O dispositivo "antes e depois" nas cirurgias estéticas íntimas: novas formas de materialização das normas de gênero / The "before and after" dispositive in intimate aesthetic surgeries: new ways of materializing gender norms / El dispositivo "antes y después" en las cirugías estéticas íntimas: nuevas formas de materializar las normas de género

Resumo Este artigo tem como ponto de partida uma reflexão sobre a produção de imagens e narrativas circunscritas em torno do dispositivo antes e depois. Argumenta que a divulgação de padrões estéticos, especialmente nas redes sociais, opera de modo a prescrever uma necessária transformação e aprimoramento de si. Analisa relatos de experiências de mulheres que realizaram a chamada cirurgia íntima (ninfoplastia ou redução dos pequenos lábios vaginais) com a intenção de melhoria estética. Os depoimentos provêm de um grupo de discussão em torno desses procedimentos na internet. Nos casos em que as intervenções cirúrgicas são avaliadas negativamente, o antes e depois não se realizam da forma prevista. Nesse cenário, as mulheres tendem a ressignificar a necessidade da cirurgia e a reconhecer a imposição, por parte da sociedade, de padrões corporais idealizados. Este processo é discutido por meio do debate acerca do pós-feminismo e constrangimentos de gênero.

Abstract This article analyzes the production of images and narratives circumscribed around the dispositive before and after. It argues that the dissemination of aesthetic standards, especially on social networks, operates in order to prescribe a necessary transformation and improvement of the self. It analyzes reports of experiences of women who underwent the so-called intimate surgery (nymphoplasty or reduction of the labia minora) with the intention of aesthetic improvement. The testimonies come from a discussion group around these procedures on the internet. In cases where surgical interventions are negatively evaluated, the before and after are not performed as expected. In this scenario, women tend to resignify the need for surgery and recognize the imposition, by society, of idealized body standards. This process is discussed through the debate about post-feminism and gender constraints.

Resumen Este artículo tiene como punto de partida una reflexión sobre la producción de imágenes y narrativas circunscritas en torno al dispositivo antes y después. Argumenta que la difusión de normas estéticas, especialmente en las redes sociales, opera para prescribir una necesaria transformación y mejora del yo. Analiza relatos de experiencias de mujeres que se sometieron a la llamada cirugía íntima (ninfoplastía o reducción de labios menores) con la intención de mejorar estéticamente. Los testimonios provienen de un grupo de discusión sobre estos procedimientos en Internet. En los casos en que las intervenciones quirúrgicas son evaluadas negativamente, el antes y el después no se realizan como se esperaba. En ese escenario, las mujeres tienden a resignificar la necesidad de la cirugía y reconocen la imposición, por parte de la sociedad, de patrones corporales idealizados. Este proceso se discute a través del debate sobre el posfeminismo y las restricciones de género.

Avoiding Complications on the Upper Face Treatment With Botulinum Toxin: A Practical Guide.

BACKGROUND: Currently, botulinum toxin (BoNT) injections are the most commonly performed non-invasive procedure for rejuvenation on the upper face. The therapeutic use of botulinum toxin has generally been safe and well tolerated. Adverse effects are considered mild, transient, and self-limited. However, as with all other injectable procedures, this one is also susceptible to adverse events and complications. When the safety zones are respected, the chance of any of these complications is practically null. Thus, this review aims to describe the main complications of treatment with BoNT on the upper face and to present a practical guide based on current evidence on how to avoid them. METHODS: The literature research considered published journal articles (clinical trials or scientific reviews). Studies were identified by searching electronic databases (MEDLINE and PubMed) and reference lists of respective articles. RESULTS: The main complications secondary to BoNT injections on the upper face are: ptosis of eyelid or eyebrow, eyebrow asymmetry, diplopia, Lakeophthalmos, Palpebral ectropion, and prominence of the palpebral bags. To avoid such complications, it is necessary to have knowledge of the anatomy of this region and adequate and individualized planning based on the existing patterns of the frontalis muscle, glabella, and crow's feet. This review presents the specificities of each of these regions and practical suggestions to obtain satisfactory results, avoiding complications. CONCLUSION: Particularly on the upper face treatment with BoNT offers predictable results, has few adverse effects, and is associated with high patient satisfaction. However, it is suggested that the commented parameters and safety areas be incorporated into daily practice so that the possibilities of complications are minimized as much as possible. 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 www.springer.com/00266 .

Descripción del manejo cosmético de la pirámide nasal complementario a cirugía ortognática. Revisión narrativa / Description of the cosmetic management of the nasal pyramid complementary to orthognathic surgery. Narrative review

RESUMEN: Objetivo: Describir los cambios de la pirámide nasal al realizar una osteotomía Le Fort I y el manejo cosmético complementario a la cirugía ortognática. Material y método: Se realizó una búsqueda electrónica en las bases de datos PubMed, EBSCO, Scopus, The Cochrane Library, y en el metabuscador Epistemonikos a través de las palabras clave "Le Fort 1", "Orthognathic Surgery", "Maxillary Surgery", "Nasolabial Changes", "Nasal Change", "Nasolabial Esthetics", "Soft Tissue", "Nasal Profile", "Nose" y "Cosmetic", relacionadas entre sí con los términos booleanos AND y OR. Resultados: se seleccionaron 25 artículos: 15 estudios observacionales, 5 revisiones narrativas, 3 ensayos clínicos y 2 notas técnicas. Conclusión: se establece cierto patrón que permitiría predecir cambios que sufrirá la nariz: aumento en la proyección nasal, disminución del largo columelar y ensanchamiento de la base alar son uno de ellos. En otros aspectos como el ángulo nasolabial o la posición final de la punta nasal no se ha logrado definir un patrón común. Para evitarlos se han descrito muchas técnicas. Sin embargo, falta mayor evidencia.

ABSTRACT: Objective: To describe the changes of the nasal pyramid when performing a Le Fort I osteotomy and its cosmetic management complementary to the orthognathic surgery. Materials and Methods: An electronic search was made in PubMed, EBSCO, Scopus, The Cochrane Library and Epistemonikos using the keywords "Le Fort 1", "orthognathic surgery", "maxillary surgery", "nasolabial changes", "nasal change", "nasolabial esthetics", "soft tissue", "nasal profile", "nose" and "cosmetic" related to each other with the Boolean terms AND and OR. Results: 25 articles were selected; 15 observational studies, 5 narrative reviews, 3 clinical trials and 2 technical notes. Conclusion: Nasal changes tend to follow a certain pattern that allows to predict them when facing surgery: increase of nose projection, decrease in columellar length and widening of the alar base, among others. As for other aspects such as the nasolabial angle or the final position of the nasal tip, it has not been possible to define a common pattern. To avoid them, several techniques have been described. However, more evidence is needed.

Infectious complications related to medical tourism.

BACKGROUND: Medical tourism has been increasing dramatically globally, with people travelling from developed countries to low-income or middle-income countries, often to avoid high costs or long delays associated with seeking healthcare in their countries of origin. The current review summarizes healthcare-related infections associated with medical tourism, focusing on cosmetic surgery and organ transplantation. METHODS: A systematic MEDLINE and PubMed search from January 2010 to December 2019 yielded 80 relevant articles, including 49 articles on medical tourism-related infections focusing on cosmetic surgery and organ transplantation, which were included in this reviews. RESULTS: The literature reveals specific types of cross-border, healthcare-related infections depending on medical intervention. Destinations include low-income countries such as countries of Asia and the Indian subcontinent, middle-income countries including Central and South America, and high-income countries such as the United States and Europe. In terms of type of infections, in 36 (68%) and 15 (28.3%) studies, wound and blood-borne infections were documented, respectively, while in 21 studies (58.3%) non-tuberculous mycobacteria were isolated, including Mycobacterium abscessus, Mycobacterium chelonae, Mycobacterium senegalense and Mycobacterium fortuitum. The choices of medical tourists could have significant consequences for them and their home countries, including infectious complications and importation of pathogens, particularly antibiotic-resistant microorganisms, with public health implications. CONCLUSIONS: There is a need for public health strategies in order to prevent morbidity and mortality as well as future management and education of patients engaging in medical tourism.

Mycobacterium abscessus subspecies abscessus infection associated with cosmetic surgical procedures: Cases series.

BACKGROUND: Mycobacterium abscessus is one of the most pathogenic and drug-resistant opportunistic microorganisms among the nontuberculous mycobacteria (NTM) involved in skin and soft tissue infections (SSTI) associated with cosmetic surgical procedures. However, NTM infection is often wrongly diagnosed initially causing prolonged suffering. Here is described the author's experience working with patients who developed M. abscessus SSTI after cosmetic procedures. METHODS: Patients who developed NTM infection after undergoing cosmetic procedures, and who presented at the Hospital Metropolitano and Hospital Vozandes (Quito, Ecuador) between 2013-2016. A review of patient medical records was performed. RESULTS: Five patients with culture proven M. abscessus subspecies abscessus SSTI after cosmetic surgeries were identified. All patients were treated with aggressive surgical debridement and antibiotics. CONCLUSIONS: A rapidly spreading wound infection presenting two or more weeks after a cosmetic procedure that fails to respond to standard antimicrobial therapy should raise suspicion for NTM infection. Samples for acid-fast bacilli smear, cultures, and PCR from infected tissue should be taken. Surgical drainage and debridement are recommended along with a long course of antibiotics. In the absence of clinical trials, a combination of amikacin, imipenem, and clarithromycin may be an adequate initial treatment for M. abscessus subspecies abscessus SSTI in immunocompetent patients.

High Definition Lipoabdominoplasty.

OBJECTIVE: To describe the author's experience with the high definition lipoabdominoplasty technique for the treatment of abdominal flaccidity and lipodystrophy, with correction of muscle diastasis and definition of body contours. METHODS: This is a retrospective study analyzing the results of 146 patients operated on with the high definition lipoabdominoplasty procedure. RESULTS: The average age was 37.93 years (25 to 58). The average body mass index was 25.68 kg/m2 (19.6 to 29.9 kg/m2). Combined surgeries were associated in 76 cases (52%). The results obtained are demonstrated by comparing the pre and postoperative photos. DISCUSSION: With the advent of high definition liposuction, the results improved significantly, reaching a higher degree of definition and giving a more athletic and aesthetically pleasing contour. However, this procedure is not free of complications, and should be performed cautiously, while following specific protocols. With proper patient selection, this technique provides excellent outcomes when combined with abdominoplasty. LEVEL OF EVIDENCE IV: 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 .

Risk and Reward: Public Perception of Gluteal Fat Grafting Safety.

BACKGROUND: This study aims to understand how sociodemographic factors influence perceptions of "Brazilian Butt Lift" (BBL), the cosmetic procedure with the highest reported mortality rate, among adult women. We also investigate whether education about risks changes willingness to receive this procedure. METHODS: A Qualtrics© survey including education about BBL was administered on Amazon Mechanical Turk, with inclusion criteria of female sex. RESULTS: Survey data from 489 female participants were included. 78.1% of participants found the BBL mortality rate to be higher than expected. 70.1% of the original 177 willing or neutral participants became unwilling to undergo a BBL after education. Multivariate logistic regression indicated that individuals who were more willing to undergo BBL after education were individuals who have a diagnosis of body dysmorphic disorder (OR 60.5, p = 0.02) or have an acquaintance who received a BBL (OR 230.2, p < 0.01). CONCLUSIONS: Overall, survey participants were less willing to undergo BBL after learning its risks, indicating the critical role of patient education during informed consent. Additionally, individuals who are unhappy with their body shape, or who feel cultural or social pressure to attain a certain body shape, may accept higher levels of risk to improve their looks, suggesting patient motivation for the procedure may limit even the most effective informed consent process. In light of these findings, the surgical community may consider regulating the BBL procedure and improving safety using evidence-based risk reduction techniques. Ensuring that patients fully understand the risks associated with the BBL procedure is critical for both surgeon and patient. LEVEL OF EVIDENCE V: 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 .

Contributions of the First Female Plastic Surgeon to Modern-Day Rhytidectomies.

Dr. Suzanne Noël was a pioneer for female surgeons and made fundamental contributions to the field of plastic surgery. Her hallmark operation, the "petit operation," defined the fundamental aspects to many modern rhytidectomies including the mini-lift and the short scar facelift. These contributions included camouflaging incisions in the hairline, limiting incision length, avoiding tension on the skin, meticulous handling of the skin edges, appropriate and precise vector placement, and staging operation when required. Through understanding the history of the fundamental principles on which rhytidectomy was constructed will help the cosmetic surgeon understand the nuances of this operation. LEVEL OF EVIDENCE V: 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 Table of Contents or online Instructions to Authors www.springer.com/00266.

Lipoinyección labial con grasa autóloga con fines estéticos / Autologous fat lipoinjection for aesthetic purposes

Introducción. La Lipoinyección de grasa autóloga con fines estéticos es una de las técnicas más jóvenes que permiten resolver problemas relacionados con valores concernientes a las elecciones personales que apuntan hacia la belleza, es un procedimiento quirúrgico sencillo y con resultados rápidos. Es una alternativa segura, real, sencilla y accesible que abarata costos, sobre todo con el uso de equipos y tecnología. Objetivos. Caracterizar los resultados estéticos de la Lipoinyección Labial con Grasa Autóloga en pacientes que asistieron a la consulta externa de Cirugía Plástica del Hospital Universitario "General Calixto García". Material y Método. Se realizó un estudio prospectivo, descriptivo, de corte transversal, en el período comprendido entre octubre de 2018 a septiembre del 2019. Se seleccionaron aquellos que cumplieron los criterios de inclusión y aceptaran a participar en el estudio voluntariamente. La muestra quedó constituida por 23 pacientes. La información obtenida se procesó mediante bases de datos confeccionadas en Excel, lo que permitió la realización de la estadística descriptiva simple para las variables individuales como media, desviación estándar y razón. La disposición a colaborar en el estudio se recogió en el modelo de Consentimiento Informado elaborado para esta investigación. Resultados. Predominio del sexo femenino en el 60.87 % de los operados. El grupo de edad entre 51 a 61 años fue el de mayor número de pacientes. Las complicaciones inmediatas más frecuentes en los labios fueron: la inflamación y los hematomas; las tardías fueron nodulaciones y endurecimiento. El 82.60 % de los pacientes se mostró satisfecho con los resultados. Conclusiones. La Lipoinyección labial con Grasa Autóloga se caracterizó por ser un método capaz de satisfacer el resultado estético. Las variables edad y sexo evidencian que las mujeres se realizaron más Cirugía Estética Labial que los hombres. Las variables clínicas labios finos y volumen evidencian que el aumento de la edad es una condición importante que se asocia a la demanda de esta técnica quirúrgica y que el ser hombre o mujer no establece una diferencia para la solitud de este tipo de técnica quirúrgica. Se presentaron complicaciones inmediatas y tardías. Los niveles de satisfacción expresados por los pacientes fueron altos.

Introduction. Autologous fat lipoinjection for aesthetic purposes is one of the youngest techniques that allow solving problems related to values concerning personal choices that point towards beauty, it is a simple surgical procedure with quick results. It is a safe, real, simple and accessible alternative that lowers costs, especially with the use of equipment and technology,Objectives. To characterize the aesthetic results of Lip Lipoinjectionwith Autologous Fat in patients who attended the Plastic Surgery outpatient clinic at the "General Calixto García" University Hospital. Material and Method. A prospective, descriptive, cross-sectional study was conducted in the period from October 2018 to September 2019. Those who met the inclusion criteria and voluntarily agreed to participate in the study were selected. The sample consisted of 23 patients. The information obtained was processed through databases prepared in Excel, which allowed the performance of simple descriptive statistics for individual variables such as mean, standard deviation and ratio. The willingness to collaborate in the study was included in the Informed Consent model prepared for this research. Results. female predominance in 60.87% of those operated on. The age group between 51 and 61 years was the one with the largest number of patients. The most frequent immediate complications on the lips were: inflammation and bruising; the later ones were nodulations and hardening. 82.60% of the patients were satisfied with the results.Conclusions. Lip Lipoinjection with Autologous Fat was characterized as a method capable of satisfying the aesthetic result. The age and sex variables show that women underwent more cosmetic lip surgery than men. The clinical variables thin lips and volume show that increasing age is ́t a condition that is associated with the demand for this technique and that the Being male or female does not make a difference to the solitude of this type of surgical technique. There were immediate and late complications. The satisfaction levels expressed by the patients were high.

Translation, Cross-Cultural Adaptation and Linguistic Validation of the FACE-Q Questionnaire for Brazilian Portuguese.

BACKGROUND: Patient-reported outcomes measurement instruments (PRO) are a good way to measure results after aesthetic procedures. FACE-Q is a systematized and standardized PRO tool and was not available in Portuguese. METHODS: This cross-sectional study included four stages: translation of FACE-Q, backtranslation, testing in patients who underwent facial aesthetic procedures and review of the questionnaires between September and December, 2018. Guidelines merging WHO and ISPOR's rules were followed. RESULTS: Translation was conducted by two translators, resulting in two versions, translation A and translation B, which were reconciled to generate the first Portuguese version. Reconciliation showed inconsistencies between TA and TB in 63% (n = 222) of the 353 questions, which were solved by maintaining TA in 25% of cases (n = 87), TB in 27% and a new version in 11% (n = 40) of the questions. Backtranslation showed written differences with the original FACE-Q in 64 (22.7%) of the 353 question, but only one case of semantic difference, which was corrected resulting in production of the second Portuguese version. Seven patients with a mean age of 35.8 years were interviewed to assess the difficulty in understanding the questionnaires. Four patients had no or minor difficulties understanding the questionnaire, and the other three had difficulties and suggested changes that led to a third Portuguese version. The third version was reviewed for grammar and spelling resulting in the final Portuguese version. CONCLUSION: A Brazilian Portuguese version of the FACE-Q questionnaire was obtained maintaining equivalency with the source instrument. This will allow cross-cultural research and comparison of results between different studies. LEVEL OF EVIDENCE V: 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 .

Satisfacción y motivación de la cirugía estética en mujeres y su relación con los esquemas desadaptativos tempranos / Satisfaction and motivation of cosmetic surgery in women and the relation with early maladaptive schemas

Resumen El objetivo de esta investigación fue investigar los Esquemas Desadaptativos Tempranos (EDT) en mujeres con cirugías estéticas, e indagar si existían relaciones con: satisfacción, motivación hacia nuevas cirugías y variables relacionadas a la intervención quirúrgica. Se trabajó con una muestra de 67 mujeres de entre 18 y 40 años con al menos una cirugía, administrando el Cuestionario Esquemas Desadaptativos Tempranos de Young y una encuesta Ad Hoc. Como resultado el es quema Estándares Inflexibles se encontró en más del 50 % y se encontraron correlaciones significativas con las variables analizadas: motivación, satisfacción y variables quirúrgicas con EDT (cantidad, edad y antigüedad). Se discuten los resultados en función de la influencia entre los EDT y las intervenciones quirúrgicas estéticas.

Abstract The purpose of this study was to investigate the Early Maladaptative Schemas (EMS) in women who have undergone cosmetic surgeries (CS) and to research if there was a relation to the satis faction with the CS, the motivation to undergo more surgeries and the variables related to cos metic surgery. A non-experimental, cross-sectional, descriptive correctional study was carried out. The deliberately selected sample was comprised of 67 women between 18 and 40 years old who had undergone, at least, one cosmetic surgery. Data was collected from the responses to Jeffrey Young's questionnaire entitled Early Maladaptive Schemas and an ad hoc survey. As a result, from the investigation, it was observed that the schema of Unrelenting Standards was found in more than 50 % of the sample, and meaningful correlations with the analyzed variables were found: motivation, satisfaction and surgical variables with EMS (quantity, age and age of the first one). The results are discussed in relation to the influence among the EMS and the cosmetic surgeries.

Transformative Possibilities: Politics and Cosmetic Surgery in the Bolivarian Revolution.

I examine the intersection of politics and aesthetics in a public hospital in Caracas, Venezuela in the first years of the twenty-first century. Given Venezuela's long-standing embrace of physical enhancement and the contradictions of the medical values of cosmetic surgery with those of Bolivarian socialism, the changing surgical practices at a well-established public site offer a significant case for considering how different actors negotiate the dialectics of care. In the face of increasing resource shortages, negotiations of aesthetic care contributed to tensions in the clinical encounter as patients creatively pushed Bolivarian policies to support their pursuits of aesthetic self-improvement.

Duas técnicas de cirurgia oncoplástica simultaneamente no tratamento de tumor de mama na linha paraesternal direita / Two Oncoplastic techniques for treatment of breast tumor located in the right parasternal line

De maneira geral, a mesma técnica de reconstrução mamária deve ser utilizada nas duas mamas, seguindo os preceitos básicos da oncoplastia. No entanto, o mastologista ou o cirurgião de ma- mas pode lançar mão de duas técnicas diferentes, em casos de tumores em localizações pouco comuns. O relato de caso se refere a uma mulher com tumor de mama EC: IIIB, localizado na li- nha paraesternal da mama direita, em uma região chamada, por autores americanos, de "terra de ninguém". Para conseguir resultado estético satisfatório, os autores deste trabalho usaram duas técnicas de oncoplastia: na mama direita, onde havia tumor, optaram por Batwing e, na mama esquerda, sadia, para corrigir a ptose e dar simetria, utilizaram a técnica de Lejour. O resultado nal motivou a apresentação deste caso clínico.

It should be used the same technique of mammary reconstruction in both breasts, in oncoplastic. However, the breast cancer specialist or the breast surgeon can opt for two di erent surgical tech- niques, when he/she faced tumor in unusual locations. is case report refers to a woman with breast tumor EC: IIIB, located near sternum bone, in a region called 'no man's land' by American authors. To achieve satisfactory aesthetic result, the authors of this case report used two di erent oncoplastic techniques. On the right breast, where there was the tumor, they decided for Batwing and, for the oth- er breast, healthy, the choice was Lejour technique. e result led to the publication of this case report.

Global aesthetic surgery statistics: a closer look.

INTRODUCTION: Obtaining quality global statistics about surgical procedures remains an important yet challenging task. The International Society of Aesthetic Plastic Surgery (ISAPS) reports the total number of surgical and non-surgical procedures performed worldwide on a yearly basis. While providing valuable insight, ISAPS' statistics leave two important factors unaccounted for: (1) the underlying base population, and (2) the number of surgeons performing the procedures. METHODS: Statistics of the published ISAPS' 'International Survey on Aesthetic/Cosmetic Surgery' were analysed by country, taking into account the underlying national base population according to the official United Nations population estimates. Further, the number of surgeons per country was used to calculate the number of surgeries performed per surgeon. RESULTS: In 2014, based on ISAPS statistics, national surgical procedures ranked in the following order: 1st USA, 2nd Brazil, 3rd South Korea, 4th Mexico, 5th Japan, 6th Germany, 7th Colombia, and 8th France. When considering the size of the underlying national populations, the demand for surgical procedures per 100,000 people changes the overall ranking substantially. It was also found that the rate of surgical procedures per surgeon shows great variation between the responding countries. CONCLUSION: While the US and Brazil are often quoted as the countries with the highest demand for plastic surgery, according to the presented analysis, other countries surpass these countries in surgical procedures per capita. While data acquisition and quality should be improved in the future, valuable insight regarding the demand for surgical procedures can be gained by taking specific demographic and geographic factors into consideration.

Multistate US Outbreak of Rapidly Growing Mycobacterial Infections Associated with Medical Tourism to the Dominican Republic, 2013-2014(1).

During 2013, the Maryland Department of Health and Mental Hygiene in Baltimore, MD, USA, received report of 2 Maryland residents whose surgical sites were infected with rapidly growing mycobacteria after cosmetic procedures at a clinic (clinic A) in the Dominican Republic. A multistate investigation was initiated; a probable case was defined as a surgical site infection unresponsive to therapy in a patient who had undergone cosmetic surgery in the Dominican Republic. We identified 21 case-patients in 6 states who had surgery in 1 of 5 Dominican Republic clinics; 13 (62%) had surgery at clinic A. Isolates from 12 (92%) of those patients were culture-positive for Mycobacterium abscessus complex. Of 9 clinic A case-patients with available data, all required therapeutic surgical intervention, 8 (92%) were hospitalized, and 7 (78%) required ≥3 months of antibacterial drug therapy. Healthcare providers should consider infection with rapidly growing mycobacteria in patients who have surgical site infections unresponsive to standard treatment.

Labioplastía genital, experiencia y resultados en 500 casos consecutivos / Genital labiaplasty, experience and results in 500 consecutive cases

ANTECEDENTES: La cosmetoginecología se ha instalado, no exenta de controversia, en la práctica ginecológica durante la última década. OBJETIVO: Presentar los resultados obtenidos en una serie de 500 labioplas-tías de labios menores realizadas por dos cirujanos en el curso de 10 años. MÉTODO: Estudio descriptivo del universo de labiobioplastías practicadas por dos cirujanos entre octubre de 2003 y abril de 2014. La decisión de intervención quirúrgica se basó en razones estéticas, funcionales y psicológicas, y no por una clasificación de hipertrofia de labios menores. RESULTADOS: Aproximadamente la mitad se realizó utilizando láser y la otra mitad electrobisturí, sin ventajas de alguna técnica sobre la otra, en cuanto a complicaciones, grado de satisfacción y resultado final estético. Las indicaciones fueron: estética en 95,4% de las intervenciones, funcional en 37,2% y psicológicas en 17,4%. Los resultados fueron satisfactorios en el 99% de las pacientes, según un autoreporte. No hubo complicaciones importantes y sólo en dos casos se presentó hemorragia post operatoria que requirió una sutura. El procedimiento, cuando fue único, fue ambulatorio, requiriendo no más de 8 horas de hospitalización. En esta experiencia, el 46% se asoció a otra cirugía ginecológica. CONCLUSIÓN: A nuestro parecer, la hipertrofia de labios menores, aún cuando pueda considerarse subjetiva, es una condición que merece ser corregida cuando es requerido por la paciente y que las técnicas actuales ofrecen resultados seguros y satisfactorios.

BACKGROUND: Cosmetogynecology is installed, not without controversy, in gynecological practice in the last decade. Aims: We present a descriptive study of 500 labia minora labiaplasty performed by two surgeons in the course of 10 years. METHOD: A descriptive study of the universe of labiobioplastys performed by two surgeons between October 2003 and April 2014. The decision for surgery was based on aesthetic, functional and psychological reasons and not on a classification of labia minora hypertrophy. RESULTS: Approximately, half was performed using laser, and electrocautery the other half, without any technical advantages over the other, in terms of complications, satisfaction and aesthetic final outcome. Indications for surgery were: in 95.4% of interventions, functional in 37.2% and 17.4% psychological. The results were satisfactory in 99% of patients, according to a self-report. There were no major complications and only two cases presented postoperative bleeding that required stitches. The procedure was ambulatory when it was unique, requiring no more than 8 hours of hospitalization. In this experience, 46% was associated with another gynecological surgery. CONCLUSION: In our view, the labia minora hypertrophy, even though it may be considered subjective, is a condition that should be corrected as required by the patient and the current techniques provide safe and satisfactory results.

Mamoplastias redutoras e mastopexias realizadas no HC-UNICAMP: análise comparativa entre duas técnicas / Reduction mammoplasties and mastopexies performed at HC-UNICAMP: comparative analysis between two techniques

Introdução: Diferentes técnicas para mamoplastia redutora e mastopexia são descritas na literatura, visando a resultados que reconstituam o polo superior, ofereçam melhor projeção e proporcionem tratamento adequado para a ptose mamária. No entanto, devemos nos atentar para a segurança da técnica, com manutenção da vascularização, inervação dos tecidos e possibilidade de amamentação. Análise comparativa com pacientes operadas pela técnica com retalho de pedículo inferior e pacientes operadas pela técnica com sutura circular em bolsa. Métodos: Análise de 85 pacientes submetidas à mamoplastia redutora ou mastopexia sem implantes, entre janeiro de 2011 e dezembro de 2012, no Hospital de Clínicas da Unicamp. Foram excluídos 31 pacientes, as quais foram submetidas apenas à mamoplastia redutora pela técnica de Pitanguy (sem utilização de retalhos ou sutura circular). Dentre as 54 pacientes restantes, cinco foram posteriormente excluídas devido ao não comparecimento à consulta ou à não realização da ultrassonografia pós-operatória. Foram agrupadas 16 pacientes submetidas à sutura circular contínua e 33 pacientes operadas pela técnica de pedículo inferior. Resultados: Dados demográficos foram semelhantes nos dois grupos. Maior número de pequenas complicações e resultados insatisfatórios foi observado no grupo submetido à técnica de pedículo inferior, bem como maior índice de achados ultrassonográficos relevantes no pós-operatório. Conclusão: A técnica de sutura circular contínua apresentou elevado índice de satisfação, menor número de complicações e resultados mais duradouros quando comparados com a técnica de pedículo inferior, durante o período analisado.

Introduction: Several reduction mammoplasty and mastopexy techniques are described in the literature, with the aim of reconstituting the upper pole, offering better projection, and providing adequate treatment for breast ptosis. However, particular attention should be devoted to the safety of the technique, with maintenance of vascularization, tissue innervation, and the capability of breastfeeding. Female patients operated on with the inferior pedicle flap technique were compared with those operated on with purse-string circular suturing. Methods: Eighty-five patients who had undergone reduction mammoplasty or mastopexy without implants, between January 2011 and December 2012 at Unicamp's Clinical Hospital, were evaluated. Thirty-one patients who only underwent reduction mammoplasty by Pitanguy's technique (without the use of flaps or circular sutures) were excluded. Of the remaining 54 patients, five were subsequently excluded for not attending medical appointments or failure to have postoperative ultrasonography. A group of 16 patients who had undergone circular suturing and a group of 33 operated on by the inferior pedicle technique were considered. Results: Demographic data were similar for both groups. A higher number of minor complications and unsatisfactory results were observed in the group that underwent the inferior pedicle technique, who also had a higher rate of relevant post-operative ultrasonography events. Conclusion: The circular suturing technique resulted in a high satisfaction rate, lower number of complications, and longer lasting results than the inferior pedicle technique, during the period analyzed in this study.

Perfeccionismo y Cirugía Estética: Revisión Teórica de una Novísima Asociación

En los últimos años se ha incrementado la cantidad de investigaciones encaminadas al estudio del perfeccionismo como una variable que puede tener un profundo impacto sobre la salud y el bienestar psicológico. Por otra parte, la cirugía estética es cada vez más popular a nivel mundial. Como es evidente al sentido común, un ideal de perfección debe estar presente en los millones de personas que se someten a cirugía estética cada año. Después de presentar una aproximación psicométrica para el abordaje del perfeccionismo (como rasgo de personalidad y en la modalidad de auto-presentación perfeccionista), y tras revisar algunas tendencias actuales sobre los procedimientos estéticos, este artículo reseña los principales hallazgos e implicaciones de la reciente investigación desarrollada por la psicología respecto a la relación entre el perfeccionismo y el interés en la cirugía estética. Finalmente, se sugieren ideas y recomendaciones para estudios futuros.

The amount of research on perfectionism has increased over the years for being a variable that can have a deep impact on health and psychological wellbeing. On the other hand, cosmetic surgery is becoming more popular globally. The ideal of perfection must be present in the millions of individuals who undergo cosmetic surgery every year. After first presenting a psychometric approach for the study of perfectionism (trait perfectionism and perfectionistic self-presentation) and after reviewing some current trends in cosmetic procedures, this article reviews the main findings and implications of the recent research developed by psychology regarding the relationship between perfectionism and interest in cosmetic surgery. Finally, ideas and recommendations for future studies are suggested.

La responsabilidad médica en cirugía estética: obligación de medios o de resultados?: antecedentes, jurisprudencia argentina y española, camino radical en la doctrina y criterio jurisprudencial español / Medical liability in cosmetic surgery: obligation or output media history, Argentina and Spanish jurisprudence, radical way in doctrine and Spanish legal criteria

En el presente artículo se aborda un tema de actualidad dentro de la responsabilidad médica: la obligación de medios y la de resultados. Si bien la primera es la que predomina en cualquier relación médico paciente, existe algunas especialidades como cirugía estética, radiología, radioterapia, anatomía patología y anestesia, en las que la obligación de resultados ha venido a formar parte de muchos de sus procedimientos. Con base en estos supuestos se exploran casos de la jurisprudencia Argentina y española y se nota cómo esta última ha evolucionado al punto de no abordar un caso a priori como de obligación de medios o de resultados, sino analizarlo individualmente para emitir la sentencia y la probable compensación...

Procedimentos estéticos: percepção do cliente quanto ao esclarecimento para a tomada de decisão / Aesthetic procedures: customer perception regarding clarification for decision making

Este trabalho teve como objetivo verificar a percepção do cliente quanto ao esclarecimento para tomada de decisão referente à realização de procedimentos estéticos. O estudo, do tipo descritivo, exploratório, com abordagem quantitativa dos dados, foi realizado com amostra de 44 clientes, frequentadores da Clínica de Estética e Cirurgia Plástica. A coleta de dados foi realizada por intermédio de um instrumento com base na Escala de Likert, constituída por 28 proposições, classificadas em três categorias: Informação, Competência e Liberdade. Completaram o instrumento, duas escalas, com a finalidade de medir a percepção global dos clientes quanto ao esclarecimento das informações e a liberdade para tomada de decisão. Os resultados mostraram que, em relação ao grau de instrução, houve predomínio dos clientes de nível superior. Quanto à profissão/ocupação, a maioria enquadrou-se nos níveis III, IV e V, que corresponderam aos cargos de ocupação manual especializada, cargos de supervisão e gerência e profissionais liberais e cargos de alta administração, respectivamente; em referência à renda familiar, houve predomínio dos clientes com renda superior a R$ 8000,00 ou mais. Verificou-se também predomínio da faixa etária de 41 a 50 anos, com a maioria dos clientes do sexo feminino e, estado civil casado. Quanto ao tipo de tratamento, o clínico predominou sobre o cirúrgico. Analisadas as três categorias, identificou-se uma discreta superioridade do escore médio atribuído à categoria. Competência em relação ao atribuído às categorias Informação e Liberdade, porém a maioria dos escores das três categorias foi bastante homogênea, sendo os escores médios das categorias superiores a 4,5, ou seja, variando de concordante à alta concordância. Os escores para Informação, Competência e Liberdade estão associados com o tipo de tratamento, mas não com a idade dos clientes. Constatou-se também que, em média, os clientes que se ) submeteram a tratamento clínico atribuíram escores menores do que os clientes que tiveram tratamento cirúrgico. Quanto às questões globais referentes ao esclarecimento das informações e à liberdade para tomada de decisão para o procedimento, temos médias de 9,41 e 9,70 respectivamente. Estes resultados mostram que os profissionais de saúde forneceram informações claras, suficientes e adaptadas às necessidades dos clientes, deixando-os livres e competentes para a tomada de decisão quanto ao procedimento estético

This paper aims at verifying client's perception in relation to the information given for the decision making process relating to aesthetic procedures. The descriptive, exploratory, correlating, with a quantitative approach, was carried out with a sample of 44 clients of the Aesthetic and Plastic Surgery Clinic. The data collection was carried out by means of an instrument based on the Likert Scales, consisting of 28 propositions, classified in three categories: Information, Competence and Freedom. Two other scales completed the instrument so as to measure clients' global perception concerning the elucidation of given information and freedom to make a decision. The level of significance was 5% and the results revealed that as far as education was concerned, most clients had university degrees. Concerning profession/occupation, most clients were positioned in levels III, IV and V, which refer to skilled manual work, supervision and management positions, self-employed professionals and high administrative positions, respectively. As far as family income was concerned, most clients had a monthly income above R$ 8000,00. It was also suggested that there was a slight predominance of clients from the 41-50 year-old age group, being most of them married women. In relation to the treatment, there was a slight predominance of clinical treatments, when compared to the surgical ones, and the procedures chosen were first peeling, 22%, followed by botulinum toxin and filling, 16% each. Among the surgical procedures, the most common was liposuction - 14% of the clients, followed by breast surgeries, 12%. During the analysis of the three categories a slight superiority of the average score given to the 'Competence' category was identified, when compared to the scores given to the 'Information' and 'Freedom' categories, although the average scores for the three categories were quite homogeneous, being all above 4.5, that is, varying from 'agree' to 'totally agree'. The 'information', 'competence' and 'freedom' scores are related to the type of treatment, but not to the clients' age. The survey also confirmed that on average the clients who underwent clinical treatment gave lower scores than the ones who underwent surgical treatment. In relation to global questions, concerning elucidation of information and freedom to make the decision regarding the procedures, we have the average of 9.41 and 9.70 respectively. These results reveal that health professionals provided clients with clear, sufficient and relevant information based on their clients' needs, leaving them free and competent to take the best decision in relation to aesthetic procedures