Although suction-assisted liposuction under tumescent anesthesia remains the traditional
method for body sculpting, newer technologies promise to increase efficiency, decrease
surgeon fatigue, and minimize complication. Power-, ultrasound-, and laser-assisted devices
are ideal in large volume cases and in areas of fibrous tissues as an adjunct to
traditional liposuction. Although skepticism remains chemical lipolysis, more commonly
termed mesotherapy or lipodissolve may be an alternative to surgical treatment of localized
fat. This article reviews the recent advancements in the field of liposuction and the current
literature which support their use.
Semin Cutan Med Surg 27:72-82 © 2008 Elsevier Inc. All rights reserved.
The demographics of the US population continue to change at an extremely rapid pace. As
of 2008, Asians, Hispanics, and African Americans accounted for 31% of the US population,
and it is estimated that by the year 2050 half of the population of America will be
represented by darker ethnic skin types. With the increase in the total number of individuals
of skin of color, the demand for safe and effective laser therapy in darker skin types
continues to increase. However, despite the increase in demand, the current literature
regarding the use of lasers in darker skin remains limited. Most of the treatment parameters
defined for laser platforms have been established primarily through extensive testing on
skin phototypes I to III, and those studies that have been conducted on darker skin
phototypes have been overwhelmingly conducted on Asian skin. Nevertheless, it has
become clear that effective cutaneous laser surgery in darker skin types can be accomplished
despite a relative overall greater risk for complications. Therefore, as the diversity
of America continues to grow, the laser surgeon needs to maintain a clear understanding
of the complexities associated with treating ethnic skin and remain mindful of the current,
and ever-changing, therapeutic modalities available. This will allow the conscientious
physician to maximize outcome and minimize risk when performing laser surgery on darker
Semin Cutan Med Surg 28:130-140 © 2009 Elsevier Inc. All rights reserved.
Imaging has always had an important role in the practice
and evolution of medicine. Even in the earliest medical
documents, illustrations were used to depict tumors, lesions,
and procedures. The development of small film cameras revolutionized
medical imaging in the twentieth century. The
office-based practitioner could readily process film into
prints or slides for personal records and for teaching purposes.
1 Today’s digital cameras have further improved medical
imaging by decreasing the time and expense needed to
view and share photos.
Photography is particularly important in the visuallybased
specialty of dermatology. Medical dermatologists use
photographs to display the pattern of a cutaneous eruption,
the characteristics of skin surface changes, and location, size,
shape, and color of a visible lesion.2,3 Surgical dermatologists
record preoperative, intraoperative, and postoperative images
to evaluate tumor growth, location, defect size, and
wound healing.4 Cosmetic dermatologists use photography
to evaluate a patient’s appearance pre- and postcosmetic intervention.
Digital photography has revolutionized the dermatology
office by providing cost-effective imaging, storage, and retrieval.
Initial equipment costs and recurring costs are nominal,
storage space needed for medical images is minimal, and
properly labeled digital photographs can be rapidly retrieved
and viewed with no degradation of picture quality over time.
Who benefits and who pays for the electronic health records? Patients may obtain better
health care, while payers benefit from lower costs. Providers pay greater costs to implement
health information technology, however, and may experience lower revenues after
implementation. Although large multispecialty practices or medical centers may benefit
from electronic health record systems, dermatologists—particularly those in dermatology
specialty groups or in solo practice—may be adequately served by document-management
systems that are less complex and less expensive. This article offers a perspective on
medical record documentation alternatives.
Semin Cutan Med Surg 27:86-88 © 2008 Elsevier Inc. All rights reserved.
The Use of High Definition Video Modules for Delivery of Informed Consent and Wound Care Education in the Mohs Surgery Unit
The use of video in the informed consent process has been well documented in the
literature to improve patient satisfaction, understanding, comprehension, and to decrease
anxiety. At the MD Anderson Mohs Surgery Unit, we use high-definition (HD) audiovisual
(AV) modules to assist with the delivery of informed consent and to educate patients on the
subject of postoperative wound care. The purpose of this work was to develop HD-AV
media to inform patients of the risks, benefits, and alternatives of Mohs surgery before they
are asked to sign the consent form and to educate patients on basic wound care after Mohs
Surgery. The use of a HD virtual surgeon and nurse in the videos educates the patient,
allowing the surgeon and nursing staff to attend to other patients within the Mohs Surgery
Unit. Using HD digital recording equipment, we captured real-time HD-AV media to explain
the risks, alternatives, and benefits of Mohs surgery (surgeon explanation) and to give
detailed instructions for postoperative wound care (nurse explanation). Once captured, HD
modules were created and stored on a central University of Texas–MD Anderson Cancer
Center server in the Texas Medical Center approximately 1 mile from the Mohs Surgery
Unit. The full-screen HD modules are accessed on demand at the point of need with the use
of standard institutional computers within any of the Mohs’s center’s examination/surgical
suites. An early evaluation of this quality improvement initiative was performed to measure
patient satisfaction, efficiency, and efficacy of the videos followed by physician/nurse
discussion compared with physician/nurse discussion alone. Early evaluation of HD-AV
modules used for the delivery of informed consent and postoperative wound care in the MD
Anderson Mohs surgery Unit revealed that patient satisfaction was maintained and that this
medium was preferred by patients in the video group over physician/nurse discussion
alone. The HD modules allowed increased efficiency and patient comprehension, which
improved patient education in the Mohs Surgery Unit.
Semin Cutan Med Surg 27:89-93 © 2008 Elsevier Inc. All rights reserved.