Faculty Bibliography

This review article outlines all the latest light or electromagnetic radiation based technologies used for nonablative skin rejuvenation. While many technologies have been available for a number of years, emerging technologies are also discussed, which may play a role in treatment of photoaged skin in the very near future. The principles behind these technologies are discussed in detail

BACKGROUND: This investigation was initiated because of a growing concern by the American Society for Dermatologic Surgery about the proliferation of nonphysicians practicing medicine and its impact on public health, safety, and welfare. OBJECTIVE: Prompted by an alarming rise in anecdotal reports among dermatologic surgeons, the study sought to determine whether there was a significant increase in the number of patients seeking corrective treatment due to complications from laser and light-based hair removal, subsurface laser/light rejuvenation techniques, chemical peels, microdermabrasion, injectables, and other cosmetic medical/surgical procedures performed by nonphysicians without adequate training or supervision. METHODS: A survey of 2,400 American Society for Dermatologic Surgery members in July 2001 and in-depth phone interviews with eight patients who experienced complications from nonphysicians performing cosmetic dermatologic surgery procedures were conducted. RESULTS: Survey data and qualitative research results attributed patient complications primarily to 'nonphysician operators' such as cosmetic technicians, estheticians, and employees of medical/dental professionals who performed various invasive medical procedures outside of their scope of training or with inadequate or no physician supervision. CONCLUSION: The results underscore the need for improved awareness, legislation, and enforcement regarding the nonphysician practice of medicine, along with further study of this issue

BACKGROUND AND OBJECTIVES: This 6-month study evaluated the efficacy and safety of treatment with a nonablative radiofrequency (RF) device. STUDY DESIGN/MATERIALS AND METHODS: Eighty-six subjects received a single treatment with the ThermaCool TC System (Thermage, Inc., Hayward, CA) and were evaluated for 6 months after treatment. RESULTS: Independent scoring of blinded photographs resulted in Fitzpatrick wrinkle score improvements of at least 1 point in 83.2% (99/119) of treated periorbital areas. Treating physicians, without reference to pre-treatment photographs, noted improvements in 28.9% (48/166) of treatment areas. Fifty percent (41/82) of subjects reported being satisfied or very satisfied with periorbital wrinkle reductions. Objective photographic analysis showed that 61.5% (40/65) of eyebrows were lifted by at least 0.5 mm. Rates and duration of edema/erythema were very low (e.g., vs. ablative procedures). Overall 2nd-degree burn incidence was 0.36% (21 per 5,858 RF applications). Three patients had small areas of residual scarring at 6 months. CONCLUSIONS: A single treatment with this RF tissue tightening (RFTT) device produces objective and subjective reductions in periorbital wrinkles, measurable changes in brow position, and acceptable epidermal safety. These changes were indicative of a thermally induced early tissue-tightening effect followed by additional tightening over a time course consistent with a thermal wound healing response.