• Like


Flash Player 9 (or above) is needed to view presentations.
We have detected that you do not have it on your computer. To install it, go here.

American Society of Dermatologic Surgeons Annual Meeting ...

Uploaded on


  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Be the first to comment
    Be the first to like this
No Downloads


Total Views
On Slideshare
From Embeds
Number of Embeds



Embeds 0

No embeds

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

    No notes for slide


  • 1. American Society of Dermatologic Surgeons Annual Meeting Advances Skin Related Procedures By Michael Moretti, Editor 46 Aesthetic Buyers Guide November/December 2005 www.miinews.com
  • 2. Leading edge society of dermasurgeons gather to chart new directions for aesthetic medicine field. early 1,000 of the top U.S. dermato- 40% of ASDS physicians reported an increase N logic surgeons convened in Atlanta, Georgia in late October for the 2005 American Society for Dermatologic Surgery in patients seeking treatment because of dam- age caused by untrained non-physicians per- forming light-based rejuvenation techniques, (ASDS) and American College of Mohs chemical peels, acne therapy and other skin Micrographic Surgery and Cutaneous Oncology procedures. On the other hand, there was (ACMMSCO) combined annual meeting. enthusiasm for radiofrequency and newer Physicians presented more than 300 abstracts light-based devices that are safer, less painful, that addressed the newest research and tech- and effective in diminishing a variety of skin niques in dermatologic procedures (both elec- conditions. Attendees also had the opportunity tive and medical). to observe live procedures using a variety of The practice of medicine by the non-physi- innovative techniques for liposuction, laser cian is a growing concern for this society. About therapy and silicone injections. Aesthetic Buyers Guide November/December 2005 www.miinews.com 47
  • 3. An ASDS survey released prior to the meeting indi- vein treatment (70%), light-based therapy (65%), facial cated that some five million skin surgeries will be per- filler injections (64%) and skin resurfacing (63%). formed in the U.S. during 2005. This represents a 32% Since 2003, the greatest relative increases have increase over the past four years. According to the sur- occurred in the categories of facial filler injections vey, the major reason for this sharp jump is the popu- (+55%) and light treatment (+33%). “New fillers that larity of minimally invasive cosmetic procedures, can volumize as well as fill in lines have changed the which are up a staggering 58 percent from 2001. “In- market dramatically,” Dr. Narins observed. “When you office, minimally invasive treatments are driving the can only fill in lines, you still need growth of skin surgery, primarily because these proce- to perform surgery to get rid of dures are very safe and require minimal recovery excess skin. But now, you time,” said outgoing ASDS president Rhoda Narins, can actually use up the M.D. “As a result, an increasing excess skin by replacing the number of patients are willing to volume that is lost from undergo convenient outpatient that excess skin. In fact, I surgery for both medically neces- think fillers are the single sary and cosmetic purposes.” most exciting development Baby boomers account for 65% in aesthetics. The accept- Botox by Allergan of all cosmetic procedures, accord- ance of Botox is also very ing to the survey, which continues gratifying.” a trend identified in 2001. “The Other notable changes in the industry include most common patient age is the Rhoda Narins, M.D. increases in non-ablative skin rejuvenation (+28%), mid-forties. But it ranges from resurfacing (+26%) and Botox injections (+25%). The age 35 to 55,” said Dr. Narins, a dermasurgeon in pri- average patient age is 51 years old, remaining vate practice in New York City and Westchester unchanged since 2003. However, women are substan- County, N.Y. About 80% of light therapy patients are tially younger (48 years old) than men (59). Women women, and women account for 88% of patients treat- also comprise the majority (69%) of patients. ed with Botox (Allergan). In addition, 86% of soft tissue Light-based therapies are used primarily to treat augmentation procedures are for filling wrinkles, and patients with vascular lesions (30%) or for hair “More and more physicians are aware removal (28%). Other uses include wrinkles (11%, a they can perform these procedures with- new category in 2005), pigmented lesions (8%), acne (7%) and tattoo removal (6%). In contrast, Botox was out the dangers of general anesthesia. most often used for frowns (25%), followed by wrinkles I believe body contouring will continue (12%), or a combination of frowns and wrinkles (39%). Light-based devices, microdermabrasion and to grow in popularity.” chemical peels are the three primary procedures used in resurfacing, almost equal in popularity (28%, 28%, and 26%, respectively). Of these three modalities, light Restylane (Medicis) is the most frequently used filler treatment appears to be increasing from 15% in 2003, (51%). Conversely, collagen now accounts for just 13% while chemical peels appear to be decreasing, down of augmentation procedures. from 41% in 2003. Cosmetic skin surgery is a strong competency for “We are also finding out that liposuction with local dermasurgeons. Two-thirds to three-quarters of the anesthesia is a really safe procedure,” Dr. Narins respondents reported doing Botox injections (71%), noted. “More and more physicians are aware they can 48 Aesthetic Buyers Guide November/December 2005 www.miinews.com
  • 4. perform these procedures without the dangers of gen- hydroxylapatite (CaHA) microspheres suspended in an eral anesthesia. I believe body contouring will continue aqueous gel carrier. “I think Radiesse shows great to grow in popularity.” potential as a filler for the average practitioner treat- “We continue to witness the same dramatic ing the average case of HIV facial wasting,” Dr. advances that have led dermasurgery into the fore- Carruthers said. Outcomes out to eight months show front of the cosmetic arena,” said Alastair Carruthers, that the effect of Radiesse lasts longer than the M.D., a clinical professor of der- hyaluronics, but it is not a permanent treatment. matology at the University of In the same positive vein, Dr. British Columbia in Vancouver, Carruthers is finally con- Canada. At the meeting, Dr. vinced that radiofrequen- Carruthers reported on patient cy resurfacing “is work- perception of Botox injections for ing and is going to deliver treating the entire upper face. the kind of results we are “This is quite different from most accustomed to with the Botox studies, whereby results intense pulsed light (IPL)- are recorded by a disinterested Alastair Carruthers, M.D. type machines.” The new algo- Radiesse by BioForm observer, typically the injecting rithm for the ThermaCool TC System physician,” he reported. A total of 60 patients each from Thermage, Inc. (Hayward, Calif.) allows for “up to received 16 injections during one treatment session. ten passes, at lower energy levels, during a single “Our study showed that one can measure how well peo- treatment session,” he explained. “This will often pro- ple perceive results,” Dr. Carruthers said. “The higher duce the results that you desire. Patient discomfort is the dose, the better the response, as perceived by the also reduced.” individual. Higher doses also resulted in a prolonged “Revising the treatment protocol of the effect. But there was no increase in adverse events.” ThermaCool has allowed for a safer treatment and a Dr. Carruthers, who is president-elect of the ASDS, much more consistent response,” added Roy is also excited about using fillers to treat facial wast- Geronemus, M.D., director of the Laser & Skin Surgery ing. “I believe that patients with HIV-associated facial of New York, in New York City. “The safety profile has “The higher the dose, the better the also improved for those people response, as perceived by the individual. who are less experienced with the device.” Most patients require Higher doses also resulted in a prolonged only one treatment session. A sec- effect. But there was no increase in ond session may be scheduled three to four months later. adverse events.” “We’re enthusiastic about a new larger treatment tip, which allows for more rapid treatment and lypoatrophy face challenges that are much more basic wider patient acceptance,” Dr. Roy Geronemus, M.D. than cosmetic, such as self-esteem,” he said. “In a major Geronemus continued. “This new study on facial wasting using injectable silicone oil, we tip has also made the procedure easier to perform.” achieved great results.” Besides speaking on the ThermaCool, Dr. A second major study is ongoing using Radiesse Geronemus discussed options in treating acne scar- (formerly Radiance FN, BioForm Medical), which is a ring. The Fraxel SR Laser from Reliant Technologies synthetic injectable implant composed of smooth calcium (San Diego, Calif.) “has become the treatment of 52 Aesthetic Buyers Guide November/December 2005 www.miinews.com
  • 5. choice,” he stated. “The Fraxel laser has the ability to different from our collagen fillers. Evolence is porcine deliver the microthermal zones into the deeper part of collagen as opposed to bovine collagen,” said Dr. the dermis, which allows for the creation of new colla- Monheit, a dermatologic and cosmetic surgeon in pri- gen in a broad area within the dermis itself. This vate practice in Birmingham, Ala. “One of the advan- process smoothes out the scars and tightens some of tages of Evolence is that it is long lasting. The claims the pitted scars. The broader rolling scars also become in Europe state that it can last up to two years. This more even, texturally. We generally do five treatments, filler is also very natural in feel and appearance, like but sometimes more, at normally two to three week the other collagen fillers. Evolence has the stiffness to intervals.” truly hold up nasolabial folds and marionette lines “Over the next few years, though, I think very naturally, as well as for lip augmentation.” we’re going to see a much greater empha- Reloxin from Ipsen Pharmaceuticals (London, United Kingdom) is a botulinum toxin type A product sis and improved results in skin types IV similar to Botox. “In our experience, the onset of action through VI, using such technologies as of Reloxin may occur a bit earlier than Botox. The longevity may be slightly longer as well,” reported Dr. radiofrequency and fractional resurfacing.” Monheit, an associate clinical professor of dermatology Dr. Geronemus noted that one of the more important advances in aesthetics “is the ability to have more reproducible results in a broader range of skin types. Historically, lasers have been most effective in treating patients with lighter skin types (Fitzpatrick I – III). Over the next few years, though, I think we’re going to see a much greater emphasis and improved results in skin types IV through VI, using such technologies as radiofrequency and fractional resurfacing.” Gary Monheit, M.D., the new president of ASDS, is enthused about new fillers from Europe. Gary Monheit, M.D. Juvederm from L.E.A. Derm (Paris, France) is a long lasting hyaluronic acid filler that is “showing excellent results,” said Dr. Monheit, who helped conduct the North American clinical trials. “Juvederm has longevity, stability and there is mini- mal inflammation and swelling. In my experience, the duration of effect is at least six months. It is also an easy filler to inject.” In contrast, Evolence from ColBar LifeScience (Herzliya, Israel) is a collagen filler. “The bonding is Evolence by ColBar (Clockwise: Before Tx, After Tx, During Tx) Aesthetic Buyers Guide November/December 2005 www.miinews.com 53
  • 6. at the University of Alabama Medical Center in better results and much longer lasting results in Birmingham. Both Reloxin and Botox are injected the 100% of patients. Silikon is a product approved for same way. “I think Reloxin will become a strong com- use in the vitreous of the eye for a retinal detach- petitor to Botox. There is already growing acceptance ment. Despite patients being able to have as much “The silicone lasted at least 18 months, in Europe.” Overall in aesthetics, “we are decreasing the which was the follow-up period of the aggressiveness of our procedures, making them more study, compared to the collagen, which office oriented and simpler, with less downtime and reduced risk,” Dr. Monheit conveyed. lasted only several months.” Among the acne treatment presentations, Jeffrey Dover, M.D., FRCPC, a clinical associate professor of dermatology at Yale University School of Medicine, shared the results of two studies that will be submitted collagen as they wanted, with repeat treatments, the for publication. “The Smoothbeam (Candela) and the silicone lasted and the collagen did not. The silicone Aramis (Quantel Medical) are both mid-infrared lasers lasted at least 18 months, which was the follow-up that are pretty effective in treating moderate-to-severe period of the study, compared to the collagen, which acne,” Dr. Dover said. Each laser was studied in a sep- lasted only several months.” arate trial. “The advantage of the Aramis is that it In a separate presentation on pearls of wisdom for hurts less and a topical anesthetic is not necessary fillers, Dr. Dover noted that “the more you practice, the before the procedure,” he said. “However, we feel the better you get at it. It is also much more of an art form Smoothbeam may be slightly more effective per treat- than Botox. The more attention you pay to detail and ment session.” to the art form, along with closer patient follow-up, the For both studies, patients committed to four ses- better you will get over time. Fillers are very tech- sions, spaced three weeks apart. “However, in clinical nique-dependent. But once you master the technique, practice, we typically schedule six sessions, at about the results are exquisite. However, there is no univer- one month intervals,” Dr. Dover sal ideal filler. And in some patients, it makes sense to said. “There is usually improve- use multiple fillers, even up to three. There are lots of ment after one or two sessions. If new, interesting fillers being developed, which I think we see no improvement after two are slowly but surely changing the way we practice sessions, we stop and determine aesthetic medicine. Restylane has already made a that it is not going to work.” Long- huge difference in how we practice over the past two term follow-up with the Aramis to three years.” study showed that adding one Similarly, improved techniques are achieving “much booster treatment session several better results with non-ablative laser technologies, months after the final session Jeffrey Dover, M.D., such as fractional laser resurfacing,” Dr. Dover said. helped prolong the effect. FRCPC Foremost in this arena is the Fraxel laser. Dr. Dover also participated in a “I now have two years of experience treating a controversies session on using silicone oil as a filler. large variety of patients with the Fraxel laser,” said In a multicenter study comparing silicone oil (Silikon Tina Alster, M.D., director of the Washington Institute from Richard-James, Inc.) to bovine collagen (Zyplast of Dermatologic Laser Surgery in Washington, D.C. “I from Inamed) for treating nasolabial folds, “the dif- am very happy with the results. In fact, I no longer per- ference was staggering,” pointed out Dr. Dover, who form skin resurfacing with CO2 and erbium lasers. The was one of the investigators. “The silicone produced Fraxel laser has basically replaced my ablative lasers. 54 Aesthetic Buyers Guide November/December 2005 www.miinews.com
  • 7. I think we can come close, if not mimic, the results of and six months after the final session. Before and after ablative skin resurfacing by scheduling a series of photographs were evaluated by two masked medical Fraxel treatments. Even though it assessors after the series of treatments were complete. is a series as opposed to one treat- Clinical scores improved about 50%. “Circumferential ment, the series is much easier for thigh measurements were reduced by 0.8 centimeters patients post-operatively. An on the treatment side.” ablative procedure requires many Nearly all patients (18 of 20) noticed an overall clin- return visits anyway. Well over ical improvement “and 17 of those 18 indicated they 90% of my Fraxel patients need would pursue treatment of the contralateral thigh,” Dr. only three treatments at three to Alster reported. “Side effects were limited to transient four week intervals, rather than erythema. Bruising was observed in two patients, but five or six sessions.” Tina Alster, M.D. stopped after the first couple of sessions.” In practice, a With Fraxel treatment, patients maintenance session is commonly scheduled once a experience only a few days of redness and swelling, month “to further enhance the clinical results and pre- “indistinguishable from a sunburn, followed by a cou- vent any decrease,” Dr. Alster said. ple of days of peeling,” said Dr. Alster, who outlined Two sessions on rejuvenation of the hands, includ- the advantages of the Fraxel laser during a contro- ing a video demonstration on fat injection, were pre- versies session on this new technology. “In most sented by Kimberly Butterwick, M.D., a dermatologic patients, this peeling amounts to a gritty feel to the surgeon in private practice in La Jolla, Calif. “Up until skin, like sandpaper, so the patient is not peeling all now, the hand has been relatively “Well over 90% of my Fraxel patients need ignored,” she said. “Many women only three treatments at three to four-week comment to me that their hands don’t match their rejuvenated intervals, rather than five or six sessions.” face. And the public is now aware that the hand gives away a per- son’s age.” at once. I’m very happy with improvements in blotchy Fat injection is one of only a few skin or dyspigmented skin, fine rhytides, atrophic treatment modalities that can acne scars or other types of atrophic scars, pore tight- effectively address the soft tissue ening and skin tightening. With repeated treatments, atrophy on the back of the hand. Kimberly Butterwick, M.D. we have also observed some collagen contraction and “We are unable to resurface the some tightening.” hand aggressively enough to thicken up the skin,” Dr. Dr. Alster also shared the results of a cellulite Butterwick said. “Fat is a very simple, straightforward study using the VelaSmooth from Syneron, Inc. procedure that can be performed at the same time as (Richmond Hill, Ontario, Canada). “We treated one facial rejuvenation, or at a different time.” thigh and not the other in 20 adult women with differ- The patient’s own fat (typically 10 cc) is taken ent types of skin and moderate bilateral thigh and but- from a donor site, such as the abdomen, hips or outer tocks cellulite,” Dr. Alster conveyed. Each patient thigh. “The fat is centrifuged, then transferred to 1 cc underwent eight treatment sessions over a four week syringes and injected with a blunt tip cannula,” Dr. period. “The contralateral side was used as a non-treat- Butterwick explained. Most patients require only one ed control,” she said. Patients were evaluated with treatment session, consisting of approximately 10 cc standardized digital photography and leg measure- per hand. “It is best to use a 1 cc syringe because it ments before each treatment session and at one, three will deliver smaller parcels of fat. Those very thin 56 Aesthetic Buyers Guide November/December 2005 www.miinews.com
  • 8. strands of fat will develop a blood supply more readi- ly than a 10 cc syringe.” Patients can anticipate “a much smoother, younger looking hand, with loss of the skeletal appearance and the tendons showing,” Dr. Butterwick said. “You can also expect the veins to be much less prominent. The Contour Threads by Surgical Specialties skin overlying the fat will have a brighter, younger appearance. The duration of effect lasts usually in the hypopigmentation, and the results may approach CO2 order of two to three years.” Sometimes, the patient’s laser resurfacing. Patient downtime ranges from excess fat is frozen for a touch-up session about one roughly seven to ten days.” year later. The Portrait PSR usually requires only one treat- Dr. Butterwick also discussed alternative treat- ment session. “However, you can use the device in a ment options for rejuvenating the aging hands. “For minimally invasive mode, where it acts similar to a cutaneous rejuvenation, there are chemical peels. medium depth chemical peel,” Dr. Moy said. Light-based treatments can also be quite effective. And In a separate presentation, Dr. Moy shared what’s for the veins, sclerotherapy is a relatively simple pro- new in cosmetic surgery, including the contour lift, cedure that can be performed quite safely. Some physi- which is FDA approved. The Contour Threads lift cians are also beginning to use some dermal fillers for from Surgical Specialties Corp. (Redding, Penn.) is a the backs of the hands, such as Sculptra (Dermik non-absorbable barbed stitch made of permanent Labs), although there are not any studies as of yet. In polypropylene stitches. “This is a summary, both surgeons and patients alike need to be lifting that is relatively minimal- aware that there are simple ly invasive,” Dr. Moy explained. treatments for the hands “You don’t have to make any inci- that can be done concomi- sions and it can be performed tantly with facial proce- under local anesthesia. You can dures. Having increased achieve significant mid-face lift- awareness will prevent this ing. However, improvement is not discrepancy that reveals as noticeable in lower-face lift- the patient’s age.” ing. But you can get some brow Ron Moy, M.D. The Portrait PSR (plas- lifting, some neck lifting and ma skin regeneration) sys- some jowl lifting.” tem from Rhytec, Inc. Dr. Moy believes the contour lift is much better (Waltham, Mass.) “is anoth- Sculptra by Dermik than the FeatherLift. “The FeatherLift is not fixated – er form of resurfacing that it is not attached or tightened to anything – so it improves wrinkles more significantly than any of the is sort of free-floating sutures. In contrast, the non-invasive procedures,” said Ron Moy, M.D., a clini- ContourLift is tightened to the deep temporal fascia. cal professor of dermatology at the University of As with a face lift, results will likely last years, but it California, Los Angeles. “Plasma is a new form of ener- will not be permanent.” gy we are working with. I think plasma causes signifi- In general, “the aesthetic arena is growing by leaps and cant tightening because of the fair amount of heat gen- bounds,” Dr. Moy observed. “We can’t even anticipate the erated. The side effect profile of the Portrait PSR also new fillers and new technology that will be introduced. appears to be better than CO2 laser resurfacing. I, Who could have imagined products like the Fraxel laser, along with many other physicians, have not seen the Portrait PSR and Contour Threads?” I Aesthetic Buyers Guide November/December 2005 www.miinews.com 57