Abstract della lezione
Full-Face
Laser Resurfacing and Rhytidectomy, Dott.
Giacomo
Dell'Antonio
Aesthetic
Plast Surg 1999 Mar;23(2):101-106
Full-Face
Laser Resurfacing and Rhytidectomy.
Graf
RM, Bernardes A, Auerswald A, Noronha L
Curitiba,
Brazil
The
Ultrapulse CO2 laser (Coherent Inc., Palo Alto, CA, USA) was used in 239
patients, from March 1996 to July 1998, for full-face laser resurfacing. In 106
(43%) of these patients rhytidectomy was performed in the same procedure. All
patients submitted to laser resurfacing were prepared for 1 to 2 months
beforehand with retinoic acid and hydroquinone. The procedures were done under
local anesthesia controlled by an anesthesiologist. A clear film dressing
impregnated with silicone gel (Silon TSR; Bio-Med Sciences, Bethlehem, PA, USA)
was used for 6 to 7 days and complete healing was observed in 7 to 10 days.
Complications were exclusively dermatologic, without relation to surgery. No
necrosis of the cutaneous flap was observed. Skin biopsies of 10 consecutive
patients undergoing the combined procedures revealed no vascular impairment to
the dermis. The patients were able to resume their activities 2 weeks after the
procedure.
Arch
Dermatol 1999 Apr;135(4):444-54
Why
does carbon dioxide resurfacing work? A review.
Ross
EV, McKinlay JR, Anderson RR
Department
of Dermatology, Naval Medical Center San Diego, Calif 92134, USA.
vross@snd10.med.navy.mil
Despite
the unquestionable efficacy of carbon dioxide laser skin resurfacing, mechanisms
for cosmetic enhancement remain poorly characterized. Histological studies have
provided some insight into the cascade of events from initial laser impact to
final skin rejuvenation. However, there are few comprehensive studies of gross
and microscopic wound healing. Additionally, the literature is fragmented;
excellent individual articles appear in journals from widely disparate
disciplines. For example, some reports relevant to laser skin resurfacing are
"sequestered" in the engineering literature. This article is intended
to update the physician on laser skin resurfacing based on the broadest review
of the current literature. It proceeds from a discussion of initial laser-tissue
interactions, such as collagen denaturation, to examination of long-term
biological sequlae. At some cost to scientific rigor, mathematical models
describing laser-tissue interactions are not presented.
Arch
Dermatol 1999 Apr;135(4):391-7
Comparison
of erbium:YAG and carbon dioxide lasers in resurfacing of facial rhytides.
Khatri
KA, Ross V, Grevelink JM, Magro CM, Anderson RR
Department
of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston
02114, USA.
OBJECTIVE:
To compare the efficacy, adverse effects, and histological findings of erbium:YAG
(Er:YAG) and carbon dioxide (CO2) laser treatment in removing facial rhytides.
DESIGN: An intervention study of 21 subjects with facial rhytides. All
participants were followed up for 6 months. The end points of the study were
wrinkle improvement and duration of adverse effects. SETTING: Academic referral
center. SUBJECTS: Nineteen female and 2 male volunteers with skin type I to III
and wrinkle class I to III participated in the study.
INTERVENTION:
In all subjects, 1 side of the face was treated with a CO2 laser and other side
with an Er:YAG laser. Skin biopsies were performed in 6 subjects before
treatment and immediately, 1 day, 2 days, and 6 months after
treatment.Observations were recorded by subjects, investigators, and a blinded
panel of experts.
MAIN
OUTCOME MEASURES: Improvement in wrinkles and severity and duration of adverse
effects. RESULTS: The CO2 laser-treated side had relatively better wrinkle
improvement when evaluating all subjects (P<.03). However, in subjects
receiving more than 5 passes of Er:YAG laser, improvement scores were not
significantly different from those for 2 to 3 passes of CO2 laser treatment.
Posttreatment erythema was noted at 2 weeks in 14 subjects (67%) on the Er:YAG
laser-treated side and 20 subjects (95%) on the CO2 laser-treated side. The
frequency of erythema was significantly less after Er:YAG laser treatment at 2
(P=.001) and 8 (P=.03) weeks. Hypopigmentation was seen in 1 Er:YAG-treated (5%)
and 9 CO2-treated (43%) sides (chi2, P<.05). Histological evaluation showed
residual thermal damage of up to 50 microm on the Er:YAG-treated side and up to
200 microm on the CO2-treated side. CONCLUSIONS: Erbium:YAG laser is safe and
effective in removing facial rhytides. Subjects treated with Er:YAG laser
recover more quickly from the procedure than those receiving CO2 laser treament.
Dermatol
Surg 1999 Mar;25(3):169-73; discusion 174
Long-term
effects of one general pass laser resurfacing. A look at dermal tightening and
skin quality.
Ruiz-Esparza
J, Barba Gomez JM
Department
of Dermatology, University of California, San Diego, USA.
BACKGROUND:
Laser resurfacing with high-energy, short-pulsed lasers is generally a safe and
cosmetically rewarding procedure. Nevertheless, the aggressive use of these
instruments has the potential for unpredictable, undesirable complications. It
has long been held that multiple passes are needed to achieve dermal tightening
(collagen shrinkage), which will result in a cosmetically desirable appearance.
The observation of skin tightening after one general pass has not been
previously reported. OBJECTIVE: To look at the long-term results after only one
general pass and of focal multiple passes over lines, with particular attention
to the degree of tightening and quality of the skin. METHODS: Fifteen patients
with varying degrees of photodamage and resulting skin laxity, and with at least
eighteen months follow-up, were evaluated. High quality photographic records
were compared between pre- and postoperative pictures at three different angles
on each. RESULTS: Cosmetically significant dermal tightening was observed in all
of these patients. This was noted in some patients after six months and
continued for several months after. All patients were pleased with the cosmetic
improvement obtained. Of note were fast healing and the absence of significant
complications in these patients.
CONCLUSIONS:
The appearance of dermal tightening as a late occurrence in the postoperative
course after one single general pass has not been previously reported. When
numerous general passes are done, dermal tightening is quite impressive and
appears much sooner; however,much of this result is due to edema and the
resulting skin quality in these patients is different. A more natural look is
achieved if only one pass is done. The procedure is safer and has a faster
recovery period.
Dermatol
Surg 1999 Mar;25(3):164-7; discussion 167-8
Laser
resurfacing of the neck with the Erbium: YAG laser.
Goldman
MP, Fitzpatrick RE, Manuskiatti W
Dermatology
Associates/Cosmetic Laser Associates of San Diego County, Inc, USA.
BACKGROUND:
Laser resurfacing of the face is widely used to correct the effects of
photoaging. The neck also develops a similar degree of photoaging, but is not
usually treated because a higher incidence of adverse effects can occur with
laser treatment. OBJECTIVE: To present a new method for treating photoaged skin
of the neck with an erbium:yttrium aluminum garnet (Er:YAG) laser.
METHODS:
Twenty patients underwent Er:YAG laser resurfacing of the neck with one of two
methods. Method 1 consisted of using the Er:YAG with a 5-mm diameter collimated
beam at a fluence of 8.7 J/cm2 followed by a second pass using a 0.2 mm diameter
non-collimated spot at 1.7 J in a defocused mode with spot sizes ranging from
about 5 to 10 mm in diameter (fluences from 2-9 J/cm2). Method 2 consisted of
treating the entire neck with a single pass of the Er:YAG laser with a 4 mm
diameter non-collimated spot at 1.7 J (fluence of 13.5 J/cm2). A second pass at
identical settings was made of the
upper half of the neck with a more defocused pass using a 6-10 mm diameter spot
(fluence of 2-6 J/cm2) on the lower half of the neck. Patients were evaluated by
two nontreating physicians as to overall satisfaction and improvement in skin
texture and color.
RESULTS:Overall,
51% of patients were satisfied with their results. Skin texture improved an
average of 39%. Method 1 produced a 28% improvement, Method 2 a 48%
improvement. Skin color improved an average of 37%. Method 1 produced a 28%
improvement, Method 2 a 45% improvement. CONCLUSION: Photoaged skin of the neck
Dermatol
Surg 1999 Mar;25(3):160-3
Combined
laser resurfacing with the 950-microsec pulsed CO2 + Er:YAG lasers.
Goldman
MP, Manuskiatti W
Dermatology
Associates of San Diego County, Inc., La Jolla, California 92037, USA.
INTRODUCTION:
Laser resurfacing with the 950 microsec pulsed CO2 laser has been proven to be
efficacious in improving photodamaged skin and acne scarring. Unfortunately,
prolonged erythema and delayed wound healing are common adverse sequelae, which
require intensive patient education and intervention. These
Dermatol
Surg 1999 Mar;25(3):153-8; discussion 159
Comparison
of four carbon dioxide resurfacing lasers. A clinical and histopathologic
evaluation.
Alster
TS, Nanni CA, Williams CM
Washington
Institute of Dermatologic Laser Surgery, Washington, DC, USA.
BACKGROUND:
Several high-energy, pulsed and scanned carbon dioxide (CO2) lasers are
currently available for cutaneous resurfacing. Although each laser system
RESULTS:
The four CO2 lasers produced equivalent clinical improvement of rhytides and
scars. Re-epithelialization occurred in all laser quadrants by day 7.
Postoperative erythema was most intense in the quadrants treated by
UltraPulse and NovaPulse; however, overall duration of erythema was equivalent
for all four laser systems (3 months). Postinflammatory hyperpigmentation was
the most frequently encountered side effect and occurred with equal frequency in
each quadrant. No scarring, hypopigmentation, or infections were observed. After
one laser pass, histologic examination revealed partial ablation of the
epidermis with the TruPulse laser and complete epidermal ablation using the
UltraPulse, NovaPulse, and FeatherTouch laser systems. The greatest degree of
residual thermal damage was seen after FeatherTouch and NovaPulse laser
irradiation. New collagen formation was greatest in the UltraPulse and
FeatherTouch laser-irradiated quadrants. CONCLUSIONS: Equivalent clinical
results were observed using the FeatherTouch, NovaPulse, TruPulse, and
UltraPulse CO2 lasers. While postoperative erythema intensity differed between
laser systems, total duration of erythema was equivalent. The four lasers under
study resulted in minimal residual thermal damage and stimulated new collagen
formation within 6 months after treatment.
J
Am Acad Dermatol 1999 Apr;40(4):615-22
Depth
of vaporization and the effect of pulse stacking with a high-energy, pulsed
carbon dioxide laser.
Fitzpatrick
RE, Smith SR, Sriprachya-anunt S
Department
of Medicine, University of California, San Diego, USA.
BACKGROUND:
Laser resurfacing of photodamaged skin has become popular, but questions
regarding its safety with regard to the risks of scarring have arisen. OBJECTIVE:
This study was designed to investigate the depth of vaporization and residual
thermal necrosis of single-pulse vaporization and multiple passes versus
pulse-stacking and multiple passes. The potential significance of operator
technique and laser parameters is considered. METHODS: Skin samples from
surgical excisions were treated by means of a Coherent Ultrapulse carbon dioxide
laser at 250 mJ per pulse and 500 mJ per pulse with a 3 mm collimated beam and a
repetition rate of 10 Hz. A total of 70 treatment areas were performed. Blinded
analysis of the histologic effects of single-pulse, double-pulse, and
triple-pulse vaporization after 1 through 10 passes was undertaken. RESULTS: A
plateau of vaporization was observed after 3 passes at both 250 and 500 mJ
whether single-, double-, or triple-pulse
vaporization was used. This plateau occurs at approximately 100 to 250 microm
from the skin surface. Thermal necrosis is well controlled only with
single-pulse vaporization. There is a direct linear increase in the depth of
thermal necrosis both with the number of pulses stacked and the number of
passes. CONCLUSION: Pulsed carbon dioxide laser resurfacing is a safe and
self-limited procedure if a pulse width of less than 1 msec is used with
single-pulse vaporization and fluences of 3.5 J/cm2 and 7.0 J/cm2. There appears
to be little justification for performing more than 3 or 4 passes. Pulse
stacking may significantly increase residual thermal necrosis, thereby
increasing the risk of scarring. Operator technique may be significant in
avoidance of this occurrence.
Lasers
Surg Med 1999;24(2):103-12
Effects
of overlap and pass number in CO2 laser skin resurfacing: a study of residual
thermal damage, cell death, and wound healing.
Ross
EV, Barnette DJ, Glatter RD, Grevelink JM
Dermatology
Laser Center and Wellman Laboratories of Photomedicine,
BACKGROUND:
Newer CO2 laser systems incorporating short pulse and scanning technology have
been used effectively to resurface the skin. As the number of resurfacing cases
has increased, hypertrophic scarring has been reported more commonly. Previous
dermabrasion and continuous wave CO2 studies have suggested that depth of injury
and thermal damage are important predictors of scarring for a given anatomic
region. To determine whether rapid overlapping of laser pulses/scans
significantly altered wound healing, we examined residual thermal
damage, cell death, and histologic and clinical wound healing in a farm pig.
METHODS AND MATERIALS: Two popular CO2 systems were used, with a range of
radiant exposures, degrees of overlap, and numbers of passes. Thermal damage was
assessed by histology, and dermal cell viability was measured with
nitrotetrazolium blue staining. Presence or absence of clinical scarring was
determined by textural change and loss of skin markings. RESULTS: We observed
that dermal thermal damage did not increase significantly with pass number when
performed as in the normal clinical setting (for 2-4 passes); however, by
delivering rapidly overlapping pulses and scans, residual thermal damage and
cell death depth were increased as much as 100% over areas without immediate
overlap of laser impacts. CONCLUSIONS: Immediate overlapping of CO2 laser pulses
and scans is a significant risk factor in increasing thermal damage, cell death,
and possibly scarring.
Lasers
Surg Med 1999;24(2):87-92
Clinical
and histologic evaluation of six erbium:YAG lasers for cutaneous resurfacing.
Alster
TS
Washington
Institute of Dermatologic Laser Surgery, Washington, DC 20037, USA.
BACKGROUND:
Several erbium:YAG lasers are currently available for cutaneous laser
resurfacing. Although different laser systems are purported to produce
equivalent laser energies to produce similar laser-tissue interactions, no
comparative clinical or histologic studies have been performed to objectively
demonstrate their relative efficacies. OBJECTIVE: The purpose of the present
study was to examine the in vivo clinical and histopathologic effects of six
different erbium:YAG resurfacing lasers. METHODS: A blinded, prospective study
using six different erbium lasers (Candela, Continuum Biomedical, HGM, MDLT,
SEO, Sharplan/ESC) was performed. The facial halves of 12 patients were randomly
resurfaced with one of the six laser systems by using an identical laser
technique at 5.0 J/cm2. Intraoperative skin biopsies were obtained after each of
three laser passes in two patients for blinded histologic determination of
tissue ablation level and presence of residual thermal damage. Clinical
assessments of reepithelialization rates, severity and duration of erythema,
side effects, and degree of clinical improvement were made at 0.5, 1, 2, 4, 12,
CONCLUSIONS:
Equivalent clinical and histologic results were seen after each of the six
erbium:YAG lasers studied. Erbium:YAG laser resurfacing can be used to
Lasers
Surg Med 1999;24(2):81-6
Periorbital
skin resurfacing using high energy erbium:YAG laser: results in 50 patients.
Weiss
RA, Harrington AC, Pfau RC, Weiss MA, Marwaha S
Department
of Dermatology, Johns Hopkins University School of Medicine,
OBJECTIVE:
To evaluate Erbium:YAG regional periorbital laser resurfacing clinically and
histologically. STUDY DESIGN/MATERIALS AND METHODS: Photographic
RESULTS:
Re-epithelization in the periorbital region was rapid with a mean duration of
2.65 days. Erythema ranged from a longest of six weeks to the shortest of seven
days with a mean duration of 15.4 days. Evaluation of
J
Am Acad Dermatol 1999 Mar;40(3):401-11
Long-term
effectiveness and side effects of carbon dioxide laser resurfacing for photoaged
facial skin.
Manuskiatti
W, Fitzpatrick RE, Goldman MP
Dermatology
Associates and Cosmetic Laser Associates of San Diego County, Inc.,La Jolla, CA
92037, USA.
BACKGROUND:
Laser resurfacing has been used for treatment of photoaged facial skin since
late 1993. Very few long-term follow-up studies regarding the effectiveness and
side effects of this procedure have been reported. METHOD: Patients who received
carbon dioxide laser resurfacing for facial photoaging and wrinkling from Dec
17, 1993, to Nov 30, 1996, were followed up with
Int
J Dermatol 1999 Jan;38(1):58-64
Electron
microscopy comparison of CO2 laser flash scanning and pulse technology one year
after skin resurfacing.
Trelles
MA, Rigau J, Pardo L, Garcia-Solana L, Velez M
Instituto
Medico Vilafortuny/Fundacion Antoni de Gimbernat, Cambrils, Spain.
BACKGROUND:
The recent adaptation of laser technology in plastic and dermatologic surgery
has provided a means to reduce efficiently the irregularities of the surface of
the skin. Previous studies have analyzed the
Dermatol
Surg 1999 Feb;25(2):121-3
Erbium:YAG
laser resurfacing for refractory melasma.
Manaloto
RM, Alster T
Washington
Institute of Dermatologic Laser Surgery, Washington, DC, USA.
BACKGROUND:
Melasma is a facial dyspigmentation which is a common complaint in patients with
darker skin tones. Many current therapies used for this conditionare ineffective
and can cause significant adverse effects. OBJECTIVE: The purpose of this study
was to evaluate the role of erbium:YAG laser resurfacing in the management of
refractory melasma. METHODS: Ten female patients with melasma unresponsive to
previous therapy of bleaching creams and chemical peels were included in this
study. Full face skin resurfacing using an erbium: YAG laser (2.94 microm) was
performed using 5.1-7.6 J/cm2 energy. Clinical evaluations using the Melasma
Area and Severity Index (MASI) and melanin
reflectance spectrometry measurements were taken preoperatively and at 0.5, 1,
1.5, 3, and 6 weeks and 3, 5, and 6 months postoperatively. Adverse effects
after laser resurfacing such as prolonged erythema, infection, and
hyperpigmentation were recorded. RESULTS: There was marked improvement of the
melasma immediately after laser surgery using the parameters outlined; however,
between 3 and 6 weeks postoperatively, all patients exhibited post-inflammatory
hyperpigmentation. Decreased MASI and melanin reflectance spectrometry
measurement scores were noted after biweekly glycolic acid peels and at the end
of 6 months, significant clinical improvement in the melasma was seen compared
to the preoperative evaluation. CONCLUSION: Erbium:YAG laser resurfacing
effectively improves melasma; however, the almost universal appearance of
transient post-inflammatory hyperpigmentation necessitates prompt and persistent
intervention. The use of this laser therapy is recommended only for refractory
melasma.
Ann
Plast Surg 1999 Jan;42(1):21-6
Combination
therapy: utilization of CO2 and Erbium:YAG lasers for skin resurfacing.
Collawn
SS
Carraway
Laser Center, Birmingham, AL, USA.
Skin
resurfacing with carbon dioxide (CO2) lasers is a commonly used method for skin
rejuvenation. With these lasers, there is substantial skin improvement
Plast
Reconstr Surg 1999 Feb;103(2):619-32; discussion 633-4
Cutaneous
resurfacing with CO2 and erbium: YAG lasers: preoperative,intraoperative, and
postoperative considerations.
Alster
TS
Washington
Institute of Dermatologic Laser Surgery and Georgetown University
The
development and integration of pulsed and scanned CO2 and erbium:YAG laser
systems into mainstream surgical practice over the past years has revolutionized
cutaneous resurfacing. These lasers are capable of delivering to
Plast
Reconstr Surg 1999 Feb;103(2):602-16; discussion 617-8
Erbium
laser resurfacing: current concepts.
Weinstein
C
Medical
Cosmetic Laser Centre, Melbourne, Australia.
Laser
skin resurfacing has enjoyed great popularity in recent years with the
introduction of computerized, pulsed carbon dioxide lasers. However, the
morbidity and side effects of carbon dioxide lasers have stimulated a search for
alternative methods of skin remodeling. The erbium:YAG laser can be successfully
used for skin resurfacing, with lower morbidity than the carbon dioxide laser.
In a series of 625 patients who had erbium:YAG resurfacing, the following
conclusions were reached. (1) Long-term (> 6 months) improvement in
wrinkles and acne scars required total fluences exceeding 20 J/cm2. Periocular
wrinkles required total fluences of between 20 and 40 J/cm2, depending on the
depth of the wrinkles and skin thickness. Perioral rhytids required total
fluences of between 40 and 80 J/cm2, whereas the cheeks and forehead required
total fluences of 30 to 60 J/cm2. (2) Deeper wrinkles were best treated with a
combination of erbium and carbon dioxide lasers, which minimized the bleeding
that occurs with deeper erbium resurfacing. The simultaneous combined erbium
with carbon dioxide laser was particularly advantageous. (3) Complications were
relatively uncommon using the scanning erbium laser, and most adverse effects
occurred early in the series. Scarring occurred in 5 of the 625 patients (0.8
percent) and mostly resolved with intralesional steroids. Hyperpigmentation
occurred in 21 of the 625 patients (3.4 percent) and was temporary in nature.
Hypopigmentation, which became evident after 6 months, occurred in 25 of the 625
patients (4.0 percent) but was mild and not a significant cosmetic problem,
except in one patient who developed scarring on the neck. Hypopigmentation
seemed to be related to the depth of resurfacing. Four of the 625 patients (0.6
percent) developed temporary scleral show, but no patients had permanent
ectropion. Eight of the 625 (1.3 percent) developed synechiae under the lower
eyelid, which required minor correction.
J
Am Acad Dermatol 1999 Apr;40(4):603-6
A
clinical and histologic prospective controlled comparative study of the
picosecond titanium:sapphire (795 nm) laser versus the Q-switched alexandrite
Herd
RM, Alora MB, Smoller B, Arndt KA, Dover JS
Department
of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School,
Boston, USA.
BACKGROUND: Theory predicts that picosecond lasers should be more effective than the currently available nanosecond lasers in removing tattoo ink. In addition to thermal confinement, such pulse widths cause optimal photomechanical disruption of the target. OBJECTIVE: This study compared the efficacy of the picosecond titanium:sapphire (795 nm, 500 psec) laser and the Q-switched alexandrite (752 nm, 50 nsec) laser in the treatment of tattooed guinea pigs. METHODS: Six albino guinea pigs, each with 6 uniformly 1 cm circular black tattoos, were treated. Three of the tattoos were divided into 2; one half was treated with the titanium:sapphire laser and the other half with the alexandrite laser. Fluences used for both lasers were 6.11, 4.24, and 2.39 J/cm2 with spot sizes of 1.25, 1.5, and 2 mm, respectively. The remaining spots served as control. Clinical evaluation and biopsies were performed at baseline and at 11 and 16 weeks after a single laser treatment. RESULTS: Greater clearance of tattoo was observed in titanium:sapphire laser-treated areas in 2 of the 4 surviving guinea pigs. In some areas total clearing was observed after the single titanium:sapphire laser treatment. Clearing improved with higher fluences. No scarring was present. Histologic results showed similar findings.
CONCLUSION:
Our findings suggest that the picosecond titanium:sapphire laser is more
effective than the Q-switched alexandrite laser in removing tattoo pigment
Dermatol
Surg 1999 Jan;25(1):34-7
Recalcitrant
scarring follicular disorders treated by laser-assisted hair removal: a
preliminary report.
Chui
CT, Berger TG, Price VH, Zachary CB
Department
of Dermatology, Stanford University School of Medicine, California,
BACKGROUND:
Recalcitrant scarring follicular disorders have been treated previously by
removing hair follicles both surgically by scalp resection with skin grafting
and with X-ray epilation. Laser-assisted hair removal may provide an alternate
method of hair removal with less associated morbidity. OBJECTIVE: The goal is to
determine whether laser-assisted hair removal can be used to
Aesthetic
Plast Surg 1998 Mar;22(2):75-80
The
Emerging Role of Laser Resurfacing in Combination with Traditional Aesthetic
Facial Plastic Surgery.
Roberts
TL 3rd Spartanburg, South
Carolina, USA
Traditional
aesthetic plastic surgery procedures (facelift, browlift, blepharoplasty, etc.)
can make dramatic improvement in the facial appearance by
Arch
Dermatol 1996 Oct;132(10):1226-9
Treatment
of traumatic tattoos with the Q-switched neodymium:YAG laser.
Suzuki
H
Department
of Plastic Surgery, Johoku Hospital, Kyoto, Japan.
BACKGROUND:
Treatment for traumatic tattoos often results in incomplete removal of the
pigment or produces unacceptable scars or textural changes. Successful results
using Q-switched ruby lasers have been reported. The Q-switched neodymium:YAG
laser, with a wavelength of 1064 nm and a pulse duration of 5 to 7 nanoseconds,
penetrates deeper into the skin and has less interaction with melanin than the
Q-switched ruby laser. OBSERVATIONS: The present study documents 32 cases of
traumatic tattoos involving 51 sites of the face, trunk, and extremities in
patients ranging in age from 6 to 58 years. All patients were treated with the
Q-switched neodymium:YAG laser. Excellent results were noted for 50 of 51
treated tattoos. The number of treatments to achieve excellent results ranged
from 1 to 6, with an average of 1.7. No scarring, atrophy, textural changes, or
hypopigmentation was noted in any of the cases.
Transient postinflammatory hyperpigmentation of 3 months' duration was noted in
1 patient. CONCLUSION: The Q-switched neodymium:YAG laser was effective in
removing traumatic tattoos without any significant side effects.
J
Am Acad Dermatol 1995 Jul;33(1):69-73
Q-switched
alexandrite laser treatment (755 nm) of professional and amateur tattoos.
Alster
TS
Georgetown
University Medical Center, Washington, DC, USA.
BACKGROUND: Several laser techniques have been proposed for the removal of decorative tattoos. The lasers that have been used most successfully are Q-switched red or near-infrared systems because of their ability to target tattoo pigment selectively with minimal risk of scarring or permanent pigmentary changes. OBJECTIVES: The objectives of this study were to determine the clinical effectiveness of the newest Q-switched system, the alexandrite laser, in removing amateur and professional tattoos and to observe side effects. METHODS: Twenty-four multicolored professional tattoos and 18 blue-black amateur tattoos were treated with the Q-switched alexandrite laser (755 nm, 100 nsec) at 2-month intervals until total clearing was achieved. The 510 nm pulsed dye laser was used to treat tattoos that contained red pigment. RESULTS: Professional tattoos required an average of 8.5 alexandrite laser treatments for total clearance, whereas only 4.6 treatments were necessary to remove amateur tattoos. Red tattoo pigment was successfully treated with an average of two 510 nm pulsed dye laser sessions. No scarring or long-standing pigmentary changes were seen in laser-irradiated skin. CONCLUSION: The Q-switched alexandrite laser is highly effective in removing multicolored professional and amateur tattoos without adverse sequelae. The 510 nm pulsed dye laser was useful in eliminating red tattoo pigment.
Plast
Reconstr Surg 1999 Feb;103(2):592-601
Long-term
assessment of CO2 facial laser resurfacing: aesthetic results and complications.
Schwartz
RJ, Burns AJ, Rohrich RJ, Barton FE Jr, Byrd HS
Department
of Plastic and Reconstructive Surgery, University of Texas Southwestern Medical
Center, Dallas 75235, USA.
Several
series have documented the ability of the carbon dioxide laser to smooth facial
rhytids; however, follow-up has been limited to several months. Since 1995, more
than 600 full or partial facial resurfacings were performed with the pulsed CO2
laser. To assess the long-term efficacy and safety of this procedure, the
results of 211 resurfacings were retrospectively reviewed using
Dermatol
Surg 1999 Jan;25(1):15-7
Effect
of pretreatment on the incidence of yperpigmentation following cutaneous CO2
laser resurfacing.
West
TB, Alster TS
Washington
Institute of Dermatologic Laser Surgery, Washington, DC, USA.
BACKGROUND: Transient hyperpigmentation is the most common complication seen following cutaneous carbon dioxide (CO2) laser resurfacing. OBJECTIVE: Thepurpose of this study was to determine whether the use of a topical skin lightening regimen prior to cutaneous laser resurfacing reduces the incidence of post-laser resurfacing hyperpigmentation. METHODS: One hundred consecutive CO2 laser resurfacing patients (skin types I-III) were randomized to receive preoperative treatment with 10% glycolic acid cream twice daily (n=25), hydroquinone 4% cream qHS and tretinoin 0.025% cream twice daily (n=25) or no pretreatment (n=50, control) for at least 2 weeks. Clinical and photographic assessments were performed prior to laser resurfacing and at 4 and 12 weeks following treatment. RESULTS: There was no significant difference in the incidence of post-CO2 laser resurfacing hyperpigmentation between subjects who received pretreatment with either topical glycolic acid cream or combination tretinoin/hydroquinone creams and those who received no pretreatment regimen.
CONCLUSION:
It is postulated that reepithelialization after cutaneous laser resurfacing
includes follicular melanocytes that have not been affected by topical
pretreatment. When instituted as a component of the skin care regimen
postoperatively, topical hydroquinone, tretinoin and/or glycolic acid
preparations may be helpful in reducing post-laser resurfacing
hyperpigmentation.
Dermatol
Surg 1998 Dec;24(12):1390-6
Skin
resurfacing of facial rhytides and scars with the 90-microsecond short pulse CO2
laser. Comparison to the 900-microsecond dwell time CO2 lasers and clinical
experience.
Moy
RL, Bucalo B, Lee MH, Wieder J, Chalet MD, Ostad A, Dishell WD
UCLA
Division of Dermatology, USA.
BACKGROUND:
Carbon dioxide lasers that produce either short pulses or scanned continuous
beams have been used for skin resurfacing to improve wrinkles or scars. Using a
high peak power, short pulse CO2 laser can produce clinically effective results
with minimal thermal damage. OBJECTIVE: To evaluate the effectiveness of skin
resurfacing using the 90-microsecond pulse duration CO2 laser compared to other
laser systems. Erythema, healing time, complications, and histological
measurement of the depth of ablation and thermal damage per pass with this
system were also assessed. METHODS: Forty-one patients with facial rhytides and
scars underwent resurfacing with a 90 microseconds pulse duration CO2 laser.
Using patient survey, patients were evaluated for effectiveness of therapy,
healing time, and complication rates. Comparisons of histologic and clinical
findings were made with different short pulse CO2 lasers. RESULTS: Healing time,
duration of erythema, and post-operative pain were less with the 90 microseconds
pulse CO2 laser than with the 900-microsecond dwell time and 950-microsecond
pulse duration lasers, while effectiveness was comparable. Complications were
few with the 90-microsecond pulse laser, including three patients (9.1%)
developing hyperpigmentation. One pass with the 90-microsecond pulse duration
CO2 laser produced 100 microns of ablation with 17 microns of thermal damage.
Ablation and damage were additive so that, by six passes, ablation depth was 350
microns and depth of thermal damage was 63 microns. This thermal damage is less
than that reported with lasers having a longer pulse duration or dwell time with
comparable depths of vaporization. CONCLUSION: Treatment with the 90-microsecond
pulse duration laser results in a more rapid healing time and shorter duration
erythema. The clinical improvements in wrinkles and sun damage were comparable.
The 90-microsecond pulse duration laser provides an effective, predictable, and
safe means of improving facial rhytides and scars.
Dermatol
Surg 1998 Dec;24(12):1314-6
Quantitative
comparison of inflammatory infiltrate and linear contraction in human skin
treated with 90-microsecond pulsed and 900-microsecond dwell timecarbon
dioxide lasers.
Bucalo
BD, Moy RL
UCLA
Division of Dermatology, USA.
BACKGROUND:
Skin resurfacing with 90-microsecond pulse duration carbon dioxide (CO2)
resurfacing lasers has been reported to have shorter duration of erythema
compared with skin resurfacing with 900-microsecond dwell time lasers. The
presence of inflammatory infiltrate following resurfacing may correlate with the
persistence of this erythema. Furthermore, skin treated with the 90-microsecond
pulse duration laser and the 900-microsecond dwell time lasers both result in
equivalent improvement of rhytids in the treated skin. OBJECTIVE: To
quantitative the inflammatory cell infiltrate and linear
contraction of skin treated with the 90-microsecond pulsed and 900-microsecond
dwell time CO2 lasers at intervals of 2 and 4 weeks after treatment. MATERIALS
Plast
Reconstr Surg 1998 Dec;102(7):2480-9
Simultaneous
face lifting and skin resurfacing.
Fulton
JE
Although
face lifting and skin resurfacing both produce dramatic facial rejuvenations,
the simultaneous combination has never been popularized. The development of new
methods of lifting and resurfacing may now allow are
evaluation of this combination. The objective was to evaluate the safety and
efficacy of this combined face lift and skin resurfacing. The facial skin was
resurfaced with a trichloroacetic acid peel or a "short-pulse" CO2
laser and, then, lifted after liposuction and superficial musculoaponeurotic
system tightening. A dramatic rejuvenation was produced in these 25 cases. There
were no incidents of persistent erythema, pigmentation, hyperpigmentation, or
full-thickness flap necrosis. Side effects were the usual sequelae of edema and
ecchymoses. The small areas of "dusky" erythema of the skin flaps were
no more significant than those after a face lift alone. By following the
guidelines developed in this report, the combination of controlled skin
resurfacing with face lifting is safe and effective. Other procedures, such as
blepharoplasties, can also be added. After one recovery period of 6 to 8 weeks,
these patients reported that they looked 15 to 20 years younger. The complexion
continued to improve during the 1-year follow-up period.
J
Am Acad Dermatol 1998 Dec;39(6):975-81
Incidence
of postoperative infection or positive culture after facial laser resurfacing: a pilot study, a case report, and a proposal for
a rational approach to antibiotic prophylaxis.
Ross
EV, Amesbury EC, Barile A, Proctor-Shipman L, Feldman BD
Department
of Dermatology, Naval Medical Center San Diego, CA 92134-5000, USA.
BACKGROUND:
Laser skin resurfacing (LSR) has emerged as a popular procedure for facial
rejuvenation; however, there are no clear guidelines regarding systemic
antibiotic prophylaxis. OBJECTIVE: We attempt to provide practical guidelines
for antibiotic prophylaxis in LSR based on our experiences, pharmacology, and a
review of the literature. METHODS: In a pilot study, four consecutive full-face
LSR patients were treated without oral or topical antibiotics. The next four
patients received oral prophylaxis with a narrow spectrum antibiotic. We also
report the case of a severe gram-negative infection after LSR. RESULTS: For
full-face LSR, 2 of 4 consecutive patients without antibiotic prophylaxis
experienced focal Staphylococcus aureus infection. The next 4 consecutive
patients, who had received gram-positive oral prophylaxis, were all culture
negative after 2 days. All test sites (5 of 5) were culture negative despite the
absence of systemic or topical antibiotics. One patient not in the pilot study
receiving gram-positive antibiotic prophylaxis experienced a gram-negative
infection. CONCLUSION: We recommend narrow-spectrum gram-positive oral
antibiotic coverage for full-face and regional LSR.
Lasers
Surg Med 1998;23(4):185-93
Imaging
of the irradiation of skin with a clinical CO2 laser system: implications for
laser skin resurfacing.
Choi
B, Barton JK, Chan EK, Welch AJ
The
University of Texas at Austin Biomedical Engineering Laser Laboratory, 78712,
USA.
BACKGROUND
AND OBJECTIVE: Several published reports describe the benefits of using the
carbon dioxide laser for cutaneous resurfacing. The mechanisms on which skin
resurfacing work are still not completely understood. This study was performed
to obtain quantitative and qualitative information describing the thermal
response of skin during high-energy, short-pulsed CO2 laser
irradiation. STUDY DESIGN/MATERIALS AND METHODS: A Tissue Technologies TruPulse
CO2 laser was used to irradiate an in vivo rat model. The laser parameters that
were used were a 100-micros pulse width, a 1-Hz repetition rate, a 3 mm x 3 mm
square spot size, and 2.4 J/cm2 and 3.9 J/cm2 radiant exposures. A 3-5 microm
thermal camera was used to obtain temperature information during irradiation.
Single spots were irradiated with one pulse, and the temperature-time history
was obtained. In a different experiment, 15 pulses were applied to single spots,
and both thermal and video images were obtained.
RESULTS:
Irradiation with one pulse at 2.4 J/cm2 and 3.9 J/cm2 led to peak temperatures
>100 degrees C. The temperature relaxation time was approximately 25-150 ms.
Multiple-pulse irradiation at 2.4 J/cm2 led to a slight rise in the peak
temperature with each pulse. At 3.9 J/cm2, the peak temperature increased with
successive pulses until pulse 10, after which the peak temperature oscillated
between 300 and 400 degrees C. Video images showed concurrent burning events
that occurred during pulses
10-15. CONCLUSION: Temperatures >100 degrees C were measured during CO2 laser
irradiation of skin. Pulse stacking can lead to peak temperatures approaching
400 degrees C and to tissue charring with as few as three stacked pulses. It is
crucial for the physician to manipulate the laser handpiece at parameters with
which he or she can avoid pulse overlap.
Ophthalmology
1998 Nov;105(11):2154-9
Laser
blepharoplasty and skin resurfacing. American Academy of Ophthalmology.
The
purpose of the Committee on Ophthalmic Procedures Assessment is to evaluate on a
scientific basis new and existing ophthalmic tests, devices, and procedures for
their safety, efficacy, clinical effectiveness, and appropriate uses.
Evaluations include examination of available literature, epidemiologic analyses
when appropriate, and compilation of opinions from recognized experts and other
interested parties. After appropriate review by all contributors, including
legal counsel, assessments are submitted to the Academy's Board of Trustees for
consideration as official Academy policy.