NOV-DEC 2018

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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44 NOVEMBER/DECEMBER 2018 | MedEsthetics © GETTY IMAGES EVOLUTION OF SCAR TREATMENTS SOFTENING BURN SCARS "We are so lucky here in the U.S. to have the equipment that we do," says Jill Waibel, MD, medical director of the Miami Dermatology and Laser Institute, and clinical volun- teer assistant professor at the University of Miami. "Laser treatment of scars has been a huge innovation since frac- tional lasers came out. In 2004, I was the fi rst person that I know of to use the Deep FX fractional ablative CO 2 laser by Lumenis on a burn patient. The more times you treat the skin, the better it gets. You can see 70 to 80 percent improvement, which is life-changing." Today Dr. Waibel has more than 60 lasers in her prac- tice. "They have changed the world of scars and given hope to patients whose skin has been disfi gured," she says. "In addition to smoothing out the skin, we can improve range of motion, pain, burning and itching." In the past, the standard of care for burn scars was to wait a year for the scar to "mature." Based on research led by Dr. Waibel, it is now recommended to begin treatment as soon as skin grafts and donor sites are healed, which is usually about three months post-injury. "There has been a paradigm shift to initiating earlier treatment of scars than in years past," says Paul M. Friedman, MD, medical director of the Dermatology and Laser Surgery Center in Hous- ton and clinical assistant professor at the department of dermatology, University of Texas Medical School and Weill Cornell Medical College. Newer technologies can transform the lives of patients with old burn scars as well. One of Dr. Waibel's most memorable patients is Kim Phuc, "the napalm girl' from the iconic Pulitzer Prize-winning photo that shocked the world during the Vietnam War era. Phuc came to Dr. Waibel's practice in October 2015 for the fi rst of nine pro- bono treatments. At age 52, she was still in constant pain from her wounds, which had melted her fl esh and muscles to her bones. She also had itching, as well as some im- paired mobility. Over the course of two years, Dr. Waibel used a com- bination of ablative and vascular lasers to treat Phuc. "Her pain intensity went from a level 10 to a 3," says Dr. Waibel. "The itching abated, and she recovered more motion in her arm. In addition, sensitive nerves near the surface of her skin that had been damaged regenerated so she is now more receptive to touch in those areas." Because scars vary from patient to patient and, in some cases, from one centimeter to the next, Dr. Waibel advo- cates for a customized approach broken up into what she describes as "courses." "I have an IPL and vascular lasers to take away the red or brown color of a scar—that's the ap- petizer; fractional ablative CO 2 lasers or Er:YAG lasers for the main course of removing scar columns and generating collagen; and laser-assisted delivery of drugs to minimize and control scarring from continuing to grow for dessert," she says. The drugs she delivers with the help of her ablative la- sers vary based on the type of scar. "Some of these drugs include Triamcinolone Acetonide and 5-Fluorouracil used for hypertrophic scars; Poly-L-Lactic Acid which can be used for atrophic scars; Bimatoprost 0.03% topical solu- tion for hypopigmented scars; and botulinumtoxinA, which is an emerging laser-assisted drug for contracture scars," says Dr. Waibel. "The more times you treat the skin, the better it gets. You can see 70 to 80 percent improvement." Combination laser treatments can reduce discoloration, remove scar tissue and stimulate new collagen production for dramatic improvement in scarring.

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