The Unhappy Cosmetic Patient: Lessons From Unfavorable Online Reviews of Minimally and Noninvasive Cosmetic Procedures.

BACKGROUND: The number of patients receiving minimally and noninvasive cosmetic procedures is increasing. Often, patients turn to online review forums to gain and share advice regarding cosmetic procedures. Understanding and discussing patient-reported outcome data can help align physician and patient expectations and ultimately help improve the patient experience. OBJECTIVE: To determine the most common reasons patients are dissatisfied with a selection of minimally and noninvasive cosmetic procedures. MATERIALS AND METHODS: Negative patient reviews from the RealSelf.com website were analyzed, and the reason for patient discontent was recorded for the following treatments: tissue stabilized-guided subscision, cryolipolysis, electromagnetic therapy, deoxycholic acid injections, energy-induced thermolysis, radio thermoplasty, threadlifts, and ultrasound therapy. RESULTS: One thousand two hundred four reviews were included in analysis. For all treatments analyzed, the most common reason for patient dissatisfaction was ineffectiveness (n = 782, 65.0%), followed by complications (n = 301, 25.0%). The most common complications were as follows: lumps for tissue stabilized-guided subscision (n = 6, 50.0%), treated area enlargement for cryolipolysis (n = 23, 22.1%), swelling for deoxycholic acid injections (n = 9, 47.4%), numbness for energy-induced thermolysis (n = 6, 35.3%), fat loss for radio thermoplasty (n = 26, 53.1%) and ultrasound therapy (n = 32, 48.5%), and indentations for threadlifts (n = 10, 30.3%). CONCLUSION: Ineffectiveness and complications were the most common reasons for dissatisfaction among all treatments analyzed. Patient-reported outcome data may offer insight into how physicians can improve their patient's satisfaction with cosmetic procedures.

Common Skin Disorders in Pediatric Skin of Color.

Children with skin of color represent a large proportion of the pediatric population. There are numerous skin conditions that commonly occur in this population, including but not limited to acne, atopic dermatitis, pityriasis alba, tinea versicolor, progressive macular hypomelanosis, traction alopecia, and confluent and reticulated papillomatosis. This article highlights the clinical presentations of these conditions in skin of color and briefly addresses pathophysiology and treatment modalities.

Independent Variables Affecting Outcome of Carpal Tunnel Release Surgery.

BACKGROUND: In making the decision to undergo carpal tunnel release (CTR), patients may consider probability of symptom resolution. Prior studies have examined potential preoperative variables that might influence the postoperative outcome. Few studies, however, contain the sample size, prospective design, and high participant completion rate to provide solid data from which to counsel patients. The purpose of this study was to prospectively evaluate factors that have been implicated or dismissed in past studies as sources of outcome variation following CTR surgery and provide patient-relatable facts that the surgeon might use in preoperative patient counseling. METHODS: One thousand thirty-one consecutive patients undergoing open CTR were prospectively enrolled. Preoperative frequency of daytime numbness, nighttime awakening, and duration of symptoms were recorded in addition to physical exam, height, weight, gender, history of diabetes, history of thyroid disease, and severity of electrodiagnostic findings. After surgery, patients reported percent resolution of numbness at defined intervals. RESULTS: Age and gender are the only independent factors that predict the degree of resolution of numbness 6 months following surgery. All other studied variables are not independent factors nor are any paired combinations of factors. Below the age of 50, the average reported resolution of daytime numbness by 6 months is 97.3% (men 91.8% and women 99.4%). After age 50, there is a linear 0.77% decline in average resolution of daytime numbness per year. CONCLUSIONS: Age and gender but no other studied factors predict resolution of daytime numbness in a multivariate model of patients undergoing CTR.

Ultrasound Imaging Improves Identification of Prominent Hardware in the Surgical Treatment of Distal Radius Fractures: A Cadaveric and Prospective Clinical Study.

Background Volarly applied locking plates are one of several current treatment options for displaced fractures of the distal radius. Presently, surgeons use intraoperative depth gauges and fluoroscopy to select and confirm proper screw length. The contour of the dorsal cortex beneath the extensor compartments along with fracture comminution may limit the accuracy of screw length selection. Question/Purpose To evaluate the accuracy of ultrasound (US) and fluoroscopy in the detection of dorsally prominent screws placed during volar plating of experimentally created distal radius fractures and extend this prospectively into the clinical setting. Patients and Methods Distal radius fractures were experimentally induced in fresh cadaveric arms. The fractures were then internally fixated with volar locking plates utilizing fluoroscopic imaging. US imaging of the dorsal surface of the radius was then performed followed by dorsal dissection and direct caliper measurements to quantitate screw tips as recessed, flush, or protruding from the dorsal cortex. A small, prospective clinical study was also conducted to validate the clinical usefulness of using US to provide additional information regarding screw tip prominence. Results Our study demonstrated that US was able to detect dorsally prominent screw tips not visible on fluoroscopy. Cadaveric dissection showed a higher statistical correlation between US imaging and actual prominence than between fluoroscopy and actual prominence. Conclusions US examination after volar plate fixation of comminuted distal radius fractures may detect dorsal screw tip prominence when screw lengths are selected to engage the dorsal cortex. Level of Evidence IV.