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Difference in crusting and erythema between areas covered and not covered by closed dressing. A, Day of procedure. The patient underwent pulsed dye laser treatment of nose followed by combination carbon dioxide and erbium:YAG full-face laser skin resurfacing. The silicone occlusive dressing was placed immediately postoperatively. Openings cut for the eyes, nose, and mouth were small, and an additional dressing piece was placed over the nose bridge to provide uniform coverage.

Skin rejuvenation sillicon

Skin rejuvenation sillicon

Skin rejuvenation sillicon

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Difference in crusting and erythema between areas covered and not covered by closed dressing. A, Day of procedure. The patient underwent pulsed dye laser treatment of nose followed by combination carbon dioxide and erbium:YAG full-face laser skin resurfacing. The silicone occlusive dressing was placed immediately postoperatively. Openings cut for the eyes, nose, and mouth were small, and an additional dressing piece was placed over the nose bridge to provide uniform coverage.

B, Postoperative day 3. The openings cut for the eyes and lips have been widened, and the dressing piece covering the nose bridge has been removed. Those areas not covered by the closed dressing have markedly increased crusting and erythema compared with those areas covered by the dressing.

Arch Dermatol. In a prospective evaluation, 27 patients with closed dressings were then compared with 27 historical controls matched by age, sex, skin type, and treatment technique. Erythema, crusting, swelling, pain, pruritus, purpura, long-term complications, and dressing comfort were evaluated.

Swelling resolution was more rapid in the dressing group Crusting was limited to uncovered areas in the dressing group, and crusting duration was shorter 5. Pain was more likely to be reported prospectively, but severity was mild, in the closed-dressing group. Other short- and long-term complications did not differ significantly. Subjective patient attitudes toward the dressing were positive. Long-term results and complication rates remain unchanged.

The optimal wound care regimen for resurfacing has been the subject of widespread discussion. A number of closed dressings have become available for postoperative wound care. However, the advantage of using such dressings compared with open-wound care with compresses and lubricants remains largely anecdotal. Dressings provide a semiocclusive environment that protects the wound from exogenous bacteria and provides a moist environment for the exchange of oxygen and water vapor. Drainage of wound exudates via the dressing also prevents excess crust formation.

Proposed advantages of closed dressings after LSR include reduced postoperative pain, decreased erythema, increased rate of epithelialization, and simplified wound management. In addition, dressings may create a restrictive or claustrophobic environment. The purpose of this study was to compare postoperative healing, complications, and subjective attitudes retrospectively and prospectively in patients receiving a silicone occlusive dressing vs open-wound care after combination carbon dioxide CO 2 and erbium Er :YAG full-face LSR.

The dressing evaluated was considered representative of semiocclusive polymer films, a silicone dressing with a polytetrafluorethylene inner polymer network Silon-TSR; Bio Med Sciences, Inc, Bethlehem, Pa. Open-wound care consisted of frequent soaks and application of healing ointment Aquaphor; Beiersdorf, Inc, Norwalk, Conn.

To gather preliminary data, a retrospective analysis was first performed. Thirty-five patients who had the silicone dressing placed for 3 days postoperatively were selected randomly and retrospectively compared with 35 randomly selected patients treated during the same period with open-wound care. Comparable groups were picked that were similar in age, sex, skin type distribution, and treatment technique.

Patients were treated preoperatively with 0. Therapy with dicloxacillin sodium, mg twice a day, or if allergic, azithromycin, mg once a day, was started 24 hours before the procedure and continued for 10 days. Therapy with valacyclovir hydrochloride, mg twice a day, was started 24 hours before the procedure and continued for 7 days. Patients' skin was gently cleaned with isotonic sodium chloride solution between passes of the CO 2 laser, and debris were removed using sterile gauze.

The procedure was performed using intravenous sedation with propofol, midazolam hydrochloride, and fentanyl citrate administered by an anesthesiologist. Local and regional nerve blocks were performed for facial anesthesia. After the procedure, in-study subjects who had the dressing placed, the face was blotted dry and the silicone occlusive dressing was applied.

The polymer film comes in a transparent face mask design with perforations to allow drainage of excess fluid. The mask was held in place by drawstrings tied behind the head. Openings were cut for the eyelids, nose, and central lips, and a smaller patch of dressing was applied to cover the nose bridge. The resurfaced area was inspected through the mask, and accumulated exudate or crust was removed from the uncovered areas using isotonic sodium chloride solution.

Patients were instructed to begin soaks with ice water through the mask for 20 to 30 minutes at 2- to 3-hour intervals while awake. Patients returned again at the third postoperative day, and the dressing was removed. Patients continued soaks at 3- to 4-hour intervals, followed by application of healing ointment. By 7 to 10 days after the procedure, soaks were replaced with gentle cleansing, and patients switched to application of a moisturizer-sunscreen.

The postoperative regimen for control patients in the study consisted of open-wound care without any placement of an occlusive dressing. After the procedure, patients began to minute soaks with ice water at 2- to 3-hour intervals immediately followed by application of healing ointment. The frequency of the soaks and ointment application decreased as reepithelialization progressed; soaks were stopped once reepithelialization was complete.

The use of ointment was then tapered until replaced by lighter moisturizer-sunscreen. Patients are seen at the first and third days postoperatively on identical appointment regimens as those patients receiving the dressing. Erythema, swelling, crusting, pain, pruritus, purpura, and complications in the closed-dressing and open-wound care groups were all evaluated based on retrospective chart review.

Since the retrospective analysis was limited in the amount of information that could be derived and by the inherent statistical bias in retrospective data, 5 we undertook a prospective study of postoperative occlusive dressing in patients undergoing the combination CO 2 —Er:YAG LSR procedure.

We included for prospective evaluation 27 consecutive patients who underwent the procedure at the Beth Israel Deaconess Cosmetic Surgery and Laser Center from August 1, , through October 31, , and had the silicone occlusive dressing placed. No patient refused to participate in the study.

These patients were compared with 27 historic controls treated with open-wound care who underwent LSR from July 1, , through July 31, , and were matched by age, sex, skin type, and treatment technique.

The laser technique, anesthesia, and methods of postoperative care were the same as previously described for the retrospective analysis.

Variables evaluated prospectively included the severity and duration of erythema, swelling, crusting, pain, pruritus, and purpura. Severity was measured on a scale of 0 to 3 by 1 of 3 clinicians R.

Data were also collected on requirement and dosage of pain medications and antihistamines for pruritus. The progress of epithelialization was evaluated prospectively, and complications including acne flare, milia, hyperpigmentation, and hypopigmentation were noted. Patients were asked their subjective experience with the closed dressing at each visit, including comfort, claustrophobia, discomfort in covered and uncovered areas, and work intensiveness of soaks.

All responses were scored on a 4-point scale, where 0 indicates none; 1, mild; 2, moderate; and 3, extreme. We used commercially available software Microsoft Excel; Microsoft Corp, Redmond, Wash for data compilation and management, and a software package Stata, Version 6. Results from pairs analysis were compared using 2-sample t tests for independent samples assuming equal population variances.

A 2-tailed P value of less than. The retrospective study included 35 patients in the closed-dressing group and 35 patients in the open-wound care group.

There were 33 women and 2 men in the closed-dressing group and 32 women and 3 men in the open-wound care group. The mean maximum severity of erythema in the closed-dressing group was significantly less than that in the open-wound care group 1.

The duration of noticeable erythema was shorter in the closed-dressing group In the retrospective analysis, swelling severity and duration did not differ significantly between the closed-dressing and open-wound care groups.

Mean severity of swelling grade was 1. Crusting was limited to the areas not covered by dressing in the closed-dressing group, and the duration of crusting was significantly shorter at 6. The duration of pain was 3. There were no significant differences in incidence or duration of pruritus, purpura, acne flare, or infection. After gathering preliminary data in the retrospective comparison, a prospective study of 27 patients who had the silicone occlusive dressing placed was conducted compared with 27 historical controls treated using open-wound care and matched by age, sex, skin type, and treatment technique.

As in the retrospective study, the maximum severity, duration, and time until complete resolution of erythema were significantly less in the closed-dressing group compared with the open-wound care group. These results are summarized in Table 1. In the prospectively studied group, although the severity of swelling was similar, duration of swelling and time until complete resolution were significantly shorter Table 1. Crusting was limited to the areas not covered by dressing, as seen in Figure 1 , and the duration was significantly shorter in the closed-dressing group 5.

The mean time until complete reepithelialization was 7. There were no significant differences in the incidence or duration of purpura, acne flare, infection, or other short- or long-term complications between groups. The mean severity of pain was 1. The mean duration of pain in the closed-dressing group was 3.

The most common prescription regimens were a combination of acetaminophen and codeine phosphate Tylenol with Codeine or of acetaminophen and hydrocodone bitartrate Vicodin , 1 to 2 tablets twice a day. Mean severity score for pruritus was 1. The closed-dressing and open-wound care groups noted pruritus at The most common over-the-counter drug was diphenhydramine hydrochloride, 25 to 50 mg every night, and those requiring prescription medication took hydroxyzine hydrochloride, 25 mg 2 to 3 times daily.

Patients were surveyed prospectively regarding the comfort and acceptability of the dressing, with the results given in Table 2. There was a significant difference in discomfort in covered areas compared with those not covered by the dressing 0. Animal and human studies have shown the benefits of a moist environment in epidermal wound healing, since dry crust or scab impedes keratinocyte migration.

The use of closed occlusive dressings after LSR, based on studies in burn literature, 13 , 14 has increased largely based on anecdotal evidence with little quantitative evaluation. Recent comparative studies of closed dressings after LSR have been difficult to interpret since skin types, lasers, and number of passes differed among patients in different study groups. Skin types, lasers, and treatment technique were uniform and matched to minimize confounding and to focus on the postoperative effect of the dressing alone.

Our data indicate that the application of an occlusive silicone dressing significantly decreases immediate postoperative morbidity. There was a clinically and statistically significant reduction in the severity of erythema after the procedure in patients who had the dressing placed, and the duration of noticeable erythema and time until complete resolution were approximately halved in the closed-dressing group.

In addition, the duration of swelling was significantly shorter in the closed-dressing group, with less than half the time until complete resolution. Crusting in the closed-dressing group was limited to only the uncovered areas and resolved in slightly more than half the time than in the open-wound care group. Complication rates and long-term results were unchanged by the application of the closed dressing.

The most common complications were the development of 1 or more milia in approximately two thirds of patients and self-limited hyperpigmentation, which occurred in approximately one third of patients.

Bringing global techniques from places such as Milan, London and Los Angeles, you will find yourself in the trusted hands of our medical team backed by the award winning Dr V. Candidates Laser skin resurfacing is not for everyone. View Metrics. Chest radiography findings and the serum angiotensin-converting enzyme and total serum calcium levels were normal. You may make a good candidate for laser skin rejuvenation if you are dealing with unwanted wrinkles, lines, superficial facial scars, or uneven pigmentation.

Skin rejuvenation sillicon

Skin rejuvenation sillicon

Skin rejuvenation sillicon

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Her skin examination showed indurated erythematous papules coalescing into plaques over the forehead, cheeks, and chin Figure 1 B. Biopsy of indurated papules in both cases showed foreign body—type granulomatous reaction Figure 2 A and B.

Focal, polarizable material was detectable in the cytoplasm of few giant cells. Chest radiography findings and the serum angiotensin-converting enzyme and total serum calcium levels were normal. Results of tissue bacterial, mycobacterial, and fungal cultures were negative.

Skin biopsy showed a foreign body—type granulomatous reaction with dermal histiocytes and foreign body giant cells surrounded by lymphocytes and few plasma cells. Given the high clinical suspicion for delayed hypersensitivity granulomas after intradermal injection of Vita C Serum, we conducted patch testing with a standard tray, cosmetic tray, mixture of topical anesthetics, and Vita C Serum. Prick testing for contact urticaria immunoglobulin E—mediated type I hypersensitivity reaction was negative.

A biopsy specimen of the patch test area showed spongiotic dermatitis with follicular, perivascular, and periadnexal lymphocytic inflammation, without any evidence of granulomas. The patch test reaction faded after 4 to 5 days. Subsequent control patch testing of 5 healthy volunteers to Vita C Serum was negative. Treatment with midpotency topical corticosteroids alternating with a topical calcineurin inhibitor for 6 months was ineffective.

This resulted in partial improvement after 3 months of therapy. At a 9-month follow-up check, these women had persistent, mildly indurated erythematous papules and plaques on the microneedle-treated areas. An otherwise healthy woman in her 50s underwent 3 sessions of microneedle therapy at a local spa using the Dermapen device for facial skin rejuvenation.

During the first and third treatments, a gel product Boske Hydra-Boost Gel; Boske Dermaceuticals was applied to the skin surface before the microneedling. The patient reported an erythematous rash affecting the entire treated area of the face a few days after the first procedure.

The rash progressively worsened with subsequent microneedling sessions and became papular after the third session. Her medical and family histories were nonsignificant and she had no allergies. She was taking no medications other than multivitamins. She presented to our clinic 3 months after the third microneedling session. Her skin examination revealed indurated erythematous papules on her bilateral cheeks and chin Figure 1 C.

Examination of a skin biopsy specimen confirmed a foreign body—type granulomatous reaction with evidence of polarizable foreign material in giant cells. Tissue cultures were negative and she had normal chest radiography findings and a normal serum angiotensin-converting enzyme level. The patient refused a patch test. Given our experience with the first 2 cases, we suspected delayed-type allergic granulomas.

Therapy was started with a topical midpotency corticosteroid and oral minocycline hydrochloride, mg, twice a day. After 3 weeks, the woman had almost complete clinical resolution. Our cases represent granulomatous reactions after intradermal tattooing with an antigenic topical product. Given the positive patch test results in the first 2 cases, we believe that these cases were true delayed-type hypersensitivity granulomas. Granulomatous hypersensitivity reaction has traditionally been associated 5 with intradermal tattooing of metallic elements in the red dyes, including mercury, cadmium, aluminum, calcium, silicon, iron, and titanium.

Similar reactions have been reported 6 with skin penetration of topically applied products containing zirconium and silica after injection of dermal fillers, such as bovine and human collagen, polymerized silicones, hyaluronic acid, and polylactic acid, 7 and more recently with transdermal permeation of topical products through a skin rejuvenation technology called electroporation.

Topical application of the culprit antigen ie, during patch testing results in allergic contact dermatitis. This explains the histologic findings of spongiotic dermatitis that were seen on biopsy specimens from the patch test site in our first 2 patients.

However, intradermal injection of the allergen ie, intradermal testing results in the development of granulomas. Systemic symptoms, including fever, malaise, and arthralgia as well as erythema nodosum in one of the patients, suggest systemic hypersensitivity. Similar findings have been reported with other cosmetic injections, including red tattoos 11 and silicone implants. Management of potential systemic hypersensitivity symptoms can require prolonged courses of anti-inflammatory or immunomodulator medications.

Our first patient did not respond to a short course of systemic corticosteroids; instead, she required long-term nonsteroidal anti-inflammatory drugs.

The prevalence of allergic reactions to this topical product is not known. Based on the data voluntarily provided by the cosmetic treatment facility, 60 patients had received microneedling using Vita C Serum during 3 weeks, and none had developed a similar hypersensitivity reaction. Results of patch testing to the ingredients that we were able to obtain from other sources, including retinyl palmitate, cholecalciferol, C tinctorius , and lecithin, were negative.

We hypothesize that the culprit allergenic chemical is one of the nontested ingredients or an unlisted ingredient of Vita C Serum, such as an unknown fragrance or preservative. Differential diagnosis of granulomatous reaction at the site of injection of foreign materials includes bacterial, mycobacterial, and fungal infections as well as sarcoidosis, which has been reported at the site of tattoos 13 and dermal fillers.

Other treatments include oral antihistamines and UV light therapy, imiquimod, isotretinoin, allopurinol, tacrolimus, doxycycline, minocycline, and cyclosporine. These patients experienced a disfiguring adverse effect resulting from unauthorized use of topical products that were not designed for intradermal injection.

Microneedles are powerful means of transdermal delivery of drugs. Thus, only chemicals approved for intradermal injection are safe to be used in conjunction with microneedling. At the time of preparation of this article, there were neither regulations from the US Food and Drug Administration nor specific guidelines from the manufacturers about application of cosmeceuticals prior to microneedling.

Microneedle rollers, stamps, and pens are accessible for home use and are widely applied in cosmetic practices and medical spas. Most of these treatments are performed without the direct supervision of a physician. We believe that numerous similar adverse reactions are happening and are not reported in the medical literature. Application of various nonapproved topical products before a microneedling procedure can introduce immunogenic particles into the dermis and potentiate local or systemic hypersensitivity reactions.

Given the increasing popularity of microneedling in cosmetic practices, dermatologists should be aware of its potential consequences. The use of topical products in conjunction with microneedling needs to be regulated and limited to products approved for intradermal injection in humans. Published Online: November 20, Author Contributions: Drs Soltani-Arabshahi and Powell had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Critical revision of the manuscript for important intellectual content: Powell. Conflict of Interest Disclosures: None reported. Correction: This article was corrected on November 19, , to fix the Abstract. JAMA Dermatol. All Rights Reserved. Save Preferences. Privacy Policy Terms of Use. Twitter Facebook Email. View Correction. This Issue. Views 90, Citations View Metrics. Report of Cases.

Case 1. View Large Download. Case 2. Further Investigations and Follow-up. Cases 1 and 2. Case 3. Back to top Article Information. Microneedles for transdermal drug delivery. Adv Drug Deliv. Skin needling to enhance depigmenting serum penetration in the treatment of melasma. Plast Surg Int. PubMed Google Scholar. Percutaneous collagen induction therapy: an alternative treatment for scars, wrinkles, and skin laxity. If you are unhappy with the condition of your skin, you can likely find results from laser skin rejuvenation in Silicon Valley.

Laser skin rejuvenation in Silicon Valley can help rejuvenate the appearance of your skin by reducing the damaging effects of sun exposure, certain facial skin disorders, and the aging process. Laser treatments have been proven to be safe and effective, as well as extremely convenient.

Laser skin rejuvenation targets irregular skin with brief, focused beams of light to remove skin layer by layer. The procedure is sometimes called laser vaporization or laser peel. One of the advantages to cosmetic laser treatment is that your cost will be minimal in comparison to other treatments. Laser skin rejuvenation helps you to remove damaged skin layers to stimulate the production of new collagen and elastin fibers, renewing and rejuvenating the appearance of your skin so that you look like a younger version of yourself.

Laser skin resurfacing procedures help to minimize the appearance of skin imperfections through the use of a laser that dissolves the bonds that are formed by skin layers.

Your own body then removes the damaged skin and replaces it with new skin tissue that forms from below and pushes upward to displace old, damaged skin tissue.

Laser skin resurfacing is not for everyone. For most patients, the treatment offers excellent results in the minimization of common skin problems like acne scars, wrinkles, and hyperpigmentation.

The Efficacy of Silicone Gel for the Treatment of Hypertrophic Scars and Keloids

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Skin rejuvenation sillicon

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