Publications by authors named "Danielle P Dubin"

22 Publications

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J Am Acad Dermatol 2021 Feb 4. Epub 2021 Feb 4.

private practice, New York, New York.

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http://dx.doi.org/10.1016/j.jaad.2021.02.002DOI Listing
February 2021

Brief Educational Video Improves Patient Understanding of Mohs Surgery: A Randomized Controlled Trial.

Dermatol Surg 2020 Dec 15;Publish Ahead of Print. Epub 2020 Dec 15.

Division of Dermatologic Surgery, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York; Albany Medical College, Albany, New York.

Background: Patient's retention and recall of material discussed in a medical consultation is often inadequate.

Objective: To assess patient's knowledge, anxiety, and understanding of Mohs surgery after viewing a brief educational video.

Method: A prospective, investigator-blinded, randomized controlled trial of 120 consecutive patients before the first Mohs surgery procedure. Sixty subjects viewed an instructional video and 60 subjects did not. A survey was administered to both groups, measuring knowledge, anxiety, and understanding of Mohs surgery.

Results: The video group scored higher than the control group on the knowledge portion of the survey (median score 78% vs 56%, p < .01), but there were no differences in anxiety or understanding scores between groups. The percentage of subjects who answered each knowledge question correctly was greater in the video group than in the control group. In the subgroup of patients who had not previously had a consultation with a Mohs surgeon, the video group had higher median knowledge scores (67% vs 44%, p < .01), higher median understanding scores (8 vs 6, p = .05), and lower median visual analogue anxiety scores (4 vs 6, p = .01) compared with the control group.

Conclusion: A brief educational video increases patient's knowledge of Mohs surgery. For patients who have not yet had a consultation with a Mohs surgeon, the video may also reduce anxiety.
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http://dx.doi.org/10.1097/DSS.0000000000002843DOI Listing
December 2020

Intraoperative Electrosurgical Depilation of a Skin Graft.

J Cutan Aesthet Surg 2020 Jul-Sep;13(3):257-258

Division of Dermatologic Surgery, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, USA.

Full-thickness skin grafts harvested from hair-bearing areas may negatively impact cosmetic outcomes if the recipient site is hairless. Intraoperative depilation of unwanted hair follicles using an electrosurgical device can permanently remove hair with a single treatment and improve overall cosmesis.
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http://dx.doi.org/10.4103/JCAS.JCAS_31_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7646417PMC
November 2020

Basal cell nevus syndrome: From DNA to therapeutics.

Clin Dermatol 2020 Jul - Aug;38(4):467-476. Epub 2020 Mar 25.

Division of Dermatologic Surgery, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.

Basal cell nevus syndrome, also known as Gorlin syndrome, is a hereditary cancer syndrome associated with multiple basal cell carcinomas, congenital defects, and nondermatologic tumors. This disease is autosomal dominant with variable expressivity and is caused by abnormalities in the sonic hedgehog signaling pathway. Management requires a multidisciplinary approach and should include the biopsychosocial needs of patients and their families. Genetic testing is necessary to confirm an unclear diagnosis, evaluate at-risk relatives, and assist with family planning.
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http://dx.doi.org/10.1016/j.clindermatol.2020.03.003DOI Listing
October 2020

Cutaneous Manifestations of COVID-19: An Evidence-Based Review.

Am J Clin Dermatol 2020 Oct;21(5):627-639

Division of Plastic and Reconstructive Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, 1510 San Pablo St., Suite #415, Los Angeles, CA, 90033, USA.

Background: The coronavirus disease 2019 (COVID-19) pandemic has affected 18 million people and killed over 690,000 patients. Although this virus primarily causes respiratory symptoms, an increasing number of cutaneous manifestations associated with this disease have been reported.

Objective: The aim of this review was to collate and categorize the dermatologic findings reported in patients with COVID-19 and identify specific lesions that may facilitate diagnosis and prognostication.

Methods: An evidence-based review of the PubMed database was conducted on 14 May, 2020 using the search terms "Covid-19 skin," "Covid-19 rash," "Covid-19 exanthem," and "Covid-19 chilblains." Peer-reviewed publications containing original COVID-19 patient cases and a discussion of the associated cutaneous findings were included in the analysis.

Results: The literature search identified 115 records, of which 34 publications describing 996 patients with dermatologic conditions were included. Case reports (n = 15), case series (n = 13), and observational prospective studies (n = 4) were the most common publication types. Acral lesions resembling pseudo-chilblains were the most frequent lesion identified (40.4% of cases), appearing in young adults (mean age, 23.2 years) after the onset of extracutaneous COVID-19 symptoms (55/100 patients). Erythematous maculopapular rashes affected 21.3% of patients, most frequently impacting middle-aged adults (mean age, 53.2 years) and occurring at the same time as non-cutaneous symptoms (110/187 patients). Vesicular rashes affected 13.0% of patients, appearing in middle-aged adults (mean age, 48.3 years) after the onset of other symptoms (52/84 patients). Urticarial rashes affected 10.9% of patients, appearing in adults (mean age, 38.3 years) and occurring at the same time as non-cutaneous symptoms (46/78 patients). Vascular rashes resembling livedo or purpura were uncommon (4% of cases), appearing in elderly patients (mean age, 77.5 years) and occurring at the same time as non-cutaneous COVID-19 symptoms (18/29 patients). Erythema multiforme-like eruptions, although infrequent (3.7% of cases), affected mostly children (mean age, 12.2 years).

Conclusions: Vesicular rashes may suggest an initial diagnosis of COVID-19, acral lesions may be most appropriate for epidemiological uses, and vascular rashes may be a useful prognostic marker for severe disease. As a potential correlate to disease severity, prognosis, or infectibility, it is critical that all healthcare professionals be well versed in these increasingly common cutaneous manifestations of COVID-19.
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http://dx.doi.org/10.1007/s40257-020-00558-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7456663PMC
October 2020

Botulinum Toxin for Paramedian Interpolated Forehead Flaps.

J Cutan Aesthet Surg 2020 Apr-Jun;13(2):170-172

Division of Dermatologic Surgery, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

The forehead skin closely resembles the texture and color of the midface region. As such, the use of a paramedian forehead flap to repair a midface defect provides optimal cosmesis; however, the donor forehead site may be left with an undesirable scar in a highly visible region of the face. Cutaneous surgeons possess a variety of traditional techniques intended to minimize scarring. We have found that the addition of 50 units of botulinum toxin at the time of wound closure has improved scar outcomes for patients undergoing reconstruction with paramedian interpolated flaps. Possible mechanisms for the efficacy of botulinum toxin lie in its ability to chemically paralyze the frontalis muscle and glabella complex. This immobilization leads to a reduction in unwanted wound tension during the most vulnerable first few days of healing.
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http://dx.doi.org/10.4103/JCAS.JCAS_56_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7394119PMC
August 2020

Polydioxanone Threads for Atrophic Neck Scars.

Dermatol Surg 2020 Aug 5. Epub 2020 Aug 5.

Division of Dermatologic Surgery, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York.

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http://dx.doi.org/10.1097/DSS.0000000000002535DOI Listing
August 2020

The effect of platelet-rich plasma on female androgenetic alopecia: A randomized controlled trial.

J Am Acad Dermatol 2020 Nov 7;83(5):1294-1297. Epub 2020 Jul 7.

Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York.

Background: Platelet-rich plasma (PRP) may be a useful treatment for androgenetic alopecia (AGA), although objective studies are needed.

Objective: To determine whether PRP injections improve female AGA.

Method: Prospective randomized controlled trial of 30 women diagnosed with AGA. Patients received subdermal scalp injections of Eclipse system PRP or placebo saline at weeks 0, 4, and 8. Outcome measures were changes in hair density (hair/cm), hair caliber (mm), and blinded global photographic assessment (improved or not improved) at week 24.

Results: Blinded global photographic assessment indicated that 57% of patients receiving PRP versus 7% of patients receiving saline improved at week 24 from baseline (P < .01). Compared to baseline, there was improvement in mean density in the PRP group versus the placebo group at week 8 (+71.1 vs -26.7 hairs/cm; P < .01) and week 24 (+105.9 vs -52.4 hairs/cm; P < .01). Compared to baseline, there was improvement in mean caliber in the PRP group versus the placebo group at week 8 (+0.0043 vs -0.0034 mm; P < .01) and week 24 (+0.0053 vs -0.0060 mm; P < .01). Adverse effects included headache, scalp tightness, swelling, redness, and postinjection bleeding.

Limitations: Two patients lost to follow-up.

Conclusions: PRP with the Eclipse system is a safe and effective intervention for female AGA.
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http://dx.doi.org/10.1016/j.jaad.2020.06.1021DOI Listing
November 2020

Antibiotic Practices in Mohs Micrographic Surgery.

J Drugs Dermatol 2020 May;19(5):493-497

Background: Mohs micrographic surgery is a safe procedure with low rates of infection.

Objective: To establish current antibiotic prescribing practices amongst Mohs surgeons.

Methods And Materials: 16-question survey sent to American College of Mohs Surgery members.

Results: 305 respondents with collectively 7,634+ years of experience. The majority performed outpatient surgery (95.0%) and avoided oral or topical antibiotics for routine cases (67.7% and 62.8%, respectively). Prophylactic antibiotics were routinely prescribed for artificial cardiac valves (69.4%), anogenital surgery (53.0%), wedge excision (42.2%), artificial joints (41.0%), extensive inflammatory skin disease (40.1%), immunosuppression (38.9%), skin grafts (36.4%), leg surgery (34.2%), and nasal flaps (30.1%). A minority consistently swabbed the nares to check for staphylococcus aureus carriage (26.7%) and decolonized carriers prior to surgery (28.0%).

Conclusion: Disparity exists in antibiotic prescribing practices amongst Mohs surgeons. There may be under-prescription of antibiotics for high risk factors like nasal flaps, wedge excisions, skin grafts, anogenital/lower extremity site, and extensive inflammatory disease. Conversely, there may be over-prescription for prosthetic joints or cardiac valves. Increased guideline awareness may reduce post-operative infections and costs/side effects from antibiotic over-prescription. J Drugs Dermatol. 2020;19(5): doi:10.36849/JDD.2020.4695.
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May 2020

The Impact of Submental Deoxycholic Acid Injections on Neck Surgery

J Drugs Dermatol 2019 Dec;18(12):1281

Non-invasive procedures targeting the submental fat or “double chin” have undergone a surge in popularity. Injections of deoxycholic acid, a secondary bile acid, have recently received FDA-approval for fat reduction in this area. With appropriate patient selection, this preparation of 10 mg/mL of sodium deoxycholate (Kybella®, Kythera Biopharmaceuticals, Westlake Village, CA) leads to aesthetic improvement of moderate-to-severe convexity or fullness associated with submental fat in adults.
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December 2019

Methacrylate Polymer Powder Dressing for a Nasal Surgical Defect

J Drugs Dermatol 2019 Dec;18(12):1274-1275

The fusion of technology and medicine has led to the advent of advanced wound healing techniques that may be adapted to the management of surgical defects. Shortened duration of healing and ease-of-use are two potential benefits under investigation. Here we describe a 65-year-old male with a nasal alar wound that was allowed to heal with secondary intention, assisted by a novel methacrylate polymer powder dressing. J Drugs Dermatol. 2019;18(12):1274-1275.
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December 2019

Management of Pearly Penile Papules: A Review of the Literature.

J Cutan Med Surg 2020 Jan/Feb;24(1):79-85. Epub 2019 Nov 5.

5925 Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Pearly penile papules (PPPs) are benign, dome-shaped lesions found around the corona of the penis. Despite being asymptomatic and benign in nature, the appearance of PPPs may cause a great deal of psychological distress to both the patient and their sexual partner. While patient reassurance may be the first-line treatment, several other treatment modalities including cryotherapy, electrodessication and curettage, and laser therapy have all been used to treat PPPs in order to achieve a cosmetic outcome that satisfies the patient. Based on the evaluation of the existing literature, ablative laser therapies offer satisfactory cosmetic outcomes with good long-term results.
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http://dx.doi.org/10.1177/1203475419887730DOI Listing
November 2020

Practices in the Usage and Reconstitution of Poly-L-Lactic Acid

J Drugs Dermatol 2019 Sep;18(9):880-886

BACKGROUND: Poly-L-lactic acid (PLLA) is increasingly used for a range of indications, from HIV lipodystrophy to gluteal augmentation; however, there is no clear consensus on appropriate product preparation and use. OBJECTIVE: To establish current practices for PLLA reconstitution and usage in the USA. METHODS AND MATERIALS: A 19-question survey pertaining to the reconstitution and use of PLLA was distributed to members of the American Board of Cosmetic Surgery and American Board of Facial Cosmetic Surgery and at several cosmetic conferences. 410 questionnaires were returned anonymously over a 3-month period. The results were collated and analyzed. RESULTS: The commonest indication for PLLA was HIV lipodystrophy (46.8%), followed by gluteal augmentation (42.4%). For the face, the majority used a dilution of 9-10 mL (60.4%). For the gluteal region, the majority used a dilution greater than 21 mL (51.3%). Most respondents reconstituted PLLA in sterile water (59.8%) more than 21 hours before use (51.0%) and added lidocaine to the solution (94.7%). Most physicians used topical anesthetic cream (83.2%), manual agitation (85.8%) and recommended self-massage post-treatment (99.6%). CONCLUSION: There is considerable variation in PLLA reconstitution and use. Further well-designed studies are needed to establish the safest, most effective ways to use this product. J Drugs Dermatol. 2019;18(9):880-886.
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September 2019

Response to Commentary on Intralesional Deoxycholic Acid as a Neoadjuvant Treatment of a Large Lipoma.

Dermatol Surg 2020 05;46(5):718-719

Division of Dermatologic Surgery, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York.

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http://dx.doi.org/10.1097/DSS.0000000000002136DOI Listing
May 2020

Presurgical Curettage Improves Accuracy for Nonmelanoma Skin Cancer Excision.

J Cutan Med Surg 2019 Nov/Dec;23(6):617-623. Epub 2019 Aug 17.

Division of Dermatologic Surgery, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Background: Presurgical curettage before nonmelanoma skin cancer surgery may help delineate tumor subclinical extensions.

Objective: To determine histologically whether presurgical curettage appropriately or inappropriately changes excision specimen size.

Materials And Methods: One hundred fifty consecutive nonmelanoma skin cancers treated with Mohs micrographic surgery. The clinical margin (CM) was marked. Presurgical curettage was then performed and the resultant presurgical curettage margin (PCM) marked. Frozen section analysis of the CM and PCM revealed whether the curettage-induced margin change was appropriate or unnecessary.

Results: Presurgical curettage appropriately increased the surgical margin in 9.3% of cases, reducing the number of Mohs stages from 2 to 1. It appropriately decreased the surgical margin in 17.3% thereby conserving normal skin. In 19.4% of cases the curettage increased the margin in situations where the CM had underestimated the size of the tumor; however, in these cases, the curettage did not increase the margin sufficiently to clear the tumor. In 44.0% of cases the PCM did not change the size of the stage I specimen compared to the CM and confirmed the CM. In 10.0% of cases, preoperative curettage reduced margin accuracy by removing healthy tissue (8.0%) or underestimating tumor (2.0%). These errors were associated with eyelid location, severe background photodamage, and morpheiform/infiltrating/sclerosing basal cell carcinomas.

Conclusion: Presurgical curettage can improve tumor excision accuracy and efficiency. Careful tumor selection is important to optimize curette utility.
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http://dx.doi.org/10.1177/1203475419871048DOI Listing
August 2020

Acellular Porcine Transitional Cell Matrix Xenograft for Genital Wounds.

Dermatol Surg 2020 09;46(9):1245-1246

Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York.

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http://dx.doi.org/10.1097/DSS.0000000000002096DOI Listing
September 2020

Nitrous Oxide Reduces Pain Associated With Local Anesthetic Injections.

J Cutan Med Surg 2019 Nov/Dec;23(6):602-607. Epub 2019 Aug 12.

Division of Dermatologic Surgery, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Background: Local anesthetic injections can be painful and distressing.

Objective: The aim of this study was to determine whether nitrous oxide, ice, vibration, or topical anesthetic improves analgesia for local anesthetic injections.

Method: A cohort study of 400 patients undergoing Mohs micrographic surgery with local anesthetic was conducted. Patients received no intervention ( = 200), ice ( = 50), topical anesthetic cream ( 50), vibration device ( = 50), or nitrous oxide ( = 50). Pain was rated using the Visual Analogue Scale (VAS) and Wong-Baker FACES Pain Rating Scale.

Results: Without intervention, mean VAS was 4.2 and FACES was 4.6. Nitrous oxide was the most successful in reducing pain (mean VAS 1.6 vs. 4.2, < .01, FACES 1.2 vs. 4.6, < .01). Topical ice reduced pain (mean VAS 3.0 vs. 4.2, < .01, FACES 3.0 vs. 4.6, < .01). Vibration reduced pain (mean VAS 3.5 vs. 4.2, < .01, FACES 3.6 vs. 4.6, < .01). Higher pain scores were associated with age <50 ( = .02), male sex ( = .05), and surgery on the nose, lip, ear, or eyelid ( = .02).

Conclusion: Nitrous oxide, ice, and vibration reduce injection pain. These interventions are especially useful for younger males undergoing surgery on the nose, lip, ear, or eyelid.
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http://dx.doi.org/10.1177/1203475419867606DOI Listing
August 2020

Level of Evidence Review for a Gene Expression Profile Test for Cutaneous Melanoma.

Am J Clin Dermatol 2019 Dec;20(6):763-770

Department of Dermatology, Icahn School of Medicine at Mount Sinai, 234 East 85th Street, 5th Floor, New York, NY, 10028, USA.

Background: The advent of molecular medicine may allow for individualized cancer prognostication, which should enable better clinical management and, hopefully, improve patient outcomes. A 31-gene expression profile (31-GEP) test is currently available for patients diagnosed with cutaneous melanoma; this test helps inform patients' individual treatment plans, especially when combined with traditional biomarkers.

Objective: The objective of this study was to review the current literature and establish the level of evidence for a cutaneous melanoma 31-GEP test.

Methods: A review of seven development and validation studies for the 31-GEP test was conducted. The respective strengths and weaknesses of each study were applied to the level of evidence criteria from major organizations that publish guidelines for melanoma management: American Joint Committee on Cancer, National Comprehensive Cancer Network, and American Academy of Dermatology.

Results: Evaluating each study led to classifying the 31-GEP test as level I/II, I-IIIB, and IIA according to American Joint Committee on Cancer, National Comprehensive Cancer Network, and American Academy of Dermatology criteria, respectively. This stands in contrast to the official unrated status conferred by the American Joint Committee on Cancer and National Comprehensive Cancer Network and the II/IIIC rating designated by the American Academy of Dermatology.

Conclusions: Differences between the authors' findings and official published ratings may be attributed to chronological issues, as many of the studies were not yet published when the aforementioned organizations conducted their reviews. There was also difficulty in applying the National Comprehensive Cancer Network criteria to this prognostic test, as their guidelines were intended for evaluation of predictive markers. Nevertheless, based upon the most current data available, integration of the 31-GEP test into clinical practice may be warranted in certain clinical situations.
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http://dx.doi.org/10.1007/s40257-019-00464-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6872504PMC
December 2019

Intralesional Deoxycholic Acid as Neoadjuvant Treatment of a Large Lipoma.

Dermatol Surg 2020 05;46(5):715-717

Division of Dermatologic Surgery, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York.

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http://dx.doi.org/10.1097/DSS.0000000000002034DOI Listing
May 2020

Poly-L-Lactic Acid for Minimally Invasive Gluteal Augmentation.

Dermatol Surg 2020 03;46(3):386-394

Division of Dermatologic and Cosmetic Surgery, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York.

Background: There is increased emphasis on the importance of the gluteal region in the perception of beauty. Biodegradable fillers provide a nonsurgical method of augmenting and rejuvenating this area.

Objective: To review pertinent aspects of anatomy, patient evaluation, injection technique, and complications for gluteal augmentation using injectable biodegradable fillers.

Methods: The authors review the literature for poly-L-lactic acid-based gluteal augmentation.

Results: Like many aesthetic procedures, there is a paucity of literature on this emerging treatment modality (Level 4, Centre for Evidence-Based Medicine, Oxford). However, the collective clinical experience is that poly-L-lactic acid fillers are an effective treatment for patients seeking noninvasive gluteal enhancement with minimal downtime. Physicians must understand gluteal anatomy and avoid injecting deeply in the danger triangle to prevent intravascular injection into the gluteal vessels or injury to the sciatic nerve. Other safety elements include the use of blunt cannulas, reduced pressures, smaller volumes, and retrograde delivery.

Conclusion: Gluteal augmentation with fillers can safely and effectively improve gluteal firmness, shape, proportion, and projection. Practitioners injecting fillers in the gluteal region must be aware of appropriate patient selection, regional anatomy, and safe injection techniques. Given the increasing demand for this procedure, further high-quality studies are needed.
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http://dx.doi.org/10.1097/DSS.0000000000001967DOI Listing
March 2020

Review of non-invasive body contouring devices for fat reduction, skin tightening and muscle definition.

Australas J Dermatol 2019 Nov 6;60(4):278-283. Epub 2019 Jun 6.

Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA.

Non-invasive body contouring is a rapidly growing field in cosmetic dermatology. Non-invasive contouring devices improve the body's appearance through the removal of excess adipose tissue, particularly in areas in which fat persists despite optimal diet and exercise routine. The technology can also be used for skin tightening. This article reviews the five FDA-approved non-invasive body contouring modalities: cryolipolysis, laser, high-intensity focused electromagnetic field, radiofrequency and high-intensity focused ultrasound. These devices have emerged as a popular alternative to surgical body contouring due to their efficacy, favourable safety profile, minimal recovery time and reduced cost. Although they do not achieve the same results as liposuction, they are an attractive alternative for patients who do not want the risks or costs associated with surgery. When used appropriately and correctly, these devices have demonstrated excellent clinical efficacy and safety.
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http://dx.doi.org/10.1111/ajd.13090DOI Listing
November 2019

Acellular porcine transitional cell matrix xenograft for surgical defects.

Australas J Dermatol 2019 Nov 22;60(4):e345-e346. Epub 2019 May 22.

Division of Dermatologic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

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http://dx.doi.org/10.1111/ajd.13080DOI Listing
November 2019