Table Of Content

Cheryl M.Burgess (Ed.) Cosmetic Dermatology Cheryl M.Burgess (Ed.) Cosmetic Dermatology With 35 Figures and 33 Tables Cheryl M.Burgess,M.D.,F.A.A.D. 2311M Street NW Suite 504 Washington,D.C.20037 USA Library of Congress Control Number:2004115994 ISBN 3-540-23064-5 Springer Berlin Heidelberg New York This work is subject to copyright.All rights are reserved,whether the whole or part of the material is concerned,specifically the rights of translation,reprinting,reuse of illustrations, recitation,broadcasting,reproduction on microfilm or in any other way,and storage in data banks.Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9,1965,in its current version,and permission for use must always be obtained from Springer.Violations are liable to prosecution under the German Copyright Law. Springer is a part of Springer Science+Business Media springeronline.com © Springer-Verlag Berlin Heidelberg 2005 Printed in Germany The use of general descriptive names,registered names,trademarks,etc.in this publication does not imply,even in the absence of a specific statement,that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product liability:the publishers cannot guarantee the accuracy of any information about dosage and application contained in this book.In every individual case the user must check such information by consulting the relevant literature. Editor:Marion Philipp Desk Editor:Irmela Bohn Production:ProEdit GmbH,69126 Heidelberg,Germany Cover:Frido Steinen-Broo,EStudio Calamar,Spain Typesetting:K.Detzner,67346 Speyer,Germany Printed on acid-free paper 21/3150ML 5 4 3 2 1 0 Preface Two years ago,this book was merely a concept, fueled by the clinical needs ofa new and young- (cid:1) Newer,noninvasive clinical interventions er generation seeking cosmetic procedures and a and therapeutics offer viable alternatives desire to share my own clinical experiences with for younger patients seeking cosmetic botulinum toxin and soft tissue augmentation. enhancements.These entry-level proce- Asthe concept evolved,the number oftopics did dures often accommodate patients’clini- likewise,expanding the book’s scope.With mul- cal needs as well as life styles (e.g.,time tiple topics, additional contributing authors away from work). were recruited. In contemplating the level of (cid:1) With changing patient demographics, writing effort required,I had to ask myself:“How matching clinical technique to patients’ willthis book differ from existing cosmetic der- unique skin type,tone,and color is cru- matology textbooks”? Patients’changing demo- cial. When possible, recommendations graphics coupled with technological advance- reference the Fitzpatrick rating scale. ments and new FDA product approvals for dermatology have created an overwhelming need (cid:1) Patients seeking cosmetic enhance- for cutting-edge information. This book at- ments have definite expectations, and tempts to fill the information deficit. patient counseling is imperative.Manag- Today’s demographics are transforming rap- ing patient expectations is medically idly.Aging is no longer associated with frailty and ethical and essential.Apart from discuss- impaired ability; growing old no longer means ing obvious issues of procedures,contra- looking old.While the stigma associated with be- indications, and potential adverse ef- ing “old”is decreasing,patient demand for cos- fects, dermatologists must convey a re- metic enhancements is increasing,particularly in alistic assessment of predicted outcome the younger generation who seek interventions at and determine if patients have similar the earliest signs ofaging.Additionally,by 2050, expectations.Although time-consuming, the U.S.Census Bureau predicts non-Caucasian informed consent procedures cannot be populations will comprise greater than 50% of short circuited. the total population. Ethnic, racial, and gender (cid:1) Cosmetic dermatology is a field with few differences present new challenges and necessi- established treatment algorithms.Unlike tate changes in clinical techniques:practitioners’ other medical specialties where clinical skills must accommodatedemographic shifts lest guidelines are standardized by expert clinical interventions falter. consensus panels, dermatologists must This book’s eight chapters focus on cutting- evaluate each patient on a case-by-case edge approaches to assessment and treatment basis and strategize accordingly.Detailed of the earliest signs of aging. Topics selected treatment planning must include patient represent areas where technology and im- participation. proved understanding of cellular biology have advanced considerably in the past two decades. Chapters,although distinct,are unified by several important themes: VI Preface The chapters are also united in another impor- In Chap. 5,“Botulinum Toxin,” I cover the tant but unique dimension: all authors are history, science, and treatment of botulinum women and each has had one or more of the toxin. Indications, patient selection, pretreat- procedures discussed.Equally significant is the ment considerations, postinjection considera- authors’diverse ethnic and racial mix:African tions,complications,and adverse reactions are American,Latino,Jewish,and Caucasian.Why highlighted. Along with botulinum toxin, my female authors who are ethnically and racially specialty includes tissue augmentation.Tissue diverse? These experiential characteristics add augmentation offers an alternative to invasive a depth ofunderstanding and insight that tran- surgical procedures for facial aging and is the scend technique and credentials. Each author fastest growing segment among plastic and firmly believes her experiences strengthen dermatologic procedures.In “Soft Tissue Aug- therapeutic relationships with patients.Authors’ mentation”(Chap.6),I discuss numerous aug- personal self-selected dermatological proce- mentation options, ranging from natural to dures coupled with their gender,racial,and eth- synthetic fillers, which confront practitioners. nic experiences resulted in each refining,modi- Treatment considerations surrounding perma- fying,and improving clinical techniques within nent and temporary fillers are also highlighted. their specialties,bringing an experiential clini- Chapter 7,“Laser Skin Resurfacing,”by Tina cal richness that otherwise would be lacking. S.Alster and Seema Doshi,details ablative and Chapter 1,“Anti-aging Medicine As It Relates nonablative technologies. Ablative technology to Dermatology,” by Rafaela M. Quiroga, dis- has historically led to excellent clinical out- cusses the clinical science of anti-aging medi- comes,particularly with one or a combination cine emphasizing the physiological impact of of the CO and Er:YAG lasers, although these 2 freeradical damage and the importance ofdiet, procedures usually require significant down- exercise,and lifestyle changes in the aging pro- time.Younger patients desiring less aggressive cess.Jeannette Grafcontinues the discussion of methods of photo rejuvenation or procedures anti-aging in Chap.2,“Anti-aging Skin Care In- resulting in less downtime are good candidates gredient Technologies,”focusing on molecular for the rapidly evolving nonablative proce- changes at the cellular level and the impact of dures.Results achieved with nonablative tech- nutrients upon physiological processes. Topic nology, however, are subtler and take several discussion goes beyond antioxidants and free months.Side-effects profiles can be significant radical damage and focuses on the role ofpep- with both approaches, and the importance of tides,beta-glucan,polyphenols,and other mo- clinical technique,postoperative treatment,and lecular structures ofcell life. patient selection are detailed. “Photoaging and Pigmentary Changes ofthe “Sclerotherapy,”Chap.8,by Jonith Breadon, Skin”(Chap.3),by Susan C.Taylor,begins by first first reviews physiological factors involved in differentiating clinical characteristics between the development of varicose veins,a condition intrinsic aging and photoaging and then pro- affecting up to 60% ofthe population,which is ceeds to a comprehensive discussion of the associated with pain,lipodermatosclerosis,ve- clinical characteristics of photoaging and pig- nous ulcerations, thrombophlebitis, and deep mentary changes in Asians,African Americans, vein thrombosis.Jonith Breadon’s discussion of and Caucasians. specific techniques, treatment planning, and The history of chemical peels dates back to patient evaluation offers insights that even vet- the Egyptians and has become increasingly eran practitioners will find useful. popular in the arena of anti-aging medicine. Collectively, these eight chapters meet the Chapter 4, “Chemexfoliation and Superficial needs ofa diverse target audience.Those wish- Skin Resurfacing,”by Paula E.Bourelly and An- ing information on a single topic only will find gela J.Lotsikas-Baggili,reviews chemical peel- the chapters can be read independently. Der- ing agents and techniques.Since its introduc- matologists seeking to broaden their expertise tion in 1995, microdermabrasion has gained will find the presentations up to date,well re- popularity and is also covered. searched,and clinically relevant.The chapters Preface VII do not offer “how to” instruction, but practi- cal specialists,today’s cosmetic dermatologists tioners willfind a plethora ofissues to consider are practicing in a time when diagnostics and that will assist them in clinical decision mak- treatment advances are exploding at an expo- ing. Dermatologists by no means have a nential rate.It is truly an extraordinary time for monopoly on cosmetic enhancements. Other dermatologists and their patients – a time filled cosmetic specialties will find much useful in- with exciting challenges and options. And I formation that willenrich their patient consul- hope this book in some small way conveys both tations and clinical practice.Finally,this book the excitement and the challenge! will benefit dermatology residents and medical students alike as these topics are core to most medical training curricula. Many oftoday’s treatment interventions were Cheryl M.Burgess,M.D. nonexistent just 20 years ago.Like other medi- November 2004 Contents 1 Medicine As It Relates 5 Botulinum Toxin . . . . . . . . . . 83 to Dermatology . . . . . . . . . . 1 CherylM. Burgess Rafaela M. Quiroga 6 Soft Tissue Augmentation . . . . . 93 2 Anti-aging Skin Care Ingredient CherylM. Burgess Technologies . . . . . . . . . . . . 17 Jeannette Graf 7 Laser Skin Resurfacing . . . . . . . 111 Tina Alster,Seema Doshi 3 Photoaging and Pigmentary Changes of the Skin . . . . . . . . 29 Susan C. Taylor 8 Sclerotherapy . . . . . . . . . . . . 127 JonithBreadon 4 Chemexfoliation and Superficial Skin Resurfacing . . . . . . . . . . 53 Paula E. Bourelly, Angela J. Lotsikas-Baggili Subject Index . . . . . . . . . . . . . . 167 List of Contributors Tina Alster,M.D.,F.A.A.D. Jeannette Graf,M.D.,F.A.A.D. (e-mail:[email protected]) (e-mail:[email protected]) 2311M Street,NW Suite 200 88 Bayview Ave. Washington,D.C.20037,USA Great Neck,NY 11021,USA Paula E.Bourelly,M.D. Angela J.Lotsikas-Baggili,M.D. (e-mail:[email protected]) (e-mail:[email protected]) 2412 Norbeck Farm Place 1610 Grace Church Road Olney,MD 20832,USA Silver Spring,MD 20910,USA Jonith Breadon,M.D. Rafaela M.Quiroga,M.D. 2525N.Lincoln Ave. (e-mail:[email protected]) Chicago,IL 60614,USA 5353 Columbia Pike Suite #604 Arlington VA22204,USA Cheryl M.Burgess,M.D.,F.A.A.D. (e-mail:Cheryl.burgess@ Susan C.Taylor,M.D. ctr4dermatology.com) (e-mail:[email protected]) 2311M Street,NW Suite 504 932 Pine Street Washington,D.C.20037,USA Philadelphia,PA 19107,USA Seema Doshi,M.D. Washington Institute ofDermatologic Laser Surgery,Washington,D.C.,USA Chapter 1 1 Anti-Aging Medicine As It Relates to Dermatology Rafaela M.Quiroga 1.7 Growth Hormone in the Aging Process 6 Core Messages 1.8 Consequences ofReduced GrowthHormone Secretion (cid:1) Anti-aging medicine physicians,scien- on the Skin . . . . . . . . . . . . . . . 6 tists,and researchers are dedicated to 1.9 Can Human Growth Hormone Reverse the beliefthat the process ofphysical the Effects ofAging? . . . . . . . . . . 8 aging in humans can be slowed,stop- 1.9.1 Growth Hormone Secretagogues . . . 8 ped,or even reversed through existing medical and scientific interventions. 1.10 Side Effects ofGrowth Hormone Therapy . . . . . 9 (cid:1) Possible theories ofthe aging process 1.11 A BriefGuide include the free radical theory of to Anti-Aging Supplements and Growth-Hormone-Releasing aging,oxidation,cell senescence,and Nutrients for the Skin . . . . . . . . . 10 cleavage oftelomere during DNA syn- thesis. 1.12 Oral Antioxidant Nutrients . . . . . . 10 1.12.1 Vitamin C . . . . . . . . . . . . . . . . 10 1.12.1.1 FoodSources . . . . . . . . . . . . . . 11 (cid:1) A good diet slows the aging process 1.12.1.2 Risks with HighDoses . . . . . . . . . 11 and adds healthier years to life. 1.12.2 Vitamin E . . . . . . . . . . . . . . . . 11 1.12.2.1 Role in the Body and Consequences (cid:1) A therapeutic guide for vitamin sup- ofDeficiency . . . . . . . . . . . . . . 11 1.12.2.2 RecommendedDailyAllowance . . . . 11 plements and recommended anti- 1.12.2.3 FoodSources . . . . . . . . . . . . . . 12 aging doses is provided. 1.12.2.4 Risks with HighDoses . . . . . . . . . 12 1.12.2.5 Interactions with Other Nutrients and Drugs . . . . . . . . . . . . . . . . 12 1.12.3 Carotenoids . . . . . . . . . . . . . . . 12 1.12.3.1 Role in the Body and Consequences Contents ofDeficiency . . . . . . . . . . . . . . 12 1.12.3.2 RecommendedDailyAllowance . . . . 13 1.1 Introduction . . . . . . . . . . . . . . 2 1.12.3.3 FoodSources . . . . . . . . . . . . . . 13 1.12.3.4 Risks with HighDoses . . . . . . . . . 13 1.2 The Clinical Science 1.12.4 Selenium . . . . . . . . . . . . . . . . . 13 ofAnti-Aging Medicine . . . . . . . . 2 1.12.4.1 Role in the Body and Consequences 1.3 The Aging Process . . . . . . . . . . . 2 ofDeficiency . . . . . . . . . . . . . . 13 1.12.4.2 RecommendedDailyAllowance . . . . 13 1.4 Free Radical Theory ofAging . . . . . 3 1.12.4.3 FoodSources . . . . . . . . . . . . . . 13 1.4.1 Antioxidizing Processes . . . . . . . . 3 1.12.4.4 Risks with HighDoses . . . . . . . . . 14 1.5 Diet and Nutrition . . . . . . . . . . . 3 1.12.4.5 Interactionswith Other Nutrients . . . 14 1.6 Hormonal Regulation ofAging . . . . 4 1.13 Glycemic Index . . . . . . . . . . . . . 14 1.6.1 Adrenopause . . . . . . . . . . . . . . 5 1.14 Final Remarks . . . . . . . . . . . . . 14 1.6.2 Menopause . . . . . . . . . . . . . . . 5 References . . . . . . . . . . . . . . . . 14 1.6.3 Andropause . . . . . . . . . . . . . . . 5 1.6.4 Somatopause . . . . . . . . . . . . . . 6