J Cutan Aesthet Surg
· 2025 · PMID 40027538
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The triple advancement flap has traditionally been used on the trunk, but gained popularity for facial defects of the neck and temple. Advantages of this closure technique include evenly dispersed tension vectors, less n...The triple advancement flap has traditionally been used on the trunk, but gained popularity for facial defects of the neck and temple. Advantages of this closure technique include evenly dispersed tension vectors, less need for extensive subcutaneous undermining and mobilization compared to standard facial reconstruction techniques. The nasal sidewall, root, and bridge often pose reconstructive challenges, with convergence of competing tension lines and surrounding anatomic landmarks. Our purpose is to introduce, describe, and illustrate application of the triple advancement flap for reconstruction of the nasal sidewall, bridge, and root. A triple advancement flap employs aspects of a purse-string closure and an advancement flap. Burow's triangles are excised from three equidistant points of a round defect. Tissue undermining is encouraged. A purse-string suture is used to approximate flap edges together along three tension lines. The central defect is subsequently allowed to heal either by secondary intention or with application of a Burow's graft. When applied appropriately, the triple advancement flap can provide pleasing cosmetic and functional results in areas that have traditionally posed a reconstructive challenge. This new application broadens the scope of the triple advancement flap and provides reconstructive surgeons with an additional tool when approaching nasal root, bridge, or sidewall defects.
J Cutan Aesthet Surg
· 2025 · PMID 40027537
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Basal cell carcinoma (BCC) represents the commonest cutaneous malignancy globally. Its diagnosis in patients with skin of color is often delayed due to its low prevalence which reduces clinical suspicion and its indolent...Basal cell carcinoma (BCC) represents the commonest cutaneous malignancy globally. Its diagnosis in patients with skin of color is often delayed due to its low prevalence which reduces clinical suspicion and its indolent course. Studies on BCC in India are few. Considering that it is a locally invasive tumor commonly seen in the head and neck region, its management calls for the complete clearance of the cancer accompanied by minimal cosmetic disfigurement. One modality fitting the said requirements is Mohs micrographic surgery. However, the facilities for the same are limited in our country. We report here cases of histologically confirmed BCC managed successively with Mohs surgery, a technique associated with low recurrence rates while also being aesthetically superior when compared to traditional surgical excision.
Wollina U, Goldman A, Machado Luz P
… +1 more, Guindani Marson V
J Cutan Aesthet Surg
· 2025 · PMID 40027536
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BACKGROUND: The earlobe plays a significant role in framing the face and complementing the appearance of earrings, hairstyles, and other facial features. In addition to the growth of the earlobes with the aging process,...BACKGROUND: The earlobe plays a significant role in framing the face and complementing the appearance of earrings, hairstyles, and other facial features. In addition to the growth of the earlobes with the aging process, other changes can compromise the shape, size, and overall youthful appearance of this region. The main changes are evidenced by the elongation and ptosis of the earlobes, loss, atrophy of soft tissues, and formation of wrinkles in addition to deformities produced by surgical procedures, placement of earrings, and piercings or earlobe gauging. OBJECTIVE: The authors describe the main changes in the earlobes and review the current treatment modality for earlobe rejuvenation and reconstruction, addressing the anatomy, common esthetic concerns, and various therapeutic approaches. METHODS: A narrative review of treatment options was performed. We searched PubMed databases. Based on the diagnosis of changes, less invasive surgical procedures, use of laser, and fillers with fat or hyaluronic acid represent therapeutic options. RESULTS: Significant improvement of the senile earlobe and correction of anatomical and esthetic deformities can be attenuated or corrected through different approaches. Proper diagnosis of the changes will determine the best treatment or even the combination of procedures. CONCLUSION: Surgical procedures, laser rejuvenation, fat injection, and fillers represent simple and effective options for treating esthetic problems and acquired deformities of the earlobes.
J Cutan Aesthet Surg
· 2025 · PMID 40027535
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Epidermal graft produced by suction is useful in treating vitiligo. However, it is very difficult to handle thin, flimsy, and translucent epidermis due to its in-curling and wrinkling properties. This is due to the hemis...Epidermal graft produced by suction is useful in treating vitiligo. However, it is very difficult to handle thin, flimsy, and translucent epidermis due to its in-curling and wrinkling properties. This is due to the hemispherical blister roof surface area which is twice its circular base. The correction of the epidermal surface and its resizing is a cumbersome and time-consuming task during epidermal grafting. To combat these problems, the blister roof is patched with micropore adhesive tape as a novel technique for harvestation and transfer of the suction blister graft.
Ninama K, Mahajan R, Baxi D
… +2 more, Patil RS, Marfatia Y
J Cutan Aesthet Surg
· 2025 · PMID 40027534
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OBJECTIVES: The study aimed to compare the efficacy of two treatment modalities in vitiligo vulgaris that is - potent topical corticosteroid (betamethasone-dipropionate lotion 0.05%) with FrCO laser versus Potent topical...OBJECTIVES: The study aimed to compare the efficacy of two treatment modalities in vitiligo vulgaris that is - potent topical corticosteroid (betamethasone-dipropionate lotion 0.05%) with FrCO laser versus Potent topical corticosteroid (PTS) alone, and to observe side effects if any. MATERIAL AND METHODS: Sixty cases with stable vitiligo (vitiligo vulgaris including focal vitiligo) >12 years of age with <27% body surface area were included in the study. The Institutional Ethics Committee approval was taken. After taking consent and clinical photographs, cases were randomly allocated into two groups of 30 patients each: Group A received FrCO laser (power-6W, random mode) once a month + twice daily application of PTS (betamethasone dipropionate lotion 0.05%) over patches and Group B applied PTS only twice daily (betamethasone dipropionate lotion 0.05%). The response was assessed at the end of 3 months. RESULTS: The mean vitiligo area scoring index (VASI) score at baseline for Group A was 1.17 ± 0.59, and after 3 months was 0.60 ± 0.56. For Group B, the mean VASI at baseline was 0.87 ± 0.35 and after 3 months was 0.63 ± 0.50. The p value of group B was 0.003 and for group A was 0.001. Even though the reduction in mean VASI was statistically significant in both groups, Group A showed a better response. Group A showed good to excellent response in 16.67% while Group B only cases in 3.3%. This suggests that the addition of FrCO to steroids may provide superior repigmentation. CONCLUSION: The addition of FrCO laser to topical corticosteroids offers a safe and promising approach and can be considered in patients who are unresponsive to other treatment modalities.
Khalili M, Solhjou S, Amiri R
… +2 more, Rukerd MRZ, Aflatoonian M
J Cutan Aesthet Surg
· 2025 · PMID 40027533
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OBJECTIVES: Vitiligo significantly impacts patients' quality of life. Current evidence indicates that combination therapy results in faster improvement, enhancing patient adherence to treatment and leading to higher sati...OBJECTIVES: Vitiligo significantly impacts patients' quality of life. Current evidence indicates that combination therapy results in faster improvement, enhancing patient adherence to treatment and leading to higher satisfaction among patients. In this study, we compare the efficacy of combined fractional carbon dioxide (FCO) laser and excimer lamp with platelet-rich plasma (PRP) or topical tacrolimus in patients with refractory vitiligo. MATERIAL AND METHODS: This is a prospective, single-blind, randomized split-body clinical trial involving 41 patients with resistant focal patches of vitiligo vulgaris. Each patient had two similar lesions randomly assigned to receive either a combination of FCO laser, excimer lamp, and intradermal PRP injections or a combination of FCO laser, excimer lamp, and topical 0.1% tacrolimus (applied twice daily for 12 weeks). The FCO laser and PRP treatments were administered in three monthly sessions, and the excimer lamp was used twice a week over 12 weeks. The efficacy of treatment was assessed based on the physician's assessment and patient's satisfaction. RESULTS: Despite significant improvement in both treatment groups during the course of treatment, the PRP group showed significantly superior efficacy (more than 50% improvement) compared to the tacrolimus group (56.1% and 26.8%, respectively). Furthermore, the PRP group exhibited greater improvement in resistant acral areas compared to the tacrolimus group (51.2% and 19.5%, respectively). CONCLUSION: The combination of FCO, an excimer lamp, and PRP demonstrates superior efficacy, particularly in resistant acral areas. As a result, this combination can be recommended in difficult-to-treat areas in patients with vitiligo.
Chugh D, Kolalapudi SA, Praveen S
… +3 more, Konala S, Swetha NS, Reddy MK
J Cutan Aesthet Surg
· 2025 · PMID 40027532
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OBJECTIVES: The objective of this study was to evaluate the efficacy and adverse effects of non-cultured, nontrypsinized dermabraded epidermal cell graft followed by narrowband ultraviolet B (NB-UVB) therapy for stable v...OBJECTIVES: The objective of this study was to evaluate the efficacy and adverse effects of non-cultured, nontrypsinized dermabraded epidermal cell graft followed by narrowband ultraviolet B (NB-UVB) therapy for stable vitiligo. MATERIAL AND METHODS: A hospital-based and prospective interventional study was carried out on 45 patients (18-65 years) of both genders after approval from the Ethics Committee. The donor site was dermabraded after applying mupirocin ointment, and the material obtained was spread over the dermabraded recipient site. NBUVB phototherapy was initiated 3 weeks after the procedure and given for 3 months. Photographs were taken before the procedure and at the end of 3 month of phototherapy and assessed for extent, pattern, and color matching of repigmented area according to physician global assessment (PGA) score and patient satisfaction score (PSS). Dermoscopic improvement was also noted. RESULTS: Forty-five patients were enrolled in the study, out of which 43 patients completed the study. According to the intention to treat analysis, results were calculated in all 45 patients. Good to excellent response (50-100% improvement) was seen in 46.7% of patients according to the PGA score and in 57.8% of patients according to PSS. Most patients achieved the same color match with their normal skin at the end of the follow-up (73.3%). The most common repigmentation pattern was diffuse (46.7%), both clinically and dermoscopically. Among the clinical types, vitiligo vulgaris showed the maximum good to excellent repigmentation (61.3% and 77.4% of patients with PGA scores and PSS, respectively). Adverse effects were erythema, infection, and post-inflammatory hyper-pigmentation at the donor and recipient sites, whereas scarring was seen at the recipient site. CONCLUSION: It is a safe, simplified, cost-effective, and less time-consuming technique than earlier techniques and provides good to excellent repigmentation in a considerable proportion of participants.
J Cutan Aesthet Surg
· 2025 · PMID 40027531
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Suction blister epidermal grafting (SBEG) is a standard technique for treating vitiligo on challenging areas like fingertips and lips but often results in pigment halos and difficulties with small, curved surfaces. We pr...Suction blister epidermal grafting (SBEG) is a standard technique for treating vitiligo on challenging areas like fingertips and lips but often results in pigment halos and difficulties with small, curved surfaces. We propose a modified SBEG technique, utilizing trypsinization of one blister graft to improve melanocyte spread and reduce peri-graft halo. Trypsin ethylenediaminetetraacetic acid (EDTA) solution is introduced into a selected blister, creating a cell suspension applied to dermabraded gaps and peripheries, including eyelid margins. At 5-month follow-up, complete re-pigmentation with no halo effect was achieved, indicating this modified approach's potential in enhancing SBEG outcomes for complex sites.
J Cutan Aesthet Surg
· 2025 · PMID 40027529
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Vitiligo, a chronic skin disorder characterized by depigmented patches, often presents challenges in management due to the unpredictable nature of repigmentation. Mini punch grafting, a surgical technique, is a widely ac...Vitiligo, a chronic skin disorder characterized by depigmented patches, often presents challenges in management due to the unpredictable nature of repigmentation. Mini punch grafting, a surgical technique, is a widely accepted treatment for stable vitiligo. This article focuses on the innovative use of customized short punches in mini punch grafting. The aim is to provide insights into their advantages, the customization process, and their role in improving outcomes for vitiligo patients.
J Cutan Aesthet Surg
· 2024 · PMID 39649772
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While various treatment options exist for vitiligo, surgical interventions have gained significant attention due to their potential for long-lasting repigmentation. Several surgical procedures have been developed, includ...While various treatment options exist for vitiligo, surgical interventions have gained significant attention due to their potential for long-lasting repigmentation. Several surgical procedures have been developed, including miniature punch grafting, thin Theirsch's split-thickness skin grafting (STSG), suction blister technique, and ultrathin STSG. The decision-making process should also consider the potential risks and benefits associated with each technique. Factors such as graft survival, color match, post-operative complications, and long-term stability of repigmentation should be evaluated. In addition, patient factors such as comorbidities, skin type, and psychological impact should be carefully considered to ensure optimal surgical outcomes. We, hereby, aim to explore the potential execution of vitiligo surgery using the most conceivable technique, considering factors such as efficacy, safety, and patient-specific characteristics.
J Cutan Aesthet Surg
· 2024 · PMID 39649770
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Intralesional injections to wide, thick lesions and lesions on curved surfaces are challenging with the syringe and needle unit being held parallel to the skin surface. Bending the needle eases negotiation by lifting the...Intralesional injections to wide, thick lesions and lesions on curved surfaces are challenging with the syringe and needle unit being held parallel to the skin surface. Bending the needle eases negotiation by lifting the syringe away from the skin surface with the needle entering parallel to the lesion ensuring uniform and optimal drug delivery.
Velazco de Maldonado GJ, Suarez-Vega DV, Miller-Kobisher B
… +1 more, Víctor GG
J Cutan Aesthet Surg
· 2024 · PMID 39649769
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OBJECTIVES: Evaluate the controlled release of silicon from smart polydioxanone suture (Smart PDOs™) and the clinical effect of the Cartesian Technique™ in face lifting. MATERIAL AND METHODS: This study was preclinical a...OBJECTIVES: Evaluate the controlled release of silicon from smart polydioxanone suture (Smart PDOs™) and the clinical effect of the Cartesian Technique™ in face lifting. MATERIAL AND METHODS: This study was preclinical and clinical trials randomized, uncontrolled, and phase I carried out. Preclinical trials included instrumental analysis of silicon-enriched sutures by light microscopy, electron microscopy, and Ultraviolet-visible (UV-vis) spectroscopy. The clinical trial included 35 patients with primary and secondary rhytides, grade I lipomatosis, and grade I deflation. Polydioxanone (PDO) sutures are inserted following the Cartesian Technique™, a vectorial lift from the intersection of the Cartesian planes of the face. Once the cannulas were inserted with the PDO thread, 0.1 mL of organic silicon was dosed. Turgidity was examined by the pinch test of skin turgor. To measure the position of flaccid or deflated tissues, the scale used was the deflation scale. RESULTS: The controlled release of organic silicon from the PDO sutures was verified. Its clinical application revealed that after 8 days the improvement in turgidity, wrinkle reversal, and flaccidity tightening was maintained in 100% of the sample. At 15 days, reversal of rhytides was observed, softening of deep furrows in 80%, and the initial turgor and skin tightening maintained without deflation in 90% of cases. Histopathological findings reveal that silicon synergistically potentiates the tissue effect of the PDO suture, generating greater biostimulation of fibroblasts with better quality collagen fibers, greater restructuring and redensification of the skin, and avoiding the late inflammatory response. CONCLUSION: The Cartesian Technique™ with Smart PDOs™ is an effective protocol for skin replenishment that enhances cell biostimulation through the release of bioactive drugs.
Bhingradia YM, Vetal AA, Singdia H
… +1 more, Kinjalk A
J Cutan Aesthet Surg
· 2024 · PMID 39649768
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Patients seeking reconstructive facial surgery desire aesthetically pleasing outcomes with minimal visible scarring. For scalp incisions, beveled angle of 45° is typically preferred to preserve hair follicles. However, n...Patients seeking reconstructive facial surgery desire aesthetically pleasing outcomes with minimal visible scarring. For scalp incisions, beveled angle of 45° is typically preferred to preserve hair follicles. However, no consensus exists regarding the ideal incision angle for the brow area. This observational study analyzed the surgical outcomes of 12 patients with eyebrow defects treated using a simple elliptical excision with a beveled incision, addressing various indications such as posttraumatic scars, post-burn scars, and tumors. Outcomes were evaluated using the Physician Global Esthetic Improvement Scale at 7 days and 3 months post-surgery. At 7 days, 50% of patients showed very good improvement, and the other 50%showed moderate improvement. By 3 months, 33% of patients exhibited exceptional improvement, 50% showed very good improvement, and 17% demonstrated moderate improvement. This study concludes that direct excision and approximation with an angled incision along the hair follicle direction provide favorable aesthetic results for eyebrow reconstruction.
J Cutan Aesthet Surg
· 2024 · PMID 39649767
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Langer's lines, lines of cleavage, and biodynamic excisional skin tension (BEST) lines have been defined for cutaneous surgery to ensure excisional wound closure with the least tension on any part of the body and minimiz...Langer's lines, lines of cleavage, and biodynamic excisional skin tension (BEST) lines have been defined for cutaneous surgery to ensure excisional wound closure with the least tension on any part of the body and minimize scarring. This article describes nail unit incision lines (NUIL) with a similar perspective. NUIL are followed by nail surgeons to help regrowth of a normal nail; however, they are not widely understood or respected during nail surgery. Within the anatomically small nail unit, the orientation of these lines varies depending on the area being operated upon. Nail bed incisions should be oriented longitudinally, while nail matrix incisions should be oriented horizontally. Being the germinative portion, the nail matrix should be dealt with more cautiously, avoiding the lunular margin. Lateral nail fold incisions should be longitudinal, while proximal nail fold incisions should be radial. Distal nail fold (hyponychial) incisions should preferably be oriented parallel to the distal nail ridge. Knowledge and compliance with NUIL can help minimize scarring outcomes in nail surgery.
Vashisht D, Das P, Choudhary SSR
… +4 more, Singh GK, Sinha P, Bahuguna A, Sapra D
J Cutan Aesthet Surg
· 2024 · PMID 39649766
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Injecting botulinum toxin under simple topical anesthesia using a eutectic mixture of lignocaine and prilocaine is a painful procedure. A simple hyper-occlusive modification in the existing technique of topical anesthesi...Injecting botulinum toxin under simple topical anesthesia using a eutectic mixture of lignocaine and prilocaine is a painful procedure. A simple hyper-occlusive modification in the existing technique of topical anesthesia of palms facilitates painless injections leading to greater patient satisfaction and compliance.
J Cutan Aesthet Surg
· 2024 · PMID 39649765
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A stable and less voluminous nail dressing is required after nail surgery over the nail unit. The bandage should take care of trauma, water and discharge from the wound. We described the use of two layered non-sticky and...A stable and less voluminous nail dressing is required after nail surgery over the nail unit. The bandage should take care of trauma, water and discharge from the wound. We described the use of two layered non-sticky and absorptive bandages. It was cut into dumbbell shape and wrapped over the toe with a nail, and tied at the base of the toe with moderate pressure. To observe the toe, a window is made in the center of the bandage.
J Cutan Aesthet Surg
· 2024 · PMID 39649764
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OBJECTIVES: Stretch marks and post-surgical scar marks may have negative cosmetic and psychological impacts.. Thus, this study aimed to compare the efficacy and safety of microneedling monotherapy versus microneedling in...OBJECTIVES: Stretch marks and post-surgical scar marks may have negative cosmetic and psychological impacts.. Thus, this study aimed to compare the efficacy and safety of microneedling monotherapy versus microneedling in combination with autologous platelet-rich plasma (PRP) for the treatment of stretch marks and post-surgical scars. MATERIAL AND METHODS: This was a prospective randomized non-controlled study. A total of 30 study participants with stretch marks and post-surgery scars were enrolled and randomly divided into two groups, each with 15 study participants. All received three treatment sessions using microneedling monotherapy (Group A) or autologous PRP with microneedling (Group B) at 4-week intervals. Clinical response to treatment was assessed at the end of 20 weeks by comparing clinical photographs, Manchester Scar scale (MSS) score, dermoscopy images, and patient satisfaction scores. RESULTS: At the end of the study, statistically significant esthetic improvement in terms of MSS scores was seen in Group B when compared to Group A. In Group A, 73.3% of the study participants were satisfied while in Group B, 86.6% were very satisfied with the results. Dermoscopy pictures substantiated the findings of clinical improvement. No major side effects were documented. CONCLUSION: PRP in combination with microneedling has a better outcome as compared to microneedling monotherapy. Furthermore, dermoscopy is a non-invasive tool that can be used to evaluate therapeutic response.
J Cutan Aesthet Surg
· 2024 · PMID 39649763
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Post-acne atrophic scars (PAS) are a common complication of acne, and their treatment can be limited in people of color due to dyspigmentation and scarring risks. This split-face study compared the efficacy of microneedl...Post-acne atrophic scars (PAS) are a common complication of acne, and their treatment can be limited in people of color due to dyspigmentation and scarring risks. This split-face study compared the efficacy of microneedling with topical insulin (TI) on one side of the face with microneedling with platelet-rich plasma (PRP) on the other side for the treatment of PAS. The study included 50 participants with Fitzpatrick skin types III to VI who had never been treated for PAS. Both sides of the face showed significant improvement, with the left side being treated with TI showing a 52% improvement and the right side being treated with PRP showing a 28% improvement. The treatment was well-tolerated, with no significant adverse effects, and no changes in blood glucose levels were observed. The researchers suggest that combining TI or PRP with microneedling can improve PAS treatment, with TI being a superior option due to its ease of use, low cost, and noninvasive nature.