Cosmetic use of poly-l-lactic acid: a retrospective study of 130 patients.

BACKGROUND: Poly-l-lactic acid (PLLA) is an effective treatment for patients seeking to correct volume loss due to aging. Although the Food and Drug Administration has approved PLLA for use in people with the human immunodeficiency virus (HIV), it is well-suited for patients seeking cosmetic treatment. OBJECTIVE: To evaluate the efficacy and incidence of adverse events of HIV-negative patients treated with PLLA for volume restoration. MATERIALS AND METHODS: This is a retrospective, single-center study of 130 HIV-negative patients treated with PLLA from 2003 to 2008. Patient satisfaction and incidence of adverse reactions were evaluated. RESULTS: The most common reaction to PLLA treatment was the formation of nodules (8.5%). Almost all of the nodules were palpable; only one was visible. Treatment areas with the highest incidence of post-treatment nodules were the hands (12.5%) and cheeks (7.2%). Overall, patients were satisfied, with 55% having good to excellent correction; 75% of patients with five or more treatments rated their correction as good to excellent. Sixty-eight percent of all patients would repeat the procedure again. CONCLUSION: PLLA is a safe, biodegradable volumizer used to reverse the signs of aging by gradually correcting volume loss. Patients should be aware of possible adverse reactions during the course of treatment. Nodule formation is low, with most patients having good to excellent correction.

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.

Benefits of using a hydroquinone/tretinoin skin care system in patients undergoing intense pulsed light therapy for photorejuvenation: a placebo-controlled study.

A hydroquinone/tretinoin (HQ/tret) skin care system designed for use with non-surgical facial rejuvenation procedures has recently become available. In this observer-masked study, 36 patients with moderate-to-severe wrinkling of the skin around the eyes and lips were randomly assigned to use either the 4% hydroquinone/0.05% tretinoin skin care system or placebo products, each day for 90 days. In addition, all patients received intense pulsed light (IPL) treatment on days 30 and 60. At day 90, > or = 75% overall improvement was reported in 72% and 19% of patients in the HQ/tret + IPL group and the placebo + IPL group, respectively. HQ/tret + IPL was also associated with significantly lower mean hyperpigmentation scores at days 30, 60 and 90 (P < or = 0.05), and significantly lower mean laxity scores at day 90 (P< or =0.05) compared with placebo + IPL. Adjunctive use of the HQ/tret system enhances the improvements in facial skin achieved with IPL treatment.