Kimberly J. Butterwick, MD, is a dermatologist in private practice in San Diego. Her blog will focus on issues related to cosmetic dermatology.

BLOG: Cosmetic Pearls from the AAD Annual Meeting: Part II

I always try to look back at my meeting notes because I’m so inundated with information at the time, and I tend to forget what I learned until I review it. Here are a few more tips from the 74th Annual AAD meeting:

  • Jeff Dover, MD, discussed the use of a long pulsed Nd:YAG laser for periorbital veins. These blue reticular veins respond well to this laser. Settings he mentioned were 140-160J/cm2 with a 3mm spot and a 40msec pulse. He suggested using a red Sharpie marker to dot out the vein before treatment and don’t overlap. For eye safety, do not treat inside the orbital rim and, of course, use metal goggles on the patient and eye protection for the physician and staff. Treatments can be repeated at 6 to 8 week intervals. Venous lakes also respond well to this laser, which is a tip I have not yet tried.
  • Roy Geronemus, MD, offered his experience with treatment of surgical scars. He likes to treat early, 6 to 8 weeks post-surgery, and prefers treating with an ablative fractional CO2 laser at low densities and medium fluences. Higher setting would be required for thicker scars. Exact settings obviously vary by the device and the location of the scar, with reduction of density and fluence in non-facial areas. Non-ablative fractional lasers can also be used, but may take more sessions. He has also had success with treating PIH in scars with the Fraxel Clear and Brilliant laser utilizing the 1927 tip. I’m anxious to try this. For hypopigmented scars, he will use the 1550 non-ablative fractional laser to stimulate pigment production.
  • Dr. Geronemus also provided tips on the treatment of tattoos. For green colors, he finds the PicoSure 755nm laser quite effective, and for yellow tattoos, the PicoWay 532nm laser works well. When treating eyeliner tattoos, it is important to place metal shields under the lid. He advises going close to the lashes or brow if necessary, as hair tends to come back. After treating tattoos, he goes over them with an ablative fractional CO2 at low settings for less post-operative blistering.
  • There were several good practice pearls throughout the meeting. Here’s one I liked: For staff motivation, what gets rewarded seems to get done. For example, if you want to try to teach behavioral standards to your staff to improve patient satisfaction, you can start a board listing good things patients have said about your staff or overall experience. Once you reach a certain number, everyone gets pizza.
  • Dr. Dover had several cost-saving tips. To be successful, he advised finding that one staff member who really loves to save money and give them the title of “purchasing officer.” His officer significantly cut costs (>80%) on drinking water, cautery tips and scalpel blades.
  • Need a “new” treatment for flushing? Dr. Rosen offered a low cost, temporary method: A piece of ice can be placed between the gum and cheek. This fools the temperature control system. Patients can try this for 20 minutes before a public speaking engagement. The effects should last 1 to 2 hours.
  • Lastly, Dr. Rosen found this great general derm tip in an obscure journal for patients suffering from severe apthae. A comparison study of 94 patients treated either with honey four times a day for 5 days, orobase, or TAC in orobase revealed that application of honey to be most helpful in reducing pain and duration of the apthae. Who knew? (Quintessence Int. 2014;45:691-701)

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