# Safe and Effective Treatment Protocol for Facial Pigmentary Disorders in Asian Patients: A Key to Success for Plastic Surgery Residents With Limited Clinical Experience in Aesthetic Dermatology

## TL;DR

A treatment protocol for facial pigmentation in Asian patients is safe and effective, even for residents with limited experience in aesthetic dermatology.

## Contribution

A standardized treatment protocol for aging complex pigmentation that enables residents to gain hands-on experience with minimal adverse outcomes.

## Key findings

- All patients were diagnosed and treated exclusively by residents with no major adverse effects.
- The mean MASI score decreased significantly from 19 to 2.8 after treatment.
- Residents gained essential experience while minimizing risks and improving team efficiency.

## Abstract

Introduction: Asian patients seeking facial rejuvenation treatments have a high incidence of melasma and senile lentigo, collectively known as aging complex pigmentation (ACP), making accurate diagnosis essential for appropriate treatment planning. This study evaluates the versatility of a treatment protocol established by attending plastic surgeons for residents with limited clinical experience in aesthetic dermatology.

Methods: This retrospective observational study included 27 consecutive Asian patients who visited our clinic between December 2020 and December 2021 with a chief complaint of facial pigmentary disorders. Patients suspected of having ACP underwent protocol-based treatment, which consisted of oral medications (tranexamic acid, vitamin C, and vitamin E), chemical bleaching (topical hydroquinone and retinoic acid ointment), and laser therapy. Treatment outcomes were assessed in a blinded manner by two board-certified attending physicians using the Melasma Area and Severity Index (MASI).

Results: All patients were diagnosed and treated exclusively by a resident. Six patients with ACP completed the combination therapy without any major adverse effects. The mean MASI score showed a significant improvement, decreasing from 19 before treatment to 2.8 after treatment (p=0.0054; unpaired t-test).

Discussion: The combination therapy provided satisfactory outcomes, regardless of the resident's clinical experience. Residents acquire essential hands-on experience in aesthetic dermatology while minimizing the risk of adverse outcomes. Moreover, the standardized treatment protocol streamlined the training process, reducing the time and effort needed from attending surgeons, ultimately improving team efficiency.

Conclusion: Our findings suggest that this standardized treatment protocol is an effective and safe approach for managing ACP while providing residents with valuable clinical training in aesthetic dermatology. Implementing such structured protocols in academic settings may enhance both patient outcomes and the educational experience of trainees.