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Biomedical subjects

T S Alster

Publications and source records attributed to T S Alster.

At least 19 recordsLinked to original sources
PubMed2001

Erbium:YAG cutaneous laser resurfacing.

The short-pulsed Er:YAG laser system is an excellent ablative tool for cutaneous resurfacing. This system is most efficacious for patients with milder cutaneous involvement, including mild photoinduced facial rhytides, mildly atrophic scars, and textural changes caused by fibrosis and dermatochalasis. The Er:YAG laser cannot achieve the same dramatic clinical and histologic improvements produced with the CO2 laser but does offer some distinct advantages that make it a valuable addition to the laser surgeon's armamentarium. The Er:YAG laser, because of its higher affinity for water-containing tissues, effects a much finer level of tissue ablation. Although erbium laser resurfacing results in decreased postoperative morbidity with a shorter recovery period, it cannot effect the same degree of improvement in photodamaged skin as can the CO2 laser. Excellent results, however, can be achieved with this laser, up to 50% or more overall clinical improvement, in patients with milder photodamage and scarring (Glogau classes I and II). In darker-skinned patients, the Er:YAG laser is often the preferred treatment modality. Continued research in the field has already led to the development of longer-pulsed Er:YAG lasers, which offer a compromise between the CO2 laser and the short-pulsed Er:YAG lasers in terms of clinical benefits while maintaining the safety profile of the traditional short-pulsed system. In addition, many surgeons now use a combination approach with the CO2 and Er:YAG lasers in an effort to maximize collagen contraction in certain areas and limit postoperative morbidity. As more research is conducted within the field of cutaneous resurfacing, newer systems will be developed in the continuing effort to create the ideal laser system--one which ameliorates the signs of photoaging without risk of major side effects or significant postoperative recovery.

Anesthesia↗
PubMed2001

Comparison of long-pulsed diode and long-pulsed alexandrite lasers for hair removal: a long-term clinical and histologic study.

BACKGROUND: Unwanted facial and body hair is a common problem, generating a high level of interest for treatment innovations. Advances in laser technology over the past several years has led to the development and distribution of numerous red and infrared lasers and light sources to address this issue. Despite the impressive clinical results that have been reported with the use of individual laser hair removal systems, long-term comparative studies have been scarce. OBJECTIVE: To compare the clinical and histologic efficacy, side effect profile, and long-term hair reduction of long-pulsed diode and long-pulsed alexandrite laser systems. METHODS: Twenty women with Fitzpatrick skin types I-IV and dark terminal hair underwent three monthly laser-assisted hair removal sessions with a long-pulsed alexandrite laser (755 nm, 2-msec pulse, 10 mm spot) and a long-pulsed diode laser (800 nm, 12.5 msec or 25 msec, 9 mm spot). Axillary areas were randomly assigned to receive treatment using each laser system at either 25 J/cm2 or 40 J/cm2. Follow-up manual hair counts and photographs of each area were obtained at each of the three treatment visits and at 1, 3, and 6 months after the final laser session. Histologic specimens were obtained at baseline, immediately after the initial laser treatment, and 1 and 6 months after the third treatment session. RESULTS: After each laser treatment, hair counts were successively reduced and few patients found it necessary to shave the sparsely regrown hair. Optimal clinical response was achieved 1 month after the second laser treatment, regardless of the laser system or fluence used. Six months after the third and final treatment, prolonged clinical hair reduction was observed with no significant differences between the laser systems and fluences used. Histologic tissue changes supported the clinical responses observed with evidence of initial follicular injury followed by slow follicular regeneration. Side effects, including treatment pain and vesiculation, were rare after treatment with either laser system, but were observed more frequently with the long-pulsed diode system at the higher fluence of 40 J/cm2. CONCLUSION: Equivalent clinical and histologic responses were observed using a long-pulsed alexandrite and a long-pulsed diode laser for hair removal with minimal adverse sequelae. While long-term hair reduction can be obtained in most patients after a series of laser treatments, partial hair regrowth is typical within 6 months, suggesting the need for additional treatments to improve the rate of permanent hair removal.

Adult↗
PubMed2001

Pulsed dye laser treatment of multiple eccrine hidrocystomas: a novel approach.

BACKGROUND: Multiple eccrine hidrocystomas are benign cystic lesions that pose a significant treatment challenge due to their facial location and tendency to scar after traditional surgical and other destructive modalities. METHODS: A 585nm pulsed dye laser was used at fluences ranging 7.0 J/cm2 to 7.5 J/cm2 at 6- to 8-week intervals to treat multiple lesions on the face of a 54-year-old man. RESULTS: Near complete resolution of all papules was seen after four laser sessions. There was no evidence of lesional recurrence 18 months after the final treatment. CONCLUSION: The 585nm pulsed dye laser can effectively treat eccrine hidrocystomas. The mechanism of action whereby this vascular-specific laser produced improvement is unclear.

Face↗
PubMed2001

Laser treatment of atrophoderma vermiculata.

Atrophoderma vermiculata is a rare genodermatosis with usual onset in childhood, characterized by a "honey-combed" reticular atrophy of the cheeks. The course is generally slow, with progressive worsening. We report successful treatment of 2 patients by means of the carbon dioxide and 585 nm pulsed dye lasers.

Adult↗
PubMed2001

Lasers in dermatology. An overview of types and indications.

Advances in laser technology have been so marked over the past two decades that successful eradication of many cutaneous pathologies and congenital defects, including vascular and pigmented lesions, tattoos, scars, and unwanted hair, can now be fully realized. Because of the relative ease with which many of these lesions can be removed, coupled with a low incidence of adverse postoperative sequelae, demand for laser surgery has increased substantially. In this review, the currently available laser systems with cutaneous application are outlined, with special reference to recent advancements and modifications in laser technology that have greatly expanded the laser surgeon's armamentarium and improved upon overall treatment efficacy.

Forecasting↗
PubMed2001

Long-pulsed Nd:YAG laser-assisted hair removal in pigmented skin: a clinical and histological evaluation.

OBJECTIVE: To determine the safety and effectiveness of a long-pulsed Nd:YAG laser at 1064 nm in effecting long-term hair reduction in patients with darkly pigmented skin. DESIGN: Nonrandomized before-after clinical and histological trial. SETTING: Private practice, ambulatory care facility. PATIENTS: Twenty women with skin phototypes IV through VI and dark brown to black terminal hair on the face, axillae, or legs. INTERVENTION: A series of 3 long-pulsed (50-millisecond) 1064-nm Nd:YAG laser treatments at fluences ranging from 40 to 50 J/cm(2) were delivered to the identified treatment areas on a monthly basis by a single operator. MAIN OUTCOME MEASURES: Global clinical grading scores of comparable before-after treatment photographs were determined by 2 independent medical assessors during each laser session and 1, 3, 6, and 12 months postoperatively. A dermatopathologist reviewed unmarked histological specimens obtained at baseline, immediately after the initial laser treatment, and at 1 and 6 months after the final laser session. RESULTS: Substantial hair reduction was seen after each of the 3 treatment sessions. Prolonged hair loss was observed 12 months after the final laser treatment (70%-90% hair reduction). Axillary hair was substantially more responsive to laser irradiation than was hair located on the legs and face. Adverse effects included mild to moderate treatment pain and rare occurrences of vesiculation and transient pigmentary alteration without fibrosis or scarring. Histological tissue changes mirrored clinical response rates, with evidence of selective follicular injury without epidermal disruption. CONCLUSION: The long-pulsed 1064-nm Nd:YAG laser is a safe and effective method of long-term hair reduction in patients with darkly pigmented skin.

Adult↗
PubMed2001

Skin rejuvenation with cool touch 1320 nm Nd:YAG laser: the nurse's role.

Nonablative laser remodeling with the Cool Touch system is a new skin-rejuvenation procedure. Nurses play several valuable roles in educating and caring for patients undergoing this procedure including assisting with patient selection, preoperative preparation, intraoperative set up and delivery, postoperative care, and followup.

Aftercare↗
PubMed2000

Cutaneous hypersensitivity reaction to injectable hyaluronic acid gel.

BACKGROUND: Injectable hyaluronic acid gel is a non-animal biomaterial used for soft tissue augmentation. OBJECTIVE: The dermal implantation of this naturally occurring polysaccharide is reported to be well tolerated by patients, with a longer duration in tissue than bovine collagen without any major local or systemic side effects. We report a case of an acute hypersensitivity reaction in a woman after her third injection for improvement of melolabial fold wrinkles. METHODS: An adverse granulomatous-like response to the intradermal injection of a modified hyaluronic acid gel is described. RESULTS: The patient developed indurated and erythematous papulocystic nodules in the melolabial folds bilaterally at the sites of injection. CONCLUSION: Injectable hyaluronic acid gel can be associated with severe allergic reactions and patients should be warned of this possible treatment side effect.

Acute Disease↗
PubMed2000

Laser treatment of hypertrophic scars, keloids, and striae.

The successful use of the 585-nm pulsed dye laser for the treatment of hypertrophic scars has been well established over the past decade. Although 5 years ago this treatment option might have been considered as a viable choice only after all other methods failed, it is now generally recognized as an excellent first-line treatment option. Early scar treatment with pulsed dye laser irradiation effectively prevents scar formation or worsening and yields a better and more prolonged clinical improvement. The concomitant use of corticosteroids, 5-fluorouracil, or other treatments is proving to be of particular importance in reducing scar bulk and symptoms of more proliferative scars. Although optimal management for keloids and striae has yet to be determined, pulsed dye laser irradiation will no doubt continue to play a role in their treatment.

Adult↗
PubMed2000

Human-derived and new synthetic injectable materials for soft-tissue augmentation: current status and role in cosmetic surgery.

The recent development of human-derived and new synthetic filling agents heralds a new era in soft-tissue augmentation. Many of the disadvantages of xenogenic and prior exogenous materials have been overcome with the advent of these autologous, allogeneic, and inert synthetic alternatives. Early reports using human-derived and inert exogenous filling agents have demonstrated good results and prolonged correction. It is too early, however, to assess the long-term efficacy of these agents. Future investigations should include histologic examination after facial implantation to document long-term safety and efficacy.

Biocompatible Materials↗
PubMed1999

Clinical and histologic evaluation of six erbium:YAG lasers for cutaneous resurfacing.

BACKGROUND: Several erbium:YAG lasers are currently available for cutaneous laser resurfacing. Although different laser systems are purported to produce equivalent laser energies to produce similar laser-tissue interactions, no comparative clinical or histologic studies have been performed to objectively demonstrate their relative efficacies. OBJECTIVE: The purpose of the present study was to examine the in vivo clinical and histopathologic effects of six different erbium:YAG resurfacing lasers. METHODS: A blinded, prospective study using six different erbium lasers (Candela, Continuum Biomedical, HGM, MDLT, SEO, Sharplan/ESC) was performed. The facial halves of 12 patients were randomly resurfaced with one of the six laser systems by using an identical laser technique at 5.0 J/cm2. Intraoperative skin biopsies were obtained after each of three laser passes in two patients for blinded histologic determination of tissue ablation level and presence of residual thermal damage. Clinical assessments of reepithelialization rates, severity and duration of erythema, side effects, and degree of clinical improvement were made at 0.5, 1, 2, 4, 12, 26, and 52 weeks postoperatively. RESULTS: Irrespective of the erbium laser system used, complete reepithelialization typically occurred at 0.5 weeks and resolution of erythema was noted within 1-2 weeks postoperatively. A mean clinical improvement of 50% was observed, with photodamaged skin showing greater improvement than scarred skin. The most common postoperative side effect was hyperpigmentation, with all affected patients having either darker skin tones or preceding dermal inflammation. Three laser passes were needed to effect total epidermal ablation when using any one of the erbium:YAG systems. CONCLUSIONS: Equivalent clinical and histologic results were seen after each of the six erbium:YAG lasers studied. Erbium:YAG laser resurfacing can be used to significantly improve mild cutaneous photodamage and atrophic scars.

Adult↗
PubMed1999

Long-pulsed alexandrite laser-assisted hair removal at 5, 10, and 20 millisecond pulse durations.

BACKGROUND: Several laser systems with varying wavelengths, pulse durations, and energy fluences are currently utilized for hair removal. However, the ideal laser parameters and treatment candidates for photoepilation remain largely unknown. The medical literature lacks a wealth of experimental data to sufficiently document the long-term safety and efficacy of laser-assisted hair removal. This study examines the clinical efficacy and side effect profile of long-pulsed alexandrite laser-assisted hair removal utilizing laser pulse durations of either 5, 10, or 20 milliseconds (ms). STUDY DESIGN/METHODS: Laser-assisted hair removal was performed on 36 subjects with a long-pulsed alexandrite laser. Areas of unwanted hair growth on the face, back, and legs were divided linearly into four 1 cm2 or 2 cm2 quadrants. Experimental regions included a control quadrant and three additional quadrants, which were treated with the alexandrite laser using an average fluence of 18 J/cm2, with a 10 mm spot size at either a 5, 10, or 20 ms pulse duration. Hair counts and photographs were obtained before treatment, immediately following irradiation, 1 week and 1, 3, and 6 months postoperatively. RESULTS: All laser-treated quadrants displayed a significant delay in hair regrowth compared to control nontreated quadrants at postoperative week 1 and months 1 and 3. Hair counts were reduced by 66% at 1 month, 27% at 3 months, and 4% at 6 months. No significant differences in clinical efficacy or side effect profiles were observed between treatment quadrants, yet a trend towards less post-treatment erythema and hyperpigmentation was noted with the 20 ms pulse duration. CONCLUSIONS: Equivalent long-term hair removal for up to 6 months was achieved with the long-pulsed alexandrite laser at 5, 10, and 20 ms pulse durations at an average fluence of 18 J/cm2. Side effects were limited and transient.

Adult↗
PubMed1999

Laser-assisted hair removal: side effects of Q-switched Nd:YAG, long-pulsed ruby, and alexandrite lasers.

BACKGROUND: Laser-assisted hair removal has become popularized using wavelengths in both the red and infrared regions of the electromagnetic spectrum. These photoepilation devices target follicular melanin or an exogenous pigment placed within the follicle resulting in thermal damage to the hair follicle and shaft. However, melanocytes and keratinocytes located within the superficial layers of the skin also absorb red and infrared laser radiation. This may result in unwanted epidermal injury during the hair removal process. OBJECTIVE: The purpose of this study was to examine a large patient population to determine the frequency of side effects using 3 different hair removal laser systems with various wavelengths, pulse durations, and treatment protocols. METHODS: A retrospective chart review and digital photographic analysis of the side effects resulting from 900 consecutive laser-assisted hair removal treatments delivered over a 24-month study period, by means of either a Q-switched Nd:YAG laser with pretreatment wax-epilation and topical carbon solution, a long-pulse ruby laser with a contact cooling tip, or a long-pulse alexandrite laser are reported. RESULTS: Treatment pain, erythema, edema, hypopigmentation and hyperpigmentation, blistering, crusting, erosions, purpura, and folliculitis were observed. The majority of undesirable tissue effects occurred on tanned skin or in Fitzpatrick skin phototypes III and higher. The ruby and alexandrite laser systems resulted in the majority of side effects seen. The effects of seasonal variations, anatomic treatment location, and sun exposure were striking within the ruby and alexandrite laser groups. No infections, scarring, or long-term complications occurred. CONCLUSION: Laser-assisted hair removal is a safe procedure when patient characteristics such as skin type, anatomic location, and sun-exposed or tanned skin are considered during selection of laser treatment parameters. Lasers emitting wavelengths with high melanin absorption capabilities should be used in a conservative manner when treating patients with dark skin phototypes or suntans. No long-term complications, infections, or scarring occurred in this study population.

Adult↗
PubMed1999

Periorbital rejuvenation: a review of dermatologic treatments.

BACKGROUND: The periorbital region serves as a barometer of chronologic and environmental age and, as such, patients often seek its cosmetic rejuvenation. OBJECTIVE: The purpose of this article was to review the dermatologic treatments available for periorbital skin rejuvenation. METHODS: Topical retinoic and glycolic acid preparations, chemical peels, botulinum and collagen injections, dermabrasion, and laser resurfacing procedures for periorbital skin rejuvenation were reviewed. The relative benefits and risks of each treatment were detailed. RESULTS: Minimal photodamage with mild rhytides should be responsible to topical acid therapy and superficial peels, whereas moderate wrinkling and photodamage generally require medium-depth peels, collagen injections, or erbium:YAG laser resurfacing. Deeper rhytides and more extensive cutaneous photo-damage usually necessitate CO2 laser resurfacing and botulinum injections. CONCLUSIONS: Proper patient selection and assessment of aging severity are critical to determine the best therapeutic option.

Botulinum Toxins, Type A↗