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Plume Effect of Fractional Radiofrequency Verus Laser Resurfacing: Considerations in the COVID-19 Pandemic.
Dayan, Erez; Theodorou, Spero; Katz, Bruce; Dover, Jeffrey S.
  • Dayan E; Avance Plastic Surgery Institute, Reno, Nevada.
  • Theodorou S; Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York.
  • Katz B; Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York.
  • Dover JS; SkinCare Physicians, Chestnut Hill, Massachusetts.
Lasers Surg Med ; 53(1): 115-118, 2021 01.
Article in English | MEDLINE | ID: covidwho-1060012
Semantic information from SemMedBD (by NLM)
1. Consideration COEXISTS_WITH COVID-19
Subject
Consideration
Predicate
COEXISTS_WITH
Object
COVID-19
2. patient safety COEXISTS_WITH Elective procedure
Subject
patient safety
Predicate
COEXISTS_WITH
Object
Elective procedure
3. Erbium-Doped Yttrium Aluminum Garnet Lasers compared_with Medical Devices
Subject
Erbium-Doped Yttrium Aluminum Garnet Lasers
Predicate
compared_with
Object
Medical Devices
4. Medical Devices compared_with Erbium-Doped Yttrium Aluminum Garnet Lasers
Subject
Medical Devices
Predicate
compared_with
Object
Erbium-Doped Yttrium Aluminum Garnet Lasers
5. Consideration COEXISTS_WITH COVID-19
Subject
Consideration
Predicate
COEXISTS_WITH
Object
COVID-19
6. patient safety COEXISTS_WITH Elective procedure
Subject
patient safety
Predicate
COEXISTS_WITH
Object
Elective procedure
7. Erbium-Doped Yttrium Aluminum Garnet Lasers compared_with Medical Devices
Subject
Erbium-Doped Yttrium Aluminum Garnet Lasers
Predicate
compared_with
Object
Medical Devices
8. Medical Devices compared_with Erbium-Doped Yttrium Aluminum Garnet Lasers
Subject
Medical Devices
Predicate
compared_with
Object
Erbium-Doped Yttrium Aluminum Garnet Lasers
ABSTRACT

INTRODUCTION:

The COVID-19 pandemic requires us all to re-evaluate aesthetic practices to ensure optimal patient safety during elective procedures. Specifically, energy-based devices and lasers require special consideration, as they may emit plume which has been shown to contain tissue debris and aerosolized biological materials. Prior studies have shown transmission of viruses and bacteria via plume (i.e., HIV and papillomavirus). The purpose of this study was to evaluate plume characteristics of the ErYAG resurfacing laser (Sciton; Palo Alto, CA) and compare it to the Morpheus8 fractional radiofrequency device (InMode; Lake Forest, CA).

METHODS:

Five patients who underwent aesthetic resurfacing and/or skin tightening of the face and neck were treated with the ErYAG (Sciton Joule, Palo Alto, CA) and/or fractional radiofrequency (Morpheus8, Lake Forest, CA) between April 1 and May 11, 2020. Data collected included patient demographics, past medical history, treatment parameters, adverse events, particle counter data, as well as high magnification video equiptment. Patients were evaluated during treatment with a calibrated particle meter (PCE; Jupiter, FL). The particle meter was used at a consistent focal distance (6-12 inches) to sample the surrounding environment during treatment at 2.83 L/min to a counting efficiency of 50% at 0.3 µm and 100% at >0.45 µm. Recordings were obtained with and without a smoke evacuator.

RESULTS:

Of our cohort (n = 5), average age was 58 years old (STD ±7.2). Average Fitzpatrick type was between 2 and 3. Two patients received ErYAG fractional resurfacing in addition to fractional radiofrequency during the same treatment session. Two patients had fractional radiofrequency only, and one patient had laser treatment with the ErYAG only. There were no adverse events recorded. The particle counter demonstrated ambient baseline particles/second (pps) at 8 (STD ±6). During fractional radiofrequency treatment at 1-mm depth, the mean recording was 8 pps (STD ±8). At the more superficial depth of 0.5 mm, recordings showed 10 pps (STD ±6). The ErYAG laser resurfacing laser had mean readings of 44 pps (STD ±11). When the particle sizes were broken down by size, the fractional radiofrequency device had overall smaller particle sizes with a count of 251 for 0.3 µm (STD ±147) compared with ErYAG laser with a count of 112 for 0.3 µm (STD ±84). The fractional radiofrequency did not appear to emit particles >5 µm throughout the treatment, however, the ErYAG laser consistently recorded majority of particles in the range of 5-10 µm. The addition of the smoke evacuator demonstrated a 50% reduction in both particles per second recorded as well as all particle sizes.

CONCLUSION:

Re-evaluation of the plume effect from aesthetic devices has become important during the COVID-19 pandemic. Further studies are required to characterize viability of COVID-19 viability and transmissibility in plume specimens. Based on this pilot study, we recommend that devices that generate little to no plume such as fractional radiofrequency devices be used in Phase I reopening of practice while devices that generate a visible plume such as ErYAG laser resurfacing devices be avoided and only used with appropriate personal protective equipment in addition to a smoke evacuator in Phase IV reopening.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Skin Aging / Cosmetic Techniques / Laser Therapy / Lasers, Solid-State / Radiofrequency Ablation / COVID-19 Type of study: Etiology study / Incidence study / Observational study / Risk factors Limits: Aged / Female / Humans / Male / Middle aged Language: English Journal: Lasers Surg Med Year: 2021 Document Type: Article

Full text: Available Collection: International databases Database: MEDLINE Main subject: Skin Aging / Cosmetic Techniques / Laser Therapy / Lasers, Solid-State / Radiofrequency Ablation / COVID-19 Type of study: Etiology study / Incidence study / Observational study / Risk factors Limits: Aged / Female / Humans / Male / Middle aged Language: English Journal: Lasers Surg Med Year: 2021 Document Type: Article