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Biomedical subjects

Brian D Zelickson

Publications and source records attributed to Brian D Zelickson.

11 recordsLinked to original sources
PubMed2006

Complications of laser dermatologic surgery.

BACKGROUND AND OBJECTIVE: Innovations in lasers, light and radiofrequency devices have allowed for improved therapeutic efficacy and safety and the ability to treat patients with an ever-increasing number of medical and aesthetic indications. Safety remains a primary concern and the timely communication of complications and their management is vital to insure that treatments be as safe as possible. The purpose of this report on the Proceedings of the First International Laser Surgery Morbidity Meeting is to provide laser experts the opportunity to present and discuss complications that their patients have experienced and how they were successfully managed. METHODS: Laser experts were invited to present complications of laser, light, and radiofrequency treatments that their patients have experienced and to discuss the potential mechanisms leading to the complications their management and final outcomes. RESULTS: Nineteen unique cases are presented and the clinical management of each case discussed. Eighteen sets of pre- and post-operative photos are presented. CONCLUSION: This report shows that even experts, with extensive experience using light-based therapies, can and do have patients who develop complications. Sound clinical judgment, and knowing how to avoid complications and their timely post-operative management, is essential to insure optimal therapeutic outcome.

Cicatrix↗
PubMed2006

Treatment of inflammatory facial acne with the 1,450 nm diode laser alone versus microdermabrasion plus the 1,450 nm laser: a randomized, split-face trial.

BACKGROUND: The 1,450 nm laser has been effective in treating acne. Microdermabrasion may help treat acne and reduce skin barriers to increase the delivery rate of topical anesthetics. OBJECTIVES: To evaluate the efficacy, safety, and pain associated with the treatment of inflammatory facial acne with the 1,450 nm laser alone versus microdermabrasion plus the 1,450 nm laser. METHODS: Twenty patients with facial acne were treated with the 1,450 nm laser alone and microdermabrasion plus the 1,450 nm laser in a randomized, split-face trial. RESULTS: Laser alone and microdermabrasion plus laser significantly reduced the total number of acne lesions. Mean reductions of 53.5% and 55.6% were found after three treatments for laser alone and microdermabrasion plus laser, respectively. Clinical improvement was maintained 12 weeks after the last treatment. Mean pain scores were 5.3 6 1.5 for microdermabrasion plus laser and 5.2 6 1.5 for laser alone. There was no statistical difference between treatment levels for efficacy or pain. There was an average 10% increase in sequential pain as the laser treatment progressed. CONCLUSION: The 1,450 nm laser is effective, well tolerated, and safe for treating facial acne. This small pilot study did not demonstrate increased clinical efficacy or decreased associated pain with the addition of microdermabrasion to treatment with the 1,450 nm laser. A larger study may be needed to demonstrate any additional benefit.

Acne Vulgaris↗
PubMed2006

The use of photodynamic therapy in dermatology: results of a consensus conference.

Photodynamic therapy (PDT) has significant promise in improving outcomes of patients with a variety of cutaneous conditions. A group of experts met to review the principles, indications, and clinical benefits of PDT with 5-aminolevulinic acid (ALA). They also reviewed PDT with methyl aminolevulinate. The experts established consensus statements for pretreatment, posttreatment, ALA contact time, light sources, and numbers of sessions associated with ALA PDT for actinic keratosis and superficial basal cell carcinoma, photorejuvenation and cosmetic enhancement, acne, sebaceous skin, rosacea, and rhinophyma. They based consensus recommendations on their clinical experience and the medical literature. They also suggested future applications of ALA PDT. Experts concluded that ALA PDT is a safe and effective modality for the treatment of conditions commonly encountered in dermatology. Since downtime is minimal, the technique is suitable for patients of all ages and lifestyles. Appropriate light sources are available in many dermatology offices. The expanding clinical and financial benefits of PDT justify the purchase of an appropriate light source.

Aminolevulinic Acid↗
PubMed2004

Histological and ultrastructural evaluation of the effects of a radiofrequency-based nonablative dermal remodeling device: a pilot study.

BACKGROUND: Many light- and laser-based systems are used to reduce cutaneous wrinkles, and some have been shown to stimulate dermal collagen production. Using the ThermaCool TC radiofrequency device to treat bovine tendon and human abdominal skin, we documented the cutaneous effects of a radiofrequency-based system for nonablative treatment. OBSERVATIONS: Electron microscopy of bovine tendon treated at varied heat and cooling settings revealed collagen fibrils with increased diameter and loss of distinct borders as deep as 6 mm. Human skin treated at varied heat and cooling settings and examined by means of routine light microscopy demonstrated no significant changes in the epidermis or dermal ground substance immediately after treatment; there was scattered mild perivascular and periadnexal inflammation. Three and 8 weeks after treatment, no observable changes were noted. Ultrastructural analysis, however, disclosed isolated, scattered areas of collagen fibrils with increased diameter and loss of distinct borders. In addition, Northern blot analysis demonstrated an increase in collagen type I messenger RNA steady-state expression. CONCLUSIONS: Our findings suggest that collagen fibril contraction occurs immediately after treatment and gives rise to tissue contraction and thermally mediated wounding, which induces new collagen production.

Abdominal Wall↗
PubMed2004

Confocal microscopy study of nerves and blood vessels in untreated and treated port wine stains: preliminary observations.

BACKGROUND AND OBJECTIVE: Vascular ectasia in port wine stain birthmarks (PWS) might result from reduced innervation with loss of autonomic stimulation. We investigated this theory and evaluated nerve and blood vessel density, and mean blood vessel size in untreated and treated PWS skin. METHODS: Skin biopsy specimens were obtained from uninvolved skin, untreated PWS, PWS with a good response to laser treatment and PWS with a poor response to laser treatment. Confocal microscopy was performed to determine nerve and blood vessel density, and mean blood vessel size. RESULTS: Nerve density was significantly decreased in all PWS sites compared to uninvolved skin. Mean blood vessel diameter was larger in untreated compared to treated PWS. PWS with a good response to treatment had decreased nerve density but blood vessel density and mean diameter was relatively normal. PWS with a poor response to treatment had decreased nerve density but increased blood vessel density and mean blood vessel diameter compared to normal skin. CONCLUSION: Nerve density was decreased in all evaluated PWS sites and this may be a factor in lesion pathogenesis. PWS blood vessel size correlated with pulsed dye laser response and may prove to be a useful prognostic indicator of therapeutic outcome.

Adult↗
PubMed2003

Full-face laser resurfacing using a supplemented topical anesthesia protocol.

BACKGROUND: Laser resurfacing has become a popular modality for the treatment of photodamaged skin, rhytids, and acne scarring. In many cases, this procedure is performed under general anesthesia or intravenous sedation in conjunction with nerve blocks and local infiltration. OBJECTIVE: To evaluate the safety and efficacy of facial carbon dioxide laser resurfacing using a supplemented topical anesthesia protocol. DESIGN: Nonrandomized case series of patients observed for 1 year. SETTING: Outpatient surgery center. PATIENTS: Two hundred consecutive patients undergoing treatment for facial rhytids or acne scarring. Intervention Full-face carbon dioxide laser resurfacing procedures were performed using a supplemented topical anesthesia protocol. Pretreatment medications included diazepam, oral analgesics, and intramuscular ketorolac tromethamine. MAIN OUTCOME MEASURES: Tolerability of procedure, healing times, and adverse effects. RESULTS: Topical anesthesia provided effective and sufficient anesthesia in most cases. Only 10 of 200 patients required additional anesthesia (regional nerve blocks and/or local infiltration). Substantial improvement of rhytids, photodamage, and acne scarring was observed. Posttreatment hypopigmentation was seen in 1 patient. Scarring was not observed. Conclusion A supplemented topical anesthesia protocol for full-face laser resurfacing is a safe and effective alternative to traditional anesthesia strategies.

Acne Vulgaris↗
PubMed2002

Comparative pilot study evaluating the treatment of leg veins with a long pulse ND:YAG laser and sclerotherapy.

BACKGROUND AND OBJECTIVE: To date there have been very few side by side comparison studies of laser versus sclerotherapy in treating small leg veins. This study compares a long pulsed Nd:YAG laser with contact cooling to sclerotherapy for treating small diameter leg veins by evaluating objective and subjective clinical effects. STUDY DESIGN/MATERIALS AND METHODS: Twenty patients were selected with leg veins ranging from 0.25 to 3 mm at two comparable sites. One site was treated with long pulsed Nd:YAG laser and the other received sotradecol sclerotherapy. The patients followed up at 8 weeks for another possible laser retreatment and 3 months following the last treatment. Photographs were taken pre- and post-operatively and at each follow-up visit and used for objective comparative analysis. The patients also completed a Quality of Life survey. RESULTS: Improvement was tabulated from the photographic assessment on an improvement scale from 0 (no change)-4 (greater than 75% clearing). The laser treated areas averaged 2.50 and sclerotherapy treated sites averaged 2.30. Patient surveys show 35% preferred laser and 45% choose sclerotherapy. CONCLUSION: This pilot study demonstrates that the Lyra Long Pulse Nd:YAG laser can yield results similar to sclerotherapy in the treatment of small leg veins.

Adult↗
PubMed2002

Use of a novel erbium laser in a Yucatan minipig: a study of residual thermal damage, ablation, and wound healing as a function of pulse duration.

BACKGROUND AND OBJECTIVE: Theoretical models show that varying pulse duration influences residual thermal damage in erbium YAG skin resurfacing. Accordingly, our objective was to compare residual thermal damage, ablation, tissue shrinkage, and wound healing between a variable pulsewidth erbium YAG laser and a popular CO2 resurfacing laser. STUDY DESIGN/MATERIALS AND METHODS: The erbium laser delivered a typical ablative pulse (250 microseconds), followed by a heating pulse of variable duration. Pulse durations for specific coagulation depths were selected based on existing heat transfer models. The bilateral flanks of one Yucatan pig were irradiated. Eight sites were treated per group. Biopsies were performed just after treatment and 1, 3, 7, 21, and 60 days postoperatively. RESULTS: Just after irradiation, gross examination of "cold" (without a coagulation pulse) erbium sites showed a reddish papillary dermis consistent with conventional erbium laser ablation. Two and three pass CO2 sites showed uniform surface yellowing. The longer pulsewidth ("hot") erbium groups showed only slight surface yellowing. Biopsies showed immediate thermal damage that increased with erbium pulse duration; however, actual residual thermal damage (RTD) was sometimes less than that predicted by the laser control panel. All wounds healed uneventfully by 14 days. CONCLUSIONS: An erbium laser with a variable macropulse pulsewidth was capable of achieving RTD of up to 80 mum. Even greater RTD depths may be obtainable with future manipulations of fluence and pulse duration.

Animals↗
PubMed2002

Biophysics of nonablative dermal remodeling.

This article explores the physics of nonablative skin remodeling as well as the histologic sequelae. Although there have been several studies of nonablative skin remodeling, the exact mechanisms of action and thus the optimum device-specific parameters are not yet known. The article is divided into a discussion of the physics of laser-tissue interactions, followed by a review of the types of devices used for nonablative skin remodeling, and the histologic findings that follow treatment.

Biophysical Phenomena↗
PubMedDate not supplied

Radiofrequency treatment for middle and lower face laxity.

OBJECTIVE: To compare the effectiveness of 1 and 2 radiofrequency (RF) treatments with the ThermaCool TC system (Thermage Inc, Hayward, Calif) on middle and lower face laxity. METHODS: Twenty patients with mild to moderate laxity of the middle and lower face were randomly assigned to receive either a single RF treatment or 2 treatments spaced 1 month apart. Treatment energy levels were titrated to patient tolerance and ranged from 85 to 135 J/cm(2). Acute clinical response was recorded after each session. Standardized photographs were taken before treatment and at 1 and 4 months after the last treatment. Using a percentage scale, 4 blinded physicians experienced in dermatologic laser therapy independently rated improvement in nasolabial folds, marionette lines, jowls, laxity under the chin, and overall appearance. In addition, subjects completed quality-of-life surveys 1 and 4 months after treatment. Each patient paid the same fee for involvement in the study. RESULTS: Eleven patients received a single RF treatment, and 9 patients underwent 2 treatments. All subjects experienced mild edema and mild to moderate erythema as an acute clinical response; no patients experienced burns, skin breakdown, or scarring. At 4-month follow-up, patients in the 2-treatment group received higher scores in all categories of photographic analysis; the difference in improvement in the nasolabial folds was statistically significant (P = .04). In self-assessment ratings, individuals receiving 2 treatments reported more improvement than subjects in the single-treatment group 4 months after treatment (P = .03). In both treatment groups, physician photographic assessment demonstrated continued improvement in all subsites between the 1-month and 4-month assessments (P<.05). Although the overall change noted by both patients and physicians was modest in most patients, 75% of subjects (n = 15) stated they would consider paying for additional treatments. CONCLUSIONS: Two RF treatments yielded significantly better improvement than a single treatment in the nasolabial folds. Significant improvement in laxity after treatment was seen between the 1- and 4-month follow-up visits in both single- and 2-treatment groups. Although overall improvements were modest in both groups, patient satisfaction was relatively high.

Adult↗