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Chemical and Mechanical Skin Resurfacing

Synonyms ▪ Chemical resurfacing: chemical peeling, chemexfoliation ▪ Mechanical resurfacing: dermabrasion (includes dermasanding) ▪ Cosmeceutical: topical agent possessing pharmacologic and physiologic effects but promoted to a variable degree as a cosmetic ▪ Jessner's peel: Combes' peel ▪ Baker–Gordon peel: deep phenol peel Key features ▪ Chemical peeling, dermabrasion, and laser ablation are the three main methods of skin resurfacing ▪ Chemical and mechanical resurfacing procedures have…

Cosmetics and Cosmeceuticals

Synonyms ▪ Cosmetics ▪ Skin care products ▪ Cosmeceuticals ▪ Bioactive cosmetics ▪ Nail products ▪ Hair care products ▪ Exfoliants ▪ Moisturizers ▪ Cleansers Key features ▪ Colored cosmetics and skin care products have an important role in the prevention of dermatologic disease and the maintenance of skin health ▪ Hair is a non-living structure whose appearance and behavior can be improved via the use…

Evaluation of Beauty and the Aging Face

Introduction “It is amazing how complete is the delusion that beauty is goodness.” ~Leo Tolstoy Nancy Etcoff, in Survival of the Prettiest: the Science of Beauty , explains that beauty is a universal component of the human experience which promotes pleasure, rivets attention, and impels action that helps ensure survival of our genes . Striving to be more beautiful is not a new phenomenon. Human preoccupation…

Surgical Complications and Optimizing Outcomes

Key features ▪ A thorough preoperative assessment of the patient is required to increase the probability of a successful outcome for any surgical procedure ▪ Attention to detail, selection of the simplest procedures that will produce the desired result, and meticulous intraoperative technique will prevent many complications ▪ Anticipation of avoidable complications and careful management of unavoidable ones optimize results ▪ Clear communication between patient and…

Mohs Micrographic Surgery

Synonyms ▪ Mohs surgery ▪ Chemosurgery ▪ Mohs chemosurgery (fresh tissue technique and fixed tissue technique) Key features ▪ Based upon the concept of contiguous spread of a tumor from a single focus ▪ 100% microscopic tissue margin examination ▪ Highest evidence-based cure rate for cutaneous malignancies, but success is dependent on resources and skills of the surgeon and histotechnician ▪ Same physician serves as both…

Nail Surgery

Key features ▪ A thorough understanding of the anatomy and physiology of the nail unit is a prerequisite for performing successful nail surgery ▪ The nail matrix forms the nail plate; any damage to the matrix (including from surgical procedures) can cause permanent nail dystrophy ▪ Because there is no subcutaneous tissue in the nail unit, the dermis of the nail bed sits on the periosteum…

Grafts

Key features ▪ Free skin grafts are pieces of skin that have been severed from their local blood supply and transferred to another location ▪ Grafts for soft tissue reconstruction can be divided into four types: full-thickness skin grafts, split-thickness skin grafts, composite grafts, and free cartilage grafts ▪ In dermatologic surgery, grafts are most commonly used to repair defects created after removal of skin cancers;…

Flaps

Key features ■ A cookbook approach to flap reconstruction is not realistic ■ The mnemonic STARTS lists basic reconstruction options: simple side-to-side closures, transposition flaps, advancement flaps, rotation flaps, tissue importation flaps, and skin grafts ■ Understanding the dynamics of a flap optimizes its execution ■ For reconstruction, the simplest approach that achieves the desired result is often best ■ Extensive undermining, everted wound edges, meticulous…

Biopsy Techniques and Basic Excisions

Key features ▪ Choice of a particular biopsy technique is based upon the anatomic site, type of skin lesion, desired histologic information, and patient preference ▪ Wound closure is accomplished via suturing (primary intention) or second intention ▪ Choice of a specific suturing technique depends upon the needs of the wound (e.g. eversion of the edges), with the goal being an optimal functional and aesthetic result…

Dressings

Key features ■ Wound dressings have evolved from simple wound coverings to more active wound management tools that directly interact with the wound environment ■ No perfect dressing exists for all wounds but when used appropriately, dressings can improve healing time and cosmesis as well as reduce pain and infections ■ Semipermeable or occlusive dressings provide a moist environment, retain wound fluid that contains growth factors…

Wound Closure Materials and Instruments

Key features ■ The characteristics ascribed to a suture include: physical configurations capillarity USP size elasticity coefficient of friction memory plasticity pliability tensile strength tissue reactivity ■ Sutures used to approximate the dermis and deeper tissue layers are generally absorbable, while cutaneous sutures are usually non-absorbable and require removal ■ The most commonly employed needle in dermatologic surgery is a 3/8 circle that is triangular in…

Anesthesia

Key features ■ Local anesthetics are classified into two groups – amides and esters, depending upon the linkage in their intermediate chain ■ “Anesthetic allergies” vary from palpitations secondary to epinephrine and vasovagal reactions, to urticaria and anaphylaxis from preservatives or the local anesthetic (especially esters) ■ Additives to the local anesthetic include epinephrine, sodium bicarbonate and hyaluronidase ■ Nerve blocks are particularly helpful when performing…

Surgical Anatomy of the Head and Neck

Key features ■ The muscles of facial expression all arise from the second branchial arch, are concentrated in the central facial region, and receive their motor innervation from the facial nerve (cranial nerve VII) ■ The superficial musculoaponeurotic system (SMAS) is a fibromuscular layer that ensheathes and connects the facial muscles and plays an intricate role in coordinating facial expressions ■ The SMAS can be utilized…

Biology of Wound Healing

Key features ▪ Wound healing is a complex and dynamic biologic process, consisting of three consecutive phases: inflammation, tissue formation, and tissue remodeling ▪ Effective wound healing requires synchronization of cell–cell and cell–matrix interactions as well as an interplay of cytokines ▪ Extracellular matrix proteins are multifunctional molecules that bind directly to cell surface receptors (e.g. integrins) and influence the effects of growth factors on cells…

Electrosurgery

Synonym ▪ Radiosurgery Key features ▪ Electrosurgery encompasses a group of procedures by which tissue is removed or destroyed through the application of electrical energy ▪ True electrocautery uses direct current to create a red-hot tip, which can be safer for patients with pacemakers and implantable cardioverter-defibrillators ▪ In modern electrosurgery, high-frequency alternating current is converted to heat within the treated tissues as a result of…

Radiotherapy

Synonyms ▪ Radiation therapy ▪ X-ray therapy ▪ Radiation treatment Key features ▪ Radiotherapy is an important modality in the treatment of patients with skin malignancies ▪ Radiotherapy may reduce morbidity (as compared to surgery), decrease the risk of recurrent disease, and even be life-saving ▪ Although most patients with skin cancer are adequately treated by modalities other than radiotherapy, there are factors that may favor…

Cryosurgery

Synonym ■ Cryotherapy Key features ■ A minimally invasive surgical technique that utilizes subzero temperatures to destroy benign, premalignant, and malignant lesions ■ Compared to standard excisional surgery, cryosurgery requires less time to perform but healing time is often longer ■ Damage to surrounding structures is predictable and can be limited, with the preserved underlying stroma providing a structural framework for wound repair ■ The preferred…

Lasers and Other Energy-Based Therapies

The advancements in laser and light therapies over the past three decades are built upon the foundation of Albert Einstein's The Quantum Theory of Light . In these prescient 1917 writings, he proposed, amongst other concepts, that light consists of quanta of energy, and he hinted at the notion of amplification. In 1958, Townes and Schawlow described Microwave Amplification by Stimulated Emission of Radiation (MASER). This…

Lasers and Other Energy-Based Technologies – Principles and Skin Interactions

Synonym ▪ LASER – light amplification by stimulated emission of radiation Key features ▪ Laser surgery works via precise tissue heating when optical energy is absorbed within the skin ▪ Heat is created exactly where light is absorbed by molecules called chromophores ▪ The major chromophores for visible and near-infrared light are melanin and hemoglobins; water is the major far-infrared chromophore ▪ Red and near-infrared wavelengths…

Photodynamic Therapy

Synonym ▪ Photoradiation therapy Key features ▪ Over the past two decades, photodynamic therapy (PDT) has evolved into a practical and effective therapeutic option, especially for actinic keratoses (AKs) and superficial non-melanoma skin cancers, with an expanding range of applications including acne, photoaging, cutaneous infections, and vascular anomalies ▪ The photodynamic effect is due to a photochemical reaction that generates singlet oxygen and it requires three…