Cosmetic Dermatology Research Articles

Körperdysmorphe Störung

Between 0.8 and 1.8 % of the German population suffers from a body dysmorphic disorder. In specific settings like dermatological offices up to 11.9 % of patients suffer from this disease. The highest prevalence could be found in the field of cosmetic dermatology with a prevalence of 13.1 %. Until now, the diagnosis has been made too rarely. The body dysmorphic disorder is a chronic psychic disease, in which the patients feel disfigured and experience shame and disgust at the same time. Comorbidities like social phobia, depression, suicidality, and eating disorders are frequent. The diagnosis is made using questionnaires (e.g., dysmorphic concern questionnaire) or by use of the DSM-5 manual. An early diagnosis seems to be important to avoid chronification and suicidal ideas. Therapeutic approaches should include cognitive behavioral therapies as well as the use of SSRIs.

Complications in the Cosmetic Dermatology Patient

Over recent decades, the options available to patients for cosmetic rejuvenation have expanded dramatically. The range of options commonly available to patients now includes neuromodulators, fillers, sclerotherapy, chemical peels, lasers, lights and other energy devices, and liposculpture and continues to grow. Like all therapeutic interventions, these cosmetic dermatologic procedures are not without risk. Timely recognition of complications and intervention are paramount for optimal patient outcomes. Part 1 of this review focused on the common complications that may result from injectable cosmetic procedures. The second part will discuss the complications of chemical peels, lasers, light and energy devices, and fat removal/sculpture procedures. A MEDLINE search was performed on cosmetic dermatology complications from 1989 to 2015, and results are summarized. Practical considerations of these complications are also provided. Reports of complications after neuromodulator, injectable hyaluronic acid, calcium hydroxylapatite, poly-L-lactic acid, polymethylmethacrylate, sclerotherapy, fat transfer, liposuction, cryolipolysis, chemical peels, lasers, and light sources, such as Q-switched laser, intense pulsed light, and nonablative and ablative resurfacing lasers, were found. Review of the literature revealed multiple management options for potential complications of the multitude of cosmetic dermatology procedures now available to patients.

Complications in the Cosmetic Dermatology Patient: A Review and Our Experience (Part 1).

Over recent decades, the options available to patients for cosmetic rejuvenation have expanded dramatically. The range of options commonly available to patients now includes neuromodulators, fillers, sclerotherapy, chemical peels, liposculpture, lasers, and lights and other energy devices and continues to grow. As with all therapeutic interventions, these cosmetic dermatologic procedures are not without risk. Timely recognition of complications and intervention are paramount for optimal patient outcomes. Part 1 of this review will focus on the common complications of injectable cosmetic procedures, such as neuromodulators, fillers, and sclerotherapy. The second part will discuss the complications of chemical peels, lasers, light and energy devices, and fat removal procedures. A MEDLINE search was performed on cosmetic dermatology complications from 1989 to 2015, and results are summarized. Practical considerations of these complications are also provided. Reports of complications after neuromodulator, injectable hyaluronic acid, calcium hydroxylapatite, poly-L-lactic acid, polymethylmethacrylate, sclerotherapy, fat transfer, liposuction, cryolipolysis, chemical peels, lasers, and light sources, such as Q-switched laser, intense pulsed light, nonablative and ablative resurfacing lasers, were found. Review of the literature revealed multiple management options for potential complications of the multitude of cosmetic dermatology procedures now available to patients.

Papular Acne Scars of the Nose and Chin: An Under-recognised Variant of Acne Scarring.

Background:Scarring following acne vulgaris is common and can be of profound psychosocial consequence.Aims and Objectives:We have clinically noted a variant of acne scarring, overlooked by previous categorisation schemes, which we have denominated as papular acne scars of the nose and chin. We sought to characterise these novel entities further.Materials and Methods:Initially, we identified 14 patients with papular acne scars of the nose and chin in a cosmetic dermatology clinic, of whom two were female and rest were male. We then prospectively evaluated 100 consecutive patients attending our tertiary referral acne isotretinoin clinic and 49 patients attending a general dermatology clinic.Results:Amongst 149 patients, from a general dermatology and tertiary acne clinic, soft papular scars were noted in four patients, distributed on the nose and chin. Three of the four patients were male, three patients had additional acne scars and the median age was 23.5.Conclusions:We have identified 18 patients with papular acne scars of the nose and chin and propose that this new category should be added to acne scarring classification schemes. Future work should be directed at corroborating the epidemiology of such lesions and describing effective treatment modalities.

British Cosmetic Dermatology Group

British Cosmetic Dermatology Group

O DOENTE, A CONSULTA E ASPECTOS MÉDICO-LEGAIS EM DERMATOLOGIA COSMÉTICA

O exercício profissional dos médicos ocorre actualmente num ambiente restritivo e constrangedor e é alvo de um crescente escrutínio por parte da sociedade. Restrições, exigências e condicionamentos de natureza financeira, regulamentar, burocrática e administrativa subvertem a prática médica, em grau que contrasta de forma flagrante com a liberdade com que exercem profissionais não qualificados de áreas paramédicas ou de formas de medicina ditas complementares ou alternativas. A inevitável conotação estética da pele e a disponibilização de tecnologias e procedimentos cosméticos de alcance ambulatorial vieram permitir a consolidação da área da Dermatologia Cosmética. Área que suscita múltiplas interrogações no plano da relação médico-doente, da litigiosidade, da ética e da deontologia médica. Num registo aberto e reflexivo são enunciadas algumas dessas especificidades, elencadas as principais ameaças inerentes, revisto de forma sumária o enquadramento jurídico e deontológico, suscitados alguns problemas éticos e, finalmente, propostas algumas recomendações.

The Use of Non-Physicians in Cosmetic Dermatology: Legal and Regulatory Standards

The demand for cosmetic medical procedures continues to rise. Dermatologists are increasingly employing non-physicians, and medical spas are hiring individuals without a medical license to meet this demand. This new frontier in medicine has opened the door to a number of legal and regulatory issues regarding scope of practice and appropriate physician supervision of these procedures. Further confounding the matter is state-by-state variation in laws and a lack of federal oversight. We discuss some of the most salient factors clinicians need to be cognizant of in this rapidly evolving field of cosmetic dermatology. Physicians must be aware of the pertinent legal issues they face when using non-physicians in their practice or when acting as the medical director of cosmetic procedures taking place in a non-medical setting. As a medical community, we should be aware of the risks and benefits of non-physicians performing cosmetic procedures on patients.

Minimally invasive eyelid care in dermatology: Medical, laser, and cosmetic therapies

There is a high demand for facial aesthetic enhancement, and the periorbital region is one of the first areas to show signs of aging. Many nonsurgical therapies exist to tackle these problems. These therapies are becoming more efficacious while reducing postprocedural recovery time. The goal is to restore the natural youthful appearance rather than to create an effect that differs from the patient’s appearance earlier in life. Eyelid care, and cosmetic dermatology in general, intends to restore balance and symmetry. We discuss the initial consultation, relevant anatomy for the dermatologist, and medical, laser and cosmetic therapies.

Effects of intense pulsed light on tissue vascularity and wound healing: a study with mouse island skin flap model.

Intense pulsed light (IPL) has been used extensively in aesthetic and cosmetic dermatology. To test whether IPL could change the tissue vascularity and improve wound healing, mice were separated into 4 groups. Mice in Group I were not treated with IPL, whereas, dorsal skins of mice in Groups II, III, and IV were treated with 35 J/cm2, 25 J/cm2, and 15 J/cm2 IPL, respectively. After 2 weeks, dorsal island skin flaps were raised, based on the left deep circumflex iliac vessels as pedicles; then, survival rate was assessed. Flaps in Group IV (treated with lowest dose of IPL) have a survival rate significantly higher than other groups. Counting blood vessels did not demonstrate any significant differences; however, vessel dilation was found in this group. The results show that IPL at the therapeutic doses which are usually applied to humans is harmful to mouse dorsal skin and did not enhance wound healing, whereas, IPL at much lower dose could improve wound healing. The possible mechanism is the dilation of tissue vasculature thanks to the electromagnetic character of IPL. Another mechanism could be the heat-shock protein production.

Book Review of Dermatologic Clinics: Advances in Cosmetic Dermatology

Neil S. Sadick and Nils Krueger, Advances in Cosmetic Dermatology . New York, NY: Elsevier, 2014. 112 pp. ISBN-10: 0323263887. ISBN-13: 978-0323263887. $99. ![Graphic][1] I had the great pleasure of reading the book Advances in Cosmetic Dermatology , edited by Drs Neil Sadick and Nils Krueger, cover to cover during a 3-hour plane ride. The book, which is the January 2014 volume of Dermatologic Clinics, is user-friendly and easy to read, and it captured my attention from start to finish. As I flipped through the table of contents, I knew that it would be a treat for me to read a collection of review articles exclusively devoted to cosmetic dermatology, neatly tied into a single volume. Practicing dermatology for more than 30 years, Dr Sadick is clinical professor of dermatology at Weill Cornell Medical College and immediate past president of the American Academy of Cosmetic Surgery. He is certainly well qualified to spearhead a project such as this. His coeditor, Dr Krueger, holds a PhD and is employed by the Sadick Research Group, a leading international research center with more than 25 years of experience in large multicenter studies. Most of the contributing authors selected by the editors are key opinion leaders, well respected in the field of cosmetic dermatology. Many have lectured and published extensively and … [1]: /embed/inline-graphic-1.gif

The Use of Hyaluronidase in Cosmetic Dermatology: A Review of the Literature

Background: Hyaluronidase can be employed to manage a variety of complications associated with cosmetic hyaluronic acid (HA) filler injection. However, the indications and treatment protocol for hyaluronidase use have not been well established.

Men's aesthetic dermatology.

Cosmetic dermatology is continuing to see a dramatic increase in both procedures performed and technological advancements. Men's aesthetic dermatology is burgeoning with more men seeking cosmetic consultations and intervention. Whether it is targeted cosmeceuticals for men or male-specific procedures, dermatologists must be aware of this evolving demographic and understand the biological, anatomical, and psychological aspects that separate this cohort from their female counterparts. Cosmetic dermatology has moved beyond just applying the same techniques used for females onto males. The use of our cosmetic toolbox can differ for men in terms of technique and dosage. This article will review the state of men's aesthetic dermatology with.

Use of radiofrequency in cosmetic dermatology: focus on nonablative treatment of acne scars

Acne is a common affliction among many teens and some adults that usually resolves over time. However, the severe sequela of acne scarring can lead to long-term psychological and psychiatric problems. There exists a multitude of modalities to treat acne scars such as more invasive surgical techniques, subcision, chemical peels, ablative lasers, fractional lasers, etc. A more recent technique for the treatment of acne scars is nonablative radiofrequency (RF) that works by passing a current through the dermis at a preset depth to produce small thermal wounds in the dermis which, in turn, stimulates dermal remodeling to produce new collagen and soften scar defects. This review article demonstrates that out of all RF modalities, microneedle bipolar RF and fractional bipolar RF treatments offers the best results for acne scarring. An improvement of 25%–75% can be expected after three to four treatment sessions using one to two passes per session. Treatment results are optimal approximately 3 months after final treatment. Common side effects can include transient pain, erythema, and scabbing. Further studies are needed to determine what RF treatment modalities work best for specific scar subtypes, so that further optimization of RF treatments for acne scars can be determined.

Multicenter prospective cohort study of the incidence of adverse events associated with cosmetic dermatologic procedures: lasers, energy devices, and injectable neurotoxins and fillers.

Common noninvasive to minimally invasive cosmetic dermatologic procedures are widely believed to be safe given the low incidence of reported adverse events, but reliable incidence data regarding adverse event rates are unavailable to date. To assess the incidence of adverse events associated with noninvasive to minimally invasive cosmetic dermatologic procedures, including those involving laser and energy devices, as well as injectable neurotoxins and fillers. A multicenter prospective cohort study (March 28, 2011, to December 30, 2011) of procedures performed using laser and energy devices, as well as injectable neurotoxins and soft-tissue augmentation materials, among 8 geographically dispersed US private and institutional dermatology outpatient clinical practices focused on cosmetic dermatology, with a total of 23 dermatologists. Participants represented a consecutive sample of 20 399 cosmetic procedures. Data acquisition was for 3 months (13 weeks) per center, with staggered start dates to account for seasonal variation. Web-based data collection daily at each center to record relevant procedures, by category type and subtype. Adverse events were detected by (1) initial observation by participating physicians or staff; (2) active ascertainment from patients, who were encouraged to self-report after their procedure; and (3) follow-up postprocedural phone calls to patients by staff, if appropriate. When adverse events were not observed by physicians but were suspected, follow-up visits were scheduled within 24 hours to characterize these events. Detailed information regarding each adverse event was entered into an online form. The main outcome was the total incidence of procedure-related adverse events (total adverse events divided by total procedures performed), as verified by clinical examination. Forty-eight adverse events were reported, for a rate of 0.24% (95% CI, 0.18%-0.31%). Overall, 36 procedures resulted in at least 1 adverse event, for a rate of 0.18% (95% CI, 0.13%-0.25%). No serious adverse events were reported. Adverse events were infrequently associated with known risk factors. Noninvasive to minimally invasive cosmetic dermatologic procedures, including energy, neurotoxin, and filler procedures, are safe when performed by experienced board-certified dermatologists. Adverse events occur in less than 1% of patients, and most of these are minor and transient.

Ultrasound Skin Imaging

The interaction of high-frequency ultrasound waves with the skin provides the basis for noninvasive, fast, and accessible diagnostic imaging. This tool is increasingly used in skin cancer and inflammatory conditions as well as in cosmetic dermatology. This article reviews the basic principles of skin ultrasound and its applications in the different areas of dermatology.

Forehead wrinkles: a histological and immunohistochemical evaluation.

Wrinkles are associated with cutaneous aging especially on sun-exposed skin. Despite they are considered a major topic in cosmetic dermatology, very few reports have studied the specific histological and immunohistochemical changes characteristic for wrinkles. The study aims to evaluate the histological and immunohistochemical changes of static forehead wrinkles in relation to surrounding photoaged skin. Biopsy specimens were obtained from the forehead wrinkles of 20 volunteers of Glogau's class III-IV wrinkles. Using histological and immunostaining methods coupled with computerized morphometric analysis, measurement of epidermal thickness and quantitative evaluation of total elastin and tropoelastin as well as collagen types I, III, and VII were performed for skin biopsies. In the wrinkle site, there was statistically significant lower epidermal thickness (P=0.001), elastin (P<0.001), tropoelastin (P<0.001), and collagen VII (P<0.001) than the surrounding photoaged skin. Meanwhile, there was no significant difference between the wrinkle site and adjacent photoaged skin regarding collagen type I (P=0.07) or III (P=0.07). This study detected some histological and immunohistochemical differences in the wrinkle site when compared to adjacent photoaged skin. This may help in understanding the pathophysiology of facial wrinkling as well as its ideal way of management.

Molecular basis for stratum corneum maturation and moisturization

This themed edition of BJD is dedicated to the work of Professor Ronald Marks for his untiring work on the understanding of stratum corneum (SC) structure and function. He and his coworkers, in my opinion, had the right focus for cosmetic dermatology issues. Namely, consumers experience the wonderful properties of the SC through sight, touch and the somatosensory system. They do not experience, for example, transepidermal water loss and skin conductance or capacitance! Marks understood this and set about developing the methodologies to examine the changes in SC architecture and function when desquamation goes haywire. More importantly, he understood that moisturizers do far more than simply hydrate the SC, as exemplified in the paper by Tree and Marks, 'An explanation for the placebo effect of bland ointment bases.' Moisturizing ingredients influence the properties of the SC in many ways with the sole purpose of overcoming the signs and symptoms of dry skin. Marks demonstrated the decrease in SC cohesion following use of hydrating agents, which led to the mechanistic work on the effects of a simple molecule like glycerol on the desquamatory process. In further exploiting forced desquamation and use of abrasion, he showed that improvements in exfoliation contribute to the mitigation of the signs of photodamaged skin, which can explain part of the antiageing effect of simple moisturizers. It is here that I should point out that at least this particular author in 1988 was 'standing on the shoulders of' a great corneologist whose work influenced his research directions. So this paper will provide an update on the latest developments for the molecular basis of SC maturation and moisturization, while highlighting the contributions of Professor Marks in the different areas.

Book Review: Soft Tissue Augmentation: Procedures in Cosmetic Dermatology Series

Jean Carruthers, Alastair Carruthers, eds. Soft Tissue Augmentation: Procedures in Cosmetic Dermatology Series. 3rd ed. Series: Procedures in Cosmetic Dermatology (Jeffrey S. Dover, Murad Alam, eds). Philadelphia, PA: Saunders Elsevier, 2012. ISBN-10: 1455727822 The third edition of Soft Tissue Augmentation , edited by Drs Jean and Alastair Carruthers, is a comprehensive review of presently available soft-tissue injectable fillers and a practical guide for their use. The book contains 31 chapters, grouped into 3 major sections. Chapters 3 through 12 (the first section) address individual agents, including their development, physiochemical properties, and clinical applications. Chapters 13 through 24 pertain to treatment of specific anatomic areas (eg, forehead, glabella, nose) with various agents. The final section, Chapters 26 through 28, deals with possible complications related …

Ecografía cutánea

The interaction of high-frequency ultrasound waves with the skin provides the basis for noninvasive, fast, and accessible diagnostic imaging. This tool is increasingly used in skin cancer and inflammatory conditions as well as in cosmetic dermatology. This article reviews the basic principles of skin ultrasound and its applications in the different areas of dermatology.

11th International Symposium of Facial Plastic Surgery. Preface.

As facial plastic surgeons, we are bound by the desire to perform the highest quality work and provide the best care for our patients. It is with great pleasure that we introduce this issue of Facial Plastic Surgery, focusing on the 11th International Symposium of Facial Plastic Surgery. This meeting is jointly sponsored by the American Academy of Facial Plastic and Reconstructive Surgeons (AAFPRS) and the International Society of Facial Plastic Surgery Societies, and marks the 50th anniversary of the AAFPRS. For 5 days in May 2014, the world's top facial plastic surgeons, plastic surgeons, cosmetic dermatologists, and oculoplastic surgeons will gather together in New York City to discuss the latest techniques and technologies in facial plastic and reconstructive surgery. The cornerstone of our professional societies is education and the sharing of knowledge; this educational program will be a testimonial to the growth and advancement of facial plastic surgery throughout the world.