Nazanin Saedi

Guest Editor for the following articles:

Vol. 32. No. 1

Microfocused Ultrasound for Skin Tightening

Elizabeth L Tanzi, MD | Jennifer L McGregor, MD

The demand for noninvasive skin tightening procedures is increasing as patients seek safe
and effective alternatives to aesthetic surgical procedures of the face, neck, and body. Over
the past decade, radiofrequency and infrared laser devices have been popularized owing to
their ability to deliver controlled heat to the dermis, stimulate neocollagenesis, and effect
modest tissue tightening with minimal recovery. However, these less invasive approaches
are historically associated with inferior efficacy so that surgery still remains the treatment
of choice to address moderate to severe tissue laxity. Microfocused ultrasound was
recently introduced as a novel energy modality for transcutaneous heat delivery that
reaches the deeper subdermal connective tissue in tightly focused zones at consistent
programmed depths. The goal is to produce a deeper wound healing response at multiple
levels with robust collagen remodeling and a more durable clinical response. The Ulthera
device (Ulthera, Inc, Meza, AZ), with refined microfocused ultrasound technology, has been
adapted specifically for skin tightening and lifting with little recovery or risk of complications
since its introduction in 2009. As clinical parameters are studied and optimized,
enhanced efficacy and consistency of clinical improvement is expected.
Semin Cutan Med Surg 32:18-25 © 2013 Frontline Medical Communications

Vol. 31. No. 2

New Frontiers in Laser Surgery

Doru T. Alexandrescu, MD

The simultaneous advances in engineering, medicine, and molecular biology have accelerated
the pace of introductions of new light-based technologies in dermatology. In this
review, the authors examine recent advances in laser surgery as well as peer into the future
of energy-based cutaneous medicine. The future landscape of dermatology will almost
undoubtedly include (1) noninvasive imaging technologies and (2) improved “destructive”
modalities based on real-time feedback from the skin surface.
Semin Cutan Med Surg 31:88-97 © 2012 Elsevier Inc. All rights reserved.

Vol. 32. No. 1

New Waves for Fat Reduction: High-Intensity Focused Ultrasound

Michael E. Kaminer, MD | Nazanin Saedi, MD

With the rising demand for body contouring, noninvasive devices for fat reduction have
become increasingly popular and have grown dramatically over the past decade. Highintensity
focused ultrasound (HIFU) has been used for nearly half a century for the
noninvasive treatment of tumors of various organs, but has only recently been evaluated as
a method for the selective destruction of adipose tissue. HIFU works by ablating subcutaneous
adipose tissue and causing molecular vibrations that increase the temperature of
local tissue and induce rapid cell necrosis. Several studies reveal the safety and efficacy of
HIFU for fat reduction in the abdomen and the flanks. These studies indicate consistent
reduction in abdominal circumference >2 cm after a single treatment. The adverse events
are limited to transient tenderness, bruising, and edema. Increased utility of HIFU for fat
reduction will likely increase over time.

Vol. 32. No. 1

Cryolipolysis: A Historical Perspective and Current Clinical Practice

H Ray Jalian, MD | Mathew M. Avram, MD, JD

Dermatologists have long used cold-based therapeutic approaches for a variety of applications.
Based on the differences in chemical composition, it is possible to selectively
target certain tissues rich with lipid, while sparing the surrounding tissue predominantly
containing water. With historical observations of cold-induced panniculitis suggesting the
feasibility of this strategy, cryolipolysis has emerged as a new methodology using controlled
cooling to selectively target fat. Both preclinical and clinical studies have established
the safety and efficacy of cryolipolysis for noninvasive body contouring. This review
will focus on the evolution of cryolipolysis from initial case reports of cold-induced panniculitis,
to preclinical and clinical studies, and the current clinical practice.
Semin Cutan Med Surg 32:31-34 © 2013 Frontline Medical Communications

Vol. 31. No. 2

The Horizon for Treating Cutaneous Vascular Lesions

Amit M. Patel, MD | Elizabeth L. Chou, BS | Kristen M. Kelly, MD

Dermatologists encounter a wide range of cutaneous vascular lesions, including infantile
hemangiomas, port-wine stain birthmarks, arteriovenous malformations, venous malformations,
Kaposi sarcomas, angiosarcomas, and angiofibromas. Current treatment modalities to
reduce these lesions include topical and/or intralesional steroids, laser therapy, surgical
resection, and endovascular therapy. However, each method has limitations owing to recurrence,
comorbidities, toxicity, or lesion location. Photodynamic therapy, antiangiogenic therapy,
and evolving methods of sclerotherapy are promising areas of development that may mitigate
limitations of current treatments and offer exciting options for patients and their physicians.
Semin Cutan Med Surg 31:98-104 © 2012 Elsevier Inc. All rights reserved.