Journal of Cutaneous and Aesthetic Surgery
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   Table of Contents - Current issue
Coverpage
October-December 2017
Volume 10 | Issue 4
Page Nos. 183-234

Online since Friday, February 2, 2018

Accessed 1,983 times.

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CME ARTICLE  

Umbilicus reconstruction after melanoma excision p. 183
Miguel Costa-Silva, Barbara Ferreira, Ana Brinca, Ricardo Vieira
DOI:10.4103/JCAS.JCAS_49_17  
An 81-year-old woman was admitted with a nodular cutaneous melanoma of the abdominal wall involving the umbilicus. After performing wide excision with 2 cm margin of the melanoma, umbilical reconstruction and defect closure were planned. After careful consideration, we decided to use an island pedicle flap which allowed closure of the defect and reconstruction of the umbilicus.
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REVIEW ARTICLE Top

Standard guidelines of care: Performing procedures in patients on or recently administered with isotretinoin Highly accessed article p. 186
Venkataram Mysore, Omprakash H Mahadevappa, Shyamanta Barua, Imran Majid, Vishalakshi Viswanath, Ramesh M Bhat, Suresh Talwar, Salim Thurakkal, Sanjeev J Aurangabadkar, Manas Chatterjee, Anil Ganjoo
DOI:10.4103/JCAS.JCAS_110_17  
Background: Currently, the standard protocol regarding the performance of procedures on patients receiving or having recently received isotretinoin (13-cis-retinoic acid) states that the procedures should not be performed. The recommendations in standard books and drug insert require discontinuation of isotretinoin for 6 months before performing cosmetic procedures, including waxing, dermabrasion, chemical peels, laser procedures, or incisional and excisional cold-steel surgery. These recommendations have been followed for over two decades despite little evidence for the stated increased risk of scarring. Objective: The Association of Cutaneous Surgeons (I) constituted a task force to review the evidence and to recommend consensus guidelines regarding the safety of skin procedures, including resurfacing, energy-device treatments, and dermatosurgical procedures in patients with concurrent or recent isotretinoin administration. Materials and Methods: Data were extracted from the literature through a PubMed search using the keywords “isotretinoin,” “safety,” “scarring,” “keloids,” “hypertrophic scarring,” and “pigmentation.” The evidence was then labeled and circulated to all members of task force for review. Results: The task force is of the opinion that there is insufficient evidence to support the current protocol of avoiding and delaying treatments in the patient group under consideration and recommends that the current practice should be discontinued.The task force concludes that performing procedures such as laser hair removal, fractional lasers for aging and acne scarring, lasers for pigmented skin lesions, fractional radio-frequency microneedling, superficial and medium-depth peels, microdermabrasion, dermaroller, biopsies, radio-frequency ablation, and superficial excisions is safe in patients with concurrent or recent isotretinoin administration.
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ORIGINAL ARTICLES Top

Decoding facial esthetics to recreate an esthetic hairline: A method which includes forehead curvature p. 195
Anil K Garg, Seema Garg
DOI:10.4103/JCAS.JCAS_51_17  
Context: The evidence suggests that our perception of physical beauty is based on how closely the features of one’s face reflect phi (the golden ratio) in their proportions. By that extension, it must certainly be possible to use a mathematical parameter to design an anterior hairline in all faces. Aim: To establish a user-friendly method to design an anterior hairline in cases of male pattern alopecia. Materials and Methods: We need a flexible measuring tape and skin marker. A reference point A (glabella) is taken in between eyebrows. Mark point E, near the lateral canthus, 8 cm horizontal on either side from the central point A. A mid-frontal point (point B) is marked 8 cm from point A on the forehead in a mid-vertical plane. The frontotemporal points (C and C’) are marked on the frontotemporal area, 8 cm in a horizontal plane from point B and 8 cm in a vertical plane from point E. The temporal peak points (D and D’) are marked on the line joining the frontotemporal point C to the lateral canthus point E, slightly more than halfway toward lateral canthus, usually 5 cm from the frontotemporal point C. This line makes an anterior border of the temporal triangle. Result: We have conducted a study with 431 cases of male pattern alopecia. The average distance of the mid-frontal point from glabella was 7.9 cm. The patient satisfaction reported was 94.7%. Conclusion: Our method gives a skeletal frame of the anterior hairline with minimal criteria, with no need of visual imagination and experience of the surgeon. It automatically takes care of the curvature of the forehead and is easy to use for a novice surgeon.
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Follicular unit grafting in chronic nonhealing leg ulcers: A clinical study p. 200
Leelavathy Budamakuntla, Eswari Loganathan, Sacchidananda A Sarvajnamurthy, HV Nataraj
DOI:10.4103/JCAS.JCAS_38_17  
Introduction and Objectives: The restoration of the epithelium after injury takes place by migration of epithelial cells adjoining a wound or by centrifugal migration from hair follicles. To evaluate the feasibility and potential healing capacity of scalp follicular unit grafts transplanted into the wound bed of chronic leg ulcers. Materials and Methods: Patients with chronic nonhealing ulcers of more than 6 weeks duration were selected for the study. Those with infected ulcers and uncontrolled diabetes were excluded from the study. Fifteen patients were included in the study. Follicular unit grafts were harvested under local anesthesia using small-diameter (1 mm) circular punches. A density of 5 follicular grafts/cm2 was implanted into the ulcer bed. The ulcer was dressed with Vaseline gauze and elastic bandage for 24 h. The wound area and volume were calculated by length × width × 0.7854 and length × width × depth × 0.7854, respectively. The treatment outcome was defined as the percentage in change of area and volume of the ulcer, 18 weeks after intervention. Results: A total of 15 patients with 17 ulcers were treated with the above method. Of these 17 ulcers, 11 were venous ulcers, 2 were pyoderma gangrenosum associated with varicose veins, 2 were traumatic ulcers, and 2 were trophic ulcers. The baseline mean area of the ulcer was 6.72 cm2 (SD 5.65) and baseline volume was 2.87 cm3 (SD 2.9). The final area of the ulcer at the end of 18 weeks after the procedure was 3.84 cm2 (SD 5.43) and the final volume was 1.21 cm3 (SD 2.45), which was statistically significant. The mean percentage improvement in the area and volume of the ulcer was 48.8% and 71.98%, respectively. Two patients did not respond to the treatment. There were no adverse events after the procedure. Conclusion: We conclude that follicular unit grafting into wound beds is feasible and represents a promising therapeutic alternative for managing nonhealing chronic leg ulcers.
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Safety and early satisfaction assessment of patients seeking nonsurgical rhinoplasty with filler p. 207
Raffaele Rauso, Giuseppe Colella, Nicola Zerbinati, Giovanni Salti
DOI:10.4103/JCAS.JCAS_89_17  
Background: Nonsurgical aesthetic treatments are usually preferred by patients because their effects are visible immediately after the treatment and patients can return to their normal activities on the same day. Although many studies have indicated safety and efficacy of filler injection to improve facial appearance, it is not absolutely confirmed for nose reshaping. Objectives: To assess the safety and early satisfaction of 52 consecutive patients underwent nonsurgical rhinoplasty with an injection of a 20-mg/mL smooth, cohesive, and viscous hyaluronic acid (HA) filler. Materials and Methods: Fifty-two consecutive healthy patients, dissatisfied with the appearance of their nose, were treated with HA injections between November 2014 and November 2016. Complications and side effects were documented. Aesthetic outcomes were scored subjectively on a scale of 1–4 represented by four emoticons. Results: Among patients, 96.15% affirmed to be “very satisfied” at the end of the procedure (50 patients over 52 treated). No major complications and side effects occurred. Conclusions: Outcomes of this study, with the limitation of a non-comparative open-label study, show that surgical remodeling of the nose, with the use of a 20-mg/mL smooth, cohesive, and viscous HA filler, is a safe and predictable technique, with a high degree of satisfaction for the patients.
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CASE REPORTS Top

Langerhans cell histiocytosis – a challenge for the dental professional p. 215
Shweta Bansal, Arun Garg, Richa Khurana
DOI:10.4103/JCAS.JCAS_66_17  
Langerhans cell histiocytosis (LCH) is a group of rare disorders histologically characterized by the proliferation of LC, involving multiple organs and systems. Typically, there is bone involvement and, less frequently, lesions may be found in the lungs, liver, lymph nodes, skin, and mucosae. Oral soft tissue lesions without bone involvement are rare. Antigenic markers that react with CD1a glycoprotein, cytoplasmatic protein S100 detected by immunoperoxidase staining, and/or presence of Birbeck granules on electron microscopic examination are required for a definitive diagnosis of LCH. In this article, we report a case of LCH, which had presented with multiple oral lesions without any other systemic signs and symptoms. Management of such children with periodontal manifestations should include hematological and, if possible, immunological investigations at an early stage. Careful clinical examination, good diagnostic skill, and awareness of characteristic cytological features of LCH can lead to earlier diagnosis and treatment with minimal deformity.
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Lip repositioning: A boon in smile enhancement p. 219
Anamika Sharma, Shatakshi Sharma, Harshita Garg, Vineeta Singhal, Pooja Mishra
DOI:10.4103/JCAS.JCAS_50_17  
This clinical report describes the successful use of lip repositioning technique for the reduction of excessive gingival display. The lip repositioning technique was performed with the main objective of reducing gummy smile by limiting the retraction of elevator muscles (e.g., zygomaticus minor, levator anguli, orbicularis oris, and levator labii superioris). This technique includes removing a strip of mucosa from the maxillary buccal vestibule, creating a partial-thickness flap between mucogingival junction and upper lip musculature, and suturing the lip mucosa with mucogingival junction, resulting in a narrow vestibule and restricted muscle pull, thereby reducing gingival display.
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Multiple asymptomatic juxta-articular nodules mimicking tuberous-xanthoma–a unusual presentation of tophaceous gout p. 223
Sidharth Tandon, Kabir Sardana, Purnima Malhotra, Jasmeet Singh
DOI:10.4103/JCAS.JCAS_78_17  
Asymptomatic, juxta-articular nodules are an uncommon morphology, which is usually diagnosed as xanthomas, calcinosis cutis or rheumatoid nodules. This study was represented as a case of gout, which is a disorder of purine metabolism resulting in elevation of serum uric acid and deposition of monosodium urate crystals within and around joints and manifests clinically as inflammatory arthritis. Urate crystal deposits have also been found in tendons, ligaments, viscera, and the skin, with the term “tophi” being used for the non-articular deposits. In the chronic stage, the lesion can be asymptomatic lesions and is often misdiagnosed.
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CORRESPONDENCES Top

Clearance of recalcitrant onychomycosis following Q-switched Nd-Yag laser p. 226
Vijay Zawar, Aarti Sarda, Abhishek De
DOI:10.4103/JCAS.JCAS_18_17  
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Thread lift in breast ptosis p. 228
Gulhima Arora, Sandeep Arora
DOI:10.4103/JCAS.JCAS_91_17  
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INNOVATION Top

Radiofrequency-assisted body piercing p. 231
Preethitha Babu, Ravi K Chittoria, Hemant K Sudhanva, S Kumaran, Elan S Kumar
DOI:10.4103/JCAS.JCAS_79_17  
The art of body piercing is ancient; however, nowadays it has evolved into a fashion statement. In the Indian subcontinent, ear and nose piercing hold religious and cultural significance in addition to being done for aesthetic reasons. Body piercing is routinely performed by railroading technique or by piercing guns; many modifications of the technique have emerged. Irrespective of the technique used, the main complications associated are intraoperative bleeding and postoperative infection. To overcome these problems, we describe a novel and simple technique of ear and nose piercing using the radio frequency cautery.
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COMMENTARY Top

My experience with the ACSI Fellowship Program at Cutis Institute of Dermatology p. 234
Shazia Jeelani
DOI:10.4103/JCAS.JCAS_132_17  
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