issue tightening refers to the correction of skin laxity. Suitable patients for nonsurgical skin ... more issue tightening refers to the correction of skin laxity. Suitable patients for nonsurgical skin tightening are those who do not want surgery or are poor candidates for rhytidectomy. 1 In addition, some patients who have undergone a face lift procedure have found that postoperative nonsurgical skin tightening enhances their results. MECHANISM OF COLLAGEN SHRINKAGE Collagen is a polymer that exists as a triple helix with chains held together by hydrogen bonds. These molecules are aggregated and organized as fibrils with tensile properties attributable to intermolecular cross-links. 2 When collagen is denatured by heat, the intramolecular hydrogen bonds rupture and the triple helices "unwind to produce a gel of random-coil molecules." 3 Tissue tension in human skin increases because, although the fibers become shorter, 4,5 the heat-stable cross-links between molecules are maintained, thus increasing the rubber-elastic properties of the collagen polymer. 4 The heat-modified tissues then undergo remodeling associated with fibroplasia and new collagen deposition. 2,3 When denaturation is complete, further increases in temperature result in additional fiber shortening, probably because of peptide bond hydrolysis. 4,5 The mechanism of collagen shrinkage has been described in detail. 3
Objective: In PSO-LONG, long-term proactive management (PAM) of psoriasis with fixed-dose combina... more Objective: In PSO-LONG, long-term proactive management (PAM) of psoriasis with fixed-dose combination calcipotriol 50 mg/g and betamethasone dipropionate 0.5 mg/g (Cal/BD) aerosol foam was superior to conventional reactive management. This post-hoc analysis investigated long-term PAM with Cal/BD foam in PSO-LONG patients who could be more susceptible to corticosteroid-induced hypothalamic-pituitary-adrenal (HPA) axis suppression. Methods: Efficacy and safety of PAM with Cal/BD foam (twice-weekly) versus reactive management (twice-weekly vehicle foam), with once-daily rescue Cal/BD foam for four weeks following relapse, was assessed in the HPA subgroup (n ¼ 66); patients had moderate-to-severe psoriasis (physician global assessment score 3; 10-30% body surface area affected). Primary endpoint was time to first relapse. Results: PAM with Cal/BD foam was associated with longer median time to first relapse (111 versus 31 days), reduced risk of first relapse (hazard ratio: 0.49; p ¼ .029), greater proportion of days in remission (17%; p ¼ .001) and reduced rate of relapse (60% reduction; p < .001) than reactive management. Adverse events occurred in 37.5% (PAM) and 47.1% (reactive management) of patients, with no new safety signals. No clinically significant HPA-axis suppression was observed. Conclusion: Efficacy of PAM with Cal/BD foam is maintained in patients with moderate-to-severe psoriasis, with no new safety signals.
Journal of the American Association of Nurse Practitioners, 2018
There is a need for new treatment options for moderate-to-severe atopic dermatitis (AD) in adults... more There is a need for new treatment options for moderate-to-severe atopic dermatitis (AD) in adults. Dupilumab, a fully human anti-interleukin-4 receptor α monoclonal antibody, has recently been approved for this indication. A pooled analysis of a phase 2a (NCT01548404) and a phase 2b (NCT01859988) study and a subanalysis of the 2b study evaluated the efficacy and safety of subcutaneous dupilumab 300 mg once weekly (qw) and every 2 weeks (q2w) in adults with moderate-to-severe AD. Dupilumab significantly improved clinical outcomes in both analyses at week 12. Itch was significantly improved in the pooled analysis as measured by peak pruritus Numerical Rating Scale, 5-dimension pruritus scale, and SCORing Atopic Dermatitis (SCORAD) Visual Analog Scale (VAS) pruritus scores (all p < .0001 vs. placebo at week 12). Sleep loss was significantly improved (SCORAD VAS sleep loss score; p < .0001 vs. placebo at week 12); similar results were shown for the q2w dose. Dupilumab had an accep...
Journal of cosmetic and laser therapy : official publication of the European Society for Laser Dermatology, 2018
The market for home-use photobiomodulation devices to treat androgenetic alopecia has rapidly exp... more The market for home-use photobiomodulation devices to treat androgenetic alopecia has rapidly expanded, and the Food and Drug Administration (FDA) has recently cleared many devices for this purpose. Patients increasingly seek the advice of dermatologists regarding the safety and efficacy of these hair loss treatments. The purpose of this guide was threefold: (1) to identify all home-use photobiomodulation therapy devices with FDA-clearance for treatment of androgenetic alopecia; (2) to review device design, features and existing clinical evidence; and (3) to discuss practical considerations of photobiomodulation therapy, including patient suitability, treatment goals, safety, and device selection. A search of the FDA 510(k) Premarket Notification database was conducted using product code "OAP" to identify all home-use devices that are FDA-cleared to treat androgenetic alopecia. Thirteen commercially available devices were identified and compared. Devices varied in shape, w...
Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.], Jan 20, 2017
Hyaluronic acid (HA) dermal fillers are frequently used to correct or smooth facial wrinkles and ... more Hyaluronic acid (HA) dermal fillers are frequently used to correct or smooth facial wrinkles and folds such as nasolabial folds. To compare the efficacy and safety of 2 HA gels, formulated by 2 different manufacturing processes: XpresHAn Technology (HARRL [with lidocaine]) and Hylacross technology (HAJU-a comparator product without lidocaine). One hundred seventy subjects with bilateral nasolabial folds rated as moderate or severe, according to the Wrinkle Severity Rating Scale (WSRS), received injections of HARRL in the nasolabial folds on one side of the face and HAJU on the other side. Investigator- and subject-assessed wrinkle severity was measured up to 48 weeks after final injection. HARRL exhibited a similar safety and efficacy profile compared with HAJU. Noninferiority of HARRL was demonstrated at 24 weeks (WSRS mean change from baseline mean difference -0.1 [95% confidence interval: -0.15, 0.01], p = .090). Incidence of adverse events was 40% for both treatments. HARRL exhi...
Cellulite is a metabolic condition, predominately seen in females, that affects the subcutaneous ... more Cellulite is a metabolic condition, predominately seen in females, that affects the subcutaneous tissue of the posterolateral thighs, buttocks, pelvic region, and abdomen. It is characterized by skin dimpling and lumpiness resembling an orange peel. Despite the wide range of treatment options for patients with cellulite, there is a paucity of empirical data supporting their efficacy. The objective of this study was to evaluate the efficacy of a new-generation multipolar radiofrequency (RF) device for the treatment of cellulite. A multipolar RF device with pulsed magnetic fields was used to treat abdominal cellulite. Twenty-five healthy adult females with stage II or stage III abdominal cellulite underwent 8 weekly treatments. Assessments were performed at baseline and at weeks 1, 4, and 12 following the final treatment. Reduction in subcutaneous thickness in the axial and sagittal plane of the abdomen was observed at 1 week following treatment initiation. Results from self-reported questionnaires revealed a significantly high level of patient satisfaction (60%). Assessments by a blinded investigator at one, four, and twelve weeks after the final treatment demonstrated a significant improvement in cellulite appearance. No adverse effects were reported and the treatment was well tolerated. This study demonstrates the safety, efficacy, and subject satisfaction of multipolar RF with pulsed magnetic field therapy in the treatment of abdominal cellulite.
International Journal of Women's Dermatology, 2016
Physiologic changes in a woman's life, such as childbirth, weight fluctuations, and hormonal chan... more Physiologic changes in a woman's life, such as childbirth, weight fluctuations, and hormonal changes due to aging and menopause, may alter the laxity of the vaginal canal, damage the pelvic floor, and devitalize the mucosal tone of the vaginal wall. These events often lead to the development of genitourinary conditions such as stress urinary incontinence; vaginal atrophy; dryness; and physiologic distress affecting a woman's quality of life, self-confidence, and sexuality. Various treatment modalities are currently available to manage these indications, varying from invasive vaginal surgery to more benign treatments like topical vaginal hormonal gels or hormone-replacement therapy. A new trend gaining momentum is the advent of energy-based devices for vaginal rejuvenation that apply thermal or nonthermal energy to the various layers of the vaginal tissue, stimulating collagen regeneration contracture of elastin fibers, neovascularization, and improved vaginal lubrication. This review aims to present the available technologies offering vaginal rejuvenation and the scientific evidence that underlines their safety and efficacy for this indication.
Background: A distinct trend in aesthetic medicine is the patient's demand for efficient, noninva... more Background: A distinct trend in aesthetic medicine is the patient's demand for efficient, noninvasive treatments with no downtime. Ongoing with this, these so-called lunchtime procedures are expected to be as safe and painless as possible. A new technique based on a combination of radiofrequency (RF) and pulsed electromagnetic fields (PEMF) was recently introduced and is supposed to be effective in the treatment of facial wrinkles and virtually pain free. The objective of this study was to investigate the safety and efficacy of this technology for the treatment of facial rhytides. Methods: Thirty-one subjects with facial wrinkles and rhytides were entered into this study. Every subject received 10 treatments of the face with a device that combines 1 MHz radiofrequency with PEMF with a flux of 15 gauss. Patients rated the pain level immediately after the treatment by using a visual analog scale (VAS) for pain. Side effects were recorded at every visit. The study's efficacy end point was evaluated by 2 blinded physicians who rated the standardized pictures from baseline and 3-month follow-up using the Fitzpatrick Wrinkle and Elastosis Scale (FWES). Results: No unexpected adverse side effects were detected or reported for the duration of the study. Both raters recognized improvements of at least 1 grade on the FWES in 30 of 31 subjects (97%). The score decreased from 5.2 before the first treatment to 3.6 at 3 months after the last treatment. Furthermore, all patients rated the treatment to be free of pain on the VAS pain scale. Conclusion: The results of this study show that the combination of multipolar RF with PEMF is a safe, effective, and painless approach to treat facial rhytides and is suitable to answer the demands of patients for safe treatments without pain or downtime.
After more than 25 years of research and development, in October 2006 ArteFill Ò became the first... more After more than 25 years of research and development, in October 2006 ArteFill Ò became the first and only permanent injectable wrinkle filler to receive FDA approval. ArteFill is a third-generation polymeric microsphere-based filler, following its predecessor Artecoll Ò , which was marketed outside the United States between 1994 and 2006. ArteFill is approved for the correction of nasolabial folds and has been used in over 15,000 patients since its U.S. market introduction in February 2007. No serious side effects have been reported to date according to the FDA's MAUDE reporting database. Ar-teFill consists of polymethylmethacrylate (PMMA) microspheres (20% by volume), 30-50 lm in diameter, suspended in 3.5% bovine collagen solution (80% by volume) and 0.3% lidocaine. The collagen carrier is absorbed within 1 month after injection and completely replaced by the patient's own connective tissue within 3 months. Each cc of ArteFill contains approximately six million microspheres and histological studies have shown that long-term wrinkle correction consists of 80% of the patient's own connective tissue and 20% microspheres. The standard injection technique is subdermal tunneling that delivers a strand of ArteFill at the dermal-subdermal junction. This strand beneath a wrinkle or fold acts like a support structure that protects against further wrinkling and allows the diminished thickness of the dermis to recover to its original thickness. Keywords ArteFill Á Dermal filler Á Permanent filler Á Soft tissue augmentation Á Wrinkle treatment The first commercially successful, FDA-approved injectable filler for soft tissue augmentation was a solution of soluble collagen [1, 2] marketed by Collagen Corporation in 1983. Until then, the only widely used ''off-the-shelf'' injectable filler had been liquid dimethylpolysiloxane (silicone). Complications from liquid silicone (LIS), however, were often disfiguring and challenging to correct. Collagen injections, on the other hand, were never held out as permanent corrective devices for the treatment of soft tissue defects, whether scar depressions, atrophy, or wrinkle lines. The corollary mantras ''temporary solution, but temporary problems'' (if an adverse event should occur), and ''permanent solution, permanent problems'' were associated with collagen and silicone, respectively. However, although both patients and physicians accepted the inconvenience and repeated expense of short-term fillers, they have long sought a dermal filler substance that
The successful treatment of acne still remains problematic. Conventional therapies often prove in... more The successful treatment of acne still remains problematic. Conventional therapies often prove inconsistent with unacceptable side effects and recurrence rates, leading to patient noncompliance. A thermal phototherapy treatment using a combination of blue light and red light has recently attracted much attention and seems to offer an effective alternative. The objective of this study was to evaluate the efficacy of blue light (415 nm) in combination with red light (633 nm) in the reduction of inflammatory lesions on the face of subjects (n=21) with mild to moderate acne vulgaris after a course of 8 20-minute (blue) or 30-minute (red) alternated light treatments, self-administered by a handheld unit over a period of 4 weeks. Lesion counts progressively reduced throughout the 4-week light therapy period and continued to reduce up to 8 weeks posttherapy, with a final average reduction of 69% seen 8 weeks after the treatment course (P&amp;amp;amp;amp;amp;amp;gt;.001). This pattern is similar to previously reported studies.
Female pattern hair loss affects many women; its pathogenetic basis has been held to be similar t... more Female pattern hair loss affects many women; its pathogenetic basis has been held to be similar to men with common baldness. The objective of this study was to determine the role of immunity and inflammation in androgenetic alopecia in women and modulate therapy according to inflammatory and immunoreactant profiles. 52 women with androgenetic alopecia (AA) underwent scalp biopsies for routine light microscopic assessment and direct immunofluroescent studies. In 18 patients, serologic assessment for antibodies to androgen receptor, estrogen receptor and cytokeratin 15 was conducted. A lymphocytic folliculitis targeting the bulge epithelium was observed in many cases. Thirty-three of 52 female patients had significant deposits of IgM within the epidermal basement membrane zone typically accompanied by components of complement activation. The severity of changes light microscopically were more apparent in the positive immunoreactant group. Biopsies from men with androgenetic alopecia showed a similar pattern of inflammation and immunoreactant deposition. Serologic assessment for antibodies to androgen receptor, estrogen receptor or cytokeratin 15 were negative. Combined modality therapy with minocycline and topical steroids along with red light produced consistent good results in the positive immunoreactant group compared to the negative immunoreactant group. A lymphocytic microfolliculitis targeting the bulge epithelium along with deposits of epithelial basement membrane zone immunoreactants are frequent findings in androgenetic alopecia and could point toward an immunologically driven trigger. Cases showing a positive immunoreactant profile respond well to combined modality therapy compared to those with a negative result.
The Journal of Dermatologic Surgery and Oncology, Oct 1, 1989
A technique of alopecia reduction utilizing a curvilinear ellipse employing a sequential excision... more A technique of alopecia reduction utilizing a curvilinear ellipse employing a sequential excision and suture technique is described. Advantages of the technique over previously described procedures are presented. Measurements of individual scalp elasticity and alternating suture tension vectors help to produce an excellent cosmetic result with minimal complications.
To determine whether autologously transferred human adipose tissue maintains viability in vivo fo... more To determine whether autologously transferred human adipose tissue maintains viability in vivo for prolonged periods. Design: Six healthy female patients (mean age, 61.5 years; mean body mass index, 23.4 kg/m 2) received autologous fat transplants from the gluteus to the nasolabial folds. Subcutaneous fat was sampled from facial and gluteal sites 4 times in 1 year.
issue tightening refers to the correction of skin laxity. Suitable patients for nonsurgical skin ... more issue tightening refers to the correction of skin laxity. Suitable patients for nonsurgical skin tightening are those who do not want surgery or are poor candidates for rhytidectomy. 1 In addition, some patients who have undergone a face lift procedure have found that postoperative nonsurgical skin tightening enhances their results. MECHANISM OF COLLAGEN SHRINKAGE Collagen is a polymer that exists as a triple helix with chains held together by hydrogen bonds. These molecules are aggregated and organized as fibrils with tensile properties attributable to intermolecular cross-links. 2 When collagen is denatured by heat, the intramolecular hydrogen bonds rupture and the triple helices "unwind to produce a gel of random-coil molecules." 3 Tissue tension in human skin increases because, although the fibers become shorter, 4,5 the heat-stable cross-links between molecules are maintained, thus increasing the rubber-elastic properties of the collagen polymer. 4 The heat-modified tissues then undergo remodeling associated with fibroplasia and new collagen deposition. 2,3 When denaturation is complete, further increases in temperature result in additional fiber shortening, probably because of peptide bond hydrolysis. 4,5 The mechanism of collagen shrinkage has been described in detail. 3
Objective: In PSO-LONG, long-term proactive management (PAM) of psoriasis with fixed-dose combina... more Objective: In PSO-LONG, long-term proactive management (PAM) of psoriasis with fixed-dose combination calcipotriol 50 mg/g and betamethasone dipropionate 0.5 mg/g (Cal/BD) aerosol foam was superior to conventional reactive management. This post-hoc analysis investigated long-term PAM with Cal/BD foam in PSO-LONG patients who could be more susceptible to corticosteroid-induced hypothalamic-pituitary-adrenal (HPA) axis suppression. Methods: Efficacy and safety of PAM with Cal/BD foam (twice-weekly) versus reactive management (twice-weekly vehicle foam), with once-daily rescue Cal/BD foam for four weeks following relapse, was assessed in the HPA subgroup (n ¼ 66); patients had moderate-to-severe psoriasis (physician global assessment score 3; 10-30% body surface area affected). Primary endpoint was time to first relapse. Results: PAM with Cal/BD foam was associated with longer median time to first relapse (111 versus 31 days), reduced risk of first relapse (hazard ratio: 0.49; p ¼ .029), greater proportion of days in remission (17%; p ¼ .001) and reduced rate of relapse (60% reduction; p < .001) than reactive management. Adverse events occurred in 37.5% (PAM) and 47.1% (reactive management) of patients, with no new safety signals. No clinically significant HPA-axis suppression was observed. Conclusion: Efficacy of PAM with Cal/BD foam is maintained in patients with moderate-to-severe psoriasis, with no new safety signals.
Journal of the American Association of Nurse Practitioners, 2018
There is a need for new treatment options for moderate-to-severe atopic dermatitis (AD) in adults... more There is a need for new treatment options for moderate-to-severe atopic dermatitis (AD) in adults. Dupilumab, a fully human anti-interleukin-4 receptor α monoclonal antibody, has recently been approved for this indication. A pooled analysis of a phase 2a (NCT01548404) and a phase 2b (NCT01859988) study and a subanalysis of the 2b study evaluated the efficacy and safety of subcutaneous dupilumab 300 mg once weekly (qw) and every 2 weeks (q2w) in adults with moderate-to-severe AD. Dupilumab significantly improved clinical outcomes in both analyses at week 12. Itch was significantly improved in the pooled analysis as measured by peak pruritus Numerical Rating Scale, 5-dimension pruritus scale, and SCORing Atopic Dermatitis (SCORAD) Visual Analog Scale (VAS) pruritus scores (all p < .0001 vs. placebo at week 12). Sleep loss was significantly improved (SCORAD VAS sleep loss score; p < .0001 vs. placebo at week 12); similar results were shown for the q2w dose. Dupilumab had an accep...
Journal of cosmetic and laser therapy : official publication of the European Society for Laser Dermatology, 2018
The market for home-use photobiomodulation devices to treat androgenetic alopecia has rapidly exp... more The market for home-use photobiomodulation devices to treat androgenetic alopecia has rapidly expanded, and the Food and Drug Administration (FDA) has recently cleared many devices for this purpose. Patients increasingly seek the advice of dermatologists regarding the safety and efficacy of these hair loss treatments. The purpose of this guide was threefold: (1) to identify all home-use photobiomodulation therapy devices with FDA-clearance for treatment of androgenetic alopecia; (2) to review device design, features and existing clinical evidence; and (3) to discuss practical considerations of photobiomodulation therapy, including patient suitability, treatment goals, safety, and device selection. A search of the FDA 510(k) Premarket Notification database was conducted using product code "OAP" to identify all home-use devices that are FDA-cleared to treat androgenetic alopecia. Thirteen commercially available devices were identified and compared. Devices varied in shape, w...
Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.], Jan 20, 2017
Hyaluronic acid (HA) dermal fillers are frequently used to correct or smooth facial wrinkles and ... more Hyaluronic acid (HA) dermal fillers are frequently used to correct or smooth facial wrinkles and folds such as nasolabial folds. To compare the efficacy and safety of 2 HA gels, formulated by 2 different manufacturing processes: XpresHAn Technology (HARRL [with lidocaine]) and Hylacross technology (HAJU-a comparator product without lidocaine). One hundred seventy subjects with bilateral nasolabial folds rated as moderate or severe, according to the Wrinkle Severity Rating Scale (WSRS), received injections of HARRL in the nasolabial folds on one side of the face and HAJU on the other side. Investigator- and subject-assessed wrinkle severity was measured up to 48 weeks after final injection. HARRL exhibited a similar safety and efficacy profile compared with HAJU. Noninferiority of HARRL was demonstrated at 24 weeks (WSRS mean change from baseline mean difference -0.1 [95% confidence interval: -0.15, 0.01], p = .090). Incidence of adverse events was 40% for both treatments. HARRL exhi...
Cellulite is a metabolic condition, predominately seen in females, that affects the subcutaneous ... more Cellulite is a metabolic condition, predominately seen in females, that affects the subcutaneous tissue of the posterolateral thighs, buttocks, pelvic region, and abdomen. It is characterized by skin dimpling and lumpiness resembling an orange peel. Despite the wide range of treatment options for patients with cellulite, there is a paucity of empirical data supporting their efficacy. The objective of this study was to evaluate the efficacy of a new-generation multipolar radiofrequency (RF) device for the treatment of cellulite. A multipolar RF device with pulsed magnetic fields was used to treat abdominal cellulite. Twenty-five healthy adult females with stage II or stage III abdominal cellulite underwent 8 weekly treatments. Assessments were performed at baseline and at weeks 1, 4, and 12 following the final treatment. Reduction in subcutaneous thickness in the axial and sagittal plane of the abdomen was observed at 1 week following treatment initiation. Results from self-reported questionnaires revealed a significantly high level of patient satisfaction (60%). Assessments by a blinded investigator at one, four, and twelve weeks after the final treatment demonstrated a significant improvement in cellulite appearance. No adverse effects were reported and the treatment was well tolerated. This study demonstrates the safety, efficacy, and subject satisfaction of multipolar RF with pulsed magnetic field therapy in the treatment of abdominal cellulite.
International Journal of Women's Dermatology, 2016
Physiologic changes in a woman's life, such as childbirth, weight fluctuations, and hormonal chan... more Physiologic changes in a woman's life, such as childbirth, weight fluctuations, and hormonal changes due to aging and menopause, may alter the laxity of the vaginal canal, damage the pelvic floor, and devitalize the mucosal tone of the vaginal wall. These events often lead to the development of genitourinary conditions such as stress urinary incontinence; vaginal atrophy; dryness; and physiologic distress affecting a woman's quality of life, self-confidence, and sexuality. Various treatment modalities are currently available to manage these indications, varying from invasive vaginal surgery to more benign treatments like topical vaginal hormonal gels or hormone-replacement therapy. A new trend gaining momentum is the advent of energy-based devices for vaginal rejuvenation that apply thermal or nonthermal energy to the various layers of the vaginal tissue, stimulating collagen regeneration contracture of elastin fibers, neovascularization, and improved vaginal lubrication. This review aims to present the available technologies offering vaginal rejuvenation and the scientific evidence that underlines their safety and efficacy for this indication.
Background: A distinct trend in aesthetic medicine is the patient's demand for efficient, noninva... more Background: A distinct trend in aesthetic medicine is the patient's demand for efficient, noninvasive treatments with no downtime. Ongoing with this, these so-called lunchtime procedures are expected to be as safe and painless as possible. A new technique based on a combination of radiofrequency (RF) and pulsed electromagnetic fields (PEMF) was recently introduced and is supposed to be effective in the treatment of facial wrinkles and virtually pain free. The objective of this study was to investigate the safety and efficacy of this technology for the treatment of facial rhytides. Methods: Thirty-one subjects with facial wrinkles and rhytides were entered into this study. Every subject received 10 treatments of the face with a device that combines 1 MHz radiofrequency with PEMF with a flux of 15 gauss. Patients rated the pain level immediately after the treatment by using a visual analog scale (VAS) for pain. Side effects were recorded at every visit. The study's efficacy end point was evaluated by 2 blinded physicians who rated the standardized pictures from baseline and 3-month follow-up using the Fitzpatrick Wrinkle and Elastosis Scale (FWES). Results: No unexpected adverse side effects were detected or reported for the duration of the study. Both raters recognized improvements of at least 1 grade on the FWES in 30 of 31 subjects (97%). The score decreased from 5.2 before the first treatment to 3.6 at 3 months after the last treatment. Furthermore, all patients rated the treatment to be free of pain on the VAS pain scale. Conclusion: The results of this study show that the combination of multipolar RF with PEMF is a safe, effective, and painless approach to treat facial rhytides and is suitable to answer the demands of patients for safe treatments without pain or downtime.
After more than 25 years of research and development, in October 2006 ArteFill Ò became the first... more After more than 25 years of research and development, in October 2006 ArteFill Ò became the first and only permanent injectable wrinkle filler to receive FDA approval. ArteFill is a third-generation polymeric microsphere-based filler, following its predecessor Artecoll Ò , which was marketed outside the United States between 1994 and 2006. ArteFill is approved for the correction of nasolabial folds and has been used in over 15,000 patients since its U.S. market introduction in February 2007. No serious side effects have been reported to date according to the FDA's MAUDE reporting database. Ar-teFill consists of polymethylmethacrylate (PMMA) microspheres (20% by volume), 30-50 lm in diameter, suspended in 3.5% bovine collagen solution (80% by volume) and 0.3% lidocaine. The collagen carrier is absorbed within 1 month after injection and completely replaced by the patient's own connective tissue within 3 months. Each cc of ArteFill contains approximately six million microspheres and histological studies have shown that long-term wrinkle correction consists of 80% of the patient's own connective tissue and 20% microspheres. The standard injection technique is subdermal tunneling that delivers a strand of ArteFill at the dermal-subdermal junction. This strand beneath a wrinkle or fold acts like a support structure that protects against further wrinkling and allows the diminished thickness of the dermis to recover to its original thickness. Keywords ArteFill Á Dermal filler Á Permanent filler Á Soft tissue augmentation Á Wrinkle treatment The first commercially successful, FDA-approved injectable filler for soft tissue augmentation was a solution of soluble collagen [1, 2] marketed by Collagen Corporation in 1983. Until then, the only widely used ''off-the-shelf'' injectable filler had been liquid dimethylpolysiloxane (silicone). Complications from liquid silicone (LIS), however, were often disfiguring and challenging to correct. Collagen injections, on the other hand, were never held out as permanent corrective devices for the treatment of soft tissue defects, whether scar depressions, atrophy, or wrinkle lines. The corollary mantras ''temporary solution, but temporary problems'' (if an adverse event should occur), and ''permanent solution, permanent problems'' were associated with collagen and silicone, respectively. However, although both patients and physicians accepted the inconvenience and repeated expense of short-term fillers, they have long sought a dermal filler substance that
The successful treatment of acne still remains problematic. Conventional therapies often prove in... more The successful treatment of acne still remains problematic. Conventional therapies often prove inconsistent with unacceptable side effects and recurrence rates, leading to patient noncompliance. A thermal phototherapy treatment using a combination of blue light and red light has recently attracted much attention and seems to offer an effective alternative. The objective of this study was to evaluate the efficacy of blue light (415 nm) in combination with red light (633 nm) in the reduction of inflammatory lesions on the face of subjects (n=21) with mild to moderate acne vulgaris after a course of 8 20-minute (blue) or 30-minute (red) alternated light treatments, self-administered by a handheld unit over a period of 4 weeks. Lesion counts progressively reduced throughout the 4-week light therapy period and continued to reduce up to 8 weeks posttherapy, with a final average reduction of 69% seen 8 weeks after the treatment course (P&amp;amp;amp;amp;amp;amp;gt;.001). This pattern is similar to previously reported studies.
Female pattern hair loss affects many women; its pathogenetic basis has been held to be similar t... more Female pattern hair loss affects many women; its pathogenetic basis has been held to be similar to men with common baldness. The objective of this study was to determine the role of immunity and inflammation in androgenetic alopecia in women and modulate therapy according to inflammatory and immunoreactant profiles. 52 women with androgenetic alopecia (AA) underwent scalp biopsies for routine light microscopic assessment and direct immunofluroescent studies. In 18 patients, serologic assessment for antibodies to androgen receptor, estrogen receptor and cytokeratin 15 was conducted. A lymphocytic folliculitis targeting the bulge epithelium was observed in many cases. Thirty-three of 52 female patients had significant deposits of IgM within the epidermal basement membrane zone typically accompanied by components of complement activation. The severity of changes light microscopically were more apparent in the positive immunoreactant group. Biopsies from men with androgenetic alopecia showed a similar pattern of inflammation and immunoreactant deposition. Serologic assessment for antibodies to androgen receptor, estrogen receptor or cytokeratin 15 were negative. Combined modality therapy with minocycline and topical steroids along with red light produced consistent good results in the positive immunoreactant group compared to the negative immunoreactant group. A lymphocytic microfolliculitis targeting the bulge epithelium along with deposits of epithelial basement membrane zone immunoreactants are frequent findings in androgenetic alopecia and could point toward an immunologically driven trigger. Cases showing a positive immunoreactant profile respond well to combined modality therapy compared to those with a negative result.
The Journal of Dermatologic Surgery and Oncology, Oct 1, 1989
A technique of alopecia reduction utilizing a curvilinear ellipse employing a sequential excision... more A technique of alopecia reduction utilizing a curvilinear ellipse employing a sequential excision and suture technique is described. Advantages of the technique over previously described procedures are presented. Measurements of individual scalp elasticity and alternating suture tension vectors help to produce an excellent cosmetic result with minimal complications.
To determine whether autologously transferred human adipose tissue maintains viability in vivo fo... more To determine whether autologously transferred human adipose tissue maintains viability in vivo for prolonged periods. Design: Six healthy female patients (mean age, 61.5 years; mean body mass index, 23.4 kg/m 2) received autologous fat transplants from the gluteus to the nasolabial folds. Subcutaneous fat was sampled from facial and gluteal sites 4 times in 1 year.
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Papers by Neil Sadick