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Sclerotherapy of Varicose Veins

Chapter Summary The aim of sclerotherapy is the transformation of a treated vein into a fibrous cord. Liquid sclerotherapy is the method of choice for telangiectasia and reticular veins. Foam is more effective than liquid sclerotherapy in saphenous veins, tributaries and venous malformations. Introduction Sclerotherapy involves the injection of a sclerosant for targeted elimination of intracutaneous, subcutaneous, and/or transfascial varicose veins (perforating veins), as well as…

Laser and Light Treatment of Acquired and Congenital Vascular Lesions

Chapter Summary Lasers and light sources are the treatments of choice for a variety of congenital and acquired cutaneous vascular lesions. Based on the principles of selective photothermolysis, lasers induce photocoagulation of vessels by using wavelengths well absorbed by hemoglobin. Appropriate pulse durations, equal to or shorter than the thermal relaxation time of the vessels, are chosen to confine the thermal damage. Lights with longer wavelengths…

Laser-based Treatment of the Aging Face for Skin Resurfacing: Ablative and Non-ablative Lasers

Chapter Summary Many aspects of dermatoheliosis are amenable to treatment with a variety of ablative and non-ablative lasers and light sources. Ablative laser skin resurfacing offers the most substantial clinical improvement, but is associated with greater postoperative recovery. Non-ablative laser skin remodeling is a good alternative for patients who desire modest improvement of dermatoheliosis with a limited post-treatment recovery period. Fractionated laser systems provide the benefits…

Photodynamic Therapy

Chapter Summary Photodynamic therapy combines a photosensitizing chemical, oxygen, and light to induce a selective destruction of abnormal cells. Photodynamic therapy has evolved as an efficacious field treatment for actinic keratoses. Photodynamic therapy can be utilized for superficial non-melanoma skin cancers with an acceptable cure rate and superior cosmesis compared with other treatment modalities. By integrating novel light sources, photodynamic therapy can be used for photorejuvenation.…

Laser Treatment of Tattoos and Pigmented Lesions

Chapter Summary Various lasers and light sources effectively treat pigmented lesions and tattoos with minimal downtime and superior cosmetic outcomes. Q-switched and picosecond lasers with extremely short pulse durations are best suited for the selective destruction of commonly encountered pigmented lesions. Intense pulsed light sources can improve superficial pigmentary as well as vascular components of photodamaged skin. Multiple treatments with fractional photothermolysis can improve pigmented lesions…

Laser Hair Removal

Chapter Summary Lasers and light sources can provide temporary hair reduction for all individuals. At present, permanent hair reduction is possible only in individuals with pigmented terminal hairs. Proper patient selection is vital to ensure effective treatment with minimal side effects. A thorough knowledge of laser–tissue interactions is mandatory to minimize side effects. Treatment outcome is optimized by understanding the attributes of specific laser and light…

Follicular Unit Hair Transplantation

Chapter Summary Follicular unit hair transplantation (FUHT) is a method of hair restoration surgery that relocates permanent donor hair to balding areas in naturally occurring follicular unit hair groupings. The small size of the units allows for tremendous versatility in their placement, the creation of hair patterns that closely mimic nature, and the transplantation of a large enough number of grafts so that a full restoration…

Autologous Fat Transfer: Evolving Concepts and Techniques

Chapter Summary Autologous fat transfer (AFT) is a long established means of facial volume restoration in cosmetic rejuvenation, where it is not only a corrective technique for soft tissue defects and rhytids but also for facial atrophy due to the aging process. Because of an improved understanding of the process of neovascularization and fat as a living graft, the emphasis has shifted from overcorrection to transfer…

Liposuction

Chapter Summary Tumescent local anesthesia using lidocaine and epinephrine allows the removal of large volumes of fat with minimal blood loss and low postoperative morbidity. A preconsultation questionnaire standardizes the medical history and focuses the consultation on issues that are crucial to the success of the liposuction. Most bleeding disorders and any medications that prolong bleeding time are a contraindication to liposuction. Liposuction is not a…

Botulinum Toxins

Chapter Summary Botulinum toxin (BoNT) is a neurotoxin produced by Clostridium botulinum , a Gram-positive anaerobic bacterium. It blocks acetylcholine release after binding to the presynaptic cholinergic receptors, thus preventing muscular contraction of the affected muscles. BoNT type A (BoNT-A) products are commercially available typically in a lyophilized form, and require reconstitution prior to use, with 0.9% saline. The main indications of BoNT in dermatology include…

Implants

Chapter Summary The chin plays a key role in contributing to facial balance and harmony, from ancient history through contemporary culture. Proper head positioning in the Frankfort horizontal plane is essential for preoperative assessment. Proper implant material selection and design achieve pleasing results with minimal complications. Techniques are described for the submental and subperiosteal approaches to placing an extended Silastic implant. Suggestions are presented for improving…

Chemical Peels

Chapter Summary Indications for chemical peels Understanding the different depths achieved by the various agents used in chemical peeling Patient selection criteria Techniques for predictable outcomes with a variety of chemical peels Identification and treatment of potential complications Introduction Chemical peeling is the application of one or more exfoliating agents to the skin, to produce controlled wounding. The agent, usually an acid solution, removes varying amounts…

Soft-tissue Augmentation

Chapter Summary The ideal soft-tissue filler would be characterized by the following properties: safety, efficacy, reproducibility, ease of administration, non-carcinogenicity, non-teratogenicity, non-migratory, cost-effective, physiologic, semi- or non-permanent, and government sanctioned. The available fillers have varying levels of particle size, desired placement depth, biodegradability, allergenicity, and durability. Indications for soft-tissue augmentation include atrophic scarring, rhytides, volume loss, lip atrophy, and contour defects. Setting appropriate patient expectations is…

Evaluation and Management of the Aging Face

Chapter Summary Evaluation of the aging face must take into account changes that occur in all levels of tissue. Young faces are characterized by arcs and fullness, not merely by the absence of wrinkles. The morphologic changes that occur in the aging face are due mostly to the redistribution of fat and changes in muscle tone (both increased and decreased) but bony remodeling also plays a…

Psychosocial Issues and the Cosmetic Surgery Patient

Chapter Summary Psychosocial factors are important in cosmetic surgery patient selection. An appropriate preoperative psychiatric examination is essential. By recognizing the key features of common personality and mental disorders, cosmetic surgeons can plan effective treatment for each individual patient. Body dysmorphic disorder is one of the more common psychological disorders seen in people seeking cosmetic surgery. Surgical success rates are poor for patients who have body…

Revision of Surgical Scars

Chapter Summary Scar revision methodology includes intralesional steroids, lasers targeting superficial vasculature, non-ablative and ablative lasers – including fractional resurfacing devices, surgical excision, and dermabrasion, and is occasionally as simple as allowing more time for the original scar to mature. Fusiform elliptical excision is the simplest surgical technique but the resultant scar is always longer than the original scar. W-plasty, geometric broken-line closure, and Z-plasty each…

Acne Scar Revision

Chapter Summary Post-acne scarring remains a common entity despite advances in our understanding and treatment of acne. The management of post-acne scarring remains as much an ongoing challenge as ever, with improvement not eradication as the goal. This strategy or paradigm used in aesthetic dermatology concentrates on the effects of surface, volume and movement changes seen in the skin as we age and to improve our…

Skin Grafting

Chapter Summary A skin graft is a portion of skin that has been separated from its vascular supply. Full-thickness grafts (epidermis and dermis plus adnexal structures) generally give better results than split-thickness grafts (epidermis and partial-thickness dermis only) because there is better retention of skin function, but split-thickness grafts are more appropriate where a large area is to be grafted. The choice of donor site involves…

Axial Pattern Flaps

Chapter Summary Axial pattern flaps have a pedicle containing a named cutaneous artery, compared with random pattern flaps whose blood supply is based on the less robust subdermal plexus. As a result of their robust blood supply, axial pattern flaps can reconstruct defects beyond the reach of random pattern flaps. The paramedian forehead flap has a pedicle most commonly based on the supratrochlear artery. This staged…

Random Pattern Cutaneous Flaps

Chapter Summary Random pattern flaps are ideal closures for surgical wounds that will neither predictably heal by second intention nor be easily repaired by direct linear closure. For each operative wound, several flaps may be suitable, but one will likely be optimal. To improve outcomes, a reconstructive surgeon must be able to match an appropriate repair to a given surgical defect. Flap execution requires attention to…