DYE LASER ---------------------------------------------------------- Has anyone had success treating striae on the legs and abdomen with flashlamp pulsed dye laser, either Candela or Cyanosure? I have patients asking for such treatment, and I have been fairly unimpressed with the pictures published in the laser company brochures. It appears to take away some of the erythema, which usually fades anyway in one to two years. I have also not been impressed with Retin-A. Mike Crowe, M.D. ---------------- I have done 3 cases with the pulsed dye laser and have been unimpressed. Jay Barnett ----------- I have been using Candela brand PDL and have been pretty unimpressed with results. I've done three patients for no charge so far with really no significant results other than a little decrease in redness. It's really curious how these "results" get into press and then often do not seem to work out in the real world. I am getting great results, however, with erythematous hypertrophic scars with decreased tenderness and itching (for those that have been symptomatic) and decreased visibility (from a cosmetic point of view). I'll be interested to hear if others have had better results than me with striae. Eliot Eliot N. Mostow, MD, MPH ------------------------ This issue of ultrapulse/silktouch scarring has previously been discussed on the list. Perhaps now is the time for an update. I am currently aware of two cases of Two cases of such scarring in Australia. The archived discussion refers to 3 cases, one case reported to the list by "merril c" and two cases presented at "controversies in laser Bermuda". How many more cases are members of the list aware of? Has anyone published a percentage risk as yet. The two Australian cases that I am aware of were patients with acne scarring. Philip Bekhor ------------- I have been using the UltraPulse for resurfacing for two years, and have had two cases of persistent scarring. One was a very fair-skinned red-headed lady; others have noted that this group is at higher risk. Her scars are at the vermilion borders of the lips. When I did her procedure, the computer pattern generator was not yet available; I also was going onto the vermilion. Probably got too much exposure overlap consequent collateral thermal damage. At Dick Fitzpatrick's suggestion, I no longer am going past the vermilion border. This patient's scars are not responding particularly well to intralesional Kenalog, and of course it's quite uncomfortable for her to have it injected. Another complicating factor was a possible wound infection. My other patient, while not as serious, is more interesting. She had a full-face resurfacing with the CPG, and washed her face with Hibiclens several times during the first week. She had not been advised to use the Hibiclens; she just thought it up on her own. When she complained of irritation, I got a history and found out she was using it, and told her to stop immediately. Subsequently, she developed a fine cobblestone-like hypertrophic scarring over the whole face, which is better after nine months, but has yet to resolve. The patient adamantly refused to believe that the Hibiclens had anything to do with her scarring, and I was quite doubtful, until I taught a laser seminar with a plastic surgeon from Florida. He was presenting slides of his resurfacing complications, and lo and behold, there was the same cobblestone scarring in a patient who had used Hibiclens! Go figure. Fortunately, in my patient the scarring is not visible, just palpable, and otherwise she has a terrific result. Unfortunately, it won't photograph, so I doubt we'd have much luck publishing it. Jay McCarty ----------- I dress all my patients with flexan/flexipore and the dressings are changed by us at the office for the first week which would hopefully prevent a "hibiclens episode". I am interested in the advice about not crossing the Vermilion border as I do not understand the logic of it. Vermilionectomies are routinely performed with Ultrapulse/Silktouch causing minimal problems other than recurrence or inadequate removal of the keratoses. I therefore do not understand why a single pass over the vermilion should be a problem. Lipstick bleeding is a significant complaint from our patients which requires crossing the border. I do agree however that multiple passes over the vermilion should be avoided. Philip Bekhor ------------- I've done about 40 cases. At the time the first patient's lips were done, I was not using dressings. Now I use Silon II for the first 3-4 days, with a great reduction in pain and wound infection. As suggested, I think this patient's scarring resulted in too many passes and too much overlap. The chief reason I don't go onto the vermilion now is that the patients complain so much about the discomfort. If they're insistent, I'll do it, but I tell them I don't want to hear anything about how uncomfortable it is. I too have done many vermilionectomies with the UltraPulse with great results, but also with a lot of postop moaning and groaning. I can't recall for sure whether the Hibiclens patient received a dressing or not. She looks great, though. I show her photos in my seminars. Jay McCarty -----------