Glynis Ablon, MD and Seth Matarasso, MD with Eliza Cabana
Innovation is a process of change or transformation. It can be subtle, obvious, or disruptive, or all 3 in the ever-evolving field of cosmetic dermatology.
The Dermatology Digest asked 2 recognized experts in cosmetic dermatology to share what they believe the most innovative aesthetic treatments are today, how they’ve affected their treatment approaches, and what advice they have for others interested in adding such treatment options to their practice.
Hair supplements: subtle yet effective
For Glynis Ablon, MD, FAAD, of Ablon Skin Institute and Research Center, Manhattan Beach, California, hair supplements top the list of innovations in cosmetic dermatology. “Diet and nutrition are key to everything that has to do with hair, skin, and nails. And as dermatologists that’s what we do. That’s our specialty. So, an extension of that really is supplements,” she said. But supplements may offer only delayed gratification, at best, and aren’t always an easy sell—to the patient or the dermatologist. “I think we’re getting more and more information about supplements in general, and there are many different ones out there,” said Dr. Ablon. “There are more studies coming and we really are seeing that they can change people’s lives with hair, skin, and nails.”
Dr. Ablon has conducted and published studies on supplements for hair loss in men and women, the latest of which appeared in 2018 in the Journal of Drugs in Dermatology. 1
The 6-month, randomized, double-blind, placebo-controlled study assessed the safety and efficacy of an oral supplement (Nutrafol Women’s Balance Capsules) to promote hair growth in 70 perimenopausal, post-menopausal, or menopausal women with perceived hair thinning. “We saw an increase in terminal and vellus hairs throughout the 6-month study,” said Dr. Ablon. “It was really exciting because I see a lot of hair loss in my practice, and having
something that I can offer my patients that is natural, a nutraceutical … that they can take at home I think is a really big deal.”
Neurotoxins (and fillers), obviously
Seth L. Matarasso, MD, Clinical Professor of Dermatology at the University of California School of Medicine in San Francisco, said the single most innovative aesthetic dermatology treatment is “unequivocally, neurotoxins.”
Although there are multiple FDA-approved neurotoxins available to dermatologists (with more on the horizon), the innovative aspect isn’t so much in the neurotoxins themselves—it’s in the plethora of ways and areas in which
they’re used, he said. “I think of it more … in terms of how we’ve approached people with neurotoxins,” said Dr. Matarasso, who recalls the days of yore when the glabella was the sole indication for neurotoxin injections. “Now [we use it for] the forehead, crow’s feet, masseter and platysma muscles, and sometimes in the perioral area.”
But even more notable, he said, “We’ve refined and finessed the technique so that we’re able to soften lines, as opposed to paralyze muscles.” Neurotoxins have been remarkably effective in cosmetic dermatology, but, said Dr. Matarasso, they also have extraordinary therapeutic benefits.
“For patients with hyperhidrosis … for patients with migraine headaches, for patients with temporal mandibular joint syndrome—it is a game-changer.”
It can also be a game-changer for dermatologists who decide to foray into aesthetics. In this case, Dr. Matarasso called neurotoxins the “gateway drug.” “For someone who really wants to add this to their practice, I think this is a great way to start because it’s not too terribly expensive. The procedure is quick, the results are predictable, and it is safe,” he said. “So, for a young dermatologist coming out of their training, or a physician who has been in practice for a few years and wants to add some aesthetic procedures, to me this is really an ideal way to break that ice.”
Like neurotoxins, many FDA-approved dermal fillers are now available, with many more to come. The innovation here, said Dr. Matarasso, is how they help to refine overall aesthetic results. “In addition to the patient’s face, their hands and their neck really can unmask what their chronologic age can be. [A dermal filler] really gives them a more homogenous unified appearance,” he explained.
For dermatologists who plan to add neurotoxins, fillers, or both to their practice, Dr. Matarasso offered this advice: “Go slow. Start with FDA-approved products and indications.” He also recommended looking to professional
societies and manufacturers for injectable product and technique education and guidance.
“For those who are just starting, the manufacturers are more than happy to help you educate yourself on the injectable. And equally as important, the AAD and the ASDS have many courses with hands-on training, so that you
can learn the anatomy and learn the proper technique, so that you can learn to recognize a complication, and most importantly, how to treat a complication,” he said.
Microneedling (and PRP: the disruptor)
It’s not a new technology, but combining microneedling with other treatments makes it a tool ripe for disruptive innovation. “I use my microneedling device for many different things. I don’t just use it for wrinkles and I don’t just use it for acne scars,” said Dr. Ablon, who combines it with platelet-rich plasma (PRP) for hair loss and other topical
actives for specific skin conditions. “It’s really nice for resistant melasma. I’ll use transdermal drug delivery systems, using the microneedling device to get that medicine into the skin,” she said.
While Dr. Ablon admitted that the clinical benefits of PRP may not yet be fully realized in medicine, she believes it’s worth serious consideration by the dermatologist. “[PRP] acts like a fertilizer. You’re getting growth factors and when the platelets are activated, we can see some dramatic results,” she said. “I think that it’s important to understand that it can be used for many dermatologic conditions.”
She especially likes the benefits it offers to accident patients who have facial wounds or scars. Dr. Ablon acknowledged that there are no guarantees with PRP, but there’s not much in dermatology that comes with them. But, she said, in her experience, using a microneedling device to get PRP into the skin returns great results.
“It doesn’t work 100%, but I think if you’re using the right devices and getting good PRP, you can see some really nice results with scars, hair loss, and other conditions.”
Another plus? Microneedling is colorblind. “You’re dealing with a device that can be used on all skin types,” she said. “It has a very, very rare risk of post inflammatory hyperpigmentation and patients do really well.”
But not all microneedling devices are alike, cautioned Dr. Ablon. “I think it’s important to know that whatever device you do choose is one that has been tested, [and] there are studies that have been performed on that specific device, because they do work slightly differently from one another.”
REFERENCE
- Ablon G, Kogan S. A randomized, double-blind, placebo-controlled study evaluating the ability and
safety of a nutraceutical supplement with standardized botanicals to promote hair growth in perimenopausal,
menopausal, and postmenopausal women with self-perceived thinning hair. J Drugs Dermatol. 2018 May 1;17(5):558-565.
DISCLOSURES
Dr. Matarasso has been a consultant to Allergan, Galderma and Revance.
Dr. Ablon is a research investigator for Nutrafol and Ameinmed and serves on the advisory board for Omnilux.