Scientific validation of three-dimensional stereophotogrammetry compared to the IGAIS clinical scale for assessing wrinkles and scars after laser treatment.

Measuring outcomes from treatments to the skin is either reliant upon patient's subjective feedback or scale-based peer assessments. Three-Dimensional stereophotogrammetry intend to accurately quantify skin microtopography before and after treatments. The objective of this study is comparing the accuracy of stereophotogrammetry with a scale-based peer evaluation in assessing topographical changes to skin surface following laser treatment. A 3D stereophotogrammetry system photographed skin surface of 48 patients with facial wrinkles or scars before and three months after laser resurfacing, followed immediately by topical application of vitamin C. The software measured changes in skin roughness, wrinkle depth and scar volume. Images were presented to three observers, each independently scoring cutaneous improvement according to Investigator Global Aesthetic Improvement Scale (IGAIS). As for the results, a trend reflecting skin/scar improvement was reported by 3D SPM measurements and raters. The percentage of topographical change given by the raters matched 3D SPM findings. Agreement was highest when observers analysed 3D images. However, observers overestimated skin improvement in a nontreatment control whilst 3D SPM was precise in detecting absence of intervention. This study confirmed a direct correlation between the IGAIS clinical scale and 3D SPM and confirmed the efficacy and accuracy of the latter when assessing cutaneous microtopography alterations as a response to laser treatment.

Treatment of Scars with Laser-Assisted Delivery of Growth Factors and Vitamin C: A Comparative, Randomised, Double-blind, Early Clinical Trial.

BACKGROUND: Scarring can jeopardize the final result of plastic surgeries. Deep dermal injuries activate dermal fibroblasts that produce excessive amount of collagen and inflammatory cytokines and growth factors, which contributes to increased fibrous tissue and scarring tissue formation. OBJECTIVES: The aim of this early study, double-blind, prospective, randomised clinical trial was to investigate the use of laser-assisted drug delivery (LADD) for scar improvement to support the establishment of LADD as standard therapy modality and to indicate suitable drugs for dermal administration. MATERIAL AND METHODS: In total, 132 patients seeking scar treatment were consented and randomised. The control group (64 patients) received laser resurfacing immediately followed by skin surface application of Vitamin C and 68 patients received laser treatment followed by skin surface application of a cosmeceutical containing growth factors (GFs) and Vitamin C. Photographs were obtained before and three months after the procedure and submitted to three-dimensional reconstruction by the software Dermapix®. Objective measurements provided by the software were statistically analysed and established the differences in the treatment result between the two groups. RESULTS: There was a significant reduction in scar roughness and volume in both groups (p < 0.01). Mann-Whitney test confirmed that the group treated vitamin C and GFs presented significantly better results than the group treated with vitamin C alone (p < 0.01). CONCLUSION: LADD has proven efficient as scars were reduced in both study groups. Furthermore, the addition of growth factors provided statistically significant better outcomes and resulted in more inconspicuous scars. No adverse reactions were observed. CLINICAL TRIAL REGISTRATION: Plataforma Brasil under the number CAAE: 63710716.2.0000.5664. LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors   www.springer.com/00266 .

Comparative Study on the Outcome of Periorbital Wrinkles Treated with Laser-Assisted Delivery of Vitamin C or Vitamin C Plus Growth Factors: A Randomized, Double-blind, Clinical Trial.

BACKGROUND: Despite promising results, laser-assisted drug delivery (LADD) is not yet considered as standard therapies and published data rely mainly on laboratory tests, animal experiments or cadaver skin. OBJECTIVES: This double-blind, prospective, randomized clinical trial investigates the impact in topical application of vitamin C and a cosmeceutical containing growth factors (GFs) on periorbital wrinkles primarily treated with laser skin resurfacing. MATERIAL AND METHODS: In total, 149 female patients with periorbital wrinkles were consented and randomized into two study groups, R-C (receiving vitamin C only) and R-CGF (receiving vitamin C and a cosmeceutical containing growth factors). The statistical analysis evaluated the efficacy of each treatment regimen using software readouts provided by a three-dimensional stereophotogrammetry system prior to treatment and three months after the procedure. Results were compared to confirm if there was a significant change in the skin roughness and the average depth of the wrinkles between the two groups after treatment. RESULTS: There was a significant reduction in both skin roughness and average depth of the wrinkles in the group treated with vitamin C and growth factors (p <0.01) than those treated with LADD followed by topical application of vitamin C alone. There were no cutaneous reactions or adverse systemic reactions observed in this study related to LADD with vitamin C and GFs. CONCLUSION: Controlled laser application might have a great potential to facilitate the absorption of exogenous macromolecules by the skin. Periorbital wrinkles were reduced in both groups, but LADD using vitamin C and GFs provided significantly better results. LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Leiomioma cutâneo piloeretor: relato de caso e análise de possibilidades terapêuticas / Cutaneous pilar leiomyoma: case report and analysis of therapeutic possibilities

Introdução: O leiomioma cutâneo piloeretor (LCP) é um tumor benigno de pele, de incidência rara, proveniente do músculo eretor do pelo. Sua apresentação clínica mais frequente é o aparecimento de nódulos isolados ou em grande número. Em geral, são dolorosos, sensíveis ao frio, toque, pressão e à emoção. Vários agentes farmacológicos têm sido utilizados com algum sucesso para redução da dor e do desconforto local. Entretanto, em casos nos quais os sintomas dolorosos são intensos ou causam restrição social, a cirurgia torna-se uma abordagem alternativa a ser considerada. Neste artigo relatamos o caso de um paciente do sexo masculino, portador de múltiplos leiomiomas cutâneos na parede torácica anterior à esquerda e no abdome, bem como a terapêutica utilizada para seu caso. Métodos: O tratamento compreendeu a ressecção cirúrgica total da lesão, com fechamento da ferida com o uso de enxerto de pele parcial, retirado da região anterolateral da coxa direita. Resultados: A reconstrução imediata do defeito resultante, com enxerto de pele parcial, assegurou a cicatrização sem intercorrências. Após o tratamento, houve completa remissão do quadro doloroso, o que permitiu completa reintegração social do paciente, tendo sido alcançado ainda resultado estético aceitável. Conclusão: O LCP constitui patologia de difícil tratamento, embora tenha várias possibilidades terapêuticas. A ressecção cirúrgica completa de múltiplos leiomiomas cutâneos pode impedir a recorrência da doença, embora alguma recidiva local seja relatada na literatura.

Introduction: Cutaneous pilar leiomyoma (CPL) is a rare benign skin tumor arising from arrector pili muscles. Its most common clinical manifestation is the appearance of nodules that may either be isolated or clustered. In general, these tumors are painful and sensitive to cold, touch, pressure, and emotional stimuli. Several pharmacological agents have been used with some success to reduce local pain and discomfort. However, in cases with intensely painful symptoms or that cause social constraints to the patient, surgery becomes an alternative approach. Here, we report the case of a male patient with multiple cutaneous leiomyomas in the left anterior chest wall and abdomen, and the therapeutic approaches used for this case. Methods: The treatment included a complete surgical resection of the tumor and wound closure with partial skin graft taken from the anterolateral region of the right thigh. Results: The immediate reconstruction of the resulting defect with a partial skin graft ensured healing without complications. After the treatment, complete remission of the pain symptoms occurred, in addition to an acceptable aesthetic outcome, which allowed the full social reintegration of the patient. Conclusion: CPL is a disease that is difficult to treat; however, several therapeutic approaches can be used. The complete surgical resection of multiple cutaneous leiomyomas can prevent the recurrence of the disease, although some local recurrences have been reported in the literature.

Captação e fidelização do paciente ao cirurgião plástico / Captation and patient's loyalty to plastic surgeon

RESUMO Este artigo versa sobre a delicada natureza da relação médicopaciente, suas limitações, nuances e particularidades. Nele, tecemos considerações sobre o comportamento atual da mídia e internet, cada vez mais exigentes e tendenciosas, bem como o atuar dentro do consultório médico. Observamos que a ética, e um amplo entendimento de nossas possibilidades e limitações são a chave para se obter boa relação médico-paciente evitando demandas judiciais. .

ABSTRACT This article is about the tender nature of patient-doctor relationship, its limitations, details and particularities. Here, we make some considerations about actual behavior of media and internet, each time more and more demanding and tendentious, as well as how to act in a consultation room. We realized that Ethics and an abroad comprehension of our possibilities and limitations are the key for avoiding juridic problems and to obtain a satisfactory patient-doctor relationship.

Cicatrizes inestéticas da face / Unsatisfactory scars on the face

O autor analisa 231 casos de cicatrizes inestéticas da face, consequentes a traumatismos, excluindo-se queimaduras, submetidos a tratamento cirúrgico na Clínica Ivo Pitanguy, no período de janeiro de 1981 a dezembro de 1991. Säo analisados a distribuiçäo entre sexo, faixa etária, agente causador, tempo de evoluçäo das cicatrizes, queixas, diagnóstico, procedimentos utilizados e os resultados obtidos. É feita uma discussäo sobre as técnicas utilizadas, avaliando-se suas melhores indicaçöes em relaçäo às regiöes da face envolvidas às linhas de tensäo da pele. A face foi dividida em 7 unidades estéticas: frontal superciliar, periorbitária, nasal, geniana, perioral e metoniana. A literatura sobre os diferentes procedimentos utilizados no tratamento dessas cicatrizes e as regiöes da face onde foram mais comumente empregados säo discutidas