Publications by authors named "Jeffrey S Dover"

165 Publications

Evidence-Based Clinical Practice Guidelines for Laser-Assisted Drug Delivery.

JAMA Dermatol 2022 Aug 17. Epub 2022 Aug 17.

Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut.

Importance: Laser-assisted drug delivery (LADD) is used for various medical and cosmetic applications. However, there is insufficient evidence-based guidance to assist clinicians performing LADD.

Objective: To develop recommendations for the safe and effective use of LADD.

Evidence Review: A systematic literature review of Cochrane Central Register of Controlled Trials, Embase, and MEDLINE was conducted in December 2019 to identify publications reporting research on LADD. A multidisciplinary panel was convened to draft recommendations informed by the systematic review; they were refined through 2 rounds of Delphi survey, 2 consensus meetings, and iterative review by all panelists until unanimous consensus was achieved.

Findings: Of the 48 published studies of ablative fractional LADD that met inclusion criteria, 4 were cosmetic studies; 21, oncologic; and 23, medical (not cosmetic/oncologic), and 6 publications of nonablative fractional LADD were included at the request of the expert panel, producing a total of 54 studies. Thirty-four studies (63.0%) were deemed to have low risk of bias, 17 studies (31.5%) had moderate risk, and 3 (5.5%) had serious risk. The key findings that informed the guidelines developed by the expert panel were as follows: LADD is safe in adults and adolescents (≥12 years) with all Fitzpatrick skin types and in patients with immunosuppression; it is an effective treatment for actinic keratosis, cutaneous squamous cell carcinoma in situ, actinic cheilitis, hypertrophic scars, and keloids; it is useful for epidermal and dermal analgesia; drug delivery may be increased through the application of heat, pressure, or occlusion, or by using an aqueous drug solution; laser settings should be selected to ensure that channel diameter is greater than the delivered molecule; antibiotic prophylaxis is not recommended, except with impaired wound healing; antiviral prophylaxis is recommended when treating the face and genitalia; and antifungal prophylaxis is not recommended. The guideline's 15 recommendations address 5 areas of LADD use: (I) indications and contraindications; (II) parameters to report; (III) optimization of drug delivery; (IV) safety considerations; and (V) prophylaxis for bacterial, viral, and fungal infections.

Conclusions And Relevance: This systematic review and Delphi consensus approach culminated in an evidence-based clinical practice guideline for safe and effective use of LADD in a variety of applications. Future research will further improve our understanding of this novel treatment technique.
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http://dx.doi.org/10.1001/jamadermatol.2022.3234DOI Listing
August 2022

Laser Safety Checklists: An Update on How We Do It.

Dermatol Surg 2022 Aug 3;48(8):882-883. Epub 2022 Jun 3.

SkinCare Physicians, Chestnut Hill, Massachusetts.

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http://dx.doi.org/10.1097/DSS.0000000000003502DOI Listing
August 2022

TikTok Sheds Light on Tanning: Tanning Is Still Popular and Emerging Trends Pose New Risks.

Dermatol Surg 2022 Jul 15. Epub 2022 Jul 15.

SkinCare Physicians, Chestnut Hill, Massachusetts.

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http://dx.doi.org/10.1097/DSS.0000000000003549DOI Listing
July 2022

Commentary On: Facial Soft Tissue Repositioning With Neuromodulators: Lessons Learned From Facial Biomechanics.

Aesthet Surg J 2022 May 16. Epub 2022 May 16.

Private practice in Chestnut Hill, MA.

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http://dx.doi.org/10.1093/asj/sjac123DOI Listing
May 2022

Review of Lasers and Energy-Based Devices for Skin Rejuvenation and Scar Treatment With Histologic Correlations.

Dermatol Surg 2022 04;48(4):441-448

Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.

Background: Lasers and energy-based devices (EBD) are popular treatments for skin rejuvenation and resurfacing. Achieving desired outcomes and avoiding complications require understanding the effects of these devices at a histologic level. Currently, no comprehensive review summarizing the histologic effects of laser and energy-based treatments exists.

Objective: To describe how lasers and EBD alter skin histology and improve the overall understanding of these devices.

Materials And Methods: A PubMed search was conducted for studies with histologic analysis of fractional picosecond laser, fractional radiofrequency microneedling, nonablative lasers, and ablative lasers.

Results: Fractional picosecond lasers induce intraepidermal and/or dermal vacuoles from laser-induced optical breakdown. Fractional radiofrequency microneedling delivers thermal energy to the dermis while sparing the epidermis, making it safer for patients with darker skin phototypes. Fractional nonablative lasers induce conical zones of coagulation of the epidermis and upper dermis. Ablative lasers vaporize the stratum corneum down to the dermis. Traditional ablative lasers cause diffuse vaporization while fractional ablative lasers generate columns of tissue ablation.

Conclusion: Lasers and EBD are effective for skin resurfacing and rejuvenation and have different mechanisms with disparate targets in the skin. Safe and effective use of devices requires understanding the histologic laser-tissue interaction.
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http://dx.doi.org/10.1097/DSS.0000000000003397DOI Listing
April 2022

1,550 nm Erbium-Doped and 1,927 nm Thulium Nonablative Fractional Laser System: Best Practices and Treatment Setting Recommendations.

Dermatol Surg 2022 Feb;48(2):195-200

Miami Dermatology & Laser Institute, Miami, Florida.

Background: The Fraxel Dual laser system (Solta Medical, Inc., Bothell, WA) contains a 1,550 and 1,927 nm wavelength single handpiece with different indications for each wavelength.

Objective: To discuss treatment setting recommendations and best practices for select on-label and investigational applications of the 1,550 and 1,927 nm dual laser system.

Materials And Methods: Eight board-certified dermatologists with 10 or more years of experience with the 1,550 and 1,927 nm laser system completed an online survey about their clinical experience with the system and then participated in a roundtable to share clinical perspectives and best practices for using the laser system.

Results: For all Fitzpatrick skin types, treatment recommendations were described for selected approved indications for the 1,550 and 1,927 nm laser system, including both lasers in combination. Treatment recommendations were also reached for investigational applications with the 1,550 nm laser and 1,927 nm laser. Best practices for using the lasers during the treatment session to achieve optimal outcomes and decrease the post-treatment recovery time were compiled.

Conclusion: The 1,550 and 1,927 nm dual laser system is effective for a wide range of aesthetic and therapeutic applications, on and off the face and across all Fitzpatrick skin types.
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http://dx.doi.org/10.1097/DSS.0000000000003321DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8806037PMC
February 2022

Use of Neuromuscular Electrical Stimulation for Abdominal and Quadriceps Muscle Strengthening: A Randomized Controlled Trial.

Dermatol Surg 2022 03;48(3):334-338

SkinCare Physicians, Chestnut Hill, Massachusetts.

Background: Radiographic imaging has demonstrated muscle hypertrophy after treatment with noninvasive body contouring devices that target skeletal muscles.

Objective: This pilot study sought to evaluate whether increased muscle mass translated to improved functional strength and endurance.

Methods: A prospective, single-center, randomized open-label controlled study included 26 subjects randomized into 3 groups: 2 treatment groups and 1 control group. Both treatment groups received 4 neuromuscular electrical stimulation (NMES) treatments over a 2-week period. Muscle performance testing was conducted at baseline and 2-week and 4-week posttreatment. Anthropometric measurements were assessed at baseline and at 4-week posttreatment. Study participants completed subject satisfaction surveys and a personal experience assessment.

Results: Treatment with NMES resulted in statistically significant improvements in abdominal and quadriceps strength and endurance from baseline through 4-week posttreatment. Mean waist circumference decreased and quadriceps circumference increased, both nonsignificantly. Subject satisfaction regarding abdominal and quadriceps strength was reported as "satisfied or very satisfied" in 89% and 92% at 4-week and 8-week posttreatment, respectively.

Conclusion: Treatment of the abdomen and quadriceps with NMES leads to significant improvements in muscular strength and endurance.
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http://dx.doi.org/10.1097/DSS.0000000000003368DOI Listing
March 2022

Actinic Keratosis Color and Its Associations: A Retrospective Photographic, Dermoscopic, and Histologic Evaluation.

Dermatol Surg 2022 Jan;48(1):57-60

SkinCare Physicians, Chestnut Hill, Massachusetts.

Background And Objective: Actinic keratoses (AKs) have been described with varying color and morphology; however, no reports have demonstrated associations between color, vasculature, and inflammation. In this retrospective study, we analyze the clinical, dermoscopic, and histopathologic features of AKs to elucidate this relationship.

Methods: A retrospective search for patients diagnosed with AK between January 2018 and October 2019 was performed. Clinical and dermoscopic photographs and pathology slides for all included subjects were reviewed.

Results: Forty-nine images and histopathology slides were analyzed. Dermoscopy of white AKs demonstrated scale and absence of erythema with corresponding absence of inflammation on histopathology. Dermoscopy of brown AKs revealed pseudonetwork, absent scale, and a variable vessel pattern with pigment incontinence and absence of inflammation on histopathology. Red AKs had a distinct polymorphous vessel pattern and presence of erythema on dermoscopy. On histopathology, about half of samples showed increased vascularity and variable inflammation. Pink AK dermoscopy revealed a presence of erythema with corresponding presence of inflammation on histopathology.

Conclusion: This report adds to our understanding of AKs and confirms that, in general, the pinker or redder the AK, the more prominent the inflammatory infiltrate and vasculature, respectively. Dermatologists should continue to use their diagnostic skills to successfully diagnose and triage AKs.
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http://dx.doi.org/10.1097/DSS.0000000000003281DOI Listing
January 2022

Darker skin types are underrepresented in sunscreen clinical trials: Results of a literature review.

J Am Acad Dermatol 2021 Nov 16. Epub 2021 Nov 16.

SkinCare Physicians, Chestnut Hill, Massachusetts; Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut.

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http://dx.doi.org/10.1016/j.jaad.2021.11.009DOI Listing
November 2021

A pilot study evaluating the efficacy and tolerability of a comprehensive, hydrating topical antioxidant developed specifically for men.

J Cosmet Dermatol 2021 Sep 3;20(9):2816-2823. Epub 2021 Aug 3.

SkinCare Physicians, Chestnut Hill, MA, USA.

Introduction: There is growing interest in skincare products designed for men. This pilot study evaluated the efficacy and tolerability of a comprehensive antioxidant product in men.

Methods: This 12-week study evaluated improvements from baseline in erythema, lines/wrinkles, skin tone, texture, brightness, dryness/flaking and pores (6-point scale), global improvements (5-point scale), and sebum levels following daily application in males with mild to moderate photodamaged skin. Subject self-assessments and adverse events (AEs) were captured.

Results: Twenty-two subjects completed the study. Early mean percent improvements from baseline were demonstrated in all categories at week 4 with visible improvements in skin tone (29%; p = .0001) and pores (28%; p < .0001). Reductions in skin surface sebum levels (forehead region) from baseline were demonstrated at 8 (p < .0001) and 12 (p < .0003) weeks. Ninety-six percent of subjects reported overall visible improvement of their skin and that the study product calmed/soothed skin, reducing redness and irritation after shaving. One subject reported mild dryness.

Conclusion: Once daily application of a comprehensive topical antioxidant designed for men led to significant improvements in skin appearance, substantial reductions in skin surface sebum levels, and was well tolerated with a high level of subject satisfaction over 12 weeks.
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http://dx.doi.org/10.1111/jocd.14314DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8457217PMC
September 2021

The Second of Two One-Year, Multicenter, Open-Label, Repeat-Dose, Phase II Safety Studies of PrabotulinumtoxinA for the Treatment of Moderate to Severe Glabellar Lines in Adult Patients.

Aesthet Surg J 2021 11;41(12):1423-1438

Background: PrabotulinumtoxinA is a 900-kDa botulinum toxin type A produced by Clostridium botulinum.

Objectives: The authors sought to investigate the safety of prabotulinumtoxinA for treatment of glabellar lines.

Methods: This was a multicenter, open-label, repeat-dose, 1-year phase II safety study. Adults with moderate to severe glabellar lines at maximum frown, as independently assessed by both investigator and patient on the validated 4-point photonumeric Glabellar Line Scale (0 = no lines, 1 = mild, 2 = moderate, 3 = severe), were enrolled. On day 0, patients received an initial treatment (IT) of 20 U prabotulinumtoxinA (4 U/0.1 mL final vacuum-dried formulation injected into 5 glabellar sites). On and after day 90, patients received a repeat treatment (RT) if their Glabellar Line Scale score was ≥2 at maximum frown by investigator assessment. Safety outcomes were evaluated throughout the study.

Results: The 570 study patients received a median total dose of 60 U, that is, 3 treatments. Sixty-one patients (10.7%) experienced adverse events (AEs) assessed as possibly study drug related; 6.5% experienced study drug-related AEs after the IT. With each RT, progressively lower percentages of patients experienced study drug-related AEs. Eight patients (1.4%) experienced study drug-related AEs of special interest: 5 experienced eyelid ptosis (0.9%), 3 eyebrow ptosis (0.5%), 1 blepharospasm (0.2%), and 1 blurred vision (0.2%). Seven patients (1.2%) experienced serious AEs, but none were study drug related. A total of 4060 serum samples were tested for antibotulinum toxin antibodies; no seroconversion was observed.

Conclusions: The safety of RTs of 20 U of prabotulinumtoxinA for moderate to severe glabellar lines was confirmed in this second phase II study based on a broad range of outcomes.

Level Of Evidence: 2:
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http://dx.doi.org/10.1093/asj/sjaa382DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8598184PMC
November 2021

Is Nonsurgical Rhinoplasty Portrayed as Risk-Free in Social Media ?

Dermatol Surg 2021 09;47(9):1312-1314

SkinCare Physicians, Chestnut Hill, Massachusetts.

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http://dx.doi.org/10.1097/DSS.0000000000003023DOI Listing
September 2021

Microneedling as an adjuvant to topical therapies for melasma: A systematic review and meta-analysis.

J Am Acad Dermatol 2022 04 12;86(4):797-810. Epub 2021 Apr 12.

SkinCare Physicians, Chestnut Hill, Massachusetts; Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut; Brown Medical School, Providence, Rhode Island. Electronic address:

Background: Microneedling as an adjuvant to topical medications has shown promising but variable results in the treatment of melasma.

Objective: To conduct a systematic review and meta-analysis on the efficacy of microneedling as an adjuvant to topical therapies for the treatment of melasma.

Methods: This study followed PRISMA guidelines. All comparative, prospective studies on the use of topical interventions with microneedling for the treatment of melasma were included. Studies involving radiofrequency microneedling were excluded.

Results: Twelve eligible studies comprising 459 patients from 7 different countries were included. Topical therapies included topical tranexamic acid, vitamin C, platelet-rich plasma, non-hydroquinone-based depigmentation serums, and hydroquinone-based depigmenting agents. Topical therapy with microneedling improved melasma severity with a large effect (standardized mean difference >0.8) beyond 8 weeks, with best results seen at 12 weeks. Compared to topical therapy alone, topical therapy with microneedling resulted in an additional improvement in melasma severity with a moderate effect at 8 weeks and a large effect at 12-16 weeks. Microneedling was well tolerated across studies, with no serious adverse events reported.

Limitations: Heterogeneity in study designs did not allow for a comparison of the efficacy of various topical therapies with microneedling.

Conclusion: Microneedling is useful adjuvant to topical therapies for the treatment of melasma.
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http://dx.doi.org/10.1016/j.jaad.2021.03.116DOI Listing
April 2022

Lasers as an adjuvant for vulvar lichen sclerosus: A systematic review and meta-analysis.

J Am Acad Dermatol 2022 03 5;86(3):694-696. Epub 2021 Mar 5.

SkinCare Physicians, Chestnut Hill, Massachusetts; Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut; Brown Medical School, Providence, Rhode Island.

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http://dx.doi.org/10.1016/j.jaad.2021.02.081DOI Listing
March 2022

Commentary on: The Role of the Laser Safety Officer and Laser Safety Programs in Clinical Practice.

Aesthet Surg J 2021 10;41(11):NP1555-NP1556

Yale University School of Medicine, New Haven, CT.

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http://dx.doi.org/10.1093/asj/sjaa245DOI Listing
October 2021

Radiofrequency Microneedling: A Comprehensive and Critical Review.

Dermatol Surg 2021 06;47(6):755-761

SkinCare Physicians, Chestnut Hill, Massachusetts.

Background: Many studies have evaluated radiofrequency microneedling (RFMN) in various dermatologic conditions. However, the efficacy and safety of RFMN, and how it compares with other energy-based devices in a clinician's armamentarium, remains unclear.

Objective: To review higher-quality evidence supporting RFMN and the dermatologic conditions which it can be used in.

Materials And Methods: A search was conducted in MEDLINE and EMBASE from inception to May 13, 2020, using the terms: "radiofrequency microneedling" OR "fractional radiofrequency" OR "radiofrequency needling" OR "radiofrequency percutaneous collagen induction." Only randomized, split body or blinded studies with original data on humans were included. Non-English or non-dermatology-related studies were excluded.

Results: Forty-two higher-quality studies were included after applying the inclusion and exclusion criteria. There were 14 studies for skin rejuvenation, 7 for acne scars, 6 for acne vulgaris, 5 each for striae and axillary hyperhidrosis, 2 for melasma, and 1 each for rosacea, cellulite, and androgenetic alopecia.

Conclusion: Radiofrequency microneedling is an effective intervention that can be used repeatedly and safely in combination with other treatment modalities and in individuals with darker skin phototypes. Radiofrequency microneedling-induced dermal remodeling and neocollagenesis are slow and progressive but continue to improve even 6 months after treatment.
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http://dx.doi.org/10.1097/DSS.0000000000002972DOI Listing
June 2021

Needle Manufacturing, Quality Control, and Optimization for Patient Comfort.

J Drugs Dermatol 2021 01;20(1):44-48

Introduction: There is an increasing rise of cosmetic injectables. We sought to understand the manufacturing, quality control process, and needle selection of hypodermic needles for fillers.

Objective: To understand the process of manufacturing and quality control of hypodermic needles and the relevance to an aesthetic clinician.

Methods: We conducted a search of the internet and contacted medical device companies to understand the manufacturing process. We then collaborated with the Executive director of global pharmaceutical technology from Abbvie as well as the packaging and device engineer at Galderma and summarized our findings. Finally, we reviewed the literature and summarized existing recommendations on techniques to minimize pain related to injection.

Results: Hypodermic needles undergo an extensive manufacturing and regulatory process. Many considerations are taken into account in needle manufacturing as well as the selection process with commercially available hyaluronic acid filler products. Needle manufacturers are held to universal standards though the International Organization for Standardization (ISO). Filler companies perform their own testing to evaluate suitability of needles for their product including leakage force, penetration force, extrusion force, etc. Finally, parameters such as needle length, needle diameter, and wall thickness are considered for selection of needle/hub with individual filler viscosity.

Conclusion: There is extensive consideration that goes into needle manufacturing, quality control, and optimization for hyaluronic acid filler. Understanding the technical process helps inform the clinician and guide patient care for maximum comfort. J Drugs Dermatol. 2021;20(1):44-48. doi:10.36849/JDD.5591.
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http://dx.doi.org/10.36849/JDD.5591DOI Listing
January 2021

Rates of Vascular Occlusion Associated With Using Needles vs Cannulas for Filler Injection.

JAMA Dermatol 2021 02;157(2):174-180

Skin Care and Laser Physicians of Beverly Hills, Los Angeles, California.

Importance: Soft-tissue augmentation with skin fillers can be delivered with needles or microcannulas, but unwanted vascular occlusions are possible.

Objective: To determine whether filler-associated vascular occlusion events of the face occur more often with injections performed with needles than with microcannulas.

Design, Setting, And Participants: This retrospective cohort study included a random sample of board-certified dermatologists deemed eligible based on membership in relevant professional societies and attendance at relevant national professional meetings. Participants completed detailed forms in which they could enter deidentified data and volume statistics pertaining to patients undergoing filler procedures in their practices. Data were collected from August 2018 to August 2019.

Exposures: Injectable fillers approved by the US Food and Drug Administration delivered via needles or microcannulas.

Main Outcomes And Measures: The primary outcome measure was intravascular occlusion. Occlusion events were graded by severity (no sequelae, scar, and ocular injury or blindness).

Results: A total of 370 dermatologists (mean [SD] years in practice, 22.3 [11.1] years) participated and reported 1.7 million syringes injected. The risk of occlusion with any particular filler type using needle or cannula never exceeded 1 per 5000 syringes injected. Overall, 1 occlusion per 6410 per 1-mL syringe injections was observed with needles and 1 per 40 882 with cannulas (P < .001). Of the 370 participants, 106 (28.6%) reported at least 1 occlusion. Multivariate analysis found that injections with cannula had 77.1% lower odds of occlusion compared with needle injections. Participants injecting fillers for more than 5 years had 70.7% lower odds of occlusion than those who were less experienced. For each additional injection per week, the odds of occlusion decreased by 1%, and 85% of occlusions had no long-term sequelae. Nasolabial folds and lips were most likely to be occluded, with mean severity level of occlusions highest at the glabella.

Conclusions And Relevance: In this cohort study, filler injections with either needles or cannulas were associated with a very low risk of intravascular occlusion events. Moreover, the vast majority of such events were minor and resolved without scar or other injury. Injections with microcannulas were less often associated with occlusion events than injections with needles. Occlusion risk per syringe appeared decreased after the first few years of clinical practice and was also lower among those who more frequently inject fillers. Whether a needle or cannula is most appropriate for injection may depend on patient factors, anatomic site, and the type of defect being treated.
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http://dx.doi.org/10.1001/jamadermatol.2020.5102DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7774041PMC
February 2021

Development and Validation of the Patient-Reported Submental Fat Rating Scale and the Patient-Reported Submental Fat Impact Scale.

Dermatol Surg 2021 04;47(4):522-525

Peloton Advantage, an OPEN Health company, Parsippany, NJ.

Background: No validated assessment tools are available to evaluate patient-reported outcomes specifically related to submental fat (SMF).

Objective: To develop and validate scales measuring the severity (Patient-Reported SMF Rating Scale [PR-SMFRS]) and psychological impact (Patient-Reported SMF Impact Scale [PR-SMFIS]) of SMF.

Materials And Methods: A literature review, content validation interviews (concept elicitation [n = 29] and cognitive debriefing [n = 15]) in adults with SMF, and expert interviews (n = 3) were conducted to develop the PR-SMFRS and PR-SMFIS. Psychometric validity (acceptability, reliability, and validity) for the PR-SMFRS and PR-SMFIS was assessed using data from 1 phase 2 and 5 phase 3 ATX-101 studies in patients with excess SMF.

Results: The PR-SMFRS was constructed as a single-item, 5-point rating of the SMF amount/size. The PR-SMFIS was constructed as a 6-item scale, with an 11-point numeric rating for each item. Both scales demonstrated acceptable psychometric properties (test-retest reliability and internal consistency). The anchor-based minimally important difference analysis suggests a 1-point improvement on the PR-SMFRS (scale of 0‒4) and a 3-point improvement on the PR-SMFIS (scale of 0‒10) represent clinically meaningful change.

Conclusion: The PR-SMFRS and PR-SMFIS are reliable, valid instruments for assessing the severity and psychosocial impact, respectively, of SMF and detecting clinically meaningful change with intervention.
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http://dx.doi.org/10.1097/DSS.0000000000002908DOI Listing
April 2021

Plume Effect of Fractional Radiofrequency Verus Laser Resurfacing: Considerations in the COVID-19 Pandemic.

Lasers Surg Med 2021 01 8;53(1):115-118. Epub 2020 Nov 8.

SkinCare Physicians, Chestnut Hill, Massachusetts.

Introduction: The COVID-19 pandemic requires us all to re-evaluate aesthetic practices to ensure optimal patient safety during elective procedures. Specifically, energy-based devices and lasers require special consideration, as they may emit plume which has been shown to contain tissue debris and aerosolized biological materials. Prior studies have shown transmission of viruses and bacteria via plume (i.e., HIV and papillomavirus). The purpose of this study was to evaluate plume characteristics of the Er:YAG resurfacing laser (Sciton; Palo Alto, CA) and compare it to the Morpheus8 fractional radiofrequency device (InMode; Lake Forest, CA).

Methods: Five patients who underwent aesthetic resurfacing and/or skin tightening of the face and neck were treated with the Er:YAG (Sciton Joule, Palo Alto, CA) and/or fractional radiofrequency (Morpheus8, Lake Forest, CA) between April 1 and May 11, 2020. Data collected included patient demographics, past medical history, treatment parameters, adverse events, particle counter data, as well as high magnification video equiptment. Patients were evaluated during treatment with a calibrated particle meter (PCE; Jupiter, FL). The particle meter was used at a consistent focal distance (6-12 inches) to sample the surrounding environment during treatment at 2.83 L/min to a counting efficiency of 50% at 0.3 µm and 100% at >0.45 µm. Recordings were obtained with and without a smoke evacuator.

Results: Of our cohort (n = 5), average age was 58 years old (STD ±7.2). Average Fitzpatrick type was between 2 and 3. Two patients received Er:YAG fractional resurfacing in addition to fractional radiofrequency during the same treatment session. Two patients had fractional radiofrequency only, and one patient had laser treatment with the Er:YAG only. There were no adverse events recorded. The particle counter demonstrated ambient baseline particles/second (pps) at 8 (STD ±6). During fractional radiofrequency treatment at 1-mm depth, the mean recording was 8 pps (STD ±8). At the more superficial depth of 0.5 mm, recordings showed 10 pps (STD ±6). The Er:YAG laser resurfacing laser had mean readings of 44 pps (STD ±11). When the particle sizes were broken down by size, the fractional radiofrequency device had overall smaller particle sizes with a count of 251 for 0.3 µm (STD ±147) compared with Er:YAG laser with a count of 112 for 0.3 µm (STD ±84). The fractional radiofrequency did not appear to emit particles >5 µm throughout the treatment, however, the Er:YAG laser consistently recorded majority of particles in the range of 5-10 µm. The addition of the smoke evacuator demonstrated a 50% reduction in both particles per second recorded as well as all particle sizes.

Conclusion: Re-evaluation of the plume effect from aesthetic devices has become important during the COVID-19 pandemic. Further studies are required to characterize viability of COVID-19 viability and transmissibility in plume specimens. Based on this pilot study, we recommend that devices that generate little to no plume such as fractional radiofrequency devices be used in Phase I reopening of practice while devices that generate a visible plume such as Er:YAG laser resurfacing devices be avoided and only used with appropriate personal protective equipment in addition to a smoke evacuator in Phase IV reopening.
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http://dx.doi.org/10.1002/lsm.23336DOI Listing
January 2021

A 12-Week, Prospective, Non-Comparative, Non-Randomized Study of Magnetic Muscle Stimulation for Improvement of Body Satisfaction With the Abdomen and Buttocks.

Lasers Surg Med 2021 01 8;53(1):79-88. Epub 2020 Nov 8.

AbbVie Inc, Irvine, California, 92612.

Background And Objective: Magnetic muscle stimulation (MMS) is a relatively new energy-based technology that provides a non-invasive option for body contouring through stimulation and toning of underlying skeletal muscles. This study was conducted to examine the safety, efficacy, and body satisfaction scores of MMS using a CoolToneTM prototype for the aesthetic improvement of abdominal and buttock contour.

Study Design/materials And Methods: This was a prospective, non-comparative, non-randomized, 12-week, multicenter study. Male and female participants aged 22-65 years received 4 MMS treatment sessions to the abdomen and/or buttocks. Body Satisfaction Questionnaire (BSQ) scores for abdomen and/or buttocks were assessed at baseline, immediately post final treatment, at 4 weeks (primary endpoint), and 12 weeks post final treatment. Subject-rated Global Aesthetic Improvement Scale (SGAIS) was assessed at 4 weeks post final treatment (secondary endpoint), and 12 weeks post final treatment. Additional efficacy assessment included abdominal circumference obtained by 3D imaging at baseline, immediately post final treatment, and at 4 and 12 weeks post final treatment. A Subject Experience Questionnaire (SEQ) was used to assess treatment satisfaction and perspectives at 4 weeks and 12 weeks post final treatment. Adverse events (AEs) were monitored throughout the study.

Results: A total of 110 participants were recruited, who were 75% female, 80% Caucasian (mostly non-Hispanic), average age of 39.5 years (range 22-59) with an average body mass index (BMI) of 23.3 kg/m2 (range 18-29.9). At the 4-week post final treatment visit, the average BSQ score for participants receiving abdominal treatment (n = 93) was significantly improved with a 5.1 average increase in total score from baseline (possible score range 10-50) and by a 5.5 average increase from baseline for participants receiving buttocks treatment (n = 32) (p < 0.05). At 4 weeks post final treatment, the proportion of participants with SGAIS scores >"Improved" was 68.1% for participants receiving treatment of the abdomen (n = 94), and 81.8% for those receiving buttocks treatment (n = 33). The mean total decrease from baseline in waist circumference was significant at all time points. At the 12-week post final treatment visit, SEQ data revealed that a majority of participants were "Satisfied" or "Very Satisfied" with overall treatment results and "Agreed" or "Strongly Agreed" that they were motivated to maintain results either by working out or by additional treatment. A total of 6 AEs related to the device and/or treatment were reported, which resolved spontaneously during the study.

Conclusion: Treatment of the abdomen and/or buttocks with MMS was well-tolerated and demonstrated significant improvement in aesthetic appearance through the 12-week post final treatment study duration. As a stand-alone treatment, MMS expands the range of options for individualized treatment planning for patients seeking abdominal and/or gluteal muscle toning. © 2020 The Authors. Lasers in Surgery and Medicine published by Wiley Periodicals, Inc.
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http://dx.doi.org/10.1002/lsm.23348DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7894278PMC
January 2021

Education and Research in Dermatologic Surgery: Private Versus Academic.

Dermatol Surg 2020 10;46(10):1357-1361

SkinCare Physicians, Chestnut Hill, Massachusetts.

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http://dx.doi.org/10.1097/DSS.0000000000002040DOI Listing
October 2020

Cutaneous Photoaging: A Notable Pattern of Distribution of Lentigines on the Face.

J Drugs Dermatol 2020 Jul;19(7):755-757

Importance: Facial lentigines are a common patient complaint encountered in general and cosmetic dermatology practices. Lentigines are a marker of photoaging and understanding their distribution will provide insight into the aging process in order to better counsel patients. Objectives: To compare the relative distribution of lentigines in facial cosmetic subunits. Methods: We reviewed clinical photographs of patients receiving Alexandrite laser treatment for facial lentigines during the time period 11/1/2017-12/1/2018. Individual lentigines were plotted for each patient into one of 21 aesthetic units. A "heat map" was created to compare the relative density of these lesions. Results: Grouped peripheral cosmetic subunits contained more lentigines compared to grouped central cosmetic units. The mean number of lentigines in the central units was 0.60 and in the peripheral units was 0.85. This finding was statistically significant with a p value of 0.0001. J Drugs Dermatol. 2020;19(7): doi:10.36849/JDD.2020.5193.
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http://dx.doi.org/10.36849/JDD.2020.5193DOI Listing
July 2020

Delayed Inflammatory Reactions to Hyaluronic Acid Fillers: A Literature Review and Proposed Treatment Algorithm.

Clin Cosmet Investig Dermatol 2020 18;13:371-378. Epub 2020 May 18.

Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.

Background And Objectives: There is a wide diversity of opinions regarding the management of delayed inflammatory reactions (DIRs) secondary to hyaluronic acid (HA)-based fillers. The plethora of approaches has led the authors to conduct a review regarding management and treatment of DIRs as well as establish therapeutic guidelines for this purpose.

Materials And Methods: A review of the literature was performed through databases such as PubMed using keywords including HA-fillers and complications, delayed HA filler sequelae and therapy, soft tissue and dermal filler reactions and management. Additionally, a survey comprised of questions regarding the management and treatment of DIRs was sent to 18 physicians highly experienced with soft-tissue filler injections in 10 countries. Their answers and recommendations were analyzed and debated amongst these panelists.

Results: Sixteen panelists favored antibiotic therapy as first-line treatment for DIRs, specifically dual antibiotic therapy consisting of a fluoroquinolone along with a tetracycline or macrolide for a period of 3-6 weeks. The majority refrained from the use of intralesional (IL) or systemic steroids except in the case of disfiguring or recalcitrant reactions. IL hyaluronidase was recommended by 13 panelists; however, some preferred a watchful waiting approach for a period of 48 hours to 2 weeks prior to IL hyaluronidase, and in cases where antibiotics did not lead to improvement.

Conclusion: A consensus was reached and summarized to propose a clear, easy-to-follow, stepwise algorithm for the treatment of DIRs.
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http://dx.doi.org/10.2147/CCID.S247171DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7244356PMC
May 2020

Oxymetazoline and Energy-Based Therapy in Patients with Rosacea: Evaluation of the Safety and Tolerability in an Open-Label, Interventional Study.

Lasers Surg Med 2021 01 6;53(1):55-65. Epub 2020 May 6.

Aclaris Therapeutics, Inc., 640 Lee Road, Suite 200, Wayne, Pennsylvania, 19087.

Background And Objectives: The objectives of this study were to evaluate the safety, tolerability, and efficacy of oxymetazoline hydrochloride cream, 1% (oxymetazoline) when used as an adjunctive treatment with energy-based therapy for patients with moderate to severe facial erythema associated with rosacea.

Study Design/materials And Methods: In this Phase 4, multicenter, interventional, open-label study, eligible patients received one of four energy-based therapies (potassium titanyl phosphate laser, intense pulsed light therapy, pulsed-dye laser Vbeam Perfecta, or pulsed-dye laser Cynergy) on day 1 and day 29 and once-daily application of oxymetazoline on days 3 through 27 and days 31 through 56. Improvement from baseline in Clinician Erythema Assessment (CEA) score, patient satisfaction measures, incidence of treatment-emergent adverse events (TEAEs), and worsening from baseline on dermal tolerability assessments and the Clinician Telangiectasia Assessment (CTA) were assessed. Data were summarized using descriptive statistics.

Results: A total of 46 patients (mean age, 51.1 years; 78.3% female) enrolled in this study. Similar numbers of patients received each of the energy-based therapies in addition to oxymetazoline. All patients demonstrated an improvement from baseline in CEA during the study with 39 of 43 evaluable patients (90.7%) demonstrating an improvement 6 hours posttreatment on day 56. Most patients were satisfied or very satisfied with treatment at the end of the study. All TEAEs were mild or moderate in severity. Some patients experienced worsening in dermal tolerability assessment symptoms (range: 4-21 patients; 8.7-45.7%). Worsening in CEA and CTA were each reported by three patients (6.5%) at any time during the study.

Conclusions: Treatment with oxymetazoline as adjunctive therapy with energy-based therapy was safe, well tolerated, and reduced facial erythema in patients with moderate to severe persistent facial erythema associated with rosacea. Lasers Surg. Med. © 2020 The Authors. Lasers in Surgery and Medicine published by Wiley Periodicals LLC.
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http://dx.doi.org/10.1002/lsm.23253DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7891417PMC
January 2021
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