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

Rejuvenecimiento periorbitario fisiológico / Physiological periorbital rejuvenation

Pivoting Brow Lift es una nueva opción terapéutica cuyas ventajas son tres mínimas incisiones, prácticamente imperceptibles, bien aceptadas por pacientes de todas las edades, sexo y incluso pacientes calvos. Una incisión se realiza en la región temporal y otra dentro del cuero cabelludo en la región medio frontal o en una arruga en pacientes calvos. La disección en región frontal es sub-perióstica, muchas veces llega a la punta nasal para reposicionarla. La disección en la región temporal se realiza entre las hojas superficiales y profundas extendiéndose hasta el tarso y canto externo del ojo; en la región palpebral la disección se realiza entre la piel y el musculo. La fijación son dos puntos externos en el cuero cabelludo y unos papeles adherentes. Los puntos del cuero cabelludo se retiran a los 14 días. Evita las complejas fijaciones que se realizan actualmente con tornillos, puntos internos o Endotime. La sencillez del procedimiento hace que este se pueda realizar entre 30 y 45 minutos, con anestesia local y sedación; esto permite lograr una mayor seguridad operatoria. Se han documentado pacientes tratados hace 9 años donde se demuestra la duración en el tiempo. El bajo índice de complicaciones y la alta satisfacción de los pacientes documentadas en encuestas hace que este procedimiento pueda ser considerado como una nueva opción terapéutica.

Aplicação do ultrassom microfocado no rejuvenescimento facial: uma revisão da literatura / Application of microfocused ultrasound in facial rejuvenation: a literature review

Introdução: O aumento da expectativa média de vida leva a população a buscar, com maior frequência, tratamentos estéticos que visem o rejuvenescimento da face e do pescoço. O Ultrassom microfocado (MFU) é descrito como uma opção de tratamento não-invasiva para a flacidez facial e o envelhecimento. Objetivo: Revisar a literatura científica quanto ao uso do MFU no processo de rejuvenescimento facial e correção da flacidez da pele. Metodologia: Trata-se de uma revisão narrativa da literatura, baseada na pesquisa de artigos científicos nas bases de dados PubMed e Biblioteca Virtual em Saúde realizada durante o mês de março de 2022, através da seguinte estratégia de busca: "Microfocused Ultrasound AND Facial Rejuvenation AND Skin Laxity Treatment". Um total de 19 manuscritos foram incluídos em síntese qualitativa. Desenvolvimento: O MFU pode ser aplicado no tecido subcutâneo, produzindo pequenos pontos de coagulação térmica dentro da camada reticular média a profunda da derme e subderme. A aplicação de calor nesses discretos pontos de coagulação térmica faz com que haja neossíntese de colágeno e consequente enrijecimento da pele. Estudos recentes evidenciaramresultados promissores quanto a aplicação do MFU em regiões de sulco nasolabial, linha da mandíbula, sobrancelhas, região infraorbital, palpebra inferior e ligamentos de retenção zigomático-bucais. Considerações finais: O MFU tem se mostrado uma técnica segura, sendo considerado eficaz, não-invasiva, bem tolerada pelos pacientes e viável para a prática clínica médica e odontológica.

Introduction: The increase in average life expectancy leads the population to seek, with greater frequency, aesthetic treatments aimed at rejuvenating the face and neck. Microfocused ultrasound (MFU) is described as a non-invasive treatment option for facial sagging and aging. Objective: To review the scientific literature regarding the use of MFU in the process of facial rejuvenation and correction of sagging skin. Methodology: This is a narrative review of the literature, based on the search for scientific articles in the PubMed and Virtual Health Library databases carried out during the month of March 2022, using the following search strategy: "Microfocused Ultrasound AND Facial Rejuvenation AND Skin Laxity Treatment". A total of 19 manuscripts were included in a qualitative synthesis. Development: MFU can be applied to the subcutaneous tissue, producing small points of thermal coagulation within the middle to deep reticular layer of the dermis and subdermis. The application of heat to these discrete points of thermal coagulation causes collagen neosynthesis and consequent skin tightening. Recent studies have shown promising results regarding the application of MFU in regions of the nasolabial sulcus, jaw line, eyebrows, infraorbital region, lower eyelid and zygomatic-buccal retention ligaments. Final considerations: MFU has been shown to be a safe technique, being considered effective, non-invasive, well tolerated by patients and viable for clinical medical and dental practice.

Rejuvenecimiento facial con plasma rico en plaquetas autólogo / Facial rejuvenation with autologous platelet rich plasma

Introducción: La creciente necesidad de una piel de aspecto juvenil impulsa innovaciones continuas con procedimientos mínimamente invasivos. El plasma rico en plaquetas autólogo representa una terapéutica regenerativa incluida en el novedoso arsenal de intervenciones que buscan este efecto. Objetivo: Evaluar los resultados de la terapéutica con plasma rico en plaquetas autólogo en pacientes con envejecimiento facial. Métodos: La muestra estuvo constituida por 68 pacientes valorados con la escala para valoración clínica de fotoenvejecimiento cutáneo al inicio del tratamiento. Se sometieron a cuatro sesiones de plasma rico en plaquetas cada 15 días y una sesión adicional a los 3 meses de concluir el tratamiento inicial. Los pacientes fueron seguidos durante 6 meses al cabo de los cuales se volvieron a evaluar con el mismo instrumento. Resultados: Las edades estuvieron comprendidas entre 21 y 73 años con una media de 46,80 años, predominó el sexo femenino (89,9 %). Los resultados significativos en el tratamiento de las arrugas, los surcos, la textura de la piel y las lesiones cutáneas estuvieron relacionados con la mesoterapia con plasma rico en plaquetas. El procedimiento produjo una mejoría valorada a través de la escala para valoración clínica de fotoenvejecimiento cutáneo. Conclusiones: La terapia con plasma rico en plaquetas tiene buenos resultados en el tratamiento de pacientes con envejecimiento facial.

Introduction: The growing need for youthful looking skin drives continued innovations with minimally invasive procedures. Autologous platelet-rich plasma represents a regenerative therapeutic included in the new arsenal of interventions that seek this effect. Objective: Assess the results of platelet-rich plasma therapy in patients with facial aging. Methods: The sample consisted of 68 patients assessed with the scale for the clinical assessment of cutaneous photoaging (SCACPH). They underwent four PRP sessions every 15 days and an additional session 3 months after completing the initial treatment. The patients were followed up for 6 months, after which they were reevaluated which the same instrument. Results: The ages of the patients were between 21 and 73 years with a mean of 46.80 years, the female sex predominated (89.9%). Significant results in the treatment of wrinkles, furrows, and skin texture and skin lesions were related to PRP mesotherapy. The procedure produced an improvement assessed with the SCACPH. Conclusions: Autologous PRP therapy has good results in the treatment of patients with facial aging.

Morphometric and aesthetic analysis of people following application of platelet rich plasma for neck rejuvenation / Análisis morfométrico y estético de personas tras la aplicación de plasma rico en plaquetas para el rejuvenecimiento del cuello

SUMMARY: Several studies have shown beneficial effects of platelet-rich plasma. However, there are very few studies investigating the effectiveness of PRP in the neck region. We aimed to assess the efficacy of PRP injection for neck rejuvenation in females aged 40-55. Fifty-two female consecutive participants had PRP injected and roller applied in three sessions at 3-week intervals. Evaluations were blindly performed by comparing the improvements from the pre- to post-application assessments of anatomical measurements of the neck area based on before and after photography of the participants by two anatomists and three medical aesthetic doctors. The Fitzpatrick Skin Scale, Fitzpatrick Goldman Scale, Wrinkle Assessment Scale (Dedo classification system) and patient satisfaction scale were used for assessment. Additionally, skin stiffness and elasticity, cervicomental angle and jawline angle measurements were performed to analyze anatomical changes in the neck area. The study enrolled 52 volunteers with a mean age of 48.60±5.35 years, mean body weight of 63.21±8.43 kg and mean height of 163.25±4.56 cm. Significant differences were found in the elasticity, jawline angle, cervicomental angle, wrinkling, elasticity G and patient satisfaction scores before and after the treatment. When the results of anatomical parameters and scales are compared, it was revealed that PRP is effective in neck rejuvenation.

RESUMEN: Varios investigaciones han demostrado los efectos beneficiosos del plasma rico en plaquetas. Sin embargo, existen muy pocos estudios que investiguen la efectividad del PRP en la región del cuello. Nuestro objetivo fue evaluar la eficacia de la inyección de PRP para el rejuvenecimiento del cuello en mujeres de 40 a 55 años. A cincuenta y dos mujeres participantes consecutivas se les inyectó PRP y se les aplicó rodillo en tres sesiones a intervalos de 3 semanas. Las evaluaciones se realizaron a ciegas comparando las mejoras de las evaluaciones previas y posteriores a la aplicación de las medidas anatómicas del área del cuello basadas en fotografías de antes y después de los participantes realizadas por dos anatomistas y tres médicos especialistas en cirugía estética. Para la evaluación se utilizaron la escala de piel de Fitzpatrick, la escala de Fitzpatrick Goldman, la escala de evaluación de arrugas (sistema de clasificación Dedo) y la escala de satisfacción del paciente. Además, se realizaron mediciones de rigidez y elasticidad de la piel, ángulo cervicomentoniano y ángulo de la línea de la mandíbula, para analizar los cambios anatómicos en el área del cuello. El estudio inscribió a 52 voluntarios con una edad media de 48,60±5,35 años, un peso corporal medio de 63,21±8,43 kg y una altura media de 163,25±4,56 cm. Se encontraron diferencias significativas en las puntuaciones de elasticidad, ángulo mandibular, ángulo cervicomentoniano, arrugas, elasticidad G y satisfacción del paciente antes y después del tratamiento. Cuando se compararon los resultados de los parámetros anatómicos y las escalas, se reveló que el PRP es eficaz en el rejuvenecimiento del cuello.

Frontoplastia endoscópica para tratamiento del envejecimiento facial / Endoscopic Frontoplasty for Treating Facial Aging

Introducción: En el concepto moderno de rejuvenecimiento facial, lo principal es conseguir un resultado natural sin marcas quirúrgicas. El lifting endoscópico fronto-témporo-orbitario es en la actualidad, el mejor método para conseguirlo. Objetivo: Determinar la efectividad de la técnica de frontoplastia endoscópica para el tratamiento del envejecimiento facial. Métodos: Se realizó un estudio observacional descriptivo de una serie de 28 casos con diagnóstico de envejecimiento facial atendidos en el Centro Nacional de Cirugía de Mínimo Acceso en el período comprendido entre enero de 2014 hasta enero de 2017. Se estudiaron las variables de: sexo, edad, estado civil, escolaridad, raza, tiempo quirúrgico y complicaciones transoperatorias. Resultados: La edad media fue de 54,4 (40-73) años. Predominó el sexo femenino (89,3 por ciento). El nivel medio de escolaridad 61,5 por ciento, estado civil casado 52,0 por ciento. La ptosis de las cejas con presencia de arrugas frontales y glabelares fue el diagnóstico más frecuente 13; 46,4 por ciento. El tiempo quirúrgico medio fue 80,9 (40-120) minutos. No existieron complicaciones intraoperatorias, conversiones, ni reintervenciones. En 27 pacientes (96,4 por ciento) hubo permanencia de los resultados en el tiempo. Se presentaron complicaciones en 4 pacientes (14,3 por ciento). Hubo 19 pacientes atendidos de manera ambulatoria (67,9 por ciento), con estancia hospitalaria de un día (32,1 por ciento). La totalidad mostró satisfacción con los resultados obtenidos. Conclusiones: La frontoplastia endoscópica es un método poco invasivo y muy efectivo para reposicionar las cejas descendidas además tratar las arrugas frontales y glabelares(AU)

Introduction: In the modern concept of facial rejuvenation, the main thing is to achieve a natural result without surgical marks. The endoscopic fronto-temporo-orbital lifting is currently the best method to achieve this. Objective: To determine the effectiveness of the endoscopic frontoplasty technique for the treatment of facial aging. Methods: A descriptive observational study of a series of 28 cases with a diagnosis of facial aging treated at the National Center for Minimal Access Surgery in the period from January 2014 to January 2017 was carried out. The variables of: sex, age, marital status, schooling, race, surgical time and intraoperative complications. Results: The mean age was 54.4 (40-73) years. The female sex prevailed (89.3 percent). The average level of schooling 61.5 percent, married marital status 52.0 percent. Ptosis of the eyebrows with the presence of frontal and glabellar wrinkles was the most frequent diagnosis 13; 46.4 percent. The mean surgical time was 80.9 (40-120) minutes. There were no intraoperative complications, conversions, or reinterventions. In 27 patients (96.4 percent) there was permanence of the results over time. Complications occurred in 4 patients (14.3 percent). There were 19 patients treated as outpatients (67.9 percent), with a hospital stay of one day (32.1 percent). All showed satisfaction with the results obtained. Conclusions: Endoscopic foreheadoplasty is a minimally invasive and very effective method for repositioning lowered eyebrows, as well as treating frontal and glabellar wrinkles(AU)

Rejuvenescimento periorbicular por indução ultrassônica: um estudo de casos / Periorbicular rejuvenation by ultrasonic induction: a report case

A blefaroplastia é atualmente o tratamento cirúrgico mais indicado na reversão dos efeitos do envelhecimento palpebral. Porém, a técnica é cara, extremamente invasiva, com recuperação pós-cirúrgica lenta e só pode ser realizada por cirurgiões em ambiente hospitalar. O ultrassom tem se mostrado um método seguro e eficaz no tratamento antienvelhecimento cutâneo, mas pouco se tem pesquisado sobre o efeito do ultrassom na dermatocalase. Este estudo piloto têm como objeto avaliar um emissor ultrassônico no tratamento de rejuvenescimento da região periorbicular. Trata-se uma pesquisa qualitativa descritiva de estudo de casos, no qual foram avaliadas duas voluntárias submetidas a tratamento com ultrassom. Após as sessões, foi possível observar retomada de viço e redução de flacidez palpebral, com consequente minimização da dermatocalase e rugas adjacentes. O uso do ultrassom se mostrou satisfatório e eficaz, principalmente na remodelação na região acometida por dermatocalase. Além disso, a técnica apresenta melhor custo-benefício e recuperação pós-procedimento mais curta em relação a outras terapias atualmente empregadas para tratamento da região periorbital. (AU)

Difusão e propaganda sobre antienvelhecimento na mídia brasileira: um estudo de representações sociais / Diffusion and propaganda about anti-aging in brazilian media: a study of social representations / Difusión y propaganda sobre el antienvejecimiento en los medios de comunicación brasileños: un estudio de las representaciones sociales

Esta pesquisa buscou mapear conteúdos relativos ao antienvelhecimento em revistas de grande circulação e no noticiário brasileiro, entre 1º de janeiro de 2016 e 31 de dezembro de 2019. Foram investigadas as revistas Claudia, Boa Forma, VIP e Carbono Uomo. Houve ainda coleta no portal de notícias G1, da Rede Globo de Televisão, voltado ao público geral. Foram criados dois corpora distintos formados pelos conteúdos do G1 e das revistas que, então, foram submetidos à Classificação Hierárquica Descendente pelo software IRaMuTeQ, dando origem a dois subcorpora e quatro classes para cada um. Os resultados apontam uma forte tendência mercadológica nas revistas, que buscam conduzir os leitores ao consumo de produtos e à realização de procedimentos estéticos. Por outro lado, as notícias jornalísticas apregoam um modelo de vida mais saudável como principal prática antienvelhecimento, ao mesmo tempo que alertam sobre os riscos envolvidos nos procedimentos e produtos estéticos irregulares. Em geral, o conteúdo das revistas dissipa representações sociais que idealizam um padrão de beleza do corpo jovial, associando a velhice à fealdade, enquanto o do portal de notícias G1 voltam-se à saúde e longevidade.(AU)

This survey aimed to map anti-aging content, in magazines with wide circulation and also in Brazilian news, between January 1, 2016 and December 31, 2019. Claudia, Boa Forma, VIP and Carbono Uomo magazines were studied. News were also collected from the G1 news portal, from Globo television network, aimed at the general audience. Two distinct corpora formed by the contents of the G1 and the magazines were created, which were then submitted to the Descending Hierarchical Classification, by the IRaMuTeQ software, leading to two subcorpora and four classes for each. The results show a strong market orientation in the magazines, which aim to lead readers to purchase products and undertake aesthetic procedures. The news reports, on the other way, promote a healthier life model as the main anti-aging practice, while warning about the risks involved in irregular aesthetic procedures and products. In general, the content of the magazines spreads social representations which idealize a pattern of beauty of a young body, connecting old age with ugliness, whereas that of the G1 news portal are focused on health and longevity.(AU)

Esta iniciativa buscó mapear material de antienvejecimiento, en revistas de gran tirada y en las noticias de Brasil, entre el 1 de enero de 2016 y el 31 de diciembre de 2019. Se analizaron las revistas Claudia, Boa Forma, VIP y Carbono Uomo. También se recogieron noticias del sitio de noticias G1 y de la red de televisión Globo, ambas dirigidas al público en general. Se crearon dos corpora distintos formados por el contenido del G1 y de las revistas, que luego fueron sometidos a la Clasificación Jerárquica Descendente, por el software IRaMuTeQ, dando lugar a dos subcorpora y cuatro clases para cada uno de los corpora. Los resultados señalan una fuerte orientación del mercado de promoción en las revistas, que buscan llevar a los lectores a consumir productos y realizar procedimientos estéticos. En cambio, las noticias periodísticas difunden un modelo de vida más saludable como la principal práctica antienvejecimiento, mientras que al mismo tiempo advierten sobre los riesgos que implican los procedimientos irregulares y los productos estéticos. De forma general, el contenido de las revistas difunde representaciones sociales que idealizan un estándar de belleza del cuerpo joven, asociando la vejez con la fealdad, mientras que el del portal de noticias G1 se orienta a la salud y la longevidad.(AU)

Análise termográfica da ação do jato de plasma no tratamento de rugas faciais ­ série de casos clínicos / Thermographic analysis of plasma jet action in the treatment of facial wrinkles ­ serie of clinical cases

Introdução: o processo de senescência do indivíduo ocorre de forma lenta e contínua e pode gerar inúmeras alterações, dentre elas o envelhecimento cutâneo, derivado do declínio das atividades celulares. Inúmeros recursos têm sido criados ao longo dos anos com a finalidade de frear e ou reverter os aspectos inestéticos da pele, ocasionados por esse processo. Um novo recurso terapêutico vem sendo usado com o objetivo de promover o rejuvenescimento através da diminuição de rugas e linhas de expressão, trata-se do Jato de plasma. Objetivo: avaliar o padrão de variação térmica do tecido tratado com jato de plasma, através da termografia infravermelha. Metodologia: trata-se de uma série de casos clínicos que envolveu 5 pacientes mulheres, com idade acima de 40 anos que apresentavam rugas faciais. As pacientes foram avaliadas e anestesiadas previamente. Em seguida, foi realizada a terapia com o jato de plasma, na região supraorbital. As pacientes foram avaliadas termograficamente antes e depois da anestesia e pósterapia. Resultado: constatou-se através da análise termográfica, uma significativa variação no coeficiente de temperatura da pele onde foi aplicado o anestésico e em seguida o jato de plasma (ΔT > 0,4 °C), em todas as pacientes. Conclusão: o presente estudo comprovou através da utilização da termografia, que o jato de plasma foi capaz de gerar um aumento da temperatura local. Os autores sugerem que tal variação térmica pode ser resultante de um processo de vasodilatação na região tratada.

Introduction: individual's senescence process takes place slowly and continuously beyond generates several changes including skin aging, since the decline in cellular activities. Countless resources have been created over the years, with the goal of stopping and / or reversing the unsightly aspects of the skin caused by this process. Thus, plasma jet, a new therapeutic resource has been used in order to promote rejuvenation through the reduction of wrinkles and expression lines. Objective: To evaluate the pattern of thermal variation of the tissue treated with a plasma jet, using infrared thermography. Methodology: this was a series of clinical cases involving 5 female patients over the age of 40 who had facial wrinkles. Patients were previously evaluated and anesthetized. Then, plasma jet therapy was performed in the supra-orbital region. Patients were evaluated for thermal imaging before and after anesthesia and post-therapy. Result: it was found through thermographic analysis, a significant variation in the temperature coefficient of the skin of all patients where the anesthetic and plasma jet were applied (ΔT > 0.4 °C). Conclusion: the present study proved through the use of thermography that the plasma jet was able to generate an increase in local temperature. The authors suggest that such thermal variation may be the result of a process of vasodilation in the treated region.

Resultados funcionales de la blefaroplastia superior / Functional results of upper blepharoplasty

Objetivo: Describir los resultados funcionales de la blefaroplastia superior. Métodos: Se realizó un estudio descriptivo longitudinal prospectivo de 99 pacientes (198 párpados) con diagnóstico de dermatochalasis de párpado superior, algunos asociados a ptosis palpebral y de la ceja, en el Instituto Cubano de Oftalmología "Ramón Pando Ferrer", en el período comprendido de febrero del año 2019 a enero de 2020. Resultados: El 85,8 por ciento fueron del sexo femenino y el 43,5 por ciento eran mayores de 62 años. Predominó la dermatochalasis del párpado superior y la ptosis palpebral en el 68,4 por ciento, así como la dermatochalasis y la ptosis palpebral severa, las cuales representaron el 47,5 y el 50 por ciento respectivamente. En el grupo de 56 a 61 años sobresalió la dermatochalasis del párpado superior y la ptosis de la ceja, con el 61 por ciento. En el 98 por ciento de los casos intervenidos se obtuvo la corrección total de la dermatochalasis del párpado superior, la corrección de la ptosis en el 86 por ciento y de la ceja en el 88 por ciento. No se presentaron complicaciones en el 94 por ciento de los párpados intervenidos. La complicación más frecuente fue el sangramiento, con el 2,5 por ciento. Conclusiones: El abordaje de la ptosis palpebral y de las cejas transblefaroplastia superior logra en la mayoría de los pacientes la corrección total de estas afecciones y de la dermatochalasis. Este procedimiento constituye una herramienta importante para el rejuvenecimiento facial(AU)

Objective: Describe the functional results of upper blepharoplasty. Methods: A prospective longitudinal descriptive study was conducted of 99 patients (198 eyelids) diagnosed with upper eyelid dermatochalasis, in some cases associated to eyelid and eyebrow ptosis. The study was carried out at Ramón Pando Ferrer Cuban Institute of Ophthalmology from February 2019 to January 2020. Results: Of the total patients studied, 85.8 percent were female and 43.5 percent were aged over 62 years. Upper eyelid dermatochalasis and palpebral ptosis prevailed with 68.4 percent, whereas severe dermatochalasis and palpebral ptosis represented 47.5 percent and 50 percent, respectively. A predominance was found of upper eyelid dermatochalasis and eyebrow ptosis in the 56-61 age group (61 percent). Total correction of upper eyelid dermatochalasis was achieved in 98 percent of the cases intervened, eyelid ptosis correction in 86 percent and eyebrow ptosis correction in 88 percent. No complications appeared in 94 percent of the eyelids intervened. The most common complication was bleeding with 2.5 percent. Conclusions: In most cases, management of palpebral ptosis and upper eyebrow transblepharoplasty achieves total correction of these disorders and dermatochalasis. The procedure is an important tool for facial rejuvenation(AU)

Awareness about vulvovaginal aesthetics procedures among medical students and health professionals in saudi arabia

Abstract Objective The present study aimed to explore the opinion and ethical consideration of vulvovaginal aesthetics procedures (VVAPs) among health professionals and medical students in Saudi Arabia. Methods This is a cross-sectional study performed between January 2020 and April 2020. Data was collected through electronic media, WhatsApp, and emails. The results were analyzed by applying the Students t-test, and correlations were considered significant if they presented a p-value<0.05. Results There is significant demand to educate doctors, health professionals, medical students, and gynecologists for the VVAPs to have a solid foundation, justified indications, and knowledge about various aesthetic options. Although female doctors, medical students, young doctors, and gynecologists have more knowledge about VVAPs, all health professionals ought to be aware of recent trends in vulvovaginal aesthetics (VVA). The present analysis determined that VVA should be under the domain of gynecologists, rather than under that of plastic surgeons, general surgeons, and cosmetologists. Themajority of the participants considered that vaginal rejuvenation, "G-spot" augmentation, clitoral surgery, and hymenoplasty are not justifiable on medical grounds. Conclusion The decision to opt for different techniques for vaginal tightening and revitalization should be taken very carefully, utilizing the shared decision-making approach. Ethical aspects and moral considerations are important key factors before embarking in the VVAPs purely for cosmetic reasons. Further research is required to determine the sexual, psychological, and body image outcomes for women who underwent elective VVAPs. Moreover, medical educators must consider VVAPs as part of the undergraduate and postgraduate medical curriculum.

Antioxidant and antiaging effect of traditional Thai rejuvenation medicines in Caenorhabditis elegans / 中西医结合学报

OBJECTIVE@#This study explored the rejuvenation mechanisms of Thai polyherbal medicines using different approaches, including in vitro methods, as well as a well-defined nematode model, Caenorhabditis elegans.@*METHODS@#THP-R-SR012 decoction was selected from 23 polyherbal medicines, based on metal-chelating and chain-breaking antioxidant capacities. The influences of this extract on the survival and some stress biomarkers of C. elegans under paraquat-induced oxidative stress were evaluated. Furthermore, lifespan analysis and levels of lipofuscin accumulation were examined in senescent nematodes. The phytochemical profile of THP-R-SR012 was analyzed.@*RESULTS@#Supplementation with THP-R-SR012 decoction significantly increased the mean lifespan and reduced the oxidative damage to C. elegans under oxidative stress conditions. Further, THP-R-SR012 supplementation slightly influenced the lifespan and the level of lipofuscin accumulation during adulthood. Antioxidant-related phytochemical constituents of THP-R-SR012 decoction were rutin, naringenin, 3,4-dihydroxybenzoic acid, gallic acid, glycyrrhizic acid, demethoxycurcumin and 18α-glycyrrhetinic acid.@*CONCLUSION@#The antioxidant potential of THP-R-SR012 was due to its scavenging properties, its enhancement of antioxidant-related enzyme activities, and the presence of the antioxidant-related compound. These results support the traditional use of THP-R-SR012 decoction as a tonic for nourishing and strengthening the whole body.

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.

Injeção de agregados plaquetários no rejuvenescimento facial: uma revisão sistemática / Injection of platelet aggregates in facial rejuvenation: a systematic review

Introdução: Essa revisão sistemática foi conduzida para avaliar se a associação da aplicação da injeção de agregados plaquetários quando comparada a outras terapias faciais favorece no rejuvenescimento facial em pacientes adultos. Métodos: A pesquisa buscou ensaios clínicos randomizados que compararam uso de técnicas de rejuvenescimento facial isoladas com as mesmas técnicas aliadas à injeção de agregados plaquetários. A busca foi realizada em bases de dados indexadas e literatura cinzenta. A ferramenta de risco de viés da "Cochrane Collaboration" foi aplicada para a avaliação da qualidade dos estudos. Resultados: Foram identificados 7137 artigos. Apenas quatro estudos permaneceram na síntese qualitativa, e os demais foram considerados com risco indefinido de viés nos domínios chaves. Conclusão: Existem poucos estudos na literatura que comparam o uso de agregados plaquetários em rejuvenescimento facial e os que estão disponíveis têm risco de viés "indefinido" ou "alto". Há necessidade de realizar mais estudos clínicos bem delineados que comparem o uso de injeção de agregados plaquetários associados ou não às técnicas de rejuvenescimento facial.

Introduction: This systematic review was conducted to assess whether the use of a platelet aggregate injection with or without associated facial rejuvenation techniques favors facial rejuvenation in adult patients. Methods: Randomized clinical trials that compared the use of techniques for facial rejuvenation alone with the same techniques coupled with the injection of platelet aggregates were searched. The search was performed in indexed databases and in the gray literature. The Cochrane Collaboration bias risk tool was applied to assess the quality of the studies. Results: In total, 7137 articles were identified. Only four studies remained in the qualitative synthesis, and the others were considered as having undefined bias risk in the key domains. Conclusion: There are few studies in the literature that compare the use of platelet aggregates in facial rejuvenation and those that are available have a risk of "undefined" or "high" bias. There is a need for more well-designed clinical studies comparing the use of platelet aggregate injection with or without associated facial rejuvenation techniques.

A novel photonumeric hand grading scale for hand rejuvenation

BACKGROUND: Few scales are currently available to evaluate changes in hand volume. We aimed to develop a hand grading scale for quantitative assessments of dorsal hand volume with additional consideration of changes in skin texture; to validate and prove the precision and reproducibility of the new scale; and to demonstrate the presence of clinically significant differences between grades on the scale. METHODS: Five experienced plastic surgeons developed the Hand Volume Rating Scale (HVRS) and rated 91 images. Another five plastic surgeons validated the scale using 50 randomly selected images. Intra- and inter-rater agreement was calculated using the weighted kappa statistic and intraclass correlation coefficients (ICCs). Paired images were also evaluated to verify whether the scale reflected clinical differences. RESULTS: The intra-rater agreement was 0.95 (95% confidence interval, 0.922–0.974). The interrater ICCs were excellent (first rating, 0.94; second rating, 0.94). Image pairs that differed by 1, 2, and 3 grades were considered to contain clinically relevant differences in 80%, 100%, and 100% of cases, respectively, while 84% of image pairs of the same grade were found not to show clinically relevant differences. This confirmed that the scale of the HVRS corresponded to clinically relevant distinctions. CONCLUSIONS: The scale was proven to be precise, reproducible, and reflective of clinical differences.

Aging-related changes in the mid-face skin elasticity in East Asian women

BACKGROUND: Age-related changes in facial skin is a major concern in women. This study aimed to objectively evaluate normal skin elasticity and age-related differences in the faces of East Asian women. There are no standard values for data related to normal skin on East Asian women. METHODS: We studied 129 healthy East Asian women without a history of cosmetic procedures or surgeries. Skin elasticity was assessed at the cheek and lower eyelid points, which were assessed on both the right and left sides of the face. RESULTS: The age of the subjects showed significant negative correlations with the R2 and R7 parameters, which represent skin elasticity after deformation. CONCLUSION: We therefore concluded that the primary decrease in skin elasticity in East Asian women occurs in the midface region.

Feasibility of a de-epithelialized orbicularis oculi musculocutaneous flap for subbrow blepharoplasty

BACKGROUND: Subbrow blepharoplasty (SBB) has advantages over traditional blepharoplasty in that it results in more natural-looking creases and contours and is more effective for lateral periorbital rejuvenation. However, in older patients with sunken upper eyelid, this procedure might make the superior eyelid sulcus appear worse because the thicker upper eyelid tissue in the subbrow area is replaced by thinner tissue. To overcome this limitation, we developed a de-epithelialized musculocutaneous flap for SBB. METHODS: From August 2016 to January 2018, 13 patients with sunken upper eyelid deformity underwent SBB. For each of these patients, a typical SBB incision was made, but the tissue usually removed in SBB was dissected as a flap based on the branch of the ophthalmic vessel. After elevation, the flap was transposed or folded to correct the sunken deformity. The results were assessed by the patients themselves and by three plastic surgeons at 6 months postoperatively. RESULTS: The mean age of the patients was 63 years (range, 47–81 years). There were no postoperative complications related to wound dehiscence, hypertrophic scarring, or sensory changes. All patients and plastic surgeons provided scores indicating good to excellent results and were satisfied with the cosmetic outcomes. All patients reported improved functional visual acuity after surgery. CONCLUSIONS: Our technique is simple and effectively addresses both sunken upper eyelid deformity and dermatochalasis. Unlike fat or dermofat grafting, our new technique does not require an additional donor site, and it is more reliable in terms of vascularity.