Cross-cultural perspectives on patient expectations in cosmetic dermatology: A comparative analysis across countries and ethnicities.

Patient expectations in cosmetic dermatology exhibit significant variations across countries, cultures, and ethnicities, thereby reflecting individual desires, concerns, and goals. While some individuals seek aesthetic enhancements, others prioritize addressing specific skin conditions within the context of beauty norms in their respective countries. The provision of personalized and culturally sensitive care plays a crucial role in meeting these diverse expectations. Skin characteristics and concerns differ among ethnicities, influencing treatment preferences. For instance, individuals with darker skin tones may prioritize the treatment of pigmentation disorders, whereas those with lighter skin tones may focus on achieving a fair complexion. Furthermore, differences in facial anatomy among various ethnicities necessitate tailored treatment approaches. This commentary aims to contribute to the effective understanding and management of patient expectations, ultimately leading to satisfactory outcomes. Additional research and regional studies are required to further deepen our understanding of patient expectations in cosmetic dermatology and enable the delivery of improved and culturally appropriate care on a global scale.

Predicting the risk of postinflammatory hyperpigmentation: The palmar creases pigmentation scale.

BACKGROUND: Postinflammatory hyperpigmentation (PIH) may affect any skin type but has been linked more often to darker skin. While propensity to hyperpigmentation has not been fully elucidated, there may be a direct correlation to one's palmar crease pigmentation. OBJECTIVE: The aim of this study is to validate the reliable use of a palmar creases pigmentation (PCP) scale, and its accuracy in predicting the risk of PIH. METHODS: A prospective, comparative, and blinded study was conducted through photo-numeric analysis of 126 photographs of pairs of palms. We utilized a 4-point visual scale based on the level of contrast between palmar crease pigment and that of the surrounding skin. Score 0 indicated no difference, score 1 referred to a low difference, score 2 meant a moderate difference, and score 3 related to a high difference. Scores were subdivided based on the risk of PIH. Scores 0-1 are low risk and scores 2-3 are high risk. A panel of 8 medical experts independently evaluated and re-evaluated the photographs that were shown in a random order. RESULTS: A significant degree of inter-rater reliability was found at both evaluation visits, with an intra-class correlation coefficient (ICC) = 0.908, P <.001, at the first evaluation and an ICC = 0.924, P <.001, at the second evaluation, demonstrating a validity of the scale. Global Fleiss kappa for intra-rater reliability for all physicians was 0.514. CONCLUSION: The PCP scale can be effectively used by any physician to predict hyperpigmentation risk.

Noninvasive submental fat reduction using colder cryolipolysis.

BACKGROUND: Cryolipolysis has shown to significantly reduce localized subcutaneous fat, including submental fat. Temperatures below -11°C have not been used to treat the submental region. OBJECTIVE: The purpose of this study was to evaluate safety and efficacy of Cryolipolysis for noninvasive reduction of submental fat using lower temperatures and reduced treatment time. METHODS: A small volume applicator was used to treat 15 subjects, using a noninvasive tissue cooling device (CoolSculpting System, ZELTIQ Aesthetics, Pleasanton, CA, USA) during 45 and 30 minutes at -12 and -15°C, respectively, to induce reduction of submental fat. Two treatments with an interval of 10 weeks were performed. Adverse events were monitored to assess safety. Treated area was evaluated using digital photography, and caliper measurements prior treatment, 10 weeks after first treatment and 12 weeks after second treatment. All patients were also evaluated before and after 12-week postlast treatment by Magnetic Resonance Imaging (MRI). RESULTS: The mean (SD) reduction measured by skin fold caliper was 33% (3.2 mm [1.7 mm]), (95% CI, 0.2297-0.4236; P=.05), and by MRI, mean (SD) reduction was 1.78 mm (1.157 mm). Independent blinded panel was able to correctly identify 60% of before and after photographs; 12 of 15 subjects (80%) were satisfied or very satisfied with the treatment. Side effects were mild and resolved completely within 10 weeks, except for one hyperpigmentation, which resolved spontaneously within 6 months after last treatment. CONCLUSION: Cryolipolysis with colder temperature and reduced treatment time continues to be effective and is safe for noninvasive reduction of the submental fat.

Facial Laxity Rating Scale Validation Study.

BACKGROUND: Age, weight change, clinical or surgical procedures, and distinctive characteristics, combine to be perceived as degrees of flaccidity. There is an absence of a validated scale to accurately assess the firmness-laxity spectrum of the face and neck with accepted classification and terminology. OBJECTIVE: To create a simplified assessment tool to measure the degree of laxity in the face and neck: the Facial Laxity Rating (FLR) scale. METHODS: The FLR scale evaluates 4 distinctive signs (eyelid folds, nasojugal folds, jowls, and neck profile) in 4 regions: upper face, middle face, lower face, and neck. This study incorporated a focused training component for 7 independent physician blinded photograph scorers. A total of 188 ratings were assessed. RESULTS: Combined weighted kappa inter-rater agreement was 0.77 (95% CI, 0.76-0.78) for 188 ratings. Mean inter-rater agreement for laxity class was 0.78 (95% CI, 0.77-0.80). Agreement scoring relative to the truth standard was 92.53% (90.31-94.21), averaged for 7 investigators. CONCLUSION: This study effectively presents the validation of the FLR scale for both inter-rater and agreement relative to the truth standard, demonstrating that the FLR scale may be used as a reliable instrument for quantitative assessment of chronological or treatment related laxity of the face and neck.

Expansión cutánea transoperatoria / Cutaneous intraoperative expansion

Se trataron 15 pacientes entre 4 y 88 años de edad con el método de expanción cutánea transoperatoria, como adyuvante para lograr el cierre directo complejo de amplios defectos quirúrgicos resultantes de la extirpación de diversas lesiones cutáneas. Se utilizaron sondas de Foley como expansores. El expansor se coloca a uno o a ambos lados del defecto, se realizan varios ciclos de expansión para lograr la distensión de la piel vecina al defecto y con la piel distendida se procede al cierre de la herida quirúrgica. En el 70 por ciento de nuestros casos el resultado cosmético fue considerado excelente. El volumen medio de llenado por ciclo necesario para lograr la distención cutánea adecuada fue de 18.3 cc. En todos los pacientes se logró el cierre directo de la herida quirúrgica, por lo que concluimos que la expansión cutánea transoperatoria es un método eficaz para lograr el cierre directo de heridas quirúrgicas en la resección de amplias lesiones cutáneas