Full-face and neck resurfacing with a novel ablative fractional 2910 nm erbium-doped fluoride glass fiber laser for advanced photoaging.

OBJECTIVES: Ablative fractional lasers have long been considered the gold standard for facial resurfacing for advanced photoaging. These lasers offer an improved safety profile compared to traditional ablative lasers but typically require more treatment sessions given their fractional approach. In this study, we evaluate a new novel 2910 nm erbium-doped fluoride glass fiber laser (2910 nm fiber laser) (UltraClear; Acclaro Medical) for full-face and neck resurfacing for the treatment of advanced photoaging. METHODS: Twenty-two healthy subjects aged 44-80 years presenting for advanced facial photoaging and rhytides were enrolled in the study. All subjects received three full-face and neck, multipass treatments utilizing the 2910 nm fiber laser spaced 6-8 weeks apart. Subjects were asked to rate the average level of pain during the treatment. At 90 days following subjects' third treatment subjects evaluated their improvement using a Global Aesthetic Improvement Scale (GAIS) and rated their satisfaction with the treatment. Evaluation of pretreatment and posttreatment photos was completed by two blinded physician reviewers. Reviewers were asked to identify the pretreatment and posttreatment photographs and to rate the degree of improvement utilizing a GAIS. RESULTS: Fifteen participants completed the study; six were exited from the study (withdrew or lost to follow-up). The average subject GAIS score for overall appearance was 3.8. The average subject satisfaction level at follow-up was 4.8. The average subject pain score was 4.9. One blinded physician reviewer correctly identified 100% of subjects' posttreatment photographs, while the second blinded reviewer correctly identified 93%. Blinded evaluation of digital photographs revealed an average GAIS score of 3.2. Posttreatment skin responses included pin-point hemorrhage, erythema, edema, and soft tissue crusting lasting 5-7 days. There were no instances of infection, scarring or hypopigmentation. There were two instances of temporary hyperpigmentation. CONCLUSIONS: Treatment with the novel 2910 nm fiber laser is safe and effective in treating advanced photoaging and rhytides. Three treatments produced moderate to marked improvement with high patient satisfaction and treatment was associated with less discomfort and downtime compared to conventional fractional ablative lasers.

The 730 nm picosecond titanium sapphire laser for treatment of café-au-lait macules in all skin types.

OBJECTIVES: Café-au-lait macules (CALM) are benign birthmarks presenting as uniformly pigmented, well demarcated, brown patches that can be distressing to patients, especially when located in cosmetically sensitive areas. As with all pigmentary lesions in skin of color patients, CALMs have been particularly challenging to treat. Here we present the first case series characterizing treatment parameters and clinical outcomes utilizing the 730-nm picosecond titanium sapphire laser for the treatment of CALMs. This device provides an additional safe and effective treatment option for these challenging cases. METHODS: We performed a retrospective review of patients treated at a single institution between April 2021 and December 2023. Clinical photographs were graded by 3 outside board-certified dermatologists using a 5-point visual analog scale. RESULTS: Fourteen patients (age range: 10 months-66 years, mean age: 27.4 years, Fitzpatrick skin types II-VI) were treated for CALM on the face (11) or body (3). On average, patients received 4.3 treatments, with treatment intervals ranging from 4 to 40 weeks. Treatment remains ongoing with the 730-nm picosecond laser for eight patients. Overall, patients were rated to have a mean improvement of 26%-50%. Two patients (FST III and VI) achieved 100% clearance after 4-5 treatment sessions. Our study included four patients whose CALM were of the smooth bordered "coast of California" subtype, three of whom had a mean improvement rating of only 1%-25%. The fourth patient had near complete resolution. Follow up for these patients has ranged from 6 weeks to 1.5 years. Of the patients treated, one patient experienced transient post-inflammatory hyperpigmentation and another transient post-inflammatory hypopigmentation, while a third patient experienced mild persistent guttate hypopigmentation. Three patients experienced partial recurrence indicating that maintenance treatments may be needed in some patients. CONCLUSION: The 730-nm picosecond titanium sapphire laser is a safe and efficacious treatment option, in the right morphologic setting, to improve the cosmetic appearance of CALMs in a wide range of ages and skin types. To our knowledge, this is the first reported treatment of CALMs with picosecond lasers in FST V and VI patients. Our study also supports prior studies which have found that CALM with smooth-bordered "coast of California" morphology have a poor response to laser therapy as compared to those with jagged or ill-defined bordered "coast of Maine" morphology.

Split-face study to evaluate efficacy of global cryomodulation for reduction of pain and inflammation after nonablative fractional resurfacing.

OBJECTIVES: Cryomodulation, or the delivery of controlled cooling to downregulate inflammatory processes in the skin, has been proposed to mitigate acute side effects following various dermatologic treatments. A new controlled cooling device has been developed to deliver cryomodulation for a range of different indications. In this clinical study, we evaluate the device for the reduction of pain, erythema, and edema following nonablative fractional resurfacing (NAFR). METHODS: A single-blind, prospective, randomized, split-face study was conducted to assess the efficacy of the controlled dermal cooling device for the reduction of pain, edema, and erythema following nonablative fractional resurfacing with the dual 1550 nm erbium-doped fiber and 1927 nm thulium fiber laser. Subjects were randomized to receive a 10-min controlled cooling treatment to either the left or right side of the face immediately following full face NAFR. Pain ratings were recorded immediately postlaser treatment and immediately postcryomodulation treatment. At follow-up, subjects were surveyed for reduction of side effects and treatment satisfaction. Blinded review of photographs by two physicians was conducted to assess efficacy. RESULTS: The average pain score for subjects immediately post-NAFR was 5.15. Following cryomodulation, the average pain score on the treatment side was reduced by 69%, to an average of 1.6. The untreated side of the face was reduced by 19%, to an average of 4.2. Overall, 90% of subjects endorsed reduced discomfort. At follow-up, 70% of subjects reported a noticeable improvement in edema and 50% reported a noticeable improvement in erythema between the treatment and control sides. The average subject satisfaction score for the cryomodulation treatment was 4.2. All subjects (100%) indicated that they would elect to undergo the cryomodulation treatment again. Both blinded physician reviewers were successful in identifying the cryomodulation-treated side of the face in 70% of subjects' posttreatment photographs. CONCLUSIONS: The results of this split-face study support the efficacy of a global cryomodulation device for the reduction of pain, edema, and erythema following NAFR treatment. Cryomodulation was delivered in a simple 10 min procedure and yielded high patient satisfaction.

Dermatology's role in the fight against human trafficking: A report from the AAD Ad Hoc Task Force and call to action.

While the majority of American Academy of Dermatology members have some broad awareness of human trafficking, most are not aware of it in their communities or of the skin signs that could prompt identification of those being exploited, and have requested educational resources to assist patients affected by trafficking. The American Academy of Dermatology Ad Hoc Task Force on Dermatologic Resources for the Intervention and Prevention of Human Trafficking has been working to develop relevant resources, including an online toolkit on the American Academy of Dermatology website: https://www.aad.org/member/clinical-quality/clinical-care/human-trafficking.

Delegation and oversight of non-physician practitioners in dermatology.

A rising demand for dermatologic procedures has led to a recent increase in the number of non-physician operators (NPOs) in the dermatology workforce. Nurse practitioners, physician assistants, and aestheticians commonly perform procedures in both physician-based practices and medical spas with varying degrees of dermatology-specific training and physician oversight. Although the lack of regulations can negatively impact patient outcomes and adverse events, the role of NPOs in dermatology continues to grow. Among Medicare beneficiaries, nurse practitioners and physician assistants are independently billing for a growing number of dermatologic procedures, whereas the number performed by dermatologists remains relatively stable. Medical spas are an increasingly popular destination for aesthetic consumers, and the majority employ only NPOs as primary providers. Recent data suggest that compared to dermatologists, NPOs have a higher rate of adverse events. As attempts are made to standardize and improve the training requirements for dermatologic procedures, a concerted effort should be made to prioritize patient outcomes and safety.

Largest comparative analysis: Novel large spot size 595 nm, high-energy, pulsed dye laser reduces number of treatments for improvement of adult and pediatric port wine birthmarks.

OBJECTIVE: Port wine birthmarks (PWBs) are vascular malformations affecting 0.3%-0.5% of newborns with the tendency to persist into adulthood without adequate treatment of the heterogenous ectatic vessels. This study compares treatment outcomes and parameters of the prior generation pulsed dye laser (PPDL) and the larger spot novel generation pulsed dye laser (NPDL) to establish whether a larger spot size laser provides greater clearance with fewer treatments. METHODS: One hundred and sixty patients were treated with either the PPDL (80 patients) and NPDL (80 patients) with retrospective review of age, body site, laser treatment parameters, number of treatments, and improvement following laser therapy. RESULTS: Patients treated with PPDL were older on average than patients treated with NPDL (mean 24.8 ± 19.7 vs. mean 17.1± 19.3 years, p < 0.05). The majority of lesions treated with PPDL were located on the face and neck, whereas truncal and extremity sites were more frequently treated with the NPDL. Use of NPDL was associated with a mean maximum spot size of 13.1 mm and mean maximum fluence of 7.3 J/cm2 with pulse durations of 0.45-3 ms, whereas use of the PPDL was associated with a mean spot size of 10.8 mm and mean maximum fluence of 8.8 J/cm2 with pulse durations of 0.45-6 ms. Fifty percent improvement was seen with 8.8 PPDL treatments compared to 4.3 NPDL treatments (p ≤ 0.01) with no significant difference in overall mean improvement between both devices at the chosen parameters. Multiple regression analysis showed that device type, not age or lesion location, was the only statistically significant independent variable to affect the endpoint of at least 50% improvement of the lesion. CONCLUSIONS: Use of the larger spot NPDL is associated with achieving 50% improvement with fewer treatments.

#CoreCosmeticSpecialties: An analysis of nonsurgical cosmetic procedure hashtags on Instagram.

OBJECTIVES: In this study, we seek to characterize both the account credentials and content type for posts among the most popular nonsurgical cosmetic procedure hashtags on Instagram. METHODS: Twenty-five hashtags related to nonsurgical cosmetic procedures were identified with over 250,000 posts each, ranging from 256,000 to 12.1 million posts per hashtag. The first 10 posts displayed under the "Top" section for each hashtag within Instagram, as sorted by Instagram's proprietary algorithm, were analyzed for account type and content type. Posts unrelated to the cosmetic procedure or with non-English captions were excluded. In total, 680 posts were queried with 250 posts meeting the inclusion criteria. RESULTS: Content creators included nonphysician providers (68%), core cosmetic physicians (12%), noncore cosmetic physicians (8%), and consumers or others (13%). Content type included before and after (45%), self-promotional (23%), educational (17%), personal (5%), entertainment (5%), and promotional (5%). Among the different content creator types, core cosmetic physicians had the largest proportion of educational content at 38%. CONCLUSIONS: High-quality educational content on Instagram from core cosmetic specialties is scarce. By increasing their presence on Instagram, core cosmetic physicians can provide patient education, counteract misinformation, and raise awareness on training and qualifications regarding nonsurgical cosmetic procedures.

Treatment of Nevus of Ota in Black patients with the 1064 nm QS or picosecond laser and nonablative fractional photothermolysis.

OBJECTIVES: Nevus of Ota is a benign melanocytic lesion that presents as a unilateral blue gray to brown facial patch favoring the distribution of the first two branches of the trigeminal nerve. Incidence is highest in Asian and Black populations, however, the overwhelming majority of studies are limited to diagnosis and treatment in Asian patients. We herein present 10 Black patients with Fitzpatrick skin types (FST) V and VI who underwent laser treatment for Nevus of Ota. METHODS: We performed a retrospective review of Black patients presenting with Nevus of Ota. Race was self-designated by all patients and documented in the medical record at the time of initial consultation. Primary outcomes were based on improvement using before and after photographs which were graded by three independent board-certified dermatologists using a 5-point visual analog scale. RESULTS: Ten FST V or VI patients with an age range of 9 months to 45 years were treated for Nevus of Ota. All patients were treated with the 1064 nm Q-switched neodymium doped yttrium aluminum garnet (QS Nd:YAG) and on average received 4.7 treatments at 2-10 month intervals. Fluence ranged from 1.8 to 2.3 J/cm2 , and total pulse count ranged from 510.9 to 776.6. 2/10 patients were additionally treated with 1550 nm nonablative fractional resurfacing (NAFR), and 1/10 patients underwent combination therapy with both NAFR and 1064 nm picosecond laser therapy. Overall, patients saw a mean improvement of 51%-75% at follow-up 5-254 weeks (mean 51.5 weeks) after treatment. Three patients experienced mild guttate hypopigmentation in treated areas. No other long-term adverse events were encountered. CONCLUSION: 1064 nm QS Nd:YAG laser therapy is a safe and efficacious treatment for Nevus of Ota in patients with FST V and VI. When patient improvement plateaus, combining therapy with 1550 nm NAFR or transitioning to 1064 nm picosecond laser may be of benefit. Patients should be counseled on the risk of guttate hypopigmentation. This is the largest case series to date of Black patients with Nevus of Ota, highlighting the need for further investigation to determine optimal device settings and treatment parameters for this population.

Liberating more than light: Laser removal of branding tattoos is impactful in the recovery of sex trafficking survivors.

OBJECTIVES: Sex trafficking involves the use of force, fraud, or coercion to compel another person to engage in commercial sex acts. In 2020, 16,658 individuals were identified as sex trafficking victims in the United States, with thousands more not reported. Many victims are branded by their traffickers with tattoos conveying ownership, including names, symbols, and barcodes. We have partnered with local non-profits in Houston supporting sex trafficking survivors by providing pro bono laser tattoo removal, however we believe there is a greater need at a national level to support these survivors, allowing them to reclaim their bodies. METHODS: An online survey aimed at assessing the need and potential impact for pro bono branding tattoo laser removal services was distributed to United States organizations that support sex trafficking survivors. RESULTS: Forty organizations based in the Northeast (15%), Midwest (20%), South (45%), and West (20%) responded. Organizations support on average 81 survivors annually, ranging from 3 to 600 survivors, and estimate that 47% of survivors have branding tattoos. Among survivors with branding tattoos, approximately 67% were identified at an appropriate recovery stage to undergo laser removal. On a scale of 1-10 with 10 being the most impactful on recovery, removal of branding tattoos received an average impact score of 9.2. On a scale of 1-10, with 10 being the most need, pro bono services for laser removal received an average need score of 9.1. Qualitative responses provided several insights: laser removal may be associated with enhanced healing compared to tattoo cover-up, and survivors frequently move during their recovery process thus a successful removal campaign would require a nationwide network of partnering laser surgeons. CONCLUSIONS: Approximately 1 in 2 sex trafficking survivors are estimated to have branding tattoos and the removal of these tattoos is recognized as highly impactful on recovery. We propose a philanthropic campaign which involves the American Society for Laser Medicine and Surgery (ASLMS) establishing a national directory to connect sex trafficking survivors seeking removal of branding tattoos with interested ASLMS board-certified physician members.

Combination 1550 nm non-ablative fractional resurfacing and laser hair removal for treatment of Becker's nevi in skin types III-VI.

OBJECTIVES: Becker's nevus is a cosmetically bothersome benign hamartoma typically associated with basal layer hyperpigmentation and hypertrichosis. We herein present the largest case series characterizing treatment parameters and clinical outcomes of combined 1550 nm non-ablative fractional resurfacing and laser hair removal (long-pulsed neodymium-doped yttrium aluminum garnet or alexandrite) in the treatment of Becker's nevus. This is also the largest case series of laser treatment of Becker's nevus in Fitzpatrick skin types V and VI. METHODS: We performed a retrospective review of patients treated between 2016 and 2021. Clinical photographs were graded by three independent physicians using a 5-point visual analog scale. RESULTS: Twelve patients (mean age: 24.8 years, Fitzpatrick skin types III-VI) were treated for Becker's nevus on the face (4) or the trunk and/or extremities (8). Four patients were Fitzpatrick skin types V or VI. On average, patients received 5.3 treatments in 1-4-month intervals. Ten of the 12 patients had concomitant laser hair removal preceding same-day non-ablative fractional resurfacing (n = 7 with long-pulsed 1064 nm neodymium-doped yttrium aluminum garnet and n = 3 with long-pulsed 755 nm alexandrite). The number of treatments with each modality was determined by patient satisfaction with improvement in hyperpigmentation and hypertrichosis. At follow-up, which ranged from 6 to 40 weeks (mean 10.5 weeks), patients were given a mean improvement score of 51%-75%. No long-term adverse events were encountered in either group. Limitations include a small sample size and a lack of long-term follow-up. CONCLUSION: Combination 1550 nm non-ablative fractional resurfacing and laser hair removal is safe and efficacious in the cosmetic reduction of hyperpigmentation and hypertrichosis associated with Becker's nevus, including those with Fitzpatrick skin types V and VI.

Enhancing Skin Uptake of Topical Antioxidants With 1,440-nm Nonablative Fractional Diode Laser Pretreatment.

BACKGROUND: Energy-based devices, such as nonablative lasers, are a promising method to enhance the delivery and absorption of topically applied molecules. OBJECTIVE: To characterize ex vivo uptake of common antioxidant topicals after pretreatment with a nonablative laser wavelength. MATERIALS AND METHODS: Using donor human skin tissue, uptake of 3 topical antioxidants was analyzed (C E Ferulic with 15% l-ascorbic acid [15% vitamin C serum], Phloretin CF with ferulic acid [10% vitamin C serum], and Phyto+ [botanical serum]; SkinCeuticals, Dallas, TX; 2010 formulations) after pretreatment with a 1,440-nm nonablative fractional diode laser. RESULTS: Pretreatment with the 1,440-nm laser enhanced uptake of 15% and 10% vitamin C serums by approximately 10 and 21 times, respectively, compared to controls. Laser pretreatment also enhanced uptake of botanical serum by approximately 6 times relative to controls. Permeation of vitamin C and botanical serums was also enhanced through laser pretreatment. CONCLUSION: Nonablative laser pretreatment increased uptake and permeation of topical antioxidants. Optimizing treatment requires consideration of the device and treatment parameters as well as the properties of the topical formulation.

Enhanced Uptake and Retention of 0.03% Bimatoprost, 0.5% 5-Fluorouracil, and 5% Minoxidil After 1,550-nm or 1,927-nm Nonablative Laser Pretreatment.

BACKGROUND: Laser pretreatment with cosmeceutical topicals is growing in popularity. However, lasers may also enhance the uptake of medical topicals that treat dermatologic conditions, such as vitiligo, alopecia, and cancerous and precancerous lesions. Permeation of these topicals must be quantified to optimize treatment protocols. OBJECTIVE: To analyze transdermal uptake of 3 topicals after nonablative fractional 1,550-nm erbium-doped glass or 1,927-nm thulium fiber laser pretreatment. METHODS AND MATERIALS: Human donor tissue was pretreated with a nonablative fractional 1,550-nm erbium-doped glass or 1,927-nm thulium fiber laser followed by application of 0.03% bimatoprost, 0.5% 5-fluorouracil, or 5% minoxidil. Permeation and retention were measured over 24 hours (bimatoprost and 5-fluorouracil) or 90 minutes (minoxidil), and uptake was calculated. RESULTS: Pretreatment with 1,927-nm thulium laser (500 MTZ/cm2; 5 mJ; 5 W) enhanced uptake and retention of bimatoprost versus untreated control at 24 hours post-treatment. Pretreatment with 1,550-nm erbium-doped glass laser (2,000 MTZ/cm2; 10 mJ; 30 W) enhanced permeation, uptake, and retention of 5-fluorouracil at 24 hours post-treatment and enhanced permeation and uptake of minoxidil at 90 minutes post-treatment. CONCLUSION: Nonablative laser pretreatment may enhance topical treatment of dermatologic conditions. Device settings must be optimized to maximize topical permeation while minimizing laser-associated thermal side effects.

Key parameters of non-ablative fractional laser pretreatments for enhanced topical uptake.

BACKGROUND: The uptake of topical formulations can be enhanced through laser pretreatments. Newer technologies, such as non-ablative fractional lasers (NAFLs), can target dermal tissues and spare the stratum corneum (SC), which can mitigate common side effects associated with ablative laser treatment. OBJECTIVE: To discuss the parameters of 2 NAFL pretreatment systems (1440-nm/1927-nm diode system or 1550-nm erbium-doped glass/1927-nm thulium system), which can be paired with topicals to improve their cutaneous uptake. METHODS AND MATERIALS: The parameters of the 1440-nm/1927-nm diode system and 1550-nm erbium-doped glass/1927-nm thulium system were reviewed, as well as in vivo experiments using both laser systems. RESULTS: Multiple parameters should be optimized to enhance the uptake of various topical formulations and minimize side effects, including wavelength, spot size, density, pulse duration, thermal properties, and topical formulation. Chosen therapeutic parameters must account for patient-specific factors, such as treatment indication, therapeutic area, and Fitzpatrick skin type. In vivo experiments have demonstrated that both laser systems are effective in enhancing the uptake of various topical therapies relative to untreated controls. CONCLUSION: Individualization of laser system parameters increases efficiency and minimizes risk.

Quantifying Skin Uptake of Topicals After 1,927-nm and 1,440-nm Nonablative Fractional Diode Laser Treatment.

BACKGROUND: Although the stratum corneum limits transdermal absorption of topicals, laser devices can enhance topical uptake by disrupting the skin barrier. Nonablative lasers are commonly used, but their effects on topical uptake should be quantified to optimize outcomes. OBJECTIVE: The objective of this study is to analyze transdermal uptake of 4 topicals after nonablative fractional diode laser pretreatment. METHODS AND MATERIALS: Human donor tissue was pretreated ex vivo with a nonablative fractional diode laser (1,927 nm or 1,440 nm, at varying treatment densities, powers, and peak energies) followed by application of either 2% salicylic acid, 10% ascorbic acid, over-the-counter mineral eye serum, or 4% hydroquinone. Topical uptake was quantified over 24 hours. RESULTS: Despite lower power settings, pretreatment with the 1,927 nm wavelength was associated with greater uptake of 10% ascorbic acid, mineral eye serum, and 4% hydroquinone than the 1,440 nm wavelength. In addition, 1,440-nm laser pretreatment with higher density (320 microscopic treatment zones [MTZ]/cm 2 ) and peak power (3 W) was associated with similar uptake but greater retention of 2% salicylic acid and greater uptake of 10% ascorbic acid than that with lower density (80 MTZ/cm 2 ) and peak power (1.2 W). CONCLUSION: When using laser pretreatment, device settings should be adjusted to balance outcomes with potential side effects.