Aesthetic Dermatology

A great victory for our patients suffering from cicatricial alopecia—Dr. Pratima Karnik, assistant professor of dermatology at Cleveland’s Case Western Reserve University, received a $1.77 National Institutes of Health grant to fund a 5 year study on hair follicle, stem cell specific, PPAR-gamma deficiency in scarring alopecia.

Her research, published in the Journal of Investigative Dermatology, linked a defect in lipid processing and peroxisome biogenesis to cicatricial alopecia. As a result, it paved the way for a breakthrough finding in understanding the pathophysiology of the permanent hair loss disorder (J Invest Dermatol. 2009 May;129(5):1066-70).

Dr. Karnik and her colleagues found that unprocessed lipids are responsible for developing scarring hair loss. Their research suggests that processed lipids are necessary for hair growth and unprocessed lipids are toxic to hair. The bench-side research has led to clinical findings that treating patients with drugs that enhance lipid processing may relieve the clinical symptoms of the disorder.

Central centrifugal cicatricial alopecia, a scarring hair loss prevalent in African Americans, has no well-defined cause and has been difficult to and frustrating for patients.

Dr. Karnik’s research, and the work of the Cicatricial Alopecia Research Foundation (www.carfintl.org), is helping patients and physicians understand the biology, natural history, and treatment options for patients.
 
I personally attended a session with NIH Director Dr. Francis S. Collins, on behalf of CARF, where underrepresented and underfunded organizations had a chance to voice their opinions to the NIH and gain the well deserved attention they need.

Dr. Collins suggested that a new structure of communication was being established at the NIH, noting that any organization can send a brief summary of issues it would like to bring to the attention of the NIH. The e-mail address is [email protected]. He ensured us he would look at every e-mail and respond to each one.

Often, rare diseases are difficult to study given the lack of attention and funding.  The work of Dr. Karnik and her collaborative team, and organizations like CARF, give hope to the thousands of people suffering from cicatricial alopecia.

A great victory for our patients suffering from cicatricial alopecia—Dr. Pratima Karnik, assistant professor of dermatology at Cleveland’s Case Western Reserve University, received a $1.77 National Institutes of Health grant to fund a 5 year study on hair follicle, stem cell specific, PPAR-gamma deficiency in scarring alopecia.

Her research, published in the Journal of Investigative Dermatology, linked a defect in lipid processing and peroxisome biogenesis to cicatricial alopecia. As a result, it paved the way for a breakthrough finding in understanding the pathophysiology of the permanent hair loss disorder (J Invest Dermatol. 2009 May;129(5):1066-70).

Dr. Karnik and her colleagues found that unprocessed lipids are responsible for developing scarring hair loss. Their research suggests that processed lipids are necessary for hair growth and unprocessed lipids are toxic to hair. The bench-side research has led to clinical findings that treating patients with drugs that enhance lipid processing may relieve the clinical symptoms of the disorder.

Central centrifugal cicatricial alopecia, a scarring hair loss prevalent in African Americans, has no well-defined cause and has been difficult to and frustrating for patients.

Dr. Karnik’s research, and the work of the Cicatricial Alopecia Research Foundation (www.carfintl.org), is helping patients and physicians understand the biology, natural history, and treatment options for patients.
 
I personally attended a session with NIH Director Dr. Francis S. Collins, on behalf of CARF, where underrepresented and underfunded organizations had a chance to voice their opinions to the NIH and gain the well deserved attention they need.

Dr. Collins suggested that a new structure of communication was being established at the NIH, noting that any organization can send a brief summary of issues it would like to bring to the attention of the NIH. The e-mail address is [email protected]. He ensured us he would look at every e-mail and respond to each one.

Often, rare diseases are difficult to study given the lack of attention and funding.  The work of Dr. Karnik and her collaborative team, and organizations like CARF, give hope to the thousands of people suffering from cicatricial alopecia.

A great victory for our patients suffering from cicatricial alopecia—Dr. Pratima Karnik, assistant professor of dermatology at Cleveland’s Case Western Reserve University, received a $1.77 National Institutes of Health grant to fund a 5 year study on hair follicle, stem cell specific, PPAR-gamma deficiency in scarring alopecia.

Her research, published in the Journal of Investigative Dermatology, linked a defect in lipid processing and peroxisome biogenesis to cicatricial alopecia. As a result, it paved the way for a breakthrough finding in understanding the pathophysiology of the permanent hair loss disorder (J Invest Dermatol. 2009 May;129(5):1066-70).

Dr. Karnik and her colleagues found that unprocessed lipids are responsible for developing scarring hair loss. Their research suggests that processed lipids are necessary for hair growth and unprocessed lipids are toxic to hair. The bench-side research has led to clinical findings that treating patients with drugs that enhance lipid processing may relieve the clinical symptoms of the disorder.

Central centrifugal cicatricial alopecia, a scarring hair loss prevalent in African Americans, has no well-defined cause and has been difficult to and frustrating for patients.

Dr. Karnik’s research, and the work of the Cicatricial Alopecia Research Foundation (www.carfintl.org), is helping patients and physicians understand the biology, natural history, and treatment options for patients.
 
I personally attended a session with NIH Director Dr. Francis S. Collins, on behalf of CARF, where underrepresented and underfunded organizations had a chance to voice their opinions to the NIH and gain the well deserved attention they need.

Dr. Collins suggested that a new structure of communication was being established at the NIH, noting that any organization can send a brief summary of issues it would like to bring to the attention of the NIH. The e-mail address is [email protected]. He ensured us he would look at every e-mail and respond to each one.

Often, rare diseases are difficult to study given the lack of attention and funding.  The work of Dr. Karnik and her collaborative team, and organizations like CARF, give hope to the thousands of people suffering from cicatricial alopecia.

The Food and Drug Administration announced April 7 that it sent warning letters to six medical spas and a Brazilian company asking them to cease and desist from making false and misleading claims about injectable lipodissolve products.

The companies cited by the FDA have made claims that their injectables are superior to other fat-dissolving or -removing procedures, and the injections can treat conditions such as gynecomastia and surgical deformities, said Kathleen Anderson, deputy director of the Division of New Drugs and Labeling Compliance at the FDA’s Center for Drug Evaluation and Research, in a briefing with reporters. The claims are illegal without clinical evidence or explicit FDA approval for the injectables, which generally contain phosphatidylcholine (PPC) and/or deoxycholate, and a variety of vitamins, minerals, and herbal extracts.

The letters were sent by overnight mail on April 5 to six American spas: Monarch Medspa, King of Prussia, Penn.; Spa 35, Boise, Idaho; Medical Cosmetic Enhancements, Chevy Chase, Md.; Innovative Directions in Health, Edina, Minn.; Pure Med Spa, Boca Raton, Fla.; and All About You Med Spa, Madison, Ind.

The Brazilian company cited by the FDA sells lipodissolve products through its two Web sites www.zipmed.net and www.mesoone.com. The agency has issued an import alert for the Web sites, which should prevent the importation and distribution of the products.

Ms. Anderson said the companies were singled out because they had made what were considered to be the most egregious claims among the sites the FDA has monitored.

The agency is hoping to warn consumers that if they purchase these services, they are receiving therapies that are not approved by the FDA, she said. In addition, the drug components—PPC and deoxycholate—are not specifically approved as injectables or for fat dissolution. They are approved for inhalation as a lung surfactant in acute respiratory distress syndrome, said Ms. Anderson.

A complete list of concerns about lipodissolve, also known as mesotherapy or injectable lipolysis, can be found on an updated page for consumers on the FDA Web site. Among the safety concerns are permanent scarring, skin deformation, and painful knots under the skin. The agency has received five reports of such adverse events, Ms. Anderson said.

The FDA also said that clinicians who are using lipodissolve products should submit an application for approval so the agency can evaluate safety and efficacy. The Aesthetic Surgery Education and Research Foundation is conducting a small, placebo-controlled study using sham injections, compared with injections of PPC and sodium deoxycholate. The FDA has approved the study.

But most professional societies, including the Physicians Coalition for Injectable Safety, the American Society for Aesthetic Plastic Surgery (ASAPS), and the American Society for Dermatologic Surgery, have warned against fat-dissolving injections until there is further proof of efficacy and safety.

The FDA, for its part, said it would be monitoring further use of lipodissolve, whether by unlicensed practitioners or physicians. “If there are clinics and medical practices that are going to be making false and misleading claims, then we will go after them as well,” said Sudha Shukla, Pharm. D., of the FDA’s Division of New Drugs and Labeling Compliance, during the briefing.

It is not clear how many lipodissolve procedures are done each year. The ASAPS reported that 18,000 were done in 2008, but that an insufficient number of clinicians responded to its annual survey in 2009 to give a reliable number.

The companies cited by the FDA have 15 days to respond to the agency’s warning. If sufficient steps are not taken, then the agency has the power to issue an injunction or seize products, said Ms. Anderson.

The Food and Drug Administration announced April 7 that it sent warning letters to six medical spas and a Brazilian company asking them to cease and desist from making false and misleading claims about injectable lipodissolve products.

The companies cited by the FDA have made claims that their injectables are superior to other fat-dissolving or -removing procedures, and the injections can treat conditions such as gynecomastia and surgical deformities, said Kathleen Anderson, deputy director of the Division of New Drugs and Labeling Compliance at the FDA’s Center for Drug Evaluation and Research, in a briefing with reporters. The claims are illegal without clinical evidence or explicit FDA approval for the injectables, which generally contain phosphatidylcholine (PPC) and/or deoxycholate, and a variety of vitamins, minerals, and herbal extracts.

The letters were sent by overnight mail on April 5 to six American spas: Monarch Medspa, King of Prussia, Penn.; Spa 35, Boise, Idaho; Medical Cosmetic Enhancements, Chevy Chase, Md.; Innovative Directions in Health, Edina, Minn.; Pure Med Spa, Boca Raton, Fla.; and All About You Med Spa, Madison, Ind.

The Brazilian company cited by the FDA sells lipodissolve products through its two Web sites www.zipmed.net and www.mesoone.com. The agency has issued an import alert for the Web sites, which should prevent the importation and distribution of the products.

Ms. Anderson said the companies were singled out because they had made what were considered to be the most egregious claims among the sites the FDA has monitored.

The agency is hoping to warn consumers that if they purchase these services, they are receiving therapies that are not approved by the FDA, she said. In addition, the drug components—PPC and deoxycholate—are not specifically approved as injectables or for fat dissolution. They are approved for inhalation as a lung surfactant in acute respiratory distress syndrome, said Ms. Anderson.

A complete list of concerns about lipodissolve, also known as mesotherapy or injectable lipolysis, can be found on an updated page for consumers on the FDA Web site. Among the safety concerns are permanent scarring, skin deformation, and painful knots under the skin. The agency has received five reports of such adverse events, Ms. Anderson said.

The FDA also said that clinicians who are using lipodissolve products should submit an application for approval so the agency can evaluate safety and efficacy. The Aesthetic Surgery Education and Research Foundation is conducting a small, placebo-controlled study using sham injections, compared with injections of PPC and sodium deoxycholate. The FDA has approved the study.

But most professional societies, including the Physicians Coalition for Injectable Safety, the American Society for Aesthetic Plastic Surgery (ASAPS), and the American Society for Dermatologic Surgery, have warned against fat-dissolving injections until there is further proof of efficacy and safety.

The FDA, for its part, said it would be monitoring further use of lipodissolve, whether by unlicensed practitioners or physicians. “If there are clinics and medical practices that are going to be making false and misleading claims, then we will go after them as well,” said Sudha Shukla, Pharm. D., of the FDA’s Division of New Drugs and Labeling Compliance, during the briefing.

It is not clear how many lipodissolve procedures are done each year. The ASAPS reported that 18,000 were done in 2008, but that an insufficient number of clinicians responded to its annual survey in 2009 to give a reliable number.

The companies cited by the FDA have 15 days to respond to the agency’s warning. If sufficient steps are not taken, then the agency has the power to issue an injunction or seize products, said Ms. Anderson.

The Food and Drug Administration announced April 7 that it sent warning letters to six medical spas and a Brazilian company asking them to cease and desist from making false and misleading claims about injectable lipodissolve products.

The companies cited by the FDA have made claims that their injectables are superior to other fat-dissolving or -removing procedures, and the injections can treat conditions such as gynecomastia and surgical deformities, said Kathleen Anderson, deputy director of the Division of New Drugs and Labeling Compliance at the FDA’s Center for Drug Evaluation and Research, in a briefing with reporters. The claims are illegal without clinical evidence or explicit FDA approval for the injectables, which generally contain phosphatidylcholine (PPC) and/or deoxycholate, and a variety of vitamins, minerals, and herbal extracts.

The letters were sent by overnight mail on April 5 to six American spas: Monarch Medspa, King of Prussia, Penn.; Spa 35, Boise, Idaho; Medical Cosmetic Enhancements, Chevy Chase, Md.; Innovative Directions in Health, Edina, Minn.; Pure Med Spa, Boca Raton, Fla.; and All About You Med Spa, Madison, Ind.

The Brazilian company cited by the FDA sells lipodissolve products through its two Web sites www.zipmed.net and www.mesoone.com. The agency has issued an import alert for the Web sites, which should prevent the importation and distribution of the products.

Ms. Anderson said the companies were singled out because they had made what were considered to be the most egregious claims among the sites the FDA has monitored.

The agency is hoping to warn consumers that if they purchase these services, they are receiving therapies that are not approved by the FDA, she said. In addition, the drug components—PPC and deoxycholate—are not specifically approved as injectables or for fat dissolution. They are approved for inhalation as a lung surfactant in acute respiratory distress syndrome, said Ms. Anderson.

A complete list of concerns about lipodissolve, also known as mesotherapy or injectable lipolysis, can be found on an updated page for consumers on the FDA Web site. Among the safety concerns are permanent scarring, skin deformation, and painful knots under the skin. The agency has received five reports of such adverse events, Ms. Anderson said.

The FDA also said that clinicians who are using lipodissolve products should submit an application for approval so the agency can evaluate safety and efficacy. The Aesthetic Surgery Education and Research Foundation is conducting a small, placebo-controlled study using sham injections, compared with injections of PPC and sodium deoxycholate. The FDA has approved the study.

But most professional societies, including the Physicians Coalition for Injectable Safety, the American Society for Aesthetic Plastic Surgery (ASAPS), and the American Society for Dermatologic Surgery, have warned against fat-dissolving injections until there is further proof of efficacy and safety.

The FDA, for its part, said it would be monitoring further use of lipodissolve, whether by unlicensed practitioners or physicians. “If there are clinics and medical practices that are going to be making false and misleading claims, then we will go after them as well,” said Sudha Shukla, Pharm. D., of the FDA’s Division of New Drugs and Labeling Compliance, during the briefing.

It is not clear how many lipodissolve procedures are done each year. The ASAPS reported that 18,000 were done in 2008, but that an insufficient number of clinicians responded to its annual survey in 2009 to give a reliable number.

The companies cited by the FDA have 15 days to respond to the agency’s warning. If sufficient steps are not taken, then the agency has the power to issue an injunction or seize products, said Ms. Anderson.

Polidocanol injection for treating varicose veins has been approved by the Food and Drug Administration, according to the agency.

Distributed by BioFarm Medical Inc. as Asclera, polidocanol is approved to treat small spider and reticular veins, specifically those ranging in size from less than 1 mm to up to 3 mm. The injectable agent improves the appearance of varicose veins by damaging the cell lining of the blood vessels, thus causing vessels to close and be replaced by less-visible types of tissue.

"Varicose veins are a common condition. Asclera is indicated for the treatment of small types of varicose veins when the aim of treatment is to improve appearance," said Dr. Norman Stockbridge, director of the division of cardiovascular and renal products at the FDA's Center for Drug Evaluation and Research, Silver Spring, Md.

It is estimated that as many as 55% of American women and 45% of American men have some form of vein problem, according to the U.S. Department of Health and Human Services. Varicose veins affect half of people age 50 years and older.

Asclera is manufactured by the German company Chemische Fabrik Kreussler & Co.

Common adverse reactions to polidocanol include leakage and collection of blood from damaged blood vessels at the injection site (hematoma), bruising, irritation, discoloration, and pain at the injection site, the FDA said.

Most commonly occurring in the legs, varicose veins are caused by a number of factors, including genetics, age, female gender, pregnancy, and obesity; prolonged periods of standing may increase the risk for varicose veins, according to the agency.

Polidocanol has been used to treat varicose veins in Europe for more than 40 years.

Polidocanol injection for treating varicose veins has been approved by the Food and Drug Administration, according to the agency.

Distributed by BioFarm Medical Inc. as Asclera, polidocanol is approved to treat small spider and reticular veins, specifically those ranging in size from less than 1 mm to up to 3 mm. The injectable agent improves the appearance of varicose veins by damaging the cell lining of the blood vessels, thus causing vessels to close and be replaced by less-visible types of tissue.

"Varicose veins are a common condition. Asclera is indicated for the treatment of small types of varicose veins when the aim of treatment is to improve appearance," said Dr. Norman Stockbridge, director of the division of cardiovascular and renal products at the FDA's Center for Drug Evaluation and Research, Silver Spring, Md.

It is estimated that as many as 55% of American women and 45% of American men have some form of vein problem, according to the U.S. Department of Health and Human Services. Varicose veins affect half of people age 50 years and older.

Asclera is manufactured by the German company Chemische Fabrik Kreussler & Co.

Common adverse reactions to polidocanol include leakage and collection of blood from damaged blood vessels at the injection site (hematoma), bruising, irritation, discoloration, and pain at the injection site, the FDA said.

Most commonly occurring in the legs, varicose veins are caused by a number of factors, including genetics, age, female gender, pregnancy, and obesity; prolonged periods of standing may increase the risk for varicose veins, according to the agency.

Polidocanol has been used to treat varicose veins in Europe for more than 40 years.

Polidocanol injection for treating varicose veins has been approved by the Food and Drug Administration, according to the agency.

Distributed by BioFarm Medical Inc. as Asclera, polidocanol is approved to treat small spider and reticular veins, specifically those ranging in size from less than 1 mm to up to 3 mm. The injectable agent improves the appearance of varicose veins by damaging the cell lining of the blood vessels, thus causing vessels to close and be replaced by less-visible types of tissue.

"Varicose veins are a common condition. Asclera is indicated for the treatment of small types of varicose veins when the aim of treatment is to improve appearance," said Dr. Norman Stockbridge, director of the division of cardiovascular and renal products at the FDA's Center for Drug Evaluation and Research, Silver Spring, Md.

It is estimated that as many as 55% of American women and 45% of American men have some form of vein problem, according to the U.S. Department of Health and Human Services. Varicose veins affect half of people age 50 years and older.

Asclera is manufactured by the German company Chemische Fabrik Kreussler & Co.

Common adverse reactions to polidocanol include leakage and collection of blood from damaged blood vessels at the injection site (hematoma), bruising, irritation, discoloration, and pain at the injection site, the FDA said.

Most commonly occurring in the legs, varicose veins are caused by a number of factors, including genetics, age, female gender, pregnancy, and obesity; prolonged periods of standing may increase the risk for varicose veins, according to the agency.

Polidocanol has been used to treat varicose veins in Europe for more than 40 years.

ORLANDO - The fractional eCO2 laser appears to be an effective and safe tool for eyelid resurfacing, with quick re-epithelialization and resolution of erythema, according to a chart review of 28 patients.

Patients treated with the laser at a 120-mcm spot size healed an average of 1.2 days faster than those treated with a 300-mcm spot size, but they expressed similar levels of satisfaction with both sizes, Dr. Julie Woodward (photographed on the left) said at the annual meeting of the American Academy of Cosmetic Surgery.

Eyelid resurfacing with the Lutronic eCO2 laser holds several advantages over traditional CO2 laser resurfacing, said Dr. Woodward of Duke University Medical Center, Durham, N.C.

"Fractional eCO2 allows laser energy to heat tissue deep in the reticular dermis via microablative columns without removing all of the surface epithelium as traditional CO2 lasers did," she said in an interview. "The healing time is significantly reduced with fractional eCO2 in comparison to traditional resurfacing, which is an advantage for patients who want to return to work."

All of the 28 patients underwent eyelid resurfacing with the eCO2 laser. The study included patients with Fitzpatrick skin types I-IV, with the majority being II and III. Patients were randomly assigned to the 120-mcm spot size (17) or the 300-mcm spot size (11).

Twenty of the patients underwent a concurrent bilateral lower-lid transconjunctival blepharoplasty. They were instructed to use vinegar and Aquaphor for the first two postop days, followed by vinegar and a sunscreen with zinc until epithelialization.

Two physicians who were blinded to the clinic visits evaluated patient response by rating more than 260 photos, which were presented in random order from preoperative to 6 months postoperative. They rated erythema, rhytids, telangiectasias, and dyschromia. The study also included patient reports of overall satisfaction and dry eye.

Erythema was similar in both groups, peaking at 1 week (level of 2 on 4-point scale) and then decreasing sharply to 0.5 by 1 month and 0 by 6 months.

Patients in the 120-mcm group experienced epithelization in an average of 5.6 days; the 300-mcm group took 6.4 days.

Rhytids, rated on a 3-point scale, decreased from an average of 2.5 to 1 by 1 week, with no significant between-group difference. By 6 months, rhytids were an average of 1.7, with no difference between the groups.

Telangiectasias were low at baseline (0.25 on a 5-point scale) and remained unchanged by 6 months, with no between-group difference. There also was no difference in the occurrence of dry eye. Dyschromias improved from 1 to 0.5. Patient satisfaction was high in both groups, rising from 0 to 2.5 on a scale of 0-4 at 1 month and 3.5 at 6 months. Patient satisfaction for the eight patients who did not have blepharoplasty was very similar.

There was no ectropion, infection, herpetic outbreaks, or hypopigmentation. Two patients developed postinflammatory hyperpigmentation, which resolved with hydroquinone 4%.

 "This is an exciting new treatment with high patient satisfaction that can be done in a single treatment under local anesthesia. Traditional CO2 resurfacing may tighten the skin and reduce more rhytids than fractional resurfacing, but with the eCO2 laser, a physician can use the 1-mm spot size to do a traditional resurfacing if indicated," Dr. Woodward said.

The laser used in the study is on loan from the manufacturer, Lutronic Inc. Neither Dr. Woodward nor any of her coinvestigators accept remuneration from the company.

ORLANDO - The fractional eCO2 laser appears to be an effective and safe tool for eyelid resurfacing, with quick re-epithelialization and resolution of erythema, according to a chart review of 28 patients.

Patients treated with the laser at a 120-mcm spot size healed an average of 1.2 days faster than those treated with a 300-mcm spot size, but they expressed similar levels of satisfaction with both sizes, Dr. Julie Woodward (photographed on the left) said at the annual meeting of the American Academy of Cosmetic Surgery.

Eyelid resurfacing with the Lutronic eCO2 laser holds several advantages over traditional CO2 laser resurfacing, said Dr. Woodward of Duke University Medical Center, Durham, N.C.

"Fractional eCO2 allows laser energy to heat tissue deep in the reticular dermis via microablative columns without removing all of the surface epithelium as traditional CO2 lasers did," she said in an interview. "The healing time is significantly reduced with fractional eCO2 in comparison to traditional resurfacing, which is an advantage for patients who want to return to work."

All of the 28 patients underwent eyelid resurfacing with the eCO2 laser. The study included patients with Fitzpatrick skin types I-IV, with the majority being II and III. Patients were randomly assigned to the 120-mcm spot size (17) or the 300-mcm spot size (11).

Twenty of the patients underwent a concurrent bilateral lower-lid transconjunctival blepharoplasty. They were instructed to use vinegar and Aquaphor for the first two postop days, followed by vinegar and a sunscreen with zinc until epithelialization.

Two physicians who were blinded to the clinic visits evaluated patient response by rating more than 260 photos, which were presented in random order from preoperative to 6 months postoperative. They rated erythema, rhytids, telangiectasias, and dyschromia. The study also included patient reports of overall satisfaction and dry eye.

Erythema was similar in both groups, peaking at 1 week (level of 2 on 4-point scale) and then decreasing sharply to 0.5 by 1 month and 0 by 6 months.

Patients in the 120-mcm group experienced epithelization in an average of 5.6 days; the 300-mcm group took 6.4 days.

Rhytids, rated on a 3-point scale, decreased from an average of 2.5 to 1 by 1 week, with no significant between-group difference. By 6 months, rhytids were an average of 1.7, with no difference between the groups.

Telangiectasias were low at baseline (0.25 on a 5-point scale) and remained unchanged by 6 months, with no between-group difference. There also was no difference in the occurrence of dry eye. Dyschromias improved from 1 to 0.5. Patient satisfaction was high in both groups, rising from 0 to 2.5 on a scale of 0-4 at 1 month and 3.5 at 6 months. Patient satisfaction for the eight patients who did not have blepharoplasty was very similar.

There was no ectropion, infection, herpetic outbreaks, or hypopigmentation. Two patients developed postinflammatory hyperpigmentation, which resolved with hydroquinone 4%.

 "This is an exciting new treatment with high patient satisfaction that can be done in a single treatment under local anesthesia. Traditional CO2 resurfacing may tighten the skin and reduce more rhytids than fractional resurfacing, but with the eCO2 laser, a physician can use the 1-mm spot size to do a traditional resurfacing if indicated," Dr. Woodward said.

The laser used in the study is on loan from the manufacturer, Lutronic Inc. Neither Dr. Woodward nor any of her coinvestigators accept remuneration from the company.

ORLANDO - The fractional eCO2 laser appears to be an effective and safe tool for eyelid resurfacing, with quick re-epithelialization and resolution of erythema, according to a chart review of 28 patients.

Patients treated with the laser at a 120-mcm spot size healed an average of 1.2 days faster than those treated with a 300-mcm spot size, but they expressed similar levels of satisfaction with both sizes, Dr. Julie Woodward (photographed on the left) said at the annual meeting of the American Academy of Cosmetic Surgery.

Eyelid resurfacing with the Lutronic eCO2 laser holds several advantages over traditional CO2 laser resurfacing, said Dr. Woodward of Duke University Medical Center, Durham, N.C.

"Fractional eCO2 allows laser energy to heat tissue deep in the reticular dermis via microablative columns without removing all of the surface epithelium as traditional CO2 lasers did," she said in an interview. "The healing time is significantly reduced with fractional eCO2 in comparison to traditional resurfacing, which is an advantage for patients who want to return to work."

All of the 28 patients underwent eyelid resurfacing with the eCO2 laser. The study included patients with Fitzpatrick skin types I-IV, with the majority being II and III. Patients were randomly assigned to the 120-mcm spot size (17) or the 300-mcm spot size (11).

Twenty of the patients underwent a concurrent bilateral lower-lid transconjunctival blepharoplasty. They were instructed to use vinegar and Aquaphor for the first two postop days, followed by vinegar and a sunscreen with zinc until epithelialization.

Two physicians who were blinded to the clinic visits evaluated patient response by rating more than 260 photos, which were presented in random order from preoperative to 6 months postoperative. They rated erythema, rhytids, telangiectasias, and dyschromia. The study also included patient reports of overall satisfaction and dry eye.

Erythema was similar in both groups, peaking at 1 week (level of 2 on 4-point scale) and then decreasing sharply to 0.5 by 1 month and 0 by 6 months.

Patients in the 120-mcm group experienced epithelization in an average of 5.6 days; the 300-mcm group took 6.4 days.

Rhytids, rated on a 3-point scale, decreased from an average of 2.5 to 1 by 1 week, with no significant between-group difference. By 6 months, rhytids were an average of 1.7, with no difference between the groups.

Telangiectasias were low at baseline (0.25 on a 5-point scale) and remained unchanged by 6 months, with no between-group difference. There also was no difference in the occurrence of dry eye. Dyschromias improved from 1 to 0.5. Patient satisfaction was high in both groups, rising from 0 to 2.5 on a scale of 0-4 at 1 month and 3.5 at 6 months. Patient satisfaction for the eight patients who did not have blepharoplasty was very similar.

There was no ectropion, infection, herpetic outbreaks, or hypopigmentation. Two patients developed postinflammatory hyperpigmentation, which resolved with hydroquinone 4%.

 "This is an exciting new treatment with high patient satisfaction that can be done in a single treatment under local anesthesia. Traditional CO2 resurfacing may tighten the skin and reduce more rhytids than fractional resurfacing, but with the eCO2 laser, a physician can use the 1-mm spot size to do a traditional resurfacing if indicated," Dr. Woodward said.

The laser used in the study is on loan from the manufacturer, Lutronic Inc. Neither Dr. Woodward nor any of her coinvestigators accept remuneration from the company.

The use of harsh hair care practices and acquired hair shaft defects are very common in African American and Hispanic patients. Many studies have previously highlighted the structural damage that hair colors, relaxers, and perms can have on hair. Similar to chemicals, thermal damage can also damage the hair shaft when used over time and at high temperatures (J. Cosmet. Sci. 2004;55:13–27).

In a commentary in the January issue of the Journal of the American Academy of Dermatology, Dr. Paradi Mirmirani discussed the use of ceramic flatirons in Hispanic and African American women and acquired distal trichorrhexis nodosa sustained from repeated thermal injury (J. Am. Acad. Derm. 2010;62:145-7).

Trichorrhexis nodosa is an inherited or acquired hair shaft defect in which the hair is fragile and easily broken; on microscopic examination, filaments of the hair shaft are frayed like a broomstick.

Hot combs have been used for decades to straighten curly hair. Newer flatirons also provide temporary hair straightening, and are widely popular among women of every ethnic background. The uniform temperature distribution among the hair iron tongs allows the heat to temporarily break and reform the hydrogen bonds within the hair shaft.

In the process, the heat causes damage to the hair cuticle resulting in breakage and trichorrhexis nodosa.

Dr. Mirmirani, a dermatologist in Vallejo, Calif., noted that the ceramic coating of the metal in flatirons known as “thermal barrier coating,” decreases the impact of heat on the underlying metal (Annu. Rev. Materials Res. 2003;33:383–417), resulting in better heat distribution, retention, and transfer thought to result in “safer” heating of the hair.

However Dr. Mirmirani commented that although the ceramic-coated flatirons may be more efficient than metal ones, they result in more damage with improper use. Hair becomes dry, brittle, breaks easily and looks more untamed, leading to increased flatiron use to tame uneven hair.

Ceramic flatirons reach temperatures of up to 210° C which damages most hair, particularly chemically or color treated hair. African American hair which is extremely fragile and is often chemically relaxed, sustains significant damage with these high temperatures, and breakage occurs with repeated use of flatirons.  Dr. Mirmirani counsels patients with trichorrhexis nodosa to avoid any heat or chemicals, to cut off the damaged hair, and to practice gentle hair care in order to minimize friction that can result in breakage.

^{Image courtesy Flickr user strangelibrarian (Creative Commons)}

The use of harsh hair care practices and acquired hair shaft defects are very common in African American and Hispanic patients. Many studies have previously highlighted the structural damage that hair colors, relaxers, and perms can have on hair. Similar to chemicals, thermal damage can also damage the hair shaft when used over time and at high temperatures (J. Cosmet. Sci. 2004;55:13–27).

In a commentary in the January issue of the Journal of the American Academy of Dermatology, Dr. Paradi Mirmirani discussed the use of ceramic flatirons in Hispanic and African American women and acquired distal trichorrhexis nodosa sustained from repeated thermal injury (J. Am. Acad. Derm. 2010;62:145-7).

Trichorrhexis nodosa is an inherited or acquired hair shaft defect in which the hair is fragile and easily broken; on microscopic examination, filaments of the hair shaft are frayed like a broomstick.

Hot combs have been used for decades to straighten curly hair. Newer flatirons also provide temporary hair straightening, and are widely popular among women of every ethnic background. The uniform temperature distribution among the hair iron tongs allows the heat to temporarily break and reform the hydrogen bonds within the hair shaft.

In the process, the heat causes damage to the hair cuticle resulting in breakage and trichorrhexis nodosa.

Dr. Mirmirani, a dermatologist in Vallejo, Calif., noted that the ceramic coating of the metal in flatirons known as “thermal barrier coating,” decreases the impact of heat on the underlying metal (Annu. Rev. Materials Res. 2003;33:383–417), resulting in better heat distribution, retention, and transfer thought to result in “safer” heating of the hair.

However Dr. Mirmirani commented that although the ceramic-coated flatirons may be more efficient than metal ones, they result in more damage with improper use. Hair becomes dry, brittle, breaks easily and looks more untamed, leading to increased flatiron use to tame uneven hair.

Ceramic flatirons reach temperatures of up to 210° C which damages most hair, particularly chemically or color treated hair. African American hair which is extremely fragile and is often chemically relaxed, sustains significant damage with these high temperatures, and breakage occurs with repeated use of flatirons.  Dr. Mirmirani counsels patients with trichorrhexis nodosa to avoid any heat or chemicals, to cut off the damaged hair, and to practice gentle hair care in order to minimize friction that can result in breakage.

^{Image courtesy Flickr user strangelibrarian (Creative Commons)}

The use of harsh hair care practices and acquired hair shaft defects are very common in African American and Hispanic patients. Many studies have previously highlighted the structural damage that hair colors, relaxers, and perms can have on hair. Similar to chemicals, thermal damage can also damage the hair shaft when used over time and at high temperatures (J. Cosmet. Sci. 2004;55:13–27).

In a commentary in the January issue of the Journal of the American Academy of Dermatology, Dr. Paradi Mirmirani discussed the use of ceramic flatirons in Hispanic and African American women and acquired distal trichorrhexis nodosa sustained from repeated thermal injury (J. Am. Acad. Derm. 2010;62:145-7).

Trichorrhexis nodosa is an inherited or acquired hair shaft defect in which the hair is fragile and easily broken; on microscopic examination, filaments of the hair shaft are frayed like a broomstick.

Hot combs have been used for decades to straighten curly hair. Newer flatirons also provide temporary hair straightening, and are widely popular among women of every ethnic background. The uniform temperature distribution among the hair iron tongs allows the heat to temporarily break and reform the hydrogen bonds within the hair shaft.

In the process, the heat causes damage to the hair cuticle resulting in breakage and trichorrhexis nodosa.

Dr. Mirmirani, a dermatologist in Vallejo, Calif., noted that the ceramic coating of the metal in flatirons known as “thermal barrier coating,” decreases the impact of heat on the underlying metal (Annu. Rev. Materials Res. 2003;33:383–417), resulting in better heat distribution, retention, and transfer thought to result in “safer” heating of the hair.

However Dr. Mirmirani commented that although the ceramic-coated flatirons may be more efficient than metal ones, they result in more damage with improper use. Hair becomes dry, brittle, breaks easily and looks more untamed, leading to increased flatiron use to tame uneven hair.

Ceramic flatirons reach temperatures of up to 210° C which damages most hair, particularly chemically or color treated hair. African American hair which is extremely fragile and is often chemically relaxed, sustains significant damage with these high temperatures, and breakage occurs with repeated use of flatirons.  Dr. Mirmirani counsels patients with trichorrhexis nodosa to avoid any heat or chemicals, to cut off the damaged hair, and to practice gentle hair care in order to minimize friction that can result in breakage.

^{Image courtesy Flickr user strangelibrarian (Creative Commons)}

At the annual meeting of the American Academy of Dermatology, Dr. Jonith Breadon gave an update on keloid management at the Skin of Color Symposium. Below are the highlights, in case you missed it.

Several studies were published within the last year about the use of imiquimod as a treatment for keloids, said Dr. Breadon, a dermatologist in Chicago. In one study, investigators treated nine patients with imiquimod 5% cream daily for 8 weeks after excision and primary closure of trunk keloids. The keloids recurred in eight of the nine patients, and one patient was lost to follow-up (Dermatol. Surg. 2009;35:629-33).

However, prior studies have shown some promise for imiquimod as an effective adjunctive therapy for keloids.  In 2003, investigators conducted a prospective, double-blind, placebo-controlled pilot study of 20 patients treated with imiquimod daily for 2 weeks, then 3 times a week under occlusion, after shave keloid excision. At 6 months, 37.5% recurrence was noted in the imiquimod group and 75% recurrence in the placebo group, without a statistically significant difference (J. Craniofac. Surg. 2003;14:654-7).

Overall, the recently published studies for imiquimod as a treatment for keloids, post-excision, showed mixed results. A large, prospective, double-blind, placebo-controlled study is needed with enough statistical power to draw firm conclusion, noted Dr. Breadon.

Another group of investigators used topical tamoxifen therapy in hypertrophic scars or keloids in burns. Prior research has shown that transforming growth factor (TGF-β1) promotes keloid scar formation. Topical tamoxifen citrate inhibits TGF-β1. They found a reduction in erythema and size of immature hypertrophic burn scars.  While larger trials are needed, the results of this study are promising (Arch. Dermatol. Res. 2010;302:1-4).

 Another promising study used 5-fluorouracil as a treatment for hypertrophic and keloid scars.  Two groups were studied: 24 patients with hypertrophic scars and 32 patients with keloids.  The keloids were excised, whereas the hypertrophic scars were not. All patients received 10 monthly injections of 50 mg 5-fluorouracil (50mg/mL) plus 10 mg 1% lidocaine. In the keloid group, six recurrences were noted at 1 year follow-up. In the hypertrophic scar group, one-third had complete resolution at 1 year, and 86% maintained symptom improvement for 1 year (Plas. Reconstr. Surg. 2009;123:139-48).

The bottom line: Imiquimod use post-excision has not shown consistent results. Topical tamoxifen may be a promising new therapy for keloids, and 5-fluorouracil was shown to be helpful in a recent study.

At the annual meeting of the American Academy of Dermatology, Dr. Jonith Breadon gave an update on keloid management at the Skin of Color Symposium. Below are the highlights, in case you missed it.

Several studies were published within the last year about the use of imiquimod as a treatment for keloids, said Dr. Breadon, a dermatologist in Chicago. In one study, investigators treated nine patients with imiquimod 5% cream daily for 8 weeks after excision and primary closure of trunk keloids. The keloids recurred in eight of the nine patients, and one patient was lost to follow-up (Dermatol. Surg. 2009;35:629-33).

However, prior studies have shown some promise for imiquimod as an effective adjunctive therapy for keloids.  In 2003, investigators conducted a prospective, double-blind, placebo-controlled pilot study of 20 patients treated with imiquimod daily for 2 weeks, then 3 times a week under occlusion, after shave keloid excision. At 6 months, 37.5% recurrence was noted in the imiquimod group and 75% recurrence in the placebo group, without a statistically significant difference (J. Craniofac. Surg. 2003;14:654-7).

Overall, the recently published studies for imiquimod as a treatment for keloids, post-excision, showed mixed results. A large, prospective, double-blind, placebo-controlled study is needed with enough statistical power to draw firm conclusion, noted Dr. Breadon.

Another group of investigators used topical tamoxifen therapy in hypertrophic scars or keloids in burns. Prior research has shown that transforming growth factor (TGF-β1) promotes keloid scar formation. Topical tamoxifen citrate inhibits TGF-β1. They found a reduction in erythema and size of immature hypertrophic burn scars.  While larger trials are needed, the results of this study are promising (Arch. Dermatol. Res. 2010;302:1-4).

 Another promising study used 5-fluorouracil as a treatment for hypertrophic and keloid scars.  Two groups were studied: 24 patients with hypertrophic scars and 32 patients with keloids.  The keloids were excised, whereas the hypertrophic scars were not. All patients received 10 monthly injections of 50 mg 5-fluorouracil (50mg/mL) plus 10 mg 1% lidocaine. In the keloid group, six recurrences were noted at 1 year follow-up. In the hypertrophic scar group, one-third had complete resolution at 1 year, and 86% maintained symptom improvement for 1 year (Plas. Reconstr. Surg. 2009;123:139-48).

The bottom line: Imiquimod use post-excision has not shown consistent results. Topical tamoxifen may be a promising new therapy for keloids, and 5-fluorouracil was shown to be helpful in a recent study.

At the annual meeting of the American Academy of Dermatology, Dr. Jonith Breadon gave an update on keloid management at the Skin of Color Symposium. Below are the highlights, in case you missed it.

Several studies were published within the last year about the use of imiquimod as a treatment for keloids, said Dr. Breadon, a dermatologist in Chicago. In one study, investigators treated nine patients with imiquimod 5% cream daily for 8 weeks after excision and primary closure of trunk keloids. The keloids recurred in eight of the nine patients, and one patient was lost to follow-up (Dermatol. Surg. 2009;35:629-33).

However, prior studies have shown some promise for imiquimod as an effective adjunctive therapy for keloids.  In 2003, investigators conducted a prospective, double-blind, placebo-controlled pilot study of 20 patients treated with imiquimod daily for 2 weeks, then 3 times a week under occlusion, after shave keloid excision. At 6 months, 37.5% recurrence was noted in the imiquimod group and 75% recurrence in the placebo group, without a statistically significant difference (J. Craniofac. Surg. 2003;14:654-7).

Overall, the recently published studies for imiquimod as a treatment for keloids, post-excision, showed mixed results. A large, prospective, double-blind, placebo-controlled study is needed with enough statistical power to draw firm conclusion, noted Dr. Breadon.

Another group of investigators used topical tamoxifen therapy in hypertrophic scars or keloids in burns. Prior research has shown that transforming growth factor (TGF-β1) promotes keloid scar formation. Topical tamoxifen citrate inhibits TGF-β1. They found a reduction in erythema and size of immature hypertrophic burn scars.  While larger trials are needed, the results of this study are promising (Arch. Dermatol. Res. 2010;302:1-4).

 Another promising study used 5-fluorouracil as a treatment for hypertrophic and keloid scars.  Two groups were studied: 24 patients with hypertrophic scars and 32 patients with keloids.  The keloids were excised, whereas the hypertrophic scars were not. All patients received 10 monthly injections of 50 mg 5-fluorouracil (50mg/mL) plus 10 mg 1% lidocaine. In the keloid group, six recurrences were noted at 1 year follow-up. In the hypertrophic scar group, one-third had complete resolution at 1 year, and 86% maintained symptom improvement for 1 year (Plas. Reconstr. Surg. 2009;123:139-48).

The bottom line: Imiquimod use post-excision has not shown consistent results. Topical tamoxifen may be a promising new therapy for keloids, and 5-fluorouracil was shown to be helpful in a recent study.

Lip augmentation with autologous sternocleidomastoid muscle and fascia grafts results in enhanced vermilion show and lip projection up to 2 years post procedure, according to a single-center, retrospective study.

“This is another tool in the plastic surgeon’s armamentarium to combat the aging lip, which along with every other technique has some limitations, yet is effective in our practice,” wrote Dr. Anurag Agarwal, of the Aesthetic Surgery Center, Naples, Florida, and colleagues in the March/April issue of Archives of Facial Plastic Surgery.

“Based on the present study, patients who desire subtle, yet long-term lip augmentation can be counseled to expect approximately a 20% to 25% increase in vermilion show and approximately a 1-mm increase in lip projection at 2 years and longer from baseline.”

The study compared baseline and postprocedure photographs of 25 consecutive patients who underwent sternocleidomastoid (SCM) muscle and fascia augmentation of the lips with concurrent cervicofacial rhytidectomy (Arch. Facial Plast. Surg. 2010;12:97-102).

They were compared to similar baseline and postprocedure photographs of 25 control patients who received cervicofacial rhytidectomy alone, with no lip augmentation.

The mean postoperative photograph was taken at 25 months in the SCM group and 21 months in the control group. The ages of the patients were not reported.

For each patient, frontal and right lateral photographs were analyzed. The frontal analysis included measurement of the right and left, upper and lower lip vermilion show. The right lateral analysis included measurement of the anterior-most projection of the upper and lower lips.

Exclusion criteria included a concomitant chin augmentation, as well as use of injectable and/or surgical lip fillers or perioral skin resurfacing within 6 months of the preoperative photograph.

Compared with the group that did not receive lip augmentation, the mean changes from baseline in the lip augmentation group were statistically significant, reported the authors.

Comparing baseline and postprocedure photographs among the lip augmentation patients, the mean increase in upper lip projection from baseline was 0.99 mm, and in lower lip projection it was 0.90 mm. The mean increase in upper lip vermilion show from baseline was 20% on the right side and 22% on the left. The mean increase in lower lip vermilion show from baseline was 23% on the right side and 24% on the left.

Regarding complications, “there were no contour deformities, no limitations in head movement, no increased postauricular neck pain, no spinal accessory nerve injuries, and no difference in temporary numbness around the ears between the SCM graft and control group patients,” wrote the authors.

A medical chart review revealed that a deep focal lump developed in the upper lip of one SCM patient 3 years postoperatively. The etiology of the lump was unknown but it resolved after two triamcinolone acetonide injections, they reported.

“All patients were subjectively pleased with their degree of lip augmentation,” but one patient requested additional augmentation 2 years postoperatively, which was performed successfully with injectable gel, they said.

The SCM muscle and fascia graft has been performed by the authors since 1996, most commonly in conjunction with cervicofacial rhytidectomy, but also as a stand-alone procedure.

When performed with rhytidectomy, the superficial musculoaponeurotic system incision is extended inferiorly along the anterior border of the SCM muscle. Then, a segment of the SCM muscle and fascia is harvested from the mastoid process inferiorly, along the posterior border. Hemostasis is achieved with bipolar cautery, and the donor defect is closed.

After completion of the cervicofacial rhytidectomy, single incisions are made just inside the mucosa on each corner of the mouth, through which upper and lower lip tunnels are created in the superficial orbicularis oris muscle. The graft material is then pulled through the tunnels and positioned symmetrically, and the incisions are closed. “It is imperative to contour the grafts so that they are smooth and free of any muscle bulges that may be visible postoperatively,” they wrote. The grafts are intentionally left slightly longer than the distance between the incisions. “We have found that tucking the lateral ends of the grafts slightly lateral to the corner of the mouth incisions helps counteract the natural tendency for the grafts to horizontally shorten. This allows preservation of lateral lip fullness,” they explained.

After the procedure, antibiotic ointment is applied and patients are asked to limit their mouth opening for 2 weeks postoperatively.

When performed without rhytidectomy, “the same horizontal limb of the rhytidectomy incision is performed in the hair-bearing scalp to access this portion of the SCM, but the patient must be counseled about a donor site incision that would not be required with a nonautologous implant material.”

 

Neither dermal cysts, or prolonged stiffness or sensory changes were encountered in the study group – problems that have been reported with other lip augmentations procedures, they wrote.

“We have seen occasional asymmetries in the lips after SCM grafting,” they wrote. “Fortunately, these findings are rare,” they continued, without specifying their frequency in the study group. “There are several possible explanations for this finding: the presence of slight contour irregularities in the grafts when they are implanted; asymmetric graft compression; differential resorption with a given graft; and/or a contribution from dynamic movement of the lips.”

They study’s main limitation was some variation in the camera’s distance from the patient, although an attempt was made to control for this with the calibration of photographs, the authors wrote. In addition, they noted, patient satisfaction was not formally measured.

The researchers reported no financial disclosures.

Lip augmentation with autologous sternocleidomastoid muscle and fascia grafts results in enhanced vermilion show and lip projection up to 2 years post procedure, according to a single-center, retrospective study.

“This is another tool in the plastic surgeon’s armamentarium to combat the aging lip, which along with every other technique has some limitations, yet is effective in our practice,” wrote Dr. Anurag Agarwal, of the Aesthetic Surgery Center, Naples, Florida, and colleagues in the March/April issue of Archives of Facial Plastic Surgery.

“Based on the present study, patients who desire subtle, yet long-term lip augmentation can be counseled to expect approximately a 20% to 25% increase in vermilion show and approximately a 1-mm increase in lip projection at 2 years and longer from baseline.”

The study compared baseline and postprocedure photographs of 25 consecutive patients who underwent sternocleidomastoid (SCM) muscle and fascia augmentation of the lips with concurrent cervicofacial rhytidectomy (Arch. Facial Plast. Surg. 2010;12:97-102).

They were compared to similar baseline and postprocedure photographs of 25 control patients who received cervicofacial rhytidectomy alone, with no lip augmentation.

The mean postoperative photograph was taken at 25 months in the SCM group and 21 months in the control group. The ages of the patients were not reported.

For each patient, frontal and right lateral photographs were analyzed. The frontal analysis included measurement of the right and left, upper and lower lip vermilion show. The right lateral analysis included measurement of the anterior-most projection of the upper and lower lips.

Exclusion criteria included a concomitant chin augmentation, as well as use of injectable and/or surgical lip fillers or perioral skin resurfacing within 6 months of the preoperative photograph.

Compared with the group that did not receive lip augmentation, the mean changes from baseline in the lip augmentation group were statistically significant, reported the authors.

Comparing baseline and postprocedure photographs among the lip augmentation patients, the mean increase in upper lip projection from baseline was 0.99 mm, and in lower lip projection it was 0.90 mm. The mean increase in upper lip vermilion show from baseline was 20% on the right side and 22% on the left. The mean increase in lower lip vermilion show from baseline was 23% on the right side and 24% on the left.

Regarding complications, “there were no contour deformities, no limitations in head movement, no increased postauricular neck pain, no spinal accessory nerve injuries, and no difference in temporary numbness around the ears between the SCM graft and control group patients,” wrote the authors.

A medical chart review revealed that a deep focal lump developed in the upper lip of one SCM patient 3 years postoperatively. The etiology of the lump was unknown but it resolved after two triamcinolone acetonide injections, they reported.

“All patients were subjectively pleased with their degree of lip augmentation,” but one patient requested additional augmentation 2 years postoperatively, which was performed successfully with injectable gel, they said.

The SCM muscle and fascia graft has been performed by the authors since 1996, most commonly in conjunction with cervicofacial rhytidectomy, but also as a stand-alone procedure.

When performed with rhytidectomy, the superficial musculoaponeurotic system incision is extended inferiorly along the anterior border of the SCM muscle. Then, a segment of the SCM muscle and fascia is harvested from the mastoid process inferiorly, along the posterior border. Hemostasis is achieved with bipolar cautery, and the donor defect is closed.

After completion of the cervicofacial rhytidectomy, single incisions are made just inside the mucosa on each corner of the mouth, through which upper and lower lip tunnels are created in the superficial orbicularis oris muscle. The graft material is then pulled through the tunnels and positioned symmetrically, and the incisions are closed. “It is imperative to contour the grafts so that they are smooth and free of any muscle bulges that may be visible postoperatively,” they wrote. The grafts are intentionally left slightly longer than the distance between the incisions. “We have found that tucking the lateral ends of the grafts slightly lateral to the corner of the mouth incisions helps counteract the natural tendency for the grafts to horizontally shorten. This allows preservation of lateral lip fullness,” they explained.

After the procedure, antibiotic ointment is applied and patients are asked to limit their mouth opening for 2 weeks postoperatively.

When performed without rhytidectomy, “the same horizontal limb of the rhytidectomy incision is performed in the hair-bearing scalp to access this portion of the SCM, but the patient must be counseled about a donor site incision that would not be required with a nonautologous implant material.”

 

Neither dermal cysts, or prolonged stiffness or sensory changes were encountered in the study group – problems that have been reported with other lip augmentations procedures, they wrote.

“We have seen occasional asymmetries in the lips after SCM grafting,” they wrote. “Fortunately, these findings are rare,” they continued, without specifying their frequency in the study group. “There are several possible explanations for this finding: the presence of slight contour irregularities in the grafts when they are implanted; asymmetric graft compression; differential resorption with a given graft; and/or a contribution from dynamic movement of the lips.”

They study’s main limitation was some variation in the camera’s distance from the patient, although an attempt was made to control for this with the calibration of photographs, the authors wrote. In addition, they noted, patient satisfaction was not formally measured.

The researchers reported no financial disclosures.

Lip augmentation with autologous sternocleidomastoid muscle and fascia grafts results in enhanced vermilion show and lip projection up to 2 years post procedure, according to a single-center, retrospective study.

“This is another tool in the plastic surgeon’s armamentarium to combat the aging lip, which along with every other technique has some limitations, yet is effective in our practice,” wrote Dr. Anurag Agarwal, of the Aesthetic Surgery Center, Naples, Florida, and colleagues in the March/April issue of Archives of Facial Plastic Surgery.

“Based on the present study, patients who desire subtle, yet long-term lip augmentation can be counseled to expect approximately a 20% to 25% increase in vermilion show and approximately a 1-mm increase in lip projection at 2 years and longer from baseline.”

The study compared baseline and postprocedure photographs of 25 consecutive patients who underwent sternocleidomastoid (SCM) muscle and fascia augmentation of the lips with concurrent cervicofacial rhytidectomy (Arch. Facial Plast. Surg. 2010;12:97-102).

They were compared to similar baseline and postprocedure photographs of 25 control patients who received cervicofacial rhytidectomy alone, with no lip augmentation.

The mean postoperative photograph was taken at 25 months in the SCM group and 21 months in the control group. The ages of the patients were not reported.

For each patient, frontal and right lateral photographs were analyzed. The frontal analysis included measurement of the right and left, upper and lower lip vermilion show. The right lateral analysis included measurement of the anterior-most projection of the upper and lower lips.

Exclusion criteria included a concomitant chin augmentation, as well as use of injectable and/or surgical lip fillers or perioral skin resurfacing within 6 months of the preoperative photograph.

Compared with the group that did not receive lip augmentation, the mean changes from baseline in the lip augmentation group were statistically significant, reported the authors.

Comparing baseline and postprocedure photographs among the lip augmentation patients, the mean increase in upper lip projection from baseline was 0.99 mm, and in lower lip projection it was 0.90 mm. The mean increase in upper lip vermilion show from baseline was 20% on the right side and 22% on the left. The mean increase in lower lip vermilion show from baseline was 23% on the right side and 24% on the left.

Regarding complications, “there were no contour deformities, no limitations in head movement, no increased postauricular neck pain, no spinal accessory nerve injuries, and no difference in temporary numbness around the ears between the SCM graft and control group patients,” wrote the authors.

A medical chart review revealed that a deep focal lump developed in the upper lip of one SCM patient 3 years postoperatively. The etiology of the lump was unknown but it resolved after two triamcinolone acetonide injections, they reported.

“All patients were subjectively pleased with their degree of lip augmentation,” but one patient requested additional augmentation 2 years postoperatively, which was performed successfully with injectable gel, they said.

The SCM muscle and fascia graft has been performed by the authors since 1996, most commonly in conjunction with cervicofacial rhytidectomy, but also as a stand-alone procedure.

When performed with rhytidectomy, the superficial musculoaponeurotic system incision is extended inferiorly along the anterior border of the SCM muscle. Then, a segment of the SCM muscle and fascia is harvested from the mastoid process inferiorly, along the posterior border. Hemostasis is achieved with bipolar cautery, and the donor defect is closed.

After completion of the cervicofacial rhytidectomy, single incisions are made just inside the mucosa on each corner of the mouth, through which upper and lower lip tunnels are created in the superficial orbicularis oris muscle. The graft material is then pulled through the tunnels and positioned symmetrically, and the incisions are closed. “It is imperative to contour the grafts so that they are smooth and free of any muscle bulges that may be visible postoperatively,” they wrote. The grafts are intentionally left slightly longer than the distance between the incisions. “We have found that tucking the lateral ends of the grafts slightly lateral to the corner of the mouth incisions helps counteract the natural tendency for the grafts to horizontally shorten. This allows preservation of lateral lip fullness,” they explained.

After the procedure, antibiotic ointment is applied and patients are asked to limit their mouth opening for 2 weeks postoperatively.

When performed without rhytidectomy, “the same horizontal limb of the rhytidectomy incision is performed in the hair-bearing scalp to access this portion of the SCM, but the patient must be counseled about a donor site incision that would not be required with a nonautologous implant material.”

 

Neither dermal cysts, or prolonged stiffness or sensory changes were encountered in the study group – problems that have been reported with other lip augmentations procedures, they wrote.

“We have seen occasional asymmetries in the lips after SCM grafting,” they wrote. “Fortunately, these findings are rare,” they continued, without specifying their frequency in the study group. “There are several possible explanations for this finding: the presence of slight contour irregularities in the grafts when they are implanted; asymmetric graft compression; differential resorption with a given graft; and/or a contribution from dynamic movement of the lips.”

They study’s main limitation was some variation in the camera’s distance from the patient, although an attempt was made to control for this with the calibration of photographs, the authors wrote. In addition, they noted, patient satisfaction was not formally measured.

The researchers reported no financial disclosures.

Despite a continuing downturn in the economy, surgical and nonsurgical cosmetic procedures remained popular in 2009.

When compared with 2008, there were only 2% fewer procedures performed in 2009, according to statistics from the American Society for Aesthetic Plastic Surgery (ASAPS). Surgical procedures dropped by almost 17%, but nonsurgical procedures increased by 0.6%.

Injection of botulinum toxin type A (Botox and Dysport) was the leading procedure overall, at 2.5 million. Nonsurgical procedures far outnumbered surgical procedures: 8.5 million to 1.4 million.

After botulinum toxin injections, which accounted for 26% of all nonsurgical procedures, the second most popular procedure was hyaluronic acid injections, including Hylaform, Juvéderm, and Perlane/Restylane. About 1.3 million procedures were performed.

Laser hair removal followed closely behind in popularity, with 1.28 million procedures. Microdermabrasion and chemical peels rounded out the top five nonsurgical procedures.

With the exception of laser hair removal, which decreased only slightly, there was a larger dip in other types of laser procedures. Intense pulsed light treatments dropped by 14%, laser skin resurfacing by 10%, and laser treatment of leg veins by 10%. The decline does not appear to be entirely related to cost, according to the ASAPS data.

The largest increase among nonsurgical procedure was for Sculptra (poly-L-lactic acid). In 2008, there were 31,928 Sculptra procedures; in 2009, there were 39,516 - an increase of almost 24%.

Nonsurgical procedures were most popular in the 35- to 50-year-old age group (45%), followed by the 51- to 64-year-old group (27%).

Women are still the largest users of cosmetic procedures. About 9% of procedures were performed in men, which is an increase of 8% from 2008. About a quarter of cosmetic procedures were performed in racial and ethnic minorities, with the most being performed in Hispanics (9%).

A new ASAPS survey also found that cosmetic surgery is becoming more acceptable to Americans of all income levels. Of people earning less than $25,000, 48% said that they approved of cosmetic surgery, compared with 52% of those with incomes of $25,000-$50,000, 55% of those with incomes of $50,000-$75,000, and 62% of those with incomes of more than $75,000.

The ASAPS said that 58% of cosmetic procedures were performed in an office-based facility and 23% in freestanding surgical centers. Eighty-eight percent of the 928 plastic surgeons, dermatologists, and otolaryngologists who completed the survey said that they do not work with medical spas.

The top five surgical procedures in 2009 were breast augmentation, liposuction, eyelid surgery, abdominoplasty, and facelifts.

Americans spent $4.5 billion on nonsurgical treatments in 2009 and $6 billion on surgical procedures.

Despite a continuing downturn in the economy, surgical and nonsurgical cosmetic procedures remained popular in 2009.

When compared with 2008, there were only 2% fewer procedures performed in 2009, according to statistics from the American Society for Aesthetic Plastic Surgery (ASAPS). Surgical procedures dropped by almost 17%, but nonsurgical procedures increased by 0.6%.

Injection of botulinum toxin type A (Botox and Dysport) was the leading procedure overall, at 2.5 million. Nonsurgical procedures far outnumbered surgical procedures: 8.5 million to 1.4 million.

After botulinum toxin injections, which accounted for 26% of all nonsurgical procedures, the second most popular procedure was hyaluronic acid injections, including Hylaform, Juvéderm, and Perlane/Restylane. About 1.3 million procedures were performed.

Laser hair removal followed closely behind in popularity, with 1.28 million procedures. Microdermabrasion and chemical peels rounded out the top five nonsurgical procedures.

With the exception of laser hair removal, which decreased only slightly, there was a larger dip in other types of laser procedures. Intense pulsed light treatments dropped by 14%, laser skin resurfacing by 10%, and laser treatment of leg veins by 10%. The decline does not appear to be entirely related to cost, according to the ASAPS data.

The largest increase among nonsurgical procedure was for Sculptra (poly-L-lactic acid). In 2008, there were 31,928 Sculptra procedures; in 2009, there were 39,516 - an increase of almost 24%.

Nonsurgical procedures were most popular in the 35- to 50-year-old age group (45%), followed by the 51- to 64-year-old group (27%).

Women are still the largest users of cosmetic procedures. About 9% of procedures were performed in men, which is an increase of 8% from 2008. About a quarter of cosmetic procedures were performed in racial and ethnic minorities, with the most being performed in Hispanics (9%).

A new ASAPS survey also found that cosmetic surgery is becoming more acceptable to Americans of all income levels. Of people earning less than $25,000, 48% said that they approved of cosmetic surgery, compared with 52% of those with incomes of $25,000-$50,000, 55% of those with incomes of $50,000-$75,000, and 62% of those with incomes of more than $75,000.

The ASAPS said that 58% of cosmetic procedures were performed in an office-based facility and 23% in freestanding surgical centers. Eighty-eight percent of the 928 plastic surgeons, dermatologists, and otolaryngologists who completed the survey said that they do not work with medical spas.

The top five surgical procedures in 2009 were breast augmentation, liposuction, eyelid surgery, abdominoplasty, and facelifts.

Americans spent $4.5 billion on nonsurgical treatments in 2009 and $6 billion on surgical procedures.

Despite a continuing downturn in the economy, surgical and nonsurgical cosmetic procedures remained popular in 2009.

When compared with 2008, there were only 2% fewer procedures performed in 2009, according to statistics from the American Society for Aesthetic Plastic Surgery (ASAPS). Surgical procedures dropped by almost 17%, but nonsurgical procedures increased by 0.6%.

Injection of botulinum toxin type A (Botox and Dysport) was the leading procedure overall, at 2.5 million. Nonsurgical procedures far outnumbered surgical procedures: 8.5 million to 1.4 million.

After botulinum toxin injections, which accounted for 26% of all nonsurgical procedures, the second most popular procedure was hyaluronic acid injections, including Hylaform, Juvéderm, and Perlane/Restylane. About 1.3 million procedures were performed.

Laser hair removal followed closely behind in popularity, with 1.28 million procedures. Microdermabrasion and chemical peels rounded out the top five nonsurgical procedures.

With the exception of laser hair removal, which decreased only slightly, there was a larger dip in other types of laser procedures. Intense pulsed light treatments dropped by 14%, laser skin resurfacing by 10%, and laser treatment of leg veins by 10%. The decline does not appear to be entirely related to cost, according to the ASAPS data.

The largest increase among nonsurgical procedure was for Sculptra (poly-L-lactic acid). In 2008, there were 31,928 Sculptra procedures; in 2009, there were 39,516 - an increase of almost 24%.

Nonsurgical procedures were most popular in the 35- to 50-year-old age group (45%), followed by the 51- to 64-year-old group (27%).

Women are still the largest users of cosmetic procedures. About 9% of procedures were performed in men, which is an increase of 8% from 2008. About a quarter of cosmetic procedures were performed in racial and ethnic minorities, with the most being performed in Hispanics (9%).

A new ASAPS survey also found that cosmetic surgery is becoming more acceptable to Americans of all income levels. Of people earning less than $25,000, 48% said that they approved of cosmetic surgery, compared with 52% of those with incomes of $25,000-$50,000, 55% of those with incomes of $50,000-$75,000, and 62% of those with incomes of more than $75,000.

The ASAPS said that 58% of cosmetic procedures were performed in an office-based facility and 23% in freestanding surgical centers. Eighty-eight percent of the 928 plastic surgeons, dermatologists, and otolaryngologists who completed the survey said that they do not work with medical spas.

The top five surgical procedures in 2009 were breast augmentation, liposuction, eyelid surgery, abdominoplasty, and facelifts.

Americans spent $4.5 billion on nonsurgical treatments in 2009 and $6 billion on surgical procedures.

WAIKOLOA, Hawaii —  Interim results of the largest- and longest-ever U.S. safety study of a soft-tissue filler paint a reassuring portrait of Artefill, the polymethylmethacrylate-based permanent filler.

At 18 months of follow-up in the 5-year study, there has been just one biopsy-confirmed granuloma and no infections in 991 patients who underwent bilateral treatment with a mean 1.25-cc volume of Artefill injected per nasolabial fold, Dr. Christopher Zachary reported at the annual Hawaii dermatology seminar sponsored by Skin Disease Education Foundation.

"I think the 18-month results are significant for the fact that there have been so few complications. This is a product which people are extremely skeptical of, but I think it's time for aesthetic physicians around the world to look at this product based on its merits, based on the evidence, not based on the fear we all have that a permanent filler is inherently bad. From my point of view this is a great product. If you are prepared to have something that will last at least 5 years, then Artefill is something to consider," he said in an interview.

Experience has shown that this filler is very easy to use, he added. It is placed deep to fill areas where bone has recessed in patients with substantial volume loss.

"The problem with aging is not simply that the skin is getting old, it's that the underlying structures - be they bone or muscle - are receding. What we're trying to do with this filler is reconstitute the form upon which the skin sits," explained Dr. Zachary, professor and chair of the department of dermatology at the University of California, Irvine.

All of the adverse events documented thus far in the long-term safety study have occurred at rates similar to or lower than those recorded in the pivotal trial of Artefill and described in the current product labeling, he said.

The most frequent adverse event - lumpiness at the area of injection more than 1 month after treatment - has occurred in 1.8% of participants in the 5-year safety study, compared with 4.6% of those in the pivotal trial.

The one inflammatory granuloma that occurred responded completely to a single intralesional injection of triamcinolone and 5-fluorouracil coupled with a course of oral antibiotics, Dr. Zachary noted.

At 18 months, 88% of subjects reported being very satisfied or satisfied with their results, suggesting a lasting correction, he said.

Dr. Zachary serves on the advisory board for and holds shares of stock in Suneva Medical Inc., which markets Artefill. SDEF and this news organization are owned by Elsevier.

WAIKOLOA, Hawaii —  Interim results of the largest- and longest-ever U.S. safety study of a soft-tissue filler paint a reassuring portrait of Artefill, the polymethylmethacrylate-based permanent filler.

At 18 months of follow-up in the 5-year study, there has been just one biopsy-confirmed granuloma and no infections in 991 patients who underwent bilateral treatment with a mean 1.25-cc volume of Artefill injected per nasolabial fold, Dr. Christopher Zachary reported at the annual Hawaii dermatology seminar sponsored by Skin Disease Education Foundation.

"I think the 18-month results are significant for the fact that there have been so few complications. This is a product which people are extremely skeptical of, but I think it's time for aesthetic physicians around the world to look at this product based on its merits, based on the evidence, not based on the fear we all have that a permanent filler is inherently bad. From my point of view this is a great product. If you are prepared to have something that will last at least 5 years, then Artefill is something to consider," he said in an interview.

Experience has shown that this filler is very easy to use, he added. It is placed deep to fill areas where bone has recessed in patients with substantial volume loss.

"The problem with aging is not simply that the skin is getting old, it's that the underlying structures - be they bone or muscle - are receding. What we're trying to do with this filler is reconstitute the form upon which the skin sits," explained Dr. Zachary, professor and chair of the department of dermatology at the University of California, Irvine.

All of the adverse events documented thus far in the long-term safety study have occurred at rates similar to or lower than those recorded in the pivotal trial of Artefill and described in the current product labeling, he said.

The most frequent adverse event - lumpiness at the area of injection more than 1 month after treatment - has occurred in 1.8% of participants in the 5-year safety study, compared with 4.6% of those in the pivotal trial.

The one inflammatory granuloma that occurred responded completely to a single intralesional injection of triamcinolone and 5-fluorouracil coupled with a course of oral antibiotics, Dr. Zachary noted.

At 18 months, 88% of subjects reported being very satisfied or satisfied with their results, suggesting a lasting correction, he said.

Dr. Zachary serves on the advisory board for and holds shares of stock in Suneva Medical Inc., which markets Artefill. SDEF and this news organization are owned by Elsevier.

WAIKOLOA, Hawaii —  Interim results of the largest- and longest-ever U.S. safety study of a soft-tissue filler paint a reassuring portrait of Artefill, the polymethylmethacrylate-based permanent filler.

At 18 months of follow-up in the 5-year study, there has been just one biopsy-confirmed granuloma and no infections in 991 patients who underwent bilateral treatment with a mean 1.25-cc volume of Artefill injected per nasolabial fold, Dr. Christopher Zachary reported at the annual Hawaii dermatology seminar sponsored by Skin Disease Education Foundation.

"I think the 18-month results are significant for the fact that there have been so few complications. This is a product which people are extremely skeptical of, but I think it's time for aesthetic physicians around the world to look at this product based on its merits, based on the evidence, not based on the fear we all have that a permanent filler is inherently bad. From my point of view this is a great product. If you are prepared to have something that will last at least 5 years, then Artefill is something to consider," he said in an interview.

Experience has shown that this filler is very easy to use, he added. It is placed deep to fill areas where bone has recessed in patients with substantial volume loss.

"The problem with aging is not simply that the skin is getting old, it's that the underlying structures - be they bone or muscle - are receding. What we're trying to do with this filler is reconstitute the form upon which the skin sits," explained Dr. Zachary, professor and chair of the department of dermatology at the University of California, Irvine.

All of the adverse events documented thus far in the long-term safety study have occurred at rates similar to or lower than those recorded in the pivotal trial of Artefill and described in the current product labeling, he said.

The most frequent adverse event - lumpiness at the area of injection more than 1 month after treatment - has occurred in 1.8% of participants in the 5-year safety study, compared with 4.6% of those in the pivotal trial.

The one inflammatory granuloma that occurred responded completely to a single intralesional injection of triamcinolone and 5-fluorouracil coupled with a course of oral antibiotics, Dr. Zachary noted.

At 18 months, 88% of subjects reported being very satisfied or satisfied with their results, suggesting a lasting correction, he said.

Dr. Zachary serves on the advisory board for and holds shares of stock in Suneva Medical Inc., which markets Artefill. SDEF and this news organization are owned by Elsevier.

Last year was particularly rough on the nation’s psyche, with the continuing recession, high unemployment rates, and the rising number of home foreclosures. So, it comes as no surprise that Americans continued to treat themselves to a variety of confidence-boosting and image-enhancing cosmetic procedures in 2009.

That’s according to the American Society for Aesthetic Plastic Surgery (ASAPS), which released its annual tabulation of surgical and nonsurgical cosmetic procedures today. There was only a 2% overall dip in the number of nonsurgical and surgical procedures from last year, according to the ASAPS.

Not suprisingly, injections of botulinum toxin type A (Botox and Dysport) led the way, with 2.5 million procedures performed (largely in women). The number of nonsurgical procedures far outweighed surgical procedures at 8.5 million, compared with 1.4 million.

The ASAPS also said that cosmetic plastic surgery is gaining acceptance among Americans of all income levels. In a survey, 48% of those with incomes under $25,000 said they approved of cosmetic surgery, compared with 52% of those with incomes of $25,000-$50,000, 55% of those with incomes of $50,000-$75,000, and 62% of those with incomes of more than $75,000.

One can only venture to guess exactly what these statistics indicate about the nation’s zeitgeist. What are you seeing in your practice?

More details on the 2009 ASAPS data to come.

Alicia Ault (on Twitter @aliciaault)

^{Image courtesy Flickr user Smabs Sputzer (Creative Commons)}

Last year was particularly rough on the nation’s psyche, with the continuing recession, high unemployment rates, and the rising number of home foreclosures. So, it comes as no surprise that Americans continued to treat themselves to a variety of confidence-boosting and image-enhancing cosmetic procedures in 2009.

That’s according to the American Society for Aesthetic Plastic Surgery (ASAPS), which released its annual tabulation of surgical and nonsurgical cosmetic procedures today. There was only a 2% overall dip in the number of nonsurgical and surgical procedures from last year, according to the ASAPS.

Not suprisingly, injections of botulinum toxin type A (Botox and Dysport) led the way, with 2.5 million procedures performed (largely in women). The number of nonsurgical procedures far outweighed surgical procedures at 8.5 million, compared with 1.4 million.

The ASAPS also said that cosmetic plastic surgery is gaining acceptance among Americans of all income levels. In a survey, 48% of those with incomes under $25,000 said they approved of cosmetic surgery, compared with 52% of those with incomes of $25,000-$50,000, 55% of those with incomes of $50,000-$75,000, and 62% of those with incomes of more than $75,000.

One can only venture to guess exactly what these statistics indicate about the nation’s zeitgeist. What are you seeing in your practice?

More details on the 2009 ASAPS data to come.

Alicia Ault (on Twitter @aliciaault)

^{Image courtesy Flickr user Smabs Sputzer (Creative Commons)}

Last year was particularly rough on the nation’s psyche, with the continuing recession, high unemployment rates, and the rising number of home foreclosures. So, it comes as no surprise that Americans continued to treat themselves to a variety of confidence-boosting and image-enhancing cosmetic procedures in 2009.

That’s according to the American Society for Aesthetic Plastic Surgery (ASAPS), which released its annual tabulation of surgical and nonsurgical cosmetic procedures today. There was only a 2% overall dip in the number of nonsurgical and surgical procedures from last year, according to the ASAPS.

Not suprisingly, injections of botulinum toxin type A (Botox and Dysport) led the way, with 2.5 million procedures performed (largely in women). The number of nonsurgical procedures far outweighed surgical procedures at 8.5 million, compared with 1.4 million.

The ASAPS also said that cosmetic plastic surgery is gaining acceptance among Americans of all income levels. In a survey, 48% of those with incomes under $25,000 said they approved of cosmetic surgery, compared with 52% of those with incomes of $25,000-$50,000, 55% of those with incomes of $50,000-$75,000, and 62% of those with incomes of more than $75,000.

One can only venture to guess exactly what these statistics indicate about the nation’s zeitgeist. What are you seeing in your practice?

More details on the 2009 ASAPS data to come.

Alicia Ault (on Twitter @aliciaault)

^{Image courtesy Flickr user Smabs Sputzer (Creative Commons)}