Standard - Wiley Online Library

50
American
Society
for Laser
Medicine
Purpose: The purpose of this study was to compare the results produced
by laser vs. sclerotherapy both subjectively and objectively.
Methods: Twenty patients with leg veins 0.7 to 3 mm in diameter with
two comparable sites preferable on bilateral legs. One 7x1 I cm area was
injected with sotradecol and the other site was treated with the Lyra
1064nm laser at 150- 190 J/cm2 and 50 - 100 ms, 3 -5 mm spot size
using the coolspot handpiece and cool gel. Pre and post op photos were
taken. The patients followed up at eight weeks for a possible retreatment
of the laser site. 80% of the patients received a second treatment. Photos
were taken at each visit. The final follow up was at 3 months at which
the patients were asked to complete a Quality of Life survey. Three
blinded physicians reviewed the pre-op and 3 month post op slides.
Results: The quality of life surveys tabulated that 35% of the patients
preferred the laser treatments to sclerotherapy; 45 % choose sclerotherapy
and 20% were undecided. Scores tabulated by the three blinded observers
showed that on a scale from 0 - 4 (0 = no clearance, 2 = I- 25%
clearance, 3 = 51 - 75% clearance, and 4 = 76 - 100% clearance) the
laser treatment site averaged 2.50 on the improvement scale and the
sclerotherapy averaged 2.30.
Conclusion: This study demonstrated that the long pulsed Nd:YAG can
yield comparable results in the treatment of blue leg veins up to 3 mm in
diameter.
217
TREATMENT
OF BROWN
FACIAL
PATCHES
IN ASIAN
PATIENTS
WITH Q-SWITCHED
ALEXANDRITE
AND QSWITCHED
RUBY LASERS.
Richard
E. Fitzpatrick
and Syed
Amity.
Dermatology
Associates
of San Diego County,
Inc., La Jolla,
CA
Purpose:
To evaluate response and side effects, treatment of facial
brown patches (melasma, junctional
nevi, lentigines, and nevus of Ota)
using Q-switched
lasers.
Method:
Fifteen patients with brown facial patches were treated with
Q-switched
alexandrite
and Q-switched
ruby lasers in l-3 treatment
sessions.
Results:
Excellent cosmetic results were achieved in all patients even
though 100% elimination
of pigmentation
was not possible. All patients
experienced
at least 75% improvement
in pigmentation
and were
satisfied with the results. The main side effect of treatment was postinflammatory
pigmentation
which was successfully
treated with
sunscreen, Retin-A and topical vitamin C. Multiple treatment sessions
were often necessary.
Conclusions:
Q-switched
alexandrite
and Q-switched
ruby lasers are
effective modalities
for treatment of brown patches (melasma, junctional
nevi, lentigines, and nevus of Ota) in Asian patients.
and Surgery
Abstracts
Methods:
Twenty skin specimens fi-om patients with basal cell carcinoma
(BCC) excised using MMS technique were used in this study. After the
frozen section slides stained with hematoxylin
and eosin (H&E) were
prepared and read by a Mohs surgeon, the remainder of the skin sample
was scanned with the CLMS. The maps from CLMS and H&E outlining
basal cell carcinoma in these samples were compared.
Results:
Maps from CLMS correlated
well with maps from H&E for
large masses of nodular or superficial BCC. For less well defined, smaller
masses of nodular/superficial
BCC and morpheaform
BCC samples, the
correlation
between the maps was more difficult to obtain.
Conclusions:
The CLMS images correlate
well with H&E frozen
sections from MMS containing large masses of nodular/superficial
BCC.
With this current system, CLMS may be useful in MMS to screen out
grossly positive margins in a relatively short amount of time.
219*
EXTENDED
THEORY
OF SELECTIVE
PHOTOTHERMOLYSIS
G.B. Altshuler’,
R.R. Anderson’,
D. Manstein2,
H.H. Zenzie’,
M.Z.
Smimov’
‘Palomar Medical Technologies,
Burlington,
MA
’ Wellman Laboratories
of Photomedicine,
Massachusetts
General
Hospital, Boston, MA
‘Institute of Fine Mechanics
and Optics, St. Petersburg,
Russia
The theory of selective photothermolysis
(SP) developed by Anderson
and Parrish is applicable to the case where the target has uniformly
distributed
chromophore
and is damaged by direct heating. The laser
wavelength
and pulsewidth
are chosen to produce
selective
target
damage while leaving the surrounding
tissue unaffected.
However,
in
certain cases (e.g. hair follicle),
part of the target may not contain
chromophore
and therefore must be damaged by heat diffusion
from
pigmented areas within the target. Three parameters
of the light source
must be properly chosen to achieve optimum target damage using this
method. First, similar to SP, the light-source
wavelength
must be
selectively
absorbed by the pigmented areas within the target. Second.
the light pulsewidth
should be approximately
equal to the thermal
damage time (TDT), which is the time required to thermally
damage
the entire target (including
both pigmented
and unpigmented
areas)
while leaving
the surrounding
tissue
unaffected.
The TDT
is
significantly
longer than the thermal
relaxation
time due to the
requirement
that the temperature
at the target boundary
be in the 65
70°C range required for thermal denaturation.
Third, the power density
must be sufficient
to raise the target temperature
above the thermal
damage threshold;
however,
it must be low enough
to prevent
chromophore
destruction
and subsequent
absorption
loss in the
pigmented
area. In combination
with contact
cooling
during light
application
to protect the epidermis,
this new method can be used for
hair removal and leg vein treatment.
218
COMPARISON
BETWEEN
CONFOCAL
LASER
SCANNING
MICROSCOPE
IMAGES
AND FROZEN
SECTION
HISTOLOGY
OF
BASAL
CELL
CARCINOMA
FROM
MOHS
MICROGRAPHIC
SURGERY
S. Brian Jianq, Joseph A. Lower-y, Lara Kelley
Dermatologic
Surgery Unit of Beth Israel Deaconess Medical Center,
Harvard Medical School, Boston, MA
Purpose:
Confocal
Laser Scanning Microscope
(CLMS)
is a FDA
approved
imaging device which provides real time magnified images
(4 000X) of skin up to 500 microns in depth in about 5 minutes.
The
purpose of this study is to compare the images of CLMS with frozen
section histology from Mohs Micrographic
Surgery (MMS).
POSTERS
223
TREATMENT
WITH
THE
(FLPDL)
OF HYPERTROPHIC
585nm - FLUSH
IN ASIAN
SKIN
SCARS
LUMP
(HS)
PUMPED
AND
DYE
KELOIDS
LASER
American
I
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K;IYO~O
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1 : I)q~arlmcnl.
Mc(licinc,
‘li)yo;lk(?,
Surp-y
M;li,sun;lgi~‘,
of’ I)orm;ll,ology,
Clinic,
Aichi
IC(lc:orlsl,rrlc:l,iv(~
I Ic;ltLh
for Laser
Yo~Ic~:~”
School
2 : Suzuki
:I : I)cparf,mont,
I+‘rl.jiI.;l
Kci
lJnivcrsit,y
rJ:ll)iln.
192,
cJill);ln.
Surgery,
Suzuki’,
I~~!jit,;~ I I(!alf,h
170-l
Kyob,
I I;lru(?
Society
of’
I’lasl,ic:
of’ I’lasl~ic:
University
and
School
of’
M(I(Iicino.
1i’wpwr!l ‘I%(! numt)c?r
Wll,tl
1~111’1)11 hilS
14’1,l’l)l,
l,rc~al,rnc~nl,
l);lt,ic!nts
J)ilrt,ic:il);ll,(~(l
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Many
Lr(~;llmon&
fi)r
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sirnl~lc~.
WC
I IS ;If’lcr
irnl~rovc?mcnl,.
SigJlih:ilJlb
(Io(:roilsc
show(?tI
f’rom
ciitln’l,
laser
The
f,ho 2 casts
I
11,shouI(I
il low
incitlcncc~
t)(! in(Iic:;ll,c?(l
of’ l.hc
~SuI~~jc?cA,s~36
t,o any
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LJnivcrsit.y
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cooling
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syst.cm.
irradi;lLion.
of’ c!ryl.hcm;rl.ous
improvcmcnt,
pcrfbrm
irr;ldial,ion,
ot,hcr
many
irradi;ll,ion
of’ microvcssc!ls.
and
c:onsctrv;lt,ivc
casts
achicvcd
findings
showed
of’ t,hc
signif’icant,
IConclusionl
of’ sick? c?f’fi!c:l,s, and
fi)r I IS ;lnd kcloids
c:oIor
of’ height,
hisl.ot);ll,holoRic:aI
;If’l,(br las(!r
ol’c~xc:c~ssivc~ t~roIili~rat,ion
(::IIIS(!S
(Clinic.
some
kcloitls
:IJI~~
had nol, rcspondd
b’ujit,a
SOCJI was f,hc imI~rovc?mcnl,
(:ils(!s
skin.
1hc usc of’ t,hc clynamic:
no (:x;l(:(~rt);lLc?(l
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tiirr(trwss.
They
of’ t IS
f,hc cf’ficacy
in Asian
visil,c?(l
Surgery
wil,houl,
wils
Mosl. (\f’li~(:t,ivc?rlr!ss
Wl/:H;).
f,i~s~lc!s
an(I
l’l:~sLi(:
b’l ,l’l)l,
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kdoitls
in lohis sLutly.
or Srlzuki
wil,h
OJI l,rcii!,mcnl,
WC invcsl,igat.ccI
I IS an(I
OJI
!,r(?ir1,JTIc!Jl~,
I Iosl)il,al
i,hc:m
of’ !.hc rcporl,
irlc:rc?ilsc!tl.
‘I’hc
t,hc mc?t,hotl
in Asian
skin.
is
Medicine
and Surgery
Abstracts
225
TREATMENT OF FACIAL TELANGIECTASIA WITH
MODIFIED HIGH-FLUENCE PULSED-DYE LASER:
COMPARISON OF EFFICACY WITH FLUENCES
IMMEDIATELY ABOVE AND BELOW THE PURPURA
THRESHOLD
Murad Alam, MD,’ Jeffrey S. Dover, MD, ly2Kenneth A. Amdt,
MDlJ
‘SkinCare Physicians of Chestnut Hill, Chestnut Hill, MA; 2Beth
Israel Deaconess Medical Center, Boston, MA; 3Harvard Medical
School, Boston, MA
Purpose:
To investigate whether the high-fluence modified pulseddye laser is effective in the treatment of fine facial telangiectasia in
the absence of post-treatment purpura. Methods:
Symmetrical,
matched areas of telangiectatic skin on the left and right sides of
subjects’ faces were assigned to be control or treatment sites,
respectively. A third, small area of the face with telangiectasia was
used to determine the minimum fluence required to elicit nontransient purpura within 10 minutes after treatment with a modified
pulsed-dye laser device (V-beam, Candela, Wayland, MA, 595 nm,
4-15 J/cm2). Designated treatment areas were then treated with the
minimum purpura fluence, and the control areas, with a fluence 1
J/cm2 less than this threshold. Other parameters, including pulse
duration and cooling, were equivalent. Subjects returned for
evaluation of degree of purpura three days and one week after
treatment. Resolution of telangiectasia at both sites was assessed
after one month. Results: In selected patients, telangiectasia treated
with fluences below the purpura threshold were less improved than
telangiectasia treated with fluences above the purpura threshold.
Conclusions:
While pulsed-dye laser can effectively treat
telangiectasia at both low and high fluences, high fluences that
induce significant purpura may be more efficacious than low
fluences resulting in minimal purpura.
224
CANDIDA COLONIZATION OF SKIN AFTER LASER
RESURFACING: AN INNOCENT BYSTANDER OR A CAUSE
OF PRURITUS
Murad Alam, MD,’ Nayomi E. Omura, MD,’ Kenneth A. Amdt,
MD,*‘* Jeffrey S. Dover, MD ly3
*Skin&e Physicians of Chestnut Hill, Chestnut Hill, MA; 2Harvard
Medical School, Boston, MA; 3Beth Israel Deaconess Medical
Center, Boston, MA
Purpose:
To investigate whether the facial skin of patients with
post-laser resurfacing pruritus is concurrently colonized or infected
with Candida species. Methods:
Candida cultures were obtained
from the facial skin of patients undergoing elective till-face
resurfacing of the face with CO2 laser, Er:YAG laser, or combination
CO2 and Er:YAG lasers. Cultures were collected immediately
before resurfacing, and at post-operative days 3 and 6. All sampled
areas were at least one centimeter distant from mucosal surfaces of
the mouth, nose, or eyes. At each culture collection session,patients
were asked about the extent to which they were experiencing various
symptoms, including pain and pruritus, and the results were entered
on a data collection sheet. Results: Candida colonization appears to
be associated with facial pruritus and postoperative discomfort in
some but not all post-laser resurfacing patients who complain of
significant pruritus. Conclusions:
While Candida colonization or
infection may be etiologically related to post-laser resurfacing
pruritus, further studies are needed to confirm such an association.
Clinicians confronted with post-resurfacing patients presenting with
pruritus should consider the possible role of Candida.
COMMERCIAL FEASIBILITY OF AN EXCIMER LASER FOR
TREATMENT OF PSORIASIS
Murad Alam, MD,’ Kenneth A. Amdt, MD,ly2 Jay A. Goldstein,
MD,3 Jeffrey S. Dover, MD,ly4 Michael L. Rothman, MD,’ Robin L.
Travers, MD ’
‘SkinCare Physicians of Chestnut Hill, Chestnut Hill, MA; 2Harvard
Medical School, Boston, MA; 3Boston University School of
Medicine, Boston, MA; 4Beth Israel Deaconess Medical Center,
Boston, MA; ‘Innovative Clinical Solutions Limited, Providence, RI
Purpose:
Clinical studies have demonstrated that excimer lasers can
induce regression of psoriatic plaques. The purpose of this study
was to investigate the commercial feasibility of such an excimer
laser for treatment of plaque-type psoriasis. Methods:
A nonrandomized, prospective multicenter trial enrolled patients with
plaque-type psoriasis of the trunk affecting 1- 10% of body surface
area. Initial minimum erythema dose (MED) testing was followed
by 4-10 treatments, administered twice weekly, with a 308 run
xenon chloride excimer laser (XTRAC, PhotoMedex, Radnor, PA).
Photographs of treatment sites and psoriasis area and severity index
(PASI) scores were obtained before initiation of treatment and after
treatment conclusion in each patient. Subjects also completed a
quality of life questionnaire before and after treatment. The
treatment process was managed by a non-transferable key card
system, which permitted each patient 1- 10 treatments over a fixed
51
52
American
Society
for Laser
Medicine
time interval.
Results:
Investigator
and patient assessments
indicated improvement
in psoriasis plaques after short-term
treatment with the excimer laser key card system. Conclusions:
Excimer laser is an effective treatment modality for psoriasis that
can improve plaque-type
lesions. Moreover,
the currently available
key card protocol is a commercially
feasible delivery system.
227
TREATMENT
OF A VARIETY
OF PIGMENTED
LESIONS
WITH
THE LIGHTSHEER
DIODE
LASER
SYSTEM
Marla L. McClaren,
Vera A. Chotzen,
Suzanne L. Kilmer.
Laser &
Skin Surgery
Center of Northern
California,
Sacramento,
CA.
The purpose of this study is to determine the safety and efficacy of the
Light Sheer Diode Laser System (Coherent)
in removal of pigmented
lesions including intradermal
melanocytic
nevi, epidermal nevi, nevus
spilus, lentigos, seborrheic
keratoses, cafk au lait macules and melasma.
Patients were consented and lesions were photographed,
then treated with
the LightSheer
at 40-60 J/cm2 with 20-30 msec pulse durations.
l-3
pulses per lesion were utilized and lighter lesions (less pigment) were
treated with the chill tip off. Many of the smaller pigmented lesions were
wiped away with wet gauze immediately
after treatment.
For larger
lesions, the overlying
epidermis of the treated pigmented lesion was left
in place. Wound care consisted of emollients
until complete
reepithelialization
occurred.
Follow up visits were 2-6 weeks later, at
which time photographs
were taken and lesions were retreated if portions
of the lesion remained.
Results showed that the more superficial
pigmented
lesions were ablated in a single treatment and only 25% of
lesions required a second treatment (usually deeper nevi). Longer term
follow up suggests the treatment is permanent for dermal nevi, lentigos,
seborrheic
keratosis and nevus spilus. The cafi au lait macules have had
only short term follow up. Although
the melasma cleared completely
at
the time of treatment it had returned by one month follow up. Skin types
I-V were included with no evidence of post inflammatory
dyspigmentation.
Patient satisfaction
was very high. While skin cooling
is beneficial
for epidermal protection,
in the case of lighter lesions in
lighter skin types, turning off the chill tip allows this laser system to
better target the pigmented lesion with excellent cosmetic results. For
darker skin types, the chill tip may need to be left on to protect any
surrounding
epidermis.
In summary,
we present an effective treatment
for pigmented
lesions utilizing the LightSheer
Diode Laser System which
has the appropriate
fluence and pulse durations as well as the option of
disengaging
the chill tip to better target lighter lesions. Comparisons
underwav
with the CoolGlide
(1064nm)
and Apogee (Cynosure.
755nm).
and Surgery
Abstracts
received a series of intense pulsed light treatments at three week
intervals. A single pass of double pulsed light with fluences of 30 to 36
J/cm2 was used.
Results: All patients showed visible improvement in wrinkling,
lentigines, freckling and skin laxity of all treated areas. No scarring or
serious complications were observed with the technique used. There
was minimal or no patient downtime following treatments. Treatments
were readily tolerated using only a topical lidocaine anesthetic cream.
Conclusion: Intense pulsed light is an effective and safe modality in the
visible improvement of photoaged non-facial skin.
229
PHOTOSENSITIZERS
ACCUMULATION
IN SPONTANEOUS
MDR-1
RESISTANT
CELLS (RHODAMINE
123, ROSE
BENGAL
ACETATE
AND PHOTOFRIN)
A.C. Croce,
K.S. Lanza,
S. Fiorani,
R. Supine*,
D. Locatelli,
P.
Baglioni”,
G. Bottiroli.
Center for Histochemistry,
CNR, University,
Pavia;
*National
Tumor
Institute,
Milano;
“Chemistry
Dept.,
University,
Firenze,
ITALY
One
of the most
important
causes
of cross-resistance
to
chemotherapeutic
agents
is the overexpression
of transporter
related proteins,
as in the case of MDR-1
resistance
mechanism.
In this work
the influence
of MDR-1,
and of other
eventual
phenotype
changes
accompanying
the rising of resistance,
was
studied
in relation
with
the
intracellular
accumulation
of:
Rhodamine
123 (R123),
typical substrate
of MDR-1 ; Rose Bengal
(RB),
administered
as Rose
bengal
acetate,
a fluorogenic
substrate,
which accumulation
depends
on the balance
of three
processes:
substrate
influx,
esterase
hydrolysis,
product
efflux;
which intracellular
accumulation
depends
on the
and Photofrir?,
aggregated
species
and on the disaggregation
process.
Two
cultured
cell lines expressing
MDR-1
were used: Bl6, and A2780,
derived
respectively
from a mouse
melanoma
and from a human
ovarian
carcinoma.
The study
was performed
by means
of
microspectrofluorimetric
analysis
on single cells and biochemical
evaluation
on cell extracts.
Data
obtained
showed
that,
as
expected,
MDR-1
plays a very important
role in the accumulation
process
of R123.
Verapamil,
a specific
inhibitor
of MDR-1,
demonstrated
a participation
of MDR-1 on the extrusion
of RB and
Photofrin@,
although
to different
extents.
As to Photofrir?,
different
intracellular
turnovers
take place in the cell variants,
and influence
the release
of the fluorescent
fractions,
that is favored
in resistant
cells than in wild type. A greater
accumulation
of RB in resistant
cells than in the wild types was found, explained
by the increased
esterase
activity
and membrane
traffic,
counterbalancing
the
improved
extrusion
of the product.
Work supported
by CNR “Target
Project
Biotechnology”
228*
REJUVENATION
OF PHOTOAGED NONFACIAL
SKIN USING
INTENSE PULSED LIGHT
Patrick Bitter, Jr
Campbell, CA
Purpose: Multiple modalities are available for rejuvenation of
photoaged facial skin. Fewer options are available or effective for nonfacial skin. The use of intense pulsed light for improvement of
photoaged facial skin has been recently reported. The purpose of this
study was to assses the effectiveness of a series of intense pulsed light
treatments in the improvement of photodamaged non- facial skin.
Methods: A broad band intense pulsed light source emitting noncoherent light in the visible range was used for all treatments. Patients
with photodamage of the neck, chest, dorsal hand or forearm skin
Title: CAN THE
TREATMENT
PRETREATMENT
CONGENITAL
NAEVI(CMN).
Authors: R Dave,
Laser Treatment
Aim: The aim of
of a pretreatment
laser for CMN.
RESULT
OF LASER
BE PREDICTED
BY A
BlOPSY
FOR
MELANOCYTIC
P Mahaffey.
Centre, Bedford UK.
the study was to determine the role
biopsy in predicting the efficacy of
American
Methods:
40 patients
referred
with CMN
were
included in the study. A punch biopsy was taken at
the preliminary
consultation
for diagnostic
purposes
and in the hope of assessing correlation
to treatment
outcome. A concomitant
test patch was also carried
out. The histology
service
was also asked to
comment
on the depth of pigment and if possible
deepest extent of melanocytic
tissue. Patients were
entered
into the treatment
program
which
was
continued
until a useful response was obtained or
otherwise.
Results: The correlation
between the depth of the
pigment and response to laser treatment was poor.
Conclusion:
A simple depth assessment
of the
pigment
cells is not a reliable
indicator
to
responsiveness
of a melanocytic
lesion to laser
treatment.
A better indicator may be depth of naevus
cells within the lesion.
231
Society
for Laser
Medicine
and Surgery
53
Abstracts
laver;
4 the SMAS and its extension into the
temporal and platysmal areas.Weperform the
surgical facelift with the Co2 laser. By
shrinking the temporal, malar, SMAS and
platysmal fat and aponeurosis,we tighten the
laxed, soft tissuesand also releasethe tension
of the closureline.The final stage is the facial
resurfacing. These three stagescomplement
and supplement each other and becauseof
their additive actions, each individual
procedure does not have to be pushed to a
maximumThis results in lesscomplications
and a shorter recovery time. The operating
time is greatly reduced (lesssuturing and
hemostasis)andwe obtain a stronger
rejuvenation.(3 layers).
233*
Title:THE
ROLE OF THE ULTRAPULSE
LASER IN TREATMENT
OF BOWENS
DISEASE
OF THE LEGS.
R Dave, B.Monk, P Mahaffey.
Laser Treatment Centre, Bedford Hospital, Bedford,
UK.
Purpose: The aim of the study was to determine if
the carbon-dioxide
laser could be used to treat
Bowens disease on the legs.
Methods: This was a prospective
study wherein
patients were recruited after gaining informed
consent. 16 patients with 25 biopsy proven lesions
were included in the study. The treatment was
carried out by the ultrapulse laser with the 3mm hand
piece at suitable settings. Passes were made until
dermal shrinkage was observed. The treated areas
were left to heal by secondary intention.
Results: 8 lesions took longer than 4 weeks to heal
but all of them were healed by 8 weeks. No clinical
recurrence was noted at the 6 month visit. The
patients were able to look after the treated sites on
their own without the need for bulky dressings. 2
patients developed infections which needed dressings
and antibiotics.
Conclusion:
Ultrapulse laser is a safe modality for the
treatment of Bowens Disease of the legs. It also
presents significant advantages over other treatments
like cryotherapy
and surgical excision.
THE SHRINKAGE OF THE
S.M.A.S WITH THE CO2 LASER.
Michel de Cordier,M.D.
Kim Julian, M.D.
Cosmetic Laser Clinic, Copenhagen,
Denmark
The superior resultsof a facelift combined
with immediate laser resurfacing are well
known by now.We have added to this the
laser resurfacing of the third and deepest
234
ABLATIVE
AND
NONABLATIVE
ER:YAG
LASER: HISTOLOGICAL
Brigita DrnovSek-Olup,
Aleksander
Ljubljana, Slovenia.
SKIN
RESURFACING
AND CLINICAL
ASPECTS
Rotter, University
Clinical
Purpose: To present histological
and clinical
ablative and nonablative
skin resurfacing.
findings
with Er:YAG
WITH
Center
laser,
54
American
Society
for Laser
Medicine
Methods:
A new type of Er:YAG
laser (Fotona Fidelis) with variable
pulselength
has been used. Pulse duration
varies between
100~s and
1000~s. The laser pulses were selected as VSP (very short pulse - 100~s).
SP (short pulse - 3OOps), and VLP (very long pulse - 1000~s).
Ablative
skin resurfacing
has been performed
with SP (energy 25OmJ,
spot diameter 5mm and repetition rate 12- 15 Hz), with 60% overlapping.
Non ablative skin resurfacing
has been performed
with VLP (1 ms, energy
23OmJ, spot diameter 5mm and frequency
lOHz).VLP
laser pulses have
been used for stronger thermal effects on the tissue, with less ablation.
No special pretreatment
therapy has been used. -411 procedures
have been
performed
in local anesthesia.
Laser irradiation
has been performed
to upper and lover eyelids and
specimen
have been taken during blepharoplasty.
Specimen has been
histologicaly
examined.
Results: Histological
pictures
show deeper heating effects
in ablative
skin resurfacing
with high degree of overlapping
(70~),
than in
nonablative
(30-50~).
Uncomplete
ablation was observed
histologicaly
and clinically
in cases treated with VLP. Final
cosmetic
results were
good in both cases. but better in ablative.
Conclusions:
new generation
of Er:YAG
laser offers wide possibilities
for skin resurfacing.
235
EPILATION
WITH
A DIODE
LASER
COMPARED
TO
FLASH
LIGHT:
QUICKER
AND MORE
PERMANENT?
Sabine Stangl, Michael Drosner , Barbara Hertenberger
cutaris Institute for Laser Research in Dermatology,
Munich, Germany
A
The epilation technique
using a flash lamp (intense light source =
IPL) has been widely performed.
To compare the efficiency
of IPL to
recently
developed
modalities,
such as a diode laser, 13 volunteers
(11 f, 2 m, mean age 26,8 y, 23-68 y) were treated on one side with a
non-coherent
filtered flash lamp (EpiLightTM)
and on the opposite side
with a diode laser system (LightSheerTM).
Hair counts where obtained
before each treatment
within marked
rectangles.
At this time, the 3 months follow up is completed
and
consecutive
hair
counts
have
been performed
in 8 different
localizations
(back, bikini, cheek, chin, hypogastrium,
forearm,
neck,
upper lip) prior to each repeated treatment
after intervals
of 4 (face)
or 4-6 (body)
weeks.
In response
to the clinical
reaction,
the
following
parameters
were used: 25-40 J/cm2 and up to 30 ms for the
diode laser, 3 l-50 J/cm2 and 2-4 x 4-6 ms (lo-30 ms delay) for the
IPL using the 645 cut off filter.
A satisfying
degree of epilation
(flash lamp 68.9 % , diode laser
73.6 % hairloss) was achieved after an average of 6 (4- 11) consecutive
treatments.
After a follow up of 3 months diode laser treated areas
showed an increase in hair counts by 10.0%) while IPL counted plus
26.7 % . This difference
is not statistically
significant
(p = 0.347).
Hair counts per cm2
diode laser
% flash lamp
%
Befor treatment
12.9
100.0
13.5
100.0
After 4- 11 treatments
3.4
26.4
4.2
31.1
3 months follow up
4.7
36.4
7.8
57.8
In conclusion
both systems achieved a reduction of hair growth. With
longer follow up the differences
in regrowth could become more
evident and will be reported.
236”
TREATMENT
ALEXANDRITE
Dermatology
OF CONGENITAL
NEVI WITH
LONGPULSE
LASER.
Richard
E. Fitzpatrick
and Syed Amiry.
Associates
of San Diego County,
Inc., La Jolla, CA
a
and Surgery
Abstracts
Purpose:
To determine response of congenital
nevi to long pulse
Alexandrite
laser.
Method:
Four patients with benign congenital nevi on hand (1 patient),
on thigh (1 patient), and entire back (2 patients) underwent
several
treatments using long pulse Alexandrite
laser (15-25 J/cm’ and 3 msec
pulse duration).
Treatment interval was 3 to 12 weeks. The average
number of treatments was four.
Results:
Every congenital nevus showed complete clearing of the nevus
in some areas and elimination
of pigmentation
and nevus cells of 500pm
of superficial
dermis, making deeper dermal nevus cells less visible; thus
improving
cosmetic appearance of nevus cells.
Conclusions:
Long pulse Alexandrite
laser is at least partially effective
for treatment of benign congenital nevi, leading to either complete
clearing and/or reducing visibility
of pigmentation
within congenital
nevi.
237
COMBINING
FACIAL
LASER RESURFACING
WITH
A
NECKLIFT
FACILITATES
FACIAL
REJUVENATION
Bruce M. Freedman - McLean, Virginia
A multimodality
approach has been used to concurrently
treat separate
cosmetic facial units in different tissue planes. Extending this concept
to include the neck expands the scope of the rejuvenation
process. In
our experience there is a distinct group of patients who are primarily
concerned about excess skin on the neck in conjunction
with prominent
facial rhytides; they were adverse to undergoing
a &ll facelift
procedure.
We identified those patients and offered them a course of treatment
consisting of:
1. Laser facial resurfacing
2. Necklifi with platysmal modification
Ten patients, ages 46 - 72, were treated under intravenous
sedation on
an outpatient basis. Facial laser resurfacing
was performed with the
Coherent UltraPulse CO1 laser at 300mJ/60W
for the first two passes
and 250mJ/45W
for the third pass, followed immediately
by the
necklift procedure using submental and post-auricular
incisions
Platysmorraphy
was performed
laterally and medially as needed. Postoperative laser skin care was prescribed
using the open technique and
the incisions were cared for routinely.
Photographs
were taken prior to
surgery and at regularly scheduled post-operative
intervals.
Photographs
and clinical assessments showed significant improvement
of the facial and neck irregularities.
There were no observed
complications
post-operatively
and patients were pleased with their
results. The combined procedure
met their specific expectations
for a
more youthfil
appearance while minimizing the incisions and potential
healing complications
associated with a full facelift procedure.
In summary, combining laser resurfacing
of the face with incisional
surgery on the neck expands the physician’s
ability to treat different
structural problems concurrently,
providing more options in the realm
of facial rejuvenation.
238”
LASER RESONANCE
RAMAN
DETECTOR
FOR ANTI-OXIDANT
MOLECULES
IN HUMAN
TISSUE
Igor V. Ermakov+,
Robert W. McClane’,
Theresa A. Scholz*,
Paul S.
Bernstein+,
Nikita B. Katz’, and Werner Gellermann+;
‘University
of
Utah, Salt Lake City; *Gateway
Aesthetic
Institute
and Laser Center,
SLC, UT
Purpose:
We developed
a novel, optics-based
technology
to measure
anti-oxidant
molecule
levels in human tissue in vivo.
Information
of
these levels
may help in assessing
risk for age-related
macular
degeneration
and skin cancer. Methods:
We used Resonance
Raman
American
Society
for Laser
scattering
as a linear spectroscopy
technique
to detect the vibrational
transitions
of the molecules,
and constructed
a compact
portable
instrument
for use in a clinical
setting.
Results:
Using blue-green
spectral lines from an argon laser, we excite the anti-oxidant
molecules
resonantly
in their spectrally
broad absorption
transitions
in the visible
wavelength
range. The chain-like
conjugated
carbon backbone
of the
anti-oxidant
molecules
gives rise to characteristic
carbon single- and
double bond stretch vibrations
at -1160
and -1530
wavenumbers,
respectively.
The strengths of these Raman signals scale linearly with
tissue anti-oxidant
molecule
content,
and therefore
can be used to
quantity
the anti-oxidant
concentration.
The excitation
laser light is
routed to the tissue via fiber optics, the Raman scattered light is collected
in a backscattering
geometry,
routed via dichroic
beamsplitters
and
separate fiber path to a small spectrograph,
and imaged onto a CCD
camera. The spectral information
is read out by customized
software and
plotted out in nearly real-time onto a computer
screen. Conclusion:
It is
possible to non-invasively
measure anti-oxidant
molecule levels of tissue
in a non-invasive
and quantitative
way at safe laser light powers.
A
prototype
instrument
will be demonstrated
for in-vivo measurements
of
skin.
239
HY PERTROPHIC
SCARS AFTER CO2 LASER SUCCESSFULLY
TREATED
WITH THE 585-nm PULSED DYE LASER
.
.
no Grinblat, Iara G. Yoshinaga, Luciana Conrado, Selma Cemea
Hospital
Israelita Albert Einstein, Department
of Dermatology,
Sao
Paufo, Brazil
Hypertrophic
scars are exuberant fibrous repair tissue difficult to treat.
Treatment
with the CO2 laser may lead to this type of scar, specially if
used at high fluences, and depending on the anatomic location of the
wound. Arm, chest and lips are reported as being at high risk. We present
a case of exuberant
hypertrophic
scars on arms and dorsum of hands
due to CO2 laser successfully
treated with the 585-nm pulsed dye laser
(PDL).
An oriental 63-year-old
woman, presented with exuberant hypertrophic
scars on the dorsum of the hands and arms, after a CO2 laser treatment
for actinic keratosis, performed by her ophthalmologist.
Since the CO2
laser treatment was not performed
by our group, we do not know what
energy levels were applied. The lesions were seriously impairing the
patient’s social life. We treated the whole area only with the 585-nm
pulsed dye laser. The PDL was used at 6.5 J/cm2 with a 7-mm spot
size, in multiple sessions with 4-6 weeks intervals. The treatment was
well tolerated without anesthesia.
After four sessions,
the elevated
scars became flatter and less
eritematous.
The final cosmetic result was considered
excellent by the
patient and the physicians.
This type of complication
may occur in spite of the parameters used
for the CO2 laser. Nevertheless,
untrained physicians
should be aware
of the risks of performing
such procedures
inadequately.
In this case,
the PDL was an effective and quick treatment for this type of scar.
240
COMPARISON
OF DIFFERENT
LASER
SYSTEMS
FOR
TREATMENT
OF SOLAR LENTIGO
S. Brian Jianq, Sandy Tsao, Lara Kelley
Beth Israel Deaconess Medical Center, Harvard Medical School, Boston,
MA
Medicine
and Surgery
Abstracts
55
Purpose:
Different
laser systems have been shown to be safe and
effective for the treatment of solar lentigos. The purpose of this study is
to compare the difference in efficacy and treatment associated discomfort
between several commonly used lasers.
Methods:
Ten patients with solar lentigines were treated with QS ruby
(694nm),
QS Alexandrite
(755nm),
and frequency-doubled
Nd:YAG
Photographic
and clinical evaluations
of the solar
(532nm)
lasers.
lentigines were performed pre- and postoperatively.
Patient’s subjective
assessment of the results and the treatment associated
pain were also
obtained.
Results: All laser systems showed similar effectiveness in removing solar
lentigines.
They were associated with minimal intra-operative
pain and
short recovery periods. There was no scarring or permanent pigmentary
changes associated with any laser system.
Conclusions:
The QS ruby (694nm),
QS Alexandrite
(755nm),
and
frequency-doubled
Nd:YAG
(532~1) lasers are effective treatment options
for removal of unwanted solar lentigines.
The differences
in effkacy and
treatment associated discomfort
will be discussed.
241
LASER
HAIR
REMO\‘AL
Francisco Jimknez and Rube J. Pardo*. Dermatnlogia Laser Clinica San Roque,
Canary Islands, Spair and Coral Gables Dermatology and Laser Center, Cor .I
Gables, Florida*.
We have devoloped a model to assess patient satisfaction and expectations prior to
laser hair removal.
All the hairs contained in a 3 cm by 3 cm square of thoracic hairy skin ti-om a
volunteer patient were counted and photographed. Hairs were ramdomly eliminated by
plucking and photographs were taken at 10% intervals. Sequential photographs, each
showing 10 % hair loss, were shown to patients. Each patient was asked to grade the
photographs under the following scale: bad, moderate, good and excellent result. ln
adition, they also asked at which photographic point they would feel satisfied after one
laser hair removal session and after the last session.
Patients graded as a bad result photos that contained 70 to 100% of the original hair
count, moderate as 40 to 60% of the original hair count, good as 20 to 30% of the
original hair count and excellent as 10% of the original hair count. Most patients
(~80%) responded that they would only be satisfied with over 50% hair loss, and that
they would he very satistied with greater that 90% hair loss after the last laser session.
In conclusion, having a photographic scale is useful for consultation prior to laser hair
removal therapy, so that patients can have a more realistic expectation of the
procedure. According to the literature, hair removal lasers achieve approximately 2030% permanent hair loss per treatment session. According to this model, we feel that
patients will not he satistied with laser hair removal until after the 3rd or 4’ treatment
session.
242*
MULTIPLE
COLOR CHANGES FOLLOWING
LASER THERAPY OF
COSMETIC TATTOOS
Eduardo
Weiss,
Gloria
Jimenez,
James M. Spencer*
Department
of Dermatology
and Cutaneous
Surgery,University
of Miami
School
of Medicine,
Miami,
Florida
Mount
Sinai
Medical
Center,
New York,
NY*
PURPOSE: To emphasize
the wisdom
of small
test
area
when
and the need of multiple
laser
treating
cosmetic
tattoos,
systems.
METHODS: A 48 year
old woman presented
requesting
removal
of permanent
makeup
(cosmetic
tattoos)
of her
eyebrows
and around
her lips.
Physical
examination
revealed
a
brown
tattoo
of both
eyebrows
and dark
red
lip
liner
around
both
lips.
A test
area was performed
to the red
tattoo
on the lips.
A Nd/YAG laser
(continuum
Biomedical,
Inc,
Dublin
CA) frequency
doubled
at 532 nm,2.0
J/cm2,
2mm spot size
was utilized
for the eyebrows.
The patient
returned
for followup
1 month later,
at which
the test
The black
ink on the lip
area of the lip turned
black.
56
American
Society
for Laser
Medicine
was treated
with
the same laser
at 1064 nm, 3mm spot,
4.2J/cm2,
with
satisfactory
resolution
in two treatments.
The brown eyebrow
were treated
with
the 1064nm Nd YAG
One follow
up one month later
both eyelaser,
3mm, 3.95.
brows
had turned
bright
orange,
and treated
with
the
532nm, 3mm, 3.0 J/cm2.
One month later
the eyebrows
were
now a mixture
of yellow
ink and dark
green.
The yellow
area was treated
with
532 nm, 3mm, 2.3.J/cm2
while
the
dark
green was treated
with
the 1064nm laser,
3mm spot,
4.25.
One month later
little
improvement
was noted,
so Q
switch
ruby laser
at 694nm,
(Lamda photometrics,
London
England)
6mm spot,
165 was utilized.
An additional
four
treatments
were given
utilizing
a combination
of both the
ruby
and the 532 Nd/YAG lasers
for green
and the yellow
pigment
respectively.
RESULTS:
Significant
but not complete,
resolution
of the
tattoo
ink was achieved.
COtiCLUSION:
Multiple
laser
systems
are needed
to remove
ccsmetic
tattoo,
test
area must be done before
treatment.
243
TREATMENT
OF FACIAL
TELANGIECTASIA
WITH
A
PULSED
KTP LASER AND AQUEOUS
GEL
Arielle N.B. Kauvar’
and Kathryn
E. Frew2
’ Laser and Skin Surgery Center of New York, New York, New York
and ‘Dartmouth
Hitchcock
Medical Center, Lebanon, New Hampshire
Purpose:
The pulsed KTP Laser provides excellent clearing of facial
telangiectasia
without purpura, but edema and crusting may result.
The utility of an aqueous gel in reducing postoperative
side effects
was investigated.
Methods:
Nineteen patients with extensive facial telangiectasia
were
treated with a pulsed 532 M-I KTP laser (Versapulse,
Coherent
Medical, Palo Alto, CA) equipped with contact cooling at 4°C. Laser
pulses were delivered with a pulse duration of 10 msec, a 4 mm spot
size and a fluence of 9.5 J/cm2. A 3 mm thick coating of an aqueous
gel was applied to the right or left face in a randomized
fashion prior
to treatment.
Results: Adverse effects including pain, erythema, edema and
crusting were reduced with the use of the aqueous gel. Clearance
rates were equivalent with our without the aqueous gel in all patients.
Use of the aqueous gel also provided easier movement of the laser
handpiece across the skin.
Conclusions:
The use of an aqueous gel in conjunction
with contact
cooling during pulsed KTP laser photocoagulation
of facial
telangiectasia
decreases treatment associated side effects.
244
COMBINED
RUBY
LASER (NORMAL
LASER)
TREATMENT
MODE
RUBY
LASER
ON CONGENITAL
AND Q-SWITCHED
HAIRY
MELANOCYTIC
NEVI
Taro Kono, MD*, Motohiro Nozaki, MD*, Henry H. Chan, M.D.**
* Department of Plastic and Reconstnrctive
Surgery, Tokyo Women’s
University,
Tokyo, Japan, ** Division
of Dermatology,
University
Medical
of Hong Kong
and Surgery
Abstracts
Background:
Although melanocytic
nevus is commonly
seen in all ethnic
groups, unlike the Caucasian, Asian rarely developed melanoma from these
lesions. As a result, the use of laser for the removal of melanocytic nevus is a
common practice in Asian countries. Our experience indicated that a combined
ruby laser approach (normal mode ruby immediately
followed by multiple
passes of Q-switched ruby) is more effective than the conventional laser method
in the removal of melanocytic
nevus. As a result, we have performed
a
prospective study looking at the efficacy of our technique.
Purpose: To evaluate the efficacy of the using normal mode ruby immediately
followed by three passes of Q-switched ruby laser in the treatment on congenital
hairy melanocytic nevi.
Methods: Thirty-four
Japanese patients with hairy pigmented nevi were treated
with the normal mode ruby laser (16-20 J/cm2, 1 msec) at 2OJ/cm2, followed
immediately by three passes of Q-switched
ruby laser (7 J/cm’, 30 nsec). The
degree of clearing was measured objectively by the use of chronometer before
and after treatment (average number of treatment session 7, range 4 to 14). Two
independent observers further evaluated the degree of clearing as well as the
effect of hair removal.
Results: The objective degree of improvement
ranged from 34.0% to 95.2%,
with an average of 77.7%. After treatment, clear hair-removal was observed in
26 patients, while the remaining 8 had little or no such effect.
Conclusion: Combined ruby laser is effective in the removal of hairy
melanocytic nevus both in term of degree of clearing and hair removal. Further
study is necessary to look at the complication of this technique.
245
DIODE LASER-ASSISTED
RETROSPECTIVE
STUDY
HAIR REMOVAL
OF 101 JAPANESE
THERAPY
PATlENTS
IN ASIANS:
A
Taro Kono, MD*, Motohiro Nozaki, MD*, Henry H.L. Chan, M.D.**
* Department of Plastic and Reconstructive
Surgery, Tokyo Women’s Medical
University,
Tokyo, Japan, ** Division of Dermatology,
University
of Hong
Kong
Background: Long-pulsed Diode (800nm) laser has been successful used in the
laser assisted hair removal in Caucasian race. Asian with higher epidennal
melanin context is more prone to adverse effect and higher fluence may be
necessary to achieve the desirable effect. Study looking at the efficacy and
complication
of diode laser (800nm) is therefore necessary. Purpose: To
evaluate the efficacy and complication of the diode (800nm) laser system in hair
removal among Japanese patients.
Methods: One hundred and one Japanese patients with dark brown or black hair
growth were treated with the diode laser (800 nm, IO-40 J/cm2, 5-30 msec, 9
mm 9 mm, 5OC chilled handpiece). Hair re-growth rate and complications
were
assessed by photographic evulation by two independent observers. Patients were
assessed 1 week after their first treatment and 6 months after their last treatment.
The average number of treatment session was 2.4 (range from 1 to 8).
Results: Although all patients achieved temporary hair loss, only half of them
had 60% hair reduction 6 months after their last treatment. lmmediate side
effect
was common
including
erythema
(8%), blistering
( 1%) and
folIiculitis(8%).
Long-term complications
(detected 6 months after last laser
therapy) were rare and included hyperpigmentation
(2%) and hypopigmentation
(1%).
Conclusion: Long-pulsed Diode 800nm laser is effective in laser assisted hair
removal among Asian and although immediate complications
were common,
they were transient in nature.
American
Society
for Laser
246
zJunichiro
OF SKIN
of Plast,ic
School of Medicine,
[Purpose]
LJLCERS
WITH
and Reconstructive
Tokyo,
Pe rsistent
resistant
to
skin
ulcers
conventional
wound
to treat
DEFOCTJSED
Diode
resistant
from
therapeutic
ulcers
laser
DIODE
of skin ulcers.
This
convenient,
combined
of complete
The use of Q-switched
Alexandrite
nevus of Ota-like
macules(ABNOM)
with
defocused
on
the defocused
patients
diode laser
care, this
for
therapy
safe and side effect-free
good wound
healing
used with
applied
method
therapy
(QS Alex)
laser in the treatment
of acquired
Mary
Background:
Acquired
bilateral nevus of Ota-like
macules (ABNOM)
or Hori’s
nevus is a
common
Asian’s
condition
characterized
clinically
by bluish
brown
or slate
gray
hyperpigmentation
in bilateral
malar regions and histologically
by dermal melanocytosis.
Unlike nevus of Ota, ABNOM
is an acquired condition that often develops after twenty years
of age, involved both sides of the face and mucosal involvement
is not seen. Recently,
both QS
Ruby 693 laser and QS Nd-YAG
1064 laser have been reported to be effective
in the clearing
of this condition. The role of QS Alex laser has not been looked into.
Purpose: To retrospectively
assess the efficacy
and complication
of QS Alex laser in the
treatment of ABNOM
Methods: 32 female Chinese patients with ABNOM
(age range 28-66) were involved
in the
study. All underwent QS Alex laser treatment
(755nm, spot size 3mm, 8J/cm2).
Topical
hydroquinone
and tretinoin
cream was given to those with hyperpigmentation
post laser
surgery. Clinical
photographs were taken before and after laser surgery and assessed by two
independent observers.
The degree of clearing
was scored and complications
including
hypopigmentation,
hyperpigmentation,
scarring and erythema were assessed.
Result: The mean number of treatment session was 7(range 2 to 11) and the mean treatment
interval was 33 days(range 14 to 42 days). Both observers identified
over 80% of the patients
as having more than 50% degree of clearing and complete clearance was seen in more than
28% of the patients. Although
most patients had post-laser hyperpigmentation
and were on
depigmentary
regimen, hyperpigmentation
was seen only in 12.5% of the patients during
photographic
evaluation.
A mild hypopigmentation
was seen in 50% of patients and transient
erythema in 4 1%.
Conclusion:
QS Alex appears to be effective
in the treatment of ABNOM.
Pigmentary
changes
were frequently seen post-operatively.
Further study is necessary to compare the effectiveness
of QS laser used together with topical depigmentary
cream to that of QS laser on its own.
LASER
of 669 mw/cm’
in continuous
wit.h
contact
surface
of the
ulcer
at
6.3 J/cm?
once
patients
skin
presents
and other
therapy.
for skin
power
wave
defocused
and
factors.
ulcers
that
had
system
of 1000 mw,
a power
laser
was
to 5 cm above
diode
the
or t<wice a week
the defocused
diode laser therapy
ulcers
Purpose:
To evaluate
unwanted
during
responded
very
well
Methods:
Twenty-nine
long-pulse
Nd:YAG
The average
the
period.
5 representative
with a long pulse 1064 nm
laser in facial hirsutism.
L&y*,;
Mario Trelles***,
Adeline de Ratnecourt**,
* Centre Laser Dermatologique,
Marseille,
France
** Instituto Medico Vilafortuny,
Cambrils,
Spain
*** Centre d’kpilation
spkcialisk,Paris,France
in removing
The diode laser
mode. The
method
often
Epilation
Nd:YAG
Jean-Luc
the efficacy
of the Long-pulse
Nd:YAG
laser
facial hair.
has been proved
diode laser
treatment.
an output
density
therapy
are
blood flow
was indicated
applied
etiologies
patients
were treated
laser with Iluences
hair reduction
at 3, 6 and 9 months.
Results
: The average
diameter
as baseline
density
The hair-free
reduction
exclusively
between
was assessed
interval
was 439~6 at 3 months.
with a
56 and 70 J/cm’.
post operatively
was also evaluated.
in hair counts
for hairs of the same
36% at 6 months
to
46% at 9 months.
The hair-free
interval
with respect to social
t.he
may
for
increased
of the skin ulcers.
Aaron YM Lam 1, Henry H Chan 1, David S Wong 2, LK Lam 2, WS Ho 3
1. Division
of Dermatology,
Department of Medicine, The University
of Hong Kong.
2. Division
of Plastic and Reconstructive
Surgery, Department
of Surgery, Queen
Hospital, Hong Kong.
3. Division
of Plastic and Reconstructive
Surgery, Prince of Wales Hospital,
Hong Kong.
IJniversit,y
met,hodologies,
Laser
defocused
conservative
of 830 nm,
non-
Kyorin
various
by enhancing
with
therapy
to past
the
Surgery,
and surgeons.
healing
skin
a wavelength
[Results]
successfully
248
Japan
for both patients
t#o accelerate
treatment
was
an addit.ional
healing.
the incidence
Kubota
Department
has
healing
offer
wound
THERAPY
proved
The 830 nm , 1000 mw diode laser
therapy
laser
57
249
TREATMENT
[Methods]
Abstracts
diode
well
247
We tried
and Surgery
IConclusions]
enhanced
STONE
CLEARANCE
USING
THE LOW POWER
HOLMIUM
LASER
Geoffrey B Kostiner; Sean M DeLair; Michael R Crone; Matthew D
DuMont;
Guy Sheaf; Thomas A Lanyi; P Gary Katz; Robert H
Hackler;
and Timothy
D Averch, Medical College of Virginia,
Richmond,
Virginia.
Purpose.
The high power Holmium
laser (HoL) is a versatile and
effective lithotripter
in the endourological
management
of urinary
tract calculi, yet at an added cost. Low power HoL with a maximum
of 15 Watts can come at a lower cost. Therefore,
the efficacy of the
low power HoL was evaluated in the treatment of urolithiasis.
Methods.
We prospectively
reviewed the data of 105 stone patients
treated with the low power HoL from January 1997 through July
1999. A total of 126 renal units (RU) were evaluated. Twenty-one
patients underwent multiple lithotripsies,
4 had bilateral disease and 2
had bladder calculi for a total of 141 procedures.
The mean age was
46 years old (15-89yrs).
A New Star 1000 (Auburn, CA, USA) with a
1OW maximum
and a Domier HoL (Kennesaw,
GA, USA) with a
15 W maximum
were used for all procedures.
Successful
stone
clearance was defined as no evidence of radiopaque calculi greater
than 3mm on a follow-up
KUB within 3 months of the first
lithotripsy.
Results. All major stone compositions
were treated, including
calcium-oxalate
monohydrate
and cystine. The mean stone size was
1.7cm (0.3-5.0cm).
Calculus location included all renal calyces, ureter
and bladder. Retrograde
ureteroscopy
was employed in all but 12
cases. Average power was 5.4W (3.8-9.6W).
Mean pulse energy was
1 .OJ (0.7-l .3J). Mean follow-up
was 21.0 months (3.4-33.8mon).
Of
the 100 RU (79%) that were successfully
cleared, 95 (95%) required
only one procedure and 7 (7%) were left with stones < 3mm in
diameter.
Conclusions.
The low power HoL is effective in treating urinary tract
calculi, however, randomized
studies need to be conducted for a
direct comparison.
problems
Medicine
and
American
58
comfort
was multiplied
Society
by a factor
for Laser
from 2 to 6.
No significant
complications
were observed
Conclusions:
The long-pulse
Nd:YAG
for long-lasting
hair removal
of hair appears
to explain
Medicine
in different
skin types.
laser is effective
and safe
in all skin types. The delay in re-growth
subject
and Surgery
Abstracts
at 2 weeks for follow up. Photographs
documented
results.
Repeat treatments
were given if any physical
evidence
of the wart remained.
RESULTS:
Pre and post-photographs
were evaluated
as
well as the number
of laser treatments
required
to
achieve
wart clearance.
CONCLUSION:
Preliminary
data demonstrates
that the
V-star laser is more efficacious
for the treatment
of warts.
satisfaction.
252"
250
LASER TREATMENT
TREATMENT
OF POST lRRADlATlON
SKIN CHANGES
WlTH
THE PULSED
DYE LASER.
J Friedman,
M Levy, J Pielop:
Baylor College of Medicine,
Houston,
Texas
Purpose:
To investigate
utility of pulsed dye laser in treatment
of
external
beam radiation
(XRT) induced telangiectasia.
Methods:
Four patients
were treated for multiple telangectasias
of the central and upper chest following
mastectomy
and
postoperative
XRT. Areas of involvement
were considered
by all
patients
to be significant
cosmetic
consequence.
All patients were
treated
in a single session
with the Candela@
flash lamp pulsed
dye vascular
laser. The energy was delivered
@ 585nm with a
pulse duration
of 450msec.
Spot size varied from 3-l Omm. Local
anesthesia
with EMLAB
cream was used in one patient.
Results:
All 4 patients
tolerated
the procedure
well and no side
effects or wound healing complications
were noted. Excellent
resolution
(80-90%)
was achieved
in all patients after a single
session.
All patients
were pleased
with their results.
Conclusion:
The flash lamp pulsed dye laser can effectively
improve
the telangiectasias
which commonly
occur following
XRT.
No adverse
effects were noted and as such, we believe that
broader
application
of this form of treatment
in patients following
XRT is warranted.
251
COMPARISON
STUDY
EVALUATING
EFFICACY
OF THE
PHOTOGENICA
LASER
VS. THE PHOTOGENICA
THE TREATMENT
OF WARTS.
Jenifer
R. Lloyd The Lloyd Dermatology
Center
Youngstown,
OH
THE
V-STAR
V LASER
OF STRETCH BIRTHMARKS
L, Longo, MD, *O. Marangoni, MD, **M. Melato, MD
General Surgery institute and Phlebology Center, Siena University (ITAL y)
*Multilaser, Diagnostica lerapeutica, Trieste
“Department of Pathological Anatomy, University of Trieste
There is no specific treatment that will completely eliminate stretch birthmarks.
Some types of laser have been used in recent years with some positive results.
The role of the laser in cicatrization and its effect on tissue metabolism is still under
investigation.
The aim of our study was to test the efficacy of the 577 and 532 nm lasers in the
treatment of stretch birthmarks,
We treated stretch birthmarks of women ranging from 20 to 40 years of age, that were
resistant to treatment with various topical creams, applied until two months before the
laser therapy. The lesions were located on the breast, lumbar-sacraf region, lower
abdomen and femoral regions. With both lasers we used: fluence 8-20 Joule/cm?
duration of pulse 20 milliseconds on the breast, 40 milliseconds on the other regions,
spot/size 1.6 mm. We made a cycle of 3-6 applications, at a rate of one application for
15 days.
We divided the results into three groups, according to the parameters of: color, depth,
length, size of the stretch birthmarks. Positive results were obtained. We tested the
results with histopathological analyses.
Differences were noted between recent and old stretch marks, the breast and other
locations.
The goal of this treatment was the removal of the fibrous tissue on the superficial
dermis, while the epidermis and other superficial layers remained intact or with fewer
temporary lesions that remodeled themselves.
We found that the dosage of laser used could increase the active hyperemia, the local
drainage of acid and collagen substances and stimulate the good repair of all layers
of the skin. This theoretical mechanism still requires further scientific confirmation.
In conclusion, reviewing our data, the 577 nm laser could play a positive role in the
treatment of the stretch birthmarks.
IN
and Laser
PURPOSE:
The purpose
of this study is to compare
the
efficacy
of the V-Star laser (595nm)
with the V laser
(585nm)
(Cynosure,
Inc.) for the treatment
of warts.
METHODS:
Fifteen patients
with multiple warts were
entered
into the study.
The patients
warts were
photographed
pretreatment
and then randomly
assigned
to a treatment
laser.
The laser parameters
were as
follows:
Photogenica
V laser (7 mm spot size, 9 J/cm2,
0.45 msec pulse duration
and 585nm)
and Photogenica
V-star laser (7mm spot size, 9 J/cm2, 0.50 msec pulse
duration
and 595 nm). Each wart received
3 stacking
laser pulses from the designated
laser.
Patients
returned
253"
POST - LASER TREATMENT OF TELANGIECTASES
L. Longo, MD, S. Mancini, MD, *M. Postiglione, MD
Genera/ Surgery Inst. & Phlebology Center Siena University - /ta/y
*Institute for Laser Medicine, Florence
Currently, laser therapy is the elective treatment for facial telangiectases, while leg
telangiectases are treatable with lasers and light sources only after an accurate
diagnosis. Research now focuses on improving the post-procedure course and
specifically, reducing erythema, healing time, exudation and disorders of the
pigmentation and above all accelerating reepithelialization and reabsorption of the
edema.
The purpose of our study is to review the importance of the substances used before,
during and after laser beam treatment. We propose a treatment protocol using a
group of natural substances (Aloe Vera, Asialene and Echinacea) in the form of
American
Society
for Laser
topical sprays and gels (Resurgil*) immediately following the operation to reduce the
inflammation and to optimize the results,
We treated women ranging from 20 to 50 years of age with 577 nm laser and we
followed the patients for up to one year after the treatment. We treated the
telangiectases of the face and legs with averages of 2 sessions in one month on the
whole, and 3 sessions in three months, respectively. After each treatment, we
randomly divided the patients in two groups. One group was treated with a mixture of
Aloe Vera, Asialene and Echinacea in spray, immediately after the treatment and for
the 5 (face) and 10 (legs) following days. Another group of patients in the same age
range and with the same type of lesions was treated with cool spray (ice) immediately
after the procedure and a non-steroid, anti-inflammatory spray during the ensuing
days. This group represented the controLWe did follow-ups after 3, 8, 15 days (face),
and 10, 15, 30 days (leg) and one year after the last treatment.
The majority of the patients treated with Resurgil* spray recovered completely after 5
days(face), 10 days (legs). These results were percentually significant with respect to
the controls. These patients also had a better post-procedure course, with less
edema, erythema and itching, when compared with the untreated patients.
In conclusion, laser therapy has a positive and specific role in the treatment of full
telangiectases, but it must be used after an exact diagnosis and according to an
appropriate procedure, that includes the use of the appropriate substances during
and after treatment.
254*
Medicine
and Surgery
Abstracts
METHODS:
10 patients who received full-face resurfacing
using CO2
ultra-pulse
laser were randomly assigned to use petroleum jelly or aqua
phor dressing to one half of the face and oat beta-glucan
cream to the
other half of the face for one week after the procedure.
Physicians,
who were blinded to the treatment, rated the patients at days 3 and 7 for
percent re-epithiliazation,
redness, swellin g. signs of irritation/allergy
Patients rated the treatment for comfort and ease
and signs of infection.
of use.
RESULTS:
100% of both treatment areas were over 95% re
epithiliazed
by day 7 with no complaint of severe discomfort
for either
treatment.
Two patients had complaints
and evidence of
irritation/allergy
in the aqua phor treated side while there was 110
irritation due to the beta-glucan
cream. Redness and swelling were not
significantly
different in the two sides. There was no incidence of
infection for either side. Eight out of ten patients rated the beta-&can
cream as more soothing and easier to use.
CONCLUSION:
The immunomodulatory
activity of oat beta-glucan
has been well described.
The beta-glucans
bind macrophage
betaglucan receptors, which induces macrophage
differentiation
resulting in
enhanced activity of- macrophages,
neutrophils.
natural killer cells, T
cells and B cells. This enhanced immune function has been shown to
accelerate wound healing, as well as increase host resistance
to
neoplastic, bacterial, and fungal diseases.
We have demonstrated
that
beta-glucan
cream is safe, effective and comfortable
in post resurfacing
wound care. With its ability to accelerate wound healing and decrease
infections
it may be a superior wound care dressing for laser skin
resurfacing.
CLINICAL
EVALUATION
OF DEPILASE LONG PULSE ND:YAG LASER
IN THE TREATMENT
OF FACIAL TELEANGECTASLA
AND LEG VEINS.
Nicholas
Lowe, MD, Mario Luca Russo, MD, MSc*
Department
of Dermatology,
UCLA,
Los Angeles,
California.
*Institute of Laser Surgery, London, UK.
Purpose:
To report
Long Pulse Nd:YAG
leg veins.
on the clinical efficacy
and safety of Depilase
laser in the treatment of facial teleangectasia
and
Results: Significant
cosmetic
improvement
was seen after each of the
three
treatment
sessions.
Side effect
included
mild
treatment
disconfort,
occasional
blistering
and transient eritema.
Conclusion:
a safe and
teleangectasia
Depilase YagLase
effective
method
and leg veins.
256
LASER ACTIVATED
SHAPE MEMORY
POLYMER
MICROACTUATOR
FOR TREATING
ISCHEMIC
STROKE
Methods:
A cycle of three sessions of laser treatment with Depilase
Long Pulse Nd:YAG
laser system (Depilase Yaglase, Depilase Group
Ltd, London, UK) were delivered
on a monthly
basis to a series of
patients presenting facial teleangectasia
and/or leg veins. Patients were
follow-up
at 1, 2 and 3 months after the final treatment session.
At each treatment
and follow-up
visit, photographic
and clinical
evaluations
were documented.
Long Pulse Nd:YAG
Laser
of non invasive
treatment
System is
of facial
255*
EVALUATION
OF OPEN DRESSING TECHNIQUE
USING OAT
CLUCANCREAMAFTER
LASERSKINRESURFACING
BETA-
Marla L. McClaren,
Suzanne L. Kilmer Vera Chotzen,.
Laser &
Skin Surgery
Center of Northern
California,
Sacramento,
CA.
PUPOSE:
To evaluate the safety and efficacy of a novel wound
dressing containing oat beta-glucan
after full face resurfacing.
59
Melodie F. Metzger, Daniel Schumann and Duncan J. Maitland
Lawrence L,ivermore National Laboratory, Livermore, CA
A novel laser-activated
shape memory polymer (SMP) microactuator
for treating ischemic stroke is presented.
Current therapies, including
thrombolytic
drugs (systemic
and local delivery),
are not effective
outside of a short three-hour
window after the initial presentation
of
However
it is currently
believed that patients may
stroke symptoms.
benefit from reperfusion
of the blocked artery up to 12-24 hours after
the initial onset of stroke symptoms.
The SMP device is mounted on
a diffusing
optical fiber and delivered
through a catheter (Guidant
Tracker
18, 0.018” (450 pm) ID) distal of the occlusion
where it is
deployed to its open shape with diameter of 1400 pm. The SMP
device is deployed via optical heating by a 1.5 W, 8 10 nm diode laser.
Successful
deployment
of the microactuator
requires well-engineered
coupling of the light from the diffusing
fiber through the blood into
the SMP.
Both the microactuator
and thrombus
are then removed
tests determined
the m aximum
from the vessel.
These preliminary
hydrostatic
force and pressure against which the device could hold the
clot.
Results with porcine blood clots in polyvinyl
tubing (1.5 mm ID)
show that the SMP microactuator
is able to hold the clot under
hydrostatic
pressures up to 1200 mmHg and forces just under one
tenth of a pound. These pressure results are approximately
ten times
Successful
deployment
of the
the expected
physiological
values.
microactuator
requires well-engineered
coupling of the light from the
diffusing
fiber through the blood into the SMP.
Experimental
and
theoretical
studies show that no peripheral
damage to the blood and
blood vessels from either direct laser interactions
or contacted
with
the heated SMP are anticipated in a clinical system,
60
American
Society
for Laser
Medicine
and Surgery
Abstracts
257*
EVALUATION
OF SELECTIVE
OF THE SEBACEOUS
GLANDS
TREATMENT
PHOTOTHERMOLYSIS
FOR NOVEL
ACNE
Jenifer R. Lloyd The Lloyd Dermatology and Laser Center
Youngstown, OH
Mirko Mirkov Cynosure, Inc Chlemsford, MA
PURPOSE: The purpose of this study is to evaluate the
efficacy of the DioDerm laser (Cynosure, Inc) to target and
destroy enlarged sebaceous glands which are preloaded with
ICG chromophore.
METHODS: Ten treatment sites were chosen on the backs of
patients with active acne. Topical ICG (cardiogreen) dye was
applied to a 10 x IOcm area and covered with an occlusive
dressing 24 hours prior to procedure. The designated area
cleansed and treated with the DioDerm laser (4mm. 8OOnm,
50msec, 4OJ/cm2). Photographs and biopsies were taken
before and after laser irradiation.
RESULTS: Fluorescence microscopy of biopsy samples show
evidence of ICG penetration into the sebaceous glands. In
addition, preliminary clinical results demonstrate a decrease in
acne noted in the treatment area at 3 months follow up.
CONCLUSION: ICG and DioDerm laser treatment is a novel
new approach to the treatment of acne.
LASER HAIR REMOVAL IN A PATIENT WITH VITILIGO
Keyvan
Nouri,
Gloria
Jimenez,
Jonette
Keri
University
of Miami School
of Medicine,
Dept.
Dermatology
& Cutaneous
Surgery,
Miami,
Florida
of
PURPOSE: To assess
the efficacy
of the Gentlase
Alexandrite
755nm laser
(Candela,
Wayland,
MA) hair
removal
in areas
of vitiliga
vs. normal
skin.
METHODS: A subject
with
skin
type
IV with
a biopsy
proven
vitiligo
was chosen.
Two areas
in the axilla
were
selected
(one area with
vitiligo
and another
area of
normal
skin.)
Initial
hair
counts
were made prior
to the
treatment
and prior
to each subsequent
treatment
at both
sites.
Monthly
treatment
of the sites
were done using
the Gentlase
755nm Alexandrite
755nm laser
using
18 mm
spot size
20 Joules
and 70 microsecond
cooling
spray
time.
RESULTS: There was significant
reduction
of hair
counts
in
the normal
skin
site.
However,
there
was an actual
increase
in the white
vitiliginous
hair
at the vitiligo
treated
site.
CONCLUSION:
Laser
hair
removal
is not effective
for
This
treatment
of whitish
hair
in vitiliginous
skin.
case confirms
the theory
that
melanin
is the actual
target
in laser
hair
removal.
260
258
TREATMENT OF PIGMENTED HYPERTROPHIC SCARS WITH THE 585 NM
FLASHLAMP-PUMPED
PULSED DYE LASER, THE 532NM Q-SWITCHED
FREQUENCY-DOUBLED
Nd:YAG LASER, AND THE 532NM VARIABLE
PULSE FREQUENCY-DOUBLED
Nd:YAG LASER:A COMPARATIVE STUDY.
Leyda E. Bowes, Keyvan
Nouri,
Brian
Berman,
Gloria
Jimenez,
Rube Pardoj
James M. Spencer*
University
of Miami School
of Medicine,
Department
of
Dermatology
and Cutaneous
Surgery,
Miami,
Florida,
Mount Sinai
Medical
Center,
New York,
NY
OBJECTIVE:
To determine
the efficacy
of the 532nm
frequency-doubled
Nd:YAG laser
in the treatment
of pigmentas compared
to the 585nm FLPDL.
ed hypertrophic
scars,
METHODS: Six patients
with pigmented
hyperthrophic
scars
and skin
phototypes
2 to 4, were chosen.
One scar
was
selected
for treatment
in each patient,
and divided
into
Three
segments
were treated
with
a
4 equal
2 cm segments.
different
laser
modality
each,
and one was left
untreated
to serve
as the control.
The 585 nm FLPDL and the 532nm
frequency-doubled
Nd:YAG laser,
both in the Q-switched
and
Variable
Pulse modes,
were used.
An average
of 3.3 treatments was performed
on each scar
segment,
with
follow-up
visits
every
4 weeks
and a maximum duration
of follow-up
of 22 weeks.
Treatment
outcome
was graded
by a blind
observer
based on the Vancouver
General
Hospital
(VGH)
Burn Scar Assessment
Scale.
RESULTS: Treatment
of the hypertrophic
pigmented
scars
with
the 532nm Q-switched
Nd:YAG laser
led to a significant
improvement
of 38% in the VGH scores
when compared
to baseline
(=0.005).
The 585nm FLPDL also
had a favorable
effect
on the scars,
with
an average
improvement
of 36.1%
in the VGH scores.
There was no significant
difference
noted
between
the outcome
of these
two lasers.
Treatment
with
the 532nm Variable
Pulse Nd:YAG let to a 19% improvement in the GVH scores
of scars,
which
did not differ
significantly
from the 16.1% improvement
observed
in
control
scars
on the last
follow-un.
CONCLUSIONS:
The 532 nm Q-switched&Nd:YAG
laser
and the
585 nm FLPDL offer
comparable
favorable
results
in the
treatment
of pigmented
hypertrophic
scars.
LASER HAIR REMOVAL IN FITZPATRICK'S
SKIN TYPE VI
Keyvan
Nouri,
Gloria
Jemenez,
Jennifer
Trent
Department
of Dermatology
& Cutaneous
Surgery,
University
of Miami School
of Medicine,
Miami,
Florida
PURPOSE: To determine
the safety
and efficacy
of the
Gentlelase
Alexandrite
755nm (Candela,
Wayland,
MA)hair
removal
laser
in the treatment
of a patient
with
Fitzpatrick's
skin
type VI.
METHODS: A 36 year
old woman with
Fitzpatrick's
skin
type VI was treated
with
the Gentlelase
Alexandrite
755nm laser
for the hair
removal
on her cheeks
and chin.
She received
8 treatments
over
10 months
with
the above
laser
at the following
settings:
12-15 mm spot
size,
lo-16
Joules,
and 60-70
ms cooling
spray
time.
RESULTS: There
was a significant
decrease
in hair
The hairs
that
did grow back were lighter
growth
(75%).
and thinner.
There were no side effects
or pigmentary
changes
observed
during
this
time period.
CONCLUSION:
Laser
hair
removal
in darker
skin
types
has
represented
a therapeutic
challenge
secondary
to an
increased
risk
of post-inflammatory
pigmentary
alterations.
The Gentlelase
Alexandrite
755nm laser
seems to be safe
and effective
for hair
removal
in
patients
with
skin
type VI.
261
COOLING
CONCEPTS
IN LASERMEDICINE
SOME SIMPLE
BUT EFFECTIVE
METHODS
FOR SKIN PROTECTION
AND PAIN RELIEF
I’hilbp,
~_
C.M.,
Krankenhaus
Algermisscn,
Neukiilln
B., Quint,
, Dept.
C., Poetke,
Lasermedicine,
M., Urban,
Berlin,
P., Miiller
Germany;
-
U., Berlien,
H.-P.
www.knk-berlin.de
Cooling of skin during transcutaneous
laser treatment with argon-ionKTP- FPDL-, cw- or long pulsed dye-, Ruby-, Alexandrite-,
Diode- and
Nd:YAG-lasers
enhances the depth effect of the irradiation
and
American
Society
for Laser
diminishes or inhibits thermal side effects on the epidermis. With three
simple methods, which represent a wide range of effectiveness,
cooling
for different purposes, can be achieved.
During ALA-PDT
the patients often suffer from strong burning,
stinging and pain. An effective reduction of pain was achieved by using
continuous
compressed
air cooling
(1 bar) of the lesion during
irradiation. Thermographic
readings showed a temperature reduction of
the exposed lesions of only 3-4 degrees Celsius with compressed air
cooling. In a patient questionaire all patients reported a more then 5060% pain reduction under air cooling. The influence of this temperature
reduction on pain is questionable, however.
A cooling chamber provides skin protection and helps to minimize the
use of anesthesia in the treatment of PWS and hypertrophic
scars. A
flexible membran, facing the skin of the patient, provides close contact
and good thermal conduction
and the possibility
of compression.
The
temperature
and flow of the cooling fluid can be varied. The same
cooling chamber is used with the Nd:YAG-laser
for the scarless removal
of leg teleangiectasias.
Continuous
ice cube cooling during irradiation
with a Nd:YAG-laser
(1064nm) provides a safe protection of the skin in
the treatment
of hemangiomas
with combined
subcutaneous
and
cutaneous portions. Compression can be used to enhance the depth of the
laser effect. Experimental
data and computer
simulations
show a
significant
reduction
of thermal stress for the epidermis
for both
methods. With the ice cube cooling the temperatures
measured in 4mm
tissue depth are more than 10 degrees Celsius higher compared to lmm
tissue depth.
Medicine
and Surgery
Abstracts
61
Purpose:
To evaluate the safety and efficacy of a 1320 nm Nd:YAG
laser with cryogen cooling device in the treatment of lip rhytides and to
evaluate effect of number of treatments
and time interval between
treatments.
Methods:
30 patients were treated on their upper lip with a 1320 nm
Nd:YAG
laser with cryogen cooling device (CoolTouch.
Laser
Aesthetics,
Inc., Auburn, CA). Patients were divided into one of 3
treatment groups: 1) Group 1 received 4 treatments spaced every 4
weeks, 2) Group 2 received 6 treatments spaced every 4 weeks, and 3)
Group 3 received 4 treatments
spaced every 6 weeks. Two passes with
the laser was performed
at each treatment sessions. Laser settings were
as follows: 28-36 J/cm’, cryogen cooling duration of 20-30ms with a
laser delay of 30-40ms. Fluence was set so that epidermal temperatures
(measured with an infrared thermometer
in the laser head) reached 4045” C. Optical profilometry
measurements
were made before and after
all treatments were completed.
Results:
Most patients had improvement
of 25-40%. In patients with
severe photodamage
(Fitzpatrick
photoaging
score of 8 or 9), only mild
or no improvement
was noted. No adverse sequelae were observed.
Improvement
in nasolabial folds was observed in many patients.
Conclusion:
The 1320 Nd:YAG
non-ablative
laser is a safe treatment for
lip rhytides; however, for patients with severe rhytides only mild or no
improvement
is observed.
264*
HAND REJUVENATION:
THE NEXT FRONTIER
Jason N. Pozner, Cynthia Weinstein
Boca Raton, Florida and Melbourne,
Australia
There has been a great deal of attention afforded to rejuvenation
of the aging face yet the hands often show similar changes with
loss of elasticity,
wrinkling,
pigment dyschromia
and loss of
subcutaneous
fat. Traditional
resurfacing
procedures e.g. laser
resurfacing
are unpredictable
and hazardous for the hands due to
the paucity of appendageal structures.
We treated 52 patients with 104 “aging” hands using a
combined
approach. In all patients the pigment dyschromia
was
treated using a frequency-doubled,
Q switched Nd:YAG
laser,
at 532nm using fluences between 2-5.6 j/cm2. In 42 patients
wrinkling
was treated using a 1032 nm COOL TOUCH TM laser.
A surface temperature
of 39-44 “C was obtained using 2 passes,
fluences between 30-35j/cm2,
a cooling time of 30 msecs, and a
delay between laser pulses of 40 msecs. No anesthesia was
required. Fat grafting was also performed
in 32 patients under
local anesthesia with donor fat being obtained from the
abdomen.
Results were graded by the patients, 2 nurses and the treating
physician.
In all cases > 70% improvement
was achieved with a
high degree of patient satisfaction.
Side effects and morbidity
were minimal, with the worst effect being minor bruising.
A combined approach to the aging hand with correction
of
pigment changes, improvement
of elasticity and fat grafting
appear to be able to rejuvenate the hand with minimal
morbidity.
Long-term
data needs to be accumulated
and further
research needs to be performed.
TREATMENT
OF NECK RHYTIDES
WITH
A 1320 ND:YAG
NON-ABLATIVE
LASER.
Elizabeth
F. Rostan and Richard
E.
Fitzpatrick.
Dermatology
Associates
of San Diego County,
Inc.
Purpose:
To evaluate the safety and efficacy of a 1320 nm Nd:YAG
laser with cryogen cooling device in the treatment of neck rhytides.
Methods:
15 patients were treated on one side of their anterior neck
from base of neck to jawline with a 1320 nm Nd:YAG
laser with
cryogen cooling device (CoolTouch,
Laser Aesthetics,
Inc., Auburn,
CA). Two passes with the laser was performed
at three week intervals
for a total of 4 treatments.
Laser settings were as follows: 28-36 J/cm’,
cryogen cooling duration of 20-30ms with a laser delay of 30-40ms.
Fluence was set so that epidermal temperatures
(measured with an
infrared thermometer
in the laser head) reached 40-45” C. Biopsies were
taken prior to treatment and at 3 months after last treatment. Optical
profilometry
measurements
were made before and after 4 treatments.
After 4 treatments to one side of the
surgeries-neck,
the opposite side was treated for 4 treatments at 3 week
intervals, during which time observation
were continued on the initial
treament side.
Results: All patients showed improvement.
75% of patients had 50-75%
improvement
and 25% had 25-49% improvement.
Improvement
was
noted in skin tightening and in texture with the greatest improvement
observed in fine textural irregularities/rhytides.
One patient reported a
blister following
a treatment, but this did not result in a scar. Several
patients reported asymptomatic
firm papules on the neck occurring
l-2
days after a treatment and resovling in 3-4 days with no sequelae.
Conclusion:
The 1320 Nd:YAG
non-ablative
laser is a safe treatment for
neck rhytides and can result in significant
improvement
in fine textural
changes and fine rhytides of the neck and may also induce mild
tightening of the skin of the neck.
265
263”
TREATMENT
OF UPPER LIP RHYTIDES
WITH A 1320
ND:YAG
NON-ABLATIVE
LASER.
Elizabeth Rostan and Richard E.
Fitzpatrick,
Dermatology
Associates
of San Diego County&c.,
La Jolla,
CA.
LONG-TERM
RESULT
OF LASER
Katharina RUSSE-WILFLINGSEDER,
HAIR REMOVAL
Manfred HEROLD
Introduction.
Laser treatment
for hair reduction
is efficient
and well
accepted
but reports about long term results are still rare (1). We
evaluated our experience
of laser-assisted
hair removal
of more than
two years.
62
American
Society
for Laser
Medicine
Methods: In a retrospective
study we analyzed our results on 98 patients
(female; 14 to 62 years of age; mean + SD = 38.2 rt 9.7 years) treated
with long-pulse
alexandrite
laser for hair removal (face, axilla, bikini
line, legs) in our office. Number and time interval of treatments
are not
fixed but chosen according
to the intentions of the patients. Within this
study all patients were seen between June and September
2000 for
evaluation
of long-term
hair reduction.
Result of hair removal
was
estimated
by patients using a rating scale between
1 and 5 (1 =
excellent),
by doctors assessing the appropriate
hair loss according
to
pretreatment
pictures.
Results: 29 patients had stable hair reduction
for
(50 to 118 weeks; mean f SD = 67.4 f 15.9 weeks)
Most patients were highly content with the result
2.1 + 1.1) , only two patients rated 4 (very poor)
effect).
Estimated
hair reduction
(mean + SD =
between 30% (two patients) and 95% (six patients).
more than 50 weeks
after last treatment.
(1 to 5; mean + SD =
and 1 patient 5 (no
73.2% + 22.0) was
Conclusion:
Long-pulse
alexandrite
laser is efficient
only as an immediate effect but also in long-term
few treatments.
in hair removal not
efficacy even after
Literature:
(1) Lloyd
JR, Mirkov
M. Dermatol
Surg 2000;26:633-637
STANDARD
2136.3
CARE FACILITIES.
ON THE
SAFE USE OF
David H. Sliney, U.S. Army Center for Health Promotion and
Preventive
Medicine
Stephen Trokel, Columbia Presbyterian
Medical Center, New York
The sub-committee
on the “Safe Use of Lasers in Health Care Facilities”
has been working for the past two years to revise the current ANSI
Standard Z136.3.1995.
Since the ANSI standards development
process
requires a consensus approach, the development
and updating of a
standard can be a tedious process. The sub-committee
met three times
to debate the level of control to be exercised by the clinician and
assisting staff and the Laser Safety Officer.
The major change in
emphasis has been away from the use of surgical lasers in the operating
rooms of large institution
settings to the small clinic and private office
settings, where lasers are now far more widespread.
In this case,
perhaps only two or three persons are involved and the administrative
detail is considerably
less. The meaning of the term “laser operator”
was debated and resolved.
The duties of the Laser Safety Officer (LSO)
were refined and clarified.
Safety issues relating to changing
technology,
such as evolution of skin resurfacing
and other
dermatological
use of lasers, were addressed.
Occupational
exposure
limits, the Maximum
Permissible
Exposure limits (MPE’s) were
changed in the basic standard, ANSI Z136.1-2000,
and this has had
some impact on the applications
of sub-nanosecond
lasers in
ophthalmology
and in determining
safe viewing durations for lengthy
exposure to visible lasers. The application
of the Nominal Hazard Zone
(NHZ) was also further clarified.
Abstracts
Treatment
with the pulsed dye laser (PDL) improves port-wine
stains (PWS), but not all patients achieve the desired degree of
paling even after many sessions. We investigated
the effect of the
Orion KTP (532nm) or the PDL (585nm) at higher energies in
PDL-resistant
PWS.
In PDL-resistant
PWS we performed
3 test areas using the KTP:
spot sizes of 1, 2 and 4mm with a pulse width of 10, 20 and 40ms.
The highest fluence tolerated was used, aiming for minimal
blanching. In addition, 1 area was tested with the PDL, 5mm spot,
lOJ/cm* and dynamic coolin g. After 2 months, the response was
assessed by the patient, the physician with the aid of photos and
by spectrophotometry.
We recruited 22 patients of Fitzpatrick
skin type I-IV (9 male,
mean age 3 1 years, range 14-54). Eighteen PWS were on the
face, 2 on the arm and 1 each on the neck and leg. The fluences
used with the KTP in the 3 areas were 7-14J/cm*,
7-l 6J/cm* and
6-14J/cm*.
Adverse effects were more frequent with the KTP than
with the PDL. This table outlines the treatment response:
improved
O-25%
26-50%
5 l-75%
76-90%
91-100%
These results
modest if any
High fluence
proportion
of
266
REVISION
OF ANSI
LASERS IN HEALTH
and Surgery
PDL
59%
18%
14%
9%
0
KTP lmm
77%
18%
0
5%
0
KTP 2mm
69%
21%
10%
0
0
KTP Jmm
81%
11%
0
S%
0
indicate that the KTP laser generally produces
additional improvement
in PDL-resistant
PWS.
585nm PDL is more likely to be beneficial in a small
patients.
268
CARBON
DIOXIDE
LASER BLEPHAROPLASTY
A RETROSPECTIVE
STUDY
Fiona Steel/David Kitchen
Elite Laser Clinic Mackay Queensland Australia
American Society for Laser Medicine and Surgery
American Board of Laser Surgery
Assessment of CO2 Laser assisted Blepharoplasty
using a
retrospective
study of 50 patients from our clinic. Study includes
data such as age sex presenting condition medical or cosmetic,
operation performed, technique used, complications
and
outcomes. Our purpose is to show, using supporting figures, that
laser assisted blepharoplasty
is effective with a low incidence of
intraoperative
and postoperative
complications
and a high level
of patient satisfaction. Using the correct techniques and post
operative care, excellent results can be achieved. Methods /
techniques used for our study include Transconjunctival
Lower Lid Blepharoplasty
using CO2 laser +/- Erbium
Resurfacing of lower lids and Transcutaneous
Upper Lid
Blepharoplasty
using CO2 laser. Retrospectively
our study
showed a low incidence of intraoperative
and postoperative
complications,
excellent medical and cosmetic outcomes
and a high level of patient satisfaction.
The conclusion we have reached is that CO2 laser is both safe
and effective. We found that laser blepharoplasty
is tolerated
very well by patients of all ages both intraoperatively
and
postoperatively
with excellent cosmetic and medical results.
269”
267
Does the Orion Laser improve
Port-Wine
Treatment
with the Pulsed Dye Laser?
S Sommer. J Ravenscroft. R Sheehan-Dare
Leeds Dermatology Laser Centre. England
Stains
resistant
to
A CLINICAL
AND HISTOLOGICAL
STUDY OF A PULSE DIODE
940NM LASER WITH CONTACT
AND REFRIGERATED
AIR
COOLING
FOR THE TREATMENT
OF ABNORMAL
LEG VEINS
The 940-diode laser with its longer wavelength
and deeper dermal
penetration, peak in oxyhemoglobin
absorption should offer promise in
treating abnormal leg veins. Cooling with this laser should optimize
American
Society
for Laser
results by wicking heat from melanin absorption in the epidermis thereby
facilitating
the use of higher fluences and multiple passes to achieve
vessel destruction.
Methods:
20 patients with abnormal leg veins measuring between 0.5
mm and 2.0 mm were treated with the 940 nm diode laser (Domier
Medilas, Skin Pulse S) with spot sizes l.O-5mm.
Pulse durations
between 20-80 ms and optimized fluences were used. Cooling was
accomplished
in one group with a refrigerated
air cooling
device(Zimmer)
and in another group with a contact-cooling
device.
Multiple passes were performed
until vessel disappearance
or
microvascular
clot was observed.
An additional treatment was done at
week 4 for resistant vessels. Histological
studies were performed
20
minutes after treatment and 4 weeks later.
Results: Patients were evaluated 4, 8, and 12 weeks after the final
treatment.
Efficacy was determined
by investigator
evaluation and by
blinded photographic
analysis. Incidents and types of adverse side effects
were noted. Data from the two sites was then pooled for statistical
evaluation.
Conclusion:
This study demonstrates
the efficacy and histological
response of this new technology.
Emil A. Tanghetti,
Center for Dermatology
and Laser Surgery,
Sacramento,
Robert M. Adrian, Center for Cosmetic and Laser Surgery,
Washington
D.C.
270
VERRlJCOUS
EPIDERMAL NEVI: COMBINED
CO2 AND QSWITCHED
RUBY LASER
u&a,
Selma Cernea,
Luciana
Grinblat,
and Mario Grinblat
Hospital
Israelita
Albert Einstein, Department
Sao Paulo, Brazil
TREATMENT
WITH
A. Conrado,
Medicine
and Surgery
Abstracts
63
271
EFFICACY
OF AZITHAOMYCIN
PROPHYLAXIS
FOE LASER
VS. CEPHALEXIN
BACTERIAL
FACIAL
SKIN RESURFACING
Medical
Skin
Center
MD, Laser
Author:
Paul
Van Camp
Bend,
OR 97702
Purpose:
To compare
infection
rates
after
laser
resurfacing
in patients
given
azithromycin
vs.
cephalexinas
bacterial
prophylaxis.
Methods:
Charts
were
reviewed
for
65 sequential
cases
of full
or partial
facial
resurfacing.
All
patients
were
treated
by the
same
inter
and postop regimens
including
antiviral
and antibacterial
p:ophylaxis.
30 patients
received
azithromycin
for
fqve
uayTt, beginning
one day
pre-treatment
(500
mg
then
2ScI my X 4 days.)
35 patients
then
received
cephalexin
500 mg. TID
for
7 days
beginning
1 day
pre-op.
Resurfacing
was by dual-mode
Erbium
laser
(Sciton
Contour).Wound
care
included
24 hrs
of occlusion
with
Silon
TSR,
then
open
care
with
bland
petrolatum.
Patients
were
examined
on days
lf3,5r7J.
14,and
as needed.
Cultures
were
taken
for
any
symptoms
or signs
of possible
infection.
Rzsults:
Of thirty
consecutive
resurfacing
patients
on azithromycin
prophylaxis,
seven
(23%)
had wound
infections
in the
first
7 days.
Cultures
(6 of 7)
showed
Staph.
aureus
resistant
to erythromycin.
Of
3s patients
on cephalexin
prophylaxis
one
(3%) had
a staph
wound
infection.
This
is a significant
difference
(p=.Ol).
Conclusion:
Using
an open
dressing
technique
after
occlusion
for
24 hours
post
Erbium
laser
resurfaccephalexin
prophylaxis
started
one day
prior
ing,
to resurfacing
and continued
until
epithelialization
was complete
significantly
reducedthe
rate
of wound
infection
when
compared
to azithromycin
prophylaxis.
Beni
of Dermatology,
Epidermal
nevi are organoid
nevi arising from the pluripotential
germinative
cells in the basal
layer
of the embryonic
epidermis.
Extensive
segmental
lesions are difficult
to treat.
Surgery
by excision,
dermabrasion
or grafting
can lead to
unsatisfactory
scar formation.
We present two cases treated by
a combination
of CO2 and Qswitched
ruby laser (QSR). The
purpose was to determine
the effectiveness
and ease of the CO2
and the QSR laser used in combination
in the treatment
of
extensive
lesions of epidermal
nevi.
A 42-year-old
woman (case 1) and a 38-year-old
man (case 2)
presented
with verrucous
epidermal
nevi since birth.
The
lesions were localized
on the trunk,
axillae, left arm (case l),
and on the neck (case 2). The CO2 laser was used in the
ultrapulsed
mode at 300 mJ or in a continuous
wave of 5-10
watts
to treat the more keratotic
regions.
Then, the QSR
(S-10 J/cm2,
Smm spot) was used to treat thinner
lesions in
the same session,
or in subsequent
sessions
to treat
hyperpigmented
areas left after the first treatment.
General
anesthesia
was required
for treatment
of large areas. Topical
2.5% lidocaine
with 2.5% prilocaine
or no anesthesia
was required when the QSR laser was used alone. Topical bacitracin
ointment
and Vaseline were used until healing.
The lesions healed within
2 to 4 weeks. In one area on the
axillae,
exposed
to radiotherapy
in the past, healing
was
delayed.
No hypertrophic
scars were observed.
The final
cosmetic
result was considered
excellent
by the patients
and
the physicians.
There was no recurrence
after 3 years (case 1)
of follow-up.
Laser treatment
of epidermal
nevi is a valuable
therapeutic
alternative.
With the combination
of CO2 and QSR lasers, it is
possible
to target
both the hyperpigmentation
and the
hyperkeratotic
component
of the lesion.
It is a selective
and
less aggressive
approach
with encouraging
results.
272
DISSEMINATED
SUPERFICIAL
ACTINIC
POROKERATOSIS:
ER:YAG LASER TREATMENT
M. Vklez-Gonzilez,
, M”. Nicolas-Playans,
RM. Pujol, J G. Camarasa
Department of Dermatology
Hospital de1 Mar. IMAS, Barcelona (Spain )
INTRODUCTION
Disseminated superficial actinic porokeratosis (DSAP) is the most frequent type of
porokeratosis. Clinically is manifested by multiple erythematous atrophic maculopapules with a raised peripheral margin, involving almost exclusively sun-exposed
areas, but sparing the face. It is often only an aesthetic problem, although the
development of a cutaneous squamous cell carcinoma on long-standing lesions of
DSAP is a well-known phenomenon. To date, there is no effective treatment for the
DSAP. Different therapeutic options as topical retinoids, topical 5-FU,
electrodisecation, CO2 laser, cryotherapy, etc. have been postulated, with variable
results. Treatment of DSAP with these techniques may cause residual residual scars.
The Er:YAG laser application in the treatment of DSAP was proposed in order to
obtain a better control of possible side effects. Er:YAG laser has a high ablative
capacity, as well as a low thermal scattering and an accurate control of the depth of the
selective thermolysis. We present our experience in the treatment of DSAP with
Erbium: YAG laser.
REPORT OF CASES
Three patients with DSAP were included in the study. One patient presented multiple
disseminated lesions and in two patients the lesions involved mainly the lower
extremities. Treatment with the Erbium:YAG laser (2940nm) of pulsed emission
(350~s) at the rate of fluence :15 J/cm2 was administered. Local anaesthesia (EMLA)
was applied one hour before. The number of sessions of treatment was variable
depending to the clinical response. Pre-treatment and post-treatment biopsy specimens
were obtained in order to have an evolutive histopathological control. An evident
clinical improvement was observed and good aesthetic results were obtained. Minimal
scarring was noted after the treatment. No recurrence of the lesions was noted after 6
months of a follow- up period.
64
American
Society
for Laser
Medicine
COMMENT
Taking our results into account, we consider that Er:YAG laser can be an effective
alternative treatment in DSAP, with low rates of side effects and good cosmetic results.
REFERENCES
Groot DW, Jhonston PA: Carbon dioxide laser treatment of poroqueratosis of Mibelli . Laser
Surg Med; 1985; 5: 603-606.
Merkle T. Hohenleutner U, Braun-Falco 0, Landthaler M: Reticulate porokeratosis
successful treatment with CO2 laser vaporization. Clin Exp Dermatol 1992; 17: 178-181.
Rabbin PE, Baldwin HE: Treatment of porokeratosis of Mibelli with CO2 laser vaporization
Versus surgical excision with split-thickness skin graft. A comparis0n.J. Dermatol Surg Oncol
1993; 19:199-202.
273
XANTHELASMA:
Er:YAG
LASER
INTRODUCTION:
Xanthelasma is often an aesthetic problem, but also a therapeutic challenge. Treatment
of xanthelasma may be difficult, since the lesions are located in the proximity to the eye
and a high rate of recurrence after surgical removal has reported. Several therapeutic
procedures have been proposed; chemical ablation (TCA...), surgical excision and
electrodisecation and CO2 laser (1). The Er:YAG laser application in the treatment of
xanthelasmas was proposed in order to obtain a better therapeutic result with minima1
scarring and side-effects. Er:YAG laser has a high ablative capacity, as well as a low
thermal scattering and good control of the depth in the treatment of cutaneous lesions.
We present our experience in the treatment of xanthelasma with Erbium:YAG laser.
CLINICAL CASE
Eight patients with xanthelasma were included in the study. The lesions were located on
the upper eyelid (4 cases), lower eyelid (1 case) or both (3 cases). Treatment with
Erbium:YAG laser (2940nm) of pulsed emission (350~s) at the rate of fluence : 15
J/cm2 was administered. Local anaesthesia was applied, making several passes until
achieving the total ablation of the lesion. Each treatment consisted of one a two
sessions depending on the extension. An evident clinical improvement of the lesions
was observed and good aesthetic results were obtained. Minimal scarring was noted
after treatment. No recurrence of the lesions was noted , after 6 months of follow-up
period.
COMMENTS
As has been previously proposed (2,3). We considered that the application of Er:YAG
laser can be an effective alternative treated in xanthelasma, with a low rate of side
effects and a good cosmetic result.
BIBLIOGRAPHY
2.
3.
Abstracts
uniform pulse duration of 900 microseconds, dynamic cooling of 20
milliseconds with a short interval of 10 milliseconds before the laser pulse.
Two-three passes were made during each treatment session. Surface skin
temperature was measured during the first three pulses and fluence adjusted to
reach a target of 44 to 46 degrees C at the surface. Results were evaluated by
an independent observer using digital images taken just prior to treatment and
at one month after the last treatment. Results were graded as none, mild,
moderate and excellent improvement.
Results at one month post a series of 3
treatments showed that a total of 76% of patients demonstrated some
improvement as judged by digital image. 20 % had excellent improvement,
33% moderate, 23 % mild and 24 % showed no improvement.
Most notable
improvement was seen in non-dynamic lines. Side effects included 2 patients
with one site of vesicle formation, 5 patients with erythematous papules lasting
for 72 hours but in the vast majority erythema lasted from 10 minutes to one
hour. No pigmentation changes were observed. Dynamically
cooled 1320nm
laser with monitoring of surface temperature is an effective alternative for
improvement of peri-orbital rhytides. This treatment is accompanied by a very
low side effect pri;file even in skin types V.
TREATMENT
M. Wez-Gonzhlez,
A.M. Gimhez-Arnau:
C. Pla, D. Soler, RM. Pujol, J.G.
Camarasa, Deparment of. Dermatology.
Hospital de1 Mar. IMAS, Passeig
Maritimo, 25-28, Barcelona (Spain).
1.
and Surgery
Raulin C, Schoenermark
MP, Werner S, Greve B: Xantelasma palpebrarum :
treatment with ultrapulsed CO2 laser. Laser Surg Med 1999; 24(2): 122- 127
Riedel F, Windberger
J, Stein E, Hormann K: Treatment of peri-ocular skin
lesions with the erbium:YAG laser . Ophthalmologe 1998; 95:771-775.
Dmovsek-Olup
B, Vedlin B: Use of Er:YAG laser for benign disorders. Laser
Surg Med 1997; 21: 13-19.
275”
FACIAL
LASER HAIR REMOVAL
USING
1064NM Nd:YAG:
A
COMPARISON
OF TWO DIFFERENT
COOLING
METHODS
RA Weiss, MA Weiss, Johns Hopkins,
Baltimore,
MD
Comparison
of both contact and dynamically
cooled 1064nm lasers for
treatment of facial hirsuitism
in type V and VI skin patients was
performed.
Twenty female type V and VI patients with excess hair on
the face were treated with two treatments two months apart and
evaluated at month 3 for hair counts and side effects.
Hair counts using
dual polarized light were performed
in a lcm* area, before and at one
month following
the last treatment.
Parameters for the contact cooled
1064nm laser included a 6 mm spot size, 80 J/cm2, and pulse duration of
16 milliseconds.
Contact cooling was placed for 3 seconds at 1 degee C
prior to the laser pulse. Parameters for dynamic cooling included precooling of 20 millisec and post-cooling
of 20 millisec using 80 J/cm2
with a 50 msec pulse width and 5.5 mm spot size.
Hair counts revealed 34% reduction after two treatments with the contact
cooling 1064nm laser. Using the contact cooled system 50% of the
patients developed hypopigmented
circles lasting for 4 - 6 months. Hair
counts for the dynamic cooling system showed 58% reduction after 2
treatments.
Cryogen spray cooled skin showed 25% of the patients
developing
isolated areas of hyperpigmentaton
lasting for 2 - 3 months.
These results indicate that the 1064nm is effective for hair removal in
types V and VI skin with acceptable side effects.
Dynamic cooling
reduces side effects and yields improved hair reduction.
276
274”
SUBSURFACE
RESURFACING
USING A CRYOGEN
SPRAY
COOLED
1320NM LASER
RA Weiss, MA Weiss, Johns Hopkins, Baltimore,
MD
A dynamically
cooled 1320nm laser has been used to treat actinic and
dynamic changes of the peri-orbital
region including the crow’s feet
region and lax skin of the lower eyelid. A thermal effect at 150 - 200
microns below the surface is theoretically
responsible
for the stimulation
of collagen synthesis.
40 patients with skin types I - V, with rhytides of the lower lid and peri-orbital
region, Glogau types I - II, were treated on 3 occasions one month apart with a
dynamically cooled 1320nm laser using parameters of 28 - 34 Jlcm2, a
INFRARED
V. Zharov’?
IMAGING
M. Warier*
OF SUBCUTANEOUS
S Ferguson’,
J. Eidt3
VEINS
STRUCTURE
***Philips Classic Laser Laboratory,
University
of Arkansas for Medical
Sciences (UAMS),
Little Rock, AR
*Department
of Otolaryngology,
UAMS, Little Rock, AR
3Department
Vascular and General Surgery, UAMS, Little Rock, AR
The aim of this study was to test a method of infrared imaging for
visualization
subcutaneous
veins with focus on clinical trials. The
practical possibilities
of near infrared (IR) imaging of skin in diffuse
reflection and transillumination
modes are revised. The dependence
of
IR image properties on wavelength,
methods of illumination,
polarization
effects, type of sources (IR lasers, LED arrays with different
American
Society
for Laser
wavelengths
and lamps with filters) and profile of surface are studied. It
is shown that contrast is spectral depending on combination
absorption
and scattering parameters of different layers and compounds
(melanin,
water, lipids, cutaneous blood, collagen fiber etc,) and for visualization
each individuals
subcutaneous
structure, preferable wavelength
and
methods of illumination
exist. The IR images at different wavelength
were obtained in vivo with monochromatic
illumination
from the high
power xenon lamp after monochromator.
A relatively
simple IR device
called “IRIS” was developed for imaging different subcutaneous
structures.
“IRIS” uses a head-mounted
IR LED arrays, set of polarizers,
filters and diffusers, small conventional
CCD camera with virtual reality
optics that are worn like glasses. The reasonably high quality of IR
images shows this technique very promising in different medical
applications
including:
vascular surgery; determination
of margins of
burning tissue; dermatology;
phlebotomy;
cosmetics; monitoring
of
catheter localization’s;
quality control hair removal. The primary
research focused mostly on visualization
veins different sizes and
location particular
for pediatry to guide drawing a blood sample, to set
up an intravenous
drip for baby, diagnosis of women’s veins leg
pathology,
feedback control of laser vascular surgery.
Medicine
and Surgery
Abstracts
system. The new combined US-LED
device was developed with three
modes: contact below and above cavitation threshold and non-contact
aerosol treatment. The main parameters:
US frequency
26,5 kHz; PSaluminum phtalocyanine
l-8 mg/l; LED array 660 nm, 5 mW); duration
treatment lo-30 min. The study of several bacteria mortality
(St.aureus,
Streptococus,
E.coli, Pseudomonas
aeruginosa and Proteus) in different
modes (A,US +A, PDT, US+PDT,
US+PDT+A)
on models and animals
show significant
advantage of US+PDT and US+PDT+A
modes. The
clinical trials in Moscow with 41 patients with different post-operation
infectious complications
different origin demonstrated
advantage of new
technology
in comparison
with conventional
methods in cases of
extended and profound wounds.
278
LONG PULSED
DYE LASER FOR TREATMNT OF
FACIAL TELANGIECTASIA.
m
ZelicksQn
Charlotte
277
COMBINATION
OF PHOTODYNAMIC
AND ULTRASONIC
TECHNOLOGIES
FOR TREATMENT
OF INFECTED
WOUND
Vladimir
P.Zharov’,
Valery V. Bagdasarov*,
Yulian A. Menyev3
‘The Philips Classic Laser Laboratory,
University
of Arkansas for
Medical Sciences, Little Rock, AR *Moscow
Clinical Hospital, Russia
3Bauman Moscow
State University
of Technology,
Russia
The aim of this study was development
of new photo-ultrasonic
technology
for treatment of infected wound with focus on clinical trials.
The feature of this technology
is combination
of two methods:
photodynamic
therapy (PDT) and ultrasonic therapy (UST) with
antibiotics
(A) as tools for effective killing bacteria. The principle of
UST itself is based on introducing
of US oscillation
in solution with
antibiotics
(A) around wound. The principle combined methods PDTUST is based in introduction
in wound solution both with photosencitizer
(PS) and (A) and followed light irradiation
and US low-frequency
impact. As result simultaneously
several phenomena appear in wound:
cavitation,
acoustic stream, sound pressure and photodynamic
effects. It
brings some new advantages:
effective mix drug and PS in wound
solution; enhance diffusion
antibiotic in tissue; increasing penetration of
PS in bacteria; US clearing of surface from necrotic adjournment;
additional US-induced
bactericidal
effect; increasing efficacy of light
irradiation
in non-transparent
wound; combined activation
of immune
65
Coles. Center for Cosmetic Care, Edina, MN.
The purpose of this study was to compare results of treating
facialtelangiectasia
and erythema using the Long Pulsed Dye
Laser (LPDP) and a 532 nm wavelength
KTP Laser.
Twenty-two
patients with faci&langiectasia/erythema
were
randomized
to which side of the face the chosen therapy woulc
be administered.
Pre and post-op photos were taken. Patients
followed up at 1 and 6 days after treatment for photos and
assessment of side effects. At thethree month post-op visit
photos were taken and if the patient did not have 90% or better
clearance they received a second treatment using the same
randomization.
The same follow up schedule was followed. At
three months after the final treatment each patient completed a
survey. Treatment
parameters for the LPDL were 595 nm, 9.5
11 J/cm*, 20-30 ms pulse width and a7 mm spot size using
dynamic cooling. With the532 nm wavelength
the treatment
parameters ranged from 13-17 J/cm, 20-50 ms pulse width and
a l-4 mm spot size. The pre and three month post-op slide:
were scored by three blinded health care professionals
on an
improvement
scale from 0 - 4 (0% = no clearance,
1 = l-25%,
= 26-50%, 3 = 51-75% and 4 = 76100%
clearance).
On the patient survey 50% chose the LPDL, 40% chose thl
KTP laser and 10% felt there was no difference from on side tc:
the other. The slide review assessment revealed that the LPDL
had an improvement
score of 1.43 and the KTP was 1.00. Post.
operatively
15% of the patients had mild purpura that laste
about 10 days and 20% had moderate edema for 3-6 days on
the side treated with the LPDL, whereas, 30% had modera
edema for 3-6 days on the KTP treated side.
This study shows that the LPDL is an effective
treatment for
facial telangiectasia/erythema
with minimal side effects an
minimal occurrence
of purpura.