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Biomedical subjects

R E Fitzpatrick

Publications and source records attributed to R E Fitzpatrick.

At least 37 records · Page 2Linked to original sources
PubMed1999

Laser resurfacing of the neck with the Erbium: YAG laser.

BACKGROUND: Laser resurfacing of the face is widely used to correct the effects of photoaging. The neck also develops a similar degree of photoaging, but is not usually treated because a higher incidence of adverse effects can occur with laser treatment. OBJECTIVE: To present a new method for treating photoaged skin of the neck with an erbium:yttrium aluminum garnet (Er:YAG) laser. METHODS: Twenty patients underwent Er:YAG laser resurfacing of the neck with one of two methods. Method 1 consisted of using the Er:YAG with a 5-mm diameter collimated beam at a fluence of 8.7 J/cm2 followed by a second pass using a 0.2 mm diameter non-collimated spot at 1.7 J in a defocused mode with spot sizes ranging from about 5 to 10 mm in diameter (fluences from 2-9 J/cm2). Method 2 consisted of treating the entire neck with a single pass of the Er:YAG laser with a 4 mm diameter non-collimated spot at 1.7 J (fluence of 13.5 J/cm2). A second pass at identical settings was made on the upper half of the neck with a more defocused pass using a 6-10 mm diameter spot (fluence of 2-6 J/cm2) on the lower half of the neck. Patients were evaluated by two nontreating physicians as to overall satisfaction and improvement in skin texture and color. RESULTS: Overall, 51% of patients were satisfied with their results. Skin texture improved an average of 39%. Method 1 produced a 28% improvement, Method 2 a 48% improvement. Skin color improved an average of 37%. Method 1 produced a 28% improvement, Method 2 a 45% improvement. CONCLUSION: Photoaged skin of the neck can be effectively treated with the Er:Yag laser with minimal adverse effects.

Female↗
PubMed1997

Laser resurfacing of rhytides.

A discussion of the pathologic findings found with aging and photodamage is used to formulate a rational preoperative regimen, treatment technique, and maintenance regimen. Details of laser treatment technique, anesthesia, and postoperative care are given. Possible contraindications are discussed, as are the pros and cons of early versus late treatment.

Anesthesia, General↗
PubMed1997

Infections complicating pulsed carbon dioxide laser resurfacing for photoaged facial skin.

BACKGROUND: With proper technique and instrumentation, laser resurfacing for facial wrinkles has been found to be highly effective and relatively safe. Most, if not all, of the noninfectious complications such as pigmentary changes, scarring, and persistent erythema can either be avoided or managed with appropriate therapy. Postoperative infections, on the other hand, may develop despite proper technique and instrumentation. Without proper management, they may cause significant physical morbidity and psychological distress defying the expected benefit of the procedure. OBJECTIVE: To quantify the incidence and to study the characteristics of infections arising after laser resurfacing for facial wrinkles with pulsed carbon dioxide laser treatment. METHOD: A retrospective study was carried out by reviewing the records of all patients undergoing laser resurfacing for facial wrinkles from January 1, 1995 to April 30, 1996. An infection is defined as a positive culture in the presence of signs or symptoms of an infection. RESULTS: Over 16 months, 395 procedures were performed and 17 cases of culture-proven infection recorded, an incidence of 4.3%. All patients had symptoms starting between days 2 and 10 after the operation. Over half of the patients had multiple infections with two to three microorganisms. Pseudomonas aeruginosa was the most common causative agent, found in 41% of all infected cases, followed by Staphylococcus aureus (35%), S. epidermidis (35%), and Candida species (24%). Multiple drug-resistant, gram-negative bacteria were found in four cases, implicating the possibility of hospital-acquired infections. Almost all isolates of gram-positive bacteria were resistant to both erythromycin and penicillin, but not oxacillin. With proper treatment, most patients healed normally. Only one patient had persistent, multiple atrophic scars due to locally disseminated herpes simplex infection despite proper prophylaxis and treatment. CONCLUSIONS: Postoperative infection is uncommon and manageable with early recognition and proper treatment. The types of infectious agents being found are very similar to those reported in burn patients. This complication has been found to be much more common in patients undergoing full face resurfacing and those using a bio-occlusive dressing postoperatively. With comprehensive preventive and management measures, it is likely that this type of uncommon, yet distressful, complication can be avoided and more successfully treated. Recommendations are made for prevention and management of suspected postoperative infections.

Candidiasis↗
PubMed1997

Laser resurfacing.

Explore the source record for details and available documents.

Dermatologic Surgical Procedures↗
PubMed1996

Preoperative anesthesia and postoperative considerations in laser resurfacing.

This article details patient selection, preoperative preparation, and postoperative considerations for conducting UltraPulse (Coherent Medical, Palo Alto, CA) CO2 laser resurfacing. The authors share their more than 3 years experience with more than 1,000 patients to help physicians perform this technique, choose optimal treatment parameters, and select appropriate patients for treatment. Methods to decrease postlaser adverse sequelae are discussed. Particular emphasis is placed on the minimization of postoperative infections. An extensive section on anesthesia techniques is also provided.

Anesthesia↗
PubMed1996

Pulsed carbon dioxide laser resurfacing of photo-aged facial skin.

BACKGROUND AND DESIGN: public demand for procedures to rejuvenate photoaged skin have stimulated the use of high-energy short-pulsed carbon dioxide lasers as a precise and predictable treatment modality. The purpose of this study was to determine the degree of clinical improvement achieved in treating perioral and periorbital wrinkles with a high-energy, microsecond-domain pulsed CO2 laser. Photodamaged skin in the perioral (n=73) and periorbital (n=38) regions was treated with multiple passes of confluent single pulses of CO2 laser energy (10 600 nm, 3-mm collimated beam, <1- millisecond pulse, 450 mJ per pulse, 2 to 5 W), with the tissue being cleansed and débrided with normal saline between passes. A nine-point clinical scoring system was devised for evaluation of the degree of wrinkling and photodamage present. Preoperative and postoperative photographs were independently scored by four ¿blinded¿ reviewers. The patients were observed postoperatively for 1 to 12 months for the course of healing, and adverse events were recorded. RESULTS: All three classes (mild, moderate, and severe) of photoaging of the skin responded equally well, showing an average wrinkling score reduction of 2.25 for the periorbital region and 2.34 for the perioral region, the most superficial wrinkles and photodamage being eliminated and the more severe being markedly improved. An unexpected finding was tightening of loose and folded skin. Side effects included transient erythemia and postinflammatory hyperpigmentation, and one instance of an isolated hypertrophic scar. CONCLUSIONS: Resurfacing of photoaged skin by means of a high-energy, microsecond-domain pulsed CO2 laser with a specific clinical treatment protocol results in predictable improvement in perioral and periorbital wrinkling and photodamage with minimal risks. Heat-induced collagen shrinkage appears to contribute to these results by tightening loose skin and folds.

Adult↗
PubMed1995

Laser treatment of scars.

BACKGROUND: Erythematous and hypertrophic scars may occur after surgical procedures. This paper describes a novel technique for their resolution. OBJECTIVE: The purpose of this paper is to describe long-term results of treating erythematous, hypertrophic scars with the flashlamp-pumped pulsed dye laser (FLPDL). METHODS: Forty-eight patients who presented with erythematous/hypertrophic scars were treated with the FLPDL with or without intralesional triamcinolone. Patients were evaluated by physicians on a 25% increment of objective improvement. RESULTS: Seventy-three percent of scars appearing on the face for less than 1 year totally resolved in an average of 2.3 treatments. Twenty percent of scars on the face for greater than 1 year had a total resolution in 4.4 treatments with an average improvement of 88%. Scars on nonfacial areas for less than 1 year had a 25% incidence of total resolution over an average of 2.5 treatments with an average improvement of 81%. Scars in nonfacial distributions over 1 year of age had a 12% total resolution with an average 62% improvement over 2.2 treatments. CONCLUSION: The FLPDL is a useful adjuvant in the treatment of erythematous, hypertrophic scars.

Cicatrix↗
PubMed1995

Laser hair transplantation. Tissue effects of laser parameters.

BACKGROUND: Micro- and minigrafting have become increasingly popular in hair transplantation over the past decade, resulting in larger numbers of grafts per session and lengthy, potentially technically difficult procedures. The advent of very high energy pulsed carbon dioxide lasers as surgical instruments has led to the investigation of their use in hair transplantation, as bloodless surgery with tissue removal by vaporization has obvious advantages as far as surgical speed is concerned. METHODS: A prospective study of eight patients comparing conventional micro- and minigrafting using 18- and 14-gauge needle punctures with dilators versus laser-vaporized donor sites with variation of laser parameters was conducted with monthly evaluation of healing and hair growth for 6 months. In addition, an in vitro histological study of laser vaporization recipient sites on excised scalp tissue was conducted to evaluate the residual thermal damage of various laser parameters. RESULTS: The conventional micro- and minigrafts healed faster and resulted in better hair growth than the laser vaporization sites. The donor sites were judged to be comparable as far as healing, but more time consuming with the laser. The operative time for the laser recipient sites was 50% of that of the conventional sites. CONCLUSIONS: The clinical results of laser hair transplantation are very dependent upon the laser parameters and technique used. Though operative time may be significantly reduced, the end result clinically is dependent on proper choices of pulse parameters and technique.

Adult↗
PubMed1995

Laser treatment of erythematous/hypertrophic and pigmented scars in 26 patients.

Fifteen patients with erythematous/hypertrophic scars and 11 patients with postinflammatory hyperpigmentation were treated with a flashlamp pumped pulsed-dye laser at 585 nm or a flashlamp pulsed-dye laser at 510 nm. An average of 1.8 treatments resulted in an average improvement of 77 percent. Forty-seven percent of the patients had 100 percent improvement after one to three treatments. Eleven patients with postinflammatory hyperpigmentation were treated with the flashlamp pumped pulsed-dye laser at 510 nm with a pulse width of 300 ns. There was an average of 80 percent improvement with 1.45 treatments. Forty-five percent of the patients had 100 percent improvement after one or two treatments. The pathophysiology of postoperative scarring is reviewed. Theoretical reasons for the efficacy of laser treatment are detailed.

Cicatrix↗
PubMed1994

Laser ablation of facial cosmetic tattoos.

The application of facial cosmetic tattoos (eyeliner, lipliner, and rouge) has become popular over the past five years and has resulted in an increasing number of patients requesting removal of these permanent cosmetics. Poor positioning or misapplication of the tattoo pigment has been the most common reason for requesting removal. Because of the almost inevitable probability of scarring, removal of these facial tattoos has been difficult at best. We report the successful removal of facial cosmetic tattoos in ten different patients with the use of five different lasers. We have found the superpulsed CO2 laser and the Q-switched alexandrite laser to be effective in removal of black tattoo pigment. The alexandrite laser is effective without causing scarring, and the CO2 laser is extremely precise and provides the capability of removing tattoo pigment between eyelash or eyebrow hairs without damaging the hair follicles. Both the argon laser and the flashlamp pumped dye laser reacted with red tattoo pigment and offered some improvement but were not ideally suited for tattoo removal. However, the flashlamp pumped dye laser for pigment was very effective in removing red tattoo pigment possibly because of its short pulse width (300 ns) in addition to its appropriate wavelength. The combination of these three lasers (super-pulsed CO2, alexandrite, and flashlamp pigment lasers) is very effective in removing black and red (or shades thereof) facial tattoos. Caution must be taken to determine the presence of flesh-colored tattoo pigment, as this pigment (FE2O3) will reduce to black (FeO) upon laser impact.

Adult↗
PubMed1994

Flashlamp-pumped pulsed dye laser treatment of port-wine stains.

BACKGROUND: Port-wine stains, or capillary malformations, occur in 0.3-0.5% of newborns and have been shown to be very responsive to treatment with a pulsed dye laser (585 nm, 450 microseconds). Lesional characteristics that may help predict the ease of response to therapy have not been delineated. There exists a great range of variation in response to treatment. OBJECTIVE: A retrospective study of 133 patients with 140 port-wine stain malformations being treated with the flashlamp-pumped pulsed dye laser was undertaken. Lesion characteristics such as color and location, patient age, and skin type were evaluated as to their correlation with clinical response. Adverse sequelae were evaluated as well. METHODS: Charts of treated patients were reviewed and results tabulated. The five treating physicians were each responsible for reviewing and evaluating their own patients. Patients were treated at 8-12-week intervals using slightly overlapping pulses with fluences from 5.5 to 7.5 J/cm.2 RESULTS: Factors favoring a positive clinical response were pink lesion color, lesion location of the head and neck, patient age less than 10 years, and patient skin types I-III. Factors having a more negative impact on clinical result include purple lesion color, lesion location on the distal extremities, patient age > 50 years, and skin types IV and V. CONCLUSION: Examination of various patient and lesional characteristics shows trends that may be useful in a predictive manner regarding ease of treatment with the flashlamp-pumped pulsed dye laser.

Adolescent↗
PubMed1994

Clinical advantage of the CO2 laser superpulsed mode. Treatment of verruca vulgaris, seborrheic keratoses, lentigines, and actinic cheilitis.

BACKGROUND: Unintended thermal damage occurring during surgery with the CO2 laser limits its usefulness because of slow healing and increased scarring. The superpulsed mode was developed to address this problem, but little clinical data exist to evaluate its effectiveness. OBJECTIVE: Patients having warts of the hands and feet, seborrheic keratoses, lentigines, and actinic cheilitis were treated by three experienced laser surgeons using both the conventional continuous mode CO2 laser and a superpulsed CO2 laser. Effectiveness of therapy, healing time, and rates of scarring were compared for the two groups of patients. METHODS: Charts of patients treated in 1988 and 1989 were reviewed and data recorded regarding surgical parameters, healing time, scarring, and effectiveness of therapy. Patients were placed in a diagnosis category with each laser only if there was a corresponding patient treated by the same physician using the other laser. CONCLUSION: The superpulsed mode was found to convey only a slight advantage. The use of a 50-millisecond pulse was even more advantageous. The superpulse parameters are analyzed and ideal parameters to prevent unwanted thermal damage are suggested.

Cheilitis↗
PubMed1994

Tattoo removal using the alexandrite laser.

BACKGROUND: Until the recent development of the Q-switched lasers, it was not possible to remove tattoos without causing scarring, sometimes very disfiguring. Variations in wavelengths and pulse widths used may result in different clinical effectiveness or risks. The objective of this study was to determine the effectiveness of the alexandrite laser in removing professional and amateur tattoo pigment without adverse tissue response. RESULTS: We describe the clinical and histologic effects of the use of a new Q-switched laser for treatment of tattoos, the alexandrite laser (wavelength, 755 nm; pulse width, 100 nanoseconds). The results of treatment of 17 patients with professional tattoos and eight patients with amateur tattoos are analyzed. Greater than 95% removal of tattoo pigment averaged 8.9 treatment sessions. Transient hypopigmentation occurred in approximately 50% of patients, and transient textural surface changes occurred in 12%. CONCLUSIONS: The alexandrite laser is a safe and effective treatment modality for removal of black and blue-black tattoo pigment.

Humans↗
PubMed1993

Cosmetic tattoo ink darkening. A complication of Q-switched and pulsed-laser treatment.

BACKGROUND: High-energy, short-pulse lasers, eg, Q-switched lasers, emitting visible and near-infrared light have recently been developed for removing tattoos, with little risk of scarring. The mechanisms of action, and possible adverse effects other than scarring and hypopigmentation, are not fully understood. OBSERVATIONS: We describe five cases of pulsed-laser-induced, immediate, irreversible darkening of cosmetic, white, flesh (skin-color), and pink-red colored tattoos. Irreversible ink darkening can be an insidious complication, because immediate whitening of the skin temporarily obscures the subsequently impressive color change. Among these cases, irreversible ink darkening occurred with Q-switched ruby (694 nm), Q-switched neodymium (Nd):YAG (1064 nm/532 nm), and pulsed green dye (510 nm) lasers. Attempts to remove the darkened ink with further laser treatment failed in two cases, and surgical excision was necessary. In the other three cases, subsequent laser treatments successfully removed the darkened ink. The red cosmetic tattoo ink used in one of the cases was placed in agar in vitro and was converted to a black compound immediately on Q-switched ruby laser exposure. Ferric oxide, a brown-red ingredient commonly used in cosmetic tattoos, was similarly tested and blackened in vitro by Q-switched ruby laser exposures. CONCLUSIONS: Although most tattoos are not darkened by laser treatment, short-pulsed lasers over a wide spectrum can cause immediate darkening of some tattoo inks. Patients should be warned of the potential for irreversible cosmetic tattoo darkening, and test-site exposures should be performed prior to treatment. In some cases, subsequent laser treatments may remove the blackened ink. The mechanism probably involves, at least for some tattoos, reduction of ferric oxide (Fe2O3, "rust") to ferrous oxide (FeO, jet black), but the chemical reaction that is involved remains unknown.

Adult↗
PubMed1993

Use of the alexandrite laser (755 nm, 100 nsec) for tattoo pigment removal in an animal model.

BACKGROUND: All previous treatment modalities for the removal of tattoos, with the possible exception of the Q-switched ruby and YAG lasers, result in scarring. OBJECTIVE: The purpose of this study was to investigate the use of a new laser that may remove tattoo pigment without leaving a scar. METHODS: A Yucatan micropig was tattooed by a professional tattoo artist with black, blue, green, and red pigments. These tattoos were then treated with single overlapping pulses with the alexandrite laser (wavelength 755 nm, pulse 100 nsec) and evaluated clinically and histologically. Comparison treatment with an argon laser (wavelength 488 nm, 514 nm, continuous-wave) and flashlamp-pumped dye laser (wavelength 585 nm, pulse 450 microseconds) was performed as well for removal of red tattoo pigment. RESULTS: The alexandrite laser was found to be very effective in removal of professional and amateur black tattoo pigment, moderately effective in removal of blue and green pigment, and minimally effective in removal of red pigment. No scarring was seen clinically or histologically. CONCLUSION: The alexandrite laser shows promise as a treatment modality for tattoo removal without scarring.

Aluminum Oxide↗
PubMed1993

Treatment of port-wine stains (capillary malformation) with the flashlamp-pumped pulsed dye laser.

Forty-three children with 49 separate port-wine stain vascular malformations were treated with the flashlamp-pumped pulsed dye laser at 585 nm. The patients ranged in age from 2 weeks to 14 years. Overall, 16% of patients had more than 95% resolution of their port-wine stains after an average of 4.8 (1 to 11) treatments. There was an average improvement of 69% in those lesions not clearing completely (average of 3.7 treatments). Lesions in patients less than 4 years of age were almost twice as likely to clear than were those in older children (20% vs 12%), and in fewer treatments (3.8 vs 6.5). An approximate 50% clearing was obtained with one treatment. Subsequent treatments resulted in an additional 10% clearing. There were no episodes of scarring or persistent pigmentary changes in any of the patients. Lesions on the hand and arm responded less well than lesions on the face, neck, and torso. The flashlamp-pumped pulsed dye laser has proved to be a safe and effective treatment modality for port-wine stain capillary malformations in infants and children.

Adolescent↗