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Trends in the use of neurotoxins and dermal fillers by US physicians
2048
1235
The effects promoted by a collagen booster formulation on the human skin Ana Coutinho, MD, Dermage Laboratories, S~ao Paulo, Brazil; Simone Ribeiro, MD, Dermage Laboratories, S~ao Paulo, Brazil; Carolina Holleben, Dermage Laboratories, S~ao Paulo, Brazil; Neise Avelar, Dermage Laboratories, S~ao Paulo, Brazil
Trends in the use of neurotoxins and dermal fillers by US physicians Laura Sandoval, DO, Wake Forest University Health Sciences, Winston Salem, NC, United States; Karen Huang, MS, Wake Forest University Health Sciences, Winston Salem, NC, United States; Scott Davis, Wake Forest University Health Sciences, Winston-Salem, NC, United States; Steven Feldman, MD, PhD, Wake Forest University Health Sciences, Winston, NC, United States; Sarah Taylor, MD, Wake Forest Baptist Health, Winston Salem, NC, United States
Introduction and objectives: UVB exposure is well known to induce skin photodamage and photoaging that correlates with qualitative and quantitative deterioration of the dermal extracellular matrix (ECM) due to upregulation of matrix metalloproteinases (MMPs), critical step for collagenolysis. Collagen is the most abundant protein in human skin, comprising more than 90% of its weight. The correlation of the appearance of the signs of aging with decreased collagen turns it into a viable way of treatment, necessary for recovery of skin aging synthesis and inhibition of collagen breakdown. The aim of this study was to assess the efficacy of a collagen booster formulation after 28 days of treatment with the product. Materials and methods: The evaluation was performed using two studies. Ex vivo and in vivo studies. For ex vivo evaluation, fragments of the skin were obtained from blepharoplasty of the Surgical Center Hospital of the State University of Campinas with previous approval of the Ethics Committee in Clinical Research of the referred center. After preparation, the specimens were exposed to the formulation for 48 hours, and then were analyzed by immunofluorescent antibody test. The in vivo, open, comparative study was carried out on 30 female volunteers, aged 45-53 years and ranked according to Goglau Scale. The study population was oriented to apply the formulation on clean skin with gentle movements two times a day for 28 days. Results: Ex vivo study: the fragments treated with the formulation presented more positive results in collagen detection than the control group in the immunofluorescent antibody test, suggesting that the Booster Collagen formulation is effective in stimulating collagen synthesis. In vivo study: In the perceived effectiveness by volunteers, all parameters showed a significant improvement, compared to the baseline, Eighty seven-percent of volunteers reported improvement in firmness/elasticity, ninety three-percent in skin radiance, seventy seven-percent in tone and texture and, finally, ninety-percent in reduction of wrinkles and fine lines. Conclusion: The Collagen Booster formulation was perceived as an effective therapeutic agent to improve collagen synthesis in the skin.
Demand for minimally invasive cosmetic procedures have led to an increased market of available products for facial rejuvenation. We sought to characterize trends in the usage of aesthetic products, specifically the use of botulinum toxins and dermal fillers, by US physicians. Data from the National Ambulatory Medical Care Survey were analyzed from 1993-2010 to evaluate the use of dermal fillers and neurotoxins in the US outpatient setting. The types of physician specialties administering these products and their preferences in products were characterized. There were an estimated 100,000 annual cosmetic visits at which a dermal filler was administered from 1993-2010. From 2002-2010, there were 140,000 annual cosmetic visits for a dermal filler and 440,000 visits for a neurotoxin. While collagen was the most common filler used over the entire study period, its use declined 8% annually. Hyaluronic acid fillers were preferred from 2002-2010, followed by calcium hydroxylapatite filler, representing 50% and 16.1% of visits, respectively. The leading neurotoxin was onabotulinumtoxin A, used at 87.1% of visits. Dermatologists were the leading specialty for the cosmetic use of both dermal fillers and neurotoxins. Providers preference for cosmetic products appears to be influenced by their familiarity with them, with products that first came to market such as the neurotoxin onabotulinumtoxin A and the hyaluronic acid fillers being used most frequently from 2002-2010. Supported by Merz North America, Inc. The Center for Dermatology Research is supported by an unrestricted educational grant from Galderma Laboratories, L.P.
25% is Sponsored by Dermage Laboratories.
1071 Treatment of lateral canthal rhytides with a medium depth chemical peel with or without pretreatment with onabotulinum toxin type A: A randomized control trial Anne Marie Mahoney, MD, Loyola University, Maywood, IL, United States; Karlee Novice, Loyola University, Maywood, IL, United States; Loebat Kamalpour, MD, Loyola Unviersity, Maywood, IL, United States; Meghan Dubina, MD, Northwestern University, Chicago, IL, United States; Meredith Hancock, MD, Loyola University, Maywood, IL, United States; Rong Guo, MS, Loyola University, Maywood, IL, United States; Cindy Krol, Loyola University, Maywood, Maywood, IL, United States; Rebecca Tung, MD, Loyola University, Maywood, IL, United States Background: Combination therapies used to rejuvenate photoaged skin have become more popular as there is growing evidence to support greater efficacy and improved clinical outcomes compared to single treatment modalities. Objectives: The purpose of this study was to evaluate the safety and efficacy of sequential use of onabotulinumtoxin-A (onaBTX-A) with Jessner’s and 35% trichloroacetic acid (TCA) peels for the treatment of mild to moderate periocular rhytides and to compare the relative effectiveness of utilizing chemical peels alone versus chemical peels with adjunctive onaBTX-A. Methods: Twenty-six subjects with Fitzpatrick skin types I-III were randomized to receive treatment of their lateral canthal rhytide complex with Jessner’s and TCA peel with or without pretreatment with onaBTX-A. The primary outcome measure was wrinkle reduction determined by comparison of lateral canthal wrinkle scores at baseline and week 10 using the four-point facial wrinkle severity scale (FWSS). At the week 0 visit subjects in the combined group received onaBTX-A injection and then returned at week 1 for application of Jessner’s followed by TCA. The group randomized to peel treatment only had application of Jessner’s followed by TCA at week 0. All subjects followed up at week 10 for photographs and blinded FWSS ratings. Results: Comparison between the two treatment groups demonstrated mean FWSS scores in subjects receiving combination treatment were significantly lower than FWSS scores in patients treated with peels only (P ¼.002). In addition, there was no significant association between skin type and treatment groups (P ¼ .11). There were no serious adverse events. Two subjects experienced mild irritant dermatitis that resolved with a low potency topical steroid. Conclusions: The results of this study demonstrate that treating the lateral canthal rhytide complex with a combination of onaBTX-A injections followed by Jessner’s and 35% TCA peel is well tolerated and more effective than treatment with the chemical peels alone. In addition, we did not find any correlation between treatment efficacy and skin type. A neuromodulator and medium depth chemical peel pairing offers a reliable, cost-effective rejuvenation for mild to moderate periocular rhytides. Commercial support: None identified.
MAY 2015
J AM ACAD DERMATOL
AB21
1235
The effects promoted by a collagen booster formulation on the human skin Ana Coutinho, MD, Dermage Laboratories, S~ao Paulo, Brazil; Simone Ribeiro, MD, Dermage Laboratories, S~ao Paulo, Brazil; Carolina Holleben, Dermage Laboratories, S~ao Paulo, Brazil; Neise Avelar, Dermage Laboratories, S~ao Paulo, Brazil
Trends in the use of neurotoxins and dermal fillers by US physicians Laura Sandoval, DO, Wake Forest University Health Sciences, Winston Salem, NC, United States; Karen Huang, MS, Wake Forest University Health Sciences, Winston Salem, NC, United States; Scott Davis, Wake Forest University Health Sciences, Winston-Salem, NC, United States; Steven Feldman, MD, PhD, Wake Forest University Health Sciences, Winston, NC, United States; Sarah Taylor, MD, Wake Forest Baptist Health, Winston Salem, NC, United States
Introduction and objectives: UVB exposure is well known to induce skin photodamage and photoaging that correlates with qualitative and quantitative deterioration of the dermal extracellular matrix (ECM) due to upregulation of matrix metalloproteinases (MMPs), critical step for collagenolysis. Collagen is the most abundant protein in human skin, comprising more than 90% of its weight. The correlation of the appearance of the signs of aging with decreased collagen turns it into a viable way of treatment, necessary for recovery of skin aging synthesis and inhibition of collagen breakdown. The aim of this study was to assess the efficacy of a collagen booster formulation after 28 days of treatment with the product. Materials and methods: The evaluation was performed using two studies. Ex vivo and in vivo studies. For ex vivo evaluation, fragments of the skin were obtained from blepharoplasty of the Surgical Center Hospital of the State University of Campinas with previous approval of the Ethics Committee in Clinical Research of the referred center. After preparation, the specimens were exposed to the formulation for 48 hours, and then were analyzed by immunofluorescent antibody test. The in vivo, open, comparative study was carried out on 30 female volunteers, aged 45-53 years and ranked according to Goglau Scale. The study population was oriented to apply the formulation on clean skin with gentle movements two times a day for 28 days. Results: Ex vivo study: the fragments treated with the formulation presented more positive results in collagen detection than the control group in the immunofluorescent antibody test, suggesting that the Booster Collagen formulation is effective in stimulating collagen synthesis. In vivo study: In the perceived effectiveness by volunteers, all parameters showed a significant improvement, compared to the baseline, Eighty seven-percent of volunteers reported improvement in firmness/elasticity, ninety three-percent in skin radiance, seventy seven-percent in tone and texture and, finally, ninety-percent in reduction of wrinkles and fine lines. Conclusion: The Collagen Booster formulation was perceived as an effective therapeutic agent to improve collagen synthesis in the skin.
Demand for minimally invasive cosmetic procedures have led to an increased market of available products for facial rejuvenation. We sought to characterize trends in the usage of aesthetic products, specifically the use of botulinum toxins and dermal fillers, by US physicians. Data from the National Ambulatory Medical Care Survey were analyzed from 1993-2010 to evaluate the use of dermal fillers and neurotoxins in the US outpatient setting. The types of physician specialties administering these products and their preferences in products were characterized. There were an estimated 100,000 annual cosmetic visits at which a dermal filler was administered from 1993-2010. From 2002-2010, there were 140,000 annual cosmetic visits for a dermal filler and 440,000 visits for a neurotoxin. While collagen was the most common filler used over the entire study period, its use declined 8% annually. Hyaluronic acid fillers were preferred from 2002-2010, followed by calcium hydroxylapatite filler, representing 50% and 16.1% of visits, respectively. The leading neurotoxin was onabotulinumtoxin A, used at 87.1% of visits. Dermatologists were the leading specialty for the cosmetic use of both dermal fillers and neurotoxins. Providers preference for cosmetic products appears to be influenced by their familiarity with them, with products that first came to market such as the neurotoxin onabotulinumtoxin A and the hyaluronic acid fillers being used most frequently from 2002-2010. Supported by Merz North America, Inc. The Center for Dermatology Research is supported by an unrestricted educational grant from Galderma Laboratories, L.P.
25% is Sponsored by Dermage Laboratories.
1071 Treatment of lateral canthal rhytides with a medium depth chemical peel with or without pretreatment with onabotulinum toxin type A: A randomized control trial Anne Marie Mahoney, MD, Loyola University, Maywood, IL, United States; Karlee Novice, Loyola University, Maywood, IL, United States; Loebat Kamalpour, MD, Loyola Unviersity, Maywood, IL, United States; Meghan Dubina, MD, Northwestern University, Chicago, IL, United States; Meredith Hancock, MD, Loyola University, Maywood, IL, United States; Rong Guo, MS, Loyola University, Maywood, IL, United States; Cindy Krol, Loyola University, Maywood, Maywood, IL, United States; Rebecca Tung, MD, Loyola University, Maywood, IL, United States Background: Combination therapies used to rejuvenate photoaged skin have become more popular as there is growing evidence to support greater efficacy and improved clinical outcomes compared to single treatment modalities. Objectives: The purpose of this study was to evaluate the safety and efficacy of sequential use of onabotulinumtoxin-A (onaBTX-A) with Jessner’s and 35% trichloroacetic acid (TCA) peels for the treatment of mild to moderate periocular rhytides and to compare the relative effectiveness of utilizing chemical peels alone versus chemical peels with adjunctive onaBTX-A. Methods: Twenty-six subjects with Fitzpatrick skin types I-III were randomized to receive treatment of their lateral canthal rhytide complex with Jessner’s and TCA peel with or without pretreatment with onaBTX-A. The primary outcome measure was wrinkle reduction determined by comparison of lateral canthal wrinkle scores at baseline and week 10 using the four-point facial wrinkle severity scale (FWSS). At the week 0 visit subjects in the combined group received onaBTX-A injection and then returned at week 1 for application of Jessner’s followed by TCA. The group randomized to peel treatment only had application of Jessner’s followed by TCA at week 0. All subjects followed up at week 10 for photographs and blinded FWSS ratings. Results: Comparison between the two treatment groups demonstrated mean FWSS scores in subjects receiving combination treatment were significantly lower than FWSS scores in patients treated with peels only (P ¼.002). In addition, there was no significant association between skin type and treatment groups (P ¼ .11). There were no serious adverse events. Two subjects experienced mild irritant dermatitis that resolved with a low potency topical steroid. Conclusions: The results of this study demonstrate that treating the lateral canthal rhytide complex with a combination of onaBTX-A injections followed by Jessner’s and 35% TCA peel is well tolerated and more effective than treatment with the chemical peels alone. In addition, we did not find any correlation between treatment efficacy and skin type. A neuromodulator and medium depth chemical peel pairing offers a reliable, cost-effective rejuvenation for mild to moderate periocular rhytides. Commercial support: None identified.
MAY 2015
J AM ACAD DERMATOL
AB21