Gold Skin Care Center, Tennessee Clinical Research Center, Nashville, TN Vanderbilt University School of Nursing, Nashville, TN Meharry Medical College, School of Medicine; Huashan Hospital, Fudan University, Shanghai, China; The First Hospital of China Medical University, Shenyang, China Guangdong Provincial People’s Hospital, Guangzhou, China First People’s Hospital of Foshan, Guangzhou, China The First Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang, China The People’s Hospital of Hunan Province, Changsha, Hunan Province, China
lasers. Recent studies have shown that the picosecond lasers are useful in treating various pigmentary concerns. Some of the newer fractionated picoseconds are not just producing results with pigment, but are addressing wrinkles and texture as well. Picosecond lasers are becoming more and more useful, not only for tattoo removal, but also for pigment and rejuvenation effects seen in our patients.13,14 RF energy also is popular to use for skin tightening. Many of the laser companies have entered this market and claim superiority over others in how well their device tightens the skin. Bulk RF heating through either monopolar, unipolar, or bipolar RF has shown, in multiple clinical studies, to have a positive effect for skin tightening. The effects work over a time period, and multiple treatments will normally be required to achieve the desired effects. Maintenance treatments will also need to be given, although this part of the equation has never been fully elicited from an evidence-based method. Many devices exist in this category as noted and we always recommend that one study the published reports on these individual devices and that choose one based on science rather than on hype from the manufacturer. These devices differentiate themselves by varying the RF electrode con guration and by how many electrodes are actually employed with each system.15-17 We will move away from non-invasive rejuvenation and EBDs and describe one of the more exciting trends that has entered the US market recently – the use of absorbable sutures for skin lifting. The use of permanent threads is not new to the US market and over the past decade we have seen several of these products come and go. Some have left the market because they were fraught with adverse events that were not acceptable to any of us. This led to the adoption by many of an absorbable suture, known as the Silhouette InstaLift, which has become the go-to product for skin lifting in our era. The material used in the US is poly-glycolic acid, although outside the US, polylactic acid is used. For all practical purposes, the products act identically. The sutures are composed of bidirectional cones and knots, as shown in Figure 6. When applied through proper vector placement within the skin, immediate and dramatic lifting is accomplished, which actually improves over time as the suture materials absorb and form
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