Journal of Cutaneous and Aesthetic Surgery
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  Most popular articles (Since April 15, 2008)

 
 
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CASE REPORTS
Insects are crawling in my genital warts
Jyoti Dhawan, Saurabh Singh, Somesh Gupta
May-August 2011, 4(2):129-131
DOI:10.4103/0974-2077.85037  PMID:21976905
A 23-year-old woman presented with large exophytic genital wart arising from perineum, vulva, introitus of the vagina, and inner aspect of thighs. Patient developed severe itching and formication (insect-crawling sensation) in the lesions for past 1 week, though careful examination did not reveal any insects. Considering that the disease was causing psychological stress and physical symptoms, radiofrequency excision was planned. However, during the procedure, several maggots appeared from the crypts. The procedure was abandoned and maggots were removed manually. Subsequently external giant warts were removed using radiofrequency device. There was no recurrence of excised warts during 3 month follow-up. To our knowledge, this is the second reported case of maggots in genital warts.
  32,957 169 -
CME
Complications of minimally invasive cosmetic procedures: Prevention and management
Lauren L Levy, Jason J Emer
April-June 2012, 5(2):121-132
DOI:10.4103/0974-2077.99451  PMID:23060707
Over the past decade, facial rejuvenation procedures to circumvent traditional surgery have become increasingly popular. Office-based, minimally invasive procedures can promote a youthful appearance with minimal downtime and low risk of complications. Injectable botulinum toxin (BoNT), soft-tissue fillers, and chemical peels are among the most popular non-invasive rejuvenation procedures, and each has unique applications for improving facial aesthetics. Despite the simplicity and reliability of office-based procedures, complications can occur even with an astute and experienced injector. The goal of any procedure is to perform it properly and safely; thus, early recognition of complications when they do occur is paramount in dictating prevention of long-term sequelae. The most common complications from BoNT and soft-tissue filler injection are bruising, erythema and pain. With chemical peels, it is not uncommon to have erythema, irritation and burning. Fortunately, these side effects are normally transient and have simple remedies. More serious complications include muscle paralysis from BoNT, granuloma formation from soft-tissue filler placement and scarring from chemical peels. Thankfully, these complications are rare and can be avoided with excellent procedure technique, knowledge of facial anatomy, proper patient selection, and appropriate pre- and post-skin care. This article reviews complications of office-based, minimally invasive procedures, with emphasis on prevention and management. Practitioners providing these treatments should be well versed in this subject matter in order to deliver the highest quality care.
  23,714 675 5
REVIEW ARTICLE
Advanced nail surgery
Eckart Haneke
September-December 2011, 4(3):167-175
DOI:10.4103/0974-2077.91247  PMID:22279381
Six techniques not yet widely known or used in the dermatologic surgery of the nails are briefly described. Small-to-medium-sized tumours of the proximal nail fold (PNF) can be excised and the defect repaired with advancement or rotation flaps. A superficial biopsy technique of the matrix for the diagnosis of longitudinal brown streaks in the nail, which allows rapid histological diagnosis of the melanocyte focus to be performed, is described here. Because the excision is very shallow and leaves the morphogenetic connective tissue of the matrix intact, the defect heals without scarring. Laterally positioned nail tumours can be excised in the manner of a wide lateral longitudinal nail biopsy. The defect repair is performed with a bipedicled flap from the lateral aspect of the distal phalanx. Malignant tumours of the nail organ often require its complete ablation. These defects can be covered by a full-thickness skin graft, reversed dermal graft, or cross-finger flap. The surgical correction of a split nail is often difficult. The cicatricial tissue of the matrix and PNF have to be excised and the re-attachment of these wounds prevented. The matrix defect has to be excised and sutured or covered with a free matrix graft taken either from the neighbouring area or from the big toe nail.
  22,217 525 2
ORIGINAL ARTICLE
Combination therapy in the management of atrophic acne scars
Shilpa Garg, Sukriti Baveja
January-March 2014, 7(1):18-23
DOI:10.4103/0974-2077.129964  PMID:24761094
Background: Atrophic acne scars are difficult to treat. The demand for less invasive but highly effective treatment for scars is growing. Objective: To assess the efficacy of combination therapy using subcision, microneedling and 15% trichloroacetic acid (TCA) peel in the management of atrophic scars. Materials and Methods: Fifty patients with atrophic acne scars were graded using Goodman and Baron Qualitative grading. After subcision, dermaroller and 15% TCA peel were performed alternatively at 2-weeks interval for a total of 6 sessions of each. Grading of acne scar photographs was done pretreatment and 1 month after last procedure. Patients own evaluation of improvement was assessed. Results: Out of 16 patients with Grade 4 scars, 10 (62.5%) patients improved to Grade 2 and 6 (37.5%) patients improved to Grade 3 scars. Out of 22 patients with Grade 3 scars, 5 (22.7%) patients were left with no scars, 2 (9.1%) patients improved to Grade 1and 15 (68.2%) patients improved to Grade 2. All 11 (100%) patients with Grade 2 scars were left with no scars. There was high level of patient satisfaction. Conclusion: This combination has shown good results in treating not only Grade 2 but also severe Grade 4 and 3 scars.
  21,536 843 -
ORIGINAL ARTICLES
An assessment of the efficacy and safety of cross technique with 100% TCA in the management of ice pick acne scars
Deepali Bhardwaj, Niti Khunger
May-August 2010, 3(2):93-96
DOI:10.4103/0974-2077.69020  PMID:21031068
Background : Chemical reconstruction of skin scars (CROSS) is a technique using high concentrations of trichloroacetic acid (TCA) focally on atrophic acne scars to induce inflammation followed by collagenisation. This can lead to reduction in the appearance of scars and cosmetic improvement. Aims : The aim of this pilot study is to investigate the safety of the CROSS technique, using 100% TCA, for atrophic ice pick acne scars. Settings and Design : Open prospective study. Materials and Methods : Twelve patients with predominant atrophic ice pick post acne scars were treated with the CROSS technique, using 100% TCA, applied with a wooden toothpick, at two weekly intervals for four sittings. Efficacy was assessed on the basis of the physician's clinical assessment, photographic evaluation at each sitting and patient's feedback after the fourth treatment, and at the three-month and six-month follow-up period, after the last treatment. Results : More than 70% improvement was seen in eight out of ten patients evaluated and good results (50 - 70% improvement) were observed in the remaining two patients. No significant side effects were noted. Transient hypopigmentation and hyperpigmentation was observed in one patient each. Physician's findings were in conformity with the patient's assessment. Three months after the last treatment, one patient noted a decrease in improvement with no further improvement even at the six-month follow-up period. Conclusion : The CROSS technique with 100% TCA is a safe, efficacious, cost-effective and minimally invasive technique for the management of ice pick acne scars that are otherwise generally difficult to treat. In few patients the improvement may not be sustained, probably due to inadequate or delayed collagenisation.
  19,707 611 -
SYMPOSIUM
Infraorbital dark circles: A review of the pathogenesis, evaluation and treatment
Ivan Vrcek, Omar Ozgur, Tanuj Nakra
April-June 2016, 9(2):65-72
DOI:10.4103/0974-2077.184046  PMID:27398005
Infraorbital dark circles represent a common and multifactorial challenge in the world of aesthetic medicine and are the result of a variety of factors including deep facial anatomy, soft tissue changes, as well as contributions from the skin. A variety of treatment options exist, and a customised management strategy can be developed for the particular anatomic changes present. A literature search using MEDLINE and non-MEDLINE sources was performed utilising keywords including: 'Dark circles' 'infraorbital dark circles', 'infraorbital pigment', 'under-eye circles' and 'lower eyelid bags'. A comprehensive review of the literature was performed and the data were assimilated with evidence from our practice. This review provides a detailed discussion of the aetiology, pathogenesis, evaluation and management of infraorbital dark circles. An understanding of the deep and superficial anatomy is crucial to the management of this complex entity. The armamentarium for treatment includes minimally invasive interventions such as makeup and cosmeceuticals, a variety of laser and chemical treatments, fillers and fat transfer, as well as more invasive surgical manoeuvres.
  18,105 606 -
CASE REPORTS
Giant lipoma of posterior neck with bleeding decubitus ulcer: A rare entity
Manish Varma, Sanjay Kala, RK Singh, Satyajeet Verma
May-August 2010, 3(2):119-121
DOI:10.4103/0974-2077.69027  PMID:21031074
Giant lipomas are benign soft tissue tumours. They are found relatively rarely on the posterior part of the neck. Bleeding pressure ulcer in this giant tumour is a rare presentation. Surgical interventions in these tumours are very challenging because, sometimes, extension to the spinal cord and malignant change may occur, especially in old age. Knowledge of the anatomy and meticulous surgical techniques are needed for such giant lipomas.
  17,730 165 -
LETTER
Different modalities used to treat concurrent lymphangioma of chest wall and scrotum
Bilal Mirza, Lubna Ijaz, Muhammad Saleem, Afzal Sheikh
September-December 2010, 3(3):189-190
DOI:10.4103/0974-2077.74501  PMID:21430837
  15,878 121 -
REVIEW ARTICLES
Cystic hygroma: An overview
Bilal Mirza, Lubna Ijaz, Muhammad Saleem, Muhammad Sharif, Afzal Sheikh
September-December 2010, 3(3):139-144
DOI:10.4103/0974-2077.74488  PMID:21430825
Cystic hygromas are the cystic variety of lymphangioma, common locations being cervico-facial regions and axilla. Respiratory distress, recurrent infections or cosmetic reasons are the main indications of the treatment. The ideal treatment is complete surgical excision; however, there is a gradual conversion towards sclerosant therapy. This article reviews the current literature and discusses the various problems encountered during the management of these lesions.
  15,548 384 6
Fillers: Contraindications, side effects and precautions
Philippe Lafaille, Anthony Benedetto
January-April 2010, 3(1):16-19
DOI:10.4103/0974-2077.63222  PMID:20606987
Fillers are generally considered safe. However side effects may happen and hence a practicing dermatologist need to be aware of such side effects, contraindicatons and precaution to be adopted while using fillers.
  14,837 610 3
Lasers for treatment of melasma and post-inflammatory hyperpigmentation
Pooja Arora, Rashmi Sarkar, Vijay K Garg, Latika Arya
April-June 2012, 5(2):93-103
DOI:10.4103/0974-2077.99436  PMID:23060704
Hyperpigmentary disorders, especially melasma and post-inflammatory hyperpigmentation (PIH), cause significant social and emotional stress to the patients. Although many treatment modalities have been developed for melasma and PIH, its management still remains a challenge due to its recurrent and refractory nature. With the advent of laser technology, the treatment options have increased especially for dermal or mixed melasma. To review the literature on the use of cutaneous lasers for melasma and PIH. We carried out a PubMed search using following terms "lasers, IPL, melasma, PIH". We cited the use of various lasers to treat melasma and PIH, including Q-switched Nd:YAG, Q-switched alexandrite, pulsed dye laser, and various fractional lasers. We describe the efficacy and safety of these lasers for the treatment of hyperpigmentation. Choosing the appropriate laser and the correct settings is vital in the treatment of melasma. The use of latter should be restricted to cases unresponsive to topical therapy or chemical peels. Appropriate maintenance therapy should be selected to avoid relapse of melasma.
  14,246 972 1
Botulinum toxin: Non-cosmetic indications and possible mechanisms of action
Uwe Wollina
January-June 2008, 1(1):3-6
DOI:10.4103/0974-2077.41148  PMID:20300330
Botulinum toxin (BTX) has gained a great interest in cosmetic dermatology for its effects on hyperkinetic facial lines. Understanding the basic research and analysis of effects of this potent drug can lead to other possible indications of interest for dermatologists. The use of BTX in focal hyperhidrosis is well established, but BTX has also effects on pain perception, itch and inflammation as discussed in this review.
  14,081 756 4
Dermal fillers for the treatment of tear trough deformity: A review of anatomy, treatment techniques, and their outcomes
Jaishree Sharad
October-December 2012, 5(4):229-238
DOI:10.4103/0974-2077.104910  PMID:23378704
Tear trough deformity is a major concern in a lot of individuals seeking periorbital rejuvenation. A prominent tear trough deformity is characterised by a sunken appearance of the eye that results in the casting of a dark shadow over the lower eyelid, giving the patient a fatigued appearance despite adequate rest, and is refractory to attempts at cosmetic concealment. The tear trough deformity is a natural consequence of the anatomic attachments of the periorbital tissues. A variety of techniques have evolved to address this cosmetic issue. Traditional techniques relied on surgical excision of skin, muscle, and fat as well as chemical peels. Treatment is now tailored towards specific anatomic abnormalities and often employs multiple modalities including surgery, botulinum toxin, and replacement of volume. Various original research articles, text book publications and review articles were studied. Data specific to the historical aspect and anatomy of tear trough have been enumerated. Techniques of different authors were analysed and their results and complications have been summarised. The technique of the author has also been described here.
  12,633 862 -
ORIGINAL ARTICLES
Microneedling therapy in atrophic facial scars: An objective assessment
Imran Majid
January-June 2009, 2(1):26-30
DOI:10.4103/0974-2077.53096  PMID:20300368
Background: Atrophic facial scars are always a challenge to treat, especially the ones that are deep-seated and/or involve much of the face. Microneedling or dermaroller therapy is a new addition to the treatment armamentarium for such scars that offers a simple and reportedly effective management of these scars. Aims: The aim of the present study was to perform an objective evaluation of the efficacy of dermaroller treatment in atrophic facial scars of varying etiology. Materials and Methods: Thirty-seven patients of atrophic facial scarring were offered multiple sittings of microneedling (dermaroller) treatment and their scars were evaluated and graded clinically and by serial photography at the start as well as at two months after the conclusion of the treatment protocol. Any change in the grading of scars after the end of treatment and follow-up period was noted down. The patients were also asked to evaluate the effectiveness of the treatment received on a 1-10 point scale. The efficacy of dermaroller treatment was thus assessed both subjectively by the patients as well as objectively by a single observer. Results: Overall 36 out of the total of 37 patients completed the treatment schedule and were evaluated for its efficacy. Out of these 36 patients, 34 achieved a reduction in the severity of their scarring by one or two grades. More than 80% of patients assessed their treatment as 'excellent' on a 10-point scale. No significant adverse effects were noted in any patient. Conclusions: Microneedling therapy seems to be a simple and effective treatment option for the management of atrophic facial scars.
  11,454 1,503 20
Medial thighplasty: Horizontal and vertical procedures after massive weight loss
L Labardi, Pietro Gentile, S Gigliotti, M Marianetti, GM Colicchia, M Pascali, L Brinci, V Cervelli
January-March 2012, 5(1):20-25
DOI:10.4103/0974-2077.94330  
Background: The 'medial thigh lift' was first described by Lewis in 1957, but did not receive the widespread acceptance because of the various postoperative complications, such as scar migration with vulvar deformities and early recurrence of ptosis. For this reason, Lockwood developed a technique of anchoring the dermis to the Colles' fascia, to make the surgical outcome more stable over time and to prevent scar migration. In this article, we describe our approaches to the medial thigh lift in post-bariatric surgery patients. Materials and Methods: A total of 45 females underwent medial thigh reduction. In 15 patients with Grade 2 on Pittsburgh Scale (PS), we performed a thigh lift with a horizontal scar; in 15 patients with Grade 2 on PS, we used a technique with a vertical scar; in 15 patients with Grade 3 on PS, the above-mentioned two procedures were combined. When it was really necessary, we also did the liposuction of the medial thigh. The patients were observed every 6 months with a 60-month median follow-up (range: 12-108 months). Results: In six patients was observed scar enlargement due to poor wound healing (one patient with a horizontal scar, three patients with a vertical scar and two with the combined procedure). In two patients with a horizontal scar, minimal scar migration was observed. In three patients, the recurrence of ptosis was evident (one patient with a horizontal scar and two patients with the combined procedure). No skin necrosis was observed. Conclusion: The medial thigh lift surgery is remarkably simple and free of major complications, if the basic anatomy of this region is understood, in order to preserve important structures such as the great saphenous vein and femoral vessels. The only complication is the presence of extensive and visible scars along the thigh, in the case of vertical procedure, and along the inguinal canal, with a possible distortion of the labia major, in the case of horizontal procedure.
  12,293 241 1
REVIEW ARTICLE
Principles and methods of preparation of platelet-rich plasma: A review and author's perspective
Rachita Dhurat, MS Sukesh
October-December 2014, 7(4):189-197
DOI:10.4103/0974-2077.150734  PMID:25722595
The utility of platelet-rich plasma (PRP) has spanned various fields of dermatology from chronic ulcer management to trichology and aesthetics, due to its role in wound healing. Though PRP is being used over a long time, there is still confusion over proper terminology to define, classify and describe the different variations of platelet concentrates. There is also a wide variation in the reported protocols for standardization and preparation of PRP, in addition to lack of accurate characterization of the tested products in most articles on the topic. Additionally, the high cost of commercially available PRP kits, precludes its use over a larger population. In this article, we review the principles and preparation methods of PRP based on available literature and place our perspective in standardizing a safe, simple protocol that can be followed to obtain an optimal consistent platelet yield.
  10,759 1,771 -
CME
Complications of medium depth and deep chemical peels
Nanma Nikalji, Kiran Godse, Jagdish Sakhiya, Sharmila Patil, Nitin Nadkarni
October-December 2012, 5(4):254-260
DOI:10.4103/0974-2077.104913  PMID:23378707
Superficial and medium depth peels are dynamic tools when used as part of office procedures for treatment of acne, pigmentation disorders, and photo-aging. Results and complications are generally related to the depth of wounding, with deeper peels providing more marked results and higher incidence of complications. Complications are also more likely with darker skin types, certain peeling agents, and sun exposure. They can range from minor irritations, uneven pigmentation to permanent scarring. In very rare cases, complications can be life-threatening.
  12,001 382 1
CASE REPORTS
Desire for penile girth enhancement and the effects of the self-injection of hyaluronic acid gel
Enis Rauf Coskuner, Halil Ibrahim Canter
July-September 2012, 5(3):198-200
DOI:10.4103/0974-2077.101382  PMID:23112518
Penile girth enhancement is a controversial subject but demands for enhancement are increasing steadily. Although various fillers have been widely used for soft tissue augmentation, there is no reliable material for this particular situation. Here we report a case of an acute hypersensitivity reaction in a man after his first self-injection of a filler material, which, he claimed, was hyaluronic acid gel for penile girth enhancement and glans penis augmentation.
  11,681 197 -
ORIGINAL ARTICLES
Novel technology in the treatment of acne scars: The matrix-tunable radiofrequency technology
M Ramesh, MG Gopal, Sharath Kumar, Ankur Talwar
May-August 2010, 3(2):97-101
DOI:10.4103/0974-2077.69021  PMID:21031069
Background : Despite the many advances, scarring, particularly acne or pimple scarring, does not have a satisfactory treatment. A new armamentarium in this field is this recently devised matrix-tunable radiofrequency technology, which utilizes radiofrequency emission in the treatment of acne scars. Aims : To evaluate the efficiency of the new matrix-tunable radiofrequency technology in patients with acne scars of varying sizes. Settings and Design : A prospective study of 30 randomly selected patients with acne scars was carried out. Materials and Methods : Thirty healthy patients with different types of acne scars - ice pick, box and rolling type - were randomly selected. The scars were either shallow or deep, varied in size from 2 to 20 mm and ranged in number from 10 to 50. These patients were first treated with broad-spectrum antibiotics and local exfoliating agents (topical tretinoin 0.025%) and then subjected to matrix-tunable radiofrequency technology. Each scar was treated at intervals of 1 month. A maximum of four such sittings were carried out. Patients were followed-up every 15 days. Results were noted at the end of 2 months and 6 months. Improvement was assessed by using the visual analog scale (VAS) at 2 months and 6 months, and results were noted in terms of percentage improvement of the whole face by calculating an average of percentage improvement on the basis of interviews of the patient and his/her accompanying relatives. The visual analog scaling was performed by means of high-resolution digital photographs taken at the baseline and at each subsequent visit. Results : The VAS improvement in scars ranged from 10 to 50% at the end of 2 months to 20 to 70% at the end of 6 months. Of the 30 patients of acne scars, the cosmetic result was excellent (>60% improvement) in four, good (35-60% improvement) in 18 and moderate to poor (<35% improvement) in eight. A few patients reported burning sensation and a mild sunburn-like sensation for about 1 h after treatment. The patients reported a pinkish tone for 2-3 days. Importantly, with the help of some slight make up, all the 30 patients could return to work the following day. Conclusion : Matrix-tunable radiofrequency technology is a safe and economically viable option for the dermatologists for the treatment of acne scars, because of the effective results coupled with a low downtime.
  11,277 362 -
CASE REPORTS
Facial granulomas secondary to injection of semi-permanent cosmetic dermal filler containing acrylic hydrogel particles
Mukta Sachdev, YN Anantheswar, BC Ashok, Sunaina Hameed, Sanjay A Pai
September-December 2010, 3(3):162-166
DOI:10.4103/0974-2077.74493  PMID:21430829
Various reports of long-term complications with semi-permanent fillers, appearing several years after injections have created some concern about their long-term safety profile. We report a case of foreign body granuloma secondary to dermal filler containing a copolymer of the acrylic hydrogel particles, hydroxyethylmethacrylate and ethylmethacrylate, occurring 2 years after the injection. The foreign body granulomas could not be treated satisfactorily with intralesional steroids, and the patient required a surgical excision of her granulomas. The physical and psychological consequences to such patients can be quite devastating.
  11,357 235 4
RESIDENTS PAGE
Microneedling with dermaroller
Satish Doddaballapur
July-December 2009, 2(2):110-111
DOI:10.4103/0974-2077.58529  PMID:20808602
Microneedling with dermaroller is a new treatment modality for the treatment of scars, especially acne scars, stretch marks, wrinkles, and for facial rejuvenation. It is a simple and relatively cheap modality that also can be used for transdermal drug delivery.
  9,744 1,678 17
ORIGINAL ARTICLES
Sheares' Method of Vaginoplasty - Our Experience
Somajita Chakrabarty, Partha Mukhopadhyay, Gouri Mukherjee
May-August 2011, 4(2):118-121
DOI:10.4103/0974-2077.85032  PMID:21976903
Introduction: The Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is one of the most common causes of primary amenorrhoea and is associated with vaginal atresia and absent uterus despite the presence of normal ovaries and external genitalia. Various techniques have been used, with many disadvantages, to create a neovagina. Aims and Objectives: Our aim is to create a neovagina with a simple and safe method. Materials and Methods: We have operated 18 cases of MRKH syndrome with the Sheares' method of vaginoplasty, in which the space between the two labia is dilated with a Hegar's dilator along the vestigial Mullerian ducts. Thus, two tunnels are created and the central septum is excised to form a single vagina. A mould covered with amnion is placed in the neovagina. All cases are followed up for six months. They have all had a good length of vagina with regular manual dilatation. Conclusions: The Sheares' method of vaginoplasty is an easy and safe method to create a neovagina with least complications, like injury to urinary bladder, rectum or bleeding.
  10,986 172 1
LETTERS
Scald burn mimicking genitalia amputation
Ali A Mohammadi, Hamed Ghoddusi Johari
July-September 2012, 5(3):218-218
DOI:10.4103/0974-2077.101399  PMID:23112526
  11,094 63 -
QUIZ
A case of papillary growth from the areola
Alok Vardhan Mathur, S Kudesia, M Anand, M Singh
May-August 2010, 3(2):122-124
DOI:10.4103/0974-2077.69028  PMID:21031075
  10,064 135 -
REVIEW ARTICLES
A review of modern surgical hair restoration techniques
Richard C Shiell
January-June 2008, 1(1):12-16
DOI:10.4103/0974-2077.41150  PMID:20300332
The field of hair restoration has had a chequered history. From the days of punch grafting to the present day techniques of follicular unit hair transplantation, the field has seen a number of new advances. This article reviews these developments.
  9,311 792 3
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