Electron microscopy comparison of CO2 laser flash scanning and pulse technology one year after skin resurfacing

Available techniques to minimize scars in surgical management of gynecomastia - a comprehensive review

Objective

Gynecomastia and lipomastia are benign proliferations of the male breast affecting 32-65% of men. Numerous surgical procedures often result in stigmatizing scars when it comes to skin resection. The purpose of this study was to review skin-sparing techniques and to describe our skin-sparing approach to treat skin excess using transcutaneous netting.

Materials and Methods

A comprehensive review of the literature was conducted aiming at identifying available techniques to avoid skin resection in gynecomastia or lipomastia patients (Simon's grade IIb and III). Surgical techniques, patient satisfaction, time of follow-up, and complications were assessed.

Results

Seven studies detailed skin retraction techniques, including laser-, ultrasound-, and radiofrequency-assisted liposuction (LAL, UAL, and RAL), microneedling, and nipple-areolar complex (NAC) plaster lifting. All articles provided Simon's grade classification, with most studies including patients with and without skin laxity. Complication rates were low (1.5-10%), and patient satisfaction ranged from 87.5% to 100%.While transcutaneous netting has been reported to reduce hematoma in gynecomastia surgery, no studies specifically examined its role in managing skin redundancy.

Conclusions

Limited data exist on scarless skin retraction techniques for gynecomastia. While LAL, UAL, and RAL show some potential, controlled studies are lacking, and skin resection is often performed for high skin redundancy. We recommend a skin-sparing approach using liposuction and transcutaneous netting for gynecomastia up to Simon's grade III, which allows for skin retraction and NAC fixation. No literature was found assessing the efficacy of transcutaneous netting in promoting skin retraction in gynecomastia.

The Clinical Effects of Pixel CO2 Laser on Bladder Neck and Stress Urinary Incontinence

Background: Our study aims to assess Pixel CO2 laser efficacy for female stress urinary incontinence (SUI). Methods: In the study, 25 women with SUI were included and scheduled for vaginal Pixel CO2 Laser (FemiLift™, Alma Lasers, Israel) treatment. All subjects had a baseline and 6-month post-treatment assessment that included three-dimensional perineal ultrasound and validated questionnaires. Results: Data showed that monthly three-session vaginal Pixel CO2 Laser treatment significantly improved SUI symptoms, as evidenced by validated questionnaires, including UDI-6, IIQ-7, ICIQ, and vaginal laxity questionnaire (p < 0.05). The Pixel CO2 Laser efficacy in vaginal treatment was 20/25 (80%), and the perineal sonography showed that laser treatment significantly decreased bladder neck mobility and middle urethral area (during resting and straining). Permanent adverse events were not found. Conclusions: The results of our study suggested that for the treatment of mild to moderate SUI symptoms, Pixel CO2 Laser is effective and safe; however, more studies and a longer follow-up should be conducted to confirm its efficacy and durability.

Effects of laser-assisted lipolysis on nipple-areola complex

BACKGROUND

Gynecomastia, as a most common benign condition, represents itself as the enlargement of the male breast and also nipple-areola complex as the severity of the condition increases. With this study, we aimed to clarify the effects of 980-nm diode laser on nipple-areola complex (NAC).

OBJECTIVES

Although numerous open techniques have been described to correct gynecomastia, nowadays trends have shifted to minimally invasive techniques such as laser-assisted lipolysis (LAL).

METHODS

A total of 25 patients with bilateral gynecomastia treated with LAL by using a 980-nm diode laser.

RESULTS

The resultant contour and reduced size of the complex were satisfactory.

CONCLUSIONS

LAL leads to significant reduction of the size of NAC.

[Laser-assisted lipolysis for gynecomastia: safe and effective skin retraction]

OBJECTIVES

To evaluate efficacy of laser lipolysis in the treatment of gynecomastia to correct breast volume, flaccidity and excess skin without its excision.

METHODS

Prospectively, 32 patients with gynecomastia under tumescent anaesthesia and sedation underwent laser lipolysis with 980 nm diode laser, 15W continuous emission and 8 to 12 kJ energy per breast. Externally cold air was used to protect the skin. No drainages were used but a compressive bandage. Patients evaluated results on a VAS scale. Two doctors evaluated results comparing before and 6 month after photographs and also measured the areola and chest diameter.

RESULTS

Twenty three patients considered results as Very Good, 7 Good and 2 Fair Cutaneous retraction of the areola was noticeable one month after the surgery and was maximum 6 months after. Evaluation by doctors was 26 Very Good, 5 Good and 1 Fair. There were no burns, ischemia or lesions in areolas or nipples.

CONCLUSION

Laser assisted liposuction is a simple and efficacious technique, barely traumatic and permits a rapid reincorporation to normal activities.

Oral tissue response to ovine grafting biomaterial: morphological and morphometric study using scanning electron and light microscopy tissue response to ovine grafting biomaterial

OBJECTIVE

To evaluate the oral tissue response to an experimental particle ovine biomaterial by scanning electron microscopy (SEM) and light microscopy (LM).

MATERIAL AND METHODS

Forty-eight rats had surgical periodontal defects treated with either blood clotting (control), bovine biomaterial™ (B), or an experimental ovine biomaterial (O). Data from SEM analysis (defect exposure, root surface exposure, diameter of matrix fibers and bundles, and globuli areas; n = 5) were applied to Shapiro-Wilk, Kruskal-Wallis, and Dunn's test, whereas LM analysis (tissue cicatrization characteristics and diameter defect; n = 3) had data applied to two-way analysis of variance. Animals were monitored for 1 and 3 weeks.

RESULTS

By SEM, the O samples showed significant differences from B and C in the area of defect exposure (H(2,15) = 8.66; P < 0.05). In both periods, O and B samples showed similar results for matrix fiber diameters, differently than C samples (H(2,15) = 14.0; P < 0.05). All other SEM variables were considered equivalent among the groups (P > 0.05). Under LM, an acute and chronic granulomatous inflammation was seen in the presence of both biomaterials (B and O, 1 week); both the control and the ovine grafting samples showed mature bone in the repair site (3 weeks); the defect diameter showed similar values among groups, at both monitoring periods (F(2,12) = 1.0401; P > 0.05).

CONCLUSION

The ovine particles of this study showed a favorable response to oral tissue repair, demonstrating to be a potential source for the development of bone grafting biomaterials.

Safe and effective one-session fractional skin resurfacing using a carbon dioxide laser device in super-pulse mode: a clinical and histologic study

Carbon dioxide (CO(2)) laser ablative fractional resurfacing produces skin damage, with removal of the epidermis and variable portions of the dermis as well as associated residual heating, resulting in new collagen formation and skin tightening. The nonresurfaced epidermis helps tissue to heal rapidly, with short-term postoperative erythema. The results for 40 patients (8 men and 32 women) after a single session of a fractional CO(2) resurfacing mode were studied. The treatments included resurfacing of the full face, periocular upper lip, and residual acne scars. The patients had skin prototypes 2 to 4 and wrinkle degrees 1 to 3. The histologic effects, efficacy, and treatment safety in various clinical conditions and for different phototypes are discussed. The CO(2) laser for fractional treatment is used in super-pulse mode. The beam is split by a lens into several microbeams, and super-pulse repetition is limited by the pulse width. The laser needs a power adaptation to meet the set fluence per microbeam. Laser pulsing can operate repeatedly on the same spot or be moved randomly over the skin, using several passes to achieve a desired residual thermal effect. Low, medium, and high settings are preprogrammed in the device, and they indicate the strength of resurfacing. A single treatment was given with the patient under topical anesthesia. However, the anesthesia was injected on areas of scar tissue. Medium settings (2 Hz, 30 W, 60 mJ) were used, and two passes were made for dark skins and degree 1 wrinkles. High settings (2 Hz, 60 W, 120 mJ) were used, and three passes were made for degree 3 wrinkles and scar tissue. Postoperatively, resurfaced areas were treated with an ointment of gentamycin, Retinol Palmitate, and DL-methionine (Novartis; Farmaceutics, S.A., Barcelona, Spain). Once epithelialization was achieved, antipigment and sun protection agents were recommended. Evaluations were performed 15 days and 2 months after treatment by both patients and clinicians. Treatment improved wrinkle aspect and scar condition, and no patient reported adverse effects or complications, irrespective of skin type, except for plaques of erythema in areas that received extra laser passes, which were not seen at the 2-month assessment. The results evaluated by clinicians were very much in correlation with those of patients. Immediately after treatment, vaporization was produced by stacked pulses, with clear ablation and collateral heat coagulation. An increased number of random pulses removed more epidermis, and with denser pulses per area, a thermal deposit was noted histologically. At 2 months, a thicker, multicelluar epidermis and an evident increase in collagen were observed. Fractional CO(2) laser permits a variety of resurfacing settings that obtain safe, effective skin rejuvenation and correct scar tissue in a single treatment.

Lasers and optical technologies in facial plastic surgery

Lasers and optical technologies play a significant role in aesthetic and reconstructive surgery. The unique ability of optical technologies to target specific structures and layers in tissues to effect chemical, mechanical, or thermal changes makes them a powerful tool in cutaneous rejuvenation, hair removal, fat removal, and treatment of vascular lesions such as port-wine stains, among many other procedures. With the development of adjunct techniques such as epidermal cooling, lasers and optical technologies have become more versatile and safe. The constant improvement of existing applications and the emergence of novel applications such as photodynamic therapy, nanoparticles, spectroscopy, and noninvasive imaging continue to revolutionize aesthetic medicine by offering a minimally invasive alternative to traditional surgery. In the future, therapies will be based on individualized, maximum, safe radiant exposure to deliver optimal dosimetry. Lasers and optical technologies are headed toward safer, easier, more quantifiable, and more individualized therapy.

Pulsed and scanned carbon dioxide laser resurfacing 2 years after treatment: comparison by means of scanning electron microscopy

Studies have reported short-term and long-term (1-year) findings for laser skin resurfacing. Two of the most popular systems used for this procedure, the continuous-wave Sharplan 40C SilkTouch system and the pulsed Coherent 5000C UltraPulse system with a computer pattern generator, were previously compared for a range of follow-up times up to 1 year, using light microscopy and transmission electron microscopy. This study analyzed the 2-year morphological differences using scanning electron microscopy. Tissue samples were obtained from 10 patients (age range, 50 to 72 years; skin types II and III) who had undergone laser resurfacing 2 years previously. One half of the face of each patient had been treated with the continuous-wave system and the other half with the pulsed system. The samples were subjected to scanning electron microscopy. On the continuous-wave-treated side, significantly better dermal collagen organization was observed at 2 years, with plump-appearing fibers that were closely knit to form a compact structure. On the side treated with the pulsed system, the collagen fibers in the papillary dermis were more loosely arranged and appeared drier. In both the continuous-wave-treated and pulsed-treated areas, the epidermis appeared healthy and exhibited some signs of age-related deterioration, with slightly flatter plaques and somewhat more flaking keratin on the pulsed-treated side. Probably because of the greater degree of residual thermal damage associated with the continuous-wave system, at 2 years after treatment there was more prolific synthesis and better orientation of collagen fibers, which were maintained for longer times, compared with the pulsed-treated specimens.

Laser ablative resurfacing for photorejuvenation based on more than a decade's experience and 1200 patients: personal observations

BACKGROUND

Before lasers, the rejuvenation of photoaged skin, presented clinicians with many problems. Conventional methods, such as dermabrasion and various peels, gave inconsistent results with the potential for adverse side-effects. Lasers have dramatically changed resurfacing procedures and results, although the potential for severe side-effects still exists.

PATIENTS AND METHODS

The author's experience of over a decade in the use of the pulsed and continuous wave CO(2), Er:YAG, and combined CO(2) and Er:YAG lasers in ablative resurfacing in more than 1200 patients is summarized. Parameters are discussed, and laser/tissue interactions are investigated.

RESULTS

Among the CO(2) lasers used, the C/W system proved more effective in the long term than the pulsed system. For the Er:YAG laser, a novel dual-mode approach was developed which was seen to give better results than the usual ablative Er:YAG settings. The combined Er:YAG/CO(2) system proved, in the author's hands at least, to be an ideal laser ablative resurfacing system when used with the collimated hand-piece and a 50% overlap, which achieves a two-pass equivalence in a single pass. Representative case reports are presented.

CONCLUSIONS

Laser ablative resurfacing with the CO(2) or Er:YAG dual-mode lasers has the potential to produce excellent and long-lasting results, but at the cost of patient downtime and unpleasant side-effects. The combined Er: YAG/CO(2) system, in combination with good wound management techniques has helped reduce downtime and adverse effects.

Skin resurfacing improved with a new dual wavelength Er:YAG/CO2 laser system: a comparative study

OBJECTIVE

The efficacy of a new dual wavelength Er:YAG and CO2 laser system was tested for skin resurfacing results on rabbits' ears and human facial skin. The dual wavelength laser delivers simultaneous pulses of low-energy CO2 and high-energy Er:YAG energies. Theoretically, combining the strengths of both laser types in one console should lead to improved clinical outcome.

SUMMARY BACKGROUND DATA

The use of the laser for skin resurfacing and remodeling has dramatically increased over the past few years. The CO2 laser was the first laser to be used in this field, followed more recently by the E:YAG laser. Both lasers offer unique advantages and disadvantages.

METHODS

The present study consists of an ear chamber experiment, conducted on eight rabbits, to examine vascular network formation, after laser resurfacing with a standard CO2 laser and the Er:YAG/CO2 laser. Resurfacing was also performed on human patients with the Er:YAG/CO2 laser and the results were compared with previously published results of CO2 laser resurfacing.

RESULTS

Significant advantages, including an attenuation in the degree of edema and erythema and a shorter reepithelialization time compared to results with conventional CO2 systems, were observed with the Er:YAG/CO2 system. Improved tissue reorganization and good clinical results in nine of the ten patients (six ratings of "very good" and three "good") were observed. The clinical outcome of the remaining patient was rated as "fair." Minimal side effects were reported and observed in only three patients. The learning curve required to maximize the efficiency of the system is steep, however, requiring a thorough understanding of the different laser/tissue interactions associated with the two wavelengths.

CONCLUSION

It is the authors' opinion that the dual wavelength Er:YAG/CO2 laser system offers a particularly efficient and flexible system to perform standard CO2 procedures for skin resurfacing with an improved clinical outcome, as well as other applications with the CO2 or Er:YAG energy delivered separately.