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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: Masters of aesthetics share tips on lasers, radiofrequency and cryolipolysis

I recently participated in a gem of a conference in San Diego, the second annual Masters of Aesthetics Symposium, which offered two days of practical advice with detailed how-to videos and live demonstrations.

The symposium was the brainchild of the late Richard E. Fitzpatrick, MD, who was renowned as an innovator and thought leader in dermatologic laser surgery.  His vision for this conference was aptly carried out by course directors, Mathew Avram, MD, and Arisa Ortiz, MD

Rox Anderson, MD, gave the Richard E. Fitzpatrick memorial lecture and urged the audience to “venture forth from your comfy island of knowledge into the sea of ignorance” to reach new frontiers of understanding and treatment.

Our American Society for Dermatologic Surgery fellow Joanna Bolton, MD, described the event: “Live patient demos and real world clinic/patient examples made information delivered in lectures very useful. It was NOT your typical death by PowerPoint”.

Some of the tips gained from the seasoned faculty included:

1. For tattoos, Dr. Avram explained pico lasers are superior for their quicker healing and improved efficacy.

2. Suzanne Kilmer, MD, explained that acne scars are best treated with fractional lasers at higher fluences but lower densities. For nonablative treatments, she recommended four to five treatments 2 months apart or two ablative treatments 6-12 months apart.  Assessment of clinical results should be 3-6 months post the cycle of treatments.  Acne scar patients need to have realistic expectations and be reminded their skin will never be completely scar-free.

3. Skin tightening has made great strides with microfocused ultrasound and new modalities of radiofrequency.  While both modalities are effective, again patients need to have realistic expectations.  Underpromise results and your patients will be happy.

4. Rox Anderson gave an interesting lecture about cryolipolysis and the effects on the cutaneous nerves.  It turns out that myelin sheaths are lipid-rich structures rendering them vulnerable to demyelination by the cold injury.  Sensory effects induced by cryolipolysis such as hypoesthesia, attenuated itching and decreased pain sensitivity were studied in 11 patients.  The symptoms begin at 2-7 days and persist for at least 35 days.  This finding is an example of thinking outside the box as it may lead to new treatments in controlled skin cooling for chronic cutaneous pain and itching.

5. Speaking of demyelination, it turns out Kybella (deoxycholic acid, Kythera) may have this effect on the cutaneous nerves, which explains why numbness is a common side effect.  The myelin generally regenerates within 45 days after treatment according to Dr. Avram.

6. Rox also spoke about new horizons in acne therapy with technology and medication that will target the sebaceous gland,  detailing upcoming laser/light devices (i.e. a 1726nm laser, high fluence red light) and medications that will target sebum (i.e. Dermira). He truly feels targeting sebum/sebaceous glands is of utmost importance to control acne.

Be sure to check out my next blog entry on, when I will cover additional tips from the Masters of Aesthetics Symposium.