Publications (15)22.88 Total impact
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Article: Randomized crossover study comparing efficacy of transnasal endoscopy with that of standard endoscopy to detect Barrett's esophagus.
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ABSTRACT: Unsedated transnasal endoscopy (TNE) may be safer and less expensive than standard endoscopy (SE) for detecting Barrett's esophagus (BE). Emerging technologies require robust evaluation before routine use. To evaluate the sensitivity, specificity, and acceptability of TNE in diagnosing BE compared with those of SE. Prospective, randomized, crossover study. Single, tertiary-care referral center. This study enrolled consecutive patients with BE or those referred for diagnostic assessment. All patients underwent TNE followed by SE or the reverse. Spielberger State-Trait Anxiety Inventory short-form questionnaires, a visual analogue scale, and a single question addressing preference for endoscopy type were administered. Diagnostic accuracy and tolerability of TNE were compared with those of SE. Of 95 patients randomized, 82 completed the study. We correctly diagnosed 48 of 49 BE cases by TNE for endoscopic findings of columnar lined esophagus compared with the criterion standard, SE, giving a sensitivity and specificity of 0.98 and 1.00, respectively. The BE median length was 3 cm (interquartile range [IQR] 1-5 cm) with SE and 3 cm (IQR 2-4 cm) with TNE, giving high correlations between the two modalities (R(2) = 0.97; P < .001). The sensitivity and specificity for detecting intestinal metaplasia by TNE compared with those by SE was 0.91 and 1.00, respectively. The mean (± standard deviation) post-endoscopy Spielberger State-Trait Anxiety Inventory short-form score for TNE (30.0 ± 1.10 standard error of the mean [SEM]) was lower than that for SE (30.7 ± 1.29 SEM), (P = .054). The visual analogue scale scores were no different (P = .07). The majority of patients (59%) expressed a preference for TNE. This is a small study, with limited generalizability, a high prevalence of patients with BE, differential drop-out between the two procedures, and use of sedation. TNE is an accurate and well-tolerated method for diagnosing BE compared with SE. TNE warrants further evaluation as a screening tool for BE.Gastrointestinal endoscopy 03/2012; 75(5):954-61. · 6.71 Impact Factor -
Article: Facial Soft-Tissue Fillers: Assessing the State of the Science conference---Proceedings report.
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ABSTRACT: The American Academy of Dermatology and the American Society of Plastic Surgeons, with the support of other sister societies, conducted the Facial Soft-Tissue Fillers: Assessing the State of the Science conference in December of 2009. The American Academy of Dermatology and the American Society of Plastic Surgeons established a panel of leading experts in the field of soft-tissue fillers-from researchers to clinicians-and other stakeholders for the conference to examine and discuss issues of patient safety, efficacy, and effectiveness in relation to the approved and off-label use of soft-tissue fillers, and other factors, including the training and level of experience of individuals administering fillers. This report summarizes the deliberations and key points made by the panel and presenters to the panel, and includes a summary of the panel's near-term and longer term recommendations for next steps to help guide future efforts to address the safety, efficacy, and effectiveness of facial soft-tissue fillers. This report represents the panel's assessment of the medical knowledge available on facial soft-tissue fillers at the time of the conference.Journal of the American Academy of Dermatology 04/2011; 64(4 Suppl):S53-65. · 3.99 Impact Factor -
Article: Facial Soft-Tissue Fillers conference: Assessing the State of the Science.
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ABSTRACT: The American Academy of Dermatology and the American Society of Plastic Surgeons, with the support of other sister societies, conducted the Facial Soft-Tissue Fillers: Assessing the State of the Science conference in December of 2009. The American Academy of Dermatology and the American Society of Plastic Surgeons established a panel of leading experts in the field of soft-tissue fillers-from researchers to clinicians-and other stakeholders for the conference to examine and discuss issues of patient safety, efficacy, and effectiveness in relation to the approved and off-label use of soft-tissue fillers, and other factors, including the training and level of experience of individuals administering fillers. This report represents the systematic literature review that examines comprehensively the available evidence and gaps in the evidence related to soft-tissue fillers, to inform and support the work of the state-of-the-science conference panel. This evidence-based medicine review will serve as the foundation for future evidence-based medicine reports in this growing field.Journal of the American Academy of Dermatology 04/2011; 64(4 Suppl):S66-85, S85.e1-136. · 3.99 Impact Factor -
Article: Facial volume restoration of the aging face with poly-l-lactic acid.
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ABSTRACT: The purpose of this article is to discuss current techniques used with poly-l-lactic acid to safely and effectively address changes observed in the aging face. Several important points deserve mention. First, this unique agent is not a filler but a stimulator of the host's own collagen, which then acts to volumize tissue in a gradual, progressive, and predictable manner. The technical differences between the use of biostimulatory agents and replacement fillers are simple and straightforward, but are critically important to the safe and successful use of these products and will be reviewed in detail. Second, in addition to gains in technical insights that have improved our understanding of how to use the product to best advantage, where to use the product to best advantage in facial filling has also improved with ever-evolving insights into the changes observed in the aging face. Finally, it is important to recognize that a patient's final outcome, and the amount of product and work it will take to get there, is a reflection of the quality of tissues with which they start. This is, of course, an issue of patient selection and not product selection.Dermatologic Therapy 01/2011; 24(1):2-27. · 1.69 Impact Factor -
Article: Facial shaping: beyond lines and folds with fillers.
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ABSTRACT: Facial attractiveness is the most important determinant of physical attractiveness, and an important factor in social and interpersonal interactions. The field of facial rejuvenation using minimally invasive procedures has expanded exponentially over the last decade. Historically, aging and the resulting changes were primarily attributed to changes in the skin and the underlying musculoskeletal system. However, more recent understanding of the changes associated with facial aging has shifted the focus to changes in the distribution of subcutaneous fat. With the introduction of seemingly endless varieties of fillers over the last decade, restoration of volume loss by subcutaneous fat, and to some extent bone, has never been easier. Here, the authors review the basic principles that govern facial beauty, facial anatomy, the aging process, and the wide variety of fillers available on the market today that enable a dermatologic surgeon to revitalize the face.Journal of drugs in dermatology: JDD 08/2010; 9(8 Suppl ODAC Conf Pt 2):s129-37. · 1.57 Impact Factor -
Article: Using poly-L-lactic acid (PLLA) to mimic volume in multiple tissue layers.
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ABSTRACT: Sculptra (Sanofi-Aventis, Bridgewater, NJ) was approved by the U.S. Food Drug Administration (FDA) for use in HIV-related lipoatrophy in 2004 and received FDA approval for cosmetic use as Sculptra Aesthetic in July 2009. The authors have experience with this product in both applications. The purpose of this article is to share their methodology. Both soft-tissue and supraperiosteal injections will be illustrated and discussed in detail. Much progress has been made in the last decade in understanding of volume changes in all structural layers of the face, and this will be briefly reviewed as it is pertinent to the methodology. Equally important is the issue of patient selection. Ultimately, the quality of the result, and the time and amount of product that it takes to achieve that result, is contingent on the quality of tissues with which one starts. A very lipoatrophic patient, or an elderly patient with advanced volume loss and poor skin integrity is more difficult to correct-requiring more product and more treatment sessions (with any product) than that needed for a younger or plumper face.Journal of drugs in dermatology: JDD 10/2009; 8(10 Suppl):s5-14. · 1.57 Impact Factor -
Article: Dermatological implications of skeletal aging: a focus on supraperiosteal volumization for perioral rejuvenation.
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ABSTRACT: It is becoming widely accepted that volume changes in the skin and soft tissue contribute greatly to age-related facial reshaping. A significant contribution to these volume changes is the loss of craniofacial skeletal support to the overlying soft tissue. Gravity, once considered the major culprit in facial aging, is now recognized to determine the direction, rather than the extent, of tissue deflation. Although the sequence of events observed in aging is somewhat predictable, its pace among individuals is variable and may be influenced by both intrinsic (e.g., gender, genetics) and extrinsic (e.g., photoaging, smoking, stress) factors. Changes in different tissue layers within a single individual do not occur independently, but interdependently; changes in one tissue within an individual may influence subsequent changes in other tissues. Midfacial soft tissue descent has been observed in response to decreased craniofacial support in both congenital craniofacial hypoplasia and following trauma, leading to a hypothesis that the loss of underlying bony support for any reason, including aging, leads to soft tissue descent in the face. As craniofacial support (the "table") decreases, it leaves less surface area for the outer soft tissue envelope (the "tablecloth") causing it to fold or sag. Replacing this deep support with craniofacial implants has been shown to reposition the overlying soft tissue. Following a brief review of the current literature on aging changes in the skin, soft tissue, and bone; the authors describe their experience with the use of poly-L-lactic acid (PLLA), both as a soft tissue volumizer and as an injectable craniofacial implant in a supraperiosteal location to address both soft tissue volume loss and loss of craniofacial support. In the cases presented, the most striking result noted was the ability to restore a youthful proportion to the perioral area, which had not been achieved previously with soft tissue treatment alone.Journal of drugs in dermatology: JDD 04/2008; 7(3):209-20. · 1.57 Impact Factor -
Article: Late-appearing abscesses after injections of nonabsorbable hydrogel polymer for HIV-associated facial lipoatrophy.
Dermatologic Surgery 01/2008; 33 Suppl 2:S193-8. · 1.80 Impact Factor -
Article: Update on facial aging.
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ABSTRACT: Facial aging was once thought to be the result of the relentless downward pull of gravity on skin and underlying fat. In turn, facial fat was believed to be a contiguous sheet of tissue. However, over the past four decades, a number of investigators have examined more closely the causes of facial aging, leading to a better understanding of age-related changes, and have confirmed and further explored the proposal by Gonzalez-Ulloa and Flores in 1965 that facial aging involves changes in muscle and bone, as well as skin and fat. Further, the recent work of Rohrich and Pessa (and other authors) has demonstrated that facial fat is not a sheet of tissue, but rather is compartmentalized throughout the face. This discovery has allowed the evolution of improved techniques for facial rejuvenation.Aesthetic surgery journal / the American Society for Aesthetic Plastic surgery 30 Suppl:11S-24S. -
Article: Appropriate selection and application of nonsurgical facial rejuvenation agents and procedures: panel consensus recommendations.
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ABSTRACT: As injectable products have been introduced and as clinicians have gained experience with them, applications and techniques for injection have evolved, with better cosmetic results, enhanced patient safety, and greatly improved patient satisfaction. Within the past four years, several consensus recommendation panels have been convened to summarize the accumulated clinical experience and knowledge about the application of these products. The guidelines that already exist in the literature are referred to, and suggested guidelines for the administration of poly-L-lactic acid-for which no consensus guidelines have previously been published-are included in this article.Aesthetic surgery journal / the American Society for Aesthetic Plastic surgery 30 Suppl:36S-45S. -
Article: Discuss injectable shaping agents within the context of the established and emerging concepts of facial aging. Introduction.
Aesthetic surgery journal / the American Society for Aesthetic Plastic surgery 30 Suppl:9S-10S. -
Article: Nonsurgical modalities to treat the aging face.
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ABSTRACT: Injectable shaping agents include neurotoxins (botulinum toxin type A products), replacement fillers (hyaluronic acid [HA] agents), and biostimulatory fillers (calcium hydroxylapatite [CaHA], polymethylmethacrylate [PMMA], and poly-L-lactic acid [PLLA]). This article presents an overview of the agents currently available for use in facial rejuvenation in the United States.Aesthetic surgery journal / the American Society for Aesthetic Plastic surgery 30 Suppl:31S-5S. -
Article: Facial aesthetic analysis.
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ABSTRACT: Consideration of the individual patient's appearance based on systematic mapping and a three-dimensional evaluation of the four levels of facial structure (bone, muscle, fat, and skin) will help the clinician choose the most appropriate modalities for facial rejuvenation. This article addresses these concepts and also discusses universal perceptions of attractiveness.Aesthetic surgery journal / the American Society for Aesthetic Plastic surgery 30 Suppl:25S-7S. -
Article: Surgical versus nonsurgical rejuvenation.
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ABSTRACT: The number of cosmetic procedures for facial rejuvenation has increased steadily over the past decade. The increase in the application of nonsurgical modalities, particularly injectable shaping agents, has been remarkable. As knowledge and experience about facial aging has increased, techniques and tools have improved, and it is increasingly apparent that surgical and nonsurgical/injectable modalities are complementary.Aesthetic surgery journal / the American Society for Aesthetic Plastic surgery 30 Suppl:28S-30S. -
Article: Facial dermal fillers.
Aesthetic surgery journal / the American Society for Aesthetic Plastic surgery 28(6):699-701; author reply 701.
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Institutions
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2009–2011
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University of California, Los Angeles
Los Angeles, CA, USA
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