Faculty Bibliography

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

Clinical characteristics of skin exposed to ultraviolet and infrared radiation include dryness, dyschromia, laxity, roughness, sallowness, scaling, telangiectasia, and wrinkles. Fractional photothermolysis promotes skin remodeling by formation of new dermal collagen. The nonablative fractional diode laser (NFDL) system employs fractional photothermolysis to rejuvenate the skin, using 2 distinct handpieces for wavelengths of 1440 nm and 1927 nm. Fractional photothermolysis from nonablative fractional diode lasers facilitates delivery of small molecular-weight compounds, such as L-ascorbic acid, through the skin without compromising barrier function of the stratum corneum. Both handpieces of the NFDL system are effective for rejuvenation of photodamaged facial skin, providing clinical improvement in skin tone, skin texture, fine lines, and dyschromia and reducing the number of detectable skin pores. Application of the 1927 nm wavelength handpiece has shown clinical improvement of hyperpigmentation, melasma, and postinflammatory hyperpigmentation, which have been challenging to treat effectively with other laser devices. With a target chromophore of water, the infrared energy of the 1440 nm and 1927 nm NFDL system is appropriate for skin rejuvenation and treatment of dyschromia in skin of color, with a reduced risk of the adverse events observed with other nonablative and ablative fractional lasers. Clinical data have demonstrated that both the 1440 nm and 1927 nm wavelengths are effective, with high levels of patient satisfaction, transient side effects, and minimal patient downtime.

BACKGROUND:Adipose and adipose derived regenerative cells (ADRCs) play an increasing role in androgenetic alopecia (AGA). OBJECTIVES/OBJECTIVE:To evaluate the safety and feasibility of fat grafts enriched with ADRCs in early AGA. METHODS:Seventy-one subjects were treated: 16 with Puregraft fat and 1.0 x 106 ADRCs/cm2 scalp; 22 with Puregraft fat and 0.5 x 106 ADRC/cm2 scalp; 24 with Puregraft fat alone; and 9 saline control. Treatments were delivered into the skin and subcutaneous layer of the scalp. 40 cm2 of scalp was treated and macrophotography and global photography were obtained at baseline and at 6, 24, and 52 weeks. RESULTS:The 71 subjects tolerated the procedures well. No unanticipated adverse events associated were reported. When evaluating all subjects at 24 weeks, there were no statistical differences between any of the treatment groups with respect to non-vellus (terminal) hair counts or width. There were increases (mean change from baseline) in terminal hair count for the low-dose ADRC group in the Norwood Hamilton 3 subgroup at week 6 (13.90±16.68), week 12 (11.75±19.42), week 24 (16.56±14.68), and week 52 (2.78±16.15). For this subgroup, the difference in hair count between low-dose ADRC group and no-fat saline control was statistically significant (p=0.0318) at Week 24. CONCLUSIONS:Puregraft fat and ADRCs are safe and well tolerated. In early male hair loss, this therapy demonstrated a statistically significant increase in terminal hair counts relative to control population at 24 weeks and represents a promising approach for early androgenetic alopecia.

BACKGROUND:Prescription opioid use often precedes opioid misuse, abuse, and addiction. OBJECTIVE:To characterize the national opioid prescription practices of Mohs surgeons, with general dermatologists serving as a comparison group. METHODS:A retrospective cross-sectional study using Medicare prescription data to analyze opioid prescription characteristics. RESULTS:In 2014, 2,190 Mohs surgeons prescribed a total of 86,526 opioids, whereas 10,347 non-Mohs dermatologists prescribed 45,033 opioids. Among Mohs surgeons, 51.8% prescribed more than 10 opioids, whereas 93.3% of non-Mohs dermatologists prescribed 0 to 10. The estimated opioid prescription rates for Mohs surgeons and non-Mohs dermatologists were 5.9% and 0.7%, respectively. Among those prescribing at least 10 opioid claims, the mean number of opioids supplied and mean opioid prescription rate was 72.4 and 13.5, respectively, for Mohs surgeons versus 32.5 and 5.1 , respectively, for non-Mohs dermatologists. The mean days' supply of opioids was 3.9 for Mohs surgeons versus 7.9 for non-Mohs dermatologists. There was a minimal-to-moderate association between the number of procedures performed and the number of opioids prescribed. Men and Mohs surgeons located in southern states tend to prescribe a greater number of opioids. CONCLUSION/CONCLUSIONS:Mohs surgeons prescribed short courses of opioids and less than both the national average and providers that care for patients in pain.

BACKGROUND AND OBJECTIVES/OBJECTIVE:Post inflammatory hyperpigmentation (PIH) can be difficult to treat especially in patients with darker skin types as darker skin carries increased epidermal melanin content. Various treatments available to improve the appearance of PIH may incite further pigmentation thus making treatment extremely difficult and frustrating. The purpose of this study was to perform a retrospective chart and photographic review to evaluate the efficacy and safety profile of a low energy low density non-ablative fractional1927 nm wavelength laser treatment for PIH in patients with Fitzpatrick skin types IV-VI. STUDY DESIGN/METHODS:A retrospective evaluation of 61 patients with PIH treated with a 1927 nm laser was conducted at a single center. Inclusion criteria required at least 2 treatment sessions so that before and after treatment photographs would be available for comparison and study purposes. Two blinded physician-evaluators using a visual analog scale for percentage of pigmentary clearance in standard photographs assessed treatment efficacy. RESULTS:The mean percent improvement after treatment, evaluated by two dermatologists was 43.24%. The correlation between raters was statistically significant (Pearson's correlation coefficienct of r = 0.59, p < 0.0001). No side effects were observed in the patients treated with the 1927 nm laser. CONCLUSION/CONCLUSIONS:The low energy low density non-ablative fractional 1927 nm wavelength laser is a safe and effective modality for improving post inflammatory hyperpigmentation in patients with darker skin types. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

BACKGROUND:Microneedling and soft-tissue filler injections have been used independently to improve acne scarring. The effectiveness of a combined approach using microneedling followed by polymethylmethacrylate (PMMA)-collagen gel has not been carefully studied. OBJECTIVE:The goal of this study was to assess the effectiveness and safety of microneedling alone versus microneedling followed by injection of PMMA-collagen gel filler for correction of atrophic facial acne scars. METHODS:We conducted a multicenter, open-label, randomized, prospective study on subjects with distensible atrophic acne scars in the face to determine whether microneedling with PMMA-collagen gel is a superior acne scar treatment over microneedling alone. Forty-four subjects received 3 microneedling treatments over a 12-week period followed by randomization to treatments with PMMA-collagen gel (treatment group) or no further treatment (control group). RESULTS:At 24 weeks, the treatment group achieved a statistically significant improvement in acne scores over microneedling alone. The improvement continued at 36 weeks. At 24 weeks, the treatment group showed a strong trend in improvement on the Physician Global Aesthetic Improvement Scale compared with microneedling alone.