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. ||Download (.pdf) 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) |
|Lentigines, melasma ||Irritation |
|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 |
Table 34-2.Surgical and devices/laser treatment modalities for cosmetic disorders. ||Download (.pdf) Table 34-2. Surgical and devices/laser treatment modalities for cosmetic disorders.
|Modality ||Cosmetic Disorders ||Potential Adverse Effects |
|Facelift ||Deeper wrinkles, lax skin ||Scar, ...|