BACKGROUND: Radiofrequency microneedling (RFMN) is increasingly used for rejuvenation, acne scars, and tightening. Although marketed as minimally invasive, lasting adverse effects have been reported. Postmarketing survei...BACKGROUND: Radiofrequency microneedling (RFMN) is increasingly used for rejuvenation, acne scars, and tightening. Although marketed as minimally invasive, lasting adverse effects have been reported. Postmarketing surveillance provides insight into real-world safety. OBJECTIVE: To characterize adverse events associated with RFMN devices reported to the US FDA MAUDE database, emphasizing the frequency and spectrum of complications. MATERIALS AND METHODS: A retrospective review of FDA MAUDE reports from January 2013 to October 2025 was conducted. Entries involving RFMN were analyzed for treatment location and adverse outcomes. Narrative descriptions were categorized into clinically relevant events, and descriptive statistics summarized complication frequencies and anatomic sites. RESULTS: A total of 114 reports with 224 events were identified. The most frequent complications included textural changes (n = 56, 25.0%), pigmentary alteration (n = 41, 18.3%), and fat loss (n = 26, 11.6%). Inflammatory reactions (n = 18, 8.0%), burns (n = 14, 6.3%), and pain (n = 12, 5.4%) were also frequently reported. The face, neck, and abdomen were the most treated anatomic regions. CONCLUSION: Although RFMN is generally safe, significant complications may occur. Experience and proper training are crucial to minimizing risks. Clinicians should counsel patients, monitor outcomes, and support surveillance and standardized reporting to improve safety.
BACKGROUND: Helical-rim reconstruction is limited by rigid cartilage and minimal laxity. Linear repair may be used for defects <1.5 cm², whereas larger wounds require flaps that increase complication risk; data on simple...BACKGROUND: Helical-rim reconstruction is limited by rigid cartilage and minimal laxity. Linear repair may be used for defects <1.5 cm², whereas larger wounds require flaps that increase complication risk; data on simple linear closure with cartilage sculpting are lacking. OBJECTIVE: To evaluate cosmetic outcomes and complications of linear closure with cartilage sculpting for helical rim defects ≤2.5 cm². METHODS: Fifteen patients with helical rim defects underwent Mohs micrographic surgery followed by cartilage trimming and primary complex closure. Complications were assessed at suture removal (7-10 days). At ≥ 3 months, scars were evaluated by 2 blinded dermatologic surgeons using the SCAR scale, and patients completed the Patient Observer Scar Assessment Scale (POSAS). RESULTS: No infections or hematomas occurred, and one dehiscence (6.7%) was reported. Among 30 SCAR ratings, scar spread was none/pencil-thin in 26 (86.7%), erythema absent/light-pink in 29 (96.7%), track marks absent in 29 (96.7%), and overall appearance "desirable" in 27 (90.0%). The mean POSAS score was 8.3 ± 3.6/60; the mean overall satisfaction was 1.1 ± 0.3/10 (lower = better). CONCLUSION: Linear closure with limited cartilage trimming yields excellent cosmesis and minimal complications for helical rim defects up to 2.5 cm².
BACKGROUND: Accurate description of biopsy sites is critical to prevent wrong-site procedures, which carry serious patient safety and medicolegal consequences. Despite existing guidelines, insufficient site documentation...BACKGROUND: Accurate description of biopsy sites is critical to prevent wrong-site procedures, which carry serious patient safety and medicolegal consequences. Despite existing guidelines, insufficient site documentation remains a persistent challenge. OBJECTIVE: Identify factors associated with incorrect anatomical site descriptions in dermatologic surgery referrals. MATERIALS AND METHODS: Prospective, observational cohort of 1,000 consecutive referrals for surgery at a single private dermatologic surgery practice was assessed for correct anatomical site description, defined as concordance between documented biopsy location and the clinically evident lesion or scar at the time of surgery. Referral documentation was assessed for clinical photographs, anatomical diagrams, age, sex, tumor type, tumor location, lesion size, and referring provider type. RESULTS: Anatomical location significantly influenced correctness (χ2 = 22.47, p = .002), with nasal lesions more likely to be incorrectly described (residual = -3.64). Referrals including a clinical photograph (χ2 = 4.14, p = .042) or an anatomical diagram (χ2 = 12.33, p < .001) were significantly more likely to be correctly described, however, only 67.1% of referrals included a photograph and 53.9% included an anatomical diagram. Moreover, 100% of referrals that included triangulation were correctly described. CONCLUSION: These findings highlight areas for targeted intervention to improve referral documentation.
BACKGROUND: Health care resource use, pollution, and greenhouse gas emissions are increasingly studied to balance quality patient care with environmental, social, and financial impacts. However, consolidated sustainabili...BACKGROUND: Health care resource use, pollution, and greenhouse gas emissions are increasingly studied to balance quality patient care with environmental, social, and financial impacts. However, consolidated sustainability recommendations for Mohs micrographic surgery (MMS) remain unexplored. OBJECTIVE: To assess current recommendations and studies on environmental sustainability in MMS. MATERIALS AND METHODS: Following PRISMA-ScR guidelines, a literature review was conducted across PubMed, ScienceDirect, Scopus, Web of Science, and Cochrane databases from 2014 to 2024. English peer-reviewed studies using keywords "climate change," "margin control," "environment," "sustainability," "waste," "resource," "Mohs micrographic," "Mohs," and "micrographic" were included. Duplicates and conference abstracts were excluded. RESULTS: Of 5,526 articles, nine met inclusion criteria after independent review. Recommendations included standardized surgical sets, limiting instruments to essentials, and redesigning procedure rooms to improve recycling access. Three articles found no significant difference in infection rates between sterile and nonsterile glove use. Other suggestions involved recycling plastics, using microtubules to reduce chromacoding dye waste by minimizing spillage and drying, and scheduling virtual preoperative visits to reduce travel emissions. Insurance reimbursement for virtual visits remains a limitation. CONCLUSION: Restructuring surgical protocols and procedure room design encourages innovation and addresses workflow inefficiencies rooted in tradition rather than evidence, promoting sustainability in MMS.
BACKGROUND: Platelet-rich plasma (PRP) is widely used in regenerative medicine due to its high concentration of platelets and growth factors that promote tissue repair and angiogenesis. In hair transplantation, PRP has m...BACKGROUND: Platelet-rich plasma (PRP) is widely used in regenerative medicine due to its high concentration of platelets and growth factors that promote tissue repair and angiogenesis. In hair transplantation, PRP has mainly been studied as an adjunct for hair growth, whereas its effect on donor-area wound healing after follicular unit excision (FUE) remains insufficiently documented. OBJECTIVE: To evaluate the effect of PRP on donor-area wound healing, after FUE harvesting. METHODS: Nineteen healthy male patients aged 30 to 59 years with no prior hair transplantation were enrolled. Two equal 1 cm 2 areas were marked in the occipital donor region. Follicular units were harvested using a 1.1-mm sharp motorized punch. One area received an intradermal injection of 0.1-mL PRP prepared by single-spin centrifugation at 3,500 rpm for 12 minutes, whereas the contralateral area served as control. Wound surface areas were assessed immediately and 24 hours postharvesting, using image analysis. Statistical analysis was performed on 49 wounds. RESULTS: After 24 hours, mean wound surface reduction was 21.3% in the control group and 49.95% in the PRP-treated group ( p < .001). CONCLUSION: PRP significantly accelerates donor-area wound healing after FUE harvesting.
BACKGROUND: As unshaven hair transplantation grows in popularity, terminology has become inconsistent across publications and advertising. This creates confusion for patients and clinicians and undermines informed consen...BACKGROUND: As unshaven hair transplantation grows in popularity, terminology has become inconsistent across publications and advertising. This creates confusion for patients and clinicians and undermines informed consent. OBJECTIVE: To map usage, identify confusion sources, and propose definitions for the spectrum of "Unshaven" follicular unit excision (FUE) approaches. METHODS: The authors performed a structured review of scientific literature, Google Trends for public-facing terms, searches of clinic and media webpages, and standardized prompts to artificial intelligence chatbots. Findings were synthesized into operational definitions and classification. RESULTS: For the FUE procedure, the authors observed overlap, misuse, and conflation of techniques labeled "Unshaven," particularly between partially shaven methods and truly unshaven approaches. Synthesis yielded five categories with explicit procedural boundaries: Shaven FUE, Partially Shaven FUE, Unshaven FUE with pretrimming, Unshaven FUE without pretrimming, and Long-Hair FUE. For each, the authors outline defining steps, patient-visible outcomes, indications, and recommend patient-facing descriptors. The authors propose that 'Shaven' versus 'Unshaven' FUE terminology should be defined exclusively by the donor harvesting technique, irrespective of whether the recipient area is shaved. CONCLUSION: The proposed standardized nomenclature clarifies FUE categories, improves counseling and expectation-setting, and supports transparent reporting, ethical advertising, and comparability across studies. The authors encourage adoption by clinicians, training programs, and journals.
BACKGROUND: Image-guided superficial radiotherapy (IGSRT) has been advocated for and advertised as having lower recurrence rates, lack of surgical scars, morbidity, and being more cost-effective in comparison with Mohs s...BACKGROUND: Image-guided superficial radiotherapy (IGSRT) has been advocated for and advertised as having lower recurrence rates, lack of surgical scars, morbidity, and being more cost-effective in comparison with Mohs surgery (MMS). OBJECTIVE: Evaluate and perform a modeled cost analysis using CPT/Medicare rates comparing IGSRT versus MMS in squamous cell carcinoma (SCC). MATERIALS AND METHODS: The authors evaluated 3 exemplary and representative SCC lesions classified by stage (T1, T2, and Tis) and divided by anatomical location (head and neck/trunk and extremities). RESULTS: Average cost of a Mohs procedure for both the head/neck and trunk/extremities ranged from $1,010.15 to $1,566.68 depending on the repair type. IGSRT had a wide variety and range in price from $1,450.49 to $10,244.93 for a 10-session regimen versus $2,058.74 to $ 25,510.58 for the recommended 25 session regimen. SRT delivery only accounts for 3.74% of the cost per session. CONCLUSION: Their results show that SRT can theoretically be 1.11 to 22.99 times more expensive regardless of MMS repair complexity. Overall time of the procedure is similar to twice as long but is also divided over the course of 10 to 25 days.