The 975 nm Diode Laser in the Photothermal Treatment of the Aging and Sagging Face and Neck.

OBJECTIVE: The purpose of this study was to investigate the use of a 975 nm diode laser for skin tightening. BACKGROUND DATA: The photothermal effect of laser irradiation on the hypodermis causes retraction of superficial and deep skin layers by the heating of fibrous septa. New devices have been developed for repairing deformities in the cervicofacial region associated with aging and skin laxity. MATERIALS AND METHODS: This retrospective, cross-sectional study included the medical records of 17 patients who had undergone photothermal laser therapy to correct deformities in the cervicofacial region between June 2013 and February 2015. An energy dose of 3 kJ per 100 cm(2) skin area was used as a safety parameter to calculate the optimal cumulative energy for the treated areas. Four cervicofacial lines were measured preoperatively (baseline), immediately after treatment, and 3 months post-treatment with a caliper. Measurements were compared using the Wilcoxon test at a significance level of 0.05 (p < 0.05). RESULTS: A significant skin tightening was observed in all patients 3 months after the procedure. Mean length reductions found in the cervicofacial lines L1, L2, L3, and L4 at the 3-month follow-up were 0.9, 1.18, 1.32, and 1.27 cm, respectively. CONCLUSIONS: The use of a 975 nm diode laser resulted in skin tightening.

Laser lipolysis: skin tightening in lipoplasty using a diode laser.

BACKGROUND: New devices have been developed for surgical repair of deformities caused by localized fat deposits associated with skin laxity. The use of these devices requires the adoption of safety parameters. The aim of this study was to investigate skin tightening by laser lipolysis, using a dual-wavelength diode laser. METHODS: This prospective, cross-sectional study was conducted between June of 2008 and July of 2010 with 41 consecutive patients who underwent laser lipolysis to correct contour deformities. Laser lipolysis was performed with a diode laser operating at two wavelengths (924 and 975 nm) controlled independently, and using three different tip lengths, allowing treatment of small, medium, and large areas of adipose tissue. The procedure was performed under local anesthesia in a surgical setting. To calculate the optimal cumulative energy, a total energy dose of 5 kJ/10 × 10-cm skin area was used as a safety parameter to prevent treatment complications. The circumferences of body regions were measured preoperatively, immediately after surgery, and 90 days later. Measurements were compared using the Wilcoxon test at a significance level of 0.05 (p < 0.05). RESULTS: A significant skin tightening was observed in all patients, regardless of the body site involved (i.e., face, breast, arms, or waist regions), and no complications occurred. CONCLUSION: Laser lipolysis results in progressive skin tightening over time. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Quebra de ponta de cânula, no plano gorduroso, durante lipoaspiração / Breakage of the tip of the cannula in the adipose tissue during liposuction

Durante procedimento de lipoaspiração, uma cânula teve seu segmento distal de 3 cm quebrado no plano adiposo. Os autores apresentam, neste trabalho, a conduta adotada para solução do caso, de maneira simples e rápida, com emprego de um intensificador de imagens, sem grandes dificuldades.

During liposuction, 3 cm of the distal segment of the cannula broke within the patient's adipose tissue. We used an image intensifier to easily and quickly address this complication without the development of any sequelae for the patient.

Laserlipólise: redução da pele e prevenção de umbigo flácido nas lipoplastias seguindo parâmetrosde segurança no uso do laser de diodo - com duplo comprimento de onda 924 e 975 nm / Laserlipolysis: skin tightening and prevention of flabby umbilical region with lipoplasty following security parameters for use of diode laser with double wavelength 924 and 975 nm

Apresentar as alterações na dimensão da pele, obedecendo aos parâmetros de segurança relativos à energia acumulada em procedimentos de laserlipólise em diversas regiões anatômicas, empregando aparelho de laser diodo com duplo comprimento de onda (924 e 975nm). Método: Um estudo prospectivo, transversal, tipo série de casos, incluiu 41 pacientes submetidos à laserlipólise para tratamento de deformidades do contorno corporal, entre junho de 2008 e julho de 2010. A laserlipólise foi realizada com aparelho de laser diodo com dois comprimentos de ondas independentemente controlados, um operando a 924 nm e outro a975 nm, empregando ponteiras de três tamanhos, segundo adequação a pequenas, médias ou grandes áreas de tecido adiposo tratado. As aferições foram comparadas pelo teste de Wilcoxon, em nível de significância de 0,05. Resultados: Em todos os pacientes, houve retração significante da pele, independente do sítio cirúrgico (face, adiposidade mamária, braços ou cintura), em ausência de complicações. Conclusão: O laser diodo mostrou-se capaz de promover retração da pele, progressiva e persistente, obedecido o parâmetro de segurança proposto.

To present the changes in the size of the skin, according to security parameters for the stored energy in laser lipolysis procedures in several anatomical regions, using diode laser device, with dual wave length. Method: A prospective, cross-sectional case series included 41 patients undergoing laser lipolysis of deformities of the body contour, between June 2008 and July 2010. The laser lipolysis was performed with diode laser device, accessory to the Aspire platform, brand Slim-Lipo® (Palomar Medical Technologies, Inc), with two independently controlled wavelength, one operating at 924 nm and another at 975 nm, using tips in three sizes, according suitability for small, medium or large areas of adipose tissue treated. Measurements were compared the Wilcoxon test at a significance level of 0.05. Results: All patients had significant retraction of the skin independent of the surgical site (face, breast adiposity, arm or waist), in the absence of complications. Conclusion: The laser diode proved capable to promote progressive and persistent skin retraction, complying with the proposed security parameter.

Utilização do retalho brow slide em reconstruções cutâneas / Use of the brow slide flap in cutaneous reconstructions

Objetivo: Neste trabalho, foi proposta a análise de um procedimento cirúrgico pouco conhecido para o tratamento dos tumores cutâneos. Método: Os autores descrevem sua experiência na utilização do retalho “brow slide” em reconstruções cutâneas em 47 pacientes e comparam os resultados obtidos, enfatizando a simplicidade de execução da técnica em relação a outras descritas na literatura. Assim, dentro dessa nova perspectiva, o retalho “brow slide” pode ser empregado nas reparações de face ou de outras regiões. Conclusão: Com base nos resultados obtidos, os autores advogam o uso rotineiro do retalho “brow slide” nas reparações do tecido cutâneo, por obter cicatrizes em ziguezague, quase sempre dentro das linhas naturais da pele.

Objective: This article presents a new, comprehensive and less know surgical procedure in skin tumors treatment. Methods: The authors report their experience with “brow slide” flap in cutaneous reconstructions of 47 patients. They compared obtained results, with emphasis in the ease to performed this technique in comparison to others procedures described in literature. Thus, the "brow slide” flap can be use in face and others areas that needs reconstructions. Conclusion: Based on the results, the authors recommend the routine use of this technique in the reconstructions of skin tumors. The advantages of this method include Zplasty scars almost of them located at the lines of expression and contour lines of the skin.

Tratamento de fístula salivar cutânea por lesão da glândula parótida pós-ritidectomia com uso de microcânula / Treatment parotid salivary fistula following rhytidectomy with the use of microcanule

As lesões iatrogênicas da glândula parótida pós-ritidectomia são incomuns e têm incidência aproximada de 2%. No presente artigo, é relatado um caso com a solução encontrada pelos autores para a resolução da fístula.

The iatrogenic injuries of the parotid gland after ritidectomia are uncommon and have incidence around 2%. In the present article, a case is reported, followed by the solution found by the authors for the resolution of fistula.

Lipoenxertia guiada por ultrassonografia / Lipoplasty guided by ultrasound

Introdução: A lipoenxertia iniciou-se com Neuber, em 1893, que a utilizou para corrigiruma depressão na face. Desde então, é utilizada em diversas condições, como preenchimentode cicatrizes deprimidas e rugas, correção de lipodistrofias faciais, entre outras. Para umamelhor integração do enxerto, os artigos mostram que adipócitos a serem doados devem serobtidos com menor pressão de sucção e ter manipulação delicada. Assim, além de cânulasmais modernas, novos métodos foram desenvolvidos para se obter um melhor resultado;entre eles, o da lipoenxertia guiada por ultrassonografiia. Objetivos: O trabalho visa a demonstrara importância de associar a ultrassonografia à lipoenxertia e os resultados obtidos.Método: Entre 2005 e 2008, 73 pacientes, com idades entre 16 e 68 anos, foram submetidosa este método e analisados retrospectivamente. O procedimento consistia em lipoaspirar opaciente tradicionalmente para, com ajuda da máquina ultrassonográfica, encontrar o melhorlugar para posicionar o enxerto e, então, fazê-lo. As áreas receptoras mais frequentes noestudo foram glúteos (52,05%) e face (20,54%); houve também injeção peniana de gordura.Resultados: Em algumas áreas com aponeurose mais fina, a ultrassonografia demonstrouque o enxerto intramuscular é fácil, seguro e de pouca absorção. Em locais com aponeuroseespessa, o ideal é lipoenxertia mista, subcutânea e intramuscular. Observou-se menor incidênciade efeitos colaterais com o método empregado nesse estudo em comparação à lipoenxertiatradicional. Conclusão: Lipoenxertia guiada por ultrassonografia apresenta grandeeficácia em selecionar melhor o local de injeção do enxerto e melhorar o pós-operatório dopaciente, além de prevenir algumas complicações do método tradicional.

Introduction: The lipoplasty began with Neuber, in 1893, that used to correct a depressionin the face. Since then, it is used in various conditions, such as filling depressed scars andwrinkles, correction of facial lipodystrophy, among others. For better graft’s integration,the articles show that donated adipocytes must be obtained with lower pressure and delicatehandling. Thus, in addition to more modern canules, new methods were developed to obtainbetter results, among them, the lipoplasty guided by ultrasound. Objective: This study aimsto show the importance of involving the ultrasound to lipoplasty and the results obtained.Method: Between 2005 and 2008, 73 patients, from 16 to 68 years, have been subjected tothis method and analyzed retrospectively. The procedure consisted of traditional liposuctionto then, with the help of the ultrasound, find the best place to position the graft, and do it.Areas receiving more frequently in the study were gluteus (52.05%) and face (20.54%);there was also a penile injection of fat. Results: In some areas with thinner aponeurosis,the ultrasound showed that the intramuscular graft is easy, safe and has a low absorptionrate. In areas with thick aponeurosis, the ideal is a mixed lipoplasty - subcutaneous andintramuscular injections. Less side-effects were seen in comparison to traditional method.Conclusion: The results points to great effectiveness of the method in selecting the bestlocation for the graft and improvement of the postoperative, and it also points to preventionof some complications of the traditional method.

Novas cânulas para lipoaspiração e lipoenxertias: compontas maciças fixas e pontas maciças rosqueadas / New liposuction cannulas: with fixed massive tips and or threading massive tips

Neste artigo, são apresentadas novas cânulas para lipoaspirações e lipoenxertias, com pontasmaciças fixas e ou pontas maciças rosqueadas.

In this paper, new liposuction cannulas with fixed massive tips and or threading massivetips were presented.

Full-face undermining using progressive dilators.

The application of a new and simple method of facial cutaneous detachment using specially designed bifaceted rigid steel wands called Dilson Luz Vascular Dilation Wands is described. These wands considerably reduce the bleeding during face-lift surgery, reducing both postoperative hematomas and the risk of facial nerve injury. This technique involves stretching the blood vessels to the point of rupture by inserting progressively larger wands. At the point of rupture, a spontaneous coagulation within the vascular extremities occurs. This is attributable to a significant blood platelet migration induced by the stimulation from the rupture of the vascular intima. The wands, varying in dimension from 1.5 to 20 mm, and are used for cutaneous facial detachment. This method has been found to result in minimal bleeding across the detached surface as well as an excellent perfusion of the overlying skin. With the use of these Dilson Luz Vascular Dilation Wands in combination with this new technique, the authors have obtained improved cutaneous detachment; reduced postoperative swelling, edema, and ecchymosis; prophylaxis of facial nerve damage; reduced procedural time; and above all, greater reduction in immediate and late postoperative hematoma formation.

Advanced rhinomyoplasty and ultrasound / Rinomioplastia avançada com ultra-sonografia

The authors include a dynamic nasal SMAS assessment in the pre-operative routine, and then include selective myoplasties in surgical planning of the nose (rhinomyoplasties). Management and 3 mounth to 2 year follow-up results are described for each case. The authors conclude the study by establishing the benefits forpatients in procedures in the following muscles: pyramidal, transverse, nasolabial, myrtiform (tip depressor), tip and lip elevator (all elements of the nasal structure), identified through ultrasound using the needle technique.