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2.
Dermatol Surg ; 45(5): 700-710, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31033596

RESUMO

BACKGROUND: Tear trough and infraorbital region changes are one of the first signs recognizable aging. This is a common consultation for cosmetic dermatologists and there are many treatment options available. OBJECTIVE: This article provides a review of the anatomy and changes that occur in the infraorbital region as we age. We also suggest the use of the osseous, color, underlying anatomy, laxity, adipose, rhytides (OCULAR) mnemonic to evaluate these changes and review the literature for treatments options. MATERIALS AND METHODS: A literature search was performed through PubMed, using search terms "Tear trough," "Infra-orbital," "Dark-circles," "Lower-Eyelid," and "Midface." RESULTS: Fillers, lasers, radiofrequency devices, chemical peels, various topicals, and botulinum toxin are available non-surgical treatment options discussed in the literature found to significantly improve and rejuvenate the infraorbital region. CONCLUSION: A complete understanding of the anatomy and changes that occur with aging are of most importance when assessing the infraorbital region. Organizing these changes into the OCULAR mnemonic is one way to assess the infraorbital region and achieve optimal rejuvenation.


Assuntos
Técnicas Cosméticas , Pálpebras/anatomia & histologia , Face/anatomia & histologia , Órbita/anatomia & histologia , Rejuvenescimento , Envelhecimento da Pele , Humanos
3.
J Drugs Dermatol ; 18(3): s127-131, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30909360

RESUMO

Hispanics/Latinos are one of the fastest growing segments in the skin of color population in the United States. Utilization of lasers especially in people with skin of color requires a thorough understanding of laser physics and laser tissue interactions. In this article, we will outline the different lasers used in our practice based on each chromophore. Pretreatment recommendations as well as management of complications will also be shortly discussed. Our goal is for the readers to grasp the importance of proper device selection, understand the concept of selective photothermolysis, and the various treatment parameters required for optimal safety and efficacy. J Drugs Dermatol. 2019;18(3 Suppl):s127-131.


Assuntos
Técnicas Cosméticas/instrumentação , Hispano-Americanos , Lasers/efeitos adversos , Rejuvenescimento , Pele/efeitos da radiação , Técnicas Cosméticas/efeitos adversos , Feminino , Humanos , Seleção de Pacientes , Pigmentação da Pele/fisiologia , Pigmentação da Pele/efeitos da radiação
6.
Cutis ; 104(6): 366-367, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31939926

RESUMO

We highlight the use of intraprocedural hydrogen peroxide (H2O2) as a hemostatic agent during dermatologic surgery, with no clinical evidence of wound-healing impairment or worsening scar outcome. We describe the use of H2O2 to clean the surgical field and prevent mild persistent oozing of the wound edges intraoperatively.

7.
JAMA Dermatol ; 154(10): 1167-1174, 2018 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-30140900

RESUMO

Importance: Despite the growing popularity of cosmetic procedures, the sociocultural and quality-of-life factors that motivate patients to undergo such procedures are not well understood. Objective: To estimate the relative importance of factors that motivate patients to seek minimally invasive cosmetic procedures. Design, Setting, and Participants: This prospective, multicenter observational study was performed at 2 academic and 11 private dermatology practice sites that represented all US geographic regions. Adult patients presenting for cosmetic consultation or treatment from December 4, 2016, through August 9, 2017, were eligible for participation. Exposures: Participants completed a survey instrument based on a recently developed subjective framework of motivations and a demographic questionnaire. Main Outcomes and Measures: Primary outcomes were the self-reported most common motivations in each quality-of-life category. Secondary outcomes were other frequently reported motivations and those associated with specific procedures. Results: Of 529 eligible patients, 511 agreed to participate, were enrolled, and completed the survey. Typical respondents were female (440 [86.1%]), 45 years or older (286 [56.0%]), white (386 [75.5%]), and college educated (469 [91.8%]) and had previously received at least 2 cosmetic procedures (270 [52.8%]). Apart from motivations pertaining to aesthetic appearance, including the desire for beautiful skin and a youthful, attractive appearance, motives related to physical health, such as preventing worsening of condition or symptoms (253 of 475 [53.3%]), and psychosocial well-being, such as the desire to feel happier and more confident or improve total quality of life (314 of 467 [67.2%]), treat oneself or celebrate (284 of 463 [61.3%]), and look good professionally (261 of 476 [54.8%]) were commonly reported. Motivations related to cost and convenience were rated as less important (68 of 483 [14.1%]). Most motivations were internally generated, designed to please the patients and not others, with patients making the decision to undergo cosmetic procedures themselves and spouses seldom being influential. Patients younger than 45 years were more likely to undertake procedures to prevent aging (54 of 212 [25.5%] vs 42 of 286 [14.7%] among patients ≥45 years; P < .001). Patients seeking certain procedures, such as body contouring (19 of 22 [86.4%]), acne scar treatment (36 of 42 [85.7%]), and tattoo removal (8 of 11 [72.7%]), were more likely to report psychological and emotional motivations. Conclusions and Relevance: This initial prospective, multicenter study comprehensively assessed why patients seek minimally invasive cosmetic procedures. Common reasons included emotional, psychological, and practical motivations in addition to the desire to enhance physical appearance. Differences relative to patient age and procedures sought may need further exploration.


Assuntos
Técnicas Cosméticas/psicologia , Motivação , Qualidade de Vida , Autoeficácia , Adolescente , Adulto , Idoso , Beleza , Tomada de Decisões , Feminino , Felicidade , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Recompensa , Autorrelato , Envelhecimento da Pele , Adulto Jovem
9.
Dermatol Surg ; 44(5): 721-725, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29315143

RESUMO

BACKGROUND: Botulinum-derived neurotoxins have become a substantial tool in dermatologists' armamentarium for facial/neck rejuvenation. Current literature discusses anatomical "danger zones" to avoid during neurotoxin injection to prevent brow ptosis, blepharoptosis, and lower facial ptosis. OBJECTIVE: The aim of this study was to determine whether lidocaine 1% local anesthetic can be used to predict botulinum toxin treatment outcomes and prevent adverse effects of unwanted paralysis. MATERIALS AND METHODS: One percent lidocaine was drawn up using BD ultra-fine 31 G (5/16″), 0.5-mL insulin syringes in the same quantity that would be drawn up for neurotoxin placement. The patient's face was cleansed and mapped; 0.1 mL of 1% lidocaine was injected × 5 sites in the glabella; and 3 sites were injected with 0.05 mL in the frontalis. The patient was assessed after 10 minutes. RESULTS: Improvement in frontalis and glabellar rhytides was appreciated, with noted "spocking" of the lateral brows. This technique allowed the authors to visualize the need for placement of toxin more laterally with eventual successful predictive placement for neurotoxin. CONCLUSION: This technique of using local 1% lidocaine allows the practitioner to devise a neurotoxin distribution map tailored for each patient to limit unwanted paralysis from improper neurotoxin placement.


Assuntos
Toxinas Botulínicas Tipo A/administração & dosagem , Neurotoxinas/administração & dosagem , Rejuvenescimento , Envelhecimento da Pele/efeitos dos fármacos , Adulto , Anestésicos Locais/administração & dosagem , Toxinas Botulínicas Tipo A/efeitos adversos , Técnicas Cosméticas , Face , Humanos , Injeções Intradérmicas , Lidocaína/administração & dosagem , Masculino , Pescoço , Neurotoxinas/efeitos adversos , Valor Preditivo dos Testes , Medição de Risco , Fatores de Risco , Resultado do Tratamento
15.
JAMA Dermatol ; 153(6): 575-577, 2017 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-28403392

RESUMO

Importance: Minor bleeding is the most common complication of dermatologic surgery. Topical brimonidine, 0.33%, gel has been reported for the use of hemostasis in dermatologic surgery. The safety profile and risk of systemic toxic effects when brimonidine is used topically for hemostasis is unknown. Objective: To determine the risk of systemic toxic effects of topical brimonidine, 0.33%, gel when used for hemostasis. Design, Setting, and Participants: In this case series from a private practice (Hollywood Dermatology), 2 patients presented for dermatologic procedures, complicated by persistent bleeding. Interventions: Patients were treated with 10 g of brimonidine, 0.33%, gel applied under occlusion for hemostasis. Main Outcomes and Measures: Mental status, cardiopulmonary function. Results: Both patients experienced deterioration of mental status, respiratory depression, and somnolence. Results from cardiac testing, laboratory workup, and imaging were negative for cardiac or neurologic etiology. Both patients improved in less than 24 hours. Conclusions and Relevance: Topical brimonidine, 0.33%, gel can result in systemic central nervous system toxic effects when used as a hemostatic agent. At present, it is not possible to define a quantity with which brimonidine can be used safely, nor can a safe wound size be defined. We, therefore, urge against the use of topical brimonidine as a hemostatic agent until its safety is further investigated.


Assuntos
Tartarato de Brimonidina/efeitos adversos , Hemostáticos/efeitos adversos , Transtornos Mentais/induzido quimicamente , Administração Cutânea , Idoso , Idoso de 80 Anos ou mais , Tartarato de Brimonidina/administração & dosagem , Distúrbios do Sono por Sonolência Excessiva/induzido quimicamente , Géis , Hemostáticos/administração & dosagem , Humanos , Masculino , Insuficiência Respiratória/induzido quimicamente
16.
Dermatol Surg ; 42(10): 1164-73, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27661429

RESUMO

BACKGROUND: The American Council of Graduate Medical Education, which oversees much of postgraduate medical education in the United States, has championed the concept of "milestones," standard levels of achievement keyed to particular time points, to assess trainee performance during residency. OBJECTIVE: To develop a milestones document for the American Society for Dermatologic Surgery (ASDS) Cosmetic Dermatologic Surgery (CDS) fellowship program. METHODS: An ad hoc milestone drafting committee was convened that included members of the ASDS Accreditation Work Group and program directors of ASDS-approved Cosmetic Dermatologic Surgery (CDC) fellowship training programs. Draft milestones were circulated through email in multiple rounds until consensus was achieved. RESULTS: Thirteen milestones were developed in the 6 Accreditation Council for Graduate Medical Education (ACGME) competency areas, with 8 of these being patient-care milestones. Additional instructions for milestone administration more specific to the CDS fellowship than general ACGME instructions were also approved. Implementation of semiannual milestones was scheduled for the fellowship class entering in July 2018. CONCLUSION: Milestones are now available for CDS fellowship directors to implement in combination with other tools for fellow evaluation.


Assuntos
Técnicas Cosméticas , Procedimentos Cirúrgicos Dermatológicos/educação , Educação de Pós-Graduação em Medicina , Bolsas de Estudo , Objetivos Organizacionais , Acreditação , Humanos , Sociedades Médicas , Estados Unidos
17.
Dermatol Surg ; 41(11): 1249-56, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26445291

RESUMO

BACKGROUND: Cutaneous biopsy sites are often difficult to discern or are frequently misidentified when patients present for the treatment of skin cancers. This frustrating situation can lead to delays in treatment and wrong site surgeries. Current methods aiming to prevent this situation are not perfect. OBJECTIVE: This study seeks to determine the efficacy of ultraviolet-fluorescent tattoos in facilitating the correct identification of suspected nonmelanoma skin cancer biopsy sites. METHODS: In this prospective cohort, 51 shave biopsy sites were tattooed with ultraviolet-fluorescent ink in a series of 31 patients suspected of having a cutaneous malignancy. At the time of follow-up, the ability of the patient and the physician to identify the correct site with and without ultraviolet illumination of the tattoo was recorded. Visibility of the tattoo was graded before and after treatment. RESULTS: Patients could not positively identify their biopsy site in 35% of cases. In 7% of cases, physicians could not confidently identify the site without the aid of ultraviolet illumination. In conjunction with tattoo illumination, physicians confidently identified the site in 100% of the cases. No adverse events occurred. CONCLUSION: Ultraviolet-fluorescent tattoos offer a safe and reliable means of accurately marking cutaneous biopsy sites.


Assuntos
Carcinoma Basocelular/patologia , Carcinoma de Células Escamosas/patologia , Corantes Fluorescentes , Neoplasias Cutâneas/patologia , Tatuagem/métodos , Idoso , Idoso de 80 Anos ou mais , Biópsia , Carcinoma Basocelular/cirurgia , Carcinoma de Células Escamosas/cirurgia , Feminino , Humanos , Ceratose Actínica/patologia , Ceratose Actínica/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Pele/patologia , Neoplasias Cutâneas/cirurgia , Raios Ultravioleta
19.
Dermatol Surg ; 41(1): 40-7, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25521098

RESUMO

BACKGROUND: Anxiety toward pain has been shown in several studies to increase postoperative pain after surgical procedures. This anxiety can be measured by several validated questionnaires, the Pain Catastrophizing Scale (PCS) and the Pain Anxiety Symptoms Scale (PASS). Higher scores on these scales correlate with increased pain after surgery, but this has not yet been demonstrated in dermatologic surgery. OBJECTIVE: To assess whether pain anxiety will predict postoperative pain after Mohs micrographic surgery (MMS). MATERIALS AND METHODS: Patients at 2 private Mohs practices were recruited to fill out 2 pain questionnaires, the PCS and the PASS. Their postoperative pain was assessed after MMS. RESULTS: Three hundred fifty-six patients completed the study. Overall, most patients experienced little postoperative pain after Mohs surgery. However, for people with high anxiety toward pain, they also experienced statistically significant greater postoperative pain. Other factors that contributed to greater postoperative pain included female gender and lower extremity location. Second intention healing had lower pain than other repair types. CONCLUSION: This study shows that postoperative pain is affected by pain anxiety, even in dermatologic surgery. However, most patients still had very little discomfort after surgery, further supporting MMS as an effective and safe procedure with relatively few postoperative problems.


Assuntos
Ansiedade/psicologia , Carcinoma Basocelular/cirurgia , Carcinoma de Células Escamosas/cirurgia , Neoplasias de Cabeça e Pescoço/cirurgia , Cirurgia de Mohs/efeitos adversos , Dor Pós-Operatória/etiologia , Escalas de Graduação Psiquiátrica , Neoplasias Cutâneas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Ansiedade/diagnóstico , Feminino , Humanos , Extremidade Inferior , Masculino , Pessoa de Meia-Idade , Medição da Dor , Valor Preditivo dos Testes , Fatores Sexuais
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