Aesthetic Dermatology

The eyes may be windows to the soul but those darn wrinkles may be a window to the bones. In one of the more interesting studies presented at the annual meeting of The Endocrine Society, Dr. Lubna Pal revealed evidence of an association between bone density and skin wrinkling.

"In postmenopausal women, the appearance of the skin may offer a glimpse at the skeletal well-being, a relationship not previously described,” she said in a press statement. "This information may allow the possibility of identifying postmenopausal women at fracture risk at a glance, without dependence on costly tests."

Image courtesy of Wikimedia Commons user Szakalová Edina

Dr. Lubna and her coinvestigators gave 114 postmenopausal women a score for face and neck wrinkles (based on the number of sites and depth). They also attempted to measure skin rigidity, using a durometer. BMD was measured with DEXA.

They found a significant association between wrinkle severity and bone density; more severe wrinkling was associated with lower bone density.

It is not as far-fetched as it may sound. After all, skin and bone share some common building blocks - collagen. Changes in collagen with age may affect both skin and bone.

However, all bets are off for women who cannot refrain from botox, fillers, peels, and plastic surgery.

—Kerri Wachter

The eyes may be windows to the soul but those darn wrinkles may be a window to the bones. In one of the more interesting studies presented at the annual meeting of The Endocrine Society, Dr. Lubna Pal revealed evidence of an association between bone density and skin wrinkling.

"In postmenopausal women, the appearance of the skin may offer a glimpse at the skeletal well-being, a relationship not previously described,” she said in a press statement. "This information may allow the possibility of identifying postmenopausal women at fracture risk at a glance, without dependence on costly tests."

Image courtesy of Wikimedia Commons user Szakalová Edina

Dr. Lubna and her coinvestigators gave 114 postmenopausal women a score for face and neck wrinkles (based on the number of sites and depth). They also attempted to measure skin rigidity, using a durometer. BMD was measured with DEXA.

They found a significant association between wrinkle severity and bone density; more severe wrinkling was associated with lower bone density.

It is not as far-fetched as it may sound. After all, skin and bone share some common building blocks - collagen. Changes in collagen with age may affect both skin and bone.

However, all bets are off for women who cannot refrain from botox, fillers, peels, and plastic surgery.

—Kerri Wachter

The eyes may be windows to the soul but those darn wrinkles may be a window to the bones. In one of the more interesting studies presented at the annual meeting of The Endocrine Society, Dr. Lubna Pal revealed evidence of an association between bone density and skin wrinkling.

"In postmenopausal women, the appearance of the skin may offer a glimpse at the skeletal well-being, a relationship not previously described,” she said in a press statement. "This information may allow the possibility of identifying postmenopausal women at fracture risk at a glance, without dependence on costly tests."

Image courtesy of Wikimedia Commons user Szakalová Edina

Dr. Lubna and her coinvestigators gave 114 postmenopausal women a score for face and neck wrinkles (based on the number of sites and depth). They also attempted to measure skin rigidity, using a durometer. BMD was measured with DEXA.

They found a significant association between wrinkle severity and bone density; more severe wrinkling was associated with lower bone density.

It is not as far-fetched as it may sound. After all, skin and bone share some common building blocks - collagen. Changes in collagen with age may affect both skin and bone.

However, all bets are off for women who cannot refrain from botox, fillers, peels, and plastic surgery.

—Kerri Wachter

In this month's episode reporters discuss a possible cure for acne based on research being conducted by Dr. R. Rox Anderson.

Photo credit: Naseem Miller

Dr. Albert C. Yan goes head to head with lice. He talks about a regimen that uses Cetaphil to suffocate the bugs.

Tips for reducing infection rates during nail surgery are given by Dr. Nathaniel Jellinek.

Dr. Lily Talakoub talks all things sunscreen.

And, last but not least, Dr. Alan Rockoff closes this month's episode with a story about a patient with very strong opinions, and he does a little singing too.

In this month's episode reporters discuss a possible cure for acne based on research being conducted by Dr. R. Rox Anderson.

Photo credit: Naseem Miller

Dr. Albert C. Yan goes head to head with lice. He talks about a regimen that uses Cetaphil to suffocate the bugs.

Tips for reducing infection rates during nail surgery are given by Dr. Nathaniel Jellinek.

Dr. Lily Talakoub talks all things sunscreen.

And, last but not least, Dr. Alan Rockoff closes this month's episode with a story about a patient with very strong opinions, and he does a little singing too.

In this month's episode reporters discuss a possible cure for acne based on research being conducted by Dr. R. Rox Anderson.

Photo credit: Naseem Miller

Dr. Albert C. Yan goes head to head with lice. He talks about a regimen that uses Cetaphil to suffocate the bugs.

Tips for reducing infection rates during nail surgery are given by Dr. Nathaniel Jellinek.

Dr. Lily Talakoub talks all things sunscreen.

And, last but not least, Dr. Alan Rockoff closes this month's episode with a story about a patient with very strong opinions, and he does a little singing too.

MIAMI BEACH – An antibiotic-coated monofilament suture provides strength, flexibility, and elasticity for dermatologic surgery, but requires an extra throw to prevent knot slippage and comes with an initial learning curve, Dr. Susan H. Weinkle said.

"I’ve been using the same sutures almost 30 years until about 9 months ago," Dr. Weinkle said at this year’s South Beach Symposium.

The Monocryl Plus (poliglecaprone 25, Ethicon) is an absorbable, monofilament suture coated with triclosan antibiotic. The antibiotic "is the plus" and it can lower wound closing costs, Dr. Weinkle said.

The suture can be buried or it can run along the surface of the skin, Dr. Weinkle said. This product is associated with low tissue reactivity, so you get wounds with very little inflammation. "If someone cannot get back to my office quickly enough for suture removal, there [still] is very little reaction."

Absorption of the suture begins in about 12 days and can take considerably longer. "That’s a good thing. It stays underneath for up to 120 days, which is longer than Vicryl would last," Dr. Weinkle said. "However, (the sutures) don’t absorb fast enough on the skin. You still need to see the patient back." She asks patients to return to check wound healing anyway, especially to rule out any hematoma "because everyone I do surgery on is on (a blood thinner)."

"When I sew with Vicryl (polyglactin 910 suture, Ethicon), I tend to only put three knots in the wound. Two throws to start, and then another one on top of that." With this monofilament suture, a fourth throw is generally required to secure the knot, Dr. Weinkle said.

Wound infection risk generally is lower with a monofilament suture. In contrast, although easier to use, braided or twisted multifilament sutures carry a higher infection risk. "In a braided suture you have many more areas for fluid and bacteria to get in – that is very important."

There is an initial learning curve with this monofilament suture and "you are not going to love it in the beginning," said Dr. Weinkle, a private practice dermatologist and Mohs surgeon in Bradenton, Fla. "I sent some of these to a colleague in town and he did not like them." She added: "That is only because he tried one pack. You need at least eight packages until you can actually bond with this suture."

This suture features good elasticity, an imperative for wounds where a lot of local anesthesia was injected and edema results when the wound is closed. The suture stretches, and when that edema dissipates, the suture needs to come back down, she explained.

Using one monofilament suture compared to a two-suture closure can save costs, Dr. Weinkle said. The cost of one monofilament suture to close both deeply and superficially is about $12, compared with almost $18 to use a combination of Vicryl and nylon sutures. "Say you work 48 weeks a year and you do 30 incisions a week." Save $6 on each of these 1,440 annual wound closures "and you're looking at a savings of $8,640."

How you buy this suture is also important, Dr. Weinkle said. "I have a low overhead because I check the prices." Multiple national distributors carry this suture. "Make sure whoever you are buying from knows you’re a surgeon. Otherwise, you may end up paying more money for the same packet of sutures because you’re a dermatologist – you're a different category," Dr. Weinkle said. Also consider joining a group purchasing organization.

"Talk to your rep, say you'd like some samples, and say you'll need at least eight packs," Dr. Weinkle said. "I'm telling you, this is going to save you money and do an even better job for your patients."

Dr. Weinkle said that she did not have any relevant financial disclosures.

MIAMI BEACH – An antibiotic-coated monofilament suture provides strength, flexibility, and elasticity for dermatologic surgery, but requires an extra throw to prevent knot slippage and comes with an initial learning curve, Dr. Susan H. Weinkle said.

"I’ve been using the same sutures almost 30 years until about 9 months ago," Dr. Weinkle said at this year’s South Beach Symposium.

The Monocryl Plus (poliglecaprone 25, Ethicon) is an absorbable, monofilament suture coated with triclosan antibiotic. The antibiotic "is the plus" and it can lower wound closing costs, Dr. Weinkle said.

The suture can be buried or it can run along the surface of the skin, Dr. Weinkle said. This product is associated with low tissue reactivity, so you get wounds with very little inflammation. "If someone cannot get back to my office quickly enough for suture removal, there [still] is very little reaction."

Absorption of the suture begins in about 12 days and can take considerably longer. "That’s a good thing. It stays underneath for up to 120 days, which is longer than Vicryl would last," Dr. Weinkle said. "However, (the sutures) don’t absorb fast enough on the skin. You still need to see the patient back." She asks patients to return to check wound healing anyway, especially to rule out any hematoma "because everyone I do surgery on is on (a blood thinner)."

"When I sew with Vicryl (polyglactin 910 suture, Ethicon), I tend to only put three knots in the wound. Two throws to start, and then another one on top of that." With this monofilament suture, a fourth throw is generally required to secure the knot, Dr. Weinkle said.

Wound infection risk generally is lower with a monofilament suture. In contrast, although easier to use, braided or twisted multifilament sutures carry a higher infection risk. "In a braided suture you have many more areas for fluid and bacteria to get in – that is very important."

There is an initial learning curve with this monofilament suture and "you are not going to love it in the beginning," said Dr. Weinkle, a private practice dermatologist and Mohs surgeon in Bradenton, Fla. "I sent some of these to a colleague in town and he did not like them." She added: "That is only because he tried one pack. You need at least eight packages until you can actually bond with this suture."

This suture features good elasticity, an imperative for wounds where a lot of local anesthesia was injected and edema results when the wound is closed. The suture stretches, and when that edema dissipates, the suture needs to come back down, she explained.

Using one monofilament suture compared to a two-suture closure can save costs, Dr. Weinkle said. The cost of one monofilament suture to close both deeply and superficially is about $12, compared with almost $18 to use a combination of Vicryl and nylon sutures. "Say you work 48 weeks a year and you do 30 incisions a week." Save $6 on each of these 1,440 annual wound closures "and you're looking at a savings of $8,640."

How you buy this suture is also important, Dr. Weinkle said. "I have a low overhead because I check the prices." Multiple national distributors carry this suture. "Make sure whoever you are buying from knows you’re a surgeon. Otherwise, you may end up paying more money for the same packet of sutures because you’re a dermatologist – you're a different category," Dr. Weinkle said. Also consider joining a group purchasing organization.

"Talk to your rep, say you'd like some samples, and say you'll need at least eight packs," Dr. Weinkle said. "I'm telling you, this is going to save you money and do an even better job for your patients."

Dr. Weinkle said that she did not have any relevant financial disclosures.

MIAMI BEACH – An antibiotic-coated monofilament suture provides strength, flexibility, and elasticity for dermatologic surgery, but requires an extra throw to prevent knot slippage and comes with an initial learning curve, Dr. Susan H. Weinkle said.

"I’ve been using the same sutures almost 30 years until about 9 months ago," Dr. Weinkle said at this year’s South Beach Symposium.

The Monocryl Plus (poliglecaprone 25, Ethicon) is an absorbable, monofilament suture coated with triclosan antibiotic. The antibiotic "is the plus" and it can lower wound closing costs, Dr. Weinkle said.

The suture can be buried or it can run along the surface of the skin, Dr. Weinkle said. This product is associated with low tissue reactivity, so you get wounds with very little inflammation. "If someone cannot get back to my office quickly enough for suture removal, there [still] is very little reaction."

Absorption of the suture begins in about 12 days and can take considerably longer. "That’s a good thing. It stays underneath for up to 120 days, which is longer than Vicryl would last," Dr. Weinkle said. "However, (the sutures) don’t absorb fast enough on the skin. You still need to see the patient back." She asks patients to return to check wound healing anyway, especially to rule out any hematoma "because everyone I do surgery on is on (a blood thinner)."

"When I sew with Vicryl (polyglactin 910 suture, Ethicon), I tend to only put three knots in the wound. Two throws to start, and then another one on top of that." With this monofilament suture, a fourth throw is generally required to secure the knot, Dr. Weinkle said.

Wound infection risk generally is lower with a monofilament suture. In contrast, although easier to use, braided or twisted multifilament sutures carry a higher infection risk. "In a braided suture you have many more areas for fluid and bacteria to get in – that is very important."

There is an initial learning curve with this monofilament suture and "you are not going to love it in the beginning," said Dr. Weinkle, a private practice dermatologist and Mohs surgeon in Bradenton, Fla. "I sent some of these to a colleague in town and he did not like them." She added: "That is only because he tried one pack. You need at least eight packages until you can actually bond with this suture."

This suture features good elasticity, an imperative for wounds where a lot of local anesthesia was injected and edema results when the wound is closed. The suture stretches, and when that edema dissipates, the suture needs to come back down, she explained.

Using one monofilament suture compared to a two-suture closure can save costs, Dr. Weinkle said. The cost of one monofilament suture to close both deeply and superficially is about $12, compared with almost $18 to use a combination of Vicryl and nylon sutures. "Say you work 48 weeks a year and you do 30 incisions a week." Save $6 on each of these 1,440 annual wound closures "and you're looking at a savings of $8,640."

How you buy this suture is also important, Dr. Weinkle said. "I have a low overhead because I check the prices." Multiple national distributors carry this suture. "Make sure whoever you are buying from knows you’re a surgeon. Otherwise, you may end up paying more money for the same packet of sutures because you’re a dermatologist – you're a different category," Dr. Weinkle said. Also consider joining a group purchasing organization.

"Talk to your rep, say you'd like some samples, and say you'll need at least eight packs," Dr. Weinkle said. "I'm telling you, this is going to save you money and do an even better job for your patients."

Dr. Weinkle said that she did not have any relevant financial disclosures.

GRAPEVINE, TEX. – The nonablative fractional thulium 1927-nm laser effectively treated actinic cheilitis in 15 patients, without subsequent downtime or significant side effects, Dr. Robert Anolik reported at the annual meeting of the American Society for Laser Medicine and Surgery.

Current treatments for actinic cheilitis – including surgery, carbon dioxide/erbium laser ablation, electrodesiccation, and 5-fluorouracil – typically involve significant pain, edema, and other adverse effects, including permanent scarring. The 1927-nm thulium laser, which is effective and well tolerated for superficial resurfacing, has been approved by the Food and Drug Administration for treating actinic keratoses, said Dr. Anolik of the Laser and Skin Surgery Center of New York.

Charts were reviewed for the 15 patients with actinic cheilitis who had been treated with the nonablative fractional 1,927-nm laser at two private laser and skin surgery centers. All were pretreated with topical anesthetic creams and given oral antiviral prophylaxis. Treatment parameters were 10-20 mJ per MTZ, 65%-70% coverage density, and total delivered energy of 0.08-0.1 kJ.

In blinded assessments of before and after photographs using a quartile improvement scale, all 15 patients had improvements of either 76%-100% (9 patients) or 51%-75% (6 patients) after 1-2 treatments. No adverse events occurred, and the only side effects were transient erythema for 1-4 days and edema for 1-3 days. "This is in stark contrast to the wounding, pain, and downtime expected with the other common treatment strategies," Dr. Anolik commented.

Planned next steps include increasing the patient pool, trial treatment of patients with a range of actinic cheilitis severity, assessment of before/after or left/right specimens for molecular features of actinic cheilitis such as p53, and an evaluation of long term benefit, he noted.

Dr. Anolik stated that he has no relevant relationships with industry.

GRAPEVINE, TEX. – The nonablative fractional thulium 1927-nm laser effectively treated actinic cheilitis in 15 patients, without subsequent downtime or significant side effects, Dr. Robert Anolik reported at the annual meeting of the American Society for Laser Medicine and Surgery.

Current treatments for actinic cheilitis – including surgery, carbon dioxide/erbium laser ablation, electrodesiccation, and 5-fluorouracil – typically involve significant pain, edema, and other adverse effects, including permanent scarring. The 1927-nm thulium laser, which is effective and well tolerated for superficial resurfacing, has been approved by the Food and Drug Administration for treating actinic keratoses, said Dr. Anolik of the Laser and Skin Surgery Center of New York.

Charts were reviewed for the 15 patients with actinic cheilitis who had been treated with the nonablative fractional 1,927-nm laser at two private laser and skin surgery centers. All were pretreated with topical anesthetic creams and given oral antiviral prophylaxis. Treatment parameters were 10-20 mJ per MTZ, 65%-70% coverage density, and total delivered energy of 0.08-0.1 kJ.

In blinded assessments of before and after photographs using a quartile improvement scale, all 15 patients had improvements of either 76%-100% (9 patients) or 51%-75% (6 patients) after 1-2 treatments. No adverse events occurred, and the only side effects were transient erythema for 1-4 days and edema for 1-3 days. "This is in stark contrast to the wounding, pain, and downtime expected with the other common treatment strategies," Dr. Anolik commented.

Planned next steps include increasing the patient pool, trial treatment of patients with a range of actinic cheilitis severity, assessment of before/after or left/right specimens for molecular features of actinic cheilitis such as p53, and an evaluation of long term benefit, he noted.

Dr. Anolik stated that he has no relevant relationships with industry.

GRAPEVINE, TEX. – The nonablative fractional thulium 1927-nm laser effectively treated actinic cheilitis in 15 patients, without subsequent downtime or significant side effects, Dr. Robert Anolik reported at the annual meeting of the American Society for Laser Medicine and Surgery.

Current treatments for actinic cheilitis – including surgery, carbon dioxide/erbium laser ablation, electrodesiccation, and 5-fluorouracil – typically involve significant pain, edema, and other adverse effects, including permanent scarring. The 1927-nm thulium laser, which is effective and well tolerated for superficial resurfacing, has been approved by the Food and Drug Administration for treating actinic keratoses, said Dr. Anolik of the Laser and Skin Surgery Center of New York.

Charts were reviewed for the 15 patients with actinic cheilitis who had been treated with the nonablative fractional 1,927-nm laser at two private laser and skin surgery centers. All were pretreated with topical anesthetic creams and given oral antiviral prophylaxis. Treatment parameters were 10-20 mJ per MTZ, 65%-70% coverage density, and total delivered energy of 0.08-0.1 kJ.

In blinded assessments of before and after photographs using a quartile improvement scale, all 15 patients had improvements of either 76%-100% (9 patients) or 51%-75% (6 patients) after 1-2 treatments. No adverse events occurred, and the only side effects were transient erythema for 1-4 days and edema for 1-3 days. "This is in stark contrast to the wounding, pain, and downtime expected with the other common treatment strategies," Dr. Anolik commented.

Planned next steps include increasing the patient pool, trial treatment of patients with a range of actinic cheilitis severity, assessment of before/after or left/right specimens for molecular features of actinic cheilitis such as p53, and an evaluation of long term benefit, he noted.

Dr. Anolik stated that he has no relevant relationships with industry.