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National market analysis for body contouring providers: Medical spas and physician practices

Wang, Jordan V; Murgia, Robert D; Noell, Claire; Saedi, Nazanin; Zachary, Christopher B; Weiss, Robert; Geronemus, Roy G
BACKGROUND:Non-invasive body contouring has experienced recent growth. To meet demand, medical spas and non-physician operators have grown. Insights into their practice can provide information on their impact. OBJECTIVE:Our study investigated the current market distribution of body contouring providers in the aesthetic field. MATERIALS AND METHODS/METHODS:For the 30 most populous cities, data was collected for non-invasive body contouring providers in medical spas and physician practices. Descriptive ratios were calculated, and various local factors were examined. RESULTS:The cities with the greatest number of body contouring providers were New York (138), Los Angeles (106), and Houston (87). Population size had a significant relationship, while median household income did not. For number of body contouring providers per 100,000 persons, the top cities were Austin (4.87), Houston (3.74), and Las Vegas (3.41). The mean ratio of providers in medical spas to physician practices was 1.81. In total, 70.0% of cities had equal or more body contouring providers in medical spas than physician practices. CONCLUSION/CONCLUSIONS:Certain cities have experienced an unequal distribution of body contouring providers, and many cities favor medical spas over physician-based practices.
PMID: 33811789
ISSN: 1473-2165
CID: 4838712

Reconstruction of the external auditory canal: The tragal flap revisited and review of contemporary reconstructive techniques

Shaari, Ariana L; Xing, Monica H; Mundi, Neil; Khorsandi, Azita S; Geronemus, Roy; Urken, Mark L
BACKGROUND:Primary malignancies arising in the external auditory canal (EAC) are rare and usually are treated surgically. We review techniques to reconstruct the EAC following ablative surgery, and introduce a rarely utilized tragal skin flap which has particular advantages for reconstruction of limited anterior EAC defects. METHODS:The terms "tragal flap", "external auditory canal", "preauricular tragal flap", "reconstructive techniques" were searched on PubMed and Google Scholar. RESULTS:Our review identified one description of a tragal flap to reconstruct the EAC following resection of a malignancy. We add an additional case of a preauricular tragal flap to reconstruct the anterior EAC following resection of a recurrent basal cell carcinoma located in the EAC that led to a circumferential defect. CONCLUSION/CONCLUSIONS:There are several surgical techniques that can be utilized to reconstruct the EAC. We describe a novel tragal flap used to reconstruct the anterior EAC following resection of a recurrent tumor.
PMID: 34102581
ISSN: 1532-818x
CID: 4913892

Safety Profile of Combined Same-Day Treatment for Botulinum Toxin With Full Face Nonablative Fractionated Laser Resurfacing

Pomerantz, Hyemin; Akintilo, Lisa; Shaw, Katharina; Lederhandler, Margo; Anolik, Robert; Geronemus, Roy G
BACKGROUND:Spread of botulinum toxin outside the treated muscle is a concern, when energy-based device treatment is performed on the same day as toxin injection. OBJECTIVE:We assessed the frequency of eyelid ptosis after the glabella/periorbital botulinum toxin injection and nonablative fractionated laser performed at the same session. METHODS AND MATERIALS/METHODS:This single-center, retrospective study identified treatments consisting of glabella and/or periorbital botulinum toxin injection and nonablative fractionated laser treatment to full face from 2017 to 2019 and eyelid ptosis determined by documentation of the complication at a follow-up encounter, or prescription of apraclonidine. RESULTS:Six hundred sixteen treatments of glabella/periorbital botulinum toxin injection and full-face nonablative fractionated laser on the same day on 393 individuals were identified. Five hundred eighty treatments (94%) included botulinum toxin injected in the glabella, 541 (88%) in the periorbital areas, and 508 (82%) in the forehead. Nonablative fractionated lasers used to treat the cohort were a 1,927-nm thulium and a 1,550-nm er:glass laser. Eyelid ptosis complication was documented in one case (0.2%) following the combined laser and toxin treatment. CONCLUSION/CONCLUSIONS:The risk of spread of glabella/periorbital botulinum toxin to an unintended muscle was minimal in the setting of the concomitant full-face nonablative fractionated laser.
PMID: 33165055
ISSN: 1524-4725
CID: 4664772

Scoring of the Vermilion Lip for Optimal Post-Surgical Realignment

Lederhandler, Margo; Geronemus, Roy G
PMID: 33852239
ISSN: 1545-9616
CID: 4846052

The Rise and Fall of the Pale Puffy Lower Eyelid Pillow

Lederhandler, Margo; Belkin, Daniel; Anolik, Robert; Geronemus, Roy G
This case series demonstrates an exaggerated form of the clinical presentation of a known distressing late complication of retained hyaluronic acid filler – the “pale puffy pillow.” This presentation is often, unfortunately for the patient, misdiagnosed as festoons. However, the correction with liberal hyaluronidase is simple. Additionally, we have demonstrated that ablative fractional carbon dioxide laser resurfacing is an excellent tool that may be utilized after hyaluronidase to correct the residual skin laxity.J Drugs Dermatol. 20(4):475-476. doi:10.36849/JDD.5509.
PMID: 33852245
ISSN: 1545-9616
CID: 4846062

Safety of combining cosmetic injectables with radiofrequency microneedling: A 4.5-year review

Wang, Jordan V; Valiga, Alexander; Albornoz, Christian A; Geronemus, Roy G
Pairing energy-based treatments, including radiofrequency microneedling, with either injectable neuromodulators or soft-tissue fillers can be an effective therapy for facial rejuvenation. However, there remains concerns by some physicians that this combination may add new risks for adverse events. Theoretical risks of combining energy-based treatment with neuromodulator injections include unintentional spread, which may result in eyelid ptosis and asymmetry. Potential risks with soft-tissue fillers include unexpected loss of filler volume, necrosis, burn, and product migration. In order to shed more light on this topic, we performed a retrospective chart review of single-session facial treatments with radiofrequency microneedling and cosmetic injectables over a 4.5 year period. We found no documented adverse events recorded related to combination treatment. This is important information that adds to the patient safety literature.
PMID: 33522699
ISSN: 1473-2165
CID: 4775912

Oral Angiotensin Converting Enzyme Inhibitors for the Treatment of Delayed Inflammatory Reaction of Dermal Hyaluronic Acid Fillers Following COVID-19 Vaccination - A Model for Inhibition of Angiotensin II-Induced Cutaneous Inflammation [Case Report]

Munavalli, Girish Gilly; Knutsen-Larson, Siri; Lupo, Mary P; Geronemus, Roy G
PMID: 33681439
ISSN: 2352-5126
CID: 4808992

Evaluating the Impact of Indoor Tanning Legislation in the United States

Singh, Gaurav; Feng, Hao; Geronemus, Roy
PMID: 31634250
ISSN: 1524-4725
CID: 4171562

Consensus Statement for the Management and Treatment of Port-Wine Birthmarks in Sturge-Weber Syndrome

Sabeti, Sara; Ball, Karen L; Burkhart, Craig; Eichenfield, Lawrence; Fernandez Faith, Esteban; Frieden, Ilona J; Geronemus, Roy; Gupta, Deepti; Krakowski, Andrew C; Levy, Moise L; Metry, Denise; Nelson, J Stuart; Tollefson, Megha M; Kelly, Kristen M
Importance/UNASSIGNED:Sturge-Weber syndrome (SWS) is a neurocutaneous syndrome involving the skin, brain, and eyes. Consensus recommendations for management are lacking. Objective/UNASSIGNED:To consolidate the current literature with expert opinion to make recommendations that will guide treatment and referral for patients with port-wine birthmarks (PWBs). Evidence Review/UNASSIGNED:In this consensus statement, 12 nationally peer-recognized experts in dermatology with experience treating patients with SWS were assembled. Key topics and questions were formulated for each group and included risk stratification, optimum treatment strategies, and recommendations regarding light-based therapies. A systematic PubMed search was performed of English-language articles published between December 1, 2008, and December 1, 2018, as well as other pertinent studies identified by the expert panel. Clinical practice guidelines were recommended. Findings/UNASSIGNED:Treatment of PWBs is indicated to minimize the psychosocial impact and diminish nodularity and potentially tissue hypertrophy. Better outcomes may be attained if treatments are started at an earlier age. In the US, pulsed dye laser is the standard for all PWBs regardless of the lesion size, location, or color. When performed by experienced physicians, laser treatment can be safe for patients of all ages. The choice of using general anesthesia in young patients is a complex decision that must be considered on a case-by-case basis. Conclusions and Relevance/UNASSIGNED:These recommendations are intended to help guide clinical practice and decision-making for patients with SWS and those with isolated PWBs and may improve patient outcomes.
PMID: 33175124
ISSN: 2168-6084
CID: 4684312

Oxymetazoline and Energy-Based Therapy in Patients with Rosacea: Evaluation of the Safety and Tolerability in an Open-Label, Interventional Study

Tanghetti, Emil A; Goldberg, David J; Dover, Jeffrey S; Geronemus, Roy G; Bai, Zane; Alvandi, Nancy; Shanler, Stuart D
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.
PMID: 32378241
ISSN: 1096-9101
CID: 4430432