Split-face comparison study of cryogen spray cooling versus pneumatic skin flattening in skin tightening treatments using a long-pulsed Nd:YAG laser.

BACKGROUND: Nd:YAG pulsed lasers are used for non-ablative skin tightening treatment. A common drawback of this procedure is pain, which is often intolerable. Pneumatic skin flattening (PSF) is a new technology which alleviates pain in laser treatments. The purpose of this study is to assess the clinical efficacy and pain reduction in Nd:YAG laser skin tightening treatments with PSF compared to Nd:YAG laser skin tightening treatments with cryogen spray cooling (CSC). METHODS: Eleven patients were treated on the face with an Nd:YAG laser operated at an energy setting of 30 J/cm(2) and a pulse duration of 50 ms. Half of the face was treated with the Nd:YAG using CSC and the other side was treated with the Nd:YAG using PSF. A comparison of pain elicited from each treatment was done by comparing each patient's VAS pain scoring of the two sides. RESULTS: Treatment efficacy with CSC and with PSF was identical. The study confirmed significant pain reduction with PSF (p < 0.01). The average pain scores for PSF and CSC were 2.4 and 6.9, respectively. Mild ecchymosis was observed in two patients on the PSF side. CONCLUSION: Nd:YAG laser skin tightening treatments with PSF are less painful than Nd:YAG laser skin tightening treatments with CSC; the PSF treatments can be done with minimum side effects.

Comparison study of intense pulsed light versus a long-pulse pulsed dye laser in the treatment of facial skin rejuvenation.

Currently, various nonablative skin resurfacing techniques are being used to rejuvenate facial skin, including lasers and intense pulsed light (IPL). There are few direct comparison studies between IPLs and lasers. The objective of our study is to compare the effectiveness of intense pulsed light versus a long-pulse pulsed dye laser (LPDL) in the treatment of facial skin rejuvenation. Ten Asian patients with Fitzpatrick skin types III-IV were enrolled in this study. One half of the face was treated with IPL (6 treatment sessions) and the other side was treated by LPDL (3 treatment sessions). An LPDL with a wavelength of 595 nm and spot size of 7 mm was used. Utilizing the compression method, lentigines were treated using a PDL with a fluence between 9-12 J/cm and a pulse duration of 1.5 ms. Wrinkles were treated with fluences between 10 to 12 J/cm and a pulse duration of 20 ms, using a pulse-stacking technique. An IPL with a type B handpiece was used. Lentigines and wrinkles were treated with fluences between 27 to 40 J/cm and a pulse duration of 20 ms. The improvement of lentigines was 62.3% and 81.1% for IPL and LPDL respectively. There was no significant difference between IPL and LPDL in wrinkle reduction. There was no scarring or pigmentary change seen with either device. Both IPL and LPDL are effective for facial skin rejuvenation in Asians, but LPDL treatment is significantly better than IPL treatment in the treatment of lentigines. The use of the compression technique may allow this LPDL to be used effectively for facial rejuvenation and with fewer treatment sessions, when compared with the IPL.

Mongolian spots with involvement of mandibular area.

A 1-year-old boy had grayish pigmentation on the left side of his face over the area supplied by the mandibular branch of the trigeminal nerve. Upon further examination, the lesion was also found on the left side of the neck, shoulder, upper arm, right lower back and buttock. The pigmentation was uniform in intensity. This case report demonstrates that Mongolian spots can occur on the face in the area supplied by the mandibular branch of the trigeminal nerve. These spots should not be misdiagnosed as nevus of Ota.

Evaluation of fluence and pulse-duration on purpuric threshold using an extended pulse pulsed-dye laser in the treatment of port wine stains.

Laser therapy of port-wine stains (PWS) using the extended pulse pulsed-dye laser (EPPDL) is accepted as the optimal approach because the thermal relaxation time for the vessels in PWS is actually 1-10 msec. The purpose of this study is to elucidate the purpuric threshold using the EPPDL for treatment of PWS. One hundred and seventy-seven Japanese patients with PWS were recruited for this study. All the patients were dark-skinned with skin phototype III (n = 103) and IV (n = 74). PWS were treated with the EPPDL with a pulse duration ranging 1.5-10 msec, fluence ranging 9-15 J/cm(2), and a spot size of 7 mm. Cryogen spray cooling (CSC) was fixed to 30 msec of delay and 30 msec of spray duration. Patients returned to our clinic within 1 week after their initial laser therapy and the treatment sites were examined for the evidence of purpura formation. Of the 177 patients, 108 developed purpura. The lowest fluences that caused purpura and were seen in more than 50% of patients were 10 J/cm(2) with a pulse duration of 1.5 msec, 12 J/cm(2) with a pulse duration of 3 msec, 13 J/cm(2) with a pulse duration of 6 msec, and 13 J/cm(2) with a pulse duration of 10 msec. The fluence and pulse duration thresholds were 12.5 J/cm(2) and 1.65 msec, respectively. Because purpura is one of the treatment endpoints when using a pulsed-dye laser for PWS, higher fluences are necessary when using a long pulse duration.

Comparison study of a traditional pulsed dye laser versus a long-pulsed dye laser in the treatment of early childhood hemangiomas.

BACKGROUND AND OBJECTIVE: The role of pulsed dye laser (PDL) in the treatment of childhood hemangiomas is still controversial because of the inherent characteristics of hemangiomas as well as the side effects of the PDL. Recently, the long pulsed dye laser (LPDL) with cryogen spray cooling (CSC) has been found relatively more effective and safer than the PDL in the treatment of port-wine stains and telangiectasia. This study was designed to compare the efficacy and complication rate of PDL versus LPDL for treating childhood hemangiomas. STUDY DESIGN/MATERIALS AND METHODS: We did a prospective, randomized, controlled trial in which we enrolled 52 Asian infants, aged 1-3 months, with early hemangiomas. These infants were assigned to PDL treatment (n = 26) or LPDL treatment (n = 26) and followed to age 1 year. A PDL with a wavelength of 585 nm and spot size of 7 mm and a LPDL with a wavelength of 595 nm and spot size of 7 mm were used. Each patient in the PDL group was treated with energy fluence between 6 and 7 J/cm(2) and a pulse duration of 0.45 milliseconds without epidermal cooling. Each patient in the LPDL group was treated with energy fluence between 9 and 15 J/cm(2) and a pulse duration of 10-20 milliseconds, utilizing CSC to protect the epidermis. Each group was treated at 4-week intervals until the lesion cleared. When each patient reached an age of 1 year, outcome measures such as clearance rate, time period of maximum proliferation, and complications were assessed. RESULTS: The number of children whose lesions showed complete clearance or minimal residual signs at 1 year of age was 14 (54%) in the PDL group and 17 (65%) in the LPDL group (P = 0.397). Compared with the LPDL, PDL treated children had more hypopigmentation (3, 12% vs. 8, 31%; P = 0.001), more hyperpigmentation (2, 8% vs. 4, 15%; P = 0.005), and more textural changes (1, 4% vs. 6, 23%; P = 0.001). The average time period of maximum proliferation in the LPDL group was significantly shorter than that of the PDL group (106 days vs. 177 days; P = 0.01). CONCLUSION: Early treatment of childhood hemangiomas with the LPDL is safer and more effective than the PDL.