Objectives: The objective of the study is to evaluate the short-term clinical outcomes and tolerability of a structured sequential protocol combining fractional carbon dioxide laser resurfacing with multilayer hyaluronic acid (HA) skinbooster injections for rejuvenation of the periocular region, neck, and décolleté. Material and Methods: This prospective, non-interventional, multicenter observational study enrolled consecutively treated adults with aging-related changes in the periocular, neck, or décolleté regions. Participants underwent a three-phase protocol consisting of HA skinbooster priming, fractional carbon dioxide laser resurfacing, and subsequent refinement injections. The pre-specified interim analysis assessed outcomes at day 42 using patient- and investigator-reported 5-point Likert scales. Paired baseline-to-day 42 comparisons were analyzed using the Wilcoxon signed-rank test. Results: Thirty-one participants completed the day 42 assessment, with no dropouts. The cohort was 80.6% female, the median age was 55.5 years, the age range was 29–74 years, and all participants had Fitzpatrick skin types II to III. All evaluated patient- and investigator-reported domains improved significantly from baseline to day 42 (all p < 0.001). Mean patient scores increased from 2.48–2.74 at baseline to 4.23–4.58 at day 42, and mean investigator scores increased from 2.68–3.13 to 3.97–4.48. Mean patient satisfaction was 4.58/5.0, willingness to recommend treatment was 4.65/5.0, minimal post-inflammatory hyperpigmentation occurred in 1/31 participants (3.2%), and the median downtime was 3 days. Conclusion: In this interim analysis, the sequential combination protocol was associated with clinically relevant short-term improvement across the assessed skin-quality domains and good tolerability. Because of the single-arm observational design, absence of image-derived endpoints at this interim stage, and lack of region-specific efficacy scoring, the findings should be interpreted as hypothesis-generating real-world data. Controlled comparative studies are required to determine the incremental contribution of HA skinbooster treatment over fractional carbon dioxide laser monotherapy.
Lymphangioma circumscriptum (LC) is a rare lymphatic malformation majorly localized in the skin. We report a case of 12-year-old girl with LC which was simultaneously treated with carbon dioxide laser (10600 nm) and 1540 nm non-ablative fractional laser, followed by topical sirolimus during and after the procedure for a total of seven sessions. Simultaneous combination of 1540 nm non-ablative fractional and CO2 laser as a targeted therapeutic strategy for LC has been limited to one case in the past, but without the use of sirolimus. This report highlights the application and immediate outcomes of this combined use of different lasers along with topical sirolimus, underscoring its potential relevance for future clinical practice and research.
Blepharoplasty is a commonly performed esthetic and functional eyelid surgery. However, post-operative complications such as hematoma formation and wound dehiscence can compromise surgical outcomes. This article presents a novel modification – placing a floor bite during wound closure – to improve hemostasis, enhance wound stability, and minimize complications. The technique is simple, reproducible, and effective in reducing hematoma risk while ensuring a more secure closure with an esthetic outcome.
Objectives: To evaluate the clinicodemographic characteristics and anatomical distribution of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) and identify independent predictors of SCC. Material and Methods: A retrospective analysis of 374 patients (BCC = 209, SCC = 165) was performed. Variables included age, sex, and tumor localization. High-risk locations were the lip, scalp, and temporal regions. Univariate and multivariate logistic regression analyses were performed. Age was analyzed continuously and categorically (<60, 60–80, >80 years). Model performance was assessed using receiver operating characteristic analysis. Results: The mean age was 68.2 ± 12.8 years in the BCC group and 70.5 ± 12.7 years in the SCC group ( p = 0.082). SCC was more frequent in males (72.1% vs. 56.0%, p = 0.003). In multivariate analysis, male sex (odds ratio [OR]: 1.87, p = 0.012) and high-risk localization (OR: 3.30, p < 0.001) were independent predictors of SCC. Age ≥80 years was also associated with SCC (OR: 2.54, p = 0.008), whereas age 60–80 years was not ( p = 0.352). The optimal probability cutoff for SCC was 0.608 (sensitivity: 41.3%, specificity: 89.7%; area under the receiver operating characteristic curve [AUC] = 0.660). Conclusion: Male sex and high-risk anatomical localization are strong predictors of SCC. Age exhibits a nonlinear association, with increased SCC risk only in patients >80 years.
Objectives: The objective of the study is to compare the therapeutic efficacy and side effects of Q-switched neodymium-doped yttrium aluminium garnet (Nd:YAG) laser versus topical 4% hydroquinone cream in the treatment of melasma. Material and Methods: Eighty patients with clinically diagnosed melasma were randomly assigned to two groups: Group A received three sessions of Q-switched Nd:YAG laser 4 weeks apart, while Group B applied 4% hydroquinone cream once daily for 12 weeks. Efficacy was assessed using modified melasma area and severity index (mMASI) scores; investigator’s global assessment (IGA); and patient global assessment (PGA) at weeks 4, 8, and 12. Results: In our study, the mean age was 34.48 ± 6.7 years, with a male-to-female ratio of 1:4. Both groups showed statistically significant reductions in mMASI scores over 12 weeks, with Group B consistently demonstrating lower mMASI scores (Week 12: Group A 3.97 ± 2.59 vs. Group B 2.98 ± 1.93; p = 0.023). Patient and IGA scores also improved in both groups, with Group B showing significantly better patient-reported outcomes at week 12 ( p = 0.043). The mean percentage reduction in mMASI increased progressively over time in both treatment arms. Although Group B showed numerically greater percentage reduction at all visits, the inter-group differences were not statistically significant at any time point. Side effects were mild and comparable; erythema was more common in Group B (17.50% vs. 5%). Conclusion: Both treatments produced significant improvement in melasma over 12 weeks. Although hydroquinone achieved lower absolute mMASI scores and greater patient-reported improvement at week 12, the percentage reduction in mMASI between the groups was comparable, suggesting that both modalities are effective treatment options.
Objectives: The objectives of the study are to assess current social media practices, ethical perceptions, and regulatory awareness among esthetic surgeons in India. Material and Methods: A cross-sectional, anonymous, questionnaire-based survey was conducted among esthetic surgeons in India. The questionnaire evaluated professional use of social media, nature of content shared, consent practices, awareness of regulatory guidelines, and ethical perceptions. Descriptive statistics were used for analysis. Results: A total of 96 responses were analyzed. 78.1% respondents reported professional use of social media. Before-and-after images were posted by 61.5%, while 54.7% consistently obtained written consent for online use. 58.3% respondents reported awareness of National Medical Commission advertising regulations. A majority (72.9%) believed that social media promotes unrealistic patient expectations, and 81.2% supported the need for clearer ethical guidelines for esthetic practice. Conclusion: Social media is widely used by esthetic surgeons in India, often with variable ethical safeguards. Gaps in consent practices and regulatory awareness highlight the need for clearer guidelines and structured education on digital ethics in esthetic surgery.
Hyperpigmentation disorders such as melasma and post-inflammatory hyperpigmentation are common concerns in dermatology particularly in darker skin types. This narrative review evaluates the efficacy, mechanisms, and safety of cosmeceuticals used in their management, with relevance to Indian practice. A literature search (2013–2026) identified clinical and experimental studies on topical and systemic agents. Traditional depigmenting agents including hydroquinone, azelaic acid, and kojic acid act primarily through tyrosinase inhibition but are limited by tolerability concerns. Newer cosmeceuticals such as thiamidol, cysteamine, tranexamic acid and resorcinol derivatives provide targeted, multi-pathway effects with improved safety profiles. Adjunctive agents including Vitamin C, niacinamide, and various botanicals offer antioxidant, anti-inflammatory and barrier-restoring benefits. Although these agents show promising results, further large-scale studies with standardized outcomes are needed to establish long-term efficacy and optimize treatment strategies.
Glomus tumors are rare benign neoplasms of the digits arising from glomus bodies. Transungual excision is the preferred approach for the complete removal of subungual glomus tumors. However, secure repositioning of the nail plate following excision remains technically challenging. We describe a simple, minimally traumatic technique for nail plate fixation following transungual glomus tumor excision. We performed this technique in two patients.
Recipient site scalp necrosis (RSN) is a rare but potentially devastating complication of hair transplantation that can result in permanent tissue loss and graft failure. Although factors such as excessive graft density, deep implantation, infection, and pharmacologic vasoconstriction have been proposed, these explanations do not fully explain the observed regional predilection of ischemic complications in the frontal and mid-scalp. In this narrative review, we propose a unifying, anatomy-driven framework to explain RSN based on regional vascular vulnerability and cumulative microvascular injury. We focus on the distal course of the frontal branch of the superficial temporal artery, which often travels superficially with substantial interindividual variation, creating patient-specific high-risk vascular zones in the frontal scalp. We further explore how incision geometry, instrument-related injury patterns, and cumulative incision burden – particularly in the frontal tuft – may interact with regional perfusion reserve to precipitate ischemic breakdown. Rather than presenting definitive causal claims, this review synthesizes clinical observations, anatomical principles, and procedural mechanics to generate testable hypotheses. By reframing RSN through a perfusion-conscious perspective, this work aims to inform safer recipient site design while preserving aesthetic outcomes in modern hair transplantation.
Suction blister grafting has been used for repigmentation in patients with vitiligo, but its use in treating hypopigmentation in patients with Hansen’s disease has not been reported. Herein, we report a case of successful repigmentation of a persistent hypopigmented patch of a patient with Hansen’s disease using suction blister grafting.
Ectodermal dysplasia is a congenital disorder often causing sparse or absent eyebrows, leading to aesthetic and psychological distress. Eyebrow transplantation using follicular unit extraction (FUE) is a viable solution, but donor site selection is crucial. This case explores the use of high beard hair from the maxillary region for eyebrow reconstruction, offering dual benefits. A 26-year-old male with ectodermal dysplasia presented with sparse eyebrows, complete scalp hair loss, and a high beard line with papular eruptions. He suffered from depression, anxiety, and social withdrawal. Eyebrow reconstruction was performed using FUE technique, 150 single follicular units per eyebrow were transplanted. The procedure not only restored the eyebrows but also removed unwanted beard hair and resolved papular eruptions, enhancing facial aesthetics. At three months, most transplanted hairs had regrown, and the donor site healed well without requiring additional laser hair removal. Over two years, the patient maintained good eyebrow density and reported significant improvement in confidence, self-esteem, and social interactions. Using high beard hair for eyebrow transplantation in ectodermal dysplasia provided a successful aesthetic and psychological outcome. The dual benefit of repurposing unwanted beard hair for eyebrow restoration makes this approach a valuable option for similar cases.
Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare benign vascular proliferation that poses therapeutic challenges due to frequent recurrence and cosmetic concerns. We report a 40-year-old woman with nodular ALHE of the right ear, previously unresponsive to corticosteroid injections, successfully treated with intralesional radiofrequency (RF) using an insulated microneedle RF (MNRF) needle. The uniqueness of our case is the use of an innovative and cost-effective insulated needle assembly adapted from an MNRF probe. This modification was specifically designed to enhance precision while minimizing surrounding epidermal damage. This design improves durability and conductivity while reducing complications often seen with conventional probes. Six monthly sessions achieved marked lesion regression and excellent cosmetic outcome without recurrence at 6 months.
Objectives: Blepharoplasty is the most commonly performed facial esthetic procedure in the US, with increasing patient reliance on social media platforms for surgical information. The quality, accuracy, and engagement dynamics of blepharoplasty-related content remain poorly characterized. Material and Methods: This cross-sectional study analyzed 140 TikTok videos under the hashtag #Blepharoplasty (August 12–13, 2025). Videos were categorized by creator type, content theme, and engagement metrics (likes, comments, shares). Informational quality was assessed using the global quality scale (GQS) and modified DISCERN (mDISCERN) tools through dual human review and artificial intelligence (AI)-assisted scoring. High engagement was defined as ≥15,000 likes and ≥900 shares (upper 25 th percentile). Sentiment analysis of 1,337 comments was performed by two independent reviewers and validated by AI. Results: Patients (47%) and surgeons (44%) were the predominant content creators, with post-operative experience (41%) being the most frequent category. Median engagement included 2,385 likes, 168 shares, and 94 comments per video. Overall content quality was low (median GQS: 2; median mDISCERN: 1–2). Highly liked and highly shared videos demonstrated significantly greater interaction ( P < 0.001) but lower mDISCERN scores ( p = 0.012–0.041). Sentiment analysis revealed that AI classified more comments as positive (42%) and negative (15%) compared to human reviewers (38–39% positive; 8–12% negative). Inter-rater reliability between human reviewers was substantial (k = 0.747). Conclusion: Blepharoplasty-related content on TikTok demonstrates high engagement but low informational quality. High-performing videos prioritize engagement over reliability, underscoring the need for surgeon-led, evidence-based content to improve patient education and mitigate misinformation.
Hair transplantation is a safe esthetic procedure, and donor-site complications are uncommon. We report a rare case of necrotic ulceration at a pubic hair donor site caused by Klebsiella pneumoniae in a previously undiagnosed diabetic patient. A 52-year-old man presented 6 weeks after undergoing follicular unit transfer involving scalp and pubic grafts, with painful swelling and ulceration in the inguinal region. Examination revealed a tender erythematous swelling and a 3 × 5 cm necrotic ulcer with adherent black eschar and surrounding erythema. Laboratory investigations were normal except for elevated random blood glucose (283 mg/dL). Wound culture grew K. pneumoniae , sensitive to doxycycline. The patient was treated with sharp surgical debridement, enzymatic wound care, oral doxycycline, topical mupirocin, and initiation of antidiabetic therapy. Complete healing occurred within 3 weeks without compromise of graft survival. This case underscores the importance of metabolic screening and early culture-guided management in preventing donor-site morbidity.
Objectives: Eyebrows are a significant aspect of facial esthetics, and eyebrow loss can substantially affect an individual’s quality of life, often leading to a perceived reduction in physical attractiveness. This study aimed to explore individuals’ experiences before and after undergoing eyebrow transplantation. Material and Methods: This qualitative study used content analysis to explore the experiences and insights of professionals involved in natural eyebrow transplantation surgery. The study was conducted over 4 months, from April to July 2024. A total of thirty participants, each possessing extensive expertise in the field, were recruited for the study after providing informed consent. Data collection was performed through semi-structured interviews, allowing for in-depth exploration of participants’ perspectives while maintaining a flexible interview format. The collected data were systematically analyzed using established qualitative content analysis techniques, which facilitated the identification of prominent themes, patterns, and insights related to surgical practices, patient outcomes, and professional experiences. Results: The analysis revealed two main categories: Issues related to eyebrow baldness and outcomes of eyebrow transplantation. The issues associated with eyebrow baldness include factors such as genetic predisposition, aging, and certain medical conditions that contribute to hair loss in the eyebrow region. The outcomes of eyebrow transplantation encompass both benefits, such as improved esthetic appearance and increased confidence, and potential complications, including scarring, uneven hair growth, and transplant failure. Recognizing these categories is crucial for clinicians and patients to make informed decisions regarding treatment options and to establish realistic expectations. Conclusion: Eyebrow transplantation has gained popularity as a cosmetic procedure. Participants’ experiences indicate that the procedure can significantly enhance appearance and boost self-confidence. However, potential complications such as rashes, itching, social stigma, and additional costs have been reported, emphasizing the importance of high-quality service and thorough pre-operative consultation to ensure satisfactory outcomes.
Nail spicules are a rare but distressing sequela of improper toenail surgery. They are often extremely painful and refractory to conservative measures. We report two cases of nail spicules following improper or suboptimal surgery for an ingrown nail. Both patients presented with painful lateral nail fold swelling after surgical treatment for an ingrown nail at different centers. We treated both with spiculectomy combined with chemical matricectomy of the ectopic matrix. Only one of the four treated spicules recurred, which was again treated with the same procedure. Formation of a nail spicule is an unfortunate outcome of nail surgery, highlighting the importance of a proper knowledge of the nail anatomy and precise surgical technique. It is important to prevent spicule formation by attending to the lateral horns of the nail matrix. Management requires meticulous spiculectomy, matricectomy, and regular follow-up to ensure both functional correction and esthetic preservation.
