Facial rejuvenation: the role of skin retraction

We have been performing "refreshing" techniques for the past three years, offering an alternative to the classical facelift for facial rejuvenation. We can start treating some of our patients at an earlier age, and, as well, improve the aspect of faces that have been "over-stretched" by one or several rhytidoplasties. With these techniques we can improve the facial appearance of patients of all ages, using our technique of Superficial Syringe Liposculpture - SSL -(1) with fine cannulas to recontour the jaw line, injecting fat with fine needles in the naso-labial, malar and glabellar regions, postponing the first facelift, or complementing our older patients' facelift. "Refreshing" is not however, a technique giving the same results of rhytidoplasty, neither we advocate this operation to be abandoned. Refreshing is a gentle facial recontouring procedure and an adjunct to rhytidoplasty, a complement to other techniques. It is a way of looking at facial rejuvenation, without the rigid confines taught in our early years of plastic surgery. Instead, we can appreciate the wants of the patient, looking to improve the appearance with minimal morbidity through a simpler, faster procedure, other than the "cut and stretch" techniques. We can offer smaller procedures under local anesthesia, with no need for hospitalization, a major factor in the patients' consideration.

Superficial syringe liposculture: a personal technique

"Superficial Syringe Liposculpture" - SSL allows for the treatment of localized fat deposits in patients with flaccid skin, skin irregularities, depression, cellulite and liposuction sequaelae. We have developed a special cannula - the Toledo cannula - a fork tipped needle-dissector with a single lateral hole. The tips of the fork are blunt, so as not to perforate the skin while workin in the superficial layer of fat, and the inner part of the "V" is sharp, to cut the septi or flbrous adherences. It can also suction and inject fat. This technique changes the concept that it is only possible through liposuction to alter the conditions of the deep layer of fat in young patients with good skin tone. With our development of working in the superficial layer of fat using fine cannulas, we provoke skin retraction. Now flaccid skin patients can also opt for body contour surgery. We can remodel the entire body with disposable syringes and fine cannulas, improving not only contour defects, but also superficial irregularities.

Remodelagem dos supercílios: um aspecto importante da ritidoplastia / Remodelling of the eyebrows: an important aspects of the rhytidoplasty

Apresenta-se uma técnica de ritidoplastia utilizando dois planos de dissecçäo, um supra-aponeurótico e um subcutâneo, que permite o deslocamento e remodelagem dos supercílios, pálpebras superiores e inferiores, glabela e de toda a regiäo frontal

Fatores positivos e negativos no emprego do colágeno em cirurgia plástica: imunologia / Positive and negative factors of the use of collagen in plastic surgery: immunology

Apresentamos os principais fatores positivos e negativos no emprego do atelocolágeno bovino como implante em cirurgia plástica. Esses fatores foram divididos de acordo com o produto, a técnica de aplicaçäo e a indicaçäo do método. É dada uma avaliaçäo atualizada da imunologia. Concluímos que, quando corretamente utilizado, o implante de colágeno tem grandes possibilidades em cirurgia plástica

Melanoma maligno da pele abdominal / Malignant melanoma of abdominal skin

Damos ênfase ao diagnóstico clínico e ao diagnóstico diferencial das lesöes de pele. O microestadiamento da lesäo deve ser feito cuidadosamente, pois influirá no prognóstico. O tratamento deve ser diferente para cada caso, porém ainda é válido o princípio de Handley (1907) da ressecçäo ampla tridimensional. Näo fazemos o esvaziamento ganglionar profilático. Cada caso é analisado separadamente. Como o cirurgiäo plástico é freqüentemente procurado para tratar lesöes pigmentadas da pele é fundamental desconfiar e obter um bom reconhecimento macroscópico do melanoma incipiente. Caso näo esteja familiarizado com os procedimentos necessários é preferivel deixar a lesäo intacta e encaminhar o paciente a um cancerologista

Liposculpture of the face and body

Liposculpture is a new technique that combines two recent concepts in Plastic Surgery-liposuction with a disposablesyringe and autologous fat grafting. Localized fat is extracted with the syringe and, withno air contact, is inmediately re-injected where needed. We talk about reduction Liposculpture when re-injection is not needed. Fat is smoothly extracted with the syringe, this means less apin post-operatively, less bruising and a faster recovery