The DUBLiN Lift: To establish the clinical effectiveness of combining five treatments in the rejuvenation of the ageing face in an effort to increase aesthetic effect, patient safety, and reduce laser downtime.
Unit I herbs as raw materials, biodynamic agriculture.ppt
The DUBLiN Lift
1. ARTICLE | facial aesthetics |
Combining therapies
for optimal outcomes
in treating the ageing
face: introducing the
DUBLiN Facelift
Patrick Treacy xxxxxx
[AQ1: please provide an author image]
ABSTRACT
Objective radio frequency lasers, platelet-rich plasmas repositioning of facial fat.
The DUBLiN Lift: To establish the clinical (PRP) microneedling, microdermabrasion,
effectiveness of combining five treatments botulinum toxin injections, and laser This article examines the possibility of
in the rejuvenation of the ageing face in an resurfacing. Each treatment has its own combining five established therapies
effort to increase aesthetic effect, patient relative benefit, as well as risks2, 3. in an attempt to address these deficits.
safety, and reduce laser downtime. The facial rejuvenating therapies include
In recent years, facial rejuvenation has been microneedling, low-dose UltraLase laser,
The face is the area for which the majority of revolutionised with the development of PRP growth factors, Omnilux 633 nm light,
patients seek cosmetic rejuvenation as the CO2 fractional laser skin resurfacing. This and neurotoxins. The technique is called
convex lines of a youthful appearance tend procedure benefits from faster recovery the DUBLiN facelift as an acronym of the
to flatten and droop as one grows older. The time, more precise control of ablation procedures involved: Dermaroller, UltraLase
younger face is characterised by a balance depth, and reduced risk of post-procedural laser, Blood growth factors, Light (near-red
Dr Patrick Treacy is captured in the classic shape of the inverted problems. However, there have been cases 633 nm), and Neurotoxin.
Medical Director of Ailesbury triangle. The reversal of this ‘triangle of of hypopigmentation, hypertrophic scars
Clinics Ltd and Ailesbury Hair beauty’ as ageing proceeds is considered and skin mottling, most often seen on The author compared this method to
Clinics Ltd; Chairman of the generally less aesthetically appealing1. At the face, neck and chest when the laser fractional laser skin resurfacing with regard
Irish Association of Cosmetic present, a variety of different dermatologic parameters are used more aggressively4. to the reduction of photoageing and overall
Doctors; and Irish Regional and volumising treatments are available for Furthermore, the technique does not attend aesthetic effect. Neurotoxin was used in
Representative of the British facial rejuvenation. These include chemical to chronological ageing problems such as both arms of the study.
Association of Cosmetic Doctors peels, dermal fillers, intense pulsed light and volume deficits resulting from the loss and
T
email: ptreacy@gmail.com
he face, and particularly the eyes, is very barometer of a patient’s chronological and
important for contact between humans, environmental age, and mastering the proper evaluation
as these areas provide a window to the and execution of their aesthetic rejuvenation is
rest of society with regard to a patient’s paramount for all cosmetic doctors.
level of health, tiredness and emotional More recently, patients are seeking effective facial
status, as well as interest in others4. Many rejuvenation procedures with less downtime and low
Keywords health professionals consider the periorbital area of the risks6. This change in attitude has been prompted by a
fractionalised laser resurfacing, face as the most important area of rejuvenation as realisation of both doctors and patients that the much
platelet-rich plasma,
microneedling, Omnilux 633 nm eye‑to-eye communication occurs in approximately hyped non-ablative methods were often subject to
light, neurotoxin 80% of all human interactions6. Both areas present a extravagant claims in terms of efficacy2–4. For many
18 September 2012 | prime-journal.com
2. ARTICLE | facial aesthetics |
years, CO2 laser resurfacing was considered the ‘gold regeneration. The author used microneedling with low
standard’ in treating photodamaged facial skin6–11. energy laser, and platelet rich plasma (PRP) to address
Cutaneous laser resurfacing with a fractional (CO2) laser these issues.
involves the vapourisation of the entire epidermis, as It is recognised that the most important rejuvenation
well as a variable thickness of the dermis. Many process for photoaged skin is the collagen remodelling
physicians stated that the ultrapulsed CO2 laser was the process, and dermal fibroblasts are known to have the
most effective method of laser resurfacing12–13. most important function29. Rejuvenation of skin injury
Photodamaged skin is the result of years of exposure to caused by UV light is a complex process that organically
harmful ultraviolet light and is clinically demonstrated as involves cytokines interacting with a number of growth
a gradual deterioration of cutaneous structure and factors and control proteins28. The procedures evaluated
function. This results in the epidermis and upper included PRP, microneedling, and Omnilux 633 nm
papillary dermis having a roughened surface texture, as near‑red light, with neurotoxins as an adjunct to low-level
well as laxity, telangiectasias, wrinkles and variable fractional laser skin resurfacing. Cells in the epidermis
degrees of skin pigmentation14–15. and dermis can be targeted by microneedling and
Although ultrapulsed CO2 resurfacing lasers were near‑red light, resulting in fibroblast stimulation. Omnilux
considered the best treatment option, they had many Revive™ (633 nm) therapy stimulates fibroblast activity,
post-procedural problems16, 17, including prolonged leading to faster and more efficient collagen synthesis
post‑operative recovery, pigmentary changes, and a high and extracellular matrix (ECM) proteins. It also increases
incidence of acne flares and herpes simplex virus (HSV) cell vitality by increasing the production of cellular
infection18, 19. Many patients complained of oedema, adenosine triphosphate (ATP) and stimulates the
burning, and erythema that sometimes lasted for many contractile phase of the remodelling process producing
months20, 21. The implied risks and long downtime made better lineated collagen30–33. Collagen induction therapy is
many patients reluctant to accept this method of an aesthetic medical procedure that involves repeatedly
treatment22, 23. More recently, fractional resurfacing lasers puncturing the skin with tiny, sterile needles. Typically,
have addressed many of these earlier problems with this is done with a specialised instrument called a
benefits of faster recovery time, more precise control of microneedling device.
ablation depth, and reduced risk of post procedural Controlled studies have suggested that the application
problems8. These lasers are extremely versatile, in that of autogenous PRP can enhance wound healing in both
they can be used for the treatment of facial rhytides, acne animals and humans29. Five major growth factors such as
scars, surgical scars, melasma and photodamaged skin, transforming growth factor (TGF), insulin-like growth
and many have entered the market at the same time24. factor (IGF), platelet-derived growth factor (PDGF),
With the advent of fractional laser skin resurfacing, the epidermal growth factor (EGF), and vascular endothelial
number of completely ablative resurfacing cases has growth factor (VEGF) are known to be related to the
declined for most practitioners. However, care should be wound-healing processes28. These growth factors are
taken when treating sensitive areas such as the eyelids, released from platelets and the production of collagen
upper neck, and especially the lower neck and chest, by and fibroblasts is stimulated by IGF, EGF, Interleukin-1
using lower energy and density, and scarring has been (IL‑1) and tumour necrosis factor (TNF)-α34, 35. In vivo
noted in these areas25. Scarring after fractional CO2 laser studies report TGF-β to be the most stimulative growth
therapy is considered mainly a result of overly-aggressive factor. PRP may be used for dermal augmentation and
treatments and a lack of technical finesse. Physicians Sclafani observed aesthetic improvements of the
have also recorded post‑operative infections leading to nasolabial fold in less than 2 weeks, and the results lasted
scarring, although it is generally felt that these may be for up to 3 months28, 29.
prevented by careful history-taking, vigilant
post‑operative monitoring, and/or the use of prophylactic Research design and methods
antibiotics26, 27. This multi-centre randomised study included 44 patients
With regard to facial rejuvenation, CO2 laser light at a of skin types 1 and 2 aged between 39 and 68 years,
10 600 nm wavelength results in vaporisation with presenting with photoageing of the skin, 25 of whom
thermal denaturation of type I collagen, collagen were women and 4 were men [AQ2: what about the
shrinkage and later, collagen deposition. However, in remaining 15?]. The subjects presented with the typical
very deep rhytides, acne scarring and severe elastotic hallmarks of chronological and photoageing, such as
changes from sun damage, fractional CO2 therapy expression lines, rhytides, wrinkles, eyelid skin laxity,
requires multiple treatments to achieve the same results dermatochalasis, lowered brows, lateral hooding, and
as the older lasers28. A number of studies have evaluated prominent fat pads. All patients were subjected to a
using different laser combinations in the same session in programme of skin tightening and neocollogenesis by
order to improve collagen deposition, with a wider zone one of two methods: conventional fractional laser skin
of fibroplasia6–9, 28. Owing to the inherent risks of fractional resurfacing (Group 1) or the DUBLiN Lift (Group 2). The
laser skin resurfacing and its inability to deal with some mean patient age in Group 1 was 49 years (range 37–
evidence of chronological ageing, it was advocated to 71 years) and in Group 2 was 55 years (range 41–76 years).
here establish the clinical effectiveness of using a Fifteen patients underwent Lumenis ActiveFx™ with
multi‑procedural approach to volumisation and collagen settings as (energy) 125 mJ and (rate) 19 w CPG 3/5/4.
20 September 2012 | prime-journal.com
3. | facial aesthetics | ARTICLE
Twenty-nine patients received the DUBLiN Lift, a three- also given to patients.
phase combination of established treatments with The ActiveFX is a protocol of settings applied in
microneedling, platelet growth hormones, near-red conjunction with an improved computer pattern
633 nm light, and low-energy UltraLase fractional CO2 generator to the ultrapulsed CO2 laser (UltraPulse
laser skin tightening. All patients received Dysport® in Encore, Lumenis Ltd). Technical differences between
three areas 1 week prior to the other treatments as an this non-sequential fractional device and the older
adjunct to the laser resurfacing. ultrapulsed CO2 include tissue bridges left between spots,
The DUBLiN Lift was introduced as three phases over a resulting in faster healing time, and less thermal damage
period of 3 weeks. Phase 1 included Dysport® at dilution to the basal cell membrane. The device has a smaller
3.5 : 1 to three areas — glabellar, frontalis and periorbital. spot size (1300 mm rather than 2500 mm), resulting in
Phase 2 introduced intense fibroblast stimulation and less post-procedure erythema.
modification through microneedling, PRP growth factor The computer pattern generator lays down a random
induction, and near-red phototherapy. Phase 3 series of spots rather than a sequential sequence
administered the low–level (CO2) UltraPulse laser at resulting in less overheating of the treated tissue. This
100 mJ 14 w CPG 3/5/2, and adjunct near-red 633 nm application is termed ‘Cool Scan’, and was used with
phototherapy. The study evaluated post-procedural every patient in the study.
aesthetic results at 2 weeks, 4 weeks and 12 weeks. The The Traylife Kit (PRP) (Promoitalia Wellness Research)
length of downtime, patient discomfort and adverse provides blood plasma enriched with a concentrated
side‑effects were noted for each phase. source of autologous platelets that releases a number of
Clinical assessment of patients in each group was growth factors and other cytokines that stimulate the
made at 2 weeks, 1 month and 3 months post‑operatively healing of soft tissue.
in the presence of two aesthetic staff. The degree of Omnilux Revive™ (633 nm) (Photo Therapeutics, Inc.,
improvement in photoageing was based on the degree of UK) stimulates fibroblast activity, leading to faster and
re-epithelialisation rate, reduction of rhytides, reduction more efficient collagen synthesis and extracellular
of tactile roughness, and loss of hyperpigmentation and matrix proteins.
telangiectasias. The prolongation and severity of Dermaroller™ Collagen Induction Therapy (CIT)
erythema as well as the presence of negative side-effects (AesthetiCare®, UK) is a minimally-invasive cosmetic
(e.g. herpes) were also recorded. procedure that involves the use of a micro-needling
The efficacy of treatment was evaluated using a device.
variation of the five-point scale (Table 1) originally Scoring charts are presented in Tables 1–4.
suggested by Dover et al36. Investigators and patients
evaluated efficacy using palpability assessments and
change from baseline score at 0, 6 and 12 weeks. A total
global score was recorded in each patient based on the
Table 1 Patient treatment (positive) scoring chart
addition of points obtained from six photodamage Parameter 0 1 2 3 4
variables. The degree of perceived improvement in
Global score Area of Area of Area of Area of Area of
overall aesthetic effect reflecting chronological age was roughness roughness roughness roughness roughness
assessed separately by patients and physicians using the x 0 x 1 x2 x3 x4
Wrinkle Severity Rating Scale (WSRS) and the Global Fine lines None Rare Several Moderate Many
Aesthetic Improvement Scale (GAIS). The WSRS is Pigmentary None Patchy Moderate Heavy Marked
recognised as a valid and reliable instrument for problems
quantitative assessment of facial skin folds, with good Touch Even Rare Mild Moderate Severe
inter- and intra-observer consistency5. Wrinkle severity is problems
measured using a wrinkle severity rating scale with 1 Facial veins None Rare Several Moderate Severe
being absent and 5 being extreme. By allowing objective Coarse lines None Rare Several Moderate Many
grading of data, these proved useful clinical tools for Complexion Pink Pale Grey Slightly Distinct
assessing the effectiveness of facial volumisation with yellow-grey yellow-grey
PRP and microneedling–633.
Interventions Table 2 Patient treatment (negative) scoring chart
The following treatment protocols were used for this
study: Lumenis ActiveFX CO2 laser, Traylife PRP, Omnilux Parameter 0 1 2 3 4
633 nm red light, Dermaroller®, and Dysport®. All Erythema severity None Rare Several Moderate Severe
participants received selective regional anaesthesia Infective outbreak None Rare Several Moderate Severe
blocks with 2% lignocaine plus adrenaline, a topical (herpes/acne)
combination anaesthetic of 23% lignocaine, and Crusting None Rare Several Moderate Severe
prophylactic Valtrex 500 mg twice daily for 8 days. Pain of None Mild Tolerable Moderate Severe
Valium 5–10 mg stat was given as a pre-medication to procedure
some patients. A post-procedural advice sheet and Improvement None Minimal Fair Good Excellent
Nurofen or codeine with paracetamol — as required — was
prime-journal.com | September 2012 21
4. ARTICLE | facial aesthetics |
into the buccal cavity with the needle directed
Table 3 WSRS Patient scoring chart towards the infraorbital foramen
■■ Mental nerve block. 1 cc of 1–2% Lidocaine injected into
5 Extreme Extremely deep and long folds, detrimental to facial appearance
the mental foramen just above the bone level.
4 Severe Very long and deep folds; prominent facial features; less than
2 mm visible
3 Moderate Moderately deep folds; clear facial feature visible at normal
Group 2: DUBLiN lift
appearance, but not when stretched
2 Mild Shallow but visible fold with a slight indentation; Phase 1
minor facial feature Dysport® treatment to three areas: glabellar, frontalis and
1 Absent No visible nasolabial fold; continuous skin, injectable periorbital.
implant alone
Phase 2 (Week 2)
Microneedling
Table 4 Global Aesthetic Improvement Scale (GAIS) Topical anaesthesia: benzocaine 20%, Lidocaine Base 6%,
and tetracaine 4%.
Degree Description
Each patient received Chiroxy cream post-procedure
1 Exceptional improvement Excellent corrective result at week 12. No further to reduce erythema and inflammation. Tepid water was
treatment required
used to cleanse the face for the following 48 hours, and
2 Very improved patient Marked improvement of appearance, but not
completely optimal dried gently. It was recommended that make-up was not
applied for 12 hours after the procedure. After the
3 Improved patient Improvement of the appearance, better compared with
the initial condition. Touch-up is advised procedure, a broad-spectrum UVA/UVB sunscreen with
4 Unaltered patient The appearance substantially remains the same SPF 50 was recommended for use.
compared with the original condition
5 Worsened patient The appearance has worsened compared with the PRP preparation
original condition Draw blood (4 ml for each tube), then centrifuge tubes at
2000 rpm for 5 minutes. Take the syringe, insert the
needle and withdraw 0.5 ml DNA Activator (10% calcium
Group 1: fractional laser skin chloride). Withdraw platelets and mix with the DNA
resurfacing Activator.
Multiple injections (0.05–0.1 ml for a single injection)
Phase 1 were applied to the intra/sub dermis using the
Dysport® treatment to three areas: glabellar, frontalis and ‘multi‑pricking’ or retrograde linear techniques
periorbital.
Omnilux 633 nm LED
Phase 2 (Week 2) This was applied for 20 minutes per session (126 J/cm2).
Lumenis ActiveFX with settings (energy) 125 mJ (rate)
1 9w CPG 3/9/4 Phase 3 (Week 3)
In the pre-laser procedure, the author typically
prescribes Valium (Diazepam 5–10 mg orally) for anxiety, Low-level Ultralase
administered 45 minutes before the procedure. Lumenis ActiveFX with settings (energy) 100 mJ rRate)
For infection prophylaxis, Famvir (famciclovir) 750 mg 14 w CPG 3/5/2.
daily or Valtrex (valcyclovir) 500 mg twice per day for 7
days, was prescribed for every patient starting 3 days Omnilux 633 nm LED
before procedure. If the patient had a strong history of This was applied for 20 minutes per session (126 J/cm2).
acne, By-Mycin (doxycycline 100 mg daily) or Keflex
(cephalexin 500 mg twice per day) was prescribed for Histology
7 days, beginning on the day of surgery. Diflucan Skin biopsies were obtained from five of the patients
(fluconazole 150 mg) was not routinely prescribed in any intra-operatively, before Phase 2 of the treatment, and at
patient. 3 months post-operatively, and were performed to
The patients were treated under topical and regional determine the amount of epidermal damage, subsequent
anaesthesia. Topical anaesthesia comprised benzocaine inflammation, and new collagen synthesis. The extent of
20%, Lidocaine Base 6%, and tetracaine 4%). Regional neocollogenesis was compared with data on file for
anaesthesia was three-fold: patients who had skin biopsies for laser resurfacing and
■■ Supraorbital and supratrochlear nerve block. The neurotoxin alone in 2007. Each 1 cm by 1 cm piece of skin
supraorbital foramen was located and 1 cc of 1–2% was fixed with 10% formalin solution, neutral buffered.
Lidocaine injected just above the bone laterally, with After treatment with polyester wax, the skin samples
the needle directed medially, parallel to the brow and were sliced into 6 μm thicknesses. The sliced sections
toward the nose were treated with haematoxylin and eosin statin (H&E)
■■ Infraorbital nerve block. 1 cc of 1–2% Lidocaine injected and Masson’s trichrome staining solutions. Through
22 September 2012 | prime-journal.com
5. | facial aesthetics | ARTICLE
tissue evaluations, the thickness of the dermal layer and the ‘softer’ settings.
presence of collagen fibres were observed. The thickness According to investigator-based WSRS and GAIS
of the dermal layer was calculated by measuring five assessments at 3 months after baseline, the DUBLiN lift
different sites from each section, and the mean value of was superior in 62% and 55.2% of patients respectively,
the thickness of the dermal layer for each group was while fractional laser skin resurfacing was superior in
used for the comparison. 33.3% and 34.4% of patients. (P < 0.0004). An ‘optimal’
cosmetic result was achieved in a higher percentage of
Results patients in Group 2 compared with Group 1.
Over 3 months, 29 subjects (Group 2) were selected to Investigator-based and patient-based ratings using
compare the effect of low energy fractional laser skin both the WSRS and GAIS indicated that the DUBLiN lift
resurfacing with adjunctive treatments to conventional was more effective than conventional ablative laser
ablative laser resurfacing. These patients received a resurfacing in creating cosmetic correction to the lower
three‑phase combination of established treatments with face. This resulted from the volumising effect of adding
neurotoxin, microneedling, platelet growth hormones, PRP to the larger folds in this area. At 3 months
near-red 633 nm light, and low-energy Ultralase fractional post‑treatment, a higher proportion of patients showed a
CO2 laser skin tightening over a 3-week period. Phase 1 greater than or equal to 1-grade improvement in WSRS
included the administration of Dysport® neurotoxin to with DUBLiN Lift compared with fractional laser skin
the upper face. Phase 2 introduced fibroblast stimulation resurfacing. The author suspects the PRP may have a
from microneedling and PRP growth factor induction longer aesthetic effect when used in association with
with near-red phototherapy, and Phase 3 included microneedling and 633 nm light than previously noted27, 29.
low‑level (CO2) UltraPulse laser with adjunct near-red However, the results were almost reversed whenever
633 nm phototherapy. Results were compared to the periorbital rejuvenation was assessed alone, with almost
reamining 15 patients (Group 1) who received fractional every patient (93%) favouring conventional fractional
laser skin resurfacing (125 mJ; 19 w CPG 3/5/4), and whose laser skin resurfacing. Investigator-based GAIS
data was already on file. Patients in both groups were assessment of this region at 3 months after baseline
administered Dysport® neurotoxin 1 week prior to indicated that fractional resurfacing was superior in 93%
treatment to complement and preserve the overall of patients, while the DUBLiN Lift was superior in 6.8% of
aesthetic effect. The study evaluated post-procedural patients (P = 0.0025).
aesthetic results at baseline, 6 weeks and 12 weeks by Re-epithelialisation occurred in all laser-treated areas
means of a scoring system based on Dover’s photoageing of both groups by day 7, and this appeared to be clinically
scale, as well as using the WSRS and GAIS. similar for both procedures. Mean duration of erythema
Histological results were obtained from both groups was 6.9 days after resurfacing (range 4–10 days) in Group 1
showing the depth of laser penetration and consequential and 4.2 days in Group 2 (range 3–7 days). This appeared to
formation of new collagen. All skin biopsies showed be in keeping with previous studies37. All patients
thermal coagulation of epidermis and superficial dermis reported having no ‘crusting’ effect remaining on their
in a depth ranging from 85 to 113 µ. The zone of residual face after 6 days. Residual erythema remained in one
thermal (coagulative) damage was less in the Group 2 patient in Group 1 for a period of 14 days, but this was
patients, in whom less laser energy was used. The best minimal. Post-operative erythema was most intense in
neocollogenesis results — at 3 months — were evident in the areas treated by with the ActiveFX at an energy level
Group 1 where one patient NMG [AQ3: what does this above 125 mJ.
signify?] (Image E) had evidence of effect at 700 µ. This The mean pain sensation [AQ5: how was this assessed?]
was reflected in the patient’s skin, which continued to felt during the DUBLiN lift was 2.2 compared to
improve over the period. Owing to the variance in energy conventional fractional resurfacing treatment, which
of the CO2 laser in Group 1 and Group 2, it was expected was 3.4. The author noted that most patients did not feel
that the documented depth of histological ablation and much pain at all with the ActiveFX until the energy level
thermal effects would vary between them. Responses of crosses 100 mJ. No patient experienced any adverse
aesthetic effect were evaluated at 6 and 12 weeks after reaction to laser skin resurfacing, except one case of
baseline. herpetic infection in each group. (Group 1 6.6%; Group 2
The two methods appeared to produce different 3.4%). Both treatments were well tolerated. Clumping of
clinical improvement of lesions and rhytides. The global platelets occurred in 10% of patients treated with PRP
score [AQ4: are you referring to the GAIS? are the total for and the author felt that this was a result of the
tables 1-4?] for photoageing for the DUBLiN lift improved concentration of solution used. In fact, anecdotal
from 13.2 to 10.2 at day 30. This compared to 13.8 at evidence suggests that most cosmetic physicians are
baseline and 9.6 at day 30 for conventional FLRS alone. using PPP (platelet-poor plasma) in most areas of the face,
The score for fine lines was the most significant reduction, rather than the higher concentrations used by
dropping from 3.6 at baseline to 1.4 at day 30. The score for orthopaedic surgeons.
reduction of coarse wrinkles (3.2 at baseline to 2.2 at
6 weeks) was more difficult to interpret in this Conclusions
heterogeneous age grouping, with older patients Facial ageing is a consequence of many interacting
requiring the conventional ActiveFX settings rather than intrinsic and extrinsic factors. The most important of
prime-journal.com | September 2012 23
6. ARTICLE | facial aesthetics |
these include sun exposure or photoageing, and the
intrinsic changes associated with chronological ageing.
Over time, the muscles of facial expression produce
dynamic and static facial lines and folds. Laser
resurfacing has long been recognised as a skin
rejuvenation procedure for tissue that has lost its
elasticity and become less able to resist stretching.
However, despite the advent of newer fractionalised
lasers, it has adverse risks and does not adequately
address the problems associated with chronological
ageing as gravity exerts its toll on the facial structures. It is
important to apply supplementary methods, such as
dermal fillers or PRP, to address nasolabial or marionette
lines and volume deficits resulting from the loss and
repositioning of facial fat.
Declaration of interest [AQ6: please state]
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12. Fitzpatrick RE. CO2 laser resurfacing. Dermatol Clin 2001; 25. Bjerring P. Photorejuvenation — an overview. Med Laser 1247–52
19(3): 443–51 Appl 2004; 19: 186–95 37. Lowe NJ, Lask G, Griffin ME, Maxwell A, Lowe P, Quilada F.
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with CO2 laser resurfacing. Dermatol Clin 2002; 20(1): 77–86 treatment of acneiform scarring with CO2 ablative fractional Observations on 100 patients. Dermatol Surg 1995; 21(12):
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7. | facial aesthetics | ARTICLE
Further reading
Matteo Tretti Clementoni a; Patrizia Gilardino a; Gabriele F. Muti a; preauricular and postauricular skin after high-energy, short-pulse
Daniela Beretta b; Rossana Schianch. Non sequential fractional carbon dioxide laser. Arch Dermatol. 1996;132:425-428.
ultrapulsed C02 resurfacing of photoaged skin. Journal of Cosmetic and Rubach BW, Schoenrock LD. Histological and clinical evaluation of facial
Laser Therapy, Volume 9, Issue 4 2007 , pages 218 – 225 resurfacing using a carbon dioxide laser with the computer pattern
Lask G, Keller G, Lowe N, Gormley D. Laser skin resurfacing with the generator. Arch Otolaryngol Head Neck Surg. 1997;123:929-934.
SilkTouch flashscanner for facial rhytides. Dermatol Surg 1995;21:1021– Fitzpatrick RE, Tope WD, Goldman MP, Satur NM. Pulsed carbon dioxide
1024. laser, trichloroacetic acid, baker-gordon phenol, and dermabrasion: a
Bernstein L, Kauvar A, Grossman M, Geronemus R. The short and long comparative clinical and histologic study of cutaneous resurfacing in a
term side effects of carbon dioxide laser resurfacing. Dermatol Surg porcine model. Arch Dermatol. 1996;132:469-471.
1997;23:519–525. P Bonan, P Campolmi, G Cannarozzo, N Bruscino, A Bassi, S Betti, T Lotti.
Alster TS. Side effects and complications of laser surgery. In: Alster TS. 1468-3083. 2011. 04034. Journal of the European Academy of
Manual of Cutaneous Laser Techniques. Philadelphia: Lippinco, 2000 Dermatology and Venereology Eyelid skin tightening: a novel ‘Niche’ for
Burkhardt BR, Maw R. Are more passes better? safety versus efficacy fractional CO2 rejuvenation
with the pulsed CO2 laser. Plast Reconstr Surg. 1997;99:1531-1534. G.F. Pierce, D. Brown, T.A. Mustoe Quantitative analysis of inflammatory
Treacy PJ. Article on fractionalised lasers Jan 2008 Health & Living cell influx, procollagen type I synthesis, and collagen cross-linking in
Magazine www.hlaw.ie incisional wounds: influence of PDGF-BB and TGF-beta 1 therapy J Lab
Clin Med, 117 (1991), pp. 373–382
David Goldberg, MD: Reduced Down-time Associated with Novel
Fractional UltraPulse CO2 Treatment (Active FX) as Compared to Mathew M. Avram, MD, JD,1,* Whitney D. Tope, MPhil, MD,2 Thomas Yu,
Traditional Resurfacing P3115 -65th Annual American Academy of MD,3 Edward Szachowicz, MD, PhD,4 and J. Stuart Nelson, MD, PhD5
Dermatology Meeting Hypertrophic Scarring of the Neck Following Ablative Fractional Carbon
Dioxide Laser Resurfacing
Smith KJ, Skelton HG, Graham JS, et al. Depth of morphologic skin
damage and viability after one, two and three passes of a high-energy, Baez F and Reilly LR. The use of light-emitting diode therapy in the
short-pulse CO2 laser in pig skin. J Am Acad Dermatol. 1997;27:204-210. treatment of photoaged skin. Journal of Cosmetic Dermatology. 2007; 6:
189-194
Fitzpatrick R, Ruiz-Esparaza J, Goldman M. The depth of thermal
necrosis using the CO2 laser. J Dermatol Surg Oncol. 1991;17:340-344. Lee SY, et al. A prospective, randomized, placebo-controlled, double-
blinded, and split-face clinical study on LED phototherapy for skin
Tina S. Alster MD & Christopher A. Nanni MD Famciclovir Prophylaxis of rejuvenation: Clinical, profilometric, histologic, ultrastructural, and
Herpes Simplex Virus Reactivation After Laser Skin Resurfacing biochemical evaluations and comparison of three different treatment
Dermatol Surg Volume 25 Issue 3 Page 242-246, March 1999 settings. Journal of Photochemistry and Photobiology B. 2007; 88: 51-67
Mario A. Trelles; Inés Allones Red light-emitting diode (LED) therapy Majid I (January 2009). Microneedling therapy in athrophic facial scars:
accelerates wound healing post-blepharoplasty and periocular laser an objective assessment. J Cutan Aesthet Surg 2 (1): 26–30.
ablative resurfacing Journal of Cosmetic and Laser Therapy: formerly
Journal of Cutaneous Laser Therapy, Volume 8, Issue 1, 2006, Pages 39 Doddaballapur S (July 2009). Microneedling with dermaroller J Cutan
– 42 Aesthet Surg 2 (2): 110
Kauvar ANB, Waldorf HA, Geronemus R. A histopathologic comparison Day DJ, Littler CM, Swift RW, Gottlieb S. The wrinkle severity rating scale:
of char-free lasers. Dermatol Surg. 1996;22:343-348. a validation study Am J Clin Dermatol. 2004;5(1):49-52. Department of
Dermatology, New York University Medical Center, New York, New York
Cotton J, Hood A, Gonin R, Beeson W, Hanke C. Histologic evaluation of 10021, USA
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