Doug Brunk

DANA POINT, CALIF. (IMNG) – It may seem counterintuitive, but fractional ablative lasers have become a mainstay for treating all types of scars.

At a meeting sponsored by SkinCare Physicians and Northwestern University, Dr. Jill Waibel said that fractional lasers provide symptomatic relief, functional improvement, and rehabilitation to the target scars. "Lasers are emerging as the standard of care for scars," said Dr. Waibel, a dermatologic surgeon with the Miami Dermatology and Laser Institute.

"If you’re not using these on your scars, your patients may be missing out," she said. The effects are "permanent, powerful, and they can change the lives of your patients."

She favors a multimodal approach to scar treatment that she likened to a three-course meal. For the "appetizer," she’ll use one of several lasers to remove color from the scar. "I’ll use a vascular laser if it’s red; I’ll use a thulium or Q-switched laser if it’s hyperpigmented. I’ll use a nonablative fractional laser if it’s an atrophic scar."

The "main course" involves same-day treatment of the scar with a fractional ablative device such as the fractional ablative carbon dioxide or fractional ablative erbium laser. She uses a low density of 10% and recommends matching the depth of the laser to the depth of the scar, which typically amounts to 600-800 mcm.

For "dessert," she’ll use adjunctive therapies such as triamcinolone acetonide, 5-fluorouracil, hyaluronidase, Z-plasty, punch biopsies, compression, or subcision. "If you do these procedures together you are really going to increase your results," Dr. Waibel said. "The more procedures, the better. You don’t hit a wall like you often do treating port-wine stains. If you want to get 70%-90% improvement, you’re looking at between seven and nine treatments."

Clinicians are also using lasers to assist in the delivery of certain agents to enhance scar healing. For example, Dr. Waibel and her associates found that combination same-session therapy with laser-assisted delivery of triamcinolone acetonide offered efficient, safe, and effective treatment of challenging scars (Lasers Surg. Med. 2013;45:135-40). She has also conducted similar studies that involve the laser-assisted delivery of 5-fluorouracil to the scar site, which inhibits cell proliferation of fibroblasts.

Currently, Dr. Waibel and her colleagues at the University of Miami are working on a pilot study supported by the Department of Defense to test the hypothesis that ablative fractional lasers could deliver mesenchymal stem cells to skin using a porcine full-thickness wound model. So far, "we have shown that the stem cell can be delivered either autologously or allogeneically," she said. "It creates a woundless scar and re-creates the epidermal ridges. Fractional lasers are one of our greatest discoveries."

Dr. Waibel disclosed that she is a speaker for and has received honoraria for equipment or clinical trials from numerous device and skin care product manufacturers.

dbrunk@frontlinemedcom.com

DANA POINT, CALIF. (IMNG) – It may seem counterintuitive, but fractional ablative lasers have become a mainstay for treating all types of scars.

At a meeting sponsored by SkinCare Physicians and Northwestern University, Dr. Jill Waibel said that fractional lasers provide symptomatic relief, functional improvement, and rehabilitation to the target scars. "Lasers are emerging as the standard of care for scars," said Dr. Waibel, a dermatologic surgeon with the Miami Dermatology and Laser Institute.

"If you’re not using these on your scars, your patients may be missing out," she said. The effects are "permanent, powerful, and they can change the lives of your patients."

She favors a multimodal approach to scar treatment that she likened to a three-course meal. For the "appetizer," she’ll use one of several lasers to remove color from the scar. "I’ll use a vascular laser if it’s red; I’ll use a thulium or Q-switched laser if it’s hyperpigmented. I’ll use a nonablative fractional laser if it’s an atrophic scar."

The "main course" involves same-day treatment of the scar with a fractional ablative device such as the fractional ablative carbon dioxide or fractional ablative erbium laser. She uses a low density of 10% and recommends matching the depth of the laser to the depth of the scar, which typically amounts to 600-800 mcm.

For "dessert," she’ll use adjunctive therapies such as triamcinolone acetonide, 5-fluorouracil, hyaluronidase, Z-plasty, punch biopsies, compression, or subcision. "If you do these procedures together you are really going to increase your results," Dr. Waibel said. "The more procedures, the better. You don’t hit a wall like you often do treating port-wine stains. If you want to get 70%-90% improvement, you’re looking at between seven and nine treatments."

Clinicians are also using lasers to assist in the delivery of certain agents to enhance scar healing. For example, Dr. Waibel and her associates found that combination same-session therapy with laser-assisted delivery of triamcinolone acetonide offered efficient, safe, and effective treatment of challenging scars (Lasers Surg. Med. 2013;45:135-40). She has also conducted similar studies that involve the laser-assisted delivery of 5-fluorouracil to the scar site, which inhibits cell proliferation of fibroblasts.

Currently, Dr. Waibel and her colleagues at the University of Miami are working on a pilot study supported by the Department of Defense to test the hypothesis that ablative fractional lasers could deliver mesenchymal stem cells to skin using a porcine full-thickness wound model. So far, "we have shown that the stem cell can be delivered either autologously or allogeneically," she said. "It creates a woundless scar and re-creates the epidermal ridges. Fractional lasers are one of our greatest discoveries."

Dr. Waibel disclosed that she is a speaker for and has received honoraria for equipment or clinical trials from numerous device and skin care product manufacturers.

dbrunk@frontlinemedcom.com

DANA POINT, CALIF. (IMNG) – It may seem counterintuitive, but fractional ablative lasers have become a mainstay for treating all types of scars.

At a meeting sponsored by SkinCare Physicians and Northwestern University, Dr. Jill Waibel said that fractional lasers provide symptomatic relief, functional improvement, and rehabilitation to the target scars. "Lasers are emerging as the standard of care for scars," said Dr. Waibel, a dermatologic surgeon with the Miami Dermatology and Laser Institute.

"If you’re not using these on your scars, your patients may be missing out," she said. The effects are "permanent, powerful, and they can change the lives of your patients."

She favors a multimodal approach to scar treatment that she likened to a three-course meal. For the "appetizer," she’ll use one of several lasers to remove color from the scar. "I’ll use a vascular laser if it’s red; I’ll use a thulium or Q-switched laser if it’s hyperpigmented. I’ll use a nonablative fractional laser if it’s an atrophic scar."

The "main course" involves same-day treatment of the scar with a fractional ablative device such as the fractional ablative carbon dioxide or fractional ablative erbium laser. She uses a low density of 10% and recommends matching the depth of the laser to the depth of the scar, which typically amounts to 600-800 mcm.

For "dessert," she’ll use adjunctive therapies such as triamcinolone acetonide, 5-fluorouracil, hyaluronidase, Z-plasty, punch biopsies, compression, or subcision. "If you do these procedures together you are really going to increase your results," Dr. Waibel said. "The more procedures, the better. You don’t hit a wall like you often do treating port-wine stains. If you want to get 70%-90% improvement, you’re looking at between seven and nine treatments."

Clinicians are also using lasers to assist in the delivery of certain agents to enhance scar healing. For example, Dr. Waibel and her associates found that combination same-session therapy with laser-assisted delivery of triamcinolone acetonide offered efficient, safe, and effective treatment of challenging scars (Lasers Surg. Med. 2013;45:135-40). She has also conducted similar studies that involve the laser-assisted delivery of 5-fluorouracil to the scar site, which inhibits cell proliferation of fibroblasts.

Currently, Dr. Waibel and her colleagues at the University of Miami are working on a pilot study supported by the Department of Defense to test the hypothesis that ablative fractional lasers could deliver mesenchymal stem cells to skin using a porcine full-thickness wound model. So far, "we have shown that the stem cell can be delivered either autologously or allogeneically," she said. "It creates a woundless scar and re-creates the epidermal ridges. Fractional lasers are one of our greatest discoveries."

Dr. Waibel disclosed that she is a speaker for and has received honoraria for equipment or clinical trials from numerous device and skin care product manufacturers.

dbrunk@frontlinemedcom.com

SAN DIEGO – Family medicine residents reported that documentation time increased by about 16 minutes per patient encounter following implementation of an electronic health record system at two academic medical institutions in Southern California.

"We have learned about how electronic health records are going to improve our patient care and our efficiency in the clinic but not a lot of studies have explored how the implementation of an electronic health record at academic centers is going to impact resident education," Dr. Maisara Rahman said in an interview during a poster session at the annual meeting of the American Academy of Family Physicians.

Dr. Rahman and her associates surveyed 122 family medicine residents, attending physicians, and other clinical staff from Riverside County Regional Medical Center (RCRMC) and Pomona Valley Hospital Medical Center (PVHMC) to assess their perceptions about the adequacy of EHR training, the amount of time spent on documentation, and the effects of EHRs on patient care and resident education. Of the 122 people surveyed, 99 responded, for a response rate of 83%.

Dr. Rahman, in the department of family medicine at Loma Linda University and an attending physician in the department of family medicine at RCRMC, reported that there was an overall decrease in resident productivity at both academic institutions following implementation of the EHR: a 30% decrease at RCRMC and a 20% decrease at PVHMC. Overall, respondents indicated that EHR documentation took about 16 minutes longer to complete compared with documentation by paper chart (an average of 37 vs. 21 minutes, respectively.)

The residents also reported missing an average of two educational didactic lecture sessions per month in order to complete EHR notes. In addition to missing didactic lectures, residents from both institutions used an average of 45 minutes of personal time to complete notes for a typical half-day clinic. "That’s pretty significant," Dr. Rahman said. "Resident satisfaction with EHR implementation was highly correlated with whether the respondents had adequate EHR training. When we compared the residents from the two academic sites, we noticed that a lot of the RCRMC residents were not satisfied and were not happy with the system. They were less efficient and less productive in clinic, and it was correlated to the training hours. This is most likely related to RCRMC being a county facility and there are fewer resources to provide adequate EHR training for residents."

In their poster, the researchers concluded that as academic teaching hospitals implement EHRs to meet financial incentives for meaningful use, "it is imperative that these institutions customize and implement EHR systems that enhance and support resident education. EHR has a unique potential to become an educational tool if it is customized and developed for resident education. The traditional teaching methods in ambulatory clinics will need to adapt to a more innovative, technology-enhanced learning environment. Further research is needed to identify improved EHR systems that optimize and enhance residents’ education."

The researchers stated that they had no relevant financial conflicts to disclose.

dbrunk@frontlinemedcom.com

SAN DIEGO – Family medicine residents reported that documentation time increased by about 16 minutes per patient encounter following implementation of an electronic health record system at two academic medical institutions in Southern California.

"We have learned about how electronic health records are going to improve our patient care and our efficiency in the clinic but not a lot of studies have explored how the implementation of an electronic health record at academic centers is going to impact resident education," Dr. Maisara Rahman said in an interview during a poster session at the annual meeting of the American Academy of Family Physicians.

Dr. Rahman and her associates surveyed 122 family medicine residents, attending physicians, and other clinical staff from Riverside County Regional Medical Center (RCRMC) and Pomona Valley Hospital Medical Center (PVHMC) to assess their perceptions about the adequacy of EHR training, the amount of time spent on documentation, and the effects of EHRs on patient care and resident education. Of the 122 people surveyed, 99 responded, for a response rate of 83%.

Dr. Rahman, in the department of family medicine at Loma Linda University and an attending physician in the department of family medicine at RCRMC, reported that there was an overall decrease in resident productivity at both academic institutions following implementation of the EHR: a 30% decrease at RCRMC and a 20% decrease at PVHMC. Overall, respondents indicated that EHR documentation took about 16 minutes longer to complete compared with documentation by paper chart (an average of 37 vs. 21 minutes, respectively.)

The residents also reported missing an average of two educational didactic lecture sessions per month in order to complete EHR notes. In addition to missing didactic lectures, residents from both institutions used an average of 45 minutes of personal time to complete notes for a typical half-day clinic. "That’s pretty significant," Dr. Rahman said. "Resident satisfaction with EHR implementation was highly correlated with whether the respondents had adequate EHR training. When we compared the residents from the two academic sites, we noticed that a lot of the RCRMC residents were not satisfied and were not happy with the system. They were less efficient and less productive in clinic, and it was correlated to the training hours. This is most likely related to RCRMC being a county facility and there are fewer resources to provide adequate EHR training for residents."

In their poster, the researchers concluded that as academic teaching hospitals implement EHRs to meet financial incentives for meaningful use, "it is imperative that these institutions customize and implement EHR systems that enhance and support resident education. EHR has a unique potential to become an educational tool if it is customized and developed for resident education. The traditional teaching methods in ambulatory clinics will need to adapt to a more innovative, technology-enhanced learning environment. Further research is needed to identify improved EHR systems that optimize and enhance residents’ education."

The researchers stated that they had no relevant financial conflicts to disclose.

dbrunk@frontlinemedcom.com

SAN DIEGO – Family medicine residents reported that documentation time increased by about 16 minutes per patient encounter following implementation of an electronic health record system at two academic medical institutions in Southern California.

"We have learned about how electronic health records are going to improve our patient care and our efficiency in the clinic but not a lot of studies have explored how the implementation of an electronic health record at academic centers is going to impact resident education," Dr. Maisara Rahman said in an interview during a poster session at the annual meeting of the American Academy of Family Physicians.

Dr. Rahman and her associates surveyed 122 family medicine residents, attending physicians, and other clinical staff from Riverside County Regional Medical Center (RCRMC) and Pomona Valley Hospital Medical Center (PVHMC) to assess their perceptions about the adequacy of EHR training, the amount of time spent on documentation, and the effects of EHRs on patient care and resident education. Of the 122 people surveyed, 99 responded, for a response rate of 83%.

Dr. Rahman, in the department of family medicine at Loma Linda University and an attending physician in the department of family medicine at RCRMC, reported that there was an overall decrease in resident productivity at both academic institutions following implementation of the EHR: a 30% decrease at RCRMC and a 20% decrease at PVHMC. Overall, respondents indicated that EHR documentation took about 16 minutes longer to complete compared with documentation by paper chart (an average of 37 vs. 21 minutes, respectively.)

The residents also reported missing an average of two educational didactic lecture sessions per month in order to complete EHR notes. In addition to missing didactic lectures, residents from both institutions used an average of 45 minutes of personal time to complete notes for a typical half-day clinic. "That’s pretty significant," Dr. Rahman said. "Resident satisfaction with EHR implementation was highly correlated with whether the respondents had adequate EHR training. When we compared the residents from the two academic sites, we noticed that a lot of the RCRMC residents were not satisfied and were not happy with the system. They were less efficient and less productive in clinic, and it was correlated to the training hours. This is most likely related to RCRMC being a county facility and there are fewer resources to provide adequate EHR training for residents."

In their poster, the researchers concluded that as academic teaching hospitals implement EHRs to meet financial incentives for meaningful use, "it is imperative that these institutions customize and implement EHR systems that enhance and support resident education. EHR has a unique potential to become an educational tool if it is customized and developed for resident education. The traditional teaching methods in ambulatory clinics will need to adapt to a more innovative, technology-enhanced learning environment. Further research is needed to identify improved EHR systems that optimize and enhance residents’ education."

The researchers stated that they had no relevant financial conflicts to disclose.

dbrunk@frontlinemedcom.com

SAN DIEGO – Family medicine residents reported that documentation time increased by about 16 minutes per patient encounter following implementation of an electronic health record system at two academic medical institutions in Southern California.

"We have learned about how electronic health records are going to improve our patient care and our efficiency in the clinic but not a lot of studies have explored how the implementation of an electronic health record at academic centers is going to impact resident education," Dr. Maisara Rahman said in an interview during a poster session at the annual meeting of the American Academy of Family Physicians.

Dr. Rahman and her associates surveyed 122 family medicine residents, attending physicians, and other clinical staff from Riverside County Regional Medical Center (RCRMC) and Pomona Valley Hospital Medical Center (PVHMC) to assess their perceptions about the adequacy of EHR training, the amount of time spent on documentation, and the effects of EHRs on patient care and resident education. Of the 122 people surveyed, 99 responded, for a response rate of 83%.

Dr. Rahman, in the department of family medicine at Loma Linda University and an attending physician in the department of family medicine at RCRMC, reported that there was an overall decrease in resident productivity at both academic institutions following implementation of the EHR: a 30% decrease at RCRMC and a 20% decrease at PVHMC. Overall, respondents indicated that EHR documentation took about 16 minutes longer to complete compared with documentation by paper chart (an average of 37 vs. 21 minutes, respectively.)

The residents also reported missing an average of two educational didactic lecture sessions per month in order to complete EHR notes. In addition to missing didactic lectures, residents from both institutions used an average of 45 minutes of personal time to complete notes for a typical half-day clinic. "That’s pretty significant," Dr. Rahman said. "Resident satisfaction with EHR implementation was highly correlated with whether the respondents had adequate EHR training. When we compared the residents from the two academic sites, we noticed that a lot of the RCRMC residents were not satisfied and were not happy with the system. They were less efficient and less productive in clinic, and it was correlated to the training hours. This is most likely related to RCRMC being a county facility and there are fewer resources to provide adequate EHR training for residents."

In their poster, the researchers concluded that as academic teaching hospitals implement EHRs to meet financial incentives for meaningful use, "it is imperative that these institutions customize and implement EHR systems that enhance and support resident education. EHR has a unique potential to become an educational tool if it is customized and developed for resident education. The traditional teaching methods in ambulatory clinics will need to adapt to a more innovative, technology-enhanced learning environment. Further research is needed to identify improved EHR systems that optimize and enhance residents’ education."

The researchers stated that they had no relevant financial conflicts to disclose.

dbrunk@frontlinemedcom.com

SAN DIEGO – Family medicine residents reported that documentation time increased by about 16 minutes per patient encounter following implementation of an electronic health record system at two academic medical institutions in Southern California.

"We have learned about how electronic health records are going to improve our patient care and our efficiency in the clinic but not a lot of studies have explored how the implementation of an electronic health record at academic centers is going to impact resident education," Dr. Maisara Rahman said in an interview during a poster session at the annual meeting of the American Academy of Family Physicians.

Dr. Rahman and her associates surveyed 122 family medicine residents, attending physicians, and other clinical staff from Riverside County Regional Medical Center (RCRMC) and Pomona Valley Hospital Medical Center (PVHMC) to assess their perceptions about the adequacy of EHR training, the amount of time spent on documentation, and the effects of EHRs on patient care and resident education. Of the 122 people surveyed, 99 responded, for a response rate of 83%.

Dr. Rahman, in the department of family medicine at Loma Linda University and an attending physician in the department of family medicine at RCRMC, reported that there was an overall decrease in resident productivity at both academic institutions following implementation of the EHR: a 30% decrease at RCRMC and a 20% decrease at PVHMC. Overall, respondents indicated that EHR documentation took about 16 minutes longer to complete compared with documentation by paper chart (an average of 37 vs. 21 minutes, respectively.)

The residents also reported missing an average of two educational didactic lecture sessions per month in order to complete EHR notes. In addition to missing didactic lectures, residents from both institutions used an average of 45 minutes of personal time to complete notes for a typical half-day clinic. "That’s pretty significant," Dr. Rahman said. "Resident satisfaction with EHR implementation was highly correlated with whether the respondents had adequate EHR training. When we compared the residents from the two academic sites, we noticed that a lot of the RCRMC residents were not satisfied and were not happy with the system. They were less efficient and less productive in clinic, and it was correlated to the training hours. This is most likely related to RCRMC being a county facility and there are fewer resources to provide adequate EHR training for residents."

In their poster, the researchers concluded that as academic teaching hospitals implement EHRs to meet financial incentives for meaningful use, "it is imperative that these institutions customize and implement EHR systems that enhance and support resident education. EHR has a unique potential to become an educational tool if it is customized and developed for resident education. The traditional teaching methods in ambulatory clinics will need to adapt to a more innovative, technology-enhanced learning environment. Further research is needed to identify improved EHR systems that optimize and enhance residents’ education."

The researchers stated that they had no relevant financial conflicts to disclose.

dbrunk@frontlinemedcom.com

SAN DIEGO – Family medicine residents reported that documentation time increased by about 16 minutes per patient encounter following implementation of an electronic health record system at two academic medical institutions in Southern California.

"We have learned about how electronic health records are going to improve our patient care and our efficiency in the clinic but not a lot of studies have explored how the implementation of an electronic health record at academic centers is going to impact resident education," Dr. Maisara Rahman said in an interview during a poster session at the annual meeting of the American Academy of Family Physicians.

Dr. Rahman and her associates surveyed 122 family medicine residents, attending physicians, and other clinical staff from Riverside County Regional Medical Center (RCRMC) and Pomona Valley Hospital Medical Center (PVHMC) to assess their perceptions about the adequacy of EHR training, the amount of time spent on documentation, and the effects of EHRs on patient care and resident education. Of the 122 people surveyed, 99 responded, for a response rate of 83%.

Dr. Rahman, in the department of family medicine at Loma Linda University and an attending physician in the department of family medicine at RCRMC, reported that there was an overall decrease in resident productivity at both academic institutions following implementation of the EHR: a 30% decrease at RCRMC and a 20% decrease at PVHMC. Overall, respondents indicated that EHR documentation took about 16 minutes longer to complete compared with documentation by paper chart (an average of 37 vs. 21 minutes, respectively.)

The residents also reported missing an average of two educational didactic lecture sessions per month in order to complete EHR notes. In addition to missing didactic lectures, residents from both institutions used an average of 45 minutes of personal time to complete notes for a typical half-day clinic. "That’s pretty significant," Dr. Rahman said. "Resident satisfaction with EHR implementation was highly correlated with whether the respondents had adequate EHR training. When we compared the residents from the two academic sites, we noticed that a lot of the RCRMC residents were not satisfied and were not happy with the system. They were less efficient and less productive in clinic, and it was correlated to the training hours. This is most likely related to RCRMC being a county facility and there are fewer resources to provide adequate EHR training for residents."

In their poster, the researchers concluded that as academic teaching hospitals implement EHRs to meet financial incentives for meaningful use, "it is imperative that these institutions customize and implement EHR systems that enhance and support resident education. EHR has a unique potential to become an educational tool if it is customized and developed for resident education. The traditional teaching methods in ambulatory clinics will need to adapt to a more innovative, technology-enhanced learning environment. Further research is needed to identify improved EHR systems that optimize and enhance residents’ education."

The researchers stated that they had no relevant financial conflicts to disclose.

dbrunk@frontlinemedcom.com

DANA POINT, CALIF. – For skin tightening, there’s no comparison between surgical and nonsurgical approaches as far as quality, predictability, and longevity, according to Dr. A. Jay Burns.

"Anyone who suggests to patients that nonsurgical contouring and rejuvenation share comparable results is either self-serving, dishonest, grossly naive, or misinformed," said Dr. Burns of the Dallas Plastic Surgery Institute. "In my opinion, surgical treatments are extremely reliable and nonsurgical treatments are extremely variable. But I’m not in an ivory tower. I realize that [surgical approaches result in] more complications and that they’re more expensive."

Surgical skin tightening involves total elevation, full repositioning, centimeter changes, and control, with predictable, clear results, he said at the meeting, sponsored by SkinCare Physicians and Northwestern University.

On the other hand, nonsurgical skin tightening involves no elevation, no repositioning, millimeter changes, and no control. This leads to results that he characterized as "unpredictable and subtle."

Dr. Burns acknowledged certain advantages of nonsurgical skin tightening approaches, such as the fact that they’re typically less expensive (except for brow dynamic line elimination), they eliminate the risk of nerve damage, and they require less downtime. He said he advises clinicians to recommend nonsurgical skin tightening for patients who prioritize downtime, cost, and risk over results. Surgical skin tightening is for those who want optimal results, maximum quality and predictability, and elegance, he said.

Dr. Burns said that there is "a clear place for" nonsurgical skin tightening techniques in his practice, and he emphasized the importance of fostering integrity during patient consultations. This includes informed consent, representing the technology honestly, and being honest with patients about expectations from procedures that you offer. Such practice "shows character and aids your reputation," he said. "It also prioritizes patient care over revenue."

He noted that the ThermiRF, developed by Southlake, Tex.–based ThermiAesthetics, represents a promising advance in noninvasive skin technology because it features a continuous temperature monitor on its internal probe. This radiofrequency device enables the user to administer the precise amount of heat for the collagen layer, Dr. Burns said. "There are some really nice results on the skin and neck," he said.

Dr. Burns disclosed that he has received equipment loans or discounts on equipment from Cynosure, Zeltiq Aesthetics, and other companies. He has held stock or stock options with Skin Medica and Zeltiq and has received honoraria from Solta Medical and Ulthera. He is an advisory board member for Cynosure, Ulthera, and Zeltiq.

dbrunk@frontlinemedcom.com

DANA POINT, CALIF. – For skin tightening, there’s no comparison between surgical and nonsurgical approaches as far as quality, predictability, and longevity, according to Dr. A. Jay Burns.

"Anyone who suggests to patients that nonsurgical contouring and rejuvenation share comparable results is either self-serving, dishonest, grossly naive, or misinformed," said Dr. Burns of the Dallas Plastic Surgery Institute. "In my opinion, surgical treatments are extremely reliable and nonsurgical treatments are extremely variable. But I’m not in an ivory tower. I realize that [surgical approaches result in] more complications and that they’re more expensive."

Surgical skin tightening involves total elevation, full repositioning, centimeter changes, and control, with predictable, clear results, he said at the meeting, sponsored by SkinCare Physicians and Northwestern University.

On the other hand, nonsurgical skin tightening involves no elevation, no repositioning, millimeter changes, and no control. This leads to results that he characterized as "unpredictable and subtle."

Dr. Burns acknowledged certain advantages of nonsurgical skin tightening approaches, such as the fact that they’re typically less expensive (except for brow dynamic line elimination), they eliminate the risk of nerve damage, and they require less downtime. He said he advises clinicians to recommend nonsurgical skin tightening for patients who prioritize downtime, cost, and risk over results. Surgical skin tightening is for those who want optimal results, maximum quality and predictability, and elegance, he said.

Dr. Burns said that there is "a clear place for" nonsurgical skin tightening techniques in his practice, and he emphasized the importance of fostering integrity during patient consultations. This includes informed consent, representing the technology honestly, and being honest with patients about expectations from procedures that you offer. Such practice "shows character and aids your reputation," he said. "It also prioritizes patient care over revenue."

He noted that the ThermiRF, developed by Southlake, Tex.–based ThermiAesthetics, represents a promising advance in noninvasive skin technology because it features a continuous temperature monitor on its internal probe. This radiofrequency device enables the user to administer the precise amount of heat for the collagen layer, Dr. Burns said. "There are some really nice results on the skin and neck," he said.

Dr. Burns disclosed that he has received equipment loans or discounts on equipment from Cynosure, Zeltiq Aesthetics, and other companies. He has held stock or stock options with Skin Medica and Zeltiq and has received honoraria from Solta Medical and Ulthera. He is an advisory board member for Cynosure, Ulthera, and Zeltiq.

dbrunk@frontlinemedcom.com

DANA POINT, CALIF. – For skin tightening, there’s no comparison between surgical and nonsurgical approaches as far as quality, predictability, and longevity, according to Dr. A. Jay Burns.

"Anyone who suggests to patients that nonsurgical contouring and rejuvenation share comparable results is either self-serving, dishonest, grossly naive, or misinformed," said Dr. Burns of the Dallas Plastic Surgery Institute. "In my opinion, surgical treatments are extremely reliable and nonsurgical treatments are extremely variable. But I’m not in an ivory tower. I realize that [surgical approaches result in] more complications and that they’re more expensive."

Surgical skin tightening involves total elevation, full repositioning, centimeter changes, and control, with predictable, clear results, he said at the meeting, sponsored by SkinCare Physicians and Northwestern University.

On the other hand, nonsurgical skin tightening involves no elevation, no repositioning, millimeter changes, and no control. This leads to results that he characterized as "unpredictable and subtle."

Dr. Burns acknowledged certain advantages of nonsurgical skin tightening approaches, such as the fact that they’re typically less expensive (except for brow dynamic line elimination), they eliminate the risk of nerve damage, and they require less downtime. He said he advises clinicians to recommend nonsurgical skin tightening for patients who prioritize downtime, cost, and risk over results. Surgical skin tightening is for those who want optimal results, maximum quality and predictability, and elegance, he said.

Dr. Burns said that there is "a clear place for" nonsurgical skin tightening techniques in his practice, and he emphasized the importance of fostering integrity during patient consultations. This includes informed consent, representing the technology honestly, and being honest with patients about expectations from procedures that you offer. Such practice "shows character and aids your reputation," he said. "It also prioritizes patient care over revenue."

He noted that the ThermiRF, developed by Southlake, Tex.–based ThermiAesthetics, represents a promising advance in noninvasive skin technology because it features a continuous temperature monitor on its internal probe. This radiofrequency device enables the user to administer the precise amount of heat for the collagen layer, Dr. Burns said. "There are some really nice results on the skin and neck," he said.

Dr. Burns disclosed that he has received equipment loans or discounts on equipment from Cynosure, Zeltiq Aesthetics, and other companies. He has held stock or stock options with Skin Medica and Zeltiq and has received honoraria from Solta Medical and Ulthera. He is an advisory board member for Cynosure, Ulthera, and Zeltiq.

dbrunk@frontlinemedcom.com

SAN DIEGO – Use of a standardized checklist with information describing opiate therapy and the source of the patient’s chronic pain improved resident and faculty satisfaction with management of chronic pain patients, results from a single-center study found.

"The management of chronic pain is so different for each individual patient, but the unique thing about this checklist is that it’s standardized to an entire panel," Dr. Filza Akhtar said in an interview during a poster session at the annual meeting of the American Academy of Family Physicians. "It allows us to manage this panel of patients in a way that we feel gives us some control."

In an effort to increase compliance with the clinic opiate policy for family medicine resident patients with chronic pain, Dr. Akhtar and her associates in the department of family medicine at Oregon Health and Science University (OHSU), Portland, added a standardized checklist to the department’s existing electronic health records system (EHR) that contained elements of the clinic-wide chronic pain policy.

The checklist includes nine items: chronic pain source or diagnosis; pain contract date; last urine drug screen date; monthly medication dosage and fill number; functional goals such as activities of daily living and exercise; opiate abuse risk assessment; other modalities such as acupuncture, sauna, and massage; depression/bowel habits screening date; and statewide controlled substance registry query status and date.

The researchers surveyed family medicine residents before and after implementation of the checklist into the EHR to assess comfort and satisfaction with management of 132 adult patients with ongoing chronic pain conditions on their own panels who were seen during the 2011-2012 academic year. Family medicine faculty completed surveys to assess their comfort managing family medicine residents’ chronic pain patients when the residents were not available in clinic. The family medicine department at OHSU consists of 12 residents, 12 faculty physicians, and 8 advanced practice nurses/physician assistants.

On a 10-point Likert scale, residents’ comfort with managing their own patients receiving chronic opiates improved from a baseline average of 4.25 to 6.55 after implementation of the checklist. One survey participant noted that standardizing EHR and patient expectations regarding the use of chronic narcotics "greatly improved my happiness as a resident physician." Another survey participant commented that conversations in the exam room "were much easier with standardization in place. It also seemed to cut down on ‘doctor shopping’ at our clinic."

The faculty comfort with management of family medicine residents’ patients receiving chronic opiates also improved from a baseline of 4.73 to 5.69 after implementation of the checklist.

Another study author, Dr. Eric Chen, a family medicine resident at OHSU, acknowledged that trying to map out a course of care for patients receiving chronic opiates can be difficult. "It’s a very sensitive topic because it brings up a lot of charged views with new residents who come into a training program inheriting patients who are managed on these opioid regimens," he said. "This tool is used mainly as kind of a historical marker of what has been done. It can shape what [approach] the physician would like to take going forward."

The researchers stated that they had no relevant financial conflicts to disclose.

dbrunk@frontlinemedcom.com

SAN DIEGO – Use of a standardized checklist with information describing opiate therapy and the source of the patient’s chronic pain improved resident and faculty satisfaction with management of chronic pain patients, results from a single-center study found.

"The management of chronic pain is so different for each individual patient, but the unique thing about this checklist is that it’s standardized to an entire panel," Dr. Filza Akhtar said in an interview during a poster session at the annual meeting of the American Academy of Family Physicians. "It allows us to manage this panel of patients in a way that we feel gives us some control."

In an effort to increase compliance with the clinic opiate policy for family medicine resident patients with chronic pain, Dr. Akhtar and her associates in the department of family medicine at Oregon Health and Science University (OHSU), Portland, added a standardized checklist to the department’s existing electronic health records system (EHR) that contained elements of the clinic-wide chronic pain policy.

The checklist includes nine items: chronic pain source or diagnosis; pain contract date; last urine drug screen date; monthly medication dosage and fill number; functional goals such as activities of daily living and exercise; opiate abuse risk assessment; other modalities such as acupuncture, sauna, and massage; depression/bowel habits screening date; and statewide controlled substance registry query status and date.

The researchers surveyed family medicine residents before and after implementation of the checklist into the EHR to assess comfort and satisfaction with management of 132 adult patients with ongoing chronic pain conditions on their own panels who were seen during the 2011-2012 academic year. Family medicine faculty completed surveys to assess their comfort managing family medicine residents’ chronic pain patients when the residents were not available in clinic. The family medicine department at OHSU consists of 12 residents, 12 faculty physicians, and 8 advanced practice nurses/physician assistants.

On a 10-point Likert scale, residents’ comfort with managing their own patients receiving chronic opiates improved from a baseline average of 4.25 to 6.55 after implementation of the checklist. One survey participant noted that standardizing EHR and patient expectations regarding the use of chronic narcotics "greatly improved my happiness as a resident physician." Another survey participant commented that conversations in the exam room "were much easier with standardization in place. It also seemed to cut down on ‘doctor shopping’ at our clinic."

The faculty comfort with management of family medicine residents’ patients receiving chronic opiates also improved from a baseline of 4.73 to 5.69 after implementation of the checklist.

Another study author, Dr. Eric Chen, a family medicine resident at OHSU, acknowledged that trying to map out a course of care for patients receiving chronic opiates can be difficult. "It’s a very sensitive topic because it brings up a lot of charged views with new residents who come into a training program inheriting patients who are managed on these opioid regimens," he said. "This tool is used mainly as kind of a historical marker of what has been done. It can shape what [approach] the physician would like to take going forward."

The researchers stated that they had no relevant financial conflicts to disclose.

dbrunk@frontlinemedcom.com

SAN DIEGO – Use of a standardized checklist with information describing opiate therapy and the source of the patient’s chronic pain improved resident and faculty satisfaction with management of chronic pain patients, results from a single-center study found.

"The management of chronic pain is so different for each individual patient, but the unique thing about this checklist is that it’s standardized to an entire panel," Dr. Filza Akhtar said in an interview during a poster session at the annual meeting of the American Academy of Family Physicians. "It allows us to manage this panel of patients in a way that we feel gives us some control."

In an effort to increase compliance with the clinic opiate policy for family medicine resident patients with chronic pain, Dr. Akhtar and her associates in the department of family medicine at Oregon Health and Science University (OHSU), Portland, added a standardized checklist to the department’s existing electronic health records system (EHR) that contained elements of the clinic-wide chronic pain policy.

The checklist includes nine items: chronic pain source or diagnosis; pain contract date; last urine drug screen date; monthly medication dosage and fill number; functional goals such as activities of daily living and exercise; opiate abuse risk assessment; other modalities such as acupuncture, sauna, and massage; depression/bowel habits screening date; and statewide controlled substance registry query status and date.

The researchers surveyed family medicine residents before and after implementation of the checklist into the EHR to assess comfort and satisfaction with management of 132 adult patients with ongoing chronic pain conditions on their own panels who were seen during the 2011-2012 academic year. Family medicine faculty completed surveys to assess their comfort managing family medicine residents’ chronic pain patients when the residents were not available in clinic. The family medicine department at OHSU consists of 12 residents, 12 faculty physicians, and 8 advanced practice nurses/physician assistants.

On a 10-point Likert scale, residents’ comfort with managing their own patients receiving chronic opiates improved from a baseline average of 4.25 to 6.55 after implementation of the checklist. One survey participant noted that standardizing EHR and patient expectations regarding the use of chronic narcotics "greatly improved my happiness as a resident physician." Another survey participant commented that conversations in the exam room "were much easier with standardization in place. It also seemed to cut down on ‘doctor shopping’ at our clinic."

The faculty comfort with management of family medicine residents’ patients receiving chronic opiates also improved from a baseline of 4.73 to 5.69 after implementation of the checklist.

Another study author, Dr. Eric Chen, a family medicine resident at OHSU, acknowledged that trying to map out a course of care for patients receiving chronic opiates can be difficult. "It’s a very sensitive topic because it brings up a lot of charged views with new residents who come into a training program inheriting patients who are managed on these opioid regimens," he said. "This tool is used mainly as kind of a historical marker of what has been done. It can shape what [approach] the physician would like to take going forward."

The researchers stated that they had no relevant financial conflicts to disclose.

dbrunk@frontlinemedcom.com

SAN DIEGO – Use of a standardized checklist with information describing opiate therapy and the source of the patient’s chronic pain improved resident and faculty satisfaction with management of chronic pain patients, results from a single-center study found.

"The management of chronic pain is so different for each individual patient, but the unique thing about this checklist is that it’s standardized to an entire panel," Dr. Filza Akhtar said in an interview during a poster session at the annual meeting of the American Academy of Family Physicians. "It allows us to manage this panel of patients in a way that we feel gives us some control."

In an effort to increase compliance with the clinic opiate policy for family medicine resident patients with chronic pain, Dr. Akhtar and her associates in the department of family medicine at Oregon Health and Science University (OHSU), Portland, added a standardized checklist to the department’s existing electronic health records system (EHR) that contained elements of the clinic-wide chronic pain policy.

The checklist includes nine items: chronic pain source or diagnosis; pain contract date; last urine drug screen date; monthly medication dosage and fill number; functional goals such as activities of daily living and exercise; opiate abuse risk assessment; other modalities such as acupuncture, sauna, and massage; depression/bowel habits screening date; and statewide controlled substance registry query status and date.

The researchers surveyed family medicine residents before and after implementation of the checklist into the EHR to assess comfort and satisfaction with management of 132 adult patients with ongoing chronic pain conditions on their own panels who were seen during the 2011-2012 academic year. Family medicine faculty completed surveys to assess their comfort managing family medicine residents’ chronic pain patients when the residents were not available in clinic. The family medicine department at OHSU consists of 12 residents, 12 faculty physicians, and 8 advanced practice nurses/physician assistants.

On a 10-point Likert scale, residents’ comfort with managing their own patients receiving chronic opiates improved from a baseline average of 4.25 to 6.55 after implementation of the checklist. One survey participant noted that standardizing EHR and patient expectations regarding the use of chronic narcotics "greatly improved my happiness as a resident physician." Another survey participant commented that conversations in the exam room "were much easier with standardization in place. It also seemed to cut down on ‘doctor shopping’ at our clinic."

The faculty comfort with management of family medicine residents’ patients receiving chronic opiates also improved from a baseline of 4.73 to 5.69 after implementation of the checklist.

Another study author, Dr. Eric Chen, a family medicine resident at OHSU, acknowledged that trying to map out a course of care for patients receiving chronic opiates can be difficult. "It’s a very sensitive topic because it brings up a lot of charged views with new residents who come into a training program inheriting patients who are managed on these opioid regimens," he said. "This tool is used mainly as kind of a historical marker of what has been done. It can shape what [approach] the physician would like to take going forward."

The researchers stated that they had no relevant financial conflicts to disclose.

dbrunk@frontlinemedcom.com

SAN DIEGO – Use of a standardized checklist with information describing opiate therapy and the source of the patient’s chronic pain improved resident and faculty satisfaction with management of chronic pain patients, results from a single-center study found.

"The management of chronic pain is so different for each individual patient, but the unique thing about this checklist is that it’s standardized to an entire panel," Dr. Filza Akhtar said in an interview during a poster session at the annual meeting of the American Academy of Family Physicians. "It allows us to manage this panel of patients in a way that we feel gives us some control."

In an effort to increase compliance with the clinic opiate policy for family medicine resident patients with chronic pain, Dr. Akhtar and her associates in the department of family medicine at Oregon Health and Science University (OHSU), Portland, added a standardized checklist to the department’s existing electronic health records system (EHR) that contained elements of the clinic-wide chronic pain policy.

The checklist includes nine items: chronic pain source or diagnosis; pain contract date; last urine drug screen date; monthly medication dosage and fill number; functional goals such as activities of daily living and exercise; opiate abuse risk assessment; other modalities such as acupuncture, sauna, and massage; depression/bowel habits screening date; and statewide controlled substance registry query status and date.

The researchers surveyed family medicine residents before and after implementation of the checklist into the EHR to assess comfort and satisfaction with management of 132 adult patients with ongoing chronic pain conditions on their own panels who were seen during the 2011-2012 academic year. Family medicine faculty completed surveys to assess their comfort managing family medicine residents’ chronic pain patients when the residents were not available in clinic. The family medicine department at OHSU consists of 12 residents, 12 faculty physicians, and 8 advanced practice nurses/physician assistants.

On a 10-point Likert scale, residents’ comfort with managing their own patients receiving chronic opiates improved from a baseline average of 4.25 to 6.55 after implementation of the checklist. One survey participant noted that standardizing EHR and patient expectations regarding the use of chronic narcotics "greatly improved my happiness as a resident physician." Another survey participant commented that conversations in the exam room "were much easier with standardization in place. It also seemed to cut down on ‘doctor shopping’ at our clinic."

The faculty comfort with management of family medicine residents’ patients receiving chronic opiates also improved from a baseline of 4.73 to 5.69 after implementation of the checklist.

Another study author, Dr. Eric Chen, a family medicine resident at OHSU, acknowledged that trying to map out a course of care for patients receiving chronic opiates can be difficult. "It’s a very sensitive topic because it brings up a lot of charged views with new residents who come into a training program inheriting patients who are managed on these opioid regimens," he said. "This tool is used mainly as kind of a historical marker of what has been done. It can shape what [approach] the physician would like to take going forward."

The researchers stated that they had no relevant financial conflicts to disclose.

dbrunk@frontlinemedcom.com

SAN DIEGO – Use of a standardized checklist with information describing opiate therapy and the source of the patient’s chronic pain improved resident and faculty satisfaction with management of chronic pain patients, results from a single-center study found.

"The management of chronic pain is so different for each individual patient, but the unique thing about this checklist is that it’s standardized to an entire panel," Dr. Filza Akhtar said in an interview during a poster session at the annual meeting of the American Academy of Family Physicians. "It allows us to manage this panel of patients in a way that we feel gives us some control."

In an effort to increase compliance with the clinic opiate policy for family medicine resident patients with chronic pain, Dr. Akhtar and her associates in the department of family medicine at Oregon Health and Science University (OHSU), Portland, added a standardized checklist to the department’s existing electronic health records system (EHR) that contained elements of the clinic-wide chronic pain policy.

The checklist includes nine items: chronic pain source or diagnosis; pain contract date; last urine drug screen date; monthly medication dosage and fill number; functional goals such as activities of daily living and exercise; opiate abuse risk assessment; other modalities such as acupuncture, sauna, and massage; depression/bowel habits screening date; and statewide controlled substance registry query status and date.

The researchers surveyed family medicine residents before and after implementation of the checklist into the EHR to assess comfort and satisfaction with management of 132 adult patients with ongoing chronic pain conditions on their own panels who were seen during the 2011-2012 academic year. Family medicine faculty completed surveys to assess their comfort managing family medicine residents’ chronic pain patients when the residents were not available in clinic. The family medicine department at OHSU consists of 12 residents, 12 faculty physicians, and 8 advanced practice nurses/physician assistants.

On a 10-point Likert scale, residents’ comfort with managing their own patients receiving chronic opiates improved from a baseline average of 4.25 to 6.55 after implementation of the checklist. One survey participant noted that standardizing EHR and patient expectations regarding the use of chronic narcotics "greatly improved my happiness as a resident physician." Another survey participant commented that conversations in the exam room "were much easier with standardization in place. It also seemed to cut down on ‘doctor shopping’ at our clinic."

The faculty comfort with management of family medicine residents’ patients receiving chronic opiates also improved from a baseline of 4.73 to 5.69 after implementation of the checklist.

Another study author, Dr. Eric Chen, a family medicine resident at OHSU, acknowledged that trying to map out a course of care for patients receiving chronic opiates can be difficult. "It’s a very sensitive topic because it brings up a lot of charged views with new residents who come into a training program inheriting patients who are managed on these opioid regimens," he said. "This tool is used mainly as kind of a historical marker of what has been done. It can shape what [approach] the physician would like to take going forward."

The researchers stated that they had no relevant financial conflicts to disclose.

dbrunk@frontlinemedcom.com

DANA POINT, CALIF. – If you’re in the market for a body contouring device, Dr. Robert Weiss advises factoring in "solid clinical evidence" before you buy.

"You want to see histologic evidence – apoptosis of fat cells, or at least diminution of fat cells," he said at a meeting sponsored by SkinCare Physicians and Northwestern University. "You want to see ultrasound confirmation of fat reduction, something that’s reproducible and objective. It [the device] also has to have ease of use," he said.

Courtesy Dr. Robert Weiss

"Most importantly, you want to know if patients themselves see a clinically meaningful response, a significant improvement. If they don’t see improvement, it [the objective value] doesn’t matter," he added.

Other important factors to consider before buying a body contouring device include making sure it has undergone animal studies of internal thermocoupling, and that it has an external temperature monitor for skin. "Infrared camera technology will also help to show how uniform the heating is, and how the skin relates to fat," said Dr. Weiss of the Maryland Laser Skin and Vein Institute, Hunt Valley.

Courtesy Dr. Robert Weiss

In his practice, Dr. Weiss uses four devices for body contouring: two cryolipolysis devices, one monopolar radiofrequency (RF) device, and one focused-field RF device. The last device, known as the Vanquish, was introduced at the 2013 American Academy of Dermatology meeting. Manufactured by Prague-based BTL Industries, Vanquish is a noncontact device that delivers focused-field RF through panels that are placed over the desired treatment area while the patient is lying horizontally. "The focal point is 10 mm below the skin surface, and it heats to 43-45° C," said Dr. Weiss, who was part of a team of researchers that demonstrated the efficacy of Vanquish in a porcine model (Lasers Surg. Med. 2013;45:235-39). "There are positive and negative fields created within the applicator," Dr. Weiss said. "What happens is that the fat creates more resistance, so the fat heats up but skin and muscle do not. We feel that this [device is] going to be a real game-changer."

In the study, a 70% reduction in abdominal fat was observed in pigs that were treated four times with the Vanquish for 30 minutes each. "Histologic evaluation revealed that epidermis, dermis, and adnexal structures such as hair follicles were unaffected by the treatment, while adipocytes were significantly affected," Dr. Weiss and his colleagues wrote.

Patients who have undergone treatment of excessive abdominal fat with the Vanquish describe a warm sensation during the procedure, with minimal side effects, Dr. Weiss said. "The more hydrated you are, the more selectivity there’s going to be, so we encourage people to drink water before the procedure," he said.

Dr. Weiss disclosed that he is a speaker and investigator for BTL Industries. He also has received honoraria and equipment from the company.

dbrunk@frontlinemedcom.com

DANA POINT, CALIF. – If you’re in the market for a body contouring device, Dr. Robert Weiss advises factoring in "solid clinical evidence" before you buy.

"You want to see histologic evidence – apoptosis of fat cells, or at least diminution of fat cells," he said at a meeting sponsored by SkinCare Physicians and Northwestern University. "You want to see ultrasound confirmation of fat reduction, something that’s reproducible and objective. It [the device] also has to have ease of use," he said.

Courtesy Dr. Robert Weiss

"Most importantly, you want to know if patients themselves see a clinically meaningful response, a significant improvement. If they don’t see improvement, it [the objective value] doesn’t matter," he added.

Other important factors to consider before buying a body contouring device include making sure it has undergone animal studies of internal thermocoupling, and that it has an external temperature monitor for skin. "Infrared camera technology will also help to show how uniform the heating is, and how the skin relates to fat," said Dr. Weiss of the Maryland Laser Skin and Vein Institute, Hunt Valley.

Courtesy Dr. Robert Weiss

In his practice, Dr. Weiss uses four devices for body contouring: two cryolipolysis devices, one monopolar radiofrequency (RF) device, and one focused-field RF device. The last device, known as the Vanquish, was introduced at the 2013 American Academy of Dermatology meeting. Manufactured by Prague-based BTL Industries, Vanquish is a noncontact device that delivers focused-field RF through panels that are placed over the desired treatment area while the patient is lying horizontally. "The focal point is 10 mm below the skin surface, and it heats to 43-45° C," said Dr. Weiss, who was part of a team of researchers that demonstrated the efficacy of Vanquish in a porcine model (Lasers Surg. Med. 2013;45:235-39). "There are positive and negative fields created within the applicator," Dr. Weiss said. "What happens is that the fat creates more resistance, so the fat heats up but skin and muscle do not. We feel that this [device is] going to be a real game-changer."

In the study, a 70% reduction in abdominal fat was observed in pigs that were treated four times with the Vanquish for 30 minutes each. "Histologic evaluation revealed that epidermis, dermis, and adnexal structures such as hair follicles were unaffected by the treatment, while adipocytes were significantly affected," Dr. Weiss and his colleagues wrote.

Patients who have undergone treatment of excessive abdominal fat with the Vanquish describe a warm sensation during the procedure, with minimal side effects, Dr. Weiss said. "The more hydrated you are, the more selectivity there’s going to be, so we encourage people to drink water before the procedure," he said.

Dr. Weiss disclosed that he is a speaker and investigator for BTL Industries. He also has received honoraria and equipment from the company.

dbrunk@frontlinemedcom.com

DANA POINT, CALIF. – If you’re in the market for a body contouring device, Dr. Robert Weiss advises factoring in "solid clinical evidence" before you buy.

"You want to see histologic evidence – apoptosis of fat cells, or at least diminution of fat cells," he said at a meeting sponsored by SkinCare Physicians and Northwestern University. "You want to see ultrasound confirmation of fat reduction, something that’s reproducible and objective. It [the device] also has to have ease of use," he said.

Courtesy Dr. Robert Weiss

"Most importantly, you want to know if patients themselves see a clinically meaningful response, a significant improvement. If they don’t see improvement, it [the objective value] doesn’t matter," he added.

Other important factors to consider before buying a body contouring device include making sure it has undergone animal studies of internal thermocoupling, and that it has an external temperature monitor for skin. "Infrared camera technology will also help to show how uniform the heating is, and how the skin relates to fat," said Dr. Weiss of the Maryland Laser Skin and Vein Institute, Hunt Valley.

Courtesy Dr. Robert Weiss

In his practice, Dr. Weiss uses four devices for body contouring: two cryolipolysis devices, one monopolar radiofrequency (RF) device, and one focused-field RF device. The last device, known as the Vanquish, was introduced at the 2013 American Academy of Dermatology meeting. Manufactured by Prague-based BTL Industries, Vanquish is a noncontact device that delivers focused-field RF through panels that are placed over the desired treatment area while the patient is lying horizontally. "The focal point is 10 mm below the skin surface, and it heats to 43-45° C," said Dr. Weiss, who was part of a team of researchers that demonstrated the efficacy of Vanquish in a porcine model (Lasers Surg. Med. 2013;45:235-39). "There are positive and negative fields created within the applicator," Dr. Weiss said. "What happens is that the fat creates more resistance, so the fat heats up but skin and muscle do not. We feel that this [device is] going to be a real game-changer."

In the study, a 70% reduction in abdominal fat was observed in pigs that were treated four times with the Vanquish for 30 minutes each. "Histologic evaluation revealed that epidermis, dermis, and adnexal structures such as hair follicles were unaffected by the treatment, while adipocytes were significantly affected," Dr. Weiss and his colleagues wrote.

Patients who have undergone treatment of excessive abdominal fat with the Vanquish describe a warm sensation during the procedure, with minimal side effects, Dr. Weiss said. "The more hydrated you are, the more selectivity there’s going to be, so we encourage people to drink water before the procedure," he said.

Dr. Weiss disclosed that he is a speaker and investigator for BTL Industries. He also has received honoraria and equipment from the company.

dbrunk@frontlinemedcom.com

SAN DIEGO – The next time you enter an exam room without first donning your white coat or name tag, you might consider backtracking to retrieve them.

According to a survey of patients presenting to a family medicine clinic, 51% hold some opinion about your attire. "Even if they don’t admit that they care about those things, patients are picking the options of having physicians wear a white coat and having a traditional look," study author Dr. Seema Tayal said in an interview during a poster session at the annual meeting of the American Academy of Family Physicians. "Traditional looks still matter."

©Lars Lindblad/Fotolia.com

For the study, Dr. Tayal, a third-year resident in the family medicine department at the Brooklyn (N.Y.) Hospital Center, and her associates set out to determine what effects exist between the patient’s perception of a physician’s physical appearance and the patient’s compliance with medical recommendations. They distributed anonymous questionnaires to 200 patients who presented to the practice.

More than half of respondents (59%) were between the ages of 18 and 50 years, while the remaining 41% were over age 51. The majority (69%) were female.

When asked, "Do you feel your decision to follow a physician’s advice is influenced by his/her gender?" 91% responded yes and 9% responded no.

When asked, "Do you feel your decision to follow a physician’s advice is influenced by his/her appearance?" 83% responded yes and 17% responded no.

When asked, "Do you feel your decision to follow a physician’s advice is influenced by his/her age?" 85% responded yes and 15% responded no.

When asked about the preference of a physician’s attire, 49% had no preference and 51% did. Among those who did have a preference, the appearance accessory rated as most desirable was a white coat (52%), followed by a name tag (41%), stethoscope (25%), a "clean" look (33%), scrubs (15%), dress pants (14%), a tie and dress shirt (12%), dress shoes (10%), cologne/perfume (8%), short hair (6%), and jewelry (4%).

In another part of the questionnaire, respondents were asked to choose the most professional-looking image from a set of six photographs depicting medical personnel, including one of Dr. Gregory House, the fictional physician played by actor Hugh Laurie on the "House" television series. The "winning" image depicted a clean-looking young female with short hair who wore a white coat and a stethoscope.

The researchers stated that they had no relevant financial conflicts to disclose.

dbrunk@frontlinemedcom.com

SAN DIEGO – The next time you enter an exam room without first donning your white coat or name tag, you might consider backtracking to retrieve them.

According to a survey of patients presenting to a family medicine clinic, 51% hold some opinion about your attire. "Even if they don’t admit that they care about those things, patients are picking the options of having physicians wear a white coat and having a traditional look," study author Dr. Seema Tayal said in an interview during a poster session at the annual meeting of the American Academy of Family Physicians. "Traditional looks still matter."

©Lars Lindblad/Fotolia.com

For the study, Dr. Tayal, a third-year resident in the family medicine department at the Brooklyn (N.Y.) Hospital Center, and her associates set out to determine what effects exist between the patient’s perception of a physician’s physical appearance and the patient’s compliance with medical recommendations. They distributed anonymous questionnaires to 200 patients who presented to the practice.

More than half of respondents (59%) were between the ages of 18 and 50 years, while the remaining 41% were over age 51. The majority (69%) were female.

When asked, "Do you feel your decision to follow a physician’s advice is influenced by his/her gender?" 91% responded yes and 9% responded no.

When asked, "Do you feel your decision to follow a physician’s advice is influenced by his/her appearance?" 83% responded yes and 17% responded no.

When asked, "Do you feel your decision to follow a physician’s advice is influenced by his/her age?" 85% responded yes and 15% responded no.

When asked about the preference of a physician’s attire, 49% had no preference and 51% did. Among those who did have a preference, the appearance accessory rated as most desirable was a white coat (52%), followed by a name tag (41%), stethoscope (25%), a "clean" look (33%), scrubs (15%), dress pants (14%), a tie and dress shirt (12%), dress shoes (10%), cologne/perfume (8%), short hair (6%), and jewelry (4%).

In another part of the questionnaire, respondents were asked to choose the most professional-looking image from a set of six photographs depicting medical personnel, including one of Dr. Gregory House, the fictional physician played by actor Hugh Laurie on the "House" television series. The "winning" image depicted a clean-looking young female with short hair who wore a white coat and a stethoscope.

The researchers stated that they had no relevant financial conflicts to disclose.

dbrunk@frontlinemedcom.com

SAN DIEGO – The next time you enter an exam room without first donning your white coat or name tag, you might consider backtracking to retrieve them.

According to a survey of patients presenting to a family medicine clinic, 51% hold some opinion about your attire. "Even if they don’t admit that they care about those things, patients are picking the options of having physicians wear a white coat and having a traditional look," study author Dr. Seema Tayal said in an interview during a poster session at the annual meeting of the American Academy of Family Physicians. "Traditional looks still matter."

©Lars Lindblad/Fotolia.com

For the study, Dr. Tayal, a third-year resident in the family medicine department at the Brooklyn (N.Y.) Hospital Center, and her associates set out to determine what effects exist between the patient’s perception of a physician’s physical appearance and the patient’s compliance with medical recommendations. They distributed anonymous questionnaires to 200 patients who presented to the practice.

More than half of respondents (59%) were between the ages of 18 and 50 years, while the remaining 41% were over age 51. The majority (69%) were female.

When asked, "Do you feel your decision to follow a physician’s advice is influenced by his/her gender?" 91% responded yes and 9% responded no.

When asked, "Do you feel your decision to follow a physician’s advice is influenced by his/her appearance?" 83% responded yes and 17% responded no.

When asked, "Do you feel your decision to follow a physician’s advice is influenced by his/her age?" 85% responded yes and 15% responded no.

When asked about the preference of a physician’s attire, 49% had no preference and 51% did. Among those who did have a preference, the appearance accessory rated as most desirable was a white coat (52%), followed by a name tag (41%), stethoscope (25%), a "clean" look (33%), scrubs (15%), dress pants (14%), a tie and dress shirt (12%), dress shoes (10%), cologne/perfume (8%), short hair (6%), and jewelry (4%).

In another part of the questionnaire, respondents were asked to choose the most professional-looking image from a set of six photographs depicting medical personnel, including one of Dr. Gregory House, the fictional physician played by actor Hugh Laurie on the "House" television series. The "winning" image depicted a clean-looking young female with short hair who wore a white coat and a stethoscope.

The researchers stated that they had no relevant financial conflicts to disclose.

dbrunk@frontlinemedcom.com

DANA POINT, CALIF. – Use of a bipolar radiofrequency probe to the frontalis and corrugator branches of the temporal facial nerve resulted in the diminishment of forehead wrinkles that lasts two to three times longer than treatment with botulinum toxin, according to Dr. James Newman.

At a meeting sponsored by SkinCare Physicians and Northwestern University, Dr. Newman described his early clinical experience with the Serene Solution, a Food and Drug Administration–cleared device created by Serene Medical designed to target nerves and create radiofrequency lesions.

Photos courtesy Dr. James Newman

"The purpose of this type of treatment is to take a finite probe, which allows the physician to stimulate and target a very specific nerve on the body," said Dr. Newman, a plastic surgeon in private practice in Palo Alto, Calif. "In this case we’re using a bipolar radiofrequency probe within 1-2 mm of the frontalis and corrugator branches of the temporal facial nerve."

The device, which consists of a control unit and 20-gauge dual-purpose probe, enables one or more small radiofrequency lesions to interrupt the motor nerve signal and reduce muscle activity. "The advantage is that the effect is instant," said Dr. Newman, who is chief medical officer for Serene Medical. "It’s long lasting, produces minimal collateral damage, and allows reconnection along the original path of [the] nerve." The effect can last 6-18 months, depending on the lesion, compared with botulinum that lasts for about 3-6 months.

Photos courtesy Dr. James Newman

In split-face studies conducted by Dr. Newman and his associates, 20 patients underwent a single treatment with the Serene Solution to create a radiofrequency lesion on the frontalis and corrugator branches of the temporal facial nerve. Six months post treatment, patient wrinkles remained improved compared with baseline, according to evaluation with Merz Aesthetics Scales. "The muscle response to stimulation currently demonstrates that nerve function is fully restored, when compared to the untreated side," Dr. Newman said. "That told us that the nerve sheath is still intact and that we do not have a complete nerve block." The fact that improvement persists long term in the treated side "may be due to a smaller or less-conditioned frontalis muscle," he said.

Dr. Newman and his associates plan to study the hypothesis that creating three radiofrequency lesions along the frontalis nerve will prolong the period of nerve discontinuity by two to three times. "If we create more than one lesion, perhaps we can prolong relaxation of the frontalis muscle and those wrinkle scores might be improved as well," he said.

Dr. Newman disclosed that he is a stockholder in Serene Medical and that he is a speaker for and has received honoraria from Valeant Pharmaceuticals.

dbrunk@frontlinemedcom.com

DANA POINT, CALIF. – Use of a bipolar radiofrequency probe to the frontalis and corrugator branches of the temporal facial nerve resulted in the diminishment of forehead wrinkles that lasts two to three times longer than treatment with botulinum toxin, according to Dr. James Newman.

At a meeting sponsored by SkinCare Physicians and Northwestern University, Dr. Newman described his early clinical experience with the Serene Solution, a Food and Drug Administration–cleared device created by Serene Medical designed to target nerves and create radiofrequency lesions.

Photos courtesy Dr. James Newman

"The purpose of this type of treatment is to take a finite probe, which allows the physician to stimulate and target a very specific nerve on the body," said Dr. Newman, a plastic surgeon in private practice in Palo Alto, Calif. "In this case we’re using a bipolar radiofrequency probe within 1-2 mm of the frontalis and corrugator branches of the temporal facial nerve."

The device, which consists of a control unit and 20-gauge dual-purpose probe, enables one or more small radiofrequency lesions to interrupt the motor nerve signal and reduce muscle activity. "The advantage is that the effect is instant," said Dr. Newman, who is chief medical officer for Serene Medical. "It’s long lasting, produces minimal collateral damage, and allows reconnection along the original path of [the] nerve." The effect can last 6-18 months, depending on the lesion, compared with botulinum that lasts for about 3-6 months.

Photos courtesy Dr. James Newman

In split-face studies conducted by Dr. Newman and his associates, 20 patients underwent a single treatment with the Serene Solution to create a radiofrequency lesion on the frontalis and corrugator branches of the temporal facial nerve. Six months post treatment, patient wrinkles remained improved compared with baseline, according to evaluation with Merz Aesthetics Scales. "The muscle response to stimulation currently demonstrates that nerve function is fully restored, when compared to the untreated side," Dr. Newman said. "That told us that the nerve sheath is still intact and that we do not have a complete nerve block." The fact that improvement persists long term in the treated side "may be due to a smaller or less-conditioned frontalis muscle," he said.

Dr. Newman and his associates plan to study the hypothesis that creating three radiofrequency lesions along the frontalis nerve will prolong the period of nerve discontinuity by two to three times. "If we create more than one lesion, perhaps we can prolong relaxation of the frontalis muscle and those wrinkle scores might be improved as well," he said.

Dr. Newman disclosed that he is a stockholder in Serene Medical and that he is a speaker for and has received honoraria from Valeant Pharmaceuticals.

dbrunk@frontlinemedcom.com

DANA POINT, CALIF. – Use of a bipolar radiofrequency probe to the frontalis and corrugator branches of the temporal facial nerve resulted in the diminishment of forehead wrinkles that lasts two to three times longer than treatment with botulinum toxin, according to Dr. James Newman.

At a meeting sponsored by SkinCare Physicians and Northwestern University, Dr. Newman described his early clinical experience with the Serene Solution, a Food and Drug Administration–cleared device created by Serene Medical designed to target nerves and create radiofrequency lesions.

Photos courtesy Dr. James Newman

"The purpose of this type of treatment is to take a finite probe, which allows the physician to stimulate and target a very specific nerve on the body," said Dr. Newman, a plastic surgeon in private practice in Palo Alto, Calif. "In this case we’re using a bipolar radiofrequency probe within 1-2 mm of the frontalis and corrugator branches of the temporal facial nerve."

The device, which consists of a control unit and 20-gauge dual-purpose probe, enables one or more small radiofrequency lesions to interrupt the motor nerve signal and reduce muscle activity. "The advantage is that the effect is instant," said Dr. Newman, who is chief medical officer for Serene Medical. "It’s long lasting, produces minimal collateral damage, and allows reconnection along the original path of [the] nerve." The effect can last 6-18 months, depending on the lesion, compared with botulinum that lasts for about 3-6 months.

Photos courtesy Dr. James Newman

In split-face studies conducted by Dr. Newman and his associates, 20 patients underwent a single treatment with the Serene Solution to create a radiofrequency lesion on the frontalis and corrugator branches of the temporal facial nerve. Six months post treatment, patient wrinkles remained improved compared with baseline, according to evaluation with Merz Aesthetics Scales. "The muscle response to stimulation currently demonstrates that nerve function is fully restored, when compared to the untreated side," Dr. Newman said. "That told us that the nerve sheath is still intact and that we do not have a complete nerve block." The fact that improvement persists long term in the treated side "may be due to a smaller or less-conditioned frontalis muscle," he said.

Dr. Newman and his associates plan to study the hypothesis that creating three radiofrequency lesions along the frontalis nerve will prolong the period of nerve discontinuity by two to three times. "If we create more than one lesion, perhaps we can prolong relaxation of the frontalis muscle and those wrinkle scores might be improved as well," he said.

Dr. Newman disclosed that he is a stockholder in Serene Medical and that he is a speaker for and has received honoraria from Valeant Pharmaceuticals.

dbrunk@frontlinemedcom.com

DANA POINT, CALIF. – Nonablative fractional photothermolysis technology is a well-suited model for over-the-counter product development, especially within the 1430 nm to 1450 nm range, Dr. Brian S. Biesman said at a meeting sponsored by SkinCare Physicians and Northwestern University.

"I want to dispel the myth that there’s nothing in the home-use realm that works," said Dr. Biesman, director of the Nashville (Tenn.) Center for Laser and Facial Surgery. "There is a lot of money in the investment community tied up in the home-use realm, and there are some real significant devices in this area."

Photos courtesy Dr. James Leyden

Considerations for adoption of intense pulsed light and laser devices for home use should involve "the exact same standards that we apply to the devices that we use in the office," Dr. Biesman said. These include the safety of core technology, in both use and misuse settings: tolerability, predictable efficacy, ease of use, affordable cost, robust premarket evidence, and alignment between claims and reality.

Three nonablative fractional laser options exist for home-based treatment of photodamaged skin: the 1435-nm Palomar PaloVia, the 1410-nm Solta RéAura (not yet FDA cleared), and the 1410-nm Tria Beauty SRL, which is also pending FDA clearance.

Photos courtesy Dr. James Leyden

Dr. Biesman discussed the Tria SRL, a 1440-nm fractional nonablative laser device that can deliver energy up to 260 microns in depth with an adjustable energy range of 5-12 millijoules/pulse. "At first, given the parameters within which this device operated, I didn’t expect it to be clinically useful," Dr. Biesman noted.

In a safety, efficacy, and tolerability study sponsored by Tria, 90 patients aged 32-70 years old underwent treatment for dyschromia, periorbital wrinkles, and textural irregularities on the face. Of the 90 patients, 87 were women, 87 were white, and 62% had Fitzpatrick skin types II or III.

Patients underwent full face treatment 5 days/week for 12 weeks. They were then followed at 1 day, 2 weeks, 4 weeks, 8 weeks, and 12 weeks after the final treatment. Standard and polarized photos were taken on a VISIA CR system by Canfield Scientific, at baseline, every 2 weeks during treatment, and at each follow-up visit. Blinded investigators used a validated nine-point scale to evaluate each indication.

Dr. Biesman, who was not an investigator in the study, reported that investigator scoring showed statistically significant and clinically meaningful improvements in texture, periorbital wrinkles, and discoloration at 4 weeks and 12 weeks post treatment (all with a P value of less than.001). Common side effects included erythema, stinging/prickling sensations, and warm sensations. All side effects were reported to be mild and self-resolving, and no serious adverse events were reported.

Self-reported patient satisfaction ranged from 80%-90%, "which are similar numbers if you look at the subject satisfaction for the office-based nonablative devices," Dr. Biesman said.

Dr. Biesman advises clinicians to think of home-use laser devices for the treatment of photoaging, acne, and hair reduction "as prescriptives, much as we would retinoids. They’re not going to replace what we do in the office," he said. "But if someone has made a substantial investment for an office-based treatment plan, why not recommend something they can use at home that will help them maintain that outcome?"

In his opinion, nonablative resurfacing is "the next area of great opportunity" in home devices. "But I think the area of greatest opportunity is using these nonablative devices with other over-the-counter or prescriptive topical agents for laser-enhanced drug delivery," he noted.

"Using this approach, I believe we can accomplish some unique and very interesting objectives. This is an area that is only just beginning to be explored, but which holds tremendous potential. I look forward to the future of these devices as stand-alone treatments and to enhance drug delivery to facilitate reaching challenging therapeutic and aesthetic endpoints," he added.

Dr. Biesman disclosed that he is a consultant for and has received travel funds from Tria Beauty.

dbrunk@frontlinemedcom.com

*Correction, 9/26/2013: An earlier version of this story included incorrect image order and captions.

DANA POINT, CALIF. – Nonablative fractional photothermolysis technology is a well-suited model for over-the-counter product development, especially within the 1430 nm to 1450 nm range, Dr. Brian S. Biesman said at a meeting sponsored by SkinCare Physicians and Northwestern University.

"I want to dispel the myth that there’s nothing in the home-use realm that works," said Dr. Biesman, director of the Nashville (Tenn.) Center for Laser and Facial Surgery. "There is a lot of money in the investment community tied up in the home-use realm, and there are some real significant devices in this area."

Photos courtesy Dr. James Leyden

Considerations for adoption of intense pulsed light and laser devices for home use should involve "the exact same standards that we apply to the devices that we use in the office," Dr. Biesman said. These include the safety of core technology, in both use and misuse settings: tolerability, predictable efficacy, ease of use, affordable cost, robust premarket evidence, and alignment between claims and reality.

Three nonablative fractional laser options exist for home-based treatment of photodamaged skin: the 1435-nm Palomar PaloVia, the 1410-nm Solta RéAura (not yet FDA cleared), and the 1410-nm Tria Beauty SRL, which is also pending FDA clearance.

Photos courtesy Dr. James Leyden

Dr. Biesman discussed the Tria SRL, a 1440-nm fractional nonablative laser device that can deliver energy up to 260 microns in depth with an adjustable energy range of 5-12 millijoules/pulse. "At first, given the parameters within which this device operated, I didn’t expect it to be clinically useful," Dr. Biesman noted.

In a safety, efficacy, and tolerability study sponsored by Tria, 90 patients aged 32-70 years old underwent treatment for dyschromia, periorbital wrinkles, and textural irregularities on the face. Of the 90 patients, 87 were women, 87 were white, and 62% had Fitzpatrick skin types II or III.

Patients underwent full face treatment 5 days/week for 12 weeks. They were then followed at 1 day, 2 weeks, 4 weeks, 8 weeks, and 12 weeks after the final treatment. Standard and polarized photos were taken on a VISIA CR system by Canfield Scientific, at baseline, every 2 weeks during treatment, and at each follow-up visit. Blinded investigators used a validated nine-point scale to evaluate each indication.

Dr. Biesman, who was not an investigator in the study, reported that investigator scoring showed statistically significant and clinically meaningful improvements in texture, periorbital wrinkles, and discoloration at 4 weeks and 12 weeks post treatment (all with a P value of less than.001). Common side effects included erythema, stinging/prickling sensations, and warm sensations. All side effects were reported to be mild and self-resolving, and no serious adverse events were reported.

Self-reported patient satisfaction ranged from 80%-90%, "which are similar numbers if you look at the subject satisfaction for the office-based nonablative devices," Dr. Biesman said.

Dr. Biesman advises clinicians to think of home-use laser devices for the treatment of photoaging, acne, and hair reduction "as prescriptives, much as we would retinoids. They’re not going to replace what we do in the office," he said. "But if someone has made a substantial investment for an office-based treatment plan, why not recommend something they can use at home that will help them maintain that outcome?"

In his opinion, nonablative resurfacing is "the next area of great opportunity" in home devices. "But I think the area of greatest opportunity is using these nonablative devices with other over-the-counter or prescriptive topical agents for laser-enhanced drug delivery," he noted.

"Using this approach, I believe we can accomplish some unique and very interesting objectives. This is an area that is only just beginning to be explored, but which holds tremendous potential. I look forward to the future of these devices as stand-alone treatments and to enhance drug delivery to facilitate reaching challenging therapeutic and aesthetic endpoints," he added.

Dr. Biesman disclosed that he is a consultant for and has received travel funds from Tria Beauty.

dbrunk@frontlinemedcom.com

*Correction, 9/26/2013: An earlier version of this story included incorrect image order and captions.

DANA POINT, CALIF. – Nonablative fractional photothermolysis technology is a well-suited model for over-the-counter product development, especially within the 1430 nm to 1450 nm range, Dr. Brian S. Biesman said at a meeting sponsored by SkinCare Physicians and Northwestern University.

"I want to dispel the myth that there’s nothing in the home-use realm that works," said Dr. Biesman, director of the Nashville (Tenn.) Center for Laser and Facial Surgery. "There is a lot of money in the investment community tied up in the home-use realm, and there are some real significant devices in this area."

Photos courtesy Dr. James Leyden

Considerations for adoption of intense pulsed light and laser devices for home use should involve "the exact same standards that we apply to the devices that we use in the office," Dr. Biesman said. These include the safety of core technology, in both use and misuse settings: tolerability, predictable efficacy, ease of use, affordable cost, robust premarket evidence, and alignment between claims and reality.

Three nonablative fractional laser options exist for home-based treatment of photodamaged skin: the 1435-nm Palomar PaloVia, the 1410-nm Solta RéAura (not yet FDA cleared), and the 1410-nm Tria Beauty SRL, which is also pending FDA clearance.

Photos courtesy Dr. James Leyden

Dr. Biesman discussed the Tria SRL, a 1440-nm fractional nonablative laser device that can deliver energy up to 260 microns in depth with an adjustable energy range of 5-12 millijoules/pulse. "At first, given the parameters within which this device operated, I didn’t expect it to be clinically useful," Dr. Biesman noted.

In a safety, efficacy, and tolerability study sponsored by Tria, 90 patients aged 32-70 years old underwent treatment for dyschromia, periorbital wrinkles, and textural irregularities on the face. Of the 90 patients, 87 were women, 87 were white, and 62% had Fitzpatrick skin types II or III.

Patients underwent full face treatment 5 days/week for 12 weeks. They were then followed at 1 day, 2 weeks, 4 weeks, 8 weeks, and 12 weeks after the final treatment. Standard and polarized photos were taken on a VISIA CR system by Canfield Scientific, at baseline, every 2 weeks during treatment, and at each follow-up visit. Blinded investigators used a validated nine-point scale to evaluate each indication.

Dr. Biesman, who was not an investigator in the study, reported that investigator scoring showed statistically significant and clinically meaningful improvements in texture, periorbital wrinkles, and discoloration at 4 weeks and 12 weeks post treatment (all with a P value of less than.001). Common side effects included erythema, stinging/prickling sensations, and warm sensations. All side effects were reported to be mild and self-resolving, and no serious adverse events were reported.

Self-reported patient satisfaction ranged from 80%-90%, "which are similar numbers if you look at the subject satisfaction for the office-based nonablative devices," Dr. Biesman said.

Dr. Biesman advises clinicians to think of home-use laser devices for the treatment of photoaging, acne, and hair reduction "as prescriptives, much as we would retinoids. They’re not going to replace what we do in the office," he said. "But if someone has made a substantial investment for an office-based treatment plan, why not recommend something they can use at home that will help them maintain that outcome?"

In his opinion, nonablative resurfacing is "the next area of great opportunity" in home devices. "But I think the area of greatest opportunity is using these nonablative devices with other over-the-counter or prescriptive topical agents for laser-enhanced drug delivery," he noted.

"Using this approach, I believe we can accomplish some unique and very interesting objectives. This is an area that is only just beginning to be explored, but which holds tremendous potential. I look forward to the future of these devices as stand-alone treatments and to enhance drug delivery to facilitate reaching challenging therapeutic and aesthetic endpoints," he added.

Dr. Biesman disclosed that he is a consultant for and has received travel funds from Tria Beauty.

dbrunk@frontlinemedcom.com

*Correction, 9/26/2013: An earlier version of this story included incorrect image order and captions.