The CME staff are so confused about what is acceptable that presentations are often changed by them without permission, often at the last minute and without informing the speakers.

Device (and drug)  names are removed from PowerPoint slides leaving the audience without any basis upon which to understand the difference between one device or another.

Eyes and periorbital regions are covered in photographs, despite signed use agreements, even in cases depicting pre and post eyelid surgery.

Requirement for talks to be submitted weeks or months before the meetings …. (is anyone really that organized?)

“The pendulum has swung too far”, said Dr Zachary. “It’s time for reason to set in”. If doctors can’t tell the difference between science and a sales job, then our medical schools have failed to educate them appropriately”.

Other problems to be avoided include the development of bulk heating by poor scanning techniques. “It is critical that the spatial separation of fractionated laser pulses is not lost by overlapping the scan or stamp patterns”.  Bulk heating can and will lead to full thickness loss of skin leading to significant scarring.

Dr Christopher Zachary decribes a step by step technique to induce cryolipolysis in a safe and predictable manner.

David J. Goldberg, MD, a clinical professor of dermatology at NYC’s Mount Sinai School of Medicine and coauthor of the only published research on the treatment. “…  without clinical results, it’s really medi-spa hype at this point.”

Fractional ablative lasers have literally changed the face of laser rejuvenation, making this procedure safer in all ethnic types, with faster healing, fewer complications, and with predictable outcomes. This will never have the same benefit compared with traditional CO2 laser resurfacing, which still has a place in modern rejuvenating processes. But since the latter takes so long to recover, has persistent redness, and the strong possibility of delayed onset permanent hypopigmentation, it is much less commonly used.  And for acne scarring, while traditional CO2 and Er:YAG lasers were useful, this author believes that the same benefits can be achieved with the fractional ablative lasers, if used aggressively (70mj/70%) and on multiple occasions. A detailed explanation of the science and optimal techniques will be given.

Energy based devices for facial rejuvenation

25 years ago, there were only a few devices available for facial rejuvenation, including the CW CO2 laser, the argon lasers, the copper vapor laser, and a few others. So it was relatively easy to become an expert in these few devices, though one needed great technique to avoid complications and achieve nice results. How the times have changed! There are literally hundreds of devices available, which are pushed and marketed by the laser companies. Some physicians in the community have seen the easy money in cosmetic surgery and have become Cosmetic Surgeons overnight, with very little training, and few ethics. This presentation will emphasize those devices that work, those that are practical, and those to be avoided.

Fat and cellulite: Do Devices Really work?

The next billion $$ market, or so the device manufacturers would have us believe, will be the treatment of fat and cellulite. These two are often bundled together, though they are really very separate conditions. Neither of them is indeed abnormal; they are both normal and physiological. However, nearly 100% of women have cellulite, and most of them might like to lose this curd cheese appearance of their thighs.  Most of the technologies marketed for these conditions are at best temporary, and many do not work at all. Sorting through all the marketing hype is not too difficult; most of it is nonsense. We should demand side by side comparisons, require some element of standardization, bring some component of reality to the equation. In the end, it will be the consumer who will make the final assessment of efficacy. In the meantime, most will be fooled by the sharp advertisements and the fancy talk. As physicians, we stand to lose all credibility unless we become more objective, more thoughtful, and less involved with the mythology.

Cryolipolysis and Radiofrequency for localized fat reduction

The bright areas of hope for localized fat reduction are in cryolipolysis, RF, and possibly in ultrasound. As always, physicians should look to good medical advice relating to a healthy lifestyle, a good diet and regular exercise. But for those areas where individuals can’t lose that love handle or prominent abdomen, there is indeed hope. Tumescent liposuction remains the mainstay for fat reduction in these areas, but is invasive, and is associated with a healing process and the potential for complications. The advent of cryolipolysis has changed this equation dramatically. This presentation will underscore the science behind the technologies, and look at some objective data as they pertain to fat reduction.

“It‘s probably a very good moisturizer, but that’s all. The ‘h’ in 3Lab’s ‘h’ Serum stands for Human Growth Hormone,” Zachary said. “There’s no way in ‘h’ for hell that it gets through the top layer of the skin. The molecular weight it just too large. So if you like the product, use it. But don’t buy the ‘BS’ of the ‘h’, because it’s nonsense!”

On Latisse …..

That’s simply “the cost of beauty,” said Dr. Christopher Zachary, chairman of the UCI Department of Dermatology, told yesterday’s  online chat.  “If you want to bat those eyelashes, you need something to bat.”

On Madonna’s Oxygen therapy

“The concept that high-pressure oxygen would do anything to help the skin is such nonsense as to be laughable,” said Dr. Zachary, who has not examined the oxygen-compression machine himself.

He suggested that the plumping or swelling effect might be mild inflammation caused by the blasts of compressed oxygen. “If you wanted puffy eyes, you could also go out for a hard night’s drinking,” he said.

from Colin Stewart’s Health Blog

Aging women seeking a wrinkly role model might look no further than Helen Mirren. She almost deserves it.

The British actress, who turns 64 this weekend, was a subject of this week’s “In Your Face CHAT” featuring fellow Brit Dr. Christopher Zachary, chairman of the UCI Department of Dermatology.

Mirren is an Oscar winner who shuns Botox, letting her beauty shine through her wrinkles, and last summer’s photos of her in a bikini caused a minor sensation worldwide.

If everyone followed her example, cosmetic doctors would go out of business, since Mirren relies on common sense rather than the arts of plastic surgeons and dermatologists.

“I don’t smoke and I don’t drink too much, exercise occasionally but not ferociously, and I’ve never had any work done,” Mirren says.

Some celebrity watchers suspect Mirren has undergone a few cosmetic procedures, but Zachary is a fan who takes her at her word and doesn’t mind her lack of interest in his profession.

“What a Dame she is! How many 63-year-old ladies sport a bikini?” Zachary said, referring to her honorary status as a Dame Commander of the Order of the British Empire.

If she came to him for a consultation, what would Zachary tell her?

“I would give her a mirror and ask her what she was worried about. I think she is living the perfect life.”

Yet even with that “perfect life,” she falls short in the role-model department, since a role model should be someone to gauge yourself against and model yourself after. Considered that way, Mirren had it relatively easy.

For one thing, she hasn’t put her body through the strains of pregnancy and childbirth. That made it easier for her to maintain her figure near her reported measurements of 38C-26-37 when she was in her late 40s.

Mothers shouldn’t beat up on themselves if their figures don’t match Mirren’s.

If we consider her a role model, are we implying that it’s OK to grow old as long as you look young? That seems an implication of praise for Mirren’s bikini photos, though photos of her wrinkled face make aging look appealing.

Mirren reportedly also engages in some uncommon skin-care techniques, such as putting used tea bags on her eyes to relieve puffiness.

Zachary approves of that technique. “You can improve the appearance of puffy, irritated and inflamed skin by good moisturization, and I guess tea bags are a neat way to contain the moisturization in one location.”

But he sees no value in Mirren’s reportedly use of 3Lab’s $200-a-pop “h” Serum as a skin-rejuvenation method.

“It‘s probably a very good moisturizer, but that’s all. The ‘h’ in 3Lab’s ‘h’ Serum stands for Human Growth Hormone,” Zachary said. “There’s no way in ‘h’ for hell that it gets through the top layer of the skin. The molecular weight it just too large. So if you like the product, use it. But don’t buy the ‘BS’ of the ‘h’, because it’s nonsense!”

A final drawback to considering Mirren as a role model is that her good looks overall and the gracefulness of her aging in particular must depend on good genes. They’re not something that anyone can aspire to and work toward. Rather, they could aggravate any negative self-image suffered by women with much different genes.

“I have to agree,” Zachary said. “She comes from Russian stock. Genes are all important. Caucasian skin is going to be more at risk for sun damage and early sun-related aging. Darker skin types are protected to a certain degree.”

“She is growing old gracefully,” he said. “In the U.S., we don’t respect age, unlike some cultures. And wrinkling is just a feature of aging, as well as sun damage.”

A gently edited transcript of the portion of Zachary’s “In Your Face CHAT” related to Mirren is below.

More about “In Your Face CHATs”:

http://inyourface.freedomblogging.com/2009/07/24/helen-mirren-wrinkly-role-model/8145/

You really want longer eyelashes?  If you want to bat your eyelashes …. you need something to bat ….

http://inyourface.freedomblogging.com/2009/07/23/are-longer-eyelashes-really-worth-1400-a-year/8157/

http://www.ocregister.com/articles/zachary-23103-laser-skin.html

Cryolipolysis is now available at The Dermatology Center! 

Remarkable technique which works by heat extraction induces ‘apoptosis’ or programmed cell death giving rise to impressive reduction in fat, particularly in the love handles and abdominal regions.

Approved in in the US for skin cooling, the Zeltiq device is simple to apply, and allows the patient to spend the treatment reading, working or chatting on the phone.  The treatment takes about one hour per area, and is not associated with any downtime. Dr Zachary who was involved in the early research with this device considers it one of the few treatments that really work for localized fat reduction. This is for people who are of normal weight who just can’t lose that love handle or excessive fatty tire on their abdomens.

http://inyourface.freedomblogging.com/2009/12/17/lipo-rival-zeltiq-aims-to-freeze-away-fat/13699/