Main Line Center for Laser Surgery

ABSTRACTBackgroundCellulite is a common aesthetic condition of the skin, predominantly affecting more than 90% of postpubertal females. Energy‐based devices (EBDs) have demonstrated efficacy in treating a variety of dermatologic concerns. A controlled thermal injury to the dermis can stimulate remodeling of the extracellular matrix (ECM), leading to skin tightening, an effect that may improve the dimpled appearance of cellulite.ObjectiveTo assess the efficacy and safety of synchronous parallel ultrasound using a high‐density handpiece for improving cellulite appearance.Materials and MethodsSixty subjects, aged 23–65, were enrolled in a prospective, open‐label, non‐randomized, multicenter study. Subjects underwent two treatment sessions using a novel ultrasonic system equipped with a new high‐density handpiece, applied on either one side or both sides of the thighs and/or buttocks. The follow‐up period extended up to 3 months after the second treatment. Clinical improvements were evaluated by three blinded physicians based on baseline and follow‐up photographs, using the Cellulite Severity Scale (CSS), Global Aesthetic Improvement Scale (GAIS), and Laxity Scale (LS). Satisfaction questionnaires were completed by subjects. Treatment discomfort was rated immediately after treatment using the Numerical Scale Response (NSR).ResultsSixty subjects, with a mean age of 47, were enrolled in the study. GAIS results showed improvement in 91% of the treated areas, CSS score improved by 69%, while LS score improved by 53%. Most subjects (73%) reported satisfaction. Mean pain score was 4.26 ± 2.33. No serious adverse events were reported.ConclusionThe novel ultrasound system was found to be effective and safe for improving cellulite appearance.

A new dual-wavelength, high-energy, solid-state laser incorporating both 532 and 1064 nm wavelengths was developed with cryogen spray cooling and the unique ability to deliver three types of pulse structures including single pulses of a specific pulse-duration or pulses composed of a train of subpulses in the millisecond or microsecond domain with an intervening delay over the selected pulse-duration. We investigate the efficacy of this laser using all three pulse structures and the 532 nm wavelength for treating rosacea. Twenty-one subjects were enrolled in this IRB-approved study. A total of up to three treatments were administered at monthly intervals. Each treatment consisted of a first pass tracing linear vessels with a 40 ms pulse-duration immediately followed by a second pass using a 5 ms pulse, using all three available pulse structures. Assessment of cross-polarized digital images by blinded physician observers compared baseline and 3-month follow-up images. Blinded observers correctly identified the posttreatment images 89% of the time, in 17 of 19 subjects completing the study, with an average overall improvement rating of 39% after only three treatments. Side effects were limited to short-term erythema and edema. This study demonstrates that this new, variable-pulse-structure, dual wavelength, solid state, KTP laser with dynamic cooling is a safe and effective for treating rosacea.

Abstract BackgroundCurrent Guidelines from the National Institute of Allergy and Infectious Disease (NIAID) are based on the Learning Early About Peanut Allergy Study (LEAP Study) results and recommend early introduction of peanuts to children with atopic dermatitis (AD) depending on their disease severity. There is yet to be a widely accepted method of evaluating AD severity among clinicians. Thus, the purpose of this study was to determine the association between AD severity as measured by patient‐oriented scoring of atopic dermatitis(PO‐SCORAD) and Patient Oriented Eczema Measure (POEM) surveys and peanut sensitivity as measured by Immunoglobulin E (IgE) or skin prick test levels.ObjectivesThe primary objective of this study was to determine the association between AD severity as measured by PO‐SCORAD and POEM surveys and peanut sensitivity as measured by IgE or skin prick test levels. The secondary objective of this study was to determine the rate of peanut sensitisation amongst patients with ‘mild AD’ as defined by PO‐SCORAD score of 1−27 and a POEM score of 0‐7.MethodsPatients between 3 months and 18 years old undergoing IgE or skin prick testing for peanut allergy were recruited from two allergy clinics in the Chicagoland area. Patients or their guardians completed a PO‐SCORAD survey and POEM survey.ResultsThere was no significant difference in AD severity (as measured by PO‐SCORAD or POEM score) between sexes or age groups (<12 months vs. ≥12 months). Moreover, there was no significant relationship found between PO‐SCORAD or POEM scores and rate of peanut sensitivity.ConclusionDespite no significant relationship found between PO‐SCORAD or POEM score and peanut sensitivity, the hypothesis that AD severity can predict risk of peanut sensitivity may still be valid based on a growing body of evidence. The negative results of this study are likely due to the small study population used due to limitations of the COVID‐19 pandemic. Moreover, evaluating AD severity through PO‐SCORAD and POEM surveys may not be ideal for paediatric patients.

Over the past 20years, evidence has emerged indicating oral isotretinoin could be considered a potential treatment for photoaged skin. In this review, we provide a succinct overview of the available evidence and provide commentary on the current and future directions for utilizing oral isotretinoin as a potential treatment for photoaging. We prepared a review protocol and searched the PubMed and Cochrane databases for relevant literature published between January 1982 and April 2020. Using a defined keyword search, a total of 23 papers were initially identified by the main author. Two authors independently reviewed each of the 23 articles, and 6 articles were deemed relevant to this study. Of the six studies included in this review, three were randomized clinical trials, one was a nonrandomized clinical trial and two were prospective cohort studies. All studies were conducted between 2000 and 2015. Across all 6 studies, 251 patients were recruited, with a mean of 42 patients per study. Four studies were in favor of isotretinoin to improve photoaged skin, 1 study showed no benefit, and 1 study showed no benefit when compared to topical tretinoin treatment. Of the studies available, many were hampered by methodological challenges. Oral isotretinoin may be useful for treating photoaging but there is currently insufficient evidence to support its use. In comparison with other established anti-photoaging treatments, it is not clear whether the potential benefits of oral isotretinoin outweigh the potential risks.

Facial plastic and reconstructive surgery (FPRS) training programs offer exceptional exposure to the most current techniques in the field. However, applicants have many factors to weigh when ranking programs. Therefore, it is important to examine the factors that applicants believe to be the most critical when choosing an FPRS fellowship. This is an anonymous online survey of FPRS fellows between the years 2018 and 2020 (total 147). Respondents were asked to rate importance of program factors on a Likert scale (1-5). Of 147 applicants, 63 (43%) responded. Applicants found the type of practice, academic or private, equally important, with score averages of 3.02 and 3.25, respectively. The two most important program factors to applicants were exposure to the business of medicine/practice management (3.94) and location (3.4). The two most important areas of surgical exposure include rhinoplasty (4.54) and aging face (4.44). Of 63 applicants, 41 (65%) were interested in private practice, with 51% seeking a facial plastics/plastic reconstructive surgery group setting versus solo practice, general otolaryngology group, or dermatology group practice. Of 61 applicants, 48 (76%) wanted a mix of cosmetic/reconstructive surgery in their first 5 years of practice. Finally, applicants were not interested (average: 1.94) in keeping general otolaryngology as part of their practice. Applicants want strong exposure to the business of medicine, rhinoplasty, aging face, all while in their preferred location. Additionally, the majority of applicants seek employment in a plastic surgery focused group practice, with the sole focus being the breadth of FPRS.

Percutaneous spinal cord stimulation as an option to treat chronic neuropathic pain has proven to be a powerful tool. Many different conditions within the cervical spine which contribute to structural abnormalities which lead to neuropathic pain can be effectively treated with properly placed percutaneous cervical spinal cord stimulator leads. Accurately placed and anchored leads placed within the cervical spine percutaneously can provide a dramatic reduction in symptomatology and a permanent improvement in a chronic pain patient’s quality of life and activity tolerance. Placement of cervical percutaneous spinal cord stimulator leads to the level of the C2 vertebral body can provide pain relief within the occipital region. Leads spanning from C2 across multiple vertebral body levels can provide pain relief within the neck and upper extremities consistently and reproducibly.

Spinal cord stimulation (SCS) has been used to treat a variety of neuropathic pain syndromes with strong evidence for its value in treating complex regional pain syndrome (CRPS) and failed back surgery syndrome (FBSS). Commonly when was used for focal neuropathic pain syndromes such as in CRPS I and II, SCS missed coverage for the most distal part of extremity or produced bothering extraneous paresthesia outside the painful areas. This leads to poor satisfaction scores and possibly leading to explant of the therapy. Recent advances in the space of implantable therapies have shown that dorsal root ganglion (DRG), a spinal structure located in the spinal foramen, can be modulated for such focal neuropathic pain syndromes with highly specific pain relief to the painful area and no extraneous paresthesia, thus leading to better outcomes and higher patient satisfaction scores.

ObjectivesThe pulsed‐dye laser has long been a gold standard in the treatment of poikiloderma of Civatte. Recent advances in pulsed dye laser technology enable output energies 50% higher, enabling beam diameters of up to 15 mm with clinically relevant fluences. In this study, we investigate this new laser for treatment of this condition.Materials and MethodsTwenty subjects were enrolled in the study. A total of four treatments were administered at monthly intervals. Blinded assessment of digital, cross‐polarized photographs taken at baseline and two months following the last treatment was performed by blinded physician raters using an 11‐point clearance scale. Subject reported pain scores immediately following treatment and side effects at all visits were recorded by the investigator.ResultsSeventeen subjects completed the study. Blinded reviewers correctly identified the baseline photo in 48 of 51 cases (94%). All three reviewers mis‐identified the same subjects. The blinded reviewers scored 14 out of the 17 subjects with an improvement greater than 40% and 10 out of the 17 subjects greater than 50%. Average improvement was 49% for all 17 subjects. Side effects were limited to mild edema, and mild to moderate erythema and purpura. Pain scores averaged 3.5 on using an 11‐point scale.ConclusionThis study demonstrates the safety and effectiveness of a new pulsed‐dye laser with a 15 mm spot and 50% higher fluences for the treatment of poikiloderma of Civatte. Lasers Surg. Med. 51:54–58, 2019. © 2018 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.