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.

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.

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 neck and submental remodeling in Rohrich type IV patients: fact or fiction?

BACKGROUND: Since the first studies by Apfelberg in 1994 and the mathematical model of Mordon introduced in 2004, laser-assisted lipolysis (LAL) has been on the rise. In a previous study, we presented our results in patients treated with LAL for Rohrich type I to III aging neck. The average cervicomental angle decreased from 152.6 ± 5.9 to 123.6 ± 8.8 degrees after LAL. This demonstrated a systematic decrease in fat thickness, and improved skin tightening. OBJECTIVE: This new protocol focuses solely on LAL in the Rohrich type IV aging neck. METHODS: Between June 2012 and February 2013, a prospective study was performed on 10 patients treated with LAL for Rohrich type IV aging neck. The laser used in this study was a 1470 nm diode laser (Alma Lasers, Caesarea, Israel). Laser energy was transmitted through a 600 µm optical fiber and delivered in a continuous mode, at 15 W power. Previous mathematical modeling suggested that 0.1 kJ was required in order to destroy 1 ml of fat. Patients were asked to fill out a satisfaction questionnaire. The cervicomental angle was measured 6 months postoperatively, and compared with the preoperative values. RESULTS: No seromas were observed, but prolonged edema was observed in two patients. Pain during anesthesia and discomfort after the procedure were minimal. The average cervicomental angle decreased from 191.5 ± 5.7 to 164.9 ± 14.2 degrees (p < 0.01). This demonstrated a systematic decrease in fat thickness and improved skin tightening. Even though the cervicomental angle was higher than 140° in each case, the investigators, in agreement with the patients, decided to perform a complementary surgery with platysma muscle advancement and plication six months after LAL, in only two of the ten patients. This complementary surgery led to a mean cervicomental angle of 140.2 ± 11.4, and fair satisfaction of both patients and investigators. CONCLUSION: LAL alone appears insufficient for complete remodeling in Rohrich type IV aging neck. While LAL alone is sufficient for Grade I to III, a complementary surgery must be added for Grade IV.

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.

Laser assisted lipolysis for neck and submental remodeling in Rohrich type I to III aging neck: a prospective study in 30 patients.

BACKGROUND: Since the first studies by Apfelberg in 1994 and the mathematical model by Mordon in 2004, laser lipolysis (LAL) has been on the rise. Laser lipolysis has the advantages of reduced operator fatigue, excellent patient tolerance, quick recovery time, as well as the additional benefit of dermal tightening. This article reports our experience with laser-assisted lipolysis (LAL) in submental and neck remodelling. METHODS: Between June 2010 and January 2013, a prospective study was performed on 30 patients treated for Rohrich type I to III aging neck, with LAL. The laser used in this study was a 980 nm diode laser (Quanta system, spa model D-plus, Solbate Olona (VA), Italy). Laser energy was transmitted through a 600 µm optical fiber and delivered in a continuous mode 15 W power. Previous mathematical modelling suggested that 0.1 kJ was required in order to destroy 1 ml of fat. Patients were asked to fill out a satisfaction questionnaire. The cervicomental angle was measured 6 months post-operatively and compared with the preoperative values. RESULTS: Other than three patients who developed mild hyperpigmentation that disappeared after 4 months, there were no complications in the series. Pain during the anaesthesia and discomfort after the procedure were minimal. The time taken to return to normal activities was 3.2 ± 1 days. All patients would strongly recommend this treatment. Overall satisfaction was high with both patients and investigators and was validated by decrease in cervicomental angle demonstrating a systematic decrease in fat thickness and improved skin tightening. CONCLUSION: LAL is a safe and reproducible technique for remodeling in Rohrich type I to III aging neck. The procedure allows for a reduction in the amount of adipose deposits while providing concurrent skin contraction.

Long-term outcomes of laser assisted blepharoplasty for ptosis: about 104 procedures in 52 patients.

BACKGROUND: Eyelid ptosis or blepharoptosis is defined as an abnormal drooping of the upper eyelid when looking straight ahead. Laser-assisted blepharoplasty (LAB), first introduced by Baker in 1984, presents the following advantages: improved intraoperative haemostasis, decreased operating time and improved appearance in the immediate postoperative periods. This article reports our long-term experience with LAB in ptosis correction surgery and underlines the advantages of the technique. METHODS: A total of 52 patients were treated for ptosis with LAB between 2000 and 2011. The patients had an average age of 59.5 ± 9.6 years. Etiologies were senile ptosis in 34 cases, traumatic ptosis in 9 cases and congenital ptosis in 9 cases. The ptosis was classified as mild in 24 cases, moderate in 11 cases, and severe in 17 cases. The surgical technique was similar to the one described by Baker. The laser used in our studies was the CO2 Lumenis Active(™) with the following parameters for skin incision: ultrapulse mode, continuous emission, 3-W power (program 1). The laser was then reprogrammed (program 2) with the following parameters for resection of a skin-orbicular muscle flap: regular mode, continuous emission, 9-W power with the beam slightly defocused. RESULTS: Early complications included oedema in 8 patients. More than 1 mm of lid asymmetry was seen in 8 patients with 6 patients under corrected and two over corrected. Two of them chose secondary surgery. Mean down time was 5.5 ± 1.7 days (2-7 days). The mean late follow-up was performed after 2-10 years (mean 6.6 ± 1.7 years). Late complications included 4 recurrences 5, 6, 6, and 8 years, respectively, after the first procedure. All but one were successfully re-operated with the same technique. Overall patient satisfaction ranked high and all but one would recommend this treatment to others. CONCLUSION: LAB in ptosis surgery is a safe and reproducible technique particularly appreciated by patients. The procedure allows for improved intraoperative haemostasis, decreased operating time and improved appearance in the immediate postoperative periods.

Optimal and safe treatment of spider leg veins measuring less than 1.5 mm on skin type IV patients, using repeated low-fluence Nd:YAG laser pulses after polidocanol injection.

Treatment of micro-veins of less than 1.5 mm with laser and with chemical sclerosis is technically challenging because of their difficulty to remedy. Laser treatment is even more difficult when dark phototypes are involved.Three groups of 30 patients each, skin type IV, and vessels measuring less than 1.5 mm in diameter, were enrolled for two treatment sessions 8 weeks apart: group A, polidocanol (POL) micro-foam injection; group B, Nd:YAG laser alone; and group C, laser after POL injection. Repeated 8-Hz low-fluence pulses, moving the hand piece over a 3-cm vein segment with an average of five laser passes maximum and with a total time irradiation of 1 s were used. Sixteen weeks after the second treatment, statistically, degree of clearance after examining photographs and patients satisfaction index, plotted on a visual analogue scale and comparing results of all three groups, results were significantly better for group C (p<0.0001). No significant differences in complications were noticed between the three groups. Efficacy of combining POL and laser proved safe and satisfactory in 96 % of patients using low-fluence laser pulses with a total cumulative energy in the 3 cm venous segment, lower than that of conventional treatment. Very few and transient complications were observed. POL foam injection followed by laser pulses is safe and efficient for vein treatment in dark-skinned patients.

Nonanimal stabilized hyaluronic acid for tissue augmentation of the dorsal hands: a prospective study on 38 patients.

BACKGROUND: Often ignored, hands are one of the most telltale signs of aging. This prospective study was initiated to evaluate the effect of subcutaneous hyaluronic acid (HA) injections in aging hands, with special attention to complications and long-term outcomes. METHODS: Between January 2010 and December 2010, a total of 38 patients with skin phototypes II-IV and between 58 and 76 years old were treated with HA injection for aging hands. The quantity of injection never exceeded 1.0-1.5 ml HA per hand. A clinical follow-up was performed at 2 weeks, 4 weeks, 3 months, and 6 months after injection. Complications were reviewed for the whole series. At the first follow-up, 2 weeks after the procedure, ultrasound was carried out to determine if additional filling material was required. At each follow-up, patients were asked to fill out a satisfaction questionnaire. RESULTS: Nine patients developed slight ecchymosis that disappeared after 1 week. No other complications were seen in the series. Pain during the injection and discomfort after the procedure were minimal. At the 2-week follow-up, after ultrasound control, nine patients received a complementary injection. At each follow-up, overall patient satisfaction was high and was validated by clearance of rhytids, veins, bony prominences, and dermal and subcutaneous atrophy. CONCLUSION: Skin revitalization with injectable HA can improve the clinical appearance of the back of the hands. However, this therapy requires knowledge of the possible complications and their remediation as well as knowledge and respect of injected doses. Moreover, despite excellent results at each follow-up, the results of our series are not as good after 6 months, and a longer follow-up would be needed to determine if this procedure provides long-lasting benefit. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

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.

1064-nm Nd: YAG laser-assisted cartilage reshaping for treating ear protrusions.

BACKGROUND: Correction of prominent ears is a common plastic surgical procedure. The laser-assisted cartilage reshaping (LACR) technique for protruding ears was developed at the French National Institute of Health and Medical Research in Lille, France, using both the 1064- and 1540-nm wavelengths, with a view to simplifying the surgical procedure. Herein we report our results with the 1064-nm wavelength. METHODS: Between 2008 and 2010, twenty-six 1064-nm LACR procedures in 14 patients were performed. Twelve patients received treatment to both ears, and 2 patients received treatment to one ear. Each procedure consisted of a single treatment session. The treatment consisted of laser irradiation of both sides of the helix with single pulses of 70 J/cm2. The beam diameter was 6 mm. Early and late complications were defined and reviewed for all patients. Satisfaction was assessed by patients using a visual analogue scale from 0 (unsatisfied) to 20 (highly satisfied). The superior and middle cephaloauricular distances were prospectively evaluated at 6 months after treatment. RESULTS: Complications included eight cases of localized skin burns and one case of dermatitis. The mean right/left superior and middle cephaloauricular distances were 10.5±1.5 mm/10.7±1.0 mm and 16.3±2.2 mm/16.3±2.8 mm, respectively, as compared to 17.5±2.9 mm/18.6±2.5 mm (P<0.01) and 24.5±2.6 mm/24.7±1.7 mm (P<0.01) before the operation. Mean patient satisfaction was 16.8/20±3.3. CONCLUSION: Despite promising results for cartilage reshaping, the 1064-nm LACR procedure often leads to skin burns and inflammatory tissue reaction after treatment. Moreover, LACR with the 1064-nm wavelength is painful and necessitates local anaesthesia. LEVEL OF EVIDENCE: 4.

Respuesta al comentario de la Dra. P. Erazo / No disponible

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Tratamiento del bruxismo con toxina botulínica tipo A. Estudio clínico prospectivo / Bruxism treatment with botulinum toxin type A. Prospective clinical study

Introducción y objetivo: El bruxismo (BRX) se define como rechinar y/o apretar los dientes, involuntaria e intensamente, debido a hipertrofia y/o contracción reiterada de los músculos masticatorios, especialmente los maseteros. Puede suceder durante el sueño o de día indistintamente. Los tratamientos empleados tienen la finalidad de limitar el daño sobre diferentes estructuras biológicas, especialmente la articulación témporo-mandibular (ATM), y oscilan desde oclusión irreversible, interposición de férulas, tratamiento farmacológico y/o terapias cognitivas, así como el empleo de toxina botulínica tipo A (TB-A). El objetivo de nuestro estudio fue investigar el efecto de relajación inducido por la inyección de TB-A en los maseteros y su relación con el alivio de los síntomas referidos por los pacientes con BRX. Material y método. Estudio clínico, prospectivo y longitudinal en 25 pacientes, mujeres, de 24 a 67 años (37.2 ± 10.7), desde setiembre de 2018 a marzo de 2019.Los controles de evaluación se realizaron antes, 2 semanas y 4 meses después del tratamiento con TB-A. Se tomaron fotografías digitales, se valoró el índice de desgaste dental de Smith-Knigth y se realizó ortopantomografía. Algunas pacientes aportaron resonancia magnética nuclear. Se tomaron medidas del diámetro bigonial mediante calibre digital y se valoró el grosor de los maseteros en reposo y contracción, por medición ecográfica. Resultados: Después del tratamiento con TB-A, el 24% de las pacientes se vieron libres de BRX y el 76% restante obtuvo gran mejoría; hubo escasos y transitorios efectos adversos. Conclusiones: La TB-A protege las estructuras orofaciales (dientes, músculos mandibulares, ATM) del daño inducido por el BRX, al tiempo que alivia el dolor y los síntomas relacionados con la excesiva contracción muscular

Background and objective: Bruxism (BRX) is defined as grinding or clenching of teeth, involuntarily and intensely, due to hypertrophy and/or contraction of muscles related to chewing, with particular involvement of masseters. It can happen during sleep or wakefulness indistinctly. Treatments are intended to limit destructive effects of BRX on different biological structures, especially the temporomandibular joint; are variable and range from irreversible occlusion, interposition of splints, pharmacological therapies, cognitive-behavioral approaches and the use of botulinum toxin type A (BoNT-A). The aim of this study was to investigate the relaxation effect of BoNT-A injection in masseter muscles and its relation to relief of symptoms in patients with BRX. Methods: This study is a clinical, prospective and longitudinal trial on 25 adult female patients between age ranges 24 to 67 (3.,2 ± 10.7), carried out from September 2018 to March 2019.Evaluation controls were done before, 2 weeks and 4 months after treatment with BoNT-A. Examination protocol in the trial included digital photography, Smith and Knight tooth wear index, orthopantomogra- phy and magnetic resonance imaging. Measurements of bigonial diameters were taken by calliper, at rest and during contraction, and the thickness of each masseter muscle was also evaluated in the same conditions, by ultrasound at every control. Results.As a result, after BoNT-A treatment, 24% of the patients were free of BRX, while the remaining 76% obtained a significant improvement, with few and transient adverse effects. Conclusions: BoNT-A can be used to protect oral-facial structures (such as teeth, jaw muscles, temporomandibular joint), from excessive forces and harmful damage caused by BRX, and to relieve accompanying pain and related complaints by decreasing the muscle forces exerted during contraction

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

[Laser-assisted lipolysis for gynecomastia: safe and effective skin retraction]. / Lipólisis láser y liposucción en ginecomastia: retracción cutánea eficaz y segura.

OBJECTIVES: To evaluate efficacy of laser lipolysis in the treatment of gynecomastia to correct breast volume, flaccidity and excess skin without its excision. METHODS: Prospectively, 32 patients with gynecomastia under tumescent anaesthesia and sedation underwent laser lipolysis with 980 nm diode laser, 15W continuous emission and 8 to 12 kJ energy per breast. Externally cold air was used to protect the skin. No drainages were used but a compressive bandage. Patients evaluated results on a VAS scale. Two doctors evaluated results comparing before and 6 month after photographs and also measured the areola and chest diameter. RESULTS: Twenty three patients considered results as Very Good, 7 Good and 2 Fair Cutaneous retraction of the areola was noticeable one month after the surgery and was maximum 6 months after. Evaluation by doctors was 26 Very Good, 5 Good and 1 Fair. There were no burns, ischemia or lesions in areolas or nipples. CONCLUSION: Laser assisted liposuction is a simple and efficacious technique, barely traumatic and permits a rapid reincorporation to normal activities.

Lipólisis láser y liposucción en ginecomastia: retracción cutánea eficaz y segura / Laser-assisted lipolysis for gynecomastia: safe and effective skin retraction

OBJETIVO: Valorar la eficacia de la lipólisis-láser para corregir el volumen, flacidez y excedente cutáneo sin escisión. MÉTODOS: Prospectivamente, en 32 pacientes con ginecomastia, bajo anestesia tumescente y sedación se realizó lipólisis con láser de diodo 980nm, 15W en emisión continua, 8kJ a 12kJ de energía por mama. Externamente se utilizó aire frío para protección de la piel. Después se utilizó lipoaspiración convencional. No se emplearon drenajes pero si vendaje compresivo. Los pacientes evaluaron los resultados en una escala visual analógica. Dos médicos evaluaron los resultados por fotografías de antes y seis meses después, y midieron las areolas y contorno torácico. RESULTADOS: Veintitrés pacientes consideraron los resultados como Muy Bueno, siete Bueno y dos Regular. La retracción cutánea en la areola fue notable un mes después de la intervención y fue máxima a los seis meses. La valoración de los médicos fue 26 Muy Bueno, cinco Bueno y un Regular. No existieron quemaduras, isquemia, ni lesiones en areolas o pezón. CONCLUSIÓN: La liposucción asistida por láser es eficaz y de ejecución sencilla, poco traumática y permite una temprana reintegración a las actividades.

OBJECTIVES: To evaluate efficacy of laser lipolysis in the treatment of gynecomastia to correct breast volume, flaccidity and excess skin without its excision. METHODS: Prospectively, 32 patients with gynecomastia under tumescent anaesthesia and sedation underwent laser lipolysis with 980nm diode laser, 15W continuous emission and 8 to 12 kJ energy per breast. Externally cold air was used to protect the skin. No drainages were used but a compressive bandage. Patients evaluated results on a VAS scale. Two doctors evaluated results comparing before and 6 month after photographs and also measured the areola and chest diameter. RESULTS: Twenty three patients considered results as Very Good, 7 Good and 2 Fair Cutaneous retraction of the areola was noticeable one month after the surgery and was maximum 6 months after. Evaluation by doctors was 26 Very Good, 5 Good and 1 Fair. There were no burns, ischemia or lesions in areolas or nipples. CONCLUSION: Laser assisted liposuction is a simple and efficacious technique, barely traumatic and permits a rapid reincorporation to normal activitie.