Faculty Bibliography

BACKGROUND:Cosmetic procedures have demonstrated beneficial effects on physical appearance based on anatomic markers as well as patient-perceived self-image and quality of life. Recent studies of observer-reported outcomes (OROs) suggest an additional benefit from aesthetic interventions. OBJECTIVE:The authors aimed to review the evidence of OROs from cosmetic procedures performed on the head and neck. PATIENTS, METHODS AND MATERIALS:PubMed, Embase, and Cochrane Library databases were searched for relevant studies, yielding 24 included original investigations. RESULTS:These studies captured 686 total patients, 8,257 observer evaluations, and a variety of interventions including face-lifts, blepharoplasty, rhinoplasty, and minimally invasive treatments including botulinum toxins and hyaluronic acid fillers. Forty-one distinct reported OROs were grouped into 12 descriptive domains. Domains were further grouped into 3 higher-order categories: aesthetics and wellness, social capacities, and skills and competencies. Improved perception after cosmetic intervention is most reproducibly demonstrated for the following ORO domains: age, attractiveness, sociability, relationship success, and occupational and financial competency. CONCLUSION:The synthesized findings imply a tertiary layer of benefit for cosmetic intervention beyond anatomical and patient-centered outcomes through enhanced perceptions of others. These findings may inform the pre-procedure risk-benefit discussion with patients of cosmetic medicine and drive future research into longitudinal outcomes.

BACKGROUND:The association between isotretinoin and psychiatric disturbance, including depression and suicidal behavior, is controversial. OBJECTIVE:To investigate whether acne patients prescribed isotretinoin or antibiotics were more likely to have psychiatric disorders and/or engage in suicidal behavior. METHODS:Retrospective cohort study identified acne patients prescribed isotretinoin or oral antibiotics in the IBM® MarketScan® Databases of commercial US insurance claims data from 2011-2017 who were also diagnosed with psychiatric disorders or suicidal behavior. RESULTS:A total of 72,555 patients were included. Compared to acne patients prescribed isotretinoin, patients in the general population were 1.47 times more likely to be diagnosed with suicidal ideation or attempt (adjusted OR 1.47; 1.27, 1.70, p <.0001). However, the general population (adjusted OR 0.87; 0.84, 0.89, p<0.0001) and acne patients prescribed antibiotics (adjusted OR 0.88; 0.85, 0.91, p<0.0001) were less likely to have a psychiatric diagnosis compared to acne patients prescribed isotretinoin. The prevalence of suicidal behavior during isotretinoin treatment was lower (0.10%) (p=0.082), than during the year prior to (0.22%) and during the year after isotretinoin treatment (0.34%), (p = 0.004). LIMITATIONS/CONCLUSIONS:Study excludes individuals with public or no insurance and relies on physician coding accuracy. CONCLUSIONS:Compared to the general population, acne patients prescribed isotretinoin were less likely to engage in suicidal behavior. Further exploration is warranted into the slight increase in suicidal behavior seen in isotretinoin patients one year after therapy.

PURPOSE/OBJECTIVE:We aim to demonstrate an initial proof of concept for the presence of addictive behaviors in cosmetic procedure utilization . METHOD/METHODS:ology Adult subjects visiting a cosmetic dermatology practice with history of at least one cosmetic procedure and consideration of at least one cosmetic procedure in the past 12 months were included. Two previously validated instruments in the detection of alcohol use disorder (AUD), the CAGE (Cut down, Annoyed, Guilty, Eye-opener) questionnaire and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) criteria were modified to evaluate subjects for a substance-related disorder (SRD) in cosmetic procedure. RESULTS:Of 153 adults, 34 (22.2%) met modified CAGE criteria and 40 (26.1%) met modified DSM-V criteria. Results from both instruments were significantly associated (P < 0.0002). Significant differences in consideration and utilization of cosmetic treatments were found in SRD positive versus negative groups (P<0.0001; P=0.009). CONCLUSIONS:and Relevance A type of SRD involving cosmetic procedures may exist and qualifying individuals may have increased cosmetic treatment utilization. Future efforts to rigorously validate an instrument for SRD detection in cosmetic procedure use are warranted for future research and clinical application.

BACKGROUND/OBJECTIVE/OBJECTIVE:Papular scars are a recently described clinical phenotype of acne scarring characterized by papules occurring on the nose and chin. We have observed a similar presentation of nasal papules among patients seen in our clinic for acne and sought to further characterize the clinical and histopathological characteristics of this entity. METHODS:In this single-site case series, a retrospective review of electronic medical records of patients with nasal papules in association with acne vulgaris between April 2018 and April 2019 was performed. Clinical and histopathologic findings were recorded. RESULTS:We identified 20 patients who presented with a similar clinical phenotype of predominantly skin-colored, dome-shaped papules concentrated on the nose and chin in association with a history of more classic facial acne vulgaris. Papular lesions were seen predominately in adolescent Hispanic males. Concomitant acne on other areas of the face was identified in 18 patients at presentation while two patients had a history of adolescent acne. Biopsies were performed for five patients. Histopathologic examination demonstrated features of fibrosis and dilated thin-walled blood vessels, typical of angiofibromas. CONCLUSION/CONCLUSIONS:We present a series of adolescent patients with large, flesh-colored to erythematous papules seen predominantly on the nose. These lesions are histologically indistinguishable from angiofibromas and may represent an under-recognized yet disfiguring sequela of acne that may disproportionately affect adolescents with skin of color.

The clinical phenomenon of a cosmetic procedure use disorder has not been formally introduced into the medical lexicon. However, anecdotal clinical experience from physicians and the popular media indicates that there may be a subset of patients who demonstrate addictive-like behaviours [Landsverk G. The 'human Ken doll' has spent more than $750,000 on 72 cosmetic surgeries, and doctors warn that his addiction has gotten dangerous. Available at: https://urldefense.com/v3/__https://www.insider.com/hu__;!!MXfaZl3l!PwVrW7_JP2tY0xvqxwLQjbKx-1gEoGBvlIefnofQPZZtBvMl4YTGebXm0UP5qVRx$ man-ken-doll-plastic-surgery-addiction-2019-10 (last accessed 14 April 2020]. To date, the only other investigation establishing a role of addiction psychiatry in aesthetic treatmentseeking behaviour is with ultraviolet light tanning (Warthan MM, Uchida T, Wagner Jr RF. UV light tanning as a type of substance-related disorder. JAMA Dermatol 2005; 141: 963-6). We aimed to investigate the possibility of a novel diagnosis of substance-related use disorder involving cosmetic procedures. We hypothesize that individuals with abuse or dependence on cosmetic procedures exist and can be captured through the administration of modified questionnaires designed to detect alcohol use disorder (AUD). We implemented a cross-sectional survey study of self-identified behaviour with cosmetic procedures. Two validated instruments, the CAGE (Cut down, Annoyed, Guilty, Eye-opener) questionnaire and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for AUD, were modified to evaluate patients for abuse or dependence on cosmetic procedures. Adults (> 18 years) were surveyed in a waiting room of a laser and skin surgery private practice in New York. Respondents were included if they indicated having received at least one cosmetic procedure in the past 12 months. A positive response on the modified CAGE questionnaire was a score of 2 or more out of four questions, which is similar to the cutoff for AUD screening. Positive findings on the modified DSM-5 questionnaire was defined as two or more out of 11 questions, which is similar to the cutoff for a diagnosis of AUD. Statistical association of the two diagnostic instruments was performed using the Pearson c2-test. Of the 55 participants, six (11%) met the modified CAGE criteria and 13 (24%) met modified DSM-5 criteria, indicating that a subset of individuals may qualify for abuse or dependence on cosmetic procedures. The results from both instruments were significantly associated (P = 0.0019). A novel type of substance-related disorder involving cosmetic procedures may exist. Further investigations with larger and varied study populations may validate these findings and ascertain the nature of the dependence and its relation to increased utilization. Validated screening tools may help physicians recognize these patients, guide informed consent, and provide risk-benefit counselling prior to the initiation of cosmetic procedures

Background/UNASSIGNED:The use of fine art in medical education has a long history. Numerous studies have investigated the potential benefits of incorporating art in medical education; however, there are gaps in knowledge regarding the efficacy, methodology, and clinical significance of these studies. Objective/UNASSIGNED:This scoping review of the literature aims to describe the available literature on the incorporation of art education in medical school and residency. Methods/UNASSIGNED:PubMed, Google Scholar, and MedEDPortal were queried from their inception dates through December 2019. English-language studies providing a detailed methodology and detailed analysis were included. A total of 37 studies were identified. Upon further screening of the studies' methodologies and results, 16 studies describing art education implemented with medical students and 12 studies describing art education implemented with residents were included for final review. Results/UNASSIGNED:Various methods of art education exist, including Visual Thinking Strategies (VTS), rigorous curricula, and unstructured roundtable discussions with art curators or artistically minded clinicians. Studies range in duration, art media, and type of analysis. Conclusions/UNASSIGNED:There has been an increasing effort to incorporate fine art education into medical training, primarily to enhance visual perception skills and empathy. Although there is limited research on its efficacy, and wide variations in study methodologies exist, results consistently indicate that participants find the incorporation of art into curricula beneficial. Further research analyzing which methodologies are most likely to yield statistically and clinically significant improvements in visual perception and empathy may lead to increased utilization of this teaching method.