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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.
  20 17,000 1,850
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.
  17 19,135 2,531
Nonmelanoma skin cancer
Venura Samarasinghe, Vishal Madan
January-March 2012, 5(1):3-10
Nonmelanoma skin cancer (NMSC) represents the most common form of cancer in Caucasians, with continuing increase in incidence worldwide. Basal cell carcinoma (BCC) accounts for 75% of cases of NMSC, and squamous cell carcinoma (SCC) accounts for the remaining majority of NMSC cases. Whilst metastasis from BCC is extremely rare, metastasis from high-risk SCC may be fatal. In this article, we review the aetiology, diagnosis and management of NMSC.
  14 11,486 440
Elevation of the corner of the mouth using Botulinum toxin type A
Alberto Goldman, Uwe Wollina
September-December 2010, 3(3):145-150
DOI:10.4103/0974-2077.74490  PMID:21430826
Indications for botulinum toxin type A have been constantly evolving, and it can currently be used in virtually any area of the face and neck. The authors present their experience with this neurotoxin in treating the platysmal bands and depressor anguli oris muscle with the purpose of cosmetically improving the anterior neck and lifting the oral commissure.
  7 10,397 524
Laugier-hunziker syndrome: A rare cause of oral and acral pigmentation
Silonie Sachdeva, Shabina Sachdeva, Pranav Kapoor
January-April 2011, 4(1):58-60
DOI:10.4103/0974-2077.79199  PMID:21572687
Laugier-Hunziker syndrome (LHS) is an acquired, benign pigmentary skin condition involving oral cavity including lower lip in the form of brown black macules 1-5 mm in size, frequently associated with longitudinal melanonychia. There is no underlying systemic abnormality or malignant predisposition associated with LHS, and therefore the prognosis is good. Important differential diagnoses include Peutz Jeghers syndrome and Addison's disease among other causes of oral and acral pigmentation. Treatment is sought mainly for cosmetic reasons and Q-switched Nd-Yag laser/ Q-switched alexandrite therapy and cryosurgery have been tried with varying success.
  6 9,600 290
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.
  6 18,726 493
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.
  5 35,134 923
A comparison of low-fluence 1064-nm Q-switched Nd: YAG laser with topical 20% azelaic acid cream and their combination in melasma in Indian patients
Charu Bansal, Hira Naik, Hemanta K Kar, Amrita Chauhan
October-December 2012, 5(4):266-272
DOI:10.4103/0974-2077.104915  PMID:23378709
Background: Melasma is an acquired symmetric hypermelanosis characterised by irregular light to gray-brown macules on sun-exposed skin with a predilection for the cheeks, forehead, upper lip, nose and chin. The management of melasma is challenging and requires meticulous use of available therapeutic options. Aims: To compare the therapeutic efficacy of low-fluence Q-switched Nd: YAG laser (QSNYL) with topical 20% azelaic acid cream and their combination in melasma in three study groups of 20 patients each. Materials and Methods: Sixty Indian patients diagnosed as melasma were included. These patients were randomly divided in three groups (group A = 20 patients of melasma treated with low-fluence QSNYL at weekly intervals, group B = 20 patients of melasma treated with twice daily application of 20% azelaic acid cream and group C = 20 patients of melasma treated with combination of both). Study period was of 12 weeks each. Response to treatment was assessed using melasma area and severity index score. Statistical Analysis: The statistical analysis was done using Chi-square test, paired and unpaired student t-test. Results: Significant improvement was recorded in all the three groups. The improvement was statistically highly significant in Group C as compared to group A ( P < 0.001) and group B ( P < 0.001). Conclusions: This study shows the efficacy of low-fluence QSNYL, topical 20% azelaic acid cream and their combination in melasma. The combination of low-fluence QSNYL and topical 20% azelaic acid cream yields better results as compared to low-fluence QSNYL and azelaic acid alone.
  5 6,214 357
The efficacy of silicone gel for the treatment of hypertrophic scars and keloids
Neerja Puri, Ashutosh Talwar
July-December 2009, 2(2):104-106
DOI:10.4103/0974-2077.58527  PMID:20808600
Topical self drying silicone gel is a relatively recent treatment modality promoted as an alternative to topical silicone gel sheeting. Thirty patients with scars of different types including superficial scars, hypertrophic scars, and keloids were treated with silicon gel application. The results of the self-drying silicone gel have been satisfactory.
  5 9,461 831
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.
  4 15,801 264
Management of gingival hyperpigmentation by semiconductor diode laser
Geeti Gupta
September-December 2011, 4(3):208-210
DOI:10.4103/0974-2077.91256  PMID:22279390
Gingival hyperpigmentation is caused by excessive deposition of melanin in the basal and suprabasal cell layers of the epithelium. Although melanin pigmentation of the gingiva is completely benign, cosmetic concerns are common, particularly in patients having a very high smile line (gummy smile). Various depigmentation techniques have been employed, such as scalpel surgery, gingivectomy, gingivectomy with free gingival autografting, cryosurgery, electrosurgery, chemical agents such as 90% phenol and 95% alcohol, abrasion with diamond burs, Nd:YAG laser, semiconductor diode laser, and CO 2 laser. The present case report describes simple and effective depigmentation technique using semiconductor diode laser surgery - for gingival depigmentation, which have produced good results with patient satisfaction.
  4 5,505 417
Tumescent liposuction: A review
Jayashree Venkataram
July-December 2008, 1(2):49-57
DOI:10.4103/0974-2077.44159  PMID:20300344
Liposuction is a cosmetic procedure to remove fat. Liposuction may be performed either under general anaesthesia or under local anaesthesia. The procedure has been reported to be associated with significant morbidity and risk of mortality under general anaesthesia. Since the first description by Jeffrey Klein, dermatologic surgeons have made significant contributions in this field, and tumescent liposuction using microcannuale under local anaesthesia, is regarded as safe and effective. The author has performed over 200 liposuctions in the last four years in India and this article describes the procedure of microcannular tumescent liposuction in the light of her experience.
  4 6,399 856
Giant epithelial malignancies (basal cell carcinoma, squamous cell carcinoma): A series of 20 tumors from a single center
Uwe Wollina, Yousef Bayyoud, Claudia Krönert, Andreas Nowak
January-March 2012, 5(1):12-19
Background: Among nonmelanoma skin cancer (NMSC), basal cell carcinoma (BCC), and squamous cell carcinoma (SCC) are the most common. Giant NMSCs have occasionally reported in the medical literature with particular problems related to diagnosis and treatment. The aim of this study was to analyze patients, treatment, and outcome with giant BCC/SCC. Materials and Methods: We analyzed our files between January 1, 2008, and December 31, 2011, of an academic teaching hospital in the dermatology department. Patients were analyzed according to demographic factors, clinical presentation, histopathology, treatment, and outcome. American Society of Anesthesiology physical status system was used to assess the fitness of patients before surgery. Results: The frequency of giant NMSC was estimated as 0.4% for both tumor entities. 80% of giant BCC patients were female and 100% of giant SCC patients were male. The mean age was 81.5 ± 8.5 years for BCC) and 79.5 ± 11.4 years for SCC. The major anatomical site was the scalp. Four of 10 BCCs were classified metatypic (basosquamous). Perineural infiltration was seen in 5 NMSCs. Seventy percent of patients had an ASA score ≥3. Surgery was performed in general anaesthesia in 5 (BCC) and 6 (SCC) patients, respectively. All other patients were operated in local or tumescence anesthesia. Blood transfusions were necessary in five patients. The primary treatment was delayed Mohs technique. Defect closure was realized with rotational flaps in most cases. Neoadjuvant chemoimmune therapy and adjuvant combined cetuximab/radiotherapy have been performed in three patients. We observed three deaths, all unrelated to NMSC. 75% of patients achieved complete remission. Conclusions: Giant NMSC is uncommon but not rare. These tumors are high-risk subtypes. Treatment needs an interdisciplinary approach.
  4 7,889 220
Effect of carbon dioxide laser ablation followed by intralesional steroids on keloids
Gaurav A Garg, Prajct P Sao, Uday S Khopkar
January-April 2011, 4(1):2-6
DOI:10.4103/0974-2077.79176  PMID:21572673
Abstract : Keloid is a difficult-to-treat condition and an ideal treatment modality is not available. Carbon dioxide (CO 2 ) laser is one of the modalities to treat keloids. Aim : To evaluate the effect of CO 2 laser ablation followed by intralesional steroids on keloids. Settings and Design : This was a prospective, single-center, uncontrolled, open study. Materials and Methods : Twenty-eight patients having 35 keloids were included in the study. Keloids were ablated or excised with CO 2 laser followed by intralesional steroid 3-4 weeks apart for 6 months. Results were evaluated after 6 months of stopping of intralesional steroids. Statistical Analysis : Fisher's exact test was applied for obtaining difference in recurrence rate of regular and irregular patients. Results : Thirteen patients followed up regularly for intralesional steroids. During 6 months of follow-up after stoppage of steroids, only two patients showed recurrence. Ten patients were irregular for intralesional steroids and seven of them showed recurrence. Difference in recurrence rate of regular and irregular patients was significant. Conclusion : Only CO 2 laser ablation is not sufficient for halting the pathogenesis of keloid formation.We therefore conclude that CO 2 laser followed by intralesional steroid is a useful therapeutic approach for the treatment of keloids; however, patients need to be observed for recurrence over the next 1 year.
  4 10,600 497
Evaluation of tissue tightening by the subdermal Nd: Yag laser-assisted liposuction versus liposuction alone
Alberto Goldman, Uwe Wollina, Elsa Cristina de Mundstock
May-August 2011, 4(2):122-128
DOI:10.4103/0974-2077.85035  PMID:21976904
Background: Skin tightening is a desirable outcome for skin flaccidity. Objective: We evaluated the applicability, safety, capacity and intensity of skin tightening with the subdermal 1,064 nm Nd: YAG laser application to the upper arms, and compared the results with liposuction. Materials and Methods: Patients with lipodystrophy and mild-to-severe skin laxity of the arms were included (n=28). In half of patients, a single treatment with a subcutaneous laser and liposuction was performed, while the other 14 had a regular liposuction. Treatment parameters, adverse effects and photographic documentation were recorded. Results: Aesthetic improvement and skin retraction was superior by laser lipolysis. The procedure was well tolerated without significant complications. Conclusions: The subdermal laser-assisted liposuction using a 1,064 nm Nd: YAG laser achieves improved skin tightening.
  4 4,925 236
Honey dressing versus silver sulfadiazene dressing for wound healing in burn patients: A retrospective study
Shilpi Singh Gupta, Onkar Singh, Praveen Singh Bhagel, Sonia Moses, Sumit Shukla, Raj Kumar Mathur
September-December 2011, 4(3):183-187
DOI:10.4103/0974-2077.91249  PMID:22279383
Objective : The aim was to evaluate the effect of honey dressing and silver sulfadiazene (SSD) dressing on wound healing in burn patients. Materials and Methods : We retrospectively reviewed the records of 108 patients (14-68 years of age), with first and second degree burns of less than 50% of the total body surface area admitted to our institution, over a period of 5 years (2004-2008). Fifty-one patients were treated with honey dressings and 57 with SSD. Time elapsed since burn, site, percentage, degree and depth of burns, results of culture sensitivity at various time intervals, duration of healing, formation of post-treatment hypertrophic scar, and/or contracture were recorded and analyzed. Results : The average duration of healing was 18.16 and 32.68 days for the honey and SSD group, respectively. Wounds of all patients reporting within 1 h of burns became sterile with the honey dressing in less than 7 days while there was none with SSD. All wounds treated with honey became sterile within 21 days while for SSD-treated wounds, this figure was 36.5%. A complete outcome was seen in 81% of all patients in the "honey group" while in only 37% patients in the "SSD group." Conclusion : Honey dressings make the wounds sterile in less time, enhance healing, and have a better outcome in terms of hypertropic scars and postburn contractures, as compared to SSD dressings.
  4 9,196 501
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.
  4 15,551 836
Biofilms: Their role in dermal fillers
Anitha B Sadashivaiah, Venkataram Mysore
January-April 2010, 3(1):20-22
DOI:10.4103/0974-2077.63257  PMID:20606988
Fillers are commonly used in several aesthetic indications. Though considered safe, several side effects have been reported. The role of biofilms in the causation of some of these side effects has been elucidated only recently and this article presents a short review of the subject.
  4 4,515 389
Stability in vitiligo: Why such a hullabaloo?
Somesh Gupta
January-June 2009, 2(1):41-42
DOI:10.4103/0974-2077.53101  PMID:20300373
  3 3,248 402
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.
  3 17,875 725
Soft tissue augmentation in dermatology - 2009 update
Michael H Gold
January-April 2010, 3(1):2-10
DOI:10.4103/0974-2077.63220  PMID:20606985
The number of products available to dermatologists for soft tissue augmentation has grown significantly over the past several years in the US. This manuscript will review the various hyaluronic acid fillers and other Food and Drug Administration -approved products we are utilizing for our patients in the rejuvenation process. It is hoped that through this article clinicians will feel more comfortable using these products in their everyday practice of dermatology.
  3 6,169 741
Finasteride-its impact on sexual function and prostate cancer
B Anitha, Arun C Inamadar, S Ragunatha
January-June 2009, 2(1):12-16
DOI:10.4103/0974-2077.53093  PMID:20300365
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.
  3 10,523 718
Pharmacological sphincterotomy for chronic anal fissures by botulinum toxin A
Uwe Wollina
July-December 2008, 1(2):58-63
DOI:10.4103/0974-2077.44160  PMID:20300345
Chronic anal fissure is a common proctologic disease. Botulinum toxin (BTX) can be used for temporary chemical denervation to treat this painful disorder. Its application is by intramuscular injections into either the external or internal anal sphincter muscle. The mode of action, application techniques, and possible complications or adverse effects of BTX therapy are discussed in this report. The healing rate is dependent on the BTX dosage. The short-term healing rate (≤ 6 months) is 60-90%, whereas about 50% of the patients show a complete response in long-term follow-up studies (> 1 year). Adverse effects are generally mild, but relapses occur more often than with surgery. Conservative therapy is currently considered as a first-line treatment. With increasing evidence for its efficacy, BTX can now be considered among the first-line nonsurgical treatements. Although, surgical management by lateral sphincterotomy is the most effective treatment, it shows a higher incidence of incontinence and greater general morbidity rate than BTX. BTX is a useful alternative to surgery and in many cases, surgery can be avoided with the use of BTX.
  3 10,176 660
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.
  3 11,084 892
QYAG5 Q-switched Nd:YAG laser treatment of nevus of ota: An Indian study of 50 patients
Sanjeev Aurangabadkar
July-December 2008, 1(2):80-84
DOI:10.4103/0974-2077.44164  PMID:20300349
Background: Nevus of Ota is very common in Asian patients. The condition is more common in females, with a male-female ratio of 1:4.8. Most patients seek treatment early in life due to the psychological trauma and cosmetic disfigurement. The Q-switched lasers have changed the way we approach the condition and have become the mainstay of therapy. Aims and Objectives: To evaluate long-term safety and efficacy of pigmented lesion laser Palomar QYAG5 Q-switched Nd:YAG in 50 Indian patients. Materials and Methods: Fifty patients of nevus of Ota underwent multiple treatments (average 6 sessions) carried out over a period of 1year with a Q-switched Nd:YAG laser (QYAG5, Palomar, USA). Of the 50 patients, 2 were males; and the rest, females. Five patients had a bilateral involvement. Skin types treated included phototypes 4 and 5. The response after subsequent treatments was documented through serial photographs that were taken before and after the completion of treatments. Patients were followed up for a period of 1 year after the last session. Response to treatment was graded based on physician's global assessment. Results: Excellent improvement was noted in a majority of the patients at the end of the treatments. Greater-than-60% improvement was seen in 66% of the patients. The remaining patients had moderate clearing of pigmentation (30%-60% improvement). No significant adverse effects were seen immediately after the treatments and on long-term follow-up. Transient post-inflammatory hyperpigmentation was observed in 5 (10%) patients, which cleared with use of sunscreens and bleaching agents within 2 months. No textural change or scarring was seen. Hypopigmentation (guttate type) was observed in 1 (2%) patient, which resolved within 3 months. No recurrence was observed after 1 year of follow-up. Conclusion: This study validates the superior efficacy of Q-switched Nd:YAG laser when compared to conventional methods for treatment of nevus of Ota.
  3 6,061 586
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