Comparison of Techniques in Acne Scar Treatment

Comparison of Techniques in Acne Scar Treatment Punch excision techniques are utilized for depressed scars such as ice pick and boxcar scars. According to the diameter of the scar, a biopsy punch of appropriate size is used to excise the scar. If the scar is > 3.5 mm in size, it is excised and sutured after undermining, in a direction parallel to the relaxed skin tension lines. Procedure: Surgical preparation is done. Local anaesthesia infiltration and marking of the scar is done. Initial undermining of the scar is done. Based on the diameter of the scar, a biopsy punch of appropriate size is inserted till the subcutaneous fat layer and the punch graft is removed and discarded. After removal of the plug, the area becomes elliptical. Undermining with an artery forceps is done and is followed by suturing with 6-0 prolene. (Illustration 33.5) A linear scar ensues lying along the RSTL. Dressing is done. Antibiotics and NSAIDs are administered for 7 days. Depressed pitted ice pick scars up to 4 mm in diameter, are excised and replaced with an autologous, full-thickness punch graft. The donor site is commonly the post-auricular region or the gluteal region. Care should be taken to avoid cobblestoning, which is a common complication. Procedure: Surgical preparation is done. Local anaesthesia infiltration and marking of the scar is done. Initial undermining of the scar is done. Based on the diameter of the scar, a biopsy punch of appropriate size is inserted till the subcutaneous fat layer and the punch graft is removed and discarded. From the donor site, a full thickness punch graft> 0.5 mm than the excised scar is taken. This is then fit into the recipient area( Area of excised scar), if needed it is trimmed. Sutures or surgical glue is applied. (Illustration 33.6) Dressing is done. Antibiotics and NSAIDs are administered for 7 days. All the punch techniques require a postoperative follow up after 1 week to check for the donor/ recipient site and removal of sutures, if required. In selected cases, when scarring is linear and extensive, scar revision techniques such as Z, M and Y plasty may be useful. These need to be performed by a dermatosurgeon properly trained in performing these procedures. [41, 42] Various techniques such as microneedling, threadlifts are being used in atrophic acne scars. Intralesional steroids and cytotoxics along with silicone sheets are the mainstay for hypertrophic scars. Skin needling, also called â€Å"collagen induction therapy† or â€Å"needle dermabrasion† is the technique of rolling a device composed of a barrel studded with hundreds of needles, which create thousands of micropunctures in the skin to the level of the papillary to mid-dermis. [ 43] The optimal scars to treat with skin lesion are the same as fractional laser resurfacing— rolling acne scars, superficial boxcar scars, or erythematous or hypopigmented macular scars. A dermaroller device is used with needles of length 1.5 to 2.5mm is rolled across the skin with pressure in multiple directions until the area demonstrates uniform pinpoint bleeding through thousands of micropuncture sites. One study describes rolling the device four times in four different directions (horizontally, vertically, and diagonally right and left) for a total of 16 passes. [44] In the author’s experience, the number of passes required to achieve uniform pinpoint bleeding of the treat ment area is variable and is inversely proportional to the density of the needles on the rolling barrel. Usually, three or more treatments are required to achieve optimal clinical benefit, separated by four-week intervals. Figure 33.6 shows good results with dermaroller microneedling. Microneedling with fractional radiofrequency (MFR) technology is now being used for acne scars. MFR is useful for distensible scars and non- distensible scars with associated volume loss. The procedural details and clinical studies have been detailed in Chapter 10. Non-surgical face lifts with threads are also being used for acne scar treatment. Polydioxanone (PDO) threads are used for lifting and tissue tightening and scar resurfacing; it stimulates production of collagen and fibroblasts in response to its implantation. Threadlift with PDO is indicated in patients of scars who cannot come repeatedly for multiple number of sittings for derma roller, or do not want to undergo laser/ lights or radiofrequency treatments. Evidence based studies are lacking with this technique. The procedure has been detailed in chapter 15. Intralesional triamcinolone 10-40 mg/mL with or without cytotoxics, like 5-fluorouracil, is indicated for the treatment of hypertrophic scars and keloids. These are repeated at 3-4 weekly intervals until resolution; care is taken to avoid atrophy. [45, 46, 47, 48] Administration of fluorouracil (5-FU) or bleomycin into the scars, results in gradual flattening of the scars. [49, 50, 51] 5-FU inhibits rapidly proliferating fibroblasts found in dermal wounds. [52]The therapy is efficacious for facial acne scars as monotherapy, [53, 54] and in combination with intralesional corticosteroids and a 585 nm pulsed dye laser. [50 ] Studies with 5-FU use a concentration of 50 mg/mL with a total dose per session ranging from 50 mg to 150 mg and can be given multiple times a week to increase treatment efficacy. Bleomycin is another antineoplastic agent that inhibits collagen synthesis through cytotoxic effects on rapidly dividing fibroblasts. [55, 56] Silicone dressings are chemically and biologically inert; silicon sheets or gels are found to be useful in flattening keloids and hypertrophic scars, reducing discoloration and making scars cosmetically acceptable. [57, 58] Scarring in areas which are subjected to repeated movements (chin, marionette lines) are prone to become more obvious with aging. The synergistic combination of botulinum toxin and fillers may prove to be a useful modality in these scars. Botulinum toxin relaxes the muscles and hence decreases the tensile forces surrounding the scar. [20] Combining 2 or 3 modalities of acne scar treatment in a single session or sequential planning of the procedure can prove advantageous to a monotherapy. Various combination therapies are practiced. Combination of different interventions can result in satisfactory improvement of acne scarring. It is useful to combine subcision with various modalities. Subscision treatments followed by microneedling performed immediately the day after and TCA 15% peel done a fortnight later was found to improve the grade of scar. [59] Another sequential combination therapy is TCA peeling, subcision, and subsequent fractional laser irradiation. Dot peeling and subcision is done twice at an interval of 2-3 weeks and fractional laser irradiation is done every 3-4 weeks. The duration of therapy is 12 months. A marked decrease in acne scar severity was noted. [60] Combination of PRP with microneedling, fractional CO2 and erbium YAG also constitutes an effective alternative that produces synergistic benefits with fewer adverse effects. [61, 62, 63] The aim of good postoperative care is to prevent or minimize complications and ensure early recovery. Preventive actions must be taken promptly to avert complications, which may lead to unacceptable aesthetic or functional result. This is most important in ablative resurfacing procedures, particularly in darker skinned patients, where pigmentary alterations are common. Supportive medical therapy and a careful maintenance program are essential to maintain results of surgical treatment in most patients. Complications related to individual procedures are discussed in details in respective chapters. In general, the complications include conditions such as active herpes simplex, immunosuppressive conditions, which may predispose to infection and delayed healing. Post inflammatory hyperpigmentation is a common and dreaded complication of acne surgery, especially in dark skinned patients. Patients with unrealistic expectations or uncooperative patients who do not follow treatment regimens are more prone to develop complications. Adequate counselling, priming the skin and supportive medical therapy, apart from good intra- and postoperative care are essential for satisfactory surgical outcomes. The tips for management based on the author’s experience are outlined in Box 33.4 Box 33.4: Pearls and Pitfalls Procedural treatment in acne provides gratifying results. These are an adjunct treatment in active acne, however post acne scarring is being better managed with the advent of various procedural interventions. Fractional resurfacing lasers have proven to be one of the most beneficial technologies for post acne scarring. Judicious use of combination therapies in a single or sequential sessions have a synergistic role and are increasingly being used in clinical practice. Appropriate patient selection and a good understanding of patient expectations are vital to achieve an optimal therapeutic outcome. Acne surgery involves the use of appropriate surgical interventions for treatment of active acne as well as improving cosmetic outcomes in postacne scarring. In active acne, surgical intervention is used as an adjunctive to medical therapy. The treatment of post acne scars involves a multimodal approach as different types of scars may exist in an individual. Each scar and each patient must be evaluated and treated accordingly. The main goal of treatment is to achieve maximal improvement rather than perfection. The procedures can be classified as resurfacing, lifting, excisional modalities.For superficial scars, non-invasive or minimally invasive techniques such as microdermabrasion, superficial chemical peels or the newer non ablative lasers, are better treatment options. For deeper scars, a combined approach with subcision, punch excision techniques in conjunction with resurfacing procedures, are essential to achieve optimum results. Many complications can be prevented by thorough p reoperative evaluation, sound surgical technique, and careful follow-up care. Good patient rapport and effective communication with patients are invaluable.

New Criticism

New Criticism was a trend in literary theory that emphasized the predominance of the literary text: â€Å"New Criticism was the dominant trend in English and American literary criticism in the mid twentieth century, from the 1920’s to the early 1960’s. Its adherents were emphatic in their advocacy of close reading and attention to texts themselves, and their rejection of criticism based on extra-textual sources, especially biography. At their best, New Critical readings were brilliant, articulately argued, and broad in scope, but sometimes they were idiosyncratic and moralistic† (Wikipedia). The emergence of New Criticism coincided with the reaction from literary studies to the nineteenth century philological tradition and its emphases on extra-literary phenomena and biographism. Essentially, the adherents of the New Criticism school were opposed to the interpretation of literary texts in light of the authors’ lives, stating that the literary text is a self-sufficient entity and its significance is independent from reality in general. Also read: Absolute Statement Fallacy One of the aspects which is less known and discussed is that the main theses of the New Criticism school had many affinities with Prague Structuralist Circle which was developing at the same time. Such elements as the rejection of the extra-textual in the interpretation of literature or of the author’s intention are to be encountered in the studies of the Prague structuralists too. The common denominator between the two schools – and this explains the nature of their focus – is Russian Formalism, which was developed in the early twentieth century and which had a very strong impact on the critical approaches of both schools. The main theorists of New Criticism were: John Crowe Ransom, Allen Tate, R.P. Blackmur, Robert Penn Warren, I.A. Richards, William Empsom, Cleanth Brooks, William Wimsatt, & Monroe Beardsley. It was the 1941 book by John Crowe Ransom – New Criticism – that formally constituted the diverse critics into a school in its own right. The New Critics were highly prolific and, although they are largely rejected today, their studies on literature became famous and a necessary reference in the history of literary criticism. Some of the most influential studies were: Brooks’ The Well Wrought Urn, Empson’s Seven Types of Ambiguity, Brooks and Warren’s Understanding Poetry, and Richard’s Practical Criticism or Monroe and Beardsley’s essay â€Å"The Intentional Fallacy†. The main elements of New Criticism were: NC sees the text as an autotelic (a word that was a NC fave) artifact; it is something autonomous, written for its own sake, unified (an aspect never fully fleshed out in any logical or coherent way by the NCs) in form, & independent of the writer’s life, intent, etc. In fact- 3 of the major tenets of NC were: 1) self-sufficiency: the poem should be independent of biography, historical content or effect on the reader– which were called the Intentional, Historical & Affective fallacies. 2) unity: the poem should be a coherent whole- a very traditional view, albeit limited. 3) complexity: thought to be the central element of poetry. NC believed it was the reader’s duty to seek this out in the art. Violations of these tenets were examples of the Intentional Fallacy- that the artist’s intent is the primary value of the art (Schneider, 1). In other words, proper criticism was to avoid the three main fallacies and focus solely on the text. Ironically, it was these main assumptions that were challenged by later schools of criticism such as Reader Response or New Historicism, which argued for the importance of readership and historicity in our understanding of literature. The primacy of the text in unveiling the meaning of literature signified that the New Critics posited a direct relationship between form and meaning. Their analyses of literary texts consisted mostly of in-depth formal and structural discussions of poetic language and devices. For instance, William Empson’s Seven Types of Ambiguity focused solely on the semantic aspect of poetry, which he could grasp by an analysis of specific poetic devices such as paradox or metaphor. Many of the New Critics’ statements took on an absolute value, consisting of formulations which resembled inviolable laws of literature. For example, Cleanth Brooks’ The Well-Wrought Urn starts with a definition of the relation between paradox and poetry as absolute: â€Å"Few of us are prepared to accept the statement that the language of poetry is the language of paradox† (Brooks, 3). Perhaps a wiser stance towards this matter – especially when it comes to finding specificity in poetry – might be to argue for a poetics of differences and a more relativistic point of view from which to contemplate paradox in the particular context of its use. These absolute and generalizing stances towards literature were seriously challenged by many critics as reductive, eclectic and deterministic. As other critics from Reception or New Historicism schools have shown, a trans-historical or reader-blind approach to literature cannot do justice to the literary work, nor can it account for its meaning because there is a permanent dialogue between literature and reality, the text and its reader and the text’s significance can be redefined in these encounters. Works Cited: Brooks, Cleanth. The Well-Wrought Urn. Studies in the Structure of Poetry. Harcourt,  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Brace and World, Inc., New York, 1947. â€Å"New Criticism†. Wikipedia. 18.12.2006 . Schneider, Dan. â€Å"New Criticism: Same Old Game Redux†. On American Poetry  Ã‚   Criticism & Other Dastardly –Isms. 18.12.2006 http://www.cosmoetica.com/D20-DES14.htm.            

Personal Statement French Studies Essay

Dear Sir, Dear Madam, I am writing in application for a place in your graduate program, namely the Ph. D. in French Studies with a concentration in Language and Identity, to start in the fall of 2006. I am currently completing my Master 1 at the Sorbonne University (Paris Ill), having also acquired my B. A. (Licence) in that institution. My Bachelors and my current Masters at the Sorbonne primarily consist of the study of French literature and dramaturgical texts from the 16th up until the present day. I have had the opportunity to study in depth classic authors uch as Moliere, Racine or Corneille. I have been especially marked by the latter author in his tragedy â€Å"Le Cid†. My education has also included the works of Rousseau, Beaumarchais, Montesquieu, Hugo, Zola Chateaubriand, Apollinaire, Aragon and other 18th to 20th Century writers. Many of the ideas advanced by these 18th Century writers went on to play a tremendous role in shaping France and Europe via their influence on the revolutionaries of 1789. Hugo and Zola also influenced their generation by exposing societal injustice in their works, most notably n â€Å"Germinal†and â€Å"Les Miserables†. Throughout my high school and university education I have studied foreign languages such as French and English. I have always had a particular passion for France (where I have lived for several years) and French culture and language. I was admitted to the Perm State University in order to learn French. In order to broaden my knowledge I enthusiastically took up the opportunity to move to France, where I have spent most of the last five years of my life, working and studying at the same time. When I arrived in France, I worked as an au pair (alongside my studies), as well as for a tour operator. I have also taught French to both teenagers and adults while in Russia, and Russian and French whilst in France. These experiences have greatly aided me in developing my teaching and communication capabilities. I also have a long-standing interest for history, art and politics, both within Europe, the US, the former Soviet Union and the wider world. I have found these interests to be extremely helpful when studying literature, ocieties and cultures during my education, as they enable one to understand the underlying meaning of texts which are at times hidden, or to place such texts in their broader context. During my education I have closely studied the evolution of the treatment of women in both France and Russia. It seems natural for me to advance as a thesis proposal comparative research into the influence of French and American 20th Century literature on the condition of women in France and the US, and to determine the impact that this had on other groups of society. This topic would allow me to examine issues ranging from personal and group identities to politics and philosophy. I will also be able to bring into such research my own background, as I have also studied extensively Russian authors like Chekhov who also focus on these issues in plays like â€Å"Three Sisters† or â€Å"Uncle Vanya†. I take a great interest in research work, may it be for my courses at university or during my internship in New Orleans, and find it both challenging and extremely rewarding. I have always wanted o graduate from such a prominent institution as Tulane University, which has a well- deserved reputation for excellence. More specifically, study in New Orleans, with Ph. D. in French Studies from Tulane University would constitute both a highly beneficial experience for me and an additional step towards becoming an expert in French literary culture and thought, possibly working in the academic field or within the broader intellectual community. ‘ am motivated and extremely hard working, and would relish the opportunity to study at your institution. I am grateful for your consideration.

Sociology and the Holocaust Essay - 977 Words

Fascism is one type of political system based on the notion that some races are superior to others. Something that seems ridiculous in to enlightened modern day thinkers, which unfortunately makes it all the more difficult to try and understand for someone who has not experienced it. However by looking through history and taking into account some of the results of practised fascism, we can maybe begin to understand why so many people took up, and are still taking up fascism. Hopefully then we can understand exactly what we should learn from it, and possibly understand how we can prevent it appearing on the scale it did in the Second World War. Firstly I will look at some of the effects of fascism, starting with one of the most†¦show more content†¦But why racism? It is generally believed by sociologists that one cannot be a racist unless he is distinguishing between different biological traits between people, which somehow make one biological race superior to another. And Hi tler knew how bitter the Germans were about the loss of the First World War, so he needed a reason to give them as to why they lost. So he turned to racism and began distinguishing the Aryans from other races in Germany such as the Jews and homosexuals. By blaming the mixing of these inferior races into Aryan blood he gave the people a reason to believe they were better than someone else, and gave them a purpose, people to blame for Germanys devastated economy. What exactly have these acts of fascism taught us? Have they shown us how easily a country with a population the size Germanys can turn into murderer racists and fascists if left in the correct conditions? It would certainly be incorrect to assume that this is not why the Germans embraced fascism, but are there any implications of other influences that may have caused these events. Socially, we can try to argue that even deprivation on the scale felt by the German people is not enough to force a society to become something they are not, unless really they already are. Throughout history there have been so many wars between different races. Although issues of religion are often the main driving forces between warringShow MoreRelatedHolocaust Sociology Essay1561 Words   |  7 PagesGevorg Petrosyan Professor Wonser Intro to Sociology 23 June 2012 Final Project, Assignment 2: Nazi Germany and Holocaust The Holocaust was the genocide of around six million European Jews during World War II. (Holocaust History) Nazi Germany led by Adolf Hitler had targeted every single Jew to be perished. Unfortunately Nazi Germany succeeded to murder two-thirds of the nine million Jews who were stationed in Europe. 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