Laser Techniques Associated with Facial Aesthetic and Reparative Surgery

The combination of rhytidoplasty and fractional CO2 laser therapy in the treatment of facial aging

BACKGROUND

Facial aging is a natural biological process with symptoms such as sagging tissue, accentuated lines, furrows, wrinkles, dyschromias, and loss of facial volume. Rhytidectomy alone often fails to achieve a patient's expected goals, which is why there is a high demand for adjunct laser skin treatment.

METHODS

From January 2007 to February 2013, a total of 80 patients with skin types Fitzpatrick I-IV underwent large undermined cutaneous flap rhytidectomy and superficial muscular aponeurotic system (SMAS) plicature plus hyaluronic acid injection on the nasolabial folds and lips and concomitant Lumenis UltraPulse CO2 Active FX total ablation mode resurfacing of nonundermined skin. The undermined skin was treated with a fractional laser using different energies depending on the type of skin. Patients were evaluated at 5, 10, 15, 30, 60, and 90 days after the operation. At the last evaluation patients completed a specific questionnaire about satisfaction.

RESULTS

Complications included expansive hematomas (5 %), partial necrosis (1.25 %), bacterial infection (1.25 %), herpetic infection (1.25 %), hypertrophic scar (1.25 %), and spot hyperchromia (1.25 %). 95 % of patients were extremely satisfied, 3.75 % were satisfied, and only 1.25 % were unsatisfied.

CONCLUSION

The combination of subcutaneous flap rhytidectomy and SMAS plicature with fractional laser resurfacing plus hyaluronic acid injection is a safe procedure with low incidence of major complications and improves patient satisfaction.

[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.

Low density, non-ablative fractional CO2 laser rejuvenation

BACKGROUND AND OBJECTIVES

Fractional skin rejuvenation has gained increased interest since its introduction in 2003. Both non-ablative and ablative lasers as well as different treatment techniques have been devised. Recent clinical studies indicate that a paradigm of low spot density combined with high fluences tend to produce better clinical results and less risk of post-inflammatory hyperpigmentation in darker skin types. The present study is focused on investigations of the clinical outcome by non-ablative fractional CO(2) treatments with a single pass with low spot density.

METHODS AND MATERIALS

A CO(2) laser was equipped with a scanner enabling it to perform fractional treatments with 36, 64 or 100 microthermal zones (MTZ)/cm(2). Twelve patients participated in the study. The perioral area was treated three times with 1-month intervals using a spot density of 64 MTZ/cm(2), a spot diameter of 0.5 mm, a micro-beam energy of 36-60 mJ, and a pulse duration of 3-5 milliseconds. Follow-up was performed 3 months after the last treatment.

RESULTS

At the 3-month follow-up 72.7% of the volunteers had obtained improvement in ultrasonographically determined dermal density, and the average improvement was 40.2% (SD: 48.0%). This improvement was statistically significant (P<0.006). Eighty percent of the volunteers rated the reduction in visible perioral wrinkles to be fair, good or excellent. For reduction of irregular pigmentation, fair, good or excellent clearance was reported by 62.5% of the volunteers.

CONCLUSIONS

The present study demonstrates subjective improvements in wrinkles, skin texture and mottled pigmentation as well as statistically significant objectively measured improvements in ultrasonographical dermal density after three non-ablative fractional CO(2) laser treatments.