Picosecond Laser: Tattoos and Skin Rejuvenation.

Picosecond laser technology was cleared by Food and Drug Administration in 2012 and enhanced our ability to clear both benign pigmentation and dermal ink through a photomechanical impact created in the tissue. This impact created is greater than comparative nanotechnology and can be accomplished with lower fluences and smaller pulse durations. The addition of a diffractive lens array (FOCUS lens) has created a new category in skin rejuvenation by stimulating elastin and collagen through photomechanical and photoacoustic effects and not only through traditional photothermal tissue effects.

Evaluation of the Safety and Efficacy of a Low Fluence, Picopulsed, Alexandrite Laser in a Pico-Toning Technique With a Diffractive Lens Optic for the Treatment of Photodamage and Textural Improvement in "Off the Face" Applications.

BACKGROUND: The diffractive optic coupled with a picosecond pulsed alexandrite laser has been shown to effectively minimize pigmen- tation while improving the appearance of textural irregularities and rhytides. We evaluated the safety and ef cacy of the diffractive optic laser treatment for off of the face applications including the hands and décolletage in a pico-toning technique. STUDY: 20 healthy female patients (40-70 years of age) were treated with a picosecond pulsed alexandrite laser with a diffractive lens. 10 of the patients were enrolled in a prospective hand assessment study (20 hands) while the remaining 10 subjects were enrolled in an IRB approved study treating photodamage of the décolletage. Protocol for both groups included 4 treatments to the designated area with a picopulsed alexandrite laser with a diffractive lens on a 6mm handpiece delivering 0.71 j/cm2 with 10 hz repetition at 3 week intervals (+- 7 days) with follow up at 1 month and 3 months post fourth treatment using standardized digital photography. RESULTS: Statistically signi cant improvement in the overall appearance of pigmentation, texture and rhytides were recorded at each sub- sequent visit and at 1 and 3 months post the nal laser treatment. Clinical photographs were evaluated from baseline to the final photo at 3 months post last laser treatment by the treating physician, patient, and an independent evaluator. All hand subjects and chest subjects showed improvement in all 3 areas which were found to be statistically signi cant. No adverse events occurred in either study group. CONCLUSION: These study results show signi cant improvement in not only pigmentation, but in texture and rhytides in all subjects receiving pico-toning laser treatments to off of the face areas. The laser was well tolerated by all patients with no adverse effects. The use of a diffractive lens optic on a 6 mm xed spot size handpiece with a picopulsed alexandrite laser, in a pico-toning technique, provides a safe, low uence, yet effective treatment for not only pigment dyschromia but also textural irregularities and rhytides when treating the hands and décolletage. J Drugs Dermatol. 2016;15(11):1398-1401..

Dual-wavelength laser lipolysis treatment of lipomas: a case report.

Lipomas, which occur in 1% of the population, can be cosmetically unacceptable to patients. Excision of these benign tumors may leave visually unacceptable scars. The authors report a case of lipomas that were treated with laser lipolysis followed by digital extraction via a 1.5 mm opening thereby decreasing the risk of scarring.

A comparison of three separate clinical studies evaluating the safety and efficacy of laser-assisted lipolysis using 1,064, 1,320 nm, and a combined 1,064/1,320 nm multiplex device.

BACKGROUND: Laser-assisted lipolysis has been suggested to augment traditional liposculpture by improving skin laxity and providing hemostasis. Previous studies have reported improved hemostasis and smoother post-operative appearance with the 1,064 Nd:YAG laser-assisted lipolysis system. METHODS: Three separate pilot studies were performed. In the first study, both arms were treated with tumescent liposculpture. One arm was randomized to treatment with a subcutaneous 1,064 nm Nd:YAG laser. The second study treated multiple sites with half of the area randomized to receive the 1,064 nm versus the 1,320 nm system followed by aspiration at equal power. The third study treated patients using a combined 1,064/1,320 nm multiplex laser system at multiple sites. The endpoint of laser treatment was determined by an external skin surface temperature of 40 degrees C. In all three studies, photographs were compared at 1 week, 1 month, and 3 months post-operatively. RESULTS: In the first study, no significant improvement over tumescent liposculpture alone was noted using the 10 W, 1,064 nm laser. The second study showed no difference using the 10 W, 1,320 nm versus the 10 W, 1,064 nm laser-assisted lipolysis system. Finally, the multiplex 1,064/1,320 nm system appeared to show improvement in skin laxity and fat reduction. Complications included intra-operative thermal burns in 2 of 20 patients using the multiplex system. No complications were noted using the 1,064 or 1,320 nm 10 W systems. CONCLUSIONS: Laser-assisted lipolysis provides an innovative way to address the problem of skin laxity and fat reduction. Clinical results increased dramatically with the combined 1,064/1,320 nm multiplex system. However, caution should be used when exceeding external skin temperatures of 40 degrees C to avoid unwanted thermal burns. Future studies comparing the end temperature and wavelengths independently may help to conclusively delineate the optimal system.

Histologic and clinical response to varying density settings with a fractionally scanned carbon dioxide laser.

OBJECTIVE: An evaluation of the histological and clinical response to varying density settings (-10%, 0, and 10% overlap) with a fractionally scanned CO2 laser. STUDY DESIGN: Clinical and histological study evaluating abdominoplasty excised tissue for depth of penetration and width of tissue ablated with varying density and energy settings utilizing a scanned microsecond pulsed CO2 laser. These parameters were correlated clinically with patients treated with similar density settings. PARTICIPANTS: Fifteen patients were enrolled with 5 patients in each group: group 1 (density 1 settings), group 2 (density 2 settings) and group 3 (density 3 settings). MAIN OUTCOME: Histological differences of width and depth of tissue ablated with varying density settings and correlation with photodamage improvement clinically. METHODS: Six samples of excised abdominoplasty tissue were treated with increased energy and density settings and were evaluated histologically. Clinically, 15 patients with photodamage to the face were randomized to receive a fractional CO2 laser treatment with density levels ranging from 1 to 3. RESULTS: Microarrays of tissue injury were visualized with multiple areas of superficial to full-thickness epidermal thermal damage. As energy increased (90 W to 100 W), the width of basophilic coagulation of the subepidermal collagen increased. Increased density paralleled increased depth of penetration of subepidermal coagulation. Patient assessment of discomfort, erythema, edema, and satisfaction with the procedure was proportional to increasing densities. CONCLUSION: A fractional CO2 laser produces photorejuvenation, erythema, edema and discomfort in proportion with the depth and extent of epidermal and subepidermal thermal damage.

Histologic evaluation of interstitial lipolysis comparing a 1064, 1320 and 2100 nm laser in an ex vivo model.

BACKGROUND AND OBJECTIVES: Laser lipolysis using a pulsed Nd:YAG laser has been shown to be a safe and effective modality for the treatment of small areas of fat in conjunction with microcannula liposuction. The purpose of this study is to compare the histologic effects on ex vivo human fatty tissue using three separate wavelengths of laser light (1064, 1320 and 2100 nm) at three predetermined energy levels. STUDY DESIGN/MATERIALS AND METHODS: Nine samples of freshly harvested abdominal subcutaneous tissue were tumesced and then cannulated in a single tunnel in the superficial subcutaneous tissue. They were irradiated with a 320 microm polyimide fiber using a pulsed 1064 nm Nd:YAG, 1320 nm Nd:YAG and 2100 nm thulium holmium chromium:YAG (THC:YAG) laser at 4, 6 and 8 W (CoolTouch Corp., Roseville, CA). The fiber was withdrawn at a rate of 1 mm/second in a single pass. A tenth sample was cannulated without irradiation and served as a control. Irradiation with the 1320 nm Nd:YAG was performed in vivo on a lipoma in a similar fashion with repetitive tunneling. Fat was removed the following day by incisional punch biopsy for histologic evaluation. The tissue was studied in a blinded fashion with hematoxylin eosin staining. RESULTS: Light microscopy after irradiation showed thermal damage in the subcutaneous tissue that preferentially affected the fibrous septae with some fat cell damage. The diameter of thermal damage around the fiber ranged from 1 to 4-5 mm depending on the laser wavelength and average power of the settings. No clear fat liquefaction was seen histologically in the ex vivo samples but was seen with the 1320 nm Nd:YAG irradiation of the in-vivo lipoma tissue. CONCLUSION: Laser lipolysis works through a combination of photoacoustic ablation and selective photothermolysis of fibrous septae. Acoustic damage occurs with thermal damage and is difficult to capture histologically. The greatest amount of thermal damage was seen in the specimens with the highest energy per pulse, however, the patchiness and variability of thermal damage within the cross-sections evaluated make it difficult to draw any strong conclusions. Further studies are warranted to more fully evaluate the histologic effects and mechanisms behind laser lipolysis.

The effect of botulinum toxin type A on full-face intense pulsed light treatment: a randomized, double-blind, split-face study.

BACKGROUND: Botulinum toxin type A (BTX) is commonly used in combination therapy, and it has been reported that periocular BTX treatment enhances the aesthetic improvements attained with intense pulsed light (IPL). OBJECTIVE: The objective was to evaluate if intradermal BTX treatment of the cheeks also enhances the efficacy of IPL. METHODS AND MATERIALS: Fifteen females enrolled in this prospective, randomized, double-blind, split-face study (14 completed, 1 lost to follow-up). All received standard IPL treatment and were randomly assigned to receive eight 0.1-mL intradermal injections of BTX (BOTOX Cosmetic, Allergan) in one cheek (8 U total dose) and eight injections of saline in the contralateral cheek. Small wrinkles and fine lines, erythema, hyperpigmentation, apparent pore size, skin texture, and overall appearance were evaluated for 8 weeks. RESULTS: A significantly higher proportion of patients showed improvement in small wrinkles and fine lines with IPL plus BTX than IPL plus saline--93% versus 29% at Week 4 (p=.003). Adjunctive BTX also achieved a greater degree of improvement in erythema (although statistical significance was not achieved). Other efficacy measures showed comparable improvements with both regimens. CONCLUSION: The adjunctive use of BTX enhances the improvement in small wrinkles and fine lines, and possibly erythema, achieved with IPL alone.

Comparative evaluation of long-pulse alexandrite and long-pulse Nd:YAG laser systems used individually and in combination for axillary hair removal.

BACKGROUND: The 755-nm alexandrite and the 1,064-nm Nd:YAG lasers are both utilized for hair removal. Advances in laser technology have led to the development of dual-wavelength treatment for increased efficacy. OBJECTIVE: The objective was to evaluate the safety and efficacy of combining 755- and 1,064-nm wavelengths for axillary hair removal. METHODS: Twenty patients received three treatments at 4- to 6-week intervals in four axillary quadrants. The left upper axilla was treated with the alexandrite laser, the left lower axilla with the Nd:YAG laser, the right upper axilla with combination alexandrite and Nd:YAG laser, and the right lower quadrant with the diode laser. At 1- and 2-month follow-up visits, subjects completed questionnaires and were assessed for percentage of hair reduction. RESULTS: Eighteen subjects completed the study. The greatest reduction was seen with the alexandrite laser at 70.3% and combination of alexandrite and Nd:YAG laser at 67.1%. The diode laser was less efficacious at 59.7% and the Nd:YAG laser had the least improvement with 47.4% reduction. Subjects found the alexandrite and diode lasers to be the most tolerable and the Nd:YAG and combination treatment to be the most painful. CONCLUSION: Combination treatment of alexandrite and Nd:YAG lasers provides no added benefit over the alexandrite laser alone.

Outpatient management of traumatic microhyphema.

OBJECTIVE: This study was performed to evaluate the clinical course of patients treated for traumatic microhyphema and the occurrence of elevated intraocular pressure (IOP) and secondary hemorrhage in these patients. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: Records of all patients treated for traumatic microhyphema through the Wills Eye Hospital Emergency Department from January 1997 through September 1999 were analyzed retrospectively. Patients examined for 3 consecutive days after presentation and 2 weeks after initial presentation were included. Patients with open-globe injury were excluded. A total of 162 patients met the study criteria. INTERVENTION: All patients were treated initially as outpatients according to the standard Wills Eye Hospital protocol for traumatic microhyphema (atropinization, bedrest, shield, restriction of antiplatelet medications). Three patients were subsequently hospitalized. MAIN OUTCOME MEASURES: The occurrence of IOP elevation (greater than 21 mmHg) and rebleeding was recorded. The effect of topical corticosteroids was evaluated. RESULTS: IOP was elevated in 14 patients. Six patients had IOP less than 26 mmHg and required no treatment. Six patients had IOP greater than 26 mmHg and received medical treatment. In two patients, IOP increased after initial presentation. Of 150 patients with normal IOP at presentation, only one (0.7%) developed an elevated IOP at any point to warrant treatment (28 mmHg). Rebleeding was documented in three patients, one of whom developed a layered hyphema. The incidence of rebleeding was not statistically associated with the use of topical corticosteroids. CONCLUSIONS: Complications from traumatic microhyphema treated with standard measures are few. Closeness of follow-up may be determined by IOP on presentation. Secondary hemorrhage seems to be unaffected by the use of topical corticosteroids.