Lara C. Pullen, PhD

March 24, 2015

People looking to freeze time and reduce the appearance of facial wrinkles might be able to harness the power of focused cold therapy, according to a study presented at the American Academy of Dermatology 73rd Annual Meeting in San Francisco.

The minimally invasive aesthetic treatment uses cold thermal injury to block the impulse control of motor nerves, leading to temporary muscle relaxation and a reduction in dynamic facial wrinkles.

"The bottom line is that this technology may offer a toxin-free option for interested patients, with near immediate results," investigator Jeremy Brauer, MD, from the Laser and Skin Surgery Center of New York in South Hampton, told Medscape Medical News.

In their study, Dr Brauer and his team evaluated the application of focused cold to the temporal branch of the facial nerve with a novel cryotherapy device in 63 patients. Of these, 32 patients were randomized to receive immediate treatment and 31, who served as the control group, were randomized to receive delayed treatment.

Blinded evaluators assessed patients with the validated 5-point wrinkle scale. They found that patients treated with focused cold had improvements in the short term and 30 days after treatment.

At day 30, 93% of the treatment group reported at least a 25% improvement in the appearance of their wrinkles, and 84% reported at least a 50% improvement.

Table. Wrinkle Outcomes at Day 30

Improvement Treatment Group, % Control Group, %
≥1 point 96.9 6.5
≥2 points 93.8 0.0


Investigator ratings revealed a sustained effect in 67% of patients at day 60.

There were no serious adverse events. The most common adverse effects were bruising, swelling, and pain on palpation, the majority of which were mild or moderate and resolved within 2 weeks.

Adverse events included headache (11.4%), eyelid or eyebrow drooping (4.5%), pain (4.5%), eyelid or eyebrow heaviness (2.8%), nausea (2.8%), and bruising (1.1%). All device- and procedure-related adverse events resolved during the follow-up period with no intervention or with over-the-counter medication.

"It will produce relaxation of the forehead without botulinum toxin," said Richard Glogau, MD, from the University of California at San Francisco, who was not involved in the study.

The focused cold approach has been in development for a while. The idea is that cold can create thermal injury. "It is pretty much an all-or-nothing phenomenon," he told Medscape Medical News.

Targeting the Nerves

Typically, when dermatologists use cold as therapy, such as when they treat warts, they are careful to not hit the nerves. In contrast, with focused cold therapy, the nerves are the target.

The concern with this therapy is whether the ice ball that forms in the tissue adversely affects the skin itself. It is important to avoid blistering and altered pigmentation.

The procedure has evolved, and now hollow needles are used to effectively drop the temperature only around the nerve. The effect "literally kicks in immediately," Dr Glogau explained.

Moreover, the procedure has the advantage of selectively affecting the frontalis nerve, which is somewhat counterintuitive, he pointed out. This makes it possible to selectively avoid dropping the eyebrows, a common effect of botulinum toxin.

Study device and funding was provided by Myoscience Inc. Dr Brauer and Dr Glogau have disclosed no relevant financial relationships.

American Academy of Dermatology (AAD) 73rd Annual Meeting: Abstract 1789. Presented March 21, 2015.


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