Seminars in cutaneous medicine and surgery
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Performing dermatologic surgery in infants and children presents unique challenges. A thorough understanding of both pediatric developmental milestones and their unique surgical circumstances is essential to providing optimal dermatologic care of the pediatric patient. In this work, we combine the authors' experiences with data from the literature to provide pediatric dermatologic procedural pearls.
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Nonsurgical procedures have become very popular for the rejuvenation of the aging face. Trends now are for less invasive procedures as well as for more preventative intervention to slow the damage from ultraviolet light and environmental factors, as well as from intrinsic aging. The goal of these procedures is to eliminate or delay the need for corrective surgery. ⋯ The availability of improved fillers that are less allergenic and longer lasting has resulted in a renaissance in filler techniques. No single filler has proven to be more popular than the category of hyaluronic acids (HA). This article will review the use of the hyaluronic acid fillers that are currently approved for use by the Federal Drug Administration in the United States and describe the significant differences between them to assist the practicing cosmetic physician in choosing and using this category of dermal filler.
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Health care accreditation is a process of demonstrating compliance with nationally-recognized standards of excellence. Compliance with standards is verified during an on-site survey by specially-trained surveyors. Office-based surgery accreditation is available to dermatologists through the Accreditation Association for Ambulatory Health Care (AAAHC), and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).
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The Accreditation Council for Graduate Medical Education (ACGME) is an agency that accredits residency-training programs, thus assuring the public of the highest-quality medical education in the United States. Only those residents who complete ACGME-accredited programs qualify for certification by an American Board of Medical Specialties (ABMS)-sponsored board. ⋯ Procedural dermatology is a surgical subspecialty of dermatology that includes cutaneous oncology (along with Mohs micrographic surgery), cutaneous reconstructive surgery, and cosmetic surgery of the skin. The recent approval by the ACGME to accredit procedural dermatology fellowships establishes the specialty of dermatology as an organ-based body of knowledge that includes medical, pathologic, and surgical skills.
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The histological aspects of resorbable heterologous fillers (bovine collagen, acid hyaluronique), autologous fillers (lipofilling, dermis-fat graft), biodegradable fillers (New-Fill), and permanent fillers (silicone, Artecoll, Evolution, Aquamid, DermaLive, DermaDeep, Bioplastique, Paraffin) are described. This article relates the morphological aspect of these materials, the normal tissue reaction after injection, and its chronological evolution as the morphological aspects from the different side effects, more frequently observed for the permanent fillers. They mainly consist of granulomatous reactions which may appear long after injection.