Er:YAG laser ablation of plantar verrucae with red LED therapy-assisted healing.

OBJECTIVE: The aim of this study was to evaluate Er:YAG ablation of plantar verrucae with red light-emitting diode (LED) therapy to assist healing. BACKGROUND DATA: Successful removal of troublesome plantar verrucae still presents problems, particularly regarding complete removal and pain both postoperatively and during healing. A further problem is a high recurrence rate due to the aggressive viral dissemination associated with this kind of wart. METHODS: Over 2 years, the author treated 121 plantar warts under local anesthesia in 58 patients with Er:YAG laser ablation followed by red LED therapy to assist wound healing. The Er:YAG laser (96 J/cm2, 2.0 J/pulse, 350 microsec pulsewidth, 2-mm collimated handpiece) is used first to ablate precisely the verrucous tissue until normal architecture is seen. Immediately after treatment, a red LED therapy system is applied (633 nm, 20 min, 96 J/cm2) to the wound and surrounding area. LED therapy at the same parameters is repeated on postoperative days 2, 6, and 10. A representative plantar verruca case is presented. RESULTS: The Er:YAG laser precisely and cleanly ablates the plantar verrucae with clear margins into normal skin architecture, exhibiting minimal secondary thermal damage. After the first treatment session, patients are usually able to walk normally without any pain, even those who have bilateral verrucae, and no exudate is usually seen from postoperative day 2 on. By postoperative day 6, the wounds have shrunk noticeably and are filled with healthy granulation tissue, and by day 15 they are usually completely healed, with minimal scarring. At the 12-month follow-up, recurrence rates have been less than 6% (3/58 patients). CONCLUSION: From the author's experience in 121 cases, the Er:YAG laser is ideally suited for precise and speedy ablation of plantar verrucae with minimal thermal damage to surrounding tissue, which, when coupled with visible red LED therapy, has given excellent, accelerated, and pain-free healing in these difficult-to-treat and slow-to-heal lesions with very low recurrence rates.

Red light-emitting diode (LED) therapy accelerates wound healing post-blepharoplasty and periocular laser ablative resurfacing.

BACKGROUND AND AIMS: Blepharoplasties can be associated with sequelae-related patient downtime, often extended or reinforced by periocular laser ablative resurfacing. The present controlled study examined the effects of a new-generation LED phototherapy system on enhancing wound healing following such combination surgery. METHODS: Two males and eight females participated in the trial, with ages ranging from 44 to 59 years (average 52.3 years). Following blepharoplasty and Er:YAG/CO2 laser ablative resurfacing, one-half of each subject's face was treated with the red LED therapy (20 min, 96 J/cm2, 633 nm), the contralateral half being the unirradiated control. Patients reported subjectively on pain levels and resolution. Resolution of erythema, edema, bruising and days to healing were independently evaluated from the clinical photography. All findings were compared between the treated and untreated sides. RESULTS: In all instances, the LED therapy-treated side was statistically significantly superior to the unirradiated control by a factor of two to three. CONCLUSIONS: In this small series of 10 patients, red LED phototherapy after blepharoplasty and laser ablative resurfacing cut the time to resolution of side effects and the healing time by one-half to one-third compared with contralateral unirradiated controls. Further studies are warranted with larger populations to confirm these findings.

The 800-nm diode laser in the treatment of leg veins: assessment at 6 months.

BACKGROUND: The efficacy of the 800-nm diode laser system in clearing leg veins was analyzed subjectively and objectively in a variety of leg veins. METHODS: A total of 10 women (age 25-55 years, skin types II-IV) with a variety of leg vein types were treated with an 800-nm diode laser. A sequence of pulses (5-8 stacked pulses, pulse duration 50 milliseconds, delay 50 milliseconds) was applied on a 3-mm spot (210-336 J/cm2 fluence, depending on vessel size). Treatment on the same vein was performed at intervals of 2 months until complete clearance was achieved (maximum: 3 treatments). The results were assessed at 6 months from the last treatment. Patients evaluated their subjective improvement by means of a questionnaire to elicit the satisfaction index. In an independent objective assessment, the clearance index was based on the pretreatment and posttreatment clinical photography, also analyzed by a computer program. RESULTS: All patients completed the trial with mild but transient side effects. The patient 6-month assessments for very good, good, fair, poor, and worse were 1, 5, 3, 1, and 0, respectively. For the clinician-assessed clearance index, the numbers for the same grades were 2, 6, 2, 0, and 0, and for the computer assessment they were 1, 6, 2, 1, and 0. No patient scored worse in any assessment. The overall satisfaction index and clinician and computer clearance indexes were 60%, 80%, and 70%, respectively. LIMITATIONS: No control group could be obtained in this study. CONCLUSIONS: The 800-nm diode laser as used in the study may well offer an effective treatment method for leg veins that is comparatively pain and side-effect free. Best results were obtained in vessels of 3 to 4 mm in diameter located on the thigh, and in patients with phototype III skin. No correlation was seen between results and patient age.

Erbium:YAG laser as a method of deepithelization in corrective and reductive breast surgery.

Deepithelization of the breast in breast ptosis surgery is important, being associated with risks which could affect the clinical outcome. The role of Er:YAG laser deepithelization was investigated. A total of 12 bilateral mammoplasties were performed, randomly assigned to 2 groups, one of experienced and one of less-experienced surgeons. Results were compared between the 2 groups of surgeons for scalpel deepithelization on one breast and the Er:YAG laser on the contralateral breast. No complications; less edema, pain, and erythema; and quicker wound healing were observed in the laser-deepithelized breasts, with a shorter operation time even for the less-experienced surgeons. The authors do not suggest that the Er:YAG laser should replace the scalpel in the hands of the expert surgeon for breast deepithelization in breast ptosis surgery, but the results of the study suggest that Er:YAG laser ablation is a safe, precise, effective and complication-free method.

Nd:YAG laser combined with IPL treatment improves clinical results in non-ablative photorejuvenation.

BACKGROUND: Intense pulsed light (IPL) sources have been reported in non-ablative photorejuvenation, but the excellent histological findings do not always coincide with the clinical results and patient satisfaction index (SI). METHODS: Ten female patients (two forehead, four periocular and four perioral), ages ranging from 28 to 46 years, skin types II-IV, wrinkle types I-III, participated in the study. The IPL system was applied with the yellow (570 nm) cut-off filter, 30 J/cm(2), single pulse, followed by the Nd:YAG at 120 J/cm(2), double pulse (7 ms per shot with 20 ms between pulses) on the wrinkled areas only. Three sessions were given at monthly intervals, and an assessment was made 1 and 6 months after the third session. Biopsies were taken from four consenting patients as a cross-section before the first treatment and then 1 and 6 months after the third session. For clinical control and contrast of tissue results, a group of 10 patients (two forehead, four periocular and four perioral; ages ranging from 27 to 47 years, skin types II-IV, wrinkle types I-III) was treated only with IPL, using the same parameters and sessions. Histologies were taken from four consenting patients. RESULTS: The histology showed thickening of the epidermis with good dermal collagen organization in both groups. However, the combined treatment showed more dramatic changes in histological tissue condition, and ectatic blood vessels were seen in the deeper dermis. The patient SI values, related to the results, were lower when IPL was used alone. All patients completed the study. In the combined treatment group, overall SIs of 8 (80%) and 8 (80%) were obtained at the control points of 1 and 6 months, respectively, after session 3, compared with SIs of 6 (60%) and 4 (40%) scored by patients in the IPL group at the same points. Discomfort and side effects were minimal in both groups. CONCLUSIONS: The addition of the Nd:YAG laser to the IPL regimen in non-ablative skin rejuvenation gave very good histological results, which were echoed by stronger patient satisfaction than in the control group treated only with IPL. Visible improvement in the skin condition of both groups was achieved, but was better in the combined treatment group.

Hair removal evaluated with a filterless flashlamp-based system: a preliminary study in 10 patients.

BACKGROUND: A relatively inexpensive, portable epilation system based on unfiltered flashlamp technology (Spa Touch, Epilast, Paris, France)was macroscopically and histologically evaluated for efficacy and duration of hair removal. PATIENTS AND METHODS: Ten patients participated (eight female, two male, aged 22-62 years, skin types I-V). The system delivers a 35 ms pulse of 6-7.5 J/cm2 of broadband infrared visible light through a large treatment window in the handpiece, held in light contact with the target skin,without skin cooling or anaesthesia. The skin was shaved before the first treatment, and the subsequent frequency of application over a further four sessions was done every month. RESULTS: Histology revealed the destruction of most of the hair shaft, with regrowth of finer and lighter hair approximately 4 weeks after the final treatment, depending on the area treated. Patients were satisfied with results if epilation was maintained on a monthly basis. A delay in treatment allows hair to grow back. An interesting observation was recorded on white and vellous hair. Nine of the 10 patients noted better skin condition in the treated area. CONCLUSIONS: This system retards hair regrowth and acts as a 'light razor' that can be implemented for speedy epilation at a reasonable cost.

Pulsed and scanned carbon dioxide laser resurfacing 2 years after treatment: comparison by means of scanning electron microscopy.

Studies have reported short-term and long-term (1-year) findings for laser skin resurfacing. Two of the most popular systems used for this procedure, the continuous-wave Sharplan 40C SilkTouch system and the pulsed Coherent 5000C UltraPulse system with a computer pattern generator, were previously compared for a range of follow-up times up to 1 year, using light microscopy and transmission electron microscopy. This study analyzed the 2-year morphological differences using scanning electron microscopy. Tissue samples were obtained from 10 patients (age range, 50 to 72 years; skin types II and III) who had undergone laser resurfacing 2 years previously. One half of the face of each patient had been treated with the continuous-wave system and the other half with the pulsed system. The samples were subjected to scanning electron microscopy. On the continuous-wave-treated side, significantly better dermal collagen organization was observed at 2 years, with plump-appearing fibers that were closely knit to form a compact structure. On the side treated with the pulsed system, the collagen fibers in the papillary dermis were more loosely arranged and appeared drier. In both the continuous-wave-treated and pulsed-treated areas, the epidermis appeared healthy and exhibited some signs of age-related deterioration, with slightly flatter plaques and somewhat more flaking keratin on the pulsed-treated side. Probably because of the greater degree of residual thermal damage associated with the continuous-wave system, at 2 years after treatment there was more prolific synthesis and better orientation of collagen fibers, which were maintained for longer times, compared with the pulsed-treated specimens.