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An unhappy rhinoplasty patient suggested to dermatologist Cameron Rokhsar, M.D., F.A.A.D., F.A.A.C.S., that he use Radiesse, which he was about to inject in her nasolabial folds, to diminish the divots in her nose from a previous rhinoplasty.

This is an excellent question because it relates to current lifestyle as well as future planning. You used the word sacrifice and, since you only go around once, why would anyone want to needlessly diminish the quality of life that they could currently enjoy? Your question brings up significant issues, which call into question the very premise of traditional financial planning.

Starting Oct. 1, 2007, the Centers for Medicare and Medicaid Services (CMS) officially endorsed the practice of physicians charging a fee to Medicare beneficiaries who fail to show up for appointments. If you charge Medicare patients a fee for missing appointments, however, you must charge the same fee to all who skip appointments, regardless of the payer.

The worst financial foe, unmanageable personal and business debt, has reached an alarming level in the United States. According to Cambridge Consumer Credit Index, an astonishing 42 percent of Americans are paying only the minimum due on their credit card balances each month. Chip away at existing debt little by little, starting by paying off the smallest balance.

Key coding concerns for 2008 include Medicare's elimination of the Mohs surgery exemption to the multiple-procedure reduction rule, and the continuing impact of the PQRI, an expert says.

All dermatologic surgeons have to manage facial nerve injuries and subsequent facial nerve paralysis, whether temporary or permanent, when performing facial surgery. Avoiding facial nerve injury is the best route and this can be best achieved by adequate knowledge of the anatomy as well as understanding tumor type and size.

With multiple advantages compared with newer technology-based treatments and efficacy substantiated by histologic studies, chemical peeling continues to have an important role in multiple indications.

Patient demand - and age - are on the rise for minimally invasive facelifts. Older patients are willing to accept 'modest' neck tightening in exchange for less-invasive surgery and less risky anesthesia.

Results of an online survey link communication skills, accessibility, and follow-up to patient satisfaction with medical care. Steven R. Feldman, MD, PhD, discusses the importance of characterizing factors influencing patient satisfaction and strategies for improving it.

Sacramento, Calif. - Publishing in dermatologic and other peer-reviewed journals can boost a dermatologist's credibility, knowledge base, ego and sense of giving back. But doing what it takes - doing the research, writing the paper, submitting the manuscript and making necessary corrections - requires significant time and energy for a task that does not directly boost income.

Much of the virulence of community-associated methicillin resistant S. aureus (CA-MRSA) is caused by phenol-soluble modulin (PSM) peptides, a family of proteins that had not previously been studied in the pathogen. The discovery, published in Nature Medicine, opens the door to a better understanding of the infection and potential new targets for intervention.

Basic research has been building the case for decades of how stress negatively affects human health-from tumor genesis, to immune function, to skin barrier function-but clinical management of these interactions has lagged far behind.

The "black box" of how psychological stress increases susceptibility to infection has been unlocked in a study in the mouse model. The mechanism of action is not through the adaptive immune system, as many had thought, but rather through the secretion of endogenous glucocorticoids that in turn affect the production of two key antimicrobial peptides (AMPs) made by the epidermis.

A red annular "bull's eye" patch, known as erythema migrans (EM), is the most common presentation of early Lyme disease

The elimination of the Mohs surgery exemption to Medicare's multiple-surgery reduction rule will mean that Mohs surgeons who perform multiple in-office surgeries in one day will earn less for secondary procedures than they cost, sources say.

Dermatologists once again find themselves at the mercy of the politicians in Washington, facing significant reductions in Medicare reimbursement for 2008, unless Congress once again comes to the rescue - and President Bush signs whatever legislation is passed.

Dr. Suit has a large dermatology practice in the Sunbelt. He has seen countless numbers of malignant melanoma patients over the past 20 years. Unfortunately, he has been sued four times on the issue of misdiagnosis of melanoma. Three cases went to court, and in the two cases in which the patient died, he lost multimillion-dollar lawsuits because of sympathetic juries.

The year 2008 is under way. It's a year that promises a lot of discussion of healthcare delivery and costs, and promises of change. On Call wondered what direction dermatologists expect to take in their practices in the coming year. What are their priorities for their practices? What are their New Year's resolutions for their practices? For several of the dermatologists who spoke to On Call, the business end of their practice is slated to get a lot of attention this year as they try to run their offices as efficiently as possible.

A recent headline in Dermatology Times read, "Niacin boosts IPL outcome." In small print, the sub-headline read, "Small study sees non-statistical improvement in skin texture." The summary of the article, called "Quick Read," had the following statement: "A niacin-based skincare cosmeceutical regimen combined with intense pulsed light (IPL) treatments offers better skin rejuvenation outcomes than IPL alone, a new study suggests."

National report - Prompted by dermatologists' concern over the safety of a recently approved permanent dermal filler, the FDA has formed a team to study postmarket experience with all newer dermal fillers, focusing mainly on the permanent variety.

When Discovery Channel invited Anthony Gaspari, M.D., to diagnose what might be causing tree-like structures to grow on an Indonesia man, the suspicion was an extreme case of epidermodysplasia verruciformis. But Dr. Gaspari, professor and chairman of the department of dermatology, University of Maryland School of Medicine, Baltimore, found the man was disfigured by disseminated HPV-2, infection. A genetic flaw robbed Dede, the Indonesian, of his ability to ward off warts that had spread like wild fire around his body-even to the point of causing tree-limb-like cutaneous horns.

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Toronto - The College of Physicians and Surgeons of Ontario is urging legislators to pass measures that will help the college crack down on nonspecialists who are performing cosmetic surgery, The Ottawa Citizen reports.

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Toronto - The College of Physicians and Surgeons of Ontario is urging legislators to pass measures that will help the college crack down on nonspecialists who are performing cosmetic surgery, The Ottawa Citizen reports.

Cincinnati - Reuters reports that researchers at Procter & Gamble say they have sequenced the genome of Malassezia globosa, a fungus that grows on the skin of between 50 percent and 90 percent of the population, causing dandruff and other skin conditions.

Lexington, Mass. - Synta Pharmaceuticals has launched a phase 3 trial of elesclomol in treating metastatic melanoma, Bioworld.com reports.

Exton, Pa. - Biotech company Isolagen, based here, has announced the initiation of a phase 3 clinical study to test Isolagen Therapy for the treatment of moderate to severe acne scars, PRNewswire reports.

Boston - Results of what is reportedly the largest phase 3 study ever conducted with a biologic treatment suggest that patients with active psoriatic arthritis (PsA) achieve significant, sustained improvements in joint and skin manifestations of the disease after monthly subcutaneous injections of investigative golimumab, DocGuide.com reports.