Microneedling-Associated Procedures to Enhance Facial Rejuvenation.

Microneedling, also referred to as percutaneous collagen induction therapy, uses small needles to create mechanical injury to the skin, stimulating the wound-healing cascade and new collagen formation. Compared with other skin resurfacing techniques, microneedling preserves the epidermis and is nonablative, therefore reducing inflammation, downtime, and risk of dyspigmentation. In addition to increasing collagen production in fibroblasts, microneedling also helps normalize cell function of keratinocytes and melanocytes and can be used to increase absorption of topical medications, growth factors, or deliver radiofrequency directly to the dermis. The benefits of microneedling, associated procedures, indications for use, technical considerations, and potential complications are discussed.

Microneedling-Associated Procedures to Enhance Facial Rejuvenation.

Microneedling, also referred to as percutaneous collagen induction therapy, uses small needles to create mechanical injury to the skin, stimulating the wound-healing cascade and new collagen formation. Compared with other skin resurfacing techniques, microneedling preserves the epidermis and is nonablative, therefore reducing inflammation, downtime, and risk of dyspigmentation. In addition to increasing collagen production in fibroblasts, microneedling also helps normalize cell function of keratinocytes and melanocytes and can be used to increase absorption of topical medications, growth factors, or deliver radiofrequency directly to the dermis. The benefits of microneedling, associated procedures, indications for use, technical considerations, and potential complications are discussed.

Pre- and Postoperative Care for Interventional Skin Rejuvenation.

Facial aging is a combination of descent of facial tissues, atrophy of fat compartments, bony remodeling, and photoaging/chronologic changes of the skin. Photoaging of the skin is clinically and histologically distinct from the genetically programmed aging process. Photoaging is due to UV-A and UV-B-generated free radicals that cause DNA mutations, structural and enzymatic protein alterations, and lipid peroxidation.

Evaluating New Technology.

There are multiple complex issues to consider when evaluating any new technology. First evaluate the efficacy of the device. Then considering your patient population decide whether this technology brings an added benefit to your patients. If it meets these 2 criteria, then proceed to the financial analysis of acquiring this technology. The complete financial analysis has several important components that include but are not limited to cost, value, alternatives, return on investment, and associated marketing expense.

Current Status of Fractional Laser Resurfacing.

Fractional lasers were first developed based on observations of lasers designed for hair transplantation. In 2007, ablative fractional laser resurfacing was introduced. The fractionation allowed deeper tissue penetration, leading to greater tissue contraction, collagen production and tissue remodeling. Since then, fractional erbium:YAG resurfacing lasers have also been introduced. These lasers have yielded excellent results in treating photoaging, acne scarring, and dyschromia. With the adjustment of microspot density, pulse duration, number of passes, and fluence, the surgeon can adjust the treatment effects. These lasers have allowed surgeons to treat patients with higher Fitzpatrick skin types (types IV to VI) and greater individualize treatments to various facial subunits. Immunohistochemical analysis has demonstrated remodeling effects of the tissues for several months, producing longer lasting results. Adjuvant treatments are also under investigation, including concomitant face-lift, product deposition, and platelet-rich plasma. Finally, there is a short recovery time from treatment with these lasers, allowing patients to resume regular activities more quickly. Although there is a relatively high safety profile for ablative fractionated lasers, surgeons should be aware of the limitations of specific treatments and the associated risks and complications.

Laser facial nerve welding in a rabbit model.

OBJECTIVE: To assess the feasibility of laser tissue welding for repair of facial nerve injury. METHODS: In a prospective in vivo animal survival surgery model, rabbit facial nerve injury was followed by either standard suture neurorrhaphy or laser tissue welding using a diode laser (808 ± 1 nm) to weld biological solder. Rabbits were evaluated at 4, 8, 12, and 16 weeks by facial videography and electromyography. Histopathological analysis of the repair was performed at 4 and 16 weeks. RESULTS: Videographic analysis demonstrated the laser tissue welding repair trended toward superior outcomes compared with suture neurorrhaphy at all 4 time points. Electrophysiological analysis demonstrated similar or better results, with statistically significant improvement at week 16 (P < .05). Histologic analysis demonstrated no difference in axon organization or extravasation between groups; however, the laser nerve repair created a greater initial inflammatory reaction. An analysis of operative time demonstrated significantly decreased time and ease of use for laser tissue welding. CONCLUSIONS: This pilot study demonstrates that laser nerve welding may be an expedient, feasible, and safe method for facial nerve repair in a rabbit model. Further experiments with larger numbers are needed to provide additional evidence that laser tissue welding produces a neurorrhaphy that has functional, electrophysiological, and histological results that could rival traditional suture neurorrhaphy.

Fractional CO(2) laser resurfacing.

Fractionated CO(2) lasers are a new treatment modality for skin resurfacing. These lasers have been shown efficacious in treating facial photoaging changes and scars. These lasers have an improved safety and recovery profile compared with traditional CO(2) laser resurfacing. Precise treatment parameters vary between patients, the pathology treated, and the details of the particular laser.

Laser treatment of cutaneous vascular tumors and malformations.

Cutaneous vascular lesions are common in both children and adults. The vast majority of these lesions respond well to laser treatment. A select few lesions may require surgical intervention. In order to choose the optimal laser treatment for a given lesion, it is important to have a thorough understanding of the available technology. This understanding includes the characteristics of each laser wavelength, pulse duration, and possible associated epidermal cooling. Furthermore, it is important to understand the specific characteristics of each individual vascular lesion. Together, laser treatment of cutaneous vascular lesions of the head and neck region can be optimized.

Laser treatment of facial scars.

PURPOSE OF REVIEW: Facial scars can develop as a result of trauma, surgery, burns, acne, or other conditions. These scars are often quite distressing to patients. Lasers were first used to treat these scars in the 1990s. Recently, new laser technology has been used to prevent and treat scars. This literature review and the report of the senior author's recent experience summarize the recent advances in laser treatment of scars. RECENT FINDINGS: With the development of new laser technology, the treatment options for hypotrophic scars and developing scars have increased. Furthermore, there are expanded options for treatment of established hypertrophic scars. Recent studies have shown that nonablative and fractionated lasers can be effective for treating hypotrophic and developing scars. Scar improvements may be due to direct effects of the laser and/or histochemical effects, including production of heat shock proteins and tumor growth factors. Nonablative and fractionated lasers have a shorter recovery period than CO2 resurfacing lasers. This can vary from a few hours to up to 7 days. SUMMARY: Recent new laser technology has increased the options for treatment of scars. These have been shown to be beneficial for hypotrophic, incipient, and established scars. The benefits of laser therapy may be due to direct and/or histochemical effects.

Laser treatment of facial scars.

Laser treatment of facial scars cannot substitute for optimal initial repair. Nonetheless, laser treatments may serve as valuable adjunct interventions after initial wound healing. Proper classification of scars into atrophic, hypertrophic, and keloid categories enables the appropriate selection of laser modality.

Financial analysis of technology acquisition using fractionated lasers as a model.

Ablative fractional lasers are among the most advanced and costly devices on the market. Yet, there is a dearth of published literature on the cost and potential return on investment (ROI) of such devices. The objective of this study was to provide a methodological framework for physicians to evaluate ROI. To facilitate this analysis, we conducted a case study on the potential ROI of eight ablative fractional lasers. In the base case analysis, a 5-year lease and a 3-year lease were assumed as the purchase option with a $0 down payment and 3-month payment deferral. In addition to lease payments, service contracts, labor cost, and disposables were included in the total cost estimate. Revenue was estimated as price per procedure multiplied by total number of procedures in a year. Sensitivity analyses were performed to account for variability in model assumptions. Based on the assumptions of the model, all lasers had higher ROI under the 5-year lease agreement compared with that for the 3-year lease agreement. When comparing results between lasers, those with lower operating and purchase cost delivered a higher ROI. Sensitivity analysis indicates the model is most sensitive to purchase method. If physicians opt to purchase the device rather than lease, they can significantly enhance ROI. ROI analysis is an important tool for physicians who are considering making an expensive device acquisition. However, physicians should not rely solely on ROI and must also consider the clinical benefits of a laser.

Laser treatment for ethnic skin.

With the growth of new technology and products over the last 10 years, there has been an increased ability to improve a patient's appearance with procedures that can be performed in an office setting, including laser procedures. Demand for these procedures has grown among all ethnic groups. Patients with ethnic skin can have varying response to lasers. This factor should be considered when planning their treatment. After laser treatment, Patients with ethnic skin are at greater risk for laser energy absorption by melanin, postinflammatory hyperpigmentation, and loss of pigment due to laser effects on melanin production leading to hypopigmentation. Therefore, any laser therapy should be planned carefully, especially in the treatment of patients with darker skin types.

Facial skin tightening with an 1100-1800 nm infrared device.

BACKGROUND/OBJECTIVES: To determine the efficacy of the 1100-1800 nm infrared device for facial and cervical skin tightening. METHODS: Ten female patients, with a mean age of 56.5 years, received two treatments 1 month apart with a chilled tip infrared device (Titan; Cutera, Brisbane, CA, USA). Individuals were examined and photographed prior to treatment and at 1 and 3 months post-treatment. Three treatment-independent evaluators compared the photographs and graded them on a standardized scale applied to seven regions subdividing the face and neck. After evaluating the photographs, the difference in pretreatment and post-treatment scores was expressed as a percentage. The patients also rated their results. RESULTS/CONCLUSION: The greatest tightening was achieved over the malar region, the upper neck and the body of the mandible. In these areas the average tightening was 10%, 10%, and 12% respectively. The patients reported a 32% improvement in the appearance of their cheeks and a 20% visible improvement in their necks. Overall, they were pleased with the result of this non-surgical skin tightening.

Is there an ideal facelift procedure?

PURPOSE OF REVIEW: The following article provides a review of the major rhytidectomy techniques in practice today. The current literature on facelift techniques generally details surgeons' methods and operative results. A few studies have compared results between methods. This review synthesizes the existing literature, incorporates the authors' experience and analysis, and addresses the considerations that should concern a surgeon in choosing the ideal facelift procedure for each patient. Additionally, operative results and modifications of the leading surgeons in the field are detailed. RECENT FINDINGS: Techniques discussed include the traditional rhytidectomy, deep-plane or composite techniques, limited incision approach (e.g. lateral SMASectomy, S-lift, MACS-lift) and suspension suture lift (e.g. APTOS, Contour Threads). SUMMARY: This article provides surgeons performing facial rejuvenation surgery with a reference for evaluating which surgical techniques to add into their repertoires and a consensus of the experts as to the indications for each procedure, from major operative procedures to techniques that can be performed in the office.

Cervical facial skin tightening with an infrared device.

Improvement of facial and cervical skin laxity has been difficult to achieve without surgical procedures. A device called the Titan, (Cutera, Inc., Brisbane, California) uses infrared light to volumetrically heat the dermis. It is designed to thermally induce collagen contraction, with subsequent collagen remodeling and neocollagen synthesis. The epidermis is protected via pre-, parallel, and post-treatment cooling. Because there is minimal to no discomfort during the procedure, no anesthesia is necessary. With this device, improvements in skin laxity and facial and neck contours have been achieved. Results can vary, however. This variation may be caused by patient selection variability and differences in technique. This article presents an effective approach to patient selection, evaluation, and treatment planning, and a detailed treatment protocol.

Evaluation of acne scar treatment with a 1450-nm midinfrared laser and 30% trichloroacetic acid peels.

OBJECTIVE: To evaluate the efficacy of treatment of established acne scars with a sequential combination of treatment using a 1450-nm, midinfrared, nonablative diode laser with dynamic cooling spray and 30% trichloroacetic acid peels. METHODS: In this prospective study 9 patients with atrophic rolling, boxcar, or both types of scars received 4 monthly treatments using a 1450-nm, midinfrared, nonablative, diode laser with dynamic cooling spray followed by 2 bimonthly treatments with 30% trichloroacetic acid peels. Blinded evaluators and the patients rated the results. RESULTS: The group of patients in this study had a greater improvement in their acne scars than has been reported for nonablative laser treatments by other authors. Comparing the results of treatment 2 months after the laser treatments with 2 months after the chemical peels, the patients had a greater improvement after the additional chemical peels. There were no complications in this study. The patients were able to continue all of their regular activities throughout the study. CONCLUSION: This sequential treatment regimen using the 1450-nm, midinfrared, nonablative diode laser with dynamic cooling spray and 30% trichloroacetic acid peels produced a noticeable improvement in the acne scars without any associated morbidity.