Background : Eyelid ptosis or blepharoptosis is defined as an abnormal drooping of the upper eyelid when looking straight ahead. Laser-assisted blepharoplasty (LAB), first introduced by Baker in 1984, presents the following advantages: improved intraoperative haemostasis, decreased operating time and improved appearance in the immediate postoperative periods. This article reports our long-term experience with LAB in ptosis correction surgery and underlines the advantages of the technique. Methods : A total of 52 patients were treated for ptosis with LAB between 2000 and 2011. The patients had an average age of 59.5 +/- 9.6 years. Etiologies were senile ptosis in 34 cases, traumatic ptosis in 9 cases and congenital ptosis in 9 cases. The ptosis was classified as mild in 24 cases, moderate in 11 cases, and severe in 17 cases. The surgical technique was similar to the one described by Baker. The laser used in our studies was the CO2 Lumenis Active T with the following parameters for skin incision: ultrapulse mode, continuous emission, 3-W power (program 1). The laser was then reprogrammed (program 2) with the following parameters for resection of a skin-orbicular muscle flap: regular mode, continuous emission, 9-W power with the beam slightly defocused. Results : Early complications included oedema in 8 patients. More than 1 mm of lid asymmetry was seen in 8 patients with 6 patients under corrected and two over corrected. Two of them chose secondary surgery. Mean down time was 5.5 +/- 1.7 days (2-7 days). The mean late follow-up was performed after 2-10 years (mean 6.6 +/- 1.7 years). Late complications included 4 recurrences 5, 6, 6, and 8 years, respectively, after the first procedure. All but one were successfully re-operated with the same technique. Overall patient satisfaction ranked high and all but one would recommend this treatment to others. Conclusion : LAB in ptosis surgery is a safe and reproducible technique particularly appreciated by patients. The procedure allows for improved intraoperative haemostasis, decreased operating time and improved appearance in the immediate postoperative periods.

Background: Unsightly fat knees are a frustrating aesthetic deformity exacerbated by genetic predisposition and resistance to diet. This article reports our experience with laser-assisted lipolysis (LAL) in knee remodelling. Methods: A total of 30 patients were treated for unsightly fat knees with LAL. The 924/975-nm diode laser used in this study consists of two lasers, one emitting at 924 nm and another at 975 nm. Previous mathematical modelling suggested that 0.1 kJ was required in order to destroy 1 ml of fat, in dual emission mode at 924/975 nm. Patients were asked to fill out a satisfaction questionnaire. Ultrasound was used to measure the fat thickness pre-and post-operatively. Results: Other than one patient who developed mild hyperpigmentation that disappeared after 2 months, there were no complications in the series. Pain during the anaesthesia and discomfort after the procedure were minimal. Return to normal activities never took longer than 2 days and mean downtime was 0.92 days. Of the 30 patients, 29 would recommend this treatment. Overall satisfaction was high with both patients and investigators and was validated by ultrasound measurements demonstrating a systematic decrease in fat thickness. Conclusion: LAL in knee remodelling is a safe and reproducible technique, particularly appreciated by patients. The procedure allows for a reduction in the amount of adipose deposits while providing concurrent skin contraction.

Background : Laser Assisted Skin Healing (LASH) was first introduced in 2001 by Capon and Mordon to prevent keloids and hypertrophic scars. LASH requires homogenous heating throughout the full thickness of the skin around the wound. However, LASH therapy with 808-nm diode laser is deemed to be only applicable for phototype I-IV due to melanin absorption. This prospective ex-vivo study aims to evaluate the thermal effects of different wavelengths (808, 1064, 1210 and 1320 nm) on human skin phototype II, IV and VI. Material and methods : Laser shots were applied on skin explants phototypes II, IV and VI. The following laser settings were used: 808, 1064, 1210 and 1320-nm diode laser, Spot size 20 x 3.7 mm, Power 3 W, Irradiance 4 W/cm(2), 50 shots for each phototype and wavelength. The surface temperature at 2 and 4-mm depth respectively was evaluated by an infrared camera and a low inertia micro thermocouple. Results : For the 1064, 1210 and 1320-nm wavelengths, the temperature gradient between the surface and 2-mm depth after an irradiation time of 15 s was less than 4.0 degrees C for each phototype. For the 808 nm, the gradient was 0.8 degrees C and 4.4 degrees C in phototype II and IV respectively, but reached 17.2 degrees C in phototype VI. Strong absorption by melanin of skin phototype VI induced unwanted temperature increases at the dermis-epidermis junction, making this wavelength unsuitable for LASH therapy for this phototype. Among the three other wavelengths, the discussion section indicates strong blood absorption at 1064 nm and presents both 1210 and 1320 nm as excellent compromises for LASH therapy across the whole range of phototypes. Conclusion : Being poorly absorbed by melanin, both 1210 and 1320-nm wavelengths ensure homogeneity of temperature throughout the full skin explant thickness. Their possible utilization for efficient LASH therapy should now be confirmed by prospective in vivo studies.

BACKGROUND:Since the first studies by Apfelberg in 1994, laser lipolysis (LAL) has been on the rise. Laser lipolysis leads to reduced operator fatigue, excellent patient tolerance, quick recovery time, as well as the additional benefit of dermal tightening. This article reports a 5-year experience of LAL and underlines the potential evolutions of the technique. METHODS:Between January 2006 and December 2010, 674 LAL procedures in 359 patients were performed at the Antoni De Gimbernat Foundation in collaboration with the French National Institute of Health and Medical Research (INSERM) U703. LAL was performed with a 980-nm diode laser after tumescent anaesthesia. The following laser settings were used: 600-μm optical fiber, continuous mode, power depending on individual body areas (18-40 W). The cumulative energy used for each area was recorded. Early and late complications were defined and reviewed for the whole series. Satisfaction was assessed by the patients using a visual analogue scale from 0 (unsatisfied) to 10 (highly satisfied). RESULTS:Mean cumulative energy ranged from 12 to 60 kJ. Ecchymoses were observed in all patients but resolved in less than 10 days. A touch up was needed in four patients to remove small cushions of fat missed. Mean patient satisfaction ranged from 6/10 to 9.5/10 depending on the treated area. Moreover, all patients reported they would be willing to undergo the procedure again, if needed. CONCLUSION:980-nm LAL appears to be a safe, effective and reproducible alternative to conventional lipoplasty. However, refinements in dosimetry should be developed in order to optimise outcomes.

Lasers in Surgery and MedicineVolume 41, Issue 8 p. 543-544 Letter to the Editor Is a vein filled with blood a good model for studying endovenous laser ablation? Serge Mordon PhD, Corresponding Author Serge Mordon PhD serge.mordon@inserm.fr INSERM U 703, Université Nord de France Lille University Hospital, CHRU Lille, FranceINSERM U 703, 152, rue du Dr. Yersin, 59120 LOOS, France.Search for more papers by this authorBenjamin Wassmer MSc, Benjamin Wassmer MSc Osyris Medical, Villeneuve d'Ascq, FranceSearch for more papers by this authorPascal Servell MSc, Pascal Servell MSc Osyris Medical USA, Dallas, TexasSearch for more papers by this authorJacques Desmyttère MD, Jacques Desmyttère MD S.E.L. Angéio-Phlébo Interventionnelle Lomme, FranceSearch for more papers by this authorChristophe Grard MD, Christophe Grard MD S.E.L. Angéio-Phlébo Interventionnelle Lomme, FranceSearch for more papers by this authorGuillaume Stalnikiewicz MD, Guillaume Stalnikiewicz MD S.E.L. Angéio-Phlébo Interventionnelle Lomme, FranceSearch for more papers by this author Serge Mordon PhD, Corresponding Author Serge Mordon PhD serge.mordon@inserm.fr INSERM U 703, Université Nord de France Lille University Hospital, CHRU Lille, FranceINSERM U 703, 152, rue du Dr. Yersin, 59120 LOOS, France.Search for more papers by this authorBenjamin Wassmer MSc, Benjamin Wassmer MSc Osyris Medical, Villeneuve d'Ascq, FranceSearch for more papers by this authorPascal Servell MSc, Pascal Servell MSc Osyris Medical USA, Dallas, TexasSearch for more papers by this authorJacques Desmyttère MD, Jacques Desmyttère MD S.E.L. Angéio-Phlébo Interventionnelle Lomme, FranceSearch for more papers by this authorChristophe Grard MD, Christophe Grard MD S.E.L. Angéio-Phlébo Interventionnelle Lomme, FranceSearch for more papers by this authorGuillaume Stalnikiewicz MD, Guillaume Stalnikiewicz MD S.E.L. Angéio-Phlébo Interventionnelle Lomme, FranceSearch for more papers by this author First published: 03 September 2009 https://doi.org/10.1002/lsm.20809Citations: 15AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume41, Issue8October 2009Pages 543-544 RelatedInformation

Selective dermal remodeling using diode or 1.32 mu m Nd:YAG lasers has been recently proposed for skin rejuvenation. This new technique consists in inducing collagen tightening and/or neocollagen synthesis without significant damage of the overlying epidermis. Such an approach requires i) a cooling system in order to target dermal collagen with relatively good protection of the epidermal layer, ii) a specific wavelength for confining the thermal damage into the upper dermis (100 to 400 mu m). Based on previous studies, demonstrating a better water absorption and a reduced melanin absorption at 1.54 mu m compared to the 1.32 mu m, this experimental study aimed to evaluate a new laser (co-doped Yb-Er:phosphate glass material, Aramis, Quantel-France) emitting at 1.54 mu m. This laser was used in combination with the Dermacool system (Dermacool, Mableton, USA) in order to achieve epidermis cooling before, during and after irradiation. Male hairless rats were used for the study. Pulse train irradiation (1.1J, 3Hz, 30 pulses) and different cooling temperatures (+5 degrees C, 0 degrees C, -5 degrees C) were screened with clinical examination and histological evaluation at i, 3, and 7 days after laser irradiation. The clinical effects showed that pulse train irradiation produced reproducible epidermal preservation and confinement of the thermal damage into the dermis. The different cooling temperatures did not provide detectable differences in terms of size and depth of thermal damage. New collagen synthesis was confirmed by a marked fibroblastic proliferation, detected in the lower dermis at D3 and clearly seen in the upper dermis at D7. This new laser appears to be a promising new tool for the treatment of skin laxity, solar elastosis, facial rhytids and mild reduction of wrinkles.