Nonsurgical Procedures Research Articles

DERMALIC DERMOSUPPORT WITH BIDIRECTIONAL SPICATED POLYDIOXANONE THREADS

This study is a narrative review of the literature that addresses the topic of orofacial harmonization with the use of polydioxanone (PDO) threads. PDO threads have been used as an option to slow down the natural aging process, promoting facial rejuvenation. The non-surgical procedure is performed in the office and is minimally invasive. However, there are still contraindications, for example, in the case of autoimmune diseases, pregnancy, and use of anticoagulants. In these cases, complications such as hematoma and infection may occur; however, they are mostly easy to manage, since they are transient and disappear in a few days. Furthermore, it is essential to apply the technique correctly to avoid complications, such as thread migration. Although most studies point to positive results with the use of PDO, research is still needed to verify its long-term effectiveness, especially in older people and those with more facial sagging, since this technique is more suitable for patients with mild wrinkles and sagging. Based on this, the objective of this study was to conduct a narrative review of the literature on the effectiveness of using PDO threads in orofacial harmonization. To this end, searches for scientific articles were carried out on the PubMed and SciElo platforms in 2024, using the descriptors: “Orofacial harmonization”, “PDO threads”. Nine articles were selected and presented in order to contribute with theoretical basis on the benefits, indications, applicability, safety, in addition to highlighting the effectiveness of use.

Using large administrative data for mining patients' trajectories for risk stratification: An example from urological diseases.

To identify latent clusters among urological patients by examining hospitalisation rate trajectories and their association with risk factors and outcome quality indicators. Victorian Admitted Episodes Dataset, containing information on all hospital admissions in Victoria from 2009 to 2019. The top twenty ICD-10 primary diagnosis codes in urology were used to select patients (n = 98,782) who were included in the study. Latent class trajectory modelling (LCTM) was used to cluster urological patient hospitalisation trajectories. Logistic regression was used to find baseline factors that influence cluster membership, the variables tested included comorbidities, baseline diagnosis codes, and socio-demographic factors. The analysis was further stratified into non-surgical procedures and surgical procedures. Five clusters of hospitalisation trajectories were identified based on clustering hospitalisation rates over time. Higher hospitalisation clusters were strongly associated with longer length of stay, higher readmission rates and higher complication rates. Higher-risk groups were strongly associated with comorbidities such as renal disease and diabetes. For surgical procedures, urological cancers (kidney, prostate and bladder cancer) and irradiation cystitis were associated with higher-risk groups. For non-surgical procedures, calculus of the bladder, urethral stricture and bladder neck obstruction were associated with higher-risk groups. For patients with two or more admissions, liver cardiovascular disease and being diagnosed with benign prostatic hyperplasia were also associated with higher risk groups. A novel statistical approach to cluster hospitalisation trajectories for urological patients was used to explore potential clusters of patient risks and their associations with outcome quality indicators. This study supports the observation that baseline comorbidities and diagnosis can be predictive of higher hospitalisation rates and, therefore, poorer health outcomes. This demonstrates that it is possible to identify patients at risk of developing complications, higher length of stay and readmissions by using baseline comorbidities and diagnosis from administrative data.

Non-Surgical Medical Aesthetics and Patient Quality of Life: An Umbrella Review

Abstract Background Non-surgical cosmetic facial procedures have become popular treatment options for individuals seeking aesthetic improvements. Despite a breadth of literature on patient satisfaction with treatment outcomes, there is a lack of information specific to changes in quality of life outcomes. Objectives The objective of this umbrella review was to report the effectiveness of non-surgical facial aesthetic treatments on reported quality of life in cosmetic treatment seeking patients. We also aimed to identify gaps in the literature on measures of quality of life outside of patient satisfaction. Methods We completed a comprehensive, systematic search of review articles across six databases including Medline, CINAHL Plus, EMBASE, APA PsychINFO, Cochrane Reviews and Google Scholar. We included review-level studies examining the change in quality of life measures following treatment. Critical appraisal was completed for each review article included. Results A total of seven reviews included. One review was of strong quality, two moderate, and four were weak. Several non-surgical procedures were evaluated across reviews including injectable neurotoxins, dermal fillers and laser skin resurfacing. The majority of included studies reported increases in measures of quality of life, post treatment in the same patient or compared to controls. The most commonly reported measure was psychological wellbeing, followed by self-perception. There was a lack of measures outside of improvements to aesthetics, including those specific to mental health (e.g., depression). Conclusions Overall, studies that report on non-surgical treatments report increases in overall quality of life. This conclusion should be interpreted with caution as the majority of reviews included were of moderate to weak quality. A major gap in this literature includes mental health outcomes. Future research should focus on increasing the rigour of reporting for systematic reviews.

Intragastric Balloon Placement as an Effort for Weight Reduction in Morbid Obesity Cases

In The background: The term "morbid obesity" refers to cases of obesity with a body mass index (BMI) ≥ 35 kg/m² accompanied by health conditions related to obesity. Intragastric balloon placement is a non-surgical endoscopic bariatric therapy for obesity. We present a case of morbid obesity that underwent intragastric balloon placement. Case report: A 36-year-old woman experienced continuous weight gain over the past 10 years. Various attempts to lose weight had been made, but none were successful. She reported worsening heartburn over the last 3 months, which did not improve with medication. The BMI was calculated at 35.6 kg/m². Gastroscopy revealed mucosal hyperemia in the distal one-third of the esophagus, concluding that the patient had esophagitis. An intragastric balloon was placed via endoscopy, and the patient followed a special diet after the procedure. One month after placement, a weight loss of 9 kg was observed, and her heartburn complaints had significantly improved. Conclusion: We report a case of morbid obesity that improved following intragastric balloon placement. This non-surgical endoscopic bariatric procedure is the first of its kind performed in Surabaya.

Management of subgingival proximal defects

Deep proximal cavities can be progressively elevated by a restorative procedure known as deep margin elevation (DME), which improves margins for either direct or indirect restorations. Dietschi and Spreafico (1998) introduced the non-surgical alternative procedure of DME for crown lengthening. Other names for the DME concept include “coronal margin relocation,” “proximal box elevation,” and “cervical margin relocation.” A DME treatment’s therapeutic effectiveness depends on a proper indication, and its clinical efficacy is largely dependent on how well the DME is adjusted. In addition to maintaining periodontal health, a suitable DME adaption may be able to lessen bacterial buildup and the occurrence of secondary caries. Here, we report on three cases of DME that were performed when adequate isolation was possible, and caries was progressing subgingivally.

Hemangioma in Children: Literature Review

Hemangioma is a vascular anomaly that is benign and generally occurs in children. ISVVA 2018 classifies vascular anomalies into two categories, namely vascular malformations and vascular tumors (hemangioma). The prevalence of hemangioma is higher in low birth weight babies, premature babies, and girls. Several theories suggest that hemangiomas are caused by vasculogenesis and angiogenesis or an imbalance between angiogenic and antiangiogenic factors. Hemangiomas grow through a proliferation phase, involution phase, and post-involution phase. Hemangioma classification is based on the depth of the lesion, time of appearance of the lesion, distribution of the lesion, and its relationship to syndrome complication.. Diagnosis of hemangioma is based on anamnesis, physical examination, and supporting examinations which include USG, MRI, and CT-Scan. Hemangiomas that lead to complications should require immediate treatment. Hemangioma treatment can be done with topical therapy, systemic therapy (propranolol, corticosteroids, β-blockers, vincristine, rapamycin), laser therapy (PDL, diode, Nd: YAG, argon, KTP, CO2, IPL), and other treatments consisting of from surgical and non-surgical procedures (bleomycin injection).

Comparison of Surgical and Non-Surgical Treatments for Proximal Humerus Fractures: A Cross-Sectional Study

Background: The proximal humerus fracture (PHF) is one of the most common fractures of the upper limbs. PHF is more common in older people, usually following a fall, whereas in younger people this form of fracture is typically caused by high-energy trauma. There are several treatment options for PHFs, including surgical and non-surgical procedures. Our aim was to compare the outcomes of surgical and non-surgical treatment methods in Iranian patients with PHFs. Methods: Sixty patients with PHFs participated in this single-center cross-sectional study. Medical records were reviewed and evaluated according to demographic characteristics, underlying diseases, type of treatment, complications, need for reintervention, and Constant score. Results: The mean age of the patients was 45.65 years. Among those older than 50 years, women significantly outnumbered men (66.7%, P = 0.009). Thirty-one patients received surgical treatment, while 29 patients received non surgical care. The Constant scores of patients who underwent surgery were considerably higher than those of non-surgical patients [mean ± standard deviation (SD): 80.41 ± 1.89 versus 69.82 ± 1.82, P = 0.009]. This significant relationship was observed only in the age group of 18 to 49 years. Conclusion: Overall, the complications arising from both surgical and nonsurgical treatments were not statistically significant; however, patients under the age of 50 and men had higher Constant scores, indicating better clinical outcomes.

TRANSTORNO DISMÓRFICO CORPORAL:UMA REVISÃO INTEGRATIVA DO INSUSTENTÁVEL PESO DA BELEZA

This article explores the relationship between social media use and body dysmorphic disorder (BDD), contextualizing the increase in dissatisfaction with body image in an increasingly connected society. The objective was to understand the impact and influence of the search for beauty standards imposed by social media in relation to body dysmorphic disorder. The methodology used was an integrative literature review; the research was carried out through articles published in the last 10 years, in the PubMed, SciELO and Google Scholar databases; the search and selection path of the articles was arranged in an adapted flowchart. Four articles were included for the review and the results are presented in a summary table with the main elements of the studies. The discussion held understood that there is a strong correlation between the intensive use of social networks and the intensification of concerns about appearance, especially in relation to the face and belly. The discussions also revealed that the use of image-centered social media, such as Instagram and Snapchat, influences the perception of appearance, exacerbates comparative behaviors and fosters dysmorphic behaviors, and that constant exposure to idealized aesthetic standards and the use of filters and effects on published images contribute to increased body dissatisfaction with the consequent search for surgical and non-surgical aesthetic procedures. It was concluded that social media significantly influences the intensification of BDD, impacting individuals’ quality of life in the areas of physical and emotional health and social and professional relationships.

Avascular Necrosis of the Talus: Diagnosis, Treatment, and Modern Reconstructive Options.

Talar avascular necrosis (AVN) is a devastating condition that frequently follows type III and IV talar neck fractures. As 60% of the talus is covered by hyaline cartilage, its vascular supply is limited and prone to trauma, which may eventually lead to AVN development. Early detection of AVN (Hawkins sign, MRI) is crucial, as it may prevent the development of the irreversible stages III and IV of AVN. Alertness is advised regarding non-obvious conditions that may cause this complication (sub chondroplasty, systemic lupus erythematosus, diabetes mellitus). Although, in stages I-II, AVN may be treated with non-surgical procedures (ESWT therapy, non-weight bearing) or joint-sparing techniques (core drilling, bone marrow aspirate injections), stages III-IV require more advanced procedures, such as joint-sacrificing procedures (hindfoot arthrodesis/ankle arthrodesis), or replacement surgery, including total talar replacement (TTR) or combined total ankle replacement (TAR). The advancement of 3D-printing technology and increased access to implant manufacturing are contributing to a rise in the production rates of third-generation total talar prostheses. As a result, there is a growing frequency of alloplasty procedures and combined total ankle replacement (TAR) surgeries. By performing TTR as opposed to deses, the operator avoids (i) delayed union, (ii) a shortening of the limb, (iii) a lack of mobility, and (iv) the stiffening of adjacent joints, which are the main disadvantages of joint-sacrificing procedures. Simultaneously, TTR and combined TAR offer (i) a brief period of weight-bearing restriction, (ii) quick pain relief, and (iii) preservation of the length of the limb. Here, we summarize the most up-to-date knowledge regarding AVN diagnosis and treatment, with a special focus on the role of TTR.

The Cosmetic Readiness Questionnaire (CRQ): Validation of a Pre-Operative Psychological Screening Tool for Aesthetic Procedures.

Several psychological risk factors are associated with patient dissatisfaction with aesthetic procedures, such as body dysmorphic disorder (BDD), unmanaged mental health concerns or unrealistic expectations. Identifying these risks via preoperative screening may protect patients from adverse psychological outcomes and provide reputational or legal protection for practitioners. This study aimed to further develop and validate the Cosmetic Readiness Questionnaire (CRQ), a comprehensive psychological screening tool to assess patient suitability for surgical and non-surgical aesthetic procedures. The CRQ was validated across two studies in clinical contexts, examining structural and construct validity in a sample of 8031 individuals who completed the CRQ as part of routine clinical care. In a further sample (n = 574), criterion validity was explored through the relationship between the CRQ and dissatisfaction with past aesthetic treatments. Risk category cut-off scores were developed. Results supported the reliability and validity of a five-factor CRQ which measures Body Dysmorphia, Psychological Distress, Self-Criticism, Unrealistic Expectations and Lack of Openness. High scorers on the CRQ were 78% more likely to report dissatisfaction with a past cosmetic procedure than low scorers. The CRQ is a comprehensive and valid screening measure to identify patients who may require further psychological assessment or additional support prior to aesthetic treatment. Instructions are provided on how to implement the CRQ in clinical practice.

Methods used for caries detection and diagnosis in Ontario dental practices: a cross-sectional survey

BackgroundEarly detection of caries is essential for applying non-surgical treatment procedures and preventing the formation of cavitated lesions leading to unnecessary removal of tooth structure. Understanding dentists’ preferences for caries detection tools can inform stakeholders about their strategies and knowledge of contemporary, evidence-based caries management approaches. However, there is a lack of research exploring the detection methods of caries commonly used by dentists in Ontario, Canada. The objective of this study was to investigate the methods of caries detection and diagnosis preferred by dentists in Ontario.MethodsA 21-item self-reported survey was mailed to one thousand Ontario dental practices in the Winter of 2022. Descriptive and bivariate data analysis were performed to determine the associations between: demographics and professional practice characteristics (explanatory variables), and methods for detecting and diagnosing dental caries (outcome variables) using SPSS Statistics 29.0.ResultsA total of 325 dentists (33%) responded to the survey, with 274 answering all of the questions completely. The highest proportion of respondents were 35–44 years of age (32.8%) and male (53.4%). More than half of the respondents reported using a dental explorer to assess primary occlusal caries (57.6%), secondary caries (57.1%), and cervical caries (57.5%). Likewise, 57.9% of the participants reported using dental radiographs to diagnose proximal caries. Among additional caries detection tools, digital radiography (89.8%) and traditional radiography (84.7%) were the most used methods/modalities, while cone beam computed tomography was the least (12.8%). Most study participants did not use any caries classification system (77.7%) or caries risk assessment tool (85.3%).ConclusionsParticipants preferred conventional methods for caries detection, instead of contemporary visual-tactile caries lesions classification and/or caries risk assessment systems. These findings indicate a need for continuing dental education programs tailored to evidence-based caries management approaches.

The level of inflammatory markers in patients with myocardial infarction after percutaneous coronary intervention

Cardiovascular diseases are among the most widespread diseases in the world that affect all ages and sometimes can lead to death. Atherosclerosis, coronary syndrome and myocardial infarction are usually associated with artery occlusion and require percutaneous coronary intervention (PCI) as a non-surgical procedure to restore blood flow to the heart. Inflammatory biomarkers, especially interleukins and cardiac biomarkers, have an important role in diagnosing the state of patients with heart damage. The goal of the study was to estimate the serum levels of interleukins and cardiac biomarkers after PCI to reduce the risk of acute coronary syndrome. The study included 100 persons between the ages of 40 and 69 diagnosed with acute coronary syndrome who had successful PCI and a control group consisting of 50 healthy participants of the same age. The levels of interleukins, сreatine kinase MB and myoglobin were measured using an enzyme-linked immunosorbent assay. Troponin and D-dimer levels were measured using immunoassay. It was found that patients before PCI had significantly higher levels of IL-1β, IL-6, IL-8, cardiac troponin I, D-dimer, creatine kinase-MB and myoglobin compared to the control group. One day after PCI, the levels of IL -6, IL-8, cardiac troponin I and D-dimer remained elevated. One week after PCI, the levels of IL-1β, IL-6, IL-8, CK-MB and myoglobin did not show significant differences compared to the control group, while the levels of cardiac troponin I and D-dimer remained higher. Results obtained indicate that in patients after PCI, the levels of interleukins decreased, indicating the reduction of inflammatory processes, but cardiac damage persists to a certain degree, even a week after PCI. Keywords: creatine kinase MB, D-dimer, interleukin, myocardial infarction, myoglobin, percutaneous coronary intervention

Arthroscopic Mumford Procedure for AC Joint Arthritis

Background: Acromioclavicular (AC) joint arthritis is a common cause of shoulder pain in young patients. Management has been focused on relieving pain mainly with conservative nonsurgical procedures such as corticoid injections, physical therapy and even, recently, orthobiological interventions with platelet-rich plasma and hyaluronic acid injections. However, failed conservative management opens the door to surgical interventions such as the arthroscopic distal third of the clavicle resection. Indications: Patients submitted to this surgery must have a confirmed diagnosis of an arthritic, painful AC joint that has not been properly responding to nonoperative management. Technique Description: The surgical procedure is done in the beach chair position with standard arthroscopic portals. After a proper intraarticular evaluation of the structures and ruling out any other causes of pain, the surgeon passes to the subacromial space. Identification of the AC joint is made by following the coracoacromial ligament medial and with manipulation of the clavicle from the patient's skin. Debridement should start by releasing the anterior and posterior ligaments to allow for proper visualization of the articulation. A bur or a 5.5-mm shaver is used to start resection of the distal third of the clavicle under visualization and with care to not create a vault. The procedure is considered done when a smooth articular surface is visualized and with at least 5 mm of space between the clavicle and the acromion. Results: The proposed technique, which is a variant of the classic distal clavicle excision, has shown improved functional outcomes with reproducible postoperative scores and low complications rates in the setting of patients with isolated AC joint arthritis. Conclusion: Surgical management of the painful, arthritic AC joint has been evolving alongside with the history of shoulder arthroscopy; the proposed arthroscopic approach is an easy and effective way of freeing the patient of pain and discomfort with quick return to activities and sports. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Management Of Large Periapical Lesion With A Noninvasive Approach: A Case Report

Periapical lesions develop as a sequela to pulpal diseases. The majority of inflammatory periapical lesions are initially treated with conservative non-surgical procedures. The success of root canal treatment is based on thorough cleaning, shaping and obturation of the root canal system. Calcium hydroxide and triple antibiotic paste (TAP) are recommended as intracanal medicaments due to its antibacterial properties. This case report describes the non-surgical management of a large cyst-like periapical lesion in relation to the maxillary lateral incisor of a 19-year-old male with the chief complaint of periodic swelling and pus drainage from the palatine region with a history of a traumatic accident in the same area. The present case highlights the use of calcium hydroxide and TAP as an interappointment endodontic dressing for non-surgical management of large periapical radiolucency, which resulted in favourable clinical and radiographic outcomes

Development of a Pre-Operative Psychological Screening Tool: Piloting the Cosmetic Readiness Questionnaire (Pilot-CRQ).

Patients with psychological risk factors, such as body dysmorphic disorder (BDD), and unmanaged mental health concerns are considered higher risk of dissatisfaction with aesthetic procedures. Identifying these risks before a procedure may decrease the chance of adverse outcomes for patients and practitioners. This study aimed to develop a comprehensive psychological screening tool to assess patient's psychological suitability for surgical and non-surgical aesthetic procedures. Items for the Pilot-Cosmetic Readiness Questionnaire (CRQ) were developed by psychologists (n = 3) and then reviewed by plastic surgeons (n = 2) and non-surgical cosmetic doctors (n = 3). Patient interviews (n = 15) and piloting of the questionnaire (n = 69) provide data to examine the scale's initial psychometric properties. Results supported the reliability and validity of the Pilot-CRQ's subscales of Body Dysmorphia, Psychological Distress, Self-Criticism, Perfectionism, and Lack of Openness. 'Lack of Openness' is a validity scale which examines the degree that respondents may be underreporting symptoms. The CRQ predicted individuals with a BDD diagnosis as rated by a blinded expert clinical psychologist, with high sensitivity and specificity. These results provide support for the Pilot-CRQ in identifying people with BDD and psychological factors related to aesthetic treatment outcomes and provide a strong basis for using the CRQ in clinical contexts and in future research.

Super-Selective Intra-arterial Thrombolytic Therapy for Peripheral Facial Paralysis After Postauricular Hyaluronic Acid Injection for the Esthetic Correction of Lying Ears.

Hyaluronic acid (HA) injection in the auricular base is one of the most popular and non-surgical cosmetic procedures for correcting lying ears and optimizing the facial profile because of its minimal invasiveness, immediate effect and safety (Li et al. in Aesthet Surg J 44: 746-75, 2024). But we have recently discovered that this treatment may lead to a new and rare complication called peripheral facial paralysis that has never been reported before. Until now, the etiology, clinical traits, treatment strategies, outcomes and possible reversibility have not been characterized. In the present study, we enrolled 4 patients with peripheral facial paralysis after subcutaneous postauricular HA filler injection. Preoperative digital subtraction angiography revealed a vascular embolism. Then, the patients underwent super-selective facial arterial thrombolytic therapy via hyaluronidase and papaverine injections. Simultaneously, general symptomatic treatment and nutritional therapy were performed. The patients were relieved of their clinical symptoms and the significant improvement was observed in terms of motor function in her left facial areas after treatment. The auricular skin necrosis of all patients was restored to near normal appearance. Our results indicate that super-selective facial arterial thrombolytic therapy is feasible for patients with peripheral facial paralysis induced by HA embolism. It was also beneficial in the recovery from skin necrosis. The therapy was shown to be worthy of clinical application. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Effect of Electroacupuncture on the Treatment of Chronic Achilles Tendinopathy: A Case Report

Background and Objective: Chronic Achilles tendinopathy is among the most prevalent musculoskeletal disorders, especially among athletes. Despite numerous non-surgical procedures performed for this disorder, the treatment of these patients is still challenging. Given that electroacupuncture is a novel technique for the treatment of tendinopathy, a few studies have addressed it. This case report aimed to present the electroacupuncture technique for the treatment of chronic Achilles tendinopathy. Case Presentation: A 53-year-old male patient with a 6-month history of left Achilles tendon pain and limited daily activities was referred to Mobasher Physiotherapy Clinic in January 2024. For this purpose, 3-mm needles were inserted into the distal part of Achilles tendon at points BL 60, BL 61, KI 3, and KI 4. The patient received ten 20-min sessions of electroacupuncture treatment (three times per week at the frequency of 5 Hz and current intensity of 5 mA). Pain intensity and ankle range of motion were evaluated at first and last sessions. Conclusion: As evidenced by the results of this study, applying electroacupuncture for Achilles tendinopathy, especially chronic tendinitis that has not been treated with other conservative procedures, could improve the patient’s symptoms and ankle function, enhancing the patient’s functional activities and life quality.

Trends in Surgical and Nonsurgical Aesthetic Procedures: A 14-Year Analysis of the International Society of Aesthetic Plastic Surgery-ISAPS.

Trends in Surgical and Nonsurgical Aesthetic Procedures: A 14-Year Analysis of the International Society of Aesthetic Plastic Surgery-ISAPS.

LC-OCT as a tool to visualize in vivo location of dermal fillers.

Dermal fillers have emerged as a popular non-surgical solution for facial rejuvenation and enhancement. Apart from botulinum toxin injections, they are the most common non-surgical procedure performed in the US. Line-field optical coherence tomography (LC-OCT; deepLive system Damae Medical, France) represents one of the most recent developments in non-invasive skin imaging technologies. We performed LC-OCT image acquisition on six patients that were treated with hyaluronic acid (HA) dermal fillers in various locations on the face. The images were acquired before the application of the fillers (T0), immediately after (T1), and at a 6- to 8-week (T2) follow-up visit. At T0, we were able to appreciate a normal-appearing epidermis, dermoepithelial junction, and dermis. At T1, the intradermal filler deposits appeared as homogeneously hyporeflective areas, clearly discernible from surrounding vessels and other structures. At T2, the deposits were distinguishable as hyporeflective areas, although they were diminished in size compared to T1. On enface view, collagen fibers had increased thickness and were more homogeneously organized and hyperreflective. We established the usefulness of LC-OCT in the non-invasive evaluation of dermal HA fillers to visualize both short-term and medium-term effects. LC-OCT may be a valuable tool in evaluating the precise location of filler placement and follow-up of resulting in vivo changes.

Complications of Chemical Peels, Lasers, and Energy-Based Device Procedures Performed by Core Cosmetic Physicians: A Retrospective Analysis.

There has been a proliferation of physicians of different levels of experience and training offering nonsurgical cosmetic procedures. Rising demand, compounded by increasing utilization of new and existing technologies by numerous physician specialties, compels discussion of adequate standardized training and patient safety. A retrospective chart review of patients who presented to our single site dermatology clinic for managment of complications following chemical peel, laser or energy-based device treatments performed by core cosmetic physicians between the years of 2013 and 2024 was conducted. Core cosmetic physicians included plastic surgery, facial surgery/otolaryngology, oculoplastic surgery, and dermatology. Charts were reviewed for documentation of the type of complication, procedure causing the complication, and physician credentials, and referral source. Twenty-five patients were identified as having complications from chemical peeling, laser treatment or energy-based devices. Devices implicated included CO2 laser (fractional or fully ablative), chemical peels, 1064 nm long-pulsed Nd:YAG laser, 1320 nm Nd:YAG laser, intense pulsed light, 595 nm pulsed dye laser, Q-switched Nd:YAG laser, radiofrequency with and without microneedling, and 1550 nm erbium-doped fiber laser. Complications included hypertrophic scarring, atrophic scarring, post-inflammatory erythema, post-inflammatory hyperpigmentation, and post-inflammatory hypopigmentation. Even in experienced hands, complications can arise. It is imperative that all physicians offering cosmetic treatments are equipped to recognize clinical endpoints, identify and manage complications, or make a timely referral to decrease the risk of a permanent and potentially devastating esthetic outcome for patients.