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Full-face photorejuvenation using nonablative plasma skin resurfacing
Skin Anatomy, Embryology, and Physiology P2900 ASSESSMENT OF STRATUM CORNEUM BARRIER LAYER AND pH CHANGES BY MEANS OF TAPE-STRIPPING Tam Tiet, BS, Christine Lee, BS, Frank Dreher, PhD, Howard Maibach, MD, University of California, San Francisco, San Francisco, CA, United States Introduction: The stratum corneum (SC) consists of corneocytes embedded in lipid multilayers and serves as the main barrier for skin penetration of various topical drugs. The anatomical localization of the main barrier against diffusional water loss through the skin was suggested to be the horny layer.1 The relative importance of the different layers of the SC has long been discussed. Some consider the horny layer uniform in functional barrier characteristics, whereas others consider it nonidentical. Based on lipid analysis and barrier properties, it has been suggested that the lowest region of the horny layer is mainly responsible for preventing evaporative water loss.2 Previous studies have also shown that transepidermal water loss (TEWL) increases while SC pH value decreases with decreasing thickness of the horny layer.3 In this study, we wish to assess the functional role of different layers of the SC in preventing diffusional water loss and pH gradient changes in relation to SC depth using adhesive tape stripping technique and colorimetric protein assay described by Dreher et al.4 Method: Six healthy Caucasian volunteers between the ages of 36 and 63 years participated in the study. Two test sites were selected and labeled A and B on each participant’s volar forearm. Participants acclimated for 30 minutes at room temperature and constant humidity before baseline TEWL and pH measurements. Each site was tape stripped 40 times. Each tape was applied to the test site with forceps and pressed onto the skin with a standardized 10 kPa pressure for 3 seconds. The tape was unidirectionally removed from the skin and placed into glass scintillation vials for subsequent protein analysis. TEWL was measured on site A and SC pH was measured on site B every 2 tape strippings by using the Delfin Evaporimeter and the Skin-pH meter, respectively. Colorimetric protein assay was then performed on every 40 tape strips for each site utilizing the Bio-Rad DC Protein Assay. Finally, statistical analysis was performed using analysis of variance for assessing changes in skin parameters according to SC depth. Results: Detailed data and statistics on different layers of SC protein content, TEWL, and pH changes in relation to SC depth will be fully presented at the meeting.
References 1. 2. 3. 4.
P3001 DIPHENHYDRAMINE INTRAORAL AND INFRAORBITAL NERVE BLOCKS BEFORE HYALURONIC ACID–BASED FILLERS Jennifer Cather, MD, Alan Menter, MD, Carol Ghatreehee, RN, Olga Munoz, MA, Texas Dermatology Associates, Dallas, TX, United States Two new hyaluronic acidebased fillers are being used for soft tissue augmentation. Unlike the collagen-based fillers, hyaluronic acidebased fillers are not dispersed in lidocaine; therefore separate methods for local anesthesia are frequently required. Commonly used local anesthetics can be divided into two groups: ester of benzoic and aminobenzoic derivatives (e.g., cocaine, benzocaine, procaine, tetracaine, butacaine) or amide-derivatives of xylidine and toluidine groups (e.g., lidocaine, mepivacaine, prilocaine). For patients allergic to lidocaine, diphenhydramine has been used successfully as an alternative for both cutaneous and intraoral surgeries. However, the utility for anesthesia before injection of hyaluronic acidebased fillers has not been evaluated. Twenty-seven patients had a 20% benzocaine gel applied to their oral mucosa 1 minute before a diphenhydramine intraoral infraorbital nerve block, with injection of hyaluronic acid fillers for correction of nasolabial folds and lip augmentation performed 5 to 10 minutes later. In this study, diphenhydramine administration provided adequate anesthesia. No clinically important complications were noted. The concentration and amount of diphenhydramine used in the intraoral nerve block and the injection technique will be illustrated along with the anesthetic outcome observed (time to onset and time to resolution vs. lidocaine). The intraoral diphenhydramine infraorbital nerve block after adjunctive topical anesthesia was well tolerated and was associated with a shorter duration of upper lip anesthesia. This technique may be useful as an anesthetic alternative in patients with histories of allergy to local anesthetics. Greater dynamic mobility of the lips compared with the traditionally used lidocaine intraoral infraorbital block was also noted. Dr. Cather has received research support and/or is a consultant and/or lecturer for Abbott Laboratories, Allergan, Inc., Amgen, Inc., Astralis, Inc., Berlex, Inc., Biogen Idec, Bradley Pharmaceuticals, Brymill Cryogenics, Centocor, Inc., Collagenex Pharmaceuticals, Connetics Corporation, Corixa Corporation, Dermik Laboratories, Doak Dermatologics, Ferndale Laboratories, Inc., Fujisawa Healthcare, Inc., Galderma, Genentech, Inc., GlaxoSmithKline, IDEC Corporation, Inamed Corporation, Ligand Pharmaceuticals, Medicis, MedImmune, Inc., Novartis Pharmaceuticals, Otsuka Pharmaceutical, Inc., Protein Design Labs, Serono, Synta Pharma, and 3M Pharmaceuticals.
Scheuplein. 1976. Bowser. 1985. Berardesca, et al. 1998. Dreher, et al. 1998.
Nothing to disclose.
P3002
Surgery (Cosmetic) P3000 A NEW HIGH-FREQUENCY ELECTRICAL DEVICE WITH A VACUUM FOR THE TREATMENT OF FACIAL WRINKLES AND RHYTIDS Michael Gold, MD, Gold Skin Care Center, Nashville, TN, United States; Mitchel Goldman, MD, Jaggi Rao, MD, Dermatology/Cosmetic Laser Associates and LaJolla SpaMD, LaJolla, CA, United States Skin tissue tightening to reduce facial wrinkles and rhytids has emerged as a new procedure in the dermatology arena over the past several years. By utilizing a new device with high-frequency and an associated vacuum apparatus, tissue may be manipulated and made more firm than previously realized. Forty patients were entered into this pilot trial with this new high-frequency vacuum device. Patients with facial wrinkles and rhytids were treated 8 times at 1-week intervals. Follow-up evaluations were made at 4 weeks and 3 months after therapy. The results of this pilot study will be presented to determine whether this new highfrequency vacuum type of device will become useful for dermatologists to treat facial wrinkles and rhytids. Patient acceptance and clinical results will be presented. This new device may become a new option for our patients seeking therapies for facial wrinkles and rhytids. Drs. Gold, Goldman, and Rao are research consultants/speakers for Lumenis. Research study/printing costs funded by Lumenis.
MARCH 2005
FULL-FACE PHOTOREJUVENATION USING NONABLATIVE PLASMA SKIN RESURFACING Jean-Francois Tremblay, MD, University of Montreal, St-Bruno, QC, Canada; Ronald Moy, MD, Jeffrey So, BSc, University of California Los Angeles, Los Angeles, CA, United States Background and objective: Our previous research data have shown that the novel Plasma Skin Resurfacing (PSR) system can induce superficial thermal ablation of the skin with resulting skin tightening and textural improvement. This study was designed to assess the clinical and histologic rejuvenating properties of repeated PSR treatment using nonablative energy parameters. Study design: Eight patients underwent a series of 4 full-face PSR treatments over a period of 3 months. Topical anesthesia was used exclusively. Patients were treated with energy settings of 1.5 to 2 J (3 Hz) using a sweeping nonoverlapping motion. Assessment of changes in dyspigmentation, wrinkles, skin roughness, and skin tightness was made serially by direct clinical evaluation, standardized pictures, and patients’ questionnaires. Results: The procedure was well tolerated by all patients. Mild erythema and fine desquamation was experienced for an average of 2 to 4 days after each treatment. Significant improvement in dyspigmentation was observed in 6 of 8 patients after 2 treatments. All patients reported improved skin smoothness (30%-60%), skin tightening (20%-30%) and wrinkle reduction (10%-50%) progressively over 4 treatments. Patient satisfaction rate was found to be unanimously excellent. Conclusion: The use of repeated nonablative PSR treatments appears to be more effective than currently available nonablative rejuvenating devices in improving dyspigmentation, textural changes, and skin laxity associated with aging. Supported by Gyrus Medical
J AM ACAD DERMATOL
P205
References 1. 2. 3. 4.
P3001 DIPHENHYDRAMINE INTRAORAL AND INFRAORBITAL NERVE BLOCKS BEFORE HYALURONIC ACID–BASED FILLERS Jennifer Cather, MD, Alan Menter, MD, Carol Ghatreehee, RN, Olga Munoz, MA, Texas Dermatology Associates, Dallas, TX, United States Two new hyaluronic acidebased fillers are being used for soft tissue augmentation. Unlike the collagen-based fillers, hyaluronic acidebased fillers are not dispersed in lidocaine; therefore separate methods for local anesthesia are frequently required. Commonly used local anesthetics can be divided into two groups: ester of benzoic and aminobenzoic derivatives (e.g., cocaine, benzocaine, procaine, tetracaine, butacaine) or amide-derivatives of xylidine and toluidine groups (e.g., lidocaine, mepivacaine, prilocaine). For patients allergic to lidocaine, diphenhydramine has been used successfully as an alternative for both cutaneous and intraoral surgeries. However, the utility for anesthesia before injection of hyaluronic acidebased fillers has not been evaluated. Twenty-seven patients had a 20% benzocaine gel applied to their oral mucosa 1 minute before a diphenhydramine intraoral infraorbital nerve block, with injection of hyaluronic acid fillers for correction of nasolabial folds and lip augmentation performed 5 to 10 minutes later. In this study, diphenhydramine administration provided adequate anesthesia. No clinically important complications were noted. The concentration and amount of diphenhydramine used in the intraoral nerve block and the injection technique will be illustrated along with the anesthetic outcome observed (time to onset and time to resolution vs. lidocaine). The intraoral diphenhydramine infraorbital nerve block after adjunctive topical anesthesia was well tolerated and was associated with a shorter duration of upper lip anesthesia. This technique may be useful as an anesthetic alternative in patients with histories of allergy to local anesthetics. Greater dynamic mobility of the lips compared with the traditionally used lidocaine intraoral infraorbital block was also noted. Dr. Cather has received research support and/or is a consultant and/or lecturer for Abbott Laboratories, Allergan, Inc., Amgen, Inc., Astralis, Inc., Berlex, Inc., Biogen Idec, Bradley Pharmaceuticals, Brymill Cryogenics, Centocor, Inc., Collagenex Pharmaceuticals, Connetics Corporation, Corixa Corporation, Dermik Laboratories, Doak Dermatologics, Ferndale Laboratories, Inc., Fujisawa Healthcare, Inc., Galderma, Genentech, Inc., GlaxoSmithKline, IDEC Corporation, Inamed Corporation, Ligand Pharmaceuticals, Medicis, MedImmune, Inc., Novartis Pharmaceuticals, Otsuka Pharmaceutical, Inc., Protein Design Labs, Serono, Synta Pharma, and 3M Pharmaceuticals.
Scheuplein. 1976. Bowser. 1985. Berardesca, et al. 1998. Dreher, et al. 1998.
Nothing to disclose.
P3002
Surgery (Cosmetic) P3000 A NEW HIGH-FREQUENCY ELECTRICAL DEVICE WITH A VACUUM FOR THE TREATMENT OF FACIAL WRINKLES AND RHYTIDS Michael Gold, MD, Gold Skin Care Center, Nashville, TN, United States; Mitchel Goldman, MD, Jaggi Rao, MD, Dermatology/Cosmetic Laser Associates and LaJolla SpaMD, LaJolla, CA, United States Skin tissue tightening to reduce facial wrinkles and rhytids has emerged as a new procedure in the dermatology arena over the past several years. By utilizing a new device with high-frequency and an associated vacuum apparatus, tissue may be manipulated and made more firm than previously realized. Forty patients were entered into this pilot trial with this new high-frequency vacuum device. Patients with facial wrinkles and rhytids were treated 8 times at 1-week intervals. Follow-up evaluations were made at 4 weeks and 3 months after therapy. The results of this pilot study will be presented to determine whether this new highfrequency vacuum type of device will become useful for dermatologists to treat facial wrinkles and rhytids. Patient acceptance and clinical results will be presented. This new device may become a new option for our patients seeking therapies for facial wrinkles and rhytids. Drs. Gold, Goldman, and Rao are research consultants/speakers for Lumenis. Research study/printing costs funded by Lumenis.
MARCH 2005
FULL-FACE PHOTOREJUVENATION USING NONABLATIVE PLASMA SKIN RESURFACING Jean-Francois Tremblay, MD, University of Montreal, St-Bruno, QC, Canada; Ronald Moy, MD, Jeffrey So, BSc, University of California Los Angeles, Los Angeles, CA, United States Background and objective: Our previous research data have shown that the novel Plasma Skin Resurfacing (PSR) system can induce superficial thermal ablation of the skin with resulting skin tightening and textural improvement. This study was designed to assess the clinical and histologic rejuvenating properties of repeated PSR treatment using nonablative energy parameters. Study design: Eight patients underwent a series of 4 full-face PSR treatments over a period of 3 months. Topical anesthesia was used exclusively. Patients were treated with energy settings of 1.5 to 2 J (3 Hz) using a sweeping nonoverlapping motion. Assessment of changes in dyspigmentation, wrinkles, skin roughness, and skin tightness was made serially by direct clinical evaluation, standardized pictures, and patients’ questionnaires. Results: The procedure was well tolerated by all patients. Mild erythema and fine desquamation was experienced for an average of 2 to 4 days after each treatment. Significant improvement in dyspigmentation was observed in 6 of 8 patients after 2 treatments. All patients reported improved skin smoothness (30%-60%), skin tightening (20%-30%) and wrinkle reduction (10%-50%) progressively over 4 treatments. Patient satisfaction rate was found to be unanimously excellent. Conclusion: The use of repeated nonablative PSR treatments appears to be more effective than currently available nonablative rejuvenating devices in improving dyspigmentation, textural changes, and skin laxity associated with aging. Supported by Gyrus Medical
J AM ACAD DERMATOL
P205