Treating the face of women with botulinum toxin type A: 7-year review / Tratamento da face de mulheres com toxina botulínica do tipo A: revisão de 7 anos

Introduction: Botulinum toxin type A (BTX-A) is the number one aesthetic procedure worldwide, and the difficulty in standardizing the aesthetic treatment of the face results in a broad range of treatment possibilities. The objective this study aimed to describe the author's experience treating facial wrinkles of women with BTX-A and suggest a standardized initial treatment method. Methods: A documentary retrospective review of all medical records from the main author's clinic from 2010 to 2017 in São Paulo, Brazil, was performed, searching for female patients who required the BTX-A aesthetic treatment to reduce facial wrinkles. The main author obtained, reviewed, and classified photographic data ("Carruthers Grading Scale for Forehead Lines"). Results: The BTX-A used in all patients was Botox® (Allergan Inc., Irvine, CA, USA). A total of 156 female treatments with BTX-A were identified. The average total units of BTX-A used for the referred treatment was 32.43U. The average period between treatments in the same patient was 8.73 months. All patients showed an improved "Grading Scale for Forehead Lines" post-treatment Conclusion: The review suggests a safe and effective technique is possible with even lower complication rates than found in the literature using fewer units, resulting in lower product costs. One should always try to minimize risks in aesthetic treatments.

Introdução: A aplicação de toxina botulínica do tipo A (BTX-A) é o procedimento estético mais realizado no mundo. Não há consenso sobre a forma ideal de realizar essa aplicação, que defina os locais de aplicação e a quantidade ideal necessária para o referido tratamento. O objetivo do estudo tem como objetivos descrever a experiência do autor no tratamento das rugas faciais em mulheres com BTX-A e sugerir uma padronização para o tratamento inicial. Método: Foi realizado um estudo documental retrospectivo de todos os prontuários médicos da clínica do autor principal, em São Paulo - SP, Brasil, desde 2010 até 2017, em busca dos dados de pacientes do sexo feminino que foram submetidas ao tratamento das rugas faciais com BTX-A, por razões estéticas. Os arquivos fotográficos foram obtidos, revisados e classificados pelo autor principal de acordo com a "Carruthers Grading Scale for Forehead Lines". Resultados: A BTX-A utilizada em todas as pacientes foi: Botox® (Allergan Inc., Irvine, CA, USA). Um total de 156 tratamentos com BTX-A foi encontrado. A média de unidade de toxina utilizada para o tratamento foi de 32,43U. O período médio de retorno para nova aplicação, na mesma paciente, foi de 8,73 meses. Todas as pacientes apresentaram melhora da classificação obtida através da "Grading Scale for Forehead Lines" após o tratamento. Conclusão: A revisão sugere que uma técnica efetiva e segura para o tratamento é possível, com menos unidades e menor taxa de complicações, quando comparada à literatura. Devemos sempre minimizar os riscos em tratamentos estéticos.

Eficácia do rejuvenescimento da região periorbital com uma sessão de laser fracionado Erbium: YAG 2940nm no modo duplo / Efficacy of periorbital region rejuvenation with a single session of Erbium: YAG 2940nm fractional laser in dual mode

Introdução: rugas e flacidez na região periorbital são queixas frequentes. O laser fracionado ablativo (LFA) CO2 10600nm e o Erbium: YAG 2940nm têm a capacidade de induzir a neocolagênese e a contração das fibras de colágeno. Objetivos: o objetivo do nosso estudo foi observar a eficácia de uma única sessão de laser fracionado Erbium: YAG 2940nm dual mode no tratamento de flacidez, rítides e bolsas de gordura das pálpebras superiores e inferiores. Métodos: 17 pacientes com flacidez, rítides e bolsas de gordura das pálpebras superiores e inferiores foram submetidos a uma sessão de laser fracionado ablativo Erbium: YAG 2940nm da plataforma Etherea em modo duplo. Os registros fotográficos foram realizados no mesmo ambiente antes do tratamento e um mês após o término do protocolo. A avaliação foi realizada objetivamente por cinco dermatologistas e cirurgiões plásticos independentes ao estudo. Resultados: as melhorias na avaliação de rítides, linhas de expressão e flacidez foram clínica e estatisticamente significativas, com poucos efeitos adversos, como edema, eritema e descamação. No entanto, as bolsas de gordura não melhoraram significativamente. Conclusão: uma única sessão com o modo duplo LFA Erbium: YAG 2940nm pode contribuir para uma melhoria significativa de rítides, linhas finas e flacidez da área periorbital.

Background: Wrinkles and flaccidity in the periocular region are frequent complaints. Ablative fractional lasers (AFL) CO2 10600nm and Erbium:YAG 2940nm can induce neocollagenesis and contraction of collagen fibers. Objective: Our study aimed to observe the effectiveness of one session of dual mode Erbium:YAG 2940nm fractional laser to treat sagging, rhytids, and fat bags of the upper and lower eyelids. Methods: Seventeen patients with sagging, rhytids, and fat bags of the upper and lower eyelids underwent one session of Ablative fractional laser (AFL) 2940nm from the Etherea platform in dual mode. Photographic records were taken in the same environment before treatment and one month after the end of the protocol, and five dermatologists and plastic surgeons independent of the study assessed them objectively. Results: The improvements in the evaluation of rhytids, fine lines, and flaccidity were clinically and statistically significant with few adverse events such as edema, erythema, and desquamation. However, eyelid bags did not improve significantly. Conclusion: A single session with the dual mode AFL Erbium:YAG tip 2940 can contribute to a significant improvement in rhytids, fine lines, and flaccidity of the periorbital area.

Fios de PDO, hidroxiapatita de cálcio e ácido l-polilático para flacidez vulvar - indicações, técnica e resultados / PDO threads, calcium hydroxyapatite and l-polylactic acid for vulvar flaccidity - indications, technique and results

Os grandes lábios tornam-se flácidos com o envelhecimento. Apesar de o preenchimento com ácido hialurônico proporcionar um rejuvenescimento significativo, ele também pode levar à formação de verdadeiros testículos vulvares se mal indicado, principalmente em vulvas excessivamente flácidas, que não suportam qualquer volumização adicional. Nesses casos de flacidez excessiva, acreditamos que os bioestimuladores de colágeno seriam o melhor tratamento inicial, pois sua injeção levaria à reposição de colágeno dérmico, com melhora da frouxidão, sem acréscimo expressivo de volume. Temos utilizado a hidroxiapatita de cálcio, o ácido l-polilático e os fios não espiculados de PDO, desde 2019, com bons resultados.

The labia majora become saggy with aging. Although filling with hyaluronic acid provides significant rejuvenation, it can also lead to the formation of true vulvar testicles if poorly indicated, especially in excessively flaccid vulvas, which do not support any further volumization. In these cases of excessive flaccidity, we believe that collagen biostimulators would be the best initial treatment, as their injection would lead to the replacement of dermal collagen and improvement in laxity, without a significant increase in volume. We have been using calcium hydroxyapatite, l-polylactic acid, and PDO threads since 2019, with good results.

Utilização do biofeedback eletromiográfico na terapia fonoaudiológica para atenuar sinais de envelhecimento facial: relato de caso / Utilization of electromyographic biofeedback in speech therapy to attenuate the signs of facial aging: a case report

RESUMO A intervenção mioterápica em estética facial tem como meta atenuar rugas e sinais de envelhecimento facial. A relação entre contração exagerada dos músculos durante a mastigação, deglutição e comunicação oral e aparecimento de rugas faciais é preconizada na literatura fonoaudiológica neste campo de atuação. Este estudo teve por objetivo relatar o efeito da utilização do biofeedback eletromiográfico associado ao treinamento dos padrões de mastigação, deglutição e sorriso, durante intervenção fonoaudiológica direcionada à atenuação de rugas e sulcos faciais, em mulher de 55 anos de idade. O programa terapêutico incluiu exercícios isotônicos, isométricos e procedimentos clínicos para diminuir a contração dos músculos mímicos faciais, que não foram associados ao treinamento com biofeedback eletromiográfico. A coleta de sinais e o treinamento com o software Biotrainer foram realizados com o aparelho New Miotool Face (Miotec) em nove sessões realizadas semanalmente. Foram realizadas duas avaliações (antes e após as nove sessões), por meio do Protocolo MBGR (avaliação da mastigação, deglutição e sorriso) e de escalas validadas descritas na literatura (avaliação dos sinais de envelhecimento facial). No caso descrito, constatou-se o efeito adjuvante do biofeedback eletromiográfico no aprendizado dos padrões miofuncionais orofaciais treinados, como também, a melhoria das funções mastigação e deglutição e a diminuição dos sinais de envelhecimento facial. Porém, são necessárias pesquisas mais robustas que comprovem efeitos positivos do biofeedback eletromiográfico associado à terapia miofuncional direcionada a atenuar os sinais de envelhecimento facial.

ABSTRACT Myotherapy intervention in facial aesthetics aims to attenuate wrinkles and signs of facial aging. The relationship between accentuated muscle contraction during chewing, swallowing and speaking and the appearance of facial wrinkles has been suggested by speech-language pathology literature. This study aimed to report the effect of electromyographic biofeedback associated with training of chewing, swallowing, and smiling patterns, during speech therapy intervention aimed at reducing the signs of facial wrinkles and furrows, in a 55-year-old woman. The therapy also included isotonic and isometric exercises and clinical procedures to decrease the contraction of facial mimicry muscles, which were not associated with training using electromyographic biofeedback. Signal collection and training were performed using the Biotrainer software on the New Miotool Face by Miotec, over nine weekly sessions. Two assessments were performed (before and after the nine sessions), using the MBGR Protocol (assessment of chewing, swallowing, and smiling) and validated scales described in the literature (assessment of signs of facial aging). In the reported case, the usefulness of electromyographic biofeedback was verified for learning trained orofacial myofunctional patterns, as well as to improve chewing and swallowing functions and decrease signs of facial aging. However, further research is needed to demonstrate the positive effects of electromyographic biofeedback associated with myofunctional therapy aimed at attenuating the signs of facial aging.

"RichBlend" protocol for full-face filling and collagen biostimulation / Protocolo "RichBlend" para preenchimento facial e bioestimulação de colágeno

ABSTRACT The "RichBlend" protocol was designed for facial filling and collagen biostimulation, by means of a mixture of calcium hydroxyapatite (CaHA), hyaluronic acid (AH) and autologous platelet concentrates. This work reports the case of a 53-year-old patient with cutaneous photoaging, loss of facial volume, multiple rhythms in the frontal and periorbital regions, also marked skin flaccidity, especially the eyelid. The treatment was done with botulinum toxin (65 U) and the "RichBlend" protocol. Venipuncture was performed and the blood was centrifuged to obtain i-PRF (injectable platelet-rich fibrin) and plasma gel. After venipuncture and blood centrifugation, i-PRF and plasma gel were obtained. CaHA (Radiesse®) was diluted: a) in saline solution + i-PRF (hyperdilution) for biostimulationof the lower third of the face; and b) in AH (Juvederm Ultraplus XC®) + plasma gel, for hydrolifting on the forehead and dark circles, malar and temples. Plasma gel was applied to the nasogenian grooves and then the entire face was properly massaged. The "RichBlend" protocol rejuvenated the patient, as it promoted filling, volumizing, collagen formation (biostimulation), reduction of flaccidity, in addition to skin whitening. Since HA and CaHA are high-cost products, their mixture with autologous platelet concentrates, in liquid or gel form, allows the use of a greater amount of filled and biostimulator material on the face, at a more affordable cost.

RESUMO O protocolo "RichBlend" foi idealizado para preenchimento facial e bioestimulação de colágeno, por meio da mistura de hidroxiapatita de cálcio (CaHA), ácido hialurônico (AH) e concentrados plaquetários autólogos. Este trabalho relata o caso de um paciente de 53 anos, com fotoenvelhecimento cutâneo, perda de volume facial, múltiplas rítides nas regiões frontal e periorbital, apresentando também acentuada flacidez cutânea, especialmente palpebral. Foi feito o tratamento com toxina botulínica (65 U) e protocolo "RichBlend". Foi realizada a venopunção e o sangue foi centrifugado para obtenção da i-PRF (fibrina rica em plaquetas injetável) e do plasma gel. Após venopunção e centrifugação sanguínea, obtiveram-se a i-PRF e o plasma gel. A CaHA (Radiesse®) foi diluída: a) em soro + i-PRF (hiperdiluição) para bioestimulação do terço inferior da face; e b) em AH (Juvederm Ultraplus XC®) + plasma gel, para hidrolifting na fronte e preenchimentos de olheira, malar e têmporas. Plasma gel foi aplicado nos sulcos nasogenianos e, em seguida, toda a face foi devidamente massageada. O protocolo "RichBlend" rejuvenesceu o paciente, pois promoveu preenchimento, volumização, formação de colágeno (bioestimulação), redução da flacidez, além do clareamento cutâneo. Uma vez que o AH e a CaHA são produtos de alto custo, sua mistura com os concentrados plaquetários autólogos, na forma líquida ou gel, permite a utilização de uma maior quantidade de material preenchedor e bioestimulador na face, com custo mais acessível.

Facial lifting effect of SMAS multi-vector suspension / 中华医学美学美容杂志

Objective:To explore the rejuvenation effect of SMAS (Superficial musculoaponeurotic system) multi-vector suspension in the face and neck.Methods:From December 2019 to March 2023, the Plastic Surgery Department of the Plastic Surgery Hospital of the Chinese Academy of Medical Sciences implemented 34 cases of cheek rhytidectomy and 10 cases of cheek andneck rhytidectomy. Following general anaesthesia, liposuction is performed on the cheek and mandibular margins, and incisions are made anterior and posterior to the ear. At the end of the subcutaneous dissection, the SMAS in the region of the parotid gland is separated, and the SMAS is then secured by purse string multi-vector suture suspension. Intheend, excess skin is removed and the incision is reduced in tension.Results:All patients underwent successful surgeries and were satisfied with the postoperative follow-up results. The sagging soft tissues were effectively repositioned, resulting in natural facial and neck lift. There were no serious complications such as facial nerve injury, subcutaneous hematoma, incision infection, or skin flap necrosis.Conclusions:The utilization of MAS multi-vector suspension can significantly improve the relaxation of cheek and neck tissue, with fewer complications and satisfactory rejuvenation effect.

Effects of fat suction combined with bipolar radiofrequency on facial and neck rejuvenation / 中华医学美学美容杂志

Objective:To investigate the efficacy and safety of fat suction combined with bipolar radiofrequency on face and neck rejuvenation.Methods:A total of 115 patients with face and neck fat deposits and skin laxity underwent fat suction combined with bipolar radiofrequency between December 2021 and October 2022 by the same surgeon in Changsha My Like Medical Cosmetology Hospital. There were 3 men and 112 women in this research. The mean age was 36.1 years (range, 26-55 years) and the mean body mass index was 21.4 (range, 16.8-27.7 kg/cm 2). Postoperative patient satisfaction surveys were conducted and 2 independent doctors evaluated clinical effect with preoperative and postoperative photographs at 3-6 months postoperatively. Results:The mean amount of fat aspirated was 44.5 ml (range, 10-92 ml) and the mean energy delivered was 4.5 kJ (range, 2.1-8.9 ml). 88.7% of patients were satisfied with their postoperative effect (102/115 patients). 92.2% of doctors were satisfied with the postoperative effect (106/115 patients). Four out of 115 patients (3.5%) developed irregularity by fat suction.Conclusions:Fat suction combined with bipolar radiofrequency can effectively reduce the fat accumulation of facial and neck and significantly improve skin relaxation. It is an effective method to rejuvenate facial and neck.

Efficacy of autologous peripheral blood nucleated cell therapy on periocular wrinkles / 中华医学美学美容杂志

Objective:To explore the clinical effect of dermal and subcutaneous injection of autologous peripheral blood nucleated cells in improving periocular wrinkles.Methods:Eighteen cases of beauty seekers who planned to improve periocular wrinkles were selected as the research objects of this study. Autologous nucleated cells and blood active components were isolated and purified by negative collection mixed method and evenly injected into the periocular skin of patients. VISIA image analysis system, and satisfactory score were used to detect and evaluate the related characteristics of periocular skin at different stages before and after treatment. The scores were compared and analyzed, and the complications after treatment were recorded.Results:The 18 patients were followed up. The score of VISIA periorbital static wrinkles decreased from (22.09±8.21) before treatment to (18.31±7.84) one month after treatment, and the difference was statistically significant ( t=-7.495, P<0.05). 17 patients were satisfied; After 3 months of follow-up, 15 cases were satisfied. The texture, consistency and pore state of periorbital skin were improved in some patients (10 cases). Conclusions:Autologous peripheral blood nucleated cell therapy can improve periorbital wrinkles, especially skin fine lines, and geta high satisfactory rate. There are almost no adverse reactions after the treatment, which is worthy of clinical application.

Características y resultados del tratamiento aplicado a los pacientes con cáncer de páncreas / Rejuvenation Surgery with High-Superficial Musculoaponeurotic System Flap

Introducción: El cáncer de páncreas mantiene un pronóstico ominoso a pesar de los avances en técnicas quirúrgicas y cuidados perioperatorios. Objetivo: Caracterizar los resultados del tratamiento aplicado a los pacientes con cáncer de páncreas. Métodos: Se realizó un estudio observacional, descriptivo y transversal de una serie de 70 pacientes con diagnóstico de cáncer de páncreas. Se estudiaron las variables: localización, tamaño del tumor, procedimiento quirúrgico, estadificación preoperatoria, diagnóstico histológico, estancia hospitalaria, complicaciones posoperatorias y estado al egreso, mediante el análisis de frecuencias absolutas, relativas y la media así como la prueba de ji al cuadrado y el IC 95 por ciento. Resultados: El procedimiento quirúrgico más frecuente fue derivativo en 47 enfermos (67,1 por ciento). La operación de Whipple se realizó en 10 pacientes (14,3 por ciento) con tumores localizados en la cabeza del páncreas y la pancreatectomía corporocaudal en 11 (15,7 por ciento) con tumores de cuerpo y cola del páncreas. La mayoría correspondió a los estadios III y IV. El 47,1 por ciento de los pacientes presentó un adenocarcinoma poco diferenciado. La estadía fluctuó entre 15 y 30 días en el 54,3 por ciento de la serie. Las complicaciones se presentaron en 19 enfermos (27,1 por ciento). Fallecieron 15 pacientes (21,4 por ciento) del total. Conclusiones: El tratamiento debe ser individualizado mediante equipos multidisciplinarios, con protocolos de actuación uniformes en cada institución que permita realizar estudios multicéntricos, con el objetivo de obtener estadísticas propias en aras de disminuir la morbilidad y la mortalidad, así como aumentar la calidad de vida de estos pacientes(AU)

Introduction: Facial rhytidectomy is the technique for correcting facial aging features, but they are becoming increasingly complex due to the incorporation of deeper planes in the process. The superficial musculoaponeurotic system techniques have the advantage of providing a greater degree of naturalness and permanence in time. Objective: To evaluate the effectiveness of the high-superficial musculoaponeurotic system technique for facial rejuvenation. Methods: A prospective and longitudinal case series study was carried out in the plastic surgery service of Hospital General Universitario "Vladimir Ilich Lenin" with patients who requested facial rejuvenation and were treated with the high-superficial musculoaponeurotic system technique, from January 1, 2018 to June 30, 2020. The variables age, sex, skin type, degree of aging, operative complications, patient satisfaction and aesthetic outcomes were studied. Results: The female sex predominated, together with the age group 50-59 years, the degrees of aging II and III, as well as white and light brown skin colors, while the most frequent operative complication was wound dehiscence of the suture line at the auricle root. The patients' satisfaction with the aesthetic outcomes of the surgical intervention was verified and the aesthetic outcomes was assessed as favorable in 100 percent of the cases for the used surgical technique. Conclusions: The high-superficial musculoaponeurotic system surgical technique for rhytidectomy offers harmonic, long-lasting outcomes with a low percentage of complications, making it a valuable alternative for patients(AU)

Rejuvenecimiento facial con plasma rico en plaquetas autólogo / Facial rejuvenation with autologous platelet rich plasma

Introducción: La creciente necesidad de una piel de aspecto juvenil impulsa innovaciones continuas con procedimientos mínimamente invasivos. El plasma rico en plaquetas autólogo representa una terapéutica regenerativa incluida en el novedoso arsenal de intervenciones que buscan este efecto. Objetivo: Evaluar los resultados de la terapéutica con plasma rico en plaquetas autólogo en pacientes con envejecimiento facial. Métodos: La muestra estuvo constituida por 68 pacientes valorados con la escala para valoración clínica de fotoenvejecimiento cutáneo al inicio del tratamiento. Se sometieron a cuatro sesiones de plasma rico en plaquetas cada 15 días y una sesión adicional a los 3 meses de concluir el tratamiento inicial. Los pacientes fueron seguidos durante 6 meses al cabo de los cuales se volvieron a evaluar con el mismo instrumento. Resultados: Las edades estuvieron comprendidas entre 21 y 73 años con una media de 46,80 años, predominó el sexo femenino (89,9 %). Los resultados significativos en el tratamiento de las arrugas, los surcos, la textura de la piel y las lesiones cutáneas estuvieron relacionados con la mesoterapia con plasma rico en plaquetas. El procedimiento produjo una mejoría valorada a través de la escala para valoración clínica de fotoenvejecimiento cutáneo. Conclusiones: La terapia con plasma rico en plaquetas tiene buenos resultados en el tratamiento de pacientes con envejecimiento facial.

Introduction: The growing need for youthful looking skin drives continued innovations with minimally invasive procedures. Autologous platelet-rich plasma represents a regenerative therapeutic included in the new arsenal of interventions that seek this effect. Objective: Assess the results of platelet-rich plasma therapy in patients with facial aging. Methods: The sample consisted of 68 patients assessed with the scale for the clinical assessment of cutaneous photoaging (SCACPH). They underwent four PRP sessions every 15 days and an additional session 3 months after completing the initial treatment. The patients were followed up for 6 months, after which they were reevaluated which the same instrument. Results: The ages of the patients were between 21 and 73 years with a mean of 46.80 years, the female sex predominated (89.9%). Significant results in the treatment of wrinkles, furrows, and skin texture and skin lesions were related to PRP mesotherapy. The procedure produced an improvement assessed with the SCACPH. Conclusions: Autologous PRP therapy has good results in the treatment of patients with facial aging.

Corrección de bolsas malares con colgajo invertido del músculo orbicular en la blefaroplastia transcutánea

Las deformidades en el párpado inferior frecuentemente están asociadas al envejecimiento facial. La cirugía plástica de los párpados se popularizó desde la segunda mitad del siglo XX. Furnas identificó la redundancia del músculo orbicular inferior, se centró en la resección del exceso de tejido flácido para restaurar una apariencia más juvenil. Se presenta el caso de una paciente femenina, de 40 años de edad, que acudió a consulta de Cirugía Plástica solicitando corrección de sus párpados superiores e inferiores, y con la inconformidad de bolsas malares. Los defectos fueron corregidos mediante colgajo invertido del músculo orbicular inferior, el cual se fijó a la fascia del músculo temporal a través de una blefaroplastia transcutánea. Los resultados estéticos alcanzados en esta paciente evidencian que la blefaroplastia transcutánea y la utilización de un colgajo invertido del músculo orbicular son alternativas efectivas para lograr el rejuvenecimiento de los párpados y corrección de las bolsas malares, al conferir una mayor armonía de estas estructuras en relación con la cara.

Lower eyelid deformities are frequently associated with facial aging. Plastic surgery of the eyelids became popular in the second half of the 20th century. Furnas identified the redundancy of the inferior orbicularis muscle, focused on resection of excess flaccid tissue to restore a more youthful appearance. The case of a 40-years-old female patient is presented, who attended the Plastic Surgery consultation requesting correction of her upper and lower eyelids, and with malar bags nonconformity. The defects were corrected with an inverted inferior orbicularis muscle flap, which was fixed to the fascia of the temporalis muscle through a transcutaneous blepharoplasty. The aesthetic results achieved in this patient show that transcutaneous blepharoplasty and the use of an inverted flap of the orbicularis oculi are effective alternatives to achieve eyelid rejuvenation and correction of the malar bags, by conferring a greater harmony of these structures in relation to face.

Morphometric and aesthetic analysis of people following application of platelet rich plasma for neck rejuvenation / Análisis morfométrico y estético de personas tras la aplicación de plasma rico en plaquetas para el rejuvenecimiento del cuello

SUMMARY: Several studies have shown beneficial effects of platelet-rich plasma. However, there are very few studies investigating the effectiveness of PRP in the neck region. We aimed to assess the efficacy of PRP injection for neck rejuvenation in females aged 40-55. Fifty-two female consecutive participants had PRP injected and roller applied in three sessions at 3-week intervals. Evaluations were blindly performed by comparing the improvements from the pre- to post-application assessments of anatomical measurements of the neck area based on before and after photography of the participants by two anatomists and three medical aesthetic doctors. The Fitzpatrick Skin Scale, Fitzpatrick Goldman Scale, Wrinkle Assessment Scale (Dedo classification system) and patient satisfaction scale were used for assessment. Additionally, skin stiffness and elasticity, cervicomental angle and jawline angle measurements were performed to analyze anatomical changes in the neck area. The study enrolled 52 volunteers with a mean age of 48.60±5.35 years, mean body weight of 63.21±8.43 kg and mean height of 163.25±4.56 cm. Significant differences were found in the elasticity, jawline angle, cervicomental angle, wrinkling, elasticity G and patient satisfaction scores before and after the treatment. When the results of anatomical parameters and scales are compared, it was revealed that PRP is effective in neck rejuvenation.

RESUMEN: Varios investigaciones han demostrado los efectos beneficiosos del plasma rico en plaquetas. Sin embargo, existen muy pocos estudios que investiguen la efectividad del PRP en la región del cuello. Nuestro objetivo fue evaluar la eficacia de la inyección de PRP para el rejuvenecimiento del cuello en mujeres de 40 a 55 años. A cincuenta y dos mujeres participantes consecutivas se les inyectó PRP y se les aplicó rodillo en tres sesiones a intervalos de 3 semanas. Las evaluaciones se realizaron a ciegas comparando las mejoras de las evaluaciones previas y posteriores a la aplicación de las medidas anatómicas del área del cuello basadas en fotografías de antes y después de los participantes realizadas por dos anatomistas y tres médicos especialistas en cirugía estética. Para la evaluación se utilizaron la escala de piel de Fitzpatrick, la escala de Fitzpatrick Goldman, la escala de evaluación de arrugas (sistema de clasificación Dedo) y la escala de satisfacción del paciente. Además, se realizaron mediciones de rigidez y elasticidad de la piel, ángulo cervicomentoniano y ángulo de la línea de la mandíbula, para analizar los cambios anatómicos en el área del cuello. El estudio inscribió a 52 voluntarios con una edad media de 48,60±5,35 años, un peso corporal medio de 63,21±8,43 kg y una altura media de 163,25±4,56 cm. Se encontraron diferencias significativas en las puntuaciones de elasticidad, ángulo mandibular, ángulo cervicomentoniano, arrugas, elasticidad G y satisfacción del paciente antes y después del tratamiento. Cuando se compararon los resultados de los parámetros anatómicos y las escalas, se reveló que el PRP es eficaz en el rejuvenecimiento del cuello.

Frontoplastia endoscópica para tratamiento del envejecimiento facial / Endoscopic Frontoplasty for Treating Facial Aging

Introducción: En el concepto moderno de rejuvenecimiento facial, lo principal es conseguir un resultado natural sin marcas quirúrgicas. El lifting endoscópico fronto-témporo-orbitario es en la actualidad, el mejor método para conseguirlo. Objetivo: Determinar la efectividad de la técnica de frontoplastia endoscópica para el tratamiento del envejecimiento facial. Métodos: Se realizó un estudio observacional descriptivo de una serie de 28 casos con diagnóstico de envejecimiento facial atendidos en el Centro Nacional de Cirugía de Mínimo Acceso en el período comprendido entre enero de 2014 hasta enero de 2017. Se estudiaron las variables de: sexo, edad, estado civil, escolaridad, raza, tiempo quirúrgico y complicaciones transoperatorias. Resultados: La edad media fue de 54,4 (40-73) años. Predominó el sexo femenino (89,3 por ciento). El nivel medio de escolaridad 61,5 por ciento, estado civil casado 52,0 por ciento. La ptosis de las cejas con presencia de arrugas frontales y glabelares fue el diagnóstico más frecuente 13; 46,4 por ciento. El tiempo quirúrgico medio fue 80,9 (40-120) minutos. No existieron complicaciones intraoperatorias, conversiones, ni reintervenciones. En 27 pacientes (96,4 por ciento) hubo permanencia de los resultados en el tiempo. Se presentaron complicaciones en 4 pacientes (14,3 por ciento). Hubo 19 pacientes atendidos de manera ambulatoria (67,9 por ciento), con estancia hospitalaria de un día (32,1 por ciento). La totalidad mostró satisfacción con los resultados obtenidos. Conclusiones: La frontoplastia endoscópica es un método poco invasivo y muy efectivo para reposicionar las cejas descendidas además tratar las arrugas frontales y glabelares(AU)

Introduction: In the modern concept of facial rejuvenation, the main thing is to achieve a natural result without surgical marks. The endoscopic fronto-temporo-orbital lifting is currently the best method to achieve this. Objective: To determine the effectiveness of the endoscopic frontoplasty technique for the treatment of facial aging. Methods: A descriptive observational study of a series of 28 cases with a diagnosis of facial aging treated at the National Center for Minimal Access Surgery in the period from January 2014 to January 2017 was carried out. The variables of: sex, age, marital status, schooling, race, surgical time and intraoperative complications. Results: The mean age was 54.4 (40-73) years. The female sex prevailed (89.3 percent). The average level of schooling 61.5 percent, married marital status 52.0 percent. Ptosis of the eyebrows with the presence of frontal and glabellar wrinkles was the most frequent diagnosis 13; 46.4 percent. The mean surgical time was 80.9 (40-120) minutes. There were no intraoperative complications, conversions, or reinterventions. In 27 patients (96.4 percent) there was permanence of the results over time. Complications occurred in 4 patients (14.3 percent). There were 19 patients treated as outpatients (67.9 percent), with a hospital stay of one day (32.1 percent). All showed satisfaction with the results obtained. Conclusions: Endoscopic foreheadoplasty is a minimally invasive and very effective method for repositioning lowered eyebrows, as well as treating frontal and glabellar wrinkles(AU)

Complicações em procedimentos de harmonização orofacial: uma revisão sistemática / Complications in orofacial harmonization procedures: a systematic review

Atualmente, as alterações estéticas faciais e a insatisfação com a autoimagem são influências que motivam a busca por procedimentos estéticos rápidos, não cirúrgicos e menos invasivos. Por esse motivo, a procura de pacientes que procuram por procedimentos estéticos orofaciais é crescente. O objetivo deste estudo foi elencar as complicações decorrentes dos procedimentos de harmonização orofacial por meio de uma revisão sistemática da literatura, identificando quais tipos de complicações e áreas são mais acometidas. As seguintes bases de dados foram pesquisadas: Medline (PubMed), SciELO, Scopus, Cochrane, Lilacs e Web of Science, de março a setembro de 2020, selecionando os estudos que apresentavam os seguintes critérios de inclusão: estudos originais em humanos sobre complicações após procedimentos de harmonização orofacial. Foram selecionados 33 estudos da literatura que apresentavam relatos de complicações em pacientes após o procedimento de harmonização orofacial na testa, nariz, olhos, região periocular e lábios. Mesmo a execução de procedimentos estéticos faciais menos invasivos pode acarretar possíveis complicações imediatas ou tardias após o procedimento, principalmente na região periocular e nos olhos. É importante alertar previamente os profissionais para essa possibilidade.

Currently, facial aesthetic changes and dissatisfaction with self-image are influences that motivate the search for quick, non-surgical and less invasive cosmetic procedures. For this reason, the demand for patients looking for orofacial aesthetic procedures is increasing. The objective of this study was List the complications resulting from orofacial harmonization procedures through a systematic literature review, identifying which types of complications and areas are most affected. The following databases were searched: Medline (PubMed), SciELO, Scopus, Cochrane, Lilacs and Web of Science, from March to September 2020, selecting the studies that presented the following inclusion criteria: original studies in humans, about complications after orofacial harmonization procedures. Thirty-three studies from the literature were selected that presented reports of complications in patients after the orofacial harmonization procedure in the forehead, nose, eyes, periocular region and lips. Even the execution of less invasive facial cosmetic procedures can cause possible immediate or late complications after the procedure, especially in the periocular region and eyes. It is important to make professionals aware of this possibility beforehand.

Cosmetic surgical procedures on the vulva and vagina - an overview

Cosmetic surgery is defined as any procedure involving a change in the appearance or aesthetics of a normal anatomy where there are no congenital or acquired pathologies. The procedures that can be included under female cosmetic genital surgery are the following: reduction labiaplasty, vaginoplasty, hymenoplasty, “G Spot amplification”, and miscellaneous. Those who support these procedures could argue that women undergo such procedures as a matter of choice, whereas those opposed could argue that this choice is made because of society’s fascination with physical appearance and feeling young. Prima facie these procedures appear to contradict the Hippocratic principle of “primum non nocere”. There has been an increase in the marketing and conduct of the above mentioned procedures. Practitioners need to be both sceptical and cautious while performing these surgeries. Patients requesting them need to be counseled regarding the lack of data supporting their efficacy, and the potential complications of the procedures.

Rejuvenescimento cirúrgico do lóbulo senil: uma inovação técnica / Surgical rejuvenating for the aged earlobe: a technical innovation

Os autores apresentam técnica corretiva conservadora para o lóbulo senil. A literatura pertinente é rica em técnicas redutoras de lóbulos longilíneos ou rasgados. Os autores creem que a cirurgia para os lóbulos deve poupar tecidos in situ, a despeito de usuais técnicas de preenchimento com material orgânico e biocompatíveis. A presente técnica se baseia na clássica redução lobular periférica da borda livre, que agrega ao componente do face lifting para reduzir o lóbulo e ao mesmo tempo poupar tecidos e encorpá-lo na cicatriz oculta retrolobular. Resolução tripartite até hoje não apresentada na literatura. Com oito casos operados: seis tipo pec-man no passado; um na forma clássica marginal e três recentes com esta modificação técnica.

The authors present a new surgical approach to the aging earlobe. The technique is based on the classic marginal reduction technique of the earlobe contour that has been improved. In essence, it seeks to preserve the subdermal fat layer of the distal flap created for the purpose of raising the earlobe while being shortened, thickened and smooth, in a hidden scar. It is a tripartite resolution to this problem never seen in the relevant literature. Four 68-yearold women were treated: the first with the classic manner in 2009 and the others with this modification to improve the earlobe withered appearance in 2017-2019. The study shows a rejuvenating eutrophic reduction technique.

Microagulhamento no vitiligo: Uma revisão sistemática / Microneedling in vitiligo: A systematic review

Panorama: Esta revisão analisa a literatura sobre técnicas, eficácia e segurança do microagulhamento, para o tratamento do vitiligo. Métodos: Relatos de casos e de séries de casos, e ensaios foram pesquisados no PubMed para identificar o tratamento com microagulhamento para vitiligo. Resultados: Os 14 artigos avaliados relataram melhora das lesões após o tratamento com microagulhamento. A combinação de microagulhamento e tacrolimo tópico, 5-FU, calcipotriol e betametasona tópicos, NB-UVB com ou sem TFD e solução de triancinolona acetonida apresentou maior eficácia do que microagulhamento em monoterapia. Conclusão: O microagulhamento é uma técnica segura e eficiente e uma terapia adjuvante para o tratamento do vitiligo.

Background: Microneedling was initially introduced for skin rejuvenation. This review analyzes the current literature on microneedling techniques, efficacy, and safety for vitiligo treatment. Methods: An extensive PubMed search was performed to identify literature on microneedling therapy for vitiligo. Case reports, case series, and clinical trials were included. Results: All 14 articles evaluated showed improvement of lesions after microneedling treatment. Combination of microneedling and topical tacrolimus, 5-FU, topical calcipotriol and betamethasone, NB-UVB with or without PDT, and triamcinolone acetonide solution yielded more efficacy than microneedling monotherapy. Conclusion: Microneedling is a safe and efficient technique and an adjuvant treatment for vitiligo treatment.

Autologous platelet concentrates for facial rejuvenation

Abstract Autologous platelet concentrates (APCs) are promising therapeutic agents in facial rejuvenation since they are a great source of cytokines, growth factors and other biologically active substances. Obtained from the patient's blood, they have the advantages of reducing immunological reactions, making the procedure safer, well tolerated, with minimal adverse effects and lower cost. Currently, they are used for facial rejuvenation both in combination with microneedling and in mesotherapy techniques, as well as to treat facial acne scars, melasma and wounds after laser ablative treatments. This review summarizes current knowledge on the use of APCs, ranging from basic concepts related to their composition and mechanisms of action to up-to-date information on their clinical efficacy. Methodology MEDLINE (PubMed) was searched from inception through 2021 for English language publications on APCs for facial rejuvenation. Results A total of 100 files were found. Based on the available literature, APCs for skin rejuvenation are safe and well tolerated. The most studied product is the first-generation material, platelet-rich plasma (PRP). Conclusions The results are in general favorable, but the quality of the studies is low. The second and third generation products, platelet-rich fibrin (PRF) and injectable platelet-rich fibrin (i-PRF), respectively, are easier to be obtained and, at least in vitro , seem to induce greater collagen production than PRP, especially under lower relative centrifugation forces, but to date only a few clinical trials evaluating these products exist. More high-quality trials with appropriate follow-up are necessary to provide adequate evidence that may help to improve the treatment regimens with APCs. Many aspects should be considered when designing clinical trials to evaluate APCs, such as the patients' characteristics that best predict a favorable response, the optimal number of sessions and the interval between them, the characteristics of the studies and the development of better instruments to evaluate skin aging.

Effect of frontotemporal aesthetic division combined with high density fat transplantation on facial beautification and rejuvenation / 中华医学美学美容杂志

Objective:To make the facial rejuvenation of autologous fat transplantation more consistent with facial aesthetic morphology toimprove the therapeutic effect.Methods:From December 2017 to May 2020, Zhengzhou Mylike Medical Cosmetic Hospital received autologous high density fat filling treatment for 425 female patients aged 18-55 years, with an average age of 32.7 years. Autologous high density fat face transplantation was performed according to the aesthetic zoning of the forehead and topic.Results:Three months after the operation, 376 patients were satisfied with the effect of one filling, 49 patients were not satisfied, 45 of them received two supplementary injections. 376 cases were satisfied with the appearance after the first operation, with a satisfactory rate of 88.5%. After two fillings, a total of 420 cases were satisfied, with a total satisfactory rate of 98.8%. The total effective rate was 100%. There were no serious postoperative complications.Conclusions:The facial rejuvenation treatment according to the aesthetic division of frontal and topographical area combined with autologous high density fat transplantation has a natural postoperative appearance and high satisfactory rate.

Clinical efficacy of injection of recombinant humanized type Ⅲ collagen in facial rejuvenation / 中华医学美学美容杂志

Objective:To evaluate the efficacy of recombinant humanized type Ⅲ collagen injected by microneedles in facial rejuvenation.Methods:Twenty-five cases recruited from July to December 2021 were included as the research objects in this study. Recombinant humanized type Ⅲ collagen was injected into the face skin using microneedles. Images were collected before the treatment and 1, 2, and 3 months after the end of the treatment. The VISIA image analysis system was used for comparative analysis. Patient′s satisfaction evaluation and the occurrence of complications after treatment were also recorded.Results:According to results of VISIA, the scores of spots were (32.06±6.92) and (27.59±7.69); red areas were (32.79±11.80) and (27.74±9.49); pores were (17.66±9.79) and (14.60±7.07) and brown spots were (43.61±11.93) and (37.59±16.22) after the treatment were lower than those before treatment, and the results were statistically different ( F=3.442, 4.209, 7.473, 7.113, P<0.05). One month after the end of the of treatment. Patient′s self-satisfaction reached 84% (21 cases); three months after the end of the treatment, the patient′s self-satisfaction reached 80% (20 cases). No serious adverse reactions were occurred. Conclusions:The recombinant humanized type Ⅲ collagen injected by microneedles can be effective and durable for facial rejuvenation and get high patient satisfaction. It has high safety and is worthy of clinical promotion.