Emmy M. Graber

Guest Editor for the following articles:

Dec
2009
Vol. 28. No. 4

Laser Lipolysis: Current Practices

Melanie D. Palm, MD | Mitchel P. Goldman, MD

Laser-assisted liposuction (LAL) is a recent innovation within the field of liposculpture. In
addition to body contouring, the indications of LAL are skin retraction in areas of flaccidity
and fat melting for challenging surgical cases including revisions, areas of dense
fibrosity, and large-volume cases. A photothermal effect explains the effects of LAL on
tissue, regardless of the wavelength used. Advantages of LAL include reduced bruising,
edema, pain, and recovery time. Disadvantages are most often related to thermal effects on
tissue, such as skin blistering. Currently, 3 wavelengths, 980, 1064, and 1320 nm, are Food
and Drug Administration-approved for LAL. Comparative studies examining the safety and
efficacy of LAL have appeared in the medical literature. Technical considerations, emerging
technology, and future indications are important to the success and continued development
of this procedure.
Semin Cutan Med Surg 28:212-219 © 2009 Elsevier Inc. All rights reserved.

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Jun
2016
Vol. 35. No. 2

Topical retinoids for acne

Lauren Meshkov Bonati, MD | Lindsey Yeh, MD | Nanette B Silverberg, MD

Topical retinoids are currently approved by the US Food and Drug Administration for the treatment of acne vulgaris in nonpregnant, nonlactating patients 12 years of age and older. Their efficacy, safety, and tolerability are well documented for inflammatory and noninflammatory acne with studies repeatedly demonstrating a decrease in the number of lesions, significant improvement in acne severity, improvement in the cosmetic appearance of acne, and the prevention of acne lesions through microcomedone formation. There is some variability between prescription retinoid products regarding efficacy, safety, and tolerability; with erythema, peeling, and dryness being common, potential side effects. Due to their efficacious and safe profile, topical retinoids remain the first-line treatment for acne vulgaris.

Semin Cutan Med Surg 35:50-56 © 2016 Frontline Medical Communications

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Jun
2016
Vol. 35. No. 2

Topical and oral antibiotics for acne vulgaris

James Q Del Rosso, DO

Antibiotics, both oral and topical, have been an integral component of the management of acne vulgaris (AV) for approximately 6 decades. Originally thought to be effective for AV due to their ability to inhibit proliferation of Propionibacterium acnes, it is now believed that at least some antibiotics also exert anti-inflammatory effects that provide additional therapeutic benefit. To add, an increase in strains of P acnes and other exposed bacteria that are less sensitive to antibiotics used to treat AV have emerged, with resistance directly correlated geographically with the magnitude of antibiotic use. Although antibiotics still remain part of the therapeutic armamentarium for AV treatment, current recommendations support the following when used to treat AV: 1) monotherapy use should be avoided; 2) use benzoyl peroxide concomitantly to reduce emergence of resistant P acnes strains; 3) oral antibiotics should be used in combination with a topical regimen for moderate-to-severe inflammatory AV; and 4) use oral antibiotics over a limited duration to achieve control of inflammatory AV with an exit plan in place to discontinue their use as soon as possible. When selecting an oral antibiotic to treat AV, potential adverse effects are important to consider.

Semin Cutan Med Surg 35:57-61 © 2016 Frontline Medical Communications

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Jun
2016
Vol. 35. No. 2

Antibiotic-resistant acne: getting under the skin

Anamika Bhattacharyya, PhD | Jeffrey S Dover, MD | Kenneth A Arndt, MD | Mau Sinha, PhD | Shamik Ghosh, PhD | Shiladitya Sengupta, PhD | Shilpi Jain, MD | Suresh Sadhasivam, MD

Propionibacterium acnes is a key pathogenic factor in the development of acne. Antibiotics are the first choice of treatment for mild-to-moderate, mixed, papular/pustular, and moderate nodular acne, and an alternative choice in severe, nodular/conglobate acne. The emergence of resistance to the currently available antibiotics poses a serious set-back to this algorithm, and the reduced arsenal can diminish efficacy of treatment. This emerging situation should catalyze innovations in dermatology; for example, newer drugs and technologies such as next-generation antibiotics with excellent potency and low propensity to develop resistance, rapid diagnostic platforms to select responders and nonresponders, and delivery technologies that target the bacteria. Such innovations can dramatically expand the arsenal for dermatologists in the management of acne.

Semin Cutan Med Surg 35:62-67 © 2016 Frontline Medical Communications

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Dec
2009
Vol. 28. No. 4

Laser-Assisted Liposuction for Facial and Body Contouring and Tissue Tightening: A 2-Year Experience With 75 Consecutive Patients

Ana Tevez, RN | Gordon H. Sasaki, MD, FACS

Internal liposuction remains the standard and most reliable method to remove fat and
contour the face and body. The recent introduction (2006 FDA clearance) of a higher and
more controlled energized internal laser system is purported to increase tissue contraction
and damage unwanted fat deposits through dual 1064 nm/1320-nm wavelengths that are
initially used at a deep level of subcutaneous fat, and subsequently at a shallow level
beneath the dermis along with liposuction. Using classical principles of selective photothermolysis,
the sequential exposure of these wavelengths on target tissue chromophores
results in selective thermo-lipolysis and thermo-denaturation of collagen fibers (H2O)
within the septal architecture and lower reticular dermis for enhanced skin retraction
(accommodation) and contraction. This article reviews this innovative laser system, discusses
the latest clinical protocol changes, tabulates the measurements of time and energy
during each phase of treatment and temperature endpoints, and correlates the histologic
findings to energy deposition. The collected objective data are used to improve on the
safety and efficacy treatment profiles at 11 sites in 75 consecutive patients. Further clinical
studies and comparative trials are recommended to validate these outcomes.
Semin Cutan Med Surg 28:226-235 © 2009 Elsevier Inc. All rights reserved.

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