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

BLOG: Global advances in minimally invasive aesthetics

Earlier this summer, I participated in an exciting session called, “The State of the Art in Minimally Invasive Aesthetics,” sponsored by the American Society of Dermatologic Surgery, held the day before the start of the World Congress of Dermatology in Vancouver, British Columbia.

This was an amazing day of stimulating lectures spanning the gamut of the latest noninvasive treatments for face and body. Audience participation allowed for lively discussion and elicited even more pearls and pitfalls.

Given that the FDA had just issued a warning about vascular adverse events related to fillers, the sessions on fillers were particularly timely and informative. From injectable experts we learned about the trickier areas of nasal and forehead filler injections, with caveats about vascular danger zones. Andre Braz, MD, of Brazil showed videos with exquisite anatomy dissections of these and other areas, carefully mapping out the vascularity and appropriate planes for injection.

Each area of the face was analyzed by presenters with regard to optimal injection techniques and results. Adverse events were reviewed and appropriate treatment recommended. A lively discussion of “biofilms” followed, with most agreeing that this term is an overdiagnosis as it is really more of a description or hypothesis of what may cause a granulomatous response to fillers. Some feel these rare nodules may be more immunologic than infectious in origin.

Nonfacial treatments also were part of the program from hands to chest and neck. Fillers for these regions include CaHA to hands, low G’ hyaluronic acids for deep lines of the neck, and PLLA in dilute solutions of 16ccs or more for the chest.

Lasers and energy devices were included in the program for skin rejuvenation, skin tightening and noninvasive fat removal. C02 ablative lasers were recognized as the best for tightening, but prolonged healing, increased patient morbidity and potential adverse effects limit their use to small regions such as the upper lids and perioral areas. Fractional lasers, both ablative and nonablative, were reviewed for face and nonfacial areas, with more tightening expected of ablative fractional lasers.

Radiofrequency and microfocused ultrasound were discussed as the major technologies for non-invasive tightening. Although we don’t yet have the technology to tighten severe cases of laxity, mild-to-moderate improvement is usually seen with these devices. Similarly in the noninvasive fat removal space, more and more devices are coming to the market, with cryolipolysis, ultrasound and radiofrequency the main tools for effective and safe body contouring.

Technology has evolved greatly in recent years and we expect more to come.

Rounding out the day of information was an excellent list of top 10 pearls by Kevin Smith, MD, of Canada. A simple but effective tip is to simply ask your patient at the end of the session, “Is there anything else I can do for you?” This question has led to more satisfied patients getting combinations of treatments. Marking your injection syringe with a Sharpie to distinguish quantities more easily is also a helpful tip.

This was an excellent seminar with so many pearls and concepts presented. We can hope that the ASDS will offer similar formats in the future to assure the best and safest treatments for our patients.