Effects of Laser and RF Devices on HA Filler

hyaluronic acid filler injections

A study published in the April issue of Dermatologic Surgery has revealed the effects that various laser rejuvenation treatments can cause on hyaluronic acid (HA) fillers.

In Histologic Effects of Fractional Laser and Radiofrequency Devices on Hyaluronic Acid Filler, Sarah Ham Hsu, MD, Hye Jin Chung, MD, MMS, and Robert Weiss, MD, divided abdominoplasty skin samples into eight zones. They administered HA filler intradermally into seven zones, leaving the eighth zone untreated to act as control. Following injection, they proceeded to treat six of the zones with a 1,540nm, 1,550nm, 1927nm or 10,600nm fractional laser, or fractional bipolar RF delivered through insulated microneedles, or fractional bipolar RF delivered through non-insulated microneedles. Biopsies were collected post-treatment for H&E (Haemotoxylin and Eosin) staining.

There were no morphologic changes to the filler following treatment with 1,540nm, 1,550nm, 1927nm and 10,600nm lasers, although researchers did observe thermal changes from the 1,540nm and 1,550nm lasers in very close proximity to the filler. Both RF devices caused thermal damage to the filler along the microneedle tracks. The authors concluded that the deeper dermal penetration from the RF energy will result in damage to fillers administered in the mid to lower dermis, and advised caution in using microneedle RF devices over recently injected HA fillers.

Authors note that obvious study limitations include testing on non-facial skin and lack of inflammatory response.

Currently in Australia it is common practice for most practitioners to advise clients to wait between 2-6 weeks after injectables before receiving any laser resurfacing or RF microneedling treatments. There are also other providers who subscribe to the school of thought that injectables should be administered after completion of laser treatment, since the laser treatment can change the contour of the face as collagen is stimulated, thereby changing the volume or location of fillers needed. Choice of treatment plan and amount of time in between injectables and laser treatments varies between clinics/practitioners.

 

Source:

Hsu, Sarah Hahn, MD; Chung, Hye Jin, MD, MMS; Weiss, Robert A., MD. (2019). Histologic Effects of Fractional Laser and Radiofrequency Devices on Hyaluronic Acid Filler. Dermatologic Surgery, [online] 45(4), pp.552-556. Available at: https://journals.lww.com/dermatologicsurgery/Abstract/2019/04000/Histologic_Effects_of_Fractional_Laser_and.10.aspx

Clinical Paper Review: Pulsed Dye Laser Treatment of Port-Wine Stains in Infancy Without the Use of General Anesthesia

 

Transcript: Hi guys, Kieren here, mechanical and biomedical engineer, and welcome to the first episode of Cosmetic Compare. We’re going to be going through a variety of different clinical papers in a way that’s hopefully easy for everyone to digest.

 

The very first paper I’ve chosen is Pulsed Dye Laser Treatment of Port-Wine Stains in Infancy Without the Need for General Anesthesia. Authors of the paper are Roy Geronemus, Leonard Bernstein, Hana Jeon, Daniel Belkin and Sabrina Ghalili. The reason why I chose this paper in particular- it was quite interesting to me in that all of the patients in the paper were less one year old, as well as they were all treated without any general anesthetic. For those of you who have had vascular treatments, you know that they’re quite painful treatments. So the idea of doing this on infants without any anesthetic is very interesting proposition.

 

The reason why treating at such a young age is essential, by the way, is because in theory firstly, you should get better results because the skin’s thickness isn’t quite as thick at a young age. On top of that the collagen mixture is a bit different so you would get less backscatter in theory. When it comes to port-wine stain there’s quite a few clinical papers that have shown it causes quite a lot of psychological stresses and can lead to things such as depression and/or low self-esteem. For most children the socialisation ages are about 3 to 6. And so it’s really quite critical we clear it before that age of socialisation. As said with the results of this paper, we definitely can. So that’s fantastic.

 

In this paper in particular, 197 patients, 124 girls, 73 boys. 90% of the patients were Fitzpatrick I to III. 75% of the port-wine stain was located within the facial region. The treatment settings used for those who are interested 10 to 12 millimeter spot size, 6.5 to 9 J/cm2 fluence, as well as 0.45 to 1.5 millisecond pulse duration. 25.9% of the patients showed a full clearance and a further 41.1% of patient showed a 75 to 99% reduction. As you can see on screen now, these are really great results. Over half the patients got at a 75% reduction. Now that being said, the average number of treatments was 9.7 treatments with a 37.29 date interval between treatments. This isn’t a miracle laser in that you do one treatment and it’s gone. But to get this level of clearance without anesthetic- you know, that’s a fantastic service and that’s enough to change a life. Really, really fantastic results in this paper. The youngest patient in this study, by the way (which is the one that’s on screen now) was 5 days old initial consult and 10 days old at first treatment. So that’s going to be a lifelong blessing for that child.

 

For those who are interested- the system being used in this study is the Vbeam Perfecta, and it’s from Candela Medical. Now they do have a new system called The Vbeam Prima and there are few differences. Mainly that there’s a 1064 Nd:YAG laser added and there’s a few different quality life and power changes, but both systems would be able to do this study sufficiently. So you are still going get the great outcomes either way. If you are looking a system whether it’s a Vbeam Prima, Perfecta, or any other system for your clinic, please feel free to reach out because what we can do is we can search the market and make sure you’re getting a great system at a great price for the clinic and make sure you really going to get great treatment outcomes.

 

One thing I just wanted to note as well is in terms of this paper. While this was done by a team in America primarily, we actually have a great doctor – a dermatologist – here in Australia who is one the world’s leaders on port-wine stain. That is of course, Dr Phil Bekhor. Dr Phil Bekhor is the director the laser unit at the Royal Children’s Hospital, as well as he has his practice here in Melbourne called Laser Dermatology. He has a heap of clinical papers, so I’m going be going through his clinical papers quite a lot in the near future. If anyone’s interested in any of his work, or perhaps you’re a doctor listening and you’ve got some clinical papers and you’d like to have them aired and have them reviewed, please feel free to reach out. As I said, I’d love to really focus on Australian doctors because when you meet an Australian doctor and you read the paper, you know the story behind the paper, and it’s not just some people in Israel or some guy in Germany, and it’s hard to have the mental backing or validation for it. Whereas when it’s by an Australian doctor whom we know the story behind, it provides a lot more weight to it.

 

If there’s any particular indications or treatments that you guys would like to see more of, please feel free to let me know, we’re open for feedback. And ultimately if there’s anything that you guys would like to see a lot of, I’m happy to do a lot more in-depth research into those areas to make sure that you guys have the right clinical knowledge to operate the business. If there’s anything you need in terms of clinical papers, or anything you’d like to research, feel free reach out. We’re open for feedback. Otherwise, I’ll see you guys on the next episode, and we’ll see you soon. Have a great day.

 

Source:

Jeon  H, Bernstein  LJ, Belkin  DA, Ghalili  S, Geronemus  RG.  Pulsed dye laser treatment of port-wine stains in infancy without the need for general anesthesia  [published online March 13, 2019].  JAMA Dermatology. doi:10.1001/jamadermatol.2018.5249

 

I would like to be contacted in regards to your clinical paper reviews