Medesthetics Special


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Sebum Control Focused Ultrasound for Oil Reduction Dermal Botulinum Toxin Injection Botulinum toxin injections paralyze muscles, but can they slow down oil production in the skin? For "Safety and Efficacy of Intradermal Injection of Botulinum Toxin for the Treatment of Oily Skin" (Dermatologic Surgery, March 2013), David J. Goldberg, MD, and Amy E. Rose, MD, of Skin & Laser Surgery Specialists of New York and New Jersey, treated 25 patients with oily skin with intradermal botulinum toxin injections. Oil production was measured by sebometer at baseline, one week, one month, two months and three months following treatment. 6 July/August 2013 | ACNE & ROSACEA only 10 patients have completed treatment and evaluation, but the results are promising. At 60 days, there was an average 80% reduction in comedonal and non-comedonal lesions. "The inflammatory lesions responded a little better, and that makes sense because the oil glands are a little bigger target," he says. At 180 days post-treatment, 100% of patients had a reduction in both lesion count and sebum production. "In the forehead, it was a 45% reduction in sebum activity. In the cheeks and chin, it was about 30%, so there was a global reduction in oil gland production," says Dr. Munavalli. "At one week, the average decrease in oil production was 75%. Our next data point was one month after treatment and that was when it peaked at an 80% average decrease," says Dr. Rose. At two months and three months post-treatment, the average reduction was 72% and 59%, respectively. "At three months, the oil production is starting to creep up a little bit. It's still significantly lower than when they started, but you do see the effects starting to wear off," she says. Dr. Rose notes that the injection technique targeting sebum production differs from that used for wrinkle reduction. "When you're targeting wrinkles you go much deeper and go straight into the muscle and typically put the needle straight in at a 90° angle," she says. To target oil production, Dr. Rose and Dr. Goldberg targeted the dermis and deep dermis. "It's a little bit of a tricky thing to do. We angle the needle at like a 75° angle and then what we look for is some extrusion of fluid from the pores around it. That's an indication that you're more superficial because you're seeing some of the fluids leak out," says Dr. Rose. She believes that the treatment may offer relief for patients with mild acne and those with oily skin and large pores. The effect of the treatment on pore size, specifically, is something she hopes to address in future studies. © When Ulthera ( introduced Ultherapy—a focused ultrasound device that allows physicians to target specific dermal depths for noninvasive skin tightening and brow lifting—Girish "Gilly" Munavalli, MD, saw more than a cosmetic treatment. He saw a potential acne treatment. "The idea was to choose a depth where the sebaceous glands are and treat a zone and look to see if, in the process of treating that zone, we affect the activity of the oil glands, and the answer appears to be yes," he says. The device's ability to create a defined depth of injury combined with its use of ultrasound energy led Dr. Munavalli to believe it could offer an interesting alternative to laser treatments. "It doesn't have the same barriers that laser does," he says. "The energy doesn't get absorbed by the melanin and the blood, and it doesn't affect the skin's surface like a laser would." He is currently conducting a pilot study that involves treating patients with moderate-to-severe acne with three Ultherapy sessions. The patients are evaluated—through acne lesion count and sebometer—throughout treatment and 180 days after completing their final sessions. So far,

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