Dermatologic Surgery最新文献

Background: Aging leads to noticeable changes in lip volume, definition, and projection largely due to alterations in the orbicularis oris muscle. Although superficial signs of aging are well-documented, deeper muscular changes remain underexplored. These anatomical shifts can influence both lip aesthetics and the effectiveness of interventions such as dermal fillers and botulinum toxin.

Objective: This study aimed to evaluate age-related changes in the angle of the orbicularis oris muscle and to examine potential sex-based differences.

Materials and methods: Thirty healthy participants (17 women and 13 men), aged 20 to 60 years, with normal body mass index (18.5-24.9), were enrolled. None of the patients had any history of lip surgery or injections. Using high-resolution ultrasonography, the angle of the orbicularis oris muscle was measured at 5 standardized anatomical points on both the upper and lower lips.

Results: A significant decrease in the muscle angle was observed with age, particularly in female participants. These changes were most pronounced in the upper lip and associated with a more inverted lip shape.

Conclusion: Age-related changes in the orbicularis oris muscle, especially in female participants, contribute to altered lip morphology. Understanding these changes can help develop more effective and natural rejuvenation strategies using injectables.

Background: Melasma is a common hyperpigmentation disorder influenced by ultraviolet exposure, genetics, and hormonal factors. Although associations with pregnancy and oral contraceptives are well established, the impact of hormone replacement therapy (HRT) on melasma is poorly researched.

Objective: The aim was to evaluate existing evidence on the relationship between HRT and melasma and propose evidence-based management guidelines.

Methods and materials: A literature search of PubMed, Embase, and Scopus was conducted. Studies involving oral oestrogen-only HRT, combined HRT, transdermal oestrogen, topical oestrogen, and vaginal oestrogen were included. Guidelines were proposed based on the strength of evidence available.

Results: Evidence is limited and largely comprises case reports. High-dose oral oestrogen-only HRT has the strongest documented association, with case reports suggesting an association to forearm melasma in women with Fitzpatrick types III-VI. Case reports exist for combined oral and transdermal HRT, whereas topical and vaginal HRT formulations have minimal evidence to support their association with melasma. In vitro fertilization has no reported associated cases of melasma.

Conclusion: HRT-associated melasma is underrepresented in the literature. Clinicians should counsel at-risk women on melasma risk and ensure strict photoprotection. Prospective studies are needed to clarify melasma risk across different HRT formulations.

Background: Skin quality is an aggregate term encompassing a broad range of skin attributes that convey its overall look, feel, and health.

Objective: To assess consistency in definitions and treatment outcomes for various skin quality attributes.

Materials and methods: We searched PubMed, MEDLINE, and Embase to perform 2 systematic reviews. The initial search identified published articles (January 1, 2000-October 13, 2021) and abstracts (January 1, 2019-October 13, 2021) that used an objective or subjective instrument to assess skin quality at ≥2 timepoints. A supplemental search of meta-analyses published from 2010 to May 2024 was conducted to evaluate treatment outcomes for each skin quality attribute.

Results: The initial search included 903 studies comprising 4,668 individual observations. Subjective end points comprised 87% of observations. Substantial inconsistencies were identified in the definition of individual skin quality attributes across studies, with multiple definitions in use in the literature for each attribute (range, 7-17) and no clear consensus.

Conclusion: This extensive review of the current state of the aesthetic medicine literature revealed an absence of consensus definitions for skin quality attributes, which poses a barrier to comparative evaluation of treatment options and could affect physician recommendations, potentially with downstream effects on patient outcomes.

Background: Evaluating postoperative outcomes after Mohs micrographic surgery (MMS) necessitates the use of patient-reported outcome measures (PROMs) and clinician (± patient) scar assessment tools.

Objective: To review patient- and clinician-reported outcome tools that have been developed to evaluate postoperative outcomes that are relevant to MMS.

Methods: A literature search was conducted to identify patients and clinician-reported outcome tools developed for surgery on the head and neck and for skin cancer surgery (including MMS).

Results: Sixteen articles were included. Five PROMs (dermatology life quality index, Skindex 16/29, skin cancer index [SCI], Skin Cancer Quality of Life Impact Tool/SF, Facial Apperance Related Questionnaire [FACE-Q]) and 5 clinician (± patient) scar assessment tools (Vancouver Scar Scale, Patient and Observer Scar Assessment Scale [POSAS], Manchester Scar Scale [MSS], Stony Brook Scar Evaluation Scale, Global Cosmetic Rating/Visual Analog Scale) are evaluated in detail. Among PROMs, the SCI and FACE-Q Skin Cancer module have demonstrated the strongest validation for facial skin cancers. Emerging tools, for example, Mohs micrographic surgery reconstruction questionnaire-12, reflect efforts to refine patient-centered outcome assessment specific to MMS. Clinician scar assessment tools remain valuable with POSAS widely regarded for combining objective scar characteristics with patient-reported symptoms. Vancouver Scar Scale and MSS offer structured observer-based evaluations, whereas other tools provide simple early postoperative assessments.

Conclusion: Integrating PROMs with clinician-reported scar assessment tools enables a comprehensive, multidimensional understanding of surgical outcomes-capturing both the subjective patient experience and objective clinical metrics.

Background: Patient satisfaction with Mohs micrographic surgery is dependent on multiple clinical and surgical factors. This study implements a novel survey to assess patient satisfaction in multiple domains.

Objective: (1) To assess whether satisfaction changes over time and (2) to evaluate predictors of patient satisfaction in multiple satisfaction domains.

Materials and methods: The Oxford Skin Cancer Treatment Scale (OxSCanTr) assesses patient satisfaction with scar aesthetics, treatment choice, surgical experience, and postoperative concerns. Surveys were completed immediately after surgery and at 1 week and 4 weeks postoperatively. Clinical and demographic data were collected. Statistical analysis included repeated-measures analysis of variance, univariate, and multivariate repeated-measures linear regression.

Results: Satisfaction does not vary significantly over time. Diabetes, immunosuppression, and linear closure methods are associated with higher total satisfaction. Linear closure method predicts higher total, aesthetic outcome, and treatment experience satisfaction. Patient age, number of Mohs stages, noncutaneous cancer history, tumor location, skin cancer history, postoperative defect size, and absorbable top sutures predict patient satisfaction in at least one domain.

Conclusion: This study increases awareness of the clinical and surgical factors that contribute to patient satisfaction with Mohs procedures, which can help to advance patient-centered care.