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Azzalure (Galderma) is a newly approved European botulinum neurotoxin type A (BoNT-A) specifically designed for aesthetic usages. It is sourced from Dysport (Ipsen Ltd.), which has a 20-year product consistency and has been used widely for various therapeutic and aesthetic applications. Azzalure and Dysport are collectively referred to as BoNT-A (Speywood Unit; s.U) (or abobotulinumtoxinA in the U.S.) after their biological activity unit, which is unique and not interchangeable with units of other commercial BoNT-A preparations. Azzalure is approved for the treatment of moderate-to-severe glabellar lines, with a total dose of 50 s.U distributed evenly among 5 injection points. To ensure optimal treatment outcomes with BoNT-A (s.U), it is crucial for injectors to adopt proper methods of reconstitution and injection, which can be acquired through training. We review here the method of reconstitution for BoNT-A (s.U), as well as the injection dose, points and techniques for glabellar line treatment. We also review the efficacy and safety results of BoNT-A (s.U) demonstrated in 11 clinical studies, most of which were randomized, double-blind and placebo-controlled. The studies included assessments after single injections as well as after up to 6 repeated treatment sessions. We summarize the clinical efficacy results, which include the responder rate 1 month post-injection, onset of response and duration of action, as well as safety results, which include incidence of treatment-emergent adverse events and specifically eyelid ptosis. The efficacy and safety profiles reported here are unique to BoNT-A (s.U) and cannot be generalized to other BoNT-A products. [ABSTRACT FROM AUTHOR]

Background: The methods described to achieve intraoperative tissue expansion have drawbacks., Objective: To report an intraoperative tissue expansion technique using standard suture material and hemostats to create a "modified" winch stitch., Methods: A continuous running suture is placed with both ends left free. A "fixed" hemostat is placed above the skin at one end. After pulling at the other end with a second hemostat, a third hemostat is placed proximal to this hemostat just above the skin, which is left in place to produce stretching. The second and third hemostats are then used in an alternating pulling and holding fashion., Results: This method produces significant tissue expansion. If the desired degree of approximation is achieved, the ends of the suture can be tied together, as in the previously described winch stitch., Conclusion: The modified winch stitch is a simple and inexpensive means to facilitate closure of wounds under a significant amount of tension.

Chemical peeling remains a valuable tool for the cosmetic surgeon to treat photoaging skin. Choices available include superficial, medium, and deep chemical peeling agents along with preparatory cosmoceutical agents to prep the skin and maintain rejuvenation. This article will prepare the cosmetic surgeon to include the latest agents in his practice and correctly choose which treatment is best for patients with individual problems of photoaging of the face and body, acne scars, and pigmentary problems. These modalities will be compared with other treatment modalities, such as laser and dermabrasion.

The combination medium-depth chemical peel (Jessner's solution +35% TCA) has been accepted as a safe, reliable, and effective method for the treatment of moderate photoaging skin. This article discusses the procedure in detail, including postoperative considerations.

For many decades, chemical peeling has played an important role in facial rejuvenation. These procedures are safe and effective in the management of photoaging, scarring, pigmentary dyschromias, and in the destruction of superficial skin lesions. Chemical peels are classified into superficial, medium, and deep according to their level of injury to the skin. It is the responsibility of the surgeon to assist the patient in choosing the resurfacing procedure that will most effectively satisfy his or her goals while maintaining a high margin of safety. With the current availability of various microdermabrasion and laser systems for facial rejuvenation, chemical peeling continues to be an integral part of a facial rejuvenation program because of its popularity with patients and minimal costs to the physician.

The Jessner's + TCA peel is an enhanced medium-depth peel that is a combination of two acidic compounds. It has been found to be effective as a peeling procedure for moderately photoaging skin, actinic keratoses, and superficial acne scars.

The Jessner's-trichloroacetic acid (TCA) peel is a procedure developed by Monheit to produce a safe, effective medium-depth chemical peel for the treatment of photoaged skin, actinic keratoses, and superficial acne scars. The technique of pretreatment degreasing and combination chemicals allow a deeper penetration for the 35% TCA, increasing its efficacy while preserving its safety. Technique and methods are reviewed.

An approach to head and neck skin lesions is presented as an alternative to excisional surgery. Dermaplaning, curettage, electrodesiccation, cryosurgery, and chemosurgery are presented as alternative approaches to the eradication of selective skin lesions.

The Jessner's + TCA peel, a method of chemexfoliation, is a combination of two acidic compounds. It has been found to be an effective peeling procedure that produces a medium-depth peel for photoaging skin, actinic keratoses, and rhytides.

Competence in nail surgery requires a full understanding of the anatomy and structural relationship of the parts of the nail unit. A further facility to delineate the nail components allows the dermatosurgeon to approach the nail unit surgically and to correct any of its parts. This review has been an attempt to introduce the principles of nail surgery and analyze in depth four office nail surgical techniques. The techniques of nail plate avulsion, nail bed and matrix biopsy, matricectomy, and lateral wall excision are the most commonly used surgical modalities of the nail. These four techniques will give the dermatosurgeon the tools to treat most surgical nail problems.

A patient with extensive systemic mastocytosis and the mastocytosis syndrome was studied by light and electron microscopy. Mast cell proliferation was found in the bone marrow, the liver, spleen and lymph node. In addition, the patient had telangiectasia macularis eruptiva perstans and elevated histamine levels.

The rhomboid flap has proved to be a useful local pedicle flap for repair of full-thickness defects near free margins. The rhomboid flap utilizes the dynamics of both rotation and transposition of tissue. An analysis of rhomboid closures demonstrates its applicability for the repair of eyelids, the nose, and defects of the oral lips.

The authors have illustrated the use of the Mohs technique on periorbital skin cancer. The indications for the technique are documented for eyelid and canthal neoplasia, and the case histories illustrate the potential danger of skin cancer in this area. It is the well balanced team of micrographic surgeons and reconstructive surgeons that will give the patient the best result.