Nazanin Saedi

Guest Editor for the following articles:

Vol. 31. No. 2

Ablative Fractional Resurfacing for the Treatment of Traumatic Scars and Contractures

E. Victor Ross, MD | Nathan S Uebelhoer, DO

After a decade of military conflict, thousands of wounded warriors have suffered debilitating
and cosmetically disfiguring scars and scar contractures. Clearly, there is a need for
effective scar treatment regimens to assist in the functional and cosmetic rehabilitation of
these patients. Traditional treatments, including aggressive physical and occupational
therapy and dedicated wound care, are essential. Adjunctive treatments with established
laser technologies, such as vascular lasers and full-field ablative lasers, have had a
somewhat limited role in scar contractures due to modest efficacy and/or an unacceptable
side effect profile in compromised skin. Refractory scar contractures often require surgical
revision, which can be effective, but is associated with additional surgical morbidity and a
significant risk of recurrence. Furthermore, current scar treatment paradigms often dictate
scar maturation for approximately a year to allow for spontaneous improvement before
surgical intervention. Since 2009, the Dermatology Clinic at the Naval Medical Center San
Diego has been treating scars and scar contractures in wounded warriors and others using
ablative fractionated laser technology. Although traditionally associated with the rejuvenation
of aged and photo-damaged skin, our clinical experience and a handful of early reports
indicate that laser ablative fractional resurfacing demonstrates promising efficacy and an
excellent side effect profile when applied to the functional and cosmetic enhancement of
traumatic scars and contractures. This article discusses our clinical experience with
ablative fractional resurfacing and its potential prominent role in rehabilitation from traumatic
injuries, including a possible shift in scar treatment paradigms toward earlier procedural
intervention. Potential benefits include the optimization of scar trajectory and higher
levels of full or adapted function in a more favorable time course.
Semin Cutan Med Surg 31:110-120 © 2012 Published by Elsevier Inc.

Vol. 32. No. 1

Body Contouring Using 635-nm Low Level Laser Therapy

Aditya K Gupta, MD, PhD, FRCPC | Jessica Newburger, DO | Mark S Nestor, MD, PhD | Matthew B Zarraga, DO

Noninvasive body contouring has become one of the fastest-growing areas of esthetic
medicine. Many patients appear to prefer nonsurgical less-invasive procedures owing to
the benefits of fewer side effects and shorter recovery times. Increasingly, 635-nm lowlevel
laser therapy (LLLT) has been used in the treatment of a variety of medical conditions
and has been shown to improve wound healing, reduce edema, and relieve acute pain.
Within the past decade, LLLT has also emerged as a new modality for noninvasive body
contouring. Research has shown that LLLT is effective in reducing overall body circumference
measurements of specifically treated regions, including the hips, waist, thighs, and
upper arms, with recent studies demonstrating the long-term effectiveness of results. The
treatment is painless, and there appears to be no adverse events associated with LLLT. The
mechanism of action of LLLT in body contouring is believed to stem from photoactivation
of cytochrome c oxidase within hypertrophic adipocytes, which, in turn, affects intracellular
secondary cascades, resulting in the formation of transitory pores within the adipocytes’
membrane. The secondary cascades involved may include, but are not limited to, activation
of cytosolic lipase and nitric oxide. Newly formed pores release intracellular lipids, which
are further metabolized. Future studies need to fully outline the cellular and systemic
effects of LLLT as well as determine optimal treatment protocols.
Semin Cutan Med Surg 32:35-40 © 2013 Frontline Medical Communications

Vol. 31. No. 2

Fractionation: Past, Present, Future

H Ray Jalian, MD | Nazanin Saedi, MD | Anthony Petelin, MD | Christopher Zachary, MBBS, FRCP

The development of fractional photothermolysis is a milestone in the history of laser technology and cutaneous resurfacing. Based on the concept that skin is treated in a fractional manner, where narrow cylinders of tissue are thermally heated and normal adjacent skin is left unaffected, the fractional devices have shown effectiveness in treating a variety of conditions. Since its development, we are becoming more adept at using optimal parameters to induce near carbon dioxide laser benefits with a much more comfortable postoperative period and fewer complications. The future remains bright for fractionated laser devices and with new devices and wavelengths, the applications of this technology continue to grow.
Semin Cutan Med Surg 31:105-109 © 2012 Elsevier Inc. All rights reserved.

Vol. 31. No. 2

Body Contouring: The Skinny on Noninvasive Fat Removal

H Ray Jalian, MD

Historically, the approach to body contouring has largely involved invasive procedures,
such as liposuction. Recently, several new devices for noninvasive fat removal have
received clearance by the Food and Drug Administration for the treatment of focal adiposity.
Modalities are aimed primarily at targeting the physical properties of fat that differentiate
it from the overlying epidermis and dermis, thus selectively resulting in removal. This
review will focus on 3 novel approaches to noninvasive selective destruction of fat.
Semin Cutan Med Surg 31:121-125 © 2012 Published by Elsevier Inc.

Vol. 32. No. 1

Low-Level Laser (Light) Therapy (LLLT) in Skin: Stimulating, Healing, Restoring

Asheesh Gupta, PhD | Daniela Vecchio, PhD | Magesh Sadasivam, MTech | Michael R Hamblin, PhD | Nadav Pam, MD | Pinar Avci, MD | Zeev Pam, MD

Low-level laser (light) therapy (LLLT) is a fast-growing technology used to treat a multitude
of conditions that require stimulation of healing, relief of pain and inflammation, and
restoration of function. Although skin is naturally exposed to light more than any other
organ, it still responds well to red and near-infrared wavelengths. The photons are absorbed
by mitochondrial chromophores in skin cells. Consequently, electron transport, adenosine
triphosphate nitric oxide release, blood flow, reactive oxygen species increase, and diverse
signaling pathways are activated. Stem cells can be activated, allowing increased tissue
repair and healing. In dermatology, LLLT has beneficial effects on wrinkles, acne scars,
hypertrophic scars, and healing of burns. LLLT can reduce UV damage both as a treatment
and as a prophylactic measure. In pigmentary disorders such as vitiligo, LLLT can increase
pigmentation by stimulating melanocyte proliferation and reduce depigmentation by inhibiting
autoimmunity. Inflammatory diseases such as psoriasis and acne can also be managed.
The noninvasive nature and almost complete absence of side effects encourage
further testing in dermatology.
Semin Cutan Med Surg 32:41-52 © 2013 Frontline Medical Communications