Medesthetics Special

AR Supplement

Surgical Aesthetics and Acne & Rosacea are special editions of Medesthetics. To see Surgical Aesthetics, go to http://surgicalaestheticsmagazine.epubxp.com

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Smoothing the Surface has any big events coming up." If the patient's sister is getting married in two weeks, for example, you may want to use fillers, but not a fractional ablative laser. If the wedding is in six months, "you can do just about whatever you want without risk of appearance problems on the big day," says Dr. Smith. If the patient is a man who must regularly make presentations to clients, vacations may be the ideal time for treating acne scars. "If a male patient commits to fractional ablative laser treatment, he has to be willing to not shave for a while," says Dr. Sarnoff. "Women can use cosmetics to cover the pinkness, but for men it's harder to have that down time." Age and skin type also play an important role in determining the most effective treatment modailities. "As you get older, the skin envelope is looser," says Dr. Sarnoff, "and gravity comes into play. Often, patients are more bothered as they get older because the scarring appears worse." In some cases, she improves the overall appearance of the scars by removing some of the skin from the sides of the face, "it's like a skin reduction facelift," Dr. Sarnoff says. "It tightens the overall skin envelope." She also uses a more controversial method of filling deep scars with 'microdroplets' of silicone used off-label. Older skin—whether the result of instrinsic or extrinsic aging—has less plasticity and responds less favorably to acne scar treatments than younger, more pliable skin. "Because [the skin] has less plasticity, it may not heal as well or rebound as well after a procedure," says Dr. Wasserman. Darker skin types, "push me more to non-heat-driven procedures, because these patients have a higher risk of post-inflammatory hyperpigmentation," adds Dr. Wasserman. "People of color often cannot take aggressive treatments," agrees Dr. Sarnoff. "The physician has to worry about doing something that will change the color of the patient's skin. If you improve the contour but upset the pigmentation, you haven't done a good job." Ethnic skin is more at risk for pigmentary alteration following CO2 laser resurfacing, "but turning down the energy can affect the amount of improvement," says Dr. Wasserman. Radiofrequency-based devices "are more colorblind," he adds, "and may actually be better for acne scarring than a laser." Dr. Smith recommends treating darker skin during winter months, when patients have less exposure to ultraviolet light. An Array of Options There are several accepted treatment options for acne scarring—covering the spectrum from fully invasive to noninvasive. Each has its benefits and drawbacks. • The CROSS—chemical reconstruction of skin scars—technique is indicated for icepick scars. Using a 90% to 100% concentration of trichloroacetic acid (TCA) on a toothpick, the physician wounds the scar pits to stimulate healing and reduce pitting. After the site crusts over, patients will see 12 July/August 2012 | ACNE & ROSACEA Nonablative lasers offer some improvement for acne scars, but are generally not a top choice for more severe cases. "Often patients are more bothered as they get older because the scarring appears worse." some effects of neocollagenesis, resulting in improvement of the scarring, according to Dr. Sarnoff. The downside of the CROSS procedure is that it can be tedious, and generally requires as many as half a dozen treatments, at six-week-or-so intervals. • Hyaluronic acid fillers are being used to lift depressed scars, such as boxcars, and to stimulate the production of collagen for some long-term improvement. The patient will need to come in every six to 12 months to maintain results, but the procedure is safe and relatively inexpensive. • Nonablative lasers and fractional radiofrequency devices, with their ability to stimulate collagen production, can improve the appearance of acne scarring, but they do require

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