Its Spring time…Turn a page of any beauty and fashion magazine in the last month, and chances are you have seen every cosmeceutical product and technology on the market claiming to treat any cosmetic concern on the face and body. As we approach the summer months preparing to bare more skin, cellulite is one of the most common complaints amongst women. For decades, the industry has sought to find a cure for cellulite, a dimpling of the skin, which can be caused by several factors including diet, stress, and genetic predisposition in particular. While numerous technologies exist to treat cellulite, none have proven to have a long lasting effect.

Cellulaze is a device produced by Cynosure, the makers of Smartlipo, and has gained much media recognition recently. This “new” technology is a surgical procedure and uses a laser fiber to break up or ‘subcise’ the connective tissue under the skin that causes cellulite while tightening the skin. This technology is similar to the Smartlipo device which is used for liposuction; A device that breaks up and removes the fat while tightening the skin. Cellulaze treatments can range from $2,500-$10,000 depending on the areas treated. In my opinion, the present Cellulaze technology offers no long term resolution for a problem that is difficult to treat while warranting the cost of the procedure.

Thermage continues to be a successful option for tightening the skin. Used In conjunction with fillers and subcision, cellulite can be corrected and maintained. For larger areas of cellulite and fat removal, liposuction remains a more long term option for evening out the skin. While I am hopeful that technology industry leaders will offer a more permanent option to treat cellulite, at the moment the cost-benefit ratio is not enough to promote Cellulaze as the end all for cellulite.

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Wrinkle fillers have come a long way in a very short time. Hyaluronic Acid (HA) wrinkle fillers such as Restylane and Juvederm remain the most popular as they offer versatility and reversibility. Merz Aesthetics, the makers of the deeper dermal filler Radiesse is approaching the release of Belotero, the latest HA that is best for fine lines. I am proud to be one of the first physicians in the country to be using Belotero.

The most exciting component of Belotero is that it can be used to treat the fine lines throughout the face, neck, and chest that Botulinum Toxins (Botox, Dysport, Xeomin) and laser are hard to treat. Fine lines above the lip and around the mouth in particular are vanished. The difference is not only the composition of Belotero, but the actual technique of injection which is performed more superficially reducing the possibility of a “tyndell effect” (a darkening of the skin or blue hue) which other HA products can create if not injected properly. This quality makes it ideal to use under the eyes (tear troughs) in particular and around the mouth.

The Fraxel Dual and Repair remain the gold standard of technology for diminishing the appearance of pigment on the face, neck, and chest. While Fraxel Repair resurfacing treats fine lines, there is significant downtime and cost associated with the procedure and not everyone is a suitable candidate. In an effort to create an overall appearance of rejuvenation, Belotero is a unique option and I feel confident that it will have a significant place in the palette of options that I currently offer in my practice.

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Melasma is the number one concern of my female patients. If the spots on your face that you thought were freckles are now larger clusters of irregular patches on your cheeks, forehead, or upper lip, chances are you have developed melasma. One day you don’t have it, the next day it suddenly pops up leaving you frustrated. One patient described it as, “trying to prune a field of weeds”, it keeps coming back. Chances are, if you are in your 20s and 30s, have a more olive complexion, and have sun damage, you have developed melasma or will most likely have it at some point in your life. So, in an effort to clarify the many options for treatment, I would like to address the most successful treatment protocol and maintenance which have kept my patient’s melasma free.

It is known that the main causes of melasma are hormonal imbalances and can be exacerbated by changes in estrogen levels caused by oral contraceptives, and pregnancy (known as ‘the mask of pregnancy’). Diet, exercise, and stress also play a critic role as an imbalance of any of these can wreak havoc on a woman’s hormones. Therefore, anyone can get it even if you are not pregnant or taking birth control. The challenge for many women is to maintain clarity and choose from the numerous skincare products and treatment options. As the warm sunny months approach, melasma is challenging to control as even the slightest bit of sun exposure or heat will cause an outbreak. Following an outbreak, it takes a diligent commitment to treatment and maintenance to get the skin back to normal.
The days of hydroquinone based products and AHA’s, alpha hydroxy acids (such as glycolic, lactic, kojic and azelaic acids), have been surpassed by products containing Arbutin and lignin peroxidase, a natural derivative from mushrooms. Earlier treatment protocol consisted of acid peels and high concentrations of hydroquinone such as Cosmelan leaving the skin in a sense ‘open’ and ‘raw’, making it more susceptible to environmental damage from sunlight, pigmentation, as well as thinning the skin.

Fractionated technology remains the best treatment protocol to reduce the pigment caused by melasma in my practice. The Fraxel Thulium (http://www.pfrankmd.com/thulium.html) and Clear & Brilliant treatments (http://www.pfrankmd.com/clear-brilliant.html) reduce the pigment at the source without damaging the top layer of skin. While there are often questions about skin color, and post inflammatory hyper pigmentation, it is important to be treated by an experienced laser surgeon. Following treatment, a daily regimen of spf 15 or higher moisturizer is essential as well as a product to maintain clarity. Elure™ (http://www.pfrankmd.com/elure.html ) is the latest and greatest product on the block which breaks down excess melanin (pigment).

Used daily, skin is kept clear and unlike hydroquinone and AHA’s will not make the skin light sensitive. Depending on the severity of a patient’s melasma, a product containing Arbutin or kojic acid may be added to the treatment protocol, short term, to inhibit the production of the enzyme tyrosinase which produces melanin. The goal is to reduce the existing pigment while preventing it from reproducing. With the right course of treatment and daily skincare maintenance, you can put your best face forward. For information on treatment for melasma please visit www.pfrankmd.com

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Hyperhidrosis is a surprisingly popular condition in dermatology practices. With the advent of Botox injections as a overwhelmingly successful treatment for localized areas of excessive sweating, the prevelance of this condition has become more apparent. Often found in young adults, Hyperhidrosis most commonly occurs on the underarms and hands and feet. Occasionally, individuals experience the problem all over the body causing significant psychosocial debilitation. In addition, the excessive sweat functions as a skin irritant causing a long list of rashes that effect the health of the skin.
Several treatments do exist that range from prescription based topical antiperspirants to oral anticholinergic therapy to more extreme measures such as surgery- a treatment that does carry some degree of risk and side effects. The most popular treatment which seems to only work for localized areas, is the injection of botulinum toxin, or BOTOX. The drug has the unique ability to stun sweat glands locally without any side effects or rebound sweating elsewhere. It is easy, safe, but expensive. Insurance companies ocassionally pay for the treatment, but coverage is becoming less frequent and is difficult to get. A large percentage of patients still pay out of pocket which can cost up to 1800-2500 dollars a year (twice a year treatments).
As a more permanent option there is a localized surgical treatment that works only on the armpits. Under local anesthesia, a small ultrasonic wand called VASER is run under the skin through a small incision and can be used to kill the sweat glands without any significant risk. Treatment is performed 1-2 times with long term efficacy. I have been performing this technique for several years nowand patients are happy. But , new technology has come out which may be more simple. Miradry- is a device that uses microwaves to destroy superficial sweat glands. It is a nonsurgical treatment that involves injecting anesthesia and then passing the device over the area. Two treatments are preformed at 4-6 week intervals and results have been significant and long lasting. Recovery is like the vaser treatment with a few days of mild soreness and bruising . The limiting factor of all these treatments is cost. Unfortunately, like most cosmetic treatments these surgical or device oriented treatments are not at all covered by insurance and can cost about 4500 dollars for the completion of the treatments. Hopefully with the increasing prevalence and efficacy of new treatments we will see the cost improve as well. Please refer to our website for more details. www.pfrankmd.com

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With fractional resurfacing being clearly the most popular treatment over the past 1-2 years, patients are seeking procedures with the most limited downtime to accomodate their busy lives. Although there will always be some degree of ‘no pain, no gain’ to laser treatments, technologies are certainly maximizing results with limited recovery. Recently the developers of Fraxel released a fractional device called Clear & Brilliant. Although not as clinically dramatic in results as other Fraxel devices, the technology uses a novel wavelength of light that minimizes peeling during recovery. From our experience thus far, the technology benefits younger patients with limited amounts of sun damage or more advanced patients who are looking for no downtime maintenance to other procedures they have done in the past. The treatment takes about 15 min and produces mild redness that lasts only a few hours. Makeup can be applied immediately and the skin will feel dry for a few days only. Thus far, Clear and Brilliant seems like a very promising minimally invasive treatment for overall skin rejuvenation. Although the results are not as dramatic as other Fraxel procedures, it will certainly fill a much needed niche in the field of laser resurfacing.

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So there is a new treatment on the block. It may not seem like anything new in skin tightening and fine line wrinkle treatments. Thermage, Titan and newer treatments such as Ulthera have the same premise of delivering heat deep in the skin causing immediate contraction and future development of fresh collagen. The problem with many of these effective treatments is that they hurt quite a bit and for some of the stronger ones can cause some degree of swelling which can effect daily activities. Pelleve is a radiofrequency device that delivers skin tightening energy in a low level and deeply penetrating continuous fashion rather that intense pulses. This manner of delivery allows for extremely comfortable treatments that can be done at 2-4 week intervals until the desired result is achieved. There is zero downtime and most patients are describing the treatment as a pleasurable warm facial massage. The catch is that it does require several treatments- usually 3-6 depending on a patient’s needs. Is it better than the other devices? Not likely in efficacy. But for that patient that is adverse to any downtime and discomfort and is willing to get several treatments, I believe the Pelleve device is an excellent addition to the battle against time. To find out more about it go to our website-www.pfrankmd.com

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So it been years now that the US market has been waiting for effective non invasive fat removal devices. Zeltiq is the most popular now but has alot of limitation in terms of lack of sculpting , time for treatment and ability to treat various areas and sizes. Zerona was a total failure and a bit of a scam, if you ask me. But Liposonix is an ultrasound device that has been used in Canada and Europe for a few years now. Although the first device was not overwhelmingly impressive, there is science behind it and most importantly, room to grow in the technology. Well, just recently, Liposonix developed a second generation machine that promises to work faster and better than its predecessor. Solta medical, the distributors of Fraxel technology, will be marketing it in the US as early as the begginning of 2012. Although it will certainly not be a replacement for the tumescent liposuction procedures i perform everyday, i do believe that it will be a good addition to the armamentarium we use in fat reduction….Stay tuned. We will very likely be one of the first practices in the country to offer this exciting new device. Check in with our website www.pfrankmd.com and sign up to our newsletter for updates on Liposonix.

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With all the obsession with vampires in pop culture, the prince of darkness has infiltrated the cosmetic world with what has been called the ‘vampire facelift’. This is nothing particularly new. The vampire facelift is a technology called PRP or platelet rich plasma, a natural portion of blood that can be isolated from patients and injected for various purposes. All the growth factors that circulate throughout the body can be found in the processed blood and “theoretically” would be of some use. Orthopedic surgeons have used the technique of injecting one’s own blood with mixed success to help healing joints and tendons. As a cosmetic application, we have found very limited to no benefit as compared to the huge success of various fillers on the market. Aside from its limited effectiveness for wrinkles, we do not know the long term effects of injecting any sort of growth factors into the skin. There are some studies that show improved healing with aggressive lasers and similar procedures. The improvement may not be enough to significantly incur extra cost though. As for PRP for beauty, filling and wrinkles, Dr. Frank’s consensus- don’t believe the hype. Just keep watching ‘True Blood’ and ‘Twilight’.

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So much skin to tighten and so many toys! What to do? what works better? These are the daily questions. Well, here’s the update. Thermage has been a gold standard for a decade in skin tightening, offering modest but significant efficacy in well chosen patients. Technologies advance and time moves forward. Ulthera has been out for a year and up until recently has been unimpressive in its differentiation from other technologies. With time, experience, and technological tweaks, the treatment protocols and technology has advanced dramatically. Although i still use thermage regularly on the body, I find Ultherapy to be the most effective facial tightening treatment to date. The technology definitely penetrates deeper into the skin with greater, more controlled energies as demonstrated by the ability to visualize the skin on the ultrasound screen. What is also unique is the ability to treat specific areas as opposed to only entire faces. What is still essential is choosing the right candidate. This is not for patients with loose sagging skin. Ultherapy treats mild to moderate laxity and is appropriate for patients in their 30’s 40’s and 50’s. You can read more about it at www.pfrankmd.com

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Pores are one topic that never seems to gets old. People are obsessed with them. Understandably so….they are the portals to your skin and body. They allow the skin to breath, to lubricate, to control heat regulation and to generally control the skin’s well being. So the answer to everyone’s question is- you cannot remove them.Unfortunately, many people have complaints about their pores. Some are bigger than others, some secrete too much or too little oils, some are more visible or scar looking than others. It is obvious why pores are such a popular topic and why billions of dollars in cosmeceuticals and laser treatments have been spent trying to alter them. What must be remembered is first- we can not rid of them. They are an important part of our skin. Second- their visibility and size has a lot to do with genetics, normal aging and with progressive sun damage. You can control the sun damage part. Any finally, although you cannot close them for good, there are ways to minimize them, conceal them, and help control any dysfunction they may present.. Many topical agents, including many acne medications, can keep them empty of sebum, thus making them appear smaller and keeping them from progressively swelling. More procedural things that can be done range from chemical peels to microdermabrasion to pore cleansing acne lasers such as Isolaz.
As with most cosmetic concerns, sometimes the best treatment is good lighting and makeup. There are several pore refining and matte finishing products out of the market that help conceal the pores that perturb so many. One of my favorites is Z-pore by GoodSkin Labs. This product give a smooth matte finish to the skin that lasts all day. A product such as this alone or along with other pore refining techniques can minimize the appearance and concerns regarding the pore dillemma.

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