402 JOURNAL OF COSMETIC SCIENCE OVERVIEW: COSMETIC DERMATOLOGY Mindy S. Goldstein, Ph.D. Estee Lauder Companies, 125 Pinelawn Road, Melville NY 11747 People want to look as good as they feel. Today, there is more openness about cosmetic procedures. Each year 22 million Americans, both male and female, visit the dermatologist. In addition, 80 million people visit the spa, with 2.8 people going to medical spas. The top five non-surgical treatments at the dermatologist or medi-spa are botox, laser hair removal, chemical peels, microdermabrasion and restylane. The top lunchtime treatments are botox and restylane which are in many cases done at the same time. How does this affect our business? 70% of the dermatologists in the United States recommend an OTC product treatment to their patients after a procedure. Approximately 3 5% of the dermatologists sell many of these products in their offices. These products may be their own private line, another dermatologist's line or a private label line. 56% of female visitors (14 million) purchase one or more of these products from the dermatologist's office. In addition, there is a growing number of dermatologist brands found on the store shelves. All of these statistics indicate that the consumer is increasingly looking to the dermatologist for their cosmetic anti-aging treatment products. The goal of this session is to learn about the treatments that are being done in the dermatologist's office and how we can formulate products to complement those procedures.

2006 ANNUAL SCIENTIFIC SEMINAR A C RITICAL EVALUATION OF PROCEDU RAL COSMETIC DERMATOLOGY Zoe Diana Draelos, M.D. Dermatology Consulting Services zdraelos@northstate.net 403 The development of new materials and technologies has expanded the field of procedural cosmetic dermatology. These procedures are part of the armamentarium of the dermatologist that must be combined with skin care and cosmetic products to achieve an optima] anti-aging result. lllis presentation critically evaluates procedural cosmetic dennatology to include antiaging therapies for wrinkles at rest, wrinkles in motion, and texture abnormalities exploring new opportunities that have arisen within this realm. Botulinum Toxins The adaptation of neurotoxins, originally developed to treat medically significant muscle spasms, into cosmetic procedural dermatology was a major change in the treatment algorithm for the aging face. For the first time, hyperkinetic lines of facial expression could be temporarily minimized to create a facial appearance more consistent with the internal disposition of the mature individual. There are many types of botulinum toxin in existence, known as subtypes A through G, but only botulinum toxin A (Botox, Reloxin) and botulinum toxin B (Myoblock) have been commercialized. The most commonly used neurotoxin worldwide is Botox. It is the longest lasting with the lowest protein load, thus conferring decreased resistance to the toxin itself. Yet, there still exists concern that the effectiveness of botulinum toxin A may decrease with prolonged use, although I have not personally experienced this phenomenon. Botulinum toxin B offers the benefit of storing the vials at room temperature before opening, which is in contrast to botulinum toxin A that must be kept frozen until the bottle is diluted, but injection pain is more pronounced and the duration of action decreased. Botulinum toxins are used primarily above the nose on the face for wrinkles that occur with facial expression, known as wrinkles of motion. The parnlyzing effect lasts for 3 months with a one-week delay before onset of action. Hyaluronic Acid Injectables Hyaluronic acid has quickJy become the gold standard filler for use in facial reconstruction. FilJers are used for wrinkJes predominantly below the nose that are present at rest. Most of 1hese wrink.Jes are due to loss of the bony architecture of the face accompanied by subcutaneous fat loss. Hyaluronic acid is a nonnal constituent of the dermis and functions as a humectant to regulate skin hydration. Injectable hyaluronic acid (Restylane, H)·laform, Captique) is inserted into the dermis to attract and hold water, thus expanding the skin fold. In addition to attracting water, the hyaluronic acid also attracts blood, thus bruising and swelling for 48 hours after injection are common. The hyaluronic acid is also painful to inject requiring the use of topical and injectable Jidocaine prior to insertion. Hyaluronic acid fillers are extremely \'ersatile and can be used in the lips, around the mouth, in the chin, in the cheeks, in the forehead, and around the eyes. The typically duration of the correction is about 6 months, except in persons who smoke or when the hyaluronic acid is placed in areas of the face with frequent movement. In these cases, the correction lasts for a shorter period of time. Collagen lnjectables The first filler introduced in the United States and the only filler available for many years was bovine collagen (Zydenn, Zyplast). This was followed by a synthetic human collagen (Cosmodenn, Cosmoplast), since skin testing was required prior to use of the bovine collagen. The collagen fillers have the benefit that they contain lidocaine, which is sufficient to minimize the pain of injection. Swelling and bruising are not as common with collagen compared to the hyaluronic acid fillers, but the collagen fillers generally only last 3 months. Collagen is a stiffer filler than hyaluronic acid and is best used for folds around the mouth. It is not suitable for use arowid the eyes or in the frown area between the eyes. Miscellaneous lnjectables There are a variety of longer lasting injectables that have been approved for use in the United States to include Sculptura and Radiesse. Sculptura is a poly-lactic acid gel, similar to the material used in absorbable sutures, approved for use in the facial Jipoatrophy associated with HIV medications. Radiesse is a hydroxyapatite material used for bladder stem supJX)rt in the treatment off emale incontinence. Both of