American Society for Dermatologic Surgery (ASDS): Annual Meeting

ATLANTA – Noninvasive body contouring is the "new frontier" in dermatologic surgery, according to Dr. Michael S. Kaminer.

Last year in the United States, noninvasive contouring was performed more often than liposuction, and while the competition between devices is getting fierce, not all are created equal, said Dr. Kaminer, a dermatologist in private practice in Chestnut Hill, Mass.

In fact, only four devices are approved by the Food and Drug Administration for noninvasive fat removal. Of those, Dr. Kaminer discussed three for which the data – and his own experience – are most compelling: CoolSculpting, which destroys fat through cryolipolysis; Liposonix, which destroys fat using high-intensity focused ultrasound; and the Zerona laser, which destroys fat using LED light.

The CoolSculpting device from Zeltiq made its debut about 7 years ago and was approved in 2012 for fat reduction. Cryolipolysis induces apoptosis in the adipocyte, and then the body clears the dead fat cells.

Case reports suggest that CoolSculpting reduces fat by about 21%, on average, with a single procedure, Dr. Kaminer said at the annual meeting of the American Society for Dermatologic Surgery.

In some cases, 50% fat reduction can be achieved within 90 days. The effects, which include skin tightening, seem to be durable based on 4-year follow-up studies, he said.

In a small pilot study in his practice, Dr. Kaminer found that 80% of patients were happy (rating their improvement as at least a 7 on a scale of 1-10) after a single procedure. The remaining 20% reached that level of satisfaction after a second treatment.

CoolSculpting is particularly useful for treating fat at the bra line and at the waist, with these areas typically requiring two or three treatments in his office, he said.

The CoolCurve+, a new applicator developed by Zeltiq to expand the capabilities of the CoolSculpting device, allows for treatment in more areas.

Liposonix from Solta Medical destroys unwanted subcutaneous adipose tissue and fat using high-intensity focused ultrasound. This device "made a big splash" when it was approved specifically for noninvasive waist circumference reduction in 2011, Dr. Kaminer said.

Most of the end effects are based on heat, although there is some mechanical or acoustical component that disrupts and "basically kills" the fat cells. Some evidence also suggests that this device promotes contraction and thickening of collagen, thereby tightening the skin.

"I think the jury may still be out on that one ... I don’t know if it is a skin-tightening device, but I haven’t seen any proof that would say that it definitely is," he said.

One particular benefit of this device is its customizability. The transducer can be used more heavily in areas where there is more fat and lighter in areas where there is less fat, and it can be worked around the umbilicus in those with an umbilical hernia, so it can be used more as a sculpting device than a "bulk fat remover," he said.

Patient comfort can be an issue with this device. "This hurts, so what we’ve started to do is use a low fluence, multiple-pass protocol," he said. When low fluencies are used, no pain medicine is needed. The exception is treatment of the sensitive inner thighs.

The Zerona laser from Erchonia Medical is approved for general body contouring and basically uses low-level laser therapy to deliver light to the skin. "The key effect of Zerona – and this is sort of the concept that I think we are all going to have to start to think about and decide if we buy it – is the concept of a transitory pore, which is basically a hole that’s poked into a fat cell by exposing it to 635-nm red light," he said. The fat leaks out of the adipocytes, causing long-lasting and perhaps permanent change.

Dr. Kaminer said that he uses CoolSculpting as his "go-to device" for love handles, bra line, and abdomen treatments. The workflow is easy: A nurse can put the applicator on and the patient can read a book for an hour or watch television. This treatment – like any treatment that uses suction – can be problematic in patients with an umbilical hernia, however, he added.

The Liposonix device also can do a nice job on the abdomen and love handles, and perhaps the bra line, and it is really the only device that can be used on the arms and the outer and inner thighs, which "respond really nicely to Liposonix," he said. Treatment can be painful, however, and this can be limiting in some practices.

Dr. Kaminer has been a consultant to Thermage, Sciton, and Zeltiq and has stock ownership or options in Cabochon, Miramar Labs, and Thermage.

ATLANTA – Noninvasive body contouring is the "new frontier" in dermatologic surgery, according to Dr. Michael S. Kaminer.

Last year in the United States, noninvasive contouring was performed more often than liposuction, and while the competition between devices is getting fierce, not all are created equal, said Dr. Kaminer, a dermatologist in private practice in Chestnut Hill, Mass.

In fact, only four devices are approved by the Food and Drug Administration for noninvasive fat removal. Of those, Dr. Kaminer discussed three for which the data – and his own experience – are most compelling: CoolSculpting, which destroys fat through cryolipolysis; Liposonix, which destroys fat using high-intensity focused ultrasound; and the Zerona laser, which destroys fat using LED light.

The CoolSculpting device from Zeltiq made its debut about 7 years ago and was approved in 2012 for fat reduction. Cryolipolysis induces apoptosis in the adipocyte, and then the body clears the dead fat cells.

Case reports suggest that CoolSculpting reduces fat by about 21%, on average, with a single procedure, Dr. Kaminer said at the annual meeting of the American Society for Dermatologic Surgery.

In some cases, 50% fat reduction can be achieved within 90 days. The effects, which include skin tightening, seem to be durable based on 4-year follow-up studies, he said.

In a small pilot study in his practice, Dr. Kaminer found that 80% of patients were happy (rating their improvement as at least a 7 on a scale of 1-10) after a single procedure. The remaining 20% reached that level of satisfaction after a second treatment.

CoolSculpting is particularly useful for treating fat at the bra line and at the waist, with these areas typically requiring two or three treatments in his office, he said.

The CoolCurve+, a new applicator developed by Zeltiq to expand the capabilities of the CoolSculpting device, allows for treatment in more areas.

Liposonix from Solta Medical destroys unwanted subcutaneous adipose tissue and fat using high-intensity focused ultrasound. This device "made a big splash" when it was approved specifically for noninvasive waist circumference reduction in 2011, Dr. Kaminer said.

Most of the end effects are based on heat, although there is some mechanical or acoustical component that disrupts and "basically kills" the fat cells. Some evidence also suggests that this device promotes contraction and thickening of collagen, thereby tightening the skin.

"I think the jury may still be out on that one ... I don’t know if it is a skin-tightening device, but I haven’t seen any proof that would say that it definitely is," he said.

One particular benefit of this device is its customizability. The transducer can be used more heavily in areas where there is more fat and lighter in areas where there is less fat, and it can be worked around the umbilicus in those with an umbilical hernia, so it can be used more as a sculpting device than a "bulk fat remover," he said.

Patient comfort can be an issue with this device. "This hurts, so what we’ve started to do is use a low fluence, multiple-pass protocol," he said. When low fluencies are used, no pain medicine is needed. The exception is treatment of the sensitive inner thighs.

The Zerona laser from Erchonia Medical is approved for general body contouring and basically uses low-level laser therapy to deliver light to the skin. "The key effect of Zerona – and this is sort of the concept that I think we are all going to have to start to think about and decide if we buy it – is the concept of a transitory pore, which is basically a hole that’s poked into a fat cell by exposing it to 635-nm red light," he said. The fat leaks out of the adipocytes, causing long-lasting and perhaps permanent change.

Dr. Kaminer said that he uses CoolSculpting as his "go-to device" for love handles, bra line, and abdomen treatments. The workflow is easy: A nurse can put the applicator on and the patient can read a book for an hour or watch television. This treatment – like any treatment that uses suction – can be problematic in patients with an umbilical hernia, however, he added.

The Liposonix device also can do a nice job on the abdomen and love handles, and perhaps the bra line, and it is really the only device that can be used on the arms and the outer and inner thighs, which "respond really nicely to Liposonix," he said. Treatment can be painful, however, and this can be limiting in some practices.

Dr. Kaminer has been a consultant to Thermage, Sciton, and Zeltiq and has stock ownership or options in Cabochon, Miramar Labs, and Thermage.

ATLANTA – Noninvasive body contouring is the "new frontier" in dermatologic surgery, according to Dr. Michael S. Kaminer.

Last year in the United States, noninvasive contouring was performed more often than liposuction, and while the competition between devices is getting fierce, not all are created equal, said Dr. Kaminer, a dermatologist in private practice in Chestnut Hill, Mass.

In fact, only four devices are approved by the Food and Drug Administration for noninvasive fat removal. Of those, Dr. Kaminer discussed three for which the data – and his own experience – are most compelling: CoolSculpting, which destroys fat through cryolipolysis; Liposonix, which destroys fat using high-intensity focused ultrasound; and the Zerona laser, which destroys fat using LED light.

The CoolSculpting device from Zeltiq made its debut about 7 years ago and was approved in 2012 for fat reduction. Cryolipolysis induces apoptosis in the adipocyte, and then the body clears the dead fat cells.

Case reports suggest that CoolSculpting reduces fat by about 21%, on average, with a single procedure, Dr. Kaminer said at the annual meeting of the American Society for Dermatologic Surgery.

In some cases, 50% fat reduction can be achieved within 90 days. The effects, which include skin tightening, seem to be durable based on 4-year follow-up studies, he said.

In a small pilot study in his practice, Dr. Kaminer found that 80% of patients were happy (rating their improvement as at least a 7 on a scale of 1-10) after a single procedure. The remaining 20% reached that level of satisfaction after a second treatment.

CoolSculpting is particularly useful for treating fat at the bra line and at the waist, with these areas typically requiring two or three treatments in his office, he said.

The CoolCurve+, a new applicator developed by Zeltiq to expand the capabilities of the CoolSculpting device, allows for treatment in more areas.

Liposonix from Solta Medical destroys unwanted subcutaneous adipose tissue and fat using high-intensity focused ultrasound. This device "made a big splash" when it was approved specifically for noninvasive waist circumference reduction in 2011, Dr. Kaminer said.

Most of the end effects are based on heat, although there is some mechanical or acoustical component that disrupts and "basically kills" the fat cells. Some evidence also suggests that this device promotes contraction and thickening of collagen, thereby tightening the skin.

"I think the jury may still be out on that one ... I don’t know if it is a skin-tightening device, but I haven’t seen any proof that would say that it definitely is," he said.

One particular benefit of this device is its customizability. The transducer can be used more heavily in areas where there is more fat and lighter in areas where there is less fat, and it can be worked around the umbilicus in those with an umbilical hernia, so it can be used more as a sculpting device than a "bulk fat remover," he said.

Patient comfort can be an issue with this device. "This hurts, so what we’ve started to do is use a low fluence, multiple-pass protocol," he said. When low fluencies are used, no pain medicine is needed. The exception is treatment of the sensitive inner thighs.

The Zerona laser from Erchonia Medical is approved for general body contouring and basically uses low-level laser therapy to deliver light to the skin. "The key effect of Zerona – and this is sort of the concept that I think we are all going to have to start to think about and decide if we buy it – is the concept of a transitory pore, which is basically a hole that’s poked into a fat cell by exposing it to 635-nm red light," he said. The fat leaks out of the adipocytes, causing long-lasting and perhaps permanent change.

Dr. Kaminer said that he uses CoolSculpting as his "go-to device" for love handles, bra line, and abdomen treatments. The workflow is easy: A nurse can put the applicator on and the patient can read a book for an hour or watch television. This treatment – like any treatment that uses suction – can be problematic in patients with an umbilical hernia, however, he added.

The Liposonix device also can do a nice job on the abdomen and love handles, and perhaps the bra line, and it is really the only device that can be used on the arms and the outer and inner thighs, which "respond really nicely to Liposonix," he said. Treatment can be painful, however, and this can be limiting in some practices.

Dr. Kaminer has been a consultant to Thermage, Sciton, and Zeltiq and has stock ownership or options in Cabochon, Miramar Labs, and Thermage.

A marine protein–based oral food supplement was safe and associated with significant hair growth in women with self-perceived thinning hair, according to findings from a small randomized controlled, double-blind study.

The mean number of terminal hairs in a 4 cm² area at the junction of the frontal and lateral hairlines was measured. In 10 women randomized to receive the supplement, terminal hairs increased from 271 at baseline to 571 after 90 days of treatment and 610 after 180 days of treatment. The mean number of terminal hairs in five women randomized to receive placebo was 256 at baseline, 245 after 90 days, and 242 after 180 days, Dr. Glynis Ablon reported in a poster at the annual meeting of the American Society for Dermatologic Surgery.

The mean number of vellus hairs in the treatment group was 46.5 at baseline and did not appreciably change over 180 days; the mean number of vellus hairs in the placebo group was 57 at baseline, 68 at 90 days, and 66 at 180 days, said Dr. Ablon, a Manhattan Beach, Calif.–based dermatologist.

Treated subjects were significantly more likely to report improvements in overall hair volume, scalp coverage, and hair body thickness after 90 days. Improved hair shine, skin moisture retention, and skin smoothness were reported after 180 days, she noted.

Study participants were women aged 21-75 years (mean age, 50 in the treatment group and 48 in the control group) with Fitzpatrick I-IV skin types. All were in generally good health but had perceived hair thinning. All study participants agreed to maintain their baseline diet, medications, and exercise level during the study period, and to maintain consistent hair care throughout the study period.

Treatment group subjects were instructed to take one tablet of the proprietary supplement (Viviscal) each morning and evening with water after a meal.

The study was supported by Lifes2good Inc., the maker of Viviscal. Dr. Ablon received a research grant from Lifes2good.

A marine protein–based oral food supplement was safe and associated with significant hair growth in women with self-perceived thinning hair, according to findings from a small randomized controlled, double-blind study.

The mean number of terminal hairs in a 4 cm² area at the junction of the frontal and lateral hairlines was measured. In 10 women randomized to receive the supplement, terminal hairs increased from 271 at baseline to 571 after 90 days of treatment and 610 after 180 days of treatment. The mean number of terminal hairs in five women randomized to receive placebo was 256 at baseline, 245 after 90 days, and 242 after 180 days, Dr. Glynis Ablon reported in a poster at the annual meeting of the American Society for Dermatologic Surgery.

The mean number of vellus hairs in the treatment group was 46.5 at baseline and did not appreciably change over 180 days; the mean number of vellus hairs in the placebo group was 57 at baseline, 68 at 90 days, and 66 at 180 days, said Dr. Ablon, a Manhattan Beach, Calif.–based dermatologist.

Treated subjects were significantly more likely to report improvements in overall hair volume, scalp coverage, and hair body thickness after 90 days. Improved hair shine, skin moisture retention, and skin smoothness were reported after 180 days, she noted.

Study participants were women aged 21-75 years (mean age, 50 in the treatment group and 48 in the control group) with Fitzpatrick I-IV skin types. All were in generally good health but had perceived hair thinning. All study participants agreed to maintain their baseline diet, medications, and exercise level during the study period, and to maintain consistent hair care throughout the study period.

Treatment group subjects were instructed to take one tablet of the proprietary supplement (Viviscal) each morning and evening with water after a meal.

The study was supported by Lifes2good Inc., the maker of Viviscal. Dr. Ablon received a research grant from Lifes2good.

A marine protein–based oral food supplement was safe and associated with significant hair growth in women with self-perceived thinning hair, according to findings from a small randomized controlled, double-blind study.

The mean number of terminal hairs in a 4 cm² area at the junction of the frontal and lateral hairlines was measured. In 10 women randomized to receive the supplement, terminal hairs increased from 271 at baseline to 571 after 90 days of treatment and 610 after 180 days of treatment. The mean number of terminal hairs in five women randomized to receive placebo was 256 at baseline, 245 after 90 days, and 242 after 180 days, Dr. Glynis Ablon reported in a poster at the annual meeting of the American Society for Dermatologic Surgery.

The mean number of vellus hairs in the treatment group was 46.5 at baseline and did not appreciably change over 180 days; the mean number of vellus hairs in the placebo group was 57 at baseline, 68 at 90 days, and 66 at 180 days, said Dr. Ablon, a Manhattan Beach, Calif.–based dermatologist.

Treated subjects were significantly more likely to report improvements in overall hair volume, scalp coverage, and hair body thickness after 90 days. Improved hair shine, skin moisture retention, and skin smoothness were reported after 180 days, she noted.

Study participants were women aged 21-75 years (mean age, 50 in the treatment group and 48 in the control group) with Fitzpatrick I-IV skin types. All were in generally good health but had perceived hair thinning. All study participants agreed to maintain their baseline diet, medications, and exercise level during the study period, and to maintain consistent hair care throughout the study period.

Treatment group subjects were instructed to take one tablet of the proprietary supplement (Viviscal) each morning and evening with water after a meal.

The study was supported by Lifes2good Inc., the maker of Viviscal. Dr. Ablon received a research grant from Lifes2good.

ATLANTA – Low-level laser therapy produced a significant and durable reduction in upper arm circumference in a randomized, double-blind, sham-controlled study of 62 patients.

An overall reduction in upper arm circumference of at least 1.25 cm was achieved in 58% of 31 patients randomized to receive three, 20-minute treatments each week for 2 weeks, compared with 3% of 31 patients randomized to receive sham treatments, Dr. Mark S. Nestor reported at the annual meeting of the American Society for Dermatologic Surgery.

The mean combined reductions in arm circumference were 2.0 cm after three treatments and 3.7 cm after six active treatments in the intervention group patients, compared with a gain of 0.1 cm and a reduction of 0.3 cm after 3 and 6 treatments, respectively, in the sham-treated control group, said Dr. Nestor, a dermatologist in private practice in Aventura, Fla.

The differences between the intervention and control group were statistically significant, he said.

The results were unchanged at the 2-week follow up. In 14 intervention group patients available for follow-up at 5-10 months post treatment, the decrease in upper arm circumference persisted at 3.25 cm, which was "essentially unchanged from the 4-week result," he noted.

The low-level laser therapy device used for this study (Zerona) consists of five independent diodes emitting 17 mW of red 635-nm laser light in overlapping patterns. A total of 3.94 J/cm² of energy was delivered during each treatment.

The device has been cleared as a noninvasive body contouring therapy for reducing hip, waist, and thigh circumference, but potential effects of confounding variables when it comes to measuring results have created confusion about the extent of the effects, Dr. Nestor said.

For example, abdominal measures from one day to the next can easily be affected by diet and other factors, he explained.

Upper arm circumference provides a more objective measure.

"I think that this model for body contouring is really wonderful, because [with the upper arm] you don’t see a lot of change from exercise or diet in the short term," he said.

Subjects in this study, who agreed to abstain from changes in diet or exercise during the study period, were treated at one of three participating centers. Arm circumference was measured at three equidistant points between the elbow and shoulder.

There were no reports of pain or discomfort, and no adverse events occurred.

Patient satisfaction was high, Dr. Nestor said. More subjects in the treatment group than in the control group reported satisfaction with the results (65% vs. 22%), improved appearance (81% vs. 26%), and results that exceeded expectations (45% vs. 17%).

Dr. Nestor reported that he has served as a consultant for and received research funding from Erchonia, maker of the Zerona laser therapy device used in this study.

ATLANTA – Low-level laser therapy produced a significant and durable reduction in upper arm circumference in a randomized, double-blind, sham-controlled study of 62 patients.

An overall reduction in upper arm circumference of at least 1.25 cm was achieved in 58% of 31 patients randomized to receive three, 20-minute treatments each week for 2 weeks, compared with 3% of 31 patients randomized to receive sham treatments, Dr. Mark S. Nestor reported at the annual meeting of the American Society for Dermatologic Surgery.

The mean combined reductions in arm circumference were 2.0 cm after three treatments and 3.7 cm after six active treatments in the intervention group patients, compared with a gain of 0.1 cm and a reduction of 0.3 cm after 3 and 6 treatments, respectively, in the sham-treated control group, said Dr. Nestor, a dermatologist in private practice in Aventura, Fla.

The differences between the intervention and control group were statistically significant, he said.

The results were unchanged at the 2-week follow up. In 14 intervention group patients available for follow-up at 5-10 months post treatment, the decrease in upper arm circumference persisted at 3.25 cm, which was "essentially unchanged from the 4-week result," he noted.

The low-level laser therapy device used for this study (Zerona) consists of five independent diodes emitting 17 mW of red 635-nm laser light in overlapping patterns. A total of 3.94 J/cm² of energy was delivered during each treatment.

The device has been cleared as a noninvasive body contouring therapy for reducing hip, waist, and thigh circumference, but potential effects of confounding variables when it comes to measuring results have created confusion about the extent of the effects, Dr. Nestor said.

For example, abdominal measures from one day to the next can easily be affected by diet and other factors, he explained.

Upper arm circumference provides a more objective measure.

"I think that this model for body contouring is really wonderful, because [with the upper arm] you don’t see a lot of change from exercise or diet in the short term," he said.

Subjects in this study, who agreed to abstain from changes in diet or exercise during the study period, were treated at one of three participating centers. Arm circumference was measured at three equidistant points between the elbow and shoulder.

There were no reports of pain or discomfort, and no adverse events occurred.

Patient satisfaction was high, Dr. Nestor said. More subjects in the treatment group than in the control group reported satisfaction with the results (65% vs. 22%), improved appearance (81% vs. 26%), and results that exceeded expectations (45% vs. 17%).

Dr. Nestor reported that he has served as a consultant for and received research funding from Erchonia, maker of the Zerona laser therapy device used in this study.

ATLANTA – Low-level laser therapy produced a significant and durable reduction in upper arm circumference in a randomized, double-blind, sham-controlled study of 62 patients.

An overall reduction in upper arm circumference of at least 1.25 cm was achieved in 58% of 31 patients randomized to receive three, 20-minute treatments each week for 2 weeks, compared with 3% of 31 patients randomized to receive sham treatments, Dr. Mark S. Nestor reported at the annual meeting of the American Society for Dermatologic Surgery.

The mean combined reductions in arm circumference were 2.0 cm after three treatments and 3.7 cm after six active treatments in the intervention group patients, compared with a gain of 0.1 cm and a reduction of 0.3 cm after 3 and 6 treatments, respectively, in the sham-treated control group, said Dr. Nestor, a dermatologist in private practice in Aventura, Fla.

The differences between the intervention and control group were statistically significant, he said.

The results were unchanged at the 2-week follow up. In 14 intervention group patients available for follow-up at 5-10 months post treatment, the decrease in upper arm circumference persisted at 3.25 cm, which was "essentially unchanged from the 4-week result," he noted.

The low-level laser therapy device used for this study (Zerona) consists of five independent diodes emitting 17 mW of red 635-nm laser light in overlapping patterns. A total of 3.94 J/cm² of energy was delivered during each treatment.

The device has been cleared as a noninvasive body contouring therapy for reducing hip, waist, and thigh circumference, but potential effects of confounding variables when it comes to measuring results have created confusion about the extent of the effects, Dr. Nestor said.

For example, abdominal measures from one day to the next can easily be affected by diet and other factors, he explained.

Upper arm circumference provides a more objective measure.

"I think that this model for body contouring is really wonderful, because [with the upper arm] you don’t see a lot of change from exercise or diet in the short term," he said.

Subjects in this study, who agreed to abstain from changes in diet or exercise during the study period, were treated at one of three participating centers. Arm circumference was measured at three equidistant points between the elbow and shoulder.

There were no reports of pain or discomfort, and no adverse events occurred.

Patient satisfaction was high, Dr. Nestor said. More subjects in the treatment group than in the control group reported satisfaction with the results (65% vs. 22%), improved appearance (81% vs. 26%), and results that exceeded expectations (45% vs. 17%).

Dr. Nestor reported that he has served as a consultant for and received research funding from Erchonia, maker of the Zerona laser therapy device used in this study.

ATLANTA – Cryolipolysis appears as safe and effective in dark skin types as in lighter skin types, according to a review of outcomes in 396 patients.

The primary goal of the study was to assess whether this technology is safe in patients with dark skin types, given their increased risk for developing postinflammatory hyperpigmentation with cold exposure and other treatments such as laser treatments, Dr. Ava Shamban said at the annual meeting of the American Society for Dermatologic Surgery.

However, no differences were seen in efficacy or safety based on skin type or ethnicity in the patients who participated in the multicenter study, she said.

"Cryolipolysis is, indeed, a color-blind technology."

In fact, patients with darker skin types had slightly higher satisfaction with the procedure, raising the question of whether the treatment might even be more effective in these patients, said Dr. Shamban, a dermatologist in private practice in Santa Monica, Calif.

The patients were treated on the back, flank, and/or abdomen, with most having multiple areas treated. Fitzpatrick skin types II-VI were represented: 85 had type II, 185 had type III, 104 had type IV, 18 had type V, and 4 had type VI.

Numerous ethnicities also were represented: 7 patients were African American, 38 were Asian, 295 were white, 37 were Latino, 5 were Mediterranean, and 14 were of Middle Eastern descent.

Women comprised 84% of the study population, and patients ranged in age from 24 to 74 years, with most in their late 40s to early 50s, Dr. Shamban noted.

No major adverse events occurred. Some patients did, however, experience minor effects, including bruising in 16%, swelling in 20%, and both bruising and swelling in 4%, she said, adding that the incidence of these effects did not differ between those with Fitzpatrick skin types II-III and those with type IV-VI.

Satisfaction with the procedure and outcomes also did not differ between those groups in 201 patients who completed a patient-satisfaction assessment. Only 7% of 122 patients with skin types II-III and 4% of 79 patients with skin types IV-VI were unsatisfied with the results, Dr. Shamban said.

"Cryolipolysis is, indeed, a color-blind technology, and it is a safe and effective method to reduce fat and thickening in patients of all skin types and ethnicities," she concluded.

Dr. Shamban had no disclosures to report. Her coauthor, Dr. Vic Narurkar, reported serving as a consultant for Zeltiq, the maker of the CoolSculpting cryolipolysis system used in this study.

ATLANTA – Cryolipolysis appears as safe and effective in dark skin types as in lighter skin types, according to a review of outcomes in 396 patients.

The primary goal of the study was to assess whether this technology is safe in patients with dark skin types, given their increased risk for developing postinflammatory hyperpigmentation with cold exposure and other treatments such as laser treatments, Dr. Ava Shamban said at the annual meeting of the American Society for Dermatologic Surgery.

However, no differences were seen in efficacy or safety based on skin type or ethnicity in the patients who participated in the multicenter study, she said.

"Cryolipolysis is, indeed, a color-blind technology."

In fact, patients with darker skin types had slightly higher satisfaction with the procedure, raising the question of whether the treatment might even be more effective in these patients, said Dr. Shamban, a dermatologist in private practice in Santa Monica, Calif.

The patients were treated on the back, flank, and/or abdomen, with most having multiple areas treated. Fitzpatrick skin types II-VI were represented: 85 had type II, 185 had type III, 104 had type IV, 18 had type V, and 4 had type VI.

Numerous ethnicities also were represented: 7 patients were African American, 38 were Asian, 295 were white, 37 were Latino, 5 were Mediterranean, and 14 were of Middle Eastern descent.

Women comprised 84% of the study population, and patients ranged in age from 24 to 74 years, with most in their late 40s to early 50s, Dr. Shamban noted.

No major adverse events occurred. Some patients did, however, experience minor effects, including bruising in 16%, swelling in 20%, and both bruising and swelling in 4%, she said, adding that the incidence of these effects did not differ between those with Fitzpatrick skin types II-III and those with type IV-VI.

Satisfaction with the procedure and outcomes also did not differ between those groups in 201 patients who completed a patient-satisfaction assessment. Only 7% of 122 patients with skin types II-III and 4% of 79 patients with skin types IV-VI were unsatisfied with the results, Dr. Shamban said.

"Cryolipolysis is, indeed, a color-blind technology, and it is a safe and effective method to reduce fat and thickening in patients of all skin types and ethnicities," she concluded.

Dr. Shamban had no disclosures to report. Her coauthor, Dr. Vic Narurkar, reported serving as a consultant for Zeltiq, the maker of the CoolSculpting cryolipolysis system used in this study.

ATLANTA – Cryolipolysis appears as safe and effective in dark skin types as in lighter skin types, according to a review of outcomes in 396 patients.

The primary goal of the study was to assess whether this technology is safe in patients with dark skin types, given their increased risk for developing postinflammatory hyperpigmentation with cold exposure and other treatments such as laser treatments, Dr. Ava Shamban said at the annual meeting of the American Society for Dermatologic Surgery.

However, no differences were seen in efficacy or safety based on skin type or ethnicity in the patients who participated in the multicenter study, she said.

"Cryolipolysis is, indeed, a color-blind technology."

In fact, patients with darker skin types had slightly higher satisfaction with the procedure, raising the question of whether the treatment might even be more effective in these patients, said Dr. Shamban, a dermatologist in private practice in Santa Monica, Calif.

The patients were treated on the back, flank, and/or abdomen, with most having multiple areas treated. Fitzpatrick skin types II-VI were represented: 85 had type II, 185 had type III, 104 had type IV, 18 had type V, and 4 had type VI.

Numerous ethnicities also were represented: 7 patients were African American, 38 were Asian, 295 were white, 37 were Latino, 5 were Mediterranean, and 14 were of Middle Eastern descent.

Women comprised 84% of the study population, and patients ranged in age from 24 to 74 years, with most in their late 40s to early 50s, Dr. Shamban noted.

No major adverse events occurred. Some patients did, however, experience minor effects, including bruising in 16%, swelling in 20%, and both bruising and swelling in 4%, she said, adding that the incidence of these effects did not differ between those with Fitzpatrick skin types II-III and those with type IV-VI.

Satisfaction with the procedure and outcomes also did not differ between those groups in 201 patients who completed a patient-satisfaction assessment. Only 7% of 122 patients with skin types II-III and 4% of 79 patients with skin types IV-VI were unsatisfied with the results, Dr. Shamban said.

"Cryolipolysis is, indeed, a color-blind technology, and it is a safe and effective method to reduce fat and thickening in patients of all skin types and ethnicities," she concluded.

Dr. Shamban had no disclosures to report. Her coauthor, Dr. Vic Narurkar, reported serving as a consultant for Zeltiq, the maker of the CoolSculpting cryolipolysis system used in this study.

ATLANTA – The routine use of imaging for the staging or surveillance of asymptomatic patients with primary cutaneous melanoma appears unwarranted, according to findings from a comprehensive literature review.

Even in high-risk patients, the use of chest x-ray (CXR), computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET), or PET-CT, yields unacceptably high rates of false positive results and has minimal impact on treatment plans, Dr. Daniel Eisen reported at the annual meeting of the American Society for Dermatologic Surgery.

The findings, which are based on an extensive systematic search of the Medline database for all relevant imaging studies conducted from 1970 to 2011, did suggest that high-frequency ultrasonography might be of diagnostic value for the early detection of subclinical lymph node metastases when used with routine follow-up in high-risk patients, but additional comparative prospective studies are needed to confirm this, said Dr. Eisen of the University of California, Davis.

Among the notable findings, CXR for staging yielded 14 true positive results in 4,320 patients (0.3%) in the reviewed studies. None of these was mentioned as amenable to surgical intervention. In addition, 326 false positives were reported in 3,447 (9.4%) patients with relevant data.

"So, [with CXR for staging] you have about a 20-fold chance of causing your patient undue psychological or iatrogenic harm," Dr. Eisen said.

CXR for surveillance yielded 198 true positive results in 10,046 patients (2%), and false positive results in 384 of 4,055 patients (9.5%).

Based on findings from studies that reported true positives as well as the number of patients who were eligible for or who underwent surgery as a result, 47 of 4,849 patients (1%) may have benefited from CXR surveillance, Dr. Eisen said.

The literature included fewer studies for CT than for CXR, likely because of the increased expense for CT, he noted.

CT was slightly more sensitive for staging, but false positives still outweighed true positives by at least threefold for staging; among 1,111 patients, there were 112 (10%) false positives vs. 41 (3.6%) true positives. CT results altered treatment in 1 of 338 patients (0.3%).

CT for routine surveillance yielded true positives in 63 of 467 patients (13.5%), and false positives in 13 of 127 patients (10.2%). There were no data on the number of patients eligible for surgical intervention based on CT surveillance, Dr. Eisen said.

Even fewer studies were available for MRI, which was almost exclusively used for cerebral imaging. MRI yielded true positives in 13 of 285 patients (4.5%), and false positives in 1 of 185 patients (0.5%). MRI for routine surveillance was addressed in only one study, which showed a true positive rate in 1 of 43 patients (2.3%).

PET for staging yielded true positives in 40 of 821 patients (4.9%), and false positives in 87 of 821 patients (10.6%). PET failed to detect disease in 159 of the patients, for a false negative rate of 19.3%, and changed management decisions in 21 of 191 patients (11%). Only 2 of these patients (1%) were eligible for surgery, however.

PET for post-treatment surveillance yielded true positives in 10 of 252 patients (4%), false positives in 16 of 218 patients (7.3%), and false negatives in 30 of 204 patients (14.7%).

Based on one study, 3 of 30 patients (10%) were found to be eligible for surgery as a result of PET imaging. PET-CT was more sensitive, but results were similarly disappointing, Dr. Eisen said.

Findings were slightly more encouraging for lymph node ultrasonography. In 11 studies, ultrasound staging yielded true positive rates in 100 of 1,035 patients (10%), and false positive results in 73 of 1,035 patients (7%); 44 patients were spared sentinel lymph node biopsies as a result of ultrasound imaging, and instead, proceeded to complete lymph node dissection, Dr. Eisen said. However, ultrasound for staging yielded a false negative result in 120 of 688 patients (17.4%).

Based on 9 studies, ultrasound for surveillance yielded true positive results in the absence of clinical findings in 79 of 1,266 patients (6.2%), false positive results in 12 of 966 patients for whom data were reported (1.2%), and false negative results in 5 of 806 patients (0.62%).

The data are imperfect, but seem to suggest that use of these imaging technologies can do more harm than good, Dr. Eisen said.

While patients may specifically request imaging to alleviate concerns that their primary cutaneous melanoma has advanced or will advance, it is important to keep in mind that, based on these results, the risk of causing unnecessary stress and iatrogenic harm outweigh the potential benefits, he concluded.

Dr. Eisen reported having no disclosures.

ATLANTA – The routine use of imaging for the staging or surveillance of asymptomatic patients with primary cutaneous melanoma appears unwarranted, according to findings from a comprehensive literature review.

Even in high-risk patients, the use of chest x-ray (CXR), computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET), or PET-CT, yields unacceptably high rates of false positive results and has minimal impact on treatment plans, Dr. Daniel Eisen reported at the annual meeting of the American Society for Dermatologic Surgery.

The findings, which are based on an extensive systematic search of the Medline database for all relevant imaging studies conducted from 1970 to 2011, did suggest that high-frequency ultrasonography might be of diagnostic value for the early detection of subclinical lymph node metastases when used with routine follow-up in high-risk patients, but additional comparative prospective studies are needed to confirm this, said Dr. Eisen of the University of California, Davis.

Among the notable findings, CXR for staging yielded 14 true positive results in 4,320 patients (0.3%) in the reviewed studies. None of these was mentioned as amenable to surgical intervention. In addition, 326 false positives were reported in 3,447 (9.4%) patients with relevant data.

"So, [with CXR for staging] you have about a 20-fold chance of causing your patient undue psychological or iatrogenic harm," Dr. Eisen said.

CXR for surveillance yielded 198 true positive results in 10,046 patients (2%), and false positive results in 384 of 4,055 patients (9.5%).

Based on findings from studies that reported true positives as well as the number of patients who were eligible for or who underwent surgery as a result, 47 of 4,849 patients (1%) may have benefited from CXR surveillance, Dr. Eisen said.

The literature included fewer studies for CT than for CXR, likely because of the increased expense for CT, he noted.

CT was slightly more sensitive for staging, but false positives still outweighed true positives by at least threefold for staging; among 1,111 patients, there were 112 (10%) false positives vs. 41 (3.6%) true positives. CT results altered treatment in 1 of 338 patients (0.3%).

CT for routine surveillance yielded true positives in 63 of 467 patients (13.5%), and false positives in 13 of 127 patients (10.2%). There were no data on the number of patients eligible for surgical intervention based on CT surveillance, Dr. Eisen said.

Even fewer studies were available for MRI, which was almost exclusively used for cerebral imaging. MRI yielded true positives in 13 of 285 patients (4.5%), and false positives in 1 of 185 patients (0.5%). MRI for routine surveillance was addressed in only one study, which showed a true positive rate in 1 of 43 patients (2.3%).

PET for staging yielded true positives in 40 of 821 patients (4.9%), and false positives in 87 of 821 patients (10.6%). PET failed to detect disease in 159 of the patients, for a false negative rate of 19.3%, and changed management decisions in 21 of 191 patients (11%). Only 2 of these patients (1%) were eligible for surgery, however.

PET for post-treatment surveillance yielded true positives in 10 of 252 patients (4%), false positives in 16 of 218 patients (7.3%), and false negatives in 30 of 204 patients (14.7%).

Based on one study, 3 of 30 patients (10%) were found to be eligible for surgery as a result of PET imaging. PET-CT was more sensitive, but results were similarly disappointing, Dr. Eisen said.

Findings were slightly more encouraging for lymph node ultrasonography. In 11 studies, ultrasound staging yielded true positive rates in 100 of 1,035 patients (10%), and false positive results in 73 of 1,035 patients (7%); 44 patients were spared sentinel lymph node biopsies as a result of ultrasound imaging, and instead, proceeded to complete lymph node dissection, Dr. Eisen said. However, ultrasound for staging yielded a false negative result in 120 of 688 patients (17.4%).

Based on 9 studies, ultrasound for surveillance yielded true positive results in the absence of clinical findings in 79 of 1,266 patients (6.2%), false positive results in 12 of 966 patients for whom data were reported (1.2%), and false negative results in 5 of 806 patients (0.62%).

The data are imperfect, but seem to suggest that use of these imaging technologies can do more harm than good, Dr. Eisen said.

While patients may specifically request imaging to alleviate concerns that their primary cutaneous melanoma has advanced or will advance, it is important to keep in mind that, based on these results, the risk of causing unnecessary stress and iatrogenic harm outweigh the potential benefits, he concluded.

Dr. Eisen reported having no disclosures.

ATLANTA – The routine use of imaging for the staging or surveillance of asymptomatic patients with primary cutaneous melanoma appears unwarranted, according to findings from a comprehensive literature review.

Even in high-risk patients, the use of chest x-ray (CXR), computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET), or PET-CT, yields unacceptably high rates of false positive results and has minimal impact on treatment plans, Dr. Daniel Eisen reported at the annual meeting of the American Society for Dermatologic Surgery.

The findings, which are based on an extensive systematic search of the Medline database for all relevant imaging studies conducted from 1970 to 2011, did suggest that high-frequency ultrasonography might be of diagnostic value for the early detection of subclinical lymph node metastases when used with routine follow-up in high-risk patients, but additional comparative prospective studies are needed to confirm this, said Dr. Eisen of the University of California, Davis.

Among the notable findings, CXR for staging yielded 14 true positive results in 4,320 patients (0.3%) in the reviewed studies. None of these was mentioned as amenable to surgical intervention. In addition, 326 false positives were reported in 3,447 (9.4%) patients with relevant data.

"So, [with CXR for staging] you have about a 20-fold chance of causing your patient undue psychological or iatrogenic harm," Dr. Eisen said.

CXR for surveillance yielded 198 true positive results in 10,046 patients (2%), and false positive results in 384 of 4,055 patients (9.5%).

Based on findings from studies that reported true positives as well as the number of patients who were eligible for or who underwent surgery as a result, 47 of 4,849 patients (1%) may have benefited from CXR surveillance, Dr. Eisen said.

The literature included fewer studies for CT than for CXR, likely because of the increased expense for CT, he noted.

CT was slightly more sensitive for staging, but false positives still outweighed true positives by at least threefold for staging; among 1,111 patients, there were 112 (10%) false positives vs. 41 (3.6%) true positives. CT results altered treatment in 1 of 338 patients (0.3%).

CT for routine surveillance yielded true positives in 63 of 467 patients (13.5%), and false positives in 13 of 127 patients (10.2%). There were no data on the number of patients eligible for surgical intervention based on CT surveillance, Dr. Eisen said.

Even fewer studies were available for MRI, which was almost exclusively used for cerebral imaging. MRI yielded true positives in 13 of 285 patients (4.5%), and false positives in 1 of 185 patients (0.5%). MRI for routine surveillance was addressed in only one study, which showed a true positive rate in 1 of 43 patients (2.3%).

PET for staging yielded true positives in 40 of 821 patients (4.9%), and false positives in 87 of 821 patients (10.6%). PET failed to detect disease in 159 of the patients, for a false negative rate of 19.3%, and changed management decisions in 21 of 191 patients (11%). Only 2 of these patients (1%) were eligible for surgery, however.

PET for post-treatment surveillance yielded true positives in 10 of 252 patients (4%), false positives in 16 of 218 patients (7.3%), and false negatives in 30 of 204 patients (14.7%).

Based on one study, 3 of 30 patients (10%) were found to be eligible for surgery as a result of PET imaging. PET-CT was more sensitive, but results were similarly disappointing, Dr. Eisen said.

Findings were slightly more encouraging for lymph node ultrasonography. In 11 studies, ultrasound staging yielded true positive rates in 100 of 1,035 patients (10%), and false positive results in 73 of 1,035 patients (7%); 44 patients were spared sentinel lymph node biopsies as a result of ultrasound imaging, and instead, proceeded to complete lymph node dissection, Dr. Eisen said. However, ultrasound for staging yielded a false negative result in 120 of 688 patients (17.4%).

Based on 9 studies, ultrasound for surveillance yielded true positive results in the absence of clinical findings in 79 of 1,266 patients (6.2%), false positive results in 12 of 966 patients for whom data were reported (1.2%), and false negative results in 5 of 806 patients (0.62%).

The data are imperfect, but seem to suggest that use of these imaging technologies can do more harm than good, Dr. Eisen said.

While patients may specifically request imaging to alleviate concerns that their primary cutaneous melanoma has advanced or will advance, it is important to keep in mind that, based on these results, the risk of causing unnecessary stress and iatrogenic harm outweigh the potential benefits, he concluded.

Dr. Eisen reported having no disclosures.

ATLANTA – A cyanoacrylate adhesive–based implant is feasible, safe, and effective for the treatment of great saphenous vein incompetence, according to 1-year follow-up data from the first study of the product in humans.

The treatment requires neither local anesthesia nor use of medical compression stockings, Dr. Thomas Proebstle reported at the annual meeting of the American Society for Dermatologic Surgery.

Of 38 patients with an incompetent great saphenous vein who were treated with a proprietary formulation of cyanoacrylate adhesive (commonly known as superglue), 100% demonstrated complete closure of the vein immediately and at the 48-hour follow-up, as measured using duplex ultrasound and clinical examination; at 1-year follow-up, 92% maintained complete closure of the vein, said Dr. Proebstle of Hirschberg, Germany. One complete recanalization and two partial recanalizations occurred during follow-up – at 1, 3, and 6 months, respectively, he noted.

Most patients (89%) had improvement in leg edema within 48 hours, and all had venous clinical severity score improvement, which changed from a mean of 6.1 at baseline to a mean of 1.1 at 6 months.

The study involved 29 women and 9 men with a median age of 51 years. Treatment was administered by catheter deployment under ultrasound guidance via a repetitive bolus injection algorithm, Dr. Proebstle noted. No tumescent anesthesia or compression stockings were used.

For this study, the mean total volume of endovenous cyanoacrylate adhesive delivered was 1.26 mL. Side effects were mild and self-limited.

The cyanoacrylate adhesive implant, known as the VenaSeal Sapheon closure system, has received European Union regulatory approval. The manufacturer, Sapheon, is currently preparing for U.S. clinical trials and Food and Drug Administration approval, according to the company’s website.

Dr. Proebstle is a consultant for Sapheon. He also owns stock in the company.

ATLANTA – A cyanoacrylate adhesive–based implant is feasible, safe, and effective for the treatment of great saphenous vein incompetence, according to 1-year follow-up data from the first study of the product in humans.

The treatment requires neither local anesthesia nor use of medical compression stockings, Dr. Thomas Proebstle reported at the annual meeting of the American Society for Dermatologic Surgery.

Of 38 patients with an incompetent great saphenous vein who were treated with a proprietary formulation of cyanoacrylate adhesive (commonly known as superglue), 100% demonstrated complete closure of the vein immediately and at the 48-hour follow-up, as measured using duplex ultrasound and clinical examination; at 1-year follow-up, 92% maintained complete closure of the vein, said Dr. Proebstle of Hirschberg, Germany. One complete recanalization and two partial recanalizations occurred during follow-up – at 1, 3, and 6 months, respectively, he noted.

Most patients (89%) had improvement in leg edema within 48 hours, and all had venous clinical severity score improvement, which changed from a mean of 6.1 at baseline to a mean of 1.1 at 6 months.

The study involved 29 women and 9 men with a median age of 51 years. Treatment was administered by catheter deployment under ultrasound guidance via a repetitive bolus injection algorithm, Dr. Proebstle noted. No tumescent anesthesia or compression stockings were used.

For this study, the mean total volume of endovenous cyanoacrylate adhesive delivered was 1.26 mL. Side effects were mild and self-limited.

The cyanoacrylate adhesive implant, known as the VenaSeal Sapheon closure system, has received European Union regulatory approval. The manufacturer, Sapheon, is currently preparing for U.S. clinical trials and Food and Drug Administration approval, according to the company’s website.

Dr. Proebstle is a consultant for Sapheon. He also owns stock in the company.

ATLANTA – A cyanoacrylate adhesive–based implant is feasible, safe, and effective for the treatment of great saphenous vein incompetence, according to 1-year follow-up data from the first study of the product in humans.

The treatment requires neither local anesthesia nor use of medical compression stockings, Dr. Thomas Proebstle reported at the annual meeting of the American Society for Dermatologic Surgery.

Of 38 patients with an incompetent great saphenous vein who were treated with a proprietary formulation of cyanoacrylate adhesive (commonly known as superglue), 100% demonstrated complete closure of the vein immediately and at the 48-hour follow-up, as measured using duplex ultrasound and clinical examination; at 1-year follow-up, 92% maintained complete closure of the vein, said Dr. Proebstle of Hirschberg, Germany. One complete recanalization and two partial recanalizations occurred during follow-up – at 1, 3, and 6 months, respectively, he noted.

Most patients (89%) had improvement in leg edema within 48 hours, and all had venous clinical severity score improvement, which changed from a mean of 6.1 at baseline to a mean of 1.1 at 6 months.

The study involved 29 women and 9 men with a median age of 51 years. Treatment was administered by catheter deployment under ultrasound guidance via a repetitive bolus injection algorithm, Dr. Proebstle noted. No tumescent anesthesia or compression stockings were used.

For this study, the mean total volume of endovenous cyanoacrylate adhesive delivered was 1.26 mL. Side effects were mild and self-limited.

The cyanoacrylate adhesive implant, known as the VenaSeal Sapheon closure system, has received European Union regulatory approval. The manufacturer, Sapheon, is currently preparing for U.S. clinical trials and Food and Drug Administration approval, according to the company’s website.

Dr. Proebstle is a consultant for Sapheon. He also owns stock in the company.