Head-to-Toe Aesthetic Innovations
Get caught up on the latest approaches to cosmetic dermatology.
As the aesthetic marketplace continues to expand, Houston dermatologist Suneel Chilukuri, MD says that the evolution of combinations is the most significant current innovation.
“I don’t think there’s anything brand new on the market, it’s a question of how we can use things together,” Dr. Chilukuri says. “So when we talk about combining our fillers with our neuromodulators, we’ve been doing that for a long time. But how about adding technology now? So if you’re using your lasers, your radiofrequency devices, your ultrasound devices and you put that together with your skincare package, we’re seeing much greater effect for all of our patients.”
Head-to-toe rejuvenation is the new norm, but patient demand for peri-ocular treatments remains strong. In an interview with DermTube.com, Ardmore, PA-based facial plastic surgeon Jason Bloom, MD discussed his approach with fillers. “I’m extremely conservative,” he says. “I like to think that this is one of the most technique-dependent areas in all the face. When we’re talking about the tear trough and the lower eyelid periorbital area, I tend to use cannulas for this area.”
Specifically, Dr. Bloom says he uses a 27-gauge 1.5 inch long cannula. He prefers low cross-linked fillers, like Restylane, in this area. Lower cross-linking seems to allow hyaluronidase to work more quickly, if needed. “Because I’m very conservative and this is a very technique-dependent area, if there is a problem there, I want to make sure I can get rid of the filler right away,” he explains.
A self-proclaimed “purely laser surgeon,” Eric Bernstein, MD of Ardmore, PA, highlights device-based innovations of note. One is the PicoWay device (Syneron Candela). “It allows me to treat with every wavelength in one box that I need to remove tattoos. Then it has two ingenious handpieces that actually, they’re formed in crystal, I assume with other lasers, little lenses that focus 101 tiny little beams,” he says.
“The other advance has been around forever,” Dr. Bernstein says. The Syris light allows Dr. Bernstein to see below the skin’s surface. “It’s indispensable. It’s a tool I think should be used by every dermatologist,” he says.
Other cosmetic surgeons share their insights ahead.
Tina Alster, MD, who has been known as the Laser Queen is now assuming the mantle of “Microneedling Queen.” Speaking at the October meeting of the American Society for Dermatologic Surgery, she addressed the growing use of microneedling in aesthetics practice and emphasized its benefits. She recently authored a review of the procedure in Dermatologic Surgery.
The 595nm pulsed dye laser has been used for some time for the management of erythematous and hypertrophic scars. “Now, I’m using microneedling with the 595nm pulsed dye laser for slightly erythematous hypertophic scars, but ones that actually need a little bit more of a texture change. You can combine the two together very nicely, which amplifies the clinical effect,” Dr. Alster says. Microneedling can also be used alone, Dr. Alster says.
“Many people probably do need a bigger procedure, but at least in Washington, DC, nobody wants to take the time to recuperate. So I often have to do some of these smaller procedures that do add up to almost equate with a fractionated ablative laser treatment.”
Male “muffin top” is a reality. “We can use certain spot treatments,” says Suneel Chilukuri, MD. He utilizes a variety of devices and tends to use combinations for optimal fat reduction and tightening for male patients.
“I’m very particular about photos. I always take photos before we start any treatment and again at the four- to six-week mark, when we’re starting to see a change,” he says. “Typically in our practice, I bring everybody back at the four-week mark, even though we may not see changes right away, because I want them to weigh in…I want to make sure that they’re staying on their regimen so that I can make sure we can guarantee results are going to be great.”
“Crosslinking affects the amount of tissue augmentation, flexibility, and support we can provide,” explains Michael Somenek MD, in a discussion of the expanding HA filler market.
“If you do understand the basic science that every single filler is able to offer, you are able to tailor that to the specific tissue and to the specific location within each patient. I do think that what we have in the United State today really is a great toolbox of fillers…There are specific qualities of fillers that are really more appropriate for certain areas of the face.”
Erasing Acne scars
When it comes to managing acne scars, it’s important to set realistic expectations from the start, says Philadelphia’s Nazanin Saedi, MD. She says that she tends to prefer non-ablative treatments, suggesting that patients will be 50 percent better with four to six treatments.
“I incorporate all the treatment modalities…I break it down into erythematous scars, atrophic scars, and hypertrophic scars. If they have erythematous scars, I typically go to a vascular laser, and those patients are really happy.”