Innovations in minimally invasive facial treatments.

Patients are seeking healthier lives, and at the same time their concern about having a beautiful face and maintaining a youthful appearance over time has increased. Traditionally, surgeries based on tissue resection and resurfacing were the focus in facial rejuvenation. Over the last decade, minimally invasive procedures have expanded exponentially because of the variety of cosmetic products available on the market and because patients are looking for a better appearance with nonincision methods. The understanding of the aging process, facial anatomy, and ideal proportions is extremely important for successful rejuvenation procedures. Also, neuromodulators, chemical peels, filler properties, correct indications, and effectiveness must be well known by the injector for favorable results. Therefore, knowledge of all facial cosmetic options and an adequate facial analysis are essential for a better performance. In this article, the authors review some different product options and show cases of minimally invasive cosmetic procedures for the face currently used.

Diode Laser for Laryngeal Surgery: a Systematic Review.

UNLABELLED: Introduction The diode laser has been frequently used in the management of laryngeal disorders. The portability and functional diversity of this tool make it a reasonable alternative to conventional lasers. However, whether diode laser has been applied in transoral laser microsurgery, the ideal parameters, outcomes, and adverse effects remain unclear. Objective The main objective of this systematic review is to provide a reliable evaluation of the use of diode laser in laryngeal diseases, trying to clarify its ideal parameters in the larynx, as well as its outcomes and complications. Data Synthesis We included eleven studies in the final analysis. From the included articles, we collected data on patient and lesion characteristics, treatment (diode laser's parameters used in surgery), and outcomes related to the laser surgery performed. Only two studies were prospective and there were no randomized controlled trials. Most of the evidence suggests that the diode laser can be a useful tool for treatment of different pathologies in the larynx. In this sense, the parameters must be set depending on the goal (vaporization, section, or coagulation) and the clinical problem. CONCLUSION: The literature lacks studies on the ideal parameters of the diode laser in laryngeal surgery. The available data indicate that diode laser is a useful tool that should be considered in laryngeal surgeries. Thus, large, well-designed studies correlated with diode compared with other lasers are needed to better estimate its effects.

Update in alar base reduction in rhinoplasty.

PURPOSE OF REVIEW: The purpose of this article is to further explore the techniques available for alar base reduction by a recent review in this topic, focusing in the current advances in the field, in a clear and readable format. RECENT FINDINGS: Among the numerous techniques available, the management of cases with wide nasal base and alar flaring remains limited to three options: cinching sutures to pull in the alae together; or to use alar base excisions that remove tissue from the alar lobule to decrease flare and from inside the nostril to decrease width; and flap advancement. SUMMARY: Surgical modification of the nasal base is not a routine part of rhinoplasty and should be performed in a conservative manner to prevent complications like nasal stenosis. Moreover, this maneuver should always be the last one in rhinoplasty, as alar base modifications cannot be properly assessed until all other steps have been carried out. VIDEO ABSTRACT.

Clinical evaluation for chin augmentation: literature review and algorithm proposal.

INTRODUCTION: The esthetic balance of the face results from harmonic and symmetrical facial proportions. The literature describes several methods for lower-third facial analysis, but lacks a simple and practical method. OBJECTIVE: To review the methods of analysis of the ideal projections of the chin based on soft tissues, showing the advantages and disadvantages of each. METHODS: Literature review through the PubMed database. RESULTS: The following methods for chin analysis based on soft tissues were reviewed: Gonzalles-Ulloa, Goode, Merrifield, Silver, Legan, Gibson & Calhoun, cervicomentual angle, and mentocervical angle. CONCLUSION: An adequate analysis of the proportions of the face and facial disharmony is essential for the correct indication of the necessary procedures and good surgical outcome. The authors propose an algorithm to facilitate the indication for chin augmentation surgery.

Diode Laser for Laryngeal Surgery: a Systematic Review

Abstract Introduction The diode laser has been frequently used in the management of laryngeal disorders. The portability and functional diversity of this tool make it a reasonable alternative to conventional lasers. However, whether diode laser has been applied in transoral laser microsurgery, the ideal parameters, outcomes, and adverse effects remain unclear. Objective The main objective of this systematic review is to provide a reliable evaluation of the use of diode laser in laryngeal diseases, trying to clarify its ideal parameters in the larynx, as well as its outcomes and complications. Data Synthesis We included eleven studies in the final analysis. From the included articles, we collected data on patient and lesion characteristics, treatment (diode laser's parameters used in surgery), and outcomes related to the laser surgery performed. Only two studies were prospective and there were no randomized controlled trials. Most of the evidence suggests that the diode laser can be a useful tool for treatment of different pathologies in the larynx. In this sense, the parameters must be set depending on the goal (vaporization, section, or coagulation) and the clinical problem. Conclusion: The literature lacks studies on the ideal parameters of the diode laser in laryngeal surgery. The available data indicate that diode laser is a useful tool that should be considered in laryngeal surgeries. Thus, large, well-designed studies correlated with diode compared with other lasers are needed to better estimate its effects.

Clinical evaluation for chin augmentation: literature review and algorithm proposal / Avaliação clínica para avanço de mento: revisão da literatura e proposta de um algoritmo

ABSTRACT INTRODUCTION: The esthetic balance of the face results from harmonic and symmetrical facial proportions. The literature describes several methods for lower-third facial analysis, but lacks a simple and practical method. OBJECTIVE: To review the methods of analysis of the ideal projections of the chin based on soft tissues, showing the advantages and disadvantages of each. METHODS: Literature review through the PubMed database. RESULTS: The following methods for chin analysis based on soft tissues were reviewed: Gonzalles-Ulloa, Goode, Merrifield, Silver, Legan, Gibson & Calhoun, cervicomentual angle, and mentocervical angle. CONCLUSION: An adequate analysis of the proportions of the face and facial disharmony is essential for the correct indication of the necessary procedures and good surgical outcome. The authors propose an algorithm to facilitate the indication for chin augmentation surgery.

Resumo Introdução: O equilíbrio estético da face resulta de proporções faciais harmônicas e simétricas. A literatura descreve vários métodos de análise do terço inferior da face, mas carece de um método simples e prático. Objetivo: Revisar os métodos de análise da projeção ideal do mento baseadas em tecidos moles, mostrando as vantagens e desvantagens de cada um. Método: Revisão da literatura através da base de dados Pubmed. Resultados: Os seguintes métodos para análise do mento baseada em partes moles são revisados: Gonzalles-Ulloa, Goode, Merrifield, Silver, Legan, Gibson & Calhoun, ângulo cervicomentual e ângulo mentocervical. Conclusão: A análise adequada das proporções da face e desarmonia facial faz-se essencial para a correta indicação dos procedimentos necessários e bom resultado cirúrgico. Propomos um algoritmo para facilitar indicação de avanço de mento.

Violência doméstica contra crianças: nível de conhecimento dos pais de crianças em escolas pública e privada / Domestic violence against children: knowledge of parents of children enrolled in public and private schools

Objetivo: Investigar o conhecimento dos pais ou responsáveis por crianças matriculadas no ensino fundamental sobre a violência infantil e identificar a sua postura em relação à educação de seus filhos. Métodos: Trata-se de um estudo descritivo. Os dados foram coletados a partir de um questionário, que abordava questões sobre violência infantil e práticas educativas, respondidopelos pais/responsáveis de alunos matriculados em uma escola pública e, em outra particular, em Catanduva, São Paulo. Resultados: Foram aplicados 1.429 questionários na escola pública e 256 na particular, havendo retorno de, respectivamente, 670 (47%) e 115 (45%) deles. As respostas foram (particular/pública): 1) não aceitam que educadores punam com castigos físicos (99/96%); 2) chamam atenção dos filhos diante de comportamento inadequado (90/92%); 3) discordam que ôpalmadaõ prepara a criança para a vida (80/66%); 4) acham incorreto repreender os filhos na frente de outros (87/73%); 5) concordam que ôtapas/palmadasõ prejudicam o relacionamento pais/filhos (59/57%); 6) concordam que conversar sobre ôerrosõ faz parte da educação (97/91%); 7) concordam que ôxingarõ causa danos à criança (81/60%); 8) acham que ômedoõ não significa ôrespeitoõ (86/57%); 9) concordam que ôcriança não esquece fácilõ(92/79%); 10) concordam com a notificação de violência infantil (93/90%); 11) preocupam-se com a violência na casa alheia (51/30%); 12) sabem que agressões domésticas podem levar à morte (97/94%); 13) consideram baixa a violência em seus lares (89/86%). Houve diferença significativa entre os grupos para as respostas às questões 3, 4, 7, 8, 9 e 11 (p≤0,001).Conclusões: Os entrevistados demonstraram conhecimento satisfatório sobre violência infantil, embora os da escola pública tenham apresentado pior desempenho nas questões relacionadas à educação familiar.Palavras-chave: violência doméstica; maus-tratos infantis;família; educação infantil.

Objective: To study the knowledge about domestic violence of parents and caregivers of children enrolled in elementary schools, and to identify how they deal with this subject in their children education.Methods: This descriptive study used a questionnaire about child abuse and educational practices applied to parents/caregivers of children from one public and one private school in Catanduva, São Paulo State, Brazil.Results: The questionnaires were sent to caregivers in the public school and (1429) and private school (256), and they were answered respectively by 670 (47%) and 115 (45%) of them. The answers were (private/public school): 1) do not approve physical punishment by educators (99/96%); 2) draw the attention of children to bad behavior(90/92%); 3) disagree that ôslappingõ prepares for life (80/66%); 4) agree that it is wrong to reprimand children in front of others (87/73%); 5) agree that ôslaps/smacksõ affect the relationship between parents and children (59/57%); 6) talk about ômistakesõ as a part of education (97/91%); 7) agree that ôinsultingõ causes damage to a child (81/60%); 8) think that ôfearõ is not the same as ôrespectõ (86/57%); 9) agree that a ôchild does not forget easilyõ (92/79%); 10) agree with child abuse notification (93/90%); 11) worry about violence in someone else's house (51/30%); 12) know that domestic violence may kill (97/94%); 13) consider the violence level in their homes low (89/86%). There were diferences between schools regarding questions 3, 4, 7, 8, 9 and 11 (p≤0.001).Conclusions: Caregivers of children attending elementary schools are aware of the main concepts regarding child abuse, although participants from the public school presented a worse performance regarding educational questions.

Estudo descritivo de aspectos etiopatogênicos da obesidade sob a óptica de pacientes obesos / Descriptive study of ety-pathogenics aspects of obesity related by obese patients

Objetivos: Avaliar respostas de pacientes subjetivamente obesos que procuraram por um tratamento médico para redução de peso corporal e identificar os diferentes e múltiplos aspectos etiológicos envolvidos na gênese do excesso ponderal sob avaliação do próprio paciente. Métodos: Foram analisados 11.218 pacientes de ambos e sexos e faixa etária de 11 a 70 anos, de janeiro de 1988 a junho de 1997. Para coleta dos dados, foi utilizado um questionário contendo informações sobre o paciente (atividade profissional, idade, peso, altura, índice de massa corporal, circunferência do abdome, circunferência do quadril e índice abdominal pélvico) e a pergunta: Qual(is) a(s) causa(s) que contribuíram para seu excesso de peso?. O questionário foi aplicado sempre pelo mesmo médico na primeira consulta do paciente. Resultados: Entre os pacientes obesos que procuraram tratamento médico para redução ponderal, 7.629 eram do sexo feminino e 3.589 do masculino. Os homens apresentaram um índice de massa corporal superior ao das mulheres (34,5 e 31, 2 kg/m2 respectivamente). As cinco causas mais incidentes relatadas por ambos os sexos foram: hereditariedade, alterações emocionais, desde criança, pós-inatividade física e pós-gravidez. Para as mulheres, as cinco causas mais incidentes foram: hereditariedade, pós-gravidez, alterações emocionais, desde criança e pós-casamento; para os homens: inatividade física, hereditariedade, desde criança, alterações emocionais e atividade ocupacional. Conclusão: A causa mais freqüente relatada por pacientes do sexo feminino foi o fator hereditário, seguido pelos fatores pós-gravidez e alterações emocionais, enquanto os pacientes do sexo masculino associaram o ganho ponderal aos fatores inatividade física, hereditariedade e obesidade, desde criança...