Aesthetics

Kissimmee, Fla. — The sale of cosmeceuticals in dermatology offices may have become commonplace, but some contention still surrounds physician involvement in selling skincare products.

By now, most practices are familiar with Medicare's Correct CodingInitiative (CCI) introduced by CMS in 1996.

Researchers have engineered two oncolytic adenoviruses that specifically target and kill melanocytic cells.

Orlando — According to Zoe Draelos, M.D., the cosmeceutical market is evolving rapidly because of new raw materials, better insight into skin physiology, and changing consumer demands.

Las Vegas — Among the latest developments in the burgeoning cosmeceutical market are data comparing active antioxidant ingredients, lines of products touting the antiaging powers of peptides and growth factor, and a new focus for the industry: the treatment of facial redness.

Newport Beach, Calif. — Among treatment options for HIV lipoatrophy, the best choices for most patients are liquid injectable silicone or the recently approved filler Sculptra (Dermik Laboratories), said Derek H. Jones, M.D., at the Pacific Dermatologic Association meeting here.

Kissimmee, Fla. — A pulsed dye laser (PDL) and intense pulsed light (IPL) source both have roles in a dermatology practice for esthetic and non-esthetic indications. But in a situation where a practice must decide between the two, an IPL is probably the preferred acquisition because it covers a broader range of targets, Vic A. Narurkar, M.D., said at the Orlando Dermatology & Cosmetic Conference here last fall.

Victoria, British Columbia — Botulinum toxin type A (Botox, Allergan) is safe and effective to smooth facial wrinkles over long term and multiple treatments, says Alastair Carruthers, M.D.

Aruba — A number of nonablative techniques for dermal remodeling can afford improvements in skin texture, tone and elasticity, but a combination approach integrating additional noninvasive techniques, including dermal fillers, botulinum toxin type A injection, chemical peels and/or microdermabrasion, is desirable for enhancing facial rejuvenation, said Elizabeth L. Tanzi, M.D. at the Fourth Annual Caribbean Dermatology Symposium. Dr. Tanzi reviewed recent advances in nonablative rejuvenation, including the use of photodynamic therapy (PDT), radiofrequency skin tightening and photomodulation.

Stanford, Calif. — Against the numerous advances in cosmetic dermatology, chemical peels retain a valuable role as a time-proven, safe and cost-effective modality for aging skin rejuvenation and other indications, according to Cherie M. Ditre, M.D.

They used stereology, which would make it possible to uniquely identify a melanosome in a plane.

Lake Buena Vista, Fla. - David Goldberg, M.D., says that for prospective cosmetic surgery patients wishing to quickly but effectively tighten facial wrinkles, radiofrequency (RF) rejuvenation - particularly with the ThermaCool ?TC machine developed by Thermage ?, which won federal approval as a full-face treatment last July - may be the way to go.

National report — The recent Florida case of four people paralyzed by botulism after receiving massive doses of unapproved bulk botulinum toxin type A may represent the tip of the iceberg regarding bogus Botox.

New York — Interest in tumescent liposuction has expanded to a variety of new indications, including postmenopausal "lumpy" back fat deposits and as an alternative to more invasive procedures such as abdominoplasty and surgical mammoplasty, according to Naomi Lawrence, M.D.

Buenos Aires — "Controle sus lunares por una piel sana" (control your moles for a healthy skin) is a message that people throughout Argentina heard repeatedly last November, thanks to the efforts of Rebeca Rubinson, M.D., and her colleagues at the Sociedad Argentina de Dermatologia (SAD) here. Dr. Rubinson is a pediatric dermatologist affiliated with Hospital Abel Zubizarreta in Buenos Aires and the coordinator of the 2004 campaign on recognition and prevention of skin cancer.

New York City — While comprehensively covering the subject of fillers in the clinical setting at the recent meeting for the American Society for Dermatologic Surgery (ASDS), celebrity dermatologist Fred Brandt, M.D., feels compelled to start with hyaluronic acids, saying, "I think that's the biggest revolution in fillers now."

Miami Beach, Fla. — "Make sure you really see what you're looking at." A point that might well be called the "Klein Oath" for all cosmetic procedures, was what Botox pioneer Arnold W. Klein, M.D. repeatedly emphasized as he addressed the topic "Botulinum Toxin Type A 2004: My Perspective" at the H & H Dermatology Seminar here.

Tampa, Fla. — A new filler product unlike any available before is showing good results in correcting the signs of fat loss or lipoatrophy in the maturing face. The product called Sculptra? (Aventis) is an injectable implant that contains microparticles of poly-L-lactic acid, a biodegradable, synthetic polymer from the alpha-hydroxy-acid family.

Miami Beach, Fla. — Although the man behind Goldie Hawn's outrageously puffed lips in the movie First Wives Club was among the first to experiment with collagen in the lips, Arnold Klein, M.D., admits that, for that scene, he injected Ms. Hawn's lips with saline.

Kissimmee, Fla. — In dermatology practices today, two basic types of procedures exist: "desire-based" cosmetic procedures and "disease-based" procedures, such as the removal of a skin cancer. Traditionally in medicine, physicians have employed a set of relatively objective criteria to define an acceptable outcome in the second type of procedure. It is the first category, elective and cosmetic procedures, where the physician must satisfy another, more subjective, set of criteria — one that is frequently the cause of disappointment, remorse, dissatisfaction, anger and, all too often, malpractice litigation.

Fort Worth, Texas — The proliferation of new fillers creates both opportunity and risk for cosmetic dermatologists. Paul M. Friedman, M.D., clinical assistant professor at the University of Texas Medical School, Houston, says knowledge and technical expertise are vital for using the fillers to both the dermatologist's and the patient's benefit.

San Antonio — After three decades, the cosmetic profession is finally starting to sit up and take notice of autologous fat transfers, according to plastic surgeon Tolbert Wilkinson, M.D., F.A.C.S.

Peptides clearly represent the most novel active in the current cosmeceutical market.

San Francisco — Along with helping patients, the advent of biologic drugs has restored some much-needed luster to the practice of medical dermatology.

National report — Anecdotal evidence indicates that the onion extract/allantoin gel product Mederma (Merz Pharmaceuticals) might be an effective first-line therapy for diminishing scars and associated symptoms.