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Chapter 34: Cosmetic Dermatology

Christopher B. Zachary; Gretchen Bellefeuille; Hadley Johnson; Tiana Kazemi; Ronda Farah

INTRODUCTION TO CHAPTER

With regard to aesthetic issues, dermatologists have an important role in guiding their patients and can offer a wide variety of treatment modalities for skin rejuvenation and restoration. Furthermore, many patients with diseases of the skin are understandably concerned about the potential long-lasting effects on their appearance. Understanding the range of options available and the potential treatment outcomes is an important component of helping these patients reach a desired outcome. Moreover, cosmetic treatments can improve a person's self-image and, by extension, quality of life. When our patients feel comfortable with their bodies, they project self-confidence that others pick up on, which may lead to social and economic benefits.

Although many treatments are available, we present below favored treatment strategies. A more comprehensive list of treatment options for specific conditions is summarized in Tables 34-1 and 34-2.

Table 34-1.Non-surgical and minimally invasive treatment modalities for cosmetic disorders. On and off-label treatment options are reviewed.
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Table 34-1. Non-surgical and minimally invasive treatment modalities for cosmetic disorders. On and off-label treatment options are reviewed.
Modality Cosmetic Disorders Notable Adverse Effects
Topical Products
Retinoids Fine and deep wrinkles, lax skin, lentigines, melasma, depressed scars Irritation
Sunscreen Facial erythema and telangiectasias, lentigines, melasma Irritation (chemical sunscreens)

Tyrosinase

Inhibitors

 Lentigines, melasma Irritation

Silicone Gel

Sheeting

 Elevated scars None
Eflornithine Hair reduction Irritation
Minoxidil Hair restoration Irritation, hypertrichosis
Bimatoprost Eyelash growth Irritation, hypertrichosis
Oral Medications
5-alpha Reductase Inhibitors Hair restoration Sexual dysfunction (males), gynecomastia (males), breast tenderness (females), irregular menstrual spotting (females) teratogenic (hypospadias), suicidal ideation
Minimally Invasive
Botulinum Toxin Fine and deep wrinkles, ptosis, hyperhidrosis Asymmetry, brow/lid ptosis
Fillers Fine and deep wrinkles, lax skin, depressed scars, volumetric reduction Asymmetry, allergy, granulomatous reaction, bruising, vascular occlusion, blindness and stoke.
Autologous Fat Transfer Fine and deep wrinkles, lax skin, depressed scars, volumetric reduction Asymmetry, variable take
Mesotherapy Deoxycholic acid Excess body fat Bruising, discomfort, numbness, rare temporary nerve injury (marginal mandibular branch of facial nerve)
Subcision Depressed scars Pain, bruising
Sclerotherapy Spider and varicose veins Post inflammatory hyper-pigmentation, coagulum
Intralesional 5-Fluorouracil Elevated scars, keloids Necrosis, post inflammatory hyper- or hypo-pigmentation
Intralesional Corticosteroid Elevated scars, keloids Atrophy, hypopigmentation
Physical Treatments
Chemical Peels Fine and deep wrinkles, lentigines, melasma, depressed scars Irritation, erythema, scar, post inflammatory hyper- or hypo-pigmentation
Dermabrasion Fine and deep wrinkles, lentigines, melasma, depressed scars Irritation, erythema, scar, post inflammatory hyper- or hypo-pigmentation
Cryotherapy Lentigines, elevated scars Blister, scar, post inflammatory hyper- or hypo-pigmentation
TCA CROSS technique Depressed scars Scar, post inflammatory hyper- or hypo-pigmentation
Pressure Elevated scars None
Compression Stockings Spider veins None

Trichloroacetic acid chemical reconstruction of skin scars, TCA CROSS

Table 34-2.Surgical and devices/laser treatment modalities for cosmetic disorders.
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Table 34-2. Surgical and devices/laser treatment modalities for cosmetic disorders.
Modality Cosmetic Disorders Potential Adverse Effects
Surgical
Facelift Deeper wrinkles, lax skin Scar, ...

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