Noninvasive procedural dermatology has evolved at a dizzying pace, and continues to do so.
In addition to an array of procedures for skin tightening, skin resurfacing, and fat reduction, emerging technologies such as complex feedback devices, nanotechnology, and stem cell–based therapies promise to keep dermatology at the forefront of the cosmetic and esthetic realm, according to Dr. Murad Alam.
Dr. Murad Alam
In an article featured in the March issue of Seminars in Cutaneous Medicine and Surgery, Dr. Alam of Northwestern University, Chicago, makes several predictions about the future of these technologies (Semin. Cutan. Med. Surg. 2013;32:61-63).
For example, like modern vehicles equipped with computer chips that can change steering and braking in response to environmental conditions, dermatologic devices will soon include technology that uses precise feedback to make automated setting changes, he said.
"Over time, the reduced cost of microelectronics, feedback controls, and computing power is simplifying the capacity of devices to analyze intraoperative information and adjust the procedure to compensate. For instance, certain laser and energy devices already have tips that are able to sense the temperature in the microenvironment and adjust power output to maintain site-specific temperature within a narrow band," he explained.
This technology could increase effectiveness and improve the safety of devices by reducing the level of operator time and expertise needed, and by making setting changes faster than humanly possible.
Autonomous nanotechnology devices are another advance described by Dr. Alam.
Miniaturization will become more feasible and affordable, and eventually devices will become "so exceedingly small that they will be mostly disposable and deployed in large numbers to the treatment site," he said.
The concept of hundreds of minuscule machines deployed to resurface skin or repair a wound may sound like science fiction, but the rapid advances in nanotechnology could make it a reality that could lead to the creation of new procedures such as ways to treat scars that can’t be corrected using currently available technologies, he added.
Dr. Alam’s other predictions for the future of noninvasive procedural dermatology included:
• Optimization of minimally invasive procedures for fat reduction and skin tightening, which currently provide only mild to modest results and longevity.
• The use of stem cells for augmentation of tissue layers, which could provide genuine rejuvenation rather than simply repair and concealment.
• The improvement of artificial dermal substitutes that can develop many of the functions of live skin, and can be grafted without inducing contractures.
• The development of rapid treatments for pigmentation using nanotechnology and cellular therapies, which will allow for precise melanocyte and melanosome transfer and automatic recoloration of discolored skin.
While these technologies continue to emerge, plenty of others have already established their places in the dermatology arena. The many and varied applications of one of these – low-level laser therapy, or LLLT – are described in another article in the March issue of Seminars in Cutaneous Medicine and Surgery (Semin. Cutan. Med. Surg. 2013;32:42-54).
"LLLT involves exposing cells or tissue to low levels of red and near-infrared light. ... Recently, medical treatment with LLLT at various intensities has been found to stimulate or inhibit an assortment of cellular processes," wrote Dr. Pinar Avci of Massachusetts General Hospital, Boston, and his colleagues, noting that the mechanism associated with the cellular photobiostimulation by LLLT is not yet fully understood, but appears to have a wide range of effects at the molecular, cellular, and tissue levels.
Describing LLLT as "possibly the ultimate noninvasive approach to treating the skin," the researchers highlighted numerous existing or emerging applications for the technology, outlined below.
Skin rejuvenation
Many modalities developed to reverse the dermal and epidermal signs of photoaging and chronological aging depend on the removal of the epidermis and the induction of a controlled form of skin wounding to promote collagen biosynthesis and dermal matrix remodeling. Examples include retinoic acid, dermabrasion, chemical peels, and ablative laser resurfacing.
These modalities require intensive posttreatment care and prolonged down time, and are associated with a risk of numerous complications, the researchers said.
LLLT represents an alternative that is known to increase microcirculation and vascular perfusion in the skin. Data from previous studies have shown that LLLT increased collagen and improved wrinkles and skin laxity with less down time and risk than that of other treatments.
In one study, for example, 300 patients treated with only a light-emitting diode (LED) LLLT device set at 590 nm, 0.10 J/cm2, were compared with 600 patients who received the LED therapy in combination with a thermal-based photorejuvenation procedure. Of those who received LED therapy alone, 90% reported softer skin and less roughness and fine lines. The changes ranged from subtle to significant.