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SkinCare Physicians/ Northwestern University: Controversies and Conversations in Laser and Cosmetic Surgery
When is too young for antiaging procedures?
DANA POINT, CALIF. – When is someone too young for antiaging procedures with cosmetic fillers or laser resurfacing?
Chronologic age "is somewhat irrelevant," in the opinion of Dr. Elizabeth L. Tanzi, codirector of the Washington (D.C.) Institute of Dermatologic Laser Surgery. "I’m looking at dermatologic age, with a critical evaluation of [a patient’s] need," she said at a meeting sponsored by SkinCare Physicians and Northwestern University.
Dr. Tanzi noted that genetics also plays a role in how each person’s skin ages over time. "Some people have inherited facial expressions," she explained. "They may get hyperdynamic movement in certain parts of their face and develop wrinkles much earlier than you would anticipate. Environmental exposure clearly plays a large role. Excessive ultraviolet exposure, growing up with outdoor sporting activities, tanning bed use, or poor habits such as smoking are going to lead to an accelerated aging process," she said.
The importance of establishing realistic patient expectations starts with the first office consultation, when clinicians emphasize that "we can slow down the signs of aging on your skin, but we cannot stop the process completely," said Dr. Tanzi, who is also an assistant professor of dermatology at George Washington University Medical Center, Washington. "I think it’s more important to talk about looking youthful, energetic, and vibrant, not necessarily looking young, because we may be inadvertently delivering the wrong message – that all aging is preventable if treatments are started early enough – and that sets the stage for unrealistic expectations."
Encouraging sun protection behaviors is sensible, and "most dermatologists realize that you can use neuromodulators and fillers strategically early on," Dr. Tanzi said. "But the idea of using fractionated laser resurfacing treatments to promote improved skin function is intriguing to me. We know we can improve the skin cosmetically through a series of fractional laser resurfacing treatments. But can we functionally improve the skin as it’s aging?" she questioned.
Cutting-edge research suggests that may be the case. In 2012, Dan F. Spandau, Ph.D., and his colleagues (J. Invest. Dermatol. 2012;132:1591-6) published data showing that dermal wounding procedures such as fractional resurfacing can "wake up senescent dermal fibroblasts to produce more insulin-like growth factor-1 (IGF-1), which helps the epidermis ward off the damaging effects of UVB on the skin," Dr. Tanzi said. In that case, she continued, "should we be recommending fractional resurfacing as part of a healthy antiaging routine? If so, at what age? These are exciting developments that need additional research to help guide new treatment protocols."
Although she is enthusiastic about preventing some signs of aging and helping patients maintain a youthful appearance, Dr. Tanzi expressed some concerns. "If we are not careful, we could be setting ourselves up for an expectation of being able to stop the aging process, and this can be a slippery slope, especially for women," she said. "Especially when it comes to fillers and neuromodulators, if not done judiciously they can lead to a very artificial look which, ironically, makes women look much older," Dr. Tanzi said. "As thoughtful physicians, it’s important to keep perspective and guide patients to know when enough is enough [in terms of procedures]," she added.
Dr. Tanzi disclosed that she is a consultant for Cynosure/Palomar, Lumenis, and other companies.
DANA POINT, CALIF. – When is someone too young for antiaging procedures with cosmetic fillers or laser resurfacing?
Chronologic age "is somewhat irrelevant," in the opinion of Dr. Elizabeth L. Tanzi, codirector of the Washington (D.C.) Institute of Dermatologic Laser Surgery. "I’m looking at dermatologic age, with a critical evaluation of [a patient’s] need," she said at a meeting sponsored by SkinCare Physicians and Northwestern University.
Dr. Tanzi noted that genetics also plays a role in how each person’s skin ages over time. "Some people have inherited facial expressions," she explained. "They may get hyperdynamic movement in certain parts of their face and develop wrinkles much earlier than you would anticipate. Environmental exposure clearly plays a large role. Excessive ultraviolet exposure, growing up with outdoor sporting activities, tanning bed use, or poor habits such as smoking are going to lead to an accelerated aging process," she said.
The importance of establishing realistic patient expectations starts with the first office consultation, when clinicians emphasize that "we can slow down the signs of aging on your skin, but we cannot stop the process completely," said Dr. Tanzi, who is also an assistant professor of dermatology at George Washington University Medical Center, Washington. "I think it’s more important to talk about looking youthful, energetic, and vibrant, not necessarily looking young, because we may be inadvertently delivering the wrong message – that all aging is preventable if treatments are started early enough – and that sets the stage for unrealistic expectations."
Encouraging sun protection behaviors is sensible, and "most dermatologists realize that you can use neuromodulators and fillers strategically early on," Dr. Tanzi said. "But the idea of using fractionated laser resurfacing treatments to promote improved skin function is intriguing to me. We know we can improve the skin cosmetically through a series of fractional laser resurfacing treatments. But can we functionally improve the skin as it’s aging?" she questioned.
Cutting-edge research suggests that may be the case. In 2012, Dan F. Spandau, Ph.D., and his colleagues (J. Invest. Dermatol. 2012;132:1591-6) published data showing that dermal wounding procedures such as fractional resurfacing can "wake up senescent dermal fibroblasts to produce more insulin-like growth factor-1 (IGF-1), which helps the epidermis ward off the damaging effects of UVB on the skin," Dr. Tanzi said. In that case, she continued, "should we be recommending fractional resurfacing as part of a healthy antiaging routine? If so, at what age? These are exciting developments that need additional research to help guide new treatment protocols."
Although she is enthusiastic about preventing some signs of aging and helping patients maintain a youthful appearance, Dr. Tanzi expressed some concerns. "If we are not careful, we could be setting ourselves up for an expectation of being able to stop the aging process, and this can be a slippery slope, especially for women," she said. "Especially when it comes to fillers and neuromodulators, if not done judiciously they can lead to a very artificial look which, ironically, makes women look much older," Dr. Tanzi said. "As thoughtful physicians, it’s important to keep perspective and guide patients to know when enough is enough [in terms of procedures]," she added.
Dr. Tanzi disclosed that she is a consultant for Cynosure/Palomar, Lumenis, and other companies.
DANA POINT, CALIF. – When is someone too young for antiaging procedures with cosmetic fillers or laser resurfacing?
Chronologic age "is somewhat irrelevant," in the opinion of Dr. Elizabeth L. Tanzi, codirector of the Washington (D.C.) Institute of Dermatologic Laser Surgery. "I’m looking at dermatologic age, with a critical evaluation of [a patient’s] need," she said at a meeting sponsored by SkinCare Physicians and Northwestern University.
Dr. Tanzi noted that genetics also plays a role in how each person’s skin ages over time. "Some people have inherited facial expressions," she explained. "They may get hyperdynamic movement in certain parts of their face and develop wrinkles much earlier than you would anticipate. Environmental exposure clearly plays a large role. Excessive ultraviolet exposure, growing up with outdoor sporting activities, tanning bed use, or poor habits such as smoking are going to lead to an accelerated aging process," she said.
The importance of establishing realistic patient expectations starts with the first office consultation, when clinicians emphasize that "we can slow down the signs of aging on your skin, but we cannot stop the process completely," said Dr. Tanzi, who is also an assistant professor of dermatology at George Washington University Medical Center, Washington. "I think it’s more important to talk about looking youthful, energetic, and vibrant, not necessarily looking young, because we may be inadvertently delivering the wrong message – that all aging is preventable if treatments are started early enough – and that sets the stage for unrealistic expectations."
Encouraging sun protection behaviors is sensible, and "most dermatologists realize that you can use neuromodulators and fillers strategically early on," Dr. Tanzi said. "But the idea of using fractionated laser resurfacing treatments to promote improved skin function is intriguing to me. We know we can improve the skin cosmetically through a series of fractional laser resurfacing treatments. But can we functionally improve the skin as it’s aging?" she questioned.
Cutting-edge research suggests that may be the case. In 2012, Dan F. Spandau, Ph.D., and his colleagues (J. Invest. Dermatol. 2012;132:1591-6) published data showing that dermal wounding procedures such as fractional resurfacing can "wake up senescent dermal fibroblasts to produce more insulin-like growth factor-1 (IGF-1), which helps the epidermis ward off the damaging effects of UVB on the skin," Dr. Tanzi said. In that case, she continued, "should we be recommending fractional resurfacing as part of a healthy antiaging routine? If so, at what age? These are exciting developments that need additional research to help guide new treatment protocols."
Although she is enthusiastic about preventing some signs of aging and helping patients maintain a youthful appearance, Dr. Tanzi expressed some concerns. "If we are not careful, we could be setting ourselves up for an expectation of being able to stop the aging process, and this can be a slippery slope, especially for women," she said. "Especially when it comes to fillers and neuromodulators, if not done judiciously they can lead to a very artificial look which, ironically, makes women look much older," Dr. Tanzi said. "As thoughtful physicians, it’s important to keep perspective and guide patients to know when enough is enough [in terms of procedures]," she added.
Dr. Tanzi disclosed that she is a consultant for Cynosure/Palomar, Lumenis, and other companies.
AT CONTROVERSIES AND CONVERSATIONS IN LASER AND COSMETIC SURGERY
Fractional ablative lasers a ‘mainstay’ for scar treatment
DANA POINT, CALIF. (IMNG) – It may seem counterintuitive, but fractional ablative lasers have become a mainstay for treating all types of scars.
At a meeting sponsored by SkinCare Physicians and Northwestern University, Dr. Jill Waibel said that fractional lasers provide symptomatic relief, functional improvement, and rehabilitation to the target scars. "Lasers are emerging as the standard of care for scars," said Dr. Waibel, a dermatologic surgeon with the Miami Dermatology and Laser Institute.
"If you’re not using these on your scars, your patients may be missing out," she said. The effects are "permanent, powerful, and they can change the lives of your patients."
She favors a multimodal approach to scar treatment that she likened to a three-course meal. For the "appetizer," she’ll use one of several lasers to remove color from the scar. "I’ll use a vascular laser if it’s red; I’ll use a thulium or Q-switched laser if it’s hyperpigmented. I’ll use a nonablative fractional laser if it’s an atrophic scar."
The "main course" involves same-day treatment of the scar with a fractional ablative device such as the fractional ablative carbon dioxide or fractional ablative erbium laser. She uses a low density of 10% and recommends matching the depth of the laser to the depth of the scar, which typically amounts to 600-800 mcm.
For "dessert," she’ll use adjunctive therapies such as triamcinolone acetonide, 5-fluorouracil, hyaluronidase, Z-plasty, punch biopsies, compression, or subcision. "If you do these procedures together you are really going to increase your results," Dr. Waibel said. "The more procedures, the better. You don’t hit a wall like you often do treating port-wine stains. If you want to get 70%-90% improvement, you’re looking at between seven and nine treatments."
Clinicians are also using lasers to assist in the delivery of certain agents to enhance scar healing. For example, Dr. Waibel and her associates found that combination same-session therapy with laser-assisted delivery of triamcinolone acetonide offered efficient, safe, and effective treatment of challenging scars (Lasers Surg. Med. 2013;45:135-40). She has also conducted similar studies that involve the laser-assisted delivery of 5-fluorouracil to the scar site, which inhibits cell proliferation of fibroblasts.
Currently, Dr. Waibel and her colleagues at the University of Miami are working on a pilot study supported by the Department of Defense to test the hypothesis that ablative fractional lasers could deliver mesenchymal stem cells to skin using a porcine full-thickness wound model. So far, "we have shown that the stem cell can be delivered either autologously or allogeneically," she said. "It creates a woundless scar and re-creates the epidermal ridges. Fractional lasers are one of our greatest discoveries."
Dr. Waibel disclosed that she is a speaker for and has received honoraria for equipment or clinical trials from numerous device and skin care product manufacturers.
DANA POINT, CALIF. (IMNG) – It may seem counterintuitive, but fractional ablative lasers have become a mainstay for treating all types of scars.
At a meeting sponsored by SkinCare Physicians and Northwestern University, Dr. Jill Waibel said that fractional lasers provide symptomatic relief, functional improvement, and rehabilitation to the target scars. "Lasers are emerging as the standard of care for scars," said Dr. Waibel, a dermatologic surgeon with the Miami Dermatology and Laser Institute.
"If you’re not using these on your scars, your patients may be missing out," she said. The effects are "permanent, powerful, and they can change the lives of your patients."
She favors a multimodal approach to scar treatment that she likened to a three-course meal. For the "appetizer," she’ll use one of several lasers to remove color from the scar. "I’ll use a vascular laser if it’s red; I’ll use a thulium or Q-switched laser if it’s hyperpigmented. I’ll use a nonablative fractional laser if it’s an atrophic scar."
The "main course" involves same-day treatment of the scar with a fractional ablative device such as the fractional ablative carbon dioxide or fractional ablative erbium laser. She uses a low density of 10% and recommends matching the depth of the laser to the depth of the scar, which typically amounts to 600-800 mcm.
For "dessert," she’ll use adjunctive therapies such as triamcinolone acetonide, 5-fluorouracil, hyaluronidase, Z-plasty, punch biopsies, compression, or subcision. "If you do these procedures together you are really going to increase your results," Dr. Waibel said. "The more procedures, the better. You don’t hit a wall like you often do treating port-wine stains. If you want to get 70%-90% improvement, you’re looking at between seven and nine treatments."
Clinicians are also using lasers to assist in the delivery of certain agents to enhance scar healing. For example, Dr. Waibel and her associates found that combination same-session therapy with laser-assisted delivery of triamcinolone acetonide offered efficient, safe, and effective treatment of challenging scars (Lasers Surg. Med. 2013;45:135-40). She has also conducted similar studies that involve the laser-assisted delivery of 5-fluorouracil to the scar site, which inhibits cell proliferation of fibroblasts.
Currently, Dr. Waibel and her colleagues at the University of Miami are working on a pilot study supported by the Department of Defense to test the hypothesis that ablative fractional lasers could deliver mesenchymal stem cells to skin using a porcine full-thickness wound model. So far, "we have shown that the stem cell can be delivered either autologously or allogeneically," she said. "It creates a woundless scar and re-creates the epidermal ridges. Fractional lasers are one of our greatest discoveries."
Dr. Waibel disclosed that she is a speaker for and has received honoraria for equipment or clinical trials from numerous device and skin care product manufacturers.
DANA POINT, CALIF. (IMNG) – It may seem counterintuitive, but fractional ablative lasers have become a mainstay for treating all types of scars.
At a meeting sponsored by SkinCare Physicians and Northwestern University, Dr. Jill Waibel said that fractional lasers provide symptomatic relief, functional improvement, and rehabilitation to the target scars. "Lasers are emerging as the standard of care for scars," said Dr. Waibel, a dermatologic surgeon with the Miami Dermatology and Laser Institute.
"If you’re not using these on your scars, your patients may be missing out," she said. The effects are "permanent, powerful, and they can change the lives of your patients."
She favors a multimodal approach to scar treatment that she likened to a three-course meal. For the "appetizer," she’ll use one of several lasers to remove color from the scar. "I’ll use a vascular laser if it’s red; I’ll use a thulium or Q-switched laser if it’s hyperpigmented. I’ll use a nonablative fractional laser if it’s an atrophic scar."
The "main course" involves same-day treatment of the scar with a fractional ablative device such as the fractional ablative carbon dioxide or fractional ablative erbium laser. She uses a low density of 10% and recommends matching the depth of the laser to the depth of the scar, which typically amounts to 600-800 mcm.
For "dessert," she’ll use adjunctive therapies such as triamcinolone acetonide, 5-fluorouracil, hyaluronidase, Z-plasty, punch biopsies, compression, or subcision. "If you do these procedures together you are really going to increase your results," Dr. Waibel said. "The more procedures, the better. You don’t hit a wall like you often do treating port-wine stains. If you want to get 70%-90% improvement, you’re looking at between seven and nine treatments."
Clinicians are also using lasers to assist in the delivery of certain agents to enhance scar healing. For example, Dr. Waibel and her associates found that combination same-session therapy with laser-assisted delivery of triamcinolone acetonide offered efficient, safe, and effective treatment of challenging scars (Lasers Surg. Med. 2013;45:135-40). She has also conducted similar studies that involve the laser-assisted delivery of 5-fluorouracil to the scar site, which inhibits cell proliferation of fibroblasts.
Currently, Dr. Waibel and her colleagues at the University of Miami are working on a pilot study supported by the Department of Defense to test the hypothesis that ablative fractional lasers could deliver mesenchymal stem cells to skin using a porcine full-thickness wound model. So far, "we have shown that the stem cell can be delivered either autologously or allogeneically," she said. "It creates a woundless scar and re-creates the epidermal ridges. Fractional lasers are one of our greatest discoveries."
Dr. Waibel disclosed that she is a speaker for and has received honoraria for equipment or clinical trials from numerous device and skin care product manufacturers.
AT CONTROVERSIES AND CONVERSATIONS IN LASER AND COSMETIC SURGERY
Surgical procedures best for skin tightening, expert says
DANA POINT, CALIF. – For skin tightening, there’s no comparison between surgical and nonsurgical approaches as far as quality, predictability, and longevity, according to Dr. A. Jay Burns.
"Anyone who suggests to patients that nonsurgical contouring and rejuvenation share comparable results is either self-serving, dishonest, grossly naive, or misinformed," said Dr. Burns of the Dallas Plastic Surgery Institute. "In my opinion, surgical treatments are extremely reliable and nonsurgical treatments are extremely variable. But I’m not in an ivory tower. I realize that [surgical approaches result in] more complications and that they’re more expensive."
Surgical skin tightening involves total elevation, full repositioning, centimeter changes, and control, with predictable, clear results, he said at the meeting, sponsored by SkinCare Physicians and Northwestern University.
On the other hand, nonsurgical skin tightening involves no elevation, no repositioning, millimeter changes, and no control. This leads to results that he characterized as "unpredictable and subtle."
Dr. Burns acknowledged certain advantages of nonsurgical skin tightening approaches, such as the fact that they’re typically less expensive (except for brow dynamic line elimination), they eliminate the risk of nerve damage, and they require less downtime. He said he advises clinicians to recommend nonsurgical skin tightening for patients who prioritize downtime, cost, and risk over results. Surgical skin tightening is for those who want optimal results, maximum quality and predictability, and elegance, he said.
Dr. Burns said that there is "a clear place for" nonsurgical skin tightening techniques in his practice, and he emphasized the importance of fostering integrity during patient consultations. This includes informed consent, representing the technology honestly, and being honest with patients about expectations from procedures that you offer. Such practice "shows character and aids your reputation," he said. "It also prioritizes patient care over revenue."
He noted that the ThermiRF, developed by Southlake, Tex.–based ThermiAesthetics, represents a promising advance in noninvasive skin technology because it features a continuous temperature monitor on its internal probe. This radiofrequency device enables the user to administer the precise amount of heat for the collagen layer, Dr. Burns said. "There are some really nice results on the skin and neck," he said.
Dr. Burns disclosed that he has received equipment loans or discounts on equipment from Cynosure, Zeltiq Aesthetics, and other companies. He has held stock or stock options with Skin Medica and Zeltiq and has received honoraria from Solta Medical and Ulthera. He is an advisory board member for Cynosure, Ulthera, and Zeltiq.
DANA POINT, CALIF. – For skin tightening, there’s no comparison between surgical and nonsurgical approaches as far as quality, predictability, and longevity, according to Dr. A. Jay Burns.
"Anyone who suggests to patients that nonsurgical contouring and rejuvenation share comparable results is either self-serving, dishonest, grossly naive, or misinformed," said Dr. Burns of the Dallas Plastic Surgery Institute. "In my opinion, surgical treatments are extremely reliable and nonsurgical treatments are extremely variable. But I’m not in an ivory tower. I realize that [surgical approaches result in] more complications and that they’re more expensive."
Surgical skin tightening involves total elevation, full repositioning, centimeter changes, and control, with predictable, clear results, he said at the meeting, sponsored by SkinCare Physicians and Northwestern University.
On the other hand, nonsurgical skin tightening involves no elevation, no repositioning, millimeter changes, and no control. This leads to results that he characterized as "unpredictable and subtle."
Dr. Burns acknowledged certain advantages of nonsurgical skin tightening approaches, such as the fact that they’re typically less expensive (except for brow dynamic line elimination), they eliminate the risk of nerve damage, and they require less downtime. He said he advises clinicians to recommend nonsurgical skin tightening for patients who prioritize downtime, cost, and risk over results. Surgical skin tightening is for those who want optimal results, maximum quality and predictability, and elegance, he said.
Dr. Burns said that there is "a clear place for" nonsurgical skin tightening techniques in his practice, and he emphasized the importance of fostering integrity during patient consultations. This includes informed consent, representing the technology honestly, and being honest with patients about expectations from procedures that you offer. Such practice "shows character and aids your reputation," he said. "It also prioritizes patient care over revenue."
He noted that the ThermiRF, developed by Southlake, Tex.–based ThermiAesthetics, represents a promising advance in noninvasive skin technology because it features a continuous temperature monitor on its internal probe. This radiofrequency device enables the user to administer the precise amount of heat for the collagen layer, Dr. Burns said. "There are some really nice results on the skin and neck," he said.
Dr. Burns disclosed that he has received equipment loans or discounts on equipment from Cynosure, Zeltiq Aesthetics, and other companies. He has held stock or stock options with Skin Medica and Zeltiq and has received honoraria from Solta Medical and Ulthera. He is an advisory board member for Cynosure, Ulthera, and Zeltiq.
DANA POINT, CALIF. – For skin tightening, there’s no comparison between surgical and nonsurgical approaches as far as quality, predictability, and longevity, according to Dr. A. Jay Burns.
"Anyone who suggests to patients that nonsurgical contouring and rejuvenation share comparable results is either self-serving, dishonest, grossly naive, or misinformed," said Dr. Burns of the Dallas Plastic Surgery Institute. "In my opinion, surgical treatments are extremely reliable and nonsurgical treatments are extremely variable. But I’m not in an ivory tower. I realize that [surgical approaches result in] more complications and that they’re more expensive."
Surgical skin tightening involves total elevation, full repositioning, centimeter changes, and control, with predictable, clear results, he said at the meeting, sponsored by SkinCare Physicians and Northwestern University.
On the other hand, nonsurgical skin tightening involves no elevation, no repositioning, millimeter changes, and no control. This leads to results that he characterized as "unpredictable and subtle."
Dr. Burns acknowledged certain advantages of nonsurgical skin tightening approaches, such as the fact that they’re typically less expensive (except for brow dynamic line elimination), they eliminate the risk of nerve damage, and they require less downtime. He said he advises clinicians to recommend nonsurgical skin tightening for patients who prioritize downtime, cost, and risk over results. Surgical skin tightening is for those who want optimal results, maximum quality and predictability, and elegance, he said.
Dr. Burns said that there is "a clear place for" nonsurgical skin tightening techniques in his practice, and he emphasized the importance of fostering integrity during patient consultations. This includes informed consent, representing the technology honestly, and being honest with patients about expectations from procedures that you offer. Such practice "shows character and aids your reputation," he said. "It also prioritizes patient care over revenue."
He noted that the ThermiRF, developed by Southlake, Tex.–based ThermiAesthetics, represents a promising advance in noninvasive skin technology because it features a continuous temperature monitor on its internal probe. This radiofrequency device enables the user to administer the precise amount of heat for the collagen layer, Dr. Burns said. "There are some really nice results on the skin and neck," he said.
Dr. Burns disclosed that he has received equipment loans or discounts on equipment from Cynosure, Zeltiq Aesthetics, and other companies. He has held stock or stock options with Skin Medica and Zeltiq and has received honoraria from Solta Medical and Ulthera. He is an advisory board member for Cynosure, Ulthera, and Zeltiq.
EXPERT ANALYSIS FROM CONTROVERSIES AND CONVERSATIONS IN LASER AND COSMETIC SURGERY
Check clinical evidence behind body contouring devices
DANA POINT, CALIF. – If you’re in the market for a body contouring device, Dr. Robert Weiss advises factoring in "solid clinical evidence" before you buy.
"You want to see histologic evidence – apoptosis of fat cells, or at least diminution of fat cells," he said at a meeting sponsored by SkinCare Physicians and Northwestern University. "You want to see ultrasound confirmation of fat reduction, something that’s reproducible and objective. It [the device] also has to have ease of use," he said.
"Most importantly, you want to know if patients themselves see a clinically meaningful response, a significant improvement. If they don’t see improvement, it [the objective value] doesn’t matter," he added.
Other important factors to consider before buying a body contouring device include making sure it has undergone animal studies of internal thermocoupling, and that it has an external temperature monitor for skin. "Infrared camera technology will also help to show how uniform the heating is, and how the skin relates to fat," said Dr. Weiss of the Maryland Laser Skin and Vein Institute, Hunt Valley.
In his practice, Dr. Weiss uses four devices for body contouring: two cryolipolysis devices, one monopolar radiofrequency (RF) device, and one focused-field RF device. The last device, known as the Vanquish, was introduced at the 2013 American Academy of Dermatology meeting. Manufactured by Prague-based BTL Industries, Vanquish is a noncontact device that delivers focused-field RF through panels that are placed over the desired treatment area while the patient is lying horizontally. "The focal point is 10 mm below the skin surface, and it heats to 43-45° C," said Dr. Weiss, who was part of a team of researchers that demonstrated the efficacy of Vanquish in a porcine model (Lasers Surg. Med. 2013;45:235-39). "There are positive and negative fields created within the applicator," Dr. Weiss said. "What happens is that the fat creates more resistance, so the fat heats up but skin and muscle do not. We feel that this [device is] going to be a real game-changer."
In the study, a 70% reduction in abdominal fat was observed in pigs that were treated four times with the Vanquish for 30 minutes each. "Histologic evaluation revealed that epidermis, dermis, and adnexal structures such as hair follicles were unaffected by the treatment, while adipocytes were significantly affected," Dr. Weiss and his colleagues wrote.
Patients who have undergone treatment of excessive abdominal fat with the Vanquish describe a warm sensation during the procedure, with minimal side effects, Dr. Weiss said. "The more hydrated you are, the more selectivity there’s going to be, so we encourage people to drink water before the procedure," he said.
Dr. Weiss disclosed that he is a speaker and investigator for BTL Industries. He also has received honoraria and equipment from the company.
DANA POINT, CALIF. – If you’re in the market for a body contouring device, Dr. Robert Weiss advises factoring in "solid clinical evidence" before you buy.
"You want to see histologic evidence – apoptosis of fat cells, or at least diminution of fat cells," he said at a meeting sponsored by SkinCare Physicians and Northwestern University. "You want to see ultrasound confirmation of fat reduction, something that’s reproducible and objective. It [the device] also has to have ease of use," he said.
"Most importantly, you want to know if patients themselves see a clinically meaningful response, a significant improvement. If they don’t see improvement, it [the objective value] doesn’t matter," he added.
Other important factors to consider before buying a body contouring device include making sure it has undergone animal studies of internal thermocoupling, and that it has an external temperature monitor for skin. "Infrared camera technology will also help to show how uniform the heating is, and how the skin relates to fat," said Dr. Weiss of the Maryland Laser Skin and Vein Institute, Hunt Valley.
In his practice, Dr. Weiss uses four devices for body contouring: two cryolipolysis devices, one monopolar radiofrequency (RF) device, and one focused-field RF device. The last device, known as the Vanquish, was introduced at the 2013 American Academy of Dermatology meeting. Manufactured by Prague-based BTL Industries, Vanquish is a noncontact device that delivers focused-field RF through panels that are placed over the desired treatment area while the patient is lying horizontally. "The focal point is 10 mm below the skin surface, and it heats to 43-45° C," said Dr. Weiss, who was part of a team of researchers that demonstrated the efficacy of Vanquish in a porcine model (Lasers Surg. Med. 2013;45:235-39). "There are positive and negative fields created within the applicator," Dr. Weiss said. "What happens is that the fat creates more resistance, so the fat heats up but skin and muscle do not. We feel that this [device is] going to be a real game-changer."
In the study, a 70% reduction in abdominal fat was observed in pigs that were treated four times with the Vanquish for 30 minutes each. "Histologic evaluation revealed that epidermis, dermis, and adnexal structures such as hair follicles were unaffected by the treatment, while adipocytes were significantly affected," Dr. Weiss and his colleagues wrote.
Patients who have undergone treatment of excessive abdominal fat with the Vanquish describe a warm sensation during the procedure, with minimal side effects, Dr. Weiss said. "The more hydrated you are, the more selectivity there’s going to be, so we encourage people to drink water before the procedure," he said.
Dr. Weiss disclosed that he is a speaker and investigator for BTL Industries. He also has received honoraria and equipment from the company.
DANA POINT, CALIF. – If you’re in the market for a body contouring device, Dr. Robert Weiss advises factoring in "solid clinical evidence" before you buy.
"You want to see histologic evidence – apoptosis of fat cells, or at least diminution of fat cells," he said at a meeting sponsored by SkinCare Physicians and Northwestern University. "You want to see ultrasound confirmation of fat reduction, something that’s reproducible and objective. It [the device] also has to have ease of use," he said.
"Most importantly, you want to know if patients themselves see a clinically meaningful response, a significant improvement. If they don’t see improvement, it [the objective value] doesn’t matter," he added.
Other important factors to consider before buying a body contouring device include making sure it has undergone animal studies of internal thermocoupling, and that it has an external temperature monitor for skin. "Infrared camera technology will also help to show how uniform the heating is, and how the skin relates to fat," said Dr. Weiss of the Maryland Laser Skin and Vein Institute, Hunt Valley.
In his practice, Dr. Weiss uses four devices for body contouring: two cryolipolysis devices, one monopolar radiofrequency (RF) device, and one focused-field RF device. The last device, known as the Vanquish, was introduced at the 2013 American Academy of Dermatology meeting. Manufactured by Prague-based BTL Industries, Vanquish is a noncontact device that delivers focused-field RF through panels that are placed over the desired treatment area while the patient is lying horizontally. "The focal point is 10 mm below the skin surface, and it heats to 43-45° C," said Dr. Weiss, who was part of a team of researchers that demonstrated the efficacy of Vanquish in a porcine model (Lasers Surg. Med. 2013;45:235-39). "There are positive and negative fields created within the applicator," Dr. Weiss said. "What happens is that the fat creates more resistance, so the fat heats up but skin and muscle do not. We feel that this [device is] going to be a real game-changer."
In the study, a 70% reduction in abdominal fat was observed in pigs that were treated four times with the Vanquish for 30 minutes each. "Histologic evaluation revealed that epidermis, dermis, and adnexal structures such as hair follicles were unaffected by the treatment, while adipocytes were significantly affected," Dr. Weiss and his colleagues wrote.
Patients who have undergone treatment of excessive abdominal fat with the Vanquish describe a warm sensation during the procedure, with minimal side effects, Dr. Weiss said. "The more hydrated you are, the more selectivity there’s going to be, so we encourage people to drink water before the procedure," he said.
Dr. Weiss disclosed that he is a speaker and investigator for BTL Industries. He also has received honoraria and equipment from the company.
EXPERT ANALYSIS FROM CONTROVERSIES AND CONVERSATIONS IN LASER AND COSMETIC SURGERY
Forehead wrinkles stay smoother longer with nerve fiber treatment
DANA POINT, CALIF. – Use of a bipolar radiofrequency probe to the frontalis and corrugator branches of the temporal facial nerve resulted in the diminishment of forehead wrinkles that lasts two to three times longer than treatment with botulinum toxin, according to Dr. James Newman.
At a meeting sponsored by SkinCare Physicians and Northwestern University, Dr. Newman described his early clinical experience with the Serene Solution, a Food and Drug Administration–cleared device created by Serene Medical designed to target nerves and create radiofrequency lesions.
"The purpose of this type of treatment is to take a finite probe, which allows the physician to stimulate and target a very specific nerve on the body," said Dr. Newman, a plastic surgeon in private practice in Palo Alto, Calif. "In this case we’re using a bipolar radiofrequency probe within 1-2 mm of the frontalis and corrugator branches of the temporal facial nerve."
The device, which consists of a control unit and 20-gauge dual-purpose probe, enables one or more small radiofrequency lesions to interrupt the motor nerve signal and reduce muscle activity. "The advantage is that the effect is instant," said Dr. Newman, who is chief medical officer for Serene Medical. "It’s long lasting, produces minimal collateral damage, and allows reconnection along the original path of [the] nerve." The effect can last 6-18 months, depending on the lesion, compared with botulinum that lasts for about 3-6 months.
In split-face studies conducted by Dr. Newman and his associates, 20 patients underwent a single treatment with the Serene Solution to create a radiofrequency lesion on the frontalis and corrugator branches of the temporal facial nerve. Six months post treatment, patient wrinkles remained improved compared with baseline, according to evaluation with Merz Aesthetics Scales. "The muscle response to stimulation currently demonstrates that nerve function is fully restored, when compared to the untreated side," Dr. Newman said. "That told us that the nerve sheath is still intact and that we do not have a complete nerve block." The fact that improvement persists long term in the treated side "may be due to a smaller or less-conditioned frontalis muscle," he said.
Dr. Newman and his associates plan to study the hypothesis that creating three radiofrequency lesions along the frontalis nerve will prolong the period of nerve discontinuity by two to three times. "If we create more than one lesion, perhaps we can prolong relaxation of the frontalis muscle and those wrinkle scores might be improved as well," he said.
Dr. Newman disclosed that he is a stockholder in Serene Medical and that he is a speaker for and has received honoraria from Valeant Pharmaceuticals.
DANA POINT, CALIF. – Use of a bipolar radiofrequency probe to the frontalis and corrugator branches of the temporal facial nerve resulted in the diminishment of forehead wrinkles that lasts two to three times longer than treatment with botulinum toxin, according to Dr. James Newman.
At a meeting sponsored by SkinCare Physicians and Northwestern University, Dr. Newman described his early clinical experience with the Serene Solution, a Food and Drug Administration–cleared device created by Serene Medical designed to target nerves and create radiofrequency lesions.
"The purpose of this type of treatment is to take a finite probe, which allows the physician to stimulate and target a very specific nerve on the body," said Dr. Newman, a plastic surgeon in private practice in Palo Alto, Calif. "In this case we’re using a bipolar radiofrequency probe within 1-2 mm of the frontalis and corrugator branches of the temporal facial nerve."
The device, which consists of a control unit and 20-gauge dual-purpose probe, enables one or more small radiofrequency lesions to interrupt the motor nerve signal and reduce muscle activity. "The advantage is that the effect is instant," said Dr. Newman, who is chief medical officer for Serene Medical. "It’s long lasting, produces minimal collateral damage, and allows reconnection along the original path of [the] nerve." The effect can last 6-18 months, depending on the lesion, compared with botulinum that lasts for about 3-6 months.
In split-face studies conducted by Dr. Newman and his associates, 20 patients underwent a single treatment with the Serene Solution to create a radiofrequency lesion on the frontalis and corrugator branches of the temporal facial nerve. Six months post treatment, patient wrinkles remained improved compared with baseline, according to evaluation with Merz Aesthetics Scales. "The muscle response to stimulation currently demonstrates that nerve function is fully restored, when compared to the untreated side," Dr. Newman said. "That told us that the nerve sheath is still intact and that we do not have a complete nerve block." The fact that improvement persists long term in the treated side "may be due to a smaller or less-conditioned frontalis muscle," he said.
Dr. Newman and his associates plan to study the hypothesis that creating three radiofrequency lesions along the frontalis nerve will prolong the period of nerve discontinuity by two to three times. "If we create more than one lesion, perhaps we can prolong relaxation of the frontalis muscle and those wrinkle scores might be improved as well," he said.
Dr. Newman disclosed that he is a stockholder in Serene Medical and that he is a speaker for and has received honoraria from Valeant Pharmaceuticals.
DANA POINT, CALIF. – Use of a bipolar radiofrequency probe to the frontalis and corrugator branches of the temporal facial nerve resulted in the diminishment of forehead wrinkles that lasts two to three times longer than treatment with botulinum toxin, according to Dr. James Newman.
At a meeting sponsored by SkinCare Physicians and Northwestern University, Dr. Newman described his early clinical experience with the Serene Solution, a Food and Drug Administration–cleared device created by Serene Medical designed to target nerves and create radiofrequency lesions.
"The purpose of this type of treatment is to take a finite probe, which allows the physician to stimulate and target a very specific nerve on the body," said Dr. Newman, a plastic surgeon in private practice in Palo Alto, Calif. "In this case we’re using a bipolar radiofrequency probe within 1-2 mm of the frontalis and corrugator branches of the temporal facial nerve."
The device, which consists of a control unit and 20-gauge dual-purpose probe, enables one or more small radiofrequency lesions to interrupt the motor nerve signal and reduce muscle activity. "The advantage is that the effect is instant," said Dr. Newman, who is chief medical officer for Serene Medical. "It’s long lasting, produces minimal collateral damage, and allows reconnection along the original path of [the] nerve." The effect can last 6-18 months, depending on the lesion, compared with botulinum that lasts for about 3-6 months.
In split-face studies conducted by Dr. Newman and his associates, 20 patients underwent a single treatment with the Serene Solution to create a radiofrequency lesion on the frontalis and corrugator branches of the temporal facial nerve. Six months post treatment, patient wrinkles remained improved compared with baseline, according to evaluation with Merz Aesthetics Scales. "The muscle response to stimulation currently demonstrates that nerve function is fully restored, when compared to the untreated side," Dr. Newman said. "That told us that the nerve sheath is still intact and that we do not have a complete nerve block." The fact that improvement persists long term in the treated side "may be due to a smaller or less-conditioned frontalis muscle," he said.
Dr. Newman and his associates plan to study the hypothesis that creating three radiofrequency lesions along the frontalis nerve will prolong the period of nerve discontinuity by two to three times. "If we create more than one lesion, perhaps we can prolong relaxation of the frontalis muscle and those wrinkle scores might be improved as well," he said.
Dr. Newman disclosed that he is a stockholder in Serene Medical and that he is a speaker for and has received honoraria from Valeant Pharmaceuticals.
EXPERT ANALYSIS FROM CONTROVERSIES AND CONVERSATIONS IN LASER AND COSMETIC SURGERY
Home-use products show progress
DANA POINT, CALIF. – Nonablative fractional photothermolysis technology is a well-suited model for over-the-counter product development, especially within the 1430 nm to 1450 nm range, Dr. Brian S. Biesman said at a meeting sponsored by SkinCare Physicians and Northwestern University.
"I want to dispel the myth that there’s nothing in the home-use realm that works," said Dr. Biesman, director of the Nashville (Tenn.) Center for Laser and Facial Surgery. "There is a lot of money in the investment community tied up in the home-use realm, and there are some real significant devices in this area."
Considerations for adoption of intense pulsed light and laser devices for home use should involve "the exact same standards that we apply to the devices that we use in the office," Dr. Biesman said. These include the safety of core technology, in both use and misuse settings: tolerability, predictable efficacy, ease of use, affordable cost, robust premarket evidence, and alignment between claims and reality.
Three nonablative fractional laser options exist for home-based treatment of photodamaged skin: the 1435-nm Palomar PaloVia, the 1410-nm Solta RéAura (not yet FDA cleared), and the 1410-nm Tria Beauty SRL, which is also pending FDA clearance.
Dr. Biesman discussed the Tria SRL, a 1440-nm fractional nonablative laser device that can deliver energy up to 260 microns in depth with an adjustable energy range of 5-12 millijoules/pulse. "At first, given the parameters within which this device operated, I didn’t expect it to be clinically useful," Dr. Biesman noted.
In a safety, efficacy, and tolerability study sponsored by Tria, 90 patients aged 32-70 years old underwent treatment for dyschromia, periorbital wrinkles, and textural irregularities on the face. Of the 90 patients, 87 were women, 87 were white, and 62% had Fitzpatrick skin types II or III.
Patients underwent full face treatment 5 days/week for 12 weeks. They were then followed at 1 day, 2 weeks, 4 weeks, 8 weeks, and 12 weeks after the final treatment. Standard and polarized photos were taken on a VISIA CR system by Canfield Scientific, at baseline, every 2 weeks during treatment, and at each follow-up visit. Blinded investigators used a validated nine-point scale to evaluate each indication.
Dr. Biesman, who was not an investigator in the study, reported that investigator scoring showed statistically significant and clinically meaningful improvements in texture, periorbital wrinkles, and discoloration at 4 weeks and 12 weeks post treatment (all with a P value of less than.001). Common side effects included erythema, stinging/prickling sensations, and warm sensations. All side effects were reported to be mild and self-resolving, and no serious adverse events were reported.
Self-reported patient satisfaction ranged from 80%-90%, "which are similar numbers if you look at the subject satisfaction for the office-based nonablative devices," Dr. Biesman said.
Dr. Biesman advises clinicians to think of home-use laser devices for the treatment of photoaging, acne, and hair reduction "as prescriptives, much as we would retinoids. They’re not going to replace what we do in the office," he said. "But if someone has made a substantial investment for an office-based treatment plan, why not recommend something they can use at home that will help them maintain that outcome?"
In his opinion, nonablative resurfacing is "the next area of great opportunity" in home devices. "But I think the area of greatest opportunity is using these nonablative devices with other over-the-counter or prescriptive topical agents for laser-enhanced drug delivery," he noted.
"Using this approach, I believe we can accomplish some unique and very interesting objectives. This is an area that is only just beginning to be explored, but which holds tremendous potential. I look forward to the future of these devices as stand-alone treatments and to enhance drug delivery to facilitate reaching challenging therapeutic and aesthetic endpoints," he added.
Dr. Biesman disclosed that he is a consultant for and has received travel funds from Tria Beauty.
*Correction, 9/26/2013: An earlier version of this story included incorrect image order and captions.
DANA POINT, CALIF. – Nonablative fractional photothermolysis technology is a well-suited model for over-the-counter product development, especially within the 1430 nm to 1450 nm range, Dr. Brian S. Biesman said at a meeting sponsored by SkinCare Physicians and Northwestern University.
"I want to dispel the myth that there’s nothing in the home-use realm that works," said Dr. Biesman, director of the Nashville (Tenn.) Center for Laser and Facial Surgery. "There is a lot of money in the investment community tied up in the home-use realm, and there are some real significant devices in this area."
Considerations for adoption of intense pulsed light and laser devices for home use should involve "the exact same standards that we apply to the devices that we use in the office," Dr. Biesman said. These include the safety of core technology, in both use and misuse settings: tolerability, predictable efficacy, ease of use, affordable cost, robust premarket evidence, and alignment between claims and reality.
Three nonablative fractional laser options exist for home-based treatment of photodamaged skin: the 1435-nm Palomar PaloVia, the 1410-nm Solta RéAura (not yet FDA cleared), and the 1410-nm Tria Beauty SRL, which is also pending FDA clearance.
Dr. Biesman discussed the Tria SRL, a 1440-nm fractional nonablative laser device that can deliver energy up to 260 microns in depth with an adjustable energy range of 5-12 millijoules/pulse. "At first, given the parameters within which this device operated, I didn’t expect it to be clinically useful," Dr. Biesman noted.
In a safety, efficacy, and tolerability study sponsored by Tria, 90 patients aged 32-70 years old underwent treatment for dyschromia, periorbital wrinkles, and textural irregularities on the face. Of the 90 patients, 87 were women, 87 were white, and 62% had Fitzpatrick skin types II or III.
Patients underwent full face treatment 5 days/week for 12 weeks. They were then followed at 1 day, 2 weeks, 4 weeks, 8 weeks, and 12 weeks after the final treatment. Standard and polarized photos were taken on a VISIA CR system by Canfield Scientific, at baseline, every 2 weeks during treatment, and at each follow-up visit. Blinded investigators used a validated nine-point scale to evaluate each indication.
Dr. Biesman, who was not an investigator in the study, reported that investigator scoring showed statistically significant and clinically meaningful improvements in texture, periorbital wrinkles, and discoloration at 4 weeks and 12 weeks post treatment (all with a P value of less than.001). Common side effects included erythema, stinging/prickling sensations, and warm sensations. All side effects were reported to be mild and self-resolving, and no serious adverse events were reported.
Self-reported patient satisfaction ranged from 80%-90%, "which are similar numbers if you look at the subject satisfaction for the office-based nonablative devices," Dr. Biesman said.
Dr. Biesman advises clinicians to think of home-use laser devices for the treatment of photoaging, acne, and hair reduction "as prescriptives, much as we would retinoids. They’re not going to replace what we do in the office," he said. "But if someone has made a substantial investment for an office-based treatment plan, why not recommend something they can use at home that will help them maintain that outcome?"
In his opinion, nonablative resurfacing is "the next area of great opportunity" in home devices. "But I think the area of greatest opportunity is using these nonablative devices with other over-the-counter or prescriptive topical agents for laser-enhanced drug delivery," he noted.
"Using this approach, I believe we can accomplish some unique and very interesting objectives. This is an area that is only just beginning to be explored, but which holds tremendous potential. I look forward to the future of these devices as stand-alone treatments and to enhance drug delivery to facilitate reaching challenging therapeutic and aesthetic endpoints," he added.
Dr. Biesman disclosed that he is a consultant for and has received travel funds from Tria Beauty.
*Correction, 9/26/2013: An earlier version of this story included incorrect image order and captions.
DANA POINT, CALIF. – Nonablative fractional photothermolysis technology is a well-suited model for over-the-counter product development, especially within the 1430 nm to 1450 nm range, Dr. Brian S. Biesman said at a meeting sponsored by SkinCare Physicians and Northwestern University.
"I want to dispel the myth that there’s nothing in the home-use realm that works," said Dr. Biesman, director of the Nashville (Tenn.) Center for Laser and Facial Surgery. "There is a lot of money in the investment community tied up in the home-use realm, and there are some real significant devices in this area."
Considerations for adoption of intense pulsed light and laser devices for home use should involve "the exact same standards that we apply to the devices that we use in the office," Dr. Biesman said. These include the safety of core technology, in both use and misuse settings: tolerability, predictable efficacy, ease of use, affordable cost, robust premarket evidence, and alignment between claims and reality.
Three nonablative fractional laser options exist for home-based treatment of photodamaged skin: the 1435-nm Palomar PaloVia, the 1410-nm Solta RéAura (not yet FDA cleared), and the 1410-nm Tria Beauty SRL, which is also pending FDA clearance.
Dr. Biesman discussed the Tria SRL, a 1440-nm fractional nonablative laser device that can deliver energy up to 260 microns in depth with an adjustable energy range of 5-12 millijoules/pulse. "At first, given the parameters within which this device operated, I didn’t expect it to be clinically useful," Dr. Biesman noted.
In a safety, efficacy, and tolerability study sponsored by Tria, 90 patients aged 32-70 years old underwent treatment for dyschromia, periorbital wrinkles, and textural irregularities on the face. Of the 90 patients, 87 were women, 87 were white, and 62% had Fitzpatrick skin types II or III.
Patients underwent full face treatment 5 days/week for 12 weeks. They were then followed at 1 day, 2 weeks, 4 weeks, 8 weeks, and 12 weeks after the final treatment. Standard and polarized photos were taken on a VISIA CR system by Canfield Scientific, at baseline, every 2 weeks during treatment, and at each follow-up visit. Blinded investigators used a validated nine-point scale to evaluate each indication.
Dr. Biesman, who was not an investigator in the study, reported that investigator scoring showed statistically significant and clinically meaningful improvements in texture, periorbital wrinkles, and discoloration at 4 weeks and 12 weeks post treatment (all with a P value of less than.001). Common side effects included erythema, stinging/prickling sensations, and warm sensations. All side effects were reported to be mild and self-resolving, and no serious adverse events were reported.
Self-reported patient satisfaction ranged from 80%-90%, "which are similar numbers if you look at the subject satisfaction for the office-based nonablative devices," Dr. Biesman said.
Dr. Biesman advises clinicians to think of home-use laser devices for the treatment of photoaging, acne, and hair reduction "as prescriptives, much as we would retinoids. They’re not going to replace what we do in the office," he said. "But if someone has made a substantial investment for an office-based treatment plan, why not recommend something they can use at home that will help them maintain that outcome?"
In his opinion, nonablative resurfacing is "the next area of great opportunity" in home devices. "But I think the area of greatest opportunity is using these nonablative devices with other over-the-counter or prescriptive topical agents for laser-enhanced drug delivery," he noted.
"Using this approach, I believe we can accomplish some unique and very interesting objectives. This is an area that is only just beginning to be explored, but which holds tremendous potential. I look forward to the future of these devices as stand-alone treatments and to enhance drug delivery to facilitate reaching challenging therapeutic and aesthetic endpoints," he added.
Dr. Biesman disclosed that he is a consultant for and has received travel funds from Tria Beauty.
*Correction, 9/26/2013: An earlier version of this story included incorrect image order and captions.
EXPERT ANALYSIS FROM CONTROVERSIES AND CONVERSATIONS IN LASER AND COSMETIC SURGERY
1,927-nm laser unveils improvements for melasma patients
DANA POINT, CALIF. – Patients with melasma who underwent treatment with a new low-energy and low-density nonablative fractional 1,927-nm diode laser experienced significant reduction of hyperpigmentation with limited side effects, a single-center study demonstrated.
At a meeting sponsored by SkinCare Physicians and Northwestern University, Dr. Roy G. Geronemus discussed his experience treating patients with the FDA-cleared technology, which is known as the Clear + Brilliant Permea.
Dr. Geronemus of the Laser and Skin Surgery Center of New York noted that existing laser treatments have so far failed to yield a consistent and long-term reduction in pigmentation, especially in patients with darker skin types. "Many current [laser] treatments for melasma make the condition worse," he said "What we ideally need is something that will be helpful, will not make it worse, and that can be repeated, because [melasma] probably will recur over time."
In an ongoing prospective study, Dr. Geronemus and his associates evaluated the 1,927-nm diode laser in melasma patients with a hunch that it would improve pigmentation and appearance with an improved safety profile and overall treatment outcomes. They enrolled patients aged 18-65 years with Fitzpatrick skin types I-VI who had clinical evidence of melasma or postinflammatory hyperpigmentation. They excluded patients who were either pregnant, breast-feeding, contemplating pregnancy, or not using effective means of birth control, as well as those known to be hypersensitive to light exposure and those with a history of melanoma or nonmelanoma skin cancer, keloidal scarring, immunosuppression, or immune deficiency disorder. Images were taken at baseline, prior to each treatment, and at follow-up using the Canfield VISIA complexion analysis system.
Up to six treatments were performed every 2 weeks, Dr. Geronemus said, with spot sizes of 100-180 mcm, energy of 5 mJ, 5-7.5% treatment coverage, and an average of 4-12 passes.
The researchers asked patients to rate their pain after each treatment, as well as their overall improvement in pigmentation. Pain was assessed on an 11-point scale, with 0 being none and 10 being "intolerable." Pigmentation improvement was measured on a 5-point scale, with 0 being none, 1 being mild (1-25%), 2 being moderate (26-50%), 3 being marked (51-75%), and 4 being very significant (76-100%). At the final 3-month visit, patients were asked to rate their overall satisfaction with the treatment on a 5-point scale ranging from very dissatisfied (1) to very satisfied (5).
Dr. Geronemus presented results from 14 patients who had completed 3-month follow-up visits. These 14 women included 10 with melasma and 4 with postinflammatory hyperpigmentation. The mean age of the patients was 42 years, and 9 had Fitzpatrick skin types I-III.
The patients rated their pain as 3.25 out of 10, their overall pigment improvement as 3 out of 4, and their overall satisfaction with the procedure as a 4.33 out of 5, Dr. Geronemus reported. "This is often technique sensitive," he said of the procedure. "I’ll have physicians call me up and say, ‘I’m not getting any results.’ I think you need 10-12 passes to get the [optimal] results."
The most common side effect was erythema, which typically resolved within 1 day. Though the device is effective as monotherapy, Dr. Geronemus pointed out that it is "ideally suited for combination therapy with a mild hydroquinone."
Dr. Geronemus disclosed that he serves on the medical advisory boards for Zeltiq, Syneron/Candela, and Cynosure. He also serves as an investigator for numerous device and pharmaceutical companies, and he holds stock in Zeltiq and OnLight Sciences.
DANA POINT, CALIF. – Patients with melasma who underwent treatment with a new low-energy and low-density nonablative fractional 1,927-nm diode laser experienced significant reduction of hyperpigmentation with limited side effects, a single-center study demonstrated.
At a meeting sponsored by SkinCare Physicians and Northwestern University, Dr. Roy G. Geronemus discussed his experience treating patients with the FDA-cleared technology, which is known as the Clear + Brilliant Permea.
Dr. Geronemus of the Laser and Skin Surgery Center of New York noted that existing laser treatments have so far failed to yield a consistent and long-term reduction in pigmentation, especially in patients with darker skin types. "Many current [laser] treatments for melasma make the condition worse," he said "What we ideally need is something that will be helpful, will not make it worse, and that can be repeated, because [melasma] probably will recur over time."
In an ongoing prospective study, Dr. Geronemus and his associates evaluated the 1,927-nm diode laser in melasma patients with a hunch that it would improve pigmentation and appearance with an improved safety profile and overall treatment outcomes. They enrolled patients aged 18-65 years with Fitzpatrick skin types I-VI who had clinical evidence of melasma or postinflammatory hyperpigmentation. They excluded patients who were either pregnant, breast-feeding, contemplating pregnancy, or not using effective means of birth control, as well as those known to be hypersensitive to light exposure and those with a history of melanoma or nonmelanoma skin cancer, keloidal scarring, immunosuppression, or immune deficiency disorder. Images were taken at baseline, prior to each treatment, and at follow-up using the Canfield VISIA complexion analysis system.
Up to six treatments were performed every 2 weeks, Dr. Geronemus said, with spot sizes of 100-180 mcm, energy of 5 mJ, 5-7.5% treatment coverage, and an average of 4-12 passes.
The researchers asked patients to rate their pain after each treatment, as well as their overall improvement in pigmentation. Pain was assessed on an 11-point scale, with 0 being none and 10 being "intolerable." Pigmentation improvement was measured on a 5-point scale, with 0 being none, 1 being mild (1-25%), 2 being moderate (26-50%), 3 being marked (51-75%), and 4 being very significant (76-100%). At the final 3-month visit, patients were asked to rate their overall satisfaction with the treatment on a 5-point scale ranging from very dissatisfied (1) to very satisfied (5).
Dr. Geronemus presented results from 14 patients who had completed 3-month follow-up visits. These 14 women included 10 with melasma and 4 with postinflammatory hyperpigmentation. The mean age of the patients was 42 years, and 9 had Fitzpatrick skin types I-III.
The patients rated their pain as 3.25 out of 10, their overall pigment improvement as 3 out of 4, and their overall satisfaction with the procedure as a 4.33 out of 5, Dr. Geronemus reported. "This is often technique sensitive," he said of the procedure. "I’ll have physicians call me up and say, ‘I’m not getting any results.’ I think you need 10-12 passes to get the [optimal] results."
The most common side effect was erythema, which typically resolved within 1 day. Though the device is effective as monotherapy, Dr. Geronemus pointed out that it is "ideally suited for combination therapy with a mild hydroquinone."
Dr. Geronemus disclosed that he serves on the medical advisory boards for Zeltiq, Syneron/Candela, and Cynosure. He also serves as an investigator for numerous device and pharmaceutical companies, and he holds stock in Zeltiq and OnLight Sciences.
DANA POINT, CALIF. – Patients with melasma who underwent treatment with a new low-energy and low-density nonablative fractional 1,927-nm diode laser experienced significant reduction of hyperpigmentation with limited side effects, a single-center study demonstrated.
At a meeting sponsored by SkinCare Physicians and Northwestern University, Dr. Roy G. Geronemus discussed his experience treating patients with the FDA-cleared technology, which is known as the Clear + Brilliant Permea.
Dr. Geronemus of the Laser and Skin Surgery Center of New York noted that existing laser treatments have so far failed to yield a consistent and long-term reduction in pigmentation, especially in patients with darker skin types. "Many current [laser] treatments for melasma make the condition worse," he said "What we ideally need is something that will be helpful, will not make it worse, and that can be repeated, because [melasma] probably will recur over time."
In an ongoing prospective study, Dr. Geronemus and his associates evaluated the 1,927-nm diode laser in melasma patients with a hunch that it would improve pigmentation and appearance with an improved safety profile and overall treatment outcomes. They enrolled patients aged 18-65 years with Fitzpatrick skin types I-VI who had clinical evidence of melasma or postinflammatory hyperpigmentation. They excluded patients who were either pregnant, breast-feeding, contemplating pregnancy, or not using effective means of birth control, as well as those known to be hypersensitive to light exposure and those with a history of melanoma or nonmelanoma skin cancer, keloidal scarring, immunosuppression, or immune deficiency disorder. Images were taken at baseline, prior to each treatment, and at follow-up using the Canfield VISIA complexion analysis system.
Up to six treatments were performed every 2 weeks, Dr. Geronemus said, with spot sizes of 100-180 mcm, energy of 5 mJ, 5-7.5% treatment coverage, and an average of 4-12 passes.
The researchers asked patients to rate their pain after each treatment, as well as their overall improvement in pigmentation. Pain was assessed on an 11-point scale, with 0 being none and 10 being "intolerable." Pigmentation improvement was measured on a 5-point scale, with 0 being none, 1 being mild (1-25%), 2 being moderate (26-50%), 3 being marked (51-75%), and 4 being very significant (76-100%). At the final 3-month visit, patients were asked to rate their overall satisfaction with the treatment on a 5-point scale ranging from very dissatisfied (1) to very satisfied (5).
Dr. Geronemus presented results from 14 patients who had completed 3-month follow-up visits. These 14 women included 10 with melasma and 4 with postinflammatory hyperpigmentation. The mean age of the patients was 42 years, and 9 had Fitzpatrick skin types I-III.
The patients rated their pain as 3.25 out of 10, their overall pigment improvement as 3 out of 4, and their overall satisfaction with the procedure as a 4.33 out of 5, Dr. Geronemus reported. "This is often technique sensitive," he said of the procedure. "I’ll have physicians call me up and say, ‘I’m not getting any results.’ I think you need 10-12 passes to get the [optimal] results."
The most common side effect was erythema, which typically resolved within 1 day. Though the device is effective as monotherapy, Dr. Geronemus pointed out that it is "ideally suited for combination therapy with a mild hydroquinone."
Dr. Geronemus disclosed that he serves on the medical advisory boards for Zeltiq, Syneron/Candela, and Cynosure. He also serves as an investigator for numerous device and pharmaceutical companies, and he holds stock in Zeltiq and OnLight Sciences.
EXPERT ANALYSIS FROM CONTROVERSIES AND CONVERSATIONS IN LASER AND COSMETIC SURGERY
Lasers promising for onychomycosis treatment
DANA POINT, CALIF. – Lasers are playing a key role in the treatment of onychomycosis, with cure rates exceeding that of terbinafine in most cases, Dr. Jill S. Waibel said at a meeting sponsored by SkinCare Physicians and Northwestern University.
The development is welcome because currently approved treatment options are "suboptimal," said Dr. Waibel, a dermatologic surgeon with Miami (Fla.) Dermatology & Laser Institute. "There’s also a big need; 34% of diabetics have onychomycosis. They are at an increased risk of developing complications including foot ulcers and amputations. In addition, 50% of individuals over age 70 have onychomycosis. The market for treatment in the United States is $1.6 billion," she said.
All infectious agents can be killed by heat except prions, which makes laser therapy a promising option for onychomycosis, Dr. Waibel said. The mechanism of action is not fully understood, but she shared three hypotheses. The first is that water in the keratin of the nail absorbs the laser energy and creates nonspecific bulk heating, which denatures fungal organelles. The second hypothesis is that free radicals are created by the laser, and these kill the dermatophyte. The third hypothesis is that microscopic selective photothermolysis occurs in Trichophyton species that contain melanin in their cell walls. Microcavitation and acoustic shock waves are created, which decapsulate the spores. The mechanism of action "is probably a combination of all three," she speculated.
Before laser treatment, the patient’s toenails and the surrounding skin are cleaned, and photos are taken of the nails, Dr. Waibel said. The affected areas of nail are treated with randomly assigned laser or light wavelengths until a temperature of 46° C is reached.
"The thicker the nail, the more energy we put into it," Dr. Waibel said of the treatment. "For every 5° C increase in temperature, there is an exponential decrease in the time to cell death. When laser energy first strikes the nail bed, there is a rapid spike in temperature reaching the lower 60° C range," she explained. "If you’re at 60° C, it only takes about 6 seconds to kill the dermatophyte. At 70° C, that takes about 6 ms, so the lasers are getting to the temperature to kill the dermatophyte."
If the patient becomes uncomfortable, "We stop [the laser] and then return after a few seconds," Dr. Waibel said. "The average treatment time in my practice is 10 minutes. We give two to three treatments 1 week apart. The patients are very satisfied."
Post therapy, Dr. Waibel said she instructs patients to use antifungal spray in their shoes and to use fungal cream, "because you can get onychomycosis from having athlete’s foot." But, she added, "80% of toenail fungus comes from sleeping with your spouse. So if you treat the woman and you don’t treat the man, when they sleep at night and their toes touch, they’ll pass it back and forth."
In a prospective study conducted at the Dermatology & Laser Institute, 21 patients with positive dermatophytic periodic acid–Schiff (PAS) or positive cultures were randomly assigned to undergo treatment with one of three light source options: a 1,064-nm laser (at an energy fluence of 17 J/cm2, a pulse width of 0.3 ms, 5 pulses/sec, and a spot size of 3 mm); broadband light (with a SkinTyte filter delivered at 20° C for 30 seconds), or a 1,319-nm laser (at an energy fluence of 5 J/cm2, a pulse width of 10 ms, 5 pulses/sec, and a spot size of 3 mm). At 6 months’ follow-up, all but one patient in the 1,319-nm group was culture negative, "which is impressive," Dr. Waibel said. Oral terbinafine has a cure rate of only 50%, she noted.
In a separate retrospective study conducted at the center, 73 patients with onychomycosis were treated with the 1,064-nm laser with temperature feedback. Each patient completed three to four treatments 1 week apart. At 12 months’ follow-up, 67 patients were clear of infection, while 6 had a recurrent infection or had become newly infected. That’s still better than terbinafine, Dr. Waibel said.
She and her associates conducted a 12-month retrospective analysis of patients choosing therapy for positive culture/positive PAS during the year 2012. The patients were offered three treatment options: laser therapy, terbinafine, or no therapy. Nearly two-thirds (64%) chose laser, 20% chose terbinafine, and 16% chose no therapy.
Dr. Waibel disclosed that she is a speaker for and/or has received honoraria for equipment or clinical trials from numerous device and skin care product manufacturers.
DANA POINT, CALIF. – Lasers are playing a key role in the treatment of onychomycosis, with cure rates exceeding that of terbinafine in most cases, Dr. Jill S. Waibel said at a meeting sponsored by SkinCare Physicians and Northwestern University.
The development is welcome because currently approved treatment options are "suboptimal," said Dr. Waibel, a dermatologic surgeon with Miami (Fla.) Dermatology & Laser Institute. "There’s also a big need; 34% of diabetics have onychomycosis. They are at an increased risk of developing complications including foot ulcers and amputations. In addition, 50% of individuals over age 70 have onychomycosis. The market for treatment in the United States is $1.6 billion," she said.
All infectious agents can be killed by heat except prions, which makes laser therapy a promising option for onychomycosis, Dr. Waibel said. The mechanism of action is not fully understood, but she shared three hypotheses. The first is that water in the keratin of the nail absorbs the laser energy and creates nonspecific bulk heating, which denatures fungal organelles. The second hypothesis is that free radicals are created by the laser, and these kill the dermatophyte. The third hypothesis is that microscopic selective photothermolysis occurs in Trichophyton species that contain melanin in their cell walls. Microcavitation and acoustic shock waves are created, which decapsulate the spores. The mechanism of action "is probably a combination of all three," she speculated.
Before laser treatment, the patient’s toenails and the surrounding skin are cleaned, and photos are taken of the nails, Dr. Waibel said. The affected areas of nail are treated with randomly assigned laser or light wavelengths until a temperature of 46° C is reached.
"The thicker the nail, the more energy we put into it," Dr. Waibel said of the treatment. "For every 5° C increase in temperature, there is an exponential decrease in the time to cell death. When laser energy first strikes the nail bed, there is a rapid spike in temperature reaching the lower 60° C range," she explained. "If you’re at 60° C, it only takes about 6 seconds to kill the dermatophyte. At 70° C, that takes about 6 ms, so the lasers are getting to the temperature to kill the dermatophyte."
If the patient becomes uncomfortable, "We stop [the laser] and then return after a few seconds," Dr. Waibel said. "The average treatment time in my practice is 10 minutes. We give two to three treatments 1 week apart. The patients are very satisfied."
Post therapy, Dr. Waibel said she instructs patients to use antifungal spray in their shoes and to use fungal cream, "because you can get onychomycosis from having athlete’s foot." But, she added, "80% of toenail fungus comes from sleeping with your spouse. So if you treat the woman and you don’t treat the man, when they sleep at night and their toes touch, they’ll pass it back and forth."
In a prospective study conducted at the Dermatology & Laser Institute, 21 patients with positive dermatophytic periodic acid–Schiff (PAS) or positive cultures were randomly assigned to undergo treatment with one of three light source options: a 1,064-nm laser (at an energy fluence of 17 J/cm2, a pulse width of 0.3 ms, 5 pulses/sec, and a spot size of 3 mm); broadband light (with a SkinTyte filter delivered at 20° C for 30 seconds), or a 1,319-nm laser (at an energy fluence of 5 J/cm2, a pulse width of 10 ms, 5 pulses/sec, and a spot size of 3 mm). At 6 months’ follow-up, all but one patient in the 1,319-nm group was culture negative, "which is impressive," Dr. Waibel said. Oral terbinafine has a cure rate of only 50%, she noted.
In a separate retrospective study conducted at the center, 73 patients with onychomycosis were treated with the 1,064-nm laser with temperature feedback. Each patient completed three to four treatments 1 week apart. At 12 months’ follow-up, 67 patients were clear of infection, while 6 had a recurrent infection or had become newly infected. That’s still better than terbinafine, Dr. Waibel said.
She and her associates conducted a 12-month retrospective analysis of patients choosing therapy for positive culture/positive PAS during the year 2012. The patients were offered three treatment options: laser therapy, terbinafine, or no therapy. Nearly two-thirds (64%) chose laser, 20% chose terbinafine, and 16% chose no therapy.
Dr. Waibel disclosed that she is a speaker for and/or has received honoraria for equipment or clinical trials from numerous device and skin care product manufacturers.
DANA POINT, CALIF. – Lasers are playing a key role in the treatment of onychomycosis, with cure rates exceeding that of terbinafine in most cases, Dr. Jill S. Waibel said at a meeting sponsored by SkinCare Physicians and Northwestern University.
The development is welcome because currently approved treatment options are "suboptimal," said Dr. Waibel, a dermatologic surgeon with Miami (Fla.) Dermatology & Laser Institute. "There’s also a big need; 34% of diabetics have onychomycosis. They are at an increased risk of developing complications including foot ulcers and amputations. In addition, 50% of individuals over age 70 have onychomycosis. The market for treatment in the United States is $1.6 billion," she said.
All infectious agents can be killed by heat except prions, which makes laser therapy a promising option for onychomycosis, Dr. Waibel said. The mechanism of action is not fully understood, but she shared three hypotheses. The first is that water in the keratin of the nail absorbs the laser energy and creates nonspecific bulk heating, which denatures fungal organelles. The second hypothesis is that free radicals are created by the laser, and these kill the dermatophyte. The third hypothesis is that microscopic selective photothermolysis occurs in Trichophyton species that contain melanin in their cell walls. Microcavitation and acoustic shock waves are created, which decapsulate the spores. The mechanism of action "is probably a combination of all three," she speculated.
Before laser treatment, the patient’s toenails and the surrounding skin are cleaned, and photos are taken of the nails, Dr. Waibel said. The affected areas of nail are treated with randomly assigned laser or light wavelengths until a temperature of 46° C is reached.
"The thicker the nail, the more energy we put into it," Dr. Waibel said of the treatment. "For every 5° C increase in temperature, there is an exponential decrease in the time to cell death. When laser energy first strikes the nail bed, there is a rapid spike in temperature reaching the lower 60° C range," she explained. "If you’re at 60° C, it only takes about 6 seconds to kill the dermatophyte. At 70° C, that takes about 6 ms, so the lasers are getting to the temperature to kill the dermatophyte."
If the patient becomes uncomfortable, "We stop [the laser] and then return after a few seconds," Dr. Waibel said. "The average treatment time in my practice is 10 minutes. We give two to three treatments 1 week apart. The patients are very satisfied."
Post therapy, Dr. Waibel said she instructs patients to use antifungal spray in their shoes and to use fungal cream, "because you can get onychomycosis from having athlete’s foot." But, she added, "80% of toenail fungus comes from sleeping with your spouse. So if you treat the woman and you don’t treat the man, when they sleep at night and their toes touch, they’ll pass it back and forth."
In a prospective study conducted at the Dermatology & Laser Institute, 21 patients with positive dermatophytic periodic acid–Schiff (PAS) or positive cultures were randomly assigned to undergo treatment with one of three light source options: a 1,064-nm laser (at an energy fluence of 17 J/cm2, a pulse width of 0.3 ms, 5 pulses/sec, and a spot size of 3 mm); broadband light (with a SkinTyte filter delivered at 20° C for 30 seconds), or a 1,319-nm laser (at an energy fluence of 5 J/cm2, a pulse width of 10 ms, 5 pulses/sec, and a spot size of 3 mm). At 6 months’ follow-up, all but one patient in the 1,319-nm group was culture negative, "which is impressive," Dr. Waibel said. Oral terbinafine has a cure rate of only 50%, she noted.
In a separate retrospective study conducted at the center, 73 patients with onychomycosis were treated with the 1,064-nm laser with temperature feedback. Each patient completed three to four treatments 1 week apart. At 12 months’ follow-up, 67 patients were clear of infection, while 6 had a recurrent infection or had become newly infected. That’s still better than terbinafine, Dr. Waibel said.
She and her associates conducted a 12-month retrospective analysis of patients choosing therapy for positive culture/positive PAS during the year 2012. The patients were offered three treatment options: laser therapy, terbinafine, or no therapy. Nearly two-thirds (64%) chose laser, 20% chose terbinafine, and 16% chose no therapy.
Dr. Waibel disclosed that she is a speaker for and/or has received honoraria for equipment or clinical trials from numerous device and skin care product manufacturers.
EXPERT ANALYSIS FROM CONTROVERSIES AND CONVERSATIONS IN LASER AND COSMETIC SURGERY
Multiple same-day laser treatment may be effective for unwanted tattoos
DANA POINT, CALIF. – When it comes to removing unwanted tattoos with lasers, repetitive treatments on the same day appear to expedite tattoo clearance compared with a single treatment, a small study has shown.
Dr. Suzanne L. Kilmer discussed results from a study that she conducted with her associate, Dr. Omar Ibrahimi, that examined the effect of repetitive laser treatments on 17 patients who had a total of 26 tattoos among them. Of the 26 tattoos, 15 were divided into a grid that received one, two, three, or four laser treatments on the same day, while the remaining 17 were bisected and received one or four treatments in the same day, she said at a meeting sponsored by SkinCare Physicians and Northwestern University.
The researchers performed the treatments with a 755-nm Q-switched alexandrite laser or with a 532-nm and 1,064-nm Nd:YAG laser. Patients who underwent multiple treatments waited a minimum of 20 minutes between treatment sessions.
Dr. Kilmer, who heads a laser and skin surgery group practice in Sacramento, reported that lesion clearance on tattoos that had undergone multiple treatments on the same day "was clearly better" than on those receiving a single treatment on the same day. For example, at 1-month follow-up, the clearance rate jumped from 36% with one treatment to 50% for two same-day treatments, but the improvement was less pronounced with same-day treatments four and five (55%, and 59%, respectively).
Patients noted increased swelling with multiple same-day treatments "but there was no increase in pain," said Dr. Kilmer. "In fact, most felt less pain with subsequent treatments. There was no difference in post-inflammatory hyperpigmentation, and no scarring was noted. All patients preferred more rapid clearance of tattoos."
Dr. Kilmer said that the clearance of Cynosure’s PicoSure 750-nm picosecond aesthetic laser in 2012 represented an important advance in tattoo treatment. Its shorter pulse duration "shatters" the target ink into tiny particles, she said. In her clinical experience the PicoSure is especially effective for resistant tattoos – often with as few as two treatments though it makes less of a dent in red ink tattoos. "Colors matter," Dr. Kilmer noted. "We thought that the PicoSure would make color indifferent, but it doesn’t. We still need red light for green ink and green light for red ink."
Dr. Kilmer disclosed that she is a member of the medical advisory board for Candela-Syneron, Living Proof, Lumenis, Miramar, Ulthera, and Zeltiq. She also has received research support from Allergan and from numerous device companies.
DANA POINT, CALIF. – When it comes to removing unwanted tattoos with lasers, repetitive treatments on the same day appear to expedite tattoo clearance compared with a single treatment, a small study has shown.
Dr. Suzanne L. Kilmer discussed results from a study that she conducted with her associate, Dr. Omar Ibrahimi, that examined the effect of repetitive laser treatments on 17 patients who had a total of 26 tattoos among them. Of the 26 tattoos, 15 were divided into a grid that received one, two, three, or four laser treatments on the same day, while the remaining 17 were bisected and received one or four treatments in the same day, she said at a meeting sponsored by SkinCare Physicians and Northwestern University.
The researchers performed the treatments with a 755-nm Q-switched alexandrite laser or with a 532-nm and 1,064-nm Nd:YAG laser. Patients who underwent multiple treatments waited a minimum of 20 minutes between treatment sessions.
Dr. Kilmer, who heads a laser and skin surgery group practice in Sacramento, reported that lesion clearance on tattoos that had undergone multiple treatments on the same day "was clearly better" than on those receiving a single treatment on the same day. For example, at 1-month follow-up, the clearance rate jumped from 36% with one treatment to 50% for two same-day treatments, but the improvement was less pronounced with same-day treatments four and five (55%, and 59%, respectively).
Patients noted increased swelling with multiple same-day treatments "but there was no increase in pain," said Dr. Kilmer. "In fact, most felt less pain with subsequent treatments. There was no difference in post-inflammatory hyperpigmentation, and no scarring was noted. All patients preferred more rapid clearance of tattoos."
Dr. Kilmer said that the clearance of Cynosure’s PicoSure 750-nm picosecond aesthetic laser in 2012 represented an important advance in tattoo treatment. Its shorter pulse duration "shatters" the target ink into tiny particles, she said. In her clinical experience the PicoSure is especially effective for resistant tattoos – often with as few as two treatments though it makes less of a dent in red ink tattoos. "Colors matter," Dr. Kilmer noted. "We thought that the PicoSure would make color indifferent, but it doesn’t. We still need red light for green ink and green light for red ink."
Dr. Kilmer disclosed that she is a member of the medical advisory board for Candela-Syneron, Living Proof, Lumenis, Miramar, Ulthera, and Zeltiq. She also has received research support from Allergan and from numerous device companies.
DANA POINT, CALIF. – When it comes to removing unwanted tattoos with lasers, repetitive treatments on the same day appear to expedite tattoo clearance compared with a single treatment, a small study has shown.
Dr. Suzanne L. Kilmer discussed results from a study that she conducted with her associate, Dr. Omar Ibrahimi, that examined the effect of repetitive laser treatments on 17 patients who had a total of 26 tattoos among them. Of the 26 tattoos, 15 were divided into a grid that received one, two, three, or four laser treatments on the same day, while the remaining 17 were bisected and received one or four treatments in the same day, she said at a meeting sponsored by SkinCare Physicians and Northwestern University.
The researchers performed the treatments with a 755-nm Q-switched alexandrite laser or with a 532-nm and 1,064-nm Nd:YAG laser. Patients who underwent multiple treatments waited a minimum of 20 minutes between treatment sessions.
Dr. Kilmer, who heads a laser and skin surgery group practice in Sacramento, reported that lesion clearance on tattoos that had undergone multiple treatments on the same day "was clearly better" than on those receiving a single treatment on the same day. For example, at 1-month follow-up, the clearance rate jumped from 36% with one treatment to 50% for two same-day treatments, but the improvement was less pronounced with same-day treatments four and five (55%, and 59%, respectively).
Patients noted increased swelling with multiple same-day treatments "but there was no increase in pain," said Dr. Kilmer. "In fact, most felt less pain with subsequent treatments. There was no difference in post-inflammatory hyperpigmentation, and no scarring was noted. All patients preferred more rapid clearance of tattoos."
Dr. Kilmer said that the clearance of Cynosure’s PicoSure 750-nm picosecond aesthetic laser in 2012 represented an important advance in tattoo treatment. Its shorter pulse duration "shatters" the target ink into tiny particles, she said. In her clinical experience the PicoSure is especially effective for resistant tattoos – often with as few as two treatments though it makes less of a dent in red ink tattoos. "Colors matter," Dr. Kilmer noted. "We thought that the PicoSure would make color indifferent, but it doesn’t. We still need red light for green ink and green light for red ink."
Dr. Kilmer disclosed that she is a member of the medical advisory board for Candela-Syneron, Living Proof, Lumenis, Miramar, Ulthera, and Zeltiq. She also has received research support from Allergan and from numerous device companies.
AT CONTROVERSIES AND CONVERSATIONS IN LASER AND COSMETIC SURGERY
Body contouring procedures find their groove
DANA POINT, CALIF. – The market for nonsurgical body contouring has "settled into a rhythm," and increasing numbers of patients accept the fact that these technologies work, in the opinion of Dr. Michael S. Kaminer.
However, the evolution of technology in the realm of nonsurgical body contouring has slowed. "The absence of technology evolution will allow low-cost providers to gain market share," Dr. Kaminer said at a meeting sponsored by SkinCare Physicians and Northwestern University.
"It’s essential for us to brand these procedures as requiring skillful assessment and contouring expertise. In the short term, it may be more important for us to focus on superior results with current technology rather than trying to win the technology arms race. Advances in technology will help, but are they coming? Maybe it’s time to focus on getting better results with what we already own."
According to the results of a 2011 survey of American Society for Dermatologic Surgery members, noninvasive treatment of fat and cellulite was the most common body sculpting procedure, with 74,000 procedures noted. Cryolipolysis accounted for 12% of body sculpting treatments with a total of 55,500 procedures, followed by tumescent liposuction with 18,500 procedures.
"The bottom line is that our noninvasive procedures are far outstripping liposuction," said Dr. Kaminer, a managing partner at SkinCare Physicians, Chestnut Hill, Mass. "Because of this, patients and physicians are shifting their focus to noninvasive methods for fat removal. But they are also starting to expect more. I think that’s where our opportunity is. If we don’t advance the technology, it has the potential to go the route of laser hair removal, with competition based on price and convenience rather than on science and outcomes."
He went on to discuss ways to optimize outcomes with the existing technology cleared for body contouring. With cryolipolysis (CoolSculpting), for example, combining massage with the procedure has been shown to improve outcomes by as much as 60%, compared with patients who did not undergo concomitant massage.
Dr. Kaminer’s additional tips for cryolipolysis included performing multiple cycles over time for more complete fat removal and shape change, and learning how to use and optimize different applicators. "There are many of them, which is frustrating, but if you learn how to use the different applicators effectively you will get better body sculpting results," said Dr. Kaminer, who also serves as an associate clinical professor of dermatology at Yale University, New Haven, Conn. To that end, consider treating the inner and outer thighs with different applicators. Vertical placement of the flat applicator works well on inner thighs, he said, while the curved applicator works well on outer thighs.
When using ultrasound (Liposonix) for body sculpting, stacked pulses at lower fluences yield results similar to those of nonstacked pulses at high fluences, "but improve comfort for the patient," he said.
In Dr. Kaminer’s clinical experience, patients are satisfied with 40%-50% fat removal after 1-2 treatments with CoolSculpting and Liposonix. Workflow, staffing, patient pain, and time per treatment differ for each device. "Multiple procedures have the potential to give liposuction-like results," he noted. "To me, that’s where we should focus as a specialty. Also, should we focus more on the final shape rather than on how much fat we’re removing? This will differentiate us from spalike providers."
Dr. Kaminer disclosed that he is a consultant for and has received research funding from Zeltiq and Solta Medical.
DANA POINT, CALIF. – The market for nonsurgical body contouring has "settled into a rhythm," and increasing numbers of patients accept the fact that these technologies work, in the opinion of Dr. Michael S. Kaminer.
However, the evolution of technology in the realm of nonsurgical body contouring has slowed. "The absence of technology evolution will allow low-cost providers to gain market share," Dr. Kaminer said at a meeting sponsored by SkinCare Physicians and Northwestern University.
"It’s essential for us to brand these procedures as requiring skillful assessment and contouring expertise. In the short term, it may be more important for us to focus on superior results with current technology rather than trying to win the technology arms race. Advances in technology will help, but are they coming? Maybe it’s time to focus on getting better results with what we already own."
According to the results of a 2011 survey of American Society for Dermatologic Surgery members, noninvasive treatment of fat and cellulite was the most common body sculpting procedure, with 74,000 procedures noted. Cryolipolysis accounted for 12% of body sculpting treatments with a total of 55,500 procedures, followed by tumescent liposuction with 18,500 procedures.
"The bottom line is that our noninvasive procedures are far outstripping liposuction," said Dr. Kaminer, a managing partner at SkinCare Physicians, Chestnut Hill, Mass. "Because of this, patients and physicians are shifting their focus to noninvasive methods for fat removal. But they are also starting to expect more. I think that’s where our opportunity is. If we don’t advance the technology, it has the potential to go the route of laser hair removal, with competition based on price and convenience rather than on science and outcomes."
He went on to discuss ways to optimize outcomes with the existing technology cleared for body contouring. With cryolipolysis (CoolSculpting), for example, combining massage with the procedure has been shown to improve outcomes by as much as 60%, compared with patients who did not undergo concomitant massage.
Dr. Kaminer’s additional tips for cryolipolysis included performing multiple cycles over time for more complete fat removal and shape change, and learning how to use and optimize different applicators. "There are many of them, which is frustrating, but if you learn how to use the different applicators effectively you will get better body sculpting results," said Dr. Kaminer, who also serves as an associate clinical professor of dermatology at Yale University, New Haven, Conn. To that end, consider treating the inner and outer thighs with different applicators. Vertical placement of the flat applicator works well on inner thighs, he said, while the curved applicator works well on outer thighs.
When using ultrasound (Liposonix) for body sculpting, stacked pulses at lower fluences yield results similar to those of nonstacked pulses at high fluences, "but improve comfort for the patient," he said.
In Dr. Kaminer’s clinical experience, patients are satisfied with 40%-50% fat removal after 1-2 treatments with CoolSculpting and Liposonix. Workflow, staffing, patient pain, and time per treatment differ for each device. "Multiple procedures have the potential to give liposuction-like results," he noted. "To me, that’s where we should focus as a specialty. Also, should we focus more on the final shape rather than on how much fat we’re removing? This will differentiate us from spalike providers."
Dr. Kaminer disclosed that he is a consultant for and has received research funding from Zeltiq and Solta Medical.
DANA POINT, CALIF. – The market for nonsurgical body contouring has "settled into a rhythm," and increasing numbers of patients accept the fact that these technologies work, in the opinion of Dr. Michael S. Kaminer.
However, the evolution of technology in the realm of nonsurgical body contouring has slowed. "The absence of technology evolution will allow low-cost providers to gain market share," Dr. Kaminer said at a meeting sponsored by SkinCare Physicians and Northwestern University.
"It’s essential for us to brand these procedures as requiring skillful assessment and contouring expertise. In the short term, it may be more important for us to focus on superior results with current technology rather than trying to win the technology arms race. Advances in technology will help, but are they coming? Maybe it’s time to focus on getting better results with what we already own."
According to the results of a 2011 survey of American Society for Dermatologic Surgery members, noninvasive treatment of fat and cellulite was the most common body sculpting procedure, with 74,000 procedures noted. Cryolipolysis accounted for 12% of body sculpting treatments with a total of 55,500 procedures, followed by tumescent liposuction with 18,500 procedures.
"The bottom line is that our noninvasive procedures are far outstripping liposuction," said Dr. Kaminer, a managing partner at SkinCare Physicians, Chestnut Hill, Mass. "Because of this, patients and physicians are shifting their focus to noninvasive methods for fat removal. But they are also starting to expect more. I think that’s where our opportunity is. If we don’t advance the technology, it has the potential to go the route of laser hair removal, with competition based on price and convenience rather than on science and outcomes."
He went on to discuss ways to optimize outcomes with the existing technology cleared for body contouring. With cryolipolysis (CoolSculpting), for example, combining massage with the procedure has been shown to improve outcomes by as much as 60%, compared with patients who did not undergo concomitant massage.
Dr. Kaminer’s additional tips for cryolipolysis included performing multiple cycles over time for more complete fat removal and shape change, and learning how to use and optimize different applicators. "There are many of them, which is frustrating, but if you learn how to use the different applicators effectively you will get better body sculpting results," said Dr. Kaminer, who also serves as an associate clinical professor of dermatology at Yale University, New Haven, Conn. To that end, consider treating the inner and outer thighs with different applicators. Vertical placement of the flat applicator works well on inner thighs, he said, while the curved applicator works well on outer thighs.
When using ultrasound (Liposonix) for body sculpting, stacked pulses at lower fluences yield results similar to those of nonstacked pulses at high fluences, "but improve comfort for the patient," he said.
In Dr. Kaminer’s clinical experience, patients are satisfied with 40%-50% fat removal after 1-2 treatments with CoolSculpting and Liposonix. Workflow, staffing, patient pain, and time per treatment differ for each device. "Multiple procedures have the potential to give liposuction-like results," he noted. "To me, that’s where we should focus as a specialty. Also, should we focus more on the final shape rather than on how much fat we’re removing? This will differentiate us from spalike providers."
Dr. Kaminer disclosed that he is a consultant for and has received research funding from Zeltiq and Solta Medical.
EXPERT ANALYSIS FROM CONTROVERSIES AND CONVERSATIONS IN LASER AND COSMETIC SURGERY
