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Bhardwaj V, Handler MZ, Mao J, Azadegan C, Panda PK, Breunig HG, Wenskus I, Diaz I, König K. A novel professional-use synergistic peel technology to reduce visible hyperpigmentation on face: Clinical evidence and mechanistic understanding by computational biology and optical biopsy. Exp Dermatol 2024; 33:e15069. [PMID: 38568090 DOI: 10.1111/exd.15069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 02/03/2024] [Accepted: 03/14/2024] [Indexed: 04/05/2024]
Abstract
Topicals and chemical peels are the standard of care for management of facial hyperpigmentation. However, traditional therapies have come under recent scrutiny, such as topical hydroquinone (HQ) has some regulatory restrictions, and high concentration trichloroacetic acid (TCA) peel pose a risk in patients with skin of colour. The objective of our research was to identify, investigate and elucidate the mechanism of action of a novel TCA- and HQ-free professional-use chemical peel to manage common types of facial hyperpigmentation. Using computational modelling and in vitro assays on tyrosinase, we identified proprietary multi-acid synergistic technology (MAST). After a single application on human skin explants, MAST peel was found to be more effective than a commercial HQ peel in inhibiting melanin (histochemical imaging and gene expression). All participants completed the case study (N = 9) without any adverse events. After administration of the MAST peel by a dermatologist, the scoring and VISIA photography reported improvements in hyperpigmentation, texture and erythema, which could be linked to underlying pathophysiological changes in skin after peeling, visualized by non-invasive optical biopsy of face. Using reflectance confocal microscopy (VivaScope®) and multiphoton tomography (MPTflex™), we observed reduction in melanin, increase in metabolic activity of keratinocytes, and no signs of inflammatory cells after peeling. Subsequent swabbing of the cheek skin found no microbiota dysbiosis resulting from the chemical peel. The strong efficacy with minimum downtime and no adverse events could be linked to the synergistic action of the ingredients in the novel HQ- and TCA-free professional peel technology.
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Affiliation(s)
- Vinay Bhardwaj
- Department of Global Personal Care and Skin Health R&D, Colgate-Palmolive Company, Piscataway, New Jersey, USA
| | - Marc Zachary Handler
- Dermal Clinical Research, Colgate-Palmolive Company, Piscataway, New Jersey, USA
| | - Junhong Mao
- Department of Global Personal Care and Skin Health R&D, Colgate-Palmolive Company, Piscataway, New Jersey, USA
| | - Chloe Azadegan
- Department of Global Personal Care and Skin Health R&D, Colgate-Palmolive Company, Piscataway, New Jersey, USA
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Pritam K Panda
- Department of Physics and Astronomy, Uppsala University, Uppsala, Sweden
- Nerdalytics, Uppsala, Sweden
| | | | | | - Isabel Diaz
- Dermal Clinical Research, Colgate-Palmolive Company, Piscataway, New Jersey, USA
| | - Karsten König
- JenLab GmbH, Berlin, Germany
- Department of Biophotonics and Laser Technology, Saarland University, Saarbrucken, Germany
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Content and Readability of Online Recommendations for Breast Implant Size Selection. Plast Reconstr Surg Glob Open 2023; 11:e4787. [PMID: 36699215 PMCID: PMC9872969 DOI: 10.1097/gox.0000000000004787] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 12/05/2022] [Indexed: 01/26/2023]
Abstract
Breast augmentation is one of the most frequently performed aesthetic procedures in the United States. Online information is often used by patients to make decisions when undergoing cosmetic procedures. It is vital that online medical information includes relevant decision-making factors and uses language that is understandable to broad patient audiences. Ideally, online resources should aid patient decisions in aesthetic surgical planning, especially implant size selection for breast augmentation. We describe patient decision-making factors and readability of breast implant size selection recommended by private practice plastic surgery webpages. Methods Using a depersonalized, anonymous query to Google search engine, the terms "breast implant size factors" and "breast implant size decision" were searched, and 52 plastic surgery private practice webpages were identified. Webpages were analyzed for reported decision-making factors of implant size selection. Readability analyses of webpages were performed with Readability Studio and Hemingway Editor. Results The two major decision-making factors for implant size selection reported by webpages were body/tissue-based measurements and surgeon input. Ten factors related to patient lifestyle, surgical goals, and procedural options were also identified. Average webpage scores for five readability measures exceeded recommended levels for medical information. Conclusions Reported decision-making factors for implant size selection emphasize a plastic surgeon's expertise but may enhance the patient's role in preoperative planning. Webpages describing breast implant size selection exceed the sixth and eighth grade reading levels recommended by the AMA and NIH, respectively. Improving the readability of webpages will refine the role of online medical information in preoperative planning of breast augmentation.
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Websites or Videos: Which Offer Better Information for Patients? A Comparative Analysis of the Quality of YouTube Videos and Websites for Cosmetic Injectables. Plast Reconstr Surg 2022; 149:596-606. [PMID: 35006207 DOI: 10.1097/prs.0000000000008827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND YouTube is used by more than 70 percent of adults and 81 percent of 15- to 25-year-olds. The information quality of videos related to the two most performed aesthetic procedures-botulinum toxin type A (Botox) and soft-tissue filler injections-has not been assessed or compared to that of websites. METHODS A YouTube search for "Botox" and "fillers" was performed in July of 2020, identifying the most popular health information videos. Quality was assessed using the validated Journal of American Medical Association, Health on the Net principles, and the DISCERN criteria in addition to a procedure-specific content score. Quality scores were compared between different groups of video contributors and against websites. RESULTS A total of 720 measurements of quality were performed across 95 YouTube videos and 85 websites. The mean quality scores were as follows: Journal of the American Medical Association, 1.74/4 ± 0.718; Health on the Net, 6.66/16 ± 2.07; DISCERN, 40.0/80 ± 9.25; and content, 39.1/100 ± 11.9. Physician, nonphysician health professionals, and other (news, magazine channels, and influencers) were all of higher quality than patient-based videos (p < 0.001). The mean DISCERN percentage score for videos was 50.04 ± 11.57 and significantly less than that of websites, 55.46 ± 15.74 (p = 0.010). The mean content scores showed a similar result, 39.06 ± 11.92 versus 60.76 ± 17.65 (p < 0.001), respectively. CONCLUSIONS Improvement is needed in the quality of YouTube videos related to aesthetic injectables. Plastic surgeons, who are the most frequent video contributors, are most qualified to provide this change. Plastic surgeons should include videos as part of their online presence, as they may help facilitate a greater viewership.
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Hibler BP, Eliades PJ, Kagha KC, Avram MM. Litigation Arising From Minimally Invasive Cosmetic Procedures: A Review of the Literature. Dermatol Surg 2021; 47:1606-1613. [PMID: 34417380 DOI: 10.1097/dss.0000000000003202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Minimally invasive cosmetic procedures are on the rise. To meet this rising demand, increasing numbers of physicians and nonphysicians are performing these procedures. Understanding malpractice trends and reasons for litigation in cosmetic medicine is important to establish safeguards for patient care and minimize liability. OBJECTIVE Perform a comprehensive review of the literature on litigation associated with minimally invasive cosmetic procedures and discuss strategies to avoid facing a lawsuit. MATERIALS AND METHODS The authors searched PubMed databases using a variety of keywords to identify studies of lawsuits arising from minimally invasive cosmetic procedures through December 2020. RESULTS A total of 12 studies of litigation meeting inclusion criteria were identified: botulinum toxin (1), soft tissue fillers (3), lasers (5), body contouring/liposuction (1), chemical peels/dermabrasion (1), and sclerotherapy (1). Principle factors associated with litigation included negligence, lack of informed consent, vicarious liability for action of delegates, lack of communication, poor cosmetic result, failure to inform of risks, inappropriate treatment or dose, and failure to recognize or treat injury. CONCLUSION Understanding malpractice trends and reasons for litigation in minimally invasive cosmetic procedures can strengthen the patient-provider relationship, establish safeguards for patient care, and may minimize future risk of a lawsuit.
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Affiliation(s)
- Brian P Hibler
- Department of Dermatology, Dermatology Laser and Cosmetic Center, Massachusetts General Hospital, Boston, Massachusetts
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Karen C Kagha
- Department of Dermatology, Dermatology Laser and Cosmetic Center, Massachusetts General Hospital, Boston, Massachusetts
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mathew M Avram
- Department of Dermatology, Dermatology Laser and Cosmetic Center, Massachusetts General Hospital, Boston, Massachusetts
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Sarmiento S, Wen C, Cheah MA, Lee S, Rosson GD. Malpractice Litigation in Plastic Surgery: Can We Identify Patterns? Aesthet Surg J 2020; 40:NP394-NP401. [PMID: 31563936 DOI: 10.1093/asj/sjz258] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Malpractice litigation has a significant impact on healthcare costs and important professional implications for healthcare providers. OBJECTIVES The authors sought to comprehensively characterize the litigation landscape in plastic surgery across its different subspecialties. METHODS The authors utilized the Westlaw legal database to conduct a comprehensive search of malpractice cases in the United States in the following categories: cosmetic, reconstructive, hand, craniofacial, and gender affirmation surgery. They conducted both a Boolean and a natural language search to identify cases in which a plastic surgeon was the defendant. Data were analyzed employing descriptive statistics, logistic regression, and relative risk calculations. RESULTS In total, 165 cases were included. Most surgeons accused of malpractice worked in a private setting (148 [90%]). Among the 22 (13%) cases that contained information on board certification status, most surgeons were board certified (17 [77%]). Resident involvement was mentioned in only 5 (3%) cases. The majority of cases were successfully defended by surgeons (98 [60%] vs 65 [40%]), particularly in craniofacial surgery (risk ratio: 1.54; P = 0.03; 95% CI: 1.03-2.3). Surgeons who successfully defended a case were more likely to benefit from summary judgment (P = 0.005). CONCLUSIONS Malpractice litigation is commonplace in medical practice, and no specialty is spared. Legal outcomes were in favor of plastic surgeons in the majority of cases, particularly those that proceeded to summary judgment. Surgeons can avoid litigation by maintaining detailed office and surgical notes, always obtaining informed consent, adequately following and monitoring patients after surgery, and ensuring compliance by communicating frequently and effectively.
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Affiliation(s)
- Samuel Sarmiento
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Charles Wen
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Michael A Cheah
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Stacey Lee
- Law and Ethics, Carey Business School, Johns Hopkins University, Baltimore, MD
| | - Gedge D Rosson
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
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Chen C, Lin CF, Chen CC, Chiu SF, Shih FY, Lyu SY, Lee MB. Potential media influence on the high incidence of medical disputes from the perspective of plastic surgeons. J Formos Med Assoc 2017; 116:634-641. [PMID: 28372854 DOI: 10.1016/j.jfma.2017.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 01/16/2017] [Accepted: 01/17/2017] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND/PURPOSE The main purpose of this study is to investigate the prevalence of medical disputes among plastic surgeons in Taiwan and to elucidate their perspectives regarding the influence of medical litigation media coverage on the physician-patient relationship. METHODS A self-administered questionnaire was distributed among plastic surgeons attending a series of continuing education training lectures organized by the Taiwan Society of Plastic Surgery in 2015. RESULTS Of the 109 respondents, over a third (36.4%) had previously experienced a medical dispute. The vast majority of both physicians who had medical disputes (77.1%) and those who did not (72.1%) felt that the media tends to be supportive of patients in their reporting, and 37.1% of all plastic surgeons felt that the media always portrays the patient as a victim. Respondents who experienced medical disputes in this study felt that the top five leading causes of the high incidence of medical disputes were patient disappointment with procedure results (81.1%), insufficient patient psychological preparation or emotional instability (61.7%), inadequate risk communication on the part of the physician (64.9%), patient uneasiness with the procedure or perception of carelessness (60.6%), and insufficient physician training or incorrect medical evaluation (57.4%). CONCLUSION Over a third of the respondents had previously experienced a medical dispute. This study highlights the perception among plastic surgeons that the media reporting of medical disputes and medical litigation is biased in favor of the patients, with 37.1% of the plastic surgeons surveyed opining that patients are always cast as victims.
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Affiliation(s)
- Chiehfeng Chen
- Division of Plastic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Public Health, School of Medicine, College of Medicine, Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
| | - Ching-Feng Lin
- School of Public Health, Taipei Medical University, Taipei, Taiwan; Keelung Hospital, Ministry of Health and Welfare, Keelung, Taiwan; Department of Public Health, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Cha-Chun Chen
- Department of Plastic Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Shih-Feng Chiu
- Professional Master Program in Pharmaceutics and Biotechnology, Taipei Medical University, Taipei, Taiwan
| | - Fuh-Yuan Shih
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Shu-Yu Lyu
- School of Public Health, Taipei Medical University, Taipei, Taiwan; Department of Leisure Industry and Health Promotion, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
| | - Ming-Been Lee
- Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Psychiatry, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
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Aicher RH. Commentary on: unattractive consequences: litigation from facial dermabrasion and chemical peel procedures. Aesthet Surg J 2014; 34:1250-1. [PMID: 25077485 DOI: 10.1177/1090820x14545868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Robert H Aicher
- Mr Aicher has been General Counsel for the American Society for Aesthetic Plastic Surgery since 1998
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