Autoestima e qualidade de vida em pacientes submetidos a cirurgia plástica / Self-esteem and quality of life in patients undergoing plastic surgery

Introdução: A autoestima é definida pelo valor que as pessoas dão a si mesmas. É um componente avaliativo do autoconhecimento. A cirurgia plástica tem sido uma alternativa para as pessoas melhorarem a visão de si mesmas, sentindo-se mais confiantes e satisfeitas com seus aspectos corporais. Dessa forma, com a elevação da autoestima nessas pessoas, a cirurgia é capaz de interferir de forma positiva não somente na autoavaliação corporal, mas também na dimensão psicossocial. Método: Foi realizado um estudo observacional descritivo e analítico longitudinal prospectivo no qual foi avaliado o impacto da cirurgia plástica na autoestima e nos relacionamentos pessoais e profissionais. Aplicamos um questionário sociodemográfico, a Escala de Autoestima de Rosenberg, além do Questionário de Qualidade de Vida da OMS abreviado (WHOQOL-bref) em pacientes no pré-operatório e que serão submetidos a cirurgia plástica com, pelo menos, 3 meses de pós-operatório, graduando, desta forma, a melhora ou não da autoestima e qualidade de vida. Resultados: Participaram da pesquisa 52 pacientes, sendo 48 mulheres (92,3%), apresentando idade média de 37±11 anos. Através da aplicação da Escala de Autoestima de Rosenberg, pudemos notar uma evolução da autoestima, em que os pacientes apresentaram uma média de 29,87±2,10 pontos no escore do período pré-operatório, passando para 34,92±1,84 pontos no período pós-operatório. (p<0,001). Já no WHOQOL-bref, foi obtida uma melhora da autoestima através dos escores dos 4 domínios. Conclusão: Através deste estudo, foi evidenciado um aumento da autoestima e qualidade de vida.

Introduction: Self-esteem is defined by the value people place on themselves. It is an evaluative component of self-knowledge. Plastic surgery has been an alternative for people to improve their vision of themselves, feeling more confident and satisfied with their body aspects. Therefore, by increasing self-esteem in these people, surgery is capable of positively interfering not only with body self-assessment but also in the psychosocial dimension. Method: A prospective longitudinal descriptive and analytical observational study was carried out in which the impact of plastic surgery on self-esteem and personal and professional relationships was assessed. We applied a sociodemographic questionnaire, the Rosenberg Self-Esteem Scale, in addition to the abbreviated WHO Quality of Life Questionnaire (WHOQOL-bref) in patients in the preoperative period and who will undergo plastic surgery at least 3 months after surgery. surgery, thus determining whether or not self-esteem and quality of life improve. Results: 52 patients participated in the research, 48 of whom were women (92.3%), with a mean age of 37±11 years. Through the application of the Rosenberg Self-Esteem Scale, we were able to notice an evolution in self-esteem, in which patients presented an average of 29.87±2.10 points in the preoperative period score, rising to 34.92±1.84 points in the postoperative period (p<0.001). In the WHOQOL-bref, an improvement in self-esteem was obtained through the scores of the 4 domains. Conclusion: Through this study, an increase in self-esteem and quality of life was evidenced.

Técnica Boomerang para plástica genital estética feminina / Boomerang technique for female genital aesthetic surgery

Introdução: A hipertrofia de pequenos lábios combinada com capuz clitoriano redundante é uma queixa comum entre mulheres que procuram cirurgia plástica genital cosmética por queixas funcionais, psicológicas e estéticas. O objetivo deste estudo foi descrever a técnica boomerang, um tratamento cirúrgico da hipertrofia labial que se estende a todo o capuz clitoriano. Método: Foi conduzido um estudo retrospectivo, de caráter analítico, para avaliar os prontuários médicos de 48 pacientes consecutivas submetidas a cirurgia estética genital feminina entre julho de 2017 e julho de 2021. Todos os procedimentos cirúrgicos foram realizados pela mesma cirurgiã. A técnica utilizada nas pacientes consistiu na ressecção longitudinal dos excessos de pequenos lábios vaginais associado à ressecção de capô clitoriano em forma de boomerang e à clitoropexia. Resultados: A idade média das pacientes submetidas a cirurgia foi de 36,25 anos (intervalo 18-59 anos), entre as quais 94,44% apresentaram queixas estéticas associadas ou não a queixas funcionais, e 5,56% apresentaram somente queixas funcionais. Duas pacientes apresentaram hematomas nos grandes lábios no pós-operatório imediato, e uma paciente teve deiscência de sutura nos pequenos lábios. Conclusão: A técnica boomerang é reprodutível e proporciona benefícios estéticos e/ou funcionais na genitália feminina.

Introduction: Hypertrophy of the labia minora combined with a redundant clitoral hood is a common complaint among women seeking aesthetic genital cosmetic surgery for functional, psychological, and aesthetic complaints. The objective of this study was to describe the boomerang technique, a surgical treatment for labial hypertrophy that extends to the entire clitoral hood. Method: A retrospective, analytical study was conducted to evaluate the medical records of forty-eight consecutive patients who underwent female genital cosmetic surgery between July 2017 and July 2021. The same surgeon performed all surgical procedures. The technique used in the patients consisted of longitudinal resection of excess small vaginal lips associated with resection of the boomerang-shaped clitoral hood associated with clitoroplasty. Results: The average age of patients undergoing surgery was 36.25 years (range 18-59 years), among whom 94.44% had aesthetic complaints associated or not with functional complaints, and 5.56% had only functional complaints. Two patients had bruises on the labia majora in the immediate postoperative period, and one patient had suture dehiscence on the labia minora. Conclusion: The boomerang technique is reproducible and provides aesthetic and/or functional benefits to the female genitalia.

Robotic-assisted free flap harvesting for diverse soft tissue reconstruction: a PRISMA scoping review of clinical outcomes over the last decade.

Introduction: The aim of our study was to assess the advantages and limitations of robotic technology in diverse reconstructive procedures. METHODS: A scoping review was conducted in Oct'23, on published studies from 2013 to 2023, focussing on robotic-assisted free flap harvesting. Three databases Ovid-MEDLINE, Scopus, and PubMed were searched. Original research studies reporting robotic-assisted free flap harvest were included. Studies on lesion excision, microvascular anastomosis, local flap harvest, roboticassisted flap inset, review articles, abstract-only studies, non-English documents, and animal studies were excluded from this review. RESULTS: Sixteen studies met the inclusion criteria out of a total of 318, searched initially. These studies included a total of 128 patients, who underwent robotic-assisted free flap harvest for the reconstruction of various defects, with 140 free flaps harvested. The most common flaps harvested by robotic technique were deep inferior epigastric artery perforator (DIEP) flap 120 (85.7%), radial forearm free (RFF) flap 11 (7.9%), latissimus dorsii flap 4 (2.9%), rectus abdominus flap 4 (2.9%), and omental flap 1 (0.7%). Breast reconstruction was the major procedure done i.e. 120 (85.7%) followed by head and neck 11 (7.9%) and limb defects 9 (6.4%) reconstruction procedures. The reported clinical outcomes were acceptable in all the studies with a 99% flap success rate and minimal complications. Variability in operating time was observed depending upon surgical steps undertaken with robotic systems. CONCLUSIONS: This scoping review highlights the role of robotic-assisted free flap harvesting in plastic surgery and its potential benefits on clinical outcomes, due to its high precision and minimal invasiveness. However, challenges like cost effectiveness, resource distribution and learning curve are there.

Mechanical Purification of Lipofilling: The Relationship Between Cell Yield, Cell Growth, and Fat Volume Maintenance.

BACKGROUND: The mechanical manipulations of fat tissue represented from centrifugation, filtration, washing, and fragmentation were considered the most effective strategies aiming to obtain purified lipofilling with different impacts both in terms of adipose-derived stem cells amount contained in stromal vascular fraction, and fat volume maintenance. OBJECTIVES: The present work aimed to report results in fat volume maintenance obtained by lipofilling purification based on the combined use of washing and filtration, in a clinical study, and to deeply investigate the adipose-derived stem cells yield and growth capacity of the different stromal vascular fraction extraction techniques with an in vitro approach. METHODS: A preliminary prospective, case-control study was conducted. 20 patients affected by face and breast soft tissue defects were treated with lipofilling and divided into two groups: n = 10 patients (study group) were treated with lipofilling obtained by washing and filtration procedures, while n = 10 (control group) were treated with lipofilling obtained by centrifugation according to the Coleman technique. 6 months after the lipofilling, the volume maintenance percentage was analyzed by clinical picture and magnetic resonance imaging comparisons. Additionally, extracted stromal vascular fraction cells were also in vitro analyzed in terms of adipose-derived stem cell yield and growth capacity. RESULTS: A 69% ± 5.0% maintenance of fat volume after 6 months was observed in the study group, compared with 44% ± 5.5% in the control group. Moreover, the cellular yield of the control group resulted in 267,000 ± 94,107 adipose-derived stem cells/mL, while the study group resulted in 528,895 ± 115,853 adipose-derived stem cells /mL, with a p-value = 0.1805. Interestingly, the study group showed a fold increase in cell growth of 6758 ± 0.7122, while the control group resulted in 3888 ± 0.3078, with a p < 0.05 (p = 0.0122). CONCLUSIONS: The comparison of both groups indicated that washing and filtration were a better efficient system in lipofilling preparation, compared to centrifugation, both in terms of volume maintenance and adipose-derived stem cell growth ability. LEVEL OF EVIDENCE III: 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 http://www.springer.com/00266 .

Ghana 3D Telemedicine International MDT: A proof-of-concept study.

A real-time 3D Telemedicine system - leveraging Microsoft's Holoportation™ communication technology - enabled an international multidisciplinary team meeting (MDT) to consult with complex reconstructive patients before, during, and after an overseas surgical collaboration. METHODS: A proof-of-concept international 3D MDT clinic took place in November 2022, between the Canniesburn Plastic Surgery Unit, UK, and the National Reconstructive Plastic Surgery and Burns Centre, Korle Bu Teaching Hospital, Ghana. The 3D system was utilised 1) previsit to assess patients and enable logistical planning, 2) on-site in Ghana to further allow patients to see themselves and proposed operations in 3D, and 3) post visit to debrief the team and patients. RESULTS: Four Ghana patients were followed through their patient journey (mandibular ameloblastoma, sarcoma thigh, maxillary tumour, sarcoma back). Thirteen participants (four patients, four Ghana clinicians, and five UK clinicians) completed feedback on the 3D MDT. Outcome measures were rated highly with satisfaction 84.31/100, perceived benefit 4.54/5, overall quality 127.3/147 (Telehealth Usability Questionnaire), and usability 83.2/100 (System Usability Scale). These data show close alignment with that previously published on high-income countries. CONCLUSIONS: This novel technology has the potential to enhance the delivery of overseas surgical visits to low-to-middle-income countries, by improving planning, informed discussion with patients, expert consensus on complex cases, and fostering engagement with professionals who may be thousands of miles away. This is the first demonstration that real-time 3D Telemedicine can both work, and enhance care within an international MDT clinic, and may thus enable change in the approach to overseas surgical collaborations.

Robotic and Plastic Surgery: actuality and prospects for the near future, a scoping review

ABSTRACT Objective This work aims to review the existing use of robotics in plastic surgery. Methods A meticulous selection process identified 22 articles relevant to this scoping review. Results The literature on the use of robotics in plastic surgery is sparse. Nonetheless, this review highlights emerging benefits in microsurgery, breast reconstruction, and transoral surgery. Conclusion This scoping review identifies critical articles reporting the emerging use of robotics in plastic surgery. While the scientific medical community has yet to extensively document its use, the available evidence suggests a promising future for robotics in this field.

Rinoplastia ultrasónica, mitos y verdades / Ultrasonic rhinoplasty, myths and truths

Introducción: : la cirugía plástica facial tiene una evolución constante en su técnica, análisis y resultados. La rinoplastia es una de las cirugías más frecuentes de cirugía plástica facial. Para esta cirugía se han empleado instrumentos de metal que cortan de la forma más adecuada posible para dejar el dorso nasal sin irregularidades, enderezar la pirámide nasal y disminuir asimetrías de huesos nasales. En la actualidad contamos con piezas de acero de uso médico quirúrgico y piezas de corte mecánico rotativo u oscilantes que permiten un corte preciso a través de macrovibraciones. Desde hace algunos años tenemos a disposición el bisturí ultrasónico que permite el corte a través de la microvibración, al tiempo que realiza hemostasia gracias al efecto de cavitación generado por el ultrasonido, con mejor calidad en los trazos de fractura deseados y menor lesión del tejido, lo que da como resultado un menor trauma y disminuye, a nivel macro, manifestaciones como sangrado, equimosis, hematomas, edema y dolor postoperatorio. Objetivo: el objetivo de este artículo es actualizar a los cirujanos de nariz interesados en conocer la tecnología ultrasónica y sus beneficios en cirugía de nariz. Discusión y conclusiones: la rinoplastia implica investigación y avance tanto en la técnica como en la anatomía y tecnología; ahora disponemos de equipos de microvibración ultrasónica relacionada con la piezoelectricidad que proporciona condiciones que mejoran tanto la calidad en los resultados como la confortabilidad para el paciente en el posoperatorio por un menor sangrado, menor inflamación, menor dolor, menor lesión de tejidos blandos y mejor calidad en los resultados.

Introduction: Facial plastic surgery has a constant evolution in its technique, analy-sis, and results. Rhinoplasty is one of the most frequent surgeries of facial plastic surgery, for this surgery metal instruments have been used since the beginning of his-tory that cut in the most appropriate way possible to leave the nasal dorsum without irregularities, straighten the nasal pyramid and reduce asymmetries of the nasal bo-nes. Nowadays we have steel parts for surgical medical use, rotary and oscillating mechanical cutting parts, which allow precise cuts through macro vibrations. For a few years, we have available the ultrasonic scalpel that allows cutting through micro vibrations while performing hemostasis thanks to the cavitation effect generated by the ultrasound, with better quality in the desired fracture stokes and fewer tissue in-juries resulting in less trauma, decreasing at the macro level the manifestations such as bleeding, ecchymosis, bruising, swelling, and post-surgery pain. Objective: The objective of this article is to update nose surgeons interested in knowing ultrasonic technology and its benefits in nose surgery. Discussion and conclusions: Rhinoplas-ty involves research and advancement in both technique anatomy and technology. We now have ultrasonic micro-vibration equipment related to piezoelectricity that provides conditions that improve both the quality of the results and the comfort of the patient in the postoperative period due to less bleeding, less inflammation, less pain, less soft tissue injury, and better-quality results.

Efficacy of adhesive strapping on umbilical hernia in children: a systematic review and meta-analysis of cohort studies.

Background: Although adhesive strapping (AS) for pediatric umbilical hernia (UH), which was once obsolete, has been reconsidered as a common practice in Japan, its efficacy is still unclear. This study aimed to evaluate its efficacy by reviewing related articles. Methods: A comprehensive literature search of PubMed, Cochrane, Google Scholar, and Igaku Chuo Zasshi via Ichushi-Web was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Cohort studies reporting on the UH closure rate after AS compared with observation-only management were included. Results: A total of 10 cohort studies were included, and the overall UH closure rate was not statistically significant (p=0.31, risk ratio (RR)=0.76, 95% confidence interval (CI) 0.45 to 1.28). However, there were significant differences in the UH closure rate at the age of 6 months (p<0.01, RR=0.55, 95% CI 0.41 to 0.75) and the efficacy of preventing protruding umbilici with redundant skin (p=0.049, RR=0.16, 95% CI 0.03 to 0.99). Conclusions: Although the efficacy of AS on UH compared with observation-only management did not differ in terms of the UH closure rate, the application of AS may be effective for faster UH closure and the prevention of protruding umbilici. However, due to the high heterogeneity of the study, further large-scale studies, particularly randomized controlled trials, are warranted to reach a conclusion. PROSPERO registration number: CRD42022314417.

Reconstrucción palpebral postumorectomía. Presentación de un caso / Lower eyelid reconstruction after lumpectomy. A case report

Algunos pacientes en la tercera edad desarrollan con frecuencia diversas enfermedades, entre ellas se encuentra el cáncer de piel y la predisposición a la aparición de tumores, tanto en los párpados como en la conjuntiva. Entre los tumores epiteliales malignos se destacan: el carcinoma basocelular y el carcinoma epidermoide; con menor frecuencia, el carcinoma de células de Meibomio y el melanoma palpebral, y raramente, el carcinoma de células de Merkel. Por esta causa, se realizó la presentación de un caso clínico que recibió tratamiento en el Servicio de Cirugía Plástica del Hospital Vladimir Ilich Lenin, de Holguín, al cual se le aplicó la técnica de Mustardé por presentar tumor del párpado inferior. El objetivo fue presentar un paciente con reconstrucción palpebral postumorectomía y mostrar su resultado funcional y estético postoperatorio. Este caso evolucionó satisfactoriamente, sin aparición de complicaciones transoperatorias o postoperatorias.

Some elderly patients frequently develop various diseases, including skin cancer as well as a predisposition to the appearance of tumours, both in the eyelids and conjunctiva. Basal cell carcinoma and epidermoid carcinoma stand out among the malignant epithelial lesions; meibomian cell carcinoma and palpebral melanoma which are less common, and Merkel cell carcinoma rarely known. We present a male patient who received treatment in the plastic surgery service at "Vladimir Ilich Lenin" Hospital, in Holguín, to which Mustardé technique was applied for a tumour of the lower eyelid. An eyelid reconstruction was performed after lumpectomy which allowed us to show a postoperative functional and aesthetic result. This case evolved satisfactorily, without the appearance of intraoperative or postoperative complications.

Impactos da pandemia de COVID-19 nas especialidades cirúrgicas em um hospital universitário da Bahia: um estudo transversal retrospectivo / Impacts of the COVID-19 pandemic on surgical specialties at a university hospital in Bahia: a retrospective cross-sectional study

Introdução: Desde o início da pandemia de COVID-19, as especialidades médicas adaptaram sua rotina, postergando procedimentos não essenciais, o que resultou em redução no número de atendimentos cirúrgicos, impactando diretamente nos hospitais de ensino. O objetivo desse trabalho é avaliar o impacto da pandemia de COVID-19 nas atividades das especialidades cirúrgicas do Hospital Universitário Professor Edgard Santos (C-HUPES), localizado em Salvador-BA. Método: Estudo observacional, transversal, retrospectivo, que compara o ano de 2020 ao ano de 2019, em que são analisados os impactos da pandemia nas atividades cirúrgicas (especialmente na cirurgia plástica) do hospital, através do número total de procedimentos, internações e de consultas ambulatoriais das especialidades cirúrgicas. Resultados: Redução de 45,45% no número total de procedimentos cirúrgicos foi observada, havendo um total de 220 cirurgias em 2019 e 120 cirurgias em 2020. Redução de 37,29% no número total de internamentos, total de 236 em 2019 e 148 em 2020. Observou-se diminuição de 40,90% nas consultas ambulatoriais, realizadas 2941 consultas em 2019 e 1738 consultas em 2020. Percebe-se que os piores períodos de redução em 2020 foram de março a junho, além de nova queda em novembro e dezembro. Conclusão: A pandemia impactou as atividades das especialidades cirúrgicas do C-HUPES, devido à redução total da quantidade de cirurgias, consultas e internamentos em 2020, prejudicando a assistência aos pacientes da cirurgia plástica em números absolutos. Infere-se que a pandemia de COVID-19 prejudicou a formação dos residentes de cirurgia plástica.

Introduction: Since the beginning of the COVID-19 pandemic, medical specialties have adapted their routine, postponing non-essential procedures, which resulted in a reduction in the number of surgical visits, directly impacting teaching hospitals. This work aims to evaluate the impact of the COVID-19 pandemic on the activities of the surgical specialties at the University Hospital Professor Edgard Santos (C-HUPES), located in Salvador-BA. Method: Observational, cross-sectional, retrospective study, which compares the year 2020 to the year 2019, in which the impacts of the pandemic on the surgical activities (especially plastic surgery) of the hospital are analyzed through the total number of procedures, hospitalizations, and outpatient consultations of surgical specialties. Results: A reduction of 45,45% of the total number of surgical procedures was observed, with 220 surgeries in 2019 and 120 surgeries in 2020. Reduction of 37.29% in hospitalizations, totaling 236 in 2019 and 148 in 2020. There was a decrease of 40.90% in outpatient consultations, with 2941 consultations performed in 2019 and 1738 consultations in 2020. It is noticed that the worst periods of reduction in 2020 were from March to June, in addition to a new drop in November and December. Conclusion: The pandemic impacted the activities of the surgical specialties at C-HUPES due to the total reduction in the number of surgeries, consultations, and hospitalizations in 2020, impairing the care of plastic surgery patients in absolute numbers. It is inferred that the COVID-19 pandemic hampered the training of plastic surgery residents.

Evaluación clínica para el aumento del mentón en pacientes sometidos a rinoplastia / Clinical evaluation for chin augmentation in patients undergoing rhinoplasty

Introducción: el análisis detallado de las proporciones nasofaciales desempeña un papel fundamental para lograr la armonía facial e identificar desequilibrios; asi se dirige el tratamiento quirúrgico para lograr mejores resultados postoperatorios. El objetivo de este estudio fue determinar la prevalencia de pacientes sometidos a rinoplastia que requerían, además, un aumento del mentón. Materiales y métodos: se seleccionaron 100 pacientes voluntarios sometidos a rinoplastia entre los 17 y 55 años y se les realizó un estudio fotográfico preoperatorio. Se realizó un análisis facial del tercio inferior de la cara mediante tres métodos: González-Ulloa, Goode y Silver, y se hizo un análisis univariado y bivariado. Resultados: 100 pacientes voluntarios ingresaron al estudio; de estos, 7 fueron excluidos y quedaron 73 mujeres y 20 hombres; la edad mínima fue de 17 años y la máxima de 55 años, con un promedio de 28,4 años. La edad media de los hombres fue de 30,9 años y de las mujeres de 28,2 años. Del total de pacientes, 96,7 % de los pacientes cumplían con 2 o 3 métodos para aumento del mentón; de estos, 78,8 % eran mujeres y 21,1 % eran hombres. Conclusión: un análisis adecuado de las proporciones nasofaciales es fundamental para determinar los procedimientos necesarios para lograr un buen resultado quirúrgico y una mayor satisfacción del paciente. Estos métodos no sustituyen el juicio estético del cirujano; sin embargo, proporcionan un estándar objetivo para el diagnóstico de los desequilibrios faciales.

Introduction: Detailed analysis of nasofacial proportions plays a fundamental role in achieving facial harmony and identifying imbalances; thus, surgical treatment is directed to achieve better postoperative outcomes. The aim of this study was to determine the prevalence of patients undergoing rhinoplasty who also required chin augmentation. Materials and methods: 100 volunteer rhinoplasty patients between 17 and 55 years of age were selected and a preoperative photographic study was performed. Facial analysis of the lower third of the face was performed by three methods: Gonzalez-Ulloa, Goode and Silver, univariate and bivariate analysis was performed. Results: 100 voluntary patients entered the study, 7 of these were excluded, leaving 73 women and 20 men, the minimum age was 17 years and the maximum 55 years, with an average of 28.4 years. The mean age of the men was 30.9 years and of the women 28.2 years. Of the total number of patients, 96.7% of the patients com- plied with 2 or 3 methods for chin augmentation, of these 78.8% were women and 21.1% men. Conclusions: Adequate analysis of nasofacial proportions is essential to determine the procedures necessary to achieve a good surgical outcome and greater patient satisfaction. These methods do not replace the surgeon's aesthetic judgment; however, they provide an objective standard for the diagnosis of facial imbalances.

Treating the face of women with botulinum toxin type A: 7-year review / Tratamento da face de mulheres com toxina botulínica do tipo A: revisão de 7 anos

Introduction: Botulinum toxin type A (BTX-A) is the number one aesthetic procedure worldwide, and the difficulty in standardizing the aesthetic treatment of the face results in a broad range of treatment possibilities. The objective this study aimed to describe the author's experience treating facial wrinkles of women with BTX-A and suggest a standardized initial treatment method. Methods: A documentary retrospective review of all medical records from the main author's clinic from 2010 to 2017 in São Paulo, Brazil, was performed, searching for female patients who required the BTX-A aesthetic treatment to reduce facial wrinkles. The main author obtained, reviewed, and classified photographic data ("Carruthers Grading Scale for Forehead Lines"). Results: The BTX-A used in all patients was Botox® (Allergan Inc., Irvine, CA, USA). A total of 156 female treatments with BTX-A were identified. The average total units of BTX-A used for the referred treatment was 32.43U. The average period between treatments in the same patient was 8.73 months. All patients showed an improved "Grading Scale for Forehead Lines" post-treatment Conclusion: The review suggests a safe and effective technique is possible with even lower complication rates than found in the literature using fewer units, resulting in lower product costs. One should always try to minimize risks in aesthetic treatments.

Introdução: A aplicação de toxina botulínica do tipo A (BTX-A) é o procedimento estético mais realizado no mundo. Não há consenso sobre a forma ideal de realizar essa aplicação, que defina os locais de aplicação e a quantidade ideal necessária para o referido tratamento. O objetivo do estudo tem como objetivos descrever a experiência do autor no tratamento das rugas faciais em mulheres com BTX-A e sugerir uma padronização para o tratamento inicial. Método: Foi realizado um estudo documental retrospectivo de todos os prontuários médicos da clínica do autor principal, em São Paulo - SP, Brasil, desde 2010 até 2017, em busca dos dados de pacientes do sexo feminino que foram submetidas ao tratamento das rugas faciais com BTX-A, por razões estéticas. Os arquivos fotográficos foram obtidos, revisados e classificados pelo autor principal de acordo com a "Carruthers Grading Scale for Forehead Lines". Resultados: A BTX-A utilizada em todas as pacientes foi: Botox® (Allergan Inc., Irvine, CA, USA). Um total de 156 tratamentos com BTX-A foi encontrado. A média de unidade de toxina utilizada para o tratamento foi de 32,43U. O período médio de retorno para nova aplicação, na mesma paciente, foi de 8,73 meses. Todas as pacientes apresentaram melhora da classificação obtida através da "Grading Scale for Forehead Lines" após o tratamento. Conclusão: A revisão sugere que uma técnica efetiva e segura para o tratamento é possível, com menos unidades e menor taxa de complicações, quando comparada à literatura. Devemos sempre minimizar os riscos em tratamentos estéticos.

Quality of life of Brazilian plastic surgeons / Qualidade de vida dos cirurgiões plásticos brasileiros

Introduction: Medical quality of life (QoL) is an international object of study. Brazilian Plastic Surgeons QoL hasn`t yet been assessed, with few studies to perform any evaluation on the subject or estimate variables involved. Methods: This is a transversal, non-comparative, non-experimental, contemporary and of full selection study. An on-line research was performed between July and December in 2021, through the WHOQOL-bref questionnaire application, added with social-demographic information. The population will be composed of plastic surgery residents and surgeons associated with the Brazilian Society of Plastic Surgery (SBCP). Results: We obtained 168 answers via Google Forms®, which allowed us to determine our population through social- demographic questionnaire and make associations with the WHOQOL-bref findings. Conclusion: The current study identified correlations between sociodemographics and quality of life of the Brazilian plastic surgeon. We bring forward descriptive data on a subpopulation of responders inside the SBCP, which achieved a score positively higher than 50% in all of the questionnaire domains.

Introdução: A qualidade de vida (QV) dos médicos é objeto de atenção e de estudo internacionalmente. A QV dos cirurgiões plásticos do Brasil ainda não foi avaliada e não existem descrições das nuances e variáveis que estão mais ou menos relacionadas com a QV dos mesmos. Método: Trata-se de um estudo transversal, de seleção completa, não comparado, não experimental, contemporâneo. Pesquisa foi realizada on-line, entre julho e dezembro de 2021, por meio da aplicação do questionário WHOQOL-bref aos médicos residentes da especialização em cirurgia plástica e médicos cirurgiões plásticos associados à Sociedade Brasileira de Cirurgia Plástica (SBCP). As características sociodemográficas e ocupacionais serão relacionadas à QV. Resultados: Obtivemos 168 respostas dos formulários preenchidos via Google Forms®, o que possibilitou determinar a população estudada pelo questionário sociodemográfico e realizar as associações com os achados do WHOQOL-bref. Conclusão: O presente estudo identificou associação de fatores sociodemográficos à qualidade de vida do cirurgião plástico brasileiro. Delimitamos uma população específica dentro dos participantes da SBCP, a qual pontuou acima de 50% positivamente em todos os domínios do questionário.

Cutaneous traction as a complement to the parascapular flap in major cancer loss: case report / Tração cutânea como complemento ao retalho paraescapular em grande perda oncológica: relato de caso

Introduction: Squamous cell carcinoma (SCC) is a malignant epidermal keratinocyte tumor closely related to sun exposure. When diagnosed, through biopsy, its staging, tumor resection with oncological safety margins must be performed, and lymph node dissection and treatment of metastases, if present, may be performed. Case Report: Skin traction is reported as a complement to the parascapular flap, used reconstructively after the excision of a large SCC in the left shoulder. Conclusion: The technique used proved effective for the satisfactory correction of large dehiscence in the postoperative period of the parascapular flap, promoting partial closure of the defect, reduced time to perform, and correction of the residual defect in a single step.

Introdução: O carcinoma espinocelular (CEC) é um tumor maligno dos queratinócitos epidérmicos e está intimamente relacionado à exposição solar. Quando diagnosticado, por meio de biópsia, deve ser realizado seu estadiamento, ressecção tumoral com margens de segurança oncológica, podendo ser feito esvaziamento ganglionar e tratamento de metástases, caso presentes. Relato de Caso: Reporta-se a utilização da tração cutânea como complemento ao retalho paraescapular, utilizado reconstrutivamente pós excisão de CEC de grande dimensão em ombro esquerdo. Conclusão: A técnica utilizada mostrou-se eficaz para correção satisfatória de grandes deiscências em pós-operatório de retalho paraescapular, promovendo fechamento parcial do defeito, tempo reduzido para realização e correção do defeito residual em tempo único.

Mechanical and Enzymatic Digestion of Autologous Fat Grafting (A-FG): Fat Volume Maintenance and AD-SVFs Amount in Comparison.

BACKGROUND: Currently, several techniques for autologous fat graft (A-FG) preparation aimed at obtaining purified tissue exist. Both mechanical digestions via centrifugation, filtration, and enzymatic digestion were considered the most effective with different impacts in terms of adult adipose-derived stromal vascular fraction cells (AD-SVFs) amount that volume maintenance. OBJECTIVES: This article aimed to report the in vivo and in vitro results, represented by fat volume maintenance and AD-SVFs amount, obtained by four different procedures of AD-SVFs isolation and A-FG purification based on centrifugation, filtration, centrifugation with filtration, and enzymatic digestion. METHODS: A prospective, case-control study was conducted. In total, 80 patients affected by face and breast soft tissue defects were treated with A-FG and divided into four groups: n=20 were treated with A-FG enhanced with AD-SVFs obtained by enzymatic digestion (study group 1 [SG-1]); n=20 were treated with A-FG enhanced with AD-SVFs obtained by centrifugation with filtration (SG-2); n=20 were treated with A-FG enhanced with AD-SVFs obtained by only filtration (SG-3); n=20 were treated with A-FG obtained by only centrifugation according to the Coleman technique (control group [CG]). Twelve months after the last A-FG session, the volume maintenance percentage was analyzed by magnetic resonance imaging (MRI). Isolated AD-SVF populations were counted using a hemocytometer, and cell yield was reported as cell number/mL of fat. RESULTS: Starting with the same amount of fat analyzed (20 mL), 50,000 ± 6956 AD-SVFs/mL were obtained in SG-1; 30,250 ± 5100 AD-SVFs/mL in SG-2; 33.333 ± 5650 AD-SVFs/mL in SG-3, while 500 AD-SVFs/mL were obtained in CG. In patients treated with A-FG enhanced with AD-SVFs obtained by automatic enzymatic digestion, a 63% ± 6.2% maintenance of fat volume restoring after 1 year was observed compared with 52% ± 4.6% using centrifugation with filtration, 39% ± 4.4% using only centrifugation (Coleman), and 60% ± 5.0% using only filtration. CONCLUSIONS: In vitro AD-SVFs cell analysis indicated that filtration was the most efficient system-between mechanical digestion procedures-thanks to the highest amount of cells obtained with fewer cell structure damage, producing in vivo, the most volume maintenance after 1 year. Enzymatic digestion produced the best number of AD-SVFs and the best fat volume maintenance. LEVEL OF EVIDENCE III: 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 http://www.springer.com/00266 .

Ear shut and Dentistry: ethical and legal approach / Ear shut e Odontologia: abordagem ética e legal

Introduction: As a health science, dentistry seeks to raise self-esteem and improve patients' quality of life. However, the emergence of the aesthetic procedure "ear shut," which proposes correcting protruding ears without surgery, has raised ethical and legal doubts in the dental profession, especially concerning the limits of professional activity. Objective: To conduct a survey of the laws, norms, and resolutions on the area of performance of dental surgeons, as well as to discuss the limits and consequences of their extrapolation from the perspective of the procedure propagated as "ear shut." Method: A search was carried out for administrative norms on the Federal Council of Dentistry (CFO) websites and the Federal Council of Medicine and legal provisions on the Portal da Legislação website. Results: In the civil sphere, the disclosure of procedures such as the "ear shut" can characterize a promise of result and lead to judicial accountability. Exceeding professional boundaries constitutes an illegal exercise and a crime under the Brazilian Penal Code. In addition to not covering the area of clinical practice of dentists, at the administrative level, CFO Resolutions No. 198/2019 and No. 230/2020 emphasize that ear procedures are not part of the scope of procedures relevant to Dentistry and may lead to ethical infractions and consequent administrative proceedings. Conclusion: At present, based on the skills, prohibitions, rights, and duties of dentists, it can be stated that performing the "ear shut" by these professionals confronts civil, criminal, and administrative obligations.

Introdução: Como ciência da saúde, a Odontologia busca elevar a autoestima e melhorar a qualidade de vida dos pacientes. Entretanto, o surgimento do procedimento estético "ear shut", que propõe a correção da orelha em abano sem cirurgia, gerou dúvidas de ordem ética e legal na classe odontológica, sobretudo no que diz respeito aos limites de atuação profissional. Objetivo: Realizar o levantamento das leis, normativas e resoluções sobre a área de atuação dos cirurgiões-dentistas, bem como discutir os limites e as consequências de sua extrapolação sob a perspectiva do procedimento propagado como "ear shut". Método: Foi realizada uma busca de normas administrativas nos sites do Conselho Federal de Odontologia (CFO) e do Conselho Federal de Medicina, bem como de dispositivos legais no site Portal da Legislação. Resultados: Em âmbito cível, a divulgação de procedimentos como o "ear shut" pode caracterizar promessa de resultado e levar à responsabilização judicial. Ultrapassar os limites profissionais constitui exercício ilícito e constitui crime segundo o Código Penal Brasileiro. Além de não abranger a área de atuação clínica dos cirurgiões-dentistas, no âmbito administrativo, as Resoluções do CFO N° 198/2019 e N° 230/2020 enfatizam que procedimentos na orelha não compõem o escopo de procedimentos pertinentes à Odontologia, podendo levar a infrações éticas e consequente processo administrativo. Conclusão: No momento atual, com base nas competências, vedações, direitos e deveres dos cirurgiões-dentistas, pode-se afirmar que a realização do "ear shut" por estes profissionais confronta obrigações de ordem cível, penal e administrativa.

The impact of partially removing the Bichat fat pad in the linear facial measurements, satisfaction with facial aesthetics and quality of life: a single-arm CONSORT-guided clinical trial.

OBJECTIVE: To evaluate the influence of Bichat's ball removal on postoperative inflammatory parameters (pain, edema, and trismus), facial volume reduction, facial esthetic satisfaction, and oral health-related quality of life. MATERIAL AND METHODS: A single-arm clinical trial with 21 patients undergoing Bichat's ball removal. The following parameters were assessed at baseline and up to 3 months postoperatively: Visual Analogue Scale pain scores (0-10), rescue medication consumption, mouth opening, AM-Tr, AM-CEO, AM-NA, AM-CL, and AM-PM measurements, Oral Health Impact Profile (OHIP)-14 QoL scores, and satisfaction with facial esthetics (FACE-Q Satisfaction with Facial Appearance Overall Scale (SFAOS). X2, analysis of variance-repeated measures/Bonferroni, or Friedman/Dunn tests were used (p < 0.05, SPSS v20.0). RESULTS: Peak pain occurred after 2 h and, 10 h later, the levels returned to baseline values (p < 0.001). Rescue medication consumption peaked in the first 24 h reducing significantly after 72 h (p < 0.001). Mean mouth opening decreased after 24 h and returned to baseline levels after 1 month, and all linear facial measures reduced significantly after 1 or 3 months (p < 0.05). OHIP-14 scores and FACE-Q SFAOS scores showed significant improvement after 1 month (p < 0.001), but patients aged > 25 years showed a significant reduction in FACE-Q SFAOS at the end of the study (p = 0.006). CONCLUSIONS: Surgical removal of the Bichat's ball induces a mild inflammatory process controlled by rescue medication, significantly reduces face volume, and improves QoL and satisfaction with facial esthetics 3 months postoperatively. However, the efficacy of this procedure in patients > 25 years old is questionable. CLINICAL RELEVANCE: Evaluate the effectiveness of bichectomy in terms of clinical effects and impact on quality of life.