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Massage/Mechanical Techniques: Cellulite Reduction

Key Messages Cellulite is a multifactorial condition which benefits from a combination approach to treatment Reduced blood flow and lymphatic drainage, which worsen the appearance of cellulite, can be improved by mechanical manipulation Mechanical manipulation, while beneficial as a safe, noninvasive technique, does not result in the permanent resolution of cellulite The etiology of cellulite has long been debated and several mechanisms have been proposed. While…

Cellulite: Anatomy, Etiology, Treatment Indications

Key Messages Cellulite is an architectural condition of human adipose tissue Cellulite is characterized by a padded and nodular appearance of the skin in cellulite-prone areas, such as posterolateral thighs and buttocks in post-pubertal females Fundamental knowledge regarding its pathophysiology is lacking, which makes understanding and treating this condition a challenge Introduction Cellulite is thought of as a localized metabolic phenomenon that evokes an alteration in…

Injectable Fat-reducing Therapies: Fat Reduction

Key Messages Adipocytolysis refers to the subcutaneous injection of chemicals, such as the detergent sodium deoxycholate, which ablates or lyses rather than shrinks fat cells Injection lipolysis, otherwise known as pharmaceutical lipoplasty, refers to the subcutaneous injection of compounds, such as the beta agonist, salmeterol xinafoate, which mobilizes triglyceride and reduces fat cell size without lysing or ablating the fat cell While there are currently no…

Laser Lipolysis: Fat Reduction

Key Messages Laser-assisted lipolysis is an effective procedure for localized adipose removal that may also induce simultaneous skin tightening The mechanism of action of laser-assisted lipolysis includes photo-acoustic, photomechanical, and photothermal effects Fibrous areas, previously treated areas, and areas of fat accumulation that have overlying skin laxity are some examples of areas amenable to laser-assisted liposuction Introduction Since its inception, lipoplasty, or liposuction, has continued to…

Liposuction, Ultrasound-assisted and Powered: Fat Reduction

Key Messages Tumescent liposuction was developed and continues to be widely practiced by dermatologic surgeons The tumescent local anesthesia offers significant safety benefits over general anesthesia Ultrasonic liposuction may increase the risk of seroma, thermal burns, and necrosis, and consequently should be used with caution Powered liposuction, using a reciprocating cannula, increases the rate of fat removal, improves patient recovery, and decreases the physician's physical strain…

Ultrasound Treatment: Fat Reduction

Key Messages The demand for noninvasive body sculpting procedures is on the rise High intensity focused ultrasound (HIFU) offers a noninvasive alternative for body contouring HIFU is FDA cleared for the reduction of waist circumference HIFU treatment is indicated for treatment of localized collections of subcutaneous adipose tissue resistant to diet and exercise A single HIFU treatment of the abdomen and flanks generally produces a >2 cm…

Radiofrequency Treatment: Fat Reduction

Key Messages Radiofrequency (RF) devices are a recent advancement in noninvasive technology designed to reduce the appearance of fat. Often, they are based on the emission of an electromagnetic field that results in a current running through subcutaneous tissue and causing bulk heating. These innovations are safe with low side effect profiles, and they can be used on all skin types Ideal patients for most of…

Cryolipolysis: Fat Reduction

Key Messages Cryolipolysis is a novel approach to noninvasive subcutaneous fat reduction It is both safe and effective with essentially no post-procedure downtime Commonly treated areas include flanks, upper and lower abdomen, and back fat pads The pre-procedure consultation is critical to selecting appropriate patients for this treatment Erythema, mild edema and petechiae are common immediate sequelae that typically resolve within a week A transient reduction…

Subcutaneous Fat: Anatomy, Physiology, and Treatment Indications

Key Messages Subcutaneous adipose tissue, once considered a passive storage receptacle with a fixed number of cells and limited purpose, is now recognized as a complicated organ with important endocrine and metabolic functions Both increased and decreased adipose tissue mass as seen in obesity, anorexia and lipodystrophy, have profound effects on multiple body systems such as the immune, reproductive and hematopoietic systems Mature adipocytes exist as…

Micro-focused Ultrasound: Skin Tightening

Key Messages Skin laxity is a common sign of photoaging Skin lifting and tightening are desirable outcomes for a large majority of patients interested in photo-rejuvenation Noninvasive treatment options for skin tightening and skin lifting are very limited. Micro-focused ultrasound with visualization (MFU-V) has been shown to provide skin lifting and tightening, making it the only FDA cleared technology (Ulthera Inc., Mesa, AZ) with a ‘lifting’…

Radiofrequency Treatment: Skin Tightening

Key Messages There is a high patient demand for safe and effective ways to decrease redundant or lax skin and smooth irregular body contours Patients tend to prefer noninvasive skin-tightening procedures with less risk, no scarring and reduced recovery time despite a decrease in effectiveness when compared with traditional skin excision techniques such as abdominoplasty or brachioplasty Treatment protocols with reduced energy settings are standard of…

Lasers and Lights: Skin Tightening

Key Messages There is increasing demand for nonsurgical approaches to skin tightening on the body without downtime and with minimal risk. Lasers and light-based devices are being developed to meet this demand The ideal patient candidate is one with mild to moderate skin laxity and realistic expectations of outcome These devices are used extensively and safely on the face. Studies and experienced users have demonstrated their…

Skin Laxity: Anatomy, Etiology, and Treatment Indications

Key Messages Skin laxity is defined as the acquired loose, relaxed state of the skin that develops with age as a result of skin extensibility (stretch) and decreased skin recoil (return to original state after stretch) Intrinsic and extrinsic aging cause specific cutaneous changes, such as epidermal thinning, loss of collagen, degradation of elastin, and redistribution of subcutaneous fat, that all lead to significant skin laxity…

Complementary and Alternative Approaches II

Key points A review of a variety of alternative therapies for atopic dermatitis (AD) is the focus of this chapter. Among those reviewed are acupuncture, cupping, and herbal therapies, which are common traditional Chinese therapies used by AD patients. We discuss the limited, but compelling research surrounding acupuncture and its subtypes’ success in treating AD symptoms such as itch. Cupping has less clear evidence for its…

Complementary and Alternative Approaches I

Key points Current first-line conventional treatments for atopic dermatitis include topical corticosteroids, emollients, and topical and/or systemic immunomodulators (e.g., dupilumab). However, a majority of patients with atopic dermatitis are interested in or have tried complementary and alternative medicine (CAM) approaches. CAM approaches with clinical evidence in atopic dermatitis include topical and oral oils, topical and oral micronutrients, bathing additives, fabric selection, and topical endocannabinoids. Treatment of…

Itch and Pain Treatments

Key points Itch and pain are key symptoms of atopic dermatitis (AD) that significantly affect quality of life; various classes of treatment aim to reduce these symptoms. Nonpharmacologic and topical therapies are effective for mild or moderate itch or pain symptoms and for maintenance therapy of AD. Systemic therapies that target the immune system are effective as antipruritics, but many have side effects that limit their…

Microbiome Modulation

Key points The use of probiotics to promote a healthy state has been widely studied. Oral probiotics have been shown to aid in the prevention of atopic dermatitis in select populations. Oral probiotics may also help in the treatment of atopic dermatitis, though data to support this are less clear. Details on specific probiotic strain, dose, and duration of treatment for efficacy are lacking. Multiple topical…

Emerging Targeted Treatments

Key points This chapter provides an overview of the pathogenesis of atopic dermatitis and the key mediators that are of therapeutic interest. As we acquire more knowledge into the pathogenesis of atopic dermatitis, we will be able to use more targeted treatments The two most recently Food and Drug Administration–approved medications are dupilumab and crisaborole. There are a number of topical and systemic novel and emerging…

Skin Barrier Repair

Key points Moisturizers help with skin barrier repair and continue to be the mainstay of maintenance treatment and prevention of flares in atopic dermatitis (AD). Though greasier moisturizer delivery systems such as ointments and creams are most effective, patient compliance should be weighed in selection of an appropriate delivery system. Though a tremendous variety of moisturizers at difference price points exist on the market, studies do…