Multicenter prospective cohort study of the incidence of adverse events associated with cosmetic dermatologic procedures

Lasers, energy devices, and injectable neurotoxins and fillers

Murad Alam*, Rohit Kakar, Michael Nodzenski, Omer Ibrahim, Wareeporn Disphanurat, Diana Bolotin, Judy H. Borovicka, Natalie Pace, Tina S. Alster, Kenneth A. Arndt, Kenneth R. Beer, Joshua M. Berlin, Leonard J. Bernstein, Lori A. Brightman, Kimberly Butterwick, Sue Ellen Cox, Vera Chotzen, Sabrina G. Fabi, Richard E. Fitzpatrick, Roy G. Geronemus & 12 others Mitchel P. Goldman, William F. Groff, Michael S. Kaminer, Suzanne Kilmer, Thomas E. Rohrer, Elizabeth L. Tanzi, Susan K. Silva, Simon S Yoo, Susan H. Weinkle, John Strasswimmer, Emily Poon Samuelson, Jeffrey S. Dover

*Corresponding author for this work

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

IMPORTANCE: Common noninvasive to minimally invasive cosmetic dermatologic procedures are widely believed to be safe given the low incidence of reported adverse events, but reliable incidence data regarding adverse event rates are unavailable to date. OBJECTIVE: To assess the incidence of adverse events associated with noninvasive to minimally invasive cosmetic dermatologic procedures, including those involving laser and energy devices, as well as injectable neurotoxins and fillers. DESIGN, SETTING, AND PARTICIPANTS: A multicenter prospective cohort study (March 28, 2011, to December 30, 2011) of procedures performed using laser and energy devices, as well as injectable neurotoxins and soft-tissue augmentation materials, among 8 geographically dispersed US private and institutional dermatology outpatient clinical practices focused on cosmetic dermatology, with a total of 23 dermatologists. Participants represented a consecutive sample of 20 399 cosmetic procedures. Data acquisition was for 3 months (13 weeks) per center, with staggered start dates to account for seasonal variation. EXPOSURES: Web-based data collection daily at each center to record relevant procedures, by category type and subtype. Adverse events were detected by (1) initial observation by participating physicians or staff; (2) active ascertainment from patients, who were encouraged to self-report after their procedure; and (3) follow-up postprocedural phone calls to patients by staff, if appropriate. When adverse events were not observed by physicians but were suspected, follow-up visits were scheduled within 24 hours to characterize these events. Detailed information regarding each adverse event was entered into an online form. MAIN OUTCOMES AND MEASURES: The main outcome was the total incidence of procedure-related adverse events (total adverse events divided by total procedures performed), as verified by clinical examination. RESULTS: Forty-eight adverse events were reported, for a rate of 0.24% (95% CI, 0.18%-0.31%). Overall, 36 procedures resulted in at least 1 adverse event, for a rate of 0.18% (95% CI, 0.13%-0.25%). No serious adverse events were reported. Adverse events were infrequently associated with known risk factors. CONCLUSIONS AND RELEVANCE: Noninvasive to minimally invasive cosmetic dermatologic procedures, including energy, neurotoxin, and filler procedures, are safe when performed by experienced board-certified dermatologists. Adverse events occur in less than 1% of patients, and most of these are minor and transient.

Original languageEnglish (US)
Pages (from-to)271-277
Number of pages7
JournalJAMA dermatology
Volume151
Issue number3
DOIs
StatePublished - Mar 1 2015

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Neurotoxins
Cosmetics
Lasers
Cohort Studies
Prospective Studies
Equipment and Supplies
Injections
Incidence
Dermatology
Physicians
Self Report
Outpatients
Observation

ASJC Scopus subject areas

  • Dermatology

Cite this

Alam, Murad ; Kakar, Rohit ; Nodzenski, Michael ; Ibrahim, Omer ; Disphanurat, Wareeporn ; Bolotin, Diana ; Borovicka, Judy H. ; Pace, Natalie ; Alster, Tina S. ; Arndt, Kenneth A. ; Beer, Kenneth R. ; Berlin, Joshua M. ; Bernstein, Leonard J. ; Brightman, Lori A. ; Butterwick, Kimberly ; Cox, Sue Ellen ; Chotzen, Vera ; Fabi, Sabrina G. ; Fitzpatrick, Richard E. ; Geronemus, Roy G. ; Goldman, Mitchel P. ; Groff, William F. ; Kaminer, Michael S. ; Kilmer, Suzanne ; Rohrer, Thomas E. ; Tanzi, Elizabeth L. ; Silva, Susan K. ; Yoo, Simon S ; Weinkle, Susan H. ; Strasswimmer, John ; Samuelson, Emily Poon ; Dover, Jeffrey S. / Multicenter prospective cohort study of the incidence of adverse events associated with cosmetic dermatologic procedures : Lasers, energy devices, and injectable neurotoxins and fillers. In: JAMA dermatology. 2015 ; Vol. 151, No. 3. pp. 271-277.
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title = "Multicenter prospective cohort study of the incidence of adverse events associated with cosmetic dermatologic procedures: Lasers, energy devices, and injectable neurotoxins and fillers",
abstract = "IMPORTANCE: Common noninvasive to minimally invasive cosmetic dermatologic procedures are widely believed to be safe given the low incidence of reported adverse events, but reliable incidence data regarding adverse event rates are unavailable to date. OBJECTIVE: To assess the incidence of adverse events associated with noninvasive to minimally invasive cosmetic dermatologic procedures, including those involving laser and energy devices, as well as injectable neurotoxins and fillers. DESIGN, SETTING, AND PARTICIPANTS: A multicenter prospective cohort study (March 28, 2011, to December 30, 2011) of procedures performed using laser and energy devices, as well as injectable neurotoxins and soft-tissue augmentation materials, among 8 geographically dispersed US private and institutional dermatology outpatient clinical practices focused on cosmetic dermatology, with a total of 23 dermatologists. Participants represented a consecutive sample of 20 399 cosmetic procedures. Data acquisition was for 3 months (13 weeks) per center, with staggered start dates to account for seasonal variation. EXPOSURES: Web-based data collection daily at each center to record relevant procedures, by category type and subtype. Adverse events were detected by (1) initial observation by participating physicians or staff; (2) active ascertainment from patients, who were encouraged to self-report after their procedure; and (3) follow-up postprocedural phone calls to patients by staff, if appropriate. When adverse events were not observed by physicians but were suspected, follow-up visits were scheduled within 24 hours to characterize these events. Detailed information regarding each adverse event was entered into an online form. MAIN OUTCOMES AND MEASURES: The main outcome was the total incidence of procedure-related adverse events (total adverse events divided by total procedures performed), as verified by clinical examination. RESULTS: Forty-eight adverse events were reported, for a rate of 0.24{\%} (95{\%} CI, 0.18{\%}-0.31{\%}). Overall, 36 procedures resulted in at least 1 adverse event, for a rate of 0.18{\%} (95{\%} CI, 0.13{\%}-0.25{\%}). No serious adverse events were reported. Adverse events were infrequently associated with known risk factors. CONCLUSIONS AND RELEVANCE: Noninvasive to minimally invasive cosmetic dermatologic procedures, including energy, neurotoxin, and filler procedures, are safe when performed by experienced board-certified dermatologists. Adverse events occur in less than 1{\%} of patients, and most of these are minor and transient.",
author = "Murad Alam and Rohit Kakar and Michael Nodzenski and Omer Ibrahim and Wareeporn Disphanurat and Diana Bolotin and Borovicka, {Judy H.} and Natalie Pace and Alster, {Tina S.} and Arndt, {Kenneth A.} and Beer, {Kenneth R.} and Berlin, {Joshua M.} and Bernstein, {Leonard J.} and Brightman, {Lori A.} and Kimberly Butterwick and Cox, {Sue Ellen} and Vera Chotzen and Fabi, {Sabrina G.} and Fitzpatrick, {Richard E.} and Geronemus, {Roy G.} and Goldman, {Mitchel P.} and Groff, {William F.} and Kaminer, {Michael S.} and Suzanne Kilmer and Rohrer, {Thomas E.} and Tanzi, {Elizabeth L.} and Silva, {Susan K.} and Yoo, {Simon S} and Weinkle, {Susan H.} and John Strasswimmer and Samuelson, {Emily Poon} and Dover, {Jeffrey S.}",
year = "2015",
month = "3",
day = "1",
doi = "10.1001/jamadermatol.2014.2494",
language = "English (US)",
volume = "151",
pages = "271--277",
journal = "JAMA Dermatology",
issn = "2168-6068",
publisher = "American Medical Association",
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Alam, M, Kakar, R, Nodzenski, M, Ibrahim, O, Disphanurat, W, Bolotin, D, Borovicka, JH, Pace, N, Alster, TS, Arndt, KA, Beer, KR, Berlin, JM, Bernstein, LJ, Brightman, LA, Butterwick, K, Cox, SE, Chotzen, V, Fabi, SG, Fitzpatrick, RE, Geronemus, RG, Goldman, MP, Groff, WF, Kaminer, MS, Kilmer, S, Rohrer, TE, Tanzi, EL, Silva, SK, Yoo, SS, Weinkle, SH, Strasswimmer, J, Samuelson, EP & Dover, JS 2015, 'Multicenter prospective cohort study of the incidence of adverse events associated with cosmetic dermatologic procedures: Lasers, energy devices, and injectable neurotoxins and fillers', JAMA dermatology, vol. 151, no. 3, pp. 271-277. https://doi.org/10.1001/jamadermatol.2014.2494

Multicenter prospective cohort study of the incidence of adverse events associated with cosmetic dermatologic procedures : Lasers, energy devices, and injectable neurotoxins and fillers. / Alam, Murad; Kakar, Rohit; Nodzenski, Michael; Ibrahim, Omer; Disphanurat, Wareeporn; Bolotin, Diana; Borovicka, Judy H.; Pace, Natalie; Alster, Tina S.; Arndt, Kenneth A.; Beer, Kenneth R.; Berlin, Joshua M.; Bernstein, Leonard J.; Brightman, Lori A.; Butterwick, Kimberly; Cox, Sue Ellen; Chotzen, Vera; Fabi, Sabrina G.; Fitzpatrick, Richard E.; Geronemus, Roy G.; Goldman, Mitchel P.; Groff, William F.; Kaminer, Michael S.; Kilmer, Suzanne; Rohrer, Thomas E.; Tanzi, Elizabeth L.; Silva, Susan K.; Yoo, Simon S; Weinkle, Susan H.; Strasswimmer, John; Samuelson, Emily Poon; Dover, Jeffrey S.

In: JAMA dermatology, Vol. 151, No. 3, 01.03.2015, p. 271-277.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Multicenter prospective cohort study of the incidence of adverse events associated with cosmetic dermatologic procedures

T2 - Lasers, energy devices, and injectable neurotoxins and fillers

AU - Alam, Murad

AU - Kakar, Rohit

AU - Nodzenski, Michael

AU - Ibrahim, Omer

AU - Disphanurat, Wareeporn

AU - Bolotin, Diana

AU - Borovicka, Judy H.

AU - Pace, Natalie

AU - Alster, Tina S.

AU - Arndt, Kenneth A.

AU - Beer, Kenneth R.

AU - Berlin, Joshua M.

AU - Bernstein, Leonard J.

AU - Brightman, Lori A.

AU - Butterwick, Kimberly

AU - Cox, Sue Ellen

AU - Chotzen, Vera

AU - Fabi, Sabrina G.

AU - Fitzpatrick, Richard E.

AU - Geronemus, Roy G.

AU - Goldman, Mitchel P.

AU - Groff, William F.

AU - Kaminer, Michael S.

AU - Kilmer, Suzanne

AU - Rohrer, Thomas E.

AU - Tanzi, Elizabeth L.

AU - Silva, Susan K.

AU - Yoo, Simon S

AU - Weinkle, Susan H.

AU - Strasswimmer, John

AU - Samuelson, Emily Poon

AU - Dover, Jeffrey S.

PY - 2015/3/1

Y1 - 2015/3/1

N2 - IMPORTANCE: Common noninvasive to minimally invasive cosmetic dermatologic procedures are widely believed to be safe given the low incidence of reported adverse events, but reliable incidence data regarding adverse event rates are unavailable to date. OBJECTIVE: To assess the incidence of adverse events associated with noninvasive to minimally invasive cosmetic dermatologic procedures, including those involving laser and energy devices, as well as injectable neurotoxins and fillers. DESIGN, SETTING, AND PARTICIPANTS: A multicenter prospective cohort study (March 28, 2011, to December 30, 2011) of procedures performed using laser and energy devices, as well as injectable neurotoxins and soft-tissue augmentation materials, among 8 geographically dispersed US private and institutional dermatology outpatient clinical practices focused on cosmetic dermatology, with a total of 23 dermatologists. Participants represented a consecutive sample of 20 399 cosmetic procedures. Data acquisition was for 3 months (13 weeks) per center, with staggered start dates to account for seasonal variation. EXPOSURES: Web-based data collection daily at each center to record relevant procedures, by category type and subtype. Adverse events were detected by (1) initial observation by participating physicians or staff; (2) active ascertainment from patients, who were encouraged to self-report after their procedure; and (3) follow-up postprocedural phone calls to patients by staff, if appropriate. When adverse events were not observed by physicians but were suspected, follow-up visits were scheduled within 24 hours to characterize these events. Detailed information regarding each adverse event was entered into an online form. MAIN OUTCOMES AND MEASURES: The main outcome was the total incidence of procedure-related adverse events (total adverse events divided by total procedures performed), as verified by clinical examination. RESULTS: Forty-eight adverse events were reported, for a rate of 0.24% (95% CI, 0.18%-0.31%). Overall, 36 procedures resulted in at least 1 adverse event, for a rate of 0.18% (95% CI, 0.13%-0.25%). No serious adverse events were reported. Adverse events were infrequently associated with known risk factors. CONCLUSIONS AND RELEVANCE: Noninvasive to minimally invasive cosmetic dermatologic procedures, including energy, neurotoxin, and filler procedures, are safe when performed by experienced board-certified dermatologists. Adverse events occur in less than 1% of patients, and most of these are minor and transient.

AB - IMPORTANCE: Common noninvasive to minimally invasive cosmetic dermatologic procedures are widely believed to be safe given the low incidence of reported adverse events, but reliable incidence data regarding adverse event rates are unavailable to date. OBJECTIVE: To assess the incidence of adverse events associated with noninvasive to minimally invasive cosmetic dermatologic procedures, including those involving laser and energy devices, as well as injectable neurotoxins and fillers. DESIGN, SETTING, AND PARTICIPANTS: A multicenter prospective cohort study (March 28, 2011, to December 30, 2011) of procedures performed using laser and energy devices, as well as injectable neurotoxins and soft-tissue augmentation materials, among 8 geographically dispersed US private and institutional dermatology outpatient clinical practices focused on cosmetic dermatology, with a total of 23 dermatologists. Participants represented a consecutive sample of 20 399 cosmetic procedures. Data acquisition was for 3 months (13 weeks) per center, with staggered start dates to account for seasonal variation. EXPOSURES: Web-based data collection daily at each center to record relevant procedures, by category type and subtype. Adverse events were detected by (1) initial observation by participating physicians or staff; (2) active ascertainment from patients, who were encouraged to self-report after their procedure; and (3) follow-up postprocedural phone calls to patients by staff, if appropriate. When adverse events were not observed by physicians but were suspected, follow-up visits were scheduled within 24 hours to characterize these events. Detailed information regarding each adverse event was entered into an online form. MAIN OUTCOMES AND MEASURES: The main outcome was the total incidence of procedure-related adverse events (total adverse events divided by total procedures performed), as verified by clinical examination. RESULTS: Forty-eight adverse events were reported, for a rate of 0.24% (95% CI, 0.18%-0.31%). Overall, 36 procedures resulted in at least 1 adverse event, for a rate of 0.18% (95% CI, 0.13%-0.25%). No serious adverse events were reported. Adverse events were infrequently associated with known risk factors. CONCLUSIONS AND RELEVANCE: Noninvasive to minimally invasive cosmetic dermatologic procedures, including energy, neurotoxin, and filler procedures, are safe when performed by experienced board-certified dermatologists. Adverse events occur in less than 1% of patients, and most of these are minor and transient.

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DO - 10.1001/jamadermatol.2014.2494

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JO - JAMA Dermatology

JF - JAMA Dermatology

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