Expert shares pearls for using neuromodulators, dermal fillers, lasers
MAUI, Hawaii — As the popularity of neuromodulators rises, so does the need for knowledge about the procedures and the endpoints that dermatologists should be aware of, according to a presentation at Maui Derm for Dermatologists 2020.
Joel L. Cohen, MD, the director of AboutSkin Dermatology and DermSurgery in metropolitan Denver and an associate clinical professor in the department of dermatology at the University of California, Irvine, presented a range of information about neuromodulators, including examples from his experiences with patients.
If patients are concerned with lines just starting to imprint in the orbicularis oris area, neuromodulators could be a treatment choice. Cohen discussed using neuromodulators to treat the upper and lower lip areas.
“I think [neuromodulators are] a great treatment for younger people who are starting to etch and they want to minimize some of those muscles that are causing the etching,” Cohen said. “In my opinion, fillers are for people who really don’t want to do ablative laser and have a few lines that we can easily get into with a 30- to 32-gauge needle.”
He said that when patients think about fillers, they think it is an immediate treatment without downtime, but in reality, some degree of bruising is quite common especially with the serial puncture technique used for fine lines.
When patients do choose to go the ablative resurfacing route, treating patients with a combination of neuromodulators and resurfacing leads to better results, according to a few studies Cohen cited.
“I do use neuromodulators 1 to 2 weeks prior to resurfacing of the peri-oral and peri-ocular areas because I don’t want these people to mechanically contract the underlying muscle below the skin and recapitulate those imprinted lines in the skin during the healing process,” Cohen said. “If they’re fully mechanically contracting while they’re healing, then they’re imprinting these lines in exactly the same spot.”
Cohen said that he does heavy full-field erbium resurfacing around the mouth and eyes followed by fractional ablative resurfacing over these areas and throughout the rest of a patient’s face. The use of full-field erbium 2940 nm resurfacing allows the recognition of pinpoint bleeding in patients, which is an important clinical endpoint for dermatologists to be aware of, and erbium is efficiently absorbed, so that significantly lessens the risk of substantial pigmentary loss to the patient. – by Erin T. Welsh
Cohen JL. Fillers tips & anatomic considerations. Presented at: Maui Derm for Dermatologists; Jan 25-29, 2020; Maui, Hawaii.
Disclosure: Cohen reports he is a consultant, speaker and scientific advisory board member for Sciton.