Targeted and Individualized Gluteal Poly-L-Lactic Acid Injection for Optimal Aesthetic Results in the Gluteal Region.

Objective: The robust safety and efficacy profile associated with the use of biodegradable fillers such as poly-L-lactic acid (PLLA) for facial rejuvenation has resulted in a growing interest in off-label use for various aesthetic applications, including gluteal augmentation. The authors describe a novel targeted and individualized technique of PLLA injection into the buttock region. Methods: The technique involves clinical and anatomical evaluations of the gluteal region, and there are three distinct approaches for injecting PLLA in the gluteal region based on the most important factor to be improved: (1) skin quality, (2) contour and lifting, or (3) projection and volume. Results: This novel technique is associated with favorable patient outcomes in terms of improvements across all key areas of gluteal augmentation; improvement in skin quality and laxity, contour improvement and lifting, and gluteal volume and projection. Since its initiation, this technique has been found to be both cost-effective and clinically efficacious, with demonstratable benefits achieved with a lower volume of PLLA compared to other PLLA injection techniques. Limitations: Assessment of patient outcomes with this technique have, to date, been subjective clinical observations, which does not include quantitative outcomes such as patient satisfaction data or safety outcomes. Conclusion: We describe an optimized and individualized approach for injecting the collagen biostimulator PLLA in the gluteal region according to the needs of each patient.

A promising alternative for mature skin: the effects of phytoestrogens on human skin and its topical use / Alternativa promissora para peles maduras: os efeitos dos fitoestrógenos na pele humana e seu uso tópico

Skin quality deteriorates with age for various reasons, including hormone deficiencies. In women, the decline in estrogen levels during menopause plays an important role in skin degeneration, with consequent atrophy, collagen reduction, loss of elasticity, and impaired wound healing. Research has demonstrated the beneficial effects of topical phytoestrogen in preventing and repairing skin aging, with localized action and without side effects. The objective of this study was to review the relevant literature, demonstrating that this can be a safe and effective alternative for treating the skin of perimenopausal women.

A qualidade da pele deteriora-se com a idade por vários motivos, incluindo as deficiências hormonais. Nas mulheres, o declínio dos níveis de estrógeno, durante a menopausa, tem papel importante na degeneração cutânea, com consequente atrofia, redução do colágeno, perda de elasticidade e deficiência da cicatrização de feridas. Pesquisas têm demonstrado efeitos benéficos do fitoestrogênio tópico na prevenção e reparação do envelhecimento cutâneo, com ação localizada e sem efeitos colaterais. O objetivo deste estudo foi revisar a literatura pertinente ao assunto, demonstrando que esta pode ser uma alternativa segura e eficaz para o tratamento da pele de mulheres na perimenopausa.

Terapia tópica para prevenção e tratamento da radiodermatite aguda das mamas: revisão integrativa da literatura / Topical treatment for prevention and management of acute radiation dermatitis in breast cancer patients: an integrative review

Introdução: A radioterapia desempenha um importante papel adjuvante ao tratamento cirúrgico do câncer de mama, pois diminui as taxas de recorrência local e aumenta a sobrevida global. Entretanto, até 95% das pacientes expostas à radiação ionizante desenvolverão algum grau de radiodermatite. O presente estudo revisa a literatura referente às terapias tópicas disponíveis para prevenção e tratamento da radiodermatite aguda das mamas, sintetizando as evidências disponíveis e auxiliando a tomada de decisão clínica. Métodos: Revisão integrativa da literatura publicada nos últimos 10 anos, utilizando as bases de dados LILACS, Medline e Biblioteca Cochrane. Foram utilizados os descritores neoplasias da mama, radiodermatite, higiene da pele e creme para a pele. Resultados: Dos 158 artigos encontrados, 48 foram incluídos nesta revisão. Foram identificadas 40 diferentes terapias tópicas que foram agrupadas em sete categorias para facilitar a análise e interpretação dos dados: fitoterápicos, hormônios/vitaminas/fatores de crescimento, corticoesteroides, barreira (filme ou creme), ácido hialurônico, curativos à base de prata e outros. Conclusões: Existe evidência científica proveniente de ensaios clínicos randomizados de boa qualidade embasando a indicação dos corticosteroides tópicos de alta (valerato de 17-betametasona) e média potência (furoato de mometasona 0,1%), assim como de filmes barreira como Mepitel®, Mepilex Lite® e Hydrofilm®, no manejo da radiodermatite aguda das mamas. As demais terapias não mostraram benefícios na prevenção e/ou tratamento da radiodermatite ou têm evidência científica limitada, contraindicando ou restringindo sua utilização na prática clínica.

Introduction: Radiotherapy plays an important adjuvant role in the surgical treatment of breast cancer by reducing locoregional recurrence and improving overall survival. However, up to 95% of patients experience some degree of radiodermatitis. This study aims to review the literature regarding topical agent therapies in preventing and treating acute radiation dermatitis in breast cancer patients. Methods: Integrative review of LILACS, Medline and Cochrane Library databases. We searched for original articles published between 2010 and 2020, including the descriptors breast neoplasms, radiodermatitis, skincare, and skin cream. Results: The initial search returned 158 articles. After screening for eligibility, 48 articles were included. Forty different topical agent therapies were identified and grouped into seven categories to facilitate data analysis: herbal medicines, hormones/vitamins/growth factors, topical corticosteroids, barrier products (film or cream), hyaluronic acid, silver-based dressings and others. Conclusions: This review identifies that topical corticosteroids of high (betamethasone-17-valerate) and medium potency (mometasone furoate 0.1%), as well as barrier films such as Mepitel®, Mepilex Lite®, and Hydrofilm®, are effective in managing acute breast radiodermatitis. The other topical agent therapies did not show benefits in preventing and/or treating acute radiodermatitis or have limited evidence.

Tratamento de siringomas periorbitários: revisão da literatura científica nos últimos 5 anos / Treatment of periorbital syringomas: review of scientific literature in the last 5 years

Introdução: O siringomas são tumores anexais benignos com caraterísticas histopatológicas decorrentes dos ductos écrinos, em forma de pápulas amareladas ou cor da pele, de 1-3 mm, comumente na região periorbitária inferior, podendo causar problemas cosméticos importantes. O objetivo do tratamento é melhorar a aparência, através da destruição completa do tumor usando métodos minimamente invasivos e inclusa cirurgia. Existem na literatura múltiplas opções de tratamento com vários graus de sucesso, porém pouco se conhece sobre a eficácia. Em geral, a remoção completa não é bem-sucedida, e têm sido descritos efeitos colaterais, sendo a recorrência o mais frequente. Métodos: Trata-se de uma revisão narrativa de literatura, de publicações científicas no período de 2014-2019. Resultados: Após revisar 45 artigos, e identificar os publicados nos últimos cinco anos que tiveram registro de número de pacientes, descrição de tratamento, escalas de avaliação dos resultados e acompanhamento, foram selecionados seis artigos. Do número total de seis artigos, foram encontrados: uma revisão sistemática, e cinco estudos retrospectivos, sendo um comparativo. Foi designado um número para cada artigo analisado, e coletados o número de pacientes incluídos, tratamento realizado, escalas de avaliação e resultados, complicações e conclusões. Conclusões: Os siringomas periorbitários ainda são um desafio terapêutico, e até agora nenhum tratamento demostrou ser consistentemente eficaz. O laser CO2 continua sendo a primeira escolha de tratamento quando usado fracionado, e a eletrocoagulação intralesional representa uma segunda alternativa com resultados moderados e menor risco de complicações. Novos tratamentos como Laser Erbium Laser Erbium Yttrium Aluminum Garnet, Neodymium-Doped Yttrium Aluminum Garnet e monoterapia com toxina botulínica A poderiam ser boas alternativas. Estudos prospetivos comparativos são necessários.

Introduction: Syringomas are benign adnexal tumors with histopathological characteristics arising from the eccrine ducts, in yellowish or skin-colored papules, 1-3 mm, commonly in the lower periorbital region, which can cause important cosmetic problems. The goal of treatment is to improve appearance by destroying the tumor using minimally invasive methods and including surgery. There are multiple treatment options in the literature with varying degrees of success, but little is known about their effectiveness. Complete removal is unsuccessful, and side effects have been described, recurrence being the most frequent. Methods: This is a narrative review of the literature of scientific publications in the period 2014-2019. Results: After reviewing 45 articles and identifying those published in the last five years that had a record of the number of patients, treatment description, scales of evaluation of results and follow-up, six articles were selected. Of the total number of six articles, we found: a systematic review and five retrospective studies, one being a comparative one. A number was assigned to each article analyzed, and the number of patients included, treatment performed, assessment scales and results, complications and conclusions were collected. Conclusions: Periorbital syringomas are still a therapeutic challenge, and so far, no treatment is consistently effective. The CO2 laser remains the first choice of treatment when used fractionally, and intralesional electrocoagulation represents a second alternative with moderate results and a lower risk of complications. New treatments such as Laser Erbium Laser Erbium Yttrium Aluminum Garnet, Neodymium-Doped Yttrium Aluminum Garnet and botulinum toxin A monotherapy could be good alternatives. Comparative prospective studies are needed.

Expert Recommendations on the Use of Injectable Poly-L-lactic Acid for Contour Deficiencies of the Buttocks.

Poly-L-lactic acid (PLLA) is an injectable biodegradable biostimulator that promotes collagen production and is approved for use in aesthetic facial augmentation. PLLA is well tolerated with minimal downtime and has demonstrated an excellent safety profile, as well as a longevity benefit of at least 2 years following injection. The robust safety and efficacy profile associated with PLLA for facial rejuvenation has resulted in a growing interest in the use of PLLA for other body areas such as the buttocks, which are an increasingly popular target of aesthetic enhancement. Patient goals for gluteal enhancement include improving contour and texture, reduction in visible cellulite and increased volume and lift. In order to achieve optimal outcomes and patient satisfaction, it is essential to ensure correct usage of PLLA; however, there is currently a lack of guidelines and expert recommendations in this area. This report reflects consensus recommendations for the use of PLLA in non-invasive buttock contouring, including patient selection, PLLA preparation, dosing, injection and, efficacy and safety assessments. Recommendations were provided by the collective author group, comprising international leaders in the field of aesthetics, dermatology, and plastic surgery. J Drugs Dermatol. 2022;21(1):21-26. doi:10.36849/JDD.6180.

Algoritmos para manejo de cicatrizes: a importância da sistematização de condutas / Algorithms for the management of scars: the importance of systematizing behaviors

■ RESUMO Introdução: As cicatrizes patológicas ocorrem a partir de hiperproliferaçãoo de fibroblastos, podendo ser classificadas em cicatrizes hipertróficas e queloides, basicamente as cicatrizes hipertróficas não crescem além dos limites da ferida original, enquanto os queloides crescem horizontalmente de forma nodular. Apesar da diversidade de instrumentos utilizados para orientar a prevenção, tratamento e seguimento de cicatrizes patológicas, existe a necessidade de instrumentos que contemplem realidades locais. O objetivo é realizar uma revisão narrativa de literatura sobre algoritmos para manejo de cicatrizes e criar um algoritmo atualizado. Métodos: Estudo descritivo de revisão narrativa de literatura, sendo realizado uma pesquisa nas bases de dados PubMed, SciELO, LILACS, MEDLINE e Cochrane, no período de novembro de 2010 até novembro de 2020, publicados nos idiomas inglês, português e espanhol. Os descritores utilizados foram: "cicatrix", "keloid", "algorithms" e "wound healing". A seleção da amostra consistiu da identificação dos artigos, leitura dos títulos e resumos e seleção de estudos relacionados ao tema e, posteriormente, foi realizada a leitura na íntegra dos estudos selecionados e classificação segundo os critérios de elegibilidade. Resultados: Foram encontrados 209 artigos sendo eliminados 116 devido duplicidade resultando em 45 artigos. Foram identificados um total de 8 artigos que preencheram os critérios de inclusão e após análise e reunião de consenso foram excluídos quatro artigos devido à ausência de algoritmos com rigor científico sendo este estudo composto de quatro artigos. Conclusão: Foram encontrados quatro algoritmos na revisão de literatura que resultaram na elaboração de um algoritmo atualizado para cicatrizes.

■ ABSTRACT Introduction: Pathological scars occur from the hyperproliferation of fibroblasts and can be classified into hypertrophic scars and keloids. Basically, hypertrophic scars do not grow beyond the limits of the original wound, while keloids grow horizontally in a nodular form. Despite the diversity of instruments used to guide the prevention, treatment and follow-up of pathological scars, there is a need for instruments that address local realities. The objective is to carry out a narrative review of the literature on scar management algorithms and create an updated algorithm. Methods: Descriptive study of narrative literature review, with a search in PubMed, SciELO, LILACS, MEDLINE and Cochrane databases, from November 2010 to November 2020, published in English, Portuguese and Spanish. The descriptors used were: "cicatrix," "keloid," "algorithms," and "wound healing." The sample selection consisted of identifying the articles, reading the titles and abstracts, and selecting studies related to the topic. Subsequently, the full reading of the selected studies and classification according to the eligibility criteria were carried out. Results: 209 articles were found, and 116 were eliminated due to duplicity, resulting in 45 articles. A total of 8 articles that met the inclusion criteria were identified. Four articles were excluded after analysis and consensus meeting due to the absence of algorithms with scientific rigor; this study is composed of four articles. Conclusion: Four algorithms were found in the literature review that resulted in the development of an updated algorithm for scars.

"Projeto Pele Alerta": prevenção e detecção precoce do câncer de pele direcionado a profissionais de beleza / "Pele Alerta Project": prevention and early detection of skin cancer aimed at beauty professionals

Introdução: O câncer de pele é a neoplasia mais incidente em vários países, incluindo o Brasil, e a sua incidência continua subindo. A detecção precoce e a prevenção primária são as principais formas de diminuir a morbidade e mortalidade. Locais como cabeça, pescoço e dorso são de difícil visualização pela própria pessoa. Há um potencial nos profissionais de beleza em detecção precoce destas lesões e encaminhamento para avaliação e conduta médica. Objetivos: Desenvolver um projeto on-line com ferramentas para educação de profissionais de beleza sobre o câncer de pele. Métodos: Baseado na literatura atual, foram formulados vídeos e material ilustrado educativos, disponíveis em um website. Resultados: O "Projeto Pele Alerta" pode ser acessado em www.projetopelealerta.com; este conta atualmente com 4 tópicos, cada qual com um vídeo (YouTube) e material de apoio em PDF. Conclusão: O projeto em questão é viável, de fácil execução e permite grande alcance na educação em relação ao câncer de pele.

Introduction: Skin cancer is the most common neoplasm in several countries, including Brazil, and its incidence continues to rise. Early detection and primary prevention are the main ways to reduce morbidity and mortality. Places such as the head, neck and back are difficult to see by the person himself. There is a potential in beauty professionals for the early detection of these lesions and referral for evaluation and medical conduct. Objectives: Develop an online project with tools to educate beauty professionals about skin cancer. Methods: Based on current literature, videos and educational illustrated material were made available on a website. Results: The "Pele Alerta Project" can be accessed at www.projetopelealerta.com; this currently has four topics, each with a video (YouTube) and support material in PDF. Conclusion: The project in question is feasible, easy to execute and allows comprehensive education concerning skin cancer.

Os efeitos dos estrogênios e fitoestrogênios na pele humana e seu uso tópico para prevenção do envelhecimento cutâneo: revisão da literatura / The effects of estrogens and phytoestrogens on human skin and its topical use for prevention of skin aging - Literature Review

A qualidade e a função da pele reduzem-se drasticamente com a idade devido ao envelhecimento cronológico, ao fotoenvelhecimento, aos fatores ambientais e às deficiências hormonais. O declínio dos níveis de estrógeno na menopausa tem papel importante na atrofia cutânea, redução do colágeno, perda de elasticidade e deficiência da cicatrização de feridas. Pesquisas têm demonstrado os efeitos benéficos do estrogênio tópico, que teria ação mais localizada na pele sem efeitos colaterais sistêmicos. O objetivo deste estudo foi revisar a literatura pertinente ao assunto, demonstrando que o uso do estrogênio tópico pode ser uma alternativa segura e eficaz para o tratamento da pele de mulheres na perimenopausa.

Skin quality and function drastically reduces with age due to chronological aging, photoaging, environmental factors and hormonal deficiencies. Decreased menopausal estrogen levels play a role in cutaneous atrophy, collagen and water content, loss of elasticity, skin wrinkling and deficiency of wound healing. Much research has been done to elucidate the beneficial effects of topical estrogen, which would have a more localized action on the skin without systemic side effects. The objective of this study was to review the relevant literature, demonstrating that this may be a safe and effective alternative for the treatment of women's skin in perimenopause

Recommendations on the Use of Injectable Poly-L-Lactic Acid for Skin Laxity in Off-Face Areas

Injectable poly-L-lactic acid (PLLA) is a biodegradable synthetic polymer that stimulates collagen production, leading to gradual volume restoration. The treatment of sagging skin in body areas is still a big challenge, as there are few aesthetic procedures aiming to improve it. This article provides recommendations on the use of PLLA in the treatment of skin laxity in off-face areas, as the neck, décolletage, arms, abdomen, buttocks, and thighs, including the patient selection, product preparation, and injection techniques. The use of PLLA is a promising method for the treatment of skin laxity in corporal areas, improving body contour and appearance. Further investigation is needed to better understand the efficacy and durability of PLLA in non-facial indications and to provide the best evidence for optimal patient outcomes. J Drugs Dermatol. 2019;18(9):929-935.

Impacto do tratamento com laser fracionado de CO2 em cicatrizes hipertróficas e queloides: uma revisão sistemática / Impact of fractional CO2 laser treatment on hypertrophic scars and keloids: a systematic review

Introdução: Cicatrizes hipertróficas e queloides causam dano estético e funcional e são de difícil tratamento. O objetivo desta revisão foi identificar estudos prospectivos do tratamento com o laser fracionado de CO2, mostrando as alterações clínicas e histológicas e a metodologia utilizada para a avaliação das cicatrizes antes e após intervenção. Métodos: Foi realizada uma revisão eletrônica (LILACS, Medline e SciELO) de estudos publicados entre janeiro de 2004 e dezembro de 2017, com os termos "keloid/queloide", "hypertrophic scar/cicatriz hipertrófica" e "laser CO2", de acordo com o PRISMA Statement, sendo selecionados os estudos que comparassem as cicatrizes antes e depois de tratamento isolado com laser fracionado de CO2. Os dados foram analisados por dois revisores independentes. Resultados: Foram analisados 102 artigos, sendo que 7 cumpriam os critérios estabelecidos. Destes, os 7 analisaram cicatrizes hipertróficas, 2 deles também analisaram queloides, e 3 estudaram alterações histológicas. Houve diferença estatística entre os escores clínicos medidos antes e após tratamento de cicatrizes hipertróficas na maioria dos estudos, com melhora nos sintomas, na flexibilidade e altura da cicatriz. Entre os 2 estudos que analisaram os queloides, 1 deles demonstrou diferença clínica após tratamento. Nas alterações histológicas, houve diferença na orientação e densidade das fibras de colágeno e na espessura da epiderme. Conclusão: O laser fracionado de CO2 deve ser considerado como opção promissora no tratamento de cicatrizes patológicas, visto que melhora os sinais e sintomas clínicos como cor, espessura e prurido.

Introduction: Hypertrophic scars and keloids cause aesthetic and functional damages, and are difficult to treat. This review aimed to identify prospective studies on fractional CO2 laser to present the clinical and histological changes and the methodology used for the evaluation of scars before and after intervention. Methods: We conducted an electronic review (LILACS, Medline, and SciELO) of studies published between January 2004 and December 2017, using the search terms "keloid/queloide," "hypertrophic scar/cicatriz hipertrófica," and "CO2 laser ," according to the PRISMA Statement. Studies that compared scars before and after isolated treatment with fractional CO2 laser were selected. Two independent reviewers analyzed the data. Results: One hundred two articles were analyzed, of which 7 met the inclusion criteria. Of the 7 articles, all analyzed hypertrophic scars, 2 analyzed keloids in addition to hypertrophic scars, and 3 analyzed histological changes. Most studies showed a statistically significant difference in clinical scores between before and after treatment of hypertrophic scars, with improvement in symptoms, flexibility, and scar height. Between the 2 studies that analyzed keloids, 1 reported a clinical difference after treatment. The histological changes showed significant differences in the orientation and density of the collagen fibers, and in the thickness of the epidermis. Conclusion: The use of fractional CO2 laser should be considered as a promising treatment option for pathological scars, as it improves clinical signs and symptoms such as color, thickness, and pruritus.

Managing the Aesthetic Patient

wide variety of therapeutic options, some challenges have arisen: designing an adequate treatment plan, electing the most suitable procedures for the patient, taking into consideration the rheological characteristics of the products, considering the amount needed to achieve a natural look, but also defining the safest way to deliver the treatment. Aging of the facial structural tissue layers occurs at a different pace and the requirements for the aesthetic approach of a 30-year-old patient are different from a 60-year-old patient. A group of twelve experts in minimally invasive injectable procedures sought to identify common changes observed in different age groups in order to help in establishing a plan of treatment for patients of different ages. The individualized aesthetic plan should consider the main pillars of the aesthetic treatment -- aging process, facial assessment, and facial anatomy, to identify and systematize common changes observed in different age groups, as well as the safest and most reproducible techniques, especially for new injectors. J Drugs Dermatol. 2019;18(1):92-102.

Impact of Fractional Ablative Carbon Dioxide Laser on the Treatment of Rhinophyma.

BACKGROUND: Rhinophyma results in nasal deformity, which may lead to significant distress, embarrassment, social isolation, and low self-esteem. Fractional carbon dioxide (CO2) laser treatment is a simple, noninvasive, outpatient procedure with a low complication rate that has proved useful in rhinophyma treatment. OBJECTIVES: The aim of this study was to assess the impact of fractional ablative CO2 laser treatment on self-esteem in patients with rhinophyma. METHODS: Twelve patients with rhinophyma, between 50 and 80 years of age, received 4 monthly treatment sessions with a fractional ablative CO2 laser. The laser parameters were chosen based on the severity of the condition of each patient. Patient satisfaction was assessed through a study-specific questionnaire administered 1 month after treatment. Self-esteem was assessed by the Rosenberg Self-Esteem (RSE) Scale, which was administered before treatment, and at 1, 6, and 12 months after treatment. RESULTS: A decrease in RSE scores was observed in the post-treatment period, indicating an improvement in self-esteem among patients. All patients were satisfied with the aesthetic results and would recommend the treatment to a friend. CONCLUSIONS: Fractional ablative CO2 laser treatment is associated with high levels of rhinophyma patient satisfaction, and significant improvements in self-esteem.

UNIFESP Info Plastica - An informative application covering the most frequently performed plastic surgeries worldwide.

OBJECTIVES: The objective of this study was to develop a free smartphone application with reliable and useful information for the lay public on the most frequently performed plastic surgeries worldwide. METHODS: The five most frequently performed surgeries worldwide according to ISAPS (International Society of Aesthetic Plastic Surgery) were selected. Information from the websites of the American Society of Plastic Surgeons (ASPS), American Society for Aesthetic Plastic Surgery (ASAPS) and Brazilian Society of Plastic Surgery (SBCP) and from the Outpatient and Hospital Medicine Guide of the Plastic Surgery Division at the Federal University of São Paulo (UNIFESP) was used for content assembly. YouTube videos with patients' postoperative testimonials were used for an improved understanding of their real concerns. Printed text was distributed to patients in Brazil's Unified Health Service to improve comprehensibility. Content on each of the five surgeries was presented in the application with the following layout: What is the surgery?; Who are the candidates?; Preparations for surgery; Stages of surgery; Recovery after surgery; Complications; Choice of surgeon; Consultation; What is the cost? and Glossary. All material was delivered to an outsourced company to produce the application software. RESULTS: The result was the creation of an application with extensive content on the most frequently performed plastic surgeries. CONCLUSION: The UNIFESP Info Plastica application is an academically based, free and reliable source of information for the lay public interested in all aspects of the most frequently performed plastic surgeries worldwide.

UNIFESP Info Plastica - An informative application covering the most frequently performed plastic surgeries worldwide

OBJECTIVES: The objective of this study was to develop a free smartphone application with reliable and useful information for the lay public on the most frequently performed plastic surgeries worldwide. METHODS: The five most frequently performed surgeries worldwide according to ISAPS (International Society of Aesthetic Plastic Surgery) were selected. Information from the websites of the American Society of Plastic Surgeons (ASPS), American Society for Aesthetic Plastic Surgery (ASAPS) and Brazilian Society of Plastic Surgery (SBCP) and from the Outpatient and Hospital Medicine Guide of the Plastic Surgery Division at the Federal University of São Paulo (UNIFESP) was used for content assembly. YouTube videos with patients' postoperative testimonials were used for an improved understanding of their real concerns. Printed text was distributed to patients in Brazil's Unified Health Service to improve comprehensibility. Content on each of the five surgeries was presented in the application with the following layout: What is the surgery?; Who are the candidates?; Preparations for surgery; Stages of surgery; Recovery after surgery; Complications; Choice of surgeon; Consultation; What is the cost? and Glossary. All material was delivered to an outsourced company to produce the application software. RESULTS: The result was the creation of an application with extensive content on the most frequently performed plastic surgeries. CONCLUSION: The UNIFESP Info Plastica application is an academically based, free and reliable source of information for the lay public interested in all aspects of the most frequently performed plastic surgeries worldwide.

Conceitos atuais no uso do ácido poli-l-láctico para rejuvenescimento facial: revisão e aspectos práticos / Current concepts in the use of poly-L-lactic acid for facial rejuvenation: literature review and practical aspects

O conceito de rejuvenescimento facial abrange atualmente visão tridimensional, que reconhece como sinais de envelhecimento não só a perda da textura cutânea e as rugas de expressão, mas também as perdas volumétricas secundárias à remodelação óssea e a redistribuição da gordura facial. O objetivo do presente artigo é apresentar uma revisão da literatura sobre o ácido poli-l-láctico para rejuvenescimento facial, incluindo suas indicações, técnicas de injeção, resultados esperados e possíveis efeitos adversos.

The concept of facial rejuvenation currently includes a three-dimensional perspective, which recognizes as signs of aging not only the loss of the skin's texture and the emergence of expression wrinkles, but also the volumetric losses secondary to bone remodeling and redistribution of facial fat. This article was aimed at reviewing the literature on poly-L-lactic acid for facial rejuvenation ­ including its indications, injection techniques, expected results and possible adverse effects ­ and offer practical guidelines, based on the authors' 12-year experience with the product.

Translation, cultural adaptation, and validation of the American Skindex-29 quality of life index.

BACKGROUND: Measuring the quality of life measure of patients with dermatologic diseases is an important concern. The instruments to evaluate it are commonly originally written in English and need to be translated and validated to be used in different cultures. OBJECTIVE: The purpose of this paper is to translate and validate the Skindex-29 questionnaire to Brazilian Portuguese to be used in our country as a quality of life assessment instrument in dermatologic patients. METHODS: The first step was the translation from English to Brazilian Portuguese and the back-translation by two native speakers. The translated version was then used for the second step, when three questionnaires were applied to 75 patients (43 of whom were classified as lightly affected and 32 as heavily affected by their dermatologic conditions): an identification questionnaire, the translated version of Skindex-29, and the Brazilian Portuguese version of Dermatologic Life Quality Index (DLQI). Additionally, the generic questionnaire Short Form 36 (SF-36) was applied to 41 of these patients. The last step to evaluate reproducibility was repeating the Skindex-29 questionnaire by the same researcher one week later in 44 patients. RESULTS: Reliability was observed in global Skindex-29 scale (α=0.934), and its domains emotions (α=0.926), symptoms (α=0,702), and psycosocial functioning (α=0.860). The reproducibility showed high intraclass correlations. High intra class correlations was observed, thus validating reliability. CONCLUSIONS: The Skindex-29 quality of life questionnaire was properly translated and validated to Brazilian Portuguese.

Translation, cultural adaptation, and validation of the American Skindex-29 quality of life index

BACKGROUND: Measuring the quality of life measure of patients with dermatologic diseases is an important concern. The instruments to evaluate it are commonly originally written in English and need to be translated and validated to be used in different cultures. OBJECTIVE: The purpose of this paper is to translate and validate the Skindex-29 questionnaire to Brazilian Portuguese to be used in our country as a quality of life assessment instrument in dermatologic patients. METHODS: The first step was the translation from English to Brazilian Portuguese and the back-translation by two native speakers. The translated version was then used for the second step, when three questionnaires were applied to 75 patients (43 of whom were classified as lightly affected and 32 as heavily affected by their dermatologic conditions): an identification questionnaire, the translated version of Skindex-29, and the Brazilian Portuguese version of Dermatologic Life Quality Index (DLQI). Additionally, the generic questionnaire Short Form 36 (SF-36) was applied to 41 of these patients. The last step to evaluate reproducibility was repeating the Skindex-29 questionnaire by the same researcher one week later in 44 patients. RESULTS: Reliability was observed in global Skindex-29 scale (α=0.934), and its domains emotions (α=0.926), symptoms (α=0,702), and psycosocial functioning (α=0.860). The reproducibility showed high intraclass correlations. High intra class correlations was observed, thus validating reliability. CONCLUSIONS: The Skindex-29 quality of life questionnaire was properly translated and validated to Brazilian Portuguese. .

Striae distensae after breast augmentation: treatment using the nonablative fractionated 1550-nm erbium glass laser.

BACKGROUND: Stretch marks, or striae distensae, are dermal scars and result in considerable aesthetic concern. The responsible factors for their development are poorly understood. Development of striae distensae is a rare complication after breast augmentation. Successfully treating striae distensae has always been challenging. Lasers and light devices have recently become a good therapeutic option. The fractional laser has shown encouraging results with less risk of pigmentation in the treatment of recent stretch marks. METHODS: Forty-seven patients underwent breast augmentation over a period of 2 months; of these, 10 patients developed new striae distensae. They were submitted to nonablative fractionated 1550-nm erbium glass laser treatment. Response was assessed from photographs obtained before and 4 weeks after the end of treatment. Two plastic surgeons analyzed improvements clinically and photographically, and a patient satisfaction score was recorded as well. RESULTS: There was a significant relationship between age and development of striae, (p = 0.003), but there was no significant relationship between striae distensae and nulliparity (p = 0.147), volume of the silicone implant (p = 0.892), or use of oral contraceptive (p = 1.00). The scores achieved by both the evaluators and the patients were high, with 50 percent of them between 9 and 10 (maximum scores), and with a high index of satisfaction with the treatment. CONCLUSIONS: Age is statistically significant in the development of striae distensae after breast augmentation. This report demonstrates excellent patient and plastic surgeon satisfaction after treatment. The use of fractional photothermolysis is a good treatment modality for striae rubrae.

Assessment of quality of life in patients who underwent minimally invasive cosmetic procedures.

UNLABELLED: There are increasingly more patients seeking minimally invasive procedures, which have become more effective and safer in reducing the signs of facial aging. This study included 40 female adult patients who voluntarily underwent selected minimally invasive procedures (filling with hyaluronic acid and botulinum toxin injection) for facial rejuvenation. All patients were followed for a period of 6 months. They were evaluated with the use of questionnaires, a quality-of-life questionnaire (DLQI), the self-esteem scale of Rosenberg (EPM/Rosenberg), and a pain scale. The minimally invasive procedures resulted in improvement in quality of life and self-esteem, which were stronger the first 3 months after the procedures but remained at a higher level than that before treatment, even after 6 months. Hyaluronic acid with lidocaine in the formula is more comfortable for the patient as it makes the injection less painful. 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 .