Dermatologic Surgery最新文献

Background: Mohs micrographic surgery causes significant postsurgical pain, particularly when more extensive reconstructions are required. Although opioids are a reasonable choice for pain control in select cases, the risks of dependency and overdose warrant stringent opioid stewardship.

Objective: To determine how the opioid prescribing practices among Mohs surgeons treating Medicare beneficiaries have changed during the opioid epidemic using the available Medicare claims data from 2014 to 2022.

Methods: A retrospective analysis of opioid prescribing using Medicare claims data.

Results: Between 2014 and 2022, the percent of Mohs surgeons prescribing opioids decreased from 48% to 33%. Factors associated with opioid prescribing included medical school graduation in 1990 or after; location in the South, Midwest, or West; higher Mohs case volume; and performing higher complexity repairs. Surgeons prescribing opioids decreased the average days' supply by 19%. The percent of opioid prescriptions for hydrocodone decreased by 28% while those for tramadol increased by 246%.

Conclusion: Mohs surgeons' opioid prescribing practices have continued to improve since 2014 through limiting the frequency and duration of opioid prescriptions, with most surgeons not prescribing opioids in 2022.

Background: Surgical site infections after lower extremity dermatologic procedures increase morbidity, recovery time, and health care costs. This study examined whether the introduction of a skin adhesive closure method influenced infection rates and antibiotic use over a 10-year period.

Patients and methods: The authors performed a single-center retrospective cohort analysis of adult patients undergoing lower-leg dermatologic surgery between 2013 and 2023. The 3 cohorts were procedures before adhesive availability closed with sutures only, after adhesive availability closed with sutures, and after adhesive availability closed with the adhesive material. The primary outcome was occurrence of surgical site infection within 30 days, confirmed by culture or clinical signs. Secondary outcomes included incidence of prophylactic and postoperative antibiotic prescriptions, wound closure length, and Mohs micrographic stages.

Results: Introduction of adhesive was associated with a decrease in confirmed surgical site infections from 4.78% to 1.94% ( p = .0156) and clinically suspected infections from 7.96% to 3.16% ( p = .0008). Prophylactic antibiotic use dropped from 86.31% to 77.40% ( p = .0011), and postoperative antibiotics from 7.96% to 3.04% ( p = .0005). Closure length decreased from 6.59 cm to 5.07 cm ( p = .003), and Mohs stages decreased by 0.13 stages ( p < .001).

Conclusion: Skin adhesive correlated with reduced infection rates, antibiotic use, and more efficient procedures in lower-extremity dermatologic surgery.

Background: It is unknown whether facial injectable treatments before rhytidectomy increase the risk of surgical complications, and data on the safety of rhytidectomy after prior injectable (PI) treatments are essential for clinicians and patients.

Objective: The authors sought to determine whether facial injectable treatments increase complications from rhytidectomy surgery.

Materials and methods: The authors performed a retrospective chart review of all patients who had a deep-plane rhytidectomy over a 15-month period. The authors recorded PIs comprising HA, calcium hydroxylapatite, and/or poly-l-lactic acid, or no prior injectables (NPI) to determine whether patients with prior facial injectables were at increased risk of complications after rhytidectomy.

Results: More than half of patients (57%) had received injectable treatments before surgery. Twenty five patients (24%) had complication after rhytidectomy. Of these, 17 had PI and 8 had NPI. The rate of complications among all PI patients was 17/106 (16%), and the rate of complications among all NPI patients was 8/106 (8%), which is not statistically significant p = .188.

Conclusion: Their study demonstrates no significant increased risk of complications after rhytidectomy in patients with a history of facial injectable procedures. To the best of the authors' knowledge, this is the first study documenting the safety of rhytidectomy after PI procedures.

Background: Scarless healing has always been the ultimate goal of surgery. Early intervention with a CO 2 ablative fractional laser (CO 2 AFL) has been found to improve the appearance of surgical scars.

Objective: To investigate the mechanism of early intervention with a CO 2 AFL in promoting skin wound healing and the role of follicular stem cells.

Methods: The authors used seven-week-old male LGR5-Cre, Rosa-mtmg (LGR5-mtmg), krt14-gfp-creer2, and BALBc mice to establish a skin incision model and apply CO 2 AFL treatment. The histological analysis and transcriptome sequencing were performed, and the results were verified using RT-PCR and western blotting. Transgenic fluorescent mice expressing Lgr5 and K14 were used to follow the trajectories of hair follicle stem cells and epidermal stem cells during wound healing.

Results: Histological analyses revealed that after CO 2 AFL treatment, the number of incision marks in the incision tissue was lower. After treatment, the number of Lgr6 and Lgr5+ hair follicle stem cells and K14 epidermal stem cells increased, and the expression of Trps1 and its downstream Wnt pathway increased.

Conclusion: Early intervention with a CO 2 AFL to promote skin incision healing in mice may be achieved by activating Trps1 to regulate the Wnt/β-catenin pathway and promote hair follicle stem-cell participation in skin wound healing.

Background: Evolving patterns of global migration, cultural exchange, and social media exposure have diversified perceptions of facial attractiveness and reshaped patient expectations for aesthetic treatment. Conventional assessment tools based on Western-centric beauty ideals no longer fully capture this heterogeneity.

Objective: To identify current gaps in facial assessment practices and propose a culturally sensitive, patient-centric framework that integrates emerging concepts in aesthetic medicine.

Materials and methods: An expert panel of nine specialists in dermatology, oculoplastic, and plastic surgery convened to review literature on facial assessment, global beauty standards, and ethnic variations. The authors also analyzed market research from 2021-2022 exploring aesthetic priorities across diverse racial, ethnic, and gender groups.

Results: Findings highlight significant variability in aesthetic ideals across populations and an unmet need for standardized yet flexible assessment tools. The newly developed Galderma Facial Assessment Scale (FASTM) provides a structured, five-domain framework-skin quality, facial shape, proportions, symmetry, and expression-that supports objective evaluation adaptable to different ethnic and cultural contexts.

Conclusion: Modern aesthetic assessment must move beyond neoclassical norms toward individualized, diversity aware, and evidence-based evaluation. Tools such as the Galderma FASTM enable clinicians to achieve holistic, culturally sensitive, and patient-aligned treatment planning.

Background: The midface, encompassing the nose, nasolabial folds, and cheeks, plays a central role in facial harmony and perceived youthfulness. Midface aging involves skeletal remodeling, fat compartment atrophy, and ligamentous laxity, which vary across ethnic and cultural groups.

Objective: To describe the anatomical and ethnic variations that influence midface aging and to outline evidence-based strategies for individualized, culturally sensitive rejuvenation.

Materials and methods: An expert panel of dermatologists, oculoplastic, and plastic surgeons reviewed current anatomical, anthropometric, and clinical data, integrating findings from global literature and market research on aesthetic preferences across diverse populations.

Results: Distinct ethnic patterns of midface aging were identified, including variable maxillary retrusion, fat redistribution, and nasal morphology. Rejuvenation strategies such as hyaluronic acid fillers, poly-l-lactic acid biostimulators, and selective use of autologous fat grafting provide structural support and restore contour. Complementary resurfacing techniques-chemical peels and fractional lasers-can improve skin texture and enhance volumetric outcomes within a holistic treatment plan.

Conclusion: Midface assessment must integrate anatomical precision with cultural awareness. Combining volumetric restoration, surface rejuvenation, and individualized aesthetic goals yields natural, balanced results that respect each patient's ethnic identity and personal ideals.