ADAS Dermatology

By David T. Harvey, MD, FAAD, FACP

Fig 1. Evolence

I wanted to blog about a new state of the art filler that I was recently introduced to and one of the first to use in the Jacksonville, Florida  area… Evolence™. This product is the latest filler to be used by dermatologists and plastic surgeons and has quite a few advantages over others (as I pleasantly found out). First of all,  the material is very, very smooth and easy to place. I was pretty amazed when I treated a patient’s cutaneous upper lip on a smoker I was sure needed a CO2 laser procedure (Fig 2).

The material is derived from porcine (pig based) collagen. It is processed in a very unique way, which eliminates the need for pretesting. The process of ribosylation, evidently reduces some of the secondary post-op swelling that is seen with some of the other products that we commonly use (Restylane™ and Juvederm™).

Anecdotal reports have the material lasting from 15 to 24 months but I am not commenting until I see it for myself. To date, I am very impressed with how the material seems to finds the small lines and virtually erases them. Bruising is minimal. Cost is similar to the other products mentioned and varies from $600 to $800 dollars per vial.

Fig 2a. Before upper lip line treatment

Fig 2b. After treatment

A new filler, Evolence Breeze™, is set to hit the US market next year and this can be used in the lip region.

I will keep you posted of my personal experiences with this material but so far …so good.

By David T. Harvey, MD, FAAD, FACP

Fractional CO2 Technology

Recently, I had the pleasure of lecturing to fellow colleagues at the Advances in Dermatologic Surgery  Meeting in West Palm Beach and demonstrating what I  believe to be one of the greatest advancements in cosmetic laser surgery…..Fractional CO2 Laser Technology.

CO2 Laser has been around for many years. In fact, I remember that the technique was just coming out as I was  finishing my dermatology residency in 1995. It was a revolutionary laser but had many problems. First off, patients would complain of the pain and downtime. they had to have IV or general anesthesia. Another issue was that these patients would look disfigured and red for up to 14 days. Then we saw the complications (and did we!).  Poor utilization and technique as well as “off label” uses lead to unintended scarring and in some instances permanent disfigurement.

I have over 10 years experience with the CO2 laser and what I love about the fractional CO2 technology is that it finally offers us some unique advantages over traditional CO2 laser including…predictable results, off face uses, less downtime, requires topical anesthesia only, is minimally painful and very affordable. I can report from my own personal experience that this technology is pretty painless. I had my eyelids treated at low settings and found the experience to be very tolerable (reporting a 1 to 3 out of 10 pain scale.. in some areas I did not even require a topical anesthetic).

Fractional CO2 laser makes use of tiny dots which penetrate the skin and cause a disruption of the middle portion of the skin known as the dermis. Through a combination of selective tissue evaporation and heating, the dermis remodels and tightens.. This treatment is excellent for acne scars, wrinkles, oil gland enlargement, neck and hand laxity and much more. We can even use this laser in a unique way for our eyelid surgery cases. It is quite an awesome tool!

In short, I am blogging the Fractional CO2 laser because I am truly a believer of the technology. If you don’t believe me, check out our before and after pics and research the technology on your own. I am sure that you will be amazed like I was… in short order.