Lasers and laser‐like devices: Part one

doi:10.1111/AJD.12034

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Lasers and laser‐like devices: Part one

Journal Article•DOI•

Lasers and laser‐like devices: Part one

Nicholas Stewart, Adrian Lim¹, Patricia Lowe², Greg J. Goodman•Institutions (2)

Royal North Shore Hospital¹, University of Sydney²

01 Aug 2013-Australasian Journal of Dermatology (Australas J Dermatol)-Vol. 54, Iss: 3, pp 173-183

TL;DR: Non‐laser energy devices utilising intense pulsed light, plasma, radiofrequency, ultrasound and cryolipolysis contribute to the modern laser practitioners' armamentarium and will also be discussed.

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Abstract: Lasers have been used in dermatology for nearly 50 years. Through their selective targeting of skin chromophores they have become the preferred treatment for many skin conditions, including vascular malformations, photorejuvenation and acne scars. The technology and design of lasers continue to evolve, allowing greater control of laser parameters and resulting in increased safety and efficacy for patients. Innovations have allowed the range of conditions and the skin types amenable to treatment, in both general and cosmetic dermatology, to expand over the last decade. Integrated skin cooling and laser beam fractionation, for example, have improved safety, patient tolerance and decreased downtime. Furthermore, the availability and affordability of quality devices continues to increase, allowing clinicians not only to access laser therapies more readily but also to develop their personal experience in this field. As a result, most Australian dermatologists now have access to laser therapies, either in their own practice or within referable proximity, and practical knowledge of these technologies is increasingly required and expected by patients. Non-laser energy devices utilising intense pulsed light, plasma, radiofrequency, ultrasound and cryolipolysis contribute to the modern laser practitioners' armamentarium and will also be discussed.

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Challenger Tafe, WestOne

01 Jul 2004

TL;DR: In this article, the authors developed a center to address state-of-the-art research, create innovating educational programs, and support technology transfers using commercially viable results to assist the Army Research Laboratory to develop the next generation Future Combat System in the telecommunications sector that assures prevention of perceived threats, and non-line of sight/Beyond line of sight lethal support.

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Abstract: Home PURPOSE OF THE CENTER: To develop the center to address state-of-the-art research, create innovating educational programs, and support technology transfers using commercially viable results to assist the Army Research Laboratory to develop the next generation Future Combat System in the telecommunications sector that assures prevention of perceived threats, and Non Line of Sight/Beyond Line of Sight lethal support.

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1,713 citations

Journal Article•DOI•

Infantile hemangioma. Part 2: Management.

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Deshan F. Sebaratnam¹, Deshan F. Sebaratnam², Ana Isabel Rodríguez Bandera¹, Li-Chuen F. Wong¹, Orli Wargon³ - Show less +1 more•Institutions (3)

Children's Hospital at Westmead¹, Liverpool Hospital², Boston Children's Hospital³

19 Aug 2021-Journal of The American Academy of Dermatology

TL;DR: In this paper, the majority of infantile hemangiomas (IH) can be managed conservatively, but for those requiring active treatment, management has been revolutionized in the last decade by the discovery of propranolol.

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Abstract: The majority of infantile hemangiomas (IH) can be managed conservatively, but for those requiring active treatment, management has been revolutionized in the last decade by the discovery of propranolol. Patients that may require active intervention should receive specialist review, ideally before 5 weeks of age to mitigate the risk of sequelae. Propranolol can commence for most infants in the outpatient setting and the most frequently employed dosing regimen is 1 mg/kg twice daily. In the future, β-blockers with a more-selective mechanism of action, such as atenolol, show some promise. In recalcitrant lesions, systemic corticosteroids or sirolimus may be considered. For small, superficial IHs, topical timolol maleate or pulsed dye laser may be considered. Where the IH involutes with cutaneous sequelae, a range of interventions have been reported, including surgery, laser, and embolization. IHs have a well-described clinical trajectory and are readily diagnosed and managed via telemedicine. Algorithms have been constructed to stratify those patients who can be managed remotely from those who warrant in-person review during the COVID-19 pandemic.

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34 citations

Journal Article•DOI•

Laser and light-based therapy for cutaneous and soft-tissue metastases of malignant melanoma: a systematic review.

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Evan Austin¹, Evan Austin², Andrew Mamalis², Andrew Mamalis¹, Derek Ho¹, Derek Ho², Jared Jagdeo³, Jared Jagdeo¹, Jared Jagdeo² - Show less +5 more•Institutions (3)

Veterans Health Administration¹, University of California, Davis², State University of New York System³

17 Mar 2017-Archives of Dermatological Research

TL;DR: Non-fractionated carbon dioxide laser had the best palliative efficacy of the reviewed laser and light-based therapies, while other treatment modalities may have potential as adjunctive therapy to standard of care.

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Abstract: Invasive cutaneous melanoma is a growing health concern. Although surgical excision can effectively treat in situ tumors, use for metastatic melanoma is limited. Laser and light-based therapies may be a valuable palliative treatment option for patients with stage III and stage IV cutaneous metastatic melanoma. Our goal is to review the published literature and provide evidence-based recommendations on laser and light-based palliative therapies for metastatic melanoma. A search of the databases Pubmed, EMBASE, Web of Science, and CINAHL was performed on March 10, 2016. Key search terms were related to melanoma, laser, and light-based modalities. Our search initially identified 13,923 articles and 27 original articles met inclusion criteria for our review. Grade of recommendation: C for non-fractionated carbon dioxide laser, Grade of recommendation: D for fractionated carbon dioxide laser, ruby laser, neodymium laser, near-infrared diode laser, and photodynamic therapy. Non-fractionated carbon dioxide laser had the best palliative efficacy of the reviewed laser and light-based therapies, while other treatment modalities may have potential as adjunctive therapy to standard of care.

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32 citations

Cites background from "Lasers and laser‐like devices: Part..."

...LLBT Laser and light-based therapies MM Metastatic melanoma AEs Adverse events ILP Isolated limb perfusion US United States AJCC American Joint Committee on Cancer RCT Randomized controlled trial CS Case series CR Case report LOE Level of evidence PRISMA Preferred Reporting Items for Systematic Reviews and Meta-Analyses CO2 Carbon dioxide MTZ Microthermal Zone PDL Pulsed dye laser Nd Neodymium Nd:Yag Neodymium-doped yttrium aluminum garnet nIR Near-infrared diode ECOG Eastern Cooperative Oncology Group PDT Photodynamic therapy ALA Aminolevulinic acid HPD Hematoporphyrin derivatives MB Methylene blue nm Nanometer...
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...Fractionated CO2 laser is a 10,600-nm laser that ablates in a pixelated pattern termed microthermal zones (MTZ) while preserving intervening tissue to act as a healing reservoir for nearby MTZ [44]....
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...Fractionated CO2 Laser Fractionated CO2 laser is a 10,600-nm laser that ablates in a pixelated pattern termed microthermal zones (MTZ) while preserving intervening tissue to act as a healing reservoir for nearby MTZ [44]....
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Journal Article•DOI•

Complications associated with cutaneous aesthetic procedures

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Daniela Hartmann¹, Thomas Ruzicka¹, Gerd G. Gauglitz¹•Institutions (1)

Ludwig Maximilian University of Munich¹

01 Aug 2015-Journal Der Deutschen Dermatologischen Gesellschaft

TL;DR: The following review aims to give a broad overview of nowadays most frequently used approaches in the dermato‐aesthetic field and their related complications.

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Abstract: In recent years, a plethora of novel therapeutic approaches to fight signs of aging and to influence external body appearance have become available in aesthetic dermatology. Extensive research in this field has led to advanced understanding of the anatomy and physiology of the aging face. To successfully address the complex age-related alterations anti-aging treatment nowadays calls for a multi-faceted approach. Most frequently utilized aesthetic procedures include the use of botulinum toxin, a variety of filling substances, microneedling (collagen induction therapy), chemical peeling, lasers, radiofrequency, thread facelift and injectional lipolysis with phosphatidylcholine/deoxycholate among others. Unfortunately, many clinicians still lack in-depth understanding of potential complications, risk factors and side effects associated with minimal-invasive procedures. The following review aims to give a broad overview of nowadays most frequently used approaches in the dermato-aesthetic field and their related complications.

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27 citations

Journal Article•DOI•

Assessment of Laser Effects on Skin Rejuvenation

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Hazhir Heidari Beigvand¹, Mohammadreza Razzaghi², Mohammad Rostami-Nejad², Majid Rezaei-Tavirani¹, Saeed Safari², Mostafa Rezaei-Tavirani², Vahid Mansouri², Mohammad Hossein Heidari² - Show less +4 more•Institutions (2)

Iran University of Medical Sciences¹, Shahid Beheshti University of Medical Sciences and Health Services²

15 Mar 2020-Journal of lasers in medical sciences

TL;DR: The survival and activation of fibroblasts and new keratinocytes with an increase of collagen and elastin fibers in the dermis and the reduction of matrix metalloproteinases and heat shock proteins as a result of different low-power laser therapies of skin are revealed.

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Abstract: Laser skin resurfacing has changed the approach of facial skin rejuvenation over the past decade. This article evaluates the laser effects on skin rejuvenation by the assessment of laser characteristics and histological and molecular changes, accompanied by the expression of proteins during and after laser-assisted rejuvenation of skin. It is important to note that different layers of skin with different cells are normally exposed to the sun’s UV radiation which is the most likely factor in aging and damaging healthy skin. To identify the expression of proteins, using validated databases and reviewing existing data could reveal altered proteins which could be analyzed and mapped to investigate their expression and their different effects on cell biological responses. In this regard, proteomics data can be used for better investigation of the changes in the proteomic profile of the treated skin. Different assessments have revealed the survival and activation of fibroblasts and new keratinocytes with an increase of collagen and elastin fibers in the dermis and the reduction of matrix metalloproteinases (MMPs) and heat shock proteins (HSPs) as a result of different low-power laser therapies of skin. There are a wide range of biological effects associated with laser application in skin rejuvenation; therefore, more safety considerations should be regarded in the application of lasers in skin rejuvenation.

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26 citations

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Journal Article•DOI•

Fractional Photothermolysis: A New Concept for Cutaneous Remodeling Using Microscopic Patterns of Thermal Injury

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Dieter Manstein¹, G. Scott Herron, R. Kehl Sink, Heather Tanner, R. Rox Anderson¹ - Show less +1 more•Institutions (1)

Harvard University¹

01 Jun 2004-Lasers in Surgery and Medicine

TL;DR: This work introduces and clinically examine a new concept of skin treatment called fractional photothermolysis (FP), achieved by applying an array of microscopic treatment zones (MTZ) of thermal injury to the skin.

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Abstract: Background and Objectives: We introduce and clinically examine a new concept of skin treatment called fractional photothermolysis (FP), achieved by applying an array of microscopic treatment zones (MTZ) of thermal injury to the skin. Study Design/Materials and Methods: Two prototype devices emitting at 1.5 mm wavelength provided a pattern of micro-exposures with variable MTZ density. Effects of different MTZ densities were tested on the forearms of 15 subjects. Clinical effects and histology were assessed up to 3 months after exposure. Treatment of photoaged skin on the periorbital area in an additional 30 subjects receiving four treatments over a period of 2–3 weeks was also tested. Tissue shrinkage and clinical effects were assessed up to 3 months after treatment. Results: Pattern densities with spacing of 250 mm or more were well tolerated. Typical MTZ had a diameter of 100 mm and penetrated 300 mm into the skin. Reepithelialization was complete within 1 day. Clinical effects were assessed over a 3-month period. Histology at 3 months revealed enhanced undulating rete ridges and increased mucin deposition within the superficial dermis. Periorbital treatments were well tolerated with minimal erythema and edema. Linear shrinkage of 2.1% was measured 3 months after the last treatment. The wrinkle score improved 18% (P < 0.001) 3 months after the last treatment. Conclusions: FP is a new concept for skin restoration treatment. Safety and efficacy were demonstrated with a prototype device. Further clinical studies are necessary to refine the optimum parameters and to explore further dermatological applications. Lasers Surg. Med. 34:426– 438, 2004. 2004 Wiley-Liss, Inc.

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1,369 citations

"Lasers and laser‐like devices: Part..." refers background in this paper

...Anderson also helped introduce the concept of fractional laser technology and, more recently, cryolipolysis.(8,9)...
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Journal Article•DOI•

Endovenous therapies of lower extremity varicosities: a meta-analysis.

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Renate van den Bos¹, Lidia R. Arends¹, Michael Kockaert¹, Martino Neumann¹, Tamar Nijsten¹ - Show less +1 more•Institutions (1)

Erasmus University Rotterdam¹

01 Jan 2009-Journal of Vascular Surgery

TL;DR: A systematic review of Medline, Cochrane Library, and Cinahl was performed to identify studies on the effectiveness of the four minimally invasive techniques up to February 2007 as discussed by the authors.

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451 citations

Journal Article•DOI•

The spectrum of laser skin resurfacing: Nonablative, fractional, and ablative laser resurfacing

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Macrene Alexiades-Armenakas¹, Jeffrey S. Dover¹, Jeffrey S. Dover², Jeffrey S. Dover³, Kenneth A. Arndt - Show less +1 more•Institutions (3)

Yale University¹, Dartmouth College², Chestnut Hill College³

01 May 2008-Journal of The American Academy of Dermatology

TL;DR: Neither nonablative nor fractional resurfacing produces results comparable to ablative laser skin resurfacing, but both have become much more popular than the latter because the risks of treatment are limited in the face of acceptable improvement.

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Abstract: The drive to attain cosmetic facial enhancement with minimal risk and rapid recovery has inspired the field of nonsurgical skin rejuvenation. Laser resurfacing was introduced in the 1980s with continuous wave carbon dioxide (CO 2 ) lasers; however, because of a high rate of side effects, including scarring, short-pulse, high-peak power, and rapidly scanned, focused-beam CO 2 lasers and normal-mode erbium-doped yttrium aluminium garnet lasers were developed, which remove skin in a precisely controlled manner. The prolonged 2-week recovery time and small but significant complication risk prompted the development of non-ablative and, more recently, fractional resurfacing in order to minimize risk and shorten recovery times. Nonablative resurfacing produces dermal thermal injury to improve rhytides and photodamage while preserving the epidermis. Fractional resurfacing thermally ablates microscopic columns of epidermal and dermal tissue in regularly spaced arrays over a fraction of the skin surface. This intermediate approach increases efficacy as compared to nonablative resurfacing, but with faster recovery as compared to ablative resurfacing. Neither nonablative nor fractional resurfacing produces results comparable to ablative laser skin resurfacing, but both have become much more popular than the latter because the risks of treatment are limited in the face of acceptable improvement. Learning objectives At the completion of this learning activity, participants should be familiar with the spectrum of lasers and light technologies available for skin resurfacing, published studies of safety and efficacy, indications, methodologies, side effects, complications, and management.

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443 citations

"Lasers and laser‐like devices: Part..." refers background or methods in this paper

...This technology is occasionally still used as a relatively bloodless skin incision tool, but for resurfacing purposes has given way to pulsed carbon dioxide laser technology.(21) Ablation, defined as rapid cellular heating and instant tissue vaporisation,(11) denudes 20–60 mm of the skin surface(20) (Fig....
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...The latter may take up to several months to achieve its maximal effect, but the resulting improvement in rhytides and scarring is clinically significant.(21,26) In the mid-1990s this technology offered an exciting alternative to the problematic treatment modalities available to resurface skin, which included deep chemical peels and wire brush or diamond dermabrasion....
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...However, the pulsed carbon dioxide lasers were not without their own potential risks, including infection, pain, prolonged erythema (sometimes > 6 months), milia, scarring, permanent late hypopigmentation and cosmetically unacceptable demarcation lines between treated and non-treated skin.(11,14,21,23,26)...
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...The first is haemostasis, which occurs almost instantly, and the second is skin tightening, which results from the healing and remodelling of damaged proteins.(11,21)...
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...The effect of this is a more superficial ablation, which not only reduces healing time but also markedly increases patients’ tolerance.(11,20,21) Significant downsides of superficial ablation are reduced haemostasis and loss of adequate collateral heating of the underlying dermis....
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Journal Article•DOI•

Lasers in dermatology: four decades of progress.

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Elizabeth L. Tanzi, Jason R. Lupton, Tina S. Alster

01 Jul 2003-Journal of The American Academy of Dermatology

TL;DR: In this review, the currently available laser systems with cutaneous applications are outlined, with primary focus placed on recent advancements and modifications in laser technology that have greatly expanded the cutaneous laser surgeon's armamentarium and improved overall treatment efficacy and safety.

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Abstract: Advances in laser technology have progressed so rapidly during the past decade that successful treatment of many cutaneous concerns and congenital defects, including vascular and pigmented lesions, tattoos, scars, and unwanted hair-can be achieved. The demand for laser surgery has increased substantially by patients and dermatologists alike as a result of the relative ease with which many of these lesions can be removed, combined with a low incidence of adverse postoperative sequelae. Refinements in laser technology and technique have provided patients and practitioners with more therapeutic choices and improved clinical results. In this review, the currently available laser systems with cutaneous applications are outlined, with primary focus placed on recent advancements and modifications in laser technology that have greatly expanded the cutaneous laser surgeon's armamentarium and improved overall treatment efficacy and safety.

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308 citations

"Lasers and laser‐like devices: Part..." refers background or methods in this paper

...488 nm/ 512 nm argon, 511 nm copper vapour, 520 nm krypton, 532 nm Nd:YAG-KTP) were originally used to treat pigmented lesions, but their pulse durations far exceeded the TRT of melanosomes (~1ms) and often led to scarring and textual irregularities from excessive collateral tissue damage.(20,23,25) Consequently, continuous wave lasers are no longer routinely used for pigmentary disorders....
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...Superficial (epidermal) pigment is encountered in solar lentigines, ephelides, café-au-lait macules and seborrhoeic keratoses, whereas deep (dermal) pigment is a feature of melanocytic naevi, blue naevi, naevi of Ota and Ito, drug-induced hyperpigmentation, Becker’s naevi, naevus spilus and tattoos.(20,25)...
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...The original Q-switched Nd:YAG’s long wavelength (1064 nm) allows targeting of deeper dermal pigment, such as that found in melanocytic naevi and blue or black tattoos.(20,25)...
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...The Nd:YAG laser has a wavelength of 1064 nm, which can also be used in the treatment of vascular lesions.(20,22)...
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...The effect of this is a more superficial ablation, which not only reduces healing time but also markedly increases patients’ tolerance.(11,20,21) Significant downsides of superficial ablation are reduced haemostasis and loss of adequate collateral heating of the underlying dermis....
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Journal Article•DOI•

Selective cryolysis: a novel method of non-invasive fat removal.

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Dieter Manstein¹, Hans Joachim Laubach¹, Kanna Watanabe¹, William A. Farinelli¹, David Zurakowski¹, R. Rox Anderson¹ - Show less +2 more•Institutions (1)

Harvard University¹

01 Nov 2008-Lasers in Surgery and Medicine

TL;DR: This study describes non‐invasive cold‐induced selective destruction of subcutaneous fat in mice through cryosurgery at very low temperatures.

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Abstract: Background and Objectives Excess fat poses a host of local and systemic problems. Various energy sources, for example, laser, ultrasound, and radiofrequency electric current have been studied as potential non-invasive treatments aimed at local destruction of subcutaneous fat. Cryosurgery at very low temperatures is routinely used for non-specific tissue destruction, however the potential for tissue-specific cold injury has not been investigated. This study describes non-invasive cold-induced selective destruction of subcutaneous fat. Materials and Methods Black Yucatan pigs under general anesthesia were exposed within test sites to preset temperatures of 20, −1, −3, −5, and −7°C for 10 minutes. Gross and histological assessments were performed immediately, 1 day, 2, 7, 14 and 28 days post-cold exposure for four pigs, and up to 3.5 months for one pig. Additionally, six pigs were exposed between −5°C and −8°C for 10 minutes, at sites covering approximately 15% body surface area, followed by serum lipid level determinations at various time points up to 3 months. Results A lobular panniculitis was induced by cooling, followed for some test sites by grossly obvious loss of several mm of subcutaneous fat occurring gradually during the 3.5 months study period. Loss of adipocytes, the appearance of lipid-laden mononuclear inflammatory cells, and local thickening of fibrous septae were noted. Typically there was no clinical or histological evidence of injury to skin, and no scarring. Serum lipids were not significantly increased. Conclusions Prolonged, controlled local skin cooling can induce selective damage and subsequent loss of subcutaneous fat, without damaging the overlying skin. Selective cryolysis warrants further study as a local treatment for removal of adipose tissue. Lesers Surg. Med. 40:595–604, 2008. © 2008 Wiley-Liss, Inc.

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297 citations

"Lasers and laser‐like devices: Part..." refers background in this paper

...subcutaneous fat and cellulite.(9,42) The role of lasers as an adjunct to surgical liposuction is also promising(45) and will be included in the second part of this review....
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...The low temperature induces a lobular panniculitis and thickening of the interlobular fibrous septae over several months after a single treatment, resulting in apoptosis of adipocytes and an increase in the collagen: adipose tissue ratio.(9) Clinically, this manifests as a reduction in the thickness of the subcutaneous fat layer....
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...Anderson also helped introduce the concept of fractional laser technology and, more recently, cryolipolysis.(8,9)...
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...Cryolipolysis, first described in 2008, is a process of coldinduced, non-invasive, selective destruction of subcutaneous fat.(9) It has applications for sculpting subcutaneous tissue and in the treatment of cellulite....
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...There is no clinical or histological evidence of damage to the overlying epidermis or dermis, including the adnexal structures,(42) which seemingly limits local side-effects to discomfort and transient erythema at the time of treatment.(9,42) In addition, no deleterious effects on serum lipid levels or liver function tests have been demonstrated after serial measurements (over months) across multiple studies....
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