Medesthetics

MAR 2016

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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SMOOTH OPERATORS 30 MARCH 2016 | Med Esthetics LPG Systems Endermologie is a handheld treatment device that grabs about an inch of skin between its rollers and squeezes it, increasing blood and lymphatic fl ow and stretching out the fi brous septae. The recommended number of treatments is about 14. Radiofrequency (RF)-based treatments are another alternative. They include the Thermi250, Valeant/Solta Medical Thermage, BTL Exilis, EndyMed 3DEEP and Syneron-Candela VelaShape (formerly VelaSmooth). All are indicated for temporary improvement in the appearance of cellulite, and Dr. Kilmer confi rms: "VelaShape and VelaSmooth improve the appearance of cellulite but they are temporary, with results lasting about one month." Topical creams may offer a very short-term improvement in the appearance of cellulite. There are two key actives to look for: Caffeine-infused creams help even out the appearance of cellulite due to the temporary tightening effects they have on the skin; and creams that contain a vitamin A derivative can eventually thicken the outer layer of the skin, making lumps less visible. "Topical creams that contain caffeine have been shown to reduce swelling and can lead to a temporary improvement in the appearance of cellulite," says Tina Alster, MD, founding director of the Washington Institute of Dermatologic Laser Surgery in Washington, D.C. COMBINING MODALITIES Even with more effective, minimally invasive tools, patients are best served with a combination of modalities. "For patients with discrete dimples, Cellfi na treatment is the best option and can be used in a single session to release the dermal bands that are responsible for the skin indentations. For patients with loose skin and contour irregularities, I recommend bulk tissue heating using Thermage RF to tighten the underlying skin and build collagen, and VelaShape treatments can be used to further recontour the skin," says Dr. Alster. Dr. Mills combines the subcision of Cellfi na with fat grafting to provide more signifi cant improvement. "I've done Cellfi na and put in a fat graft if the dimpling is a little bit deeper," he says, noting that KYBELLA (Allergan/KYTHER A) may be an option in the future to address fat bulges, but it remains too early to know if the product would be effective. MANAGING PATIENT EXPECTATIONS As with any procedure, managing patient expectations can be a challenge. The onslaught of airbrushed, poreless, smooth-skinned models and celebrities appearing on magazine covers can cloud the reality that patients face in their consultations. "Patients should be forewarned that cellulite will likely not be totally eradicated with these treatments," says Dr. Alster. "The best results are obtained TINA S. ALSTER, MD Washington Institute of Dermatologic Laser Surgery skinlaser.com JOEL L. COHEN, MD AboutSkin Dermatology aboutskinderm.com SUZANNE KILMER, MD Laser & Skin Surgery Center of Northern California skinlasers.com DANIEL MILLS, MD Aesthetic Plastic Surgical Institute danmillsmd.com CYNTHIA POULOS, MD Classique Medical Spa drpoulos.com

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