Aesthetic Dermatology

Skin cancer treatments ranked as the most-performed procedures (3.08 million total procedures) for the fourth year in a row, according to survey results released by the American Society for Dermatologic Surgery (ASDS). Of them, 2.8 million procedures were for nonmelanoma skin cancers, and 206,000 were for melanomas. This finding confirms the growing incidence of skin cancer and the expertise of dermatologic surgeons in diagnosis and treatment.

Data were collected for the 2014 experience from 826 practicing members of the ASDS, with nearly 9.5 million medically necessary and cosmetic procedures performed.

Dermatologic surgeons performed 6.4 million cosmetic treatments in 2014. The top 5 cosmetic treatments were:

• Laser and light/energy-based devices: 2.06 million total procedures
• Wrinkle-relaxing injections (injectable neuromodulators): 1.74 million total procedures
• Soft-tissue fillers: 1.01 million total procedures
• Laser hair removal: 633,000 total procedures
• Chemical peels: 564,000 total procedures

Most laser and light/energy-based device treatments were reported for facial redness, followed by photorejuvenation, phototherapy, age spots, tissue tightening, laser resurfacing, acne scars, surgical scars, tattoo removal, and birthmarks.

Of the injectable neuromodulators used, nearly 1.2 million procedures were reported for onabotulinumtoxinA, followed by abobotulinumtoxinA (382,000) and incobotulinumtoxinA (175,000). The highest percentage of neuromodulator injections was reported in patients aged 46 to 50 years. Also, females (87%) received more injections than males (13%).

Soft-tissue fillers were performed the most in patients older than 55 years. Females (91%) received more treatments than males (9%).

The number of laser hair removal procedures performed in 2014 increased 27% from 2013 and 51% from 2012, emphasizing the role of dermatologists in providing safe and effective treatment.

Body sculpting procedures accounted for 208,000 total procedures, a 53% increase since 2012. The top treatments were cryolipolysis (79,000) and radiofrequency therapy (49,600).

View the full results of this survey on the ASDS Web site.

Skin cancer treatments ranked as the most-performed procedures (3.08 million total procedures) for the fourth year in a row, according to survey results released by the American Society for Dermatologic Surgery (ASDS). Of them, 2.8 million procedures were for nonmelanoma skin cancers, and 206,000 were for melanomas. This finding confirms the growing incidence of skin cancer and the expertise of dermatologic surgeons in diagnosis and treatment.

Data were collected for the 2014 experience from 826 practicing members of the ASDS, with nearly 9.5 million medically necessary and cosmetic procedures performed.

Dermatologic surgeons performed 6.4 million cosmetic treatments in 2014. The top 5 cosmetic treatments were:

• Laser and light/energy-based devices: 2.06 million total procedures
• Wrinkle-relaxing injections (injectable neuromodulators): 1.74 million total procedures
• Soft-tissue fillers: 1.01 million total procedures
• Laser hair removal: 633,000 total procedures
• Chemical peels: 564,000 total procedures

Most laser and light/energy-based device treatments were reported for facial redness, followed by photorejuvenation, phototherapy, age spots, tissue tightening, laser resurfacing, acne scars, surgical scars, tattoo removal, and birthmarks.

Of the injectable neuromodulators used, nearly 1.2 million procedures were reported for onabotulinumtoxinA, followed by abobotulinumtoxinA (382,000) and incobotulinumtoxinA (175,000). The highest percentage of neuromodulator injections was reported in patients aged 46 to 50 years. Also, females (87%) received more injections than males (13%).

Soft-tissue fillers were performed the most in patients older than 55 years. Females (91%) received more treatments than males (9%).

The number of laser hair removal procedures performed in 2014 increased 27% from 2013 and 51% from 2012, emphasizing the role of dermatologists in providing safe and effective treatment.

Body sculpting procedures accounted for 208,000 total procedures, a 53% increase since 2012. The top treatments were cryolipolysis (79,000) and radiofrequency therapy (49,600).

View the full results of this survey on the ASDS Web site.

Skin cancer treatments ranked as the most-performed procedures (3.08 million total procedures) for the fourth year in a row, according to survey results released by the American Society for Dermatologic Surgery (ASDS). Of them, 2.8 million procedures were for nonmelanoma skin cancers, and 206,000 were for melanomas. This finding confirms the growing incidence of skin cancer and the expertise of dermatologic surgeons in diagnosis and treatment.

Data were collected for the 2014 experience from 826 practicing members of the ASDS, with nearly 9.5 million medically necessary and cosmetic procedures performed.

Dermatologic surgeons performed 6.4 million cosmetic treatments in 2014. The top 5 cosmetic treatments were:

• Laser and light/energy-based devices: 2.06 million total procedures
• Wrinkle-relaxing injections (injectable neuromodulators): 1.74 million total procedures
• Soft-tissue fillers: 1.01 million total procedures
• Laser hair removal: 633,000 total procedures
• Chemical peels: 564,000 total procedures

Most laser and light/energy-based device treatments were reported for facial redness, followed by photorejuvenation, phototherapy, age spots, tissue tightening, laser resurfacing, acne scars, surgical scars, tattoo removal, and birthmarks.

Of the injectable neuromodulators used, nearly 1.2 million procedures were reported for onabotulinumtoxinA, followed by abobotulinumtoxinA (382,000) and incobotulinumtoxinA (175,000). The highest percentage of neuromodulator injections was reported in patients aged 46 to 50 years. Also, females (87%) received more injections than males (13%).

Soft-tissue fillers were performed the most in patients older than 55 years. Females (91%) received more treatments than males (9%).

The number of laser hair removal procedures performed in 2014 increased 27% from 2013 and 51% from 2012, emphasizing the role of dermatologists in providing safe and effective treatment.

Body sculpting procedures accounted for 208,000 total procedures, a 53% increase since 2012. The top treatments were cryolipolysis (79,000) and radiofrequency therapy (49,600).

View the full results of this survey on the ASDS Web site.

To improve patient care and outcomes, leading dermatologists offered their recommendations on the top OTC cleansers for rosacea patients. Consideration must be given to:

• Avène Antirougeurs Redness Relief Dermo-Cleansing Milk
  Pierre Fabre Dermo-Cosmétique USA
  Recommended by Julie Woodward, MD, Durham, North Carolina

• Avène Extremely Gentle Cleanser Lotion
  Pierre Fabre Dermo-Cosmétique USA
  Recommended by Julie Woodward, MD, Durham, North Carolina

• Cetaphil Gentle Skin Cleanser
  Galderma Laboratories, LP
  “I always recommend for all of my rosacea patients a strict regimen of cleansing and sun protection with Cetaphil cleanser and moisturizing sunscreen.”—Wm. Philip Werschler, MD, Seattle, Washington
  Recommended by Julie Woodward, MD, Durham, North Carolina

• Toleriane Dermo-Cleanser
  La Roche-Posay Laboratoire Dermatologique
  “Excellent for rosacea because it doesn’t contain any surfactants. This product has a very hydrated formula that helps repair the skin barrier.”—Whitney Bowe, MD, Brooklyn, New York
  Recommended by Gary Goldenberg, MD, New York, New York

Cutis invites readers to send us their recommendations. Face washes and products for babies will be featured in upcoming editions of Cosmetic Corner. Please e-mail your recommendation(s) to cutis@frontlinemedcom.com.

Disclaimer: Opinions expressed herein do not necessarily reflect those of Cutis or Frontline Medical Communications Inc and shall not be used for product endorsement purposes. Any reference made to a specific commercial product does not indicate or imply that Cutis or Frontline Medical Communications Inc endorses, recommends, or favors the product mentioned. No guarantee is given to the effects of recommended products.

To improve patient care and outcomes, leading dermatologists offered their recommendations on the top OTC cleansers for rosacea patients. Consideration must be given to:

• Avène Antirougeurs Redness Relief Dermo-Cleansing Milk
  Pierre Fabre Dermo-Cosmétique USA
  Recommended by Julie Woodward, MD, Durham, North Carolina

• Avène Extremely Gentle Cleanser Lotion
  Pierre Fabre Dermo-Cosmétique USA
  Recommended by Julie Woodward, MD, Durham, North Carolina

• Cetaphil Gentle Skin Cleanser
  Galderma Laboratories, LP
  “I always recommend for all of my rosacea patients a strict regimen of cleansing and sun protection with Cetaphil cleanser and moisturizing sunscreen.”—Wm. Philip Werschler, MD, Seattle, Washington
  Recommended by Julie Woodward, MD, Durham, North Carolina

• Toleriane Dermo-Cleanser
  La Roche-Posay Laboratoire Dermatologique
  “Excellent for rosacea because it doesn’t contain any surfactants. This product has a very hydrated formula that helps repair the skin barrier.”—Whitney Bowe, MD, Brooklyn, New York
  Recommended by Gary Goldenberg, MD, New York, New York

Cutis invites readers to send us their recommendations. Face washes and products for babies will be featured in upcoming editions of Cosmetic Corner. Please e-mail your recommendation(s) to cutis@frontlinemedcom.com.

Disclaimer: Opinions expressed herein do not necessarily reflect those of Cutis or Frontline Medical Communications Inc and shall not be used for product endorsement purposes. Any reference made to a specific commercial product does not indicate or imply that Cutis or Frontline Medical Communications Inc endorses, recommends, or favors the product mentioned. No guarantee is given to the effects of recommended products.

To improve patient care and outcomes, leading dermatologists offered their recommendations on the top OTC cleansers for rosacea patients. Consideration must be given to:

• Avène Antirougeurs Redness Relief Dermo-Cleansing Milk
  Pierre Fabre Dermo-Cosmétique USA
  Recommended by Julie Woodward, MD, Durham, North Carolina

• Avène Extremely Gentle Cleanser Lotion
  Pierre Fabre Dermo-Cosmétique USA
  Recommended by Julie Woodward, MD, Durham, North Carolina

• Cetaphil Gentle Skin Cleanser
  Galderma Laboratories, LP
  “I always recommend for all of my rosacea patients a strict regimen of cleansing and sun protection with Cetaphil cleanser and moisturizing sunscreen.”—Wm. Philip Werschler, MD, Seattle, Washington
  Recommended by Julie Woodward, MD, Durham, North Carolina

• Toleriane Dermo-Cleanser
  La Roche-Posay Laboratoire Dermatologique
  “Excellent for rosacea because it doesn’t contain any surfactants. This product has a very hydrated formula that helps repair the skin barrier.”—Whitney Bowe, MD, Brooklyn, New York
  Recommended by Gary Goldenberg, MD, New York, New York

Cutis invites readers to send us their recommendations. Face washes and products for babies will be featured in upcoming editions of Cosmetic Corner. Please e-mail your recommendation(s) to cutis@frontlinemedcom.com.

Disclaimer: Opinions expressed herein do not necessarily reflect those of Cutis or Frontline Medical Communications Inc and shall not be used for product endorsement purposes. Any reference made to a specific commercial product does not indicate or imply that Cutis or Frontline Medical Communications Inc endorses, recommends, or favors the product mentioned. No guarantee is given to the effects of recommended products.

Rare but serious side effects can result when soft tissue fillers are unintentionally injected into blood vessels in the face, according to a press release from the Food and Drug Administration.

Blood vessels can be blocked and blood flow restricted following unintentional soft tissue filler injection. The injection material can also migrate and embolization may cause vision impairment, blindness, stroke, and skin necrosis. Some injection sites result in blood vessel blockage more often, including the glabella and the periorbital region, though blockage can occur at any site on the face.

The FDA recommends that only people with appropriate training and knowledge of injection areas deliver injections, and that patients understand the risk beforehand and potential symptoms afterwards. A full list of recommendations can be found on the FDA website.

“FDA is working with manufacturers to update their labeling. The request asks that the labeling include additional warnings, precautions, and other statements about the risk of unintentional injection into blood vessels, consistent with the recommendations in this communication, so that both health care providers and patients would have a better understanding of the risks,” the FDA said.

Find the full press release on the FDA website.

lfranki@frontlinemedcom.com

Rare but serious side effects can result when soft tissue fillers are unintentionally injected into blood vessels in the face, according to a press release from the Food and Drug Administration.

Blood vessels can be blocked and blood flow restricted following unintentional soft tissue filler injection. The injection material can also migrate and embolization may cause vision impairment, blindness, stroke, and skin necrosis. Some injection sites result in blood vessel blockage more often, including the glabella and the periorbital region, though blockage can occur at any site on the face.

The FDA recommends that only people with appropriate training and knowledge of injection areas deliver injections, and that patients understand the risk beforehand and potential symptoms afterwards. A full list of recommendations can be found on the FDA website.

“FDA is working with manufacturers to update their labeling. The request asks that the labeling include additional warnings, precautions, and other statements about the risk of unintentional injection into blood vessels, consistent with the recommendations in this communication, so that both health care providers and patients would have a better understanding of the risks,” the FDA said.

Find the full press release on the FDA website.

lfranki@frontlinemedcom.com

Rare but serious side effects can result when soft tissue fillers are unintentionally injected into blood vessels in the face, according to a press release from the Food and Drug Administration.

Blood vessels can be blocked and blood flow restricted following unintentional soft tissue filler injection. The injection material can also migrate and embolization may cause vision impairment, blindness, stroke, and skin necrosis. Some injection sites result in blood vessel blockage more often, including the glabella and the periorbital region, though blockage can occur at any site on the face.

The FDA recommends that only people with appropriate training and knowledge of injection areas deliver injections, and that patients understand the risk beforehand and potential symptoms afterwards. A full list of recommendations can be found on the FDA website.

“FDA is working with manufacturers to update their labeling. The request asks that the labeling include additional warnings, precautions, and other statements about the risk of unintentional injection into blood vessels, consistent with the recommendations in this communication, so that both health care providers and patients would have a better understanding of the risks,” the FDA said.

Find the full press release on the FDA website.

lfranki@frontlinemedcom.com

KISSIMMEE, FLA. – Eight treatments with a noninvasive radiofrequency device reduced unwanted abdominal fat by an average of 428 cc in a prospective study.

“Can we consider this permanent fat loss? Yes, if a healthy lifestyle is maintained,” said Dr. Diane Duncan of Plastic Surgical Associates in Fort Collins, Colo. “I think the best candidates for these treatments are thin to modestly overweight patients, because while we did see significant fat reductions in obese patients, they want all their fat gone, and this won’t do that,” she said at the annual conference of the American Society for Laser Medicine and Surgery.

©imagedepotpro/iStockphoto.com

The study assessed the effects of the BodyFX device (Invasix, Yokneam, Israel) on 19 women aged 20-65 years who had localized abdominal adiposity, with body mass indices ranging from 18 to 30 kg/m². Dr. Duncan used an energy setting of 42 watts until the target area reached 41° Celsius, which typically took 3-5 minutes, she said. Then she administered high-voltage pulses of oscillating radiofrequency waves in order to create holes in the cell walls of adipocytes, which triggered gradual cell death.

After adjusting for age and height, eight treatments with the device led to a 53% decrease in abdominal fat thickness at a 3-month follow-up visit, Dr. Duncan reported. “Visual results were similar to liposuction,” she added. “But generally, not much change was noted before the fourth treatment.”

The analysis included sequences of three-dimensional Vectra ultrasound measurements, which were taken at four sites around the abdomen at the moment when patients reached their maximum exhale, Dr. Duncan said. She excluded two patients from final analyses because they had gained or lost more than 5 pounds, compared with baseline.

“I think the mechanism of action of this device is what makes it so special,” said Dr. Duncan. Scanning electron microscope photographs showed that adipocytes treated with the radiofrequency device underwent pyroptosis, which combines programmed cell death with the proinflammatory features of necrosis. That process stimulates formation of new collagen, resulting in localized skin tightening, she noted. “These new SEM data show a different and more beneficial process is taking place,” she explained. “Apoptosis, by definition, would not stimulate neocollagenesis, so no tissue tightening would occur.”

Dr. Duncan reported no funding sources or relevant financial disclosures.

KISSIMMEE, FLA. – Eight treatments with a noninvasive radiofrequency device reduced unwanted abdominal fat by an average of 428 cc in a prospective study.

“Can we consider this permanent fat loss? Yes, if a healthy lifestyle is maintained,” said Dr. Diane Duncan of Plastic Surgical Associates in Fort Collins, Colo. “I think the best candidates for these treatments are thin to modestly overweight patients, because while we did see significant fat reductions in obese patients, they want all their fat gone, and this won’t do that,” she said at the annual conference of the American Society for Laser Medicine and Surgery.

©imagedepotpro/iStockphoto.com

The study assessed the effects of the BodyFX device (Invasix, Yokneam, Israel) on 19 women aged 20-65 years who had localized abdominal adiposity, with body mass indices ranging from 18 to 30 kg/m². Dr. Duncan used an energy setting of 42 watts until the target area reached 41° Celsius, which typically took 3-5 minutes, she said. Then she administered high-voltage pulses of oscillating radiofrequency waves in order to create holes in the cell walls of adipocytes, which triggered gradual cell death.

After adjusting for age and height, eight treatments with the device led to a 53% decrease in abdominal fat thickness at a 3-month follow-up visit, Dr. Duncan reported. “Visual results were similar to liposuction,” she added. “But generally, not much change was noted before the fourth treatment.”

The analysis included sequences of three-dimensional Vectra ultrasound measurements, which were taken at four sites around the abdomen at the moment when patients reached their maximum exhale, Dr. Duncan said. She excluded two patients from final analyses because they had gained or lost more than 5 pounds, compared with baseline.

“I think the mechanism of action of this device is what makes it so special,” said Dr. Duncan. Scanning electron microscope photographs showed that adipocytes treated with the radiofrequency device underwent pyroptosis, which combines programmed cell death with the proinflammatory features of necrosis. That process stimulates formation of new collagen, resulting in localized skin tightening, she noted. “These new SEM data show a different and more beneficial process is taking place,” she explained. “Apoptosis, by definition, would not stimulate neocollagenesis, so no tissue tightening would occur.”

Dr. Duncan reported no funding sources or relevant financial disclosures.

KISSIMMEE, FLA. – Eight treatments with a noninvasive radiofrequency device reduced unwanted abdominal fat by an average of 428 cc in a prospective study.

“Can we consider this permanent fat loss? Yes, if a healthy lifestyle is maintained,” said Dr. Diane Duncan of Plastic Surgical Associates in Fort Collins, Colo. “I think the best candidates for these treatments are thin to modestly overweight patients, because while we did see significant fat reductions in obese patients, they want all their fat gone, and this won’t do that,” she said at the annual conference of the American Society for Laser Medicine and Surgery.

©imagedepotpro/iStockphoto.com

The study assessed the effects of the BodyFX device (Invasix, Yokneam, Israel) on 19 women aged 20-65 years who had localized abdominal adiposity, with body mass indices ranging from 18 to 30 kg/m². Dr. Duncan used an energy setting of 42 watts until the target area reached 41° Celsius, which typically took 3-5 minutes, she said. Then she administered high-voltage pulses of oscillating radiofrequency waves in order to create holes in the cell walls of adipocytes, which triggered gradual cell death.

After adjusting for age and height, eight treatments with the device led to a 53% decrease in abdominal fat thickness at a 3-month follow-up visit, Dr. Duncan reported. “Visual results were similar to liposuction,” she added. “But generally, not much change was noted before the fourth treatment.”

The analysis included sequences of three-dimensional Vectra ultrasound measurements, which were taken at four sites around the abdomen at the moment when patients reached their maximum exhale, Dr. Duncan said. She excluded two patients from final analyses because they had gained or lost more than 5 pounds, compared with baseline.

“I think the mechanism of action of this device is what makes it so special,” said Dr. Duncan. Scanning electron microscope photographs showed that adipocytes treated with the radiofrequency device underwent pyroptosis, which combines programmed cell death with the proinflammatory features of necrosis. That process stimulates formation of new collagen, resulting in localized skin tightening, she noted. “These new SEM data show a different and more beneficial process is taking place,” she explained. “Apoptosis, by definition, would not stimulate neocollagenesis, so no tissue tightening would occur.”

Dr. Duncan reported no funding sources or relevant financial disclosures.

KISSIMMEE, FLA. – Early treatment with fractional carbon dioxide ablative laser and light-emitting diode phototherapy sped healing and improved texture, discoloration, and range of motion in hypertrophic burn scars in a controlled, blinded study of 20 patients.

“I think as long as we have intact epithelium, we’re going to have improvements if we can laser these patients as early as possible,” Dr. Jill Waibel said at the annual conference of the American Society for Laser Medicine and Surgery.

Approximately 100 million new scars occur annually in developed countries, almost a third of which result from trauma or burns, noted Dr. Waibel, a dermatologist specializing in treating burn scars at the Miami Dermatology and Laser Institute. Scarred areas begin to hypertrophy about 3-7 months after injury, when they undergo increased collagen production and slowed collagen breakdown, said Dr. Waibel. “Traditionally, reconstructive efforts have been delayed until a year after injury,” she emphasized. “But by this time, many patients have formed hypertrophic scars and have significant decreases in range of motion.”

To determine how early treatment with a combination of laser/LED therapy might interrupt hypertrophy and improve outcomes, Dr. Waibel and coinvestigator Ashley Rudnick treated 20 patients aged 21-55 years with moderate to severe burns on at least 5% of the body surface area that had occurred in the past 1-3 months. For each patient, they divided similarly scarred areas into four 5- by 5-cm squares, one of which served as an untreated control. They treated the other three areas with 120-micron spot fractional ablative carbon dioxide laser only, continuous wave LED phototherapy only, or fractional ablative laser followed by LED. They spaced the three laser sessions 2 months apart, and used eight 20-minute LED treatments per laser session. The fractional laser wavelength was 10,600 nm, energy was 80-120 mJ per pixel, and the frequency was up to 200 Hz, Dr. Waibel said. The LED wavelength was 830 nm, and energy intensity was 40-100 mW per cm².

All treated areas improved more than the untreated control areas of scarring, but combining the modalities was associated with the fastest healing, according to blinded photographic reviews by physicians based on the visual analog Manchester scar scale, Dr. Waibel reported.

Phototherapy with LED can penetrate up to an inch of tissue and promotes selective ATP production and DNA and RNA activity, she added. “The positive effects occur only in injured cells,” she said. “LED has wound healing and anti-inflammatory effects that might benefit acutely wounded skin.”

Based on her experience, patients usually need from three to five sessions of fractional laser/LED sessions to see clear results, Dr. Waibel said in response to a question from an audience member. “We know that every time we treat a hypertrophic scar, it will get better,” she added. “When patients stop coming for treatment, you know they’re happy. If you can combine modalities softly and safely, you’ll need fewer treatments.”

Dr. Waibel disclosed financial and advisory relationships with ALMA, Cutera, DUSA, Harvest Technologies, L’Oreal/SkinCeuticals, Lumenis, Lutronics, Sebacia, Syneron-Candela, Valeant, and Zeltiq.

KISSIMMEE, FLA. – Early treatment with fractional carbon dioxide ablative laser and light-emitting diode phototherapy sped healing and improved texture, discoloration, and range of motion in hypertrophic burn scars in a controlled, blinded study of 20 patients.

“I think as long as we have intact epithelium, we’re going to have improvements if we can laser these patients as early as possible,” Dr. Jill Waibel said at the annual conference of the American Society for Laser Medicine and Surgery.

Approximately 100 million new scars occur annually in developed countries, almost a third of which result from trauma or burns, noted Dr. Waibel, a dermatologist specializing in treating burn scars at the Miami Dermatology and Laser Institute. Scarred areas begin to hypertrophy about 3-7 months after injury, when they undergo increased collagen production and slowed collagen breakdown, said Dr. Waibel. “Traditionally, reconstructive efforts have been delayed until a year after injury,” she emphasized. “But by this time, many patients have formed hypertrophic scars and have significant decreases in range of motion.”

To determine how early treatment with a combination of laser/LED therapy might interrupt hypertrophy and improve outcomes, Dr. Waibel and coinvestigator Ashley Rudnick treated 20 patients aged 21-55 years with moderate to severe burns on at least 5% of the body surface area that had occurred in the past 1-3 months. For each patient, they divided similarly scarred areas into four 5- by 5-cm squares, one of which served as an untreated control. They treated the other three areas with 120-micron spot fractional ablative carbon dioxide laser only, continuous wave LED phototherapy only, or fractional ablative laser followed by LED. They spaced the three laser sessions 2 months apart, and used eight 20-minute LED treatments per laser session. The fractional laser wavelength was 10,600 nm, energy was 80-120 mJ per pixel, and the frequency was up to 200 Hz, Dr. Waibel said. The LED wavelength was 830 nm, and energy intensity was 40-100 mW per cm².

All treated areas improved more than the untreated control areas of scarring, but combining the modalities was associated with the fastest healing, according to blinded photographic reviews by physicians based on the visual analog Manchester scar scale, Dr. Waibel reported.

Phototherapy with LED can penetrate up to an inch of tissue and promotes selective ATP production and DNA and RNA activity, she added. “The positive effects occur only in injured cells,” she said. “LED has wound healing and anti-inflammatory effects that might benefit acutely wounded skin.”

Based on her experience, patients usually need from three to five sessions of fractional laser/LED sessions to see clear results, Dr. Waibel said in response to a question from an audience member. “We know that every time we treat a hypertrophic scar, it will get better,” she added. “When patients stop coming for treatment, you know they’re happy. If you can combine modalities softly and safely, you’ll need fewer treatments.”

Dr. Waibel disclosed financial and advisory relationships with ALMA, Cutera, DUSA, Harvest Technologies, L’Oreal/SkinCeuticals, Lumenis, Lutronics, Sebacia, Syneron-Candela, Valeant, and Zeltiq.

KISSIMMEE, FLA. – Early treatment with fractional carbon dioxide ablative laser and light-emitting diode phototherapy sped healing and improved texture, discoloration, and range of motion in hypertrophic burn scars in a controlled, blinded study of 20 patients.

“I think as long as we have intact epithelium, we’re going to have improvements if we can laser these patients as early as possible,” Dr. Jill Waibel said at the annual conference of the American Society for Laser Medicine and Surgery.

Approximately 100 million new scars occur annually in developed countries, almost a third of which result from trauma or burns, noted Dr. Waibel, a dermatologist specializing in treating burn scars at the Miami Dermatology and Laser Institute. Scarred areas begin to hypertrophy about 3-7 months after injury, when they undergo increased collagen production and slowed collagen breakdown, said Dr. Waibel. “Traditionally, reconstructive efforts have been delayed until a year after injury,” she emphasized. “But by this time, many patients have formed hypertrophic scars and have significant decreases in range of motion.”

To determine how early treatment with a combination of laser/LED therapy might interrupt hypertrophy and improve outcomes, Dr. Waibel and coinvestigator Ashley Rudnick treated 20 patients aged 21-55 years with moderate to severe burns on at least 5% of the body surface area that had occurred in the past 1-3 months. For each patient, they divided similarly scarred areas into four 5- by 5-cm squares, one of which served as an untreated control. They treated the other three areas with 120-micron spot fractional ablative carbon dioxide laser only, continuous wave LED phototherapy only, or fractional ablative laser followed by LED. They spaced the three laser sessions 2 months apart, and used eight 20-minute LED treatments per laser session. The fractional laser wavelength was 10,600 nm, energy was 80-120 mJ per pixel, and the frequency was up to 200 Hz, Dr. Waibel said. The LED wavelength was 830 nm, and energy intensity was 40-100 mW per cm².

All treated areas improved more than the untreated control areas of scarring, but combining the modalities was associated with the fastest healing, according to blinded photographic reviews by physicians based on the visual analog Manchester scar scale, Dr. Waibel reported.

Phototherapy with LED can penetrate up to an inch of tissue and promotes selective ATP production and DNA and RNA activity, she added. “The positive effects occur only in injured cells,” she said. “LED has wound healing and anti-inflammatory effects that might benefit acutely wounded skin.”

Based on her experience, patients usually need from three to five sessions of fractional laser/LED sessions to see clear results, Dr. Waibel said in response to a question from an audience member. “We know that every time we treat a hypertrophic scar, it will get better,” she added. “When patients stop coming for treatment, you know they’re happy. If you can combine modalities softly and safely, you’ll need fewer treatments.”

Dr. Waibel disclosed financial and advisory relationships with ALMA, Cutera, DUSA, Harvest Technologies, L’Oreal/SkinCeuticals, Lumenis, Lutronics, Sebacia, Syneron-Candela, Valeant, and Zeltiq.

KISSIMMEE, FLA. – A noninvasive microwave system reduced light and dark axillary hair by approximately 70%, with durable results 1 year after treatment, according to data from a prospective multicenter study of 44 patients.

The device is Food and Drug Administration–approved for thermal treatment of axillary sweat glands, and has been used for about 35,000 such procedures, Dr. Jeremy Brauer said at the annual meeting of the American Society for Laser Medicine and Surgery.

The system targets microwave energy at the interface between the dermis and the hypodermis, “and we hypothesized that heat at this level in the skin may also have an important effect on the hair bulb,” he said.

Hair reduction is the third most common cosmetic procedure that U.S. dermatologists perform, said Dr. Brauer, a dermatologist with the Laser & Skin Surgery Center of New York. Laser is the primary modality, but is not always effective and can cause serious tissue damage if melanin concentrations in the hair and skin are too similar, he said.

For the study, Dr. Bauer and his associates used the microwave device to treat the axillae of 44 patients during either one or two treatment sessions. Average age of the patients was 33 years (range, 18-61 years), 80% were female, and 62% had dark axillary hair. Most had Fitzpatrick skin type II (33%), III (27%), or I (23%), but about 18% had type IV or V. During follow-up visits at 3, 6, 9, and 12 months, three blinded assessors counted hairs within a 2 cm x 2 cm area in the center of each axilla, and also qualitatively compared follow-up and baseline photos.

The blinded assessors correctly chose the baseline photos for all the photographic series, Dr. Brauer said. At 12 months, mean hair reduction was 75% for all patients, 72% for light-haired patients, and 76% for dark-haired patients, he reported. Ranges of response within these subgroups were relatively narrow, but patients who were treated at higher energy levels (settings of 3 or 4) achieved significantly more hair reduction (P < .0001) at 12 months than did patients who were treated at a setting of 1, he said. He recommended that future studies examine dose response and optimal number of treatment sessions.

Dr. Brauer reported consulting fees from Miramar, maker of the device.

KISSIMMEE, FLA. – A noninvasive microwave system reduced light and dark axillary hair by approximately 70%, with durable results 1 year after treatment, according to data from a prospective multicenter study of 44 patients.

The device is Food and Drug Administration–approved for thermal treatment of axillary sweat glands, and has been used for about 35,000 such procedures, Dr. Jeremy Brauer said at the annual meeting of the American Society for Laser Medicine and Surgery.

The system targets microwave energy at the interface between the dermis and the hypodermis, “and we hypothesized that heat at this level in the skin may also have an important effect on the hair bulb,” he said.

Hair reduction is the third most common cosmetic procedure that U.S. dermatologists perform, said Dr. Brauer, a dermatologist with the Laser & Skin Surgery Center of New York. Laser is the primary modality, but is not always effective and can cause serious tissue damage if melanin concentrations in the hair and skin are too similar, he said.

For the study, Dr. Bauer and his associates used the microwave device to treat the axillae of 44 patients during either one or two treatment sessions. Average age of the patients was 33 years (range, 18-61 years), 80% were female, and 62% had dark axillary hair. Most had Fitzpatrick skin type II (33%), III (27%), or I (23%), but about 18% had type IV or V. During follow-up visits at 3, 6, 9, and 12 months, three blinded assessors counted hairs within a 2 cm x 2 cm area in the center of each axilla, and also qualitatively compared follow-up and baseline photos.

The blinded assessors correctly chose the baseline photos for all the photographic series, Dr. Brauer said. At 12 months, mean hair reduction was 75% for all patients, 72% for light-haired patients, and 76% for dark-haired patients, he reported. Ranges of response within these subgroups were relatively narrow, but patients who were treated at higher energy levels (settings of 3 or 4) achieved significantly more hair reduction (P < .0001) at 12 months than did patients who were treated at a setting of 1, he said. He recommended that future studies examine dose response and optimal number of treatment sessions.

Dr. Brauer reported consulting fees from Miramar, maker of the device.

KISSIMMEE, FLA. – A noninvasive microwave system reduced light and dark axillary hair by approximately 70%, with durable results 1 year after treatment, according to data from a prospective multicenter study of 44 patients.

The device is Food and Drug Administration–approved for thermal treatment of axillary sweat glands, and has been used for about 35,000 such procedures, Dr. Jeremy Brauer said at the annual meeting of the American Society for Laser Medicine and Surgery.

The system targets microwave energy at the interface between the dermis and the hypodermis, “and we hypothesized that heat at this level in the skin may also have an important effect on the hair bulb,” he said.

Hair reduction is the third most common cosmetic procedure that U.S. dermatologists perform, said Dr. Brauer, a dermatologist with the Laser & Skin Surgery Center of New York. Laser is the primary modality, but is not always effective and can cause serious tissue damage if melanin concentrations in the hair and skin are too similar, he said.

For the study, Dr. Bauer and his associates used the microwave device to treat the axillae of 44 patients during either one or two treatment sessions. Average age of the patients was 33 years (range, 18-61 years), 80% were female, and 62% had dark axillary hair. Most had Fitzpatrick skin type II (33%), III (27%), or I (23%), but about 18% had type IV or V. During follow-up visits at 3, 6, 9, and 12 months, three blinded assessors counted hairs within a 2 cm x 2 cm area in the center of each axilla, and also qualitatively compared follow-up and baseline photos.

The blinded assessors correctly chose the baseline photos for all the photographic series, Dr. Brauer said. At 12 months, mean hair reduction was 75% for all patients, 72% for light-haired patients, and 76% for dark-haired patients, he reported. Ranges of response within these subgroups were relatively narrow, but patients who were treated at higher energy levels (settings of 3 or 4) achieved significantly more hair reduction (P < .0001) at 12 months than did patients who were treated at a setting of 1, he said. He recommended that future studies examine dose response and optimal number of treatment sessions.

Dr. Brauer reported consulting fees from Miramar, maker of the device.

KISSIMMEE, FLA. – Patients who received more local anesthesia before undergoing microwave-based treatment for axillary hyperhidrosis were happier with results and achieved the same objective improvements as patients who received less anesthesia, a follow-up study found.

“Patient satisfaction with the procedure was extremely high,” said Dr. Carolyn Jacob, a dermatologist and founding director of Chicago Cosmetic Surgery and Dermatology. “You can’t regenerate sweat glands – once they’re gone, they’re gone, and these patients have sustained results.”

The microwave system has been used commercially for more than 30,000 treatment sessions over 3 years and achieved high rates of efficacy and patient satisfaction in two pivotal trials, Dr. Jacob noted (Dermatol. Surg. 2012;38:185-91; Dermatol. Surg. 2012;38:728-35).

But clinicians often have kept to the relatively low volumes of local anesthesia used in the trials because they were concerned that higher volumes would interact with microwave energy and diminish efficacy, she said at the annual meeting of the American Society for Laser Medicine and Surgery.

To investigate that concern and assess overall longer-term treatment outcomes, Dr. Jacob and her associates compared 110 patients who received 10-25 cc of local lidocaine/epinephrine solution per axilla (the amount used in the clinical trials) with 30 patients who received 60-275 cc per axilla before undergoing microwave-based treatment of hyperhidrosis. At baseline, the two groups scored similarly on the 4-point measure of hyperhidrosis severity and on 10-point measures of sweat and odor severity (average scores of 3.4, 8.5, and 5.2, respectively, for the group that received less anesthesia and 3.3, 8.7, and 5.8, respectively, for the group that received more anesthesia), said Dr. Jacob. Patients were treated at energy levels of 3-5, and most were female. The researchers followed the lower anesthesia group and the higher anesthesia group for an average of 6 and 9 months, respectively.

At follow-up, 88% of patients in the lower-volume anesthesia group scored 1 or 2 on the 4-point measure of hyperhidrosis, as did 93% of patients in the higher-volume group, said Dr. Jacob. The groups also had very similar efficacy results on the 10-point measures of sweat and odor severity, she said (respective average scores, 3.0 and 3.2 on the sweat measure, and 1.9 and 2.0 on the odor measure). In all, 85% of patients who received less anesthesia said they were satisfied with results, as did 93% of patients in the higher-volume group.

Patients usually needed two treatment sessions that lasted 60-75 minutes each, depending on the size of the treatment area, Dr. Jacob noted. A few needed only one session. “There’s a high efficacy that’s consistent with the previous publications we have,” she concluded. “The high volumes of anesthesia seem to work just as well as the lower volumes.”

KISSIMMEE, FLA. – Patients who received more local anesthesia before undergoing microwave-based treatment for axillary hyperhidrosis were happier with results and achieved the same objective improvements as patients who received less anesthesia, a follow-up study found.

“Patient satisfaction with the procedure was extremely high,” said Dr. Carolyn Jacob, a dermatologist and founding director of Chicago Cosmetic Surgery and Dermatology. “You can’t regenerate sweat glands – once they’re gone, they’re gone, and these patients have sustained results.”

The microwave system has been used commercially for more than 30,000 treatment sessions over 3 years and achieved high rates of efficacy and patient satisfaction in two pivotal trials, Dr. Jacob noted (Dermatol. Surg. 2012;38:185-91; Dermatol. Surg. 2012;38:728-35).

But clinicians often have kept to the relatively low volumes of local anesthesia used in the trials because they were concerned that higher volumes would interact with microwave energy and diminish efficacy, she said at the annual meeting of the American Society for Laser Medicine and Surgery.

To investigate that concern and assess overall longer-term treatment outcomes, Dr. Jacob and her associates compared 110 patients who received 10-25 cc of local lidocaine/epinephrine solution per axilla (the amount used in the clinical trials) with 30 patients who received 60-275 cc per axilla before undergoing microwave-based treatment of hyperhidrosis. At baseline, the two groups scored similarly on the 4-point measure of hyperhidrosis severity and on 10-point measures of sweat and odor severity (average scores of 3.4, 8.5, and 5.2, respectively, for the group that received less anesthesia and 3.3, 8.7, and 5.8, respectively, for the group that received more anesthesia), said Dr. Jacob. Patients were treated at energy levels of 3-5, and most were female. The researchers followed the lower anesthesia group and the higher anesthesia group for an average of 6 and 9 months, respectively.

At follow-up, 88% of patients in the lower-volume anesthesia group scored 1 or 2 on the 4-point measure of hyperhidrosis, as did 93% of patients in the higher-volume group, said Dr. Jacob. The groups also had very similar efficacy results on the 10-point measures of sweat and odor severity, she said (respective average scores, 3.0 and 3.2 on the sweat measure, and 1.9 and 2.0 on the odor measure). In all, 85% of patients who received less anesthesia said they were satisfied with results, as did 93% of patients in the higher-volume group.

Patients usually needed two treatment sessions that lasted 60-75 minutes each, depending on the size of the treatment area, Dr. Jacob noted. A few needed only one session. “There’s a high efficacy that’s consistent with the previous publications we have,” she concluded. “The high volumes of anesthesia seem to work just as well as the lower volumes.”

KISSIMMEE, FLA. – Patients who received more local anesthesia before undergoing microwave-based treatment for axillary hyperhidrosis were happier with results and achieved the same objective improvements as patients who received less anesthesia, a follow-up study found.

“Patient satisfaction with the procedure was extremely high,” said Dr. Carolyn Jacob, a dermatologist and founding director of Chicago Cosmetic Surgery and Dermatology. “You can’t regenerate sweat glands – once they’re gone, they’re gone, and these patients have sustained results.”

The microwave system has been used commercially for more than 30,000 treatment sessions over 3 years and achieved high rates of efficacy and patient satisfaction in two pivotal trials, Dr. Jacob noted (Dermatol. Surg. 2012;38:185-91; Dermatol. Surg. 2012;38:728-35).

But clinicians often have kept to the relatively low volumes of local anesthesia used in the trials because they were concerned that higher volumes would interact with microwave energy and diminish efficacy, she said at the annual meeting of the American Society for Laser Medicine and Surgery.

To investigate that concern and assess overall longer-term treatment outcomes, Dr. Jacob and her associates compared 110 patients who received 10-25 cc of local lidocaine/epinephrine solution per axilla (the amount used in the clinical trials) with 30 patients who received 60-275 cc per axilla before undergoing microwave-based treatment of hyperhidrosis. At baseline, the two groups scored similarly on the 4-point measure of hyperhidrosis severity and on 10-point measures of sweat and odor severity (average scores of 3.4, 8.5, and 5.2, respectively, for the group that received less anesthesia and 3.3, 8.7, and 5.8, respectively, for the group that received more anesthesia), said Dr. Jacob. Patients were treated at energy levels of 3-5, and most were female. The researchers followed the lower anesthesia group and the higher anesthesia group for an average of 6 and 9 months, respectively.

At follow-up, 88% of patients in the lower-volume anesthesia group scored 1 or 2 on the 4-point measure of hyperhidrosis, as did 93% of patients in the higher-volume group, said Dr. Jacob. The groups also had very similar efficacy results on the 10-point measures of sweat and odor severity, she said (respective average scores, 3.0 and 3.2 on the sweat measure, and 1.9 and 2.0 on the odor measure). In all, 85% of patients who received less anesthesia said they were satisfied with results, as did 93% of patients in the higher-volume group.

Patients usually needed two treatment sessions that lasted 60-75 minutes each, depending on the size of the treatment area, Dr. Jacob noted. A few needed only one session. “There’s a high efficacy that’s consistent with the previous publications we have,” she concluded. “The high volumes of anesthesia seem to work just as well as the lower volumes.”

KISSIMMEE, FLA. – Ablative laser resurfacing may be the most effective cosmetic treatment for the periorbital area, excluding blepharoplasty, according to Dr. Suzanne L. Kilmer, a dermatologist specializing in laser and skin surgery in Sacramento, Calif.

“It gives you definite tightening and has the most predictable results,” Dr. Kilmer said at the annual meeting of the American Society for Laser Medicine and Surgery. “It also has the worst down time and side effects, but not for the upper lid – I’ve never had any scarring on the upper eyelid.”

In addition to its cosmetic potential, ablative laser resurfacing can remove epidermal lesions that might otherwise become actinic keratoses or basal cell carcinomas, and can smooth out syringomas, nevi, and seborrheic keratoses, Dr. Kilmer said. She shared some of her top tips for successful use of this technique.

Technique, safety, and analgesia

When treating patients with perioperative ablative laser resurfacing, Dr. Kilmer said she performs the first pass with a carbon dioxide laser at computerized pattern-generator (CPG) settings of pattern 3, size 9, density 6. She follows that with erbium laser resurfacing at a depth of 75-100 microns. “The first pass removes the epidermis,” she said. “Be sure to feather peripherally, and wipe everywhere you will do a second pass.”

The skin usually tightens visibly with the second pass, which can include the upper eyelids if patients have lax skin in this area, Dr. Kilmer noted. “You can be aggressive, like 3-9-5 [CPG settings],” she added. She then performs a “very light” second pass to the lower lids, with lower CPG settings of 3-7-3 or 3-6-2. She again follows with erbium ablation, including to the areas of the central face and midcheek.

The third pass includes the glabella and perioral area, as well as the upper eyelids if they are especially lax, Dr. Kilmer said. She ends with a sculpting pass with erbium laser.

Dr. Kilmer explained that she always treats the upper eyelids with ablative laser therapy in combination with fractional carbon dioxide laser treatment. “I also will include any area I think looks safe to do ablative on an individual patient,” she added. She noted that she sometimes combines ablative and fractional therapies with botulinum toxin treatment.

Patients should always wear eye shields during laser treatment sessions, Dr. Kilmer emphasized. Acceptable options include David-Baker lid clamps, Jaeger lid plates, and individual steel eye shields, but plastic corneal protectors should be avoided because they can sustain thermal damage with laser exposure, she said.

Options for analgesia during treatment include codeine, hydrocodone, hydromorphone, or nonsteroidal anti-inflammatory agents such as Toradol (ketorolac), which Dr. Kilmer gives intramuscularly at a dose of 30-60 mg. Furthermore, EMLA (lidocaine/prilocaine) cream enhances comfort, even if patients are also receiving conscious sedation or blocks, she said. The cream helps prevent several adverse effects, including superficial coagulative thermal damage, prolonged erythema, and delayed hypopigmentation, and does not seem to decrease efficacy, she added.

Before treatment

Clinicians should consider how a patient’s unique characteristics might affect treatment outcomes, Dr. Kilmer said. For example, ablation is more likely to cause hypopigmentation in patients with lighter skin types, and is unlikely to sufficiently resolve wrinkles that involve the facial muscles. “Always discuss Botox [botulinum toxin],” added Dr Kilmer. “If you’re tightening up the skin, and the area underneath is moving a lot, you’re not going to get as much tightening.” Clinicians also should discuss a face lift as an option for patients with substantial excess facial skin, she said.

The overall treatment plan should address existing skin lesions, too. Larger syringomas, trichoepitheliomas, and hyperplastic sebaceous glands should be “drilled out” with erbium ablation, but small tumors usually need only multiple or fractional laser treatment, said Dr. Kilmer.

For antimicrobial prophylaxis, patients should receive acyclovir, valcyclovir, or famvir starting 1 day before the procedure and continuing for 10-14 days, Dr. Kilmer said. “If I’m just treating around the eyes, I don’t worry as much about antivirals. I think about them more if I’m doing the full face,” she noted. Likewise, preoperative antibiotics such as doxycycline, cephalexin, azithromycin, or ciprofloxacin are especially important for full face or perioral ablative resurfacing, she said. To help prevent yeast infections, she gives patients a dose of fluconazole on day 3 after the procedure. “If they have a history of multiple yeast infections, I give it four times a day,” she said.

After the procedure

Postoperative diligence is key to good outcomes, Dr. Kilmer emphasized. During the first 10-14 days after the procedure, patients and clinicians should watch for signs of complications such as pain, purulence, itching, and worsening redness. If patients develop pain accompanied by purulence and redness, clinicians should perform bacterial cultures and switch patients to a quinolone, Dr. Kilmer said. Patients who develop pain consistent with herpes simplex virus infection should receive valcyclovir, she added. “If they’re itchy and red, think about yeast [infection] or contact dermatitis, and treat for both if you’re unsure,” she said.

Dr. Kilmer disclosed advisory relationships with Candela-Syneron, Living Proof, Lumeis, Miramar, Ulthera, and Zeltiq. She reported having received research funding from the same companies, and also from Allergan, CoolTouch, Cutera, Cynosure, Palomar, Sciton, and Solta.

KISSIMMEE, FLA. – Ablative laser resurfacing may be the most effective cosmetic treatment for the periorbital area, excluding blepharoplasty, according to Dr. Suzanne L. Kilmer, a dermatologist specializing in laser and skin surgery in Sacramento, Calif.

“It gives you definite tightening and has the most predictable results,” Dr. Kilmer said at the annual meeting of the American Society for Laser Medicine and Surgery. “It also has the worst down time and side effects, but not for the upper lid – I’ve never had any scarring on the upper eyelid.”

In addition to its cosmetic potential, ablative laser resurfacing can remove epidermal lesions that might otherwise become actinic keratoses or basal cell carcinomas, and can smooth out syringomas, nevi, and seborrheic keratoses, Dr. Kilmer said. She shared some of her top tips for successful use of this technique.

Technique, safety, and analgesia

When treating patients with perioperative ablative laser resurfacing, Dr. Kilmer said she performs the first pass with a carbon dioxide laser at computerized pattern-generator (CPG) settings of pattern 3, size 9, density 6. She follows that with erbium laser resurfacing at a depth of 75-100 microns. “The first pass removes the epidermis,” she said. “Be sure to feather peripherally, and wipe everywhere you will do a second pass.”

The skin usually tightens visibly with the second pass, which can include the upper eyelids if patients have lax skin in this area, Dr. Kilmer noted. “You can be aggressive, like 3-9-5 [CPG settings],” she added. She then performs a “very light” second pass to the lower lids, with lower CPG settings of 3-7-3 or 3-6-2. She again follows with erbium ablation, including to the areas of the central face and midcheek.

The third pass includes the glabella and perioral area, as well as the upper eyelids if they are especially lax, Dr. Kilmer said. She ends with a sculpting pass with erbium laser.

Dr. Kilmer explained that she always treats the upper eyelids with ablative laser therapy in combination with fractional carbon dioxide laser treatment. “I also will include any area I think looks safe to do ablative on an individual patient,” she added. She noted that she sometimes combines ablative and fractional therapies with botulinum toxin treatment.

Patients should always wear eye shields during laser treatment sessions, Dr. Kilmer emphasized. Acceptable options include David-Baker lid clamps, Jaeger lid plates, and individual steel eye shields, but plastic corneal protectors should be avoided because they can sustain thermal damage with laser exposure, she said.

Options for analgesia during treatment include codeine, hydrocodone, hydromorphone, or nonsteroidal anti-inflammatory agents such as Toradol (ketorolac), which Dr. Kilmer gives intramuscularly at a dose of 30-60 mg. Furthermore, EMLA (lidocaine/prilocaine) cream enhances comfort, even if patients are also receiving conscious sedation or blocks, she said. The cream helps prevent several adverse effects, including superficial coagulative thermal damage, prolonged erythema, and delayed hypopigmentation, and does not seem to decrease efficacy, she added.

Before treatment

Clinicians should consider how a patient’s unique characteristics might affect treatment outcomes, Dr. Kilmer said. For example, ablation is more likely to cause hypopigmentation in patients with lighter skin types, and is unlikely to sufficiently resolve wrinkles that involve the facial muscles. “Always discuss Botox [botulinum toxin],” added Dr Kilmer. “If you’re tightening up the skin, and the area underneath is moving a lot, you’re not going to get as much tightening.” Clinicians also should discuss a face lift as an option for patients with substantial excess facial skin, she said.

The overall treatment plan should address existing skin lesions, too. Larger syringomas, trichoepitheliomas, and hyperplastic sebaceous glands should be “drilled out” with erbium ablation, but small tumors usually need only multiple or fractional laser treatment, said Dr. Kilmer.

For antimicrobial prophylaxis, patients should receive acyclovir, valcyclovir, or famvir starting 1 day before the procedure and continuing for 10-14 days, Dr. Kilmer said. “If I’m just treating around the eyes, I don’t worry as much about antivirals. I think about them more if I’m doing the full face,” she noted. Likewise, preoperative antibiotics such as doxycycline, cephalexin, azithromycin, or ciprofloxacin are especially important for full face or perioral ablative resurfacing, she said. To help prevent yeast infections, she gives patients a dose of fluconazole on day 3 after the procedure. “If they have a history of multiple yeast infections, I give it four times a day,” she said.

After the procedure

Postoperative diligence is key to good outcomes, Dr. Kilmer emphasized. During the first 10-14 days after the procedure, patients and clinicians should watch for signs of complications such as pain, purulence, itching, and worsening redness. If patients develop pain accompanied by purulence and redness, clinicians should perform bacterial cultures and switch patients to a quinolone, Dr. Kilmer said. Patients who develop pain consistent with herpes simplex virus infection should receive valcyclovir, she added. “If they’re itchy and red, think about yeast [infection] or contact dermatitis, and treat for both if you’re unsure,” she said.

Dr. Kilmer disclosed advisory relationships with Candela-Syneron, Living Proof, Lumeis, Miramar, Ulthera, and Zeltiq. She reported having received research funding from the same companies, and also from Allergan, CoolTouch, Cutera, Cynosure, Palomar, Sciton, and Solta.

KISSIMMEE, FLA. – Ablative laser resurfacing may be the most effective cosmetic treatment for the periorbital area, excluding blepharoplasty, according to Dr. Suzanne L. Kilmer, a dermatologist specializing in laser and skin surgery in Sacramento, Calif.

“It gives you definite tightening and has the most predictable results,” Dr. Kilmer said at the annual meeting of the American Society for Laser Medicine and Surgery. “It also has the worst down time and side effects, but not for the upper lid – I’ve never had any scarring on the upper eyelid.”

In addition to its cosmetic potential, ablative laser resurfacing can remove epidermal lesions that might otherwise become actinic keratoses or basal cell carcinomas, and can smooth out syringomas, nevi, and seborrheic keratoses, Dr. Kilmer said. She shared some of her top tips for successful use of this technique.

Technique, safety, and analgesia

When treating patients with perioperative ablative laser resurfacing, Dr. Kilmer said she performs the first pass with a carbon dioxide laser at computerized pattern-generator (CPG) settings of pattern 3, size 9, density 6. She follows that with erbium laser resurfacing at a depth of 75-100 microns. “The first pass removes the epidermis,” she said. “Be sure to feather peripherally, and wipe everywhere you will do a second pass.”

The skin usually tightens visibly with the second pass, which can include the upper eyelids if patients have lax skin in this area, Dr. Kilmer noted. “You can be aggressive, like 3-9-5 [CPG settings],” she added. She then performs a “very light” second pass to the lower lids, with lower CPG settings of 3-7-3 or 3-6-2. She again follows with erbium ablation, including to the areas of the central face and midcheek.

The third pass includes the glabella and perioral area, as well as the upper eyelids if they are especially lax, Dr. Kilmer said. She ends with a sculpting pass with erbium laser.

Dr. Kilmer explained that she always treats the upper eyelids with ablative laser therapy in combination with fractional carbon dioxide laser treatment. “I also will include any area I think looks safe to do ablative on an individual patient,” she added. She noted that she sometimes combines ablative and fractional therapies with botulinum toxin treatment.

Patients should always wear eye shields during laser treatment sessions, Dr. Kilmer emphasized. Acceptable options include David-Baker lid clamps, Jaeger lid plates, and individual steel eye shields, but plastic corneal protectors should be avoided because they can sustain thermal damage with laser exposure, she said.

Options for analgesia during treatment include codeine, hydrocodone, hydromorphone, or nonsteroidal anti-inflammatory agents such as Toradol (ketorolac), which Dr. Kilmer gives intramuscularly at a dose of 30-60 mg. Furthermore, EMLA (lidocaine/prilocaine) cream enhances comfort, even if patients are also receiving conscious sedation or blocks, she said. The cream helps prevent several adverse effects, including superficial coagulative thermal damage, prolonged erythema, and delayed hypopigmentation, and does not seem to decrease efficacy, she added.

Before treatment

Clinicians should consider how a patient’s unique characteristics might affect treatment outcomes, Dr. Kilmer said. For example, ablation is more likely to cause hypopigmentation in patients with lighter skin types, and is unlikely to sufficiently resolve wrinkles that involve the facial muscles. “Always discuss Botox [botulinum toxin],” added Dr Kilmer. “If you’re tightening up the skin, and the area underneath is moving a lot, you’re not going to get as much tightening.” Clinicians also should discuss a face lift as an option for patients with substantial excess facial skin, she said.

The overall treatment plan should address existing skin lesions, too. Larger syringomas, trichoepitheliomas, and hyperplastic sebaceous glands should be “drilled out” with erbium ablation, but small tumors usually need only multiple or fractional laser treatment, said Dr. Kilmer.

For antimicrobial prophylaxis, patients should receive acyclovir, valcyclovir, or famvir starting 1 day before the procedure and continuing for 10-14 days, Dr. Kilmer said. “If I’m just treating around the eyes, I don’t worry as much about antivirals. I think about them more if I’m doing the full face,” she noted. Likewise, preoperative antibiotics such as doxycycline, cephalexin, azithromycin, or ciprofloxacin are especially important for full face or perioral ablative resurfacing, she said. To help prevent yeast infections, she gives patients a dose of fluconazole on day 3 after the procedure. “If they have a history of multiple yeast infections, I give it four times a day,” she said.

After the procedure

Postoperative diligence is key to good outcomes, Dr. Kilmer emphasized. During the first 10-14 days after the procedure, patients and clinicians should watch for signs of complications such as pain, purulence, itching, and worsening redness. If patients develop pain accompanied by purulence and redness, clinicians should perform bacterial cultures and switch patients to a quinolone, Dr. Kilmer said. Patients who develop pain consistent with herpes simplex virus infection should receive valcyclovir, she added. “If they’re itchy and red, think about yeast [infection] or contact dermatitis, and treat for both if you’re unsure,” she said.

Dr. Kilmer disclosed advisory relationships with Candela-Syneron, Living Proof, Lumeis, Miramar, Ulthera, and Zeltiq. She reported having received research funding from the same companies, and also from Allergan, CoolTouch, Cutera, Cynosure, Palomar, Sciton, and Solta.

KISSIMMEE, FLA. – Single noninvasive treatments with a prototype 1,060-nm diode laser led to statistically significant, visually discernible reductions of adipose tissue covering the abdomen and flanks in two prospective multicenter studies.

“The treatment is well tolerated, with only mild and transient side effects,” said Dr. Bruce Katz of Mount Sinai School of Medicine in New York, who presented the results of the flank study at the annual meeting of the American Society for Laser Medicine and Surgery.

Most patients were “satisfied” or “very satisfied” with the results, added Dr. Sean Doherty, a plastic surgeon in group practice in Boston, who presented the results of the abdominal study.

© Schlegelfotos/Thinkstock

Noninvasive fat reduction procedures rose 43% in the past year, said Dr. Doherty. The 1,060-nm diode laser damages adipocytes in targeted areas, eventually resulting in apoptosis, he added. Sessions in both studies lasted 25 minutes, with irradiance at 0.9-1.4 W/cm² and treatment areas of 48-144 cm² for the flanks and 192-288 cm² for the abdomen, the investigators said.

The abdominal study included 34 patients, and the flank study included 42 patients. Investigators treated only one side for each patient in the flank study, reserving the other as a “sham” or control, Dr. Katz said. A blinded review of photographs taken before and 12 weeks after the procedures served as the primary endpoint in both studies. Assessors correctly identified an average of 95% of “before” photographs of the abdomen and 90.3% of those of the flank, Dr. Doherty and Dr. Katz reported.

The secondary endpoint was change in thickness of the adipose layer at 12 weeks post procedure, as measured by ultrasound. The average reduction was 3.1 mm for the abdomen (standard deviation, 1.7 mm) and 2.6 mm for the flank (standard deviation not reported; P < .001 for both), the researchers said. In the abdominal study, 85% of patients said they were “satisfied” or “extremely satisfied” with the results, while 6% were “slightly satisfied,” Dr. Doherty said. In the flank study, 86% of patients said they were “satisfied” or “extremely satisfied,” while 10% were “slightly satisfied.”

Mean pain scores were 3.7 out of 10 for the abdominal procedure and 4.0 out of 10 for the flank procedure. The most common side effect was mild to moderate tenderness that usually subsided within about 2 weeks of treatment. Other side effects included localized firmness, edema, and ecchymosis. No patients had serious adverse effects, the researchers said.

Most of the patients were approximately 45-49 years of age. Those in the abdominal study had an average body mass index of 25.5 kg/m², while those in the flank study averaged 26.4 kg/m^2, the researchers reported. Most of the patients in both studies were women (94% of abdominal patients and 86% of flank patients).

The average weight gain at 12 weeks for the abdominal study was 0.1 pounds (range, –5.2 to 5.6 pounds), while patients in the flank study gained an average of 0.8 pounds (range, –0.7 to 13 pounds), the researchers noted. Six patients in the flank study gained more than 5 pounds, and one gained more than 37 pounds and was therefore excluded from the efficacy analysis, Dr. Katz noted.

The researchers did not report funding sources for the studies. They disclosed advisory and financial relationships with Allergan, Merz Pharmaceuticals, Cynosure, Valeant, Syneron, and several other pharmaceutical companies.

KISSIMMEE, FLA. – Single noninvasive treatments with a prototype 1,060-nm diode laser led to statistically significant, visually discernible reductions of adipose tissue covering the abdomen and flanks in two prospective multicenter studies.

“The treatment is well tolerated, with only mild and transient side effects,” said Dr. Bruce Katz of Mount Sinai School of Medicine in New York, who presented the results of the flank study at the annual meeting of the American Society for Laser Medicine and Surgery.

Most patients were “satisfied” or “very satisfied” with the results, added Dr. Sean Doherty, a plastic surgeon in group practice in Boston, who presented the results of the abdominal study.

© Schlegelfotos/Thinkstock

Noninvasive fat reduction procedures rose 43% in the past year, said Dr. Doherty. The 1,060-nm diode laser damages adipocytes in targeted areas, eventually resulting in apoptosis, he added. Sessions in both studies lasted 25 minutes, with irradiance at 0.9-1.4 W/cm² and treatment areas of 48-144 cm² for the flanks and 192-288 cm² for the abdomen, the investigators said.

The abdominal study included 34 patients, and the flank study included 42 patients. Investigators treated only one side for each patient in the flank study, reserving the other as a “sham” or control, Dr. Katz said. A blinded review of photographs taken before and 12 weeks after the procedures served as the primary endpoint in both studies. Assessors correctly identified an average of 95% of “before” photographs of the abdomen and 90.3% of those of the flank, Dr. Doherty and Dr. Katz reported.

The secondary endpoint was change in thickness of the adipose layer at 12 weeks post procedure, as measured by ultrasound. The average reduction was 3.1 mm for the abdomen (standard deviation, 1.7 mm) and 2.6 mm for the flank (standard deviation not reported; P < .001 for both), the researchers said. In the abdominal study, 85% of patients said they were “satisfied” or “extremely satisfied” with the results, while 6% were “slightly satisfied,” Dr. Doherty said. In the flank study, 86% of patients said they were “satisfied” or “extremely satisfied,” while 10% were “slightly satisfied.”

Mean pain scores were 3.7 out of 10 for the abdominal procedure and 4.0 out of 10 for the flank procedure. The most common side effect was mild to moderate tenderness that usually subsided within about 2 weeks of treatment. Other side effects included localized firmness, edema, and ecchymosis. No patients had serious adverse effects, the researchers said.

Most of the patients were approximately 45-49 years of age. Those in the abdominal study had an average body mass index of 25.5 kg/m², while those in the flank study averaged 26.4 kg/m^2, the researchers reported. Most of the patients in both studies were women (94% of abdominal patients and 86% of flank patients).

The average weight gain at 12 weeks for the abdominal study was 0.1 pounds (range, –5.2 to 5.6 pounds), while patients in the flank study gained an average of 0.8 pounds (range, –0.7 to 13 pounds), the researchers noted. Six patients in the flank study gained more than 5 pounds, and one gained more than 37 pounds and was therefore excluded from the efficacy analysis, Dr. Katz noted.

The researchers did not report funding sources for the studies. They disclosed advisory and financial relationships with Allergan, Merz Pharmaceuticals, Cynosure, Valeant, Syneron, and several other pharmaceutical companies.

KISSIMMEE, FLA. – Single noninvasive treatments with a prototype 1,060-nm diode laser led to statistically significant, visually discernible reductions of adipose tissue covering the abdomen and flanks in two prospective multicenter studies.

“The treatment is well tolerated, with only mild and transient side effects,” said Dr. Bruce Katz of Mount Sinai School of Medicine in New York, who presented the results of the flank study at the annual meeting of the American Society for Laser Medicine and Surgery.

Most patients were “satisfied” or “very satisfied” with the results, added Dr. Sean Doherty, a plastic surgeon in group practice in Boston, who presented the results of the abdominal study.

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Noninvasive fat reduction procedures rose 43% in the past year, said Dr. Doherty. The 1,060-nm diode laser damages adipocytes in targeted areas, eventually resulting in apoptosis, he added. Sessions in both studies lasted 25 minutes, with irradiance at 0.9-1.4 W/cm² and treatment areas of 48-144 cm² for the flanks and 192-288 cm² for the abdomen, the investigators said.

The abdominal study included 34 patients, and the flank study included 42 patients. Investigators treated only one side for each patient in the flank study, reserving the other as a “sham” or control, Dr. Katz said. A blinded review of photographs taken before and 12 weeks after the procedures served as the primary endpoint in both studies. Assessors correctly identified an average of 95% of “before” photographs of the abdomen and 90.3% of those of the flank, Dr. Doherty and Dr. Katz reported.

The secondary endpoint was change in thickness of the adipose layer at 12 weeks post procedure, as measured by ultrasound. The average reduction was 3.1 mm for the abdomen (standard deviation, 1.7 mm) and 2.6 mm for the flank (standard deviation not reported; P < .001 for both), the researchers said. In the abdominal study, 85% of patients said they were “satisfied” or “extremely satisfied” with the results, while 6% were “slightly satisfied,” Dr. Doherty said. In the flank study, 86% of patients said they were “satisfied” or “extremely satisfied,” while 10% were “slightly satisfied.”

Mean pain scores were 3.7 out of 10 for the abdominal procedure and 4.0 out of 10 for the flank procedure. The most common side effect was mild to moderate tenderness that usually subsided within about 2 weeks of treatment. Other side effects included localized firmness, edema, and ecchymosis. No patients had serious adverse effects, the researchers said.

Most of the patients were approximately 45-49 years of age. Those in the abdominal study had an average body mass index of 25.5 kg/m², while those in the flank study averaged 26.4 kg/m^2, the researchers reported. Most of the patients in both studies were women (94% of abdominal patients and 86% of flank patients).

The average weight gain at 12 weeks for the abdominal study was 0.1 pounds (range, –5.2 to 5.6 pounds), while patients in the flank study gained an average of 0.8 pounds (range, –0.7 to 13 pounds), the researchers noted. Six patients in the flank study gained more than 5 pounds, and one gained more than 37 pounds and was therefore excluded from the efficacy analysis, Dr. Katz noted.

The researchers did not report funding sources for the studies. They disclosed advisory and financial relationships with Allergan, Merz Pharmaceuticals, Cynosure, Valeant, Syneron, and several other pharmaceutical companies.