IMPORTANCE Recent concerns regarding repetitive use of general anesthesia in children younger than 3 years have placed greater importance on the controversy surrounding the timing of the initiation of port-wine stain (PWS) laser treatment. OBJECTIVE To evaluate the use of PWS treatments at the age of 1 year or younger in the office setting without general anesthesia. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study based on medical record reviews at a single, high-volume laser center for children who started pulsed dye laser treatment at the age of 1 year or younger for their PWS between 2000 and 2017. The data cutoff was at 1 year after the initial treatment to have comparable data points. MAIN OUTCOMES AND MEASURES The primary outcome was improvement of PWSs using before and after photographs, which were reviewed by 4 physicians independently and graded using the following 5-point visual analog scale (VAS): poor (grade 1: 0%-25% improvement), fair (grade 2: 26%-50% improvement), good (grade 3: 51%-75% improvement), excellent (grade 4: 76%-99% improvement), and complete (grade 5: 100% improvement) clearance. RESULTS Of the 197 patients (73 [37.1%] boys; 124 [62.9%] girls), most (149 [75.6%]) had facial lesions. The mean age at the time of first treatment was 3.38 months (range, 5-355 days) and the mean number of treatments was 9.8 (range, 2-23; median, 10). Per the mean physician VAS grading of 197 patients, 51 patients (25.9%) showed 100% clearance (mean [range] VAS score of 4.78 [4.5-5]); 81 patients (41.1%) showed 76 to 99% improvement (mean [range] VAS score of 3.91 [3.5 to <4.5]); 44 patients (22.3%) showed 51% to 75% improvement (mean [range] VAS score of 2.86 [2.5 to <3.5]); 13 patients (6.6%) showed 26% to 50% improvement (mean [range] VAS score of 2.12 [1.5 to <2.5]); and 8 patients (4.1%) showed 0 to 25% improvement (mean [range] VAS score of 0.78 [0 to <1.5]). The presence of a V1 (first branch of the trigeminal nerve [ophthalmic nerve]) lesion was associated with a statistically significantly higher clearance rate by a VAS grade of 0.55 (95% CI, 0.25-0.84; P < .001). The mean (SD) VAS grade for all patients was 3.65 (1.26), corresponding to excellent clearance. None of the patients experienced scarring or permanent pigmentary change. CONCLUSIONS AND RELEVANCE In this study, treatment of PWSs in infancy was both safe and effective. Early intervention allows for treatment without general anesthesia, maximizing the chance to achieve clearance before school age and thereby minimizing the negative outcome of PWSs for both the patient and the family.

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Dermal fillers for soft tissue augmentation have become increasingly popular among patients of all ages and ethnicities. With more widespread use, there has been an increased incidence of adverse reactions, one of which is the granulomatous foreign body reaction (GFBR). This is a relatively rare, but significant complication of dermal filler use, as it presents both aesthetic and medical implications such

The practice of reaching an audience through social media to promote non-surgical treatments of the face is in its infancy. Young adults, arguably the most health-literate generation to date, comprise both the majority of users targeted by social media and the fastest growing demographic seeking cosmetic consultation. We know that this age group is also at an increased risk of depression and body dysmorphia in an era where non-surgical cosmetic options are typically thought to be gateways to surgical treatments. In light of these facts, it seems the ethics of medicine might be lagging behind the amorphous, rapidly evolving nature of social media and, specifically, its use as a platform for business promotion and health information. As cosmetic treatments become a normalized facet of society's health care routine, in large part due to its ubiquity on social media platforms, its promotion by providers requires reexamination so that its pro-social potential can be realized. This is ensured by fostering a social media presence and in-office attitude that treatments should be an agreement between patient and provider on realistic expectations and how best to meet them.