Social Media Ratings of Minimally Invasive Fat Reduction Procedures: Benchmarking Against Traditional Liposuction.

BACKGROUND: Minimally invasive fat reduction procedures are rapidly growing in popularity. OBJECTIVE: Evaluate online patient reviews to inform practice management. MATERIALS AND METHODS: Data from RealSelf.com, a popular online aesthetics platform, were reviewed for all minimally invasive fat reduction procedures. Reviews were also aggregated based on the primary method of action (e.g., laser, radiofrequency, ultrasound, etc.) and compared with liposuction. A chi-square test was used to assess for differences with the Marascuilo procedure for pairwise comparisons. RESULTS: A total of 13 minimally invasive fat reduction procedures were identified encompassing 11,871 total reviews. Liposuction had 4,645 total reviews and a 66% patient satisfaction rate. Minimally invasive fat reduction procedures had 7,170 aggregate reviews and a global patient satisfaction of 58%. Liposuction had statistically significantly higher patient satisfaction than cryolipolysis (55% satisfied, n = 2,707 reviews), laser therapies (61% satisfied, n = 3,565 reviews), and injectables (49% satisfied, n = 319 reviews) (p < .05). Injectables and cryolipolysis had statistically significantly lower patient satisfaction than radiofrequency therapies (63% satisfied, n = 314 reviews) and laser therapies. Ultrasound therapies had 275 reviews and a 73% patient satisfaction rate. CONCLUSION: A large number of patient reviews suggest that minimally invasive fat reduction procedures have high patient satisfaction, although liposuction still had the highest total patient satisfaction score. However, there are significant pitfalls in interpreting patient reviews, as they do not provide important data such as a patient's medical history or physician experience and skill.

Consumer Preferences, Product Characteristics, and Potentially Allergenic Ingredients in Best-selling Moisturizers.

Importance: Because moisturizer use is critical for the prevention and treatment of numerous dermatological conditions, patients frequently request product recommendations from dermatologists. Objective: To determine the product performance characteristics and ingredients of best-selling moisturizers. Design and Setting: This cohort study involved publicly available data of the top 100 best-selling whole-body moisturizing products at 3 major online retailers (Amazon, Target, and Walmart). Products marketed for use on a specific body part (eg, face, hands, eyelids) were excluded. Main Outcomes and Measures: Pairwise comparisons of median price per ounce on the basis of marketing claims (eg, dermatologist recommended, fragrance free, hypoallergenic) and presence of ingredients represented in the North American Contact Dermatitis Group (NACDG) series were conducted using Wilcoxon rank sum tests. The effect of vehicle type (eg, ointment, lotion, cream, butter) was assessed using the Kruskal-Wallis test. Cross-reactors and botanicals for fragrances were derived from the American Contact Dermatitis Society's Contact Allergen Management Program database. Results: A total of 174 unique best-selling moisturizer products were identified, constituting 109 713 reviews as of August 2016. The median price per ounce was $0.59 (range, $0.10-$9.51 per ounce) with a wide range (9400%). The most popular vehicles were lotions (102 [59%]), followed by creams (22 [13%]), oils (21 [12%]), butters (14 [8%]), and ointments (3 [2%]). Only 12% (n = 21) of best-selling moisturizer products were free of NACDG allergens. The 3 most common allergens were fragrance mix (n = 87), paraben mix (n = 75), and tocopherol (n = 74). Products with the claim "dermatologist recommended" had higher median price per ounce ($0.79; interquartile range [IQR], $0.56-$1.27) than products without the claim ($0.59; IQR, $0.34-$0.92). Products with the claim "phthalate free" had higher median price per ounce ($1.38; IQR, $0.86-$1.63) than products without the claim ($0.59; IQR, $0.35-$0.91). Lotions (median, $0.49; IQR, $0.31-0.68) were statistically less expensive per ounce than butters (median, $1.20; IQR, $0.76-$1.63), creams (median, $0.80; IQR, $0.69-$1.25) and oils (median, $1.30; IQR, $0.64-$2.43). For products with a claim of "fragrance free," 18 (45%) had at least 1 fragrance cross-reactor or botanical ingredient. Products without any ingredients in the NACDG (median, $0.83; IQR, $0.47-$1.69) were not statistically more expensive per ounce than products with 1 or more allergens (median, $0.60; IQR, $0.35-$1.06). Conclusions and Relevance: Best-selling moisturizers vary widely by price and product characteristics. Given the lack of readily available comparison data on moisturizer efficacy, dermatologists should balance consumer preference, price, and allergenicity in their recommendations.

"Weighing the risk": Obesity and outcomes following liver transplantation.

Obesity is on the rise worldwide. As a result, unprecedented rates of patients are presenting with end stage liver disease in the setting of non-alcoholic fatty liver disease (NAFLD) and are requiring liver transplantation. There are significant concerns that the risk factors associated with obesity and the metabolic syndrome might have a detrimental effect on the long term outcomes following liver transplantation. In general, short term patient and graft outcomes for both obese and morbidly obese patients are comparable with that of non-obese patients, however, several studies report an increase in peri-operative morbidity and increased length of stay. Continued studies documenting the long-term outcomes from liver transplantation are needed to further examine the risk of recurrent disease (NAFLD) and also further define the role risk factors such cardiovascular disease might play long term. Effective weight reduction in the post liver transplant setting may mitigate the risks associated with the metabolic syndrome long-term.