Anti-aging treatments rarely go soloAnti-aging treatments rarely go solo

National report — As consumers' savviness and physicians' expertise grow, it's increasingly unlikely that any patient will be satisfied with a stand-alone anti-aging treatment, experts tell Cosmetic Surgery Times.

As researchers, manufacturers and plastic surgeons delve more deeply into what works best, "Combination therapy is clearly becoming the forefront of aesthetic medicine," says Mark S. Nestor, M.D., Ph.D., director, Center for Cosmetic Enhancement and clinical associate professor of dermatology and cutaneous surgery at the University of Miami School of Medicine.

"The trend is that we're mixing and matching different technologies in the same patient. Very few of my patients only get one thing done. People are doing at least two or three treatments every time they come in," says Tina S. Alster, M.D., director, Washington Institute of Dermatologic Laser Surgery and clinical professor of dermatology, Georgetown University Medical Center. She adds, "Many people still come in for treatment of the face, but now people are paying attention to other body parts" such as the neck, chest, hands and arms.
Dr. Alster
"Less is more these days," adds Patricia K. Farris, M.D., a dermatologist in private practice in Metairie, La.

While everyone in the cosmetic arena knows that more aggressive procedures produce more downtime and tangible results, "The consumer drives this no-downtime, easy approach to anti-aging," she says.

Unrealistic expectations

By combining downtime-free procedures, Dr. Farris adds, "We can achieve appreciable results, albeit not as great as those we achieved years ago doing more ablative procedures such as dermabrasion and laser resurfacing."

However, she says that mass media and make-over mavens sometimes fuel unrealistic patient expectations about what nonablative and no downtime procedures can accomplish. To counter these perceptions, she says that before-and-after photos can help convince patients that such procedures are "not going to move mountains."

On the whole, Dr. Nestor says combination therapy requires tailoring appropriate combinations of procedures — from conventional lifts to less invasive modalities such as lasers, fillers and botulinum toxin — and products such as prescription and nonprescription topical agents to maximize results in any individual patient. Dr. Farris The growth in combination therapy rests partly on the realization that aesthetic and medical concerns often intertwine, he adds.

"Treating disease processes such as sun damage, rosacea, acne and other processes tends not only to help those diseases, but also to help people look better," Dr. Nestor explains.

As a corollary, he says that because disease processes — especially sun damage and rosacea — are so common, making patients look their best demands that one address such underlying medical conditions.

"That's become a central element of aesthetic medicine," Dr. Nestor says.

To treat a patient with wrinkles and severe sun damage, he says, "One may want to use photodynamic therapy to get rid of sun damage," followed by an ablative procedure such as erbium resurfacing, Fraxel (Reliant Technologies) or a micro laser peel, then perhaps a tightening procedure such as ThermaCool™ (Thermage®) or Titan (Cutera). In some cases, more invasive procedures such as thread lifts or facelifts may be required to get the best immediate response, he says.

"This is then coupled with the use of sunscreen, retinoids and bleaching agents such as TriLuma (hydroquinone, fluocinolone acetonide, tretinoin; Galderma) to work together with the procedures for the best overall response," Dr. Nestor adds.