Minimally Invasive Injectable Cosmetic Procedures Increase Feelings of Authenticity.

BACKGROUND: Minimally invasive cosmetic dermatology procedures continue to be increasingly popular; however, the extant literature has poorly documented the psychological antecedents of interest in cosmetic procedures and their psychological consequences. OBJECTIVE: To better inform dermatologists on their patients' motivations for cosmetic enhancement. MATERIALS AND METHODS: In a general population survey, an online representative sample of 984 Americans reported the extent to which they feel authentic using the validated authenticity scale and whether they were interested in undergoing a cosmetic procedure. In a prospective dermatology office survey, 102 participants reported their feelings of authenticity immediately before and 2 weeks after receiving a minimally invasive injectable cosmetic procedure. RESULTS: In the general population survey, participants interested in cosmetic procedures felt significantly less authentic than participants who were not interested ( p = .003). In the prospective dermatology office survey, participants felt significantly more authentic 2 weeks after their minimally invasive injectable cosmetic procedure than before ( p = .018). CONCLUSION: Lower feelings of authenticity are associated with interest in cosmetic procedures. Participants felt more authentic 2 weeks after receiving a minimally invasive injectable cosmetic procedure. Cosmetic procedures may present patients with an opportunity to feel more like their real, genuine selves.

Patient satisfaction and our clinical experience with 459 microfocused ultrasound treatments.

PURPOSE: Microfocused ultrasound (MFUS) is a safe and effective method for noninvasive skin tightening. Previous clinical studies demonstrate a 60-100% patient satisfaction after MFUS. We used an anonymous online platform after MFUS to assess patient satisfaction. DESIGN: Patients treated with MFUS between January 2013 and 2016 were invited to complete an anonymous online survey at least 4 months post-treatment. Patients were asked to rate improvement in skin tightening as none (0%), mild (0-25%), moderate (26-50%), significant (51-75%), or dramatic (76-100%) and treatment satisfaction as disappointed, neutral, satisfied, or extremely satisfied. SUMMARY: Between January 2013 and 2016, 253 patients received 459 MFUS treatments at our center. A total of 83 surveys were received with data. Nearly 80% of responders reported at least mild improvement, with 14.5% indicating significant improvement, 27.7% indicating moderate, 37.3% indicating mild, and 20.5% indicating none. In addition, 53.1% of responders reported being satisfied or extremely satisfied with the results. 44.6% of responders did not feel treatment results met expectations. CONCLUSION: Patient satisfaction with elective cosmetic procedures is an important indicator of success. Our current study demonstrates a high response rate, with almost 80% of responders indicating at least mild tightening with MFUS treatment. Interestingly, only 53.1% of patients reported satisfaction after treatment, a lower satisfaction rate than reported in previous non-anonymous studies and lower than patients report in our office follow-up appointments. This discrepancy may be due to gratitude bias. Anonymous surveys likely provide a more accurate assessment of patients' perceptions and will improve physician's future counseling efforts. Lasers Surg. Med. 51:495-499, 2019. © 2019 Wiley Periodicals, Inc.

Necrobiotic xanthogranuloma of the extremities with paraproteinemia and without periorbital involvement at presentation.

We report a rare case of necrobiotic xanthogranuloma (NXG) of the extremities with paraproteinemia and without periorbital involvement at presentation in a 58-year-old white woman. A combination of oral cyclophosphamide and oral dexamethasone was attempted, but the patient then developed a left intraorbital lesion. Treatment was not successful in that the gammopathy did not improve and the patient continued to develop more lesions.

Improvement in arm and post-partum abdominal and flank subcutaneous fat deposits and skin laxity using a bipolar radiofrequency, infrared, vacuum and mechanical massage device.

BACKGROUND AND OBJECTIVES: Skin laxity of the body is a growing cosmetic concern. Laxity can result from chronological or photoaging and changes in body dimensions during pregnancy or weight loss. The end result is loose, sagging skin, and localized fat deposits. Liposuction and abdominoplasty or brachioplasty are established approaches to these issues. Patient desire for alternatives to surgical correction has spawned the development of non-invasive body contouring devices. The combination of infrared light (IR), bipolar radiofrequency (RF), vacuum and mechanical massage (Velashape, Syneron Medical Ltd, Israel) has demonstrated efficacy in improving skin appearance and circumference of the thighs [Goldberg et al., Derm Surg 2008; 34:204-209; Fisher et al., Derm Surg 2005; 31:1237-1241; Arnoczky and Aksan, J Am Acad Orthop Surg 2000; 8:305-313; Alster and Tanzi, J Cosmetic Laser Therapy 2005; 7:81-85; Wanitphakdeedecha and Manuskiatti, J Cosmet Dermatol 2006; 5:284-288; Nootheti et al., Lasers Surg Med 2006; 38: 908-912], but only anecdotal evidence has supported its use on other anatomic locations. This study was designed to evaluate the efficacy and safety of Velashape on additional body sites and more rigorously examine the technology's impact on upper arm as well as abdominal and flank circumference. STUDY DESIGN AND METHODS: Subjects were 28-70 years old, skin types I-V. Nineteen subjects underwent 5 weekly treatments of the upper arms, and 10 subjects underwent 4 weekly treatments of the abdomen and flanks. Treatments were performed using Velashape. Circumference measurements, photographs, and subject weights were performed prior to treatment and at 1- and 3-month follow-ups. Subjects were asked to record their treatment satisfaction level. RESULTS: Change in arm circumference, at the 5th treatment was statistically significant with a mean loss of 0.625 cm. At 1- and 3-month follow-ups, mean loss was 0.71 and 0.597 cm respectively. Reduction of abdominal circumference at 3rd treatment was statistically significant with a 1.25 cm mean loss. At 1- and 3-month follow-ups, average loss was 1.43 and 1.82 cm respectively. CONCLUSIONS: This study demonstrates with statistical significance, sustainable reduction in circumference and improvement in appearance of arms and abdomen following treatment with Velashape.

Outcomes of childhood hemangiomas treated with the pulsed-dye laser with dynamic cooling: a retrospective chart analysis.

BACKGROUND: Laser treatment of childhood hemangiomas remains controversial. Previous studies have used outdated technology, resulting in a potential overrepresentation of adverse outcomes. OBJECTIVE: To evaluate outcomes of hemangiomas treated with the most current laser technology. METHODS: A retrospective chart analysis of 90 patients with a median age of 3.0 months and a total of 105 hemangiomas were enrolled over a 2.5-year period. All were treated with the 595-nm long-pulse pulsed-dye laser (LP-PDL) with dynamic epidermal cooling at 2- to 8-week intervals depending on the stage of growth. Exclusion criteria were previous laser, surgical, or corticosteroid treatment. Three reviewers assessed outcomes. RESULTS: Near-complete or complete clearance in color were achieved for 85 (81%) and in thickness for 67 (64%) hemangiomas. There was no scarring or atrophy. Ulceration occurred in one case and resolved during treatment. Hyperpigmentation and hypopigmentation occurred in 4% and 14% of hemangiomas, respectively. CONCLUSION: Early treatment of childhood hemangiomas with the 595-nm LP-PDL with dynamic cooling may reduce the proliferative phase and result in excellent rates of clearing and few adverse events.

Radiofrequency devices for body shaping: a review and study of 12 patients.

Radiofrequency (RF) devices such as ThermaCool TC (Solta Medical Inc., Hayward, CA) offer a nonablative and noninvasive treatment option for unwanted skin concerns of the head, neck, and body. Relatively fewer studies address RF treatment on the body when compared with the head and neck. The purpose of this report is to investigate the use of the ThermaCool TC system with the novel Thermage Multiplex Tip for the enhancement of body shape. Additionally, this report will review the literature of RF technology with a concentration on body shaping. Twelve subjects underwent ThermaCool TC treatments using the Thermage Multiplex Tip. Waist circumference, standardized photographs, skin laxity score, global aesthetic improvement score, and patient satisfaction surveys were assessed at baseline and several follow-up visits after treatment. Average waist circumference and skin laxity scores decreased after ThermaCool TC treatment, using the Thermage Multiplex Tip at follow-up visits held at 1, 2, 4, and 6 months after treatment. Global aesthetic improvement score and patient satisfaction surveys reflected these objective clinical improvements. RF devices, such as the ThermaCool TC offer a nonablative and noninvasive treatment option for unwanted skin findings of the head, neck, and body.

The safety and efficacy of fractional photothermolysis for the correction of striae distensae.

BACKGROUND: Improving the appearance of striae distensae, particularly striae alba, has remained a challenge due to the limited availability of effective and low-risk treatment options. Fractional photothermolysis, a novel concept in skin rejuvenation, has been reported to be effective in the treatment of facial rhytides, acne scars, and surgical scars, but its use in the treatment of striae has not been well studied. OBJECTIVE: To determine the safety and efficacy of fractional photothermolysis treatment on striae alba and striae rubra. METHODS: Twenty female patients with striae rubra or striae alba on their abdomen, thighs, or buttocks were enrolled in the study. Lesions were randomized to receive treatment, with site-matched normal control areas. Patients received a total of 6 treatments using a 1550-nm, erbium-doped fiber laser with 2 to 3 weeks of elapsed time between treatments. Clinical response to treatment was assessed at each visit, and at 1-month, 2-month, and 3-month follow-up intervals by the patient and investigator. A comparison evaluation of 8 patients examining photographs of striae at baseline and at the 3-month follow-up evaluation which was assessed by 4 independent dermatologists using the quartile grading scale. RESULTS: The independent evaluators' assessments of improvement from photographs of 8 randomly selected patients showed an overall improvement of 26% to 50% in 63% (5/8) of patients. A less than 25% improvement in dyschromia was noted in 50% (4/8) of patients. An improvement in texture of 26% to 50% was observed in 50% (4/8) of patients. The clinical responses were independent of age, gender, and skin phototype. The treatments were tolerated well by all patients with a majority of patients experiencing transient posttreatment erythema and edema. CONCLUSION: Fractional photothermolysis can be effectively and safely used in the treatment of striae rubra and striae alba.

Eyelid tightening and improved eyelid aperture through nonablative fractional resurfacing.

BACKGROUND AND OBJECTIVE: The effects of fractional resurfacing on eyelid tightening and aperture are unknown. Our purpose was to retrospectively examine the potential for eyelid tightening and eye-aperture opening in patients treated with nonablative fractional resurfacing for facial photorejuvenation. STUDY DESIGN/MATERIALS AND METHODS: Fractional laser treatments using a 1,550-nm erbium-doped fiber laser system on the upper and lower eyelids were given at a pulse energy of 17 to 20 mJ at 125 micro-thermal zones (MTZ)/cm(2) to a final density of 500 to 750 MTZ/cm(2). Each patient had 3 to 7 treatments. Standard pre- and post-treatment photographs were taken at each visit. Physicians who graded 31 preselected patient photographs using a 4-point scale evaluated eyelid tightening. Increase in eyelid aperture was also evaluated. RESULTS: All patients had some degree of eyelid tightening; 19% achieved 1% to 25% tightening, 26% achieved 25% to 50%, 26% achieved 50% to 75%, and 29% achieved 75% to 100%. Increase in eyelid aperture was seen in 55.9% of patients. Postoperative wounding, hypopigmentation, hyperpigmentation, persistent erythema, and scarring were not observed. All patients experienced mild or no edema for a few days after treatment. CONCLUSION: Fractional resurfacing tightens and increases eyelid aperture without wounding, downtime, or long-term complications.

Successful treatment of acneiform scarring with CO2 ablative fractional resurfacing.

BACKGROUND: Acneiform scarring after severe episodes of acne is a common cosmetic concern, treatable by a variety of modalities with varying degrees of success. Ablative CO(2) laser resurfacing, while effective, is associated with an undesirable side effects profile, lengthy recovery period, and risk of infection as well as potential pigmentary alterations. Newer modalities using the principles of fractional photothermolysis (FP) create patterns of tiny microscopic wounds surrounded by undamaged tissue beneath the skin with an erbium-doped 1,550 nm laser. These devices produce more modest results in many cases than traditional carbon dioxide (CO(2)) lasers but with fewer side effects and shorter recovery periods. A novel ablative 30 W CO(2) laser device uses a technique called ablative fractional resurfacing (AFR), combines CO(2) ablation with a FP system. METHODS: Thirteen subjects (skin types I-IV, aged 28-58 years) with moderate to severe acne scars underwent two or three treatments with the AFR device at 1-2 months intervals. Post-treatment erythema and edema as well as improvements in texture, atrophy, and overall satisfaction with appearance were graded on a quartile scale by subjects and investigators after each treatment and 1 and 3 months after the final treatment. Petechiae, oozing and crusting, dyschromia, and scarring were graded as present or absent 3 days, 1 week, 1 month, and 3 months following each treatment. A three-dimensional optical profiling system (Primos imaging) was used to generate a high resolution topographic representation of the acneiform scar in order to measure the depths of 10 scars from each cheek prior to the first treatment and 3 months after the last treatment. RESULTS: Post-treatment side effects were mild to moderate and transient, resolving rapidly within the study period. No delayed onset hypo-pigmentation or permanent scarring was observed. Quartile grading scores correlating to at least 26-50% improvements in texture, atrophy, and overall improvement were noted in all patients. Primos topographic analysis showed that all patients had quantifiable objective improvement in the depths of acneiform scars that ranged from 43% to 79.9% with a mean level of improvement of 66.8%. CONCLUSION: Successfully combining ablative technology with FP, AFR treatments constitute a safe and effective treatment modality for acneiform scarring.

Efficacy of early treatment of facial port wine stains in newborns: a review of 49 cases.

BACKGROUND: Port wine stains (PWS) affect 0.3-0.5% of both sexes of newborns, usually occurring on the face. OBJECTIVE: To document safety and effectiveness of cryogen spray cooled, pulsed-dye laser at higher fluences than previously used to lighten facial PWS in infants < or =6 months, and establish that frequent treatment early in life yields better clearance than if delayed until later in life. MATERIALS AND METHODS: Forty-nine infants who had been treated with pulsed-dye laser treatments for facial PWS at < or =6 months were identified by case review of photographs, age, sex, PWS severity score prior to laser treatment, number of treatments, and improvement following laser therapy. RESULTS: Patients averaged 9.3 (range 2-16) treatments at 4-6 week intervals at 7.75-9.5 J/cm(2). Average surface area treated was 24.0% with 88.6% average clearance after 1 year. Average clearance was 90.7% for lesions covering <20% surface area and 85.6% for lesions > or =20%. Location (V1, V2, V3, eye, and/or scalp), treated surface area, treatment number, and fluence predicted clearance. Average clearance for sole involvement of V1 was highest (at 93.8%), followed by V2 (at 91.1%), V3 (at 84.3%), V1/V2 (at 83.7%), V1/V2/V3 (at 81.0%), periocular (at 88.6%), and scalp (at 89.9%). All patients tolerated the higher treatment fluences without atrophy or scarring. DISCUSSION/CONCLUSIONS: Frequent, high energy pulsed-dye laser treatments are safe and highly effective in improving facial PWS in infants < or =6 months of age. Patients with PWS should be referred for pulsed-dye laser treatment during early infancy.

Broad area photodynamic therapy for treatment of multiple basal cell carcinomas in a patient with nevoid basal cell carcinoma syndrome.

We report a case of a 73-year-old man with nevoid basal cell carcinoma syndrome who was referred to us with multiple basal cell carcinomas on his face and chest. The patient underwent photodynamic therapy utilizing a 1-hour incubation of Levulan Kerastick delta-aminolevulinic acid 20% topical solution applied to the full face and illumination with a BLU-U blue light source (10 J/cm2) every 2 to 3 months for a total of 4 treatments. This treatment strategy resulted in multiple benefits, including reducing the number and size of his existing basal cell carcinomas, improving the appearance of previous surgical scars, and decreasing the rate of tumor development.

Our approach to pediatric dermatologic laser surgery.

BACKGROUND AND OBJECTIVES: Many pediatric dermatological conditions may be successfully treated with laser surgery. STUDY DESIGN/MATERIALS AND METHODS: The clinical approach to various pediatric dermatological conditions utilizing laser treatment options is discussed. RESULTS: Clinical uses of various modalities such as pulsed dye laser, KTP laser, Nd-YAG laser, Q-switched ruby laser, erbium-YAG laser, diode laser, non-coherent blue light sources, and fractional resurfacing are presented with successful parameters, developed over 22 years, utilized on a daily basis in a laser surgery clinic. CONCLUSION: Laser surgery can make a significant improvement in many pediatric skin lesions, thanks to the unique properties of pediatric skin and a vast array of laser technologies.

Excision of malignant melanoma overlying a pacemaker.

BACKGROUND: With the increasing number of patients with implantable cardiac devices, dermatologic surgeons must be increasingly familiar with the types of devices and potential interference by surgical procedures. OBSERVATIONS: We report the excision of a 1 cm malignant melanoma in situ occurring on the skin directly overlying the patient's pacemaker. CONCLUSIONS: Successful excision of malignant lesions in the setting of implantable cardiac devices requires an understanding of pacemaker implantation anatomy following well-established guidelines for electrosurgery in the setting of implantable cardiac devices and careful coordination with cardiac and anesthesia specialists.