Kyle M. Coleman

The Efficacy of EMLA versus ELA‐Max for Pain Relief in Medium‐Depth Chemical Peeling: A Clinical and Histopathologic Evaluation

Background. Medium‐depth chemical peels are an effective and popular treatment for actinic damage, fine wrinkles, and pigmentary dyschromias. However, they are also uncomfortable. A previous attempt to study the effectiveness of a topical anesthetic gel in 35% trichloroacetic acid (TCA) peeling found a reduction in discomfort but an increased depth of penetration and delayed healing. Objective. To evaluate both the efficacy of two topical anesthetic agents in medium‐depth combination peeling as well as the histologic result from chemical peeling combined with topical anesthesia. Method. Seventy percent glycolic acid (GA) was applied to the entire face of 10 patients and diluted with water after 2 minutes. This was followed by the sequential application of EMLA cream (lidocaine 2.5% and prilocaine 2.5%), ELA‐Max cream (lidocaine 4%), and placebo to selected areas on the face for 30 minutes without occlusion. These agents were then removed and 35% TCA was applied to the entire face. The level of discomfort felt by the patients during the TCA peel was recorded, clinical photographs were taken, and bilateral preauricular biopsies were performed at baseline, 48 hours, and 90 days postoperatively. Results. Clinically there was a statistically significant decrease in pain felt during the 70% GA‐35% TCA peel with topical anesthesia when compared to the control. There was no statistically significant difference in efficacy between EMLA and ELA‐Max. There was also no difference in either the clinical or the histopathologic appearance between the medium‐depth peel combined with topical anesthesia and the medium‐depth peel with control. Conclusion. Both EMLA and ELA‐Max decrease the discomfort felt during medium‐depth combination chemical peeling without influencing either the clinical or the histopathologic result.

Non-Invasive, External Ultrasonic Lipolysis

Numerous nonsurgical techniques and devices have sought to reproduce the effectiveness of liposuction. Unfortunately, the vast majority of these has fallen short of adequate results or has been plagued with complications. UltraShape (UltraShape; Yoqneam, Israel) is a device that is able to accomplish the reduction of the subcutaneous fat with a procedure that is both comfortable and leads to good patient satisfaction. Its design of a nonthermal ultrasonic energy is able to produce cavitation leading to fat cell lysis while sparing adjacent blood vessels and nerves. Although the results are not equivalent to surgical results, this device will offer a safe and effective alternative for patients who are apprehensive about undergoing liposuction.

Neocollagenesis after Injection of Calcium Hydroxylapatite Composition in a Canine Model

The ability of soft tissue fillers to induce neocollagenesis is a concept emerging in importance in predicting longevity of filler injections. Over the past three decades, an increased demand for skin rejuvenation and wrinkle correction has led to the development of a diverse set of cosmetic skin fillers. With recent evidence showing that hyaluronic acid filler can lead to fibroblast cell changes indicative of possible endogenous production of collagen, it is important to see if similar responses are found with different fillers. Investigators sought to determine if injection of Radiesse (calcium hydroxylapatite; BioForm Medical Inc., San Mateo, CA) can lead to neocollagenesis over time in a canine model.

Special Issue: Deoxycholic Acid Injection Treatment for Reduction of Submental Fat

The introduction of an FDA-approved and Health Canada–approved nonsurgical injection treatment option has opened the treatment doors to many subjects who would otherwise have remained frustrated as they did not wish to undergo surgery. The patients are all very busy with family, work, and social commitments and appreciate the limited downtime as well as the excellent effect and safety of this new injection procedure.

Combination Therapy for Rejuvenation of the Outer Thigh and Buttock: A Review and Our Experience.

BACKGROUND Combination therapies are becoming more popular as a multifaceted approach to treating common aesthetic conditions. OBJECTIVE Often, the use of multiple techniques and modalities can lead to improved outcomes; however, there is a lack of current evidence on the use of combination therapies in the literature. METHODS AND MATERIALS With the recent expansion of minimally and noninvasive options for treatment of the outer thigh and buttock, it is important to understand how these techniques can be used together while avoiding increased risk. RESULTS AND CONCLUSIONS This review of current available therapeutic options for treatment of the outer thigh and buttock emphasizes current available literature and author experiences.