Integrating resurfacing technologies requires restraint

Dermatologists considering incorporating resurfacing (or a new resurfacing procedure) into their practices must make sure they're very comfortable with its indications, contraindications and complications, as well as treatment of those complications, according to Dr. Matarasso, clinical professor of dermatology, University of California, San Francisco, School of Medicine.

"Aesthetic medicine never was a case of 'see one, do one, teach one,' " he says. "And this is especially true with resurfacing techniques," which he says can be very unforgiving.

Dr. Matarasso says physicians who lack experience in resurfacing would do well to begin slowly, with milder indications. Addressing comedonal acne with superficial chemical peels to provide some reduction in the pustular component is a good way to begin, he says.

He says once one is comfortable with light resurfacing, one can progress to treating patients who have some fine lines and lentigines, perhaps with medium-depth peels. That's also a nice way to start because the cost of chemical agents is very low."

CONSIDERING LASERS

Once one is comfortable with resurfacing and the re-epithelialization process, Dr. Matarasso says, one might then want to consider lasers, which can efface deeper rhytids.

He says that in his own practice, he's much more cautious in integrating resurfacing technologies or offering them to patients because, as technologies continue to evolve, "one does not always know if the results are predictable and reproducible. It is very tempting to be influenced by the manufacturers and the media. There can some delayed complications," as was the case when CO₂ lasers were first introduced.

Dr. Matarasso explains, "Everybody got very excited about CO₂ resurfacing because it was a tool that had the capability of simultaneously removing both wrinkles and actinic damage. After the initial excitement waned, we realized the tradeoff was that many patients were losing too much pigment. The lesson that I learned was that I always wait at least a year or so before integrating a new technique or procedure into my practice."

INTENSE PULSED LIGHT

When intense pulsed light (IPL) photorejuvenation was introduced, Dr. Matarasso says he waited until unbiased studies substantiated manufacturers' claims before introducing it to his patients.

Furthermore, he says a cardinal rule is that he would never use a brand new technology on a new patient. "For example," he says, "I would not recommend Fraxel (Reliant Technologies) resurfacing or any brand new technique to a first-time patient." Rather, he says he'd offer it to a patient with whom he has an established rapport. That way, in case a complication arises or expectations are not met, any conflicts can be amicably resolved.

During patient consultations, Dr. Matarasso recommends being frank and explaining that a particular technology is new and still evolving. By the same token, he says he finds providing appropriate literature during consultations is an effective way to introduce new technologies to patients.

He adds that, although some physicians consider showing patients pre-and post-operative photographs to be a good internal marketing tool, he does not offer such photos because this practice not only can compromise another patient's privacy, but it also can establish inappropriate expectations.

"It is also a good idea to underestimate the expectations of a procedure. This balances out the media's hype, and when the results are better than anticipated, the patient will be much more satisfied," Dr. Matarasso adds.

He says this lesson applies to two of the latest technologies, fractional resurfacing and tissue tightening procedures.