Blinded, Randomized, Controlled Trial Evaluating the Effects of Light-Emitting Diode Photomodulation on Lower Extremity Wounds Left to Heal by Secondary Intention BACKGROUND Light-emitting diode (LED) has been used for wound healing because of its stimulatory effects on fibroblast proliferation, matrix synthesis, angiogenesis, and downmodulation of inflammatory reactions. OBJECTIVE The aim of the authors' study was to investigate the effects of red LED (wavelength 633 nm) photomodulation on lower extremity surgical defects left to heal by secondary intention. MATERIALS AND METHODS Fourteen subjects with surgical defects of the lower leg were irradiated with a 633 ± 3-nm light source for 20 minutes (105 mW/cm2, 126 J/cm2) at 4 weekly sessions. RESULTS The number of days required for wounds to heal was greater in the treatment group (63.2 ± 12.2 days) than in the control group (48.67 ± 11.1 days), although this difference was not statistically significant (p = .07). The percentage of the original wound remaining was not statistically different between treatment and control groups between Weeks 1 and 2 (p = .71) and Weeks 3 and 4 (p = .56). It was significant between Weeks 2 and 3 (p = .01). CONCLUSION This study revealed that red LED photomodulation at a wavelength of 633 nm did not result in clinical improvement in wound healing of surgical defects on the lower extremities. Address correspondence and reprint requests to: Marina Perper, BS, Department of Dermatology and Cutaneous Surgery, University of Miami Hospital, 1475 NW 12th Avenue Suite 2175, Miami, FL 33136, or e-mail: m.perper@med.miami.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.

Point-of-View Dermatologic Surgery Video Recording No abstract available

Superficial Basal Cell Cancers Demonstrate Higher Rates of Mixed Histology on High-Risk Anatomical Sites BACKGROUND The Mohs Appropriate Use Criteria (MAUC) have come into question recently regarding the most appropriate treatment for superficial basal cell carcinoma (sBCC). At the heart of this debate is the limited body of evidence describing tumor behavior of sBCC based on clinical factors relevant to the MAUC. OBJECTIVE To determine whether sBCC is more likely to harbor aggressive subtypes in high-risk anatomical locations and in immunocompromised patients. MATERIALS AND METHODS A single institution retrospective review produced 133 evaluable Mohs cases performed on sBCC over a 10-year period. All slides from the respective cases were reviewed for the presence of histologic patterns other than known sBCC. Cases were then grouped by both MAUC anatomical zone (H, M, and L) and patient immune status for statistical analysis. RESULTS A significantly higher rate of mixed histology (MH) was observed when comparing Zone H with Zone L across all patients, healthy patients, and immunocompromised patients. The same was true when comparing Zone M with Zone L for all patients and healthy patients (immunocompromised did not reach significance). CONCLUSION The authors' data very clearly demonstrate a higher rate of MH in sBCC of the head and neck which provides strong support to the current MAUC scoring. Address correspondence and reprint requests to: Deborah F. MacFarlane, MD MPH, 1400 Pressler Street, Houston, TX 77030, or e-mail: dmacfarl@mdanderson.org 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.

Commentary on Hyfrecation and Interference With Implantable Cardiac Devices No abstract available

Weight Loss: How Does It Fit in With Liposuction? BACKGROUND Weight loss is traditionally viewed as straightforward counting of calories in and calories out, with little regard to the role of the adipocytes tasked with storing said calories. However, the body executes a complex compensatory response to any intervention that depletes its energy stores. Here, the authors discuss the methods used to attain weight loss, the body's response to this weight loss, and the difficulties in maintaining weight loss. Furthermore, the authors provide an overview of the literature on the physiological effects of liposuction. OBJECTIVE To describe the role of adipose tissue in energy homeostasis, methods of weight loss, weight regain, and the effect of liposuction on endocrine signaling. METHODS The authors conducted a narrative review of representative studies. CONCLUSION A variety of strategies for weight loss exist, and optimizing one's weight status may in turn optimize the aesthetic outcomes of liposuction. This is most apparent in the preferential reaccumulation of fat in certain areas after liposuction and the ability to avoid this with a negative energy balance. Address correspondence and reprint requests to: Naomi Lawrence, MD, Section of Procedural Dermatology, Cooper University Hospital, 10000 Sagemore Drive, Suite 10103, Marlton, NJ 08053, or e-mail: lawrence-naomi@cooperhealth.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.

Hyfrecation and Interference With Implantable Cardiac Devices BACKGROUND Mohs micrographic surgery, excisional surgery, and electrodessication and curettage (ED&C) are common dermatologic procedures that often use electrodessication through hyfrecators to achieve hemostasis. According to in vitro studies, electrodessication is considered safe in patients with implanted cardiac devices. To the authors' knowledge, there are no in vivo data to support this claim. OBJECTIVE In this study, the authors aim to describe the outcomes of hyfrecation during dermatologic procedures in patients with pacemakers and implantable cardiac devices. METHODS Retrospective chart review was completed from March 2014 to April 2018 at a single center. Forty-five patients met criteria of having a cardiac device and having undergone an electrosurgery procedure using the Conmed 2000 Hyfrecator (Utica, NY). Adverse perioperative and postoperative outcomes, as well as device malfunction, were evaluated. RESULTS No adverse perioperative effects were reported. Device reports were examined for inappropriate firing of the defibrillator, loss of capture, temporary inhibition of pacing, battery drainage, pacing at an elevated or erratic rate, failure to deliver antitachycardia, reversion to asynchronous pacing, induction of arrhythmias, or tissue damage at lead tissue, but no such issues were found. CONCLUSION The lack of complications associated with cardiac devices with hyfrecation is reassuring. However, prospective and larger retrospective studies are warranted. Address correspondence and reprint requests to: Sima D. Amin, MD, Texas A&M College of Medicine, 8447 Bryan Road, Bryan, TX 77807, or e-mail: Sima2015@gmail.com 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.

Efficacy of Intralesional Cryosurgery in the Treatment of Multiple Extragenital Cutaneous Warts: A Randomized Controlled Study BACKGROUND The efficacy of intralesional (IL) cryosurgery in the treatment of cutaneous warts has not been previously studied. OBJECTIVE To compare the efficacy and safety of IL cryosurgery versus electrosurgery in multiple extragenital warts and investigate their effect on serum interleukin (IL)-12 and interferon-gamma (IFN-γ). MATERIALS AND METHODS Thirty-one patients were included; 18 received IL cryosurgery, and 13 had electrosurgery. Treatment was performed for the largest or few (2–3) small warts (target) until cleared, leaving the remaining (distant) warts untreated. Clinical response of the target and distant warts and adverse effects were evaluated. Serum IL-12 and IFN-γ levels were assessed before and after treatment. RESULTS All patients had complete clearing of the treated wart in both groups. IL cryosurgery was well tolerated; infection, ulceration, and recurrence occurred only with electrosurgery. Complete/near-complete resolution of the distant untreated warts was seen in 33.3% versus none of patients in the IL cryosurgery and electrosurgery groups, respectively (p = .003). Furthermore, IL-12 and IFN-γ levels showed a tendency to increase after IL cryosurgery, and their increase correlated with distant wart response. CONCLUSION Intralesional cryosurgery is effective not only in clearing treated warts but also resolving untreated warts and possibly enhances human papillomavirus–directed immune response. Address correspondence and reprint requests to: Doaa A.E. Abou-Taleb, MD, Department of Dermatology, Venereology, and Andrology, Assiut University Hospital, Assiut 71511, Egypt, or e-mail: dodda_aboutaleb@yahoo.com 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.

Insurance Coverage for Hair Removal Procedures in the Treatment of Gender Dysphoria No abstract available

Perspectives on Direct Observation Teaching for Preoperative Dermatologic Surgery Consultations No abstract available

Eyebrow Hair Transplantation in Frontal Fibrosing Alopecia: Pitfalls of Short- and Long-Term Results BACKGROUND Eyebrow hair loss is usually a primary feature of frontal fibrosing alopecia (FFA), which causes significant distress to patients and consequently seek medical help. Eyebrow hair transplantation is a well-accepted and aesthetically successful treatment, but there is a lack of information about the short- and long-term results in this subset of patients. OBJECTIVE To report the short- and long-term eyebrow hair transplantation results in patients with FFA. PATIENTS AND METHODS Ten patients diagnosed with FFA underwent eyebrow hair transplantation. The transplanted hairs were harvested from nonaffected follicles of the occipital scalp skin. On average, 120 to 270 single-hair follicles were implanted per eyebrow. RESULTS Eighty percent of patients achieved excellent hair growth at 6- to 12-month follow-up and satisfactory short-term results (<2 years). However, majority started losing the transplanted hairs after 3 to 4 years. Only 1 patient did not lose transplanted hair in the long-term follow-up (>4 years). CONCLUSION The results of eyebrow hair transplantation in FFA patients are variable and contentious. The short-term outcome is satisfactory, but in most patients, a progressive loss of transplanted hairs can be expected. Therefore, FFA patients inquiring about eyebrow transplantation should be advised about the high possibility of hair graft loss over time. Address correspondence and reprint requests to: Francisco Jimenez, MD, Mediteknia Dermatology and Hair Transplant Clinic, Av. Alcalde Jose Ramirez Bethencourt, 20, Las Palmas de Gran Canaria 35004, Spain, or e-mail: fjimenez@mediteknia.com 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.