Aesthetic Practices Treating More Dark-Skinned Patients

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World News Source For Treatment, Trends & Technology                                                                                                                                                                                    January/February 2009 | Vol. 4, issue 1

Aesthetic Practices Treating                                                                                                                                                                                                      Hydradermabrasion
                                                                                                                                                                                                                                  Shows Promise for
More Dark-Skinned Patients                                                                                                                                                                                                        Facial Rejuvenation
                                                                                                                                                                                                                                  The modality, which involves
Medical and technological                                                                                                                                                                                                         pneumatic application of an
advances have addressed                                                                                                                                                                                                           antioxidant serum, decreased
some important concerns                                                                                                                                                                                                           fine lines, pore size, and

C                                                                                                                                                                                                                                 P
            linicians historically have been wary of per-                                                                                                                                                                                 neumatic application of a
            forming various aesthetic procedures such                                                                                                                                                                                     polyphenolic antioxidant serum
            as chemical peeling and laser resurfacing in                                                                                                                                                                                  using hydradermabrasion—
            darker-skinned individuals out of concern for                                                                                                                                                                         a novel modality for nonablative
the potential side effects, such as post-inflammatory                                                                                                                                                                             facial rejuvenation—is associated
hyperpigmentation. Advances in aesthetic technique                                                                                                                                                                                with positive improvements in
and a greater comfort level among clinicians in treating                                                                                                                                                                          skin, whereas manual intermittent
darker skin, however, have given people of color greater                                                                                                                                                                          application of the serum does not,
opportunity to have appearance-enhancing treatments.                                                                                                                                                                              a study suggests.
                           “We have entered a new era of                                                                                                                                                                             “Hydradermabrasion, the term
                        dermatology in several respects,”                                                                                                                                                                         coined to describe the procedure
                        said Susan Taylor, M.D., assistant                                                                                                                                                                        that combines crystal-free micro-

                        clinical professor of dermatology at                                                                                                                                                                      dermabrasion using an abrading tip
                        Columbia University College of Phy-                                                                                                                                                                       with the pneumatic application of an
                        sicians and Surgeons in New York.                                                                                                                                                                         antioxidant-rich serum, represents
                           “First, clinical trials are includ-                                                                  and devices may work differently in people of color.”                                             another step in the evolution of mi-
                        ing people of color and a diverse sub-                                                                     Dr. Taylor helped found the Skin of Color Center at St.                                        crodermabrasion therapy,” said study
Susan Taylor, M.D.      ject population has become an FDA                                                                       Luke’s Roosevelt Hospital Center in New York almost a                                             investigator Bruce M. Freedman, M.D.,
requirement for medications as well as devices. Also, the                                                                       decade ago. Now, similar centers are popping up in cities                                         Medical Director of Plastic Surgery
pharmaceutical companies are interested in serving peo-                                                                         around the country, including Detroit, Miami, Boston, and                                         Associates of Northern Virginia in
ple of color. They are the fastest growing segment of the                                                                       Washington D.C., to name a few. Scientific advances have                                          McLean, Va.
population and will be in the majority in the year 2040. So,
there is a genuine interest in looking at how medications                                                                       aeStHetiC, see page 16                                                         >>                 HyDRaDeRmaBRaSion, see page 6                        >>

          By the numBers:                                                   non-invasive Procedures Offered                                                          Cellular Grafting Found Effective
       Botox treatment was the non-invasive procedure offered by the largest proportion of
       cosmetic surgery practices surveyed by the American Academy of Cosmetic Surgery in
       2007. Shown here are the five top non-invasive procedures according to the proportion of
                                                                                                                                                                     for Vitiligo in Difficult-To-Treat Sites
       practices offering them.                                                                                                                                      Autologous noncultured cellular graft-                       ligo. They graded repigmentation as
                                                                                                                                                                     ing may be a feasible therapeutic option                     excellent if there was 95 percent to 100
                                                                                                                                                                     for vitiligo in anatomic sites considered                    percent repigmentation of the treated
                                                                                                                                                                     difficult to treat, a study suggests.                        area, good if repigmentation was 65
                                                                                                                                    88%                                  Sanjeev V. Mulekar, M.D., and col-                       percent to 94 percent, fair if repigmen-
                                                                                                                                                                     leagues at the National Center for                           tation with 25 percent to 64 percent,
                                                                                                                         78%        Non-Invasive
                                                                                                                                      botox                          Vitiligo and Psoriasis in Riyadh, Saudi                      and poor if repigmentation was 0 per-
                                                                                                         69%                          Hyaluronic acid                Arabia, used noncultured melanocyte-                         cent to 24 percent. The following ana-
                                                                                                                                      Chemical Peels
                                                                                                                                      laser Hair removal             keratinocyte transplantation (MKT) to                        tomic sites were considered difficult
                                                                                                  65%                                 laser resurfacing              treat 40 patients (13 male, 27 female)                       to treat: fingers, toes, palms, elbows,
                                                                                                                                                                     with bilateral vitiligo and nine (four
      0              10             20              30             40             50              60                70         80         90        100              male, five female) with unilateral viti-                     GRaFtinG, see page 15                                >>
source: 2007 american academy of Cosmetic surgery Procedural statistics. access online at

                                                                                                                                                                                                                                  inside this issue >>
                                                                                                                                                   4       PDL found superior to IPL for
                                                                                                                                                           port-wine stain                      6    Once-weekly application of
                                                                                                                                                                                                     imiquimod cream improves
                                                                                                                                                                                                     actinic keratoses
                                                                                                                                                                                                                                           8 The Benefits of Lycopene
                                                                                                                                                                                                                                               By GaRy i. WeinBeRGeR, m.D., F.a.C.S.

                                                                                                                                                   4       A topical 2% tea lotion is an
                                                                                                                                                           effective option for treating acne
                                                                                                                                                                                                10   Medical Spas Get Creative
                                                                                                                                                                                                     With Downturn
                                                                                                                                                                                                                                           9   Are Botanical Extracts Safe and Effective?
                                                                                                                                                                                                                                               By Zoe Diana DRaeLoS, m.D.

                                                                                                                                                   6       Capryloyl salicylic acid peel
                                                                                                                                                           works as well as glycolic acid
                                                                                                                                                                                                18   The art and science of lip
                                                                                                                                                                                                                                           12 Around the World
                                                                                                                                                                                                                                           14 Global Literature Review
                                                                                                                                                                                                                                           24 Meetings
 6          aestHetiC Dermatology news | January/February 2009 |

    NeWs iN brief

Hydradermabrasion                              novel Chemical Peel Works as Well as Glycolic acid
shows Promise
>> continued from page 1                       Capryloyl salicylic acid
                                               may even be slightly better
    He randomized 20 female pa-                for facial rejuvenation,
tients aged 34-56 years into two               researchers say
groups. Group A underwent a series
of six facial hydradermabrasion                Capryloyl salicylic acid (LHA), a novel
treatments with the serum spaced               derivative of salicylic acid, is as effective
7-10 days apart. In Group B the same           as glycolic acid (GA) peel in decreasing
serum was applied manually to the              facial hyperpigmentation and fine lines/
skin for a total of six treatments at          wrinkles, data show.
7- to 10-day intervals.                           Investigators led by Christian
                                                                                               Photo illustration: alena brozova/Dreamstime

    Patients in Group A had an                 Oresajo, Ph.D., of L’Oréal Research in
increase in epidermal thickness,               Clark, N.J., conducted a split-face study
papillary dermal thickness, and poly-          of 50 female volunteers aged 35-60
phenolic antioxidant levels, according         years who had mild to moderate facial
to a report in the Journal of Cosmetic         hyperpigmentation and fine lines/
Dermatology (2008;7:275-280). In               wrinkles. At biweekly intervals for 12
addition, Dr. Freedman observed re-            weeks, subjects had LHA applied to
placement of elastotic dermal tissue,          one side of their face and GA to the                                                               Of the 44 subjects who completed            of LHA-treated and 34 percent of GA-
collagen hyalinization, and increased          other. Increasing peel concentrations                                                          the study, 41 percent of the LHA-treated        treated subjects had significant reduc-
fibroblast density. He also observed           were applied (5%-10% LHA or 20%-                                                               and 30 percent of the GA-treated sub-           tion of hyperpigmentation. Although
decreases in fine lines, pore size, and        50% GA) based on subjects’ tolerance                                                           jects showed significant reduction              LHA appeared to be slightly superior
hyperpigmentation following treat-             level and clinical observations of a                                                           of fine lines/wrinkles compared with            to GA, the differences between the two
ment. Patients reported no compli-             dermatologist. At week 12, patients                                                            baseline, the researchers reported in           treatments were not statistically signifi-
cations. Patients in Group B had no            returned to the dermatologist for a final                                                      the Journal of Cosmetic Dermatology             cant. LHA appeared to reduce dryness
change in skin structure, antioxidant          observation.                                                                                   (2008;7:259-262). In addition, 46 percent       and scaling better than GA peel.
levels, or clinical skin attributes.
    Dr. Freedman explained that
preparing the skin with the micro-
dermabrasion element appears to
increase skin penetration of the
antioxidants, which would explain
                                                  Imiquimod Cream Once Weekly Improves AK
the findings.                                     Local adverse effects                                                                        ment); and 4 (cured). Patients rated skin      the placebo-treated side.
    In a companion study, Dr. Freed-                                                                                                           irritation in the treatment area using a          In addition, the average total lesion
man showed that application of a
                                                  reportedly were minimal                                                                      six-point scale: 0 (no irritation); 1 (trace   number score on the imiquimod-treated
topical antioxidant serum enhances                when patients applied the                                                                    irritation); 2 (mild irritation); 3 (moder-    side decreased from 1.93 to 1.47; on
the effects of facial microdermabra-              cream less frequently than is                                                                ate irritation); 4 (marked irritation); and    the placebo side, the average score in-
sion. The study included 10 women                                                                                                              5 (severe irritation).                         creased from 2.07 to 2.13. No patient re-
aged 38-52 years who underwent
                                                  approved                                                                                         Five discontinued the study for rea-       ported skin irritation greater than mild.

six diamond-tip crystal-free micro-                    miquimod 5% cream applied once                                                          sons other than adverse effects. Of the        “Local adverse events, including local
dermabrasion facial treatments                         weekly for 24 weeks rather than                                                         15 patients who completed the study,           skin reactions, were minimal or non-
spaced 7-10 days apart. A poly-                        the approved regimen of twice                                                           six had marked improvement and one             existent in most patients,” the authors
phenol-rich antioxidant serum was                      weekly application for 16 weeks ef-                                                     was cured on the imiquimod-treated             noted. The investigators observed no
applied pneumatically to half the                 fectively treats actinic keratoses (AK)                                                      side, whereas only one patient had             serious or unexpected adverse events.
face immediately after each micro-                with minimal adverse effects, according
dermabrasion. Compared with skin                  to a study.
treated with microdermabrasion                        Joshua A. Zeichner, M.D., and his col-                                                    Regimen may be an option for patients concerned
alone, the skin treated with micro-               leagues at Mount Sinai Medical Center in                                                      about experiencing local skin reactions.
dermabrasion and antioxidant se-                  New York tested this new treatment regi-
rum showed significantly increased                men in 20 patients with at least six AK                                                      marked improvement on the placebo-                “Once weekly application of imiqui-
epidermal and papillary dermal                    lesions on the face, head, or scalp. For                                                     treated side, Dr. Zeichner’s group re-         mod 5% cream may be an appropriate
thickness and increased fibroblast                24 weeks, subjects applied imiquimod                                                         ported in the Journal of the American          option for patients concerned about ex-
density, Dr. Freedman reported                    5% cream to a 20 cm2 area on one side of                                                     Academy of Dermatology (2009;60:59-            periencing local skin reactions, especial-
in the Journal of Dermatological                  their head and placebo cream to a simi-                                                      62). All patients had some improvement         ly with respect to cosmetic appearance,
Treatment (2008; published online                 lar area on the other side. The research-                                                    on the imiquimod-treated side whereas          on the face or head during treatment,”
ahead of print). “This combination                ers evaluated patients with a seven-point                                                    six patients had no improvement and            the authors concluded. “This regimen
should strengthen the use of mi-                  investigator assessment scale (IAS): -2                                                      seven had slight worsening on the              may also serve as an alternative for pa-
crodermabrasion as a non-invasive                 (much worse); -1 (slightly worse); 0 (no                                                     placebo-treated side. The average              tients who have not adequately tolerated
facial rejuvenation tool and support              change); 1 (mild improvement); 2 (mod-                                                       change in IAS score was +2.20 for the          local skin reactions experienced with
the role of topical antioxidants as               erate improvement); 3 (marked improve-                                                       imiquimod-treated side versus -0.27 for        more frequent dosing.”
anti-aging factors,” he concluded.