Medesthetics

JAN-FEB 2015

MedEsthetics magazines offers business education and in-depth coverage of the latest noninvasive cosmetic procedures for physicians and practice managers working in the medical aesthetics industry.

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BEST PR ACTICES 6 JANUARY/FEBRUARY 2015 | Med Esthetics Laser Energy Output Varies During Treatment The energy output of aesthetic lasers can fl uctuate signifi cantly during treatment, which may explain variances in outcomes seen by providers, according to Tim S. Lister, MD, and Mark P. Brewin, PhD, of the Salisbury Laser Clinic in Salisbury, Wilshire, UK. For their study, "Variations in Laser Energy Outputs Over a Series of Simulated Treatments" (British Jour- nal of Dermatology, November 2014), Dr. Lister and Brewin recorded the energy and pulse time data of seven laser systems using a pyroelectric measure- ment head with an optical diffuser and associated meter. Each laser was used to perform a pattern of eight simulated 10-minute treatments followed by fi ve-minute delays. The data was recorded directly into a computer for analysis. All devices had been serviced within six months of the experiment. Some of their fi ndings included a 22% reduction in energy output (6.4J to 5.1J) over the course of eight treatments with a long-pulse pulsed dye laser; a 29% and 13% reduction in energy output with the Q-switch alexandrite laser and Er:YAG laser, respectively; and a gradual increase (9.6J to 11.4J) in output of a 1064nm Nd:YAG laser following an initial drop in energy per pulse during the fi rst treatment. The authors encourage laser operators to be aware of potential variances in energy output, particularly when looking at pretreatment patch tests and recom- mended treatment levels. Re-Evaluating the Use of Antibiotics for Acne In an eff ort to reach a consensus on treatment guidelines, a panel of Canadian dermatologists reviewed the role of antibiotics and their resistance in the treatment of mild to moderate acne vulgaris. T eir fi ndings were published in the Journal of Drugs in Dermatology (November 2014). Charles W. Lynde, MD, Frcpc, and Anneke An- driessen, PhD, convened an expert panel of derma- tologists and asked them to fi ll out a survey on their current practices. T e authors also conducted a literature review using PubMed, Cochrane Library, Medline and EMBASE. Based on this information, the authors concluded that, oral antibiotics should only be used for a short period of time, and topical antibiotics should notbe used alone as a monotherapy at all. Rather, such topicals should be combined with a retinoid or ben- zoyl peroxide when treating mild to moderate acne. T ese guidelines are consistent with U.S. recom- mendations that were presented in Pediatrics (May 2013), in which the American Acne and Rosacea Society convened a panel of pediatricians and derma- tologists to develop evidence-based pro- tocols. T ey, too, suggest a combination of benzoyl peroxide, topical retinoids and antibiotics when treating mild to moderate pediatric acne. Vascular occlusion leading to blindness is one of the most serious complications of dermal fi ller use. To help physi- cians reduce the risks, Jean D. Carruthers, MD, et al, have published "Blindness Caused by Cosmetic Filler Injection: A Review of Cause and Therapy" (Plastic and Reconstruc- tive Surgery, December 2014), which includes the following recommendations: • Use blunt cannulas or small-bore needles. • Inject epinephrine with the fi ller to reduce the size of the vessels. Give the epinephrine time to work before completing the full injection. • Use smaller syringes, preferably 0.5cc to 1cc, so that less pressure is required on the plunger. • Always withdraw before you inject. Rheologic customization of the fi ller before injection may be helpful. • Inject slowly, gently and in small aliquots. • Never inject in a previously traumatized area. • Know your anatomical plane and depth for each injection. • Cease injection immediately if the subject complains of pain or vision loss, contact an ophthalmologist or oculoplastic colleague immediately and transport the subject to their clinic—not to a generalized emer- gency department. • Always have non-expired hyaluronidase in the offi ce. Preventing Vascular Occlusion © GETTY IMAGES

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