Aesthetic Dermatology

LAKE BUENA VISTA, FLA. — Endovenous saphenous-vein obliteration with a 1,320-nm laser produces results comparable to those of radiofrequency, the preferred method, and better than those of 810-nm laser treatment, Girish Munavalli, M.D., said at the annual meeting of the American Society for Laser Medicine and Surgery.

Treatment with an 810-nm-diode laser uses that wavelength's hemoglobin specificity to essentially boil blood and transfer the heat to the vein wall, shrinking it. Radiofrequency (RF) treatment works by heating the vein wall to contract collagen. The 1,320-nm laser uses the water specificity of that wavelength to heat water and collagen in the vein wall to cause contraction, said Dr. Munavalli, a dermatologic surgeon affiliated with Johns Hopkins University, Baltimore.

In this retrospective study, 36 patients were treated with the 810-nm EVLT system (Diomed Inc.), 98 were treated with the 1,320-nm CTEV system (CoolTouch Inc.), and 224 were treated with RF using fast pullback at 90° C. The Closure Plus catheter (VNUS Medical Technologies Inc.) was used to facilitate closure in RF procedures. Endovenous occlusion was performed with single puncture under Duplex-guided tumescent anesthesia.

The 810-nm-laser procedure was performed using manual pullback; the 1,320-nm-laser procedure was performed using automatic pullback (1 mm/sec); and the RF procedure was guided by temperature feedback from the embedded thermocouple feedback loop. CoolTouch, Diomed, and VNUS provided discounted use of equipment for the study. Lead author Robert A. Weiss, M.D., receives consulting fees from CoolTouch and VNUS.

All treatments were evaluated using Duplex ultrasound at 1 day, 6 weeks, and 6 months post treatment.

Using the 810-nm laser, "we saw thickened vein walls on Duplex ultrasound," said Dr. Munavalli, also of the University of Maryland, Baltimore. With RF, "we frequently saw a double wall within the vein." With the 1,320-nm laser, "we actually observed complete retraction of the vein wall and disappearance of the lumen."

At 1-year follow-up, occlusion rates were 86%, 98%, and 92% for the 810-nm laser, 1,320-nm laser, and RF procedures, respectively. At 2 years, the rates were 82%, 96%, and 90%.

LAKE BUENA VISTA, FLA. — Endovenous saphenous-vein obliteration with a 1,320-nm laser produces results comparable to those of radiofrequency, the preferred method, and better than those of 810-nm laser treatment, Girish Munavalli, M.D., said at the annual meeting of the American Society for Laser Medicine and Surgery.

Treatment with an 810-nm-diode laser uses that wavelength's hemoglobin specificity to essentially boil blood and transfer the heat to the vein wall, shrinking it. Radiofrequency (RF) treatment works by heating the vein wall to contract collagen. The 1,320-nm laser uses the water specificity of that wavelength to heat water and collagen in the vein wall to cause contraction, said Dr. Munavalli, a dermatologic surgeon affiliated with Johns Hopkins University, Baltimore.

In this retrospective study, 36 patients were treated with the 810-nm EVLT system (Diomed Inc.), 98 were treated with the 1,320-nm CTEV system (CoolTouch Inc.), and 224 were treated with RF using fast pullback at 90° C. The Closure Plus catheter (VNUS Medical Technologies Inc.) was used to facilitate closure in RF procedures. Endovenous occlusion was performed with single puncture under Duplex-guided tumescent anesthesia.

The 810-nm-laser procedure was performed using manual pullback; the 1,320-nm-laser procedure was performed using automatic pullback (1 mm/sec); and the RF procedure was guided by temperature feedback from the embedded thermocouple feedback loop. CoolTouch, Diomed, and VNUS provided discounted use of equipment for the study. Lead author Robert A. Weiss, M.D., receives consulting fees from CoolTouch and VNUS.

All treatments were evaluated using Duplex ultrasound at 1 day, 6 weeks, and 6 months post treatment.

Using the 810-nm laser, "we saw thickened vein walls on Duplex ultrasound," said Dr. Munavalli, also of the University of Maryland, Baltimore. With RF, "we frequently saw a double wall within the vein." With the 1,320-nm laser, "we actually observed complete retraction of the vein wall and disappearance of the lumen."

At 1-year follow-up, occlusion rates were 86%, 98%, and 92% for the 810-nm laser, 1,320-nm laser, and RF procedures, respectively. At 2 years, the rates were 82%, 96%, and 90%.

LAKE BUENA VISTA, FLA. — Endovenous saphenous-vein obliteration with a 1,320-nm laser produces results comparable to those of radiofrequency, the preferred method, and better than those of 810-nm laser treatment, Girish Munavalli, M.D., said at the annual meeting of the American Society for Laser Medicine and Surgery.

Treatment with an 810-nm-diode laser uses that wavelength's hemoglobin specificity to essentially boil blood and transfer the heat to the vein wall, shrinking it. Radiofrequency (RF) treatment works by heating the vein wall to contract collagen. The 1,320-nm laser uses the water specificity of that wavelength to heat water and collagen in the vein wall to cause contraction, said Dr. Munavalli, a dermatologic surgeon affiliated with Johns Hopkins University, Baltimore.

In this retrospective study, 36 patients were treated with the 810-nm EVLT system (Diomed Inc.), 98 were treated with the 1,320-nm CTEV system (CoolTouch Inc.), and 224 were treated with RF using fast pullback at 90° C. The Closure Plus catheter (VNUS Medical Technologies Inc.) was used to facilitate closure in RF procedures. Endovenous occlusion was performed with single puncture under Duplex-guided tumescent anesthesia.

The 810-nm-laser procedure was performed using manual pullback; the 1,320-nm-laser procedure was performed using automatic pullback (1 mm/sec); and the RF procedure was guided by temperature feedback from the embedded thermocouple feedback loop. CoolTouch, Diomed, and VNUS provided discounted use of equipment for the study. Lead author Robert A. Weiss, M.D., receives consulting fees from CoolTouch and VNUS.

All treatments were evaluated using Duplex ultrasound at 1 day, 6 weeks, and 6 months post treatment.

Using the 810-nm laser, "we saw thickened vein walls on Duplex ultrasound," said Dr. Munavalli, also of the University of Maryland, Baltimore. With RF, "we frequently saw a double wall within the vein." With the 1,320-nm laser, "we actually observed complete retraction of the vein wall and disappearance of the lumen."

At 1-year follow-up, occlusion rates were 86%, 98%, and 92% for the 810-nm laser, 1,320-nm laser, and RF procedures, respectively. At 2 years, the rates were 82%, 96%, and 90%.

PHOENIX, ARIZ. — Locally invasive skin cancers with histologies amenable to frozen section are candidates for Mohs surgery, Neil A. Swanson, M.D., said at a clinical dermatology conference sponsored by Medicis.

But the exacting technique is not always appropriate.

Physicians should consider multiple factors in deciding which therapy to use, said Dr. Swanson, chair of dermatology at Oregon Health and Science University in Portland.

"Mohs is not indicated for every cancer but for the ones that are high risk," he said.

Dr. Swanson described a strategy outlining how to decide whether to use the surgical technique for various melanoma and nonmelanoma skin cancers.

Basal cell carcinomas that recur or have been incompletely excised would be treated with Mohs surgery, which Dr. Swanson described as the "penultimate margin control."

For low-risk basal cell carcinoma, he favored excision, curettage and electrodesiccation, cryosurgery, or radiation.

Most basal cell carcinomas will be low-risk, according to Dr. Swanson.

To identify the few cancers that are high risk, he suggested considering the following four factors:

▸ Location. Tumors could be more aggressive in certain facial areas.

▸ Histology. Mohs surgery would be indicated for morpheaform (sclerotic) and for keratotic (metatypical) basal cell tumors.

For noduloulcerative and superficial types, he recommended choosing one of the alternative therapies.

▸ Size. Use Mohs surgery when a basal cell tumor is 2 cm or greater.

Smaller tumors can be treated with another therapy.

▸ Clinical nature. Mohs surgery would be indicated for a tumor that has ill-defined borders, is multicentric, or evidences immunosuppression.

In some large and aggressive cases, he suggested the dermatologist work cooperatively with a specialist.

"One of the most time-consuming things in the operating room is [figuring out] what is this margin going to be," he commented.

"The day before, we do the peripheral margin. We leave the center of the tumor. It is going to be removed anyway by the surgeon."

For melanoma, Dr. Swanson recommended Mohs surgery as an option in head and neck cases; these are often positioned in difficult anatomic sites where tissue preservation is a concern.

He said he always starts with a Wood's light, which he finds especially useful for defining margins.

"I outline the tumor clinically," Dr. Swanson said. "I turn the lights off, and I shine the Wood's light, and I find the margin changes."

After removing the center scar and residual lesions, he will create a standard Mohs rim and repeat frozen sections until the area is "clear." He recommended that the permanent rim always have an additional 2-mm margin.

Nonmelanoma fibrous tumors are also candidates for Mohs surgery. "These are tumors that look fairly small and end up fairly large," he said.

With Merkel cell carcinoma, however, the choice of therapy is difficult to make. "Mohs may or may not be indicated," said Dr. Swanson.

"Leave to the head and neck surgeon to take margins, and hit it with everything you have in the first go-around," he suggested.

Mohs surgery can be effective for leiomyosarcoma and carcinomas in the eyelid, he continued.

Angiosarcoma has very a poor prognosis, however. Although some physicians have attempted to treat it with Mohs surgery, Dr. Swanson said he has not and will not do so.

PHOENIX, ARIZ. — Locally invasive skin cancers with histologies amenable to frozen section are candidates for Mohs surgery, Neil A. Swanson, M.D., said at a clinical dermatology conference sponsored by Medicis.

But the exacting technique is not always appropriate.

Physicians should consider multiple factors in deciding which therapy to use, said Dr. Swanson, chair of dermatology at Oregon Health and Science University in Portland.

"Mohs is not indicated for every cancer but for the ones that are high risk," he said.

Dr. Swanson described a strategy outlining how to decide whether to use the surgical technique for various melanoma and nonmelanoma skin cancers.

Basal cell carcinomas that recur or have been incompletely excised would be treated with Mohs surgery, which Dr. Swanson described as the "penultimate margin control."

For low-risk basal cell carcinoma, he favored excision, curettage and electrodesiccation, cryosurgery, or radiation.

Most basal cell carcinomas will be low-risk, according to Dr. Swanson.

To identify the few cancers that are high risk, he suggested considering the following four factors:

▸ Location. Tumors could be more aggressive in certain facial areas.

▸ Histology. Mohs surgery would be indicated for morpheaform (sclerotic) and for keratotic (metatypical) basal cell tumors.

For noduloulcerative and superficial types, he recommended choosing one of the alternative therapies.

▸ Size. Use Mohs surgery when a basal cell tumor is 2 cm or greater.

Smaller tumors can be treated with another therapy.

▸ Clinical nature. Mohs surgery would be indicated for a tumor that has ill-defined borders, is multicentric, or evidences immunosuppression.

In some large and aggressive cases, he suggested the dermatologist work cooperatively with a specialist.

"One of the most time-consuming things in the operating room is [figuring out] what is this margin going to be," he commented.

"The day before, we do the peripheral margin. We leave the center of the tumor. It is going to be removed anyway by the surgeon."

For melanoma, Dr. Swanson recommended Mohs surgery as an option in head and neck cases; these are often positioned in difficult anatomic sites where tissue preservation is a concern.

He said he always starts with a Wood's light, which he finds especially useful for defining margins.

"I outline the tumor clinically," Dr. Swanson said. "I turn the lights off, and I shine the Wood's light, and I find the margin changes."

After removing the center scar and residual lesions, he will create a standard Mohs rim and repeat frozen sections until the area is "clear." He recommended that the permanent rim always have an additional 2-mm margin.

Nonmelanoma fibrous tumors are also candidates for Mohs surgery. "These are tumors that look fairly small and end up fairly large," he said.

With Merkel cell carcinoma, however, the choice of therapy is difficult to make. "Mohs may or may not be indicated," said Dr. Swanson.

"Leave to the head and neck surgeon to take margins, and hit it with everything you have in the first go-around," he suggested.

Mohs surgery can be effective for leiomyosarcoma and carcinomas in the eyelid, he continued.

Angiosarcoma has very a poor prognosis, however. Although some physicians have attempted to treat it with Mohs surgery, Dr. Swanson said he has not and will not do so.

PHOENIX, ARIZ. — Locally invasive skin cancers with histologies amenable to frozen section are candidates for Mohs surgery, Neil A. Swanson, M.D., said at a clinical dermatology conference sponsored by Medicis.

But the exacting technique is not always appropriate.

Physicians should consider multiple factors in deciding which therapy to use, said Dr. Swanson, chair of dermatology at Oregon Health and Science University in Portland.

"Mohs is not indicated for every cancer but for the ones that are high risk," he said.

Dr. Swanson described a strategy outlining how to decide whether to use the surgical technique for various melanoma and nonmelanoma skin cancers.

Basal cell carcinomas that recur or have been incompletely excised would be treated with Mohs surgery, which Dr. Swanson described as the "penultimate margin control."

For low-risk basal cell carcinoma, he favored excision, curettage and electrodesiccation, cryosurgery, or radiation.

Most basal cell carcinomas will be low-risk, according to Dr. Swanson.

To identify the few cancers that are high risk, he suggested considering the following four factors:

▸ Location. Tumors could be more aggressive in certain facial areas.

▸ Histology. Mohs surgery would be indicated for morpheaform (sclerotic) and for keratotic (metatypical) basal cell tumors.

For noduloulcerative and superficial types, he recommended choosing one of the alternative therapies.

▸ Size. Use Mohs surgery when a basal cell tumor is 2 cm or greater.

Smaller tumors can be treated with another therapy.

▸ Clinical nature. Mohs surgery would be indicated for a tumor that has ill-defined borders, is multicentric, or evidences immunosuppression.

In some large and aggressive cases, he suggested the dermatologist work cooperatively with a specialist.

"One of the most time-consuming things in the operating room is [figuring out] what is this margin going to be," he commented.

"The day before, we do the peripheral margin. We leave the center of the tumor. It is going to be removed anyway by the surgeon."

For melanoma, Dr. Swanson recommended Mohs surgery as an option in head and neck cases; these are often positioned in difficult anatomic sites where tissue preservation is a concern.

He said he always starts with a Wood's light, which he finds especially useful for defining margins.

"I outline the tumor clinically," Dr. Swanson said. "I turn the lights off, and I shine the Wood's light, and I find the margin changes."

After removing the center scar and residual lesions, he will create a standard Mohs rim and repeat frozen sections until the area is "clear." He recommended that the permanent rim always have an additional 2-mm margin.

Nonmelanoma fibrous tumors are also candidates for Mohs surgery. "These are tumors that look fairly small and end up fairly large," he said.

With Merkel cell carcinoma, however, the choice of therapy is difficult to make. "Mohs may or may not be indicated," said Dr. Swanson.

"Leave to the head and neck surgeon to take margins, and hit it with everything you have in the first go-around," he suggested.

Mohs surgery can be effective for leiomyosarcoma and carcinomas in the eyelid, he continued.

Angiosarcoma has very a poor prognosis, however. Although some physicians have attempted to treat it with Mohs surgery, Dr. Swanson said he has not and will not do so.

LAKE BUENA VISTA, FLA. — Treatment with an erbium:glass laser can safely reduce moderate to severe acne lesions by as much as 80% up to 1 year after therapy, according to the results of two studies presented at the annual meeting of the American Society for Laser Medicine and Surgery.

In the first study, 18 patients (15 women) had a baseline total of 275 lesions—77 comedones, 173 pustules and papules, and 25 nodules, said Sylvie Angel, M.D., of the Cabinet de Dermatologie in Paris. At 12 months' follow-up, only 20% of the baseline lesions remained (55 total lesions—24 comedones, 28 pustules and papules, and 3 nodules). At 6 months' follow-up, there were 87 total lesions—32 comedones, 52 pustules and papules, and 3 nodules.

"All patients observed that their skin was less prone to oiliness and reported quicker healing when new lesions appeared after the treatments," she said.

All the patients had acne—severity greater than 2 on the Burton scale—on the back (10 patients) or face (8 patients). All the patients had received standard acne therapies but were not satisfied by the results. Antibiotic and Accutane (isotretinoin) treatments were stopped 6 and 12 months, respectively, prior to this study. No other therapies were used during the study.

Dr. Angel and her colleagues used a 1,540-nm erbium:glass laser (Aramis, Quantel Medical) in combination with contact cooling set at 5° C. The protocol involved four pulses at 10 J/cm

On average, the patients rated pain during treatments at 1.4, based on a scale of 1-4. There were no adverse events, except for some transient edema and erythema.

Dr. Angel and her colleagues say they believe that the laser induces a thermal injury in the upper- to mid-dermis. Penetration depth has been shown to range between 200 and 900 μm—sebaceous gland depth. Contact cooling protects the dermis from thermal injury.

She suggested future studies be designed to find the ideal number of treatments.

In the second study, 15 patients with moderate to severe inflammatory acne of the face—grade 3 or higher on the Burton scale—were treated with an erbium:glass laser (Aramis, Quantel Medical), which has a 4-mm spot size and 3.3-ms pulse duration. Contact cooling was also used. Quantel Medical provided equipment and funding for the study.

"The treatment worked well for all types of inflammatory lesions," said Melissa A. Bogle, M.D., a practicing dermatologist in Chestnut Hill, Mass. As the treatment course progressed, patients had a steady decline in the total number of lesions. At 6 months, only 20% of the baseline lesions remained. There was essentially no change in sebum production, even though the patients reported that their skin felt less oily.

The patients were treated four times at 2-week intervals. The protocol consisted of first treating the active lesions using bursts of six pulses (10 J/cm

At the 6-month follow-up, improvement was more than 80%, as subjectively determined by the investigator. Patients felt their acne had improved by 70%.

Patients rated treatment on average at 2.25 on a scale of 1-4. Dr. Bogle noted that there was some minimal erythema that resolved in 5-10 minutes.

"I think the most exciting thing about it is that it's a relatively painless device," Dr. Bogle said.

A patient with inflammatory acne is shown prior to treatment with an erbium:glass laser.

The same patient is shown 1 month after receiving four laser treatments at 2-week intervals. Photos courtesy Dr. Melissa A. Bogle

LAKE BUENA VISTA, FLA. — Treatment with an erbium:glass laser can safely reduce moderate to severe acne lesions by as much as 80% up to 1 year after therapy, according to the results of two studies presented at the annual meeting of the American Society for Laser Medicine and Surgery.

In the first study, 18 patients (15 women) had a baseline total of 275 lesions—77 comedones, 173 pustules and papules, and 25 nodules, said Sylvie Angel, M.D., of the Cabinet de Dermatologie in Paris. At 12 months' follow-up, only 20% of the baseline lesions remained (55 total lesions—24 comedones, 28 pustules and papules, and 3 nodules). At 6 months' follow-up, there were 87 total lesions—32 comedones, 52 pustules and papules, and 3 nodules.

"All patients observed that their skin was less prone to oiliness and reported quicker healing when new lesions appeared after the treatments," she said.

All the patients had acne—severity greater than 2 on the Burton scale—on the back (10 patients) or face (8 patients). All the patients had received standard acne therapies but were not satisfied by the results. Antibiotic and Accutane (isotretinoin) treatments were stopped 6 and 12 months, respectively, prior to this study. No other therapies were used during the study.

Dr. Angel and her colleagues used a 1,540-nm erbium:glass laser (Aramis, Quantel Medical) in combination with contact cooling set at 5° C. The protocol involved four pulses at 10 J/cm

On average, the patients rated pain during treatments at 1.4, based on a scale of 1-4. There were no adverse events, except for some transient edema and erythema.

Dr. Angel and her colleagues say they believe that the laser induces a thermal injury in the upper- to mid-dermis. Penetration depth has been shown to range between 200 and 900 μm—sebaceous gland depth. Contact cooling protects the dermis from thermal injury.

She suggested future studies be designed to find the ideal number of treatments.

In the second study, 15 patients with moderate to severe inflammatory acne of the face—grade 3 or higher on the Burton scale—were treated with an erbium:glass laser (Aramis, Quantel Medical), which has a 4-mm spot size and 3.3-ms pulse duration. Contact cooling was also used. Quantel Medical provided equipment and funding for the study.

"The treatment worked well for all types of inflammatory lesions," said Melissa A. Bogle, M.D., a practicing dermatologist in Chestnut Hill, Mass. As the treatment course progressed, patients had a steady decline in the total number of lesions. At 6 months, only 20% of the baseline lesions remained. There was essentially no change in sebum production, even though the patients reported that their skin felt less oily.

The patients were treated four times at 2-week intervals. The protocol consisted of first treating the active lesions using bursts of six pulses (10 J/cm

At the 6-month follow-up, improvement was more than 80%, as subjectively determined by the investigator. Patients felt their acne had improved by 70%.

Patients rated treatment on average at 2.25 on a scale of 1-4. Dr. Bogle noted that there was some minimal erythema that resolved in 5-10 minutes.

"I think the most exciting thing about it is that it's a relatively painless device," Dr. Bogle said.

A patient with inflammatory acne is shown prior to treatment with an erbium:glass laser.

The same patient is shown 1 month after receiving four laser treatments at 2-week intervals. Photos courtesy Dr. Melissa A. Bogle

LAKE BUENA VISTA, FLA. — Treatment with an erbium:glass laser can safely reduce moderate to severe acne lesions by as much as 80% up to 1 year after therapy, according to the results of two studies presented at the annual meeting of the American Society for Laser Medicine and Surgery.

In the first study, 18 patients (15 women) had a baseline total of 275 lesions—77 comedones, 173 pustules and papules, and 25 nodules, said Sylvie Angel, M.D., of the Cabinet de Dermatologie in Paris. At 12 months' follow-up, only 20% of the baseline lesions remained (55 total lesions—24 comedones, 28 pustules and papules, and 3 nodules). At 6 months' follow-up, there were 87 total lesions—32 comedones, 52 pustules and papules, and 3 nodules.

"All patients observed that their skin was less prone to oiliness and reported quicker healing when new lesions appeared after the treatments," she said.

All the patients had acne—severity greater than 2 on the Burton scale—on the back (10 patients) or face (8 patients). All the patients had received standard acne therapies but were not satisfied by the results. Antibiotic and Accutane (isotretinoin) treatments were stopped 6 and 12 months, respectively, prior to this study. No other therapies were used during the study.

Dr. Angel and her colleagues used a 1,540-nm erbium:glass laser (Aramis, Quantel Medical) in combination with contact cooling set at 5° C. The protocol involved four pulses at 10 J/cm

On average, the patients rated pain during treatments at 1.4, based on a scale of 1-4. There were no adverse events, except for some transient edema and erythema.

Dr. Angel and her colleagues say they believe that the laser induces a thermal injury in the upper- to mid-dermis. Penetration depth has been shown to range between 200 and 900 μm—sebaceous gland depth. Contact cooling protects the dermis from thermal injury.

She suggested future studies be designed to find the ideal number of treatments.

In the second study, 15 patients with moderate to severe inflammatory acne of the face—grade 3 or higher on the Burton scale—were treated with an erbium:glass laser (Aramis, Quantel Medical), which has a 4-mm spot size and 3.3-ms pulse duration. Contact cooling was also used. Quantel Medical provided equipment and funding for the study.

"The treatment worked well for all types of inflammatory lesions," said Melissa A. Bogle, M.D., a practicing dermatologist in Chestnut Hill, Mass. As the treatment course progressed, patients had a steady decline in the total number of lesions. At 6 months, only 20% of the baseline lesions remained. There was essentially no change in sebum production, even though the patients reported that their skin felt less oily.

The patients were treated four times at 2-week intervals. The protocol consisted of first treating the active lesions using bursts of six pulses (10 J/cm

At the 6-month follow-up, improvement was more than 80%, as subjectively determined by the investigator. Patients felt their acne had improved by 70%.

Patients rated treatment on average at 2.25 on a scale of 1-4. Dr. Bogle noted that there was some minimal erythema that resolved in 5-10 minutes.

"I think the most exciting thing about it is that it's a relatively painless device," Dr. Bogle said.

A patient with inflammatory acne is shown prior to treatment with an erbium:glass laser.

The same patient is shown 1 month after receiving four laser treatments at 2-week intervals. Photos courtesy Dr. Melissa A. Bogle

LAKE BUENA VISTA, FLA. — An experimental light technique using pneumatic pressure treats unwanted hair, photodamage, and pigmented and vascular lesions with greater efficacy and safety than do comparable techniques, according to research presented at the annual meeting of the American Society for Laser Medicine and Surgery.

Photopneumatic pixilation combines vacuum pneumatic energy with a broadband light source, allowing four to five times the energy of other laser and light source techniques to be transmitted to the target area, said Vic A. Narurkar, M.D., a dermatologist practicing in San Francisco. As a result, lower wavelengths can be used.

The investigational device was provided by Aesthera Inc. Dr. Narurkar has equity in the company and is also on its medical advisory board.

The device works by switching from positive to negative pressure once in contact with the skin, essentially sucking the skin closer to the light source. "During this 2-second phase of vacuum application, the blood concentration and melanin concentrations are reduced. So theoretically, every skin type behaves as what I like to call skin type zero," Dr. Narurkar said.

In the instant that light is applied, fluences are about one-tenth what would be used with competitive technologies. As a result, there is very selective destruction of the targets. Finally the skin is released.

The treatment area is fairly large and the technique rapid, allowing treatment of the back in about 15 minutes and a hand in 2-3 minutes, Dr. Narurkar explained.

Dr. Narurkar said he has completed a 60-patient trial with promising results. Beta testing of the device is ongoing.

LAKE BUENA VISTA, FLA. — An experimental light technique using pneumatic pressure treats unwanted hair, photodamage, and pigmented and vascular lesions with greater efficacy and safety than do comparable techniques, according to research presented at the annual meeting of the American Society for Laser Medicine and Surgery.

Photopneumatic pixilation combines vacuum pneumatic energy with a broadband light source, allowing four to five times the energy of other laser and light source techniques to be transmitted to the target area, said Vic A. Narurkar, M.D., a dermatologist practicing in San Francisco. As a result, lower wavelengths can be used.

The investigational device was provided by Aesthera Inc. Dr. Narurkar has equity in the company and is also on its medical advisory board.

The device works by switching from positive to negative pressure once in contact with the skin, essentially sucking the skin closer to the light source. "During this 2-second phase of vacuum application, the blood concentration and melanin concentrations are reduced. So theoretically, every skin type behaves as what I like to call skin type zero," Dr. Narurkar said.

In the instant that light is applied, fluences are about one-tenth what would be used with competitive technologies. As a result, there is very selective destruction of the targets. Finally the skin is released.

The treatment area is fairly large and the technique rapid, allowing treatment of the back in about 15 minutes and a hand in 2-3 minutes, Dr. Narurkar explained.

Dr. Narurkar said he has completed a 60-patient trial with promising results. Beta testing of the device is ongoing.

LAKE BUENA VISTA, FLA. — An experimental light technique using pneumatic pressure treats unwanted hair, photodamage, and pigmented and vascular lesions with greater efficacy and safety than do comparable techniques, according to research presented at the annual meeting of the American Society for Laser Medicine and Surgery.

Photopneumatic pixilation combines vacuum pneumatic energy with a broadband light source, allowing four to five times the energy of other laser and light source techniques to be transmitted to the target area, said Vic A. Narurkar, M.D., a dermatologist practicing in San Francisco. As a result, lower wavelengths can be used.

The investigational device was provided by Aesthera Inc. Dr. Narurkar has equity in the company and is also on its medical advisory board.

The device works by switching from positive to negative pressure once in contact with the skin, essentially sucking the skin closer to the light source. "During this 2-second phase of vacuum application, the blood concentration and melanin concentrations are reduced. So theoretically, every skin type behaves as what I like to call skin type zero," Dr. Narurkar said.

In the instant that light is applied, fluences are about one-tenth what would be used with competitive technologies. As a result, there is very selective destruction of the targets. Finally the skin is released.

The treatment area is fairly large and the technique rapid, allowing treatment of the back in about 15 minutes and a hand in 2-3 minutes, Dr. Narurkar explained.

Dr. Narurkar said he has completed a 60-patient trial with promising results. Beta testing of the device is ongoing.

LAKE BUENA VISTA, FLA. — Laser lipolysis without fat suction appears safe and effective for the removal of small volumes of focal fat, according to data presented at the annual meeting of the American Society for Laser Medicine and Surgery.

Based on MRI, patients who underwent laser lipolysis alone showed an average of 17% reduction in fat, said Karen H. Kim, M.D., a dermatologist in New York. Those treated under the chin showed the greatest average loss (25%); other areas averaged a 13% reduction.

In this study, 10 patients were treated with laser lipolysis using a Nd-YAG laser (Cynosure Inc.), and 12 were treated with laser lipolysis and the Tri-Active therapeutic laser massage device (12 treatments). There were also 10 control volunteers. The patients had unwanted fat less than 120 cc in volume. Cynosure provided equipment and funding for the study.

Treatment involves the use of a 1,064-nm Nd:YAG laser with a 100-μm optic fiber and 1-mm microcannula. The low-power laser produces a photothermal effect when in contact with fat, Dr. Kim said. Treated fat was allowed to drain naturally in the patients. The Tri-Active device was used on 10 patients to facilitate drainage.

Of the 30 patients enrolled, 29 completed treatment. The area under the chin was the most commonly treated area. Total energy ranged from 758 J to more than 7,000 J. Greater energy was used at larger treatment sites, Dr. Kim said.

At 3 months, patients who received treatment considered the treated area to have improved 37% on average, based on observation.

For those treated with the Tri-Active device and for the laser lipolysis only group, the figures were 47% and 33%, respectively. The most common side effects were bruising, swelling, and tenderness.

The technique seems to be well suited for the treatment of focal areas of excess fat, Dr. Kim said. She and her colleagues are planning a larger multicenter trial using the technique.

This technique has been used in South America, Europe, and Japan. Previous studies have shown that it destroys more adipocytes than cannulation alone.

LAKE BUENA VISTA, FLA. — Laser lipolysis without fat suction appears safe and effective for the removal of small volumes of focal fat, according to data presented at the annual meeting of the American Society for Laser Medicine and Surgery.

Based on MRI, patients who underwent laser lipolysis alone showed an average of 17% reduction in fat, said Karen H. Kim, M.D., a dermatologist in New York. Those treated under the chin showed the greatest average loss (25%); other areas averaged a 13% reduction.

In this study, 10 patients were treated with laser lipolysis using a Nd-YAG laser (Cynosure Inc.), and 12 were treated with laser lipolysis and the Tri-Active therapeutic laser massage device (12 treatments). There were also 10 control volunteers. The patients had unwanted fat less than 120 cc in volume. Cynosure provided equipment and funding for the study.

Treatment involves the use of a 1,064-nm Nd:YAG laser with a 100-μm optic fiber and 1-mm microcannula. The low-power laser produces a photothermal effect when in contact with fat, Dr. Kim said. Treated fat was allowed to drain naturally in the patients. The Tri-Active device was used on 10 patients to facilitate drainage.

Of the 30 patients enrolled, 29 completed treatment. The area under the chin was the most commonly treated area. Total energy ranged from 758 J to more than 7,000 J. Greater energy was used at larger treatment sites, Dr. Kim said.

At 3 months, patients who received treatment considered the treated area to have improved 37% on average, based on observation.

For those treated with the Tri-Active device and for the laser lipolysis only group, the figures were 47% and 33%, respectively. The most common side effects were bruising, swelling, and tenderness.

The technique seems to be well suited for the treatment of focal areas of excess fat, Dr. Kim said. She and her colleagues are planning a larger multicenter trial using the technique.

This technique has been used in South America, Europe, and Japan. Previous studies have shown that it destroys more adipocytes than cannulation alone.

LAKE BUENA VISTA, FLA. — Laser lipolysis without fat suction appears safe and effective for the removal of small volumes of focal fat, according to data presented at the annual meeting of the American Society for Laser Medicine and Surgery.

Based on MRI, patients who underwent laser lipolysis alone showed an average of 17% reduction in fat, said Karen H. Kim, M.D., a dermatologist in New York. Those treated under the chin showed the greatest average loss (25%); other areas averaged a 13% reduction.

In this study, 10 patients were treated with laser lipolysis using a Nd-YAG laser (Cynosure Inc.), and 12 were treated with laser lipolysis and the Tri-Active therapeutic laser massage device (12 treatments). There were also 10 control volunteers. The patients had unwanted fat less than 120 cc in volume. Cynosure provided equipment and funding for the study.

Treatment involves the use of a 1,064-nm Nd:YAG laser with a 100-μm optic fiber and 1-mm microcannula. The low-power laser produces a photothermal effect when in contact with fat, Dr. Kim said. Treated fat was allowed to drain naturally in the patients. The Tri-Active device was used on 10 patients to facilitate drainage.

Of the 30 patients enrolled, 29 completed treatment. The area under the chin was the most commonly treated area. Total energy ranged from 758 J to more than 7,000 J. Greater energy was used at larger treatment sites, Dr. Kim said.

At 3 months, patients who received treatment considered the treated area to have improved 37% on average, based on observation.

For those treated with the Tri-Active device and for the laser lipolysis only group, the figures were 47% and 33%, respectively. The most common side effects were bruising, swelling, and tenderness.

The technique seems to be well suited for the treatment of focal areas of excess fat, Dr. Kim said. She and her colleagues are planning a larger multicenter trial using the technique.

This technique has been used in South America, Europe, and Japan. Previous studies have shown that it destroys more adipocytes than cannulation alone.

MIAMI BEACH — Calcium hydroxylapatite can effectively fill wrinkles, correct acne and other scars, and augment lips, although there is a learning curve with lips, David J. Goldberg, M.D., said at a symposium sponsored by the Florida Society of Dermatology and Dermatologic Surgery.

Calcium hydroxylapatite (Radiesse, BioForm Medical Inc.) is identical to a natural compound in human bone and teeth. Oncologists, orthopedists, dentists, and other health care professionals have used the material for years in implants and drug delivery systems. The Food and Drug Administration approved the biomaterial for vocal cord injections, as a tissue marker, and for periodontal use for onlay of bone. Nasolabial folds and HIV facial lipoatrophy studies are currently pending.

Soft tissue filler uses are off label, but it is a legal use of the product, according to Dr. Goldberg, who is in private practice in Westwood, N.J.

There is no need for sensitization testing because calcium hydroxylapatite is nonallergic. Other advantages from a patient's perspective include the product's long-term effectiveness, its lack of migration, and minimal downtime (soft tissue swelling for about 24-48 hours and some bruising are possible).

Dr. Goldberg surveyed 155 of his patients 6 months after soft tissue augmentation with the filler, and 90% indicated they would use it again.

Calcium hydroxylapatite is packaged as cellulose-based gel with a glycerin-water base. No reconstitution is required. Its consistent viscosity makes it easy to inject. Other potential advantages for physicians include its stability, a shelf life of 2 years without refrigeration, and its compatibility with other cosmetic procedures, said Dr. Goldberg, who is also director of laser research and Mohs surgery at Mount Sinai School of Medicine, New York.

The filler stays soft in tissue. It is long lasting but not permanent, and eventually resorbs. A disadvantage is predicting exactly how long the correction will last. For example, 12-22 months after injection, 30%-100% of initial results remain, according to Dr. Goldberg. Another potential disadvantage is formation of lip nodules. Use of the filler in lips is best left to experienced operators, he emphasized at the meeting.

A small volume is needed for correction. For example, only 1-2 cc is required for nasolabial folds or the corners of the mouth. A total of about 1 cc is required for upper and lower lip augmentation, unless a very large increase in volume is desired.

Dr. Goldberg recommended a threading technique. Inject a thin thread of the material as the needle is withdrawn. The typical injection is 0.05 cc. A 25- to 27-gauge, 1.25-inch needle is recommended for nasolabial folds. A smaller 0.5-inch, 25- to 27-gauge needle is recommended for injecting the corners of the mouth.

Local anesthesia with epinephrine is recommended. Also consider doing a nerve block prior to lip augmentation. A small amount of local anesthetic in the lips promotes vasoconstriction, Dr. Goldberg said.

The calcium hydroxylapatite implant does not calcify or ossify. The particles act as scaffold for tissue infiltration, he explained. There is a self-limited fibroblastic response. The particles are not osteoinductive: They do not cause fibroblasts to differentiate to become osteoblasts.

MIAMI BEACH — Calcium hydroxylapatite can effectively fill wrinkles, correct acne and other scars, and augment lips, although there is a learning curve with lips, David J. Goldberg, M.D., said at a symposium sponsored by the Florida Society of Dermatology and Dermatologic Surgery.

Calcium hydroxylapatite (Radiesse, BioForm Medical Inc.) is identical to a natural compound in human bone and teeth. Oncologists, orthopedists, dentists, and other health care professionals have used the material for years in implants and drug delivery systems. The Food and Drug Administration approved the biomaterial for vocal cord injections, as a tissue marker, and for periodontal use for onlay of bone. Nasolabial folds and HIV facial lipoatrophy studies are currently pending.

Soft tissue filler uses are off label, but it is a legal use of the product, according to Dr. Goldberg, who is in private practice in Westwood, N.J.

There is no need for sensitization testing because calcium hydroxylapatite is nonallergic. Other advantages from a patient's perspective include the product's long-term effectiveness, its lack of migration, and minimal downtime (soft tissue swelling for about 24-48 hours and some bruising are possible).

Dr. Goldberg surveyed 155 of his patients 6 months after soft tissue augmentation with the filler, and 90% indicated they would use it again.

Calcium hydroxylapatite is packaged as cellulose-based gel with a glycerin-water base. No reconstitution is required. Its consistent viscosity makes it easy to inject. Other potential advantages for physicians include its stability, a shelf life of 2 years without refrigeration, and its compatibility with other cosmetic procedures, said Dr. Goldberg, who is also director of laser research and Mohs surgery at Mount Sinai School of Medicine, New York.

The filler stays soft in tissue. It is long lasting but not permanent, and eventually resorbs. A disadvantage is predicting exactly how long the correction will last. For example, 12-22 months after injection, 30%-100% of initial results remain, according to Dr. Goldberg. Another potential disadvantage is formation of lip nodules. Use of the filler in lips is best left to experienced operators, he emphasized at the meeting.

A small volume is needed for correction. For example, only 1-2 cc is required for nasolabial folds or the corners of the mouth. A total of about 1 cc is required for upper and lower lip augmentation, unless a very large increase in volume is desired.

Dr. Goldberg recommended a threading technique. Inject a thin thread of the material as the needle is withdrawn. The typical injection is 0.05 cc. A 25- to 27-gauge, 1.25-inch needle is recommended for nasolabial folds. A smaller 0.5-inch, 25- to 27-gauge needle is recommended for injecting the corners of the mouth.

Local anesthesia with epinephrine is recommended. Also consider doing a nerve block prior to lip augmentation. A small amount of local anesthetic in the lips promotes vasoconstriction, Dr. Goldberg said.

The calcium hydroxylapatite implant does not calcify or ossify. The particles act as scaffold for tissue infiltration, he explained. There is a self-limited fibroblastic response. The particles are not osteoinductive: They do not cause fibroblasts to differentiate to become osteoblasts.

MIAMI BEACH — Calcium hydroxylapatite can effectively fill wrinkles, correct acne and other scars, and augment lips, although there is a learning curve with lips, David J. Goldberg, M.D., said at a symposium sponsored by the Florida Society of Dermatology and Dermatologic Surgery.

Calcium hydroxylapatite (Radiesse, BioForm Medical Inc.) is identical to a natural compound in human bone and teeth. Oncologists, orthopedists, dentists, and other health care professionals have used the material for years in implants and drug delivery systems. The Food and Drug Administration approved the biomaterial for vocal cord injections, as a tissue marker, and for periodontal use for onlay of bone. Nasolabial folds and HIV facial lipoatrophy studies are currently pending.

Soft tissue filler uses are off label, but it is a legal use of the product, according to Dr. Goldberg, who is in private practice in Westwood, N.J.

There is no need for sensitization testing because calcium hydroxylapatite is nonallergic. Other advantages from a patient's perspective include the product's long-term effectiveness, its lack of migration, and minimal downtime (soft tissue swelling for about 24-48 hours and some bruising are possible).

Dr. Goldberg surveyed 155 of his patients 6 months after soft tissue augmentation with the filler, and 90% indicated they would use it again.

Calcium hydroxylapatite is packaged as cellulose-based gel with a glycerin-water base. No reconstitution is required. Its consistent viscosity makes it easy to inject. Other potential advantages for physicians include its stability, a shelf life of 2 years without refrigeration, and its compatibility with other cosmetic procedures, said Dr. Goldberg, who is also director of laser research and Mohs surgery at Mount Sinai School of Medicine, New York.

The filler stays soft in tissue. It is long lasting but not permanent, and eventually resorbs. A disadvantage is predicting exactly how long the correction will last. For example, 12-22 months after injection, 30%-100% of initial results remain, according to Dr. Goldberg. Another potential disadvantage is formation of lip nodules. Use of the filler in lips is best left to experienced operators, he emphasized at the meeting.

A small volume is needed for correction. For example, only 1-2 cc is required for nasolabial folds or the corners of the mouth. A total of about 1 cc is required for upper and lower lip augmentation, unless a very large increase in volume is desired.

Dr. Goldberg recommended a threading technique. Inject a thin thread of the material as the needle is withdrawn. The typical injection is 0.05 cc. A 25- to 27-gauge, 1.25-inch needle is recommended for nasolabial folds. A smaller 0.5-inch, 25- to 27-gauge needle is recommended for injecting the corners of the mouth.

Local anesthesia with epinephrine is recommended. Also consider doing a nerve block prior to lip augmentation. A small amount of local anesthetic in the lips promotes vasoconstriction, Dr. Goldberg said.

The calcium hydroxylapatite implant does not calcify or ossify. The particles act as scaffold for tissue infiltration, he explained. There is a self-limited fibroblastic response. The particles are not osteoinductive: They do not cause fibroblasts to differentiate to become osteoblasts.

LAKE BUENA VISTA, FLA. — Potassium titanyl phosphate laser treatment can provide results comparable to and perhaps even better than intense pulsed light that is now considered the preferred method for treatment of photoaging, according to data presented at the annual meeting of the American Society for Laser Medicine and Surgery.

In a study designed to compare the two treatments, a 532-nm potassium titanyl phosphate (KTP) "green" laser (Gemini, made by Laserscope) with a 10-mm spot size was used to treat one side of the face, and intense pulsed light (Quantum SR, made by Lumenis) was used to treat the other side, said Girish Munavalli, M.D., a dermatologic surgeon at Johns Hopkins University in Baltimore. A total of 16 patients with diffuse redness and photoaging pigmentation (Fitzpatrick skin types I-IV) were treated.

The emission profile of the 532-nm KTP laser predicts very good absorption by hemoglobin and melanin. "In addition to the absorption spectrum, as you increase the spot size to 10 mm you get deeper penetration of this wavelength," Dr. Munavalli explained.

Treatment with the KTP laser lasted for 90-120 seconds at 7-9 J/cm

Dr. Munavalli has no financial interest in either of the devices used in this study.

Patients were evaluated at 1 week and at 1 month using a standardized scale (1-10) by the treating physician. Canfield stereotactic imaging was performed, and a physician blinded to the study evaluated these images.

At 1 week, physician evaluation rated the KTP treatment as producing an overall improvement in vascularity and pigmentation of 64%, compared with a 50% improvement for IPL. Patients rated the two treatments as producing overall improvements of 56% and 40%, respectively.

At 1 month, both sides were rated as producing an improvement of 50%. However, 14 of 16 patients opted for the KTP laser for subsequent treatments, preferring its efficacy, treatment times, and comfort. KTP induced slightly more erythema and edema at 10 and 24 hours posttreatment.

Stereotactic imaging resulted in equivalent if not slightly better reduction of the components of photoaging (lentigines, telangiectasias) with KTP, compared with IPL alone.

The Gemini laser can also be set for spot sizes between 1 and 5 mm, in 0.1-mm increments. In addition the KTP laser can be switched out with a 1,064-nm Nd:YAG laser.

The system has received Food and Drug Administration clearance for the treatment of acne, wrinkles, vascular and pigmented lesions, and hair removal.

LAKE BUENA VISTA, FLA. — Potassium titanyl phosphate laser treatment can provide results comparable to and perhaps even better than intense pulsed light that is now considered the preferred method for treatment of photoaging, according to data presented at the annual meeting of the American Society for Laser Medicine and Surgery.

In a study designed to compare the two treatments, a 532-nm potassium titanyl phosphate (KTP) "green" laser (Gemini, made by Laserscope) with a 10-mm spot size was used to treat one side of the face, and intense pulsed light (Quantum SR, made by Lumenis) was used to treat the other side, said Girish Munavalli, M.D., a dermatologic surgeon at Johns Hopkins University in Baltimore. A total of 16 patients with diffuse redness and photoaging pigmentation (Fitzpatrick skin types I-IV) were treated.

The emission profile of the 532-nm KTP laser predicts very good absorption by hemoglobin and melanin. "In addition to the absorption spectrum, as you increase the spot size to 10 mm you get deeper penetration of this wavelength," Dr. Munavalli explained.

Treatment with the KTP laser lasted for 90-120 seconds at 7-9 J/cm

Dr. Munavalli has no financial interest in either of the devices used in this study.

Patients were evaluated at 1 week and at 1 month using a standardized scale (1-10) by the treating physician. Canfield stereotactic imaging was performed, and a physician blinded to the study evaluated these images.

At 1 week, physician evaluation rated the KTP treatment as producing an overall improvement in vascularity and pigmentation of 64%, compared with a 50% improvement for IPL. Patients rated the two treatments as producing overall improvements of 56% and 40%, respectively.

At 1 month, both sides were rated as producing an improvement of 50%. However, 14 of 16 patients opted for the KTP laser for subsequent treatments, preferring its efficacy, treatment times, and comfort. KTP induced slightly more erythema and edema at 10 and 24 hours posttreatment.

Stereotactic imaging resulted in equivalent if not slightly better reduction of the components of photoaging (lentigines, telangiectasias) with KTP, compared with IPL alone.

The Gemini laser can also be set for spot sizes between 1 and 5 mm, in 0.1-mm increments. In addition the KTP laser can be switched out with a 1,064-nm Nd:YAG laser.

The system has received Food and Drug Administration clearance for the treatment of acne, wrinkles, vascular and pigmented lesions, and hair removal.

LAKE BUENA VISTA, FLA. — Potassium titanyl phosphate laser treatment can provide results comparable to and perhaps even better than intense pulsed light that is now considered the preferred method for treatment of photoaging, according to data presented at the annual meeting of the American Society for Laser Medicine and Surgery.

In a study designed to compare the two treatments, a 532-nm potassium titanyl phosphate (KTP) "green" laser (Gemini, made by Laserscope) with a 10-mm spot size was used to treat one side of the face, and intense pulsed light (Quantum SR, made by Lumenis) was used to treat the other side, said Girish Munavalli, M.D., a dermatologic surgeon at Johns Hopkins University in Baltimore. A total of 16 patients with diffuse redness and photoaging pigmentation (Fitzpatrick skin types I-IV) were treated.

The emission profile of the 532-nm KTP laser predicts very good absorption by hemoglobin and melanin. "In addition to the absorption spectrum, as you increase the spot size to 10 mm you get deeper penetration of this wavelength," Dr. Munavalli explained.

Treatment with the KTP laser lasted for 90-120 seconds at 7-9 J/cm

Dr. Munavalli has no financial interest in either of the devices used in this study.

Patients were evaluated at 1 week and at 1 month using a standardized scale (1-10) by the treating physician. Canfield stereotactic imaging was performed, and a physician blinded to the study evaluated these images.

At 1 week, physician evaluation rated the KTP treatment as producing an overall improvement in vascularity and pigmentation of 64%, compared with a 50% improvement for IPL. Patients rated the two treatments as producing overall improvements of 56% and 40%, respectively.

At 1 month, both sides were rated as producing an improvement of 50%. However, 14 of 16 patients opted for the KTP laser for subsequent treatments, preferring its efficacy, treatment times, and comfort. KTP induced slightly more erythema and edema at 10 and 24 hours posttreatment.

Stereotactic imaging resulted in equivalent if not slightly better reduction of the components of photoaging (lentigines, telangiectasias) with KTP, compared with IPL alone.

The Gemini laser can also be set for spot sizes between 1 and 5 mm, in 0.1-mm increments. In addition the KTP laser can be switched out with a 1,064-nm Nd:YAG laser.

The system has received Food and Drug Administration clearance for the treatment of acne, wrinkles, vascular and pigmented lesions, and hair removal.

WAILEA, HAWAII — Ice, vibrators, "talk-esthesia," and sundry topical anesthetic creams and gels were advocated as safe and effective options for relieving pain during a mini-symposium at the annual Hawaii dermatology seminar sponsored by the Skin Disease Education Foundation.

"How much is a happy patient worth? If you hurt them, they won't come back," said Kevin C. Smith, M.D., a dermatologist practicing in Niagara Falls, Ont.

The discussion focused on patients undergoing cosmetic procedures, but the techniques, listed here, can be used on medical dermatology patients as well:

▸ Ice. It's effective and about as cheap as pain relief gets. "We use it a lot," said Alastair Carruthers, M.B., a dermatologist in practice in Vancouver, B.C.

▸ Vibrators. Snickers aside, the Hitachi Magic Wand with a Wonder Wand attachment provides excellent pain relief when applied under a patient's chin during facial procedures by blocking pain signals to the brain, said Dr. Smith.

The devices can be found at the Web site www.drugstore.com

▸ Talk therapy. "It's not enough to put some cream on a patient," Dr. Smith said. From the time a patient first calls the office, the staff and the physician should convey calm reassurance. Patients will have less pain if they feel "confident of your skill and your care."

He said he always uses "talk-esthesia" to talk patients through procedures, even when other forms of pain relief are used.

▸ Analgesics. Some procedures call for up-front pain relief. Dr. Smith sometimes advises patients to take an NSAID in combination with acetaminophen for an additive effect. Patients who do not have asthma may be prescribed propranolol, which provides analgesia but does not interfere with a patient's ability to drive.

▸ L.M.X. 4. This 4% lidocaine cream (formerly ELA-Max 4%) is sold over the counter, does not require occlusion, and provides anesthesia 30 minutes after application, Dr. Carruthers explained.

He tested it against a vehicle cream in 24 patients receiving Botox (botulinum toxin type A) injections for crow's feet.

"I like to think this is not a very painful procedure, so in order to reduce the discomfort, this stuff has to work very well," he said.

The study showed a significant difference in patient visual analogue scale scores and observer ratings of discomfort when L.M.X. 4 was used, with P values in the range of .005.

▸ L.M.X. 5. This anorectal anesthetic cream is more appropriate for use in the mouth than alcohol-containing topical gels, which can cause sloughing of mucous membranes and irritation and stinging if they get in the eyes, Dr. Smith said.

For lip procedures, optimal anesthesia can be obtained by numbing the mucosal surface of the lips, including the anterior mucosae of the anterior labioalveolar sulci down to the gingival sulcus as well as the vermilion and a 1-cm margin around the vermilion border.

To achieve this without getting anesthetic all over the inside of the patient's mouth, he cuts a Telfa pad to mimic a plastic laser shield designed to protect the teeth from laser work performed around the mouth. He cuts a 3-by-4-inch Telfa pad in half, lengthwise, then folds it over and cuts a slit in the middle (to allow the patient to breathe) and slits at the top and bottom to accommodate the frenula.

He inserts the pad into the patient's mouth, against the teeth. He then uses a tongue depressor to apply L.M.X. 5 thickly over the lips and gums and attends to other patients for 30-45 minutes, until his watch alarm sounds to remind him to return to perform the procedure.

At that time, he can inject lidocaine painlessly or, for simple filler procedures, move directly to injections of Restylane (nonanimal stabilized hyaluronic acid gel).

Dr. Smith noted that previous research has determined that the anesthetic mixture in L.M.X. 5 does not produce toxic blood levels, even when applied to mucous membranes.

Dr. Carruthers disclosed that he has financial ties to Allergan Inc., which distributes Botox. Dr. Smith received L.M.X. 5 samples from Ferndale Laboratories Inc. for his research.

The Skin Disease Education Foundation and this newspaper are wholly owned subsidiaries of Elsevier.

WAILEA, HAWAII — Ice, vibrators, "talk-esthesia," and sundry topical anesthetic creams and gels were advocated as safe and effective options for relieving pain during a mini-symposium at the annual Hawaii dermatology seminar sponsored by the Skin Disease Education Foundation.

"How much is a happy patient worth? If you hurt them, they won't come back," said Kevin C. Smith, M.D., a dermatologist practicing in Niagara Falls, Ont.

The discussion focused on patients undergoing cosmetic procedures, but the techniques, listed here, can be used on medical dermatology patients as well:

▸ Ice. It's effective and about as cheap as pain relief gets. "We use it a lot," said Alastair Carruthers, M.B., a dermatologist in practice in Vancouver, B.C.

▸ Vibrators. Snickers aside, the Hitachi Magic Wand with a Wonder Wand attachment provides excellent pain relief when applied under a patient's chin during facial procedures by blocking pain signals to the brain, said Dr. Smith.

The devices can be found at the Web site www.drugstore.com

▸ Talk therapy. "It's not enough to put some cream on a patient," Dr. Smith said. From the time a patient first calls the office, the staff and the physician should convey calm reassurance. Patients will have less pain if they feel "confident of your skill and your care."

He said he always uses "talk-esthesia" to talk patients through procedures, even when other forms of pain relief are used.

▸ Analgesics. Some procedures call for up-front pain relief. Dr. Smith sometimes advises patients to take an NSAID in combination with acetaminophen for an additive effect. Patients who do not have asthma may be prescribed propranolol, which provides analgesia but does not interfere with a patient's ability to drive.

▸ L.M.X. 4. This 4% lidocaine cream (formerly ELA-Max 4%) is sold over the counter, does not require occlusion, and provides anesthesia 30 minutes after application, Dr. Carruthers explained.

He tested it against a vehicle cream in 24 patients receiving Botox (botulinum toxin type A) injections for crow's feet.

"I like to think this is not a very painful procedure, so in order to reduce the discomfort, this stuff has to work very well," he said.

The study showed a significant difference in patient visual analogue scale scores and observer ratings of discomfort when L.M.X. 4 was used, with P values in the range of .005.

▸ L.M.X. 5. This anorectal anesthetic cream is more appropriate for use in the mouth than alcohol-containing topical gels, which can cause sloughing of mucous membranes and irritation and stinging if they get in the eyes, Dr. Smith said.

For lip procedures, optimal anesthesia can be obtained by numbing the mucosal surface of the lips, including the anterior mucosae of the anterior labioalveolar sulci down to the gingival sulcus as well as the vermilion and a 1-cm margin around the vermilion border.

To achieve this without getting anesthetic all over the inside of the patient's mouth, he cuts a Telfa pad to mimic a plastic laser shield designed to protect the teeth from laser work performed around the mouth. He cuts a 3-by-4-inch Telfa pad in half, lengthwise, then folds it over and cuts a slit in the middle (to allow the patient to breathe) and slits at the top and bottom to accommodate the frenula.

He inserts the pad into the patient's mouth, against the teeth. He then uses a tongue depressor to apply L.M.X. 5 thickly over the lips and gums and attends to other patients for 30-45 minutes, until his watch alarm sounds to remind him to return to perform the procedure.

At that time, he can inject lidocaine painlessly or, for simple filler procedures, move directly to injections of Restylane (nonanimal stabilized hyaluronic acid gel).

Dr. Smith noted that previous research has determined that the anesthetic mixture in L.M.X. 5 does not produce toxic blood levels, even when applied to mucous membranes.

Dr. Carruthers disclosed that he has financial ties to Allergan Inc., which distributes Botox. Dr. Smith received L.M.X. 5 samples from Ferndale Laboratories Inc. for his research.

The Skin Disease Education Foundation and this newspaper are wholly owned subsidiaries of Elsevier.

WAILEA, HAWAII — Ice, vibrators, "talk-esthesia," and sundry topical anesthetic creams and gels were advocated as safe and effective options for relieving pain during a mini-symposium at the annual Hawaii dermatology seminar sponsored by the Skin Disease Education Foundation.

"How much is a happy patient worth? If you hurt them, they won't come back," said Kevin C. Smith, M.D., a dermatologist practicing in Niagara Falls, Ont.

The discussion focused on patients undergoing cosmetic procedures, but the techniques, listed here, can be used on medical dermatology patients as well:

▸ Ice. It's effective and about as cheap as pain relief gets. "We use it a lot," said Alastair Carruthers, M.B., a dermatologist in practice in Vancouver, B.C.

▸ Vibrators. Snickers aside, the Hitachi Magic Wand with a Wonder Wand attachment provides excellent pain relief when applied under a patient's chin during facial procedures by blocking pain signals to the brain, said Dr. Smith.

The devices can be found at the Web site www.drugstore.com

▸ Talk therapy. "It's not enough to put some cream on a patient," Dr. Smith said. From the time a patient first calls the office, the staff and the physician should convey calm reassurance. Patients will have less pain if they feel "confident of your skill and your care."

He said he always uses "talk-esthesia" to talk patients through procedures, even when other forms of pain relief are used.

▸ Analgesics. Some procedures call for up-front pain relief. Dr. Smith sometimes advises patients to take an NSAID in combination with acetaminophen for an additive effect. Patients who do not have asthma may be prescribed propranolol, which provides analgesia but does not interfere with a patient's ability to drive.

▸ L.M.X. 4. This 4% lidocaine cream (formerly ELA-Max 4%) is sold over the counter, does not require occlusion, and provides anesthesia 30 minutes after application, Dr. Carruthers explained.

He tested it against a vehicle cream in 24 patients receiving Botox (botulinum toxin type A) injections for crow's feet.

"I like to think this is not a very painful procedure, so in order to reduce the discomfort, this stuff has to work very well," he said.

The study showed a significant difference in patient visual analogue scale scores and observer ratings of discomfort when L.M.X. 4 was used, with P values in the range of .005.

▸ L.M.X. 5. This anorectal anesthetic cream is more appropriate for use in the mouth than alcohol-containing topical gels, which can cause sloughing of mucous membranes and irritation and stinging if they get in the eyes, Dr. Smith said.

For lip procedures, optimal anesthesia can be obtained by numbing the mucosal surface of the lips, including the anterior mucosae of the anterior labioalveolar sulci down to the gingival sulcus as well as the vermilion and a 1-cm margin around the vermilion border.

To achieve this without getting anesthetic all over the inside of the patient's mouth, he cuts a Telfa pad to mimic a plastic laser shield designed to protect the teeth from laser work performed around the mouth. He cuts a 3-by-4-inch Telfa pad in half, lengthwise, then folds it over and cuts a slit in the middle (to allow the patient to breathe) and slits at the top and bottom to accommodate the frenula.

He inserts the pad into the patient's mouth, against the teeth. He then uses a tongue depressor to apply L.M.X. 5 thickly over the lips and gums and attends to other patients for 30-45 minutes, until his watch alarm sounds to remind him to return to perform the procedure.

At that time, he can inject lidocaine painlessly or, for simple filler procedures, move directly to injections of Restylane (nonanimal stabilized hyaluronic acid gel).

Dr. Smith noted that previous research has determined that the anesthetic mixture in L.M.X. 5 does not produce toxic blood levels, even when applied to mucous membranes.

Dr. Carruthers disclosed that he has financial ties to Allergan Inc., which distributes Botox. Dr. Smith received L.M.X. 5 samples from Ferndale Laboratories Inc. for his research.

The Skin Disease Education Foundation and this newspaper are wholly owned subsidiaries of Elsevier.

SAN DIEGO — Electrocautery using the Colorado needle appears to be at least as effective as the UltraPulse CO2 laser for blepharoplasty, Cameron K. Rokhsar, M.D., reported at the annual meeting of the American Academy of Cosmetic Surgery.

The techniques resulted in equivalent amounts of ecchymosis, edema, and erythema, as assessed by both physician and patient during the 30-day postoperative period. In addition, there were no significant differences in the width of the scar left by each method, said Dr. Rokhsar, a dermatologist in private practice in San Diego.

The study involved 12 patients, 11 of whom had an upper-eyelid blepharoplasty and 2 of whom had a lower-eyelid conjunctival blepharoplasty. After an initial incision with a 15C blade, they were randomly assigned to have the skin, orbicularis, and fat of one eye excised by the CO2 laser and those of the other eye excised using the Colorado needle and electrocautery.

The CO2 laser was operated with a coherent 0.2-mm beam at 150 mJ, 3.5 W, and 25 Hz. The Colorado needle has an ultrasharp, 5-μm tungsten tip; it was operated in this study at a cutting setting of 2 and a coagulation setting of 2.

Patients were assessed at days 1, 3, 7, 14, and 30 following surgery. At day 30, eyes treated with the CO2 laser had scars 1.03 mm in width, and eyes treated with the Colorado needle had scars 1.08 mm in width. These did not differ significantly.

SAN DIEGO — Electrocautery using the Colorado needle appears to be at least as effective as the UltraPulse CO2 laser for blepharoplasty, Cameron K. Rokhsar, M.D., reported at the annual meeting of the American Academy of Cosmetic Surgery.

The techniques resulted in equivalent amounts of ecchymosis, edema, and erythema, as assessed by both physician and patient during the 30-day postoperative period. In addition, there were no significant differences in the width of the scar left by each method, said Dr. Rokhsar, a dermatologist in private practice in San Diego.

The study involved 12 patients, 11 of whom had an upper-eyelid blepharoplasty and 2 of whom had a lower-eyelid conjunctival blepharoplasty. After an initial incision with a 15C blade, they were randomly assigned to have the skin, orbicularis, and fat of one eye excised by the CO2 laser and those of the other eye excised using the Colorado needle and electrocautery.

The CO2 laser was operated with a coherent 0.2-mm beam at 150 mJ, 3.5 W, and 25 Hz. The Colorado needle has an ultrasharp, 5-μm tungsten tip; it was operated in this study at a cutting setting of 2 and a coagulation setting of 2.

Patients were assessed at days 1, 3, 7, 14, and 30 following surgery. At day 30, eyes treated with the CO2 laser had scars 1.03 mm in width, and eyes treated with the Colorado needle had scars 1.08 mm in width. These did not differ significantly.

SAN DIEGO — Electrocautery using the Colorado needle appears to be at least as effective as the UltraPulse CO2 laser for blepharoplasty, Cameron K. Rokhsar, M.D., reported at the annual meeting of the American Academy of Cosmetic Surgery.

The techniques resulted in equivalent amounts of ecchymosis, edema, and erythema, as assessed by both physician and patient during the 30-day postoperative period. In addition, there were no significant differences in the width of the scar left by each method, said Dr. Rokhsar, a dermatologist in private practice in San Diego.

The study involved 12 patients, 11 of whom had an upper-eyelid blepharoplasty and 2 of whom had a lower-eyelid conjunctival blepharoplasty. After an initial incision with a 15C blade, they were randomly assigned to have the skin, orbicularis, and fat of one eye excised by the CO2 laser and those of the other eye excised using the Colorado needle and electrocautery.

The CO2 laser was operated with a coherent 0.2-mm beam at 150 mJ, 3.5 W, and 25 Hz. The Colorado needle has an ultrasharp, 5-μm tungsten tip; it was operated in this study at a cutting setting of 2 and a coagulation setting of 2.

Patients were assessed at days 1, 3, 7, 14, and 30 following surgery. At day 30, eyes treated with the CO2 laser had scars 1.03 mm in width, and eyes treated with the Colorado needle had scars 1.08 mm in width. These did not differ significantly.