Nonablative cutaneous remodeling using radiofrequency devices.

In recent years, several new radiofrequency devices have been introduced for treatment of a variety of skin conditions, particularly, skin wrinkling and laxity. These nonsurgical systems induce tissue tightening and contour changes through dermal collagen remodeling without disruption of the overlying epidermis, obviating a significant recovery period or risk of serious adverse sequelae. As such, radiofrequency-based systems have been used successfully for nonablative skin rejuvenation, atrophic scar revision, and treatment of unwanted hair, vascular lesions, and inflammatory acne.

Lasers in dermatology: four decades of progress.

Advances in laser technology have progressed so rapidly during the past decade that successful treatment of many cutaneous concerns and congenital defects, including vascular and pigmented lesions, tattoos, scars, and unwanted hair-can be achieved. The demand for laser surgery has increased substantially by patients and dermatologists alike as a result of the relative ease with which many of these lesions can be removed, combined with a low incidence of adverse postoperative sequelae. Refinements in laser technology and technique have provided patients and practitioners with more therapeutic choices and improved clinical results.

Botulinum toxin type B for dynamic glabellar rhytides refractory to botulinum toxin type A.

Background: Botulinum toxin type B (BTX-B; Myobloc) has recently been introduced for the treatment of dynamic rhytides. This serotype is structurally similar to botulinum toxin type A (BTX-A; Botox) and appears to produce equivalent muscular paralysis. Because of the fact that some patients may become resistant to the effects of BTX-A with its continued use or may require large doses of type A to exert adequate muscular paralysis, the use of BTX-B may prove beneficial in these cases.

Are all infrared lasers equally effective in skin rejuvenation.

In an attempt to limit the prolonged postoperative healing associated with ablative laser skin resurfacing and in response to growing public interest in less invasive treatment modalities, nonablative laser and light source technology was developed. Over the past few years, several clinical and histologic research studies have been conducted to determine the relative efficacy of these nonablative systems. These systems stimulate dermal collagen remodeling using wavelengths and concomitant tissue cooling that limit injury to the epidermis, thereby minimizing or eliminating postoperative sequelae.

Evaluation of a novel topical anesthetic agent for cutaneous laser resurfacing: a randomized comparison study.

Background: A variety of topical anesthetic compounds are available for use prior to minimally or moderately painful cutaneous laser procedures. A novel lidocaine/tetracaine-based peel has recently been developed that is applied to the skin as a cream and, once air dried, is removed as a flexible film that may prove useful in providing adequate dermal anesthesia for dermatologic laser surgery.

Objective: To evaluate the clinical efficacy of a novel topical anesthetic peel preparation for induction of local anesthesia prior to full-face cutaneous laser resurfacing.

Nonablative laser skin resurfacing using a 1540 nm erbium glass laser: a clinical and histologic analysis.

Background: A variety of laser systems have recently become available that allow for selective dermal remodeling without disruption of the epidermal surface. Modest clinical improvement in mild to moderate photoinduced facial rhytides with minimal morbidity is typical of these nonablative lasers, providing a significant advantage over traditional ablative laser systems.

Objective: To determine the clinical and histologic effects of a novel 1540 nm erbium glass laser on facial rhytides.

Clinical comparison of sclerotherapy versus long-pulsed Nd:YAG laser treatment for lower extremity telangiectases.

Background: Sclerotherapy has traditionally been considered the gold standard of treatment for leg veins, but patient fear of multiple needle injections and side effects of treatment have fueled investigation into other treatment alternatives. As a result, vascular-specific laser and light sources have been developed in an effort to treat these vessels with minimal morbidity and improved efficacy.

Objective: To compare the clinical efficacy of leg telangiectasia treatment with sodium tetradecyl sulfate sclerotherapy to long-pulsed 1064 nm Nd:YAG laser irradiation.

Laser scar revision.

A variety of lasers can be used to treat scars and striae effectively. It is of paramount importance that the type of scar be properly classified on initial examination so that the most appropriate method of treatment can be chosen. Classification also allows the laser surgeon to discuss with the patient the anticipated response to treatment.

Regional anesthesia with monitored anesthesia care for dermatologic laser surgery.

This article describes an anesthetic technique that the authors have found useful for cutaneous laser surgery in keeping with the standards for office-based anesthesia practice. Although still in its infancy, office-based anesthesia for dermatologic laser procedures has become one of the most challenging yet rewarding fields of anesthesia today. As laser procedures continue to flourish, with seemingly endless technologic advances, surgeons, anesthesia providers, and other medical personnel must work collaboratively in developing appropriate office-based practice.

Laser resurfacing of darkly pigmented patients.

Hyperpigmentation following laser resurfacing in darker-skinned individuals is common but treatable. This pigmentation is usually heralded by persistent erythema and can be prevented in most patients if aggressive laser resurfacing is curtailed and conservative or single-pass techniques are applied. Avoiding excessive intraoperative frictional trauma when removing the desiccated tissue Avoiding excessive intraoperative frictional trauma when removing the desiccated tissue and potentially irritating agents or infections in the pre- or postoperative period is also instrumental in avoiding long-term complications.

Cutaneous metastasis from an intracranial glioblastoma multiforme.

A 34-year-old white man with a history of an intracranial glioblastoma multiforme was treated with surgical excision and radiotherapy. Five months later, the patient had a rapidly growing scalp mass develop. This lesion was excised, and the histology revealed a tumor that was similar to the originally resected intracranial glioblastoma.