Medesthetics

NOV-DEC 2016

MedEsthetics—business education for medical practitioners—provides the latest noninvasive cosmetic procedures, treatment trends, product and equipment reviews, legal issues and medical aesthetics industry news.

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62 NOVEMBER/DECEMBER 2016 | Surgical Aesthetics intralesional steroids or 5-fl uorouracil (5-FU) has been shown to improve outcomes. Bruce Katz, MD, a board certifi ed dermatologist and found- er of Juva Skin & Laser Center in New York City, uses PDL to reduce erythema and fl atten raised scars as well as a fractional CO 2 to reduce scar tissue and stimulate new collagen. He stresses that the ideal time to begin treatment is six to eight weeks after the scar has developed. "The common misconception, even among doctors, is to wait a year until the scar matures," says Dr. Katz. "However studies have shown that the earlier you treat scars, the more effective the treatment." Dr. Khansa, et al, found that PDL treatment offers the best results in immature hypertrophic scars (less than one year old) that are still hypervascular and erythematous. As the scar matures, treatment becomes less effective and patients require more sessions to achieve improvement. Dr. Katz notes that the number of laser sessions needed is highly variable—ranging from two to as many as 10. "It all depends on how thick the scar is, how long it has been there and how raised it is," he says. "On average, it takes four to six treatments." Intense pulsed light (IPL) is also effective at reducing erythema and hypervascularity. "We observe patients during the fi rst three months, and if we see any over-healing or overzealous scars, we'll inject a steroid directly into the scar and use IPL every three to four weeks," says Dr. Williams. Keloid scars are the most challenging cases to treat. Dr. Khansa, et al, noted that multimodal treatment—combin- ing surgical or CO 2 laser-assisted excision with intralesional injections of steroid, mitomycin C or bleomycin, plus PDL, silicone compression and, in some cases, radiation—is of- ten required to reduce the keloid and prevent recurrence. Treatment at the Time of Surgery There is mixed evidence for treatments delivered at the time of surgery to reduce hypertrophic scarring. Richard M. Goldfarb, MD, FACS, founder of the Center for SmartLipo & Plastic Surgery in Langhorne, Pennsylvania, injects Selphyl (Factor Medical) directly into the wound at the time of the closure. "We've gotten great results with this," he says. The concept is based largely on evidence showing that growth factors in platelet-rich plasma (PRP) help induce healing in chronic diabetic ulcers. In September 2011, Marissa J. Carter, PhD, et al, published a review study of PRP for wound healing in ePlasty. After reviewing 24 eligible studies, they concluded that PRP improved complete and partial wound healing compared to control wound care. When reviewing fi ve studies on the use of PDL de- livered at the time of suture removal, Dr. Khansa, et al, found two studies showing that treatment improved ery- thema, scar pliability and overall appearance compared to the untreated side of the scar. But three additional studies showed no long-term improvement between treated and untreated areas. Currently, there is no treatment that will completely eliminate scarring, but physicians can help patients achieve signifi cant improvement. "Scars do not typically go away completely but raised scars will fl atten and red scars will go back to regular skin color," says Dr. Katz. Good postoperative follow-up care can be your best tool for halting the growth of hypervascularized and hyper- trophic scars. Dr. Goldfarb has his surgical patients come in two weeks, six weeks, three months and six months after their procedures to monitor their wound healing. "You want to constantly monitor the scar area because if you let a poorly healing scar go three to six months without care, it will continue to thicken and become more diffi cult to treat," he says. Daniel Casciato is a freelance writer based in Pittsburgh. PHOTOS COURTESY OF EDWIN F. WILLIAMS III, MD, FAACS AFTER BEFORE This patient underwent roughly 10 PDL treatments over a 12-month period to repair an upper lip defect following skin cancer resection. After surgery, she used a silicone- and sunscreen-based lotion daily with strict sun avoidance. SURGICAL AESTHETICS SCAR REVISION

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