Gary Goldenberg, MD

De Pasquale and colleagues (Aesthetic Plast Surg. 2013;37:587-591) published a review of the use of hyaluronic acid (HA) fillers for tear trough deformity. In this study, 22 patients were injected with HA filler and evaluated 7 days after injection; then after 1, 6, and 12 months; and then yearly up to 3 years (20/22 patients). High-frequency ultrasonography using a 15-MHz scanner with an axial resolution of 15 mm was utilized to evaluate the presence of filler at each follow-up visit. Injection technique with 3 punctures and filler deposit was used.

The amount of filler used in each area ranged from 0.1 to 0.3 mL (mean [standard deviation], 0.267±0.128 mL). At 1-week follow-up, 21 patients required another injection in the same area or adjacent to the injected area to improve the appearance. The filler was always identifiable by ultrasonography, and it was possible to measure the amount of filler in the tissue. Filler measurement during the first follow-up scan ranged from 4.31 to 1.81 mm (mean [standard deviation], 3.06±0.70 mm), whereas the last follow-up scan showed values ranging from 1 to 2.3 mm (mean [standard deviation], 1.40±0.29 mm).

What's the issue?

The study showed several interesting findings. The fact that ultrasonography can reliably show HA filler agent in this area is very interesting. Because the tear trough is one of the more sensitive areas we inject with HA, it may be useful to utilize this technology for follow-up patients. The ultrasound also showed that some HA filler was present for as long as 3 years, which confirms the clinical observation that patients require less agent at a greater duration in this area. The authors also stressed that the technique of 3 to 5 injections perpendicular to the skin below the orbital rim created filler deposits deep in the orbicularis oculi muscle and was safe and effective. Does this technique differ from the one you use? Do you use a different technique for different patients? Have you seen different results based on your technique?

We want to know your views! Tell us what you think.

De Pasquale and colleagues (Aesthetic Plast Surg. 2013;37:587-591) published a review of the use of hyaluronic acid (HA) fillers for tear trough deformity. In this study, 22 patients were injected with HA filler and evaluated 7 days after injection; then after 1, 6, and 12 months; and then yearly up to 3 years (20/22 patients). High-frequency ultrasonography using a 15-MHz scanner with an axial resolution of 15 mm was utilized to evaluate the presence of filler at each follow-up visit. Injection technique with 3 punctures and filler deposit was used.

The amount of filler used in each area ranged from 0.1 to 0.3 mL (mean [standard deviation], 0.267±0.128 mL). At 1-week follow-up, 21 patients required another injection in the same area or adjacent to the injected area to improve the appearance. The filler was always identifiable by ultrasonography, and it was possible to measure the amount of filler in the tissue. Filler measurement during the first follow-up scan ranged from 4.31 to 1.81 mm (mean [standard deviation], 3.06±0.70 mm), whereas the last follow-up scan showed values ranging from 1 to 2.3 mm (mean [standard deviation], 1.40±0.29 mm).

What's the issue?

The study showed several interesting findings. The fact that ultrasonography can reliably show HA filler agent in this area is very interesting. Because the tear trough is one of the more sensitive areas we inject with HA, it may be useful to utilize this technology for follow-up patients. The ultrasound also showed that some HA filler was present for as long as 3 years, which confirms the clinical observation that patients require less agent at a greater duration in this area. The authors also stressed that the technique of 3 to 5 injections perpendicular to the skin below the orbital rim created filler deposits deep in the orbicularis oculi muscle and was safe and effective. Does this technique differ from the one you use? Do you use a different technique for different patients? Have you seen different results based on your technique?

We want to know your views! Tell us what you think.

De Pasquale and colleagues (Aesthetic Plast Surg. 2013;37:587-591) published a review of the use of hyaluronic acid (HA) fillers for tear trough deformity. In this study, 22 patients were injected with HA filler and evaluated 7 days after injection; then after 1, 6, and 12 months; and then yearly up to 3 years (20/22 patients). High-frequency ultrasonography using a 15-MHz scanner with an axial resolution of 15 mm was utilized to evaluate the presence of filler at each follow-up visit. Injection technique with 3 punctures and filler deposit was used.

The amount of filler used in each area ranged from 0.1 to 0.3 mL (mean [standard deviation], 0.267±0.128 mL). At 1-week follow-up, 21 patients required another injection in the same area or adjacent to the injected area to improve the appearance. The filler was always identifiable by ultrasonography, and it was possible to measure the amount of filler in the tissue. Filler measurement during the first follow-up scan ranged from 4.31 to 1.81 mm (mean [standard deviation], 3.06±0.70 mm), whereas the last follow-up scan showed values ranging from 1 to 2.3 mm (mean [standard deviation], 1.40±0.29 mm).

What's the issue?

The study showed several interesting findings. The fact that ultrasonography can reliably show HA filler agent in this area is very interesting. Because the tear trough is one of the more sensitive areas we inject with HA, it may be useful to utilize this technology for follow-up patients. The ultrasound also showed that some HA filler was present for as long as 3 years, which confirms the clinical observation that patients require less agent at a greater duration in this area. The authors also stressed that the technique of 3 to 5 injections perpendicular to the skin below the orbital rim created filler deposits deep in the orbicularis oculi muscle and was safe and effective. Does this technique differ from the one you use? Do you use a different technique for different patients? Have you seen different results based on your technique?

We want to know your views! Tell us what you think.

The US Food and Drug Administration recently approved a new use for Botox Cosmetic (onabotulinumtoxinA)(Allergan, Inc): temporary improvement in the appearance of moderate to severe crow’s-feet (lateral canthal lines). As reported in the prescribing information, 2 placebo-controlled clinical studies evaluated 833 adult participants with moderate to severe lateral canthal lines. Each participant received 4 U of onabotulinumtoxinA or placebo into 3 sites per side for a total of 24 U in the lateral orbicularis oculi muscle. The first injection was placed approximately 1.5 to 2.0 cm temporal to the lateral canthus and just temporal to the orbital rim. The second and third injection was either above and below, respectively, the first injection or both below the first injection depending on the appearance of wrinkles. Results showed that participants treated with onabotulinumtoxinA had greater improvement compared to placebo in the appearance of crow’s-feet. The most common side effect was lid edema, which occurred in 1% of participants.

What’s the issue?

Although dermatologists and cosmetic surgeons have been using onabotulinumtoxinA and other neurotoxins for treatment of crow’s-feet for a long time (off label), it is now approved for this indication. The volume used on label also is important because it gives guidance as to how much product can be used. Of course each patient is different and many clinicians may decide to use more or less product to achieve a desired correction. The fact that onabotulinumtoxinA is now deemed safe to be used in the crow’s-feet area also is important because it gives the physician some medical/legal protection. Will this approval really change anything that you currently do or don’t do?

We want to know your views! Tell us what you think.

The US Food and Drug Administration recently approved a new use for Botox Cosmetic (onabotulinumtoxinA)(Allergan, Inc): temporary improvement in the appearance of moderate to severe crow’s-feet (lateral canthal lines). As reported in the prescribing information, 2 placebo-controlled clinical studies evaluated 833 adult participants with moderate to severe lateral canthal lines. Each participant received 4 U of onabotulinumtoxinA or placebo into 3 sites per side for a total of 24 U in the lateral orbicularis oculi muscle. The first injection was placed approximately 1.5 to 2.0 cm temporal to the lateral canthus and just temporal to the orbital rim. The second and third injection was either above and below, respectively, the first injection or both below the first injection depending on the appearance of wrinkles. Results showed that participants treated with onabotulinumtoxinA had greater improvement compared to placebo in the appearance of crow’s-feet. The most common side effect was lid edema, which occurred in 1% of participants.

What’s the issue?

Although dermatologists and cosmetic surgeons have been using onabotulinumtoxinA and other neurotoxins for treatment of crow’s-feet for a long time (off label), it is now approved for this indication. The volume used on label also is important because it gives guidance as to how much product can be used. Of course each patient is different and many clinicians may decide to use more or less product to achieve a desired correction. The fact that onabotulinumtoxinA is now deemed safe to be used in the crow’s-feet area also is important because it gives the physician some medical/legal protection. Will this approval really change anything that you currently do or don’t do?

We want to know your views! Tell us what you think.

The US Food and Drug Administration recently approved a new use for Botox Cosmetic (onabotulinumtoxinA)(Allergan, Inc): temporary improvement in the appearance of moderate to severe crow’s-feet (lateral canthal lines). As reported in the prescribing information, 2 placebo-controlled clinical studies evaluated 833 adult participants with moderate to severe lateral canthal lines. Each participant received 4 U of onabotulinumtoxinA or placebo into 3 sites per side for a total of 24 U in the lateral orbicularis oculi muscle. The first injection was placed approximately 1.5 to 2.0 cm temporal to the lateral canthus and just temporal to the orbital rim. The second and third injection was either above and below, respectively, the first injection or both below the first injection depending on the appearance of wrinkles. Results showed that participants treated with onabotulinumtoxinA had greater improvement compared to placebo in the appearance of crow’s-feet. The most common side effect was lid edema, which occurred in 1% of participants.

What’s the issue?

Although dermatologists and cosmetic surgeons have been using onabotulinumtoxinA and other neurotoxins for treatment of crow’s-feet for a long time (off label), it is now approved for this indication. The volume used on label also is important because it gives guidance as to how much product can be used. Of course each patient is different and many clinicians may decide to use more or less product to achieve a desired correction. The fact that onabotulinumtoxinA is now deemed safe to be used in the crow’s-feet area also is important because it gives the physician some medical/legal protection. Will this approval really change anything that you currently do or don’t do?

We want to know your views! Tell us what you think.

Weiss and colleagues (J Am Acad Dermatol. 2013;68:98-102) conducted a 6-month safety, tolerance, and efficacy trial of nonablative 1927-nm fractional resurfacing of facial actinic keratosis (AK) with the Fraxel Dual (Solta Medical) laser. Twenty-four patients (5 male; 19 female) underwent up to 4 facial treatments with the 1927-nm laser with a 6-month follow-up period. The average patient age was 60 years, and Fitzpatrick skin types I and II were most common. Skin biopsy was performed in 7 patients prior to the initial procedure and at the 6-month follow-up.

Overall, there was an 86.6% reduction in absolute number of AK lesions at the 6-month follow-up visit. Cosmetic improvement was assessed on a 4-point scale. At the end of the 6-month study, the patients graded their improvement as 3.04 and investigators graded the improvement as 3.54. All 7 patient biopsies confirmed AK prior to treatment. At 6-month follow-up, 6 specimens (85.7%) showed histologic evidence of AK clearance.

What’s the issue?

The fractionated 1927-nm nonablative thulium laser is approved by the US Food and Drug Administration for the treatment of AK. Fraxel works by creating thermal zones, and the thermal damage targets AK lesions in the superficial skin. Actinic keratosis, the second most common condition treated by dermatologists, has many therapeutic options, including cryosurgery, photodynamic therapy, and multiple topical agents.

According to this study, 1927-nm fractional resurfacing appears to be a promising option for facial AK treatment. The added cosmetic benefit is a huge plus for many patients. More studies with long-term follow-up are needed.

How do you use Fraxel Dual to treat AK?

We want to know your views! Tell us what you think.

Weiss and colleagues (J Am Acad Dermatol. 2013;68:98-102) conducted a 6-month safety, tolerance, and efficacy trial of nonablative 1927-nm fractional resurfacing of facial actinic keratosis (AK) with the Fraxel Dual (Solta Medical) laser. Twenty-four patients (5 male; 19 female) underwent up to 4 facial treatments with the 1927-nm laser with a 6-month follow-up period. The average patient age was 60 years, and Fitzpatrick skin types I and II were most common. Skin biopsy was performed in 7 patients prior to the initial procedure and at the 6-month follow-up.

Overall, there was an 86.6% reduction in absolute number of AK lesions at the 6-month follow-up visit. Cosmetic improvement was assessed on a 4-point scale. At the end of the 6-month study, the patients graded their improvement as 3.04 and investigators graded the improvement as 3.54. All 7 patient biopsies confirmed AK prior to treatment. At 6-month follow-up, 6 specimens (85.7%) showed histologic evidence of AK clearance.

What’s the issue?

The fractionated 1927-nm nonablative thulium laser is approved by the US Food and Drug Administration for the treatment of AK. Fraxel works by creating thermal zones, and the thermal damage targets AK lesions in the superficial skin. Actinic keratosis, the second most common condition treated by dermatologists, has many therapeutic options, including cryosurgery, photodynamic therapy, and multiple topical agents.

According to this study, 1927-nm fractional resurfacing appears to be a promising option for facial AK treatment. The added cosmetic benefit is a huge plus for many patients. More studies with long-term follow-up are needed.

How do you use Fraxel Dual to treat AK?

We want to know your views! Tell us what you think.

Weiss and colleagues (J Am Acad Dermatol. 2013;68:98-102) conducted a 6-month safety, tolerance, and efficacy trial of nonablative 1927-nm fractional resurfacing of facial actinic keratosis (AK) with the Fraxel Dual (Solta Medical) laser. Twenty-four patients (5 male; 19 female) underwent up to 4 facial treatments with the 1927-nm laser with a 6-month follow-up period. The average patient age was 60 years, and Fitzpatrick skin types I and II were most common. Skin biopsy was performed in 7 patients prior to the initial procedure and at the 6-month follow-up.

Overall, there was an 86.6% reduction in absolute number of AK lesions at the 6-month follow-up visit. Cosmetic improvement was assessed on a 4-point scale. At the end of the 6-month study, the patients graded their improvement as 3.04 and investigators graded the improvement as 3.54. All 7 patient biopsies confirmed AK prior to treatment. At 6-month follow-up, 6 specimens (85.7%) showed histologic evidence of AK clearance.

What’s the issue?

The fractionated 1927-nm nonablative thulium laser is approved by the US Food and Drug Administration for the treatment of AK. Fraxel works by creating thermal zones, and the thermal damage targets AK lesions in the superficial skin. Actinic keratosis, the second most common condition treated by dermatologists, has many therapeutic options, including cryosurgery, photodynamic therapy, and multiple topical agents.

According to this study, 1927-nm fractional resurfacing appears to be a promising option for facial AK treatment. The added cosmetic benefit is a huge plus for many patients. More studies with long-term follow-up are needed.

How do you use Fraxel Dual to treat AK?

We want to know your views! Tell us what you think.