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Nonablative and minimally ablative facial rejuvenation has become increasingly popular over the last several years. Patients desire less invasive cosmetic procedures with maximal effect and minimal downtime. Despite the tremendous effort going into developing novel treatments, currently available nonablative laser and light therapies have demonstrated minimal to moderate improvement in photoaged skin. Recently, the concept of using two different modalities to treat the photoaged skin has been explored. The idea behind this is that two varying mechanisms that target the same downstream event theoretically could lead to an additive and even possibly a synergistic effect to improve the photoaged skin. There is recent evidence for the effectiveness of sequential combined treatment using a broadband light (BBL) therapy followed by an Er:YAG microlaser peel (Profile, Sciton Inc.) for skin rejuvenation.
BBL technology utilizes a polychromatic, noncoherent, continuous band of wavelengths to target multiple aspects of photoaging during a single treatment session. As the primary tissue chromophores are melanin and oxyhemoglobin, both pigmented and vascular lesions may be treated simultaneously, while nonspecific bulk heating stimulates dermal remodeling and new collagen formation. Clinically, this correlates with a concomitant reduction and lightening of melanin containing pigmented lesions, telangiectasia, and baseline erythema as well as a mild to modest softening of fine rhytids. Cutoff filters are used to define and limit the lower end of the wavelength spectrum, depending on the clinical lesions to be treated.
The most common cosmetic procedure in the United States currently is treatment with botulinum toxin A. It has been proven as a safe and effective treatment for improvement of glabellar lines. It is also commonly used to treat rhytids in the forehead, periocular, perinasal, periorbital, chin, and platysmal areas, among others. Given its extensive safety history and the use of the material in millions of patients for over twenty years, along with its high satisfaction profile and ease of use, knowledge of this treatment is of paramount importance for practicing aesthetic physicians.
Clostridium botulinum toxin type A (BTX-A), developed and marketed as BOTOX Cosmetic by Allergan Inc., is the first type A botulinum toxin approved in the United States and is supplied as a vacuum-dried powder, 100 units per vial. Of note, different botulinum toxins are defined and treated as different products by the Food and Drug Administration (FDA) and other international regulatory agencies. The FDA does not recognize generic biologics (such as botulinum toxins) because the different manufacturing processes alter the final products significantly. Units of BOTOX Cosmetic are not interchangeable with units of other types of botulinum toxin, and there is no recognized conversion factor between different types of botulinum toxin. This is clear since the dose response curves of different toxins are not parallel to each other and the optimal ratio between products appears to be different for different indications. Unreconstituted BOTOX Cosmetic should be stored at 2–8 degrees Celsius.
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