Use of an insulated ultrafine-point electrocautery for transconjunctival blepharoplasty of the lower eyelids.
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Blepharoplasty↗
Biomedical subjects
S Eremia
Publications and source records attributed to S Eremia.
Laser hair removal with alexandrite versus diode laser using four treatment sessions: 1-year results.
BACKGROUND: Laser hair removal is the treatment of choice for hypertrichosis. The two most commonly used hair removal lasers are compared. OBJECTIVE: To present the results of a comparative study examining the role of wavelength, fluence, spot size, pulse width, and cooling systems on long-term results after a series of four laser hair removal treatments using the 755 nm alexandrite and 800-810 nm diode lasers. METHODS: The axillae of 15 untanned, type I-V patients were treated side by side four times at 4- to 6-week intervals with a 755 nm, 3-msec pulse width, cryogen spray-equipped alexandrite laser and an 800 nm, variable pulse width, cooled sapphire window-equipped diode laser. Each patient was pretested and treated with the maximum fluence tolerated at the largest spot size available for each laser (12 mm round/113 mm2 for the alexandrite and 9 mm for the diode). RESULTS: Evaluations were done at 3, 6, 9, and 12 months after the last treatment. Twelve-month results with the alexandrite and diode lasers achieved 85% versus 84% hair reduction. The fact that tan avoidance was strictly followed permitted the use of relatively high fluences (25-30+ J/cm(2)) even in type IV patients. For most patients, four treatment sessions using high fluences (30-40 J/cm(2)) with relatively large spot sizes (12 mm round for the 755 nm alexandrite and 9 mm for the 800 nm diode) resulted in 12-month hair reductions in the 90% range. CONCLUSION: Both the alexandrite and diode lasers in this 12-month study produced excellent long-term hair reductions.
Adult↗
Laser hair removal: long-term results with a 755 nm alexandrite laser.
BACKGROUND: Hypertrichosis is a common problem for which laser hair removal is becoming the treatment of choice. Optimal wavelength, pulse duration, spot size, fluence, and skin cooling parameters for various skin types have not yet been firmly established. OBJECTIVE: To evaluate the long-term efficacy and safety of a 3-msec 755 nm alexandrite laser equipped with a cryogen cooling device for patients with Fitzpatrick skin types I-V. METHODS: Eighty-nine untanned patients with skin types I-V underwent a total of 492 treatments of laser hair removal over a 15-month period. Each patient in the study underwent a minimum of three treatment sessions spaced 4-6 weeks apart (mean treatments 5.6). Retrospective chart review and patient interviews were used to establish hair reduction results. Treatment sites included the axillae, bikini, extremities, face, and trunk. A 3-msec pulse width, 755 nm alexandrite laser equipped with a cryogen spray cooling device was used in this study. Spot sizes of 10-15 mm were used. A spot size of 10 mm was used for fluences greater than 40 J/cm(2), a spot size of 12 mm was used for fluences of 35-40 J/cm(2), and spot sizes of 12 and 15 mm were used for fluences less than 30 J/cm(2). Fluences ranging from 20 to 50 J/cm(2) (mean fluence 36 J/cm(2)) were used. RESULTS: The patients had a mean 74% hair reduction. Skin type I patients had an average of 78.5% hair reduction using a mean fluence of 40 J/cm(2) (35-50 J/cm(2)) and a 10-12 mm spot size (12 mm in more than 95% of treatments). Skin type II patients had a mean 74.3% hair reduction using a mean fluence of 38 J/cm(2) (30-40 J/cm2) and a 12-15 mm spot size. Skin type III patients had a mean 73.4% hair reduction using a mean fluence of 37 J/cm(2) (25-40 J/cm(2)) and a 12-15 mm spot size. Skin type IV patients had a mean 71.0% hair reduction using a mean fluence of 31 J/cm2 (25-35 J/cm(2)) and a 12-15 mm spot size. A patient with skin type V had a 60% hair reduction using a mean fluence of 23 J/cm(2) (20-25 J/cm(2)) and a 12-15 mm spot size. The efficiency of hair removal directly correlates significantly with the fluence used. Rare side effects included transient postinflammatory hyperpigmentation (n = 9; 10%), burn with blisters (n = 1; 1%), and postinflammatory hypopigmentation (n = 2; 2%). All complications resolved without permanent scarring. CONCLUSION: The 3-msec cryogen cooling-equipped alexandrite laser can safely and effectively achieve long-term hair removal in patients with skin types I-V. The best results are achieved in untanned patients with skin types I-IV.
Female↗
Treatment of leg and face veins with a cryogen spray variable pulse width 1064-nm Nd:YAG laser--a prospective study of 47 patients.
OBJECTIVE: Throughout the 1990s laser treatment of leg veins has been a challenge. Newer, longer wavelength lasers capable of delivering high fluences with larger spot sizes, with variable pulse width have shown promising preliminary results. Experience with these lasers for the treatment of facial telangiectasia and periorbital reticular veins is even more scant. To the authors' knowledge this is the first prospective study to evaluate a variable pulse width, cryogen spray-equipped 1064-nm Nd:YAG laser for the treatment of both leg and face veins, including larger periorbital reticular veins. METHODS: A total of 47 volunteers aged 32-67 years (30 skin type I-V with leg telangiectasia and reticular veins, and 17 skin type I-IV with face telangiectasia and reticular periorbital veins) were treated with the Nd:YAG laser. For leg vein patients, two to three sets of different leg veins were treated with a maximum of three treatments. Patients were examined 1 week after each treatment and at 1, 2, and 3 months after the last treatment. All face vein patients received one treatment and were examined at 1 month post treatment. Treatment parameters for both leg and face veins varied with the size of vessels being treated. Pre and post treatment 35-mm photographs were taken. Improvement was judged by two experienced physicians both visually on patients and by comparison of pre and post treatment photos. Results were graded as percentage resolution, in five groups: 0%, 0-25%, 25-50%, 50-75% and 75-100%. RESULTS: In all, 23 of 30 patients completed the leg vein segment of the study. A total of 41 leg vein sites were treated. Greater than 75% improvement was observed at 85% of the treated sites; greater than 50% improvement was observed at 95% of the treated sites; less than 25% improvement was observed at 5% of the treated sites. In all, 17 of 17 patients completed the face vein segment of the study. A total of 32 sites were treated (24 on cheeks, nose, and chin telangiectasia and eight periorbital reticular veins). Greater than 75% improvement was observed at 97% of the treated sites; greater than 50% improvement was observed at 100% of the treated sites. Notably, 100% of the facial reticular veins treated had essentially 100% resolution. Pain during treatment was variably perceived by patients, but occasionally was sufficient for patients to decline further treatment. Transient hemosiderin pigmentation, as seen with sclerotherapy, was common with larger vessels. CONCLUSION: The cryogen spray-equipped 1064-nm Nd:YAG laser was remarkably effective and safe for skin type I-V patients. Excellent results for leg veins, approaching sclerotherapy outcomes, were obtained for both 0.3-1.5-mm telangiectasia and larger 1.5-3-mm reticular veins. Furthermore, this laser is also an outstanding tool for treatment of facial telangiectasia with little if any risk of purpura. For the first time it appears that there is a safe and effective treatment for 1-2-mm periorbital reticular veins. However, the use of topical anesthesia may be needed for some patients.
Adult↗
Topical anesthesia for laser hair removal: comparison of spot sizes and 755 nm versus 800 nm wavelengths.
BACKGROUND: The Candela alexandrite and the Coherent diode laser systems come equipped with built-in skin cooling systems that are designed to both protect the epidermis, allowing higher fluences, and to alleviate discomfort. Nevertheless, pain can be a significant problem especially with treatment of larger areas. Scatter of the laser beam is reportedly affected by the spot size. It is claimed that larger spot sizes are more effective at identical fluences. OBJECTIVE: This study evaluated the effectiveness of a topical 5% lidocaine cream (ELA-Max) to control pain and compared pain levels at identical fluences between the 8 mm and 12 mm spot size of the alexandrite laser and between the alexandrite and diode laser with its 9 mm spot size. METHODS: The study was conducted in the axillae of 12 patients. Each axilla was divided in half for side-by-side comparison. Half of the right axilla was treated with the alexandrite 8 mm and the other half with the 12 mm spot size at identical fluences. The left axilla was treated at the maximum tolerated fluences with the alexandrite 12 mm spot size and the diode 9 mm spot size. RESULTS: At identical fluences and other parameters, there was significantly more pain with the alexandrite 12 mm spot size than with the alexandrite 8 mm spot size, both with or without topical anesthesia. The alexandrite laser was significantly less painful than the diode laser both with and without topical anesthetic. The difference was most noticeable between the alexandrite 8 mm spot size and the diode 9 mm spot size. Topical 5% lidocaine anesthesia was effective in reducing pain, though not completely, for both the alexandrite and the diode lasers. CONCLUSION: Topical 5% lidocaine cream is a simple and effective method for reducing patient discomfort during laser hair removal procedures, even when a skin cooling device is being used. A larger spot size causes more pain than a smaller spot size at identical fluences. The 800 nm diode laser causes greater discomfort than the 755 nm alexandrite laser.
Adolescent↗
Long-term follow-up after autologous fat grafting: analysis of results from 116 patients followed at least 12 months after receiving the last of a minimum of two treatments.
BACKGROUND: The effectiveness of long-term results for correction of facial rhytides with single or multiple autologous fat transplants remains controversial. OBJECTIVE: This study is a retrospective review of short- and long-term results for 116 patients who underwent multiple autologous fat grafting sessions into the nasolabial and melolabial (lateral oral commissure) fold, and in some cases additional sites such as lips and glabella. METHODS: Criteria for inclusion into the study included at least two treatment sessions and at least a 12-month follow-up evaluation after the last treatment received. A 14-gauge needle cannula was used to aspirate the donor fat and to inject the fat grafts. RESULTS: For the nasolabial and melolabial folds, short-term results at 3-4 months were uniformly excellent. Gradual correction loss was noted between 5 and 8 months, with 25% of patients still rated as excellent and 40% as good. Most patients continued to show correction loss between 9 and 14 months. Only 3-4% of the patients truly maintained long-term correction for more than 14 months. Multiple re-treatments did not significantly increase the percent of patients showing long-term results. For the glabella, the results were very disappointing, with most patients showing complete loss of correction after 3-4 months. For lip augmentation, correction loss was slower than in the glabella, but most patients showed complete loss of correction by 5-8 months. Complications were minimal. CONCLUSION: Autologous fat grafting is most effective for relatively short-term improvement of facial aging changes in the nasolabial and oral commissures areas. It is less effective for lip augmentation and completely ineffective for the glabella area.
Adipose Tissue↗
The minimal mechanical trauma technique.
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Dermabrasion↗
Reconstruction of the nose utilizing a bilobed flap.
BACKGROUND: Defects of the distal nose are particularly challenging to reconstruct because of this area's unique texture, lack of elasticity, and possible distortion of the alar rim. The bilobed flap has been criticized for having a high incidence of "trapdooring," flap necrosis, dog ears, and prominent suture lines. METHODS: Patients who underwent bilobed flap repairs of the distal nose (n = 171) were reviewed for complications and cosmetic results. The modifications from the traditional design include minimizing the angle of transposition between lobes, thinning of the flap, basing the pedicle on the lateral aspect of the nose, and creating the lobes of the flap to be of equal diameter to the defect. RESULTS: There was a 3% incidence of infection, 7% incidence of partial flap necrosis, and 5% incidence of "trapdooring" and contour distortion. Color match and contour were excellent for all other patients. CONCLUSIONS: The modified bilobed flap is an excellent choice for reconstruction of defects of the lower nose because of the good skin match and low incidence of complications.
Humans↗
Quantitative assessment of augmentation therapy.
We report the results obtained from 18 women whose facial folds and furrows were treated with augmentation therapy. The results of treatment with microlipoinjection and injectable collagen were measured and compared at regular intervals for a period of 1 year using a method of optical profilometry. Subsidence was noted with both modalities. Collagen gave consistent results. Seventy-five percent of correction on the average is lost at 6 months, but 22% of the collagen-treated subjects maintained at least 30% correction 1 year from the time of treatment. Autologous fat gave unpredictable results ranging from poor to excellent. A good result at 6 months is likely to be maintained until 1 year from the time of treatment. Forty-four percent of fat augmented subjects maintained at least 30% correction 1 year after treatment.
Adipose Tissue↗