Computerized Pattern Generator Research Articles

An alternative approach for involutional entropion: a preliminary study

Involutional entropion is an inward rotation of the eyelid margin because of increased horizontal lid laxity, an overriding preseptal orbicularis, atrophied lid retractors, and involutional enophthalmos. There are a myriad of surgical approaches to treat involutional entropion, but the medical co-morbidities that are common in this patient population often make a less-invasive method more appropriate. In this study, a novel and less-traumatic method was tested. Tissue shrinkage effect of the CO(2) laser was used to create cicatricial changes to treat involutional entropion in five patients. Resurfacing was accomplished with the Ultra Pulse CO(2) (carbon dioxide) laser (model UP 5005, Coherent Medical Group, Santa Clara, CA) by the help of computerized pattern generator (CPG) scanning device. The first pass was performed to the entire lower lid and periorbital area, sparing the subciliary region, using 200mJ of energy. The second pass used the same energy level, but this time resurfacing was extended as close as the lash line. All four of the five patients available for follow-up clinical evaluation (interval between 5 and 21months) had surgical success with no recurrence of entropion, or symptoms such as itching or irritation. One of the patients who never came back for routine was lost to follow-up. The ectropion was never seen in the long-term follow-up. This method is a suitable alternative for elderly patients with comorbid conditions that prevent them from having invasive surgical procedures.

Facial resurfacing: An overview

Facial resurfacing is a broad topic referring to procedures that change the texture and appearance of skin. Resurfacing procedures are broadly classified as ablative or nonablative. Ablative procedures are considered the first line treatment for the most common indications for facial resurfacing, which are photoaging and acne scarring. The goal of this review is to provide an overview of the factors that optimize the clinical efficacy of an ablative procedure, including careful patient selection, preoperative skin preparation, correct operative technique, and vigilant postoperative care, as well as review both the traditional and some of the latest technologies that effectively resurface facial skin.

Combination of short-pulsed CO2 laser resurfacing and cultured epidermal sheet autografting in the treatment of vitiligo: a preliminary report.

Cultured epidermal autografting has been employed in a variety of clinical treatments including vitiligo management. In this study, we successfully treated 2 patients with vitiligo using a short-pulsed CO2 laser and by grafting the autologous cultured epidermis. Small pieces of uninvolved skin (2 x 1 cm) were taken for cultivation from a pudendal or axillary area and were expanded into 2 pieces of epidermal sheets 100 cm. Before grafting, the lesions were abraded superficially using a short-pulsed CO2 laser with a computerized pattern generator. After successful grafting, repigmentation was visible within 1 to 2 months. One year after grafting, the skin color was almost the same as that of the surrounding normal skin. Thus, the combination of short-pulsed CO2 laser resurfacing and cultured epidermal grafting is a powerful option for treating an asymmetric and wide vitiliginous lesion.

Treatment of Vitiligo with Suction Epidermal Grafting by the Use of an Ultrapulse CO2 Laser with a Computerized Pattern Generator

Treatment of Vitiligo with Suction Epidermal Grafting by the Use of an Ultrapulse CO2 Laser with a Computerized Pattern Generator

Treatment of Vitiligo with Suction Epidermal Grafting by the Use of an Ultrapulse CO2Laser with a Computerized Pattern Generator

Laser ablation is used to remove the recipient epidermis in the suction epidermal grafting in vitiligo surgery. To evaluate the effectiveness and safety of a suction epidermal grafting method after the removal of the epidermis by the use of the Ultrapulse CO2 laser with a computerized pattern generator. Eleven patients with 34 lesions of refractory stable vitiligo were studied. Of the 34 lesion sites, excellent repigmentation was seen in 30 and the other 4 had good repigmentation. No complications occurred. The Ultrapulse CO2 laser is particularly well suited for deepithelialization in vitiligo surgery.

Effects of varying density patterns and passes on depth of penetration in facial skin utilizing the carbon dioxide laser with automated scanner.

Histologic data describing the depth of penetration that occurs with the CO2 laser using variations in delivered energy, number of passes, and density settings have been limited. Most of the initial studies used a 3-mm collimated handpiece; few studies used the computerized pattern generator, which is now standard in treatment. This study examined histologic depth of thermal damage with varying density settings and number of passes using the computerized pattern generator. The Coherent UltraPulse 5000 CO2 laser with a computerized pattern generator was used. Preauricular (sun-exposed) and postauricular (sun-protected) facial skin samples were used from seven rhytidectomy patients aged 37 to 68 years. Preoperative skin treatment regimen included Retin-A and hydroquinone application for 3 weeks before the procedure. Three adjacent sites from the preauricular and postauricular regions were chosen from each ear (12 sites per patient). A density setting of 5 (30 percent overlap) was chosen for the right ear, and a density setting of 9 (60 percent overlap) was used for the left ear. Each region was subjected to one, two, and three passes. The laser delivers approximately 7.5 J/cm2 of fluence at a spot size of 2.25 mm and 300 mJ. Excisional biopsies were performed at the time of cervicofacial flap redraping. All specimens were evaluated for depth of thermal damage by a dermatopathologist who was blinded to the treatment parameters for each test site. Histologic examination of the treated test sites consistently demonstrated that one pass at these settings obliterated most or all of the epidermis, with minimal invasion into the papillary dermis. Test sites treated with two or three passes resulted in increased cumulative depth of penetration and thermal injury into the papillary dermis. Only one sample site showed any thermal injury extending into the reticular dermis. Depth of penetration was greater at the postauricular sites. Additionally, depth of penetration was greater with a density of 9 (60 percent overlap) than one of 5 (30 percent overlap) in both the preauricular and postauricular sites. Our study supported previous observations that the cumulative depth of penetration is greater with increasing levels of energy and additional passes. Additionally, we saw a greater average depth of penetration as density overlap increased, as one would predict. However, at these settings, fewer passes at a higher density setting did not achieve the same depth of penetration as more passes at a lower density setting. Furthermore, we found that the margin of safety using these settings is high: only 1 of 84 sites extended into the reticular dermis.

Deepithelialization Prior to Onlay Grafting Using the UltraPulse Carbon Dioxide Laser

When used in a defoeused mode, the UltraPulse carbon dioxide laser causes skin vaporization at a subepidermal level with minimal surrounding thermal destruction, allowing early reepithelialization from retained skin appendages. This attribute is of paramount importance if only skin resurfacing is desired. However, because the effect essentially is total removal of the epidermis, such a sequela can also be used advantageously to prepare a vascularized dermal bed prior to onlay of composite grafts or secondary overgrafting. This skin deepithelialization can be achieved in a bloodless field, permitting constant visualization of the depth of penetration, and an integrated computerized pattern generator scanner allows rapid, precise, and consistent desurfacing to the desired level. This preliminary investigation demonstrates that successful overgrafting is possible on a viable dermal plane exposed by the UltraPulse carbon dioxide laser, as another example of its role in skin deepithelialization.

Carbon dioxide laser resurfacing of the aged face.

Aging of the skin of the face consists of an intrinsic aging process that is genotypically inherent and inevitable, which accounts for the thinness of tissue that is lax and redundant. It can include benign and premalignant neoplasms [1, 2]. While photoaging or extrinsic aging is environmentally mediated and is characterized by fine and deep facial skin wrinkling; it can be characterized by thickened, coarse, yellow, sallow skin, that is studded with telangiectasia, macules of hyper-and hypopigmentation, benign, premalignant and malignant neoplastic lesions [1, 3—6]. There are many ways to rejuvenate aged skin, which include topical treatments with vitamin A acid [7,8], alpha and beta hydroxy acids [9, 11] and various types of skin resurfacing either by chemical peelings of glycolic, trichloracetric or phenolic acids for superficial, medium to deep depth resurfacing respectively [12, 13], or by performing a mechanical dermabrasion [14, 17]. This presentation will highlight rejuvenating the photodamaged and aged skin of the face by the currently most popular modality of resurfacing, which is using a high energy carbon dioxide laser that is either pulsed or flashscanned [18—23].

Ultrapulse carbon dioxide laser with CPG scanner for full-face resurfacing for rhytids, photoaging, and acne scars.

Eleven female patients are reported who underwent full-face resurfacing. Three patients were treated for cosmetic rhytids, five for residual acne scarring, and three for photoaging. There were no complications or side effects in this group of patients. Reepithelialization was achieved in an average of 9.3 days, and erythema disappeared in an average of 8.9 weeks. The UltraPulse carbon dioxide laser with computerized pattern generator (CPG) scanner allows a rapid, uniform laserbrasion. The sequence of the procedure involves close application of adjacent squares at 60 W, 200 to 300 ml, at moderate density. Skin preparation with Retin-A and bleaching agents is important for best wound healing. Postoperative wound care includes maintenance of a moist environment and Zovirax for herpes prophylaxis.