MedEsthetics magazines offers business education and in-depth coverage of the latest noninvasive cosmetic procedures for physicians and practice managers working in the medical aesthetics industry.
Issue link: https://medesthetics.epubxp.com/i/101607
BEYOND THE FACE Lisa A. Zdinak, MD, chief surgeon, Precision Aesthetics, New York. ���Te number of of-face treatments in my practice has been increasing steadily since 2008. Prior to that, about one in 10 patients came in for of-face treatments, and most of those were Termage treatments on the neck, botulinum toxin for platysmal banding, rejuvenation of the d��collet�� and, of course, fllers and IPL treatments for aging hands. After a period of rapid advancement in the noninvasive technologies using RF skin tightening and the fractional laser, now body work encompasses more than half of the procedures we ofer in any given day. ���Other than body contouring, our most popular of-face treatments are probably hands and the d��collet��. Crepiness and wrinkles in the cleavage area are big concerns for many aging patients. I don���t like to use lasers on the body, because of the increased risk of dispigmentation. Instead I suggest one or two IPL sessions to reduce discoloration and home use of the Obagi Elastiderm D��colletage System (Obagi Medical, obagi.com) or the elure Advanced Skin Brightening Technology (Syneron Medical, syneron.com). But the best way to rejuvenate this area is with platelet-rich protein (PRP) injections. ���We draw three to four tubes of blood from the patient���s arm and process it using the SELPHYL System (UBS Aesthetics, selphyl.com) to extract the platelets which, when activated, release platelet-derived growth factor, epidermal growth factor and basic fbroblast growth factor, to name a few. Tese signaling molecules instruct skin stem cells to divide and make fresh, new skin. Tey also stimulate fbroblast cells already present in the skin to wake up and make more collagen. Tere is no sting, because it comes from your own blood and the pH is the same as your skin, and no lumps or bumps. ���We actually inject the area with about 25% more of the blood fller than if we were using a hyaluronic-based fller. Over the next couple of days the body resorbs the plasma, and it may appear as if nothing is diferent, but four weeks later the collagen arrives. Our usual protocol is to treat once, wait eight weeks and then treat again if needed. Te results last up to one year. ���We are seeing more patients who have undergone weight loss and need a solution for loose skin in the upper arms. Te problem is not lack of ftness but collagen loss, which responds well to Termage treatments. We use the bigger body tip to tighten skin on the arms and 34 JANUARY/FEBRUARY 2013 | MedEsthetics Impact Technology Although many aesthetic physicians already include topical preparations in their treatment regimens, two innovations in this area may make topicals an even more important part of future combination treatments. In April 2012, Solta Medical announced a partnership with SkinCeuticals to ofer the frst fractional laser treatment plus in-ofce and home-use antioxidant skincare regimen. Roy G. Geronemous, MD, clinical professor of dermatology at New York University Medical Center and director of the Laser & Skin Surgery Center of New York, presented data from a clinical study of 18 patients treated with a combination of the Clear + Brilliant Perm��a handpiece with a low-power 1927nm wavelength for nonablative resurfacing and SkinCeuticals CE Ferulic Acid, which contains L-ascorbic acid as its key active ingredient, at the 2012 annual ASLMS meeting in Orlando, Florida. Results indicated that the combination treatment cut resurfacing recovery time by two days, and patients experienced less redness and swelling. At the same meeting, Maria Claudia Almeida Issa, MD, PhD, clinical professor of dermatology at Fluminense Federal University, Rio de Janeiro, Brazil, presented data from her clinical trial of the new iTED system from Alma Lasers. Te iTED system is a three-step, transepidermal delivery solution that combines microperforation of the skin using fractional technology, application of topical active agents on the perforated skin and the application of IMPACT, an ultrasonic sonotrode module that emits acoustic waves and air pressure to gently drive active agents in to the subepidermal layers. Dr. Issa used a variety of cosmeceuticals to treat scars, stretch marks and aging skin in 70 patients; results were signifcant but varied. can usually get 1 to 1�� inches of circumference reduction. For patients with pigmentation issues, we might combine the Termage with IPL treatments and we often suggest that patients use elure at home. ���One area where we don���t yet have a great solution is crepiness and fat pockets in the knees. I���ve tried using Termage, Exilis and carboxytherapy (injecting minute amounts of carbon dioxide gas just below the surface of the skin to destroy subdermal fat cells), but getting knees completely smooth and youthful looking is very difcult. In the future, perhaps ultrasound will prove the best therapy for this problem.��� ME Linda W. Lewis is a contributing editor to MedEsthetics.