Safety and Efficacy of a Novel, Variable-Sequenced, Long-Pulsed, 532-nm and 1,064-nm Laser With Cryogen Spray Cooling for Pigmented and Vascular Lesions.

BACKGROUND: Patients frequently seek treatment for vascular and pigmented lesions. More recently, a novel, variable-sequenced, long-pulsed, 532-nm and 1,064-nm laser with cryogen spray cooling was developed to offer greater flexibility in treatments. OBJECTIVE: A prospective clinical trial evaluated the safety and efficacy of a novel, variable-sequenced, long-pulsed, 532-nm and 1,064-nm laser with cryogen spray cooling (DermaV, Lutronic, South Korea). MATERIALS AND METHODS: Subjects with vascular and/or pigmented lesions were enrolled and underwent laser treatments. RESULTS: Twenty-three subjects were enrolled with vascular lesions (39.1%), pigmented lesions (17.4%), and both (43.5%). Mean age was 53.1 years, and 91.3% were women. Fitzpatrick skin types II-IV were included. All subjects were treated with 532 nm, and 4 were also treated with 1,064 nm. According to 4 blinded physician reviewers, correct before and after photographs were selected in 94.7%, 92.1%, 84.2%, and 76.3% of cases. Overall, 86.8% were responders, meaning that at least 3 of 4 reviewers agreed. For Global Aesthetic Improvement Scale, improvement occurred in 81.6%, 81.6%, 81.6%, and 76.3% of cases. No serious adverse events occurred. Overall, 87.0% of subjects reported being very satisfied or satisfied. CONCLUSION: A novel, variable-sequenced, long-pulsed, 532-nm and 1,064-nm laser with cryogen spray cooling can safely and effectively improve vascular and pigmented lesions.

Feasibility Study of Electromagnetic Muscle Stimulation and Cryolipolysis for Abdominal Contouring.

BACKGROUND: In addition to reducing subcutaneous fat for body contouring, some patients are interested in toning the underlying muscle layer. OBJECTIVE: This feasibility study evaluated the safety and efficacy of electromagnetic muscle stimulation (EMMS) alone, cryolipolysis alone, and cryolipolysis with EMMS for noninvasive contouring of abdomen. METHODS: Abdomens of 50 subjects were treated in a study with 3 cohorts: EMMS alone, Cryolipolysis alone, and Cryolipolysis + EMMS in combination. Electromagnetic muscle stimulation treatments were delivered in 4 sessions over 2 weeks. Cryolipolysis treatments were delivered in one session. Combination treatments consisted of one cryolipolysis and 4 EMMS visits. Efficacy was assessed by independent physician Global Aesthetic Improvement Scale (GAIS), circumferential measurement, Subject GAIS (SGAIS), and Body Satisfaction Questionnaire (BSQ). RESULTS: Safety was demonstrated for all study cohorts with no device- or procedure-related adverse events. Independent photo review showed greatest mean GAIS score for the Cryolipolysis + EMMS cohort followed by Cryolipolysis only, then EMMS only cohort. BSQ showed greatest average score increase for Cryolipolysis + EMMS cohort followed by Cryolipolysis only cohort, then EMMS only cohort. Mean circumferential reduction measurements were greatest for Cryolipolysis + EMMS cohort followed by Cryolipolysis only, and then EMMS only cohort. The mean SGAIS improvement score was equal for the Cryolipolysis only and Cryolipolysis + EMMS cohorts, followed by the EMMS only cohort. CONCLUSION: A multimodal approach using cryolipolysis and EMMS was safe and demonstrated enhanced body contouring efficacy for this feasibility study.

Safety and Efficacy of Nanosecond Pulsed Electric Field Treatment of Sebaceous Gland Hyperplasia.

BACKGROUND: Nanosecond pulsed electric field (nsPEF) technology involves delivery of ultrashort pulses of electrical energy and is a nonthermal, drug-free technology that has demonstrated favorable effects on cellular structures of the dermis and epidermis. OBJECTIVE: Determine the tolerability and effectiveness of nsPEF treatment of sebaceous gland hyperplasia (SGH). METHODS: This study was a prospective, randomized, open-label, multisite, nonsignificant risk trial in which each subject served as their own control. After injection of local anesthetic, high-intensity, ultrashort pulses of electrical energy were used to treat 72 subjects resulting in a total of 222 treated lesions. Subjects returned for 3 to 4 follow-up evaluations with photographs. RESULTS: At the final study visit, 99.6% of treated SGH lesions were rated clear or mostly clear and 79.3% of the subjects were satisfied or mostly satisfied with the outcome. At 60 days after nsPEF treatment, 55% of the lesions were judged to have no hyperpigmentation and 31% exhibited mild post-treatment hyperpigmentation. At the last observation for all lesions, 32% of the 222 lesions were noted as having slight volume loss. CONCLUSION: Nanosecond pulsed electric field procedure is well tolerated and is very effective in the removal of SGHs. TRIAL REGISTRATION: ClinicalTrials.gov NCT03612570.

Three-Dimensional Rejuvenation of the Décolletage.

BACKGROUND: Photodamaged skin of the chest is characterized by skin laxity, lines/wrinkles, hyperpigmentation, erythema, tactile roughness, atrophy, and telangiectasias. METHODS: A MEDLINE search was performed on combination treatments in chest rejuvenation, and the results are summarized. Practical applications for these combinations of procedures are discussed. RESULTS: Reports of injectable poly-L-lactic acid (PLLA), hyaluronic acid (HA), and chemical peels, along with lasers and light therapies such as intense pulsed light (IPL), vascular lasers, photodynamic therapy (PDT), nonablative fractionated lasers (NAFLs), ablative fractionated lasers (AFLs), and microfocused ultrasound (MFU) have been reported for chest rejuvenation. Few articles were discovered pertaining to combination therapy. The authors review their approaches to combination therapy. CONCLUSION: Multiple options exist alone or in combination for minimally invasive rejuvenation of the skin of the chest including PLLA, HA, chemical peels, IPL, vascular lasers, PDT, NAFL, AFL, and MFU. Little was found in the literature pertaining to the safety and efficacy of combining such procedures and devices. The authors' experience in clinical practice is that combination, same day chest rejuvenation techniques can be performed safely. A combination approach often produces the most optimal outcome for the patient seeking chest rejuvenation.

Long-term clinical evaluation of a 800-nm long-pulsed diode laser with a large spot size and vacuum-assisted suction for hair removal.

BACKGROUND: The long-pulsed diode (800-810-nm) laser is one of the most commonly used and effective lasers for hair removal. Limitations of currently available devices include a small treatment spot size, treatment-associated pain, and the need for skin cooling. OBJECTIVE: To evaluate the long-term hair reduction capabilities of a long-pulsed diode laser with a large spot size and vacuum assisted suction. METHODS: Thirty-five subjects were enrolled in a prospective, self-controlled, single-center study of axillary hair removal. The study consisted of three treatments using a long-pulsed diode laser with a large spot size and vacuum-assisted suction at 4- to 6-week intervals with follow-up visits 6 and 15 months after the last treatment. Hair clearance was quantified using macro hair-count photographs taken at baseline and at 6- and 15-month follow-up visits. Changes in hair thickness and color, levels of treatment-associated pain, and adverse events were additional study endpoints. RESULTS: There was statistically significant hair clearance at the 6 (54%) and 15-month (42%) follow-up visits. Remaining hairs were thinner and lighter at the 15-month follow-up visit, and the majority of subjects reported feeling up to mild to moderate pain during treatment without the use of pretreatment anesthesia or skin cooling. CONCLUSIONS: A long-pulsed diode laser with a large spot size and vacuum-assisted suction is safe and effective for long-term hair removal. This is the largest prospective study to evaluate long-term hair removal and the first to quantify decreases in hair thickness and darkness with treatment.

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.

A pilot study on the use of a plasma skin regeneration device (Portrait PSR3) in full facial rejuvenation procedures.

A new modality, the Portrait plasma skin regeneration (PSR(3)) system, allows precise and rapid treatment of photo-damaged skin, with controlled thermal injury and modification. Radio frequency (RF) energy converts nitrogen gas into plasma within the handpiece. Rapid heating of the skin occurs as the plasma rapidly gives up energy to the skin. This energy transfer is not chromophore dependent. The gold standard, carbon dioxide (CO(2)) laser resurfacing, has decreased in popularity due to high morbidity and downtime. There is demand for a technology that can provide the degree of improvement obtained with resurfacing without the complications associated with its use. This study evaluated the PSR(3) technology in full facial procedures. A two-site prospective study evaluated safety and efficacy for a single pass treatment of the full face using the Portrait PSR(3) system. Improvement in skin texture, tone, fine lines, dyschromia, and rhytides were assessed. Two-millimeter punch biopsy specimens were taken pre- and 90 days post-treatment. Follow-up was performed at days 2, 5, 7, 30, and 90 post-treatment to monitor recovery, improvement, and any subsequent sequelae. Patients developed erythema and edema shortly after treatment, with no immediate epidermal loss or charring. Epidermal loss occurred in the subsequent 24-48 h followed by epidermal recovery in approximately 7 days. Histological investigation showed regenerative epidermal and dermal architecture. The Rhytec Portrait PSR(3) system provides an attractive alternative to standard lasers that is well tolerated by patients, stimulates collagen remodeling, and provides excellent clinical outcomes.

Complications of laser dermatologic surgery.

BACKGROUND AND OBJECTIVE: Innovations in lasers, light and radiofrequency devices have allowed for improved therapeutic efficacy and safety and the ability to treat patients with an ever-increasing number of medical and aesthetic indications. Safety remains a primary concern and the timely communication of complications and their management is vital to insure that treatments be as safe as possible. The purpose of this report on the Proceedings of the First International Laser Surgery Morbidity Meeting is to provide laser experts the opportunity to present and discuss complications that their patients have experienced and how they were successfully managed. METHODS: Laser experts were invited to present complications of laser, light, and radiofrequency treatments that their patients have experienced and to discuss the potential mechanisms leading to the complications their management and final outcomes. RESULTS: Nineteen unique cases are presented and the clinical management of each case discussed. Eighteen sets of pre- and post-operative photos are presented. CONCLUSION: This report shows that even experts, with extensive experience using light-based therapies, can and do have patients who develop complications. Sound clinical judgment, and knowing how to avoid complications and their timely post-operative management, is essential to insure optimal therapeutic outcome.

Combined nonablative rejuvenation techniques.

BACKGROUND: Nonablative technologies have been used for fine lines and improvement of skin texture without significant downtime. Nonablative technologies may also be used in combination. OBJECTIVE: To present a brief review on nonablative technologies and discuss using nonablative procedures in combination and with other adjunctive therapies. MATERIALS AND METHODS: A review of the literature was done to identify combination nonablative studies. We also discuss our own experience in combining these procedures. RESULTS: Various nonablative technologies can be used together, often with better outcomes and fewer treatments. CONCLUSION: Nonablative and adjunctive treatments should be performed in combination to optimize the results. Much of the information in this publication is from personal experience and expresses the opinions of these authors while citing relevant literature and studies.

Multicenter study of the safety and efficacy of a 585 nm pulsed-dye laser for the nonablative treatment of facial rhytides.

OBJECTIVE: The objective of this study was to assess the safety and efficacy of a 585 nm flashlamp pulsed-dye laser for the nonablative treatment of facial rhytides. METHODS: A multicenter prospective randomized controlled study on 58 volunteers was performed. A split-face approach was adopted, with one periorbital region acting as a control and the other receiving either one or two treatments. Patients were photographed and imaged three-dimensionally before and after treatment. Histologic sections were analyzed. RESULTS: Three-dimensional topographic evaluation showed improvements of 9.8% (p = .0022) and 15% (p = .0029) in surface roughness for single and double treatments, respectively. Histology revealed an increase in type I collagen messenger ribonucleic acid expression, type III procollagen, chondroitin sulfate, and grenz zone thickness. Two treatments resulted in greater improvement than one treatment. CONCLUSION: Clinical improvement was achieved following a single treatment. Further improvement was observed following a second treatment. The subjective evaluation of clinical improvement was consistent with both histologic and topographic quantitative measurements.

Photorejuvenation with intense pulsed light: results of a multi-center study.

This multi-center study evaluating the role of Intense Pulsed Light (IPL) in the non-ablative rejuvenation of Type I and Type II photoaged skin study was conducted in order to evaluate the clinical efficacy and safety of using IPL in treating clinical indications associated with photoaged skin. Ninety-three patients of Fitzpatrick skin phenotypes I-III, Fitzpatrick Wrinkle Classes I-II, and Elastosis Scores 1-6 were enrolled in the study. Up to five treatments were performed at 4-week intervals with follow-up visits at 4 and 6 months after the last treatment. Patients received full-face treatments using the recommended parameters of the Quantum SR/HR (Lumenis Ltd.) with the 560 or 640 nm cutoff filter. Parameters of elastometry, physicians' evaluation of the Elastosis Score ('W/ES'), and global improvement as well as patient satisfaction were analyzed. Results showed that the average Fitzpatrick W/ES improved significantly (p<0.001) by 1.39 and 1.32 units at the 4 and 6 months follow-ups, respectively; an improved W/ES evaluation was recorded for 82% and 75% of the patients at each of these time points. In conclusion, IPL treatment is an effective non-invasive, non-ablative method for rejuvenating photoaged skin with minimal adverse events, no downtime, excellent long-term results, and a very high measure of patient satisfaction.

Hair removal using a combination radio-frequency and intense pulsed light source.

BACKGROUND AND OBJECTIVE: The long-term removal of unwanted hair is achieved by many laser and intense pulse light sources. One limitation is the treatment of individuals with dark skin. The light energy with the current systems has to penetrate through the epidermis before being absorbed by the hair follicle. In individuals with dark skin the high melanin concentration in the epidermis absorbs high energies that can lead to complications. The objective of our study was to study a new system that combines optical energy, intense pulsed light (IPL), with radio frequency (RF). This allows for the use of less optical energy due to the addition of RF energy. The lower optical fluence allows for safer treatment of darker skin types. STUDY DESIGN/MATERIALS AND METHODS: This was a multicenter study, in which 87 patients were enrolled. A single treatment was performed on a specified body site. Twenty-one of the 69 subjects that completed the study had skin types IV-VI. Each subject was evaluated at 1, 7, 30, and 90 days after the treatment session. RESULTS: Hair counts were significantly reduced from baseline after one treatment by an average of 46%. Individual patient data showed that the percentage in hair count reduction achieved ranged from 0 to 100%, with 43% of the patients having a 50% or greater decrease. CONCLUSIONS: The combination of optical energy and RF when delivered simultaneously achieves effective hair reduction with the use of less optical energy, allowing for the safe treatment of all skin types.