BACKGROUNDSince the approval of OnabotulinumtoxinA, the introduction of new botulinum toxin formulations has raised concerns regarding the potential development of neutralizing antibodies, diminished efficacy, and reduced duration of effect. However, long-term data on the safety of repeated cosmetic OnabotA treatments remain limited, particularly in real-world clinical practice.OBJECTIVETo evaluate the long-term use and patient perceived age after consecutive cosmetic OnabotA injections.METHODSSingle-center, single-injector, retrospective cohort study evaluating the long-term use of consecutive OnabotA injections and assessing patient perceived age.RESULTSFifty patients (48 females, 2 males) were included, with a mean follow-up duration of 15.04 years (range: 8–26) and a total of 1,098 treatment cycles (8–67 cycles/patient). The cumulative OnabotA dose ranged from 332 to 3,684 units, with an average cumulative dose of 1,232 units/patient. When asked how old they perceived themselves compared to their current age, no patient reported feeling older than their chronologic age. Ninety-four percent stated appearing at least 2 years younger, while 76% perceived themselves to be between 5 and 12 years younger.CONCLUSIONIn this cohort of 50 patients treated over an average of 15 years, OnabotA demonstrated no evidence of treatment failure or diminished duration of aesthetic outcomes.

BACKGROUNDPatients frequently seek laser treatment for vascular conditions. More recently, a novel 532 and 1,064 nm laser was developed to offer greater flexibility.OBJECTIVEA prospective clinical trial evaluated the safety and efficacy of a novel, variable-sequenced, long-pulsed, 532 and 1,064 nm laser with cryogen spray cooling (DermaV, Lutronic, South Korea).MATERIALS AND METHODSSubjects with vascular conditions were enrolled for laser treatments. Clinical evaluations and optical coherence tomography (OCT) imaging were performed.RESULTSThirteen subjects were enrolled. The mean age was 51.3 years, and 92.3% were women. Fitzpatrick skin types I–IV were included. Treatment indications included broken blood vessels, rosacea, port-wine birthmark, and spider angioma. For physician investigator grading, all subjects were graded as improved at both 30-day and 90-day follow-up. Blinded photographic review by 3 independent, blinded physicians had a mean of 89.7% of cases selected correctly with at least 2 of 3 in agreement for 100.0% of cases. Optical coherence tomography imaging showed significant reductions in vessel density (p = .018) and diameter (p = .003) of the superficial vascular plexus. No serious adverse events occurred.CONCLUSIONA novel, variable-sequenced, long-pulsed, 532 and 1,064 nm laser with cryogen spray cooling can safely and effectively improve vascular conditions and lesions as determined by both clinical and OCT evaluation.

*Dept Dermatol Inselspital, Univ Bern, Bern, Switzerland; †Private Dermatol Practice Dermaticum, Freiburg, Germany The author has indicated no significant interest with commercial supporters.

Hooper, Perry B. MD*; Dover, Jeffrey S. MD*,†,‡; Arndt, Kenneth A. MD*,†; Rohrer, Thomas E. MD* Author Information

Mohs micrographic surgery, involving pathology of the surgical margin, has the lowest recurrence rate for skin cancer. Moreover, because of technological advances, digital pathology systems are gradually being adopted in hospitals. Yongin Severance Hospital was the first hospital to construct a fully digitalized pathology system in Korea. To evaluate the efficiency and characteristics of the digital pathology system for Mohs micrographic surgery. The medical records of 80 patients with skin cancer who underwent Mohs micrographic surgery from March 2020 to August 2022 were analyzed for the number of frozen margins, number of stages, operation time, and recurrence rate to compare cases based on the pathology system. Overall, 23 and 57 patients were examined using the conventional and digital pathology systems, respectively. The mean number of final stages was 0.494 lower ( p -value = .008), the time from the previous to the next stage was 0.687-fold shorter ( p = .002), and the rate of switching from positive to negative margins was 1.990 times higher ( p = .044) in the digital than the conventional group. Retrospective single-center experience; short follow-up time. Digital pathology reduces operative time and increases accuracy in Mohs micrographic surgery.

Ear keloids are disfiguring disorders resistant to various treatments. The authors aimed to assess the efficacy of surgical treatment of ear keloids in a Chinese population using a tongue flap with electron beam radiotherapy. The authors conducted a retrospective analysis of 41 patients treated at the Affiliated Hospital of Nantong University between January 2018 and May 2021. Core excision with a tongue flap was performed, followed by 3 days of electron beam radiotherapy and 3 to 6 months of pressure clip application. The Vancouver Scar Scale (VSS) and the Visual Analog Scale (VAS) were used to assess the results. The mean age of the patients was 28.10 years (9-61 years). Postoperative follow-up ranged from 5 to 32 months (mean:12.07). The patients underwent 3 days of postoperative radiotherapy followed by pressure clips for 2 to 6 months. Thirty-seven patients had no recurrence, whereas 4 had a mild recurrence (<3 mm in height) with redness and itchiness. The VSS and VASscores significantly decreased. (p < .05). Excision with a tongue flap and radiotherapy can be used as the primary treatment for ear keloids considering the good outcome and long-term management.

Actinic keratoses (AKs) are common and some may evolve into squamous cell carcinoma. Photodynamic therapy (PDT), imiquimod, cryotherapy, and other methods have been reported to have good effects. However, which treatment is the most effective with the best cosmetic results and fewest complications is uncertain. To evaluate which method has the best efficacy and cosmetic results with less adverse events and recurrence rate. All relevant articles up to July 31, 2022 were searched from Cochrane, Embase, and PubMed databases. Extract and analyze the data of efficacy, cosmetic results, local reactions, and adverse effects. Twenty-nine articles with 3,,850 participants and 24,747 lesions were included. Quality of evidence was generally high. The efficacy of PDT was better in complete response (CR) (lesions CR; risk ratio (RR) 1.87; 95% confidence interval (CI) 1.55-1.87/patient CR; RR 3.07; 95% CI 2.07-4.56), overall preference, and cosmetic results. The time cumulative meta-analysis showed that the curative effect was gradually increasing before 2004, and then gradually stabilizing. Two groups showed no statistically significant differences in recurrence. Compared with other methods, PDT is significantly more effective for AK with excellent cosmetic results and reversible adverse effects.