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Por favor indique a entidade (pessoa ou empresa): Michael Krychman is a paid consultant for Viveve Medical

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Objectives: The aim of this study is to evaluate the results achieved in treating immature scars using KTP/Nd:YAP laser with radiation combining two wavelengths (540/1079 nm).

Introduction: Plastic surgery scars can be pose cosmetic challenges and significantly reduce patient satisfaction of aesthetic result. Prevention of pathological scarring is important in the postoperative period. At unfavorable factors hypertrophic scar begins to form in the period 30-90 days after surgery. The clinical manifestation of this is an increase in the volume of scar, tissue stiffness, vascularity and itching.

Materials / method: A pilot prospective study with three sessions of laser-treatments for immature plastic surgery scars on face and body from 1 to 3 months old with signs of progressive hypertrophy. Settings of laser radiation were adjusted to each individual scar. Documentation was based on modern scales and questionnaires, like the Patient and Observer Scar Assessment Scale (POSAS) and Dermatology Life Quality Index (DLQI), as well as photographs and ultrasonic scans of scars. The evaluation of the results achieved was carried out before each treatment session and two weeks after the last third session.

Results: Eighteen patients signed up for the study and evreryone completed it. The positive dynamics of the scar condition was observed in all patients of the study group after the fist session. The POSAS Patient Scale overall score before treatment was 34.20 ± 8.24. It declined throughout the study, eventually dropping by 73.5% to 9.08 ± 6.82 two weeks after third session (p=0,003). The largest differences in scoring could be observed in the categories itching, color difference, stiffness and thickness. The POSAS Observer Scale showed an initial overall score of 25.40 ± 9.04, dropping by 83% to 4.32 ± 2.84 (p=0,001). The largest changes could be observed in the categories vascularity, pliability, thickness and relief. Over the course of the study, a 52.3% drop (p = 0.003) in the DLQI score from an initial 6.5 ± 1.9 to 3.1 ± 1.7 two weeks after treatment could be observed. Ultrasonography indicated reduction of thikness and hyperechoic scar tissue. There was no case of progression of hypertrophy during and after laser treatment. Five patients (22,7%) showed significant but incomplete positive dynamics after three sessions of laser treatment, wich indicates the necessity of more sessions in the course.

Conclusion: Laser treatment using KTP/Nd:YAP laser with radiation combining two wavelengths (540/1079 nm) is a safe and effective metod for the improvement of immature plastic surgery scars with progressive hypertrophy. Implementing the results of this study into standardized treatment protocols is necessary to optimize post-surgical scars.

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Objectives: Aim: to compare effectiveness of different densities of fractional CO2 laser in the treatment of mature hypertrophic burn scars.

Introduction: Fractional CO2 laser has been shown effective in improving pigmentation, pruritus, pain, and tightness of hypertrophic burn scars. However, there is no consensus on the optimal treatment parameters.

Materials / method: The study included 25 patients of both sexes with 3 or more mature hypertrophic burn scars. Three scars were randomly assigned to low, medium and high density fractional CO2 laser treatment. The degree of improvement was assessed clinically using VSS and POSAS scores, and histologically through evaluation of collagen (Masson’s Trichrome stain) before and one month after end of therapy.

Results: High density parameters showed significant higher improvement in VSS and POSAS assessment scores (P value <0.001). Pliability and relief are the most improved parameters. Histopathological evaluation revealed a significant drop in the mean area percent of collagen in the three used parameters, with highest improvement with high density laser treatment (P value <0.001).

Conclusion: Fractional CO2 laser is an effective and safe modality for the treatment of hypertrophic burn scars. High density treatment gives more improvement of burn scars on clinical and histopathological aspects.

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Objectives: For nonsurgical blepharoplasty I choose Er:Yag 2940nm laser system. I always use comprehensive approach in preparation before ablation. The first aim is to hydrate skin, because the main target for ablation is water. The second aim is avoids such sides effects as hyperpigmention, long lasting erythema, minimize sweeling after ablative technology. And the third one is to block premature ageing of skin, to block chronic inflammation and death of cells

Introduction: The majority of patients after 45th age has extra skin on eyelid. Eyelid skin is the thinnest and the driest on face, it has no sweat and greasy glands and appropriate to premature ageing. In my practice I collaborate with surgeons a lot. Anyway I have patients refusing to surgery. In some cases I can offer nonsurgical blepharoplasty to reduce, to tighten skin flap or improve skin tone after surgery

Materials / method: I use skin enhancement as the first step of effective restoration with a product containing 11 mg/ml hyaluaronic acid and 16 mg/ml succinic acid.
For tightening skin flap I choose Er:Yag 2940nm in fractional mode to make contolled ablation to 200mkm in depth. Microscopic zones of ablation stimulates skin rejuvenation and tightening due to non-ablated zones serve as a reservoir of cells that promote rapid healing. And 3 session is skin enhancement of product of 1,8 mg/ml hyaluronic acid and 16 mg/ml succinic acid.

Results: Laser treatment is always associated with edema or swelling of periorbital area. The preparation is highly recommended for better and shorter rehabilitation after laser ablation

Conclusion: Preparation impacts on skin’s ability to recover and influence on inflammageing, reducing proinflammatory cytikines and matrix metalloproteinases. As a result It prolongates life of cells and improves skin quality rehabilitaon

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Objectives: In the Indian perspective facial hair in females is a great social stigma and is indeed a therapeutic indication rather than a cosmetic one , the skin of colour requires special energy densities and treatment intervals to reduce adverse effects and pih
White hair removal is now a reality with this carbon atom dye

Introduction: The carbon atom dye reaches the level of the istimus and provides an artificial chromophore for the diode to act on , in this paper we also illicit techniques to reduce PIH and other side effects in colour of skin FP TYPE 3 TO 5 also we explore how to deal with fine hair

Materials / method: Carbon Atom Dye
USFDA DIODE 810

Results: We have achieved 60-80 percent LHR with white hair in 8-12 sessions using the carbon atom dye and in black hair 85-95 percent hair reduction with minimal PIH using a single wavelength diode with several passes mode

Conclusion: In the Indian context and skim of colour female facial hair and hirsutism are a big social problem and the patients entire life depends on it so reducing the facial hair is now more therapeutic indication preventing depression,anxiety and social stigma for the patient , we have deviced techniques to help the FP type 3 to 5 and patients with grey/white hair keeping affordability in mind

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Objectives: In this retrospective study we set the clinical outcome of a single treatment of micro-focused ultrasound and analyzed the differences among the amount of energy spot delivered.

Introduction: Transcutaneous micro-focused ultrasound has been proved to be effective for non-invasive skin tightening. This technique is clinically effective and has low complication rate.
So far not a single scientific paper has addressed clinical outcome based on skin ptosis and energy spot delivered. Since 2014 we have been using a new fda-approved medical device that uses micro-focused ultrasound with visualization (MFU-V) in order to achieve face and neck lifting.

Materials / method: Eight hundred and sixty-four patients with a mean age of 51,3 years and soft to moderate skin laxity and ptosis of the face, received an average of 828 spot lines in a single session. Two homogeneous groups of 100 patients which differed only for the number of energy spot delivered were set.
Patients of group 1 received an average of 526 energy spot lines while patients of group 2 received 1142. Clinical outcome of aesthetic improvement were assessed by two independent doctors (F.A; M.A;). Patient’s satisfaction were assessed by a Patient Satisfaction Questionnaire (PSQ).

Results: All patients completed the follow-up after 6 months and no major side effects were reported. Skin redness appeared on 2,6% of patients and multiple sub centimeters white papule appeared on 4.6%of group 2 and resolved completely after 4 days.
34% of patients of group 1 were minimally satisfied and 66% were not satisfied.
On group 2, the majority of patients showed significative aesthetic improvement in skin laxity and ptosis at 180 days. The majority of patients were very satisfied (68%) or satisfied (22%) and only 10% were minimally satisfied

Conclusion: Our retrospective study proves that micro-focused ultrasound is a safe and effective treatment for collagen regeneration and tissue contraction (lifting effect) but it’s necessary to deliver a significant number of energy micro-focused ultrasound spot lines in order to achieve significative clinical difference and patient satisfaction

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Objectives: How to induce optimal photomechanical effect in treating pigmentation
How to induce maximal collagen remodeling in skin rejuvenation
How to avoid complication of pigment alteration with picosecond laser

Introduction: Picosecond laser is recently emerging and popular in the aesthetic market. However, the result of the picosecond laser, being new technology, could be sometimes disappointed without optimal fluency. we will present different clinical results with different fluecne based on the theory of photomechanical effects.

Materials / method: Patients with different pigmentation and aging were treated with different fluency of picosecond laser. The results were grading and compared.

Results: Pigmentation including epidermal and dermal melanosis with high photomechanical effect protocol can be removed without significant downtime. Risk of pigment alteration can be also reduced.

Conclusion: Picosecond laser with low fluence high photomechanical effect protocol is safe and effective in the treatment of asian pigmentation and rejuvenation.

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Objectives: Asian skin has more common pigmentary problems due to its skin properties and genetic predisposition, while they have more abundant epidermal melanin and light-related complication (hyper-/Hypo-pigmentation). With the invention of newer generation Picosecond laser of various wavelengths, we are to demonstrate the treatment efficacy and safety superiority of using photomechanical effect of picosecond lasers with a good combination of wavelengths.

Introduction: Picosecond laser is a new laser technology with even further newer generations produced recently which is useful in treating various cutaneous benign pigmentary conditions with better efficacy and wider safety margin through photomechanical effect and Laser Induced Optical Breakdown (LIOB). For Asian skins, due to specific genetics and skin properties, pigmentary problems are common. While Asian skin typically associates with more laser complications including burn, hyper-/hypo-pigmentations, and textural changes. Therefore, PS laser is a good choice for treating pigments in Asian skins.

Materials / method: Patients of asian origin and varivous skin pigments like freckles, ABNOM, Nevus of Ota, Melasma, tattoo are studied. Picosecond laser with wavelengths of 532/670/1064 were used. The outcome, skin response and post-treatment follow up condition are well documentated. The skin pigment problem improvements are graded by the patient themsevles and the physcicians in charge.

Results: All of the asian patients with various pigment problems responded to newer generation picosecond laser with wavelengths 532/670/1064nm used.

Conclusion: Treatment of various asian skin pigment (freckles, ABNOM, Nevus of Ota, Melasma, tattoo ) are largely successful by using picosceond laser with lower fluence when compared to traditional lasers, with better outcome and less down time and complications.

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Objectives: Evaluation of the results was performed at 1 month, 3 months and 6 months post treatment. One-month follow-up revealed objective clinical improvement in both unwanted fat and skin appearance in 72% of the patients. Results at three months showed an average reduction between 2-5 centimeters in the circumference of each area treated. Finally, six months later, satisfaction rates were quite high as the results were more visible for the majority of the patients. The only treatment-induced complications mentioned were a mild discomfort and small hematomas afterwards that subsided in a few days.

Introduction: Laser liposuction is a modern, less aggressive than traditional liposuction technique to remove localized fat deposits. Laser energy is used to liquefy excess fat from the areas treated, followed by aspiration, additionally providing the advantage of collagenesis and skin tightening. In this case series we evaluated the efficacy and safety of the use of 1064nm Nd:YAG Laser in the treatment of local fat.

Materials / method: 751 different patients, 549 women & 202 men, were conducted in our study between the years 2011-2016. The 1st stage included the infusion of tumescent anesthesia with Klein solution, followed by the lipolysis stage performed with a Nd:YAG Laser at 1064nm. Finally, the liquefied fat was removed through aspiration as in traditional liposuction. The mean energy delivered in the subcutaneous tissue per area was 3650 Joules, with a maximum of 10000 Joules per session. The areas treated varied between men & women, with the most common among them being outer thighs, abdomen, waistline, inner thights.

Results: Evaluation of the results was performed at 1 month, 3 months and 6 months post treatment. One-month follow-up revealed objective clinical improvement in both unwanted fat and skin appearance in 72% of the patients. Results at three months showed an average reduction between 2-5 centimeters in the circumference of each area treated. Finally, six months later, satisfaction rates were quite high as the results were more visible for the majority of the patients. The only treatment-induced complications mentioned were a mild discomfort and small hematomas afterwards that subsided in a few days.

Conclusion: Nd:YAG Laser liposuction constitutes a safe and effective treatment choice for resistant local fat, providing comparable results to those of traditional liposuction with the additional positive effect of skin tightening.

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Objectives: Persisting hyper-vascularity as erythema or telangiectasia is of major aesthetic concern in many patients with post-surgical or traumatic scars. Low fluence non-ablative and/or ablative fractional laser scar correction become a mainstay of treatment options in scar treatment aiming to improve scar texture, vascularity, pigmentation and thickness without risk for side effects.

Introduction: 15 patients age range 48-65 yr-old; female (n=10) male (=5) were referred to a private laser clinic within 6-8 weeks post surgical procedure to seek functional and aesthetic improvement in their scar appearance. In all cases, the scar area was erythemous and demarcated with micro-vessels across the skin graft. We used a novel non-ablative fractional 1064-nm Q-switched nanosecond domain (7 nsec) laser with variable focused depth control optical penetration (250- 500µm). The patient underwent 3 treatments spaced every 4 weeks.

Results: The patients scar appearance was significantly improved in all patients. Follow-up results at 1.5 month after the last treatment revealed a significant and dramatic improvement (>75%) in the degree of erythema, hyper-vascularity and overall scar texture based on independent physician clinical assessment using a quartile grading scale (0–25%:no improvement; 25–50%:mild improvement;50–75%: moderate improvement; >75%: dramatic improvement) in 85% of patients

Conclusion: Q-switched fractional 1064-nm laser is a safe and effective treatment modality for surgical scars and results in rapid clinical improvement along with minimal risk for side effects.

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