Medesthetics Special

AR Supplement

Surgical Aesthetics and Acne & Rosacea are special editions of Medesthetics. To see Surgical Aesthetics, go to

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Page 15 of 27

Smoothing the Surface The new XD Optic tip from Palomar offers deeper penetration of laser energy without increasing downtime and epidermal damage. multiple, costly treatments. They are also less effective on cases of severe scarring. • Ablative laser treatments often require far fewer sessions than nonablative to achieve desired results. But practitioners must be aware of a patient's skin type and tolerance for downtime. A recent treatment trend involves combining both fractional ablative and nonablative lasers to improve acne scarring. Dr. Sarnoff presented a split-face pilot study at the American Society for Laser Medicine and Surgery Conference in Florida in April that involved 10 patients. She treated one side of the face with both ablative CO2 and nonablative 1440nm fractional laser technologies—the nonablative treatment is performed just prior to the ablative—and she treated the other side with ablative only. Patient satisfaction rates increased with the combined treatment and Dr. Sarnoff reported that there were no additional adverse events or downtime on the sides that received the dual treatment. • Punch excision with primary closure is indicated for deep, narrow scars that often feature collagen that is too tough to break up with other modalities. "The physician uses a cookie cutter-like device to excise the scar, then sews up the hole," says Dr. Sarnoff . • Punch elevation or punch grafting is similar to punch excision, "but instead of removing the scar and attaching side A to side B, the physician allows the skin to swivel up a bit, and heal where it lies," says Dr. Sarnoff. "A few weeks later, the physician buffs the area with a laser." Both punch excisions and punch grafting are labor-intensive and expensive. • Subcision can help to break up adhesions and elevate atrophic scarring as it heals. • For some patients, simply injecting a saline solution under the scar to tumesce the area will help to release scarred areas. Performed multiple times, the treatment works by stretching the adhesions enough to produce some improvement in the appearance of the scars. 14 July/August 2012 | ACNE & ROSACEA "The procedures described above all work with atrophic scars," says Dr. Sarnoff. "For raised, inflamed scars, the mainstays of treatment involve injection of a steroid—often triamcinolone acetonide—use of a topical silastic gel sheeting and treatment with a pulsed dye laser." New Modalities and Combination Treatments While fractional ablative lasers and HA fillers remain a top choice for atrophic scarring among the physicians we spoke with, new technologies and techniques continue to emerge. LaViv (Fibrocell Science,, a new autologous cellular product containing fibroblast cells grown from a patient's postauricular skin biopsy, has received United States Food & Drug Administration approval for improvement in the appearance of moderate to severe nasolabial folds. It is also being used off-label to treat atrophic acne scarring. A recent treatment trend involves combining both fractional ablative and nonablative lasers to improve acne scarring. Palomar Medical ( recently introduced the Lux 1540 handpiece with XD Optic, a point-compression tip that compresses the tissue and pushes out water, resulting in less epidermal damage and more dermal damage. According to Robert Weiss, MD, who presented his experiences with the XD Optic at the ASLMS conference in Florida, the tip offers a 20% to 50% increase in depth of penetration. Continued on page 23

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