The Physician's Guide to Platelet-Rich Plasma in Dermatologic Surgery Part II: Clinical Evidence BACKGROUND Platelet-rich plasma (PRP) is an increasingly popular treatment modality for various dermatologic conditions, but there are limitations in both the published literature and clinician knowledge. OBJECTIVE To create a high-yield, in-depth analysis of PRP in procedural dermatology by reviewing available data on its role in hair restoration, soft-tissue remodeling, resurfacing, and rejuvenation; identifying practice gaps and controversies; and making suggestions for future research that will establish dermatologists as pioneers of regenerative medicine. MATERIALS AND METHODS A two-part systematic review and expert analysis of publications before October 2018. RESULTS AND CONCLUSION Most studies on PRP report favorable outcomes with the strongest level of evidence existing for androgenetic alopecia followed by postprocedure wound healing, scar revision, striae, rejuvenation, and dermal filling. There is a dearth of large randomized controlled trials, considerable heterogeneity in the variables studied, and lack of specificity in the preparatory protocols, which may influence clinical outcomes. Future investigations should use consistent nomenclature, find ideal solution parameters for each cutaneous indication, determine significant outcome metrics, and follow double-blinded, randomized, controlled methodologies. Addressing these deficiencies will take sound scientific inquiry but ultimately has the potential to benefit the authors' specialty greatly. Address correspondence and reprint requests to: Amelia K. Hausauer, MD, Aesthetx Plastic Surgery & Dermatology, 3803 South Bascom Avenue, Suite 100 Campbell, CA 95008, or e-mail: drh@aesthetx.com Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.dermatologicsurgery.org). A. K. Hausauer led an investigator-initiated trial using an Eclipse Aesthetic PRP device. The authors have indicated no significant interest with commercial supporters. © 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

Validation of Photonumeric Assessment Scales for Temple Volume Deficit, Infraorbital Hollows, and Chin Retrusion BACKGROUND Assessment scales are valuable tools in aesthetic clinical research and practice. OBJECTIVE To validate 3 photonumeric scales covering temple volume deficit, infraorbital hollows, and chin retrusion. MATERIALS AND METHODS Subjects reflecting the whole range of the scales were assessed independently by 3 evaluators at 2 separate occasions. Intraobserver agreement (the ability of each evaluator to assess the same grade for a specific subject at both evaluation occasions) and interobserver agreement (the degree to which evaluators independently provided identical grades for the same subject) were measured by weighted kappa statistics and percent exact agreement. RESULTS Approximately 70 subjects were included in each scale validation. The predefined success criteria of an intraobserver weighted kappa coefficient of ≥0.6 and an interobserver median pairwise weighted kappa coefficient of ≥0.6 were met for each scale. These results indicate substantial agreement, both between the 2 evaluations, and between the 3 evaluators. CONCLUSION These scales covering temple volume deficit, infraorbital hollows, and chin retrusion are validated assessment tools, based on live evaluations. Intraobserver agreement (between the 2 evaluations) and interobserver agreement (between the 3 evaluators) were both substantial. Address correspondence and reprint requests to: Amir Moradi, MD, Private Practice, 2023 W. Vista Way, Suite F, Vista, CA 92083, or e-mail: moradimd@gmail.com The study was funded by Galderma. A. Moradi is a consultant, and clinical investigator for Galderma. Lin is employed by Galderma. S. Allen is a consultant trainer and advisor for Galderma. S. Fagien is a consultant, advisor, and clinical investigator for Galderma. M. Norberg is employed by Galderma. S. Smith is a consultant and clinical investigator for Galderma. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. © 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

Variation of a Trap Door Flap for Tissue-Sparing Fascial Biopsy No abstract available

Strip Graft of the Eyebrow for the Treatment of Traumatic Madarosis of Upper and Lower Eyelid No abstract available

Mohs Micrographic Surgery for the Treatment of External Ear Melanoma: an Outcome Study BACKGROUND The external ear is composed of thin skin overlying cartilage making melanoma on the external ear difficult to resect while preserving the intricate anatomy. Although surgeons have achieved robust clinical outcomes for nonmelanoma and most recently melanoma skin cancers with Mohs micrographic surgery (MMS), there is still not enough evidence on the MMS application for external ear melanoma treatment. OBJECTIVE The authors examined survival outcomes in patients treated with MMS, narrow margin excision (NME), and wide margin excision (WME) for melanoma on the external ear. METHODS Data from the NCI SEER program was retrospectively analyzed. Patients who received surgical treatment on the external ear and had microscopically confirmed diagnosis of cutaneous melanoma were included in the study. The effect of different surgery types: MMS, NME, and WME, on melanoma survival was evaluated. RESULTS A total of 8,212 melanoma cases of the external ear performed during the years 2000 to 2015 were considered for analysis. There were no significant differences in survival comparing NME and WME with MMS. CONCLUSION Mohs micrographic surgery is at least equivalent to WME for the treatment of melanoma of the external ear. Address correspondence and reprint requests to: Maria M. Tsoukas, MD, PhD, Department of Dermatology, College of Medicine, University of Illinois Hospital and Health Sciences System, 808 S. Wood Street, Chicago, IL 60612, or e-mail: tsoukasm@uic.edu The authors have indicated no significant interest with commercial supporters. © 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

Depth Map for Face and Neck Deep Chemical Peel Resurfacing BACKGROUND Chemical peels are applied to the face and neck to improve rhytides and the photoaged appearance of the skin. Peels can be applied to different skin depths depending on the types of chemicals, the volume of solution, and the amount of pressure or friction applied. If a peel is applied too superficially, rhytides will not be removed. If a peel is applied too deeply, scarring or hypopigmentation could occur. OBJECTIVE To create face and neck depth maps for chemical peeling, which can guide safety when removing rhytides and improving the skin's appearance. MATERIALS AND METHODS A multicenter retrospective review of records was conducted of patients who underwent phenol–croton oil peeling, from January 1, 2018, to December 31, 2018. Information was collected on facial and neck cosmetic units peeled, peel formula and strength used, outcomes, and complications. RESULTS A total of 410 patients received deep peels. Two depth maps were created that corresponded to the most common patterns of deep chemical peel applications. CONCLUSION Different areas of the face and neck are treated with different chemical peel application depths to safely improve rhytides and appearance. Depth maps are created to balance safety and efficacy. Address correspondence and reprint requests to: J. B. Sterling, MD, 215 Morris Avenue, Spring Lake, NJ 07762, or e-mail: bartonsterling@hotmail.com The authors have indicated no significant interest with commercial supporters. All authors made substantial contributions to the conception, acquisition of data, and interpretation of data. All authors were involved in reviewing the initial drafts of the article and the final submission. All authors were involved and important for the intellectual content of the article. © 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

Update and Review of Bleeding Considerations in Dermatologic Surgery: Anticoagulants and Antiplatelets BACKGROUND Bleeding is an unavoidable risk of dermatologic surgery. The risk may be higher in patients taking agents that affect hemostasis. OBJECTIVE The aim of this study was to provide an updated review of current anticoagulant and antiplatelet therapy available in the market and their associated risk of bleeding complications in cutaneous surgery. MATERIALS AND METHODS A review of PubMed and MEDLINE was performed to review the English-language medical literature. RESULTS Many anticoagulant and antiplatelet therapies exist. Several studies recommend the continued use of antiplatelet and anticoagulant medications in the perioperative period. Combination regimens and novel oral anticoagulants may be associated with an increased risk of bleeding. CONCLUSION An updated understanding of antiplatelet and anticoagulant agents is critical for the surgeon. Current evidence does not support the discontinuation of antiplatelet and anticoagulant agents in the perioperative period under most circumstances. However, relevant data on novel oral anticoagulant agents are still sparse, suggesting that a precautionary approach is warranted. Address correspondence and reprint requests to: Sanjana Iyengar, MD, West Virginia University, Department of Dermatology, 1 Medical Center Drive, PO Box 9158, Morgantown, WV 26506, or e-mail: sanjana.iyengar@hsc.wvu.edu The authors have indicated no significant interest with commercial supporters. © 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

Impact of Preoperative Acetaminophen and Carbohydrate Loading on Pain and Functional Status in Patients Undergoing Mohs Micrographic Surgery for Nonmelanoma Skin Cancers BACKGROUND Preoperative acetaminophen and carbohydrate loading has been shown to improve the functional recovery of surgical patients. OBJECTIVE To determine the effects of preoperative acetaminophen and carbohydrates on functional outcomes and the use of pain medications after surgery in patients undergoing Mohs Micrographic Surgery (MMS) for nonmelanoma skin cancer (NMSC). MATERIALS AND METHODS One hundred patients treated with MMS for NMSC at an academic center were randomized into a control group receiving standard preoperative care or an intervention group receiving acetaminophen and carbohydrate drinks immediately before surgery. Patients rated levels of pain, thirst, hunger, anxiety, and fatigue on the day of surgery on a scale of 0 to 100, and reported through a phone interview the use of pain medications within 48 hours of surgery. RESULTS There was no significant difference between intervention and control groups in maximum pain score on the day of surgery; maximum pain score 48 hours after surgery; use of nonopioid pain medications; and use of opioids. However, the intervention group had lower anxiety levels during and at the end of surgery. CONCLUSION Patients undergoing MMS for NMSC reported very low levels of pain during and after surgery. Preoperative acetaminophen and carbohydrate loading had no impact on pain levels or the use of pain medications but did reduce levels of anxiety. Address correspondence and reprint requests to: Bichchau Nguyen, MD, MPH, Department of Dermatology, Tufts Medical Center, 260 Tremont Street, 14th Floor, Boston, MA 02116, or e-mail: bnguyen2@tuftsmedicalcenter.org This study was funded by the 2015 Cutting Edge Research Grant (CERG) from the American Society of Dermatologic Surgery. The authors have indicated no significant interest with commercial supporters. The authors consent for publication of this manuscript. This study has been approved by the institutional review board at Tufts Medical Center. The principles outlined in the Declaration of Helsinki were followed in the production of this manuscript. © 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

Use of Bridge Flaps for Primary Closure of Donor Sites of Interpolated Forehead Flaps No abstract available

Infliximab Prophylaxis in Patients With Postoperative Pyoderma Gangrenosum Requiring Surgical Intervention No abstract available