46 results on '"Goldman, M."'
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2. Energy density and numbers of treatment affect response of keloidal and hypertrophic sternotomy scars to the 585-nm flashlamp-pumped pulsed-dye laser.
- Author
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Manuskiatti W, Fitzpatrick RE, and Goldman MP
- Subjects
- Adult, Aged, Cicatrix, Hypertrophic pathology, Female, Humans, Keloid pathology, Male, Middle Aged, Postoperative Complications therapy, Sternum surgery, Treatment Outcome, Wound Healing, Cicatrix, Hypertrophic therapy, Keloid therapy, Laser Therapy
- Abstract
Background: The 585-nm flashlamp-pumped pulsed-dye laser (PDL) has proven to be the treatment of choice for certain keloids and hypertrophic scars, but the precise fluence, numbers of treatment, and treatment interval remain anecdotal., Objective: This study was performed to determine whether the therapeutic outcome of the PDL varies with the energy density (fluence) of the laser pulses and numbers of treatment., Method: Ten previously untreated, erythematous, keloidal or hypertrophic median sternotomy scars of 10 patients were divided into 4 segments and were randomly treated with a 585-nm PDL at a fluence of 3, 5, and 7 J/cm(2) to 3 of 4 segments every 4 weeks for a total of 6 treatment sessions. One segment of each patient's scars was untreated and served as a control. Clinical improvement including scar height, erythema, and pliability was evaluated before treatment and every 8 weeks for a total period of 32 weeks. Self-assessment was also determined by patients on a 25% increment of improvement scale comparing week 0 and week 32., Results: A significant improvement in scar height, erythema, and pliability was noted in all laser-treated scar areas. There was no significant difference in treatment outcome versus the fluence of the laser (3, 5, and 7 J/cm(2)), although there was a trend for lower fluences to show more improvement. Objective clinical improvement was seen as early as week 16, after more than two treatments were given. Multiple treatments (>2) appeared to provide a greater percentage of scar resolution., Conclusions: The clinical improvement of scars after PDL treatment demonstrates no statistically significant fluence dependence in this study, but a trend toward better response with lower fluences is seen. In addition, multiple treatment sessions are suggested for achieving greater response.
- Published
- 2001
- Full Text
- View/download PDF
3. CO2 laser resurfacing of the face and neck.
- Author
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Goldman MP
- Subjects
- Carbon Dioxide, Humans, Dermatologic Surgical Procedures, Face surgery, Laser Therapy adverse effects, Laser Therapy instrumentation, Laser Therapy methods, Neck surgery, Skin Aging
- Abstract
Laser resurfacing with the short-pulsed, high-energy CO2 laser has been used to treat photodamaged skin and acne scars. Efficacy and safety have been demonstrated with this technique since 1992. Newer treatment methods, including sequential or combination treatment with the Er:YAG laser have led to increased efficacy with a decrease in adverse sequelae. This article details the author's experience with CO2 laser resurfacing and promotes the use of sequential CO2/Er:YAG laser resurfacing.
- Published
- 2001
4. Interpenetrating polymer network wound dressing versus petrolatum following facial CO2 laser resurfacing: a bilateral comparison.
- Author
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Weiss RA and Goldman MP
- Subjects
- Carbon Dioxide, Humans, Laser Therapy instrumentation, Postoperative Complications prevention & control, Treatment Outcome, Bandages, Emollients therapeutic use, Laser Therapy methods, Petrolatum therapeutic use, Polytetrafluoroethylene therapeutic use, Rhytidoplasty methods, Silicones therapeutic use, Wound Healing physiology
- Abstract
Background: Occlusive dressings increase the speed of epidermal wound healing by decreasing wound adherence, maintaining a moisture barrier, and allowing contact with healing factors., Objective: To test whether a thin film of silicone and polytetrafluoroethylene blended into an interpenetrating polymer network (SPIPN) can provide improved healing over petrolatum following CO2 laser resurfacing injury., Methods: A bilateral comparison of closed SPIPN versus open healing following two different CO2 laser delivery systems for resurfacing was performed. Twenty patients were followed and evaluated at days 1, 2, 3, 7, 14, 30, 60, and 90 for exudate, erythema, rate of epithelialization, pigment changes, postoperative pain, pruritus, cosmetic results, preference, and duration of postoperative complications., Results: Results demonstrated improved healing for SPIPN compared to petrolatum alone. Markedly decreased exudate was seen in 90% of the SPIPN dressing sides. Erythema during the first 72 hours was 1.95 for SPIPN versus 2.6 for open (scale 1-4) (P <.05). Pruritus was 1.67 versus 2.44 (P <.05) for SPIPN versus open during the first 3 days postoperatively. Approximately 75% of the patients preferred SPIPN to control petrolatum. The rate of reepithelialization was also better for the SPIPN dressing, taking only 2 days versus 2.8 days for open control. Approximately 50% of the patients reported decreased pain on the SPIPN side at days 1 and 2., Conclusions: SPIPN dressing provides an easily applied, easily tolerated dressing for use after laser resurfacing. Many patients benefit from faster healing, reduced exudate, better appearance during the postoperative period, and decreased postoperative discomfort.
- Published
- 2001
- Full Text
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5. Resurfacing of photodamaged skin on the neck with an UltraPulse((R)) carbon dioxide laser.
- Author
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Fitzpatrick RE, Goldman MP, and Sriprachya-Anunt S
- Subjects
- Aged, Carbon Dioxide, Esthetics, Female, Follow-Up Studies, Humans, Male, Middle Aged, Neck, Radiation Dosage, Treatment Outcome, Laser Therapy methods, Plastic Surgery Procedures methods, Skin Aging drug effects
- Abstract
Background and Objective: Successful treatment of facial wrinkles with carbon dioxide or erbium laser resurfacing brings about a more youthful appearance of the skin on the face. A variable degree of contrast with the untreated skin on the neck prompts many patients to request treatment for photodamaged skin on the neck. The objective is to investigate the feasibility of resurfacing photodamaged skin on the neck with the UltraPulse((R)) carbon dioxide laser. SUDY DESIGN/MATERIALS AND METHODS: The study was carried out in two phases. During the first phase, a small area on the upper neck was tested with three different parameters. The best parameter was then used to treat the neck area in a single pass in 10 cases in the second phase. Patients were then evaluated at 3-6 months., Results: The three parameters tested were 200 mJ at CPG settings of pattern 3, size 9, density 6, 300 mJ at CPG 3-9-5, and 300 mJ at CPG 3-9-6. The latter seemed to achieve the best results, and there were no complications at any test sites. This setting was used to treat the whole anterior and anterolateral part of the neck with a single pass, wiping away the resultant epidermal debris. Moderate improvement in color and texture, but no improvement in wrinkling, were observed at 3-6 months. However, a mild degree of patchy hypopigmented scarring in the lower neck was encountered in three cases, as well as one other case of patchy hypopigmentation without textural changes., Conclusions: Despite some obvious improvements, the risk of scarring and hypopigmentation with the tested parameters out-weighs the potential benefits. The lower part of the neck responded very differently from the upper part. Alternative strategies to achieve better results are discussed., (Copyright 2001 Wiley-Liss, Inc.)
- Published
- 2001
- Full Text
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6. Laser resurfacing with a long pulse erbium:YAG laser compared to the 950 ms pulsed CO(2) laser.
- Author
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Rostan EF, Fitzpatrick RE, and Goldman MP
- Subjects
- Face surgery, Humans, Middle Aged, Skin Aging, Laser Therapy
- Abstract
Background and Objective: Laser resurfacing with the 950 micros pulsed CO(2) laser is an effective treatment for photodamage and acne scarring; however, the potential for prolonged erythema and delayed re-epithelialization dissuade many patients from the procedure. With the use of erbium lasers alone, there is a decrease in the incidence and severity of these adverse sequelae; however, it is difficult to achieve the same degree of improvement as with the CO(2) laser because of the more superficial depth of resurfacing. Thus, new erbium lasers have been developed with longer pulse durations to deliver increased thermal effects to tissue. It is hypothesized that with the use of these lasers, diminished erythema and faster wound healing will be observed as well as enhanced clinical outcomes., Study Design/materials and Methods: Sixteen patients were randomized to receive laser resurfacing on one-half of the face with the 950 micros pulsed CO(2) laser (UPCO(2)) followed by short pulse erbium:YAG ablation, and to the other half with a variable pulsed erbium laser (VP Er:YAG) followed by traditional short pulse erbium laser. Patients were evaluated clinically before resurfacing and at 1, 2, 4, 8, and 12 weeks post-operatively. Histologic samples taken at various time periods before and after resurfacing were also evaluated., Results: Overall clinical improvement was equal for both UPCO(2) and VP Er:YAG treated sides with an average improvement in photoaging scores of 57%. Decreased erythema, less edema, and faster healing were observed on the VP Er:YAG treated side., Conclusion: The VP Er:YAG laser can achieve a similar degree of improvement as seen with short pulse CO(2) laser resurfacing with decreased thermal tissue effects and decreased risk for adverse sequelae., (Copyright 2001 Wiley-Liss, Inc.)
- Published
- 2001
- Full Text
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7. Q-switched ruby laser treatment for postsclerotherapy hyperpigmentation.
- Author
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Tafazzoli A, Rostan EF, and Goldman MP
- Subjects
- Humans, Male, Middle Aged, Time Factors, Hyperpigmentation etiology, Hyperpigmentation therapy, Laser Therapy, Sclerotherapy adverse effects
- Abstract
Background: One of the most common adverse sequelae of sclerotherapy is cutaneous hyperpigmentation., Objective: We used the Q-switched ruby laser to treat postsclerotherapy hyperpigmentation., Methods: Eight patients developed pigmentation lasting more than 1 year (1-2 years on average) after sclerotherapy treatment for reticular and telangiectatic veins in the legs ranging in size from 0.2 to 4 mm in diameter. All patients were treated with a Q-switched ruby laser at 694 nm, 4 mm beam size, and fluence range of 5.6-10.5 J/cm2., Results: Ninety-two percent of lesions lightened after treatment. There was significant (75-100%) resolution of hyperpigmentation in 58% of treated areas, 25% improvement in 33% of treated areas, and no improvement in the remaining areas., Conclusion: Our impression is that given a choice of lasers, the Q-switched ruby laser provides the greatest efficacy for treating postsclerotherapy hyperpigmentation.
- Published
- 2000
- Full Text
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8. Treatment of spider veins with the 595 nm pulsed-dye laser.
- Author
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Goldman MP, Sadick NS, and Weiss RA
- Subjects
- Humans, Lasers adverse effects, Pigmentation Disorders etiology, Laser Therapy, Telangiectasis radiotherapy
- Published
- 2000
- Full Text
- View/download PDF
9. Regarding CO2 laser resurfacing infection rates.
- Author
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Goldman MP
- Subjects
- Bacterial Infections etiology, Bacterial Infections prevention & control, Humans, Antibiotic Prophylaxis, Dermatologic Surgical Procedures, Laser Therapy adverse effects, Surgical Wound Infection prevention & control
- Published
- 2000
- Full Text
- View/download PDF
10. Treatment of facial skin using combinations of CO2, Q-switched alexandrite, flashlamp-pumped pulsed dye, and Er:YAG lasers in the same treatment session.
- Author
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Manuskiatti W, Fitzpatrick RE, and Goldman MP
- Subjects
- Acne Vulgaris surgery, Cicatrix surgery, Combined Modality Therapy, Follow-Up Studies, Humans, Laser Therapy instrumentation, Skin Aging, Telangiectasis surgery, Treatment Outcome, Dermatologic Surgical Procedures, Face surgery, Laser Therapy methods
- Abstract
Background: Many patients who seek facial CO2 laser resurfacing for improvement of photodamage are also concerned with "dark circles" under their eyes (periorbital hyperpigmentation) and/or telangiectasia as well as various types of deep scars on their faces. CO2 laser resurfacing alone provides limited improvement for these problems., Objective: The purpose of this study was to demonstrate the conjunctive therapeutic effects of the CO2, Q-switched alexandrite, Er:YAG, and/or flashlamp-pumped pulsed dye lasers on facial skin treatments., Method: Thirty patients who underwent CO2 laser resurfacing were treated with additional lasers specific for their cosmetic concerns. Twenty patients with facial telangiectasias were treated with the pulsed dye laser immediately prior to CO2 laser resurfacing. Eleven patients with periorbital hyperpigmentation were treated with the Q-switched alexandrite laser immediately following use of the pulsed CO2 laser. Eight patients having sharply defined acne scars were treated with the Er:YAG laser following use of the CO2 laser. All patients had peripheral feathering performed with the Er:YAG laser. Nine patients were treated with all four lasers., Results: In addition to significant improvement of the wrinkle scores from the CO2 laser resurfacing, patients had 75-100% clearing of the periorbital hyperpigmentation. All patients with facial telangiectasia showed virtually 100% improvement. All deep wrinkles and sharply defined scars responded with combined CO2/Er:YAG laser better than with CO2 laser resurfacing alone. All feathering was more uniform, with a more subtle transition to nontreated skin. There were no complications that could be attributed to the simultaneous use of multiple lasers., Conclusions: For patients who present with multiple cosmetic complaints, combined treatment using appropriate lasers offers excellent therapeutic outcome.
- Published
- 2000
- Full Text
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11. Laser skin resurfacing of the face with a combined CO2/Er:YAG laser.
- Author
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Goldman MP, Marchell N, and Fitzpatrick RE
- Subjects
- Adolescent, Adult, Aged, Biopsy, Evaluation Studies as Topic, Face pathology, Female, Humans, Laser Therapy instrumentation, Middle Aged, Preoperative Care, Prospective Studies, Skin pathology, Skin Aging pathology, Time Factors, Dermatologic Surgical Procedures, Face surgery, Laser Therapy methods
- Abstract
Background: A combined, dual-wavelength CO2/Er:YAG laser system having the ability to deliver both clean ablation of skin with the erbium wavelength and a simultaneous deeper penetrating subablative thermal pulse of CO2 was developed for full-face resurfacing. The CO2 component can be pulsed from 1 to 100 msec at a power of 1-10 W with the Er:YAG component pulsed at 350 microsec at 1.7 J/cm2 through either a computer pattern generator with 3 mm diameter spot size or through a noncollimated spot ranging from 0.2 to 8 mm in diameter. Our previous study using this laser on the neck using a 4-8 mm diameter spot with Er:YAG fluence at 1.7 J and the CO2 at 5 W with a 50 msec pulse at a frequency of 10 Hz showed a higher degree of overall patient satisfaction, as well as improvement in skin texture and skin color, compared to patients treated with an Er:YAG laser alone., Objective: This study evaluated the CO2/Er:YAG laser treatment modality in facial resurfacing., Methods: Ten patients were treated with four passes at 1.7 J with a 4 mm diameter spot and the CO2 at 5 W with a 50-msec pulse at a frequency of 10 Hz. Photoaging scores as well as thermal damage and new collagen formation were compared immediately before and after treatment as well as at 2 weeks and 3 months postoperatively., Results: The average pretreatment periorbital score was 6.2 The average posttreatment periorbital scores were 4.2 (P =.0239) at 2 weeks postoperatively (32% improvement) and 3.8 (P =.0028) at 3 months postoperatively (38% improvement). The average pretreatment perioral score was 5.9. The average posttreatment perioral scores were 3.0 (P =.0001) at 2 weeks postoperatively (49% improvement) and 3.3 (P =.0009) at 3 months postoperatively (44% improvement). The average pretreatment cheek score was 4.7. The average posttreatment cheek scores were 2.7 (P =.0066) at 2 weeks postoperatively (43% improvement) and 3.8 (P =. 0152) at 3 months postoperatively (36% improvement). The average pretreatment forehead score was 4.7. The average posttreatment forehead scores were 3.8 (P =.0340) at 2 weeks postoperatively (33% improvement) and 3.6 (P =.0147) at 3 months postoperatively (37% improvement). The average depth of collagen measured in the dermis pretreatment was 29 microm. The average depth of collagen 3 months posttreatment was 54 microm. This is an average increase of 25 microm or an 86% increase in collagen (P =.006). The average thermal damage immediately after treatment was 20 microm., Conclusion: The CO2/Er:YAG laser utilized with four passes at the above-mentioned parameters results in a similar degree of improvement as other forms of laser resurfacing with high-energy, short-pulsed CO2 lasers.
- Published
- 2000
- Full Text
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12. Laser resurfacing of the neck with the combined CO2/Er:YAG laser.
- Author
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Goldman MP and Marchell NL
- Subjects
- Adult, Aged, Female, Humans, Middle Aged, Patient Satisfaction, Rhytidoplasty methods, Treatment Outcome, Laser Therapy methods, Neck surgery
- Abstract
Background: Several clinical studies on laser resurfacing on the neck have yielded variable results with adverse sequelae of hypopigmentation and scarring using the CO2 laser. The Er:YAG laser on the neck resulted in an improved appearance with no adverse sequelae. The combined CO2/Er:YAG laser is a laser that combines a low fluence CO2 laser with the Er:YAG laser in a near simultaneous beam., Objective: To study the effects of the CO2/Er:YAG laser on the neck. The decreased nonspecific thermal damage of the CO2/Er:YAG laser should result in decreased postoperative erythema and improved wound healing., Methods: Eleven patients were treated with the CO2/Er:YAG laser on the neck as well as the face at identical settings. The face was treated with four passes while the neck was treated with two passes. The patients were evaluated for the first 2 weeks then 3-6 months postoperatively. Patients were asked about treatment satisfaction and improvement in skin texture and color using a 25% scale. Skin texture and color, as well as improvement in wrinkling and adverse results were judged by a dermatologist using a 0-4 scale., Results: Moderate improvement was seen in skin color while a higher degree of improvement was seen in skin texture and wrinkling in all 11 patients. No adverse sequelae, including hypopigmentation or scarring, were observed. The majority of patients had a 75-100% improvement in skin texture and color in addition to a 75-100% overall satisfaction rating., Conclusions: There is a higher degree of overall patient satisfaction, as well as improvement in skin texture and skin color, compared to patients treated with the Er:YAG laser alone. The CO2/Er:YAG laser is a highly effective laser for neck resurfacing with no adverse sequelae to date.
- Published
- 1999
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13. Regarding pulse durations.
- Author
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Goldman MP
- Subjects
- Humans, Facial Dermatoses surgery, Laser Therapy methods, Telangiectasis surgery
- Published
- 1999
- Full Text
- View/download PDF
14. Cutaneous laser resurfacing.
- Author
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Ratner D, Tse Y, Marchell N, Goldman MP, Fitzpatrick RE, and Fader DJ
- Subjects
- Anesthesia methods, Humans, Patient Selection, Postoperative Care methods, Postoperative Complications epidemiology, Preoperative Care methods, Skin pathology, Dermatologic Surgical Procedures, Laser Therapy adverse effects, Laser Therapy methods
- Abstract
Unlabelled: Cutaneous resurfacing with the new generation of carbon dioxide and erbium lasers has recently come into favor for the treatment of facial rhytides, photodamage, and scarring. The precise control of these resurfacing lasers over the extent of tissue vaporization minimizes thermal damage to the skin while maximizing therapeutic efficacy. Proper use of resurfacing lasers is contingent upon a complete understanding of their clinical, histologic, and ultrastructural effects, as well as an appreciation of the principles of laser safety. An organized approach to the preoperative, intraoperative, and postoperative management of the patient undergoing laser resurfacing will be provided, including a discussion of prevention and treatment of postoperative side effects and complications. (J Am Acad Dermatol 1999;41:365-89.), Learning Objective: At the conclusion of this learning activity, participants should be familiar with the clinical, histologic, and ultrastructural effects of resurfacing lasers and be able to discuss the preoperative, intraoperative, and postoperative management of patients undergoing laser resurfacing.
- Published
- 1999
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15. The role of lasers and light sources in the treatment of leg veins.
- Author
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Dover JS, Sadick NS, and Goldman MP
- Subjects
- Algorithms, Humans, Leg, Sclerotherapy adverse effects, Telangiectasis therapy, Laser Therapy, Lasers, Light, Telangiectasis surgery
- Abstract
Telangiectasia of the legs occurs in 29% to 41% of women in the United States. The variation in size, flow, depth, and type preclude the possibility of a single effective treatment modality. When a systematic approach is used where feeder vessels are first surgically removed and sclerotherapy proceeds from largest to smallest vessels, 80-90% of vessels respond to a single sclerotherapy treatment. Because of the relatively modest results demonstrated with lasers and light sources and the high rate of success and the relatively low cost of ambulatory phlebectomy, compression sclerotherapy and superficial sclerotherapy, we generally recommend using lasers and light sources only for vessels that remain after this treatment approach. Lasers and light sources should be considered prior to sclerotherapy in patients who are fearful of needles, who do not tolerate sclerotherapy, who fail to respond to sclerotherapy, or who are prone to telangiectatic matting. Carefully monitored, controlled studies are essential to better define the role of the available laser and light sources in the treatment of leg veins.
- Published
- 1999
- Full Text
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16. Laser resurfacing of the neck with the Erbium: YAG laser.
- Author
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Goldman MP, Fitzpatrick RE, and Manuskiatti W
- Subjects
- Female, Humans, Patient Acceptance of Health Care, Skin pathology, Laser Therapy methods, Neck surgery, Rhytidoplasty methods
- Abstract
Background: Laser resurfacing of the face is widely used to correct the effects of photoaging. The neck also develops a similar degree of photoaging, but is not usually treated because a higher incidence of adverse effects can occur with laser treatment., Objective: To present a new method for treating photoaged skin of the neck with an erbium:yttrium aluminum garnet (Er:YAG) laser., Methods: Twenty patients underwent Er:YAG laser resurfacing of the neck with one of two methods. Method 1 consisted of using the Er:YAG with a 5-mm diameter collimated beam at a fluence of 8.7 J/cm2 followed by a second pass using a 0.2 mm diameter non-collimated spot at 1.7 J in a defocused mode with spot sizes ranging from about 5 to 10 mm in diameter (fluences from 2-9 J/cm2). Method 2 consisted of treating the entire neck with a single pass of the Er:YAG laser with a 4 mm diameter non-collimated spot at 1.7 J (fluence of 13.5 J/cm2). A second pass at identical settings was made on the upper half of the neck with a more defocused pass using a 6-10 mm diameter spot (fluence of 2-6 J/cm2) on the lower half of the neck. Patients were evaluated by two nontreating physicians as to overall satisfaction and improvement in skin texture and color., Results: Overall, 51% of patients were satisfied with their results. Skin texture improved an average of 39%. Method 1 produced a 28% improvement, Method 2 a 48% improvement. Skin color improved an average of 37%. Method 1 produced a 28% improvement, Method 2 a 45% improvement., Conclusion: Photoaged skin of the neck can be effectively treated with the Er:Yag laser with minimal adverse effects.
- Published
- 1999
- Full Text
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17. Long-term effectiveness and side effects of carbon dioxide laser resurfacing for photoaged facial skin.
- Author
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Manuskiatti W, Fitzpatrick RE, and Goldman MP
- Subjects
- Biopsy, Cicatrix etiology, Female, Follow-Up Studies, Humans, Hyperpigmentation etiology, Hypopigmentation etiology, Male, Middle Aged, Patient Satisfaction, Skin pathology, Skin Pigmentation radiation effects, Surgery, Plastic adverse effects, Time, Treatment Outcome, Face radiation effects, Laser Therapy adverse effects, Skin radiation effects, Skin Aging radiation effects
- Abstract
Background: Laser resurfacing has been used for treatment of photoaged facial skin since late 1993. Very few long-term follow-up studies regarding the effectiveness and side effects of this procedure have been reported., Method: Patients who received carbon dioxide laser resurfacing for facial photoaging and wrinkling from Dec 17, 1993, to Nov 30, 1996, were followed up with clinical evaluation and patient questionnaires. Histologic study was also performed in 10 representative patients who had had preoperative biopsies. All treatments were performed by 2 experienced laser surgeons (R. E. F. and M. P. G.)., Results: One hundred four patients were examined and interviewed with an average 24-month postoperative follow-up (range 12 to 44 months). We observed high patient satisfaction ratings and significant persistence of wrinkle score improvement. Long-term histologic features confirmed the long-lasting nature of the clinical improvement and demonstrated continuing, progressive improvement in solar clastosis deep in the dermis for an average follow-up period of 2 years. Prolonged use of topical tretinoin (retinoic acid) postoperatively may contribute to continued improvement. The incidence of long-term side effects, including pigmentary changes and scarring, was generally very low and these side effects were usually not noticed by the patients., Conclusion: Improvement from cutaneous laser resurfacing has persisted for an average 24-month postoperative period with a low incidence of side effects. Hypopigmentation is the most common long-term side effect and appears to be related to the degree of pre-existing photodamage as it contrasts with the newly healed undamaged skin.
- Published
- 1999
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18. Combined laser resurfacing with the 950-microsec pulsed CO2 + Er:YAG lasers.
- Author
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Goldman MP and Manuskiatti W
- Subjects
- Erythema prevention & control, Humans, Postoperative Complications prevention & control, Skin pathology, Laser Therapy methods, Rhytidoplasty methods
- Abstract
Introduction: Laser resurfacing with the 950 microsec pulsed CO2 laser has been proven to be efficacious in improving photodamaged skin and acne scarring. Unfortunately, prolonged erythema and delayed wound healing are common adverse sequelae, which require intensive patient education and intervention. These adverse effects may be due to the degree of nonspecific thermal damage present after resurfacing with the CO2 laser. Since erbium: YAG (Er:YAG) laser vaporization leaves far less thermal damage, it is hypothesized that its use after CO2 laser resurfacing will decrease the extent of nonspecific damage and result in improved wound healing., Methods: Ten patients were randomized to receive laser resurfacing of one-half of the face with the 950 Msec pulsed CO2 laser with 3 passes at 300 mJ, utilizing the computer pattern generator (CPG) at settings of 596, 595, 584, and the other half of the face (randomly chosen) resurfaced with the 950 Msec pulsed CO2 laser 2 passes with the CPG at 300 mJ at settings of 596 and 595, followed by 2 passes with the Er:YAG laser (Derma-20 or Derma-K, ESC Medical Systems, Inc., Needham, MA) with a 4 mm diameter spot size at 1.7 J (approximately 14 J/cm2). Patients were evaluated in a "blinded" manner clinically and histologically before resurfacing, immediately after resurfacing, 2 to 3 days postoperatively, 1 week postoperatively, and, 4 to 8 weeks postoperatively., Results: There was slightly less inflammation with the CO2/Er:YAG-treated patients. The epidermis re-formed 1 to 2 days faster with combination (UPCO2)/Er:YAG treatment than with UPCO2 laser treatment alone. In 7 of 10 patients, Er:YAG erythema resolved within 2-3 weeks with CO2 x 3 erythema persisting at the 8-week follow-up period in all patients. Three of 10 patients had no difference in the degree of erythema between the 2 treatment areas. Clinical findings correlated with histologic findings of vascularity. There was no difference in the extent or time of edema between techniques. The usual demarcation line between cheek and neck at the mandibular angle was less apparent when the UPCO2/Er:YAG combination was used. Two of 10 patients noted quicker healing with the combination laser technique., Conclusion: Treating a patient with the Er:YAG laser after treatment with the UPCO2 laser results in a decreased incidence of adverse sequelae without a noticeable difference in the degree of wrinkle improvement.
- Published
- 1999
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19. Prophylactic antibiotics in patients undergoing laser resurfacing of the skin.
- Author
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Manuskiatti W, Fitzpatrick RE, Goldman MP, and Krejci-Papa N
- Subjects
- Anti-Bacterial Agents administration & dosage, Anti-Bacterial Agents therapeutic use, Antiviral Agents administration & dosage, Antiviral Agents therapeutic use, Drug Therapy, Combination administration & dosage, Female, Herpes Simplex prevention & control, Humans, Male, Surgical Wound Infection epidemiology, Time Factors, Antibiotic Prophylaxis, Drug Therapy, Combination therapeutic use, Facial Dermatoses surgery, Laser Therapy, Surgical Wound Infection prevention & control
- Abstract
Background: Carbon dioxide (CO2) laser resurfacing produces a superficial second-degree burn that needs to be protected from bacterial and fungal infections., Objective: We investigated the effects of various systemic and topical antimicrobial regimens., Methods: Four different regimens using oral ciprofloxacin, topical antibiotics (intranasal mupirocin ointment and otic solution), oral ketoconazole, and oral fluconazole were tested in four time periods. The frequency and types of the infections with various regimens was compared., Results: The study included 356 sequential patients who underwent facial CO2 laser resurfacing. Infections occurred in 27 patients (7.6%). Without antibiotic prophylaxis, 8.2% of patients had bacterial infections from days 3 to 12 after the procedure (average, day 5). With prophylactic ciprofloxacin only, 4.3% of patients had bacterial infections; these occurred almost exclusively after ciprofloxacin was discontinued. For 7 months, patients were randomly assigned to either receive or not receive mupirocin intranasally. All Staphylococcus aureus infections that occurred were seen in patients who had used intranasal mupirocin. Yeast infections were seen in 6 patients (1.7%), but mostly occurred more than 10 days after the procedure. Yeast infections were of approximately equal occurrence in the ciprofloxacin group (2.2%) and in the non-ciprofloxacin group (1.8%). No yeast infections occurred in patients who had undergone antifungal prophylaxis., Conclusion: Post-CO2 resurfacing infections are not rare but can appear subtly and might only be noticeable in the second postoperative week. Prophylactic intranasal mupirocin is ineffective, but ciprofloxacin is effective in preventing infection with both gram-positive and gram-negative bacteria. Oral ketoconazole and fluconazole are effective in preventing yeast infections.
- Published
- 1999
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20. Comparison of the Q-switched alexandrite, Nd:YAG, and ruby lasers in treating blue-black tattoos.
- Author
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Leuenberger ML, Mulas MW, Hata TR, Goldman MP, Fitzpatrick RE, and Grevelink JM
- Subjects
- Adolescent, Adult, Aged, Female, Humans, Male, Middle Aged, Treatment Outcome, Dermatologic Surgical Procedures, Laser Therapy instrumentation, Lasers, Tattooing
- Abstract
Background: A new generation of highly selective short-pulsed lasers has emerged in recent years for the treatment of tattoos. Several studies (including reports by the present investigators) have proven the efficacy of each of the three commercially available, FDA approved devices; namely, the Q-switched alexandrite, Q-switched Nd:YAG and Q-switched ruby lasers. Considerable differences among the three have been reported in relation to the rate of clearing of the tattoo ink particles, tissue effects, beam profile, wound healing, and side effects., Objective: This study was primarily conducted to examine and compare the clinical response of patients with blue-black tattoos simultaneously treated with three different Q-switched lasers (alexandrite, Nd:YAG, ruby) with a focus on the percentage of tattoo lightening/clearance and the occurrence or non-occurrence of pigmentary change as a side effect., Methods: A total of forty-two blue-black tattoos seen at two laser centers (Massachusetts General Hospital Dermatology Laser Center and Laser and Skin Surgery Center of La Jolla) were simultaneously treated with three types of Q-switched lasers: a Candela Q-switched alexandrite laser (755nm 50-100 nanoseconds, 3.0 mm spot size, 6-8 J/cm2); a Continuum Biomedical Q-switched Nd:YAG laser (1064nm, 10-20 nanoseconds, 3.0 mm spot size, 5-10 J/cm2); and a Spectrum Q-switched ruby laser (694 nm, 25-40 nanoseconds, 5.0 mm spot size, 4-10 J/cm2). Paired t-tests and McNemar tests were used to compare the treatment outcome and pigmentation side effects between sites per tattoo, with each site representative of one of the three lasers. The statistical significance level was set at p < .05., Results: Overall, the Q-switched ruby laser had a significant difference in tattoo lightening versus the Q-switched Nd:YAG and Q-switched alexandrite lasers. An increase in the number of treatments paralleled a statistically significant increase in tattoo clearance for all three Q-switched lasers., Conclusion: The Q-switched ruby laser had the highest clearance rate in blue-black tattoos and the highest incidence of long-lasting hypopigmentation. The Nd:YAG had no incidence of hypopigmentation.
- Published
- 1999
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21. Cultured versus uncultured pearls.
- Author
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Goldman MP
- Subjects
- Humans, Dermabrasion methods, Dermatologic Surgical Procedures, Laser Therapy methods
- Published
- 1998
22. Techniques for erbium:YAG laser skin resurfacing: initial pearls from the first 100 patients.
- Author
-
Goldman MP
- Subjects
- Face, Humans, Laser Therapy instrumentation, Surgery, Plastic instrumentation, Dermatologic Surgical Procedures, Laser Therapy methods, Surgery, Plastic methods
- Published
- 1997
- Full Text
- View/download PDF
23. Infections complicating pulsed carbon dioxide laser resurfacing for photoaged facial skin.
- Author
-
Sriprachya-Anunt S, Fitzpatrick RE, Goldman MP, and Smith SR
- Subjects
- Candidiasis etiology, Drug Resistance, Multiple, Facial Dermatoses etiology, Female, Humans, Postoperative Complications, Pseudomonas Infections etiology, Retrospective Studies, Skin Aging, Staphylococcal Infections etiology, Wound Healing, Face surgery, Infections etiology, Laser Therapy adverse effects, Rhytidoplasty adverse effects
- Abstract
Background: With proper technique and instrumentation, laser resurfacing for facial wrinkles has been found to be highly effective and relatively safe. Most, if not all, of the noninfectious complications such as pigmentary changes, scarring, and persistent erythema can either be avoided or managed with appropriate therapy. Postoperative infections, on the other hand, may develop despite proper technique and instrumentation. Without proper management, they may cause significant physical morbidity and psychological distress defying the expected benefit of the procedure., Objective: To quantify the incidence and to study the characteristics of infections arising after laser resurfacing for facial wrinkles with pulsed carbon dioxide laser treatment., Method: A retrospective study was carried out by reviewing the records of all patients undergoing laser resurfacing for facial wrinkles from January 1, 1995 to April 30, 1996. An infection is defined as a positive culture in the presence of signs or symptoms of an infection., Results: Over 16 months, 395 procedures were performed and 17 cases of culture-proven infection recorded, an incidence of 4.3%. All patients had symptoms starting between days 2 and 10 after the operation. Over half of the patients had multiple infections with two to three microorganisms. Pseudomonas aeruginosa was the most common causative agent, found in 41% of all infected cases, followed by Staphylococcus aureus (35%), S. epidermidis (35%), and Candida species (24%). Multiple drug-resistant, gram-negative bacteria were found in four cases, implicating the possibility of hospital-acquired infections. Almost all isolates of gram-positive bacteria were resistant to both erythromycin and penicillin, but not oxacillin. With proper treatment, most patients healed normally. Only one patient had persistent, multiple atrophic scars due to locally disseminated herpes simplex infection despite proper prophylaxis and treatment., Conclusions: Postoperative infection is uncommon and manageable with early recognition and proper treatment. The types of infectious agents being found are very similar to those reported in burn patients. This complication has been found to be much more common in patients undergoing full face resurfacing and those using a bio-occlusive dressing postoperatively. With comprehensive preventive and management measures, it is likely that this type of uncommon, yet distressful, complication can be avoided and more successfully treated. Recommendations are made for prevention and management of suspected postoperative infections.
- Published
- 1997
- Full Text
- View/download PDF
24. Treatment of benign vascular lesions with the Photoderm VL high-intensity pulsed light source.
- Author
-
Goldman MP
- Subjects
- Hemangioma radiotherapy, Humans, Lasers adverse effects, Leg blood supply, Port-Wine Stain radiotherapy, Skin Neoplasms radiotherapy, Telangiectasis radiotherapy, Laser Therapy, Vascular Diseases radiotherapy
- Published
- 1997
25. Preoperative anesthesia and postoperative considerations in laser resurfacing.
- Author
-
Fitzpatrick RE, Williams B, and Goldman MP
- Subjects
- Face, Humans, Wound Healing, Anesthesia methods, Laser Therapy methods, Postoperative Care methods, Preoperative Care methods, Skin Diseases surgery
- Abstract
This article details patient selection, preoperative preparation, and postoperative considerations for conducting UltraPulse (Coherent Medical, Palo Alto, CA) CO2 laser resurfacing. The authors share their more than 3 years experience with more than 1,000 patients to help physicians perform this technique, choose optimal treatment parameters, and select appropriate patients for treatment. Methods to decrease postlaser adverse sequelae are discussed. Particular emphasis is placed on the minimization of postoperative infections. An extensive section on anesthesia techniques is also provided.
- Published
- 1996
- Full Text
- View/download PDF
26. Pulsed carbon dioxide laser resurfacing of photo-aged facial skin.
- Author
-
Fitzpatrick RE, Goldman MP, Satur NM, and Tope WD
- Subjects
- Adult, Aged, Aged, 80 and over, Dermatologic Surgical Procedures, Face surgery, Female, Humans, Middle Aged, Postoperative Care, Preoperative Care, Laser Therapy instrumentation, Laser Therapy methods, Laser Therapy statistics & numerical data, Skin Aging
- Abstract
Background and Design: public demand for procedures to rejuvenate photoaged skin have stimulated the use of high-energy short-pulsed carbon dioxide lasers as a precise and predictable treatment modality. The purpose of this study was to determine the degree of clinical improvement achieved in treating perioral and periorbital wrinkles with a high-energy, microsecond-domain pulsed CO2 laser. Photodamaged skin in the perioral (n=73) and periorbital (n=38) regions was treated with multiple passes of confluent single pulses of CO2 laser energy (10 600 nm, 3-mm collimated beam, <1- millisecond pulse, 450 mJ per pulse, 2 to 5 W), with the tissue being cleansed and débrided with normal saline between passes. A nine-point clinical scoring system was devised for evaluation of the degree of wrinkling and photodamage present. Preoperative and postoperative photographs were independently scored by four ¿blinded¿ reviewers. The patients were observed postoperatively for 1 to 12 months for the course of healing, and adverse events were recorded., Results: All three classes (mild, moderate, and severe) of photoaging of the skin responded equally well, showing an average wrinkling score reduction of 2.25 for the periorbital region and 2.34 for the perioral region, the most superficial wrinkles and photodamage being eliminated and the more severe being markedly improved. An unexpected finding was tightening of loose and folded skin. Side effects included transient erythemia and postinflammatory hyperpigmentation, and one instance of an isolated hypertrophic scar., Conclusions: Resurfacing of photoaged skin by means of a high-energy, microsecond-domain pulsed CO2 laser with a specific clinical treatment protocol results in predictable improvement in perioral and periorbital wrinkling and photodamage with minimal risks. Heat-induced collagen shrinkage appears to contribute to these results by tightening loose skin and folds.
- Published
- 1996
27. Pulsed carbon dioxide laser, trichloroacetic acid, Baker-Gordon phenol, and dermabrasion: a comparative clinical and histologic study of cutaneous resurfacing in a porcine model.
- Author
-
Fitzpatrick RE, Tope WD, Goldman MP, and Satur NM
- Subjects
- Animals, Phenols therapeutic use, Skin pathology, Swine, Trichloroacetic Acid therapeutic use, Chemexfoliation, Dermabrasion, Dermatologic Surgical Procedures, Laser Therapy
- Published
- 1996
28. Treatment of recalcitrant warts using the pulsed dye laser.
- Author
-
Webster GF, Satur N, Goldman MP, Halmi B, and Greenbaum S
- Subjects
- Humans, Laser Therapy, Warts radiotherapy
- Abstract
Recalcitrant warts are a common therapeutic problem. We used the 585 nm pulsed dye laser to treat flat, common, plantar/palmar, and periungual warts that had failed to respond to keratolytic or destructive therapy. Flat warts were most responsive, but all wart types had a significant response to this benign treatment modality.
- Published
- 1995
29. Laser treatment of scars.
- Author
-
Goldman MP and Fitzpatrick RE
- Subjects
- Cicatrix pathology, Humans, Injections, Intralesional, Skin pathology, Triamcinolone administration & dosage, Cicatrix radiotherapy, Laser Therapy
- Abstract
Background: Erythematous and hypertrophic scars may occur after surgical procedures. This paper describes a novel technique for their resolution., Objective: The purpose of this paper is to describe long-term results of treating erythematous, hypertrophic scars with the flashlamp-pumped pulsed dye laser (FLPDL)., Methods: Forty-eight patients who presented with erythematous/hypertrophic scars were treated with the FLPDL with or without intralesional triamcinolone. Patients were evaluated by physicians on a 25% increment of objective improvement., Results: Seventy-three percent of scars appearing on the face for less than 1 year totally resolved in an average of 2.3 treatments. Twenty percent of scars on the face for greater than 1 year had a total resolution in 4.4 treatments with an average improvement of 88%. Scars on nonfacial areas for less than 1 year had a 25% incidence of total resolution over an average of 2.5 treatments with an average improvement of 81%. Scars in nonfacial distributions over 1 year of age had a 12% total resolution with an average 62% improvement over 2.2 treatments., Conclusion: The FLPDL is a useful adjuvant in the treatment of erythematous, hypertrophic scars.
- Published
- 1995
- Full Text
- View/download PDF
30. The adjuvant use of macrophage colony stimulating factor in tattoo removal using laser surgery.
- Author
-
Cohen PR and Goldman MP
- Subjects
- Combined Modality Therapy, Dermabrasion, Humans, Skin drug effects, Dermatologic Surgical Procedures, Laser Therapy, Macrophage Colony-Stimulating Factor therapeutic use, Tattooing
- Abstract
Tattoos are acquired pigmented lesions of the skin that may be removed with laser surgery. Following laser treatment, macrophages engulf the altered pigment. The activity of macrophages can be influenced by macrophage colony-stimulating factor. In order to evaluate the potential adjunctive use of macrophage colony-stimulating factor in tattoo removal using laser surgery, a prospective study, initially in an animal model, to serially evaluate the clinical and histopathologic clearing of tattoo pigment following laser surgery at variable macrophage colony-stimulating factor dose concentrations and injection schedules, could be performed. Since the clearing of tattoo pigment following laser surgery is influenced by the presence of macrophages at the site of treatment, and since macrophage colony-stimulating factor influences macrophage activity, it is logical to hypothesize that the adjuvant use of this cytokine to recruit additional macrophages could expedite the removal of tattoo pigment following laser surgery.
- Published
- 1995
- Full Text
- View/download PDF
31. Laser treatment of erythematous/hypertrophic and pigmented scars in 26 patients.
- Author
-
Dierickx C, Goldman MP, and Fitzpatrick RE
- Subjects
- Cicatrix pathology, Erythema pathology, Humans, Hypertrophy, Cicatrix therapy, Erythema therapy, Laser Therapy, Pigmentation Disorders therapy
- Abstract
Fifteen patients with erythematous/hypertrophic scars and 11 patients with postinflammatory hyperpigmentation were treated with a flashlamp pumped pulsed-dye laser at 585 nm or a flashlamp pulsed-dye laser at 510 nm. An average of 1.8 treatments resulted in an average improvement of 77 percent. Forty-seven percent of the patients had 100 percent improvement after one to three treatments. Eleven patients with postinflammatory hyperpigmentation were treated with the flashlamp pumped pulsed-dye laser at 510 nm with a pulse width of 300 ns. There was an average of 80 percent improvement with 1.45 treatments. Forty-five percent of the patients had 100 percent improvement after one or two treatments. The pathophysiology of postoperative scarring is reviewed. Theoretical reasons for the efficacy of laser treatment are detailed.
- Published
- 1995
32. Advances in carbon dioxide laser surgery.
- Author
-
Fitzpatrick RE and Goldman MP
- Subjects
- Carbon Dioxide, Humans, Laser Therapy classification, Laser Therapy instrumentation, Laser Therapy methods, Skin Diseases surgery
- Published
- 1995
- Full Text
- View/download PDF
33. Laser ablation of facial cosmetic tattoos.
- Author
-
Fitzpatrick RE, Goldman MP, and Dierickx C
- Subjects
- Adult, Aged, Esthetics, Face, Female, Humans, Middle Aged, Laser Therapy, Tattooing
- Abstract
The application of facial cosmetic tattoos (eyeliner, lipliner, and rouge) has become popular over the past five years and has resulted in an increasing number of patients requesting removal of these permanent cosmetics. Poor positioning or misapplication of the tattoo pigment has been the most common reason for requesting removal. Because of the almost inevitable probability of scarring, removal of these facial tattoos has been difficult at best. We report the successful removal of facial cosmetic tattoos in ten different patients with the use of five different lasers. We have found the superpulsed CO2 laser and the Q-switched alexandrite laser to be effective in removal of black tattoo pigment. The alexandrite laser is effective without causing scarring, and the CO2 laser is extremely precise and provides the capability of removing tattoo pigment between eyelash or eyebrow hairs without damaging the hair follicles. Both the argon laser and the flashlamp pumped dye laser reacted with red tattoo pigment and offered some improvement but were not ideally suited for tattoo removal. However, the flashlamp pumped dye laser for pigment was very effective in removing red tattoo pigment possibly because of its short pulse width (300 ns) in addition to its appropriate wavelength. The combination of these three lasers (super-pulsed CO2, alexandrite, and flashlamp pigment lasers) is very effective in removing black and red (or shades thereof) facial tattoos. Caution must be taken to determine the presence of flesh-colored tattoo pigment, as this pigment (FE2O3) will reduce to black (FeO) upon laser impact.
- Published
- 1994
- Full Text
- View/download PDF
34. Tattoo removal using the alexandrite laser.
- Author
-
Fitzpatrick RE and Goldman MP
- Subjects
- Humans, Pigmentation radiation effects, Skin radiation effects, Time Factors, Laser Therapy, Tattooing methods
- Abstract
Background: Until the recent development of the Q-switched lasers, it was not possible to remove tattoos without causing scarring, sometimes very disfiguring. Variations in wavelengths and pulse widths used may result in different clinical effectiveness or risks. The objective of this study was to determine the effectiveness of the alexandrite laser in removing professional and amateur tattoo pigment without adverse tissue response., Results: We describe the clinical and histologic effects of the use of a new Q-switched laser for treatment of tattoos, the alexandrite laser (wavelength, 755 nm; pulse width, 100 nanoseconds). The results of treatment of 17 patients with professional tattoos and eight patients with amateur tattoos are analyzed. Greater than 95% removal of tattoo pigment averaged 8.9 treatment sessions. Transient hypopigmentation occurred in approximately 50% of patients, and transient textural surface changes occurred in 12%., Conclusions: The alexandrite laser is a safe and effective treatment modality for removal of black and blue-black tattoo pigment.
- Published
- 1994
35. Flashlamp-pumped pulsed dye laser treatment of port-wine stains.
- Author
-
Fitzpatrick RE, Lowe NJ, Goldman MP, Borden H, Behr KL, and Ruiz-Esparza J
- Subjects
- Adolescent, Adult, Age Factors, Aged, Child, Child, Preschool, Cicatrix etiology, Female, Hamartoma pathology, Humans, Infant, Infant, Newborn, Laser Therapy adverse effects, Male, Middle Aged, Pigmentation Disorders etiology, Retrospective Studies, Skin Diseases pathology, Skin Pigmentation, Treatment Outcome, Hamartoma surgery, Laser Therapy instrumentation, Skin Diseases surgery
- Abstract
Background: Port-wine stains, or capillary malformations, occur in 0.3-0.5% of newborns and have been shown to be very responsive to treatment with a pulsed dye laser (585 nm, 450 microseconds). Lesional characteristics that may help predict the ease of response to therapy have not been delineated. There exists a great range of variation in response to treatment., Objective: A retrospective study of 133 patients with 140 port-wine stain malformations being treated with the flashlamp-pumped pulsed dye laser was undertaken. Lesion characteristics such as color and location, patient age, and skin type were evaluated as to their correlation with clinical response. Adverse sequelae were evaluated as well., Methods: Charts of treated patients were reviewed and results tabulated. The five treating physicians were each responsible for reviewing and evaluating their own patients. Patients were treated at 8-12-week intervals using slightly overlapping pulses with fluences from 5.5 to 7.5 J/cm.2, Results: Factors favoring a positive clinical response were pink lesion color, lesion location of the head and neck, patient age less than 10 years, and patient skin types I-III. Factors having a more negative impact on clinical result include purple lesion color, lesion location on the distal extremities, patient age > 50 years, and skin types IV and V., Conclusion: Examination of various patient and lesional characteristics shows trends that may be useful in a predictive manner regarding ease of treatment with the flashlamp-pumped pulsed dye laser.
- Published
- 1994
- Full Text
- View/download PDF
36. Clinical advantage of the CO2 laser superpulsed mode. Treatment of verruca vulgaris, seborrheic keratoses, lentigines, and actinic cheilitis.
- Author
-
Fitzpatrick RE, Goldman MP, and Ruiz-Esparza J
- Subjects
- Cheilitis etiology, Cheilitis surgery, Humans, Keratosis, Seborrheic surgery, Lentigo surgery, Treatment Outcome, Warts surgery, Laser Therapy methods, Skin Diseases surgery
- Abstract
Background: Unintended thermal damage occurring during surgery with the CO2 laser limits its usefulness because of slow healing and increased scarring. The superpulsed mode was developed to address this problem, but little clinical data exist to evaluate its effectiveness., Objective: Patients having warts of the hands and feet, seborrheic keratoses, lentigines, and actinic cheilitis were treated by three experienced laser surgeons using both the conventional continuous mode CO2 laser and a superpulsed CO2 laser. Effectiveness of therapy, healing time, and rates of scarring were compared for the two groups of patients., Methods: Charts of patients treated in 1988 and 1989 were reviewed and data recorded regarding surgical parameters, healing time, scarring, and effectiveness of therapy. Patients were placed in a diagnosis category with each laser only if there was a corresponding patient treated by the same physician using the other laser., Conclusion: The superpulsed mode was found to convey only a slight advantage. The use of a 50-millisecond pulse was even more advantageous. The superpulse parameters are analyzed and ideal parameters to prevent unwanted thermal damage are suggested.
- Published
- 1994
- Full Text
- View/download PDF
37. Advances in cutaneous laser surgery.
- Author
-
Fitzpatrick RE and Goldman MP
- Subjects
- Cicatrix, Hemangioma, Capillary surgery, Humans, Risk, Skin Neoplasms surgery, Tattooing, Dermatologic Surgical Procedures, Laser Therapy methods
- Published
- 1993
38. Use of the alexandrite laser (755 nm, 100 nsec) for tattoo pigment removal in an animal model.
- Author
-
Fitzpatrick RE, Goldman MP, and Ruiz-Esparza J
- Subjects
- Aluminum Oxide, Animals, Argon, Beryllium, Dose-Response Relationship, Radiation, Epidermis pathology, Epidermis radiation effects, Macrophages pathology, Pigments, Biological radiation effects, Skin pathology, Skin radiation effects, Swine, Swine, Miniature, Laser Therapy, Tattooing
- Abstract
Background: All previous treatment modalities for the removal of tattoos, with the possible exception of the Q-switched ruby and YAG lasers, result in scarring., Objective: The purpose of this study was to investigate the use of a new laser that may remove tattoo pigment without leaving a scar., Methods: A Yucatan micropig was tattooed by a professional tattoo artist with black, blue, green, and red pigments. These tattoos were then treated with single overlapping pulses with the alexandrite laser (wavelength 755 nm, pulse 100 nsec) and evaluated clinically and histologically. Comparison treatment with an argon laser (wavelength 488 nm, 514 nm, continuous-wave) and flashlamp-pumped dye laser (wavelength 585 nm, pulse 450 microseconds) was performed as well for removal of red tattoo pigment., Results: The alexandrite laser was found to be very effective in removal of professional and amateur black tattoo pigment, moderately effective in removal of blue and green pigment, and minimally effective in removal of red pigment. No scarring was seen clinically or histologically., Conclusion: The alexandrite laser shows promise as a treatment modality for tattoo removal without scarring.
- Published
- 1993
- Full Text
- View/download PDF
39. Laser treatment of benign pigmented epidermal lesions using a 300 nsecond pulse and 510 nm wavelength.
- Author
-
Fitzpatrick RE, Goldman MP, and Ruiz-Esparza J
- Subjects
- Adult, Aged, Child, Female, Humans, Hyperpigmentation etiology, Keratosis, Seborrheic radiotherapy, Lasers adverse effects, Lentigo radiotherapy, Male, Methods, Middle Aged, Hyperpigmentation radiotherapy, Laser Therapy
- Abstract
Sixty-five patients having a total of 492 lesions were treated with the Candela pigmented lesion dye laser (510 nm, 300 ns). Lesions treated included café-au-lait macules, lentigines, seborrheic keratoses, and postinflammatory hyperpigmentation. Fluences varied from 2.0 J/cm2 to 3.5 J/cm2, but averaged 2.25 J/cm2. Response was good to excellent after one treatment with 40-50% completely clearing and an additional 33% clearing by 75% or more. Repeated treatments were capable of clearing residual lesions. Histologic examination revealed vacuolization of melanin-containing cells and suprabasilar vesicles. The only adverse sequelae were transient hypopigmentation and hyperpigmentation, which resolved in 4 to 6 months.
- Published
- 1993
- Full Text
- View/download PDF
40. Postsclerotherapy hyperpigmentation. Treatment with a flashlamp-excited pulsed dye laser.
- Author
-
Goldman MP
- Subjects
- Humans, Pigmentation Disorders etiology, Pigmentation Disorders pathology, Laser Therapy methods, Pigmentation Disorders surgery, Sclerotherapy adverse effects
- Abstract
Seventeen patients with 22 areas of postsclerotherapy hyperpigmentation lasting from 1 to 7 years were treated with a flashlamp-excited pulsed dye laser at 510 nm with a pulse duration of 300 nanoseconds between 2 to 3 J/cm2. Depth of hemosiderin pigmentation ranged from 0.2 to 2.8 mm. Forty-five percent of lesions lightened after treatment with significant lightening occurring in 27% of lesions. Four lesions in two patients developed postinflammatory hyperpigmentation after treatment. There was no significant difference in treatment response to pigment location or laser energy.
- Published
- 1992
- Full Text
- View/download PDF
41. Gallstone susceptibility to in vitro fragmentation by a 480-nm pulsed dye laser. Correlation with computed tomography characteristics.
- Author
-
Lehman CD, Goldman ML, Baron RL, Richardson ML, Starr FE 3rd, and Lee SP
- Subjects
- Cholelithiasis diagnostic imaging, Humans, In Vitro Techniques, Cholelithiasis therapy, Laser Therapy, Lithotripsy, Lithotripsy, Laser, Tomography, X-Ray Computed
- Abstract
The object of this investigation was to determine gallstone susceptibility to laser lithotripsy and to discover whether this susceptibility is related to the computed tomography (CT) appearance of gallstones. Gallstones collected from surgery were scanned by CT and classified as homogeneously dense (greater than 90 Hounsfield units [HU]), homogeneously faint (30-60 HU), or rimmed. Sixty stones were subjected to laser energy at 20, 40, 60, 80, or 100 mJ. Fracture and fragmentation (all particles less than 2 mm) were assessed in relation to the energy level setting and number of laser pulses delivered. The authors found that a 480-nm, flashlamp-pumped pulsed dye laser can fragment completely all the types of human gallstones that were tested, although there is significant variability in gallstone susceptibility to laser lithotripsy. This susceptibility varies with CT appearance: dense stones require fewer pulses and lower energies for fracture and fragmentation, compared to faint or rimmed stones. The authors anticipate that CT characterization of gallstones may be a clinically useful screening tool before laser lithotripsy.
- Published
- 1991
- Full Text
- View/download PDF
42. Flash lamp pumped dye laser for rosacea-associated telangiectasia and erythema.
- Author
-
Lowe NJ, Behr KL, Fitzpatrick R, Goldman M, and Ruiz-Esparza J
- Subjects
- Adult, Aged, Erythema etiology, Female, Humans, Male, Middle Aged, Prognosis, Telangiectasis etiology, Erythema surgery, Laser Therapy, Rosacea complications, Telangiectasis surgery
- Abstract
The persistence of facial telangiectasis and erythema in patients with rosacea frequently presents a major cosmetic problem. It may also contribute to relapses of papular and pustular lesions. This study of 27 patients treated for their telangiectasia and erythema with a flash lamp pumped dye laser tuned at 585 nm is described. The laser gave good or excellent reduction of telangiectasia and erythema and overall appearance in 24 of the patients with between one and three treatments. In addition, papule and pustule activity was decreased in 59.2% of the patients, with those with the most severe pre-treatment activity having the most significant improvement. It is suggested that this is a useful additional form of treatment that may improve the telangiectasia and erythematous component of rosacea.
- Published
- 1991
43. The depth of thermal necrosis using the CO2 laser: a comparison of the superpulsed mode and conventional mode.
- Author
-
Fitzpatrick RE, Ruiz-Esparza J, and Goldman MP
- Subjects
- Dermatologic Surgical Procedures, Humans, Necrosis, Reference Values, Laser Therapy methods, Skin pathology
- Abstract
In order to compare the depth of thermal necrosis on human skin using the superpulse CO2 laser to the conventional CO2 laser, single impacts of various laser settings were fired at both ends of fusiform excisions done for other clinical purposes. These laser impacts were then examined histologically and the superpulse mode was found to limit the depth of thermal necrosis by approximately a factor of two.
- Published
- 1991
- Full Text
- View/download PDF
44. Pulsed dye laser treatment of telangiectases with and without subtherapeutic sclerotherapy. Clinical and histologic examination in the rabbit ear vein model.
- Author
-
Goldman MP, Martin DE, Fitzpatrick RE, and Ruiz-Esparza J
- Subjects
- Animals, Combined Modality Therapy, Ear blood supply, Endothelium, Vascular pathology, Erythrocytes pathology, Polidocanol, Polyethylene Glycols therapeutic use, Rabbits, Random Allocation, Sclerosing Solutions therapeutic use, Telangiectasis pathology, Telangiectasis therapy, Thrombophlebitis pathology, Veins, Laser Therapy, Sclerotherapy, Telangiectasis radiotherapy
- Abstract
The treatment of leg telangiectases with the carbon dioxide or argon laser results in a low success rate and an unacceptable risk of scarring. Sclerotherapy is effective; however, pigmentation and telangiectatic matting induced by extravasation of RBCs and excessive posttreatment inflammation are common. We conducted a clinical and histologic study of therapy with the 585 nm pulsed dye laser alone and in combination with subtherapeutic sclerotherapy in the rabbit ear vein model. The pulsed dye laser alone was effective when 10 joule/cm2 was used. In combination with immediate injection of the sclerosant, effective endosclerosis occurred with all tested laser energies (8 to 10 joule/cm2).
- Published
- 1990
- Full Text
- View/download PDF
45. Pulsed-dye laser treatment of leg telangiectasia: with and without simultaneous sclerotherapy.
- Author
-
Goldman MP and Fitzpatrick RE
- Subjects
- Adult, Aged, Bandages, Combined Modality Therapy, Female, Humans, Leg Ulcer etiology, Middle Aged, Pigmentation Disorders etiology, Pigmentation Disorders surgery, Polidocanol, Polyethylene Glycols therapeutic use, Sclerosing Solutions therapeutic use, Telangiectasis therapy, Laser Therapy adverse effects, Leg blood supply, Sclerotherapy adverse effects, Telangiectasis surgery
- Abstract
Thirty consecutive female patients with red leg telangiectasia less than 0.2 mm in diameter were treated with a Candela SPTL-1 Pulsed Dye Laser (PDL) tuned to 585 nm with a pulse duration of 450 microseconds at energies ranging from 6.0 to 8.5 J/cm2 delivered through a 5-mm spot size to the entire length of the telangiectasia. Seven patients with 25 patches of telangiectatic matting after previous sclerotherapy were also treated. Twenty-seven patients with symmetrical telangiectatic patches or a large "starburst" telangiectatic flair that could be divided into two separate treatment sites were treated at one site with PDL alone, and at the other site with a combination of PDL followed immediately by sclerotherapy (SCL) with Polidocanol 0.1-0.25 ml per injection site at a concentration of either 0.25%, 0.5%, or 0.75%. PDL treatment is efficacious for both essential telangiectasia and vessels that arise through the phenomena of telangiectatic matting. Sixty-five percent of vessels are completely faded with treatment. PDL alone has a remarkably low incidence of adverse sequelae. Treatment is most efficacious if all vessels larger than 0.2 mm in diameter, especially varicose and reticular feeding veins, are treated first. Treatment results are not affected by vessel location. And post-treatment compression of this type of vessel appears unnecessary. Combination PDL/SCL treatment appears to offer no advantage to sclerotherapy treatment alone and has a significant degree of complications when treatment is limited to red telangiectasia less than 0.2 mm in diameter with the laser parameters utilized.
- Published
- 1990
- Full Text
- View/download PDF
46. Tattoo removal with minimal scarring: the chemo-laser technique.
- Author
-
Ruiz-Esparza J, Goldman MP, and Fitzpatrick RE
- Subjects
- Cicatrix, Coloring Agents, Combined Modality Therapy, Humans, Time Factors, Dermatologic Surgical Procedures, Laser Therapy methods, Tattooing, Urea therapeutic use
- Abstract
A method useful in the removal of decorative tattoos too large for simple excision, or tattoos located in anatomic areas prone to hypertrophic scarring, is described. The method employs the carbon dioxide (CO2) laser for partial ablation of the tattooed area, followed by the repeated application of a urea mixture to complete the removal of the dyes. (These applications continue until the wound is totally healed.) Results indicate that even in areas that typically develop hypertrophic scarring, such as the upper chest, breast, and upper arm, this technique can effectively remove over 95% of the pigment and leave a perfectly flat scar.
- Published
- 1988
- Full Text
- View/download PDF
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