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Oct 8, 2008
Hello everyone and happy October! I don't know about you, but fall is my favorite time of year. Maybe it has to do with getting a break from the heat! :)
I hope all of you had a good summer. I kept very busy with work and meetings. I have been promising an update for awhile, and should have had it sent earlier, but my computer crashed....well, that's another story. Anyway, I'm back up and running now, and will try to get back to the business of keeping you informed of new cosmetic trends.
I went to two cosmetic meetings this summer. The first was "The Aesthetic Show" in Las Vegas. It was all glitz and glam, complete with celebrity dermatologists and plastic surgeons from shows like "Extreme Makeover" and "Dr. 90210". I learned about some procedures that are hot on the West Coast, and making their way here, like high def VASER liposuction (which is a way to sculpt six-pack abs), cosmetic gynecology (don't ask) and the Brazilian butt lift. Sorry, but I don't plan to offer any of these procedures! These were some eye-popping presentations, though. The highlight for me was hearing Dr. Michael Kane, one of my idols, talk. He is an NYC plastic surgeon who is amazing with Botox and fillers. I always get good ideas from his lectures. Two of the new, hot areas for fillers are the hands and the earlobes. I have done hands, which are fairly easy. I have not tried earlobes yet, but it looks easy as well. Let me know if you're interested.
Unfortunately, I didn't learn much about lasers at this meeting as all the speakers clearly had industry ties and were very biased. The attendees were mostly "non-core" physicians; that is, physicians outside of dermatology and plastic surgery. I met many OB's and family physicians who were "thinking about getting into cosmetics." I won't be attending this meeting in the future, but at least the hotel was nice (Mandalay Bay) and I won $100.00 in one hand on video poker. :)
The second meeting was the "Controversies in Laser and Cosmetic Surgery" meeting in Whistler, BC. This is usually a good meeting, as the faculty is comprised of some of the best cosmetic and laser gurus in the world. Attendance is about 90% "core" physicians. There were several interesting topics discussed, which I will attempt to summarize:
Botox: there are going to be some new competing products coming to the market in the next few years, but it is unclear whether they will be any better than Botox. We'll have to see how they compare in price.
Fillers: There are several new fillers on the market, including Artefill, Evolence, and Prevelle Silk. Artefill is the supposedly "permanent" filler, consisting of microspheres suspended in a bovine collagen matrix. Its predecessor, Artecoll, was associated with some side effects like granulomas. Artefill may be safer, but a 5 year study has just begun. I think I'll wait. Evolence is a porcine derived collagen that lasts longer than the bovine or human collagen we have had up to now. It is supposed to last as long as the hyaluronans, such as Restylane or Juvederm. This sounds good, because I like collagen for fine lines, but those who use it say that Evolence is like "quick dry cement" in that there is a very short window before it "sets" and there have been problems with hard lumps. Again, I think I'll pass. Prevelle Silk is a new hyaluronan which contains lidocaine for added anesthesia and comfort. However, I think they missed the boat, because most of us are already mixing our fillers with lidocaine.
Fractional Lasers: Nowadays, all the buzz is about fractional laser resurfacing. There are different types: ablative and non-ablative. Both technologies produce zones of heating and coagulation in the skin, which leads to increased collagen formation and improvement of wrinkles and scarring. The difference is that ablative lasers also destroy part of the epidermis, or outer layer of skin, creating a wound and longer downtime. The trade-off is downtime vs efficacy. The non-ablative systems (such as the original Fraxel) have less downtime (generally only some swelling and redness) but require 4 to 6 treatments to get the full benefit. The newer ablative systems (such as the new Fraxel RE:pair and others) are associated with 7 to 10 days of downtime (this means hiding out for 3 to 4 days, then looking red for up to 2 weeks) but may only require 1 or 2 treatments. I am very interested in these systems, and I am taking my time evaluating them. My concerns are: efficacy, pain, and safety. I have just about decided against the new Fraxel, as physicians are having problems with pain control. Some other systems, such as the SmartXide DOT, and MixTo, seem to be better tolerated, but I'm not sure yet about efficacy. Stay tuned.
Skin tightening: there are multiple devices on the market using heat or radiofrequency for skin tightening, such as Thermage and Titan, but the overall impression is that efficacy is minimal and difficult to measure. A company to watch, however, is Ulthera, which is developing a focused ultrasound device that looks very promising. I sat next to one of the chief investigators for the company last year, and was very impressed with what he was saying. They should be bringing their device to market in the next year or so, I hope.
Fat: Fat is the new frontier. You can melt it, dissolve it, blast it, freeze it or suck it out. There are some new technologies being developed at a rapid pace. We'll have new treatment options available to us in the next 5 years. I should note that mesotherapy (fat-dissolving injections) is still under study and is not FDA approved. Therefore, I'm not doing it. I'm still wondering if VelaShape or Ultrashape really work. Nobody mentioned them in Whistler, while everyone in Las Vegas was gushing about them. Go figure.
I just visited a colleague in Alabama last month and got some good filler tips. I'll be traveling to California in a few weeks to visit another colleague who does a ton of fillers. I always learn something when I visit another practice. I actually find these sessions more valuable than meetings, so I'm looking forward to the next trip.
As I was finishing up this letter, my phone rang. It was a laser salesman I had met in Las Vegas. He wants to sell me a laser, of course, but he also mentioned that he had started a company that trains physicians to do cosmetic procedures, and that many of them have gone on to set up their own cosmetic practices. He proudly told me that after his two day course, participants would have a complete knowledge of lasers, Botox, fillers, and microdermabrasion and would be ready to practice! I promise, I am not making this up! It sent a chill down my spine. All I can say is, be very careful out there!
I'll wind this up, but I will try to send another update in the next month. I get asked a lot of questions about skin care, and I recently gave a talk to the employees at Sephora. I'll try to pass along some of what we discussed.
Thank you for being a part of our practice. I enjoy getting to know all of you and look forward to seeing you again!
Kathy Farady
Balcones Dermatology
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Katherine Farady, M.D.
phone: 459-4869
David: ext 19
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