PracticalDermatology

The ongoing evolution of energy-based devices for aesthetic indications ranging from photoaging to fat continues to draw interest. In fact, demand for the energy-based device session at this year’s Maui Derm for Dermatologists meeting was so high that organizers made a last-minute relocation to the facility’s largest room to accommodate all of the interested attendees. Ahead are key pearls from speakers on the panel.

Know Thy Laser

Keeping those ever-present latte cups and bottles of water off of laser equipment hardly seems like rocket science for most people. But according to E. Victor Ross, MD injuries from fires and explosions caused by leaky beverages unfortunately happen more frequently than can be imagined. “Don’t do that,” he said of placing beverages on these delicate devices. “It’s just a bad idea.”

Laser safety means using appropriate eye protection at all times and also making sure that devices are maintained. Keep bever- ages and other hazards away from devices.

With interactions between physicians and their devices on the rise, simply understanding how lasers work and the basics of safety can help professionals become more effective and to stay out of potential trouble, said Dr. Ross, Director of the Laser and Cosmetic Dermatology Center at Scripps Clinic in San Diego. Everyone in the office should also know the core fundamentals and common nomenclature. “Make sure you know your laser,” he told the crowd.

Dr. Ross, the 2008 president of the American Society of Laser Medicine and Surgery and a former board member of the American Society for Dermatologic Surgery, said another piece of standard but often forgotten safety advice is to always wear protective eyewear when in the same room as a functioning laser. It’s your only way of avoiding hazards from ultraviolet or infrared light used in the machines, he warned.

“Sometimes, it’s the lasers you can’t see that are most likely to hurt you,” he said.

2. No Need to Cut and Sew

A new era in contouring has dawned thanks to the growing popularity of energy-based technologies. Mitchel P. Goldman, MD discussed how Ultherapy and other non-surgical procedures can be used to lift and tighten a patient’s face and upper neck area. “It’s very painful,” he said of ultrasound-based treatment, so pain control is essential.

AVOID COMPLICATIONS/MAXIMIZE RESULTS

Learn how to avoid complications with lasers and get best results in this video update from the AAD Annual Meeting in Washington, DC. Eric Bernstein, MD recaps his panel and offers tips for laser surgeons.

Watch now: DermTube.com/AAD2016

Dr. Goldman, founder and medical director of Goldman, Butterwick, Fitzpatrick, Groff, & Fabi, Cosmetic Laser Dermatology, said the trouble he encountered was that some patients just don’t improve. So, it’s up to the physician to figure out which patients might react best, he said. Younger patients and non-smokers seem to respond better, but the ultimate answer as to why it works for some and not for others is still a mystery.

It’s been called the lift without surgery, but not everyone may be happy with the intense level of throbbing pain that patients have reported experiencing, he said. According to Dr. Goldman, some patients simply don’t approve of enduring a full hour of experiencing a five to six on the pain scale.

Also generating excitement: controlled dermal RF heating. Dr. Goldman said a recently published study found 64 out of 77 patients who underwent the treatment reported experiencing improvement. ThermiTight RF technology had the lowest adverse impact to patients, he said. “Patients can have the procedure done on Friday and go back to work on Monday,” he said.

3. Tattoo You

According to Sandy Tsao, MD, one in seven people says they wish they had never gotten a tattoo, and they’ll come to you looking to get rid of it. Thankfully, she said, laser removal treatments are helping make that wish come true more easily than ever. (Despite advances in technology, though, yellows, pastels, and fluorescents are still the most challenging colors to remove.)

Dr. Tsao, of the Massachusetts General Hospital Dermatology Laser and Cosmetic Center, said a combination of ablative fractional lasers and Q-switched lasers has been her go-to treatment over the past few years. Cynosure’s PicoSure has been one of the most effective means of fragmenting tattoo particles, she said. Offering laser bursts shorter than a nanosecond, the laser may clear a tattoo in one to two treatments instead of 10, she said. Placing DeScribe’s Transparent PFD Patch on top of a tattoo prevents epidermal whitening and allows for multiple laser passes at one time, leading to faster tattoo clearance.

4. Changing the Game

Is microneedling therapy the next big thing in resurfacing? Pen devices, such as the Aquagold finetouch, are becoming more popular for minimally invasive treatment of pigmented lesions, scars, and loose skin. Michael H. Gold, MD, Founder of Gold Skin Care Center, Advanced Aesthetics Medical Spa, The Laser and Rejuvenation Center and Tennessee Clinical Research Center in Nashville, said the devices are simply changing the game. “It’s becoming one of the more important technologies,” Dr. Gold said of the pens.

He forecasts things have just gotten started with the technology. He expects the remainder of 2016 will feature even more devices being brought to the market.

5. Fat Fighters

Destroying fat cells through cryolipolysis is a whole lot easier now thanks to the CoolSculpting “Cool Mini” applicator, said Suzanne Kilmer, MD, Founder of the Laser and Skin Surgery Center of Northern California. She called the new technology a breakthrough that can help to serve an emerging market. The FDA-cleared, non-surgical fat reduction treatment uses controlled cooling to eliminate stubborn fat in a safe and effective way, she said. The new small applicator is designed for submental fat and optimized for smaller bulges.

According to Kilmer, a successful treatment can occur in just a single 60-minute visit. She said most patients should only expect two treatment visits, that should take place at least six weeks apart. A final follow-up appointment would be required 12 weeks later.

Other treatments Dr. Kilmer mentioned included Cynosure’s SculpSure, the world’s first FDA-cleared laser treatment for non-invasive lipolysis of the flanks and abdomen. Dr. Kilmer also briefly touched on subscision surgery for cellulite in the buttocks and thigh areas and discussed successes she had seen with the use of the Cellfina System. n