Assessment of the Efficacy and Durability of IncobotulinumtoxinA in the Treatment of the Upper Face in Adult Women.

INTRODUCTION: IncobotulinumtoxinA (Xeomin®) is used in the treatment of dynamic wrinkles and the aesthetic repositioning of facial structures. The duration of its muscular effect typically extends for around 4 months. However, the residual aesthetic benefit can be observed for a longer period. To date, the long-term aesthetic benefit of incobotulinumtoxinA in facial aesthetics has not been systematically evaluated. This study aimed to evaluate longitudinally the duration and aesthetic benefits of incobotulinumtoxinA in the treatment of the upper face in adult women. METHODS: A quasi-experimental, evaluator-blind, clinical trial involving 28 adult women (30-60 years old) with facial movement lines, undergoing treatment of the upper face with incobotulinumtoxinA by two injectors, following an individualized protocol (ONE21 and glabellar contraction patterns) was performed. Participants were evaluated on the day of the intervention (day 0) and days 30, 120, 180, and 240, and subjected to standardized photographs. The following outcomes were evaluated blindly at each visit: Merz Aesthetics Facial Contraction Scale (MAS), GAIS (Global Aesthetic Improvement Scale), and patient satisfaction. Adverse effects were evaluated at each visit. RESULTS: Participants ranged in age from 30 to 60 years, 93% were self-declared white, and most of their baseline MAS scores for dynamic lines were moderate and severe. All the parameters presented significative reduction from baseline until day 180. At day 240, the dynamic MAS scores were lower than baseline for forehead lines in 15.4% (95% confidence interval (CI) 0.8-30.0%) of the participants, for glabellar lines in 38.5% (95% CI 18.8-58.1%), and for crow's feet lines in 26.9% (95% CI 9.0-44.8%). Aesthetic improvement compared to baseline was identified in 35% (CI 95% 23‒50%) of the participants at day 240, and 62% (CI 95% 42‒81%) of the sample kept reporting some satisfaction with the procedure. CONCLUSION: The aesthetic treatment of the upper face with incobotulinumtoxinA demonstrates enduring clinical benefits, and patient satisfaction lasting up to 180 days in most participants. The length of efficacy, which exceeded those reported in the literature, may be attributed to the use of techniques based on individualized assessment such as ONE21 and glabellar patterns of contraction.

IncobotulinumtoxinA for the Treatment of Glabella and Forehead Dynamic Lines: A Real-Life Longitudinal Case Series.

Background: There is substantial interpersonal variation in the patterns of muscular contraction that substantiates the use of personalized points of application and dosages in clinical practice to achieve optimal results. Nevertheless, there has been no real-life therapeutic series with botulinum toxin for aesthetic treatment of the face in which the subjects were systematically followed to assess its long-term benefit. Purpose: To assess the performance and length of the treatment of glabellar and forehead lines with IncobotulinumtoxinA in a real-life setting. Patients and Methods: We enrolled 20 adults with indications for the treatment of upper facial dynamic lines (glabella and forehead) with botulinum toxin. The protocols of injection points were personalized by the injectors. The participants were photographed under maximum facial contraction before the application (D0) and after 15, 90, 120, and 180 days. The photos were randomly assessed by two blinded experienced raters to consensually grade the dynamic lines according to the Merz Aesthetics Scales (MAS). Efficacy was defined as the reduction in the MAS score. Results: At D15, 18 (90%; 95% CI: 80%-100%) participants reached the zero score, or a 2-point reduction on the MAS score from the forehead and 16 (80%; 95% CI: 65-90%) reached that reduction for the glabella. These values from D90 were 14 (70%; 95% CI: 55-85%) for both sites. At D120, these values were 11 (55%; 95% CI: 35-75%) and 8 (40%; 95% CI: 25-55%) for the forehead and glabella. At D180, 10 (50%; 95% CI: 30-70%) participants presented a MAS score for forehead or glabella dynamic lines lower than the score assessed at D0. Conclusion: As much as 70% of the patients sustained a reduction of scores after 120 days of the treatment for dynamic glabellar and forehead lines. Half of the patients evidenced prolonged benefit at 180 days.

Consensus Recommendations for the Use of Hyperdiluted Calcium Hydroxyapatite (Radiesse) as a Face and Body Biostimulatory Agent.

BACKGROUND: Calcium hydroxyapatite (CaHA) is a well-established collagen stimulator. In recent years, it has been increasingly used in hyperdiluted form as a biostimulatory agent rather than a volumizing filler to improve skin quality and firmness in both facial and corporal areas. However, guidelines on the techniques required to achieve optimal results are still lacking. The objective of this study was to develop a consensus recommendation for the safe and effective use of hyperdiluted CaHA for face and body biostimulation. METHODS: A team of 10 experts with extensive experience in dermal fillers and biostimulatory treatments for facial and body rejuvenation convened for a live meeting. Consensus was defined as approval by 70%-89% of all participants, whereas agreement of ≥90% denoted strong consensus. RESULTS: For most items, the group achieved a majority consensus. Recommendations have been provided for the face, neck, décolletage, buttocks, thighs, arms, abdomen, knees, and elbows with detailed injection techniques, providing information on insertion points, dosages, and volumes for both needle and cannula injections as well as the number of treatment sessions and intervals. CONCLUSIONS: The expert consensus supports and provides guidance for the use of CaHA as a biostimulatory agent for face and body rejuvenation. However, further clinical studies are necessary to provide physicians with the best evidence for the best treatment practices.

Capacitação em cirurgia robótica no programa de residência em enfermagem perioperatória / Robotic surgery training in the perioperative nursing residency program / Capacitación en cirugía robótica en el programa de residencia en enfermería perioperatoria

Objetivo: Desenvolver um programa de treinamento para enfermeiros residentes em cirurgia robótica. Método: Trata­se de um relato de experiência em um hospital filantrópico privado de grande porte no município de São Paulo. Para o programa de residência em Enfermagem foi desenvolvido um treinamento para enfermeiras residentes com foco na especialização em cirurgia robótica com carga teórico­prática para o sistema do robô Da Vinci. Resultados: As enfermeiras residentes desenvolveram o conhecimento cognitivo com o treinamento virtual e a habilidade técnica durante a simulação com o manuseio do robô, dos instrumentais e dos equipamentos. Foram liberadas para iniciação prática com supervisão de enfermeiro especialista até que possuam segurança na execução do procedimento de montagem do robô Da Vinci. Conclusão: O treinamento foi avaliado pelas residentes como satisfatório para aquisição de conhecimento teórico­prático. A capacitação de profissionais especialistas em cirurgia robótica é um diferencial na residência de Enfermagem perioperatória.

Objective: To develop a training program in robotic surgery addressed to resident nurses. Method: This is a case report conducted in a major private, philanthropic hospital in the city of São Paulo. For the Nursing Residency Program, resident nurses were trained focusing on the specialization in robotic surgery, including theory and practice, to use the Da Vinci robot system. Results: The resident nurses developed cognitive knowledge through virtual training, and technical skills during the simulation of robot handling, as well as the instruments and the equipment. They were referred to practical initiation, supervised by an expert nurse, until they were confident to execute the procedure of assembling the Da Vinci robot. Conclusion: The residents considered the training satisfactory to acquire theoretical and practical knowledge. The training of professionals specialized in robotic surgery is a differential in perioperative Nursing residency.

Objetivo: Desarrollar un programa de capacitación para enfermeros residentes en cirugía robótica. Método: Se trata de un relato de experiencia en un hospital filantrópico privado de grande porte en el municipio de São Paulo. Para el programa de residencia en Enfermería fue desarrollada una capacitación para enfermeras residentes con enfoque en la especialización en cirugía robótica con carga teórico­práctica para el sistema del robot Da Vinci. Resultados: Las enfermeras residentes desarrollaron el conocimiento cognitivo con la capacitación virtual y la habilidad técnica durante la simulación con el manejo del robot, de los instrumentos y de los equipos. Fueron liberadas para iniciación práctica con supervisión de enfermero especialista hasta que posean seguridad en la ejecución del procedimiento de montaje del robot Da Vinci. Conclusión: La capacitación fue evaluada por las residentes como satisfactorio para adquisición de conocimiento teórico­práctico. La capacitación de profesionales especialistas en cirugía robótica es un diferencial en la residencia de Enfermería perioperatoria.

Unidade pré-operatória: uma nova proposta de atendimento e gestão / Unidad de preparación quirúrgica: una nueva propuesta de servicios y gestión / Preoperative unit: a new proposal for services and management

Objetivo: Apresentar os resultados do processo da implantação de uma Unidade Pré-operatória. Método: Estudo descritivo e analítico tipo relato de experiência, tendo como meta o relato da implantação de uma unidade pré-operatória em um hospital geral privado, localizado no município de São Paulo, e da experiência dos profissionais envolvidos. Resultados: Constatou-se a eficiência de uma unidade pré-operatória como estratégia de otimização do centro cirúrgico, estabelecendo os processos com agilidade por uma equipe com olhar focado neste tipo de paciente. Conclusão: A Unidade Pré-operatória foi implantada como uma oportunidade de minimização da falta de leitos, visando centralizar serviços de forma a agilizá-lo, com o objetivo de promover maior integração e continuidade dos cuidados pré-operatórios à assistência proposta pelo Centro Cirúrgico, além de melhor organização das atividades administrativas e assistenciais.

Objetivo: Presentar los resultados del proceso de la implementación de una unidad de preparación quirúrgica. Método: Estudio descriptivo y analítico incluyendo relato de experiencia, con el objetivo de orientar la implementación de una unidad de preparación quirúrgica en un hospital general privado en la ciudad de São Paulo y relatar la experiencia de los profesionales involucrados. Resultados: La eficiencia de una unidad de preparación quirúrgica como estrategia de optimización del centro quirúrgico y el establecimiento de procesos agiles conducidos por un equipo enfocado en el paciente quirúrgico. Conclusión: La unidad de preparación quirúrgica se estableció como una oportunidad para reducir al mínimo la indisponibilidad de camas, para centralizar los servicios de manera ágil con el fin de promover una mayor integración y continuidad de la asistencia para el cuidado preoperatorio propuesto por el Centro Quirúrgico y una mejor organización de las actividades administrativas y asistenciales.

Objective: To present the results of the implementation process of a preoperative unit. Method: Descriptive and analytical study including experience report, with the goal of reporting the implementation of a preoperative unit in a private general hospital in the city of São Paulo, as well as the experience of the professionals involved. Results: The efficiency of a preoperative unit was confirmed as an optimization strategy for the surgical center, whose processes are established with agility by a team focused on this type of patient. Conclusion: The preoperative unit was established as an opportunity to minimize the lack of beds, to centralize services to streamline them, and to promote greater integration and continuity of preoperative care to the assistance proposed by the surgical center, as well as a better organization of administrative and health-care activities.