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What’s New With Keloid Treatment - Pearls From AAD: Part 1
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.
Dr. Suzanne Kilmer's Favorite Laser for Acne Tx Is ...
Dermatologist Suzanne Kilmer of UC Davis Medical Center shares her preferred laser treatment device for acne. Dr. Kilmer spoke at the Hawaii Dermatology Seminar, sponsored by the Skin Disease Education Foundation. SDEF and this news organization are owned by Elsevier.
Dr. Kilmer disclosed serving as an advisor to Aesthera and many of the other major dermatologic laser manufacturers.
Dermatologist Suzanne Kilmer of UC Davis Medical Center shares her preferred laser treatment device for acne. Dr. Kilmer spoke at the Hawaii Dermatology Seminar, sponsored by the Skin Disease Education Foundation. SDEF and this news organization are owned by Elsevier.
Dr. Kilmer disclosed serving as an advisor to Aesthera and many of the other major dermatologic laser manufacturers.
Dermatologist Suzanne Kilmer of UC Davis Medical Center shares her preferred laser treatment device for acne. Dr. Kilmer spoke at the Hawaii Dermatology Seminar, sponsored by the Skin Disease Education Foundation. SDEF and this news organization are owned by Elsevier.
Dr. Kilmer disclosed serving as an advisor to Aesthera and many of the other major dermatologic laser manufacturers.
New Breast Reconstruction Technique
New technique for breast reconstruction after breast cancer surgery (using an acellular dermal matrix) allows for an earlier implant, less scarring, and a more natural shape.
New technique for breast reconstruction after breast cancer surgery (using an acellular dermal matrix) allows for an earlier implant, less scarring, and a more natural shape.
New technique for breast reconstruction after breast cancer surgery (using an acellular dermal matrix) allows for an earlier implant, less scarring, and a more natural shape.
Sternocleidomastoid Muscle, Fascia Grafts an Option for Aging Lips
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.
Recession Hasn't Put Damper on Cosmetic 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.
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.
Favorable Results Reported in Long-Term Safety Study of Artefill
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.
No Receding Interest in Beauty Treatments
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)
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)
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)
Skin of Color Society to Meet in Miami
If you would like to learn more about issues in skin of color, and be part of an organization dedicated to promoting awareness and excellence in dermatology, please attend the Skin of Color Society's scientific symposium at the American Academy of Dermatology's annual meeting in Miami this Thursday, March 4, at 2 pm in the Loews Miami Beach Hotel (Ponciana 4 Room).
We hope to see you there!
Lily & Naissan
If you would like to learn more about issues in skin of color, and be part of an organization dedicated to promoting awareness and excellence in dermatology, please attend the Skin of Color Society's scientific symposium at the American Academy of Dermatology's annual meeting in Miami this Thursday, March 4, at 2 pm in the Loews Miami Beach Hotel (Ponciana 4 Room).
We hope to see you there!
Lily & Naissan
If you would like to learn more about issues in skin of color, and be part of an organization dedicated to promoting awareness and excellence in dermatology, please attend the Skin of Color Society's scientific symposium at the American Academy of Dermatology's annual meeting in Miami this Thursday, March 4, at 2 pm in the Loews Miami Beach Hotel (Ponciana 4 Room).
We hope to see you there!
Lily & Naissan