This week in aesthetics, Jill Waibel, MD, discusses lasers for scars and keloids, Dustin Portela, DO, and medical aesthetician, Cassandra Bankson, react to cystic acne TikToks in this week’s “Pointers With Dr Portela”, and a study examines how non-prescription skin care regimens improve hyperpigmentation.

Jill Waibel, MD, discusses her recommendations on how to treat keloids and scaring using lasers in her presentation at the Skin of Color Update 2021.

Pointers With Dr Portela: Reacting to Cystic Acne with Cassandra Bankson

In this week’s Pointers with Dr Portela, the 208SkinDoc and Cassandra Bankson, a medical aesthetician and skin advocate, react to cystic acne TikToks and offer commentary.

Novel, Non-Prescription Regimen Improves Hyperpigmentation

A cosmetic topical brightener serum combined with a dual antioxidant system show promise in treating moderate to severe hyperpigmentation in skin of color patients.

Articles

This week in aesthetics, we highlight this week’s “Pointers With Dr Portela”, laser therapy for scars and keloids, and more. 

This Week in Aesthetics: September 20-24 

A combination treatment regimen that includes a cosmetic brightener, dual antioxidant system, facial cleanser, sunscreen, and moisturizer could provide a new solution for moderate to severe facial hyperpigmentation disorders in skin of color patients, according to a poster presented at the Skin of Color Update 2021, held virtually September 10-12.

“Hyperpigmentation disorders disproportionately affect individuals with skin of color,” wrote the authors. “These conditions are challenging to treat in patients with skin of color, and these disorders are often recalcitrant or relapsing and require continuous treatment.”

That poses an ongoing problem, they wrote. “The gold standard therapies containing hydroquinone (HQ) cannot be used for extended periods because of adverse effects [AEs],” they added. “Cosmetic topical therapies are in demand, but current options lack efficacy.”

In their view, “comprehensive treatment regimens are needed to adequately address hyperpigmentation.” The aim of their research was to evaluate the safety and efficacy of a comprehensive regimen that would include agents “that reduce melanogenesis or neutralize extrinsic stressors” when used together; a comprehensive HQ-free retinol-free cosmetic topical brightener (Lytera 2.0 (LYT2), SkinMedica) and a dual serum that provided antioxidant protection and skin repair support (Lumivive System (LVS), SkinMedica).

All of the patients enrolled in the open-label, single center study (n=13) were Asian (38.5%), Hispanic/Other (38.5%) or African American (23.0%). To be eligible to participate, individuals had to have been investigator-assessed as having moderate to severe overall facial hyperpigmentation which was defined as a score of 4-9 on the modified Griffiths scale, according to the authors. Women could not be pregnant or nursing.

Of the study participants, 12 were women, and the mean age was 44 years. Data showed that 23% were Fitzpatrick Skin Type III; 39%, Type IV; 23%, Type V and 15%, Type VI. The study authors evaluated the following treatment regimen:

LVS Day and Night serum used each once daily

Facial Cleanser (SkinMedica) used twice daily

Broad-spectrum SPF 35 sunscreen (SkinMedica) used once daily, reapplied as needed

Ultra Sheer Moisturizer (SkinMedica) used twice daily

Standardized Digital Photography(Canfield VISIA-CR) and investigator assessments evaluated overall hyperpigmentation, skin tone evenness and radiance were assessed at study visits at baseline, week 2, week 4, week 8, and week 12.

“Significant” changes in skin-tone evenness and radiance were observed as early as week 4 and, according to the authors, continued through the end of the study. Results of those assessments showed “significant improvements” versus baselines for all parameters by week 12.

Results for self-assessed efficacy at 12 weeks revealed 100% of the 10 subjects who completed the study agreed the regimen had improved the overall appearance of their skin; improved their skin’s tone, brightness, youthful appearance, condition and feel.

One AE was reported, with 1 patient reported experiencing irritation and stinging. Symptoms resolved when the subject discontinued the treatment. This patient withdrew.

Study results show that the LYT2+LVS regimen was well tolerated, generated high patient-perceived efficacy and overall satisfaction. The regimen may be a good choice for patients with skin of color who want to improve hyperpigmentation and skin quality.

Desai SR; Manry S; Makino E; Mehta R. The efficacy and tolerability of a comprehensive brightening serum plus a dual antioxidant system in skin of color patients with moderate to severe hyperpigmentation. Poster presented at: Skin of Color Update 2021; September 10-12, 2021. Virtual.

Dustin Portela, DO, a board-certified dermatologist and dermatologic surgeon at Treasure Valley Dermatology in Boise, Idaho, and aesthetician and YouTube personality, Cassandra Banks, react to viral TikTok’s detailing one woman’s cystic acne journey.

While watching the TikToks, the duo reacts to DIY treatments, the emotional burden of acne, and differences in prescription acne medications. Additionally, Bankson shares her personal story with severe cystic acne and her experience as a medical aesthetician treating acne patients, along with educating her viewers online about the condition.

Watch the video below for more video commentary and acne treatment opinions.

Opinions expressed are that of Portela and do not express the views or opinions of 

Jill Waibel, MD, presented at the Skin of Color Update, held virtual September 10-12 on lasers and their uses for both scar and keloid treatment.

 Waibel is medical director and owner, Miami Dermatology and Laser Institute, subsection chief of dermatology, Baptist Hospital, medical director, Multidisciplinary Skin Cancer Clinic, Miami Cancer Institute, all in Miami Florida and 

She explained that scar formation is affected by the level of wound trauma, personal genetics, and location of scar. Keloids tend to form in the same location multiple times due to tension; however, Waibel said that the issue could be deeper than what it seems.

Although it is usually used for wrinkles, ablative fraction laser (AFL), according to Waibel, was the laser that changed the treatment world for scars. She says combination treatment is needed when choosing an approach, but the scar type determines the different combination therapies to use.

“The one thing that I almost always do with every scar patient I treat and every keloid patient I treat is laser assisted drug delivery,” Waibel said. She expanded on this, noting that when using a fractional ablative laser, columns open on the skin and these holes are open for about 48 hours. She said, most research suggests a physicians can inject FDA approved medication into a scar. Previously when she treated triplets, Waibel injected 1 of the triplets, resulting in the 1 patient healing 60% better than her other 2 sisters.

When treating hyperpigmentation, Waibel uses 1927 nm laser and AFL for treatment. For hypopigmentation, which she said is tough to treat, she said she can use a multitude of solutions, like a nonAFL (NAFL), AFL, AFL and bimatoprost, and CelluTome (KCI). When she uses bimatoprost, which is FDA approved to treat glaucoma, she injects immediately after the laser treatment then twice a day for a week, which repigments the skin.

For atrophic scars, the dermal depressions occur after a loss of dermal collagen and can represent a reconstruction challenge. Waibel’s solution is AFL with an after topical treatment of poly-L-lactic acid (PLLA) for both deep atrophic and thin skin atrophic scars. She reminds her patients that it does take 3 to 6 months for collagen remodeling.

For post inflammatory erythema (PIE) and post inflammatory hyperpigmentation (PIH), which she stated comes from acne which must be treated first. She treated a patient with a pulse dye laser, and while some inflammation remained, it stopped the spread.

When it comes to excessive scaring such as those created after surgery, the etiologies include location, hormones, genetics, chronic inflammation (acne), tension wound borders, and delayed epithelization. Waibel believes if a scar is less than 6 months old, it can be prevented, and they have to be treated gently and she tends to only use NAFL, and it works on all skin types.

For keloids, as the knowledge is still growing on how to treat them, Waibel explained that she never tells a patient it won’t come back after treatment. When treating keloids, she shaves off the keloid and then uses a laser, but never sutures as, in her experience, it makes the keloid come back worse than before. She uses is fractional laser and if the patient has not had surgery in that area before, she applies triamcinolone acetonide 10 mg. Waibel does not use a higher dose as it runs a risk of hyperpigmentation.

For burn and trauma scars, she can use multiple lasers. For a burn patient Waibel had, she used a 1550 nm laser and a 1927 nm NAFL and within 2 sessions the scarring looked more even. When doing these treatments, she works closely with reconstructive surgeons as they can work together to create the best treatment for the patient.

Not only cosmetic improvement can be made, but motion improvement can also be made according to Waibel and to keep in mind symptoms are sometimes what brings a patient in. She also learned that scars may be deeper than expected and have different depths are different levels.

“We have seen that the sooner you treat scars, and this is all scars, they melt away,” Waibel said. She stated laser treatments have a major role in trauma rehabilitation and give the physician power to heal patients and help alleviate suffering.

Jill Waibel, MD, has done clinical trials for AbbVie, ArgenX, Cytrellis, Eli Lilly and Company, Lumenis, Lutronics, Michelson Diagnostics, Novartis, Pfizer, RegenX, Sciton, Syneron/Candela, and UCB. She has been on advisory boards for Cytrellis, Dominion Aesthetic Technologies, Sciton. A speaker for Eli Lilly and Company, Loreal, Novartis, and Syneron/Candela. Equipment from Michelson Diagnostics. She also discusses FDA off label uses.

1. Waibel. J. Lasers As First Line of Therapy for Keloids and Other Scars - Pearls from the Expert. Presented at the: Skin of Color Update; September 10, 2021; Virtual.

Jill Waibel, MD, discusses her recommendations on how to treat keloids and scaring using lasers in her presentation at the Skin of Color Update 2021.  

Laser Therapy for Scars and Keloids

 details minimally invasive and nonsurgical treatments for forehead wrinkles, 

 highlights the beauty of being bald and losing eyelash hairs. 

Where Does Skincare Go After You Apply It?

How to Get Rid of Those Deep Forehead Wrinkles Once and For All 

What to Know About Microcurrent Facials, the Skincare Treatment All Over Your Instagram Feed

This week, consumer magazines highlight embracing the beauty of being bald, microcurrent facials, and more.  

The Beauty of Being Bald

This week in aesthetics, we dive into what products are trending for the month of September, a study examines 730-nm picosecond-domain laser for non-facial lentigines, in his most recent “Pointers With Dr Portela”, Dustin Portela, DO, ranks different pimple patches, and Dermala announces a patent for compositions and methods for preventing, slowing, and reversing skin aging.

What’s Trending in Skin Care? September 2021

Click here to find out what products are trending for the month of September.

Study: 730 nm Picosecond Laser for Treatment of Lentigines

A recent study delved into how well the 730 nm picosecond-domain laser could treat facial and non-facial lentigines in patients.

Pointers With Dr Portela: Battle of the Pimple Patches

This week’s Pointers With Dr Portela, Dustin Portela, DO, explains pimple patches and hydrocolloid patches, diving into how to treat acne when it surfaces.

Dermala is Granted Patent for Microbiome Anti-Aging

Dermala announces a patent for compositions and methods for preventing, slowing, and reversing skin aging.

This week in aesthetics, we highlight what's trending in skin care, 730 nm picosecond-domain laser for non-facial lentigines, and more.  