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Biomedical subjects

David J Goldberg

Publications and source records attributed to David J Goldberg.

16 recordsLinked to original sources
PubMed2003

Electrosurgical resurfacing: a clinical, histologic, and electron microscopic evaluation.

BACKGROUND: Radiofrequency resurfacing is a new technology for ablative facial resurfacing. OBJECTIVES: To evaluate the efficacy of radiofrequency resurfacing in reduction of perioral and periorbital rhytides, and to assess it's effects on collagen remodeling by electron microscopic evaluation. RESULTS: Fourteen of the fifteen subjects (93%) were 100% re-epithelialized by day 7. All 15 patients (100%) had resolution of post-treatment erythema by 3 months. Clinical investigator assessment evaluation revealed mild to moderate improvement in 100% of patients. Histologic changes were consistent with new upper papillary dermal collagen formation. Post-treatment ultrastuctural changes showed either new Type III or mature Type I collagen formation. CONCLUSIONS: Radiofrequency resurfacing is an effective ablative resurfacing method for mild to moderate improvement of Fitzpatrick Type I-III rhytides. It is a low risk procedure with potentially shorter periods of post-operative re-epithelialization and erythema as compared to standard ablative laser procedures.

Electrosurgery↗
PubMed2003

Millisecond 1064-nm neodymium:YAG laser treatment of facial telangiectases.

BACKGROUND: Millisecond pulse duration 1064-nm Neodymium:YAG (Nd:YAG) lasers have been shown to be effective in the treatment of some lower leg telangiectases. OBJECTIVE: To evaluate the efficacy and complication rate of a millisecond pulse duration 1064-nm Nd:YAG laser in the treatment of facial telangiectases. METHODS: Fifteen subjects were evaluated. RESULTS: Moderate to significant improvement was seen in 73% patients at day 30 and in 80% of patients at 3 months. These results were seen in the treatment of both blue/red and red facial telangiectases. CONCLUSION: The millisecond pulse duration 1064-nm Nd:YAG laser is effective for treatment of facial telangiectases.

Facial Dermatoses↗
PubMed2003

Laser-assisted hair removal in Asian skin: efficacy, complications, and the effect of single versus multiple treatments.

BACKGROUND: Alexandrite laser hair removal can be quite successful in lighter skin types. Effective hair removal in Asians can be difficult, and multiple treatments are usually required for effective treatment. OBJECTIVE: To evaluate the safety and efficacy of alexandrite laser hair removal in Asian skin, to determine the benefit of multiple treatments, and to evaluate the value of test patches before laser treatment. METHODS: One hundred forty-four Asian subjects with Fitzpatrick skin types III to V were treated with a cooled 40-ms alexandrite laser with fluences of 16 to 24 J/cm2. Initially, all treated subjects underwent test patch application. After test patch application, 35 subjects with 66 anatomic sites received three treatments. Thirty-five subjects with 66 anatomic sites received two treatments, and 74 subjects with 124 anatomic received a single treatment. All subjects were followed for 9 months after their final treatment. RESULTS: In subjects that were treated three times, a 55% hair reduction was noted at 9 months after the third treatment. In subjects treated two times, a 44% hair reduction was noted at 9 months after the second treatment. In subjects treated only one time, a 32% hair reduction was noted at 9 months after the single treatment. No subjects had scarring or long-term pigmentary changes. There appeared to be no correlation between test patch acute complications and those seen after actual treatments. CONCLUSION: Although Asian skin can be effectively treated with a cooled, long-pulsed alexandrite laser, complications do occur. Laser hair removal efficacy was increased with multiple treatments. There does not appear to be an exact correlation in Asian skin between complications occurring after test patch treatment and those seen with subsequent treatments.

Adolescent↗
PubMed2003

308-nm Excimer laser treatment of mature hypopigmented striae.

BACKGROUND: The 308-nm excimer laser has been shown to be effective in the treatment of disorders of hypopigmentation. OBJECTIVE: To evaluate the effectiveness of the 308-nm excimer laser in the treatment of mature hypopigmented striae. RESULTS: Seventy-five subjects were treated for a total of 615 treatments. All patients achieved a substantial increase in the darkening of their striae after an average of 8.4 treatments. Clinically evident improvement in cosmetic appearance of striae was noted by 80% of subjects. CONCLUSION: The 308-nm excimer laser is effective for increasing pigmentation in mature hypopigmented striae. This pigmentation is cosmetically significant. Future studies are required to determine the duration of clinical improvement.

Adult↗
PubMed2003

Atrophic and a mixed pattern of acne scars improved with a 1320-nm Nd:YAG laser.

BACKGROUND: Acne scar correction remains a challenge to the dermatologic surgeon. With nonablative laser resurfacing, this correction is imputed to dermal collagen remodeling and acne scar reorganization. Although atrophic acne scars tend to respond to laser treatment, the deeper ice pick and boxcar scars tend to be laser resistant. OBJECTIVE: To investigate the treatment of atrophic and a mixed pattern of facial acne scars, we evaluated a 1320-nm Nd:YAG laser. Twelve subjects with atrophic facial acne scars (N=6) or a combination of atrophic and pitted, sclerotic, or boxcar scars (N=6) received three laser treatments. Physician and patient acne scar ratings were performed at baseline and at 6 months after the last treatment. Acne scars were rated with a 10-point severity scale. RESULTS: Mean acne scar improvement was 1.5 points on physician assessments (P=0.002) and 2.2 points on patient assessments (P=0.01). Acne scars were rated more severely by patients than by the physician at all intervals. There were no noted complications at 6 months. CONCLUSION: The 1320-nm Nd:YAG laser is a safe and effective nonablative modality for the improvement of atrophic and a mixed pattern of facial acne scars.

Acne Vulgaris↗
PubMed2003

Lasers for facial rejuvenation.

Laser and laser-like assisted facial rejuvenation has become very popular during the last decade. Although a myriad of techniques are available, such approaches can be divided into four basic approaches. There are those that (i) ablate the epidermis, cause dermal wounding, and provide a significant thermal effect (CO(2) lasers); (ii) ablate the epidermis, cause dermal wounding, and minimal thermal effects (short pulsed Erbium:Ytrrium-Aluminum-Garnet [Er:YAG] lasers); (iii) ablate the epidermis, cause dermal wounding, and provide variable thermal effects (combined CO(2)/Er:YAG lasers, variable pulsed Er:YAG lasers, and ablative radiofrequency devices); and (iv) do not ablate the epidermis, cause dermal wounding, and provide minimal thermal effects (non-ablative lasers and light sources). Each of the four modalities has now been shown to be effective in promoting facial rejuvenation. As would be expected, each has some advantages and disadvantages.CO(2) lasers, because they ablate the epidermis, cause a dermal wound, and provide a significant thermal effect, appear to be most useful for those individuals with advanced photoaged skin. Such lasers provide the greatest degree of skin tightening for these individuals. However, it is that very same thermal effect that leads to the possibility of delays in healing sometimes noted with these systems. Short pulsed Er:YAG lasers, because they promote so little thermal damage, when used in a superficial manner, lead to the possibility of quicker healing than is seen with CO(2) lasers. However, less clinical improvement and more bleeding may be noted. Combined CO(2)/Er:YAG lasers, variable pulsed Er:YAG lasers, and ablative radiofrequency devices lead to an effect somewhere in between that of pulsed CO(2) lasers and short pulsed Er:YAG lasers. The newest group of systems includes the non-ablative devices that do not ablate the epidermis, cause dermal wounding, and provide for a minimal thermal effect. This area of technology is still evolving. Although such techniques, because they do not ablate the epidermis, are cosmetically elegant, the clinical results are usually not quite as good as the more aggressive ablative techniques.

Humans↗
PubMed2002

Non-ablative laser treatment of facial rhytides: a comparison of 1450-nm diode laser treatment with dynamic cooling as opposed to treatment with dynamic cooling alone.

BACKGROUND AND OBJECTIVE: Non-ablative dermal remodeling has been shown to create new dermal collagen. This is thought to occur secondary to a laser-induced injury to the skin. Other mechanisms of injury may lead to similar results. The aim of this study was to evaluate the efficacy and complication rate of a 1450-nm diode laser and compare clinical effect when the laser is used in conjunction with cryogen cooling as compared to the use of cryogen cooling alone. STUDY DESIGN/MATERIALS AND METHODS: Twenty subjects, skin types I-IV, age range 42-70 years, with Class I and II rhytides were enrolled in the study. Subjects were treated with 2-4 laser treatments and cryogen cooling on one side of their face, while the contralateral side was treated with cryogen cooling alone. Subjects were evaluated six months after their final treatment. RESULTS: Thirteen subjects showed clinical improvement on the laser/cryogen treated side. No subjects were noted to have any improvement at the cryogen alone side. CONCLUSION: The 1450-nm diode laser can lead to non-ablative improvement of rhytides. This effect appears to be a direct laser induced effect.

Adult↗
PubMed2002

Laser hair removal.

Laser hair removal created controversy when it was first described over 5 years ago. It has now become an accepted modality for long-term hair reduction. It rivals electrolysis in the successful treatment of small hair-bearing areas. It surpasses any modality in the treatment of larger hair-bearing anatomic areas.

Hair↗
PubMed2002

Nd:YAG laser (1064 nm) irradiation for lower extremity telangiectases and small reticular veins: efficacy as measured by vessel color and size.

BACKGROUND: Laser treatment of lower extremity telangiectases and small reticular veins has remained difficult because of vessel color, diameter, depth, and associated high-pressure flow. Traditionally, larger-caliber blue leg veins do not respond well to laser treatment. Nd:YAG laser (1064 nm) irradiation is absorbed by oxyhemoglobin and reduced hemoglobin and is associated with greater depth of penetration than other previously studied vascular lasers. OBJECTIVE: To evaluate a millisecond contact-cooled 1064 nm Nd:YAG laser for the treatment of telangiectases and small reticular veins. METHODS: Twenty-one lower extremity sites, with Fitzpatrick skin types I-IV, received two laser treatments separated by a 4 to 6-week period. Blue and red vessels, ranging in size from 0.25 to 4.0 mm were treated. Pulse durations of 10-50 msec were utilized at fluences of 90-187 J/cm2. Three months after the last treatment, patients were evaluated for vessel improvement and complications. RESULTS: Seventy-one percent of lower extremity vessels had improvement graded as significant. All vessel colors and sizes were successfully treated. The only complication at 3 months was postinflammatory hyperpigmentation. CONCLUSION: 1064 nm Nd:YAG laser irradiation with associated contact cooling is a safe and effective treatment for telangiectases and small reticular veins of the lower extremities.

Adult↗
PubMed2002

Evaluation of a new super-long-pulsed 810 nm diode laser for the removal of unwanted hair: the concept of thermal damage time.

BACKGROUND: Laser hair removal is based on the dual concepts of selective photothermolysis and thermal relaxation time. In most laser hair removal systems, light with emitted pulse durations of 2-50 msec targets hair follicles. A novel concept of laser hair removal uses the thermal damage time rather than the thermal relaxation time of the hair follicle. The follicle's thermal damage time is the amount of time required for diffusion of delivered laser energy from the treated hair to follicular-associated hair stem cells. This can range from 170 to 1000 msec. OBJECTIVE: To investigate the theory of thermal damage time, we performed a pilot study to evaluate the clinical efficacy and side effect profile of a modified 810 nm diode laser device operating in a super-long-pulse mode (200-1000 msec). METHODS: Ten female subjects with Fitzpatrick skin types I-VI received either one or two laser treatments at eight test sites. Super-long pulse durations of 200-1000 msec were evaluated with delivered fluences ranging from 23 to 115 J/cm2. Subjects were followed for 6 months after the first treatment. Subjects were evaluated for hair removal efficiency, optimal pulse duration and delivered fluence, and associated complication rate. RESULTS: The clinical results show that safe hair removal in all skin types can be accomplished with an 810 nm diode laser delivering super-long pulse durations. Pain and complications were greatest at the highest pulse duration (1000 msec) and the highest fluence (115 J/cm2). Optimal hair reduction at 6 months (31%) was achieved at a thermal diffusion time of 400 msec (46 J/cm2). CONCLUSION: The super-long pulsed 810 nm diode laser can safely remove unwanted hair in a full variety of skin types. Pain and increased risk of complications may preclude the use of the laser at very high fluences and pulse duration in the range of 1000 msec.

Adult↗
PubMed2002

Evaluation of a long-pulsed Nd:YAG laser at different parameters: an analysis of both fluence and pulse duration.

BACKGROUND: Effective hair removal continues to pose a challenge to the physician. The use of lasers represents a significant advance in epilation, but still requires further refinement. The long-pulsed Nd:YAG laser may offer advantages over other systems because of its significant depth of penetration and minimal absorption by epidermal melanin, but ideal parameters need to be determined. OBJECTIVE: To evaluate the efficacy of a long-pulsed Nd:YAG laser system and determine the optimal parameters for hair removal. METHODS: Twenty-two subjects were treated with a cryogen spray-cooled long-pulsed Nd:YAG laser. Four adjacent sites were assigned to each subject, where the following sets of parameters were utilized: 50 J/cm2 with a 25-msec pulse duration, 60 J/cm2 with a 50-msec pulse duration, 80 J/cm2 with a 50-msec pulse duration, and control. Hair counts were obtained immediately, 1 week, 1 month, and 3 months after treatment, and multivariate regression analysis was used to determine the significance of hair reduction. Acute reactions and adverse events were also evaluated. RESULTS: Treatment at all three sets of parameters resulted in significant mean hair reductions immediately, at 1 week, and at 1 month (P <.001). At 3 months, the higher settings of 60 J/cm2 and 50 msec and 80 J/cm2 and 50 msec were statistically significant for reduced mean hair counts (P =.014, P =.042, respectively), while the lowest setting at 50 J/cm2 and 25 msec was not significant (P =.079). Patient and physician assessments suggested optimal hair reduction at the highest fluence (80 J/cm2) and longest pulse duration (50 msec). The most common acute reactions were pain during treatment, erythema, and perifollicular edema, all of which were more severe with higher fluences. CONCLUSION: The long-pulsed Nd:YAG laser is a safe and effective method of hair removal. Increased fluence (60-80 J/cm2) and longer pulse duration (50 msec) settings were generally correlated with reduced hair counts and improved clinical outcome.

Adult↗
PubMed2002

Botulinum B treatment of the glabellar and frontalis regions: a dose response analysis.

BACKGROUND: Botulinum toxin injections represent the most commonly performed cosmetic procedure in the US. There is an enormous reported experience documenting the efficacy of botulinum toxin A injections. There is very limited published information about the efficacy and appropriate dosage of botulinum toxin B injections. OBJECTIVE: The aim of this study was to evaluate the dosage response and side effect profile of botulinum toxin B injections. METHOD: Twenty-six subjects received botulinum B injections to their glabellar area. Eighteen subjects received botulinum B injections to their frontalis region. Three different dosages were used. In the glabellar treated subjects the low dose group received a total of 1875 units; the medium dose group received a total of 2500 units; and the high dose group received a total of 3125 units. In the frontalis treated group, the low dose group received a total of 2250 units; the medium dose group received a total of 3000 units; and the high dose group received a total of 3750 units of botulium B toxin. RESULTS: In the glabellar group, most subjects showed some evidence of paralysis at 2 months. Only in the high dose group did a significant cadre of treated subjects still show a significant response at 3 months after treatment. In the frontalis group, response was often still seen at 2 months. However, at 3 months most subjects showed no continued effect from botulinum B toxin. CONCLUSION: Botulinum B toxin injections represent an alternative to botulinum A treatment for glabellar and frontalis hyperkinetic wrinkles. At the doses utilized in this study, the effect does not generally appear to last as long as has been reported with botulinum A injections. However, the onset of action may be sooner with botulinum B injections.

Adult↗