Aesthetic Outcomes of Nasal Burow's Grafts With Interdomal Sutures After Mohs Micrographic Surgery.

BACKGROUND: Post-Mohs reconstruction of distal nasal defects is challenging. Many repair options exist, each with advantages and disadvantages. Utilization of a Burow's graft in combination with manipulation of the underlying nasal cartilages with interdomal sutures is an underreported yet effective repair option. OBJECTIVE: To present the authors' experience with Burow's grafts facilitated by interdomal sutures for repair of nasal defects after Mohs micrographic surgery (MMS). MATERIALS AND METHODS: Patients who underwent repair with Burow's grafts and interdomal sutures from 2013 to 2017 at a single university were identified. Demographics, follow-up, and complications were recorded. Two independent, board-certified dermatologists evaluated photographs for cosmesis and alar symmetry. RESULTS: Thirty-one patients were identified. A total of 5/31 patients (16.1%) experienced minor complications without permanent sequelae. A total of 4/31 (12.9%) patients underwent cosmetic revision. No incidences of pincushioning, nasal valve dysfunction, or graft necrosis occurred. Aesthetic ratings were good to excellent with mean visual analog score of 80.8. Alar symmetry was excellent. CONCLUSION: A Burow's full-thickness skin graft facilitated by an interdomal suture to maintain nasal tip orientation and projection is an elegant repair technique for distal nasal oncologic defects with good to excellent aesthetic outcomes. It should be considered in the armamentarium for repair of distal nasal defects after MMS.

Treating acne scars in patients with Fitzpatrick skin types IV to VI using the 1450-nm diode laser.

Individuals with Fitzpatrick skin types IV to VI are becoming a larger proportion of our patient base. Although acne scarring can be difficult to treat in all skin types, it presents a greater challenge in darker skin types due to an increased risk for scarring and postinflammatory hyperpigmentation (PIH). Few studies have focused on infrared laser treatment of acne scarring in darker skin types. In this study, we assess the efficacy and side-effect profile of a 1450-nm diode laser for the treatment of acne scars in participants with Fitzpatrick skin types IV to VI. Our findings show the nonablative 1450-nm diode laser to be safe and effective in improving the appearance of atrophic acne scars in darker skin types. Postinflammatory hyperpigmentation was a common occurrence.

Localized dyskeratotic plaque with milia associated with sorafenib.

Sorafenib, a multitargeted kinase inhibitor used for the treatment of unresectable hepatocellular carcinoma and advanced renal cell carcinomas, received FDA approval in 2005. Since its introduction to the market, there have been various dermatologic side effects reported in the literature, the most well known being hand-foot skin reaction. This article presents a case of an atypical localized cutaneous eruption with an unusual course and protracted resolution time associated with sorafenib therapy.

A pilot study on the use of a plasma skin regeneration device (Portrait PSR3) in full facial rejuvenation procedures.

A new modality, the Portrait plasma skin regeneration (PSR(3)) system, allows precise and rapid treatment of photo-damaged skin, with controlled thermal injury and modification. Radio frequency (RF) energy converts nitrogen gas into plasma within the handpiece. Rapid heating of the skin occurs as the plasma rapidly gives up energy to the skin. This energy transfer is not chromophore dependent. The gold standard, carbon dioxide (CO(2)) laser resurfacing, has decreased in popularity due to high morbidity and downtime. There is demand for a technology that can provide the degree of improvement obtained with resurfacing without the complications associated with its use. This study evaluated the PSR(3) technology in full facial procedures. A two-site prospective study evaluated safety and efficacy for a single pass treatment of the full face using the Portrait PSR(3) system. Improvement in skin texture, tone, fine lines, dyschromia, and rhytides were assessed. Two-millimeter punch biopsy specimens were taken pre- and 90 days post-treatment. Follow-up was performed at days 2, 5, 7, 30, and 90 post-treatment to monitor recovery, improvement, and any subsequent sequelae. Patients developed erythema and edema shortly after treatment, with no immediate epidermal loss or charring. Epidermal loss occurred in the subsequent 24-48 h followed by epidermal recovery in approximately 7 days. Histological investigation showed regenerative epidermal and dermal architecture. The Rhytec Portrait PSR(3) system provides an attractive alternative to standard lasers that is well tolerated by patients, stimulates collagen remodeling, and provides excellent clinical outcomes.

Does laser inactivate botulinum toxin?

BACKGROUND: Botulinum toxin is a popular and effective treatment for dynamic rhytids. It is a neurotoxic protein complex that exerts its effect by inhibiting acetylcholine release at the presynaptic neuromuscular junction. Nonablative resurfacing treatments have also become well liked by patients and physicians owing to the minimal downtime associated with treatment. Currently, same-day nonablative laser treatments are performed prior to botulinum toxin injection owing to the concern that the laser may inactivate it. On occasion, it may be desirable to perform nonablative laser after the botulinum toxin has been injected (ie, patient afterthought, scheduling concern). OBJECTIVE: To determine whether the use of nonablative rejuvenation laser or intense pulsed light (IPL) immediately following botulinum toxin injections has any effect on the efficacy of the botulinum toxin treatment. METHODS: Nineteen subjects received botulinum toxin injections to either the glabellar or crow's-feet areas. One side of the treated glabellar or periorbital area was treated with either VBeam laser (Candela, Wayland, MA, USA), SmoothBeam laser (Candela), CoolGlide laser (Cutera, Brisbane, CA, USA), or an IPL or radiofrequency (RF) device within 10 minutes of botulinum toxin injection. Pretreatment and 2-week post-treatment photographs were compared. RESULTS: No decrease in the efficacy of botulinum toxin denervation was observed when glabellar or perioral areas were treated with VBeam laser, SmoothBeam laser, CoolGlide laser, or an IPL or RF device within 10 minutes of botulinum toxin injection. CONCLUSION: Patients may be treated with several nonablative lasers and IPL or RF devices immediately after botulinum toxin injection without loss of efficacy or other apparent untoward effect.

Botulinum toxin A treatment of perioral rhytides.

BACKGROUND: Botulinum toxin A is well documented as a useful therapy for smoothing dynamic facial rhytides of the upper face. Most controlled studies have focused on the treatment of glabellar frown lines, horizontal forehead lines, and crow's feet. Reports of botulinum toxin A use in the lower face are few and anecdotal. OBJECTIVE: We present our experience using botulinum toxin A in the lip as a treatment of vertical perioral rhytides, which resulted in the added cosmetic benefits of lip eversion and enhanced lip fullness. METHODS: Eighteen patients were injected with botulinum toxin A into the vertical lip rhytides. The effect of treatment was evaluated at 2 to 3 weeks after procedure. RESULTS: Smoothening of hyperfunctional lines and upper lip fullness/eversion is observed in patients treated with perioral botulinum toxin A injections; 72% of patients continued treatment. CONCLUSIONS: In select patients, perioral botulinum toxin A results in amelioration of perioral rhytides and enhancement of lip fullness and lip eversion.