Dr. Suzanne Kilmer
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Neck Rejuvenation with Energy-based Devices Neck rejuvenation requires a multimodal approach, combining neuromodulators for platysma band relaxation with energy-based devices to address vascular changes, pigmentation, laxity, and structural aging. Vascular and pigmentary issues respond well to PDL, IPL, Q-switched, and picosecond lasers, while picosecond devices also stimulate collagen and elastin to improve laxity. For tightening, monopolar and bipolar radiofrequency, RF microneedling, HIFU, and synchronous parallel beam ultrasound deliver thermal remodeling with minimal downtime. Ablative and fractional lasers remain useful for resurfacing fine lines and texture, and new innovations such as focal point laser technology and 2,910 nm fiber laser-coring provide precise collagen remodeling and skin tightening without surgery. |
Dr. Mathew Avram
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Beyond the Scalpel: Non-invasive Treatment to Treat and Prevent Nonmelanoma Skin Cancers Lasers, particularly PDL and long-pulsed Nd:YAG, are promising non-invasive options for treating basal cell carcinoma and reducing risk of future skin cancers. They offer scarless outcomes, potential one-time treatments, and preventive benefits, positioning them as important complements or alternatives to surgery in dermatologic oncology. Fractional lasers can cut future risk of BCC/SCC by about 50% and improve DNA repair and immune response. PDL has also been associated with lower rates of future keratinocyte carcinomas. |
Dr. Roy Geronemus
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Multimodal Approach to Successfully Treating Melasma and Hyperpigmentation Melasma and hyperpigmentation are best managed with a multimodal approach. Sun protection and topical agents form the foundation, while procedures like peels, microneedling, and lasers (especially picosecond and non-ablative fractional devices) can improve resistant cases. Combining therapies speeds clearance, reduces recurrence, and allows safer, tailored treatment across skin types. Setting expectations and focusing on long-term management are key to success. |
Dr. Mark Nestor
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Update on Neuromodulators Botulinum toxin A products work via the same mechanism, but differ in clinical effect due to variations in molecular potency, receptor binding, and distribution. Efficacy, onset, and duration depend on how many active molecules reach the neuron and how well they spread in the target muscle. Units aren’t directly comparable across brands, thinking in terms of a “molecular potency quotient” (balancing effect and cost) can be valuable. Technique (dilution, injection spread, and number of sites) is key to optimizing results and consistency. |
Dr. Catherine DiGiorgio
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Starting Your Own Practice Prioritize patient care above all, lean on trusted colleagues for advice, keep overhead low and add devices gradually, always consider ROI before investments, and stay true to your brand and mission. |
Treatment Pearls
- PDL combined with hyperdilute botulinum toxin may have synergistic benefits in treating erythematotelangiectatic rosacea.
- Early counseling on the chronic and relapsing nature of melasma is essential for setting realistic expectations and improving long-term patient satisfaction.
- A blended approach using hyaluronic acid and calcium hydroxyapatite fillers can produce significant improvement of infraorbital hollows.
- Brief pre-treatment icing is unlikely to impact botulinum toxin diffusion or efficacy.
- PDL combined with hyperdilute botulinum toxin may have synergistic benefits in treating erythematotelangiectatic rosacea.
- Early counseling on the chronic and relapsing nature of melasma is essential for setting realistic expectations and improving long-term patient satisfaction.
- A blended approach using hyaluronic acid and calcium hydroxyapatite fillers can produce significant improvement of infraorbital hollows.
- Brief pre-treatment icing is unlikely to impact botulinum toxin diffusion or efficacy.