Helium Plasma Dermal Resurfacing With and Without Concurrent Aesthetic Surgery of the Face and Neck: A Retrospective Review.

Background: Helium plasma dermal resurfacing (HPDR) is an emerging off-label use for an existing FDA-approved device. Objectives: Retrospective evaluation of patient satisfaction and adverse events (AEs) following facial skin resurfacing with HPDR technology. Methods: Single-site, retrospective review of 301 patient charts following HPDR treatment of the face. Patient satisfaction data were collected during review of medical records. AE data were analyzed to determine the effects of demographic, procedural, and posttreatment variables on the presence or absence of AEs. Results: HPDR was performed concurrently with other facial/non-facial surgical procedures in 193 of 301 patients (64.1%) including over undermined facial skin in 58 patients (19.3%) during rhytidectomy. No serious AEs were observed. Nonserious AEs were noted, however, in 20 patients (7.3%) and included erythema/prolonged erythema, hyperpigmentation, milia, slow healing, and upper lip hypertrophic scar. Among the 288 patients returning for follow-up (mean 2 months postprocedure), satisfaction with HPDR treatment results was documented in 275 patients (95.5%); the remaining 13 patients' charts did not reference satisfaction or dissatisfaction, and no AEs were recorded for this patient subgroup. Conclusions: This retrospective study supports the use and safety of HPDR technology for facial skin rejuvenation; no serious AEs and relatively few nonserious AEs were observed following either sole modality HPDR or HPDR with concurrent treatment of undermined skin tissue during rhytidectomy procedures. Patient satisfaction and observed results are comparable to full-field laser skin resurfacing treatments.

High energy, double pass helium plasma dermal resurfacing: A prospective, multicenter, single-arm clinical study.

BACKGROUND: A previous multi-center clinical study of low energy (20% power), single-pass helium plasma dermal resurfacing (HPDR) showed positive results but did not fully reveal the true potential of this novel technology. A second multi-center clinical study, reported herein, was therefore undertaken to evaluate efficacy and safety of high energy (40%), double pass HPDR for treatment of facial rhytids (ClinicalTrials.gov Identifier: NCT04185909). METHODS: Fifty-five eligible subjects seeking improvement in facial rhytids were enrolled for study at one of four investigational sites. All subjects underwent full-face HPDR treatment. The forehead, nose, cheeks, and peri-oral treatment zones were treated at 40% power with two passes whereas the peri-orbital and jawline/mandibular zones were treated at 20% power (up to 40% for jawline/mandibular zone) and one or two passes. Photographic images of the face were captured using the VISIA-CR system. Three-month posttreatment Fitzpatrick Wrinkle and Elastosis Scale (FWS) scores were compared to baseline scores as determined by blinded independent photographic reviewers (IPRs) and study investigators. RESULTS: Blinded IPRs and study investigators observed a ≥1-point FWS improvement in 100% of subjects with mean change in IPR FWS from baseline to the 90-day visit of -3.6 (±1.2). 96.4% of subjects indicated "improvement" in appearance at the 90-day visit utilizing the modified Global Aesthetic Improvement Scale. Evaluation of VISIA-CR data revealed statistically significant improvements in wrinkles, brown spots, and pore counts. Overall, 269 Adverse Events in 55 subjects were reported; most were mild-moderate in severity (99.3%), anticipated (86.2%), and of relatively short duration with most having resolved within 30 days (60.6%) of treatment. CONCLUSION: Treatment of facial rhytids with high energy, double pass HPDR as detailed herein enables a marked improvement in FWS that parallels or surpasses competing technologies. VISIA-CR analysis demonstrates additional improvements in skin quality with statistically significant quantitative improvements in brown spots and enlarged pores as well as wrinkles. Effective rhytid effacement combines with high subject satisfaction and few unanticipated adverse events for a reasonable benefit-risk ratio.

A Prospective Study Evaluating the Use of Helium Plasma for Dermal Resurfacing.

BACKGROUND AND OBJECTIVES: A novel helium plasma device was evaluated for efficacy and safety for dermal resurfacing (ClinicalTrials.gov Identifier: NCT03286283). The helium plasma device delivers energy in a controlled, bimodal fashion that when compared with the nitrogen plasma predicate device in a porcine animal model demonstrated a more limited depth of thermal effect but a greater skin tissue contraction. STUDY DESIGN/MATERIALS AND METHODS: Fifty-five eligible subjects seeking improvement in facial rhytids were enrolled for study at one of three investigational sites. Most subjects underwent full-face treatment. Power levels were limited to 20% at peri-oral and peri-orbital areas-a level that correlates to an energy density 40% lower than the highest setting on the predicate device. Three-month post-treatment Fitzpatrick Wrinkle and Elastosis Scale (FWS) scores were compared with baseline scores as determined by blinded independent photographic reviewers (IPRs) and study investigators. RESULTS: Blinded IPRs observed a ≥1-point FWS improvement in 63.64% of subjects whereas study investigators noted a ≥1-point FWS improvement in 54 of 55 subjects (98.18%) of subjects. 90.9% of subjects indicated "improvement" in appearance utilizing the modified Global Aesthetic Improvement Scale. Subgroup analysis showed 1-point (±0.05) FWS improvement by IPRs and study investigators for Fitzpatrick Skin Types II and III, age≥62, two of three study sites, and post-treatment oral steroid use. Eighty Non-Serious Adverse Events in 39 subjects were reported, most of which resolved within 14 days or less. There were no Serious Adverse Events or Unanticipated Device Effects reported. CONCLUSION: At the modest power level studied, a significant improvement from a single pass helium plasma dermal resurfacing treatment was observable in most subjects by IPRs and investigators, and no serious adverse events were reported. The discrepancy between IPR and study investigator FWS improvement may be explained in part by the limitations of assessing two-dimensional photographs versus live in-person evaluation of subjects. Studies evaluating higher energy levels and/or multiple treatment passes are ongoing. Lasers Surg. Med. © 2020 The Authors. Lasers in Surgery and Medicine published by Wiley Periodicals, Inc.

Plasma Energy Skin Rejuvenation.

Nitrogen plasma skin regeneration (PSR) initiated the use of cold atmospheric plasma (CAP) in skin rejuvenation over a decade ago. Helium gas CAP is already in widespread use worldwide for many surgical applications, whereas its use in skin rejuvenation is now emerging as a viable tool for treatment of facial rhytidosis. Animal studies comparing these CAPs suggest that observed differences in skin tissue interaction result from differences in plasma generation and in energy deposition wherein greater skin tissue contraction observed with helium PSR may result from its unique bimodal energy deposition and more complete full field treatment of the tissue.

Helium Plasma Skin Regeneration: Evaluation of Skin Tissue Effects in a Porcine Model and Comparison to Nitrogen Plasma Skin Regeneration.

BACKGROUND AND OBJECTIVES: Helium plasma skin regeneration (PSR) is a novel skin rejuvenation technology with significant differences compared with nitrogen PSR technology but that may exert similar skin tissue effects. Study objectives included a comparison of acute and chronic skin tissue changes among the two plasmas in a porcine animal model. STUDY DESIGN/MATERIALS AND METHODS: In this study, both helium and nitrogen gas plasmas were used to treat the dorsal skin of Yorkshire cross mini pigs with 20% (8.6 J/cm2 ) and 40% (17.8 J/cm2 ) power helium plasma single pass treatment (4 liter gas flow, continuous energy delivery, and linear non-overlapping passes) compared with high energy nitrogen plasma double pass treatment (PSR3 @ 14.1 J/cm2 : 4.0 J, 2.5 Hz pulse rate, overlapping horizontal, and vertical passes). Acute and chronic skin contraction, maximum acute depth of injury and chronic reparative healing depth were assessed along with representative histopathology in each treatment paradigm. RESULTS: High-energy nitrogen plasma treatment exhibited greatest mean depth of acute tissue injury 4 hours post-treatment whereas helium plasma treatment exhibited greater acute skin tissue contraction. Then, 20% and 40% power helium plasma treatment results were each very similar among animals as a percentage of nitrogen plasma treatment results for both depths of acute tissue injury and acute skin tissue contraction. Mean depths of reparative tissue healing were similar among treatment paradigms 30 days after treatment with significant intra- and inter-animal variability observed within each treatment paradigm. Thirty-day mean skin tissue contraction was greater for helium plasma treatment; however, the data varied significantly between animals in all paradigms. Histopathologic tissue evaluation after 30 days showed similar findings among the treatment paradigms with epidermal hyperplasia, flattening of rete ridges and with regenerative granulation tissue expanding the superficial and papillary dermis. CONCLUSIONS: This study demonstrates modestly reduced depth of the thermal effect, greater skin tissue contraction and similarity of acute and chronic histopathological findings for helium plasma when compared with nitrogen plasma in a porcine animal model. © 2019 The Authors. Lasers in Surgery and Medicine published by Wiley Periodicals, Inc.

Contemporary Laser and Light-Based Rejuvenation Techniques.

Laser and light skin rejuvenation have changed dramatically in the last 10 years. CO2 and erbium:YAG remain the main wavelengths, but fractional, nonablative, and combination devices have been added. For those patients with lighter skin types and extensive photodamage and rhytids, full-field ablative laser resurfacing remains the procedure of choice. For those seeking less downtime and risks, fractional devices offer an excellent and growing alternative, although multiple treatments may be required for optimal results. A new generation of hybrid and nonablative devices offers many advantages, yet many of these results may be duplicated with well-proven intense pulsed light.

Laser-assisted facelift.

A variety of factors influence successful face and neck lift outcomes. Limited incision and/or dissection approaches as well as more traditional approaches impose certain limitations on surgeons' ability to effectively manage lower facial fullness and jowl ptosis. Laser-assisted facial contouring using a thermally confined 1,444 nm Nd:YAG micropulsed interstitial fiber laser enables precision volumetric reduction and shaping of lower facial fullness; the closed technique also predissects and facilitates greater vertical repositioning of an extended facelift flap. Use of the thermally confined 1,444 nm Nd:YAG micropulsed interstitial fiber laser in the neck (laser-assisted neck contouring) brings a similar benefit in predissecting, debulking, and shaping the neck and also significantly impacts surgical management of the platysma. This article focuses on methodology and benefits as well as limitations and complications of the laser-assisted facelift.

Thermally confined micropulsed 1444-nm Nd:YAG interstitial fiber laser in the aging face and neck: an update.

This article provides an update on the contemporary use of the thermally confined micropulsed 1444-nm Nd:YAG interstitial fiber laser in the aging face and neck. Beginning with the concept that the use of Nd:YAG fiber lasers in aesthetic surgery is no longer limited to laser lipolysis, the article also covers the differentiating characteristics of the available Nd:YAG fiber laser wavelengths and laser tissue interaction and safety considerations when incorporating the use of these lasers into aging face surgery.

Ablation efficiency and relative thermal confinement measurements using wavelengths 1,064, 1,320, and 1,444 nm for laser-assisted lipolysis.

Laser-assisted lipolysis is routinely used for contouring the body and the neck while modifications of the technique have recently been advocated for facial contouring. In this study, wavelength-dependence measurements of laser lipolysis effect were performed using different lasers at 1,064, 1,320, and 1,444 nm wavelengths that are currently used clinically. Fresh porcine skin with fatty tissue was used for the experiments with radiant exposure of 5-8 W with the same parameters (beam diameter = 600 µm, peak power = 200 mJ, and pulse rate = 40 Hz) for 1,064, 1,320 and 1,444 nm laser wavelengths. After laser irradiation, ablation crater depth and width and tissue mass loss were measured using spectral optical coherence tomography and a micro-analytical balance, respectively. In addition, thermal temporal monitoring was performed with a thermal imaging camera placed over ex vivo porcine fat tissue; temperature changes were recorded for each wavelength. This study demonstrated greatest ablation crater depth and width and mass removal in fatty tissue at the 1,444 nm wavelength followed by, in order, 1,320 and 1,064 nm. In the evaluation of heat distribution at different wavelengths, reduced heat diffusion was observed at 1,444 nm. The ablation efficiency was found to be dependent upon wavelength, and the 1,444 nm wavelength was found to provide both the highest efficiency for fatty tissue ablation and the greatest thermal confinement.

Versatility of erbium YAG laser: from fractional skin rejuvenation to full-field skin resurfacing.

For the laser surgeon, the Er-YAG laser is an invaluable tool that delivers unsurpassed ablation efficiency, and with appropriate functionality (quasi long-pulse feature) provides sufficient tissue coagulation to remodel deep rhytids. As such, the 2940-nm wavelength is well suited for routine laser skin rejuvenation in full-field, fractional, and point-beam modes with additional benefits, including applicability to diverse skin types, short healing times, and a low likelihood of energy-related complications.

Laser-assisted facial contouring using a thermally confined 1444-nm Nd-YAG laser: a new paradigm for facial sculpting and rejuvenation.

The micropulsed 1444-nm neodymium-doped lipolysis laser exhibits favorable characteristics for novel application in facial contouring. The study described herein is the first clinical report of laser-assisted facial contouring (LAFC). We retrospectively reviewed records of 478 LAFC patients (mean age 52) who underwent contouring of 1278 individual mid- and lower facial treatment sites over 18 months. Along with clinical assessment, study parameters evaluated among "original" and "modified" (where protocol updates included deep dermal soft tissue coagulation as an optional step) protocol groups included laser power, pulse energy, and total energy delivery as well as lipoaspirate volume at each treatment site. Mean power and pulse energy were similar (within 5%) and total energy use was greater (70% higher for mid- and lower face) in the original protocol group. Lipoaspirate volume was similar for both groups for the midface (within 10%) but elevated in the modified protocol group for the lower face (40% higher). Treatment complications were observed in 47 of 363 treatment sites (13%) in the original and in 12 of 915 treatment sites (1%) in the modified protocol group with the majority (63%) of the complications comprising over- versus undercorrections of desired tissue contour. Clinical efficacy varied with improvements of mid- and/or lower facial contour ranging from marginal to subtle to very apparent. LAFC as detailed herein is a novel treatment modality that enables selective soft tissue removal for greater precision in three-dimensional contouring of the face. Protocol modifications based on laboratory and observed tissue photothermodynamics have improved LAFC safety.

Self-assessment of cancer competencies and physician assistant cancer education: instrument development and baseline testing.

PURPOSE: Although the benefits of primary and secondary prevention of cancer are well recognized among health care providers, insufficient knowledge or skill often leads to inadequate assessment and management, particularly in the primary care setting. The scant literature on physician assistant (PA) cancer-related competencies suggests that PAs may not be well-prepared in this arena. Thus, curriculum reform in PA education is paramount for improving PAs' abilities to provide cancer risk assessment and management services. The Physician Assistant Cancer Education (PACE) project was designed for such a purpose. Following instrument development, baseline measurement of perceived abilities for cancer-related core competencies was assessed in a representative cohort of PA students. METHODS: Literature search strategies, expert review, and a nationwide survey of PA program directors yielded the 26-item Competencies in Cancer Assessment and Management (C-CAM) instrument. Baseline self-efficacy data were gathered from students across eight PACE-affiliated PA programs. Statistical analysis focused upon instrument quality and comparisons of reported self-efficacy among respondent cohorts. RESULTS: Data were collected from 544 PA students. Overall instrument reliability was excellent (Chronbach's alpha 0.97). Exploratory factor analysis identified three factors explaining 72.83% of response variance. Mean values varied somewhat across institutional cohorts. Clinical students demonstrated higher self-efficacy than preclinical students. CONCLUSIONS: The C-CAM is an effective instrument to assess PA student self-efficacy in cancer prevention, risk assessment, and risk management competencies. Although a trend toward higher self-efficacy was observed among clinical students, further research is required to assess the extent to which reported self-efficacy may be expected to change over time.

Development and implementation of a health behavioral counseling curriculum for physician assistant cancer education.

A health behavioral counseling curriculum grounded in Motivational Interviewing and the Transtheoretical Model of behavior change was developed to enhance knowledge and clinical skill among physician assistant (PA) students in managing cancer risk behaviors. A literature and curriculum review informed course content, teaching strategies, and learning activities. The course was evaluated over two pilot years. Students demonstrated increased knowledge and skills regarding the basic principles of the intervention models. The course was integrated into the pre-clinical year of PA training and will be disseminated, beginning with a faculty development workshop for all PA training programs in Texas, USA.

Facelift adjunctive techniques: skin resurfacing and volumetric contouring.

Optimizing outcomes for rhytidectomy patients involves careful evaluation for conditions likely to benefit from adjunctive facial contouring and/or skin resurfacing procedures. On an individual basis, concurrent procedures should be performed only if benefits far outweigh any added risk and patient safety is not compromised. In this manner, physicians may improve practice productivity and overall patient satisfaction.

Nitrogen plasma skin regeneration and aesthetic facial surgery: multicenter evaluation of concurrent treatment.

OBJECTIVE: To evaluate the safety and efficacy of aesthetic facial surgery with concurrent nitrogen plasma skin regeneration. METHODS: During a 28-month period, we independently completed 272 concurrent procedures in 95 patients aged 42 to 80 years in whom nitrogen plasma skin regeneration was performed immediately on completion of various aesthetic procedures, including brow-lift, blepharoplasty, lateral canthoplasty, midface-lift, rhytidectomy, cheek augmentation, lip vermillion advancement, filler injections, and augmentation mentoplasty. The treatment variables evaluated included nitrogen plasma pulse energy, pass number, and pulse count, and outcomes monitored included complications and subjective aesthetic improvement. RESULTS: The various treatment combinations were well tolerated at all anatomical sites. Rhytidectomy flap treatment included escalation of single-pass low-energy to high-energy nitrogen plasma treatment. Although perioperative complications did not otherwise negatively affect results, they included erythema with acneiform eruption (in 2 patients) and presumed herpes simplex virus infection, brief healing delay, and postinflammatory hyperpigmentation (in 1 patient each). In general, the treatment combinations were synergistic. CONCLUSIONS: Combining nitrogen plasma skin regeneration with aesthetic facial surgery enhances outcomes for procedures in the forehead and in the periorbital, midface, and perioral regions. It does not seem to increase the risk of dermatologic or surgical complications for the procedures described herein.

Educating physician assistants as agents in cancer control: issues and opportunities.

BACKGROUND: Lifestyle factors (eg, smoking, diet) and compliance with screening recommendations play a role in cancer risk, and emerging technologies (eg, new vaccines, genetic testing) hold promise for improved risk management. METHODS: However, optimal outcomes from cancer control efforts require better preparation of health professionals in risk assessment, risk communication, and implementing health behavioral change strategies that are vitally important to cancer control. RESULTS AND CONCLUSION: Although physician assistants (PAs) are substantively engaged in cancer-related service delivery in primary care settings, few models exist to facilitate integration of cancer control learning experiences into the curricula used in intense, fast-paced, 24- to 30-month PA training programs.

A qualitative assessment of systematic instructional design training by CLS faculty members.

OBJECTIVE: To determine the perceived value clinical laboratory science (CLS) faculty members gave to their participation in workshops on the use of a modified systematic instruction design (SID) model to develop curriculum and on-line courses. DESIGN: A survey assessing the perceived value of SID training was sent to 27 CLS faculty members. The survey asked the respondents to assess the value of the training that they received in developing their skills in Web-based, distance learning course development and teaching, and expanding their skills in traditional course development and teaching. The eight components of SID were listed and the respondents rated each component as to its value to them on a 5-point Likert scale of 5 = very valuable to 1 = not very valuable. In addition to rating the value of each SID component, the respondents were asked if they would like more training in any of the eight components. RESULTS: A majority of the 18 respondents (67%) reported that the training in SID was valuable to them. A strong majority of the respondents indicated that their training in goal and instructional analyses (96%), media selection (94%), and aligning objectives, assessments, and instructional strategies (94%) were valuable to their distance education programs and their traditional teaching skills. CONCLUSION: Faculty members who actively participated in SID training valued their new skills in developing distance education courses as well as improving their traditional teaching activities. Research is needed on the effect these new teaching skills have on student learning.

Differential effects of messages for breast and cervical cancer screening.

The aim of this study was to compare responses to two interventions (personalized-form [PF] letter messages versus personalized-tailored [PT] letter messages) using medical record data for promoting appointment scheduling and screening for breast and cervical cancer among urban low-income women from three ethnic groups: African-American, Mexican-American, and non-Hispanic white women. The 1,574 women participating in the randomized controlled trial were assigned to one of three groups: (1) PF letter, (2) PT letter, (3) control (no letter). Logistic regression analyses show that (1) personalized-tailored letters containing individualized references to recipients' cancer risk factors failed to increase rates of recommended cancer screening behaviors, especially among non-Hispanic white women; and that (2) in contrast, a personalized-form letter with general breast and cervical cancer screening messages increased cancer screening rates in this population, especially among non-Hispanic white and Mexican-American women.

Aesthetic facial surgery of male patients: demographics and market trends.

Evaluation of member survey data from the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) and the American Society for Aesthetic Plastic Surgery (ASAPS) from 2000 through 2004 reveals several procedure-specific as well as overall trends regarding utilization of aesthetic facial enhancement services. This gender-specific 5-year retrospective review indicates that males undergo significantly fewer procedures than females except for surgical hair restoration and otoplasty. There is a slight general trend toward decreased surgical but increased nonsurgical facial enhancement procedures. On a case per physician basis, AAFPRS physicians performed significantly more procedures for both males and females for every procedure and every year evaluated. Evaluation of age group data indicates that the 40- to 59-year-old age group accounts for the majority of surgical and non surgical facial enhancement requests. Despite anticipated growth of the 60- to 79-year-old age group, the 40- to 59-year-old age group is projected to remain relatively stable. Although continuing to pursue aesthetic facial enhancement services in significant numbers, men still represent a vast untapped market. This study yields important demographic and trend information that has implications for the current and future delivery of aesthetic facial enhancement services.

Tailored messages for breast and cervical cancer screening of low-income and minority women using medical records data.

Barriers to screening and early detection often result in cancers in low-income and minority women diagnosed at stages too advanced for optimal treatment. This randomized controlled trial examined whether a personalized form (PF) letter containing generic cancer information and a personalized tailored (PT) letter containing minimally tailored individualized risk factor information based on medical records data affected breast and cervical cancer screening among 1574 urban low-income and minority women. The personalized form-letter group was significantly more likely to schedule a screening appointment and to have undergone a Pap test and mammography within 1 year after the intervention than were the tailored letter and control groups (P<0.001 for all comparisons). Personalized tailored letters that contain individualized cancer risk factor information may decrease the likelihood of receiving cancer screening among medically underserved low-income and minority women, but personalized form letters that contain generic cancer information may improve these rates in this disadvantaged population.