Current use of botulinum neurotoxin in esthetic practice-Clinical guide and review.

BACKGROUND: Botulinum neurotoxin is one of the most versatile and widely used medical products in the world. AIMS: The review's focus is the plastic and dermatologic uses of botulinum neurotoxin currently supported by published data. METHODS: Relevant clinical articles regarding botulinum neurotoxin use in plastic surgery, dermatology, and general esthetic literature were searched and reviewed. RESULTS: The search yielded 258 studies. Two hundred articles were excluded following title and abstract review. Twenty-one studies were excluded following full-text screening. A total of 37 studies remained and were discussed in this review. CONCLUSIONS: Botulinum neurotoxin is widely used for numerous off-label indications from head to toe. Some uses are well documented, and their safety has been demonstrated in controlled trials, yet most remain poorly researched.

Embelezamento facial com injetáveis e principais diferenças entre os gêneros / Facial beautification with fillers and main differences between genders

A percepção da beleza é ainda algo pouco compreendida, apesar de francamente notável. Pessoas consideradas belas notadamente tem melhor autoestima e um melhor desempenho em suas relações interpessoais. A procura por tratamentos cosmiátricos está em franca ascensão e o crescimento entre os homens é ainda maior. A perfeita compreensão das diferenças entre os atributos masculinizantes e feminilizantes em uma face deve ser encorajado, a fim de obter melhores resultados estéticos e a prevenção de estigmas de tratamento. Nesta revisão, será abordada cada região facial, pormenorizando os padrões de beleza de cada gênero, norteando os detalhes do tratamento.

The beauty perception is still poorly understood, though downright remarkable. People considered beautiful notably have better self-esteem and perform better in their interpersonal relationships. Demand for cosmetic treatments is on the rise and growth among men is even higher. Perfect understanding of the differences between masculinizing and feminizing attributes on a face should be encouraged in order to achieve better aesthetic results and the prevention of treatment stigmas. This review will cover each facial region, detailing the beauty standards of each gender, guiding the details of treatment.

Resorbable Versus Titanium Fixation of Le Fort I Osteotomy.

Resorbable and titanium systems have been used in maxillary fixation. The aim of this review was to evaluate stability and morbidity of Le Fort I osteotomy by comparing both systems. It was performed in 11 databases, and reported according to preferred reporting items for systematic reviews and meta-analysis. Randomized and nonrandomized clinical trials, and retrospective comparative studies with patients who underwent nonsegmented Le Fort I osteotomy were included. Eleven articles were selected, with a total of 262 patients treated with resorbable and 252 with titanium fixation. The meta-analysis showed that when measured at point A, horizontal stability was 0.06 mm (95% confidence interval [CI] -0.19, 0.30), vertical stability for impaction was -0.43 mm (95% CI -0.94, 0.07), and for inferior repositioning was -1.29 mm (95% CI -2.62, 0.04). Morbidity was similar in the groups. Regarding infection, resorbable presented an absolute risk (AR) = 0.032, and titanium an AR = 0.025 (P = 1.0). For soft tissue reaction, an AR = 0.120 was shown for resorbable, and an AR = 0.132 for titanium (P = 0.85). Removal of fixation showed an AR = 0.024 for resorbable, and an AR = 0.025 for titanium (P = 1.0). Based on these results, resorbable and metal fixation systems seem to be equivalent with respect to stability and morbidity. This review was limited by the quality of the studies. Future studies should address these quality limitations to improve comparison between these 2 fixation approaches.

Padronização da aplicação corporal de hidroxiapatita de cálcio com a técnica de figuras vetorizadas / Standardization of the body vectoring technique with calcium hydroxyapatite

Introdução: a hidroxiapatita de cálcio em gel carreador de carboximetilcelulose apresenta resultados inequívocos para a melhora cutânea facial, estimulando a produção de colágeno e elastina. Seu uso para tratamento corporal tornou-se on- label apenas recentemente, após comprovações científicas de seu benefício em maior diluição. O objetivo deste trabalho foi demonstrar uma padronização técnica para racionalização da aplicação corporal. Neste estudo foram idealizadas figuras vetorizadas para aplicação da hidroxiapatita de cálcio com diluição intermediária. Com a técnica proposta, é possível calcular, com exatidão, o volume de produto necessário para cada paciente em função do tamanho da unidade anatômica a ser tratada e das características topográficas da região. A racionalidade desta técnica permite ainda distribuição homogênea, minimização das complicações por acúmulo de produto, boa tolerabilidade pela paciente e otimização dos resultados. Conclusões: a simplicidade técnica das figuras vetorizadas facilita a aplicação da hidroxiapatita de cálcio, e as customizações devem ser feitas com a maior experiência do injetor.

Introduction: Calcium hydroxyapatite in a carboxymethylcellulose carrier gel presents unequivocal results for facial skin improvement, stimulating the collagen and elastin production. Regulatory agencies recently approved its use after scientific proof of its benefit in greater dilution. Objective: This study aimed to demonstrate a technical standardization to rationalize body application. Methods: This study idealized vectorized figures to apply calcium hydroxyapatite with intermediate dilution (1:4). Results and discussion: The proposed technique makes it possible to accurately calculate the required for each patient, depending on the anatomical unit's size to be treated and the region's topographic characteristics. This technique's rationale also allows homogeneous distribution, minimization of complications due to product accumulation, good tolerability by the patient and optimization of results. Conclusions: The vectorized figures' technical simplicity facilitates calcium hydroxyapatite application, and customizations must be made with the injector's greatest experience

Resorbable versus titanium fixation of Le Fort I osteotomy

Resorbable and titanium systems have been used in maxillary fixation. The aim of this review was to evaluate stability and morbidity of Le Fort I osteotomy by comparing both systems. It was performed in 11 databases, and reported according to preferred reporting items for systematic reviews and meta-analysis. Randomized and nonrandomized clinical trials, and retrospective comparative studies with patients who underwent nonsegmented Le Fort I osteotomy were included. Eleven articles were selected, with a total of 262 patients treated with resorbable and 252 with titanium fixation. The meta-analysis showed that when measured at point A, horizontal stability was 0.06 mm (95% confidence interval [CI] −0.19, 0.30), vertical stability for impaction was −0.43 mm (95% CI −0.94, 0.07), and for inferior repositioning was −1.29 mm (95% CI −2.62, 0.04). Morbidity was similar in the groups. Regarding infection, resorbable presented an absolute risk (AR) = 0.032, and titanium an AR = 0.025 (P = 1.0). For soft tissue reaction, an AR = 0.120 was shown for resorbable, and an AR = 0.132 for titanium (P = 0.85). Removal of fixation showed an AR = 0.024 for resorbable, and an AR = 0.025 for titanium (P = 1.0). Based on these results, resorbable and metal fixation systems seem to be equivalent with respect to stability and morbidity. This review was limited by the quality of the studies. Future studies should address these quality limitations to improve comparison between these 2 fixation approaches.

Mucinous adenocarcinoma associated with chronic suppurative hidradenitis: Report of a case and review of the literature.

INTRODUCTION: Chronic suppurative hidradenitis (CSH) is a benign condition that can affect the perineal region and often leads to the formation of abscesses and fistulas. It is rare for CSH to undergo malignant degeneration into mucinous adenocarcinoma. PRESENTATION OF CASE: We report a case of a 55-year-old male patient with perineal CSH who suffered worsening long-term pain despite multiple surgical procedures to alleviate his symptoms. Pelvic magnetic resonance imaging (MRI) showed multiloculated cystic lesion on the left side wall of the distal rectum with gluteal extension. Pathological examination revealed mucinous adenocarcinoma. The patient underwent an abdominoperineal resection (APR) of the rectum with cutaneous muscle flap reconstruction. Although histopathological sections showed clear margins, the tumor recurred 6 months following surgery. DISCUSSION: Perineal mucinous adenocarcinoma arising in a patient with CSH is an extremely rare condition. This diagnosis is often difficult, due to the paucity of signs of malignant degeneration as well as the rarity of the disease itself. Surgical resection of the lesions is a well-established approach. In this case, diagnosing the tumor at such a late stage likely compromised his outcome. CONCLUSION: Malignant degeneration to mucinous adenocarcinoma must be suspected in patients with a history of long-term CSH. In such cases, local biopsies and a radiological examination, such as MRI can help in the diagnosis.

Cyclooxygenase-2 (COX2) and p53 protein expression are interdependent in breast cancer but not associated with clinico-pathological surrogate subtypes, tumor aggressiveness and patient survival.

UNLABELLED: In the last decade, different molecular subtypes of breast cancer have been proposed. Although displaying appreciable association with disease prognosis and the prognostic value of cytotoxic and endocrine therapeutic modalities, the subtypes seem to fail at completely explaining disease behavior and response to treatment. Molecules such as those of the cyclocooxigenase (COX) family, currently composed of three entities (COX 1, 2 and 3) have been shown to be associated with breast carcinogenesis, and the analysis of p53 expression in breast tumors may also offer some additional prognostic clues. Our study is aimed at assessing COX2 and p53 expression in these clinico-pathological surrogate subtypes, and to evaluate whether the expression of these molecules can help further explain the variability in prognosis still found within the clinico-pathological subtypes groups of breast cancer. METHODS: A total of 183 breast cancer samples were obtained from women treated at the Womens Hospital of Campinas State University, Campinas, Brazil, between June 2008 and January 2011. Immunohistochemistry was performed to detect the expression of ER, PR, ki67, COX2, and p53 and the HER2 status of the 183 specimens was assessed using FISH. Two COX2 staining thresholds were used to define COX2 positivity: low threshold (LT): moderate and intense staining were considered positive; high-threshold (HT): only intense staining was considered positive. RESULTS: There was no trend in COX2 overexpression from Luminal A-like to Triple-negative subtypes. By contrast, p53 was expressed in roughly 67% of the Luminal A-like tumors, 50% of the Luminal B-like HER2 positive tumors, 60.9% of the Luminal B-like HER2 negative, approximately 82% of the HER2 positive (non-luminal) and 87% of the Triple-negative tumors (p for trends=0.06). There was a significantly higher proportion of COX2 positive (LT) tumors (66.9%) when p53 was also positive compared to when the tumor was negative for p53 (in which case only18.0% of the tumors were positive for COX2; p<0.001). Neither marker was found to be associated with patients' survival. CONCLUSIONS: There seems to be a positive association between the expressions of COX2 and p53. Otherwise, neither the expression of COX nor that of p53 was associated with clinico-pathological subtypes, tumor features and prognosis. It seems to be too early to elect the detection of COX2 using IHC as prognostic or predictive tool, but incipient evidence points toward a possible role for the marker.