Faculty Bibliography

Combining laser treatments with cosmetic injectables can offer synergistic benefit, increased convenience for both patients and physicians, and lessened overall patient downtime. Although paired treatments can be effective, there remain theoretical concerns that this may add new risks. Theoretical risks of combining laser treatment with neurotoxin injections include unintentional spread of the neurotoxin, which may result in eyelid ptosis and muscle weakness. Potential risks with soft-tissue fillers include unexpected loss of filler volume, necrosis, burn, and product migration. This retrospective chart review of single-session, same-day facial treatments using a low-energy, low-density 1927 nm fractional thulium fiber laser and cosmetic injectables found no adverse events related to this combination approach. This is important safety information that can offer reassurance to physicians using this clinical approach.

Pairing energy-based treatments, including radiofrequency microneedling, with either injectable neuromodulators or soft-tissue fillers can be an effective therapy for facial rejuvenation. However, there remains concerns by some physicians that this combination may add new risks for adverse events. Theoretical risks of combining energy-based treatment with neuromodulator injections include unintentional spread, which may result in eyelid ptosis and asymmetry. Potential risks with soft-tissue fillers include unexpected loss of filler volume, necrosis, burn, and product migration. In order to shed more light on this topic, we performed a retrospective chart review of single-session facial treatments with radiofrequency microneedling and cosmetic injectables over a 4.5 year period. We found no documented adverse events recorded related to combination treatment. This is important information that adds to the patient safety literature.

This commentary examines the growing popularity of cosmetic procedures in men. With the recent increase in aesthetic procedures across the nation, it is important for physicians to understand trends as they evolve, which can help to optimize clinical training, business operations, and practice management. Although the popularity of cosmetic procedures in men has increased, available data on consumer behavior is limited. Our data fills this gap by examining the patterns of cosmetic procedures in men. Due to hormonal and anatomic differences, the pathophysiology of cutaneous aging differs between sexes, which can have significant implications for treatment. Our data demonstrates a positive trend in recent years and also breaks it down by individual procedures.

Importance/UNASSIGNED:Sturge-Weber syndrome (SWS) is a neurocutaneous syndrome involving the skin, brain, and eyes. Consensus recommendations for management are lacking. Objective/UNASSIGNED:To consolidate the current literature with expert opinion to make recommendations that will guide treatment and referral for patients with port-wine birthmarks (PWBs). Evidence Review/UNASSIGNED:In this consensus statement, 12 nationally peer-recognized experts in dermatology with experience treating patients with SWS were assembled. Key topics and questions were formulated for each group and included risk stratification, optimum treatment strategies, and recommendations regarding light-based therapies. A systematic PubMed search was performed of English-language articles published between December 1, 2008, and December 1, 2018, as well as other pertinent studies identified by the expert panel. Clinical practice guidelines were recommended. Findings/UNASSIGNED:Treatment of PWBs is indicated to minimize the psychosocial impact and diminish nodularity and potentially tissue hypertrophy. Better outcomes may be attained if treatments are started at an earlier age. In the US, pulsed dye laser is the standard for all PWBs regardless of the lesion size, location, or color. When performed by experienced physicians, laser treatment can be safe for patients of all ages. The choice of using general anesthesia in young patients is a complex decision that must be considered on a case-by-case basis. Conclusions and Relevance/UNASSIGNED:These recommendations are intended to help guide clinical practice and decision-making for patients with SWS and those with isolated PWBs and may improve patient outcomes.

BACKGROUND:Melasma can be associated with immense psychosocial stress, which can impact quality of life. One theory suggests that ultraviolet light can increase plasmin activity in keratinocytes, which has led to the investigation of tranexamic acid for treating melasma, since it possesses anti-plasmin properties. The use of laser-assisted drug delivery can also increase the uptake of topical medications. AIMS/OBJECTIVE:A prospective pilot study was performed to assess the utility of combination treatment with low-energy, low-density 1927 nm fractional thulium fiber laser and topical tranexamic acid for melasma. PATIENTS/METHODS/METHODS:A total of 10 subjects were enrolled. Each received 5 treatments to the full face with a low-energy, low-density 1927 nm fractional thulium fiber laser. Immediately following treatment, topical tranexamic acid was applied, and subjects were instructed to apply it twice daily for 7 days. Clinical measures, quality of life, and patient satisfaction were assessed. RESULTS:Mean improvements in Melasma Area and Severity Index (MASI) scores were 1.1 (P = .0899), 3.5 (P = .0395), and 2.5 (P = .2429) at 30-, 90-, and 180-day follow-up, respectively. Maximum improvement occurred at 90-day follow-up. The mean improvement of Melasma Quality of Life Scale (MELASQOL) score was 9.6 (P = .0024) at 30-day follow-up. In addition to changes in pigmentation, subjects also believed their skin felt better, looked more radiant, and had improvements in skin texture and tone. CONCLUSION/CONCLUSIONS:Combination of low-energy, low-density 1927 nm fractional thulium fiber laser and topical tranexamic acid improved clinical outcomes and quality of life associated with melasma. This combination treatment was safe, well-tolerated, and well-liked by subjects.

BACKGROUND:Spread of botulinum toxin outside the treated muscle is a concern, when energy-based device treatment is performed on the same day as toxin injection. OBJECTIVE:We assessed the frequency of eyelid ptosis after the glabella/periorbital botulinum toxin injection and nonablative fractionated laser performed at the same session. METHODS AND MATERIALS/METHODS:This single-center, retrospective study identified treatments consisting of glabella and/or periorbital botulinum toxin injection and nonablative fractionated laser treatment to full face from 2017 to 2019 and eyelid ptosis determined by documentation of the complication at a follow-up encounter, or prescription of apraclonidine. RESULTS:Six hundred sixteen treatments of glabella/periorbital botulinum toxin injection and full-face nonablative fractionated laser on the same day on 393 individuals were identified. Five hundred eighty treatments (94%) included botulinum toxin injected in the glabella, 541 (88%) in the periorbital areas, and 508 (82%) in the forehead. Nonablative fractionated lasers used to treat the cohort were a 1,927-nm thulium and a 1,550-nm er:glass laser. Eyelid ptosis complication was documented in one case (0.2%) following the combined laser and toxin treatment. CONCLUSION/CONCLUSIONS:The risk of spread of glabella/periorbital botulinum toxin to an unintended muscle was minimal in the setting of the concomitant full-face nonablative fractionated laser.

BACKGROUND AND OBJECTIVES/OBJECTIVE:Melasma may be related to aberrant blood vessels, but there has been no report on the utility of dynamic optical coherence tomography (D-OCT) in studying vessel characteristics in melasma. We studied the characteristics of cutaneous blood vessels in melasma and the effects of oral tranexamic acid (TXA) with D-OCT. STUDY DESIGN/MATERIALS AND METHODS/METHODS:Six patients with moderate to severe melasma had a D-OCT scanning of the areas on the face affected by melasma and not affected by it. Three of them had scans within 3 months after starting oral TXA and at a follow-up visit. Blood flow at different depths of the skin and vessel diameter were compared between the melasma and normal skin. For those taking oral TXA, we compared the percent change of blood flow and diameter between the melasma and normal skin. RESULTS:Dermal blood flow and vessel diameter were greater in the melasma skin than in the normal skin. Oral TXA reduced dermal blood flow in both the melasma and normal skin, but the reduction was more dramatic in the lesional melasma skin. CONCLUSIONS:D-OCT findings that (i) dermal blood vessels in melasma are increased in size and flow and (ii) oral TXA reduced the vessel size and flow, providing evidence supporting the relationship between melasma and cutaneous blood vessels. D-OCT may be utilized in measuring response to treatments targeting melasma. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.