Clinical and laboratory results in vaginal wall restoration using a fractional-pixel-CO2 laser: histological findings and changes in the Ki67 protein and telomere length.

Thermal deposition of laser energy in the vaginal epithelium in genitourinary syndrome of menopause (GSM) results in clinical and biological effects, but many cellular and molecular changes indicating cell proliferation or senescence inhibition are unknown. The aim of this study is to evaluate the clinical efficacy of the fractional-pixel-CO2 laser in the possible improvement of GMS signs and symptoms that can be correlated with histological changes or with cellular or molecular indicators of restoration. A detailed prospective study was designed to assess 17 women diagnosed with GSM who were treated intravaginally with two laser sessions. Seven non-treated women diagnosed with GSM were used as controls. Three validated outcome questionnaires for assessment of quality of sexual life and urinary incontinence were performed. Vaginal biopsies were collected before the first laser treatment and 4 months following the second session. Histological status, elastin, collagen, and hyaluronic acid content of the biopsies were also evaluated. Cell proliferation was assessed by Ki67 staining. Telomere length (TL) was measured by qPCR. The results show an improvement of the clinical symptoms of GSM (p < 0.05), vaginal epithelium recovery and enhancement of collagen (p < 0.05), elastic fibers (p < 0.005), and hyaluronic acid (p < 0.0005) content in the lamina propria after fractional-pixel-CO2 laser treatment. The laser treatment induced a significant rise on the TL of vaginal epithelial cells (VECs), and a positive correlation was found between the improvements of the collagen and hyaluronic acid content and TL changes (r = 0.82, p < 0.05; r = 0.38, p < 0.05). The percentage of proliferative Ki67-positive VECs was increased in patients whose vaginal TL lengthened after laser treatment (p < 0.05). In conclusion, the results indicate that laser treatment may induce restoration of the vaginal epithelium which is associated to increased TL and proliferation in the VECs. Performing a TL assay could be a suitable tool to evaluate the efficacy of vaginal laser treatment.

Procedure and results on lower face and neck rejuvenation using a temperature-controlled bipolar fractional radiofrequency microneedling device.

BACKGROUND AND OBJECTIVE: Radiofrequency (RF) devices which are under ongoing technological development, are being increasingly used for minimally invasive rejuvenation procedures. The objective is to evaluate the efficacy and safety of a procedure that uses bipolar RF microneedles for rejuvenation of the lower face and neck. STUDY DESIGN AND METHODS: A prospective clinical and histological study, with a blind evaluation of the results by independent evaluators. Twenty-four women over 40 years of age were evaluated, who were treated with bipolar RF equipment (Profound™; Candela Medical) during a single session. Biopsy samples were taken from 12 patients. Microscopy images related to the immediate effects of RF and the changes observed 4 months after treatment were examined. The clinical results were established through questionnaires and by comparing before and after photographs. Mean (m), range (R), and percentage (%) values were calculated. RESULTS: Immediate lysis of adipocytes in submental fat was observed, as well as an increase in the density and compaction of elastin and collagen fibers 4 months later. The average percentage of reduction in fine lines, wrinkles, furrows, and folds was around 30%, while the average improvement of the neck silhouette was around 20%. Photographic signs of aging improved significantly, both in the face (p = 0.0007) and the neck (p = 0.002). Patient and therapist satisfaction with the results was 8.3/10 (R = 3-10) and 9.3/10 (R = 8-10), respectively. The adverse effects were mild and temporary and no complications were observed. CONCLUSION: The procedure is safe, clinically effective, and satisfactory for patients.

Tratamiento de quemaduras mediante plasma heterólogo rico en plaquetas (PRPh). A propósito de un caso pediátrico / Treatmen of burns by heterologous rich platelet plasma (hRPP). About a pediatric case report

Presentamos un caso en el que empleamos con éxito plasma rico en plaquetas heterólogo (PRPh) para la reparación de una quemadura de difícil evolución en un paciente pediátrico. Mostramos la seguridad y eficacia del uso del PRPh proveniente de la madre en un caso de quemadura AB-A por agua caliente. Se trata de una paciente de 3 años de edad que fue intervenida quirúrgicamente en otro centro, sin resultados positivos y profundizándose, por lo que se vio complicada su recuperación. El objetivo fue regenerar el tejido afectado e inducir de manera asistida la formación de tejido epitelial utilizando PRPh de la madre de la paciente. Aplicamos técnica de curación cerrada en 2 sesiones ambulatorias mediante la aplicación de PRPh sin necesidad de procedimientos adicionales. No se presentaron complicaciones, signos de rechazo ni infecciones y la recuperación se obtuvo en 14 días

The safety and efficacy of the use of heterologous rich platelet plasma (hRPP) from the mother is shown in a case of AB-A burn by hot water. This is a 3-year-old patient who was surgically operated in another center, without positive results and deepening, so recovery was complicated. The objective was to regenerate the affected tissue and to induce in an assisted way the formation of epithelial tissue using hRPP from the patient's mother. We apply the closed healing technique in 2 outpatient sessions by applying hRPP without the need for additional procedures. There were no complications, signs of rejection or infections, and their recovery was obtained in 14 days

¿Se Acaba La Crisis Del Coronavirus? Carencias En La Sanidad Y En La Política / Is the Coronavirus Crisis Over? Gaps in Healthcare and Politics

La crisis del coronavirus que sufrimos globalmente pronto debiera acabar. En el momento de escribir estetexto (17/4/2020), en el mundo se contabilizan más de 150 000 muertos por esta causa, y casi un millón decasos confirmados. Por la carencia de tests diagnósticos y por la política sanitaria de efectuar análisis, principalmente a los queingresan con respiratorios en los hospitales, se desconoce la cifra real de afectados, que debe ser muchomayor a los casos contabilizados. Nosotros, autores de esta carta al editor tenemos familiares afectados,incluso en Unidades de Cuidados Intensivos (UCI). Las autoridades sanitarias y políticas no paran de decirque lo peor está por llegar, y ciertamente, ciertamente, algo importante, que todos nos quedemos encasa. Una vez decretado por los Gobiernos el estado de alarma nacional, el cumplimiento del aislamientodebemos tomarlo como una obligación para todos.

The coronavirus crisis we are suffering globally should soon be over. As of this writing (4/17/2020), there have been 150,000 deaths accounted for due to this cause and almost one million confirmed cases worldwide. Due to the lack of diagnostic testing and health politics to carry out analysis, mainly to those who are admitted to hospitals with symptoms, we still do not know the actual number of affected individuals, but it must be much higher than reported cases. The authors themselves have affected family members, even in Intensive Care Units (ICU). The healthcare and political authorities continue to say that the worst is yet to come. And certainly, very important, that we all stay at home. Once the national state of emergency is declared by governments, physical distancing compliance should be taken as an obligation for all.

Quantum biology in low level light therapy: death of a dogma.

BACKGROUND: It is shown that despite exponential increase in the number of clinically exciting results in low level light therapy (LLLT), scientific progress in the field is retarded by a wrong fundamental model employed to explain the photon-cell interaction as well as by an inadequate terminology. This is reflected by a methodological stagnation in LLLT, persisting since 1985. The choice of the topics is, by necessity, somewhat arbitrary. Obviously, we are writing more about the fields we know more about. In some cases, there are obvious objective reasons for the choice. Progress in LLLT is currently realized by a trial and error process, as opposed to a systematic approach based on a valid photon-cell interaction model. METHODS: The strategy to overcome the current problem consists in a comprehensive analysis of the theoretical foundation of LLLT, and if necessary, by introducing new interaction models and checking their validity on the basis of the two pillars of scientific advance (I) agreement with experiment and (II) predictive capability. The list of references used in this work, does contain a representative part of what has been done in the photon-cell interaction theory in recent years, considered as ascertained by the scientific community. RESULTS: Despite the immense literature on the involvement of cytochrome c oxidase (COX) in LLLT, the assumption that COX is the main mitochondrial photoacceptor for R-NIR photons no longer can be counted as part of the theoretical framework proper, at least not after we have addressed the misleading points in the literature. Here, we report the discovery of a coupled system in mitochondria whose working principle corresponds to that of field-effect transistor (FET). The functional interplay of cytochrome c (emitter) and COX (drain) with a nanoscopic interfacial water layer (gate) between the two enzymes forms a biological FET in which the gate is controlled by R-NIR photons. By reducing the viscosity of the nanoscopic interfacial water layers within and around the mitochondrial rotary motor in oxidatively stressed cells R-NIR light promotes the synthesis of extra adenosine triphosphate (ATP). CONCLUSIONS: Based on the results of our own work and a review of the published literature, we present the effect of R-NIR photons on nanoscopic interfacial water layers in mitochondria and cells as a novel understanding of the biomedical effects R-NIR light. The novel paradigm is in radical contrast to the theory that COX is the main absorber for R-NIR photons and responsible for the increase in ATP synthesis, a dogma propagated for more than 20 years.

Remodelación de la grasa localizada con ultrasonidos de baja frecuencia, intensidad media y múltiple focalización: conclusiones preliminares / Abdominal fat remodeling using low frequency, medium intensity ultrasounds and multiple focalization: preliminary conclusions

INTRODUCCIÓN Y OBJETIVO: Los ultrasonidos focalizados de alta intensidad (HIFU) producen lisis del adipocito por calor con la finalidad no invasiva de remodelar la grasa corporal localizada. Observamos de forma prospectiva los efectos de un sistema que emite ultrasonidos de baja frecuencia, intensidad media y múltiple focalización, y sus posibilidades de disminución y remodelación de los acúmulos de grasa subcutánea del abdomen. MATERIAL Y MÉTODO: Presentamos el primer análisis técnico específico de un sistema de emisión diferente a los clásicos HIFU, y los resultados en 10 pacientes entre 24 y 56 años e IMC < 28, que recibieron 3 sesiones de tratamiento en abdomen con idéntico protocolo y separadas por 3 semanas. Evaluamos resultados finales a los 3 meses de la tercera sesión, comparando con el estado al inicio del tratamiento. Medimos con plicometría el contorno abdominal y el grosor del pliegue graso. Comparamos fotografías estandarizadas y obtuvimos muestras para microscopía en 3 tiempos de control del estudio empleando tinciones de hematoxilina, tricrómico de Masson e inmunohistoquímica. Implementamos cuestionarios para que pacientes, terapeuta y 2 médicos ajenos al estudio evaluaran resultados. RESULTADOS: El control específico de las características técnicas del sistema empleado indicó que, a diferencia de los HIFU, la emisión es de ultrasonidos de baja frecuencia, intensidad media y múltiple focalización. En las fotografías, plicometría y circunferencia abdominal encontramos reducción significativa del volumen abdominal. Las respuestas a las preguntas de los cuestionarios fueron positivas en cuanto a resultados, tanto por las pacientes como por los médicos evaluadores y la terapeuta que realizó los tratamientos. En las histologías observamos cambio de la forma típica del adipocito y lisis de su membrana tras la primera sesión de tratamiento. Identificamos desarrollo de nuevo colágeno y mejoría de la elastosis, significativas de mejoría de la tensión en las áreas tratadas. De las 10 pacientes, 9 confirmaron estar muy satisfechas y 1 satisfecha con la reducción del contorno y volumen del abdomen que se mantuvo 3 meses después del último tratamiento. No observamos efectos adversos importantes salvo ligero eritema y edema tras las sesiones, que desapareció a las 24 horas. CONCLUSIONES: El sistema empleado, con su particular modo de emisión y actuación sobre el tejido subcutáneo, resultó eficaz en la remodelación de la grasa localizada. Consideramos que además puede emplearse como tratamiento no invasivo para complementar las liposucciones quirúrgicas

BACKGROUND AND OBJECTIVE: High intensity focused ultrasound (HIFU) produce fat cell lysis during the treatment of subcutaneous tissue due to termal effect. In this study, an ultrasound system of low frequency, medium intensity and multiple focalizations was used for reduction and remodeling of the subcutaneous fat layer. METHODS: This study presents the first specific technical analysis of a system which differs from the traditional concept of HIFU energy emission. Ten patients received 3 sessions of treatment, following the same protocol, 3 weeks apart from each other. Patients ages were between 24 and 56 with a BMI < 28. Final control was done 3 months after the third session to compare the results with the status at the beginning of treatments. Abdomen circumference was measured, as well as the fat fold using a plicometer. Equal photographs of before and 3 months after the last treatment session were compared. Samples were obtained for microscopic analysis at the 3 points of control of the study, stained with hematoxilin, Masson trichromic and immuno-histochemical techniques. Questionnaires were implemented for evaluation of results by patients, the nurse who did the treatments and 2 doctors estrange to the study. RESULTS: Plicometry and abdominal circumference measurements found a significant objective and subjective reduction in the abdomen volume, which was also verified by comparing photographs. Histology following treatment showed adipocite changes in shape and membrane lysis. New collagen formation was present in samples taken before the third treatment session. At this control, dermis showed better condition regarding elastosis which was notable less. Patients' satisfaction degrees coincided with that of the nurse and the 2 doctors. Nine of the 10 patients were very satisfied and 1 was satisfied with the reduced circumference and decreased abdomen volume achieved. Results were maintained 3 months after the last session. No significant adverse effects were observed, only slight erythema and edema at the end of sessions, which disappeared within 24 hours. CONCLUSIONS: The system used in the study, with its particular mode of emission and action on fat tissue, is efficacious in decreasing and remodeling localized fat accumulation, and could be used as a non-invasive complementary treatment to surgical liposuction

Face and neck rejuvenation using an improved non-ablative fractional high power 1064-nm Q-switched Nd:YAG Laser: clinical results in 16 women.

OBJECTIVE: To evaluate the safety and efficacy of a specific treatment protocol using a new and improved non-ablative fractional high-power 1064-nm Q-switched Nd:YAG laser for face and neck rejuvenation. METHODS: Sixteen women, aged 30 to 60 years old, were selected to undergo three consecutive treatment sessions with this new laser at maximum energy (2,400 mJ/pulse, Clear Lift laser®-Harmony XL-Pro, Alma Lasers Ltd.). Face and neck were treated in eight patients, respectively. Each treatment used the same protocol. The efficacy was evaluated by the therapist (TS), the patient (PS), and two separate independent experts who were blind to the study (E1 and E2). RESULTS: According to E1 and E2, the mean reduction in signs of skin aging on a Global Esthetic Improvement Scale was 30-40%. Using a 0-10 points scale, TS and PS mean (range) satisfaction rates were 9.0 (8-10); 9.2 (6-10) for the face and 8.7 (8-10); 8.0 (3-10), for the neck, respectively. The procedure was practically painless, no significant adverse effects were observed, and the patients returned to their daily and work activities without downtime. CONCLUSION: This laser was safe and effective for face and neck minimally invasive rejuvenation, with excellent results using our usual routine use conditions.

Histopathological Changes After Experimental Skin Resurfacing Using an Improved Fractional High-Power 1064-nm Q-Switched Nd:YAG Laser

BACKGROUND: Several studies confirm microscopic changes in the cutaneous architecture following various rejuvenation techniques using non-ablative lasers. OBJECTIVE: To investigate the histological changes that occur after the application of an improved high-power 1064-nm fractional Q-switched Nd: YAG laser, using different focusing tips. MATERIAL AND METHODS: Experimental skin resurfacing of the retroauricular area in 15 female volunteers, in three treatment sessions of one pass each, using the Clear Lift® laser (Alma Lasers, Israel) and five different focusing tips. Biopsies were taken before and immediately after the first treatment session, one month after the first session, and one month after the third session. A total of 60 microscopic images were evaluated at a micrometric scale. RESULTS: The five tips used caused characteristic and similar histological changes in both the dermis and the epidermis. The signs of thermal damage and the formation of new collagen were observed at different depths, in accordance with the focal length of each tip. Neo-formation of collagen with the increase, reorganization and compaction of fibers began one month after the first treatment session, and was blindly confirmed, with all the tips used, one month after the third treatment session. CONCLUSION: The skin takes on a new conformation, with histological signs of skin rejuvenation, concordant with previous clinical observations. J Drugs Dermatol. 2019;18(12):1261-1266.

Effects of 1064-nm Nd:YAG long-pulse laser on polidocanol microfoam injected for varicose vein treatment: a controlled observational study of 404 legs, after 5-year-long treatment.

Sclerotherapy continues to be the treatment of choice for varicose veins in the legs. However, isolated treatment using microfoam or lasers requires a high number of sessions to eliminate them. In 2013, we published results about the efficacy and safety 3 years after the combined treatment with microfoam injections and subsequent application of Nd:YAG laser. The aim of this paper is to clinically evaluate the treatment of varices in a control visit after 5 years, when polidocanol microfoam is used and is immediately irradiated in the tissue with 1064-nm Nd:YAG laser beam. The outcome persistence after 5 years was studied in the legs that had received combined treatment and had been studied 3 years after treatment. Patients were contacted by phone, interviewed, and examined with echo-Doppler. Out of the 259 patients who were contacted, 221 agreed to make the appointment, although in the end, only 202 came, which meant analysing 404 legs. At 5 years, the clearance rates were very high: patients were included in class CEAP C1 showing vessels of from 0.5 to 3 mm diameter. The patients showed a high level of satisfaction. Regarding adverse effects, only 4 cases of hypopigmentation described in the previous publication persisted. Although the action mechanisms between the microfoam and the Nd:YAG laser must still be elucidated, it is notable that combining microfoam with laser exposure obtained a complete, effective treatment of legs in only 2 sessions, with high clearance rates and high level of satisfaction among patients.

Valoración clínica e histológica de resultados de una tecnología innovadora de láser Erbio: YAG para rejuvenecimiento facial / Clinical and histological results evaluation of an innovative Erbium: YAG laser technology for facial rejuvenation

Introducción y Objetivo: En los últimos años existe un creciente interés en el empleo de tecnología láser parcialmente ablativa en el rejuvenecimiento facial. Entre los láseres desarrollados con esta finalidad, el de Erbio:YAG acoplado a un sistema de ablación espacial modulada (RecoSMA(R), Linline, Minsk, Bielorrusia) merece atención porque cambia el tradicional depósito térmico del láser por un fenómeno de empuje mecánico. Nuestro objetivo fue determinar la eficacia y seguridad de un nuevo método de rejuvenecimiento facial que emplea un láser de Erbio:YAG acoplado al sistema RecoSMA®. Material y Método: Estudiamos 26 mujeres, con fototipos II a V y signos de envejecimiento facial entre moderados y severos en relación con su edad cronológica. Todas se sometieron a 2 sesiones de tratamiento separadas por 3 semanas. En cada sesión tratamos la totalidad de la cara. Tomamos fotografías y biopsias antes del primer tratamiento y 3 y 6 meses después del segundo. Evaluamos la eficacia clínica, tolerancia, efectos adversos, complicaciones y cambios clínicos e histológicos. Resultados: Las líneas finas, arrugas y las características del envejecimiento facial global mejoraron de forma significativa (p< 0.0001). La media de mejoría de líneas finas y arugas en ambos grupos fue de 66,4 ± 9,4 (r= 4585). La media de mejoría del envejecimiento global en ambos grupos (A+B) fue de 76.2% ± 6.2 (r = 60 - 85%) a los 3 meses, y de 59.4% ± 9.6 (r= 40 -75%) a los 6 meses. Mostramos a todas las pacientes fotografías comparativas de antes y después del tratamiento, y el 85% manifestaron estar satisfechas o muy satisfechas con los resultados. Vimos también que los resultados obtenidos a los 3 meses disminuían en la evaluación a los 6 meses, con un 62% de pacientes satisfechos. Conclusiones: El perfil eficacia-seguridad fue muy satisfactorio con ventajas adicionales respecto a otros láseres empleados para el rejuvenecimiento facial. Hay que tener en cuenta la disminución de resultados a los 6 meses para indicar sesiones adicionales, aunque debe advertirse previamente a los pacientes

Introduction and Objective: In recent years there has been a growing interest in the use of partially ablative laser technology in facial rejuvenation. Among the lasers developed for this purpose, the Erbium: YAG laser coupled to a modulated space ablation system (RecoSMA®, Linline, Minsk, Belarus) deserves attention because it changes the traditional thermal deposit of the laser due to a push mechanic phenomenon. Our aim was to determine the effectiveness and safety of a new method of facial rejuvenation using an Er:YAG laser together with a system of spatially modulated ablation. Methods: Twenty six women, phototypes II to V, with signs of moderate to severe facial aging were studied in relation to their chronological age. All patients received 2 treatments 3 weeks apart. At each session the entire face was treated. Photographs and biopsies were taken before the 1st treatment and 3 and 6 months after the 2nd treatment. Clinical effectiveness, tolerance, adverse effects, complications, clinical and histological changes were evaluated. Results: Fine lines, wrinkles, and overall characteristics of skin ageing improved significantly (p < 0.0001). The mean of improvement in fine lines and wrinkles in both groups (A+B) was by 66.4 ± 9.4 (r= 45-85). Several signs of facial ageing improved an average by 76.2% ± 6.2 (r = 60 - 85%) at 3 months, and by 59.4% ± 9.6 (r= 40 - 75%) at 6 months.The patients were shown the before and after photographs and 85% were satisfied or very satisfied. It was observed that the results obtained decrease slightly in the evaluation at 6 months (62% satisfied patients) making additional treatment sessions necessary. Conclusions: Compared to other lasers used for facial rejuvenation, results of this study showed to have additional benefits and an excellent effectivenesssafety ratio. We must take into account the decrease of positive results at 6 months, so additional sessions are required although patients must be warned previously

Clinical assessment of a new 755 nm diode laser for hair removal: Efficacy, safety and practicality in 56 patients.

BACKGROUND AND OBJECTIVE: Recently, the first diode laser with a wavelength of 755 nm for in-motion hair removal came on the market. The objective of this study was to check its efficacy, safety, and practicality under different options for its use. METHODS: A prospective study in a heterogeneous group of 56 patients who had hair removed from various areas of their bodies using three different treatment methods. Four sessions were scheduled in all cases, with a gap of 3 months between each session. Efficacy was assessed by counting of hairs per cm2 and the adverse effects in each session were recorded in detail in the patients' clinical histories. RESULTS: The three tested options achieved a significant reduction in the number of hairs (P < 0.0001). The average clearances achieved using the conventional method (HR), the in-motion method (SHR) and the stacking method were 75.5%, 70.1%, and 41.9%, respectively. The degree of satisfaction of the participants on a scale of 0-10 was 7.7, 8.1 and 6.8, respectively. Erythema and perifollicular edema, which are characteristic responses in laser hair removal, were observed. The incidence of burns was 1.33%. CONCLUSION: The 755-nm diode laser performed efficiently and safely in all the tested areas, using high total accumulated energy per surface unit. Based on our prior experience with other equipment, the results are promising. Lasers Surg. Med. 49:355-360, 2017. © 2016 Wiley Periodicals, Inc.

Cuttlefish Ink Melanin Encapsulated in Nanolipid Bubbles and Applied Through a Micro-Needling Procedure Easily Stains White Hair Facilitating Photoepilation.

BACKGROUND: Photothermolysis of unwanted hair depends on the presence of melanin in the hair follicle as the chromophore, but is not effective in patients with non-pigmented, melanin-sparse hair shafts and follicles. This split-scalp, double-blind study was to monitor the efficacy of melanin bound in nanosomes to inject exogenous melanin into the hair follicles thus potentiating successful photothermolysis.
MATERIAL AND METHODS: Twelve patients, phototypes II-III, with white or very fair hair, were treated with a compound containing melanin encapsulated in nanosomes (Melaser®) together with a fluorescent marker. Two equal 6 cm² areas were marked on each side of the occiput of the subjects. The compound was applied to a randomly selected experimental side on each patient (area A), and a saline solution applied in the same manner to the contralateral control side (area B). Penetration of the melanin into the hair follicle was assessed using optical and fluorescence microscopy. Also, condition of hair structure was checked in vivo after standard laser settings used for epilation.
RESULTS: A slight transient erythema was observed in those areas where the compound was applied with some perifollicular edema. No such effects were noticed in those areas where saline solution was applied. No persistent complications such as scarring, hypo- or hyperpigmentation were observed in any of the experimental or control areas. Under fluorescence microscopy, the hair structures in the areas to which the compound had been applied showed a clear melanin deposit confirmed by the immunofluorescence intensity, which was highest at 2 hours after application. By optical microscopy, external melanin was deposited in hair follicles. Tests with standard settings for epilation were efficacious in damaging melanin-marked white hair.
CONCLUSION: This study strongly suggests the safety and efficacy of the application of nanosomes encapsulating melanin for the introduction of melanin into hair follicles. Changes noticed in the hair structure compromising its viability indicated potential application of this external melanin marker for white hair photoepilation.

J Drugs Dermatol. 2016;15(5):615-625.

Laser-assisted lipolysis for arm contouring in Teimourian grades III and IV: A prospective study involving 22 patients.

BACKGROUND: Upper arm deformities secondary to weight loss or senile elastosis have led to an increased demand for aesthetic contouring procedures. OBJECTIVE: To objectively assess whether, in Teimourian high-grade upper arm remodelling, laser-assisted lypolysis (LAL) alone could result in patient satisfaction. METHODS: Between 2012 and 2013, 22 patients were treated for excessive upper arm fat (Teimourian grade III and IV) solely with LAL. The laser used in the present study was a 1470 nm diode laser (Alma Lasers, Israel) with the following parameters: continuous mode, 15 W power and transmission through a 600 µm optical fibre. Previous mathematical modelling suggested that 0.1 kJ was required to destroy 1 mL of fat. Patients were asked to complete a satisfaction questionnaire. The arm circumference was measured pre- and postoperatively. Treatment parameters, adverse effects and outcomes were recorded. RESULTS: Pain during the anesthesia and discomfort after the procedure were minimal. Complications included ecchymoses and prolonged edema. The mean (± SD) arm circumference decreased 5.5±1.0 cm in the right arm (P<0.01) and 5.2±1.1 cm in the left arm (P<0.01) in grade III patients and 4.9±1.1 cm in the right arm (P<0.01) and 4.9±1.1 cm in the left arm (P<0.01) in grade IV patients. Although the circumference of both arms significantly decreased in grade III and grade IV patients, the skin tightening remained incomplete. Overall, the average opinion of treatment was poor for both patients and investigators. Of the 22 patients, only nine (41%) would recommend this treatment. CONCLUSION: LAL for upper arm remodelling is not sufficient to ensure full skin tightening for patients with Teimourian grades III and IV upper arm deformities. A complementary surgery is mandatory for grades III and IV.

ETAT DE L'ART: Les déformations des bras attribuables à une perte de poids ou à l'élastose sénile ont suscité l'augmentation des demandes d'interventions de redrapage esthétique. OBJECTIF: Evaluer objectivement si la lipolyse laser (LL) seule, utilisée pour le redrapage des bras de grades Teimourian III et IV, permet la satisfaction des patients. MATÉRIEL ET MÉTHODES: Entre 2012 et 2013, 22 patients ont été traités par LL seule pour le redrapage des bras de grades Teimourian III et IV. Le laser diode 1470 nm (Alma Lasers, Israël) était utilisé avec les paramètres suivants : mode continu, puissance de 15W, et transmission par fibre optique de 600µm. Selon notre modélisation antérieure, 0,1 kJ était nécessaire pour détruire 1 mL de tissus adipeux. Les patients ont été invités à remplir un questionnaire de satisfaction. La circonférence des bras étaient consignée avant et après intervention. Les paramètres laser requis, les complications, et les résultats étaient enregistrés de manière prospective. RÉSULTATS: La douleur pendant l'anesthésie et l'inconfort après l'intervention étaient minimes avec cette technique. Les complications incluaient des ecchymoses et un oedème prolongé. La circonférence moyenne des bras a diminué de 5,5±1,0 cm au bras droit (p<0,01) et 5,2±1,1 cm au bras gauche (p<0,01) chez les patients de grade Teimourian III, et de 4,9±1,1 cm au bras droit (p<0,01) et 4,9±1,1 cm au bras gauche (p<0,01) chez les patients de grade IV. Même si la circonférence des deux bras a diminué considérablement pour les grades Teimourian III et IV, le redrapage cutané est demeuré incomplet. En moyenne, le résultat est jugé insatisfaisant tant pour les patients que pour les investigateurs. Sur les 22 patients, seuls neuf (41%) recommanderaient le traitement. CONCLUSION: La lipolyse laser est insuffisante pour assurer un redrapage complet des déformations des bras de grades Teimourian III et IV. Une chirurgie complémentaire reste nécessaire dans ces cas-là.

Clinical and histological results in the treatment of atrophic and hypertrophic scars using a combined method of radiofrequency, ultrasound, and transepidermal drug delivery.

Scars are problematic for thousands of patients. Scarring is a natural part of the healing process after an injury. However, the appearance of a scar and its treatment depend on multiple factors and on the experience of the therapist and the options available. Despite a plethora of rapidly evolving treatment options and technical advances, the management of atrophic and hypertrophic scars remains difficult. Innovative technologies provide an attractive alternative to conventional methods in the treatment of scars. The purpose of this trial was to determine the clinical and histological results of a method of treatment that combines radiofrequency, ultrasound, and transepidermal drug delivery. This was a prospective study conducted on 14 patients with scars of different sizes, types, and characteristics. All patients underwent six treatment sessions with the Legato device. Atrophic scars were treated with retinoic acid and hypertrophic scars with triamcinolone. Photographs and biopsies were taken before treatment and at 6 months after the last treatment session. The scars improved significantly (P < 0.0001). The mean attenuation in the severity of scars was 67% (range: 50-75%), where 100% indicates complete disappearance of the scar. Clinical and histological images of scar tissue in six patients in whom attenuation in the range of 55-75% was achieved are shown. Biopsies show regenerative changes in the scar tissue, in both the epidermis and dermis. The method makes it possible to treat extensive, heterogeneous scars on different sites with good results that are similar and predictable.

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Efficacy and safety of laser therapy on axillary hyperhidrosis after one year follow-up: a randomized blinded controlled trial.

INTRODUCTION: Hyperhidrosis is a debilitating problem that is not only uncomfortable and inconvenient, but also embarrassing in work and social situations. In spite of the availability of several options for the treatment of axillary hyperhidrosis, recently, there has been an increasing interest in the use of laser therapy. This study aims to evaluate the efficacy of a laser diode device emitting at wavelengths of 924 and 975 nm and classical curettage either alone, simultaneously or in combination. MATERIAL AND METHODS: A randomized prospective controlled trial was carried out on 100 patients divided into four groups, each with a different protocol: Laser alone at 975 nm (group 1), laser alone at 924/975 nm simultaneously (group 2), curettage alone (group 3), and finally laser at 924/975 nm followed by curettage (group 4). HDSS, starch test and GAIS were used to assess treatment efficacy. The follow-up extended to one year. Statistical analysis (SPSS) was used to determine the accuracy of the results. RESULT: Two patients of group 1 experienced burns during treatment, which took over a month to heal. This group of patients achieved the worst results: The starch test scale results after treatment were 2.48 ± 0.51 and 2.76 ± 0.44 (at 1 and 12 months). The GAIS results were 1.04 ± 0.35 and 0.92 ± 0.28 (1 and 12 months). In group 2 the starch test scale results after treatment were 1.36 ± 0.49 and 1.48 ± 0.51 (at 1 and 12 months). The GAIS results were 2.36 ± 0.49 and 2.72 ± 0.46 (at 1 and 12 months). In group 3, the starch test scale results after treatment were 1.56 ± 0.51 and 1.76 ± 0.60 (at 1 and 12 months), which corresponds to small to substantially smaller dark areas. The GAIS results were 2.28 ± 0.46 and 2.64 ± 0.49 (at 1 and 12 months). The best results were obtained in group 4: HDSS scores were reduced from 3.88 ± 0.33 before treatment to 1.24 ± 0.44 and 0.48 ± 0.51 at the 1 and 12 months controls. The starch test scale results after treatment were 0.40 ± 0.50 and 0.44 ± 0.51 (at 1 and 12 months). The GAIS results were 3.72 ± 0.54 and 3.76 ± 0.44 (at 1 and 12 months). CONCLUSION: In this study, the laser at 924/975 nm combined with curettage was determined to be the optimal treatment option of those tested for axillary hyperhidrosis. This treatment was safe, with few side effects and improvement that persisted to one year follow-up.

Laser-assisted lipolysis for arm contouring in Teimourian grades I and II: a prospective study of 45 patients.

Upper arm deformities secondary to weight loss or senile elastosis have led to an increased demand for aesthetic contouring procedures. We conducted this study to objectively assess if, in Teimourian low-grade upper arm remodelling, one session of laser-assisted lypolisis (LAL) could result in full patient satisfaction. Between 2011 and 2013, 45 patients were treated for unsightly fat arm Teimourian grade I (15 patients), grade IIa (15 patients) and grade IIb (15 patients) with one session of LAL. The laser used in this study was a 1470-nm diode laser (Alma Lasers, Cesarea, Israel) with the following parameters: continuous mode, 15 W power and transmission through a 600-µm optical fibre. Previous mathematical modelling suggested that 0.1 kJ was required in order to destroy 1 ml of fat. Treatment parameters and adverse effects were recorded.The arm circumference and skin pinch measurements were assessed pre and postoperatively. Patients were asked to file a satisfaction questionnaire. Pain during the anaesthesia and discomfort after the procedure were minimal. Complications included prolonged oedema in 11 patients. The average arm circumference decreased by 4.9 ± 0.4 cm in the right arm (p < 0.01) and 4.7 ± 0.5 cm in the left arm (p < 0.01) in grade I patients, 5.5 ± 0.6 cm in the right arm (p < 0.01) and 5.2 ± 0.5 cm in the left arm (p < 0.01) in grade IIa patients and 5.4 ± 0.5 cm in the right arm (p < 0.01) and 5.3 ± 0.5 cm in the left arm (p < 0.01) in grade IIB patients. The skin tightening effect was confirmed by the reduction of the skin calliper measurements in all three groups. Overall mean opinion of treatment was high for both patients and investigators. Of the 45 patients, all but one would recommend this treatment. A single session of LAL in upper arm remodelling for Teimourian grades I to IIb is a safe and reproducible technique. The procedure allows reduction in the amount of adipose deposits while providing full skin tightening.