Cosmetic approach to the Asian population.

The types of cosmetic procedures favored by Asian individuals are unique and tailored to their anatomical differences. Thus, a customized approach is taken for different cosmetic procedures, ranging from neurotoxins and fillers to nonablative fractional resurfacing. The purpose of this review article is to identify the different types of cosmetic procedures commonly sought by Asian individuals and to understand how these different procedures are customized toward their aesthetic preferences. This review integrates the findings from multiple clinical trials available on PubMed. The procedures listed are those that are mostly performed in dermatology offices.

Traumatic neuromas of the penis: a clinical, histopathological and immunohistochemical study of 17 cases.

We present 17 penile traumatic neuromas. The mean patient age at presentation was 38 years (range 23-59 years). The most common site involved was the penile shaft. The lesions ranged from 1 to 7 mm in greatest dimension. The clinical diagnosis in all cases included condyloma acuminatum. In all cases, a history of trauma because of prior biopsy and/or circumcision was found. Histologically, all lesions showed similar features consisting of an increased number of dermal nerve bundles embedded within a fibrous stroma. Often, single or multiple Meissner corpuscle-like structures were noted in the papillary dermis. Our study suggests that circumcision or other forms of trauma to the skin of the penis likely plays an important role in the pathogenesis and clinical presentation of this peculiar neural neoplasm. We call attention to this entity because it is often clinically misdiagnosed as condyloma acuminatum.

The short pulse carbon dioxide laser versus the colorado needle tip with electrocautery for upper and lower eyelid blepharoplasty.

BACKGROUND/OBJECTIVE: Various techniques for blepharoplasty have been described, including those performed with the assistance of the short pulse carbon dioxide laser and those performed with the assistance of the Colorado microdissection needle attached to an electrocautery unit. Although the superiority of the carbon dioxide laser to cold steel has been demonstrated for the performance of eyelid blepharoplasty, no studies have ever compared the carbon dioxide laser to the Colorado needle. STUDY DESIGN/MATERIALS AND METHODS: This is a paired comparison study in which 12 healthy patients underwent bilateral blepharoplasty of their upper and/or lower eyelids by a single surgeon. For each patient, a short pulse carbon dioxide laser was used on one side, and a Colorado needle attached to an electrocautery unit was used on the other. Intraoperative times were recorded. At five post-operative visits patients were evaluated for post-operative healing parameters including edema, erythema, scar width, and bruising. Finally, excised tissue was assessed histologically for thermal damage. RESULTS: Comparing both techniques, no difference in patient or physician-measured parameters of healing were noted up to 1 month post-operatively. However, Colorado needle assisted blepharoplasty resulted in slightly shorter intraoperative times. It also resulted in less thermal damage on a histologic level, although these differences were not clinically significant. CONCLUSIONS: For the performance of blepharoplasty, the Colorado needle tip with electrocautery offers benefits equivalent to those of the short pulsed CO2 laser but has the advantage of shorter intraoperative times and lower cost.

The treatment of melasma with fractional photothermolysis: a pilot study.

BACKGROUND: Melasma is a common pigmentary disorder that remains resistant to available therapies. Facial resurfacing with the pulsed CO2 laser has been reported successful but requires significant downtime, and there is a risk of adverse sequelae. OBJECTIVE: To determine if melasma will respond to a new treatment paradigm, fractional resurfacing. METHODS: Ten female patients (Fitzpatrick skin types III-V) who were unresponsive to previous treatment were treated at 1- to 2-week intervals with the Fraxel laser (Reliant Technologies, Palo Alto, CA, USA). Wavelengths of 1,535 and 1,550 nm were both used, and 6 to 12 mJ per microthermal zone with 2,000 to 3,500 mtz/cm2 were the treatment parameters. Four to six treatment sessions were performed. Responses were evaluated according to the percentage of lightening of original pigmentation. Two physicians evaluated the photographs, and each patient evaluated her own response. RESULTS: The physician evaluation was that 60% of patients achieved 75 to 100% clearing and 30% had less than 25% improvement. The patients' evaluations agreed, except for one patient, who graded herself as 50 to 75% improved as opposed to the physician grading of over 75%. There was one patient with postinflammatory hyperpigmentation and no patient with hypopigmentation. No downtime was necessary for wound healing. CONCLUSIONS: Fractional resurfacing affords a new treatment algorithm for the treatment of melasma that combines decreased risk and downtime with significant efficacy. This treatment modality deserves further exploration to maximize benefits.

Review of photorejuvenation: devices, cosmeceuticals, or both?

BACKGROUND: Both the public and the medical profession have placed a lot of attention on reversal of signs of aging and photodamage, resulting in numerous cosmeceutical products and nonablative laser techniques designed to achieve these results. OBJECTIVE: The purpose of this report is to briefly review both the cosmeceutical products and nonablative laser techniques that appear to be most promising based on published studies. After this review, recommendations for potential enhancement of benefits by combining cosmeceuticals and laser treatments will be explored. RESULTS: Pulsed dye lasers targeting microvessels, intense pulsed light targeting both melanin and microvessels, and midinfrared lasers targeting dermal water and collagen all appear to have some ability to improve skin texture, color, and wrinkling. Retinoids, vitamin C, alpha-hydroxy acids, and topical growth factors may also stimulate repair mechanisms that result in similar improvements in photodamaged skin. CONCLUSION: Although supported only by theoretic considerations and anecdotal reports, it seems logical that the concurrent use of appropriate cosmeceuticals with nonablative laser photorejuvenation should result in enhanced benefits.