Aesthetic Dermatology

What does your patient need to know at the first visit?

In my practice, we try our best to start the education process before the patient even comes in for the first visit. If a patient is going to have a filler injection, we mail out an information packet that contains information on what to expect, how to minimize bruising, what side effects (eg, bruising, swelling) may occur, and what to avoid posttreatment. By providing them with this information prior to their visit, they can better plan their treatment around social and work obligations.

We ask patients to avoid or minimize blood-thinning agents such as aspirin, ibuprofen, fish oil, or vitamin E starting 2 weeks prior to and 1 week after the procedure. We recommend that patients take a pineapple extract such as bromelain 500 mg twice daily on an empty stomach starting 1 week prior to the treatment and for up to 1 week posttreatment. We ask that patients avoid exercise for 24 hours to reduce late-onset bruising and to avoid dental work for 2 weeks posttreatment to reduce the risk for the filler becoming infected.

What are your go-to treatments?

I use a variety of fillers depending on the area I am treating (thin vs thick skin) or the amount of lift I need (ie, G')(Restylane [Galderma Laboratories, LP] has a high G', thus it gives a lot of lift) versus the amount of water absorption I am seeking to further plump an area after the filler integrates (Juvéderm [Allergan] can absorb up to 300% its weight in water) versus the filler’s cohesiveness (Belotero [Merz Aesthetics] is highly cohesive). If I am treating a thin-faced individual, I may start with a global volumizer such as poly-L-lactic acid to get a good foundation set in the temples, cheeks, and jawline, and then after a few months, I will add a hyaluronic acid filler to focal areas that still need to be lifted (eg, nasolabial folds, tear troughs).

What are the side effects?

Side effects are divided into common and rare. Common would be bruising and swelling, which are temporary and will go away in all patients. Rare but serious side effects are infection and embolization. Both can cause notable tissue loss and risk to the patient. Every practitioner needs to know how to recognize and treat these complications should they arise.

How do you keep patients compliant?

Patients who get good results will always return, which means being up front about how much filler a patient needs and how frequently he/she will need it, and also doing everything we can to reduce bruising and swelling.


Suggested Readings

• Dayan SH, Arkins JP, Brindise R. Soft tissue fillers and biofilms. Facial Plast Surg. 2011;27:23-28.
• Orsini RA; Plastic Surgery Educational Technology Assessment Committee. Bromelain. Plast Reconstr Surg. 2006;118:1640-1644.

What does your patient need to know at the first visit?

In my practice, we try our best to start the education process before the patient even comes in for the first visit. If a patient is going to have a filler injection, we mail out an information packet that contains information on what to expect, how to minimize bruising, what side effects (eg, bruising, swelling) may occur, and what to avoid posttreatment. By providing them with this information prior to their visit, they can better plan their treatment around social and work obligations.

We ask patients to avoid or minimize blood-thinning agents such as aspirin, ibuprofen, fish oil, or vitamin E starting 2 weeks prior to and 1 week after the procedure. We recommend that patients take a pineapple extract such as bromelain 500 mg twice daily on an empty stomach starting 1 week prior to the treatment and for up to 1 week posttreatment. We ask that patients avoid exercise for 24 hours to reduce late-onset bruising and to avoid dental work for 2 weeks posttreatment to reduce the risk for the filler becoming infected.

What are your go-to treatments?

I use a variety of fillers depending on the area I am treating (thin vs thick skin) or the amount of lift I need (ie, G')(Restylane [Galderma Laboratories, LP] has a high G', thus it gives a lot of lift) versus the amount of water absorption I am seeking to further plump an area after the filler integrates (Juvéderm [Allergan] can absorb up to 300% its weight in water) versus the filler’s cohesiveness (Belotero [Merz Aesthetics] is highly cohesive). If I am treating a thin-faced individual, I may start with a global volumizer such as poly-L-lactic acid to get a good foundation set in the temples, cheeks, and jawline, and then after a few months, I will add a hyaluronic acid filler to focal areas that still need to be lifted (eg, nasolabial folds, tear troughs).

What are the side effects?

Side effects are divided into common and rare. Common would be bruising and swelling, which are temporary and will go away in all patients. Rare but serious side effects are infection and embolization. Both can cause notable tissue loss and risk to the patient. Every practitioner needs to know how to recognize and treat these complications should they arise.

How do you keep patients compliant?

Patients who get good results will always return, which means being up front about how much filler a patient needs and how frequently he/she will need it, and also doing everything we can to reduce bruising and swelling.


Suggested Readings

• Dayan SH, Arkins JP, Brindise R. Soft tissue fillers and biofilms. Facial Plast Surg. 2011;27:23-28.
• Orsini RA; Plastic Surgery Educational Technology Assessment Committee. Bromelain. Plast Reconstr Surg. 2006;118:1640-1644.

What does your patient need to know at the first visit?

In my practice, we try our best to start the education process before the patient even comes in for the first visit. If a patient is going to have a filler injection, we mail out an information packet that contains information on what to expect, how to minimize bruising, what side effects (eg, bruising, swelling) may occur, and what to avoid posttreatment. By providing them with this information prior to their visit, they can better plan their treatment around social and work obligations.

We ask patients to avoid or minimize blood-thinning agents such as aspirin, ibuprofen, fish oil, or vitamin E starting 2 weeks prior to and 1 week after the procedure. We recommend that patients take a pineapple extract such as bromelain 500 mg twice daily on an empty stomach starting 1 week prior to the treatment and for up to 1 week posttreatment. We ask that patients avoid exercise for 24 hours to reduce late-onset bruising and to avoid dental work for 2 weeks posttreatment to reduce the risk for the filler becoming infected.

What are your go-to treatments?

I use a variety of fillers depending on the area I am treating (thin vs thick skin) or the amount of lift I need (ie, G')(Restylane [Galderma Laboratories, LP] has a high G', thus it gives a lot of lift) versus the amount of water absorption I am seeking to further plump an area after the filler integrates (Juvéderm [Allergan] can absorb up to 300% its weight in water) versus the filler’s cohesiveness (Belotero [Merz Aesthetics] is highly cohesive). If I am treating a thin-faced individual, I may start with a global volumizer such as poly-L-lactic acid to get a good foundation set in the temples, cheeks, and jawline, and then after a few months, I will add a hyaluronic acid filler to focal areas that still need to be lifted (eg, nasolabial folds, tear troughs).

What are the side effects?

Side effects are divided into common and rare. Common would be bruising and swelling, which are temporary and will go away in all patients. Rare but serious side effects are infection and embolization. Both can cause notable tissue loss and risk to the patient. Every practitioner needs to know how to recognize and treat these complications should they arise.

How do you keep patients compliant?

Patients who get good results will always return, which means being up front about how much filler a patient needs and how frequently he/she will need it, and also doing everything we can to reduce bruising and swelling.


Suggested Readings

• Dayan SH, Arkins JP, Brindise R. Soft tissue fillers and biofilms. Facial Plast Surg. 2011;27:23-28.
• Orsini RA; Plastic Surgery Educational Technology Assessment Committee. Bromelain. Plast Reconstr Surg. 2006;118:1640-1644.

Ensuring patients have a realistic expectation of cosmetic procedures starts with good communication between the physician and patient. Dr. Emmy Graber describes how to have a happy patient and focuses on conversations with patients regarding downtime, side effects, and treatment results. She also addresses the financial consequences of cosmetic procedures.

Ensuring patients have a realistic expectation of cosmetic procedures starts with good communication between the physician and patient. Dr. Emmy Graber describes how to have a happy patient and focuses on conversations with patients regarding downtime, side effects, and treatment results. She also addresses the financial consequences of cosmetic procedures.

Ensuring patients have a realistic expectation of cosmetic procedures starts with good communication between the physician and patient. Dr. Emmy Graber describes how to have a happy patient and focuses on conversations with patients regarding downtime, side effects, and treatment results. She also addresses the financial consequences of cosmetic procedures.

In order to achieve optimal treatment results, clinicians must consider the anatomy of the head and neck when injecting cutaneous fillers in these areas. Dr. Anthony Rossi discusses the importance of knowing where and how to place the filler to attain the desired effect and provides practical tips for injecting the lateral cheeks, temple area, and masseter muscle.

In order to achieve optimal treatment results, clinicians must consider the anatomy of the head and neck when injecting cutaneous fillers in these areas. Dr. Anthony Rossi discusses the importance of knowing where and how to place the filler to attain the desired effect and provides practical tips for injecting the lateral cheeks, temple area, and masseter muscle.

In order to achieve optimal treatment results, clinicians must consider the anatomy of the head and neck when injecting cutaneous fillers in these areas. Dr. Anthony Rossi discusses the importance of knowing where and how to place the filler to attain the desired effect and provides practical tips for injecting the lateral cheeks, temple area, and masseter muscle.

BOSTON – Patients with rosacea, particularly the erythrotelangiectatic form, are considered good candidates for treatment with lasers and light therapies, but for acne, treatments with these therapies are still in the development stage.

For acne, treatments that are being studied include those that target the sebaceous glands, according to Mathew M. Avram, MD, who spoke about laser and light therapies for acne and rosacea at the American Academy of Dermatology summer meeting.

Light therapies for rosacea

Oxyhemoglobin in the blood absorbs light from lasers at wavelengths of about 595 nm (pulsed dye laser) and 532 nm (KTP laser), creating heat that helps destroy capillaries that contribute to the appearance of rosacea. Over a period of 3-4 weeks, the vessels are resorbed, and facial redness diminishes.

Patients with rosacea that are expected to do best with laser therapy are those with telangiectasia. Laser therapy is also effective for background redness but will be less effective for people with the papules associated with rosacea and “almost not effective at all for preventing flushing,” Dr. Avram said in an interview at the meeting.

Intense pulsed light (IPL) is another modality for treating rosacea. As with lasers, the mode of action is heating of certain structures and chromophores, causing their destruction and resorption, but unlike lasers, IPL output is broad spectrum and can be modified using filters.

With IPL, “basically, the endpoint that you want to see is transient purpural change, just a fleeting period of some black and blue, or if you’re treating vessels, you want to see vessel clearance when you’re firing the laser or the intense pulsed light,” said Dr. Avram, director of the Massachusetts General Hospital Dermatology Laser & Cosmetic Center, Boston.

On-screen settings of laser or IPL devices are essential, “but ultimately, if you want to have an effective treatment you really have to see what’s happening to your target … you need to pay attention to clinical endpoints, which is seeing that black and blue or that vessel clearance, not just paying attention to what’s on the screen.”

With IPL, too much pressure can compress vessels and blanch the skin, resulting in a less effective treatment, he added. He noted that tissue graying, whitening, or contraction indicates overly aggressive treatment, with the risk of scarring.

Certain factors can reduce the efficacy of IPL treatments of rosacea. Dr. Avram recommended against treating tanned skin and pointed out that anemic patients may benefit less from this approach since less hemoglobin presents a less-absorptive target for the treatments. He also advised particular caution when treating darker skin phototypes. But the most common factor that may make these treatments less effective is when a patient is on any type of anticoagulant, including NSAIDs or warfarin (Coumadin), because the mechanism of action is immediate microvascular hemorrhage, thrombosis, and eventual resorption.

For best results, Dr. Avram advises “appropriate overlap with the laser” to get an even and uniform improvement in the redness, with about a 15% overlap. Spacing laser spots too far apart can result in “foot printing,” the appearance of clearance in the areas of the laser pulse, but not in areas immediately around it “so it looks almost polka dotted.” After treatments, all patients should avoid the sun, he added.

What’s ahead for acne treatment

Until now, laser and light-based treatments for acne, “have provided inconsistent benefits for patients and all too often disappointing results,” Dr. Avram said in the interview. But several developments on the horizon may offer more effective therapies based on completely different technologies than are currently available. “Each of these therapies will be targeting the sebaceous glands in order to provide improved treatment for acne.”

One is a cryolysis device that uses cooling to selectively target lipids in the sebaceous glands. (Cryolysis is similar to cryolipolysis, which uses cooling to target fat cells.) The lipid-filled adipocytes are more sensitive to cold than is the water-rich dermis, thereby preserving the surrounding structures. There are also laser wavelengths that are absorbed by lipids, one of which is at about 1720 nm. In this case, heating rather than cooling targets the lipids.

Another technology in development is the use of nanoparticles coated with elements such as gold that are massaged through the skin into the sebaceous glands. Laser treatment with multiple different wavelengths targets the nanoparticles, heating them within the sebaceous glands, resulting in improvements in acne. In this case, treatment does not depend on the absorption spectrum of lipids. Clinical trials of this approach are now underway.

It is too early to tell which of these technologies is going to be effective or what potential side effects may occur. “However, the exciting news is that there will be multiple different technologies” designed to improve acne by targeting the sebaceous gland, and there is “the promise of potentially more effective noninvasive treatments that don’t require topical medications or oral medications,” Dr. Avram said.

For these potential new treatments, some objective outcome measure is needed to judge their efficacy. Right now, all that can be said is that they target the sebaceous gland, and clinical work still needs to be done to determine whether they will be effective, the degree of effectiveness, and how to optimize treatment, he noted.

Dr. Avram reported financial relationships with Cytrellis Biosystems, Invasix, Kythera, Masters of Aesthetics, Sciton, Zalea, and Zeltiq Aesthetics.

BOSTON – Patients with rosacea, particularly the erythrotelangiectatic form, are considered good candidates for treatment with lasers and light therapies, but for acne, treatments with these therapies are still in the development stage.

For acne, treatments that are being studied include those that target the sebaceous glands, according to Mathew M. Avram, MD, who spoke about laser and light therapies for acne and rosacea at the American Academy of Dermatology summer meeting.

Light therapies for rosacea

Oxyhemoglobin in the blood absorbs light from lasers at wavelengths of about 595 nm (pulsed dye laser) and 532 nm (KTP laser), creating heat that helps destroy capillaries that contribute to the appearance of rosacea. Over a period of 3-4 weeks, the vessels are resorbed, and facial redness diminishes.

Patients with rosacea that are expected to do best with laser therapy are those with telangiectasia. Laser therapy is also effective for background redness but will be less effective for people with the papules associated with rosacea and “almost not effective at all for preventing flushing,” Dr. Avram said in an interview at the meeting.

Intense pulsed light (IPL) is another modality for treating rosacea. As with lasers, the mode of action is heating of certain structures and chromophores, causing their destruction and resorption, but unlike lasers, IPL output is broad spectrum and can be modified using filters.

With IPL, “basically, the endpoint that you want to see is transient purpural change, just a fleeting period of some black and blue, or if you’re treating vessels, you want to see vessel clearance when you’re firing the laser or the intense pulsed light,” said Dr. Avram, director of the Massachusetts General Hospital Dermatology Laser & Cosmetic Center, Boston.

On-screen settings of laser or IPL devices are essential, “but ultimately, if you want to have an effective treatment you really have to see what’s happening to your target … you need to pay attention to clinical endpoints, which is seeing that black and blue or that vessel clearance, not just paying attention to what’s on the screen.”

With IPL, too much pressure can compress vessels and blanch the skin, resulting in a less effective treatment, he added. He noted that tissue graying, whitening, or contraction indicates overly aggressive treatment, with the risk of scarring.

Certain factors can reduce the efficacy of IPL treatments of rosacea. Dr. Avram recommended against treating tanned skin and pointed out that anemic patients may benefit less from this approach since less hemoglobin presents a less-absorptive target for the treatments. He also advised particular caution when treating darker skin phototypes. But the most common factor that may make these treatments less effective is when a patient is on any type of anticoagulant, including NSAIDs or warfarin (Coumadin), because the mechanism of action is immediate microvascular hemorrhage, thrombosis, and eventual resorption.

For best results, Dr. Avram advises “appropriate overlap with the laser” to get an even and uniform improvement in the redness, with about a 15% overlap. Spacing laser spots too far apart can result in “foot printing,” the appearance of clearance in the areas of the laser pulse, but not in areas immediately around it “so it looks almost polka dotted.” After treatments, all patients should avoid the sun, he added.

What’s ahead for acne treatment

Until now, laser and light-based treatments for acne, “have provided inconsistent benefits for patients and all too often disappointing results,” Dr. Avram said in the interview. But several developments on the horizon may offer more effective therapies based on completely different technologies than are currently available. “Each of these therapies will be targeting the sebaceous glands in order to provide improved treatment for acne.”

One is a cryolysis device that uses cooling to selectively target lipids in the sebaceous glands. (Cryolysis is similar to cryolipolysis, which uses cooling to target fat cells.) The lipid-filled adipocytes are more sensitive to cold than is the water-rich dermis, thereby preserving the surrounding structures. There are also laser wavelengths that are absorbed by lipids, one of which is at about 1720 nm. In this case, heating rather than cooling targets the lipids.

Another technology in development is the use of nanoparticles coated with elements such as gold that are massaged through the skin into the sebaceous glands. Laser treatment with multiple different wavelengths targets the nanoparticles, heating them within the sebaceous glands, resulting in improvements in acne. In this case, treatment does not depend on the absorption spectrum of lipids. Clinical trials of this approach are now underway.

It is too early to tell which of these technologies is going to be effective or what potential side effects may occur. “However, the exciting news is that there will be multiple different technologies” designed to improve acne by targeting the sebaceous gland, and there is “the promise of potentially more effective noninvasive treatments that don’t require topical medications or oral medications,” Dr. Avram said.

For these potential new treatments, some objective outcome measure is needed to judge their efficacy. Right now, all that can be said is that they target the sebaceous gland, and clinical work still needs to be done to determine whether they will be effective, the degree of effectiveness, and how to optimize treatment, he noted.

Dr. Avram reported financial relationships with Cytrellis Biosystems, Invasix, Kythera, Masters of Aesthetics, Sciton, Zalea, and Zeltiq Aesthetics.

BOSTON – Patients with rosacea, particularly the erythrotelangiectatic form, are considered good candidates for treatment with lasers and light therapies, but for acne, treatments with these therapies are still in the development stage.

For acne, treatments that are being studied include those that target the sebaceous glands, according to Mathew M. Avram, MD, who spoke about laser and light therapies for acne and rosacea at the American Academy of Dermatology summer meeting.

Light therapies for rosacea

Oxyhemoglobin in the blood absorbs light from lasers at wavelengths of about 595 nm (pulsed dye laser) and 532 nm (KTP laser), creating heat that helps destroy capillaries that contribute to the appearance of rosacea. Over a period of 3-4 weeks, the vessels are resorbed, and facial redness diminishes.

Patients with rosacea that are expected to do best with laser therapy are those with telangiectasia. Laser therapy is also effective for background redness but will be less effective for people with the papules associated with rosacea and “almost not effective at all for preventing flushing,” Dr. Avram said in an interview at the meeting.

Intense pulsed light (IPL) is another modality for treating rosacea. As with lasers, the mode of action is heating of certain structures and chromophores, causing their destruction and resorption, but unlike lasers, IPL output is broad spectrum and can be modified using filters.

With IPL, “basically, the endpoint that you want to see is transient purpural change, just a fleeting period of some black and blue, or if you’re treating vessels, you want to see vessel clearance when you’re firing the laser or the intense pulsed light,” said Dr. Avram, director of the Massachusetts General Hospital Dermatology Laser & Cosmetic Center, Boston.

On-screen settings of laser or IPL devices are essential, “but ultimately, if you want to have an effective treatment you really have to see what’s happening to your target … you need to pay attention to clinical endpoints, which is seeing that black and blue or that vessel clearance, not just paying attention to what’s on the screen.”

With IPL, too much pressure can compress vessels and blanch the skin, resulting in a less effective treatment, he added. He noted that tissue graying, whitening, or contraction indicates overly aggressive treatment, with the risk of scarring.

Certain factors can reduce the efficacy of IPL treatments of rosacea. Dr. Avram recommended against treating tanned skin and pointed out that anemic patients may benefit less from this approach since less hemoglobin presents a less-absorptive target for the treatments. He also advised particular caution when treating darker skin phototypes. But the most common factor that may make these treatments less effective is when a patient is on any type of anticoagulant, including NSAIDs or warfarin (Coumadin), because the mechanism of action is immediate microvascular hemorrhage, thrombosis, and eventual resorption.

For best results, Dr. Avram advises “appropriate overlap with the laser” to get an even and uniform improvement in the redness, with about a 15% overlap. Spacing laser spots too far apart can result in “foot printing,” the appearance of clearance in the areas of the laser pulse, but not in areas immediately around it “so it looks almost polka dotted.” After treatments, all patients should avoid the sun, he added.

What’s ahead for acne treatment

Until now, laser and light-based treatments for acne, “have provided inconsistent benefits for patients and all too often disappointing results,” Dr. Avram said in the interview. But several developments on the horizon may offer more effective therapies based on completely different technologies than are currently available. “Each of these therapies will be targeting the sebaceous glands in order to provide improved treatment for acne.”

One is a cryolysis device that uses cooling to selectively target lipids in the sebaceous glands. (Cryolysis is similar to cryolipolysis, which uses cooling to target fat cells.) The lipid-filled adipocytes are more sensitive to cold than is the water-rich dermis, thereby preserving the surrounding structures. There are also laser wavelengths that are absorbed by lipids, one of which is at about 1720 nm. In this case, heating rather than cooling targets the lipids.

Another technology in development is the use of nanoparticles coated with elements such as gold that are massaged through the skin into the sebaceous glands. Laser treatment with multiple different wavelengths targets the nanoparticles, heating them within the sebaceous glands, resulting in improvements in acne. In this case, treatment does not depend on the absorption spectrum of lipids. Clinical trials of this approach are now underway.

It is too early to tell which of these technologies is going to be effective or what potential side effects may occur. “However, the exciting news is that there will be multiple different technologies” designed to improve acne by targeting the sebaceous gland, and there is “the promise of potentially more effective noninvasive treatments that don’t require topical medications or oral medications,” Dr. Avram said.

For these potential new treatments, some objective outcome measure is needed to judge their efficacy. Right now, all that can be said is that they target the sebaceous gland, and clinical work still needs to be done to determine whether they will be effective, the degree of effectiveness, and how to optimize treatment, he noted.

Dr. Avram reported financial relationships with Cytrellis Biosystems, Invasix, Kythera, Masters of Aesthetics, Sciton, Zalea, and Zeltiq Aesthetics.

One of the most frustrating problems we encounter is helping patients with skin issues that we cannot immediately fix or cure. Teaching them the art of concealing skin blemishes gives patients a sense of relief. Color correction is an art and requires an understanding of basic color theory and Fitzpatrick skin type.

On the color wheel, each color sits directly across from another color, making them complementary colors.

Thoth_Adan (thinkstockimages)

If we look at red, the color opposing it is green. When red and green are combined, they neutralize each other. One of the greatest dermatologists of all time and my mentor, Timothy Berger, MD, taught me that in dermatology color “hue” is a clue to understanding morphology. Everything that is red cannot just be called “erythematous.” There is orange/red (pityriasis rosea, tinea versicolor, seborrheic dermatitis), deep red (cellulitis, Sweet’s syndrome, acne scars, rosacea, psoriasis), purple/red (vasculitis, lichen planus (LP), veins, under-eye circles), brown/red (pigmented purpura, pigmented acne scars, sarcoid).

The combination of the underlying pathology, morphology, and Fitzpatrick type is both a clue to diagnosis and a pallet for skin concealers. We can use the following techniques to help patients color correct skin imperfections:

Red: rosacea, acne scars, acne

Green-based concealers and primers are the best option to significantly reduce the redness. While green primers and correctors tend to be great for Fitzpatrick skin types I-III, a yellow-based concealer/corrector can help to cover redness on those with skin types IV-VI.

Blue: periorbital veins

If you are dealing with blue-toned skin lesions, such as periorbital veins, the ideal corrector is one with a peach or orange undertones. For skin types I-III, a peach/salmon corrector works best, whereas skin types IV-VI requires an orange-toned corrector.

Purple: under-eye circles, LP, postprocedure bruising

If under-eye circles tend to have a more purple hue to them, a yellow-based corrector works best for skin types I-III. For skin types IV-VI skin types, you will need a corrector with a red undertone.

Yellow: bruising

Purple/lavender correctors are best suited for eliminating yellow tones from the face. Purple also combats sallow undertones of the skin.

Brown: lentigines, melasma, seborrheic keratosis, post-inflammatory hyperpigmentation, nevi, café au lait spots

Brown is actually the hardest of all colors to correct. The deeper the pigment (ashy dermatitis, melasma) the more gray the areas appear with skin concealers. The more superficial the pigment (ephelides, lentigines), the easier it is to correct. Generally speaking, peach toned concealers work best, not beige or brown. The corrector, however, should be lighter than the skin tone or the lesion itself will appear darker.

Helping patients conceal imperfections with these simple guidelines is a great way to help relieve some anxiety and help our patients fell more confident in their skin.

Dr. Talakoub and Dr. Wesley are co-contributors to this column. Dr. Talakoub is in private practice in McLean, Va. Dr. Wesley practices dermatology in Beverly Hills, Calif. This month’s column is by Dr. Talakoub. Write to them at [email protected].

One of the most frustrating problems we encounter is helping patients with skin issues that we cannot immediately fix or cure. Teaching them the art of concealing skin blemishes gives patients a sense of relief. Color correction is an art and requires an understanding of basic color theory and Fitzpatrick skin type.

On the color wheel, each color sits directly across from another color, making them complementary colors.

Thoth_Adan (thinkstockimages)

If we look at red, the color opposing it is green. When red and green are combined, they neutralize each other. One of the greatest dermatologists of all time and my mentor, Timothy Berger, MD, taught me that in dermatology color “hue” is a clue to understanding morphology. Everything that is red cannot just be called “erythematous.” There is orange/red (pityriasis rosea, tinea versicolor, seborrheic dermatitis), deep red (cellulitis, Sweet’s syndrome, acne scars, rosacea, psoriasis), purple/red (vasculitis, lichen planus (LP), veins, under-eye circles), brown/red (pigmented purpura, pigmented acne scars, sarcoid).

The combination of the underlying pathology, morphology, and Fitzpatrick type is both a clue to diagnosis and a pallet for skin concealers. We can use the following techniques to help patients color correct skin imperfections:

Red: rosacea, acne scars, acne

Green-based concealers and primers are the best option to significantly reduce the redness. While green primers and correctors tend to be great for Fitzpatrick skin types I-III, a yellow-based concealer/corrector can help to cover redness on those with skin types IV-VI.

Blue: periorbital veins

If you are dealing with blue-toned skin lesions, such as periorbital veins, the ideal corrector is one with a peach or orange undertones. For skin types I-III, a peach/salmon corrector works best, whereas skin types IV-VI requires an orange-toned corrector.

Purple: under-eye circles, LP, postprocedure bruising

If under-eye circles tend to have a more purple hue to them, a yellow-based corrector works best for skin types I-III. For skin types IV-VI skin types, you will need a corrector with a red undertone.

Yellow: bruising

Purple/lavender correctors are best suited for eliminating yellow tones from the face. Purple also combats sallow undertones of the skin.

Brown: lentigines, melasma, seborrheic keratosis, post-inflammatory hyperpigmentation, nevi, café au lait spots

Brown is actually the hardest of all colors to correct. The deeper the pigment (ashy dermatitis, melasma) the more gray the areas appear with skin concealers. The more superficial the pigment (ephelides, lentigines), the easier it is to correct. Generally speaking, peach toned concealers work best, not beige or brown. The corrector, however, should be lighter than the skin tone or the lesion itself will appear darker.

Helping patients conceal imperfections with these simple guidelines is a great way to help relieve some anxiety and help our patients fell more confident in their skin.

Dr. Talakoub and Dr. Wesley are co-contributors to this column. Dr. Talakoub is in private practice in McLean, Va. Dr. Wesley practices dermatology in Beverly Hills, Calif. This month’s column is by Dr. Talakoub. Write to them at [email protected].

One of the most frustrating problems we encounter is helping patients with skin issues that we cannot immediately fix or cure. Teaching them the art of concealing skin blemishes gives patients a sense of relief. Color correction is an art and requires an understanding of basic color theory and Fitzpatrick skin type.

On the color wheel, each color sits directly across from another color, making them complementary colors.

Thoth_Adan (thinkstockimages)

If we look at red, the color opposing it is green. When red and green are combined, they neutralize each other. One of the greatest dermatologists of all time and my mentor, Timothy Berger, MD, taught me that in dermatology color “hue” is a clue to understanding morphology. Everything that is red cannot just be called “erythematous.” There is orange/red (pityriasis rosea, tinea versicolor, seborrheic dermatitis), deep red (cellulitis, Sweet’s syndrome, acne scars, rosacea, psoriasis), purple/red (vasculitis, lichen planus (LP), veins, under-eye circles), brown/red (pigmented purpura, pigmented acne scars, sarcoid).

The combination of the underlying pathology, morphology, and Fitzpatrick type is both a clue to diagnosis and a pallet for skin concealers. We can use the following techniques to help patients color correct skin imperfections:

Red: rosacea, acne scars, acne

Green-based concealers and primers are the best option to significantly reduce the redness. While green primers and correctors tend to be great for Fitzpatrick skin types I-III, a yellow-based concealer/corrector can help to cover redness on those with skin types IV-VI.

Blue: periorbital veins

If you are dealing with blue-toned skin lesions, such as periorbital veins, the ideal corrector is one with a peach or orange undertones. For skin types I-III, a peach/salmon corrector works best, whereas skin types IV-VI requires an orange-toned corrector.

Purple: under-eye circles, LP, postprocedure bruising

If under-eye circles tend to have a more purple hue to them, a yellow-based corrector works best for skin types I-III. For skin types IV-VI skin types, you will need a corrector with a red undertone.

Yellow: bruising

Purple/lavender correctors are best suited for eliminating yellow tones from the face. Purple also combats sallow undertones of the skin.

Brown: lentigines, melasma, seborrheic keratosis, post-inflammatory hyperpigmentation, nevi, café au lait spots

Brown is actually the hardest of all colors to correct. The deeper the pigment (ashy dermatitis, melasma) the more gray the areas appear with skin concealers. The more superficial the pigment (ephelides, lentigines), the easier it is to correct. Generally speaking, peach toned concealers work best, not beige or brown. The corrector, however, should be lighter than the skin tone or the lesion itself will appear darker.

Helping patients conceal imperfections with these simple guidelines is a great way to help relieve some anxiety and help our patients fell more confident in their skin.

Dr. Talakoub and Dr. Wesley are co-contributors to this column. Dr. Talakoub is in private practice in McLean, Va. Dr. Wesley practices dermatology in Beverly Hills, Calif. This month’s column is by Dr. Talakoub. Write to them at [email protected].

The use of psychotropic medications was similar between patients seeking cosmetic dermatology treatment and those presenting with medical dermatologic conditions in a study published in the Journal of Drugs in Dermatology.

A retrospective chart review of 154 adult female patients presenting for cosmetic dermatology and 156 presenting for medical reasons to a suburban dermatology private practice found that 26.8% of the cosmetic group and 22.2% of the medical group reported taking psychotropic medications (P = .09).

©moodboard/Thinkstock

The most common medication type was a selective serotonin reuptake inhibitor antidepressant, reported Dr. Heather K. Hamilton, a dermatologist in Chestnut Hill, Mass., at the time of the study, and her associates. An SSRI was used by 23 patients (56.1%) in the cosmetic group and 25 (71.4%) of the general dermatology patients, followed by benzodiazepines, tricyclic antidepressants, and attention-deficit/hyperactivity disorder medications (J Drugs Dermatol. 2016; 15 9[7]:858-61).

The study also found no significant difference between the two groups in self-reported record of a psychiatric disorder, with four such cases in the medical group and six in the cosmetic group (P = .139).

Cosmetic patients presenting for appearance-related dermatologic therapy are often perceived as being more difficult to satisfy than those with dermatologic problems, the authors noted. “While the reasons for this perception are many, some have hypothesized that this may be related to a higher rate of anxiety, mild depression, or body image issues among this patient population,” they wrote.

The authors referred to the high proportion of patients in both groups taking psychotropic medications in the study, a finding that was “even more striking” since the study excluded patients with conditions known to be associated with psychopathology, such as vitiligo, psoriasis, and neurotic excoriations.

“This finding serves as a reminder that we should take full medical histories as mental health may play a role in compliance and satisfaction with treatment,” the authors stated.

They acknowledged that there were limitations of the study, including using psychotropic medication as a marker for mental health problems and the use of self-reported data.

No conflicts of interest were declared. Dr. Hamilton now practices outside of New York.

The use of psychotropic medications was similar between patients seeking cosmetic dermatology treatment and those presenting with medical dermatologic conditions in a study published in the Journal of Drugs in Dermatology.

A retrospective chart review of 154 adult female patients presenting for cosmetic dermatology and 156 presenting for medical reasons to a suburban dermatology private practice found that 26.8% of the cosmetic group and 22.2% of the medical group reported taking psychotropic medications (P = .09).

©moodboard/Thinkstock

The most common medication type was a selective serotonin reuptake inhibitor antidepressant, reported Dr. Heather K. Hamilton, a dermatologist in Chestnut Hill, Mass., at the time of the study, and her associates. An SSRI was used by 23 patients (56.1%) in the cosmetic group and 25 (71.4%) of the general dermatology patients, followed by benzodiazepines, tricyclic antidepressants, and attention-deficit/hyperactivity disorder medications (J Drugs Dermatol. 2016; 15 9[7]:858-61).

The study also found no significant difference between the two groups in self-reported record of a psychiatric disorder, with four such cases in the medical group and six in the cosmetic group (P = .139).

Cosmetic patients presenting for appearance-related dermatologic therapy are often perceived as being more difficult to satisfy than those with dermatologic problems, the authors noted. “While the reasons for this perception are many, some have hypothesized that this may be related to a higher rate of anxiety, mild depression, or body image issues among this patient population,” they wrote.

The authors referred to the high proportion of patients in both groups taking psychotropic medications in the study, a finding that was “even more striking” since the study excluded patients with conditions known to be associated with psychopathology, such as vitiligo, psoriasis, and neurotic excoriations.

“This finding serves as a reminder that we should take full medical histories as mental health may play a role in compliance and satisfaction with treatment,” the authors stated.

They acknowledged that there were limitations of the study, including using psychotropic medication as a marker for mental health problems and the use of self-reported data.

No conflicts of interest were declared. Dr. Hamilton now practices outside of New York.

The use of psychotropic medications was similar between patients seeking cosmetic dermatology treatment and those presenting with medical dermatologic conditions in a study published in the Journal of Drugs in Dermatology.

A retrospective chart review of 154 adult female patients presenting for cosmetic dermatology and 156 presenting for medical reasons to a suburban dermatology private practice found that 26.8% of the cosmetic group and 22.2% of the medical group reported taking psychotropic medications (P = .09).

©moodboard/Thinkstock

The most common medication type was a selective serotonin reuptake inhibitor antidepressant, reported Dr. Heather K. Hamilton, a dermatologist in Chestnut Hill, Mass., at the time of the study, and her associates. An SSRI was used by 23 patients (56.1%) in the cosmetic group and 25 (71.4%) of the general dermatology patients, followed by benzodiazepines, tricyclic antidepressants, and attention-deficit/hyperactivity disorder medications (J Drugs Dermatol. 2016; 15 9[7]:858-61).

The study also found no significant difference between the two groups in self-reported record of a psychiatric disorder, with four such cases in the medical group and six in the cosmetic group (P = .139).

Cosmetic patients presenting for appearance-related dermatologic therapy are often perceived as being more difficult to satisfy than those with dermatologic problems, the authors noted. “While the reasons for this perception are many, some have hypothesized that this may be related to a higher rate of anxiety, mild depression, or body image issues among this patient population,” they wrote.

The authors referred to the high proportion of patients in both groups taking psychotropic medications in the study, a finding that was “even more striking” since the study excluded patients with conditions known to be associated with psychopathology, such as vitiligo, psoriasis, and neurotic excoriations.

“This finding serves as a reminder that we should take full medical histories as mental health may play a role in compliance and satisfaction with treatment,” the authors stated.

They acknowledged that there were limitations of the study, including using psychotropic medication as a marker for mental health problems and the use of self-reported data.

No conflicts of interest were declared. Dr. Hamilton now practices outside of New York.

The use of sterile or nonsterile gloves during outpatient dermatologic and dental procedures resulted in similar rates of postoperative surgical site infections (SSIs), results from a large systematic review and meta-analysis demonstrated.

“During the past few decades, the use of surgical gloves has become standard practice to prevent postoperative wound infections or surgical site infection,” researchers led by Dr. Jerry Brewer wrote in a study published online Aug. 3, 2016 in JAMA Dermatology. “However, whether the use of sterile vs. non-sterile gloves makes a difference in the development of postoperative SSIs in the setting of cutaneous and minor outpatient surgical procedures remains unclear.”

In an effort to examine that question, Dr. Brewer of the division of dermatologic surgery at Mayo Clinic, Rochester, Minn., and his associates conducted a systematic review and meta-analysis of randomized clinical trials and comparative studies with information on sterile vs. non-sterile gloves in outpatient surgical procedures (JAMA Dermatol. 2016 Aug. 3. doi: 10.1001/jamadermatol.2016.1965). Patients in the studies underwent outpatient cutaneous or mucosal surgical procedures, including Mohs micrographic surgery, repair of a laceration, standard excisions, and tooth extractions.

The final meta-analysis included 11,071 patients from 13 studies. Of these, 6,040 underwent procedures with sterile gloves and 5,031 underwent procedures with nonsterile gloves. The researchers reported that a total of 228 patients (2.1%) had a postoperative SSI, including 107 in the nonsterile glove group (2.1%), and 121 in the sterile glove group (2%). The overall relative risk for an SSI with nonsterile glove use was 1.06.

In an interview, Dr. Brewer estimated that sterile gloves cost anywhere from $0.27 to $1.29 per pair, compared with about 8 cents per pair for clean nonsterile gloves. “This cost difference may not seem like much, but if you think about all the surgeries that are done on a regular basis across the country, that’s a huge difference in cost,” he said.

The authors acknowledged certain limitations of the study, including the potential for selection bias, since many of the studies included in the meta-analysis were observational. They also noted that findings from some previous studies on the topic run counter to theirs (see Dermatol. Surg. 2010; 36[10]:1529-36 and J. Hosp. Infect. 2007;65[3]:258-63 ). “Although the broad use of nonsterile clean gloves may be justified, caution is advised in generalizing this justification to more advanced outpatient surgical procedures that may not pertain to the information summarized in this review and meta-analysis,” they concluded. “Future study could include whether duration of surgery and complexity of the repair influence postoperative SSI development in the setting of sterile vs. nonsterile gloves.”

The researchers reported having no financial disclosures.

[email protected]

The use of sterile or nonsterile gloves during outpatient dermatologic and dental procedures resulted in similar rates of postoperative surgical site infections (SSIs), results from a large systematic review and meta-analysis demonstrated.

“During the past few decades, the use of surgical gloves has become standard practice to prevent postoperative wound infections or surgical site infection,” researchers led by Dr. Jerry Brewer wrote in a study published online Aug. 3, 2016 in JAMA Dermatology. “However, whether the use of sterile vs. non-sterile gloves makes a difference in the development of postoperative SSIs in the setting of cutaneous and minor outpatient surgical procedures remains unclear.”

In an effort to examine that question, Dr. Brewer of the division of dermatologic surgery at Mayo Clinic, Rochester, Minn., and his associates conducted a systematic review and meta-analysis of randomized clinical trials and comparative studies with information on sterile vs. non-sterile gloves in outpatient surgical procedures (JAMA Dermatol. 2016 Aug. 3. doi: 10.1001/jamadermatol.2016.1965). Patients in the studies underwent outpatient cutaneous or mucosal surgical procedures, including Mohs micrographic surgery, repair of a laceration, standard excisions, and tooth extractions.

The final meta-analysis included 11,071 patients from 13 studies. Of these, 6,040 underwent procedures with sterile gloves and 5,031 underwent procedures with nonsterile gloves. The researchers reported that a total of 228 patients (2.1%) had a postoperative SSI, including 107 in the nonsterile glove group (2.1%), and 121 in the sterile glove group (2%). The overall relative risk for an SSI with nonsterile glove use was 1.06.

In an interview, Dr. Brewer estimated that sterile gloves cost anywhere from $0.27 to $1.29 per pair, compared with about 8 cents per pair for clean nonsterile gloves. “This cost difference may not seem like much, but if you think about all the surgeries that are done on a regular basis across the country, that’s a huge difference in cost,” he said.

The authors acknowledged certain limitations of the study, including the potential for selection bias, since many of the studies included in the meta-analysis were observational. They also noted that findings from some previous studies on the topic run counter to theirs (see Dermatol. Surg. 2010; 36[10]:1529-36 and J. Hosp. Infect. 2007;65[3]:258-63 ). “Although the broad use of nonsterile clean gloves may be justified, caution is advised in generalizing this justification to more advanced outpatient surgical procedures that may not pertain to the information summarized in this review and meta-analysis,” they concluded. “Future study could include whether duration of surgery and complexity of the repair influence postoperative SSI development in the setting of sterile vs. nonsterile gloves.”

The researchers reported having no financial disclosures.

[email protected]

The use of sterile or nonsterile gloves during outpatient dermatologic and dental procedures resulted in similar rates of postoperative surgical site infections (SSIs), results from a large systematic review and meta-analysis demonstrated.

“During the past few decades, the use of surgical gloves has become standard practice to prevent postoperative wound infections or surgical site infection,” researchers led by Dr. Jerry Brewer wrote in a study published online Aug. 3, 2016 in JAMA Dermatology. “However, whether the use of sterile vs. non-sterile gloves makes a difference in the development of postoperative SSIs in the setting of cutaneous and minor outpatient surgical procedures remains unclear.”

In an effort to examine that question, Dr. Brewer of the division of dermatologic surgery at Mayo Clinic, Rochester, Minn., and his associates conducted a systematic review and meta-analysis of randomized clinical trials and comparative studies with information on sterile vs. non-sterile gloves in outpatient surgical procedures (JAMA Dermatol. 2016 Aug. 3. doi: 10.1001/jamadermatol.2016.1965). Patients in the studies underwent outpatient cutaneous or mucosal surgical procedures, including Mohs micrographic surgery, repair of a laceration, standard excisions, and tooth extractions.

The final meta-analysis included 11,071 patients from 13 studies. Of these, 6,040 underwent procedures with sterile gloves and 5,031 underwent procedures with nonsterile gloves. The researchers reported that a total of 228 patients (2.1%) had a postoperative SSI, including 107 in the nonsterile glove group (2.1%), and 121 in the sterile glove group (2%). The overall relative risk for an SSI with nonsterile glove use was 1.06.

In an interview, Dr. Brewer estimated that sterile gloves cost anywhere from $0.27 to $1.29 per pair, compared with about 8 cents per pair for clean nonsterile gloves. “This cost difference may not seem like much, but if you think about all the surgeries that are done on a regular basis across the country, that’s a huge difference in cost,” he said.

The authors acknowledged certain limitations of the study, including the potential for selection bias, since many of the studies included in the meta-analysis were observational. They also noted that findings from some previous studies on the topic run counter to theirs (see Dermatol. Surg. 2010; 36[10]:1529-36 and J. Hosp. Infect. 2007;65[3]:258-63 ). “Although the broad use of nonsterile clean gloves may be justified, caution is advised in generalizing this justification to more advanced outpatient surgical procedures that may not pertain to the information summarized in this review and meta-analysis,” they concluded. “Future study could include whether duration of surgery and complexity of the repair influence postoperative SSI development in the setting of sterile vs. nonsterile gloves.”

The researchers reported having no financial disclosures.

[email protected]

Cosmetic dermatology patients are increasingly seeking hand rejuvenation procedures to eliminate appearance discrepancies between the face and hands, reported Ramin Fathi, MD, and Joel L. Cohen, MD, FAAD, who reviewed the benefits and complications of soft filler methods.

Pre-procedure evaluation includes assessing volume of lost fat from the skin via the Merz hand grading scale. Prior to augmentation, a detailed patient history, including medications, medical problems, and bleeding abnormalities, is typically taken, as well as assessment of patient lifestyle issues involving extensive hand activity, such as typing on a keyboard or playing piano. The authors reviewed three hand rejuvenation methods: autologous fat grafting, hyaluronic acid (HA), and poly-L-lactic acid (PLLA).

Although autologous fat grafting is still done in some practices, it is more invasive compared with soft tissue fillers, and can result in complications such as infection, cyst formation, temporary dysesthesia, and significant edema, the authors noted. PLLA is not approved for dorsal hand augmentation, and is used off label.

Hyaluronic acid (HA) fillers such as Restylane, Belotero, and Juvederm are approved only in the United States for facial soft tissue augmentation, and are also used off label for hand rejuvenation. The authors cited a small study of 16 patients evaluating small gel particle HA in the dorsal hand, in which vascular, tendon, bony prominence, and skin turgor were improved by 60.9%, 65.2%, 73.7%, and 26.3%, respectively, 2 weeks after treatment. “A distinct advantage of HA is that imperfections or undesired product can usually be reversed in the short term using hyaluronidase enzyme,” they added.

Despite the common adverse effects of erythema, pruritus, ecchymosis, and edema, “hand augmentation with soft tissue filler, alone or in conjunction with other rejuvenation modalities, can have a significant impact on improving appearance of the dorsal hands,” satisfying patient cosmetic objectives, the authors concluded.

Read the full article in the Journal of Drugs in Dermatology (J Drugs Dermatol. 2016;15[7]:809-15).

Cosmetic dermatology patients are increasingly seeking hand rejuvenation procedures to eliminate appearance discrepancies between the face and hands, reported Ramin Fathi, MD, and Joel L. Cohen, MD, FAAD, who reviewed the benefits and complications of soft filler methods.

Pre-procedure evaluation includes assessing volume of lost fat from the skin via the Merz hand grading scale. Prior to augmentation, a detailed patient history, including medications, medical problems, and bleeding abnormalities, is typically taken, as well as assessment of patient lifestyle issues involving extensive hand activity, such as typing on a keyboard or playing piano. The authors reviewed three hand rejuvenation methods: autologous fat grafting, hyaluronic acid (HA), and poly-L-lactic acid (PLLA).

Although autologous fat grafting is still done in some practices, it is more invasive compared with soft tissue fillers, and can result in complications such as infection, cyst formation, temporary dysesthesia, and significant edema, the authors noted. PLLA is not approved for dorsal hand augmentation, and is used off label.

Hyaluronic acid (HA) fillers such as Restylane, Belotero, and Juvederm are approved only in the United States for facial soft tissue augmentation, and are also used off label for hand rejuvenation. The authors cited a small study of 16 patients evaluating small gel particle HA in the dorsal hand, in which vascular, tendon, bony prominence, and skin turgor were improved by 60.9%, 65.2%, 73.7%, and 26.3%, respectively, 2 weeks after treatment. “A distinct advantage of HA is that imperfections or undesired product can usually be reversed in the short term using hyaluronidase enzyme,” they added.

Despite the common adverse effects of erythema, pruritus, ecchymosis, and edema, “hand augmentation with soft tissue filler, alone or in conjunction with other rejuvenation modalities, can have a significant impact on improving appearance of the dorsal hands,” satisfying patient cosmetic objectives, the authors concluded.

Read the full article in the Journal of Drugs in Dermatology (J Drugs Dermatol. 2016;15[7]:809-15).

Cosmetic dermatology patients are increasingly seeking hand rejuvenation procedures to eliminate appearance discrepancies between the face and hands, reported Ramin Fathi, MD, and Joel L. Cohen, MD, FAAD, who reviewed the benefits and complications of soft filler methods.

Pre-procedure evaluation includes assessing volume of lost fat from the skin via the Merz hand grading scale. Prior to augmentation, a detailed patient history, including medications, medical problems, and bleeding abnormalities, is typically taken, as well as assessment of patient lifestyle issues involving extensive hand activity, such as typing on a keyboard or playing piano. The authors reviewed three hand rejuvenation methods: autologous fat grafting, hyaluronic acid (HA), and poly-L-lactic acid (PLLA).

Although autologous fat grafting is still done in some practices, it is more invasive compared with soft tissue fillers, and can result in complications such as infection, cyst formation, temporary dysesthesia, and significant edema, the authors noted. PLLA is not approved for dorsal hand augmentation, and is used off label.

Hyaluronic acid (HA) fillers such as Restylane, Belotero, and Juvederm are approved only in the United States for facial soft tissue augmentation, and are also used off label for hand rejuvenation. The authors cited a small study of 16 patients evaluating small gel particle HA in the dorsal hand, in which vascular, tendon, bony prominence, and skin turgor were improved by 60.9%, 65.2%, 73.7%, and 26.3%, respectively, 2 weeks after treatment. “A distinct advantage of HA is that imperfections or undesired product can usually be reversed in the short term using hyaluronidase enzyme,” they added.

Despite the common adverse effects of erythema, pruritus, ecchymosis, and edema, “hand augmentation with soft tissue filler, alone or in conjunction with other rejuvenation modalities, can have a significant impact on improving appearance of the dorsal hands,” satisfying patient cosmetic objectives, the authors concluded.

Read the full article in the Journal of Drugs in Dermatology (J Drugs Dermatol. 2016;15[7]:809-15).

To improve patient care and outcomes, leading dermatologists offered their recommendations on lip balms. Consideration must be given to:
 

• Aquaphor Lip Repair
  Beiersdorf, Inc
  Recommended by Gary Goldenberg, MD, New York, New York
   
• CeraVe Healing Ointment
  Valeant Pharmaceuticals North America LLC
  “Combining ceramides with hyaluronic acid in a waxy ointment base, it hydrates, protects, and repairs the damaged skin barrier.”—Joshua Zeichner, MD, New York, New York
   
• Lip Balm #1
  Kiehl’s
  “It is quite moisturizing with squalene, aloe vera, vitamin E, and wheat germ oil.”—Anthony M. Rossi, MD, New York, New York
   
• Lip Renewal SPF 50
  June Jacobs Laboratories LLC
  “This lip balm contains shea butter and vitamin E for hydration with a hint of pomegranate flavor. It also provides photoprotection for daily use.”—Cherise M. Levi, DO, New York, New York
   
• Neutrogena Revitalizing Lip Balm SPF 20
  Johnson & Johnson Consumer Inc
  “It moisturizes the lips, protects from UV rays, and is available in a variety of shades. It should be reapplied frequently for UV protection.”—Shari Lipner, MD, PhD, New York, New York
   
• Vanicream Lip Protectant SPF 30
  Pharmaceutical Specialties, Inc
  “It has titanium dioxide for good UV protection.”—Anthony M. Rossi, MD, New York, New York
   
• Xtend Your Youth Lip Filler & Volumizer
  Dr. Brandt Skincare
  “This unique formula restores moisture and smooths the lip surface, creating a canvas for longer-lasting lip color. Its potent blend of antioxidants including vitamin E, green tea, white tea, and grape seed extract protects lips from free radical damage, while also working to reduce the look of lines and wrinkles.”—Whitney Bowe, MD, New York, New York
   

Cutis invites readers to send us their recommendations. Self-tanners and cleansing devices will be featured in upcoming editions of Cosmetic Corner. Please e-mail your recommendation(s) to the Editorial Office.

Disclaimer: Opinions expressed herein do not necessarily reflect those of Cutis or Frontline Medical Communications Inc. and shall not be used for product endorsement purposes. Any reference made to a specific commercial product does not indicate or imply that Cutis or Frontline Medical Communications Inc. endorses, recommends, or favors the product mentioned. No guarantee is given to the effects of recommended products.

To improve patient care and outcomes, leading dermatologists offered their recommendations on lip balms. Consideration must be given to:
 

• Aquaphor Lip Repair
  Beiersdorf, Inc
  Recommended by Gary Goldenberg, MD, New York, New York
   
• CeraVe Healing Ointment
  Valeant Pharmaceuticals North America LLC
  “Combining ceramides with hyaluronic acid in a waxy ointment base, it hydrates, protects, and repairs the damaged skin barrier.”—Joshua Zeichner, MD, New York, New York
   
• Lip Balm #1
  Kiehl’s
  “It is quite moisturizing with squalene, aloe vera, vitamin E, and wheat germ oil.”—Anthony M. Rossi, MD, New York, New York
   
• Lip Renewal SPF 50
  June Jacobs Laboratories LLC
  “This lip balm contains shea butter and vitamin E for hydration with a hint of pomegranate flavor. It also provides photoprotection for daily use.”—Cherise M. Levi, DO, New York, New York
   
• Neutrogena Revitalizing Lip Balm SPF 20
  Johnson & Johnson Consumer Inc
  “It moisturizes the lips, protects from UV rays, and is available in a variety of shades. It should be reapplied frequently for UV protection.”—Shari Lipner, MD, PhD, New York, New York
   
• Vanicream Lip Protectant SPF 30
  Pharmaceutical Specialties, Inc
  “It has titanium dioxide for good UV protection.”—Anthony M. Rossi, MD, New York, New York
   
• Xtend Your Youth Lip Filler & Volumizer
  Dr. Brandt Skincare
  “This unique formula restores moisture and smooths the lip surface, creating a canvas for longer-lasting lip color. Its potent blend of antioxidants including vitamin E, green tea, white tea, and grape seed extract protects lips from free radical damage, while also working to reduce the look of lines and wrinkles.”—Whitney Bowe, MD, New York, New York
   

Cutis invites readers to send us their recommendations. Self-tanners and cleansing devices will be featured in upcoming editions of Cosmetic Corner. Please e-mail your recommendation(s) to the Editorial Office.

Disclaimer: Opinions expressed herein do not necessarily reflect those of Cutis or Frontline Medical Communications Inc. and shall not be used for product endorsement purposes. Any reference made to a specific commercial product does not indicate or imply that Cutis or Frontline Medical Communications Inc. endorses, recommends, or favors the product mentioned. No guarantee is given to the effects of recommended products.

To improve patient care and outcomes, leading dermatologists offered their recommendations on lip balms. Consideration must be given to:
 

• Aquaphor Lip Repair
  Beiersdorf, Inc
  Recommended by Gary Goldenberg, MD, New York, New York
   
• CeraVe Healing Ointment
  Valeant Pharmaceuticals North America LLC
  “Combining ceramides with hyaluronic acid in a waxy ointment base, it hydrates, protects, and repairs the damaged skin barrier.”—Joshua Zeichner, MD, New York, New York
   
• Lip Balm #1
  Kiehl’s
  “It is quite moisturizing with squalene, aloe vera, vitamin E, and wheat germ oil.”—Anthony M. Rossi, MD, New York, New York
   
• Lip Renewal SPF 50
  June Jacobs Laboratories LLC
  “This lip balm contains shea butter and vitamin E for hydration with a hint of pomegranate flavor. It also provides photoprotection for daily use.”—Cherise M. Levi, DO, New York, New York
   
• Neutrogena Revitalizing Lip Balm SPF 20
  Johnson & Johnson Consumer Inc
  “It moisturizes the lips, protects from UV rays, and is available in a variety of shades. It should be reapplied frequently for UV protection.”—Shari Lipner, MD, PhD, New York, New York
   
• Vanicream Lip Protectant SPF 30
  Pharmaceutical Specialties, Inc
  “It has titanium dioxide for good UV protection.”—Anthony M. Rossi, MD, New York, New York
   
• Xtend Your Youth Lip Filler & Volumizer
  Dr. Brandt Skincare
  “This unique formula restores moisture and smooths the lip surface, creating a canvas for longer-lasting lip color. Its potent blend of antioxidants including vitamin E, green tea, white tea, and grape seed extract protects lips from free radical damage, while also working to reduce the look of lines and wrinkles.”—Whitney Bowe, MD, New York, New York
   

Cutis invites readers to send us their recommendations. Self-tanners and cleansing devices will be featured in upcoming editions of Cosmetic Corner. Please e-mail your recommendation(s) to the Editorial Office.

Disclaimer: Opinions expressed herein do not necessarily reflect those of Cutis or Frontline Medical Communications Inc. and shall not be used for product endorsement purposes. Any reference made to a specific commercial product does not indicate or imply that Cutis or Frontline Medical Communications Inc. endorses, recommends, or favors the product mentioned. No guarantee is given to the effects of recommended products.

NEWPORT BEACH, CALIF. – It’s unclear how well deoxycholic acid (Kybella) will work in the clinic because doctors and patients are generally opting for fewer injections and fewer treatment sessions than were evaluated in phase III studies, according to Lawrence Bass, MD.

The fat cytolytic was approved in 2015 for shrinking double chins, with up to six 50-injection sessions. In trials, patients tended to get more than 40 shots in their first two sessions and more than 30 in subsequent sessions. At that dosing, 40.5% of patients in one trial and 46% in another lost at least 10% of their submental volume on MRI, according to Food and Drug Administration review documents.

However, at the Summit in Aesthetic Medicine, Dr. Bass, a plastic surgeon in New York City, said that, in clinical practice, patients are typically being treated with 20 injections for two or three sessions – partly because of cost. “This product costs $300 for each 2 mL vial, which means in a typical 20-injection treatment, you use $600 of material,” he noted. An average treatment session in Manhattan costs patients about $1,500. In other parts of the country, sessions are probably around $1,200 each, he added.

Also, the necks of patients enrolled in trials “had to be pretty big, but the necks we are probably going to treat with this are the smaller and medium ones. The big ones are just going to do liposuction or something else,” he said. Given all the variables, “we don’t know how well the study experience is going to match clinical experience.”

Dr. Bass treated his first postapproval patient, a 52-year-old woman, with two 20-injection treatment sessions 2 months apart. “The fat definitely cleaned out” and her skin looked a bit tighter, but it’s tough to know if her skin truly tightened or simply draped flatter, he said.

FDA labeling notes that “the safe and effective use of Kybella for the treatment of subcutaneous fat outside the submental region has not been established and is not recommended,” but this advice is unlikely to keep doctors from trying it in off-label areas.

One issue is that “almost every other area is a whole lot bigger” than a double chin, Dr. Bass said. Treating a tummy with 50 injections six to eight times, for example, would cost patients $12,000-$15,000, which is “a whole lot more than lipo,” he added.

Also, administering more than 50 injections at a time for a larger area is not possible because of toxicity. Trying to get around that limit and cut costs by diluting deoxycholic acid or spacing the injections farther apart doesn’t seem to be an option, since phase II testing showed a loss of efficacy with that approach.

Dr. Bass tried deoxycholic acid on a woman with leftover tummy bulges following liposuction. After two 40-injection sessions, “there was still a little shape there, so I don’t think I’ll be doing that again,” he said at the meeting, which is held by Global Academy for Medical Education. Global Academy and this news organization are owned the same company.

Gynecomastia, meanwhile, would probably require too many shots, and the jowl, another potential target, is too close to the marginal mandibular branch of the facial nerve, “so you are not supposed to inject there,” Dr. Bass said. Diluted deoxycholic acid might be an option for bulging periorbital fat, “but I am going to let somebody who is braver than me try that for a while before I go there.”

Dr. Bass is an investigator and speaker for Cynosure, an investigator for Endo Pharmaceuticals and Neothetics, and an advisor to Merz. He participated in phase III testing of deoxycholic acid.

The indication approved for deoxycholic acid is “for improvement in the appearance of moderate to severe convexity or fullness associated with submental fat in adults.”

[email protected]

NEWPORT BEACH, CALIF. – It’s unclear how well deoxycholic acid (Kybella) will work in the clinic because doctors and patients are generally opting for fewer injections and fewer treatment sessions than were evaluated in phase III studies, according to Lawrence Bass, MD.

The fat cytolytic was approved in 2015 for shrinking double chins, with up to six 50-injection sessions. In trials, patients tended to get more than 40 shots in their first two sessions and more than 30 in subsequent sessions. At that dosing, 40.5% of patients in one trial and 46% in another lost at least 10% of their submental volume on MRI, according to Food and Drug Administration review documents.

However, at the Summit in Aesthetic Medicine, Dr. Bass, a plastic surgeon in New York City, said that, in clinical practice, patients are typically being treated with 20 injections for two or three sessions – partly because of cost. “This product costs $300 for each 2 mL vial, which means in a typical 20-injection treatment, you use $600 of material,” he noted. An average treatment session in Manhattan costs patients about $1,500. In other parts of the country, sessions are probably around $1,200 each, he added.

Also, the necks of patients enrolled in trials “had to be pretty big, but the necks we are probably going to treat with this are the smaller and medium ones. The big ones are just going to do liposuction or something else,” he said. Given all the variables, “we don’t know how well the study experience is going to match clinical experience.”

Dr. Bass treated his first postapproval patient, a 52-year-old woman, with two 20-injection treatment sessions 2 months apart. “The fat definitely cleaned out” and her skin looked a bit tighter, but it’s tough to know if her skin truly tightened or simply draped flatter, he said.

FDA labeling notes that “the safe and effective use of Kybella for the treatment of subcutaneous fat outside the submental region has not been established and is not recommended,” but this advice is unlikely to keep doctors from trying it in off-label areas.

One issue is that “almost every other area is a whole lot bigger” than a double chin, Dr. Bass said. Treating a tummy with 50 injections six to eight times, for example, would cost patients $12,000-$15,000, which is “a whole lot more than lipo,” he added.

Also, administering more than 50 injections at a time for a larger area is not possible because of toxicity. Trying to get around that limit and cut costs by diluting deoxycholic acid or spacing the injections farther apart doesn’t seem to be an option, since phase II testing showed a loss of efficacy with that approach.

Dr. Bass tried deoxycholic acid on a woman with leftover tummy bulges following liposuction. After two 40-injection sessions, “there was still a little shape there, so I don’t think I’ll be doing that again,” he said at the meeting, which is held by Global Academy for Medical Education. Global Academy and this news organization are owned the same company.

Gynecomastia, meanwhile, would probably require too many shots, and the jowl, another potential target, is too close to the marginal mandibular branch of the facial nerve, “so you are not supposed to inject there,” Dr. Bass said. Diluted deoxycholic acid might be an option for bulging periorbital fat, “but I am going to let somebody who is braver than me try that for a while before I go there.”

Dr. Bass is an investigator and speaker for Cynosure, an investigator for Endo Pharmaceuticals and Neothetics, and an advisor to Merz. He participated in phase III testing of deoxycholic acid.

The indication approved for deoxycholic acid is “for improvement in the appearance of moderate to severe convexity or fullness associated with submental fat in adults.”

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NEWPORT BEACH, CALIF. – It’s unclear how well deoxycholic acid (Kybella) will work in the clinic because doctors and patients are generally opting for fewer injections and fewer treatment sessions than were evaluated in phase III studies, according to Lawrence Bass, MD.

The fat cytolytic was approved in 2015 for shrinking double chins, with up to six 50-injection sessions. In trials, patients tended to get more than 40 shots in their first two sessions and more than 30 in subsequent sessions. At that dosing, 40.5% of patients in one trial and 46% in another lost at least 10% of their submental volume on MRI, according to Food and Drug Administration review documents.

However, at the Summit in Aesthetic Medicine, Dr. Bass, a plastic surgeon in New York City, said that, in clinical practice, patients are typically being treated with 20 injections for two or three sessions – partly because of cost. “This product costs $300 for each 2 mL vial, which means in a typical 20-injection treatment, you use $600 of material,” he noted. An average treatment session in Manhattan costs patients about $1,500. In other parts of the country, sessions are probably around $1,200 each, he added.

Also, the necks of patients enrolled in trials “had to be pretty big, but the necks we are probably going to treat with this are the smaller and medium ones. The big ones are just going to do liposuction or something else,” he said. Given all the variables, “we don’t know how well the study experience is going to match clinical experience.”

Dr. Bass treated his first postapproval patient, a 52-year-old woman, with two 20-injection treatment sessions 2 months apart. “The fat definitely cleaned out” and her skin looked a bit tighter, but it’s tough to know if her skin truly tightened or simply draped flatter, he said.

FDA labeling notes that “the safe and effective use of Kybella for the treatment of subcutaneous fat outside the submental region has not been established and is not recommended,” but this advice is unlikely to keep doctors from trying it in off-label areas.

One issue is that “almost every other area is a whole lot bigger” than a double chin, Dr. Bass said. Treating a tummy with 50 injections six to eight times, for example, would cost patients $12,000-$15,000, which is “a whole lot more than lipo,” he added.

Also, administering more than 50 injections at a time for a larger area is not possible because of toxicity. Trying to get around that limit and cut costs by diluting deoxycholic acid or spacing the injections farther apart doesn’t seem to be an option, since phase II testing showed a loss of efficacy with that approach.

Dr. Bass tried deoxycholic acid on a woman with leftover tummy bulges following liposuction. After two 40-injection sessions, “there was still a little shape there, so I don’t think I’ll be doing that again,” he said at the meeting, which is held by Global Academy for Medical Education. Global Academy and this news organization are owned the same company.

Gynecomastia, meanwhile, would probably require too many shots, and the jowl, another potential target, is too close to the marginal mandibular branch of the facial nerve, “so you are not supposed to inject there,” Dr. Bass said. Diluted deoxycholic acid might be an option for bulging periorbital fat, “but I am going to let somebody who is braver than me try that for a while before I go there.”

Dr. Bass is an investigator and speaker for Cynosure, an investigator for Endo Pharmaceuticals and Neothetics, and an advisor to Merz. He participated in phase III testing of deoxycholic acid.

The indication approved for deoxycholic acid is “for improvement in the appearance of moderate to severe convexity or fullness associated with submental fat in adults.”

[email protected]