Faculty Bibliography

OBJECTIVES/OBJECTIVE:To achieve consensus among expert laser surgeons on standards for the prevention and management of adverse events from fully ablative laser resurfacing of the face. MATERIALS AND METHODS/METHODS:Delphi study with two rounds of ratings and revisions until consensus was achieved. The draft set of statements was developed by a steering committee based on expert clinical experience. This was followed by two rounds of rating and revisions completed by an expert panel, then a virtual consensus meeting. In both rounds, respondents rated the draft statements on a 9-point Likert scale (1 = strongly disagree; 9 = strongly agree) and optionally provided comments. The consensus meeting was supplemented by the results of a systematic review of the literature (from 2000 to 2023). RESULTS:Two rounds of Delphi survey were completed by 34 participants across four countries. Represented specialties were dermatology, facial plastic surgery, plastic surgery, and oculoplastic surgery. The initial 105 statements from round 1 expanded to 112 in round 2, with 96 statements achieving consensus. These included possible adverse events (11 statements); absolute and relative contraindications to treatment (5 statements); preoperative care and antimicrobial prophylaxis precautions (16 statements); intraoperative precautions (17 statements); postoperative care (21 statements); monitoring for and management of infection (16 statements); management of pigmentation changes (6 statements); and management of scarring and incipient scarring (4 statements). CONCLUSION/CONCLUSIONS:An international consensus statement was developed for the prevention and management of complications associated with fully ablative laser resurfacing of the face. While expert practices vary, key factors for optimizing outcomes include careful patient selection, counseling, and meticulous pre- and postoperative care. Further research will improve our understanding of this treatment technique.

GENERAL PURPOSE/OBJECTIVE:To provide an evidence-based review of strategies for the prevention and management of wounds and postoperative scars following microsurgical autologous breast reconstruction. TARGET AUDIENCE/BACKGROUND:This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and registered nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES/OBJECTIVE:After participating in this educational activity, the participant will: 1. Identify operative considerations to promote wound healing in microsurgical autologous breast reconstruction. 2. Synthesize management strategies for major flap complications following microsurgical autologous breast reconstruction. 3. Explain features in the assessment, prevention, and treatment of scars following microsurgical autologous breast reconstruction.

BACKGROUND:Ultrasound-based devices have been developed to improve various cosmetic indications, including fines lines, wrinkles, eyebrow laxity, and submental laxity. Ultrasound waves of high intensity targeting the dermis can induce neocollagenesis, neoelastogenesis, and subsequent remodeling to improve the clinical appearance of these indications. OBJECTIVE:To examine the utility of a novel ultrasound device that utilizes high-intensity, high-frequency, parallel ultrasound beams to improve the clinical appearance of skin laxity on the upper arms. MATERIALS AND METHODS/METHODS:A prospective, multicenter, clinical study investigated this novel ultrasound device using two treatments. RESULTS:Forty-six subjects were enrolled and underwent treatment. Mean age was 59 years, and 100% were women. Fitzpatrick skin types I-IV were represented. Assessments compared baseline to 3-month follow-up. Two out of 3 blinded reviewers agreed in identifying pretreatment and post-treatment photographs for 88.9% of subjects (p < .0001), who were considered responders. Blinded reviewers rated significant improvements in skin crepiness and laxity scale (1.97 vs 2.95; p < .0001) and also in Global Aesthetic Improvement Scale in 93.3% of photographs. No device-related adverse events occurred. CONCLUSION/CONCLUSIONS:A novel ultrasound device that utilizes high-intensity, high-frequency, parallel ultrasound beams can safely and effectively improve skin laxity of the upper arms.

BACKGROUND:Neck rejuvenation has consistently become a popular cosmetic procedure. While various treatment modalities have been used, a novel fractional thermomechanical skin rejuvenation system was recently developed to create dermal coagulation through direct heat transfer with subsequent neocollagenesis. OBJECTIVE:A prospective clinical trial evaluated the efficacy and safety of a thermomechanical fractional injury device (Tixel 2, Novoxel, Netanya, Israel) for neck rhytides. MATERIALS AND METHODS/METHODS:Subjects with moderate to severe neck rhytides were enrolled for 4 monthly treatments. RESULTS:Twenty-six subjects were enrolled and completed all study visits. The mean age was 58.4 years, and 100.0% were women. Fitzpatrick skin types I to IV were included. For Fitzpatrick Wrinkle Classification System (FWCS), the mean baseline score was 6.3. As per investigator, there was a mean 1.5-grade improvement in FWCS at 1-month follow-up (p < .00001) and 1.4-grade improvement in FWCS at 3-month follow-up (p < .00001). For physician Global Aesthetic Improvement Scale, all subjects (100%) had improvement at both 1- and 3-month follow-up visits. There were no severe adverse events, and subjects experienced minimal pain. CONCLUSION/CONCLUSIONS:A novel thermomechanical fractional injury device is effective and safe for the treatment of neck rhytides.

BACKGROUND:Few studies show how dermatologic surgeons manage problems with site identification. OBJECTIVE:To estimate frequency and characterize management of skin cancer treated by surgery when the anatomic location of the tumor is in question. METHODS:Nationwide, prospective, multisite cohort study. RESULTS:Among 17,076 cases at 22 centers, 98 (0.60%) were lesions in question for which site identification was initially uncertain, with these more often in patients who were male, older, and biopsied more than 30 days ago. Surgeons employed on average 5.0 (95% CI: 4.61-5.39) additional techniques to confirm the site location, with common approaches including: re-checking available documentation (90 lesions, 92%); performing an expanded physical examination (89 lesions, 91%); and asking the patient to point using a mirror (61 lesions, 62%). In 15%, photographs were requested from the biopsying provider, and also in 15%, frozen section biopsies were obtained. In 10%, the referring physician was contacted. Eventually, surgeons succeeded in definitively identifying 82% (80 of 98) of initially uncertain sites, with the remaining 18% (18 of 98) postponed. Most postponed surgeries were at non-facial sites. LIMITATIONS/CONCLUSIONS:Sites were academic centers. CONCLUSIONS:When the anatomic location of the tumor is uncertain, dermatologic surgeons use multiple methods to identify the site, and sometimes cases are postponed.

INTRODUCTION/BACKGROUND:The 595-nm wavelength pulsed dye laser (PDL) is well-established in the treatment of vascular lesions. In June 2023, it received FDA clearance for the treatment of port-wine birthmarks (PWB) and infantile hemangiomas (IH) in the pediatric population. OBJECTIVE:Review the evidence regarding the efficacy, safety, and implications of using PDL for management of pediatric PWB and IH. METHODS:A systematic literature search was performed to identify peer-reviewed articles and clinical trials published between July 2002 and December 2022 in which PDL was used to treat pediatric PWB and IH. RESULTS:After application of criteria, 33 journal articles with 7725 total patients were included. Only 16 (0.8%) of the 2,033 patients with PWB and 11 (0.2%) of the 5692 patients with hemangioma reported permanent adverse effects including scarring, keloids, or permanent pigmentation change, and none reported blindness or other serious injury. Good, excellent, or complete clearance after PDL-on average or in greater than 50% of patients-was reported in 17 of 19 studies (89%) that reported these measures for PWB, and seven of the seven studies (100%) for IH. CONCLUSION/CONCLUSIONS:The 595-nm PDL is an excellent treatment option for early intervention in pediatric patients with PWB or IH.