A prescription for fine-tuning

If you’re looking for a symposium that packs a punch, don’t miss “Finessing Surgical and Cosmetic Techniques” (S010). In this session, seven experts will address relevant, essential techniques from their individual specialties and perspectives. Attendees will learn how to properly identify and apply these techniques to maximize functional and cosmetic outcomes.

Dermatology World Meeting News spoke with several of the speakers in advance to capture their best practices. To learn more, be sure to attend this symposium on Saturday from 9 a.m. to 12 p.m. in Grand Ballroom EF.

Emily de Golian, MD
“Favorite Cosmetic Pearls from Fellowship”
Acne scarring is a frequent reason for cosmetic consultation, often in young patients who have ongoing issues with active acne. Instead of more traditional options like non-ablative laser resurfacing, needle radiofrequency (RF) devices are emerging as a go-to option for acne scarring. Needle RF is safe for active acne and has the added benefit of helping treat active lesions, whereas non-ablative laser should be avoided until acne lesions are clear. Needle radiofrequency technology is also useful for fine lines and wrinkles, tightening, and improving overall skin tone as it promotes collagen remodeling.

Robert Eilers, MD
“Suturing Techniques: Beyond the Basics”
Planning and preparation are essential in obtaining an optimal surgical outcome. I try and focus on three key objectives when performing any surgical reconstruction. First, take the time to prepare the wound prior to suture placement. This includes ensuring that wound edges are perpendicular to the skin surface, that the defect is widely undermined, and that meticulous hemostasis is performed. Second, place the deep sutures in a manner that promotes wound edge eversion. The key to achieving this is to aggressively reflect the exposed wound edge with the non-dominant hand while curving the arc of the needle through the wound though supination of the dominant hand. Finally, always pay attention to placing epidermal sutures in a meticulous, neat manner. The care in which these sutures are placed should reflect the care with which the wound was prepared. Consistently performing these steps increases the likelihood of an aesthetically pleasing surgical reconstruction.

Jennifer Hau, MD
“Surgical and Cosmetic Anatomy”
Understanding lower face and neck anatomy is paramount when incising or injecting. The marginal mandibular nerve exits the parotid and courses anteriorly along or 1-2 cm (up to 4 cm) below the inferior mandibular before moving superiorly across the mandible at the antegonial notch. Nerve damage results in lower lip depression and eversion deficits. The cervical nerve exits the parotid and travels anteriorly across the neck innervating platysma, which contributes to lip depression. Marginal mandibular nerve pseudo-paralysis, or lip depressor dysfunction from cervical nerve injury, has been reported with facelifts. A similar phenomenon described by Sorenson and Chesnut may result from deoxycholic acid injection causing cervical nerve or direct platysma injury. Mentalis function of lip eversion remains intact, thus differentiating these cases from marginal mandibular nerve injury. Performing deoxycholic acid injection anterior to antegonial notch and 1-1.5 cm below the mandibular border while directing injection into the midsubcutaneous space superficial to the platysma are important measures to prevent these injuries.

Swati Kannan, MD
“Favorite Surgical Pearls from Fellowship”
When facing friable or thin skin with epidermis that tears easily, place steri-strips in a parallel fashion along both edges of the wound and suture through the strips in an interrupted manner. This helps the skin edges to approximate without tearing through the epidermis.

Arisa Ortiz, MD
“Techniques for Scar Revision”
When addressing scarring, it is important to treat each aspect of the scar. It’s important to not only address the texture of the scar, but also to address the color. If a scar is red or pigmented, then you want to use a vascular laser or a pigment laser, respectively. Sometimes, if the redness is removed first, the scar is less visible without addressing texture. Multiple modalities may be safely performed on the same day if done appropriately. For example, if you want to address both redness and texture on the same day, perform the vascular laser prior to using a resurfacing laser so you don’t exacerbate non-specific erythema if you reverse the order. Additionally, scars respond best to a lower density. When using a resurfacing laser, I generally keep the density below 15%, while the fluence will be determined by the thickness of the scar. The thicker the scar, the higher the fluence. If a scar is atrophic, then after resurfacing, the results may be augmented with a hyaluronic acid filler. Most importantly, patients need to understand that scar revision requires multiple treatments and scars can never be erased, only softened.

 

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