Cosmetic Treatments with Energy-Based Devices in Skin of Color.

The use of energy-based devices in cosmetic treatments for patients with higher Fitzpatrick skin types is a topic of concern due to the increased risk of complications such as hyperpigmentation and scarring. Advancements in technology have enabled the development of safe and effective energy-based modalities for improving skin tone, texture, and signs of aging in patients with higher Fitzpatrick skin types. This article reviews various modalities that have shown positive outcomes in Fitzpatrick skin types 4 to 6.Radiofrequency (RF) skin tightening devices have emerged as a noninvasive method for improving skin laxity by stimulating collagen and elastin production without generating excessive heat, making them suitable for darker skin tones. Microfocused ultrasound (MFUS) is another noninvasive option for skin tightening and lifting. By producing thermal coagulation in the deeper layers of the skin, MFUS stimulates collagen production, resulting in improved skin tightness. Fractional laser resurfacing, both ablative and nonablative, offers effective treatment options for various concerns such as acne scars, skin texture, and dyspigmentation. Nonablative fractional lasers, which target water rather than melanin, are particularly safer for darker skin types. Broadband light devices that emit different wavelengths have shown success in skin rejuvenation, improving wrinkles, pore size, erythema, telangiectasias, and dyspigmentation. Additionally, RF microneedling combines the benefits of both modalities, delivering safe treatment for skin laxity and textural concerns. The short-pulse neodymium-doped yttrium aluminum garnet (Nd:YAG) laser has become a transformative tool for patients with Fitzpatrick skin types 4 to 6. This laser targets melanin, hemoglobin, and water, providing improvements in hyperpigmentation, acne, fine lines, and scar texture. Combining the short-pulse Nd:YAG laser with other treatments like chemical peels or microneedling has shown synergistic effects and enhanced outcomes. Understanding these modalities and tailoring treatments to specific concerns is crucial for safe and effective solutions in patients with higher Fitzpatrick skin types.

Combining Laser Resurfacing and Facial Rejuvenation Surgery.

Facial aging is a multifactorial process involving skin laxity, volume loss, facial rhytids and solar elastosis. Surgical interventions can address the laxity of the skin and restore volume loss but do not fully correct the texture of the skin. Historically, there were concerns over the safety of combining laser resurfacing with facelifting procedures, but now there is much evidence to support the safe use of this combination treatment. When done appropriately, the combination of laser resurfacing with facial rejuvenation surgery can provide a synergistic effect for optimal clinical results. Here, we review the many laser options available and how they may be combined safely with surgical facial rejuvenation. We also review clinical contexts and candidate selection to provide safe, reliable results and minimize complications.

Microcannula Injection of Large Gel Particle Hyaluronic Acid for Cheek Augmentation and the Correction of Age-Related Midface Contour Deficiencies.

BACKGROUND: There is a growing trend toward the use of blunt-tip microcannulas for the treatment of midface volume loss with injectable hyaluronic acid. OBJECTIVE: To evaluate the safety and efficacy of large gel particle hyaluronic acid with lidocaine, injected with a blunt-tip microcannula, for cheek augmentation and the correction of age-related midface contour deficiency. MATERIALS AND METHODS: Sixty subjects with mild to substantial loss of midface fullness were treated to optimal correction. Adverse events (AEs) were obtained during each examination visit. Efficacy was evaluated using the Global Aesthetic Improvement Scale, the Medicis Midface Volume Scale (MMVS), and the FACE-Q subject satisfaction questionnaire through 16 weeks. RESULTS: Five AEs were reported, with only one being considered injection procedure-related (mild presyncope). No serious AEs were reported. Global aesthetic improvements were reported for the majority of subjects (≥98.3% for investigator-assessed and ≥91.5% for subject-assessed) for up to 16 weeks. At 8 weeks, the MMVS responder rate was 100% and subject satisfaction scores (5/6 questions) in the FACE-Q were ≥91.5%. CONCLUSION: Hyaluronic acid with lidocaine, injected with a blunt-tip microcannula, has a favorable safety profile and is effective up to 16 weeks for cheek augmentation and the correction of age-related midface contour deficiencies (NCT03160716).

Mycotic pseudoaneurysm of the internal maxillary artery: case report and review of the literature.

Pseudoaneurysms of the internal maxillary artery are rare entities that are most commonly caused by trauma. Herein we report a novel case of an internal maxillary artery pseudoaneurysm of infectious etiology and discuss the diagnosis and treatment of this disease.

Skin Care.

Aging skin is among the most common patient concerns in a facial plastic surgery practice. Ultraviolet (UV)-induced damage expedites the pace of intrinsic aging, resulting in many of the visible signs of aging, such as rough skin texture, pigmentation irregularities, fine and deep wrinkling, and inelasticity. Primary prevention of UV and environmental damage with proper skin care and the use of sunscreen are critical. There is great interest in topically applied products to reverse or delay the visible signs of photoaging. We discuss the most common topically applied agents for photoaging, reviewing their mechanisms and supporting evidence.

Predictors of satisfaction with facial plastic surgery: results of a prospective study.

OBJECTIVE: To identify demographic and psychological factors that predict satisfaction or dissatisfaction with outcomes among patients undergoing facial plastic surgery. METHODS: All patients presenting to the Center for Facial Cosmetic Surgery at the University of Michigan between January 1, 2007, and January 1, 2008, were asked to participate. Patients answered an initial baseline survey consisting of demographic information and an assessment of their baseline level of optimism/pessimism in addition to a surgery-specific outcome questionnaire both preoperatively and 4 to 6 months postoperatively. RESULTS: Fifty-one patients (mean [SD] age, 53 [13.0]; 69% female; 98% white) participated. Patients over the mean age of 53 years were more satisfied with their results than those under the mean age (P = .01). Patients currently being treated for depression were more satisfied with surgical outcomes than those not being treated (P = .05). No correlation was identified between baseline optimism/pessimism or other baseline factors and patients' perceived surgical outcomes. Surgeons were decidedly less positive in their assessment of the outcome than patients. CONCLUSION: Despite a priori hypotheses that patients treated for depression might be more pessimistic and rate their satisfaction lower than other patients, patients treated for depression show a trend toward greater satisfaction from facial plastic surgical procedures than those not treated for depression.

Clinical outcomes of chronic rhinosinusitis in response to medical therapy: results of a prospective study.

BACKGROUND: Little information exists regarding the outcome of medical management of chronic rhinosinusitis (CRS) in adults. The aim of this study was to examine whether baseline patient demographics, symptoms, objective findings, or treatment strategies were associated with improved CRS outcomes over time. METHODS: Eighty-four new patients with CRS were evaluated and medically treated for up to 12 months. Patients completed monthly health status questionnaires. The average change of symptom scores using the Sino-Nasal Outcome Test plus one additional symptom--sense of smell (SNOT-20+1)-was the primary outcome measure. RESULTS: Overall, patients experienced a modest improvement in SNOT-20+1 scores (delta = -0.61; p< 0.0001), but this did not reach the predetermined level of a clinically meaningful effect (delta = -0.80). Baseline facial pain or facial pressure was negatively associated with outcome (p = 0.048 and 0.029, respectively) and did not correlate with extent of disease by sinus CT scoring. Other factors, including nasal discharge, hyposmia, cough, nasal polyps, and sinus CT severity, did not predict outcomes. The use of either oral antibiotics or oral steroids was associated with trends toward improved outcomes only when sinus-specific symptoms alone were considered. CONCLUSION: The majority of CRS patients receiving medical treatment show modest improvement over time in SNOT-20+1 scores. Facial pain or facial pressure at entry are negatively associated with outcomes and may reflect causes other than CRS. These findings highlight the limitations of current medical treatment for CRS and the need for novel treatment strategies.