A Review of Aesthetic Considerations for Treating the Transgender Patient.

BACKGROUND: As gender diversity becomes increasingly embraced by society, and despite growing recognition of the unique needs of transgender patients, the literature remains devoid of guidelines for gender affirming facial feminization or masculinization techniques. OBJECTIVE: The authors seek to identify and discuss target feminine and masculine facial features, as well as an armamentarium of surgical and nonsurgical strategies to effectively address and achieve them in the transgender population. METHODS: A search of the National Library of Medicine database (PubMed) was undertaken to identify the existing literature on gender-affirming facial feminization and masculinization techniques. RESULTS: The importance of assessing proportional relationships between the bitemporal, bizygomatic, and bigonial distances is discussed; ideal masculine faces possess a rectangular face shape, with ratios for these 3 areas tending toward 1:1:1. Conversely, the ideal female face is heart shaped with projection at the zygoma and a tapered jawline. Strategic positioning of the cheek apex serves as an anchor in sculpting a distinctly masculine or feminine face. Other considerations include the enhancement of skin quality and implications of hormonal therapy. CONCLUSION: The aesthetic considerations provided in this study can serve as a valuable guidance for aesthetic physicians seeking to deliver optimal care for their transitioning patients.

Contouring Plus: A Comprehensive Approach of the Lower Third of the Face with Calcium Hydroxylapatite and Hyaluronic Acid.

A well-defined jawline is aesthetically pleasing, so that rejuvenation of the jawline is becoming part of routine aesthetic practice. Restoring balance to the lower face without surgical intervention requires a multiple treatment approach, among which the minimally invasive injectables play a central role. Nevertheless, amidst the plethora of different injectable products available, choosing the option that best suits the patient's need can be a challenge. A panel of experts sought to describe herein 4 clinical cases, illustrating the Contouring Plus technique, which provides a practical guidance for lower third assessment, choice of products, and treatment execution, especially among hyaluronic acid and calcium hydroxylapatite, aiming for immediate, as well as mid-to-long-term results.

From Anatomical Modifications to Skin Quality: Case Series of Botulinum Toxin and Facial Fillers for Facial Feminization in Transgender Women.

A transgender individual is someone who does not identify with his or her biological sex1. During the transgender transition process, minimally invasive procedures (MIP) provide a versatile tool in the clinician's therapeutic armamentarium, since the changes can be impactful for the patient, yet reversible, especially for the patient who is unsure about proceeding with a definite surgery. We report 5 cases of facial feminization of transgender women, illustrating the use of minimally invasive facial remodeling procedures for male-to-female transitioning patients.

Physiological and lifestyle factors contributing to risk and severity of peri-orbital dark circles in the Brazilian population.

BACKGROUND: Peri-orbital dark circles are a cosmetic concern worldwide, and have been attributed to hyperpigmentation from allergy or atopic dermatitis, blood stasis, structural shadowing effects, and a thin epidermis/dermis under the eye. It is of interest to better understand lifestyle and demographic risk factors and the relative impact of melanin, blood and epidermal/dermal factors on the severity of Peri-orbital dark circles. OBJECTIVE: To compare by non-invasive imaging the impact of biological factors to a visual grading scale for Peri-orbital dark circles, and test the correlation of various demographic factors with Peri-orbital dark circles. METHODS: Subjects completed a lifestyle and health survey, and Peri-orbital dark circles severity was evaluated using standardized photographs. Hyperspectral image analysis was used to assess the contributions of melanin, blood volume, degree of blood oxygen saturation, and dermal scattering. RESULTS: Family history was the most significant risk factor for Peri-orbital dark circles. The average age of onset was 24 years, and earlier onset correlated with higher severity scores. Asthma was significantly associated with Peri-orbital dark circles scores, but self-reported allergy was not. In this study, sleep was not correlated with Peri-orbital dark circles scores. Hyperspectral imaging indicated that melanin was the dominant correlate for Peri-orbital dark circles severity, while oxygen saturation was secondary. The difference between under-eye and cheek measurements for ΔL*and ΔE* were the most significant instrumental parameters correlated with visual assessment of Peri-orbital dark circles severity. CONCLUSION: Although typically associated with lack of sleep, risk of Peri-orbital dark circles is primarily hereditary. The main factors contributing to the appearance of Peri-orbital dark circles are melanin and (deoxygenated) blood.

Physiological and lifestyle factors contributing to risk and severity of peri-orbital dark circles in the Brazilian population

AbstractBACKGROUND:Peri-orbital dark circles are a cosmetic concern worldwide, and have been attributed to hyperpigmentation from allergy or atopic dermatitis, blood stasis, structural shadowing effects, and a thin epidermis/dermis under the eye. It is of interest to better understand lifestyle and demographic risk factors and the relative impact of melanin, blood and epidermal/dermal factors on the severity of Peri-orbital dark circles.OBJECTIVE:To compare by non-invasive imaging the impact of biological factors to a visual grading scale for Peri-orbital dark circles, and test the correlation of various demographic factors with Peri-orbital dark circles.METHODS:Subjects completed a lifestyle and health survey, and Peri-orbital dark circles severity was evaluated using standardized photographs. Hyperspectral image analysis was used to assess the contributions of melanin, blood volume, degree of blood oxygen saturation, and dermal scattering.RESULTS:Family history was the most significant risk factor for Peri-orbital dark circles. The average age of onset was 24 years, and earlier onset correlated with higher severity scores. Asthma was significantly associated with Peri-orbital dark circles scores, but self-reported allergy was not. In this study, sleep was not correlated with Peri-orbital dark circles scores. Hyperspectral imaging indicated that melanin was the dominant correlate for Peri-orbital dark circles severity, while oxygen saturation was secondary. The difference between under-eye and cheek measurements for ΔL*and ΔE* were the most significant instrumental parameters correlated with visual assessment of Peri-orbital dark circles severity.CONCLUSION:Although typically associated with lack of sleep, risk of Peri-orbital dark circles is primarily hereditary. The main factors contributing to the appearance of Peri-orbital dark circles are melanin and (deoxygenated) blood.

Avaliação da eficácia e segurança de um dermocosmético contendo retinaldeído, ácido glicólico e nicotinamida no tratamento do envelhecimento corporal / Efficacy and safety of treating body aging with a dermocosmetic containing retinaldehyde, glycolic acid, and nicotinamide

Introdução: A paroníquia crônica é doença inflamatória da dobra ungueal proximal, geralmente presente por mais de seis semanas. O tratamento cirúrgico está indicado nos casos resistentes ao tratamento clínico e tem como objetivo a retirada da prega ungueal proximal. Objetivo: O objetivo deste trabalho foi analisar a manutenção da resposta ao tratamento cirúrgico da paroníquia crônica a longo prazo. Métodos: Estudo de coorte prospectivo no qual foram convocados 62 pacientes que haviam realizado tratamento cirúrgico para correção de paroníquia crônica no período de novembro de 2004 a abril de 2008. Os pacientes foram convocados a retornar ao serviço para reavaliação clínica e observação da presença ou não de sinais de paroníquia crônica e divididos em dois grupos: curados e não curados. Resultados: Dos pacientes convocados, 12 compareceram à reavaliação clínica, totalizando 31 procedimentos. A média de tempo do seguimento dos pacientes foi de cinco anos e dois meses e houve manutenção do resultado em 27 (87%) dos procedimentos realizados. Conclusões: A cirurgia de remoção da dobra ungueal proximal constitui boa opção para o tratamento de paroníquia crônica, sendo simples, eficaz e duradoura.

Introduction: Chronic paronychia is an inflammatory disease of the proximal nail fold that usually lasts for more than six weeks. Surgical of removal the proximal nail fold is recommended in cases that are resistant to clinical treatment. Objective: To analyze the long-term response to the surgical treatment of chronic paronychia. Methods: Prospective cohort study of 62 patients who had undergone surgical treatment to correct chronic paronychia from November 2004 to April 2008. The patients were asked to return for reassessment and clinical observation of the presence or absence of signs of chronic paronychia and were classified into two groups: cured and uncured. Results: Of the 62 patients, 12 attended the clinical reassessment, for a total of 31 procedures for analysis. The average length of patient follow-up was 5 years and 2 months. The results were maintained in 27 (87%) of the procedures performed. Conclusions: Surgical removal of the proximal nail fold is a good option for the treatment of chronic paronychia due to its simplicity, effectiveness, and long-lasting results.