PracticalDermatology

This year marks the fifteenth anniversary of Music City SCALE. The meeting has become one of the most respected and well attended medical dermatology, aesthetic and cosmetic medicine, and practice management meetings in the country. It is a meeting you don’t want to miss. We always bring to Nashville the top thought leaders and experts in each of the fields represented in our program. We pride ourselves on being different. Our faculty is always readily available to the attendees throughout the meeting, and we make a point of showcasing the newest products and procedures that are surely going to impact how we care for our patients both in the immediate future, as well as down the road. This year we will pnce again cover topics that matter the most in cosmetic and aesthetic medicine, medical dermatology, and practice management.

Fifteen years is a milestone for SCALE, and we are indebted to all the attendees who have graced us with their presence to make SCALE so successful. We have incredible industry support, and major players in all parts of our industry regularly attend SCALE, making our exhibit hall truly special. We thank our industry colleagues for their trust and guidance, and we will showcase many of their products through Product Theaters and special Industry Workshops.

Our Cadaver Course is one of the finest in the country. We bring in experts to teach and interact with our attendees, so that each participant has an opportunity to come away with a better understanding of the fine details of anatomy, successful injection technique, and safety when using fillers and neuromodulators in the facial areas. We have continued to expand on this great course and are sure that you will learn more than you would have ever imagined and will be able to take home useful pearls and information that will translate into better care for your patients.

We are proud to call Nashville home. SCALE started when Nashville was considered a small city. As many of you know, over the past 10 years, Nashville has been called the “it” city on many occasions. From the music to our food to our cultural activities, there really is something for everyone here.

We are committed to having the best meeting in the US—and we strive each and every day to make sure that you, our attendees, are our top priority. We look forward to welcoming you to Nashville and to Music City SCALE for our fifteenth anniversary event in July.

—Brian Biesman, MD and Michael H. Gold, MD

SCALE Insights: New Ways of Thinking in Aesthetics

What is beautiful? How do we perceive beauty? What is aesthetic bias and how does it influence our perceptions? These are the types of questions that Chicago facial plastic surgeon Steven Dayan, MD spends his time exploring. And his insights pepper his presentations. This is especially true at Music City SCALE. When he visits Nashville this summer, Dr. Dayan, author of Subliminally Exposed, will touch on issues like how blind people detect beauty. His musings are not simply esoteric; they have practical implications for patient care.

Last fall, Dr. Dayan and colleagues published a study showing that cosmetic procedures objectively improve a patient’s health-related quality of life, especially in terms of mental health and emotional scales. (Facial Plast Surg. 35(5):549-558)

Dr. Biesman demonstrates injection technique at Music City SCALE 2019.

Dr. Gold speaks at Music City SCALE 2019.

At SCALE, he’ll address another recent publication. “I will be talking about new ways of thinking when it comes to your patients, your practice, and yourself. I’ll give some tips that for sure will change the way people think,” Dr. Dayan says. “I hope to put out there some ideas that will be talked about at dinner that evening.”

Dr. Dayan and colleagues recently published in Dermatologic Surgery results of a pilot study (Jan 2020, e-pub) showing that sighted and blind individuals assessed the beauty of models similarly; however, non-blind, masked individuals differed in their assessment of “beautiful” models. Dr. Dayan says he is excited to present on these findings for the first time since their publication and explore the implications for how we perceive beauty and deliver aesthetic services and products.

Dr. Dayan is also looking forward to sharing pearls for practice success. “I am pretty confident that attendees can use some of these pearls in their practices when they return Monday morning,” he suggests.

AESTHETIC TRENDS
HOT TOPIC

Technological advancements continue to emerge rapidly in the aesthetic space. But when it comes to day-to-day practice, it’s often patient desires that drive innovation in the clinic. Several trends are affecting practice now, says Ava Shamban, MD, Los Angeles dermatologist and co-host of “The Gist” on YouTube.

Gender identity is an important emerging topic in patient care, Dr. Shamban says. When it comes to aesthetics, the cosmetic surgeon needs to consider the patient’s identity and aesthetic desires when determining a treatment plan. Understanding of classically male or female features and how to achieve or diminish these can be important to providing the outcomes patients seek.

Dr. Shamban will discuss her tentpole technique for rejuvenation of the mid- and lower face when she presents this summer. The tentpole technique emerged in response to the need to stop “chasing” lines and folds with fillers. Attempts to directly fill the nasolabial folds often has resulted in an unnatural or distorted effect, which the tentpole technique avoids. Rather than address specific wrinkles or folds, the tentpole technique allows for a redraping of the skin by using deep plane injections that serve as support pillars—similar to the poles of a tent.

Dr. Shamban will also address the role of absorbable sutures for lifting. The latest generation of these devices, still relatively new to the space, can be used alone but are especially useful in combination with energy-based devices or injectables to re-contour the jawline.

Overall, Dr. Shamban says, she plans to emphasize the “usefulness of injecting strategically” as well as “the artistic process.”

SCALE Insights: What’s New in Acne

The field of acne therapy has seen new treatments approved, and there are several more agents in the pipeline. Among the recently approved agents is trifarotene (Aklief Cream 0.005%, Galderma), for the topical treatment of acne—the first new retinoid approved for acne in more than 20 years. Unlike other topical retinoids, trifarotene selectively targets retinoic acid receptor (RAR) gamma. According to Linda Stein Gold, MD of Henry Ford Hospital Medical Center in Michigan, trifarotene, “more specifically targets the retinoid receptors specific for the skin. This drug showed efficacy on the face as well as on the trunk and was well tolerated.”

In two pivotal Phase 3 clinical trials of once-daily Aklief Cream in patients with moderate acne on the face and trunk, treatment significantly reduced inflammatory lesions as early as two weeks on the face and four weeks on the back, shoulders, and chest compared to vehicle (p<0.05). Aklief Cream was well tolerated when used on the face, back, shoulders, and chest. The most common adverse reactions (incidence >1%) included application site irritation, application site pruritus, and sunburn.

Dr. Stein Gold will also address Arazlo (tazarotene lotion 0.045%, Ortho Dermatologics), which she describes as, “a new formulation in an enhanced vehicle that is well tolerated.” In two, Phase 3 clinical trials, tazarotene lotion was generally well-tolerated.

“We also have a new topical minocycline 4% foam that delivers high concentrations of drug directly to the skin with minimal systemic absorption,” Dr. Stein Gold adds. Amzeeq (minocycline, Foamix Pharmaceuticals) topical foam, 4% is the first topical minocycline to be approved by the FDA. It is approved for the treatment of inflammatory lesions of non-nodular moderate to severe acne vulgaris in adults and pediatric patients 9 years of age and older.

“Finally we have a new androgen receptor antagonist, clascoterone, that is before the FDA, awaiting approval for topical treatment of acne,” Dr. Stein Gold says. Cassiopea SpA filed the NDA for clascoterone cream 1% this past fall, and the FDA set a Prescription Drug User Fee Act (PDUFA) action date of August 27, 2020.

Clascoterone is a new chemical entity and, if approved, would be a first-in-class topical androgen receptor inhibitor for the treatment of acne. It is also in late-stage development for the treatment of androgenetic alopecia in men.

The key take-away Dr. Stein Gold hopes to leave with her audience? “New topical formulations are better tolerated for acne,” she says. “And don’t forget about truncal acne!”