J Cutan Aesthet Surg
· 2023 · PMID 38189075
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Surgical re-excision is the recommended treatment for the complete removal of incompletely excised skin cancers (SCs), but it may not always lead to this goal. In the present study, the re-excision rate and the presence...Surgical re-excision is the recommended treatment for the complete removal of incompletely excised skin cancers (SCs), but it may not always lead to this goal. In the present study, the re-excision rate and the presence of residual tumors in re-excised SCs were evaluated. In this retrospective descriptive study, the pathological archives of a hospital center were examined for incompletely excised tumors. Out of the 96 incompletely excised tumors, 19 cases (19.8%) underwent re-excision, of which residual tumors were observed again in 7 cases (36.8%). The highest rate of residual tumor was found in the cheek (66.66%), and the involvement with tumor remnants of both margins combined was greater than the involvement of each of the lateral and deep margins alone. Collecting and reporting of surgical results of re-excised tumors may assist clinicians in determining the patient's condition and making appropriate decisions to increase the success rate of reoperations.
J Cutan Aesthet Surg
· 2023 · PMID 38189074
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Local flap reconstruction is an important skill used to excise and repair many cutaneous defects in various anatomical regions of body. In this article, the authors have described the bilobed flap reconstruction techniqu...Local flap reconstruction is an important skill used to excise and repair many cutaneous defects in various anatomical regions of body. In this article, the authors have described the bilobed flap reconstruction technique useful in the resection of various circular and semicircular defects, especially over nose tip and lateral wall of the nose. The authors have highlighted various indications, procedural techniques, and complications related to the surgery which will help in better esthetic outcome.
Kanathur S, Divya G, Shanmukhappa Asha G
… +2 more, Venkataramaiah Lakshmi D, Eswari L
J Cutan Aesthet Surg
· 2023 · PMID 38189073
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INTRODUCTION: Flap surgeries are the standard choice for reconstruction of defects post excision of cutaneous tumours. Complications following these surgeries predominantly result as a consequence of bleeding, tension, i...INTRODUCTION: Flap surgeries are the standard choice for reconstruction of defects post excision of cutaneous tumours. Complications following these surgeries predominantly result as a consequence of bleeding, tension, ischemia, infection. STUDY DESIGN: A Prospective study of patients treated for tumor excision and flap reconstruction between the period of 2014 and 2020 were followed up and complications encountered were analysed. RESULTS: A total of 70 patients with cutaneous malignancies underwent flap surgeries. Complications encountered were bleeding, hematoma, infection, necrosis, pincushioning, keloid, hypertrophic scars. CONCLUSION: Successful outcome depends on pre operative evaluation, appropriate technique selection based on site of tumor, intraoperative care, post operative care and timely management of complications if any.
J Cutan Aesthet Surg
· 2023 · PMID 38189072
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To simplify the chemical cautery, micropipette and syringe outlet are stuffed with cotton wick for a better flow of chemical due to capillary action. However, the corrosive effect of chemicals on metallic needle and on r...To simplify the chemical cautery, micropipette and syringe outlet are stuffed with cotton wick for a better flow of chemical due to capillary action. However, the corrosive effect of chemicals on metallic needle and on rubber/plastic cap of the piston leads to the leakage of chemicals. Hypodermic needle and tooth picks have been used for chemical cautery, but it requires frequent dipping into the chemical, which is not safe. A bent (hooked) hypodermic needle is described as an alternative for safe, quick, and precise cauterization of multiple small skin lesions.
J Cutan Aesthet Surg
· 2023 · PMID 38189071
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Filler complications have a wide array of presentations including early and late manifestations. A rare late complication is the foreign body granuloma or granulomatous foreign body reaction. We present a case of giant f...Filler complications have a wide array of presentations including early and late manifestations. A rare late complication is the foreign body granuloma or granulomatous foreign body reaction. We present a case of giant foreign body granulomas developing 7 years after polymethylmethacrylate (PMMA) filler injection. The patient had an excellent response to a single intralesional injection of triamcinolone acetonide and 5-fluorouracil. The unique opportunity to have pretreatment and posttreatment magnetic resonance imaging (MRI) allows for appreciation of the multidirectional expansion of these granulomas as well as the response in this case. Updated treatment recommendations based on the literature review support the use of oral antibiotics, oral steroids, and intralesional therapies. Surgical excision is reserved as an absolute last resort due to potential complications.
J Cutan Aesthet Surg
· 2023 · PMID 38189070
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Since the 1990s, face transplants have gotten a lot of press and public attention across the world. After a transplant was disclosed in November 2005, the first recipient, Isabelle Dinoire, found herself at the center of...Since the 1990s, face transplants have gotten a lot of press and public attention across the world. After a transplant was disclosed in November 2005, the first recipient, Isabelle Dinoire, found herself at the center of a spectacular event of surgical innovation. Up till August 2020, 47 transplants have been performed globally (including two retransplants), all of which have received substantial media attention. Hundreds of publications addressing the procedure's medicinal, physical, psychological, and ethical ramifications have been published in the scholarly literature, far outnumbering the procedure's occurrence. Face transplants have also appeared in films, television shows, and novels, indicating a desire to explore the social and interpersonal consequences of face variance. This is an attempt to present a comprehensive context of face transplantation progress and practice, based mostly on extant documentary sources. It traces the history of face transplants, identifying major milestones and themes along the way and focusing on its development as a therapeutic option for individuals with severe facial abnormalities. There are still important questions to be asked about the patient's perspective, as well as the complex philosophical and sociological meanings of the face, but this article focuses on the institutional and cultural factors that have allowed for such an ethically complex and radical surgery to take place. Opportunity and financial feasibility are among them, as are expertise, ambition, and an awareness of patient needs.
J Cutan Aesthet Surg
· 2023 · PMID 38189069
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BACKGROUND: Men of various ages feel that an increase in penile size would give them and their sexual partners an increased confidence. There are a variety of methods for increasing penile girth, such as injection therap...BACKGROUND: Men of various ages feel that an increase in penile size would give them and their sexual partners an increased confidence. There are a variety of methods for increasing penile girth, such as injection therapies and surgery. All of these methods have a high complication rate which must be emphasized to the patients. In this article, the techniques used for increasing penile girth using dermofat grafts and SEPA (superior external pudendal artery) flaps are highlighted along with their complications and their management thereof. PATIENTS AND METHODS: Ten patients were operated for penile girth augmentation between June 2016 and March 2022. Of these, six patients had augmentation using dermofat grafts and four patients had SEPA flaps. Patients were chosen as per the Augmentation Phalloplasty Patient Selection and Satisfaction Inventory (APPSSI) score which was between 2 and 6 in the pre-operative period. The age range of the patients were between 25 and 57 years. The mid-penile girth in the flaccid state ranged from 8.8 to 12.3 cm. RESULTS: Post-operatively, after 6 months, the final girth increase varied from 1.9 to 2.6 cm. The complication rate was 50% and included skin loss, urinary obstruction, fat necrosis, and so on. The post-operative APPSSI score ranged from 2 to 12. Complications were more in uncircumcised patients and in those who desired excessive augmentation. CONCLUSION: Penis girth augmentation using SEPA flaps and dermofat grafts is indicated in patients who fulfill the criteria and give appreciable girth increase, but patients need to be aware of the potential complications of these surgeries.
J Cutan Aesthet Surg
· 2023 · PMID 38189068
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BACKGROUND: Nevus of Ota is a facial dermal melanocytic hamartoma occurring more commonly in Asians. The mainstay of treatment is 1064-nm Q-Switched neodymium-doped yttrium aluminum garnet (Nd:YAG) laser, which has shown...BACKGROUND: Nevus of Ota is a facial dermal melanocytic hamartoma occurring more commonly in Asians. The mainstay of treatment is 1064-nm Q-Switched neodymium-doped yttrium aluminum garnet (Nd:YAG) laser, which has shown variable results in pigmented skin. OBJECTIVE: The aim of this study was to determine whether Q-Switched Nd:YAG laser treatment combined with fractional CO laser is more efficacious than Q-Switched Nd:YAG laser alone. MATERIALS AND METHODS: This was a prospective study with 81 patients. The patients were randomly divided into two groups. Group 1 received 1064-nm Q-Switched Nd:YAG laser alone and group 2 in addition received a fractional CO laser as well. Both groups received six sittings at monthly intervals. The treatment response was documented with physician global assessment (PGA) and patient's treatment satisfaction on Wong-Baker Facial Pain Scale (WBFPS). Dermoscopic evaluation was done to see subsurface pigment clearance. RESULTS: In the combination group, 25% of patients had more than 50% improvement as compared with 5.71% in group 1. To achieve a mean PGA score of 1.4, it took six sessions for group 1 versus only four for group 2. Dermoscopic evaluation showed faster pigment clearance in the combination group. CONCLUSION: Combining two lasers shows statistically significant faster and greater degree of improvement as compared with Q-Switched Nd:YAG laser monotherapy in nevus of Ota.
J Cutan Aesthet Surg
· 2023 · PMID 38189067
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Follicular unit excision is widely used for hair transplantation because it lacks a donor scar and is associated with less postoperative pain. Obtaining high-quality grafts and minimizing hair follicle damage during graf...Follicular unit excision is widely used for hair transplantation because it lacks a donor scar and is associated with less postoperative pain. Obtaining high-quality grafts and minimizing hair follicle damage during graft harvesting are key. This review elaborates on the types and dynamics of punches used in follicular unit extraction. We also describe the utility and advantages of a new "Multi-Wave Punch," a new type of punch designed to optimize graft extraction and reduce follicular injury. This multi-wave punch is composed of three different parts. The cutting edge at the end is blunt-angled. Adjacent is the leading edge, which is characterized by several horizontally oriented multi-wave shapes. Most proximal is the main body, which is decagonal in shape. Because of the multi-wave and decagonal structure, the punch easily enters the outer layers of the scalp. The wave energy is transmitted to the surrounding tissue, separating hair follicles from adjacent tissue, facilitating extraction, reducing follicular damage, and ensuring higher quality grafts.
J Cutan Aesthet Surg
· 2023 · PMID 38189065
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The paramedian forehead flap (PFF) provides a reliable reconstruction option for complex nasal tip defects. The robust blood supply from a well perfused pedicle allows for reconstruction of large defects of the nasal tip...The paramedian forehead flap (PFF) provides a reliable reconstruction option for complex nasal tip defects. The robust blood supply from a well perfused pedicle allows for reconstruction of large defects of the nasal tip for which simpler methods/techniques would provide inadequate coverage or result in inferior cosmesis. A well-designed PFF containing the supratrochlear artery inherently predisposes to small vessel bleeding from the pedicles cut edge. Due to the well perfused nature of the pedicle, there is an increased risk of post-operative bleeding. We describe a technique for better identifying bleeding points from the pedicle to optimise intra-operative haemostasis by performing the Valsalva maneuver using a syringe intraoperatively.
Mortada H, Alshenaifi SA, Samawi HA
… +3 more, Marzoug MM, Alhumsi T, Alaithan B
J Cutan Aesthet Surg
· 2023 · PMID 38189064
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AIM: Our study aims to assess the safety of large amounts of liposuction in a new light. MATERIALS AND METHODS: This is a retrospective review of patients who underwent large-volume liposuction from August 2020 to April...AIM: Our study aims to assess the safety of large amounts of liposuction in a new light. MATERIALS AND METHODS: This is a retrospective review of patients who underwent large-volume liposuction from August 2020 to April 2021. Patient demographics, liposuction areas, the amount of infiltrate and aspirate, the surface area of liposuction areas, anesthesia duration, pain score after surgery, preoperative and 4-h postoperative hemoglobin, and basic metabolic panel (sodium, potassium, creatinine, urea) were measured. RESULTS: Out of the 28 patients, 26 (92.85%) were females. The mean age was 37.1 years old. The mean preoperative hemoglobin was 13.73 g/dL. The average anesthesia time was 220.39 min. The average amount of liposuction infiltrated was 7.55 L, and the average amount of liposuction aspirate was 6.83 L. The mean hemoglobin 4 h postoperatively was 13.7 g/dL. CONCLUSIONS: With proper patient selection and a comprehensive physical exam with preoperative blood workup performed in an accredited facility with a highly experienced plastic surgeon and anesthesiologist, mega liposuction can be safely performed as a day surgery procedure.
J Cutan Aesthet Surg
· 2023 · PMID 38189063
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BACKGROUND: Striae distensae are atrophic scars that are often cosmetically distressing. The efficacy of fractional carbon dioxide (CO) laser and platelet-rich plasma (PRP) in treating striae individually has been evalua...BACKGROUND: Striae distensae are atrophic scars that are often cosmetically distressing. The efficacy of fractional carbon dioxide (CO) laser and platelet-rich plasma (PRP) in treating striae individually has been evaluated previously. However, not many studies described the combined efficacy of both. AIMS AND OBJECTIVES: The aim of this study was to compare the efficacy and safety of fractional CO laser alone and in combination with PRP. MATERIALS AND METHODS: Twenty-four patients with striae presenting bilaterally in the abdomen, upper limbs, and lower limbs were included. PRP was prepared by double-spin method and cell count was done to ensure at least fourfold concentration of platelets. The patients were treated CO laser on both sides and PRP on the left side along with laser, every month for three sessions. Digital photography and dermoscopy were done at baseline, every treatment session, and 6 months after treatment. Clinical improvement was assessed by comparing photographs and patient satisfaction before and after treatment. RESULTS: All patients showed improvement on both sides. In CO-laser-treated patients, responses in 6 patients (25%) were moderate, 14 (56%) were good, and 4 (16.6%) were excellent. In CO-laser and PRP-treated patients, responses in 5 patients (20.8%) were moderate, 11 (45.8%) were good, and 8 (33.3%) were excellent. Hyperpigmentation was the most common side-effect seen (19 patients) on both sides, which resolved spontaneously by 6 months. CONCLUSION: These results support the use of ablative CO fractional laser as effective and safe treatment modalities for striae. However, slightly better efficacy was noted with the addition of PRP.
J Cutan Aesthet Surg
· 2023 · PMID 38189062
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BACKGROUND: The aesthetic aspect of Type I incomplete split ear lobe is underestimated. Most of the hole-retaining techniques described for large and split ear lobes are difficult to perform in Type I deformity. AIM: (1)...BACKGROUND: The aesthetic aspect of Type I incomplete split ear lobe is underestimated. Most of the hole-retaining techniques described for large and split ear lobes are difficult to perform in Type I deformity. AIM: (1) To conduct a pilot study based on the postoperative review of the cases of Type I ear lobe deformities surgically managed with hole-retaining lobeplasty in a tertiary care centre in South India.(2) To assess the postoperative outcome of the hole retaining lobeplasty based on the Global aesthetic improvement scale and Patient satisfaction in Likert scale. MATERIALS AND METHODS: A pilot study of hole-retaining lobeplasty technique was done based on the postoperative review of 6 patients with bilateral type1 incomplete split ear lobes who were operated in our institution with the same. The results were validated based on descriptive statistics and postoperative outcomes using GAIS score and Patient Satisfaction Score measured in a Likert scale. RESULTS: None of the patients had any postoperative complications. At six months follow up, all patients had centrally placed, circular ear holes, well settled support flap and rounded lobe contour with an average GAIS score of 4.83 ± 0.38. All the patients were satisfied with their newly created ear hole and lobe contour, with an average Patient Satisfaction Score of 4.8 ± 0.4. CONCLUSION: Hole- retaining lobeplasty is a simple, cost effective, single staged, day-case procedure for repair of Type I large ear holes, that can be easily duplicated by young plastic surgeons with is aesthetically better, circular and centrally placed ear hole with a more rounded ear lobe with support to prevent recurrence.
Bhatnagar A, Mitra D, Kishore K
… +4 more, Kumar M, Valarmathi T, Kumar A, Kumar R
J Cutan Aesthet Surg
· 2023 · PMID 38189060
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BACKGROUND: Acne vulgaris is a chronic disease of pilosebaceous units that affects approximately 80% of adult population. Despite various treatment modalities being reported, treating acne with minimal side effects is di...BACKGROUND: Acne vulgaris is a chronic disease of pilosebaceous units that affects approximately 80% of adult population. Despite various treatment modalities being reported, treating acne with minimal side effects is difficult. Specifically, topical carbon suspension combined with QsNdYAG laser treatment (carbon peel laser technique) has gained popularity recently for effective treatment of acne vulgaris. OBJECTIVES: To study the efficacy of carbon peel laser technique in the management of acne vulgaris (Grade II-IV) in skin of color. MATERIALS AND METHODS: A prospective observational study was done on 35 patients who presented with acne vulgaris Grade II-IV, who were poorly compliant to treatment with topical/systemic agents owing to side effects or failure of treatment, to meet patient's expectations. The patients were subjected to an initial topical application of carbon suspension (Cosderma Carbon gel) followed by treatment with quality switching neodymium yttrium aluminum garnet (Qs:NdYAG) laser in two modes (quasi long pulsed mode followed by Q switched mode 1064 nm). The treatment consisted of three sittings with intervals of 2 weeks. The patients were asked to avoid use of any topical/systemic medication for acne during this period. RESULTS: Significant reduction of erythematous and nodular acne lesions was noted after three sittings of "carbon peel laser technique". Among 35 patients, 28 (80%) showed >80% improvement and 7 (20%) showed 50%-80% improvement in skin lesions in the form of decrease in the number and size of lesions and extent of inflammation, with no patients nonresponsive to treatment. The postprocedure complications were minimal; 6 (20%) developed erythema, and 1 (3.3%) patient developed mild tolerable pain with no post inflammatory hyper/hypopigmentation. The postprocedure mean ISGA (Investigator Status Global Assessment) was 1.342 as compared with preprocedure mean ISGA of 3.657 with value of <0.0001. CONCLUSION: Carbon peel laser technique is an effective method for the management of acne vulgaris in skin of color with minimal side effects and significant results.
J Cutan Aesthet Surg
· 2023 · PMID 38189059
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INTRODUCTION: Vitiligo is a multifactorial acquired disorder clinically characterized by amelanotic lesions on the skin, due to destruction of melanocytes. The course of vitiligo is unpredictable. Vitiligo causes signifi...INTRODUCTION: Vitiligo is a multifactorial acquired disorder clinically characterized by amelanotic lesions on the skin, due to destruction of melanocytes. The course of vitiligo is unpredictable. Vitiligo causes significant psychological impact and cosmetic disfigurement. Treatment of vitiligo is challenging and requires a multidisciplinary approach. MATERIALS AND METHODS: A prospective comparative interventional study was carried out from October 2018 to March 2020. The study enrolled 60 stable vitiligo patients divided into groups A and B. Group A (30 patients) was treated with both fractional CO laser and autologous platelet-rich plasma (PRP) injection. Group B (30 patients) was treated with fractional CO laser alone. A total of four sessions were conducted in each group at 1-month interval along with photographic assessment. Final assessment was done 1 month after the completion of four sessions. RESULTS: In group A, the median values of repigmentation and visual-analog score (VAS) were 3 and 7, and in group B, the median values of repigmentation and VAS were 1 and 2, respectively. Lesions over the trunk showed the best response followed by face and extremities lesions. Acral lesions showed the least response. CONCLUSION: A combination of fractional CO laser and PRP is superior to fractional CO laser alone in the treatment of stable vitiligo.
Elgarhy LH, Eltatawy RA, Rizk O
… +1 more, Ismail M
J Cutan Aesthet Surg
· 2023 · PMID 37554687
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BACKGROUND/PURPOSE: Psoriasis is a multifactorial disease. It is a combination of genetic, immunological, and environmental factors. Vitamin D receptor (VDR) is a nuclear receptor that regulates epidermal cell growth thr...BACKGROUND/PURPOSE: Psoriasis is a multifactorial disease. It is a combination of genetic, immunological, and environmental factors. Vitamin D receptor (VDR) is a nuclear receptor that regulates epidermal cell growth through the inhibition of proliferation and induction of keratinocytes terminal differentiation. Aim of the study was to investigate the effect of Narrow-band UVB (NB-UVB) therapy on VDR expression in the skin of psoriasis patients. MATERIALS AND METHODS: Forty patients with different severities of psoriasis were assessed using the psoriasis area and severity index (PASI) score. Lesional and non-lesional skin biopsies were obtained from each patient before NB-UVB therapy, and then a third lesional biopsy was performed after completing 24 sessions of NB-UVB. Immunohistochemistry for VDR was performed on all specimens. RESULTS: There was a significant decrease in VDR expression in psoriatic lesions compared to that in non-lesional skin before treatment. A statistically negative correlation was detected between the degree of VDR expression before treatment and PASI score, family history, and duration of psoriasis. There was a significant increase in VDR expression at the sites of psoriasis lesions post-NB-UVB therapy compared to pretreatment lesional skin. CONCLUSION: VDR expression was down-regulated in psoriatic lesions compared to non-lesional skin, and NB-UVB therapy improved VDR expression in psoriasis skin lesions.
Kulkarni V, Salunke TS, Mandhane AG
… +1 more, Vaidya P
J Cutan Aesthet Surg
· 2023 · PMID 37554685
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BACKGROUND: With the advent of antiretroviral treatment (ART), human immunodeficiency virus/AIDS has become a chronic manageable disease. Though life expectancy has improved, it brings alongside effects of long-term medi...BACKGROUND: With the advent of antiretroviral treatment (ART), human immunodeficiency virus/AIDS has become a chronic manageable disease. Though life expectancy has improved, it brings alongside effects of long-term medical treatment. One of the major side effects is body dysmorphism, which leads to esthetic problems. Problems of lipodystrophy (LDS), especially facial lipoatrophy as well as facial and upper back lipohypertrophy are perceived by patients as highly stigmatizing manifestations of their human immunodeficiency virus infection. It has been reported to affect mood and quality of life, as well as reduced adherence to antiretroviral medications. Patients feel discomfort while sleeping, dressing, and during day-to-day activities. AIM: The aim of this study was to test a relatively cost-effective and efficacious treatment modality for long-standing ART-associated lipohypertrophy of the submental fat and dorsocervical fat. MATERIALS AND METHODS: This was a prospective open-label clinical study, in which 21 patients on regular ART with associated lipohypertrophy were enrolled in this open-label study. Deoxycholic acid (DCA) was given intralesionally once every 4-6 weeks. Patients were assessed for response, any adverse events, and patient satisfaction during every visit. RESULTS: Intralesional DCA seems to be a promising treatment modality for long-standing ART-induced LDS with better cost-benefit in comparison with surgical interventions. LIMITATIONS: It was a small-sized sample that was studied. The lag time between starting the treatment and optimum results was long in comparison with liposuction. The result is better appreciated at the end of treatment rather than after every session implying that it has a cumulative effect. Neither pre- and post-ultrasonography nor metric documentation was done. CONCLUSIONS: Intralesional DCA seems to be a promising treatment modality for long-standing ART-induced LDS with better cost-benefit in comparison with surgical interventions.