Faculty Bibliography

The development of lasers using deeper-penetrating, near-infrared wavelengths with millisecond pulse durations and skin-cooling methods has produced safer and more predictable results for the treatment of leg veins less than 1 mm in diameter and depth. Recent prospective studies of the near-infrared lasers show comparable efficacy and side effect profiles to those observed with sclerotherapy. Treatment of reticular and varicose veins is effective with these wavelengths but is limited by patient discomfort when compared with sclerotherapy. Visible light lasers (such as the pulsed dye and KTP) and intense pulsed-light sources are reproducibly effective only for superficial, nonarborizing pink-to-red telangiectasia, in the absence of points of proximal reflux. Because most lower-extremity vascular ectasias comprise a heterogeneous group of vessel sizes and depths, many patients achieve the best results using a combination of techniques. This article reviews the fundamentals of laser tissue interactions for the treatment of leg veins and details the recent clinical experience with the newer near-infrared devices

BACKGROUND: Lasers and light-based therapy have been used to treat port-wine stains and hemangiomas for the past two decades. METHODS AND RESULTS: Laser treatment produces dramatic clearing of port-wine stains with minimal scarring or epidermal damage, minimizes hypertrophy of lesions, decreases the risk of bleeding from pyogenic granlomas, and reduces the associated psychosocial morbidity. Lasers are used to halt the proliferation of the superficial component of hemangiomas, reduce the mass of the lesions, and to treat the vascular ectasia as well as the atrophic scarring that develops following involution. CONCLUSION: Laser therapy provides a safe and effective modality with low morbidity for cutaneous vascular anomalies

BACKGROUND: Millisecond-pulsed Nd:YAG lasers have been developed for the treatment of reticular leg veins. OBJECTIVE: We evaluated the effectiveness of a single treatment with a 50 millisecond 1064 nm Nd:YAG laser in the treatment of reticular veins of the lower extremity. METHODS: Twenty patients with reticular veins measuring 1.0 to 3.0 mm in diameter received one treatment with a 1064 nm Nd:YAG laser (Coolglide, Altus, Burlingame, Calif) at fluences of 100 J/cm(2) and 50 millisecond pulse duration. Symmetric matched areas that were left untreated served as the control. Eleven patients were pretreated with a topical anesthetic cream for 1 hour before treatment and wore compression stockings for 5 days after treatment. Nine patients were treated without topical anesthesia and did not wear compression stockings. Percent clearing and side effects were determined by 3 nontreating physicians (at each respective site) comparing projected Kodachrome images 1 month and 3 months after treatment. Patients also performed a self-assessment of their results. RESULTS: Two-thirds of vessels measuring 1 to 3 mm in diameter cleared more than 75% with one treatment. Larger vessels appeared to improve more than smaller vessels. Immediate treatment discomfort was tolerable. Side effects were minimal and included superficial thrombosis, delayed bruising, hyperpigmentation, and matting. CONCLUSION: Millisecond-pulsed Nd:YAG lasers used with 50 millisecond pulses are effective in the treatment of reticular leg veins

BACKGROUND: The treatment of inverse psoriasis can be both challenging and frustrating. Conventional topical and systemic treatments can be limited in terms of efficacy, acceptability and safety. The 308 nm excimer laser has been shown to be effective in the treatment of psoriatic plaques. METHODS: A patient with chronic inverse psoriasis was treated with 308 nm excimer laser using a 3.5 cm spot, a dosage of 2 minimal erythema doses and a pulse width of 30 ns. RESULTS: Complete clearance of the psoriatic lesions was obtained after 3 weeks of treatment. Remission duration was at least 6 months. CONCLUSION: The 308 nm excimer laser is safe and effective for the treatment of inverse psoriasis. Treatments are well tolerated with minimal side effects

BACKGROUND: Nonanimal hyaluronic acid gel was recently developed for soft tissue augmentation and volume expansion and has been shown to offer several advantages in comparison to other augmentation materials. There are rare reports of adverse events believed to be secondary to trace amounts of proteins in the hyaluronic acid raw material. OBJECTIVE: To determine the safety profile of nonanimal stabilized hyaluronic acid gel (Restylane, Perlane, Restylane Fine Lines, Q-Med AB, Uppsala, Sweden) for soft tissue augmentation using a retrospective review of all adverse events data from Europe, Canada, Australia, South American, and Asia from 1999 and 2000. RESULTS: Data from an estimated 144,000 patients treated in 1999 indicated the major reaction to injectable hyaluronic acid was localized hypersensitivity reactions, occurring in approximately 1 of every 1400 patients treated. In 1999 there was an adverse event reported for 1 of every 650 patients (0.15%) treated. These were temporary events that included redness, swelling, localized granulomatous reactions, bacterial infection, as well as acneiform and cystic lesions. For 2000 there was an estimated 262,000 patients treated with hyaluronic acid gel. The total number of adverse events was 144, corresponding to one adverse event for every 1800 patients (0.06%) treated. The major adverse event was again hypersensitivity, occurring in 1 of every 5000 patients treated. CONCLUSION: According to the reported worldwide adverse events data, hypersensitivity to nonanimal hyaluronic acid gel is the major adverse event and is most likely secondary to impurities of bacterial fermentation. According to data from 2000, the incidence of hypersensitivity appears to be declining after the introduction of a more purified hyaluronic acid raw material

BACKGROUND: A new method for treating facial rhytides and acne scars with nonablative laser and light source techniques has recently been introduced. Given the inherent limitations of photographic and clinical evaluation to assess subtle changes in rhytides and surface topography, a new noninvasive objective assessment is required to accurately assess the outcomes of these procedures. OBJECTIVE: The purpose of this study was to measure and objectively quantify facial skin using a novel, noninvasive, In-vivo method for assessing three-dimensional topography. This device was used to quantify the efficacy of five treatment sessions with the 1064 nm QS Nd:YAG laser for rhytides and acne scarring, for up to six months following laser treatment. METHODS: Two subjects undergoing facial rejuvenation procedures were analyzed before and after therapy using a 30-mm, three-dimensional microtopography imaging system (PRIMOS, GFM, Teltow, Germany). The imaging system projects light on to a specific surface of the skin using a Digital Micromirror Device (DMD Texas Instruments, Irving, TX) and records the image with a CCD camera. Skin Surface microtopography is reconstructed using temporal phase shift algorithms to generate three-dimensional images. Measurements were taken at baseline, at various times during the treatment protocol, and then at three and six-month follow-up visits. Silicone skin replicas (FLEXICO, Herts, England) were also made before and after the laser treatment protocol for comparison to In-vivo acquisition. RESULTS: Skin roughness decreased by 11% from baseline after three treatment sessions in the wrinkles subject, while a 26% improvement of skin roughness was recorded by 3D In-vivo assessment six months following the fifth treatment session. The subject with acne scarring demonstrated a 33% decrease in roughness analysis after three treatment sessions by 3D In-vivo assessment. A 61% improvement in surface topography was recorded 3-months following the fifth treatment session, which was maintained at the 6-month follow-up. CONCLUSION: Three-dimensional In-vivo optical skin imaging provided a rapid and quantitative assessment of surface topography and facial fine lines following multiple treatment sessions with a 1064-nm QS Nd:YAG laser, correlating with clinical and subjective responses. This imaging technique provided objective verification and technical understanding of nonablative laser technology. Wrinkle depth and skin roughness decreased at the three and six-month follow-up evaluations by 3D In-vivo assessment, indicating ongoing dermal collagen remodeling after the laser treatment protocol. Future applications may include comparison of nonablative laser technology, optimization of treatment regimens, and objective evaluation of other aesthetic procedures performed by dermatologists

Background and Objective Pulsed KTP lasers effectively treat facial telangiectasia without purpura production. Transient side effects following treatment include erythema, edema, and vesiculation leading to crust formation. The aim of this study was to investigate the utility of an aqueous gel in reducing side effects associated with pulsed KTP laser treatment of facial telangiectasia. Study Design/Materials and Methods Nineteen patients with extensive facial telangiectasias were treated with a pulsed KTP laser (Versapulse, Coherent, Palo Alto, CA). The laser was used with the water cooled handpiece chilled to 4C, a 4 mm spot size, a 10-millisecond pulse duration and a fluence of 9.5 J/cm(2). One side of the face was treated with the laser using the cooling handpiece alone. The other side was treated using the cooling handpiece applied to a 2-mm film of aqueous gel spread over the treatment area. RESULTS: Treatment side effects, including pain, erythema, edema, vesiculation, and crusting were scored following treatment with and without the aqueous gel. Use of the aqueous gel in conjunction with the cooling handpiece decreased the incidence and severity of pain, erythema, edema, and crusting following pulsed KTP laser treatment of facial telangiectasia. Most patients demonstrated 50--75% clearance of their telangiectasias 1 month after one treatment session, and use of the gel did not alter the treatment efficacy. CONCLUSIONS: The application of an aqueous gel during pulsed KTP laser treatment of facial telangiectasia improves treatment associated side effects without affecting vessel clearance