Aesthetic Dermatology

SAN FRANCISCO — Three techniques can help make nasal reconstruction surgery easier while providing positive results.

Dr. Hayes B. Gladstone recommends using a more diamond-shaped bilobed flap instead of curved incisions, doing a shave contour instead of defatting a staged melolabial flap, and dividing a paramedian forehead flap after 1 week instead of 3 weeks.

The diamond bilobed flap results in less stress and tension during healing and may reduce the risk of pincushioning, also called trap-door deformity. A shave division of a staged melolabial flap is much easier than defatting, and patients seem pleased to shorten the time to division of a paramedian forehead flap, he said at the annual meeting of the Pacific Dermatologic Association.

▸ Bilobed flap. The original design for a bilobed flap was modified in 1989 to change the angles in order to reduce pincushioning, in which the flap raises up. "If you look in the literature, there is still about a 5%–10% risk" of pincushioning with a bilobed flap, probably caused by wound contraction, said Dr. Gladstone of Stanford (Calif.) University.

By using more angular incision lines (instead of curved lines) to give the flap more of a diamond shape, only 2 mm of undermining is needed instead of the 3 mm needed with a conventional bilobed flap. "It's more of an advancement flap in its angular design," he said.

Computer modeling suggests that the diamond bilobed flap reduces strain on the closure points by 85%, compared with a conventional bilobed flap.

"With angles you're going to get less compression and less contraction, and therefore you're going to get less risk of pincushioning," Dr. Gladstone said.

▸ Melolabial flap. He follows the conventional technique for most patients with thin, nonlobular alar rims who undergo a staged melolabial flap for nasal reconstruction, but after 3 weeks, instead of defatting the flap, he does a shave contour that takes around 3–4 minutes. He lets that heal by second intent.

"It seems a little counterintuitive, but it actually heals very well," accompanied by closure of a small cheek defect when needed, he said.

The key to shave contouring the melolabial flap is to not be too aggressive, which can result in a divot or raising of the alar rim, he added.

▸ Paramedian forehead flap. Most patients dislike waiting 3 weeks to divide a paramedian forehead flap because the flap disrupts vision, making it difficult to read or drive; decreases quality of life; and can cause psychological stress.

One patient tore off his flap after 4 days but healed well. "That's how I decided to start doing this" division earlier, Dr. Gladstone said.

He plans to submit for publication the results for 35 patients who underwent division of a paramedian forehead flap after 1 week.

A survey of the first 15 patients found that all preferred to have the procedure done after 1 week instead of 3 weeks. Tests showed good blood flow, and only three patients required small revisions, he said.

One 95-year-old patient with an active dating life was a prime candidate for the 1-week division of the paramedian forehead flap because "he wasn't going to tolerate 3 weeks," Dr. Gladstone said. The patient healed well.

SAN FRANCISCO — Three techniques can help make nasal reconstruction surgery easier while providing positive results.

Dr. Hayes B. Gladstone recommends using a more diamond-shaped bilobed flap instead of curved incisions, doing a shave contour instead of defatting a staged melolabial flap, and dividing a paramedian forehead flap after 1 week instead of 3 weeks.

The diamond bilobed flap results in less stress and tension during healing and may reduce the risk of pincushioning, also called trap-door deformity. A shave division of a staged melolabial flap is much easier than defatting, and patients seem pleased to shorten the time to division of a paramedian forehead flap, he said at the annual meeting of the Pacific Dermatologic Association.

▸ Bilobed flap. The original design for a bilobed flap was modified in 1989 to change the angles in order to reduce pincushioning, in which the flap raises up. "If you look in the literature, there is still about a 5%–10% risk" of pincushioning with a bilobed flap, probably caused by wound contraction, said Dr. Gladstone of Stanford (Calif.) University.

By using more angular incision lines (instead of curved lines) to give the flap more of a diamond shape, only 2 mm of undermining is needed instead of the 3 mm needed with a conventional bilobed flap. "It's more of an advancement flap in its angular design," he said.

Computer modeling suggests that the diamond bilobed flap reduces strain on the closure points by 85%, compared with a conventional bilobed flap.

"With angles you're going to get less compression and less contraction, and therefore you're going to get less risk of pincushioning," Dr. Gladstone said.

▸ Melolabial flap. He follows the conventional technique for most patients with thin, nonlobular alar rims who undergo a staged melolabial flap for nasal reconstruction, but after 3 weeks, instead of defatting the flap, he does a shave contour that takes around 3–4 minutes. He lets that heal by second intent.

"It seems a little counterintuitive, but it actually heals very well," accompanied by closure of a small cheek defect when needed, he said.

The key to shave contouring the melolabial flap is to not be too aggressive, which can result in a divot or raising of the alar rim, he added.

▸ Paramedian forehead flap. Most patients dislike waiting 3 weeks to divide a paramedian forehead flap because the flap disrupts vision, making it difficult to read or drive; decreases quality of life; and can cause psychological stress.

One patient tore off his flap after 4 days but healed well. "That's how I decided to start doing this" division earlier, Dr. Gladstone said.

He plans to submit for publication the results for 35 patients who underwent division of a paramedian forehead flap after 1 week.

A survey of the first 15 patients found that all preferred to have the procedure done after 1 week instead of 3 weeks. Tests showed good blood flow, and only three patients required small revisions, he said.

One 95-year-old patient with an active dating life was a prime candidate for the 1-week division of the paramedian forehead flap because "he wasn't going to tolerate 3 weeks," Dr. Gladstone said. The patient healed well.

SAN FRANCISCO — Three techniques can help make nasal reconstruction surgery easier while providing positive results.

Dr. Hayes B. Gladstone recommends using a more diamond-shaped bilobed flap instead of curved incisions, doing a shave contour instead of defatting a staged melolabial flap, and dividing a paramedian forehead flap after 1 week instead of 3 weeks.

The diamond bilobed flap results in less stress and tension during healing and may reduce the risk of pincushioning, also called trap-door deformity. A shave division of a staged melolabial flap is much easier than defatting, and patients seem pleased to shorten the time to division of a paramedian forehead flap, he said at the annual meeting of the Pacific Dermatologic Association.

▸ Bilobed flap. The original design for a bilobed flap was modified in 1989 to change the angles in order to reduce pincushioning, in which the flap raises up. "If you look in the literature, there is still about a 5%–10% risk" of pincushioning with a bilobed flap, probably caused by wound contraction, said Dr. Gladstone of Stanford (Calif.) University.

By using more angular incision lines (instead of curved lines) to give the flap more of a diamond shape, only 2 mm of undermining is needed instead of the 3 mm needed with a conventional bilobed flap. "It's more of an advancement flap in its angular design," he said.

Computer modeling suggests that the diamond bilobed flap reduces strain on the closure points by 85%, compared with a conventional bilobed flap.

"With angles you're going to get less compression and less contraction, and therefore you're going to get less risk of pincushioning," Dr. Gladstone said.

▸ Melolabial flap. He follows the conventional technique for most patients with thin, nonlobular alar rims who undergo a staged melolabial flap for nasal reconstruction, but after 3 weeks, instead of defatting the flap, he does a shave contour that takes around 3–4 minutes. He lets that heal by second intent.

"It seems a little counterintuitive, but it actually heals very well," accompanied by closure of a small cheek defect when needed, he said.

The key to shave contouring the melolabial flap is to not be too aggressive, which can result in a divot or raising of the alar rim, he added.

▸ Paramedian forehead flap. Most patients dislike waiting 3 weeks to divide a paramedian forehead flap because the flap disrupts vision, making it difficult to read or drive; decreases quality of life; and can cause psychological stress.

One patient tore off his flap after 4 days but healed well. "That's how I decided to start doing this" division earlier, Dr. Gladstone said.

He plans to submit for publication the results for 35 patients who underwent division of a paramedian forehead flap after 1 week.

A survey of the first 15 patients found that all preferred to have the procedure done after 1 week instead of 3 weeks. Tests showed good blood flow, and only three patients required small revisions, he said.

One 95-year-old patient with an active dating life was a prime candidate for the 1-week division of the paramedian forehead flap because "he wasn't going to tolerate 3 weeks," Dr. Gladstone said. The patient healed well.

SAN FRANCISCO — Respect the nasolabial folds, vermilion border, and mental crease to get the most natural-looking results from reconstructive surgery around the mouth.

Put linear surgical scars into those lines—not across them—to avoid a noticeable asymmetry that "gets very exaggerated during movement" of the mouth, Dr. Ken K. Lee said at the annual meeting of the Pacific Dermatologic Association. Even respecting the lines of current or future rhytids can help hide a scar.

Surgeons commonly used to use a transition flap from the cheek to repair surgical defects on the upper cutaneous lip, but this would blunt the entire nasolabial fold. "If the crease is completely gone, it looks unnatural," so surgeons today shy away from that technique, said Dr. Lee, director of dermatologic and laser surgery at Oregon Health and Science University, Portland.

Perioral surgical defects on the upper lip tend to leave indented scars unless the surgeon hypereverts the incision. "The natural tendency—the reason we get wrinkles in this area—is it wants to invert. So you really have to do an exaggerated eversion to prevent this type of indented scar," he said. The creation of a little ridge when a defect is closed helps produce a nearly invisible scar instead of an indented one.

Closing in a linear fashion may not suffice for larger defects, but the surgeon still should respect the cosmetic lines when using other techniques for closure. Aligning the closure of a rotation flap with the nasolabial fold, rhytids, mental crease, or vermilion border will help hide a scar.

For larger defects, the island pedicle flap becomes the surgeon's work horse, in all its variations. "It allows me to bring skin in from outside the lip unit to fill in larger defects in the lip," Dr. Lee said.

He used a pedicle flap from outside the nasolabial fold to help close a complex defect in the upper cutaneous lip, nose, and cheek in one patient, closing along the nasolabial fold and advancing the cheek. "Recreating all the cosmetic borders is important," he said.

For a young woman in her 30s with little extra skin compared with older patients, it is difficult to repair a defect that takes up a large portion of the upper cutaneous lip just by using the skin inside of the nasolabial fold. It's okay to tap the reservoir of cheek skin for an island pedicle flap to repair this, but "the important thing is that when you zip up the island pedicle—the defect behind it—that line needs to follow the nasolabial fold," he said.

The downside of island pedicle flaps is potential "pincushioning," he added, but if the incision has been adequately undermined and the edges everted, resulting in a good-looking scar, pincushioning will go away in time.

'The natural tendency—the reason we get wrinkles in this area—is it wants to invert.' DR. LEE

An island pedicle flap can utilize skin from outside the perioral borders to fill a defect in the upper lip, with closure along the nasolabial fold for a good cosmetic result as demonstrated in the patient above. The patient is shown before and after surgery (left and middle, respectively), and after the wound had healed (right). Photos courtesy Dr. Ken K. Lee

SAN FRANCISCO — Respect the nasolabial folds, vermilion border, and mental crease to get the most natural-looking results from reconstructive surgery around the mouth.

Put linear surgical scars into those lines—not across them—to avoid a noticeable asymmetry that "gets very exaggerated during movement" of the mouth, Dr. Ken K. Lee said at the annual meeting of the Pacific Dermatologic Association. Even respecting the lines of current or future rhytids can help hide a scar.

Surgeons commonly used to use a transition flap from the cheek to repair surgical defects on the upper cutaneous lip, but this would blunt the entire nasolabial fold. "If the crease is completely gone, it looks unnatural," so surgeons today shy away from that technique, said Dr. Lee, director of dermatologic and laser surgery at Oregon Health and Science University, Portland.

Perioral surgical defects on the upper lip tend to leave indented scars unless the surgeon hypereverts the incision. "The natural tendency—the reason we get wrinkles in this area—is it wants to invert. So you really have to do an exaggerated eversion to prevent this type of indented scar," he said. The creation of a little ridge when a defect is closed helps produce a nearly invisible scar instead of an indented one.

Closing in a linear fashion may not suffice for larger defects, but the surgeon still should respect the cosmetic lines when using other techniques for closure. Aligning the closure of a rotation flap with the nasolabial fold, rhytids, mental crease, or vermilion border will help hide a scar.

For larger defects, the island pedicle flap becomes the surgeon's work horse, in all its variations. "It allows me to bring skin in from outside the lip unit to fill in larger defects in the lip," Dr. Lee said.

He used a pedicle flap from outside the nasolabial fold to help close a complex defect in the upper cutaneous lip, nose, and cheek in one patient, closing along the nasolabial fold and advancing the cheek. "Recreating all the cosmetic borders is important," he said.

For a young woman in her 30s with little extra skin compared with older patients, it is difficult to repair a defect that takes up a large portion of the upper cutaneous lip just by using the skin inside of the nasolabial fold. It's okay to tap the reservoir of cheek skin for an island pedicle flap to repair this, but "the important thing is that when you zip up the island pedicle—the defect behind it—that line needs to follow the nasolabial fold," he said.

The downside of island pedicle flaps is potential "pincushioning," he added, but if the incision has been adequately undermined and the edges everted, resulting in a good-looking scar, pincushioning will go away in time.

'The natural tendency—the reason we get wrinkles in this area—is it wants to invert.' DR. LEE

An island pedicle flap can utilize skin from outside the perioral borders to fill a defect in the upper lip, with closure along the nasolabial fold for a good cosmetic result as demonstrated in the patient above. The patient is shown before and after surgery (left and middle, respectively), and after the wound had healed (right). Photos courtesy Dr. Ken K. Lee

SAN FRANCISCO — Respect the nasolabial folds, vermilion border, and mental crease to get the most natural-looking results from reconstructive surgery around the mouth.

Put linear surgical scars into those lines—not across them—to avoid a noticeable asymmetry that "gets very exaggerated during movement" of the mouth, Dr. Ken K. Lee said at the annual meeting of the Pacific Dermatologic Association. Even respecting the lines of current or future rhytids can help hide a scar.

Surgeons commonly used to use a transition flap from the cheek to repair surgical defects on the upper cutaneous lip, but this would blunt the entire nasolabial fold. "If the crease is completely gone, it looks unnatural," so surgeons today shy away from that technique, said Dr. Lee, director of dermatologic and laser surgery at Oregon Health and Science University, Portland.

Perioral surgical defects on the upper lip tend to leave indented scars unless the surgeon hypereverts the incision. "The natural tendency—the reason we get wrinkles in this area—is it wants to invert. So you really have to do an exaggerated eversion to prevent this type of indented scar," he said. The creation of a little ridge when a defect is closed helps produce a nearly invisible scar instead of an indented one.

Closing in a linear fashion may not suffice for larger defects, but the surgeon still should respect the cosmetic lines when using other techniques for closure. Aligning the closure of a rotation flap with the nasolabial fold, rhytids, mental crease, or vermilion border will help hide a scar.

For larger defects, the island pedicle flap becomes the surgeon's work horse, in all its variations. "It allows me to bring skin in from outside the lip unit to fill in larger defects in the lip," Dr. Lee said.

He used a pedicle flap from outside the nasolabial fold to help close a complex defect in the upper cutaneous lip, nose, and cheek in one patient, closing along the nasolabial fold and advancing the cheek. "Recreating all the cosmetic borders is important," he said.

For a young woman in her 30s with little extra skin compared with older patients, it is difficult to repair a defect that takes up a large portion of the upper cutaneous lip just by using the skin inside of the nasolabial fold. It's okay to tap the reservoir of cheek skin for an island pedicle flap to repair this, but "the important thing is that when you zip up the island pedicle—the defect behind it—that line needs to follow the nasolabial fold," he said.

The downside of island pedicle flaps is potential "pincushioning," he added, but if the incision has been adequately undermined and the edges everted, resulting in a good-looking scar, pincushioning will go away in time.

'The natural tendency—the reason we get wrinkles in this area—is it wants to invert.' DR. LEE

An island pedicle flap can utilize skin from outside the perioral borders to fill a defect in the upper lip, with closure along the nasolabial fold for a good cosmetic result as demonstrated in the patient above. The patient is shown before and after surgery (left and middle, respectively), and after the wound had healed (right). Photos courtesy Dr. Ken K. Lee

CHICAGO — The first large-scale trial of calcium hydroxylapatite in patients with Fitzpatrick skin types IV-VI showed no keloid formation, hypertropic scarring, or skin discoloration when used to treat nasolabial folds.

Although the reasons for scarring and keloids are not clear, anecdotally these side effects appear to present more in patients with darker skin types, lead investigator Dr. Ellen Marmur, chief of dermatologic surgery at Mount Sinai School of Medicine, New York, said in an interview.

"This study liberates many women and men with darker skin types to undergo cosmetic filler treatments with calcium hydroxylapatite," she said. "Past concerns about keloid scarring and discoloration now can be minimized, if not totally alleviated, for these patients.

"Their safety profiles matched those of the larger safety studies in lighter skin types showing this filler is safe to use in all skin types," she added.

The open-label, multicenter, nonrandomized prospective trial enrolled 100 patients with moderate to severe nasolabial folds and Fitzpatrick skin types IV (24%), V (35%), and VI (41%). Calcium hydroxylapatite 0.6 mL–2.8 mL (mean 1.24 mL) was injected subdermally with a 25- to 27-gauge needle using a linear threading/fanning technique.

The mean patient age was 52 years and 94 were female; 85% were African American, 12% were Hispanic, 2% were Asian, and 1%, other.

Evaluation of 100 patients at 3 months and 98 patients at 6 months revealed no keloid formation, hypertrophic scarring, hypopigmentation, hyperpigmentation, or other clinically significant adverse events, Dr. Marmur and her associates reported in a poster at the American Academy of Dermatology's Academy 2008 meeting.

The study did not objectively evaluate efficacy, but treatment benefit, based on physician assessment, persisted for up to 6 months. Radiesse contains calcium-based microspheres suspended in a water-based gel that absorbs in 2–4 weeks, and builds volume by stimulating collagen growth around the implanted material.

Calcium hydroxylapatite (Radiesse) is approved for HIV-associated facial lipoatrophy, and is used as a cosmetic dermal filler.

The study was sponsored by BioForm Medical Inc., the maker of Radiesse. Dr. Marmur is on the medical education faculty for BioForm.

CHICAGO — The first large-scale trial of calcium hydroxylapatite in patients with Fitzpatrick skin types IV-VI showed no keloid formation, hypertropic scarring, or skin discoloration when used to treat nasolabial folds.

Although the reasons for scarring and keloids are not clear, anecdotally these side effects appear to present more in patients with darker skin types, lead investigator Dr. Ellen Marmur, chief of dermatologic surgery at Mount Sinai School of Medicine, New York, said in an interview.

"This study liberates many women and men with darker skin types to undergo cosmetic filler treatments with calcium hydroxylapatite," she said. "Past concerns about keloid scarring and discoloration now can be minimized, if not totally alleviated, for these patients.

"Their safety profiles matched those of the larger safety studies in lighter skin types showing this filler is safe to use in all skin types," she added.

The open-label, multicenter, nonrandomized prospective trial enrolled 100 patients with moderate to severe nasolabial folds and Fitzpatrick skin types IV (24%), V (35%), and VI (41%). Calcium hydroxylapatite 0.6 mL–2.8 mL (mean 1.24 mL) was injected subdermally with a 25- to 27-gauge needle using a linear threading/fanning technique.

The mean patient age was 52 years and 94 were female; 85% were African American, 12% were Hispanic, 2% were Asian, and 1%, other.

Evaluation of 100 patients at 3 months and 98 patients at 6 months revealed no keloid formation, hypertrophic scarring, hypopigmentation, hyperpigmentation, or other clinically significant adverse events, Dr. Marmur and her associates reported in a poster at the American Academy of Dermatology's Academy 2008 meeting.

The study did not objectively evaluate efficacy, but treatment benefit, based on physician assessment, persisted for up to 6 months. Radiesse contains calcium-based microspheres suspended in a water-based gel that absorbs in 2–4 weeks, and builds volume by stimulating collagen growth around the implanted material.

Calcium hydroxylapatite (Radiesse) is approved for HIV-associated facial lipoatrophy, and is used as a cosmetic dermal filler.

The study was sponsored by BioForm Medical Inc., the maker of Radiesse. Dr. Marmur is on the medical education faculty for BioForm.

CHICAGO — The first large-scale trial of calcium hydroxylapatite in patients with Fitzpatrick skin types IV-VI showed no keloid formation, hypertropic scarring, or skin discoloration when used to treat nasolabial folds.

Although the reasons for scarring and keloids are not clear, anecdotally these side effects appear to present more in patients with darker skin types, lead investigator Dr. Ellen Marmur, chief of dermatologic surgery at Mount Sinai School of Medicine, New York, said in an interview.

"This study liberates many women and men with darker skin types to undergo cosmetic filler treatments with calcium hydroxylapatite," she said. "Past concerns about keloid scarring and discoloration now can be minimized, if not totally alleviated, for these patients.

"Their safety profiles matched those of the larger safety studies in lighter skin types showing this filler is safe to use in all skin types," she added.

The open-label, multicenter, nonrandomized prospective trial enrolled 100 patients with moderate to severe nasolabial folds and Fitzpatrick skin types IV (24%), V (35%), and VI (41%). Calcium hydroxylapatite 0.6 mL–2.8 mL (mean 1.24 mL) was injected subdermally with a 25- to 27-gauge needle using a linear threading/fanning technique.

The mean patient age was 52 years and 94 were female; 85% were African American, 12% were Hispanic, 2% were Asian, and 1%, other.

Evaluation of 100 patients at 3 months and 98 patients at 6 months revealed no keloid formation, hypertrophic scarring, hypopigmentation, hyperpigmentation, or other clinically significant adverse events, Dr. Marmur and her associates reported in a poster at the American Academy of Dermatology's Academy 2008 meeting.

The study did not objectively evaluate efficacy, but treatment benefit, based on physician assessment, persisted for up to 6 months. Radiesse contains calcium-based microspheres suspended in a water-based gel that absorbs in 2–4 weeks, and builds volume by stimulating collagen growth around the implanted material.

Calcium hydroxylapatite (Radiesse) is approved for HIV-associated facial lipoatrophy, and is used as a cosmetic dermal filler.

The study was sponsored by BioForm Medical Inc., the maker of Radiesse. Dr. Marmur is on the medical education faculty for BioForm.

CHICAGO — Injectable poly-L-lactic acid used to treat nasolabial fold wrinkles produced significantly fewer overall product-related adverse events than human-derived collagen, study results have shown.

In a randomized multicenter trial of 233 patients with nasolabial fold wrinkles, the overall product-related adverse event rate was 21% with poly-L-lactic acid (PLLA; Sculptra) and 36% with human collagen (Cosmoplast), resulting in a P value of less than .05.

Compared with the PLLA group, the collagen group had more injection-site erythema (26.5% vs. 2.6%) and pruritus (8% vs. 1%), Dr. Marta Rendon and the Cosmetic Study Trial Group reported in a poster at the American Academy of Dermatology's Academy 2008 meeting.

The PLLA group reported more injection-site pain (5.2% vs. 3.4%); more application-site papules, defined as palpable elevations less than 5 mm in diameter (8.6% vs. 3.4%); and more application-site nodules, defined as lesions 5 mm or more in diameter (7% vs. 6%). The difference between the groups was statistically significant for nodules.

The papules and nodules were nonvisible, palpable, and mild or moderate in intensity; all but one event resolved spontaneously during the 13-month follow-up period.

The frequency of adverse events with injectable PLLA, including injection-site pain, papules, and nodules, was lower than reported in early published reports in patients with HIV-related facial lipoatrophy, reported Dr. Rendon, who is in private practice in Boca Raton, Fla., and her associates.

No product-related serious adverse events occurred during the study, which was sponsored by Sanofi-Aventis U.S., which markets Sculptra in the United States through its subsidiary, Dermik Laboratories.

Injectable PLLA is currently approved in the United States for HIV-related facial lipoatrophy and is under review for volume restoration and/or correction of facial wrinkles and folds.

Patients (mean age 51 years) in the study had scores of 2–4 on a 5-point photo-numeric wrinkle assessment scale (WAS) for both the right and left nasolabial fold.

They underwent bilateral injections of PLLA (maximum 5 mL of reconstituted product per session) or collagen (1–2 cc per session) at one to four treatment sessions at 3-week intervals until an optimal correction was achieved for both folds. Roughly 40% in each group were Fitzpatrick skin type III.

Both the PLLA and collagen groups had significant reductions from baseline in WAS scores 3 weeks after the last treatment, as assessed by three plastic surgeons/dermatologists blinded to treatment.

Comparisons between the two groups in the change from baseline in mean WAS scores at subsequent time points resulted in significant differences favoring PLLA at months 3, 6, 9, and 13, reported Dr. Rendon and her associates.

CHICAGO — Injectable poly-L-lactic acid used to treat nasolabial fold wrinkles produced significantly fewer overall product-related adverse events than human-derived collagen, study results have shown.

In a randomized multicenter trial of 233 patients with nasolabial fold wrinkles, the overall product-related adverse event rate was 21% with poly-L-lactic acid (PLLA; Sculptra) and 36% with human collagen (Cosmoplast), resulting in a P value of less than .05.

Compared with the PLLA group, the collagen group had more injection-site erythema (26.5% vs. 2.6%) and pruritus (8% vs. 1%), Dr. Marta Rendon and the Cosmetic Study Trial Group reported in a poster at the American Academy of Dermatology's Academy 2008 meeting.

The PLLA group reported more injection-site pain (5.2% vs. 3.4%); more application-site papules, defined as palpable elevations less than 5 mm in diameter (8.6% vs. 3.4%); and more application-site nodules, defined as lesions 5 mm or more in diameter (7% vs. 6%). The difference between the groups was statistically significant for nodules.

The papules and nodules were nonvisible, palpable, and mild or moderate in intensity; all but one event resolved spontaneously during the 13-month follow-up period.

The frequency of adverse events with injectable PLLA, including injection-site pain, papules, and nodules, was lower than reported in early published reports in patients with HIV-related facial lipoatrophy, reported Dr. Rendon, who is in private practice in Boca Raton, Fla., and her associates.

No product-related serious adverse events occurred during the study, which was sponsored by Sanofi-Aventis U.S., which markets Sculptra in the United States through its subsidiary, Dermik Laboratories.

Injectable PLLA is currently approved in the United States for HIV-related facial lipoatrophy and is under review for volume restoration and/or correction of facial wrinkles and folds.

Patients (mean age 51 years) in the study had scores of 2–4 on a 5-point photo-numeric wrinkle assessment scale (WAS) for both the right and left nasolabial fold.

They underwent bilateral injections of PLLA (maximum 5 mL of reconstituted product per session) or collagen (1–2 cc per session) at one to four treatment sessions at 3-week intervals until an optimal correction was achieved for both folds. Roughly 40% in each group were Fitzpatrick skin type III.

Both the PLLA and collagen groups had significant reductions from baseline in WAS scores 3 weeks after the last treatment, as assessed by three plastic surgeons/dermatologists blinded to treatment.

Comparisons between the two groups in the change from baseline in mean WAS scores at subsequent time points resulted in significant differences favoring PLLA at months 3, 6, 9, and 13, reported Dr. Rendon and her associates.

CHICAGO — Injectable poly-L-lactic acid used to treat nasolabial fold wrinkles produced significantly fewer overall product-related adverse events than human-derived collagen, study results have shown.

In a randomized multicenter trial of 233 patients with nasolabial fold wrinkles, the overall product-related adverse event rate was 21% with poly-L-lactic acid (PLLA; Sculptra) and 36% with human collagen (Cosmoplast), resulting in a P value of less than .05.

Compared with the PLLA group, the collagen group had more injection-site erythema (26.5% vs. 2.6%) and pruritus (8% vs. 1%), Dr. Marta Rendon and the Cosmetic Study Trial Group reported in a poster at the American Academy of Dermatology's Academy 2008 meeting.

The PLLA group reported more injection-site pain (5.2% vs. 3.4%); more application-site papules, defined as palpable elevations less than 5 mm in diameter (8.6% vs. 3.4%); and more application-site nodules, defined as lesions 5 mm or more in diameter (7% vs. 6%). The difference between the groups was statistically significant for nodules.

The papules and nodules were nonvisible, palpable, and mild or moderate in intensity; all but one event resolved spontaneously during the 13-month follow-up period.

The frequency of adverse events with injectable PLLA, including injection-site pain, papules, and nodules, was lower than reported in early published reports in patients with HIV-related facial lipoatrophy, reported Dr. Rendon, who is in private practice in Boca Raton, Fla., and her associates.

No product-related serious adverse events occurred during the study, which was sponsored by Sanofi-Aventis U.S., which markets Sculptra in the United States through its subsidiary, Dermik Laboratories.

Injectable PLLA is currently approved in the United States for HIV-related facial lipoatrophy and is under review for volume restoration and/or correction of facial wrinkles and folds.

Patients (mean age 51 years) in the study had scores of 2–4 on a 5-point photo-numeric wrinkle assessment scale (WAS) for both the right and left nasolabial fold.

They underwent bilateral injections of PLLA (maximum 5 mL of reconstituted product per session) or collagen (1–2 cc per session) at one to four treatment sessions at 3-week intervals until an optimal correction was achieved for both folds. Roughly 40% in each group were Fitzpatrick skin type III.

Both the PLLA and collagen groups had significant reductions from baseline in WAS scores 3 weeks after the last treatment, as assessed by three plastic surgeons/dermatologists blinded to treatment.

Comparisons between the two groups in the change from baseline in mean WAS scores at subsequent time points resulted in significant differences favoring PLLA at months 3, 6, 9, and 13, reported Dr. Rendon and her associates.

SANTA MONICA, CALIF. — Dermatologists have a bountiful bag of tricks when it comes to making patients look great eventually, but not so many options that make them look great instantly—especially after procedures that have left them temporarily red, bruised, or hypopigmented.

"They want appearance improvement and they want it immediately," said Dr. Howard Steinman, a dermatologist in private practice in Chula Vista, Calif.

"They're extremely unhappy when they've had a—quote—'no down time' procedure that results in discoloration."

There was a time when the only options were to call in sick to work, brave stares at the brightly lit Nordstrom cosmetic counter, or locate a highly trained professional paramedical camouflage therapist trained to cover scars and disfigurement.

However, that has all changed with the advent of highly effective, easy to apply mineral makeups, Dr. Steinman said at a cosmetic dermatology seminar sponsored by Skin Disease Education Foundation.

"These have revolutionized the use of medical makeup," he said.

A variety of products is now available that can be applied by a minimally trained individual with a brush or a sponge, with profound results for expected or unanticipated discoloration from procedures.

Patients with melasma and vitiligo also are surprised and grateful for the instantaneous improvement in appearance they can achieve with carefully applied mineral makeup, said Dr. Steinman.

"Anyone in your office can be trained to do this—your manager, receptionist, nurse, or spouse," he added.

Dr. Steinman's wife, Diedre, is a professional makeup artist who is skilled in masking difficult-to-cover abnormalities such as keloid scars, acne scars, and traumatic defects.

However, she saw the need for products that were more easily applied by office personnel and evaluated a variety of mineral makeup for use on routine patients.

Her choice, Youngblood, offers a variety of concealers, foundations, and powders that can used on men or women, said Dr. Steinman, who has no financial connections with the company.

The amount required to cover a patient's face for a few days or weeks of healing costs so little—$10–$12—that Dr. Steinman makes the service complimentary, rather than charging a fee.

It is well worth the cost, he said, not only in terms of patient satisfaction. "When you do something untoward to a patient [like cause a bruise with a Botox injection], you don't have to worry about it as much. You're going to fix it immediately in your office," he said.

Male patients are quietly appreciative, he said. Female patients are thrilled that they can safely use make-up right away.

Mineral makeups, which are crushed inert minerals in powder form, are non-comedogenic, hypoallergenic, and water resistant. As soon as sutures are removed and the skin is completely epithelialized and dry to the touch, they can be applied.

For some women, "not wearing makeup is like not being completely dressed," he said—like going to "a formal event in a bathing suit and a T-shirt."

Even postprocedure trips to a dermatology office can be traumatic, Dr. Steinman explained.

After an ablative procedure, for example, a physician will say, "You look great! This is great healing. I'll see you in 2 weeks," he said.

"But she doesn't feel great. She doesn't feel like she can go out in public," he said.

A woman's normal makeup will fail to cover bruises or dyspigmentation, but mineral makeup will, and give her confidence to return to her regular routine while she waits to enjoy the final results of her procedure, he concluded.

Dr. Steinman and his wife disclosed having no conflicts of interest.

SDEF and this news organization are wholly owned subsidiaries of Elsevier.

Since the amount of makeup required costs so little, consider making the service complimentary. DR. STEINMAN

SANTA MONICA, CALIF. — Dermatologists have a bountiful bag of tricks when it comes to making patients look great eventually, but not so many options that make them look great instantly—especially after procedures that have left them temporarily red, bruised, or hypopigmented.

"They want appearance improvement and they want it immediately," said Dr. Howard Steinman, a dermatologist in private practice in Chula Vista, Calif.

"They're extremely unhappy when they've had a—quote—'no down time' procedure that results in discoloration."

There was a time when the only options were to call in sick to work, brave stares at the brightly lit Nordstrom cosmetic counter, or locate a highly trained professional paramedical camouflage therapist trained to cover scars and disfigurement.

However, that has all changed with the advent of highly effective, easy to apply mineral makeups, Dr. Steinman said at a cosmetic dermatology seminar sponsored by Skin Disease Education Foundation.

"These have revolutionized the use of medical makeup," he said.

A variety of products is now available that can be applied by a minimally trained individual with a brush or a sponge, with profound results for expected or unanticipated discoloration from procedures.

Patients with melasma and vitiligo also are surprised and grateful for the instantaneous improvement in appearance they can achieve with carefully applied mineral makeup, said Dr. Steinman.

"Anyone in your office can be trained to do this—your manager, receptionist, nurse, or spouse," he added.

Dr. Steinman's wife, Diedre, is a professional makeup artist who is skilled in masking difficult-to-cover abnormalities such as keloid scars, acne scars, and traumatic defects.

However, she saw the need for products that were more easily applied by office personnel and evaluated a variety of mineral makeup for use on routine patients.

Her choice, Youngblood, offers a variety of concealers, foundations, and powders that can used on men or women, said Dr. Steinman, who has no financial connections with the company.

The amount required to cover a patient's face for a few days or weeks of healing costs so little—$10–$12—that Dr. Steinman makes the service complimentary, rather than charging a fee.

It is well worth the cost, he said, not only in terms of patient satisfaction. "When you do something untoward to a patient [like cause a bruise with a Botox injection], you don't have to worry about it as much. You're going to fix it immediately in your office," he said.

Male patients are quietly appreciative, he said. Female patients are thrilled that they can safely use make-up right away.

Mineral makeups, which are crushed inert minerals in powder form, are non-comedogenic, hypoallergenic, and water resistant. As soon as sutures are removed and the skin is completely epithelialized and dry to the touch, they can be applied.

For some women, "not wearing makeup is like not being completely dressed," he said—like going to "a formal event in a bathing suit and a T-shirt."

Even postprocedure trips to a dermatology office can be traumatic, Dr. Steinman explained.

After an ablative procedure, for example, a physician will say, "You look great! This is great healing. I'll see you in 2 weeks," he said.

"But she doesn't feel great. She doesn't feel like she can go out in public," he said.

A woman's normal makeup will fail to cover bruises or dyspigmentation, but mineral makeup will, and give her confidence to return to her regular routine while she waits to enjoy the final results of her procedure, he concluded.

Dr. Steinman and his wife disclosed having no conflicts of interest.

SDEF and this news organization are wholly owned subsidiaries of Elsevier.

Since the amount of makeup required costs so little, consider making the service complimentary. DR. STEINMAN

SANTA MONICA, CALIF. — Dermatologists have a bountiful bag of tricks when it comes to making patients look great eventually, but not so many options that make them look great instantly—especially after procedures that have left them temporarily red, bruised, or hypopigmented.

"They want appearance improvement and they want it immediately," said Dr. Howard Steinman, a dermatologist in private practice in Chula Vista, Calif.

"They're extremely unhappy when they've had a—quote—'no down time' procedure that results in discoloration."

There was a time when the only options were to call in sick to work, brave stares at the brightly lit Nordstrom cosmetic counter, or locate a highly trained professional paramedical camouflage therapist trained to cover scars and disfigurement.

However, that has all changed with the advent of highly effective, easy to apply mineral makeups, Dr. Steinman said at a cosmetic dermatology seminar sponsored by Skin Disease Education Foundation.

"These have revolutionized the use of medical makeup," he said.

A variety of products is now available that can be applied by a minimally trained individual with a brush or a sponge, with profound results for expected or unanticipated discoloration from procedures.

Patients with melasma and vitiligo also are surprised and grateful for the instantaneous improvement in appearance they can achieve with carefully applied mineral makeup, said Dr. Steinman.

"Anyone in your office can be trained to do this—your manager, receptionist, nurse, or spouse," he added.

Dr. Steinman's wife, Diedre, is a professional makeup artist who is skilled in masking difficult-to-cover abnormalities such as keloid scars, acne scars, and traumatic defects.

However, she saw the need for products that were more easily applied by office personnel and evaluated a variety of mineral makeup for use on routine patients.

Her choice, Youngblood, offers a variety of concealers, foundations, and powders that can used on men or women, said Dr. Steinman, who has no financial connections with the company.

The amount required to cover a patient's face for a few days or weeks of healing costs so little—$10–$12—that Dr. Steinman makes the service complimentary, rather than charging a fee.

It is well worth the cost, he said, not only in terms of patient satisfaction. "When you do something untoward to a patient [like cause a bruise with a Botox injection], you don't have to worry about it as much. You're going to fix it immediately in your office," he said.

Male patients are quietly appreciative, he said. Female patients are thrilled that they can safely use make-up right away.

Mineral makeups, which are crushed inert minerals in powder form, are non-comedogenic, hypoallergenic, and water resistant. As soon as sutures are removed and the skin is completely epithelialized and dry to the touch, they can be applied.

For some women, "not wearing makeup is like not being completely dressed," he said—like going to "a formal event in a bathing suit and a T-shirt."

Even postprocedure trips to a dermatology office can be traumatic, Dr. Steinman explained.

After an ablative procedure, for example, a physician will say, "You look great! This is great healing. I'll see you in 2 weeks," he said.

"But she doesn't feel great. She doesn't feel like she can go out in public," he said.

A woman's normal makeup will fail to cover bruises or dyspigmentation, but mineral makeup will, and give her confidence to return to her regular routine while she waits to enjoy the final results of her procedure, he concluded.

Dr. Steinman and his wife disclosed having no conflicts of interest.

SDEF and this news organization are wholly owned subsidiaries of Elsevier.

Since the amount of makeup required costs so little, consider making the service complimentary. DR. STEINMAN

SANTA MONICA, CALIF. — In the early days of cosmetic botulinum toxin type A therapy, rumors greatly outnumbered scientific facts about its safety, storage, and storied effect on furrowed brows and deep crow's feet.

The faculty at a recent cosmetic dermatology seminar sponsored by Skin Disease Education Foundation helped to put some of these myths to rest.

▸ Botox is deadly. Among 28 deaths reported to the Food and Drug Administration from December 1989 to May 2003, none involved cosmetic use of Botox (J. Am. Acad. Dermatol. 2005;53:407–15). Indeed, of 16 deaths recently highlighted by citizens' groups, all involved serious disorders treated with huge volumes of Botox, said Dr. Allan Wirtzer, a dermatologist in private practice in Sherman Oaks, Calif.

Among the potentially deadly uses of Botox is treatment of severe cervical dystonia, which can lead to spread of the toxin to the esophagus, prompting dysphagia or aspiration pneumonia.

▸ Book prewedding Botox sessions on Friday afternoons. Disappointed brides and furious mothers-in-law will blame you for the wedding pictures if you schedule cosmetic procedures too close to the ceremony, said Dr. Mitchell Goldman, a dermatologist in private practice in La Jolla, Calif. Botox's full effect takes 5–6 days, and unexpected bruising may need time to heal.

▸ Avoid freezing. The refrigerator is the place for Botox, but Dr. Richard Glogau, a dermatologist in San Francisco, may have chipped away at the myth that freezing "will degrade the molecule," when Botox that was frozen by mistake worked just fine on his patients, Dr. Goldman said.

▸ Save the paralysis for the muscles. There was a day when patients were told to sit perfectly upright, avoid exercise, and cancel air travel plans for hours after Botox injections. These precautions are "just old wives' tales—such ridiculous stuff," said Dr. Goldman.

Dr. Wirtzer has served as a consultant for Medicis, distributor of Reloxin (botulinum toxin type A, not approved in the United States). Dr. Goldman has received grant support from, and served as a consultant and speaker for, Allergan Inc., maker of Botox.

SDEF and this news organization are wholly owned subsidiaries of Elsevier.

SANTA MONICA, CALIF. — In the early days of cosmetic botulinum toxin type A therapy, rumors greatly outnumbered scientific facts about its safety, storage, and storied effect on furrowed brows and deep crow's feet.

The faculty at a recent cosmetic dermatology seminar sponsored by Skin Disease Education Foundation helped to put some of these myths to rest.

▸ Botox is deadly. Among 28 deaths reported to the Food and Drug Administration from December 1989 to May 2003, none involved cosmetic use of Botox (J. Am. Acad. Dermatol. 2005;53:407–15). Indeed, of 16 deaths recently highlighted by citizens' groups, all involved serious disorders treated with huge volumes of Botox, said Dr. Allan Wirtzer, a dermatologist in private practice in Sherman Oaks, Calif.

Among the potentially deadly uses of Botox is treatment of severe cervical dystonia, which can lead to spread of the toxin to the esophagus, prompting dysphagia or aspiration pneumonia.

▸ Book prewedding Botox sessions on Friday afternoons. Disappointed brides and furious mothers-in-law will blame you for the wedding pictures if you schedule cosmetic procedures too close to the ceremony, said Dr. Mitchell Goldman, a dermatologist in private practice in La Jolla, Calif. Botox's full effect takes 5–6 days, and unexpected bruising may need time to heal.

▸ Avoid freezing. The refrigerator is the place for Botox, but Dr. Richard Glogau, a dermatologist in San Francisco, may have chipped away at the myth that freezing "will degrade the molecule," when Botox that was frozen by mistake worked just fine on his patients, Dr. Goldman said.

▸ Save the paralysis for the muscles. There was a day when patients were told to sit perfectly upright, avoid exercise, and cancel air travel plans for hours after Botox injections. These precautions are "just old wives' tales—such ridiculous stuff," said Dr. Goldman.

Dr. Wirtzer has served as a consultant for Medicis, distributor of Reloxin (botulinum toxin type A, not approved in the United States). Dr. Goldman has received grant support from, and served as a consultant and speaker for, Allergan Inc., maker of Botox.

SDEF and this news organization are wholly owned subsidiaries of Elsevier.

SANTA MONICA, CALIF. — In the early days of cosmetic botulinum toxin type A therapy, rumors greatly outnumbered scientific facts about its safety, storage, and storied effect on furrowed brows and deep crow's feet.

The faculty at a recent cosmetic dermatology seminar sponsored by Skin Disease Education Foundation helped to put some of these myths to rest.

▸ Botox is deadly. Among 28 deaths reported to the Food and Drug Administration from December 1989 to May 2003, none involved cosmetic use of Botox (J. Am. Acad. Dermatol. 2005;53:407–15). Indeed, of 16 deaths recently highlighted by citizens' groups, all involved serious disorders treated with huge volumes of Botox, said Dr. Allan Wirtzer, a dermatologist in private practice in Sherman Oaks, Calif.

Among the potentially deadly uses of Botox is treatment of severe cervical dystonia, which can lead to spread of the toxin to the esophagus, prompting dysphagia or aspiration pneumonia.

▸ Book prewedding Botox sessions on Friday afternoons. Disappointed brides and furious mothers-in-law will blame you for the wedding pictures if you schedule cosmetic procedures too close to the ceremony, said Dr. Mitchell Goldman, a dermatologist in private practice in La Jolla, Calif. Botox's full effect takes 5–6 days, and unexpected bruising may need time to heal.

▸ Avoid freezing. The refrigerator is the place for Botox, but Dr. Richard Glogau, a dermatologist in San Francisco, may have chipped away at the myth that freezing "will degrade the molecule," when Botox that was frozen by mistake worked just fine on his patients, Dr. Goldman said.

▸ Save the paralysis for the muscles. There was a day when patients were told to sit perfectly upright, avoid exercise, and cancel air travel plans for hours after Botox injections. These precautions are "just old wives' tales—such ridiculous stuff," said Dr. Goldman.

Dr. Wirtzer has served as a consultant for Medicis, distributor of Reloxin (botulinum toxin type A, not approved in the United States). Dr. Goldman has received grant support from, and served as a consultant and speaker for, Allergan Inc., maker of Botox.

SDEF and this news organization are wholly owned subsidiaries of Elsevier.

Besides Angelica sinensis, discussed last month, other species of Angelica have been studied for their medicinal potential, and, gradually, these species have been introduced into topical formulations.

Antitumor Activity

In a 2005 study, mice with highly metastatic drug-resistant tumors were used to test the effects of various herbal compounds on tumor growth and metastasis. Although the focus of the study was stilbene compounds, investigators found that two chalcone derivatives from Angelica keiskei roots inhibited tumor growth and metastasis. The chalcone derivatives worked by suppressing tumor-induced neovascularization and/or reducing the immune suppression brought on by tumors (In Vivo 2005;19:37–60).

Chalcone extracts of A. keiskei root, also known as ashitaba, which is consumed as a vegetable in Japan, also exhibited antitumorigenic activity in the two-phase mouse skin cancer model, in which carcinogenesis is induced by 7,12-dimethylbenz[a]anthracene (DMBA) and promoted by 12-O-tetradecanoylphorbol-13-acetate (TPA) (Planta Med. 1991;57:242–6).

In another study, xanthoangelol, a major chalcone constituent of A. keiskei, was found to dose-dependently decrease the survival rates of human neuroblastoma (IMR-32) and leukemia (Jurkat) cell lines. The findings indicated that the angelica component induced apoptosis by activating caspase-3 in neuroblastoma and leukemia cells without involving Bax/Bcl-2 proteins. The investigators concluded that xanthoangelol has potential as an agent against these cancers (Biol. Pharm. Bull. 2005;28:1404–7).

Other Angelica species besides keiskei and sinensis have shown antitumorigenic activity. Constituents of the Japanese drug shi-un-kou, which contains A. acutiloba, have been evaluated in assays. A. acutiloba alone and in combination with another constituent, Macrotomia euchroma, exhibited inhibitory effects, including reduced cytotoxicity, on Epstein-Barr virus activation induced by the tumor promoter TPA. The authors reported that a subsequent in vivo study in mice showed that shi-un-kou significantly inhibited skin tumor formation induced by TPA (Yakugaku Zasshi 1989;109:843–6).

In other research, investigators isolated the coumarin compound decursin from Korean angelica (A. gigantis, also known as A. gigas) root. They observed that decursin treatment for 24–96 hours strongly inhibited growth and dose-dependently induced apoptosis in human prostate carcinoma cells (Urol. Oncol. 2005;23:379–80).

In addition, another Angelica species, A. archangelica, exhibits antitumorigenic properties. Investigators evaluated the in vitro and in vivo effects of A. archangelica leaf extract on the growth of Crl mouse breast cancer cells. In vitro, the extract was found to be mildly antiproliferative. In the in vivo segment of the study, 11 of 20 mice were injected with A. archangelica leaf extract, and 9 of them developed no or small tumors, whereas control mice developed tumors that were significantly larger. The antitumor properties of A. archangelica extract could not be attributed to the antiproliferative characteristics of the furanocoumarins in the extract (In Vivo 2005;19:191–4).

Significant antiproliferative activity has also been identified in the tincture of A. archangelica, using the human pancreas cancer cell line PANC-1 as a model. Investigators ascribed most of the antiproliferative activity to imperatorin and xanthotoxin, the two furanocoumarins most prevalent in the A. archangelica tincture (Z. Naturforsch. [C] 2004;59:523–7).

Dermatologic Potential

In addition to antitumorigenic activity, several Angelica species have exhibited properties pertinent to clinical dermatology. Hwaotang, a traditional Korean formulation that combines seven herbs, including A. gigas, exerts anti-inflammatory effects related to the inhibition of human neutrophil functions and of nitric oxide and prostaglandin E2 production (Immunopharmacol. Immunotoxicol. 2004;26:53–73).

In a study of the anti-inflammatory activity of a new formulation containing Synurus deltoides and A. gigas extracts, along with glucosamine sulfate, the medication (SAG) dose dependently inhibited ear edema in mice induced by arachidonic acid and TPA. Prostaglandin E2 production associated with mouse skin lesions was also significantly reduced by SAG, as well as by treatment with S. deltoides extract alone. The authors acknowledged that although SAG is not as potent as anti-inflammatory products in widespread use, this A. gigas-containing preparation has potential benefits as a neutraceutical therapy for inflammatory conditions (Arch. Pharm. Res. 2005;28:848–53).

A study of herbs used in traditional Chinese and Japanese medicine to treat acne revealed that the ethanol extract (0.01%) of Angelica dahurica substantially inhibited neutrophil chemotaxis, at a level comparable to that of erythromycin (0.01%). In the same study, Rhizoma coptidis displayed a stronger antilipogenic effect than did retinoic acid (0.01%), and Glycyrrhiza glabra (licorice) showed significant antibacterial activity against P. acnes. These results led the researchers to conclude that a formulation containing all three herbs would have potential in the prevention and treatment of acne (Skin Pharmacol. Appl. Skin Physiol. 2003;16:84–90). A. dahurica, which also contains lactones and psoralen, and has been used traditionally to treat psoriasis and for its reputed antihistamine effects.

In a study evaluating extracts from 15 plants used in traditional Chinese medicine to treat topical inflammations, investigators focused on the inhibitory effects on enzymes that are therapeutic targets in cutaneous conditions, specifically 5-lipoxygenase, cyclooxygenase, and elastase. Four plant species, including A. dahurica and A. pubescens, inhibited elastase in intact leukocytes and platelets (J. Pharm. Pharmacol. 2003;55:1275–82; Planta Med. 1998;64:525–9). In addition, A. pubescens has been found to confer analgesic and anti-inflammatory effects (Planta Med. 1995;61:2–8). One of the main active components isolated from A. pubescens, osthole, a coumarin compound, has also been shown to exert a nonspecific relaxant effect on the trachea of guinea pigs (Naunyn Schmiedebergs Arch. Pharmacol. 1994;349:202–8).

At the Store

Zestra Feminine Arousal Fluid (Zestra Laboratories Inc.) is a topical botanical formulation containing A. archangelica along with borage seed oil, evening primrose oil, ascorbyl palmitate, and alpha tocopherol. The product is intended to enhance female sexual pleasure and arousal.

Investigators conducted a randomized, double-blind, crossover study to assess the efficacy and safety of Zestra in 10 women with and 10 women without female sexual arousal disorder. Using questionnaires, participants reported on a range of sexual functions pertaining to home use of the formulation. The results indicated statistically significant overall improvements in sexual function in both test groups, compared with placebo (J. Sex Marital Ther. 2003;29 [Suppl 1]:33–44).

Conclusions

A wide range of Angelica species possess properties found to be of medical, including dermatologic, benefit. In addition to A. sinensis (discussed in this column in August), A. archangelica, A. dahurica, and A. gigas have been used successfully in traditional herbal medicines, and research is ongoing on these and other species, including A. keiskei, A. pubescens, and A. acutiloba.

While the overall body of research is slim on the efficacy of these herbs, the extant evidence supports further investigation and provides reasons for optimism. In the meantime, as is typical in the case of myriad botanic ingredients, there are several unproven formulations available to consumers that contain botanical cocktails including the biologically active Angelica species.

Besides Angelica sinensis, discussed last month, other species of Angelica have been studied for their medicinal potential, and, gradually, these species have been introduced into topical formulations.

Antitumor Activity

In a 2005 study, mice with highly metastatic drug-resistant tumors were used to test the effects of various herbal compounds on tumor growth and metastasis. Although the focus of the study was stilbene compounds, investigators found that two chalcone derivatives from Angelica keiskei roots inhibited tumor growth and metastasis. The chalcone derivatives worked by suppressing tumor-induced neovascularization and/or reducing the immune suppression brought on by tumors (In Vivo 2005;19:37–60).

Chalcone extracts of A. keiskei root, also known as ashitaba, which is consumed as a vegetable in Japan, also exhibited antitumorigenic activity in the two-phase mouse skin cancer model, in which carcinogenesis is induced by 7,12-dimethylbenz[a]anthracene (DMBA) and promoted by 12-O-tetradecanoylphorbol-13-acetate (TPA) (Planta Med. 1991;57:242–6).

In another study, xanthoangelol, a major chalcone constituent of A. keiskei, was found to dose-dependently decrease the survival rates of human neuroblastoma (IMR-32) and leukemia (Jurkat) cell lines. The findings indicated that the angelica component induced apoptosis by activating caspase-3 in neuroblastoma and leukemia cells without involving Bax/Bcl-2 proteins. The investigators concluded that xanthoangelol has potential as an agent against these cancers (Biol. Pharm. Bull. 2005;28:1404–7).

Other Angelica species besides keiskei and sinensis have shown antitumorigenic activity. Constituents of the Japanese drug shi-un-kou, which contains A. acutiloba, have been evaluated in assays. A. acutiloba alone and in combination with another constituent, Macrotomia euchroma, exhibited inhibitory effects, including reduced cytotoxicity, on Epstein-Barr virus activation induced by the tumor promoter TPA. The authors reported that a subsequent in vivo study in mice showed that shi-un-kou significantly inhibited skin tumor formation induced by TPA (Yakugaku Zasshi 1989;109:843–6).

In other research, investigators isolated the coumarin compound decursin from Korean angelica (A. gigantis, also known as A. gigas) root. They observed that decursin treatment for 24–96 hours strongly inhibited growth and dose-dependently induced apoptosis in human prostate carcinoma cells (Urol. Oncol. 2005;23:379–80).

In addition, another Angelica species, A. archangelica, exhibits antitumorigenic properties. Investigators evaluated the in vitro and in vivo effects of A. archangelica leaf extract on the growth of Crl mouse breast cancer cells. In vitro, the extract was found to be mildly antiproliferative. In the in vivo segment of the study, 11 of 20 mice were injected with A. archangelica leaf extract, and 9 of them developed no or small tumors, whereas control mice developed tumors that were significantly larger. The antitumor properties of A. archangelica extract could not be attributed to the antiproliferative characteristics of the furanocoumarins in the extract (In Vivo 2005;19:191–4).

Significant antiproliferative activity has also been identified in the tincture of A. archangelica, using the human pancreas cancer cell line PANC-1 as a model. Investigators ascribed most of the antiproliferative activity to imperatorin and xanthotoxin, the two furanocoumarins most prevalent in the A. archangelica tincture (Z. Naturforsch. [C] 2004;59:523–7).

Dermatologic Potential

In addition to antitumorigenic activity, several Angelica species have exhibited properties pertinent to clinical dermatology. Hwaotang, a traditional Korean formulation that combines seven herbs, including A. gigas, exerts anti-inflammatory effects related to the inhibition of human neutrophil functions and of nitric oxide and prostaglandin E2 production (Immunopharmacol. Immunotoxicol. 2004;26:53–73).

In a study of the anti-inflammatory activity of a new formulation containing Synurus deltoides and A. gigas extracts, along with glucosamine sulfate, the medication (SAG) dose dependently inhibited ear edema in mice induced by arachidonic acid and TPA. Prostaglandin E2 production associated with mouse skin lesions was also significantly reduced by SAG, as well as by treatment with S. deltoides extract alone. The authors acknowledged that although SAG is not as potent as anti-inflammatory products in widespread use, this A. gigas-containing preparation has potential benefits as a neutraceutical therapy for inflammatory conditions (Arch. Pharm. Res. 2005;28:848–53).

A study of herbs used in traditional Chinese and Japanese medicine to treat acne revealed that the ethanol extract (0.01%) of Angelica dahurica substantially inhibited neutrophil chemotaxis, at a level comparable to that of erythromycin (0.01%). In the same study, Rhizoma coptidis displayed a stronger antilipogenic effect than did retinoic acid (0.01%), and Glycyrrhiza glabra (licorice) showed significant antibacterial activity against P. acnes. These results led the researchers to conclude that a formulation containing all three herbs would have potential in the prevention and treatment of acne (Skin Pharmacol. Appl. Skin Physiol. 2003;16:84–90). A. dahurica, which also contains lactones and psoralen, and has been used traditionally to treat psoriasis and for its reputed antihistamine effects.

In a study evaluating extracts from 15 plants used in traditional Chinese medicine to treat topical inflammations, investigators focused on the inhibitory effects on enzymes that are therapeutic targets in cutaneous conditions, specifically 5-lipoxygenase, cyclooxygenase, and elastase. Four plant species, including A. dahurica and A. pubescens, inhibited elastase in intact leukocytes and platelets (J. Pharm. Pharmacol. 2003;55:1275–82; Planta Med. 1998;64:525–9). In addition, A. pubescens has been found to confer analgesic and anti-inflammatory effects (Planta Med. 1995;61:2–8). One of the main active components isolated from A. pubescens, osthole, a coumarin compound, has also been shown to exert a nonspecific relaxant effect on the trachea of guinea pigs (Naunyn Schmiedebergs Arch. Pharmacol. 1994;349:202–8).

At the Store

Zestra Feminine Arousal Fluid (Zestra Laboratories Inc.) is a topical botanical formulation containing A. archangelica along with borage seed oil, evening primrose oil, ascorbyl palmitate, and alpha tocopherol. The product is intended to enhance female sexual pleasure and arousal.

Investigators conducted a randomized, double-blind, crossover study to assess the efficacy and safety of Zestra in 10 women with and 10 women without female sexual arousal disorder. Using questionnaires, participants reported on a range of sexual functions pertaining to home use of the formulation. The results indicated statistically significant overall improvements in sexual function in both test groups, compared with placebo (J. Sex Marital Ther. 2003;29 [Suppl 1]:33–44).

Conclusions

A wide range of Angelica species possess properties found to be of medical, including dermatologic, benefit. In addition to A. sinensis (discussed in this column in August), A. archangelica, A. dahurica, and A. gigas have been used successfully in traditional herbal medicines, and research is ongoing on these and other species, including A. keiskei, A. pubescens, and A. acutiloba.

While the overall body of research is slim on the efficacy of these herbs, the extant evidence supports further investigation and provides reasons for optimism. In the meantime, as is typical in the case of myriad botanic ingredients, there are several unproven formulations available to consumers that contain botanical cocktails including the biologically active Angelica species.

Besides Angelica sinensis, discussed last month, other species of Angelica have been studied for their medicinal potential, and, gradually, these species have been introduced into topical formulations.

Antitumor Activity

In a 2005 study, mice with highly metastatic drug-resistant tumors were used to test the effects of various herbal compounds on tumor growth and metastasis. Although the focus of the study was stilbene compounds, investigators found that two chalcone derivatives from Angelica keiskei roots inhibited tumor growth and metastasis. The chalcone derivatives worked by suppressing tumor-induced neovascularization and/or reducing the immune suppression brought on by tumors (In Vivo 2005;19:37–60).

Chalcone extracts of A. keiskei root, also known as ashitaba, which is consumed as a vegetable in Japan, also exhibited antitumorigenic activity in the two-phase mouse skin cancer model, in which carcinogenesis is induced by 7,12-dimethylbenz[a]anthracene (DMBA) and promoted by 12-O-tetradecanoylphorbol-13-acetate (TPA) (Planta Med. 1991;57:242–6).

In another study, xanthoangelol, a major chalcone constituent of A. keiskei, was found to dose-dependently decrease the survival rates of human neuroblastoma (IMR-32) and leukemia (Jurkat) cell lines. The findings indicated that the angelica component induced apoptosis by activating caspase-3 in neuroblastoma and leukemia cells without involving Bax/Bcl-2 proteins. The investigators concluded that xanthoangelol has potential as an agent against these cancers (Biol. Pharm. Bull. 2005;28:1404–7).

Other Angelica species besides keiskei and sinensis have shown antitumorigenic activity. Constituents of the Japanese drug shi-un-kou, which contains A. acutiloba, have been evaluated in assays. A. acutiloba alone and in combination with another constituent, Macrotomia euchroma, exhibited inhibitory effects, including reduced cytotoxicity, on Epstein-Barr virus activation induced by the tumor promoter TPA. The authors reported that a subsequent in vivo study in mice showed that shi-un-kou significantly inhibited skin tumor formation induced by TPA (Yakugaku Zasshi 1989;109:843–6).

In other research, investigators isolated the coumarin compound decursin from Korean angelica (A. gigantis, also known as A. gigas) root. They observed that decursin treatment for 24–96 hours strongly inhibited growth and dose-dependently induced apoptosis in human prostate carcinoma cells (Urol. Oncol. 2005;23:379–80).

In addition, another Angelica species, A. archangelica, exhibits antitumorigenic properties. Investigators evaluated the in vitro and in vivo effects of A. archangelica leaf extract on the growth of Crl mouse breast cancer cells. In vitro, the extract was found to be mildly antiproliferative. In the in vivo segment of the study, 11 of 20 mice were injected with A. archangelica leaf extract, and 9 of them developed no or small tumors, whereas control mice developed tumors that were significantly larger. The antitumor properties of A. archangelica extract could not be attributed to the antiproliferative characteristics of the furanocoumarins in the extract (In Vivo 2005;19:191–4).

Significant antiproliferative activity has also been identified in the tincture of A. archangelica, using the human pancreas cancer cell line PANC-1 as a model. Investigators ascribed most of the antiproliferative activity to imperatorin and xanthotoxin, the two furanocoumarins most prevalent in the A. archangelica tincture (Z. Naturforsch. [C] 2004;59:523–7).

Dermatologic Potential

In addition to antitumorigenic activity, several Angelica species have exhibited properties pertinent to clinical dermatology. Hwaotang, a traditional Korean formulation that combines seven herbs, including A. gigas, exerts anti-inflammatory effects related to the inhibition of human neutrophil functions and of nitric oxide and prostaglandin E2 production (Immunopharmacol. Immunotoxicol. 2004;26:53–73).

In a study of the anti-inflammatory activity of a new formulation containing Synurus deltoides and A. gigas extracts, along with glucosamine sulfate, the medication (SAG) dose dependently inhibited ear edema in mice induced by arachidonic acid and TPA. Prostaglandin E2 production associated with mouse skin lesions was also significantly reduced by SAG, as well as by treatment with S. deltoides extract alone. The authors acknowledged that although SAG is not as potent as anti-inflammatory products in widespread use, this A. gigas-containing preparation has potential benefits as a neutraceutical therapy for inflammatory conditions (Arch. Pharm. Res. 2005;28:848–53).

A study of herbs used in traditional Chinese and Japanese medicine to treat acne revealed that the ethanol extract (0.01%) of Angelica dahurica substantially inhibited neutrophil chemotaxis, at a level comparable to that of erythromycin (0.01%). In the same study, Rhizoma coptidis displayed a stronger antilipogenic effect than did retinoic acid (0.01%), and Glycyrrhiza glabra (licorice) showed significant antibacterial activity against P. acnes. These results led the researchers to conclude that a formulation containing all three herbs would have potential in the prevention and treatment of acne (Skin Pharmacol. Appl. Skin Physiol. 2003;16:84–90). A. dahurica, which also contains lactones and psoralen, and has been used traditionally to treat psoriasis and for its reputed antihistamine effects.

In a study evaluating extracts from 15 plants used in traditional Chinese medicine to treat topical inflammations, investigators focused on the inhibitory effects on enzymes that are therapeutic targets in cutaneous conditions, specifically 5-lipoxygenase, cyclooxygenase, and elastase. Four plant species, including A. dahurica and A. pubescens, inhibited elastase in intact leukocytes and platelets (J. Pharm. Pharmacol. 2003;55:1275–82; Planta Med. 1998;64:525–9). In addition, A. pubescens has been found to confer analgesic and anti-inflammatory effects (Planta Med. 1995;61:2–8). One of the main active components isolated from A. pubescens, osthole, a coumarin compound, has also been shown to exert a nonspecific relaxant effect on the trachea of guinea pigs (Naunyn Schmiedebergs Arch. Pharmacol. 1994;349:202–8).

At the Store

Zestra Feminine Arousal Fluid (Zestra Laboratories Inc.) is a topical botanical formulation containing A. archangelica along with borage seed oil, evening primrose oil, ascorbyl palmitate, and alpha tocopherol. The product is intended to enhance female sexual pleasure and arousal.

Investigators conducted a randomized, double-blind, crossover study to assess the efficacy and safety of Zestra in 10 women with and 10 women without female sexual arousal disorder. Using questionnaires, participants reported on a range of sexual functions pertaining to home use of the formulation. The results indicated statistically significant overall improvements in sexual function in both test groups, compared with placebo (J. Sex Marital Ther. 2003;29 [Suppl 1]:33–44).

Conclusions

A wide range of Angelica species possess properties found to be of medical, including dermatologic, benefit. In addition to A. sinensis (discussed in this column in August), A. archangelica, A. dahurica, and A. gigas have been used successfully in traditional herbal medicines, and research is ongoing on these and other species, including A. keiskei, A. pubescens, and A. acutiloba.

While the overall body of research is slim on the efficacy of these herbs, the extant evidence supports further investigation and provides reasons for optimism. In the meantime, as is typical in the case of myriad botanic ingredients, there are several unproven formulations available to consumers that contain botanical cocktails including the biologically active Angelica species.

The Dermatology Foundation has awarded its prestigious Discovery Award to Dr. John A. Parrish and Dr. R. Rox Anderson. The award acknowledges their landmark development of the use of selective photothermolysis in the treatment of birthmarks and other skin conditions. For more information, visit www.dermatologyfoundation.org

The Dermatology Foundation has awarded its prestigious Discovery Award to Dr. John A. Parrish and Dr. R. Rox Anderson. The award acknowledges their landmark development of the use of selective photothermolysis in the treatment of birthmarks and other skin conditions. For more information, visit www.dermatologyfoundation.org

The Dermatology Foundation has awarded its prestigious Discovery Award to Dr. John A. Parrish and Dr. R. Rox Anderson. The award acknowledges their landmark development of the use of selective photothermolysis in the treatment of birthmarks and other skin conditions. For more information, visit www.dermatologyfoundation.org

More women than men have sought tattoo removal in recent years, a reversal of the pattern that prevailed 10 years earlier, according to a report in the Archives of Dermatology.

Today, women report receiving significantly more negative comments and having more problems with "stigma" regarding their tattoos than do men. Women with tattoos are more likely to report embarrassment and "more societal fallout" than men with tattoos, according to Myrna L. Armstrong, Ed.D., of Texas Tech University Health Sciences Center, Marble Falls, and her associates.

The researchers studied the issue because "dermatologists are increasingly hearing stories of regrets and requests for tattoo removal. Estimated prevalence rates of dissatisfied tattoo wearers hover around 20%, with a smaller number who actually seek removal (6%)," they noted.

Dr. Armstrong and her colleagues assessed present-day tattoo removal using an anonymous survey of 196 clients aged 14–73 years who were attending four dermatology clinics in Arizona, Colorado, Massachusetts, and Texas. They compared the results with those from a similar survey conducted in 1996.

Although most of these subjects had been pleased with their tattoos when they first got them, they reported feeling dissatisfied with the tattoos for an average of 10 years before finally seeking removal. Most people who wanted to remove tattoos in 1996 were men, whereas most of those seeking removal in the present day were women, especially "career-minded" women.

Women reported receiving significantly more negative comments and suffering significantly more embarrassment regarding their tattoos than did men. In particular, women reported their tattoos interfered with their job or career and that they elicited negative comments in the workplace, in public, and in school settings, as wells as from significant others.

Currently, women also reported having to hide their tattoos with cosmetics or bandages and being unable to wear certain clothing because of their tattoos more often than men did. These findings correspond with reports in the literature that tattoo wearers are perceived as having lower credibility, competence, and sociability, particularly in the workplace, Dr. Armstrong and her associates said (Arch. Dermatol. 2008;144:879–84).

"For women, their tattoo procurement may be a way to break out of the gender norms and take some social risk by visually displaying their assertive identity. Yet, there still may be many members of society who consider tattoos on women to be a 'transgression of gender boundaries,'" the researchers wrote.

The major reason cited for getting a tattoo among both men and women who later sought removal was that it "helped me feel unique." Most of these subjects grew "disillusioned because their unique product had lost its luster and excitement." Some also said they were actively dissociating from their past or shifting their identity focus in order to "move on."

Dr. Armstrong is an education consultant for Freedom

More women than men have sought tattoo removal in recent years, a reversal of the pattern that prevailed 10 years earlier, according to a report in the Archives of Dermatology.

Today, women report receiving significantly more negative comments and having more problems with "stigma" regarding their tattoos than do men. Women with tattoos are more likely to report embarrassment and "more societal fallout" than men with tattoos, according to Myrna L. Armstrong, Ed.D., of Texas Tech University Health Sciences Center, Marble Falls, and her associates.

The researchers studied the issue because "dermatologists are increasingly hearing stories of regrets and requests for tattoo removal. Estimated prevalence rates of dissatisfied tattoo wearers hover around 20%, with a smaller number who actually seek removal (6%)," they noted.

Dr. Armstrong and her colleagues assessed present-day tattoo removal using an anonymous survey of 196 clients aged 14–73 years who were attending four dermatology clinics in Arizona, Colorado, Massachusetts, and Texas. They compared the results with those from a similar survey conducted in 1996.

Although most of these subjects had been pleased with their tattoos when they first got them, they reported feeling dissatisfied with the tattoos for an average of 10 years before finally seeking removal. Most people who wanted to remove tattoos in 1996 were men, whereas most of those seeking removal in the present day were women, especially "career-minded" women.

Women reported receiving significantly more negative comments and suffering significantly more embarrassment regarding their tattoos than did men. In particular, women reported their tattoos interfered with their job or career and that they elicited negative comments in the workplace, in public, and in school settings, as wells as from significant others.

Currently, women also reported having to hide their tattoos with cosmetics or bandages and being unable to wear certain clothing because of their tattoos more often than men did. These findings correspond with reports in the literature that tattoo wearers are perceived as having lower credibility, competence, and sociability, particularly in the workplace, Dr. Armstrong and her associates said (Arch. Dermatol. 2008;144:879–84).

"For women, their tattoo procurement may be a way to break out of the gender norms and take some social risk by visually displaying their assertive identity. Yet, there still may be many members of society who consider tattoos on women to be a 'transgression of gender boundaries,'" the researchers wrote.

The major reason cited for getting a tattoo among both men and women who later sought removal was that it "helped me feel unique." Most of these subjects grew "disillusioned because their unique product had lost its luster and excitement." Some also said they were actively dissociating from their past or shifting their identity focus in order to "move on."

Dr. Armstrong is an education consultant for Freedom

More women than men have sought tattoo removal in recent years, a reversal of the pattern that prevailed 10 years earlier, according to a report in the Archives of Dermatology.

Today, women report receiving significantly more negative comments and having more problems with "stigma" regarding their tattoos than do men. Women with tattoos are more likely to report embarrassment and "more societal fallout" than men with tattoos, according to Myrna L. Armstrong, Ed.D., of Texas Tech University Health Sciences Center, Marble Falls, and her associates.

The researchers studied the issue because "dermatologists are increasingly hearing stories of regrets and requests for tattoo removal. Estimated prevalence rates of dissatisfied tattoo wearers hover around 20%, with a smaller number who actually seek removal (6%)," they noted.

Dr. Armstrong and her colleagues assessed present-day tattoo removal using an anonymous survey of 196 clients aged 14–73 years who were attending four dermatology clinics in Arizona, Colorado, Massachusetts, and Texas. They compared the results with those from a similar survey conducted in 1996.

Although most of these subjects had been pleased with their tattoos when they first got them, they reported feeling dissatisfied with the tattoos for an average of 10 years before finally seeking removal. Most people who wanted to remove tattoos in 1996 were men, whereas most of those seeking removal in the present day were women, especially "career-minded" women.

Women reported receiving significantly more negative comments and suffering significantly more embarrassment regarding their tattoos than did men. In particular, women reported their tattoos interfered with their job or career and that they elicited negative comments in the workplace, in public, and in school settings, as wells as from significant others.

Currently, women also reported having to hide their tattoos with cosmetics or bandages and being unable to wear certain clothing because of their tattoos more often than men did. These findings correspond with reports in the literature that tattoo wearers are perceived as having lower credibility, competence, and sociability, particularly in the workplace, Dr. Armstrong and her associates said (Arch. Dermatol. 2008;144:879–84).

"For women, their tattoo procurement may be a way to break out of the gender norms and take some social risk by visually displaying their assertive identity. Yet, there still may be many members of society who consider tattoos on women to be a 'transgression of gender boundaries,'" the researchers wrote.

The major reason cited for getting a tattoo among both men and women who later sought removal was that it "helped me feel unique." Most of these subjects grew "disillusioned because their unique product had lost its luster and excitement." Some also said they were actively dissociating from their past or shifting their identity focus in order to "move on."

Dr. Armstrong is an education consultant for Freedom

Facial resurfacing using a CO₂ laser is a safe and effective treatment for rhytids demonstrating long-term results, according to a retrospective study of 47 patients who underwent an entire facial resurfacing procedure.

Dr. Shan R. Baker of the department of otolaryngology-head and neck surgery at the University of Michigan, Ann Arbor, performed the procedure from December 1996 to December 2004 using a commercially available CO₂ laser to assess long-term effects and complications of full-face CO₂ laser resurfacing. Particular attention was given to the incidence of hypopigmentation that was evident by photographic review, according to Dr. Baker and Dr. P. Daniel Ward, also of the university (Arch. Facial Plast. Surg. 2008;10:238–43).

Sixty-two patients who underwent entire facial laser resurfacing initially were identified. Complete data were available in 46 patients with Fitzpatrick skin types I, II, or III and 1 with skin type IV. The mean follow-up was 2.3 years. Many of the patients had other procedures at the time of the resurfacing, including dermabrasion, blepharoplasty, brow lift, and rhytidectomy.

The mean improvement in facial rhytid score was 45%, according to the researchers.

Reported complications included milia or acne in 14 cases (30%), hyperpigmentation in 8 cases (17%), hypopigmentation in 6 cases (13%), infection in 1 case (2%), and ectropion in 1 case (2%). The only complications present after 1 year of follow-up were six cases of hypopigmentation and one case of hyperpigmentation. Postprocedure hyperpigmentation was treated with topical hydroquinone. The case of persistent hyperpigmentation at the 1-year follow-up had resolution within 2 years of the procedure.

Patient response to treatment was assessed by comparing the mean improvement in rhytid scores with and without hypopigmentation. The researchers noted that patients with hypopigmentation had a greater response to treatment, with 73.9% mean improvement, than did patients who did not develop hypopigmentation (41.8% mean improvement), a statistically significant difference.

The researchers, who had no conflicts to report, said the results confirm previous studies that found CO₂ laser resurfacing leads to long-term improvement in facial rhytidosis.

Facial resurfacing using a CO₂ laser is a safe and effective treatment for rhytids demonstrating long-term results, according to a retrospective study of 47 patients who underwent an entire facial resurfacing procedure.

Dr. Shan R. Baker of the department of otolaryngology-head and neck surgery at the University of Michigan, Ann Arbor, performed the procedure from December 1996 to December 2004 using a commercially available CO₂ laser to assess long-term effects and complications of full-face CO₂ laser resurfacing. Particular attention was given to the incidence of hypopigmentation that was evident by photographic review, according to Dr. Baker and Dr. P. Daniel Ward, also of the university (Arch. Facial Plast. Surg. 2008;10:238–43).

Sixty-two patients who underwent entire facial laser resurfacing initially were identified. Complete data were available in 46 patients with Fitzpatrick skin types I, II, or III and 1 with skin type IV. The mean follow-up was 2.3 years. Many of the patients had other procedures at the time of the resurfacing, including dermabrasion, blepharoplasty, brow lift, and rhytidectomy.

The mean improvement in facial rhytid score was 45%, according to the researchers.

Reported complications included milia or acne in 14 cases (30%), hyperpigmentation in 8 cases (17%), hypopigmentation in 6 cases (13%), infection in 1 case (2%), and ectropion in 1 case (2%). The only complications present after 1 year of follow-up were six cases of hypopigmentation and one case of hyperpigmentation. Postprocedure hyperpigmentation was treated with topical hydroquinone. The case of persistent hyperpigmentation at the 1-year follow-up had resolution within 2 years of the procedure.

Patient response to treatment was assessed by comparing the mean improvement in rhytid scores with and without hypopigmentation. The researchers noted that patients with hypopigmentation had a greater response to treatment, with 73.9% mean improvement, than did patients who did not develop hypopigmentation (41.8% mean improvement), a statistically significant difference.

The researchers, who had no conflicts to report, said the results confirm previous studies that found CO₂ laser resurfacing leads to long-term improvement in facial rhytidosis.

Facial resurfacing using a CO₂ laser is a safe and effective treatment for rhytids demonstrating long-term results, according to a retrospective study of 47 patients who underwent an entire facial resurfacing procedure.

Dr. Shan R. Baker of the department of otolaryngology-head and neck surgery at the University of Michigan, Ann Arbor, performed the procedure from December 1996 to December 2004 using a commercially available CO₂ laser to assess long-term effects and complications of full-face CO₂ laser resurfacing. Particular attention was given to the incidence of hypopigmentation that was evident by photographic review, according to Dr. Baker and Dr. P. Daniel Ward, also of the university (Arch. Facial Plast. Surg. 2008;10:238–43).

Sixty-two patients who underwent entire facial laser resurfacing initially were identified. Complete data were available in 46 patients with Fitzpatrick skin types I, II, or III and 1 with skin type IV. The mean follow-up was 2.3 years. Many of the patients had other procedures at the time of the resurfacing, including dermabrasion, blepharoplasty, brow lift, and rhytidectomy.

The mean improvement in facial rhytid score was 45%, according to the researchers.

Reported complications included milia or acne in 14 cases (30%), hyperpigmentation in 8 cases (17%), hypopigmentation in 6 cases (13%), infection in 1 case (2%), and ectropion in 1 case (2%). The only complications present after 1 year of follow-up were six cases of hypopigmentation and one case of hyperpigmentation. Postprocedure hyperpigmentation was treated with topical hydroquinone. The case of persistent hyperpigmentation at the 1-year follow-up had resolution within 2 years of the procedure.

Patient response to treatment was assessed by comparing the mean improvement in rhytid scores with and without hypopigmentation. The researchers noted that patients with hypopigmentation had a greater response to treatment, with 73.9% mean improvement, than did patients who did not develop hypopigmentation (41.8% mean improvement), a statistically significant difference.

The researchers, who had no conflicts to report, said the results confirm previous studies that found CO₂ laser resurfacing leads to long-term improvement in facial rhytidosis.