Rejuvenating the face: New trends emerge

National report - Even as new techniques, devices and pharmaceutical developments for facial contouring and wrinkle refinement proliferate for dermatologists and cosmetic surgeons, two trends are gaining momentum - one for the better and one for the worse, according to dermatologist David H. McDaniel, M.D., and his colleague, cosmetic surgeon Kyle S. Choe, M.D.

Drs. McDaniel and Choe practice at the Laser Skin & Vein Center of Virginia in Virginia Beach, Va. Their partnership symbolizes what both say is a positive trend that is becoming more widespread: Doctors in those closely allied specialties are working in tandem to offer more effective, efficient and expedient services to their patients.

The other trend - a negative one, they say - is the proliferation of what Dr. McDaniel calls "medical spas for anti-aging." While some of these spas do have the on-staff medical expertise they claim to have - such as dermatologists and cosmetic surgeons - an increasing number of them don't.

Both trends spring from the fact that as the baby boom generation - the largest generational group in the nation - gets older, more of its members are seeking ways to stop that aging from being apparent, at least facially, and they want it done relatively quickly, with a minimum of downtime.

New developments

The doctors say several new developments in facial contouring and wrinkle refinement are worthy of mention, along with a few new twists on not-so-new techniques and procedures.

One new method that meets patients' increasing desire for quick, effective treatment is fractional resurfacing using Fraxel (Reliant Technologies), a laser therapy designed to repair lines, wrinkles and acne scars by altering fractional volumes of target tissue at a time. Dr. McDaniel says fractional resurfacing features many of the benefits of ablative laser skin resurfacing, but without the downtime, side effects and lengthy recovery period.

Another technique gaining popularity is the use of Botox (botulinum toxin A, Allergan) - which has been used for about 15 years and in more than a million patients - in a relatively new scenario: combination therapies.

"Botox is still the treatment of choice for correcting lines in the upper face," Dr. McDaniel says. "Botox is best used for correcting dynamic lines of motion, that is, those lines that appear when we squint or smile or frown - the classic crow's feet and smile lines."

Dysport on the horizon

Botox may soon be joined on the U.S. market by Dysport (Ipsen), a European botulinum toxin A product currently making its way through the Food and Drug Administration's approval process.

"There's a debate over whether Botox and Dysport are identical, and which lasts longer," Dr. McDaniel says.

Botox is already being used - and, if it's approved, Dysport likely will be - in combination with fillers and light therapy.

"While Botox works well alone for dynamic lines of motion, static lines - those deep lines that remain in the face even if we're not squinting or smiling or frowning - tend to be better treated with fillers, lasers, creams and pills," Dr. McDaniel says. "Now we've begun to see combination therapies, mixing Botox with fillers or light or topical therapy - to get a more complete overall result in correcting facial lines."