Aesthetic Dermatology

SAN FRANCISCO — Three techniques can help make nasal reconstruction surgery easier while providing positive results.

Dr. Hayes B. Gladstone recommends using a more diamond-shaped bilobed flap instead of curved incisions, doing a shave contour instead of defatting a staged melolabial flap, and dividing a paramedian forehead flap after 1 week instead of 3 weeks.

The diamond bilobed flap results in less stress and tension during healing and may reduce the risk of pincushioning, also called trap-door deformity. A shave division of a staged melolabial flap is much easier than defatting, and patients seem pleased to shorten the time to division of a paramedian forehead flap, he said at the annual meeting of the Pacific Dermatologic Association.

▸ Bilobed flap. The original design for a bilobed flap was modified in 1989 to change the angles in order to reduce pincushioning, in which the flap raises up. "If you look in the literature, there is still about a 5%–10% risk" of pincushioning with a bilobed flap, probably caused by wound contraction, said Dr. Gladstone of Stanford (Calif.) University.

By using more angular incision lines (instead of curved lines) to give the flap more of a diamond shape, only 2 mm of undermining is needed instead of the 3 mm needed with a conventional bilobed flap. "It's more of an advancement flap in its angular design," he said.

Computer modeling suggests that the diamond bilobed flap reduces strain on the closure points by 85%, compared with a conventional bilobed flap.

"With angles you're going to get less compression and less contraction, and therefore you're going to get less risk of pincushioning," Dr. Gladstone said.

▸ Melolabial flap. He follows the conventional technique for most patients with thin, nonlobular alar rims who undergo a staged melolabial flap for nasal reconstruction, but after 3 weeks, instead of defatting the flap, he does a shave contour that takes around 3–4 minutes. He lets that heal by second intent.

"It seems a little counterintuitive, but it actually heals very well," accompanied by closure of a small cheek defect when needed, he said.

The key to shave contouring the melolabial flap is to not be too aggressive, which can result in a divot or raising of the alar rim, he added.

▸ Paramedian forehead flap. Most patients dislike waiting 3 weeks to divide a paramedian forehead flap because the flap disrupts vision, making it difficult to read or drive; decreases quality of life; and can cause psychological stress.

One patient tore off his flap after 4 days but healed well. "That's how I decided to start doing this" division earlier, Dr. Gladstone said.

He plans to submit for publication the results for 35 patients who underwent division of a paramedian forehead flap after 1 week.

A survey of the first 15 patients found that all preferred to have the procedure done after 1 week instead of 3 weeks. Tests showed good blood flow, and only three patients required small revisions, he said.

One 95-year-old patient with an active dating life was a prime candidate for the 1-week division of the paramedian forehead flap because "he wasn't going to tolerate 3 weeks," Dr. Gladstone said. The patient healed well.

SAN FRANCISCO — Three techniques can help make nasal reconstruction surgery easier while providing positive results.

Dr. Hayes B. Gladstone recommends using a more diamond-shaped bilobed flap instead of curved incisions, doing a shave contour instead of defatting a staged melolabial flap, and dividing a paramedian forehead flap after 1 week instead of 3 weeks.

The diamond bilobed flap results in less stress and tension during healing and may reduce the risk of pincushioning, also called trap-door deformity. A shave division of a staged melolabial flap is much easier than defatting, and patients seem pleased to shorten the time to division of a paramedian forehead flap, he said at the annual meeting of the Pacific Dermatologic Association.

▸ Bilobed flap. The original design for a bilobed flap was modified in 1989 to change the angles in order to reduce pincushioning, in which the flap raises up. "If you look in the literature, there is still about a 5%–10% risk" of pincushioning with a bilobed flap, probably caused by wound contraction, said Dr. Gladstone of Stanford (Calif.) University.

By using more angular incision lines (instead of curved lines) to give the flap more of a diamond shape, only 2 mm of undermining is needed instead of the 3 mm needed with a conventional bilobed flap. "It's more of an advancement flap in its angular design," he said.

Computer modeling suggests that the diamond bilobed flap reduces strain on the closure points by 85%, compared with a conventional bilobed flap.

"With angles you're going to get less compression and less contraction, and therefore you're going to get less risk of pincushioning," Dr. Gladstone said.

▸ Melolabial flap. He follows the conventional technique for most patients with thin, nonlobular alar rims who undergo a staged melolabial flap for nasal reconstruction, but after 3 weeks, instead of defatting the flap, he does a shave contour that takes around 3–4 minutes. He lets that heal by second intent.

"It seems a little counterintuitive, but it actually heals very well," accompanied by closure of a small cheek defect when needed, he said.

The key to shave contouring the melolabial flap is to not be too aggressive, which can result in a divot or raising of the alar rim, he added.

▸ Paramedian forehead flap. Most patients dislike waiting 3 weeks to divide a paramedian forehead flap because the flap disrupts vision, making it difficult to read or drive; decreases quality of life; and can cause psychological stress.

One patient tore off his flap after 4 days but healed well. "That's how I decided to start doing this" division earlier, Dr. Gladstone said.

He plans to submit for publication the results for 35 patients who underwent division of a paramedian forehead flap after 1 week.

A survey of the first 15 patients found that all preferred to have the procedure done after 1 week instead of 3 weeks. Tests showed good blood flow, and only three patients required small revisions, he said.

One 95-year-old patient with an active dating life was a prime candidate for the 1-week division of the paramedian forehead flap because "he wasn't going to tolerate 3 weeks," Dr. Gladstone said. The patient healed well.

SAN FRANCISCO — Three techniques can help make nasal reconstruction surgery easier while providing positive results.

Dr. Hayes B. Gladstone recommends using a more diamond-shaped bilobed flap instead of curved incisions, doing a shave contour instead of defatting a staged melolabial flap, and dividing a paramedian forehead flap after 1 week instead of 3 weeks.

The diamond bilobed flap results in less stress and tension during healing and may reduce the risk of pincushioning, also called trap-door deformity. A shave division of a staged melolabial flap is much easier than defatting, and patients seem pleased to shorten the time to division of a paramedian forehead flap, he said at the annual meeting of the Pacific Dermatologic Association.

▸ Bilobed flap. The original design for a bilobed flap was modified in 1989 to change the angles in order to reduce pincushioning, in which the flap raises up. "If you look in the literature, there is still about a 5%–10% risk" of pincushioning with a bilobed flap, probably caused by wound contraction, said Dr. Gladstone of Stanford (Calif.) University.

By using more angular incision lines (instead of curved lines) to give the flap more of a diamond shape, only 2 mm of undermining is needed instead of the 3 mm needed with a conventional bilobed flap. "It's more of an advancement flap in its angular design," he said.

Computer modeling suggests that the diamond bilobed flap reduces strain on the closure points by 85%, compared with a conventional bilobed flap.

"With angles you're going to get less compression and less contraction, and therefore you're going to get less risk of pincushioning," Dr. Gladstone said.

▸ Melolabial flap. He follows the conventional technique for most patients with thin, nonlobular alar rims who undergo a staged melolabial flap for nasal reconstruction, but after 3 weeks, instead of defatting the flap, he does a shave contour that takes around 3–4 minutes. He lets that heal by second intent.

"It seems a little counterintuitive, but it actually heals very well," accompanied by closure of a small cheek defect when needed, he said.

The key to shave contouring the melolabial flap is to not be too aggressive, which can result in a divot or raising of the alar rim, he added.

▸ Paramedian forehead flap. Most patients dislike waiting 3 weeks to divide a paramedian forehead flap because the flap disrupts vision, making it difficult to read or drive; decreases quality of life; and can cause psychological stress.

One patient tore off his flap after 4 days but healed well. "That's how I decided to start doing this" division earlier, Dr. Gladstone said.

He plans to submit for publication the results for 35 patients who underwent division of a paramedian forehead flap after 1 week.

A survey of the first 15 patients found that all preferred to have the procedure done after 1 week instead of 3 weeks. Tests showed good blood flow, and only three patients required small revisions, he said.

One 95-year-old patient with an active dating life was a prime candidate for the 1-week division of the paramedian forehead flap because "he wasn't going to tolerate 3 weeks," Dr. Gladstone said. The patient healed well.

SAN FRANCISCO — Respect the nasolabial folds, vermilion border, and mental crease to get the most natural-looking results from reconstructive surgery around the mouth.

Put linear surgical scars into those lines—not across them—to avoid a noticeable asymmetry that "gets very exaggerated during movement" of the mouth, Dr. Ken K. Lee said at the annual meeting of the Pacific Dermatologic Association. Even respecting the lines of current or future rhytids can help hide a scar.

Surgeons commonly used to use a transition flap from the cheek to repair surgical defects on the upper cutaneous lip, but this would blunt the entire nasolabial fold. "If the crease is completely gone, it looks unnatural," so surgeons today shy away from that technique, said Dr. Lee, director of dermatologic and laser surgery at Oregon Health and Science University, Portland.

Perioral surgical defects on the upper lip tend to leave indented scars unless the surgeon hypereverts the incision. "The natural tendency—the reason we get wrinkles in this area—is it wants to invert. So you really have to do an exaggerated eversion to prevent this type of indented scar," he said. The creation of a little ridge when a defect is closed helps produce a nearly invisible scar instead of an indented one.

Closing in a linear fashion may not suffice for larger defects, but the surgeon still should respect the cosmetic lines when using other techniques for closure. Aligning the closure of a rotation flap with the nasolabial fold, rhytids, mental crease, or vermilion border will help hide a scar.

For larger defects, the island pedicle flap becomes the surgeon's work horse, in all its variations. "It allows me to bring skin in from outside the lip unit to fill in larger defects in the lip," Dr. Lee said.

He used a pedicle flap from outside the nasolabial fold to help close a complex defect in the upper cutaneous lip, nose, and cheek in one patient, closing along the nasolabial fold and advancing the cheek. "Recreating all the cosmetic borders is important," he said.

For a young woman in her 30s with little extra skin compared with older patients, it is difficult to repair a defect that takes up a large portion of the upper cutaneous lip just by using the skin inside of the nasolabial fold. It's okay to tap the reservoir of cheek skin for an island pedicle flap to repair this, but "the important thing is that when you zip up the island pedicle—the defect behind it—that line needs to follow the nasolabial fold," he said.

The downside of island pedicle flaps is potential "pincushioning," he added, but if the incision has been adequately undermined and the edges everted, resulting in a good-looking scar, pincushioning will go away in time.

'The natural tendency—the reason we get wrinkles in this area—is it wants to invert.' DR. LEE

An island pedicle flap can utilize skin from outside the perioral borders to fill a defect in the upper lip, with closure along the nasolabial fold for a good cosmetic result as demonstrated in the patient above. The patient is shown before and after surgery (left and middle, respectively), and after the wound had healed (right). Photos courtesy Dr. Ken K. Lee

SAN FRANCISCO — Respect the nasolabial folds, vermilion border, and mental crease to get the most natural-looking results from reconstructive surgery around the mouth.

Put linear surgical scars into those lines—not across them—to avoid a noticeable asymmetry that "gets very exaggerated during movement" of the mouth, Dr. Ken K. Lee said at the annual meeting of the Pacific Dermatologic Association. Even respecting the lines of current or future rhytids can help hide a scar.

Surgeons commonly used to use a transition flap from the cheek to repair surgical defects on the upper cutaneous lip, but this would blunt the entire nasolabial fold. "If the crease is completely gone, it looks unnatural," so surgeons today shy away from that technique, said Dr. Lee, director of dermatologic and laser surgery at Oregon Health and Science University, Portland.

Perioral surgical defects on the upper lip tend to leave indented scars unless the surgeon hypereverts the incision. "The natural tendency—the reason we get wrinkles in this area—is it wants to invert. So you really have to do an exaggerated eversion to prevent this type of indented scar," he said. The creation of a little ridge when a defect is closed helps produce a nearly invisible scar instead of an indented one.

Closing in a linear fashion may not suffice for larger defects, but the surgeon still should respect the cosmetic lines when using other techniques for closure. Aligning the closure of a rotation flap with the nasolabial fold, rhytids, mental crease, or vermilion border will help hide a scar.

For larger defects, the island pedicle flap becomes the surgeon's work horse, in all its variations. "It allows me to bring skin in from outside the lip unit to fill in larger defects in the lip," Dr. Lee said.

He used a pedicle flap from outside the nasolabial fold to help close a complex defect in the upper cutaneous lip, nose, and cheek in one patient, closing along the nasolabial fold and advancing the cheek. "Recreating all the cosmetic borders is important," he said.

For a young woman in her 30s with little extra skin compared with older patients, it is difficult to repair a defect that takes up a large portion of the upper cutaneous lip just by using the skin inside of the nasolabial fold. It's okay to tap the reservoir of cheek skin for an island pedicle flap to repair this, but "the important thing is that when you zip up the island pedicle—the defect behind it—that line needs to follow the nasolabial fold," he said.

The downside of island pedicle flaps is potential "pincushioning," he added, but if the incision has been adequately undermined and the edges everted, resulting in a good-looking scar, pincushioning will go away in time.

'The natural tendency—the reason we get wrinkles in this area—is it wants to invert.' DR. LEE

An island pedicle flap can utilize skin from outside the perioral borders to fill a defect in the upper lip, with closure along the nasolabial fold for a good cosmetic result as demonstrated in the patient above. The patient is shown before and after surgery (left and middle, respectively), and after the wound had healed (right). Photos courtesy Dr. Ken K. Lee

SAN FRANCISCO — Respect the nasolabial folds, vermilion border, and mental crease to get the most natural-looking results from reconstructive surgery around the mouth.

Put linear surgical scars into those lines—not across them—to avoid a noticeable asymmetry that "gets very exaggerated during movement" of the mouth, Dr. Ken K. Lee said at the annual meeting of the Pacific Dermatologic Association. Even respecting the lines of current or future rhytids can help hide a scar.

Surgeons commonly used to use a transition flap from the cheek to repair surgical defects on the upper cutaneous lip, but this would blunt the entire nasolabial fold. "If the crease is completely gone, it looks unnatural," so surgeons today shy away from that technique, said Dr. Lee, director of dermatologic and laser surgery at Oregon Health and Science University, Portland.

Perioral surgical defects on the upper lip tend to leave indented scars unless the surgeon hypereverts the incision. "The natural tendency—the reason we get wrinkles in this area—is it wants to invert. So you really have to do an exaggerated eversion to prevent this type of indented scar," he said. The creation of a little ridge when a defect is closed helps produce a nearly invisible scar instead of an indented one.

Closing in a linear fashion may not suffice for larger defects, but the surgeon still should respect the cosmetic lines when using other techniques for closure. Aligning the closure of a rotation flap with the nasolabial fold, rhytids, mental crease, or vermilion border will help hide a scar.

For larger defects, the island pedicle flap becomes the surgeon's work horse, in all its variations. "It allows me to bring skin in from outside the lip unit to fill in larger defects in the lip," Dr. Lee said.

He used a pedicle flap from outside the nasolabial fold to help close a complex defect in the upper cutaneous lip, nose, and cheek in one patient, closing along the nasolabial fold and advancing the cheek. "Recreating all the cosmetic borders is important," he said.

For a young woman in her 30s with little extra skin compared with older patients, it is difficult to repair a defect that takes up a large portion of the upper cutaneous lip just by using the skin inside of the nasolabial fold. It's okay to tap the reservoir of cheek skin for an island pedicle flap to repair this, but "the important thing is that when you zip up the island pedicle—the defect behind it—that line needs to follow the nasolabial fold," he said.

The downside of island pedicle flaps is potential "pincushioning," he added, but if the incision has been adequately undermined and the edges everted, resulting in a good-looking scar, pincushioning will go away in time.

'The natural tendency—the reason we get wrinkles in this area—is it wants to invert.' DR. LEE

An island pedicle flap can utilize skin from outside the perioral borders to fill a defect in the upper lip, with closure along the nasolabial fold for a good cosmetic result as demonstrated in the patient above. The patient is shown before and after surgery (left and middle, respectively), and after the wound had healed (right). Photos courtesy Dr. Ken K. Lee

CHICAGO — The first large-scale trial of calcium hydroxylapatite in patients with Fitzpatrick skin types IV-VI showed no keloid formation, hypertropic scarring, or skin discoloration when used to treat nasolabial folds.

Although the reasons for scarring and keloids are not clear, anecdotally these side effects appear to present more in patients with darker skin types, lead investigator Dr. Ellen Marmur, chief of dermatologic surgery at Mount Sinai School of Medicine, New York, said in an interview.

"This study liberates many women and men with darker skin types to undergo cosmetic filler treatments with calcium hydroxylapatite," she said. "Past concerns about keloid scarring and discoloration now can be minimized, if not totally alleviated, for these patients.

"Their safety profiles matched those of the larger safety studies in lighter skin types showing this filler is safe to use in all skin types," she added.

The open-label, multicenter, nonrandomized prospective trial enrolled 100 patients with moderate to severe nasolabial folds and Fitzpatrick skin types IV (24%), V (35%), and VI (41%). Calcium hydroxylapatite 0.6 mL–2.8 mL (mean 1.24 mL) was injected subdermally with a 25- to 27-gauge needle using a linear threading/fanning technique.

The mean patient age was 52 years and 94 were female; 85% were African American, 12% were Hispanic, 2% were Asian, and 1%, other.

Evaluation of 100 patients at 3 months and 98 patients at 6 months revealed no keloid formation, hypertrophic scarring, hypopigmentation, hyperpigmentation, or other clinically significant adverse events, Dr. Marmur and her associates reported in a poster at the American Academy of Dermatology's Academy 2008 meeting.

The study did not objectively evaluate efficacy, but treatment benefit, based on physician assessment, persisted for up to 6 months. Radiesse contains calcium-based microspheres suspended in a water-based gel that absorbs in 2–4 weeks, and builds volume by stimulating collagen growth around the implanted material.

Calcium hydroxylapatite (Radiesse) is approved for HIV-associated facial lipoatrophy, and is used as a cosmetic dermal filler.

The study was sponsored by BioForm Medical Inc., the maker of Radiesse. Dr. Marmur is on the medical education faculty for BioForm.

CHICAGO — The first large-scale trial of calcium hydroxylapatite in patients with Fitzpatrick skin types IV-VI showed no keloid formation, hypertropic scarring, or skin discoloration when used to treat nasolabial folds.

Although the reasons for scarring and keloids are not clear, anecdotally these side effects appear to present more in patients with darker skin types, lead investigator Dr. Ellen Marmur, chief of dermatologic surgery at Mount Sinai School of Medicine, New York, said in an interview.

"This study liberates many women and men with darker skin types to undergo cosmetic filler treatments with calcium hydroxylapatite," she said. "Past concerns about keloid scarring and discoloration now can be minimized, if not totally alleviated, for these patients.

"Their safety profiles matched those of the larger safety studies in lighter skin types showing this filler is safe to use in all skin types," she added.

The open-label, multicenter, nonrandomized prospective trial enrolled 100 patients with moderate to severe nasolabial folds and Fitzpatrick skin types IV (24%), V (35%), and VI (41%). Calcium hydroxylapatite 0.6 mL–2.8 mL (mean 1.24 mL) was injected subdermally with a 25- to 27-gauge needle using a linear threading/fanning technique.

The mean patient age was 52 years and 94 were female; 85% were African American, 12% were Hispanic, 2% were Asian, and 1%, other.

Evaluation of 100 patients at 3 months and 98 patients at 6 months revealed no keloid formation, hypertrophic scarring, hypopigmentation, hyperpigmentation, or other clinically significant adverse events, Dr. Marmur and her associates reported in a poster at the American Academy of Dermatology's Academy 2008 meeting.

The study did not objectively evaluate efficacy, but treatment benefit, based on physician assessment, persisted for up to 6 months. Radiesse contains calcium-based microspheres suspended in a water-based gel that absorbs in 2–4 weeks, and builds volume by stimulating collagen growth around the implanted material.

Calcium hydroxylapatite (Radiesse) is approved for HIV-associated facial lipoatrophy, and is used as a cosmetic dermal filler.

The study was sponsored by BioForm Medical Inc., the maker of Radiesse. Dr. Marmur is on the medical education faculty for BioForm.

CHICAGO — The first large-scale trial of calcium hydroxylapatite in patients with Fitzpatrick skin types IV-VI showed no keloid formation, hypertropic scarring, or skin discoloration when used to treat nasolabial folds.

Although the reasons for scarring and keloids are not clear, anecdotally these side effects appear to present more in patients with darker skin types, lead investigator Dr. Ellen Marmur, chief of dermatologic surgery at Mount Sinai School of Medicine, New York, said in an interview.

"This study liberates many women and men with darker skin types to undergo cosmetic filler treatments with calcium hydroxylapatite," she said. "Past concerns about keloid scarring and discoloration now can be minimized, if not totally alleviated, for these patients.

"Their safety profiles matched those of the larger safety studies in lighter skin types showing this filler is safe to use in all skin types," she added.

The open-label, multicenter, nonrandomized prospective trial enrolled 100 patients with moderate to severe nasolabial folds and Fitzpatrick skin types IV (24%), V (35%), and VI (41%). Calcium hydroxylapatite 0.6 mL–2.8 mL (mean 1.24 mL) was injected subdermally with a 25- to 27-gauge needle using a linear threading/fanning technique.

The mean patient age was 52 years and 94 were female; 85% were African American, 12% were Hispanic, 2% were Asian, and 1%, other.

Evaluation of 100 patients at 3 months and 98 patients at 6 months revealed no keloid formation, hypertrophic scarring, hypopigmentation, hyperpigmentation, or other clinically significant adverse events, Dr. Marmur and her associates reported in a poster at the American Academy of Dermatology's Academy 2008 meeting.

The study did not objectively evaluate efficacy, but treatment benefit, based on physician assessment, persisted for up to 6 months. Radiesse contains calcium-based microspheres suspended in a water-based gel that absorbs in 2–4 weeks, and builds volume by stimulating collagen growth around the implanted material.

Calcium hydroxylapatite (Radiesse) is approved for HIV-associated facial lipoatrophy, and is used as a cosmetic dermal filler.

The study was sponsored by BioForm Medical Inc., the maker of Radiesse. Dr. Marmur is on the medical education faculty for BioForm.

CHICAGO — Injectable poly-L-lactic acid used to treat nasolabial fold wrinkles produced significantly fewer overall product-related adverse events than human-derived collagen, study results have shown.

In a randomized multicenter trial of 233 patients with nasolabial fold wrinkles, the overall product-related adverse event rate was 21% with poly-L-lactic acid (PLLA; Sculptra) and 36% with human collagen (Cosmoplast), resulting in a P value of less than .05.

Compared with the PLLA group, the collagen group had more injection-site erythema (26.5% vs. 2.6%) and pruritus (8% vs. 1%), Dr. Marta Rendon and the Cosmetic Study Trial Group reported in a poster at the American Academy of Dermatology's Academy 2008 meeting.

The PLLA group reported more injection-site pain (5.2% vs. 3.4%); more application-site papules, defined as palpable elevations less than 5 mm in diameter (8.6% vs. 3.4%); and more application-site nodules, defined as lesions 5 mm or more in diameter (7% vs. 6%). The difference between the groups was statistically significant for nodules.

The papules and nodules were nonvisible, palpable, and mild or moderate in intensity; all but one event resolved spontaneously during the 13-month follow-up period.

The frequency of adverse events with injectable PLLA, including injection-site pain, papules, and nodules, was lower than reported in early published reports in patients with HIV-related facial lipoatrophy, reported Dr. Rendon, who is in private practice in Boca Raton, Fla., and her associates.

No product-related serious adverse events occurred during the study, which was sponsored by Sanofi-Aventis U.S., which markets Sculptra in the United States through its subsidiary, Dermik Laboratories.

Injectable PLLA is currently approved in the United States for HIV-related facial lipoatrophy and is under review for volume restoration and/or correction of facial wrinkles and folds.

Patients (mean age 51 years) in the study had scores of 2–4 on a 5-point photo-numeric wrinkle assessment scale (WAS) for both the right and left nasolabial fold.

They underwent bilateral injections of PLLA (maximum 5 mL of reconstituted product per session) or collagen (1–2 cc per session) at one to four treatment sessions at 3-week intervals until an optimal correction was achieved for both folds. Roughly 40% in each group were Fitzpatrick skin type III.

Both the PLLA and collagen groups had significant reductions from baseline in WAS scores 3 weeks after the last treatment, as assessed by three plastic surgeons/dermatologists blinded to treatment.

Comparisons between the two groups in the change from baseline in mean WAS scores at subsequent time points resulted in significant differences favoring PLLA at months 3, 6, 9, and 13, reported Dr. Rendon and her associates.

CHICAGO — Injectable poly-L-lactic acid used to treat nasolabial fold wrinkles produced significantly fewer overall product-related adverse events than human-derived collagen, study results have shown.

In a randomized multicenter trial of 233 patients with nasolabial fold wrinkles, the overall product-related adverse event rate was 21% with poly-L-lactic acid (PLLA; Sculptra) and 36% with human collagen (Cosmoplast), resulting in a P value of less than .05.

Compared with the PLLA group, the collagen group had more injection-site erythema (26.5% vs. 2.6%) and pruritus (8% vs. 1%), Dr. Marta Rendon and the Cosmetic Study Trial Group reported in a poster at the American Academy of Dermatology's Academy 2008 meeting.

The PLLA group reported more injection-site pain (5.2% vs. 3.4%); more application-site papules, defined as palpable elevations less than 5 mm in diameter (8.6% vs. 3.4%); and more application-site nodules, defined as lesions 5 mm or more in diameter (7% vs. 6%). The difference between the groups was statistically significant for nodules.

The papules and nodules were nonvisible, palpable, and mild or moderate in intensity; all but one event resolved spontaneously during the 13-month follow-up period.

The frequency of adverse events with injectable PLLA, including injection-site pain, papules, and nodules, was lower than reported in early published reports in patients with HIV-related facial lipoatrophy, reported Dr. Rendon, who is in private practice in Boca Raton, Fla., and her associates.

No product-related serious adverse events occurred during the study, which was sponsored by Sanofi-Aventis U.S., which markets Sculptra in the United States through its subsidiary, Dermik Laboratories.

Injectable PLLA is currently approved in the United States for HIV-related facial lipoatrophy and is under review for volume restoration and/or correction of facial wrinkles and folds.

Patients (mean age 51 years) in the study had scores of 2–4 on a 5-point photo-numeric wrinkle assessment scale (WAS) for both the right and left nasolabial fold.

They underwent bilateral injections of PLLA (maximum 5 mL of reconstituted product per session) or collagen (1–2 cc per session) at one to four treatment sessions at 3-week intervals until an optimal correction was achieved for both folds. Roughly 40% in each group were Fitzpatrick skin type III.

Both the PLLA and collagen groups had significant reductions from baseline in WAS scores 3 weeks after the last treatment, as assessed by three plastic surgeons/dermatologists blinded to treatment.

Comparisons between the two groups in the change from baseline in mean WAS scores at subsequent time points resulted in significant differences favoring PLLA at months 3, 6, 9, and 13, reported Dr. Rendon and her associates.

CHICAGO — Injectable poly-L-lactic acid used to treat nasolabial fold wrinkles produced significantly fewer overall product-related adverse events than human-derived collagen, study results have shown.

In a randomized multicenter trial of 233 patients with nasolabial fold wrinkles, the overall product-related adverse event rate was 21% with poly-L-lactic acid (PLLA; Sculptra) and 36% with human collagen (Cosmoplast), resulting in a P value of less than .05.

Compared with the PLLA group, the collagen group had more injection-site erythema (26.5% vs. 2.6%) and pruritus (8% vs. 1%), Dr. Marta Rendon and the Cosmetic Study Trial Group reported in a poster at the American Academy of Dermatology's Academy 2008 meeting.

The PLLA group reported more injection-site pain (5.2% vs. 3.4%); more application-site papules, defined as palpable elevations less than 5 mm in diameter (8.6% vs. 3.4%); and more application-site nodules, defined as lesions 5 mm or more in diameter (7% vs. 6%). The difference between the groups was statistically significant for nodules.

The papules and nodules were nonvisible, palpable, and mild or moderate in intensity; all but one event resolved spontaneously during the 13-month follow-up period.

The frequency of adverse events with injectable PLLA, including injection-site pain, papules, and nodules, was lower than reported in early published reports in patients with HIV-related facial lipoatrophy, reported Dr. Rendon, who is in private practice in Boca Raton, Fla., and her associates.

No product-related serious adverse events occurred during the study, which was sponsored by Sanofi-Aventis U.S., which markets Sculptra in the United States through its subsidiary, Dermik Laboratories.

Injectable PLLA is currently approved in the United States for HIV-related facial lipoatrophy and is under review for volume restoration and/or correction of facial wrinkles and folds.

Patients (mean age 51 years) in the study had scores of 2–4 on a 5-point photo-numeric wrinkle assessment scale (WAS) for both the right and left nasolabial fold.

They underwent bilateral injections of PLLA (maximum 5 mL of reconstituted product per session) or collagen (1–2 cc per session) at one to four treatment sessions at 3-week intervals until an optimal correction was achieved for both folds. Roughly 40% in each group were Fitzpatrick skin type III.

Both the PLLA and collagen groups had significant reductions from baseline in WAS scores 3 weeks after the last treatment, as assessed by three plastic surgeons/dermatologists blinded to treatment.

Comparisons between the two groups in the change from baseline in mean WAS scores at subsequent time points resulted in significant differences favoring PLLA at months 3, 6, 9, and 13, reported Dr. Rendon and her associates.

Argan oil is derived from the fruit of the Argania spinosa tree, which is native to the arid climate of southwestern Morocco, where the preponderance of research on the herb is conducted. Once prevalent in North Africa, the A. spinosa tree is presently grown only in Morocco, and although it is the second most common tree species there, it is considered endangered, so its oil, which is labor intensive to obtain, is becoming somewhat rare (J. Ethnopharmacol. 1999;67:7–14; SÖFW Journal 2005; 131:35–46).

Argan oil has been used for traditional purposes, including as a medicine, for several centuries (Pharmacol. Res. 2006;54:1–5). Dubbed “liquid gold,” the vitamin E-rich argan oil is highly sought after.

There is a paucity of research on this botanical compound, but the preponderance of recent investigations has focused on the cardiovascular benefits of virgin argan oil consumption. Specifically, antiatherogenic, cholesterol-lowering, antiproliferative, and antioxidant benefits have been observed (Ann. Nutr. Metab. 2005;49:196–201; Nutr. Metab. Cardiovasc. Dis. 2005;15:352–60; Evid. Based Complement. Alternat. Med. 2006;3:317–27; Cancer Invest. 2006;24:588–92; Cancer Detect. Prev. 2007;31:64–9).

Given argan oil's abundant supply of fatty acids, phenolic constituents, squalene, sterols, and tocopherols, it is also thought to be an important factor in enhancing the anticancer effects of the Moroccan diet (Eur. J. Cancer Prev. 2003;12:67–75).

Lipid-Lowering Action

The majority of published research on argan oil has been performed in Morocco by Anas Drissi and his colleagues. They recently studied the effects of regular consumption of the oil on the lipid profile and antioxidant status of 96 healthy Moroccan subjects (62 regular consumers and 34 nonconsumers), of whom 76 were women and 20 were men (Clin. Nutr. 2004;23:1159–66).

The researchers found that plasma LDL cholesterol levels were lower in the participants who regularly consumed virgin argan oil, compared with nonconsumers. The diets of the argan oil consumers contained higher levels of polyunsaturated fats.

The researchers also investigated the in vitro effects of the tocopherols, sterols, and polyphenols in the herbal extract on LDL peroxidation, and found that the argon oil consumers had lower plasma lipoperoxides, a higher molar ratio of α-tocopherol to total cholesterol, and a higher concentration of α-tocopherol, compared with nonconsumers. LDL oxidation was similar in the two groups, despite the fact that consumers had higher plasma antioxidant concentrations and lower lipoperoxide levels.

The investigators concluded that their findings clearly established that regular consumption of virgin argan oil confers antioxidant and cholesterol-lowering activity, suggesting the viability of this natural extract as a dietary adjunct for lowering the risk of cardiovascular events.

Sebum-Reducing Action

More recently, a topical application for argan oil has been deemed viable. Hristo Dobrev of Medical University Plovdiv (Bulgaria) assessed the efficacy of a cream for controlling sebum. The cream was composed of saw palmetto extract, sesame seeds, and argan oil, and was studied in 20 healthy volunteers—16 with oily facial skin and 4 with combination facial skin. During the winter months (January and February), participants applied the formulation to the face twice daily for a period of 4 weeks (J. Cosmet. Dermatol. 2007;6:113–8).

The volunteers were assessed clinically and by instrumental measurement before and after the study period. Questionnaires were completed by the participants to provide a subjective evaluation of efficacy, tolerance, and cosmetic qualities. Objective measurements were made using a photometric device (Sebumeter), sebum collector foils (Sebufix), a Visioscope camera, and surface evaluation of the living skin software.

Results indicated that all of the volunteers tolerated the product. In 95% of the participants, a visible sebum-regulating efficacy was observed. In addition, clinical evaluation scores and casual sebum levels declined significantly after 1 month of treatment. The researcher concluded that this argan oil-containing formulation was efficacious in mitigating greasiness and ameliorating the appearance of oily facial skin.

Liquid Gold in Morocco

Although argan oil might qualify as the latest flavor-of-the-month in terms of so-called miracle ingredients in the beauty industry, it is actually quite popular in France. For years, English and French tourists have been known to return with argan oil from vacations in Morocco. It is worth noting that the cultivation and harnessing of this resource endemic to Morocco are now being fostered by the Moroccan government, which helps to fund the argan cooperatives of Berber women who grind the A. spinosa fruits to extract the oil.

The government of Monaco is also offering support, and the United Nations Educational, Scientific and Cultural Organization has labeled the argan-growing region of Morocco, which comprises approximately 10,000 square miles, a biosphere reserve.

At the Store

Argan oil is the key ingredient in a line of products manufactured by Issahra Argan Cosmetics, and made available through Argan Body LLC. The product line includes Argan Oil (100% organic), Age Control Day Care (with argan oil), and Argan Creamy Milk Face Cleanser, among other products.

Argan oil is also included in the Superskin Concentrate product by Liz Earle, Naturally Active Skincare, as well as in several formulations by Kaeline Argatherapie, available through Xandra Renouvelle. In addition, Laboratoires Serobiologiques, based in Pulnoy, France, has developed proprietary ingredients such as Arganyl, for antiaging indications, and Argatensyl, specifically to combat wrinkles.

Conclusion

The body of research on argan oil is notably scant. However, its traditional uses and inclusion in novel products (as one of the latest ingredients of the moment in the beauty industry) suggest that further investigations are warranted and likely to be forthcoming. Indeed, randomized controlled trials are necessary for establishing the actual benefits and dermatologic applications to be derived, if there are any, from this rare botanical. The little evidence that is available, however, does appear promising.

Argan oil is derived from the fruit of the Argania spinosa tree, which is native to the arid climate of southwestern Morocco, where the preponderance of research on the herb is conducted. Once prevalent in North Africa, the A. spinosa tree is presently grown only in Morocco, and although it is the second most common tree species there, it is considered endangered, so its oil, which is labor intensive to obtain, is becoming somewhat rare (J. Ethnopharmacol. 1999;67:7–14; SÖFW Journal 2005; 131:35–46).

Argan oil has been used for traditional purposes, including as a medicine, for several centuries (Pharmacol. Res. 2006;54:1–5). Dubbed “liquid gold,” the vitamin E-rich argan oil is highly sought after.

There is a paucity of research on this botanical compound, but the preponderance of recent investigations has focused on the cardiovascular benefits of virgin argan oil consumption. Specifically, antiatherogenic, cholesterol-lowering, antiproliferative, and antioxidant benefits have been observed (Ann. Nutr. Metab. 2005;49:196–201; Nutr. Metab. Cardiovasc. Dis. 2005;15:352–60; Evid. Based Complement. Alternat. Med. 2006;3:317–27; Cancer Invest. 2006;24:588–92; Cancer Detect. Prev. 2007;31:64–9).

Given argan oil's abundant supply of fatty acids, phenolic constituents, squalene, sterols, and tocopherols, it is also thought to be an important factor in enhancing the anticancer effects of the Moroccan diet (Eur. J. Cancer Prev. 2003;12:67–75).

Lipid-Lowering Action

The majority of published research on argan oil has been performed in Morocco by Anas Drissi and his colleagues. They recently studied the effects of regular consumption of the oil on the lipid profile and antioxidant status of 96 healthy Moroccan subjects (62 regular consumers and 34 nonconsumers), of whom 76 were women and 20 were men (Clin. Nutr. 2004;23:1159–66).

The researchers found that plasma LDL cholesterol levels were lower in the participants who regularly consumed virgin argan oil, compared with nonconsumers. The diets of the argan oil consumers contained higher levels of polyunsaturated fats.

The researchers also investigated the in vitro effects of the tocopherols, sterols, and polyphenols in the herbal extract on LDL peroxidation, and found that the argon oil consumers had lower plasma lipoperoxides, a higher molar ratio of α-tocopherol to total cholesterol, and a higher concentration of α-tocopherol, compared with nonconsumers. LDL oxidation was similar in the two groups, despite the fact that consumers had higher plasma antioxidant concentrations and lower lipoperoxide levels.

The investigators concluded that their findings clearly established that regular consumption of virgin argan oil confers antioxidant and cholesterol-lowering activity, suggesting the viability of this natural extract as a dietary adjunct for lowering the risk of cardiovascular events.

Sebum-Reducing Action

More recently, a topical application for argan oil has been deemed viable. Hristo Dobrev of Medical University Plovdiv (Bulgaria) assessed the efficacy of a cream for controlling sebum. The cream was composed of saw palmetto extract, sesame seeds, and argan oil, and was studied in 20 healthy volunteers—16 with oily facial skin and 4 with combination facial skin. During the winter months (January and February), participants applied the formulation to the face twice daily for a period of 4 weeks (J. Cosmet. Dermatol. 2007;6:113–8).

The volunteers were assessed clinically and by instrumental measurement before and after the study period. Questionnaires were completed by the participants to provide a subjective evaluation of efficacy, tolerance, and cosmetic qualities. Objective measurements were made using a photometric device (Sebumeter), sebum collector foils (Sebufix), a Visioscope camera, and surface evaluation of the living skin software.

Results indicated that all of the volunteers tolerated the product. In 95% of the participants, a visible sebum-regulating efficacy was observed. In addition, clinical evaluation scores and casual sebum levels declined significantly after 1 month of treatment. The researcher concluded that this argan oil-containing formulation was efficacious in mitigating greasiness and ameliorating the appearance of oily facial skin.

Liquid Gold in Morocco

Although argan oil might qualify as the latest flavor-of-the-month in terms of so-called miracle ingredients in the beauty industry, it is actually quite popular in France. For years, English and French tourists have been known to return with argan oil from vacations in Morocco. It is worth noting that the cultivation and harnessing of this resource endemic to Morocco are now being fostered by the Moroccan government, which helps to fund the argan cooperatives of Berber women who grind the A. spinosa fruits to extract the oil.

The government of Monaco is also offering support, and the United Nations Educational, Scientific and Cultural Organization has labeled the argan-growing region of Morocco, which comprises approximately 10,000 square miles, a biosphere reserve.

At the Store

Argan oil is the key ingredient in a line of products manufactured by Issahra Argan Cosmetics, and made available through Argan Body LLC. The product line includes Argan Oil (100% organic), Age Control Day Care (with argan oil), and Argan Creamy Milk Face Cleanser, among other products.

Argan oil is also included in the Superskin Concentrate product by Liz Earle, Naturally Active Skincare, as well as in several formulations by Kaeline Argatherapie, available through Xandra Renouvelle. In addition, Laboratoires Serobiologiques, based in Pulnoy, France, has developed proprietary ingredients such as Arganyl, for antiaging indications, and Argatensyl, specifically to combat wrinkles.

Conclusion

The body of research on argan oil is notably scant. However, its traditional uses and inclusion in novel products (as one of the latest ingredients of the moment in the beauty industry) suggest that further investigations are warranted and likely to be forthcoming. Indeed, randomized controlled trials are necessary for establishing the actual benefits and dermatologic applications to be derived, if there are any, from this rare botanical. The little evidence that is available, however, does appear promising.

Argan oil is derived from the fruit of the Argania spinosa tree, which is native to the arid climate of southwestern Morocco, where the preponderance of research on the herb is conducted. Once prevalent in North Africa, the A. spinosa tree is presently grown only in Morocco, and although it is the second most common tree species there, it is considered endangered, so its oil, which is labor intensive to obtain, is becoming somewhat rare (J. Ethnopharmacol. 1999;67:7–14; SÖFW Journal 2005; 131:35–46).

Argan oil has been used for traditional purposes, including as a medicine, for several centuries (Pharmacol. Res. 2006;54:1–5). Dubbed “liquid gold,” the vitamin E-rich argan oil is highly sought after.

There is a paucity of research on this botanical compound, but the preponderance of recent investigations has focused on the cardiovascular benefits of virgin argan oil consumption. Specifically, antiatherogenic, cholesterol-lowering, antiproliferative, and antioxidant benefits have been observed (Ann. Nutr. Metab. 2005;49:196–201; Nutr. Metab. Cardiovasc. Dis. 2005;15:352–60; Evid. Based Complement. Alternat. Med. 2006;3:317–27; Cancer Invest. 2006;24:588–92; Cancer Detect. Prev. 2007;31:64–9).

Given argan oil's abundant supply of fatty acids, phenolic constituents, squalene, sterols, and tocopherols, it is also thought to be an important factor in enhancing the anticancer effects of the Moroccan diet (Eur. J. Cancer Prev. 2003;12:67–75).

Lipid-Lowering Action

The majority of published research on argan oil has been performed in Morocco by Anas Drissi and his colleagues. They recently studied the effects of regular consumption of the oil on the lipid profile and antioxidant status of 96 healthy Moroccan subjects (62 regular consumers and 34 nonconsumers), of whom 76 were women and 20 were men (Clin. Nutr. 2004;23:1159–66).

The researchers found that plasma LDL cholesterol levels were lower in the participants who regularly consumed virgin argan oil, compared with nonconsumers. The diets of the argan oil consumers contained higher levels of polyunsaturated fats.

The researchers also investigated the in vitro effects of the tocopherols, sterols, and polyphenols in the herbal extract on LDL peroxidation, and found that the argon oil consumers had lower plasma lipoperoxides, a higher molar ratio of α-tocopherol to total cholesterol, and a higher concentration of α-tocopherol, compared with nonconsumers. LDL oxidation was similar in the two groups, despite the fact that consumers had higher plasma antioxidant concentrations and lower lipoperoxide levels.

The investigators concluded that their findings clearly established that regular consumption of virgin argan oil confers antioxidant and cholesterol-lowering activity, suggesting the viability of this natural extract as a dietary adjunct for lowering the risk of cardiovascular events.

Sebum-Reducing Action

More recently, a topical application for argan oil has been deemed viable. Hristo Dobrev of Medical University Plovdiv (Bulgaria) assessed the efficacy of a cream for controlling sebum. The cream was composed of saw palmetto extract, sesame seeds, and argan oil, and was studied in 20 healthy volunteers—16 with oily facial skin and 4 with combination facial skin. During the winter months (January and February), participants applied the formulation to the face twice daily for a period of 4 weeks (J. Cosmet. Dermatol. 2007;6:113–8).

The volunteers were assessed clinically and by instrumental measurement before and after the study period. Questionnaires were completed by the participants to provide a subjective evaluation of efficacy, tolerance, and cosmetic qualities. Objective measurements were made using a photometric device (Sebumeter), sebum collector foils (Sebufix), a Visioscope camera, and surface evaluation of the living skin software.

Results indicated that all of the volunteers tolerated the product. In 95% of the participants, a visible sebum-regulating efficacy was observed. In addition, clinical evaluation scores and casual sebum levels declined significantly after 1 month of treatment. The researcher concluded that this argan oil-containing formulation was efficacious in mitigating greasiness and ameliorating the appearance of oily facial skin.

Liquid Gold in Morocco

Although argan oil might qualify as the latest flavor-of-the-month in terms of so-called miracle ingredients in the beauty industry, it is actually quite popular in France. For years, English and French tourists have been known to return with argan oil from vacations in Morocco. It is worth noting that the cultivation and harnessing of this resource endemic to Morocco are now being fostered by the Moroccan government, which helps to fund the argan cooperatives of Berber women who grind the A. spinosa fruits to extract the oil.

The government of Monaco is also offering support, and the United Nations Educational, Scientific and Cultural Organization has labeled the argan-growing region of Morocco, which comprises approximately 10,000 square miles, a biosphere reserve.

At the Store

Argan oil is the key ingredient in a line of products manufactured by Issahra Argan Cosmetics, and made available through Argan Body LLC. The product line includes Argan Oil (100% organic), Age Control Day Care (with argan oil), and Argan Creamy Milk Face Cleanser, among other products.

Argan oil is also included in the Superskin Concentrate product by Liz Earle, Naturally Active Skincare, as well as in several formulations by Kaeline Argatherapie, available through Xandra Renouvelle. In addition, Laboratoires Serobiologiques, based in Pulnoy, France, has developed proprietary ingredients such as Arganyl, for antiaging indications, and Argatensyl, specifically to combat wrinkles.

Conclusion

The body of research on argan oil is notably scant. However, its traditional uses and inclusion in novel products (as one of the latest ingredients of the moment in the beauty industry) suggest that further investigations are warranted and likely to be forthcoming. Indeed, randomized controlled trials are necessary for establishing the actual benefits and dermatologic applications to be derived, if there are any, from this rare botanical. The little evidence that is available, however, does appear promising.

SANTA MONICA, CALIF. — Dermatologists have a bountiful bag of tricks when it comes to making patients look great eventually, but not so many options that make them look great instantly—especially after procedures that have left them temporarily red, bruised, or hypopigmented.

"They want appearance improvement and they want it immediately," said Dr. Howard Steinman, a dermatologist in private practice in Chula Vista, Calif.

"They're extremely unhappy when they've had a—quote—'no down time' procedure that results in discoloration."

There was a time when the only options were to call in sick to work, brave stares at the brightly lit Nordstrom cosmetic counter, or locate a highly trained professional paramedical camouflage therapist trained to cover scars and disfigurement.

However, that has all changed with the advent of highly effective, easy to apply mineral makeups, Dr. Steinman said at a cosmetic dermatology seminar sponsored by Skin Disease Education Foundation.

"These have revolutionized the use of medical makeup," he said.

A variety of products is now available that can be applied by a minimally trained individual with a brush or a sponge, with profound results for expected or unanticipated discoloration from procedures.

Patients with melasma and vitiligo also are surprised and grateful for the instantaneous improvement in appearance they can achieve with carefully applied mineral makeup, said Dr. Steinman.

"Anyone in your office can be trained to do this—your manager, receptionist, nurse, or spouse," he added.

Dr. Steinman's wife, Diedre, is a professional makeup artist who is skilled in masking difficult-to-cover abnormalities such as keloid scars, acne scars, and traumatic defects.

However, she saw the need for products that were more easily applied by office personnel and evaluated a variety of mineral makeup for use on routine patients.

Her choice, Youngblood, offers a variety of concealers, foundations, and powders that can used on men or women, said Dr. Steinman, who has no financial connections with the company.

The amount required to cover a patient's face for a few days or weeks of healing costs so little—$10–$12—that Dr. Steinman makes the service complimentary, rather than charging a fee.

It is well worth the cost, he said, not only in terms of patient satisfaction. "When you do something untoward to a patient [like cause a bruise with a Botox injection], you don't have to worry about it as much. You're going to fix it immediately in your office," he said.

Male patients are quietly appreciative, he said. Female patients are thrilled that they can safely use make-up right away.

Mineral makeups, which are crushed inert minerals in powder form, are non-comedogenic, hypoallergenic, and water resistant. As soon as sutures are removed and the skin is completely epithelialized and dry to the touch, they can be applied.

For some women, "not wearing makeup is like not being completely dressed," he said—like going to "a formal event in a bathing suit and a T-shirt."

Even postprocedure trips to a dermatology office can be traumatic, Dr. Steinman explained.

After an ablative procedure, for example, a physician will say, "You look great! This is great healing. I'll see you in 2 weeks," he said.

"But she doesn't feel great. She doesn't feel like she can go out in public," he said.

A woman's normal makeup will fail to cover bruises or dyspigmentation, but mineral makeup will, and give her confidence to return to her regular routine while she waits to enjoy the final results of her procedure, he concluded.

Dr. Steinman and his wife disclosed having no conflicts of interest.

SDEF and this news organization are wholly owned subsidiaries of Elsevier.

Since the amount of makeup required costs so little, consider making the service complimentary. DR. STEINMAN

SANTA MONICA, CALIF. — Dermatologists have a bountiful bag of tricks when it comes to making patients look great eventually, but not so many options that make them look great instantly—especially after procedures that have left them temporarily red, bruised, or hypopigmented.

"They want appearance improvement and they want it immediately," said Dr. Howard Steinman, a dermatologist in private practice in Chula Vista, Calif.

"They're extremely unhappy when they've had a—quote—'no down time' procedure that results in discoloration."

There was a time when the only options were to call in sick to work, brave stares at the brightly lit Nordstrom cosmetic counter, or locate a highly trained professional paramedical camouflage therapist trained to cover scars and disfigurement.

However, that has all changed with the advent of highly effective, easy to apply mineral makeups, Dr. Steinman said at a cosmetic dermatology seminar sponsored by Skin Disease Education Foundation.

"These have revolutionized the use of medical makeup," he said.

A variety of products is now available that can be applied by a minimally trained individual with a brush or a sponge, with profound results for expected or unanticipated discoloration from procedures.

Patients with melasma and vitiligo also are surprised and grateful for the instantaneous improvement in appearance they can achieve with carefully applied mineral makeup, said Dr. Steinman.

"Anyone in your office can be trained to do this—your manager, receptionist, nurse, or spouse," he added.

Dr. Steinman's wife, Diedre, is a professional makeup artist who is skilled in masking difficult-to-cover abnormalities such as keloid scars, acne scars, and traumatic defects.

However, she saw the need for products that were more easily applied by office personnel and evaluated a variety of mineral makeup for use on routine patients.

Her choice, Youngblood, offers a variety of concealers, foundations, and powders that can used on men or women, said Dr. Steinman, who has no financial connections with the company.

The amount required to cover a patient's face for a few days or weeks of healing costs so little—$10–$12—that Dr. Steinman makes the service complimentary, rather than charging a fee.

It is well worth the cost, he said, not only in terms of patient satisfaction. "When you do something untoward to a patient [like cause a bruise with a Botox injection], you don't have to worry about it as much. You're going to fix it immediately in your office," he said.

Male patients are quietly appreciative, he said. Female patients are thrilled that they can safely use make-up right away.

Mineral makeups, which are crushed inert minerals in powder form, are non-comedogenic, hypoallergenic, and water resistant. As soon as sutures are removed and the skin is completely epithelialized and dry to the touch, they can be applied.

For some women, "not wearing makeup is like not being completely dressed," he said—like going to "a formal event in a bathing suit and a T-shirt."

Even postprocedure trips to a dermatology office can be traumatic, Dr. Steinman explained.

After an ablative procedure, for example, a physician will say, "You look great! This is great healing. I'll see you in 2 weeks," he said.

"But she doesn't feel great. She doesn't feel like she can go out in public," he said.

A woman's normal makeup will fail to cover bruises or dyspigmentation, but mineral makeup will, and give her confidence to return to her regular routine while she waits to enjoy the final results of her procedure, he concluded.

Dr. Steinman and his wife disclosed having no conflicts of interest.

SDEF and this news organization are wholly owned subsidiaries of Elsevier.

Since the amount of makeup required costs so little, consider making the service complimentary. DR. STEINMAN

SANTA MONICA, CALIF. — Dermatologists have a bountiful bag of tricks when it comes to making patients look great eventually, but not so many options that make them look great instantly—especially after procedures that have left them temporarily red, bruised, or hypopigmented.

"They want appearance improvement and they want it immediately," said Dr. Howard Steinman, a dermatologist in private practice in Chula Vista, Calif.

"They're extremely unhappy when they've had a—quote—'no down time' procedure that results in discoloration."

There was a time when the only options were to call in sick to work, brave stares at the brightly lit Nordstrom cosmetic counter, or locate a highly trained professional paramedical camouflage therapist trained to cover scars and disfigurement.

However, that has all changed with the advent of highly effective, easy to apply mineral makeups, Dr. Steinman said at a cosmetic dermatology seminar sponsored by Skin Disease Education Foundation.

"These have revolutionized the use of medical makeup," he said.

A variety of products is now available that can be applied by a minimally trained individual with a brush or a sponge, with profound results for expected or unanticipated discoloration from procedures.

Patients with melasma and vitiligo also are surprised and grateful for the instantaneous improvement in appearance they can achieve with carefully applied mineral makeup, said Dr. Steinman.

"Anyone in your office can be trained to do this—your manager, receptionist, nurse, or spouse," he added.

Dr. Steinman's wife, Diedre, is a professional makeup artist who is skilled in masking difficult-to-cover abnormalities such as keloid scars, acne scars, and traumatic defects.

However, she saw the need for products that were more easily applied by office personnel and evaluated a variety of mineral makeup for use on routine patients.

Her choice, Youngblood, offers a variety of concealers, foundations, and powders that can used on men or women, said Dr. Steinman, who has no financial connections with the company.

The amount required to cover a patient's face for a few days or weeks of healing costs so little—$10–$12—that Dr. Steinman makes the service complimentary, rather than charging a fee.

It is well worth the cost, he said, not only in terms of patient satisfaction. "When you do something untoward to a patient [like cause a bruise with a Botox injection], you don't have to worry about it as much. You're going to fix it immediately in your office," he said.

Male patients are quietly appreciative, he said. Female patients are thrilled that they can safely use make-up right away.

Mineral makeups, which are crushed inert minerals in powder form, are non-comedogenic, hypoallergenic, and water resistant. As soon as sutures are removed and the skin is completely epithelialized and dry to the touch, they can be applied.

For some women, "not wearing makeup is like not being completely dressed," he said—like going to "a formal event in a bathing suit and a T-shirt."

Even postprocedure trips to a dermatology office can be traumatic, Dr. Steinman explained.

After an ablative procedure, for example, a physician will say, "You look great! This is great healing. I'll see you in 2 weeks," he said.

"But she doesn't feel great. She doesn't feel like she can go out in public," he said.

A woman's normal makeup will fail to cover bruises or dyspigmentation, but mineral makeup will, and give her confidence to return to her regular routine while she waits to enjoy the final results of her procedure, he concluded.

Dr. Steinman and his wife disclosed having no conflicts of interest.

SDEF and this news organization are wholly owned subsidiaries of Elsevier.

Since the amount of makeup required costs so little, consider making the service complimentary. DR. STEINMAN

Girish S. Munavalli, MD, Mhs, and Robert A. Weiss, MD

Acne is a very prevalent skin disorder, affecting more than 85% of adolescents and often continuing into adulthood. Active acne and its sequelae, especially permanent scarring, may cause longstanding psychological or emotional harm in patients. Novel and promising treatments with laser/light devices (such as blue light, red light, pulsed dye laser, infrared lasers, light-emitting diodes, and pulsed light) have been reported to have varying degrees of efficacy for treatment. The authors compiled a summary of evidence-based literature on laser/light treatment for acne to assist clinicians to more appropriately identify treatment options, should they choose to supplement current medical antiacne therapies.

*For a PDF of the full article, click on the link to the left of this introduction.

Girish S. Munavalli, MD, Mhs, and Robert A. Weiss, MD

Acne is a very prevalent skin disorder, affecting more than 85% of adolescents and often continuing into adulthood. Active acne and its sequelae, especially permanent scarring, may cause longstanding psychological or emotional harm in patients. Novel and promising treatments with laser/light devices (such as blue light, red light, pulsed dye laser, infrared lasers, light-emitting diodes, and pulsed light) have been reported to have varying degrees of efficacy for treatment. The authors compiled a summary of evidence-based literature on laser/light treatment for acne to assist clinicians to more appropriately identify treatment options, should they choose to supplement current medical antiacne therapies.

*For a PDF of the full article, click on the link to the left of this introduction.

Girish S. Munavalli, MD, Mhs, and Robert A. Weiss, MD

Acne is a very prevalent skin disorder, affecting more than 85% of adolescents and often continuing into adulthood. Active acne and its sequelae, especially permanent scarring, may cause longstanding psychological or emotional harm in patients. Novel and promising treatments with laser/light devices (such as blue light, red light, pulsed dye laser, infrared lasers, light-emitting diodes, and pulsed light) have been reported to have varying degrees of efficacy for treatment. The authors compiled a summary of evidence-based literature on laser/light treatment for acne to assist clinicians to more appropriately identify treatment options, should they choose to supplement current medical antiacne therapies.

*For a PDF of the full article, click on the link to the left of this introduction.

Stephan John Kempiak, MD, PhD, and Nathan Uebelhoer, DO

Superficial chemical peels and microdermabrasion are used for many dermatologic conditions. A common condition treated with these modalities is acne vulgaris. In this review, we discuss the theory behind the technique of these procedures and describe the application and complications of each of these procedures in the office setting. The evaluation of patients before proceeding with the procedure and discuss pre- and postpeel regimens used for patients is discussed. We also analyze studies on both of these in-office procedures and comparative studies between the 2 most commonly used superficial chemical peeling agents, glycolic and salicylic acid.

*For a PDF of the full article, click on the link to the left of this introduction.

Stephan John Kempiak, MD, PhD, and Nathan Uebelhoer, DO

Superficial chemical peels and microdermabrasion are used for many dermatologic conditions. A common condition treated with these modalities is acne vulgaris. In this review, we discuss the theory behind the technique of these procedures and describe the application and complications of each of these procedures in the office setting. The evaluation of patients before proceeding with the procedure and discuss pre- and postpeel regimens used for patients is discussed. We also analyze studies on both of these in-office procedures and comparative studies between the 2 most commonly used superficial chemical peeling agents, glycolic and salicylic acid.

*For a PDF of the full article, click on the link to the left of this introduction.

Stephan John Kempiak, MD, PhD, and Nathan Uebelhoer, DO

Superficial chemical peels and microdermabrasion are used for many dermatologic conditions. A common condition treated with these modalities is acne vulgaris. In this review, we discuss the theory behind the technique of these procedures and describe the application and complications of each of these procedures in the office setting. The evaluation of patients before proceeding with the procedure and discuss pre- and postpeel regimens used for patients is discussed. We also analyze studies on both of these in-office procedures and comparative studies between the 2 most commonly used superficial chemical peeling agents, glycolic and salicylic acid.

*For a PDF of the full article, click on the link to the left of this introduction.