Dermatologic Surgery最新文献

Background: Clinical and ultrasound experience has revealed that after soft tissue injections of the lateral cheek, the filler may displace from the zygoma to the caudal temporal area.

Objective: To obtain more data to provide insight into product distribution when soft tissue fillers are injected in the zygomatic region.

Methods: Two hundred patients were examined with facial ultrasound imaging of the zygomatic and temporal region. Inclusion criteria were simply a positive response on the screening questionnaire as to whether or not they had filler injections placed in their lateral cheek. Control injections were also performed to the zygomatic regions of a body donor and in 10 patients ultrasound-guided.

Results: A correlation was found between the layers in which filler was detected on the zygoma and where it was ultimately found in the temples. Four different redistribution patterns were observed: (1) migration of filler within the superficial muscular aponeurotic system (SMAS) on the zygoma into the superficial temporal fascia. Migration of filler from the lateral suborbicularis oculi fat to (2) the deep interfacial plane of the temple or (3) to the superficial temporal fat pad; (4) migration from the supraperiosteal layer of the zygoma to the superficial temporal fat pad. Body donor and patients: filler deposits injected on the zygoma were witnessed to shift during injection into the caudal part of the temple.

Conclusion: Soft tissue filler aliquots may be redistributed into the temples after injections of the lateral side of the zygomatic arch. The displacement follows a distinct pattern depending on the initial layer of injection.

Background: Current guidelines suggest that wide local excision of thick melanomas be delayed until sentinel lymph node biopsies can be performed.

Objective: To examine the literature and determine if there is a scientific basis for delaying wide local excision of thick melanomas.

Materials and methods: A narrative review of the literature was undertaken to examine all available studies on the subject.

Results: There is no evidence that prior excision compromises sentinel lymph node identification. There are multiple unsubstantiated suggestions that large rotation flaps may lead to false negatives.

Conclusion: There is no basis for delaying wide local excision of thick melanomas until a sentinel lymph node biopsy can be performed.

Background: The efficacy of keloid treatment in randomized studies is highly variable. However, no systematic review has been performed to evaluate the effect of different keloid properties on treatment efficacy.

Objective: To identify clinically relevant keloid properties that may influence treatment efficacy.

Materials and methods: An electronic database search was conducted. Two reviewers independently selected randomized controlled trials (RCTs) and performed a methodologic quality assessment using the Cochrane risk-of-bias 2.0 tool.

Results: One thousand five hundred twenty studies were screened, and 16 RCTs, involving 1,113 patients, were included. The authors found lower efficacy in older keloids ( n = 3), keloids located on the chest, extremities, pinna, and shoulder ( n = 3), larger keloids ( n = 2), lower baseline Vancouver Scar Scale score ( n = 1), and keloids with history of recurrence ( n = 1). Overall, most studies had a high risk of bias.

Conclusion: Only a minority of studies specifically addressed keloid properties, which makes comparisons between studies challenging. The authors' results suggest that keloid location, duration prior to treatment, size, history of recurrence, and severity are clinically relevant keloid properties that affect treatment efficacy. Further studies are crucial to corroborate the authors' findings, establish a clinically relevant keloid classification, and ultimately develop an evidence-based treatment algorithm that takes these properties into account.

Background: There is an ongoing increase in the demand for injectable procedures and an increase in the number of medical spas across the United States State regulations significantly vary regarding level of supervision at these medical spas.

Objective: The aim of this study was to determine who performs cosmetic procedures, provides medical supervision, and who is being informed of complications.

Methods: Descriptive study based on a standardized telephone interview performed by a prospective patient for injectable treatments performed at medical Spas in Las Vegas. Data were then extracted and analyzed.

Results: Of 63 medical spas reviewed, most of the injectable treatments (73%) were performed by nonphysicians. An onsite physician who supervised or personally performed the cosmetic procedures was present in only 38.1% of the spas surveyed. Only 46% of surveyed medical spas notify a medical director/supervising physician in the event of a complication and only 39.7% of surveyed spas had a number to call after regular business hours.

Conclusion: The majority of treatments are performed by nonphysicians in the spas surveyed. Physician supervisors are not on site in most of the spas and about half of spas do not inform the medical director in the event of a complication.