Attention to contraindications key to maximizing aesthetic treatments

Key Points

National report - Maximizing aesthetic treatments from head to toe requires paying attention to contraindications, treating conservatively and choosing the right cosmeceutical vehicles.

When prescribing Latisse, Dr. Waldorf also carefully reviews how to use it. "One of the issues that comes up with Latisse is that some people can get irritation around the eyes, as well as erythema and pigmentation of the eyelids," all of which are reversible, she says.

"It has not yet been reported in Latisse, but I have no doubt it ultimately will be," whether it's simply an idiosyncratic reaction, or patients are over-applying the medication, she says.

In the latter area, Dr. Waldorf says most patients should use less Latisse than described in the product insert. "The instructions say to apply one drop per upper eyelid, using a different prepackaged brush for each eyelid. I tell patients that one drop on one brush will allow them to treat both upper eyelashes and eyebrows," she says. "You only put Latisse on the upper lash, and you must wipe off any excess."

Cosmeceutical vehicles

One study in which investigators compared retinol, retinoic acid and a placebo vehicle showed that retinol and retinoic acid achieved equal thickening of the epidermis (Kang S, Duell EA, Fisher GJ, et al. J Invest Dermatol. 1995. 105(4):549–556).

"Investigators observed no erythema with retinol, but there was irritation with retinoic acid," Dr. Kircik says. Researchers also analyzed the amount of retinoic acid in post-treatment skin samples to rule out the possibility that the retinol worked because it had been converted into retinoic acid. "This tells us that retinol has anti-aging activity, without the irritation and erythema that retinoic acid causes," he says.

The ability of cosmeceuticals such as retinol to penetrate the skin can be an issue. "People generally don't want any irritation. So usually, companies don't put in meaningful concentrations of active ingredients," Dr. Kircik says. To avoid this problem, he says products should contain at least 1 percent of retinol in a vehicle the skin can absorb.

"Usually, the vehicle is a cream or emulsion," he says. "Retinol is a lipophilic product, so if you put it in a cream or emulsion, it's going to get mixed with that, and it won't absorb. It needs to be suspended in a hydrophilic product so it can be absorbed."

One product with this type of vehicle is Retriderm (Biopelle), Dr. Kircik says. "It's the only retinol suspension available with the right vehicle. That's why it works better" than competitors, he says.

In clinical trials of this product, after 12 weeks of nightly use, around 40 percent of subjects had achieved at least a two-grade improvement (on a three-grade scale) in the appearance of their photodamage. Investigators also observed mean improvements of 57 percent under the eye, 43 percent in crow's feet and upper eyelids and 20 percent in forehead wrinkles (Kircik L. Presented at Cosmetic Surgery Forum; Dec. 2-4, 2010; Las Vegas).