Comparing Cosmetic Outcomes of Straight-Line Versus W-Plasty Techniques for Linear Postauricular Wound Closure: A Randomized Evaluator Blind Split-Scar Trial.

BACKGROUND: Surgeons' opinions vary on the cosmetic outcome of straight-line (SL) versus broken-line (W-plasty) closure methods. To date, no studies have compared the 2 techniques in the split-scar design model that resolves the confounding individual patient factors that affects the scar outcome. OBJECTIVE: Compare outcomes and wound cosmesis with SL versus W-plasty closure techniques. METHODS: This clinical trial was conducted with 50 linear surgical wounds randomized to SL closure on half and W-plasty on the other half. At 3 months, patients and 2 masked observers evaluated each scar using the Patient and Observer Scar Assessment Scale (Patient Observer Scar Assessment Scale [POSAS]). RESULTS: The mean (SD) sum of the POSAS observer component scores were 16.6 (6.18) for the SL side and 15.5 (6.37) for the W-plasty side ( p = .49). The mean (SD) sum of the POSAS patient scores were 14.4 (6.8) in SL and 15.1 (8.2) in W-plasty ( p = .59). The mean (SD) complications were 0.08 (0.06) for SL and 0.02 (0.14) for W-plasty ( p = .18). CONCLUSION: No statistically significant difference in wound cosmesis or complications was noted between SL versus W-plasty closure techniques. Surgeons may want to consider whether the extra time involved in placing zigzag W-plasty lines is worthwhile.

Clinical evaluation of the safety and efficacy of a 1060 nm diode laser for non-invasive fat reduction of the flanks.

BACKGROUND: Laser hyperthermia-induced lipolysis is a non-invasive method of localized fat treatment. Non-invasive approaches could be an option for a growing number of patients who are risk-averse and are seeking out non-invasive alternatives to surgical procedures such as liposuction. This study evaluated the safety and efficacy of a 1060 nm diode laser for the non-invasive fat reduction of the flanks. METHODS: A total of 30 subjects were enrolled in this prospective, single center study. Subjects received one 25-min treatment with a 1060 nm diode laser to both flanks. Follow-up visits were conducted at 6 and 12 weeks after the last treatment. Ultrasound adipose thickness, body weight, and circumference measurements were taken at baseline and at the 6- and 12-week follow-up visits. Subject satisfaction was assessed using a self-assessment of fat reduction, pain, and tolerability scales, and a subject satisfaction questionnaire. Safety was assessed via the presence or absence of any adverse events. RESULTS: The average age of subjects was 47.3 years. A total of 27 subjects completed the treatment and returned for both follow-up visits. An adipose reduction of 7.57 ± 1.15% at 6 weeks post-treatment (p < 0.0001) was measured using ultrasound. High subject satisfaction was seen, with 74% of subjects reporting being either "satisfied" or "very satisfied" with their results on a 5-point Likert Scale. Eighty-two percent of subjects stated they would recommend the treatment to their friends. All subjects had either mild or moderate pain, with 52% of subjects rating their pain as "mild" (1-3), while 48% rated their pain as moderate (4-7) on the Wong-Baker Scale. CONCLUSIONS: A single treatment with a 1060 nm diode laser was both safe and effective in reducing unwanted fat in the flanks without any unanticipated adverse events. Subjects described their treatment pain as mild or moderate and were highly satisfied with their treatment outcomes.

Clinical evaluation of the safety and efficacy of a 1064 nm diode laser, and vacuum assisted pulsed electromagnetic fields and multipolar radio frequency for noninvasive fat reduction of the abdomen and flanks.

BACKGROUND: Noninvasive cosmetic body contouring techniques are growing rapidly, and noninvasive lipolysis has been shown to have low pain, little downtime and produce consistent long-term results. The objective of this study was to evaluate the safety and efficacy of a 1064 nm diode laser combined with vacuum assisted PEMF and RF energies for noninvasive fat reduction of the abdomen and flanks. METHODS: Subjects received a series of three treatments 8 weeks apart, each consisting of a diode laser session, followed by vacuum assisted PEMF and RF. Before and after photographs were graded for overall fat reduction by three blinded evaluators. Ultrasound was used to measure changes in the thickness of adipose tissue. Subject satisfaction was assessed using the 5-Point Likert Subject Satisfaction Scale and a subject questionnaire at 16 and 24-week follow-up visits. Throughout each treatment, the subjects were given the Wong-Baker Faces Pain Rating Scale (WBFS) to assess discomfort and pain of the treatment. RESULTS: Thirty-nine subjects (average age 48.6 years) from four clinical sites were enrolled. Evaluators identified the correct before and after images 73.1% of the time and images were graded an average score of 1.12 (SE 0.1) correlating to more than a "slight change." Adipose tissue was reduced by 31.9% based on ultrasound measurements (p < 0.001). Subject satisfaction was high with an average satisfaction score of 7.8 ("satisfied") out of 10. The overall pain over time on average was rated "hurts little bit." Ninety percent of subjects reported either a mild, moderate, or significant improvement in their fat reduction and skin surface appearance. Almost 77% (76.7%) of subjects reported that they would recommend the treatment to a friend. There were six reports of adverse events related to the device during the study that were all transient and resolved rapidly. CONCLUSION: A significant reduction of subcutaneous adipose tissue was measured after treatment with a combination of diode laser and vacuum assisted PEMF and RF. Treatment pain was low and tolerable, and subjects had high levels of satisfaction with the results.

Clinical Evaluation of Fractional Radiofrequency for the Treatment and Reduction of Wrinkles: A Prospective Study.

BACKGROUND: Fractional radiofrequency (FRF) technology has been shown in clinical studies to improve skin laxity, and to treat various skin conditions related to aging and alternate collagen structures such as rhytids. The objective of this clinical study was to evaluate the safety and performance of FRF (up to 124 mJ per pin) for the treatment of facial rhytids, emphasizing the upper lip and perioral areas. METHODS: Enrolled subjects received a series of 3 FRF treatments to the full face, 3 to 5 weeks apart. Immediately after treatment, the subjects were given a scale to assess pain and tolerability of the treatment. Subject satisfaction questionnaires were completed at follow-up visits at 6 and 12 weeks post final treatment. Before and after photographs were graded for change by three blinded evaluators using the Fitzpatrick Wrinkle and Elastosis Scale (FWES) and the Global Aesthetic Improvement Scale (GAIS). RESULTS: Image sets of 10 enrolled subjects (average age 62.7 years) were assessed by blinded evaluators. The overall face FWES score improved from 5.97 (SE 0.20) at baseline to 5.78 (SE 0.22) at 12-week follow-up. The GAIS improved by 0.4 points and was significant compared to baseline (P = 0.0004). Subject satisfaction was high with subjects giving an average satisfaction score of 3.2 (“satisfied”) out of 4. Pain was rated “mild to moderate” with an average of 3.9 on a 11-point Wong Baker FACES Scale. Ninety percent (90%) of subjects reported either a mild, moderate, or significant improvement to their treatment area. Eighty percent (80%) of subjects reported that they would recommend the treatment to a friend. There were no reports of adverse events or unanticipated side effects during the duration of the study. CONCLUSION: A statistically significant reduction in rhytids of the upper lip and the perioral area, was found, as evaluated by independent blinded evaluators. There were no adverse events. Treatment pain was low and tolerable, and subjects had high levels of satisfaction with the results at last follow-up. J Drugs Dermatol. 2022;21(1):43-48. doi:10.36849/JDD.6492.

Aesthetic outcome of simple cuticular suture distance from the wound edge on the closure of linear wounds on the head and neck: A randomized evaluator blinded split-wound comparative effect trial.

BACKGROUND: Little data support the optimal distance of cuticular suture placement from the wound edge to achieve the most cosmetically appealing scar. OBJECTIVE: To compare Patient and Observer Scar Assessment Scale (POSAS) scores for cutaneous sutures spaced 2 mm versus 5 mm from the wound edge in head and neck defects repaired via linear closure. METHODS: Fifty patients were enrolled in this randomized, evaluator blinded, split-scar study. Surgical wounds were repaired with cuticular sutures 2 mm from the wound edge on one side and 5 mm on the other. POSAS scores and scar width were compared 3 months postoperatively. RESULTS: The sum observer POSAS score for this study had a mean (SD) of 16.06 (6.49) on the 2-mm side and 15.82 (6.83) on the 5-mm side (P = .807). Similarly, no difference was seen between scar width with a mean (SD) of 0.100 cm (0.058 cm) on the 2-mm side and with mean (SD) 0.100 cm (0.076 cm) on the 5-mm side (P = .967). LIMITATIONS: Linear repairs were studied on head and neck defects after extirpation of cutaneous malignancies, resulting in a homogeneous elderly white patient population. CONCLUSION: Cuticular sutures placed 2 or 5 mm from the wound edge did not result in different cosmetic outcomes in linear closures on the head and neck.

Clinical Evaluation of the Safety and Efficacy of a 1060-nm Diode Laser for Non-Invasive Fat Reduction of the Abdomen.

BACKGROUND: Despite the proven efficacy of liposuction, there is a population of patients who prefer non-surgical alternatives. Laser hyperthermia-induced lipolysis has emerged as one non-invasive alternative to liposuction. OBJECTIVES: The authors sought to evaluate the safety and efficacy of a 1060-nm (±10 nm) diode laser for non-invasive fat reduction of the abdomen. METHODS: This single-arm, 2-center study enrolled 30 patients. Patients received a 25-minute 1060-nm diode laser treatment on their abdomen. Ultrasound adipose measurements, body weight, and circumference were taken at baseline and at 6- and 12-week follow-up visits. Blinded evaluators identified "before" and "after" photos of each patient. A patient satisfaction questionnaire was completed by each patient at study exit. RESULTS: A total 29 patients completed all treatment and follow-up visits. Ultrasound images showed an adipose reduction of 8.55% at 12 weeks post-treatment (P < 0.0001). Blinded evaluators correctly identified 67% of the pre- and post-treatment images at site 01 (Sacramento, CA) and 56% at site 02 (Dallas, TX). Satisfaction was high, with 72% of patients reporting being either "satisfied" or "very satisfied" with their results on a 5-point Likert scale. Pain was rated as mild by 62% of patients, moderate by 38%, and severe by none on the Wong-Baker Scale. CONCLUSIONS: These results indicate that a single treatment with a 1060-nm (±10 nm) diode laser, per the treatment protocol, is safe and effective in reducing unwanted fat in the abdomen as objectively measured employing ultrasound. The treatment was well-tolerated among all patients, with minimal discomfort reported and high patient satisfaction.

Treatment of Moderate-to-severe Facial Acne Vulgaris with Solid-state Fractional 589/1,319-nm Laser.

Objective: The objectives of this study were to evaluate the efficacy, safety and patient satisfaction of a unique combination of wavelengths 589nm and 1,319nm for the treatment of facial acne vulgaris. Design: This was a small, randomized, prospective, split-face, single-blinded study of patients with moderate-to-severe acne vulgaris. Setting: The study took place at a single outpatient center study in Torrance, California. Participants: Nine patients underwent four treatment sessions at 2- to 3-week intervals. Each patient received one pass with the 1,319nm laser followed by one pass with the 589nm laser only to the randomized treatment side of the face. Measurements: A blinded, board-certified dermatologist reviewed photographs and counted acne lesions on treated and nontreated sides. Results: Of the nine patients, eight were Fitzpatrick Skin Type IV. At the final visit, inflammatory acne lesions were reduced by 2.5 (-23.1%) on the treatment side and increased by 1.1 (+11.1%) on the control side. No patients experienced bruising, edema, hyperpigmentation or scarring. At the conclusion of the study, 77.8 percent of the patients reported overall satisfaction. Conclusion: This unique combination of lasers appears to be safe in patients with Fitzpatrick Skin Type IV, and might be useful in treating moderate-to-severe acne vulgaris.