Polydeoxyribonucleotide improves wound healing of fractional laser resurfacing in rat model

Background: Polydeoxyribonucleotide (PDRN) is an active compound that can promote wound healing. PDRN stimulates wound healing by enhancing angiogenesis and increasing fibroblast growth rates. Laser skin resurfacing is a popular cosmetic procedure for skin rejuvenation. Despite excellent improvement of photo-damaged skin and acne scarring, it is accompanied with drawbacks, such as prolonged erythema and crusting. Objective: This study was designed to assess the effect of PDRN on wounds induced by fractional laser resurfacing. Methods: Twelve male rats aged 8 weeks were randomly assigned to the PDRN treatment group and the control group. Wounds were induced using a fractional ablative CO₂ laser. The treatment group received daily injections of PDRN and the control group received injections of the vehicle. Wound healing assessed by clinical features and histopathologic findings. Results: The process of wound healing was faster in the treatment group than in the control group. In the histopathological examination, the granulation tissue thickness score of the treatment group was significantly higher than that of the control group. Results of immunohistochemical staining showed a marked increase of VEGF-positive cells and PECAM-1/CD31-positive microvessels in the treatment group. Conclusion: PDRN may be a beneficial option to promote wound healing after laser treatment.     

Curative effects of microneedle fractional radiofrequency system on skin laxity in Asian patients: A prospective,double-blind,randomized, controlled face-split study

Background: To date, no studies compared curative effects of thermal lesions in deep and superficial dermal layers in the same patient (face-split study). Objective: To evaluate skin laxity effects of microneedle fractional radiofrequency induced thermal lesions in different dermal layers. Methods and Materials: 13 patients underwent three sessions of a randomized face-split microneedle fractional radiofrequency system (MFRS) treatment of deep dermal and superficial dermal layer. Skin laxity changes were evaluated objectively (digital images, 2 independent experts) and subjectively (patients’ satisfaction numerical rating). Results: 12 of 13 subjects completed a course of 3 treatments and a 1-year follow-up. Improvement of nasolabial folds in deep dermal approach was significantly better than that in superficial approach at three months (P=.0002) and 12 months (P=.0057) follow-up. Effects on infraorbital rhytides were only slightly better (P=.3531). Conclusion: MFRS is an effective method to improve skin laxity. Thermal lesion approach seems to provide better outcomes when applied to deep dermal layers. It is necessary to consider the skin thickness of different facial regions when choosing the treatment depth.     

Neck skin rejuvenation: Histological and clinical changes after combined therapy with a fractional non-ablative laser and stabilized hyaluronic acid-based gel of non-animal origin

Abstract

Background: The laser Affirm? (LA) is a microthermal, non-ablative fractional laser used for skin rejuvenation. Restylane Vital? Light (RVL) in the Restylane^® Injector, a formulation of stabilized hyaluronic acid-based gel of non-animal origin, is indicated for rejuvenation of delicate skin. Objectives: To assess the interaction between the LA and RVL in aging skin of the neck using clinical and histological parameters, and to determine whether combined therapy is effective. Methods: Nine female patients aged 42–62 years received four treatments, each comprising RVL followed immediately by LA treatment. Photographs and skin biopsies were taken before treatment, after the fourth session and 1 month later. Results: Improvements in fine wrinkles, tightness and skin texture were observed. Histologic evaluations showed favourable changes in cellularity, collagen and elastic fibres. Laser-induced effects (400 μm) and an inflammatory reaction (1000 μm) were seen. RVL was present at the mid–deep dermis (1000–1500 μm). Conclusions: Combined treatment with the LA and RVL improved skin appearance and structure as assessed, for the first time, with histology. The LA produced epidermal and superficial dermal changes whereas RVL acted deeper, together treating the full skin thickness.     

A prospective randomized comparative study on 60 Indian patients of melasma,comparing pixel Q-switched NdYAG (1064 nm), super skin rejuvenation (540 nm) and ablative pixel erbium YAG (2940 nm) lasers,with a review of the literature

Background: Treating melasma is a challenge due to suboptimal efficacy and recurrence encountered with most modalities. There is inadequate literature regarding the use of lasers for melasma in Indian skin. We compared three modalities SSR (Super Skin Rejuvenation 540 nm), PQSNDY (pixel Q-switched Nd: YAG 1064 nm), and ablative pixel-Er: YAG (2940 nm) laser in melasma, amongst Indian patients.

Materials/Methods: Sixty patients of recalcitrant melasma were enrolled and randomized into three groups with 20 patients each. These were treated with SSR, low fluence PQSNDY, and pixel-Er: YAG, respectively, for five sessions at 3-week intervals. Results were evaluated using Modified melasma area severity index (mMASI) by blinded comparison of digital photographs at baseline, each visit and 6 months (i.e. 2 months after the last session).

Results: All groups showed a highly significant reduction in the mMASI score (p < .001). Pixel-Er: YAG maximally reduced mMASI and homogeneity (p < .001), while the other groups showed a more uniform fading. Epidermal melasma had best results with SSR and PQSNDY (p < .001), while recalcitrant cases of dermal and mixed melasma with pixel-Er: YAG laser (p < .001). There was no persistent or rebound pigmentation observed.

Conclusions: All three modalities are effective and safe for melasma in Indian patients. Fractional technology, low fluences, adequate recovery time between sessions and a sound maintenance plan ensure efficacy and safety.     

Combined fractional resurfacing (10600 nm/1540 nm): Tridimensional imaging evaluation of a new device for skin rejuvenation

In this study were described the results, by tridimensional imaging evaluation, of the new “Combined Fractional Resurfacing” technique with the first fractional laser that overtakes the limits of traditional ablative, nonablative fractional resurfacing by combining CO₂ ablative and GaAs nonablative lasers. These two wavelengths can work separately or in a mixed modality to give the best treatment choice to all the patients. In this study, it is demonstrated that the simultaneous combination of the CO₂ wavelength (10600 nm) and GaAs wavelength (1540 nm) reduced the downtime, reduced pain during the treatment, and produced better results on fine wrinkles reduction and almost the same results on pigmentation as seen with 3D analysis by Antera (Miravex).     

Assessment of safety and efficacy of a bipolar fractionated radiofrequency device in the treatment of periorbital rhytides

Abstract

Bipolar radiofrequency (RF) has been used to treat photodamage. Periorbital rhytides are often difficult to treat. In this study bipolar RF was assessed in the 20 subjects, who are in treatment of periorbital rhytides and it was proved that it can successfully treat the periorbital rhytides.     

Combination of microneedle radiofrequency (RF), fractional RF skin resurfacing and multi-source non-ablative skin tightening for minimal-downtime,full-face skin rejuvenation

Background: In the recent years, there is a growth in demand for radiofrequency (RF)-based procedures to improve skin texture, laxity and contour. The new generation of systems allow non-invasive and fractional resurfacing treatments on one platform. Objective: The aim of this study was to evaluate the safety and efficacy of a new treatment protocol using a multisource RF, combining 3 different modalities in each patient: [1] non-ablative RF skin tightening, [2] fractional skin resurfacing, and [3] microneedling RF for non-ablative coagulation and collagen remodelling. Methods: 14 subjects were enrolled in this study using EndyMed PRO^? platform. Each patient had 8 non-ablative treatments and 4 fractional treatments (fractional skin resurfacing and Intensif). Results: The global aesthetic score was used to evaluate improvement. All patients had improvement in skin appearance. About 43% had excellent or very good improvement above 50%, 18% had good improvement between 25 and 50%, and the rest 39% had a mild improvement of < 25%. Downtime was minimal and no adverse effect was reported. Conclusions: Our data show significant improvement of skin texture, skin laxity and wrinkle reduction achieved using RF treatment platform.     

Treatment of atrophic facial acne scars with fractional Er:Yag laser

Background: Acne scars are often a permanent disfiguring sequel of acne vulgaris. Although many treatment modalities are available, they are often non satisfactory for all patients. Objective: To determine the effectiveness and safety of fractional 1540 nm erbium_glass laser treatment of facial acne scars in Iraqi patients. Patients and methods: Twenty one patients were enrolled in this prospective clinical study. Three sessions of the 1540 nm erbium glass laser were applied at 2-week intervals. The patients were assessed at 1, 3, and 6 months after the last session. The effect of treatment was assessed by objective (Sharquie scoring system for grading acne scarring and visual analog scale) and subjective (patient satisfaction) methods. Results: Two patients were defaulted. Eleven patients (57.9%) showed improvement from moderate to mild grade, and no grade changes were detected in eight patients (42.1%). The mean score of the visual analog scale prior to treatment was 8.61 ± 0.86 and decreased to 6.15 ± 1.28 (P = 0.037). Ten patients were satisfied to varying degrees. No significant side effects were noted. Conclusion: Non-ablative fractional 1540 nm erbium glass laser is an effective and safe method to treat acne scars and represent good alternative for patients who cannot use the ablative methods because of its longer downtime.     

Successful treatment of venous malformation located on glans penis with dual-wavelength 595- and 1064-nm laser system

Abstract

The management of venous malformation (VM) located on genitalia is complex and challenging. Surgical excision and sclerotherapy are the first-lines therapeutic options, but in certain areas such as the genitalia can be too aggressive. We present a case of VM on the glans penis treated successfully with dual wavelenght 595 and 1064 nm laser system.     

Clinical and histological evaluation of microneedle fractional radiofrequency treatment on facial fine lines and skin laxity in Koreans

Background

Facial wrinkles and sagging are the most visible signs of aging and can cause profound distress. Microneedle fractional radiofrequency (MFR) is a minimally invasive procedure, which utilizes both microneedling and radiofrequency energy to rejuvenate the skin.

Objective

To describe the safety and efficacy of a temperature-controlled MFR device on facial fine lines and laxity.

Patients and Methods

A retrospective chart & histology review was performed on individuals who received bipolar MFR for facial rejuvenation. A total of 15 Koreans with a median age of 46 years were included. All participants underwent a single treatment session. The results were assessed objectively using serial photography and subjectively based on the participants' satisfaction scores. Histologic changes before, immediately after MFR and at 4 months follow-up was examined. Complications were also recorded.

Results

Partially denatured collagen fibers and dermal shrinkage was observed immediately after MFR whereas an increase in elastin and collagen was noted at 4 months follow-up. 86.7% of recipients considered the results satisfactory. Consensus ratings by two independent dermatologists on the objective outcomes at 4-month follow-up were very much improved (53.3%), much improved (26.7%) and improved (20%). Treatment was well tolerated and did not cause any significant long-lasting discomfort.

Conclusion

Temperature-controlled bipolar MFR is a minimally invasive treatment option to consider for facial fine lines and laxity via neo-collagenesis and neo-elastogenesis. The procedure was safe and clinically effective.     

Treatment of hypertrophic scars and keloids with a fractional CO2 laser: A personal experience

Abstract

Keloids and hypertrophic scars are both abnormal wound responses in predisposed individuals but they differ in that keloids extend beyond the original wound and almost never regress, while hypertrophic scars remain within the original wound and tend to regress. How keloids grow is not totally clear because there is no animal model; in fact, keloids affect only humans. Different injuries can result in keloids, including burns, surgery, ear piercing, lacerations, abrasions, tattooing, vaccinations, injections, insect bites and any process causing skin inflammation (chicken pox, acne, folliculitis, zoster). Skin or wound tension is considered a critical factor in the formation of keloids and hypertrophic scars. This study is based on eight consecutive patients (four females and four males, F:M = 1:1) with a total of 12 keloids. All of whom were treated monthly with a MiXto SX CO₂ laser, using 13 W of power, 8 SX of index and 40% coverage (density) in combination with Same Plast Gel^® twice a day. Each scar required 12 treatments, and all the patients, followed up for 1 year after the last treatment, had optimum results and no recurrence.     

Intense pulsed light for the treatment of Rosacea and Telangiectasias

Abstract

Background: Rosacea is a chronic disease that affects the aesthetic appearance of skin. The use of intense pulsed light (IPL) has shown significant clearing in erythema, telangiectasia, and papules in rosacea. We seek parameters for IPL that will achieve optimal reduction in the appearance of rosacea with minimal adverse effects. Objective: To investigate the use of IPL on 102 patients at various parameters (fluence and pulse duration) in the treatment of rosacea. Methods: 102 patients with mild to severe rosacea were treated with IPL treatment using the NaturaLight IPL system (Focus Medical, Bethel, CT). Patients received treatments at 1–3 week intervals, with an average of 7.2 treatments. The Reveal Imager (Canfield Scientific, Fairfield, NJ) was used for photodocumentation and analyses. Results: Treatments were given at 2.5/5 ms double, triple, or quadruple pulsed with 20–30 ms delay time. A 530 nm filter was used with fluences varying from 10–30 J/cm², or 10–20 J/cm² with a 420 nm filter for those patients with acneiform breakouts in addition to telangiectasias. 80% of patients had reduction in redness, 78% of patients reported reduced flushing and improved skin texture, and 72% noted fewer acneiform breakouts. There were no complications or adverse effects. Conclusion: The use of IPL at specified parameters provides optimal therapy for the treatment of rosacea.     

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.     

Fractional CO2 laser resurfacing of photoaged facial and non-facial skin: Histologic and clinical results and side effects

Abstract

Background: CO₂ fractional ablation offers the potential for facial and non-facial skin resurfacing with minimal downtime and rapid recovery. Objectives: The purpose of this study was (i) to document the average depths and density of adnexal structures in non-lasered facial and non-facial body skin; (ii) to determine injury in ex vivo human thigh skin with varying fractional laser modes; and (iii) to evaluate the clinical safety and efficacy of treatments. Methods: Histologies were obtained from non-lasered facial and non-facial skin from 121 patients and from 14 samples of excised lasered thigh skin. Seventy-one patients were evaluated after varying energy (mJ) and density settings by superficial ablation, deeper penetration, and combined treatment. Results: Skin thickness and adnexal density in non-lasered skin exhibited variable ranges: epidermis (47–105 μm); papillary dermis (61–105 μm); reticular dermis (983–1986 μm); hair follicles (2–14/ HPF); sebaceous glands (2–23/HPF); sweat glands (2–7/HPF). Histological studies of samples from human thigh skin demonstrated that increased fluencies in the superficial, deep and combined mode resulted in predictable deeper levels of ablations and thermal injury. An increase in density settings results in total ablation of the epidermis. Clinical improvement of rhytids and pigmentations in facial and non-facial skin was proportional to increasing energy and density settings. Patient assessments and clinical gradings by the Wilcoxon's test of outcomes correlated with more aggressive settings. Conclusions: Prior knowledge of normal skin depths and adnexal densities, as well as ex vivo skin laser-injury profiles at varying fluencies and densities, improve the safety and efficiency of fractional CO₂ for photorejuvenation of facial and non-facial skin.     

Minimum phototoxicity dose (MPD)

Summary A pilot study was performed on groups of 5–7 volunteers to evaluate the minimum phototoxicity dose (MPD) of several light sources with different UVA qualities to optimise photochemotherapy. Visual observation was more suitable than reflection photometry in determining the threshold and gradation of erythema reactions; thermometry gave poor results. There were no individual differences between the MPD of a PUVA 4000 box and a continuously emitting argon-ion laser with 40 and 400 mW, respectively. The pulsed radiation of a nitrogen laser was the most effective. The limited validity of the Bunsen-Roscoe law for high peak power could thus be tested for a secondary photochemical reaction of the skin. The nitrogen laser (337.1 nm) proved that a repetition rate of 20 Hz was superior to 10 and 40 Hz. The MPD was intraindividually higher at 25 Hz than at 10 and 16.7 Hz for the dye laser tested (325 and 330 nm, respectively).