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Retrospective Evaluation of the Long-term Antiaging Effects of BroadBand Light Therapy
Abstract
BroadBand Light (BBL), which utilizes visible and infrared light (400.1400 nm) delivered for phototherapy, is a nonablative treatment designed to rejuvenate the skin on the face, chest, neck, forearms, legs, and hands. The objective of this retrospective study was to evaluate if participants who underwent regular treatment with BBL over a period of 5 to 11 years looked noticeably younger than their actual age. Fifteen participants aged 38 to 69 years (median, 46.0 years; interquartile range, 19.7 years) with Fitzpatrick skin types I to IV received at least 1 full-face treatment per year with a BBL device (BBL, Sciton, Inc) during the study period. Blinded evaluators (Nou491) analyzed clinical photographs taken before the first treatment and after the last treatment to estimate pretreatment and posttreatment ages of participants over 5 to 11 years. Before treatment, the median estimated age of participants was slightly lower than the median actual age, but the difference was not significant. The median estimated age at the end of the study period, which varied from 5 to 11 years depending on the participant, was significantly lower than the corresponding median actual age (Pou.0084). Although treated skin actually aged a median of 9 years, participants appeared to have aged a median of or2 years. Results from our study indicate that patients who maintain a regular annual or biannual regimen of BBL treatments over 5 to 11 years can reduce and delay the long-term signs of skin aging such as photodamage, telangiectases, fine lines and wrinkles, and skin laxity in a natural-looking way.
In a study of 115 patients, the effect of the interference of IPL exposure using filters of 640 nm and 560 nm and the use of an erbium fractional laser with a wavelength of 1565 nm on microcirculation in patients with involutive skin changes was studied. The basis of all reparative processes is the microcirculatory link, as a unit of the trophic system of the skin. Studying the effect of phototechnologies and laser fractional exposure on microcirculation, based on the results of these studies, it is possible to develop algorithms for patient management, including additional treatment methods, as well as an algorithm for standardizing procedures, including the multiplicity and number of procedures. These studies can be the starting point for the introduction of standards that will reduce the number of complications, as well as increase the clinical effectiveness of the treatment, which will make the method more widely available. The assessment of the state of microcirculation was carried out using the method of laser Doppler flowmetry (LDF), using the mathematical analysis of the wavelet transform. Under the influence of the interference of IPL exposure using filters of 640 nm and 560 nm and the use of an erbium fractional laser with a wavelength of 1565 nm, a positive dynamics of the parameters of all parts of the microcirculation was revealed according to the LDF data. In women with spastic type of MC, the initially increased neurogenic and myogenic tone of the arterioles decreased, and endothelial function improved. In women with hyperemic type of MC, there was an improvement in neurogenic tone, correction of endothelial dysfunction, and elimination of congestion in the venular link of MC. However, the above changes were more noticeable in patients with hyperemic type of MC.
From the introduction of pulsed light broad‐spectrum energy in 1995, intense pulsed light (IPL) has evolved to become an extremely popular and well‐accepted technology for rejuvenation of photodamaged skin in dermatology and plastic surgery practices as well as medical spas. This paper details where IPL is now, 25 years later, and discusses the wide variety of valuable uses for IPL in medical practices as well as the reasons for IPL's growth in popularity and usefulness.
Pulsed light has proven its usefulness, effectiveness, and versatility in treating a multitude of skin problems, delaying skin aging, maintaining healthy skin, and as an adjunct to a cosmetic surgical practice in the treatment of postsurgical scars. Practitioners contemplating adding a pulsed light device to their practice should choose a device that has at least 4 important features: a large spot size, variable-sized smaller spot adaptors, pulse rates of at least 1 pulse per second, a wide range of cutoff filters, including 515 nm, 560 nm, 590 nm, 640 nm, and 695 nm, to treat most skin types.
Background
Regardless of changes in clinical techniques and approaches, practices may find value in self‐assessment.
Objective
To propose a retrospective method by which an aesthetic practice may use patient before and after photographs to assess practice efficacy among long standing patients.
Methods
Patients who had been with the practice and undergone various aesthetic procedures (n = 73, 59 women, age range 25‐83 years) were selected, with associated photographs before treatment and after their last intervention, covering an average period of 10.71 ± 1.32 years. Photographs were examined by 11 non‐expert graders in random order (along with duplicate photographs of 50 untreated individuals) who guessed and recorded the perceived age of each patient. The difference between the actual and estimated age was compared with that of the after picture to derive numerical values, averaged from among the 11 graders for each patient photo set, followed by statistical testing for confidence interval (CI) to group patients as high, medium, or low responders.
Results
Of 73 patients, 26 were graded as responders, 23 as medium, and 24 as low, meaning that average perceived aging changed little as per the non‐expert graders.
Conclusion
Statistical analysis of before and after photographs over time may provide physicians with a window into their performance.
Facial pigmentation may be due to a generalised process but most often is localised to the face. Melasma and actinic damage pigmentation are common and tend to be bilaterally distributed and slowly progressive. Irregularly shaped isolated lesions should be viewed with more caution, and biopsy may be required. Treatments include topical and oral medications, peels, intense pulsed light therapy and laser treatment.
The use of intense pulsed light (IPL) for facial rejuvenation had been the topic of many studies. However, few of them discussed quantitative changes in extracellular matrix proteins after IPL therapy.
To objectively quantify the histological changes in extracellular matrix proteins after IPL treatment for facial wrinkles.
Biopsy specimens were obtained from the periocular area of six volunteers of Fitzpatrick skin type III-IV and Glogau's class I-III wrinkles. They were subjected to three months of IPL treatment (six sessions at two-week intervals). Using histological and immunostaining analysis coupled with computerized morphometric analysis, quantitative evaluation of collagen types I, III and VII, newly synthesized collagen, total elastin and tropoelastin was performed for skin biopsies at baseline, end of treatment, and three months post-treatment.
Clinical assessment of volunteers did not show clinically noticeable improvement in facial wrinkles after IPL treatment. Furthermore, quantitative evaluation of extracellular matrix proteins showed no statistically significant changes (P>0.05) in response to IPL treatment
Although 50 percent of volunteers showed mild improvement in skin texture at the end of IPL treatment, none of them reported improvement in skin tightening or wrinkles. No statistically significant histological changes were observed three months post IPL treatment.
A 55 year old Spanish patient, photo type III, wanted a cosmetic improvement of her forearms. She disliked the hyperpigmentation which made her look older.
After having tried several chemical peelings (50% glycolic acid plus 10% kojic acid followed by 15% MM TCA), there was no improvement in the patients's condition and it was decided to initiate intense pulsed light (IPL) treatment.
Improvement was noted after the first session, with a slight pink coloration. At two months post treatment, we noted more than 90% clearance of the hyperpigmentation on the treated areas.
This case report confirms that photorejuvenation, by treating hyperpigmented lesions with intense pulsed light source on extra-facial zones can be very effective and safe.
BACKGROUND: Intense pulsed light (IPL) is a noncoherent, nonlaser, filtered flashlamp emitting a broadband visible light that has been shown to be effective in photoepilation, as well as in a number of vascular and pigmented lesions of the skin. Their efficacy has also been reported recently in the treatment of photodamaged facial skin. In the last condition, however, there are few studies showing the clinical and microscopic changes produced by IPL.
OBJECTIVE: To assess the gross and microscopic changes that occur in photodamaged skin submitted to nonablative full-face resurfacing (NAFFR) using IPL.
METHODS: Five women were submitted to five NAFFR sessions using IPL, one every 2 weeks. Skin biopsies and photographs were taken on all of the patients before the first procedure and after the last one, as well as weekly clinical assessment. Data concerning skin features (wrinkles, oiliness, thickness, dilated pores, and general appearance) were all assessed. Microscopic improvement of the aging features in the epidermis and dermis were all assessed. For the statistical analysis a t test for small samples was used.
RESULTS: All the patients showed clinical and microscopic improvement in every one of the parameters assessed. The t test for small samples showed a statistically significant difference (P < 0.01) in epidermal thickness.
CONCLUSION: Facial photodamage was clinically and microscopically improved using IPL. Use of IPL as a rejuvenating method seems to be promising, with minimal side effects, a wide safety margin, and minimal downtime.
BACKGROUND: Dermabrasion and deep chemical peeling are used in the treatment of photoaged skin. These ablative procedures are effective enough to produce a certain improvement but have often caused postinflammatory hyperpigmentation among Asian patients. To avoid such adverse effects, a new, nonablative procedure has been sought.
OBJECTIVE: To determine the effectiveness of photorejuvenation for Asian skin using intense pulsed light (IPL). The specific parameters used, improvement ratios, side-effects, and downtime required are also discussed.
METHODS: Ninety-seven patients were treated for photoaging using IPL. The cutoff filters of 550 nm and 570 nm were utilized for three to six treatments at intervals of 2 to 3 weeks.
RESULTS: Treatment results were evaluated and rated by both patients and physicians at the end of the third treatment based on improvement in pigmentation, telangiectasia, and skin texture. A combined rating of “good” or “excellent” was given to more than 90% of the patients for pigmentation, more than 83% for telangiectasia, and more than 65% for skin texture. There were some minor complications in four cases: one had erythema that continued to the next day and three had minor blisters leaving no marks.
CONCLUSION: Photorejuvenation using IPL is a completely safe and effective procedure even for Asian skin. It will be increasingly used for skin rejuvenation in the future.
Background:
Dermabrasion and deep chemical peeling are used in the treatment of photoaged skin. These ablative procedures are effective enough to produce a certain improvement but have often caused postinflammatory hyperpigmentation among Asian patients. To avoid such adverse effects, a new, nonablative procedure has been sought.
Objective:
To determine the effectiveness of photorejuvenation for Asian skin using intense pulsed light (IPL). The specific parameters used, improvement ratios, side-effects, and downtime required are also discussed.
Methods:
Ninety-seven patients were treated for photoaging using IPL. The cutoff filters of 550 nm and 570 nm were utilized for three to six treatments at intervals of 2 to 3 weeks.
Results:
Treatment results were evaluated and rated by both patients and physicians at the end of the third treatment based on improvement in pigmentation, telangiectasia, and skin texture. A combined rating of "good" or "excellent" was given to more than 90% of the patients for pigmentation, more than 83% for telangiectasia, and more than 65% for skin texture. There were some minor complications in four cases: one had erythema that continued to the next day and three had minor blisters leaving no marks.
Conclusion:
Photorejuvenation using IPL is a completely safe and effective procedure even for Asian skin. It will be increasingly used for skin rejuvenation in the future.
Background:
Photodamaged skin is characterized not only by rhytides, but also by epidermal and dermal atrophy, rough skin texture, irregular pigmentation, telangiectasias, laxity, and enlarged pores. There is growing interest in the development of noninvasive methods to treat photodamaged skin. Skin photorejuvenation is the visible improvement of photodamaged skin using a laser or other light source. A noncoherent, broadband, pulsed light source is effective in the treatment of vascular and pigmented lesions of the skin. This study evaluates the role of intense pulsed light in the rejuvenation of photo aged skin.
Objective:
The purpose of this study was to evaluate and quantify the degree of visible improvement in photodamaged skin following a series of full-face, intense pulsed light treatments.
Methods:
Forty-nine subjects with varying degrees of photo-damage were treated with a series of four or more full-face treatments at 3-week intervals using a nonablative, nonlaser intense pulsed visible light source. Fluences varied from 30 to 50 J/cm2. Subject evaluation and skin biopsies were used to assess treatment results.
Results:
All aspects of photodamage including wrinkling, skin coarseness, irregular pigmentation, pore size, and telangiectasias showed visible improvement in more than 90% of subjects with minimal downtime and no scarring. Eighty-eight percent of subjects were satisfied with the overall results of their treatments.
Conclusion:
Treatment of photodamaged facial skin using a series of full-face treatments with intense pulsed light is a new and effective noninvasive method of skin rejuvenation with minimal risk and no patient downtime.
Background and Objective
The aim of this study was to evaluate the efficacy and complication rate of a nonablative nonlaser light source in the treatment of rhytids. Laser resurfacing, in the treatment of facial rhytids, has involved ablative methods, with their associated complications and limitations. Rhytid improvement requires dermal collagen remodeling. Interest has begun to focus on the use of wavelengths that preserve the epidermis but deliver enough energy to promote rhytid improvement.Study Design/Materials and Methods
Thirty subjects with class I–II rhytids and Fitzpatrick skin types I–II were treated with up to four treatments with an intense pulsed light source. Subjects were evaluated 6 months after the final treatment.ResultsTwenty-five subjects showed some improvement in the quality of skin. No subjects were found to have total resolution of rhytids.Conclusion
Nonlaser intense pulsed light may effectively improve some facial rhytids. Such improvement can occur without epidermal ablation. Lasers Surg. Med. 26:196–200, 2000. © 2000 Wiley-Liss, Inc.
Intense pulsed light (IPL) is regarded as the gold standard of nonablative photo-rejuvenation. Yet there is still a need to observe its efficacy and safety on dark skin using a split-face module.
Twenty-four Chinese women with photoaging were enrolled in this study. Patients were randomized to receive four IPL treatments at 3- to 4-week intervals on one side of face, with the other side spared as control. Changes of photoaging were evaluated using a global evaluation, an overall self-assessment, a Mexameter and a Corneometer. Skin biopsies were taken after four sessions of treatment on one side of face. The melanocyte density and the contents of melanin, collagen fibers, and elastic fibers were stained and used to evaluate the improvement on dyschromia and other signs of photoaging.
The global scores of photoaging on treated side decreased significantly from 3.02 to 1.22, while it remained unchanged on the untreated side. Twenty-one of 24 patients (87.5%) rated their improvement as excellent or good. The difference on the values of melanin index and erythema index on treated side were significantly larger than those on untreated side after the 1st session, the 4th session and at 3-month follow-up (P<0.05). The melanin contents were significantly decreased and the collagen fibers were obviously increased only on treated side (P<0.05). Adverse effects of treated side were limited to mild pain and transient erythema.
Using this split-face module, IPL treatment is proved both clinically and histologically to be effective in treating photoaging skin in Chinese population. Adverse effects were minimal and acceptable.
The use of lasers and intense pulsed light (IPL) technology has become established practice in dermatology and aesthetic medicine. The increase in popularity and widespread use of such equipment has been accompanied by a sharp increase in the number of case reports about professional errors.
We present 14 case studies of professional errors.
Selected representative case reports are used to illustrate and discuss typical professional errors and serve as the basis for creating preventive strategies.
Recommendations have been developed for the following areas: physician training, patient information, documentation, diagnosis, indication, test treatment, and performing treatment.
The use of lasers and IPL technology in dermatology and aesthetic medicine requires practitioners not only to have high levels of training and experience, but also to exercise professional judgment. In spite of all of the precautions taken, the risk of complications and side effects can be reduced but not completely eliminated.
For Asian skin, recent "non-ablative" skin rejuvenation techniques have become the focus of attention for darker complected patients. In our earlier research, we have shown that intense pulsed light (IPL) technology can be applied to Asian skin with a high degree of safety and efficacy. In this study, we performed full-face photorejuvenation using a new IPL device incorporating a 560 nm filter and integrated contact cooling system for the improvement of various symptoms associated with photoaging in Asian patients.
A total of 73 patients were treated with a series of five or more full-face treatments at 3-4 week intervals using IPL with integrated contact cooling. One month after the third and fifth treatments, the patient and the treating physicians subjectively evaluated improvement in five areas-in pigmentation, telangiectasia, fine wrinkles, skin texture, and over-all improvement. In addition, histological changes were evaluated.
Pigmentation improvement, telangiectasia reduction, fine wrinkle reduction, smoother skin texture, and over-all improvement were evaluated according to five grades of percentage improvement. In addition, the subjective rating by the patients and the physicians was averaged, and the combined results were evaluated. After the fifth treatment, a combined rating of greater than 60% improvement was given to more than 80% of patients for pigmentation improvement, telangiectasia reduction or removal, smoother skin texture, and overall improvement. Histological evaluations showed strong staining of Type I and Type III collagen. Complications were minor and transitory, with burning sensations and erythema in only two patients.
Full-face photorejuvenation for Asian patients using this device is not only effective but is also associated with fewer post-treatment complications than other more invasive modalities. We conclude that IPL photorejuvenation can be the basis for safe and effective skin rejuvenation in Asian patients.
Intense pulsed light (IPL) is a noncoherent, nonlaser, filtered flashlamp emitting a broadband visible light that has been shown to be effective in photoepilation, as well as in a number of vascular and pigmented lesions of the skin. Their efficacy has also been reported recently in the treatment of photodamaged facial skin. In the last condition, however, there are few studies showing the clinical and microscopic changes produced by IPL.
To assess the gross and microscopic changes that occur in photodamaged skin submitted to nonablative full-face resurfacing (NAFFR) using IPL.
Five women were submitted to five NAFFR sessions using IPL, one every 2 weeks. Skin biopsies and photographs were taken on all of the patients before the first procedure and after the last one, as well as weekly clinical assessment. Data concerning skin features (wrinkles, oiliness, thickness, dilated pores, and general appearance) were all assessed. Microscopic improvement of the aging features in the epidermis and dermis were all assessed. For the statistical analysis a t test for small samples was used.
All the patients showed clinical and microscopic improvement in every one of the parameters assessed. The t test for small samples showed a statistically significant difference (P < 0.01) in epidermal thickness.
Facial photodamage was clinically and microscopically improved using IPL. Use of IPL as a rejuvenating method seems to be promising, with minimal side effects, a wide safety margin, and minimal downtime.
Photorejuvenation involves the use of lasers or light sources to reverse signs of photoaging. Multiple devices have been shown to be effective over the short-term.
To investigate the long-term clinical results on the face, neck and chest at 4 years using filtered flashlamp intense pulsed light (IPL) for treatment of photoaging changes of telangiectasias, dyspigmentation, and rough skin texture.
A chart review of 80 randomly selected patients with skin types I-IV who were treated by IPL during 1996 and 1997 was performed. Photos and patient self-assessment were graded for features of textural smoothness, telangiectasia severity, and blotchy pigmentation into four categories of worse, no change, slightly better (less than 50% improvement) and much better (greater than 50% improvement).
At 4 years following initial treatment, skin textural improvement was noted in 83% of the subjects. Telangiectasias were improved in 82% of subjects, while pigmentation remained improved in 79%. The median number of treatments was 3. The face responded slightly better than the chest or neck. Most common side-effects included temporary mild crusting (19%), erythema (15%) and purpura (6%).
Signs of photoaging including telangiectasias and mottled pigmentation of the face, neck, and chest, can be improved by IPL with a long-lasting result. Minimal or no downtime with minimal adverse effects can be achieved with the settings reported. Skin textural smoothing, although not easily quantified, is an additional benefit observed long-term.
Intense pulsed light photorejuvenation represents a novel mode of treatment of photodamaged skin. A broad-spectrum flashlamp (500-1200 nm) targets chromophores reversing pigmentation, vascular and pilosebaceous aberrations. Both cytokine mediated as well as thermally induced deep dermal remodeling may be achieved using the varied polychromatic wavelengths associated with this technology. Inflammatory dermatosis such as rosacea may also be addressed as well. A structural approach to non-ablative rejuvenation utilizing intense pulsed light is associated with high patient satisfaction and minimal adverse sequelae.
Intense pulsed light technology (IPL) has been used for photorejuvenation or the reversal of skin aging. There are few studies to address the putative benefits from the patients' perspective. This information is critical for adequate patient counselling and satisfaction. The goal of this study was to quantify the change in apparent facial age that can be expected from the patients' point of view. Using currently available parameters that have been individualized to patients' responses, five patients underwent treatment with IPL. Their subjective improvement scores were collected using visual analog scales. All patients showed improvement from their perspective. Quantification of this improvement showed that in this population, patients can expect, on average, a two year reduction in perceived age per treatment. This finding may be useful when discussing intense pulsed light technology with current patients and those prospective patients considering this procedure.
This multi-center study evaluating the role of Intense Pulsed Light (IPL) in the non-ablative rejuvenation of Type I and Type II photoaged skin study was conducted in order to evaluate the clinical efficacy and safety of using IPL in treating clinical indications associated with photoaged skin. Ninety-three patients of Fitzpatrick skin phenotypes I-III, Fitzpatrick Wrinkle Classes I-II, and Elastosis Scores 1-6 were enrolled in the study. Up to five treatments were performed at 4-week intervals with follow-up visits at 4 and 6 months after the last treatment. Patients received full-face treatments using the recommended parameters of the Quantum SR/HR (Lumenis Ltd.) with the 560 or 640 nm cutoff filter. Parameters of elastometry, physicians' evaluation of the Elastosis Score ('W/ES'), and global improvement as well as patient satisfaction were analyzed. Results showed that the average Fitzpatrick W/ES improved significantly (p<0.001) by 1.39 and 1.32 units at the 4 and 6 months follow-ups, respectively; an improved W/ES evaluation was recorded for 82% and 75% of the patients at each of these time points. In conclusion, IPL treatment is an effective non-invasive, non-ablative method for rejuvenating photoaged skin with minimal adverse events, no downtime, excellent long-term results, and a very high measure of patient satisfaction.
To describe the introduction and use of intense pulsed light (IPL) to treat vascular and pigmented lesions comprising photorejuvenation and its use in photodynamic therapy.
Review of the medical literature and the authors' experience with IPL.
IPL is an excellent treatment modality for vascular and pigmented manifestations of photoaging and can be combined with photodynamic therapy for the treatment of early forms of skin cancer.
This study had two objectives: subjective evaluation of overall skin rejuvenation effects of relatively short-wavelength intense pulsed light (IPL) and objective changes in basic skin tone as measured by a spectrophotometer.
Twenty-five women selected at random received a series of three IPL treatments. Efficacy was evaluated over a 3-month follow-up period. Concurrently, a spectrophotometer was used to measure "lightness" (L(*)) to quantify the lightening effect changes to pretreatment and posttreatment basic skin tone.
Subjective improvement of 50% or more was seen in 18 of 25 patients for pigmentation. One patient showed exacerbation of latent epidermal melasma as a complication. In the spectrophotometric analysis, the mean value of L(*) increased from a baseline value of 60.86 to 63.22, at 3-month follow-up period, with statistical significance.
IPL skin rejuvenation using relatively shorter wavelengths and pulse widths brought about significant macroscopic and quantitative improvements, especially in the treatment of epidermal pigmentation and improvement of basic skin tone.
The incidence of adverse healing reactions occurring with Ultrapulse CO2 resurfacing during a multicenter study
- R E Fitzpatrick
- R G Geronemus
- J M Grevelink
Fitzpatrick RE, Geronemus RG, Grevelink JM, et al. The incidence of adverse healing reactions occurring with Ultrapulse CO2
resurfacing during a multicenter study. Lasers Surg Med. 1996;8(suppl):S34.
Resurfacing complications and their management
- M P Goldman
- R E Fitzpatrick
- S R Smith
Goldman MP, Fitzpatrick RE, Smith SR. Resurfacing complications and their management. In: Coleman WP, Lawrence N, eds.
Skin Resurfacing. Baltimore, MD: Lippincott William & Wilkins;1998:295-301.
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