Faculty Bibliography

We report significant changes in the appearance of the periorbital area, beyond eyelash enhancement, induced by the topical application of bimatoprost ophthalmic solution, 0.03% (Latisse(R), Allergan, Inc., Irvine, CA). To our knowledge, this is the first report in the dermatology or plastic surgery literature describing the rejuvenating effect and overall improvement in the appearance of the periorbital area resulting from applying Latisse to the upper eyelid margins. To date, reports in the literature discuss side-effects and potential complications of topical bimatoprost therapy causing a constellation of findings known as PAP (prostaglandin-associated periorbitopathy). While periorbitopathy implies pathology or a state of disease, we report changes that can be perceived as an improvement in the overall appearance of the periorbital area. We, therefore, propose a name change from PAP to PA

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Building upon the fractional CO(2) technology incorporated into the first generation SmartXide DOT (DEKA / ElEn, SpA, Calenzano, Italy) introduced in the U.S. in 2008, a second generation SmartXide Quadro has recently been introduced. This is a versatile device that has the ability to combine fractional CO(2) laser output for skin resurfacing with the synchronous delivery of bipolar radiofrequency (RF) energy for deeper, more diffuse heating. A pilot study was undertaken to demonstrate the safety and efficacy of the SmartXide Quadro, employing both fractional CO(2) laser output combined with the synchronous delivery of radiofrequency energy for the treatment of facial rhytides and acne scars. Ten patients, all women, six with facial rhytides and four with acne scarring, were treated with the SmartXide Quadro, a variably pulsed CO(2) laser with Pulse Shape Design(R) technology, a microablative DOT scanner and synchronized bipolar RF emission. Each patient was treated with a single fractional CO(2) laser-RF treatment; laser and RF parameters varied according to the severity of the rhytides or acne scars and were based upon both manufacturer-recommended settings and surgeon experience. Follow-up was at three days, one week, 2 weeks, and one month, three months, and six months after treatment. Results were judged by comparison of preoperative and post-operative photos evaluated by independent physicians, preoperative and post-operative grading by treating physicians, subjective evaluation of results by the patients themselves, and tabulation and categorization of adverse events (AEs). The SmartXide Quadro variably pulsed CO(2) laser with a microablative DOT scanner, with synchronous delivery of bipolar RF energy emission, proved to be both safe and effective in the treatment of facial rhytides and acne scars. The single treatment protocol was well tolerated and recovery was similar to fractional CO(2) laser skin resurfacing alone. The AEs were minimal and no significant complications occurred.

BACKGROUND: Laser lipolysis is a less invasive approach to neck rejuvenation than open surgery or liposuction. Wavelengths utilized for lipolysis liquefy fat and induce collagen remodeling, which tightens skin. A new Nd:YAG device has recently been developed that emits energy at a wavelength of 1440nm; this wavelength is more highly absorbed by adipose tissue and water than other wavelengths currently available
OBJECTIVE: To test the safety and efficacy of a pulsed 1440nm Nd:YAG wavelength and side-firing fiber for the treatment of subcutaneous fat and skin laxity associated with the aging neck
METHODS: Twenty-four subjects aged 40 to 65 years underwent laser lipolysis of the submental and anterior cervical areas. An average of 1205J per 5x5cm square was delivered, with a maximum internal temperature setting of 47 degrees C. Cervicomental Angle Score (CAS), Global Aesthetic Improvement Scale (GAIS), subject and investigator satisfaction, and safety were assessed
RESULTS: At six months post-treatment, 79% of subjects had a significant improvement in the CAS (P<.001) and 79% demonstrated an improvement on the GAIS. Clinical improvement was marked and evident for all but one subject, with physician and patient satisfaction scores indicating overall satisfaction with the procedure and outcomes. Adverse events were mild and transient with no incidence of burns, seromas, hematomas, infection, or nerve damage
CONCLUSION: The 1440nm Nd:YAG device with the side-firing fiber was safe and effective for the treatment of subcutaneous fat and skin laxity in the neck. This device offers an alternative to selected individuals aged 40 and over who do not wish to undergo rhytidectomy

J Drugs Dermatol 2013;12(12):1382-1388.

Full lips have always been associated with youth and beauty. Because of this, lip enhancement is one of the most frequently requested procedures in a cosmetic practice. For novice injectors, we recommend hyaluronic acid (HA) as the filler of choice. There is no skin test required; it is an easily obtainable, "off-the-shelf" product that is natural feeling when skillfully implanted in the soft tissues. Hyaluronic acid is easily reversible with hyaluronidase and, therefore, has an excellent safety profile. While Restylane(R) is the only FDA-approved HA filler with a specific indication for lip augmentation, one can use the following HA products off-label: Juvederm(R) Ultra, Juvederm Ultra Plus, Juvederm Ultra XC, Juvederm Ultra PLUS XC, Restylane-L(R), Perlane(R), Perlane-L(R), and Belotero(R). We present our six steps to achieve aesthetically pleasing augmented lips. While there is no single prescription for a "perfect" lip, nor a "one size fits all" approach for lip augmentation, these 6 steps can be used as a basic template for achieving a natural look. For more comprehensive, global perioral rejuvenation, our 6-step technique can be combined with the injection of neuromodulating agents and fractional laser skin resurfacing during the same treatment session.

Laser skin resurfacing has shifted over the past two decades from standard ablative resurfacing to non-ablative resurfacing and most recently, to fractional laser resurfacing. In this most recent category, fractional non-ablative lasers were first introduced followed by fractional ablative lasers, which offer an improved balance between safety and efficacy. In the current article, a review of fractional ablative resurfacing is presented alongside the results from a multi-center clinical study employing the fractional carbon dioxide (CO2) laser (SmartXide DOT, DEKA) for the treatment of rhytides, photoaging, scars and striae distensae

BACKGROUND: Currently, there is no standard of care for postlaser resurfacing treatment of the face. Ideally, treatment should speed re-epithelialization and reduce downtime, with minimal irritation. OBJECTIVE: This study compared the wound healing efficacy and safety of Aquaphor Healing Ointment (AHO) (Beiersdorf Inc, Wilton, CT) and Biafine Topical Emulsion (BTE) (OrthoNeutrogena, Los Angeles, CA) treatment after laser resurfacing of the perioral area. METHODS: In this double-blind, split-face study, 20 subjects with perioral rhytides received fractional carbon dioxide laser resurfacing. AHO and BTE were applied to opposite sides of the face 4 times daily after the resurfacing procedure. Clinical grading of erythema, edema, epithelial confluence, crusting/scabbing, subjective irritation, and general wound appearance were assessed using 5-point scales on days 2, 4, 7, and 14. Subjects ranked the two treatment sites daily as to which side of their face looked better. RESULTS: AHO resulted in significantly less erythema (days 2 and 7) and crusting/scabbing (days 2, 4, and 7) and higher epithelial confluence (day 4) than BTE (P </= .042). Subjective irritation assessments demonstrated significantly less stinging, itching, and tightness at day 2 and tightness at day 7 with AHO than with BTE (P </= .049). General wound appearance was graded significantly higher for AHO on days 2 and 7 (P </= .049). Significantly more subjects preferred AHO to BTE (P </= .046). LIMITATIONS: This was a small study in a homogenous population of white women. CONCLUSIONS: AHO exhibited superiority to BTE in several wound healing parameters and in overall wound condition