VIRGINIA BEACH DERMATOLOGY ASSOCIATES, PLLC.

FILLING UP WITH FILLERS

A new filler, dubbed Elevess, is about to hit the cosmetic dermatology market. While it will be the third hylaronic acid filler, following in the footsteps of Restylane and Juvederm, this one comes with a twist. It contains the anesthetic lidocaine. Those of you who have undergone the procedure, usually to correct naso-labial folds ( the furrows that extend form the corner of the nose to the lateral portion of the lips) or marionette lines (the folds traversing downward from the corner of the mouth) realize it can be a painful one, despite the judicious use of topical anesthetics, ice and hand-holding.

The new product also appears effective as reported by Dutch and German dermatologists. At three months, 96 per cent of patients showed improvement, as assessed by investigators, and 88 percent said they were satisfied with their treatment.

Elevess will be marketed by Galderma, another dermatology company diving into the cosmetic surgery waters.

PUFFY EYES

Recently, I took a cruise to Bermuda. While on board I attended one of those mini-seminars sponsored by the spa center (which are incidentally owned by a company which supplies spa services to all the cruise lines). The topic was “puffy eyes”. I promised my wife that I would keep my mouth shut. This became very difficult when the speaker blamed puffy eyes on a “toxin”. I was surprised and disappointed that none of the dozen or so women attending questioned the speaker on her assertion. Certainly, nothing in the dermatology literature supports this thesis. But if a toxin does not cause “puffy eyes” , what does

Dermatologists feel that one of the main causes of undereye bags is poor venous outflow of the blood vessels beneath the orbs. As some women know, this can be corrected with Preparation H and a number of undereye products found at the cosmetic counters. These products contain MDI, a derivative of shark cartilage which is high in mucopolysaccharides. These increase venous outflow.

The bluish-brown discoloration that bothers so many people is caused by increased blood flow and chronic rubbing. The rubbing releases tiny amounts of blood which turn into deposits of a dark brown chemical called hemosederin. This is often corrected with optical agents that increase the reflection of light. These topical products, while not actually doing much to reduce the discoloration or bagginess, increase light reelection, and thereby lessen the appearance of darkness. Really this is all smoke and mirrors.

What do I recommend that can actually change the vasculature and in addition reduce those disfiguring tiny lines and creepiness that comes with aging. First, stop rubbing your eyes. Avoid salty meals, since the edema may pool in the orbital area. Beyond this, the ingredients I feel are most effective are human growth factors (TNS Recovery System) and products containing caffeine (Teamine Eye Complex and Replenix). Human growth factors, used in the healing process, are continuing to emerge as potent antidotes to the aging process. The old saw about using tea bags under the eyes is on target. Tea contains hefty amounts of caffeine and caffeine is a blood vessel constrictor.

A study published this month confirmed the efficacy of a combination of human growth factors, cytokines, and caffeine. The product called PSP or Processed Skin Cell Proteins, was revealed to significantly reduce signs of eye wrinkles and to improve below the eye texture.

DO MEN AND WOMEN WRINKLE EQUALLY?

Two German dermatologists set out to answer this question. They employed a most unique weapon in their search. They utilized a laser-like source to detect changes in collagen and elastin. Thus, they were able to assess changes without the need of a skin biopsy, the usual means to determine tissue changes. I anticipate this method will grow in use, if not become standard in such skin experimentation.

So what did they find? Interestingly, men’s skin breaks down collagen at a slower pace than women’s. This may explain the reason men’s skin does not seem particularly aged compared to women despite the much more prevalent use of anti-aging products (which work!!) by the fairer sex.

WHO IS MOST SUN-SMART?

The American Academy of Dermatology conducted a nationwide survey to determine the “sun-smart” character of various regions. Residents were polled on their knowledge, attitudes and behaviors toward tanning and sun protection. Washington D.C. emerged as the most sun-smart city out of 32 regions. New York City was next. Chicago came in last, followed by the great state of Maine.

PEPTIDES

You may have heard a number of prominent dermatologists raving about the value of peptides on the skin (colleagues such as Perricone, Murad and Obagi). What are peptides and what do they mean for skin care?

Peptides are nothing more than chains of amino acids—the tiny fragments of proteins strung together that are found naturally in our bodies. Peptides speed healing, kick-start collagen production to prevent wrinkle formation and may disrupt muscle contractions that contribute to eye-crinkling wrinkles.

Even better, peptides are gentler than some of the other anti-aging ingredients such as Retinol and the Retinoids (RetinA, Tazarac and Differin).

Two interesting peptides are copper peptides and acetyl hexapeptide-3.

Thirty years ago surgeons noted that a naturally occurring three-chain peptide bound to copper could enhance post-surgical healing. Since wrinkles can be regarded as minor injuries to the skin’s structure, these peptides were tried and found to retard skin aging. Since the molecule is small, they can, with a boost, penetrate the skin. The medicinal benefits of copper peptides can be particularly helpful following dermatologic treatments such as laser resurfacing, chemical peels and microdermabrasion, which are essentially controlled skin injuries.

As far as acetyl hexapeptide-3, read below.

TWEAKING BOTOX

You might have heard about creams that have BOTOX effects. ( Not Strivectin–with its somewhat ludicrous Better than BOTOX? trumpeting). Most of these creams contain acetyl hexapeptide-3, also know as argireline. This is a new peptide which consists of a chain of six amino acids and may actually relax muscles.

While certainly it is asking a lot of a cream placed on the skin to ram its way through the epidermis, dermis, sub-cutaneous tissue, fat and fascia into muscle, it seems a bit of this stuff can interfere with the neurochemical signal between nerves and muscles. Thus working in a similar manner to BOTOX.

In a recent study, wrinkles were found to be 30 per cent shallower in individuals who applied a cream containing argireline daily for three months.

It appears that argilene may prolong the effects of BOTOX. The next time your dermatologist or plastic surgeon injects BOTOX into your face you might ask for a product containing this busy little bunch of proteins.

A second means of prolonging the effects of BOTOX may be the use of a more potent strength. The injector chooses the dilution. A recent paper demonstrated that when there is less dilution, for instance diluting with 1 cc of saline rather than 5 cc, the effects last up to 1 1/2 months longer.

PSORIASIS AND MORTALITY

Two recent studies presented at the Society of Investigative Dermatology meeting showed that severe psoriasis was associated with a 50% higher mortality risk. Correspondingly, there was a marked increase in the risk for hypertension, heart disease and diabetes. There was no increased risk associated with mild psoriasis.

Since inflammation is a hallmark of psoriasis, perhaps inflammation has something to do with causing heart disease and diabetes. Or maybe, some of the inflammatory substances created by psoriasis plaques spreads through the bloodstream affecting the heart and pancreas.

Genetic linkage may also be an explanation.

Besides finding these reports very troubling, it accented to me the importance of controlling this condition, using some of the more potent arrows in our armamentarium.