Dermatologic Surgery

Published by Lippincott, Williams & Wilkins
Online ISSN: 1524-4725
Publications
Showing good improvement in group I at 12 weeks.
Article
In recent years, chemical peels have become increasingly popular in the treatment of melasma. However, postpeel hyperpigmentation is a frequently encountered side effect, especially in dark-skinned individuals. The role of priming agents in preventing this complication has not been adequately evaluated. Hence, we studied the effect of hydroquinone versus tretinoin as priming agents in minimizing the incidence of this side effect in a double-blind, randomized clinical trial of 50 patients with melasma. Of a total of 50 patients, 25 patients each with a similar skin phototype, the nature and severity of melasma were assigned to groups I and II. The patients were primed with 2% hydroquinone in group I, and in group II with 0.025% tretinoin once daily (night time) 2 weeks before starting trichloroacetic acid peels. Subsequently, all of them received trichloroacetic acid peels at intervals of 2 weeks for 12 weeks, followed by monthly peels for next 12 weeks during the follow-up period. Patients continued to use a sunscreen with an SPF of greater than 15 and the recommended priming agent during the follow-up. Final assessment was made at 6 months, based on the impression of the patient, clinical examination by the physician, and photographic analysis. A total of 50 patients (25 in each group) participated in the study. The predominant Fitzpatrick skin type observed among them was type IV (56%), and the type of melasma was mixed (44%). The final results at 12 weeks were comparable in two groups. However, a significant difference was seen in the two groups during the follow-up period, with continued improvement in 24% and worsening in 28% of patients in group I and continued improvement in only 16% and worsening in 40% in group II patients. Hydroquinone is superior to tretinoin as a priming agent in maintaining the results achieved with peels and in decreasing the incidence of postpeel reactive hyperpigmentation.
 
Article
Chemical peels have become a popular modality in the treatment of melasma. The most disturbing side effect of this procedure is postinflammatory hyperpigmentation. This may be minimized with the help of priming agents. Because there is a paucity of such studies, this study was taken up to evaluate the beneficial effects of hydroquinone versus tretinoin as priming agents in treatment of melasma with glycolic acid peels. Sixty patients of melasma were randomly assigned in three groups of 20 patients each in a single-blind study. Group I received only glycolic acid peels while Groups II and III were primed with 0.025% tretinoin and 2% hydroquinone, respectively, for 2 weeks before peeling. The patients received serial glycolic acid peels fortnightly for the first 3 months and then monthly for the next 3 months and were then followed up for the next 3 months when peeling was stopped. Clinical and photographic evaluation was done at 3, 6, and 9 months, and subjective improvement was noted. There was an overall decrease in MASI from baseline to 6 months in all three groups but it was highly significant between Groups I and III (p<.001) at 6 and 9 months and significant between Groups II and III (p<.01) at 9 months. Results are better with hydroquinone as priming agent compared to tretinoin in enhancing the results with glycolic acid peels in melasma and in decreasing postpeel postinflammatory hyperpigmentation.
 
Article
The authors have indicated no significant interest with commercial supporters.
 
Article
Ocularly applied bimatoprost 0.03% is associated with increased eyelash growth. To assess the safety, efficacy, and subjective experience of using dermal application of bimatoprost 0.03% for the growth of natural eyelashes. Prospective, open-label study of subjects who desired longer, thicker (fuller), and darker natural eyelashes. Bimatoprost was applied to the upper lid margin once daily for 12 weeks. Adverse events and intraocular pressure were assessed, and subjects completed health outcomes questionnaires. Eyelash growth and darkening were scored using photographs taken at weeks 1 and 12. All subjects were female (N=28). No serious or unexpected adverse events were reported. The mean change from baseline intraocular pressure was less than 1 mmHg at each time point, but was statistically significant at weeks 1 and 4 (p< or =.047). At week 12, all subjects had noticed significant growth or darkening. Post hoc analysis of photographs corroborated these reports (p<.001). Bimatoprost was found safe for eyelid application and was associated with enhanced eyelash growth. All subjects noticed favorable changes in the appearance of their eyelashes.
 
Article
Topical treatment of striae rubra with 0.1% tretinoin and laser treatment of striae rubra and alba with the 585-nm pulsed dye laser are proven therapeutic options. However, little efficacy has been shown for treatment of striae alba topically, and the laser is currently not a suitable treatment option for darker ethnic skin types. The purpose of this study was to demonstrate that selected commercial topical agents can improve the appearance of striae alba. Ten patients of varying skin types (I-V) having straie distensae alba on the abdomen or thighs were selected to evaluate the effectiveness of two topical treatment regimens. Patients were placed on daily topical application of 20% glycolic acid (MD Forte) to the entire treatment area. In addition, the patients applied 10% L-ascorbic acid, 2% zinc sulfate, and 0.5% tyrosine to half to the treatment area and 0.05% tretinoin emollient cream (Renova) to the other half of the treatment area. The creams were applied on a daily basis for 12 weeks. Improvement was evaluated at 4 and 12 weeks in an objective unblinded fashion at the follow-up visits, a objective blinded fashion by visual grading at the conclusion of the study, and in an objective blinded fashion with profilometry. Additionally, histopathologic analysis was performed. Analysis of these data reveals: 1) both regimens can improve the appearance of stretch marks; 2) these topical therapy regimens are safe and effective in study patients with minimal irritation; 3) elastin content within the reticular and papillary dermis can increase with topical 20% glycolic acid combined with 0.05% tretinoin emollient cream therapy; 4) both regimens increased epidermal thickness and decreased papillary dermal thickness in treated stretch marks when compared with untreated stretch marks; 5) combined epidermal and papillary dermal thickness in stretch marks treated with either topical regimen approaches that of normal skin; and 6) profilometry can objectively measure differences in skin texture associated with striae treatments when compared to controls, however, it is not sensitive enough to justify comparison or quantitative improvements between similarly effective treatments.
 
Article
Mild to moderately photodamaged skin is characterized by dyspigmentation, fine wrinkles, and tactile roughness. An optimal approach to the topical treatment of photoaging would simultaneously address all appearance issues. This study was undertaken to evaluate the effect of 4% hydroquinone and 0.3% retinol in photoaging. A 16-week study was designed to evaluate the efficacy and tolerance of a single cream containing prescription topical 4% hydroquinone for dyspigmentation and the cosmeceutical 0.3% retinol for fine wrinkles in an emollient vehicle for tactile roughness. This novel formulation was compared with 0.05% tretinoin emollient cream, the standard against which all other topical photoaging treatments are compared. Investigator assessments, subject assessments, and photography represented the evaluation end points. The cosmeceutical emollient 4% hydroquinone/0.3% retinol cream more effectively diminished the collective signs of photodamage than 0.05% tretinoin emollient cream in terms of dyspigmentation, fine wrinkles, and tactile roughness in 16 weeks. Combination therapy of hydroquinone and retinol may improve photoaging-associated hyperpigmentation.
 
Article
The authors have indicated no significant interest with commercial supporters.
 
Article
It is commonly requested that perioral and lateral canthal rhytides, which result from extrinsic and intrinsic factors, be rejuvenated. To valuate the safety and efficacy of and patient satisfaction with injectable hyaluronic acid (HA) with 0.3% lidocaine hydrochloride in reducing superficial, vertical perioral wrinkles and superficial, horizontal, lateral canthal rhytides. This was a two-center, evaluator-masked, 180-day study in which 40 patients with moderate to severe superficial, vertical perioral lines or superficial, horizontal, lateral canthal lines were treated at their baseline visit with up to three 0.9-mL syringes of HA (5.5 mg/mL) with 0.3% lidocaine hydrochloride. The investigator and a blinded evaluator assessed patients 7 days after treatment and then every 30 days after the initial treatment session for 180 days. Subjects experienced statistically significant improvement in their superficial, vertical perioral lines and superficial, horizontal, lateral canthal lines and maintained those results for 180 and 120 days, respectively. Three patients experienced delayed-onset periocular nodule formation associated with swelling and erythema at sites of injection, which were histologically consistent with a granulomatous reaction to the product. Injectable HA with a particle size of 350 μm was efficacious and resulted in high patient improvement scores in improving moderate to severe superficial, vertical perioral lines and superficial, horizontal, lateral canthal lines. Three of the 40 enrolled patients demonstrated granuloma formation.
 
Article
Dermicol-P35 27G, an advanced collagen dermal filler, is effective for nasolabial fold (NLF) correction. To compare the efficacy and tolerance of Dermicol-P35 27G premixed with lidocaine with that of Dermicol-P35 27G injected after topical anesthesia for NLF correction. In a split-face protocol, 10 patients were injected with Dermicol-P35 27G/topical anest:esia or Dermicol-P35 27G/0.3% lidocaine. Patients were monitored for adverse events and for pain using the Thermometer Pain Scale (TPS) and a visual analog scale (VAS). Efficacy was measured using the Modified Fitzpatrick Wrinkle Scale and the Global Aesthetic Improvement Scale. Patients experienced significantly less pain with Dermicol-P35 27G/0.3% lidocaine than with Dermicol-P35 27G/topical anesthesia (mean clinician-assessed TPS scores +/- standard deviation: 2.0 +/- 0.8 and 5.2 +/- 2.1, respectively, p<.001). Patients reported less discomfort with Dermicol-P35 27G/0.3% lidocaine than with Dermicol-P35 27G/topical anesthesia (mean VAS scores: 2.0 +/- 1.0 and 6.3 +/- 2.0, respectively, p<.001; TPS scores: 2.3 +/- 0.6 and 5.4 +/- 1.2, respectively, p<.001). Both treatments yielded similar efficacy scores and were well tolerated. Adverse events were mild. Dermicol-P35 27G/0.3% lidocaine resulted in less pain than Dermicol-P35 27G/topical anesthesia, with no observed reduction in efficacy.
 
Article
Laser and intense pulsed light device treatments of leg veins have generally yielded disappointing results. Use of longer wavelengths, longer pulse widths, and better cooling devices have recently sparked renewed interests in these methods. To prospectively compare, side by side, a 3-msec cryogen spray-equipped 755 nm alexandrite, a sapphire window cooled super-long-pulse 810 nm diode, and a variable pulse width, cryogen spray-equipped 1064 nm Nd:YAG laser for the treatment of 0.3-3mm leg veins. Thirty female volunteers, skin types I-V, age 32-67 years with comparable sets of leg veins were treated with the Nd:YAG laser and either the diode laser, alexandrite laser, or both. In most patients two to three sets of comparable sites were treated. Treatment parameters varied with each laser and according to the size of veins being treated. Patients were examined 1 week after each treatment and at 1, 2, and 3 months after the last treatment. Pre- and posttreatment 35mm photographs were taken. Improvement was judged by two experienced physicians both visually on patients and by comparison of pre- and posttreatment photographs. Results were graded as percent resolution, in five groups, 0%, 0-25%, 25-50%, 50-75%, and 75-100%. In the 22 patients completing the study, 36 leg vein sites were treated with the Nd:YAG laser, 18 leg vein sites were treated with the diode laser, and 12 leg vein sites were treated with the alexandrite laser. Greater than 75% improvement was observed at 88% of the Nd:YAG laser-treated sites, 29% of the diode laser-treated sites, and 33% of the alexandrite laser-treated sites. Greater than 50% improvement was observed at 94% of the Nd:YAG laser-treated sites, 33% of the diode laser-treated sites, and 58% of the alexandrite laser-treated sites. Less than 25% improvement was observed at 6% of the Nd:YAG laser-treated sites, 39% of the diode laser-treated sites, and 33% of the alexandrite laser-treated sites. Pain during treatment was variably perceived by patients, but occasionally sufficient for patients to decline further treatment. Posttreatment purpura and telangiectatic matting were a significant drawback for the alexandrite laser. Transient hemosiderin pigmentation, as seen with sclerotherapy, was common with larger vessels. The cryogen spray-equipped 1064 nm Nd:YAG laser was remarkably effective and safe for the treatment of 0.3-3 mm leg veins. The use of topical anesthesia may be needed for some patients. The super-long-pulse 810 nm diode laser gave unpredictable results. Additional refinements of fluence and pulse width could improve its performance. The 3-msec, 755 nm alexandrite laser at fluences of 60-70 J/cm2 and an 8 mm spot can be effective, but inflammatory response, purpura, and matting limit its usefulness. Longer pulse widths might decrease these problems. For leg vein treatment, the 1064 nm wavelength is very safe for type V skin, the 810 nm wavelength at super-long pulse widths of 400-1000 msec is very safe for type IV and marginal for type V skin, and the 755 nm wavelength is limited to nontanned type I-III skin.
 
Article
Liposome used in spray form to encapsulate and deliver 5-aminolevulinic acid (5-ALA) into the pilosebaceous unit lowers the concentration of 5-ALA to 0.5% in photodynamic therapy (PDT) for acne, with low post-treatment photosensitivity. To investigate the clinical outcome and side effects of PDT using intense pulsed light (IPL) and 0.5% 5-ALA spray for inflammatory facial acne in Asian skin. Twelve subjects (skin types IV-V) with facial acne received full-face treatment at 3-week intervals with IPL 1 hour after being sprayed with 5-ALA. Lesion counts were assessed using serial standardized photographs taken up to 6 months after treatment. Serial sebum measurement and subjective assessment was conducted. There were mean reductions in inflammatory lesions of 52% at 1 month (p=.02) and 65% at 6 months (p=.04) after treatment. Mean subjective acne score decreased from 6.6 to 4.5 (on a scale from 1 to 10) 1 month after treatment. Significant reduction in sebum production was noted only on the forehead. No significant side effects, including postinflammatory hyperpigmentation and phototoxicity, were observed. Use of 0.5% liposome-encapsulated 5-ALA spray with IPL reduced inflammatory facial acne in Asians, with a low risk of persistent phototoxic effects after PDT in this pilot study.
 
Article
Laser resurfacing has become less popular because of its long recovery time, significant discomfort, and potential risks. Microsurfacing employs the use of single-pass erbium:YAG (Er:YAG) "mini peels," which may be performed serially. The purpose of this study was to evaluate the efficacy and patient acceptance of microresurfacing Er:YAG peels in treating facial photodamage. The variable-pulse Er:YAG system was used and was allowed a comparison of the 0.5- and 4-ms pulse widths. Six female patients underwent eight microresurfacing peels in a split-face fashion using the 0.5- and 4.0-ms pulse durations of a variable-pulse Er:YAG laser. Patients returned at postoperative Days 3 to 4 and 7 for clinical evaluation and Mexameter measurements. There were no significant differences in healing or postoperative erythema between the 0.5- and 4-ms pulse durations on postoperative Day 7. The average time to reepithelialization was 3.6 days. In a 1-year postoperative interview, four of six patients said that they would undergo the peel again periodically, and five of six stated they had maintained some level of improvement. Microresurfacing is an effective and well-tolerated procedure. Benefits include its tolerability under topical anesthesia, limited down time, and high patient satisfaction.
 
Article
The author has no conflicts to disclose.
 
Article
There are no previously published reports focusing exclusively on the use of 1,000-centistoke purified polydimethylsiloxane (PDMS-1000) for cosmetic soft-tissue augmentation. To provide clinical experience with its cosmetic use, solely and in conjunction with other nonpermanent fillers, in a private practice setting. A retrospective chart review was conducted for patients treated by the author over 6 years, beginning in 2003. Treatments were tabulated according to facial region and arbitrarily designated as rhytides, acne scars, lips, infraorbital, nasolabial, and general contour. Therefore, up to six treatments were possible with any visit. Concomitant treatment with nonpermanent fillers, as well as any significant adverse events, was noted as well. Nine hundred sixteen patients were treated (816 (89%) female, 100 (11%) male). There were 5,246 treatments over 3,307 visits, with an average of 3.5 visits per patient and 1.6 treatments per visit. Adverse events were limited to overcorrection in 11 patients (1%). Of the 916 patients, 257 (28%) were also treated with other (nonpermanent) fillers without incident. Over the 6-year period, PDMS-1000 was found to be effective and safe in the cosmetic practice setting. Other (nonpermanent) fillers were also used without incident.
 
Article
Short-scar rhytidectomies offer patients with mild to moderate facial aging an alternative to traditional face-lift surgery. Advantages of decreased recovery time, diminished risk, and decreased cost make this an attractive procedure to add to a cosmetic surgery practice. This study is a review of 1,000 consecutive short-scar rhytidectomies performed over 36 months with at least 6 months of follow-up. All patients underwent short-scar rhytidectomy with SMAS suspension. Outcome parameters examined included complications or adverse events and any interventions necessary. The most common complication was suture extrusion, observed in 148 patients (14.8%). Ten patients had hematomas (1%), while postauricular nodules were observed in 8 patients (0.8%). Eight patients (0.8%) required liposuction under local anesthesia to address asymmetry due to under removal of fat in the submental region. Revision rhytidectomy was required in 5 patients (0.5%). Five patients (0.5%) had hypertrophic scarring, while 1 patient (0.1%) developed hyperpigmentation. There were no cases of nerve injury, infection, skin flap necrosis, skin puckering or depression, hair loss, or parotid injury. Short-scar rhytidectomy is an excellent procedure for good candidates with mild to moderate aging of the face. It has a very low complication rate and can be done safely in an office environment.
 
Article
Clinical classification (C) of patients suffering from chronic venous disorders according to the Clinical, Etiology, Anatomy, and Pathophysiology Classification takes into account signs and symptoms, but the C3 (venous edema) class has been identified as poorly specific. Patients in whom physicians fail to observe significant edema (sign) frequently report a feeling of swelling (symptom). Previous studies of venoactive drugs have demonstrated significant reduction in leg volume, but the correlation with a clinical improvement was lacking. To describe the clinical status of a sample of Argentinean patients presenting with venous symptoms and signs. To demonstrate the relationship between the reduction of leg swelling and the improvement of symptoms of chronic venous disorders (CVDs) and quality of life (QoL) in patients with CVD. One thousand thirty-six patients were included prospectively and submitted to medical interrogation and examination and specific and generic self-questionnaires. Patients included were reassessed using the same tools after phlebotropic treatment (Ruscus+hesperidin+ascorbic acid), the prescription of which was expected to induce variations in clinical status. Significant correlations were observed between ankle circumference reduction and improvement of all symptoms in C2 to C3 patients: heaviness, pain, paraesthesia, and cramps. Such correlations were found in C0 to C1 patients. There was a correlation between improvement attained in QoL and the physical dimension of the Chronic Venous Insufficiency Questionnaire. Our results demonstrate the relevance of moderate ankle swelling, which is not usually described clinically as edema and is probably a typical symptom of chronic venous disorders. Future studies should focus on this insufficiently analyzed clinical feature and put to better use more specific QoL questionnaires.
 
Article
Infraorbital dark circles are a common cosmetic problem with multiple causative factors and few studies into the different treatment options. To assess the effectiveness and safety of long-pulsed 1,064-nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser therapy for infraorbital dark circles caused by visible prominent veins. Twenty-six patients with venous infraorbital dark circles were treated with a Nd:YAG laser (fluence, 130-140 J/cm(2) ; spot size, 6 mm) in double-pulse mode (pulse width, 6-10 ms; interpulse interval, 20 ms). Patients were examined 12 months after the final treatment. Results were ranked in five categories based on percentage clearance (5 = 100%, 4 = 75-99%, 3 = 50-74%, 2 = 25-49%, 1 ≤ 25% clearance). Patient satisfaction was ranked on a scale of 1 to 3 (1 = minimal improvement; 3 = completely satisfied), and pain was ranked on a scale of 1 to 10 (1 = mild pain; 10 = severe pain). Twenty-six patients completed the study. Objective improvement scores were 5 in all patients, and all patient satisfaction scores were 3. All patients tolerated the moderate pain (mean score 3.6). Transient erythema was observed in all patients. Long-pulsed 1,064-nm Nd:YAG-laser treatment appears effective and safe for the treatment of venous infraorbital dark circles and selectively removes visible prominent veins.
 
Article
Striae are frequent skin lesions that cause considerable aesthetic concern. The 1,064-nm long-pulsed Nd:YAG laser has been used to promote an increase in dermal collagen and is known to be a laser that has a high affinity for vascular chromophores. This study aims to verify the efficacy of the long-pulsed Nd:YAG laser in the treatment of immature striae. Twenty patients who had immature striae, i.e., red striae, were treated using the 1,064-nm long-pulsed Nd:YAG laser. The analysis of treatment efficacy was performed by the comparison between the images taken before and after each treatment session as well as through a subjective assessment carried out by the patients themselves. Results were considered satisfactory to both patients and doctors. A higher number of patients (55%) considered the results excellent when compared to the same assessment made by the doctor (40%). The clinical improvement of immature striae can be obtained with the use of the 1,064-nm long-pulsed Nd:YAG laser. The low incidence of side effects makes this laser a good alternative in the treatment of these common skin lesions.
 
Article
BACKGROUND Onychomycosis is difficult to cure. Systemic and topical treatments, including the 1,064-nm Nd:YAG laser, are not very effective when used individually.OBJECTIVE To compare the efficacy and safety of combined treatment with a long-pulsed 1,064-nm Nd:YAG laser and oral terbinafine with those of either treatment alone.METHODS We randomly divided 53 patients with a total of 90 infected nails into 3 treatment groups: the T group received oral terbinafine, the L group received long-pulsed Nd:YAG laser treatment, and the T + L group received both treatments. We evaluated the mycological clearance rate (MCR) and the clinical clearance rate (CCR) of the 3 groups at Weeks 4, 8, 12, 16, and 24.RESULTSThe MCR and CCR increased in all 3 groups in a time-dependent manner. The MCR and CCR of the T + L group were significantly higher than those of the T group and the L group at Weeks 8, 12, 16, and 24 (p < .05).CONCLUSION These data indicate that 12 weeks of combined treatment with a long-pulsed Nd:YAG laser and oral terbinafine produce more rapid and effective mycological and clinical clearance in patients with onychomycosis than either treatment alone, without any obvious side effects.
 
Article
To evaluate the efficacy and safety of the low-fluence 1,064-nm Q-switched neodymium-doped yttrium aluminium garnet (QSNY) laser in treating infraorbital dark circles. Thirty women with infraorbital dark circles (predominant color dark brown) participated in this open-label study. Participants underwent eight sessions of low-fluence QSNY laser treatment at 4.2 J/cm(2) at 3- to 4-day intervals. A spot size of 3.5 mm was used, with a pulse duration of 8 ns. The melanin deposition in the lesional skin was observed in vivo using reflectance confocal microscopy (RCM). Morphologic changes were evaluated using a global evaluation, an overall self-assessment, a narrow-band reflectance spectrophotometer, and a skin hydration measurement instrument. Twenty-six of 30 patients showed global improvement that they rated as excellent or good. Twenty-eight rated their overall satisfaction as excellent or good. The melanin index indicated a substantial decrease, from 225.84 at baseline to 182.65 (p < .05). RCM results showed a dramatic decrease of melanin deposition in the upper dermis. Adverse effects were minimal. The characteristic finding for dark-brown infraorbital dark circles is melanin deposition in the upper dermis. Treatment of infraorbital dark circles using low-fluence 1,064-nm QSNY laser is safe and effective. The authors have indicated no significant interest with commercial supporters.
 
Article
Effective treatment of facial acne scarring presents a major challenge. Nonablative lasers and radiofrequency devices work by thermally stimulating dermal collagen remodeling, thereby softening acne scars in a minimally invasive fashion. One such laser, a 1,064-nm short-pulsed Nd:YAG, uses rapidly scanned low-energy infrared pulses to heat the dermis selectively through the normal dermal microvasculature. In this pilot study, the safety and efficacy of a novel short-pulsed Nd:YAG laser were investigated for the treatment of moderate to severe facial acne scarring. Nine of 10 enrolled patients with moderate to severe facial acne scarring received eight sequential 1,064-nm Nd:YAG treatments (laser parameters 14 J/cm2, 0.3 milliseconds, 5-mm spot size, 7-Hz pulse rate, 2,000 pulses per side of face). Patients were graded for the presence and severity of three scar morphologies: superficial (rolling), medium-depth (boxcar), and deep (ice pick). Outcome measures included blinded evaluation of before and after photographs by three physician observers (scar severity score) and patient self-assessment. Acne scarring improved in 100% of the nine patients completing the study. Scar severity scores improved by a mean of 29.36% (95% confidence interval, 16.93%-41.79%; p = .006); 89% of patients noted greater than 10% scar improvement. No treatment-related adverse events were seen. Our findings support the use of a short-pulsed, low-fluence 1,064-nm Nd:YAG laser as a safe, effective treatment for facial acne scarring. Scar improvement was noted in all treated subjects with minimal discomfort and no downtime. This protocol appears to be most effective at reducing scar depth and softening scar contours. A laser upgrade needed for the study was provided to the authors at a reduced price.
 
Article
There are various therapeutic options for the treatment of pyogenic granuloma (PyG), but the results are frequently unsatisfactory, especially at difficult sites and with extensive lesions. To evaluate the success of treatment of PyG using the 1,064-nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser and to compare it with state-of-the-art treatment methods. Twenty patients with PyG were treated using the long-pulsed 1,064-nm Nd:YAG laser with fluences of 60 to 180 J/cm(2) , a spot size of 7 mm, and a pulse duration of 40 ms. One to four treatment sessions were necessary for complete removal. Recurrence-free healing occurred in 19 of 20 patients (follow-up ≥ 6 months, maximum 22 months). Because of heavy bleeding, one nonresponder was successfully treated using a carbon dioxide laser. The cosmetic results were good; textural changes of the skin were slight, if present at all. When used with the right strategy and patient cohort, the long-pulse 1,064-nm Nd:YAG laser is an effective, low-risk, minimally invasive method of treating PyG. This type of laser is a good therapeutic option that achieves good cosmetic results, particularly in PyG with a large diameter that are not suitable for treatment using the pulsed dye laser.
 
Article
Childhood nevus of Ota is likely to be more superficial than the adult nevus, therefore early laser treatment of nevus of Ota might have some beneficial effects in children. To evaluate the beneficial effects of early treatment of nevus of Ota with a low-fluence 1,064-nm Q-switched neodymium-doped yttrium aluminum garnet (Nd:YAG) laser. The authors performed a retrospective study of 31 Korean patients (Fitzpatrick skin Type IV) with nevus of Ota. The patients received a series of 6 to 32 treatment sessions at 2- to 3-week intervals with a Q-switched Nd:YAG laser at settings of 7- or 8-mm spot, 1.9 to 5.0 J/cm mean fluence. The mean fluence was less in patients younger than 10 years (2.2 ± 0.3 J/cm) than in those older than 10 years (2.8 ± 0.8 J/cm) (p = .006). Patients who started their first treatment earlier required fewer treatment sessions to reach moderate, marked, and near total improvement (p < .05). By starting treatment early, low mean fluence was required to reach the end point in each session (p < .001). Post-treatment hyperpigmentation was observed in 1 patient. This treatment was clinically effective and safe for early nevus of Ota using a low-fluence Q-switched Nd:YAG laser.
 
Article
Laser hair removal is an effective therapy for the treatment of hirsutism, hypertrichosis, and pseudofolliculitis barbae. Although side effects are uncommon, pain is described by most patients undergoing long-pulsed neodymium:yttrium-aluminum-garnet (Nd:YAG) 1,064 nm laser therapy. To compare the efficacy of topical eutectic mixture of local anesthetics (EMLA) versus topical lidocaine (LMX) in pain control for Nd:YAG 1,064 nm laser hair removal. Sixty-four patients were enrolled in a double-blind randomized study over a 6-month period. Each patient had half of the treatment area covered with EMLA and the other half with LMX 30 minutes prior to treatment. Neither was applied under occlusion. Immediately following their treatment session, patients completed a visual analog pain scale. There was no statistically significant difference in pain control between EMLA and LMX. However, female test subjects demonstrated lower pain scores than male test subjects. Nd:YAG 1,064 nm laser hair removal is a painful procedure. Topical anesthetics have been proven to reduce pain for laser hair removal. There is no statistically significant difference between the two most commonly used topical anesthetics for pain control in laser hair removal. Therefore, cost and minimizing potential side effects should guide the physician in selecting the appropriate anesthetic.
 
Article
OBJECTIVE To evaluate the efficacy and safety of the low-fluence 1,064-nm Q-switched neodymium-doped yttrium aluminium garnet (QSNY) laser in treating infraorbital dark circles. PARTICIPANTS AND METHODS Thirty women with infraorbital dark circles (predominant color dark brown) participated in this open-label study. Participants underwent eight sessions of low-fluence QSNY laser treatment at 4.2 J/cm(2) at 3- to 4-day intervals. A spot size of 3.5 mm was used, with a pulse duration of 8 ns. The melanin deposition in the lesional skin was observed in vivo using reflectance confocal microscopy (RCM). Morphologic changes were evaluated using a global evaluation, an overall self-assessment, a narrow-band reflectance spectrophotometer, and a skin hydration measurement instrument. RESULTS Twenty-six of 30 patients showed global improvement that they rated as excellent or good. Twenty-eight rated their overall satisfaction as excellent or good. The melanin index indicated a substantial decrease, from 225.84 at baseline to 182.65 (p<.05). RCM results showed a dramatic decrease of melanin deposition in the upper dermis. Adverse effects were minimal. CONCLUSIONS The characteristic finding for dark-brown infraorbital dark circles is melanin deposition in the upper dermis. Treatment of infraorbital dark circles using low-fluence 1,064-nm QSNY laser is safe and effective. The authors have indicated no significant interest with commercial supporters.
 
Article
Abstract Erythema ab igne (EAI) is a persistent reticular macular dermatosis caused by repetitive and prolonged thermal exposure under the threshold. It begins as a mottling caused by local hemostasis and becomes a reticulated erythema, leaving epidermal atrophy and pigmentation and rarely leads to skin ulcers or epithelial atypia. Recently, exposure to various kinds of heat sources, such as heated furniture, car heaters, or even laptop computers, has been reported to cause this condition. Because sometimes the pigmentation is long-lasting or permanent, topical treatments such as hydroquinone cream could be tried, but there has been no effective treatment for EAI. Here, we postulate that low fluenced 1,064-nm QS Nd-YAG laser treatment, so called, laser toning, can be a kind of option for the treatment of EAI.
 
Article
Pulsed dye (PDL) 595- and 1,064-nm Nd:YAG lasers are used for the treatment of vascular lesions. PDL-heated blood exhibits increased absorption of radiation at 1,064 nm, suggesting that the use of combined sequential dual wavelengths may offer benefits over single-wavelength treatments. This study compares the treatment efficacy of combined sequential dual-wavelength versus single delivery of 595-nm PDL or 1,064-nm Nd:YAG wavelengths in facial telangiectasia in a split face study design using subpurpuric parameters. Twenty patients were studied using the sequential delivery of PDL and Nd:YAG wavelengths on one side of the nose. The other side received either PDL or Nd:YAG treatment. Vessels (<0.6 mm in diameter) were treated with a 7-mm spot size at 10 J/cm(2), 10 ms with the PDL, followed by the Nd:YAG at 70 J/cm(2), 15 ms with a multiplex interpulse delay of 100 ms. Subjects received a single treatment, and results were evaluated after 4-week follow-up. Improvement was determined by blinded assessment of photographs taken before and after final evaluation. The efficacy of the dual-wavelength laser treatment when compared to Nd:YAG or PDL laser alone was significantly more evident than either single-wavelength treatment (p<.05). There was no statistically significant difference in efficacy between the single-wavelength treatment groups. The sequential delivery of 595- and 1,064-nm-wavelength radiation with an interpulse delay suggests that the synergistic approach to laser therapy for facial telangiectasia is a superior method compared to standard single wavelength therapy.
 
Article
Pigment lasers have been used in melasma with unsatisfactory results. To determine the effectiveness and safety of 1,064-nm Q-switched neodymium-doped yttrium aluminum garnet (QS-Nd:YAG) laser treatment of melasma in Asians. Split-face randomized study comparing combination QS-Nd:YAG laser and 2% hydroquinone with topical treatment in dermal or mixed-type melasma. Twenty-two patients were treated with 1,064-nm QS-Nd:YAG laser, 6-mm spot size, 3.0- to 3.8-J/cm(2) fluence for five sessions at 1-week intervals. Pigmentation was objectively recorded using a colorimeter (lightness index score), and subjective assessments were evaluated using the modified Melasma Area and Severity Index (mMASI) score. After five laser treatments, statistically significant improvement of melasma from baseline was observed in colorimeter (p<.001) and mMASI score (p<.001) on the laser side. The laser side achieved an average 92.5% improvement in relative lightness index and 75.9% improvement in mMASI, compared with 19.7% and 24%, respectively, on the control side (p<.001). Mottled hypopigmentation developed in three patients. During follow-up, four of 22 patients developed rebound hyperpigmentation, and all patients had recurrence of melasma. QS-Nd:YAG laser treatment for melasma in Asians produced only temporary improvement and had side effects. Common complications were hypopigmentation, melasma recurrence, and rebound hyperpigmentation.
 
Mean VISIA pore count analysis at each evaluation. Pore counts decreased on the carbon-assisted Q-switched plus long-pulse neodymium-doped yttrium aluminum garnet (Nd:YAG) laser and long-pulse Nd:YAG sides with number of treatments for up to 3 months of follow-up.
Adverse Effects
Mean skin lightness index after carbon-assisted Q-switched plus long-pulse neodymium-doped yttrium aluminum garnet and long-pulse laser treatment at each evaluation.
Forty-nine-year-old woman. Carbon-assisted Q-switched plus long-pulse neodymium-doped yttrium aluminum garnet side (A) before (VISIA pore count analysis=203) and (B) after (3-month follow-up; VISIA pore count analysis=125) five laser treatments. Improvement of skin texture and lightening of pigment spots also noticed. Patient self-assessment: marked improvement (51–75%).
Forty-nine-year-old woman. Long-pulse neodymium-doped yttrium aluminum garnet side (A) before (VISIA pore count analysis=284) and (B) after (3-month follow-up; VISIA pore count analysis=143). Patient self-assessment: excellent improvement (76–100%).
Article
Long-pulse and Q-switched neodymium-doped yttrium aluminum garnet (Nd:YAG) 1,064-nm laser used for facial rejuvenation can improve pore size. Topical carbon has been used to enhance efficacy. To compare the efficacy and safety of a 1,064-nm long-pulse Nd:YAG laser alone with that of a combination Q-switched Nd:YAG laser with topical carbon lotion followed by long-pulse Nd:YAG to improve enlarged pores. Twenty Thai women randomly received five treatments with a long-pulse Nd:YAG laser on one facial half (LP side) and long-pulse Nd:YAG after carbon-assisted Q-switched Nd:YAG laser on the contralateral side (carbon QS+LP side) at 2-week intervals. Participants were evaluated using digital photography, complexion analysis, and a chromometer. There was significant decrease in pore counts of 35.5% and 33% from baseline on the carbon QS+LP and LP sides, respectively. Physician-evaluated pore size improvement was 67% on the carbon QS+LP sides and 60% on the LP sides. Chromometer measurement showed an increase in skin lightness index. There was no significant difference between the two treatments, although there were more adverse effects on the carbon QS+LP side. Long-pulse Nd:YAG 1,064-nm laser improves the appearance of facial pores and skin color. Adding carbon-assisted Q-switched Nd:YAG did not enhance the results but produced more side effects.
 
Article
Nonablative laser is gaining popularity because of the low risk of complications, especially in patients with darker skin. To compare the efficacy and safety of a long-pulse neodymium-doped yttrium aluminium garnet (Nd:YAG) laser and a combined 585/1,064-nm laser for the treatment of acne scars. Nineteen patients with mild to moderate atrophic acne scars received four long-pulse Nd:YAG laser or combined 585/1,064-nm laser treatment sessions at fortnightly intervals. Treatments were administered randomly in a split-face manner. Acne scars showed mild to moderate improvement, with significant Echelle d'évaluation clinique des cicatrices d'acné (ECCA) score reductions, after both treatments. Although intermodality differences were not significant, combined 585/1,064-nm laser was more effective for deep boxcar scars. In patients with combined 585/1,064-nm laser-treated sides that improved more than long-pulse Nd:YAG laser-treated sides, ECCA scores were significantly lower for combined 585/1,064-nm laser treatment. Histologic evaluations revealed significantly greater collagen deposition, although there was no significant difference between the two modalities. Patient satisfaction scores concurred with physicians' evaluations. Both lasers ameliorated acne scarring with minimal downtime. In light of this finding, optimal outcomes might be achieved when laser treatment types are chosen after considering individual scar type and response.
 
Article
Melasma is a common pigmentary disorder that affects all skin types but is seen more in individuals with Fitzpatrick skin type IV to VI. Safe and effective treatment options for melasma need to be explored. Already proven effective for the treatment of pigmentary disorders, lasers have been used to treat melasma in recent years. To evaluate the efficacy and safety profile of a 1,064-nm Q-switched neodymium-doped yttrium aluminum garnet (QS Nd:YAG) laser in the treatment of melasma. Fifty patients were recruited for this study (47 female; 3 male). All were treated using the 1,064-nm QS Nd:YAG laser at low energy levels weekly for nine sessions. Follow-up was done 3 months after the final laser session, and recurrence rates were evaluated. Digital photographs were taken and the melanin index (MI) measured before each treatment visit and after the final treatment. Melasma Area and Severity Index (MASI) scores were evaluated for all of the patients. Patients were required to evaluate their satisfaction at the end of the nine treatments. We also used a confocal laser scanning microscope (CLSM) for several patients to investigate pathologic changes at baseline, after the treatments, and at the time of recurrence. Statistical analysis was performed to evaluate clinical response and factors related to the therapeutic outcome. Mean MI decreased 35.8%, from 70.0 at baseline to 44.9 after the treatment (p<.001). Mean MASI scores decreased 61.3% after therapy (from 10.6-4.1, p<.001); 70% of patients had more than a 50% decrease in their MASI values, and 10% had 100% clearance. Recurrence rate at the 3-month follow-up was 64%. CLSM findings indicated less melanin in the treated regions, although it increased at recurrence. Multiple linear regression indicated that the therapeutic outcome depended on disease severity at baseline (p=.001, R=0.494). Minimal adverse events were observed during the study. The 1,064-nm QS Nd:YAG laser is an effective and safe treatment for melasma, although recurrence rates remain high, and further adjunctive therapy needs to be explored to prevent this recurrence.
 
Article
We studied the safety and efficacy of a 1,064 nm neodymium:yttrium-aluminum-garnet (Nd:YAG) laser with a 300-micron fiber for the reduction of small unwanted fat areas. Thirty subjects with focal areas of fat less than 100 cc were enrolled. Ten subjects were treated with laser lipolysis and had magnetic resonance imaging (MRI) at baseline and 3 months post-treatment. Ten subjects had laser lipolysis followed by biweekly treatments with the Tri-active system. The last group of 10 subjects served as control. Patients were seen at baseline and 1-week, 1-month, and 3-month follow-up visits. Twenty-nine patients completed the study. Self-assessment evaluations reported an improvement of 37% at the 3-month follow-up visit. MRI demonstrated an average 17% reduction in fat volume. Smaller baseline volume areas, such as the submentum, had better results, suggesting a dose-response relationship. The most common side effects were mild bruising and swelling resolving within 2 weeks. Laser lipolysis using the 1,064 nm Nd:YAG laser with a 300-micron fiber appears to be a very promising procedure that delivers good, reproducible results safely and effectively. The advantages include excellent patient tolerance, quick recovery time, and the benefit of dermal tightening.
 
Article
To evaluate the efficacy of a 1,064-nm neodymium-doped yttrium aluminium garnet (Nd:YAG) laser using lower than traditional fluences (22-40 J/cm(2)) for treatment of pseudofolliculitis barbae (PFB). Twenty-two patients with PFB refractory to conservative therapy received five weekly treatments over the anterior neck using a 1,064-nm Nd:YAG laser at 12 J/cm(2). Pulse duration was 20 ms with 10 mm spot size. Topical anesthesia was not used. Treatments were completed 15 minutes after patient arrival. Patients presented for 2- and 4-week follow-up. Ten evaluators used a Global Assessment Scale (GAS) to assess dyspigmentation, papule counts, and cobblestoning by comparing baseline to 4-week follow-up visit photographs. Hair and papule counts were performed on five patients and compared with the GAS. Investigators recorded adverse effects using a visual analog and side effects scale. Eleven patients demonstrated 83% improvement on the GAS (p<.01). There was a mean reduction of 59.5% in dyspigmentation (p<.03), 91.2% in papule count (p<.01), and 75.6% in cobblestoning (p<.02). Patients reported 1 out of 10 on both adverse effects scales. Low-fluence 1,064-nm laser treatment achieved significant temporary reduction in PFB. Subjects noted minimal pain without topical anesthesia.
 
Article
Nonablative lasers are used for dermal collagen remodeling. Although clinical improvements have been reported using various laser devices, the mechanism of dermal collagen remodeling remains unknown. To investigate the effects of energy fluences of the long-pulsed neodymium-doped yttrium aluminum garnet (Nd:YAG) nonablative laser on dermal collagen remodeling and evaluate the dermal collagen remodeling mechanism. Hairless mice were pretreated with ultraviolet B irradiation to produce photo-damage. The laser treatment used a long-pulse 1,064-nm Nd:YAG laser at energy fluences of 20, 40, and 60 J/cm(2) . The amount of dermal collagen and expressions of transforming growth factor beta (TGF-β), matrix metalloproteinase-1 (MMP-1), and tissue inhibitor of metalloproteinase-1 (TIMP-1) of laser treated skin were compared with those of nontreated control skin. The long-pulse Nd:YAG laser treatment increased dermal collagen and significantly increased TGF-β expression. The expression of MMP-1 decreased with low energy fluence. The expression of TIMP-1 was not significantly different. Long-pulsed 1,064-nm Nd:YAG laser increases the dermal collagen in association with the increased expression of TGF-β.
 
Article
Thinning of the epidermis and dermis, coarse skin texture, wrinkling, pigmentation, and telangiectasias characterize photodamaged skin. Noninvasive and nonablative treatment that can improve each of the different components of photodamaged skin in one step is of growing interest. To evaluate the submillisecond 1,064-nm long-pulse neodymium-doped yttrium aluminum garnet (Nd:YAG) laser in the rejuvenation of photodamaged skin. Twelve Korean women, aged 32 to 58, received a series of five full-face treatments at 3- to 6-week (average of 4-week) intervals using a nonablative 1,064-nm Nd:YAG laser (fluence 13-14 J/cm(2), pulse duration 0.3 ms, handpiece 5 mm, repetition rate 7 pulses/s). Subject and investigators clinical evaluation; photographs; and Mexameter, Sebumeter, and Visiometer analysis of silicone replica of the left cheek were taken at baseline and before the third, fourth, and fifth procedures. RESULTS Subjects and the investigator noted clinically significant improvement in elasticity, dyschromia, wrinkles, and fine lines (p=.02). The investigator also noticed improvement in texture and pore size (p=.02). Mexameter and Visiometer confirmed these results; skin roughness, texture, and pigmentation (p=.02). A submillisecond 1,064-nm Nd:YAG laser was a safe and effective photorejuvenation method on photodamaged skin, without downtime.
 
Article
Established pigment lasers have been used in partial unilateral lentiginosis (PUL) have shown unsatisfactory results. To determine the effectiveness and safety of low-fluence 1,064-nm Q-switched neodymium-doped yttrium aluminum garnet (QS Nd:YAG) laser treatment of PUL in Koreans. Ten Korean patients with facial PUL were treated with 1,064-nm QS Nd:YAG laser, 7-mm spot size, 1.5- to 2.5-J/cm(2) fluence at 2-week intervals. Standard digital photographs were taken under the same condition at baseline and at each follow-up visit. Independent dermatologists evaluated the photographs. All patients completed a questionnaire to assess their subjective satisfaction with the laser treatment using a 5-point grading system. Degree of pain was assessed using a visual analog scale (0-10). Any complications and side effects were recorded at each visit. Patients were followed up every 4 weeks for 12 weeks after the last laser treatment. Five of 10 patients (50%) had achieved excellent improvement (76-100%) at the end of treatment, and the remaining 50% had good improvement (51-75%). In patient self-evaluation of the degree of improvement of PUL, nine (90%) assessed it as very much to much improved (>50% improvement), and 1 (10%) assessed it as moderate (50-75%). Subjects rated the pain associated with laser treatment at a mean score of 3.3 (range: 1-5) on a scale of 1 to 10. Mottled hypopigmentation developed in two patients. At follow-up, 12 weeks after the last laser session, all of the patients had partial recurrence, which wqw resolved with one to two sessions of laser treatment. Low-fluence 1,064-nm QS Nd:YAG laser treatment for facial PUL in Koreans showed improvement with no significant side effects. We recommend the low-fluence 1,064-nm QS Nd:YAG laser as a treatment option for facial PUL.
 
Top-cited authors
Jean Carruthers
  • University of British Columbia - Vancouver
Alastair Carruthers
  • University of British Columbia - Vancouver
Mitchel P Goldman
  • University of California, San Diego
Tina Alster
  • Washington Institute of Dermatologic Laser Surgery
Paul M. Friedman Md
  • Dermatology & Laser Surgery Center