Faculty Bibliography

BACKGROUND:Spin-reporting that distorts the interpretation of results-is not unusual within scientific literature. OBJECTIVE:To appraise strategies of spin among placebo-controlled double-blind clinical trials of topical treatments for photoaged skin. METHODS:A systematic review of literature was performed to identify placebo-controlled double-blind clinical trials of topical treatments for photoaged skin. A survey of spin strategies was developed and applied to the cohort of identified studies. RESULTS:Systematic review identified 20 studies, all of which employed various spin strategies, broadly classified as either inappropriate statistical analysis or inappropriate interpretation of results. Most commonly used strategies included use of multiple primary outcomes (95%), inappropriate extrapolation of the results from specific outcome to global improvement (95%), focus on within-group comparison (75%), and focus on interim analyses to give more weight to nonsignificant findings (65%). LIMITATIONS/CONCLUSIONS:Classification of spin strategies is subjective and may not encompass all methods used by studies in the published literature. CONCLUSIONS:Findings in this study may inform efforts to reduce spin in the dermatologic literature.

INTRODUCTION/BACKGROUND:Despite increasing popularity of platelet-rich plasma (PRP) in treating aging facial skin, the quality of evidence supporting its use is poor due to the lack of consistent methods of its preparation and application. OBJECTIVE:This study was conducted to assess treatment efficacy and patient satisfaction with a single PRP treatment prepared with a simplified preparation and application technique. METHODS:Four millilitre of PRP were injected into 6 standardized points on each side of the face. Outcomes were assessed by independent physician evaluation of pretreatment and posttreatment photographs using the Wrinkle Severity Rating Scale (WSRS) and Global Aesthetic Improvement Scale (GAIS). In addition, patient-reported outcomes were evaluated using the FACE-Q. RESULTS:Thirty-one participants ranging from 27 to 71 years of age (median, 38; IQR 32-58) were recruited for this study. Posttreatment WSRS scores improved in only 1 patient; the GAIS scores of 14 patients indicated aesthetic improvement. Analysis of FACE-Q scores revealed statistically significant increases in participant satisfaction with overall facial appearance and cheeks. The most frequently reported adverse effects were tenderness (23.4%; 7 of 31), facial tightness (20.0%; 6 of 31), and swelling (20.0%; 6 of 31). CONCLUSIONS:A simple method of PRP preparation offers modest benefit in treating the effects of skin aging and photodamage. Future research studies should alter our methods using a stepwise approach to optimize the treatment of aging facial skin with PRP.

Masculinizing hormonal treatment in transgender men has the potential to increase the level of androgens at end organs, including the pilosebaceous unit. Androgen-induced sebocyte growth and differentiation, sebum production, and infundibular keratinization may underlie the development of acne vulgaris among patients receiving this therapy. Despite the incidence of treatment-related acne and the unique considerations in treating transgender men, studies addressing this topic among this patient population are limited. Generally, standard guidelines for the treatment of acne can be followed in treating these patients; however, several medical, social, and psychologic factors should be considered. The aim of this article is to familiarize dermatologists with the sensitivities and challenges of treating acne in transgender male individuals.

BACKGROUND:Masculinizing top surgery (bilateral mastectomy with chest wall reconstruction) is an important gender-affirming procedure sought by many transmasculine and non-binary individuals. Current literature is primarily focused on details of surgical technique and complication rates, with limited data available on how top surgery affects subjective quality of life measures. METHODS:An anonymous online survey was distributed to 81 of the senior author's former top surgery patients. Survey response rate was 72% (58 respondents). Responses were analyzed to investigate quality of life, sexual confidence, mental health, satisfaction with top surgery, and patient attitudes toward top surgery's role in gender affirmation. RESULTS:Following top surgery, measures of quality of life and sexual confidence significantly improved (P < .001). Additionally, 86% reported improvement in gender dysphoria-related mental health conditions. All but 1 respondent reported that top surgery had an overall positive impact on their life. CONCLUSIONS:Top surgery had major positive effects on all mental health and quality of life metrics. Our findings contribute to a much-needed body of evidence that top surgery markedly improves the daily lives and functioning of transgender and non-binary individuals who choose to undergo it.

BACKGROUND:Analysis of Internet search patterns is rapidly transforming the study of human behavior. Google's data, accessed through Google Trends, have proven extremely insightful in several fields of medical research. Despite its adoption in other fields of medicine, Google Trends has not yet been explored in the field of plastic surgery. METHODS:The number of cosmetic surgery procedures from 2005 through 2016 was obtained from the American Society of Plastic Surgeons annual reports. Using Google Trends, the most commonly used keywords describing each procedure were determined, and data regarding search interest over time, interest across geographic area, and Related Queries were obtained. The number of procedures performed annually was compared to relative search volume from the corresponding year and the year prior to determine correlation. RESULTS:Of the 22 procedures evaluated, the annual number of eight procedures correlated with Internet search volume in the corresponding year, and six procedures correlated with the Internet searches performed in the year prior. Florida and New York were the states with the most searches for these procedures. Related Queries suggested that several factors, such as operative techniques, notable individuals undergoing procedures, and cost, variably drove correlations for different procedures. CONCLUSIONS:Google Trends is a powerful tool that can be used to better understand patient interest in, questions about, and decisions regarding cosmetic surgery procedures. These findings warrant action by aesthetic surgeons to increase interest, address misinformation, and help patients fill the gaps of information missed by Internet searches.

Introduction: Google Search is an important tool for patients researching skin care treatments and finding dermatologists. Data from individual patient’s searches are aggregated by Google and yield powerful data sets that can be used to trend population behaviors. This study investigates the correlations between the volume of Google searches and the number of procedures performed annually for both botulinum toxin type A and hyaluronic acid tissue fillers.