BACKGROUND: Facial revitalization has long been a prime objective for aesthetic providers and patients alike. More recently, attention has been shifting to include the neck area, driven by the desire to address visible n...BACKGROUND: Facial revitalization has long been a prime objective for aesthetic providers and patients alike. More recently, attention has been shifting to include the neck area, driven by the desire to address visible neck lines, wrinkles, and skin laxity. OBJECTIVE: This review aims to comprehensively examine the English peer-reviewed literature of fillers, including cross-linked and non-cross-linked hyaluronic acid (HA) gels, poly-l-lactic acid (PLLA), and calcium hydroxylapatite (CaHA), for neck rejuvenation, including neck lines, skin laxity, and wrinkles. MATERIALS AND METHODS: PubMed database search was performed for interventional and observational studies for neck rejuvenation, excluding case reports with fewer than 10 patients. RESULTS: A total of 24 studies which included 887 patients were included in our clinical review. Recent studies have validated the efficacy of HA gels for reducing neck wrinkles. Poly-l-lactic acid stimulates collagen synthesis and may also improve wrinkle severity. Calcium hydroxylapatite promotes collagen production and overall neck skin rejuvenation. Studies demonstrate the efficacy of all 3 of these fillers in improving neck wrinkles and skin laxity. However, heterogeneity of outcome measures, small sample sizes, and limited long-term data constrain definitive conclusions and highlight the need for further research. CONCLUSION: This review synthesizes current approaches using HA, CaHA, and PLLA for neck rejuvenation with favorable safety profiles.
BACKGROUND: Extramammary Paget disease (EMPD) is a rare cutaneous malignancy that typically presents on apocrine-rich skin, especially the genitals. Surgery is often the first-line treatment, but other nonsurgical option...BACKGROUND: Extramammary Paget disease (EMPD) is a rare cutaneous malignancy that typically presents on apocrine-rich skin, especially the genitals. Surgery is often the first-line treatment, but other nonsurgical options may be considered. Historically, local recurrence rates are high. OBJECTIVE: To describe and analyze the clinical characteristics and outcomes of EMPD based on anatomic site of presentation. METHODS: All cases of EMPD were identified from the Washington University in St. Louis institutional pathology database between January 2000 and December 2021. Medical records were manually reviewed to identify clinical data for analysis. RESULTS: Eighty patients were identified. The vulva was the most common site of presentation. Despite a majority of vulvar EMPD cases being treated with radical excision, almost 95% of patients had positive surgical margins, and vulvar cases experienced the highest rate of local recurrence. Metastatic progression was more common in perianal and penoscrotal EMPD. CONCLUSION: EMPD is a rare malignancy with an overall good prognosis that has potential to act aggressively in certain cases. Although recurrence rates are higher in vulvar EMPD, perianal and penoscrotal EMPD appear to behave more aggressively. Margin-controlled surgery may lead to better outcomes, and adjuvant therapies can be considered when clear margins are not feasible.
BACKGROUND: Hidradenitis suppurativa is a chronic inflammatory skin disease characterized by painful cutaneous nodules, abscesses, and fistulas in regions containing apocrine glands. OBEJECTIVE: This study reviews the li...BACKGROUND: Hidradenitis suppurativa is a chronic inflammatory skin disease characterized by painful cutaneous nodules, abscesses, and fistulas in regions containing apocrine glands. OBEJECTIVE: This study reviews the literature on surgical interventions of hidradenitis suppurative and their effect on quality of life. PATIENTS AND MATERIALS/METHODS: A systematic review was performed in accordance with PRISMA using Dermatologic Life Quality Index as our primary outcome. Search terms included 'hidradenitis suppurativa" and "DLQI." Eight surgical studies were included. RESULTS: Wide local excision has the shortest operative time but carries a risk of recurrence and requires daily wound care if left to secondary intention. Wide local excision with a skin graft does not seem to have any advantages over alternative methods. Photodynamic therapy after wide local excision showed promising results but requires consistent follow-up and access to the therapy. For the axilla, wide local excision with either a thoracodorsal artery perforator flap or muscle-sparing latissimus dorsi flap may be most effective at maintaining a relatively smooth postoperative course and preventing recurrence. CONCLUSION: Surgery greatly improves the lives of patients with hidradenitis suppurativa. Each surgical technique carries their own risks and benefits for postoperative outcomes.
BACKGROUND: The occurrence of wrong-site surgery (WSS) marks a significant concern. In dermatologic and Mohs micrographic surgery, high procedural volume, healed biopsy sites, and multiprovider involvement amplify the ri...BACKGROUND: The occurrence of wrong-site surgery (WSS) marks a significant concern. In dermatologic and Mohs micrographic surgery, high procedural volume, healed biopsy sites, and multiprovider involvement amplify the risk. OBJECTIVE: To systematically review and assess commonly used modalities in reducing the risk of WSS in the dermatologic and Mohs micrographic surgery setting. METHODS AND MATERIALS: A comprehensive literature search was performed through PubMed and Google Scholar to identify studies published between 2014 and 2025 evaluating WSS prevention strategies in dermatologic surgery. Eligible studies focused on site verification, documentation, photography, technology adjuncts, and team-based protocols. RESULTS: Effective WSS reduction strategies were multimodal, incorporating standardized documentation, prebiopsy and patient-captured photography, coordinate-based measurements, technological adjuncts such as ultraviolet imaging and smartphone apps, and structured team verification protocols. No single intervention was sufficient alone; layered safeguards and patient engagement were critical to minimizing risk. CONCLUSION: WSS remains a persistent but preventable challenge in dermatologic surgery. A systematic, multimodal approach integrating technical, procedural, and team-based safeguards meaningfully reduces risk and enhances surgical safety.
BACKGROUND: Prominent supratrochlear forehead veins can cause significant aesthetic discomfort in both women and men. Traditional treatments such as phlebectomy and sclerotherapy have technical limitations and potential...BACKGROUND: Prominent supratrochlear forehead veins can cause significant aesthetic discomfort in both women and men. Traditional treatments such as phlebectomy and sclerotherapy have technical limitations and potential risks, including bleeding, scarring, and visual complications. Laser-based techniques offer a minimally invasive and precise alternative. OBJECTIVE: To present the authors' 10-year experience using endovenous laser ablation for supratrochlear forehead veins, emphasizing technical evolution, safety, and long-term outcomes. MATERIALS AND METHODS: Ninety-three patients underwent endovenous laser ablation of the supratrochlear forehead veins between 2014 and 2025. Fifteen were part of an initial series and 78 were subsequently treated after procedural refinements, including tailored fiber selection and meticulous tumescent infiltration. Data on demographics, procedural details, complications, and patient satisfaction were analyzed. RESULTS: Excellent aesthetic outcomes were achieved in 90.3% of patients after a single session. Minor complications included transient ecchymosis and edema. Major complications, such as fibrous cord formation, cicatricial retraction, and skin burns, occurred infrequently and were effectively managed. Nearly all patients reported high satisfaction with the results. CONCLUSION: Endovenous laser ablation of enlarged supratrochlear forehead veins is a safe, effective, and reproducible technique providing durable aesthetic improvement and minimal complications when performed with proper expertise.