Treatment of Chronic Lower Extremity Ulcers with A New Er:Yag Laser Technology.

Chronic lower extremity ulcers (CLEUs) have a high prevalence and are difficult to treat due to their various aetiologies. The aim of this study is to evaluate the results achieved in treating CLEUs using an Erbium: YAG (Er:YAG) laser with RecoSMA technology. This laser emits thousands of microbeams of energy causing superficial epidermal ablation and a separation of dermal fibres due to a mechanical-acoustic and resonance effect. The evaluation of the results achieved was carried out by questionnaires completed by 18 patients enrolled in the study. Histological studies and photographs taken before each session (16 sessions in total) were analysed to visually monitor the clinical progress. The analyses were carried out with the help of computer software. The results after 16 treatment sessions showed the complete healing of ulcers or a decrease in their initial area of at least 55% in over 65% of the patients treated. The Student's t-test and Fisher's exact test were used for statistical analysis. The Er:YAG laser and RecoSMA technology ablates few epidermal cell layers, producing a mechanical-acoustic effect with resonance action leading to tissue regeneration mechanisms. This technology offers an effective and safe alternative for treating CLEUs.

A novel method of facial rejuvenation using a 2940-nm erbium:YAG laser with spatially modulated ablation: a pilot study.

The objective of this study was to determine the efficacy and safety of a novel method of facial rejuvenation using a 2940-nm erbium:YAG laser with Spatially Modulated Ablation™. A pilot study was performed in 16 women with moderate to severe signs of facial aging relative to chronological age, who underwent two treatment sessions with an Er:YAG laser coupled to the RecoSMA™ technology (Linline, Minsk, Belarus). The whole face was treated in all patients. Clinical efficacy, tolerance, adverse effects, complications, and histological changes due to the treatment were evaluated. Clinical photographs and biopsies were taken before treatment and 3 months after the second treatment session. All patients completed the study and presented no significant complications. Histological changes in the epidermis and dermis as a result of treatment were found. Fine lines, wrinkles, and overall facial aging improved significantly (p < 0.0001). The mean reduction of fine lines and wrinkles was 59 % (r = 40-75 %). The mean improvement of overall facial aging was 74 % (r = 55-90 %). After showing the patients the comparative photographs before and after treatment, 75 % of women stated that they were satisfied or very satisfied and would recommend the treatment. Preliminary results show an excellent safety/efficacy profile for this novel technology, which, based on observed results, can be considered to have advantages over other methods of facial rejuvenation with lasers.

Properties of polidocanol foam in view of its use in sclerotherapy.

Foam sclerotherapy is a widely used method to treat varicose veins disease. It is easy to use and apply, affordable, and has high efficiency that depends on foam stability upon injection. Since sclerotherapy is usually applied in a medical doctor's office, one of the most employed methods to generate foam is based on the Tessari technique which uses pumping cycles of liquid and air in-and-out of a double syringe system. Finally, the produced foam exits through a small orifice (∼2mm) at the output of a three-way valve. The present work shows results regarding the factors that may influence foam stability (liquid to air ratio, type of connector, syringe diameter, number of pumping cycles, etc.) of a commonly used sclerosing agent (polidocanol). Furthermore, an effort is made to evaluate the effect of adding different substances on the stability of polidocanol foams (0.5% w/w) by altering the surface tension or/and the bulk and interfacial rheological properties of the fluids. It is shown that adding small concentrations of nonionic surfactants can increase foam stability with just a very small variation of the mean bubbles size.

Clinical and microscopic evaluation of long-term (6 months) epilation effects of the ipulse personal home-use intense pulsed light (IPL) device.

BACKGROUND: The aim of this study is to investigate the cellular mechanism of long-term hair reduction using a novel, square pulse, low-fluence home-use IPL device. METHODS: Ten subjects' axillae (Fitzpatrick III-V) were treated once weekly for four consecutive weeks in a simulated home-use trial. Treated and control site punch biopsies were taken from axillary sites for H&E staining and blinded histological examination before, immediately after and six months after the fourth treatment. The contralateral axilla served as a control. RESULTS: Histologically, four sequential weekly treatments gave a significant increase in telogen compared with anagen follicles. Six months after the fourth treatment, an 87% reduction in terminal hair count (P ≤ 0.00005) was recorded. An atypical telogen with infundibular dilatation and plugging of keratin and clumping of melanin with disintegration and/or retraction of the intraluminal hair shaft were observed. The papillae remained viable and some new anagen follicles were evident after four treatments. Vellous hairs appeared unaffected by IPL exposures. A mixed inflammatory infiltrate of lymphocytes and eosinophils around vessels of the superficial and deep dermis was sometimes present but the epidermis appeared always normal. CONCLUSION: A highly significant hair density reduction through induction of telogen followed by miniaturization similar to that achieved in professionally delivered permanent laser hair reduction appears to be the major mechanism of hair reduction using home-use IPL. IPL-induced damage to the isthmus and upper stem may inhibit or interfere with the hair regrowth process. Longer term studies are required to determine if this observed damage is clinically permanent.

Fractional carbon dioxide laser and acoustic-pressure ultrasound for transepidermal delivery of cosmeceuticals: a novel method of facial rejuvenation.

BACKGROUND: This study aimed to determine the efficacy and safety of a new facial rejuvenation procedure that combines a fractional carbon dioxide (CO2) laser, an ultrasound emitter, and a cosmeceutical preparation to be applied intraoperatively. METHODS: A split-face, double-blind randomized prospective study of 14 patients was designed, in which one half of the face was treated with a fractional CO2 laser, with the other half receiving the same laser and acoustic pressure ultrasound for transepidermal delivery of cosmeceuticals. Two semiquantitative scales and two visual analog scales were completed to evaluate the efficacy of each treatment. The results were assessed on the basis of photographs taken before treatment and then after 1, 2, and 6 months afterward. Potential adverse effects and complications were recorded. RESULTS: Both treatments achieved significant improvements in all parameters evaluated (p < 0.001). The combined ultrasound and cosmeceutical treatment had better scores for reduced fine lines and wrinkles as well as for overall facial aging at 6 months (p < 0.01), with nearly 80 % overall improvement in facial aging. The treatment was well tolerated, and no unexpected adverse effects were observed. The majority of the patients (86 %) stated that they were satisfied or very satisfied with their results. CONCLUSION: One session of fractional ablative CO2 laser and acoustic pressure ultrasound technology for transepidermal delivery of cosmeceuticals is an effective method for treating facial rejuvenation.

Laser-assisted lipolysis in the treatment of gynecomastia: a prospective study in 28 patients.

Gynecomastia is the most common breast pathology. Numerous excisions and liposuction techniques have been described to correct bilateral male breast enlargement. Recently, there has been a shift from the open approach to minimally invasive techniques. This article reports a 5-year experience using laser-assisted lipolysis (LAL) to treat gynecomastia, and describes the surgical technique. Between January 2006 and December 2010, a total of 28 patients with bilateral gynecomastia were treated with LAL. Patients had a mean age of 36.5 years (range 24 to 56 years). LAL was performed with a 980-nm diode laser (continuous emission, 15 W power, 8-12 kJ total energy per breast) after tumescent anesthetic infiltration. The breast was evaluated objectively by two physicians who compared chest circumference and photographs. Patients were also asked to score the results using a visual analogue scale: 75 to 100 (very good), 50-74 (good), 25 to 49 (fair) and 0 to 24 (poor). The postoperative period for all patients was incident-free. After 6 months, 18 patients (64.3%) scored the results as "very good", 6 as "good" (21.4%), 3 as "fair" (10.7%) and 1 "poor" (3.6%). Mean chest circumferences pre- and postoperatively were, respectively, 117.4 ± 11.1 cm and 103.3 ± 7.5 cm (p < 0.001), corresponding to a mean difference of 14.1 cm. Physicians scored the photographs as "very good" in 22 patients (78.6%), as "good" in five patients (17.9%), and as "fair" in one patient (3.6%). LAL in gynecomastia is safe and produces significant effects on fatty tissue, with a reduction in breast volume, together with significant skin tightening. Provided an appropriate amount of energy is delivered by an experienced operator, the results are both significant and consistent.

Perspectivas en el uso de materiales de relleno inyectables para tejidos blandos, desde nuestra experiencia. 2ª Parte / Perspectives on the use of soft tissue fillers from our experience. Part II

El médico que emplea un determinado material de relleno dérmico debe dominar la técnica de inyección, conocer las características del producto a fondo y los posibles efectos adversos derivados de su actuación. Las indicaciones que realizamos desde nuestra experiencia no agotan las posibilidades de lograr una mejoría estética evidente solo con el empleo de materiales inyectables; por el contrario, la buena formación y el conocimiento de técnicas afines pueden ser claves para el rejuvenecimiento de las zonas que lo precisan, redundando siempre en beneficio de los pacientes. La mayoría de efectos adversos que pueden producirse son leves y/o transitorios. Destacan el eritema ,edema, equímosis o hematomas; otros pueden ser potencialmente graves o prolongarse en el tiempo hasta que se resuelven. Destacan las reacciones de hipersensibilidad, las infecciones, granulomas o necrosis. Las recomendaciones sobre el tratamiento de las complicaciones deben seguir los principios básicos de la Medicina en relación a su diagnóstico y a las recomendaciones de la literatura experta que exponemos. La creciente demanda de tratamientos con materiales de relleno dérmicos, no debe suponer un incremento de los efectos adversos asociados si se tienen en cuenta y se conocen bien las indicaciones de empleo de cada uno de ellos (AU)

It is mandatory for doctors who use dermal fillers to dominate the injection technique and to know the product characteristics as well as the possible side effects that can derive from the procedure. Indications on fillers given in this paper, based on the authors' experience, do not prevent the use of other aesthetic treatments; moreover, a solid formation and a deep knowledge of the different adjunctive techniques that can be used are the key to achieve an aesthetic rejuvenation of the treated areas and, consequently, attain patients’ satisfaction. Most of the incidents or side effects that can appear with the use of dermal fillers are mild and brief. Erythema, edema, ecchymosis and/or haematomas are the most common ones. However, other effects such as cutaneous reaction to the product, granuloma formation and/or necrosis are more serious complications. Treatment in all of these cases should follow the basic medical knowledge principles in accordance to the complication diagnosed as well as to the recommendations given in related expert medical literature. The increased demand of treatments with fillers should not imply an increase in adverse effects if indications and correct use of the different available materials are taken into account (AU)

Ventajas de la cicatrización cutánea asistida por láser (LASH) / Advantages of laser assisted scar healing (LASH)

La fase final de toda cirugía es la sutura y su cicatriz correspondiente y, frecuentemente, ésta es la única secuela visible de una intervención. La técnica LASH (cicatrización cutánea asistida por láser), estimula los mecanismos de reparación de la piel por efecto térmico, condicionando la calidad de la cicatrización. Estudios experimentales en ratones comparando los resultados obtenidos en heridas quirúrgicas radiadas con laser diodo810 nm tras ser suturadas, con los obtenidos en igual tipo de heridas suturadas de manera convencional, han demostrado que se consiguen cicatrices mucho menos visibles cuando se practica el tratamiento con láser. La histología confirma, comparativamente, una notable aceleración del proceso cicatricial con modificación del TGFß (Transforming Growth Factor-Beta) directamente implicado en la reparación tisular, en los animales en los que la sutura fue asistida por láser. Igualmente, el análisis tensiométrico demostró mayor resistencia a la acción de estiramiento mecánico en estas heridas. Estudios clínicos en pacientes sometidos a dermolipectomia, reducción mamaria y estiramiento facial, demuestran que al tratar con LASH una parte o una de las líneas de sutura, los análisis realizados tanto por los pacientes como por cirujanos independientes a los 8 días, 3 meses y un año, evidencian resultados más favorables para la técnica láser, Las dosis eficaces determinadas para las fluencias láser están entre 80 y 120 J/cm2.La técnica LASH es simple de efectuar, reproducible, rápida y ofrece una clara evidencia de que es posible reducir considerablemente la cicatriz, logrando que ésta sea de mejor calidad y más estética (aU)

Suture is the final stage of surgery and as a consequence, as car is frequently the only visible effect after an operation. LASH technique ( Laser Assisted Scar Healing) produces thermal effects to stimulate mechanisms for tissue repair that will determine the quality of the scar. In the experimental phase, rats were irradiated with 810 nm diode-laser after surgical wounds were sutured, and then, compared to another group of rats with the same type of wounds which were sutured with conventional techniques. The results were that those rats treated with laser had less visible scars. Histology comparatively confirmed a notable acceleration in the scarring process with modification of the TGFß (Transforming Growth Factor-Beta), which is directly involved in tissue repair in those rats treated with laser. The tensiometric analysis also demonstrated a better resistance to mechanical stress of wounds. Clinically, in dermolipectomy patients, breast reductions and facial lifts, in which part of the sutures were treated with LASH, at 8 days, 3 months and 1 year controls, evaluated by independent surgeons to the study and by patients, statistical results were more favourable for patients treated with LASH technique. The effective doses determined for treatment were laser fluencies between80 and 120 J/cm2.LASH is a fast, simple to carry out and reproducible method, with clear evidence that it is possible to considerably reduce scars, giving them a better quality and aesthetic appearance (AU)

Perspectivas en el uso de materiales de relleno inyectables para tejidos blandos, desde nuestra experiencia. 1ª Parte / Perspectives on the use of soft tissue fillers from our experience. Part I

Los materiales de relleno inyectable empleados con finalidad estética o para recuperar el volumen en las atrofiasgrasas cutáneas, suponen uno de los procedimientos esté-ticos más empleados en España. El conocimiento de sus características, su técnica de depósito y correcta localización, así como saber los riesgos potenciales que pueden derivarse de su uso, son capitales para una elección adecuada a fin de obtener resultados correctos con mínimos efectos adversos. La elección de un tipo de material de relleno u otro dependerá de la evaluación del área a inyectar, de la experiencia de cada profesional y del seguimiento de las recomendaciones y técnicas particulares que requiere cada producto. El adecuado aprendizaje, asesoramiento y desarrollo de experiencia, representan la garantía del éxito (AU)

Treatment with fillers for aesthetic purposes or to replace subcutaneous fat loss produced by muscle atrophyis one of the aesthetic procedures more frequently carried out in Spain. Knowledge of the properties of the products, the injection technique, correct location of the area and awareness of the potential side effects and risks involved are important at the time of selecting this therapy, with the aim of obtaining good results with minimum of adverse effects. The selection of one type of filler or another will depend on the evaluation of the area to be filled, the experience of each professional and following the advice and specific techniques that each product requires. An adequate training, assessment and experience will represent a successful outcome (AU)

Cutaneous epidermal growth factor receptor system following ultraviolet irradiation: exploring the role of molecular mechanisms.

BACKGROUND/PURPOSE: The epidermal growth factor receptor (EGFR) pathway appears to be essential in many cutaneous disorders. It is well established that ultraviolet (UV) irradiation activates the EGFR in the animal and human skin; however, the molecular mechanisms involved in such activation remain unclear. Our aim is to review and analyse them. METHODS: Computerized search and selection of original papers in the MEDLINE database (PubMed) from 1988 to 2009 were performed. Systematic analysis and breakdown of the information selected were carried out. RESULTS: Full manuscripts were retrieved for 32 citations. It was proven that UV light acts directly and indirectly on EGFR (ErbB1/ErbB2) and on numerous intermediaries of extracellular and intracellular signalling. The most closely observed changes imply concentrations and/or molecular activity of the reactive oxygen species group, hydrogen peroxide, matrix metalloproteinases, p38MAPKinase, p21WAF1, p53, signal transducers and activators of transcription 3 and telomerase. CONCLUSION: Our results help to clarify the working and importance of the UV-EGFR system in the human skin.

Sistemas láser y de luz intensa pulsada (IPL) para uso domiciliario / Home-use laser & IPL devices

Los tratamientos basados en la luz para uso doméstico están documentados desde el año 2003 y, recientemente, en Europa, se han puesto en el mercado dispositivos para depilación y rejuvenecimiento cutáneo de uso domiciliario. Varios estudios comunican sobre su seguridad y eficacia en revistas internacionales, confirmando cifras significativas de reducción de pelo y relativamente pocos efectos secundarios; no obstante, los valores de eficacia son inferiores a los tratamientos realizados por profesionales, ya que estos dispositivos no consiguen emitir los parámetros que prometen. Algunos de estos sistemas de uso doméstico son inefectivos y pueden ser inseguros. Otros no son aptos para emplearse en todo tipo de piel; hasta el momento, la FDA Americana no ha autorizado su uso en cara y cuello. En ausencia de normas internacionales adecuadas, deberíamos escrudiñar los estudios clínicos disponibles y comparar las declaraciones hechas por los fabricantes, basándonos en informes objetivos de la industria que indiquen los parámetros de emisión de los sistemas que ofertan (AU)

Home-use light based treatments have been documented since 2003 and a number of home-use devices for hair removal and skin rejuvenation have been launched recently in Europe. Several safety and efficacy studies have also appeared in international journals confirming meaningful hair reduction figures and relatively few side effects but some are still inferior to professionally delivered treatments as they fail to deliver the parameters that they claim. Some home-use products are ineffective and some may not be safe. Other devices are not suitable for all skin types and FDA marketing clearances do not so far allow use on the face and neck. In the absence of adequate international standards we should scrutinise the available published clinical studies and compare claims made by manufacturers with objective industry reports measuring the parameters of these devices (AU)

Reducción del tiempo quirúrgico y de las complicaciones en el tratamiento endovascular con láser / Reduction of surgical times and complications with endovascular laser treatment

Introducción. En los últimos años se han realizado avances signifi cativos en el tratamiento de lapatología varicosa mediante la utilización del láser endovenoso. Esta técnica se realiza mediantela inserción de una fi bra láser en el interior de la vena safena provocando su oclusión pordescarga térmica previa aplicación de anestesia tumescente en todo el territorio a tratar. Entrelas ventajas de esta técnica se encuentran no requerir anestesia general o raquídea, presentarun tiempo de intervención corto, y que es mejor tolerada por los pacientes.Objetivo. Reducir el tiempo quirúrgico de esta técnica sin modifi car su efi cacia ni efectividad,utilizando un método de protección del tejido perivenoso mediante la aplicación de frío externoevitando así la utilización de anestesia tumescente.Material y método. Se han tratado un total de 12 pacientes. En todos ellos se registró su temperaturabasal previa al tratamiento y durante la descarga láser. También registramos el tiempoquirúrgico medio y las complicaciones.Resultados. La media de la temperatura basal previa a la descarga láser fue de 33 ºC y la mediade la temperatura durante el tratamiento láser fue de 40 ºC. En cuanto al tiempo quirúrgico,obtuvimos una media de 30 minutos. No tuvimos ninguna complicación derivada del tratamiento.Por último, en el seguimiento a un año, se demostró una oclusión total del eje safeno tratadoen todos los pacientes.Conclusión. La aplicación de nuestra modalidad de protección del tejido perivenoso safeno nospermite acortar el tiempo quirúrgico del tratamiento con láser(AU)

Introduction. In recent years there have been signifi cant advances in the use of endovenouslaser in the treatment of varicose pathology. This technique is performed by prior application oftumescent anesthesia in the whole area to treat and then inserting a laser fi ber inside thesaphenous vein provoking its thermal occlusion. The advantages of this technique is that it doesnot require general or spinal anesthesia, has a short intervention time, and is better toleratedby patients.Objective. To reduce operating time of this technique without changing its efficacy andeffectiveness, we used a method of perivenous tissue protection through the application ofexternal cold, thus avoiding the use of tumescent anesthesia.Methods. We have treated a total of 12 patients. In all, basal temperature was recorded beforetreatment and during laser discharge. We also recorded the average surgical time andcomplications.Results. The average baseline temperature before laser discharge was 33 ºC, with an average of40 ºC during laser treatment. In terms of surgical time, an average of 30 minutes was achieved.There were no treatment-related complications. Finally, in the follow-up to one year, totalocclusion of saphenous vein was demonstrated in all patients.Conclusion. The application of our method of perivenous saphenous tissue protection canshorten the operating time of laser treatment(AU)

La técnica “Face up”: lifting facial mini-invasivo con hilos tensores / The Face up technique: minimally invasive facial lifting with tensor threads

Presentamos una técnica personal que hemos denominado “Face Up”, empleando suturas de poliéster dispuestas a través de incisiones mínimas, que permite lograr un rápido efecto lifting para el rejuvenecimiento de la cara. Nuestra experiencia se basa en los resultados del tratamiento de 600 pacientes intervenidos entre septiembre de 2002 y marzo de 2006.Los resultados fueron evidentes desde el postoperatorio inmediato. Las zonas tratadas quedaron firmemente ligadas al plano de anclaje dentro del cuero cabelludo. Se trataron frente, sienes, cejas, mejillas, pómulos, cuello y regiones para maxilares adyacentes a la zona de los músculos maseteros y bucinadores, que ceden por efecto de la gravedad y del envejecimiento. En las zonas seleccionadas, las suturas se deslizan a través del tejido subcutáneo, donde la aponeurosis de los músculos implicados está firmemente ligada a este plano. Para la intervención se emplea una aguja, llamada “Demax” (aguja biselada con punta en los dos extremos provista de un orificio en uno de ellos) para arrastrar la sutura que se inserta desde la región cefálica temporal hasta el punto distal de la zona de laptosis, donde se efectúa un cambio de sentido formando un bucle que produce el segundo anclaje del tejido, evitando su desplazamiento. La sutura retorna al punto de entrada para su anudamiento al periostio a fin de conseguir y mantener el levantamiento. Las complicaciones recogidas fueron hematomas leves, equímosis, edema, e infección localizada en la incisión de ingreso y nudo de la sutura. En las evaluaciones efectuadas a corto y largo plazo, los resultados fueron buenos con un índice de satisfacción alto por parte de las pacientes y del médico. La técnica “Face Up” es mínimamente traumática y aporta una alternativa al lifting quirúrgico tradicional para el tratamiento del envejecimiento y de la flacidez faciales (AU)

We present a personal technique called “Face Up”, using polyester sutures, deployed via minimal incisions which make it possible to achieve a raid lifting effect for the rejuvenation of the face. Our experience is based on the results of treating 600 patients who underwent this procedure between September 2002 and march 2006.The results were evident immediately post-surgery. The treated areas were firmly tied to the anchorage plain of the scalp. These areas were forehead, temples, eyebrows, cheeks, cheekbones, neck and paramaxillar regions adjacent to the area of masseter and buccinator muscles, which sag due to gravitational force and ageing. In the selected areas, sutures are slid along the subcutaneous tissue, where the (..) (AU)

Effects achieved on stretch marks by a nonfractional broadband infrared light system treatment.

BACKGROUND: Infrared light systems reportedly produce collagen-related effects, enabling the treatment of several skin disorders. This study was designed to evaluate effects on stretch marks from an intense pulsed light infrared device, which achieved high fluences with high-frequency stacked pulses on selected areas. METHODS: For this study, 10 patients were recruited for treatment with the NovaPlus infrared device. Three passes per session over four sessions were given 15 days apart. The patients were advised to maintain their weight throughout the study period to avoid any impact on stretch marks. Objective evaluation was performed by using a computer program to compare photographs taken before and 3 months after the last session. Three-dimensional (3D) skin surface analysis also was performed using scores of "worse," "same," "fair," "better," and "much better." Biopsies were taken immediately before the first treatment and 3 months after the last session. Also, responses to questionnaires were evaluated to determine the patients' satisfaction index. RESULTS: Few patients noted improvement. Photographs of stretch marks checked by computer analysis and 3D skin surface imagery gave a practically equal outcome, with no "worse" or "much better" results. However, these objective tests demonstrated greater improvement than shown by the clinician and patient findings. Histology showed positive changes in the epidermis and dermis related to improvement in tissue condition. The satisfaction index from the questionnaires was average. The authors recognize that the small number of subjects possibly limited the statistical power of the study. CONCLUSIONS: Objective improvement observed in the overall skin condition did not match the visual observation. The absence of side effects or complications and good compliance with the treatment suggest that extra treatment sessions with the infrared light device could be tried to obtain a better outcome.