To satisfy the public's quest for younger-looking skin, the marketplace for cosmetic procedures has expanded dramatically over the years, with little signs of slowing down. From new facial fillers that produce longer-lasting results to at-home treatments that can temporarily remove unwanted hair, the average consumer now has many choices when it comes to improving their appearance. However, this trend also has created an influx of unqualified practitioners lacking the training and expertise of dermatologists and skin care professionals who understand the science behind these cosmetic procedures and their effects on the skin. This can put patient safety at risk.
Speaking at the American Academy of Dermatology’s academy, dermatologist Ranella J. Hirsch, MD, FAAD, clinical assistant professor of dermatology at Boston University School of Medicine in Boston, discussed how new technology and products entering the growing market of cosmetic procedures are enhancing dermatologists’ ability to fine-tune treatments and the pros and cons of at-home cosmetic procedures.
Professionals select safest solutions
Advances in the use of fillers, lasers and botulinum rejuvenation are allowing dermatologists and skin care professionals to better refine treatments based on each patient’s specific cosmetic needs. Dr. Hirsch credits the influx of new technologies and products in these areas as the reason behind the expanded treatment options for patients.
“The biggest news in cosmetic procedures is the number of new products in the pipeline that allow us to truly customize and refine treatments for the individual patient,” said Dr. Hirsch. “Dermatologists are now in a position to be able to offer patients very specific solutions to each of their skin concerns.”
For example, the technology behind lasers and other light sources, which is the cornerstone of many skin rejuvenation procedures, is continually evolving. Fractional resurfacing is one of the newer laser technologies that gives dermatologists the option to safely treat patients with more extensive skin damage. Dr. Hirsch noted that the main benefits of fractional resurfacing are increased collagen production that creates more dramatic results to improve the appearance of skin texture and reduce the appearance of wrinkles and acne scars, doing so with considerably less downtime than other older invasive laser technologies.
In addition, laser technologies used to treat vascular lesions, such as port-wine stains and other birthmarks, have greatly improved over the years. This allows more patients to benefit from treatment, especially infants. For example, the pulsed dye laser selectively heats abnormal blood vessels within the port-wine stain without injuring the surrounding skin.
“It is simply best practice for a dermatologist trained in laser technologies to determine if a patient’s birthmark is conducive to treatment and how early and aggressive the intervention should be,” added Dr. Hirsch.
A number of new fillers have been introduced in recent years to replace lost volume in the skin and to shape and sculpt areas that show signs of aging. Where once natural collagen was the only filler available, now the advent of synthetic collagens, several hyaluronic acids, L-polylactic acid, and calcium hydroxyapatite allow dermatologists to correct signs of aging from sunken cheeks to fine lines around the eyes and lips.
“Fillers represent the most visible area of cosmetic procedures where new products have really expanded the menu of choices available for very specific skin problems,” said Dr. Hirsch. “Different kinds of fillers can address specific kinds of facial lines, specific kinds of aging and shaping of the face.”
Botulinum toxin, most widely known for its ability to diminish wrinkles and other facial lines, currently is being studied across many medical specialties for an array of different conditions. For example, one manufacturer is seeking FDA approval of using botulinum toxin to treat migraines. Dr. Hirsch explained that a few new manufacturers have introduced botulinum toxin formulations in recent years. This helps patients by making pricing more competitive and, hence, more affordable.
“The important thing to remember with any of these cosmetic procedures is that you have to be sure that what you’re choosing is the real McCoy—authentic and trustworthy.” cautioned Dr. Hirsch. “Unless you go to a dermatologist specifically trained in cosmetic procedures, you cannot be sure you are receiving the highest quality care—and in the case of botulinum rejuvenation, the safe dosage and manufacturer-specific formulation.”
For some consumers, the “do-it-yourself” cosmetic treatments that can be performed at home represent a viable alternative for those looking for a quick, albeit temporary, remedy. Many of the at-home products such as microdermabrasion kits and chemical peel solutions that can be purchased at drug stores can be safe when they have been thoroughly tested for this type of self-use. To ensure the highest level of safety, the concentration of the active ingredients in these products is much lower than that used by dermatologists and skin care professionals.
However, Dr. Hirsch pointed out that there are drawbacks to at-home treatments of which consumers should be aware. While most at-home treatments do not produce results as dramatic or long-lasting as the cosmetic procedures performed in dermatologists’ offices or skin care professionals' facilities, there are still safety concerns if these are used improperly or if any of the active ingredients cause an unforeseen skin reaction.
“It is important for consumers considering any at-home cosmetic treatments to first discuss these products with their dermatologist,” advised Dr. Hirsch. “For example, a person using a retinoid could be at risk for an adverse skin reaction from a chemical in these at-home products that should not be used simultaneously.”
Perhaps the most sought after new at-home cosmetic procedure that has been introduced recently is in the realm of laser hair removal devices. Unlike the laser hair removal procedures performed in dermatologists’ offices and which offer a long-term solution to unwanted facial and body hair, laser hair removal performed at home is intentionally temporary. Despite giving consumers only a temporary remedy for unwanted hair, Dr. Hirsch added that these types of devices can be expensive, ranging in price from approximately $800–1,000. These devices also can pose a safety concern for people who are tan or have darker skin.
The concern for people using an at-home laser hair removal device or for those opting to receive cosmetic treatments outside of a dermatologist’s office, such as at a spa or mall-based establishment, is that many factors could adversely affect the outcome of the procedure and pose unforeseen side effects.
“Knowing who not to treat is extremely important, and that is why consumers should remain highly skeptical of cosmetic procedures offered at local malls or venues where packages of treatments are sold,” said Dr. Hirsch. “In these cases, there is no motivation to turn anyone away, and the consequences could be very serious. To ensure the highest level of safety and efficacy, see your dermatologist or skin care professional for all your skin care needs.”
For more information on aging skin, go to the "AgingSkinNet" section of www.skincarephysicians.com, a Web site developed by dermatologists that provides patients with up-to-date information on the treatment and management of disorders of the skin, hair and nails.
Note: treatments that a licensed esthetician may perform in a medical spa space vary by state. Please consult with your state board before adopting or performing any unfamiliar treatment.