18 Dermatologic Surgery S KIN & ALLERGY N EWS • February 2007

CO2 Insufflation Touted for Eyelid Rejuvenation

BY DAMIAN MC NAMARA ture, rhytidosis, hyperpigmentation, vas- blood flow and oxygenation, leading to im- minutes with no downtime. Dr. Bosniak’s Miami Bureau cular pooling, fatty prolapse, and tissue lu- provements in skin irregularities and elas- technique is safe to use in combination with minosity,” Dr. Stephen Bosniak said. “This ticity, according to studies done by Dr. other skin improvement therapies. Some L AS V EGAS — insuf- is a unique treatment for vascular pooling. Bosniak and his colleague, Dr. Marian swelling and erythema are possible imme- flation of the eyelids provides patients A lot of people have this shadowing of the Cantisano-Zikha of Rio de Janeiro, Brazil. diately after treatment, but these effects are with an improved cosmetic appearance skin below the eye, and we have not had The theory is that local insufflation of transient, he said. Some patients might be and is the only effective treatment option a treatment for this prior to this.” carbon dioxide tricks the body into alarmed by the bulging area of insufflation for vascular pooling, according to a pre- Using what is called the CO2Cellulair thinking there is not enough and below their eye, he added, but it disappears sentation at an international symposium technique, the lower eyelid is insufflated it responds, said Dr. Bosniak, ophthal- in 3-5 minutes. “We don’t let them look in on cosmetic and laser surgery. with carbon dioxide through a 30-gauge mology surgeon, Manhattan Eye, Ear and the mirror while this is happening.” “After four or five treatments, we have needle at 20 mm/minute. The targeted de- Throat Hospital, New York. Improvements in rhytidosis and lumi- seen marked improvement in eyelid tex- livery of carbon dioxide gas increases Each treatment session takes about 10 nosity occur in patients regardless of skin type, Dr. Bosniak said. Some lightening of hyperpigmentation in darker skin types he BRIEF SUMMARY has observed could be an effect of carbon dioxide on melanin, he added. HIGHLIGHTS OF PRESCRIBING WARNINGS AND PRECAUTIONS To report SUSPECTED ADVERSE Clinical improvements tend to level off INFORMATION • Colitis: Clindamycin can cause REACTIONS, contact Medicis, after five treatments. “For some patients, These highlights do not include severe colitis, which may result in The Dermatology Company at the changes appear to be permanent. Oth- all the information needed to use death. Diarrhea, bloody diarrhea, and 1-800-900-6389 or ers need to return for retreatment in 6-9 ZIANA safely and effectively. colitis ( including pseudomembranous FDA at 1-800-FDA-1088 or months,” he said. ■ See Full Prescribing Information colitis) have been reported with www.fda.gov/medwatch for ZIANA Gel at www.Ziana.com. the use of clindamycin. ZIANA Gel should be discontinued if signifi cant INTERACTIONS ™ New Fraxel Laser ZIANA diarrhea occurs. Concomitant use of topical medications (clindamycin phosphate 1.2% with a strong drying effect can increase Tip Improves and tretinoin 0.025%) Gel • Ultraviolet Light and Environmental skin irritation. Use with caution. Exposures: Avoid exposure to Rx Only sunlight and sunlamps. Wear • ZIANA Gel should not be used in Eyelid Wrinkles For topical use only sunscreen daily. combination with erythromycin- containing products because of its L AS V EGAS — Fine wrinkling of the eyelids seemed to respond “quite nicely” ADVERSE REACTIONS clindamycin component. INDICATIONS AND USAGE to fractional laser resurfacing with a spe- ZIANA Gel is indicated for the topical Observed local adverse reactions in cially designed tip, Dr. Brian S. Biesman treatment of acne vulgaris in patients patients treated with ZIANA Gel were Manufactured for: ® said at the annual meeting of the Ameri- 12 years or older. skin erythema, scaling, itching, burning, Medicis, The Dermatology Company can Society of Cosmetic Dermatology and stinging. Other most commonly Scottsdale, AZ 85258 and Aesthetic Surgery. CONTRAINDICATIONS The new 0.25-cm2 tip for the Fraxel laser re ported adverse events (≥ 1% in Revised: 11/2006 ZIANA Gel is contraindicated in patients treated with ZIANA Gel) were extends away from the device housing to permit use on the eyelids. patients with regional enteritis, nasopharyngitis, pharyngolaryngeal 300-13B/HL This innovative approach is “not quite” ulcerative colitis, or history of pain, dry skin, cough, and sinusitis. antibiotic-associated colitis. a lunchtime procedure, requiring an hour for topical anesthetic application prior to each of four sessions and several days of downtime while swelling and erythema subside, he said. The preliminary results, however, have been “very impressive,” Dr. Biesman said following the meeting. In his study, Dr. Biesman enrolled 20 pa- tients, aged 38-70 years (average age 49), to receive four treatments at intervals of 9-28 days (average interval 14 days). At the time of his meeting presentation, 15 of the 20 patients had completed all four sessions and a 1-month follow-up was available on nine patients. Preliminary results suggest that patients tolerated the procedure well, despite mild to moderate erythema and edema lasting 3-4 days. “Patients typically returned to their ac- tivities in 2-3 days,” he said. For the first patients to complete the treatment and follow-up, improvements in texture and the appearance of wrinkling were rated 2.14 and 1.74, respectively, on a 0-4 scale. Dr. Biesman emphasized that not all patients in the study have com- pleted the follow-up examinations. “There’s definitely something there,” he said in an interview. “We’re not seeing any regression [in improvement] over time.” Dr. Biesman disclosed that he has re- ceived grant and research support from, and is a paid consultant to, Reliant Tech- nologies, manufacturer of the Fraxel laser. —Betsy Bates