Faculty Bibliography

This commentary examines the utility of arnica in cosmetic dermatology. For many years, arnica has been used to reduce the morbidity associated with various procedures, including surgeries and treatments with laser and other energy-based devices. Arnica is a traditional homeopathic remedy that can reduce post-procedural edema and bruising. Although it has been used clinically by many physicians and is widely and readily available to patients, the available data is limited and often conflicting. We reviewed the relevant information on arnica and offer our own insights into its use in order to shed more light on its peri-procedural utility.

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.

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.

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.

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.

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.