JUL-AUG 2017

MedEsthetics—business education for medical practitioners—provides the latest noninvasive cosmetic procedures, treatment trends, product and equipment reviews, legal issues and medical aesthetics industry news.

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WINNING COMBINATIONS TOP: IMAGES COURTESY OF TESS MAURICIO, MD; BACKGROUND: © GETTY IMAGES 32 JULY/AUGUST 2017 | Med Esthetics FIRST TIME PATIENTS: CHEMICAL PEEL + MIDFACE VOLUME REPLACEMENT Patients seeking facial rejuvenation typically have two main con- cerns that must be addressed, says New York-based dermatolo- gist Jeannette Graf, MD. These are skin texture and midface volume loss. When a new patient enters her practice, she often starts with a light chemical peel. "I want them to see that they can have beautiful glowing skin just by removing a dead skin cell layer, and that they don't need to have downtime," she says. "This really ups their confi dence." Next she addresses the midface. "This is where the action is. Midface volume loss is what makes your eyes look tired; the face gets fl atter and starts to look droopy," says Dr. Graf. "I tend to combine peels and fi llers for beautiful skin as well as volume, because to me volume is the most important component of a youthful face." She injects Juvéderm Voluma XC high on the zygomatic bone, "which can come close to the eye," she says. "That brightens the tear trough in addition to lifting the midface." She selects peels based on the patient's key concerns. "Chemical peels today are not like the chemical peels 20 years ago where you had to stay in the house for two weeks," says Dr. Graf. "Companies like Glytone, PCA Skin and SkinMedica have wonderful ranges of peels that offer beautiful results with no downtime. They are cocktails that allow you to address specifi c concerns." In addition to offering immediate, visible results, this combination treatment is affordable with virtually no downtime for the patient. "Voluma and peels give you the biggest bang for your buck," says Dr. Graf. "Other fi llers also can be used in the midface. Choosing the right product is a matter of training and which feels best in your hands." THE TIME MACHINE: LASER RESURFACING + PRP Patients who want to turn back the hands of time without revisiting the offi ce for regular maintenance treatments every three to six months may benefi t from the "Time Machine", a combination treatment developed by Los Angeles-based dermatologist Tess Mauricio, MD. The treatment combines laser skin resurfacing and plate- let-rich plasma (PRP) injections—both of which are tailored to the patient's needs and downtime requirements. "We start with energy-based resurfacing, which is customized based on the patient's skin type, downtime, and whether we are treating deep acne scars, superfi cial concerns or deep wrinkles vs. skin laxity. We use either an erbium laser, CO 2 or fractional radiofrequency device." Following the resurfacing treatment, PRP is administered both topically and through injection. "The downtime is mini- mal. Most swelling and redness is gone within two days, and patients can put makeup on in two to three days," says Dr. Mauricio. "I believe this is, in large part, due to the natural anti-infl ammatory effect of the PRP. We notice the immedi- ate redness and swelling goes down within minutes, and the burning sensation that accompanies a resurfacing procedure is usually gone within an hour." Patients with acne scars or deep wrinkles may also undergo microneedling. Results one year after combination laser resurfacing and PRP. AFTER BEFORE "I tend to combine peels and fi llers for beautiful skin as well as volume, because to me volume is the most important component of a youthful face."

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