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Biomedical subjects

E Victor Ross

Publications and source records attributed to E Victor Ross.

At least 19 recordsLinked to original sources
PubMed2006

Split treatment of photodamaged skin with KTP 532 nm laser with 10 mm handpiece versus IPL: a cheek-to-cheek comparison.

BACKGROUND AND OBJECTIVES: The treatment of photodamaged skin with potassium-titanyl-phosphate (KTP) laser and intense pulsed light (IPL) has been reported in several studies. Each device has strengths and weaknesses; however, patient and device variability have made it difficult to ascertain the optimal device for photorejuvenation. The objective of this study was to obtain a head-to-head comparison of IPL and KTP laser for photorejuvenation. Each patient received one KTP laser treatment on one side of the face and one IPL treatment on the other side. STUDY DESIGN/MATERIALS AND METHODS: Seventeen patients with skin types I-IV were accepted into the study based on existence of dyschromias (pigmented and vascular) and/or discrete telangiectases. After performance of test spots on each patient to determine optimal settings for both devices, patients were treated with both devices in a split face manner. Evaluations and photographs were performed 1 week and 1 month after treatment. Patient and observer evaluations of results were recorded, as well as time to perform each treatment, and patient feedback with regard to pain and edema. No anesthesia was used in these treatments. Photographs were reviewed by a panel of blinded observers to assess changes in red and brown dyschromias. RESULTS: One month average improvement (evaluator) for IPL side was (mean) 38.16%/35.08% for vascular/pigment lesions versus 41.99%/30.21% for KTP side. Patient self-evaluated global improvement at 1 month was (mean) 65.59% for IPL side versus 60.88% for KTP side. A majority of patients found the KTP to be slightly more painful with a mean pain rating of 5.27 of 10 versus 4.4 of 10 for IPL. A majority of patients experienced subjectively greater post-procedure swelling on the KTP side. Time to conduct treatment was an average of 10.0 minutes for IPL, 8.7 minutes for KTP. CONCLUSIONS: Both large spot KTP and IPL achieved marked improvement in vascular and pigmented lesions in one session. The KTP laser caused slightly more discomfort and edema than the IPL. On the other hand, the KTP laser was faster, and more ergonomically flexible.

Edema↗
PubMed2006

Optimal pulse durations for the treatment of leg telangiectasias with a neodymium YAG laser.

BACKGROUND: Leg veins can be effectively treated with lasers. However, the optimal pulse duration for small leg veins has not been established in human studies with a Nd:YAG laser. OBJECTIVES: The purpose of this study was to investigate a range of pulse durations to determine an optimal pulse duration for clearance of leg veins. STUDY DESIGN/MATERIALS AND METHODS: After mapping and photo documentation of the leg veins to be treated, a variable pulse duration Neodymium:Yttrium Aluminum Garnet (Nd:YAG) laser (3-100 milliseconds) was used in a single test site session. Pulse durations of 3, 20, 40, 60, 80, and 100 milliseconds were used. At the 3-week follow-up, the optimal pulse duration was defined as that pulse duration which resulted in the most complete clearance of vessels with the least side effects. Up to 20 vessels were then treated using the established "optimal" pulse duration. Final evaluation was at 16 weeks after the initial visit. Three blinded observers rated the percent of vessels completely cleared based on initial and final photographs. RESULTS: Eighteen patients completed the study. Fluence thresholds for immediate vessel changes varied depending on spot size and vessel diameter, with larger fluences required for smaller spot sizes and smaller vessels. Shorter pulse durations (< or =20 milliseconds) were associated with occasional spot sized purpura and spot sized post-inflammatory hyperpigmentation. Longer pulse durations (40-60 milliseconds) achieved superior vessel elimination with less post-inflammatory hyperpigmentation. With a single laser treatment, 71% of the treated vessels cleared. CONCLUSIONS: Compared to shorter pulses (<20 milliseconds), longer pulses may provide gentler heating of the vessel and a greater ratio of contraction to thrombosis.

Adult↗
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

Effect of monopolar radiofrequency treatment over soft-tissue fillers in an animal model: part 2.

BACKGROUND AND OBJECTIVE: Monopolar radiofrequency (RF) treatment is used by physicians to heat skin and promote tissue tightening and contouring. Cosmetic fillers are used to soften deep facial lines and wrinkles. Patients who have had dermal fillers implanted may also benefit from or are candidates for monopolar RF skin tightening. This study examined the effect of RF treatment on various dermal filler substances. This is the second part of a two-part study. STUDY DESIGN/MATERIALS AND METHODS: A juvenile farm pig was injected with dermal fillers including cross-linked human collagen (Cosmoplast), polylactic acid (PLA) (Sculptra), liquid injectable silicone (Silikon 1000), calcium hydroxylapatite (CaHA) (Radiesse), and hyaluronic acid (Restylane). Skin injected with dermal fillers was RF-treated using a 1.5-cm2 treatment tip and treatment levels typically used in the clinical setting. Fillers were examined histologically 5 days, 2 weeks, or 1 month after treatment. Histological specimens were scored for inflammatory response, foreign body response, and fibrosis in order to assess the effect of treatment on early filler processes, such as inflammation and encapsulation. RESULTS: Each filler substance produced a characteristic inflammatory response. No immediate thermal effect of RF treatment was observed histologically. RF treatment resulted in statistically significant increases in the inflammatory, foreign body, and fibrotic responses associated with the filler substances. CONCLUSIONS: Monopolar RF treatment levels that are typically used in the clinical setting were employed in this animal study. RF treatment resulted in measurable and statistically significant histological changes associated with the various filler materials. Additional clinical and histological studies are required to determine the optimal timing of monopolar RF treatment and filler placement for maximal potential aesthetic outcome.

Animals↗
PubMed2006

Laser versus intense pulsed light: Competing technologies in dermatology.

Lasers have been competing with non-laser intense pulsed light (IPL) sources in the cosmetic arena over the past 10 years. Initially IPLs were somewhat cumbersome and accepted by a minority of "serious" practitioners. Recently, however, the popularity of full-face visible light skin rejuvenation, enhanced engineering of IPLs, and favorable cost versus many lasers, have lead to a proliferation of IPL devices. No longer a stepchild in the rejuvenation market, IPLs may overtake lasers as the devices of choice among most physicians. We review the pros and cons of lasers and IPLs within the context of design, cost, and other practical concerns for a typical office-based practice.

Biomedical Technology↗
PubMed2006

Variable-pulse Nd:YAG laser in the treatment of facial telangiectasias.

BACKGROUND: Variable-pulse 1,064 nm wavelength lasers have been used with good effectiveness on leg telangiectasias and reticular veins and have shown promising results on facial telangiectasias as well. OBJECTIVE: To investigate the effectiveness of a variable-pulse neodymium:yttrium-aluminum-garnet (Nd:YAG) laser using a small spot size in the treatment of facial telangiectasias. METHODS: Eight male patients (mean age 75 years) underwent a single treatment session using a variable-pulse 1.5 mm spot size Nd:YAG laser with epidermal cooling. Telangiectasia diameters were 0.3 to 2.0 mm. Test sites were performed using three pulse widths (3, 20, and 60 ms), with fluences varying depending on vessel size and response. Full treatments were performed using test parameters giving the best response. Thirteen weeks later, the patients returned for final evaluation and satisfaction rating. RESULTS: Fluences ranged from 226 to 425 J/cm2, with smaller vessels requiring larger energies. Pulse duration was equally divided between the 20 and 60 ms settings. The shortest pulse width (3 ms) was inferior in all patients. Longer pulse durations achieved superior vessel elimination with minimal immediate purpura and no postinflammatory hyperpigmentation. The average mean vessel clearance was 26 to 50% in half of the patients and 51 to 75% in the other half as evaluated by three unbiased dermatologists with extensive laser experience. CONCLUSION: A small-spot size Nd:YAG laser using a pulse width of 20 ms or higher appears to be effective in clearing a significant percentage of facial telangectasias with a single pass. The side effects were minimal.

Aged↗
PubMed2005

Evaluation of a novel flash lamp system (FLS) incorporating optimal spectral filtration for the treatment of photoaging.

BACKGROUND AND OBJECTIVES: Improvement in photoaging using laser and Intense Pulsed Light (IPL) modalities is well documented in the literature. We report a prospective study evaluating the safety and efficacy of a novel flash lamp IPL system incorporating a spectral filtration system designed to maximize improvement of facial dyschromias, telangiectases, and skin texture. The device was a prototype xenon flashlamp pulsed light. The novel features of this IPL device are the extended pulse duration and smooth temporal pulse profile. STUDY DESIGN/MATERIALS AND METHODS: We enrolled 23 patients (22 female, 1 male) of Fitzpatrick skin type I-IV with evidence of photoaging (lentigenes, ephelides, telangiectases, rhytides). Each patient underwent test sites on their back to establish safe treatment parameters. Using treatment fluences of 20-37 J/cm(2), each patient was given 2-4 full-face treatments separated by 3-4 weeks. RESULTS: Test sites revealed that shorter wavelength filters and shorter pulse durations increased the risk of epidermal injury. Objective assessment by evaluation of pre and post treatment photographs of the face showed an average improvement of 53% in hyperpigmentation, 39% in telangiectases, and 8% in wrinkles. There were no significant adverse effects. CONCLUSIONS: The novel flash lamp IPL system in this study was safe and effective in reducing vascular and pigment dyschromias in patients with skin types I through IV.

Adult↗
PubMed2005

Modified superlong pulse 810 nm diode laser in the treatment of pseudofolliculitis barbae in skin types V and VI.

BACKGROUND: Laser hair removal is a well-established therapy for pseudofolliculitis barbae, but there have been few studies on the use of a very-long-pulse 810 nm diode laser for this condition. OBJECTIVE: To determine the efficacy and tolerability of a modified 810 nm superlong-pulse diode laser (Palomar Medical, Burlington, MA, USA) in the treatment of pseudofolliculitis barbae (PFB) in subjects with type V and VI skin. METHODS: Thirteen patients were treated three times at 2-week intervals on one side of their neck with varying fluences. They were evaluated for (1) reduction of shaving bumps and (2) pain tolerance on the treated versus the untreated side. RESULTS: There was a statistically significant improvement in shaving bumps. The treatment side showed a baseline PFB lesion count of 22.5 (+/- 20 SD), which decreased to a mean of 5 (+/- 5 SD) (p<.05). The control baseline mean count was 27.6 (+/- 22 SD) and at the end of the study was 15 (+/- 12 SD) (p = .13). Pain was rated at 2.5 of 10 for subjects treated both with and without anesthetic. The margin of safety was greater in type V compared with type VI skin. CONCLUSION: A modified 810 nm superlong-pulse diode laser is both effective and well tolerated in the reduction of shaving bumps, especially in patients with type V skin.

Folliculitis↗
PubMed2005

Intense pulsed light and laser treatment of facial telangiectasias and dyspigmentation: some theoretical and practical comparisons.

BACKGROUND AND OBJECTIVE: A comparative overview is presented, both theoretical and clinical, for intense pulsed light (IPL) and laser treatment of facial telangiectasias and pigmented lesions. MATERIALS AND METHODS: A narrative approach describes light penetration into the epidermis, dermis, dermal-epidermal junction, and facial ectasias. Based on mathematical models, we examine some temperature profiles for monochromatic and broadband light sources. Specifically, temperature elevations of representative vascular targets are discussed. Also, clinical scenarios are reviewed for both IPL and laser. Although multiple monochromatic devices are reviewed, only the 532 and 595 nm wavelengths are emphasized. RESULTS: In theory, an IPL can be filtered to simulate 532 and 595 nm laser light in the treatment of telangiectasias and dyschromias. In comparing our experiences with the different devices, all three (IPL, 532 nm laser, and 595 nm laser) are capable of achieving a reduction in ectasias and hyperpigmented macules. CONCLUSIONS: With an optimal set of parameters, IPLs and lasers are comparable in the treatment of vascular and pigmented lesions with respect to treatment efficiency and safety.

Humans↗
PubMed2004

Nd:YAG laser treatment of recalcitrant folliculitis decalvans.

BACKGROUND: The scarring follicular disorders pose challenging therapeutic dilemmas. OBJECTIVE: Hair removal lasers have recently been shown to be efficacious in the management of these disorders. METHODS: We present a young, Fitzpatrick skin type VI African-American patient with recalcitrant folliculitis decalvans, whom we treated with the neodymium:yttrium aluminum garnet (Nd:YAG) laser. RESULTS: A remission of folliculitis decalvans was successfully achieved using the Nd:YAG for laser depilation. CONCLUSION: Based on the optical properties of light in skin, the Nd:YAG laser is the best for laser depilation in dark individuals.

Adult↗
PubMed2003

Subsurface skin renewal by treatment with a 1450-nm laser in combination with dynamic cooling.

A new nonablative laser device, Smoothbeam, has been under evaluation for nonablative wrinkle reduction in skin with minimal side effects. This device incorporates a laser at 1450-nm wavelength to heat the dermis and cryogen spray cooling to prevent epidermal damage. The thermal injury created is internal and imperceptible. The wound-healing response to this internal injury causes improvement in the appearance of skin wrinkles. Biopsies taken immediately after treatment showed mild residual thermal damage (RTD) at a depth range of 150 to 400 microm, which is the dermal zone where most solar elastosis resides. Biopsies from two months after treatment showed fibroplasia extending over a range of depths similar to the acute RTD zones. An improvement in wrinkle severity was noted on the treated side compared with the control side.

Breast↗
PubMed2003

The effects of autologous platelet gel on wound healing.

Laser resurfacing techniques have become a popular means of achieving rejuvenation of damaged skin. Interest is great in attempting to speed re-epithelialization and healing so that patients can return to their normal activities as quickly as possible. Previous studies have demonstrated that wounds heal more quickly when they are covered and kept moist than when they are left open to the air. Until now, no study has been conducted to investigate whether the healing process of a superficial skin burn might be accelerated by the use of an autologous platelet gel as a biologic dressing. Our study of five pigs showed that autologous platelet gel can influence wound healing by stimulating an intense inflammatory process that leads to highly significant increases in the production of extracellular matrices and granulation tissue. The platelet gel accelerated vascular ingrowth, increased fibroblastic proliferation, and accelerated collagen production. However, the gel did not appear to accelerate re-epithelialization. The aggressive production of granulation tissue and the acceleration of collagen production might mean that autologous platelet gel will have a future role in the treatment of burns because the highly vascularized bed it helps create should promote the success of skin grafting in patients with deep partial-thickness and full-thickness burns.

Animals↗
PubMed2002

Acne treatment with a 1,450 nm wavelength laser and cryogen spray cooling.

BACKGROUND AND OBJECTIVES: A laser with a wavelength in the mid-IR range targeting the depth in skin where sebaceous glands are located in combination with cryogen spray cooling was evaluated for treatment of acne. In this non-ablative treatment, the laser energy heats the dermal volume encompassing sebaceous glands whereas the cold cryogen spray preserves the epidermis from thermal damage. STUDY DESIGN/MATERIALS AND METHODS: Monte Carlo simulations and heat transfer calculations were performed to optimize the heating and cooling parameters. A variety of heating and cooling parameters were tested in an in vivo rabbit ear study to evaluate the histological effect of the device on sebaceous glands and skin. Similar experiments were performed on ex vivo human skin. A clinical study for the treatment of acne on backs of human males was also conducted. RESULTS: Monte Carlo simulations and heat transfer calculations resulted in a thermal damage profile that showed epidermal preservation and peak damage in the upper dermis where sebaceous glands are located. Ex vivo human skin histology confirmed the damage profile qualitatively. In vivo rabbit ear histology studies indicated short-term thermal alteration of sebaceous glands with epidermal preservation. In the human clinical study on the back, a statistically significant reduction in lesion count on the treated side compared to the control side was seen (p < 0.001). Side effects were transient and few. CONCLUSIONS: The studies reported here demonstrate the feasibility of treating acne using a photothermal approach with a mid-IR laser and cryogen cooling.

Acne Vulgaris↗
PubMed2002

Nonablative laser skin remodeling.

Nonablative skin remodeling has become an attractive option for patients whose lifestyles demand a noninvasive approach to skin rejuvenation. This review addresses the rationales for therapy, specific devices, and study outcomes.

Aged↗
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↗
PubMed2002

Treatment of pseudofolliculitis barbae in skin types IV, V, and VI with a long-pulsed neodymium:yttrium aluminum garnet laser.

BACKGROUND: Pseudofolliculitis barbae affects a large number of individuals with coarse curly hair, and present treatment options are suboptimal. OBJECTIVE: We evaluated the safety and efficacy of a long-pulsed neodymium:yttrium aluminum garnet (Nd:YAG) laser in the treatment of pseudofolliculitis barbae. METHODS: This was a two-phase observational study conducted at a military tertiary medical facility. The study group included 37 patients (skin types IV, V, and VI) referred from primary care physicians with a diagnosis of pseudofolliculitis barbae refractory to conservative therapy. In phase I, one treatment with a Nd:YAG laser was performed on a tattooed area of the thigh with 3 light doses. Epidermal tolerance was evaluated, and hair counts were performed 3 months after treatment for each light dose. In phase II, the highest dose tolerated by the epidermis from phase I was applied to a small submental region of skin with an adjacent site as a control. Subsequently, papule counts were performed 90 days after treatment in the laser-irradiated and control areas. RESULTS: Phase I: When normalized for controls, there was 33%, 43%, and 40% hair reduction on the thigh for the 50, 80, and 100 J/cm(2) fluences, respectively, after 90 days. Overall, the highest doses tolerated by the epidermis were 50, 100, and 100 J/cm(2) for type VI, V, and IV skin, respectively. Phase II: Mean papule counts after 90 days were 6.95 and 1.0 for the control and treatment sites, respectively. CONCLUSION: Nd:YAG laser treatment may represent a safe and effective option for reducing hair and subsequent papule formation in patients with pseudofolliculitis barbae.

Adult↗