A Comparison Study of the Nonablative Fractional 1565-nm Er: glass and the Picosecond Fractional 1064/532-nm Nd: YAG Lasers in the Treatment of Striae Alba: A Split Body Double-Blinded Trial.

BACKGROUND: Few effective treatments exist for striae alba, which are the mature stage of stretch marks. OBJECTIVE: To evaluate the efficacy of the nonablative fractional 1,565-nm Erbium-glass (Er:glass) and the picosecond fractional 1,064/532-nm neodymium:yttrium-aluminum-garnet (Nd:YAG) lasers in the treatment of striae alba. MATERIALS AND METHODS: Twenty subjects with striae alba on the bilateral abdomen were treated with either the nonablative fractional 1565-nm Er:glass or the picosecond fractional 1,064/532-nm Nd:YAG laser, with a total of 3 treatments 3 weeks apart. RESULTS: A 31% (1.25/4) texture improvement was noted for both the fractional 1,565-nm Er:glass laser and the picosecond fractional 1,064/532-nm Nd:YAG laser. The degree of atrophy was improved by 30% (1.19/4) with the 1,565-nm Er:glass laser and 35% (1.38/4) with the picosecond 1,064/532-nm Nd:YAG laser. A 48% (1.9/4) subject overall assessment of improvement was noted with the fractional 1565-nm Er:glass laser and 45% (1.8/4) improvement with the picosecond fractional 1,064/532-nm Nd:YAG laser. There was no significant change in striae density with either laser. The picosecond laser was rated as less painful during all 3 sessions (p = .002) and had a shorter healing time (p = .035). The nonablative fractional 1,565-nm Er:glass and the picosecond fractional 1,064/532-nm Nd:YAG lasers were equally efficacious in improving striae alba.

A Single Center, Prospective, Randomized, Sham-Controlled, Double-Blinded, Split-Face Trial Using Microinjections of Transparent Hyaluronic Acid Gel for Cheek Rejuvenation.

BACKGROUND: "Skin boosting" with injections of hyaluronic acid has been demonstrated to improve aged skin. OBJECTIVE: The aim of this study was to determine the efficacy and safety of small-particle hyaluronic acid with lidocaine (SP-HAL) microaliquots for the correction of fine lines of the cheeks. MATERIALS AND METHODS: Twenty subjects with mild to moderate static mid to lower cheek rhytides were enrolled. The right or left cheek was randomized to receive 1 mL of SP-HAL using a microdroplet technique, with the contralateral cheek treated with sham injection of sterile normal saline. The degree of cheek wrinkling and elastosis based on the Fitzpatrick-Goldman Wrinkle and Elastosis Scale was assessed at baseline and 7, 14, 30, 90, and 180 days after treatment. Subjects rated their satisfaction at days 90 and 180. RESULTS: Fourteen patients completed the study. There were no statistically significant improvements in wrinkling or elastosis of the SP-HAL-treated cheek or control cheek at any time point. In addition, there were no significant differences in wrinkling, elastosis, or patient satisfaction between the treatment cheek and control cheek. CONCLUSION: One treatment of intradermal microdroplet injections of SP-HAL to the mid to lower cheek failed to show superiority over normal saline in improving clinical signs of skin wrinkling and elastosis.

Retrospective Evaluation of Topical Bimatoprost and Iris Pigmentation Change.

BACKGROUND: Topical bimatoprost is a topical prostaglandin analog originally used to treat glaucoma and more recently used to cosmetically induce hypertrichosis of the eyelashes. Iris pigmentation change has been noted in the treatment of glaucoma but has not been assessed with the cosmetic periorbital application of bimatoprost. OBJECTIVE: To evaluate for iris pigmentation change with the long-term cosmetic use of topical bimatoprost. MATERIALS AND METHODS: A retrospective chart review in a cosmetic dermatology practice of women (N = 50) who consistently purchased topical bimatoprost over an average of 4.59 years was compared with that of age-matched non-bimatoprost patients (N = 50). A blinded evaluator assessed each patient for iris pigmentary change. RESULTS: No iris pigmentation change was noted with the cutaneous application of bimatoprost. CONCLUSION: The cutaneous application of bimatoprost appears to be safe with minimal risk for iris pigmentation change.

Single Session Treatment of Rolling Acne Scars Using Tumescent Anesthesia, 20% Trichloracetic Acid Extensive Subcision, and Fractional CO2 Laser.

BACKGROUND: Successful treatment of acne scars is challenging. Many modalities have been used with marginal success. OBJECTIVE: The authors describe a combination of a superficial chemical peel, subcision, and fractional carbon dioxide (CO2) laser resurfacing in a single-treatment session as a novel treatment approach for rolling acne scars. METHODS: A total of 114 patients (75 women and 39 men) with predominantly rolling acne scars were treated with a 20% trichloracetic acid chemical peel, subcision with a novel dissecting instrument, and the CO2 laser under tumescent anesthesia. This was a retrospective, uncontrolled, unblinded study. RESULTS: The mean improvement after a single treatment was 2.9 on a scale of 1 to 4 with few complications. Ninety percent of the patients were satisfied with their final result and desired no additional treatment. CONCLUSION: The combination of a trichloracetic acid 20% chemical peel, subcision, and fractional CO2 laser resurfacing combined with tumescent anesthesia is both safe and effective in the treatment of rolling acne scars.

Optimizing Facial Rejuvenation with a Combination of a Novel Topical Serum and Injectable Procedure to Increase Patient Outcomes and Satisfaction.

BACKGROUND: Neuromodulator injection procedures are an effective treatment for moderate-to-severe facial wrinkles, but do not address the superficial fine lines and wrinkles caused by age-related loss of intrinsic hyaluronic acid levels in the epidermis. OBJECTIVE: In this study, the authors assess overall facial skin quality and patient satisfaction when combining topical treatment with the a topical cosmetic serum (HA5) and applying to the entire face following a pre-elected neuromodulator injection treatment to the lateral canthal areas. METHODS AND MATERIALS: Twenty female subjects aged 36 to 63 years with moderate-to-severe under-the-eye fine lines and/or wrinkles enrolled in the study. HA5 was applied the entire face at baseline immediately post-injection and twice daily for eight weeks. Clinical assessments were conducted at baseline; 15 minutes post-procedure; and at Weeks 2, 4, and 8. RESULTS: Statistically significant improvements were observed immediately post-procedure and after eight weeks, along with high patient satisfaction. CONCLUSION: The combination of topical serum and injectable procedure provided a rapid onset of improvements in fine lines/wrinkles appearance and skin texture and long-term overall improvements in areas not treated by the injection. These results support how this novel combination can provide physicians with a comprehensive approach to optimize patient outcomes.

Laser-Assisted Drug Delivery.

BACKGROUND: Laser-assisted drug delivery (LADD) is an evolving new therapy with many possible applications as a highly targeted customizable method for distribution of drugs within the skin. LADD offers the advantages of accessibility, noninvasiveness, compliance, safety, and effectiveness. OBJECTIVE: To review the available literature regarding LADD. METHODS: A MEDLINE search was performed on LADD from 1989 to 2015, and the results are summarized. Practical applications of these procedures are also discussed. RESULTS: Reports of the use of ablative, nonablative, and fractional lasers as a means to increase cutaneous permeation of the topical application of medications and cosmeceuticals were found. The focus of the review was to demonstrate the variety of topical treatments that have been used with the LADD method and the multitude of future studies needed to fully characterize the best application of this evolving technology. CONCLUSION: The most comprehensive review in the literature to date on LADD is provided. Further studies are needed to fully evaluate the safety, dosing, side effects, and results.

Acne Scar Treatment: A Multimodality Approach Tailored to Scar Type.

BACKGROUND: Acne scarring can be classified into atrophic icepick, boxcar, and rolling scars in addition to keloidal and hypertrophic scars. Additionally, these scars can be erythematous, hyperpigmented, and/or hypopigmented. Each scar type has a different structural cause warranting a customized approach. Many cosmetic options exist to address these changes individually, but little literature exists about the safety and efficacy of combining such procedures and devices. METHODS: A Medline search was performed on combination treatments because it relates to facial acne scarring, and results are summarized. Practical applications for these combinations of procedures are also discussed. RESULTS: Studies examining the efficacy and safety of ablative, nonablative, fractionated, and nonfractionated lasers, dermabrasion, chemical peels, needling, subcision, radiofrequency, stem cell therapy, fat transplantation, platelet-rich plasma, and hyaluronic acid dermal fillers for acne scars were found. The authors review their experience in combining these techniques. CONCLUSION: Review of the literature revealed multiple single options for facial acne scarring treatment with minimal evidence in the literature found on the safety and efficacy of combining such procedures and devices. The authors' experience is that combining acne scar treatment techniques can be performed safely and synergistically with optimal patient outcomes.