Brian D Zelickson

University of Minnesota Duluth, Duluth, Minnesota, United States

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Publications (73)208.32 Total impact

  • Suzanne L Kilmer · A Jay Burns · Brian D Zelickson ·
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    ABSTRACT: Background and objectives: Cryolipolysis has previously received FDA clearance for fat reduction in the abdomen, flanks, and thighs. There is also interest in small volume fat reduction for areas such as the chin, knees, and axilla. This article reports the results of a cryolipolysis pivotal IDE study for reduction of submental fullness. Study design/material and methods: A prototype small volume vacuum applicator (CoolMini applicator, CoolSculpting System, ZELTIQ Aesthetics) was used to treat 60 subjects in the submental area. At each treatment visit, a single treatment cycle was delivered at -10°C for 60 minutes, the same temperature and duration used in current commercially-available cryolipolysis vacuum applicators. At the investigator's discretion, an optional second treatment was delivered 6 weeks after the initial treatment. The primary efficacy endpoint was 80% correct identification of baseline photographs by independent physician review. The primary safety endpoint was monitoring incidence of device- and/or procedure-related serious adverse events. Secondary endpoints included assessment of fat layer thickness by ultrasound and subject satisfaction surveys administered 12 weeks after final cryolipolysis treatment. Results: Independent photo review from 3 blinded physicians found 91% correct identification of baseline clinical photographs. Ultrasound data indicated mean fat layer reduction of 2.0 mm. Patient questionnaires revealed 83% of subjects were satisfied, 80% would recommend submental cryolipolysis to a friend, 77% reported visible fat reduction, 77% felt that their appearance improved following the treatment, and 76% found the procedure to be comfortable. No device- or procedure-related serious adverse events were reported. Conclusion: The results of this clinical evaluation of 60 patients treated in a pivotal IDE study demonstrate that submental fat can be reduced safely and effectively with a small volume cryolipolysis applicator. Patient surveys revealed that submental cryolipolysis was well-tolerated, produced visible improvement in the neck contour, and generated high patient satisfaction. These study results led to FDA clearance of cryolipolysis for submental fat treatment. Lasers Surg. Med. © 2015 Wiley Periodicals, Inc.
    Lasers in Surgery and Medicine 11/2015; DOI:10.1002/lsm.22440 · 2.62 Impact Factor
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    ABSTRACT: The home beauty device market is rapidly growing, having more than tripled in the last four years. This study evaluates several specific attachment heads using a novel home skincare platform (HSP). By incorporating multiple treatment heads for cleansing, skin smoothing, and skin infusion, this device has the potential to address many potential treatment goals. The first subset of this study is a blinded, randomized split-face study evaluating the efficacy of the HSP device with a standard brush head for make-up removal and compares the HSP device to a currently marketed home cleansing device. The results show that the HSP cleansing head was comparable to the leading home skin cleansing device on the market. The HSP's skin smoothing head showed statistically significant improvement in erythema and dryness over baseline levels with significant histologic changes including normalization of epidermal thickness in only 10 days of use. This is comparable to and exceeds many well-studied antiaging treatments after weeks and months of therapy. Finally, the infusion head demonstrated improvement in skin hydration over baseline levels. J Drugs Dermatol. 2015;14(4):391-399.
    Journal of drugs in dermatology: JDD 04/2015; 14(4):391-399. · 1.45 Impact Factor
  • Brian D Zelickson · A Jay Burns · Suzanne L Kilmer ·
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    ABSTRACT: While cryolipolysis initially received FDA clearance for fat reduction in the abdomen and flanks, there was significant interest in non-surgical fat reduction for other sites, such as the inner and outer thighs. This article reports the results of an inner thigh study which contributed to FDA clearance of cryolipolysis for treatment of thighs. A flat cup vacuum applicator (CoolFit applicator, CoolSculpting System) was used to treat 45 subjects bilaterally in the inner thighs. Single cycle treatments were delivered at Cooling Intensity Factor (CIF) 41.6 for 60 minutes followed by 2 minutes of manual massage. Follow-up visits were conducted at 8 and 16 weeks. Efficacy was assessed by ultrasound imaging, circumference measurements, and photographs. Safety was assessed by monitoring adverse events. Patient satisfaction was evaluated by questionnaire. Data is presented for n = 42 patients that completed the 16 week study follow-up and maintained their weight within 5 lbs. of baseline. Independent photo review from three blinded physicians found 91% correct identification of baseline clinical photographs. Ultrasound data indicate fat layer reduction of 2.8 mm. Circumferential measurements indicate mean reduction of 0.9 cm. Patient questionnaires reveal 93% were satisfied with the CoolSculpting procedure; 84% noticed visible fat reduction; 89% would recommend to a friend; and 91% were likely to have a second treatment. There were no device- or procedure-related serious adverse events. The CoolFit flat cup vacuum applicator was found to deliver safe and effective cryolipolysis treatment to reduce inner thigh fat. Completed 16-week data from 42 subjects show 2.8 mm reduction in fat thickness and 0.9 cm reduction in circumference. Assessment of clinical photographs found 91% correct identification of baseline images. The results of this prospective, multi-center, interventional clinical study contributed to FDA clearance of cryolipolysis for treatment of thighs in April 2014. Lasers Surg. Med. © 2014 Wiley Periodicals, Inc. © 2014 Wiley Periodicals, Inc.
    Lasers in Surgery and Medicine 01/2015; 47(2). DOI:10.1002/lsm.22320 · 2.62 Impact Factor
  • Molly Goodier · Kendra Elm · Irmina Wallander · Brian Zelickson · Sarah Schram ·
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    ABSTRACT: Hyaluronic acid (HA) fillers are FDA approved for improving the appearance of the nasolabial folds. Previous reports on the use of HA for this treatment have focused on injections directly into the location of the desired correction. To our knowledge, a study has not been done evaluating the efficacy of injecting a low volume of HA into the adjacent area of volume loss to correct both volume loss and adjacent lines. The objective of this study was to compare the effectiveness and safety of three HA injection protocols including deep dermal cheek injection, mid- to deep dermal local nasolabial fold injection, and both injections for the correction of nasolabial folds. This was a split-face, randomized study evaluating the use of three injection techniques – (i) deep bolus injection into the mid- to lateral cheek, (ii) local mid- to deep dermal injection into the nasolabial fold, and (iii) both deep injection into the mid- to lateral cheek and local mid- to deep dermal injection into the nasolabial fold – for the treatment of moderate to severe nasolabial folds. Wrinkle severity and Global Aesthetic Improvement Scales were measured before and 4–6 weeks after treatment as assessed by a blinded investigator. Patient and physician observations showed improvement both globally and in wrinkle severity score with each technique used with no statistical difference between techniques. Patients showed a slight preference for injection to both the mid- to lateral cheek and nasolabial fold, which was associated with the greatest amount of filler product administered. No serious adverse events were reported. Injection of a dermal filler, at low volumes, into either the nasolabial fold or mid- to lateral cheek results in similar improvement to the correction of the nasolabial folds.
    Journal of Cosmetic Dermatology 06/2014; 13(2):91-8. DOI:10.1111/jocd.12091 · 0.88 Impact Factor
  • Zachary Zelickson · Sarah Schram · Brian Zelickson ·
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    ABSTRACT: Complications in cosmetic laser and energy based surgery affect a number of patients every year and may cause scars, burns, blisters, and pigmentation damage. To evaluate documented complications in cosmetic laser- and energy-based surgeries, determine the most common errors, and recommend a simple procedural sequence to reduce patient complications. U.S. Food and Drug Administration Manufacturer and User Facility Device Experience Adverse Event Reports after cosmetic laser- and energy-based procedures with varied devices were reviewed (N = 494). The laser manufacturer, device used, event type, injury type, cause, operator, and indication for treatment for each case were identified. In the 494 cases reviewed between 2006 and 2011, the most common complications were burns, scarring, blistering, pigmentation damage, and infection. The most common cause of these complications was user error by a healthcare provider (30%), followed by laser device malfunction (20%) and patient error (4%). Indications for treatment were unknown for 69% of cases, and 38% of the cases were an unknown cause of complication. User error was a major factor in laser surgery complications. To improve safety and reduce errors, we propose the implementation of a procedural sequence for cosmetic laser surgery.
    Dermatologic Surgery 04/2014; 40(4):378-82. DOI:10.1111/dsu.12461 · 2.11 Impact Factor
  • Susan E Walgrave · David A Kist · Ayse Noyaner-Turley · Brian D Zelickson ·
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    ABSTRACT: The 2,790 nm Er:YSGG wavelength has a lower water absorption coefficient than the 2,940 nm Er:YAG, but a higher coefficient than the 10,600 nm CO(2) laser. This allows ablative resurfacing with mild thermal coagulation, which may increase clinical efficacy while reducing patient downtime. To evaluate the efficacy and safety of the confluent 2,790 nm Erbium:YSGG (Pearl™, Cutera) laser for facial rejuvenation. Eleven subjects (mean age 50, skin types I-III) with mild to moderate photodamage and wrinkles had two facial treatments with the 2,790 nm Er:YSGG laser using a fluence of 3.5 J/cm(2), pulse duration of 0.4 msecond, and 20% overlap. Treatments were performed 6 weeks apart. Pre-auricular biopsies from five subjects were evaluated at baseline and 6 weeks after the final treatment. Data from blinded photo assessments and subjects' self-assessment of improvement were analyzed 6 weeks after the final treatment. Additionally, long-term safety and efficacy were evaluated 2 years after the final treatment. Histologically, 80% of subjects had new collagen formation in the dermal grenz zone, and 60% had increased epidermal thickness. Almost all subjects (91%) showed improvement in tone/texture, 82% of subjects showed improvement in dyschromia and fine lines, and 54% showed improvement in wrinkles 6 weeks after the final treatment. Subjects' self assessment indicated "significant" to "dramatic" improvement in dyschromia (91% of subjects) and tone/texture (82%) 6 weeks after the final treatment. All subjects saw "mild" to "significant" improvement in fine lines and wrinkles. At the 2-year follow-up visit, 57% of the overall improvement achieved at 6 weeks was maintained. No adverse events were reported throughout the study. Ablative resurfacing with the 2,790 nm Er:YSGG laser demonstrated visible improvement in photodamage with good tolerability and minimal downtime. Subjects were highly satisfied, especially with respect to dyschromia, skin tone, and texture.
    Lasers in Surgery and Medicine 02/2012; 44(2):103-11. DOI:10.1002/lsm.21124 · 2.62 Impact Factor
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    ABSTRACT: BACKGROUND: Dermabrasion has been the standard resurfacing procedure for postsurgical scars, but recovery can be long. Fractionated carbon dioxide (CO(2) ) laser is a safe, effective tissue resurfacing modality, but no prospective trial has compared its safety or efficacy with that of dermabrasion for postsurgical scar resurfacing. OBJECTIVE: To compare the safety and efficacy of single-treatment fractional photothermolysis with that of single-treatment dermabrasion for postsurgical scar resurfacing on the face. METHODS AND MATERIALS: A split-scar method was used to compare fractionated CO(2) laser and diamond fraise dermabrasion on postsurgical scars of the face. Primary endpoint was safety at day 0, 1 week, and 1 month. Secondary endpoint was efficacy at 3 months as measured by blinded evaluation of standardized photographs. RESULTS: Safety data revealed that there was less erythema (p = .001) and bleeding (p = .001) at day 0, less erythema (p = .01) and edema (p = .046) at 1 week, and a trend toward less erythema at 1 month (p = .06) with fractionated CO(2) . Efficacy data at 3 months revealed equivalent scar improvements (p = .77). CONCLUSION: Fractionated CO(2) laser therapy should be considered a safe alternative for surgical scar resurfacing on the face. The safety profile exceeds that of dermabrasion, and it has a quicker clinical recovery and equivalent cosmetic efficacy.
    Dermatologic Surgery 01/2012; 38(4). DOI:10.1111/j.1524-4725.2011.02283.x · 2.11 Impact Factor
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    ABSTRACT: Laser use in medicine is rapidly expanding as patients seek treatment for medical and cosmetic purposes. Concern is mounting about the unsupervised use of lasers and similar devices by nonphysician personnel. Minnesota is currently one of the few states with no legislation regarding the uses of lasers. To determine whether laser centers in Minnesota meet professional standards and guidelines for patient safety. Public resources were used to identify all businesses with laser services in Minnesota cities with a population of at least 1,000 people. Each laser center was contacted, and a "secret shopper," a person who posed as a potential patient administered a telephone survey. A wide range of physicians and nonphysician personnel offer laser services in Minnesota. Supervision was not standardized and varied widely across the laser centers. As the demand for laser services increases, the use of lasers must be clearly defined and regulated to prevent patient injury. The authors have indicated no significant interest with commercial supporters.
    Dermatologic Surgery 05/2011; 37(5):612-8. DOI:10.1111/j.1524-4725.2011.01952.x · 2.11 Impact Factor
  • Ricardo Ruiz-Rodriguez · Brian Zelickson ·
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    ABSTRACT: There are currently myriad methods that can be used to treat photodamaged skin. For more severe sun damage, chemical peels [Am J Clin Dermatol. 2004;5(3):179–87], dermabrasion, and laser resurfacing [Semin Cutan Med Surg. 1996;15(3):177–88] are found to be very successful.These treatments act by removing or destroying the top layers of skin and allowing new skin to grow and recover the treated areas, but recovery times can be long and scarring can occur. Today, the use of nonablative and fractionated ablative lasers has helped many patients to obtain good cosmetic results with little downtime. Among the novel methods for maximizing the efficacy of nonablative treatment is the concurrent use of a photosensitizing agent. On the other hand, many lasers at different wavelengths and light devices are currently being promoted for photodynamic therapy in rejuvenation.
    04/2011: pages 83-90;
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    ABSTRACT: An evaluation of the histological effects of a 2,940 nm fractional erbium:YAG (Er:YAG) laser device with adjustable depth and coagulation settings in a human abdominoplasty model. The goal of this study was to use light and confocal microscopy to determine the dimensions of the microthermal zones (MTZs) created by this device in the epidermal and dermal layers. Three subjects were consented and treated after being randomly assigned to a laser depth of either 250 µm, 500 µm, or 1,000 µm. Four coagulation levels were tested in each subject. Two biopsies were taken immediately, 1 and 2 weeks post-treatment from each zone and viewed by light and confocal microscopy. Two blinded observers examined the sections for changes in collagen and measured depth and width of the MTZs. Coagulation was assessed and recorded as the depth and width of denaturation; measured as the depth and width of ablation plus surrounding thickness of thermal necrosis from dissipated heat. Light microscopy findings in all treated samples showed a perforated epidermis and dermis immediately after treatment. The depths of ablation produced did not accurately reflect the three different laser settings. Depths of denaturation also did not increase with increased coagulation level settings as expected. The width of ablation in the MTZs, a non-adjustable setting, was the most accurate and reproducible in all subjects. Confocal microscopy samples revealed the presence of collagen remodeling in the dermis, which increased significantly at 1 and 2 weeks post-treatment. Treatment with the 2,940 nm Er:YAG device led to significant changes of the dermis at light microscopy levels. The adjustable laser depth and coagulation settings did not produce predictable depths of ablation or denaturation, possibly as a result of the variation of tissue hydration properties among individuals. Increased collagen remodeling was seen in the dermis in all subjects at 1 and 2 weeks post-treatment.
    Lasers in Surgery and Medicine 02/2011; 43(2):79-91. DOI:10.1002/lsm.21020 · 2.62 Impact Factor
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    Courtney M.L. Elm · Irmina D Wallander · Bart Endrizzi · Brian D Zelickson ·
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    ABSTRACT: Low-level laser therapy (LLLT) has been shown to induce cellular reactions in nonphotosynthetic cells however skepticism remains regarding efficacy at the clinical level. The purpose of this study was to evaluate the efficacy of LLLT independent of liposuction. Additionally, a weight loss supplement (Curva™, Santa Barbra Medical Innovations, Santa Barbra, CA) was evaluated. This clinical trial evaluates the effectiveness of the Erchonia EML Laser (Zerona™ System, Santa Barbra Medical Innovations) for non-invasive fat reduction and body contouring in a split-body clinical evaluation. Five subjects were enrolled and completed the study. Subjects had a body mass index (BMI) of less than or equal to 29 kg/m(2) and satisfied the set inclusion criteria. Participants were randomly assigned to receive low-level laser treatments on one side of the body three times per week for 2 weeks. One group took the weight loss supplement and was also treated with the laser. Subject satisfaction questionnaires, physician blinded photo evaluation, circumference measurements and ultrasound measurements were utilized to evaluate efficacy. Circumference measurements revealed no statistically significant reduction at either 7 days or 1 month post-treatment. One month following treatment the greatest circumference reduction overall was 0.5 ± 0.3 inches. Ultrasound measurements also did not reveal statistically significant reduction in fat layer thickness (P > 0.5). Evaluation by three blinded dermatologists resulted in average correct photo identification of 51.1%. Results reflect little clinical difference between post-treatment and baseline images. Three subjects recording a "dissatisfied" rating on satisfaction questionnaires and all subjects reported the effects of the treatment were less than expected. Subjects who took the weight loss supplement had no greater circumference reduction or identifiable clinical outcome. This small study demonstrates to the authors that there needs to be more evidence to show clinical circumferential reduction before LLLT can be recommended as an effective therapeutic option.
    Lasers in Surgery and Medicine 02/2011; 43(2):114-21. DOI:10.1002/lsm.21016 · 2.62 Impact Factor
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    ABSTRACT: Non-ablative fractional lasers have been used in skin rejuvenation procedures with some success. In general, the optimum area coverage and depths of the fractional thermal injury zones depend on the specific indications of interest. For all fractional devices, depth is adjusted with energy that also determines the coagulation area at the dermal/epidermal junction. Micro-beams (µB) of a 1,540 nm laser are co-aligned with optical pins in a device designed to provide skin compression during treatment to remodel the deeper reticular dermis and hypodermis while minimizing epidermal damage. The device is characterized in ex vivo and clinical studies. Ex vivo porcine skin was treated with a compression-pins optic connected to an Er:Glass laser hand piece. Nitroblue tetrazolium chloride (NBTC) cell viability staining of horizontal radial and vertical sections of post-treatment skin was used to assess coagulation profiles. A pilot clinical study was also performed to evaluate the effects of compression on epidermal injury. The compression-pins optic provided deeper coagulation to 1.5 mm depths and less epidermal injury than without compression. Coagulation depth was increased further with stacked pulses. The ability to de-couple depth of treatment from area coverage provides greater flexibility of treatments. The results promise greater possibilities to vary dermal injury patters which may offer increased benefit in treating a variety of cutaneous conditions.
    Lasers in Surgery and Medicine 02/2011; 43(2):137-42. DOI:10.1002/lsm.21028 · 2.62 Impact Factor
  • Courtney M.L. Elm · Irmina D Wallander · Susan E Walgrave · Brian D Zelickson ·
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    ABSTRACT: The principle of selective photo-thermolysis has been studied extensively for hair removal applications in a medical setting. A new, portable, hand-held device featuring two filtered Xenon lamps that utilizes pulsed light in low optical fluencies for hair removal has been developed for consumer use. The purpose of this clinical study was to determine the efficacy and safety of this low-energy, pulsed-intense light device intended for home use hair removal. STUDY DESIGN/ MATERIALS AND METHODS: The treatment group consisted of 10 adults with skin types I-IV who possessed unwanted dark hair in the non-facial region. The subjects received between 4 and 6 treatments on a bi-weekly basis with the device by a trained member of the clinical staff. The clinical responses were evaluated by performing manual hair counts using magnified vision and photographs which were obtained prior to treatment and at each subsequent visit. Mean hair reduction was 36% 4 weeks after the final treatment and 10% 12 weeks after the final treatment. This resulted in a mean hair count reduction of 23% over the two follow-up appointments. There was no definitive correlation between customer satisfaction and hair count reduction. Adverse reactions were limited to transient, localized, post-treatment erythema. No complications were encountered. This low-energy, pulsed-light device is a quick, safe, and relatively effective at-home hair reduction treatment option in patients with various skin phototypes.
    Lasers in Surgery and Medicine 04/2010; 42(4):287-91. DOI:10.1002/lsm.20917 · 2.62 Impact Factor
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    ABSTRACT: Background and Objective Cryolipolysis provides a method of non-invasive fat reduction that significantly reduces subcutaneous fat without injury to adjacent tissues. Preliminary animal and human data have suggested that cryolipolysis has no effect on serum lipid profiles or liver tests. This study was intended to more fully document any effect of this procedure on lipid and liver-related blood tests.Study Design/Materials and Methods Forty subjects with fat bulges on their flanks (“love handles”) were treated bilaterally with a non-invasive device (Zeltiq Aesthetics, Pleasanton, CA) that precisely cools tissue to achieve a reduction in the fat layer. Serum lipid levels and liver tests were measured prior to treatment, and at 1 day and 1, 4, 8, and 12 weeks post-treatment.ResultsNo meaningful changes in mean values were observed for any blood lipid level or liver test at any point over the 12-week follow-up period.Conclusion Cryolipolysis, when used for reduction of subcutaneous flank fat, is not associated with changes in serum lipids or liver test results. Lasers Surg. Med. 41:785–790, 2009. © 2009 Wiley-Liss, Inc.
    Lasers in Surgery and Medicine 12/2009; 41(10):785 - 790. DOI:10.1002/lsm.20850 · 2.62 Impact Factor
  • Brian D Zelickson · Thomas D Dressel ·
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    ABSTRACT: There has been a significant advancement in the use of lasers for body contouring over the past several years. This article will review the recent past and discuss the future of this trend. There is much confusion over the definition of procedures using lasers for lipolysis and liposuction. This review article discusses the definitions of suction-assisted liposuction, laser lipolysis, and laser-assisted liposuction in detail. The development of these procedures is then discussed and pertinent articles are reviewed. Pubmed and web sites were searched for published articles and FDA approved devices employing lasers for targeting fat for body contouring. This information along with the authors' personal experience was used to review and discuss this topic. There is a specific difference between suction-assisted liposuction, laser-assisted liposuction, and laser lipolysis. This review article clarifies these definitions and highlights the recent articles employing lasers for minimally invasive fat reduction.
    Lasers in Surgery and Medicine 12/2009; 41(10):709-13. DOI:10.1002/lsm.20842 · 2.62 Impact Factor
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    ABSTRACT: The treatment of skin with fractional devices creates columns of micro-ablation or micro-denaturation depending on the device. Since the geometric profiles of thermal damage depend on the treatment parameters or physical properties of the treated tissue, the size of these columns may vary from a few microns to a few millimeters. For objective evaluation of the damage profiles generated by fractional devices, this report describes an innovative and efficient method of processing and evaluating horizontal sections of skin using a novel software program. Ex vivo porcine skin was treated with the Lux1540/10, Lux1540 Zoom and Lux2940 with 500 optics. Horizontal (radial) sections of biopsies were obtained and processed with H&E and NBTC staining. Digital images of the histologic sections were taken in either transmission or reflection illumination and were processed using the SAFHIR program. NBTC- and H&E-stained horizontal sections of ex vivo skin treated with ablative and non-ablative fractional devices were obtained. Geometric parameters, such as depth, diameter, and width of the coagulated layer (if applicable), and micro-columns of thermal damage, were evaluated using the SAFHIR software. The feasibility of objective comparison of the performance of two different fractional devices was demonstrated. The proposed methodology provides a comprehensive, objective, and efficient approach for the comparison of various fractional devices. Correlation of device settings with the objective dimensions of post-treatment damage profiles serve as a powerful tool for the prediction and modulation of clinical response.
    Lasers in Surgery and Medicine 11/2009; 41(9):634-42. DOI:10.1002/lsm.20843 · 2.62 Impact Factor
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    ABSTRACT: BACKGROUND Liposuction is one of the most frequently performed cosmetic procedures in the United States, but its cost and downtime has led to the development of noninvasive approaches for adipose tissue reduction.OBJECTIVE To determine whether noninvasive controlled and selective destruction of fat cells (Cryolipolysis) can selectively damage subcutaneous fat without causing damage to the overlying skin or rise in lipid levels.METHODS Three Yucatan pigs underwent Cryolipolysis at 22 sites: 20 at cooling intensity factor (CIF) index 24.5 (−43.8 mW/cm2), one at CIF 24.9 (−44.7 mW/cm2), and one at CIF 25.4 (−45.6 mW/cm2). Treated areas were evaluated using photography, ultrasound, and gross and microscopic pathology. Lipids were at various times points. One additional pig underwent Cryolipolysis at various days before euthanasia.RESULTS The treatments resulted in a significant reduction in the superficial fat layer without damage to the overlying skin. An inflammatory response triggered by cold-induced apoptosis of adipocytes preceded the reduction in the fat layer. Evaluation of lipids over a 3-month period following treatment demonstrated that cholesterol and triglyceride values remained normal.CONCLUSIONS Cryolipolysis is worthy of further study because it has been shown to significantly decrease subcutaneous fat and change body contour without causing damage to the overlying skin and surrounding structures or deleterious changes in blood lipids.
    Dermatologic Surgery 09/2009; 35(10):1462 - 1470. DOI:10.1111/j.1524-4725.2009.01259.x · 2.11 Impact Factor
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    ABSTRACT: Pulsed carbon dioxide (CO(2)) laser devices are considered highly effective treatment options for skin resurfacing. However, the high risk for significant treatment complications following CO(2) resurfacing has warranted the development of new treatment modalities. The concept of fractional photothermolysis was developed to address the shortcomings of ablative and non-ablative device modalities. This report evaluates a fractional approach to CO(2) laser resurfacing for the treatment of moderate to severe acne scarring. The primary endpoint of the study was the overall improvement in the appearance of acne scarring. Thirty subjects, with moderate to severe acne scarring, underwent up to three treatments with an FDA IDE and IRB approved 10,600 nm fractional CO(2) laser system. All subjects were Fitzpatrick skin types I-V and 18-75 years of age. Treatment parameters ranged from 20 to 100 mJ with total densities of 600-1,600 MTZ/cm(2). Improvement of acne scarring was evaluated at 1 and 3 months post-treatment. Twenty-three out of 25 subjects sustained clinical improvement in the appearance of acne scarring at the 3-month follow-up visits according to study investigator quartile improvement scoring. Subjects also had improvement in their overall appearance, including pigmentation and rhytides. Serosanguinous oozing resolved within 24-48 hours following treatment. All subjects had transient erythema, which resolved in the majority of subjects within 1-3 months. Post-operative downtime was significantly decreased compared to traditional ablative resurfacing. No serious complications were reported. Fractional deep dermal ablation improves moderate to severe acne scarring. The added benefit is a considerable reduction both in downtime and risk of complications when compared to traditional CO(2) ablative resurfacing techniques.
    Lasers in Surgery and Medicine 02/2009; 41(2):122-7. DOI:10.1002/lsm.20725 · 2.62 Impact Factor
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    ABSTRACT: Yucatan Black pig skin was treated with a 1,540-nm erbium (Er):glass laser (Lux1540, 15 and 30 mJ) and two 1,550-nm Er-doped fiber lasers (Fraxel SR750 and SR1500, 8, 10, and 12 mJ). Histologic sections were examined to determine the depth of damage and to correlate subjects' clinical response. Concurrently, six subjects with photodamaged skin received three split-face and ipsilateral dorsal hand treatments with the 1,540-nm Er:glass laser on one side and one of the 1,550-nm Er-doped lasers (Fraxel SR750) on the other. The 1,550-nm Er-doped lasers, using lower fluences and higher densities, produced shallower micro-columns than the 1,540-nm Er:glass device at higher fluences and lower densities (mean depths 250-275 microm vs 425-525 microm, respectively). Blinded assessors found greater overall improvement in pigmentation with the 1,550-nm Er-doped laser and better overall improvement in texture with the 1,540-nm Er:glass laser. Greater densities of shallower damage columns at lower energies may better improve pigmentation, whereas deeper injuries, using higher energies and moderate densities, may better improve texture. This pilot study did not compare similar fluences and histologic damage between the two systems, and newer available systems allow for greater depth of penetration.
    Dermatologic Surgery 10/2008; 34(11):1443-53. DOI:10.1111/j.1524-4725.2008.34307.x · 2.11 Impact Factor
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    ABSTRACT: Conventional ablative resurfacing is the gold standard for removing signs of cutaneous photodamage. Despite the excellent results one can achieve with this technique, it is accompanied with significant downtime and risks. Fractional resurfacing and photodynamic therapy (PDT) with aminolevulinic acid (ALA) have been used to improve the signs of photodamage with less downtime. However, independently they do not yield results as good as ablative resurfacing. This pilot study will examine the potential for synergistic effects of combining fractional resurfacing and ALA-PDT. Four women with Fitzpatrick skin types II or III, mild to moderate rhytides and no actinic keratosis in the perioral area were treated. The perioral area was treated with 2 sessions of fractional resurfacing with the Fraxel SR (formerly Fraxel SR750, Reliant Technologies Inc, Palo Alto, CA) 3 weeks apart. Immediately after each fractional treatment we applied methyl 5-aminolevulinate (MAL or Metvix) on one half of the perioral area and 3 hours later we illuminated that area with a red light (Aktilite lamp, PhotoCure ASA, Oslo, Norway) in a dose of 37 J/cm2. Prior to treatment and at 4 and 12 weeks after the final treatment, a blinded investigator evaluated each side of the perioral area and rated the improvement from baseline as excellent, good, fair, or poor improvement of superficial wrinkles by comparing the results with pretreatment photographs. Patients also completed an evaluation form assessing their satisfaction with the treatment on each side of the perioral area while comparing the results with pretreatment photographs. The study showed increased improvement in superficial wrinkles in 3 out of 4 patients on the combined treatment side. In one patient, the investigator found no significant difference when comparing both sides. All the patients noted greater improvement in the combined fractional and PDT-treated side compared to the side only treated with fractional surfacing. This pilot study shows a potential for enhanced clinical results when using combined fractional resurfacing and ALA-PDT compared to fractional resurfacing alone.
    Journal of drugs in dermatology: JDD 09/2007; 6(8):818-20. · 1.45 Impact Factor

Publication Stats

2k Citations
208.32 Total Impact Points


  • 1995-2015
    • University of Minnesota Duluth
      • Medical School
      Duluth, Minnesota, United States
  • 2002-2006
    • Abbott Northwestern Hospital
      Minneapolis, Minnesota, United States
    • Naval Medical Center San Diego
      San Diego, California, United States
  • 2004
    • University of Texas at Dallas
      Richardson, Texas, United States
  • 2000
    • University of Pennsylvania
      Philadelphia, Pennsylvania, United States
  • 1987-1994
    • Mayo Clinic - Rochester
      • Department of Dermatology
      Rochester, Minnesota, United States