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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46 NOVEMBER/DECEMBER 2018 | MedEsthetics © GETTY IMAGES Fractional CO 2 lasers that offer deep penetration, such as the Lumenis Active and Deep FX, have become the go-to devices for removing scar tissue and stimulating new col- lagen. Fractional microneedle radiofrequency devices are also fi nding a place in scar treatment. Dr. Goldman uses Lu- tronic's Infi ni to stimulate collagen growth and smooth areas of scarring. "Both acne and trauma scars respond to it well," he says. SMOOTHING ACNE SCARS Treatment for acne scars depends on the type of scar: ice pick (deep, narrow pitting), boxcar (shallow round or oval depressions) or rolling (wide and shallow undula- tion). Fractional ablative and nonablative lasers as well as fractional RF microneedle devices can help smooth rolling and boxcar scars so they are less noticeable, but deep ice- pick scars typically need to excised and/or fi lled to achieve an acceptable outcome. Plastic surgeon Rod Rohrich, MD, of the Dallas Plastic Surgery Institute in Dallas excises the pit of the ice pick scar with a punch, fi lls the area with the patient's own fat and then resurfaces the area with a frac- tional laser—all in one appointment. Because acne is such a common skin disease in the U.S., acne scar prevention is a signifi cant area of research. "Retin-A and Accutane have been amazing treatments for acne prevention," Dr. Goldman says, "but one of the biggest advances may be changing the bacteria population on the skin without drying or irritating the skin. Instead it would prevent the big red pimples that destroy the collagen, lead- ing to scarring." Dr. Waibel is hopeful that new treatments, such as gold nanoparticles (Sebacia), will help clear acne before scarring has a chance to take hold. "These tunable gold nanoparticles absorb light. Once they are applied to the skin and trans- verse down the hair follicle/sebaceous gland, we use a laser to activate the particle," she says. "Initial data out of Poland showed a 70 percent reduction of infl ammatory lesions." Another on-the-horizon technology that may offer relief to scar patients is Rotational Fractional Resection (RFR, Recros Medica). "This company has the technology for rotational fractional resection and lipectomy that removes both fat and skin via tiny excisions," says Dr. Waibel. "These tiny excisions create a dense fractional fi eld with minimal downtime. The technology can remove up to 25 percent of skin in one treatment with no visible scarring." What is the best tool to help patients struggling with depression and anxiety over their scars? The internet, says Dr. Friedman. "Websites that allow consumers to learn how laser technology can safely and effectively improve the ap- pearance of scars are key to helping them fi nd treatment," he says. The results of the 2016 Bio-Oil study support his view. In that survey, 67 percent of those with scars said they had never sought medical advice largely because they did not know healthcare professionals could help with scarring. Judy Kirkwood is a freelance writer based in Florida. Deep ice-pick scars may require excision, ⇒ lling and resurfacing. "Websites that allow consumers to learn how laser technology can safely and effectively improve the appearance of scars are key to helping them find treatment." EVOLUTION OF SCAR TREATMENTS

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