AMA Publishing Group: Aesthetic Dermatologic Surgery Topic Collection

Picosecond Laser Pulses for Tattoo Removal: A Good, Old Idea

Ibrahimi OA, Sakamoto FH, Anderson R. — Fri, 01 Feb 2013 00:00:00 GMT

We read with great interest the recent study in this journal by Brauer et al and congratulate them for carrying out a well-designed pilot study of a picosecond laser for tattoo removal. In particular, we applaud the authors for demonstrating the potential of these lasers to remove multicolored tattoos, which often prove to be more challenging to remove than traditional black tattoos with current nanosecond technology.

Curettage as an Acceptable Treatment for Gouty Tophi on the Ear

Elam A, McCleskey PE. — Fri, 01 Feb 2013 00:00:00 GMT

Report of a Case. A 48-year-old man with a 1-year history of gouty arthritis presented for evaluation of “white bumps” on his ears. Examination revealed several 2- to 5-mm firm, white papules on the bilateral helical rims (Figure 1A). Shave biopsy specimens were submitted in formalin and ethanol (Figure 2A). Crystals from the ethanol preparation were refractile (Figure 2B) and birefringent on cross-polarization (Figure 2C and D). Subsequently, the ears were cleansed and anesthetized using lidocaine, 2%, with 1:50 000 epinephrine prior to curettage. Tophi were removed with a 3-mm disposable curette until no chalky white material was visible; minor bleeding was controlled with aluminum chloride. The patient's primary care physician prescribed allopurinol, 300 mg/d, and colchicine, 0.6 mg/d, as needed for symptoms of an acute gouty arthritis attack. Initial serum uric acid level was 10.7 mg/dL; follow-up levels at 3 months and 1 year were 10.1 and 11.6 mg/dL, respectively. (To convert uric acid to micromoles per liter, multiply by 59.485.) No new tophi appeared despite uncontrolled serum uric acid levels. The patient was pleased with the cosmetic outcome (Figure 1B) 18 months after curettage.

Nose Piercing: Historical Significance and Potential Consequences

Ladizinski B, Nutan FU, Lee KC. — Fri, 01 Feb 2013 00:00:00 GMT

Nose piercing is the process by which a needle penetrates the nostril, nasal septum, or nasal bridge to create an opening for the placement of jewelry. The practice, which is performed for symbolic or beautification purposes, originated more than 4000 years ago in the Middle East, migrating to India in the 1500s and reaching Western civilization by the 20th century.

Common Causes of Injury and Legal Action in Laser Surgery Causes of Injury and Legal Action in Laser Surgery

Jalian H, Jalian CA, Avram MM. — Fri, 01 Feb 2013 00:00:00 GMT

Objective

To identify common causes of legal action, injuries, claims, and decisions related to medical professional liability claims stemming from cutaneous laser surgery.

Design

Search of online public legal documents using a national database.

Main Outcome Measures

Frequency and nature of cases, including year of litigation, location and certification of provider, injury sustained, cause of legal action, verdict, and indemnity payment.

Results

From 1985 to 2012, the authors identified 174 cases related to injury stemming from cutaneous laser surgery. The incidence of litigation related to laser surgery shows an increasing trend, with peak occurrence in 2010. Laser hair removal was the most common litigated procedure. Nonphysician operators accounted for a substantial subset of these cases, with their physician supervisors named as defendants, despite not performing the procedure. Plastic surgery was the specialty most frequently litigated against. Of the preventable causes of action, the most common was failure to obtain an informed consent. Of the 120 cases with public decisions, 61 (50.8%) resulted in decisions in favor of the plaintiff. The mean indemnity payment was $380 719.

Conclusions

Claims related to cutaneous laser surgery are increasing and result in indemnity payments that exceed the previously reported average across all medical specialties. Nonphysicians performing these procedures will be held to a standard of care corresponding to an individual with appropriate training; thus, physicians are ultimately responsible for the actions of their nonphysician agents.

Contradictory State Administrative Regulation of Minimally Invasive Cosmetic Procedures in Kentucky and North Carolina Regulating Minimally Invasive Cosmetic Procedures

Gillum JD, Dellavalle RP. — Fri, 01 Feb 2013 00:00:00 GMT

The regulation of minimally invasive cosmetic procedures (MICPs), such as laser skin rejuvenation and hair removal, should be of keen interest to dermatologists for a number of reasons, the most important of which is patient safety.