The Year in Review for Cosmetic Dermatology
A look at clinically relevant discoveries and cutting-edge breakthroughs in cosmetic dermatology.
Ablative Fractionated Resurfacing
There are a variety of modalities that have been used in the past to minimize the appearance of atrophic scars from surgery or trauma. In a recent study, topographical photography and volumetric analysis were used to show a 38% mean reduction in the volume of atrophic scars treated with ablative fractionated resurfacing. This resulted in significant cosmetic improvement of these scars with a favorable side effect profile and significantly reduced down-time when compared to the conventional resurfacing techniques. Overall, ablative fractionated resurfacing has been shown effective for treatment of atrophic scars, has a favorable side effect profile, but does require multiple treatments under local anesthesia to obtain optimal results.
Focused Ultrasound Skin Tightening
When used for treatment, ultrasound causes vibration of adjacent molecules, and this energy is translated into heat, leading to the therapeutic effect. Focused ultrasound can be used to target various tissues in the body, depending on the frequency and focusing utilized. Dermatologists have used this technology for melting fat primarily, but this may be useful for skin tightening as well. In a recent prospective trial, 35 patients underwent a single focused ultrasound treatment to the face and neck, targeting the deep dermis and fat. Photographic analysis revealed a mean brow lift of 1.7 mm. All patients developed slight edema and erythema that resolved within 1 week. This appears to have a minimal side effect profile with good efficacy, despite the lack of optimized parameters for ultrasound.
Polidocanol
As of March 30, 2010, polidocanol (Asclera) has been approved for sclerotherapy treatment of uncomplicated spider and reticular veins of the lower extremities. This drug has been used for sclerotherapy for several years in Europe, and a multicenter patient registry has been established to examine the safety of this drug. Data from 1,605 patients with follow-up of up to 60 months revealed a total of five adverse events (rate of 0.25%) in patients receiving liquid treatment and 46 (rate of 1.07%) adverse events in patients receiving foam treatment. Overall, polidocanol has a good efficacy and side effect profile, and will be a nice addition to the approved sclerosants in the United States.
Fillers with Local Anesthesia
Early in this year, the use of lidocaine in several of the commonly used fillers including Juvederm, Restylane and Perlane were approved by the FDA. These products have been labeled Juvederm XC, Restylane-L and Perlane-L, respectively. Adding lidocaine to the filler will help decrease the pain associated with filler treatment.
Cryolipolysis
As of September 2010, CoolSculpting by Zeltiq has been approved for localized fat reduction. The device selectively reduces the thickness of the subcutaneous fat layer from discrete fat deposits by extracting heat from the tissue over a few minutes. This leads to an inflammatory response, which then resorbs the lipids and apipocytes present over a period of months following treatment. Although we lack a complete understanding of the mechanism behind this phenomenon, cryolipolysis appears to be a safe process with no major adverse effects in all animal and human studies thus far. At this point, there is no evidence that this procedure can effectively remove fat from large areas or on the same scale as liposuction. However, cryolipolysis offers a safe, non-invasive option for those patients with isolated areas of increased fat without any down time and no need for anesthesia or pain management.
Source: Skin and Aging, Volume 18 – Issue 12 – December 2010 by Lee M. Miller, MD
