Study Shows Long-Lasting Results with Alexandrite Laser Hair Removal
A study conducted by a group of investigators affiliated with Plataforma Laser in Barcelona, Spain, and in Innsbruck, Austria, offered more than 8 years of data to demonstrate long-term efficacy of laser hair removal with the Alexandrite device.
Study Method
A total of 1,000 treatment areas were evaluated in 668 patients between the ages of 12 and 75 years with Fitzpatrick skin type I to V, mainly females in their mid-30s with Fitzpatrick skin type II and III.
Laser Parameters
The Alexandrite laser parameters included pulse durations between 3 ms and 40 ms and fluences between 16 J/cm2 and 25 J/cm2, with an average of 18 J/cm2 to 23 J/cm2 at a pulse duration of 20 ms. Spot size was between 7 mm and 15 mm. Cooling devices included gel and ice packs in the earlier years and cryogen spray cooling when it became available.
Number of Treatments
The average number of treatments to achieve satisfactory results were as follows: 4.3 treatments for bikini area; 3.3 for axillae; 4.7 for legs, and 3.2 for backs.
Post-Treatment Period
The evaluation period after the first treatment was up to 8.7 years at an average of 4.6 years, and after the last treatment was 8.5 years at an average of 3.4 years.
Results
Patients were asked whether hair reduction was stable at an average of 3.4 years after treatment — 89% said yes, 10% said no, and 1% didn’t know.
Broken down by site, long-term hair removal results were best on the axillae, with 95% of study participants reporting stable hair reduction. Hair reduction rates in the long term were worst on faces (82%) and better for the bikini area (93%) and legs (92%).
Conclusion
Based on follow-up of 8.5 years, the investigators concluded that Alexandrite lasers are effective and safe for achieving long-lasting hair reduction or even permanent hair removal.
Gabriel Buendia, Eva Ciscar, Katharina Russe-Wilflingseder. Hair Removal with 755-nm Lasers: Long-term Results of 8.5 Years. Presented at the Cutaneous Laser Surgery session at ASLMS.
Retrospective Chart Review Examines Causes and Management of Hair Growth Stimulation Following Photo Epilation
Examining possible causes and management of the problem of hair growth stimulation following photo epilation treatments was the focus of a retrospective chart review performed on patients treated in a single practice in Vasquez, Spain, from 1998 to 2003.
Study Method
Patients
A total of 543 female patients age 16 to 52 years who received treatments on the “beard” area, neck, and chin were included in the study. While the predominant skin type were those with Fitzpatrick skin type III, a significant number of patients with skin type II and IV were also treated.
Treatments Equipment, Intervals and Parameters
Treatments were performed at approximately 8-week intervals, and at the time of the review, the total number of the treatments received ranged between 3 and 23. Most treatments were performed with an alexandrite laser, although a smaller number of treatments were also performed with an IPL device and Nd:YAG.
Standard parameters were used for each device, which included a short pulse duration for the alexandrite laser and longer pulse durations for the IPL and the Nd:YAG.
Evaluation Criteria
Before-and-after images were compared, and treatment results were evaluated against the following four categories: complete hair reduction, reduced hair reduction, unchanged hair reduction, or increased hair growth.
Patient medical histories were also reviewed for the presence of known hormonal abnormalities.
Observations
Results of image comparisons showed a total of 57 patients with increased hair growth, which represented 10.5% of the patients treated. No change in hair growth was reported in 44 patient, 424 had reduced hair growth, and 14 patients had complete hair reduction. At the time of review, four patients were not included because of incomplete information.
Hair growth occurred in all age groups and in all skin types. This growth was predominantly in the beard area, and it occurred within and at the periphery of treated areas.
In all patients with hair growth, prominent vellus hair had been present within the area and surrounding it prior to treatment. The onset of hair growth varied between the third and 11th treatment, although in many cases it occurred in the range of three to six treatments. In addition, 16 of the 57 (roughly 25%) patients with increased hair growth had polycystic ovary syndrome or irregular menses. With regard to skin type, hair growth was proportional to the number of patients within each skin type treated.
Possible Explanations
The author noted that several different mechanisms may explain the regrowth. That hair growth occurs around the periphery of the area treated, she said, suggested that sub-therapeutic injury to the components of the follicle that are vital for cycling may result in induction of hair growth rather than miniaturization or destruction of the follicle. And it follows, she added, that vellus follicles with a smaller amount of chromofore may be more susceptible to such partial injury.
Management/Prevention of the Problem
Based on this theory, suggested prevention approaches included applying ice packs to the skin surrounding the treated area to minimize the diffusion of heat just surrounding the vellus follicle, and avoiding the treatment of patients with vellus hair. In addition, higher fluences with a double-pass technique were used.
Conclusions
The author concluded that hair stimulation following photo epilation may be more common than previously described, and is not limited to darker skin types. It may be prevented by cooling the surrounding area during treatment and using maximal tolerated fluences with a double-pass technique.
Andrea Willey. Hair Growth Stimulation Following Auto Photo Epilation — Review of 543 Cases and Successful Management. Presented at the Cutaneous Laser Surgery session at this year’s ASLMS meeting.
Compression Handpiece Said to be Key to Avoiding Post-Treatment Pulsed Dye Laser Purpura
Using a 10-mm spot size and a compression handpiece, a pulsed dye laser (PDL) can effectively be used to treat both vascular and pigmented lesions without post-treatment purpura.
Background
Widely considered one of the most effective modalities for the treatment of vascular lesions, facial erythema, and telan-giectasia, the 595-nm pulsed dye laser has been plagued by post-treatment purpura.
Study Objectives
A study was designed to evaluate a new pulsed dye laser with a micro-pulse structure for single-pass treatment of telangiectasia and to combine that with an assessment of improvement of pigmented dyschromia using a second pass with a compression handpiece. A third objective was to assess textural improvement.
Laser Description
As described by Ken Galeckas during the Cutaneous Laser Surgery session at ASLMS, the Candela PDL used enabled the necessary pulse stacking without exceeding the purpura threshold by “chopping up each macro pulse into eight sequential micro pulses.” The result, he explained, is “a higher fluence that you can deliver to the tissues in a gentle fashion that mitigates any purpura.”
The 595-nm wavelength, he said, is also well absorbed by melanin, but due to different relaxation times, the pulse widths that are necessary to achieve photolysis for melanin frequently result in purpura from pulsing any incidental telangiectasia. To overcome this, he explained, the Candela laser employs a compression handpiece that allows the operator to apply compression to a pigmented lesion, blanch out any associated erythema or telangiectasia, thus delivering pulse widths that are effective for melanin while sparing vascular obstructors.
Study Design
Investigators enrolled 20 patients with Fitzpatrick skin types I though III, who received three treatments, each spaced 3 to 4 weeks apart.
All patients tolerated treatment with the pigmented lesion window without anesthesia, but about 25% of patients requested a topical anesthesia during the first 10 to 20 pulses with the vascular handpiece and cryogen spray. If desired, a 4% lidocaine cream was applied approximately 45 minutes before proceeding.
During the first pass, a pigmented lesion window with a 10-mm beam diameter was applied with fluences of 6.5 J/cm2 to 8 J/cm2 and a 1.5-ms pulse width. The second pass was then delivered with a standard spot with a 10-mm diameter and fluences between 9.5 J/cm2 and 10 J/cm2, pulsing the entire area with 15% overlap and with cryogen spray cooling activated.
All patients received 10 minutes of strict post-procedure icing, and they were instructed to repeat ice applications every 2 hours for approximately 10 minutes, until bedtime.
One month after final treatment, polarized and non-polarized photographs were compared using loops and 10X magnification. Dyschromias were subdivided into the following categories: telangiectasia greater and less than 600 microns, dark lentigines, and light lentigines. Dyschromias were graded clear 0 to 100% at 5% intervals. Texture was evaluated using a standardized global improvement scale, and a grade of 0 to 5 was assigned.
Results
Dark lentigines and small telangiectasias each improved 85%, while light lentigines improved 63%, and larger telangiectasias improved 42%. Average textural improvement was 34%.
Half of patients reported mild to moderate subjective infra-orbital edema, which decreased with subsequent treatments, despite increased fluence.
Eight out of 60 treatments resulted in mild to moderate purpura, although all were considered to be the result of technical inexperience with the compression handpiece, and all resolved without sequelae.
Conclusion
The application of proper compression was found to be the key to virtual elimination of purpura. When the operator applied compression, visualized the blanching, and then fired the laser, the risk of purpura was virtually eliminated.
Kenneth Galeckas. A Pulsed Dye Laser with a 10-mm Beam Diameter for Purpura-Free Photorejuvenation. Presented at the Cutaneous Laser Surgery session at ASLMS.
Disclosure: Dr Galeckas received equipment from Candela.
Fractional Photothermolysis Found Effective for Surgical and Post-Traumatic Scars
At the Cutaneous Laser Surgery session at the ASLMS meeting, David Vasily, M.D., described a study that found fractional photothermolysis using the Lux 1540 to be an effective treatment for surgical and post-traumatic scars that eliminates many of the disadvantages of laser treatments.
Treatment Approaches
Issues associated with treatments for post-surgical and post-traumatic scars include efficacy and side effects with lasers. Pulsed dye laser (PDL) treatment for hypertrophic scars and keloids have proven inconsistent, primarily in hypopigmented scars or atrophic scars. Re-contouring of atrophic scars with the CO2 laser or with the short-pulsed erbium YAG laser can paradoxically result in hypertrophic scarring and hypopigmentation.
Potential mechanisms thought to improve scars based on the mode of action of the fractional laser and its lack of side effects include dermal, collagen, and elastic remodeling, photothermolysis of scars, micro-vasculature in the dermis, and normalization of pigment by the migration of normal melanocytes to the boundaries of thermally coagulated columns.
Study
The described pilot study on the treatment of scars involved 31 patients, Fitzpatrick skin types I through V, including 13 with surgical scars and 18 with post-traumatic scars.
Treatment Parameters
A 10-mm handpiece was used to treat all patients. Each patient received one to eight treatments 3 to 4 weeks apart, using 30 to 60 mJ/mb, at a 10-ms pulse width, and three to five passes, with a 50% overlap.
Assessment
Evaluation of results was based on sequential digital images, investigator quartile assessment of improvement, subject self-assessments, and blinded observer percent improvement grading 1 month following treatment completion.
Results
Investigator quartile assessments averaged good improvement in scars at the 1-month follow-up. Blinded observer improvement rating averaged 59%, which correlated closely to very positive subjective self-assessments at 57% improvement. Results were similar for surgical scars and trauma-related scars.
Both atrophic and hypertrophic scars were responsive, and there was resolution of scar hypo- and hyperpigmentation.
In general, the percent of improvement was a function of the age of the scar, with the most responsive scars being 6 months to 2 years old, and the least responsive older than 15 years; however, even older scars had up to 40% improvement. It also showed that the percent of improvement correlates with the number of treatments, with best results using three or more 1540 treatments.
Primary side effects were limited to transient erythema and edema post-treatment. There was one incidence of transient post-inflammatory hyperpigmentation on a patient with Fitzpatrick skin type V, who was treated for an old burn scar on her lower leg. Pain levels were low, averaging 4.2 on a 0 to 10 scale, making topical anesthetic unnecessary.
Conclusion
In conclusion, fractional photothermolysis using the Lux 1540 is an effective treatment for surgical and post-traumatic scars.
David Vasily, M.D. Treatment of Post-Surgical and Post-Traumatic Scars Using the Starlux 1540 Fractionated Handpiece. Presented at the Cutaneous Laser Surgery session at ASLMS.
Disclosures: Dr. Vasily received equipment, a discount and research grant from Palomar Medical and is a stockholder with the company.
Radiofrequency Technology Achieves Significant Improvement in Cellulite Appearance and Skin Tightening
Speaking at the Cutaneous Laser Surgery session at ASLMS, David McDaniel, M.D., discussed a study using radiofrequency technology in which there was an average improvement of one grade and a 45% increase in skin tightening and global improvement in treating cellulite.
Study Description
Findings were based on a clinical trial of 10 previously untreated patients ages 18 to 75 with grade 2 to grade 3 cellulite, described as a moderate number of visible dimples. Patients received six treatment sessions at 2-week intervals.
Patients were photographed using 3-D digital imaging at weeks 0, 2, 4, 6, 8, 10, and 12, and again 90 days after final treatment. In addition, circumference and weight were measured at each visit.
An expert grader assessed the photographs. In addition, both patients and grader were asked to assess global improvement and tightening on a quintile scale.
Treatment Protocol
The treatment area was divided by grids of approximately 5 x 7 inches.The handpiece was constantly in motion within a grid before engaging energy and throughout each 30-second treatment period. Initial energy range was 150 watts to 200 watts. The bipolar handpiece was used for superficial heating, and the unipolar handpiece for deep dermal thermotherapy.
Treatment was performed to reach a therapeutic temperature of 39°C to 41°C, followed by three passes of 30 seconds each to maintain temperature for a 90-second period.
Results
The results were reported as follows: Of the nine patients who completed the study, seven improved by one grade and two improved by two grades using the visual grading scale to assess the reduction or improvement in the appearance of the cellulite. Quantified changes included reduction of 1% in weight (although one patient showed a 13-pound reduction), and 2% in body mass index and girth, respectively. Skin tightening and global improvement were assessed to be 45%.
Comments by patients included mentions that their clothes fit less tightly over the smoother skin texture achieved.
Conclusion
The small study suggests that improvement in cellulite appearance can be achieved with unipolar radiofrequency treatment. Noting the difficulty of documenting cellulite improvement, Dr. McDaniel considered the 3-D imaging used in this study promising although scientific objective models are needed.
David H. McDaniel. The Effective Unipolar Radio Frequency Treatment on Cellulite and Skin Tightening. Presented at the Cutaneous Laser Surgery session at American Society for Laser Medicine and Surgery 2007.
Disclosure: Dr. McDaniel received a discount and a research grant from Alma Lasers, and technical assistance but no discount from Canfield Scientific for the 3-D images.
The procedure described represents an off-label use of the Accent Volumetric Rf ThermoTherapy device, which is not yet FDA approved.
Study Shows Long-Lasting Results with Alexandrite Laser Hair Removal
A study conducted by a group of investigators affiliated with Plataforma Laser in Barcelona, Spain, and in Innsbruck, Austria, offered more than 8 years of data to demonstrate long-term efficacy of laser hair removal with the Alexandrite device.
Study Method
A total of 1,000 treatment areas were evaluated in 668 patients between the ages of 12 and 75 years with Fitzpatrick skin type I to V, mainly females in their mid-30s with Fitzpatrick skin type II and III.
Laser Parameters
The Alexandrite laser parameters included pulse durations between 3 ms and 40 ms and fluences between 16 J/cm2 and 25 J/cm2, with an average of 18 J/cm2 to 23 J/cm2 at a pulse duration of 20 ms. Spot size was between 7 mm and 15 mm. Cooling devices included gel and ice packs in the earlier years and cryogen spray cooling when it became available.
Number of Treatments
The average number of treatments to achieve satisfactory results were as follows: 4.3 treatments for bikini area; 3.3 for axillae; 4.7 for legs, and 3.2 for backs.
Post-Treatment Period
The evaluation period after the first treatment was up to 8.7 years at an average of 4.6 years, and after the last treatment was 8.5 years at an average of 3.4 years.
Results
Patients were asked whether hair reduction was stable at an average of 3.4 years after treatment — 89% said yes, 10% said no, and 1% didn’t know.
Broken down by site, long-term hair removal results were best on the axillae, with 95% of study participants reporting stable hair reduction. Hair reduction rates in the long term were worst on faces (82%) and better for the bikini area (93%) and legs (92%).
Conclusion
Based on follow-up of 8.5 years, the investigators concluded that Alexandrite lasers are effective and safe for achieving long-lasting hair reduction or even permanent hair removal.
Gabriel Buendia, Eva Ciscar, Katharina Russe-Wilflingseder. Hair Removal with 755-nm Lasers: Long-term Results of 8.5 Years. Presented at the Cutaneous Laser Surgery session at ASLMS.
Retrospective Chart Review Examines Causes and Management of Hair Growth Stimulation Following Photo Epilation
Examining possible causes and management of the problem of hair growth stimulation following photo epilation treatments was the focus of a retrospective chart review performed on patients treated in a single practice in Vasquez, Spain, from 1998 to 2003.
Study Method
Patients
A total of 543 female patients age 16 to 52 years who received treatments on the “beard” area, neck, and chin were included in the study. While the predominant skin type were those with Fitzpatrick skin type III, a significant number of patients with skin type II and IV were also treated.
Treatments Equipment, Intervals and Parameters
Treatments were performed at approximately 8-week intervals, and at the time of the review, the total number of the treatments received ranged between 3 and 23. Most treatments were performed with an alexandrite laser, although a smaller number of treatments were also performed with an IPL device and Nd:YAG.
Standard parameters were used for each device, which included a short pulse duration for the alexandrite laser and longer pulse durations for the IPL and the Nd:YAG.
Evaluation Criteria
Before-and-after images were compared, and treatment results were evaluated against the following four categories: complete hair reduction, reduced hair reduction, unchanged hair reduction, or increased hair growth.
Patient medical histories were also reviewed for the presence of known hormonal abnormalities.
Observations
Results of image comparisons showed a total of 57 patients with increased hair growth, which represented 10.5% of the patients treated. No change in hair growth was reported in 44 patient, 424 had reduced hair growth, and 14 patients had complete hair reduction. At the time of review, four patients were not included because of incomplete information.
Hair growth occurred in all age groups and in all skin types. This growth was predominantly in the beard area, and it occurred within and at the periphery of treated areas.
In all patients with hair growth, prominent vellus hair had been present within the area and surrounding it prior to treatment. The onset of hair growth varied between the third and 11th treatment, although in many cases it occurred in the range of three to six treatments. In addition, 16 of the 57 (roughly 25%) patients with increased hair growth had polycystic ovary syndrome or irregular menses. With regard to skin type, hair growth was proportional to the number of patients within each skin type treated.
Possible Explanations
The author noted that several different mechanisms may explain the regrowth. That hair growth occurs around the periphery of the area treated, she said, suggested that sub-therapeutic injury to the components of the follicle that are vital for cycling may result in induction of hair growth rather than miniaturization or destruction of the follicle. And it follows, she added, that vellus follicles with a smaller amount of chromofore may be more susceptible to such partial injury.
Management/Prevention of the Problem
Based on this theory, suggested prevention approaches included applying ice packs to the skin surrounding the treated area to minimize the diffusion of heat just surrounding the vellus follicle, and avoiding the treatment of patients with vellus hair. In addition, higher fluences with a double-pass technique were used.
Conclusions
The author concluded that hair stimulation following photo epilation may be more common than previously described, and is not limited to darker skin types. It may be prevented by cooling the surrounding area during treatment and using maximal tolerated fluences with a double-pass technique.
Andrea Willey. Hair Growth Stimulation Following Auto Photo Epilation — Review of 543 Cases and Successful Management. Presented at the Cutaneous Laser Surgery session at this year’s ASLMS meeting.
Compression Handpiece Said to be Key to Avoiding Post-Treatment Pulsed Dye Laser Purpura
Using a 10-mm spot size and a compression handpiece, a pulsed dye laser (PDL) can effectively be used to treat both vascular and pigmented lesions without post-treatment purpura.
Background
Widely considered one of the most effective modalities for the treatment of vascular lesions, facial erythema, and telan-giectasia, the 595-nm pulsed dye laser has been plagued by post-treatment purpura.
Study Objectives
A study was designed to evaluate a new pulsed dye laser with a micro-pulse structure for single-pass treatment of telangiectasia and to combine that with an assessment of improvement of pigmented dyschromia using a second pass with a compression handpiece. A third objective was to assess textural improvement.
Laser Description
As described by Ken Galeckas during the Cutaneous Laser Surgery session at ASLMS, the Candela PDL used enabled the necessary pulse stacking without exceeding the purpura threshold by “chopping up each macro pulse into eight sequential micro pulses.” The result, he explained, is “a higher fluence that you can deliver to the tissues in a gentle fashion that mitigates any purpura.”
The 595-nm wavelength, he said, is also well absorbed by melanin, but due to different relaxation times, the pulse widths that are necessary to achieve photolysis for melanin frequently result in purpura from pulsing any incidental telangiectasia. To overcome this, he explained, the Candela laser employs a compression handpiece that allows the operator to apply compression to a pigmented lesion, blanch out any associated erythema or telangiectasia, thus delivering pulse widths that are effective for melanin while sparing vascular obstructors.
Study Design
Investigators enrolled 20 patients with Fitzpatrick skin types I though III, who received three treatments, each spaced 3 to 4 weeks apart.
All patients tolerated treatment with the pigmented lesion window without anesthesia, but about 25% of patients requested a topical anesthesia during the first 10 to 20 pulses with the vascular handpiece and cryogen spray. If desired, a 4% lidocaine cream was applied approximately 45 minutes before proceeding.
During the first pass, a pigmented lesion window with a 10-mm beam diameter was applied with fluences of 6.5 J/cm2 to 8 J/cm2 and a 1.5-ms pulse width. The second pass was then delivered with a standard spot with a 10-mm diameter and fluences between 9.5 J/cm2 and 10 J/cm2, pulsing the entire area with 15% overlap and with cryogen spray cooling activated.
All patients received 10 minutes of strict post-procedure icing, and they were instructed to repeat ice applications every 2 hours for approximately 10 minutes, until bedtime.
One month after final treatment, polarized and non-polarized photographs were compared using loops and 10X magnification. Dyschromias were subdivided into the following categories: telangiectasia greater and less than 600 microns, dark lentigines, and light lentigines. Dyschromias were graded clear 0 to 100% at 5% intervals. Texture was evaluated using a standardized global improvement scale, and a grade of 0 to 5 was assigned.
Results
Dark lentigines and small telangiectasias each improved 85%, while light lentigines improved 63%, and larger telangiectasias improved 42%. Average textural improvement was 34%.
Half of patients reported mild to moderate subjective infra-orbital edema, which decreased with subsequent treatments, despite increased fluence.
Eight out of 60 treatments resulted in mild to moderate purpura, although all were considered to be the result of technical inexperience with the compression handpiece, and all resolved without sequelae.
Conclusion
The application of proper compression was found to be the key to virtual elimination of purpura. When the operator applied compression, visualized the blanching, and then fired the laser, the risk of purpura was virtually eliminated.
Kenneth Galeckas. A Pulsed Dye Laser with a 10-mm Beam Diameter for Purpura-Free Photorejuvenation. Presented at the Cutaneous Laser Surgery session at ASLMS.
Disclosure: Dr Galeckas received equipment from Candela.
Fractional Photothermolysis Found Effective for Surgical and Post-Traumatic Scars
At the Cutaneous Laser Surgery session at the ASLMS meeting, David Vasily, M.D., described a study that found fractional photothermolysis using the Lux 1540 to be an effective treatment for surgical and post-traumatic scars that eliminates many of the disadvantages of laser treatments.
Treatment Approaches
Issues associated with treatments for post-surgical and post-traumatic scars include efficacy and side effects with lasers. Pulsed dye laser (PDL) treatment for hypertrophic scars and keloids have proven inconsistent, primarily in hypopigmented scars or atrophic scars. Re-contouring of atrophic scars with the CO2 laser or with the short-pulsed erbium YAG laser can paradoxically result in hypertrophic scarring and hypopigmentation.
Potential mechanisms thought to improve scars based on the mode of action of the fractional laser and its lack of side effects include dermal, collagen, and elastic remodeling, photothermolysis of scars, micro-vasculature in the dermis, and normalization of pigment by the migration of normal melanocytes to the boundaries of thermally coagulated columns.
Study
The described pilot study on the treatment of scars involved 31 patients, Fitzpatrick skin types I through V, including 13 with surgical scars and 18 with post-traumatic scars.
Treatment Parameters
A 10-mm handpiece was used to treat all patients. Each patient received one to eight treatments 3 to 4 weeks apart, using 30 to 60 mJ/mb, at a 10-ms pulse width, and three to five passes, with a 50% overlap.
Assessment
Evaluation of results was based on sequential digital images, investigator quartile assessment of improvement, subject self-assessments, and blinded observer percent improvement grading 1 month following treatment completion.
Results
Investigator quartile assessments averaged good improvement in scars at the 1-month follow-up. Blinded observer improvement rating averaged 59%, which correlated closely to very positive subjective self-assessments at 57% improvement. Results were similar for surgical scars and trauma-related scars.
Both atrophic and hypertrophic scars were responsive, and there was resolution of scar hypo- and hyperpigmentation.
In general, the percent of improvement was a function of the age of the scar, with the most responsive scars being 6 months to 2 years old, and the least responsive older than 15 years; however, even older scars had up to 40% improvement. It also showed that the percent of improvement correlates with the number of treatments, with best results using three or more 1540 treatments.
Primary side effects were limited to transient erythema and edema post-treatment. There was one incidence of transient post-inflammatory hyperpigmentation on a patient with Fitzpatrick skin type V, who was treated for an old burn scar on her lower leg. Pain levels were low, averaging 4.2 on a 0 to 10 scale, making topical anesthetic unnecessary.
Conclusion
In conclusion, fractional photothermolysis using the Lux 1540 is an effective treatment for surgical and post-traumatic scars.
David Vasily, M.D. Treatment of Post-Surgical and Post-Traumatic Scars Using the Starlux 1540 Fractionated Handpiece. Presented at the Cutaneous Laser Surgery session at ASLMS.
Disclosures: Dr. Vasily received equipment, a discount and research grant from Palomar Medical and is a stockholder with the company.
Radiofrequency Technology Achieves Significant Improvement in Cellulite Appearance and Skin Tightening
Speaking at the Cutaneous Laser Surgery session at ASLMS, David McDaniel, M.D., discussed a study using radiofrequency technology in which there was an average improvement of one grade and a 45% increase in skin tightening and global improvement in treating cellulite.
Study Description
Findings were based on a clinical trial of 10 previously untreated patients ages 18 to 75 with grade 2 to grade 3 cellulite, described as a moderate number of visible dimples. Patients received six treatment sessions at 2-week intervals.
Patients were photographed using 3-D digital imaging at weeks 0, 2, 4, 6, 8, 10, and 12, and again 90 days after final treatment. In addition, circumference and weight were measured at each visit.
An expert grader assessed the photographs. In addition, both patients and grader were asked to assess global improvement and tightening on a quintile scale.
Treatment Protocol
The treatment area was divided by grids of approximately 5 x 7 inches.The handpiece was constantly in motion within a grid before engaging energy and throughout each 30-second treatment period. Initial energy range was 150 watts to 200 watts. The bipolar handpiece was used for superficial heating, and the unipolar handpiece for deep dermal thermotherapy.
Treatment was performed to reach a therapeutic temperature of 39°C to 41°C, followed by three passes of 30 seconds each to maintain temperature for a 90-second period.
Results
The results were reported as follows: Of the nine patients who completed the study, seven improved by one grade and two improved by two grades using the visual grading scale to assess the reduction or improvement in the appearance of the cellulite. Quantified changes included reduction of 1% in weight (although one patient showed a 13-pound reduction), and 2% in body mass index and girth, respectively. Skin tightening and global improvement were assessed to be 45%.
Comments by patients included mentions that their clothes fit less tightly over the smoother skin texture achieved.
Conclusion
The small study suggests that improvement in cellulite appearance can be achieved with unipolar radiofrequency treatment. Noting the difficulty of documenting cellulite improvement, Dr. McDaniel considered the 3-D imaging used in this study promising although scientific objective models are needed.
David H. McDaniel. The Effective Unipolar Radio Frequency Treatment on Cellulite and Skin Tightening. Presented at the Cutaneous Laser Surgery session at American Society for Laser Medicine and Surgery 2007.
Disclosure: Dr. McDaniel received a discount and a research grant from Alma Lasers, and technical assistance but no discount from Canfield Scientific for the 3-D images.
The procedure described represents an off-label use of the Accent Volumetric Rf ThermoTherapy device, which is not yet FDA approved.
Study Shows Long-Lasting Results with Alexandrite Laser Hair Removal
A study conducted by a group of investigators affiliated with Plataforma Laser in Barcelona, Spain, and in Innsbruck, Austria, offered more than 8 years of data to demonstrate long-term efficacy of laser hair removal with the Alexandrite device.
Study Method
A total of 1,000 treatment areas were evaluated in 668 patients between the ages of 12 and 75 years with Fitzpatrick skin type I to V, mainly females in their mid-30s with Fitzpatrick skin type II and III.
Laser Parameters
The Alexandrite laser parameters included pulse durations between 3 ms and 40 ms and fluences between 16 J/cm2 and 25 J/cm2, with an average of 18 J/cm2 to 23 J/cm2 at a pulse duration of 20 ms. Spot size was between 7 mm and 15 mm. Cooling devices included gel and ice packs in the earlier years and cryogen spray cooling when it became available.
Number of Treatments
The average number of treatments to achieve satisfactory results were as follows: 4.3 treatments for bikini area; 3.3 for axillae; 4.7 for legs, and 3.2 for backs.
Post-Treatment Period
The evaluation period after the first treatment was up to 8.7 years at an average of 4.6 years, and after the last treatment was 8.5 years at an average of 3.4 years.
Results
Patients were asked whether hair reduction was stable at an average of 3.4 years after treatment — 89% said yes, 10% said no, and 1% didn’t know.
Broken down by site, long-term hair removal results were best on the axillae, with 95% of study participants reporting stable hair reduction. Hair reduction rates in the long term were worst on faces (82%) and better for the bikini area (93%) and legs (92%).
Conclusion
Based on follow-up of 8.5 years, the investigators concluded that Alexandrite lasers are effective and safe for achieving long-lasting hair reduction or even permanent hair removal.
Gabriel Buendia, Eva Ciscar, Katharina Russe-Wilflingseder. Hair Removal with 755-nm Lasers: Long-term Results of 8.5 Years. Presented at the Cutaneous Laser Surgery session at ASLMS.
Retrospective Chart Review Examines Causes and Management of Hair Growth Stimulation Following Photo Epilation
Examining possible causes and management of the problem of hair growth stimulation following photo epilation treatments was the focus of a retrospective chart review performed on patients treated in a single practice in Vasquez, Spain, from 1998 to 2003.
Study Method
Patients
A total of 543 female patients age 16 to 52 years who received treatments on the “beard” area, neck, and chin were included in the study. While the predominant skin type were those with Fitzpatrick skin type III, a significant number of patients with skin type II and IV were also treated.
Treatments Equipment, Intervals and Parameters
Treatments were performed at approximately 8-week intervals, and at the time of the review, the total number of the treatments received ranged between 3 and 23. Most treatments were performed with an alexandrite laser, although a smaller number of treatments were also performed with an IPL device and Nd:YAG.
Standard parameters were used for each device, which included a short pulse duration for the alexandrite laser and longer pulse durations for the IPL and the Nd:YAG.
Evaluation Criteria
Before-and-after images were compared, and treatment results were evaluated against the following four categories: complete hair reduction, reduced hair reduction, unchanged hair reduction, or increased hair growth.
Patient medical histories were also reviewed for the presence of known hormonal abnormalities.
Observations
Results of image comparisons showed a total of 57 patients with increased hair growth, which represented 10.5% of the patients treated. No change in hair growth was reported in 44 patient, 424 had reduced hair growth, and 14 patients had complete hair reduction. At the time of review, four patients were not included because of incomplete information.
Hair growth occurred in all age groups and in all skin types. This growth was predominantly in the beard area, and it occurred within and at the periphery of treated areas.
In all patients with hair growth, prominent vellus hair had been present within the area and surrounding it prior to treatment. The onset of hair growth varied between the third and 11th treatment, although in many cases it occurred in the range of three to six treatments. In addition, 16 of the 57 (roughly 25%) patients with increased hair growth had polycystic ovary syndrome or irregular menses. With regard to skin type, hair growth was proportional to the number of patients within each skin type treated.
Possible Explanations
The author noted that several different mechanisms may explain the regrowth. That hair growth occurs around the periphery of the area treated, she said, suggested that sub-therapeutic injury to the components of the follicle that are vital for cycling may result in induction of hair growth rather than miniaturization or destruction of the follicle. And it follows, she added, that vellus follicles with a smaller amount of chromofore may be more susceptible to such partial injury.
Management/Prevention of the Problem
Based on this theory, suggested prevention approaches included applying ice packs to the skin surrounding the treated area to minimize the diffusion of heat just surrounding the vellus follicle, and avoiding the treatment of patients with vellus hair. In addition, higher fluences with a double-pass technique were used.
Conclusions
The author concluded that hair stimulation following photo epilation may be more common than previously described, and is not limited to darker skin types. It may be prevented by cooling the surrounding area during treatment and using maximal tolerated fluences with a double-pass technique.
Andrea Willey. Hair Growth Stimulation Following Auto Photo Epilation — Review of 543 Cases and Successful Management. Presented at the Cutaneous Laser Surgery session at this year’s ASLMS meeting.
Compression Handpiece Said to be Key to Avoiding Post-Treatment Pulsed Dye Laser Purpura
Using a 10-mm spot size and a compression handpiece, a pulsed dye laser (PDL) can effectively be used to treat both vascular and pigmented lesions without post-treatment purpura.
Background
Widely considered one of the most effective modalities for the treatment of vascular lesions, facial erythema, and telan-giectasia, the 595-nm pulsed dye laser has been plagued by post-treatment purpura.
Study Objectives
A study was designed to evaluate a new pulsed dye laser with a micro-pulse structure for single-pass treatment of telangiectasia and to combine that with an assessment of improvement of pigmented dyschromia using a second pass with a compression handpiece. A third objective was to assess textural improvement.
Laser Description
As described by Ken Galeckas during the Cutaneous Laser Surgery session at ASLMS, the Candela PDL used enabled the necessary pulse stacking without exceeding the purpura threshold by “chopping up each macro pulse into eight sequential micro pulses.” The result, he explained, is “a higher fluence that you can deliver to the tissues in a gentle fashion that mitigates any purpura.”
The 595-nm wavelength, he said, is also well absorbed by melanin, but due to different relaxation times, the pulse widths that are necessary to achieve photolysis for melanin frequently result in purpura from pulsing any incidental telangiectasia. To overcome this, he explained, the Candela laser employs a compression handpiece that allows the operator to apply compression to a pigmented lesion, blanch out any associated erythema or telangiectasia, thus delivering pulse widths that are effective for melanin while sparing vascular obstructors.
Study Design
Investigators enrolled 20 patients with Fitzpatrick skin types I though III, who received three treatments, each spaced 3 to 4 weeks apart.
All patients tolerated treatment with the pigmented lesion window without anesthesia, but about 25% of patients requested a topical anesthesia during the first 10 to 20 pulses with the vascular handpiece and cryogen spray. If desired, a 4% lidocaine cream was applied approximately 45 minutes before proceeding.
During the first pass, a pigmented lesion window with a 10-mm beam diameter was applied with fluences of 6.5 J/cm2 to 8 J/cm2 and a 1.5-ms pulse width. The second pass was then delivered with a standard spot with a 10-mm diameter and fluences between 9.5 J/cm2 and 10 J/cm2, pulsing the entire area with 15% overlap and with cryogen spray cooling activated.
All patients received 10 minutes of strict post-procedure icing, and they were instructed to repeat ice applications every 2 hours for approximately 10 minutes, until bedtime.
One month after final treatment, polarized and non-polarized photographs were compared using loops and 10X magnification. Dyschromias were subdivided into the following categories: telangiectasia greater and less than 600 microns, dark lentigines, and light lentigines. Dyschromias were graded clear 0 to 100% at 5% intervals. Texture was evaluated using a standardized global improvement scale, and a grade of 0 to 5 was assigned.
Results
Dark lentigines and small telangiectasias each improved 85%, while light lentigines improved 63%, and larger telangiectasias improved 42%. Average textural improvement was 34%.
Half of patients reported mild to moderate subjective infra-orbital edema, which decreased with subsequent treatments, despite increased fluence.
Eight out of 60 treatments resulted in mild to moderate purpura, although all were considered to be the result of technical inexperience with the compression handpiece, and all resolved without sequelae.
Conclusion
The application of proper compression was found to be the key to virtual elimination of purpura. When the operator applied compression, visualized the blanching, and then fired the laser, the risk of purpura was virtually eliminated.
Kenneth Galeckas. A Pulsed Dye Laser with a 10-mm Beam Diameter for Purpura-Free Photorejuvenation. Presented at the Cutaneous Laser Surgery session at ASLMS.
Disclosure: Dr Galeckas received equipment from Candela.
Fractional Photothermolysis Found Effective for Surgical and Post-Traumatic Scars
At the Cutaneous Laser Surgery session at the ASLMS meeting, David Vasily, M.D., described a study that found fractional photothermolysis using the Lux 1540 to be an effective treatment for surgical and post-traumatic scars that eliminates many of the disadvantages of laser treatments.
Treatment Approaches
Issues associated with treatments for post-surgical and post-traumatic scars include efficacy and side effects with lasers. Pulsed dye laser (PDL) treatment for hypertrophic scars and keloids have proven inconsistent, primarily in hypopigmented scars or atrophic scars. Re-contouring of atrophic scars with the CO2 laser or with the short-pulsed erbium YAG laser can paradoxically result in hypertrophic scarring and hypopigmentation.
Potential mechanisms thought to improve scars based on the mode of action of the fractional laser and its lack of side effects include dermal, collagen, and elastic remodeling, photothermolysis of scars, micro-vasculature in the dermis, and normalization of pigment by the migration of normal melanocytes to the boundaries of thermally coagulated columns.
Study
The described pilot study on the treatment of scars involved 31 patients, Fitzpatrick skin types I through V, including 13 with surgical scars and 18 with post-traumatic scars.
Treatment Parameters
A 10-mm handpiece was used to treat all patients. Each patient received one to eight treatments 3 to 4 weeks apart, using 30 to 60 mJ/mb, at a 10-ms pulse width, and three to five passes, with a 50% overlap.
Assessment
Evaluation of results was based on sequential digital images, investigator quartile assessment of improvement, subject self-assessments, and blinded observer percent improvement grading 1 month following treatment completion.
Results
Investigator quartile assessments averaged good improvement in scars at the 1-month follow-up. Blinded observer improvement rating averaged 59%, which correlated closely to very positive subjective self-assessments at 57% improvement. Results were similar for surgical scars and trauma-related scars.
Both atrophic and hypertrophic scars were responsive, and there was resolution of scar hypo- and hyperpigmentation.
In general, the percent of improvement was a function of the age of the scar, with the most responsive scars being 6 months to 2 years old, and the least responsive older than 15 years; however, even older scars had up to 40% improvement. It also showed that the percent of improvement correlates with the number of treatments, with best results using three or more 1540 treatments.
Primary side effects were limited to transient erythema and edema post-treatment. There was one incidence of transient post-inflammatory hyperpigmentation on a patient with Fitzpatrick skin type V, who was treated for an old burn scar on her lower leg. Pain levels were low, averaging 4.2 on a 0 to 10 scale, making topical anesthetic unnecessary.
Conclusion
In conclusion, fractional photothermolysis using the Lux 1540 is an effective treatment for surgical and post-traumatic scars.
David Vasily, M.D. Treatment of Post-Surgical and Post-Traumatic Scars Using the Starlux 1540 Fractionated Handpiece. Presented at the Cutaneous Laser Surgery session at ASLMS.
Disclosures: Dr. Vasily received equipment, a discount and research grant from Palomar Medical and is a stockholder with the company.
Radiofrequency Technology Achieves Significant Improvement in Cellulite Appearance and Skin Tightening
Speaking at the Cutaneous Laser Surgery session at ASLMS, David McDaniel, M.D., discussed a study using radiofrequency technology in which there was an average improvement of one grade and a 45% increase in skin tightening and global improvement in treating cellulite.
Study Description
Findings were based on a clinical trial of 10 previously untreated patients ages 18 to 75 with grade 2 to grade 3 cellulite, described as a moderate number of visible dimples. Patients received six treatment sessions at 2-week intervals.
Patients were photographed using 3-D digital imaging at weeks 0, 2, 4, 6, 8, 10, and 12, and again 90 days after final treatment. In addition, circumference and weight were measured at each visit.
An expert grader assessed the photographs. In addition, both patients and grader were asked to assess global improvement and tightening on a quintile scale.
Treatment Protocol
The treatment area was divided by grids of approximately 5 x 7 inches.The handpiece was constantly in motion within a grid before engaging energy and throughout each 30-second treatment period. Initial energy range was 150 watts to 200 watts. The bipolar handpiece was used for superficial heating, and the unipolar handpiece for deep dermal thermotherapy.
Treatment was performed to reach a therapeutic temperature of 39°C to 41°C, followed by three passes of 30 seconds each to maintain temperature for a 90-second period.
Results
The results were reported as follows: Of the nine patients who completed the study, seven improved by one grade and two improved by two grades using the visual grading scale to assess the reduction or improvement in the appearance of the cellulite. Quantified changes included reduction of 1% in weight (although one patient showed a 13-pound reduction), and 2% in body mass index and girth, respectively. Skin tightening and global improvement were assessed to be 45%.
Comments by patients included mentions that their clothes fit less tightly over the smoother skin texture achieved.
Conclusion
The small study suggests that improvement in cellulite appearance can be achieved with unipolar radiofrequency treatment. Noting the difficulty of documenting cellulite improvement, Dr. McDaniel considered the 3-D imaging used in this study promising although scientific objective models are needed.
David H. McDaniel. The Effective Unipolar Radio Frequency Treatment on Cellulite and Skin Tightening. Presented at the Cutaneous Laser Surgery session at American Society for Laser Medicine and Surgery 2007.
Disclosure: Dr. McDaniel received a discount and a research grant from Alma Lasers, and technical assistance but no discount from Canfield Scientific for the 3-D images.
The procedure described represents an off-label use of the Accent Volumetric Rf ThermoTherapy device, which is not yet FDA approved.
