Non‐ablative scar revision using a long pulsed frequency doubled Nd:YAG laser

OBJECTIVE: Unsightly scars often are the only reminder of a previous surgical or traumatic wound. Surgical or ablative scar revision is sought by patients, sometimes unnecessarily. When the aesthetic drawback is mainly a result of hypervascularity or hyperpigmentation, these problems can be specifically targeted with a wavelength that is well absorbed by the two above mentioned chromophores. Some degree of epidermal tightening can also be achieved, which is sometimes useful in slightly atrophic scars.

The average improvement after 2–3 sessions was 81% (75%–100%) clearance, as judged by an independent observer who reviewed pre‐ and post‐treatment photographs. No undesired effects were reported. All our patients were satisfied and required no further treatment.

METHODS: Selective photothermolysis by means of a long pulsed frequency doubled Nd:YAG laser (DioLite^? 532, IRIDEX Corporation, Mountain View, CA, USA) was used to eliminate the unsightly vascular and pigmented components of 23 mature scars (scars older than 2 years) in 22 consecutive patients. Energy densities of 17–22?j/cm2 were used with a 500?micron spot, or 65–90?j/cm2 with a 200?micron spot.

RESULTS: overall scar clearance averaged 81% after 2.4 treatments. Facial scars showed the best clearance averaging 94% after 2 treatments. Inframammary scars were the most difficult to clear averaging 46%. Postoperative undesired effects were immediate erythema and swelling that subsided within 2–10?hours and microcrusting on 19/22 (88%) patients that resolved within one week. No other temporary or permanent undesired effects such purpura, hypo‐ or hyperpigmentation were noticed, even in patients with darker skin types.     

High‐frequency ultrasound evaluation of cellulite treated with the 1064 nm Nd:YAG laser

Objectives: To investigate non‐invasive laser treatment for cellulite using the 1064?nm Nd:YAG laser and to correlate clinical results with high‐frequency skin ultrasound images. Methods: Twelve individuals of normal weight were treated on either the left or right posterior side of the thigh with the following parameters: fluence 30?J/cm, 18?mm spot size and dynamic cooling device pulse duration of 30?ms. Three treatments were performed at intervals of 3–4 weeks, and followed‐up 1 and 3 months after the last session. Photographs and ultrasound imaging were assessed before each session. Results: The 1064?nm Nd:YAG laser resulted in a tightening of the skin and an improvement in cellulite. No side effects were reported. High‐resolution ultrasound imaging showed a significant improvement in dermis density and a reduction of dermis thickness. The method is described in detail in Appendix 1. Conclusion: Infra‐red lasers may constitute a safe and effective treatment for cellulite and high‐frequency ultrasound imaging provides a quantitative and objective measurement of the treatment efficacy.     

Response of spider leg veins to pulsed diode laser (810 nm): a clinical,histological and remission spectroscopy study

BACKGROUND: Spider leg veins are common. Their treatment with laser or intensed light therapy shows generally variable success rates and often adverse side effects such as hyper‐ or hypopigmentation. This study was performed to investigate whether pulsed diode laser (810?nm) treatment is effective and safe.

METHODS: Thirty‐five female patients with spider leg veins were included in this prospective trial. They were treated twice with a pulsed diode laser (810?nm; spot size 12?mm, frequency 2–4?Hz, pulse width 60?msec, fluence 80–100?Jcm^?2). Laser therapy was performed on day 0 and day 14. Clinical assessments were carried out before and immediately after the first laser therapy, after 2 weeks, 8 weeks, and one year. Skin biopsies were taken before and immediately after the first laser treatment, and after 10 weeks. Contact‐free remittance spectroscopy was performed before laser treatment, immediately after the first treatment, after 2 weeks and 8 weeks.

RESULTS: After the first treatment 15 patients showed a complete disappearance (CR) of spider leg veins; in the remaining 20 patients a remarkable improvement (RI) was noted (n=35). After six months of follow‐up CR was seen in 6 patients, RI in 6, a stable situation in 9, and scar formation in 1 patient (n=21). The effect was almost completely stable during one year of follow‐up. The examination of histological specimens before and after laser treatment showed no cellular inflammatory reaction. The mean vascular area was significantly reduced after the first (p<0.05) and after the second (p<0.05) laser treatment. Spectral analysis showed a marked decrease of peaks for oxygenized haemoglobin immediately after laser treatment and during the follow‐up. Safety profile was excellent without purpuric reaction or pigmentary changes. Mild scarring was observed in two patients at the end of follow‐up.

CONCLUSIONS: Pulsed diode laser therapy (810?nm) is an effective and safe treatment option for spider leg veins. The effects can be seen immediately. Objective monitoring by non‐invasive remission spectroscopy and histology of biopsy specimens demonstrates selectivity of the laser action.     

Long‐pulsed Nd : YAG laser: does it give clinical benefit on the treatment of resistant telangiectasia?

Background Long‐pulsed Nd : YAG laser has been used in treating larger and deep‐seated leg veins. Objective This study investigated the effectiveness and safety of long‐pulsed Nd : YAG laser to treat alae nasae and nasal tip telangiectasia. Methods Twelve patients were evaluated in a prospective IRB approved study. They had a history of previous unsatisfactory treatments with pulsed dye laser and/or intense pulsed light for their telangiectases on alae nasae and tip (4–12 times, average 5.8 times). All patients underwent a single treatment session using long‐pulsed Nd : YAG laser. Photographic images were taken. At 12‐week follow‐up, two independent physicians evaluated the percentage of vessels cleared, and patients were asked to rate their satisfaction with the procedure. Results Five men and seven women were enrolled (aged 43 ± 5.8 years). Total clearance of vessels was 78.3%. The number of vessels in diameter of 0.1 mm was reduced by 61.1% and that of vessels in diameter of 0.2–0.3 mm decreased by 92.2% on the average at 12‐week follow‐up. Eleven of 12 patients were very satisfied with the clinical results. One patient rated as ‘satisfied’ due to hyperpigmentation after the treatment, which improved at 12‐week follow‐up. Conclusion Long‐pulsed Nd : YAG laser can be considered as another effective and safe treatment modality for stubborn telangeictasia even on face, if applied cautiously.     

Efficacy of long‐ and short pulse alexandrite lasers compared with an intense pulsed light source for epilation: a study on 532 sites in 389 patients

BACKGROUND: Undesirable hair growth presents a significant problem for many patients, and photoepilation has become a very popular procedure in aesthetic and cosmetic practice. Among the systems used are the long‐ and short‐pulsed alexandrite lasers (LP‐Alex, SP‐Alex) and intense pulsed light (IPL) sources. The present study retrospectively examined the outcome of these systems from the viewpoint of efficacy and side effects.

PATIENTS AND METHODS: Three hundred and eighty‐nine patients (370 females and 19 males, mean age 36.4?yrs, skin types II–V) were admitted to the study, with a total of 532 treated sites. They were treated either with the LP‐Alex, SP‐Alex or IPL. Subjective evaluation and interview of the patients was held prior to every treatment session. Six to eight treatments were required with the alexandrite lasers, 2.4–2.8 months between treatments, and the IPL source required 8–9 treatments, 2–2.5 months apart.

RESULTS: No significant difference was seen between the LP‐ and SP‐Alex, or between both of them and the IPL source, although the period to regrowth was longer for the lasers. Erythema and oedema were more noticeable with the LP‐Alex, as were crusting and hyper‐ and hypopigmentation. Discomfort was greatest with the LP‐Alex and the IPL source. Hair induction at the borders of the treated area on the face and neck was seen only with the LP‐Alex, and correlated statistically significantly with any episode of severe erythema, crusting or hyperpigmentation.

CONCLUSIONS: There was no statistically significant difference between the LP‐, SP‐Alex and IPL photoepilation with regard to efficacy. Transient side effects were highest with the LP‐Alex, and least with the IPL system. In the LP‐Alex treated face and neck sites, 3.1% had hair induction in the borders of the treated areas.