El reposicionamiento malar. Presentación de una técnica original: punto MM / Malar repositioning. Presentation of an original technique: point MM

El envejecimiento facial es una sinergia compleja de cambios texturales de la piel, hiper- o hipoactividad muscular, reabsorción del tejido graso y resorción ósea. El déficit de volumen resultante, la deflación y la posterior caída del tercio medio facial produce una cara menos atractiva y juvenil. Los procedimientos inyectables en región malar son cada vez más populares y solicitados por los pacientes. El conocimiento de la anatomía de la cara media es fundamental para el inyector. La comprensión de la irrigación facial puede ayudar a disminuir la exposición a la aparición de hematomas y complicaciones vasculares severas. Existen múltiples técnicas de inyección propuestas para el tercio medio, en este artículo presentamos una técnica original, simple, segura y eficaz con resultados satisfactorios y riesgo reducido

Facial aging is a complex synergy of textural skin changes, muscle hyperactivity, fat dysmorphism, bone resorption. The resulting volume deficit and deflation of the mid face produces a less attractive and youthful face. Injectable midface procedures are becoming increasingly popular and requested by patients. Knowledge of the anatomy of the midface is critical for the injector. Understanding the irrigation of the face can help decrease the risk of hematoma and severe vascular complications. There are multiple injection techniques proposed for the middle third, in this article we present a simple, safe and effective technique with satisfactory results and lower risk

Manejo quirúrgico de biopolímeros en punta nasal: reporte de caso y revisión de la literatura / Surgical Management of Biopolymers in Nasal Tip: Case Report and Literature Review

Introducción: los rellenos faciales han sido ampliamente utilizados a nivel mundial. Existen rellenos temporales, semipermanentes y permanentes. En cuanto a los rellenos permanentes, la silicona es la más utilizada y está aprobada por la agencia gubernamental de los Estados Unidos, la Administración de Alimentos y Medicamentos (FDA), en dos presentaciones para el desprendimiento de la retina. En 1997 se autorizó el uso off-label de Adatosil y Silicon 100, ambas prescritas durante la relación médico-paciente. Se han descrito múltiples eventos adversos secundarios a la inyección de silicona como relleno facial, principalmente síntomas inflamatorios, reacción a cuerpo extraño, sepsis y migración del producto, que por lo general se presentan por una aplicación inapropiada por personal sin entrenamiento. Caso clínico: se presenta el caso de un paciente masculino en la quinta década de la vida, a quien le aplicaron silicona en aceite a nivel de la punta nasal; posteriormente, presenta dermatopatía secundaria sin respuesta al manejo médico, por lo cual requiere manejo quirúrgico para el retiro del material alogénico y reconstrucción nasal secundaria. Se dan recomendaciones para el manejo quirúrgico de estos pacientes.

Introduction: Injectable facial fillers have been widely used worldwide. There are temporary, semipermanent, and permanent fillers. Regarding permanent fillers silicone is the most widely used, approved by the Food and Drug Administration (FDA) in two presentations Adatosil and Silicon 100 for retinal detachment. In 1997 the FDA allows for the off-label use prescribed within the doctor-patient relationship. There have been reported multiple adverse events, mainly inflammatory symptoms, foreign body reactions, sepsis, and product migration generally occurring by inappropriate application by untrained personnel. Case report: We present the case of a male patient in the fifth decade of life who underwent the application of silicone oil at the level of the nasal tip, and later presented secondary dermatopathy without response to medical management, which requires surgical management to remove the allogeneic material and secondary nasal reconstruction

The functional architecture of the stomatognathic system and orofacial aesthetic repositioning during the aging process

Introduction: Facial aging implies special care and personalized treatment. Thus,the new strand of Neomodern Dentistry seeks, through Orofacial Harmonization,the functional and aesthetic balance between the stomatognathic system and thefacial aspect. Objective: This article seeks to disclose, through a literature review, the aesthetical consequences of the stomatognatic system repositioning andorofacial aging. Data source: The present literature review consisted in researchesup to May 2019 using PubMed and Google Academic electronic databases. A 10-year publication limit was applied in the research. No language restriction wasapplied. Inclusion criteria were clinical investigations, books, dissertations, thesisor literature reviews that addressed the topics of interest. Data synthesis: A totalof 231 articles were retrieved from databases. After applying a 10-year publicationlimit, 111 remained and, based on the inclusion and exclusion criteria, 20 articleswere selected and included in this review. Conclusion: Considering the limitationsof the present study, it can be concluded that the aging process is natural andpredictable and can be changeable and malleable through procedures that restorethe support nutrients that were lost. The aesthetics can be achieved as a functionalconsequence of the stomatognathic system repositioning due to orofacial aging.

Introdução: O envelhecimento facial implica em cuidados especiais e um tratamento diferenciado. Desse modo, a nova vertente da Odontologia Neomoderna busca, por meio da Harmonização Orofacial, o equilíbrio funcional e estético entre o aparelho estomatognático e a face. Objetivo: Esse artigo busca compreender, por meio de uma revisão de literatura, as consequências estéticas do reposicionamento do aparelho estomatognático e envelhecimento orofacial. Fonte dos dados: A presente revisão de literatura consistiu em um viés qualitativo nas plataformas PubMed e Google Acadêmico, nos últimos 10 anos, sem restrição de idiomas. Os critérios de inclusão consistiram em estudos clínicos, livros, dissertações, teses ou revisões de literatura que abordavam os tópicos de interesse. Síntese dos dados: Foram recuperados nas bases de dados 231 artigos. Após a aplicação de um limite de publicação de 10 anos, 111 permaneceram e, com base nos critérios de inclusão e exclusão, 20 artigos foram selecionados e incluídos nesta revisão. Conclusão: Com as limitações do presente estudo, pode-se concluir que o processo de envelhecimento é natural e previsível e pode ser mutável e maleável por meio de procedimentos que restauram os nutrientes de suporte perdidos. A estética pode ser alcançada como uma consequência funcional do reposicionamento do sistema estomatognático e do envelhecimento orofacial.

Rinomodelação ou rinoplastia não-cirúrgica: uma abordagem segura e reprodutível / Rhinomodelation or non-surgical rhinoplasty: a safe and reproducible approach

Introdução: A rinoplastia é uma cirurgia que muitas vezes apresenta resultados imprevisíveis, mesmo em mãos de cirurgiões experientes. Neste sentido, a rinomodelação com preenchedores é um procedimento não-cirúrgico para corrigir pequenas alterações externas nasais em casos específicos. Métodos: Os autores descrevem a técnica de aplicação de preenchedores (ácido hialurônico ou hidroxiapatita de cálcio) para modelação nasal. Foram incluídos todos os pacientes submetidos ao preenchimento nasal, entre 2009 e 2012. Foi avaliado o edema da ponta nasal, a dor e o grau de satisfação dos pacientes com o resultado. Resultados: Foram incluídos 39 pacientes no estudo. Com relação aos desfechos analisados com ácido hialurônico: 52% apresentaram edema leve; 74% tiveram dor leve; 15% se mostraram muito satisfeitos e 74% satisfeitos com o resultado. Com relação aos pacientes submetidos à rinomodelação com hidroxiapatita de cálcio: 67% apresentaram edema moderado; 50% dor moderada; 17% dor intensa e 84% se mostraram satisfeitos com o resultado. Conclusão: A rinomodelação com preenchedores reabsorvíveis é um procedimento simples, com resultados estéticos aceitáveis, sendo necessário um profundo conhecimento anatômico para diminuir o risco de complicações.

Introduction: Rhinoplasty often leads to unpredictable results, even in the hands of experienced surgeons. However, in specific cases, rhinomodelation with fillers, a non-surgical procedure to correct minor nasal external changes, can be used. Methods: This study describes the application technique of fillers (hyaluronic acid or calcium hydroxyapatite) for nasal modeling. Patients undergoing nasal filling between 2009 and 2012 were included. Edema of the nasal tip, pain, and the degree of patient satisfaction with the outcome were assessed. Results: Thirty-nine patients were included in the study. Regarding the outcomes of rhinomodelation with hyaluronic acid, 52% patients presented with mild edema, 74% had mild pain, 15% were very satisfied, and 74% were satisfied with the result. For the outcomes of rhinomodelation with calcium hydroxyapatite, 67% patients presented with moderate edema, 50% had moderate pain; 17% had severe pain, and 84% were satisfied with the result. Conclusion: Rhinomodelation with resorbable fillers is a simple procedure with acceptable esthetic results. However, a deep anatomical knowledge is necessary to decrease the risk of complications.

Visual loss following cosmetic facial filler injection / Perda da visão após injeção de preenchimento facial para fins cosméticos

ABSTRACT Facial filler injection for soft-tissue augmentation, wrinkle reduction, and rejuvenation has recently become increasingly popular. This procedure is well accepted and widely performed because of its safety and excellent outcomes. However, complications may occur even in the most skilled hands. A 36-year-old female presented with immediate loss of vision in her right eye following the periocular injection of cosmetic hyaluronic acid facial filler into the glabellar region. The visual loss was accompanied by weakness of her left arm. Blindness may complicate cosmetic facial filler injection. The treating physician should have a firm knowledge of the facial vascular anatomy, and the patient should be aware of the potential blinding complications associated with facial filler injection.

RESUMO A injeção de preenchimento facial para o aumento de tecido mole, redução de rugas e rejuvenescimento tornou-se recentemente3 cada vez mais popular. Este procedimento é bem aceito e amplamente realizado devido à sua segurança e excelentes resultados. Porém, complicações podem ocorrer mesmo nas mãos mais habilidosas. Uma mulher de 36 anos apresentou perda da visão no seu olho direito imediatamente após uma injeção periocular de preenchimento facial à base de ácido hialurônico cosmético na região glabelar. A perda visual foi acompanhada de fraqueza no braço esquerdo. A cegueira pode ser uma complicação da injeção de preenchimento facial para fins cosméticos. O médico deve ter um sólido conhecimento da anatomia vascular da face e o paciente deve estar ciente das possíveis complicações associadas à injeção de preenchimento facial.

Reanimação estática do lábio inferior na paralisia facial como complicação de preenchimento / Static lower lip reanimation as a filler complication of facial paralysis

Procedimentos de rejuvenescimento facial substitutos da cirurgia tradicional tornaram-se cada vez mais populares para promover uma aparência jovial com procedimentos minimamente invasivos, como toxina botulínica injetável, preenchimento de tecidos moles e peelings químicos. No entanto, complicações podem ocorrer mesmo na presença de um injetor habilidoso e experiente. Apresentamos o caso de uma paciente submetida a reanimação labial estática usando retalho dermoadiposo para lesão do nervo facial direito após remoção de nódulos como complicação de preenchimento. A "abordagem modificada de bull horn" foi realizada para elevação do lábio superior em torno das asas nasais e columela e ao longo do sulco nasolabial direito. O retalho foi desepitelizado e obtido. Usando a ponta aberta de uma pequena cânula de lipoaspiração, a porção distal do retalho foi encapsulada e fixada diretamente em C-loop e foram utilizados pontos U, transfixando o retalho para o periósteo do arco zigomático. Nos três anos de seguimento não foram observadas complicações significativas e a paciente não relatou nenhuma limitação funcional ou insatisfação com o aspecto das cicatrizes no sulco nasolabial e ao redor das asas nasais e da columela.

Facial rejuvenation procedures to circumvent traditional surgery have become increasingly popular to promote a youthful appearance with minimally invasive procedures such as injectable botulinum toxin, soft-tissue fillers, and chemical peels. Nevertheless, complications can occur even with an astute and experienced injector. Here we present the case of a patient who underwent static lip reanimation using a dermoadiposal flap for right facial nerve damage following nodule removal as a filler complication. A "modified bulls horn approach" to the upper lip lift was performed around the nasal wings and columella and along the right nasolabial fold. The flap was de-epithelized and harvested. Using the open tip of a small liposuction cannula, the distal portion of the flap was tunneled and fixed directly in a C-loop fashion using U stitches, transfixing the flap to the periosteum of the zygomatic arch. At 3 years follow-up, no significant complications were observed, and the patient reported no functional limitations or dissatisfaction with the scars in the nasolabial fold or around the nasal wings and columella.

Safety and efficacy of polycaprolactone copolymer nanosphere hydrogel injected into the scalp dermal tissue of rats

BACKGROUND: Currently, dermal fillers need to be 25 µm or larger to reduce in vivo degradation by macrophages. However, the large size of fillers may cause side effects, including interruption of blood flow and nodule formation. Therefore, using rats, we tested a polycaprolactone copolymer hydrogel with nanoscale particles that could maintain a low in vivo degradation rate. METHODS: Thirty-six 6-week-old Sprague-Dawley rats were divided into group A (normal saline), group B (polycaprolactone microsphere filler), and group C (polycaprolactone copolymer nanosphere hydrogel). The corresponding materials were injected into the dermal layer of the scalp of the rats. At 4, 8, and 12 weeks after injection, blood biochemical and kidney and liver histological analyses were performed. Tissues were examined using hematoxylin-eosin staining to observe tissue infiltration of materials. Collagen formation in the dermal tissue of the scalp was observed with Masson trichrome staining and the collagen content was quantified using a soluble collagen assay kit. RESULTS: The histologic examination for organ infiltration showed no abnormal findings. All blood test results were within the normal ranges. The amount of collagen at 12 weeks increased by 1.22 mg/g in group C and by 0.6 mg/g in group B. CONCLUSIONS: The results reveal that the nanosphere complex near the injection site induced collagen formation. Regardless of the sphere size, aggregation of the copolymer prevented macrophage phagocytosis. The polycaprolactone copolymer nanosphere hydrogel was effective for more than 3 months when injected in the scalp dermal tissue of Sprague-Dawley rats and can be used safely.

Polyacrylamide hydrogel (Aquamid) filler removal after a decade

The removal of fillers used for soft-tissue augmentation is an issue of concern, as the possible need for extensive surgery to remove fillers deters their use by many surgeons. Several studies have demonstrated the safety and efficacy of polyacrylamide hydrogel (Aquamid) gel, but to date no report has described its removal after 10 years. Here, we report a case of Aquamid removal. A 33-year-old woman, who had undergone forehead augmentation 12 years previously with an Aquamid injection, visited the department of plastic and reconstructive surgery of our medical center due to a severe forehead contour irregularity. Removal of 20 mL of excess gel was performed by direct incision and squeezing under local anesthesia. Our experience shows that Aquamid removal is possible, but should be performed with appropriate surgical precautions.

Lesión bucal relacionada con relleno dérmico / Dermal filler-related oral lesion

Introduction: Oral adverse reactions related to natural dermal fillers may originate from infiltration techniques, giving rise to swellings, nodule formation doe to local material entrapment, or displacement or migration of the material used. Objective: describe a case of orofacial foreign body reaction in an elderly patient. Case report: a 65-year-old woman was referred for oral evaluation complaining of an intraoral lesion present for 15 days. Intraoral examination revealed a mobile nodule in the lower lip left portion. After the initial consultation, incisional biopsy was performed under local anesthesia and the surgical specimen was sent for histopathological analysis. Intraoral examination revealed a soft mobile nodule in the lower lip left portion. Clinical pathological and Raman microspectroscopy analysis led to a final diagnosis of calcium hydroxyapatite dermal filler-related reaction. Conclusions: this case reinforces the possibility of dermal filler-related mucosal tissue reactions in oral cavity soft tissues(AU)

Introducción: las reacciones adversas bucales relacionadas con rellenos dérmicos naturales pueden originarse a partir de técnicas de infiltración, lo que ocasiona inflamaciones, formación de nódulos por atrapamiento de material local o desplazamiento o migración del material usado. Objetivo: describir un caso de reacción a cuerpo extraño bucofacial en un adulto mayor. Presentación del caso: una mujer de 65 años de edad fue remitida para evaluación bucal por presentar una lesión intrabucal durante 15 días. El examen intrabucal reveló un nódulo móvil en la porción izquierda del labio inferior. Después de la consulta inicial, se realizó una biopsia incisional bajo anestesia local y se envió la muestra quirúrgica para su análisis histopatológico. El examen intrabucal reveló un nódulo móvil suave en la porción izquierda del labio inferior. El análisis clínico-patológico y de la micro-espectroscopia de Raman condujeron a un diagnóstico final de reacción de hidroxiapatita cálcica relacionada con el relleno dérmico. Conclusiones: este caso refuerza la posibilidad de reacciones cutáneas relacionadas con los rellenos dérmicos en los tejidos mucosos de la cavidad bucal(AU)

Complex Regional Pain Syndrome of the Upper Limbs Caused by Facial Pain / 계명의대학술지

Polyacrylamide hydrogel is a widely used filler material in cosmetic procedures performed on the face and breasts. Recently, however, complications including inflammation, deformity, and pain have been reported. The present article addresses unregulated materials/products injected as dermal fillers. The authors report a case involving a 29-year-old woman who developed severe facial pain after undergoing a cosmetic procedure with injectable triamcinolone and hyaluronidase. Two months later, the pain spread to her upper and lower limbs, and abdomen, which eventually led to the the development and diagnosis of complex regional pain syndrome (CRPS) in the upper limbs. The authors hypothesize that CRPS in the upper limbs was responsible for the facial pain through sensitization of third-order neurons and the trigeminal nucleus caudalis extending to the upper cervical segments.

Delayed Granulomas after Filler Injection in an Immunosuppressed Patient: A Case Report

Recently, dermal fillers have been used with increasing frequency to improve facial contours for cosmetic purposes. The appreciable increase in such filler procedures has led to more adverse events and complications. Herein, we report the clinical significance and differential diagnosis of delayed multiple granulomas that occurred in a patient with a history of an injection of an unknown substance as a filler 20 years previously. She was also taking oral steroids and tacrolimus for immune suppression after a kidney transplant that she received 10 years before she presented with granulomas.

Radiographic study of dermal fillers in the facial area: A series of 3 cases

In recent years, as interest in maintaining beauty and a youthful appearance has grown, filler procedures such as soft tissue augmentation have become more popular. These fillers are sometimes seen as radiopaque shadows on radiographic images, either due to the fillers themselves or because of secondary reactions; such findings may present a diagnostic challenge to dentists. The present report describes 3 cases of dermal fillers observed in panoramic and cone-beam computed tomographic (CBCT) images. All 3 elderly female patients had filler injected into their cheeks and chin area for cosmetic purposes decades ago. On panoramic images, multiple symmetric radiopacities were observed in the facial area; on CBCT, these calcifications were seen in the subcutaneous tissue in various shapes and with varying density. In conclusion, dentists should be aware of the imaging characteristics of dermal filler, and should be able to differentiate dermal filler from other pathological findings.

Complicaciones y manejo de procedimientos dermatoestéticos: una actualización para el dermatólogo / Complications associated with cutaneous aesthetic procedures: an update for the dermatologist

En las últimas décadas se han desarrollado nuevas técnicas e indicaciones de los procedimientos estéticos mínimamente invasivos, presentando cada vez mejores resultados con un alto nivel de seguridad, sin embargo, estos no se encuentran exentos de complicaciones, las que pueden ser transitorias o permanentes. El conocimiento, abordaje, tratamiento y prevención de las distintas complicaciones son esenciales para los dermatólogos y cirujanos plásticos. Los procedimientos más utilizados son: administración de rellenos, peeling químicos, láser, luz pulsada intensa y ultrasonido de alta frecuencia. La siguiente revisión tiene como objetivo reconocer las principales complicaciones de estos procedimientos y su manejo.

In recent decades, new techniques and indications of minimally invasive aesthetic procedures have been developed, presenting increasingly better results with a high level of safety, however these are not exempt from complications, which may be transient or permanent. The knowledge, approach, treatment and prevention of the different complications are essential for the dermatologist and plastic surgeons. The most used procedures are the administration of fillers, chemical peels, lasers, intense pulsed light and high frequency ultrasound. The following review aims to recognize the main complications of these procedures and their management.

Definitions of groove and hollowness of the infraorbital region and clinical treatment using soft-tissue filler

Clarification is needed regarding the definitions and classification of groove and hollowness of the infraorbital region depending on the cause, anatomical characteristics, and appearance. Grooves in the infraorbital region can be classified as nasojugal grooves (or folds), tear trough deformities, and palpebromalar grooves; these can be differentiated based on anatomical characteristics. They are caused by the herniation of intraorbital fat, atrophy of the skin and subcutaneous fat, contraction of the orbital part of the orbicularis oculi muscle or squinting, and malar bone resorption. Safe and successful treatment requires an optimal choice of filler and treatment method. The choice between a cannula and needle depends on various factors; a needle is better for injections into a subdermal area in a relatively safe plane, while a cannula is recommended for avoiding vascular compromise when injecting filler into a deep fat layer and releasing fibrotic ligamentous structures. The injection of a soft-tissue filler into the subcutaneous fat tissue is recommended for treating mild indentations around the orbital rim and nasojugal region. Reducing the tethering effect of ligamentous structures by undermining using a cannula prior to the filler injection is recommended for treating relatively deep and fine indentations. The treatment of mild prolapse of the intraorbital septal fat or broad flattening of the infraorbital region can be improved by restoring the volume deficiency using a relatively firm filler.

Forehead reconstruction using modified double-opposing rotation-advancement flaps for severe skin necrosis after filler injection

Varying degrees of complications can occur after hyaluronic acid filler injections. Tissue necrosis due to interruption of the vascular supply is an early complication that can be severe. If the site of tissue necrosis due to the filler injection is the forehead, successfully reconstructing the region without distorting the key landmarks is challenging. We describe the case of a 50-year-old man who experienced widespread forehead skin necrosis after hyaluronic acid filler injection in the glabellar area. We successfully covered the forehead area with a 3×4-cm² midline necrotic tissue using the modified double-opposing rotation-advancement flap method. Although modified double-opposing rotation-advancement flap closure has the disadvantage of leaving a longer scar compared to conventional double-opposing rotation-advancement flap closure, the additional incision line made along the superior border of the eyebrow aids in camouflaging the scar and decreases eyebrow distortion. Therefore, it is believed that the modified double-opposing rotation-advancement flap technique is an excellent tool for providing adequate soft tissue coverage and minimal free margin distortion when reconstructing widespread skin necrosis in the central mid-lower forehead that can occur after filler injection in the glabellar area.

Tratamiento de las arrugas peribucales / Treatment of oral wrinkles

Las arrugas peribucales son tal vez de las más inestéticas de la cara. Los pacientes toleran las frontales, las patas de gallo, los surcos pero no el código de barras, ya que estas son las que más nos avejentan. A través de los años se ha propuesto un sinnúmero de tratamientos, como pulido peribucal, peeling con fenol o tricloroacético, láser y más recientemente rellenos con ácido hialurónico. El fototipo del paciente suele hacernos elegir por un tratamiento u otro, ya que cuanto más oscura la piel del paciente, mayor la probabilidad de pigmentación, tanto con dermoabrasión, fenol o láser. Los rellenos de ácido hialurónico son una muy buena herramienta para cualquier tipo de piel y no dejan el clásico eritema de los otros tratamientos, a veces por hasta 30 días. El hialurónico puede combinarse con peelings mas suaves como el tricloroacético al 15 o 30%. La duración del hialurónico en las arrugas peribucales es de hasta 2 años, a diferencia del año que dura el mismo producto en los surcos nasogenianos. Hay que tener cuidado con la elección del producto y su colocación, porque los cordones, al aplicarlo muy superfi cial o el efecto Tyndall duran mucho tiempo. El índice de complicaciones es mucho menor con el hialurónico y sin los riesgos de discromías, hiperpigmentación o la alteración en la textura de la piel que observamos tantas veces con la dermoabrasión.

Peribucal wrinkles are perhaps the most unfl attering of the face. Patients tolerate the frontal wrinkles, crow's feet and grooves but not the bar code, since these are the ones that make them feel older. Over the years, a number of treatments have been proposed, such as peribucal polishing, peeling with phenol or trichloroacetic, laser and more recently fi lled with hyaluronic acid. The phototype of the patient usually makes us choose one treatment or another, since the darker the skin, the greater the chance of pigmentation, either with dermabrasion, phenol or laser. The hyaluronic acid fi llers are a very good tool for any type of skin and do not leave the classic erythema of the other treatments, sometimes lasting for up to 30 days. The hyaluronic acid fi ller can be combined with softer peels such as trichloroacetic at 15 or 30%. The duration of the fi ller in peribucal wrinkles is up to 2 years, unlike the year duration of the same product in the nasogenian furrows. You have to be careful with the choice of the product and its placement, because of the apperence of cords, when applied very superfi cial or the Tyndall eff ect that can last a long time. The rate of complications is much lower with hyaluronic acid and without the risks of dyschromia, hyperpigmentation or the alteration in skin texture observed so often with dermabrasion.

Biomateriais utilizados em substituição ao enxerto autógeno de gengiva / Biomaterials used in replacement of gingival autograft

A utilização de biomateriais na tentativa de reparar ou substituir tecidos perdidos não é recente e evoluiu juntamente com os avanços da medicina regenerativa visando à maior qualidade de vida da população. Na Odontologia a compreensão dos aspectos biomiméticos envolvidos após implantação de biomateriais como substitutos de tecido mole é de suma importância na prática clínica, uma vez que o enxerto autógeno de gengiva, considerado padrão ouro, possui inúmeras limitações em relação à dimensão da área a ser reparada, tempo cirúrgico e dor pós-operatória na loja doadora. Esta revisão tem como objetivo reunir estudos que propõem a utilização de substitutos ao enxerto autógeno de palato, ressaltando suas aplicabilidades, contraindicações, disponibilidade no mercado, além de resultados clínicos.(AU)

The use of biomaterials to repair or replace lost tissues is not new and has evolved with advances in regenerative medicine aimed at higher quality of life of the population. In dentistry, the understanding of biomimetic aspects after implantation of biomaterials used as soft tissue replacements is significant in practice, since the autograft gum considered the gold standard has many limitations regarding the size of the area to berepaired surgical time and postoperative pain in the donor area.This review aims to bring together studies that propose substitutes to autograft palate, highlighting its applicability, contraindications, availability in the market, and clinical outcomes. (AU)

Upper Eyelid Pseudocyst Related to Forehead Filler Migration: A Rare Complication of an Illegal Filler Injection

We report a very rare case of unilateral blepharoptosis and swelling as an unusual complication of a filler injection. The patient received a filler injection into the forehead 4 years previously by an unlicensed practitioner. In the operation, an encapsulated yellowish cyst with inflammation was found to be adhered to the orbital septum and was excised. To prevent additional inferior migration of the remaining foreign body in the forehead, the retro-orbicularis fascia and preaponeurotic fat pad area were sutured, with the exception of the levator aponeurosis. This cyst-like mass was histopathologically proven to be a multiple pseudocyst. After excision, the swelling disappeared and the ptotic eyelid also improved. The galea is connected with the posterior orbicularis fascia. The galea and posterior orbicularis fascia layer can function as a pathway through which the injected material can migrate from the forehead to the upper eyelid. Weakening of the orbicularis retaining ligament and leakage of the foreign body through the supraorbital foramen may also cause filler migration. This case underscores the need for clinicians to be aware of the potential migration of filler even many years after an injection. We advise that filler injections should be performed by trained physicians and that it should be made known that migration is possible.

Upper Eyelid Pseudocyst Related to Forehead Filler Migration: A Rare Complication of an Illegal Filler Injection

We report a very rare case of unilateral blepharoptosis and swelling as an unusual complication of a filler injection. The patient received a filler injection into the forehead 4 years previously by an unlicensed practitioner. In the operation, an encapsulated yellowish cyst with inflammation was found to be adhered to the orbital septum and was excised. To prevent additional inferior migration of the remaining foreign body in the forehead, the retro-orbicularis fascia and preaponeurotic fat pad area were sutured, with the exception of the levator aponeurosis. This cyst-like mass was histopathologically proven to be a multiple pseudocyst. After excision, the swelling disappeared and the ptotic eyelid also improved. The galea is connected with the posterior orbicularis fascia. The galea and posterior orbicularis fascia layer can function as a pathway through which the injected material can migrate from the forehead to the upper eyelid. Weakening of the orbicularis retaining ligament and leakage of the foreign body through the supraorbital foramen may also cause filler migration. This case underscores the need for clinicians to be aware of the potential migration of filler even many years after an injection. We advise that filler injections should be performed by trained physicians and that it should be made known that migration is possible.

Skin Necrosis with Oculomotor Nerve Palsy Due to a Hyaluronic Acid Filler Injection

Performing rhinoplasty using filler injections, which improve facial wrinkles or soft tissues, is relatively inexpensive. However, intravascular filler injections can cause severe complications, such as skin necrosis and visual loss. We describe a case of blepharoptosis and skin necrosis caused by augmentation rhinoplasty and we discuss the patient's clinical progress. We describe the case of a 25-year-old female patient who experienced severe pain, blepharoptosis, and decreased visual acuity immediately after receiving a filler injection. Our case suggests that surgeons should be aware of nasal vascularity before performing an operation, and that they should avoid injecting fillers at a high pressure and/or in excessive amounts. Additionally, filler injections should be stopped if the patient complains of severe pain, and appropriate measures should be taken to prevent complications caused by intravascular filler injections.