Harmonização orofacial: evolução normativa e conflitos legais no reconhecimento da especialidade / Orofacial harmonization: normative evolution and legal conflicts for the recognition of the specialty

A Harmonização Orofacial (HOF) é especialidade odontológica reconhecida pelo Conselho Federal de Odontologia (CFO) e, no reconhecimento dessa especialidade, discussões internas e externas à classe odontológica surgiram. O presente artigo tem como objetivo levantar reflexões acerca do processo judicial n° 1003948-83.2019.4.01.3400 julgado pelo Tribunal Regional Federal (Seção Judiciária do Distrito Federal - 8ª Vara Federal) referente a HOF enquanto especialidade odontológica. Inicialmente, são discutidos os documentos que norteiam o ensino dos cursos de graduação e pós-graduação em odontologia. Em seguida, faz-se uma reflexão sobre o processo de reconhecimento da HOF como especialidade odontológica. Por fim, discute-se acerca do citado processo judicial, os principais pontos elencados pelas partes envolvidas no processo e eventuais consequências do desfecho desse processo para a classe odontológica. O reconhecimento da HOF enquanto especialidade odontológica não seguiu os trâmites que outras especialidades odontológicas seguiram e gerou debates educacionais e formativos sob uma perspectiva ética e legal. Ademais, tal reconhecimento fomentou debates relacionados ao conflito dos procedimentos dessa especialidade odontológica com procedimentos de especialidades médicas. Tais conflitos chegaram ao Poder Judiciário, que interveio em favor da Odontologia, contudo, isso não impede que o cirurgião-dentista seja responsabilizado profissionalmente pela realização de procedimentos que fogem ao escopo da odontologia

Orofacial Harmonization (HOF) is dental specialty recognized by the Federal Council of Dentistry (CFO) and, in recognition of this specialty, internal and external discussions of the dental class have arisen. This article aims to raise reflections on judicial process number 1003948-83.2019.4.01.3400 judged by the Federal Regional Court (Judicial Section of the Federal District - 8th Federal Court) referring to HOF as a dental specialty. Initially, the documents that guide the teaching of undergraduate and graduate courses in dentistry are discussed. Then, a reflection is made on the recognition process of HOF as a dental specialty. Finally, it discusses the judicial process number 1003948-83.2019.4.01.3400, the main points listed by the parties involved in the process, and the possible consequences of the outcome of this process for the dental class. The recognition of HOF as a dental specialty did not follow the procedures that other dental specialties followed and generated educational and training debates from an ethical and legal perspective. Furthermore, such recognition has fostered debates related to the conflict between procedures in this dental specialty and procedures in medical specialties. Such conflicts reached the Judiciary, which intervened in favor of Dentistry, however, this does not prevent the dental surgeon from being held professionally responsible for carrying out procedures that fall outside the scope of dentistry

Cosmiatria: Uma análise do mercado brasileiro / Cosmiatry: An analysis of the Brazilian market

Introdução: O mercado de procedimento estéticos cresce exponencialmente no Brasil. Tal crescimento tem despertado o interesse de várias categorias profissionais. A decisão de praticar no setor deve considerar as oportunidades de mercado da localidade na qual se pretende atuar. Entretanto, a área carece de análises comparativas documentando prováveis diferenças regionais no país. O objetivo do estudo é descrever as diferenças de mercado em procedimentos estéticos entre os estados e regiões brasileiras. Um índice de potencial consumo de cosmiatria (IPCC) é calculado para tal análise comparativa. Método: Estudo transversal envolvendo prestadores de procedimentos estéticos não cirúrgicos no Brasil. Buscas no Google®-Google Maps® foram conduzidas usando termoschave e entrevistas telefônicas realizadas para obter informações sobre categorias profissionais, tipo de provedores e serviços oferecidos. Valores preditivos positivos foram obtidos para todas as estratégias de busca e usados para estimar o número total de provedores. O tamanho da população e a renda per capita foram considerados para o cálculo dos IPCCs para os estados brasileiros. Resultados: São Paulo, Minas Gerais e Rio de Janeiro apresentaram os maiores IPCCs, sendo 524, 210 e 180, respectivamente. Roraima teve um IPCC de 14, o mais baixo do país. A Região Sudeste apresentou, em média, o maior IPCC (242) entre todas as regiões brasileiras. Conclusão: Considerando o tamanho da população e a renda, a Região Sudeste apresenta as maiores oportunidades de mercado em procedimentos estéticos não cirúrgicos no Brasil. Nossos achados podem ser de interesse para profissionais de saúde e investidores que atuam ou pretendem atuar no setor.

Introduction: The aesthetic procedure market is growing exponentially in Brazil. This growth has aroused the interest of several professional categories. The decision to practice in the sector must consider the market opportunities in the location in which you intend to operate. However, the area lacks comparative analyses documenting probable regional differences in the country. The objective of the study is to describe market differences in aesthetic procedures between Brazilian states and regions. An index of potential cosmetic consumption (IPCC) is calculated for such a comparative analysis. Method: Cross-sectional study involving providers of nonsurgical aesthetic procedures in Brazil. Searches on Google Maps® were conducted using key terms, and telephone interviews were conducted to obtain information on professional categories, types of providers, and services offered. Positive predictive values were obtained for all search strategies and used to estimate the total number of providers. Population size and per capita income were considered to calculate the IPCCs for Brazilian states. Results: São Paulo, Minas Gerais, and Rio de Janeiro presented the highest IPCCs, being 524, 210, and 180, respectively. Roraima had an IPCC of 14, the lowest in the country. The Southeast Region presented, on average, the highest IPCC (242) among all Brazilian regions. Conclusion: Considering population size and income, the Southeast Region presents the greatest market opportunities for nonsurgical aesthetic procedures in Brazil. Our findings may be of interest to healthcare professionals and investors who work or intend to work in the sector.

Da superfície para a profundidade: Curva de aprendizado em lifting facial profundo estendido - meus primeiros 100 casos / From Surface to Depth: Learning Curve in Extended Deep Facelift ­ my First 100 Cases

Introdução: O envelhecimento facial é um processo gradual, complexo e multifatorial. É o resultado de mudanças na qualidade, volume e posicionamento dos tecidos. Cirurgiões plásticos têm modificado sua abordagem na cirurgia do rejuvenescimento facial optando pelo plano subaponeurótico (SMAS). O objetivo deste estudo é analisar 100 casos de pacientes operados pela técnica de SMAS profundo, avaliando sua aplicabilidade e eficácia. Método: Foram avaliados 100 pacientes, submetidos a cirurgia plástica facial pela técnica de SMAS profundo - "Deep Smas", e acompanhados por 6 meses. Observou-se a satisfação dos pacientes, número de complicações, número de reoperações, riscos e vantagens da técnica. Resultados: Foram operados 100 pacientes, num período de 3 anos. A idade variou de 41 a 79 anos, sendo 95% sexo feminino. As complicações foram 8 casos (8%) de lesões de ramos do nervo facial, sendo: 4 casos lesão do zigomático, 3 casos de lesão do mandibular e 1 caso de lesão do bucal; houve 1 caso (1%) de queloide retroauricular; 1 caso (1%) de hematoma. Em relação às revisões cirúrgicas, houve 8 casos (8%) de complementação cirúrgica por insatisfação das pacientes. Houve 15% de lesões nervosas entre a 1ª e a 40ª cirurgia, 5% entre a 41ª e a 80ª, e nenhuma lesão entre o 81º e o 100º paciente. Conclusão: O lifting facial profundo ou subSMAS mostrou ser efetivo, proporcionando bons resultados estéticos. Apresenta baixa taxa de recidiva e baixa taxa de morbidade, porém, necessita de uma longa curva de aprendizagem.

Introduction: Facial aging is a gradual, complex, and multifactorial process. It is the result of changes in the quality, volume, and positioning of tissues. Plastic surgeons have modified their approach to facial rejuvenation surgery, opting for the subaponeurotic plane (SMAS). The objective of this study is to analyze 100 cases of patients operated on using the deep SMAS technique, evaluating its applicability and effectiveness. Method: 100 patients were evaluated, undergoing facial plastic surgery using the deep SMAS technique - "Deep Smas", and followed up for 6 months. Patient satisfaction, number of complications, number of reoperations, risks, and advantages of the technique were observed. Results: 100 patients were operated on over 3 years. Age ranged from 41 to 79 years, with 95% being female. The complications were 8 cases (8%) of injuries to branches of the facial nerve, of which 4 cases of zygomatic injury, 3 cases of mandibular injury, and 1 case of buccal injury; there was 1 case (1%) of post-auricular keloid; 1 case (1%) of hematoma. Regarding surgical revisions, there were 8 cases (8%) of surgical completion due to patient dissatisfaction. There were 15% of nerve injuries between the 1st and 40th surgery, 5% between the 41st and 80th, and no injuries between the 81st and 100th patient. Conclusion: Deep facial lifting or subSMAS has proven to be effective, providing good aesthetic results. It has a low recurrence rate and low morbidity rate; however, it requires a long learning curve.

Oclusão da artéria central da retina por embolia gordurosa após injeção facial de gordura autóloga / Central retinal artery occlusion by fat embolism after facial autologous fat injection

RESUMO Com o crescimento da indústria cosmética global, a busca pela estética e pelo rejuvenescimento impulsionou o aumento de procedimentos estéticos. A gordura autóloga é o tipo de preenchimento mais comum e mais grave relacionado à cegueira iatrogênica. A oclusão iatrogênica da artéria oftálmica é uma complicação rara (mas devastadora) das injeções de preenchimento facial. Embora diversos tratamentos tenham sido relatados e propostos, até o momento não há eficácia comprovada. Na identificação da oclusão de artéria central da retina, o tempo é de fundamental importância para o prognóstico visual do paciente. Os resultados, em geral, são insatisfatórios, e há pouca ou nenhuma evidência favorável. O objetivo deste trabalho foi relatar o caso de uma paciente que apresentou oclusão de artéria central da retina após procedimento cosmético com gordura autóloga em região nasolabial.

ABSTRACT The global cosmetic industry growth and the desire for aesthetics and rejuvenation have increased the aesthetic procedures. Autologous fat is the most common and most serious type of filling related to iatrogenic blindness. Iatrogenic occlusion of the ophthalmic artery is a rare but devastating complication of facial filler injections. Although several treatments have been reported and proposed, to date there is no proven efficacy. In identifying central retinal artery occlusion, timing is crucial to the patient's visual prognosis. The results, in general, are unsatisfactory and there is little or no favorable evidence. This paper aimed to report the case of a patient who presented central retinal artery occlusion after a cosmetic procedure with autologous fat in the nasolabial region.

Tratamento cirúrgico de ginecomastia grau III com a técnica de cicatriz horizontal e transposição do complexo areolopapilar - "No vertical scar" / Surgical treatment of grade III gynecomastia with the horizontal scar technique and transposition of the nipple-areolar complex - "No vertical scar"

Introdução: A demanda por cirurgia para correção de ginecomastia tem aumentado em função da grande quantidade de pacientes submetidos a tratamentos bariátricos. A maioria destes pacientes requerem grande remoção do excesso de pele, tecido gorduroso e reposicionamento do complexo areolopapilar, assim como adequação do volume da aréola. O objetivo deste estudo é descrever a técnica de correção de ginecomastia grau III através de cicatriz horizontal sem cicatriz vertical, com reposicionamento do complexo areolopapilar. Método: Estudo prospectivo de 27 pacientes masculinos com diagnóstico de ginecomastia grau III da classificação de Simon, operados em clínica particular, entre janeiro de 2013 e agosto de 2020, pela técnica de cicatriz horizontal com transposição do complexo areolopapilar e sem cicatriz vertical. Resultados: Foram operados 27 pacientes, num período de 7,5 anos, todos ex-obesos, submetidos previamente a tratamento de perda de peso. A idade variou de 17 a 74 anos, média etária de 52 anos. O peso das peças removidas variou de 175 a 758 gramas, média de 376 gramas. As complicações foram: 1 caso de hematoma tardio (3,7%), 1 caso de seroma (3,7%) e 2 casos de cicatriz hipertrófica (7,4%). Conclusão: O tratamento cirúrgico da ginecomastia grau III através da técnica de cicatriz horizontal, sem cicatriz vertical e com reposicionamento do complexo areolopapilar demonstrou ser efetivo, com baixa morbidade e bons resultados estéticos.

Introduction: The demand for surgery to correct gynecomastia has increased due to the many patients undergoing bariatric treatments. Most patients require extensive removal of excess skin, and fatty tissue, repositioning the nipple-areolar complex, and adjusting the areola volume. This study aims to describe the correction technique for grade III gynecomastia using a horizontal scar without a vertical scar, with repositioning of the nipple-areolar complex. Method: Prospective study of 27 male patients diagnosed with Simon grade III gynecomastia, operated in a private clinic between January 2013 and August 2020, using the horizontal scar technique with transposition of the nipple-areola complex and without a vertical scar. Results: 27 patients underwent surgery over 7.5 years, all ex-obese, previously submitted to weight loss treatment. Age ranged from 17 to 74 years, mean age of 52 years. The weight of the removed parts ranged from 175 to 758 grams, an average of 376 grams. Complications were 1 case of late hematoma (3.7%), 1 case of seroma (3.7%), and 2 cases of hypertrophic scarring (7.4%). Conclusion: Surgical treatment of grade III gynecomastia using the horizontal scar technique, without a vertical scar and with repositioning of the nippleareolar complex, proved to be effective, with low morbidity and good aesthetic results.

Revisão sistemática do benefício cosmético da aplicação tópica do filtrado de fermentação / Systematic review of cosmetic benefit of topical application of ferment filtrate

O filtrado de fermentação, (FF), um subproduto de leveduras rico em nutrientes, é usado cosmeticamente no leste da Ásia desde a década de 1970. Revisamos sistematicamente os efeitos deste ativo tópico na saúde da pele e determinamos as limitações nos estudos disponíveis. A literatura recente mostrou evidências na redução do tamanho dos poros, e tambem da aspereza, hiperpigmentação e vermelhidão. No entanto, esses estudos são limitados em eficácia devido ao pequeno tamanho da amostra, muitas variáveis e capacidade limitada de validação externa. Devido ao aumento de produtos cosméticos contendo esse ingrediente, é necessária uma análise crítica da literatura disponível e futura para evitar a desinformação do consumidor

Ferment filtrate (FF), a by-product of nutrient-rich yeast, is believed to be used cosmetically in East Asia since the 1970s. We systematically reviewed the topical effects of ferment filtrate on skin health and determined limitations in the available studies. Recent literature has shown evidence in reducing the baseline fluctuation of pore size, roughness, hyperpigmentation, and redness. However, these studies are limited in efficacy due to their small sample size, their confounding variables, and their limited generalizability. Because of the increase of cosmetic products containing this ingredient, critical analysis of the available and future literature is necessary to prevent consumer misinformation.

Changes in Facial Morphology Using Poly-L-lactic Acid Application According to Vector Technique: A Case Series.

Background: The search for nonsurgical cosmetic procedures has increased considerably in recent years. A new injection technique, using vector direction, has shown good results in improving facial aesthetics but to date has only been performed with hyaluronic acid which can be associated with a risk of vascular complications. Therefore, in clinical practice, it would be interesting to assess this technique with a liquid product already widely used in the facial region, and at the same time bring the same aesthetic benefits, but with greater durability than hyaluronic acid. Objective: To investigate the improvement of facial morphology in patients with facial flaccidity submitted to the vector technique using poly-L-lactic acid (PLLA) (Sculptra®; Galderma, Lausanne, Switzerland). Case Series: Here we report the outcomes of three cases of female patients, aged between 41 and 55 years, seeking improvement of facial flaccidity. In each patient, PLLA was applied in the posterior temporal region as a bolus, in three points, with a 2-mL injection in the upper region, 1.5mL in the midpoint, and 1.5mL at the bottom point. Each of the three patients showed an improvement in face morphology, with concomitant improvement in the support and stretching of the face and improvement in skin sagging in the upper, middle, and bottom regions. Conclusion: The vector technique with PLLA is a viable alternative for the treatment of patients with facial skin flaccidity, providing harmonious and progressive improvement in the face morphology.

Labioplastia y técnicas de cirugía estética genital en Medellín, Colombia / Labiaplasty and genital cosmetic surgery techniques in Medellin, Colombia

RESUMEN Introducción: La cirugía estética genital femenina presenta una creciente demanda; sin embargo, su técnica y resultados no son bien conocidos. Objetivos. Describir los datos sociodemográficos, manifestaciones clínicas, resultados postoperatorios y la satisfacción en un grupo de mujeres a quienes se aplicó cirugía estética genital femenina. Métodos : Estudio descriptivo, retrospectivo de una base de datos institucional, en el periodo 6 de marzo de 2007 a 14 de enero de 2021. Se analizó los datos demográficos y clínicos de los registros médicos utilizando estadística descriptiva. Resultados. Se recuperaron los datos de 713 pacientes, con edad media de 34,3 años y 12 de las cuales tenían menos de 18 años. Antes de la intervención, el 87,5 % (n= 624) de pacientes estaban inconformes con el aspecto de sus genitales externos, el 74,1 % (n= 528) tenía incomodidad con sus genitales y 53,4 % (n= 381) manifestaron pérdida de gratificación sexual. Los hallazgos más comunes al examen físico fueron la hipertrofia de los labios menores (n= 616; 86,4 %) y el capuchón de clítoris redundante (n= 577; 80,9 %). La cirugía más efectuada consistió en labioplastia (n= 609; 85,4 %) y reducción del capuchón del clítoris (n= 564; 79,1 %). La satisfacción global a los 8 y 30 días fue de 99,4 % (n= 709) y 93,3 % (n= 665), respectivamente. Conclusiones : En la cohorte estudiada, las mujeres lograron altas tasas de satisfacción cosmética con los resultados quirúrgicos, y también experimentaron mejora en su satisfacción funcional. Existió una tasa baja de complicaciones.

ABSTRACT Introduction : Female genital aesthetic surgery is in increasing demand; however, its technique and results are not well known. Objectives: To describe the sociodemographic data, clinical manifestations, postoperative results and satisfaction in a group of women who underwent female genital cosmetic surgery. Methods : Descriptive, retrospective study of an institutional database, in the period March 6, 2007 to January 14, 2021. Demographic and clinical data from medical records were analyzed using descriptive statistics. Results: Data were retrieved for 713 patients, mean age 34.3 years, 12 of whom were younger than 18 years. Before the intervention, 87.5 % (n= 624) of patients were dissatisfied with the appearance of their external genitalia, 74.1 % (n= 528) had discomfort with their genitalia and 53.4 % (n= 381) reported loss of sexual gratification. The most common findings on physical examination were hypertrophy of the labia minora (n= 616; 86.4 %) and redundant clitoral hood (n= 577; 80.9 %). The most commonly performed surgery consisted of labiaplasty (n= 609; 85.4 %) and clitoral hood reduction (n= 564; 79.1 %). Overall satisfaction at 8 and 30 days was 99.4 % (n= 709) and 93.3 % (n= 665), respectively. Conclusions : In the cohort studied, women achieved high rates of cosmetic satisfaction with surgical results and improvement in their functional satisfaction. There was a low rate of complications.

Aumento mamario mediante prótesis

Introducción: La apariencia, tamaño, forma y simetría de la glándula mamaria juegan un papel importante en la sexualidad de la mujer y tienen un profundo efecto en su bienestar biopsicosocial. Objetivo: Caracterizar el aumento mamario mediante implantes protésicos. Métodos: Se realizó un estudio descriptivo, prospectivo de corte longitudinal para determinar el comportamiento del aumento mamario mediante implantes protésicos en pacientes con alteraciones mamarias que acudieron a la consulta de Cirugía Plástica del Hospital Universitario Manuel Ascunce Domenech de la provincia Camagüey en el período comprendido desde septiembre de 2017 hasta junio de 2020. Se estudiaron 35 pacientes en quienes se analizaron las variables: edad, enfermedad mamaria a corregir con los implantes, volumen de los implantes, vía de acceso de colocación del implante, localización del bolsillo mamario y complicaciones con el proceder. Resultados: Del total de las pacientes estudiadas, la hipotrofia mamaria estuvo presente en 25 féminas, predominando en las edades entre 30 a 49 años en el 68,56 % de las mismas. En doce de las pacientes que se utilizó la vía subareolar para la colocación del implante, los mismos presentaban volúmenes entre 351 y 400 mililitros. La vía de acceso menos utilizada para la colocación del implante fue la vía axilar, en una paciente y esta a su vez utilizando un bolsillo mamario retromuscular. La dehiscencia de la herida fue la complicación predominante. Conclusiones: La cirugía de aumento mamario mediante material aloplástico es un proceder frecuente que es utilizado para corregir diferentes defectos mamarios en la especialidad de Cirugía Plástica, con diversidad de técnicas y escasas complicaciones.

Introduction: Appearance, size, form and symmetry of the mammary gland play an important role in the sexuality of the woman and have a deep effect in her biopsychosocial well-being. Objective: To characterize breast augmentation using prosthetic implants. Methods: A descriptive, prospective longitudinal study was carried out to determine the behavior of breast augmentation through prosthetic implants in patients with breast disorders that attended to the consultation of Plastic Surgery of the Universitary Hospital Manuel Ascunce Domenech in Camagüey's province, from September, 2017 to June, 2020. 35 patients were studied and the following variableswere analyzed: age, breast disease to be corrected with implants, implant volume, access route for implant placement, location of the breast pocket and complications with the procedure. Results: Of all the patients studied, mammary hypotrophy was present in 25 females, predominating in the ages between 30 and 49 years in 68.56% of them. In twelve of the patients who used the subareolar route for implant placement, they presented volumes between 351 and 400 milliliters. The least used access route for implant placement was the axillary route, in one patient and this in turn used a retromuscular breast pocket. Wound dehiscence was the predominant complication. Conclusions: Breast augmentation surgery using alloplastic material is a frequent procedure that is used to correct different breast defects in the specialty of Plastic Surgery, with a variety of techniques and few complications.

Experience of applying cosmetic Etafilcon A contact lens in cases with microcornea / Experiência de aplicação de lentes de contato cosméticas Etafilcon A em casos de microcórnea

ABSTRACT Purpose: Microcornea is a rare condition that frequently resulets in serious cosmetic concerns due to the resultant asymmetrical appearance of the eye, and its cosmetic rehabilitation is possible with the use of colored contact lenses. This paper aims to present our experiences with the use of cosmetic Etafilcon A contact lenses for microcornea. Methods: Eight patients with unilateral microcornea without any systemic involvement were included in this study, and they underwent routine ophthalmological examination, corneal topography, and optical biometry. We applied the cosmetic Etafilcon A contact lens (1-DAY ACUVUE® DEFINE® with Lacreon®) of the same edge color to the patients. The levels of satisfaction in terms of cosmesis and comfort were evaluated with the use of visual analog scales (VAS). Results: In the patients, the corneal diameter asymmetry was acceptably adjusted, and each of the patients reported extreme satisfaction. The mean VAS score was 8.9 ± 1.0 (range: 7-10) for the cosmetic satisfaction rate and 8.4 ± 1.0 (range: 7-10) for the comfort rate. The patients obtained the best-corrected visual acuity without or with additional eye-glasses. None of the patients complained about vision issues under photopic and scotopic conditions. Conclusion: 1-DAY ACUVUE® DEFINE® with Lacreon® lens has promising satisfactory cosmetic outcomes along with visual enhancement in cases of microcornea. This is the first study to report the use of this lens for the cosmetic rehabilitation of patients with microcornea.

RESUMO Objetivo: A microcórnea é uma afecção rara, que frequentemente causa graves queixas estéticas devido a uma aparência assimétrica, mas passível de reabilitação estética através de lentes de contato coloridas. O objetivo deste estudo é apresentar nossas experiências no uso de lentes de contato cosméticas Etafilcon A em casos de microcórnea. Métodos: Oito pacientes com microcórnea unilateral, sem acometimento sistêmico, foram incluídos e submetidos a exame oftalmológico de rotina, topografia corneana e biometria óptica. Aplicamos nos pacientes uma lente de contato cosmética Etafilcon A (1-Day Acuvue® Define® com Lacreon®) da mesma cor da borda da córnea dos pacientes. Os níveis de satisfação em termos de estética e conforto foram avaliados por meio de escalas visuais analógicas (EVA). Resultados: A assimetria do diâmetro da córnea foi corrigida em um grau aceitável e todos os pacientes ficaram muito satisfeitos. A pontuação média da EVA foi de 8,9 ± 1,0 (variação: 7-10) para o grau de satisfação estética e 8,4 ± 1,0 (intervalo: 7-10) para o grau de conforto. Os pacientes obtiveram a melhor acuidade visual corrigida com ou sem óculos adicionais. Não houve queixas visuais em condições fotópicas ou escotópicas. Conclusão: A lente 1-Day Acuvue® Define® com Lacreon® é promissora em termos de resultados estéticos satisfatórios, bem como de melhoria da visão em casos de microcórnea. Este é o primeiro estudo a relatar o uso dessa lente na reabilitação cosmética de pacientes com microcórnea.

Planejamento e marcação simplificados de mastopexia e mamoplastia redutora: o padrão circunvertical "Matryoshka" / Simplified planning and marking of mastopexy and reduction mammoplasty: the circumvertical "Matryoshka" pattern

■ RESUMO Introdução: Como a maioria dos outros procedimentos estéticos, particularmente em órgãos pareados para os quais a simetria é crítica, o resultado bem-sucedido da mastopexia e mamoplastia redutora é amplamente determinado pelo planejamento pré-operatório. Ao considerar cuidadosamente o desenho da ressecção da pele e escolher e desenhar um pedículo apropriado, a necrose da pele, cicatrizes inestéticas e distorção da forma podem ser minimizadas. Métodos: Apresentamos uma técnica original de marcação de pele que combina as vantagens do uso de um template Wise como base para marcação de pele com aquelas do padrão de mamoplastia vertical junto com uma excisão periareolar limitada de pele para encurtar a cicatriz vertical subareolar. Resultados: O design de marcação circunvertical da pele que propomos imita a silhueta de uma boneca russa, a "Matryoshka". Conclusão: Incorporar uma marcação pré-operatória mensurável e com base geométrica certamente oferece um grande grau de controle e consistência.

■ ABSTRACT Introduction: Like most other aesthetic procedures, particularly in paired organs for which symmetry is critical, the successful outcome of mastopexy and reduction mammoplasty is greatly determined by pre-operative planning. By carefully considering the design of the skin resection and choosing and designing an appropriate pedicle, prevention of skin necrosis, unsightly scars, and shape distortion can be minimized. Methods: We present an original skin marking technique that combines the advantages of using a Wise template as the basis for skin marking with those of the vertical mammoplasty pattern together with a limited circumareolar skin excision to shorten the subareolar vertical scar. Results: The circumvertical skin marking design we propose mimics a Russian doll silhouette, the "Matryoshka." Conclusion: Incorporating a geometrically based and measurable pre-operative marking certainly offers a great degree of control and consistency.

Evaluation of the evidence level for the use of radiofrequency in aesthetic treatments: A systematic review and meta-analysis.

BACKGROUND: Radiofrequency (RF) is a non-invasive or minimally invasive procedure with a low risk of complications. It has been employed for several aesthetic purposes. AIM: This study aimed to conduct a systematic literature review on the use of RF for aesthetic applications and assess the level of accumulated evidence for each condition. METHODS: Using the MEDLINE/PubMed and EMBASE databases, we searched for articles published from 2009 to 2019 describing the use of RF treatment for aesthetic purposes. RESULTS: Our search approach identified 25 randomized clinical trials investigating the efficacy of RF in the following clinical situations: body contour improvement, facial rejuvenation, acne scar treatment, alopecia, and rosacea. There were problems with the quality of the studies, especially regarding selection, performance, and detection bias. CONCLUSION: Our study revealed that RF treatment is potentially promising in all of the evaluated clinical situations; however, we were not able to identify a level of evidence that justifies its use over other therapeutic options currently available on the market.

Oncoplastic Surgery in Breast-Conserving Treatment: Patient Profile and Impact on Quality of Life.

BACKGROUND: Breast-conserving treatment (BCT) provides better quality of life (QL) than mastectomy without reconstruction. Oncoplastic surgery (OS) encompasses a series of surgical techniques, increasing the indications for BCT, but few studies have evaluated the impact on QL in patients who undergo BCT with OS. MATERIALS AND METHODS: A prospective, cross-sectional study was conducted in women who underwent BCT. We evaluated the characteristics of patients who underwent BCT with and without OS and the associated QL. QL was assessed through the EORTC QLQ-30, EORTC QLQ-BR23, and Breast Cancer Treatment Outcome Scale (BCTOS) questionnaires. RESULTS: A total of 300 patients underwent BCT, 72 underwent breast OS, and 37 underwent bilateral surgery. Patients who underwent OS were younger (p = 0.004), had a higher level of education (p = 0.01), had a smaller time interval since the end of treatment (p = 0.02), had tumours with greater dimensions (p = 0.003), and were more likely to receive neoadjuvant chemotherapy (p = 0.05). Based on the QL questionnaires, no difference was observed between the groups. Breast symmetry was not associated with high patient satisfaction (p = 0.55). CONCLUSION: Despite the fact that OS was performed in patients with worse tumour conditions and in more demanding patients, OS allowed similar cosmetic results to classical BCT.

Breast-conserving treatment in oncoplastic times: indications, cosmesis, and quality of life

Breast-conserving treatment was established as an oncologically safe procedure for breast cancer. However, the cosmetic outcomes of breast-conserving treatments are often unsatisfactory. In this scenario, oncoplastic breast-conserving surgery incorporated plastic surgery concepts and techniques into the oncological treatment in order to ensure better cosmesis, thus increasing the indications for breast-conserving treatment. At the same time, oncoplastic breast-conserving surgery is usually presented as a generic term, which should be evaluated taking many aspects into account: indication, patient selection, the surgery itself, cosmetic quality, and quality of life ­ data that are still scarce in the literature.

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

Reversão de isquemia labial com calor local após preenchimento com ácido hialurônico / Reversal of lip ischemia with local heat after filling with Hyaluronic Acid

Introdução: uma das mais temidas complicações com o uso de preenchedores faciais é o potencial risco de uma injeção intravascular e, por isso, todos os aplicadores devem ter conhecimento do algoritmo de tratamento no caso de um quadro de isquemia. Objetivo: o presente artigo relata caso de isquemia labial após preenchimento com ácido hialurônico, com reversibilidade completa apenas com o uso de compressas mornas. Métodos: uso de compressas mornas em quadro de isquemia labial. Resultados: reversibilidade completa da isquemia. Conclusão: apesar de não ser medida única a ser adotada num quadro de isquemia após preenchimento com ácido hialurônico, este caso demonstra o valor do uso de compressas mornas que, no presente relato, foi suficiente para reverter o quadro

Introduction: One of the most feared complications when using facial fillers is the potential risk of intravascular injection. Therefore, all applicators must be aware of the treatment algorithm in the case of ischemia. Objective: This article reports a case of lip ischemia after filling with hyaluronic acid, completely reversed only after the use of warm compresses. Methods: Use of warm compresses in case of lip ischemia. Results: Complete reversibility of ischemia. Conclusions: Despite not being the only measure to be adopted in an ischemia condition after hyaluronic acid filling, this case demonstrates the value of using warm compresses, which in the present report was sufficient to revert the condition.

Radiofrequency therapy in esthetic dermatology: A review of clinical evidences.

BACKGROUND: Chronological skin aging causes the modification of genetic material through enzymes and proteins changes. The process reduces cellular proliferation, along with loss of tissue elasticity, reduced ability to regulate aqueous exchanges, and inefficient tissue replication. Appearance is negatively affected by cumulative changes in coloration, texture, and elasticity over time. The increase in the population's average life expectancy boosts the search for cosmetic therapies that can delay aging, mostly for the noninvasive modalities. Among the various options, radiofrequency therapy is a technique that can help reduce the effects of skin aging. AIM: Therefore, this study aims to review clinical evidence provided by scientific literature on the benefits of using radiofrequency therapy in reducing skin aging effects. METHODS: A review of the literature concerning skin aging, characteristics of radiofrequency therapy, and radiofrequency therapy in the treatment of skin laxity and mechanism of action was conducted using PubMed. RESULTS: The included studies have suggested that the mechanism of radiofrequency action is heating the dermis while preserving the epidermis. This heating causes immediate collagen denaturation, which is followed by the formation of new collagen, naturally providing skin tightening and greater elasticity. CONCLUSION: Even when used as single therapeutic modality, radiofrequency seems to meet the expectations in reducing the effects of skin aging.

Abordagem combinada para o tratamento de cicatrizes de acne em todos os tipos de pele: CROSS com fenol, subcisão com cânulas em dois planos e microagulhamento / A combination approach to treating acne scars in all skin types: carbolic CROSS, blunt bi-level cannula subcision, and microneedling

A acne é uma condição comum que muitas vezes resulta em cicatrizes. Propomos um novo tratamento para as cicatrizes da acne usando: 1- reconstrução química de cicatrizes (CROSS), principalmente com fenol, 2- subcisão com cânula em dois níveis, e 3- microagulhamento. Um total de 139 pacientes foram tratados em 2017 e 2018, dos quais 89 (64%) eram de Fototipos de Fitzpatrick IV-VI. Esta abordagem tripla para o tratamento de cicatrizes de acne resultou em consistente alta satisfação dos pacientes e evidência fotográfica de melhoria. A combinação de CROSS (para estimular a neocolagênese), subcisão (para liberar as traves do tecido conjuntivo dérmico) e microagulhamento (também para estimular a neocolagênese) é eficaz para tratar as cicatrizes da acne.

Acne is a common condition that often results in scarring. We propose a novel treatment of acne scarring using: 1- chemical reconstruction of skin scars (CROSS), mainly with carbolic acid, 2- blunt bi-level cannula subcision, and 3- microneedling. A total of 139 patients were treated from 2017- 2018, of which 89 (64%) were Fitzpatrick Skin Types IV-VI. This triple approach to treating acne scars resulted in consistent high satisfaction from patients and photographic evidence of improvement. A combination of CROSS (to stimulate neocollagenesis), subcision (to release dermal connective tissue tethering), and microneedling (to stimulate neocollagenesis) is effective for acne scar treatment.

Avaliação da eficácia e segurança do microagulhamento com 5-fluorouracil para o tratamento de estrias albas: ensaio clínico randomizado duplo-cego / Evaluation of the efficacy and safety of microneedling with 5-fluorouracil for the treatment of striae alba: double-blind, randomized clinical trial

Introdução: Estrias são um desafio cotidiano ao dermatologista. Na busca por terapias alternativas, surgem o 5-fluorouracil (5-FU) e o microagulhamento ao associarem as seguintes propriedades: inibir fibrose, estimular renovação do colágeno e induzir pigmentação da pele. Objetivo: Avaliar a eficácia e segurança do 5-FU, isolado ou associado ao microagulhamento, no tratamento das estrias albas. Métodos: Estudo duplo-cego comparativo, durante 180 dias, entre três grupos: Grupo A - microagulhamento e 5-FU; Grupo B - 5-FU intralesional; e Grupo C - microagulhamento sem medicação. Mensurou-se a melhora por meio de uma escala numérica de coloração da pele, considerando-se resultados positivos aqueles com redução da discrepância entre a cor da pele adjacente e a da estria. Avaliou-se também a satisfação do paciente e a irritação com cada técnica. Resultados: Grupo A obteve 10% de melhora clínica excelente; 10%, muito boa; e 60%, leve. No grupo B, nenhuma paciente teve melhora excelente ou muito boa. Já no grupo C, observaram-se 20% de melhora clínica muito boa e 70% de melhora leve. Conclusões: Todas as técnicas apresentaram algum grau de melhora das lesões. Assim, propõem- se novos estudos comparando-se as três técnicas, com amostra mais ampla, para avaliar se maior número de sessões resultaria em resultados mais expressivos.

Introduction: Stretch marks are an everyday challenge to the dermatologist. In the search for alternative therapies, we find 5-fluorouracil (5-FU) and microneedling for associating the following properties: inhibition of fibrosis, stimulation of collagen renovation and induction of skin pigmentation. Objective: To evaluate the efficacy and safety of 5-FU, in isolation or associated to microneedling, for the treatment of white stretch marks (striae alba). Methods: Comparative, double-blind study over 180 days, between 3 groups: Group A: microneedling and 5-FU; Group B intralesional 5-FU and Group C microneedling without medication. We measured improvement through a numerical scale of skin coloration, considering positive results those with reduction of the discrepancy between the adjacent skin and the stretch mark. We also evaluated patient satisfaction and irritation with each technique. Results: Group A achieved 10% of excellent clinical improvement, 10% very good and 60% mild. In group B, none of the patients had excellent of very good improvement. In group C, there was 20% of very good clinical improvement and 70% of mild. Conclusions: All techniques showed some degree of improvement of the lesions. Therefore, we propose new studies comparing all three techniques, with a larger sample, to evaluate if more treatments would result in better results.

Quality of life before and after cosmetic procedures on the face: A cross-sectional study in a public service.

BACKGROUND: Quality of life can be impaired by health conditions that modify body appearance. AIMS: The objective of this cross-sectional study was to evaluate the quality of life of patients before and after free-of-charge esthetic dermatological treatments offered in a philanthropic Dermatological Clinic for nonpathological conditions, such as anti-aging procedures. METHODS: All consecutive patients admitted between March and November 2016 were recruited. All esthetic treatments in this study were simple procedures applied in one session only, on the face, neck, arms, and upper chest, with a consult visit scheduled four weeks later for clinical evaluation. The WHOQOL-BREF instrument was used before and one month after the procedure. RESULTS: WHOQOL-BREF scores increased significantly after treatment (P < 0.001) in all the domains. CONCLUSION: Patients undergoing simple dermatological treatments applied by specialists report overall and specific domain improvements in quality of life, according to the World Health Organization instrument, regardless of the type of procedure.