Liposonix

Liposonix Bibliography

Body Sculpting Techniques: Noninvasive High-Intensity-Focused Ultrasound Innovation in Fat Removal.

Sattler, G. (2010 Dec). Journal of Clinical Dermatology, 1(2).


High-Intensity Focused Ultrasound: Changing the Face of Body Sculpting.

Jewell ML. (2010 Dec). Journal of Clinical Dermatology. 1(2).



A Randomized, Single-Blind, Postmarketing Study of Multiple Energy Levels of High-Intensity Focused Ultrasound for Noninvasive Body Sculpting.

Solish N, et al. (2011). Dermatol Surg. 38(1), 58-67.


Randomized Sham-Controlled Trial to Evaluate the Safety and Effectiveness of a High-Intensity Focused Ultrasound Device for Noninvasive Body Sculpting.

Jewell ML, et al.  (2011 Jul). Plast Reconstr Surg, 128(1), 253-62.


Evaluation of a Novel High-Intensity Focused Ultrasound Device for Ablating Subcutaneous Adipose Tissue for Noninvasive Body Contouring: Safety Studies in Human Volunteers.

Gadsden E, et al. (2011 May). Aesthet Surg J., 31(4), 401-10.

CONCLUSIONS:

HIFU appears to provide a safe means for removing and remodeling unwanted deposits of abdominal SAT.


High-Intensity Focused Ultrasound Effectively Reduces Waist Circumference by Ablating Adipose Tissue from the Abdomen and Flanks: A Retrospective Case Series.

Fatemi A, Kane MA. (2010 Oct). Aesthetic Plast Surg., 34(5), 577-82.


High-Intensity Focused Ultrasound Effectively Reduces Adipose Tissue.

Fatemi A. (2009 Dec). Semin Cutan Med Surg., 28(4), 257-62.

Liposonix is considered to be a nonsurgical treatment for body contouring that uses high-intensity focused ultrasound (HIFU) to disrupt adipocytes percutaneously. We wanted to find out about its efficacy, effectiveness, and so forth. The technique delivers energy across the skin surface at a relatively low intensity, but brings this energy to a sharp focus in the subcutaneous fat. At the skin surface, the intensity of the ultrasound energy is low enough so that no damage occurs. The focusing of the ultrasound beam at specific depths beneath the epidermis, combined with proprietary application techniques, results in adipose tissue disruption. Once adipocytes have been disrupted, chemotactic signals activate the body’s inflammatory response mechanisms. Macrophage cells are attracted to the area to engulf and transport the lipids and cell debris. This results in an overall reduction in local adipose tissue volume. Our clinical and histologic studies will show exactly what happens under the skin. We did a series of studies on gross pathology and histology, and we tried to correlate these with the clinical results. The histologies show clearly that adipocytes are disrupted by HIFU. The pathologies show the lesions, but they are always at a safe distance from dermis or the epidermis. The correlation between focal depth, energy levels, and clinical results is evident. The average circumference reduction after treatment of the abdomen and waist is 4-5 cm. Liposonix turns out to be a safe and effective technique for nonsurgical body sculpting by reduction of fat deposits.


Noninvasive Body Sculpting Technologies with an Emphasis on High-Intensity Focused Ultrasound.

Jewell ML, Solish, NJ, Desliets CS. (2011). Aesthetic Plastic Surgery, 35(5), 901-912.


High-Intensity Focused Ultrasound.

Quistgaard JU, et al. (2010 Spring). Euro Aesthet Guide, 1-16.


Clinical Safety and Histological Changes Associated with the Use of a Novel High-Intensity Focused Ultrasound Device for Non-Invasive Body Sculpting.

Gadsen E, et al. (2009).


 

Low-Level Laser Therapy as a Non-Invasive Approach for Body Contouring_ A Randomized_ Controlled Study

Jackson etal –

Lasers Surg Med. 2009 Dec;41(10):799-809. doi: 10.1002/lsm.20855.

Abstract

BACKGROUND AND OBJECTIVE:

Transmission electron microscopic images have demonstrated the formation of transitory pores in adipocyte cell membranes followed by the collapse of adipose cells subsequent to laser irradiation of 635 nm. The objective is to evaluate the application of a 635 nm and 17.5 mW exit power per multiple diode laser for the application of non-invasive body contouring of the waist, hips, and thighs.

STUDY DESIGN/PATIENTS AND METHODS:

Double-blind, randomized, placebo-controlled trial of a 2-week non-invasive laser treatment conducted from May 2007 to June 2008 across multiple-private practice sites in the United States of America. Sixty-seven volunteers between the ages of 18-65 with a body mass index (BMI) between 25 and 30 kg/m(2) and who satisfied the set inclusion criteria participated. Eight of the 67 subjects did not have circumference measurements recorded at the 2-week post-procedure measurement point. Participants were randomly assigned to receive low-level laser treatments or a matching sham treatment three times per week for 2 weeks. Reduction in the total combined inches of circumference measurements of the waist, hip and bilateral thighs from baseline to the completion of the 2-week procedure administration phase was assessed.

RESULTS:

Participants in the treatment group demonstrated an overall reduction in total circumference across all three sites of -3.51 in. (P < 0.001) compared with control subjects who revealed a -0.684 reduction (P < 0.071745). Test group participants demonstrated a reduction of -0.98 in. (P < 0.0001) across the waist, -1.05 in. (P < 0.01) across the hip, and -0.85 in. (P < 0.01) and -0.65 in. (P < 0.01) across the right and left thighs from baseline to 2 weeks (end of treatment). At 2 weeks post-procedure, test group subjects demonstrated a gain of 0.31 total inches collectively across all three sites.

CONCLUSION:

These data suggest that low-level laser therapy can reduce overall circumference measurements of specifically treated regions.


 

Evaluation of a Novel High-Intensity Focused Ultrasound Device for Ablating Subcutaneous Adipose Tissue for Noninvasive Body Contouring: Safety Studies in Human Volunteers

Aesthet Surg J (2011) 31 (4): 401-410 Ernesto Gadsden, María Teresa Aguilar, Bruce R. Smoller, Mark L. Jewell DOI: https://dx.doi.org/10.1177/1090820X11405027 First published online: 1 May 2011 (10 pages)

Abstract

Background: High-intensity focused ultrasound (HIFU) is an energy-based medical technology with many clinical applications. A device under clinical investigation in the United States (LipoSonix; Medicis Technologies Corporation, Bothell, Washington) uses HIFU to reduce localized deposits of abdominal adipose tissue.

Objectives: The authors describe the results from their clinical trial investigating the safety of this HIFU device in human patients.

Methods: Over the course of three studies evaluating the safety of the HIFU device for ablating human subcutaneous adipose tissue (SAT), 152 healthy patients were treated with total HIFU energy doses of 47 to 331 J/cm2), including patients who presented for elective abdominoplasty and underwent treatment to areas identified for subsequent excision. The safety of each treatment regimen was confirmed before the energy levels were raised. Abdominoplasty was performed up to 14 weeks following the HIFU procedure, and a pathologist performed histopathological analyses of excised tissues. Safety evaluations included an assessment of clinical chemistry and hematology profiles, physical examinations, and adverse events.

Results: Posttreatment ultrasound confirmed that the HIFU effects were limited to targeted SAT layers. Histopathology revealed well-demarcated disruption of adipocytes within the targeted SAT. Phagocytosis of released lipids and cellular debris occurred after 14 to 28 days. Phagocytized lipids underwent normal hepatic metabolism. Healing progressed normally and was 95% complete after eight to 14 weeks. Adverse events consisted primarily of temporary treatment discomfort, edema, erythema, dysesthesia, and ecchymosis. There were no changes in clinical laboratory parameters, and no serious device-related adverse events occurred. Optimal clinical outcomes were achieved with lower energy levels, which provided beneficial effects with the least amount of discomfort.

Conclusions: HIFU appears to provide a safe means for removing and remodeling unwanted deposits of abdominal SAT.

Venus Freeze Cellulite Treatment

The radiofrequency frontier: a review of radiofrequency and combined radiofrequency pulsed light technology in aesthetic medicine

Sadick N, Sorhaindo L. Facial Plast Surg 2005;21: 131–8.

Radiofrequency (RF) and combined RF light source technologies have established themselves as safe and effective treatment modalities for several dermatologic procedures, including skin tightening, hair and leg vein removal, acne scarring, skin rejuvenation, and wrinkle reduction. This article reviews the technology, clinical applications, and recent advances of RF and combined RF light/laser source technologies in aesthetic medicine.


Cutaneous Laser Surgery – the art and science of selective photothermolysis

Goldman p & Fitzpatrick E:  page 377; Mosby 1999.


Multicenter study of noninvasive, radiofrequency for periorbital tissue tightening.

Fitzpatrick R, Geronemus R, Goldberg D, et al;  Lasers Surg Med 2003;33:232–42.

Abstract

BACKGROUND AND OBJECTIVES:

This 6-month study evaluated the efficacy and safety of treatment with a nonablative radiofrequency (RF) device.

STUDY DESIGN/MATERIALS AND METHODS:

Eighty-six subjects received a single treatment with the ThermaCool TC System (Thermage, Inc., Hayward, CA) and were evaluated for 6 months after treatment.

RESULTS:

Independent scoring of blinded photographs resulted in Fitzpatrick wrinkle score improvements of at least 1 point in 83.2% (99/119) of treated periorbital areas. Treating physicians, without reference to pre-treatment photographs, noted improvements in 28.9% (48/166) of treatment areas. Fifty percent (41/82) of subjects reported being satisfied or very satisfied with periorbital wrinkle reductions. Objective photographic analysis showed that 61.5% (40/65) of eyebrows were lifted by at least 0.5 mm. Rates and duration of edema/erythema were very low (e.g., vs. ablative procedures). Overall 2nd-degree burn incidence was 0.36% (21 per 5,858 RF applications). Three patients had small areas of residual scarring at 6 months.

CONCLUSIONS:

A single treatment with this RF tissue tightening (RFTT) device produces objective and subjective reductions in periorbital wrinkles, measurable changes in brow position, and acceptable epidermal safety. These changes were indicative of a thermally induced early tissue-tightening effect followed by additional tightening over a time course consistent with a thermal wound healing response.


Monopolar vs bipolar vs radiofrequency plus laser; indications; treatment approaches; novel applications; results.

 Biesnman BS. Radiofrequency Devices:  In: Arndt KA, Dover JS, Anderson RR, editors. Controversies and Conversations in Laser and Cosmetic Surgery. Symposium Proceedings; 2005, Denver, CO.

Background:

Radiofrequency (RF) is a new technique to treat facial wrinkles. This study was designed to assess the efficacy of Accent RF in wrinkle reduction of different areas of the face.

Materials and Methods:

Patients with mild to severe facial wrinkles were treated with Accent using RF energies of 35-145 W. The average energy used in this study was 83.11 W. Patients received four subsequent weekly RF sessions. Wrinkle improvement was rated by two physicians comparing 6-month post treatment photographs with pretreatment photos. Moreover, patient satisfaction was assessed at 1 and 6 months after the last session of the treatment.

Results:

A total of 45 women participated in this study. In terms of patient satisfaction one month after the last treatment, 8.9% of the patients declared their dissatisfaction, 53.3% were somehow satisfied, 33.3% were satisfied, and 4.4% were very satisfied. At 6 months, patient satisfaction was as follows: 4.4% dissatisfied, 31.1% somehow satisfied, 46.7% satisfied, and 17.8% very satisfied. Patient satisfaction 6 months after the last treatment was significantly higher than 1 month post treatment (P = 0.006). At 6 months, patient satisfaction was not more than 75% in any treatment areas of the face.

Conclusion:

The results of this study suggest that Accent RF may be considered as a possible effective option for facial skin rejuvenation although its efficacy and safety needs to be evaluated further in randomized controlled trials.

 Effect of controlled volumetric tissue heating with radiofrequency on cellulite and the subcutaneous tissue of the buttocks and thighs.

J Drugs Dermatol. 2006 Sep;5(8):714-22. Emilia del Pino M1, Rosado RH, Azuela A, Graciela Guzmán M, Argüelles D, Rodríguez C, Rosado GM.

Abstract

BACKGROUND:

Regardless of diet and exercise, genetics plays an important part in creating puckering skin or dimples, which are difficult to hide at any age. The demand for a nonsurgical, noninvasive treatment of cellulite has inspired some manufacturers to invest in a new age of sophisticated devices and treatment therapies to repair the skin and improve contours. Although many of these new choices have demonstrated a smoothing effect (following a multitude of treatments), the objective documentation has in most cases been limited to biopsies, circumference measurements, and photographic evidence.

HYPOTHESIS:

We believe that the application of noninvasive high-energy radiofrequency (RF) to the skin of the thigh and buttocks heats the subcutaneous adipose tissue, causing collagen fibers to contract. The resulting impact to the subcutaneous tissue and collagen is expected to improve the skin’s external architecture. Given that the subcutaneous tissue and adipose tissue are difficult to evaluate through histological methods, this investigation seeks to demonstrate the changes that occur when applying 2 treatments of high-energy RF on the subcutaneous tissue of thighs and buttocks utilizing real-time ultrasound image scanning.

MATERIALS AND METHODS:

Twenty-six healthy female patients (ages 18 to 50) with visible bilateral cellulite (grade 1 to 3) on either the buttocks and/or thighs received 2 treatment sessions (15 days apart) of unipolar RF using the Accent RF System (Alma Lasers Inc). The system utilizes a unipolar RF applicator that is electrically cooled to aid in patient comfort during the treatment. Appropriate energy was set and the treatment was delivered in 3 passes of 30 seconds each. Evaluation of the thickness of the subcutaneous tissue on buttocks and thighs took place before the first treatment, second treatment, and 15 days following the second treatment with a with real-time scanning image ultrasound (Philips Medical Systems). Clinical improvement was objectively evaluated through comparative pre- and post-treatment measurements of the distance between the stratum corneum to the Camper’s fascia and from the stratum corneum to the muscle. The study also evaluated the structure and changes of the collagen (thickening and realignment of septae) resulting from 2 treatments of RE Photography was used to document contour and superficial changes.

RESULTS:

From the measurements of the distance between the stratum corneum to the Camper’s fascia and from the stratum corneum to the muscle we were able to demonstrate that 68% of the patients presented a contraction of the volume of approximately 20%.

CONCLUSIONS:

Based on the demonstrated results with real-time ultrasound scanning, we have observed that 2 RF treatments on the subcutaneous tissue of the buttocks and thighs provide a volumetric contraction effect in the majority of patients. This validates the primary hypothesis of our protocol and establishes that the RF energy works on the connective tissue of the subcutaneous adipose tissue. This effect should be the same on any other body part.

CoolSculpting

Clin Cosmet Investig Dermatol. 2014; 7: 201–205.
Published online 2014 Jun 26. doi:  10.2147/CCID.S44371
PMCID: PMC4079633

Cryolipolysis for noninvasive body contouring: clinical efficacy and patient satisfaction

Abstract

In recent years, a number of modalities have become available for the noninvasive reduction of adipose tissue, including cryolipolysis, radiofrequency, low-level laser, and high-intensity focused ultrasound. Each technology employs a different mechanism of action to cause apoptosis or necrosis of the targeted adipocytes. Among these technologies, cryolipolysis has not only been commercially available for the longest time, but has also been best researched including in vitro and animal models and randomized controlled clinical trials in humans. The principle behind cryolipolysis exploits the premise that adipocytes are more susceptible to cooling than other skin cells. The precise application of cold temperatures triggers apoptosis of the adipocytes, which invokes an inflammatory response and leads to slow digestion by surrounding macrophages. In clinical studies, cryolipolysis was shown to reduce subcutaneous fat at the treatment site by up to 25% after one treatment. Improvements were seen in 86% of treated subjects. At 73%, the patient satisfaction rate is higher than with other technologies used for noninvasive lipolysis.

Cryolipolysis has been proven to be a very safe method for body contouring, and is accomplished with only minimal discomfort. Expected side effects are temporary erythema, bruising, and transient numbness that usually resolve within 14 days after treatment. With a prevalence of 0.1%, the most common complaint is late-onset pain, occurring 2 weeks post-procedure, which resolves without intervention. Although no procedure has been accepted as the gold standard for noninvasive body contouring as yet, cryolipolysis is considered to be both safe and efficient with a high patient satisfaction rate.

CoolMini

Clin Cosmet Investig Dermatol. 2014; 7: 201–205.
Published online 2014 Jun 26. doi:  10.2147/CCID.S44371
PMCID: PMC4079633

Cryolipolysis for noninvasive body contouring: clinical efficacy and patient satisfaction

Abstract

In recent years, a number of modalities have become available for the noninvasive reduction of adipose tissue, including cryolipolysis, radiofrequency, low-level laser, and high-intensity focused ultrasound. Each technology employs a different mechanism of action to cause apoptosis or necrosis of the targeted adipocytes. Among these technologies, cryolipolysis has not only been commercially available for the longest time, but has also been best researched including in vitro and animal models and randomized controlled clinical trials in humans. The principle behind cryolipolysis exploits the premise that adipocytes are more susceptible to cooling than other skin cells. The precise application of cold temperatures triggers apoptosis of the adipocytes, which invokes an inflammatory response and leads to slow digestion by surrounding macrophages. In clinical studies, cryolipolysis was shown to reduce subcutaneous fat at the treatment site by up to 25% after one treatment. Improvements were seen in 86% of treated subjects. At 73%, the patient satisfaction rate is higher than with other technologies used for noninvasive lipolysis. Cryolipolysis has been proven to be a very safe method for body contouring, and is accomplished with only minimal discomfort. Expected side effects are temporary erythema, bruising, and transient numbness that usually resolve within 14 days after treatment. With a prevalence of 0.1%, the most common complaint is late-onset pain, occurring 2 weeks post-procedure, which resolves without intervention. Although no procedure has been accepted as the gold standard for noninvasive body contouring as yet, cryolipolysis is considered to be both safe and efficient with a high patient satisfaction rate.

Dermatol Surg. 2013 Aug;39(8):1209-16. doi: 10.1111/dsu.12238. Epub 2013 May 2.

Safety, tolerance, and patient satisfaction with noninvasive cryolipolysis.

Abstract

BACKGROUND:

Comprehensive assessment of safety, tolerance, and patient satisfaction has not been established from noninvasive body contouring techniques, such as low-level laser therapy, ultrasound, radiofrequency, and infrared light, for reduction of subcutaneous fat.

OBJECTIVE:

This multicenter study investigated the clinical outcomes of noninvasive cryolipolysis in European subjects.

METHODS:

A retrospective study was performed at clinical sites in Belgium and France. Safety was assessed according to reports of side effects. Tolerance was evaluated according to pain scores and patient perception of treatment duration. Clinical outcomes were assessed according to patient surveys, caliper measurements, and assessment of photographs.

RESULTS:

The investigators treated 518 patients. No significant side effects or adverse events were reported. The procedure was well-tolerated, with 89% of respondents reporting a positive perception of treatment duration and 96% reporting minimal to tolerable discomfort. Survey results demonstrated 73% patient satisfaction and that 82% of patients would recommend the cryolipolysis procedure to a friend. Caliper measurements demonstrated 23% reduction in fat layer thickness at 3 months. Abdomen, back, and flank treatment sites were most effective, with 86% of subjects showing improvement per investigator assessment.

CONCLUSIONS:

With proper patient selection, cryolipolysis is a safe, well-tolerated, and effective treatment method for reduction of subcutaneous fat.

Lasers Surg Med. 2016 Jan;48(1):3-13. doi: 10.1002/lsm.22440. Epub 2015 Nov 26.

Safety and efficacy of cryolipolysis for non-invasive reduction of submental fat.

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. 48:3-13, 2016. © 2015 Wiley Periodicals, Inc.

CryolipolysisTM for Subcutaneous Fat Layer Reduction

Lasers in Surgery and Medicine 41:703–708 (2009)  Mathew M. Avram, MD, JD1 * and Rosemary S. Harry.

Background and Objective: Cryolipolysis is a unique non-invasive method for the selective reduction of fat cells with controlled, localized cooling. It is important, therefore, to understand the potential efficacy and safety of this new procedure for fat layer reduction. Materials and Methods: A review of the literature associated with cryolipolysis was performed to evaluate the findings from pre-clinical and clinical studies with respect to the mechanism of action, efficacy, and safety. Results: Cryolipolysis has demonstrated efficacy in both human and animal studies. Histology findings also confirm the selective reduction of fat in both humans and animals, with evidence of a gradual thinning of the fat layer over a period of two to four months. Importantly, cryolipolysis has not produced any significant adverse side effects in studies to date and any noted effects have been minor and temporary. Conclusion: Although the mechanism of action for cryolipolysis is not yet completely understood, the efficacy and safety of this non-invasive procedure for fat layer reduction has been demonstrated in the studies available to data. Further studies willl assist in identifying the mechanism and elucidate the full potential of this technology to perform safe, non-invasive fat reduction for areas of local fat accumulation. Lasers Surg. Med. 41:703–708, 2009.  2009 Wiley-Liss, Inc.

Venus Freeze Cellulite Treatment

The radiofrequency frontier: a review of radiofrequency and combined radiofrequency pulsed light technology in aesthetic medicine

Sadick N, Sorhaindo L. Facial Plast Surg 2005;21: 131–8.

Radiofrequency (RF) and combined RF light source technologies have established themselves as safe and effective treatment modalities for several dermatologic procedures, including skin tightening, hair and leg vein removal, acne scarring, skin rejuvenation, and wrinkle reduction. This article reviews the technology, clinical applications, and recent advances of RF and combined RF light/laser source technologies in aesthetic medicine.


Cutaneous Laser Surgery – the art and science of selective photothermolysis

Goldman p & Fitzpatrick E:  page 377; Mosby 1999.


Multicenter study of noninvasive, radiofrequency for periorbital tissue tightening.

Fitzpatrick R, Geronemus R, Goldberg D, et al;  Lasers Surg Med 2003;33:232–42.

Abstract

BACKGROUND AND OBJECTIVES:

This 6-month study evaluated the efficacy and safety of treatment with a nonablative radiofrequency (RF) device.

STUDY DESIGN/MATERIALS AND METHODS:

Eighty-six subjects received a single treatment with the ThermaCool TC System (Thermage, Inc., Hayward, CA) and were evaluated for 6 months after treatment.

RESULTS:

Independent scoring of blinded photographs resulted in Fitzpatrick wrinkle score improvements of at least 1 point in 83.2% (99/119) of treated periorbital areas. Treating physicians, without reference to pre-treatment photographs, noted improvements in 28.9% (48/166) of treatment areas. Fifty percent (41/82) of subjects reported being satisfied or very satisfied with periorbital wrinkle reductions. Objective photographic analysis showed that 61.5% (40/65) of eyebrows were lifted by at least 0.5 mm. Rates and duration of edema/erythema were very low (e.g., vs. ablative procedures). Overall 2nd-degree burn incidence was 0.36% (21 per 5,858 RF applications). Three patients had small areas of residual scarring at 6 months.

CONCLUSIONS:

A single treatment with this RF tissue tightening (RFTT) device produces objective and subjective reductions in periorbital wrinkles, measurable changes in brow position, and acceptable epidermal safety. These changes were indicative of a thermally induced early tissue-tightening effect followed by additional tightening over a time course consistent with a thermal wound healing response.


Monopolar vs bipolar vs radiofrequency plus laser; indications; treatment approaches; novel applications; results.

 Biesnman BS. Radiofrequency Devices:  In: Arndt KA, Dover JS, Anderson RR, editors. Controversies and Conversations in Laser and Cosmetic Surgery. Symposium Proceedings; 2005, Denver, CO.

Background:

Radiofrequency (RF) is a new technique to treat facial wrinkles. This study was designed to assess the efficacy of Accent RF in wrinkle reduction of different areas of the face.

Materials and Methods:

Patients with mild to severe facial wrinkles were treated with Accent using RF energies of 35-145 W. The average energy used in this study was 83.11 W. Patients received four subsequent weekly RF sessions. Wrinkle improvement was rated by two physicians comparing 6-month post treatment photographs with pretreatment photos. Moreover, patient satisfaction was assessed at 1 and 6 months after the last session of the treatment.

Results:

A total of 45 women participated in this study. In terms of patient satisfaction one month after the last treatment, 8.9% of the patients declared their dissatisfaction, 53.3% were somehow satisfied, 33.3% were satisfied, and 4.4% were very satisfied. At 6 months, patient satisfaction was as follows: 4.4% dissatisfied, 31.1% somehow satisfied, 46.7% satisfied, and 17.8% very satisfied. Patient satisfaction 6 months after the last treatment was significantly higher than 1 month post treatment (P = 0.006). At 6 months, patient satisfaction was not more than 75% in any treatment areas of the face.

Conclusion:

The results of this study suggest that Accent RF may be considered as a possible effective option for facial skin rejuvenation although its efficacy and safety needs to be evaluated further in randomized controlled trials.

 Effect of controlled volumetric tissue heating with radiofrequency on cellulite and the subcutaneous tissue of the buttocks and thighs.

J Drugs Dermatol. 2006 Sep;5(8):714-22. Emilia del Pino M1, Rosado RH, Azuela A, Graciela Guzmán M, Argüelles D, Rodríguez C, Rosado GM.

Abstract

BACKGROUND:

Regardless of diet and exercise, genetics plays an important part in creating puckering skin or dimples, which are difficult to hide at any age. The demand for a nonsurgical, noninvasive treatment of cellulite has inspired some manufacturers to invest in a new age of sophisticated devices and treatment therapies to repair the skin and improve contours. Although many of these new choices have demonstrated a smoothing effect (following a multitude of treatments), the objective documentation has in most cases been limited to biopsies, circumference measurements, and photographic evidence.

HYPOTHESIS:

We believe that the application of noninvasive high-energy radiofrequency (RF) to the skin of the thigh and buttocks heats the subcutaneous adipose tissue, causing collagen fibers to contract. The resulting impact to the subcutaneous tissue and collagen is expected to improve the skin’s external architecture. Given that the subcutaneous tissue and adipose tissue are difficult to evaluate through histological methods, this investigation seeks to demonstrate the changes that occur when applying 2 treatments of high-energy RF on the subcutaneous tissue of thighs and buttocks utilizing real-time ultrasound image scanning.

MATERIALS AND METHODS:

Twenty-six healthy female patients (ages 18 to 50) with visible bilateral cellulite (grade 1 to 3) on either the buttocks and/or thighs received 2 treatment sessions (15 days apart) of unipolar RF using the Accent RF System (Alma Lasers Inc). The system utilizes a unipolar RF applicator that is electrically cooled to aid in patient comfort during the treatment. Appropriate energy was set and the treatment was delivered in 3 passes of 30 seconds each. Evaluation of the thickness of the subcutaneous tissue on buttocks and thighs took place before the first treatment, second treatment, and 15 days following the second treatment with a with real-time scanning image ultrasound (Philips Medical Systems). Clinical improvement was objectively evaluated through comparative pre- and post-treatment measurements of the distance between the stratum corneum to the Camper’s fascia and from the stratum corneum to the muscle. The study also evaluated the structure and changes of the collagen (thickening and realignment of septae) resulting from 2 treatments of RE Photography was used to document contour and superficial changes.

RESULTS:

From the measurements of the distance between the stratum corneum to the Camper’s fascia and from the stratum corneum to the muscle we were able to demonstrate that 68% of the patients presented a contraction of the volume of approximately 20%.

CONCLUSIONS:

Based on the demonstrated results with real-time ultrasound scanning, we have observed that 2 RF treatments on the subcutaneous tissue of the buttocks and thighs provide a volumetric contraction effect in the majority of patients. This validates the primary hypothesis of our protocol and establishes that the RF energy works on the connective tissue of the subcutaneous adipose tissue. This effect should be the same on any other body part.

Acne Treatment

Laser therapy for acne

Abstract from Semin Plast Surg. 2007 Aug; 21(3): 167–174. doi:  10.1055/s-2007-991185

Considered the most common skin disorder, acne affects millions of people every year. This multifactorial condition of the pilosebaceous follicle is a combination of at least four different primary pathogeneses. In recent years, acne therapies have been improving, becoming more effective, and targeting one or more of these causes. Many current therapies have drawbacks involving patient compliance, systemic toxicities, and bacterial resistance. Lasers are now established options in the armamentarium to treat acne. The 532-nm potassium titanyl phosphate laser, 585- and 595-nm pulsed dye lasers, 1450-nm diode laser, and 1540-nm erbium glass laser have been used with variable efficacy. Lasers may be best used in combination with other therapies to enhance their results. Photodynamic therapy has been successful with substances such as 5-aminolevulinic acid and indocyanine green. Lasers remain viable alternatives for people who may not desire or be able to use topical or systemic formulations. Drawbacks associated with lasers include potential pain, skin discoloration, and cost of treatment. Typically, multiple sessions are required to achieve the desired results, with future maintenance treatments possible to maintain the outcomes. With additional clinical trials underway, laser treatment of acne will surely advance and continue to be optimized in the future.

 

  Laser Treatment of Acne Vulgaris

Abstract from Clin Dermatol. 2006 Jan-Feb;24(1):26-32.

Traditional medical treatments for acne vulgaris include a variety of topical and oral medications. The combination of poor compliance, lack of durable remission, and potential side effects are common drawbacks to these treatments. The use of lasers and light devices has increased dramatically in recent years due to the overall ease of treatment, predictable clinical efficacy, and minimal adverse effects. A variety of light and laser devices has been used for the treatment of acne, including the potassium titanyl phosphate (KTP) laser, the 585- and 595-nm pulsed dye lasers, the 1450-nm diode laser, radiofrequency devices, intense pulsed light sources, low-intensity light treatment, and photodynamic therapy using 5-aminolevulinic acid and indocyanine green. These devices are thought to target underlying pathogenic factors such as Propionibacterium acnes colonization, increased sebaceous gland activity, and the cutaneous inflammatory response. Lasers in particular also have a central role in the management of acne scarring, which tends to be refractory to medical therapies. Fractional photothermolysis, the 1450-nm diode laser, and pulsed dye lasers have been used in the nonablative treatment of acne scars with significant success. In this article, we review the current status of light- and laser-based treatment of acne and related conditions and briefly review the use of lasers for the treatment of acne scarring.

 

Lasers alleviate acne.

Abstract from J Cosmet Dermatol. 2004 Jul;3(3):182-3.

 

Propionibacterium acnes (P. acnes) and sebaceous glands are involved in the pathogenesis of acne. Although often effective, traditional therapies can have drawbacks, such as photosensitivity, other toxicities, polypharmacy and frequent dosing. Lasers have been studied to seek a solution that may overcome these disadvantages. Lasers and other light therapies target the wavelengths of the porphyrins in P. acnes to induce thermal damage that causes the bacterium’s destruction. Pulsed-dye laser (PDL) or a system of light pulses and heat with wavelengths between 430 and 1100 nm are both efficacious. The 1450-nm diode laser targets sebaceous glands and is also effective. Topical indocyanine green (ICG) photodynamic therapy (PDT), using the near-infrared (NIR) laser, targets either P. acnes or sebaceous glands. ICG-PDT has fewer adverse effects than aminolevulinic acid-PDT. Lasers are still a relatively new therapy for acne and may be best used in an adjuvant role.

 

Light/laser therapy in the treatment of acne vulgaris.

Abstract from J Cosmet Dermatol. 2005 Dec;4(4):318-20.

Acne vulgaris is one of the most prevalent skin diseases known. As common as this condition is, the social and psychological consequences are limitless. Although current treatments are available and include topical or oral antibiotics, it is crucial to develop a less risky and more effective therapy such as light/laser therapy. This article focuses specifically on the benefits of the light/laser treatment on acne vulgaris. Porphyrins accumulated in the bacteria, Propionibacterium acnes, one of the etiologic factors involved in the pathogenesis, allows phototherapy to be a successful modality. They have specific absorption peaks at which lasers have optimal effects. The longer the wavelength of the light is, the deeper its penetration and thus the greater its damage to the sebaceous glands. Although blue light is best for the activation of porphyrins, red light is best for deeper penetration and an anti-inflammatory effect. Ultraviolet (UV) light, although it may have initial an anti-inflammatory effects, has been proven to be potentially carcinogenic and have adverse effects such as aging (by UV-A) and burning (by UV-B). Previous studies indicate successful long-term intervention and selective damage of the sebaceous glands by using a diode laser with indocyanine green (ICG) dye. Mid-infrared lasers have been found to decrease lesion counts while also reducing the oiliness of skin and the scarring process. Nonablative laser treatment of acne scars using the Er:YAG laser with a short-pulsed mode has been successful in reducing the appearance of scars by stimulating neocollagenesis. The light/laser therapy has started to be explored with promising results in highly selected patients that require further investigation in greater populations and well-designed protocols.

Effects of dermabrasion on acne scarring. A review and a study of 25 cases.

Aronsson A, Eriksson T, Jacobsson S, Salemark L.Acta Derm Venereol. 1997 Jan; 77(1):39-42.

RESULTS:

Twenty-four patients completed the study with 38% (9/24) having excellent results, 34% (8/24) with good results, 17% (4/24) with fair results, and 12% (3/24) with poor results. Ninety-six percent (23/24) of patients were pleased with their peel results and would recommend this procedure to others.

CONCLUSION:

The use of microdermabrasion in this pilot study appeared to produce a positive effect on the improvement of acne.

Ultherapy

Retrospective evaluation of micro-focused ultrasound for lifting and tightening the face and neck.

Dermatol Surg. 2014 May;40(5):569-75. doi: 10.1111/dsu.12471. Epub 2014 Apr 2. Fabi SG1, Goldman MP.

Abstract

BACKGROUND:

Microfocused ultrasound (MFU) is an effective means for tightening and lifting lax facial and neck skin.

OBJECTIVE:

To evaluate the safety and efficacy of MFU with visualization (MFU-V) for noninvasive treatment of facial and neck skin laxity 180 days after treatment and determine what lifestyle factors affect treatment outcomes.

MATERIALS AND METHODS:

Healthy women (N = 48) previously treated with MFU-V on the face and upper neck were enrolled. Depending on when MFU-V treatment occurred, subjects completed 90- or 180-day follow-up visits or both. Digital images of each subject were obtained before treatment and at follow-up visits.

RESULTS:

Data were obtained at 90 (N = 16) and 180 days (N = 45), and physician Global Aesthetic Improvement Scale (GAIS) scores demonstrated that 81.3% and 77.7% patients achieved improvement, respectively. At 90 and 180 days, subject GAIS scores showed 75% and 77.8% of subjects perceived improvement, respectively. At 180 days, blinded reviewer assessments indicated that 67% of subjects showed improvement in appearance. There was no association between improvement and age, Fitzpatrick skin type, alcohol intake, or major illness. One minor adverse event was reported.

DISCUSSION:

Although the data obtained at 90 days must be interpreted cautiously because of the smaller number of patients, subjects achieved significant lifting and tightening of facial and neck skin up to 180 days after one MFU treatment.

© 2014 by the American Society for Dermatologic Surgery, Inc. Published by Wiley Periodicals, Inc.

Aesthetic Plast Surg. 2014 Oct;38(5):861-8. doi: 10.1007/s00266-014-0383-6. Epub 2014 Aug 7.

Safety and efficacy of ulthera in the rejuvenation of aging lower eyelids: a pivotal clinical trial.

Pak CS1, Lee YK, Jeong JH, Kim JH, Seo JD, Heo CY.

Abstract

BACKGROUND:

The changes in the periorbital region are among the most prominent features of the aging process in the lower eyelids. Intense focused ultrasound (IFUS), known as the Ulthera System, was designed to correct this process. The current study assessed the safety and efficacy of the Ulthera System.

METHODS:

This study enrolled seven adult patients who presented from March 2011 to May 2012 for correction of lower eyelid aging by Ulthera. The subjects were treated using Ulthera 1.5 and 3.0 mm probes. The 1.5 mm probe is used to tighten of loose eyelid skin and the deep dermis, whereas the 3.0 mm probe is used to tighten the orbicularis oculi muscle and the orbital septum. The patients were evaluated for allergic reactions and other side effects. The subjects’ satisfaction with clinical photographs and the degree of pain were evaluated. Moreover, orbital computed tomography (CT) and ophthalmologic examinations were performed. The study used CT both as a research tool and as a clinical score system for evaluating aging lower eyelids and performed statistical analysis.

RESULTS:

Based on the CT images, the difference between the pre- and postoperative distances from the baseline (line between the most inferior point of the supraorbital rim and the most superior point of the infraorbital rim) to the most protruding point of the orbital septum was 0.51 ± 0.23 for the right eye (p < 0.001) and 0.54 ± 0.17 for the left eye (p < 0.001). The subjective score for patient satisfaction was 3.85 ± 0.69. The objective satisfaction scores reported by two blinded researchers were respectively 3.45 ± 1.69 and 3.25 ± 1.43. During the study period, no adverse events and no suspected serious adverse reactions were noted.

CONCLUSIONS:

Tightening of infraorbital laxity and skin can be achieved using the Ulthera System. Patients showed a minimal pain level during treatment, and topical analgesic cream was able to manage pain during the procedure.

Clin Cosmet Investig Dermatol. 2015; 8: 47–52. Published online 2015 Feb 5. doi:  10.2147/CCID.S69118 Sabrina Guillen Fabi

Abstract

Microfocused ultrasound (MFU) has been recently developed to meet the ever-growing public demand for achieving significant, noninvasive skin lifting and tightening. MFU can be focused on subcutaneous tissue where the temperature briefly reaches greater than 60°C, producing small (<1 mm3) thermal coagulation points to a depth of up to 5 mm within the mid-to-deep reticular layer of the dermis and subdermis. The intervening papillary dermal and epidermal layers of skin remain unaffected. The application of heat at these discrete thermal coagulation points causes collagen fibers in the facial planes such as the superficial musculoaponeurotic system and platysma, as well as the deep reticular dermis, to become denatured, contracting and stimulating de novo collagen. A commercially available device combines MFU with high-resolution ultrasound imaging (MFU-V), which enables visualization of tissue planes to a depth of 8 mm and allows the user to see where the MFU energy will be applied (Ultherapy®; Ulthera Inc., Mesa, AZ, USA). Using different transducers, MFU-V treatment can be customized to meet the unique physical characteristics of each patient by adjusting energy and focal depth of the emitted ultrasound. By targeting the facial superficial musculoaponeurotic system, noninvasive tightening and lifting of sagging facial and neck skin and improvements in the appearance of wrinkles can be achieved. MFU-V can also improve lines and wrinkles of the décolleté. Treatment protocols for the use of MFU-V continue to be refined, and its use in combination with other rejuvenation techniques has been demonstrated. Brief discomfort that often occurs during treatment can be minimized with oral nonsteroidal anti-inflammatory drugs. Other treatment-related adverse events include transient erythema, edema, and occasional bruising. MFU-V is best suited for patients with mild-to-moderate skin and soft tissue laxity. For older patients with severe skin laxity and marked platysmal banding, surgical treatment should be considered.

Stretch Mark Treatment

The safety and efficacy of fractional photothermolysis for the correction of striae distensae.

 J Drugs Dermatol. 2008 Sep;7(9):857-61. Stotland M1, Chapas AM, Brightman L, Sukal S, Hale E, Karen J, Bernstein L, Geronemus RG.

Abstract

BACKGROUND:

Improving the appearance of striae distensae, particularly striae alba, has remained a challenge due to the limited availability of effective and low-risk treatment options. Fractional photothermolysis, a novel concept in skin rejuvenation, has been reported to be effective in the treatment of facial rhytides, acne scars, and surgical scars, but its use in the treatment of striae has not been well studied.

OBJECTIVE:

To determine the safety and efficacy of fractional photothermolysis treatment on striae alba and striae rubra.

METHODS:

Twenty female patients with striae rubra or striae alba on their abdomen, thighs, or buttocks were enrolled in the study. Lesions were randomized to receive treatment, with site-matched normal control areas. Patients received a total of 6 treatments using a 1550-nm, erbium-doped fiber laser with 2 to 3 weeks of elapsed time between treatments. Clinical response to treatment was assessed at each visit, and at 1-month, 2-month, and 3-month follow-up intervals by the patient and investigator. A comparison evaluation of 8 patients examining photographs of striae at baseline and at the 3-month follow-up evaluation which was assessed by 4 independent dermatologists using the quartile grading scale.

RESULTS:

The independent evaluators’ assessments of improvement from photographs of 8 randomly selected patients showed an overall improvement of 26% to 50% in 63% (5/8) of patients. A less than 25% improvement in dyschromia was noted in 50% (4/8) of patients. An improvement in texture of 26% to 50% was observed in 50% (4/8) of patients. The clinical responses were independent of age, gender, and skin phototype. The treatments were tolerated well by all patients with a majority of patients experiencing transient posttreatment erythema and edema.

CONCLUSION:

Fractional photothermolysis can be effectively and safely used in the treatment of striae rubra and striae alba.

Indian J Dermatol. 2016 Mar-Apr; 61(2): 174–180. Moustafa Adam El Taieb and Ahmed Khair Ibrahim1

Abstract

Context:

Striae distensae are linear atrophic dermal scars covered with flat atrophic epidermis. They may cause disfigurement, especially in females. Many factors may cause striae distensae such as steroids, obesity, and pregnancy. Although there is no standard treatment for striae; many topical applications, peeling, and light and laser systems have been tried.

Aims:

To evaluate and compare the efficacy of fractional CO2 laser with intense pulse light in treating striae distensae.

Subjects and Methods:

Forty patients with striae distensae were recruited. Twenty of them were treated by fractional CO2 laser and 20 were treated with intense pulse light. Length and width of the largest striae were measured pre- and post-treatment. Patient satisfaction was also evaluated and graded. Patients were photographed after each treatment session and photos were examined by a blinded physician who had no knowledge about the cases.

Results:

Both groups showed significant improvement after treatments (P < 0.05). Patients treated with fractional CO2 laser showed significant improvement after the fifth session compared with those treated with ten sessions of intense pulsed light (P < 0.05) in all parameters except in the length of striae (P > 0.05).

Conclusions:

The current study has provided supportive evidence to the effectiveness of both fractional CO2 laser and intense pulse light as treatments for striae distensae. Fractional CO2 laser was found to be more effective in the treatment of striae distensae compared with intense pulse light.

The effect of succinylated atelocollagen and ablative fractional resurfacing laser on striae distensae.

J Dermatolog Treat. 2011 Apr;22(2):113-21. doi: 10.3109/09546630903476902. Epub 2010 Jul 28. Shin JU1, Roh MR, Rah DK, Ae NK, Suh H, Chung KY.

Abstract

Striae distensae are dermal atrophic scars with epidermal thinning and decreased collagen and elastic fiber. There is no ‘gold standard’ treatment modality in the treatment of striae distensae. Collagen is a major extracellular matrix component and is important in wound healing. The ablative CO(2) fractional laser is effective in various cutaneous scars and this study was attempted to evaluate the effect of succinylated atelocollagen and ablative CO(2) fractional laser in the treatment of striae distensae. Participants were divided into two groups and received three laser treatments at a 4-week interval. Clinical improvement was evaluated by participants and two blinded physicians by observing the comparative photographs. Skin biopsies were randomly taken from six participants. The ablative fractional resurfacing laser was effective in the clinical improvement of striae distensae. Statistically significant differences were partly observed between the collagen and placebo groups. Clinical improvement scored by doctors showed more improvement in the collagen group. However, scoring by participants did not show significant differences between the collagen and placebo groups. In conclusion, the ablative fractional resurfacing laser is effective in the treatment of striae distensae and succinylated atelocollagen may also be effective for striae distensae treatment. However, to prove the effect of succinylated atelocollagen, further research with a larger group of participants is needed.

J Res Med Sci. 2012 Oct; 17(10): 928–933. Farahnaz Fatemi Naein and Mehrnaz Soghrati1

Abstract

Context:

Rapid stretching of the skin over the weak connective tissue leads to development of striae distensae. Recently, researchers have shown special interest towards use of fractional photothermolysis in treatment of striae and several studies have shown its usefulness. Our aim was to assess the efficacy of Fractional CO2 laser in treatment of striae alba.

Materials and Methods:

A randomized clinical trial was carried out in female patients with striae alba. Ninety two striae were randomly selected and divided into two groups. Five sessions of laser resurfacing, were performed in Group 1, every 2–4 weeks. Group 2 was treated with 10% glycolic acid+0.05% tretinoin cream nightly during the study. Photographs were taken from the striae before and two weeks after the end of treatment. Mean surface area of striae compared between two groups. Patients’ views regarding the degree of improvement were assessed via visual analogue scale (VAS).

Results:

Forty six striae in Group 1 underwent laser resurfacing and 46 matched striae in Group 2, were treated with topical cream. Mean difference of striae surface area, was significantly decreased after treatment in Group 1 (-37.1±15.6 cm2) in comparison with Group 2(-7.9±9 cm2) (P value >0.001). Mean VAS was significantly higher in Group 1 (3.05±0.74) compared to Group 2 (0.63±0.66) (P value >0.001).

Conclusions:

Fractional photothermolysis via Fractional CO2 laser seems to be an effective method for treatment of striae alba.

Plasma Facial

Ann Dermatol. 2011 Nov; 23(4): 424–431. Dae Hun Kim, M.D., Young Jin Je, M.S., Chang Deok Kim, Ph.D., Young Ho Lee, M.D.,1 Young Joon Seo, M.D., Jeung Hoon Lee, M.D., and Young Lee, M.D.corresponding author

Abstract

Background

Autologous platelet-rich plasma has attracted attention in various medical fields recently, including orthopedic, plastic, and dental surgeries and dermatology for its wound healing ability. Further, it has been used clinically in mesotherapy for skin rejuvenation.

Objective

In this study, the effects of activated platelet-rich plasma (aPRP) and activated platelet-poor plasma (aPPP) have been investigated on the remodelling of the extracellular matrix, a process that requires activation of dermal fibroblasts, which is essential for rejuvenation of aged skin.

Methods

Platelet-rich plasma (PRP) and platelet-poor plasma (PPP) were prepared using a double-spin method and then activated with thrombin and calcium chloride. The proliferative effects of aPRP and aPPP were measured by [3H]thymidine incorporation assay, and their effects on matrix protein synthesis were assessed by quantifying levels of procollagen type I carboxy-terminal peptide (PIP) by enzyme-linked immunosorbent assay (ELISA). The production of collagen and matrix metalloproteinases (MMP) was studied by Western blotting and reverse transcriptase-polymerase chain reaction.

Results

Platelet numbers in PRP increased to 9.4-fold over baseline values. aPRP and aPPP both stimulated cell proliferation, with peak proliferation occurring in cells grown in 5% aPRP. Levels of PIP were highest in cells grown in the presence of 5% aPRP. Additionally, aPRP and aPPP increased the expression of type I collagen, MMP-1 protein, and mRNA in human dermal fibroblasts.

Conclusion

aPRP and aPPP promote tissue remodelling in aged skin and may be used as adjuvant treatment to lasers for skin rejuvenation in cosmetic dermatology.

Chemical Peel

Evidence and Considerations in the Application of Chemical Peels in Skin Disorders and Aesthetic Resurfacing.

Rendon MI, Berson DS, Cohen JL, Roberts WE, Starker I, Wang B.

The Journal of clinical and aesthetic dermatology. 2010;3(7):32-43.

Abstract

Chemical peeling is a popular, relatively inexpensive, and generally safe method for treatment of some skin disorders and to refresh and rejuvenate skin. This article focuses on chemical peels and their use in routine clinical practice. Chemical peels are classified by the depth of action into superficial, medium, and deep peels. The depth of the peel is correlated with clinical changes, with the greatest change achieved by deep peels. However, the depth is also associated with longer healing times and the potential for complications. A wide variety of peels are available, utilizing various topical agents and concentrations, including a recent salicylic acid derivative, β-lipohydroxy acid, which has properties that may expand the clinical use of peels. Superficial peels, penetrating only the epidermis, can be used to enhance treatment for a variety of conditions, including acne, melasma, dyschromias, photodamage, and actinic keratoses. Medium-depth peels, penetrating to the papillary dermis, may be used for dyschromia, multiple solar keratoses, superficial scars, and pigmentary disorders. Deep peels, affecting reticular dermis, may be used for severe photoaging, deep wrinkles, or scars. Peels can be combined with other in-office facial resurfacing techniques to optimize outcomes and enhance patient satisfaction and allow clinicians to tailor the treatment to individual patient needs. Successful outcomes are based on a careful patient selection as well as appropriate use of specific peeling agents. Used properly, the chemical peel has the potential to fill an important therapeutic need in the dermatologist’s and plastic surgeon’s armamentarium.

Chemical Peel

Evidence and Considerations in the Application of Chemical Peels in Skin Disorders and Aesthetic Resurfacing.

Rendon MI, Berson DS, Cohen JL, Roberts WE, Starker I, Wang B.

The Journal of clinical and aesthetic dermatology. 2010;3(7):32-43.

Abstract

Chemical peeling is a popular, relatively inexpensive, and generally safe method for treatment of some skin disorders and to refresh and rejuvenate skin. This article focuses on chemical peels and their use in routine clinical practice. Chemical peels are classified by the depth of action into superficial, medium, and deep peels. The depth of the peel is correlated with clinical changes, with the greatest change achieved by deep peels. However, the depth is also associated with longer healing times and the potential for complications. A wide variety of peels are available, utilizing various topical agents and concentrations, including a recent salicylic acid derivative, β-lipohydroxy acid, which has properties that may expand the clinical use of peels. Superficial peels, penetrating only the epidermis, can be used to enhance treatment for a variety of conditions, including acne, melasma, dyschromias, photodamage, and actinic keratoses. Medium-depth peels, penetrating to the papillary dermis, may be used for dyschromia, multiple solar keratoses, superficial scars, and pigmentary disorders. Deep peels, affecting reticular dermis, may be used for severe photoaging, deep wrinkles, or scars. Peels can be combined with other in-office facial resurfacing techniques to optimize outcomes and enhance patient satisfaction and allow clinicians to tailor the treatment to individual patient needs. Successful outcomes are based on a careful patient selection as well as appropriate use of specific peeling agents. Used properly, the chemical peel has the potential to fill an important therapeutic need in the dermatologist’s and plastic surgeon’s armamentarium.

Thermage Skin Tightening

Radiofrequency facial rejuvenation: evidence-based effect.

J Am Acad Dermatol. 2011 Mar;64(3):524-35. doi: 10.1016/j.jaad.2010.06.045. el-Domyati M1, el-Ammawi TS, Medhat W, Moawad O, Brennan D, Mahoney MG, Uitto J.

Abstract

BACKGROUND:

Multiple therapies involving ablative and nonablative techniques have been developed for rejuvenation of photodamaged skin. Monopolar radiofrequency (RF) is emerging as a gentler, nonablative skin-tightening device that delivers uniform heat to the dermis at a controlled depth.

OBJECTIVE:

We evaluated the clinical effects and objectively quantified the histologic changes of the nonablative RF device in the treatment of photoaging.

METHODS:

Six individuals of Fitzpatrick skin type III to IV and Glogau class I to II wrinkles were subjected to 3 months of treatment (6 sessions at 2-week intervals). Standard photographs and skin biopsy specimens were obtained at baseline, and at 3 and 6 months after the start of treatment. We performed quantitative evaluation of total elastin, collagen types I and III, and newly synthesized collagen using computerized histometric and immunohistochemical techniques. Blinded photographs were independently scored for wrinkle improvement.

RESULTS:

RF produced noticeable clinical results, with high satisfaction and corresponding facial skin improvement. Compared with the baseline, there was a statistically significant increase in the mean of collagen types I and III, and newly synthesized collagen, while the mean of total elastin was significantly decreased, at the end of treatment and 3 months posttreatment.

CONCLUSIONS:

Although the results may not be as impressive as those obtained by ablative treatments, RF is a promising treatment option for photoaging with fewer side effects and downtime.

Current concepts in nonablative radiofrequency rejuvenation of the lower face and neck.

Facial Plast Surg. 2005 Feb;21(1):65-73. Abraham MT1, Vic Ross E.

Abstract

With the multitude of treatment options and emerging technology available for rejuvenation of the lower face and neck, it is often difficult to determine which specific treatment would benefit an individual patient. Monopolar radiofrequency (MRF) nonablative skin rejuvenation is a promising new procedure that is utilized to tighten and contour nonsurgically mild to moderate laxity of the skin of the lower face and neck in patients without significant underlying structural ptosis. In these selected patients and others who wish to avoid surgical treatment modalities, MRF treatment offers a noninvasive method of tightening skin and soft tissue, causing softening of the nasolabial lines, tightening of the jowl, and improving the definition of the cervicomental angle, all without significant recovery time or complications. Further development of MRF technology and refinement of treatment protocols may allow even greater tightening of the skin and more dramatic modulation of underlying deeper structures, making the treatment more universally applicable for patients desiring facial rejuvenation.

Clin Cosmet Investig Dermatol. 2014; 7: 335–339. Published online 2014 Dec 12. doi:  10.2147/CCID.S74411 Brian J Simmons, Robert D Griffith, Leyre A Falto-Aizpurua, and Keyvan Nouri
Abstract

Acne is a common affliction among many teens and some adults that usually resolves over time. However, the severe sequela of acne scarring can lead to long-term psychological and psychiatric problems. There exists a multitude of modalities to treat acne scars such as more invasive surgical techniques, subcision, chemical peels, ablative lasers, fractional lasers, etc. A more recent technique for the treatment of acne scars is nonablative radiofrequency (RF) that works by passing a current through the dermis at a preset depth to produce small thermal wounds in the dermis which, in turn, stimulates dermal remodeling to produce new collagen and soften scar defects. This review article demonstrates that out of all RF modalities, microneedle bipolar RF and fractional bipolar RF treatments offers the best results for acne scarring. An improvement of 25%–75% can be expected after three to four treatment sessions using one to two passes per session. Treatment results are optimal approximately 3 months after final treatment. Common side effects can include transient pain, erythema, and scabbing. Further studies are needed to determine what RF treatment modalities work best for specific scar subtypes, so that further optimization of RF treatments for acne scars can be determined.

 Radiofrequency in cosmetic dermatology: a review.

Dermatol Surg. 2012 Nov;38(11):1765-76. doi: 10.1111/j.1524-4725.2012.02547.x. Epub 2012 Aug 22. Lolis MS1, Goldberg DJ.
Abstract

BACKGROUND:

Fine lines and rhytides are clinically evident signs of photodamage. Traditionally, ablative and nonablative lasers have been used for nonsurgical facial rejuvenation, but their side effects and downtime have limited their use.

OBJECTIVE:

Radiofrequency (RF) is novel nonablative technology originally used to target photodamage. It differs from lasers in that it uses an electric current rather than a light source. It is frequently used in dermatology to treat skin laxity, rhytides, acne vulgaris and scarring, and cellulite. The goal of this review is to summarize the various types of RF devices and their uses and to determine the evidence-based efficacy of these devices.

MATERIALS AND METHODS:

This article reviews the current literature on RF, its uses and clinical effectiveness, and a practical guide for application of the assorted RF devices.

RESULTS AND CONCLUSION:

Results have been favorable for the different clinical uses of RF, but many studies are nonrandomized, noncomparative trials that use subjective means of evaluation. Overall, nonablative RF is a safe, tolerable, and effective tool for skin rejuvenation and cellulite treatment that produces modest results. RF should serve as an alternative but not as an equivalent substitute to surgery.

High Tech Facials

The reliability and validity of color indicators using digital image analysis of peristomal skin photographs: results of a preliminary prospective clinical study.

Ostomy Wound Manage. 2014 Mar;60(3):12-29. Iizaka S1, Asada M1, Koyanagi H2, Sasaki S2, Naito A3, Konya C4, Sanada H1.

Abstract

Accurate assessment is necessary to evaluate peristomal skin condition, but objective methods are lacking. The purpose of this prospective, repeated-measures study was to evaluate the reliability and validity of color indicators using digital image analysis of peristomal skin photographs. The 6-month study was conducted among 21 patients (mean age 65.1 years old, 15 men) with ostomies (14 colostomies, six ileostomies, and one urostomy) at four outpatient clinics. Photographs taken by nurses of the peristomal area using point-and-shoot cameras were processed using digital image analysis, which involved color calibration, image processing, and indicator calculation. An erythema index (EI), melanin index (MI), and hypopigmentation index were created to represent increased degrees of red, black, and white color, respectively, and their average values in the peristomal region of an image were calculated relative to values for intact skin. Reproducibility was evaluated using the interclass correlation coefficient (ICC). ICCs of color indicators for intact skin were >0.7 between baseline and the end of follow-up for the 16 participants with two or more clinic visits. Differences in these indices between peristomal and intact regions were evaluated using a linear mixed model. The EI and MI of peristomal skin were significantly higher than those of intact skin (n=42, P<0.001). All color indicators in adjacent regions and areas where adhesive was applied were associated with the discoloration severity score and visual analogue pain score (all P<0.05). This objective and simple method had adequate reproducibility and criterion-related validity and may be useful for peristomal skin assessment. Further research is warranted.

Fraxel

Fractional resurfacing of facial actinic keratosis: A promising new therapeutic option
01/2013
– Journal of the American Academy of Dermatology

The Treatment of Melasma with Fractional Photothermolysis: A Pilot Study
12/2011
Cameron K. Rokhsar, MD,. and Richard E. Fitzpatrick, MD – Dermatologic Surgery

Abstract

BACKGROUND:

Melasma is a common pigmentary disorder that remains resistant to available therapies. Facial resurfacing with the pulsed CO2 laser has been reported successful but requires significant downtime, and there is a risk of adverse sequelae.

OBJECTIVE:

To determine if melasma will respond to a new treatment paradigm, fractional resurfacing.

METHODS:

Ten female patients (Fitzpatrick skin types III-V) who were unresponsive to previous treatment were treated at 1- to 2-week intervals with the Fraxel laser (Reliant Technologies, Palo Alto, CA, USA). Wavelengths of 1,535 and 1,550 nm were both used, and 6 to 12 mJ per microthermal zone with 2,000 to 3,500 mtz/cm2 were the treatment parameters. Four to six treatment sessions were performed. Responses were evaluated according to the percentage of lightening of original pigmentation. Two physicians evaluated the photographs, and each patient evaluated her own response.

RESULTS:

The physician evaluation was that 60% of patients achieved 75 to 100% clearing and 30% had less than 25% improvement. The patients’ evaluations agreed, except for one patient, who graded herself as 50 to 75% improved as opposed to the physician grading of over 75%. There was one patient with postinflammatory hyperpigmentation and no patient with hypopigmentation. No downtime was necessary for wound healing.

CONCLUSIONS:

Fractional resurfacing affords a new treatment algorithm for the treatment of melasma that combines decreased risk and downtime with significant efficacy. This treatment modality deserves further exploration to maximize benefits.
The Safety and Efficacy of Fractional Photothermolysis for the Correction of Striae Distencsae
12/2011
Mira Stotland MD, Anne M. Chapas MD, Lori Brightman MD, Sean Sukal MD, Elizabeth Hale MD, Julie Karen MD, Leonard Bernstein MD, Roy G. Geronemus MD –

Journal of Drugs in Dermatology

Fraxel Laser Treatment for Pigmentation; Texture Improvement
04/2009
Zakia Rahman, MD – Skin Therapy Letter

Utilizing Fractional Resurfacing in the Treatment of Therapy-Resistant Melasma
12/2005
Zeina Tannous, MD – Journal of Cosmetic and Laser Therapy

Combination Therapy of the Aging Hand Using Non-Ablative Fractional Resurfacing, Radiofrequency & Calcium Hydroxylapatite
05/2005
Vic A. Narurkar MD FAAD – Journal of Drugs in Dermatology

Rejuvenation of Aging Face using Fraxel Laser Treatment
03/2005
Lawrence Bass, MD – Aesthetic Surgery Journal

Rejuvenation of the aging face using Fraxel laser treatment,

Aesthetic Surgery Journal, Volume 25, Issue 3, May–June 2005, Pages 307-309,

Lawrence S. Bass,

 

Abstract: According to the author, Fraxel laser treatment produces the resurfacing effects of tissue removal, treats pigmentary changes, improves rhytids, and stimulates tissue remodeling. Compared with other classical approaches, it has the advantages of no recovery time, no open wound, few nonresponders, few complications, and the ability to be used in all skin types. Data confirm that improvement with this treatment is substantial but is not yet well defined quantitatively in comparison with laser resurfacing.

Update on Fractional Laser Technology

J Clin Aesthet Dermatol. 2010 Jan; 3(1): 42–50.

FT medical devices have been a revolution in the field of lasers. Many currently available FT devices work to improve photodamage, skin texture, and scars. Some are nonablative with minimal downtime and others are ablative with various degrees of downtime. Adverse events, such as PIH, may be kept to a minimum if proper pre- and post-skin care is given to the patients. Other adverse events, including scar formation, will be seen with more frequency unless proper training and education are given to those utilizing these machines.

Photofacial

Clin Cosmet Investig Dermatol. 2016; 9: 29–40. Published online 2016 Feb 4. doi:  10.2147/CCID.S69106 Zain Husain1 and Tina S Alster1,2

Abstract

The role of light-based technologies in dermatology has expanded dramatically in recent years. Lasers and intense pulsed light have been used to safely and effectively treat a diverse array of cutaneous conditions, including vascular and pigmented lesions, tattoos, scars, and undesired hair, while also providing extensive therapeutic options for cosmetic rejuvenation and other dermatologic conditions. Dermatologic laser procedures are becoming increasingly popular worldwide, and demand for them has fueled new innovations and clinical applications. These systems continue to evolve and provide enhanced therapeutic outcomes with improved safety profiles. This review highlights the important roles and varied clinical applications that lasers and intense pulsed light play in the dermatologic practice.

Cosmetic Injections (Botox and Dermal Fillers)

Indian J Dermatol. 2010 Jan-Mar; 55(1): 8–14. doi:  10.4103/0019-5154.60343  P K Nigam and Anjana Nigam1

Abstract

Botulinum toxin, one of the most poisonous biological substances known, is a neurotoxin produced by the bacterium Clostridium botulinum. C. botulinum elaborates eight antigenically distinguishable exotoxins (A, B, C1, C2, D, E, F and G). All serotypes interfere with neural transmission by blocking the release of acetylcholine, the principal neurotransmitter at the neuromuscular junction, causing muscle paralysis. The weakness induced by injection with botulinum toxin A usually lasts about three months. Botulinum toxins now play a very significant role in the management of a wide variety of medical conditions, especially strabismus and focal dystonias, hemifacial spasm, and various spastic movement disorders, headaches, hypersalivation, hyperhidrosis, and some chronic conditions that respond only partially to medical treatment. The list of possible new indications is rapidly expanding. The cosmetological applications include correction of lines, creases and wrinkling all over the face, chin, neck, and chest to dermatological applications such as hyperhidrosis. Injections with botulinum toxin are generally well tolerated and side effects are few. A precise knowledge and understanding of the functional anatomy of the mimetic muscles is absolutely necessary to correctly use botulinum toxins in clinical practice.

Hyaluronic acid fillers.

Monheit GD1, Coleman KM. Dermatol Ther. 2006 May-Jun;19(3):141-50.

Abstract

Although hyaluronic acids are a relatively new treatment for facial lines and wrinkles, they have provided numerous advances in the area of cosmetic surgery. This article discusses the inherent properties of hyaluronic acid fillers that make them ideal for treatment of facial lines. It encompasses a review of the current literature on U.S. Food and Drug Administration-approved hyaluronic acid fillers and the role that each of these fillers currently has in facial cosmetics. This article also discusses the potential pitfalls and adverse effects that can be associated with using hyaluronic acids for filling facial lines. Finally, it serves as an overview of current techniques for clinical assessment of patients as well as administration and treatment of facial lines and wrinkles.

Clear and Brilliant

Evaluating facial pores and skin texture after low-energy nonablative fractional 1440-nm laser treatments.

J Am Acad Dermatol. 2013 Jan;68(1):113-8. doi: 10.1016/j.jaad.2012.08.041. Epub 2012 Oct 23. Saedi N1, Petrell K, Arndt K, Dover J.

Abstract

OBJECTIVE:

We sought to investigate the use of this device to treat facial pores and to improve skin texture.

CONCLUSIONS:

A series of treatments with the nonablative low-energy fractional 1440-nm laser appears to be safe and effective for reducing detectable pores and improving overall skin appearance.

Laser Hair Removal

Laser hair removal: a review.

Dermatol Surg. 2013 Jun;39(6):823-38. doi: 10.1111/dsu.12116. Epub 2013 Jan 17. Gan SD1, Graber EM.

RESULTS:

The literature supports the use of the alexandrite, diode, Nd:YAG and IPL devices for long-term hair removal. Because of its longer wavelength, the Nd:YAG is the best laser system to use for pigmented skin. Further research is needed regarding the safety and efficacy of home-use devices.

CONCLUSION:

Current in-office laser hair removal devices effectively provide a durable solution for unwanted hair removal.

Evidence-based review of hair removal using lasers and light sources.

J Eur Acad Dermatol Venereol. 2006 Jan;20(1):9-20. Haedersdal M1, Wulf HC.

RESULTS:

A total of 9 randomized controlled (RCTs) and 21 controlled trials (CTs) were identified. The best available evidence was found for the alexandrite (three RCTs, eight CTs) and diode (three RCTs, four CTs) lasers, followed by the ruby (two RCTs, six CTs) and Nd:YAG (two RCTs, four CTs) lasers, whereas limited evidence was available for IPL sources (one RCT, one CT). Based on the present best available evidence we conclude that (i) epilation with lasers and light sources induces a partial short-term hair reduction up to 6 months postoperatively, (ii) efficacy is improved when repeated treatments are given, (iii) efficacy is superior to conventional treatments (shaving, wax epilation, electrolysis), (iv) evidence exists for a partial long-term hair removal efficacy beyond 6 months postoperatively after repetitive treatments with alexandrite and diode lasers and probably after treatment with ruby and Nd:YAG lasers, whereas evidence is lacking for long-term hair removal after IPL treatment, (v) today there is no evidence for a complete and persistent hair removal efficacy, (vi) the occurrence of postoperative side-effects is reported low for all the laser systems.

CONCLUSION:

The evidence from controlled clinical trials favours the use of lasers and light sources for removal of unwanted hair. We recommend that patients are pre-operatively informed of the expected treatment outcome.

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