User login
Tips and Trends in Teen Elective Plastic Surgery
MIAMI BEACH – Adolescents who undergo elective plastic surgery tend to "sail through surgery more easily" than adults, according to an expert.
In addition, more male teenagers seek these procedures, meaning the gender disparity is not as striking as it is among adults.
"When we do cosmetic surgery in teenagers, it is remarkably conflict free, compared with other medical interventions in teenagers, and compared with other age groups," Dr. Mary H. McGrath said. The reasons are not entirely clear – most research in adolescents addresses rhinoplasty only – but it could be because surgery comes during a time of great overall change for teenagers, she said.
Of the estimated 9.2 million surgical and nonsurgical cosmetic procedures in the United States in 2011, 18% were surgical and accounted for 63% of expenditures, according to data from the American Society for Aesthetic Plastic Surgery. Patients 18 years and younger comprised 1.4% of this total and underwent 97,214 nonsurgical and 34,663 surgical procedures.
Otoplasty was the most common 2011 elective surgical procedure in patients under the age of 18 years in 2011. About one third, 34%, of the estimated 11,000 otoplasties were performed on males. Rhinoplasty came in second on the list, with 20% of the 9,500 procedures performed in males. Breast augmentation, liposuction, and breast reduction (for cosmetic reasons) were the next most common, in order, followed by correction of gynecomastia (not surprisingly, 100% in males).
In contrast, in adult patients, more than 90% of all elective plastic surgeries are performed in women, Dr. McGrath said.
Assessment of physical and mental health is the first step when an adolescent asks about plastic surgery in the primary care setting, Dr. McGrath said at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.
Ensure the adolescent has the necessary emotional and physical maturity. "Determine that the patient has reached the growth milestone and physical maturity for that surgery. We wouldn’t do breast augmentation on a 16-year-old," for example, said Dr. McGrath, professor of surgery in the division of plastic and reconstructive surgery at the University of California, San Francisco. Also rule out any psychiatric contraindication, such as body dysmorphic disorder, she said.
Speak with the patient alone. Also talk with them with their family present to assess the degree of support. Ask the patient to articulate why they want the surgery. Ensure patient expectations are realistic. After referral, a plastic surgeon ideally will assess the specific deficit, outline what can be accomplished surgically, and describe the potential risks. Efficacy and safety considerations are critical, Dr. McGrath said.
Ask teenagers to explain how they would handle a complication. Dr. McGrath also asks them to repeat back important aspects of the discussion to ensure they understand.
Dr. McGrath shared some tips and insight on the following procedures:
• Otoplasty. The ear achieves 85% of full growth by age 3 years, which is "why kids’ ears look so big." Sometimes, the goal of surgery is to approximate symmetry. A good plastic surgeon will be familiar with the subtle anatomic features of the ear: the top of the ear is generally closer to the head than the middle, while the lobule at the bottom should stick out the most.
Otoplasty is usually an outpatient procedure. Patients can expect a bulky head dressing postoperatively, suture removal after 7-10 days, and to sleep with an elastic band around their head for 2-3 weeks. Hematoma and infection are potential early complications and residual deformity or asymmetry can emerge later. An estimated 8%-10% of patients undergo reoperations, almost always for asymmetry, Dr. McGrath said.
• Rhinoplasty. "Very rarely do we do rhinoplasty in someone younger than 17 or 18 [years old] or they can outgrow the changes in nasal contour," Dr. McGrath said. "Sometimes, I feel bad telling a 14-year-old with an exceptionally large or unattractive nose they have to wait and come back at age 17."
Prepare teenage patients for the postoperative course by showing them photos of typical patients. Tell them to expect splinting for 7 days, ecchymosis for 10-14 days, and residual swelling for 2-3 months. Postoperative changes become quickly obvious after a bony ridge removal. In contrast, a nasal tip rhinoplasty, because it involves soft tissue and more edema, can take months to see the final result.
"This is the hardest surgery we do," Dr. McGrath said. "It is complicated to understand all the pieces of the puzzle and get it right. It requires the greatest amount of art." The most common complication is bleeding in about 4% of patients.
• Breast Augmentation. Only a small minority of breast augmentation procedures, 1.5%, were performed in patients 18 years and younger in 2011. "Young women seek breast implants because their breasts look odd; it is not necessarily size that is driving it, but almost always the shape," Dr. McGrath said.
Approximately 25% of patients having breast augmentation have a reoperation within 10 years. "That is the number to know," Dr. McGrath said. "Is the likelihood of additional surgery acceptable to the patient?"
Silicone breast implants are not FDA cleared for breast reconstruction in females younger than 22 years. Therefore, only saline implants are an option in these younger patients, Dr. McGrath said. An advantage of saline implants is they can be inserted through a small incision and then filled, which is not possible with silicone gel implants.
Pain, hematoma, seroma, wound infection, and decreased skin sensation are potential complications. However, "the problems due to the implantable device are the real issues," Dr. McGrath said. Scarring can occur around 15% of implants; 8% or 9% can become malpositioned and about 7% will deflate over 5 years. In addition, patients with a family history of breast cancer may choose not to have implants.
Consultation with a qualified plastic surgeon who can focus on long-term implications is warranted, Dr. McGrath said.
• Breast Reduction. Defer surgery until full breast maturation and growth is achieved. Breast size should be stable with no continuing growth for 9-12 months, Dr. McGrath said.
Smoking, obesity, medical conditions that impair wound healing, bleeding disorders, or a body mass index greater than 30 kg/m2 are contraindications. "Some obese women have large breasts, and many are disappointed when I tell them they should defer breast reduction until after weight loss."
Another point to counsel patients about is that lactation is not always possible after breast reduction. "I have had young women walk away from this and say, ‘It’s very important for me to breast feed my baby someday.’"
• Liposuction. The American Society of Plastic Surgeons cautions that liposuction and tummy tucks are inappropriate procedures for weight loss in teens, Dr. McGrath said. "I cannot tell you how many obese teens get referred to me for liposuction. I have to tell them it’s not the right thing ... and it will not correct your basic problem."
In contrast, lipoplasty, liposculpture, or liposuction to treat localized fat deposits can be indicated in some teenagers. "The ideal patient is at or near ideal body weight with elastic skin that will retract."
"Submental liposuction of the fat pad creating a double chin in older teenagers can be fantastic," Dr. McGrath said. It can be done in an office setting. Bruising, seroma, and bumpy appearance are potential complications. Instruct patients that they will have to wear a compression garment around their head at night for about 3 weeks.
• Gynecomastia. About 8% of all gynecomastia corrections involved patients 18 years and younger. Approximately 50% are unilateral and 50% bilateral procedures.
Gynecomastia can have a hormonal etiology and be associated with obesity. Surgical results, however, are poorer in the obese patient. "The distinction between what is gynecomastia and fat tissue gets murky in overweight patients," Dr. McGrath said.
Gynecomastia can be self-limited with an average duration of 1-2 years. For those in whom it persists, some seek surgery because "it is a source of embarrassment. Like our young women, it’s not so much the size, it’s the odd look of a protuberant breast on a male."
"The central issue with any elective plastic surgery is not the presence or absence of disease, rather the effect of the problem on the person," Dr. McGrath said. "It comes down to quality of life, and whether or not you believe improving quality of life is part of our job."
Dr. McGrath recommended the American Society for Aesthetic Plastic Surgery guidelines for evaluating teenagers considering cosmetic plastic surgery.
Dr. McGrath said she had no relevant financial disclosures.
MIAMI BEACH – Adolescents who undergo elective plastic surgery tend to "sail through surgery more easily" than adults, according to an expert.
In addition, more male teenagers seek these procedures, meaning the gender disparity is not as striking as it is among adults.
"When we do cosmetic surgery in teenagers, it is remarkably conflict free, compared with other medical interventions in teenagers, and compared with other age groups," Dr. Mary H. McGrath said. The reasons are not entirely clear – most research in adolescents addresses rhinoplasty only – but it could be because surgery comes during a time of great overall change for teenagers, she said.
Of the estimated 9.2 million surgical and nonsurgical cosmetic procedures in the United States in 2011, 18% were surgical and accounted for 63% of expenditures, according to data from the American Society for Aesthetic Plastic Surgery. Patients 18 years and younger comprised 1.4% of this total and underwent 97,214 nonsurgical and 34,663 surgical procedures.
Otoplasty was the most common 2011 elective surgical procedure in patients under the age of 18 years in 2011. About one third, 34%, of the estimated 11,000 otoplasties were performed on males. Rhinoplasty came in second on the list, with 20% of the 9,500 procedures performed in males. Breast augmentation, liposuction, and breast reduction (for cosmetic reasons) were the next most common, in order, followed by correction of gynecomastia (not surprisingly, 100% in males).
In contrast, in adult patients, more than 90% of all elective plastic surgeries are performed in women, Dr. McGrath said.
Assessment of physical and mental health is the first step when an adolescent asks about plastic surgery in the primary care setting, Dr. McGrath said at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.
Ensure the adolescent has the necessary emotional and physical maturity. "Determine that the patient has reached the growth milestone and physical maturity for that surgery. We wouldn’t do breast augmentation on a 16-year-old," for example, said Dr. McGrath, professor of surgery in the division of plastic and reconstructive surgery at the University of California, San Francisco. Also rule out any psychiatric contraindication, such as body dysmorphic disorder, she said.
Speak with the patient alone. Also talk with them with their family present to assess the degree of support. Ask the patient to articulate why they want the surgery. Ensure patient expectations are realistic. After referral, a plastic surgeon ideally will assess the specific deficit, outline what can be accomplished surgically, and describe the potential risks. Efficacy and safety considerations are critical, Dr. McGrath said.
Ask teenagers to explain how they would handle a complication. Dr. McGrath also asks them to repeat back important aspects of the discussion to ensure they understand.
Dr. McGrath shared some tips and insight on the following procedures:
• Otoplasty. The ear achieves 85% of full growth by age 3 years, which is "why kids’ ears look so big." Sometimes, the goal of surgery is to approximate symmetry. A good plastic surgeon will be familiar with the subtle anatomic features of the ear: the top of the ear is generally closer to the head than the middle, while the lobule at the bottom should stick out the most.
Otoplasty is usually an outpatient procedure. Patients can expect a bulky head dressing postoperatively, suture removal after 7-10 days, and to sleep with an elastic band around their head for 2-3 weeks. Hematoma and infection are potential early complications and residual deformity or asymmetry can emerge later. An estimated 8%-10% of patients undergo reoperations, almost always for asymmetry, Dr. McGrath said.
• Rhinoplasty. "Very rarely do we do rhinoplasty in someone younger than 17 or 18 [years old] or they can outgrow the changes in nasal contour," Dr. McGrath said. "Sometimes, I feel bad telling a 14-year-old with an exceptionally large or unattractive nose they have to wait and come back at age 17."
Prepare teenage patients for the postoperative course by showing them photos of typical patients. Tell them to expect splinting for 7 days, ecchymosis for 10-14 days, and residual swelling for 2-3 months. Postoperative changes become quickly obvious after a bony ridge removal. In contrast, a nasal tip rhinoplasty, because it involves soft tissue and more edema, can take months to see the final result.
"This is the hardest surgery we do," Dr. McGrath said. "It is complicated to understand all the pieces of the puzzle and get it right. It requires the greatest amount of art." The most common complication is bleeding in about 4% of patients.
• Breast Augmentation. Only a small minority of breast augmentation procedures, 1.5%, were performed in patients 18 years and younger in 2011. "Young women seek breast implants because their breasts look odd; it is not necessarily size that is driving it, but almost always the shape," Dr. McGrath said.
Approximately 25% of patients having breast augmentation have a reoperation within 10 years. "That is the number to know," Dr. McGrath said. "Is the likelihood of additional surgery acceptable to the patient?"
Silicone breast implants are not FDA cleared for breast reconstruction in females younger than 22 years. Therefore, only saline implants are an option in these younger patients, Dr. McGrath said. An advantage of saline implants is they can be inserted through a small incision and then filled, which is not possible with silicone gel implants.
Pain, hematoma, seroma, wound infection, and decreased skin sensation are potential complications. However, "the problems due to the implantable device are the real issues," Dr. McGrath said. Scarring can occur around 15% of implants; 8% or 9% can become malpositioned and about 7% will deflate over 5 years. In addition, patients with a family history of breast cancer may choose not to have implants.
Consultation with a qualified plastic surgeon who can focus on long-term implications is warranted, Dr. McGrath said.
• Breast Reduction. Defer surgery until full breast maturation and growth is achieved. Breast size should be stable with no continuing growth for 9-12 months, Dr. McGrath said.
Smoking, obesity, medical conditions that impair wound healing, bleeding disorders, or a body mass index greater than 30 kg/m2 are contraindications. "Some obese women have large breasts, and many are disappointed when I tell them they should defer breast reduction until after weight loss."
Another point to counsel patients about is that lactation is not always possible after breast reduction. "I have had young women walk away from this and say, ‘It’s very important for me to breast feed my baby someday.’"
• Liposuction. The American Society of Plastic Surgeons cautions that liposuction and tummy tucks are inappropriate procedures for weight loss in teens, Dr. McGrath said. "I cannot tell you how many obese teens get referred to me for liposuction. I have to tell them it’s not the right thing ... and it will not correct your basic problem."
In contrast, lipoplasty, liposculpture, or liposuction to treat localized fat deposits can be indicated in some teenagers. "The ideal patient is at or near ideal body weight with elastic skin that will retract."
"Submental liposuction of the fat pad creating a double chin in older teenagers can be fantastic," Dr. McGrath said. It can be done in an office setting. Bruising, seroma, and bumpy appearance are potential complications. Instruct patients that they will have to wear a compression garment around their head at night for about 3 weeks.
• Gynecomastia. About 8% of all gynecomastia corrections involved patients 18 years and younger. Approximately 50% are unilateral and 50% bilateral procedures.
Gynecomastia can have a hormonal etiology and be associated with obesity. Surgical results, however, are poorer in the obese patient. "The distinction between what is gynecomastia and fat tissue gets murky in overweight patients," Dr. McGrath said.
Gynecomastia can be self-limited with an average duration of 1-2 years. For those in whom it persists, some seek surgery because "it is a source of embarrassment. Like our young women, it’s not so much the size, it’s the odd look of a protuberant breast on a male."
"The central issue with any elective plastic surgery is not the presence or absence of disease, rather the effect of the problem on the person," Dr. McGrath said. "It comes down to quality of life, and whether or not you believe improving quality of life is part of our job."
Dr. McGrath recommended the American Society for Aesthetic Plastic Surgery guidelines for evaluating teenagers considering cosmetic plastic surgery.
Dr. McGrath said she had no relevant financial disclosures.
MIAMI BEACH – Adolescents who undergo elective plastic surgery tend to "sail through surgery more easily" than adults, according to an expert.
In addition, more male teenagers seek these procedures, meaning the gender disparity is not as striking as it is among adults.
"When we do cosmetic surgery in teenagers, it is remarkably conflict free, compared with other medical interventions in teenagers, and compared with other age groups," Dr. Mary H. McGrath said. The reasons are not entirely clear – most research in adolescents addresses rhinoplasty only – but it could be because surgery comes during a time of great overall change for teenagers, she said.
Of the estimated 9.2 million surgical and nonsurgical cosmetic procedures in the United States in 2011, 18% were surgical and accounted for 63% of expenditures, according to data from the American Society for Aesthetic Plastic Surgery. Patients 18 years and younger comprised 1.4% of this total and underwent 97,214 nonsurgical and 34,663 surgical procedures.
Otoplasty was the most common 2011 elective surgical procedure in patients under the age of 18 years in 2011. About one third, 34%, of the estimated 11,000 otoplasties were performed on males. Rhinoplasty came in second on the list, with 20% of the 9,500 procedures performed in males. Breast augmentation, liposuction, and breast reduction (for cosmetic reasons) were the next most common, in order, followed by correction of gynecomastia (not surprisingly, 100% in males).
In contrast, in adult patients, more than 90% of all elective plastic surgeries are performed in women, Dr. McGrath said.
Assessment of physical and mental health is the first step when an adolescent asks about plastic surgery in the primary care setting, Dr. McGrath said at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.
Ensure the adolescent has the necessary emotional and physical maturity. "Determine that the patient has reached the growth milestone and physical maturity for that surgery. We wouldn’t do breast augmentation on a 16-year-old," for example, said Dr. McGrath, professor of surgery in the division of plastic and reconstructive surgery at the University of California, San Francisco. Also rule out any psychiatric contraindication, such as body dysmorphic disorder, she said.
Speak with the patient alone. Also talk with them with their family present to assess the degree of support. Ask the patient to articulate why they want the surgery. Ensure patient expectations are realistic. After referral, a plastic surgeon ideally will assess the specific deficit, outline what can be accomplished surgically, and describe the potential risks. Efficacy and safety considerations are critical, Dr. McGrath said.
Ask teenagers to explain how they would handle a complication. Dr. McGrath also asks them to repeat back important aspects of the discussion to ensure they understand.
Dr. McGrath shared some tips and insight on the following procedures:
• Otoplasty. The ear achieves 85% of full growth by age 3 years, which is "why kids’ ears look so big." Sometimes, the goal of surgery is to approximate symmetry. A good plastic surgeon will be familiar with the subtle anatomic features of the ear: the top of the ear is generally closer to the head than the middle, while the lobule at the bottom should stick out the most.
Otoplasty is usually an outpatient procedure. Patients can expect a bulky head dressing postoperatively, suture removal after 7-10 days, and to sleep with an elastic band around their head for 2-3 weeks. Hematoma and infection are potential early complications and residual deformity or asymmetry can emerge later. An estimated 8%-10% of patients undergo reoperations, almost always for asymmetry, Dr. McGrath said.
• Rhinoplasty. "Very rarely do we do rhinoplasty in someone younger than 17 or 18 [years old] or they can outgrow the changes in nasal contour," Dr. McGrath said. "Sometimes, I feel bad telling a 14-year-old with an exceptionally large or unattractive nose they have to wait and come back at age 17."
Prepare teenage patients for the postoperative course by showing them photos of typical patients. Tell them to expect splinting for 7 days, ecchymosis for 10-14 days, and residual swelling for 2-3 months. Postoperative changes become quickly obvious after a bony ridge removal. In contrast, a nasal tip rhinoplasty, because it involves soft tissue and more edema, can take months to see the final result.
"This is the hardest surgery we do," Dr. McGrath said. "It is complicated to understand all the pieces of the puzzle and get it right. It requires the greatest amount of art." The most common complication is bleeding in about 4% of patients.
• Breast Augmentation. Only a small minority of breast augmentation procedures, 1.5%, were performed in patients 18 years and younger in 2011. "Young women seek breast implants because their breasts look odd; it is not necessarily size that is driving it, but almost always the shape," Dr. McGrath said.
Approximately 25% of patients having breast augmentation have a reoperation within 10 years. "That is the number to know," Dr. McGrath said. "Is the likelihood of additional surgery acceptable to the patient?"
Silicone breast implants are not FDA cleared for breast reconstruction in females younger than 22 years. Therefore, only saline implants are an option in these younger patients, Dr. McGrath said. An advantage of saline implants is they can be inserted through a small incision and then filled, which is not possible with silicone gel implants.
Pain, hematoma, seroma, wound infection, and decreased skin sensation are potential complications. However, "the problems due to the implantable device are the real issues," Dr. McGrath said. Scarring can occur around 15% of implants; 8% or 9% can become malpositioned and about 7% will deflate over 5 years. In addition, patients with a family history of breast cancer may choose not to have implants.
Consultation with a qualified plastic surgeon who can focus on long-term implications is warranted, Dr. McGrath said.
• Breast Reduction. Defer surgery until full breast maturation and growth is achieved. Breast size should be stable with no continuing growth for 9-12 months, Dr. McGrath said.
Smoking, obesity, medical conditions that impair wound healing, bleeding disorders, or a body mass index greater than 30 kg/m2 are contraindications. "Some obese women have large breasts, and many are disappointed when I tell them they should defer breast reduction until after weight loss."
Another point to counsel patients about is that lactation is not always possible after breast reduction. "I have had young women walk away from this and say, ‘It’s very important for me to breast feed my baby someday.’"
• Liposuction. The American Society of Plastic Surgeons cautions that liposuction and tummy tucks are inappropriate procedures for weight loss in teens, Dr. McGrath said. "I cannot tell you how many obese teens get referred to me for liposuction. I have to tell them it’s not the right thing ... and it will not correct your basic problem."
In contrast, lipoplasty, liposculpture, or liposuction to treat localized fat deposits can be indicated in some teenagers. "The ideal patient is at or near ideal body weight with elastic skin that will retract."
"Submental liposuction of the fat pad creating a double chin in older teenagers can be fantastic," Dr. McGrath said. It can be done in an office setting. Bruising, seroma, and bumpy appearance are potential complications. Instruct patients that they will have to wear a compression garment around their head at night for about 3 weeks.
• Gynecomastia. About 8% of all gynecomastia corrections involved patients 18 years and younger. Approximately 50% are unilateral and 50% bilateral procedures.
Gynecomastia can have a hormonal etiology and be associated with obesity. Surgical results, however, are poorer in the obese patient. "The distinction between what is gynecomastia and fat tissue gets murky in overweight patients," Dr. McGrath said.
Gynecomastia can be self-limited with an average duration of 1-2 years. For those in whom it persists, some seek surgery because "it is a source of embarrassment. Like our young women, it’s not so much the size, it’s the odd look of a protuberant breast on a male."
"The central issue with any elective plastic surgery is not the presence or absence of disease, rather the effect of the problem on the person," Dr. McGrath said. "It comes down to quality of life, and whether or not you believe improving quality of life is part of our job."
Dr. McGrath recommended the American Society for Aesthetic Plastic Surgery guidelines for evaluating teenagers considering cosmetic plastic surgery.
Dr. McGrath said she had no relevant financial disclosures.
EXPERT ANALYSIS FROM THE NORTH AMERICAN SOCIETY FOR PEDIATRIC AND ADOLESCENT GYNECOLOGY
Key Moments in the History of Dermatologic Surgery (1952-2000)
C. William Hanke, MD, MPH, FACP
The history of surgery in dermatology (“dermatologic surgery”) is rich with significant developments and advances by multiple individuals. Only a few of these pioneers can be highlighted in this report because of space limitations. My apologies to colleagues and friends who have not been included or mentioned in this article. The Timeline: Major milestones in the history of dermatologic surgery in this article tells some of the story. The biographic pieces on 15 outstanding physicians add additional detail and perspective. Many major developments have occurred since 2000, but they are beyond the scope of this article.
*For a PDF of the full article, click on the link to the left of this introduction.
C. William Hanke, MD, MPH, FACP
The history of surgery in dermatology (“dermatologic surgery”) is rich with significant developments and advances by multiple individuals. Only a few of these pioneers can be highlighted in this report because of space limitations. My apologies to colleagues and friends who have not been included or mentioned in this article. The Timeline: Major milestones in the history of dermatologic surgery in this article tells some of the story. The biographic pieces on 15 outstanding physicians add additional detail and perspective. Many major developments have occurred since 2000, but they are beyond the scope of this article.
*For a PDF of the full article, click on the link to the left of this introduction.
C. William Hanke, MD, MPH, FACP
The history of surgery in dermatology (“dermatologic surgery”) is rich with significant developments and advances by multiple individuals. Only a few of these pioneers can be highlighted in this report because of space limitations. My apologies to colleagues and friends who have not been included or mentioned in this article. The Timeline: Major milestones in the history of dermatologic surgery in this article tells some of the story. The biographic pieces on 15 outstanding physicians add additional detail and perspective. Many major developments have occurred since 2000, but they are beyond the scope of this article.
*For a PDF of the full article, click on the link to the left of this introduction.
The Stegman Papers: Biography of a Leader in Dermatologic Surgery
Kelley P. Redbord, MD, and C. William Hanke, MD, MPH, FACP
The Stegman Papers is a biography of Dr. Samuel J. Stegman. The papers were collected by Dr. Stegman during his lifetime as a dermatologic surgeon and leader. The manuscript includes a time line of Dr. Stegman’s life and listing of his accomplishments, including significant publications.
*For a PDF of the full article, click on the link to the left of this introduction.
Kelley P. Redbord, MD, and C. William Hanke, MD, MPH, FACP
The Stegman Papers is a biography of Dr. Samuel J. Stegman. The papers were collected by Dr. Stegman during his lifetime as a dermatologic surgeon and leader. The manuscript includes a time line of Dr. Stegman’s life and listing of his accomplishments, including significant publications.
*For a PDF of the full article, click on the link to the left of this introduction.
Kelley P. Redbord, MD, and C. William Hanke, MD, MPH, FACP
The Stegman Papers is a biography of Dr. Samuel J. Stegman. The papers were collected by Dr. Stegman during his lifetime as a dermatologic surgeon and leader. The manuscript includes a time line of Dr. Stegman’s life and listing of his accomplishments, including significant publications.
*For a PDF of the full article, click on the link to the left of this introduction.
Fillers: From the Past to the Future
Richard G. Glogau, MD
Modern medical use of injectable soft-tissue augmentation fillers has evolved from the introduction of bovine collage implants to an array of synthesized materials in the current domestic and foreign markets. The concept of augmentation has moved from simple lines, scars, and wrinkles to revolumizing the aging face. A brief overview of the past, present, and future injectable fillers is presented.
*For a PDF of the full article, click on the link to the left of this introduction.
Richard G. Glogau, MD
Modern medical use of injectable soft-tissue augmentation fillers has evolved from the introduction of bovine collage implants to an array of synthesized materials in the current domestic and foreign markets. The concept of augmentation has moved from simple lines, scars, and wrinkles to revolumizing the aging face. A brief overview of the past, present, and future injectable fillers is presented.
*For a PDF of the full article, click on the link to the left of this introduction.
Richard G. Glogau, MD
Modern medical use of injectable soft-tissue augmentation fillers has evolved from the introduction of bovine collage implants to an array of synthesized materials in the current domestic and foreign markets. The concept of augmentation has moved from simple lines, scars, and wrinkles to revolumizing the aging face. A brief overview of the past, present, and future injectable fillers is presented.
*For a PDF of the full article, click on the link to the left of this introduction.
With various techniques available to address the textural changes of photoaging (such as peels and lasers, dermabrasion), the use of superficial dermal fillers and botulinum toxin left many patients with less than satisfying results, even after surgical rejuvenation.
New Frontiers in Laser Surgery
Doru T. Alexandrescu, MD, and Edward V. Ross, MD
The simultaneous advances in engineering, medicine, and molecular biology have accelerated the pace of introductions of new light-based technologies in dermatology. In this review, the authors examine recent advances in laser surgery as well as peer into the future of energy-based cutaneous medicine. The future landscape of dermatology will almost undoubtedly include (1) noninvasive imaging technologies and (2) improved “destructive” modalities based on real-time feedback from the skin surface.
*For a PDF of the full article, click on the link to the left of this introduction.
Doru T. Alexandrescu, MD, and Edward V. Ross, MD
The simultaneous advances in engineering, medicine, and molecular biology have accelerated the pace of introductions of new light-based technologies in dermatology. In this review, the authors examine recent advances in laser surgery as well as peer into the future of energy-based cutaneous medicine. The future landscape of dermatology will almost undoubtedly include (1) noninvasive imaging technologies and (2) improved “destructive” modalities based on real-time feedback from the skin surface.
*For a PDF of the full article, click on the link to the left of this introduction.
Doru T. Alexandrescu, MD, and Edward V. Ross, MD
The simultaneous advances in engineering, medicine, and molecular biology have accelerated the pace of introductions of new light-based technologies in dermatology. In this review, the authors examine recent advances in laser surgery as well as peer into the future of energy-based cutaneous medicine. The future landscape of dermatology will almost undoubtedly include (1) noninvasive imaging technologies and (2) improved “destructive” modalities based on real-time feedback from the skin surface.
*For a PDF of the full article, click on the link to the left of this introduction.
In identifying new frontiers in cutaneous laser surgery, the authors reviewed recently submitted abstracts at national meetings, examined their own research projects, and looked ahead at promising potential applications that might enhance our laser arsenal in the future.
The Horizon for Treating Cutaneous Vascular Lesions
Amit M. Patel, MD* Elizabeth L. Chou, BS, Laura Findeiss, MD, and Kristen M. Kelly, MD
Dermatologists encounter a wide range of cutaneous vascular lesions, including infantile hemangiomas, port-wine stain birthmarks, arteriovenous malformations, venous malformations, Kaposi sarcomas, angiosarcomas, and angiofibromas. Current treatment modalities to reduce these lesions include topical and/or intralesional steroids, laser therapy, surgical resection, and endovascular therapy. However, each method has limitations owing to recurrence, comorbidities, toxicity, or lesion location. Photodynamic therapy, antiangiogenic therapy, and evolving methods of sclerotherapy are promising areas of development that may mitigate limitations of current treatments and offer exciting options for patients and their physicians.
*For a PDF of the full article, click on the link to the left of this introduction.
Amit M. Patel, MD* Elizabeth L. Chou, BS, Laura Findeiss, MD, and Kristen M. Kelly, MD
Dermatologists encounter a wide range of cutaneous vascular lesions, including infantile hemangiomas, port-wine stain birthmarks, arteriovenous malformations, venous malformations, Kaposi sarcomas, angiosarcomas, and angiofibromas. Current treatment modalities to reduce these lesions include topical and/or intralesional steroids, laser therapy, surgical resection, and endovascular therapy. However, each method has limitations owing to recurrence, comorbidities, toxicity, or lesion location. Photodynamic therapy, antiangiogenic therapy, and evolving methods of sclerotherapy are promising areas of development that may mitigate limitations of current treatments and offer exciting options for patients and their physicians.
*For a PDF of the full article, click on the link to the left of this introduction.
Amit M. Patel, MD* Elizabeth L. Chou, BS, Laura Findeiss, MD, and Kristen M. Kelly, MD
Dermatologists encounter a wide range of cutaneous vascular lesions, including infantile hemangiomas, port-wine stain birthmarks, arteriovenous malformations, venous malformations, Kaposi sarcomas, angiosarcomas, and angiofibromas. Current treatment modalities to reduce these lesions include topical and/or intralesional steroids, laser therapy, surgical resection, and endovascular therapy. However, each method has limitations owing to recurrence, comorbidities, toxicity, or lesion location. Photodynamic therapy, antiangiogenic therapy, and evolving methods of sclerotherapy are promising areas of development that may mitigate limitations of current treatments and offer exciting options for patients and their physicians.
*For a PDF of the full article, click on the link to the left of this introduction.
Fractionation: Past, Present, Future
Nazanin Saedi, MD, H. Ray Jalian, MD, Anthony Petelin, MD, and Christopher Zachary, MBBS, FRCP
The development of fractional photothermolysis is a milestone in the history of laser technology and cutaneous resurfacing. Based on the concept that skin is treated in a fractional manner, where narrow cylinders of tissue are thermally heated and normal adjacent skin is left unaffected, the fractional devices have shown effectiveness in treating a variety of conditions. Since its development, we are becoming more adept at using optimal parameters to induce near carbon dioxide laser benefits with a much more comfortable postoperative period and fewer complications. The future remains bright for fractionated laser devices and with new devices and wavelengths, the applications of this technology continue to grow.
*For a PDF of the full article, click on the link to the left of this introduction.
Nazanin Saedi, MD, H. Ray Jalian, MD, Anthony Petelin, MD, and Christopher Zachary, MBBS, FRCP
The development of fractional photothermolysis is a milestone in the history of laser technology and cutaneous resurfacing. Based on the concept that skin is treated in a fractional manner, where narrow cylinders of tissue are thermally heated and normal adjacent skin is left unaffected, the fractional devices have shown effectiveness in treating a variety of conditions. Since its development, we are becoming more adept at using optimal parameters to induce near carbon dioxide laser benefits with a much more comfortable postoperative period and fewer complications. The future remains bright for fractionated laser devices and with new devices and wavelengths, the applications of this technology continue to grow.
*For a PDF of the full article, click on the link to the left of this introduction.
Nazanin Saedi, MD, H. Ray Jalian, MD, Anthony Petelin, MD, and Christopher Zachary, MBBS, FRCP
The development of fractional photothermolysis is a milestone in the history of laser technology and cutaneous resurfacing. Based on the concept that skin is treated in a fractional manner, where narrow cylinders of tissue are thermally heated and normal adjacent skin is left unaffected, the fractional devices have shown effectiveness in treating a variety of conditions. Since its development, we are becoming more adept at using optimal parameters to induce near carbon dioxide laser benefits with a much more comfortable postoperative period and fewer complications. The future remains bright for fractionated laser devices and with new devices and wavelengths, the applications of this technology continue to grow.
*For a PDF of the full article, click on the link to the left of this introduction.
Ablative Fractional Resurfacing for the Treatment of Traumatic Scars and Contractures
Nathan S. Uebelhoer, DO, E. Victor Ross, MD, and Peter R. Shumaker, MD
After a decade of military conflict, thousands of wounded warriors have suffered debilitating and cosmetically disfiguring scars and scar contractures. Clearly, there is a need for effective scar treatment regimens to assist in the functional and cosmetic rehabilitation of these patients. Traditional treatments, including aggressive physical and occupational therapy and dedicated wound care, are essential. Adjunctive treatments with established laser technologies, such as vascular lasers and full-field ablative lasers, have had a somewhat limited role in scar contractures due to modest efficacy and/or an unacceptable side effect profile in compromised skin. Refractory scar contractures often require surgical
revision, which can be effective, but is associated with additional surgical morbidity and a significant risk of recurrence. Furthermore, current scar treatment paradigms often dictate scar maturation for approximately a year to allow for spontaneous improvement before surgical intervention. Since 2009, the Dermatology Clinic at the Naval Medical Center San Diego has been treating scars and scar contractures in wounded warriors and others using ablative fractionated laser technology. Although traditionally associated with the rejuvenation of aged and photo-damaged skin, our clinical experience and a handful of early reports indicate that laser ablative fractional resurfacing demonstrates promising efficacy and an excellent side effect profile when applied to the functional and cosmetic enhancement of traumatic scars and contractures. This article discusses our clinical experience with ablative fractional resurfacing and its potential prominent role in rehabilitation from traumatic injuries, including a possible shift in scar treatment paradigms toward earlier procedural intervention. Potential benefits include the optimization of scar trajectory and higher levels of full or adapted function in a more favorable time course.
*For a PDF of the full article, click on the link to the left of this introduction.
Nathan S. Uebelhoer, DO, E. Victor Ross, MD, and Peter R. Shumaker, MD
After a decade of military conflict, thousands of wounded warriors have suffered debilitating and cosmetically disfiguring scars and scar contractures. Clearly, there is a need for effective scar treatment regimens to assist in the functional and cosmetic rehabilitation of these patients. Traditional treatments, including aggressive physical and occupational therapy and dedicated wound care, are essential. Adjunctive treatments with established laser technologies, such as vascular lasers and full-field ablative lasers, have had a somewhat limited role in scar contractures due to modest efficacy and/or an unacceptable side effect profile in compromised skin. Refractory scar contractures often require surgical
revision, which can be effective, but is associated with additional surgical morbidity and a significant risk of recurrence. Furthermore, current scar treatment paradigms often dictate scar maturation for approximately a year to allow for spontaneous improvement before surgical intervention. Since 2009, the Dermatology Clinic at the Naval Medical Center San Diego has been treating scars and scar contractures in wounded warriors and others using ablative fractionated laser technology. Although traditionally associated with the rejuvenation of aged and photo-damaged skin, our clinical experience and a handful of early reports indicate that laser ablative fractional resurfacing demonstrates promising efficacy and an excellent side effect profile when applied to the functional and cosmetic enhancement of traumatic scars and contractures. This article discusses our clinical experience with ablative fractional resurfacing and its potential prominent role in rehabilitation from traumatic injuries, including a possible shift in scar treatment paradigms toward earlier procedural intervention. Potential benefits include the optimization of scar trajectory and higher levels of full or adapted function in a more favorable time course.
*For a PDF of the full article, click on the link to the left of this introduction.
Nathan S. Uebelhoer, DO, E. Victor Ross, MD, and Peter R. Shumaker, MD
After a decade of military conflict, thousands of wounded warriors have suffered debilitating and cosmetically disfiguring scars and scar contractures. Clearly, there is a need for effective scar treatment regimens to assist in the functional and cosmetic rehabilitation of these patients. Traditional treatments, including aggressive physical and occupational therapy and dedicated wound care, are essential. Adjunctive treatments with established laser technologies, such as vascular lasers and full-field ablative lasers, have had a somewhat limited role in scar contractures due to modest efficacy and/or an unacceptable side effect profile in compromised skin. Refractory scar contractures often require surgical
revision, which can be effective, but is associated with additional surgical morbidity and a significant risk of recurrence. Furthermore, current scar treatment paradigms often dictate scar maturation for approximately a year to allow for spontaneous improvement before surgical intervention. Since 2009, the Dermatology Clinic at the Naval Medical Center San Diego has been treating scars and scar contractures in wounded warriors and others using ablative fractionated laser technology. Although traditionally associated with the rejuvenation of aged and photo-damaged skin, our clinical experience and a handful of early reports indicate that laser ablative fractional resurfacing demonstrates promising efficacy and an excellent side effect profile when applied to the functional and cosmetic enhancement of traumatic scars and contractures. This article discusses our clinical experience with ablative fractional resurfacing and its potential prominent role in rehabilitation from traumatic injuries, including a possible shift in scar treatment paradigms toward earlier procedural intervention. Potential benefits include the optimization of scar trajectory and higher levels of full or adapted function in a more favorable time course.
*For a PDF of the full article, click on the link to the left of this introduction.
Body Contouring: The Skinny on Noninvasive Fat Removal
H. Ray Jalian, MD*, and Mathew M. Avram, JD, MD
Historically, the approach to body contouring has largely involved invasive procedures, such as liposuction. Recently, several new devices for noninvasive fat removal have received clearance by the Food and Drug Administration for the treatment of focal adiposity. Modalities are aimed primarily at targeting the physical properties of fat that differentiate it from the overlying epidermis and dermis, thus selectively resulting in removal. This review will focus on 3 novel approaches to noninvasive selective destruction of fat.
*For a PDF of the full article, click on the link to the left of this introduction.
H. Ray Jalian, MD*, and Mathew M. Avram, JD, MD
Historically, the approach to body contouring has largely involved invasive procedures, such as liposuction. Recently, several new devices for noninvasive fat removal have received clearance by the Food and Drug Administration for the treatment of focal adiposity. Modalities are aimed primarily at targeting the physical properties of fat that differentiate it from the overlying epidermis and dermis, thus selectively resulting in removal. This review will focus on 3 novel approaches to noninvasive selective destruction of fat.
*For a PDF of the full article, click on the link to the left of this introduction.
H. Ray Jalian, MD*, and Mathew M. Avram, JD, MD
Historically, the approach to body contouring has largely involved invasive procedures, such as liposuction. Recently, several new devices for noninvasive fat removal have received clearance by the Food and Drug Administration for the treatment of focal adiposity. Modalities are aimed primarily at targeting the physical properties of fat that differentiate it from the overlying epidermis and dermis, thus selectively resulting in removal. This review will focus on 3 novel approaches to noninvasive selective destruction of fat.
*For a PDF of the full article, click on the link to the left of this introduction.
The Evolution of Melasma Therapy: Targeting Melanosomes Using Low-Fluence Q-Switched Neodymium-Doped Yttrium Aluminium Garnet Lasers
Arielle N.B. Kauvar, MD
Melasma is an acquired disorder of pigmentation that commonly affects women with phototypes III-V, and it has a negative impact on the quality of life in affected individuals. It presents clinically as symmetric tan or brown patches on the face, most often involving the forehead, cheeks, perioral region, and periorbital region. On histologic examination, there is increased melanin in the epidermis and/or an increased number of melanosomes in the dermis, with a normal number of highly melanized and dendritic melanocytes. The mainstay of treatment is the use of sunscreen along with topical medications that suppress melanogenesis. Clearance is usually incomplete and recurrences or exacerbations are frequent, probably because of the poor efficacy in clearing dermal melanosomes. Treatment with high-energy pigment-specific lasers, ablative resurfacing lasers, and fractional lasers results in an unacceptably high rate of postinflammatory hyper- and hypopigmentation and rebound melasma. Recently, promising results have been achieved with low-fluence Qswitched neodymium-doped yttrium aluminium garnet laser treatment, which can selectively target dermal melanosomes without producing inflammation or epidermal damage, in all skin phototypes. This article reviews the current treatment modalities for melasma, the rationale for using and the clinical results of combination therapy with low-fluence Qswitched neodymium-doped yttrium aluminium garnet lasers.
*For a PDF of the full article, click on the link to the left of this introduction.
Arielle N.B. Kauvar, MD
Melasma is an acquired disorder of pigmentation that commonly affects women with phototypes III-V, and it has a negative impact on the quality of life in affected individuals. It presents clinically as symmetric tan or brown patches on the face, most often involving the forehead, cheeks, perioral region, and periorbital region. On histologic examination, there is increased melanin in the epidermis and/or an increased number of melanosomes in the dermis, with a normal number of highly melanized and dendritic melanocytes. The mainstay of treatment is the use of sunscreen along with topical medications that suppress melanogenesis. Clearance is usually incomplete and recurrences or exacerbations are frequent, probably because of the poor efficacy in clearing dermal melanosomes. Treatment with high-energy pigment-specific lasers, ablative resurfacing lasers, and fractional lasers results in an unacceptably high rate of postinflammatory hyper- and hypopigmentation and rebound melasma. Recently, promising results have been achieved with low-fluence Qswitched neodymium-doped yttrium aluminium garnet laser treatment, which can selectively target dermal melanosomes without producing inflammation or epidermal damage, in all skin phototypes. This article reviews the current treatment modalities for melasma, the rationale for using and the clinical results of combination therapy with low-fluence Qswitched neodymium-doped yttrium aluminium garnet lasers.
*For a PDF of the full article, click on the link to the left of this introduction.
Arielle N.B. Kauvar, MD
Melasma is an acquired disorder of pigmentation that commonly affects women with phototypes III-V, and it has a negative impact on the quality of life in affected individuals. It presents clinically as symmetric tan or brown patches on the face, most often involving the forehead, cheeks, perioral region, and periorbital region. On histologic examination, there is increased melanin in the epidermis and/or an increased number of melanosomes in the dermis, with a normal number of highly melanized and dendritic melanocytes. The mainstay of treatment is the use of sunscreen along with topical medications that suppress melanogenesis. Clearance is usually incomplete and recurrences or exacerbations are frequent, probably because of the poor efficacy in clearing dermal melanosomes. Treatment with high-energy pigment-specific lasers, ablative resurfacing lasers, and fractional lasers results in an unacceptably high rate of postinflammatory hyper- and hypopigmentation and rebound melasma. Recently, promising results have been achieved with low-fluence Qswitched neodymium-doped yttrium aluminium garnet laser treatment, which can selectively target dermal melanosomes without producing inflammation or epidermal damage, in all skin phototypes. This article reviews the current treatment modalities for melasma, the rationale for using and the clinical results of combination therapy with low-fluence Qswitched neodymium-doped yttrium aluminium garnet lasers.
*For a PDF of the full article, click on the link to the left of this introduction.