Autologous cultured fibroblasts as cellular therapy in plastic surgery.

Autologous cultured fibroblasts serve as injectable protein repair systems for correction of acne scars, rhytids, and other facial scars. The system uses the patient's own cultured fibroblasts to correct contour deformities over time.

Treatment of port wine stains using the pulsed-dye laser at 585 nm with the dynamic cooling device.

Port wine stains (PWS) are common vascular malformations appearing more frequently on the face and neck. One of the most prevalent treatment modalities for PWS is the pulsed-dye laser (PDL). The first generation PDL was limited to a 450 microseconds pulse width which was inadequate for the treatment of larger caliber vessels. Second generation PDLs have pulsed widths approximately three times longer (1.5 ms). This, along with the dynamic cooling device (DCD), which allows the safe use of higher fluences, should result in more clinical improvement in the treatment of PWS that were previously resistant or minimally responsive to first generation PDL treatment. We report a case of a 29-year-old white male with extensive PWS on the left face, left neck, and back, which displayed only mild changes with the first generation PDL. However, the use of the 1.5 ms PDL at 585 nm at high fluences in conjunction with the DCD resulted in marked improvement of the patient's PWS.

Cryogen spray cooling in combination with nonablative laser treatment of facial rhytides.

BACKGROUND: Cryogen spray cooling can be used to provide epidermal protection while still achieving spatially selective photocoagulation in the upper dermis. The objective of this study is to determine the efficacy and safety of cryogen spray cooling in combination with a nonablative Nd:YAG (lambda = 1320 nm) laser treatment of facial rhytides in human volunteers. OBSERVATIONS: Thirty-five adults with bilateral periorbital rhytides were treated with cryogen spray cooling in combination with 3 nonablative laser treatments performed sequentially at intervals of 2 weeks. Small but statistically significant improvements were noted in the mild, moderate, and severe rhytid groups 12 weeks after the final laser treatment. A final assessment performed 24 weeks after the last treatment showed statistically significant improvement only in the severe rhytid group. The procedure was found to be safe; 4 sites (5.6%) developed transient hyperpigmentation. Two sites (2.8%) subsequently developed barely perceptible pinpoint pitted scars. CONCLUSIONS: Cryogen spray cooling is a safe and effective method for protecting the epidermis during nonablative laser treatment of facial rhytides thereby avoiding much of the morbidity associated with other resurfacing procedures. Minor improvements in rhytides can be achieved with the current technology. Optimization of treatment parameters may further improve these results.

Autologous fibroblasts for treatment of facial rhytids and dermal depressions. A pilot study.

OBJECTIVE: To assess effectiveness of intradermal injections of autologous fibroblasts for the treatment of facial rhytids and dermal depressions. DESIGN: Six-month prospective pilot study. Photographs and silicone molds were taken of a prominent rhytid or dermal depression from each patient prior to treatment and at 6 months after treatment. SETTING: Specialty clinic in academic medical center. PATIENTS: Ten adults (age range, 24-69 years) who each exhibited a prominent rhytid or depressed facial scar. INTERVENTION: A 3-mm postauricular skin biopsy specimen from each participant was sent to Isolagen Technologies, Inc, laboratories, where a fibroblast cell line was developed. Three injection sessions were performed at 2-week intervals; target areas were the study site as well as behind the ear. MAIN OUTCOME MEASURES: Subjective improvement scores were obtained by each patient and 2 clinicians at every follow-up visit. Skin surface topographical features were evaluated with optical profilometry by comparing silicone molds before and after injection. Histological analysis was performed on a biopsy specimen of the postauricular injection site. RESULTS: Nine of 10 patients noted a 60% to 100% improvement with the treatment; clinicians made similar observations. Size reduction of 10% up to 85% of the study site was demonstrated by optical profilometry for every patient. Microscopically, there was evidence of increased thickness and density of dermal-layer collagen. CONCLUSIONS: Intradermal injection of autologous fibroblasts may be an effective treatment option for facial rhytids and depressed scars.

Treatment of pseudofolliculitis barbae with the diode laser.

Pseudofolliculitis barbae is a common skin disorder of the beard area that is characterized by the presence of inflammatory follicular papules due to terminal hair shafts re-entering the epidermis. Postinflammatory hyperpigmentation and scarring often occur with pseudofolliculitis barbae. Such skin changes can lead to cosmetic disfigurement and be of great concern to the patient. We report a case of pseudofolliculitis barbae and hirsutism with associated postinflammatory hyperpigmentation in an African-American woman who was effectively treated with the diode laser.

Incendiary potential of the flash-lamp pumped 585-nm tunable dye laser.

The recently introduced pulsed flash-lamp pumped tunable dye laser is used to treat cutaneous port-wine stains. In our practice, infants and children receive general anesthesia for these brief, yet painful, treatments. Because the flammability of this laser has not been reported and because we administer supplemental oxygen and nitrous oxide, we analyzed the incendiary potential of this laser by measuring the flammability of gauze and Telfa strips, hair, clear plastic face masks and tracheal tubes, and green nasal cannulae in 21%-100% oxygen and in nitrous oxide at laser energies between 6.0 and 10.0 J/cm2. (Our clinical range is 6.0-7.0 J/cm2.) In room air, gauze, Telfa, masks, and tubes did not ignite; only gauze ignited at high energy in 100% oxygen. Hair ignited in room air only when struck repeatedly at high energy, but easily ignited in 100% oxygen. Wetting hair with saline prevented ignition in room air and decreased flammability in supplemental oxygen. Green nasal cannulae prongs were extremely flammable in oxygen. Caution should be taken when using supplemental oxygen/nitrous oxide during treatment with the tunable dye laser.

Laser abrasion for cosmetic and medical treatment of facial actinic damage.

Previous studies have shown the carbon dioxide (CO2) laser to be effective in the treatment of actinic cheilitis. After CO2 laser abrasion, normal skin and marked cosmetic improvement of the lip were noted. In our study, twenty-three patients were treated with CO2 laser abrasions for cosmetic improvement of facial lines and actinic changes. Pre- and postoperative histopathologic examinations were made on two patients. Preoperative examination of specimens from actinically damaged skin showed atypical keratinocytes in the basal layer of the epidermis, with overlying dense compact orthokeratosis and parakeratosis. Abundant solar elastosis was seen in the papillary dermis. Postoperative histologic specimens showed a normal-appearing epidermis with fibrosis in the papillary dermis and minimal solar elastosis (about four weeks after laser treatment). At present, various modalities are available for the regeneration of the aged skin, including chemical peels and dermabrasion. Significantly fewer complications were noted with CO2 laser abrasion than with these methods. Thus, CO2 laser abrasion can be useful in the cosmetic and medical treatment of the aged skin. Marked clinical and histologic improvement has been demonstrated.

The flashlamp-pumped 577-nm pulsed tunable dye laser: clinical efficacy and in vitro studies.

The 577-nm flashlamp-pumped tunable dye laser pulsed at 450 microseconds is rapidly becoming the treatment of choice for removal of port-wine stains and other vascular ectasias. In this study, we examined the mechanisms of vessel destruction by determining the effects of laser irradiation on three types of primary target cells in vitro: erythrocytes, endothelial cells, and fibroblasts. Clinical studies were also performed, addressing the efficacy of this laser in the treatment of port-wine stains of the head and neck, trunk, and extremities. In endothelial cell cultures, both [3H]thymidine (measuring cell proliferation) and [3H]leucine (measuring protein synthesis) incorporations were inhibited at energy levels of 5-12 J/cm2 (p less than 0.01). The laser energy in the range of 5-8.5 J/cm2 had no effect on cell viability. Erythrocytes as target cells for laser energy demonstrated rapid, dose-dependent lysis. Addition of erythrocytes into a co-culture with endothelial cells abolished the direct inhibitory effect noted in cultures when endothelial cells alone were present. The results of the latter experiment imply that erythrocytes are the primary target cell absorbing the laser energy at 577 nm. However, direct laser effects on endothelial cells may also contribute to the mechanisms of ablation of the vascular ectasias by the tunable dye laser at 577 nm. Clinical trials on 28 patients with port-wine stains of the face and neck using this laser demonstrated a 75% response rate with greater than 50% lightening of the lesions. Of 9 port-wine stain lesions on the trunk and extremities (on a total of 6 patients), 8 (89%) demonstrated significant (greater than 50%) fading of their lesions. Complications such as scarring or epidermal texture changes were minimal.

Cellular effects of the pulsed tunable dye laser at 577 nanometers on human endothelial cells, fibroblasts, and erythrocytes: an in vitro study.

The 577-nm flashlamp-pumped tunable dye laser pulsed at 450 microseconds is rapidly becoming the treatment of choice for removal of portwine stains and other vascular ectasias. In this study, we examined the mechanisms of vessel destruction by determining the effects of laser irradiation on three types of primary target cells--erythrocytes, endothelial cells, and fibroblasts. Human endothelial cells and fibroblasts in microwell plates were irradiated at various energy densities with the laser, after which several aspects of cellular biology were determined, including 1) viability of cells by trypan blue exclusion test; 2) cell proliferation by [3H]thymidine incorporation; and 3) rate of protein synthesis using [3H]leucine incorporation as a marker. In endothelial cell cultures, both [3H]thymidine and [3H]leucine incorporations were inhibited at energy levels of 5-12 J/cm2 (P less than 0.01). In fibroblast cultures, cell proliferation was similarly inhibited, while supratherapeutic energy density (greater than or equal to 12 J/cm2) was required for inhibition of protein synthesis. The laser energy in the range of 5-8.5 J/cm2 had no effect on cell viability. Erythrocytes as target cells for laser energy demonstrated rapid, dose-dependent lysis, as determined by release of free hemoglobin into culture medium. Addition of erythrocytes into a coculture with endothelial cells abolished the direct inhibitory effect noted in cultures when endothelial cells were present alone. The results of the latter experiment imply that erythrocytes are the primary target cell absorbing the laser energy at 577 nm. However, direct laser effects on endothelial cells may also contribute to the mechanisms of ablation of the vascular ectasias by the tunable dye laser at 577 nm.