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Experimental Traser Device Could Be Laser's Replacement
DANA POINT, CALIF. – A new therapeutic light source being developed in Israel may ultimately replace many of the aesthetic laser devices currently used.
The device, known as Traser (Total Reflection Amplification of Spontaneous Emission of Radiation), "is not a laser and it’s not an intense pulsed light," Dr. Christopher Zachary said at the SDEF Summit in Aesthetic Medicine sponsored by Skin Disease Education Foundation (SDEF).
"No photons come from the flash lamps. It’s one device with many wavelengths. It’s tunable, has a high peak power, and has variable pulse duration from 0.45 to 100 milliseconds," he said.
The Traser contains a "dye cell" (an internally reflecting body that hosts a fluorescent dye), one rear mirror, flashlamps above and below, an output waveguide, and a reflector cavity that houses the device. The Traser is the brainchild of Morgan Gustavsson, a pioneer of intense pulsed-light technology. It was first described in the peer-reviewed online journal PLoS ONE (2012;7:e35899 [doi: 10.1371/journal.pone.0035899]).
"It’s one device with many wavelengths. It’s tunable, has a high peak power, and has variable pulse duration from 0.45 to 100 milliseconds," Dr. Christopher Zachary said.
Unlike a laser, the Traser has no optical resonator, no output coupler, no stimulated emission, no filters, and no filter technology. "Photons from the flash lamps excite fluorescent dye material and spontaneously emit a different narrow spectrum of light," explained Dr. Zachary, professor and chair of the dermatology department at the University of California, Irvine, who plans to begin studying the device this summer.
"This traps 45%-61% of the light that’s generated, and the photons propagate axially along the length of the dye cell in both directions. The mirror redirects the light forward, and light is passively coupled out at the distal end of the cell," he said.
The dyes used to date are water soluble, "and do not require hazardous solvents or additives," wrote Dr. Zachary and Mr. Gustavsson, who is with Rockport Consulting Services in Newport Beach, Calif., in the PLoS One article. "When required, [the dyes] are reclaimed by a filter loop, which in less than a minute can completely eliminate the dye and purify the circulating water. This water is not only reconstituted with new dyes within the Traser circulation cavity, but is also used to cool the device."
Changing the dye enables the user to produce UVA, blue, green, orange, red, and near-infrared wavelengths, which allows for wide variability in a single device. The fluorescent dyes used and described in the PLoS ONE article include pyrromethene 556, rhodamine 590, and sulforhodamine 640 chloride. "The wavelength that comes out is dependent on the dye that you use and its concentration," Dr. Zachary said at the meeting. "It’s a very manipulable yet sensitive system."
In theory, the Traser "could replace the KTP laser and could be very good for individual blood vessels, for instance, or a rosaceous blush. It could replace the ruby laser as a hair-removal device, or the pulsed dye laser for port wine stains – all from a single device. All you do is change the dye. I love the science of this: It’s simple but has all the characteristics of a device that is going to be very effective. I’d like to see some studies conducted in animals and in humans."
He concluded his remarks by predicting that the TRASER will probably be less costly than a laser, and "highly tunable and with multiple pulse durations, and one that could replace three to five lasers in your office."
Dr. Zachary said that he had no relevant financial conflicts to disclose. SDEF and this news organization are owned by Elsevier.
DANA POINT, CALIF. – A new therapeutic light source being developed in Israel may ultimately replace many of the aesthetic laser devices currently used.
The device, known as Traser (Total Reflection Amplification of Spontaneous Emission of Radiation), "is not a laser and it’s not an intense pulsed light," Dr. Christopher Zachary said at the SDEF Summit in Aesthetic Medicine sponsored by Skin Disease Education Foundation (SDEF).
"No photons come from the flash lamps. It’s one device with many wavelengths. It’s tunable, has a high peak power, and has variable pulse duration from 0.45 to 100 milliseconds," he said.
The Traser contains a "dye cell" (an internally reflecting body that hosts a fluorescent dye), one rear mirror, flashlamps above and below, an output waveguide, and a reflector cavity that houses the device. The Traser is the brainchild of Morgan Gustavsson, a pioneer of intense pulsed-light technology. It was first described in the peer-reviewed online journal PLoS ONE (2012;7:e35899 [doi: 10.1371/journal.pone.0035899]).
"It’s one device with many wavelengths. It’s tunable, has a high peak power, and has variable pulse duration from 0.45 to 100 milliseconds," Dr. Christopher Zachary said.
Unlike a laser, the Traser has no optical resonator, no output coupler, no stimulated emission, no filters, and no filter technology. "Photons from the flash lamps excite fluorescent dye material and spontaneously emit a different narrow spectrum of light," explained Dr. Zachary, professor and chair of the dermatology department at the University of California, Irvine, who plans to begin studying the device this summer.
"This traps 45%-61% of the light that’s generated, and the photons propagate axially along the length of the dye cell in both directions. The mirror redirects the light forward, and light is passively coupled out at the distal end of the cell," he said.
The dyes used to date are water soluble, "and do not require hazardous solvents or additives," wrote Dr. Zachary and Mr. Gustavsson, who is with Rockport Consulting Services in Newport Beach, Calif., in the PLoS One article. "When required, [the dyes] are reclaimed by a filter loop, which in less than a minute can completely eliminate the dye and purify the circulating water. This water is not only reconstituted with new dyes within the Traser circulation cavity, but is also used to cool the device."
Changing the dye enables the user to produce UVA, blue, green, orange, red, and near-infrared wavelengths, which allows for wide variability in a single device. The fluorescent dyes used and described in the PLoS ONE article include pyrromethene 556, rhodamine 590, and sulforhodamine 640 chloride. "The wavelength that comes out is dependent on the dye that you use and its concentration," Dr. Zachary said at the meeting. "It’s a very manipulable yet sensitive system."
In theory, the Traser "could replace the KTP laser and could be very good for individual blood vessels, for instance, or a rosaceous blush. It could replace the ruby laser as a hair-removal device, or the pulsed dye laser for port wine stains – all from a single device. All you do is change the dye. I love the science of this: It’s simple but has all the characteristics of a device that is going to be very effective. I’d like to see some studies conducted in animals and in humans."
He concluded his remarks by predicting that the TRASER will probably be less costly than a laser, and "highly tunable and with multiple pulse durations, and one that could replace three to five lasers in your office."
Dr. Zachary said that he had no relevant financial conflicts to disclose. SDEF and this news organization are owned by Elsevier.
DANA POINT, CALIF. – A new therapeutic light source being developed in Israel may ultimately replace many of the aesthetic laser devices currently used.
The device, known as Traser (Total Reflection Amplification of Spontaneous Emission of Radiation), "is not a laser and it’s not an intense pulsed light," Dr. Christopher Zachary said at the SDEF Summit in Aesthetic Medicine sponsored by Skin Disease Education Foundation (SDEF).
"No photons come from the flash lamps. It’s one device with many wavelengths. It’s tunable, has a high peak power, and has variable pulse duration from 0.45 to 100 milliseconds," he said.
The Traser contains a "dye cell" (an internally reflecting body that hosts a fluorescent dye), one rear mirror, flashlamps above and below, an output waveguide, and a reflector cavity that houses the device. The Traser is the brainchild of Morgan Gustavsson, a pioneer of intense pulsed-light technology. It was first described in the peer-reviewed online journal PLoS ONE (2012;7:e35899 [doi: 10.1371/journal.pone.0035899]).
"It’s one device with many wavelengths. It’s tunable, has a high peak power, and has variable pulse duration from 0.45 to 100 milliseconds," Dr. Christopher Zachary said.
Unlike a laser, the Traser has no optical resonator, no output coupler, no stimulated emission, no filters, and no filter technology. "Photons from the flash lamps excite fluorescent dye material and spontaneously emit a different narrow spectrum of light," explained Dr. Zachary, professor and chair of the dermatology department at the University of California, Irvine, who plans to begin studying the device this summer.
"This traps 45%-61% of the light that’s generated, and the photons propagate axially along the length of the dye cell in both directions. The mirror redirects the light forward, and light is passively coupled out at the distal end of the cell," he said.
The dyes used to date are water soluble, "and do not require hazardous solvents or additives," wrote Dr. Zachary and Mr. Gustavsson, who is with Rockport Consulting Services in Newport Beach, Calif., in the PLoS One article. "When required, [the dyes] are reclaimed by a filter loop, which in less than a minute can completely eliminate the dye and purify the circulating water. This water is not only reconstituted with new dyes within the Traser circulation cavity, but is also used to cool the device."
Changing the dye enables the user to produce UVA, blue, green, orange, red, and near-infrared wavelengths, which allows for wide variability in a single device. The fluorescent dyes used and described in the PLoS ONE article include pyrromethene 556, rhodamine 590, and sulforhodamine 640 chloride. "The wavelength that comes out is dependent on the dye that you use and its concentration," Dr. Zachary said at the meeting. "It’s a very manipulable yet sensitive system."
In theory, the Traser "could replace the KTP laser and could be very good for individual blood vessels, for instance, or a rosaceous blush. It could replace the ruby laser as a hair-removal device, or the pulsed dye laser for port wine stains – all from a single device. All you do is change the dye. I love the science of this: It’s simple but has all the characteristics of a device that is going to be very effective. I’d like to see some studies conducted in animals and in humans."
He concluded his remarks by predicting that the TRASER will probably be less costly than a laser, and "highly tunable and with multiple pulse durations, and one that could replace three to five lasers in your office."
Dr. Zachary said that he had no relevant financial conflicts to disclose. SDEF and this news organization are owned by Elsevier.
EXPERT ANALYSIS FROM THE SDEF SUMMIT IN AESTHETIC MEDICINE
Frozen Fat Returns Volume to Aging Face
DANA POINT, CALIF. – Fat transfer for facial volume restoration holds certain advantages over off-the-shelf fillers, according to Dr. Lisa M. Donofrio. Chief among them is that the procedure involves adding a biologically identical substance to the targeted treatment area.
Fat transfer "is also capable of dramatic changes [and] has the potential for permanence; it's nonreactive, and it may promote stem cell growth," Dr. Donofrio said at the Summit in Aesthetic Medicine sponsored by Skin Disease Education Foundation (SDEF).
In the upper third of the face, the goal of fat transfer is to achieve a smooth, convex forehead, forehead to brow continuity, full temples, and a "railroad tracking" of the upper lid, "so that the upper lid margin and the sulcus are parallel," said Dr. Donofrio of the department of dermatology at Yale University, New Haven, Conn. Advantages of using fat in the upper face, she said, "are that the results can be dramatic; it’s opaque; it’s structural and can be put in all layers of the skin; and it’s very long lasting."
In the middle third of the face, the goal of fat transfer is to achieve a smooth, convex cheek, lid to cheek continuity, full buccal fat, and a broad cheekbone, said Dr. Donofrio, who is also with the department of dermatology at Tulane University in New Orleans. She characterized fat transfer in the middle third of the face as "the longest lasting and [most economical] large-volume filler. It’s able to achieve three-dimensional volumization and it has very predictable longevity."
In the lower third of the face, the goal of fat transfer is to achieve cheek to prementum continuity, bucca to chin continuity, a continuous jawline sweep, and a full submandibular area. "The strength of fat in this area is its ability to be structural," she explained. "When combined with microsuction, it can redistribute fat to a youthful contour."
Dr. Donofrio routinely freezes fat prior to transfer "because it works," she said. "Why does it work? I have no idea, but maybe there is some microenvironment that is creating growth factors."
She uses the centrifuge minimally, "just to remove some of the tumescent fluid," and leaves triglycerides in the syringe. She places the fat into a freezer at –20° C for up to 12 hours, and then moves it to a plasma freezer at –30° C. She defrosts the fat rapidly prior to transfer.
Of the more than 6,000 fat transfers she has performed, about three-quarters of them have involved frozen fat. When patients return to her for additional volumization, "they will not entertain the idea of doing only a fresh fat transfer, because they think the frozen fat transfer did so well," she noted.
Dr. Donofrio disclosed that she is a member of the scientific advisory board of, a consultant to, and investigator for Allergan and Medicis. She is also an investigator for Cynosure, Kythera, Mentor, and Merz.
SDEF and this news organization are owned by Elsevier.
DANA POINT, CALIF. – Fat transfer for facial volume restoration holds certain advantages over off-the-shelf fillers, according to Dr. Lisa M. Donofrio. Chief among them is that the procedure involves adding a biologically identical substance to the targeted treatment area.
Fat transfer "is also capable of dramatic changes [and] has the potential for permanence; it's nonreactive, and it may promote stem cell growth," Dr. Donofrio said at the Summit in Aesthetic Medicine sponsored by Skin Disease Education Foundation (SDEF).
In the upper third of the face, the goal of fat transfer is to achieve a smooth, convex forehead, forehead to brow continuity, full temples, and a "railroad tracking" of the upper lid, "so that the upper lid margin and the sulcus are parallel," said Dr. Donofrio of the department of dermatology at Yale University, New Haven, Conn. Advantages of using fat in the upper face, she said, "are that the results can be dramatic; it’s opaque; it’s structural and can be put in all layers of the skin; and it’s very long lasting."
In the middle third of the face, the goal of fat transfer is to achieve a smooth, convex cheek, lid to cheek continuity, full buccal fat, and a broad cheekbone, said Dr. Donofrio, who is also with the department of dermatology at Tulane University in New Orleans. She characterized fat transfer in the middle third of the face as "the longest lasting and [most economical] large-volume filler. It’s able to achieve three-dimensional volumization and it has very predictable longevity."
In the lower third of the face, the goal of fat transfer is to achieve cheek to prementum continuity, bucca to chin continuity, a continuous jawline sweep, and a full submandibular area. "The strength of fat in this area is its ability to be structural," she explained. "When combined with microsuction, it can redistribute fat to a youthful contour."
Dr. Donofrio routinely freezes fat prior to transfer "because it works," she said. "Why does it work? I have no idea, but maybe there is some microenvironment that is creating growth factors."
She uses the centrifuge minimally, "just to remove some of the tumescent fluid," and leaves triglycerides in the syringe. She places the fat into a freezer at –20° C for up to 12 hours, and then moves it to a plasma freezer at –30° C. She defrosts the fat rapidly prior to transfer.
Of the more than 6,000 fat transfers she has performed, about three-quarters of them have involved frozen fat. When patients return to her for additional volumization, "they will not entertain the idea of doing only a fresh fat transfer, because they think the frozen fat transfer did so well," she noted.
Dr. Donofrio disclosed that she is a member of the scientific advisory board of, a consultant to, and investigator for Allergan and Medicis. She is also an investigator for Cynosure, Kythera, Mentor, and Merz.
SDEF and this news organization are owned by Elsevier.
DANA POINT, CALIF. – Fat transfer for facial volume restoration holds certain advantages over off-the-shelf fillers, according to Dr. Lisa M. Donofrio. Chief among them is that the procedure involves adding a biologically identical substance to the targeted treatment area.
Fat transfer "is also capable of dramatic changes [and] has the potential for permanence; it's nonreactive, and it may promote stem cell growth," Dr. Donofrio said at the Summit in Aesthetic Medicine sponsored by Skin Disease Education Foundation (SDEF).
In the upper third of the face, the goal of fat transfer is to achieve a smooth, convex forehead, forehead to brow continuity, full temples, and a "railroad tracking" of the upper lid, "so that the upper lid margin and the sulcus are parallel," said Dr. Donofrio of the department of dermatology at Yale University, New Haven, Conn. Advantages of using fat in the upper face, she said, "are that the results can be dramatic; it’s opaque; it’s structural and can be put in all layers of the skin; and it’s very long lasting."
In the middle third of the face, the goal of fat transfer is to achieve a smooth, convex cheek, lid to cheek continuity, full buccal fat, and a broad cheekbone, said Dr. Donofrio, who is also with the department of dermatology at Tulane University in New Orleans. She characterized fat transfer in the middle third of the face as "the longest lasting and [most economical] large-volume filler. It’s able to achieve three-dimensional volumization and it has very predictable longevity."
In the lower third of the face, the goal of fat transfer is to achieve cheek to prementum continuity, bucca to chin continuity, a continuous jawline sweep, and a full submandibular area. "The strength of fat in this area is its ability to be structural," she explained. "When combined with microsuction, it can redistribute fat to a youthful contour."
Dr. Donofrio routinely freezes fat prior to transfer "because it works," she said. "Why does it work? I have no idea, but maybe there is some microenvironment that is creating growth factors."
She uses the centrifuge minimally, "just to remove some of the tumescent fluid," and leaves triglycerides in the syringe. She places the fat into a freezer at –20° C for up to 12 hours, and then moves it to a plasma freezer at –30° C. She defrosts the fat rapidly prior to transfer.
Of the more than 6,000 fat transfers she has performed, about three-quarters of them have involved frozen fat. When patients return to her for additional volumization, "they will not entertain the idea of doing only a fresh fat transfer, because they think the frozen fat transfer did so well," she noted.
Dr. Donofrio disclosed that she is a member of the scientific advisory board of, a consultant to, and investigator for Allergan and Medicis. She is also an investigator for Cynosure, Kythera, Mentor, and Merz.
SDEF and this news organization are owned by Elsevier.
EXPERT ANALYSIS FROM THE SDEF SUMMIT IN AESTHETIC MEDICINE
At-Home Hair Removal Device No Better Than Shaving
DANA POINT, CALIF. – An at-home, consumer hot-wire hair removal device worked no better than did standard shaving, according to a recent study.
"Relative to shaving, treatment with the hot-wire device did not produce statistically significant differences in the percentage change from baseline in hair count, duration of hair removal effect, or color and/or thickness of regrowing hair," Dr. Brian S. Biesman said.
There have been no controlled published studies of the no!no! hair removal device (manufactured by Radiancy) in peer-reviewed literature, which led Dr. Biesman to conduct a small study comparing the device’s efficacy with that of standard shaving.
According to information on the no!no! website, the device uses Thermicon technology "to conduct a gentle pulse of heat to the hair," which "instantly removes hair and slows the rate of hair regrowth with no pain." In Dr. Biesman’s study, however, the effectiveness of the hot-wire device, used according to the manufacturer’s recommendations (four passes per session), was found to be equivalent to standard shaving for all study end points.
For instance, active hair follicles and hair regrowth were not affected by a series of treatments with the hair removal device, compared with shaving. Also, hair thickness and color did not change after treatment with the device, Dr. Biesman reported in a poster at the Summit in Aesthetic Medicine sponsored by Skin Disease Education Foundation (SDEF).
A total of 23 patients (7 men, 16 women) aged 18-55 years completed the study; 90% of participants were white. Two sites on one leg of each patient were shaved 4 days before baseline, and then were treated every 3-4 days with the hot-wire device on one site on the leg and by shaving the other site for 8 weeks. The treatment sites were two symmetric 3 × 3 cm areas of the leg that were 3 cm apart and contained at least 15 hairs. The corners of the sites were micro-tattooed with ink, which was visible under black light.
Photographs were taken to measure hair count at baseline, weekly during treatment (before and after), at 4 days following final treatment, and at each follow-up visit (4, 8, and 12 weeks after final treatment), and "blinded visual and digital assessments were made for hair thickness and color," noted Dr. Biesman, who has a private practice in Nashville, Tenn.
The mean baseline hair count of the hot-wire and shaving sites were 86 and 79, respectively, "which remained stable during the 8-week treatment phase. No hair count reduction was seen." At post-treatment follow up, hair counts increased to 95 (treatment site) and 84 (shaving site) at 4 days, 104 and 99 at 1 month, 106 and 100 at 2 months, and 109 and 105 at 3 months. Hair regrowth was noted immediately after ceasing treatment with the hot-wire device.
The mean percent change at 4 days post treatment was 19% with the hot-wire device, compared with 14% with shaving; 41% and 41% at 1 month post treatment; 31% and 28% at 2 months post treatment; and 32% and 37% at 3 months.
A study limitation was that hair removal was evaluated only on the lower leg to sites not randomly assigned.
The study was sponsored by Tria Beauty, for which Dr. Biesman has consulted and from which he has received research support. SDEF and this news organization are owned by Elsevier.
DANA POINT, CALIF. – An at-home, consumer hot-wire hair removal device worked no better than did standard shaving, according to a recent study.
"Relative to shaving, treatment with the hot-wire device did not produce statistically significant differences in the percentage change from baseline in hair count, duration of hair removal effect, or color and/or thickness of regrowing hair," Dr. Brian S. Biesman said.
There have been no controlled published studies of the no!no! hair removal device (manufactured by Radiancy) in peer-reviewed literature, which led Dr. Biesman to conduct a small study comparing the device’s efficacy with that of standard shaving.
According to information on the no!no! website, the device uses Thermicon technology "to conduct a gentle pulse of heat to the hair," which "instantly removes hair and slows the rate of hair regrowth with no pain." In Dr. Biesman’s study, however, the effectiveness of the hot-wire device, used according to the manufacturer’s recommendations (four passes per session), was found to be equivalent to standard shaving for all study end points.
For instance, active hair follicles and hair regrowth were not affected by a series of treatments with the hair removal device, compared with shaving. Also, hair thickness and color did not change after treatment with the device, Dr. Biesman reported in a poster at the Summit in Aesthetic Medicine sponsored by Skin Disease Education Foundation (SDEF).
A total of 23 patients (7 men, 16 women) aged 18-55 years completed the study; 90% of participants were white. Two sites on one leg of each patient were shaved 4 days before baseline, and then were treated every 3-4 days with the hot-wire device on one site on the leg and by shaving the other site for 8 weeks. The treatment sites were two symmetric 3 × 3 cm areas of the leg that were 3 cm apart and contained at least 15 hairs. The corners of the sites were micro-tattooed with ink, which was visible under black light.
Photographs were taken to measure hair count at baseline, weekly during treatment (before and after), at 4 days following final treatment, and at each follow-up visit (4, 8, and 12 weeks after final treatment), and "blinded visual and digital assessments were made for hair thickness and color," noted Dr. Biesman, who has a private practice in Nashville, Tenn.
The mean baseline hair count of the hot-wire and shaving sites were 86 and 79, respectively, "which remained stable during the 8-week treatment phase. No hair count reduction was seen." At post-treatment follow up, hair counts increased to 95 (treatment site) and 84 (shaving site) at 4 days, 104 and 99 at 1 month, 106 and 100 at 2 months, and 109 and 105 at 3 months. Hair regrowth was noted immediately after ceasing treatment with the hot-wire device.
The mean percent change at 4 days post treatment was 19% with the hot-wire device, compared with 14% with shaving; 41% and 41% at 1 month post treatment; 31% and 28% at 2 months post treatment; and 32% and 37% at 3 months.
A study limitation was that hair removal was evaluated only on the lower leg to sites not randomly assigned.
The study was sponsored by Tria Beauty, for which Dr. Biesman has consulted and from which he has received research support. SDEF and this news organization are owned by Elsevier.
DANA POINT, CALIF. – An at-home, consumer hot-wire hair removal device worked no better than did standard shaving, according to a recent study.
"Relative to shaving, treatment with the hot-wire device did not produce statistically significant differences in the percentage change from baseline in hair count, duration of hair removal effect, or color and/or thickness of regrowing hair," Dr. Brian S. Biesman said.
There have been no controlled published studies of the no!no! hair removal device (manufactured by Radiancy) in peer-reviewed literature, which led Dr. Biesman to conduct a small study comparing the device’s efficacy with that of standard shaving.
According to information on the no!no! website, the device uses Thermicon technology "to conduct a gentle pulse of heat to the hair," which "instantly removes hair and slows the rate of hair regrowth with no pain." In Dr. Biesman’s study, however, the effectiveness of the hot-wire device, used according to the manufacturer’s recommendations (four passes per session), was found to be equivalent to standard shaving for all study end points.
For instance, active hair follicles and hair regrowth were not affected by a series of treatments with the hair removal device, compared with shaving. Also, hair thickness and color did not change after treatment with the device, Dr. Biesman reported in a poster at the Summit in Aesthetic Medicine sponsored by Skin Disease Education Foundation (SDEF).
A total of 23 patients (7 men, 16 women) aged 18-55 years completed the study; 90% of participants were white. Two sites on one leg of each patient were shaved 4 days before baseline, and then were treated every 3-4 days with the hot-wire device on one site on the leg and by shaving the other site for 8 weeks. The treatment sites were two symmetric 3 × 3 cm areas of the leg that were 3 cm apart and contained at least 15 hairs. The corners of the sites were micro-tattooed with ink, which was visible under black light.
Photographs were taken to measure hair count at baseline, weekly during treatment (before and after), at 4 days following final treatment, and at each follow-up visit (4, 8, and 12 weeks after final treatment), and "blinded visual and digital assessments were made for hair thickness and color," noted Dr. Biesman, who has a private practice in Nashville, Tenn.
The mean baseline hair count of the hot-wire and shaving sites were 86 and 79, respectively, "which remained stable during the 8-week treatment phase. No hair count reduction was seen." At post-treatment follow up, hair counts increased to 95 (treatment site) and 84 (shaving site) at 4 days, 104 and 99 at 1 month, 106 and 100 at 2 months, and 109 and 105 at 3 months. Hair regrowth was noted immediately after ceasing treatment with the hot-wire device.
The mean percent change at 4 days post treatment was 19% with the hot-wire device, compared with 14% with shaving; 41% and 41% at 1 month post treatment; 31% and 28% at 2 months post treatment; and 32% and 37% at 3 months.
A study limitation was that hair removal was evaluated only on the lower leg to sites not randomly assigned.
The study was sponsored by Tria Beauty, for which Dr. Biesman has consulted and from which he has received research support. SDEF and this news organization are owned by Elsevier.
FROM THE SDEF SUMMIT IN AESTHETIC MEDICINE
Major Finding: The mean percent change at 4 days post treatment was 19% with the hot-wire device, compared with 14% with shaving; 41% and 41% after 1 month; 31% and 28% after 2 months; and 32% and 37% after 3 months.
Data Source: Twenty-three patients (7 men, 16 women) aged 18-55 years completed the study; 90% of participants were white.
Disclosures: The study was sponsored by Tria Beauty, for which Dr. Biesman has consulted and from which he has received research support. SDEF and this news organization are owned by Elsevier.
Tips and Trends in Teen Elective Plastic Surgery
MIAMI BEACH – Adolescents who undergo elective plastic surgery tend to "sail through surgery more easily" than adults, according to an expert.
In addition, more male teenagers seek these procedures, meaning the gender disparity is not as striking as it is among adults.
"When we do cosmetic surgery in teenagers, it is remarkably conflict free, compared with other medical interventions in teenagers, and compared with other age groups," Dr. Mary H. McGrath said. The reasons are not entirely clear – most research in adolescents addresses rhinoplasty only – but it could be because surgery comes during a time of great overall change for teenagers, she said.
Of the estimated 9.2 million surgical and nonsurgical cosmetic procedures in the United States in 2011, 18% were surgical and accounted for 63% of expenditures, according to data from the American Society for Aesthetic Plastic Surgery. Patients 18 years and younger comprised 1.4% of this total and underwent 97,214 nonsurgical and 34,663 surgical procedures.
Otoplasty was the most common 2011 elective surgical procedure in patients under the age of 18 years in 2011. About one third, 34%, of the estimated 11,000 otoplasties were performed on males. Rhinoplasty came in second on the list, with 20% of the 9,500 procedures performed in males. Breast augmentation, liposuction, and breast reduction (for cosmetic reasons) were the next most common, in order, followed by correction of gynecomastia (not surprisingly, 100% in males).
In contrast, in adult patients, more than 90% of all elective plastic surgeries are performed in women, Dr. McGrath said.
Assessment of physical and mental health is the first step when an adolescent asks about plastic surgery in the primary care setting, Dr. McGrath said at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.
Ensure the adolescent has the necessary emotional and physical maturity. "Determine that the patient has reached the growth milestone and physical maturity for that surgery. We wouldn’t do breast augmentation on a 16-year-old," for example, said Dr. McGrath, professor of surgery in the division of plastic and reconstructive surgery at the University of California, San Francisco. Also rule out any psychiatric contraindication, such as body dysmorphic disorder, she said.
Speak with the patient alone. Also talk with them with their family present to assess the degree of support. Ask the patient to articulate why they want the surgery. Ensure patient expectations are realistic. After referral, a plastic surgeon ideally will assess the specific deficit, outline what can be accomplished surgically, and describe the potential risks. Efficacy and safety considerations are critical, Dr. McGrath said.
Ask teenagers to explain how they would handle a complication. Dr. McGrath also asks them to repeat back important aspects of the discussion to ensure they understand.
Dr. McGrath shared some tips and insight on the following procedures:
• Otoplasty. The ear achieves 85% of full growth by age 3 years, which is "why kids’ ears look so big." Sometimes, the goal of surgery is to approximate symmetry. A good plastic surgeon will be familiar with the subtle anatomic features of the ear: the top of the ear is generally closer to the head than the middle, while the lobule at the bottom should stick out the most.
Otoplasty is usually an outpatient procedure. Patients can expect a bulky head dressing postoperatively, suture removal after 7-10 days, and to sleep with an elastic band around their head for 2-3 weeks. Hematoma and infection are potential early complications and residual deformity or asymmetry can emerge later. An estimated 8%-10% of patients undergo reoperations, almost always for asymmetry, Dr. McGrath said.
• Rhinoplasty. "Very rarely do we do rhinoplasty in someone younger than 17 or 18 [years old] or they can outgrow the changes in nasal contour," Dr. McGrath said. "Sometimes, I feel bad telling a 14-year-old with an exceptionally large or unattractive nose they have to wait and come back at age 17."
Prepare teenage patients for the postoperative course by showing them photos of typical patients. Tell them to expect splinting for 7 days, ecchymosis for 10-14 days, and residual swelling for 2-3 months. Postoperative changes become quickly obvious after a bony ridge removal. In contrast, a nasal tip rhinoplasty, because it involves soft tissue and more edema, can take months to see the final result.
"This is the hardest surgery we do," Dr. McGrath said. "It is complicated to understand all the pieces of the puzzle and get it right. It requires the greatest amount of art." The most common complication is bleeding in about 4% of patients.
• Breast Augmentation. Only a small minority of breast augmentation procedures, 1.5%, were performed in patients 18 years and younger in 2011. "Young women seek breast implants because their breasts look odd; it is not necessarily size that is driving it, but almost always the shape," Dr. McGrath said.
Approximately 25% of patients having breast augmentation have a reoperation within 10 years. "That is the number to know," Dr. McGrath said. "Is the likelihood of additional surgery acceptable to the patient?"
Silicone breast implants are not FDA cleared for breast reconstruction in females younger than 22 years. Therefore, only saline implants are an option in these younger patients, Dr. McGrath said. An advantage of saline implants is they can be inserted through a small incision and then filled, which is not possible with silicone gel implants.
Pain, hematoma, seroma, wound infection, and decreased skin sensation are potential complications. However, "the problems due to the implantable device are the real issues," Dr. McGrath said. Scarring can occur around 15% of implants; 8% or 9% can become malpositioned and about 7% will deflate over 5 years. In addition, patients with a family history of breast cancer may choose not to have implants.
Consultation with a qualified plastic surgeon who can focus on long-term implications is warranted, Dr. McGrath said.
• Breast Reduction. Defer surgery until full breast maturation and growth is achieved. Breast size should be stable with no continuing growth for 9-12 months, Dr. McGrath said.
Smoking, obesity, medical conditions that impair wound healing, bleeding disorders, or a body mass index greater than 30 kg/m2 are contraindications. "Some obese women have large breasts, and many are disappointed when I tell them they should defer breast reduction until after weight loss."
Another point to counsel patients about is that lactation is not always possible after breast reduction. "I have had young women walk away from this and say, ‘It’s very important for me to breast feed my baby someday.’"
• Liposuction. The American Society of Plastic Surgeons cautions that liposuction and tummy tucks are inappropriate procedures for weight loss in teens, Dr. McGrath said. "I cannot tell you how many obese teens get referred to me for liposuction. I have to tell them it’s not the right thing ... and it will not correct your basic problem."
In contrast, lipoplasty, liposculpture, or liposuction to treat localized fat deposits can be indicated in some teenagers. "The ideal patient is at or near ideal body weight with elastic skin that will retract."
"Submental liposuction of the fat pad creating a double chin in older teenagers can be fantastic," Dr. McGrath said. It can be done in an office setting. Bruising, seroma, and bumpy appearance are potential complications. Instruct patients that they will have to wear a compression garment around their head at night for about 3 weeks.
• Gynecomastia. About 8% of all gynecomastia corrections involved patients 18 years and younger. Approximately 50% are unilateral and 50% bilateral procedures.
Gynecomastia can have a hormonal etiology and be associated with obesity. Surgical results, however, are poorer in the obese patient. "The distinction between what is gynecomastia and fat tissue gets murky in overweight patients," Dr. McGrath said.
Gynecomastia can be self-limited with an average duration of 1-2 years. For those in whom it persists, some seek surgery because "it is a source of embarrassment. Like our young women, it’s not so much the size, it’s the odd look of a protuberant breast on a male."
"The central issue with any elective plastic surgery is not the presence or absence of disease, rather the effect of the problem on the person," Dr. McGrath said. "It comes down to quality of life, and whether or not you believe improving quality of life is part of our job."
Dr. McGrath recommended the American Society for Aesthetic Plastic Surgery guidelines for evaluating teenagers considering cosmetic plastic surgery.
Dr. McGrath said she had no relevant financial disclosures.
MIAMI BEACH – Adolescents who undergo elective plastic surgery tend to "sail through surgery more easily" than adults, according to an expert.
In addition, more male teenagers seek these procedures, meaning the gender disparity is not as striking as it is among adults.
"When we do cosmetic surgery in teenagers, it is remarkably conflict free, compared with other medical interventions in teenagers, and compared with other age groups," Dr. Mary H. McGrath said. The reasons are not entirely clear – most research in adolescents addresses rhinoplasty only – but it could be because surgery comes during a time of great overall change for teenagers, she said.
Of the estimated 9.2 million surgical and nonsurgical cosmetic procedures in the United States in 2011, 18% were surgical and accounted for 63% of expenditures, according to data from the American Society for Aesthetic Plastic Surgery. Patients 18 years and younger comprised 1.4% of this total and underwent 97,214 nonsurgical and 34,663 surgical procedures.
Otoplasty was the most common 2011 elective surgical procedure in patients under the age of 18 years in 2011. About one third, 34%, of the estimated 11,000 otoplasties were performed on males. Rhinoplasty came in second on the list, with 20% of the 9,500 procedures performed in males. Breast augmentation, liposuction, and breast reduction (for cosmetic reasons) were the next most common, in order, followed by correction of gynecomastia (not surprisingly, 100% in males).
In contrast, in adult patients, more than 90% of all elective plastic surgeries are performed in women, Dr. McGrath said.
Assessment of physical and mental health is the first step when an adolescent asks about plastic surgery in the primary care setting, Dr. McGrath said at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.
Ensure the adolescent has the necessary emotional and physical maturity. "Determine that the patient has reached the growth milestone and physical maturity for that surgery. We wouldn’t do breast augmentation on a 16-year-old," for example, said Dr. McGrath, professor of surgery in the division of plastic and reconstructive surgery at the University of California, San Francisco. Also rule out any psychiatric contraindication, such as body dysmorphic disorder, she said.
Speak with the patient alone. Also talk with them with their family present to assess the degree of support. Ask the patient to articulate why they want the surgery. Ensure patient expectations are realistic. After referral, a plastic surgeon ideally will assess the specific deficit, outline what can be accomplished surgically, and describe the potential risks. Efficacy and safety considerations are critical, Dr. McGrath said.
Ask teenagers to explain how they would handle a complication. Dr. McGrath also asks them to repeat back important aspects of the discussion to ensure they understand.
Dr. McGrath shared some tips and insight on the following procedures:
• Otoplasty. The ear achieves 85% of full growth by age 3 years, which is "why kids’ ears look so big." Sometimes, the goal of surgery is to approximate symmetry. A good plastic surgeon will be familiar with the subtle anatomic features of the ear: the top of the ear is generally closer to the head than the middle, while the lobule at the bottom should stick out the most.
Otoplasty is usually an outpatient procedure. Patients can expect a bulky head dressing postoperatively, suture removal after 7-10 days, and to sleep with an elastic band around their head for 2-3 weeks. Hematoma and infection are potential early complications and residual deformity or asymmetry can emerge later. An estimated 8%-10% of patients undergo reoperations, almost always for asymmetry, Dr. McGrath said.
• Rhinoplasty. "Very rarely do we do rhinoplasty in someone younger than 17 or 18 [years old] or they can outgrow the changes in nasal contour," Dr. McGrath said. "Sometimes, I feel bad telling a 14-year-old with an exceptionally large or unattractive nose they have to wait and come back at age 17."
Prepare teenage patients for the postoperative course by showing them photos of typical patients. Tell them to expect splinting for 7 days, ecchymosis for 10-14 days, and residual swelling for 2-3 months. Postoperative changes become quickly obvious after a bony ridge removal. In contrast, a nasal tip rhinoplasty, because it involves soft tissue and more edema, can take months to see the final result.
"This is the hardest surgery we do," Dr. McGrath said. "It is complicated to understand all the pieces of the puzzle and get it right. It requires the greatest amount of art." The most common complication is bleeding in about 4% of patients.
• Breast Augmentation. Only a small minority of breast augmentation procedures, 1.5%, were performed in patients 18 years and younger in 2011. "Young women seek breast implants because their breasts look odd; it is not necessarily size that is driving it, but almost always the shape," Dr. McGrath said.
Approximately 25% of patients having breast augmentation have a reoperation within 10 years. "That is the number to know," Dr. McGrath said. "Is the likelihood of additional surgery acceptable to the patient?"
Silicone breast implants are not FDA cleared for breast reconstruction in females younger than 22 years. Therefore, only saline implants are an option in these younger patients, Dr. McGrath said. An advantage of saline implants is they can be inserted through a small incision and then filled, which is not possible with silicone gel implants.
Pain, hematoma, seroma, wound infection, and decreased skin sensation are potential complications. However, "the problems due to the implantable device are the real issues," Dr. McGrath said. Scarring can occur around 15% of implants; 8% or 9% can become malpositioned and about 7% will deflate over 5 years. In addition, patients with a family history of breast cancer may choose not to have implants.
Consultation with a qualified plastic surgeon who can focus on long-term implications is warranted, Dr. McGrath said.
• Breast Reduction. Defer surgery until full breast maturation and growth is achieved. Breast size should be stable with no continuing growth for 9-12 months, Dr. McGrath said.
Smoking, obesity, medical conditions that impair wound healing, bleeding disorders, or a body mass index greater than 30 kg/m2 are contraindications. "Some obese women have large breasts, and many are disappointed when I tell them they should defer breast reduction until after weight loss."
Another point to counsel patients about is that lactation is not always possible after breast reduction. "I have had young women walk away from this and say, ‘It’s very important for me to breast feed my baby someday.’"
• Liposuction. The American Society of Plastic Surgeons cautions that liposuction and tummy tucks are inappropriate procedures for weight loss in teens, Dr. McGrath said. "I cannot tell you how many obese teens get referred to me for liposuction. I have to tell them it’s not the right thing ... and it will not correct your basic problem."
In contrast, lipoplasty, liposculpture, or liposuction to treat localized fat deposits can be indicated in some teenagers. "The ideal patient is at or near ideal body weight with elastic skin that will retract."
"Submental liposuction of the fat pad creating a double chin in older teenagers can be fantastic," Dr. McGrath said. It can be done in an office setting. Bruising, seroma, and bumpy appearance are potential complications. Instruct patients that they will have to wear a compression garment around their head at night for about 3 weeks.
• Gynecomastia. About 8% of all gynecomastia corrections involved patients 18 years and younger. Approximately 50% are unilateral and 50% bilateral procedures.
Gynecomastia can have a hormonal etiology and be associated with obesity. Surgical results, however, are poorer in the obese patient. "The distinction between what is gynecomastia and fat tissue gets murky in overweight patients," Dr. McGrath said.
Gynecomastia can be self-limited with an average duration of 1-2 years. For those in whom it persists, some seek surgery because "it is a source of embarrassment. Like our young women, it’s not so much the size, it’s the odd look of a protuberant breast on a male."
"The central issue with any elective plastic surgery is not the presence or absence of disease, rather the effect of the problem on the person," Dr. McGrath said. "It comes down to quality of life, and whether or not you believe improving quality of life is part of our job."
Dr. McGrath recommended the American Society for Aesthetic Plastic Surgery guidelines for evaluating teenagers considering cosmetic plastic surgery.
Dr. McGrath said she had no relevant financial disclosures.
MIAMI BEACH – Adolescents who undergo elective plastic surgery tend to "sail through surgery more easily" than adults, according to an expert.
In addition, more male teenagers seek these procedures, meaning the gender disparity is not as striking as it is among adults.
"When we do cosmetic surgery in teenagers, it is remarkably conflict free, compared with other medical interventions in teenagers, and compared with other age groups," Dr. Mary H. McGrath said. The reasons are not entirely clear – most research in adolescents addresses rhinoplasty only – but it could be because surgery comes during a time of great overall change for teenagers, she said.
Of the estimated 9.2 million surgical and nonsurgical cosmetic procedures in the United States in 2011, 18% were surgical and accounted for 63% of expenditures, according to data from the American Society for Aesthetic Plastic Surgery. Patients 18 years and younger comprised 1.4% of this total and underwent 97,214 nonsurgical and 34,663 surgical procedures.
Otoplasty was the most common 2011 elective surgical procedure in patients under the age of 18 years in 2011. About one third, 34%, of the estimated 11,000 otoplasties were performed on males. Rhinoplasty came in second on the list, with 20% of the 9,500 procedures performed in males. Breast augmentation, liposuction, and breast reduction (for cosmetic reasons) were the next most common, in order, followed by correction of gynecomastia (not surprisingly, 100% in males).
In contrast, in adult patients, more than 90% of all elective plastic surgeries are performed in women, Dr. McGrath said.
Assessment of physical and mental health is the first step when an adolescent asks about plastic surgery in the primary care setting, Dr. McGrath said at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.
Ensure the adolescent has the necessary emotional and physical maturity. "Determine that the patient has reached the growth milestone and physical maturity for that surgery. We wouldn’t do breast augmentation on a 16-year-old," for example, said Dr. McGrath, professor of surgery in the division of plastic and reconstructive surgery at the University of California, San Francisco. Also rule out any psychiatric contraindication, such as body dysmorphic disorder, she said.
Speak with the patient alone. Also talk with them with their family present to assess the degree of support. Ask the patient to articulate why they want the surgery. Ensure patient expectations are realistic. After referral, a plastic surgeon ideally will assess the specific deficit, outline what can be accomplished surgically, and describe the potential risks. Efficacy and safety considerations are critical, Dr. McGrath said.
Ask teenagers to explain how they would handle a complication. Dr. McGrath also asks them to repeat back important aspects of the discussion to ensure they understand.
Dr. McGrath shared some tips and insight on the following procedures:
• Otoplasty. The ear achieves 85% of full growth by age 3 years, which is "why kids’ ears look so big." Sometimes, the goal of surgery is to approximate symmetry. A good plastic surgeon will be familiar with the subtle anatomic features of the ear: the top of the ear is generally closer to the head than the middle, while the lobule at the bottom should stick out the most.
Otoplasty is usually an outpatient procedure. Patients can expect a bulky head dressing postoperatively, suture removal after 7-10 days, and to sleep with an elastic band around their head for 2-3 weeks. Hematoma and infection are potential early complications and residual deformity or asymmetry can emerge later. An estimated 8%-10% of patients undergo reoperations, almost always for asymmetry, Dr. McGrath said.
• Rhinoplasty. "Very rarely do we do rhinoplasty in someone younger than 17 or 18 [years old] or they can outgrow the changes in nasal contour," Dr. McGrath said. "Sometimes, I feel bad telling a 14-year-old with an exceptionally large or unattractive nose they have to wait and come back at age 17."
Prepare teenage patients for the postoperative course by showing them photos of typical patients. Tell them to expect splinting for 7 days, ecchymosis for 10-14 days, and residual swelling for 2-3 months. Postoperative changes become quickly obvious after a bony ridge removal. In contrast, a nasal tip rhinoplasty, because it involves soft tissue and more edema, can take months to see the final result.
"This is the hardest surgery we do," Dr. McGrath said. "It is complicated to understand all the pieces of the puzzle and get it right. It requires the greatest amount of art." The most common complication is bleeding in about 4% of patients.
• Breast Augmentation. Only a small minority of breast augmentation procedures, 1.5%, were performed in patients 18 years and younger in 2011. "Young women seek breast implants because their breasts look odd; it is not necessarily size that is driving it, but almost always the shape," Dr. McGrath said.
Approximately 25% of patients having breast augmentation have a reoperation within 10 years. "That is the number to know," Dr. McGrath said. "Is the likelihood of additional surgery acceptable to the patient?"
Silicone breast implants are not FDA cleared for breast reconstruction in females younger than 22 years. Therefore, only saline implants are an option in these younger patients, Dr. McGrath said. An advantage of saline implants is they can be inserted through a small incision and then filled, which is not possible with silicone gel implants.
Pain, hematoma, seroma, wound infection, and decreased skin sensation are potential complications. However, "the problems due to the implantable device are the real issues," Dr. McGrath said. Scarring can occur around 15% of implants; 8% or 9% can become malpositioned and about 7% will deflate over 5 years. In addition, patients with a family history of breast cancer may choose not to have implants.
Consultation with a qualified plastic surgeon who can focus on long-term implications is warranted, Dr. McGrath said.
• Breast Reduction. Defer surgery until full breast maturation and growth is achieved. Breast size should be stable with no continuing growth for 9-12 months, Dr. McGrath said.
Smoking, obesity, medical conditions that impair wound healing, bleeding disorders, or a body mass index greater than 30 kg/m2 are contraindications. "Some obese women have large breasts, and many are disappointed when I tell them they should defer breast reduction until after weight loss."
Another point to counsel patients about is that lactation is not always possible after breast reduction. "I have had young women walk away from this and say, ‘It’s very important for me to breast feed my baby someday.’"
• Liposuction. The American Society of Plastic Surgeons cautions that liposuction and tummy tucks are inappropriate procedures for weight loss in teens, Dr. McGrath said. "I cannot tell you how many obese teens get referred to me for liposuction. I have to tell them it’s not the right thing ... and it will not correct your basic problem."
In contrast, lipoplasty, liposculpture, or liposuction to treat localized fat deposits can be indicated in some teenagers. "The ideal patient is at or near ideal body weight with elastic skin that will retract."
"Submental liposuction of the fat pad creating a double chin in older teenagers can be fantastic," Dr. McGrath said. It can be done in an office setting. Bruising, seroma, and bumpy appearance are potential complications. Instruct patients that they will have to wear a compression garment around their head at night for about 3 weeks.
• Gynecomastia. About 8% of all gynecomastia corrections involved patients 18 years and younger. Approximately 50% are unilateral and 50% bilateral procedures.
Gynecomastia can have a hormonal etiology and be associated with obesity. Surgical results, however, are poorer in the obese patient. "The distinction between what is gynecomastia and fat tissue gets murky in overweight patients," Dr. McGrath said.
Gynecomastia can be self-limited with an average duration of 1-2 years. For those in whom it persists, some seek surgery because "it is a source of embarrassment. Like our young women, it’s not so much the size, it’s the odd look of a protuberant breast on a male."
"The central issue with any elective plastic surgery is not the presence or absence of disease, rather the effect of the problem on the person," Dr. McGrath said. "It comes down to quality of life, and whether or not you believe improving quality of life is part of our job."
Dr. McGrath recommended the American Society for Aesthetic Plastic Surgery guidelines for evaluating teenagers considering cosmetic plastic surgery.
Dr. McGrath said she had no relevant financial disclosures.
EXPERT ANALYSIS FROM THE NORTH AMERICAN SOCIETY FOR PEDIATRIC AND ADOLESCENT GYNECOLOGY
Fillers: From the Past to the Future
Richard G. Glogau, MD
Modern medical use of injectable soft-tissue augmentation fillers has evolved from the introduction of bovine collage implants to an array of synthesized materials in the current domestic and foreign markets. The concept of augmentation has moved from simple lines, scars, and wrinkles to revolumizing the aging face. A brief overview of the past, present, and future injectable fillers is presented.
*For a PDF of the full article, click on the link to the left of this introduction.
Richard G. Glogau, MD
Modern medical use of injectable soft-tissue augmentation fillers has evolved from the introduction of bovine collage implants to an array of synthesized materials in the current domestic and foreign markets. The concept of augmentation has moved from simple lines, scars, and wrinkles to revolumizing the aging face. A brief overview of the past, present, and future injectable fillers is presented.
*For a PDF of the full article, click on the link to the left of this introduction.
Richard G. Glogau, MD
Modern medical use of injectable soft-tissue augmentation fillers has evolved from the introduction of bovine collage implants to an array of synthesized materials in the current domestic and foreign markets. The concept of augmentation has moved from simple lines, scars, and wrinkles to revolumizing the aging face. A brief overview of the past, present, and future injectable fillers is presented.
*For a PDF of the full article, click on the link to the left of this introduction.
With various techniques available to address the textural changes of photoaging (such as peels and lasers, dermabrasion), the use of superficial dermal fillers and botulinum toxin left many patients with less than satisfying results, even after surgical rejuvenation.
New Frontiers in Laser Surgery
Doru T. Alexandrescu, MD, and Edward V. Ross, MD
The simultaneous advances in engineering, medicine, and molecular biology have accelerated the pace of introductions of new light-based technologies in dermatology. In this review, the authors examine recent advances in laser surgery as well as peer into the future of energy-based cutaneous medicine. The future landscape of dermatology will almost undoubtedly include (1) noninvasive imaging technologies and (2) improved “destructive” modalities based on real-time feedback from the skin surface.
*For a PDF of the full article, click on the link to the left of this introduction.
Doru T. Alexandrescu, MD, and Edward V. Ross, MD
The simultaneous advances in engineering, medicine, and molecular biology have accelerated the pace of introductions of new light-based technologies in dermatology. In this review, the authors examine recent advances in laser surgery as well as peer into the future of energy-based cutaneous medicine. The future landscape of dermatology will almost undoubtedly include (1) noninvasive imaging technologies and (2) improved “destructive” modalities based on real-time feedback from the skin surface.
*For a PDF of the full article, click on the link to the left of this introduction.
Doru T. Alexandrescu, MD, and Edward V. Ross, MD
The simultaneous advances in engineering, medicine, and molecular biology have accelerated the pace of introductions of new light-based technologies in dermatology. In this review, the authors examine recent advances in laser surgery as well as peer into the future of energy-based cutaneous medicine. The future landscape of dermatology will almost undoubtedly include (1) noninvasive imaging technologies and (2) improved “destructive” modalities based on real-time feedback from the skin surface.
*For a PDF of the full article, click on the link to the left of this introduction.
In identifying new frontiers in cutaneous laser surgery, the authors reviewed recently submitted abstracts at national meetings, examined their own research projects, and looked ahead at promising potential applications that might enhance our laser arsenal in the future.
The Horizon for Treating Cutaneous Vascular Lesions
Amit M. Patel, MD* Elizabeth L. Chou, BS, Laura Findeiss, MD, and Kristen M. Kelly, MD
Dermatologists encounter a wide range of cutaneous vascular lesions, including infantile hemangiomas, port-wine stain birthmarks, arteriovenous malformations, venous malformations, Kaposi sarcomas, angiosarcomas, and angiofibromas. Current treatment modalities to reduce these lesions include topical and/or intralesional steroids, laser therapy, surgical resection, and endovascular therapy. However, each method has limitations owing to recurrence, comorbidities, toxicity, or lesion location. Photodynamic therapy, antiangiogenic therapy, and evolving methods of sclerotherapy are promising areas of development that may mitigate limitations of current treatments and offer exciting options for patients and their physicians.
*For a PDF of the full article, click on the link to the left of this introduction.
Amit M. Patel, MD* Elizabeth L. Chou, BS, Laura Findeiss, MD, and Kristen M. Kelly, MD
Dermatologists encounter a wide range of cutaneous vascular lesions, including infantile hemangiomas, port-wine stain birthmarks, arteriovenous malformations, venous malformations, Kaposi sarcomas, angiosarcomas, and angiofibromas. Current treatment modalities to reduce these lesions include topical and/or intralesional steroids, laser therapy, surgical resection, and endovascular therapy. However, each method has limitations owing to recurrence, comorbidities, toxicity, or lesion location. Photodynamic therapy, antiangiogenic therapy, and evolving methods of sclerotherapy are promising areas of development that may mitigate limitations of current treatments and offer exciting options for patients and their physicians.
*For a PDF of the full article, click on the link to the left of this introduction.
Amit M. Patel, MD* Elizabeth L. Chou, BS, Laura Findeiss, MD, and Kristen M. Kelly, MD
Dermatologists encounter a wide range of cutaneous vascular lesions, including infantile hemangiomas, port-wine stain birthmarks, arteriovenous malformations, venous malformations, Kaposi sarcomas, angiosarcomas, and angiofibromas. Current treatment modalities to reduce these lesions include topical and/or intralesional steroids, laser therapy, surgical resection, and endovascular therapy. However, each method has limitations owing to recurrence, comorbidities, toxicity, or lesion location. Photodynamic therapy, antiangiogenic therapy, and evolving methods of sclerotherapy are promising areas of development that may mitigate limitations of current treatments and offer exciting options for patients and their physicians.
*For a PDF of the full article, click on the link to the left of this introduction.
Fractionation: Past, Present, Future
Nazanin Saedi, MD, H. Ray Jalian, MD, Anthony Petelin, MD, and Christopher Zachary, MBBS, FRCP
The development of fractional photothermolysis is a milestone in the history of laser technology and cutaneous resurfacing. Based on the concept that skin is treated in a fractional manner, where narrow cylinders of tissue are thermally heated and normal adjacent skin is left unaffected, the fractional devices have shown effectiveness in treating a variety of conditions. Since its development, we are becoming more adept at using optimal parameters to induce near carbon dioxide laser benefits with a much more comfortable postoperative period and fewer complications. The future remains bright for fractionated laser devices and with new devices and wavelengths, the applications of this technology continue to grow.
*For a PDF of the full article, click on the link to the left of this introduction.
Nazanin Saedi, MD, H. Ray Jalian, MD, Anthony Petelin, MD, and Christopher Zachary, MBBS, FRCP
The development of fractional photothermolysis is a milestone in the history of laser technology and cutaneous resurfacing. Based on the concept that skin is treated in a fractional manner, where narrow cylinders of tissue are thermally heated and normal adjacent skin is left unaffected, the fractional devices have shown effectiveness in treating a variety of conditions. Since its development, we are becoming more adept at using optimal parameters to induce near carbon dioxide laser benefits with a much more comfortable postoperative period and fewer complications. The future remains bright for fractionated laser devices and with new devices and wavelengths, the applications of this technology continue to grow.
*For a PDF of the full article, click on the link to the left of this introduction.
Nazanin Saedi, MD, H. Ray Jalian, MD, Anthony Petelin, MD, and Christopher Zachary, MBBS, FRCP
The development of fractional photothermolysis is a milestone in the history of laser technology and cutaneous resurfacing. Based on the concept that skin is treated in a fractional manner, where narrow cylinders of tissue are thermally heated and normal adjacent skin is left unaffected, the fractional devices have shown effectiveness in treating a variety of conditions. Since its development, we are becoming more adept at using optimal parameters to induce near carbon dioxide laser benefits with a much more comfortable postoperative period and fewer complications. The future remains bright for fractionated laser devices and with new devices and wavelengths, the applications of this technology continue to grow.
*For a PDF of the full article, click on the link to the left of this introduction.
Ablative Fractional Resurfacing for the Treatment of Traumatic Scars and Contractures
Nathan S. Uebelhoer, DO, E. Victor Ross, MD, and Peter R. Shumaker, MD
After a decade of military conflict, thousands of wounded warriors have suffered debilitating and cosmetically disfiguring scars and scar contractures. Clearly, there is a need for effective scar treatment regimens to assist in the functional and cosmetic rehabilitation of these patients. Traditional treatments, including aggressive physical and occupational therapy and dedicated wound care, are essential. Adjunctive treatments with established laser technologies, such as vascular lasers and full-field ablative lasers, have had a somewhat limited role in scar contractures due to modest efficacy and/or an unacceptable side effect profile in compromised skin. Refractory scar contractures often require surgical
revision, which can be effective, but is associated with additional surgical morbidity and a significant risk of recurrence. Furthermore, current scar treatment paradigms often dictate scar maturation for approximately a year to allow for spontaneous improvement before surgical intervention. Since 2009, the Dermatology Clinic at the Naval Medical Center San Diego has been treating scars and scar contractures in wounded warriors and others using ablative fractionated laser technology. Although traditionally associated with the rejuvenation of aged and photo-damaged skin, our clinical experience and a handful of early reports indicate that laser ablative fractional resurfacing demonstrates promising efficacy and an excellent side effect profile when applied to the functional and cosmetic enhancement of traumatic scars and contractures. This article discusses our clinical experience with ablative fractional resurfacing and its potential prominent role in rehabilitation from traumatic injuries, including a possible shift in scar treatment paradigms toward earlier procedural intervention. Potential benefits include the optimization of scar trajectory and higher levels of full or adapted function in a more favorable time course.
*For a PDF of the full article, click on the link to the left of this introduction.
Nathan S. Uebelhoer, DO, E. Victor Ross, MD, and Peter R. Shumaker, MD
After a decade of military conflict, thousands of wounded warriors have suffered debilitating and cosmetically disfiguring scars and scar contractures. Clearly, there is a need for effective scar treatment regimens to assist in the functional and cosmetic rehabilitation of these patients. Traditional treatments, including aggressive physical and occupational therapy and dedicated wound care, are essential. Adjunctive treatments with established laser technologies, such as vascular lasers and full-field ablative lasers, have had a somewhat limited role in scar contractures due to modest efficacy and/or an unacceptable side effect profile in compromised skin. Refractory scar contractures often require surgical
revision, which can be effective, but is associated with additional surgical morbidity and a significant risk of recurrence. Furthermore, current scar treatment paradigms often dictate scar maturation for approximately a year to allow for spontaneous improvement before surgical intervention. Since 2009, the Dermatology Clinic at the Naval Medical Center San Diego has been treating scars and scar contractures in wounded warriors and others using ablative fractionated laser technology. Although traditionally associated with the rejuvenation of aged and photo-damaged skin, our clinical experience and a handful of early reports indicate that laser ablative fractional resurfacing demonstrates promising efficacy and an excellent side effect profile when applied to the functional and cosmetic enhancement of traumatic scars and contractures. This article discusses our clinical experience with ablative fractional resurfacing and its potential prominent role in rehabilitation from traumatic injuries, including a possible shift in scar treatment paradigms toward earlier procedural intervention. Potential benefits include the optimization of scar trajectory and higher levels of full or adapted function in a more favorable time course.
*For a PDF of the full article, click on the link to the left of this introduction.
Nathan S. Uebelhoer, DO, E. Victor Ross, MD, and Peter R. Shumaker, MD
After a decade of military conflict, thousands of wounded warriors have suffered debilitating and cosmetically disfiguring scars and scar contractures. Clearly, there is a need for effective scar treatment regimens to assist in the functional and cosmetic rehabilitation of these patients. Traditional treatments, including aggressive physical and occupational therapy and dedicated wound care, are essential. Adjunctive treatments with established laser technologies, such as vascular lasers and full-field ablative lasers, have had a somewhat limited role in scar contractures due to modest efficacy and/or an unacceptable side effect profile in compromised skin. Refractory scar contractures often require surgical
revision, which can be effective, but is associated with additional surgical morbidity and a significant risk of recurrence. Furthermore, current scar treatment paradigms often dictate scar maturation for approximately a year to allow for spontaneous improvement before surgical intervention. Since 2009, the Dermatology Clinic at the Naval Medical Center San Diego has been treating scars and scar contractures in wounded warriors and others using ablative fractionated laser technology. Although traditionally associated with the rejuvenation of aged and photo-damaged skin, our clinical experience and a handful of early reports indicate that laser ablative fractional resurfacing demonstrates promising efficacy and an excellent side effect profile when applied to the functional and cosmetic enhancement of traumatic scars and contractures. This article discusses our clinical experience with ablative fractional resurfacing and its potential prominent role in rehabilitation from traumatic injuries, including a possible shift in scar treatment paradigms toward earlier procedural intervention. Potential benefits include the optimization of scar trajectory and higher levels of full or adapted function in a more favorable time course.
*For a PDF of the full article, click on the link to the left of this introduction.
Body Contouring: The Skinny on Noninvasive Fat Removal
H. Ray Jalian, MD*, and Mathew M. Avram, JD, MD
Historically, the approach to body contouring has largely involved invasive procedures, such as liposuction. Recently, several new devices for noninvasive fat removal have received clearance by the Food and Drug Administration for the treatment of focal adiposity. Modalities are aimed primarily at targeting the physical properties of fat that differentiate it from the overlying epidermis and dermis, thus selectively resulting in removal. This review will focus on 3 novel approaches to noninvasive selective destruction of fat.
*For a PDF of the full article, click on the link to the left of this introduction.
H. Ray Jalian, MD*, and Mathew M. Avram, JD, MD
Historically, the approach to body contouring has largely involved invasive procedures, such as liposuction. Recently, several new devices for noninvasive fat removal have received clearance by the Food and Drug Administration for the treatment of focal adiposity. Modalities are aimed primarily at targeting the physical properties of fat that differentiate it from the overlying epidermis and dermis, thus selectively resulting in removal. This review will focus on 3 novel approaches to noninvasive selective destruction of fat.
*For a PDF of the full article, click on the link to the left of this introduction.
H. Ray Jalian, MD*, and Mathew M. Avram, JD, MD
Historically, the approach to body contouring has largely involved invasive procedures, such as liposuction. Recently, several new devices for noninvasive fat removal have received clearance by the Food and Drug Administration for the treatment of focal adiposity. Modalities are aimed primarily at targeting the physical properties of fat that differentiate it from the overlying epidermis and dermis, thus selectively resulting in removal. This review will focus on 3 novel approaches to noninvasive selective destruction of fat.
*For a PDF of the full article, click on the link to the left of this introduction.