BACKGROUND: Prior literature notes increased rates of delayed diagnosis and increased morbidity and mortality for patients with Fitzpatrick skin types IV to VI with melanoma and nonmelanoma skin cancers, noting surgical...BACKGROUND: Prior literature notes increased rates of delayed diagnosis and increased morbidity and mortality for patients with Fitzpatrick skin types IV to VI with melanoma and nonmelanoma skin cancers, noting surgical delays and larger postoperative defects. Dyschromia is among the most common concerns in Fitzpatrick skin types IV to VI. OBJECTIVE: To consolidate the latest information on patient counseling, suture selection, and interventions related to postoperative pigmentary complications for Fitzpatrick skin types IV to VI. MATERIALS AND METHODS: A literature review was conducted using the Embase, Scopus, Google Scholar, PubMed from 2014 to 2025 focused on surgical considerations, pathophysiology of surgical considerations, hypopigmented scars, suture selection, postinflammatory hyperpigmentation, and treatment and counseling of postsurgical complications or outcomes in Fitzpatrick skin types IV to VI. RESULTS: Preoperative factors that may worsen wound healing include the use of skin lightning agents. Intraoperative factors include secondary intention healing and full-thickness grafts., Opting for direct or flap closure and noninflammatory suture selection minimizes postoperative dyschromia. Postoperative considerations include Ultraviolet A/B and visible light photoprotection counseling and suture removal timing. Promising treatments need further research including microdermal grafting for hypopigmented scars. CONCLUSION: Special considerations in preoperative history taking, intraoperative repair and suture selection, and postoperative counseling minimize the risk of postoperative dyschromia.
BACKGROUND: Noninvasive targeted adipose reduction is highly sought after, with many devices using radiofrequency. Without adequate surface cooling, these treatments may not reach optimal depths and superficial burns can...BACKGROUND: Noninvasive targeted adipose reduction is highly sought after, with many devices using radiofrequency. Without adequate surface cooling, these treatments may not reach optimal depths and superficial burns can result. OBJECTIVE: To evaluate fat reduction, safety, and patient satisfaction with a device combining radiofrequency and targeted ultrasound with superficial active cooling which heats localized adipose tissue while protecting the epidermis. MATERIALS AND METHODS: Twenty-three subjects with localized fat underwent 4 treatments of radiofrequency with targeted ultrasound and active cooling. Pre- and post-treatment evaluations included photographs and measurements using a caliper and ultrasound. Subjects also completed satisfaction and comfort questionnaires. Data were collected at baseline, after the final session, and 1, 3, and 6 months post-treatment. RESULTS: Ultrasound showed a gradual fat thickness reduction: -16.3% at 1 month, and -22.5% at 3 and 6 months (p < .0005). Caliper measurements confirmed this trend: -28.4% at 1 month, -32.9% at 3 months, and -42.5% at 6 months (p < .0001). Patient satisfaction was high, with 71.4% reporting improvement at 6 months. CONCLUSION: Combining radiofrequency and ultrasound with active cooling effectively reduces adipose tissue while protecting the superficial tissues. Treatments were effective, had a high satisfaction rate, and were shown to be safe.
BACKGROUND: Nonsurgical facial aesthetic procedures including fillers, botulinum toxin, and energy-based devices are increasingly common worldwide. Although typically safe, serious complications such as vascular occlusio...BACKGROUND: Nonsurgical facial aesthetic procedures including fillers, botulinum toxin, and energy-based devices are increasingly common worldwide. Although typically safe, serious complications such as vascular occlusion, necrosis, blindness, burns, and granulomas can lead to dissatisfaction and litigation. OBJECTIVE: To systematically evaluate clinical complications and medico-legal disputes associated with nonsurgical facial procedures. METHODS: A systematic review was conducted in accordance with PRISMA 2020 guidelines. Six databases and gray literature were searched (January 2020-March 2025). Eligible studies reported adverse outcomes or litigation after nonsurgical facial procedures. Risk of bias was assessed using ROBINS-I and JBI, certainty with GRADE. Random-effects meta-analysis was performed where appropriate. RESULTS: Twenty-one studies were included, mainly retrospective cohorts and medico-legal database analyses. Frequent complications were blindness, necrosis, burns, granulomas, and pigmentary changes. Litigation was most often linked to injectables and energy-based devices, commonly driven by procedural errors, inadequate informed consent, and incomplete documentation. Pooled analysis of 14 studies (1,409 cases) showed 45% of claims favored plaintiffs (95% CI: 0.35-0.56; I 2 = 92%). CONCLUSION: Litigation after nonsurgical facial procedures is frequent and often successful for plaintiffs. Strengthened consent, documentation, and practitioner regulation are critical to reducing medico-legal risk.
BACKGROUND: Dermatologic and aesthetic surgery exposes physicians and clinical staff to infectious risks. While patient safety is emphasized, occupational exposure to sexually transmitted infections (STIs) remains underr...BACKGROUND: Dermatologic and aesthetic surgery exposes physicians and clinical staff to infectious risks. While patient safety is emphasized, occupational exposure to sexually transmitted infections (STIs) remains underrecognized. OBJECTIVE: To evaluate evidence on occupational STI risk in aesthetic dermatology and dermatologic surgery and to summarize prevention strategies. MATERIALS AND METHODS: A structured search of PubMed and major medical databases identified clinical studies, case reports, and guidelines addressing occupational STI transmission in dermatologic surgery. Evidence was categorized by level (CEBM 1a-5). RESULTS: Human papillomavirus (HPV) is the best documented occupational risk, with viral DNA consistently detected in plume and case reports of laryngeal papillomatosis and carcinoma in laser surgeons. Bloodborne pathogens pose additional risks: transmission rates are estimated at 0.3% for human immunodeficiency virus, 0.5% to 10% for hepatitis C virus, and up to 63% for hepatitis B virus (HBV) in unvaccinated individuals. Herpes simplex virus can cause whitlow and ocular infection. Protective measures include smoke evacuation, N95 or laser masks, eye and skin protection, HPV and HBV vaccination, and sharps safety. CONCLUSION: Occupational STI risk in aesthetic and surgical dermatology is preventable but underappreciated. Universal smoke evacuation, vaccination, protective equipment, and standardized postexposure protocols should be adopted to safeguard dermatologists.
BACKGROUND: The field of regenerative aesthetics is advancing rapidly, shifting from traditional cosmetic techniques to therapies targeting the biological mechanisms behind tissue degeneration. OBJECTIVE: The authors aim...BACKGROUND: The field of regenerative aesthetics is advancing rapidly, shifting from traditional cosmetic techniques to therapies targeting the biological mechanisms behind tissue degeneration. OBJECTIVE: The authors aimed to explore emerging therapies within the 3 pillars of regenerative aesthetics, cellular treatments, biochemical cues, and scaffolds highlighting recent advancements, regulatory challenges, and opportunities for further research. METHODS: A literature review was performed to identify clinical evidence for regenerative modalities in aesthetic practice, with 74 articles included for evaluation. RESULTS: The review covers adipocyte- and umbilical cord-derived stem cells and stromal vascular fraction (SVF) in aesthetic treatments. Nanofat, created through mechanical emulsification, shows promise by providing higher SVF yields while circumventing stricter regulations on enzymatic methods. Exosomes demonstrate therapeutic potential in wound healing, pigmentation disorders, and skin rejuvenation. Polydeoxyribonucleotides and polynucleotides exhibit significant tissue repair and anti-inflammatory effects; polynucleotides also serve as scaffolds for tissue volumization. In addition, new data suggest that poly- l -lactic acid promotes volumizing effects by increasing adipose-derived stem cells and remodeling the extracellular matrix. CONCLUSION: Further research and regulatory standardization are needed. Future directions may involve integrating regenerative aesthetics with longevity medicine to enhance both rejuvenation and sustained tissue function over time.