Faculty Bibliography

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 AND OBJECTIVES/OBJECTIVE:) laser has well-demonstrated safety and efficacy in resurfacing treatment of scars in the adult population and in the treatment of pediatric burn scars. However, there is a paucity of literature regarding laser resurfacing of traumatic and surgical scars for cosmetic benefit in the pediatric population, and in majority of cases previously reported, this was done under general anesthesia. STUDY DESIGN/MATERIALS AND METHODS/METHODS:laser resurfacing (FALR) of traumatic or surgical scars at a single center between 2018 and 2019, inclusive. Primary endpoints included safety and tolerance. RESULTS:A total of 31 FALR treatments were performed in 10 patients with traumatic and surgical scars located on the face (age 4-14 years, Fitzpatrick skin type [FST] I-IV, 60% female). Settings ranged from total energy per session 0.02-0.33 kJ, with a 7-mm tip and 30-50% coverage. Nine patients had two or more treatments (average 3, maximum 8) spaced at least 4 weeks apart. All resurfacing treatments were well-tolerated with local infiltration of 1% lidocaine with epinephrine (1:100,000). Six (67%) patients were treated with additional measures including pulsed dye laser, 1927-nm fractional non-ablative low-energy, low-density laser, or intralesional agents (5-fluorouracil, triamcinolone, botulinum toxin). At follow-up (of varied intervals), short-term erythema, as expected, was seen in six patients, and hyperpigmentation in one case (FST IV), both treated with aforementioned alternate devices. Although gradual, improvement in scar appearance and texture was seen with FALR treatments. No additional scarring, infection, or hypopigmentation was seen. CONCLUSIONS:Treatment with fractional ablative laser resurfacing is safe and well-tolerated in the pediatric population in an outpatient setting with local anesthesia. Traumatic scars may cause significant distress to children and parents alike. Multimodal therapy may lead to optimal cosmesis. Given the excellent tolerability, the authors recommend consideration of laser resurfacing in pediatric patients with traumatic or surgical scars when bothersome, either cosmetically or psychologically. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.

BACKGROUND AND OBJECTIVES/OBJECTIVE:The objectives of this study were to evaluate the safety, tolerability, and efficacy of oxymetazoline hydrochloride cream, 1% (oxymetazoline) when used as an adjunctive treatment with energy-based therapy for patients with moderate to severe facial erythema associated with rosacea. STUDY DESIGN/MATERIALS AND METHODS/METHODS:In this Phase 4, multicenter, interventional, open-label study, eligible patients received one of four energy-based therapies (potassium titanyl phosphate laser, intense pulsed light therapy, pulsed-dye laser Vbeam Perfecta, or pulsed-dye laser Cynergy) on day 1 and day 29 and once-daily application of oxymetazoline on days 3 through 27 and days 31 through 56. Improvement from baseline in Clinician Erythema Assessment (CEA) score, patient satisfaction measures, incidence of treatment-emergent adverse events (TEAEs), and worsening from baseline on dermal tolerability assessments and the Clinician Telangiectasia Assessment (CTA) were assessed. Data were summarized using descriptive statistics. RESULTS:A total of 46 patients (mean age, 51.1 years; 78.3% female) enrolled in this study. Similar numbers of patients received each of the energy-based therapies in addition to oxymetazoline. All patients demonstrated an improvement from baseline in CEA during the study with 39 of 43 evaluable patients (90.7%) demonstrating an improvement 6 hours posttreatment on day 56. Most patients were satisfied or very satisfied with treatment at the end of the study. All TEAEs were mild or moderate in severity. Some patients experienced worsening in dermal tolerability assessment symptoms (range: 4-21 patients; 8.7-45.7%). Worsening in CEA and CTA were each reported by three patients (6.5%) at any time during the study. CONCLUSIONS:Treatment with oxymetazoline as adjunctive therapy with energy-based therapy was safe, well tolerated, and reduced facial erythema in patients with moderate to severe persistent facial erythema associated with rosacea. Lasers Surg. Med. © 2020 The Authors. Lasers in Surgery and Medicine published by Wiley Periodicals LLC.

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:Topical adjuncts have been investigated to improve clinical outcomes associated with laser resurfacing for photodamage and cutaneous aging. One such product is a tripeptide/hexapeptide serum, which has been shown to increase dermal collagen and elastin as well as improve post-procedural recovery following treatments. OBJECTIVE:A randomized, blinded, split-face, comparative trial was performed to assess the utility of a tripeptide/hexapeptide serum as a peri-procedural adjunct to non-ablative fractional laser resurfacing. MATERIALS AND METHODS/METHODS:A total of 20 subjects were enrolled. Each hemiface was randomized to either tripeptide/hexapeptide serum or bland moisturizer for twice daily application starting 14 days prior to first laser treatment and continuing until 60 days after. All subjects received 2 treatments to entire face approximately 1 month apart with 1927nm thulium non-ablative fractional laser. Clinical measures and immediate post-procedural recovery were assessed. RESULTS:For each hemiface, scores improved for all measures, including global photodamage, lentigines, pores, radiance, texture, and tone at 30 and 60 days. The tripeptide/hexapeptide serum had greater improvements for all measures at both time points, except for radiance at 60 days, which was equal. In cases where clinical ratings differed between sides, tripeptide/hexapeptide serum more frequently had the superior outcome. Overall, subjects were satisfied with tripeptide/hexapeptide serum. No significant adverse events were observed. CONCLUSION/CONCLUSIONS:Addition of tripeptide/hexapeptide serum as a peri-procedural adjunct to non-ablative fractional laser resurfacing improved various clinical measures of photodamage and cutaneous aging and the immediate post-procedural recovery. The tripeptide/hexapeptide serum was demonstrated to be safe, well-tolerated, and well-liked by subjects.

Recent demand for minimally and non-invasive cosmetic procedures has been rising. According to the American Society for Dermatologic Surgery (ASDS), the numbers of injectable neuromodulator and soft-tissue filler procedures have increased by 42% and 78%, respectively, since 2012.¹ Similarly, laser, light, and energy-based treatments have increased by 74%. Although it has been anecdotally reported that the popularity of dermatologic procedures may peak during specific times of the year, available data on consumer behavior is limited.^2,3 Understanding seasonal trends can offer insights to better forecast patient demand and optimize practice management. In order to fill this gap in the literature, we performed a temporal analysis of various procedures in a busy dermatology clinic.

Minimally and non-invasive cosmetic procedures are on the rise. With the advent of social media, improvements in technology, and the increased visibility of cosmetic dermatologists and plastic surgeons, consumers now have greater access to information about aesthetic procedures.