BACKGROUND: Patient retention is a key quality metric in cosmetic dermatology. Initial consultations are critical for establishing trust, yet the impact of consultation duration on retention has not been well-defined. OB...BACKGROUND: Patient retention is a key quality metric in cosmetic dermatology. Initial consultations are critical for establishing trust, yet the impact of consultation duration on retention has not been well-defined. OBJECTIVE: To evaluate the association between consultation length and same-day treatment decisions, as well as short- and long-term patient retention. MATERIALS AND METHODS: In this multicenter retrospective study, data were collected over 1 year from 6 dermatology practices on new cosmetic consultations. Variables included consultation duration, visit indication, age, sex, and follow-up outcomes. Primary end points were same-day treatment, 1-year retention, and 3-year retention. RESULTS: A total of 1,951 consultations were analyzed. Longer consultation duration n was significantly associated with higher likelihood of same-day treatment (odds ratio [OR] 1.48 per 10 minutes; p < .001) and modest increases in 1-year (OR 1.07; p = .002) and 3-year retention (OR 1.08; p = .002). Consultations ≥75 minutes demonstrated the highest rates of both immediate treatment and long-term retention. CONCLUSION: Increased consultation time is associated with improved same-day treatment rates and patient retention. These findings highlight the importance of investing time during the initial visit to support both immediate decision-making and sustained patient engagement.
BACKGROUND: Melanoma in situ (MIS) and lentigo maligna (LM) present challenges, particularly in anatomically sensitive areas where surgical excision may result in morbidity. Topical imiquimod is increasingly used as a no...BACKGROUND: Melanoma in situ (MIS) and lentigo maligna (LM) present challenges, particularly in anatomically sensitive areas where surgical excision may result in morbidity. Topical imiquimod is increasingly used as a noninvasive alternative for MIS and LM. OBJECTIVE: To evaluate the efficacy, safety, and optimal treatment protocols of topical imiquimod for MIS and LM. METHODS: A review of current literature was conducted using multiple databases. Studies reporting histologically confirmed MIS or LM treated with topical imiquimod were included. Outcomes included histological clearance, recurrence, and adverse events. RESULTS: Thirteen studies encompassing 129 individual cases were analyzed (2000-2025). Reported histological clearance rates were approximately 84.5% (range, 77%-90%). Treatment duration ranged from 4 to 44 weeks, with most protocols lasting 8 to 16 weeks. Among cases with follow-up data, recurrence rates ranged from 0.5% to 15%. Common adverse effects included erythema and local irritation, and an inflammatory response was strongly associated with treatment success. CONCLUSION: Topical imiquimod is a reasonable and efficacious treatment option for MIS and LM, particularly in anatomically challenging locations, and represents a valuable nonsurgical option with an acceptable safety profile; however, heterogeneous protocols, limited long-term follow-up, and small sample sizes limit certainty, and standardized treatment protocols are needed.
BACKGROUND: Hyaluronic acid (HA) gels are popular aesthetic treatments, but product selection remains challenged by limited in-tissue data linking gel properties to clinical outcomes. OBJECTIVE: To evaluate how tissue pl...BACKGROUND: Hyaluronic acid (HA) gels are popular aesthetic treatments, but product selection remains challenged by limited in-tissue data linking gel properties to clinical outcomes. OBJECTIVE: To evaluate how tissue plane, gel indication grouping, and crosslinking technologies influence in-tissue HA gel morphology. MATERIALS AND METHODS: Eighteen crosslinked HA gels, representing 4 clinical indication groups and 5 crosslinking technologies, were injected into intradermal, subdermal, and deep planes of ex vivo human abdominal tissue under ultrasound. Bolus spread and height were quantified and mixed-effect regression models evaluated the effects of tissue plane, indication group, crosslinking technology, and their interactions. RESULTS: Tissue plane significantly influenced gel spread and height; however, the magnitude and direction of these effects varied across gel indication grouping and crosslinking structure. Distinct crosslinking technologies demonstrated different patterns of plane-dependent adaptability; the cohesive polydensified matrix gels showed more pronounced changes in morphology across tissue planes, whereas noncohesive polydensified matrix gels tended to exhibit more plane-invariant behavior. CONCLUSION: This ex vivo analysis demonstrates that HA gel morphology is influenced by the interaction between tissue plane of injection, gel subtype, and crosslinking technology and reveals that HA gels differ in the magnitude of these plane-dependent differences.
BACKGROUND: Subcision is an established minimally invasive technique for the treatment of atrophic acne scars. Adjunctive suction has been proposed to prevent early redepression, but evidence remains limited. OBJECTIVE:...BACKGROUND: Subcision is an established minimally invasive technique for the treatment of atrophic acne scars. Adjunctive suction has been proposed to prevent early redepression, but evidence remains limited. OBJECTIVE: To compare the efficacy of subcision alone versus subcision combined with suction using objective and subjective outcome measures. MATERIALS AND METHODS: This randomized, split-face, patient-blinded clinical trial included 27 patients with bilateral atrophic acne scars. Both facial sides underwent cannula subcision. One randomized side additionally received 10 suction sessions over 2 weeks, while the contralateral side received sham pressure. Outcomes were assessed at baseline, 1 month, and 4 months using the Goodman and Baron Qualitative Grading Scale, Modified Quantitative Global Scarring Grading, scar counts, and the Acne Scar Improvement Grading Scale. RESULTS: Both treatments resulted in significant improvement over time in qualitative and quantitative scar measures (p < .05). No significant differences were detected between sides for objective outcomes. Physician- and patient-rated Acne Scar Improvement Grading Scale scores were significantly higher on the suction-treated side (p = .002 and p = .026, respectively). CONCLUSION: Both subcision alone and suction-assisted subcision significantly improved atrophic acne scars. Subjective assessments favored suction-assisted subcision, suggesting clinically perceptible benefits not fully captured by objective scar-counting methods.
BACKGROUND: Reconstructive options for nasal dorsum defects are limited by poor skin laxity and high aesthetic demands. Few new techniques have been described in recent decades. OBJECTIVE: To introduce and evaluate a nov...BACKGROUND: Reconstructive options for nasal dorsum defects are limited by poor skin laxity and high aesthetic demands. Few new techniques have been described in recent decades. OBJECTIVE: To introduce and evaluate a novel reconstructive method-the bipedicled bridge flap|(BBF)-that combines the reliability of dual-pedicle vascularity with scar concealment along cosmetic subunit boundaries. METHODS: Prospective single-center study of consecutive patients undergoing BBF reconstruction of nasal dorsum defects after Mohs micrographic surgery between June 2021 and June 2025. Defect characteristics, flap variants (unilateral, bilateral, horizontal, or with M-plasty), complications, and aesthetic outcomes using the Manchester Scar Scale (MSS) were recorded. High-quality digital photographs of all defects, repairs, and follow-up to at least 6 months were recorded. RESULTS: Forty-five patients underwent BBF reconstruction (4 bilateral, 4 horizontal). Mean defect size was 1.7 cm2 (range 0.3-4.3). No infections, necrosis, dehiscence, hematoma, or hypertrophic scarring occurred. Median MSS = 4, indicating excellent cosmetic results. CONCLUSION: The BBF is a novel, reliable, and versatile single-stage option for small-to-medium nasal dorsum defects, expanding current reconstructive algorithms by combining favorable vascularity with superior aesthetic concealment.Cutaneous malignancies of the nose are common and frequently require Mohs micrographic surgery to achieve complete excision. Reconstruction of the nasal dorsum after tumor removal remains one of the most technically and aesthetically demanding challenges in dermatologic surgery. The skin of the nasal dorsum is thin, tightly adherent, and deficient in redundancy, making primary closure difficult without distortion. Positioned at the center of a highly visible cosmetic subunit, even subtle discrepancies in contour, color, or texture can be conspicuous. Successful aesthetic repair, therefore, depends on restoring natural nasal contour, with matching skin texture and symmetry while confining scars within the boundaries of cosmetic subunits.
BACKGROUND: Facial venous malformations (VMs) are congenital low-flow vascular anomalies that may cause cosmetic disfigurement and functional impairment. Because of the anatomical complexity of the facial region, managem...BACKGROUND: Facial venous malformations (VMs) are congenital low-flow vascular anomalies that may cause cosmetic disfigurement and functional impairment. Because of the anatomical complexity of the facial region, management of these lesions remains challenging, and minimally invasive approaches such as sclerotherapy have gained increasing attention. OBJECTIVE: This study evaluates the efficacy, patient satisfaction, and complications of sclerotherapy in patients with facial VMs. MATERIALS AND METHODS: A retrospective analysis was conducted on 21 patients diagnosed with facial VMs and treated with polidocanol sclerotherapy between March 2000 and January 2025. Treatment response, patient satisfaction, and complications were assessed. Statistical analyses included chi-square testing and Spearman correlation. RESULTS: Of the 21 patients, 23.8% achieved an excellent response (>90% reduction), 57.1% had a significant response (50%-90%), and 19.0% showed a mild response (<50%). Mean patient satisfaction score was 2.81/3. Complications such as pain (47.6%) and swelling (28.6%) were common but transient. A negative correlation was observed between number of procedures and treatment response (p = .032). CONCLUSION: Sclerotherapy is an effective and well-tolerated treatment option for facial VMs, associated with high patient satisfaction despite frequent but manageable minor complications.