BACKGROUND Fractional photothermolysis (FP) is one of the most significant milestones in laser technology and resurfacing. METHODS Review of the Medline English literature and recent international conferences regarding FP technology, applications, and indications. RESULTS Successful conditions treated with nonablative FP reported in the literature include acne scarring; dyschromia and fine wrinkling of photoaging on the face, chest, neck, and hands; melasma; poikiloderma of Civatte; nevus of Ota; scars; minocycline hyperpigmentation; telangiectatic matting; residual hemangioma; granuloma annulare; colloid milium; and disseminated superficial actinic porokeratosis. An advance in 2007 was the introduction of ablative FP (AFP), which results in significantly greater improvement in skin laxity and textural abnormalities. Most recently, AFP has demonstrated significantly greater improvement than nonablative FP in reducing acne scarring and skin redundancy and laxity associated with photoaging. CONCLUSIONS Through the induction of microthermal zones of injury, FP technology stimulates a robust and rapid wound healing response resulting in improvement in a diversity of aesthetic, inflammatory, and preneoplastic skin disorders. Further investigation into the technology and diverse array of cutaneous conditions that can benefit from FP is highly needed. The authors have indicated no significant interest with commercial supporters.

Postinflammatory hyperpigmentation (PIH) is a benign but cosmetically disturbing skin lesion, which is notoriously difficult to treat. Standard treatments include topical application of bleaching creams and gels. In this case report, we show that fractional photothermolysis might be a new successful option in the treatment of PIH. Its efficacy must be confirmed by further studies and balanced against possible side effects, but the initial results are promising.

BACKGROUND AND OBJECTIVE: To date, reports on the safe and effective laser treatment of disseminated granuloma annulare (GA) are still limited. STUDY DESIGN/PATIENT AND METHODS: A 58-year-old Caucasian female with disseminated GA was treated with fractional photothermolysis (FP) using a 1,440-nm Nd:YAG laser. Four lesions on the patient's left upper arm were defined as the "test region" with the remaining untreated areas serving as controls. RESULTS: A complete remission was achieved after two to three treatment sessions. Treatments were well tolerated. Due to the controlled study design, a spontaneous remission was unlikely. CONCLUSION: We conclude that FP may be a potentially efficacious therapeutic approach and should be considered in managing generalized GA. Lesers Surg. Med. 40:319-322, 2008.(c) 2008 Wiley-Liss, Inc.

Fractional resurfacing is a new laser treatment modality that creates numerous microscopic thermal injury zones of controlled width, depth, and density that are surrounded by a reservoir of spared epidermal and dermal tissue, allowing for rapid repair of laser-induced thermal injury. This unique modality, if implemented with proper laser-delivery systems, enables high-energy treatments while minimizing risks. In this article, we review the various fractional laser devices, including the new fractional ablative devices, as well as the results of studies on the clinical efficacy of fractional photothermolysis. This technology offers patients significant clinical improvement in photodamage, melasma, and scarring with modest treatment-related downtime and minimal risk of complications.

Colloid milium (CM) is a rare cutaneous deposition disease with at least 3 distinct subtypes. The exact histogenesis of the condition is still unresolved and awaits definitive elucidation. Electron microscopy and immunohistochemical analysis have allowed the distinction of CM from clinically similar conditions such as amyloidosis. Successful treatment has been achieved with dermabrasion and, more recently, with ablative and fractional laser resurfacing of affected skin.

BACKGROUND: Topical anesthetics, unlike injectable anesthetics, can be applied painlessly and can provide sufficient pain control to maintain patient comfort throughout a variety of laser procedures. Although the use of topical lidocaine is considered relatively safe, instances of cardiotoxic and neurotoxic adverse events have been reported to occur. OBSERVATIONS: A 52-year-old woman underwent fractional photothermolysis for management of severe hypopigmentation and scarring of several years' duration. Shortly after termination of treatment to her face and neck, which required prolonged exposure to a 30% lidocaine gel compound both before and during surgery, she developed clinical signs and symptoms consistent with systemic lidocaine toxicity. The results of laboratory studies confirmed serum lidocaine levels within the toxic range. We postulate that the combination of the high concentration of topical lidocaine required to achieve sufficient anesthesia, together with the laser-induced disruption in epidermal barrier function, may have been responsible for this phenomenon. CONCLUSIONS: Application of a 30% topical lidocaine gel to a limited area in conjunction with fractional photothermolysis may generate serum lidocaine levels high enough to elicit systemic toxicity. Laser surgeons should be alert to this phenomenon, particularly in patients with underlying hepatic, endocrine, cardiac, or central nervous system/psychiatric dysfunction; in patients with a low body mass index; and in patients who are taking medications that may interfere with hepatic lidocaine metabolism.

BACKGROUND: Hyperdynamic activity of the corrugator supercilii and procerus muscles causes glabellar furrows. Recently, a novel radiofrequency device has become available that can effectively ablate the efferent nerves controlling corrugator and procerus contraction, producing clinical results that are similar to those of botulinum toxin. OBJECTIVE: To assess the efficacy, longevity of effect, and side effects of the radiofrequency ablation device in the treatment of hyperdynamic glabellar furrows. MATERIALS AND METHODS: Four probe entry points were used to access branches of the temporal and angular nerves. Seven and two ablations, respectively, were delivered to each temporal branch and angular nerve. RESULTS: Twenty-nine patients underwent bilateral radiofrequency ablation of temporal branches of the facial nerve and the angular nerves. Abrogation of glabellar furrowing was achieved in 90% of patients. No major adverse events were observed. All patients developed mild to moderate swelling, and nine patients (31%) developed purpura in the treated areas. Sixty-nine percent of patients had effects that lasted 4 months or longer, 41% had effects that lasted 6 months or longer, and 10% had effects lasting longer than 12 months. CONCLUSION: Radiofrequency ablation of efferent branches of the temporal and angular nerves effectively eliminates corrugator and procerus contraction and concomitant glabellar furrowing.

Sculptra (poly-L-lactic acid), a new injectable soft tissue filler designed to stimulate neocollagenesis, increase dermal thickness, and enhance volume, is most commonly used for the midface and temporal fossa, with more limited use in the mental and prejowl areas. In the authors' practice, Sculptra injections have virtually replaced autologous fat transfer, yielding excellent results for patients with mild to moderate midface and jowl laxity.

Plasma skin regeneration (PSR) is a novel method of resurfacing that uses plasma energy to create a thermal effect on the skin. PSR is different from lasers, light sources, and ablative lasers in that it is not chromophore dependent and does not vaporize tissue, but leaves a layer of intact, desiccated epidermis that acts as a natural biologic dressing and promotes wound healing and rapid recovery. Histological studies performed on plasma resurfacing patients have confirmed continued collagen production, reduction of elastosis, and progressive skin rejuvenation beyond 1 year after treatment. PSR has received US Food and Drug Administration 510 (k) clearance for treatment of rhytides of the body, superficial skin lesions, actinic keratoses, viral papillomata, and seborrheic keratoses. PSR also has beneficial effects in the treatment of other conditions including dyschromias, photoaging, skin laxity, and acne scars. The safety profile of PSR is excellent, and there have been no reports of demarcation lines in perioral, periorbital, or jawline areas, as can sometimes be observed following CO(2) resurfacing. PSR is effective in improving facial and periorbital rhytides and can be used on nonfacial sites, including the hands, neck, and chest. Numerous treatment protocols with variable energy settings allow for individualized treatments and provide the operator with fine control over the degree of injury and length of subsequent recovery time.

The authors have indicated no significant interest with commercial supporters.

The technique of registration of pain and vibration sensitivity providing early diagnosis of painless ischemic heart disease is described. Basing on evident pathogenetic direction of a therapeutic action of laser therapy to different links of pathogenesis of arterial hypertension and ischemic heart disease, therapeutic effects of laser therapy in patients with painless myocardial ischemia in combination with essential hypertension were studied.

INTRODUCTION: The optimal parameters of low level laser therapy (LLLT) are still under debate. It has been documented that a dose or 5 J/cm2 would be capable to accelerate the wound healing process in patients. However, the optimal delivering form, i.e. power intensity, is unknown. Therefore, the aim of our study was to compare different power densities of LLLT. MATERIALS AND METHODS: Sixteen male Sprague-Dawley rats were included in this experiment and randomized into two groups, normal healthy group and streptozotocine induced diabetic group. In general anesthesia four full thickness skin incisions were performed under standard aseptic conditions on the back of each rat and immediately closed using intradermal running suture. Three wounds were stimulated with diode laser (wavelength: 635 nm; daily dose 5 J/cm2; power densities: 1 mW/cm2, 5 mW/cm2 and 15 mW/cm2) each with different power density while the fourth wound served as control. Six days after surgery animals were sacrificed and samples removed for histological evaluation. RESULTS: Our study demonstrated that LLLT positively influences wound healing. The most significant changes were observed in wounds stimulated at the highest power density 15 mW/cm2. Since using the highest power density the shortest time is needed to achieve the optimal daily dose of 5 J/cm2, it can be suggested that 15 mW/cm2 might be optimal parameter for such a therapy in patients.

INTRODUCTION: Low-intensity laser therapy (LILT) can be applied in cases when patients with diabetic polyneuropathy (DPN) suffer from chronic severe neuropathic pain. OBJECTIVE: We wanted to analyse influence of LILT on spatial perception threshold (SPT) and electroneurographic (ENG) parameters in patients with painful DPN. METHOD: We analysed 45 patients (25 males), average age 54.3 years (54.3 +/- 10.9), with clinical and ENG signs of painful DPN. The patients were divided into two groups: A and B. Group A consisted of 30 patients with DPN who had 30 LILT treatments over the period of 12 weeks and group B consisted of 15 patients with DPN who received only vitamin therapy per os within the same period. Prior to and after 12 weeks of treatment, the following ENG parameters were determined using surface electrodes: motor (MCV) and sensory conduction velocities (SCV) values (in m/s) of nervus (n.) peroneus (NP), n. tibialis (NT) and n. medianus (NM) and their motor distal latency (MDL) values (in ms). SPT value (score as number from 1 to 8) was determined with Tactile Circumferential Discriminator on dorsal part of foot's big toe skin. For statistical analysis, we used Student's t-test and Pearson correlation (sig. 2 tailed) study. RESULTS; We registered statistically significant difference between SPT (p < 0.01) values prior to (5.25 +/- 1.11) and after (4.87 +/- 0.90) LILT, as well as NMMCV (p < 0.05) values prior to (47.18 +/- 5.08) and after (49.12 +/- 3.72) LILT. Besides, we registered, only after LILT, statistically significant correlation beetwen SPT and NMDML (p < 0.01) values and also beetwen SPT and NMSCV (p < 0.05) values. The differences and correlations beetwen other analysed parameters before and after treatments were not significant (p > 0.05). CONCLUSION: In this study we registered significant decrease of SPT and increase of NMMCV after LILT and that indicated a favourable effect of this treatment in analysed patients with painful DPN. In our opinion these results need further investigation.

The ubiquity of increased sun exposure, oral contraceptives, and phototoxic drugs has led to an increased prevalence of conditions such as dyschromia, melasma, rhytides, and other signs of photoaging over the past few decades. Through the application of selective photothermolysis, laser surgery has attempted to create therapeutic options for these medically recalcitrant conditions. To date, however, this technology has been met with limited success, due to a high incidence of posttreatment side effects, inability to treat off the face, and a safety profile tailored to Fitzpatrick skin types I to III. More recently, a novel approach coined "fractional photothermolysis" was developed in an attempt to overcome these limitations. This new laser treatment modality has allowed for effective treatment of a diverse array of dermatologic conditions on and off the face with a wider therapeutic index and improved safety profile independent of Fitzpatrick skin type. This review sheds light on the technical aspects, biologic mechanisms, and clinical effects of fractional photothermolysis that help set it apart from previous modes of laser surgery.

Colloid milium (CM) is a rare cutaneous deposition disease with at least 3 distinct subtypes. The exact histogenesis of the condition is still unresolved and awaits definitive elucidation. Electron microscopy and immunohistochemical analysis have allowed the distinction of CM from clinically similar conditions such as amyloidosis. Successful treatment has been achieved with dermabrasion and, more recently, with ablative and fractional laser resurfacing of affected skin.