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Biomedical subjects

J S Dover

Publications and source records attributed to J S Dover.

At least 19 recordsLinked to original sources

The use of lasers for decorative tattoo removal.

As the incidence of tattoo placement continues to increase, so does the demand for tattoo removal, with more than 10 million people in the US alone with a tattoo. Used in an appropriate clinical setting, Q-switched lasers provide relatively efficacious clearance of decorative tattoo pigment with minimal side-effects. We present our clinical experience along with literature findings on decorative tattoo removal and the important issues practitioners should consider in the management of tattoos.

Dermatology↗

Fractional Laser treatment for pigmentation and texture improvement.

Fractional laser treatment with the 1,550 nm erbium fiber laser (Fraxel Laser, Reliant Technologies) has bridged the gap between the ablative and nonablative laser modalities used to treat the epidermal and dermal signs of skin aging. By targeting water as its chromophore, the laser induces a dense array of microscopic, columnar thermal zones of tissue injury that do not perforate or impair the function of the epidermis. The significant skin remodeling that ensues can be used to treat, with limited downtime, epidermal pigmentation, melasma, and rhytides, as well as textural abnormalities that include acne-related and surgical scars.

Cicatrix↗

Clinical Use of RESTYLANE.

There is no ideal filler, nor will there be a single product that can satisfy all requirements. However, RESTYLANE, a non-animal, stabilized hyaluronic acid (NASHA, Medicis), is a very versatile augmenting agent. It has been in clinical use for 8 years and experience has shown it to be close to the ideal filler in many respects. This review will outline the background to the use of RESTYLANE, and will focus on the clinical use of this material.

Cosmetic Techniques↗

The use of lasers in the pediatric population.

Over the past 2 decades, there have been numerous advances in laser therapy of birth-marks in the pediatric population. Concerns regarding efficacy, overall benefit, and side-effects linger. We present our opinion, based upon decades of clinical experience, on the role of lasers to treat port wine stains, superficial hemangiomas, and café au lait macules in children.

Cafe-au-Lait Spots↗

[Lasers and aesthetic dermatology].

The improved understanding of laser-tissue interaction along with the latest advances of laser technology have led to the development of sophisticated, safe, and user-friendly laser systems that provide effective treatment for a variety of aesthetic skin conditions. The use of lasers and their tissue-specific capabilities in the treatment of pigmented and vascular lesions has been greatly expanded to include rhytides, photoaged skin, atrophic scars, and unwanted hair. In addition, laser techniques have been employed in traditional "rejuvenating" procedures of aged skin, e.g., face-lifting, blepharoplasty, and hair transplantation, decreasing the intra-operative time and limiting the recovery period. These advances have led to a wide acceptance of cutaneous laser surgery by the dermatologic community and have created an increasing popularity among the public. The purpose of this article is to review the applications of lasers in aesthetic dermatology and discuss their limitations and potential side effects.

Blepharoplasty↗

Evaluation of a silicone occlusive dressing after laser skin resurfacing.

BACKGROUND: Closed dressings are thought to promote postoperative wound healing after laser skin resurfacing; however, quantitative data are lacking. OBJECTIVE: To compare postoperative healing after combination carbon dioxide and erbium:YAG full-face laser skin resurfacing in patients who were treated with a silicone occlusive dressing (Silon-TSR; Bio Med Sciences, Inc, Bethlehem, Pa) vs open-wound care consisting of soaks and ointment application. DESIGN: Thirty-five patients with closed dressings compared retrospectively with 35 control subjects with open-wound care. In a prospective evaluation, 27 patients with closed dressings were then compared with 27 historical controls matched by age, sex, skin type, and treatment technique. Erythema, crusting, swelling, pain, pruritus, purpura, long-term complications, and dressing comfort were evaluated. SETTING: Referral-based academic practice. RESULTS: Prospectively, closed-dressing and open-wound care groups differed significantly in maximum erythema severity (1.8 vs 2.0 on a scale of 0-3; P =.03), noticeable erythema duration (15.4 vs 31.1 days; P =.04), and time until complete erythema resolution (41.8 vs 96.1 days; P =.02). Swelling resolution was more rapid in the dressing group (12.1 vs 29.5 days; P =.02). Crusting was limited to uncovered areas in the dressing group, and crusting duration was shorter (5.0 vs 9.1 days; P<.001). Pain was more likely to be reported prospectively, but severity was mild, in the closed-dressing group. Other short- and long-term complications did not differ significantly. Subjective patient attitudes toward the dressing were positive. CONCLUSIONS: Occlusive silicone dressing application decreases immediate postoperative morbidity with significantly reduced severity and duration of erythema and decreased duration of swelling and crusting. Long-term results and complication rates remain unchanged.

Erythema↗

Acne scarring: a classification system and review of treatment options.

Acne is a common condition experienced by up to 80% of people between 11 and 30 years of age and by up to 5% of older adults. In some patients, the severe inflammatory response to Propionibacterium acnes results in permanent, disfiguring scars. Over the past several decades, numerous descriptive terms and surgical techniques have been used to diagnose the types, and improve the appearance, of scarring in those persons with acne. We propose a descriptive, simple, universally applicable acne scar classification system that includes 3 scar types: icepick, rolling, and boxcar. We also have developed an effective treatment algorithm for reconstructing and improving the appearance of acne scars including punch excision, punch elevation, subcutaneous incision (Subcision), and laser skin resurfacing. This new classification system for acne scars enables the physician to more precisely identify scar subtypes. Once the scar type has been defined, appropriate and effective treatment protocols can be developed.

Acne Vulgaris↗

New approaches to the treatment of vascular lesions.

BACKGROUND AND OBJECTIVE: The pulsed dye laser was developed based on the concept of selective photothermolysis. By using a wavelength of light well absorbed by the target and pulse duration short enough to spatially confine thermal injury, specific vascular injury could be produced. STUDY DESIGN/MATERIALS AND METHODS: Although the pulsed dye laser revolutionized the treatment of port wine stains (PWS) and a variety of other vascular lesions, the ideal thermal relaxation time for the vessels in PWS is actually 1-10 ms, not 450 micros of the original pulsed dye laser machines. These original theoretical calculations recently have been proven correct in a study that used both an animal vessel model and in human PWS. RESULTS: Longer wavelengths of light, within the visible spectrum, penetrate more deeply into the skin and are more suitable for deeper vessels, whereas longer pulse durations are required for larger caliber vessels. CONCLUSION: A variety of lasers recently have been developed for the treatment of vascular lesions which incorporate these concepts into their design, including pulsed dye lasers at 1.5 ms, a filtered flash-lamp pulsed light source with pulse durations of 1-20 ms, several 532-nm pulsed lasers with pulse durations of 1 ms to as high as 100 ms, long pulsed alexandrite lasers at 755 nm with pulse durations up to 20 ms, pulsed diode lasers in the 800 to 900 nm range, and long pulsed 1064 Nd:YAG sources.

Humans↗

Spontaneous bullae over laser resurfaced skin.

We report 2 cases of facial bullae occurring subsequent to full-face carbon dioxide laser skin resurfacing. Although the cause is unknown, both responded to potent topical corticosteroid treatment. Laser resurfacing is a relatively new procedure, and physicians should be aware of this complication.

Aged↗

New approaches to the laser treatment of vascular lesions.

The pulsed dye laser (PDL) was developed based on the concept of selective photothermolysis. Using a wavelength of light well absorbed by the target and a pulse duration short enough to spatially confine thermal injury, specific vascular injury could be produced. While the PDL revolutionized the treatment of port wine stains (PWS) and a variety of other vascular lesions, the mathematical model predicted that the ideal thermal relaxation time for the vessels in PWS is actually 1-10 msec, not 450 microseconds. These original theoretical calculations have been proved correct recently in a study using both an animal vessel model and in human PWS. Longer wavelengths of light within the visible spectrum penetrate deeper into the skin and are more suitable for deeper vessels; while longer pulse duration is required for larger calibre vessels. A variety of lasers have been developed recently for the treatment of vascular lesions that incorporate these concepts into their design, including PDL at 1.5 msec, a filtered flash-lamp pulsed light source with pulse durations of 1-20 msec, several 532 nm pulsed lasers with pulse durations of 1 to as high as 100 msec, long pulsed alexandrite lasers at 755 nm with pulse durations up to 20 msec, pulsed diode lasers in the 800-900 nm range, and long pulsed 1064 Nd:YAG sources. Preliminary results are encouraging.

Humans↗

Lasers in skin resurfacing.

Laser skin resurfacing has revolutionized the approach to facial skin rejuvenation over the last decade. It has also added an approach to managing both atrophic and hypertrophic scars. This paper will review the basic principles of laser skin resurfacing, the different lasers used, the approach to treatment and potential complications of the procedure, followed by a discussion of future prospects in the field.

Cicatrix↗

Lasers in skin resurfacing.

The development of short-pulse high-peak power and rapidly scanned focused beam carbon dioxide lasers and normal mode erbium:yttrium aluminum garnet lasers, which can remove photodamaged skin layer by layer in a precisely controlled manner while leaving behind a very narrow zone of thermal damage, has revolutionized skin rejuvenation and enhanced our ability to treat scars. This review highlights laser-tissue interactions; the laser used for resurfacing; preoperative, operative, and postoperative issues and how to choose a candidate for the procedure; uses of resurfacing; adverse effects and complications of the procedure; and new developments in the field.

Aged↗