Dermatology World October 2011 SUPPLEMENT : Page 15
D ermatologists are combining minimally invasive procedures to more completely address patients’ multiple cosmetic concerns. Experienced practitioners have learned that combination approaches are convenient for patients, don’t generally increase downtime, and result in higher patient satisfaction. When expert dermatologists were asked about how they were using combination therapies in their practice, they o ered varying and sometimes di ering approaches to areas that they address most commonly. fUll faCE: DR. JaCOB “Combination techniques are often based on dermatologists’ experiences in using the noninvasive approaches, along with the science behind the individual techniques,” said Chicago dermatologist Carolyn Jacob, M.D. Dr. Jacob treats a young patient population. Many are experiencing only the rst signs of aging in their faces — predominantly around the eyes — and Dr. Jacob nds that a combination approach helps them retain an overall youthful look. “A lot of my patients complain about loss of volume under the eyes,” said Dr. Jacob, an associate instructor in dermatology at Northwestern Memorial Feinberg School of Medicine in Chicago. She uses a combination of llers, a neuromodulator, and, sometimes, lasers to address the issue. She also uses a hyaluronic acid under the eyes to build volume. “However, in a lot of these cases, patients also have loss of volume in the mid-cheek, temples, lower-lateral cheeks and, sometimes, marionette area,” Dr. Jacob said. “For those areas, volume is what I think is needed. I use a poly-L-lactic acid ller throughout the cheeks and temples and marionette area because it gives a natural production of your own collagen, and softens the facial appearance without looking ‘done.’” She combines the llers initially, following up with a series of poly-L-lactic acid treatments and hyaluronic acid touchups every six to 12 months. In some cases, Dr. Jacob also adds treatment with a neuromodulator, such as abobotulinumtoxinA, to address the glabellar area. “I do the injectable wrinkle relaxer, rst; a hyaluronic acid, second; and a poly-L-lactic acid, third. That’s just because the poly-L-lactic acid can distort the area under the eyes,” she said. “I use abobotulinumtoxinA in the majority of my patients because I nd that it sets in faster, and in some patients lasts longer than botulinum toxin. Studies have shown that it lasts longer in the forehead, and works better in the crow’s feet [both o -label treatment areas].” For patients also bothered by the red blood vessels on their nose and cheeks, Dr. Jacob will add treatment with a potassium-titanyl-phosphate (KTP) laser, prior to the neuromodulator and hyaluronic acid. For some cases, Dr. Jacob also recommends resurfacing with a fractionated CO 2 laser, although this is a treatment she reserves for second visits. “I don’t do the resurfacing on the same day as the llers or neuromodulators. Sometimes you get a little bit of swelling, which would distort how much ller I need to use. And I don’t want to put in the line ller and then laser over it with the fractionated laser because it could destroy a fraction of the product, depending on how super cially the product was placed,” she said. >> SUPPLEMENT TO DERMATOLOGY WORLD // October 2011 15
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