Laser-assisted blepharoplasty: An innovative safe and effective technique.

BACKGROUND: Blepharoplasty is one of the most popular esthetic procedures with an acceptable risk profile and a relatively quick procedure. METHODS: The aim was to evaluate the efficacy and safety of a new CO2 and 1540-nm laser-assisted blepharoplasty technique applied to the upper and lower eyelids. A total of 38 patients were enrolled. Photographs were taken before the treatment and at 6-month follow-up. One "blind" observer assessed the performance of this technique by ranking the results in four categories of eyelid esthetic: 1 = no or poor results (0%-25%), 2 = slight improvement (25%-50%), 3 = moderate improvement (50%-75%) and 4 = marked improvement (75%-100%). All possible complications were monitored. RESULTS: Thirty-two patients (84 %) achieved marked improvement, four patients (11%) moderate improvement, two patients (5 %) slight improvement, while zero subjects (0%) poor or no improvement. No serious adverse effects were observed. CONCLUSIONS: Our results from clinical evaluations suggest that the CO2 and 1540-nm laser assisted blepharoplasty is proved to be a sophisticate intervention efficacious in improving the treatment of patients with various degrees of eyelid and periocular aging and also in reducing downtime.

Treatment of benign hyperpigmentations and pigmented scars by 755 alexandrite laser comparing the Single Pass versus MultiPass (MoveoPL) emission in skin types I-IV.

Lasers are effective treatments for benign hyperpigmentations but may be difficult especially in darker skin type. In this randomized split-face controlled study on benign hyperpigmentations and pigmented scars, we compare the standard Single Pass (SP) emission with the MultiPass emission (MoveoPL) 755 alexandrite laser. Patients, skin types I-IV, with solar lentigines and ephelides of the face, chest, and hands and patients with pigmented scars of the legs, underwent laser treatment, by treating one side of the body or half scar using the SP and the other side using MoveoPL. Improvements according to a grading score system, side effects, and patient satisfaction were recorded. About 63 patients were enrolled. An overall improvement of benign hyperpigmentations and pigmented scars was recorded, with a grading score (±SD) of 2.8 ± 0.8 for SP and 3.6 ± 0.5 for MoveoPL (range, 0-4). SP emission showed best results in skin types I-II whereas MotusPL obtained successfully results in all the phototypes analyzed (types I-IV). Patients preferred MoveoPL as it was associated with fewer side effects. Both standard SP and MoveoPL emission are effective and safe. MoveoPL showed a higher efficacy and safety profile for the treatment of hyperpigmentations.

Safety and efficacy of single pass vs multipass emission with 755 alexandrite laser for all-skin-type hair removal: A pilot study.

Lasers are considered the most efficient methods for hair reduction. The goal of these devices is to provide long-term effects without adverse reactions. This is a randomized split-body controlled study on body hair removal and pseudofolliculitis (PFC) treatment, comparing the standard single pass (SP) emission with the multipass emission (Moveo handpiece) with 755 alexandrite laser. Patients with Fitzpatrick skin types I to VI underwent laser hair removal, by treating one side of the body using the standard SP and the other side with Moveo. Treated areas included face, arms, legs, trunk, axillae and groins. Each patient underwent a minimum of three to a maximum of eight treatments, every 6 weeks, with a 6-month follow-up. Hair reduction, side effects, PFC severity score and patient satisfaction were recorded for all patients. Totally, 108 patients were enrolled, of whom 96 were female. The overall hair reduction rate (% ± SD), independent of skin type, was estimated as 87 ± 5.5 for standard SP and 78.5 ± 7.6 for Moveo. No significant statistically differences were found between the two groups. Side effects included pain, which was higher after standard SP (4.2 ± 0.8) than after Moveo treatment (1.5 ± 0.5). A statistical significant difference between the two devices was found (P = .0002). PFC score improved in almost all the patients. Patients declared to be satisfied with both the treatments, reporting a preference for Moveo (84% vs 16%) (P = .01). Standard SP and Moveo 755 alexandrite laser seems to be safe and effective treatments for hair removal in all Fitzpatrick skin types and for PFC. Moveo has a higher security profile with fewer side effects.

Combined pulsed dye laser and Q-switched Nd:YAG laser intraumatic facial tattoo removal: A case series.

Traumatic tattoos can be treated with several methods, including mechanical and chemical devices. However, they are rarely used due to the high risk of permanent side effects such as scarring and depigmentation. Recently, laser devices, especially the Q-switched (QS) laser and the pulsed dye laser (PDL), applied in combination, have achieved complete clearance of the lesions without any risk of side effects. Herein, we reported three cases of traumatic facial tattoos successfully treated with combined PDL and QS Nd:YAG laser.

Island flaps in the repair of medial canthus: report of 8 cases.

Reconstruction of the medial canthus following skin cancer excision is often challenging because of the complex anatomy and the cosmetic relevance of that region. The island pedicle advancement flap is an extremely versatile flap, which is commonly used to close defects in different body areas, including face, trunk, and extremities. We report our favourable experience with the use of island flaps, mobilized from the nasal saddle or lateral nasal side wall in 8 patients who had skin defects on the medial canthus region after Mohs micrographic surgery for basal cell carcinomas.

Recurrent distal digital keratoacanthoma of the periungual region treated with Mohs micrographic surgery.

We report a 42-year-old man who presented with a recurrent painful nodule on the proximal nail fold of the left fifth finger. The tumour had been surgically excised at another department a month earlier, and histological examination had shown a keratoacanthoma. The patient underwent Mohs micrographic surgery, and no recurrence was evident 16 months later. Mohs micrographic surgery appears to be an effective option in the management of this unusual variant of keratoacanthoma, which is often difficult to eradicate.

Highlights of thirty-year experience of CO2 laser use at the Florence (Italy) department of dermatology.

The CO(2) laser has been used extensively in dermatological surgery over the past 30 years and is now recognised as the gold standard for soft tissue vaporization. Considering that the continuous wave CO(2) laser delivery system and the newer "superpulsed" and scanned CO(2) systems have progressively changed our practice and patient satisfaction, a long range documentation can be useful. Our experience has demonstrated that the use of CO(2) laser involves a reduced healing time, an infrequent need for anaesthesia, reduced thermal damage, less bleeding, less inflammation, the possibility of intra-operative histologic and/or cytologic examination, and easy access to anatomically difficult areas. Immediate side effects have been pain, erythema, edema, typically see with older methods, using higher power. The percentage of after-treatment keloids and hypertrophic scars observed was very low (~1%) especially upon the usage of lower parameters. The recurrence of viral lesions (condylomas and warts) have been not more frequent than those due to other techniques. Tumor recurrence is minor compared with radiotherapy or surgery. This method is a valid alternative to surgery and/or diathermocoagulation for microsurgery of soft tissues. Our results are at times not consistent with those published in the literature, stressing the concept that multicentric studies that harmonization methodology and the patient selection are vital.

Letter: The "reading man" flap in facial reconstruction: report of 12 cases.

Reconstruction of defects in the infraorbital, malar, and temporal areas after tumor resection may present problems such as distortion of anatomic points and extra normal skin removal. The "reading man" flap is a recent local flap procedure, which has been used to solve those problems. We report our experience with this procedure, which has been used for the closure of circular defects in 12 patients (7 men and 5 women), aged 68 to 86 years (mean age: 77 years), who had undergone surgical excisions of basal cell carcinomas of the temporal, malar, and infraorbital regions. The functional and aesthetical results were satisfactory in all cases. In our experience, the "reading man" flap is a useful option for the reconstruction of circular defects in these facial areas.

Targeted and combination treatments for vitiligo. Comparative evaluation of different current modalities in 458 subjects.

The current treatment of vitiligo is not satisfactory according to the opinions of both the patient population and the dermatologists. Recently, combination therapies have been introduced, which are both systemic and targeted (microphototherapy). To evaluate the effects of topical treatments given alone or in combination with 311-nm narrow-band microphototherapy. We evaluated the efficacy and safety of: (1) 311-nm narrow-band microphototherapy;(2) tacrolimus 0.1% ointment twice a day; (3) pimecrolimus 1% cream twice a day; (4) betamethasone dipropionate 0.05% cream twice a day; (5) calcipotriol ointment 50 microg/g twice a day; and (6) 10%l-phenylalanine cream twice a day, for the treatment of exclusively vitiligo patches. A 311-nm narrow-band microphototherapy (Bioskin) was given alone or in combination with the above-mentioned popular local treatments. Four hundred and seventy patients suffering from vitiligo that affected less than 10% of the skin surface were evaluated. The patients were divided into 11 groups according to the selected treatment modalities. Four hundred and fifty-eight patients completed the study period of 6 months. Excellent repigmentation (> 75%) was achieved by 72% of the patients in group 1, 76.5% in group 2, 76.1% in group 3, 90.2% in group 4, 75.6% in group 5, 74.8% in group 6, 61% in group 7, 54.6% in group 8, 71.2% in group 9, 59.1% in group 10, and 29.3% in group 11. Marked repigmentation (50-75%) was evident in 19.8% of the patients in group 1, 18.2% in group 2, 20.1% in group 3, 6.7% in group 4, 14.1% in group 5, 11.3% in group 6, 16.1% in group 7, 18.4% in group 8, 25% in group 9, 10.6% in group 10, and 8.1% in group 11. Moderate results (25-50% repigmentation) were seen in 4.6% of the patients in group 1, 3.3% in group 2, 2.7% in group 3, 2.2% in group 4, 7.4% in group 5, 10.1% in group 6, 18.4% in group 7, 21.7% in group 8, 2.1% in group 9, 27.1% in group 10, and 55% in group 11. Finally, minimal (< 25%) or no response was achieved in 3.6% of the patients in group 1, 2% in group 2, 1.1% in group 3, 0.9% in group 4, 2.9% in group 5, 3.8% in group 6, 4.5% in group 7, 5.3% in group 8, 1.75% in group 9, 3.2% in group 10, and 7.6% in group 11. Side effects were skin atrophy (76% in group 4 and 81% in group 9), stinging and burning (groups 2, 3, 7, and 8). Targeted combination therapies in vitiligo are remarkably more effective than single treatments. When single treatments are considered alone, 311-nm narrow-band UVB microfocused phototherapy and 0.05% betamethasone dipropionate cream are the most effective treatments in our study. When combined therapies are chosen, 0.05% betamethasone dipropionate cream plus 311-nm narrow-band UVB microfocused phototherapy apparently give the highest repigmentation rate. In the short term, the only side-effects registered have been cutaneous atrophy with corticosteroid cream, and stinging and burning with 0.1% tacrolimus ointment and, less frequently, with 1% pimecrolimus cream.

Receptors in skin ageing and antiageing agents.

Skin ageing is an irreversible process during which ultrastructural and physiologic alterations happen. Dermatology has focused a lot of attention on the reversal of signs of ageing and photodamage, with the purposes of achieving cosmetic benefits and preventing photocancerogenesis. Recent advances in skin biology have clarified the mechanisms by which photoageing occurs and have given rise to new treatments to prevent and reverse this process. The understanding of the role of key receptors involved in the complex pathomechanism of skin ageing probably will lead to the development of the new therapeutic agents in the near future.

In vivo non-invasive monitoring of collagen remodelling by two-photon microscopy after micro-ablative fractional laser resurfacing.

Non-linear optical microscopy is becoming popular as a non-invasive in vivo imaging modality in dermatology. In this study, combined TPF and SHG microscopy were used to monitor collagen remodelling in vivo after micro-ablative fractional laser resurfacing. Papillary dermis of living subjects, covering a wide age range, was imaged immediately before and forty days after treatment. A qualitative visual examination of acquired images demonstrated an age-dependent remodelling effect on collagen. Additional quantitative analysis of new collagen production was performed by means of two image analysis methods. A higher increase in SHG to TPF ratio, corresponding to a stronger treatment effectiveness, was found in older subjects, whereas the effect was found to be negligible in young, and minimal in middle age subjects. Analysis of collagen images also showed a dependence of the treatment effectiveness with age but with controversial results. While the diagnostic potential of in vivo multiphoton microscopy has already been demonstrated for skin cancer and other skin diseases, here we first successfully explore its potential use for a non-invasive follow-up of a laser-based treatment.

Kaposi sarcoma of the penis in an HIV-negative patient.

BACKGROUND: The penis is an unusual site of presentation for Kaposi sarcoma, especially in immunocompetent patients. CASE PRESENTATION: A 52-year-old human immunodeficiency virus (HIV)-seronegative man presented with a reddish, 8 mm in diameter nodule on the glans penis near the coronal sulcus. Histopathology after excision of the lesion was consistent with Kaposi sarcoma. No other cutaneous or mucosal manifestations were present. After a follow-up period of 2 years, no recurrence was observed. CONCLUSION: This unusual case suggests that Kaposi sarcoma should be considered in the differential diagnosis of macular, papular, and nodular lesions involving the penis.

Melasma: treatment with 10% tretinoin peeling mask.

BACKGROUND: Melasma is one of the most frequently acquired hyperpigmentation disorders clinically characterized by symmetrical brown patches on sun exposed areas. The first approach is an avoidance of sun exposure and inflammation combined with a use of photoprotection. Patient treatment is particularly difficult and challenging, and necessitates consideration of many therapies, including tretinoin to obtain an amelioration of this important skin condition. AIMS: To evaluate the efficacy of a 10% tretinoin peeling mask before and after treatment using standardized digital photos, mexameter measures, and melasma area and severity index (MASI) evaluation. PATIENTS/METHODS: The present study was carried out on 20 female patients. RESULTS: Physician global evaluation showed moderate or marked improvement of melasma in all patients using three parameters of assessment: digital photography, mexameter measurement, and the MASI. CONCLUSIONS: Tretinoin peeling mask can be considered an alternative treatment modality in treating melasma. We noted a particular high tolerability and efficacy without adverse events.