Clinical evaluation of the safety and efficacy of a 1060 nm diode laser for non-invasive fat reduction of the flanks.

BACKGROUND: Laser hyperthermia-induced lipolysis is a non-invasive method of localized fat treatment. Non-invasive approaches could be an option for a growing number of patients who are risk-averse and are seeking out non-invasive alternatives to surgical procedures such as liposuction. This study evaluated the safety and efficacy of a 1060 nm diode laser for the non-invasive fat reduction of the flanks. METHODS: A total of 30 subjects were enrolled in this prospective, single center study. Subjects received one 25-min treatment with a 1060 nm diode laser to both flanks. Follow-up visits were conducted at 6 and 12 weeks after the last treatment. Ultrasound adipose thickness, body weight, and circumference measurements were taken at baseline and at the 6- and 12-week follow-up visits. Subject satisfaction was assessed using a self-assessment of fat reduction, pain, and tolerability scales, and a subject satisfaction questionnaire. Safety was assessed via the presence or absence of any adverse events. RESULTS: The average age of subjects was 47.3 years. A total of 27 subjects completed the treatment and returned for both follow-up visits. An adipose reduction of 7.57 ± 1.15% at 6 weeks post-treatment (p < 0.0001) was measured using ultrasound. High subject satisfaction was seen, with 74% of subjects reporting being either "satisfied" or "very satisfied" with their results on a 5-point Likert Scale. Eighty-two percent of subjects stated they would recommend the treatment to their friends. All subjects had either mild or moderate pain, with 52% of subjects rating their pain as "mild" (1-3), while 48% rated their pain as moderate (4-7) on the Wong-Baker Scale. CONCLUSIONS: A single treatment with a 1060 nm diode laser was both safe and effective in reducing unwanted fat in the flanks without any unanticipated adverse events. Subjects described their treatment pain as mild or moderate and were highly satisfied with their treatment outcomes.

Investigating the efficacy of a fractionated 1927 nm laser for diffuse dyspigmentation and actinic changes.

OBJECTIVES: Facial actinic irregularities are frequent targets for noninvasive, energy-based treatment. These irregularities are multifactorial and driven by both intrinsic factors such as aging, genetics, and hormone exposure, and extrinsic factors, such as UV exposure. Clinically, this photodamage manifests as dyschromic skin disorders like melasma and actinic features such as solar lentigines. Fractionated 1927 nm (f1927 nm) nonablative lasers are suitable for targeting epidermal lesions and have been shown to be effective in resurfacing photoaged skin as well as addressing pigmented lesions without exacerbation. The purpose of this study was to quantify the magnitude and duration of actinic pigment and photodamage response in patients of Fitzpatrick Skin Phototypes (SPT) I-IV who underwent two treatments with a fractionated, nonablative 1927 nm thulium laser (MOXI™, Sciton). METHODS: The authors conducted an IRB-approved, single-center, prospective, nonrandomized study to evaluate the efficacy of f1927 nm nonablative lasers in the treatment of diffuse dyspigmentation and actinic irregularities. Patients underwent two treatments with f1927 nm nonablative laser at a 1-month interval. F1927 nm treatment and energy parameters included a pulse energy of 15 mJ, density of 15% with 15% coverage, and six total passes. The primary endpoint for this study was pigment response after treatment, measured using the VISIA Skin Imaging and Analysis System (Canfield Scientific). Pigmentary lesions measured and analyzed included spots, UV spots, and brown spots. The Physician's Global Assessment Scale was used by plastic surgeons to provide a subjective clinical assessment of melasma response. Nonparametric testing was used to assess and compare VISIA results across the study period as well as clinician evaluations. A p value ≤ 0.05 was considered statistically significant. RESULTS: Twenty-seven patients underwent two treatments with nonablative, f1927 nm laser in May and June 2022. Ninety-six percent of patients (n = 26) completed 1-month follow-up and 89% of patients (n = 24) completed 3-month follow-up. The study cohort was 100% female, with a mean ± SD age of 47.0 ± 11.5 (range: 29-74), and a mean Fitzpatrick SPT of 2.8 (range: I-IV). No serious adverse events were observed during study treatment or follow-up. Overall, analysis showed statistically significant improvements in dyspigmentation at 1 month and an increase in pigment toward baseline at 3 months. At 1 month, there was a statistically significant decrease in spots (p = 0.002), UV spots (p < 0.001), and brown spots (p < 0.001) compared to baseline. At 3 months, Brown spots remained significantly improved compared to baseline (p = 0.05). Analysis showed 9.9% improvement in pigment on the left (p < 0.0001) and 7.5% improvement in pigment on the right (p < 0.0001) face. Right dyspigmentation remained significantly improved at 3-month follow-up (p = 0.02). Subjectively, clinician evaluators' mean Physician's Global Assessment Scale score was 3.4 (p < 0.0001) at 1-month follow-up and 3.7 (p < 0.0001) at 3-month follow-up, which correspond to an approximately 50% improvement hyperpigmentation when at both time points. CONCLUSION: These results demonstrate that fractionated, nonablative 1927 nm laser treatment is an effective modality for improving clinical and subclinical photodamage. The magnitude and duration of pigment improvement are potentially influenced by the propensity for photodamage during the summer months, which may suggest the need for multiple f1927 nm treatments over time to maintain results.

A Randomized, Placebo-Controlled Trial Evaluating the Single and Combined Efficacy of Radiofrequency and Hybrid Fractional Laser for Nonsurgical Aesthetic Genital Procedures in Post-Menopausal Women.

BACKGROUND: The efficacy of interventions that provide long-term relief of genitourinary symptoms of menopause has not been determined. OBJECTIVES: The authors sought to evaluate radiofrequency and hybrid fractional laser (HFL) treatments for menopausal vulvovaginal symptoms. METHODS: Thirty-one postmenopausal women completed all treatments and at least 1 follow-up. Outcomes included the Vulvovaginal Symptom Questionnaire (VSQ), Vaginal Laxity Questionnaire (VLQ), Urogenital Distress Short Form, Incontinence Impact Questionnaire (IIQ), Female Sexual Function Index (FSFI), laxity measurements via a vaginal biometric analyzer probe, and gene expression studies. RESULTS: Mean VSQ score decreased 2.93 (P = 0.0162), 4.07 (P = 0.0035), and 4.78 (P = 0.0089) among placebo, dual, and HFL groups 3 months posttreatment and decreased to 3.3 (P = 0.0215) for dual patients at 6 months. FSFI scores increased in the desire domain for placebo and dual groups and in arousal, lubrication, orgasm, satisfaction, and pain domains for the HFL group 3 and 6 months posttreatment. An increase of 1.14 in VLQ score (P = 0.0294) was noted 3 months and 2.2 (P = 0.002) 6 months following dual treatment. There was also a mean decrease of 15.3 (P = 0.0069) in IIQ score for HFL patients at 3 months. Dual, HFL, and RF treatments resulted in statistically significant decreases in collagen I, elastin, and lysyl oxidase expression. CONCLUSIONS: Several self-reported improvements were noted, particularly among HFL, dual, and placebo groups 3 and 6 months posttreatment. Objective biopsy analysis illustrated decreased gene expression, suggesting that treatments did not stimulate new extracellular matrix production.

A Correlation of the Glogau Scale With VISIA-CR Complexion Analysis Measurements in Assessing Facial Photoaging for Clinical Research.

BACKGROUND: Historically, standard evaluations for photoaging have involved subjective analysis; recently, however, investigators have turned to noninvasive systems for more objective evaluation of facial aging. OBJECTIVES: The aim of this study was to establish a clinical correlation between the Glogau Photoaging Scale and the VISIA-CR Complexion Analysis System (Canfield Imaging Systems, Fairfield, NJ), and thereby reduce intra- and interobserver variability when assessing photodamage. METHODS: In total, 117 subjects aged between 18 and 89 years were included. Two-dimensional facial photographs were analyzed by 3 independent reviewers and assigned Glogau scores. Images were also captured and analyzed with VISIA software. Data were grouped by median Glogau score and compared between groups. RESULTS: All groups were statistically different (P < 0.05) for Spots, Wrinkles, and Remasked Wrinkles, except for Glogau 1 and 2 for Spots and Remasked Wrinkles. Scores for Wrinkles were plotted against age, and an exponential regression model was noted to be a better fit (R2 = 0.5) than a linear model (R2 = 0.47). The same was true for Spots with an exponential model (R2 = 0.36) compared with a linear model (R2 = 0.33). Scores were also evaluated based on sun exposure history, but no significant differences were observed. CONCLUSIONS: The results illustrate that an imaging system can be used to reliably determine objective scores correlating to Glogau photoaging evaluations, and indicate that aging appears to be an exponential process. Collectively, these findings will assist future investigations of facial aging and the therapeutic options available for facial skin rejuvenation, and enable objective assessment of treatment outcomes.

Bipolar Fractional Radiofrequency Treatment of Suprapatellar Skin Assessment Using Noninvasive Devices and Microbiopsy.

BACKGROUND: Noninvasive treatments for skin tightening are gaining popularity. However, no studies have assessed bipolar fractional radiofrequency treatment on suprapatellar skin. OBJECTIVES: The purpose of this study was to evaluate the efficacy of bipolar fractional radiofrequency treatment on suprapatellar skin. METHODS: Twenty patients received 1 bilateral suprapatellar bipolar fractional radiofrequency treatment. They returned 7 days, 3 weeks, 3 months, and 6 months posttreatment. Noninvasive measurements were obtained at each visit, including high-resolution ultrasonography, optical coherence tomography, transepidermal water loss and skin elasticity. Microbiopsies were collected in the treatment area for histologic and gene expression analyses. Three clinicians completed photographic evaluations comparing texture and laxity at baseline vs 6 months posttreatment. RESULTS: Fifteen subjects completed all 6 visits. Both transepidermal water loss and dermal-epidermal junction roughness were increased at 3 weeks and 3 months posttreatment. Both attenuation coefficient and stiffness were increased significantly at 3 and 6 months posttreatment. Blood flow 0.5 mm below the surface and expression of epidermal hyaluronic acid and inflammatory genes IL-1b and IL-6 were significantly higher at 7 days posttreatment compared with pretreatment and 3 months posttreatment. There were no statistically significant changes in collagen- or elastin-related genes and proteins at 7 days or 3 months posttreatment. An improvement in texture and laxity was observed at 6 months posttreatment in 17.7% and 24.4% of photographs, respectively. CONCLUSIONS: Radiofrequency treatment by microneedling of suprapatellar skin shows limited effects in decreasing skin laxity and improving skin appearance. At a molecular level, the treatment resulted in lower elastin and hyaluronic acid levels and increased dermal-epidermal junction roughness based on histology and optical coherence tomography imaging.

Clinical Evaluation of the Safety and Efficacy of a 1060-nm Diode Laser for Non-Invasive Fat Reduction of the Abdomen.

BACKGROUND: Despite the proven efficacy of liposuction, there is a population of patients who prefer non-surgical alternatives. Laser hyperthermia-induced lipolysis has emerged as one non-invasive alternative to liposuction. OBJECTIVES: The authors sought to evaluate the safety and efficacy of a 1060-nm (±10 nm) diode laser for non-invasive fat reduction of the abdomen. METHODS: This single-arm, 2-center study enrolled 30 patients. Patients received a 25-minute 1060-nm diode laser treatment on their abdomen. Ultrasound adipose measurements, body weight, and circumference were taken at baseline and at 6- and 12-week follow-up visits. Blinded evaluators identified "before" and "after" photos of each patient. A patient satisfaction questionnaire was completed by each patient at study exit. RESULTS: A total 29 patients completed all treatment and follow-up visits. Ultrasound images showed an adipose reduction of 8.55% at 12 weeks post-treatment (P < 0.0001). Blinded evaluators correctly identified 67% of the pre- and post-treatment images at site 01 (Sacramento, CA) and 56% at site 02 (Dallas, TX). Satisfaction was high, with 72% of patients reporting being either "satisfied" or "very satisfied" with their results on a 5-point Likert scale. Pain was rated as mild by 62% of patients, moderate by 38%, and severe by none on the Wong-Baker Scale. CONCLUSIONS: These results indicate that a single treatment with a 1060-nm (±10 nm) diode laser, per the treatment protocol, is safe and effective in reducing unwanted fat in the abdomen as objectively measured employing ultrasound. The treatment was well-tolerated among all patients, with minimal discomfort reported and high patient satisfaction.

The Role of the Laser Safety Officer and Laser Safety Programs in Clinical Practice.

Recent advancements in laser technology have led to its expanded utilization in smaller clinical settings and medical spas, particularly for facial rejuvenation and the treatment of other aesthetic concerns. Despite the increasing popularity of this technology, discussion of laser safety programs has remained limited, mostly to operating rooms at larger clinical institutions. Although smaller facilities do not operate at the same capacity as a large hospital or medical center, the requirements for utilizing a laser are no less stringent. Employers must comply with local and federal regulations, the Occupational Safety and Health Administration (OSHA) General Duty Clause, American National Standards Institute (ANSI) standards, and professional recommended practices applicable to their business. Although the laser safety officer (LSO) is often a full-time position within larger facilities, smaller clinical settings and medical spas may be limited in staff number. It is important, therefore, that clinical practices establish laser policies and procedures with consideration of their individual needs and capabilities. In this paper, we will define a laser safety program, highlight basic requirements needed to establish this program, and outline the specific responsibilities of the LSO. To ensure that safe laser practices are being conducted at the healthcare facility, it is imperative that small business owners are aware of these regulations and standards in place for the operation of laser systems.

Laser and Light-Based Device Education in a Plastic Surgery Residency Program: A Continuing Medical Education Overview.

The increasing prevalence of laser use, particularly in plastic surgery, demands education of both practitioners and trainees to ensure efficacy and patient safety. The purpose of this continuing medical education module is to provide the learner with a detailed outline for laser training education for plastic surgery trainees. In this overview, a discussion of the characteristics of light, an introduction to fundamental laser principles, a comparison of lasers and pulsed light systems, and examples of several therapeutic applications for light-based devices in the clinical setting will be presented. Additionally, the 5 parameters necessary for operation of light-based devices, as well as the importance of laser safety education, will be reviewed. We hope this continuing medical education will provide both practicing plastic surgeons and trainees with the proper education on the lasers and pulsed light devices they will use in their clinical practices.

Clinical Translation of Scarless 0.33-mm Core Microbiopsy for Molecular Evaluation of Human Skin.

BACKGROUND: Skin scarring can occur after punch biopsies, prohibiting their routine utilization, especially in the central face. OBJECTIVES: This paper describes a scarless, 0.33-mm-diameter skin microbiopsy for molecular analysis of skin. METHODS: This is was single-center, randomized, prospective study with 15 patients receiving no biopsy or biopsy on the left or right nasolabial fold. Six blinded raters assessed participant photos at baseline, 1 month, and 3 months post biopsy to evaluate for a visualized scar. Patient and Observer Scar Assessment Scale was completed. Additionally, biopsies from various skin regions of body along with arm skin after treatment with a single Erbium-YAG laser were processed for molecular analysis. RESULTS: No patients exhibited scar formation based on evaluation of photographs and patient feedback. There was no mark at the biopsy site 7 days post-procedure. Optical coherence tomography showed a complete closing of the biopsy-punch wound 48 hours post-biopsy. One month post-biopsy, photography reviewers were unable to identify a scar, on average, 90% of the time at 3-month follow-up. Microbiopsies from various anatomical regions were successfully extracted for histology, electron microscopy, and gene expression analysis. Selected skin rejuvenation markers in the biopsies from Erbium-YAG-treated forearm skin resulted in significant gene upregulation in extracellular matrix molecules at 1 month posttreatment compared with untreated skin. CONCLUSIONS: A core microbiopsy of 0.33 mm can be extracted reproducibly for histological, ultrastructural, and gene expression analysis without scarring. This allows repeated sampling for assessment of skin treatments and diseases, including aesthetics and wound-healing progress.

The Effects of Aesthetic Lasers on Three Study Materials Used for Ocular Protection.

BACKGROUND: It is dangerous, although not uncommon, in some clinical settings for laser operators to place gauze underneath external patient protective eyewear when performing laser procedures. OBJECTIVES: The purpose of this study was to evaluate 4 lasers, commonly used for aesthetic facial procedures, on 3 materials commonly found in the clinical setting. METHODS: We performed tests with 4 lasers: the 2940-nm erbium-doped yttrium aluminum garnet (Er:YAG) laser, the 532-nm potassium titanyl phosphate (KTP) laser, the 1064-nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser, and a Lumenis UltraPulse 10,600-nm carbon dioxide (CO2) laser. Their effects were evaluated on dry gauze pads, wet gauze pads, and adhesive external eye shields. RESULTS: When exposed to the 2940-nm Er:YAG and 10,600-nm CO2 lasers, dry gauze smoked on the first pulse and ignited on the second pulse, whereas no damage occurred to the wet gauze or adhesive eye shields after 8 and 4 pulses, respectively. No damage to any material or the underlying surface was seen after 30 pulses of the 532-nm KTP laser. After 2 pulses of the 1064-nm Nd:YAG laser, the adhesive eye shields sparked; dry gauze smoked after 1 pulse, but no damage to the underlying surface occurred after 30 pulses. CONCLUSIONS: The results of our study highlight the inherent flammability of gauze when exposed to lasers commonly used to address aesthetic facial concerns. Although moistened gauze conveyed more protection than dry gauze, these results do not guarantee patient ocular safety. Therefore, we do not recommend the use of any gauze under protective eyewear.

Safety Guidelines Concerning the Use of Protective Eyewear and Gauze During Laser Procedures.

The advancement of laser technology has seen its use gain popularity across a wide range of specialties to treat diseases, as well as address aesthetic concerns. In order to protect both the patient and the healthcare personnel providing treatment, instruction and knowledge of laser safety remain of utmost importance. In this paper, we discuss the classification of laser systems, review ocular injuries that may be caused by inappropriate laser exposure, and provide background on laser protective eyewear. In addition, we highlight the current recommendations for proper eyewear during laser use outlined in the American National Standards Institute standard Z136.3, Safe Use of Lasers in Health Care. Finally, although it is common in some healthcare facilities to place gauze under external eye shields or use gauze alone over eyes during laser procedures, this practice poses an extreme risk to both patients and healthcare personnel. Therefore, we discuss why the use of gauze under eyewear for any laser procedures is not recommended, and instead, offer suggestions to consider when acquiring safe and comfortable patient eyewear.

Carbon Dioxide Laser Resurfacing for Rhinophyma: A Case Report and Discussion of the Literature.

Rhinophyma, an unsightly and obstructive skin lesion of the nasal area, can be difficult to treat. Numerous modalities have been tried, including medical, excision, and ablation, with various tools and results. In the present report, we have demonstrated the use of the carbon dioxide (CO2) laser on the nose of a 56-year-old man, with excellent cosmetic results even at 59 months after treatment. Discussion of the disease entity and the advantages and disadvantages of the different treatment options are presented. Given the results shown in our patient, we believe that CO2 laser ablation should be a standard treatment of rhinophyma, given its practicality, predictability, and excellent outcomes.

Novel Use of Non-Invasive Devices and Microbiopsies to Assess Facial Skin Rejuvenation Following Laser Treatment.

BACKGROUND AND OBJECTIVE: Patient-reported outcomes and blinded observer rating scales are subjective and unreliable but are extensively utilized to evaluate cosmetic office-based treatments, including ablative lasers. This study aims to assess the practicality of using non-invasive and minimally invasive methods for objective skin assessment following a skin rejuvenation treatment. STUDY DESIGN/MATERIALS AND METHODS: Twelve patients received a single 1,470/2,940 nm laser treatment for facial rejuvenation. Assessments were performed before treatment, and 7 days, 3 weeks, and 3 months post-treatment. Images were taken with the VISIA Skin Analysis System to measure wrinkles, textures, pores, ultraviolet (UV) spots, brown spots, red areas, and porphyrins. Other non-invasive skin measurements-high-resolution ultrasonography, optical coherence tomography, transepidermal water loss and BTC 2000-were used to measure epidermal/dermal thickness, blood flow, surface roughness, wrinkle depth, attenuation coefficient, elasticity, laxity, and viscoelasticity. Microbiopsies (0.33 mm in diameter or the equivalent of a 23-gauge needle) were collected for histology and gene expression of tissue rejuvenation. RESULTS: Significant improvement in facial skin aesthetics after laser treatment was recorded in UV spots, brown spots and pores after 3 weeks and in UV spots and brown spots after 3 months. The dermal attenuation coefficient decreased significantly at 3 weeks, while blood flow 0.5 to 0.7 mm below the skin surface increased significantly between 5 days and 3 weeks following treatment. Epidermal hyaluronic acid expression assessed by immunostaining and expression of inflammatory genes were elevated at 7 days post-treatment compared with untreated or 3 months post-treatment. There were no statistically significant changes in collagen or elastin-related genes between groups at the studied parameters. CONCLUSION: Non-invasive devices can be effectively used to provide objective measurements of skin structure, pigmentation, blood flow, and elasticity to assess the efficacy of facial skin rejuvenation treatments. Furthermore, microbiopsies can objectively evaluate facial skin rejuvenation without scarring. Using non-invasive skin imaging, a single treatment with the 1,470/2,940 nm laser was observed to be effective in improving skin appearance after 3 months, namely in reducing UV spots and brown spots, without significant changes in the tissue at the molecular level, as assessed by microbiopsy. Lasers Surg. © 2020 Wiley Periodicals, Inc.

Use of Optical Coherence Tomography (OCT) in Aesthetic Skin Assessment-A Short Review.

Assessments of non-surgical office-based aesthetic treatments' efficacy including lasers are mostly based on subjective evaluation of clinical photography. Accumulating evidence suggest that non-invasive skin imaging such as optical coherence tomography (OCT) can be effectively used to assess not only the skin surface but also the underlying epidermis and dermis, providing objective and clinically relevant data. In this review, we highlight the potential of OCT imaging for the aesthetic medicine field along with OCT measurement parameters and their clinical relevance to healthy and pathological skin conditions. Lasers Surg. Med. © 2020 Wiley Periodicals, Inc.

Treating Hypertrophic Burn Scar With 2940-nm Er:YAG Laser Fractional Ablation Improves Scar Characteristics as Measured by Noninvasive Technology.

Their group previously demonstrated high-patient satisfaction for the treatment of hypertrophic burn scar (HBS) with the erbium: yttrium aluminum garnet (Er:YAG) laser, but this and other literature supporting the practice suffer from a common weakness of a reliance on subjective assessments by patients or providers. Herein, they sought to prospectively study the effects of Er:YAG fractional ablation on HBS using noninvasive, objective technologies to measure outcomes. Patients with HBS had identical regions of scar designated for treatment by the Er:YAG laser (TREAT) or to be left untreated (CONTROL). They prospectively collected scar measurements of TREAT and CONTROL regions preoperatively, 3 weeks, and 3 months after Er:YAG treatment. Scar measurements included viscoelastometry, transepidermal water loss, optical coherent tomography, and high-frequency ultrasound. Outcomes were measured for the aggregate difference between the TREAT group vs the CONTROL group, as well as within each group in isolation. Seventeen patients were seen preoperatively, followed by n = 15 at 3 weeks and n = 11 at 3 months. A mixed-model repeated measures analysis showed no significant effect of fractional ablation when comparing the overall TREAT group measurements with those of the CONTROL group. However, when considered as within-group measurements, TREAT scars showed significant improvement in viscoelastic deformity (P = .03), elastic deformity (P = .004), skin roughness (P = .05), and wrinkle depth (P = .04) after fractional ablation, whereas CONTROL scars showed no such within-group changes. HBS treated by the Er:YAG laser showed objective improvements, whereas no such changes were seen within the untreated scars over the same time frame.

Impact of a Laser Service Line for Burn Scar on a Dedicated Burn OR's Flow and Productivity.

Our group began performing erbium-YAG 2940 wavelength fractional resurfacing of burn scar in our burn center's dedicated burn operating room (OR) in January 2016. The impact of these procedures on the performance of a mature, dedicated burn OR is unknown. All burn OR cases performed between January 1, 2015 and December 31, 2015 served as a pre-laser (PRE-LSR) historical control. A postintervention cohort of laser-only cases (LSR) performed between January 1, 2016 and August 17, 2016 was then identified. PRE-LSR and LSR cases were retrospectively reviewed for OR component times, and work relative value units (wRVU) billed. A total of 628 burn OR cases were done in 2015 (PRE-LSR), while 488 burn OR cases were done between January 1 and August 17, 2016. Of these 488, 59 cases were LSR (12.1%). Calculated on a monthly basis, significantly more cases were done per day in the LSR era (2.2 ± 0.4 cases/d) than PRE-LSR (1.6 ± 2.0 cases/d; P < .0001). The LSR group was significantly shorter than the PRE-LSR group for all OR component times (induction, prep, and procedure all P < .0001; transport out, P = .01; room turnover, P = .004). Aggregate OR component time was 79.2 ± 33.4 minutes for LSR and 157.5 ± 65.0 minutes for PRE-LSR (P < .0001). LSR yielded 6.9 ± 3.2 wRVU/h, while PRE-LSR generated 12.2 ± 8.9 wRVU/h (P < .0001). Despite significantly shorter OR component times and more cases being done per day, laser treatment of burn scar using a single 17108 Current Procedural Terminology code cuts wRVUs generated per hour in a mature burn OR roughly in half.

Patient satisfaction after fractional ablation of burn scar with 2940nm wavelength Erbium-Yag laser.

OBJECTIVE: Fractional laser therapy is a new treatment with potential benefit in the treatment of burn scars. We sought to determine patient satisfaction after burn scar treatment with the Erbium-Yag laser. METHODS: We performed a telephone survey of all patients who underwent fractional resurfacing of burn scars with the Erbium-Yag 2940 wavelength laser at Parkland Hospital from 01/01/2016 to 05/01/2017. Subjects were asked to rate their satisfaction with their scars' after treatment characteristics on a scale from 1 (completely unsatisfied) to 10 (completely satisfied). Subjects were also asked to assess their treatment response using the UNC 4P Scar Scale before and after treatment. RESULTS: Sixty-four patients underwent 156 treatments. A survey response rate of 77% (49/64) was seen (age: 36.8+21 years; surface area treated=435+326cm2; 35% of burn scars were >2 years old; mean scar age of 1.02+0.4 years). Overall, 46/49 (94%) of patients reported some degree of scar improvement after treatment. Patient satisfaction scores were 8.3+2.3. Number of laser treatments included: 1 (31%), 2 (33%), 3 (18%), 4(10%), >5 (8%). Treatment depth, scar age, and number of laser procedures were not significant predictors of satisfaction or UNC 4P Scar scores. The paired t-test showed a significant reduction on each of the UNC 4P Scar scale items (pain, pruritus, pliability, paresthesia). One subject reported that she felt that the laser treatment made her scar worse (2%). CONCLUSION: Burn patients treated with the Erbium-Yag laser are highly satisfied with changes in their burn scars.

Problems and complications of full-face carbon dioxide laser resurfacing for pathological lesions of the skin.

OBJECTIVE: Facial resurfacing with a CO2 laser has been used for treatment of pathologic lesions and for cosmetic purposes. Postoperative complications and problems after laser resurfacing include infections, acneiform lesions, and pigment changes. This retrospective study describes the most common problems and complications in 105 patients and assesses postoperative pain in 38 patients. STUDY DESIGN: All patients received CO2 laser resurfacing for treatment of malignant/premalignant lesions and had postoperative follow-up to assess problems and complications. Some had follow-up to assess postoperative pain. All patients had Fitzpatrick I-III skin types and underwent the same perioperative care regimen. RESULTS: There were 11 problems and 2 complications. Problems included infection, acneiform lesion/milia, and uncontrolled postoperative pain. Complications included hyperpigmentation. Among the postoperative pain group, 53% reported no pain and the rest had mild or moderate pain. CONCLUSION: Complications are rare. Infection and acneiform lesions/milia were the most common problems, as previously reported. Most patients do not experience postoperative pain.

Holmium:YAG laser bronchoscopy ablation of benign and malignant airway obstructions: an 8-year experience.

Patients suffering from severe tracheobronchial obstruction are vulnerable to dyspnea, respiratory failure, obstructive pneumonia, and death. Treatment with a holmium:YAG laser, an alternative to the neodymium:YAG laser, may provide symptomatic relief. This is the largest case series to date describing the application of the holmium:YAG laser via bronchoscopy for benign and malignant obstructive disease. The data were retrospectively collected from 99 patients, with either benign or malignant tracheobronchial obstruction, who underwent 261 interventional bronchoscopy procedures in the operating room with laser ablation between January 2004 and November 2011. Categorical variables were analyzed with the chi-square and Fisher's exact tests as appropriate in contingency tables, whereas Student's t-test was performed for comparison of continuous variables. Patient follow-up was concluded on September 15, 2013. The holmium:YAG laser was used in 261 procedures performed on 99 patients with either benign or malignant disease. Symptomatic improvement was demonstrated in 90 % of all benign etiology cases and 77 % of all malignant etiology cases. Within the benign and malignant subgroups, improvement was dependent on anatomical location rather than etiology of the lesion. Complications occurred in 2.3 % of the procedures, with mortality in less than 1 % of procedures. Results confirm the usefulness and safety of the holmium:YAG laser in the treatment of patients with severe benign and malignant obstructive tracheobronchial obstructions. The holmium:YAG laser is an appealing alternative to the neodymium:YAG laser.