Differentiate between different types of Radiation Therapy used to treat NMSC

Recognize the side effectives of different types or Radiation Therapy

Identify the types of complications that can occur with fillers for soft-tissue augmentation

Incorporate treatment regimens for dermal filler complications

2023 Virtual Grand Rounds  Session 4: March 22, 2023 - SRT to Treat NMSC, Treating Filler Complications

Aesthetics

WEDNESDAY, May 17, 2023 -- Art Filler Volume (AFV), a hyaluronic acid-based filler formulated with a unique combination of three sizes of hyaluronic acid chains, produces midface volume restoration, which persists in some individuals for 540 days, according to a study published online May 2 in the Journal of Cosmetic Dermatology.Philippe Kestemont, M.D., from the MEDITI Center in Juan-les-pins, France, and colleagues conducted an open-label study to examine AFV efficacy and safety over 18 months when used to restore midface volume. A maximum of 1.8 mL AFV was injected into each cheek area on day 0. Individuals were assessed on day 21, when a retouch could be performed if necessary. Participants were followed up at seven visits through day 540.The researchers found that 25 of the 79 Caucasians enrolled required a second injection. There was a significant improvement observed in mean overall Medicis Midface Volume Scale (MMVS) scores from day 0 to day 21 and day 42 (3.2 ± 0.4 to 1.8 ± 0.6 and 1.7 ± 0.6) in the intention-to-treat population. For each cheek, there was also significant improvement in MMVS scores, regardless of retouch on day 21; persistent benefit on day 540 was seen for 22 percent of injections without retouch. Pain on palpitation, erythema, and edema were the most common adverse events (19, 15, and 13 percent, respectively); most events were mild or moderate and resolved within two weeks."AFV shows a sustained objective and subjective benefit that persists in some subjects for at least 18 months, often without retouching," the authors write. "The sustained improvement was consistent in both cheeks, and across multiple assessment methods, suggesting the findings are robust and clinically meaningful."Two authors are employees of Laboratories FILLMED, which supported the study.

Benefit persists for 540 days in some individuals, even without retouch

Hyaluronic Acid-Based Filler Produces Midface Volume Restoration

For mild-to-moderate thigh cellulite, collagenase clostridium histolyticum-aaes (CCH-aaes) is effective and generally well tolerated, according to a study published in the January issue of the
 
 Journal of Cosmetic Dermatology
 
 .




 John H. Joseph, M.D., a plastic surgeon in private practice in Encino, California, and colleagues analyzed data from a phase 3, open-label study involving women with mild-to-moderate cellulite on both thighs. Participants received ≤0.84 mg CCH-aaes subcutaneously in up to 12 dimples per posterolateral thigh in up to three treatment sessions on days 1, 22, and 43. The interim analysis included follow-up on day 90 for 22 women (44 thighs).




 The researchers found that the percentage of responders (score of "improved" or better on the Investigator Global Aesthetic Improvement Scale) at day 90 was 86.4 percent for either thigh and 72.7 percent for both thighs. At day 90, there was a reduction noted in patient-reported bother due to cellulite (mean change, 15.3 points [85.5 percent reduction] in the BODY-Q Appraisal of Cellulite Scale total score). In some of the treated thigh areas, there was improvement from baseline in skin roughness seen on day 90 three-dimensional image scans. Injection-site bruising and pain were the most commonly reported adverse events.




 "These data support that CCH-aaes treatment is effective, markedly reduces cellulite-related bother, and is generally well tolerated for the treatment of mild-to-moderate thigh cellulite," the authors write.




 Several authors disclosed financial ties to Endo Pharmaceuticals, which manufactures CCH-aaes and funded the study.




 <a class="rm-stats-tracked" href="https://onlinelibrary.wiley.com/doi/10.1111/jocd.15451" target="_blank">
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CCH-aaes found to be effective and well tolerated for thigh cellulite, with reduction seen in patient-reported bother due to cellulite

Is Collagenase Clostridium Histolyticum-aaes Effective for Thigh Cellulite?

Duplex ultrasonography (DUS) can be used to detect hyaluronic acid (HA) filler-causing intra-arterial obstruction, according to a study published in the January issue of the
 
 Journal of the American Academy of Dermatology
 
 .




 Noting that complications, including serious vascular events, occur with use of HA filler treatments, Leonie W. Schelke, M.D., from the Erasmus Medical Center in Rotterdam, Netherlands, and colleagues aimed to improve treatment outcomes after a vascular adverse event. Twenty-one patients, aged 18 years or older, were enrolled from July 2018 through May 2019. All patients underwent physical and DUS examination of the affected area on arrival at an outpatient clinic. The treating physician attempted to inject 35 to 50 units of hyaluronidase into the obstructing intravascular bolus of filler under ultrasonographic guidance.




 The researchers found that all 21 patients with a vascular adverse event due to HA fillers were treated with hyaluronidase injections that were guided ultrasonographically. After injection of hyaluronidase into the deposits responsible for the occlusion, blood flow was immediately restored. After restoration of blood flow, clinical improvement of the livedo reticularis aspect of the skin was noted. A second treatment session was performed within 24 hours of the initial treatment in seven patients.




 "The use of DUS for facial arterial mapping, safe deployment of HA, and directed low-dose hyaluronidase reversal of impending intravascular adverse events is a welcome technological advancement," the authors write.




 <a class="rm-stats-tracked" href="https://www.jaad.org/article/S0190-9622(19)32392-8/fulltext" target="_blank">
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Blood flow can be immediately restored following ultrasonographically guided hyaluronidase injections into deposits responsible for the occlusion

Can Duplex US Help to Reverse HA Filler-Causing Intra-Arterial Obstruction?

A single well-healed facial scar does not negatively affect first impressions of attractiveness, confidence, or friendliness, but specific scar location and orientation may result in lower perceived attractiveness, according to a study published in the December issue of
 
 Plastic and Reconstructive Surgery
 
 .




 Zachary D. Zapatero, M.D., from the Children's Hospital of Philadelphia, and colleagues recruited adult volunteers to complete a face rating scale to examine how facial scars are perceived. For each face, scars were added digitally in different locations and orientations for a total of 14 unique scars. Fifty different faces were rated on confidence, friendliness, and attractiveness by each participant.




 A total of 88,850 ratings (93.4 percent scarred) were analyzed for attractiveness, friendliness, and confidence. The researchers found that the presence of a facial scar did not significantly impact attractiveness in a univariate linear mixed effects model. Interactions between location, subunit placement, and orientation to facial tension lines were examined in a second set of linear mixed effects models. Scars that were located on the lower lid mid subunit perpendicular to facial tension lines were rated as less attractive.




 "Contrary to our predictions, we found that a single well-healed scar generally does not affect individuals' first impressions of perceived attractiveness or confidence negatively and may even increase perceived friendliness," a coauthor said in a statement.




 <a class="rm-stats-tracked" href="https://journals.lww.com/plasreconsurg/Fulltext/2022/12000/Facial_Scars__Do_Position_and_Orientation_Matter_.13.aspx" target="_blank">
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However, scar located on lower lid mid subunit perpendicular to facial tension lines was rated as less attractive

Facial Scars Do Not Affect Perceived Attractiveness, Confidence

Hyaluronic acid lip filler products differ in terms of outcomes, but no product is superior in all outcome categories, according to a research letter published online Nov. 9 in the
 
 Journal of the American Academy of Dermatology
 
 .




 Serge A. Steenen, M.D., from the University of Amsterdam, and colleagues conducted a multicenter randomized clinical trial involving 143 women who requested lip augmentation. Participants were randomly assigned to receive Juvéderm Ultra 3, Belotero Intense, Restylane Kysse, or Stylage M brands in a 1:1:1:1 ratio. Outcomes were assessed at baseline, day 14, and follow-up (week 13).




 The researchers found that from baseline to follow-up, there was an overall increase in lip height ( 18.9 percent), with more of an increase for Stylage than Juvéderm ( 26.3 versus 10.9 percent). From baseline to follow-up, appearance appraisal increased overall ( 40.7 percent), with more of an increase for Juvéderm than Belotero ( 50.7 versus 29.8 percent). There were no serious adverse events reported. From baseline to follow-up, increases were seen in social function ( 9.8 percent) and psychological well-being ( 8.7 percent) scores. A greater increase in social function was seen with Stylage than Belotero ( 11.0 versus 6.3 percent). Lip height increased from baseline to day 14 checkup ( 34.4 percent), with more of an increase for Belotero than Juvéderm and Stylage ( 41.3 percent versus 27.7 and 31.1 percent, respectively). Higher side effect scores were seen for Juvéderm than Stylage.




 "Statistically significant but clinically arguably relevant superiority was found with regard to duration, patient satisfaction, and quality of life," the authors write. "No product was superior in all categories."




 <a class="rm-stats-tracked" href="https://www.jaad.org/article/S0190-9622(22)02998-X/fulltext" target="_blank">
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No one product is superior for all categories; more of an increase seen in lip heig

How Do Lip Filler Products Differ in Terms of Outcomes?

Hyaluronic acid fillers with mepivacaine or lidocaine are equally effective for pain reduction during treatment, according to a study published in the October issue of
 
 Dermatologic Surgery
 
 .




 Noting that hyaluronic acid fillers incorporating lidocaine are usually used to maximize patient comfort during hyaluronic acid gel injection, Joely Kaufman-Janette, M.D., from the Skin Research Institute LLC in Coral Gables, Florida, and colleagues conducted two randomized, split-face trials to demonstrate the noninferiority of specific hyaluronic acid fillers incorporating mepivacaine (RHA-M) versus their lidocaine controls for pain relief. In each trial, 30 patients received injections of RHA
 
 R
 
 -M versus RHA
 
 R
 
 and RHA4-M versus RHA4 in the perioral rhytids (PR) and nasolabial folds (NLF).




 The researchers found that for reducing pain, RHA-M fillers were as effective as their lidocaine counterparts. In both the PR and NLF trials, bilateral wrinkle improvement was measured at one month; responder rates were virtually identical (≥96.7 percent). Between treated sides, the common treatment responses and adverse events were similar; none was clinically significant.




 "Regardless of the anesthetic agent, RHA
 
 R
 
 and RHA4 showed an excellent effectiveness and safety profile for the treatment of dynamic wrinkles and folds as per their respective indications while ensuring patient comfort and minimal injection pain," the authors write.




 Several authors disclosed financial ties to TEOXANE, which provided materials and funding for the study.




 <a class="rm-stats-tracked" href="https://journals.lww.com/dermatologicsurgery/pages/articleviewer.aspx?year=2022&amp;issue=10000&amp;article=00010&amp;type=Fulltext" target="_blank">
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Mepivacaine found to be noninferior versus lidocaine for pain relief and bilateral wrinkle improvement

Are Hyaluronic Acid Fillers With Mepivacaine, Lidocaine Equally Effective?

People wanting to keep wrinkles at bay will soon have a new option now that the U.S. Food and Drug Administration has
 <a class="rm-stats-tracked" href="https://www.fda.gov/drugs/new-drugs-fda-cders-new-molecular-entities-and-new-therapeutic-biological-products/novel-drug-approvals-2022" target="_blank">
 approved
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 the first competitor for Botox in decades.




 Daxxify, made by Revance Therapeutics Inc. in Nashville, Tennessee, is injected into the face along worry lines. It lasts longer than Botox, with about 80 percent of users seeing no or mild facial lines at four months after injection. For half of users, the treatment lasted six months, the company said in a
 <a class="rm-stats-tracked" href="https://investors.revance.com/news-releases/news-release-details/revance-announces-fda-approval-daxxifytm-daxibotulinumtoxina" target="_blank">
 statement
 </a>
 .




 "Users do not have to go once every three months," Balaji Prasad, M.D., who covers specialty pharmaceuticals as an analyst for Barclays Investment Bank, told
 
 The New York Times
 
 . "In a world where time is of the essence, having a product with a long duration factor is extremely useful."




 The new drug now enters the $3 billion field of facial injection drugs. It is also a neuromuscular blocking agent and a botulinum toxin, like AbbVie's Botox. "It also opens up the door for what we can do with therapeutics," Revance CEO Mark Foley, told
 
 The Times
 
 . "If you think of migraines, cervical dystonia, overactive bladder, there's a huge medical opportunity as well."




 The company has begun testing the drug on these other medical issues, Foley said. While the company had been trying to create a product that needed no needle, it instead discovered a way to use peptide technology to keep the product stable. Typically, animal protein or human serum is used.




 Users of Daxxify in the Revance studies included some who experienced side effects. About 2 percent of people developed a drooping eyelid, while about 6 percent experienced headache, the company said. Toxin-based treatment can carry the potential for other side effects, such as general muscle weakness or breathing difficulties, the FDA cautioned. Daxxify study participants showed none of those symptoms.




 <a class="rm-stats-tracked" href="https://www.nytimes.com/2022/09/08/health/wrinkle-drug-botox-daxxify-fda.html" target="_blank">
 
 The New York Times
 
 Article
 </a>








 <a href="https://consumer.healthday.com/u/physiciansbriefingstaff">
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Daxxify lasts longer than Botox, with about 80 percent of users seeing no or mild facial lines at four months after injection

FDA Approves Botox Competitor That Lasts Longer

Early Postoperative Microneedling May Improve Surgical Scars

Topical tretinoin precursors (TTP) do not appear to differ from tretinoin (RA) for treating moderate-to-severe facial photodamage, according to a study published online June 8 in
 
 JAMA Dermatology.
 




 Anna L. Chien, M.D., from the Johns Hopkins School of Medicine in Baltimore, and colleagues conducted a randomized, double-blind study involving 24 patients with moderate-to-severe facial photodamage. Participants were randomly assigned to receive daily topical application of RA or TTP formulation, containing retinol, retinyl acetate, and retinyl palmitate, for 24 weeks. The analysis included 20 White women (nine randomly assigned to TTP and 11 randomly assigned to RA).




 The researchers observed no significant difference in Griffiths photoaging scores at week 24 among those receiving TTP versus RA (median, 4 versus 5). TTP treatment was associated with erythema less frequently than RA (11 versus 64 percent). In a target gene analysis, significant
 
 CRABP2
 
 mRNA induction was seen, confirming retinoic acid receptor signaling, but there were no significant changes seen in procollagen I or
 
 MMP1/3/9
 
 mRNA in samples treated with TTP. However, TTP-treated samples had a significant reduction in
 
 MMP2
 
 mRNA, and there was a strong association for changes in
 
 MMP2
 
 with changes in fine wrinkles. Greater improvements were seen in patients with severe baseline wrinkles.




 "These results highlight the potential role that
 
 MMP2
 
 may play in mediating retinoid efficacy in photoaging," the authors write. "Larger studies with more diverse patients should be pursued to validate these findings in a broader population."




 Several authors disclosed financial ties to the biopharmaceutical industry, including SkinMedica, which funded the study.




 <a class="rm-stats-tracked" href="https://jamanetwork.com/journals/jamadermatology/fullarticle/2792866" target="_blank">
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MMP2 mRNA was significantly reduced in TTP-treated samples; changes in MMP2 were associated with changes in fine wrinkles

Tretinoin Precursors, Tretinoin Work Similarly for Facial Photodamage

Twelve companies have been issued warning letters about selling over-the-counter skin lightening products containing hydroquinone, the U.S. Food and Drug Administration announced Tuesday.




 The products are unapproved drugs that are not recognized as safe and effective, according to the FDA, which has received reports of serious side effects, including rashes, facial swelling, and skin discoloration that may be permanent. The FDA said consumers should not use these products due to the potential risks. Instead, they should talk to their health care provider about treatment options for certain skin conditions, including dark or age spots.




 There are no FDA-approved or otherwise legally marketed over-the-counter skin lightening products. Some manufacturers and distributors have already removed such products from the U.S. marketplace, and the FDA said it plans to take action against businesses that continue to market what it called "potentially harmful and illegal" products. The companies that received warning letters were told to immediately correct their violations. They were given 15 days to tell the FDA what actions they have taken to address violations and prevent them from happening again.




 Currently, a prescription product called Tri-Luma is the only FDA-approved therapy containing hydroquinone. Tri-Luma is approved for short-term treatment of dark spots associated with moderate-to-severe melasma (patchy brown discoloration) of the face. The FDA said Tri-Luma should only be used under the supervision of a licensed health care professional.




 Consumers or health care providers are asked to
 <a class="rm-stats-tracked" href="https://www.fda.gov/safety/medwatch-fda-safety-information-and-adverse-event-reporting-program" target="_blank">
 report
 </a>
 problems associated with over-the-counter skin lightening products to the FDA.




 <a class="rm-stats-tracked" href="https://www.fda.gov/drugs/drug-safety-and-availability/fda-works-protect-consumers-potentially-harmful-otc-skin-lightening-products" target="_blank">
 More Information
 </a>




 <a href="https://consumer.healthday.com/u/physiciansbriefingstaff">
 <img alt="HealthDay" src="https://assets.rbl.ms/23636171/origin.png" style="max-width: 150px;"/>
 </a>




 <a class="rm-stats-tracked" href="https://jamanetwork.com/journals/jamadermatology/article-abstract/2791589" target="_blank">
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There are no FDA-approved or otherwise legally marketed over-the-counter skin lightening products

FDA Warns 12 Companies About Skin Lightening Products

Botulinum toxin type A (BTXA) is effective for preventing and treating postoperative cleft lip and/or palate (CL/P) scar hypertrophy, according to a review published online March 29 in the
 
 Journal of Cosmetic Dermatology
 
 .




 Qiang Ji, M.D., from West China Hospital at Sichuan University in Chengdu, and colleagues conducted a systematic review and meta-analysis to examine the efficacy of BTXA for preventing and treating postoperative CL/P scars. Data were included from four randomized controlled trials, with 161 cases: 83 scars were treated with BTXA and 78 were treated with placebo.




 The researchers found that BTXA showed significant differences in preventing and treating postoperative CL/P scars in terms of scar width and the Visual Analog Scale (mean difference, –0.20 and 1.30, respectively); there were no significant between-group differences noted on the Vancouver Scar Scale.




 "The meta-analysis supports the use of BTXA for aesthetically pleasing scars following CL/P repair, as evidenced by our findings from four clinical trials," the authors write. "To provide more firm data, more high-quality randomized controlled trials for the treatment of CL/P scars with BTXA should be compared thoroughly."




 <a class="rm-stats-tracked" href="https://onlinelibrary.wiley.com/doi/10.1111/jocd.14941" target="_blank">
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 </a>

Review of four studies shows significant difference in terms of scar width and Visual Analog Scale for BTXA group

Is Botulinum Toxin Type A Effective for Postop Cleft Lip/Palate Scars?

The quality of YouTube videos related to aesthetic injectables is lower than that of websites, according to a study published in the March issue of
 
 Plastic and Reconstructive Surgery
 
 .




 Anooj A. Patel, from the Northwestern University Feinberg School of Medicine in Chicago, and colleagues assessed and compared the information quality of videos related to the two most performed aesthetic procedures -- botulinum toxin type A (Botox) and soft-tissue filler injections -- with that of websites. The most popular health information videos were identified by performing a YouTube search for "Botox" and "fillers" in July 2020. The quality was assessed, and quality scores were compared for different groups of video contributors and against websites.




 A total of 720 measurements of quality were performed across 95 YouTube videos and 85 websites. The researchers found mean quality scores of 1.74/4 for the
 
 Journal of the American Medical Association
 
 ; 6.66/16 for Health on the Net; 40.0/80 for DISCERN criteria; and 39.1/100 for content. Compared with patient-based videos, physician, nonphysician health professionals, and other (news, magazine channels, and influencers) videos were all of higher quality. The mean DISCERN percentage score was 50.04 for videos, which was significantly less than the 55.46 percent for websites. A similar result was seen for the mean content scores (39.06 versus 60.76).




 "Physicians should focus their online presence to video-based platforms, where the viewership may be larger, and seek to increase the quality of their content by using the criteria set forth by various health information quality instruments," the authors write.




 <a class="rm-stats-tracked" href="https://journals.lww.com/plasreconsurg/Fulltext/2022/03000/Websites_or_Videos__Which_Offer_Better_Information.11.aspx" target="_blank">
 Abstract/Full Text
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 <a href="https://consumer.healthday.com/u/physiciansbriefingstaff">
 <img alt="HealthDay" src="https://assets.rbl.ms/23636171/origin.png" style="max-width: 150px;"/>
 </a>

Physician, nonphysician health professionals, and other videos were all of higher quality than patient videos

YouTube Video Quality for Aesthetic Injectables Lower Than Quality of Websites

In Episode 23 of Derms and Conditions, our host James Q. Del Rosso, DO talks with Patricia Farris, MD who is in practice in Old Metairie, Louisiana. Dr. Farris talks about building a successful aesthetic dermatology practice, selling skincare products, and offers tips on office dynamics.

In Episode 23 of Derms and Conditions, our host James Q. Del Rosso, DO talks with Patricia Farris, MD who is in practice in Old Metairie, Louisiana. Dr. Farris begins the episode discussing tips on how to build a successful aesthetic dermatology practice. She also offers helpful tips on office dynamics. Dr. Del Rosso asks Dr. Farris to give some advice on how to sell skin care products in a clinical practice setting. The episode ends with Dr. Farris discussing important considerations when selling a dermatology practice to a private equity group.&nbsp; FINANCIAL DISCLOSURES:&nbsp; JAMES DEL ROSSO, DO: CONSULTANT/ADVISOR Abbvie, Aclaris, Almirall, Amgen, Arcutis, Bausch Health (Ortho Dermatology), BioFrontera, BioPharmX, Bristol-Myers-Squibb, Cassiopea, Dermata, Dermavant, Encore, EPI Health, Evommune, Ferndale, Galderma, Incyte, JEM Health, Leo Pharma, La Roche Posay, Lilly (Dermira), MC2, Novan, Pfizer, Regeneron, Sanofi-Genzyme, SolGel, Sonoma (IntraDerm), Sun Pharma, Trevi, UCB, Verrica, Vyne (Foamix; Menlo) SPEAKER BUREAU Aclaris, Almirall, Amgen, Arcutis, Bausch Health (Ortho Dermatology), EPI Health, Ferndale, Galderma, Genentech, JEM Health, Leo Pharma, La Roche Posay, Lilly (Dermira), Pfizer, Regeneron, Sanofi-Genzyme, Sun Pharma, UCB, Verrica, Vyne (Foamix; Menlo) RESEARCH INVESTIGATOR Aclaris, Almirall, Amgen, Anaptys Bio, Arcutis, Athenex, Bausch Health (Ortho Dermatology), BioPharmX, Biorasi, Botanix, Brickell, Cara Therapeutics, Cassiopea, Dermavant, EPI Health, Ferndale, Galderma, Incyte, Leo Pharma, Lilly (Dermira), Novan, Pfizer, Ralexar, Regeneron, SolGel, Sun Pharma, UCB, Verrica, Vyne (Foamix; Menlo).&nbsp; PATRICIA FARRIS, MD: Co-founder of RegimenMD and serves as a consultant and/or advisory board member for Neutrogena, Neostrata, Skinceuticals, Fig-1 Skincare, Nutraceutical Wellness, and U.SK Under Skin.

Derms and Conditions Podcast

What Type Of Practice Is Right For You?

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How do you combine thread lifts with hyaluronic acid fillers?

Do you recommend treating cheeks and tear trough with hyaluronic acid filler?

With how much NS do you reconstitute your Dysport?

How much normal saline do you use to reconstitute Dysport?

Which hypochlorous acid spray do you use?

How are noncompete agreements handled in dermatology practices?

Is there any basis to the concern about delayed nodules with the Voluma group of products?

Can you make a comment on rate of blindness in fat injections?

Gwyneth Paltrow is promoting Xeomin as a 'natural' Botox. In my 13 years, we mostly use Xeomin for people that are resistant to Botox or Dysport. Thoughts?

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2023 Virtual Grand Rounds Session 4: March 22, 2023 - SRT to Treat NMSC, Treating Filler Complications