Fractional treatment of aging skin with Tixel, a clinical and histological evaluation.

OBJECTIVE: This study presents clinical results of Tixel, a new fractional skin resurfacing system based on thermo-mechanical ablation technology. Tixel employs a hot (400°C) metallic tip consisting of 81 pyramids. Treatment is performed by rapidly advancing the tip to the skin for a preset tip-skin contact duration. Thermal energy transfer to the skin creates micro-craters by evaporation. METHODS: Treatment results with tip types, D and S, with high and low thermal conductivity, were evaluated. Twenty-six subjects received three facial treatments, with 4-5-week intervals between treatments, without analgesia or cooling. In addition, histopathologies of Tixel and CO2 laser were performed. RESULTS: Crater properties are related to contact duration and to thermal conductivity. The D tip created char-free ablative craters 100-320 µm wide with a thermal zone 100-170 µm deep. The S tip created non-ablative coagulation preserving the epidermis. Skin complexion improvement was achieved in all subjects; average treatment pain of 3.1/10, downtime of 0-1 days, and erythema clearance of 3.5 days. Subject's satisfaction was 75% and wrinkle attenuation was achieved in 75% of the cases. There was no incidence of bleeding, scarring, or post-inflammatory hyperpigmentation. CONCLUSIONS: Tixel may be used safely for ablative and non-ablative resurfacing with low pain, low downtime, and quick healing.

New vision in fractional radiofrequency technology with switching, vacuum and cooling.

INTRODUCTION: Since the introduction of fractional technology, various systems were launched to the market. The first generation of fractional RF systems created epidermal ablation with coagulative/necrosis of the dermis with sufficient clinical outcomes, but with some limitations. The aim of this study was to evaluate the efficacy and safety of SVC technology, based on the principle of separate biological responses. MATERIAL AND METHODS: Fifty-two patients were treated for 3-6 sessions using fractional RF handpiece and eight patients received combination treatments with non-invasive RF handpiece. RESULTS: All volunteers showed notable to significant improvement in the photoageing symptoms, without any significant complications or adverse events. DISCUSSION: Due to its wide spectrum of parameters, the SVC technology can promote different biological responses. Owing to the "Switching" technology, the control of energy depth penetration enables delivery of the necessary thermal dose to the targeted skin layer. In addition, this novel technology includes the "Vacuum" and "Cooling" mechanisms, each contributing to the safety of the treatment. The Smart Heat function reduces the necessary energy levels and thereby reduces the pain level and risks for side effects.

Fractional vaporization of tissue with an oscillatory array of high temperature rods: part I: ex vivo study.

BACKGROUND: Short pulse duration (∼0.1-5 milliseconds) CO2 lasers are perceived as excellent tools for vaporization of craters arrays in fractional skin resurfacing. OBJECTIVES: To present a thermo-mechanical ablation technology, which affects tissue identically to fractional CO2 lasers, however at a fraction of the size and cost of a laser. MATERIAL AND METHODS: The new technology is based on heating an oscillating array of thin metallic rods to a temperature of 400°C and advancing the rods into tissue down to a precise pre-selected depth for a duration of 0.1-5 milliseconds. As a result, an array of crater is vaporized with identical properties of those produced by CO2 lasers. An ex vivo test was performed with a thermo- metallic rod array prototype. RESULTS: Arrays of 10 × 10 vaporized micro-craters of 350 micron diameter, 200 micron depth have been produced with lateral thermal damage of 80 micron while thermal damage below craters was 80-250 micron. CONCLUSIONS: A resonating thermo-mechanical array of high temperature (350-400°C) rods is capable of producing an array of craters identical to those produced with pulsed CO2 lasers.

Inflammatory seborrheic keratosis resolution after hyperbaric oxygen therapy: Case presentation and pathophysiology review.

Seborrheic keratosis (SK) is a common epidermal tumor, consisting of a benign proliferation of immature keratinocytes. The natural history of SK is a slow progression over time and complete remission is not expected. The article presents the first case of a complete resolution of a large (2.5 cm diameter) SK lesion after hyperbaric oxygen therapy (HBOT). In addition to the case presentation, the pathophysiology of SK and the potential beneficial physiological effects of HBOT are reviewed and discussed.

Non-invasive therapy of wrinkles and lax skin using a novel multisource phase-controlled radio frequency system.

Abstract The last few years have shown an increased demand for non-invasive skin tightening to improve body contour. Since light (lasers or intense pulsed light sources) has a limited ability to penetrate deep into the tissue, radio frequency (RF) modalities were introduced for the reduction of lax skin to achieve skin tightening and body circumference reduction. This study presents the use of the novel 3DEEP technology for body contouring. 3DEEP is a next generation RF technology that provides targeted heating to deeper skin layers without pain or other local or systemic side effects associated with the use of the earlier generation RF systems available today. The study included 30 treatment areas on 23 healthy volunteers at two sites. The treatment protocol included four weekly and two bi-weekly (n= 6) treatments on different body areas. Results were evaluated by standardized photography and by circumference measurements at the treatment area, and were compared to changes in body weight. Significant improvement could be observed in wrinkles and skin laxity, and in the appearance of stretch marks and cellulite. Some changes appeared as early as after a single treatment. Circumference changes of up to 4.3 cm were measured.

Exploring channeling optimized radiofrequency energy: a review of radiofrequency history and applications in esthetic fields.

INTRODUCTION: Because of its high efficiency and safety, radiofrequency (RF) energy is widely used in the dermatological field for heating biological tissue in various esthetic applications, including skin tightening, skin lifting, body contouring, and cellulite reduction. This paper reviews the literature on the use of nonablative RF energy in the esthetic field and its scientific background. The purpose of this article is to describe in detail the extensive use of medical devices based on RF technology, the development of these medical devices over the years, and recent developments and trends in RF technology. METHODS: The authors conducted a systematic search of publications that address safety and efficacy issues, technical system specifications, and clinical techniques. Finally, the authors focused on their own clinical experiences with the use of patented Channeling Optimized RF Energy technique and mechanical massage. An in-vivo study was conducted in domestic pigs, with a thermal video camera. Twenty-seven female patients participated in a cellulite and body shaping study. The treatments were conducted according to a three-phase protocol. An additional 16 females participated in a skin tightening case study. All of the patients underwent three treatment sessions at 3-week intervals, each according to a protocol specific to the area being treated. RESULTS: The review of the literature on RF-based systems revealed that these systems are safe, with low risks for potential side effects, and effective for cellulite, body contouring, and skin tightening procedures. The in-vivo measurements confirmed the theory that the penetration depth of RF is an inverse function of its frequency, and using a vacuum mechanism makes an additional contribution to the RF energy penetration. The heating effect of RF was also found to increase blood circulation and to induce collagen remodeling. The results from the cellulite and body shaping treatments showed an overall average improvement of 55% in the appearance of cellulite, with an average circumferential reduction of 3.31 cm in the buttocks, 2.94 cm in the thighs, and 2.14 cm in the abdomen. The results from the skin tightening procedure showed moderate improvement of skin appearance in 50% and significant improvement in 31%. At the follow-up visits the results were found to be sustained without any significant side effects. CONCLUSION: Of all tissue heating techniques, RF-based technologies appear to be the most established and clinically proven. The design and specifications of the described vacuumassisted bipolar RF device fall within the range of the specifications currently prescribed for esthetic, nonablative RF systems.

A new lightening approach to acne treatment-combining therapy modalities for maximizing acne treatment: Phototherapy (LHE™), drugs, skin rejuvenation and skin tightening.

BACKGROUND: Combination therapies are increasingly being used for the treatment of acne. OBJECTIVE: 2 years of clinical experience using a combination of drugs with LHE™ phototherapy on moderate to severe acne patients. METHODS: Patients first underwent a series of 8-10 bi-weekly LHE treatments to reduce their dermal inflammatory process. These treatments were combined with keratolytic agents which are not contraindicated with phototherapy. The combined LHE/drug treatment regimen was followed by a series of LHE skin rejuvenation procedures to treat post acne symptoms of localized erythema, post inflammatory hyperpigmentation and scars. CONCLUSIONS: This double phototherapy protocol appears to offer excellent clinical and aesthetic results with no side effects or complications and may be repeated if relapse occurs.

Novel multi-source phase-controlled radiofrequency technology for non-ablative and micro-ablative treatment of wrinkles, lax skin and acne scars.

The basic properties of lasers and pulsed light sources limit their ability to deliver high energy to the dermis and subcutaneous tissues without excessive damage to the epidermis. Radiofrequency was shown to penetrate deeper than optical light sources independent of skin color. The early RF-based devices used single source bipolar RF, which is safe but limited in use due to the superficial flow of energy between the two bipolar electrodes. Another type of single source RF employs a single electrode (monopolar) in which the RF energy flows from one electrode on the surface of the skin through the entire body to a plate under the body. Although more effective than bipolar, this devices require intense active cooling of the skin and may be associated with considerable pain and other systemic and local safety concerns. Latest generation of RF technology developed by EndyMed Medical Ltd. (Caesarea, Israel) utilizes simultaneously six or more phase controlled RF generators (3DEEP technology). The multiple electrical fields created by the multiple sources "repel" or "attract" each other, leading to the precise 3 dimensional delivery of RF energy to the dermal and sub-dermal targets minimizing the energy flow through the epidermis without the need for active cooling. Confocal microscopy of the skin has shown that 6 treatment sessions of Multisource RF technology improve skin structure features. The skin after treatment had longer and narrower dermal papilla and denser and finer collagen fiber typical to younger skin as compared to pre treatment skin. Ultrasound of the skin showed after 6 treatment sessions reduction of 10 percent in the thickness of the subcutaneous fat layer. Non ablative facial clinical studies showed a significant reduction of wrinkles after treatment further reduced at 3 months follow-up. Body treatment studies showed a circumference reduction of 2.9 cm immediately after 6 treatments, and 2 cm at 12 months after the end of treatment, proving long term collagen remodeling effect. Clinical studies of the multisource fractional RF application have shown significant effects on wrinkles reduction and deep atrophic acne scars after 1-3 treatment sessions.

Reduction of pain and side effects in the treatment of solar lentigines with pneumatic skin flattening (PSF).

BACKGROUND: Energy densities utilized in the treatment of pigmented lesions such as solar lentigines with intense pulsed light systems are often limited by pain and post-treatment erythema and edema. The sensation of pain associated with the treatment is immediate and acute. Application of topical anesthesia is time-consuming, with only very moderate pain relief. OBJECTIVE: (a) To test pain reduction as well as the reduction of post-treatment erythema and edema when using pneumatic skin flattening (PSF). This new technology utilizes an evacuation chamber to generate skin compression and activates tactile neural receptors in the skin. The result is an afferent inhibition of pain transmission in the dorsal horn (the 'gate theory'). (b) To test the efficacy of PSF. METHODS: Twenty patients were treated for solar lentigines. The patients were treated by three different IPLs. The evaluation of acute pain and post-treatment erythema and edema was performed on all 20 patients: one to three sites per patient treated with PSF and the same number of control sites without PSF. Identical energies and IPL were applied to both sites on each patient. The pain evaluation was performed on a 10-level scale modified McGill Pain Questionnaire. The clinical response to treatment was also evaluated. RESULTS: All 20 patients completed the study and preferred the PSF treatment side over the non-PSF side. Substantial pain reduction was observed in 19/20 patients (95%). The average reduction of pain was by two levels, from very painful to very mild pain. Erythema reductions were observed on 14/18 (77%) patients and edema reduction on 8/9 (88%) patients. Treatment efficacy on PSF sites was identical to that of non-PSF sites. CONCLUSION: The pneumatic skin flattening (PSF) technology considerably reduces pain, erythema and edema in the treatment of solar lentigines by IPLs. Treatment efficacy is preserved. The enhanced safety of PSF enables the increase of energy density and the acceleration of results.

Pneumatic skin flattening (PSF): a novel technology for marked pain reduction in hair removal with high energy density lasers and IPLs.

BACKGROUND: Intense pulsed light (IPL) aesthetic treatment, such as hair removal from large areas, is often very painful. The problems of pain and discomfort can be divided into two different phases: immediate acute pain and the long-term, milder, post-treatment discomfort also associated with erythema. The immediate acute pain is felt during each treatment pulse and can accumulate to an intolerable sensation after a few shots, resulting in the necessity of either using topical analgesic creams which have several limitations or else to considerably slow down the process and/or apply less efficient low-energy densities. The immediate pain is created by the stimulation of sensory nerves located near the basal layer of the epidermis and adjacent to the treated hair follicles. There is an interest in a technology which would significantly reduce acute pain and post-treatment erythema, without the necessity of lowering the energy density or speed of treatments. OBJECTIVES: To examine the advantages of pneumatic skin flattening (PSF) with negative pressure: (i) for the reduction or elimination of pain, without chilling the skin, during hair removal with high energy density IPLs and pulsed lasers; (ii) for the reduction of post-treatment erythema; and (iii) for the enhancement of hair removal. MATERIALS AND METHODS: We have removed hair from large areas such as legs and backs with a high-energy (42 J/cm2) pulsed diode laser and an IPL (15-20 J/cm2). Room temperature gel was applied to the skin before treatment. In all cases but one, skin was not chilled by external cooling devices. We utilized a vacuum chamber and a transparent sapphire window to generate deep negative pressure in the treatment site and flatten the skin against the window. The level of applied vacuum was in the 200-600 mmHg range. We have compared the level of pain (I-V according to a modified McGill Pain Questionnaire) and the efficacy of hair removal on a total of 40 treatment sites The results of the vacuum-assisted treatment sites were compared with the results on adjacent control areas, obtained without the application of vacuum. Post-treatment erythema was also compared. RESULTS AND CONCLUSIONS: PSF significantly reduces pain in all patients, even when higher (+30%) treatment energy levels are applied. Skin is well protected thermally by the conductive sapphire window. Post erythema and edema is considerably reduced, as well. Hair removal efficacy is preserved or enhanced. Treatment is faster and is uninterrupted by pain, without the necessity to apply topical anesthetic over a large area. Blood expulsion resulting from flattening the skin has also enabled the treatment of thin hair in light-skinned patients, using yellow and green wavelengths (540 nm cut-off filter) and short pulse durations with a higher efficacy than with the 650 nm cut-off filter.

Accelerated reduction of post-skin-resurfacing erythema and discomfort with a combination of non-thermal blue and near infrared light.

The prolonged crusting and erythematic phases following chemical and laser skin resurfacing create discomfort and aggravate patients. Depending on the aggressiveness of the procedure, post-procedure erythema may last from three weeks to several months. iClearXL (CureLight Ltd) is a non-contact, non-thermal blue (405-420 nm)/near infrared (850-900 nm) dual-band light source emitting up to 60 J/cm2 on a 30 cm by 30 cm treatment area. The blue component of the light source has been proven to have a significant anti-inflammatory effect, whereas the near infrared component enhances vascular circulation as well as lymphatic drainage in the thin, necrotized papillary layer. Facial skin laser resurfacing was performed on twelve patients. Starting one day after resurfacing, six patients received a daily 20-minute treatment of blue (405-420 nm)/near infrared (850-900 nm) light for six consecutive days, and six control patients were treated with the usual topical care protocol. Twelve days after the procedure, the treated group had a weighted average erythema score of 0.33 as compared to 1.33 in the control group. Two months after the procedure, the treated group had a weighted average erythema score of 0.16 as compared to 0.83 in the control group. Twelve days after the procedure, the treated group had a weighted average discomfort score of 0.33 as compared to 0.83 in the control group. The tested combination of non-thermal blue (405-420 nm)/near infrared (850-900 nm) dual-band light was found to significantly shorten the duration of post-laser-resurfacing erythema and discomfort with no side effects.

The utilization of nonthermal blue (405-425 nm) and near infrared (850-890 nm) light in aesthetic dermatology and surgery-a multicenter study.

BACKGROUND: A major cause of skin aging is a chronic micro-inflammation triggered by UV radiation and external pollutants. It has been demonstrated that blue light diminishes inflammatory conditions and near infrared light enhances circulation. OBJECTIVES: To assess the effectiveness of a non thermal dual wavelength -- blue (405 - 420 nm) and near infrared (850 - 900 nm) -- light source in skin rejuvenation, in the reduction of the duration of post skin resurfacing erythema and in the acceleration of healing of post surgical conditions (face lift and breast augmentation). METHODS: We have utilized a non contact, hand free dual wavelength light source (iClearXL and Clear100XL, Curelight Ltd) to treat over 60 patients and perform three controlled studies in four centers. Follow up duration was three months. Control group for photo-rejuvenation consisted of patients treated with Glycolic peeling and daily appliance of vitamin C Control group for post skin resurfacing erythema duration consisted of patients untreated by the light source and control group for post surgical healing consisted of patients untreated by the light source or treated by the light source on one side only. RESULTS: Post skin resurfacing erythema duration is reduced by 90%. The healing of post surgical conditions is substantially accelerated and discomfort is reduced. The anti aging effect of the light source includes: reduction of pore size in 90% of patients with stable results at three months follow up, enhanced skin radiance in 90% of patients with stable results at three months follow up and smoothing of fine wrinkles in 45% of patients with stable results at three months follow up. The control group showed poor results which were stable for a duration of less than one month. CONCLUSIONS: A non thermal, non contact / hand free light source emitting at 405-420 nm and 850-900 nm considerably enhances aesthetic and surgical aesthetic procedures without consuming user time.

Light therapy in the treatment of acne vulgaris.

BACKGROUND: Over the past decade, lasers and light-based systems have become a common modality to treat a wide variety of skin-related conditions, including acne vulgaris. In spite of the various oral and topical treatments available for the treatment of acne, many patients fail to respond adequately or may develop side effects. Therefore, there is a growing demand by patients for a fast, safe, and side-effect-free novel therapy. OBJECTIVES: To address the role of light therapy in the armamentarium of treatments for acne vulgaris, to discuss photobiology aspects and biomedical optics, to review current technologies of laser/light-based devices, to review the clinical experience and results, and to outline clinical guidelines and treatment considerations. RESULTS: Clinical trials show that 85% of the patients demonstrate a significant quantitative reduction in at least 50% of the lesions after four biweekly treatments. In approximately 20% of the cases, acne eradication may reach 90%. At 3 months after the last treatment, clearance is approximately 70% to 80%. The nonrespondent rate is 15% to 20%. CONCLUSIONS: Laser and light-based therapy is a safe and effective modality for the treatment of mild to moderate inflammatory acne vulgaris. Amelioration of acne by light therapy, although comparable to the effects of oral antibiotics, offers faster resolution and fewer side effects and leads to patient satisfaction.

The role of pulsed light and heat energy (LHE) in acne clearance.

BACKGROUND: Propionibacterium acnes synthesize and store a large amount of porphyrins. Once the porphyrin is exposed to visible light it becomes chemically active and transfers to an excited state, resulting in the formation of singlet oxygen, which combines with cell membranes to destroy the P. acnes. This process is dependent on the rate of production of excited porphyrin molecules, which is influenced by the concentration of porphyrins, the concentration of photons, the temperature, and the wavelength of the photons. METHODS: Nineteen patients with mild to moderate acne underwent bi-weekly treatments for 4 weeks using the ClearTouch system. During each treatment, pulses of light and heat were applied. Each pulse used an average energy density of 3.5 J/cm(2), a pulse width of 35 ms, and a wavelength between 430 and 1100 nm. RESULTS: At the end of the eighth treatment, acne clearance for the non-inflammatory and inflammatory lesions was 63 +/- 21% and 50 +/- 32%, respectively. One month after the last treatment, the acne clearance for non-inflammatory and inflammatory lesions was 79 +/- 22% and 74 +/- 20%, respectively, with further improvement in acne clearance at 2 months after the last treatment (85 +/- 17% and 87 +/- 25%, respectively). CONCLUSION: ClearTouch pulsed light and heat energy (LHE) technology is effective and safe for the treatment of acne vulgaris.

Conversion of aesthetic lasers and intense pulsed light sources into inherently eye-safe units.

BACKGROUND: Laser systems used in aesthetic treatments pose a serious risk to the eyes of bystanders and equipment operators. Although much safer than lasers, intense pulsed light (IPL) sources are also not without risk. OBJECTIVE: To present a technology that can convert most lasers and IPL units used in aesthetic clinics into inherently eye-safe devices not requiring the use of protective eyeglasses, thus making them Class I devices. With the exception of Q-switched lasers, this new technology also dramatically reduces the potential hazards of lasers that do not attain Class I level to below that attributed to flashlamps. A device that eliminates the annoying glare generated by the reflection of pulsed light from the skin is also presented. MATERIALS AND METHODS: The new eye-safe technology is based on the attachment of a highly efficient wide-angle forward scattering optical diffuser to the distal end of the laser delivery handpiece. This device is used in contact with the treated area without modification of the conventional treatment parameters and preserves clinical efficacy. The handpiece is designed to act as an eye-safe, extended diffusing light source complying with Class I eye safety standards in most laser types. The technology also makes IPL devices safer by reducing the radiance of the flashlamp, which is hazardous when viewed directly by operators or bystanders. Skin glare is also eliminated by a liquid crystal, glare-free window activated in synchronization with the treatment pulses. RESULTS: Clinical hair removal results with an 80 degree diffuser did not reveal any difference when compared with results obtained with the original laser source. The incorporation of a diffuser in an IPL unit has not modified its clinical efficacy. CONCLUSION: With the exclusion of Q-switched lasers, it is possible to convert a large number of lasers and IPL units utilized in aesthetic treatments into inherently eye-safe units, thereby considerably enhancing the comfort and safety of aesthetic clinics without sacrificing clinical efficacy.

The effective treatment of acne vulgaris by a high-intensity, narrow band 405-420 nm light source.

BACKGROUND: Available topical treatments are slow and frequently irritating. Oral therapies may be associated with increased bacterial resistance (antibiotics) or possible severe side effects (oral isotretinoin). In vitro and in vivo exposure of acne bacteria to 405-420 nm ultraviolet (UV) free blue light results in the photo-destruction of these bacteria through the effects on the porphyrins produced naturally by Propionibacterium acnes. A novel, high-intensity, narrow band 420 nm UV free blue light has been shown to decrease inflammatory acne lesions after eight bi-weekly treatments. OBJECTIVES: To examine the effects of high-intensity, narrow band 420 nm UV free blue light (ClearLight) on inflammatory acne lesions. METHODS: Three studies were carried out to examine the clinical effects of high-intensity, narrow band blue light on papulo-pustular acne: the split-face dose-response study, the full-face open trial and the split-face, double-blind controlled study. The studies enrolled 10, 13 and 23 patients respectively. RESULTS: The data show more than an 80% response to 420 nm acne phototherapy with a significant reduction of 59-67% of inflammatory acne lesions after only eight treatments of 8-15 minutes. The reduction in lesions was steady in the follow-ups at 2, 4 and 8 weeks after the end of therapy. Prolonged remission was evident in the 8 weeks after the end of therapy. No adverse effects or patient discomfort were noted in any of the patients. CONCLUSIONS: Acne phototherapy by high intensity, narrow band 405-420 nm light is proven to be an attractive, fast, effective, non-invasive alternative to current topical and parenteral anti-acne remedies.