IMPORTANCE Despite the growing popularity of cosmetic procedures, the sociocultural and quality-of-life factors that motivate patients to undergo such procedures are not well understood. OBJECTIVE To estimate the relative importance of factors that motivate patients to seek minimally invasive cosmetic procedures. DESIGN, SETTING, AND PARTICIPANTS This prospective, multicenter observational study was performed at 2 academic and 11 private dermatology practice sites that represented all US geographic regions. Adult patients presenting for cosmetic consultation or treatment from December 4, 2016, through August 9, 2017, were eligible for participation. EXPOSURES Participants completed a survey instrument based on a recently developed subjective framework of motivations and a demographic questionnaire. MAIN OUTCOMES AND MEASURES Primary outcomes were the self-reported most common motivations in each quality-of-life category. Secondary outcomes were other frequently reported motivations and those associated with specific procedures. RESULTS Of 529 eligible patients, 511 agreed to participate, were enrolled, and completed the survey. Typical respondents were female (440 [86.1%]), 45 years or older (286 [56.0%]), white (386 [75.5%]), and college educated (469 [91.8%]) and had previously received at least 2 cosmetic procedures (270 [52.8%]). Apart from motivations pertaining to aesthetic appearance, including the desire for beautiful skin and a youthful, attractive appearance, motives related to physical health, such as preventing worsening of condition or symptoms (253 of 475 [53.3%]), and psychosocial well-being, such as the desire to feel happier and more confident or improve total quality of life (314 of 467 [67.2%]), treat oneself or celebrate (284 of 463 [61.3%]), and look good professionally (261 of 476 [54.8%]) were commonly reported. Motivations related to cost and convenience were rated as less important (68 of 483 [14.1%]). Most motivations were internally generated, designed to please the patients and not others, with patients making the decision to undergo cosmetic procedures themselves and spouses seldom being influential. Patients younger than 45 years were more likely to undertake procedures to prevent aging (54 of 212 [25.5%] vs 42 of 286 [14.7%] among patients Ն45 years; P < .001). Patients seeking certain procedures, such as body contouring (19 of 22 [86.4%]), acne scar treatment (36 of 42 [85.7%]), and tattoo removal (8 of 11 [72.7%]), were more likely to report psychological and emotional motivations. CONCLUSIONS AND RELEVANCE This initial prospective, multicenter study comprehensively assessed why patients seek minimally invasive cosmetic procedures. Common reasons included emotional, psychological, and practical motivations in addition to the desire to enhance physical appearance. Differences relative to patient age and procedures sought may need further exploration.

Tofacitinib citrate is a Janus kinase 1/3 inhibitor approved for the treatment of rheumatoid arthritis, but it has recently been used to treat alopecia areata (AA). 1-3 In this study, investigators searched the medical records of the Cleveland Clinic for any patients with confirmed AA who were treated with oral tofacitinib (Xeljanz; Pfizer) using a standardized, systematic treatment regimen. Methods | A standard departmental treatment protocol was developed prior to this review. Treatment with tofacitinib citrate was initiated at 5 mg twice daily, and all other AA therapies were ceased. The daily dosage was increased, as allowable by insurance coverage, by 5 mg per month until the treating physician noted first signs of hair regrowth and then held the medication at that dose. The Cleveland Clinic Foundation Institutional Review Board approved this retrospective medical record review and waived the patient informed consent requirement. The review took place from May 1, 2016, to June 1, 2016. Scalp hair loss was calculated from visit to visit by the same treating physician (M.P. or W.B.) using the validated Severity of Alopecia Tool (SALT) 4 score, which can range from 0% to 100%; the higher the score, the greater the amount of scalp hair loss. In all, patients were treated by 2 different physicians (M.P. and W.B.

BACKGROUND Radiofrequency and high-Intensity Focused Electromagnetic (HIFEM) field procedure are well-known, stand-alone, body-shaping modalities, yet their simultaneous application has not been investigated. OBJECTIVE The aim is to evaluate the efficacy of a novel device simultaneously delivering HIFEM and radiofrequency for subcutaneous fat reduction and muscle toning. MATERIALS AND METHODS Forty-one subjects with an average age of 39.7 ± 11.5 years were recruited. The subjects received 3 abdominal treatments (one per week). Magnetic resonance imaging images of the treated area were evaluated at baseline and at 1-, 3-, and 6-month visits for changes in subcutaneous fat, muscle thickness, and abdominal separation (AS). Anthropometric data and digital photographs were collected. Subject satisfaction and therapy comfort were evaluated. RESULTS The muscle mass increase peaked at 3 months, showing 26.1% thickening. The fat thickness reduction was most prominent at 3 months, showing a 30.8% reduction. The AS decreased by 18.8% at 3 months after treatment. The waist circumference reduced by 5.87 ± 3.64 cm at a 3-month follow-up. Six-month data showed maintenance of these outcomes. The treatment was considered as comfortable with high patient satisfaction. CONCLUSION The analysis of magnetic resonance imaging images and waist measurements showed that the therapy combining HIFEM and radiofrequency is highly effective in reducing subcutaneous fat and muscle thickening.

Mohs micrographic surgery is safe, with a very low rate of adverse events, an exceedingly low rate of serious adverse events, and an undetectable mortality rate. Common complications include infections, followed by impaired wound healing and bleeding. Bleeding and wound-healing issues are often associated with preexisting anticoagulation therapy, which is nonetheless managed safely during MMS. We are not certain whether the small effects seen with the use of sterile gloves and antiseptics and antibiotics are clinically significant and whether wide-scale practice changes would be cost-effective given the small risk reductions.

amilial benign pemphigus, or Hailey-Hailey disease (HHD), is a rare autosomal dominant genetic dermatosis characterized by chronic, recurrent vesicles, erosions, and maceration in flexural areas. It results from mutations in the ATP2C1 gene (UniProt P98194) that lead to defective calcium homeostasis in the Golgi apparatus and ultimately loss of adhesion between keratinocytes. 1 Hailey-Hailey disease is often challenging to treat. Herein, we present a novel treatment option for HHD. MethodsPatients with biopsy-proven recalcitrant HHD were evaluated in the outpatient dermatology clinic at the Cleveland Clinic and treated with low-dose naltrexone hydrochloride (1.5-3.0 mg/d).Because reported dosages in the literature for low-dose naltrexone hydrochloride range from 1.5 to 4.5 mg per day, 1,2 patients were started on 1.5 mg/d and titrated monthly as needed; concomitant topical and systemic medications were ceased. The same physician (one of us, A.P.F.) administered all treatments to all patients and assessed response. Patients were followed up every 2 to 3 months. Clinical response, adverse effects, and subjective quality of life were monitored throughout the treatment. The study dates were January 2016 to January 2017. Because no standardized rating scale exists for HHD to date, response was judged and quantified by taking into account healing of areas of cutaneous breakdown, improvement in erythema, and decrease in patients' reported symptoms or pain and discomfort. No laboratory monitoring was necessary.The department of dermatology determined that institutional review board approval was not necessary for the IMPORTANCE Familial benign pemphigus, or Hailey-Hailey disease (HHD), is a rare and debilitating genetic dermatosis characterized by chronic, recurrent vesicles, erosions, and maceration in flexural areas. Despite the reported therapeutic modalities, such as topical and systemic corticosteroids, systemic immunomodulators, topical and systemic retinoids, and laser, HHD can still be markedly difficult to control. OBJECTIVE To assess low-dose naltrexone hydrochloride in the treatment of recalcitrant HHD. DESIGN, SETTING, AND PARTICIPANTSIn this case series, 3 patients with biopsy-proven recalcitrant HHD were evaluated in the outpatient dermatology clinic at the Cleveland Clinic. Each patient was treated with low-dose naltrexone hydrochloride at a dosage of 1.5 to 3.0 mg per day. No laboratory monitoring was necessary. Clinical response (healing of erosions, improvement in erythema, and alleviation of pain), adverse effects, and subjective quality of life were monitored throughout the treatment. The study dates were January 2016 to January 2017. MAIN OUTCOMES AND MEASURESObjective clinical response as assessed by the treating dermatologist, subjective quality of life as reported by the patient, and recorded adverse effects were monitored throughout the treatment at intervals of 2 to 3 months. RESULTSThe 3 patients included a woman in her 40s and 2 men in their 60s. Each patient exhibited at least an 80% improveme...