Botulinum toxin A (BTX-A), a purified protein derived from the bacteria Clostridium botulinum , has been widely used in aesthetic dermatology. Though BTX-A was initially used by neurologists extensively for neurological conditions such as blepharospasm, strabismus headaches, dystonia and spasticity, it has become popular among dermatologists and plastic surgeons for its cosmetic indications. Its use in pregnancy has been controversial and this article deals with the issues of use of BTX-A in pregnancy.

Blepharoplasty plays a vital role in facial rejuvenation, with direct aesthetic relation to the brow and the cheek. Upper and lower eyelid blepharoplasty are indicated for the treatment of excess skin and/or orbital fat. Preoperative evaluation should include a thorough medical and ophthalmic history, along with a detailed cutaneous and eye examination. Symptoms of preexisting dry eye should be elicited preoperatively, as they directly correlate with postoperative complications. Physical examination should take into account brow position, eyelid ptosis, lower eyelid position, and cheek projection. Blepharoplasty can be performed by many operative approaches. This review highlights the standard skin-only upper blepharoplasty and lower eyelid conservative fat excision or repositioning.

Finasteride, a specific and competitive inhibitor of 5a-reductase enzyme Type 2, inhibits the conversion of testosterone to dihydrotestosterone (DHT). In adults, DHT acts as primary androgen in prostate and hair follicles. The only FDA-approved dermatological indication of finasteride is androgenetic alopecia. But, apprehension regarding sexual dysfunction associated with finasteride deters dermatologists from prescribing the drug and patients from taking the drug for androgenetic alopecia. Testosterone, through its humoral endocrine and local paracrine effects is relevant in central and peripheral modulation of sexual function than locally acting DHT. Several large population-based long-term placebo-controlled studies, using International Index of Erectile Function-5 questionnaire and objective method (Nocturnal Penile Tumescence) to assess the erectile function have demonstrated no clear evidence of the negative effect of finasteride on erectile function. Reduction in ejaculatory volume is the only established causal relationship between finasteride and sexual dysfunction. Though finasteride causes significant reduction in all the semen parameters except sperm morphology, they did not fall below the threshold levels to interfere with fertility. Therefore, the sexual adverse effects associated with finasteride should be viewed in relation to normal prevalence and natural history of erectile dysfunction in the population, age of the patient, other confounding factors and also nocebo effect. The impact of finasteride on the prevention of prostate cancer has been discussed extensively. Finasteride is found to be effective in significantly reducing the incidence of low-grade prostate cancer. But the paradoxical increase in high-grade cancer in the finasteride group has been attributed to increased sensitivity and improved performance of prostate specific antigen levels to detect all grades of prostate cancer.

In recent years the interest for natural substances in dermatotherapy and cosmetics has increased. Peat is a complex natural source of humic substances that are of potential interest in both dermatology and cosmetology. Humic substances in peat have been partially characterized and pharmacologic and biologic activities have been documented. Possible clinical applications are outlined.

Background: Soft tissue augmentation with autologous fat graft has been increasingly used by plastic surgeons despite unpredictable results. Several techniques have been described to prevent the main setback of this technique, fat graft resorption. However, there is no ideal technique described for this purpose. Materials and Methods: Twenty patients with subcutaneous tissue loss, atrophy or hypoplasia were treated with lipofilling. A subcutaneous pouch is dissected at the deformed area and later it is filled with autologous fat graft. Results: Graft maintenance during the postoperative period was satisfactory. Overcorrection was not performed except for the first three cases. Patient, surgeon and layman satisfaction was surveyed. Satisfaction was rated between 0 and 10. The mean score was 7.67 ± 1.22. Conclusion: The authors describe a technique for soft tissue augmentation which effectively corrects contour deformities, provides a low resorption rate and a relatively non-visible scar without causing irregularities.

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.

Serenoa repens is one among the many naturally occurring 5 alpha reductase (5aR) inhibitors which has gained popularity as a magical remedy for androgenetic alopecia. It is widely advertised on the web and sold by direct marketing. Used as a self-medication, there is a risk of missing the early detection of prostate cancer. There is little evidence to support its efficacy, warranting larger clinical trials on androgenetic alopecia.

Aquired lymphangiectasis of the vulva is an uncommon condition and only few cases have been reported following tuberculous lymphadenitis. A case is reported that was successfully treated with a unique combination therapy of radiofrequency ablation and sclerotherapy with polidocanol. There was no recurrence at two years of follow-up.

Pilomatrixomas are uncommon in children and are frequently misdiagnosed preoperatively. We report a two-year-old female patient with an unusual localization in the earlobe. The lesion was treated by simple enucleation and in two years of follow-up there has been no evidence of recurrence. The case is being reported in view of its rarity and unusual location.