Hyaluronic Acid-based Fillers for Facial Rehabilitation in Inherited Neuropath.

Charcot-Marie-Tooth (CMT) disease is the most prevalent inherited neuromuscular disorder. It commonly leads to various musculoskeletal deformities, profoundly impacting the quality of life. The present case report explores the often under-recognized body image dissatisfaction in CMT, highlighting the potential benefits of a multidisciplinary approach to enhance aesthetic satisfaction. We present a case of a 54-year-old woman with CMT, who experienced chronic facial asymmetry, significantly impairing her quality of life. Seeking cosmetic enhancement, she underwent two sessions of facial treatment using hyaluronic acid-based fillers. The first session focused on correcting right mandibular hypoplasia and other facial asymmetries, whereas the second session focused on enhancing perioral aesthetics. The treatment resulted in significant aesthetic improvements, as demonstrated by high ratings in both the Physician Global Aesthetic Improvement Scale and the Subject Global Aesthetic Improvement Scale. Besides, there was a marked reduction in lip corner asymmetry, the patient's primary concern. The role of hyaluronic acid fillers in facial aesthetic enhancement is well established, and their application in the context of CMT is a promising under-investigated field, to our knowledge. This case study highlights the importance of considering body image in CMT patients and suggests that minimally invasive aesthetic procedures can be a valuable addition to the multidisciplinary care of patients with inherited neurological disorders. Despite being a single-case study, the significant improvement in the patient's aesthetic satisfaction requires further research in this field.

Dermal Thickness Increase and Aesthetic Improvement with Hybrid Product Combining Hyaluronic Acid and Calcium Hydroxyapatite: A Clinical and Sonographic Analysis.

Hyaluronic acid filler injections are regarded as the gold standard procedure for facial rejuvenation. Standing as the second most injected cosmetic filler, calcium hydroxyapatite-based fillers are also widely used worldwide. However, to our knowledge, prospective studies assessing patient satisfaction and sonographic changes in dermal thickness after a single session of a hybrid filler combining hyaluronic acid and calcium hydroxyapatite have not been previously published. Methods: This was a single-center, prospective, quasi-experimental study comprising 15 participants between 32 and 63 years of age. Each participant received a single-session treatment based on facial subcutaneous injections of HArmonyCa, a hybrid combination filler comprising hyaluronic acid and calcium hydroxyapatite. This study involved an intrapatient control design and a 120-day follow-up with clinical and sonographic assessment. For this purpose, standardized photographic images, high-frequency ultrasound evaluations, and physician- and patient-oriented overall aesthetic improvement scores were recorded at 0, 30, 90, and 120 following the procedure. Results: According to our findings, 20% of the subjects had an exceptional improvement; 20%, "very improved"; and 60%, "improved." Intrapatient sonographic comparison showed a significant increase in dermal thickness, at 90 and 120 days, only on the side treated (P < 0.001). Conclusion: In our clinical study, a single-session treatment with a hybrid product combining hyaluronic acid and calcium hydroxyapatite resulted in positive cosmetic satisfaction and increased dermal thickness.

A vacinação contra SARS-CoV-2 afeta o efeito imediato da toxina botulínica? Primeiras impressões / Does SARS-CoV-2 vaccination affect the immediate effect of botulinum toxin? First impressions

Introdução: A infecção por SARS-CoV-2 se espalhou rapidamente pelo mundo desde sua identificação no final de 2019. Globalmente, até abril de 2021, houve mais de 150 milhões de casos confirmados de Covid-19, incluindo mais de 3 milhões de mortes. Portanto, uma corrida foi prontamente iniciada para produzir uma vacina eficaz contra o novo vírus. A injeção de toxina botulínica continua sendo o principal procedimento cosmético não cirúrgico em todo o mundo, com alto índice de eficácia e satisfação do paciente. Objetivos: Este estudo tem como objetivo analisar a associação entre a vacina SARS-CoV-2 e a resposta imediata à toxina botulínica. Materiais e Métodos: Estudo observacional, retrospectivo e multicêntrico. Os dados foram coletados entre abril e junho de 2021, e revisão de prontuários de 71 pacientes de 27 a 76 anos que foram tratados com injeção de toxina botulínica. Resultados e Conclusão: Não houve mudanças significativas no desfecho imediato dos pacientes vacinados para Covid-19 e toxina botulínica, mas é de suma importância ressaltar que são necessários acompanhamento e mais estudos para definir se a vacina Covid-19 é capaz de alterar a duração do efeito e a eficiência da toxina botulínica.

Background: The SARS-CoV-2 infection has spread worldwide rapidly since its identification at the end of 2019. Globally, until April 2021, there have been more than 150 million confirmed cases of Covid-19, including over 3 million deaths. Therefore, a race was promptly started to produce an effective vaccine against the new virus. Botulinum toxin injection remains the leading non-surgical cosmetic procedure worldwide, with a high rate of efficacy and patient satisfaction. Aims: This study aims to analyze the association between the SARS-CoV-2 vaccine and the immediate botulinum toxin response. Materials and Methods: This was an observational, retrospective, and multicenter study. Data were collected between April and June 2021, and a medical record review of 71 patients from 27 to 76 years old treated with botulinum toxin injection. Results and Conclusion: There were no meaningful changes in the immediate outcome of patients vaccinated for Covid-19 and botulinum toxin. However, it is vital to underline that follow-up and further studies are needed to define whether the Covid-19 vaccine can alter the duration of effect and efficiency of the botulinum toxin.

A Retrospective Study Supporting the Importance of Individualizing the Dose of Botulinum Toxin According to the Age.

BACKGROUND: Botulinum toxin type A injection remains the leading nonsurgical cosmetic procedure worldwide with a high rate of efficacy and patient satisfaction. OBJECTIVE: This study aims to demonstrate the importance of individualization of botulinum toxin doses to treat the upper face according to the age of the patients, considering the muscles particularities and the specificities of each face area. MATERIALS AND METHODS: A retrospective study with 389 female patients treated with botulinum toxin type A in the upper third of the face (forehead, glabellar, and periorbital lines). Statistical analysis of the data was performed. RESULTS: The mean age was 47.49 years old and the median total dose of botulinum toxin type A was 53.76 units, whereas the median dose in the glabella was 26.28 U, the mean forehead dose was 12.23 U, and in the periorbital area was 14.79 U, adding both sides. It is possible to observe that the doses are negatively correlated with age, except in the periorbital area, where an increase in the dose was observed. CONCLUSION: It is important to highlight that although there is consensus on pre-established dose suggestions, the treatment should be individualized, respecting the individual characteristics of each patient.

Safety in immediate reconstitution of poly-l-lactic acid for facial biostimulation treatment.

Poly-L-lactic acid is presented as freeze-dried preparation of 150 mg per vial and, according to consensus, the recommendation on your preparation is hydrate in sterile water for injection (SWFI) or bacteriostatic water at room temperature for ≥24 hours. (J Drugs Dermatol; 2014;13:s44) However, in these long periods of hydration, it is time-consuming and costly for the physicians. To demonstrate the safeness of immediate reconstitution of facial biostimulation treatment with PLLA. A clinical prospective study with 26 Latin American female patients, aged between 27 and 80 years, complaining of facial laxity of treated with immediate PLLA reconstitution. One PLLA vial was injected per session in 12 mL total dilution. All patients had their pictures taken before and after the treatment in Photo Analysis Program Vectra 3D (Canfield® ). A follow-up 90 days was performed. The total of 58 facial applications of PLLA was reported in female patients with a mean age 52.62 (±13.46) years. Pain was reported in 17 injections (29.31%) and ecchymosis in 6 (10.34%). Also, 2 patients (3.44%) developed a nodule. None of the patients presented significant bruising, edema, or papules formation. Despite the literature declare that a longer hydration times (up to 48 hours) have been shown to reduce the risk of nodule formation (Aesthet Surg J; 2011;31:95), our study demonstrated the safeness of injection with immediate reconstitution and a very low adverse events rate. Immediate PLLA reconstitution is a great asset for physicians, injections in account of being less laborious, less time-consuming, and reducing product loss for the injector.

Treatment of vascular lesions located in the lip and in the oral cavity with Nd:YAG laser.

Vascular lesions such as hemangiomas can be found in the oral cavity. Some therapeutic modalities can be used in the treatment of these lesions and Nd:YAG 1064 nm long pulse laser shows good results with easy application, fewer complications and satisfactory results. This study describes the technique and outcome of a case of hemangioma located on the tongue treated with Nd:YAG laser.

Erupção medicamentosa fixa na face associada a dipirona: correlação dos achados clínicos, histopatológicos e dermatoscópicos / Fixed drug eruption on the face associated with dipyrone: correlation of clinical, histopathological and dermatoscopic findings

As reações adversas associadas aos fármacos com manifestações cutâneas não são raras, expressando-se com múltiplos aspectos clínicos, podendo gerar morbidade significativa. A erupção medicamentosa fixa é uma reação adversa comum, com envolvimento cutâneo, associada ao uso de inúmeros medicamentos. A dipirona é fármaco com efeitos analgésicos e antitérmicos amplamente utilizada no Brasil, porém, sabe-se que é uma substância potencialmente desencadeadora de reações adversas, e a erupção medicamentosa fixa entre elas. Relata-se um caso de erupção medicamentosa fixa relacionada ao uso da dipirona, com apresentação clínica singular e correlacionam-se os achados clínicos, histopatológicos e dermatoscópicos encontrados.

Adverse reactions associated with drugs presenting cutaneous manifestations are among the most common, expressing itself with multiple clinical aspects and causing significant morbidity. The fixed drug eruption (FDE) is a common adverse reaction with cutaneous involvement and is associated with the use of numerous drugs. Dipyrone is a drug with analgesic and antipyretic effects prescribed widely used in Brazil, however, it is known for its potential to triggering adverse reactions, including the FDE. This report shows an EMF case related to the use of dipyrone, with unique clinical presentation and correlate the clinical, histopathological and dermatoscopic found.

Tratamento cirúrgico seriado de múltiplos granulomas por PMMA / Surgical approach to multiple foreign body granulomas (PMMA)

Substâncias para preenchimento têm sido muito utilizadas nos últimos anos em procedimentos estéticos e para correção de lipodistrofias em pacientes HIV-positivos. O granuloma de corpo estranho pode ser secundário à aplicação de produtos absorvíveis/temporários e mais frequentemente aos preenchedores inabsorvíveis/permanentes. Não é possível prever a formação desses granulomas que podem ocorrer independentemente da técnica utilizada. Neste artigo descreve-se o tratamento cirúrgico de uma paciente com múltiplos granulomas causados por preenchimento intradérmico prévio de PMMA na face, com resposta pobre a tratamentos conservadores, e com grave comprometimento psicossocial devido a essa complicação inestética e deformante.

Injectable fillers have long been used for cosmetic purposes and in HIV induced lipodystrophy patients. A foreign body granuloma may be a side effect of the application of absorbable products/temporary and most often the nonabsorbable/permanent fillers. It is not possible to predict the formation of these granulomas, and it may occur regardless of the application technique. In this article we describe the surgical treatment of a patient with multiple granulomas caused by intradermal injection of PMMA in the face, with poor response to conservative treatments, and severe psychosocial impairment due to this unsightly and disfiguring complication.

Siliconoma: Report of Two Cases.

UNLABELLED: Injectable silicone has been used illegally for more than 60 years. Siliconoma is the term used to describe a foreign body reaction in the human body caused by the presence of silicone. The aim of this study is to report two cases of patients who underwent application of large volumes of injectable silicone with non-medical and unqualified professionals, which led to serious complications sometime after the procedure. 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.

Oral isotretinoin in photoaging: objective histological evidence of efficacy and durability.

BACKGROUND: The off-label use of oral isotretinoin in photoaging is a therapeutic tool that has been used by dermatologists. There are few studies to corroborate its effectiveness and durability. OBJECTIVES: To assess, both clinically and histologically, the changes caused by the use of oral isotretinoin in skin photoaging as well as the duration of the effects. METHODS: 20 female patients, aged 45-50 years, with phototypes II-VI, none of whom had experienced menopause, were treated with 20mg oral isotretinoin, 3 days a week, for 12 weeks. They underwent clinical analysis and skin biopsies in the pre-auricular region, while histologic cuts enabled assessment of the solar elastosis level and morphologic analysis. RESULTS: Clinically, patients, as well as the researching and the assessor physicians, noticed improvement in skin quality. One patient presented severe solar elastosis, 11 manifested the moderate form, while 8 presented the discreet type. According to histological analysis, 65% of the patients revealed alteration in the distribution and thickness of the elastic fibers, which can be interpreted as a histological improvement, while 60% showed an increase in collagen density. We observed an increase in collagen density, from 51.2% to 57.4%, (p=0.004). At the end of the 12-week follow-up period, this density decreased to 54.7% (p=0.050). There was an increase in the density of elastic fibers, from 26.5% to 31.3%, (p=0.02), which had dropped to 27.5% at the end of the 12-week follow-up period. CONCLUSIONS: The study confirmed the role of oral isotretinoin in remodeling the extracellular matrix against photoaging, as well as its durability after 12 weeks, especially when we consider collagen fibers.

Oral isotretinoin in photoaging: objective histological evidence of efficacy and durability

AbstractBACKGROUND:The off-label use of oral isotretinoin in photoaging is a therapeutic tool that has been used by dermatologists. There are few studies to corroborate its effectiveness and durability.OBJECTIVES:To assess, both clinically and histologically, the changes caused by the use of oral isotretinoin in skin photoaging as well as the duration of the effects.METHODS:20 female patients, aged 45-50 years, with phototypes II-VI, none of whom had experienced menopause, were treated with 20mg oral isotretinoin, 3 days a week, for 12 weeks. They underwent clinical analysis and skin biopsies in the pre-auricular region, while histologic cuts enabled assessment of the solar elastosis level and morphologic analysis.RESULTS:Clinically, patients, as well as the researching and the assessor physicians, noticed improvement in skin quality. One patient presented severe solar elastosis, 11 manifested the moderate form, while 8 presented the discreet type. According to histological analysis, 65% of the patients revealed alteration in the distribution and thickness of the elastic fibers, which can be interpreted as a histological improvement, while 60% showed an increase in collagen density. We observed an increase in collagen density, from 51.2% to 57.4%, (p=0.004). At the end of the 12-week follow-up period, this density decreased to 54.7% (p=0.050). There was an increase in the density of elastic fibers, from 26.5% to 31.3%, (p=0.02), which had dropped to 27.5% at the end of the 12-week follow-up period.CONCLUSIONS:The study confirmed the role of oral isotretinoin in remodeling the extracellular matrix against photoaging, as well as its durability after 12 weeks, especially when we consider collagen fibers.

Fitofotodermatite por Ruta graveolens com manifestação cutânea extensa / Phytophotodermatitis due to Ruta graveolens with extensive cutaneous manifestation

Dermatite de contato por planta ou fitodermatite é uma erupção cutânea resultante do contato com substâncias produzidas por diferentes espécies de vegetais. Ruta graveolens, popularmente conhecida como arruda, é uma planta da família das Rutaceae, que inclui algumas frutas cítricas, e contém inúmeras substâncias químicas fotossensíveis, incluindo os furocumarínicos. Relatamos um caso de reação de fitofototoxicidade grave em uma paciente que usou uma infusão de arruda pelas supostas qualidades ”místicas e purificadoras” da planta com extensa erupção cutânea.

Plant dermatitis or phytodermatitis is a cutaneous eruption resulting from contact with substances produced by different plant species. Ruta graveolens, popular known as common rue, is an herbal plant from the Rutaceae family, which includes the citrus fruits, and contains numerous photosensitizing substances, including furocoumarins. We report a severe case of phytophototoxicity reaction in a patient who used a common rue infusion because of its “powerful and purification” qualities.

Tratamento do nevo de Ota em ocidentais de fototipos altos / Treatment of Nevus of Ota in patients from Western populations with high phototypes

Introdução: O nevo de Ota é nevo melanocítico dérmico localizado na pele inervada pelos segundo e terceiro ramos do nervo facial. Ocorre principalmente em asiáticos. Nosso objetivo foi avaliar a resposta terapêutica em nossa população, em que são comuns os fototipos altos e características distintas das já estudadas. Métodos: estudo retrospectivo a partir da análise dos prontuários, busca ativa dos pacientes e aplicação de questionário. Todos foram tratados com o Q-Switched Nd:YAG laser 1064 associado ou não a ponteira de 532nm, com intervalo entre cada sessão variando de um a quatro meses, duração de pulso de 10ns, spot size de 3mm, frequência de um a 3Hz e fluência de 2-12J/cm2. Resultados: de acordo com a avaliação dos médicos pesquisadores, dos sete pacientes analisados, três tiveram melhora excelente (superior a 75%), dois tiveram resposta boa (entre 51 e 75%) e um resposta moderada (entre 25 e 50%). O grau de satisfação do paciente mostrou que quatro pacientes relataram estar muito satisfeitos e três satisfeitos. Os melhores resultados foram observados em pacientes com fototipos até IV e após sete sessões. Conclusões: os QS lasers se mostraram ferramenta útil na abordagem de pacientes com nevo de Ota e fototipos elevados.

Introduction: Nevus of Ota is a dermal melanocytic nevus located in the skin area that is innervated by the second and third branches of the facial nerve. It occurs mainly in patients of Asian ethnic background. The present study was aimed at evaluating the therapeutic response in the Western population, where higher skin types and characteristics diverse from those that have already been studied are common. Methods: A retrospective study based on the analysis of medical records, an active search of patients and the application of a questionnaire. All study patients were treated with 1,064 nm Q-Switched Nd:YAG laser, with or without a 532 nm tip, with 1 to 4-month intervals between sessions, 10ns pulse duration, 3mm spot size, 1 to 3 Hz frequencies and 2 to 12 J/cm2fluences. Results: According to the research physicians' evaluation, from the seven assessed patients, three had excellent improvement (greater than 75%), two had good response (51-75%) and one had moderate response (25-50%). The analysis of the degree of patient satisfaction showed that four patients reported being very satisfied and three, satisfied. The best results were observed in patients with phototypes up to grade IV and after having undergone seven sessions. Conclusions: QS lasers have proven a useful tool for treating patients with Nevus of Ota and high skin phototypes.

Tratamento da lipodistrofia ginoide com radiofrequência unipolar: avaliação clínica, laboratorial e ultrassonográfica / Treatment of gynoid lipodystrophy with unipolar radiofrequency: clinical, laboratory, and ultrasonographic evaluation

Introdução: A lipodistrofia ginoide pode acometer até 95% das mulheres pós-púberes. Os tratamentos visam melhorar o aspecto da pele. Procedimentos invasivos têm tempo de recuperação longo e podem causar complicações. Métodos não invasivos, como a radiofrequência, têm obtido popularidade. Objetivo: Avaliar a segurança e eficácia da radiofrequência unipolar no tratamento da lipodistrofia ginoide.Métodos: Oito mulheres com lipodistrofia ginoide grau II e III, na região glútea e coxas, foram submetidas ao tratamento com quatro sessões de radiofrequência unipolar com intervalos quinzenais. Foi realizada avaliação clinicofotográfica, laboratorial e ultrassonográfica das pacientes antes, durante e 30 dias após termo da última sessão. Resultados: Clinicamente, a melhora na flacidez da pele foi observada em todas as oito pacientes tratadas, e a melhora na morfologia em quatro delas. A avaliação ultrassonográfica mostrou aumento estatisticamente significativo (p < 0,05%) na espessura da derme após tratamento em sete das oito pacientes. Não foram observadas alterações laboratoriais. Conclusões: A radiofrequência unipolar é método eficaz e seguro no tratamento da lipodistrofia ginoide da região glútea e coxas.

Introduction: Gynoid lipodystrophy may affect up to 95% of post-pubertal women. Treatments are aimed at improving the skin's appearance. Invasive procedures have long recovery times and may cause complications. Non-invasive methods, such as radiofrequency, are increasingly becoming popular. Objective: To evaluate unipolar radiofrequency's safety and efficacy in the treatment of gynoid lipodystrophy. Methods: Eight women with gynoid lipodystrophy grades II and III, in the gluteus region and thighs, underwent treatment with four sessions of unipolar radiofrequency at fortnightly intervals. Clinical-photographic, laboratory, and ultrasound evaluations of the patients were performed before, during, and 30 days after the end of the last session. Results: Improvement in the sagging of the skin was clinically observed in all treated patients. Four patients also had improvement in morphology. The ultrasound evaluation showed a statistically significant increase (p <0. 05%) in dermal thickness after the treatment in seven of eight patients. There were no laboratory abnormalities. Conclusions: Unipolar radiofrequency is an effective and safe method in the treatment of gynoid lipodystrophy in the gluteus region and thighs.

Estudo duplo cego comparativo entre hidroquinona e extrato de uva-ursina no tratamento do melasma / Double-blind comparative study of hydroquinone and ursine grape extract in the treatment of melasma

Introdução: Melasma é hiperpigmentação adquirida e progressiva em áreas fotoexpostas. Seu tratamento continua sendo um desafio por ser dermatose recorrente e refratária. Objetivo: Avaliar a eficácia e segurança do Skin Whitening Complex no tratamento do melasma facial, e compará-lo à hidroquinona. Pacientes e Métodos: Estudo duplo-cego comparativo com 13 mulheres portadoras de melasma.Todas receberam duas formulações diferentes, identificadas como "lado direito da face" e "lado esquerdo da face", que foram aplicadas duas vezes ao dia durante 90 dias consecutivos. Apenas o farmacêutico responsável tinha conhecimento do conteúdo. Para análise estatística foram realizados os testes de Wilcoxon e χ2 de McNemar-Bowker. Resultados: Das 13 pacientes, 10 apresentaram melhora clínica global do melasma. Na hemiface tratada com hidroquinona a 4%, a melhora foi total em quatro pacientes, e parcial em seis (p = 0,004). Na hemiface tratada com Skin Whitening Complex 5%, a melhora foi total em duas pacientes, e parcial em seis (p = 0,007). Não houve diferença estatisticamente significativa entre os dois tratamentos (p = 0,223). Conclusões: Embora o tratamento com hidroquinona 4% apresente melhor resultado clínico, não houve diferença estatisticamente significativa entre os dois tratamentos. O SWC 5% mostrou-se eficiente e seguro no tratamento do melasma.

Introduction: Melasma is an acquired and progressive hyperpigmentation of photoexposed areas. For being a recurrent and refractory dermatosis, its treatment continues to be a challenge. Objective: To evaluate the efficacy and security of the Skin Whitening Complex in the treatment of the facial melasma, and to compare it to the hydroquinone. Materials and methods: Double-blind Comparative study of 13 women bearers of melasma. All received two different formulations, labelled as "right side of the face" and left "side of the face".The formulations were applied twice a day for 90 consecutive days. Only the pharmacist responsible for the formulations had knowledge of their content.The tests of Wilcoxon and χ2 of McNemar-Bowker were employed in the statistical analysis. Results: Ten of the 13 patients presented the global clinical improvement of the melasma. Four patients presented total improvement and six (p = 0004) presented partial improvement in the hemiface treated with hydroquinone 4%. In the hemiface treated with Skin Whitening Complex 5%, the improvement was total in two patients, and partial in six (p = 0007).There were no statistically significant differences between the two treatments (p = 0223). Conclusions: Although the treatment with hydroquinone 4% presents better clinical results, there were no statistically significant differences between the two treatments. Skin Whitening Complex 5% has shown efficient and safe in the treatment of the melasma.