David J Goldberg

..Increased demand for non-invasive cosmetic laser procedures has led to an increase in the use of physician extenders (PE). This demand has now led to a variety of medical legal concerns surrounding the use of lasers by non-physician PE...

..Because it is the lack of informed consent that may form the basis of a medical malpractice claim, the issues of what constitutes a medical malpractice claim will be fully described...

..The procedures that fit this model include those that promote antiaging, those that lead to rhytid treatment, and hair removal...

..Cellulite is seen in more than 85% of postpubertal women. Recent studies show that bipolar radiofrequency and low-level laser devices can produce mild skin tightening of cellulite...

..Nonablative laser surgery has been proven to improve early photodamaged skin and acne scars. These techniques include treatments with lasers, light sources, and/or radiofrequency devices...

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..The impact of the physician-physician extender relationship and the legal issues that arise from this relationship will also be discussed...

..Then the article will explore manufacturer promotion of off-label use of both drugs and devices. Finally, the legal ramifications of off-label dermal filler use will be discussed...

..Non-thermal, non-laser, phototherapy for acne with a combination of blue and red light has recently attracted attention. The present study was designed to assess the efficacy of this combination phototherapy...

..Then the chapter will explore manufacturer promotion of off-label use of both drugs and devices. Finally, the legal ramifications of off-label dermal filler use will be discussed...

..Non-ablative approaches with infrared and radiofrequency energy sources have been shown to reduce skin laxity, but studies have focused on individuals with early-stage, mild-to-moderate degenerative dermal changes...

..The future will involve office-based laser and light source hair removal, as well as a variety of laser and light-based home devices...

..This study sought to determine the efficacy and safety profile of calcium hydroxylapatite filler in the treatment of acne scars...

..Despite the documented safety of such cooling devices, there is scant data on the epidermal effects of different cooling temperatures when used with such technologies...

..To evaluate the clinical efficacy and ultrastructural changes in photodamaged skin after combined 633-nm and 830-nm light-emitting diode (LED) treatments...

..The article concludes with the legal and ethical issues associated with the promotion of cosmeceutical agents in the field of cosmetic dermatology...

..The flashlamp-pulsed dye laser has been used for nonablative dermal remodeling...

..Some newly described complications may have a variety of etiologic factors...

..5% as monotherapy and in conjunction with glycolic acid peels to treat facial actinic keratoses in two patients with extensive histories of prior actinic keratosis and skin cancer...

..The purpose of this study was to evaluate the efficacy, safety and tolerability of low-energy, multiple-treatment, fractional Er:YAG laser resurfacing for the treatment of photoaged skin...

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..To compare the safety and efficacy of two fractional carbon dioxide (CO(2)) laser devices for the treatment of photodamaged facial skin...

..Lasers and light sources emitting ultraviolet B (UVB) irradiation have been shown to repigment striae distensae...

..This article will provide readers with an extensive review of the popular chosen topical photosensitizers, varied used light sources and lasers, and medical and cosmetic indications treated with photodynamic therapy...

..In this article, we present the clinical outcomes of patients who have received treatment with a novel ribose crosslinked porcine collagen dermal filler for the correction of tear trough deformity...

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..Newer, less powerful home-device intense pulsed light sources will not replace those used in a physician's office but will augment the use of today's more powerful medical office systems...

..Multivitamin and hyaluronic acid solution facial mesotherapy does not appear to provide any significant benefit...

..We found a greater shift toward type I collagen synthesis in the ALA-IPL group compared to the IPL group. The addition of ALA to IPL treatment for photorejuvenation may be superior to IPL alone...

..CONCLUSION Soft tissue augmentation with CaHA filler leads to long-term deposition of new collagen surrounding filler microspheres, which may contribute to the overall improvement in the appearance of treated rhytids...

..This article examines breakthroughs in facial soft-tissue augmentation that have expanded the palette of options available to physicians...

..High-fluence photoacoustic Q-switched laser treatments were shown to produce results akin to those seen with some ablative lasers. Previous low-fluence, non-thermal, Q-switched Nd:YAG lasers produced almost no results...

..Phonophoresis, a method of electrically assisted percutaneous delivery of macromolecules, relies on ultrasonic waves producing alterations within the stratum corneum that result in increased absorption...

..CONCLUSION: This study is the first in vivo ultrastructural analysis of the biologic response to CaHa in human skin. CaHa shows clinical, histologic and electron microscopic evidence of persistence at 6 months...

..Extended-pulse dye lasers (EPDL) are commonly used to treat a variety of vascular lesions. This study evaluated whether differences in pulse formats and cooling methods might affect outcome in the treatment of small facial telangictasia...

..This improvement is increased with pre-treatment use of topical aminolevulinic acid. Vellus nonpigmented hairs did not respond to treatment...

..They are also extremely well suited to patients with darker skin types. In this chapter, we review the various non-ablative devices currently available on the market, with an emphasis on safety profiles and efficacy...

..Although unparalleled in its efficacy, carbon dioxide (CO2) laser resurfacing has a high risk:benefit ratio. A modified device uses a novel handpiece and software to deliver nonsequential fractional ablative CO2 laser exposures...

..This study was undertaken to evaluate the safety and efficacy of sequential dual-wavelength PDL and Nd:YAG laser treatment of photoaged facial skin...

..There were no noted complications at 6 months. CONCLUSION: The 1320-nm Nd:YAG laser is a safe and effective nonablative modality for the improvement of atrophic and a mixed pattern of facial acne scars...

..This article reviews the various complications most commonly seen with dermal fillers. In addition the appropriate consent prior to filler use and the legal implications of a lack of consent will be described...

..This chapter reviews the background of ablative lasers including the types of ablative lasers, mechanism of action, indications for ablative resurfacing, and possible side effects...

..Preliminary clinical and histologic studies have shown safety, efficacy and durability in various esthetic applications including the nasolabial folds and HIV lipoatrophy...

..We report the use of low fluence, large spot size Q-switched, Nd:Yag laser for the treatment of melasma in skin types II-IV...

..This area of technology is still evolving. Although such techniques, because they do not ablate the epidermis, are cosmetically elegant, the clinical results are usually not quite as good as the more aggressive ablative techniques...

..Recently, successful improvement in melasma has been achieved with this laser system. We undertook this study to evaluate the ultrastructural changes associated with fractional laser treatment of melasma...

..In general, at the end of 12 weeks of treatment, photodamage ranking moved from moderate to mild. Treatment was well tolerated with no significant cutaneous inflammation induced by the manganese peptide complex...

..It is a low risk procedure with potentially shorter periods of post-operative re-epithelialization and erythema as compared to standard ablative laser procedures...

..With increasing availability of a variety of soft tissue fillers, dermatologists should be aware of this delayed complication from polyacrylamide gels...

..The 980-nm wavelength has the potential benefits of a longer wavelength with the safety of shorter wavelengths...

..This study, together with earlier studies, corroborates that topical application of growth factors and cytokines are beneficial in reducing signs of facial skin aging...

..In addition, the history, pharmacology, and clinical complications of topical anesthetics are discussed...

..At this time, because the reported recurrence rates are significantly higher than those achieved with standard therapies, laser and PDT should be reserved for only those patients who cannot undergo surgical therapy for BCC and SCC...

..Pain and increased risk of complications may preclude the use of the laser at very high fluences and pulse duration in the range of 1000 msec...

..In this study, we evaluated the efficacy, safety, and histologic changes induced by 1064-nm Nd:YAG laser lipolysis. Furthermore, we investigated the benefit of suction aspiration after laser lipolysis...

..Laser hair removal efficacy was increased with multiple treatments. There does not appear to be an exact correlation in Asian skin between complications occurring after test patch treatment and those seen with subsequent treatments...

..Light-based therapies should be strongly considered in cases of serious erythema, flushing, and telangiectasia because these signs are not optimally addressed by pharmacologic interventions...

..The purpose of this review article is to present the current treatment options for the common aesthetic complaints of pigmented and vascular lesions...

..The objective of the study is to determine the effectiveness and tolerability of an Electro-Optic (EO) Q-switched Nd:YAG laser with Single Pulse and novel Double Pulse (DP) options in the treatment of photodamaged skin...

..Increased fluence (60-80 J/cm2) and longer pulse duration (50 msec) settings were generally correlated with reduced hair counts and improved clinical outcome...

..CONCLUSION: Although hair removal with commonly used systems is, as expected, highly effective, treatment with light-based devices can cause less pain, yet show efficacy similar to laser systems...

..These results were seen in the treatment of both blue/red and red facial telangiectases. CONCLUSION: The millisecond pulse duration 1064-nm Nd:YAG laser is effective for treatment of facial telangiectases...

..An understanding of the basic principles of a cause of action in medical malpractice will likely protect a physician from losing such a case in a court of law...

..It has now become an accepted modality for long-term hair reduction. It rivals electrolysis in the successful treatment of small hair-bearing areas. It surpasses any modality in the treatment of larger hair-bearing anatomic areas...

..It is likely that in the next decade, continued advancements in this field will bring us closer to the development of a more permanent and painless form of hair removal...

..The aim of this study was to evaluate the efficacy and complication rate of a 1450-nm diode laser and compare clinical effect when the laser is used in conjunction with cryogen cooling as compared to the use of cryogen cooling alone...

..This review will address the major properties of common suture materials and describe their advantages and disadvantages...

..The available literature and current recommendations are reviewed. Areas of controversy are examined and proposals for future research are made...

..At the doses utilized in this study, the effect does not generally appear to last as long as has been reported with botulinum A injections. However, the onset of action may be sooner with botulinum B injections...

..This simple, office-based treatment provides a non-surgical alternative to patients with prominent infraorbital fat pads. More clinical data are required to fully assess the long-term safety and efficacy of this procedure...

..In addition, the condition of patients with erythema may be improved. Younger patients may form more new collagen compared with older patients with photodamage...

..These data must be tempered with the need for significant further safety studies to determine whether this long-term filler has a safety profile consistent with other currently popular fillers...

..Erbium:YAG lasers have been effective in treating mild to moderate photoaging, but the need for either regional or general anesthesia, as well as the significant post-treatment recovery period has limited its use...

..CONCLUSION: The 308-nm excimer laser is effective for increasing pigmentation in mature hypopigmented striae. This pigmentation is cosmetically significant. Future studies are required to determine the duration of clinical improvement...