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

The annual meeting of the American Academy of Dermatology was a resounding success with more than 18,000 attendees and a myriad of lectures and demonstrations. The cold weather in Washington, D.C., assured that attendees stayed inside and learned!

Some of the highlights of this meeting included:

Live demonstrations of a new lifting technique with poly-l-lactic acid absorbable sutures called the Sinclair Silhouette thread lift. There are cones that secure the thread after inserting them subcutaneously with only local anesthesia at the insertion sites. No knots are needed, which was a limitation of older threads. Mark Nestor, MD, PhD, demonstrated the technique, which is fairly quick and painless. The effect is expected to last 12-15 months.

Live demonstration of percutaneous radiofrequency. I was invited to demonstrate this device (ThermiTight, ThermiGen LLC) on stage. This is a minimally invasive treatment to add to our armamentarium of options for submental fat with skin laxity. The area is anesthetized with tumescent anesthesia and the probe is placed in a subcutaneous plane. The temperature is carefully controlled by setting the subdermal plane to 55°C or 60°C for deeper subcutaneous fat and monitoring both the inside temperature with at thermal sensor on the probe and the outside temperature with an infrared thermal camera to assure the skin temperature stays close to 42°C. Patients have 1 day of downtime and require no medication for this procedure. Perhaps we will be combining this treatment with the threads in the future.

PRP for androgenic alopecia was also demonstrated on stage by Terrence Keaney, MD, utilizing a 4 mm needle. In a later talk on androgenic alopecia, I reviewed some small studies on this topic. Although the data are limited, one study demonstrated significant increase in hair density and increased hair counts of 45.9/cm2 after 3 monthly treatments (Gentile et al, Stem Cell Transl Med 2015).

At the anatomy live demonstration, Jean D.A. Carruthers, MD, did a brilliant job of clinical correlation by demonstrating on the screen the significant anatomy of a prosected head while the injectors were treating that particular area on a patient. The safe zone in the temple is on the bone in a position 1 cm superior to the lateral edge of the superior orbital rim and 1 cm lateral to the temporal fusion line. Safe areas on the forehead are again on the bone and over 1.5 cm superior to the superior orbital rim but not right at the temporal fusion plane where the tissue is very thin and vessels are vulnerable. Safety was emphasized in this session with the strong recommendation that anyone who injects should have hyaluronidase on hand and a relationship with an ophthalmologist who can assist in the unlikely case of blindness by performing a retrobulbar injection of 3 to 5 ccs of hyaluronidase.

On a lighter note, I learned something about nail gels during a lecture by Chris Adigun, MD, that I want to warn my patients about. Nail gels are cured with LED lights, but when the lights were tested, they were found to be 100% UVA wavelengths. In fact, patients are receiving four times the UV light they would receive in 1 day and current sunscreens are inadequate protection. Dr. Adigun advised patients to buy UV protection gloves for nail use or UV shields to protect the hands during treatment. These can be found online.

There are also new technologies in the body contouring arena discussed at the AAD. There is a 1060-nm laser that is applied externally with up to four applicators allowing coverage of 140 cm2.  The applicators stay on for 25 minutes and patients experience very tolerable heat. One treatment has been shown in early studies to reduce the fat layer by 24%. Perhaps in response, coming soon to the cryolipolysis market will be a new treatment head that takes only 30 minutes vs. the current hour-long treatment.

New radiofrequency devices have also been developed as well as other new external laser devices combining both ND:YAG and ErYAG lasers for sculpting and skin tightening. For those offering body contouring procedures, there are ever more options in this growing field as patient demand continues to increase. In a 2015 consumer survey of more than 7,000 consumers, the number one concern was excess weight in parts of the body, expressed by 88% of respondents. 


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