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Pulsed-dye laser found effective for erythematotelangiectatic rosacea
DALLAS – in a single-center study of 20 patients.
“Recent advances in pulsed-dye laser technology enable 50% higher output energies and much longer dye life,” lead study author Eric F. Bernstein, MD, said at the annual conference of the American Society for Laser Medicine and Surgery. “A 15-mm treatment diameter is now possible, which makes treatment faster and possibly more effective due to increased penetration of laser energy. Compared with a 10-mm spot size, which most of us use, a 15 mm is a 125% larger beam diameter, so it’s a big difference in treatment area.”
Blinded assessment of digital and cross-polarized images taken 8 weeks following the last treatment was performed using an 11-point clearance scale. The Investigator Global Assessment Scale was used to evaluate inflammatory lesions, erythema, and telangiectasia, and safety was assessed by incidence and severity of side effects. The investigators and subjects assessed satisfaction with the treatment outcome on a 5-point Likert scale (–2, very dissatisfied; –1, dissatisfied; 0, no opinion; 1, satisfied; and 2, very satisfied). Dr. Bernstein also evaluated the patients for purpura, petechiae, edema, erythema, blistering, and crusting on a 0-3 point scale (0, absent; 1, mild; 2, moderate; and 3, severe).
Of the 20 subjects, 16 females and 3 males completed the study. All had Fitzpatrick skin types II-IV and 17 of 19 subjects received four treatments, while 2 received three treatments because of scheduling challenges. Between baseline and 8 weeks following the last treatment, mean Investigator Global Assessment scores improved significantly for overall score (from 4.3 to 1.8; P less than .0001), as well as for inflammatory lesions (from 1.7 to 1.0; P less than .005), erythema (from 4.5 to 1.6; P less than .0001), and for telangiectasia (from 4.2 to 1.1; P less than .0001).
Dr. Bernstein also reported that blinded evaluators correctly identified baseline images in 55 of 57 image pairs (96.5%), while the average score improvement in their rosacea was 52.5%, and ranged from 30.0% to 86.7%. In addition, 17 of 19 subjects (89%) showed a score improvement of more than 40%, while 57% of subjects had a score improvement of greater than 50%.
Patients and investigators both recorded a mean satisfaction score of 1.9, and 18 of 19 subjects reported being “very satisfied” with the treatment.
The average pain score was 5.6 on a 0-10 scale, while common side effects that resolved within 1-3 days without intervention included mild edema, mild to moderate erythema, and mild to moderate bruising. No cases of hyperpigmentation, hypopigmentation, blistering, or scarring occurred.
“The newly designed pulsed-dye laser is a major change in a device that has performed for over 10 years with wide acceptance,” Dr. Bernstein said. In addition to a longer-lasting dye kit, he said that new features include 50% more total energy enabling clinically relevant fluences to be delivered using a 15-mm diameter treatment beam, once-daily calibration instead of after every energy or spot size change, “both contact and dynamic spray cooling, and an Nd:YAG wavelength for treating larger vessels.”
Dr. Bernstein reported having received grant funding from Syneron Candela and Zeltiq. He also has received consulting fees from and holds ownership interest in Syneron Candela, and has served on the advisory board for Novoxel, Solta, Syneron Candela, and Zeltiq.
DALLAS – in a single-center study of 20 patients.
“Recent advances in pulsed-dye laser technology enable 50% higher output energies and much longer dye life,” lead study author Eric F. Bernstein, MD, said at the annual conference of the American Society for Laser Medicine and Surgery. “A 15-mm treatment diameter is now possible, which makes treatment faster and possibly more effective due to increased penetration of laser energy. Compared with a 10-mm spot size, which most of us use, a 15 mm is a 125% larger beam diameter, so it’s a big difference in treatment area.”
Blinded assessment of digital and cross-polarized images taken 8 weeks following the last treatment was performed using an 11-point clearance scale. The Investigator Global Assessment Scale was used to evaluate inflammatory lesions, erythema, and telangiectasia, and safety was assessed by incidence and severity of side effects. The investigators and subjects assessed satisfaction with the treatment outcome on a 5-point Likert scale (–2, very dissatisfied; –1, dissatisfied; 0, no opinion; 1, satisfied; and 2, very satisfied). Dr. Bernstein also evaluated the patients for purpura, petechiae, edema, erythema, blistering, and crusting on a 0-3 point scale (0, absent; 1, mild; 2, moderate; and 3, severe).
Of the 20 subjects, 16 females and 3 males completed the study. All had Fitzpatrick skin types II-IV and 17 of 19 subjects received four treatments, while 2 received three treatments because of scheduling challenges. Between baseline and 8 weeks following the last treatment, mean Investigator Global Assessment scores improved significantly for overall score (from 4.3 to 1.8; P less than .0001), as well as for inflammatory lesions (from 1.7 to 1.0; P less than .005), erythema (from 4.5 to 1.6; P less than .0001), and for telangiectasia (from 4.2 to 1.1; P less than .0001).
Dr. Bernstein also reported that blinded evaluators correctly identified baseline images in 55 of 57 image pairs (96.5%), while the average score improvement in their rosacea was 52.5%, and ranged from 30.0% to 86.7%. In addition, 17 of 19 subjects (89%) showed a score improvement of more than 40%, while 57% of subjects had a score improvement of greater than 50%.
Patients and investigators both recorded a mean satisfaction score of 1.9, and 18 of 19 subjects reported being “very satisfied” with the treatment.
The average pain score was 5.6 on a 0-10 scale, while common side effects that resolved within 1-3 days without intervention included mild edema, mild to moderate erythema, and mild to moderate bruising. No cases of hyperpigmentation, hypopigmentation, blistering, or scarring occurred.
“The newly designed pulsed-dye laser is a major change in a device that has performed for over 10 years with wide acceptance,” Dr. Bernstein said. In addition to a longer-lasting dye kit, he said that new features include 50% more total energy enabling clinically relevant fluences to be delivered using a 15-mm diameter treatment beam, once-daily calibration instead of after every energy or spot size change, “both contact and dynamic spray cooling, and an Nd:YAG wavelength for treating larger vessels.”
Dr. Bernstein reported having received grant funding from Syneron Candela and Zeltiq. He also has received consulting fees from and holds ownership interest in Syneron Candela, and has served on the advisory board for Novoxel, Solta, Syneron Candela, and Zeltiq.
DALLAS – in a single-center study of 20 patients.
“Recent advances in pulsed-dye laser technology enable 50% higher output energies and much longer dye life,” lead study author Eric F. Bernstein, MD, said at the annual conference of the American Society for Laser Medicine and Surgery. “A 15-mm treatment diameter is now possible, which makes treatment faster and possibly more effective due to increased penetration of laser energy. Compared with a 10-mm spot size, which most of us use, a 15 mm is a 125% larger beam diameter, so it’s a big difference in treatment area.”
Blinded assessment of digital and cross-polarized images taken 8 weeks following the last treatment was performed using an 11-point clearance scale. The Investigator Global Assessment Scale was used to evaluate inflammatory lesions, erythema, and telangiectasia, and safety was assessed by incidence and severity of side effects. The investigators and subjects assessed satisfaction with the treatment outcome on a 5-point Likert scale (–2, very dissatisfied; –1, dissatisfied; 0, no opinion; 1, satisfied; and 2, very satisfied). Dr. Bernstein also evaluated the patients for purpura, petechiae, edema, erythema, blistering, and crusting on a 0-3 point scale (0, absent; 1, mild; 2, moderate; and 3, severe).
Of the 20 subjects, 16 females and 3 males completed the study. All had Fitzpatrick skin types II-IV and 17 of 19 subjects received four treatments, while 2 received three treatments because of scheduling challenges. Between baseline and 8 weeks following the last treatment, mean Investigator Global Assessment scores improved significantly for overall score (from 4.3 to 1.8; P less than .0001), as well as for inflammatory lesions (from 1.7 to 1.0; P less than .005), erythema (from 4.5 to 1.6; P less than .0001), and for telangiectasia (from 4.2 to 1.1; P less than .0001).
Dr. Bernstein also reported that blinded evaluators correctly identified baseline images in 55 of 57 image pairs (96.5%), while the average score improvement in their rosacea was 52.5%, and ranged from 30.0% to 86.7%. In addition, 17 of 19 subjects (89%) showed a score improvement of more than 40%, while 57% of subjects had a score improvement of greater than 50%.
Patients and investigators both recorded a mean satisfaction score of 1.9, and 18 of 19 subjects reported being “very satisfied” with the treatment.
The average pain score was 5.6 on a 0-10 scale, while common side effects that resolved within 1-3 days without intervention included mild edema, mild to moderate erythema, and mild to moderate bruising. No cases of hyperpigmentation, hypopigmentation, blistering, or scarring occurred.
“The newly designed pulsed-dye laser is a major change in a device that has performed for over 10 years with wide acceptance,” Dr. Bernstein said. In addition to a longer-lasting dye kit, he said that new features include 50% more total energy enabling clinically relevant fluences to be delivered using a 15-mm diameter treatment beam, once-daily calibration instead of after every energy or spot size change, “both contact and dynamic spray cooling, and an Nd:YAG wavelength for treating larger vessels.”
Dr. Bernstein reported having received grant funding from Syneron Candela and Zeltiq. He also has received consulting fees from and holds ownership interest in Syneron Candela, and has served on the advisory board for Novoxel, Solta, Syneron Candela, and Zeltiq.
REPORTING FROM ASLMS 2018
Key clinical point: A newly designed pulsed-dye laser allows for fluences to be delivered with a 15-mm diameter treatment beam.
Major finding: Blinded evaluators rated the average score improvement in subjects’ rosacea as 52.5%, and ranged from 30.0% to 86.7%.
Study details: A study of 20 patients with erythematotelangiectatic rosacea who received pulsed-dye laser treatments every 4 weeks.
Disclosures: Dr. Bernstein reported having received grant funding from Syneron Candela and Zeltiq. He also has received consulting fees from and holds ownership interest in Syneron Candela, and has served on the advisory board for Novoxel, Solta, Syneron Candela, and Zeltiq.
Collagen remodeling observed after laser treatment in EB patient
DALLAS – Fractional led to considerable clinical improvement, including thickening of the dermis, results from a case report showed.
“We have so much more to learn about how the laser treatments are modifying these intricate pathways,” lead study author Samantha Schneider, MD, said in an interview following the annual conference of the American Society for Laser Medicine and Surgery. “But, our project suggests that patients with genetic blistering diseases may benefit from fractional laser therapy in combination with topical PLLA. This may be a good option, particularly for patients who are looking for more therapeutic options for slowly healing wounds and have exhausted other more conventional treatment modalities.”
Drawing from this previous work, Dr. Schneider and her associates hypothesized that fractional ablative laser treatment and topical PLLA might help a 27-year-old RDEB patient with revertant mosaicism who presented for management of large, nonhealing erosions on her upper back and posterior neck, complicated by frequent Staphylococcus infections. Over a 2-year period the researchers administered 15 fractional CO2 laser treatments with a single-pulse, nonoverlapping technique with settings of 15 mJ of energy and 15% density. They immediately applied concentrated topical PLLA to the treated area and obtained punch biopsy specimens from treated and untreated affected skin and clinically normal-appearing skin after the seventh treatment for histopathologic and immunohistologic examination.
Since the time of treatment, the patient reported marked improvement with a decreased number of erosions, as well as decreased pain. In addition, the hematoxylin and eosin slides showed increased collagen I (mature collagen) in the treated sample, “which suggests that we may be inducing a type of neocollagenesis, which is exciting particularly if it seems to work for patients with genetic alterations in collagen,” Dr. Schneider said. “Additionally, the indirect immunofluorescence [IIF] showed increased collagen VII, which is absent in the patient’s untreated skin. This was truly surprising and warrants more investigation as to how we may be affecting patients’ biology with this combination treatment.”
She acknowledged that more studies are required to confirm the findings. “Furthermore, we did not examine the fractional laser therapy and the topical PLLA independently so we cannot say whether the effect is synergistic or due primarily to one modality versus the other,” she noted. “Lastly, the IIF interpretation was challenging particularly in the untreated skin due to the epidermal detachment and edge staining. However, when viewed in comparison to the treated skin, we noted increased collagen VII in the treated sample.”
Dr. Schneider reported having no relevant disclosures.
DALLAS – Fractional led to considerable clinical improvement, including thickening of the dermis, results from a case report showed.
“We have so much more to learn about how the laser treatments are modifying these intricate pathways,” lead study author Samantha Schneider, MD, said in an interview following the annual conference of the American Society for Laser Medicine and Surgery. “But, our project suggests that patients with genetic blistering diseases may benefit from fractional laser therapy in combination with topical PLLA. This may be a good option, particularly for patients who are looking for more therapeutic options for slowly healing wounds and have exhausted other more conventional treatment modalities.”
Drawing from this previous work, Dr. Schneider and her associates hypothesized that fractional ablative laser treatment and topical PLLA might help a 27-year-old RDEB patient with revertant mosaicism who presented for management of large, nonhealing erosions on her upper back and posterior neck, complicated by frequent Staphylococcus infections. Over a 2-year period the researchers administered 15 fractional CO2 laser treatments with a single-pulse, nonoverlapping technique with settings of 15 mJ of energy and 15% density. They immediately applied concentrated topical PLLA to the treated area and obtained punch biopsy specimens from treated and untreated affected skin and clinically normal-appearing skin after the seventh treatment for histopathologic and immunohistologic examination.
Since the time of treatment, the patient reported marked improvement with a decreased number of erosions, as well as decreased pain. In addition, the hematoxylin and eosin slides showed increased collagen I (mature collagen) in the treated sample, “which suggests that we may be inducing a type of neocollagenesis, which is exciting particularly if it seems to work for patients with genetic alterations in collagen,” Dr. Schneider said. “Additionally, the indirect immunofluorescence [IIF] showed increased collagen VII, which is absent in the patient’s untreated skin. This was truly surprising and warrants more investigation as to how we may be affecting patients’ biology with this combination treatment.”
She acknowledged that more studies are required to confirm the findings. “Furthermore, we did not examine the fractional laser therapy and the topical PLLA independently so we cannot say whether the effect is synergistic or due primarily to one modality versus the other,” she noted. “Lastly, the IIF interpretation was challenging particularly in the untreated skin due to the epidermal detachment and edge staining. However, when viewed in comparison to the treated skin, we noted increased collagen VII in the treated sample.”
Dr. Schneider reported having no relevant disclosures.
DALLAS – Fractional led to considerable clinical improvement, including thickening of the dermis, results from a case report showed.
“We have so much more to learn about how the laser treatments are modifying these intricate pathways,” lead study author Samantha Schneider, MD, said in an interview following the annual conference of the American Society for Laser Medicine and Surgery. “But, our project suggests that patients with genetic blistering diseases may benefit from fractional laser therapy in combination with topical PLLA. This may be a good option, particularly for patients who are looking for more therapeutic options for slowly healing wounds and have exhausted other more conventional treatment modalities.”
Drawing from this previous work, Dr. Schneider and her associates hypothesized that fractional ablative laser treatment and topical PLLA might help a 27-year-old RDEB patient with revertant mosaicism who presented for management of large, nonhealing erosions on her upper back and posterior neck, complicated by frequent Staphylococcus infections. Over a 2-year period the researchers administered 15 fractional CO2 laser treatments with a single-pulse, nonoverlapping technique with settings of 15 mJ of energy and 15% density. They immediately applied concentrated topical PLLA to the treated area and obtained punch biopsy specimens from treated and untreated affected skin and clinically normal-appearing skin after the seventh treatment for histopathologic and immunohistologic examination.
Since the time of treatment, the patient reported marked improvement with a decreased number of erosions, as well as decreased pain. In addition, the hematoxylin and eosin slides showed increased collagen I (mature collagen) in the treated sample, “which suggests that we may be inducing a type of neocollagenesis, which is exciting particularly if it seems to work for patients with genetic alterations in collagen,” Dr. Schneider said. “Additionally, the indirect immunofluorescence [IIF] showed increased collagen VII, which is absent in the patient’s untreated skin. This was truly surprising and warrants more investigation as to how we may be affecting patients’ biology with this combination treatment.”
She acknowledged that more studies are required to confirm the findings. “Furthermore, we did not examine the fractional laser therapy and the topical PLLA independently so we cannot say whether the effect is synergistic or due primarily to one modality versus the other,” she noted. “Lastly, the IIF interpretation was challenging particularly in the untreated skin due to the epidermal detachment and edge staining. However, when viewed in comparison to the treated skin, we noted increased collagen VII in the treated sample.”
Dr. Schneider reported having no relevant disclosures.
Key clinical point: Fractional ablative laser treatment combined with poly-L-lactic acid may aid in the care of certain patients with recessive dystrophic epidermolysis bullosa.
Major finding: Since the time of treatment, the patient reported marked improvement with a decreased number of erosions as well as decreased pain.
Study details: A case report of a 27-year-old recessive dystrophic epidermolysis bullosa patient with revertant mosaicism.
Disclosures: Dr. Schneider reported having no financial disclosures.
Study pits cryolipolysis versus HIFU for fat reduction in the flank region
DALLAS – While cryolipolysis and high-intensity focused ultrasound are both effective at reducing subcutaneous fat in the flank region, cryolipolysis appeared to be less painful and more effective in a small, randomized trial.
Noninvasive subcutaneous fat reduction is becoming increasingly popular, study author Farhaad R. Riyaz, MD, observed at the annual conference of the American Society for Laser Medicine and Surgery. “High-intensity focused ultrasound seems to be less popular than cryolipolysis. It uses sound waves to create heat and is similar in technology to light traveling through a magnifying glass to create heat at a focal point. But the two technologies really haven’t been rigorously compared in the literature,” he added.
Dr. Riyaz and his associates in the division of cutaneous and aesthetic surgery at Northwestern University, Chicago, enrolled 12 healthy female participants with a body mass index between 18 and 30 kg/m2 and moderate fat in the abdomen flanks. In the split-body, parallel-group trial, the subjects were randomized to cryolipolysis on one flank and to high-intensity focused ultrasound (HIFU) on the contralateral side. Study participants were asked to maintain their weight throughout the 12-week study. Treatments were performed at baseline, week 4, and week 8, with a follow-up visit at week 12. The primary outcome was thickness of subcutaneous fat as measured by ultrasound; secondary outcomes included pain, patient-reported improvement, and total circumference of the abdomen and flanks.
The mean age of the 12 participants was 39 years, 8 were white, and most had Fitzpatrick skin types II and IV (33% and 42%, respectively). Dr. Riyaz reported that (P = .0007 and P = .0341, respectively), as measured by diagnostic ultrasound. The researchers noted significantly less fat in the flanks on the sides treated with cryolipolysis, compared with the sides treated with HIFU (P = .007). Study participants reported significantly more pain with HIFU compared with cryolipolysis (P = .0002).
“Although participant-reported improvement in the appearance of their flanks was significant for both treatments [P less than .0001], patients couldn’t appreciate a difference between the side that was treated with HIFU and the side that was treated with cryolipolysis,” Dr. Riyaz said. “In addition, the total abdominal circumference did not change throughout the study for either group.”
He reported having no financial disclosures.
DALLAS – While cryolipolysis and high-intensity focused ultrasound are both effective at reducing subcutaneous fat in the flank region, cryolipolysis appeared to be less painful and more effective in a small, randomized trial.
Noninvasive subcutaneous fat reduction is becoming increasingly popular, study author Farhaad R. Riyaz, MD, observed at the annual conference of the American Society for Laser Medicine and Surgery. “High-intensity focused ultrasound seems to be less popular than cryolipolysis. It uses sound waves to create heat and is similar in technology to light traveling through a magnifying glass to create heat at a focal point. But the two technologies really haven’t been rigorously compared in the literature,” he added.
Dr. Riyaz and his associates in the division of cutaneous and aesthetic surgery at Northwestern University, Chicago, enrolled 12 healthy female participants with a body mass index between 18 and 30 kg/m2 and moderate fat in the abdomen flanks. In the split-body, parallel-group trial, the subjects were randomized to cryolipolysis on one flank and to high-intensity focused ultrasound (HIFU) on the contralateral side. Study participants were asked to maintain their weight throughout the 12-week study. Treatments were performed at baseline, week 4, and week 8, with a follow-up visit at week 12. The primary outcome was thickness of subcutaneous fat as measured by ultrasound; secondary outcomes included pain, patient-reported improvement, and total circumference of the abdomen and flanks.
The mean age of the 12 participants was 39 years, 8 were white, and most had Fitzpatrick skin types II and IV (33% and 42%, respectively). Dr. Riyaz reported that (P = .0007 and P = .0341, respectively), as measured by diagnostic ultrasound. The researchers noted significantly less fat in the flanks on the sides treated with cryolipolysis, compared with the sides treated with HIFU (P = .007). Study participants reported significantly more pain with HIFU compared with cryolipolysis (P = .0002).
“Although participant-reported improvement in the appearance of their flanks was significant for both treatments [P less than .0001], patients couldn’t appreciate a difference between the side that was treated with HIFU and the side that was treated with cryolipolysis,” Dr. Riyaz said. “In addition, the total abdominal circumference did not change throughout the study for either group.”
He reported having no financial disclosures.
DALLAS – While cryolipolysis and high-intensity focused ultrasound are both effective at reducing subcutaneous fat in the flank region, cryolipolysis appeared to be less painful and more effective in a small, randomized trial.
Noninvasive subcutaneous fat reduction is becoming increasingly popular, study author Farhaad R. Riyaz, MD, observed at the annual conference of the American Society for Laser Medicine and Surgery. “High-intensity focused ultrasound seems to be less popular than cryolipolysis. It uses sound waves to create heat and is similar in technology to light traveling through a magnifying glass to create heat at a focal point. But the two technologies really haven’t been rigorously compared in the literature,” he added.
Dr. Riyaz and his associates in the division of cutaneous and aesthetic surgery at Northwestern University, Chicago, enrolled 12 healthy female participants with a body mass index between 18 and 30 kg/m2 and moderate fat in the abdomen flanks. In the split-body, parallel-group trial, the subjects were randomized to cryolipolysis on one flank and to high-intensity focused ultrasound (HIFU) on the contralateral side. Study participants were asked to maintain their weight throughout the 12-week study. Treatments were performed at baseline, week 4, and week 8, with a follow-up visit at week 12. The primary outcome was thickness of subcutaneous fat as measured by ultrasound; secondary outcomes included pain, patient-reported improvement, and total circumference of the abdomen and flanks.
The mean age of the 12 participants was 39 years, 8 were white, and most had Fitzpatrick skin types II and IV (33% and 42%, respectively). Dr. Riyaz reported that (P = .0007 and P = .0341, respectively), as measured by diagnostic ultrasound. The researchers noted significantly less fat in the flanks on the sides treated with cryolipolysis, compared with the sides treated with HIFU (P = .007). Study participants reported significantly more pain with HIFU compared with cryolipolysis (P = .0002).
“Although participant-reported improvement in the appearance of their flanks was significant for both treatments [P less than .0001], patients couldn’t appreciate a difference between the side that was treated with HIFU and the side that was treated with cryolipolysis,” Dr. Riyaz said. “In addition, the total abdominal circumference did not change throughout the study for either group.”
He reported having no financial disclosures.
Key clinical point: Both cryolipolysis and high-intensity focused ultrasound (HIFU) are effective at reducing subcutaneous fat in the flank region.
Major finding: At week 12 follow-up, both cryolipolysis and HIFU significantly reduced fat in the flanks, compared with baseline (P = .0007 and P = .0341, respectively), as measured by diagnostic ultrasound.
Study details: A split-body, parallel-group trial in which 12 women were randomized to cryolipolysis on one flank and to HIFU on the contralateral side.
Disclosures: Dr. Riyaz reported having no financial disclosures.
Treatment of basal cell carcinoma with 1064-nm Nd:YAG laser promising
DALLAS – One year after patients underwent treatment of basal cell carcinoma (BCC) with the 1064-nm Nd:YAG laser, no recurrences have occurred, according to early results from a study being conducted at two centers.
“ Arisa E. Ortiz, MD, said at the annual conference of the American Society for Laser Medicine and Surgery. “Clearance rates are comparable to or better than other topical modalities such as electrodesiccation and curettage and topical imiquimod. It’s a reasonable alternative for treatment patients with multiple tumors or those who are poor surgical candidates.”
In an ongoing study, she and Mathew M. Avram, MD, director of the Massachusetts General Hospital Dermatology Laser & Cosmetic Center, Boston, have treated 19 superficial, nodular, and pigmented BCC tumors in 11 patients 31-85 years of age. Tumor sizes ranged from 3 mm x 3 mm to 21 mm x 11 mm. Indications for laser treatment have included being a poor surgical candidate (one patient had a history of bleeding complications), having multiple tumors (one patient had Curry-Jones syndrome) – or simply wishing to not undergo surgery. “They didn’t want a surgical scar, or they didn’t want to limit their activity after surgery,” Dr. Ortiz said.
Patients underwent one 1064-nm Nd:YAG laser treatment. The anesthesia was 0.5% lidocaine with no epinephrine. Treatment settings were a 5-mm spot size delivered at a fluence of 140 J/cm2 in a pulse duration of 7-8 milliseconds. The number of pulses ranged from 14 to 36. The immediate endpoint was slight graying and slight contraction. “When you’re using the 1064-nm Nd:YAG for cosmetic purposes, you don’t want to see these endpoints, but we are treating skin cancer, so you do want to see some contraction and graying,” she said. The procedure was covered under insurance and billed as malignant destruction (CPT codes 17260-17266 and 17280-17283).
Dr. Ortiz reported that there have been no recurrences in the 11 patients at 1-year follow-up as determined by clinical observation. “There are many advantages to laser treatment of basal cell carcinoma,” she concluded. “There’s only one treatment visit, so you don’t have to come back for suture removal, and it’s a very quick treatment. There’s no significant downtime or limitation on activities, and there’s minimal wound care – just ointment and a Band-Aid – and relatively decreased risk for complications such as infection or bleeding, and minimal to no scar.”
“Laser surgery also provides precision that ordinary surgical techniques cannot match. Despite the obvious obstacles, there is no reason such surgical techniques cannot be expanded someday to other internal cutaneous tumors, including GI tumors. To some extent this is happening already. Vascular lasers are being used to treat a bleeding disorder of the colon known as angiodysplasia. Cautious exploration of laser- and light-based treatments should be further explored as a means of sparing tissue and surgical morbidity.”
Dr. Ortiz disclosed that she has received grant funding from Sienna and Revance, as well as equipment from BTL, Invasix, and Sciton. She has received consulting fees from Alastin, Merz, and Sciton; honoraria from Alastin, Cutera, Invasix, and Sciton; and she holds ownership interest with Allergan. She also has served on the advisory boards for Alastin, Allergan, Invasix, Rodan + Fields, Sciton, Sienna, and Merz.
Dr. Avram disclosed that he serves on the medical advisory board of Sciton and on the scientific advisory boards of Sienna Biopharmaceuticals, Cytrellis, and Allergan. He is also a consultant for Merz Aesthetics, Allergan, Soliton, Invasix, and Revance and has intellectual property with Cytrellis. He also holds stock options with Cytrellis, Invasix, and Zalea.
DALLAS – One year after patients underwent treatment of basal cell carcinoma (BCC) with the 1064-nm Nd:YAG laser, no recurrences have occurred, according to early results from a study being conducted at two centers.
“ Arisa E. Ortiz, MD, said at the annual conference of the American Society for Laser Medicine and Surgery. “Clearance rates are comparable to or better than other topical modalities such as electrodesiccation and curettage and topical imiquimod. It’s a reasonable alternative for treatment patients with multiple tumors or those who are poor surgical candidates.”
In an ongoing study, she and Mathew M. Avram, MD, director of the Massachusetts General Hospital Dermatology Laser & Cosmetic Center, Boston, have treated 19 superficial, nodular, and pigmented BCC tumors in 11 patients 31-85 years of age. Tumor sizes ranged from 3 mm x 3 mm to 21 mm x 11 mm. Indications for laser treatment have included being a poor surgical candidate (one patient had a history of bleeding complications), having multiple tumors (one patient had Curry-Jones syndrome) – or simply wishing to not undergo surgery. “They didn’t want a surgical scar, or they didn’t want to limit their activity after surgery,” Dr. Ortiz said.
Patients underwent one 1064-nm Nd:YAG laser treatment. The anesthesia was 0.5% lidocaine with no epinephrine. Treatment settings were a 5-mm spot size delivered at a fluence of 140 J/cm2 in a pulse duration of 7-8 milliseconds. The number of pulses ranged from 14 to 36. The immediate endpoint was slight graying and slight contraction. “When you’re using the 1064-nm Nd:YAG for cosmetic purposes, you don’t want to see these endpoints, but we are treating skin cancer, so you do want to see some contraction and graying,” she said. The procedure was covered under insurance and billed as malignant destruction (CPT codes 17260-17266 and 17280-17283).
Dr. Ortiz reported that there have been no recurrences in the 11 patients at 1-year follow-up as determined by clinical observation. “There are many advantages to laser treatment of basal cell carcinoma,” she concluded. “There’s only one treatment visit, so you don’t have to come back for suture removal, and it’s a very quick treatment. There’s no significant downtime or limitation on activities, and there’s minimal wound care – just ointment and a Band-Aid – and relatively decreased risk for complications such as infection or bleeding, and minimal to no scar.”
“Laser surgery also provides precision that ordinary surgical techniques cannot match. Despite the obvious obstacles, there is no reason such surgical techniques cannot be expanded someday to other internal cutaneous tumors, including GI tumors. To some extent this is happening already. Vascular lasers are being used to treat a bleeding disorder of the colon known as angiodysplasia. Cautious exploration of laser- and light-based treatments should be further explored as a means of sparing tissue and surgical morbidity.”
Dr. Ortiz disclosed that she has received grant funding from Sienna and Revance, as well as equipment from BTL, Invasix, and Sciton. She has received consulting fees from Alastin, Merz, and Sciton; honoraria from Alastin, Cutera, Invasix, and Sciton; and she holds ownership interest with Allergan. She also has served on the advisory boards for Alastin, Allergan, Invasix, Rodan + Fields, Sciton, Sienna, and Merz.
Dr. Avram disclosed that he serves on the medical advisory board of Sciton and on the scientific advisory boards of Sienna Biopharmaceuticals, Cytrellis, and Allergan. He is also a consultant for Merz Aesthetics, Allergan, Soliton, Invasix, and Revance and has intellectual property with Cytrellis. He also holds stock options with Cytrellis, Invasix, and Zalea.
DALLAS – One year after patients underwent treatment of basal cell carcinoma (BCC) with the 1064-nm Nd:YAG laser, no recurrences have occurred, according to early results from a study being conducted at two centers.
“ Arisa E. Ortiz, MD, said at the annual conference of the American Society for Laser Medicine and Surgery. “Clearance rates are comparable to or better than other topical modalities such as electrodesiccation and curettage and topical imiquimod. It’s a reasonable alternative for treatment patients with multiple tumors or those who are poor surgical candidates.”
In an ongoing study, she and Mathew M. Avram, MD, director of the Massachusetts General Hospital Dermatology Laser & Cosmetic Center, Boston, have treated 19 superficial, nodular, and pigmented BCC tumors in 11 patients 31-85 years of age. Tumor sizes ranged from 3 mm x 3 mm to 21 mm x 11 mm. Indications for laser treatment have included being a poor surgical candidate (one patient had a history of bleeding complications), having multiple tumors (one patient had Curry-Jones syndrome) – or simply wishing to not undergo surgery. “They didn’t want a surgical scar, or they didn’t want to limit their activity after surgery,” Dr. Ortiz said.
Patients underwent one 1064-nm Nd:YAG laser treatment. The anesthesia was 0.5% lidocaine with no epinephrine. Treatment settings were a 5-mm spot size delivered at a fluence of 140 J/cm2 in a pulse duration of 7-8 milliseconds. The number of pulses ranged from 14 to 36. The immediate endpoint was slight graying and slight contraction. “When you’re using the 1064-nm Nd:YAG for cosmetic purposes, you don’t want to see these endpoints, but we are treating skin cancer, so you do want to see some contraction and graying,” she said. The procedure was covered under insurance and billed as malignant destruction (CPT codes 17260-17266 and 17280-17283).
Dr. Ortiz reported that there have been no recurrences in the 11 patients at 1-year follow-up as determined by clinical observation. “There are many advantages to laser treatment of basal cell carcinoma,” she concluded. “There’s only one treatment visit, so you don’t have to come back for suture removal, and it’s a very quick treatment. There’s no significant downtime or limitation on activities, and there’s minimal wound care – just ointment and a Band-Aid – and relatively decreased risk for complications such as infection or bleeding, and minimal to no scar.”
“Laser surgery also provides precision that ordinary surgical techniques cannot match. Despite the obvious obstacles, there is no reason such surgical techniques cannot be expanded someday to other internal cutaneous tumors, including GI tumors. To some extent this is happening already. Vascular lasers are being used to treat a bleeding disorder of the colon known as angiodysplasia. Cautious exploration of laser- and light-based treatments should be further explored as a means of sparing tissue and surgical morbidity.”
Dr. Ortiz disclosed that she has received grant funding from Sienna and Revance, as well as equipment from BTL, Invasix, and Sciton. She has received consulting fees from Alastin, Merz, and Sciton; honoraria from Alastin, Cutera, Invasix, and Sciton; and she holds ownership interest with Allergan. She also has served on the advisory boards for Alastin, Allergan, Invasix, Rodan + Fields, Sciton, Sienna, and Merz.
Dr. Avram disclosed that he serves on the medical advisory board of Sciton and on the scientific advisory boards of Sienna Biopharmaceuticals, Cytrellis, and Allergan. He is also a consultant for Merz Aesthetics, Allergan, Soliton, Invasix, and Revance and has intellectual property with Cytrellis. He also holds stock options with Cytrellis, Invasix, and Zalea.
REPORTING FROM ASLMS 2018
Key clinical point: Clinicians can noninvasively treat certain basal cell carcinoma tumor subtypes with the 1064-nm Nd:YAG laser.
Major finding: After 1 year of follow-up, no recurrences of basal cell carcinoma have occurred.
Study details: A 1-year follow-up study of 19 BCC tumors in 11 patients 31 to 85 years of age who were treated with the 1064-nm Nd:YAG laser.
Disclosures: Dr. Ortiz disclosed that she has received grant funding from Sienna and Revance, as well as equipment from BTL, Invasix, and Sciton. She has received consulting fees from Alastin, Merz, and Sciton; honoraria from Alastin, Cutera, Invasix, and Sciton; and she holds ownership interest with Allergan. She also has served on the advisory boards for Alastin, Allergan, Invasix, Rodan + Fields, Sciton, Sienna, and Merz.
Dr. Avram disclosed that he serves on the medical advisory board of Sciton and on the scientific advisory boards of Sienna Biopharmaceuticals, Cytrellis, and Allergan. He is also a consultant for Merz Aesthetics, Allergan, Soliton, Invasix, and Revance and has intellectual property with Cytrellis. He also holds stock options with Cytrellis, Invasix, and Zalea.
Novel, noninvasive skin cancer detection device shows promise
DALLAS – An investigational device that couples laser spectroscopy with a machine-learning algorithm demonstrated a high sensitivity and specificity for discriminating skin cancers from benign lesions in real time, results from a single-center study showed.
“More than 5.4 million cases of nonmelanoma skin cancer were treated in 2012, but the accuracy of skin cancer screening prior to biopsy is pretty low, about 70%, and is individual dependent,” lead study author Sung Hyun Pyun, PhD, said at the annual conference of the American Society for Laser Medicine and Surgery. “There have been several in vivo skin cancer screening devices based on noninvasive techniques such as multispectral imaging, Raman spectroscopy, and electrical impedance spectroscopy, but their diagnostic accuracies were not sufficient for clinical use and could not be applied in real time.”
For the single-site study, carried out in Australia, the researchers collected 502 emission spectra from skin cancers confirmed with biopsy results. They also collected 1,429 emission spectra from benign lesions. They achieved a sensitivity of 92% and a specificity of 90% out of 1,931 spectral data sets. No adverse events occurred and no microscopic damage of the irradiated skin was observed.
“Pathologic diagnosis-based cancer detection is considered to be time- and labor-consuming, and can sometimes be individual dependent,” Dr. Pyun said. “Our real-time, noninvasive, in vivo skin cancer detection device demonstrated a high sensitivity and specificity for discriminating skin cancers from benign lesions.” He added that the device could be helpful in office-based cancer screening and real-time, on-site cancer detection during skin cancer surgeries.
Larger, multicenter studies of the device are being planned. Dr. Pyun holds ownership interests with Speclipse, and is an employee of the company.
DALLAS – An investigational device that couples laser spectroscopy with a machine-learning algorithm demonstrated a high sensitivity and specificity for discriminating skin cancers from benign lesions in real time, results from a single-center study showed.
“More than 5.4 million cases of nonmelanoma skin cancer were treated in 2012, but the accuracy of skin cancer screening prior to biopsy is pretty low, about 70%, and is individual dependent,” lead study author Sung Hyun Pyun, PhD, said at the annual conference of the American Society for Laser Medicine and Surgery. “There have been several in vivo skin cancer screening devices based on noninvasive techniques such as multispectral imaging, Raman spectroscopy, and electrical impedance spectroscopy, but their diagnostic accuracies were not sufficient for clinical use and could not be applied in real time.”
For the single-site study, carried out in Australia, the researchers collected 502 emission spectra from skin cancers confirmed with biopsy results. They also collected 1,429 emission spectra from benign lesions. They achieved a sensitivity of 92% and a specificity of 90% out of 1,931 spectral data sets. No adverse events occurred and no microscopic damage of the irradiated skin was observed.
“Pathologic diagnosis-based cancer detection is considered to be time- and labor-consuming, and can sometimes be individual dependent,” Dr. Pyun said. “Our real-time, noninvasive, in vivo skin cancer detection device demonstrated a high sensitivity and specificity for discriminating skin cancers from benign lesions.” He added that the device could be helpful in office-based cancer screening and real-time, on-site cancer detection during skin cancer surgeries.
Larger, multicenter studies of the device are being planned. Dr. Pyun holds ownership interests with Speclipse, and is an employee of the company.
DALLAS – An investigational device that couples laser spectroscopy with a machine-learning algorithm demonstrated a high sensitivity and specificity for discriminating skin cancers from benign lesions in real time, results from a single-center study showed.
“More than 5.4 million cases of nonmelanoma skin cancer were treated in 2012, but the accuracy of skin cancer screening prior to biopsy is pretty low, about 70%, and is individual dependent,” lead study author Sung Hyun Pyun, PhD, said at the annual conference of the American Society for Laser Medicine and Surgery. “There have been several in vivo skin cancer screening devices based on noninvasive techniques such as multispectral imaging, Raman spectroscopy, and electrical impedance spectroscopy, but their diagnostic accuracies were not sufficient for clinical use and could not be applied in real time.”
For the single-site study, carried out in Australia, the researchers collected 502 emission spectra from skin cancers confirmed with biopsy results. They also collected 1,429 emission spectra from benign lesions. They achieved a sensitivity of 92% and a specificity of 90% out of 1,931 spectral data sets. No adverse events occurred and no microscopic damage of the irradiated skin was observed.
“Pathologic diagnosis-based cancer detection is considered to be time- and labor-consuming, and can sometimes be individual dependent,” Dr. Pyun said. “Our real-time, noninvasive, in vivo skin cancer detection device demonstrated a high sensitivity and specificity for discriminating skin cancers from benign lesions.” He added that the device could be helpful in office-based cancer screening and real-time, on-site cancer detection during skin cancer surgeries.
Larger, multicenter studies of the device are being planned. Dr. Pyun holds ownership interests with Speclipse, and is an employee of the company.
REPORTING FROM ASLMS 2018
Key clinical point: A novel device that uses spectroscopy and machine-learning algorithms was found to be a promising tool for the detection of skin cancer.
Major finding: Out of 1,931 spectral data sets, the device achieved a sensitivity of 92% and a specificity of 90%.
Study details: A single-center analysis of 502 emission spectra from skin cancers confirmed with biopsy results.
Disclosures: Dr. Pyun holds ownership interests with Speclipse and is an employee of the company.
Novel dermal coring device effective for facial rejuvenation without using thermal energy
DALLAS – according to preliminary results from an ongoing study.
“This differs from laser treatment in the sense that there’s no thermal injury and it takes a deep core approach, along the lines of what you might expect from a punch biopsy,” lead study author Roy G. Geronemus, MD, said at the annual conference of the American Society for Laser Medicine and Surgery. “The device causes microscale excisions below the size that causes scar. It’s mechanical only, without the use of any thermal energy. There is quantitative and directional reduction in area of skin. This leads to wrinkle improvement, tightening, smoothing of lax skin, and skin rejuvenation.”
The average age of subjects was 64 years, and all had Fitzpatrick types II or III skin. No unanticipated adverse events or serious adverse events were observed, and histology from 3 subjects showed an excellent healing profile and no scarring. The average pain during treatment was 0.36 on the 0-10 Wong-Baker scale.
Interim 90-day data demonstrated that 87% of 30 cheek areas had 1, 2, or 3 levels of improvement in moderate to severe cheek wrinkles on the Lemperle scale, according to primary investigator assessment. Investigators and subjects scored “improved to very much improved” in 93% of patients per the Global Aesthetic Improvement Scale, and 80% of the patients reported being “satisfied to extremely satisfied” with their aesthetic results.
Dr. Geronemus noted that, while it takes 2 to 7 days for wounds to close following ablative procedures, wounds close in about 10 minutes following microexcisional treatment, which possibly leads to faster healing of tissue. “Most people expect some downtime to achieve effective, long-lasting results,” he said. “The mean downtime was 3.8 days; 75% of subjects did not miss work, and 46% did not miss any social or leisure activities.”
To date, 79 subjects have been treated and a 90-day pivotal study is under way. Based on the clinical data to date, he said, “the new technique offers the ability to remove a significant amount of damaged, lax skin without concern of scarring or pigmentary change.”
Dr. Geronemus reported having served on the advisory board or as an investigator for Cynosure, Syneron Candela, Cutera, Revance Therapeutics, Allergan, Cytrellis Biosystems, the New York Stem Cell Foundation, among others. He also holds ownership interests with Cytrellis, the company that developed the coring device.
dbrunk@mdedge.com
DALLAS – according to preliminary results from an ongoing study.
“This differs from laser treatment in the sense that there’s no thermal injury and it takes a deep core approach, along the lines of what you might expect from a punch biopsy,” lead study author Roy G. Geronemus, MD, said at the annual conference of the American Society for Laser Medicine and Surgery. “The device causes microscale excisions below the size that causes scar. It’s mechanical only, without the use of any thermal energy. There is quantitative and directional reduction in area of skin. This leads to wrinkle improvement, tightening, smoothing of lax skin, and skin rejuvenation.”
The average age of subjects was 64 years, and all had Fitzpatrick types II or III skin. No unanticipated adverse events or serious adverse events were observed, and histology from 3 subjects showed an excellent healing profile and no scarring. The average pain during treatment was 0.36 on the 0-10 Wong-Baker scale.
Interim 90-day data demonstrated that 87% of 30 cheek areas had 1, 2, or 3 levels of improvement in moderate to severe cheek wrinkles on the Lemperle scale, according to primary investigator assessment. Investigators and subjects scored “improved to very much improved” in 93% of patients per the Global Aesthetic Improvement Scale, and 80% of the patients reported being “satisfied to extremely satisfied” with their aesthetic results.
Dr. Geronemus noted that, while it takes 2 to 7 days for wounds to close following ablative procedures, wounds close in about 10 minutes following microexcisional treatment, which possibly leads to faster healing of tissue. “Most people expect some downtime to achieve effective, long-lasting results,” he said. “The mean downtime was 3.8 days; 75% of subjects did not miss work, and 46% did not miss any social or leisure activities.”
To date, 79 subjects have been treated and a 90-day pivotal study is under way. Based on the clinical data to date, he said, “the new technique offers the ability to remove a significant amount of damaged, lax skin without concern of scarring or pigmentary change.”
Dr. Geronemus reported having served on the advisory board or as an investigator for Cynosure, Syneron Candela, Cutera, Revance Therapeutics, Allergan, Cytrellis Biosystems, the New York Stem Cell Foundation, among others. He also holds ownership interests with Cytrellis, the company that developed the coring device.
dbrunk@mdedge.com
DALLAS – according to preliminary results from an ongoing study.
“This differs from laser treatment in the sense that there’s no thermal injury and it takes a deep core approach, along the lines of what you might expect from a punch biopsy,” lead study author Roy G. Geronemus, MD, said at the annual conference of the American Society for Laser Medicine and Surgery. “The device causes microscale excisions below the size that causes scar. It’s mechanical only, without the use of any thermal energy. There is quantitative and directional reduction in area of skin. This leads to wrinkle improvement, tightening, smoothing of lax skin, and skin rejuvenation.”
The average age of subjects was 64 years, and all had Fitzpatrick types II or III skin. No unanticipated adverse events or serious adverse events were observed, and histology from 3 subjects showed an excellent healing profile and no scarring. The average pain during treatment was 0.36 on the 0-10 Wong-Baker scale.
Interim 90-day data demonstrated that 87% of 30 cheek areas had 1, 2, or 3 levels of improvement in moderate to severe cheek wrinkles on the Lemperle scale, according to primary investigator assessment. Investigators and subjects scored “improved to very much improved” in 93% of patients per the Global Aesthetic Improvement Scale, and 80% of the patients reported being “satisfied to extremely satisfied” with their aesthetic results.
Dr. Geronemus noted that, while it takes 2 to 7 days for wounds to close following ablative procedures, wounds close in about 10 minutes following microexcisional treatment, which possibly leads to faster healing of tissue. “Most people expect some downtime to achieve effective, long-lasting results,” he said. “The mean downtime was 3.8 days; 75% of subjects did not miss work, and 46% did not miss any social or leisure activities.”
To date, 79 subjects have been treated and a 90-day pivotal study is under way. Based on the clinical data to date, he said, “the new technique offers the ability to remove a significant amount of damaged, lax skin without concern of scarring or pigmentary change.”
Dr. Geronemus reported having served on the advisory board or as an investigator for Cynosure, Syneron Candela, Cutera, Revance Therapeutics, Allergan, Cytrellis Biosystems, the New York Stem Cell Foundation, among others. He also holds ownership interests with Cytrellis, the company that developed the coring device.
dbrunk@mdedge.com
REPORTING FROM ASLMS 2018
Key clinical point: A novel dermal microexcisional device has been designed to perform facial rejuvenation without the use of thermal energy.
Major finding: Interim 90-day data demonstrated that 87% of 30 cheek areas had 1, 2, or 3 levels of improvement in moderate to severe cheek wrinkles on the Lemperle scale.Study details: A multicenter study of 23 women who were treated bilaterally in the mid- to lower face with the 22-gauge coring device.
Disclosures: Dr. Geronemus reported having served on the advisory board or as an investigator for Cynosure, Syneron Candela, Cutera, Revance Therapeutics, Allergan, Cytrellis Biosystems, the New York Stem Cell Foundation, among others. He also holds ownership interests with Cytrellis.
Survey sheds light on consumer preferences regarding cosmetic procedures
DALLAS – The most important referral sources for cosmetic procedures are physicians and family members and friends, but there appears to be a knowledge gap as to which cosmetic providers are actually medical doctors, results from an online survey found.
“There are approximately 16 million cosmetic procedures performed in the U.S., and that number is growing rapidly,” study author Adam J. Wulkan, MD, said at the annual conference of the American Society for Laser Medicine and Surgery. “They’re performed by dermatologists, plastic surgeons, facial plastic surgeons, nurses, aestheticians, dentists, and more. Yet little is known regarding how consumers choose cosmetic procedures and providers.”
In an effort to elucidate how consumers research, self-educate, and choose cosmetic surgery procedures and providers, Dr. Wulkan and his associates used Survey Monkey to send a 20-item survey to 931 individuals in the United States. Respondents qualified for participation if they acknowledged having obtained or considered obtaining a cosmetic procedure. Of the 931 individuals polled, 323 (35%) met inclusion criteria; 84 (9%) had received a cosmetic procedure, and 239 (26%) had considered one. Nearly three-quarters of respondents (73%) were female; 22% of respondents were aged 18-29 years, 25% were aged 30-44 years, 29% were aged 45-59 years, and 24% were aged 60 years and older.
The top three sources for referral to cosmetic procedures/providers were physicians (67%), family or friends (57%), and Google searches (51%). However, fewer than half of respondents (42.5%) had a procedure performed after having a consultation. Reasons for this could be related to several factors, Dr. Wulkan said, including the cost of the procedure, fear of adverse events, or not being an appropriate candidate for treatment at the time of consultation.
The most popular cosmetic procedures were laser hair removal (28%), laser/light therapy (25%), abdominoplasty (25%), injectables (24%), and noninvasive fat reduction (24%). The survey also asked whether certain providers were medical doctors or not, and 89% of respondents thought plastic surgeons were medical doctors, and 82% thought that dermatologists were medical doctors; the respondents also thought dentists (52%), aestheticians (20%), and nurses (11%) were medical doctors. “There’s an education gap regarding which providers are medical doctors,” said Dr. Wulkan, who is a cosmetic laser and dermatology fellow at Massachusetts General Hospital, Boston. “With the growing number of nonphysician aesthetic providers, consumer education might be a valuable tool.”
Most respondents (82%) checked physician credentials prior to treatment. In addition, they were most likely to have their cosmetic procedures performed by either a plastic surgeon or by a dermatologist.
Dr. Wulkan acknowledged certain limitations of the study, including the sample size and reliability of the answers. He reported having no financial disclosures. One study coauthor had various ties to industry companies, including Allergan, Revance Therapeutics, and Cytrellis Biosystems.
DALLAS – The most important referral sources for cosmetic procedures are physicians and family members and friends, but there appears to be a knowledge gap as to which cosmetic providers are actually medical doctors, results from an online survey found.
“There are approximately 16 million cosmetic procedures performed in the U.S., and that number is growing rapidly,” study author Adam J. Wulkan, MD, said at the annual conference of the American Society for Laser Medicine and Surgery. “They’re performed by dermatologists, plastic surgeons, facial plastic surgeons, nurses, aestheticians, dentists, and more. Yet little is known regarding how consumers choose cosmetic procedures and providers.”
In an effort to elucidate how consumers research, self-educate, and choose cosmetic surgery procedures and providers, Dr. Wulkan and his associates used Survey Monkey to send a 20-item survey to 931 individuals in the United States. Respondents qualified for participation if they acknowledged having obtained or considered obtaining a cosmetic procedure. Of the 931 individuals polled, 323 (35%) met inclusion criteria; 84 (9%) had received a cosmetic procedure, and 239 (26%) had considered one. Nearly three-quarters of respondents (73%) were female; 22% of respondents were aged 18-29 years, 25% were aged 30-44 years, 29% were aged 45-59 years, and 24% were aged 60 years and older.
The top three sources for referral to cosmetic procedures/providers were physicians (67%), family or friends (57%), and Google searches (51%). However, fewer than half of respondents (42.5%) had a procedure performed after having a consultation. Reasons for this could be related to several factors, Dr. Wulkan said, including the cost of the procedure, fear of adverse events, or not being an appropriate candidate for treatment at the time of consultation.
The most popular cosmetic procedures were laser hair removal (28%), laser/light therapy (25%), abdominoplasty (25%), injectables (24%), and noninvasive fat reduction (24%). The survey also asked whether certain providers were medical doctors or not, and 89% of respondents thought plastic surgeons were medical doctors, and 82% thought that dermatologists were medical doctors; the respondents also thought dentists (52%), aestheticians (20%), and nurses (11%) were medical doctors. “There’s an education gap regarding which providers are medical doctors,” said Dr. Wulkan, who is a cosmetic laser and dermatology fellow at Massachusetts General Hospital, Boston. “With the growing number of nonphysician aesthetic providers, consumer education might be a valuable tool.”
Most respondents (82%) checked physician credentials prior to treatment. In addition, they were most likely to have their cosmetic procedures performed by either a plastic surgeon or by a dermatologist.
Dr. Wulkan acknowledged certain limitations of the study, including the sample size and reliability of the answers. He reported having no financial disclosures. One study coauthor had various ties to industry companies, including Allergan, Revance Therapeutics, and Cytrellis Biosystems.
DALLAS – The most important referral sources for cosmetic procedures are physicians and family members and friends, but there appears to be a knowledge gap as to which cosmetic providers are actually medical doctors, results from an online survey found.
“There are approximately 16 million cosmetic procedures performed in the U.S., and that number is growing rapidly,” study author Adam J. Wulkan, MD, said at the annual conference of the American Society for Laser Medicine and Surgery. “They’re performed by dermatologists, plastic surgeons, facial plastic surgeons, nurses, aestheticians, dentists, and more. Yet little is known regarding how consumers choose cosmetic procedures and providers.”
In an effort to elucidate how consumers research, self-educate, and choose cosmetic surgery procedures and providers, Dr. Wulkan and his associates used Survey Monkey to send a 20-item survey to 931 individuals in the United States. Respondents qualified for participation if they acknowledged having obtained or considered obtaining a cosmetic procedure. Of the 931 individuals polled, 323 (35%) met inclusion criteria; 84 (9%) had received a cosmetic procedure, and 239 (26%) had considered one. Nearly three-quarters of respondents (73%) were female; 22% of respondents were aged 18-29 years, 25% were aged 30-44 years, 29% were aged 45-59 years, and 24% were aged 60 years and older.
The top three sources for referral to cosmetic procedures/providers were physicians (67%), family or friends (57%), and Google searches (51%). However, fewer than half of respondents (42.5%) had a procedure performed after having a consultation. Reasons for this could be related to several factors, Dr. Wulkan said, including the cost of the procedure, fear of adverse events, or not being an appropriate candidate for treatment at the time of consultation.
The most popular cosmetic procedures were laser hair removal (28%), laser/light therapy (25%), abdominoplasty (25%), injectables (24%), and noninvasive fat reduction (24%). The survey also asked whether certain providers were medical doctors or not, and 89% of respondents thought plastic surgeons were medical doctors, and 82% thought that dermatologists were medical doctors; the respondents also thought dentists (52%), aestheticians (20%), and nurses (11%) were medical doctors. “There’s an education gap regarding which providers are medical doctors,” said Dr. Wulkan, who is a cosmetic laser and dermatology fellow at Massachusetts General Hospital, Boston. “With the growing number of nonphysician aesthetic providers, consumer education might be a valuable tool.”
Most respondents (82%) checked physician credentials prior to treatment. In addition, they were most likely to have their cosmetic procedures performed by either a plastic surgeon or by a dermatologist.
Dr. Wulkan acknowledged certain limitations of the study, including the sample size and reliability of the answers. He reported having no financial disclosures. One study coauthor had various ties to industry companies, including Allergan, Revance Therapeutics, and Cytrellis Biosystems.
REPORTING FROM ASLMS 2018
Key clinical point: An education gap exists regarding which cosmetic surgery providers are medical doctors.
Major finding: Physicians were the top source of referral to cosmetic procedures/providers, yet only 82% of consumers believe that dermatologists are medical doctors.
Study details: Responses from 323 consumers who completed a 20-item online survey about cosmetic surgery procedures and providers.
Disclosures: Dr. Wulkan reported having no financial disclosures. One study coauthor had various ties to industry companies, including Allergan, Revance, and Cytrellis.
VIDEO: Assessing consumer knowledge about cosmetic procedures
DALLAS – Most people rely on physicians, family, and friends to obtain relevant information about cosmetic procedures, but a knowledge gap exists regarding which cosmetic providers are medical doctors.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
Those are two key findings from a national survey that set out to assess how consumers research, educate themselves, and choose cosmetic procedures and providers. At the annual conference of the American Society for Laser Medicine and Surgery, study author Adam J. Wulkan, MD, discussed results from the 20-item survey, which was based on responses from 323 people who have obtained or have considered obtaining a cosmetic procedure such as laser hair removal.
Dr. Wulkan is a dermatologist at Massachusetts General Hospital, Boston. He reported having no financial disclosures. Study coauthor Mathew Avram, MD, serves on the medical advisory board of Sciton and on the scientific advisory boards of Sienna Biopharmaceuticals, Cytrellis, and Allergan. He also is consultant for Merz Aesthetics, Allergan, Soliton, Invasix, and Revance, and has intellectual property with Cytrellis. He also holds stock options with Cytrellis, Invasix, and Zalea.
DALLAS – Most people rely on physicians, family, and friends to obtain relevant information about cosmetic procedures, but a knowledge gap exists regarding which cosmetic providers are medical doctors.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
Those are two key findings from a national survey that set out to assess how consumers research, educate themselves, and choose cosmetic procedures and providers. At the annual conference of the American Society for Laser Medicine and Surgery, study author Adam J. Wulkan, MD, discussed results from the 20-item survey, which was based on responses from 323 people who have obtained or have considered obtaining a cosmetic procedure such as laser hair removal.
Dr. Wulkan is a dermatologist at Massachusetts General Hospital, Boston. He reported having no financial disclosures. Study coauthor Mathew Avram, MD, serves on the medical advisory board of Sciton and on the scientific advisory boards of Sienna Biopharmaceuticals, Cytrellis, and Allergan. He also is consultant for Merz Aesthetics, Allergan, Soliton, Invasix, and Revance, and has intellectual property with Cytrellis. He also holds stock options with Cytrellis, Invasix, and Zalea.
DALLAS – Most people rely on physicians, family, and friends to obtain relevant information about cosmetic procedures, but a knowledge gap exists regarding which cosmetic providers are medical doctors.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
Those are two key findings from a national survey that set out to assess how consumers research, educate themselves, and choose cosmetic procedures and providers. At the annual conference of the American Society for Laser Medicine and Surgery, study author Adam J. Wulkan, MD, discussed results from the 20-item survey, which was based on responses from 323 people who have obtained or have considered obtaining a cosmetic procedure such as laser hair removal.
Dr. Wulkan is a dermatologist at Massachusetts General Hospital, Boston. He reported having no financial disclosures. Study coauthor Mathew Avram, MD, serves on the medical advisory board of Sciton and on the scientific advisory boards of Sienna Biopharmaceuticals, Cytrellis, and Allergan. He also is consultant for Merz Aesthetics, Allergan, Soliton, Invasix, and Revance, and has intellectual property with Cytrellis. He also holds stock options with Cytrellis, Invasix, and Zalea.
REPORTING FROM ASLMS 2018
Probe linked to smartphone found effective in diagnosing oral cancer
DALLAS – A low-cost , in a clinical study of 92 people.
“Oral cancer is the sixth most common cancer in the world, but it’s the only major cancer whose outcome has not improved in the last 50 years,” study author Petra Wilder-Smith DDS, PhD, said in an interview following the annual conference of the American Society for Laser Medicine and Surgery Inc. “The main challenge is that over two-thirds of oral cancers are detected after they’ve metastasized. When you get spread like that, your survival is about 20% at 5 years, whereas if you detect it before spread, your survival is about 80% at 5 years.”
At the meeting, Vania Firmalino, an undergraduate student at the University of California, Irvine, discussed efforts by Dr. Wilder-Smith, Rongguang Liang, PhD, of the College of Optical Sciences at the University of Arizona, Tucson, and their colleagues to develop and evaluate the screening performance of a novel, low-cost smartphone-based mini probe for oral cancer screening and oral potentially premalignant lesions (OPMLs). The device provides high-resolution polarized white light images in combination with autofluorescence (AF) imaging capability.
The researchers found that inter-subject variation at each location was small, but inter-site differences were considerable. For example, optical data from OPMLs and oral cancer sites differed from normal with regard to white-light reflectance intensities, vascular homogeneity, and standard deviation. The AF signal in OPMLs and oral cancers shifted progressively to the red, together with a diminished green fluorescence signal. The cloud-based diagnostic algorithm based on these properties performed well, with an agreement with standard-of-care diagnosis of 80.6%.
“Artificial intelligence improves with data,” said Dr. Wilder-Smith, who is also a senior fellow at the university’s Chao Family Comprehensive Cancer Center. “We trained this system on about 200 images. When you’re up to 1,000 images per condition, that’s when you really start to get the benefits of artificial intelligence and machine learning. There’s huge potential here, especially when you think that 40% of the world’s risk for oral cancer is in India, which has good cell phone coverage. India also has a government-financed public health program whereby they already send health care workers to the remote areas of India to screen for basic diseases.”
The study won an award for best overall clinical abstract at the meeting. Dr. Wilder-Smith reported having no financial disclosures. The project was supported with funding from the National Institute of Biomedical Imaging and Bioengineering and the Beckman Foundation.
DALLAS – A low-cost , in a clinical study of 92 people.
“Oral cancer is the sixth most common cancer in the world, but it’s the only major cancer whose outcome has not improved in the last 50 years,” study author Petra Wilder-Smith DDS, PhD, said in an interview following the annual conference of the American Society for Laser Medicine and Surgery Inc. “The main challenge is that over two-thirds of oral cancers are detected after they’ve metastasized. When you get spread like that, your survival is about 20% at 5 years, whereas if you detect it before spread, your survival is about 80% at 5 years.”
At the meeting, Vania Firmalino, an undergraduate student at the University of California, Irvine, discussed efforts by Dr. Wilder-Smith, Rongguang Liang, PhD, of the College of Optical Sciences at the University of Arizona, Tucson, and their colleagues to develop and evaluate the screening performance of a novel, low-cost smartphone-based mini probe for oral cancer screening and oral potentially premalignant lesions (OPMLs). The device provides high-resolution polarized white light images in combination with autofluorescence (AF) imaging capability.
The researchers found that inter-subject variation at each location was small, but inter-site differences were considerable. For example, optical data from OPMLs and oral cancer sites differed from normal with regard to white-light reflectance intensities, vascular homogeneity, and standard deviation. The AF signal in OPMLs and oral cancers shifted progressively to the red, together with a diminished green fluorescence signal. The cloud-based diagnostic algorithm based on these properties performed well, with an agreement with standard-of-care diagnosis of 80.6%.
“Artificial intelligence improves with data,” said Dr. Wilder-Smith, who is also a senior fellow at the university’s Chao Family Comprehensive Cancer Center. “We trained this system on about 200 images. When you’re up to 1,000 images per condition, that’s when you really start to get the benefits of artificial intelligence and machine learning. There’s huge potential here, especially when you think that 40% of the world’s risk for oral cancer is in India, which has good cell phone coverage. India also has a government-financed public health program whereby they already send health care workers to the remote areas of India to screen for basic diseases.”
The study won an award for best overall clinical abstract at the meeting. Dr. Wilder-Smith reported having no financial disclosures. The project was supported with funding from the National Institute of Biomedical Imaging and Bioengineering and the Beckman Foundation.
DALLAS – A low-cost , in a clinical study of 92 people.
“Oral cancer is the sixth most common cancer in the world, but it’s the only major cancer whose outcome has not improved in the last 50 years,” study author Petra Wilder-Smith DDS, PhD, said in an interview following the annual conference of the American Society for Laser Medicine and Surgery Inc. “The main challenge is that over two-thirds of oral cancers are detected after they’ve metastasized. When you get spread like that, your survival is about 20% at 5 years, whereas if you detect it before spread, your survival is about 80% at 5 years.”
At the meeting, Vania Firmalino, an undergraduate student at the University of California, Irvine, discussed efforts by Dr. Wilder-Smith, Rongguang Liang, PhD, of the College of Optical Sciences at the University of Arizona, Tucson, and their colleagues to develop and evaluate the screening performance of a novel, low-cost smartphone-based mini probe for oral cancer screening and oral potentially premalignant lesions (OPMLs). The device provides high-resolution polarized white light images in combination with autofluorescence (AF) imaging capability.
The researchers found that inter-subject variation at each location was small, but inter-site differences were considerable. For example, optical data from OPMLs and oral cancer sites differed from normal with regard to white-light reflectance intensities, vascular homogeneity, and standard deviation. The AF signal in OPMLs and oral cancers shifted progressively to the red, together with a diminished green fluorescence signal. The cloud-based diagnostic algorithm based on these properties performed well, with an agreement with standard-of-care diagnosis of 80.6%.
“Artificial intelligence improves with data,” said Dr. Wilder-Smith, who is also a senior fellow at the university’s Chao Family Comprehensive Cancer Center. “We trained this system on about 200 images. When you’re up to 1,000 images per condition, that’s when you really start to get the benefits of artificial intelligence and machine learning. There’s huge potential here, especially when you think that 40% of the world’s risk for oral cancer is in India, which has good cell phone coverage. India also has a government-financed public health program whereby they already send health care workers to the remote areas of India to screen for basic diseases.”
The study won an award for best overall clinical abstract at the meeting. Dr. Wilder-Smith reported having no financial disclosures. The project was supported with funding from the National Institute of Biomedical Imaging and Bioengineering and the Beckman Foundation.
REPORTING FROM ASLMS 2018
Key clinical point: A compact oral probe that links to a smartphone was able to detect oral cancer.
Major finding: The optical diagnostic probe had a high rate of agreement (80.6%) with standard-of-care diagnosis.
Study details: A clinical analysis of 92 people with visually healthy oral mucosa or oral leukoplakia, erythroplakia, or ulceration.
Disclosures: Dr. Wilder-Smith reported having no financial disclosures. The National Institute of Biomedical Imaging and Bioengineering and the Beckman Foundation funded the project.
Picosecond 755-nm laser found effective for neck rejuvenation
DALLAS –
“It’s important to note that response was variable, but many patients were satisfied with the treatment,” Hana Jeon, MD said at the annual conference of the American Society for Laser Medicine and Surgery, Inc. “Further studies are needed to identify the clinical characteristics of neck laxity that would most benefit from this treatment.”
The researchers enrolled 25 patients with an average age of 58 years. The laser treatment settings were a 6-mm spot side-delivered at a fluence of 0.71 J/cm2 in a pulse width of 750 picoseconds. The patients were treated five times on the neck every 2-4 weeks, and follow-up visits were scheduled for 1 month and 3 months after the last treatment. Digital photos were taken at each visit. Formal assessment tools included patient and physician satisfaction scores and the Global Aesthetic Improvement Scale. In all, 21 women and 3 men completed the study. The majority (72%) had Fitzpatrick skin type II, while 16% had type III, 8% had type I, and 4% had type IV. An average of 5,042 pulses were delivered during each treatment session. The majority of patients (84%) required no anesthesia, while the rest used topical numbing medicine from 30 minutes to an hour prior to the procedure.
Dr. Jeon reported that the average pain score during the procedure was 4.7 on a 10-point scale. Forced-air cooling was used for comfort, and on average, mild redness following the treatment lasted less than 1 day (a mean of 0.6 days, with a range of 0-5 days). Mild pain also lasted less than 1 day (a mean of 0.1 days, with a range of 0-2 days). No swelling, crusting, bruising, bleeding, infection, blistering, scarring, burn, or dyspigmentation occurred.
On the Global Aesthetic Improvement Scale at 1 and 3 months, physicians described 43% and 23% of cases, respectively, as “improved,” 17% and 18% of cases as “much improved,” and 4% and 9% of cases as “extremely improved.”
At 3 months, 35% of patients said they would be “somewhat likely” to recommend the procedure, and 30% said they would be “extremely likely” to recommend it.
Dr. Jeon reported having no financial disclosures.
DALLAS –
“It’s important to note that response was variable, but many patients were satisfied with the treatment,” Hana Jeon, MD said at the annual conference of the American Society for Laser Medicine and Surgery, Inc. “Further studies are needed to identify the clinical characteristics of neck laxity that would most benefit from this treatment.”
The researchers enrolled 25 patients with an average age of 58 years. The laser treatment settings were a 6-mm spot side-delivered at a fluence of 0.71 J/cm2 in a pulse width of 750 picoseconds. The patients were treated five times on the neck every 2-4 weeks, and follow-up visits were scheduled for 1 month and 3 months after the last treatment. Digital photos were taken at each visit. Formal assessment tools included patient and physician satisfaction scores and the Global Aesthetic Improvement Scale. In all, 21 women and 3 men completed the study. The majority (72%) had Fitzpatrick skin type II, while 16% had type III, 8% had type I, and 4% had type IV. An average of 5,042 pulses were delivered during each treatment session. The majority of patients (84%) required no anesthesia, while the rest used topical numbing medicine from 30 minutes to an hour prior to the procedure.
Dr. Jeon reported that the average pain score during the procedure was 4.7 on a 10-point scale. Forced-air cooling was used for comfort, and on average, mild redness following the treatment lasted less than 1 day (a mean of 0.6 days, with a range of 0-5 days). Mild pain also lasted less than 1 day (a mean of 0.1 days, with a range of 0-2 days). No swelling, crusting, bruising, bleeding, infection, blistering, scarring, burn, or dyspigmentation occurred.
On the Global Aesthetic Improvement Scale at 1 and 3 months, physicians described 43% and 23% of cases, respectively, as “improved,” 17% and 18% of cases as “much improved,” and 4% and 9% of cases as “extremely improved.”
At 3 months, 35% of patients said they would be “somewhat likely” to recommend the procedure, and 30% said they would be “extremely likely” to recommend it.
Dr. Jeon reported having no financial disclosures.
DALLAS –
“It’s important to note that response was variable, but many patients were satisfied with the treatment,” Hana Jeon, MD said at the annual conference of the American Society for Laser Medicine and Surgery, Inc. “Further studies are needed to identify the clinical characteristics of neck laxity that would most benefit from this treatment.”
The researchers enrolled 25 patients with an average age of 58 years. The laser treatment settings were a 6-mm spot side-delivered at a fluence of 0.71 J/cm2 in a pulse width of 750 picoseconds. The patients were treated five times on the neck every 2-4 weeks, and follow-up visits were scheduled for 1 month and 3 months after the last treatment. Digital photos were taken at each visit. Formal assessment tools included patient and physician satisfaction scores and the Global Aesthetic Improvement Scale. In all, 21 women and 3 men completed the study. The majority (72%) had Fitzpatrick skin type II, while 16% had type III, 8% had type I, and 4% had type IV. An average of 5,042 pulses were delivered during each treatment session. The majority of patients (84%) required no anesthesia, while the rest used topical numbing medicine from 30 minutes to an hour prior to the procedure.
Dr. Jeon reported that the average pain score during the procedure was 4.7 on a 10-point scale. Forced-air cooling was used for comfort, and on average, mild redness following the treatment lasted less than 1 day (a mean of 0.6 days, with a range of 0-5 days). Mild pain also lasted less than 1 day (a mean of 0.1 days, with a range of 0-2 days). No swelling, crusting, bruising, bleeding, infection, blistering, scarring, burn, or dyspigmentation occurred.
On the Global Aesthetic Improvement Scale at 1 and 3 months, physicians described 43% and 23% of cases, respectively, as “improved,” 17% and 18% of cases as “much improved,” and 4% and 9% of cases as “extremely improved.”
At 3 months, 35% of patients said they would be “somewhat likely” to recommend the procedure, and 30% said they would be “extremely likely” to recommend it.
Dr. Jeon reported having no financial disclosures.
REPORTING FROM ASLMS 2018
Key clinical point: Response to using a picosecond 755-nm laser with focus lens array for neck rejuvenation was variable.
Major finding: On the Global Aesthetic Improvement Scale at 1 and 3 months, physicians described 43% and 23% of cases, respectively, as “improved.”
Study details: A single-center study of 25 patients treated for neck laxity.
Disclosures: Dr. Jeon reported having no financial disclosures.