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Complications in Cosmetic Dermatology: Crafting Cures
Ganesh S Pai
CHAPTER 1:
Introduction
CHAPTER 2:
Complications in Q-switched Laser
INTRODUCTION
TATTOOS
TATTOO COLOR AND PIGMENT
LASER TATTOO REMOVAL
HISTORY TO BE NOTED IN A PATIENT WITH TATTOO
TREATMENT OF PIGMENTED LESIONS
Lentigines and Freckles
Café au Lait Macules
Nevus Spilus
Becker's Nevus
Acquired Melanocytic Nevus
Melasma
Nevus of Ota
HISTORY TO BE NOTED IN A PATIENT WITH A PIGMENTED LESION
PATIENT SELECTION FOR LASER
PATIENT PREPARATION FOR LASER
TREATMENT ALGORITHM
COMPLICATIONS RELATED TO Q-SWITCHED NEODYMIUM-DOPED YTTRIUM ALUMINIUM GARNET LASER
Transient Erythema, Edema
Pain
Leukotrichia
COMPLICATIONS IN TATTOOS
Hypertrophic Scarring
Paradoxical Darkening of Tattoo Pigment
Tattoo Granuloma
CONCLUSION
CHAPTER 3:
Protocols and Complications in Fractional Carbon Dioxide in the Management of Facial Scar
INTRODUCTION
FRACTIONAL CARBON DIOXIDE LASER
SAFETY AND RISK PARAMETERS IN FRACTIONAL CARBON DIOXIDE LASER
Width of Fractional Column
Ratio of Ablation to Coagulation
Ratio of Width to Depth of Microthermal Zone
Pulse Structure
Fluence
Density of Microthermal Zones per Square Centimeter
Repetition Rate or Stacking
Hydration of Tissue
Appendage Density in Treatment Area
WHICH PATIENTS WE SHOULD AVOID?
TECHNIQUE AND PROTOCOLS FOR FACIAL ACNE SCARS (Box 3)
Before Procedure
The Procedure
Postprocedure
TECHNIQUE AND PROTOCOLS FOR CHICKENPOX SCARS
TECHNIQUE AND PROTOCOLS FOR HYPERTROPHIC SCARS
TECHNIQUE AND PROTOCOLS FOR KELOIDS
TECHNIQUE AND PROTOCOLS FOR MORPHEA
COMPLICATIONS AND HOW TO HANDLE THEM
Pain, Syncope
Postinflammatory Hyperpigmentation
Postinflammatory Hypopigmentation and Erythema
Infection
Reactivation of Herpes Simplex Labialis
Reactivation of Psoriasis
Reactivation of Lichen Planus
Reactivation of Vitiligo
Contact Allergy
Worsening of Scar
Damage to Deeper Structures
Formation of New Keloid
CONCLUSION
CHAPTER 4:
Complications in Erbium Lasers
INTRODUCTION
INDICATIONS3
CONTRAINDICATIONS3
PROCEDURE
STEPS
PATIENT INSTRUCTIONS
POST-TREATMENT SEQUELAE
ADVERSE EFFECTS
CONCLUSION
CHAPTER 5:
Vascular Lasers
INTRODUCTION
CLASSIFICATION OF VASCULAR LASER
PARAMETERS FOR OPTIMAL OUTCOME
Points to Remember
SPECIFIC CONDITIONS
Facial Telangiectasia2,11,12
Pearls
Spider Angiomas/Telangiectasia
Generalized Essential Telangiectasia
Rosacea
Poikiloderma of Civatte19,20
Pearls
Nevus Simplex or Salmon Patch/Port-wine Stain
Other Lasers for Resistant or Dark Port-wine Stain
GENERAL RULES IN TREATING PORT-WINE STAIN
Note
Hemangiomas
Spider Angiomas/Telangiectasia
MISCELLANEOUS CONDITIONS
CONCLUSION
CHAPTER 6:
Complications of Laser Hair Reduction
INTRODUCTION
EVALUATION OF WOMEN WITH HIRSUTISM1
CAUSES OF INCREASED HAIR GROWTH AND INDICATIONS FOR LASER HAIR REDUCTION2
Male Patients
Transgender
Mentally Challenged
EQUIPMENT AVAILABLE
Pain Free Lasers6
Contraindications
STEPS TO BE TAKEN BEFORE THE HAIR REMOVAL LASER IS DONE
Procedure
Technical Difficulties
COMPLICATIONS AND MANAGEMENT
CONCLUSION
CHAPTER 7:
Complications in Intense Pulsed Light Treatment
INTRODUCTION
FACTORS TO BE CONSIDERED AS A PREREQUISITE FOR THE DOCTOR OR AESTHETIC ASSISTANT
Training
Diagnosis
Knowing How to Treat Complications
FACTORS ABOUT THE INTENSE PULSED LIGHT WHICH SHOULD BE UNDERSTOOD TO PREVENT COMPLICATIONS
Parameters
Energy/Fluence
Pulse Duration and Pulse Delay (On and Off Time)
Cooling
Filters
Radiofrequency Incorporated Intense Pulsed Light
COMPLICATIONS
Immediate Postoperative Complications
Burns
Blister/Vesicle Formation/Erosion
Delayed Complications
Hyperpigmentation/Hypopigmentation
Potential Infections
CASE DISCUSSIONS
Case 1 (Figure 3)
Case 2
Case 3
Case 4 (Figure 6)
Case 5 (Figure 7)
Case 6 (Figure 8)
Case 7 (Figure 9)
Case 8 (Figure 10)
ADDITIONAL INFORMATION
CONCLUSION
CHAPTER 8:
Complications of Hair Restoration Surgery
INTRODUCTION
GENERAL COMPLICATIONS
Pain during Surgery and Postoperative Pain
Postoperative Hiccups
DONOR SITE COMPLICATIONS IN FOLLICULAR UNIT TRANSPLANTATION
Bleeding
Folliculitis
Infection
Wound Dehiscence or Necrosis13
Numbness
Pain
Persistent Pain
Suture Extrusion
Keloids
Donor Hair Effluvium
Donor Site Scars (Figure 1)
RECIPIENT AREA COMPLICATIONS
Poor Hair Line
Low Perceived Cosmetic Density and Unnatural Coverage
Recipient Area Edema (Figure 2)
Postoperative Pustules (Figure 3)
Central Scalp Necrosis
Cobblestoning
Cysts
Poor Hair Growth
Temporary Hair Loss
TIPS AND PEARLS
Conclusion
CHAPTER 9:
Complications of Fillers
INTRODUCTION
PREPROCEDURE CARE
Know How the Face Ages
Know Your Filler Product and Its Specifics
CATEGORIES OF DERMAL FILLERS
Know the Technique
Assess the Patient
Documentation
Dermal Filler Complications: Avoidance and Treatment
Early
Edema and Erythema
Management
Antibody-mediated Edema (Angioedema)
Management
Nonantibody-mediated (Delayed) Edema
Malar Edema
Skin Discoloration
Ecchymosis and Bruising
Refining the Technique
Management
Tyndall Phenomenon
Management
Lumps, Nodules
Management
Infection, Erythematous Nodule
Herpetic Outbreak
Vascular Compromise
Signs of Tissue Necrosis
Retinal Artery Occlusion
Management
In Case of Necrosis
Granuloma and Biofilm
Management
Preventive Measures
Management
Telangiectasia
Management
Migration
Management
Hypertrophic Scar
Hyaluronidase
PRACTICAL CONSIDERATION
CONCLUSION
CHAPTER 10:
Complications of Injectable Botulinum Toxin for Cosmetic Indications
INTRODUCTION
SERIOUS ADVERSE EVENTS
Temporal Artery Pseudoaneurysm
Immune Mediated Reactions
NONSERIOUS ADVERSE EVENTS
Nonresponse to Botulinum Toxin
Failure to Meet Expectations of the Patient
Local Adverse Events
Pain
Bruising
Reactions to Topical Anesthesia
Unaesthetic Effects Due to Dosage Maladjustment or Improper Placement of Injections
Asymmetry
Quizzical Eyebrow
Rippled Forehead
Exacerbation of Lower Eyelid “Bags”
Mask-like Face/Frozen Forehead
ADVERSE EVENTS DUE TO INADVERTENT DIFFUSION OF THE TOXIN
Brow Ptosis
Strabismus and Diplopia
Blepharoptosis (Upper Eyelid Ptosis)
Distorted Smile and Upper Lip Ptosis
Functional Deficit of the Lips
Neck Weakness, Hoarseness, and Dysphagia
Dry Eye Syndrome
Complications Unique to Masseter Injections
CONTRAINDICATIONS TO BOTULINUM TOXIN USAGE
LITIGATION
CONCLUSION
CHAPTER 11:
Complications of Mesotherapy
INTRODUCTION
INDICATIONS AND TREATMENT METHODOLOGY
ADVANTAGES
CONTRAINDICATIONS
COMPLICATIONS
CONCLUSION
CHAPTER 12:
Monopolar Radiofrequency: Ways to Handle Complications
INTRODUCTION
TECHNOLOGIES IN RADIOFREQUENCY DEVICES
MECHANISM OF ACTION OF MONOPOLAR RADIOFREQUENCY
Client Related Complications
Product Related Complications
Environment Related Complications
CONCLUSION
CHAPTER 13:
Complications in Bipolar Radiofrequency Therapy
INTRODUCTION
CLINICAL INDICATIONS
Inflammatory Acne
Acne Scars
Skin Rejuvenation: Improvement of Skin Texture
Skin Tightening and Contouring
Striae
WHICH PATIENTS YOU WOULD AVOID AND WHY
Procedure (Figure 2)
Treatment Protocol
Tips
Complications
Burns
Management
Underlying Melasma Trigger
Management
Postinflammatory Hyperpigmentation
Management
Linear Epidermal Breach or Scratch Marks
Management
CONCLUSION
CHAPTER 14:
Practical Problems in Chemical Peels
INTRODUCTION
INDICATIONS
CONTRAINDICATIONS
CLASSIFICATION OF CHEMICAL PEELS
Factors Modifying Depth of Peel5
GENERAL PRINCIPLES FOR CHEMICAL PEELING
Patient Evaluation and Selection
Priming the Skin
Safety Precautions before Peeling
Test Peel
Procedure
Postprocedure Care
Individual Peels
Glycolic Acid
Indications
Procedure
Postpeel
Side Effects
Management of Complications
Pain and Burning Sensation
Hyperpigmentation
Persistent Erythema
Accidental Contact with the Eye
Blister and Scab Formation
COMBINATION TREATMENT13
Lactic Acid
Indications
Procedure
Side Effects
Specific Contraindications
Procedure
Postpeel
Side Effects
Trichloroacetic Acid
Indications26
Procedure
Classification
Postpeel
Side Affects
Pyruvic Acid
Indications27
Procedure
Postpeel
Retinoic Acid Peel
Indications
Specific Contraindications
Procedure
Side Effects
Jessner's Solution
Indications
Contraindications
Procedure
Side Effects
Combinations
CONCLUSION
CHAPTER 15:
Excimer Lasers: Optimizing Results and Minimizing Complications
INTRODUCTION
INDICATIONS
PATIENT SELECTION: WHICH TO AVOID AND WHY
LASER TECHNIQUE AND PROTOCOL
COMPLICATIONS AND THEIR MANAGEMENT
Koebnerization
Hypererythema
Hyperpigmentation
Tip
Dyschromasia
Tip
Xerosis
Tip
Burn
Ecchymosis and Petechiae
Blisters
CONCLUSION
CHAPTER 16:
Adverse Effects of Dermabrasion and Microdermabrasion
HISTORICAL BACKGROUND AND EVOLUTION OF TECHNIQUE
INTRODUCTION
CURRENT LITERATURE ON COMPLICATIONS AND AUTHOR'S EXPERIENCE
CONCLUSION
CHAPTER 17:
Platelet-rich Plasma
INTRODUCTION
WHAT IS PLATELET-RICH PLASMA?
INDICATIONS OF PLATELET-RICH PLASMA IN DERMATOLOGY2
PROCEDURE
Patient Preparation for Platelet-rich Plasma
COMPLICATIONS
Pain in the Injected Area, Headaches, and Heaviness of Head
Swelling and Redness
Infection
No Improvement in Injured Area
Allergic Reactions
Skin Discoloration
Bleeding
Cross Labeling of Samples
CONCLUSION
CHAPTER 18:
Prevention of Ocular Complications
INTRODUCTION
EYE CARE DURING LASERS
EYE CARE DURING FILLERS5
Key Prevention Strategies
Key Management Strategies
CONCLUSION
CHAPTER 19:
Managing Medical Emergencies in the Office: Office Emergency
INTRODUCTION
OVERVIEW
PREVENTION
STAFF ROLES AND RESPONSIBILITIES
CLASSIFICATION OF OFFICE PROCEDURES
Level 1
Level 2
Level 3
MANAGING EMERGENCIES
Emergency Medical Equipment
Emergency Drugs
RECOGNITION OF AN EMERGENCY AND INITIAL EMERGENCY PROCEDURE
SAMPLE EMERGENCY ASSIGNMENTS
Receptionist
Assistant 1
Assistant 2
Consultant
INITIAL EMERGENCY PROCEDURE
Recognization
Assess Circulation
Access of Airway
Assess Breathing
Assess Patient and Situation
ALLERGY/ANAPHYLAXIS
Signs of Anaphylaxis
Management of Anaphylaxes
CONCLUSION
CHAPTER 20:
Suturing for Dermatologists
INTRODUCTION
OBJECTIVE OF SUTURING
INDICATIONS FOR DERMATOLOGISTS
MATERIALS AVAILABLE
BASICS OF WOUND HEALING
SUTURING TECHNIQUES
CONCLUSION
INDEX
TOC
Index
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