Miami Beach, Fla.—An aging U.S. population is showing its age on its most obvious cosmetic organ: the skin.
"About $80 billion is spent on the skin in the U.S. every year, as an increasing number of patients desire safe, effective techniques to help them turn back the clock," says Mark Steven Nestor, M.D., Ph.D., a dermatologic and laser surgeon practicing in Aventura, Fla. "Cosmetic surgeons continue to improve their techniques and technology in order to increase safety and effectiveness for their patients."Dr. Nestor, who also serves as clinical associate professor in the department of dermatology and cutaneous surgery at the University of Miami School of Medicine, covered the topic in a recent seminar, "Prophylaxis in treatment of uncomplicated skin infections in laser and cosmetic procedures," at the 2005 South Beach Symposium, here.
Assess needs, risks Dr. Nestor says that in order to provide the most safe and effective "turn- back-the-clock" treatment, a patient's needs must be evaluated and the chosen procedure's risks assessed.
"The physician should consider the patient's degree of photoaging, set realistic goals in terms of improvement, consider whether the downtime of a particular procedure is appropriate for the patient and determine the most appropriate type of anesthesia," Dr. Nestor says. "After matching the proper technique to the patient's desires and needs, the physician must inform and educate the patient about the procedure, and minimize inherent risks."
The choices available are many, Dr. Nestor says, noting that non-ablative procedures have gained in popularity because patients want cosmetic and clinical improvements that require minimal downtime.
"This has generated a rapid evolution in non-ablative procedures," he says. "And significant cosmetic improvement is now possible with little if any downtime and a decreased risk of infection and scarring."
Dr. Nestor notes, however, that ablative laser resurfacing procedures remain the most effective in the treatment of deep wrinkling and scars. He notes that although one technique, carbon dioxide laser resurfacing, produces impressive results, the number of procedures has dropped dramatically because there can be complications that require long periods of healing.
Another technique, long-pulsed Er: YAG laser resurfacing, achieves similar results without long healing times but also can involve complications such as infection and scarring. With either procedure, careful consideration must be given to proper patient selection, pre- and postoperative care and technique. According to Dr. Nestor, most physicians choose to prophylax patients with both oral antibiotics, such as extended spectrum cephalosporins and antivirals, and some feel that topical retinoids and bleaching creams improve healing attributes and enhance the final result.
'New frontier' As for non-ablative procedures, Dr. Nestor notes what he calls the "new frontier": IPL photodynamic therapy (PDT), which combines intense pulsed light (IPL) with topical 5 aminolevulinic acid (ALA).
"The ALA is absorbed by cells and converted to protoporphyrin IX (PpIX), a potent photosensitizer," Dr. Nestor says. "Precancerous, malignant or sebaceous cells selectively take up and convert ALA, and exposure to intense light of appropriate wavelength activates PpIX, leading to specific cell death.
"The selective therapeutic benefit of PDT is due to selective drug application followed by the accumulation of PpIX in target cells," he adds.
Antibiotic use Though prophylaxis with antibiotics and antivirals is not necessary with non-ablative procedures in most cases, Dr. Nestor says, aggressive non-ablative treatments can result in superficial wounds lasting two to seven days.