Cutaneous laser resurfacing is a tremendous advance in the treatment of photoaged skin. With the ... more Cutaneous laser resurfacing is a tremendous advance in the treatment of photoaged skin. With the recent developments in laser technology, the procedure has become widely utilized among many physician subspecialists. The latest laser systems permit controlled vaporization of skin so that most novice operators feel comfortable with the technique in a short period of time. Nevertheless, there are many issues that need to be addressed before performing the procedure. First, not every person is an appropriate candidate for laser resurfacing. Second, both the physician and the patient must be aware of the preoperative preparation and prolonged postoperative care involved with the procedure. Finally, the physician must be able to identify and treat, and the patient must be educated about, the side effects and potential complications associated with the procedure. It is only by addressing these issues that the clinical results obtained by CO2 laser resurfacing can be maximized.
Complications of cutaneous laser surgery can be understood by reviewing the evolution of laser te... more Complications of cutaneous laser surgery can be understood by reviewing the evolution of laser technology over the past several decades. Lasers initially were designed to operate in a continuous-wave (CW) mode, which produced a continuous beam of radiation that subsequently was absorbed by a tissue chromophore. Although particular skin structures could be destroyed using these early lasers, their use was limited because the energy emitted not only altered the target, but also conducted heat into adjacent nonirradiated tissue. The nonselective thermal injury produced in adjacent tissue resulted in significant side effects and complications; specifically, dyspigmentation, and scarring.1–3
Dermatology nursing / Dermatology Nurses' Association
Nonablative laser remodeling with the Cool Touch system is a new skin-rejuvenation procedure. Nur... more Nonablative laser remodeling with the Cool Touch system is a new skin-rejuvenation procedure. Nurses play several valuable roles in educating and caring for patients undergoing this procedure including assisting with patient selection, preoperative preparation, intraoperative set up and delivery, postoperative care, and followup.
Successful and long-standing eradication of sebaceous hyperplasia has remained difficult due to t... more Successful and long-standing eradication of sebaceous hyperplasia has remained difficult due to the propensity of these lesions to be extensive. Current treatments include excision, electrodesiccation, laser vaporization, and oral isotretinoin, each often associated with unacceptable side effects or lesional recurrence. The purpose of this study was to evaluate the safety and effectiveness of laser-assisted photodynamic therapy using topical 5-aminolevulinic acid (5-ALA) and 595 nm pulsed dye laser (PDL) irradiation for the treatment of sebaceous hyperplasia. Ten patients with sebaceous hyperplasia received 1 or 2 treatments at 6 week intervals with topical 20% 5-ALA followed 1 hour later by 595 nm PDL irradiation. Matched lesions served as controls and were either treated with PDL alone or were left untreated. Patients were evaluated at regular intervals for 3 months. Results demonstrated that combination topical 5-ALA and PDL treatment effected better clinical results than PDL treatment alone. No changes were observed in untreated control lesions. Side effects were mild and limited to transient erythema, edema, and focal crusting. It is the conclusion of the authors that laser-assisted photodynamic therapy with topical 5-ALA and PDL irradiation can achieve safe and effective improvement of sebaceous hyperplasia. Further study is warranted to determine the longevity of the clinical results observed.
Benign cutaneous vascular lesions have been treated with a wide array of modalities. Lasers are a... more Benign cutaneous vascular lesions have been treated with a wide array of modalities. Lasers are a comparatively new form of treatment for cutaneous blood vessel abnormalities. Initially, results following laser treatment were disappointing, primarily because of widespread thermal injury to surrounding normal tissue. Recent developments in laser technology and the introduction of the tunable dye laser offer the ability to selectively target laser energy at specific chromophores such as oxyhemoglobin. The technique of selective photothermolysis provides successful treatment of benign vascular lesions with minimal damage to adjacent structures.
Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.], 2013
Botulinum toxin is widely used for facial aesthetics, and its use in men continues to increase. T... more Botulinum toxin is widely used for facial aesthetics, and its use in men continues to increase. To provide a review of pertinent male anatomic features and updated clinical information on the use of botulinum toxin in men. A Medline search was performed for publications on sex differences in facial anatomy and on clinical studies examining the role of sex in botulinum toxin treatment. There are substantial facial anatomic differences between the sexes, with men having increased cranial size, unique cranial shape, greater skeletal muscle mass, higher density of facial blood vessels, and more-severe facial rhytides. A review of sex and botulinum toxin treatment identified 17 clinical studies with 5,646 total participants, of whom 629 (11.1%) were male. Only two studies accounted for sex in study design or subgroup analysis. Both studies found abobotulinumtoxinA to be less effective in men. An additional study examining onabotulinumtoxinA dosing in men found that higher doses than typi...
Journal of cosmetic and laser therapy : official publication of the European Society for Laser Dermatology, 2005
Most post-pubertal women exhibit cellulite, particularly in the thigh and buttock regions. The pr... more Most post-pubertal women exhibit cellulite, particularly in the thigh and buttock regions. The prevalence of cellulite has led to many attempts at treatment, including a variety of topical solutions, massage-based therapies, and surgical techniques--most with suboptimal clinical effects. The purpose of this controlled study was to evaluate a novel combination device involving radiofrequency, infrared light, and mechanical tissue manipulation for the treatment of cellulite. Twenty adult women (ages 25-57 years) of various skin phototypes (I-V), and with moderate bilateral thigh and buttock cellulite, received eight biweekly treatments to a randomly selected side (the contralateral side serving as a non-treated control). A combined bipolar radiofrequency, infrared light, and mechanical suction-based massage device was applied at 20 watts RF, 20 watts IR (700-1500 nm) light, and 200 millibar vacuum (750 mmHg negative pressure). Patients were evaluated using standardized digital photogr...
The use of lasers has assumed an increasingly important role in the treatment of a variety of cut... more The use of lasers has assumed an increasingly important role in the treatment of a variety of cutaneous lesions over the past few decades. Because of their effectiveness, physicians from a variety of specialties have incorporated lasers into their practices. Unfortunately, widespread availability of lasers and the public's fascination with their potential uses have created extraordinary, often unrealistic, expectations. We review the laser systems most frequently used to treat skin conditions. We discuss lasers with specificity for vascular malformations and pigmentary disorders as well as for tattoos and scars. Also, we review the latest techniques for cutaneous laser resurfacing with carbon dioxide and erbium:YAG lasers. Last, we briefly outline future uses of lasers and ongoing investigations, including laser treatment of leg veins and laser-assisted hair removal. Lasers, when properly used, offer clear advantages when compared with older, traditional approaches. Laser techno...
There are multiple different topical anesthetic options available to minimize the pain associated... more There are multiple different topical anesthetic options available to minimize the pain associated with cosmetic dermatologic procedures. These options, either alone or in combination, have diverse profiles for effectiveness, ease of use, application time, need for occlusion, and side effects. The lidocaine/tetracaine cream (Pliaglis Ò , Galderma Laboratories, Texas, USA), one of the newer combination options, offers effective pain alleviation that has been evaluated in numerous clinical trials. This combination anesthetic is associated with a very favorable profile because of its ease of use and mild side effects compared to other topical local anesthetics. An overview of available topical local anesthetics will be provided with an outline of clinical study characteristics and results regarding the use of lidocaine/ tetracaine cream.
BACKGROUND Laser skin resurfacing was popularized for photoaged and scarred skin 2 decades ago. S... more BACKGROUND Laser skin resurfacing was popularized for photoaged and scarred skin 2 decades ago. Since then, several technologic advancements have led to a new generation of delivery systems that produce excellent clinical outcomes with reduced treatment risks and faster recovery times.
The development and integration of pulsed and scanned CO2 and erbium:YAG laser systems into mains... more The development and integration of pulsed and scanned CO2 and erbium:YAG laser systems into mainstream surgical practice over the past years has revolutionized cutaneous resurfacing. These lasers are capable of delivering to skin high peak fluences to effect controlled tissue vaporization, while leaving an acceptably narrow zone of residual thermal damage. The inherent technological differences that exist between the two distant laser systems in terms of ablation depths, degree of thermal coagulation, and postoperative side-effects and complications guide patient selection and management. This article reviews the basic principles of CO2 and erbium:YAG laser resurfacing, including preoperative, intraoperative, and postoperative patient considerations. Side-effects and complications encountered after laser resurfacing are discussed with specific guidelines provided on their appropriate management. Anticipated future developments and cutting-edge research endeavors in cutaneous laser resurfacing are also briefly outlined.
Cutaneous laser resurfacing is a tremendous advance in the treatment of photoaged skin. With the ... more Cutaneous laser resurfacing is a tremendous advance in the treatment of photoaged skin. With the recent developments in laser technology, the procedure has become widely utilized among many physician subspecialists. The latest laser systems permit controlled vaporization of skin so that most novice operators feel comfortable with the technique in a short period of time. Nevertheless, there are many issues that need to be addressed before performing the procedure. First, not every person is an appropriate candidate for laser resurfacing. Second, both the physician and the patient must be aware of the preoperative preparation and prolonged postoperative care involved with the procedure. Finally, the physician must be able to identify and treat, and the patient must be educated about, the side effects and potential complications associated with the procedure. It is only by addressing these issues that the clinical results obtained by CO2 laser resurfacing can be maximized.
Complications of cutaneous laser surgery can be understood by reviewing the evolution of laser te... more Complications of cutaneous laser surgery can be understood by reviewing the evolution of laser technology over the past several decades. Lasers initially were designed to operate in a continuous-wave (CW) mode, which produced a continuous beam of radiation that subsequently was absorbed by a tissue chromophore. Although particular skin structures could be destroyed using these early lasers, their use was limited because the energy emitted not only altered the target, but also conducted heat into adjacent nonirradiated tissue. The nonselective thermal injury produced in adjacent tissue resulted in significant side effects and complications; specifically, dyspigmentation, and scarring.1–3
Dermatology nursing / Dermatology Nurses' Association
Nonablative laser remodeling with the Cool Touch system is a new skin-rejuvenation procedure. Nur... more Nonablative laser remodeling with the Cool Touch system is a new skin-rejuvenation procedure. Nurses play several valuable roles in educating and caring for patients undergoing this procedure including assisting with patient selection, preoperative preparation, intraoperative set up and delivery, postoperative care, and followup.
Successful and long-standing eradication of sebaceous hyperplasia has remained difficult due to t... more Successful and long-standing eradication of sebaceous hyperplasia has remained difficult due to the propensity of these lesions to be extensive. Current treatments include excision, electrodesiccation, laser vaporization, and oral isotretinoin, each often associated with unacceptable side effects or lesional recurrence. The purpose of this study was to evaluate the safety and effectiveness of laser-assisted photodynamic therapy using topical 5-aminolevulinic acid (5-ALA) and 595 nm pulsed dye laser (PDL) irradiation for the treatment of sebaceous hyperplasia. Ten patients with sebaceous hyperplasia received 1 or 2 treatments at 6 week intervals with topical 20% 5-ALA followed 1 hour later by 595 nm PDL irradiation. Matched lesions served as controls and were either treated with PDL alone or were left untreated. Patients were evaluated at regular intervals for 3 months. Results demonstrated that combination topical 5-ALA and PDL treatment effected better clinical results than PDL treatment alone. No changes were observed in untreated control lesions. Side effects were mild and limited to transient erythema, edema, and focal crusting. It is the conclusion of the authors that laser-assisted photodynamic therapy with topical 5-ALA and PDL irradiation can achieve safe and effective improvement of sebaceous hyperplasia. Further study is warranted to determine the longevity of the clinical results observed.
Benign cutaneous vascular lesions have been treated with a wide array of modalities. Lasers are a... more Benign cutaneous vascular lesions have been treated with a wide array of modalities. Lasers are a comparatively new form of treatment for cutaneous blood vessel abnormalities. Initially, results following laser treatment were disappointing, primarily because of widespread thermal injury to surrounding normal tissue. Recent developments in laser technology and the introduction of the tunable dye laser offer the ability to selectively target laser energy at specific chromophores such as oxyhemoglobin. The technique of selective photothermolysis provides successful treatment of benign vascular lesions with minimal damage to adjacent structures.
Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.], 2013
Botulinum toxin is widely used for facial aesthetics, and its use in men continues to increase. T... more Botulinum toxin is widely used for facial aesthetics, and its use in men continues to increase. To provide a review of pertinent male anatomic features and updated clinical information on the use of botulinum toxin in men. A Medline search was performed for publications on sex differences in facial anatomy and on clinical studies examining the role of sex in botulinum toxin treatment. There are substantial facial anatomic differences between the sexes, with men having increased cranial size, unique cranial shape, greater skeletal muscle mass, higher density of facial blood vessels, and more-severe facial rhytides. A review of sex and botulinum toxin treatment identified 17 clinical studies with 5,646 total participants, of whom 629 (11.1%) were male. Only two studies accounted for sex in study design or subgroup analysis. Both studies found abobotulinumtoxinA to be less effective in men. An additional study examining onabotulinumtoxinA dosing in men found that higher doses than typi...
Journal of cosmetic and laser therapy : official publication of the European Society for Laser Dermatology, 2005
Most post-pubertal women exhibit cellulite, particularly in the thigh and buttock regions. The pr... more Most post-pubertal women exhibit cellulite, particularly in the thigh and buttock regions. The prevalence of cellulite has led to many attempts at treatment, including a variety of topical solutions, massage-based therapies, and surgical techniques--most with suboptimal clinical effects. The purpose of this controlled study was to evaluate a novel combination device involving radiofrequency, infrared light, and mechanical tissue manipulation for the treatment of cellulite. Twenty adult women (ages 25-57 years) of various skin phototypes (I-V), and with moderate bilateral thigh and buttock cellulite, received eight biweekly treatments to a randomly selected side (the contralateral side serving as a non-treated control). A combined bipolar radiofrequency, infrared light, and mechanical suction-based massage device was applied at 20 watts RF, 20 watts IR (700-1500 nm) light, and 200 millibar vacuum (750 mmHg negative pressure). Patients were evaluated using standardized digital photogr...
The use of lasers has assumed an increasingly important role in the treatment of a variety of cut... more The use of lasers has assumed an increasingly important role in the treatment of a variety of cutaneous lesions over the past few decades. Because of their effectiveness, physicians from a variety of specialties have incorporated lasers into their practices. Unfortunately, widespread availability of lasers and the public's fascination with their potential uses have created extraordinary, often unrealistic, expectations. We review the laser systems most frequently used to treat skin conditions. We discuss lasers with specificity for vascular malformations and pigmentary disorders as well as for tattoos and scars. Also, we review the latest techniques for cutaneous laser resurfacing with carbon dioxide and erbium:YAG lasers. Last, we briefly outline future uses of lasers and ongoing investigations, including laser treatment of leg veins and laser-assisted hair removal. Lasers, when properly used, offer clear advantages when compared with older, traditional approaches. Laser techno...
There are multiple different topical anesthetic options available to minimize the pain associated... more There are multiple different topical anesthetic options available to minimize the pain associated with cosmetic dermatologic procedures. These options, either alone or in combination, have diverse profiles for effectiveness, ease of use, application time, need for occlusion, and side effects. The lidocaine/tetracaine cream (Pliaglis Ò , Galderma Laboratories, Texas, USA), one of the newer combination options, offers effective pain alleviation that has been evaluated in numerous clinical trials. This combination anesthetic is associated with a very favorable profile because of its ease of use and mild side effects compared to other topical local anesthetics. An overview of available topical local anesthetics will be provided with an outline of clinical study characteristics and results regarding the use of lidocaine/ tetracaine cream.
BACKGROUND Laser skin resurfacing was popularized for photoaged and scarred skin 2 decades ago. S... more BACKGROUND Laser skin resurfacing was popularized for photoaged and scarred skin 2 decades ago. Since then, several technologic advancements have led to a new generation of delivery systems that produce excellent clinical outcomes with reduced treatment risks and faster recovery times.
The development and integration of pulsed and scanned CO2 and erbium:YAG laser systems into mains... more The development and integration of pulsed and scanned CO2 and erbium:YAG laser systems into mainstream surgical practice over the past years has revolutionized cutaneous resurfacing. These lasers are capable of delivering to skin high peak fluences to effect controlled tissue vaporization, while leaving an acceptably narrow zone of residual thermal damage. The inherent technological differences that exist between the two distant laser systems in terms of ablation depths, degree of thermal coagulation, and postoperative side-effects and complications guide patient selection and management. This article reviews the basic principles of CO2 and erbium:YAG laser resurfacing, including preoperative, intraoperative, and postoperative patient considerations. Side-effects and complications encountered after laser resurfacing are discussed with specific guidelines provided on their appropriate management. Anticipated future developments and cutting-edge research endeavors in cutaneous laser resurfacing are also briefly outlined.
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Papers by Tina Alster