Experiences With Counterfeit Aesthetic Medical Devices and Injectables: A National Survey.

BACKGROUND: Counterfeit medical devices and injectables have recently garnered interest in the field of aesthetics. Unlike their original counterparts, these counterfeit products have neither been tested nor verified using certified quality control measures. OBJECTIVE: Our study investigated the pervasiveness of counterfeit products in the field as well as the experiences and attitudes of practitioners. MATERIALS AND METHODS: An online survey was distributed to current members of the American Society for Dermatologic Surgery (ASDS) and the American Society for Laser Medicine and Surgery (ASLMS). RESULTS: For medical devices, 37.4% have encountered counterfeits and 20.1% have experienced patients with adverse events from them. For injectables, 41.1% have encountered counterfeits and 39.7% have experienced patients with adverse events from them. Compared with their original, most respondents believe that counterfeits are worse in terms of reliability, safety, and effectiveness. The majority also believe that counterfeits are either very or extremely endangering to patient safety. CONCLUSION: Counterfeit medical devices and injectables are not uncommonly encountered. Overall, practitioners believe counterfeits are endangering patient safety and result in adverse events and think that either stricter rules and regulations or better enforcement of existing regulations is necessary.

Utility of Preinjection Aspiration for Hyaluronic Fillers: A Novel In Vivo Human Evaluation.

BACKGROUND: Hyaluronic acid (HA) fillers have increased in popularity. While complications are rare, practitioners should focus on their prevention. Preinjection aspiration remains controversial as an effective safety checkpoint. OBJECTIVES: Our study investigated the utility of preinjection aspiration as a safety checkpoint for HA fillers through comparison of physiochemical and rheological properties in a novel in vivo human model. METHODS: An in vivo human model consisted of a cannula inserted into a peripheral vein. Preinjection aspiration was evaluated using syringes of 10 commonly used HA fillers. The time required to visualize a flash was recorded. RESULTS: Using a multivariable regression model, needle gauge, HA concentration, elastic modulus (G'), viscous modulus (G″), and complex modulus (G*) had significant relationships with time to flash, whereas pullback volume did not. However, when comparing pullback volume using a more appropriate paired analysis, 0.5 cc pullback volume had a significantly decreased time to flash than 0.2 cc. CONCLUSIONS: Preinjection aspiration for HA fillers has utility as a safety checkpoint. The times to visualize flashback decreased when using a human peripheral vein model compared to a previous in vitro model, suggesting that there may be real-time clinical utility of preinjection aspiration. Waiting times to visualize flashback may be affected by physiochemical and rheological properties. Additional studies would help to validate our results.

Koebner phenomenon: pemphigus vulgaris following Mohs micrographic surgery.

Koebnerization of pemphigus vulgaris (PV) is an infrequently reported reaction. We present a 65-year-old man with Koebnerized pemphigus vulgaris after Mohs microscopic surgery for a basal cell carcinoma. We present this case to heighten awareness of the phenomenon in the dermatological community.

Diagnosis and treatment of low-risk superficial basal cell carcinoma in a single visit.

INTRODUCTION: Surgical excision remains the most commonly utilized treatment for superficial basal cell carcinoma (sBCC). In the era of cost containment of healthcare, the rising incidence of BCC and the high cost of excision require a continuous search for efficient and cost-effective management. OBJECTIVE: Examine the feasibility of the diagnosis and treatment of low-risk sBCC in a single visit. MATERIALS AND METHODS: Retrospective chart review of sBCCs diagnosed and treated in a single visit. RESULTS: The study identified 151 histologically confirmed sBCCs in 86 patients over a 5-year period, 93 (61.6%) cases of which were diagnosed as low-risk sBCC and treated in a single appointment. The majority of the cases (n = 86) were treated with curettage alone and the rest (n = 7) with a shave removal technique. The average size of the lesion was 0.82 cm located primarily on the trunk and extremities (95.7%). One recurrence on the trunk was observed in the single appointment group. Overall, diagnostic sensitivity was 95.4% and specificity was 92.0%. CONCLUSIONS: Diagnosis and treatment of sBCC in a single visit is an efficient and cost-effective management option for those who are proficient in identifying low-risk sBCC.

Tripeptide/Hexapeptide Topical in Esthetics: Evidence behind the Skincare Formulation.

The skincare market, which is projected to be worth over $180 billion by 2024, has experienced a recent rise in formulations utilizing peptides. These products have been marketed to consumers as offering many esthetic benefits. We review the literature for a tripeptide and hexapeptide formulation that has been shown to offer improved healing and clinical outcomes in conjunction with resurfacing and cryolipolysis, as well as demonstrating benefit for cutaneous rejuvenation.

Utility of Tumor Capsule Thickness as a Predictor of Invasion in Encapsulated Follicular Variant of Papillary Thyroid Carcinoma and a Diagnostic Tool for Noninvasive Follicular Thyroid Neoplasm With Papillary-Like Nuclear Features.

Context. Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) is an extremely indolent subset of noninvasive encapsulated follicular variant of papillary thyroid carcinoma (EFVPTC). These lesions share certain features including a delimiting fibrous capsule, and they are distinguished by detailed histological criteria. Objective. We sought to identify whether tumor capsule thickness differs significantly between NIFTP and noninvasive EFVPTC lesions. We also compared tumor capsule thickness between noninvasive and invasive EFVPTC in order to evaluate its utility as a predictive marker of invasion. Design. Encapsulated follicular thyroid neoplasms with papillary-like nuclear features diagnosed over a 3-year period at a single institution were subcategorized into NIFTP, noninvasive EFVPTC, and invasive EFVPTC based on current diagnostic criteria. Maximum tumor capsule thickness for each lesion was measured. Results. A total of 92 lesions (39 NIFTP, 15 noninvasive EFVPTC, and 38 invasive EFVPTC) were evaluated. Tumor capsule thickness was significantly thinner in NIFTP (P = .022) and significantly thicker in invasive EFVPTC (P = .0006) when compared with noninvasive EFVPTC. Conclusions. Tumor capsule thickness may be an additional useful marker when distinguishing between NIFTP and noninvasive EFVPTC. A capsule thickness of greater than 0.2 mm should raise suspicion for EFVPTC and thus prompt more thorough review of the submitted tissue for NIFTP exclusionary criteria. Additionally, if capsular and/or vascular invasion are not present on initial slides of an entirely evaluated capsule of EFVPTC that exceeds 0.5 mm in thickness, the pathologist should order additional tissue levels to ensure that a small focus of invasion is not missed.

Platelet-rich plasma for facial rejuvenation: An early examination.

Platelet-rich plasma (PRP) has become a popular and trendy treatment in dermatology for various skin ailments, most notably for acne scars, traumatic scars, hair regrowth, and cutaneous rejuvenation. Although PRP has been utilized in the world of orthopedics for many years, its recent entry into dermatology has been wrought with controversy, especially as some have marketed it to consumers as a type of cure-all; however, the studies behind PRP treatment, especially for cutaneous rejuvenation, are currently limited, while we await additional larger studies. Clinicians should have an understanding of the evidence behind such new trends, especially in the fast-pace world of esthetics.

Variations in pain perception during the menstrual cycle: implications for esthetic procedures.

Variations in pain perception have long been studied in the medical literature, especially for women in regards to their menstrual cycle. Anecdotally, women can be more sensitive to painful stimuli from cosmetic procedures during their menses; however, no studies have thoroughly examined variations in pain perception for women in esthetic medicine. In an effort to look into this phenomenon, we review the current literature on this topic by examining studies from other medical subspecialties and also discuss implications for clinical practice.