Faculty Bibliography

BACKGROUND:Perioral rhytides can be treated with laser and energy-based devices. More recently, a novel fractional thermomechanical skin rejuvenation system was developed to cause controlled thermal injury through direct heat transfer. OBJECTIVE:A prospective clinical trial evaluated the safety and efficacy of a thermomechanical fractional injury device (Tixel 2, Novoxel, Netanya, Israel) for perioral rhytides. MATERIALS AND METHODS:Subjects with moderate-to-severe perioral rhytides were enrolled and underwent 4 monthly treatments. RESULTS:Twenty-three subjects were enrolled and completed all study visits. Mean age was 62.5 years, and 100.0% were women. Fitzpatrick Skin Types I-IV were included. For Fitzpatrick Wrinkle Classification System (FWCS), mean baseline score was 6.9. Per investigator, there was a mean 1.9-grade improvement in FWCS at 3-month follow-up ( p < .0001). At 3-month follow-up, 8.7% (n = 2) of subjects had a 3-grade improvement, 69.6% (n = 16) had a 2-grade improvement, and 21.7% (n = 5) had a 1-grade improvement. For physician Global Aesthetics Improvement Scale at 3-month follow-up, 69.6% (n = 16) had 76% to 100% improvement, 13.0% (n = 3) had 51% to 75% improvement, and 17.4% (n = 4) had 26% to 50% improvement. There were no severe adverse events, and subjects experienced minimal pain. CONCLUSION:A novel device using thermomechanical fractional injury was demonstrated to be safe and effective in the treatment of perioral rhytides.

Growing a cosmetic dermatology practice is an often complex and arduous task. Many different factors must be considered in order to build and maintain a successful clinical practice. Devices and injectables are both integral components to operating a comprehensive cosmetic dermatology practice. Aesthetic physicians seeking to grow their cosmetic practice in these areas must be aware of the numerous considerations-both more obvious and more subtle-that play a role in the decision-making process, including the local market, patient demand, clinic space, and physician experience and training. This contribution is focused on the factors that should be carefully considered when looking to grow a cosmetic dermatology practice with devices and injectables.

OBJECTIVES/OBJECTIVE:To evaluate the temporal trends in diversity within the ASLMS board of directions from 1996 to 2021. MATERIALS AND METHODS/METHODS:A list of Board of Directors from 1996 to 2021 was obtained from ASLMS headquarters. Using a composite of publicly available resources through internet searches, board director characteristics, such as age, gender, race/ethnicity, terminal degrees, specialties/field of expertise, and current full-time affiliations, were recorded. RESULTS:One hundred forty-six unique individuals held 628 ALSMS board member positions from the years 1996-2021. The median age of the board members started with a median age of 43.0 years old in 1996 to 54.5 years old in 2021. The age spread between first and third quartiles (interquartile range) in each year in more recent years (2014-2019) was 17.0, 20.0, 18.8, 18.8, 18.0, and 15.3 years, respectively. Female representation started with 10.5% in 1996 to 30.8% in 2021. Diversity, by racial/ethnicity measures, has more representation of Asian (average across 1996-2010: 2.3% to 2010-2022: 19.0%) and Hispanic (average 1996-2010: 0.7% to 2010-2022: 4.4%) board members. No African American has held a position across these decades. MD holders (average 66.5%) and other degree holders (average 33.5%) have been relatively consistent across all years observed. From 2016 to 2021, dermatologists held board member seats at an average rate of 56.5% across these years, while prior, from 1996 to 2015, 67.3% of board member seats on average were held by members of other expertises. Most board members have full-time affiliations in private practice across most years observed (average 43.7% across all years observed). CONCLUSION/CONCLUSIONS:After analyzing the diversity trends across board members in ASLMS across 1996-2020, we have noticed overall trends of increased diversity over time that reflect a greater chance of bringing in new ideas and experiences to grow ASLMS. Although the leadership of ASLMS has become significantly more diverse over time, there remain opportunities to increase diversity further, including women, underrepresented ethnic minorities, and other experts of specialties other than dermatology.

Importance/UNASSIGNED:Laser-assisted drug delivery (LADD) is used for various medical and cosmetic applications. However, there is insufficient evidence-based guidance to assist clinicians performing LADD. Objective/UNASSIGNED:To develop recommendations for the safe and effective use of LADD. Evidence Review/UNASSIGNED:A systematic literature review of Cochrane Central Register of Controlled Trials, Embase, and MEDLINE was conducted in December 2019 to identify publications reporting research on LADD. A multidisciplinary panel was convened to draft recommendations informed by the systematic review; they were refined through 2 rounds of Delphi survey, 2 consensus meetings, and iterative review by all panelists until unanimous consensus was achieved. Findings/UNASSIGNED:Of the 48 published studies of ablative fractional LADD that met inclusion criteria, 4 were cosmetic studies; 21, oncologic; and 23, medical (not cosmetic/oncologic), and 6 publications of nonablative fractional LADD were included at the request of the expert panel, producing a total of 54 studies. Thirty-four studies (63.0%) were deemed to have low risk of bias, 17 studies (31.5%) had moderate risk, and 3 (5.5%) had serious risk. The key findings that informed the guidelines developed by the expert panel were as follows: LADD is safe in adults and adolescents (≥12 years) with all Fitzpatrick skin types and in patients with immunosuppression; it is an effective treatment for actinic keratosis, cutaneous squamous cell carcinoma in situ, actinic cheilitis, hypertrophic scars, and keloids; it is useful for epidermal and dermal analgesia; drug delivery may be increased through the application of heat, pressure, or occlusion, or by using an aqueous drug solution; laser settings should be selected to ensure that channel diameter is greater than the delivered molecule; antibiotic prophylaxis is not recommended, except with impaired wound healing; antiviral prophylaxis is recommended when treating the face and genitalia; and antifungal prophylaxis is not recommended. The guideline's 15 recommendations address 5 areas of LADD use: (I) indications and contraindications; (II) parameters to report; (III) optimization of drug delivery; (IV) safety considerations; and (V) prophylaxis for bacterial, viral, and fungal infections. Conclusions and Relevance/UNASSIGNED:This systematic review and Delphi consensus approach culminated in an evidence-based clinical practice guideline for safe and effective use of LADD in a variety of applications. Future research will further improve our understanding of this novel treatment technique.