Journal of Cutaneous and Aesthetic Surgery
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   Table of Contents - Current issue
Coverpage
October-December 2015
Volume 8 | Issue 4
Page Nos. 189-249

Online since Friday, December 18, 2015

Accessed 4,247 times.

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EDITORIAL  

Complications in cosmetic surgery: A time to reflect and review and not sweep them under the carpet p. 189
Niti Khunger
DOI:10.4103/0974-2077.172188  
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REVIEW ARTICLES Top

Complications associated with medial thigh lift: A comprehensive literature review p. 191
Andrea Sisti, Roberto Cuomo, Irene Zerini, Juri Tassinari, Cesare Brandi, Luca Grimaldi, Carlo D'Aniello, Giuseppe Nisi
DOI:10.4103/0974-2077.172189  
Medial contouring of the thigh is frequently requested to improve appearance and function of medial thigh deformities, following massive weight loss or aging process. This surgical procedure can be associated with a significant rate of complications. Our aim was to consider the complications and outcomes according to the performed technique, through a wide and comprehensive review of the literature. A search on PubMed/Medline was performed using ''medial thighplasty'', ''medial thigh lifting'' and ''technique'' as key words. As inclusion criteria, we selected the clinical studies describing techniques of medial thighplasty. We excluded the papers in which complications related to medial thighplasty were not specified. We also excluded literature-review articles. We found 16 studies from 1988 to 2015. Overall, 447 patients were treated. Different techniques were applied. Complications were observed in 191/447 patients (42.72%). The most frequent complications were wound dehiscence(18.34%) and seroma (8.05%). No major complications, such as thromboembolism and sepsis, were observed. Minor complications occurred in a high percent of patients, regardless of the performed surgical procedure. Patients should be informed about the possible occurrence of wound dehiscence and seroma, as common complications associated with this surgical procedure.
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Managing complications of fillers: Rare and not-so-rare Highly accessed article p. 198
Eckart Haneke
DOI:10.4103/0974-2077.172191  
Fillers belong to the most frequently used beautifying products. They are generally well tolerated, but any one of them may occasionally produce adverse side effects. Adverse effects usually last as long as the filler is in the skin, which means that short-lived fillers have short-term side effects and permanent fillers may induce life-long adverse effects. The main goal is to prevent them, however, this is not always possible. Utmost care has to be given to the prevention of infections and the injection technique has to be perfect. Treatment of adverse effects is often with hyaluronidase or steroid injections and in some cases together with 5-fluorouracil plus allopurinol orally. Histological examination of biopsy specimens often helps to identify the responsible filler allowing a specific treatment to be adapted.
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ORIGINAL ARTICLES Top

A study of hair follicular transplantation as a treatment option for vitiligo p. 211
Parul Thakur, S Sacchidanand, HV Nataraj, AS Savitha
DOI:10.4103/0974-2077.172192  
Background: Repigmentation of vitiligo is closely related to hair follicles. Hence, replenishing melanocytes in vitiliginous patches utilizing undifferentiated stem cells of the hair follicles using follicular unit transplantation (FUT) is a possible treatment option. Objectives of the Study: To study the efficacy of FUT in cases of segmental/stabilized vitiligo as a treatment option for leukotrichia. Materials and Methods: Fifty patients with 63 lesions of stable vitiligo over nonglabrous areas were treated with follicular unit grafts. Reduction in the size of vitiligo patches as well as improvement in the associated leukotrichia were evaluated using subjective and objective assessments. Results: Of the 63 patches, good to excellent response was seen in 39 (61.9%), fair in 16 (25.4%), and poor in eight (12.7%) lesions. No repigmentation was seen in two (4.8%) lesions. The mean improvement seen was 61.17%. Excellent color match was observed in 44 lesions (69.8%). Repigmentation of the depigmented hairs occurred in 11 out of 46 patients with associated leukotrichia. Conclusion: FUT is a safe and effective method for treating localized and segmental vitiligo, especially on hairy parts of the skin. Though labor intensive, it was found to be associated with a quick patient recovery time, very low morbidity, and good color match.
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Aesthetic reconstruction of the upper antihelix in external ear with banner pull-through flap p. 218
Ebrahimi Ali, Nejadsarvari Nasrin, Ebrahimi Azin
DOI:10.4103/0974-2077.172194  
Introduction: We can use pre auricular and post auricular skin as a pull through flap for upper antihelix defects reconstruction. Patients and Methods: This was a prospective case-series study, which was done in the Department of Plastic and Reconstructive Surgery Ward. In this study, 15 patients (3 women, 12 men), ranging from 45 to 72 years old (mean, 58 years) underwent operation with pull through banner flap for reconstruction of upper antihelix (7 cases) and triangular fossa with superior and inferior crura (5cases) caused by BCC or SCC excision. Reconstruction of upper antihelix defects up to 20 × 30 mm with post auricle pull through flap and reconstruction of triangular fossa up to 20 × 20 mm with pre auricle pull through flap were done. Results: Our study showed that pull through flap with superior pedicle from post auricular and preauricular area was an effective method for reconstruction of upper ear antihelix defects. Conclusion: We advocate that the pull through flap with superior pedicle from post auricle and pre auricle is an excellent choice for reconstruction of upper antihelix ear reconstruction in both crura and triangular fossa.
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Treatment of postinflammatory pigmentation due to acne with Q-switched neodymium-doped yttrium aluminum garnet in 78 Indian cases p. 222
Vijay P Zawar, Madhuri Agarwal, Biju Vasudevan
DOI:10.4103/0974-2077.172196  
Background: Postinflammatory hyperpigmentation (PIH) is a common sequela seen in the Indian population following affliction by acne. It is psychologically extremely disturbing for the patients and can severely affect the quality of life. Very few therapeutic modalities have proved to be really efficacious in this condition. Aims: The aim was to review our experience with 1,064-nm Q-switched neodymium-doped yttrium aluminum garnet (QSNY) laser in the treatment of PIH. Materials and Methods: Seventy-eight patients with postacne hyperpigmentation were included in the study. They were treated with six sessions at two weekly intervals using a 1,064-nm QSNY laser. Patient and physician scores were assessed at 1 month and 3 months after the last treatment. Clinical photographs also were reviewed to determine the efficacy. Adverse effects were noted. Results: Seventy percent of the patients reported significant improvement in hyperpigmentation as compared to the baseline. The majority of the adverse events were limited to mild, brief erythema. Conclusion: The 1,064-nm QSNY laser is an effective modality for the treatment of PIH caused by acne.
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SHORT COMMUNICATIONS Top

Novel treatment of Hori's nevus: A combination of fractional nonablative 2,940-nm Er:YAG and low-fluence 1,064-nm Q-switched Nd:YAG laser p. 227
Brian Wei Cheng Anthony Tian
DOI:10.4103/0974-2077.172198  
Objective: To demonstrate a combination laser therapy to treat Hori's nevus. Design: A prospective study. Setting: A Singapore-based clinic. Participants: Five female patients, aged 30-46 years, with bilateral malar Hori's nevus. Measurements: Photographs were taken before treatment and 1 month after laser treatment was completed. These were graded by three independent physicians. The patients were also asked to grade their treatment response subjectively. They were followed up for a total of 3 months after laser treatment to monitor recurrence. Materials and Methods: The fractional nonablative 2,940-nm Er:YAG laser with a fluence of 0.7 J/cm 2, spot size 12 mm, and frequency 15 Hz was used to perform a full-face single-pass treatment. Subsequently, a second pass and third pass over Hori's nevi were done bilaterally till the clinical endpoint of skin whitening. The 1,064-nm Q-switched (QS) Nd:YAG at a fluence of 2.0 J/cm 2 , frequency 2 Hz, and 4-mm spot size was used to deliver multiple passes over Hori's nevus till erythema with mild petechiae appeared. We repeated the treatment once a week for 3 more consecutive weeks. Results: All five patients had above 80% improvement in their pigmentation and two (skin type III) achieved complete 100% clearance. Based on the patients' subjective assessments, all five of them expressed satisfaction and felt that their pigmentation had improved. There were no complications noted. Conclusion: The fractional nonablative 2940 nm Er:YAG laser and Q-switched 1064nm laser Nd:YAG combination is an effective and safe treatment for Hori's nevus.
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Novel low fluence combination laser treatment of solar lentigines in type III Asian skin p. 230
Brian Wei Cheng Anthony Tian
DOI:10.4103/0974-2077.172199  
Objective: To demonstrate a novel low fluence combination laser technique [Erbium-doped yttrium aluminum garnet (Erb:YAG) and neodymium-doped yttrium aluminum garnet (Nd:YAG)] to effectively treat solar lentigines in type III Asian skin in a single session. Design: A prospective study. Setting: A Singapore-based clinic. Participants: Five patients (all females) were enrolled into the study. The ages ranged 35-60 years; all patients had Fitzpatrick skin type III. Measurements: Photographs were taken at baseline and at 1-month follow-up. These were reviewed by two independent physicians who were blinded to the study. Changes in pigment severity were assessed by a 5-point scale (1: Aggravation of pigment, 2: No change, 3: 25-50% improvement, 4: 51-75% improvement, and 5: 76-100% improvement). Results: All patients received a single treatment session. At 1-month follow-up, a reduction in pigment was observed in all patients. Both physicians' reports were independently agreeable. All patients scored 5, having >90% improvement in pigment severity. No hypopigmentation, postinflammatory hyperpigmentation (PIH), or recurrence was seen. Conclusion: Low fluence combination laser is effective and safe for clearance of solar lentigines in type III Asian skin.
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COMMENTARY Top

Lasers for lentigines, from Q-switched to erbium-doped yttrium aluminium garnet micropeel, is there a need to reinvent the wheel? p. 233
Kabir Sardana, Sneha Ghunawat
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SHORT COMMUNICATION Top

Why do females use botulinum toxin injections? p. 236
Carter Singh, Amarjit Dulku, Ahmed Haq, Tayyab Bhatti, Aqib Bhatti
DOI:10.4103/0974-2077.172201  
Background: Botulinum toxin (BT) use for enhancing the facial features has become a commonly accepted form of aesthetic intervention. This study conducted a self-report survey of female BT users in order to explore the motivating factors in its use (cost-benefit analysis). Settings and Design: This is a cross-sectional exploratory pilot study. Materials and Methods: Self-report questionnaires were administered to 41 consecutive clients attending an independent medical practice for BT injections for cosmetic purposes. All the participants were females and represented a range of age groups from the 20s to above 60s. Items in the nonstandardized questionnaire elicited questions relating to the reasons for and against BT use. Statistical Analysis Used: Descriptive analysis was used rather than inferential statistics, and involved ranking the responses according to the most likely reasons for using BT and disadvantages of its use. Results: In general, the primary motivating factor for BT use was to improve self-esteem, and the greatest disadvantage involved financial costs associated with the procedure. Conclusions: The main findings of this study suggest that females who use BT for aesthetic purposes are motivated by personal psychological gains (intrapersonal attributes) rather than social gains (interpersonal factors). In other words, they do not believe that having BT will equate to being treated any better by other people but would rather provide them with confidence and satisfaction regarding their self-image.
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RESIDENTS PAGE Top

Complications of skin biopsy p. 239
Kumar Abhishek, Niti Khunger
DOI:10.4103/0974-2077.172206  
Skin biopsy is the most commonly performed procedure by the dermatologist. Though it is a safe and easy procedure yet complications may arise. Post operative complications like wound infection and bleeding may occur. It is essential to keep the potential complications of skin biopsy in mind and be meticulous in the technique, for better patient outcomes.
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CASE REPORT Top

Chondroid syringoma of the philtral dimple p. 242
Shirol Shidlingappa, Chndramohan Kudligi, Sharanabasav Choukimath, Shubha Nayak, Srinivas Kodaganur
DOI:10.4103/0974-2077.172207  
A chondroid syringoma (CS) is an exceedingly rare mixed tumor of the skin. These tumors are relatively common in the head and neck area. Occurrence of these tumors in the philtrum is rare, with only two documented cases in English literature to the best of our knowledge. This paper presents a case of CS of the philtral dimple with aesthetically excellent philtrum reconstruction.
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CORRESPONDENCE Top

Successful treatment of recalcitrant Bowen's disease of the lower back using a bimodal approach p. 245
Aditya Kumar Bubna
DOI:10.4103/0974-2077.172208  
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An uncommon complication of hair transplant: A crack in the "slit" p. 247
Govind S Mittal, Sanjana Shivashankar, Niranjana Raj, Holavanalli Veerabhadappa Nataraj
DOI:10.4103/0974-2077.172210  
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ERRATUM Top

Erratum: Successful treatment of tattoo-induced pseudolymphoma with sequential ablative fractional resurfacing followed by Q-switched Nd: YAG 532 nm laser p. 249

DOI:10.4103/0974-2077.172211  
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