Aesthetic Dermatology

LAS VEGAS — Beware the cosmeceutical claims about green tea and its antiaging properties.

Although there is strong evidence that green tea contains substances that may ward off UVA-related skin damage, it is all from in vitro experiments, Dr. Cherie Ditre said at the annual meeting of the American Society of Cosmetic Dermatology and Aesthetic Surgery.

None of it comes from actual patient trials.

"This is all done with artificial skin and artificial-skin substrates. More work needs to be done," said Dr. Ditre, director of the University of Pennsylvania Health System's Cosmetic Dermatology and Skin Enhancement Center in Radnor.

With that caveat, Dr. Ditre said that green tea has been shown to have strong antioncogenic properties and may work in a complementary fashion to retinoids.

The most important, active component of green tea is considered to be epigallocatechin-3-gallate, or ECGC, which is a polyphenolic compound. It appears to inhibit the generation of intracellular hydrogen peroxide, one of the most active DNA-damaging oxygen species, and the formation of cyclobutane pyrimidine dimer, another source of DNA damage.

In experiments with hairless mice prone to squamous cell carcinoma, application of green tea reduced the development of tumors by 60%, relative to controls (Neoplasia 2003;5:555-65), she said.

In the skin culture systems, topical application of green tea extract of ECGC, at practical doses, has been shown to increase the expression of tissue inhibitors of matrix metalloproteinases (TIMPs). Matrix metalloproteinases contribute to the degradation of collagen, and their levels increase after UV exposure, so they may be an important pathway for sun-induced aging, Dr. Ditre said.

In particular, ECGC was shown to increase production of TIMPs in dermal fibroblasts in response to UVA exposure (J. Dermatol. Sci. 2005;40:195-204).

This is different from how retinoids work, she added. Retinoids upregulate collagen synthesis and downregulate matrix metalloproteinase expression. Matrix metalloproteinase expression is mostly increased as a result of UVB exposure.

These differences suggest that using green tea and a retinoid together could be advantageous.

"There is some harmony between these agents," Dr. Ditre said. "Perhaps the combination of retinoids with green tea could give us the maximum benefit for collagen preservation and perhaps collagen upregulation."

Dr. Ditre disclosed that she serves on the speakers' bureau and is an adviser for Topix Pharmaceuticals Inc., maker of Replenix, a skin-care line containing green tea.

LAS VEGAS — Beware the cosmeceutical claims about green tea and its antiaging properties.

Although there is strong evidence that green tea contains substances that may ward off UVA-related skin damage, it is all from in vitro experiments, Dr. Cherie Ditre said at the annual meeting of the American Society of Cosmetic Dermatology and Aesthetic Surgery.

None of it comes from actual patient trials.

"This is all done with artificial skin and artificial-skin substrates. More work needs to be done," said Dr. Ditre, director of the University of Pennsylvania Health System's Cosmetic Dermatology and Skin Enhancement Center in Radnor.

With that caveat, Dr. Ditre said that green tea has been shown to have strong antioncogenic properties and may work in a complementary fashion to retinoids.

The most important, active component of green tea is considered to be epigallocatechin-3-gallate, or ECGC, which is a polyphenolic compound. It appears to inhibit the generation of intracellular hydrogen peroxide, one of the most active DNA-damaging oxygen species, and the formation of cyclobutane pyrimidine dimer, another source of DNA damage.

In experiments with hairless mice prone to squamous cell carcinoma, application of green tea reduced the development of tumors by 60%, relative to controls (Neoplasia 2003;5:555-65), she said.

In the skin culture systems, topical application of green tea extract of ECGC, at practical doses, has been shown to increase the expression of tissue inhibitors of matrix metalloproteinases (TIMPs). Matrix metalloproteinases contribute to the degradation of collagen, and their levels increase after UV exposure, so they may be an important pathway for sun-induced aging, Dr. Ditre said.

In particular, ECGC was shown to increase production of TIMPs in dermal fibroblasts in response to UVA exposure (J. Dermatol. Sci. 2005;40:195-204).

This is different from how retinoids work, she added. Retinoids upregulate collagen synthesis and downregulate matrix metalloproteinase expression. Matrix metalloproteinase expression is mostly increased as a result of UVB exposure.

These differences suggest that using green tea and a retinoid together could be advantageous.

"There is some harmony between these agents," Dr. Ditre said. "Perhaps the combination of retinoids with green tea could give us the maximum benefit for collagen preservation and perhaps collagen upregulation."

Dr. Ditre disclosed that she serves on the speakers' bureau and is an adviser for Topix Pharmaceuticals Inc., maker of Replenix, a skin-care line containing green tea.

LAS VEGAS — Beware the cosmeceutical claims about green tea and its antiaging properties.

Although there is strong evidence that green tea contains substances that may ward off UVA-related skin damage, it is all from in vitro experiments, Dr. Cherie Ditre said at the annual meeting of the American Society of Cosmetic Dermatology and Aesthetic Surgery.

None of it comes from actual patient trials.

"This is all done with artificial skin and artificial-skin substrates. More work needs to be done," said Dr. Ditre, director of the University of Pennsylvania Health System's Cosmetic Dermatology and Skin Enhancement Center in Radnor.

With that caveat, Dr. Ditre said that green tea has been shown to have strong antioncogenic properties and may work in a complementary fashion to retinoids.

The most important, active component of green tea is considered to be epigallocatechin-3-gallate, or ECGC, which is a polyphenolic compound. It appears to inhibit the generation of intracellular hydrogen peroxide, one of the most active DNA-damaging oxygen species, and the formation of cyclobutane pyrimidine dimer, another source of DNA damage.

In experiments with hairless mice prone to squamous cell carcinoma, application of green tea reduced the development of tumors by 60%, relative to controls (Neoplasia 2003;5:555-65), she said.

In the skin culture systems, topical application of green tea extract of ECGC, at practical doses, has been shown to increase the expression of tissue inhibitors of matrix metalloproteinases (TIMPs). Matrix metalloproteinases contribute to the degradation of collagen, and their levels increase after UV exposure, so they may be an important pathway for sun-induced aging, Dr. Ditre said.

In particular, ECGC was shown to increase production of TIMPs in dermal fibroblasts in response to UVA exposure (J. Dermatol. Sci. 2005;40:195-204).

This is different from how retinoids work, she added. Retinoids upregulate collagen synthesis and downregulate matrix metalloproteinase expression. Matrix metalloproteinase expression is mostly increased as a result of UVB exposure.

These differences suggest that using green tea and a retinoid together could be advantageous.

"There is some harmony between these agents," Dr. Ditre said. "Perhaps the combination of retinoids with green tea could give us the maximum benefit for collagen preservation and perhaps collagen upregulation."

Dr. Ditre disclosed that she serves on the speakers' bureau and is an adviser for Topix Pharmaceuticals Inc., maker of Replenix, a skin-care line containing green tea.

LAS VEGAS — The new approach in the cosmetic treatment of the aging face is to look beyond simply using fillers for wrinkles and to think about restoring volume in the upper face and cheeks, Dr. W. Philip Werschler said.

"We are moving from using fillers as wrinkle and line fillers, to facial shaping agents," said Dr. Werschler, at the annual meeting of the American Society of Cosmetic Dermatology and Aesthetic Surgery. "And we divide the face into facial treatment zones in which certain facial shaping agents might be more suited."

A young face, from below the eyes, has an inverted triangle shape with the broad base of the triangle extending across from the top of the malar zygomas and the point extending down to the muscularis mentalis of the chin. As the face ages, the volume descends. Jowls form and muscle atrophies, and the face takes on an upright triangle shape with the sides framed by the marionette lines and the top at the narrowing of the nasal bone, said Dr. Werschler, who has a private dermatology practice and conducts research in Spokane, Wash.

In a recent study, researchers performed dissections on the faces of 30 cadavers, and found that the subcutaneous fat in the face is divided into distinct compartments. Malar fat, for example, is divided into three compartments. The researchers also suggested that the different compartments of fat in the face probably change differently with age, with the divergent fat pads changing location and proportion (Plast. Reconstr. Surg. 2007;119:2219-27).

A short while ago, there was a limited repertoire of fillers, said Dr. Werschler. One could use a temporary filler (bovine collagen) or a permanent filler (silicone). Now there is a broad palette of fillers, with properties that defy easy classification, such as poly-L-lactic acid (Sculptra) and calcium hydroxylapatite microspheres (Radiesse). Poly-L-lactic acid can be molded and shaped under the skin for a short while after injection, while calcium hydroxylapatite stimulates collagen growth around the implanted material and persists for over a year. Both can be used to build volume and they last much longer than collagen.

A "facial shaping artist" will plan out the rejuvenation procedure by taking into account the different properties of fillers, he said. The plan should be informed by the triangle concept, and by the concept that the face has three zones. The top zone extends roughly from the hairline to the upper eyelids. The middle zone goes roughly from the eyebrows to the upper lip. The bottom zone falls roughly from the base of the nose to include the anterior neck.

The goal should be to create balance and symmetry within each zone, and balance and proportion between the zones. The treatment concept embracing these ideas is known as RAVE, or regional aesthetic volume enhancement.

Many simply look to reduce nasolabial folds, oftentimes injecting too much and concentrating on just that one area. Patients may have fewer lines, but they can lose balance and proportion between the zones and can end up looking like "someone who has just stepped off the set of 'Planet of the Apes,'" he said.

"You have to look at facial balance," Dr. Werschler said. "Our approach now has to be more about global balance of the face. Lines and wrinkles do not necessarily define someone's age."

Dr. Werschler has served as a consultant to many companies, including Sanofi Aventis, maker of Sculptra, and BioForm Medical Inc., maker of Radiesse.

LAS VEGAS — The new approach in the cosmetic treatment of the aging face is to look beyond simply using fillers for wrinkles and to think about restoring volume in the upper face and cheeks, Dr. W. Philip Werschler said.

"We are moving from using fillers as wrinkle and line fillers, to facial shaping agents," said Dr. Werschler, at the annual meeting of the American Society of Cosmetic Dermatology and Aesthetic Surgery. "And we divide the face into facial treatment zones in which certain facial shaping agents might be more suited."

A young face, from below the eyes, has an inverted triangle shape with the broad base of the triangle extending across from the top of the malar zygomas and the point extending down to the muscularis mentalis of the chin. As the face ages, the volume descends. Jowls form and muscle atrophies, and the face takes on an upright triangle shape with the sides framed by the marionette lines and the top at the narrowing of the nasal bone, said Dr. Werschler, who has a private dermatology practice and conducts research in Spokane, Wash.

In a recent study, researchers performed dissections on the faces of 30 cadavers, and found that the subcutaneous fat in the face is divided into distinct compartments. Malar fat, for example, is divided into three compartments. The researchers also suggested that the different compartments of fat in the face probably change differently with age, with the divergent fat pads changing location and proportion (Plast. Reconstr. Surg. 2007;119:2219-27).

A short while ago, there was a limited repertoire of fillers, said Dr. Werschler. One could use a temporary filler (bovine collagen) or a permanent filler (silicone). Now there is a broad palette of fillers, with properties that defy easy classification, such as poly-L-lactic acid (Sculptra) and calcium hydroxylapatite microspheres (Radiesse). Poly-L-lactic acid can be molded and shaped under the skin for a short while after injection, while calcium hydroxylapatite stimulates collagen growth around the implanted material and persists for over a year. Both can be used to build volume and they last much longer than collagen.

A "facial shaping artist" will plan out the rejuvenation procedure by taking into account the different properties of fillers, he said. The plan should be informed by the triangle concept, and by the concept that the face has three zones. The top zone extends roughly from the hairline to the upper eyelids. The middle zone goes roughly from the eyebrows to the upper lip. The bottom zone falls roughly from the base of the nose to include the anterior neck.

The goal should be to create balance and symmetry within each zone, and balance and proportion between the zones. The treatment concept embracing these ideas is known as RAVE, or regional aesthetic volume enhancement.

Many simply look to reduce nasolabial folds, oftentimes injecting too much and concentrating on just that one area. Patients may have fewer lines, but they can lose balance and proportion between the zones and can end up looking like "someone who has just stepped off the set of 'Planet of the Apes,'" he said.

"You have to look at facial balance," Dr. Werschler said. "Our approach now has to be more about global balance of the face. Lines and wrinkles do not necessarily define someone's age."

Dr. Werschler has served as a consultant to many companies, including Sanofi Aventis, maker of Sculptra, and BioForm Medical Inc., maker of Radiesse.

LAS VEGAS — The new approach in the cosmetic treatment of the aging face is to look beyond simply using fillers for wrinkles and to think about restoring volume in the upper face and cheeks, Dr. W. Philip Werschler said.

"We are moving from using fillers as wrinkle and line fillers, to facial shaping agents," said Dr. Werschler, at the annual meeting of the American Society of Cosmetic Dermatology and Aesthetic Surgery. "And we divide the face into facial treatment zones in which certain facial shaping agents might be more suited."

A young face, from below the eyes, has an inverted triangle shape with the broad base of the triangle extending across from the top of the malar zygomas and the point extending down to the muscularis mentalis of the chin. As the face ages, the volume descends. Jowls form and muscle atrophies, and the face takes on an upright triangle shape with the sides framed by the marionette lines and the top at the narrowing of the nasal bone, said Dr. Werschler, who has a private dermatology practice and conducts research in Spokane, Wash.

In a recent study, researchers performed dissections on the faces of 30 cadavers, and found that the subcutaneous fat in the face is divided into distinct compartments. Malar fat, for example, is divided into three compartments. The researchers also suggested that the different compartments of fat in the face probably change differently with age, with the divergent fat pads changing location and proportion (Plast. Reconstr. Surg. 2007;119:2219-27).

A short while ago, there was a limited repertoire of fillers, said Dr. Werschler. One could use a temporary filler (bovine collagen) or a permanent filler (silicone). Now there is a broad palette of fillers, with properties that defy easy classification, such as poly-L-lactic acid (Sculptra) and calcium hydroxylapatite microspheres (Radiesse). Poly-L-lactic acid can be molded and shaped under the skin for a short while after injection, while calcium hydroxylapatite stimulates collagen growth around the implanted material and persists for over a year. Both can be used to build volume and they last much longer than collagen.

A "facial shaping artist" will plan out the rejuvenation procedure by taking into account the different properties of fillers, he said. The plan should be informed by the triangle concept, and by the concept that the face has three zones. The top zone extends roughly from the hairline to the upper eyelids. The middle zone goes roughly from the eyebrows to the upper lip. The bottom zone falls roughly from the base of the nose to include the anterior neck.

The goal should be to create balance and symmetry within each zone, and balance and proportion between the zones. The treatment concept embracing these ideas is known as RAVE, or regional aesthetic volume enhancement.

Many simply look to reduce nasolabial folds, oftentimes injecting too much and concentrating on just that one area. Patients may have fewer lines, but they can lose balance and proportion between the zones and can end up looking like "someone who has just stepped off the set of 'Planet of the Apes,'" he said.

"You have to look at facial balance," Dr. Werschler said. "Our approach now has to be more about global balance of the face. Lines and wrinkles do not necessarily define someone's age."

Dr. Werschler has served as a consultant to many companies, including Sanofi Aventis, maker of Sculptra, and BioForm Medical Inc., maker of Radiesse.

MIAMI — Laser treatment improved dermatosis papulosa nigra with efficacy comparable to standard electrodesiccation, according to rater assessments in a randomized, split-face pilot study of skin types IV-VI.

Subjective ratings, however, revealed a trend toward better efficacy with the laser treatment (Aura KTP [potassium titanyl phosphate], Laserscope) after 8 weeks, Dr. Roopal V. Kundu said at an international symposium sponsored by the L'Oréal Institute for Ethnic Hair and Skin Research.

"Both treatment modalities were quite efficacious; however, the KTP laser was probably preferable for patient comfort and tolerability," she said.

Dermatosis papulosa nigra (DPN) are superficial and hyperpigmented papules that occur on the head and neck of patients with darker skin. They tend to grow in size over time and do not resolve. Although benign, "they are cosmetically displeasing and psychologically distressing to many of our patients," said Dr. Kundu, who is with the department of dermatology at Northwestern University, Chicago, and has no financial disclosure regarding the KTP laser.

"The important point for dermatologists is we have a wonderful opportunity to educate patients with DPNs. Tell them they are not moles, that they are benign and have no malignant potential," she said.

Conventional treatment includes cryotherapy, snip excision, curettage, or electrodesiccation of each lesion. These approaches, however, increase the risk of pain and hypopigmentation, especially in darker skin.

All 14 participants were adults with clinically diagnosed DPN and skin types IV-VI. There were 11 women and 3 men with a mean age of 52 years. At baseline and 4 weeks, each received electrodesiccation to half of their face and KTP laser treatment to the other half. The laser was set to 15 J/cm2, 5 pulses per second repetition, and a 1-cm spot size.

A dermatologist blinded to the regimen rated left- and right-side photographs at week 8. Efficacy was rated as a score of 1-4, with each number representing a 25% clinical improvement over baseline. About 60% of photographs demonstrated a 75%-100% improvement, so the raters found no statistically significant difference between treatments.

"There was a notable improvement for both KTP laser treatment and electrodesiccation at week 8," Dr. Kundu said at the meeting, which was also sponsored by Howard University.

Participants were asked to report adverse events, treatment satisfaction, and cosmetic outcome up to week 8. They used a 1-5 rating scale, with 1 representing "not at all" and 5 "very much." There was a trend toward KTP laser treatment being more effective than electrodesiccation. In addition, there was significantly "less pain and discomfort with the KTP laser," Dr. Kundu said.

MIAMI — Laser treatment improved dermatosis papulosa nigra with efficacy comparable to standard electrodesiccation, according to rater assessments in a randomized, split-face pilot study of skin types IV-VI.

Subjective ratings, however, revealed a trend toward better efficacy with the laser treatment (Aura KTP [potassium titanyl phosphate], Laserscope) after 8 weeks, Dr. Roopal V. Kundu said at an international symposium sponsored by the L'Oréal Institute for Ethnic Hair and Skin Research.

"Both treatment modalities were quite efficacious; however, the KTP laser was probably preferable for patient comfort and tolerability," she said.

Dermatosis papulosa nigra (DPN) are superficial and hyperpigmented papules that occur on the head and neck of patients with darker skin. They tend to grow in size over time and do not resolve. Although benign, "they are cosmetically displeasing and psychologically distressing to many of our patients," said Dr. Kundu, who is with the department of dermatology at Northwestern University, Chicago, and has no financial disclosure regarding the KTP laser.

"The important point for dermatologists is we have a wonderful opportunity to educate patients with DPNs. Tell them they are not moles, that they are benign and have no malignant potential," she said.

Conventional treatment includes cryotherapy, snip excision, curettage, or electrodesiccation of each lesion. These approaches, however, increase the risk of pain and hypopigmentation, especially in darker skin.

All 14 participants were adults with clinically diagnosed DPN and skin types IV-VI. There were 11 women and 3 men with a mean age of 52 years. At baseline and 4 weeks, each received electrodesiccation to half of their face and KTP laser treatment to the other half. The laser was set to 15 J/cm2, 5 pulses per second repetition, and a 1-cm spot size.

A dermatologist blinded to the regimen rated left- and right-side photographs at week 8. Efficacy was rated as a score of 1-4, with each number representing a 25% clinical improvement over baseline. About 60% of photographs demonstrated a 75%-100% improvement, so the raters found no statistically significant difference between treatments.

"There was a notable improvement for both KTP laser treatment and electrodesiccation at week 8," Dr. Kundu said at the meeting, which was also sponsored by Howard University.

Participants were asked to report adverse events, treatment satisfaction, and cosmetic outcome up to week 8. They used a 1-5 rating scale, with 1 representing "not at all" and 5 "very much." There was a trend toward KTP laser treatment being more effective than electrodesiccation. In addition, there was significantly "less pain and discomfort with the KTP laser," Dr. Kundu said.

MIAMI — Laser treatment improved dermatosis papulosa nigra with efficacy comparable to standard electrodesiccation, according to rater assessments in a randomized, split-face pilot study of skin types IV-VI.

Subjective ratings, however, revealed a trend toward better efficacy with the laser treatment (Aura KTP [potassium titanyl phosphate], Laserscope) after 8 weeks, Dr. Roopal V. Kundu said at an international symposium sponsored by the L'Oréal Institute for Ethnic Hair and Skin Research.

"Both treatment modalities were quite efficacious; however, the KTP laser was probably preferable for patient comfort and tolerability," she said.

Dermatosis papulosa nigra (DPN) are superficial and hyperpigmented papules that occur on the head and neck of patients with darker skin. They tend to grow in size over time and do not resolve. Although benign, "they are cosmetically displeasing and psychologically distressing to many of our patients," said Dr. Kundu, who is with the department of dermatology at Northwestern University, Chicago, and has no financial disclosure regarding the KTP laser.

"The important point for dermatologists is we have a wonderful opportunity to educate patients with DPNs. Tell them they are not moles, that they are benign and have no malignant potential," she said.

Conventional treatment includes cryotherapy, snip excision, curettage, or electrodesiccation of each lesion. These approaches, however, increase the risk of pain and hypopigmentation, especially in darker skin.

All 14 participants were adults with clinically diagnosed DPN and skin types IV-VI. There were 11 women and 3 men with a mean age of 52 years. At baseline and 4 weeks, each received electrodesiccation to half of their face and KTP laser treatment to the other half. The laser was set to 15 J/cm2, 5 pulses per second repetition, and a 1-cm spot size.

A dermatologist blinded to the regimen rated left- and right-side photographs at week 8. Efficacy was rated as a score of 1-4, with each number representing a 25% clinical improvement over baseline. About 60% of photographs demonstrated a 75%-100% improvement, so the raters found no statistically significant difference between treatments.

"There was a notable improvement for both KTP laser treatment and electrodesiccation at week 8," Dr. Kundu said at the meeting, which was also sponsored by Howard University.

Participants were asked to report adverse events, treatment satisfaction, and cosmetic outcome up to week 8. They used a 1-5 rating scale, with 1 representing "not at all" and 5 "very much." There was a trend toward KTP laser treatment being more effective than electrodesiccation. In addition, there was significantly "less pain and discomfort with the KTP laser," Dr. Kundu said.

CHICAGO — The first reported treatment of fresh scars with fractional resurfacing shows the modality to be both safe and effective, which places the device in direct competition with the carbon dioxide laser.

"Fractional laser treatment using the 1,550-nm erbium fiber laser produced significant improvement in all characteristics of fresh scars," said Dr. Cameron Rokhsar, at the annual meeting of the American Society for Dermatologic Surgery.

Studies of carbon dioxide and, more recently, pulsed dye laser treatment, have shown improvements in the range of 50%-60%, which are on a par with dermabrasion, said Dr. Rokhsar of the division of dermatology at the Albert Einstein College of Medicine, New York.

Dr. Rokhsar's study included 10 patients who received half-scar treatment with the nonablative Fraxel SR 750 system at or within 2 weeks of suture removal. The untreated half of each scar served as the control. The study was sponsored through a research grant by Reliant Technologies Inc., manufacturer of the Fraxel laser system. Reliant provided the devices that were used in the study. Dr. Rokhsar is a consultant for the company.

Patients were 19-74 years old; the study excluded those with localized or systemic infections and those being treated with isotretinoin, Dr. Rokhsar said.

Half of each scar was treated every other week for 10 weeks (five sessions) using an energy level of 20 mJ and a density of 1,000-2,000 microthermal zones per square centimeter.

The patients were evaluated at 1 month and 3 months after the last treatment based on a quartile scale of 0-4 (0, no improvement; 2, 26%-50% improvement; 3, 51%-75% improvement; and 4, 76%-100% improvement), he explained.

After 3 months, all treated scar portions were rated as either 2 or 3. "The improvements were moderate to significant for all scar characteristics, with both the patients and the study investigators reporting that improvement scores for skin texture, pigmentation, and overall atrophic scar appearance were well correlated," Dr. Rokhsar said.

"The treatments were safe and well tolerated," he noted. At 1 month following the last treatment, "three subjects had mild erythema and a fourth had transient postinflammatory hyperpigmentation; all resolved by 3 months."

The bottom half of this vertical scar (starting at ruler edge) was resurfaced five times with a Fraxel laser. Courtesy Dr. Cameron Rokhsar

CHICAGO — The first reported treatment of fresh scars with fractional resurfacing shows the modality to be both safe and effective, which places the device in direct competition with the carbon dioxide laser.

"Fractional laser treatment using the 1,550-nm erbium fiber laser produced significant improvement in all characteristics of fresh scars," said Dr. Cameron Rokhsar, at the annual meeting of the American Society for Dermatologic Surgery.

Studies of carbon dioxide and, more recently, pulsed dye laser treatment, have shown improvements in the range of 50%-60%, which are on a par with dermabrasion, said Dr. Rokhsar of the division of dermatology at the Albert Einstein College of Medicine, New York.

Dr. Rokhsar's study included 10 patients who received half-scar treatment with the nonablative Fraxel SR 750 system at or within 2 weeks of suture removal. The untreated half of each scar served as the control. The study was sponsored through a research grant by Reliant Technologies Inc., manufacturer of the Fraxel laser system. Reliant provided the devices that were used in the study. Dr. Rokhsar is a consultant for the company.

Patients were 19-74 years old; the study excluded those with localized or systemic infections and those being treated with isotretinoin, Dr. Rokhsar said.

Half of each scar was treated every other week for 10 weeks (five sessions) using an energy level of 20 mJ and a density of 1,000-2,000 microthermal zones per square centimeter.

The patients were evaluated at 1 month and 3 months after the last treatment based on a quartile scale of 0-4 (0, no improvement; 2, 26%-50% improvement; 3, 51%-75% improvement; and 4, 76%-100% improvement), he explained.

After 3 months, all treated scar portions were rated as either 2 or 3. "The improvements were moderate to significant for all scar characteristics, with both the patients and the study investigators reporting that improvement scores for skin texture, pigmentation, and overall atrophic scar appearance were well correlated," Dr. Rokhsar said.

"The treatments were safe and well tolerated," he noted. At 1 month following the last treatment, "three subjects had mild erythema and a fourth had transient postinflammatory hyperpigmentation; all resolved by 3 months."

The bottom half of this vertical scar (starting at ruler edge) was resurfaced five times with a Fraxel laser. Courtesy Dr. Cameron Rokhsar

CHICAGO — The first reported treatment of fresh scars with fractional resurfacing shows the modality to be both safe and effective, which places the device in direct competition with the carbon dioxide laser.

"Fractional laser treatment using the 1,550-nm erbium fiber laser produced significant improvement in all characteristics of fresh scars," said Dr. Cameron Rokhsar, at the annual meeting of the American Society for Dermatologic Surgery.

Studies of carbon dioxide and, more recently, pulsed dye laser treatment, have shown improvements in the range of 50%-60%, which are on a par with dermabrasion, said Dr. Rokhsar of the division of dermatology at the Albert Einstein College of Medicine, New York.

Dr. Rokhsar's study included 10 patients who received half-scar treatment with the nonablative Fraxel SR 750 system at or within 2 weeks of suture removal. The untreated half of each scar served as the control. The study was sponsored through a research grant by Reliant Technologies Inc., manufacturer of the Fraxel laser system. Reliant provided the devices that were used in the study. Dr. Rokhsar is a consultant for the company.

Patients were 19-74 years old; the study excluded those with localized or systemic infections and those being treated with isotretinoin, Dr. Rokhsar said.

Half of each scar was treated every other week for 10 weeks (five sessions) using an energy level of 20 mJ and a density of 1,000-2,000 microthermal zones per square centimeter.

The patients were evaluated at 1 month and 3 months after the last treatment based on a quartile scale of 0-4 (0, no improvement; 2, 26%-50% improvement; 3, 51%-75% improvement; and 4, 76%-100% improvement), he explained.

After 3 months, all treated scar portions were rated as either 2 or 3. "The improvements were moderate to significant for all scar characteristics, with both the patients and the study investigators reporting that improvement scores for skin texture, pigmentation, and overall atrophic scar appearance were well correlated," Dr. Rokhsar said.

"The treatments were safe and well tolerated," he noted. At 1 month following the last treatment, "three subjects had mild erythema and a fourth had transient postinflammatory hyperpigmentation; all resolved by 3 months."

The bottom half of this vertical scar (starting at ruler edge) was resurfaced five times with a Fraxel laser. Courtesy Dr. Cameron Rokhsar

CHICAGO — Fractional laser photothermolysis should be considered first-line therapy for cutaneous resurfacing because of the device's efficacy in treating a wide range of skin types with minimal adverse events.

"There is a very low complication rate, compared with other ablative laser methods such as the carbon dioxide and erbium lasers. The most common side effect in our study was acneiform eruption, which occurred less than 2% of the time," said Dr. Emmy Graber at the annual meeting of the American Society for Dermatologic Surgery.

Acne-prone patients were more likely to experience posttreatment acne in a study conducted by Dr. Graber and colleagues. Use of oral antibiotics (doxycycline 20 mg b.i.d.) during subsequent treatments prevented further outbreaks.

Treatment with fractional lasers has been shown to be effective for the treatment of photodamaged skin and fresh scars. However, there are limited studies evaluating the side effects and complications of the technique. "This is the first large-scale study to evaluate complications with the Fraxel laser," said Dr. Graber, a fellow at the Washington (D.C.) Institute of Dermatologic Laser Surgery.

The investigators conducted a retrospective chart study of 961 treatments using a 1,550-nm erbium-doped fiber laser (Fraxel, Reliant Technologies Inc.). Dr. Graber, now with SkinCare Physicians in Chestnut Hill, Mass., declared no financial conflicts and said the study received no funding or equipment from Reliant.

The study included 422 patients with skin types I-IV treated by two operators between October 2004 and September 2006.

"All treatments were done with either the Fraxel 1 or Fraxel 2 using the 15-mm handpiece with a fluence range from 10 to 40 J/cm2, and the average fluence used was 25 J," she said, adding that densities ranged from 125 to 250 microscopic treatment zones per square centimeter, and average total delivered energy per treatment was 4.2 kJ.

All study patients were telephoned by a nurse 1 day after treatment and all had follow-up visits at 1 month. Most patients were followed for at least 1 year after final treatment, Dr. Graber said.

Most of those treated were women (91%) and most treatments were performed on the face (74%). Nearly one-fourth of patients were treated on both the face and other parts of the body. The majority of treatments (743) were for photodamage. The remaining treatments were for scars (175) and other diagnoses (43).

Overall, the 961 treatments resulted in 73 complications, which included acneiform eruptions (18), herpes simplex virus outbreak (17), erosions (13), prolonged erythema (8), postinflammatory hyperpigmentation (7), prolonged edema (6), dermatitis (2), impetigo (1), and purpura (1).

The side effect rate did not differ with regard to gender, age, body location, or diagnosis, Dr. Graber said.

"Those with complications had significantly darker skin types, and this discrepancy was most evident when comparing the incidence of postinflammatory hyperpigmentation, which appeared an average of 11 days post treatment and lasted an average of 50 days, which was longer than any other complication," Dr. Graber said.

In addition, 27% (259) of the 961 treatments were on patients with histories of herpes simplex virus (HSV). One-third of these patients (86) received antiviral prophylaxis, and 6 developed an HSV outbreak despite prophylaxis. Of the remaining two-thirds who did not receive prophylaxis, eight developed an HSV outbreak, she said, adding that of the 702 treatments on patients without histories of HSV, 3 resulted in HSV outbreak.

Because the complication rate in darker-skinned patients was low, pretreatment of all Fraxel patients with hydroquinones or other lighteners is not recommended, said study coauthor Dr. Tina Alster, the institute's director. "If you see a problem postoperatively, you can try to fade it out then, but in our study of close to a thousand treatments, the number of complications was virtually nil," Dr. Alster said, adding that the treatment should be avoided in tanned skin.

Fraxel 1, now called the Fraxel 750, received Food and Drug Administration approval in November 2003, according to a company spokesperson. The second-generation Fraxel 2, which has an adjustable spot-size feature, was approved last year.

CHICAGO — Fractional laser photothermolysis should be considered first-line therapy for cutaneous resurfacing because of the device's efficacy in treating a wide range of skin types with minimal adverse events.

"There is a very low complication rate, compared with other ablative laser methods such as the carbon dioxide and erbium lasers. The most common side effect in our study was acneiform eruption, which occurred less than 2% of the time," said Dr. Emmy Graber at the annual meeting of the American Society for Dermatologic Surgery.

Acne-prone patients were more likely to experience posttreatment acne in a study conducted by Dr. Graber and colleagues. Use of oral antibiotics (doxycycline 20 mg b.i.d.) during subsequent treatments prevented further outbreaks.

Treatment with fractional lasers has been shown to be effective for the treatment of photodamaged skin and fresh scars. However, there are limited studies evaluating the side effects and complications of the technique. "This is the first large-scale study to evaluate complications with the Fraxel laser," said Dr. Graber, a fellow at the Washington (D.C.) Institute of Dermatologic Laser Surgery.

The investigators conducted a retrospective chart study of 961 treatments using a 1,550-nm erbium-doped fiber laser (Fraxel, Reliant Technologies Inc.). Dr. Graber, now with SkinCare Physicians in Chestnut Hill, Mass., declared no financial conflicts and said the study received no funding or equipment from Reliant.

The study included 422 patients with skin types I-IV treated by two operators between October 2004 and September 2006.

"All treatments were done with either the Fraxel 1 or Fraxel 2 using the 15-mm handpiece with a fluence range from 10 to 40 J/cm2, and the average fluence used was 25 J," she said, adding that densities ranged from 125 to 250 microscopic treatment zones per square centimeter, and average total delivered energy per treatment was 4.2 kJ.

All study patients were telephoned by a nurse 1 day after treatment and all had follow-up visits at 1 month. Most patients were followed for at least 1 year after final treatment, Dr. Graber said.

Most of those treated were women (91%) and most treatments were performed on the face (74%). Nearly one-fourth of patients were treated on both the face and other parts of the body. The majority of treatments (743) were for photodamage. The remaining treatments were for scars (175) and other diagnoses (43).

Overall, the 961 treatments resulted in 73 complications, which included acneiform eruptions (18), herpes simplex virus outbreak (17), erosions (13), prolonged erythema (8), postinflammatory hyperpigmentation (7), prolonged edema (6), dermatitis (2), impetigo (1), and purpura (1).

The side effect rate did not differ with regard to gender, age, body location, or diagnosis, Dr. Graber said.

"Those with complications had significantly darker skin types, and this discrepancy was most evident when comparing the incidence of postinflammatory hyperpigmentation, which appeared an average of 11 days post treatment and lasted an average of 50 days, which was longer than any other complication," Dr. Graber said.

In addition, 27% (259) of the 961 treatments were on patients with histories of herpes simplex virus (HSV). One-third of these patients (86) received antiviral prophylaxis, and 6 developed an HSV outbreak despite prophylaxis. Of the remaining two-thirds who did not receive prophylaxis, eight developed an HSV outbreak, she said, adding that of the 702 treatments on patients without histories of HSV, 3 resulted in HSV outbreak.

Because the complication rate in darker-skinned patients was low, pretreatment of all Fraxel patients with hydroquinones or other lighteners is not recommended, said study coauthor Dr. Tina Alster, the institute's director. "If you see a problem postoperatively, you can try to fade it out then, but in our study of close to a thousand treatments, the number of complications was virtually nil," Dr. Alster said, adding that the treatment should be avoided in tanned skin.

Fraxel 1, now called the Fraxel 750, received Food and Drug Administration approval in November 2003, according to a company spokesperson. The second-generation Fraxel 2, which has an adjustable spot-size feature, was approved last year.

CHICAGO — Fractional laser photothermolysis should be considered first-line therapy for cutaneous resurfacing because of the device's efficacy in treating a wide range of skin types with minimal adverse events.

"There is a very low complication rate, compared with other ablative laser methods such as the carbon dioxide and erbium lasers. The most common side effect in our study was acneiform eruption, which occurred less than 2% of the time," said Dr. Emmy Graber at the annual meeting of the American Society for Dermatologic Surgery.

Acne-prone patients were more likely to experience posttreatment acne in a study conducted by Dr. Graber and colleagues. Use of oral antibiotics (doxycycline 20 mg b.i.d.) during subsequent treatments prevented further outbreaks.

Treatment with fractional lasers has been shown to be effective for the treatment of photodamaged skin and fresh scars. However, there are limited studies evaluating the side effects and complications of the technique. "This is the first large-scale study to evaluate complications with the Fraxel laser," said Dr. Graber, a fellow at the Washington (D.C.) Institute of Dermatologic Laser Surgery.

The investigators conducted a retrospective chart study of 961 treatments using a 1,550-nm erbium-doped fiber laser (Fraxel, Reliant Technologies Inc.). Dr. Graber, now with SkinCare Physicians in Chestnut Hill, Mass., declared no financial conflicts and said the study received no funding or equipment from Reliant.

The study included 422 patients with skin types I-IV treated by two operators between October 2004 and September 2006.

"All treatments were done with either the Fraxel 1 or Fraxel 2 using the 15-mm handpiece with a fluence range from 10 to 40 J/cm2, and the average fluence used was 25 J," she said, adding that densities ranged from 125 to 250 microscopic treatment zones per square centimeter, and average total delivered energy per treatment was 4.2 kJ.

All study patients were telephoned by a nurse 1 day after treatment and all had follow-up visits at 1 month. Most patients were followed for at least 1 year after final treatment, Dr. Graber said.

Most of those treated were women (91%) and most treatments were performed on the face (74%). Nearly one-fourth of patients were treated on both the face and other parts of the body. The majority of treatments (743) were for photodamage. The remaining treatments were for scars (175) and other diagnoses (43).

Overall, the 961 treatments resulted in 73 complications, which included acneiform eruptions (18), herpes simplex virus outbreak (17), erosions (13), prolonged erythema (8), postinflammatory hyperpigmentation (7), prolonged edema (6), dermatitis (2), impetigo (1), and purpura (1).

The side effect rate did not differ with regard to gender, age, body location, or diagnosis, Dr. Graber said.

"Those with complications had significantly darker skin types, and this discrepancy was most evident when comparing the incidence of postinflammatory hyperpigmentation, which appeared an average of 11 days post treatment and lasted an average of 50 days, which was longer than any other complication," Dr. Graber said.

In addition, 27% (259) of the 961 treatments were on patients with histories of herpes simplex virus (HSV). One-third of these patients (86) received antiviral prophylaxis, and 6 developed an HSV outbreak despite prophylaxis. Of the remaining two-thirds who did not receive prophylaxis, eight developed an HSV outbreak, she said, adding that of the 702 treatments on patients without histories of HSV, 3 resulted in HSV outbreak.

Because the complication rate in darker-skinned patients was low, pretreatment of all Fraxel patients with hydroquinones or other lighteners is not recommended, said study coauthor Dr. Tina Alster, the institute's director. "If you see a problem postoperatively, you can try to fade it out then, but in our study of close to a thousand treatments, the number of complications was virtually nil," Dr. Alster said, adding that the treatment should be avoided in tanned skin.

Fraxel 1, now called the Fraxel 750, received Food and Drug Administration approval in November 2003, according to a company spokesperson. The second-generation Fraxel 2, which has an adjustable spot-size feature, was approved last year.

MIAMI — Nonablative fractional resurfacing with an erbium-doped 1,550-nm laser device can safely and effectively improve acne scarring among patients with skin types IV-VI, Dr. Wendy E. Roberts said at an international symposium sponsored by L'Oréal Institute for Ethnic Hair and Skin Research.

"Treatment of acne scars with ablative lasers in skin types IV-VI has been limited because of hypopigmentation and depigmentation risks," she said. This significant risk of hypopigmentation, in particular, has limited laser resurfacing for distensible and nondistensible acne scars in skin types other than I-III.

In search of better results, researchers assessed nonablative fractional photothermolysis in 40 patients with skin types IV through VI. Dr. Roberts presented the findings on behalf of the lead investigator, Dr. Vic A. Narurkar, a dermatologist in San Francisco who was unable to attend the meeting.

"This study was motivated by the fact that most laser and light-based technologies are risky in skin types IV-VI, especially for hypopigmentation. And if they are safe, they are generally ineffective," Dr. Narurkar said in a follow-up interview.

Dr. Narurkar and his associates, Dr. Joely Kaufman and Dr. Zakia Rahman, enrolled patients with moderate to severe acne scarring from three clinical sites. Presentations included distensible, nondistensible, ice pick, and box-type scars. Participants were treated with an erbium-doped 1,550-nm Fraxel laser (Reliant Technologies) at 4- to 6-week intervals.

"Resurfacing, particularly for acne scars, has, until the development of the Fraxel laser, not been a viable option for darker skin with traditional lasers," said Dr. Narurkar, who is a consultant for Reliant. Dr. Roberts reported no conflict of interest related to the company.

A nontreating physician scored photographs taken at baseline and at 6 months or longer after completion of the three to five treatment sessions. Every participant showed some improvement, so there were no patients classified as grade 0 (no improvement). Six percent were grade 1 (up to 25% improvement); 34% were grade 2 (26%-50%); 42% were grade 3 (51%-75%); and 18% were grade 4 (76% or greater).

"The majority of patients showed a 50% or greater improvement in acne scars," said Dr. Roberts, a dermatologist in Rancho Mirage, Calif., who also is with the department of medicine at Loma Linda (Calif.) University Medical Center.

Because of the risk of adverse events, use of nonablative fractional resurfacing can be more challenging for patients with ethnic skin. "You really have to not know what you are doing with this to cause any damage in skin types I-III. But it does get tricky in skin types IV-VI. If your laser settings are not conservative, you can get edema and postinflammatory hyperpigmentation," Dr. Roberts said at the meeting, which was also sponsored by Howard University.

In the study, 22% of patients experienced transient postinflammatory hyperpigmentation (PIH) and 28% had acne flares. "We can work through the flares and treat the PIH," Dr. Roberts said. "There was no hypopigmentation, which is quite remarkable."

"We were most impressed with the fact that there were no permanent adverse effects, and even the postinflammatory hyperpigmentation eventually resolved," Dr. Narurkar said. "Future studies include the use of pre- and posttreatment regimens for Fraxel to speed up the recovery and reduce both PIH and acne flares."

A patient is shown at baseline (left) and after undergoing five treatments with an erbium-doped 1,550-nm laser. Photos courtesy Dr. Zakia Rahman

MIAMI — Nonablative fractional resurfacing with an erbium-doped 1,550-nm laser device can safely and effectively improve acne scarring among patients with skin types IV-VI, Dr. Wendy E. Roberts said at an international symposium sponsored by L'Oréal Institute for Ethnic Hair and Skin Research.

"Treatment of acne scars with ablative lasers in skin types IV-VI has been limited because of hypopigmentation and depigmentation risks," she said. This significant risk of hypopigmentation, in particular, has limited laser resurfacing for distensible and nondistensible acne scars in skin types other than I-III.

In search of better results, researchers assessed nonablative fractional photothermolysis in 40 patients with skin types IV through VI. Dr. Roberts presented the findings on behalf of the lead investigator, Dr. Vic A. Narurkar, a dermatologist in San Francisco who was unable to attend the meeting.

"This study was motivated by the fact that most laser and light-based technologies are risky in skin types IV-VI, especially for hypopigmentation. And if they are safe, they are generally ineffective," Dr. Narurkar said in a follow-up interview.

Dr. Narurkar and his associates, Dr. Joely Kaufman and Dr. Zakia Rahman, enrolled patients with moderate to severe acne scarring from three clinical sites. Presentations included distensible, nondistensible, ice pick, and box-type scars. Participants were treated with an erbium-doped 1,550-nm Fraxel laser (Reliant Technologies) at 4- to 6-week intervals.

"Resurfacing, particularly for acne scars, has, until the development of the Fraxel laser, not been a viable option for darker skin with traditional lasers," said Dr. Narurkar, who is a consultant for Reliant. Dr. Roberts reported no conflict of interest related to the company.

A nontreating physician scored photographs taken at baseline and at 6 months or longer after completion of the three to five treatment sessions. Every participant showed some improvement, so there were no patients classified as grade 0 (no improvement). Six percent were grade 1 (up to 25% improvement); 34% were grade 2 (26%-50%); 42% were grade 3 (51%-75%); and 18% were grade 4 (76% or greater).

"The majority of patients showed a 50% or greater improvement in acne scars," said Dr. Roberts, a dermatologist in Rancho Mirage, Calif., who also is with the department of medicine at Loma Linda (Calif.) University Medical Center.

Because of the risk of adverse events, use of nonablative fractional resurfacing can be more challenging for patients with ethnic skin. "You really have to not know what you are doing with this to cause any damage in skin types I-III. But it does get tricky in skin types IV-VI. If your laser settings are not conservative, you can get edema and postinflammatory hyperpigmentation," Dr. Roberts said at the meeting, which was also sponsored by Howard University.

In the study, 22% of patients experienced transient postinflammatory hyperpigmentation (PIH) and 28% had acne flares. "We can work through the flares and treat the PIH," Dr. Roberts said. "There was no hypopigmentation, which is quite remarkable."

"We were most impressed with the fact that there were no permanent adverse effects, and even the postinflammatory hyperpigmentation eventually resolved," Dr. Narurkar said. "Future studies include the use of pre- and posttreatment regimens for Fraxel to speed up the recovery and reduce both PIH and acne flares."

A patient is shown at baseline (left) and after undergoing five treatments with an erbium-doped 1,550-nm laser. Photos courtesy Dr. Zakia Rahman

MIAMI — Nonablative fractional resurfacing with an erbium-doped 1,550-nm laser device can safely and effectively improve acne scarring among patients with skin types IV-VI, Dr. Wendy E. Roberts said at an international symposium sponsored by L'Oréal Institute for Ethnic Hair and Skin Research.

"Treatment of acne scars with ablative lasers in skin types IV-VI has been limited because of hypopigmentation and depigmentation risks," she said. This significant risk of hypopigmentation, in particular, has limited laser resurfacing for distensible and nondistensible acne scars in skin types other than I-III.

In search of better results, researchers assessed nonablative fractional photothermolysis in 40 patients with skin types IV through VI. Dr. Roberts presented the findings on behalf of the lead investigator, Dr. Vic A. Narurkar, a dermatologist in San Francisco who was unable to attend the meeting.

"This study was motivated by the fact that most laser and light-based technologies are risky in skin types IV-VI, especially for hypopigmentation. And if they are safe, they are generally ineffective," Dr. Narurkar said in a follow-up interview.

Dr. Narurkar and his associates, Dr. Joely Kaufman and Dr. Zakia Rahman, enrolled patients with moderate to severe acne scarring from three clinical sites. Presentations included distensible, nondistensible, ice pick, and box-type scars. Participants were treated with an erbium-doped 1,550-nm Fraxel laser (Reliant Technologies) at 4- to 6-week intervals.

"Resurfacing, particularly for acne scars, has, until the development of the Fraxel laser, not been a viable option for darker skin with traditional lasers," said Dr. Narurkar, who is a consultant for Reliant. Dr. Roberts reported no conflict of interest related to the company.

A nontreating physician scored photographs taken at baseline and at 6 months or longer after completion of the three to five treatment sessions. Every participant showed some improvement, so there were no patients classified as grade 0 (no improvement). Six percent were grade 1 (up to 25% improvement); 34% were grade 2 (26%-50%); 42% were grade 3 (51%-75%); and 18% were grade 4 (76% or greater).

"The majority of patients showed a 50% or greater improvement in acne scars," said Dr. Roberts, a dermatologist in Rancho Mirage, Calif., who also is with the department of medicine at Loma Linda (Calif.) University Medical Center.

Because of the risk of adverse events, use of nonablative fractional resurfacing can be more challenging for patients with ethnic skin. "You really have to not know what you are doing with this to cause any damage in skin types I-III. But it does get tricky in skin types IV-VI. If your laser settings are not conservative, you can get edema and postinflammatory hyperpigmentation," Dr. Roberts said at the meeting, which was also sponsored by Howard University.

In the study, 22% of patients experienced transient postinflammatory hyperpigmentation (PIH) and 28% had acne flares. "We can work through the flares and treat the PIH," Dr. Roberts said. "There was no hypopigmentation, which is quite remarkable."

"We were most impressed with the fact that there were no permanent adverse effects, and even the postinflammatory hyperpigmentation eventually resolved," Dr. Narurkar said. "Future studies include the use of pre- and posttreatment regimens for Fraxel to speed up the recovery and reduce both PIH and acne flares."

A patient is shown at baseline (left) and after undergoing five treatments with an erbium-doped 1,550-nm laser. Photos courtesy Dr. Zakia Rahman