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Background: The uptake of topical formulations can be enhanced through laser pretreatments. Newer technologies, such as non-ablative fractional lasers (NAFLs), can target dermal tissues and spare the stratum corneum (SC), which can mitigate common side effects associated with ablative laser treatment., Objective: To discuss the parameters of 2 NAFL pretreatment systems (1440-nm/1927-nm diode system or 1550-nm erbium-doped glass/1927-nm thulium system), which can be paired with topicals to improve their cutaneous uptake., Methods and Materials: The parameters of the 1440-nm/1927-nm diode system and 1550-nm erbium-doped glass/1927-nm thulium system were reviewed, as well as in vivo experiments using both laser systems., Results: Multiple parameters should be optimized to enhance the uptake of various topical formulations and minimize side effects, including wavelength, spot size, density, pulse duration, thermal properties, and topical formulation. Chosen therapeutic parameters must account for patient-specific factors, such as treatment indication, therapeutic area, and Fitzpatrick skin type. In vivo experiments have demonstrated that both laser systems are effective in enhancing the uptake of various topical therapies relative to untreated controls., Conclusion: Individualization of laser system parameters increases efficiency and minimizes risk., (© 2022 Wiley Periodicals LLC.)

This commentary evaluates trends in the factors influencing consumer decision-making for cosmetic dermatologic procedures during the COVID-19 pandemic in the United States. This is a follow-up national survey to one that was published 1 year ago. This study compares the data from Summer 2020 to early Summer 2021, which presents a stark contrast. Our results demonstrate that consumers are now more interested in cosmetic dermatologic procedures compared to 1 year prior. Additionally, they still value the overall safety of the clinic, so physicians should ensure that certain safety measures remain in place despite any decreasing rates of COVID-19 positivity. Our survey sheds more light on current consumer perspectives, which may in turn help physicians adjust their practices to meet current demand. It is important for physicians to be knowledgeable regarding the patterns of consumer decision-making in order to deliver appropriate patient education and provide proper patient outreach during the COVID-19 pandemic., (© 2021 Wiley Periodicals LLC.)

Background: Performing multiple cosmetic treatments in a single session to target different aspects of facial rejuvenation is an effective regimen. Picosecond lasers with a fractionated handpiece can target fine lines, which can supplement submental fat reduction procedures. However, limited data exist on the safety and efficacy of single-session treatment strategies., Aims: To assess the safety and utility of paired facial treatment with 755 nm picosecond laser with diffractive lens array (DLA) and 1060 nm laser lipolysis of the submentum., Patients/methods: A prospective clinical study investigated the utility of paired facial treatment with 755 nm picosecond laser with DLA and 1060 nm diode laser lipolysis of the submentum. Subjects received treatments during the same session. Subjects were enrolled to receive up to 3 picosecond laser and 2 lipolysis treatments at 2-8-week intervals., Results: Eleven subjects completed the study. Mean age was 52.1 years, and 81.8% were female. Fitzpatrick skin types II-VI were represented. For investigator global aesthetics improvement scores (GAIS), 63.6%, 81.8%, and 85.7% had improvement from baseline at 30-, 90-, and 180-day follow-up, respectively. At 180-day follow-up, 100% maintained improvement from 90-day follow-up. At 90-day follow-up, calculations for neck laxity showed a significant improvement of 11.7% from baseline (p < 0.001) with a mean amount of lift of 42.7 mm 2 , which was above the predetermined threshold (20 mm 2 ). No serious or unexpected treatment effects were observed., Conclusion: Paired facial treatment with 755 nm picosecond laser with DLA and 1060 nm laser lipolysis of the submentum improved clinical aesthetic outcomes. This treatment regimen was demonstrated to be safe, well-tolerated, and well-liked by subjects., (© 2021 Wiley Periodicals LLC.)

Combining laser treatments with cosmetic injectables can offer synergistic benefit, increased convenience for both patients and physicians, and lessened overall patient downtime. Although paired treatments can be effective, there remain theoretical concerns that this may add new risks. Theoretical risks of combining laser treatment with neurotoxin injections include unintentional spread of the neurotoxin, which may result in eyelid ptosis and muscle weakness. Potential risks with soft-tissue fillers include unexpected loss of filler volume, necrosis, burn, and product migration. This retrospective chart review of single-session, same-day facial treatments using a low-energy, low-density 1927 nm fractional thulium fiber laser and cosmetic injectables found no adverse events related to this combination approach. This is important safety information that can offer reassurance to physicians using this clinical approach., (© 2021 Wiley Periodicals LLC.)

In recent years, the popularity of fillers has risen significantly. Traditionally, women have undergone the vast majority of cosmetic procedures, but men have steadily shown increasing interest. Recently, significant research has been dedicated to understanding the anatomic differences between male and female facial structures and their clinical aesthetic implications, especially for filler placement. In order to compare actual treatment data to evidence these discussions, we randomly selected 100 cases each of men and women, who were matched for age, and documented their filler placement locations. Facial heat maps were constructed to provide readers with visual evidence. Injections for male cheeks were more inferiomedial, while female cheeks were more superolateral. Men had more jawline fillers, while women had more lip and perioral fillers. Our study builds upon gender-specific considerations. It is important for physicians to be knowledgeable regarding the unique approaches to fillers in men and women in order to deliver more effective, tailored, and high-quality care., (© 2021 Wiley Periodicals LLC.)

This commentary examines the growing popularity of cosmetic procedures in men. With the recent increase in aesthetic procedures across the nation, it is important for physicians to understand trends as they evolve, which can help to optimize clinical training, business operations, and practice management. Although the popularity of cosmetic procedures in men has increased, available data on consumer behavior is limited. Our data fills this gap by examining the patterns of cosmetic procedures in men. Due to hormonal and anatomic differences, the pathophysiology of cutaneous aging differs between sexes, which can have significant implications for treatment. Our data demonstrates a positive trend in recent years and also breaks it down by individual procedures., (© 2020 Wiley Periodicals LLC.)

This commentary examines the utility of arnica in cosmetic dermatology. For many years, arnica has been used to reduce the morbidity associated with various procedures, including surgeries and treatments with lasers and other energy-based devices. Arnica is a traditional homeopathic remedy that can reduce post-procedural edema and bruising. Although it has been used clinically by many physicians and is widely and readily available to patients, the available data is limited and often conflicting. We reviewed the relevant information on arnica and offer our own insights into its use in order to shed more light on its periprocedural utility., (© 2021 Wiley Periodicals LLC.)

Background: Non-invasive body contouring has experienced recent growth. To meet demand, medical spas and non-physician operators have grown. Insights into their practice can provide information on their impact., Objective: Our study investigated the current market distribution of body contouring providers in the aesthetic field., Materials and Methods: For the 30 most populous cities, data were collected for non-invasive body contouring providers in medical spas and physician practices. Descriptive ratios were calculated, and various local factors were examined., Results: The cities with the greatest number of body contouring providers were New York (138), Los Angeles (106), and Houston (87). Population size had a significant relationship, while median household income did not. For number of body contouring providers per 100 000 persons, the top cities were Austin (4.87), Houston (3.74), and Las Vegas (3.41). The mean ratio of providers in medical spas to physician practices was 1.81. In total, 70.0% of cities had equal or more body contouring providers in medical spas than physician practices., Conclusion: Certain cities have experienced an unequal distribution of body contouring providers, and many cities are skewed in favor of medical spas over physician-based practices., (© 2021 Wiley Periodicals LLC.)

Pairing energy-based treatments, including radiofrequency microneedling, with either injectable neuromodulators or soft-tissue fillers can be an effective therapy for facial rejuvenation. However, there remains concerns by some physicians that this combination may add new risks for adverse events. Theoretical risks of combining energy-based treatment with neuromodulator injections include unintentional spread, which may result in eyelid ptosis and asymmetry. Potential risks with soft-tissue fillers include unexpected loss of filler volume, necrosis, burn, and product migration. In order to shed more light on this topic, we performed a retrospective chart review of single-session facial treatments with radiofrequency microneedling and cosmetic injectables over a 4.5 year period. We found no documented adverse events recorded related to combination treatment. This is important information that adds to the patient safety literature., (© 2021 Wiley Periodicals LLC.)

Oral supplementation with collagen peptides has recently grown in popularity. It has been marketed to offer skin rejuvenating properties, such as wrinkle reduction, skin plumping, and moisturizing effects. However, current data are limited regarding its effects on the skin. Despite the controversial status of oral collagen supplements, its popularity has continued to rise. Here, we examine the consumer interest in oral collagen peptides over a 5-year period in the United States., (© 2020 Wiley Periodicals, LLC.)

Platelet-rich plasma (PRP) has recently become a popular treatment for various skin conditions, including striae distensae, acne scars, traumatic scars, hair regrowth, and cutaneous rejuvenation. Although PRP has been utilized in orthopedics for many years, its recent entry into dermatology has been met with controversy. While the recent research has generally been limited and is often contradictory, this has differed from the persuasive marketing campaigns targeting patients and consumers. Aesthetic practitioners should be knowledgeable with the available evidence for PRP in the treatment of striae distensae. Here, we review the pertinent literature and offer additional insights., (© 2020 Wiley Periodicals, LLC.)

Background: Melasma can be associated with immense psychosocial stress, which can impact quality of life. One theory suggests that ultraviolet light can increase plasmin activity in keratinocytes, which has led to the investigation of tranexamic acid for treating melasma, since it possesses anti-plasmin properties. The use of laser-assisted drug delivery can also increase the uptake of topical medications., Aims: A prospective pilot study was performed to assess the utility of combination treatment with low-energy, low-density 1927 nm fractional thulium fiber laser and topical tranexamic acid for melasma., Patients/methods: A total of 10 subjects were enrolled. Each received 5 treatments to the full face with a low-energy, low-density 1927 nm fractional thulium fiber laser. Immediately following treatment, topical tranexamic acid was applied, and subjects were instructed to apply it twice daily for 7 days. Clinical measures, quality of life, and patient satisfaction were assessed., Results: Mean improvements in Melasma Area and Severity Index (MASI) scores were 1.1 (P = .0899), 3.5 (P = .0395), and 2.5 (P = .2429) at 30-, 90-, and 180-day follow-up, respectively. Maximum improvement occurred at 90-day follow-up. The mean improvement of Melasma Quality of Life Scale (MELASQOL) score was 9.6 (P = .0024) at 30-day follow-up. In addition to changes in pigmentation, subjects also believed their skin felt better, looked more radiant, and had improvements in skin texture and tone., Conclusion: Combination of low-energy, low-density 1927 nm fractional thulium fiber laser and topical tranexamic acid improved clinical outcomes and quality of life associated with melasma. This combination treatment was safe, well-tolerated, and well-liked by subjects., (© 2020 Wiley Periodicals LLC.)

This commentary examines the rise of cosmetic procedures in millennials. With the increasing popularity of aesthetic treatments and the growing share of patients who are millennials, it is important for physicians to understand the current trends, which can offer insights to better forecast patient demand and optimize practice management. Although it has been anecdotally reported that the popularity of cosmetic procedures has increased with millennials, available data on consumer behavior is limited. Our data fills this gap in the literature by examining the patterns of cosmetic procedures in millennials and discussing reasons for these findings. Our data proves an overall upward trend and also breaks down these trends for various individual procedures. Physicians can utilize this information to optimize marketing strategies for millennials in order to capture greater market share and potentially increase practice revenues., (© 2020 Wiley Periodicals LLC.)

This commentary examines the seasonality of various procedures in dermatology. With the rising demand of cosmetic procedures, it is important for physicians to understand seasonal trends of their services, which can offer insights to better forecast patient demand and optimize practice management. Although it has been anecdotally reported that the popularity of dermatologic procedures may peak during specific times of the year, available data on consumer behavior is limited. Our data fills this gap in the literature by examining the seasonality of dermatologic procedures and discussing the potential reasons for these findings. Physicians can utilize this information to optimize marketing strategies for particular procedures in order to capture greater market share and potentially increase practice revenues., (© 2020 Wiley Periodicals LLC.)

Background: Topical adjuncts have been investigated to improve clinical outcomes associated with laser resurfacing for photodamage and cutaneous aging. One such product is a tripeptide/hexapeptide serum, which has been shown to increase dermal collagen and elastin as well as improve postprocedural recovery following treatments., Aims: A randomized, blinded, split-face, comparative trial was performed to assess the utility of a tripeptide/hexapeptide serum as a peri-procedural adjunct to nonablative fractional laser resurfacing., Patients/methods: A total of 20 subjects were enrolled. Each hemiface was randomized to either tripeptide/hexapeptide serum or bland moisturizer for twice daily application starting 14 days prior to first laser treatment and continuing until 60 days after. All subjects received 2 treatments to entire face approximately 1 month apart with 1927 nm thulium nonablative fractional laser. Clinical measures and immediate postprocedural recovery were assessed., Results: For each hemiface, scores improved for all measures, including global photodamage, lentigines, pores, radiance, texture, and tone at 30 and 60 days. The tripeptide/hexapeptide serum had greater improvements for all measures at both time points, except for radiance at 60 days, which was equal. In cases where clinical ratings differed between sides, tripeptide/hexapeptide serum more frequently had the superior outcome. Overall, subjects were satisfied with tripeptide/hexapeptide serum. No significant adverse events were observed., Conclusion: Addition of tripeptide/hexapeptide serum as a peri-procedural adjunct to nonablative fractional laser resurfacing improved various clinical measures of photodamage and cutaneous aging and the immediate postprocedural recovery. The tripeptide/hexapeptide serum was demonstrated to be safe, well-tolerated, and well-liked by subjects., (© 2020 Wiley Periodicals LLC.)

This commentary examines the recent general movement in the field of cosmetic dermatology toward imitation and reproduction. The issues of medical spas, nonphysician operators, and counterfeit products have recently garnered interest in aesthetic dermatology. As physicians, it is our professional and bioethical responsibility to ensure that our patients are educated on the presence of medical spas, nonphysician operators, and counterfeit products in our field, especially given the discrepancies in patient safety and outcomes. There are also actions that dermatologists can take in order to help differentiate themselves in this current market. This will not only protect our field, but also our patients, who we are obligated to provide high-quality care for as physicians., (© 2020 Wiley Periodicals LLC.)

In recent years, the focus in the field of health care has shifted toward cost-saving strategies without the sacrifice of patient safety and clinical outcomes. Therefore, we decided to look into the use of nonsterile gloves and sterile gloves during Mohs micrographic surgery. This practice varies widely between Mohs surgeons. However, studies have shown no differences in infection rates. Here, we review the pertinent studies and also combine the data to offer readers an overall financial analysis., (© 2020 Wiley Periodicals, Inc.)

In recent years, the utility of preinjection aspiration for injectable fillers as a safety checkpoint has been debated. It is a clinical technique that has become controversial in both the literature and at national aesthetic conferences. Many consensus papers and anecdotal reports have been divided on how helpful preinjection aspiration is in reducing adverse events and subsequently increasing patient safety. Here, we summarize the prominent studies in the literature and offer an evaluation and insights., (© 2020 Wiley Periodicals, Inc.)

Recently, social media use has skyrocketed, especially with millennials. The use of filtered images and photo editing has led to a new trend of social media-induced dissatisfaction with appearance, termed "snapchat dysmorphia" and "selfie dysmorphia". It is important for practitioners to recognize and understand this trend in addition to knowing how to manage these patients. As clinicians, we have bioethical and professional obligations to educate ourselves on new and relevant trends, ensure adequate patient safety, and advocate for continued consumer education., (© 2019 Wiley Periodicals, Inc.)

In recent years, oral collagen supplements have become a popular and trendy treatment in the world of skin health. It has been widely marketed to consumers for purported benefits in wrinkle reduction, skin-rejuvenation, skin-aging reversal, and skin plumping. However, there are currently limited data available in the literature and much regarding its possible effects on the skin has yet to be fully elucidated and understood. Here, we summarize some of the prominent studies in the literature and offer an evaluation of oral collagen supplementation for skin health., (© 2019 Wiley Periodicals, Inc.)

A common complication of acne vulgaris is clinically significant scarring, which can greatly impact patient quality of life. While treatment options have included microneedling, the recent addition of platelet-rich plasma (PRP) to this regimen has led to an increased popularity of combination treatment. Here, we offer backgrounds on microneedling and PRP therapies and review the literature on combination treatment for acne scars., (© 2019 Wiley Periodicals, Inc.)

This manuscript addresses the use of whole- and partial-body cryotherapy in aesthetic dermatology. Over the past several years, these have become trendy treatments that have been marketed for many purported benefits in overall skin appearance and skin health. With increased access through cryotherapy facilities and medical spas, whole- and partial-body cryotherapy have grown in popularity. Unfortunately, many of the advertised claims have little, if any, scientific evidence behind them. Here, we summarize the data available in the literature. As trends evolve, clinicians should continue to be knowledgeable about them and their evidence in order to properly counsel patients appropriately., (© 2018 Wiley Periodicals, Inc.)

This study addresses the dilemma concerned with meeting patients who may have encountered counterfeit esthetic devices in the marketplace. Over the past several years, we have witnessed a rise in counterfeit injectables and medical devices in our field. Often times, the procedures are marketed to patients at significantly reduced prices compared to competitors. Patients may be unaware that counterfeit devices exist and may unknowingly have procedures completed using untested and uncertified devices. It is important for clinicians to recognize when their patients may be encountering counterfeit devices, know what to do in this situation, and offer the best recommendations., (© 2018 Wiley Periodicals, Inc.)