404 JOURNAL OF COSMETIC SCIENCE these substances last 6 months, possibly longer, but have the side effect of granuloma formation, manifested as the presence of tender nodules due to an inflammatory reaction within the skin. Proper injection technique with these longer lasting fillers is essential to achieving an acceptable result. Autologous Fat Transfer An autologous filler can be created by performing a mini-liposuction and removing wiwanted fat from the hips and thighs for transplantation to the face. Extra fat can be removed and frozen for use up to one year later. Fat transfer is best suited for facial areas where large volume replacement is required, such as the cheeks. Bruising and swelling are expected following the transfer procedure, but the fat may be permanent if properly implanted in small quantities in a given area. The fat is placed subcutaneously, in between the muscle bundles, and on top of the bone. Autologous fat transfer is more of a surgical procedure than a true filling procedure, but for the patient requiring many tubes of filler, the procedure is the most cost effective method for restoring a youthful facial contour. Microdermabrasion Microdermabrasion is the use of a particulate, such as alwninum oxide, silica, or baking soda, to physically bombard the skin and push away desquamating corneoc)1es. A vacuum is employed to collect the used particulate mixed with skin scale. Microdennabrasion originated in the dermatology office, but is now largely performed in medical spas, esthetician offices, and at home. It is a method of physically exf oliating the skin, as opposed to chemical peels. Superficial Peels Superficial peels chemicall}' exfoliate the skin through the use of glycolic or salicylic acid. The depth of the peel can be adjusted by varying the strength of the acid and/or the contact time with the face. Glycolic acid peels in the dermatology office are typically performed in strengths of 20-70% and salicylic acid peels arc performed in strengths of 10-30%. These peels improve the skin surface texture, but are not efficient at impro,·ing dyspigmcntation or wrinkling unless perfonned frequently or in high concentration. The major benefit is the increased smoothness appreciated when facial foundation is applied. Salicylic acid peels may be useful in individuals with comedonal acne (blackheads, whiteheads) to act as a keratol�1ic. Medium Depth Peels Medium depth peels are a true surgical procedure with a 4-day recovery period. Trichloroacetic acid in strengths of 25-35% is most commonly used in combination with a prepeel agent, such as glycolic acid, carbon dioxide slush, or a resorcinol/lactic acid/salicylic acid mixture (Jessner's solution). The intent is to destroy the stratwn comewn, epidermis, and possibly even the superficial dermis. Thus, the photoagcd skin is chemically destroyed and replaced by newly healed skin. Scarring is a possibility, however the skilled clinician can control the depth of the injury to insure an optimal result. After the peel, the face resembles a second degree swibum and is kept moist with petroleum jelly until re-epithelialization is complete. The newly healed skin must be meticulously protected from sun or irregular pigmentation may reoccur. Summary Procedural cosmetic dermatology involves the combination of treatments for the \\Tinkles of facial expression, lines and folds present on tJ1e face due to subcutaneous fat loss, and texture abnormalities arising from photodamage. These procedures must be complimented by skin care products and colored cosmetics to achieve an optimal facial appearance.

2006 ANNUAL SCIENTIFIC SEMINAR MODERN LASER THERAPY: THEORY, PRACTICE & THE INTERFACE WITH TOPICALS Eric F. Bernstein, M.D. Department of Dermatology University of Pennsylvania 405 Modern laser therapy originated over two decades ago, as the theory of selective photothermolysis was born. The last decade has seen an exponential increase in the number of devices available for skin treatment. Many lasers are available for treating each skin condition including: photoaging, rosacea, spider veins, port-wine stain birthmarks, scars, striae, brown spots, tattoos, unwanted hair and many other conditions. In addition, new areas of research including: cellulite and fat treatment, acne treatment and lasers for improving penetration of topical products to name a few. Keeping up with these advances in technology requires an understanding of not only laser physics, but biology as well. Paralleling this explosive growth in laser technology has been an equivalent growth in the chemistry of topical skin treatments. Topicals are used hand-in-hand with lasers to achieve the desired endpoints. Only by studying the combined benefits of topical treatments and lasers can maximum benefits be achieved. The future will see smart lasers that detect targets in the skin and adjust settings accordingly, used with topical agents that dramatically improve the results achieved through laser treatment. This presentation will review the various conditions treated by laser surgery. The earliest lasers used for the treatment of skin were the pulsed-dye lasers for treating port-wine stain birthmarks. These lasers were developed following landmark manuscripts in 1981 and 1983 describing selective photothermolysis: the concept of removing target tissue within skin, while leaving the surrounding skin unaffected. This concept relies on selecting a wavelength of light preferentially absorbed by the target tissue (blood vessels, pigment-containing cells, etc.). In addition, the pulse-duration of the administered light must be selected according to the size of the target structures. The time required for light to heat up the target must not be exceeded by enough time to allow heat to diffuse to surrounding skin, damaging it and leading to a scar. The first major application of this technology was for treating port-wine stain birthmarks. The earliest lasers were very slow, using small spot sizes that limited the effectiveness of these devices. Nonetheless, they were a major breakthrough in technology offering removal of vascular birthmarks without scarring for the first time. Continued innovation of this technology has lead to improvements in port-wine stain removal, and made possible the removal of numerous other vascular lesions. Cherry hemangiomas, linear telangiectasias, rosacea, erythematous scars, lower extremity spider veins and even acne have been treated with pulsed-dye lasers.