Topical antioxidant application augments the effects of intense pulsed light therapy.

BACKGROUND: There has been great interest in improving the efficacy of nonablative technologies by combining them during facial skin rejuvenation. The purpose of this study was to determine whether the addition of topical polyphenolic antioxidants to an intense pulsed light (IPL) treatment regimen augmented the effects of facial IPL treatments. METHODS: Thirty female volunteers, ages 34-52, with skin phototypes 1-3 were randomly assigned into three groups: group A (n = 10) received three full-face IPL treatments spaced 3 weeks apart; group B (n = 10) underwent 6-weekly full-face treatments of a pneumatically applied topical polyphenolic antioxidant solution; group C (n = 10) received the combination of the three full-face IPL treatments and the six full-face topical antioxidant applications. Skin biopsies, skin polyphenolic antioxidant levels, and skin moisture content levels were obtained and clinical efficacy variables were noted prior to and following the treatment period. RESULTS: Compared to group A, group C demonstrated significantly greater epidermal and papillary dermal thickness, decreased lipid peroxide concentration, increased skin moisture content, and increased polyphenolic antioxidants levels (P < 0.05). There was qualitative improvement in hydration, texture, and pore size. Compared to group B, group C demonstrated significantly greater papillary dermal thickness (P < 0.05), and qualitative improvement in reduction of fine lines, reduction of hyperpigmentation, and skin dullness. group B and group C had equivalent polyphenolic antioxidant levels, lipid peroxide concentration, and epidermal thickness. CONCLUSION: The addition of polyphenolic antioxidants to an IPL regimen improved the clinical, biochemical, and histological changes seen following IPL treatment alone. These data support the use of multimodal therapy to create synergy and to optimize clinical outcomes in nonablative facial skin rejuvenation.

Topical polyphenolic antioxidants reduce the adverse effects of intense pulsed light therapy.

BACKGROUND: Intense pulsed light therapy (IPL) has been associated with erythema and increased lipid peroxidation. Polyphenolic antioxidants have been shown to decrease inflammation and reduce oxidative stress in irradiated skin. OBJECTIVE: To determine whether the topical application of polyphenolic antioxidants to IPL-treated skin reduced the adverse effects of IPL exposure. METHODS: In a split-face study, 10 volunteers underwent three full-face IPL treatments (16 J/cm(2), 10 ms, 560 nm filter) spaced 3 weeks apart. A polyphenolic antioxidant solution was pneumatically applied to the left side of the face, beginning immediately before the first IPL treatment then weekly for six treatments. The lipid peroxide concentration, skin antioxidant level and skin moisture content were obtained before and after the study. RESULTS: Skin treated with IPL alone contained a significantly higher concentration of lipid peroxides when compared to skin treated with IPL plus polyphenolic antioxidants (p<0.05). Skin treated with IPL alone contained a significantly lower level of polyphenolic antioxidants and had a significantly lower moisture content (p<0.05). CONCLUSIONS: In this study, the concurrent pneumatic topical application of polyphenolic antioxidants reduced lipid peroxidation and skin dehydration in IPL-treated skin. Polyphenolic antioxidants may confer a protective effect on facial skin and enhance the effects of IPL therapy.

Topical antioxidant application enhances the effects of facial microdermabrasion.

BACKGROUND: Microdermabrasion has been accepted as a reliable, non-invasive method for facial rejuvenation. Recently, there has been interest in combining this technique with other modalities to increase its efficacy. The purpose of this study was to determine whether the addition of an antioxidant-based serum enhanced the dermatologic changes seen following microdermabrasion. METHODS: Ten female volunteers, aged 38-52 years, underwent a series of six diamond tip crystal-free microdermabrasion facial treatments spaced 7-10 days apart. An antioxidant serum rich in polyphenols was pneumatically applied to half the face immediately after each microdermabrasion treatment. Skin biopsies and skin polyphenolic antioxidant levels, determined by Raman spectroscopy, were obtained prior to and after the study period. Investigator ratings for efficacy were analyzed after the study period and compared to baseline. RESULTS: Compared with the skin treated with microdermabrasion only, the skin treated with microdermabrasion plus antioxidant demonstrated significantly increased epidermal and papillary dermal thickness, and increased fibroblast density (p < 0.01). There was increased hyalinization of the papillary dermis with newly deposited collagen fibers. Skin polyphenolic antioxidant levels increased 32% in the skin treated with the polyphenolic antioxidant serum after microdermabrasion (p < 0.01). Clinical efficacy variables were significantly more improved in the antioxidant group when compared to baseline (p < 0.01). These changes were supported clinically via digital photography. CONCLUSION: The addition of a polyphenolic antioxidant serum to a facial microdermabrasion regimen enhanced the clinical and histological changes seen following microdermabrasion alone. This combination should strengthen the use of microdermabrasion as a non-invasive facial rejuvenation tool and support the role of topical antioxidants as anti-aging factors.

Pregabalin has opioid-sparing effects following augmentation mammaplasty.

BACKGROUND: There has been a recent, growing concern regarding narcotic use in surgical patients. This issue, coupled with an ongoing desire to lessen postoperative discomfort, has prompted the search for alternative analgesic regimens. OBJECTIVE: The purpose of this study was to determine whether the addition of pregabalin, an anticonvulsant indicated for the management of neuropathic pain, to an analgesic regimen reduced narcotic use and reported pain following augmentation mammaplasty. METHODS: Eighty patients underwent submuscular augmentation mammaplasty with smooth shell saline mammary prostheses in an outpatient surgical facility. The patients were randomized into two groups. Group A (n = 40) used 5-mg hydrocodone tablets as needed to manage postoperative pain. Group B (n = 40) used pregabalin, 75 mg, twice daily in addition to 5-mg hydrocodone tablets as needed for postoperative pain management. Narcotic use was recorded and pain assessed daily using the Rogers Pain Scale from 1 (mild) to 10 (severe). Patients were surveyed for nausea and quality of pain. RESULTS: Group A used 115 +/- 32 mg hydrocodone during the immediate 7 day postoperative period and reported an average pain scale score of 5.3. Likewise, group B used 33 +/- 27 mg hydrocodone as well as the prescribed pregabalin dosage and reported an average pain scale score of 3.4. Patients in group B reported less nausea. These differences were statistically significant (P < .05). Patient age, implant size, and postoperative complications were similar between the two groups. CONCLUSIONS: Perioperative pregabalin administration in patients undergoing augmentation mammaplasty reduced postoperative narcotic use by 70%. There was also significantly less reported pain and a 46% reduction in nausea in the pregabalin-treated group. Pregabalin has few side effects, no drug interactions, and should be considered safe in an analgesic regimen.

Hydradermabrasion: an innovative modality for nonablative facial rejuvenation.

BACKGROUND: Hydradermabrasion is a relatively new procedure that combines crystal-free microdermabrasion with the pneumatic application of an antioxidant-based serum. OBJECTIVE: This study aims to validate the safety and efficacy of hydradermabrasion for nonablative facial rejuvenation and to determine whether antioxidant levels could be increased in the skin with this technique. METHODS: Twenty female volunteers, aged 34-56 years, were randomized into two groups. Group A underwent a series of six facial hydradermabrasion treatments using a polyphenolic antioxidant serum spaced 7-10 days apart. In Group B, the same polyphenolic antioxidant serum was applied manually to the skin for a total of six treatments at 7- to 10-day intervals. Digital photographs, skin biopsies, and skin polyphenolic antioxidant levels were obtained prior to and after the treatment regimen. Patient surveys were taken following the study. RESULTS: In Group A, treated skin demonstrated increased epidermal thickness, papillary dermal thickness, and polyphenolic antioxidant levels (P < 0.01). There was replacement of elastotic dermal tissue, collagen hyalinization, and increased fibroblast density. Fine lines, pore size, and hyperpigmentation were decreased following treatment. There were no reported complications. In Group B, there was no change in skin structure, antioxidant levels, or clinical skin attributes. CONCLUSION: Hydradermabrasion effectively improved skin quality both clinically and histologically. There were no changes to suggest that pneumatic serum application adversely affected dermal components. After hydradermabrasion, skin polyphenolic antioxidant levels were increased. In contrast, the intermittent manual application of the polyphenolic antioxidant serum without the microdermabrasion element did not result in detectable skin changes.

Celecoxib reduces narcotic use and pain following augmentation mammaplasty.

BACKGROUND: Narcotics have traditionally been used to control pain after augmentation mammaplasty, but they have adverse side effects, including addiction potential, clouded sensorium, nausea, and respiratory depression. Alternative strategies for managing postoperative pain are expensive, cumbersome, and also have their own risks. While long-term use of celecoxib has been associated with an increased risk of serious adverse cardiovascular effects, no problems have been reported with short-term use. OBJECTIVE: The purpose of this study was to determine whether the addition of celecoxib, a selective nonsteroidal anti-inflammatory, to an analgesic regimen reduced narcotic use and pain following augmentation mammaplasty. METHODS: One hundred patients underwent submuscular augmentation mammaplasty with smooth saline-filled mammary prostheses using an intravenous sedation technique. Group A (N = 50) used hydrocodone to manage postoperative pain. Group B (N = 50) used celecoxib 400 mg 1 to 2 hours before surgery and then daily in addition to hydrocodone postoperatively. Narcotic use, incidence of nausea, and complications were recorded. Pain was assessed daily with a Likert pain scale from 0 (no pain) to 10 (severe pain). RESULTS: Group A used 110 +/- 34 mg hydrocodone during the immediate 7-day postoperative period and reported an average pain scale score of 5.1. Group B, which used celecoxib, used 34 +/- 22 mg hydrocodone during the same period with an average pain scale score of 3.3. These differences were statistically significant (P < .05). Group B experienced 53% less nausea than Group A. There were no significant differences between the groups regarding age, implant size, or complications. CONCLUSIONS: Perioperative celecoxib administration in patients undergoing augmentation mammaplasty significantly reduced postoperative narcotic use, pain, and nausea. Its use should facilitate the patient's ability to resume everyday activities following surgery.

Topical becaplermin improves outcomes in work related fingertip injuries.

BACKGROUND: Fingertip injuries are common and bear significant costs associated with treatment, lost work, and functional impairment. This study compared these factors in occupationally related fingertip injuries treated with becaplermin, a recombinant human platelet-derived growth factor, and those treated with surgical reconstruction. METHODS: This was a prospective controlled trial involving occupationally related fingertip injuries. Fifty men (ages 23-51) with full thickness, single fingertip injuries > or =1.5 cm(2) with or without phalangeal exposure and distal to the distal interphalangeal (DIP) joint were evaluated. Group I (n = 25) underwent treatment with daily topical becaplermin. Group II (n = 25) underwent surgical reconstruction with a skin graft or local soft tissue flap. Time to wound healing, time to return to work, associated treatment costs, and calculated functional impairment were recorded. RESULTS: Patients in Group I returned to work in significantly less time than those in Group II-10 days versus 38 days respectively). The average calculated functional impairment in Group I was 10% versus 22% in Group II. Associated treatment costs in group A were 1580 +/- 145 US Dollars compared with 6750 +/- 785 US Dollars in Group II. All differences were statistically significant at p < 0.05 CONCLUSION: In this study, the functional and economic costs were significantly less when fingertip injuries were treated with topical becaplermin than when they were treated with surgical reconstruction. This information should allow emergency and acute care physicians to treat these injuries more efficaciously and conveniently.

The lamellar peel: a sequential nonablative and ablative laser treatment for facial skin rejuvenation.

OBJECTIVES: Ablative and nonablative laser treatments have established themselves independently in the rejuvenation of aging skin. This study was designed to determine the effects of sequential nonablative and ablative laser treatments on facial skin. MATERIALS AND METHODS: Twelve patients, ages 32-56 years, with skin phototypes I-IV, received three treatments spaced six weeks apart. Each treatment consisted of one pass with 1319-nm Nd:YAG laser at 16 J/cm(2), 50 ms pulse duration. This was immediately followed by one pass of 2940-nm Er:YAG laser at 5 J/cm(2). Photographs and biopsies were taken prior to the first treatment and following the third treatment. RESULTS: Clinical improvements in facial skin tone and texture, acne scarring and dyschromia were noted in all patients. Histologic changes included a more compact epidermal granular layer and lamellar collagen formation with decreased solar elastosis in the dermis. Compared to controls, treated skin had a thicker, more homogeneous papillary dermis. CONCLUSION: The sequential use of nonablative and superficial ablative laser treatments clinically and histologically improved photodamaged and chronologically aged skin. This occurred with minimal recovery and little morbidity, demonstrating this laser application to be a safe and effective method for facial rejuvenation.

Cervicoplasty and facial laser resurfacing: a paired technique for facial rejuvenation.

OBJECTIVE: A specific group of patients interested in facial rejuvenation was identified in a plastic surgery practice. These patients were primarily concerned with improving their neck contour and correcting their facial rhytides. To address those problems a one-stage paired technique was designed - cervicoplasty with full-face laser resurfacing. MATERIALS AND METHODS: Thirteen patients were treated with this procedure during a 1 year period. RESULTS: The patients experienced no significant complications and were extremely satisfied with their results. A retrospective study of 206 patients over the same year period revealed that the group undergoing the combination procedure: 1) was identifiable by the ranking of their specific aesthetic concerns; 2) was averse to undergoing a full facelift; and 3) comprised a significant percentage (22%) of surgical patients in the study period. CONCLUSIONS: Combining cervicoplasty with full-face laser resurfacing is a safe, effective procedure that provides another option in the realm of facial rejuvenation.

Topical platelet-derived growth factor enhances wound closure in the absence of wound contraction: an experimental and clinical study.

The effects of platelet-derived growth factor (PDGF) on wound healing in animal and human models were investigated. Four 1-cm2 wounds were made on the dorsum of 3 rats. A 0.5-cm punch wound was made behind each ear of 4 patients. Half the wounds were treated daily with vehicle, controls, and the rest were treated with PDGF. Treated wounds closed faster than the controls (animals: 16 +/- 3.2 days vs. 17.8 +/- 2.17 days; p < 0.05) and (patients: 16 +/- 0.67 days vs. 19.5 +/- 0.33 days; p < 0.05). Biopsies were taken at day 20 for polarized light-Sirius red histological analysis. The granulation tissue of PDGF-treated wounds showed fine collagen fibers with weak birefringence, characteristic of immature granulation tissue, deposited throughout the healed wound site. Such a pattern indicates wound closure by reepithelialization and filling in with scar. Control wound biopsies showed a small area of immature granulation tissue surrounded by intact dermal thick collagen fibers with strong birefringence. Such a pattern indicates wound closure by wound contraction. This shows that PDGF enhances wound closure by reepithelialization and the prevention of wound contraction.

Topical platelet-derived growth factor in patients enhances wound closure in the absence of wound contraction.

Recombinant human platelet-derived growth factor (PDGF) is reported to promote wound closure in problem wounds. The mechanism of PDGF enhancement of wound closure is not clear. Does PDGF enhance wound contraction, or re-epithelialization, or both? In four patients undergoing elective surgery, a full excision 5 cm(2) punch wound was made behind each ear. The left post-articular wound received daily PDGF in a gel and each right post-articular wound received placebo-gel daily. The placebo-treated wounds closed in 19.8 days, while the PDGF-treated wounds closed significantly faster, in 15.6 days, p=0.002. At Day 20, all healed wounds were processed for histology. PDGF-treated wounds showed granulation tissue beneath an uninterrupted epidermis. A fine birefringence pattern, consistent with granulation tissue, was found by polarized light microscopy. The control closed-wounds had a smaller area of granulation tissue under an intact epidermis and polarized light microscopy showed mostly normal dermis. The presence of intact dermis within the closed-wound site is the hallmark of wound contraction. Topical PDGF limits the role of wound contraction in wound closure. Control wounds healed by wound contraction, while PDGF-treated wounds close by re-epithelialization and filling in with scar.