Novel nonablative radio-frequency rejuvenation device applied to the neck and jowls: clinical evaluation and 3-dimensional image analysis.

OBJECTIVE: To use 3D photography to evaluate the clinical efficacy of a novel radiofrequency delivery device used to improve the appearance of rhytids and laxity of the face and neck. STUDY DESIGN: Forty-nine subjects received a total of two radio-frequency treatments to the face and neck one-month apart. The novel radio-frequency delivery device was used to heat the dermis between 41-43°C for five heat cycles. Primary outcome measures were clinical efficacy quantified by the Global Assessment Improvement Scale (GAIS) and a patient survey that assessed treatment satisfaction. RESULTS: Assessments of 3D photographs revealed an overall improvement in 74% of study subjects. 85% of patients noted an overall improvement in the appearance of their skin. 81% of patients rated their post-treatment skin laxity as improved, 85% rated their skin smoothness as improved and 62% rated their skin brightness as improved. CONCLUSION: Subjects in this study demonstrated an overall improvement in face and neck appearance with regard to skin tightening, wrinkles, and skin texture suggested by overall patient satisfaction (85%) and physician-rated GAIS improvement (74%). This study suggests that radiofrequency applied with a continuous thermal treatment device is a safe and efficacious way to improve the overall appearance of aging facial skin.

Evaluation of clinical results, histological architecture, and collagen expression following treatment of mature burn scars with a fractional carbon dioxide laser.

OBJECTIVE: To assess mature burn scars treated with a fractional carbon dioxide laser for changes in histological architecture, type I to III collagen ratios, density of elastic tissue, and subjective measures of clinical improvements. DESIGN: Uncontrolled, prospective study of patients with mature burn scars, from a clinical and histological perspective. Biopsy specimens were obtained before and 2 months after 3 treatment sessions. The tissue was prepared with Verhoff von Giesen (VVG) stain to discern elastic tissue and Herovici stain to differentiate types I and III collagen. SETTING: Subjects were recruited from the Grossman Burn Centers. PARTICIPANTS: Of 18 patients with mature burn scars, 10 completed the entire treatment protocol. INTERVENTION: Participants received 3 treatments with a fractional carbon dioxide laser. MAIN OUTCOME MEASURES: Vancouver Scar Scale and Patient and Observer Scar Assessment Scale survey scores. In histological analysis, imaging software was used to measure changes in collagen subtype and elastic tissue. A rating scale was developed to assess normal vs scar architecture. RESULTS: The first hypothesis that significant histological improvement would occur and the second hypothesis of a statistically significant increase in type III collagen expression or a decrease in type I collagen expression were confirmed. There were no significant changes in elastic tissue. Statistically significant improvements were seen in all survey data. CONCLUSIONS: Treatment with a fractional carbon dioxide laser improved the appearance of mature burn scars and resulted in a significant improvement in collagen architecture following treatment. Furthermore, in treated skin specimens, a collagen subtype (types I and III collagen) profile resembling that of nonwounded skin was found.

The expression of p63 in actinic keratoses, seborrheic keratosis, and cutaneous squamous cell carcinomas.

BACKGROUND: p63 is a tumor suppressor that likely plays a role in the development of squamous cell carcinomas (SCCs) and possibly premalignant and benign skin tumors. Little data is available on its expression in these tumors. OBJECTIVE: To study the keratinocyte expression profile of p63 in 17 SCCs, 7 actinic keratoses, 2 Bowens tumors, and 7 seborrheic keratoses. METHODS: Skin tumors specimens were stained with an antibody to p63. Quantitative and qualitative data was collected on the staining. RESULTS: There was a statistically significant increase in p63 staining of SCCs when compared with normal. Seborrheic keratoses and actinic keratoses showed a trend towards increased expression in the basal layer compared with normal skin. The pattern of expression showed diffuse staining in SCCs. In actinic keratoses and seborrheic keratoses the pattern was most prominent in the basal layer. CONCLUSIONS: p63 expression is greater and different in SCCs when compared with normal skin, actinic keratoses, and seborrheic keratoses. Interestingly seborrheic keratoses and Bowens lesions showed expression that was mostly restricted to the basal layer, however significant diffuse staining was also noted. Our results support the notion that p63 plays a role in cell differentiation and tumorigenesis of skin tumors.