www.adnmag.com TM 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 hyperpigmentation BY JOHN SCHIESZER 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- istockphoto 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 97% 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 www.cosmeticsurgery.org inside this issue >> 4 PDL found superior to IPL for port-wine stain 6 Once-weekly application of imiquimod cream improves actinic keratoses CommentaRy 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 implants DePaRtmentS 12 Around the World 14 Global Literature Review 24 Meetings 6 aestHetiC Dermatology news | January/February 2009 | www.adnmag.com 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. I 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.