No abstract

Scars are a natural part of dermal healing following lacerations, incisions, or tissue loss. They can vary in quality depending on the individual's racial characteristics, the mechanism of the trauma, and conditions in which the wound healed-all of which are factors beyond the surgeon's control. A scar on the face can have significant implications for the patient. What may seem like an insignificant issue to the casual observer can cause continuous frustration for the patient, affecting their daily lives. These can include psychological as well as social consequences, leading to a diminished quality of life. Factors that the surgeon can control include the favorable repositioning of the scar, proper alignment of the wound edges, and meticulous handling of the tissues.

Complications of the transconjunctival approach are uncommon. When they do occur, proper management results in a successful outcome.

IMPORTANCE Microcystic adnexal carcinoma (MAC) occurs primarily in older adults of white race/ethnicity on sun-exposed skin of the head and neck. There are no formal guiding principles based on expert review of the evidence to assist clinicians in providing the highest-quality care for patients. OBJECTIVE To develop recommendations for the care of adults with MAC.EVIDENCE REVIEW A systematic review of the literature (1990 to June 2018) was performed using MEDLINE, Embase, Web of Science, and the Cochrane Library. The keywords searched were microcystic adnexal carcinoma, sclerosing sweat gland carcinoma, sclerosing sweat duct carcinoma, syringomatous carcinoma, malignant syringoma, sweat gland carcinoma with syringomatous features, locally aggressive adnexal carcinoma, and combined adnexal tumor. A multidisciplinary expert committee critically evaluated the literature to create recommendations for clinical practice. Statistical analysis was used to estimate optimal surgical margins.

The ThermaCool TC nonablative radiofrequency device for in-office rejuvenation of the upper one-third of the face procedure does provide brow elevation in a majority of patients; however, the majority of the study patients did not perceive benefit from the procedure. Patient satisfaction in facial plastic surgery must be an important part of the decision of whether or not to introduce a new device into a practice setting.