The Impact of Near-Infrared in Plastic Surgery
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IBIMA Publishing Plastic Surgery: An International Journal http://www.ibimapublishing.com/journals/PSIJ/psij.html Vol. 2013 (2013), Article ID 973073, 13 pages DOI: 10.5171/2013.973073 Research Article The Impact of Near-infrared in Plastic Surgery Yohei Tanaka 1,2,3 , Yuichiro Tsunemi 2, Makoto Kawashima 2 and Hiroshi Nishida 3 1Clinica Tanaka Plastic, Reconstructive Surgery and Anti-aging Center, Matsumoto, Nagano, Japan 2Department of Dermatology, Tokyo Women’s Medical University, Tokyo, Japan 3Department of Applied Life Sciences, Niigata University of Pharmacy and Applied Life Sciences, Niigata, Japan Correspondence should be addressed to: Yohei Tanaka; [email protected] Received 22 January 2013; Accepted 21 March 2013; Published 23 June 2013 Academic Editor: Maureen Susan Thorniley Copyright © 2013 Yohei Tanaka, Yuichiro Tsunemi, Makoto Kawashima and Hiroshi Nishida. Distributed under Creative Commons CC-BY 3.0 Abstract Many studies regarding near-infrared, have used near-infrared resources without a water filter or a cooling system, and have proven its thermal effects. With these methods near-infrared energy is mainly absorbed in the superficial tissues and cannot be delivered sufficiently to deeper tissues. As solar near-infrared is filtered by atmospheric water, a water filter is essential in order to simulate solar near-infrared. Thus, these approaches could not sufficiently evaluate the effects of incident solar near-infrared that reaches the human tissue. We have clarified that the near-infrared that simulates solar near-infrared non-thermally affects subcutaneous tissues, including muscle. Importantly, the biological effects of near-infrared have both beneficial applications and deleterious effects. Near-infrared induces dermal heating thermally and non-thermally induces collagen and elastin stimulation, which results in skin tightening, and induces long-lasting vasodilation that may prevent vasospasm and may be beneficial for ischemic disorders and flap surgeries. Near-infrared also non-thermally relaxes and weakens dystonic or hypertrophic muscles to reduce wrinkles and myalgia. Its long-lasting induction of subcutaneous adipocytes may have an application in volume augmentation. However, continuous near-infrared exposure may induce photoaging and thinning of superficial muscles, which results in skin ptosis. Protection against near-infrared should be strongly considered, as over half of the solar energy is near-infrared. Although plastic surgeons are not familiar with the effects of near-infrared, its potential appears to be high and significant. This paper reviews the effects of near-infrared and introduces the new findings and applications of the biological effects of near-infrared in the field of plastic surgery. Keywords: Near-infrared; non-thermal; biological effects; photoaging. Introduction exposure on human tissue. However, the long-term effects of near-infrared (NIR) Many studies have demonstrated the exposure on human skin and effects of sun and ultraviolet (UV) subcutaneous tissues have not been well _____________ Cite this Article as : Yohei Tanaka, Yuichiro Tsunemi, Makoto Kawashima and Hiroshi Nishida (2013), "The Impact of Near-infrared in Plastic Surgery," Plastic Surgery: An International Journal, Vol. 2013 (2013), Article ID 973073, DOI: 10.5171/2013.973073 Plastic Surgery: An International Journal 2 investigated. Although various types of UV and may be beneficial for ischemic blocking materials, such as sunblock, disorders and flap surgeries in the field of sunglasses, films, and fibers are often used plastic surgery. Further, NIR non- to prevent skin damage from UV exposure, thermally relaxes and weakens dystonic or and despite the world-wide use of these hypertrophic muscles to reduce wrinkles blocking materials, unwanted and myalgia. physiological effects such as rosacea, erythema ab igne, long-lasting In addition to its therapeutic effects, vasodilation (Tanaka, 2009a; Tanaka, however, NIR also induces non-thermal 2011a), long-lasting muscle thinning DNA damage (Tanaka, 2010c; Tanaka, (Tanaka, 2010a, 2011b), and sagging and 2012c) and cell death by apoptosis skin ptosis still occur (Tanaka, 2011c; (Tirlapur, 2001). NIR induces cell death of Tanaka, 2012a, b). Both superficial muscle cancer cells and bone marrow cells thinning and skin ptosis develop with age, (Tanaka, 2011e), which may have a and though face lift surgeries and skin potential application in the treatment of tightening procedures are proven cancer (Tanaka, 2010c; Tanaka, 2012c). effective treatments, the mechanisms underlying their development remain The necessity to protect against NIR has unclear. not been well investigated to date. Fair skin with lower concentrations of melanin We previously reported that NIR from and a thin dermis might allow NIR to 1100 to 1800 nm together with a water- penetrate deeper into human tissue, and filter that excludes wavelengths between damage superficial muscles compared to 1400 and 1500 nm penetrates deep into darker skin with dense melanin and a human tissue and it is absorbed by water thick dermis (Tanaka, 2011c; Tanaka, in the skin (Tanaka, 2009a,b; Tanaka, 2012a, b). In addition to natural NIR, 2010b; Tanaka, 2011d), hemoglobin in human skin is increasingly exposed to dilated vessels (Tanaka, 2009a; Tanaka, artificial NIR from medical devices and 2011a), myoglobin in the superficial electrical appliances (Schieke, 2003; muscle (Tanaka, 2010a; Tanaka, 2011b), Schroeder, 2008). Furthermore most and bone cortical mass, and it is scattered sunscreens only block UV, but not visible by adipose cells (Tanaka, 2011e; Tanaka, light and NIR (Tanaka, 2011c; Tanaka, 2012b). 2012a, b), and sunglasses and glasses are unable to block NIR exposure. Thus, Notably, in order to experimentally individuals using sunscreens and glasses simulate solar NIR that reaches the skin should further equip themselves for (Tanaka, 2012a, b); a water filter is protection against NIR (Darvin, 2010; required, as solar NIR is filtered by Meinke, 2011; Pujol, 1993; Schieke, 2003; atmospheric water (Anderson, 1981; Gates, Schroeder, 2008; Tanaka, 2011c; Tanaka, 1966). NIR increases the surface 2012a, b), as we are exposed to temperature and induces thermal effects, tremendous amounts of NIR (Tanaka, so a contact cooling is needed to pursue the 2011c). properties of NIR (Tanaka, 2011c; Tanaka, 2012a, b). Previous studies regarding NIR have reported its application in the industrial NIR is used to treat wound healing and the agricultural fields, but have not disorders (Danno, 2001; Horwitz, 1999; well investigated the effects of NIR Schramm, 2003) and malignant tumors exposure in the medical fields, particularly (Bäumler, 1999; Dees, 2002; Kelleher, in the field of plastic surgery. 1999; Orenstein, 1999). NIR induces dermal heating thermally and non- Findings from our previous studies thermally induces collagen and elastin suggest that we should consider the stimulation, which results in skin biological effects of NIR, which have both tightening. NIR also induces long-lasting potentially usefully applications and vasodilation that may prevent vasospasm detrimental physiological effects. _______________ Yohei Tanaka, Yuichiro Tsunemi, Makoto Kawashima and Hiroshi Nishida (2013), Plastic Surgery: An International Journal, DOI: 10.5171/2013.973073 3 Plastic Surgery: An International Journal Methods to Evaluate Non-Thermal spectral region is arbitrarily divided Biological Effects of NIR according to wavelength into sub-regions of NIR (760–3000 nm), middle IR (3000– In previous studies of NIR, a light source 30 000nm), and far IR (30 000 nm–1 mm). emitting wide wavelengths of NIR were NIR from the sun is selectively filtered by used as an NIR source (Frank, 2004; atmospheric water (Anderson, 1981; Tanaka, 2012a). The temperature of the Gates, 1966), and NIR that reaches the superficial layer of a culture fluid in a Earth’s surface readily penetrates the laboratory dish under NIR irradiation rises superficial layers of the skin (Tanaka, immediately, as NIR is mainly absorbed by 2010a, 2011c, 2012a, 2011e) (Fig. 1, left). water. The energy of NIR then decreases as it penetrates deeper, and will not reach Wavelengths below 1100 nm will be enough target cells in the base. Therefore, absorbed by melanin in the skin. these previous studies were only able to Wavelengths between 1400 and 1500 nm describe the optical and thermal effects of and those above 1850 nm will be NIR, and are not useful to examine non- absorbed by water in the skin, which thermal biological effects of NIR (Tanaka, results in heating and may induce painful 2012a, b). sensations and burns (Kelleher, 1999). Filtering out the wavelengths below 1100 NIR induces dermal heating, which results nm, around 1450 nm, and above 1850 nm in the tightening of skin laxity (Bitter, enabled the delivery of NIR to deeper 2000; Chan, 2008; Goldberg, 2000; Ross, tissues (Davenport, 2006) and also 2000; Tanaka, 2009a, b; Zelickson, 2006). simulated the solar NIR that contracts In previous studies (Danno, 2001; Kim, human skin under natural conditions. 2005: Kligman, 1982) NIR devices without a water filter or contact cooling were used An NIR device that emits a spectrum of to investigate thermal effects on the NIR wavelength from 1100 to 1800 nm human body. NIR increases the skin together with a water-filter that excludes surface temperature and induces wavelengths between 1400 and 1500 nm perspiration and vasodilation, as NIR is as well as those above 1850 nm simulates primarily