Subject(s)
Certification , Cosmetic Techniques , Dermatology , Specialty Boards , Surgery, Plastic , Humans , United StatesABSTRACT
BACKGROUND: High-energy pulsed or computer-scanned continuous-wave carbon dioxide (CO2) laser resurfacing has gained popularity as a wrinkle treatment because of its minimal thermal injury and precise control of tissue vaporization depth. Manual tumescent dermabrasion has also been effective for treating facial wrinkles. This is, to our knowledge, the first study comparing the use of CO2 laser to manual tumescent dermabrasion for the treatment of wrinkles on the upper lip. OBJECTIVE: To compare prospectively the clinical efficacy of the 950 microsec dwell time CO2 laser to that of manual tumescent dermabrasion in the treatment of upper lip wrinkles. METHODS: Twenty female subjects with moderate to severe upper lip wrinkles were randomly treated with the 950 microsec dwell time CO2 laser on one side of the upper lip and manual tumescent dermabrasion on the other. RESULTS: The average upper lip laser-treated wrinkle score (0 = none to 5 = severe) decreased from 4.3 +/- 0.2 before treatment to 1.8 +/- 0.3 at 6 months after treatment. The average upper lip dermabrasion-treated wrinkle score decreased from 4.4 +/- 0.2 to 1.5 +/- 0.3. The degree to which the wrinkle score improved after laser treatment compared with that after dermabrasion was not statistically significant (P =.216). CONCLUSION: Manual tumescent dermabrasion and 950 microsec dwell time CO2 laser resurfacing are equally effective for the treatment of upper lip wrinkles.
Subject(s)
Dermabrasion , Laser Therapy , Lip , Skin Aging , Aged , Carbon Dioxide , Dermabrasion/adverse effects , Dermabrasion/methods , Female , Humans , Middle Aged , Severity of Illness IndexABSTRACT
Chemical peel, dermabrasion, and laser skin resurfacing are alternative methods to achieve skin resurfacing for reconstructive or cosmetic applications. The potential postoperative complications are similar with all of these techniques. These postoperative complications and their therapy are reviewed.
Subject(s)
Chemexfoliation/adverse effects , Dermabrasion/adverse effects , Face/surgery , Facial Dermatoses/etiology , Laser Therapy/adverse effects , Cicatrix/etiology , Ectropion/etiology , Erythema/etiology , Facial Dermatoses/diagnosis , Facial Dermatoses/therapy , Humans , Pigmentation Disorders/etiology , Pruritus/etiology , Surgical Wound Infection/etiology , Wound HealingABSTRACT
BACKGROUND: The high energy, pulsed, or computer-scanned continuous wave carbon dioxide laser (CO2 laser) has gained popularity as a wrinkle treatment because of its minimal thermal injury and precise control of tissue vaporization depth. Chemical peels such as phenol have also been effective in treating facial wrinkles. This is, to our knowledge, the first study comparing the use of CO2 laser to phenol for treatment of wrinkles on the upper lip. OBJECTIVE: To compare the effectiveness and side effect profile of the 950 microsec dwell time CO2 laser to that of unoccluded Baker's phenol chemical peel in the treatment of upper lip wrinkles. METHODS: Twenty female subjects with moderate to severe upper lip wrinkles were randomly treated with Baker's phenol on one side of the upper lip and the 950 microsec dwell time CO2 laser on the other side. RESULTS: The average upper lip laser-treated wrinkle score (0 = none to 5 = severe) decreased from 4.30+/-0.20 before treatment to 1.11+/-0.28 at 6 months after treatment. The average upper lip phenol-treated wrinkle score decreased from 4.20+/-0.20 to 0.47+/-0.12. The degree in which the wrinkle score improved after phenol treatment compared with that after laser treatment was statistically significant (p<0.03). CONCLUSION: Treatment of upper lip wrinkles with Baker's phenol resulted in greater improvement than treatment with the 950 microsec dwell time CO2 laser.
Subject(s)
Chemexfoliation , Laser Therapy , Lip/surgery , Phenol , Rhytidoplasty , Aged , Carbon Dioxide , Female , Humans , Lip/pathology , Middle Aged , Rhytidoplasty/methods , Treatment OutcomeABSTRACT
BACKGROUND: Electrosurgery has been used for many decades in medicine. Some machines generate ultra-high frequency current waveforms (radiosurgery), which minimize collateral tissue damage. OBJECTIVE: Personal experience using radiosurgery in the performance of cosmetic surgery is related in the narrative form to offer the reader a "how we do it" perspective. CONCLUSION: Radiosurgery facilitates the performance of blepharoplasty, face lifting, hair restoration surgery, abdominoplasty, nasal reduction sculpturing of rhinophyma, and minor cosmetic procedures. Collateral heat damage is minimal allowing rapid healing and aesthetically pleasing scars.
Subject(s)
Dermatologic Surgical Procedures , Electrosurgery , Rhytidoplasty , Electrosurgery/instrumentation , Electrosurgery/methods , Humans , Rhytidoplasty/instrumentation , Rhytidoplasty/methodsABSTRACT
BACKGROUND: Laser resurfacing for rhytides and dermatoheliosis is becoming more popular. As more procedures are performed, new side effects and complications are reported. METHODS: We report two cases of transepidermal elimination of elastic fibers after laser resurfacing with the carbon dioxide (CO2) laser for rhytides. Both patients presented with yellow to violaceous papules (one with papules near the lateral eyelid margins, and one with papules over the forehead and cheeks) at 18-22 days after laser resurfacing. Biopsy specimens were taken from both patients and revealed transepidermal elastic fiber elimination. CONCLUSION: To our knowledge, this has not been reported in the literature previously. We report these cases to make the clinician aware of this potential side effect after laser resurfacing and review the literature on side effects and complications of laser skin resurfacing as well as associations with transepidermal elimination of elastic fibers.
Subject(s)
Dermatologic Surgical Procedures , Laser Therapy/adverse effects , Skin Aging , Surgery, Plastic/adverse effects , Aged , Female , Humans , Middle Aged , Skin/pathology , Skin Diseases/etiology , Skin Diseases/pathologyABSTRACT
Many medications are used in the preparation, operative, and postoperative phases of skin resurfacing. This article reviews those medications that impact on laser, chemical peel, and dermabrasion surgery. Facial cosmetic surgeons must fully appreciate the "chemistry" of skin resurfacing.
Subject(s)
Chemexfoliation/methods , Dermabrasion/methods , Dermatologic Agents/therapeutic use , Skin/drug effects , Antiviral Agents/therapeutic use , Humans , Keratolytic Agents/therapeutic use , Laser Therapy/methods , Postoperative Care , Preoperative Care , Rhytidoplasty/methods , Skin Pigmentation/drug effects , Wound HealingABSTRACT
BACKGROUND: Chemical peels are an effective treatment for wrinkles, but their use is limited because of the associated risk of scarring, hypopigmentation, and the inability to accurately control the depth of tissue injury. High energy, pulsed, or computer scanned continuous wave carbon dioxide (CO2) lasers cause minimal thermal injury, decrease the risk of scarring, and allow for precise control of tissue vaporization to predictable depths. OBJECTIVE: To compare the effectiveness and side effect profile of a medium-depth chemical peel to that of the SilkTouch CO2 laser in the treatment of periorbital wrinkles. METHODS: Twenty-four subjects (nine male, 15 female) with moderate to severe periorbital wrinkles were assigned a wrinkle score (1 = mild through 5 = severe) before treatment and 6 months after treatment. Each subject was treated with Jessner's solution and 35% trichloroacetic acid on one side and the SilkTouch CO2 laser on the other side. RESULTS: The average periorbital wrinkle score decreased from 4.00 +/- 0.78 before laser treatment to 1.75 +/- 0.68 6 months after treatment. The chemical peel wrinkle score decreased from 4.13 +/- 0.85 to 3.29 +/- 0.99. The degree in which the wrinkle score improved after laser treatment compared with after chemical peel treatment was statistically significant. Posttreatment erythema lasted an average of 4.5 months for the laser-treated areas and 2.5 months for the chemical peel-treated areas. CONCLUSION: Treatment of periorbital wrinkles with the SilkTouch CO2 laser resulted in a greater degree of improvement than treatment with a medium-depth chemical peel but had longer lasting posttreatment erythema.
Subject(s)
Chemexfoliation/methods , Laser Therapy/methods , Orbit/surgery , Rhytidoplasty/methods , Administration, Cutaneous , Adult , Aged , Carbon Dioxide , Chemexfoliation/adverse effects , Cicatrix/etiology , Drug Combinations , Erythema/etiology , Ethanol/administration & dosage , Ethanol/therapeutic use , Female , Fibrosis , Follow-Up Studies , Forecasting , Humans , Hypopigmentation/etiology , Lactic Acid/administration & dosage , Lactic Acid/therapeutic use , Laser Therapy/adverse effects , Laser Therapy/instrumentation , Male , Middle Aged , Resorcinols/administration & dosage , Resorcinols/therapeutic use , Rhytidoplasty/adverse effects , Rhytidoplasty/instrumentation , Risk Factors , Salicylates/administration & dosage , Salicylates/therapeutic use , Skin/pathology , Skin Aging/pathology , Time Factors , Trichloroacetic Acid/administration & dosage , Trichloroacetic Acid/therapeutic use , Wound HealingABSTRACT
BACKGROUND: Silicone scalp extenders have been shown to facilitate the process of scalp reduction surgery. OBJECTIVE: This report demonstrates how scalp extender devices can easily be made in the physician's office out of materials that are commercially available. METHODS: A scalp extender is made by bonding a narrow strip of Dacron-reinforced Duralastic silicone sheeting to each end of a long strip of plain Duralastic silicone sheeting. A stainless steel plate of hooks is then secured to each end of the extender. At the time of the first standard scalp reduction surgery, one extender device about 3.0 x 5.0 cm is placed in the subgaleal plane, in the transauricular direction, with hooks piercing the galea 1 cm caudad to the dense-in-quantity hair fringe margin. The circumferencial approach will accommodate the placement of a second extender device in the anterior-posterior direction to elevate the posterior hair fringe. To prevent adhesion of the galea to the periosteum around the devices, a sheet of plain silicone 15 x 20 cm is placed over the periosteum before the extenders are inserted. The extenders are replaced with shorter devices 3-4 weeks later. RESULTS: Usually the average width of bald scalp can be closed fringe to fringe in three operations as compared with five or six operations when using standard scalp reduction procedures. CONCLUSIONS: The scalp extender device described can be custom made in many different sizes. Its use has significantly changed the author's surgical treatment of pattern alopecia.
Subject(s)
Alopecia/surgery , Scalp/surgery , Tissue Expansion Devices , Tissue Expansion/instrumentation , Humans , Male , Middle Aged , SiliconesABSTRACT
BACKGROUND: Chemical peeling using trichloroacetic acid (TCA) is a popular and long utilized procedure in dermatology and cosmetic surgery. OBJECTIVE: To determine the actual concentration of TCA in four disparate methods of preparation of solutions, expressed in the standard pharmaceutical method of weight to volume (wt/vol). METHODS: Method I was wt/vol, method II was weight to weight (wt/wt), method III was grams of TCA added to 100 cc water, and method IV was the usage of saturated TCA, and calling it 100%, then making appropriate dilutions. The amounts of TCA in each solution for methods II, III, and IV were converted, by calculation, to the wt/vol method. RESULTS: The relative concentrations of TCA, ranked by the wt/vol pharmaceutical standard, showed that from strongest to weakest: method IV > method II > method I > method III. CONCLUSIONS: Tremendous variations were found in the relative concentrations of TCA in these solutions. To avoid mishaps and complications, the wt/vol method should be used.
