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Biomedical subjects

M A Trelles

Publications and source records attributed to M A Trelles.

At least 19 recordsLinked to original sources
PubMed2005

Laser techniques associated with facial aesthetic and reparative surgery.

Chronological aging is a natural biological event that is seen particularly in the face. Attempts to correct the results of this facial loss of structural form are sometimes successful. The skin itself is usually neglected, and surgery sometimes fails to achieve the goals expected by the patient. The surgical laser offers an extremely elegant and powerful solution to this problem to complement or enhance the results of selected surgical facial aesthetic procedures as follows: (1) ablative full-face CO2 laser resurfacing in combination with facelifting; (2) laser surgical technique for upper eyelid ptosis; (3) lower eyelid blepharoplasty with the aid of the CO2 laser; (4) full-face resurfacing following minilifting of the lower part of the face; (5) endoscopic eyebrow lifting combined with laser resurfacing; (6) perioral CO2 laser resurfacing in combination with facelifting; and (7) several miscellaneous procedures (e.g., treatment of upper and lower xanthelasma with laser upper blepharoplasty, laser resurfacing in combination with fillers, and laser resurfacing of periocular wrinkles after surgical blepharoplasty). In the hands of the authors, the combination of laser and standard surgical procedures presented herein has consistently produced good results and high patient satisfaction. The complication rate is low and the recovery rate is excellent. Laser treatment enhances the natural look obtained by conventional surgeries.

Blepharoplasty↗
PubMed2005

Assessment of the efficacy of nonablative long-pulsed 1064-nm Nd:YAG laser treatment of wrinkles compared at 2, 4, and 6 months.

Rhytides represent an aesthetic problem for a large percentage of the population. Many methods, both noninvasive and invasive, have been used for the treatment of wrinkles. Recently, the long-pulsed 1064-nm Nd:YAG laser has been shown to enhance dermal collagen synthesis without damaging the epidermis. The purpose of this preliminary study is to evaluate the use of the long-pulsed Nd:YAG laser in the nonablative treatment of periocular and perioral wrinkles. Ten patients with facial wrinkles were treated with the long-pulsed 1064-nm Nd:YAG laser, at a spot size of 5 mm in diameter, energy density of 13 J/cm2, exposure time per pulse of 300 microseconds, and a repetition rate of 7 Hz. All patients had a total of three treatments, once every 2 weeks. Subjective (patient satisfaction index [SI]) and objective (both physician- and computer program-based clinical index [CI]) assessments were performed before the first and third treatment sessions, and at 2, 4, and 6 months after the last treatment. At 6 months after the final treatment session, the patients' subjective SI was maintained at 40%, and had peaked at 50% 2 months after the final session. Physician assessment showed a CI of 40% at the 6-month assessment point and the computer program showed a 50% CI. The greatest level of effect with long-pulsed Nd:YAG laser nonablative skin rejuvenation for facial wrinkles was seen 2 months after the final treatment. Effects were still visible at the 6-month period, but showed a tendency to decrease. Maintenance treatments are required to achieve good patient satisfaction.

Adult↗
PubMed2005

Becker's naevus: a comparative study between erbium: YAG and Q-switched neodymium:YAG; clinical and histopathological findings.

BACKGROUND: Becker's naevus (BN) may represent a distressing cosmetic handicap and a challenging issue regarding treatment. OBJECTIVES: To compare clinical and histopathological findings of patients with BN treated with two different lasers: an erbium:yttrium-aluminium-garnet (Er:YAG) system vs. a neodymium:YAG (Nd:YAG) laser. PATIENTS AND METHODS: In this prospective and comparative study we present the clinical and histopathological evolution during a 2-year follow-up of 22 patients with BN treated with only one pass of the Er:YAG laser (n = 11) or three treatment sessions with the Q-switched Nd:YAG system (n = 11). RESULTS: Clinical evaluation 2 years after treatment with the Er:YAG laser showed complete clearance (100%) in 54% of the patients (n = 6) and clearance of > 50% in 100% of the subjects. In relation to Nd:YAG laser treatments our results echo those of other authors. Numerous sessions are necessary to get an acceptable clinical clearance rate. Only one patient showed marked clearance (51-99%) after three treatment sessions. Moderate (26-50%) and mild (1-25%) clearance was observed in 45.5% (n = 5) and 27.3% (n = 3) of the patients. CONCLUSIONS: Both Er:YAG and Nd:YAG are safe tools to treat BN. However, in terms of pigment removal, one pass with Er:YAG is a superior technique to three treatment sessions with the Nd:YAG.

Adult↗
PubMed2004

An 810 nm diode laser in the treatment of small (< or = 1.0 mm) leg veins: a preliminary assessment.

A consistently effective treatment for small leg veins (< or = 1.0 mm) is still being sought. The efficacy of an 810 nm diode laser in vein removal was assessed in a preliminary study. Fifteen females, skin types I to III, vein diameters 0.5-1 mm, aged from 25 to 42 years, participated in the study. An 810 nm diode laser (90 W, 20 ms/pulse, 10 Hz rep rate, 4.0 mm hand piece) was applied along the target veins. Biopsies were taken from two patients before and after the first treatment session. No compression was applied post-treatment. Four weeks later, a second treatment was given. Results were assessed subjectively from the patients' satisfaction index (SI) and objectively from clinical photography done by an independent clinician, who also judged the venous morphology before and 4 weeks after the second session. All patients completed the trial. Pain was moderate to severe at the time of treatment and erythema which was mild, which was seen in all 15 patients; oedema occurred in 12 patients and blistering in only one. No scarring was noticed. The overall satisfaction indices at the 4- and 8-week assessments were 20.7% and 55.1%, respectively. No patient got worse. The objective evaluations at the 4- and 8-week assessments showed increasing improvement in all aspects examined. Pain at the time of treatment was a problem for all patients, so epidermal cooling should be added. Despite this, the 810 laser diode was an interesting and promising device for treatment of small leg veins, warranting further study in larger patient cohorts with a longer-term follow up.

Adult↗
PubMed2004

Laser resurfacing today and the 'cook book' approach: a recipe for disaster?

BACKGROUND: Laser ablative skin resurfacing achieves skin rejuvenation by precise ablation of photoaged skin and subsequent re-epithelialisation and dermal remodelling. Carbon dioxide (CO(2)) and Erbium:YAG (Er:YAG) lasers are the established choice. A wide range and many sets of parameters have been proposed as the gold standard for each system but results have varied. AIMS: To show that this single system 'cook book' approach must be rejected in favour of a more comprehensive approach. SUBJECTS AND METHODS: The author has experience of ablative skin resurfacing in over 1200 patients and has used both systems. A more flexible approach, using a combined wavelength system, is presented. It comprises precise ablation of the epidermal with the Er: YAG (to create an epidermal window), followed instantaneously with subablative heating of the exposed dermis with the CO(2) laser. RESULTS: Since adopting the dual wavelength/dual modality approach, more than 600 patients have been treated, with excellent results and a very high patient satisfaction index, currently around 90%, obtained from the sum of the very satisfied and satisfied patients using a five-grade scale. Possible resurfacing-related complications have included prolonged erythema, hyper or hypopigmentation, scarring and viral infections, which were more common with single system resurfacing. The author's complication rate remains under 1%, without any prophylactic use of antiviral agents. CONCLUSIONS: The cook book approach, whereby a particular set of fixed laser resurfacing parameters for a specific single laser system are adopted and rigidly applied in all patients, will not achieve the best treatment effects and may even produce a bad result and dissatisfied patients. The dual modality approach allows a combination of the favourable elements of each of the two wavelengths with excellent and consistent results.

Journal Article↗
PubMed2004

Combined nonablative skin rejuvenation with the 595- and 1450-nm lasers.

BACKGROUND: Histologic findings are not echoed in the visible effect in the epidermis after skin rejuvenation. SUBJECTS AND METHODS: Ten women (Group A) received five treatment sessions with a 595-nm pulsed dye laser immediately followed by a 1450-nm diode laser. Two other demographically similar groups of 10 patients each, Groups B and C, were treated with the 595-nm pulsed dye laser or the 1450-nm diode laser alone, respectively. RESULTS: Good dermal collagen remodeling was observed in Group A. Overall better and faster results were seen in Group A. The 6-month clinical outcome was best in Group A followed by Group C and Group B. CONCLUSIONS: Wavelengths of 595 plus 1450 nm for skin rejuvenation produced good results with much higher patient satisfaction than those obtained with the 595- or 1450-nm wavelengths alone.

Adult↗
PubMed2003

Non-ablative facial skin photorejuvenation with an intense pulsed light system and adjunctive epidermal care.

Laser skin resurfacing is popular, but the appearance of the face during healing is unpleasant. Non-ablative photorejuvenation with intense pulsed light (IPL) has been reported as being successful but with varied results. In this study we sought the possibility of enhancing the clinical effects with adjunctive epidermal care. Twenty-five women aged from 32 to 68, skin types I-IV, with a variety of wrinkle types and other conditions associated with photoaged skin, were treated with IPL according to our parameters over six sessions coupled with an adjunctive pretreatment micropeel and applications of nutritive and antipigmenting creams. Macroscopic and histological assessments were performed. At weeks 4 and 8 fair to good satisfaction was noted in 17 and 19 patients, and poor satisfaction in 8 and 6 patients, respectively. The histology showed good dermal collagen remodelling in all cases, with a reduction in elastosis. The results of IPL photorejuvenation can be enhanced, as our trials showed. The good patient satisfaction obtained was clearly demonstrated in the histologies and evaluations throughout the study.

Adult↗
PubMed2003

Photography in dermatology: comparison between slides and digital imaging.

BACKGROUND: Clinical photography is an essential tool for any medical speciality, such as dermatology, wherein accurate records are required of pre, intra and postoperative findings, plus quick access to these records for comparison and evaluation purposes. Clinical photography is important not only to the surgeon, but also to the patient, so that a realistic objective assessment of improvement may be made. Conventional emulsion film-based prints from negatives and positive colour transparencies revolutionised clinical records when they first appeared. Now the appearance and rapid development of digital photography is bringing about yet another revolution. AIM: To compare conventional with digital photography from the standpoints of cost-effectiveness, ease of archiving and ease of retrieval. The quality of the imaging was not dealt with. METHODS: A professional clinical photographer took images using: Nikon F3 (conventional emulsion based photography); FotoFinder Derma (digital photography). RESULTS: Although traditional emulsion-based photographs are quicker to take, digital imaging provides an almost immediately available image and is much swifter to use for classification, later retrieval and comparison between serial images. CONCLUSIONS: Despite the initial expense of acquiring digital equipment compared with traditional photographic apparatus, when examined over a five-year period, both formats cost approximately the same. Digital photography offers advantages in ease of archiving and storage, savings in time and space, extremely quick retrieval and very easy comparison of images. Digital photography is very much the way of the future in dermatological clinical imaging.

Journal Article↗
PubMed2002

One-pass resurfacing with a combined-mode erbium: YAG/CO2 laser system: a study in 102 patients.

BACKGROUND: The CO2 and erbium: YAG (Er: YAG) lasers have been used for skin resurfacing. A recently developed system combines pulsed ablative Er: YAG and continuous wave subablative CO2 wavelengths in one console. OBJECTIVES: To assess the potential benefits of this system. METHODS: The study follows 102 women, skin types I-V, with 26 full face, 48 perioral and 28 periocular resurfacing procedures. The ablative Er: YAG pulse (350 micros, 29 J cm(-2)) is followed immediately by a non-ablative CO2 laser shot (4-6 W, 50 ms) through the same collimated handpiece (3-mm diameter spot), 50% overlapping, repetition rate 10 Hz, giving two-pass equivalence with one single pass. RESULTS: Patients scored the results as very good (n = 67), good (n = 25) and fair (n = 10). Mild but successfully resolved side-effects occurred in only four patients. The 2-month histology showed a good band of new collagen tightening the overlying healthy epidermis. Follow-up periods ranged from 1.5 to 2 years (mean +/- SD 1.76 +/- 0.33). CONCLUSIONS: This device at the above settings offers speedy resurfacing without compromising the quality of the procedure for the patient, and may well satisfy the basic requirements of laser skin resurfacing.

Adult↗
PubMed2001

Facial rejuvenation with a nonablative 1320 nm Nd:YAG laser: a preliminary clinical and histologic evaluation.

BACKGROUND: Rejuvenation of photoaged skin involves removal of the epidermis and superficial dermis, encouraging the production of new epidermis with collagenesis and remodeling. The facial appearance during healing is unpleasant, and the complication rate is high. OBJECTIVE: We evaluate a Q-switched Nd:YAG laser operating at 1320 nm, with a cryogen delivery system and a skin temperature sensor. The system cools the target skin, followed by the laser impulse which passes through the cooled epidermis into the dermis. METHODS: Ten patients are presented. Two treatments a week were given over 4 weeks, and the patients were seen at 2 and 6 weeks after the final treatment. RESULTS: The histology showed improvement in the condition of the dermis in all 10 patients, but only 2 of the 10 patients expressed satisfaction with the results, despite similar histologic findings. CONCLUSIONS: Careful patient selection is required. Better patient education is necessary to ensure that the patients' expectations are realistic. We should add treatments that will improve the youthful aspect of the epidermis. The system may well help in maintaining the effects of collagen remodeling following traditional ablative resurfacing procedures, but studies are necessary to show this.

Aged↗
PubMed2001

Er:YAG laser resurfacing using combined ablation and coagulation modes.

BACKGROUND: The two main laser types used in resurfacing, the CO2 and the Er:YAG lasers, have their supporters and detractors, and each system has clear advantages and disadvantages. OBJECTIVE: The Er:YAG laser can be used in the usual efficient ablative mode, followed by reprogramming to achieve nonablative deeper dermal coagulation associated with the CO2 laser, thereby achieving the main advantages of both laser types. PATIENTS AND METHODS: Twenty-three female patients, ages 42-72 yrs, skin types I-IV, were treated. The epidermis was first removed in the ablative settings in a single pass with 50% overlap. The Er:YAG laser was reprogrammed for the subablative mode, and several passes produced controlled residual thermal damage (RTD) without further ablation. RESULTS: At 2 months postresurfacing the results were assessed. Thirteen patients were rated "very good," eight as "good," and two as "fair." CONCLUSION: The dual mode Er:YAG laser can first be used in the ablative mode to remove the epidermis with minimal RTD, following which, in the subablative mode, the same laser induces a controlled layer of dermal RTD, stimulating the dermis to achieve collagenesis and collagen remodeling and giving good long-term results.

Adult↗
PubMed2001

Patients' answers to a postoperative questionnaire related to laser resurfacing.

To date there is no information that evaluates, from the patient's point of view, the experience of undergoing CO(2) laser skin resurfacing. This article investigates the outcome of laser resurfacing for various cutaneous problems with respect to the patient's expectations and experiences and the surgeon's opinions. Patients were entered into the study prospectively and presented with a questionnaire, at 12 months after treatment, to evaluate the patient's skin resurfacing experience. All patients received standardized preoperative counseling and underwent a standardized surgical protocol, conducted by the same surgeon. Eighty-eight percent of patients considered the result of the laser resurfacing to be very good, and 97% indicated that they had experienced little pain or discomfort. Nevertheless, 77% of patients stated that they would be unwilling to undergo another resurfacing procedure. This discrepancy is most likely the result of the patients' experiences in relation to the degree of erythema afterward. Most patients stated a desire to have more information regarding the procedure, particularly with respect to their experiences concerning postoperative erythema and exudates in the treated area. From the study it can be concluded that patients require extensive preoperative counseling, including a full explanation of all possible sequelae of these procedures to improve the patient's experience.

Aged↗
PubMed2001

Controlled vaporization of the skin for the treatment of wrinkles.

Resurfacing with CO(2) or Er:YAG lasers is a frequent technique used to achieve skin rejuvenation. The Er:YAG has gained wide acceptance since it can reduce the morbidity associated with CO(2) resurfacing. Laser resurfacing with the CO(2) produces areas of fibroplasia with intense cellular and vascular activity. Thermal conduction towards neighbouring tissue is the cause of collagen production which acts in stretching the skin. Despite the scarce thermal conduction of the Er:YAG laser, areas of fibroplasia are also found after resurfacing. But, this may be associated with the relatively low energy density used, which provokes an increase in the thermal gradient deposited causing stimulation in the dermis. One advantage of a CO(2) and Er:YAG combined system is that it produces limited tissue aggression. High energy density Er:YAG in combination with subablative CO(2) can obtain effective epidermis elimination by the former and heat conduction for the dermis contraction by the latter. Laser is a safe, valid alternative treatment for cutaneous aging but prudence, together with observation should continuously guide skin resurfacing.

Carbon Dioxide↗
PubMed2001

Epilation with a long-pulse 1064 nm Nd:YAG laser in facial hirsutism.

BACKGROUND: Facial hirsutism and hypertrichosis are common problems and a methods are available to clinicians for the unwanted hair in a large number of patients. Several depilatory laser systems are now available and one of these modalities is the long-pulse Nd:YAG laser. OBJECTIVE: To evaluate the efficacy of the long-pulse Nd:YAG laser in removing unwanted facial hair. METHOD: In all, 29 patients completed their treatment course with a long-pulse (4 ms) Nd:YAG (1064 nm line) with fluences between 56 J/cm(2) and 70 J/cm(2). The average reduction in hair density was assessed using hair count on digital photographs at removal 3, 6 and 9 months postoperatively. The hair-free interval was variety of also evaluated. RESULTS: The average reduction of in the hair count (the same diameter as the baseline for the criterion) was 43% at 3 months, 36% at 6 months, and 46% at 9 months. The hair-free interval with laser was two- to sixfold longer than with self-applied methods. No significant complications were observed in the range of skin types treated, even in the darker skin types. CONCLUSION: The long-pulse Nd:YAG laser is an effective and safe method for long lasting hair removal in all skin types. The delay in hair regrowth most likely explains patient satisfaction.

Adolescent↗