This document describes the cosmetic, reconstructive, and medically necessary uses of a selection of techniques addressing the treatment of skin lesions and related conditions. 

Note: Please see the following related documents for additional information:

• ANC.00008 Cosmetic and Reconstructive Services of the Head and Neck
• SURG.00023 Breast Procedures including Reconstructive Surgery, Implants and Other Breast Procedures
• CG-SURG-27 Gender Reassignment Surgery

Medically Necessary: In this document, procedures are considered medically necessary if there is a significant physical functional impairment AND the procedure can be reasonably expected to improve the physical functional impairment. 

Reconstructive: In this document, procedures are considered reconstructive when intended to address a significant variation from normal related to accidental injury, disease, trauma, treatment of a disease or a congenital defect.

Note: Not all benefit contracts/certificates include benefits for reconstructive services as defined by this document. Benefit language supersedes this document.

Cosmetic: In this document, procedures are considered cosmetic when intended to change a physical appearance that would be considered within normal human anatomic variation. Cosmetic services are often described as those that are primarily intended to preserve or improve appearance. 

A.    Chemical Peels

Chemical peels (known as epidermal peels or chemotherapy of the skin) are considered medically necessary for active acne.

Medium or deep chemical peels, referred to as dermal peels are considered medically necessary when there is documented evidence of 10 or more actinic keratoses or other pre-malignant skin lesions that have failed topical retinoid treatment, topical chemotherapeutic agents and cryotherapy.

Chemical peels of any type are considered cosmetic and not medically necessary when used to treat photo-aged skin, wrinkles, acne scarring or uneven epidermal pigmentation.

B.    Collagen Injections

Collagen injections or implants are considered medically necessary when there is documented evidence of significant physical functional impairment and the treatment can be reasonably expected to improve the physical functional impairment. 

Collagen injections or implants may be reconstructive when there is significant variation from normal related to accidental injury, disease, trauma, treatment of a disease or congenital defect.   

Collagen injections or implants are considered cosmetic and not medically necessary when performed in the absence of a significant physical functional impairment, are not reconstructive and are intended to change physical appearance that would be considered within normal human anatomic variation (i.e., lip enhancement procedures).

C.    Dermabrasion

Dermabrasion (i.e. abrasion, salabrasion) is considered medically necessary for the treatment of actinic keratoses, other pre-malignant skin lesions and localized non-melanoma malignant skin lesions (e.g. basal cell carcinoma and carcinoma in-situ).

Dermabrasion or salabrasion is considered cosmetic and not medically necessary when used to enhance appearance of the upper layer of the skin as a result of acne, acne scars, uneven pigmentation or wrinkles. 

D.    Laser and Surgical Treatment of Acne Rosacea

Surgical management of acne rosacea is considered medically necessary when the following criteria are met:

1. Laser and surgical treatment of rosacea is reserved for severe and refractory forms of rosacea, unresponsive to standard medical therapy. Standard medical therapy includes an adequate trial of topical agents or oral agents or both (antibiotics); AND
2. Documentation that includes both of the following:
   • The individual has undergone and received inadequate results with conservative management; and
   • Preoperative photos document the clinical skin changes requiring treatment.

Note: Severe permanent telangiectasia may be treated by electrosurgery, laser (e.g. V-beam pulsed dye laser [PDL], 585 flash pump laser, KTP laser) or intense pulsed light (IPL) therapy.

The use of lasers or other surgical treatments for isolated telangiectasia is considered cosmetic and not medically necessary when the above criteria are not met.

E.    Treatment of Keloids and Scar Revision

Treatment of keloids is considered medically necessary when there is documented evidence of significant physical functional impairment related to the keloid and the treatment can be reasonably expected to improve the physical functional impairment. Treatment decisions must weigh the risk of causing additional keloids.

Treatment of keloids may be reconstructive when the keloids themselves produce significant anatomic variance. Treatment decisions must weigh the risk of causing additional keloids. 

Scar revision is considered medically necessary when there is documented evidence of significant physical functional impairment related to the scar and the treatment can be reasonably expected to improve the physical functional impairment. Treatment decisions must weigh the risk of causing additional scars. 

Scar revision may be reconstructive when there is significant variation from normal related to accidental injury, disease, trauma, or treatment of a disease or congenital defect.

Treatment of keloids is considered cosmetic and not medically necessary when done in the absence of a significant physical functional impairment or where the appearance is considered within normal anatomic variation.

Scar revision is considered cosmetic and not medically necessary when done in the absence of a significant physical functional impairment or where the appearance is considered within normal anatomic variation.

F.    Tattoos (Application):

Tattooing of skin may be considered medically necessary when done as part of a medically necessary therapeutic process (i.e., radiation therapy or as part of reconstructive breast surgery).    

Tattooing of skin is considered cosmetic and not medically necessary for all other indications.  

G.   Injection of Dermal Fillers  

The injection of dermal fillers (e.g. poly-L-lactic acid [PLLA] or synthetic calcium hydroxylapatite) is considered reconstructive when there is a significant variation from normal related to accidental injury, disease, trauma, or treatment of a disease or congenital defect.

H.   Port Wine Stain

Treatment of port wine stain using laser or other methods to restore appearance is considered reconstructive when there is a significant variation from normal related to a congenital defect. 

I.     Hair Procedures

Hairplasty (hair transplant) for alopecia, including but not limited to male pattern alopecia, is considered cosmetic and not medically necessary for all indications.

The temporary or permanent removal of hair using lasers, electrolysis, or waxing, is considered cosmetic and not medically necessary for all indications, including, but not limited to the treatment of hirsutism.

J.    Other Cosmetic Skin Procedures

Laser skin resurfacing is considered cosmetic and not medically necessary for all indications.

Removal or excision of a tattoo is considered cosmetic and not medically necessary for all indications.

Treatment of telangiectasias (spider veins) is considered cosmetic and not medically necessary unless the above medically necessary criteria are met for the treatment of acne rosacea.

Concepts of Medical Necessity, Reconstructive and Cosmetic

The coverage eligibility of medical and surgical therapies to treat skin conditions is often based on a determination of whether treatment is considered medically necessary, reconstructive or cosmetic in nature. In many instances the concept of reconstructive overlaps with the concept of medical necessity. For example, services intended to correct a significant physical functional impairment as a result of trauma will be considered medically necessary and thus eligible for coverage, regardless of the contract language pertaining to reconstructive services, unless some other exclusion applies. Generally, reconstructive is often taken to mean that the service "returns the patient to whole" as a result of a congenital anomaly, disease or other condition including post trauma or post therapy, while cosmetic generally describes improving a physical appearance that would be considered within normal human anatomic variation. Categories of conditions without associated functional impairment that may be included as reconstructive, include or may be due to the following: a) surgery, b) accidental trauma or injury, c) diseases, d) congenital anomalies, e) severe anatomic variants, and f) chemotherapy.

Acne vulgaris is the most common form of acne, occurring in an estimated 85% of the adolescent population in the United States. While, for the most part, the manifestations of acne vulgaris are temporary, severe cases may result in permanent scarring. There are several local factors that contribute to the development of acne vulgaris, including blocked hair follicles, enlargement of specific skin glands, over production of skin glands, use of products that promote bacterial growth, and inflammatory responses to bacterial overgrowth. Other less common causes include hormonal imbalance and some medications.

Chemical peels are a group of skin procedures used to treat a wide variety of skin conditions including pre-malignant and selected malignant skin lesions, aged skin, wrinkles, acne, acne scarring and uneven epidermal pigmentation. One of several chemical solutions is used (e.g., glycolic acid, salicylic acid, lactic acid) which are applied to the skin causing it to "blister" and eventually peel off. The new, regenerated skin is usually free of any lesions and is generally smoother and less wrinkled than the original skin.

Collagen injections and implants involve the use of collagen, a protein found in the skin, to make a body part, such as the lips or chin, appear fuller. This procedure involves either the injection of raw collagen or the surgical implantation of a pre-formed collagen implant under the surface of the skin. This procedure may be used to restore the appearance or physical function after accidental injury. It may also be used to enhance appearance.

Dermabrasion, or surgical skin planing, is a treatment of pre-malignant and malignant skin lesions and acne, which also has cosmetic uses. During this procedure, the skin is frozen and then mechanically sanded to eliminate any lesions to improve contour and achieve a rejuvenated appearance. Salabrasion although, basically the same technique uses salt impregnated gauze pads to remove the upper layers of skin.

Rosacea affects the central flush/blush areas of the face (i.e., forehead, nose, cheeks, chin), although ocular disease and extrafacial lesions are well-recognized features. Intermittent facial flushing is a central feature of the disease. Permanent telangiectasia may result. Sebaceous hyperplasia, fibrosis, and edema (rhinophyma) characterize more severe forms of the disease. The treatment of acne rosacea is dictated by the severity of the disease. Because the diagnosis of acne rosacea is made on the basis of clinical features several of which may be common to other skin conditions, differentiation of rosacea from other diseases/conditions may be required. Isolated telangiectasia in the absence of other signs and symptoms are not diagnostic of rosacea. When avoidance of common environmental (sun exposure or temperature changes) or dietary (alcohol, spicy foods) triggers is inadequate, oral antibiotics or topical agents (antibiotics, azelaic acid, isotretinoin, sulfacetamide) are employed. In general, a 12-week trial of topical treatment is used to assess response. Laser treatment and surgical intervention is reserved for cases which are unresponsive to other treatments.

Excessive hair growth on the face or body it is known as hirsutism. While this occurs in both men and women, it is usually only viewed as problematic for women. There are many ways to remove unwanted hair, including temporary measures such as waxing, shaving, or using depilatory creams. There are also more permanent methods such as electrolysis or laser hair removal. Electrolysis removes hair permanently by delivering a small electrical current through a needle inserted into the hair follicle. This current destroys the follicle and prevents regrowth.  Laser techniques use concentrated beams of light to accomplish this. Neither sporadic areas of unwanted hair nor hirsutism have been associated with any health-related problems and treatment is considered cosmetic.

Alopecia is the medical term for hair loss. The most common type of hair loss is androgenic alopecia or male pattern baldness. It is typically permanent, may occur in both men and women, and is hereditary. There are no health-related ramifications of this condition. The available treatments for alopecia are hairpieces, medications to promote hair growth, and hairplasty. Hairplasty, commonly referred to as hair transplant, involves taking tiny plugs of skin, containing one to several hairs, from the back or side of the scalp and re-implanting them into the bald scalp sections. Several transplant sessions may be needed as hereditary hair loss progresses with time.

Keloids are an overgrowth of scar tissue in response to skin injury causing a raised, hardened section of skin.  Keloids occur from such skin injuries as surgical incisions, traumatic wounds, vaccination sites, burns, chicken/pox, acne or even minor scratches. They are fairly common in young women and African Americans. Keloids require no treatment unless they cause functional problems. Keloids often recur (sometimes larger than before) after they have been removed.

Laser skin resurfacing involves using a strong laser to literally burn away unwanted skin lesions such as pre-cancerous lesions, acne scars, or wrinkles.

Some medical conditions may result in a condition called lipoatrophy, characterized by facial wasting of fat under the skin of the face and other parts of the body. Lipoatrophy results in a gaunt or wasted appearance. There are no health problems related specifically to this condition. Reconstructive treatments available to correct lipoatrophy involve the injection of FDA-approved dermal fillers such as poly-L-lactic acid implant (Sculptra™, Dermik laboratories: sanofi-aventis, U.S. LLC., Bridgewater, NJ) or synthetic calcium hydroxylapatite (Radiesse^®, BioForm Medical, Inc., San Mateo, CA). Poly-L-lactic acid is a biodegradable synthetic substance used in the manufacture of absorbable stitches and implantable medical devices. Sculptra™ is an injectable form of this material injected under the skin of an individual with lipoatrophy to restore a more normal facial or body contour. Radiesse, a semi-solid, cohesive implant whose principal component is a synthetic calcium hydroxylapatite suspended in a gel carrier, is also injected subdermally for restoration, or correction, or both for individuals with human immunodeficiency virus (HIV)-associated lipoatrophy.

Port wine stains (large congenital hemangiomas) are a type of birthmark consisting of superficial and deep dilated capillaries in the skin that produce a reddish or purplish discoloration. This condition is present at birth and usually does not pose any health problems. Many treatments have been tried for this condition but the advent of laser treatment has had the greatest impact.  

Scar revision is a surgical procedure that is intended to change a scar resulting from injury or surgery. This involves surgery on the scarred area, removal of the scar tissue and re-closing the wound in a new configuration that either will not interfere with function or has a more acceptable appearance.

Skin lesion is a nonspecific term referring to any change in the skin surface. While some skin lesions represent diseases, which require medical treatment, others do not.

Tattooing is the permanent injection of ink under the skin for decorative or medical purposes. Tattoos are usually permanent and cannot be removed without intervention. The removal of tattoos may be done with laser treatments, dermabrasion, or actual surgical removal. While tattoo removal is usually effective, some scarring or skin discoloration may result from the procedure.

Telangiectasias, also known as spider veins, are abnormally dilated blood vessels associated with a number of diseases such as ataxia-telangiectasia and scleroderma, but are mostly benign in nature and due to hereditary or unknown factors. Spider veins may appear anywhere on the body but are most commonly noted on the arms, face and legs. Treatment for spider veins may be done with laser therapy.

Professional Medical Society and Authoritative Publications

The American Academy of Dermatology (AAD) (Strauss, 2007) has published Guidelines of care for the management of acne vulgaris. The scope of these guidelines address "the management of adolescent and adult patients presenting with acne but not the consequences of disease, including the scarring, post-inflammatory erythema, or post-inflammatory hyperpigmentation. The task force has identified the following clinical issues relevant to the management of acne:

• grading and classification;
• the role of microbiology and endocrine testing; and
• the efficacy and safety of various treatments, such as topical agents, systemic antibacterial agents, hormonal agents, isotretinoin, miscellaneous therapies, complementary/alternative therapies, and dietary restriction.

Recommendations for treatment include topical therapy as the standard of care in acne management, with systemic antibiotics as the standard of care in the management of moderate and severe presentations of acne and treatment-resistant forms of inflammatory acne. Intralesional corticosteroid injections are identified as effective in the treatment of individual acne nodules, however, there is limited evidence regarding the benefit of physical modalities including glycolic acid peels and salicylic acid peels. "Both glycolic acid-based and salicylic acid-based peeling preparations have been used in the treatment of acne. There is very little evidence from the clinical trials published in the peer-reviewed literature supporting the efficacy of peeling regimens" (AAD and Strauss, 2007).

Acne rosacea: a common dermatologic condition characterized by symptoms of facial flushing and a spectrum of clinical signs, including erythema, telangiectasia, and inflammatory papular or pustular eruptions resembling acne 

Acne vulgaris: the most common form of acne; most commonly found in adolescents but may be seen in adults as well

Actinic keratoses: (also referred to as solar keratoses); common sun-exposure related skin lesions microscopically involving the epidermis alone but with the potential ultimately to progress to invasive cancer (squamous cell carcinoma) in a small percentage of cases (variously estimated from 0.1% to 20%)

Chemical peels: a group of medical procedures using various chemicals to remove the outer layers of the skin

Collagen injection or implants: the injection of raw collagen, a naturally occurring substance that gives skin its elasticity, or the implantation of an implant made of collagen, to create a fuller appearance to the skin

Dermabrasion or salabrasion: a group of medical procedures using physical scrubbing methods to remove the outer layer of the skin

Dermal fillers:  biocompatible materials used for soft-tissue augmentation

Electrolysis:  a procedure designed to permanently remove unwanted hair

Hairplasty: a surgical procedure designed to transplant or implant hair to areas where hair has been lost, such as in the case of male baldness

Hirsutism: excessive hairiness

Keloids: a condition where a scar becomes raised above the plain of normal skin and has a hardened texture

Laser skin resurfacing: a group of medical procedures using laser light methods to remove the outer layer of the skin

Poly-L-lactic acid: a biodegradable substance that can be injected under the skin to restore the appearance of an individual who has lost subcutaneous fat due to illness; this substance may also be used for cosmetic purposes to enhance an individual's appearance

Port wine stain: a large congenital hemangioma which is visible as a mark on the skin that resembles port wine in its rich ruby red color; these marks are due to an abnormal aggregation of capillaries in a portion of the skin

Scar revision: a procedure that involves surgically removing scar tissue and re-closing the wound in order to repair cosmetic or functional problems

Significant physical functional impairment: limits on normal physical functioning that may include, but are not limited to, problems with communication, respiration, eating, swallowing, visual impairments, skin integrity, distortion of nearby body parts, or obstruction of an orifice.  The cause of the physical functional impairment may be pain, structural integrity, congenital anomalies or other factors. Significant physical functional impairment excludes social, emotional, and psychological impairments or potential impairments

Telangiectasias: commonly called spider veins; a condition characterized by small, red or blue spider-web marks close to the surface of the skin caused by permanent dilation of small blood vessels. These blood vessels look like thick red lines and may occur in any part of the body, but most commonly are seen on the legs, torso and face

The following codes for treatments and procedures applicable to this document are included below for informational purposes.  Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy.  Please refer to the member's contract benefits in effect at the time of service to determine coverage or non-coverage of these services as it applies to an individual member.

Chemical Peels
Services may be Medically Necessary, when criteria are met: 

When services are Cosmetic and Not Medically Necessary:
For the procedure codes listed above, when criteria are not met, for all other diagnoses not listed; or when the code describes a procedure indicated in the Position Statement section as cosmetic and not medically necessary.

Collagen Injections
Services may be Medically Necessary when criteria are met: 

When services are Reconstructive: 
For procedure codes listed above when criteria for reconstructive services are met without significant physical functional impairment; or when the code describes a procedure indicated in the Position Statement section as reconstructive.

When services are Cosmetic and Not Medically Necessary:
For the procedure codes listed above, when criteria are not met for medically necessary or reconstructive services (in the absence of significant physical functional impairment); or when the code describes a procedure indicated in the Position Statement section as cosmetic and not medically necessary.

Dermabrasion, Abrasion
When services are Medically Necessary:

When services are Cosmetic and Not Medically Necessary:
For the procedure codes listed above, when criteria are not met, for all other diagnoses not listed; or when the code describes a procedure indicated in the Position Statement section as cosmetic and not medically necessary.

Laser /Surgical Treatment of Acne Rosacea
Services may be Medically Necessary when criteria are met: 

When services are Cosmetic and Not Medically Necessary:
For the procedure and diagnosis codes listed above, when criteria are not met; or when the code describes a procedure indicated in the Position Statement section as cosmetic and not medically necessary.

Keloids/Scar Revision
Services may be Medically Necessary when criteria are met:

When services are Reconstructive: 
For the procedure and diagnosis codes listed above when criteria for reconstructive services are met without significant physical functional impairment; or when the code describes a procedure indicated in the Position Statement section as reconstructive. 

When services are Cosmetic and Not Medically Necessary:
For the procedure and diagnosis codes listed above, when criteria are not met; or when the code describes a procedure indicated in the Position Statement section as cosmetic and not medically necessary.

Tattooing 
When services are Medically Necessary:

When services are Cosmetic and Not Medically Necessary:
For the procedure codes listed above for all other indications; or when the code describes a procedure indicated in the Position Statement section as cosmetic and not medically necessary.

Injection of Dermal Fillers
When services may be Reconstructive when criteria are met:
When the code describes a procedure indicated in the Position Statement section as reconstructive 

Services are Cosmetic and Not Medically Necessary:
For the procedure codes listed above when criteria are not met; or when the code describes a procedure indicated in the Position Statement section as cosmetic and not medically necessary.

Port Wine Stain
When services are Reconstructive:

Other
When services are Cosmetic and Not Medically Necessary:
When the code describes a procedure indicated in the Position Statement section as cosmetic and not medically necessary. 

Peer Reviewed Publications:

1. Alam M, Dover JS.  Management of complications and sequelae with temporary injectable fillers. Plast Reconstr Surg. 2007; 120(6 Suppl):98S-105S.
2. Alster T. Laser scar revision: comparison study of 585-nm pulsed dye laser with and without intralesional corticosteroids. Dermatol Surg. 2003; 29(1):25-29.
3. Ayhan S, Baran CN, Yavuzer R, et al. Combined chemical peeling and dermabrasion for deep acne and posttraumatic scars as well as aging face. Plast Reconst Surg. 1998; 102(4):1238-1246.
4. Badawy EA, Kanawati MN. Effect of hair removal by Nd:YAG laser on the recurrence of pilonidal sinus. J Eur Acad Dermatol Venereol. 2009; 23(8):883-886.
5. Faurschou A, Togsverd-Bo K, Zachariae C, Haedersdal M. Pulsed dye laser vs. intense pulsed light for port-wine stains: a randomized side-by-side trial with blinded response evaluation. Br J Dermatol. 2009; 160(2):359-364.
6. Gold MH, Nestor MS. Current treatments of actinic keratoses. J Drugs Dermatol. 2006; 5(2) Suppl):17-25.
7. Huikeshoven M, Koster PH, de Borgie CA, et al. Redarkening of port-wine stains 10 years after pulsed-dye-laser treatment. N Engl J Med. 2007; 356(12):1235-1240.
8. Jasim ZF, Handley JM. Treatment of pulsed dye laser-resistant port wine stain birthmarks. J Am Acad Dermatol. 2007; 57(4):677-682.
9. Jiang SB, Levine VJ, Nehal KS, et al. Er:YAG laser for the treatment of actinic keratoses. Dermatol Surg. 2000; 26(5):437-440.
10. Kwon SD, Kye YC. Treatment of scars with a pulsed Er: YAG laser. J Cutan Laser Ther. 2000: 2(1):27-31.
11. Lafaurie M, Dolivo M, Porcher R, et al. Treatment of facial lipoatrophy with intradermal injections of polylactic acid in HIV-infected patients. J Acquir Immune Defic Syndr. 2005; 38(4):393-398.
12. McIntyre WJ, Downs MR, Bedwell SA. Treatment options for actinic keratoses. Am Fam Physician. 2007; 76(5):667-671.
13. Mest DR, Humble GM. Retreatment with injectable poly-l-lactic acid for HIV-associated facial lipoatrophy: 24-month extension of the Blue Pacific study. Dermatol Surg. 2009; 35 Suppl 1:350-359.
14. Moyle GJ, Brown S, Lysakova L, Barton SE. Long-term safety and efficacy of poly-L-lactic acid in the treatment of HIV-related facial lipoatrophy. HIV Med. 2006; 7(3):181-185.
15. Neuhaus IM, Zane LT, Tope WD. Comparative efficacy of nonpurpuragenic pulsed dye laser and intense pulsed light for erythematotelangiectatic rosacea. Dermatol Surg. 2009; 35(6):920-928.
16. Ormerod A, Rajpara S. Basal cell carcinoma. Clin Evid (Online). 2008; pii: 1719.
17. Otley, CC, Roenigk, RK. Medium-depth chemical peeling. Semin Cutan Med Surg. 1996; 15(3):145-154.
18. Quaedvlieg PJ, Tirsi E, Thissen MR, Krekels GA. Actinic keratosis: how to differentiate the good from the bad ones? Eur J Dermatol. 2006; 16(4):335-339.
19. Rahbar R, Shah P, Mulliken JB, et al. The presentation and management of nasal dermoid: a 30-year experience. Arch Otolaryngol Head Neck Surg. 2003; 129(40):464-471.
20. Sami NA, Attia AT, Badawi AM. Phototherapy in the treatment of acne vulgaris. J Drugs Dermatol. 2008; 7(7):627-632.
21. Silvers SL, Eviatar JA, Echavez MI, Pappas AL. Prospective, open-label, 18-month trial of calcium hydroxylapatite (Radiesse) for facial soft-tissue augmentation in patients with immunodeficiency virus-associated lipoatrophy: one-year durability. Plast Reconstr Surg. 2006; 118(3 Suppl):34S-45S.
22. Tanzi EL, Alster TS. Treatment of atrophic facial acne scars with a dual-mode Er: YAG laser. Dermatol Surg. 2002; 28(7):551-555.
23. van Zuuren EJ, Graber MA, Hollis S, et al. Interventions for rosacea. Cochrane Database of Systematic Reviews 2005, Issue 3. Art. No.: CD003262. DOI: 10.1002/14651858.CD003262.pub3.
24. van Zuuren EJ, Gupta AK, Gover MD, et al. Systematic review of rosacea treatments. J Am Acad Dermatol. 2007; 56(1):107-115.

Government Agency, Medical Society, and Other Authoritative Publications:

1. American Academy of Dermatology (AAD). Actinic keratoses and non-melanoma skin cancer. 2009. Available at: http://www.aad.org/education/students/ak_nonmelanoma.htm. Accessed on December 17, 2009.
2. American Academy of Dermatology (AAD). Guidelines of care for acne vulgaris management. April 2007. Available at: http://www.aad.org/research/_doc/ClinicalResearch_Acne%20Vulgaris.pdf. Accessed on December 17, 2009.
3. Bickers DR, Lim HW, Margolis D, et al. American Academy of Dermatology Association; Society for Investigative Dermatology. The burden of skin diseases: 2004 joint project of the American Academy of Dermatology Association and the Society for Investigative Dermatology. J Am Acad Dermatol. 2006; 55(3):490-500.
4. Centers for Medicare and Medicaid Services (CMS). NCA for Dermal Injections for the Treatment of Facial Lipodystrophy Syndrome (FLS). CAG-00412N. March 23, 2010. Available at: http://www.cms.hhs.gov/mcd/viewnca.asp?nca_id=234&basket=nca:00412N:234:Dermal+injections+for+the+treatment+of+facial+lipodystrophy+syndrome+%28FLS%29:Closed:New:4. Accessed on March 26, 2010.
5. Centers for Medicare and Medicaid Services (CMS). National Coverage Determination for Laser Procedures. NCD #140.5. Effective May 1, 1997. Available at: http://www.cms.hhs.gov/mcd/index_list.asp?list_type=ncd. Accessed on December 17, 2009.
6. Centers for Medicare and Medicaid Services (CMS). National Coverage Determination for Treatment of Actinic Keratosis (AKs). NCD #250.4. Effective November 26, 2001. Available at: http://www.cms.hhs.gov/mcd/index_list.asp?list_type=ncd. Accessed on December 17, 2009.
7. Coleman WP III, Glogau RG, Klein JA, et al. American Academy of Dermatology Guidelines/Outcomes Committee. Guidelines of care for liposuction. J Am Acad Dermatol. 2001; 45(3):438-447.
8. de Berker D, McGregor JM, Hughes BR. British Association of Dermatologists Therapy Guidelines and Audit Subcommittee. Guidelines for the management of actinic keratoses. Br J Dermatol. 2007; 156(2):222-230.
9. Khunger N, Mysore V, Savant S, et al. The IADVL Task Force. Standard guidelines of care for acne surgery. Indian J Dermatol Venereol Leprol. 2008; 74 Suppl: S28-S36.
10. Krupashankar DS. IADVL Dermatosurgery Task Force. Standard guidelines of care: CO2 laser for removal of benign skin lesions and resurfacing. Indian J Dermatol Venereol Leprol. 2008; 74 Suppl:S61-67.
11. Radiesse^® Injectable Implant [Product Insert], San Mateo, CA. BioForm Medical, Inc.; December 22, 2006. Available at: http://www.accessdata.fda.gov/cdrh_docs/pdf5/P050037c.pdf. Accessed on December 17, 2009.
12. Sculptra™ [Product Insert], Bridgewater, NJ. Dermik Laboratories (sanofi-aventis U.S., LLC); June 2006. Available at: http://www.fda.gov/ohrms/dockets/dailys/04/aug04/081004/04m-0350-aav0001-04-Labeling-vol1.pdf. Accessed on December 17, 2009.
13. Strauss JS, Krowchuk DP, Leyden JJ, et al. American Academy of Dermatology. Guidelines of care for acne vulgaris management. J Am Acad Dermatol. 2007; 56:651-653.

1. American Academy of Dermatology (AAD). Available at: http://www.aad.org/. Accessed on December 17, 2009.
2. American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS). Available at: http://www.aafprs.org/. Accessed on December 17, 2009.
3. American Cancer Society (ACS). Detailed guide: Skin cancer: Basal and squamous cell. Chemotherapy. Revised March 05, 2010. Available at: http://www.cancer.org/docroot/CRI/content/CRI_2_4_4X_Chemotherapy_51.asp?sitearea=. Accessed on March 5, 2010.
4. American Society for Aesthetic Plastic Surgery (ASAPS). Available at: http://surgery.org. Accessed on December 17, 2009.
5. American Society of Plastic Surgeons (ASPS). Available at: http://www.plasticsurgery.org . Accessed on December 17, 2009.

Abrasion
Acne Rosacea
Actinic Keratoses
Alopecia
Benign Skin Lesion
Chemical Peel
Collagen Implant
Collagen Injection
Cosmetic
Dermabrasion
Dermal Peel
Electrolysis
Enhancement
Epidermal
Hairplasty
Hemangioma
Hirsutism
Implant
Keloid
Laser Skin Resurfacing
Pigmentation
Poly-L-lactic Acid (PLLA)
Port Wine Stain
Radiesse^®
Reconstructive
Salabrasion
Scar Revision
Scar
Sculptra™
Spider Vein
Skin
Tattoo
Telangiectasia
Wrinkle

The use of specific product names is illustrative only.  It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available.