Hand rejuvenation using intense pulsed light

BACKGROUND: The aging of the hands is typically characterized by wrinkles, skin thinning, and solar lentigines. The search for effective treatments has led to the use of laser and intense pulsed light (IPL) technologies. OBJECTIVE: To assess the effectiveness of an IPL device for the improvement of dyspigmentation and overall skin quality on the dorsa of the hands. METHODS: Twenty-three patients with sun damage and solar lentigines on the dorsal hands were treated with four IPL sessions at 3- to 4-week intervals. Prior to treatment, photographs were taken and informed consent was obtained. Pre- and post-treatment photography and investigator clinical assessment and patient questionnaires were collected for data analysis. RESULTS: After four treatment sessions, good to excellent results in the improvement in solar lentigines and skin quality were assessed by investigators in 100% of the cases and in 86.94% (20 of 23 subjects) by patient self-assessments. No significant side effects were observed. CONCLUSION: IPL is an effective and safe treatment option to improve solar lentigines and skin texture for hand rejuvenation.     

Acne scarring treatment using skin needling

Background. Acne is a common condition seen in up to 80% of people between 11 and 30 years of age and in up to 5% of older adults. In some patients, it can result in permanent scars that are surprisingly difficult to treat. A relatively new treatment, termed skin needling (needle dermabrasion), seems to be appropriate for the treatment of rolling scars in acne. Aim. To confirm the usefulness of skin needling in acne scarring treatment. Methods. The present study was conducted from September 2007 to March 2008 at the Department of Systemic Pathology, University of Naples Federico II and the UOC Dermatology Unit, University of Rome La Sapienza. In total, 32 patients (20 female, 12 male patients; age range 17–45) with acne rolling scars were enrolled. Each patient was treated with a specific tool in two sessions. Using digital cameras, photos of all patients were taken to evaluate scar depth and, in five patients, silicone rubber was used to make a microrelief impression of the scars. The photographic data were analysed by using the sign test statistic (α < 0.05) and the data from the cutaneous casts were analysed by fast Fourier transformation (FFT). Results. Analysis of the patient photographs, supported by the sign test and of the degree of irregularity of the surface microrelief, supported by FFT, showed that, after only two sessions, the severity grade of rolling scars in all patients was greatly reduced and there was an overall aesthetic improvement. No patient showed any visible signs of the procedure or hyperpigmentation. Conclusion. The present study confirms that skin needling has an immediate effect in improving acne rolling scars and has advantages over other procedures.     

Longitudinal study of skin aging: from microrelief to wrinkles

Aim: To study the changes in skin microrelief and periocular wrinkles during the aging process. Methods: Replicas of the crow's feet area of volunteers were recorded in 1987 and 2008 and observed comparatively. Characteristic features were quantified by image analysis. Results: Observation shows that some microrelief features disappear and even merge with wrinkles that become more marked. Some primary lines also tend to merge to form thin new wrinkles. Quantitative data support these observations: the size of small and medium objects of skin relief decreases with age while large objects are becoming larger. Conclusion: Over 21 years, in the group studied, the total area of the detected objects remains quite constant. Only the distribution between small and large detected objects (microrelief features and wrinkles, respectively) is modified.     

A pilot investigation to subjectively measure treatment effect and side-effect profile of non-ablative skin remodeling using a 532 nm, 2 ms pulse-duration laser

BACKGROUND AND OBJECTIVE : Carbon dioxide laser skin resurfacing has become a standard treatment for wrinkles and sun-damaged skin. This ablative treatment, however, is associated with undesirable complications and long recovery times. A growing body of evidence suggests that dermal inflammation and subsequent collagen formation can be stimulated without removal of the epidermis, raising the possibility of effective non-ablative skin remodeling for mild to moderately photodamaged skin. MATERIALS AND METHODS : This preliminary study was performed to evaluate the safety and subject satisfaction of non-ablative skin remodeling using a 532 nm, 2 ms pulse-duration, frequency-doubled Nd:YAG laser. Subjects with mild-to-deep lip wrinkles and mild-moderate acne scarring were treated one half of their lip (wrinkles) or cheek (acne scarring), leaving the other side as an untreated control. Subjects were treated at 3-6 week intervals for an average of three treatments. Subjective assessment of improvement was estimated by subject self-evaluation of the percentage improvement over baseline, and a blinded observer attempted to identify the treated side on physical examination. RESULTS : Subjective assessment revealed an average improvement of 51.4% and 53.6% for upper lip wrinkles and facial acne scarring, respectively. Side effects were limited to transient erythema that resolved over 0.25-2 hours following treatment. CONCLUSIONS : These results demonstrate that non-ablative treatment with the 532 nm, 2 ms pulse-duration Nd:YAG laser results in subjective improvement of rhytides and acne scarring, with a high safety profile.     

The filtrum remodelling with combined Er:YAG CO 2 laser resurfacing

BACKGROUND: Upper lip wrinkles develop with aging and they can be successfully treated with laser resurfacing. The treatment eliminates the wrinkles and, ideally, should also recover the aesthetic configuration. METHODS: This report includes 32 patients treated for wrinkles of the upper lip with the Derma? K. The first pass was done using 29 J/cm 2 , 5 Hz, 3 mm collimated spot size, plus the CO 2 laser 5 W, 50% duty cycle, 50% overlapping. Following this pass, Derma? K was reprogrammed to emit only with the Er:YAG at 1.4 J/cm 2 , 10 Hz, approximately 50% overlapping and with a beam diameter of 3 mm. Then, several passes were done where wrinkles could still be seen, focusing on the area corresponding to the filtrum . Biopsies were taken to examine possible particular implications of underlying muscle and its role in the recovery of anatomic aesthetics of young lip characteristics when using the proposed technique. RESULTS: Using Derma? K resurfacing with extra passes of the Er:YAG at relatively low density, at the aforementioned area, it was possible to achieve the recovery of the aesthetic youthful appearance of the upper lip. Also, the shape of the filtrum recovered its youthful appearance together with the cupid's bow shape. Histology samples collected at the end of resurfacing showed that the laser thermal effect was also related to muscle fibres due to the proximity of this layer to the dermis because of the narrow subcutaneous fat layer. CONCLUSION: The combination of Er:YAG and CO 2 laser of Derma? K has potential to enhance the results of resurfacing for elimination of wrinkles of the upper lip. Moreover, the fact that only one laser pass of high energy density is used permits clear and secure control of treatment, preventing complications and obtaining good results.     

Sutures and Burrow''s triangles placed in the red vermilion in the surgery of upper lip defects

BACKGROUND: In upper lip defects both the design of the flap and the position of the Burrow's triangles may be reversed so as to conceal the scars among skin wrinkles, folds and the mucosal lip to maximize the aesthetic outcome. OBJECTIVE: To report two cases of upper lip defects in which both scars and Burrow's triangles were concealed in the natural folds and the vermilion. METHODS: Both surgeries were performed under local anaesthesia. RESULT: In both patients the scars were successfully concealed and the results aesthetically acceptable. CONCLUSION: The technique described can be used to conceal scars in cases of upper lip defects with aesthetically acceptable results.     

Hair Removal Using a New Intense Pulsed Light Source in Chinese Patients

Background: Unwanted hair is a widespread cosmetic problem. Several lasers and intense pulsed light (IPL) have been utilized for this purpose. A new IPL device (Lumenis One^?) with OPT is one of the newer modalities to be studied in Chinese patients. Objective: This study evaluates the short-term efficacy and side effects of the new IPL device for epilation in Chinese patients. Methods: Eighteen Chinese women with Fitzpatrick skin types III–V and black hair, were treated four times at 4 to 6-week intervals using IPL (Lumenis One^?) on the axillae (n=13) and the upper lip (n=5). The energy density for treatment ranged from 14 to 22 J/cm². Parameters utilized were 695-/755-nm filters, triple pulse for patients on the axillae, and 640-/695-nm filters, double pulse for patients on the upper lip (3.5- to 7-ms pulse, 30- to 90-ms pulse delay, 15×35 mm spot size). Hair reduction was assessed at baseline, immediately before each treatment session, and at 4 weeks after the fourth treatment. Patient's satisfaction on a 5-point scale was also evaluated. Results: The average hair reduction for all sites was 49.9% after one session, 58.6% after two sessions, 79.3% after three sessions, and 83.8% after four sessions (p=0.001). The hair reduction of 44.1%, 52.1%, 81.1%, and 86.0% were achieved after each treatment for axillae, with 65.1%, 75.7%, 74.6%, and 78.0% for upper lip. Patients got more satisfaction after four sessions (score 3.1) than that after two sessions (2.0) (p=0.001). In both the assessments, upper lip appeared to show a better response than axillae after two IPL treatments, which reversed after four treatments. No significant complications or adverse events were reported. Conclusion: The new IPL device provides a safe and effective means of hair removal for Chinese patients. Treatment efficacy varies with the anatomic location and number of treatments. However, further study is necessary to determine the long-term clinical efficacy in Chinese patients.     

Improving lip wrinkles: lipstick-related image analysis

BACKGROUND/PURPOSE: The appearance of lip wrinkles is problematic if it is adversely influenced by lipstick make-up causing incomplete color tone, spread phenomenon and pigment remnants. It is mandatory to develop an objective assessment method for lip wrinkle status by which the potential of wrinkle-improving products to lips can be screened. The present study is aimed at finding out the useful parameters from the image analysis of lip wrinkles that is affected by lipstick application. METHODS: The digital photograph image of lips before and after lipstick application was assessed from 20 female volunteers. Color tone was measured by Hue, Saturation and Intensity parameters, and time-related pigment spread was calculated by the area over vermilion border by image-analysis software (Image-Pro). The efficacy of wrinkle-improving lipstick containing asiaticoside was evaluated from 50 women by using subjective and objective methods including image analysis in a double-blind placebo-controlled fashion. RESULTS: The color tone and spread phenomenon after lipstick make-up were remarkably affected by lip wrinkles. The level of standard deviation by saturation value of image-analysis software was revealed as a good parameter for lip wrinkles. By using the lipstick containing asiaticoside for 8 weeks, the change of visual grading scores and replica analysis indicated the wrinkle-improving effect. As the depth and number of wrinkles were reduced, the lipstick make-up appearance by image analysis also improved significantly. CONCLUSION: The lip wrinkle pattern together with lipstick make-up can be evaluated by the image-analysis system in addition to traditional assessment methods. Thus, this evaluation system is expected to test the efficacy of wrinkle-reducing lipstick that was not described in previous dermatologic clinical studies.     

Malformación capilar del síndrome CLAPO exitosamente tratado con láser de colorante pulsado

CLAPO syndrome (Capillary vascular malformation of the lower lip, Lymphatic malformations of the head and neck, Asymmetry and Partial/generalized Overgrowth) is a recently described entity, with very few published cases in the literature, and no standardized treatment. The objective of our study was to assess the efficacy and safety of PDL in patients with this syndrome. Seven patients were treated with two to four sessions of PDL at 595-nm wavelength. Laser therapy was performed using a spot size of 7 to 10 mm, a pulse duration of 0,5 to 1,5 ms and a fluence from 6 to 8 J/cm². Clinical photographs were taken before treatment and 3 weeks after procedure. Clearance of the erythema was > 75% in 4 patients. Transient purpura was present in all patients for about 2 weeks and 1 patient presented post inflammatory hypopigmentation. In conclusion we consider that PDL seems to be a safe and effective treatment for capillary malformations of the CLAPO syndrome. A marked reduction in erythema was achieved in all patients with a low incidence of side effects.     

Objective and subjective clinical effects of a Nd:YAG 532-nm frequency-doubled long-pulsed diode pumped laser system on photoaging of the face: a retrospective study on color signs, texture and rhytids.

BACKGROUND: Pulsed 532-nm lasers have been widely used in the treatment of vascular and pigmented conditions of aged skin. In addition to lesion clearance, many patients report color and texture improvements to the skin. These improvements are often difficult to appreciate from photographic analysis alone, but are significant to the patient's impression of treatment success. OBJECTIVE: To grade and compare objective and subjective results of treatments with a 532-nm frequency-doubled pulsed Nd:YAG laser using criteria of skin color, skin texture, and wrinkles based on a blinded retrospective analysis of photographs compared with results from patient questionnaires. METHODS: Clinical before and after pictures from 20 patients (skin types I-IV) treated for diffuse vascular and pigmented lesions were selected for evaluation. A blinded grading was performed using criteria of skin color, skin texture, and wrinkles. Patients were asked by questionnaire to also grade improvement using the same criteria. The results of the blinded and patient grading were reported and compared using a chi-squared analysis. RESULTS: Clinical improvements recorded by blinded photographic evaluation and patient evaluation agreed with no statistically significant differences. Both the blinded observers and patients recorded remarkable improvement in the color signs of photoaging, slight to moderate improvement in skin texture and fine wrinkles, and negligible improvement of medium depth and deep wrinkles. CONCLUSION: The 532-nm pulsed laser is a safe and effective device for the treatment of the visible signs of photoaging of skin types I-III. In addition to improvements in color defects, objectively and subjectively significant improvements in texture and fine wrinkles can be expected. Little to no improvement in medium to deep wrinkles can be anticipated.     

Use of high-frequency ultrasound in the assessment of injectable dermal fillers

Background: The use of dermal fillers for enhancing lips and reducing wrinkles is currently one of the fastest growing sectors of the cosmetic surgery market. There are numerous fillers available, some are synthetic others are isolated from biological material. Once injected the fillers have a varied lifespan ranging from months to years depending upon the material, site of injection and individual response. Current assessment techniques of filler performance are mostly limited to evaluations of the skin surface topography, and not to what is happening to the filler beneath the skin surface. The aim of this work was to see if high‐frequency ultrasound could be used to image and measure filler dimensions in situ. Method: This was a pilot study of six healthy female volunteers aged 36–53 visiting the surgical outpatients department of a hospital in Glasgow. Volunteers had been injected with filler material into their upper lip 6 months before the visit. The patients all had their upper lip scanned using high‐frequency ultrasound. The subsequent images were then assessed using the scanner software to assess the dimensions of the filler. Results: The filler material was clearly visible with the ultrasound and subsequently measurable in each scan. Each scan procedure was completed within a short time period meaning quantitative data could be acquired with minimum trauma to the volunteer. The scan images and data also provided valuable information for the volunteers and reinforced their perception of the fillers effect on their features. Conclusions: High‐frequency ultrasound scanning provides a non‐invasive, convenient and rapid technique for the assessment of filler performance. This pilot study produced three valuable pieces of information: ? The ultrasound can image the filler material from which quantitative measurements can be made. ? The technique is rapid and cost effective …? This investigation helped to reinforce the volunteer's perception of the filler effect.     

Botulinum toxin A: a 9-month clinical and 3D in vivo profilometric crow's feet wrinkle formation study.

OBJECTIVE: The objective of this study was to determine the duration of the effects of a defined dose of BTX-A on crow's feet formation wrinkles. MATERIALS AND METHODS: Twenty-five patients each received one injection of 12 units of BTX-A in the orbicularis oculi muscle on both sides of the face. The results were evaluated at 3, 6 and 9 months. Standardized photographs were taken of the wrinkle formations at rest at each step of the 9-month period following the treatment, and the wrinkles were then rated on photographs by blinded observers. Three-dimensional (3D) in vivo profilometry was also used to quantify the degree of improvement. RESULTS: Both the self-assessments by the patients themselves and the objective assessments of the 3D profilometry study provided similar results, but the independent observer assessment results were slightly more optimistic. There was a statistically significant difference observed between baseline and the evaluations at both 3 and 6 months. CONCLUSION: BTX-A is a safe and effective method for treating crow's feet wrinkles. In both the observer assessment and the 3D skin profilometric assessment, a clear improvement was shown at 6 months.     

Botulinum toxin A: a 9‐month clinical and 3D in vivo profilometric crow's feet wrinkle formation study

OBJECTIVE: The objective of this study was to determine the duration of the effects of a defined dose of BTX‐A on crow's feet formation wrinkles.

MATERIALS AND METHODS: Twenty‐five patients each received one injection of 12 units of BTX‐A in the orbicularis oculi muscle on both sides of the face. The results were evaluated at 3, 6 and 9 months. Standardized photographs were taken of the wrinkle formations at rest at each step of the 9‐month period following the treatment, and the wrinkles were then rated on photographs by blinded observers. Three‐dimensional (3D) in vivo profilometry was also used to quantify the degree of improvement.

RESULTS: Both the self‐assessments by the patients themselves and the objective assessments of the 3D profilometry study provided similar results, but the independent observer assessment results were slightly more optimistic. There was a statistically significant difference observed between baseline and the evaluations at both 3 and 6 months.

CONCLUSION: BTX‐A is a safe and effective method for treating crow's feet wrinkles. In both the observer assessment and the 3D skin profilometric assessment, a clear improvement was shown at 6 months.     

The Fabi-Bolton chest wrinkle scale: a pilot validation study

Up until now, no objective scale has existed to evaluate chest wrinkles and assess the efficacy of treatment. This study was designed to validate a new photonumeric wrinkle assessment scale using standardized photographic methodology to obtain reference photographs. Multiple photographs from 28 volunteer subjects with varying degrees of chest wrinkles were evaluated by a study team of two independent physicians. Photographs of 16 subjects representing the full spectrum of chest wrinkle severity were selected and classified using the Fabi–Bolton (F–B) 5‐point wrinkle scale (1 = wrinkles absent; 2 = shallow but visible wrinkles; 3 = moderately deep wrinkles; 4 = deep wrinkles, with well‐defined edges; 5 = wrinkles very deep with redundant folds). One representative photograph was chosen by study team consensus for each of the five scale points. A second, independent group of evaluators rated the randomly arranged photographs using the F–B wrinkle scale. The numeric results were then tabulated and compared. The F–B wrinkle scale provided a reproducible and effective method for assessing chest wrinkles with very little interrater variability. The F–B wrinkle scale is a reliable tool for the classification of chest wrinkles and evaluation of therapeutic and cosmetic interventions.     

From skin microrelief to wrinkles. An area ripe for investigation

Skin microrelief alters progressively with age. Wrinkles do not result from these changes but are superimposed upon them. Wrinkles result from structural changes in the epidermis, dermis and hypodermis. Four types of wrinkles can be recognized. Type 1 wrinkles are atrophic. Type 2 wrinkles are elastotic. Type 3 wrinkles are expressional. Type 4 wrinkles are gravitational. Each type of wrinkle is characterized by distinct microanatomical changes and each type of wrinkle develops in specific skin regions. Each is likely to respond differently to treatment. Skin microrelief and skin folds can be identified on histological examination. By contrast, only minimal dermal changes are found beneath permanent or reducible wrinkles compared with immediately adjacent skin. A series of objective and non-invasive methods is available to quantify the severity of wrinkling.     

Treatment of periorbital wrinkles with 1550‐ and 1565‐nm Er:glass fractional photothermolysis lasers: a simultaneous split‐face trial

Objective This study aimed to compare the clinical efficacies of 1550‐ and 1565‐nm Er:glass lasers in the treatment of periorbital wrinkles and to evaluate histological changes after treatment. Methods Twenty patients received five treatments each at 3‐week intervals. The right periorbital area was exposed to the 1550‐nm Er:glass laser and the left periorbital area was exposed to the 1565‐nm Er:glass laser. Clinical improvement was evaluated by two blinded physicians who assessed comparative photographs using a four‐point scale at baseline and 3 months after the final treatments. Skin biopsies were performed in five volunteers before treatment and at 3 months after the final treatment. Results The mean improvement scores 3 months after treatment with the 1550‐ and 1565‐nm Er:glass lasers were 2.25 ± 0.62 and 2.28 ± 0.59 respectively. Histological examination revealed increased epidermal thickening and decreased solar elastosis 3 months after the final laser treatments. Conclusions Both 1550‐ and 1565‐nm Er:glass lasers are safe and effective modalities in the treatment of periorbital wrinkles with no significant differences between the two lasers.     

Long pulsed Nd:YAG laser with inbuilt cool sapphire tip for long term hair reduction on type- IV and V skin: a prospective analysis of 200 patients

Background: Laser hair reduction has become a very popular means to get rid of unwanted hair. Aims: We conducted the current study to evaluate the safety and efficacy of Nd: YAG laser on dark skin. We also evaluated the effect of increasing the gap between sessions on the long term efficacy of hair reduction achieved with long pulsed Nd: YAG laser. Methods: A prospective study was conducted on 200 consecutive female patients who underwent laser hair reduction for unwanted hair over the face, at Kaya skin clinic Delhi, with long pulsed Nd: YAG laser, from May 2006 to May 2009. The gap between sessions was increased from 2 nd session itself. Results were evaluated 6 months after 6 sessions. Also a note was made of worsening of hair growth or any side effects experienced the patient during any of the sessions. Results: A total of 200 female patients (160 skin type IV and 40 skin type V) were followed up. Of these, 64 enrolled for lower face, 88 for chin or upper neck and 48 for upper lip. 6 months after 6 sessions, more than 50% improvement was seen in 68.7% of lower face, 89.69% cases of chin and 59% of upper lip cases. None of the patients had any worsening. Conclusions: The current study shows that long pulsed Nd: YAG is a very safe and effective means of hair reduction in skin types IV and V. Adequate fluences and increasing the gap between sessions from the 2 nd session could be the key to achieving long term hair reduction with Nd: YAG laser. Adequate cooling and proper shaving are the key factors determining the safety.     

A fractional 2940 nm short-pulsed,erbium-doped yttrium aluminium garnet laser is effective and minimally invasive for the treatment of photodamaged skin in Asians

Abstract

Background: Although ablative fractional laser for the facial photodamaged skin was effective and safe, there have been only limited reports regarding the efficacy and safety of fractional Er:YAG laser treatments for photodamaged facial skin in Asians. Objective: Our objective was to assess the efficacy and safety of the Er:YAG laser (2940 nm) using the ‘‘ablative’’ fractional resurfacing mode to treat photodamaged facial skin. Methods: A total of 29 Korean patients were treated for photodamaged facial skin using a fractional Er:YAG laser. The number of treatments was mean 2.3 sessions at two-week intervals. Independent investigators assessed the efficacy using standardized photographs. The patients’ satisfaction rate was also evaluated. Results: For dyspigmentation, 62.5% of the treated patients showed improvement greater than 26%. Regarding wrinkles, 50% of the treated patients showed improvement greater than 26%. All patients showed various degrees of improvement in skin laxity. Assessing the overall features, 62.5% of the study subjects showed improvement greater than 26%, and most of them (91.7%) reported that their subjective satisfaction rate was above ‘slight satisfaction’. Downtime accounted for approximately one week in most patients. Conclusions: A fractional Er:YAG laser can deliver an effective and minimally invasive treatment for photodamaged facial skin in Asians.     

Objective and subjective clinical effects of a Nd:YAG 532‐nm frequency‐doubled long‐pulsed diode pumped laser system on photoaging of the face: A retrospective study on color signs,texture and rhytids

BACKGROUND: Pulsed 532‐nm lasers have been widely used in the treatment of vascular and pigmented conditions of aged skin. In addition to lesion clearance, many patients report color and texture improvements to the skin. These improvements are often difficult to appreciate from photographic analysis alone, but are significant to the patient's impression of treatment success. OBJECTIVE: To grade and compare objective and subjective results of treatments with a 532‐nm frequency‐doubled pulsed Nd:YAG laser using criteria of skin color, skin texture, and wrinkles based on a blinded retrospective analysis of photographs compared with results from patient questionnaires. METHODS: Clinical before and after pictures from 20 patients (skin types I–IV) treated for diffuse vascular and pigmented lesions were selected for evaluation. A blinded grading was performed using criteria of skin color, skin texture, and wrinkles. Patients were asked by questionnaire to also grade improvement using the same criteria. The results of the blinded and patient grading were reported and compared using a chi‐squared analysis. RESULTS: Clinical improvements recorded by blinded photographic evaluation and patient evaluation agreed with no statistically significant differences. Both the blinded observers and patients recorded remarkable improvement in the color signs of photoaging, slight to moderate improvement in skin texture and fine wrinkles, and negligible improvement of medium depth and deep wrinkles. CONCLUSION: The 532‐nm pulsed laser is a safe and effective device for the treatment of the visible signs of photoaging of skin types I–III. In addition to improvements in color defects, objectively and subjectively significant improvements in texture and fine wrinkles can be expected. Little to no improvement in medium to deep wrinkles can be anticipated.