El reposicionamiento malar. Presentación de una técnica original: punto MM / Malar repositioning. Presentation of an original technique: point MM

El envejecimiento facial es una sinergia compleja de cambios texturales de la piel, hiper- o hipoactividad muscular, reabsorción del tejido graso y resorción ósea. El déficit de volumen resultante, la deflación y la posterior caída del tercio medio facial produce una cara menos atractiva y juvenil. Los procedimientos inyectables en región malar son cada vez más populares y solicitados por los pacientes. El conocimiento de la anatomía de la cara media es fundamental para el inyector. La comprensión de la irrigación facial puede ayudar a disminuir la exposición a la aparición de hematomas y complicaciones vasculares severas. Existen múltiples técnicas de inyección propuestas para el tercio medio, en este artículo presentamos una técnica original, simple, segura y eficaz con resultados satisfactorios y riesgo reducido

Facial aging is a complex synergy of textural skin changes, muscle hyperactivity, fat dysmorphism, bone resorption. The resulting volume deficit and deflation of the mid face produces a less attractive and youthful face. Injectable midface procedures are becoming increasingly popular and requested by patients. Knowledge of the anatomy of the midface is critical for the injector. Understanding the irrigation of the face can help decrease the risk of hematoma and severe vascular complications. There are multiple injection techniques proposed for the middle third, in this article we present a simple, safe and effective technique with satisfactory results and lower risk

Manejo quirúrgico de biopolímeros en punta nasal: reporte de caso y revisión de la literatura / Surgical Management of Biopolymers in Nasal Tip: Case Report and Literature Review

Introducción: los rellenos faciales han sido ampliamente utilizados a nivel mundial. Existen rellenos temporales, semipermanentes y permanentes. En cuanto a los rellenos permanentes, la silicona es la más utilizada y está aprobada por la agencia gubernamental de los Estados Unidos, la Administración de Alimentos y Medicamentos (FDA), en dos presentaciones para el desprendimiento de la retina. En 1997 se autorizó el uso off-label de Adatosil y Silicon 100, ambas prescritas durante la relación médico-paciente. Se han descrito múltiples eventos adversos secundarios a la inyección de silicona como relleno facial, principalmente síntomas inflamatorios, reacción a cuerpo extraño, sepsis y migración del producto, que por lo general se presentan por una aplicación inapropiada por personal sin entrenamiento. Caso clínico: se presenta el caso de un paciente masculino en la quinta década de la vida, a quien le aplicaron silicona en aceite a nivel de la punta nasal; posteriormente, presenta dermatopatía secundaria sin respuesta al manejo médico, por lo cual requiere manejo quirúrgico para el retiro del material alogénico y reconstrucción nasal secundaria. Se dan recomendaciones para el manejo quirúrgico de estos pacientes.

Introduction: Injectable facial fillers have been widely used worldwide. There are temporary, semipermanent, and permanent fillers. Regarding permanent fillers silicone is the most widely used, approved by the Food and Drug Administration (FDA) in two presentations Adatosil and Silicon 100 for retinal detachment. In 1997 the FDA allows for the off-label use prescribed within the doctor-patient relationship. There have been reported multiple adverse events, mainly inflammatory symptoms, foreign body reactions, sepsis, and product migration generally occurring by inappropriate application by untrained personnel. Case report: We present the case of a male patient in the fifth decade of life who underwent the application of silicone oil at the level of the nasal tip, and later presented secondary dermatopathy without response to medical management, which requires surgical management to remove the allogeneic material and secondary nasal reconstruction

The functional architecture of the stomatognathic system and orofacial aesthetic repositioning during the aging process

Introduction: Facial aging implies special care and personalized treatment. Thus,the new strand of Neomodern Dentistry seeks, through Orofacial Harmonization,the functional and aesthetic balance between the stomatognathic system and thefacial aspect. Objective: This article seeks to disclose, through a literature review, the aesthetical consequences of the stomatognatic system repositioning andorofacial aging. Data source: The present literature review consisted in researchesup to May 2019 using PubMed and Google Academic electronic databases. A 10-year publication limit was applied in the research. No language restriction wasapplied. Inclusion criteria were clinical investigations, books, dissertations, thesisor literature reviews that addressed the topics of interest. Data synthesis: A totalof 231 articles were retrieved from databases. After applying a 10-year publicationlimit, 111 remained and, based on the inclusion and exclusion criteria, 20 articleswere selected and included in this review. Conclusion: Considering the limitationsof the present study, it can be concluded that the aging process is natural andpredictable and can be changeable and malleable through procedures that restorethe support nutrients that were lost. The aesthetics can be achieved as a functionalconsequence of the stomatognathic system repositioning due to orofacial aging.

Introdução: O envelhecimento facial implica em cuidados especiais e um tratamento diferenciado. Desse modo, a nova vertente da Odontologia Neomoderna busca, por meio da Harmonização Orofacial, o equilíbrio funcional e estético entre o aparelho estomatognático e a face. Objetivo: Esse artigo busca compreender, por meio de uma revisão de literatura, as consequências estéticas do reposicionamento do aparelho estomatognático e envelhecimento orofacial. Fonte dos dados: A presente revisão de literatura consistiu em um viés qualitativo nas plataformas PubMed e Google Acadêmico, nos últimos 10 anos, sem restrição de idiomas. Os critérios de inclusão consistiram em estudos clínicos, livros, dissertações, teses ou revisões de literatura que abordavam os tópicos de interesse. Síntese dos dados: Foram recuperados nas bases de dados 231 artigos. Após a aplicação de um limite de publicação de 10 anos, 111 permaneceram e, com base nos critérios de inclusão e exclusão, 20 artigos foram selecionados e incluídos nesta revisão. Conclusão: Com as limitações do presente estudo, pode-se concluir que o processo de envelhecimento é natural e previsível e pode ser mutável e maleável por meio de procedimentos que restauram os nutrientes de suporte perdidos. A estética pode ser alcançada como uma consequência funcional do reposicionamento do sistema estomatognático e do envelhecimento orofacial.

Rinomodelação ou rinoplastia não-cirúrgica: uma abordagem segura e reprodutível / Rhinomodelation or non-surgical rhinoplasty: a safe and reproducible approach

Introdução: A rinoplastia é uma cirurgia que muitas vezes apresenta resultados imprevisíveis, mesmo em mãos de cirurgiões experientes. Neste sentido, a rinomodelação com preenchedores é um procedimento não-cirúrgico para corrigir pequenas alterações externas nasais em casos específicos. Métodos: Os autores descrevem a técnica de aplicação de preenchedores (ácido hialurônico ou hidroxiapatita de cálcio) para modelação nasal. Foram incluídos todos os pacientes submetidos ao preenchimento nasal, entre 2009 e 2012. Foi avaliado o edema da ponta nasal, a dor e o grau de satisfação dos pacientes com o resultado. Resultados: Foram incluídos 39 pacientes no estudo. Com relação aos desfechos analisados com ácido hialurônico: 52% apresentaram edema leve; 74% tiveram dor leve; 15% se mostraram muito satisfeitos e 74% satisfeitos com o resultado. Com relação aos pacientes submetidos à rinomodelação com hidroxiapatita de cálcio: 67% apresentaram edema moderado; 50% dor moderada; 17% dor intensa e 84% se mostraram satisfeitos com o resultado. Conclusão: A rinomodelação com preenchedores reabsorvíveis é um procedimento simples, com resultados estéticos aceitáveis, sendo necessário um profundo conhecimento anatômico para diminuir o risco de complicações.

Introduction: Rhinoplasty often leads to unpredictable results, even in the hands of experienced surgeons. However, in specific cases, rhinomodelation with fillers, a non-surgical procedure to correct minor nasal external changes, can be used. Methods: This study describes the application technique of fillers (hyaluronic acid or calcium hydroxyapatite) for nasal modeling. Patients undergoing nasal filling between 2009 and 2012 were included. Edema of the nasal tip, pain, and the degree of patient satisfaction with the outcome were assessed. Results: Thirty-nine patients were included in the study. Regarding the outcomes of rhinomodelation with hyaluronic acid, 52% patients presented with mild edema, 74% had mild pain, 15% were very satisfied, and 74% were satisfied with the result. For the outcomes of rhinomodelation with calcium hydroxyapatite, 67% patients presented with moderate edema, 50% had moderate pain; 17% had severe pain, and 84% were satisfied with the result. Conclusion: Rhinomodelation with resorbable fillers is a simple procedure with acceptable esthetic results. However, a deep anatomical knowledge is necessary to decrease the risk of complications.

Visual loss following cosmetic facial filler injection / Perda da visão após injeção de preenchimento facial para fins cosméticos

ABSTRACT Facial filler injection for soft-tissue augmentation, wrinkle reduction, and rejuvenation has recently become increasingly popular. This procedure is well accepted and widely performed because of its safety and excellent outcomes. However, complications may occur even in the most skilled hands. A 36-year-old female presented with immediate loss of vision in her right eye following the periocular injection of cosmetic hyaluronic acid facial filler into the glabellar region. The visual loss was accompanied by weakness of her left arm. Blindness may complicate cosmetic facial filler injection. The treating physician should have a firm knowledge of the facial vascular anatomy, and the patient should be aware of the potential blinding complications associated with facial filler injection.

RESUMO A injeção de preenchimento facial para o aumento de tecido mole, redução de rugas e rejuvenescimento tornou-se recentemente3 cada vez mais popular. Este procedimento é bem aceito e amplamente realizado devido à sua segurança e excelentes resultados. Porém, complicações podem ocorrer mesmo nas mãos mais habilidosas. Uma mulher de 36 anos apresentou perda da visão no seu olho direito imediatamente após uma injeção periocular de preenchimento facial à base de ácido hialurônico cosmético na região glabelar. A perda visual foi acompanhada de fraqueza no braço esquerdo. A cegueira pode ser uma complicação da injeção de preenchimento facial para fins cosméticos. O médico deve ter um sólido conhecimento da anatomia vascular da face e o paciente deve estar ciente das possíveis complicações associadas à injeção de preenchimento facial.

Reanimação estática do lábio inferior na paralisia facial como complicação de preenchimento / Static lower lip reanimation as a filler complication of facial paralysis

Procedimentos de rejuvenescimento facial substitutos da cirurgia tradicional tornaram-se cada vez mais populares para promover uma aparência jovial com procedimentos minimamente invasivos, como toxina botulínica injetável, preenchimento de tecidos moles e peelings químicos. No entanto, complicações podem ocorrer mesmo na presença de um injetor habilidoso e experiente. Apresentamos o caso de uma paciente submetida a reanimação labial estática usando retalho dermoadiposo para lesão do nervo facial direito após remoção de nódulos como complicação de preenchimento. A "abordagem modificada de bull horn" foi realizada para elevação do lábio superior em torno das asas nasais e columela e ao longo do sulco nasolabial direito. O retalho foi desepitelizado e obtido. Usando a ponta aberta de uma pequena cânula de lipoaspiração, a porção distal do retalho foi encapsulada e fixada diretamente em C-loop e foram utilizados pontos U, transfixando o retalho para o periósteo do arco zigomático. Nos três anos de seguimento não foram observadas complicações significativas e a paciente não relatou nenhuma limitação funcional ou insatisfação com o aspecto das cicatrizes no sulco nasolabial e ao redor das asas nasais e da columela.

Facial rejuvenation procedures to circumvent traditional surgery have become increasingly popular to promote a youthful appearance with minimally invasive procedures such as injectable botulinum toxin, soft-tissue fillers, and chemical peels. Nevertheless, complications can occur even with an astute and experienced injector. Here we present the case of a patient who underwent static lip reanimation using a dermoadiposal flap for right facial nerve damage following nodule removal as a filler complication. A "modified bulls horn approach" to the upper lip lift was performed around the nasal wings and columella and along the right nasolabial fold. The flap was de-epithelized and harvested. Using the open tip of a small liposuction cannula, the distal portion of the flap was tunneled and fixed directly in a C-loop fashion using U stitches, transfixing the flap to the periosteum of the zygomatic arch. At 3 years follow-up, no significant complications were observed, and the patient reported no functional limitations or dissatisfaction with the scars in the nasolabial fold or around the nasal wings and columella.

Lesión bucal relacionada con relleno dérmico / Dermal filler-related oral lesion

Introduction: Oral adverse reactions related to natural dermal fillers may originate from infiltration techniques, giving rise to swellings, nodule formation doe to local material entrapment, or displacement or migration of the material used. Objective: describe a case of orofacial foreign body reaction in an elderly patient. Case report: a 65-year-old woman was referred for oral evaluation complaining of an intraoral lesion present for 15 days. Intraoral examination revealed a mobile nodule in the lower lip left portion. After the initial consultation, incisional biopsy was performed under local anesthesia and the surgical specimen was sent for histopathological analysis. Intraoral examination revealed a soft mobile nodule in the lower lip left portion. Clinical pathological and Raman microspectroscopy analysis led to a final diagnosis of calcium hydroxyapatite dermal filler-related reaction. Conclusions: this case reinforces the possibility of dermal filler-related mucosal tissue reactions in oral cavity soft tissues(AU)

Introducción: las reacciones adversas bucales relacionadas con rellenos dérmicos naturales pueden originarse a partir de técnicas de infiltración, lo que ocasiona inflamaciones, formación de nódulos por atrapamiento de material local o desplazamiento o migración del material usado. Objetivo: describir un caso de reacción a cuerpo extraño bucofacial en un adulto mayor. Presentación del caso: una mujer de 65 años de edad fue remitida para evaluación bucal por presentar una lesión intrabucal durante 15 días. El examen intrabucal reveló un nódulo móvil en la porción izquierda del labio inferior. Después de la consulta inicial, se realizó una biopsia incisional bajo anestesia local y se envió la muestra quirúrgica para su análisis histopatológico. El examen intrabucal reveló un nódulo móvil suave en la porción izquierda del labio inferior. El análisis clínico-patológico y de la micro-espectroscopia de Raman condujeron a un diagnóstico final de reacción de hidroxiapatita cálcica relacionada con el relleno dérmico. Conclusiones: este caso refuerza la posibilidad de reacciones cutáneas relacionadas con los rellenos dérmicos en los tejidos mucosos de la cavidad bucal(AU)

Complicaciones y manejo de procedimientos dermatoestéticos: una actualización para el dermatólogo / Complications associated with cutaneous aesthetic procedures: an update for the dermatologist

En las últimas décadas se han desarrollado nuevas técnicas e indicaciones de los procedimientos estéticos mínimamente invasivos, presentando cada vez mejores resultados con un alto nivel de seguridad, sin embargo, estos no se encuentran exentos de complicaciones, las que pueden ser transitorias o permanentes. El conocimiento, abordaje, tratamiento y prevención de las distintas complicaciones son esenciales para los dermatólogos y cirujanos plásticos. Los procedimientos más utilizados son: administración de rellenos, peeling químicos, láser, luz pulsada intensa y ultrasonido de alta frecuencia. La siguiente revisión tiene como objetivo reconocer las principales complicaciones de estos procedimientos y su manejo.

In recent decades, new techniques and indications of minimally invasive aesthetic procedures have been developed, presenting increasingly better results with a high level of safety, however these are not exempt from complications, which may be transient or permanent. The knowledge, approach, treatment and prevention of the different complications are essential for the dermatologist and plastic surgeons. The most used procedures are the administration of fillers, chemical peels, lasers, intense pulsed light and high frequency ultrasound. The following review aims to recognize the main complications of these procedures and their management.

Tratamiento de las arrugas peribucales / Treatment of oral wrinkles

Las arrugas peribucales son tal vez de las más inestéticas de la cara. Los pacientes toleran las frontales, las patas de gallo, los surcos pero no el código de barras, ya que estas son las que más nos avejentan. A través de los años se ha propuesto un sinnúmero de tratamientos, como pulido peribucal, peeling con fenol o tricloroacético, láser y más recientemente rellenos con ácido hialurónico. El fototipo del paciente suele hacernos elegir por un tratamiento u otro, ya que cuanto más oscura la piel del paciente, mayor la probabilidad de pigmentación, tanto con dermoabrasión, fenol o láser. Los rellenos de ácido hialurónico son una muy buena herramienta para cualquier tipo de piel y no dejan el clásico eritema de los otros tratamientos, a veces por hasta 30 días. El hialurónico puede combinarse con peelings mas suaves como el tricloroacético al 15 o 30%. La duración del hialurónico en las arrugas peribucales es de hasta 2 años, a diferencia del año que dura el mismo producto en los surcos nasogenianos. Hay que tener cuidado con la elección del producto y su colocación, porque los cordones, al aplicarlo muy superfi cial o el efecto Tyndall duran mucho tiempo. El índice de complicaciones es mucho menor con el hialurónico y sin los riesgos de discromías, hiperpigmentación o la alteración en la textura de la piel que observamos tantas veces con la dermoabrasión.

Peribucal wrinkles are perhaps the most unfl attering of the face. Patients tolerate the frontal wrinkles, crow's feet and grooves but not the bar code, since these are the ones that make them feel older. Over the years, a number of treatments have been proposed, such as peribucal polishing, peeling with phenol or trichloroacetic, laser and more recently fi lled with hyaluronic acid. The phototype of the patient usually makes us choose one treatment or another, since the darker the skin, the greater the chance of pigmentation, either with dermabrasion, phenol or laser. The hyaluronic acid fi llers are a very good tool for any type of skin and do not leave the classic erythema of the other treatments, sometimes lasting for up to 30 days. The hyaluronic acid fi ller can be combined with softer peels such as trichloroacetic at 15 or 30%. The duration of the fi ller in peribucal wrinkles is up to 2 years, unlike the year duration of the same product in the nasogenian furrows. You have to be careful with the choice of the product and its placement, because of the apperence of cords, when applied very superfi cial or the Tyndall eff ect that can last a long time. The rate of complications is much lower with hyaluronic acid and without the risks of dyschromia, hyperpigmentation or the alteration in skin texture observed so often with dermabrasion.

Biomateriais utilizados em substituição ao enxerto autógeno de gengiva / Biomaterials used in replacement of gingival autograft

A utilização de biomateriais na tentativa de reparar ou substituir tecidos perdidos não é recente e evoluiu juntamente com os avanços da medicina regenerativa visando à maior qualidade de vida da população. Na Odontologia a compreensão dos aspectos biomiméticos envolvidos após implantação de biomateriais como substitutos de tecido mole é de suma importância na prática clínica, uma vez que o enxerto autógeno de gengiva, considerado padrão ouro, possui inúmeras limitações em relação à dimensão da área a ser reparada, tempo cirúrgico e dor pós-operatória na loja doadora. Esta revisão tem como objetivo reunir estudos que propõem a utilização de substitutos ao enxerto autógeno de palato, ressaltando suas aplicabilidades, contraindicações, disponibilidade no mercado, além de resultados clínicos.(AU)

The use of biomaterials to repair or replace lost tissues is not new and has evolved with advances in regenerative medicine aimed at higher quality of life of the population. In dentistry, the understanding of biomimetic aspects after implantation of biomaterials used as soft tissue replacements is significant in practice, since the autograft gum considered the gold standard has many limitations regarding the size of the area to berepaired surgical time and postoperative pain in the donor area.This review aims to bring together studies that propose substitutes to autograft palate, highlighting its applicability, contraindications, availability in the market, and clinical outcomes. (AU)

Development and characterization of hyaluronic acid-lysine nanoparticles with potential as innovative dermal filling

ABSTRACT Skin aging causes changes such as wrinkles and flaccidity leading to a large demand for aesthetic procedures, including dermal filling. A key agent in dermal filling is hyaluronic acid (HA), which is a naturally occurring glycosaminoglycan. However, it is a hydrophilic macromolecule that experiences great difficulty in crossing the skin barrier causing most commercial formulations containing it to be injectable, which in turn brings risks since they involve an invasive technique. In that sense, the aim of this study was to develop and characterize nanoparticles obtained from ionic interaction between HA and lysine (Lys) for use as a potential agent of dermal filling for topical application, increasing and improving its applicability and safety. To this end, nanoparticles were obtained by dripping of Lys over HA under magnetic stirring. A nanometric size was confirmed and a suitable surface charge was obtained by zeta potential. Nanoparticles were almost spherical in shape with a smooth surface. Interaction between raw materials for preparing nanoparticles was studied by FTIR and NMR spectroscopy and an ionic interaction was confirmed. These physicochemical features suggest that obtained nanoparticles can be further used as a topical dermal filling.

Modificaciones volumétricas faciales con rellenos de ácido hialurónico. Hialurónico a los 30, un camino hacia la belleza / Volumetric facial reshaping with hyaluronic acid fillers. Hyaluronic at 30, a road to beauty

Cada vez más, las pacientes jóvenes solicitan tratamientos mínimamente invasivos, como son los rellenos de ácido hialurónico, los cuales tienen una duración de más de un año. Las mujeres de 40 en adelante buscan generalmente un tratamiento de rejuvenecimiento que disminuya las arrugas, así como también la profundidad de los surcos. Las pacientes de menor edad quieren estar más bellas, solicitando muchas veces una modificación de sus proporciones faciales. Se presentan 4 casos de mujeres a las que se les realizó una modificación del volumen facial utilizando ácido hialurónico con diferentes densidades. El contar con rellenos de distintas densidades nos permite trabajar en todas las zonas y planos de la cara, así como modificar los volúmenes de la misma. El análisis de las proporciones faciales, su volumen, balance y simetría nos va a permitir trabajar sobre cada caso en particular y de esta manera lograr nuestro objetivo, la belleza. Se exponen además las complicaciones halladas con este tipo de material de relleno, su duración y su tratamiento

Younger patients seek more often minimally invasive treatments, such as hyaluronic acid fillers, which have a duration of more than one year. Women from 40 and up, generally seek rejuvenation treatment that diminishes wrinkles, as well as the depth of the grooves. The younger patients want to be more beautiful, often requesting a modification of facial proportions. Four cases of women who underwent a modification of facial volume, using hyaluronic acid with different densities are presented. Having fillers with different densities allows us to work in all areas and levels of the face, being able to modify the volumes of it. The analysis of facial proportions, volume, balance and symmetry will allow us to work on each particular case and thereby achieve our goal, beauty complications encountered with this type of filler, its duration and the treatment thereof are also presented

Tratamiento periorbitario con ácido hialurónico / Periorbital treatment with hyaluronic acid

Hoy, gran cantidad de pacientes solicitan un cambio en la zona palpebral ya que se ven con aspecto de cansados. Muchas veces presentan bolsas y piel redundante, pero no quieren someterse a una cirugía, que en muchos casos es el tratamiento de elección. Pueden ofrecerse como alternativa los rellenos con ácido hialurónico. Como problemas estéticos en la zona, se pueden encontrar: • Surco nasoyugal o de las lágrimas (tear trough) • Surco palpebromalar • Bolsas palpebrales • Bolsas malares • Flaccidez cutánea Sólo en algunas situaciones puede aplicarse relleno a nivel submuscular solamente y es cuando los pacientes presentan piel tensa con un surco nasoyugal o palpebromalar marcados. Si hay bolsas, piel redundante y atrófica deberá aplicarse, además, relleno en el plano subcutáneo, lo que generará una transición mucho más suave entre el párpado y la mejilla. Si bien hacemos una clara distinción entre la aplicación subcutánea y submuscular, no debemos olvidar que en el medio está el orbicular de los párpados y frecuentemente la aplicación se hace en el espesor del músculo mismo. Si bien puede haber complicaciones como los cordones o las pápulas, que se deben a defectos en la técnica, no suele haber reacciones inflamatorias ni graves ni crónicas, como pueden generar la silicona, el metacrilato, la poliacrilamida u otros productos aunque estén correctamente aplicados(Existen multiples reportes de complicaciones con acidos hialuronicos, algunas graves como cegueras, si existe bibliografia seria y confiable sobre "la tecnica correcta" para evitar las complicaciones aportarla como referencia). Los moretones son habituales, el edema y en menor medida el dolor son otras posibles complicaciones

Today, many patients are requesting a change in the eyelid area because they feel that look tired. Often, they have bags and redundant skin, but don't want to do a surgery, which in many cases is the treatment of choice. It can be offered as an alternative fillers with Hyaluronic acid. As aesthetic problems in the area, we can find: • Nasojugal groove or tear trough • Palpebromalar groove • Palpebral bags • Malar bags • Cutaneous flaccidity In some situations, it can be apply to submuscular filling level, only when patients present tense skin with the nasojugal or palpebromalar groove marked. If there are bags, redundant and atrophic skin, should also be applied in the subcutaneous area, generating a much smoother transition between the eyelid and the cheek. While we make a clear distinction between subcutaneous and submuscular application, we must not forget that in the middle is the orbicularis, and frequently the application is made in the thickness of the muscle itself. Hyaluronic acid is a very noble substance, unless it is misapplied, generally there are no problems with the product. While there may be complications such as cords or papules, which are flaws in technique, there is usually no inflammatory reactions or serious or chronic as can generate silicone, methacrylate, polyacrylamide or other products, even if they are properly applied. Bruises are common, edema, and in second level the pain, as other possible complications.

Complicação tardia de preenchimento cutâneo após facelift: relato de caso / Late complication of cutaneous filling after a facelift: a case report

Os autores apresentam o caso de uma paciente submetida 7 anos após aplicação de polimetilmetacrilato (PMMA) a um facelift com implante de prótese mentoniana, o qual evoluiu com granuloma por corpo estranho em região distante da aplicação do preenchimento. Após quase um ano de tratamento, a paciente evoluiu com resolução do caso.

The authors present the case of a patient who underwent a facelift with a chin implant 7 years after polymethylmethacrylate (PMMA) implantation, which evolved with foreign body granuloma in a region distant from the filling application. After nearly a year of treatment, the patient evolved with resolution of the granuloma.

Rinomodelación y uso de Metacrill® en la punta nasal: revisión de la literatura y presentación de un caso / Filler rhinoplasty and use of Metacrill® in the nasal tip: case report and review of the literature

La rinomodelación es un procedimiento en el cual se utilizan materiales de relleno inyectables para modificar el perfil nasal. Han existido más de 150 rellenos dérmicos en el mercado global, pero ninguno logra reunir todas las características ideales. El polimetilmetacrilato (PMMA) ha sido utilizado en medicina por más de 50 años como relleno dérmico y ha sido aprobado por la FDA para su uso en corrección de pliegues nasolabiales. Tras la inyección de PMMA, las microesferas generan una respuesta inflamatoria a cuerpo extraño ya que no pueden ser fagocitadas por macrófagos ni por células gigantes, dado su tamaño, permaneciendo en el tejido inalteradas. El tejido de granulación y las fibras colágenas crecen en torno a las microesferas, encapsulándolas. Se considera un producto permanente ya que el PMMA no se degrada en el tiempo. La punta nasal es un área donde se pueden obtener buenos resultados con rellenos inyectables, pero debe ser tratada con pequeños volúmenes para evitar potenciales efectos adversos, principalmente el compromiso vascular de la piel. Presentamos el caso de un paciente sometido a rinoplastía no quirúrgica con inyección de PMMA (Metacrill®) en la punta nasal y su revisión quirúrgica secundaria.

Filler rhinoplasty is a procedure in which dermal fillers are used to alter the nasal profile without invasive surgery. There have been more than 150 fillers in the global market, though none of them are considered ideal. Polymethylmetacrylate (PMMA) has been used in medical practice for more than 50 years as a dermal filler and has been approved by the FDA for the correction of nasolabial folds. Once inyected, the PMMA micro spheres cause a foreign body inflammatory reaction, yet they cannot be removed by phagocytosis because of their large size, remaining unaltered in time. Granulation tissue and collagen fibers grow sorrounding and encapsulating the micro spheres. It is considered a permanent filler due to the remainance of the PMMA micro spheres in the skin. The nasal tip is an area easy to treat with fillers, though it must be managed with small volumes to avoid adverse reactions, mainly vascular compromise of the skin. We present the case of a patient who underwent a filler rhinoplasty with PMMA (Metacrill®) in the nasal tip and a subsequent secondary revision rhinoplasty.

Necrose facial após enxerto de gordura e tratamento com oxigenioterapia hiperbárica / Facial necrosis after fat grafting and treatment with hyperbaric oxygen therapy

A lipoenxertia de face, apesar de consagrada, não é isenta de riscos e complicações. Neste relato de caso, descrevemos de forma inédita uma complicação isquêmica local, causada por enxerto de gordura. Simultaneamente, propomos a terapêutica com Oxigenioterapia Hiperbárica para o tratamento desta situação, não se limitando exclusivamente à gordura, mas principalmente ao PMMA, em que esta complicação é muito mais frequente.

Facial fat grafting is not devoid of risks and complications, despite being a widely practiced procedure. In this case report, we describe a novel form of local ischemic complication that occurred secondary to fat grafting. Simultaneously, we propose Hyperbaric Oxygen therapy for the treatment of this situation. We propose that Hyperbaric Oxygen therapy should not be limited solely to fat graft-related ischemia, but should be effective in the management of the more frequently encountered complications associated with polymethylmethacrylate fillers.