I just attended the American Academy of Dermatology Annual Meeting in Orlando, Florida, and, as in every meeting, heard a lot of information and picked up a few significant pearls from various cosmetic sessions I attended and from hallway conversations with friends and colleagues.
I’ve included some references in case you want to learn more:
The Self- Assessment Cosmetic Dermatology MOC session had an interactive audience response system and each answer to the question was reviewed and explained by the speakers. Topics included laser resurfacing, laser tattoo removal, photodynamic therapy, tumescent liposuction, leg vein treatments, chemical peels, non-invasive body contouring and injectable fillers and neurotoxins.
During the laser session, Keyvan Nouri, MD, reviewed several questions related to spot size and pulse duration. The point was made that the larger the spot size, the deeper the laser penetrates. Pulse duration should be targeted to the size of the target structure for optimal selective photothermolysis, with smaller structures and vessels ideally treated with faster pulse durations and larger vessels and structures with longer pulse durations.
Now you’ll get those right on your next MOC exam! These MOC sessions are great for confirming your fundamental knowledge and are actually a fun way to fulfill MOC requirements. Another easy way to fulfill MOC requirements is the AAD question of the week on the academy’s website.
The live demonstration of aesthetic dermatology was an excellent session, moderated by Seth Matarasso, MD. Jody Comstock, MD, demonstrated the use of the golden ratio calipers to assess the patient’s face. For example, the intercanthal distance is fixed for each patient and ideally that distance should equal nose width and chin width in females. Other measurements allow one to assess where the cheek apex should sit and the ideal brow height and length. It makes a great tool for discussing treatment goals with patients who need volumization rather than line filling. More information can be found on the web site of Arthur Swift, MD, who has pioneered this concept.
Mark Nestor, MD, PhD, demonstrated large particle HA gel injections for the hands. I typically use CaHA for this location, given that it is the only one FDA approved for this location and excellent results are achieved. However, this HA filler looked great after Dr. Nestor placed 1 ½ ccs per hand, which is much less than an article published by Brandt et al (Small Particle HA Gel for Hand Rejuvenation, Derm Surg 2012) which used an average of 4ccs of small particle HA per hand. Both Dr. Nestor and I typically use a 2” 25 gauge cannula for hand injections with a bleb of lidocaine at the cannula insertion for comfort.