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Chapter 40: Cosmetic Concerns

Khaled M. Hassan; Christopher B. Zachary

INTRODUCTION TO CHAPTER

Dermatologists have an important role in guiding their patients with regard to cosmetic and aesthetic issues and can offer a wide variety of treatment modalities for skin rejuvenation and restoration. Many patients with diseases of the skin are understandably concerned about the potential long-lasting adverse 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, in this chapter we present favored treatment strategies. A comprehensive list of treatment options for specific conditions is summarized in Tables 40-1 and 40-2.

Table 40-1.Non-surgical and minimally invasive treatment modalities for cosmetic disorders.
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Table 40-1. Non-surgical and minimally invasive treatment modalities for cosmetic disorders.
Modality Cosmetic Disorders Potential Adverse Effects
Topical products
Retinoids Fine and deep wrinkles, lax skin, lentigines, melasma, and depressed scars Irritation
Sunscreen Facial erythema, facial telangiectasias, lentigines, and melasma None
Tyrosinase inhibitors Lentigines, melasma Irritation
Silicone gel sheeting Elevated scars None
Eflornithine Hair removal Irritation
Minoxidil Hair restoration Irritation and hypertrichosis
Bimatoprost Eyelash growth Irritation and hypertrichosis
Oral medication
5-α reductase inhibitors Hair restoration Sexual dysfunction, gynecomastia, and teratogenic (hypospadias)
Minimally invasive
Botulinum toxin Fine and deep wrinkles, ptosis, and hyperhidrosis Asymmetry and brow/lid ptosis
Fillers Fine and deep wrinkles, lax skin, depressed scars, and volumetric reduction Asymmetry, allergy, granulomatous reaction, bruising, and vascular occlusion
Autologous fat transfer Fine and deep wrinkles, lax skin, depressed scars, and volumetric reduction Asymmetry and variable results
Mesotherapy (ATX101) Excess body fat Bruising and discomfort
Subcision Depressed scars Pain and bruising
Sclerotherapy Spider and varicose veins Postinflammatory hyperpigmentation, and coagulum
Intralesional 5-fluorouracil Elevated scars and keloids Necrosis and postinflammatory hyper- or hypopigmentation
Intralesional corticosteroid Elevated scars and keloids Atrophy, hypopigmentation
Physical treatments
Chemical peels Fine and deep wrinkles, lentigines, melasma, and depressed scars Irritation, erythema, scar, and postinflammatory hyper- or hypopigmentation
Dermabrasion Fine and deep wrinkles, lentigines, melasma, and depressed scars Irritation, erythema, scar, and postinflammatory hyper- or hypopigmentation
Cryotherapy Lentigines and elevated scars Blister, scar, and postinflammatory hyper- or hypopigmentation
TCA CROSS technique Depressed scars Scar and postinflammatory hyper- or hypopigmentation
Pressure Elevated scars None
Compression stockings Spider veins None
Table 40-2.abSurgical and devices/laser treatment modalities for cosmetic disorders.
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Table 40-2. Surgical and devices/laser treatment modalities for cosmetic disorders.
...
Modality Cosmetic Disorders Potential Adverse Effects
Surgical
Facelift Deeper wrinkles, lax skin a
Suture suspension lift Deep wrinkles, lax skin a
Blepharoplasty Lax skin a
Liposuction Excess body fat a
Abdominoplasty Lax skin a
Punch excision Depressed scars Scar
Surgical excision

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