Vol. 34. No. 3


We are thrilled to guest edit this issue of Seminars in Cutaneous Medicine and Surgery dedicated to off-face aesthetics. In the last decades, there has been an explosion in demand for aesthetic procedures. Although clinicians have improved their expertise in creating a restful and rejuvenated visage, off-face treatments have lagged behind. We have all seen the aesthetic patient with porcelain facial skin whose chronological age is reflected in their neglected hands and décolleté. All too often we hear from our patients, “I don’t get sun on my face, just my body.” Despite our pleadings to allow precious drops of sunscreen to fall from their face onto their neck and chest, we will surely see them in the coming years for photoaging treatments.

We as clinicians have the opportunity to educate our patients on ever evolving off-face aesthetic options, thereby helping them to create a globally rejuvenated appearance. With the recent FDA approval of injectable sodium deoxycholate (Kybella; Kythera Biopharmaceuticals, Westlake Village, California), the chin is definitely becoming a huge area of focus in our practices. Moreover, it is exciting to see some of the preliminary research on using other injectable agents for fat remodeling (ie, the abdomen).

With the launch of Cellfina (Ulthera Inc, Mesa, Arizona), it is also quite timely that we cover strategies in the treatment of cellulite. Cellfina is a treatment with 94% patient satisfaction at one year, and is specifically designed to improve the appearance of cellulite dimples. Other devices are also reviewed that are energy based and may allow for improvement in contour.

With the incidence of skin cancer increasing, strategies to minimize surgical scars has become an important focus. Patients want scars to look better sooner, and newer studies have indicated that early intervention in scars is the key to successful remodeling that minimizes and softens scars.

This issue provides an in-depth review of options for off-face laxity and tightening. Radiofrequency and high-intensity focused ultrasound among other modalities offer our patients excellent results with a high safety profile and minimal downtime. Also included is an update on noninvasive body contouring, a hot and growing market.

Each day in our cosmetic dermatology practices, patients ask how to improve the youthfulness of their hands. With the recent FDA approval of calcium hydroxylapatite (Radiesse; Merz Aesthetics, a Division of Merz Pharma Group, Raleigh, North Carolina) specifically indicated for dorsal hand rejuvenation, we can only expect more and more interest in this area. With the use of lasers and light-based modalities to treat lentigines and improve textural irregularities, we have a lot of successful strategies that can be used in combination for this area.

We are grateful to the authors for creating such exceptional manuscripts, and are confident that readers of this issue will enhance their knowledge of off-face aesthetics and thereby improve outcomes and patient satisfaction in their practices.

A noninvasive approach to off-face skin laxity and tightening: a review of the literature

Kimberly Jerdan, MD | Sabrina Fabi, MD, FAAD, FAACS

Off-face skin scales tailored to each anatomical site can measure laxity and tightening of the neck, chest, arms, hands, abdomen, buttocks, and medial thighs. Although surgery may be indicated for major weight loss patients, other noninvasive modalities may be considered including: CO2 laser, bipolar radiofrequency, monopolar radiofrequency, microfocused ultrasound, and combination therapies. We provide a review of the literature for each modality and relevance to the off-face anatomical sites.
Semin Cutan Med Surg 34:118-128 © 2015 Frontline Medical Communications


Noninvasive body contouring: cryolipolysis and ultrasound

Arisa E. Ortiz, MD | Mathew M. Avram, MD, JD

Over the past 5 years, there has been a paradigm shift in the treatment of fat. The clear trend is toward noninvasive fat removal technologies over more traditional forms of fat removal such as liposuction. While these devices do not yet approach the results seen with liposuction, noninvasive treatments are gaining popularity due to their ability to safely and effectively reduce fat with little downtime and typically no need for anesthesia. The optimal candidate is relatively fit with localized areas of adiposity, rather than an obese patient. It is important to note that there are numerous noninvasive fat devices including low-level light, radiofrequency, laser, cryolipolysis, and ultrasound. Some of these technologies have more robust data to support their efficacy than others. This review will focus on only 2 noninvasive fat technologies: cryolipolysis and ultrasound.
Semin Cutan Med Surg 34:129-133 © 2015 Frontline Medical Communications


Injectable agents affecting subcutaneous fats

David LK Chen, MD | Jeremy B Green, MD | Joel L. Cohen, MD

Mesotherapy is an intradermal or subcutaneous injection of therapeutic agents to induce local effects, and was pioneered in Europe during the 1950s. For the past 2 decades, there has been significant interest in the use of mesotherapy for minimally invasive local fat contouring. Based on the theorized lipolytic effects of the agent phosphatidylcholine, initial attempts involved its injection into subcutaneous tissue. With further studies, however, it became apparent that the activity attributed to phosphatidylcholine mesotherapy was due to the adipolytic effects of deoxycholate, a detergent used to solubilize phosphatidylcholine. Since then, clinical trials have surfaced that demonstrate the efficacy of a proprietary formulation of deoxycholate for local fat contouring. Current trials on mesotherapy with salmeterol, a b-adrenergic agonist and lipolysis stimulator, are underway—with promising preliminary results as well.
Semin Cutan Med Surg 34:134-137 © 2015 Frontline Medical Communications


Additional thoughts on the new treatment Kybella

David LK Chen, MD | Jeremy B Green, MD | Joel L. Cohen, MD | John H Joseph, MD

With the recent approval of Kythera Biopharmaceuticals (Westlake Village, California) submental fat injectable treatment Kybella, there comes a lot of excitement—but, also a bit of concern. The idea of having a nonsurgical, nonliposuction treatment for people who have a double chin is certainly exciting. The hope has been that this new treatment will provide opportunities for the many people out there who are focused on the appearance of their submental fullness to have access to a safe, affordable, and reliable treatment.With the approval of this product, there are several misconceptions that the authors herein discuss.
Semin Cutan Med Surg 34:138-139 © 2015 Frontline Medical Communications


Therapeutic approaches to cellulite

Andrei I Metelitsa, MD, FRCPC | Jeremy B Green, MD | Joel L. Cohen, MD | Joely Kaufman, MD | Michael E. Kaminer, MD

Cellulite is a condition that affects the vast majority of women. Although it is of no danger to one’s overall health, cellulite can be psychosocially debilitating. Consequently, much research has been devoted to understanding cellulite and its etiopathogenesis. With additional insights into the underlying causes of its clinical presentation, therapeutic modalities have been developed that offer hope to cellulite sufferers. This review examines evidence for topical treatments, noninvasive energy-based devices, and recently developed minimally invasive interventions that may finally provide a solution.
Semin Cutan Med Surg 34:140-143 © 2015 Frontline Medical Communications