Prospective Study of 532-nm Picosecond Laser for the Treatment of Pigmented Lesions of the Face and Dorsal Hands.

BACKGROUND: Pigmented lesions from chronic UV photoaging are extremely common on the face and hands. OBJECTIVE: To evaluate the safety and efficacy of a 532-nm picosecond laser for these types of pigmented lesions. METHODS: This was a single-center, prospective, open-label clinical trial. Eligible subjects with pigmentation on the face and hands received 3 monthly treatments, with 1 month (1M) and 3 months (3M) follow-up. Change in investigator-graded overall facial and per lesion pigmentation and subject-graded satisfaction and pigmentation improvement was evaluated by a 5-point scale. Immediate skin response and adverse events (AEs) were evaluated post-treatment. The melanin index was measured using a mexameter. Randomized before and after photographs were graded by 3 blinded physicians for degree of pigmentation improvement. RESULTS: Twenty-five subjects (22F/3M) with Fitzpatrick skin types I-III were enrolled, with 23 subjects completing. Treatments used a 532 nm wavelength, 800 ps pulse duration, 4-6mm spot size, and 0.1 to 0.6J/cm2 fluence. Good-to-excellent clearance at 1M/3M was demonstrated in ≥95% of lesions (n = 116). Only mild treatment-related pain was reported, with transient post-treatment AEs (mean downtime of 2.1 ± 2.0 days) and no serious treatment-related AEs. Subject satisfaction (satisfied or very satisfied) was 95% at 1M and 91% at 3M. CONCLUSION: Treatment with a 532-nm picosecond laser is safe and highly effective for the treatment of the pigmented lesions of the face and dorsal hands.

Efficacy and Safety of Intense Pulsed Light With a KTP/PDLlike Filter for the Treatment of Facial Telangiectasias.

BACKGROUND: An intense pulsed light (IPL) narrowband "KTP/PDL-like" filter (525–585 nm) may combine the tolerability of the IPL with the precision of KTP and PDL lasers. This study evaluated the impact of IPL with a KTP/PDL-like filter on telangiectasias. METHODS: This was a single-center, prospective study of 17 subjects with facial telangiectasias and skin types I–III. Three monthly treatments were performed using this specific filter, with follow-up visits at 1, 3, and 6 months. Telangiectasia improvement was assessed by the investigator and subjects using a 5-point scale. Facial photographs and safety assessments were obtained at each visit. Subject discomfort was evaluated using a visual analog scale (VAS) immediately posttreatment, and subject downtime was recorded at each subsequent visit. RESULTS: All facial telangiectasias significantly improved. At 1-month follow-up, >50% lesion clearance was noted in 97.1% of facial (n=36) and 85.7% of non-facial (n=7) lesions, with 73% of subjects satisfied or very satisfied. An increase in mean social downtime (0, 2.3, and 3 days) and VAS scores (3.5, 4.5, and 4.8) with treatments 1, 2, and 3, respectively, mirrored a stepwise increase in fluence with subsequent sessions. CONCLUSIONS: The use of a novel IPL narrowband KTP/PDL-like filter can significantly improve facial and non-facial telangiectasias with minimal downtime. J Drugs Dermatol. 2020;19(9):844-850. doi:10.36849/JDD.2020.4834.

Efficacy and safety of intense pulsed light with a KTP filter for the treatment of solar lentigines.

BACKGROUND: Optical energy-based devices, including intense pulsed light (IPL) and potassium titanyl phosphate (KTP) lasers achieve reduction of pigmented and vascular lesions in a relatively similar number of treatments. This study aimed to evaluate the efficacy and safety of an IPL with a "KTP-like" filter emitting a wavelength of 525-585 nm for the treatment of solar lentigines on the hands and face. METHODS: This was a single center, prospective, open-label clinical trial including 16 healthy Caucasian subjects (15 females, mean age, 55 years; skin types II and III) with hand and facial solar lentigines. Subjects were treated with three IPL treatment sessions with a KTP-like filter conducted at monthly intervals. Follow-up evaluations were performed 1, 3, and 6 months after the last treatment session. Overall pigmentation improvement, pigmentation clearance per lesion, adverse events, and subject tolerability to treatment were evaluated. RESULTS: Significant improvements in facial and hand pigmentation were noted at all follow-up visits (P < 0.0001). One month after the last treatment session, good to excellent outcomes were noted in 74.6% of treated facial areas and 90% of treated hand regions. Although the effect of treatment gradually declined in both treatment regions over the 6-month follow-up period, over 60% of subjects demonstrated good to excellent results at the study end. Clinical effectiveness was further confirmed by the reduction in Melanin Index (MI) following each treatment as compared to baseline. Downtime and complications were minimal. CONCLUSIONS: IPL treatment with a KTP-like filter is a well-tolerated and effective method for reducing facial and hand pigmentation. Lasers Surg. Med. 51:500-508, 2019. © 2019 Wiley Periodicals, Inc.

Multiple sequential light and laser sources to activate aminolevulinic acid for rosacea.

BACKGROUND AND AIMS: The use of multiple, sequential light and laser sources for topical ALA activation in photodynamic therapy (PDT) of rosacea has been largely absent from the literature. The aim of this study was to evaluate ALA-PDT for rosacea using blue light sequentially with red light, pulsed-dye laser (PDL), and/or intense pulsed light (IPL). PATIENTS/METHODS: Thirty patients (39 treatments) were enrolled in this retrospective, single-center study. Treatment groups included blue light + PDL, blue light + IPL, blue light + PDL + IPL, or blue light + red light + PDL + IPL. Patient-reported outcome measures (incidence of adverse events, improvement in rosacea, and improvement in overall skin quality) were obtained via a telephone questionnaire and graded on a 4-point scale. RESULTS: There was no statistically significant difference in patient-reported rosacea or overall skin quality improvement. Apart from decreased peeling following blue light + IPL compared to blue light + PDL (P = 0.041) and blue light + IPL + PDL (P = 0.005), there were no other statistically significant differences in postprocedure adverse events. CONCLUSIONS: The use of multiple, sequential light and laser sources with ALA-PDT for rosacea, while well tolerated, did not lead to statistically significant improvements in patient-reported efficacy. Although this retrospective study is limited by a small sample size with disparate patient numbers between groups and no physician-evaluated outcome criteria, it does demonstrate that multiple light sources with PDT can be safely used in a single session.

Multiple sequential light and laser sources to activate aminolevulinic acid in the treatment of photodamage: A retrospective study.

INTRODUCTION: The aim of this study was to retrospectively evaluate photodynamic therapy (PDT) with aminolevulinic acid (ALA) for cutaneous photorejuvenation using blue light sequentially with red light, pulsed-dye laser (PDL), and/or intense pulsed light (IPL). MATERIALS AND METHODS: Ninety-six patients (121 treatments) had photodamage treated with field-directed ALA-PDT from 2001 to 2010 in this single-center study. Treatments were performed with blue light + PDL, blue light + IPL, blue light + PDL + IPL, or blue light + red light + PDL + IPL. Outcome measures were obtained via telephone questionnaire and graded on a four-point scale. RESULTS: There were no significant differences in patient-reported improvement in photodamage, overall skin quality, and postprocedure adverse events between treatment arms. However, number of patients in the blue light + red light + PDL + IPL group was markedly smaller (n = 2) than that in the other groups (n = 14-46). DISCUSSION: Although results showed a trend toward greater efficacy with similar tolerability using multiple, sequential light and laser sources with ALA-PDT for photorejuvenation, the potential for recall bias and widely disparate number of patients between treatment groups and follow-up times between patients severely limit this retrospective study. Nevertheless, despite these major statistical flaws, the results may provide valuable information regarding the safety of multiple modalities with PDT of photodamage in a single session.

A review of the aesthetic treatment of abdominal subcutaneous adipose tissue: background, implications, and therapeutic options.

BACKGROUND: The demand for aesthetic body sculpting procedures has expanded precipitously in recent years. Subcutaneous adipose tissue (SAT) deposits of the central abdomen are especially common areas of concern for both males and females. OBJECTIVE: To review the available literature regarding the underlying pathophysiology of subcutaneous fat accumulation in the abdominal area and available treatment options. METHODS: A MEDLINE and Google Scholar search was performed accordingly. RESULTS: The preferential accumulation of SAT in the central abdomen is attributable to the reduced lipolytic sensitivity of its adipocytes. A number of therapeutic options are available for the treatment of central abdominal adiposity. Cryolipolysis, high-intensity focused ultrasound, nonthermal ultrasound, radiofrequency, and injection adipolysis lead to adipocyte destruction through multiple different mechanisms. Nonablative modalities such as injection lipolysis mobilize fat stores from viable adipocytes, although its effects may be curtailed in obese patients. Liposuction through tumescent technique, however, mechanically extricates SAT. CONCLUSION: Although tumescent liposuction remains the gold standard for SAT removal, less invasive ablative and nonablative options for targeting localized deposits of adipose tissue now permeate the aesthetic marketplace. Limited results associated with these modalities mandate multiple sessions or combination treatment paradigms.

Dark circles: etiology and management options.

Given their multifactorial nature and the fact that individual patients may have more than a single underlying cause, cosmetic practitioners should be well versed in a number of potential treatment options encompassing all facets of under-eye dark circles. New therapeutic options are also forthcoming. Longer-lasting HA fillers, wavelength tunable laser devices, and topicals speeding up healing and enhancing results after fractionated laser therapy will all serve to make the future of dark circle treatment unabatedly bright.

Combination of intense pulsed light, Sculptra, and Ultherapy for treatment of the aging face.

INTRODUCTION: Facial aging is a gradual process that involves a complex interaction of multiple factors including cutaneous photodamage and laxity, subcutaneous tissue volume loss, and bony resorption. These features have all been show to significantly improve with intense pulsed light (IPL), microfocused ultrasound (MFUS, Ultherapy), and poly-L-lactic acid (PLLA). METHODS: To review the use of IPL, MFUS, and PLLA in combination with the treatment of facial aging. RESULTS: Despite their extensive individual safety record, there is little data regarding combination therapy with these minimally invasive modalities. CONCLUSIONS: IPL, MFUS, and PLLA may be safely performed in a single treatment session to target multiple tissue planes concurrently without increased adverse events.

Comparison of intense pulsed light with 1,927-nm fractionated thulium fiber laser for the rejuvenation of the chest.

BACKGROUND: Rejuvenation of the aging chest is important to prevent noticeable disparities between the treated skin of the face and that of the untreated chest. OBJECTIVE: To compare a high-density thulium fiber laser (TFL)-based protocol for the rejuvenation of the aging chest with intense pulsed light (IPL). METHODS AND MATERIALS: We conducted a retrospective chart review comparing patients treated with IPL and those treated with TFL in combination with a quality-switched alexandrite laser and long pulsed dye laser. Blinded photographic assessment of overall improvement, rhytides, skin texture, dyspigmentation, and telangiectasia was performed. Patient satisfaction was assessed in a standardized follow-up survey. Cost and practicality were compared. RESULTS: At a mean follow-up of 45.8 days for IPL and 78.3 days for TFL, the two protocols had comparable clinical efficacy in achieving rejuvenation of the chest. Differences existed in terms of cost and practicality. CONCLUSION: TFL can be used at high density and in simultaneous combination with other targeted laser modalities to achieve rejuvenation of the aging chest. IPL achieves similar clinical efficacy. The choice between treatment modalities depends on physician and patient preferences.