The evaluation of hyaluronic acid, with and without lidocaine, in the filling of nasolabial folds as measured by ultrastructural changes and pain management.

BACKGROUND: Pain management is an important objective in procedures involving dermal fillers composed of hyaluronic acid (HA). OBJECTIVE: To compare the 1-year clinical results of filling the nasolabial fold with 2 types of filler: large-gel particle HA and large-gel particle HA plus 0.3% lidocaine (HA+L). We compared the level of pain during treatment and 10 minutes after treatment and assessed the safety and efficacy profile, satisfaction, and histological findings (using reflectance confocal microscopy [RCM]). MATERIALS AND METHODS: We performed a comparative, parallel-group, double-blind trial with an external observer (blinded to the type of treatment administered). The filler was applied to the nasolabial fold in 119 patients (HA in 62 patients and HA+L in 57). Patients were followed at months 3, 9, and 12. Pain was evaluated using a visual analog scale. Efficacy and satisfaction were evaluated using the Wrinkle Severity Rating Scale and the Global Aesthetic Improvement Scale. RCM images (n=32) were taken at baseline and at months 3 and 12. RESULTS: Pain: The severity of pain was decreased in patients treated with HA+L on application (P <.001) and 10 minutes later ( P=.008). Efficacy and satisfaction: No significant differences existed between the 2 groups at months 3, 9, and 12. RCM: Skin rejuvenation occurred with a 32% increase in the height of the dermoepidermal junction at month 12 (P <.001), which was similar in both groups. Adverse events: At month 3, the most common adverse events (AEs) were erythema (68%) and hematoma (11%). No AEs were recorded at months 9 or 12. CONCLUSION: The use of HA+L provides pain relief without affecting efficacy, satisfaction, safety, or the duration of results. RCM showed that the changes in the dermoepidermal junction represented a histological improvement in the skin with similar results in both groups.

Laser-assisted lipolysis for knee remodelling: a prospective study in 30 patients.

BACKGROUND: Unsightly fat knees are a frustrating aesthetic deformity exacerbated by genetic predisposition and resistance to diet. This article reports our experience with laser-assisted lipolysis (LAL) in knee remodelling. METHODS: A total of 30 patients were treated for unsightly fat knees with LAL. The 924/975-nm diode laser used in this study consists of two lasers, one emitting at 924 nm and another at 975 nm. Previous mathematical modelling suggested that 0.1 kJ was required in order to destroy 1 ml of fat, in dual emission mode at 924/975 nm. Patients were asked to fill out a satisfaction questionnaire. Ultrasound was used to measure the fat thickness pre-and post-operatively. RESULTS: Other than one patient who developed mild hyperpigmentation that disappeared after 2 months, there were no complications in the series. Pain during the anaesthesia and discomfort after the procedure were minimal. Return to normal activities never took longer than 2 days and mean downtime was 0.92 days. Of the 30 patients, 29 would recommend this treatment. Overall satisfaction was high with both patients and investigators and was validated by ultrasound measurements demonstrating a systematic decrease in fat thickness. CONCLUSION: LAL in knee remodelling is a safe and reproducible technique, particularly appreciated by patients. The procedure allows for a reduction in the amount of adipose deposits while providing concurrent skin contraction.

Evaluation of clinical improvement in acne scars and active acne in patients treated with the 1540-nm non-ablative fractional laser.

INTRODUCTION: Acne is a characteristic condition of puberty; however, adults who continue to have acne outbreaks frequently attend dermatology clinics. Two conditions-active acne and residual scarring-often co-occur in these patients. The objective of the present study was to evaluate the improvement in scarring and active acne after treatment with a 1540-nm erbium: glass fractional laser. MATERIAL AND METHODS: The authors treated 20 patients with acne and scarring. Each patient received panfacial treatment in four sessions with a 1-month interval between sessions. Patients, the treating physician and a blinded observer evaluated the results in four areas: improvement in scars, improvement in pores, improvement in acne, and improvement in sebum secretion. Improvements were graded using the Global Aesthetic Improvement Scale. The evaluation was made 12 weeks after treatment finished. RESULTS: Patients presented an improvement in both acne and scars. In 80 percent of cases, patients felt that the appearance of the scars had improved, and the improvement was classified as very much improved in 40 percent. In 85 percent of cases, patients felt that active acne had improved, and the improvement was classified as very much improved in 45 percent. Pore size was evaluated as improved by 75 percent of patients. Sebum secretion improved in 80 percent of cases. CONCLUSION: A 1540-nm non-ablative fractional laser provides effective treatment of acne scars. Patient satisfaction is high and active acne lesions improve significantly. Treatment of this mixed condition (scarring and active acne) with a single device is reliable, with a favorable safety profile and a high degree of patient acceptance.

Multisource, Phase-controlled Radiofrequency for Treatment of Skin Laxity: Correlation Between Clinical and In-vivo Confocal Microscopy Results and Real-Time Thermal Changes.

OBJECTIVE: The objective of this study was to analyze the correlation between degrees of clinical improvement and microscopic changes detected using confocal microscopy at the temperature gradients reached in patients treated for skin laxity with a phase-controlled, multisource radiofrequency system. DESIGN AND SETTING: Patients with skin laxity in the abdominal area were treated in six sessions with radiofrequency (the first 4 sessions were held at 2-week intervals and the 2 remaining sessions at 3-week intervals). Patients attended monitoring at 6, 9, and 12 months. PARTICIPANTS: 33 patients (all women). MEASUREMENTS: The authors recorded the following: variations in weight, measurements of the contour of the treated area and control area, evaluation of clinical improvement by the clinician and by the patient, images taken using an infrared camera, temperature (before, immediately after, and 20 minutes after the procedure), and confocal microscopy images (before treatment and at 6, 9, and 12 months). The degree of clinical improvement was contrasted by two external observers (clinicians). The procedure was performed using a new phase-controlled, multipolar radiofrequency system. RESULTS: The results reveal a greater degree of clinical improvement in patients with surface temperature increases greater than 11.5ºC at the end of the procedure and remaining greater than 4.5ºC 20 minutes later. These changes induced by radiofrequency were contrasted with the structural improvements observed at the dermal-epidermal junction using confocal microscopy. Changes are more intense and are statistically correlated with patients who show a greater degree of improvement and have higher temperature gradients at the end of the procedure and 20 minutes later. CONCLUSION: Monitoring and the use of parameters to evaluate end-point values in skin quality treatment by multisource, phased-controlled radiofrequency can help optimize aesthetic outcome.