimen again in conjunction with non-ablative FL/IPL treatments. CONCLUSIONS: This topical five-product skin care system was safe and effective in conjunction with non-ablative FL/IPL procedures.

Consensus recommendations on the use of an erbium-doped 1,550-nm fractionated laser and its applications in dermatologic laser surgery.

BACKGROUND: Nonablative fractional photothermolysis has revolutionized the way we treat a number of common skin conditions with laser technology. OBJECTIVE: A comprehensive guide is needed for clinicians using this technology to treat specific skin conditions in various skin types. MATERIALS AND METHODS: Recommendations were made from a recent round table discussion among experienced physicians and a review of recent literature findings. RESULTS: Optimal laser parameters are dependent on patient skin type and condition. We recommended guidelines for the successful treatment of several common skin conditions on and off the face using nonablative fractional photothermolysis. Specific conditions were dyschromia, rhytides, acne scars, surgical scars, melasma, and striae distensae. CONCLUSIONS: We developed reproducible guidelines to most effectively treat a variety of skin types and conditions using nonablative fractional photothermolysis. Future large, multicenter trials are indicated for further optimization of treatment parameters.

Photopneumatic technology for the treatment of acne vulgaris.

OBJECTIVE: Treatment of acne vulgaris with light sources necessitates multiple targets including Propionibacterium acnes and sebaceous glands. Traditional light sources such as blue light capitalize on P acnes bacteria as targets while infrared lasers and radiofrequency devices target the sebaceous gland. A novel device combining vacuum and a unique broadband light source was designed to combine multiple targets for the effective treatment of acne. The objective of this study was to demonstrate the safety and efficacy of a novel device that uses a combination of broadband light and pneumatic energy for the treatment of acne vulgaris. METHODS: In a retrospective multicenter study, clinical data were collected from 56 patients with mild to severe acne. Patients had been treated 2 to 4 times with a portable photopneumatic device (Aesthera PPx, Aesthera Corporation, Pleasanton, CA) that delivers broadband light (400 to 1200 nm) to the treatment site via a hand piece. For 11 of the 56 patients, 3 independent physicians blinded to the study treatment or duration evaluated PPx efficacy by comparing photographs taken before and after PPx treatment. RESULTS: For the 56 patients, the median physician-rated clearance increased from 50% after a single treatment to 90% after the fourth treatment, whereas the median patient-rated clearance improved from 50% after a single treatment to 78% after the fourth treatment. On a 4-point scale, both physician-rated and patient-rated median overall satisfaction levels increased from a 3 after a single treatment, to 4 after the second, third, and fourth treatments. Clinically significant adverse events were not observed. For the 11 patients evaluated by photography, the median papule and pustule lesion counts decreased from 8 to 3 and from 2 to 0, respectively. Median acne severity (Burton scale) decreased from 4 before treatment to 2 after the final treatment, and the median improvement was 4.5 (scale 1-5). The median erythema rating decreased from 2 before treatment to 1 after the final treatment (scale 1-4). Adverse events were limited to mild erythema. The median acne clearance was 3 (scale 1-4). CONCLUSION: Photopneumatic technology provides a safe and effective treatment of mild to severe acne vulgaris.

Nonablative fractional resurfacing in the male patient.

Skin resurfacing can be divided into nonablative, nonablative fractional, ablative fractional, and traditional ablative categories. Nonablative technologies have yielded inconsistent and unimpressive results, whereas ablative technologies, although generally clinically effective, are losing momentum as a result of prolonged recovery times, risks for hypopigmentation, limitation in lighter skin types, and the production of unnatural sheen and texture to the skin. Fractional resurfacing can produce the safety of nonablative technologies and the efficacy of traditional ablative resurfacing. Nonablative fractional resurfacing is the most widely studied of fractional technologies allowing for nonablative tissue coagulation, creation of microthermal zones, and resurfacing with extrusion and replacement of damaged tissue with rapid re-epithelialization. This article will review nonablative fractional resurfacing with 1550-nm laser in the male patient.

Skin rejuvenation with microthermal fractional photothermolysis.

Fractional resurfacing is gaining acceptance as a preferred method for skin resurfacing. Experience in treating photoaging, acne scars, and melasma is reviewed.

Management of injected hyaluronic acid induced Tyndall effects.

BACKGROUND AND OBJECTIVES: Soft tissue augmentation represents a cosmetic procedure performed with increasing frequency. STUDY DESIGN/MATERIALS AND METHODS: Correct utilization permits precise correction of facial rhytids and scars. Novice injectors occasionally inject too superficially in tissue with the resultant appearance of discoloration secondary to the Tyndall effect. RESULTS AND CONCLUSION: In this article, we will review the Tyndall effect in the skin and management options for this growing problem in aesthetic dermatology.