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
• CG-SURG-27 Gender Reassignment Surgery
• CG-SURG-31 Treatment of Keloids and Scar Revision
• SURG.00023 Breast Procedures; including Reconstructive Surgery, Implants and Other Breast Procedures

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 performed in the absence of a significant physical functional impairment and are intended to change a physical appearance that would be considered within normal human anatomic variation. Examples include, but are not limited to, treatment of photoaged 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 procedure can be reasonably expected to improve the physical functional impairment. 

Collagen injections or implants 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.   

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 a physical appearance that would be considered within normal human anatomic variation. An example includes, but is not limited to, 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. Examples include, but are not limited to, basal cell carcinoma and carcinoma in-situ.

Dermabrasion or salabrasion is considered cosmetic and not medically necessary when performed in the absence of a significant physical functional impairment and are intended to change a physical appearance that would be considered within normal human anatomic variation. Examples include, but are not limited to, enhance the 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 Rosacea and Telangiectasia

Laser or surgical management of rosacea is considered medically necessary when the rosacea is severe, refractory to standard medical therapy, and preoperative photos document the clinical skin changes requiring treatment.

Laser or surgical treatment of rosacea or isolated telangiectasias (including spider veins) is considered cosmetic and not medically necessary when performed in the absence of a significant physical functional impairment and are intended to change a physical appearance that would be considered within normal human anatomic variation.

E.  Tattoos (Application)

Tattooing of skin is considered medically necessary when done as part of a medically necessary therapeutic treatment. An example includes, but is not limited to, tattooing related to radiation therapy.

Tattooing of the skin is considered reconstructive when performed as part of a covered breast reconstruction.

Tattooing of skin is considered cosmetic and not medically necessary when the medically necessary or reconstructive criteria in this section are not met.

F.   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.

The injection of dermal fillers is considered cosmetic and not medically necessary when the reconstructive criteria in this section are not met.

G.  Cutaneous Hemangioma, Port Wine Stain, and other Vascular Lesions

Treatment of cutaneous hemangioma, port wine stain, or other vascular lesions are considered medically necessary when there is documented evidence of significant physical functional impairment (for example, bleeding or a lesion which interferes with vision) and the procedure can be reasonably expected to improve the physical functional impairment.

Treatment of cutaneous hemangioma, port wine stain, or other vascular lesions using lasers or other methods to restore appearance are considered reconstructive when intended to address a significant variation from normal related to a congenital defect.

Treatment of cutaneous hemangioma, port wine stain, or other vascular lesions 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 a physical appearance that would be considered within normal human anatomic variation.

H.  Hair Procedures

Permanent removal of hair is considered medically necessary for recurrent infected cyst, hair follicle infections, or after surgical treatment of pilonidal sinus disease.

Hairplasty for alopecia, including but not limited to male pattern alopecia, and temporary or permanent removal of hair using electrolysis, lasers, or waxing is considered cosmetic and not medically necessary when performed in the absence of a significant physical functional impairment and are intended to change a physical appearance that would be considered within normal human anatomic variation. An example includes, but is not limited to, the removal of unwanted hair due to hirsutism.

I.  Other Cosmetic Skin Procedures

Laser skin resurfacing is considered cosmetic and not medically necessary for all indications, including but not limited to the treatment of facial wrinkles and skin irregularities (e.g., acne scars or blemishes).

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

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. The American Academy of Dermatology (AAD) (Strauss, 2007) has published Guidelines of care for the management of acne vulgaris. The scope of these guidelines addresses "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/Strauss, 2007).

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 is a common skin disease characterized by intermittent facial flushing in the center of the face with redness that can slowly spread to the  eyes, forehead, nose, cheeks, and chin. Extrafacial lesions involve the ears, chest, and back. Rosacea has four subtypes, each characterized by specific signs and symptoms: 1) erythematotelangiectatic rosacea (redness, flushing, and visible blood vessels); 2) papulopustular rosacea (redness, swelling, and acne-like breakouts); 3) phymatous rosacea (skin thickens and has a bumpy texture); and 4) ocular rosacea (red and irritated eyes, swollen eyelids, and the appearance of a cyst or sty) (AAD, 2012). Permanent telangiectasias may result. Sebaceous hyperplasia, fibrosis and edema (rhinophyma), and ocular involvement characterize more severe forms of the disease. The treatment of rosacea is dictated by the severity of the disease. Because the diagnosis of 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.

Hair growth can occur anywhere on the face or body. Permanent removal of hair for recurrent infected cyst, hair follicle infections, or after surgical treatment of pilonidal sinus disease may be considered medically necessary. Hirsutism is a condition of unwanted, male-pattern hair growth in women, resulting in excessive amounts of coarse and pigmented hair on body areas such as the face, chest, and back, where men typically grow hair. The amount of body hair an individual has is largely determined by genetic makeup. Hirsutism may arise from excess male hormones called androgens, primarily testosterone, or may be due to an ethnic or family trait. Removal of unwanted hair related to hirsutism may involve a combination of self-care methods, hair-removal therapies and medications. Temporary measures to remove this unwanted hair include waxing, shaving, or use of depilatory creams.More permanent methods to remove this unwanted hair include electrolysis or laser hair removal. Electrolysis removes hair permanently by delivering a small electrical current through a needle inserted into the hair follicle. This electrical current destroys the follicle and prevents regrowth. Laser techniques use concentrated beams of light to accomplish this. Procedures to remove sporadic areas of unwanted hair as a result of hirsutism are 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.  

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 U.S. Food and Drug Administration (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^®_, Merz Aesthetics, Inc., Franksville, WI). 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.

Vascular birthmarks are commonly encountered in children and are classified as either hemangiomas or vascular malformations, with cutaneous vascular lesions being the most common pediatric birthmarks. Vascular malformations (flat lesions) include salmon patch (i.e., nevus simplex or nevus telangiectaticus) and port wine stain (i.e. nevus flammeus). Hemangiomas (raised lesions) include superficial hemangioma (i.e. capillary nevus hemangioma) and deep hemangioma (i.e. cavernous hemangioma). Treatment of hemangiomas varies depending on the presence of associated symptoms or syndromes. Some hemangiomas, including those of the nose and lip, are likely to lead to scarring and loss of function when the lesion involutes. Many superficial hemangiomas resolve with minimal sequelae (Wirth and Lowitt, 1998). Port wine stains (low-flow vascular malformations) are a condition present at birth consisting of superficial and deep dilated skin lesions appearing as flat, faint, pink-red patches. Port wine stains rarely indicate the presence of a sign of serious health problem except in conditions such as Sturge-Weber or Klippel-Trenaunay-Weber syndrome. Some port wine stains may occasionally bleed with trauma, resulting in potential deformity and disfigurement. Early treatment may prevent the progression of development to hypertrophy and nodules in later years. Evidence in the peer-reviewed medical literature suggests efficacy is increased if lesions are treated in infancy, although size and location are also predictors of outcome (Conlon and Drolet, 2004). Facial port wine stain involving the upper and lower eyelids (e.g. trigeminal or ophthalmic distribution) may be associated with the development of glaucoma. Freezing, surgery, radiation, and tattooing have been tried for the treatment of port wine stains, but laser treatment has been shown to be the most effective treatment for port wine stains and is associated with less adverse effects (i.e. post-operative scarring) (Tucci, 2009; Yang, 2005).

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 of spider veins may be done with laser therapy or injection of a sclerosing solution.

Acne vulgaris: The most common form of acne found primarily in adolescents but may be seen in adults.

Actinic keratoses: Common sun-exposure related skin lesions microscopically involving the epidermis alone but with the potential to progress to invasive cancer (squamous cell carcinoma) in a small percentage of cases; also referred to as solar keratoses.

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 (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 by taking tiny plugs of skin, containing one to several hairs, from the back or side of the scalp and re-implanting them into areas where hair has been lost, such as in the case of male pattern baldness. Several transplant sessions may be needed as hereditary hair loss progresses with time.

Hirsutism: A condition involving excessive hairiness.

Klippel-Trenaunay syndrome: A rare condition present at birth that usually involves port wine stains, excess growth of bones and soft tissue, and varicose veins.

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 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.

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.

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.

Skin lesion: A nonspecific term referring to any change in the skin surface. While some skin lesions represent conditions requiring medical treatment, others do not.

Sturge-Weber syndrome: A rare disorder present at birth with symptoms that include port wine stain birthmark (usually on the face) and nervous system problems; also referred to as encephalotrigeminal angiomatosis.

Telangiectasias: 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; commonly called spider veins.

The following codes for treatments and procedures applicable to this document are included below for informational purposes.  A draft of future ICD-10 Coding (effective 10/01/2014) related to this document, as it might look today, is included below for your reference.  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.

A.  Chemical Peels
When 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 or 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.

B.  Collagen Injections
When Services may be Medically Necessary or Reconstructive when criteria are met: 

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; or when the code describes a procedure indicated in the Position Statement section as cosmetic and not medically necessary.

C.  Dermabrasion, Abrasion
When services are Medically Necessary:

When services are Cosmetic and Not Medically Necessary:
For the procedure codes listed above 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.

When Services are also Cosmetic and Not Medically Necessary: 

D.  Treatment of Rosacea and Telangiectasia
When 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 medically necessary criteria are not met for telangiectasia diagnosis, or when the code describes a procedure indicated in the Position Statement section as cosmetic and not medically necessary.

When Services are also Cosmetic and Not Medically Necessary: 

E.  Tattooing 
When services are Medically Necessary:

When services may be Medically Necessary or reconstructive when criteria are met:
For the procedure codes listed above for the following diagnoses:
Note: for criteria for breast reconstruction, see SURG.00023

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

F.  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 

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

G.  Cutaneous Hemangiomas and Port Wine Stain
When services may be Medically Necessary or Reconstructive when criteria are met:

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; or when the code describes a procedure indicated in the Position Statement section as cosmetic and not medically necessary.

H.  Hair Procedures
When 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, 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.

When services are also Cosmetic and Not Medically Necessary: 

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. 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.
3. 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.
4. Castineiras I, Del Pozo J, Mazaira M, et al. Actinic cheilitis: evolution to squamous cell carcinoma after carbon dioxide laser vaporization. A study of 43 cases. J Dermatolog Treat. 2010; 21(1):49-53.
5. Conlon JD, Drolet BA. Skin lesions in the neonate. Pediatr Clin North Am. 2004; 51(4):863-888, vii-viii.
6. Conroy FJ, Kandamany N, Mahaffey PJ. Laser depilation and hygiene: preventing recurrent pilonidal sinus disease. J Plast Reconstr Aesthet Surg. 2008; 61(9):1069-1072.
7. 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.
8. Garzon MC, Huang JT, Enjolras O, Frieden IJ. Vascular malformations. Part II: associated syndromes. J Am Acad Dermatol. 2007; 56(4):541-564.
9. Gold MH, Nestor MS. Current treatments of actinic keratoses. J Drugs Dermatol. 2006; 5(2) Suppl):17-25.
10. Hamilton FL, Car J, Lyons C, et al. Laser and other light therapies for the treatment of acne vulgaris: systematic review. Br J Dermatol. 2009; 160(6):1273-1285.
11. 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.
12. Jasim ZF, Handley JM. Treatment of pulsed dye laser-resistant port wine stain birthmarks. J Am Acad Dermatol. 2007; 57(4):677-682.
13. Jiang SB, Levine VJ, Nehal KS, et al. Er:YAG laser for the treatment of actinic keratoses. Dermatol Surg. 2000; 26(5):437-440.
14. Karimipour DJ, Karimipour G, Orringer JS. Microdermabrasion: an evidence-based review. Plast Reconstr Surg. 2010; 125(1):372-377.
15. 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.
16. McIntyre WJ, Downs MR, Bedwell SA. Treatment options for actinic keratoses. Am Fam Physician. 2007; 76(5):667-671.
17. 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(1):350-359.
18. Minkis K, Geronemus RG, Hale EK. Port wine stain progression: a potential consequence of delayed and inadequate treatment? Lasers Surg Med. 2009; 41(6):423-426.
19. 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.
20. 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.
21. Oram Y, Kahraman F, Karincaoglu Y, Koyuncu E. Evaluation of 60 patients with pilonidal sinus treated with laser epilation after surgery. Dermatol Surg. 2010; 36(1): 88-91.
22. Ormerod A, Rajpara S. Basal cell carcinoma. Clin Evid (Online). 2008; pii: 1719.
23. Otley, CC, Roenigk, RK. Medium-depth chemical peeling. Semin Cutan Med Surg. 1996; 15(3):145-154.
24. 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.
25. 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.
26. Sami NA, Attia AT, Badawi AM. Phototherapy in the treatment of acne vulgaris. J Drugs Dermatol. 2008; 7(7):627-632.
27. 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.
28. Tucci FM, De Vincentiis GC, Sitzia E, et al. Head and neck vascular anomalies in children. Int J Pediatr Otorhinolaryngol. 2009; 73 Suppl 1:S71-76.
29. van Zuuren EJ, Gupta AK, Gover MD, et al. Systematic review of rosacea treatments. J Am Acad Dermatol. 2007; 56(1):107-115.
30. Wirth FA, Lowitt MH. Diagnosis and treatment of cutaneous vascular lesions. Am Fam Physician. 1998; 57(4):765-773.
31. Yang MU, Yaroslavsky AN, Farinelli WA, et al. Long-pulsed neodymium: yttrium-aluminum-garnet laser treatment for port-wine stains. J Am Acad Dermatol. 2005; 52(3 Pt 1):480-490. 

Government Agency, Medical Society, and Other Authoritative Publications:

1. 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.
2. Centers for Medicare and Medicaid Services (CMS). National Coverage Determinations. Available at: http://www.cms.gov/medicare-coverage-database/overview-and-quick-search.aspx. Accessed on June 16, 2012.
   • Dermal Injections for the Treatment of Facial Lipodystrophy Syndrome (LDS). NCD #250.5. Effective July 6, 2010.
   • Laser Procedures. NCD #140.5. Effective May 1, 1997.
   • Treatment of Actinic Keratosis (AKs). NCD #250.4. Effective November 26, 2001.
3. 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.
4. 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.
5. Faurschou A, Olesen AB, Leonardi-Bee J, et al. Lasers or light sources for treating port-wine stains. Cochrane Database Syst Rev. 2011; (11):CD007152.
6. 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.
7. 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.
8. NCCN Clinical Practice Guidelines in Oncology™. © 2012 National Comprehensive Cancer Network, Inc. Basal Cell and Squamous Cell Skin Cancers (V.2.2012). Revised March 12, 2012. For additional information visit the NCCN website: http://www.nccn.org/index.asp. Accessed on June 16, 2012.
9. Radiesse^® Injectable Implant [Product Insert], Franksville, WI. Merz Aesthetics™, Inc.; October 5, 2011. Available at: http://www.radiesse.com/en-US/downloads/RADIESSE_Wrinkle_Filler_Instructions_for_Use.pdf. Accessed on June 16, 2012.
10. Sculptra^® [Product Insert], Bridgewater, NJ. Dermik Laboratories (sanofi-aventis U.S., LLC); September 2009. Available at: http://www.accessdata.fda.gov/cdrh_docs/pdf3/P030050S002c.pdf. Accessed on June 16, 2012.
11. 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.
12. van Zuuren EJ, Graber MA, Hollis S, et al. Interventions for rosacea. Cochrane Database Syst Rev. 2005; (3): CD003262. 
13. Zalaudek I, Kreusch J, Giacomel J, et al. How to diagnose nonpigmented skin tumors: a review of vascular structures seen with dermoscopy: part II. Nonmelanocytic skin tumors. J Am Acad Dermatol. 2010; 63(3):377-386.

1. American Academy of Dermatology (AAD). Available at: http://www.aad.org/. Accessed on June 16, 2012.
2. American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS). Available at: http://www.aafprs.org/. Accessed on June 16, 2012.
3. American Cancer Society (ACS). Detailed guide. Skin cancer: basal and squamous cell. Systemic chemotherapy. Available at: http://www.cancer.org/Cancer/SkinCancer-BasalandSquamousCell/DetailedGuide/index. Accessed on June 16, 2012.
4. American Society for Aesthetic Plastic Surgery (ASAPS). Available at: http://surgery.org. Accessed on June 16, 2012.
5. American Society of Plastic Surgeons (ASPS). Available at: http://www.plasticsurgery.org. Accessed on June 16, 2012.

Abrasion
Actinic Keratoses
Alopecia
Chemical Peel
Collagen Implant or Injection
Cosmetic
Dermabrasion
Dermal Peel
Electrolysis
Hairplasty
Hemangioma
Hirsutism
Laser Skin Resurfacing
Poly-L-lactic Acid (PLLA)
Port Wine Stain
Radiesse
Reconstructive
Rosacea
Salabrasion
Sculptra
Spider Vein
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.