SEP 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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Page 45 of 76 | SEPTEMBER 2017 43 Previously, many physicians were wary of using existing tools to treat concerns such as crepey neck skin, sagging jowls, uneven pigmentation on the décolletage, and neck and chest redness, due to complication risks and inconsis- tent results. But with more experience and a new range of energy-based devices, neck and chest treatments have become some of the fastest-growing offerings for medical aesthetic practices and medspas. The key to achieving optimal outcomes is identifying patients' concerns and incorporating multiple modalities to address each of them effectively. "The neck, for example, is so different from the chest and has such a variety of possible problems and treatments," says Ronald M. Shelton, MD, of Laser & Skin Surgery Center of New York. "Patients can present with thin, hanging, discolored skin; fat pads; platys- mal bands; or any combination of these complaints. The fi rst step is a thorough consultation to establish what the patient wants to achieve, keeping in mind that plastic surgery can be a better option in some cases." IPL and Lasers for Photodamage Some doctors recommend IPL for photodamage; others are more likely to rely on lasers. "For brown spots or redness, IPL is the safest modality and provides fabulous results. We usually suggest a series of three to fi ve treatments at one-month intervals," says Dore J. Gilbert, MD, Newport Dermatology Laser Associates, Newport Beach, Califor- nia. "Patients see improvement after the fi rst treatment as brown spots darken and fl ake off. Redness takes a little longer but gradually fades by the third or fourth treatment. We let the patient decide how much is enough; everyone sees things like skin coloration differently. We use essentially the same procedure for face, neck, arms, hands and legs for skin types I-IV." Dr. Gilbert does not perform IPL or laser treatments on tanned skin or on patients who are using Accutane (isotretinoin). "If a patient has major neck and chest pig- mentation, we will begin IPL treatments with high fi lters and work our way down to prevent possible injury," he says. "My philosophy is that you can always add more salt to the soup." Suzanne L. Kilmer, MD, Laser and Skin Surgery Center of Northern California, prefers laser treatment to IPL. "Lasers can often do the needed correction more specifi cally and with fewer treatments," she says. Dr. Shelton's preferred device for the chest area is the Fraxel Dual (Solta Medical). "The 1550nm wavelength builds collagen and 1927nm takes care of brown spots," he says. "We usually recommend four to fi ve monthly treatments." The degree of photodamage determines which device should be used, notes Vic Narurkar, MD, of the Bay Area Laser Institute. "For mild to moderate photoaging, we perform IPL photofacials and Clear + Brilliant (Solta Medi- cal) laser treatments. For moderate to severe photoaging, we perform Fraxel Dual (Solta Medical)," he says. "Since the neck and décolletage have a higher risk of scarring, we use lower fl uencies and treatment densities than we use on the face, and perform only nonablative procedures to reduce the risks." Dr. Narurkar addresses fi ne lines that persist after laser treatment with Juvederm Volbella soft tissue fi ller injections and cosmeceuticals. "We usually recommend a combina- tion of Skinceutical's CE Ferulic and AGE Interrupter, layered with Skinmedica HA 5 ," he says. Preventive Measures To help patients achieve better outcomes and prevent future photodamage, Dr. Shelton encourages daily sun protection and antiaging topicals. "Sun damage is the underlying cause of most of these problems, and much of the damage occurs during childhood. We need to address symptoms with cosmeceuticals as soon as they appear," he says. "Newer products like Alastin help rejuvenate collagen, and we have found that skin primed with collagen-building cosmeceuticals responds better to many non- and minimally invasive treatments." Dr. Gilbert also routinely recommends sunscreens and moisturizers. "Most often, I recommend Neocutis Hyalis and Bio-Restorative Cream with a sunscreen for daytime, and Epionce Intense Defense Serum and a moisturizer at night," he says. Emily J. Kirby, MD, Kirby Plastic Surgery, Fort Worth, Texas, recommends Neocutis Microfi rm Neck Complex for patients concerned with aging on the neck and décolleté.

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