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Skin of Color: What Every Dark Skinned Patient Should Know
Many blogs, articles, and tip sheets offer suggestions for keeping skin youthful and breakout free. But often the advice doesn’t apply to all skin types. Below are nine skin care tips modified for darker skin that you can share with your patients.
1. Don’t over wash.
Washing the face once a day to remove makeup, dirt, and bacteria can be helpful to avoid breakouts, especially in acne prone skin. However, it is important to remind patients to avoid over washing, as this may dry out the skin causing increased irritation, and may even cause wrinkles to look more prominent.
Sebum production decreases with age, especially after menopause in women. It may also be decreased in black patients, compared with white patients, as shown in a recent study (Cutis 2004;73:392-396), although the data were not statistically significant.
Patients should exercise caution when applying antiaging products after washing because washing allows antiagers to penetrate deeper, leading to faster results in most skin types, but may also lead to increased irritation and then postinflammatory hyperpigmentation in darker skin.
Gentle cleansers are best, unless the skin is especially acne prone. In this case, anti-acne cleansers with ingredients like salicylic acid, benzoyl peroxide, or glycolic acid may be useful. To refresh skin, a splash of lukewarm water should do.
2. Apply products with a lower pH.
Studies have shown pH to be lower in darker skin, compared with lighter skin. For darker skin, products that are slightly acidic, such as those that contain mild glycolic acid, can help maintain the skin’s pH balance and maintain homeostasis and barrier integrity.
3. Be UV obsessed.
While the epidermis of darker skin contains more melanin content and has increased melanosomal dispersion than lighter skin—providing increased protection against UV-induced skin cancers and photoaging—UV damage can still occur.
Many patients with darker skin feel they are immune to skin cancer. Patients with darker skin, while diagnosed less frequently with melanoma, die at an increased frequency from the disease because of later diagnosis. Using a sunscreen that is SPF 30 or higher that blocks both UVA and UVB wavelengths is essential.
Patients should be reminded that nothing is more important than wearing sunscreen every day to promote younger-looking skin and prevent skin cancer.
Sunscreens, especially those with a higher SPF, often do not rub in well on darker skin. Using a sunscreen with chemical blockers, or micronized physical blockers (zinc and titanium dioxide), may go on less chalky and rub in more smoothly.
Sun exposure in darker skin also leads to prolonged postinflammatory hyperpigmentation after any skin insult. Even 10 minutes of daily exposure to UVA can cause changes that lead to wrinkles and sunspots in as few as 12 weeks.
Also, advise patients to eat foods that are rich in vitamin D to avoid deficiency.
4. Manage stress.
Emotional upheavals can make a patient’s skin look 5 years older than his or her chronological age. Constant anxiety increases the stress hormone cortisol, which causes inflammation that breaks down collagen. It also triggers a chain of responses that can lead to facial redness and acne flare-ups. To quell inflammation, advise patients to eat antioxidant-rich foods such as berries, oranges, and asparagus.
5. Use a retinoid.
Vitamin A derivatives, such as topical retinoids, speed cell turnover and collagen growth to smooth fine lines and wrinkles and fade brown spots. Prescription-strength retinoids provide the fastest results—your patient should start to see changes in about a month.
To help skin adjust to any redness or peeling, advise patients to apply a pea-size drop to the face every third night, building up to nightly use. Milder over-the-counter versions are gentler, although it can take up to 3 months for users to see noticeable results.
Redness and peeling should absolutely be avoided in darker skin to avoid postinflammatory hyperpigmentation, so retinoids, while helpful, should be used cautiously.
6. Update your routine.
Advising patients to alter just one thing in their regimen every 6-12 months jump starts more impressive improvements in tone and texture. When products are applied consistently, skin slides into maintenance mode after about a year. To keep skin primed for rejuvenation, tell patients to substitute a cream that contains alpha hydroxy acids in place of a retinoid twice a week to boost benefits. Or, you can bump up the patient’s OTC retinoid to a prescription product.
7. Eat omega-3 fats.
These “good fats,” found in foods such as salmon, flaxseed, and almonds, boost hydration, which keeps skin supple and firm. The same is not true, however, of the saturated fat in dairy products and meats, which increase free-radical damage that makes skin more susceptible to aging. Advise patients to limit their intake of saturated fat to about 17 g per day.
8. Exercise regularly.
Studies find that women who work out regularly have firmer skin than non-exercisers. The reason: Exercise infuses skin with oxygen and nutrients needed for collagen production. Patients who aim to keep skin toned should make time for at least three, 30-minute, heart-pumping workouts per week.
9. Wash your hair.
Curly hair cannot be washed as often as straight hair because it dries out more readily. However, decreased hair washing leads to increased scalp sebum production, which can lead to increased breakouts.
If hair cannot be washed, patients should wrap their hair at night so it does not touch the face, and they should change their pillow cases frequently. In addition, many persons of African descent apply oils and pomades to their hair to keep it soft and manageable. Here, hair wrapping or increased washing is also essential to avoid “pomade acne.”
Many blogs, articles, and tip sheets offer suggestions for keeping skin youthful and breakout free. But often the advice doesn’t apply to all skin types. Below are nine skin care tips modified for darker skin that you can share with your patients.
1. Don’t over wash.
Washing the face once a day to remove makeup, dirt, and bacteria can be helpful to avoid breakouts, especially in acne prone skin. However, it is important to remind patients to avoid over washing, as this may dry out the skin causing increased irritation, and may even cause wrinkles to look more prominent.
Sebum production decreases with age, especially after menopause in women. It may also be decreased in black patients, compared with white patients, as shown in a recent study (Cutis 2004;73:392-396), although the data were not statistically significant.
Patients should exercise caution when applying antiaging products after washing because washing allows antiagers to penetrate deeper, leading to faster results in most skin types, but may also lead to increased irritation and then postinflammatory hyperpigmentation in darker skin.
Gentle cleansers are best, unless the skin is especially acne prone. In this case, anti-acne cleansers with ingredients like salicylic acid, benzoyl peroxide, or glycolic acid may be useful. To refresh skin, a splash of lukewarm water should do.
2. Apply products with a lower pH.
Studies have shown pH to be lower in darker skin, compared with lighter skin. For darker skin, products that are slightly acidic, such as those that contain mild glycolic acid, can help maintain the skin’s pH balance and maintain homeostasis and barrier integrity.
3. Be UV obsessed.
While the epidermis of darker skin contains more melanin content and has increased melanosomal dispersion than lighter skin—providing increased protection against UV-induced skin cancers and photoaging—UV damage can still occur.
Many patients with darker skin feel they are immune to skin cancer. Patients with darker skin, while diagnosed less frequently with melanoma, die at an increased frequency from the disease because of later diagnosis. Using a sunscreen that is SPF 30 or higher that blocks both UVA and UVB wavelengths is essential.
Patients should be reminded that nothing is more important than wearing sunscreen every day to promote younger-looking skin and prevent skin cancer.
Sunscreens, especially those with a higher SPF, often do not rub in well on darker skin. Using a sunscreen with chemical blockers, or micronized physical blockers (zinc and titanium dioxide), may go on less chalky and rub in more smoothly.
Sun exposure in darker skin also leads to prolonged postinflammatory hyperpigmentation after any skin insult. Even 10 minutes of daily exposure to UVA can cause changes that lead to wrinkles and sunspots in as few as 12 weeks.
Also, advise patients to eat foods that are rich in vitamin D to avoid deficiency.
4. Manage stress.
Emotional upheavals can make a patient’s skin look 5 years older than his or her chronological age. Constant anxiety increases the stress hormone cortisol, which causes inflammation that breaks down collagen. It also triggers a chain of responses that can lead to facial redness and acne flare-ups. To quell inflammation, advise patients to eat antioxidant-rich foods such as berries, oranges, and asparagus.
5. Use a retinoid.
Vitamin A derivatives, such as topical retinoids, speed cell turnover and collagen growth to smooth fine lines and wrinkles and fade brown spots. Prescription-strength retinoids provide the fastest results—your patient should start to see changes in about a month.
To help skin adjust to any redness or peeling, advise patients to apply a pea-size drop to the face every third night, building up to nightly use. Milder over-the-counter versions are gentler, although it can take up to 3 months for users to see noticeable results.
Redness and peeling should absolutely be avoided in darker skin to avoid postinflammatory hyperpigmentation, so retinoids, while helpful, should be used cautiously.
6. Update your routine.
Advising patients to alter just one thing in their regimen every 6-12 months jump starts more impressive improvements in tone and texture. When products are applied consistently, skin slides into maintenance mode after about a year. To keep skin primed for rejuvenation, tell patients to substitute a cream that contains alpha hydroxy acids in place of a retinoid twice a week to boost benefits. Or, you can bump up the patient’s OTC retinoid to a prescription product.
7. Eat omega-3 fats.
These “good fats,” found in foods such as salmon, flaxseed, and almonds, boost hydration, which keeps skin supple and firm. The same is not true, however, of the saturated fat in dairy products and meats, which increase free-radical damage that makes skin more susceptible to aging. Advise patients to limit their intake of saturated fat to about 17 g per day.
8. Exercise regularly.
Studies find that women who work out regularly have firmer skin than non-exercisers. The reason: Exercise infuses skin with oxygen and nutrients needed for collagen production. Patients who aim to keep skin toned should make time for at least three, 30-minute, heart-pumping workouts per week.
9. Wash your hair.
Curly hair cannot be washed as often as straight hair because it dries out more readily. However, decreased hair washing leads to increased scalp sebum production, which can lead to increased breakouts.
If hair cannot be washed, patients should wrap their hair at night so it does not touch the face, and they should change their pillow cases frequently. In addition, many persons of African descent apply oils and pomades to their hair to keep it soft and manageable. Here, hair wrapping or increased washing is also essential to avoid “pomade acne.”
Many blogs, articles, and tip sheets offer suggestions for keeping skin youthful and breakout free. But often the advice doesn’t apply to all skin types. Below are nine skin care tips modified for darker skin that you can share with your patients.
1. Don’t over wash.
Washing the face once a day to remove makeup, dirt, and bacteria can be helpful to avoid breakouts, especially in acne prone skin. However, it is important to remind patients to avoid over washing, as this may dry out the skin causing increased irritation, and may even cause wrinkles to look more prominent.
Sebum production decreases with age, especially after menopause in women. It may also be decreased in black patients, compared with white patients, as shown in a recent study (Cutis 2004;73:392-396), although the data were not statistically significant.
Patients should exercise caution when applying antiaging products after washing because washing allows antiagers to penetrate deeper, leading to faster results in most skin types, but may also lead to increased irritation and then postinflammatory hyperpigmentation in darker skin.
Gentle cleansers are best, unless the skin is especially acne prone. In this case, anti-acne cleansers with ingredients like salicylic acid, benzoyl peroxide, or glycolic acid may be useful. To refresh skin, a splash of lukewarm water should do.
2. Apply products with a lower pH.
Studies have shown pH to be lower in darker skin, compared with lighter skin. For darker skin, products that are slightly acidic, such as those that contain mild glycolic acid, can help maintain the skin’s pH balance and maintain homeostasis and barrier integrity.
3. Be UV obsessed.
While the epidermis of darker skin contains more melanin content and has increased melanosomal dispersion than lighter skin—providing increased protection against UV-induced skin cancers and photoaging—UV damage can still occur.
Many patients with darker skin feel they are immune to skin cancer. Patients with darker skin, while diagnosed less frequently with melanoma, die at an increased frequency from the disease because of later diagnosis. Using a sunscreen that is SPF 30 or higher that blocks both UVA and UVB wavelengths is essential.
Patients should be reminded that nothing is more important than wearing sunscreen every day to promote younger-looking skin and prevent skin cancer.
Sunscreens, especially those with a higher SPF, often do not rub in well on darker skin. Using a sunscreen with chemical blockers, or micronized physical blockers (zinc and titanium dioxide), may go on less chalky and rub in more smoothly.
Sun exposure in darker skin also leads to prolonged postinflammatory hyperpigmentation after any skin insult. Even 10 minutes of daily exposure to UVA can cause changes that lead to wrinkles and sunspots in as few as 12 weeks.
Also, advise patients to eat foods that are rich in vitamin D to avoid deficiency.
4. Manage stress.
Emotional upheavals can make a patient’s skin look 5 years older than his or her chronological age. Constant anxiety increases the stress hormone cortisol, which causes inflammation that breaks down collagen. It also triggers a chain of responses that can lead to facial redness and acne flare-ups. To quell inflammation, advise patients to eat antioxidant-rich foods such as berries, oranges, and asparagus.
5. Use a retinoid.
Vitamin A derivatives, such as topical retinoids, speed cell turnover and collagen growth to smooth fine lines and wrinkles and fade brown spots. Prescription-strength retinoids provide the fastest results—your patient should start to see changes in about a month.
To help skin adjust to any redness or peeling, advise patients to apply a pea-size drop to the face every third night, building up to nightly use. Milder over-the-counter versions are gentler, although it can take up to 3 months for users to see noticeable results.
Redness and peeling should absolutely be avoided in darker skin to avoid postinflammatory hyperpigmentation, so retinoids, while helpful, should be used cautiously.
6. Update your routine.
Advising patients to alter just one thing in their regimen every 6-12 months jump starts more impressive improvements in tone and texture. When products are applied consistently, skin slides into maintenance mode after about a year. To keep skin primed for rejuvenation, tell patients to substitute a cream that contains alpha hydroxy acids in place of a retinoid twice a week to boost benefits. Or, you can bump up the patient’s OTC retinoid to a prescription product.
7. Eat omega-3 fats.
These “good fats,” found in foods such as salmon, flaxseed, and almonds, boost hydration, which keeps skin supple and firm. The same is not true, however, of the saturated fat in dairy products and meats, which increase free-radical damage that makes skin more susceptible to aging. Advise patients to limit their intake of saturated fat to about 17 g per day.
8. Exercise regularly.
Studies find that women who work out regularly have firmer skin than non-exercisers. The reason: Exercise infuses skin with oxygen and nutrients needed for collagen production. Patients who aim to keep skin toned should make time for at least three, 30-minute, heart-pumping workouts per week.
9. Wash your hair.
Curly hair cannot be washed as often as straight hair because it dries out more readily. However, decreased hair washing leads to increased scalp sebum production, which can lead to increased breakouts.
If hair cannot be washed, patients should wrap their hair at night so it does not touch the face, and they should change their pillow cases frequently. In addition, many persons of African descent apply oils and pomades to their hair to keep it soft and manageable. Here, hair wrapping or increased washing is also essential to avoid “pomade acne.”
Expertise Crucial in Filler Correction
NAPLES, Fla. - Dermatologists know best how to prevent and to correct facial filler complications, compared with medi-spa aestheticians and other employees, Dr. Oscar Hevia said.
“Our ability to identify, treat, and correct our complications [is what will set us apart]. It’s all about experience,” Dr. Hevia said at the meeting.
Some complications are more specific to particular filler types or products, whereas others can occur regardless of which agent is chosen to enhance the forehead, infraorbital area, or the nasolabial folds, for example. Appropriate expertise goes beyond recognition of early complications in the first 2 weeks, to include late complications (that arise within 1 year), and delayed complications thereafter.
“Forehead contouring is not an area we normally think about with fillers. [However,] you can get a nice correction in someone who might have brow ptosis if you used a toxin,” said Dr. Hevia, who is in private practice in Miami and on the faculty in the department of dermatology and cutaneous surgery at the University of Miami Leonard M. Miller School of Medicine.
“Looking at the eyes, the superior temporal rim is important too. Take away any bony landmarks around the eyes,” he said.
More commonly, patients will ask dermatologists to improve their infraorbital hollows. Injection of fillers to replace lost volume below the eyes is part of his restorative approach to the face, Dr. Hevia said. “Much of the early aging in patients is really around the eyes. You are taking someone from worn or tired ... to looking their best.” Calcium hydroxyapatite (Radiesse, BioForm Medical Inc.) and polydimethylsiloxane (Silikon 1000, Alcon Laboratories) are options for filling the infraorbital area.
Along with these techniques comes the potential for complications. For example, it is easy to overcorrect with calcium hydroxyapatite injections under the eyes, Dr. Hevia said. “You really should use a half-inch 30-G needle, small volumes, a little at a time, and you will do fine.” A yellowish discoloration after this product is injected into thin skin, such as under the eyes, is another specific potential complication, he added.
Bruising, tenderness, erythema, and vascular compromise are nonspecific complications, or events not associated with a specific filler product or type.
“Bruising is part of life. You are going to see it, especially when you inject around the eye,” Dr. Hevia said. If postprocedure bruising is superficial, you can treat it with lasers, he added.
Caution with infraorbital injections also is warranted when a patient has visible malar mounds. Injection of any filler into the compartmentalized fat pads under the eyes might exacerbate them, Dr. Hevia said. Infraorbital edema is another nonspecific complication in this anatomic area.
Hematoma and vascular compromises are other adverse events not necessarily associated with any particular facial filler product.
There also are more specific sequelae. For example, incorrect injection of polydimethylsiloxane can cause delayed overcorrection of nasolabial folds, rhytids, or acne scars. Dr. Hevia cited one patient, for example, with facial acne scars who developed protruding bumps on her skin. Placement of this filler too superficially is usually to blame.
Granuloma is another complication associated with some filler products more than others, Dr. Hevia said. “What we see in Miami is a ‘biopolymer’ granulomatous response.” Some patients get biopolymer injections at a medi-spa and then present to Dr. Hevia with delayed overcorrections, such as around their upper lip.
Late- or delayed-onset granuloma also can occur with poly-l-lactic acid injections, Dr. Hevia said. “In some patients, this can arise more than a year later.”
Disclosures: Dr. Hevia said he had no relevant financial disclosures.
NAPLES, Fla. - Dermatologists know best how to prevent and to correct facial filler complications, compared with medi-spa aestheticians and other employees, Dr. Oscar Hevia said.
“Our ability to identify, treat, and correct our complications [is what will set us apart]. It’s all about experience,” Dr. Hevia said at the meeting.
Some complications are more specific to particular filler types or products, whereas others can occur regardless of which agent is chosen to enhance the forehead, infraorbital area, or the nasolabial folds, for example. Appropriate expertise goes beyond recognition of early complications in the first 2 weeks, to include late complications (that arise within 1 year), and delayed complications thereafter.
“Forehead contouring is not an area we normally think about with fillers. [However,] you can get a nice correction in someone who might have brow ptosis if you used a toxin,” said Dr. Hevia, who is in private practice in Miami and on the faculty in the department of dermatology and cutaneous surgery at the University of Miami Leonard M. Miller School of Medicine.
“Looking at the eyes, the superior temporal rim is important too. Take away any bony landmarks around the eyes,” he said.
More commonly, patients will ask dermatologists to improve their infraorbital hollows. Injection of fillers to replace lost volume below the eyes is part of his restorative approach to the face, Dr. Hevia said. “Much of the early aging in patients is really around the eyes. You are taking someone from worn or tired ... to looking their best.” Calcium hydroxyapatite (Radiesse, BioForm Medical Inc.) and polydimethylsiloxane (Silikon 1000, Alcon Laboratories) are options for filling the infraorbital area.
Along with these techniques comes the potential for complications. For example, it is easy to overcorrect with calcium hydroxyapatite injections under the eyes, Dr. Hevia said. “You really should use a half-inch 30-G needle, small volumes, a little at a time, and you will do fine.” A yellowish discoloration after this product is injected into thin skin, such as under the eyes, is another specific potential complication, he added.
Bruising, tenderness, erythema, and vascular compromise are nonspecific complications, or events not associated with a specific filler product or type.
“Bruising is part of life. You are going to see it, especially when you inject around the eye,” Dr. Hevia said. If postprocedure bruising is superficial, you can treat it with lasers, he added.
Caution with infraorbital injections also is warranted when a patient has visible malar mounds. Injection of any filler into the compartmentalized fat pads under the eyes might exacerbate them, Dr. Hevia said. Infraorbital edema is another nonspecific complication in this anatomic area.
Hematoma and vascular compromises are other adverse events not necessarily associated with any particular facial filler product.
There also are more specific sequelae. For example, incorrect injection of polydimethylsiloxane can cause delayed overcorrection of nasolabial folds, rhytids, or acne scars. Dr. Hevia cited one patient, for example, with facial acne scars who developed protruding bumps on her skin. Placement of this filler too superficially is usually to blame.
Granuloma is another complication associated with some filler products more than others, Dr. Hevia said. “What we see in Miami is a ‘biopolymer’ granulomatous response.” Some patients get biopolymer injections at a medi-spa and then present to Dr. Hevia with delayed overcorrections, such as around their upper lip.
Late- or delayed-onset granuloma also can occur with poly-l-lactic acid injections, Dr. Hevia said. “In some patients, this can arise more than a year later.”
Disclosures: Dr. Hevia said he had no relevant financial disclosures.
NAPLES, Fla. - Dermatologists know best how to prevent and to correct facial filler complications, compared with medi-spa aestheticians and other employees, Dr. Oscar Hevia said.
“Our ability to identify, treat, and correct our complications [is what will set us apart]. It’s all about experience,” Dr. Hevia said at the meeting.
Some complications are more specific to particular filler types or products, whereas others can occur regardless of which agent is chosen to enhance the forehead, infraorbital area, or the nasolabial folds, for example. Appropriate expertise goes beyond recognition of early complications in the first 2 weeks, to include late complications (that arise within 1 year), and delayed complications thereafter.
“Forehead contouring is not an area we normally think about with fillers. [However,] you can get a nice correction in someone who might have brow ptosis if you used a toxin,” said Dr. Hevia, who is in private practice in Miami and on the faculty in the department of dermatology and cutaneous surgery at the University of Miami Leonard M. Miller School of Medicine.
“Looking at the eyes, the superior temporal rim is important too. Take away any bony landmarks around the eyes,” he said.
More commonly, patients will ask dermatologists to improve their infraorbital hollows. Injection of fillers to replace lost volume below the eyes is part of his restorative approach to the face, Dr. Hevia said. “Much of the early aging in patients is really around the eyes. You are taking someone from worn or tired ... to looking their best.” Calcium hydroxyapatite (Radiesse, BioForm Medical Inc.) and polydimethylsiloxane (Silikon 1000, Alcon Laboratories) are options for filling the infraorbital area.
Along with these techniques comes the potential for complications. For example, it is easy to overcorrect with calcium hydroxyapatite injections under the eyes, Dr. Hevia said. “You really should use a half-inch 30-G needle, small volumes, a little at a time, and you will do fine.” A yellowish discoloration after this product is injected into thin skin, such as under the eyes, is another specific potential complication, he added.
Bruising, tenderness, erythema, and vascular compromise are nonspecific complications, or events not associated with a specific filler product or type.
“Bruising is part of life. You are going to see it, especially when you inject around the eye,” Dr. Hevia said. If postprocedure bruising is superficial, you can treat it with lasers, he added.
Caution with infraorbital injections also is warranted when a patient has visible malar mounds. Injection of any filler into the compartmentalized fat pads under the eyes might exacerbate them, Dr. Hevia said. Infraorbital edema is another nonspecific complication in this anatomic area.
Hematoma and vascular compromises are other adverse events not necessarily associated with any particular facial filler product.
There also are more specific sequelae. For example, incorrect injection of polydimethylsiloxane can cause delayed overcorrection of nasolabial folds, rhytids, or acne scars. Dr. Hevia cited one patient, for example, with facial acne scars who developed protruding bumps on her skin. Placement of this filler too superficially is usually to blame.
Granuloma is another complication associated with some filler products more than others, Dr. Hevia said. “What we see in Miami is a ‘biopolymer’ granulomatous response.” Some patients get biopolymer injections at a medi-spa and then present to Dr. Hevia with delayed overcorrections, such as around their upper lip.
Late- or delayed-onset granuloma also can occur with poly-l-lactic acid injections, Dr. Hevia said. “In some patients, this can arise more than a year later.”
Disclosures: Dr. Hevia said he had no relevant financial disclosures.
Laser Lipolysis Used for Lipodystrophy, Laxity
Naples, Fla. — With a myriad technologies and devices available for liposuction, laser lipolysis finds a greater role for skin tightening in the hands of Dr. Katharina Russe-Wilflingseder.
Laser lipolysis (SmartLipo, Cynosure) results in less pain, swelling, and bruising than traditional liposuction, she said. Patients also experience faster, smoother recovery.
“For me it is not a fat lipolysis device, it is more of a tightening device,” Dr. Russe-Wilflingseder said, while providing an aesthetic plastic surgeon’s perspective at the the annual meeting of the Florida Society of Dermatology & Dermatologic Surgery.
Laser lipolysis is an “excellent technique ... not only for lipodystrophy, but also skin laxity,” she said, adding that the treatments are particularly well suited for certain anatomic areas, such as the submental area and upper arms. For example, postprocedure outcomes are aesthetically better with laser lipolysis of the upper arms, an area where traditional liposuction leaves large scars that are difficult to conceal.
For addressing submental fat and/or skin laxity, “we can improve our results by combining our treatments,” said Dr. Russe-Wilflingseder, who has a private practice in Innsbruck, Austria. For example, results are even better with addition of bipolar radiofrequency therapy.
Like many techniques for fat removal and skin tightening, there are drawbacks that need to be considered. For example, results with laser lipolysis are not predictable compared with outcomes following surgery. In addition, improvements are not immediate and sometimes take up to 6 months.
The device uses heat, so there is a concern about risk of burns if used improperly, she said. The temperature threshold is important. You want enough to get tissue tightening, but not so much that it produces epidermal necrosis or thickening of subdermal fat. A beneficial feature of the device in this regard is an accelerometer. This technology determines the appropriate laser energy based on speed of movement to provide even and consistent treatment.
Treatment of cellulite, striae, and gynecomastia are among other suitable indications for the laser lipolysis technique, though careful patient selection and pretreatment counseling and photography are important, Dr. Russe-Wilflingseder said. This is especially true for patients who choose skin tightening with laser lipolysis although they are better candidates for a face or neck lift surgical procedure. Results will not be as dramatic, although they can still get some improvements from minimally invasive laser lipolysis.
Another reason Dr. Russe-Wilflingseder uses laser lipolysis primarily for skin tightening is the abundance of technologies already available for liposuction. In addition to laser-assisted liposuction, options include suction-assisted, power-assisted, ultrasound-assisted, water-jet-assisted, and radiofrequency-assisted technologies.
The original 1,064-nm Nd:YAG laser lipolysis system was cleared by the Food and Drug Administration in 2006. The laser system uses photomechanical and photothermal effects to disrupt fat cells and coagulate tissue, resulting in skin tightening.
More recently, the company released a system with two wavelengths—1,064 nm and 1,320 nm (SmartLipo MPX), chosen to correspond to coefficients of energy absorption by fat cells and water. I have checked the following facts in my story: (Please initial each.)
“We also have a 1,440-nm all-in-one machine to get better disturbance of fat,” Dr. Russe-Wilflingseder said. This three-wavelength device features 1,064-nm, 1,320-nm, and 1,440-nm (SmartLipo Triplex).
Disclosures: Dr. Russe-Wilflingseder said she had no personal financial disclosures, but her practice in Austria is a laser lipolysis training reference site for Cynosure.
Naples, Fla. — With a myriad technologies and devices available for liposuction, laser lipolysis finds a greater role for skin tightening in the hands of Dr. Katharina Russe-Wilflingseder.
Laser lipolysis (SmartLipo, Cynosure) results in less pain, swelling, and bruising than traditional liposuction, she said. Patients also experience faster, smoother recovery.
“For me it is not a fat lipolysis device, it is more of a tightening device,” Dr. Russe-Wilflingseder said, while providing an aesthetic plastic surgeon’s perspective at the the annual meeting of the Florida Society of Dermatology & Dermatologic Surgery.
Laser lipolysis is an “excellent technique ... not only for lipodystrophy, but also skin laxity,” she said, adding that the treatments are particularly well suited for certain anatomic areas, such as the submental area and upper arms. For example, postprocedure outcomes are aesthetically better with laser lipolysis of the upper arms, an area where traditional liposuction leaves large scars that are difficult to conceal.
For addressing submental fat and/or skin laxity, “we can improve our results by combining our treatments,” said Dr. Russe-Wilflingseder, who has a private practice in Innsbruck, Austria. For example, results are even better with addition of bipolar radiofrequency therapy.
Like many techniques for fat removal and skin tightening, there are drawbacks that need to be considered. For example, results with laser lipolysis are not predictable compared with outcomes following surgery. In addition, improvements are not immediate and sometimes take up to 6 months.
The device uses heat, so there is a concern about risk of burns if used improperly, she said. The temperature threshold is important. You want enough to get tissue tightening, but not so much that it produces epidermal necrosis or thickening of subdermal fat. A beneficial feature of the device in this regard is an accelerometer. This technology determines the appropriate laser energy based on speed of movement to provide even and consistent treatment.
Treatment of cellulite, striae, and gynecomastia are among other suitable indications for the laser lipolysis technique, though careful patient selection and pretreatment counseling and photography are important, Dr. Russe-Wilflingseder said. This is especially true for patients who choose skin tightening with laser lipolysis although they are better candidates for a face or neck lift surgical procedure. Results will not be as dramatic, although they can still get some improvements from minimally invasive laser lipolysis.
Another reason Dr. Russe-Wilflingseder uses laser lipolysis primarily for skin tightening is the abundance of technologies already available for liposuction. In addition to laser-assisted liposuction, options include suction-assisted, power-assisted, ultrasound-assisted, water-jet-assisted, and radiofrequency-assisted technologies.
The original 1,064-nm Nd:YAG laser lipolysis system was cleared by the Food and Drug Administration in 2006. The laser system uses photomechanical and photothermal effects to disrupt fat cells and coagulate tissue, resulting in skin tightening.
More recently, the company released a system with two wavelengths—1,064 nm and 1,320 nm (SmartLipo MPX), chosen to correspond to coefficients of energy absorption by fat cells and water. I have checked the following facts in my story: (Please initial each.)
“We also have a 1,440-nm all-in-one machine to get better disturbance of fat,” Dr. Russe-Wilflingseder said. This three-wavelength device features 1,064-nm, 1,320-nm, and 1,440-nm (SmartLipo Triplex).
Disclosures: Dr. Russe-Wilflingseder said she had no personal financial disclosures, but her practice in Austria is a laser lipolysis training reference site for Cynosure.
Naples, Fla. — With a myriad technologies and devices available for liposuction, laser lipolysis finds a greater role for skin tightening in the hands of Dr. Katharina Russe-Wilflingseder.
Laser lipolysis (SmartLipo, Cynosure) results in less pain, swelling, and bruising than traditional liposuction, she said. Patients also experience faster, smoother recovery.
“For me it is not a fat lipolysis device, it is more of a tightening device,” Dr. Russe-Wilflingseder said, while providing an aesthetic plastic surgeon’s perspective at the the annual meeting of the Florida Society of Dermatology & Dermatologic Surgery.
Laser lipolysis is an “excellent technique ... not only for lipodystrophy, but also skin laxity,” she said, adding that the treatments are particularly well suited for certain anatomic areas, such as the submental area and upper arms. For example, postprocedure outcomes are aesthetically better with laser lipolysis of the upper arms, an area where traditional liposuction leaves large scars that are difficult to conceal.
For addressing submental fat and/or skin laxity, “we can improve our results by combining our treatments,” said Dr. Russe-Wilflingseder, who has a private practice in Innsbruck, Austria. For example, results are even better with addition of bipolar radiofrequency therapy.
Like many techniques for fat removal and skin tightening, there are drawbacks that need to be considered. For example, results with laser lipolysis are not predictable compared with outcomes following surgery. In addition, improvements are not immediate and sometimes take up to 6 months.
The device uses heat, so there is a concern about risk of burns if used improperly, she said. The temperature threshold is important. You want enough to get tissue tightening, but not so much that it produces epidermal necrosis or thickening of subdermal fat. A beneficial feature of the device in this regard is an accelerometer. This technology determines the appropriate laser energy based on speed of movement to provide even and consistent treatment.
Treatment of cellulite, striae, and gynecomastia are among other suitable indications for the laser lipolysis technique, though careful patient selection and pretreatment counseling and photography are important, Dr. Russe-Wilflingseder said. This is especially true for patients who choose skin tightening with laser lipolysis although they are better candidates for a face or neck lift surgical procedure. Results will not be as dramatic, although they can still get some improvements from minimally invasive laser lipolysis.
Another reason Dr. Russe-Wilflingseder uses laser lipolysis primarily for skin tightening is the abundance of technologies already available for liposuction. In addition to laser-assisted liposuction, options include suction-assisted, power-assisted, ultrasound-assisted, water-jet-assisted, and radiofrequency-assisted technologies.
The original 1,064-nm Nd:YAG laser lipolysis system was cleared by the Food and Drug Administration in 2006. The laser system uses photomechanical and photothermal effects to disrupt fat cells and coagulate tissue, resulting in skin tightening.
More recently, the company released a system with two wavelengths—1,064 nm and 1,320 nm (SmartLipo MPX), chosen to correspond to coefficients of energy absorption by fat cells and water. I have checked the following facts in my story: (Please initial each.)
“We also have a 1,440-nm all-in-one machine to get better disturbance of fat,” Dr. Russe-Wilflingseder said. This three-wavelength device features 1,064-nm, 1,320-nm, and 1,440-nm (SmartLipo Triplex).
Disclosures: Dr. Russe-Wilflingseder said she had no personal financial disclosures, but her practice in Austria is a laser lipolysis training reference site for Cynosure.
Fractional Radiofrequency Holds Promise for Skin Tightening
Destin, Fla. — Fractional radiofrequency “is new and has a lot of promise” for skin tightening to rejuvenate the jaw and facial skin, according to Dr. Marian Northington.
Similar to fractional photothermolysis, a bipolar microneedle system creates zones of thermal damage in the reticulated dermis. These zones are surrounded by untreated dermis that speeds healing. The heat delivered alters the molecular structure of the triple helix of collagen and causes collagen contraction. The heat also stimulates a “vigorous wound healing response,” Dr. Northington said at a meeting sponsored by the Alabama Dermatology Society.
Another advantage of radiofrequency is that it uses electrical current and not a light source, so there is no damage to epidural melanin. Therefore, radiofrequency treatments are safe for all skin types, she said.
“It takes time, but you get thicker, healthier dermis,” Dr. Northington said. “As this improves slowly with time, it is important to take before pictures. Patients will forget with something that gradually occurs.”
On the plus side, there is no downtime compared with more invasive approaches to facial rejuvenation. However, “patients need appropriate expectations. Fractional radiofrequency does not yield a surgical result,” Dr. Northington said. Results are modest and sometimes not reproducible.
Nevertheless, “this has a lot of promise as a nonsurgical option ... for those who don’t want a face lift, but want some improvement,” said Dr. Northington of the University of Alabama at Birmingham.
She cited a recent study of 15 fractional radiofrequency patients, in which 5 blinded raters were asked to assess outcomes from photos (Arch. Dermatol. 2010;146:396-405). The investigators mixed in photos of surgical face-lift patients. There was an average 16% improvement with radiofrequency, compared with 44% for the face-lift patients. “Although improvement with face-lift was greater, it also showed improvement with radiofrequency,” Dr. Northington said.
Unlike with standard monopolar or bipolar radiofrequency, anesthesia is not necessary so patients can provide useful feedback that they feel the heat during the treatment, Dr. Northington said. “You know the energy is going where you want it.”
Energy is delivered at 72° C for 4 seconds while the epidermis is protected with cooling. The selective heating of fibrous septae in the subcutaneous area explains why we do not see fat atrophy with radiofrequency, Dr. Northington said.
By 10 weeks the skin has replaced areas of thermal damage, according to a study of 22 patients scheduled for abdominoplasty (Lasers Med. Surg. 2009;41:1-9). “This gives us insight into what happens to the tissue. Look how much thicker all this interstitial collagen is ... with no evidence of fat necrosis or fat atrophy,” she said.
In addition, the study investigators found a significant increase in elastin in 10 weeks. “This is the first study to show this can happen in human skin. This is very exciting. It really demonstrates what this radiofrequency can do and where it’s going in the future,” Dr. Northington said.
Regarding all the advances in radiofrequency technology, Dr. Northington said, “If results are more consistent, [fractional radiofrequency] will be a real player in future for nonsurgical rejuvenation.”
Disclosures: Dr. Northington said she had no relevant disclosures.
Destin, Fla. — Fractional radiofrequency “is new and has a lot of promise” for skin tightening to rejuvenate the jaw and facial skin, according to Dr. Marian Northington.
Similar to fractional photothermolysis, a bipolar microneedle system creates zones of thermal damage in the reticulated dermis. These zones are surrounded by untreated dermis that speeds healing. The heat delivered alters the molecular structure of the triple helix of collagen and causes collagen contraction. The heat also stimulates a “vigorous wound healing response,” Dr. Northington said at a meeting sponsored by the Alabama Dermatology Society.
Another advantage of radiofrequency is that it uses electrical current and not a light source, so there is no damage to epidural melanin. Therefore, radiofrequency treatments are safe for all skin types, she said.
“It takes time, but you get thicker, healthier dermis,” Dr. Northington said. “As this improves slowly with time, it is important to take before pictures. Patients will forget with something that gradually occurs.”
On the plus side, there is no downtime compared with more invasive approaches to facial rejuvenation. However, “patients need appropriate expectations. Fractional radiofrequency does not yield a surgical result,” Dr. Northington said. Results are modest and sometimes not reproducible.
Nevertheless, “this has a lot of promise as a nonsurgical option ... for those who don’t want a face lift, but want some improvement,” said Dr. Northington of the University of Alabama at Birmingham.
She cited a recent study of 15 fractional radiofrequency patients, in which 5 blinded raters were asked to assess outcomes from photos (Arch. Dermatol. 2010;146:396-405). The investigators mixed in photos of surgical face-lift patients. There was an average 16% improvement with radiofrequency, compared with 44% for the face-lift patients. “Although improvement with face-lift was greater, it also showed improvement with radiofrequency,” Dr. Northington said.
Unlike with standard monopolar or bipolar radiofrequency, anesthesia is not necessary so patients can provide useful feedback that they feel the heat during the treatment, Dr. Northington said. “You know the energy is going where you want it.”
Energy is delivered at 72° C for 4 seconds while the epidermis is protected with cooling. The selective heating of fibrous septae in the subcutaneous area explains why we do not see fat atrophy with radiofrequency, Dr. Northington said.
By 10 weeks the skin has replaced areas of thermal damage, according to a study of 22 patients scheduled for abdominoplasty (Lasers Med. Surg. 2009;41:1-9). “This gives us insight into what happens to the tissue. Look how much thicker all this interstitial collagen is ... with no evidence of fat necrosis or fat atrophy,” she said.
In addition, the study investigators found a significant increase in elastin in 10 weeks. “This is the first study to show this can happen in human skin. This is very exciting. It really demonstrates what this radiofrequency can do and where it’s going in the future,” Dr. Northington said.
Regarding all the advances in radiofrequency technology, Dr. Northington said, “If results are more consistent, [fractional radiofrequency] will be a real player in future for nonsurgical rejuvenation.”
Disclosures: Dr. Northington said she had no relevant disclosures.
Destin, Fla. — Fractional radiofrequency “is new and has a lot of promise” for skin tightening to rejuvenate the jaw and facial skin, according to Dr. Marian Northington.
Similar to fractional photothermolysis, a bipolar microneedle system creates zones of thermal damage in the reticulated dermis. These zones are surrounded by untreated dermis that speeds healing. The heat delivered alters the molecular structure of the triple helix of collagen and causes collagen contraction. The heat also stimulates a “vigorous wound healing response,” Dr. Northington said at a meeting sponsored by the Alabama Dermatology Society.
Another advantage of radiofrequency is that it uses electrical current and not a light source, so there is no damage to epidural melanin. Therefore, radiofrequency treatments are safe for all skin types, she said.
“It takes time, but you get thicker, healthier dermis,” Dr. Northington said. “As this improves slowly with time, it is important to take before pictures. Patients will forget with something that gradually occurs.”
On the plus side, there is no downtime compared with more invasive approaches to facial rejuvenation. However, “patients need appropriate expectations. Fractional radiofrequency does not yield a surgical result,” Dr. Northington said. Results are modest and sometimes not reproducible.
Nevertheless, “this has a lot of promise as a nonsurgical option ... for those who don’t want a face lift, but want some improvement,” said Dr. Northington of the University of Alabama at Birmingham.
She cited a recent study of 15 fractional radiofrequency patients, in which 5 blinded raters were asked to assess outcomes from photos (Arch. Dermatol. 2010;146:396-405). The investigators mixed in photos of surgical face-lift patients. There was an average 16% improvement with radiofrequency, compared with 44% for the face-lift patients. “Although improvement with face-lift was greater, it also showed improvement with radiofrequency,” Dr. Northington said.
Unlike with standard monopolar or bipolar radiofrequency, anesthesia is not necessary so patients can provide useful feedback that they feel the heat during the treatment, Dr. Northington said. “You know the energy is going where you want it.”
Energy is delivered at 72° C for 4 seconds while the epidermis is protected with cooling. The selective heating of fibrous septae in the subcutaneous area explains why we do not see fat atrophy with radiofrequency, Dr. Northington said.
By 10 weeks the skin has replaced areas of thermal damage, according to a study of 22 patients scheduled for abdominoplasty (Lasers Med. Surg. 2009;41:1-9). “This gives us insight into what happens to the tissue. Look how much thicker all this interstitial collagen is ... with no evidence of fat necrosis or fat atrophy,” she said.
In addition, the study investigators found a significant increase in elastin in 10 weeks. “This is the first study to show this can happen in human skin. This is very exciting. It really demonstrates what this radiofrequency can do and where it’s going in the future,” Dr. Northington said.
Regarding all the advances in radiofrequency technology, Dr. Northington said, “If results are more consistent, [fractional radiofrequency] will be a real player in future for nonsurgical rejuvenation.”
Disclosures: Dr. Northington said she had no relevant disclosures.
Autologous Fat Injections Advised for Lipofilling
Naples, Fla. — Dermatologists can treat a range of anatomic areas with autologous fat injections—both to address aesthetic concerns and to optimize outcomes after reconstructive plastic surgery, Dr. Katharina Russe-Wilflingseder said.
Lipofilling is an appropriate technique to augment nasolabial folds, cheeks, and hands, as well as for aesthetic improvement after reconstruction breast surgery, for example. The advantages to this approach outweigh the drawbacks, although both should be considered, she said at the Annual Meeting of the Florida Society of Dermatology & Dermatologic Surgeons
Dr. Russe-Wilflingseder recommended standard wet suction aspiration of a patient’s fat with a 2.5-mm to 3-mm cannula. She also is an advocate of minimal processing, or immediate reinjection of unwashed fat, using a 1.4-mm cannula.
“It is an excellent technique—I rarely use any fillers any more,” said Dr. Russe-Wilflingseder, an aesthetic plastic surgeon in private practice in Innsbruck, Austria.
She turned to the literature to answer some basic questions about autologous fat transplantation technique. For example, the “donor site does not seem to be important for cell survival,” she said. “It should be based on your own decision, the adiposity of donor site, and on the patient’s nomination.”
Some physicians ask whether liposuction or excision is best for fat harvesting. “If we look at the literature, this does not make a difference,” she commented. Excision or gentle aspiration is the generally recommended harvesting technique.
Most reports suggest a short and gentle centrifuge is the optimal processing technique. However, Dr. Russe-Wilflingseder keeps it even simpler. She uses a 10-cc filter syringe to immediately re-inject unwashed fat. “We believe it is very important to leave everything inside.”
Her strategy is to re-inject tiny amounts, using multiple passes and applying the autologous fat to different layers using a fine cannula.
In addition, more fat is preferred to less, she said. “We believe it is better to overcorrect than to undercorrect” in part because a sufficient amount of fat is necessary for revascularization, which takes up to 7-21 days.
Redness of the skin the day after the operation is a common adverse event, Dr. Russe-Wilflingseder said. As with any invasive procedure, there is a risk of infection as well. Otherwise, “there are nearly no side effects.”
An inability to predict the stability and longevity of the fat grafts is another potential drawback to autologous lipofilling, she said. “Our experience is that about 50% [of injected fat] stays alive” in the long term. Another concern is the availability of donor site adiposity. For example, more fat is required to correct after reconstructive breast surgery. One patient, for example, required two treatments with a total 100 cc of fat.
On the plus side, fat injections can improve not only volume but the appearance of scarring after breast tumor resection. Other advantages relate to the “ideal properties” of autologous fat: It is easily available, adaptable, and takes little time to harvest and re-inject, Dr. Russe-Wilflingseder said.
She reported success with many different applications to fill soft tissue and contour defects, some done in combination with submental tissue tightening or carbon dioxide laser resurfacing. For example, 10 to 20 cc of autologous fat injected in the upper nasolabial folds yields great long-term results, she said. For another patient, 10 cc of fat rejuvenated the appearance of their hands. “The quality of the skin improves a lot after the lipofilling.”
Disclosures: Dr. Russe-Wilflingseder said she had no relevant financial disclosures.
Naples, Fla. — Dermatologists can treat a range of anatomic areas with autologous fat injections—both to address aesthetic concerns and to optimize outcomes after reconstructive plastic surgery, Dr. Katharina Russe-Wilflingseder said.
Lipofilling is an appropriate technique to augment nasolabial folds, cheeks, and hands, as well as for aesthetic improvement after reconstruction breast surgery, for example. The advantages to this approach outweigh the drawbacks, although both should be considered, she said at the Annual Meeting of the Florida Society of Dermatology & Dermatologic Surgeons
Dr. Russe-Wilflingseder recommended standard wet suction aspiration of a patient’s fat with a 2.5-mm to 3-mm cannula. She also is an advocate of minimal processing, or immediate reinjection of unwashed fat, using a 1.4-mm cannula.
“It is an excellent technique—I rarely use any fillers any more,” said Dr. Russe-Wilflingseder, an aesthetic plastic surgeon in private practice in Innsbruck, Austria.
She turned to the literature to answer some basic questions about autologous fat transplantation technique. For example, the “donor site does not seem to be important for cell survival,” she said. “It should be based on your own decision, the adiposity of donor site, and on the patient’s nomination.”
Some physicians ask whether liposuction or excision is best for fat harvesting. “If we look at the literature, this does not make a difference,” she commented. Excision or gentle aspiration is the generally recommended harvesting technique.
Most reports suggest a short and gentle centrifuge is the optimal processing technique. However, Dr. Russe-Wilflingseder keeps it even simpler. She uses a 10-cc filter syringe to immediately re-inject unwashed fat. “We believe it is very important to leave everything inside.”
Her strategy is to re-inject tiny amounts, using multiple passes and applying the autologous fat to different layers using a fine cannula.
In addition, more fat is preferred to less, she said. “We believe it is better to overcorrect than to undercorrect” in part because a sufficient amount of fat is necessary for revascularization, which takes up to 7-21 days.
Redness of the skin the day after the operation is a common adverse event, Dr. Russe-Wilflingseder said. As with any invasive procedure, there is a risk of infection as well. Otherwise, “there are nearly no side effects.”
An inability to predict the stability and longevity of the fat grafts is another potential drawback to autologous lipofilling, she said. “Our experience is that about 50% [of injected fat] stays alive” in the long term. Another concern is the availability of donor site adiposity. For example, more fat is required to correct after reconstructive breast surgery. One patient, for example, required two treatments with a total 100 cc of fat.
On the plus side, fat injections can improve not only volume but the appearance of scarring after breast tumor resection. Other advantages relate to the “ideal properties” of autologous fat: It is easily available, adaptable, and takes little time to harvest and re-inject, Dr. Russe-Wilflingseder said.
She reported success with many different applications to fill soft tissue and contour defects, some done in combination with submental tissue tightening or carbon dioxide laser resurfacing. For example, 10 to 20 cc of autologous fat injected in the upper nasolabial folds yields great long-term results, she said. For another patient, 10 cc of fat rejuvenated the appearance of their hands. “The quality of the skin improves a lot after the lipofilling.”
Disclosures: Dr. Russe-Wilflingseder said she had no relevant financial disclosures.
Naples, Fla. — Dermatologists can treat a range of anatomic areas with autologous fat injections—both to address aesthetic concerns and to optimize outcomes after reconstructive plastic surgery, Dr. Katharina Russe-Wilflingseder said.
Lipofilling is an appropriate technique to augment nasolabial folds, cheeks, and hands, as well as for aesthetic improvement after reconstruction breast surgery, for example. The advantages to this approach outweigh the drawbacks, although both should be considered, she said at the Annual Meeting of the Florida Society of Dermatology & Dermatologic Surgeons
Dr. Russe-Wilflingseder recommended standard wet suction aspiration of a patient’s fat with a 2.5-mm to 3-mm cannula. She also is an advocate of minimal processing, or immediate reinjection of unwashed fat, using a 1.4-mm cannula.
“It is an excellent technique—I rarely use any fillers any more,” said Dr. Russe-Wilflingseder, an aesthetic plastic surgeon in private practice in Innsbruck, Austria.
She turned to the literature to answer some basic questions about autologous fat transplantation technique. For example, the “donor site does not seem to be important for cell survival,” she said. “It should be based on your own decision, the adiposity of donor site, and on the patient’s nomination.”
Some physicians ask whether liposuction or excision is best for fat harvesting. “If we look at the literature, this does not make a difference,” she commented. Excision or gentle aspiration is the generally recommended harvesting technique.
Most reports suggest a short and gentle centrifuge is the optimal processing technique. However, Dr. Russe-Wilflingseder keeps it even simpler. She uses a 10-cc filter syringe to immediately re-inject unwashed fat. “We believe it is very important to leave everything inside.”
Her strategy is to re-inject tiny amounts, using multiple passes and applying the autologous fat to different layers using a fine cannula.
In addition, more fat is preferred to less, she said. “We believe it is better to overcorrect than to undercorrect” in part because a sufficient amount of fat is necessary for revascularization, which takes up to 7-21 days.
Redness of the skin the day after the operation is a common adverse event, Dr. Russe-Wilflingseder said. As with any invasive procedure, there is a risk of infection as well. Otherwise, “there are nearly no side effects.”
An inability to predict the stability and longevity of the fat grafts is another potential drawback to autologous lipofilling, she said. “Our experience is that about 50% [of injected fat] stays alive” in the long term. Another concern is the availability of donor site adiposity. For example, more fat is required to correct after reconstructive breast surgery. One patient, for example, required two treatments with a total 100 cc of fat.
On the plus side, fat injections can improve not only volume but the appearance of scarring after breast tumor resection. Other advantages relate to the “ideal properties” of autologous fat: It is easily available, adaptable, and takes little time to harvest and re-inject, Dr. Russe-Wilflingseder said.
She reported success with many different applications to fill soft tissue and contour defects, some done in combination with submental tissue tightening or carbon dioxide laser resurfacing. For example, 10 to 20 cc of autologous fat injected in the upper nasolabial folds yields great long-term results, she said. For another patient, 10 cc of fat rejuvenated the appearance of their hands. “The quality of the skin improves a lot after the lipofilling.”
Disclosures: Dr. Russe-Wilflingseder said she had no relevant financial disclosures.
Cryolipolysis Offers Results for Fat Removal
Naples, Fla. - Effective, noninvasive fat removal is here, according to Dr. Mathew Avram.
"Efficacy is limited but it is real," he said regarding cryolipolysis, a noninvasive cooling and removal of subcutaneous fat.
It is important for dermatologists to assess all emerging noninvasive fat-reduction technologies critically.
"Patients will ask you about this," Dr. Avram said. "There is a lot of snake-oil salesmanship in this field."
Cryolipolysis (CoolSculpting, Zeltiq Aesthetics) selectively kills fat cells at temperatures above freezing without affecting surrounding tissues. This selective crystallization of fat cells leads to apoptotic death and, ultimately, gradual dissolution of fat over 2-4 months, Dr. Avram said.
In 2009, researchers reported a 22% reduction in "love handles" on the side treated with cryolipolysis, compared with the side with no treatment at 4 months in an unpublished study with 32 participants.
"Whether or not that is clinically relevant is up to you to decide," Dr. Avram said at the meeting.
Results of animal studies are more robust. For example, one study conducted by researchers at the Wellman Center for Photomedicine in Boston demonstrated a 40% decrease in fat layer of pigs over 90 days on ultrasound and gross pathology (Laser Surg. Med. 2008;40:595-604).
Cryolipolysis has been approved by the Food and Drug Administration for various skin cooling applications during dermatology procedures, but the CoolSculpting device is not FDA cleared for marketing as a fat removal device, Dr. Avram said, although regulatory approval for noninvasive fat reduction is pending.
Cryolipolysis is not a weight loss device, nor is it intended as a replacement for liposuction, said Dr. Avram, director of the Massachusetts General Hospital Dermatology Laser and Cosmetic Center.
Cryolipolysis is best suited for local fat removal in areas resistant to exercise, such as love handles or the lower abdomen, Dr. Avram said, and "patient selection is crucial." Relatively thin, weight-stable people who have localized fat areas and realistic expectations are appropriate candidates. "Otherwise, patients will be disappointed. We avoid that with very careful patient selection," he said.
"We got this device at Mass General a few months ago," said Dr. Avram, who tried it himself.
Dr. R. Rox Anderson applied the gel sheet "over my love handle area [and] left it on for an hour," he said, noting that it got a little cold and the area became anesthetized after 7-8 minutes.
He reported a minor urticarial plaque on the area immediately after treatment. Redness for a few minutes to a few hours is a common postprocedure effect, as is bruising for up to a few weeks, although "not all will get it," Dr. Avram said.
A temporary dulling of sensation in the treated area that typically resolves in 1-8 weeks can also occur. No changes in pigmentation have been reported.
Dermatologists are the perfect physicians to perform cryolipolysis, Dr. Avram said. "Subcutaneous fat is a fundamental part of dermatology, and the fact that it has not been claimed by any specialty makes it ours."
Disclosures: Dr. Avram said he owns stock options and is a consultant for Zeltiq Aesthetics, Inc.
Naples, Fla. - Effective, noninvasive fat removal is here, according to Dr. Mathew Avram.
"Efficacy is limited but it is real," he said regarding cryolipolysis, a noninvasive cooling and removal of subcutaneous fat.
It is important for dermatologists to assess all emerging noninvasive fat-reduction technologies critically.
"Patients will ask you about this," Dr. Avram said. "There is a lot of snake-oil salesmanship in this field."
Cryolipolysis (CoolSculpting, Zeltiq Aesthetics) selectively kills fat cells at temperatures above freezing without affecting surrounding tissues. This selective crystallization of fat cells leads to apoptotic death and, ultimately, gradual dissolution of fat over 2-4 months, Dr. Avram said.
In 2009, researchers reported a 22% reduction in "love handles" on the side treated with cryolipolysis, compared with the side with no treatment at 4 months in an unpublished study with 32 participants.
"Whether or not that is clinically relevant is up to you to decide," Dr. Avram said at the meeting.
Results of animal studies are more robust. For example, one study conducted by researchers at the Wellman Center for Photomedicine in Boston demonstrated a 40% decrease in fat layer of pigs over 90 days on ultrasound and gross pathology (Laser Surg. Med. 2008;40:595-604).
Cryolipolysis has been approved by the Food and Drug Administration for various skin cooling applications during dermatology procedures, but the CoolSculpting device is not FDA cleared for marketing as a fat removal device, Dr. Avram said, although regulatory approval for noninvasive fat reduction is pending.
Cryolipolysis is not a weight loss device, nor is it intended as a replacement for liposuction, said Dr. Avram, director of the Massachusetts General Hospital Dermatology Laser and Cosmetic Center.
Cryolipolysis is best suited for local fat removal in areas resistant to exercise, such as love handles or the lower abdomen, Dr. Avram said, and "patient selection is crucial." Relatively thin, weight-stable people who have localized fat areas and realistic expectations are appropriate candidates. "Otherwise, patients will be disappointed. We avoid that with very careful patient selection," he said.
"We got this device at Mass General a few months ago," said Dr. Avram, who tried it himself.
Dr. R. Rox Anderson applied the gel sheet "over my love handle area [and] left it on for an hour," he said, noting that it got a little cold and the area became anesthetized after 7-8 minutes.
He reported a minor urticarial plaque on the area immediately after treatment. Redness for a few minutes to a few hours is a common postprocedure effect, as is bruising for up to a few weeks, although "not all will get it," Dr. Avram said.
A temporary dulling of sensation in the treated area that typically resolves in 1-8 weeks can also occur. No changes in pigmentation have been reported.
Dermatologists are the perfect physicians to perform cryolipolysis, Dr. Avram said. "Subcutaneous fat is a fundamental part of dermatology, and the fact that it has not been claimed by any specialty makes it ours."
Disclosures: Dr. Avram said he owns stock options and is a consultant for Zeltiq Aesthetics, Inc.
Naples, Fla. - Effective, noninvasive fat removal is here, according to Dr. Mathew Avram.
"Efficacy is limited but it is real," he said regarding cryolipolysis, a noninvasive cooling and removal of subcutaneous fat.
It is important for dermatologists to assess all emerging noninvasive fat-reduction technologies critically.
"Patients will ask you about this," Dr. Avram said. "There is a lot of snake-oil salesmanship in this field."
Cryolipolysis (CoolSculpting, Zeltiq Aesthetics) selectively kills fat cells at temperatures above freezing without affecting surrounding tissues. This selective crystallization of fat cells leads to apoptotic death and, ultimately, gradual dissolution of fat over 2-4 months, Dr. Avram said.
In 2009, researchers reported a 22% reduction in "love handles" on the side treated with cryolipolysis, compared with the side with no treatment at 4 months in an unpublished study with 32 participants.
"Whether or not that is clinically relevant is up to you to decide," Dr. Avram said at the meeting.
Results of animal studies are more robust. For example, one study conducted by researchers at the Wellman Center for Photomedicine in Boston demonstrated a 40% decrease in fat layer of pigs over 90 days on ultrasound and gross pathology (Laser Surg. Med. 2008;40:595-604).
Cryolipolysis has been approved by the Food and Drug Administration for various skin cooling applications during dermatology procedures, but the CoolSculpting device is not FDA cleared for marketing as a fat removal device, Dr. Avram said, although regulatory approval for noninvasive fat reduction is pending.
Cryolipolysis is not a weight loss device, nor is it intended as a replacement for liposuction, said Dr. Avram, director of the Massachusetts General Hospital Dermatology Laser and Cosmetic Center.
Cryolipolysis is best suited for local fat removal in areas resistant to exercise, such as love handles or the lower abdomen, Dr. Avram said, and "patient selection is crucial." Relatively thin, weight-stable people who have localized fat areas and realistic expectations are appropriate candidates. "Otherwise, patients will be disappointed. We avoid that with very careful patient selection," he said.
"We got this device at Mass General a few months ago," said Dr. Avram, who tried it himself.
Dr. R. Rox Anderson applied the gel sheet "over my love handle area [and] left it on for an hour," he said, noting that it got a little cold and the area became anesthetized after 7-8 minutes.
He reported a minor urticarial plaque on the area immediately after treatment. Redness for a few minutes to a few hours is a common postprocedure effect, as is bruising for up to a few weeks, although "not all will get it," Dr. Avram said.
A temporary dulling of sensation in the treated area that typically resolves in 1-8 weeks can also occur. No changes in pigmentation have been reported.
Dermatologists are the perfect physicians to perform cryolipolysis, Dr. Avram said. "Subcutaneous fat is a fundamental part of dermatology, and the fact that it has not been claimed by any specialty makes it ours."
Disclosures: Dr. Avram said he owns stock options and is a consultant for Zeltiq Aesthetics, Inc.
Expert analysis from the annual meeting of the Florida Society of Dermatology and Dermatologic Surgery
Anatomical Tips Optimize Volume Replacement
Acne Scar Patients Give Thumbs Up to CO2 Laser Treatment
Single treatment with a carbon dioxide fractional laser was as effective for acne scars as a nonablative fractional system, according to results of a randomized split-face study.
Fractional lasers are well tolerated and widely used to treat scarring, but patients often need multiple sessions to achieve clinical improvement, reported Dr. S.B. Cho of Yonsei University College of Medicine in Seoul, Korea, and colleagues.
However, previous studies have shown that carbon dioxide fractional laser systems can improve scars in as few as three treatments.
In this study, the researchers directly compared improvements in acne scarring after half of a patient’s face underwent a single treatment with a nonablative 1550-nm erbium-doped fractional photothermolysis system (FPS) and the other half underwent a single treatment with an ablative 10,600-nm carbon dioxide fractional laser system (CO2 FS).
The eight patients in the study were Asian males (Fitzpatrick skin type IV) aged 20 to 23 years with mild to severe atrophic acne scars.
At follow-up 3 months after FPS treatment, six of the eight patients showed clinical improvements of 26%-50% from baseline, one patient showed a clinical improvement of 51%-75%, and one showed no clinical improvement (J. Eur. Acad. Dermatol. Venereol. 2010;24:921-5). As for CO2 FS results at 3 months, five of the eight patients had a 26%-50% clinical improvement from baseline, two patients had a 51%-75% improvement, and one had an improvement of over 76%.
The level of clinical improvement was not affected by the type of acne scar (boxcar, icepick, or rolling).
The average VAS pain score on a scale of 0, no pain, to 10, severe pain, was significantly higher after the CO2 FS treatment, compared with the FPS treatment (7.0 vs. 3.9, respectively). However, patient-reported satisfaction was higher after the CO2 FS treatment. Two patients (25%) were “very satisfied,” four (50%) were “satisfied,” one (12.5%) was “slightly satisfied,” and one (12.5%) was “unsatisfied.” After the FPS treatment, none of the patients were very satisfied, two (25%) were satisfied, five (62.5%) were slightly satisfied, and one (12.5%) was unsatisfied.
Common side effects associated with both treatments included crusting, scaling, and erythema. The average duration of crusting or scaling was significantly longer in the CO2 FS group, compared with the FPS group (7.4 days vs. 2.3 days, respectively). However, the difference in post-therapy erythema was not significantly different between the two groups (11.5 days vs. 7.5 days, respectively).
“We could not completely eliminate the possibility of subject bias as the participants experienced different posttreatment responses with FPS and CO2 FS,” the researchers wrote. But the results suggest that a single treatment with CO2 FS might be more effective than a single treatment with FPS.
Although the findings are not conclusive, given the study’s small size, they could serve as a reference for clinicians choosing among laser options for acne scar treatment, the researchers added.
Dr. Cho and colleagues had no financial conflicts to disclose.
Single treatment with a carbon dioxide fractional laser was as effective for acne scars as a nonablative fractional system, according to results of a randomized split-face study.
Fractional lasers are well tolerated and widely used to treat scarring, but patients often need multiple sessions to achieve clinical improvement, reported Dr. S.B. Cho of Yonsei University College of Medicine in Seoul, Korea, and colleagues.
However, previous studies have shown that carbon dioxide fractional laser systems can improve scars in as few as three treatments.
In this study, the researchers directly compared improvements in acne scarring after half of a patient’s face underwent a single treatment with a nonablative 1550-nm erbium-doped fractional photothermolysis system (FPS) and the other half underwent a single treatment with an ablative 10,600-nm carbon dioxide fractional laser system (CO2 FS).
The eight patients in the study were Asian males (Fitzpatrick skin type IV) aged 20 to 23 years with mild to severe atrophic acne scars.
At follow-up 3 months after FPS treatment, six of the eight patients showed clinical improvements of 26%-50% from baseline, one patient showed a clinical improvement of 51%-75%, and one showed no clinical improvement (J. Eur. Acad. Dermatol. Venereol. 2010;24:921-5). As for CO2 FS results at 3 months, five of the eight patients had a 26%-50% clinical improvement from baseline, two patients had a 51%-75% improvement, and one had an improvement of over 76%.
The level of clinical improvement was not affected by the type of acne scar (boxcar, icepick, or rolling).
The average VAS pain score on a scale of 0, no pain, to 10, severe pain, was significantly higher after the CO2 FS treatment, compared with the FPS treatment (7.0 vs. 3.9, respectively). However, patient-reported satisfaction was higher after the CO2 FS treatment. Two patients (25%) were “very satisfied,” four (50%) were “satisfied,” one (12.5%) was “slightly satisfied,” and one (12.5%) was “unsatisfied.” After the FPS treatment, none of the patients were very satisfied, two (25%) were satisfied, five (62.5%) were slightly satisfied, and one (12.5%) was unsatisfied.
Common side effects associated with both treatments included crusting, scaling, and erythema. The average duration of crusting or scaling was significantly longer in the CO2 FS group, compared with the FPS group (7.4 days vs. 2.3 days, respectively). However, the difference in post-therapy erythema was not significantly different between the two groups (11.5 days vs. 7.5 days, respectively).
“We could not completely eliminate the possibility of subject bias as the participants experienced different posttreatment responses with FPS and CO2 FS,” the researchers wrote. But the results suggest that a single treatment with CO2 FS might be more effective than a single treatment with FPS.
Although the findings are not conclusive, given the study’s small size, they could serve as a reference for clinicians choosing among laser options for acne scar treatment, the researchers added.
Dr. Cho and colleagues had no financial conflicts to disclose.
Single treatment with a carbon dioxide fractional laser was as effective for acne scars as a nonablative fractional system, according to results of a randomized split-face study.
Fractional lasers are well tolerated and widely used to treat scarring, but patients often need multiple sessions to achieve clinical improvement, reported Dr. S.B. Cho of Yonsei University College of Medicine in Seoul, Korea, and colleagues.
However, previous studies have shown that carbon dioxide fractional laser systems can improve scars in as few as three treatments.
In this study, the researchers directly compared improvements in acne scarring after half of a patient’s face underwent a single treatment with a nonablative 1550-nm erbium-doped fractional photothermolysis system (FPS) and the other half underwent a single treatment with an ablative 10,600-nm carbon dioxide fractional laser system (CO2 FS).
The eight patients in the study were Asian males (Fitzpatrick skin type IV) aged 20 to 23 years with mild to severe atrophic acne scars.
At follow-up 3 months after FPS treatment, six of the eight patients showed clinical improvements of 26%-50% from baseline, one patient showed a clinical improvement of 51%-75%, and one showed no clinical improvement (J. Eur. Acad. Dermatol. Venereol. 2010;24:921-5). As for CO2 FS results at 3 months, five of the eight patients had a 26%-50% clinical improvement from baseline, two patients had a 51%-75% improvement, and one had an improvement of over 76%.
The level of clinical improvement was not affected by the type of acne scar (boxcar, icepick, or rolling).
The average VAS pain score on a scale of 0, no pain, to 10, severe pain, was significantly higher after the CO2 FS treatment, compared with the FPS treatment (7.0 vs. 3.9, respectively). However, patient-reported satisfaction was higher after the CO2 FS treatment. Two patients (25%) were “very satisfied,” four (50%) were “satisfied,” one (12.5%) was “slightly satisfied,” and one (12.5%) was “unsatisfied.” After the FPS treatment, none of the patients were very satisfied, two (25%) were satisfied, five (62.5%) were slightly satisfied, and one (12.5%) was unsatisfied.
Common side effects associated with both treatments included crusting, scaling, and erythema. The average duration of crusting or scaling was significantly longer in the CO2 FS group, compared with the FPS group (7.4 days vs. 2.3 days, respectively). However, the difference in post-therapy erythema was not significantly different between the two groups (11.5 days vs. 7.5 days, respectively).
“We could not completely eliminate the possibility of subject bias as the participants experienced different posttreatment responses with FPS and CO2 FS,” the researchers wrote. But the results suggest that a single treatment with CO2 FS might be more effective than a single treatment with FPS.
Although the findings are not conclusive, given the study’s small size, they could serve as a reference for clinicians choosing among laser options for acne scar treatment, the researchers added.
Dr. Cho and colleagues had no financial conflicts to disclose.
Ablative Fractional Resurfacing Appears Effective for Acne Scars in Asians
Ablative fractional resurfacing appears to be safe and effective in Asians with mild to moderate atrophic acne scarring, according to a study of 13 patients.
While 12 of the 13 patients experienced some postinflammatory hyperpigmentation, this resolved in all patients in an average of 5 weeks.
The Asian patients underwent three sessions of ablative fractional resurfacing (AFR) with the Ellipse Juvia 15-W CO2 laser, wrote Dr. Woraphong Manuskiatti and colleagues of Mahidol University, Bangkok. All patients had skin phototype IV. Intervals between treatments averaged 7 weeks. All patients were followed for 6 months after the third treatment.
Independent physicians blinded to the order in which clinical photos had been taken judged the improvement in scarring to be excellent in 8% of the patients, good in 38.5% of them, fair in 38.5%, and slight in 15%. None of the patients worsened (J. Am. Acad. Dermatol. 2010;63:274-83).
By the patients’ own evaluations, 46% judged their overall improvement to be fair, 23% judged it to be good, and 31% judged it to be excellent. In both physician and patient evaluations, “slight” was defined as less than 25% improvement, “fair” as 25%-50% improvement, good as 51%-75% improvement, and excellent as 76%-100% improvement.
Postinflammatory hyperpigmentation (PIH) was the most common side effect, seen in 12 of the 13 (92%) patients and after 20 of the 39 (51%) treatment sessions. All cases of PIH were graded as mild except for one that was graded as moderate. After treatment with 4% hydroquinone cream once daily, PIH resolved in all patients within 2-16 weeks (average 5 weeks).
Other adverse events were acneiform eruptions in four patients, allergic contact dermatitis in two patients, and herpes simplex infection in one patient.
Each treatment consisted of a full-face single-pass treatment with a 5-7 ms pulse width. Investigators adjusted the laser to deliver 49 microthermal zones (MTZs) per square centimeter, with each individual MTZ 500 mcm in diameter. The average percent coverage was 9.6%, and the investigators set the laser to deliver energies between 75-105 mJ/MTZ depending on the severity of scarring.
Although physicians prepared the patients for 1 hour before each treatment with a topical anesthetic applied to the full face with occlusion, on average patients rated their pain as 8.1 on a scale of 1-10. Pain scores tended to decrease for the second and third treatments.
The investigators described AFR as offering a treatment alternative midway between nonablative fractional resurfacing (NAFR) and fractional photothermolysis (FP). “Although NAFR has a patient-friendly advantage,” the investigators wrote, “the outcomes of most NAFR lasers still leave much to be desired in the treatment of photodamaged skin, rhytides, and atrophic scars. ... By depositing a pixelated pattern of microscopic ablative wounds surrounded by healthy tissue in a manner similar to that of [the] NAFR method, AFR combines the increased efficacy of ablative techniques with the safety and reduced downtime associated with FP.”
The investigators declared that they had no conflicts of interest. The study was supported by a research grant from Ellipse A/S, which manufactures the laser used in the study.
Ablative fractional resurfacing appears to be safe and effective in Asians with mild to moderate atrophic acne scarring, according to a study of 13 patients.
While 12 of the 13 patients experienced some postinflammatory hyperpigmentation, this resolved in all patients in an average of 5 weeks.
The Asian patients underwent three sessions of ablative fractional resurfacing (AFR) with the Ellipse Juvia 15-W CO2 laser, wrote Dr. Woraphong Manuskiatti and colleagues of Mahidol University, Bangkok. All patients had skin phototype IV. Intervals between treatments averaged 7 weeks. All patients were followed for 6 months after the third treatment.
Independent physicians blinded to the order in which clinical photos had been taken judged the improvement in scarring to be excellent in 8% of the patients, good in 38.5% of them, fair in 38.5%, and slight in 15%. None of the patients worsened (J. Am. Acad. Dermatol. 2010;63:274-83).
By the patients’ own evaluations, 46% judged their overall improvement to be fair, 23% judged it to be good, and 31% judged it to be excellent. In both physician and patient evaluations, “slight” was defined as less than 25% improvement, “fair” as 25%-50% improvement, good as 51%-75% improvement, and excellent as 76%-100% improvement.
Postinflammatory hyperpigmentation (PIH) was the most common side effect, seen in 12 of the 13 (92%) patients and after 20 of the 39 (51%) treatment sessions. All cases of PIH were graded as mild except for one that was graded as moderate. After treatment with 4% hydroquinone cream once daily, PIH resolved in all patients within 2-16 weeks (average 5 weeks).
Other adverse events were acneiform eruptions in four patients, allergic contact dermatitis in two patients, and herpes simplex infection in one patient.
Each treatment consisted of a full-face single-pass treatment with a 5-7 ms pulse width. Investigators adjusted the laser to deliver 49 microthermal zones (MTZs) per square centimeter, with each individual MTZ 500 mcm in diameter. The average percent coverage was 9.6%, and the investigators set the laser to deliver energies between 75-105 mJ/MTZ depending on the severity of scarring.
Although physicians prepared the patients for 1 hour before each treatment with a topical anesthetic applied to the full face with occlusion, on average patients rated their pain as 8.1 on a scale of 1-10. Pain scores tended to decrease for the second and third treatments.
The investigators described AFR as offering a treatment alternative midway between nonablative fractional resurfacing (NAFR) and fractional photothermolysis (FP). “Although NAFR has a patient-friendly advantage,” the investigators wrote, “the outcomes of most NAFR lasers still leave much to be desired in the treatment of photodamaged skin, rhytides, and atrophic scars. ... By depositing a pixelated pattern of microscopic ablative wounds surrounded by healthy tissue in a manner similar to that of [the] NAFR method, AFR combines the increased efficacy of ablative techniques with the safety and reduced downtime associated with FP.”
The investigators declared that they had no conflicts of interest. The study was supported by a research grant from Ellipse A/S, which manufactures the laser used in the study.
Ablative fractional resurfacing appears to be safe and effective in Asians with mild to moderate atrophic acne scarring, according to a study of 13 patients.
While 12 of the 13 patients experienced some postinflammatory hyperpigmentation, this resolved in all patients in an average of 5 weeks.
The Asian patients underwent three sessions of ablative fractional resurfacing (AFR) with the Ellipse Juvia 15-W CO2 laser, wrote Dr. Woraphong Manuskiatti and colleagues of Mahidol University, Bangkok. All patients had skin phototype IV. Intervals between treatments averaged 7 weeks. All patients were followed for 6 months after the third treatment.
Independent physicians blinded to the order in which clinical photos had been taken judged the improvement in scarring to be excellent in 8% of the patients, good in 38.5% of them, fair in 38.5%, and slight in 15%. None of the patients worsened (J. Am. Acad. Dermatol. 2010;63:274-83).
By the patients’ own evaluations, 46% judged their overall improvement to be fair, 23% judged it to be good, and 31% judged it to be excellent. In both physician and patient evaluations, “slight” was defined as less than 25% improvement, “fair” as 25%-50% improvement, good as 51%-75% improvement, and excellent as 76%-100% improvement.
Postinflammatory hyperpigmentation (PIH) was the most common side effect, seen in 12 of the 13 (92%) patients and after 20 of the 39 (51%) treatment sessions. All cases of PIH were graded as mild except for one that was graded as moderate. After treatment with 4% hydroquinone cream once daily, PIH resolved in all patients within 2-16 weeks (average 5 weeks).
Other adverse events were acneiform eruptions in four patients, allergic contact dermatitis in two patients, and herpes simplex infection in one patient.
Each treatment consisted of a full-face single-pass treatment with a 5-7 ms pulse width. Investigators adjusted the laser to deliver 49 microthermal zones (MTZs) per square centimeter, with each individual MTZ 500 mcm in diameter. The average percent coverage was 9.6%, and the investigators set the laser to deliver energies between 75-105 mJ/MTZ depending on the severity of scarring.
Although physicians prepared the patients for 1 hour before each treatment with a topical anesthetic applied to the full face with occlusion, on average patients rated their pain as 8.1 on a scale of 1-10. Pain scores tended to decrease for the second and third treatments.
The investigators described AFR as offering a treatment alternative midway between nonablative fractional resurfacing (NAFR) and fractional photothermolysis (FP). “Although NAFR has a patient-friendly advantage,” the investigators wrote, “the outcomes of most NAFR lasers still leave much to be desired in the treatment of photodamaged skin, rhytides, and atrophic scars. ... By depositing a pixelated pattern of microscopic ablative wounds surrounded by healthy tissue in a manner similar to that of [the] NAFR method, AFR combines the increased efficacy of ablative techniques with the safety and reduced downtime associated with FP.”
The investigators declared that they had no conflicts of interest. The study was supported by a research grant from Ellipse A/S, which manufactures the laser used in the study.
The Vitamin D Debate
Recent media reports suggest that sun exposure is the best source of vitamin D. One study even reports that one minimal erythema dose of sunlight is equivalent to ingesting approximately 20,000 IU of vitamin D2.
The skin produces approximately 10,000 IU of vitamin D in response to 20-30 minutes of sun exposure in the summer – that’s more than 50 times the U.S. government’s daily recommendation, according to the Vitamin D Council, a nonprofit group whose mission is to promote the health benefits of vitamin D (N. Engl. J. Med. 2007;357:266-81).
The American Academy of Dermatology, however, does not recommend getting vitamin D from sun exposure, indoor tanning, or any source that emits ultraviolet radiation. We know that the maximum production of vitamin D occurs after brief exposure to UV radiation; however, the exact amount of time depends on location, time of day, time of year, and skin type.
For a fair-skinned person in the Northeast, that time is 2-5 minutes at noon during the month of June. However, each variable can alter the amount of vitamin D produced. Any additional vitamin D produced by the body is not stored for future use.
Alternatively, the AAD promotes getting vitamin D from the diet, rather than from sun exposure. The Academy also suggests that dietary sources of vitamin D neither prematurely age the skin nor increase risk of developing skin cancer or actinic keratoses. Sources rich in vitamin D include fortified milk, fortified cereal, salmon, mackerel, and cod liver oil. In addition, vitamin D supplements are well tolerated, safe, and effective. In addition, vitamin D is absorbed with calcium, which must be obtained from dietary sources — not the sun. Thus, a healthy diet rich in both calcium and vitamin D is the best way to ensure appropriate levels of both agents without any of the dangers of UV exposure.
The darker the skin and the farther from the equator an individual is, the greater one’s chances of developing a vitamin D deficiency if the diet is inadequate. African Americans, in particular, have lower vitamin D levels overall, compared with age-matched whites. Dr. Michael Holick from Boston University, who is the nation’s leading vitamin D researcher, said he believes that this exaggerated vitamin D deficiency is the reason there is a gap in the health of white vs. black Americans (J. Invest. Dermatol. 2010;130:546-53).
He believes that lower vitamin D levels are why African Americans develop more prostate, breast, and colon cancers. He believes this might also be the reason why the ethnic group may get more aggressive forms of those cancers (N. Engl. J. Med. 2007;357:266-81).
However, there is no good proof in any well-controlled studies to suggest this. None of the studies reflect reduced access to health care, barriers to healthful living, and differences in income and education. In contrast, some recent studies also indicate that the regulation of vitamin D production is independent of skin color (J. Invest. Dermatol. 2010;130:546-53).
Most vitamin D supplements that are available without a prescription contain cholecalciferol (vitamin D3), which is more potent than ergocalciferol vitamin D2 (J. Clin. Endocrinol. Metab. 2004;89:5387-91; Am. J. Clin. Nutr. 2006;84:694-7; and Am. J. Clin. Nutr. 68:854-8).
Multivitamin supplements generally provide 400 IU (10 mcg) of vitamin D. Single ingredient vitamin D supplements may provide between 400 IUs and 2,000 IUs of vitamin D. Calcium supplements can also provide vitamin D.
The National Academy of Sciences Institute of Medicine (IOM) guidelines for vitamin D are a standard reference for advising patients on proper minimal intake levels.
The Department of Agriculture’s Dietary Guidelines recommend those at risk for vitamin D insufficiency to receive supplementation with a total daily dose of 1,000 IUs vitamin D.
In addition, the AAD recommends supplementation with 200 IUs vitamin D from birth to age 50 years for those who are not at increased risk for vitamin D insufficiency. However, the American Academy of Pediatrics recommends supplementation with 400 IU vitamin D/day for children younger than 18 years of age, including infants.
Because vitamin D can be toxic in high doses, the USDA’s Food and Nutrition Board has set an upper limit for safety for vitamin D intake of 2,000 IUs/day for individuals older than 12 months of age and 1,000 IUs/ day for infants.
There is no real answer to the vitamin D debate at this time. Whether the differences in vitamin D levels are because of skin color or diet are still controversial.
We know that ultraviolet radiation can have harmful effects on the skin and that adequate intake can be achieved by diet or oral supplements. So why is there a debate on how much sun one needs to achieve a so-called “normal” vitamin D level? The answer is none. Everyone, regardless of skin color, should take a daily vitamin D supplement (J. Nutr. 2006;136:1126-9; Am. J. Clin. Nutr. 2004;80:1763S-6S).
Recent media reports suggest that sun exposure is the best source of vitamin D. One study even reports that one minimal erythema dose of sunlight is equivalent to ingesting approximately 20,000 IU of vitamin D2.
The skin produces approximately 10,000 IU of vitamin D in response to 20-30 minutes of sun exposure in the summer – that’s more than 50 times the U.S. government’s daily recommendation, according to the Vitamin D Council, a nonprofit group whose mission is to promote the health benefits of vitamin D (N. Engl. J. Med. 2007;357:266-81).
The American Academy of Dermatology, however, does not recommend getting vitamin D from sun exposure, indoor tanning, or any source that emits ultraviolet radiation. We know that the maximum production of vitamin D occurs after brief exposure to UV radiation; however, the exact amount of time depends on location, time of day, time of year, and skin type.
For a fair-skinned person in the Northeast, that time is 2-5 minutes at noon during the month of June. However, each variable can alter the amount of vitamin D produced. Any additional vitamin D produced by the body is not stored for future use.
Alternatively, the AAD promotes getting vitamin D from the diet, rather than from sun exposure. The Academy also suggests that dietary sources of vitamin D neither prematurely age the skin nor increase risk of developing skin cancer or actinic keratoses. Sources rich in vitamin D include fortified milk, fortified cereal, salmon, mackerel, and cod liver oil. In addition, vitamin D supplements are well tolerated, safe, and effective. In addition, vitamin D is absorbed with calcium, which must be obtained from dietary sources — not the sun. Thus, a healthy diet rich in both calcium and vitamin D is the best way to ensure appropriate levels of both agents without any of the dangers of UV exposure.
The darker the skin and the farther from the equator an individual is, the greater one’s chances of developing a vitamin D deficiency if the diet is inadequate. African Americans, in particular, have lower vitamin D levels overall, compared with age-matched whites. Dr. Michael Holick from Boston University, who is the nation’s leading vitamin D researcher, said he believes that this exaggerated vitamin D deficiency is the reason there is a gap in the health of white vs. black Americans (J. Invest. Dermatol. 2010;130:546-53).
He believes that lower vitamin D levels are why African Americans develop more prostate, breast, and colon cancers. He believes this might also be the reason why the ethnic group may get more aggressive forms of those cancers (N. Engl. J. Med. 2007;357:266-81).
However, there is no good proof in any well-controlled studies to suggest this. None of the studies reflect reduced access to health care, barriers to healthful living, and differences in income and education. In contrast, some recent studies also indicate that the regulation of vitamin D production is independent of skin color (J. Invest. Dermatol. 2010;130:546-53).
Most vitamin D supplements that are available without a prescription contain cholecalciferol (vitamin D3), which is more potent than ergocalciferol vitamin D2 (J. Clin. Endocrinol. Metab. 2004;89:5387-91; Am. J. Clin. Nutr. 2006;84:694-7; and Am. J. Clin. Nutr. 68:854-8).
Multivitamin supplements generally provide 400 IU (10 mcg) of vitamin D. Single ingredient vitamin D supplements may provide between 400 IUs and 2,000 IUs of vitamin D. Calcium supplements can also provide vitamin D.
The National Academy of Sciences Institute of Medicine (IOM) guidelines for vitamin D are a standard reference for advising patients on proper minimal intake levels.
The Department of Agriculture’s Dietary Guidelines recommend those at risk for vitamin D insufficiency to receive supplementation with a total daily dose of 1,000 IUs vitamin D.
In addition, the AAD recommends supplementation with 200 IUs vitamin D from birth to age 50 years for those who are not at increased risk for vitamin D insufficiency. However, the American Academy of Pediatrics recommends supplementation with 400 IU vitamin D/day for children younger than 18 years of age, including infants.
Because vitamin D can be toxic in high doses, the USDA’s Food and Nutrition Board has set an upper limit for safety for vitamin D intake of 2,000 IUs/day for individuals older than 12 months of age and 1,000 IUs/ day for infants.
There is no real answer to the vitamin D debate at this time. Whether the differences in vitamin D levels are because of skin color or diet are still controversial.
We know that ultraviolet radiation can have harmful effects on the skin and that adequate intake can be achieved by diet or oral supplements. So why is there a debate on how much sun one needs to achieve a so-called “normal” vitamin D level? The answer is none. Everyone, regardless of skin color, should take a daily vitamin D supplement (J. Nutr. 2006;136:1126-9; Am. J. Clin. Nutr. 2004;80:1763S-6S).
Recent media reports suggest that sun exposure is the best source of vitamin D. One study even reports that one minimal erythema dose of sunlight is equivalent to ingesting approximately 20,000 IU of vitamin D2.
The skin produces approximately 10,000 IU of vitamin D in response to 20-30 minutes of sun exposure in the summer – that’s more than 50 times the U.S. government’s daily recommendation, according to the Vitamin D Council, a nonprofit group whose mission is to promote the health benefits of vitamin D (N. Engl. J. Med. 2007;357:266-81).
The American Academy of Dermatology, however, does not recommend getting vitamin D from sun exposure, indoor tanning, or any source that emits ultraviolet radiation. We know that the maximum production of vitamin D occurs after brief exposure to UV radiation; however, the exact amount of time depends on location, time of day, time of year, and skin type.
For a fair-skinned person in the Northeast, that time is 2-5 minutes at noon during the month of June. However, each variable can alter the amount of vitamin D produced. Any additional vitamin D produced by the body is not stored for future use.
Alternatively, the AAD promotes getting vitamin D from the diet, rather than from sun exposure. The Academy also suggests that dietary sources of vitamin D neither prematurely age the skin nor increase risk of developing skin cancer or actinic keratoses. Sources rich in vitamin D include fortified milk, fortified cereal, salmon, mackerel, and cod liver oil. In addition, vitamin D supplements are well tolerated, safe, and effective. In addition, vitamin D is absorbed with calcium, which must be obtained from dietary sources — not the sun. Thus, a healthy diet rich in both calcium and vitamin D is the best way to ensure appropriate levels of both agents without any of the dangers of UV exposure.
The darker the skin and the farther from the equator an individual is, the greater one’s chances of developing a vitamin D deficiency if the diet is inadequate. African Americans, in particular, have lower vitamin D levels overall, compared with age-matched whites. Dr. Michael Holick from Boston University, who is the nation’s leading vitamin D researcher, said he believes that this exaggerated vitamin D deficiency is the reason there is a gap in the health of white vs. black Americans (J. Invest. Dermatol. 2010;130:546-53).
He believes that lower vitamin D levels are why African Americans develop more prostate, breast, and colon cancers. He believes this might also be the reason why the ethnic group may get more aggressive forms of those cancers (N. Engl. J. Med. 2007;357:266-81).
However, there is no good proof in any well-controlled studies to suggest this. None of the studies reflect reduced access to health care, barriers to healthful living, and differences in income and education. In contrast, some recent studies also indicate that the regulation of vitamin D production is independent of skin color (J. Invest. Dermatol. 2010;130:546-53).
Most vitamin D supplements that are available without a prescription contain cholecalciferol (vitamin D3), which is more potent than ergocalciferol vitamin D2 (J. Clin. Endocrinol. Metab. 2004;89:5387-91; Am. J. Clin. Nutr. 2006;84:694-7; and Am. J. Clin. Nutr. 68:854-8).
Multivitamin supplements generally provide 400 IU (10 mcg) of vitamin D. Single ingredient vitamin D supplements may provide between 400 IUs and 2,000 IUs of vitamin D. Calcium supplements can also provide vitamin D.
The National Academy of Sciences Institute of Medicine (IOM) guidelines for vitamin D are a standard reference for advising patients on proper minimal intake levels.
The Department of Agriculture’s Dietary Guidelines recommend those at risk for vitamin D insufficiency to receive supplementation with a total daily dose of 1,000 IUs vitamin D.
In addition, the AAD recommends supplementation with 200 IUs vitamin D from birth to age 50 years for those who are not at increased risk for vitamin D insufficiency. However, the American Academy of Pediatrics recommends supplementation with 400 IU vitamin D/day for children younger than 18 years of age, including infants.
Because vitamin D can be toxic in high doses, the USDA’s Food and Nutrition Board has set an upper limit for safety for vitamin D intake of 2,000 IUs/day for individuals older than 12 months of age and 1,000 IUs/ day for infants.
There is no real answer to the vitamin D debate at this time. Whether the differences in vitamin D levels are because of skin color or diet are still controversial.
We know that ultraviolet radiation can have harmful effects on the skin and that adequate intake can be achieved by diet or oral supplements. So why is there a debate on how much sun one needs to achieve a so-called “normal” vitamin D level? The answer is none. Everyone, regardless of skin color, should take a daily vitamin D supplement (J. Nutr. 2006;136:1126-9; Am. J. Clin. Nutr. 2004;80:1763S-6S).