Vol. 33. No. 4


It is my pleasure and great honor to serve as the guest editor for this issue of Seminars in Cutaneous Medicine and Surgery, aptly titled “The State of Aesthetic Dermatology.” December not only marks the end of the year, it provides a time for reflection on the months past and prompts us to prepare for the endeavors of the New Year to come. It is my hope that this December issue supplies a framework for a judicious review of the current status and future of aesthetic dermatology. The goal of the following contributions is to highlight the key “hot topics” of cosmetic dermatology (picosecond technology, men’s aesthetics, laser-assisted drug delivery, etc.) while offering a critical take on current research and future evidence based applications. The success of this issue is entirely the result of the dedicated contributors who have humbly shared their expertise and I thank them all for their commitment to the advancement of our field. The state of aesthetic dermatology is an ever-changing and dynamic landscape in which we make evaluations, offer treatment, and conduct research. These changes are a result of shared best practices, continued education and ongoing research. Staying abreast of new and innovative research is paramount to providing excellent patient care, which is why we endeavored to present concise and clinically useful papers in this issue centered on updates in varied aesthetic topics. Critical topics in cosmetic dermatology are explored, ranging from updates on the utilization of soft tissue fillers and botulinum toxin to advancements in picosecond technology. Evolving and novel concepts such as the utilization of lasers for the treatment of scarring, laser-assisted drug delivery, and noninvasive skin tightening are also thoroughly and concisely reviewed. Evolving and novel concepts such as the utilization of lasers for the treatment of scarring, laser-assisted drug delivery, noninvasive skin tightening, men’s aesthetics, and home-use devices are also thoroughly and concisely reviewed. My hope is that you find this issue a valuable reference in navigating the ever-changing tides of aesthetic dermatology. As you read the following articles, written by experts in the field, I hope you are inspired to critically evaluate and question new procedures, technologies, and concepts. In the process, you will rekindle self-reflection on personal practices and the pursuit of continued education, thus, allowing for enhanced growth as a clinician, provider, and researcher.

Convergence of anatomy, technology, and therapeutics: a review of laser-assisted drug delivery

Andrew C Krakowski, MD | Bradley S Bloom, MD | Jeremy A Brauer, MD | Roy G Geronemus, MD | Tri Nguyen, MD
This is a very exciting time in cutaneous laser surgery with an ever-expanding therapeutic armamentarium and an increased sophistication of available technology. These recent trends have allowed for both a rapid development of interest and exploration of laser-assisted drug delivery and its potential applications. We review the current literature on anatomy, technology, and therapeutics as it relates to laser-assisted drug delivery. The focus of our review is on two areas of interest that have received much attention to date — photodynamic therapy in the treatment of actinic keratoses and nonmelanoma skin cancers as well as the treatment of scarring. We will also discuss potential complications of existing modalities used independently and in laser-assisted drug delivery and conclude with future indications for this burgeoning therapeutic methodology. Semin Cutan Med Surg

Filler frontier: what’s new and heading West to the US Market

Melanie D. Palm, MD
The amount of fillers approved by the United States Food and Drug Administration (FDA) for use in facial volume augmentation is diminutive in comparison to filler products employed worldwide. In the near future, several new hyaluronic acid filler products will be available to the United States market. Already approved fillers include Belotero Balance for fine lines, Juvéderm Voluma XC for midfacial volume loss replacement, and Restylane Silk for perioral lines and lip augmentation. Volbella, currently under FDA evaluation, will be used for fine-line correction and lip augmentation. The physiochemical properties, best practices, clinical uses, and side effects of these fillers are discussed. Additionally, evolving techniques such as the use of blunt-tipped microcannulas are explained. Semin Cutan Med Surg 33:157-163 © 2014 Frontline Medical Communications

Home-use devices in aesthetic dermatology

Emily C Keller, MD
The world of aesthetic medicine is increasingly a consumer- driven market with a wide variety of home-use devices from which the consumer can choose for treating hair removal, hair loss, acne, facial rejuvenation, and other dermatologic conditions. Where these devices fit in the physician practice and consumer routine can be confusing, as scientific studies may be weak or lacking. The specifications, price, ease-of-use, maintenance, and technology can differ greatly between devices. Thus, the physician and consumer need to define expectations and goals before deciding upon an apparatus. Semin Cutan Med Surg 33:198-204 © 2014 Frontline Medical Communications

Men’s aesthetic dermatology

Anthony M Rossi, MD
Cosmetic dermatology is continuing to see a dramatic increase in both procedures performed and technological advancements. Men’s aesthetic dermatology is burgeoning with more men seeking cosmetic consultations and intervention. Whether it is targeted cosmeceuticals for men or male-specific procedures, dermatologists must be aware of this evolving demographic and understand the biological, anatomical, and psychological aspects that separate this cohort from their female counterparts. Cosmetic dermatology has moved beyond just applying the same techniques used for females onto males. The use of our cosmetic toolbox can differ for men in terms of technique and dosage. This article will review the state of men’s aesthetic dermatology with an emphasis on the nuances that separate the sexes. Semin Cutan Med Surg 33:188-197 © 2014 Frontline Medical Communications

Picosecond lasers: the next generation of short-pulsed lasers

Andrei I Metelitsa, MD, FRCPC | Jeremy B Green, MD | Joely Kaufman, MD | Joshua R Freedman, MD
Selective photothermolysis, first discussed in the context of targeted microsurgery in 1983, proposed that the optimal parameters for specific thermal damage rely critically on the duration over which energy is delivered to the tissue. At that time, nonspecific thermal damage had been an intrinsic limitation of all commercially available lasers, despite efforts to mitigate this by a variety of compensatory cooling mechanisms. Fifteen years later, experimental picosecond lasers were first reported in the dermatological literature to demonstrate greater efficacy over their nanosecond predecessors in the context of targeted destruction of tattoo ink. Within the last 4 years, more than a decade after those experiments, the first commercially available cutaneous picosecond laser unit became available (Cynosure, Westford, Massachusetts), and several pilot studies have demonstrated its utility in tattoo removal. An experimental picosecond infrared laser has also recently demonstrated a nonthermal tissue ablative capability in soft tissue, bone, and dentin. In this article, we review the published data pertaining to dermatology on picosecond lasers from their initial reports to the present as well as discuss forthcoming technology. Semin Cutan Med Surg 33:164-168 © 2014 Frontline Medical Communications