Requisites in dermatology: Cosmetic dermatology
Authors: Dee Anna Glaser
Journal: Journal of the American Academy of Dermatology (2009)

It is challenging to learn all of the subspecialties within dermatology, but a discipline like cosmetic dermatology can be especially difficult, with the rapid additions of new laser and light devices, fillers, and ever-evolving techniques. Drs Alam, Gladstone, and Tung have created a textbook that is concise, easy to read, and yet is full of pearls. This textbook is accompanied by an online module that complements the text with video and lecture materials. This innovative use of technology will delight both the beginner and the more seasoned clinician. The book is divided into 12 chapters, starting with the approach to the cosmetic patient and finishing with advanced surgical procedures. The authors have covered cosmeceuticals, botulinum toxin, fillers, chemical peels, vascular and pigmented lasers, ablative devices, nonablative laser and light sources, skin tightening devices, hair transplantation, liposuction, and even blepharoplasty and facelifts. The botulinum toxin chapter includes a review of the different toxins and products that are available, along with general injection techniques. Commonly treated anatomic sites are then discussed, along with dosing suggestions and pearls for the different areas of the face and neck. Tips on preventing and treating complications are also discussed. Likewise, the chapter on fillers has a succinct but excellent review of complications and their treatment algorithms. The chemical peel chapter was exceptionally thorough, covering the different depths of peels and the various agents that can be used alone or in combination. Practical information reviewed how to peel different body areas, prepeel regimens, and the actual peel procedure. I was delighted to see the authors' recommendations to keep the concentration of trichloroacetic acid (TCA) below 50% and their section on using TCA to treat ice pick–type acne scars. The chapters covering lasers and other light-based devices tried to touch upon the innumerable devises available and their uses but could not be as detailed in terms of pearls for each laser and use. The Powerpoint slides nicely augment the information on vascular and pigment lasers and is a real bonus for the reader. The chapters covering ablative and nonablative technology were more detailed in reviewing treatment parameters and patient management, including the treatment of ethnic skin. Drs Carolyn Jacob and Amy Taub were very thorough in their evaluation of the skin tightening devices: not only did they review the current literature, but they also outlined the different technologies and gave treatment parameters. Their photographs showed patients in similar positions and lighting but did not always reveal the elapsed time between the pre- and posttreatment, which would have been helpful. Hair transplantation was very thorough and even discussed alternatives to surgery, such as finasteride and minoxidil. The authors included a section on the importance of the transplant “team” and how to assemble a staff that maximizes the surgeon's volume of surgery. Their discussion on the process from graft harvesting, division, and care to the creation of the recipient sites and placement of the hair units into the sites was comprehensive with excellent photographs to complement the text. This is an excellent resource for any dermatologist trying to incorporate hair transplants into their practice. Liposuction surgery is covered very well in chapter 11 by Dr Alam. The chapter is full of pearls, including ways to reduce entry site friction and trauma, reduce uneven suctioning, and avoid deep tissue injury. The photographs and illustrations are excellent and especially instructive. He reviews the most commonly treated body sites and outlines the challenges unique to each anatomic area. Although there are brief mentions of power-assisted liposuction and laser lipolysis, the focus of this chapter is on tumescent liposuction. The final chapter covers some of the more advanced procedures, such as upper and lower blepharoplasty, neck rejuvenation with liposuction and platysmal plication, and minimum-incision facelifts. Relevant anatomy, ethnic differences, and complications are included. In summary, this textbook is an excellent addition to a dermatologist's collection and one that I plan on having my residents and fellows read during their cosmetic and laser rotations. It is easy to read, concise, and practical.