Multicenter study of vacuum-assisted precise tissue release for the treatment of cellulite in a cohort of 112 Italian women assessed with cellulite dimples scale at rest.

Objectives and background: Tissue stabilized-guided subcision (TS-GS) treatment has emerged as a single session treatment for cellulite dimples. To date, studies on a few patients were reported. We present data concerning efficacy and safety of TS-GS for cellulite in a cohort of Italian patients.Patients and Methods: This is a retrospective study involving 122 patients requiring cellulite treatment, classified according to validate cellulite dimples scale at rest, at T0. TS-GS technique is assessed in terms of efficacy (masked evaluations of pre- and post-treatment pictures, satisfaction of patients and variations in cellulite dimples scale at rest), safety of results at 12 months follow-up (T1). U nivariate and multivariate analyses were carried out to evaluate variables associated with the size effect.Results: Masked evaluations of 112 patients completing the study resulted in the correct selection of pre- and post-treatment images in all cases and all patients were satisfied. The mean cellulite dimples scale at rest score improved ≥1 point at T1. We found a significant association between size effect, higher satisfaction (p < .01), cellulite grading at T0 (p < .01), higher BMI (p = .037); a higher BMI was correlated to an increased cellulite grading at T0 (p = .02). Only minor and temporary adverse events were reported.Conclusions: We confirm herein the clinical efficacy and safety of TS-GS for cellulite dimples treatment in a cohort of Italian patients assessed with the validated cellulite dimples scale at rest.

Double phase treatment with flashlamp-pumped pulsed-dye laser and long pulsed Nd:YAG laser for resistant port wine stains in adults. Preliminary reports.

BACKGROUND: Flashlamp-pumped pulsed (FLPP) dye laser still represents the standard treatment for the majority of port wine stains (PWSs), but the results on thick PWSs remain unpredictable, and many of these lesions fail to completely respond. Our aim was to report on the results obtained on unresponsive PWSs to standard laser treatments, by using a double phase laser treatment strategy using two laser passes in the same session. METHODS: Eleven adult patients with facial PWS resistant to dye laser were enrolled. Laser sessions were scheduled every 8 weeks, and each of them consisting of two laser passes. In phase one, two different laser wavelengths (595 nm and 1064 nm) were delivered consecutively to each affected area. In the second phase, the PWS was treated using a pulse stacking technique with the 1064 nm Nd:YAG. RESULTS: One patient was lost to follow-up. Among the remaining ten, 5 (50%) patients showed an excellent improvement (>75%), 3 (30%) patients showed a good improvement (51-75%), and 2 (20%) patients had no or minimal improvement (0-25%). CONCLUSIONS: Our results suggest that the combination of different wavelengths in the same session can be helpful for PWSs resistant to standard laser treatments. However, in most patients two treatment phases were necessary.

Combination of fractional erbium-glass laser and topical therapy in melasma resistant to triple-combination cream.

BACKGROUND: Melasma is a common melanosis often difficult to treat. OBJECTIVE: The aim of this paper was to report on the safety and efficacy of non-ablative fractional photothermolysis combined with the use of triple-combination cream (TCC) on a large population with melasma resistant (i.e., with no complete/near-complete clearing) to TCC alone. METHODS: Seventy-six patients with resistant melasma underwent a combined treatment protocol. The protocol consisted of a TCC (hydroquinone 4%, retinoic acid 0.03%, hydrocortisone butyrate 0.1%) applied daily for 10 days followed by four laser treatments performed in 3-week intervals with a fractional 1540-nm erbium-glass laser. During these intervals, and for 3 months after the last laser session, TCC was also applied daily following a "pulse-therapy" scheme. Improvement was assessed by the melasma-area-and-severity-index (MASI) score. RESULTS: At 1 month, marked (>75%) and moderate (51-75%) clearing of melasma were observed in 46 of 76 (67.1%) and 12 of 76 (21%) cases, respectively. At 6 months, we noticed a marked improvement in 16 of 76 (21.1%) and no improvement in 33 of 76 (43.4%) patients. CONCLUSION: Our study proposes the combination of NFP/TCC as a useful therapy for patients with melasma resistant to TCC alone, but it shows that its long-term efficacy is limited.

Melasma and low-energy Q-switched laser: treatment assessment by means of in vivo confocal microscopy.

Melasma is an acquired disorder of pigmentation for which several therapeutical options are currently available. Among them, low-energy Q-switched Nd:YAG laser (1,064 nm) has been successfully applied in case series although its long-term efficacy has yet to be proven. In vivo confocal microscopy is a novel imaging technique that permits to explore the skin tissue at a nearly histologic resolution. The aim of our study was to evaluate the laser treatment efficacy by means of confocal microscopy at different time points to elucidate the mechanism of action of the laser and its possible drawbacks. Eight women who presented with melasma on the face were subjected to low-energy Q-switched Nd:YAG laser treatment and then analyzed by means of confocal microscopy. An overall improvement of melasma was noticed clinically and microscopically by means of confocal microscopy. Four cases revealed the presence of dendritic-shaped cells upon confocal microscopy and those patients were the ones presenting with a relapse of the disease. The interpretation of these cells is that they could represent reasonably activated melanocytes. This opens the question whether laser treatment should be modulated to avoid side-effects associated with its use. Confocal microscopy has emerged as an excellent tool for a better understanding of the changes occurring during laser treatment.

Laser use for cutaneous vascular alterations of cosmetic interest.

In 1983, selective photothermolysis dramatically transformed vascular surgery, reducing the adverse effects and increasing its efficacy. As a result, laser surgery is now considered the gold standard treatment for many congenital and acquired skin vascular disorders. In this paper, the authors analyze the main laser sources for vascular surgery, the general parameters regarding laser-tissue interactions that can influence the treatment (such as hemodynamic features, anatomical areas, vessel depth, and diameters), and other aspects important for a good laser practice. Afterward, the main indications for laser treatment in vascular cutaneous disorders are discussed, with particular reference to port-wine stain, hemangioma, facial telangiectasia, rosacea, spider angioma, venous lake, varicose leg veins, and leg telangiectasias.