Showing papers in "Dermatologic Surgery in 2023"
TL;DR: In this article , the authors compared surgical scars treated with fractional carbon dioxide (CO 2 ) laser performed on Day 0 and Day 14, and found no significant difference in patient assessment (54% preferred day 0 side, 46% preferred Day 14 side, p = .58) or physician assessment (mean MMSS 8.4 for Day 0 vs 8.7 for Day 14).
Abstract: Fractional ablative laser resurfacing has been shown to improve the final cosmetic appearance of surgical scars, but optimal timing is unknown.To compare surgical scars treated with fractional carbon dioxide (CO 2 ) laser performed on Day 0 and Day 14.Prospective, randomized, split-scar, physician-blinded study of 30 surgical scars on the limbs. Scars halves received fractional CO 2 laser on either Day 0 or Day 14. Scar assessment at 6 months evaluated patient preference, physician modified Manchester Scar Scale (MMSS) score, and quantitative scar analysis on histology (fractal dimension [F D ] and lacunarity [L] analysis).There was no significant difference in patient assessment (54% preferred Day 0 side, 46% preferred Day 14 side, p = .58) or physician assessment (mean MMSS 8.4 for Day 0 vs 8.7 for Day 14, p = .28). Fractal dimensions were similar for both interventions (mean 1.778 for Day 0 vs 1.781 for Day 14, p = .80). Lacunarity was similar for both interventions (mean 0.368 for Day 0 vs 0.345 for Day 14, p = .44).Single-center study with wounds limited to limbs of skin Phototype I-II subjects; 4 of whom were lost to follow-up.Intraoperative CO 2 laser is noninferior to Day 14 laser resurfacing for surgical scar treatment.
2 citations
TL;DR: A retrospective review of the CoPath database was performed, using search terms to identify cases of vulvar basal cell carcinoma from 2000 to 2018 as mentioned in this paper , and a total of 35 cases were included, of which 28 involved the cutaneous vulva, 6 involved the suprapubic area and 1 involved the clitoris.
Abstract: There are limited data on the etiology, clinical characteristics, and optimal treatment of vulvar basal cell carcinoma (BCC).This retrospective review may aid in treatment decisions for vulvar BCC.A retrospective review of our institutional CoPath database was performed, using search terms to identify cases of vulvar BCCs from 2000 to 2018.A total of 35 cases of vulvar BCC were included. Patient age ranged from 33 to 97 years with a mean age of 70 years. Of the 35 cases, 28 (80%) involved the cutaneous vulva, 6 (17%) involved the suprapubic area, and 1 (3%) involved the clitoris. Most vulvar BCCs were treated by wide local excision (46%) and vulvectomies (37%), with 3 cases treated with Mohs (11%) and 2 with electrodesiccation and curettage (6%). Preoperative tumor sizes were 0.86 cm2 for Mohs, 0.94 cm2 for excision, and 1.54 cm2 for vulvectomy. The mean margins were 3 mm for Mohs, 4.4 mm for wide local excision, and 6 mm for vulvectomy. Most cases (77%) were identified and treated by gynecology.Mohs micrographic surgery should be considered for the advantages of being tissue sparing, evaluating the complete peripheral and deep margin, and avoiding the costs and risks of general anesthesia.
2 citations
TL;DR: In this paper , the authors evaluated the h-index of Mohs surgeons within a variety of practice settings and found that the highest h-indices were highest among Mohs surgeon in the academic setting with increasing values correlating with higher academic rank and time since fellowship completion.
Abstract: BACKGROUND The h-index is a measure of research achievement using not only the number of publications of an individual, but also the impact of the publications. OBJECTIVE The objective of this study is to evaluate the h-indices of Mohs surgeons within a variety of practice settings. MATERIALS AND METHODS A list of all American College of Mohs Society (ACMS) members with corresponding fellowships years were collected using the ACMS membership directory. Publicly available demographic information was obtained including fellowship year, practice setting, PhD status, practice location (region), total number of publications, and h-index. Descriptive statistics were calculated to compare h-indices among the demographic data. RESULTS A total of 1150 ACMS members were included. The Practice setting distribution was as follows: 10.6% academic, 85.7% private practice, and 3.7% combined. H-index differed significantly based on practice setting (p < .001), with higher h-indices in academic and combined settings compared with the private practice setting. Subanalysis among academic Mohs surgeons revealed higher mean h-indices among professors (23.9) > associate professors (10.6) > assistant professors (8.6) > clinical instructors (5) (p < .001). CONCLUSION H-indices were highest among Mohs surgeons in the academic setting with increasing values correlating with higher academic rank and time since fellowship completion.
2 citations
TL;DR: In this article , the authors compared surgical scars treated with fractional carbon dioxide (CO2) laser performed on Day 0 and Day 14, and found no significant difference in patient assessment (54% preferred day 0 side, 46% preferred Day 14 side, p = .58) or physician assessment (mean MMSS 8.4 for Day 0 vs 8.7 for Day 14).
Abstract: BACKGROUND Fractional ablative laser resurfacing has been shown to improve the final cosmetic appearance of surgical scars, but optimal timing is unknown. OBJECTIVE To compare surgical scars treated with fractional carbon dioxide (CO2) laser performed on Day 0 and Day 14. METHODS Prospective, randomized, split-scar, physician-blinded study of 30 surgical scars on the limbs. Scars halves received fractional CO2 laser on either Day 0 or Day 14. Scar assessment at 6 months evaluated patient preference, physician modified Manchester Scar Scale (MMSS) score, and quantitative scar analysis on histology (fractal dimension [FD] and lacunarity [L] analysis). RESULTS There was no significant difference in patient assessment (54% preferred Day 0 side, 46% preferred Day 14 side, p = .58) or physician assessment (mean MMSS 8.4 for Day 0 vs 8.7 for Day 14, p = .28). Fractal dimensions were similar for both interventions (mean 1.778 for Day 0 vs 1.781 for Day 14, p = .80). Lacunarity was similar for both interventions (mean 0.368 for Day 0 vs 0.345 for Day 14, p = .44). LIMITATIONS Single-center study with wounds limited to limbs of skin Phototype I-II subjects; 4 of whom were lost to follow-up. CONCLUSION Intraoperative CO2 laser is noninferior to Day 14 laser resurfacing for surgical scar treatment.
2 citations
TL;DR: VYC-12L as discussed by the authors is a recently developed hyaluronic acid filler to improve skin quality, which may be assessed by degrees of skin smoothness, fine lines, and hydration.
Abstract: Skin quality may be assessed by degrees of skin smoothness, fine lines, and hydration. VYC-12L is a recently developed hyaluronic acid filler to improve skin quality.This was a randomized, evaluator-blind study assessing safety and effectiveness of intradermal VYC-12L treatment for improving cheek skin smoothness, fine lines, and hydration.Participants (≥22 years) with moderate-to-severe investigator-assessed Allergan Cheek Smoothness Scale (ACSS) scores were randomized in 2:1 ratio to receive VYC-12L or control (no treatment with optional treatment). Effectiveness was assessed 1 month after last injection (initial or touch-up) by a responder rate (≥1-grade improvement from baseline on both cheeks) using investigator-rated ACSS and Allergan Fine Lines Scale (AFLS), and tissue dielectric constant probe-measured skin hydration. Safety was evaluated throughout.Participants (VYC-12L, n = 131; control, n = 71) were 86.1% female with a median age of 58.0 years. At month 1, ACSS and AFLS responder rates were statistically significantly higher in the VYC-12L group (57.9%, 58.3%, respectively) than in the untreated controls (4.5%, 5.4%, respectively; p < .001). VYC-12L ACSS and AFLS responder rates remained consistent throughout the 6-month follow-up. Six participants reported treatment-related adverse events; none led to study discontinuation.VYC-12L is an effective, well-tolerated treatment for lasting improvement of cheek skin smoothness, fine lines, and hydration.
1 citations
TL;DR: In this paper , the results of acne scar treatment using a filler composed of complexes of high and low molecular weight HA versus a traditional cross-linking HA filler were compared in a prospective, split-face, double-blinded, randomized controlled study.
Abstract: Supplemental Digital Content is Available in the Text. BACKGROUND Hyaluronic acid (HA)-based fillers are effective at mitigating acne scars due to their filling effect. Complexes of high and low molecular weight HA demonstrated a delayed biostimulatory effect. OBJECTIVE The authors sought to compare the results of acne scar treatment using a filler composed of complexes of high and low molecular weight HA versus a traditional cross-linking HA filler. METHODS Thirty patients with moderate-to-severe atrophic acne scarring were included in this prospective, split-face, double-blinded, randomized controlled study. Each underwent 3 monthly injections of a novel formula of combined high and low molecular weight HA (P) to the base of acne scars on 1 side of the face and traditional cross-linking HA (JV) filler on the other. Patients were evaluated 6 months after their last treatment for objective and subjective improvements. RESULTS For JV, statistically significant reductions were observed in the acne scar volume but nearly no change in elasticity and stretch during early treatments. For P, no significant differences were observed in early treatments; however, statistically significant improvements were observed in later visits. CONCLUSION Although the traditional JV filler demonstrated an earlier impact than P, the latter produced delayed positive changes that were more pronounced than the traditional filler.
1 citations
TL;DR: In this paper , the authors used RNA-Seq to detect col1A1-PDGFB in Dermatofibrosarcoma protuberans (DFSPs).
Abstract: BACKGROUND Dermatofibrosarcoma protuberans (DFSP) is a cutaneous sarcoma with obscure origin and multidirectional differentiation. Application of RNA-Seq in the detection of COL1A1–PDGFB is still at early stages. OBJECTIVE We aim to test the efficacy of fusion gene detection using bulk RNA-Seq in DFSPs, explore altered molecular pathways and biological processes for evidences of tumor origin and cell identity shift. MATERIALS AND METHODS Dermatofibrosarcoma protuberans and normal dermis samples were acquired for RNA-Seq. Fusion gene detection was performed using STAR-Fusion. RNA-Seq 2G yielded differentially expressed genes. Altered pathways, key gene ontology terms, and similar cell/tissue types were identified with gene set enrichment analysis. xCell was used for cell types enrichment analysis. RESULTS 28/30 CD34(+) cases were positive for COL1A1–PDGFB. 406 upregulated and 543 downregulated genes were determined. Among the top 10 upregulated genes, 6 had neural distribution, function, or disease correlation. The upregulated genes were related to synapse, trans-synaptic signaling, neural development, and extracellular matrix. Similarities between DFSP and nervous system components were highlighted, with fibroblast cellular abundancy increased during xCell analysis. CONCLUSION Bulk RNA-Seq provided with high detection rate of COL1A1-PDGFB. Dermatofibrosarcoma protuberans showed fibroblastic activity and neural features, which validated DFSP's fibroblast origin and tendency of neural differentiation.
1 citations
TL;DR: In this article , a comprehensive review of minimally invasive options for earlobe rejuvenation is provided, including topical medications, peels, fillers, lasers, photodynamic therapy, and dermabrasion.
Abstract: BACKGROUND As one of the defining features of the face, the ear influences perceptions of beauty. Despite its significance, comparatively little is known about rejuvenation options for the ear. OBJECTIVE To provide a comprehensive review of minimally invasive options for earlobe rejuvenation. METHODS & Materials: Cochrane, Embase, and PubMed were used to identify articles exploring minimally invasive treatments for ear rejuvenation. RESULTS Topical medications, peels, fillers, lasers, photodynamic therapy, and dermabrasion are safe and efficacious for managing a variety of concerns related to earlobe aesthetics. CONCLUSION Numerous minimally invasive treatment modalities are available for earlobe rejuvenation; further investigation is needed to design a grading system and treatment algorithm.
1 citations
TL;DR: In this article , a single-pass treatment with a CO2 and 1570-nm hybrid laser for periorbital rejuvenation between 2020 and 2022 was evaluated by four independent physicians for objective improvement.
Abstract: Supplemental Digital Content is Available in the Text. BACKGROUND Many modalities are used for periorbital rejuvenation, with a wide range of efficacy and safety. To achieve favorable outcomes with minimal downtime and adverse effects, professionals developed a hybrid laser, which allows simultaneous treatment with 2 wavelengths: fractional ablative and fractional nonablative lasers. OBJECTIVE To evaluate the safety and efficacy of a new hybrid laser for periorbital rejuvenation. MATERIALS AND METHODS This retrospective single-center study includes 24 patients who underwent a single-pass treatment with a CO2 and 1570-nm hybrid laser for periorbital rejuvenation between 2020 and 2022. Patients' standardized clinical photographs before and after the treatment were assessed by 4 independent physicians for objective improvement. Treatment data, safety, and patients' satisfaction were also reviewed. RESULTS Statistically significant objective improvements were found in all investigated scales with an improvement of 1 to 2 points on each scale. Patients' satisfaction was 3.1/4. Average downtime was 5.9 ± 1.7 days. Most adverse effects were mild to moderate in severity (89.7%), including erythema, crusting, pruritis, edema, and hyperpigmentation. CONCLUSION After a single-pass treatment, the laser generates 26% to 50% improvement in the periorbital area, with a strong safety profile and a relatively simple recovery. Further research is needed to validate the efficacy of this technology compared with more aggressive modalities.
1 citations
TL;DR: In this paper , a case series of ultrasound images and medical data of patients who were prospectively referred with non-inflammatory nodules were evaluated and the exact location of the filler material was noted.
Abstract: INTRODUCTION
Noninflammatory nodules may be persistent to dissolve. To evaluate the possible reasons, a case series of ultrasound images and medical data of patients who were prospectively referred with noninflammatory nodules were evaluated.
MATERIALS AND METHODS
A total of 27 patients with nodules but without signs of inflammation were included. All cases were assessed with an 18-MHz linear ultrasound device. Exact location of the filler material was noted. Relations with clinical data were analyzed using chi-square tests.
RESULTS
Early onset of complaints (<2 weeks) was found in 16 patients and late onset (>2 weeks) in 11. All patients had multiple nodules. In all cases, the filler nodule was found to be located inside the fascia. Extension to the subcutaneous tissue was seen in 8 cases and to the deeper planes in 5. In 14 cases, the filler material was completely located inside layers of the fascia, and migration was observed in 5 cases.
DISCUSSION
Accumulation of filler material in the superficial musculoaponeurotic system or fascia may be an important cause for the occurrence of persistent noninflammatory nodules, either by initial faulty injection technique or by later accumulation through the pathway generated with a needle or cannula. Ultrasound-guided injections are helpful to dissolve the nodule.
1 citations
TL;DR: In this article , the authors surveyed members of the American Academy of Dermatology, including 66 dermatologic surgeons (DSs) (34 male and 32 female DSs) and 252 GDs (119 male and 133 female GDs), on questions related to total annual income, demographics, current employment, and time spent providing patient care.
Abstract: Previous literature supports a disparity in income between male and female physicians across multiple specialties, even when controlling for variables such as working hours, maternity leave, and productivity.To understand if income disparity exists between male and female general dermatologists (GDs), and in dermatologists who completed a dermatologic surgical fellowship.The authors surveyed members of the American Academy of Dermatology, including 66 dermatologic surgeons (DSs) (34 male and 32 female DSs) and 252 GDs (119 male and 133 female GDs), on questions related to total annual income, demographics, current employment, and time spent providing patient care. A logarithmic ordinal regression model was used to analyze income and the effect of different variables.Male GDs were 2.46 times more likely than female GDs to be in a higher income category (95% confidence interval [CI]: 1.44-4.23). There was no significant difference between the incomes of male and female DSs (male-to-female odds ratio: 1.46, CI: -0.44 to 1.23). These findings did not change when variables of age, median patient visits, and hours worked were controlled for.Income gender inequality exists among GDs. However, this inequality does not seem to extend to DSs.
TL;DR: In this paper , the authors used Star-Fusion to detect col1A1-PDGFB in Dermatofibrosarcoma protuberans (DFSP).
Abstract: Supplemental Digital Content is Available in the Text. BACKGROUND Dermatofibrosarcoma protuberans (DFSP) is a cutaneous sarcoma with obscure origin and multidirectional differentiation. Application of RNA-Seq in the detection of COL1A1–PDGFB is still at early stages. OBJECTIVE We aim to test the efficacy of fusion gene detection using bulk RNA-Seq in DFSPs, explore altered molecular pathways and biological processes for evidences of tumor origin and cell identity shift. MATERIALS AND METHODS Dermatofibrosarcoma protuberans and normal dermis samples were acquired for RNA-Seq. Fusion gene detection was performed using STAR-Fusion. RNA-Seq 2G yielded differentially expressed genes. Altered pathways, key gene ontology terms, and similar cell/tissue types were identified with gene set enrichment analysis. xCell was used for cell types enrichment analysis. RESULTS 28/30 CD34(+) cases were positive for COL1A1–PDGFB. 406 upregulated and 543 downregulated genes were determined. Among the top 10 upregulated genes, 6 had neural distribution, function, or disease correlation. The upregulated genes were related to synapse, trans-synaptic signaling, neural development, and extracellular matrix. Similarities between DFSP and nervous system components were highlighted, with fibroblast cellular abundancy increased during xCell analysis. CONCLUSION Bulk RNA-Seq provided with high detection rate of COL1A1-PDGFB. Dermatofibrosarcoma protuberans showed fibroblastic activity and neural features, which validated DFSP's fibroblast origin and tendency of neural differentiation.
TL;DR: In this article, the authors evaluated the efficacy and safety of a fractional RF device with a micro-insulated needle to reduce submental fat in 24 adults with excess submental body fat.
Abstract: Supplemental Digital Content is Available in the Text. BACKGROUND Recently, it has been reported that a micro-insulated needle radiofrequency (RF) system is effective at achieving subcutaneous fat reduction; however, no study has yet applied this technique to reduce submental fat. OBJECTIVE To evaluate the efficacy and safety of a fractional RF device with a micro-insulated needle to reduce submental fat. MATERIALS AND METHODS In this prospective, single-blinded, pre–post comparative study, 24 adults with excess submental fat were treated once using a micro-insulated needle RF device. Outcomes included efficacy (submental fat rating by an independent investigator, fat volume quantified with a 3-dimensional camera, and patient satisfaction), assessed 1 and 2 months after the procedure, and safety (adverse events), assessed throughout the study. RESULTS The patients' Physician-Assisted Submental Fat Rating Scale score significantly decreased after 1 month and further decreased after 2 months. The average volume of submental fat was significantly decreased after 2 months (20.44 ± 5.53 cc to 16.41 ± 4.58 cc, p < .001). Patient satisfaction was high. Transient and mild local skin reactions without long-term sequelae were observed in 4 patients. CONCLUSION The micro-insulated needle RF device is beneficial for the reduction of submental fat and has tolerable safety profiles. Trial registration ClinicalTrials.gov Identifier: NCT05517824.
TL;DR: In this article , a review of the literature on field-directed therapies for actinic keratosis, comparing efficacy, cost, and adherence data for topical and in-office treatments is presented.
Abstract: Although there are evidence-based guidelines for actinic keratosis management, selecting a cost-effective field therapy is challenging because of limited studies comparing cost, efficacy, and adherence among treatments.To review the literature on field-directed therapies for actinic keratosis, comparing efficacy, cost, and adherence data for topical and in-office treatments.PubMed, Embase, Web of Science, and Google Scholar databases were searched from October 2020 to March 2021 for articles on field therapy for actinic keratosis. Total cost per regimen was estimated using wholesale acquisition cost package prices and Medicare coverage rates for May 2021. Effective cost was approximated by dividing total cost by complete response rate.Efficacy data for various field therapies range widely, and long-term follow-up is limited. Cross-study comparisons are challenging because of heterogeneity of studies. Field-directed therapy with topical 5-fluorouracil and photodynamic therapy have similar effective cost. Adherence may significantly affect real-world efficacy and long-term clearance; this would favor shorter duration topical regimens or in-office procedures.Standardization of future studies examining efficacy of field treatments for actinic keratosis will allow comparison across treatments. In-office treatments such as photodynamic therapy represent a cost-effective alternative to topical therapies with comparable efficacy.
TL;DR: In this article , the effects of Collagenase clostridium histolyticum-aaes (CCH) on volumetric changes of cellulite dimples and overall gluteal contouring were evaluated.
Abstract: Collagenase clostridium histolyticum-aaes (CCH) is approved for the treatment of moderate-to-severe cellulite.This is a retrospective image review of subjects previously enrolled in Cohort 2 of the EN3835-305 trial to determine the effects of CCH on volumetric changes of cellulite dimples and overall gluteal contouring.In this retrospective analysis, photographs from Day 90 and Day 180 were superimposed on baseline images and the volumetric change of each treated cellulite dimple was quantified. Side-by-side photographs of the buttocks were also evaluated for change in gluteal contour using the Physician Global Aesthetic Improvement Scale (PGAIS).Fifty-eight female subjects and 403 cellulite dimples were evaluated. Three-dimensional imaging analysis revealed a significant improvement in total negative dimple volume at both Day 90 and Day 180 of 27% and 26%, respectively ( p < .001 and p = .002, respectively). At Day 90, the overall gluteal contour, as signified by the mean PGAIS among the 3 blinded dermatologists, was rated as +1 (improved) in 27% ( n = 17) of the subjects. At Day 180, the mean PGAIS was +1 (improved) or +2 (very much improved) in 39% ( n = 26) of the subjects.CHH is an effective tool for treating cellulite dimples and improving gluteal contour.
TL;DR: In this article , a single-blind, randomized, controlled cohort study was conducted to determine the optimal time to apply a fractional CO2 laser for the treatment of postsecondary repair scars in patients with cleft lip.
Abstract: BACKGROUND Scar is one of the most common complications for patients with cleft lip. Fractional CO2 laser is an effective method to improve the appearance of scars. However, there are no published articles about the optimal time for applying. OBJECTIVE To determine the optimal time to apply a fractional CO2 laser for the treatment of postsecondary repair scars in patients with cleft lip. METHODS Forty-two patients with linear scarring after cleft lip repair were recruited from November 2021 to October 2022. A single-blind, randomized, controlled cohort study was conducted to examine the impact of fractional CO2 laser treatment compared with conventional conservative treatment. Thirty patients started laser treatment at 1 month (n = 10), 3 months (n = 10), and 6 months (n = 10) postoperatively, and 12 patients were in the control group. Each patient was treated with high-energy low-density fractional CO2 laser treatment 3 times at an interval of 1 month. The Vancouver Scar Scale (VSS) was used for scar evaluation to determine vascularity, pigmentation, pliability, and height. RESULTS The VSS scores decreased significantly after laser treatment (p < .05), with the most significant improvement in scars in the group that started treatment 1 month after the surgery. CONCLUSION Early postoperative fractional CO2 laser treatment of cleft lip scars is more effective than later treatment.
TL;DR: In this article , the safety and efficacy of picosecond laser removal of cosmetic facial tattoos was reviewed. But, the average number of treatments to obtain satisfactory results was only 3.
Abstract: BACKGROUND Cosmetic facial tattoos have proven difficult to remove despite advancements in laser technology. OBJECTIVE Review safety and efficacy of picosecond laser removal of cosmetic facial tattoos. METHODS & MATERIALS Retrospective chart review from January 2015 to January 2022 of patients undergoing tattoo removal of facial cosmetic tattoos. RESULT A total of 33 patients were included in the review. The average number of treatments to obtain satisfactory results was 3. Sixty 6 percent of subjects were rated as “very much improved” with 76% to 100% of the tattoo removed and 34% of subjects were rated “much improved” with 51% to 75% of the tattoo removed. Thirty percent of subjects experienced unexpected changes in the tattoo color after initial treatment with 1,064-nm picosecond laser. CONCLUSION Picosecond laser is an effective and safe treatment for cosmetic tattoos, and it highlights the underreported unmasking of an orange color postlaser treatment that can be successfully treated with a 532-nm PS laser.
TL;DR: In this paper , a single-blind, randomized, controlled cohort study was conducted to determine the optimal time to apply a fractional CO2 laser for the treatment of postsecondary repair scars in patients with cleft lip.
Abstract: BACKGROUND Scar is one of the most common complications for patients with cleft lip. Fractional CO2 laser is an effective method to improve the appearance of scars. However, there are no published articles about the optimal time for applying. OBJECTIVE To determine the optimal time to apply a fractional CO2 laser for the treatment of postsecondary repair scars in patients with cleft lip. METHODS Forty-two patients with linear scarring after cleft lip repair were recruited from November 2021 to October 2022. A single-blind, randomized, controlled cohort study was conducted to examine the impact of fractional CO2 laser treatment compared with conventional conservative treatment. Thirty patients started laser treatment at 1 month (n = 10), 3 months (n = 10), and 6 months (n = 10) postoperatively, and 12 patients were in the control group. Each patient was treated with high-energy low-density fractional CO2 laser treatment 3 times at an interval of 1 month. The Vancouver Scar Scale (VSS) was used for scar evaluation to determine vascularity, pigmentation, pliability, and height. RESULTS The VSS scores decreased significantly after laser treatment (p < .05), with the most significant improvement in scars in the group that started treatment 1 month after the surgery. CONCLUSION Early postoperative fractional CO2 laser treatment of cleft lip scars is more effective than later treatment.
TL;DR: In this paper , a prospective, single-center, double-blinded, split-body, clinical trial of 20 women with mild to moderate skin laxity of the buttocks and/or thighs contributing to mild-to-moderate cellulite was conducted.
Abstract: BACKGROUND More than 90% of women report concerns of cellulite on their skin. Poly-l lactic acid (PLLA-SCA) is a biocompatible, semipermanent, synthetic filler that induces neocollagenesis. OBJECTIVE To investigate the safety and efficacy of PLLA-SCA for the treatment of cellulite of the buttock and thigh regions. METHODS This was a prospective, single-center, double-blinded, split-body, clinical trial of 20 women with slight to moderate skin laxity of the buttocks and/or thighs contributing to mild-to-moderate cellulite. Each subject’s buttocks and thighs were randomized to receive injections with up to 2 vials of PLLA-SCA or the equivalent volume of bacteriostatic water per treatment area. Subjects received at total of 3 treatments 4 weeks apart and were followed for 330 days. RESULTS Treatment of the buttocks with PLLA-SCA resulted in significant reduction of depression depth, improvement in the morphological appearance of the skin, improvement in the grade of skin laxity, and overall improvement in cellulite appearance. Treated thighs showed reduction in the depth and number of depressions and an improvement in overall cellulite appearance. No significant procedure side effects were found. CONCLUSION Poly-l lactic acid offers an effective and safe method for treating cellulite of the buttocks and thighs.
TL;DR: In this paper , a retrospective image review of subjects previously enrolled in Cohort 2 of the EN3835-305 trial was conducted to determine the effects of Collagenase clostridium histolyticum-aaes (CCH) on volumetric changes of cellulite dimples and overall gluteal contouring.
Abstract: BACKGROUND Collagenase clostridium histolyticum-aaes (CCH) is approved for the treatment of moderate-to-severe cellulite. OBJECTIVE This is a retrospective image review of subjects previously enrolled in Cohort 2 of the EN3835-305 trial to determine the effects of CCH on volumetric changes of cellulite dimples and overall gluteal contouring. METHODS In this retrospective analysis, photographs from Day 90 and Day 180 were superimposed on baseline images and the volumetric change of each treated cellulite dimple was quantified. Side-by-side photographs of the buttocks were also evaluated for change in gluteal contour using the Physician Global Aesthetic Improvement Scale (PGAIS). RESULTS Fifty-eight female subjects and 403 cellulite dimples were evaluated. Three-dimensional imaging analysis revealed a significant improvement in total negative dimple volume at both Day 90 and Day 180 of 27% and 26%, respectively (p < .001 and p = .002, respectively). At Day 90, the overall gluteal contour, as signified by the mean PGAIS among the 3 blinded dermatologists, was rated as +1 (improved) in 27% (n = 17) of the subjects. At Day 180, the mean PGAIS was +1 (improved) or +2 (very much improved) in 39% (n = 26) of the subjects. CONCLUSION CHH is an effective tool for treating cellulite dimples and improving gluteal contour.
TL;DR: In this article , the authors surveyed members of the American Academy of Dermatology, including 66 dermatologic surgeons (DSs) (34 male and 32 female DSs) and 252 general dermatologists (GDs) (119 male and 133 female GDs), on questions related to total annual income, demographics, current employment, and time spent providing patient care.
Abstract: Supplemental Digital Content is Available in the Text. BACKGROUND Previous literature supports a disparity in income between male and female physicians across multiple specialties, even when controlling for variables such as working hours, maternity leave, and productivity. OBJECTIVE To understand if income disparity exists between male and female general dermatologists (GDs), and in dermatologists who completed a dermatologic surgical fellowship. MATERIALS AND METHODS The authors surveyed members of the American Academy of Dermatology, including 66 dermatologic surgeons (DSs) (34 male and 32 female DSs) and 252 GDs (119 male and 133 female GDs), on questions related to total annual income, demographics, current employment, and time spent providing patient care. A logarithmic ordinal regression model was used to analyze income and the effect of different variables. RESULTS Male GDs were 2.46 times more likely than female GDs to be in a higher income category (95% confidence interval [CI]: 1.44–4.23). There was no significant difference between the incomes of male and female DSs (male-to-female odds ratio: 1.46, CI: −0.44 to 1.23). These findings did not change when variables of age, median patient visits, and hours worked were controlled for. CONCLUSION Income gender inequality exists among GDs. However, this inequality does not seem to extend to DSs.
TL;DR: In this article , the authors have indicated no significant interest with commercial supporters in commercial products and have indicated that they have no commercial support with commercial companies. But they did not discuss their commercial support.
Abstract: Departments of *Dermatology, and †Neurology, Yale University School of Medicine, New Haven, Connecticut The authors have indicated no significant interest with commercial supporters.
TL;DR: In this article , the authors reviewed 13 studies that focus specifically on effectiveness of treatment options for keloids and hypertrophic scars in the pediatric population and found that keloid development is less common before adolescence and that higher rates of recurrence are observed among patients who have received monotherapy compared with those who received multimodal treatments.
Abstract: BACKGROUND Keloids and hypertrophic scars are the result of excessive fibroblast proliferation and collagen deposition in the wound healing process, leaving patients with irritating and cosmetically displeasing lesions. Despite there being numerous modalities for treatment, keloids are notoriously recalcitrant to therapy and recurrence rates are high. OBJECTIVE Because many keloids begin to develop during childhood and adolescence, it is important to better understand which treatment options may be best suited toward the pediatric population specifically. METHODS We reviewed 13 studies that focus specifically on effectiveness of treatment options for keloids and hypertrophic scars in the pediatric population. These studies cover 545 keloids in 482 patients, all aged 18 and younger. RESULTS Many treatment modalities were used, with multimodal treatment being the most common (76%). There were 92 instances of recurrence, with a total recurrence rate of 16.9%. CONCLUSION Data from the combined studies suggest that keloid development is less common before adolescence and that higher rates of recurrence are observed among patients who have received monotherapy compared with those who received multimodal treatments. More well-designed studies with standardized ways of assessing outcomes are needed to expand our understanding on how to optimally treat keloids in the pediatric population.
TL;DR: In this paper , the authors evaluated the histological effects of laser-assisted and device-assisted filler delivery to determine the optimal devices and fillers and found that the combination of fractional CO2 laser and PLLA proved to be the most effective combination for laser/device assisted filler delivery.
Abstract: Lasers and devices are used to enhance transcutaneous delivery of fillers. However, little has been published on the histologic findings of this form of laser/device-assisted delivery to determine the optimal devices and fillers.To objectively evaluate the histological effects of laser-assisted and device-assisted filler delivery.Ex vivo human abdominoplasty skin samples were treated with fractional CO2 laser (ECO2, 120 μm tip, 120 mJ), fractional radiofrequency microneedling (FRMN, Genius, 1.5 mm, 20 mJ/pin), and microneedling (2.0 mm). Immediately after poly-l-lactic acid (PLLA), hyaluronic acid gel, calcium hydroxylapatite, and black tissue marking dye were topically applied. After treatment, biopsies were collected for histologic evaluation.Histology revealed that PLLA and black dye were found in greatest abundance, hyaluronic acid was found to a lesser extent, and calcium hydroxylapatite was least found within channels created by fractional CO2 laser. Microneedling was effective only at delivering black dye, whereas FRMN failed to show significant channel formation or delivery of the studied products.Among the devices and fillers studied, fractional CO2 laser and PLLA proved to be the most effective combination for laser/device-assisted filler delivery. Neither microneedling nor FRMN was effective as devices to enhance filler delivery.
TL;DR: In this article , the authors investigated the clinicopathologic characteristics and survival outcomes of dermatofibrosarcoma protuberans (DFSP) and found that patients with tumors ≥ 10 cm in size or histologic grade III had significantly higher DFSP-specific mortality (7.07% and 10.08%, respectively, p < .001).
Abstract: BACKGROUND Limited information is available regarding survival outcomes and risk factors of dermatofibrosarcoma protuberans (DFSP). OBJECTIVE To investigate the clinicopathologic characteristics and survival outcomes of DFSP. MATERIALS AND METHODS The study cohort (7,567 patients) was selected from the Surveillance, Epidemiology, and End Results Program (2000–2018). Demographic and clinicopathologic variables, survival outcomes, and prognostic factors were analyzed. RESULTS A total of 5,640 (74.53%) and 1,927 (25.47%) tumors were located in the skin and soft tissue, respectively. The median follow-up duration was 92 months. Median follow-up times were similar between patients with lymph node (107 months) and distant (102 months) metastases; the median survival time of the 89 patients (1.18%) who died of DFSP was significantly short (41 months, p < .001). Independent risk factors for cancer-specific mortality included age at diagnosis, histologic grade, and tumor size. Patients with tumors ≥10 cm in size or histologic grade III had significantly higher DFSP-specific mortality (7.07% and 10.08%, respectively, p < .001). Tumor locations and surgical procedures did not significantly influence survival. CONCLUSION Dermatofibrosarcoma protuberans has a favorable survival prognosis, even in patients with node-positive or distant metastases. Dermatofibrosarcoma protuberans-specific mortality is significantly higher in patients with grade III or large (≥10 cm) tumors.