Emerging off-label esthetic uses of botulinum toxin in dermatology.

Botulinum toxin is a neurotoxic protein produced by Clostridium botulinum, the bacterium responsible for botulism. Botulinum toxin was first used for therapeutic indications in the 1970s for the treatment of strabismus. With greater understanding of its underlying physiology and safety profile, the use of botulinum toxin has now expanded to a range of cosmetic and medical indications. We performed a systematic review of current literature on the applications of botulinum toxin on off-label esthetic uses. Electronic databases were searched for original published studies including randomized trials, observational or cohort studies, as well as relevant case reports. To add to the body of evidence, our review summarizes and synthesizes key study characteristics, results, and level of evidence for each use case. Although the body of evidence remains weak, there is increasing support for the use of botulinum toxin in emerging off-label esthetic uses of botulinum toxin in dermatology.

Brief Educational Video Improves Patient Understanding of Mohs Surgery: A Randomized Controlled Trial.

BACKGROUND: Patient's retention and recall of material discussed in a medical consultation is often inadequate. OBJECTIVE: To assess patient's knowledge, anxiety, and understanding of Mohs surgery after viewing a brief educational video. METHOD: A prospective, investigator-blinded, randomized controlled trial of 120 consecutive patients before the first Mohs surgery procedure. Sixty subjects viewed an instructional video and 60 subjects did not. A survey was administered to both groups, measuring knowledge, anxiety, and understanding of Mohs surgery. RESULTS: The video group scored higher than the control group on the knowledge portion of the survey (median score 78% vs 56%, p < .01), but there were no differences in anxiety or understanding scores between groups. The percentage of subjects who answered each knowledge question correctly was greater in the video group than in the control group. In the subgroup of patients who had not previously had a consultation with a Mohs surgeon, the video group had higher median knowledge scores (67% vs 44%, p < .01), higher median understanding scores (8 vs 6, p = .05), and lower median visual analogue anxiety scores (4 vs 6, p = .01) compared with the control group. CONCLUSION: A brief educational video increases patient's knowledge of Mohs surgery. For patients who have not yet had a consultation with a Mohs surgeon, the video may also reduce anxiety.

A survey of long-term results with microwave energy device for treating axillary hyperhidrosis.

Microwave energy technology treats axillary hyperhidrosis through thermolysis of the apocrine and eccrine glands. Successful short-term reduction of sweating has been studied, but there is limited information on long-term efficacy and safety. To evaluate patient satisfaction with microwave energy device for axillary hyperhidrosis performed within the last 5 years. From June to August 2019, a standardized telephone survey was conducted of 24 patients who received microwave energy device treatment for bilateral axillary hyperhidrosis between June 2014 and June 2018. Demographic information, previous treatment modalities, sweat reduction scores, and side effects were reported. Eighteen patients completed the survey with a mean follow-up of 38 months (range 12-52). The mean hyperhidrosis disease severity scale (HDSS) was reduced by 1.6 (95% CI 1.2-2.0, p < .01). The mean sweat reduction was 61-70%. Sixty-seven percent of patients experienced a reduction in odor and 54% did not require deodorant after treatment. Adverse effects included bruising (67%), pain (56%), swelling (44%), numbness (28%), and nodules (22%). Sixty-six percent of side effects resolved within 2 weeks and all side effects resolved within 12 weeks. The microwave energy device is an effective, durable therapy for axillary hyperhidrosis associated with minimal downtime and a high degree of long-term patient satisfaction.

Buccal Fat Pad Reduction With Intraoperative Fat Transfer to the Temple.

There is now a growing trend for buccal fat pad reduction in patients who desire a decrease in midface and lower face volume, refinement, sculpting, or enhancement of facial features. The buccal fat pad is connected to the temporal fat, and therefore buccal fat pad reduction can result in volume depletion of the temporal fossae. In addition, most patients undergoing this procedure already have pre-existing temporal volume depletion due to aging. We describe a technique in which we remove part of the buccal fat pad and transfer the fat to the temple to achieve aesthetically pleasing facial contouring.