Nonprescription Topical Treatments for Skin Rejuvenation

Abstract Topical skin care regimens are a mainstay treatment for aging skin. All patients seeking skin rejuvenation can benefit from this low-risk intervention. This article reviews available nonprescription topical treatments for rejuvenation including moisturizers, antioxidants, retinols, and sunscreen

Lip rejuvenation and filler complications in the perioral region

Lip and perioral augmentation procedures have become increasingly popular over the last two decades due to cultural trends, emphasizing youth and beauty. An understanding of lip anatomy and aesthetics has traditionally formed the basis for successful results. However, as new technology becomes available, patient standards have increased, requiring an intricate understanding of filler properties and the advantages of different technical approaches. This chapter touches on pertinent anatomy and aesthetics of perioral evaluation. It also provides an overview of the properties of the fillers currently available in the United States marketplace for perioral rejuvenation. The technique and materials currently favored by the senior author are described in greater detail. Finally, the chapter will overview potential complications and recommended management

Six‐Month, Double‐Blind, Randomized, Split‐Face Study to Compare the Efficacy and Safety of Calcium Hydroxylapatite (CaHA) Mixed with Lidocaine and CaHA Alone for Correction of Nasolabial Fold Wrinkles

BACKGROUND Safety, pain, duration of effect, and patient satisfaction are important concerns for physicians performing dermal filler injections. OBJECTIVE This randomized, double‐blind, split‐face study compared the 6‐month safety profile of dermal injections of calcium hydroxylapatite (CaHA) mixed with lidocaine (RDF‐L) with that of CaHA alone (RDF) in nasolabial folds (NLFs). The study also assessed differences in pain perception, efficacy, and patient satisfaction of RDF‐L and RDF for correction of nasolabial wrinkles. METHODS Sixteen adult subjects with moderate to deep NLFs according to the Lemperle Rating Scale were enrolled. Pain perception was recorded from patients using a validated visual analog pain scale. Efficacy judged by a blinded injector and an independent observer was evaluated up to 24 weeks. Patient satisfaction surveys were also collected. Adverse events were recorded throughout the study. RESULTS/CONCLUSIONS Neither RDF‐L nor RDF led to significant adverse events. Comparable and limited local adverse events typical of dermal fillers were noted in both groups. No difference in duration of effect in the NLFs was shown between RDF‐L and RDF. Much less pain was reported on the RDF‐L side. In general, patients were extremely satisfied with the treatment on both sides. BioForm Medical (San Mateo, CA) provided Radiesse soft tissue filler, lidocaine, and other necessary supplies. Dr. Grunebaum has received compensation for presentations to the medical community about products manufactured by BioForm Medical

Laser treatment of facial scars

Facial scars can develop as a result of trauma, surgery, burns, acne, or other conditions. These scars are often quite distressing to patients. Lasers were first used to treat these scars in the 1990s. Recently, new laser technology has been used to prevent and treat scars. This literature review and the report of the senior author's recent experience summarize the recent advances in laser treatment of scars. With the development of new laser technology, the treatment options for hypotrophic scars and developing scars have increased. Furthermore, there are expanded options for treatment of established hypertrophic scars. Recent studies have shown that nonablative and fractionated lasers can be effective for treating hypotrophic and developing scars. Scar improvements may be due to direct effects of the laser and/or histochemical effects, including production of heat shock proteins and tumor growth factors. Nonablative and fractionated lasers have a shorter recovery period than CO2 resurfacing lasers. This can vary from a few hours to up to 7 days. Recent new laser technology has increased the options for treatment of scars. These have been shown to be beneficial for hypotrophic, incipient, and established scars. The benefits of laser therapy may be due to direct and/or histochemical effects

Evaluating New Technology

There are multiple complex issues to consider when evaluating any new technology. First evaluate the efficacy of the device. Then considering your patient population decide whether this technology brings an added benefit to your patients. If it meets these 2 criteria, then proceed to the financial analysis of acquiring this technology. The complete financial analysis has several important components that include but are not limited to cost, value, alternatives, return on investment, and associated marketing expense

Safety and efficacy of 2,790-nm laser resurfacing for chest photoaging

Chest photodamage is a common cosmetic complaint. Laser treatment of the chest may be higher risk than other areas. The objective of this study was to assess the safety and efficacy of 2,790-nm chest resurfacing for photodamage. Twelve patients with Fitzpatrick skin types I-III were enrolled in this university IRB-approved study. Photo documentation was obtained at baseline and each visit. A test spot with the 2,790-nm resurfacing laser was performed on the chest. Patients who did not have adverse effects from the test spot went on to have a full chest resurfacing procedure. Patients were instructed on standardized aftercare, including sunscreen. A 5-point healing and photodamage improvement scale was used to rate improvement by both investigators and the patients and was obtained at 2 weeks, 1 month, 2 months, and 3 months. One pass chest treatment with the 2,790-nm resurfacing laser at fluences greater than or equal to 3.0 mJ with 10% overlap leads to unacceptable rates of hyperpigmentation. Double pass chest treatment at fluences less than or equal to 2.5 mJ with 10% overlap leads to mild improvement in chest photodamage parameters without significant or persistent adverse effects. Laser treatment of aging/photodamaged chest skin remains a challenge due to the delicacy of chest skin. Mild improvement may be obtained with double pass resurfacing with the 2,790-nm wavelength

1550-nm nonablative laser resurfacing for facial surgical scars

To investigate the efficacy of 1550-nm (Fraxel SR1500 RE:Store; Solta Medical, Hayward, California) nonablative laser treatment of facial surgical scars. In this prospective clinical study, a volunteer sample of 13 adults with Fitzpatrick skin types I to III and facial surgical scars with a postoperative duration longer than 6 months were enrolled. Subjects were treated once every 4 weeks for a total of 4 treatments. Initial settings for the 1550-nm nonablative laser were at energy level 40 mJ and treatment level 4 and were subsequently increased on each visit according to the patients' tolerance level. Using a previously validated Patient and Observer Scar Assessment Scale (POSAS), the study subject and an independent evaluator completed assessments of the scar at each visit. According to the Friedman test on ratings across all occasions after the first treatment to the last evaluation, there was a statistically significant improvement in the patient's assessment of the color, stiffness, thickness, and irregularity of the scar but not for pain or itching. For the observer's ratings, there was a statistically significant improvement in pigmentation, thickness, relief, and pliability but not for vascularization. Preliminary data suggest improved aesthetic results, demonstrating the potential use of fractional photothermolysis as a scar revision technique. Future studies with a longer follow-up period could elucidate the role of fractional photothermolysis in more permanent scar improvements