Aesthetic Dermatology

SANTA MONICA, CALIF. — Live video demonstrations of several novel laser and laserlike devices generated mixed reviews from a panel of dermatologists.

Panelists at a cosmetic dermatology seminar sponsored by Skin Disease Education Foundation disagreed about the safety and efficacy of several of the devices, although they came to a meeting of the minds on some points, such as the "feel-good" potential of microdermabrasion devices.

What follows is a recap of many of the thumbs-up, thumbs-down impressions aired at the meeting.

Portrait Plasma

"I have to say I'm truly impressed with this device," said Dr. Christopher Zachary, professor and chair of dermatology at the University of California, Irvine.

"I'm not sure why it hasn't caught on."

The Portrait Plasma device, manufactured by Rhytec, derives its heat energy from nitrogen plasma rather than from a laser.

Treatment of photodamage, including fine lines and wrinkles, is attained by using a variety of energy levels up to 5–6 J, a setting that leaves behind significant erythema.

At about 4 J, the epidermis appears bronzed, with the skin remaining intact for several days "like a natural dressing," Dr. Zachary said.

Dr. Mitchel P. Goldman, a dermatologist in private practice in La Jolla, Calif., expressed concern about the variability of the energy delivery.

"I've seen profound scarring with this device," he said. "I prefer a laser where I know exactly how much heat is going to be built up between each pass."

Dr. Zachary agreed that "there is no free lunch" with the Portrait Plasma. Double passes at 3.5–4 J could definitely produce scarring, although the device also has the potential for significant improvement in the skin, he said.

"Share [the potential of side effects] with the patient," he suggested. "Let them be part of the decision."

VariLite Laser

Dr. Bill H. Halmi, a Phoenix-based dermatologist, demonstrated the use of the VariLite dual wavelength (532 nm or 940 nm) laser, manufactured by Iridex, as a "spot welding device" that can target unsightly perinasal vessels by creating a dotted line of damage, leaving untreated millimeters of tissue between the spots.

"Go for little gaps" in the visible vessel line, Dr. Zachary said during the live video presentation.

As visual evidence of the vein disappeared under the beam of the laser, Dr. Zachary marveled, "Oh, that's very nice. It's better than sex!"

Dr. Zachary stressed the need for wearing protective goggles, preferably polarized for better visualization, when using the device.

Dr. Goldman offered a less rosy opinion. "This is the single most dangerous procedure to do. It puts holes in peoples' faces," he said.

Whitened skin evident in the video close-ups represents destruction of the epidermis. He also expressed concern that the laser has no epidermal cooling system to prevent permanent heat damage.

Beyond the safety concerns, Dr. Goldman questioned the permanence of the VariLite treatment. Red telangiectasias seen at the nasal alar area originate from the nasolabial artery and "will always come back," he pointed out. "[I would] never, ever tell a patient it's permanent, and I don't think it's better than sex."

DermaSweep

One of a wide variety of dermabrasion devices, DermaSweep (developed by CosMedic) requires no anesthesia and is becoming a popular modality among physicians, said Dr. Zachary.

This particular unit uses suction to draw the skin close to a variety of different bristles that range from "a silky, superficial … polisher to aggressive bristles," he said.

The device is said to enhance penetration of infusions of hyaluronic acid, vitamin C preparations, and Levulan (DUSA Pharmaceuticals Inc.).

"There is no way an infusion of hyaluronic acid is going to do a darned thing beyond 1–2 days," said Dr. Goldman. He also questioned its use in patients with a propensity to develop telangiectasias, such as those with rosacea.

Physicians should understand that if they use it prior to a light peel, the peel will become a deep peel with all of the associated side effects.

This said, Dr. Goldman acknowledged that the DermaSweep is an "outstanding machine" and that he uses it in his spa and on patients receiving photodynamic therapy.

All of the panelists commented on the immediate smoothing created by the low-impact device.

"It feels good for a day," said Dr. Margaret Mann, who is with the department of dermatology at the University of California, Irvine. "You get what you pay for."

She said, however, that she also uses the device to enhance penetration of aminolevulinic acid before photodynamic therapy, and she sees it as a nice introductory procedure. "It's great for the patient who comes in and just wants to know what an aesthetic procedure is like," Dr. Mann said.

Once such a patient feels comfortable, he or she "might move on to something more aggressive," she suggested.

Dr. Zachary disclosed that he has received equipment loans from Rhytec, Iridex, and CosMedic.

Dr. Goldman, Dr. Mann, and Dr. Halmi had no disclosures relating to the products mentioned in this article.

Skin Disease Education Foundation and this news organization are wholly owned subsidiaries of Elsevier.

SANTA MONICA, CALIF. — Live video demonstrations of several novel laser and laserlike devices generated mixed reviews from a panel of dermatologists.

Panelists at a cosmetic dermatology seminar sponsored by Skin Disease Education Foundation disagreed about the safety and efficacy of several of the devices, although they came to a meeting of the minds on some points, such as the "feel-good" potential of microdermabrasion devices.

What follows is a recap of many of the thumbs-up, thumbs-down impressions aired at the meeting.

Portrait Plasma

"I have to say I'm truly impressed with this device," said Dr. Christopher Zachary, professor and chair of dermatology at the University of California, Irvine.

"I'm not sure why it hasn't caught on."

The Portrait Plasma device, manufactured by Rhytec, derives its heat energy from nitrogen plasma rather than from a laser.

Treatment of photodamage, including fine lines and wrinkles, is attained by using a variety of energy levels up to 5–6 J, a setting that leaves behind significant erythema.

At about 4 J, the epidermis appears bronzed, with the skin remaining intact for several days "like a natural dressing," Dr. Zachary said.

Dr. Mitchel P. Goldman, a dermatologist in private practice in La Jolla, Calif., expressed concern about the variability of the energy delivery.

"I've seen profound scarring with this device," he said. "I prefer a laser where I know exactly how much heat is going to be built up between each pass."

Dr. Zachary agreed that "there is no free lunch" with the Portrait Plasma. Double passes at 3.5–4 J could definitely produce scarring, although the device also has the potential for significant improvement in the skin, he said.

"Share [the potential of side effects] with the patient," he suggested. "Let them be part of the decision."

VariLite Laser

Dr. Bill H. Halmi, a Phoenix-based dermatologist, demonstrated the use of the VariLite dual wavelength (532 nm or 940 nm) laser, manufactured by Iridex, as a "spot welding device" that can target unsightly perinasal vessels by creating a dotted line of damage, leaving untreated millimeters of tissue between the spots.

"Go for little gaps" in the visible vessel line, Dr. Zachary said during the live video presentation.

As visual evidence of the vein disappeared under the beam of the laser, Dr. Zachary marveled, "Oh, that's very nice. It's better than sex!"

Dr. Zachary stressed the need for wearing protective goggles, preferably polarized for better visualization, when using the device.

Dr. Goldman offered a less rosy opinion. "This is the single most dangerous procedure to do. It puts holes in peoples' faces," he said.

Whitened skin evident in the video close-ups represents destruction of the epidermis. He also expressed concern that the laser has no epidermal cooling system to prevent permanent heat damage.

Beyond the safety concerns, Dr. Goldman questioned the permanence of the VariLite treatment. Red telangiectasias seen at the nasal alar area originate from the nasolabial artery and "will always come back," he pointed out. "[I would] never, ever tell a patient it's permanent, and I don't think it's better than sex."

DermaSweep

One of a wide variety of dermabrasion devices, DermaSweep (developed by CosMedic) requires no anesthesia and is becoming a popular modality among physicians, said Dr. Zachary.

This particular unit uses suction to draw the skin close to a variety of different bristles that range from "a silky, superficial … polisher to aggressive bristles," he said.

The device is said to enhance penetration of infusions of hyaluronic acid, vitamin C preparations, and Levulan (DUSA Pharmaceuticals Inc.).

"There is no way an infusion of hyaluronic acid is going to do a darned thing beyond 1–2 days," said Dr. Goldman. He also questioned its use in patients with a propensity to develop telangiectasias, such as those with rosacea.

Physicians should understand that if they use it prior to a light peel, the peel will become a deep peel with all of the associated side effects.

This said, Dr. Goldman acknowledged that the DermaSweep is an "outstanding machine" and that he uses it in his spa and on patients receiving photodynamic therapy.

All of the panelists commented on the immediate smoothing created by the low-impact device.

"It feels good for a day," said Dr. Margaret Mann, who is with the department of dermatology at the University of California, Irvine. "You get what you pay for."

She said, however, that she also uses the device to enhance penetration of aminolevulinic acid before photodynamic therapy, and she sees it as a nice introductory procedure. "It's great for the patient who comes in and just wants to know what an aesthetic procedure is like," Dr. Mann said.

Once such a patient feels comfortable, he or she "might move on to something more aggressive," she suggested.

Dr. Zachary disclosed that he has received equipment loans from Rhytec, Iridex, and CosMedic.

Dr. Goldman, Dr. Mann, and Dr. Halmi had no disclosures relating to the products mentioned in this article.

Skin Disease Education Foundation and this news organization are wholly owned subsidiaries of Elsevier.

SANTA MONICA, CALIF. — Live video demonstrations of several novel laser and laserlike devices generated mixed reviews from a panel of dermatologists.

Panelists at a cosmetic dermatology seminar sponsored by Skin Disease Education Foundation disagreed about the safety and efficacy of several of the devices, although they came to a meeting of the minds on some points, such as the "feel-good" potential of microdermabrasion devices.

What follows is a recap of many of the thumbs-up, thumbs-down impressions aired at the meeting.

Portrait Plasma

"I have to say I'm truly impressed with this device," said Dr. Christopher Zachary, professor and chair of dermatology at the University of California, Irvine.

"I'm not sure why it hasn't caught on."

The Portrait Plasma device, manufactured by Rhytec, derives its heat energy from nitrogen plasma rather than from a laser.

Treatment of photodamage, including fine lines and wrinkles, is attained by using a variety of energy levels up to 5–6 J, a setting that leaves behind significant erythema.

At about 4 J, the epidermis appears bronzed, with the skin remaining intact for several days "like a natural dressing," Dr. Zachary said.

Dr. Mitchel P. Goldman, a dermatologist in private practice in La Jolla, Calif., expressed concern about the variability of the energy delivery.

"I've seen profound scarring with this device," he said. "I prefer a laser where I know exactly how much heat is going to be built up between each pass."

Dr. Zachary agreed that "there is no free lunch" with the Portrait Plasma. Double passes at 3.5–4 J could definitely produce scarring, although the device also has the potential for significant improvement in the skin, he said.

"Share [the potential of side effects] with the patient," he suggested. "Let them be part of the decision."

VariLite Laser

Dr. Bill H. Halmi, a Phoenix-based dermatologist, demonstrated the use of the VariLite dual wavelength (532 nm or 940 nm) laser, manufactured by Iridex, as a "spot welding device" that can target unsightly perinasal vessels by creating a dotted line of damage, leaving untreated millimeters of tissue between the spots.

"Go for little gaps" in the visible vessel line, Dr. Zachary said during the live video presentation.

As visual evidence of the vein disappeared under the beam of the laser, Dr. Zachary marveled, "Oh, that's very nice. It's better than sex!"

Dr. Zachary stressed the need for wearing protective goggles, preferably polarized for better visualization, when using the device.

Dr. Goldman offered a less rosy opinion. "This is the single most dangerous procedure to do. It puts holes in peoples' faces," he said.

Whitened skin evident in the video close-ups represents destruction of the epidermis. He also expressed concern that the laser has no epidermal cooling system to prevent permanent heat damage.

Beyond the safety concerns, Dr. Goldman questioned the permanence of the VariLite treatment. Red telangiectasias seen at the nasal alar area originate from the nasolabial artery and "will always come back," he pointed out. "[I would] never, ever tell a patient it's permanent, and I don't think it's better than sex."

DermaSweep

One of a wide variety of dermabrasion devices, DermaSweep (developed by CosMedic) requires no anesthesia and is becoming a popular modality among physicians, said Dr. Zachary.

This particular unit uses suction to draw the skin close to a variety of different bristles that range from "a silky, superficial … polisher to aggressive bristles," he said.

The device is said to enhance penetration of infusions of hyaluronic acid, vitamin C preparations, and Levulan (DUSA Pharmaceuticals Inc.).

"There is no way an infusion of hyaluronic acid is going to do a darned thing beyond 1–2 days," said Dr. Goldman. He also questioned its use in patients with a propensity to develop telangiectasias, such as those with rosacea.

Physicians should understand that if they use it prior to a light peel, the peel will become a deep peel with all of the associated side effects.

This said, Dr. Goldman acknowledged that the DermaSweep is an "outstanding machine" and that he uses it in his spa and on patients receiving photodynamic therapy.

All of the panelists commented on the immediate smoothing created by the low-impact device.

"It feels good for a day," said Dr. Margaret Mann, who is with the department of dermatology at the University of California, Irvine. "You get what you pay for."

She said, however, that she also uses the device to enhance penetration of aminolevulinic acid before photodynamic therapy, and she sees it as a nice introductory procedure. "It's great for the patient who comes in and just wants to know what an aesthetic procedure is like," Dr. Mann said.

Once such a patient feels comfortable, he or she "might move on to something more aggressive," she suggested.

Dr. Zachary disclosed that he has received equipment loans from Rhytec, Iridex, and CosMedic.

Dr. Goldman, Dr. Mann, and Dr. Halmi had no disclosures relating to the products mentioned in this article.

Skin Disease Education Foundation and this news organization are wholly owned subsidiaries of Elsevier.

SANTA MONICA, CALIF. — Don't bother leafing through the pages of glossy, upscale San Diego magazines to find advertisements for Dr. Mitchel P. Goldman's successful, 6-year-old medical spa.

Magazine marketing recruits mostly "looky-loos," said Dr. Goldman at a cosmetic dermatology seminar sponsored by Skin Disease Education Foundation.

Most of the marketing for La Jolla (Calif.) Spa MD occurs only after a patient enters the column-framed, wood-and-glass doors and is greeted by one of 92 staff members for a dermatology, cosmetic surgery, or cosmetic dentistry procedure; wellness/longevity consultation; spa service, or a trip to the retail center.

Then, "it's all marketing," from the videos playing in the waiting room and the artfully displayed brochures to the up-close (and sometimes alarming) computer analysis of patients' faces and flaws, with a scorecard and list of recommended procedures.

The patient who arrives for a simple $150 massage—the least profitable service in the spa—might also be informed that a cancellation has left a Botox appointment available, for 10% off.

Spa aestheticians, massage therapists, and make-up specialists receive incentives when their clients sign up for cosmetic medical procedures.

Established patients, whose names go into the computer database, receive discount coupons, specials, and gift cards. Birthday and anniversary cards arrive each year, with $50-off coupons. The spa newsletter features special promotions.

Upward of 10,000 Web site visitors a month, often drawn to the site by word-of-mouth, learn about spa and medical services, schedule spa "packages"—(the 3-hour, four-treatment "anti-cellulite sampler" goes for $620), and purchase products once they establish an online account, thus entering the database to receive e-mail blast offers for discount services.

Although he is not big on print and broadcast advertising, Dr. Goldman said he is generous with his time for interviews with journalists. He also promotes the spa by making generous charitable donations. At any given time, the practice may be conducting 20 active clinical trials, any of which may draw a newcomer who will then return as a paying customer.

Dr. Goldman's unconventional, upscale marketing efforts seem to be paying off. In the past 3 years, the number of new patients rose from 5,600 to 5,700, to 6,000, respectively, he said.

SDEF and this newspaper are wholly owned subsidiaries of Elsevier.

Dr. Mitchel P. Goldman's upscale marketing efforts are paying off. ©Marty Mann

What's Hot and What's Not at An Upscale California MediSpa

Dr. Goldman, founder of the La Jolla Spa MD medical spa, recently shared his observations about which treatments are "in," which are "out," and which aren't worth the trouble.

Ubiquitous Botox procedures, always a draw, and requests for other facial fillers have been up 25% in recent months at his spa, as a down economy induces penny-pinching socialites to seek out temporary, relatively affordable alternatives to big-ticket cosmetic surgery procedures, according to Dr. Goldman.

As a whole, aesthetic surgery procedures declined 10% last year, while appointments for plastic surgery took a 50% dive, said Dr. Goldman. Adding that breast implants, facelifts, and blepharoplasty procedures have seen a decline "all over California."

He predicted the popularity of these procedures will rebound with "pent-up demand" once the economy improves.

Leg vein procedures, hair removal, photodynamic therapy for acne, and intense pulsed light treatments are all holding their own, and cosmetic dentistry has proved to be "very profitable," he said.

The spa's retail center, which features a variety of skin products, has shown 133% growth in 5 years, now generating $1.5 million/year in sales.

Dr. Goldman doesn't recommend catering to patients requesting laser tattoo removal.

"They're the worst patients in the world," who may have paid $100 while drunk to get a tattoo and are irritated at the notion of paying thousands for 5-50 treatments to have them removed, he said.

SANTA MONICA, CALIF. — Don't bother leafing through the pages of glossy, upscale San Diego magazines to find advertisements for Dr. Mitchel P. Goldman's successful, 6-year-old medical spa.

Magazine marketing recruits mostly "looky-loos," said Dr. Goldman at a cosmetic dermatology seminar sponsored by Skin Disease Education Foundation.

Most of the marketing for La Jolla (Calif.) Spa MD occurs only after a patient enters the column-framed, wood-and-glass doors and is greeted by one of 92 staff members for a dermatology, cosmetic surgery, or cosmetic dentistry procedure; wellness/longevity consultation; spa service, or a trip to the retail center.

Then, "it's all marketing," from the videos playing in the waiting room and the artfully displayed brochures to the up-close (and sometimes alarming) computer analysis of patients' faces and flaws, with a scorecard and list of recommended procedures.

The patient who arrives for a simple $150 massage—the least profitable service in the spa—might also be informed that a cancellation has left a Botox appointment available, for 10% off.

Spa aestheticians, massage therapists, and make-up specialists receive incentives when their clients sign up for cosmetic medical procedures.

Established patients, whose names go into the computer database, receive discount coupons, specials, and gift cards. Birthday and anniversary cards arrive each year, with $50-off coupons. The spa newsletter features special promotions.

Upward of 10,000 Web site visitors a month, often drawn to the site by word-of-mouth, learn about spa and medical services, schedule spa "packages"—(the 3-hour, four-treatment "anti-cellulite sampler" goes for $620), and purchase products once they establish an online account, thus entering the database to receive e-mail blast offers for discount services.

Although he is not big on print and broadcast advertising, Dr. Goldman said he is generous with his time for interviews with journalists. He also promotes the spa by making generous charitable donations. At any given time, the practice may be conducting 20 active clinical trials, any of which may draw a newcomer who will then return as a paying customer.

Dr. Goldman's unconventional, upscale marketing efforts seem to be paying off. In the past 3 years, the number of new patients rose from 5,600 to 5,700, to 6,000, respectively, he said.

SDEF and this newspaper are wholly owned subsidiaries of Elsevier.

Dr. Mitchel P. Goldman's upscale marketing efforts are paying off. ©Marty Mann

What's Hot and What's Not at An Upscale California MediSpa

Dr. Goldman, founder of the La Jolla Spa MD medical spa, recently shared his observations about which treatments are "in," which are "out," and which aren't worth the trouble.

Ubiquitous Botox procedures, always a draw, and requests for other facial fillers have been up 25% in recent months at his spa, as a down economy induces penny-pinching socialites to seek out temporary, relatively affordable alternatives to big-ticket cosmetic surgery procedures, according to Dr. Goldman.

As a whole, aesthetic surgery procedures declined 10% last year, while appointments for plastic surgery took a 50% dive, said Dr. Goldman. Adding that breast implants, facelifts, and blepharoplasty procedures have seen a decline "all over California."

He predicted the popularity of these procedures will rebound with "pent-up demand" once the economy improves.

Leg vein procedures, hair removal, photodynamic therapy for acne, and intense pulsed light treatments are all holding their own, and cosmetic dentistry has proved to be "very profitable," he said.

The spa's retail center, which features a variety of skin products, has shown 133% growth in 5 years, now generating $1.5 million/year in sales.

Dr. Goldman doesn't recommend catering to patients requesting laser tattoo removal.

"They're the worst patients in the world," who may have paid $100 while drunk to get a tattoo and are irritated at the notion of paying thousands for 5-50 treatments to have them removed, he said.

SANTA MONICA, CALIF. — Don't bother leafing through the pages of glossy, upscale San Diego magazines to find advertisements for Dr. Mitchel P. Goldman's successful, 6-year-old medical spa.

Magazine marketing recruits mostly "looky-loos," said Dr. Goldman at a cosmetic dermatology seminar sponsored by Skin Disease Education Foundation.

Most of the marketing for La Jolla (Calif.) Spa MD occurs only after a patient enters the column-framed, wood-and-glass doors and is greeted by one of 92 staff members for a dermatology, cosmetic surgery, or cosmetic dentistry procedure; wellness/longevity consultation; spa service, or a trip to the retail center.

Then, "it's all marketing," from the videos playing in the waiting room and the artfully displayed brochures to the up-close (and sometimes alarming) computer analysis of patients' faces and flaws, with a scorecard and list of recommended procedures.

The patient who arrives for a simple $150 massage—the least profitable service in the spa—might also be informed that a cancellation has left a Botox appointment available, for 10% off.

Spa aestheticians, massage therapists, and make-up specialists receive incentives when their clients sign up for cosmetic medical procedures.

Established patients, whose names go into the computer database, receive discount coupons, specials, and gift cards. Birthday and anniversary cards arrive each year, with $50-off coupons. The spa newsletter features special promotions.

Upward of 10,000 Web site visitors a month, often drawn to the site by word-of-mouth, learn about spa and medical services, schedule spa "packages"—(the 3-hour, four-treatment "anti-cellulite sampler" goes for $620), and purchase products once they establish an online account, thus entering the database to receive e-mail blast offers for discount services.

Although he is not big on print and broadcast advertising, Dr. Goldman said he is generous with his time for interviews with journalists. He also promotes the spa by making generous charitable donations. At any given time, the practice may be conducting 20 active clinical trials, any of which may draw a newcomer who will then return as a paying customer.

Dr. Goldman's unconventional, upscale marketing efforts seem to be paying off. In the past 3 years, the number of new patients rose from 5,600 to 5,700, to 6,000, respectively, he said.

SDEF and this newspaper are wholly owned subsidiaries of Elsevier.

Dr. Mitchel P. Goldman's upscale marketing efforts are paying off. ©Marty Mann

What's Hot and What's Not at An Upscale California MediSpa

Dr. Goldman, founder of the La Jolla Spa MD medical spa, recently shared his observations about which treatments are "in," which are "out," and which aren't worth the trouble.

Ubiquitous Botox procedures, always a draw, and requests for other facial fillers have been up 25% in recent months at his spa, as a down economy induces penny-pinching socialites to seek out temporary, relatively affordable alternatives to big-ticket cosmetic surgery procedures, according to Dr. Goldman.

As a whole, aesthetic surgery procedures declined 10% last year, while appointments for plastic surgery took a 50% dive, said Dr. Goldman. Adding that breast implants, facelifts, and blepharoplasty procedures have seen a decline "all over California."

He predicted the popularity of these procedures will rebound with "pent-up demand" once the economy improves.

Leg vein procedures, hair removal, photodynamic therapy for acne, and intense pulsed light treatments are all holding their own, and cosmetic dentistry has proved to be "very profitable," he said.

The spa's retail center, which features a variety of skin products, has shown 133% growth in 5 years, now generating $1.5 million/year in sales.

Dr. Goldman doesn't recommend catering to patients requesting laser tattoo removal.

"They're the worst patients in the world," who may have paid $100 while drunk to get a tattoo and are irritated at the notion of paying thousands for 5-50 treatments to have them removed, he said.

SANTA MONICA, CALIF. — When state coffers get low, legislators go hunting for cash.

Lately, in states such as Maryland and New York, lawmakers have been considering taxes on "luxury" items from upscale cars to aesthetic surgery offices, Dr. Ron Wheeland said at a cosmetic dermatology seminar sponsored by Skin Disease Education Foundation.

"This is not a new idea," he said, citing longstanding sales taxes on cosmetic surgery procedures in New Jersey and Minnesota.

In New Jersey, in fact, a Senate bill seeks to repeal the 2004 sales tax on cosmetic procedures because it generated far less money than expected.

But that experience hasn't stopped other states from trying.

In Tennessee, it's the same tune with different lyrics, as legislators consider a tax on devices and equipment used in cosmetic procedures, rather than targeting the consumers who pay for laser procedures and facelifts, he said.

Aesthetic procedures are also in the legislative spotlight with regard to safety and oversight, Dr. Wheeland said during a talk on the "new truths" in dermatology.

Restricting procedures and imposing tighter oversight measures are seen as "white hat" moves for legislators, who like to be seen protecting constituents, even in cases when not all the facts are in, said Dr. Wheeland, director of dermatologic surgery at the University of Missouri-Columbia.

In Virginia, House Bill 1399 would establish as a professional entity "laser light technicians" who would report not to the state boards that oversee physicians or nurses but to the board that oversees barbers and cosmetologists.

"I can only hope that that bill is defeated," he said.

In Georgia, Illinois, and California, proposed legislation would require preoperative examinations prior to laser or cosmetic surgical procedures. In Arizona, a bill is being considered that would allow nonphysicians to perform aesthetic procedures with lasers or light devices without physician supervision if they pass a 40-hour course.

Another bill in Illinois, which was referred to the rules committee in April, would permit only board-certified plastic surgeons to inject Botox, perform chemical peels, or perform aesthetic laser procedures.

"This one bothers me the most," said Dr. Wheeland. "When you think of these three procedures in particular, the first thing that ought to pop into your mind is that all three were developed by dermatologists."

It behooves dermatologists to be alert to themes and patterns in legislative proposals and to become involved when their own states are considering laws that would have a direct impact on the practice of dermatology, Dr. Wheeland said.

SDEF and this publication are wholly owned subsidiaries of Elsevier.

SANTA MONICA, CALIF. — When state coffers get low, legislators go hunting for cash.

Lately, in states such as Maryland and New York, lawmakers have been considering taxes on "luxury" items from upscale cars to aesthetic surgery offices, Dr. Ron Wheeland said at a cosmetic dermatology seminar sponsored by Skin Disease Education Foundation.

"This is not a new idea," he said, citing longstanding sales taxes on cosmetic surgery procedures in New Jersey and Minnesota.

In New Jersey, in fact, a Senate bill seeks to repeal the 2004 sales tax on cosmetic procedures because it generated far less money than expected.

But that experience hasn't stopped other states from trying.

In Tennessee, it's the same tune with different lyrics, as legislators consider a tax on devices and equipment used in cosmetic procedures, rather than targeting the consumers who pay for laser procedures and facelifts, he said.

Aesthetic procedures are also in the legislative spotlight with regard to safety and oversight, Dr. Wheeland said during a talk on the "new truths" in dermatology.

Restricting procedures and imposing tighter oversight measures are seen as "white hat" moves for legislators, who like to be seen protecting constituents, even in cases when not all the facts are in, said Dr. Wheeland, director of dermatologic surgery at the University of Missouri-Columbia.

In Virginia, House Bill 1399 would establish as a professional entity "laser light technicians" who would report not to the state boards that oversee physicians or nurses but to the board that oversees barbers and cosmetologists.

"I can only hope that that bill is defeated," he said.

In Georgia, Illinois, and California, proposed legislation would require preoperative examinations prior to laser or cosmetic surgical procedures. In Arizona, a bill is being considered that would allow nonphysicians to perform aesthetic procedures with lasers or light devices without physician supervision if they pass a 40-hour course.

Another bill in Illinois, which was referred to the rules committee in April, would permit only board-certified plastic surgeons to inject Botox, perform chemical peels, or perform aesthetic laser procedures.

"This one bothers me the most," said Dr. Wheeland. "When you think of these three procedures in particular, the first thing that ought to pop into your mind is that all three were developed by dermatologists."

It behooves dermatologists to be alert to themes and patterns in legislative proposals and to become involved when their own states are considering laws that would have a direct impact on the practice of dermatology, Dr. Wheeland said.

SDEF and this publication are wholly owned subsidiaries of Elsevier.

SANTA MONICA, CALIF. — When state coffers get low, legislators go hunting for cash.

Lately, in states such as Maryland and New York, lawmakers have been considering taxes on "luxury" items from upscale cars to aesthetic surgery offices, Dr. Ron Wheeland said at a cosmetic dermatology seminar sponsored by Skin Disease Education Foundation.

"This is not a new idea," he said, citing longstanding sales taxes on cosmetic surgery procedures in New Jersey and Minnesota.

In New Jersey, in fact, a Senate bill seeks to repeal the 2004 sales tax on cosmetic procedures because it generated far less money than expected.

But that experience hasn't stopped other states from trying.

In Tennessee, it's the same tune with different lyrics, as legislators consider a tax on devices and equipment used in cosmetic procedures, rather than targeting the consumers who pay for laser procedures and facelifts, he said.

Aesthetic procedures are also in the legislative spotlight with regard to safety and oversight, Dr. Wheeland said during a talk on the "new truths" in dermatology.

Restricting procedures and imposing tighter oversight measures are seen as "white hat" moves for legislators, who like to be seen protecting constituents, even in cases when not all the facts are in, said Dr. Wheeland, director of dermatologic surgery at the University of Missouri-Columbia.

In Virginia, House Bill 1399 would establish as a professional entity "laser light technicians" who would report not to the state boards that oversee physicians or nurses but to the board that oversees barbers and cosmetologists.

"I can only hope that that bill is defeated," he said.

In Georgia, Illinois, and California, proposed legislation would require preoperative examinations prior to laser or cosmetic surgical procedures. In Arizona, a bill is being considered that would allow nonphysicians to perform aesthetic procedures with lasers or light devices without physician supervision if they pass a 40-hour course.

Another bill in Illinois, which was referred to the rules committee in April, would permit only board-certified plastic surgeons to inject Botox, perform chemical peels, or perform aesthetic laser procedures.

"This one bothers me the most," said Dr. Wheeland. "When you think of these three procedures in particular, the first thing that ought to pop into your mind is that all three were developed by dermatologists."

It behooves dermatologists to be alert to themes and patterns in legislative proposals and to become involved when their own states are considering laws that would have a direct impact on the practice of dermatology, Dr. Wheeland said.

SDEF and this publication are wholly owned subsidiaries of Elsevier.

KYOTO, JAPAN — Facial sagging has been found to be a function not only of aging, gravity, and environmental and lifestyle factors, but also of genetics.

Melanocortin 1 receptor (MC1R) and elastin proved to be significantly associated with the sagging of facial skin in a genetic study of 530 white women age 44-70 years, Christiane Guinot, Ph.D., said at an international investigative dermatology meeting.

The MC1R gene plays a major role in skin pigmentation and sensitivity to sunlight. Elastin figures prominently in arterial wall elasticity. Neither gene had previously been linked to sagging of facial skin, said Dr. Guinot of the Chanel Epidermal and Sensory Research and Investigation Center and the University of Tours (France).

Dr. Guinot, who is president of the French Statistical Association, reported that 121 of the 530 women had severe sagging of the facial skin based upon a structured 0-10 rating scale. Nongenetic factors that proved significantly associated with severe facial sagging were age, being overweight or obese, and being menopausal and not on hormone replacement therapy (HRT).

An analysis that adjusted for these factors revealed that women carrying two variants of the MC1R gene were at a 2.3-fold increased risk of severe sagging, compared with those with the wt/wt (wild type) genotype. Women with the Ser422Gly polymorphism of the elastin gene were at a 1.8-fold increased risk.

Overweight women were 1.7 times more likely to have severe facial sagging than normal-weight women; obese women were at 2.3-fold increased risk. Menopausal women not on HRT were an adjusted 2.1-fold more likely to have severe facial skin sagging than those on HRT.

Neither smoking status nor skin color was significantly associated with severity of facial skin sagging, although the spectrum of skin colors in this all-Caucasian study was limited, Dr. Guinot noted at the meeting of the European Society for Dermatological Research, the Japanese Society for Investigative Dermatology, and the Society for Investigative Dermatology. The study was sponsored by Chanel.

Women carrying two variants of the MC1R gene were at a 2.3-fold increased risk of severe sagging. DR. GUINOT

KYOTO, JAPAN — Facial sagging has been found to be a function not only of aging, gravity, and environmental and lifestyle factors, but also of genetics.

Melanocortin 1 receptor (MC1R) and elastin proved to be significantly associated with the sagging of facial skin in a genetic study of 530 white women age 44-70 years, Christiane Guinot, Ph.D., said at an international investigative dermatology meeting.

The MC1R gene plays a major role in skin pigmentation and sensitivity to sunlight. Elastin figures prominently in arterial wall elasticity. Neither gene had previously been linked to sagging of facial skin, said Dr. Guinot of the Chanel Epidermal and Sensory Research and Investigation Center and the University of Tours (France).

Dr. Guinot, who is president of the French Statistical Association, reported that 121 of the 530 women had severe sagging of the facial skin based upon a structured 0-10 rating scale. Nongenetic factors that proved significantly associated with severe facial sagging were age, being overweight or obese, and being menopausal and not on hormone replacement therapy (HRT).

An analysis that adjusted for these factors revealed that women carrying two variants of the MC1R gene were at a 2.3-fold increased risk of severe sagging, compared with those with the wt/wt (wild type) genotype. Women with the Ser422Gly polymorphism of the elastin gene were at a 1.8-fold increased risk.

Overweight women were 1.7 times more likely to have severe facial sagging than normal-weight women; obese women were at 2.3-fold increased risk. Menopausal women not on HRT were an adjusted 2.1-fold more likely to have severe facial skin sagging than those on HRT.

Neither smoking status nor skin color was significantly associated with severity of facial skin sagging, although the spectrum of skin colors in this all-Caucasian study was limited, Dr. Guinot noted at the meeting of the European Society for Dermatological Research, the Japanese Society for Investigative Dermatology, and the Society for Investigative Dermatology. The study was sponsored by Chanel.

Women carrying two variants of the MC1R gene were at a 2.3-fold increased risk of severe sagging. DR. GUINOT

KYOTO, JAPAN — Facial sagging has been found to be a function not only of aging, gravity, and environmental and lifestyle factors, but also of genetics.

Melanocortin 1 receptor (MC1R) and elastin proved to be significantly associated with the sagging of facial skin in a genetic study of 530 white women age 44-70 years, Christiane Guinot, Ph.D., said at an international investigative dermatology meeting.

The MC1R gene plays a major role in skin pigmentation and sensitivity to sunlight. Elastin figures prominently in arterial wall elasticity. Neither gene had previously been linked to sagging of facial skin, said Dr. Guinot of the Chanel Epidermal and Sensory Research and Investigation Center and the University of Tours (France).

Dr. Guinot, who is president of the French Statistical Association, reported that 121 of the 530 women had severe sagging of the facial skin based upon a structured 0-10 rating scale. Nongenetic factors that proved significantly associated with severe facial sagging were age, being overweight or obese, and being menopausal and not on hormone replacement therapy (HRT).

An analysis that adjusted for these factors revealed that women carrying two variants of the MC1R gene were at a 2.3-fold increased risk of severe sagging, compared with those with the wt/wt (wild type) genotype. Women with the Ser422Gly polymorphism of the elastin gene were at a 1.8-fold increased risk.

Overweight women were 1.7 times more likely to have severe facial sagging than normal-weight women; obese women were at 2.3-fold increased risk. Menopausal women not on HRT were an adjusted 2.1-fold more likely to have severe facial skin sagging than those on HRT.

Neither smoking status nor skin color was significantly associated with severity of facial skin sagging, although the spectrum of skin colors in this all-Caucasian study was limited, Dr. Guinot noted at the meeting of the European Society for Dermatological Research, the Japanese Society for Investigative Dermatology, and the Society for Investigative Dermatology. The study was sponsored by Chanel.

Women carrying two variants of the MC1R gene were at a 2.3-fold increased risk of severe sagging. DR. GUINOT

SANTA MONICA, CALIF. — In the world of cosmetic skin rejuvenation, what's old is new again.

Ablative laser resurfacing with CO₂ lasers—using fractionalized laser energy this time around to reduce healing time—dominated a recent cosmetic dermatology seminar sponsored by Skin Disease Educational Foundation.

"It's almost like we're rediscovering the wheel," said Dr. Mitchel Goldman, who is a dermatologist in private practice in La Jolla, Calif.

Dr. Goldman explained that he has 32 lasers in his office, but the only ones that truly smooth wrinkles and tighten the skin are the CO₂ and erbium:YAG lasers.

The others, he said, mainly address pigmentation issues and vascular changes. They demand multiple visits, multiple passes, and generate multiple complaints from patients who see little improvement in their overall appearance.

The drawback with CO₂ lasers is the downtime to allow for healing, even with fractional ablative resurfacing. "No matter what anyone says, there is some downtime," now averaging approximately 4-5 days, compared with the 1-4 weeks for first-generation CO₂ lasers, he said.

The lure of fractional CO₂ resurfacing is its reliability in producing meaningful cosmetic skin changes with less damage by creating pinpoint "drill holes" linked by tissue bridges.

Among 356 patients who have undergone fractionalized CO₂ laser procedures in his practice in the past 3 years, "we have seen virtually no complications," he said. A 1% incidence of herpes was eliminated by the addition of antiviral prophylaxis in every case. There has been a 2% rate of erythema lasting for more than 4 days.

"That was it," he said, detailing his experience with Lumenis systems.

The three big players in ablative fractional resurfacing, according to Dr. Goldman, are the Fraxel Re:pair by Reliant, and the ActiveFX and DeepFX by Lumenis.

Speakers discussed their experiences with each, coming to the conclusion that the devices induce significant nonspecific thermal damage that induces collagen remodeling, yet invite far fewer complications than traditional CO₂ lasers, including burns and pigmentation abnormalities.

"I think there's been a quantum shift back toward CO₂. The reason is, CO₂ works," said Dr. John Fezza of Sarasota, Fla.

"There's no question, there is some redness," acknowledged Dr. Fezza, who performed a real-time video laser resurfacing procedure on a 42-year-old woman with sun damage during the meeting.

Still, in more than 2 years, he has seen no lasting hyper- or hypopigmentation—common side effects associated with traditional CO₂ laser resurfacing.

Patients with realistic expectations know that if they have a fractionated CO₂ laser procedure on a Friday, they'll be ready to go out with makeup by Monday.

"They don't mind house arrest for 3 days," he said.

Dr. Goldman said he considers fractionated CO₂ lasers "safe if you go within the [recommended] parameters," but they require care and caution just like their prototypes.

Dr. Christopher Zachary, professor and chair of dermatology at the University of California, Irvine, said he believes the reason fractionated CO₂ lasers have a measurable impact on wrinkling and skin tightening is that "they have the ability to induce a defect that is deeper than it is wide."

Dr. David Goldberg agreed. For photo damage and superficial rhytids, the key is density, but depth is what matters if the goal is skin tightening, he said.

"I'm pretty convinced," Dr. Goldberg said.

All speakers at the session disclosed grant support, laser equipment loans, and/or speakers bureau ties to companies that manufacture lasers, including Reliant and Lumenis.

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

SANTA MONICA, CALIF. — In the world of cosmetic skin rejuvenation, what's old is new again.

Ablative laser resurfacing with CO₂ lasers—using fractionalized laser energy this time around to reduce healing time—dominated a recent cosmetic dermatology seminar sponsored by Skin Disease Educational Foundation.

"It's almost like we're rediscovering the wheel," said Dr. Mitchel Goldman, who is a dermatologist in private practice in La Jolla, Calif.

Dr. Goldman explained that he has 32 lasers in his office, but the only ones that truly smooth wrinkles and tighten the skin are the CO₂ and erbium:YAG lasers.

The others, he said, mainly address pigmentation issues and vascular changes. They demand multiple visits, multiple passes, and generate multiple complaints from patients who see little improvement in their overall appearance.

The drawback with CO₂ lasers is the downtime to allow for healing, even with fractional ablative resurfacing. "No matter what anyone says, there is some downtime," now averaging approximately 4-5 days, compared with the 1-4 weeks for first-generation CO₂ lasers, he said.

The lure of fractional CO₂ resurfacing is its reliability in producing meaningful cosmetic skin changes with less damage by creating pinpoint "drill holes" linked by tissue bridges.

Among 356 patients who have undergone fractionalized CO₂ laser procedures in his practice in the past 3 years, "we have seen virtually no complications," he said. A 1% incidence of herpes was eliminated by the addition of antiviral prophylaxis in every case. There has been a 2% rate of erythema lasting for more than 4 days.

"That was it," he said, detailing his experience with Lumenis systems.

The three big players in ablative fractional resurfacing, according to Dr. Goldman, are the Fraxel Re:pair by Reliant, and the ActiveFX and DeepFX by Lumenis.

Speakers discussed their experiences with each, coming to the conclusion that the devices induce significant nonspecific thermal damage that induces collagen remodeling, yet invite far fewer complications than traditional CO₂ lasers, including burns and pigmentation abnormalities.

"I think there's been a quantum shift back toward CO₂. The reason is, CO₂ works," said Dr. John Fezza of Sarasota, Fla.

"There's no question, there is some redness," acknowledged Dr. Fezza, who performed a real-time video laser resurfacing procedure on a 42-year-old woman with sun damage during the meeting.

Still, in more than 2 years, he has seen no lasting hyper- or hypopigmentation—common side effects associated with traditional CO₂ laser resurfacing.

Patients with realistic expectations know that if they have a fractionated CO₂ laser procedure on a Friday, they'll be ready to go out with makeup by Monday.

"They don't mind house arrest for 3 days," he said.

Dr. Goldman said he considers fractionated CO₂ lasers "safe if you go within the [recommended] parameters," but they require care and caution just like their prototypes.

Dr. Christopher Zachary, professor and chair of dermatology at the University of California, Irvine, said he believes the reason fractionated CO₂ lasers have a measurable impact on wrinkling and skin tightening is that "they have the ability to induce a defect that is deeper than it is wide."

Dr. David Goldberg agreed. For photo damage and superficial rhytids, the key is density, but depth is what matters if the goal is skin tightening, he said.

"I'm pretty convinced," Dr. Goldberg said.

All speakers at the session disclosed grant support, laser equipment loans, and/or speakers bureau ties to companies that manufacture lasers, including Reliant and Lumenis.

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

SANTA MONICA, CALIF. — In the world of cosmetic skin rejuvenation, what's old is new again.

Ablative laser resurfacing with CO₂ lasers—using fractionalized laser energy this time around to reduce healing time—dominated a recent cosmetic dermatology seminar sponsored by Skin Disease Educational Foundation.

"It's almost like we're rediscovering the wheel," said Dr. Mitchel Goldman, who is a dermatologist in private practice in La Jolla, Calif.

Dr. Goldman explained that he has 32 lasers in his office, but the only ones that truly smooth wrinkles and tighten the skin are the CO₂ and erbium:YAG lasers.

The others, he said, mainly address pigmentation issues and vascular changes. They demand multiple visits, multiple passes, and generate multiple complaints from patients who see little improvement in their overall appearance.

The drawback with CO₂ lasers is the downtime to allow for healing, even with fractional ablative resurfacing. "No matter what anyone says, there is some downtime," now averaging approximately 4-5 days, compared with the 1-4 weeks for first-generation CO₂ lasers, he said.

The lure of fractional CO₂ resurfacing is its reliability in producing meaningful cosmetic skin changes with less damage by creating pinpoint "drill holes" linked by tissue bridges.

Among 356 patients who have undergone fractionalized CO₂ laser procedures in his practice in the past 3 years, "we have seen virtually no complications," he said. A 1% incidence of herpes was eliminated by the addition of antiviral prophylaxis in every case. There has been a 2% rate of erythema lasting for more than 4 days.

"That was it," he said, detailing his experience with Lumenis systems.

The three big players in ablative fractional resurfacing, according to Dr. Goldman, are the Fraxel Re:pair by Reliant, and the ActiveFX and DeepFX by Lumenis.

Speakers discussed their experiences with each, coming to the conclusion that the devices induce significant nonspecific thermal damage that induces collagen remodeling, yet invite far fewer complications than traditional CO₂ lasers, including burns and pigmentation abnormalities.

"I think there's been a quantum shift back toward CO₂. The reason is, CO₂ works," said Dr. John Fezza of Sarasota, Fla.

"There's no question, there is some redness," acknowledged Dr. Fezza, who performed a real-time video laser resurfacing procedure on a 42-year-old woman with sun damage during the meeting.

Still, in more than 2 years, he has seen no lasting hyper- or hypopigmentation—common side effects associated with traditional CO₂ laser resurfacing.

Patients with realistic expectations know that if they have a fractionated CO₂ laser procedure on a Friday, they'll be ready to go out with makeup by Monday.

"They don't mind house arrest for 3 days," he said.

Dr. Goldman said he considers fractionated CO₂ lasers "safe if you go within the [recommended] parameters," but they require care and caution just like their prototypes.

Dr. Christopher Zachary, professor and chair of dermatology at the University of California, Irvine, said he believes the reason fractionated CO₂ lasers have a measurable impact on wrinkling and skin tightening is that "they have the ability to induce a defect that is deeper than it is wide."

Dr. David Goldberg agreed. For photo damage and superficial rhytids, the key is density, but depth is what matters if the goal is skin tightening, he said.

"I'm pretty convinced," Dr. Goldberg said.

All speakers at the session disclosed grant support, laser equipment loans, and/or speakers bureau ties to companies that manufacture lasers, including Reliant and Lumenis.

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

Polyalkylimide dermal fillers can produce delayed adverse immune effects, including chronic inflammatory and granulomatous reactions, investigators reported in the Archives of Dermatology.

This is the first report of histologic granulomas related to polyalkylimide implants (PAIs) described in the literature, according to Dr. Jaume Alijotas-Reig of Vall d'Hebron University Hospital, Barcelona, and associates.

"Considering the increased use of polyalkylimide fillers in European countries and the United States, physicians should be aware that … delayed effects can occur with polyalkylimide implants just as they can with collagen, polyacrylamide, polylactic acid, or methacrylate," the researchers wrote.

PAIs are used for a variety of facial defects, including anatomic or traumatic deformities as well as aesthetic defects. They also are being used increasingly in lipodystrophy related to antiretroviral therapy in patients with HIV.

According to manufacturers PAIs do not change over time, do not move or migrate, and will not be reabsorbed, unlike other dermal implant materials. However, recent reports refute these statements, according to the investigators.

A voluntary registry of patients with delayed adverse effects related to implants was designed jointly by the Spanish Society of Cosmetic Medicine and Surgery and Dr. Alijotas-Reig and associates at the hospital's clinical immunology unit.

The researchers reported on 25 patients in the registry who had delayed adverse effects related to PAIs. Of the three study patients who were HIV-positive, two were not undergoing treatment with antiretrovirals.

"Multiple inflammatory tender nodules of different sizes, facial edema and/or angioedema, and swelling and/or skin induration were the most frequent local and/or regional complaints. … In six cases, distant or systemic manifestations appeared," including Sjögren's syndrome, they reported (Arch. Dermatol. 2008;144:637-42).

Pseudoabscesses were also common. "Recovered material looks like pus, but bacterial cultures are usually negative for organisms," Dr. Alijotas-Reig and associates wrote.

The mean interval between implantation and symptom onset was 13 months (range, 1-60 months).

Other factors—such as smoking status, personal or family history of autoimmune disease, and "triggering" events such as infection or trauma—did not contribute to granulomatous reactions in these patients.

Of the 17 patients who had laboratory assessments, 12 had at least one abnormal result. These included elevated levels of C-reactive protein and fibrinogen in 11 of the 12, "so underlying inflammatory processes in different stages had to be present."

Five patients also showed elevated lactate dehydrogenase levels, which probably indicated lymphocyte or macrophage activation. Six patients had elevated levels of angiotensin-converting enzyme, which also might be secondary to macrophage and granulomatous immune responses.

Biopsy of facial and distant nodules was performed in three patients, and all showed nonspecific foreign-body granulomas.

All patients were treated with NSAIDs, and some also received hydroxychloroquine or low-dose prednisone. At least 15 had previously received antibiotics, which were ineffective.

After an average of 21 months of follow-up, 11 patients had achieved remission, 10 had recurrent or residual nodules, induration, or edema, and 4 were lost to follow-up.

"Although infrequent, delayed, moderate to severe immune-mediated adverse effects may be caused by PAIs, occasionally with systemic manifestations," the investigators concluded.

Polyalkylimide dermal fillers can produce delayed adverse immune effects, including chronic inflammatory and granulomatous reactions, investigators reported in the Archives of Dermatology.

This is the first report of histologic granulomas related to polyalkylimide implants (PAIs) described in the literature, according to Dr. Jaume Alijotas-Reig of Vall d'Hebron University Hospital, Barcelona, and associates.

"Considering the increased use of polyalkylimide fillers in European countries and the United States, physicians should be aware that … delayed effects can occur with polyalkylimide implants just as they can with collagen, polyacrylamide, polylactic acid, or methacrylate," the researchers wrote.

PAIs are used for a variety of facial defects, including anatomic or traumatic deformities as well as aesthetic defects. They also are being used increasingly in lipodystrophy related to antiretroviral therapy in patients with HIV.

According to manufacturers PAIs do not change over time, do not move or migrate, and will not be reabsorbed, unlike other dermal implant materials. However, recent reports refute these statements, according to the investigators.

A voluntary registry of patients with delayed adverse effects related to implants was designed jointly by the Spanish Society of Cosmetic Medicine and Surgery and Dr. Alijotas-Reig and associates at the hospital's clinical immunology unit.

The researchers reported on 25 patients in the registry who had delayed adverse effects related to PAIs. Of the three study patients who were HIV-positive, two were not undergoing treatment with antiretrovirals.

"Multiple inflammatory tender nodules of different sizes, facial edema and/or angioedema, and swelling and/or skin induration were the most frequent local and/or regional complaints. … In six cases, distant or systemic manifestations appeared," including Sjögren's syndrome, they reported (Arch. Dermatol. 2008;144:637-42).

Pseudoabscesses were also common. "Recovered material looks like pus, but bacterial cultures are usually negative for organisms," Dr. Alijotas-Reig and associates wrote.

The mean interval between implantation and symptom onset was 13 months (range, 1-60 months).

Other factors—such as smoking status, personal or family history of autoimmune disease, and "triggering" events such as infection or trauma—did not contribute to granulomatous reactions in these patients.

Of the 17 patients who had laboratory assessments, 12 had at least one abnormal result. These included elevated levels of C-reactive protein and fibrinogen in 11 of the 12, "so underlying inflammatory processes in different stages had to be present."

Five patients also showed elevated lactate dehydrogenase levels, which probably indicated lymphocyte or macrophage activation. Six patients had elevated levels of angiotensin-converting enzyme, which also might be secondary to macrophage and granulomatous immune responses.

Biopsy of facial and distant nodules was performed in three patients, and all showed nonspecific foreign-body granulomas.

All patients were treated with NSAIDs, and some also received hydroxychloroquine or low-dose prednisone. At least 15 had previously received antibiotics, which were ineffective.

After an average of 21 months of follow-up, 11 patients had achieved remission, 10 had recurrent or residual nodules, induration, or edema, and 4 were lost to follow-up.

"Although infrequent, delayed, moderate to severe immune-mediated adverse effects may be caused by PAIs, occasionally with systemic manifestations," the investigators concluded.

Polyalkylimide dermal fillers can produce delayed adverse immune effects, including chronic inflammatory and granulomatous reactions, investigators reported in the Archives of Dermatology.

This is the first report of histologic granulomas related to polyalkylimide implants (PAIs) described in the literature, according to Dr. Jaume Alijotas-Reig of Vall d'Hebron University Hospital, Barcelona, and associates.

"Considering the increased use of polyalkylimide fillers in European countries and the United States, physicians should be aware that … delayed effects can occur with polyalkylimide implants just as they can with collagen, polyacrylamide, polylactic acid, or methacrylate," the researchers wrote.

PAIs are used for a variety of facial defects, including anatomic or traumatic deformities as well as aesthetic defects. They also are being used increasingly in lipodystrophy related to antiretroviral therapy in patients with HIV.

According to manufacturers PAIs do not change over time, do not move or migrate, and will not be reabsorbed, unlike other dermal implant materials. However, recent reports refute these statements, according to the investigators.

A voluntary registry of patients with delayed adverse effects related to implants was designed jointly by the Spanish Society of Cosmetic Medicine and Surgery and Dr. Alijotas-Reig and associates at the hospital's clinical immunology unit.

The researchers reported on 25 patients in the registry who had delayed adverse effects related to PAIs. Of the three study patients who were HIV-positive, two were not undergoing treatment with antiretrovirals.

"Multiple inflammatory tender nodules of different sizes, facial edema and/or angioedema, and swelling and/or skin induration were the most frequent local and/or regional complaints. … In six cases, distant or systemic manifestations appeared," including Sjögren's syndrome, they reported (Arch. Dermatol. 2008;144:637-42).

Pseudoabscesses were also common. "Recovered material looks like pus, but bacterial cultures are usually negative for organisms," Dr. Alijotas-Reig and associates wrote.

The mean interval between implantation and symptom onset was 13 months (range, 1-60 months).

Other factors—such as smoking status, personal or family history of autoimmune disease, and "triggering" events such as infection or trauma—did not contribute to granulomatous reactions in these patients.

Of the 17 patients who had laboratory assessments, 12 had at least one abnormal result. These included elevated levels of C-reactive protein and fibrinogen in 11 of the 12, "so underlying inflammatory processes in different stages had to be present."

Five patients also showed elevated lactate dehydrogenase levels, which probably indicated lymphocyte or macrophage activation. Six patients had elevated levels of angiotensin-converting enzyme, which also might be secondary to macrophage and granulomatous immune responses.

Biopsy of facial and distant nodules was performed in three patients, and all showed nonspecific foreign-body granulomas.

All patients were treated with NSAIDs, and some also received hydroxychloroquine or low-dose prednisone. At least 15 had previously received antibiotics, which were ineffective.

After an average of 21 months of follow-up, 11 patients had achieved remission, 10 had recurrent or residual nodules, induration, or edema, and 4 were lost to follow-up.

"Although infrequent, delayed, moderate to severe immune-mediated adverse effects may be caused by PAIs, occasionally with systemic manifestations," the investigators concluded.

KISSIMMEE, FLA. — Dermal and epidermal pigmentary disorders in East Asian patients can be treated successfully in many cases without causing postinflammatory hyperpigmentation by carefully combining topical bleaching agents with either a Q-switched laser or intense pulsed light.

Careful attention to the device settings as well as the patient's skin type and any presence of melasma will help to ensure the best results with a low risk of postinflammatory hyperpigmentation (PIH), said Dr. Kei Negishi of Tokyo Women's Medical University.

To remove epidermal pigmentation that commonly occurs in East Asians, such as solar lentigines, freckles, melasma, PIH, and pigmented seborrheic keratoses, Dr. Negishi advised using a Q-switched laser, intense pulsed light (set to specific lesion parameters or full-face), and/or topical bleaching cream. Her patients are mainly Japanese, but she also sees some South Korean and Chinese patients.

If the treatment is for a small number of epidermal pigmentary lesions, she recommended using a Q-switched laser or intense pulsed light (IPL) set to a specific lesion parameter, combined with a topical bleaching cream such as hydroquinone or retinoic acid.

Q-switched lasers are the only devices that are capable of removing dermal pigment, such as nevus of Ota or acquired dermal melanocytosis, without scarring. Long-pulsed lasers and IPL would cause permanent scarring, Dr. Negishi said at the annual meeting of the American Society for Laser Medicine and Surgery.

Avoiding PIH

PIH has been reported to occur 1 month after treatment for solar lentigines with a Q-switched laser in 10%-25% of Chinese patients and 43%-44% of Japanese patients. In Dr. Negishi's own studies, she has found that the addition of a bleaching cream (composed of hydroquinone and retinoic acid) to Q-switched laser treatment plus a steroid and antibiotics could reduce the incidence of PIH by 20%-40%. There was a higher risk of PIH in her patients with skin types IV and V, and in those with melasma, she reported.

To minimize the incidence of PIH, Dr. Negishi suggested using minimum fluences within the window of efficacy for each device, and testing the laser in an inconspicuous area on a patient when it will be used for large or multiple areas. Posttreatment cooling, immediately after treatment, also sometimes helps, she said.

In patients at high risk for PIH, she advises using bleaching agents 2-4 weeks before Q-switched laser treatment, followed by steroid treatment for 7 days after treatment, and then an additional 3-4 weeks of bleaching cream. She also advises patients to use sunscreen every day during the treatment period.

To treat PIH with obvious erythema, she recommended using a steroid plus a mild bleaching agent, such as vitamin C derivatives. In cases without erythema, treatment with IPL at a mild setting can shorten the recovery period, in addition to 2% or 5% hydroquinone, 0.025% or 0.05% retinoic acid, and 0.025% dexamethasone, if it is tolerable.

IPL for Epidermal Pigmentation

The main advantage of using IPL to treat epidermal pigmentation is its reduced risk of causing PIH, Dr. Negishi said. IPL does not disrupt melanosomes, unlike Q-switched lasers, but instead affects melanin-rich keratinocytes, inducing the formation of a microcrust and a partial turnover of the epidermis. Multiple IPL treatments might be necessary to treat pigmentation, and IPLs with a shorter wavelength range have greater efficacy.

Dr. Negishi reported that after an IPL treatment, reflectance-mode confocal microscopy reveals the rapid migration of melanocytes to the basal layer. This suggests that in order to stimulate IPL's efficacy, patients should begin using bleaching cream immediately after the microcrust peels off, she said. With "Q-switched lasers, bleaching creams are used to prevent PIH, but with IPL, they are used to stimulate treatment efficacy," she said.

IPL also is a good choice for full-face skin rejuvenation and whitening in East Asians, Dr. Negishi said.

For each IPL treatment, Dr. Negishi first checks the patient for melasma and acquired dermal melanocytosis. She uses the UV light in a Wood's lamp to distinguish acquired dermal melanocytosis from subtle or hidden melasma rather than just to determine the area of melasma. She then uses a spectrophotometer to check the patient's skin color.

She uses a mild parameter setting for full-face irradiation, consisting of longer wavelengths at low fluences. For specific lesions, she increases the fluence, shortens the pulse width, or shortens the wavelength, using white paper to cover the area surrounding the lesion. The immediate reaction to full-face IPL should be very slight erythema in normally pigmented areas and a slight darkening of pigmented areas with pain remaining about 3-4 on a 10-point scale.

Particular attention should be paid when using IPL for full facial skin rejuvenation in patients with darker skin, such as those with type V skin or type IV plus sun damage, because of the risk of epidermal burning. For patients with darker skin or melasma, it is preferable to use a long wavelength/low fluence setting for second passes over specific lesions with white paper covering the surrounding area, she said.

In a study, Dr. Negishi and her coinvestigators used an ultraviolet filter to identify very subtle epidermal melasma in 63 (28%) of 223 East Asian patients who had previously not been diagnosed with melasma. The patients who did not use sunscreen had a significantly higher risk of the condition than those who did use it (Dermatol. Surg. 2004;30:881-6). "This type of pigmentation tends to worsen with aggressive IPL treatment," she said.

Melasma in East Asians is thought to be epidermal, caused by an increased number of melanocytes and increased activity of melanogenic enzymes, which leaves the skin at a high risk for PIH.

IPL treatment alone is not enough to remove melasma, so Dr. Negishi commonly uses topical agents (such as 2%-5% hydroquinone, 5%-10% vitamin C derivative, or 0.025%-0.4% tretinoin) or oral tranexamic acid as her first choice to use in combination with IPL.

Oral tranexamic acid has been used for treating melasma in East Asians for more than 20 years, according to Dr. Negishi. When telangiectasias are present concurrently with melasma, she uses a long-pulse 1,064-nm Nd:YAG laser to reduce the vascular lesions while also stimulating epidermal turnover.

Dr. Negishi reported that she conducted much of her research with equipment borrowed from Cutera Inc., Danish Dermatologic Development A/S, Lumenis Ltd., and Syneron Inc., but she has no financial interests with any of these companies.

KISSIMMEE, FLA. — Dermal and epidermal pigmentary disorders in East Asian patients can be treated successfully in many cases without causing postinflammatory hyperpigmentation by carefully combining topical bleaching agents with either a Q-switched laser or intense pulsed light.

Careful attention to the device settings as well as the patient's skin type and any presence of melasma will help to ensure the best results with a low risk of postinflammatory hyperpigmentation (PIH), said Dr. Kei Negishi of Tokyo Women's Medical University.

To remove epidermal pigmentation that commonly occurs in East Asians, such as solar lentigines, freckles, melasma, PIH, and pigmented seborrheic keratoses, Dr. Negishi advised using a Q-switched laser, intense pulsed light (set to specific lesion parameters or full-face), and/or topical bleaching cream. Her patients are mainly Japanese, but she also sees some South Korean and Chinese patients.

If the treatment is for a small number of epidermal pigmentary lesions, she recommended using a Q-switched laser or intense pulsed light (IPL) set to a specific lesion parameter, combined with a topical bleaching cream such as hydroquinone or retinoic acid.

Q-switched lasers are the only devices that are capable of removing dermal pigment, such as nevus of Ota or acquired dermal melanocytosis, without scarring. Long-pulsed lasers and IPL would cause permanent scarring, Dr. Negishi said at the annual meeting of the American Society for Laser Medicine and Surgery.

Avoiding PIH

PIH has been reported to occur 1 month after treatment for solar lentigines with a Q-switched laser in 10%-25% of Chinese patients and 43%-44% of Japanese patients. In Dr. Negishi's own studies, she has found that the addition of a bleaching cream (composed of hydroquinone and retinoic acid) to Q-switched laser treatment plus a steroid and antibiotics could reduce the incidence of PIH by 20%-40%. There was a higher risk of PIH in her patients with skin types IV and V, and in those with melasma, she reported.

To minimize the incidence of PIH, Dr. Negishi suggested using minimum fluences within the window of efficacy for each device, and testing the laser in an inconspicuous area on a patient when it will be used for large or multiple areas. Posttreatment cooling, immediately after treatment, also sometimes helps, she said.

In patients at high risk for PIH, she advises using bleaching agents 2-4 weeks before Q-switched laser treatment, followed by steroid treatment for 7 days after treatment, and then an additional 3-4 weeks of bleaching cream. She also advises patients to use sunscreen every day during the treatment period.

To treat PIH with obvious erythema, she recommended using a steroid plus a mild bleaching agent, such as vitamin C derivatives. In cases without erythema, treatment with IPL at a mild setting can shorten the recovery period, in addition to 2% or 5% hydroquinone, 0.025% or 0.05% retinoic acid, and 0.025% dexamethasone, if it is tolerable.

IPL for Epidermal Pigmentation

The main advantage of using IPL to treat epidermal pigmentation is its reduced risk of causing PIH, Dr. Negishi said. IPL does not disrupt melanosomes, unlike Q-switched lasers, but instead affects melanin-rich keratinocytes, inducing the formation of a microcrust and a partial turnover of the epidermis. Multiple IPL treatments might be necessary to treat pigmentation, and IPLs with a shorter wavelength range have greater efficacy.

Dr. Negishi reported that after an IPL treatment, reflectance-mode confocal microscopy reveals the rapid migration of melanocytes to the basal layer. This suggests that in order to stimulate IPL's efficacy, patients should begin using bleaching cream immediately after the microcrust peels off, she said. With "Q-switched lasers, bleaching creams are used to prevent PIH, but with IPL, they are used to stimulate treatment efficacy," she said.

IPL also is a good choice for full-face skin rejuvenation and whitening in East Asians, Dr. Negishi said.

For each IPL treatment, Dr. Negishi first checks the patient for melasma and acquired dermal melanocytosis. She uses the UV light in a Wood's lamp to distinguish acquired dermal melanocytosis from subtle or hidden melasma rather than just to determine the area of melasma. She then uses a spectrophotometer to check the patient's skin color.

She uses a mild parameter setting for full-face irradiation, consisting of longer wavelengths at low fluences. For specific lesions, she increases the fluence, shortens the pulse width, or shortens the wavelength, using white paper to cover the area surrounding the lesion. The immediate reaction to full-face IPL should be very slight erythema in normally pigmented areas and a slight darkening of pigmented areas with pain remaining about 3-4 on a 10-point scale.

Particular attention should be paid when using IPL for full facial skin rejuvenation in patients with darker skin, such as those with type V skin or type IV plus sun damage, because of the risk of epidermal burning. For patients with darker skin or melasma, it is preferable to use a long wavelength/low fluence setting for second passes over specific lesions with white paper covering the surrounding area, she said.

In a study, Dr. Negishi and her coinvestigators used an ultraviolet filter to identify very subtle epidermal melasma in 63 (28%) of 223 East Asian patients who had previously not been diagnosed with melasma. The patients who did not use sunscreen had a significantly higher risk of the condition than those who did use it (Dermatol. Surg. 2004;30:881-6). "This type of pigmentation tends to worsen with aggressive IPL treatment," she said.

Melasma in East Asians is thought to be epidermal, caused by an increased number of melanocytes and increased activity of melanogenic enzymes, which leaves the skin at a high risk for PIH.

IPL treatment alone is not enough to remove melasma, so Dr. Negishi commonly uses topical agents (such as 2%-5% hydroquinone, 5%-10% vitamin C derivative, or 0.025%-0.4% tretinoin) or oral tranexamic acid as her first choice to use in combination with IPL.

Oral tranexamic acid has been used for treating melasma in East Asians for more than 20 years, according to Dr. Negishi. When telangiectasias are present concurrently with melasma, she uses a long-pulse 1,064-nm Nd:YAG laser to reduce the vascular lesions while also stimulating epidermal turnover.

Dr. Negishi reported that she conducted much of her research with equipment borrowed from Cutera Inc., Danish Dermatologic Development A/S, Lumenis Ltd., and Syneron Inc., but she has no financial interests with any of these companies.

KISSIMMEE, FLA. — Dermal and epidermal pigmentary disorders in East Asian patients can be treated successfully in many cases without causing postinflammatory hyperpigmentation by carefully combining topical bleaching agents with either a Q-switched laser or intense pulsed light.

Careful attention to the device settings as well as the patient's skin type and any presence of melasma will help to ensure the best results with a low risk of postinflammatory hyperpigmentation (PIH), said Dr. Kei Negishi of Tokyo Women's Medical University.

To remove epidermal pigmentation that commonly occurs in East Asians, such as solar lentigines, freckles, melasma, PIH, and pigmented seborrheic keratoses, Dr. Negishi advised using a Q-switched laser, intense pulsed light (set to specific lesion parameters or full-face), and/or topical bleaching cream. Her patients are mainly Japanese, but she also sees some South Korean and Chinese patients.

If the treatment is for a small number of epidermal pigmentary lesions, she recommended using a Q-switched laser or intense pulsed light (IPL) set to a specific lesion parameter, combined with a topical bleaching cream such as hydroquinone or retinoic acid.

Q-switched lasers are the only devices that are capable of removing dermal pigment, such as nevus of Ota or acquired dermal melanocytosis, without scarring. Long-pulsed lasers and IPL would cause permanent scarring, Dr. Negishi said at the annual meeting of the American Society for Laser Medicine and Surgery.

Avoiding PIH

PIH has been reported to occur 1 month after treatment for solar lentigines with a Q-switched laser in 10%-25% of Chinese patients and 43%-44% of Japanese patients. In Dr. Negishi's own studies, she has found that the addition of a bleaching cream (composed of hydroquinone and retinoic acid) to Q-switched laser treatment plus a steroid and antibiotics could reduce the incidence of PIH by 20%-40%. There was a higher risk of PIH in her patients with skin types IV and V, and in those with melasma, she reported.

To minimize the incidence of PIH, Dr. Negishi suggested using minimum fluences within the window of efficacy for each device, and testing the laser in an inconspicuous area on a patient when it will be used for large or multiple areas. Posttreatment cooling, immediately after treatment, also sometimes helps, she said.

In patients at high risk for PIH, she advises using bleaching agents 2-4 weeks before Q-switched laser treatment, followed by steroid treatment for 7 days after treatment, and then an additional 3-4 weeks of bleaching cream. She also advises patients to use sunscreen every day during the treatment period.

To treat PIH with obvious erythema, she recommended using a steroid plus a mild bleaching agent, such as vitamin C derivatives. In cases without erythema, treatment with IPL at a mild setting can shorten the recovery period, in addition to 2% or 5% hydroquinone, 0.025% or 0.05% retinoic acid, and 0.025% dexamethasone, if it is tolerable.

IPL for Epidermal Pigmentation

The main advantage of using IPL to treat epidermal pigmentation is its reduced risk of causing PIH, Dr. Negishi said. IPL does not disrupt melanosomes, unlike Q-switched lasers, but instead affects melanin-rich keratinocytes, inducing the formation of a microcrust and a partial turnover of the epidermis. Multiple IPL treatments might be necessary to treat pigmentation, and IPLs with a shorter wavelength range have greater efficacy.

Dr. Negishi reported that after an IPL treatment, reflectance-mode confocal microscopy reveals the rapid migration of melanocytes to the basal layer. This suggests that in order to stimulate IPL's efficacy, patients should begin using bleaching cream immediately after the microcrust peels off, she said. With "Q-switched lasers, bleaching creams are used to prevent PIH, but with IPL, they are used to stimulate treatment efficacy," she said.

IPL also is a good choice for full-face skin rejuvenation and whitening in East Asians, Dr. Negishi said.

For each IPL treatment, Dr. Negishi first checks the patient for melasma and acquired dermal melanocytosis. She uses the UV light in a Wood's lamp to distinguish acquired dermal melanocytosis from subtle or hidden melasma rather than just to determine the area of melasma. She then uses a spectrophotometer to check the patient's skin color.

She uses a mild parameter setting for full-face irradiation, consisting of longer wavelengths at low fluences. For specific lesions, she increases the fluence, shortens the pulse width, or shortens the wavelength, using white paper to cover the area surrounding the lesion. The immediate reaction to full-face IPL should be very slight erythema in normally pigmented areas and a slight darkening of pigmented areas with pain remaining about 3-4 on a 10-point scale.

Particular attention should be paid when using IPL for full facial skin rejuvenation in patients with darker skin, such as those with type V skin or type IV plus sun damage, because of the risk of epidermal burning. For patients with darker skin or melasma, it is preferable to use a long wavelength/low fluence setting for second passes over specific lesions with white paper covering the surrounding area, she said.

In a study, Dr. Negishi and her coinvestigators used an ultraviolet filter to identify very subtle epidermal melasma in 63 (28%) of 223 East Asian patients who had previously not been diagnosed with melasma. The patients who did not use sunscreen had a significantly higher risk of the condition than those who did use it (Dermatol. Surg. 2004;30:881-6). "This type of pigmentation tends to worsen with aggressive IPL treatment," she said.

Melasma in East Asians is thought to be epidermal, caused by an increased number of melanocytes and increased activity of melanogenic enzymes, which leaves the skin at a high risk for PIH.

IPL treatment alone is not enough to remove melasma, so Dr. Negishi commonly uses topical agents (such as 2%-5% hydroquinone, 5%-10% vitamin C derivative, or 0.025%-0.4% tretinoin) or oral tranexamic acid as her first choice to use in combination with IPL.

Oral tranexamic acid has been used for treating melasma in East Asians for more than 20 years, according to Dr. Negishi. When telangiectasias are present concurrently with melasma, she uses a long-pulse 1,064-nm Nd:YAG laser to reduce the vascular lesions while also stimulating epidermal turnover.

Dr. Negishi reported that she conducted much of her research with equipment borrowed from Cutera Inc., Danish Dermatologic Development A/S, Lumenis Ltd., and Syneron Inc., but she has no financial interests with any of these companies.

KISSIMMEE, FLA. — Photopneumatic therapy is highly effective and nearly painless for the treatment of acne vulgaris, according to Dr. Michael Gold.

The recently approved Aesthera PPx laser system—which combines light energy and a vacuum apparatus to cleanse pores and destroy bacteria associated with acne vulgaris—was used to treat both pustular and comedonal acne in an open-label study involving 11 patients with mild to moderate acne, Dr. Gold said at the annual meeting of the American Society for Laser Medicine and Surgery.

Up to four treatments were provided at 3-week intervals, and all of the patients experienced significant and rapid clearing of their lesions, he reported.

Drying and flattening of the lesions were noted within 2 days of treatment in more than half of the patients, and most experienced sustained clearance at 3-month follow-up with a 78% reduction in inflammatory lesions, and up to a 70% reduction in noninflammatory lesions, Dr. Gold said.

Reported pain was minimal in more than 85% of patients, and 82% of patients said they were moderately or very satisfied with the outcomes.

Adverse events included only slight dryness post treatment, which was managed with application of a daily moisturizer, he said.

The findings are comparable with those from other studies of this device as reported in the literature, all of which have demonstrated its efficacy for the treatment of acne, said Dr. Gold of the Tennessee Clinical Research Center in Nashville.

Given that more than one-third of dermatology visits are associated with acne, this device—which is the only device that has been approved by the Food and Drug Administration to treat both comedonal and inflammatory acne, and which appears to be effective even in those patients who are nonresponders to traditional therapies—is a welcome addition to the acne treatment armamentarium, he concluded.

The study was sponsored by Aesthera Corp., which provided equipment, discounts, travel expenses, a research grant, and honoraria to Dr. Gold.

Photo at left shows a patient before treatment with the photopneumatic device. Photo at right shows improvement of the patient's acne after receiving four treatments over an interval of 3 weeks. Photos courtesty Dr. Michael Gold/Tennessee Clinical Research Center

KISSIMMEE, FLA. — Photopneumatic therapy is highly effective and nearly painless for the treatment of acne vulgaris, according to Dr. Michael Gold.

The recently approved Aesthera PPx laser system—which combines light energy and a vacuum apparatus to cleanse pores and destroy bacteria associated with acne vulgaris—was used to treat both pustular and comedonal acne in an open-label study involving 11 patients with mild to moderate acne, Dr. Gold said at the annual meeting of the American Society for Laser Medicine and Surgery.

Up to four treatments were provided at 3-week intervals, and all of the patients experienced significant and rapid clearing of their lesions, he reported.

Drying and flattening of the lesions were noted within 2 days of treatment in more than half of the patients, and most experienced sustained clearance at 3-month follow-up with a 78% reduction in inflammatory lesions, and up to a 70% reduction in noninflammatory lesions, Dr. Gold said.

Reported pain was minimal in more than 85% of patients, and 82% of patients said they were moderately or very satisfied with the outcomes.

Adverse events included only slight dryness post treatment, which was managed with application of a daily moisturizer, he said.

The findings are comparable with those from other studies of this device as reported in the literature, all of which have demonstrated its efficacy for the treatment of acne, said Dr. Gold of the Tennessee Clinical Research Center in Nashville.

Given that more than one-third of dermatology visits are associated with acne, this device—which is the only device that has been approved by the Food and Drug Administration to treat both comedonal and inflammatory acne, and which appears to be effective even in those patients who are nonresponders to traditional therapies—is a welcome addition to the acne treatment armamentarium, he concluded.

The study was sponsored by Aesthera Corp., which provided equipment, discounts, travel expenses, a research grant, and honoraria to Dr. Gold.

Photo at left shows a patient before treatment with the photopneumatic device. Photo at right shows improvement of the patient's acne after receiving four treatments over an interval of 3 weeks. Photos courtesty Dr. Michael Gold/Tennessee Clinical Research Center

KISSIMMEE, FLA. — Photopneumatic therapy is highly effective and nearly painless for the treatment of acne vulgaris, according to Dr. Michael Gold.

The recently approved Aesthera PPx laser system—which combines light energy and a vacuum apparatus to cleanse pores and destroy bacteria associated with acne vulgaris—was used to treat both pustular and comedonal acne in an open-label study involving 11 patients with mild to moderate acne, Dr. Gold said at the annual meeting of the American Society for Laser Medicine and Surgery.

Up to four treatments were provided at 3-week intervals, and all of the patients experienced significant and rapid clearing of their lesions, he reported.

Drying and flattening of the lesions were noted within 2 days of treatment in more than half of the patients, and most experienced sustained clearance at 3-month follow-up with a 78% reduction in inflammatory lesions, and up to a 70% reduction in noninflammatory lesions, Dr. Gold said.

Reported pain was minimal in more than 85% of patients, and 82% of patients said they were moderately or very satisfied with the outcomes.

Adverse events included only slight dryness post treatment, which was managed with application of a daily moisturizer, he said.

The findings are comparable with those from other studies of this device as reported in the literature, all of which have demonstrated its efficacy for the treatment of acne, said Dr. Gold of the Tennessee Clinical Research Center in Nashville.

Given that more than one-third of dermatology visits are associated with acne, this device—which is the only device that has been approved by the Food and Drug Administration to treat both comedonal and inflammatory acne, and which appears to be effective even in those patients who are nonresponders to traditional therapies—is a welcome addition to the acne treatment armamentarium, he concluded.

The study was sponsored by Aesthera Corp., which provided equipment, discounts, travel expenses, a research grant, and honoraria to Dr. Gold.

Photo at left shows a patient before treatment with the photopneumatic device. Photo at right shows improvement of the patient's acne after receiving four treatments over an interval of 3 weeks. Photos courtesty Dr. Michael Gold/Tennessee Clinical Research Center

KISSIMMEE, FLA. — A new 2,790-nm yttrium-scandium-gallium-garnet laser provides an option for skin resurfacing that appears to require less downtime than does resurfacing with either CO2 or er:YAG lasers.

This was the finding in two studies presented at the annual meeting of the American Society for Laser Medicine and Surgery. The results suggest that each treatment session with Cutera Inc.'s Pearl system 2,790-nm YSGG laser typically requires a recovery period from erythema and swelling of 3–4 days, unlike the several weeks of healing usually necessary with CO2 laser resurfacing.

A study conducted by Dr. David M. Verebelyi used the 2,790-nm YSGG laser to treat facial rhytids, dyschromia, and texture abnormalities in 19 patients aged 18–63 years with Fitzpatrick Skin types I-IV. One side of the face of each patient was randomly selected for treatment while the other side was left untreated. Dr. Verebelyi used the laser at a fluence of 3–3.5 J/cm

In Dr. Verebelyi's study and the other study, investigators performed two treatments with the laser on each patient, separated by about 4 weeks. A physician who did not know which side received treatment graded photos on a 10-point scale on which 0 equaled no improvement and 10 equaled excellent improvement.

The physician gave the treated side much higher average ratings than the untreated side in 17 patients who completed two treatment sessions, as follows: for fine lines (6.5 vs. 0.2), erythema (3.5 vs. 0.4), skin texture (7.7 vs. 1.5), scar improvement (3.2 vs. 0.2), and overall appearance (6.9 vs. 0.7), reported Dr. Verebelyi, who is in private practice in Highlands Ranch, Colo.

Erythema and swelling lasted for a mean of 4 days (range of 3–7 days); no patients experienced any permanent side effects.

Dr. Kei Negishi of Tokyo Women's Medical University performed a separate study with the laser to treat 23 patients aged 30–74 years with Fitzpatrick skin types III or IV. Each procedure was performed at a fluence of 1.5–2 J/cm

Improvement was graded as excellent or moderate by 91% of patients for skin texture and elasticity, by 52% for fine lines and elasticity, by 86% for irregular or overall pigmentation, and by 18% for mottled solar lentigos.

A total of 78% of patients rated overall satisfaction as excellent or moderate.

The patients had a mean downtime of 3.4 days with erythema, followed by a mean of 6.7 days of crust formation. Patients who were young or had oilier skin had a shorter period of downtime, according to Dr. Negishi.

The presenters of each of the studies reported having no conflicts of interest with Cutera, although Dr. Negishi reported borrowing the device from the company to perform her study.

A patient is shown before treatment with a yttrium-scandium-gallium-garnet laser.

The patient is shown 28 days after her second treatment with the new laser. Photos courtesy Dr. David M. Verebelyi

KISSIMMEE, FLA. — A new 2,790-nm yttrium-scandium-gallium-garnet laser provides an option for skin resurfacing that appears to require less downtime than does resurfacing with either CO2 or er:YAG lasers.

This was the finding in two studies presented at the annual meeting of the American Society for Laser Medicine and Surgery. The results suggest that each treatment session with Cutera Inc.'s Pearl system 2,790-nm YSGG laser typically requires a recovery period from erythema and swelling of 3–4 days, unlike the several weeks of healing usually necessary with CO2 laser resurfacing.

A study conducted by Dr. David M. Verebelyi used the 2,790-nm YSGG laser to treat facial rhytids, dyschromia, and texture abnormalities in 19 patients aged 18–63 years with Fitzpatrick Skin types I-IV. One side of the face of each patient was randomly selected for treatment while the other side was left untreated. Dr. Verebelyi used the laser at a fluence of 3–3.5 J/cm

In Dr. Verebelyi's study and the other study, investigators performed two treatments with the laser on each patient, separated by about 4 weeks. A physician who did not know which side received treatment graded photos on a 10-point scale on which 0 equaled no improvement and 10 equaled excellent improvement.

The physician gave the treated side much higher average ratings than the untreated side in 17 patients who completed two treatment sessions, as follows: for fine lines (6.5 vs. 0.2), erythema (3.5 vs. 0.4), skin texture (7.7 vs. 1.5), scar improvement (3.2 vs. 0.2), and overall appearance (6.9 vs. 0.7), reported Dr. Verebelyi, who is in private practice in Highlands Ranch, Colo.

Erythema and swelling lasted for a mean of 4 days (range of 3–7 days); no patients experienced any permanent side effects.

Dr. Kei Negishi of Tokyo Women's Medical University performed a separate study with the laser to treat 23 patients aged 30–74 years with Fitzpatrick skin types III or IV. Each procedure was performed at a fluence of 1.5–2 J/cm

Improvement was graded as excellent or moderate by 91% of patients for skin texture and elasticity, by 52% for fine lines and elasticity, by 86% for irregular or overall pigmentation, and by 18% for mottled solar lentigos.

A total of 78% of patients rated overall satisfaction as excellent or moderate.

The patients had a mean downtime of 3.4 days with erythema, followed by a mean of 6.7 days of crust formation. Patients who were young or had oilier skin had a shorter period of downtime, according to Dr. Negishi.

The presenters of each of the studies reported having no conflicts of interest with Cutera, although Dr. Negishi reported borrowing the device from the company to perform her study.

A patient is shown before treatment with a yttrium-scandium-gallium-garnet laser.

The patient is shown 28 days after her second treatment with the new laser. Photos courtesy Dr. David M. Verebelyi

KISSIMMEE, FLA. — A new 2,790-nm yttrium-scandium-gallium-garnet laser provides an option for skin resurfacing that appears to require less downtime than does resurfacing with either CO2 or er:YAG lasers.

This was the finding in two studies presented at the annual meeting of the American Society for Laser Medicine and Surgery. The results suggest that each treatment session with Cutera Inc.'s Pearl system 2,790-nm YSGG laser typically requires a recovery period from erythema and swelling of 3–4 days, unlike the several weeks of healing usually necessary with CO2 laser resurfacing.

A study conducted by Dr. David M. Verebelyi used the 2,790-nm YSGG laser to treat facial rhytids, dyschromia, and texture abnormalities in 19 patients aged 18–63 years with Fitzpatrick Skin types I-IV. One side of the face of each patient was randomly selected for treatment while the other side was left untreated. Dr. Verebelyi used the laser at a fluence of 3–3.5 J/cm

In Dr. Verebelyi's study and the other study, investigators performed two treatments with the laser on each patient, separated by about 4 weeks. A physician who did not know which side received treatment graded photos on a 10-point scale on which 0 equaled no improvement and 10 equaled excellent improvement.

The physician gave the treated side much higher average ratings than the untreated side in 17 patients who completed two treatment sessions, as follows: for fine lines (6.5 vs. 0.2), erythema (3.5 vs. 0.4), skin texture (7.7 vs. 1.5), scar improvement (3.2 vs. 0.2), and overall appearance (6.9 vs. 0.7), reported Dr. Verebelyi, who is in private practice in Highlands Ranch, Colo.

Erythema and swelling lasted for a mean of 4 days (range of 3–7 days); no patients experienced any permanent side effects.

Dr. Kei Negishi of Tokyo Women's Medical University performed a separate study with the laser to treat 23 patients aged 30–74 years with Fitzpatrick skin types III or IV. Each procedure was performed at a fluence of 1.5–2 J/cm

Improvement was graded as excellent or moderate by 91% of patients for skin texture and elasticity, by 52% for fine lines and elasticity, by 86% for irregular or overall pigmentation, and by 18% for mottled solar lentigos.

A total of 78% of patients rated overall satisfaction as excellent or moderate.

The patients had a mean downtime of 3.4 days with erythema, followed by a mean of 6.7 days of crust formation. Patients who were young or had oilier skin had a shorter period of downtime, according to Dr. Negishi.

The presenters of each of the studies reported having no conflicts of interest with Cutera, although Dr. Negishi reported borrowing the device from the company to perform her study.

A patient is shown before treatment with a yttrium-scandium-gallium-garnet laser.

The patient is shown 28 days after her second treatment with the new laser. Photos courtesy Dr. David M. Verebelyi

KISSIMMEE, FLA. — Fractional CO2 laser treatment is highly effective for neck rejuvenation, offering substantial improvement in skin laxity, rhytids, texture, and pigmentation with a favorable adverse events profile, reported Dr. Lori Brightman.

In a study of 13 patients aged 30–75 years who underwent treatment of the neck using the Fraxel CO2 laser, improvement on these outcome measures was mostly in the 25%-75% range after two treatments, with some patients experiencing 75%-100% improvement, she said at the annual meeting of the American Society for Laser Medicine and Surgery.

The mean improvement for each measure was well above 50%, she said, noting that "this is something we consistently reproduced." Some patients also experienced platysmal band improvement, added Dr. Brightman of the Laser & Skin Surgery Center of New York.

The patients were treated using a 15-mm spot size, an energy setting of 4–70 mJ, and 100–200 microthermal zones with a 30%-50% density for each pass. Between two and four passes were made, depending on the degree of skin laxity and rhytids. Each patient underwent two treatments at 1–3 months apart, with follow-up at 3 months following the second procedure.

Three blinded dermatologic physicians evaluated pre- and posttreatment photos to determine improvements in the degree of rhytids, crepe-like skin, skin tightening, and pigmentation.

All patients experienced posttreatment erythema and some slight edema with resolution in about 1 week. There were no cases of scarring, hyperpigmentation, or hypopigmentation in the short or long term.

"We feel that these results strongly support the use of the fractional CO2 laser off of the face, in particular to rejuvenate the neck with a very low risk of adverse events," Dr. Brightman concluded.

Dr. Brightman stated that she had no disclosures relevant to her presentation.

KISSIMMEE, FLA. — Fractional CO2 laser treatment is highly effective for neck rejuvenation, offering substantial improvement in skin laxity, rhytids, texture, and pigmentation with a favorable adverse events profile, reported Dr. Lori Brightman.

In a study of 13 patients aged 30–75 years who underwent treatment of the neck using the Fraxel CO2 laser, improvement on these outcome measures was mostly in the 25%-75% range after two treatments, with some patients experiencing 75%-100% improvement, she said at the annual meeting of the American Society for Laser Medicine and Surgery.

The mean improvement for each measure was well above 50%, she said, noting that "this is something we consistently reproduced." Some patients also experienced platysmal band improvement, added Dr. Brightman of the Laser & Skin Surgery Center of New York.

The patients were treated using a 15-mm spot size, an energy setting of 4–70 mJ, and 100–200 microthermal zones with a 30%-50% density for each pass. Between two and four passes were made, depending on the degree of skin laxity and rhytids. Each patient underwent two treatments at 1–3 months apart, with follow-up at 3 months following the second procedure.

Three blinded dermatologic physicians evaluated pre- and posttreatment photos to determine improvements in the degree of rhytids, crepe-like skin, skin tightening, and pigmentation.

All patients experienced posttreatment erythema and some slight edema with resolution in about 1 week. There were no cases of scarring, hyperpigmentation, or hypopigmentation in the short or long term.

"We feel that these results strongly support the use of the fractional CO2 laser off of the face, in particular to rejuvenate the neck with a very low risk of adverse events," Dr. Brightman concluded.

Dr. Brightman stated that she had no disclosures relevant to her presentation.

KISSIMMEE, FLA. — Fractional CO2 laser treatment is highly effective for neck rejuvenation, offering substantial improvement in skin laxity, rhytids, texture, and pigmentation with a favorable adverse events profile, reported Dr. Lori Brightman.

In a study of 13 patients aged 30–75 years who underwent treatment of the neck using the Fraxel CO2 laser, improvement on these outcome measures was mostly in the 25%-75% range after two treatments, with some patients experiencing 75%-100% improvement, she said at the annual meeting of the American Society for Laser Medicine and Surgery.

The mean improvement for each measure was well above 50%, she said, noting that "this is something we consistently reproduced." Some patients also experienced platysmal band improvement, added Dr. Brightman of the Laser & Skin Surgery Center of New York.

The patients were treated using a 15-mm spot size, an energy setting of 4–70 mJ, and 100–200 microthermal zones with a 30%-50% density for each pass. Between two and four passes were made, depending on the degree of skin laxity and rhytids. Each patient underwent two treatments at 1–3 months apart, with follow-up at 3 months following the second procedure.

Three blinded dermatologic physicians evaluated pre- and posttreatment photos to determine improvements in the degree of rhytids, crepe-like skin, skin tightening, and pigmentation.

All patients experienced posttreatment erythema and some slight edema with resolution in about 1 week. There were no cases of scarring, hyperpigmentation, or hypopigmentation in the short or long term.

"We feel that these results strongly support the use of the fractional CO2 laser off of the face, in particular to rejuvenate the neck with a very low risk of adverse events," Dr. Brightman concluded.

Dr. Brightman stated that she had no disclosures relevant to her presentation.