David J. Goldberg's research while affiliated with Icahn School of Medicine at Mount Sinai and other places
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Publications (125)
Nonāablative laser systems are used for rejuvenation of photodamaged skin. Ablative resurfacing with CO 2 and erbiumādoped yttrium aluminum garnet lasers were first used to treat photodamaged skin in the 1980s and remain the gold standard. Nonāablative lasers have been used to successfully treat rhytides, dyspigmentation, vascular changes, skin tex...
Background:
Nonenergy and injectable treatments are frequently used for facial rejuvenation. Many publications have addressed methods to reduce adverse events related to the procedure; however, no algorithm exists on temporol before, during, and after measures for nonenergy and injectable treatments.
Methods:
A panel of dermatologists and plasti...
Nonsurgical fat reduction has become a very popular cosmetic treatment category with energy-based devices demonstrating, in clinical trials, safety, and efficacy. These devices, which use both radiofrequency and cold, will be presented in this manuscript, and their documented efficacy will be reviewed. As well, the new field of high intensity focus...
Background:
In 2018, the first device to use high intensity focused electromagnetic (HIFEM) technology to non-invasively build muscle was brought to market. Even more recently, the first HIFEM + radiofrequency combination device designed to both build muscle and eliminate fat cells came into use (HIFEM+). In view of the increase in recently publis...
Background
The wide wavelength spectrum of intense pulsed light (IPL) provides an opportunity for a versatile array of clinical applications in dermatology.
Methods
Key randomized clinical trials which took place in the past 20 years were summarized, focusing on skin rejuvenation, including pigmented and vascular lesions. We searched Pubmed using...
Background:
Radiofrequency (RF) is commonly recognized treatment option for fat reduction, utilizing heat-induced adipocyte deletion. HIFEM treatment has been proven to be an effective tool for body shaping.
Objectives:
To document the structural changes in human subcutaneous tissue induced by the combination of RF treatment with the HIFEM proce...
Keloids are a fibroproliferative disorder that can result from a cutaneous injury to the reticular dermis. Recurrence rates as high as 100% have been reported following surgical excision alone. Consequently, a variety of post-surgical techniques have been employed to prevent keloid recurrence, including the use of radiation. Although numerous studi...
BACKGROUND: Surgical treatment of keloid scars is associated with an approximately 70% recurrence rate at the excision site. OBJECTIVE: We sought to assess keloid recurrence rates when superficial radiation therapy (SRT) was applied following surgical excision. METHODS: Medical records were reviewed of subjects treated for keloid scars followed by...
Background:
AbobotulinumtoxinA has been investigated for applications beyond facial rhytides, including the treatment of oily skin.
Objective:
The authors sought to investigate the optimal number of units and the duration of abobotulinumtoxinA for the treatment of oily skin.
Materials and methods:
This randomized, double-blinded, placebo-contr...
Background
Synthetic soft tissue fillers frequently used to restore facial volume do not provide a regenerative framework, limiting their sustained efficacy. Autologous fat transfer for facial rejuvenation supports tissue regeneration but has unpredictable outcomes depending on the quality of harvesting, processing, and implantation. This review di...
Introduction
Every year in the United States, over 1 billion dollars are spent on aesthetic injectables, such as soft tissue fillers and neurotoxins. In 2018, the total amount of injectable treatments performed surpassed 2 671 130 procedures. While often mild and transient, adverse events (AEs) can occur following these procedures. AEs may include...
Background
Nonāenergy based devices used in aesthetic medicine include treatments such as microdermabrasion, microneedling, threads, and chemical peels. Practitioners may use these devices to address signs of facial photoā and chronological aging (fine lines, wrinkles, pigmentary, and skin textural changes). Currently, consensus papers or guideline...
Objective
A growing patient demand for a favorable body shape has led to the development of many new treatment modalities. Nonāinvasive devices were developed to improve body contour without physical intervention or scarring and with reduced downtime compared to surgical options such as liposuction. This study examines combining radiofrequency, inf...
Background
A variety of energyābased devices have been used to treat acne. However, all studies have been subjective and have not involved doubleāblind and randomized controlled studies.
Aims
We undertook a randomized controlled study evaluating the use of a 650 usec 1064 nm Nd:YAG laser compared with a sham in the treatment of acne.
Patients/Met...
Background and Objectives
The objectives of this study were to evaluate the safety, tolerability, and efficacy of oxymetazoline hydrochloride cream, 1% (oxymetazoline) when used as an adjunctive treatment with energyābased therapy for patients with moderate to severe facial erythema associated with rosacea.
Study Design/Materials and Methods
In th...
Background
Dermal fillers have been used safely and effectively to reāvolumize aging hands. We assess the effectiveness of polymethylmethacrylate (PMMA) to treat the volume loss of photoaged dorsal hands for up to 12 months.
Methods
In a 12āmonth prospective study, 15 subjects were treated with PMMA filler in the bilateral dorsal hands. PMMA was i...
Background
We have employed radiofrequency microneedling devices in our practice with favorable patient results. Rejuvenation, acne, acne scars, and skin laxity are the most common concerns that we treat with radiofrequency microneedling devices. Patient selection, preparation, and postāprocedure follow up can improve clinical outcomes and safety w...
Background:
Though the collagen-stimulating capacity of poly-L-lactic acid (PLLA) is well established, no data are available on collagen stimulation by the PLLA/PLGA within absorbable suspension sutures used for tissue repositioning.
Aims:
To characterize collagen stimulation by absorbable suspension sutures through examination of patient biopsi...
Background:
Changes induced by intrinsic and extrinsic photoaging result in signs of skin aging including altered pigmentation and wrinkles. A 3-in-1 night facial serum (NFS) was developed to treat skin aging by antioxidative and retinoid-like mechanisms.
Objective:
To determine the clinical and histological effects of the 3-in-1 NFS on signs of...
Intense pulsed light (IPL) devices have long been used in cosmetic medicine for facial skin rejuvenation, from problems of irregular pigmentation, rhytides, to vascular problems that arise with age. This polychromatic broadband flash lamp utilizes optical filters, allowing non-coherent wavebands of light from 500 to 1200 nm to reach the skin and de...
The cover image, by David Goldberg MD, JD, FAAD et al., is based on the Review Article Radial shockwave therapy for male erectile rejuvenation in a dermatology and/or medical aesthetic practice. DOI: 10.1111/jocd.13022.
Background:
Laser and energy-based devices may be used for many cutaneous indications, including facial resurfacing, improving skin conditions, and reducing signs of photoaging. Currently, no consensus papers or guidelines exist concerning peri-operative agents and specifically their use for laser skin resurfacing and their potential/possible role...
Introduction: Acne vulgaris is a highly prevalent skin condition that can adversely affect the quality of life. Acne-predisposed skin is in a state of subclinical inflammation leading to skin barrier dysfunction. A multi-center cohort study was designed to evaluate clinical efficacy and safety of twice daily facial cleansing using an oscillatory so...
Introduction
Erectile dysfunction is defined as the inability to achieve and maintain an erection to satisfactorily complete intercourse. Treatment depends on the cause and includes phosphodiesterase 5 inhibitor medications, penile pumps, implants, and surgery. Lowāintensity shockwave therapy has been shown to be effective and safe for the treatmen...
Background:
There are many postprocedure skin care options, but no consensus on the best formulation to optimize healing. Silicone gels have only been used to treat keloids and hypertrophic scars and typically applied after the wound has healed. This study compared the healing response after fractional ablative erbium laser resurfacing with a petr...
Background: Treatment of scars continues to be a persisting challenge. Scar classification is paramount in determining an appropriate treatment strategy. They can be classified into hypertrophic, keloid, or atrophic scars. With the increasing demand for less invasive procedures that result in equal or greater outcomes, there has been an increase in...
Background
There is an increasing interest in and demand for noninvasive antiāaging treatments, and cosmeceuticals are an effective adjunct treatment to ināoffice cosmetic treatments.
Objective
This study evaluates the shortāterm cosmetic benefits of a topical antiāwrinkle cream (Ultrascript Dermal Regenesis, Montclair, NJ) and a topical evening D...
Background:
Previous studies have shown that calcium hydroxylapatite (CaHa) injected intradermally resulted in new collagen production at 6 months after injection, and a possible increase in elastin formation. In addition, a recent study showed the formation of new collagen, elastin, and angiogenesis after injection at 4 and 9 months.
Objective:...
Introduction
Skin cleansing is important for removal of dirt, debris, and sebum and plays an important role in reduction of pollutionāinduced skin aging. Cleansing is an established part of treatment recommendations and procedures in dermatology. Different methods for facial skin cleansing are established but recommendations on use of special devic...
Background
Topical melatonin is a potent antioxidant, yet there have been few clinical studies on its antiāaging effects on the skin.
Objectives
To clinically assess the antiāaging efficacy and safety of a new 3āinā1 night facial serum (NFS) combining melatonin with bakuchiol, a novel retinolālike ingredient, and ascorbyl tetraisopalmitate, in all...
Pigmentary demarcation lines (PDLs) are physiological abrupt transitions between hyperpigmented and lighter skin, a common and sometimes troubling feature of normal skin. They are seen in a majority of darkācomplexioned women and a substantial percentage of lightācomplexioned ones too. We review this salient finding and approaches to its management...
Background: The use of superficial radiation therapy (SRT) has experienced a renaissance for treating nonmelanoma skin cancers (NMSCs) and recurrent keloids; however, published treatment guidelines are lacking. Objective: The objective of this work was to provide consensus guidelines on the use of SRT for treating NMSC and recurrent keloids based o...
Background:
Mohs micrographic surgery (MMS) is a frequently used technique that provides total margin visualization for treatment of skin neoplasms.
Objective:
To provide a comprehensive review of MMS literature, focusing on its origins, evidence behind present-day uses of MMS, and future directions.
Methods:
A literature search was conducted...
Background: Rosacea is a chronic dermatologic condition with limited treatment options.
Methods: Data were pooled from two identically designed phase 3 trials. Patients with moderate to severe persistent erythema of rosacea were randomized to receive oxymetazoline cream 1.0% or vehicle once daily for 29 days and were followed for 28 days posttreatm...
Objective
To evaluate the efficacy and safety associated with use of a 589ānm solidāstate laser for treatment of facial erythema.
Methods
A prospective, IRBāapproved study was conducted. Participants who were interested in treatment for facial erythema were recruited. They received four monthly treatments with the 589ānm laser. Erythema of the rig...
Introduction
Laser hair removal is a common lightābased aesthetic procedure. Diode lasers and specifically the longāpulse diode laser 810 nm are the most popular preference for hair removal due to the deep penetration and targeting of the hair follicle. In a recently published article, we presented our hair removal clinical evaluation results using...
Background
Rhinophyma is a cosmetically deforming disease characterized by nodular overgrowth of the lower 2/3 of the nose and is considered the end stage of acne rosacea.
Aims
Review the spectrum of procedural techniques for treatment of rhinophyma with a focus on the advantages and disadvantages of each modality.
Methods
A comprehensive literat...
Background:
A bipolar fractional radiofrequency (RF) device was developed to generate cutaneous thermal injuries using a temperature-controlled microneedle electrode array.
Objective:
Evaluate safety and efficacy of a novel subcutaneous microneedle RF for treatment of posterolateral thigh cellulite.
Methods:
The study design was an institution...
Background:
Absorbable suspension sutures for tissue repositioning represent a minimally invasive approach to facial rejuvenation. With 2015 FDA 510(k) approval of Silhouette InstaLiftā¢ (Sinclair Pharma, Irvine, CA), a completely absorbable device comprised of 82% PLLA/18% PLGA sutures and bi-directional cones, came the challenge of developing opt...
A complete approach to facial rejuvenation includes restoration of the skin's surface, relaxation of muscles that contribute to hyperkinetic movement, revolumization, and repositioning/recontouring of descended tissues and fat pads. After receiving 510(k) clearance from the US Food and Drug Administration (FDA) in 2015, the Silhouette InstaLiftā¢ ab...
Background:
Persistent facial erythema is a clinically challenging feature of rosacea.
Objective:
To evaluate persistent erythema reduction on the first day of treatment from pooled data from two pivotal trials of topical oxymetazoline cream 1.0% (oxymetazoline) in persistent facial erythema of rosacea.
Methods:
In two identically designed, ph...
Poly-L-lactic acid (PLLA) is a synthetic, biocompatible, biodegradable polymer. For soft-tissue augmentation, the size and chemical attributes of the PLLA microparticles are central to this agentās ability to promote a subclinical inflammatory response that stimulates deposition of collagen in the extracellular matrix. The resultant restoration of...
Though the incidence of complications and adverse events with dermatological fillers is inherently low, practitioners should be well versed in both prevention of filler complications and the treatment algorithms for addressing āgranulomas,ā nodules, infection, and vascular compromise. Appropriate preventative measures, coupled with timely and effec...
Paradigms in the treatment of aging have evolved to address volume loss as a central and primary hallmark of the aging face. The concept of ācomposite volumizationā was recently proposed by Dr. Z. Paul Lorenc to describe the effect of Radiesse (Merz Aesthetics, Inc., Raleigh, NC), when placed on bone in the supraperiosteal plane, on all overlying t...
The clinical performance of fillers in soft tissue augmentation depends upon their physiochemical properties, anatomical areas injected, interaction with the recipient, and the skill and experience of the physician. Scientific measures of filler properties facilitate appropriate selection of treatments for optimal treatment outcomes, and inform adj...
Loss of facial volume and soft-tissue support are common to types of facial aging. Restoration of a youthful appearance relies upon correction of this loss, and can be achieved in various capacities through use of biostimulatory or hyaluronic acids (HA) injectable fillers. Here, the authors discuss the versatility of calcium hydroxylapatite (CaHA)...
The recent approval in 2015 of Radiesse for injection into the hand by the FDA has spurred an increase in interest among patients and clinicians in nonsurgical hand rejuvenation using fillers. Application of the same techniques used to treat the face to the dorsum of the hands does not account for the unique nature of the skin and underlying anatom...
Rosacea is a chronic dermatologic condition with limited treatment options, particularly for persistent erythema. This pivotal phase 3 study evaluated oxymetazoline, an a1A-adrenoceptor agonist, for the treatment of moderate to severe persistent erythema of rosacea. Eligible patients were randomly assigned 1:1 to receive oxymetazoline cream 1.0% or...
Background:
Rosacea is a chronic dermatologic condition with limited treatment options.
Objective:
To evaluate topical oxymetazoline cream 1.0% in patients with moderate to severe persistent erythema of rosacea.
Methods:
Data were pooled from two identically designed phase 3 trials. Patients were randomized to receive oxymetazoline or vehicle...
Although biologic drugs have changed the face of psoriasis treatment, affording greater efficacy and enhancing quality of life, safety issues have been reported and the warning labels have expanded. A variety of issues are now linked to biologic associated tumor necrosis factor-alpha (TNF-Ī±) blocker use. Litigation has occurred with the use of a va...
Men are interested in reducing signs of aging, while maintaining a masculine appearance. A chief concern among men is maintenance of scalp hair. Men are also concerned with reducing under eye bags and dark circles. The concern of feminization is of significant importance. Neuromodulators remain the most common cosmetic procedure performed in men. M...
Stimulation of new collagen results from fibroblast activation. Conventional wisdom has been that fibroblast activation via fillers exclusively resulted from the use of those fillers categorized as biostimulatory, such as poly-L-lactic acid, which produce a cutaneous inflammatory reaction. An increased understanding of non-inflammatory fillers, suc...
Background:
Poly-L-lactic acid (PLLA) is a biostimulatory filler approved for use in HIV lipoatrophy as well as cosmetic improvement in facial folds and wrinkles in immunocompetent patients. Similar to the face and hands, the dƩcolletage is commonly subject to photodamage and the resulting appearance of rhytids and crepiness, which could benefit f...
Background:
Aging hands tend to lose subcutaneous volume resulting in prominence of the underlying vessels, tendons, and bone contributing to an aged appearance. Dermal fillers have been successfully used to improve the appearance of the aging dorsal hand.
Objective:
The objective is to evaluate the safety and efficacy of a small-particle hyalur...
Background:
Light-based devices have been used to treat cutaneous vascular lesions almost since the original development of the laser. After the introduction of the initial continuous wave and pulsed laser systems, the pulsed lasers became the gold standard device. Since then, new devices and methods to treat patients have been introduced.
Object...
The treatment of acne, especially severe acne, remains a challenge to dermatologists. Therapies include retinoids, antibiotics, hormones, lights, lasers, and various combinations of these modalities. Acne is currently considered a chronic rather than an adolescent condition. The appropriate treatment depends on the patient and the severity of disea...
p>BACKGROUND: Signs of facial aging include wrinkles, loss of subcutaneous volume, decreased tone, texture, and sagging of the skin. The objective of this review is to determine whether facial suspension absorbable sutures are a safe and effective modality for facial rejuvenation.
METHOD: A group of US plastic surgeons and dermatologists who pract...
Introduction: A new temperature-controlled device has been used as a percutaneous radiofrequency probe to treat lax submental and other facial areas. It has significant advantages over other aesthetic devices as it provides the dual benefit of fat lipolysis and skin tightening. Our goal here is to present consensus recommendations for treating the...
Botulinum toxin is used as a therapeutic agent for treating glabellar frown lines. Three formulations have been approved by the US Food and Drug Administration (FDA) for glabellar rhytides: onabotulinumA (Botox), abobotulinumtoxinA (Dysport), and incobotulinumtoxinA (Xeomin). botulinum toxin type A (BoNTA) is the most commonly toxin used for cosmet...
p>Dermatologists treat actinic keratosis (AK) primarily because these lesions have the potential to progress to invasive squamous cell carcinoma. Patients, on the other hand, generally seek treatment to remove the lesions and achieve an improved appearance of their skin following treatment. In selecting a treatment option for AK, dermatologists sho...
Background: Non-thermal laser therapy in dermatology, is a growing medical technology by which therapeutic effects are achieved by exposing tissues to specific wavelengths of light. Objectives: The purpose of this review was to gain a better understanding of the science behind non-thermal laser and the evidence supporting its use in dermatology.
Me...
Background:
The American Council of Graduate Medical Education, which oversees much of postgraduate medical education in the United States, has championed the concept of "milestones," standard levels of achievement keyed to particular time points, to assess trainee performance during residency.
Objective:
To develop a milestones document for the...
Melasma is an acquired pigmentary disorder commonly seen in sun-exposed areas. Predominantly affecting women of childbearing age, melasma can be difficult to treat for many patients. A variety of options currently exist; however, definitive treatment remains elusive. This review article provides a review of the current literature and examines in de...
Background:
Intense pulsed light (IPL) has a well-recognized role in the treatment of photodamaged skin.
Objective:
To assess the safety and efficacy of a novel single-band IPL handpiece versus dual-band IPL handpiece in the treatment of photodamage.
Study design/materials and methods:
This was a prospective, single-center split-face study wit...
During the last 30 years, I have witnessed firsthand the advances and innovations in laser and energy-based technology. The pioneering work of Anderson and Parrish in 1983 was instrumental in powering this evolution. Anderson and Parrish lead the industry to develop energy-based systems that were more precise, thus allowing clinicians to target spe...
Objective:
Although only licensed professionals should be performing cosmetic procedures for patients, there are often news stories of unlicensed individuals performing procedures with serious consequences. This brief report seeks to determine the scope and magnitude of the problem by determining the number of cases of unlicensed procedures and de...
The conduct of medical research that involves human subjects has many ethical and legal implications. Great strides in protecting the welfare and safety of research participants have been made in the past 40 years due to a series of unethical events. This chapter will focus on the history and evolution of the ethical and legal measures that have be...
Nonablative laser systems are used for rejuvenation of photodamaged skin. The lasers cause a dermal wounding response that results in collagen remodeling and production, while protecting the epidermis from harm. There are numerous laser, light sources, and radiofrequency devices used for nonablative resurfacing with variable results on rhytides, sc...
Surgical procedures involve unique elements related to patient safety. One must be aware of potential complications and safety issues within the practice of dermatologic surgery. Developing a high level of competence in skin surgery will address some safety issues, while implementing protocols and redundancies provides systems-based correction for...
Cosmetic procedures are growing in popularity and are associated with unique risks. Considering potential complications and prioritizing patient safety will help practitioners improve outcomes of elective procedures. In part II of this continuing medical education article, we provide a comprehensive review of patient safety in cosmetic procedures,...
Abstract Background: Verruca Vulgaris is common benign neoplasm. However, it can present a therapeutic challenge. Previous studies have suggested that the Nd-YAG laser may be beneficial in the management of warts. Objective: To determine the effectiveness and safety of a novel 100 microsecond pulsed 1064nm Nd:YAG laser for the treatment of Verruca...
Background:
Facial erythema is a frequent and often distressing complaint of patients with rosacea. Treatment of facial erythema with botulinum toxin has previously been proposed and reported. However, the current literature has mixed results.
Objective:
The primary objective of this study was to evaluate the safety and efficacy of intradermal a...
As the skin ages, a deficiency in collagen occurs, thus injectable collagen products have become a sensible and popular option for dermal filling and volume enhancement. Several types of collagen have been developed over the years, including animal sources such as bovine and porcine collagen, as well as human-based sources derived from pieces of th...
Background:
Microfocused ultrasound has been shown to lift and tighten lax eyebrows, submental, and neck skin.
Objective:
The aim of this study was to evaluate the safety and effectiveness of microfocused ultrasound to lift, tighten, and smooth the buttocks.
Materials and methods:
Thirty-one subjects, with buttock skin laxity, were entered int...
Lasers are used in many medical specialties and their use has steadily increased over time. There is a wide range of different lasers to choose from, and so it is very important to have a sound understanding of laser physics and basic laser principles to help avoid complications. This chapter provides a thorough overview of laser principles.
We determine if the use of Multispectral Digital Skin Lesion Analysis for the evaluation of nevi in children and possible detection of malignancies.
Evidence gathered from a pivotal study involving 1,383 patients with 1,831-pigmented lesions. The isolated use of the pediatric population within this study was used to determine the specificity and s...
Laser therapy of pigmented lesions is a very efficacious way of removing cosmetically unappealing lesions on the skin. It is generally very safe and case reports of using lasers on pigmented lesions date back nearly half a century ago. However, as with any treatment, there are important considerations both to ensure maximal effectiveness of treatme...
Bipolar radiofrequency (RF) has been used to treat photodamage. Periorbital rhytides are often difficult to treat. In this study bipolar RF was assessed in the 20 subjects, who are in treatment of periorbital rhytides and it was proved that it can successfully treat the periorbital rhytides.
Unlabelled:
Abstract Background: Skin laxity and cellulite on the buttocks and thighs are two common cosmetic concerns. Skin tightening with radiofrequency (RF) devices has become increasingly popular.
Objective:
The purpose of this study is to evaluate the efficacy and safety of a topical skin laxity tightening agent when used in combination wi...
Importance
Excisional skin cancer surgery is a common procedure, with no formal consensus for mitigating the risk of wrong-site cutaneous surgery.Objective
To systematically consider the usefulness and feasibility of proposed methods for correct biopsy site identification in dermatology.Evidence Review
Survey study with a formal consensus proces...
Dermatologic laser surgery is a continuously evolving field of medicine. According to the American Society for Dermatologic Surgery, over 100 million laser and light source cosmetic procedures were performed by its members in 2003. Procedures, which include hair removal, nonablative treatments, as well as removal of pigmented lesions, tattoos, and...
Objectives:
To evaluate the safety and efficacy of a microsecond 1,064-nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser for the treatment of facial telangiectasias.
Methods:
Subjects ages 35-70 with Fitzpatrick skin types I to III and facial telangiectasias underwent two treatments with a micropulse (0.65 ms) 1,064-nm Nd:YAG laser. Trea...
Objective:
To evaluate the safety and efficacy of intradermal injection of abobotulinumtoxinA for the treatment of oily skin.
Methods and materials:
Twenty-five patients with oily skin were treated in the forehead region with intradermal injections of botulinum toxin. Baseline and post-treatment sebum production was measured using a sebometer. P...
