Use of Neuromuscular Electrical Stimulation for Abdominal and Quadriceps Muscle Strengthening: A Randomized Controlled Trial.

BACKGROUND: Radiographic imaging has demonstrated muscle hypertrophy after treatment with noninvasive body contouring devices that target skeletal muscles. OBJECTIVE: This pilot study sought to evaluate whether increased muscle mass translated to improved functional strength and endurance. METHODS: A prospective, single-center, randomized open-label controlled study included 26 subjects randomized into 3 groups: 2 treatment groups and 1 control group. Both treatment groups received 4 neuromuscular electrical stimulation (NMES) treatments over a 2-week period. Muscle performance testing was conducted at baseline and 2-week and 4-week posttreatment. Anthropometric measurements were assessed at baseline and at 4-week posttreatment. Study participants completed subject satisfaction surveys and a personal experience assessment. RESULTS: Treatment with NMES resulted in statistically significant improvements in abdominal and quadriceps strength and endurance from baseline through 4-week posttreatment. Mean waist circumference decreased and quadriceps circumference increased, both nonsignificantly. Subject satisfaction regarding abdominal and quadriceps strength was reported as "satisfied or very satisfied" in 89% and 92% at 4-week and 8-week posttreatment, respectively. CONCLUSION: Treatment of the abdomen and quadriceps with NMES leads to significant improvements in muscular strength and endurance.

Safety of Laser-Assisted Delivery of Topical Poly-L-Lactic Acid in the Treatment of Upper Lip Rhytides: A Prospective, Rater-Blinded Study.

BACKGROUND: Perioral rhytides are a common complaint among dermatologic patients and can be notoriously stubborn and resistant to therapy. OBJECTIVE: We aimed to assess the safety of fractional ablative laser-assisted delivery of topical poly-L-lactic acid (PLLA) suspension in the treatment of upper cutaneous lip rhytides. MATERIALS AND METHODS: Prospective, single-arm, rater-blinded trial. Ten subjects with moderate to severe upper lip rhytides underwent 3 bimonthly treatments of low-density fractional carbon dioxide laser followed by topical application of PLLA suspension. Wrinkle severity before and after treatment was analyzed using computer-generated analyses. Blinded raters and subjects assessed improvement of wrinkles after treatment using the Global Aesthetic Improvement Scale (GAIS) (scores ranging from -3 to 3). Adverse events were recorded at each visit. RESULTS: Treatments were well tolerated. Other than expected post-laser erythema, no unanticipated adverse events were noted. After 3 treatments, the severity of upper lip wrinkles decreased by an average of 47% (p < .05) as calculated by computer-generated image analyses. Blinded raters and subjects rated wrinkles as much improved after 3 treatments (score of 2 on the GAIS). CONCLUSION: Laser-assisted delivery of PLLA is a safe and possibly effective treatment for upper lip rhytides.

Nonthermal Pulsed Ultrasound Treatment for the Reduction in Abdominal Fat: A Pilot Study.

Objective: Noninvasive fat reduction has become increasingly popular. This study evaluated the outcomes of multiple treatments with a nonthermal focused ultrasound device for the noninvasive removal of excess abdominal fat. Design: Participants underwent a total of three pulsed, focused ultrasound treatments spaced two weeks apart. Setting: This study took place in an outpatient dermatology office in a suburb of a major city. Participants: Ten healthy female subjects between 18 and 60 years of age with an abdominal thickness of at least 0.6cm and body mass index between 22 and 30kg/m2 were included. Measurements: Fat layer thickness was measured by ultrasound imaging and skin caliper and was compared with baseline at the four-, eight-, and 12-week follow-up visits after the final treatment session. Results: The study subjects underwent a total of 30 treatment sessions. Ultrasound imaging of the targeted fat layer decreased significantly by 13, 16, and 13 percent at the four-, eight-, and 12-week follow-up time points, respectively, while measurements of the fat layer as performed by skin caliper decreased by 12, 10, and 13 percent, respectively. All subjects noted improvement, while investigators noted significant improvement and expressed high satisfaction from the ultrasound treatment outcomes at the final visit. Treatments were well tolerated and no adverse events were recorded during the study period. Conclusion: Nonthermal pulsed focused ultrasound appears to be a safe and effective treatment option for the noninvasive removal of unwanted abdominal fat deposits. ClinicalTrials.gov: NCT02700152.

Picosecond laser with specialized optic for facial rejuvenation using a compressed treatment interval.

Studies using a 755 nm picosecond laser with a focus lens array have been reported to be effective for facial wrinkles and pigmentation. This study reports the safety and efficacy using a shorter interval of 2-3 weeks between treatments. Nineteen female subjects and one male subject, primarily Fitzpatrick skin types II and III (one skin type I), who had mild to moderate wrinkles and sun-induced pigmentation were enrolled and treated using the 755 nm PicoSure Laser with focus lens array. The skin was cleansed then wiped with an alcohol wipe prior to treatment. Lidocaine 30% ointment and/or forced air cooling could be used to increase subject comfort. Adjacent pulses, with minimal overlap (10% or less), were delivered to the full face. Subjects received four treatments, performed at 2-3-week intervals. The laser energy used was 0.71 J/cm2 . The physician administered 3-7 passes with an average total of 6,253 pulses per treatment. Follow-up visits occurred at 1 and 3 months post-last treatment at which the physician scored satisfaction and improvement and subjects scored satisfaction and likelihood to recommend to others. The most common side effects were mild swelling, pain, redness, and crusting, most of which subsided within hours of the treatment, with the latest resolving within 48 hours. This is similar to a previous reported study (Weiss et al. ASLMS 2015) where treatments were performed every 6 weeks with side effects resolving within 24 hours. At the 1 and 3 month follow-up visits, 94% (n = 19) and 93% (n = 15) of subjects scored themselves as satisfied or extremely satisfied with their overall results and 81% and 93% were likely to recommend the treatment based on global assessment, respectively. The treating physician was satisfied with 93% of subject's overall results. Three blinded evaluators were able to correctly identify the baseline from post-treatment photographs in 77% of the subjects at the 1 month follow-up and 69% of the subjects at the 3 month follow-up, on average. The average treatment pain score was 4.2 on a 1-10 scale. A compressed treatment interval expedites results without increasing side effects and resulted in a high physician and subject satisfaction rate. Lasers Surg. Med. 48:723-726, 2016. © 2016 Wiley Periodicals, Inc.

Evaluating facial pores and skin texture after low-energy nonablative fractional 1440-nm laser treatments.

BACKGROUND: The fractionated nonablative 1440-nm laser creates microscopic thermal wounds within the epidermis and the dermis and is used clinically to improve tone, texture, and color of skin. OBJECTIVE: We sought to investigate the use of this device to treat facial pores and to improve skin texture. METHODS: Twenty patients received 6 treatments at the highest tolerable energy level performed 2 weeks apart. Photographic assessments using the VISIA-CR (Canfield Scientific Inc, Fairfield, NJ) imaging system were performed. The pore score was calculated, which is the percentage of the skin surface that has detected pores. Subjective measurements (0-4 scale) were recorded by both the subject and investigator regarding pore appearance, skin texture, and overall skin appearance. Treatment discomfort was scored by patients (1-10 scale). RESULTS: After 6 treatments there was a significant reduction in pore score (P < .002). Total average pore score at baseline was 2.059 ± 0.8 and 2 weeks after the final treatment it was 1.700 ± 0.8, resulting in a 17% average reduction in pore score. Study investigators reported average scores being 1.95 ± 0.3 for improved pore appearance and 2.75 ± 0.2 for improved overall appearance (0-4 scale). Subjects noted average scores of 1.9 ± 0.5 for improvement of the appearance of pores and 2.85 ± 0.4 for improvement of overall appearance (0-4 scale). The average discomfort score during treatments was reported to be 4.6 ± 0.1 (1-10 scale). There were no serious adverse effects or long-term side effects. LIMITATIONS: Small sample size and limited follow-up are study limitations. CONCLUSIONS: A series of treatments with the nonablative low-energy fractional 1440-nm laser appears to be safe and effective for reducing detectable pores and improving overall skin appearance.

Treatment of tattoos with a picosecond alexandrite laser: a prospective trial.

OBJECTIVE To study a picosecond 755-nm alexandrite laser for the removal of tattoos to confirm the efficacy of this therapy, focusing on the effect of therapy on the target lesion as well as the surrounding tissues and quantifying the number of necessary treatments. DESIGN Fifteen patients with tattoos were enrolled. Treatments were scheduled approximately 6 ± 2 weeks apart. Standard photographs using 2-dimensional imaging were taken at baseline, before each treatment, and 1 month and 3 months after the last treatment. SETTING Dermatology clinic at SkinCare Physicians in Chestnut Hill, Massachusetts. PATIENTS Fifteen patients with darkly pigmented tattoos. MAIN OUTCOME MEASURES Treatment efficacy was assessed by the level of tattoo clearance in standard photographs. These photographs were assessed by a blinded physician evaluator and based on a 4-point scale. Efficacy was also assessed based on physician and patient satisfaction measured on a 4-point scale. RESULTS Twelve of 15 patients with tattoos (80%) completed the study. All 12 patients obtained greater than 75% clearance. Nine patients (75%) obtained greater than 75% clearance after having 2 to 4 treatments. The average number of treatment sessions needed to obtain this level of clearance was 4.25. All 12 patients (100%) were satisfied or extremely satisfied with the treatment. Adverse effects included pain, swelling, and blistering. Pain resolved immediately after therapy, while the swelling and blistering resolved within 1 week. Hypopigmentation and hyperpigmentation were reported at the 3-month follow-up. CONCLUSION The picosecond 755-nm alexandrite laser is a safe and very effective procedure for removing tattoo pigment.