There is an excellent story with recommendations for a few typical plastic surgeries in Great Britain published today in MailOnline.

Anastasia Stephens, 37, a writer and holisitic health expert in London, underwent a surgical procedure to remove hereditary eye-bags that made her look haggard, even after a good night’s sleep. After the cosmetic surgeon had scraped out two bags of fat from beneath each eye, she couldn’t have been happier.

Ten years later, her eyes had prematurely aged. Having the fat removed had loosened the skin under them, and over time, this has wrinkled more than it would have, and in an unnatural way. Lots of lines developed directly under each lower eyelid where the bags used to be.

She recently discovered that a few affordable laser procedures could tighten the skin under her eyes and reduce the wrinkles. She saw the effect after the third treatment and was relieved completely as she realised that her condition can be safely treated without the knife, and the results would last for many years to come.

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Rosacea is a  chronic disease that affects the skin and sometimes the eyes. Characteristics of the condition include redness, pimples, and, in advanced stages, thickened skin. Although rosacea usually affects the face, it can affect parts of the upper body. Despite how common the condition is, many people with rosacea go undiagnosed.

Approximately 14 million people in the United States have rosacea, and it is more common in women (particularly during menopause) than in men. Rosacea tends to occur more frequently in people with fair skin; however, it can occur in people of any skin color.

Common Symptoms

• Frequent redness or flushing of the face. The face may also have a burning sensation and slight swelling.
• Small red lines under the skin, which appear when the blood vessels under the skin get larger. This area of the skin may be somewhat swollen, warm, and red.
• Constant redness, along with bumps on the skin. Sometimes the bumps have pus inside (pimples), but not always. Solid bumps on the skin may later become painful.
• Inflamed eyes and eyelids.
• A swollen nose. In some people (mostly men), the nose becomes red, larger, and bumpy.
• Thicker skin.

See pictures of Rosacea

Although there is no rosacea cure, the condition can be treated and controlled. Without proper care, rosacea may progress to a more disfiguring condition, known as Rhinophyma.

What Is Rhinophyma?

The most common characteristic or symptom of rhinophyma is an enlarged, bulbous, and red nose. Rhinophyma is associated with the sebaceous (oil-producing) glands beneath the surface of the skin on the nose. The condition is more common in men than women. See pictures of Rhinophyma

Treating Rosacea and Rhinophyma

There is a common four-stage algorithm of treatment for these conditions. The first three stages of rosacea, and the fourth stage is rhinophyma. For the first stage of the pre-rosacea, the mainl treatment is focused on prevention. On the second stage, some topical and oral treatments are used. More agressive medication is typically used during the third stage. If nothing works and rosacea develops into rhinophyma, the only treatment is surgery. Topical treatment includes metronidazole gel and Retin-A; however, Retin-A may exacerbate the erythema. Oral treatments include tetracycline, metronidazole, and Accutane. Radiation and chemical scarification are no longer accepted methods. Originally all surgeries were skin grafted (decortication), as it was feared that the rhinophymatous tissue would recur. Now, however, surgical decortication with preservation of the sebaceous glands fundi is the preferred method of excision. Preservation of the glands will allow spontaneous re-epithelialization. These are the frequently used devices that we may see in rhinophymatous surgery. The oldest method of the rhinophymatous surgery is the excision (the cold technique). The risk of scarring and hypopigmentation are common. Electrosurgery for rhinophyma was introduced in 1950s. There is greater heat dispersion compared to CO2 laser and Cold Knife, which can lead to scarring and hypopigmentation. One can use a wire loop or a hockey stick attachment. Greenbaum, in an interesting study, took three patients and treated one-half of the nose with CO2 laser and then treated the other half of the nose with electrosurgery and concluded that both gave equivalent cosmetic results with equal time to re-epithelialization. However, he stated that the laser technique took him twice as long compared to the electrosurgery technique and he also reported that CO2 laser is 15 to 20 times more costly than the electrosurgery. Stucker states that you should reserve this technique only for diseases on the nasal tip. You can see why, since sometimes you may get some alar notching here. The CO2 laser was introduced in 1980s. Excision of the bulk of rhinophyma was used with the CO2 laser, and vaporization was used for the rest with the depth of 0.1mm. The Erbium:YAG laser use for rhinophyma became available and common in mid-1990s. Better  cosmetic results with shorter healing time were obvious due to the smaller thermal damage zone compared to the CO2. Dermabrasion is another technique used in rhinophyma; however, it is usually used as an adjuvant to other methods. Dermabraders are simple tools that are very effective but may cause a very sever trauma and extended hypopigmentation. The recent advances in laser technologies offer less invasive and very efficacious approach to treating rosacea and preventing rhinophyma. Nd:YAG lasers are used to reduce and control rosacea and to get patients off Accutane, which has been linked to birth defects and other complications. If rosacea has developed into rhinophyma, the Erbium laser provides very accurate tissue ablation and allows the sculpturing of the hypertrophied areas, offering good cosmetic results, with a very short healing period. Combined carbon dioxide laser and bipolar electrocoagulation is another another option to treat rhinophyma. This combined method provides a bloodless operative field which allows the sculpting of the hypertrophic areas, leading to a good cosmetic outcome and a pain-free postoperative recovery. In conclusion, it is important to diagnose rosacea at an early stage and treat it effectively before it has a chance to develop into rhinophyma and disfigure the patient’s nose and face.

Pulsed dye laser-mediated photodynamic therapy for acne inversa is not successful. Results of a study in France just came out in Journal of Dermatological Treatment.

Acne Inversa is sometimes recognized as Hidradenitis Suppurativa (HS). Acne Inversa is not contagious. It’s a recurrent disease impacting inverse parts of the body such as breasts, armpits, and groin, and places hair follicles and apocrine glands are located. It usually develops early on as one boil-resembling, pus-laden abscesses, solid sebaceous lumps, to deep-seated, painful, frequently inflamed groups of lesions with extreme seepage resulting in major scarring.

See pictures of acne inversa

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The relapses and the chronicity of acne inversa cause a significant impact on the quality of life of the affected patients and urge for a search of more effective treatments. The authors report the treatment of four consecutive acne inversa patients with pulse dye laser-mediated photodynamic therapy (PDL-PDT). Three months after the end of the treatment there was no improvement in comparison with opposite control sites. Intense pain during treatment was reported by all the patients. These cases do not support the use of PDL-PDT for treating acne inversa.

Technological advances in medical aesthetic lasers have been dramatic in the last few years. It is important to keep up and update your armamentarium as well as treatment protocols. This well illustrated book by respected authorities in the field provides the answers for the commonly encountered problems. Even established laser practitioner will be interested to learn about new generation of lasers and combination treatments.

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This is a book that should be in every aesthetic practice.

Several subscribers have asked us how lasers can be used to remove a cyst.

A sebaceous cyst is a benign lesion of the skin, which looks like a closed sac or cyst below the surface of the skin that has a lining that resembles the uppermost part of a hair follicle that is filled with a fatty white, semi-solid material called sebum. Sebum is produced by sebaceous glands of the epidermis. More about Sebaceous Cyst.

Traditional techniques to remove cyst are:

1. conventional wide excision (can remove the cyst completely but with a potentially big scar),
2. minimal excision (similar to the punch technique, which can achieve minimal scarring but carries a risk of recurrence), and
3. punch biopsy excision (high risk of recurrence).

For large cysts or cysts located in areas of thick skin, the cyst wall is more friable or not easy to squeeze. Complete cyst removal with a better cosmetic appearance in these cases is more difficult to achieve.

A new procedure for treating a Sebaceous Cyst was recently published by study group from China.

Chinese physicians have documented a what seems to be a very effective treatment protocol. They use laser punches to prepare the cyst for the removal of the content with a minimal excision.

The new method with two steps is proposed:

• A CO2 laser is used to make a small hole for removal of the cyst content;
• then the cyst wall is removed entirely with a minimal excision about 1 month later.

The method offers a good alternative for eradication of uninfected cysts with only a small scar, especially large cysts or cysts located in areas of thick skin or cosmetic concern. Images and more detailed description of the laser cyst removal procedure.

This is a brief review of a study recently published by a group of Chinese researchers (see references here).

The study evaluated the efficacy and side effects of the Lumenis One™ IPL device for epilation (hair removal) in Chinese patients. Eighteen Chinese women with Fitzpatrick skin types III-V and black hair were treated four times at 4 to 6-week intervals on the axillae (arm pits) and the upper lip.

The energy density for treatment (fluence) ranged from 14 to 22 J/cm2 with filters for 640-755-nm wavelength and 3.5-7 ms pulse duration.

Hair reduction was assessed at baseline, immediately before each treatment session, and at 4 weeks after the fourth treatment. Patient’s satisfaction on a 5-point scale was also evaluated.

Results
The average hair reduction for all sites was 49.9% after one session, 58.6% after two sessions, 79.3% after three sessions, and 83.8% after four sessions. The hair reduction of 44.1%, 52.1%, 81.1%, and 86.0% were achieved after each treatment for axillae, with 65.1%, 75.7%, 74.6%, and 78.0% for upper lip.

Patients got more satisfaction after four sessions (score 3.1) than that after two sessions (2.0). In both the assessments, upper lip appeared to show a better response than axillae after two IPL treatments, which reversed after four treatments.

No significant complications or adverse events were reported, and the study concluded that the IPL device provides a safe and effective means of hair removal for Chinese patients.

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Latest Laser Hair Removal video clips on LaserOffers.com

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Cosmetic surgeons are developing innovative techniques in order to meet the patient demand for effective procedures with less downtime and less trauma.

Dr. Patrick McMenamin, Sacramento-based cosmetic surgeon and president of American Academy of Cosmetic Surgery, is perfecting a procedure known as the “laser facelift”. He combines Smartlipo laser-assisted lipolysis and liposuction skin-and-tissue tightening associated with subcutaneous application of light and heat energy. After administering local anesthesia, the surgeon creates three or four small incisions, one behind each earlobe, and one or two under the chin. The surgeon removes a variable amount of fat (depending on the individual patient), then uses a laser probe between the skin and muscle to uniformly liquefy additional fat. In addition to removing extraneous fat underlying the skin, the laser facelift technique heats the skin, which stimulates collagen formation, tightening the tissues.

“There are all kinds of theories about what mediates this healing process, whether it’s cytokines, leukotrienes, prostaglandins,” or some other mechanism, Dr. McMenamin says. But what he knows for a certainty is that in the hands of skilled surgeons, liposuction — and laser treatments — provide exceptional results.

“In my experience, this represents a different healing process than what I’ve seen before with my standard facelift techniques. And, on some levels, based on the parameters I use with my patients, it’s better. Recovery is easier.” Patients have their procedures on Monday or Tuesday, for instance, and go back to work by the end of the week. They also have somewhat normal sensation in the area within the first week, Dr. McMenamin says.

Good candidates for this procedure include nonsmokers in good general health, with localized areas of fat in the jowl area and under the chin, and who have good skin integrity.

“The improvement on the entire jowl (to the oral commissure to the nasolabial line) has been exceptional” Dr. McMenamin notes.

“Why are we using the laser? We think we are getting better skin contraction. We think we’re getting that because we’re inducing another level of trauma — in this case heat — a more uniform level of trauma. At least, this is our hypothesis.”

Whatever the causation, Dr. McMenamin says, “It seems to be a little easier on the patient, and I’m able to get a slightly better result, specifically in the jowl, along the jowl line, and in the oral commissure and moving up nasolabial line.” This is something, he says, that he does not get with a regular facelift because the facial nerve is so superficial.

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Our medical panel believes that even though the benefits of using laser for both complex facial surgeries and rather minor liposuction treatments may still remain scientifically understudied, but anecdotal evidence proves that the use of lasers makes such treatments more controllable, less invasive, and reduces the healing time.