Consensus Recommendations for the Use of Hyperdiluted Calcium Hydroxyapatite (Radiesse) as a Face and Body Biostimulatory Agent.

BACKGROUND: Calcium hydroxyapatite (CaHA) is a well-established collagen stimulator. In recent years, it has been increasingly used in hyperdiluted form as a biostimulatory agent rather than a volumizing filler to improve skin quality and firmness in both facial and corporal areas. However, guidelines on the techniques required to achieve optimal results are still lacking. The objective of this study was to develop a consensus recommendation for the safe and effective use of hyperdiluted CaHA for face and body biostimulation. METHODS: A team of 10 experts with extensive experience in dermal fillers and biostimulatory treatments for facial and body rejuvenation convened for a live meeting. Consensus was defined as approval by 70%-89% of all participants, whereas agreement of ≥90% denoted strong consensus. RESULTS: For most items, the group achieved a majority consensus. Recommendations have been provided for the face, neck, décolletage, buttocks, thighs, arms, abdomen, knees, and elbows with detailed injection techniques, providing information on insertion points, dosages, and volumes for both needle and cannula injections as well as the number of treatment sessions and intervals. CONCLUSIONS: The expert consensus supports and provides guidance for the use of CaHA as a biostimulatory agent for face and body rejuvenation. However, further clinical studies are necessary to provide physicians with the best evidence for the best treatment practices.

Retalhos cirúrgicos para fechamento de defeitos faciais sincrônicos / Surgical flaps for closing synchronous facial defects

Poucas são as descrições da literatura sobre técnicas cirúrgicas para fechamento de defeitos sincrônicos na face. Relatamos três casos de pacientes com lesões sincrônicas na face, que foram reconstruídas utilizando-se os seguintes tipos de retalhos: dupla rotação Yin-Yang, avanço de dois triângulos de Burrow e combinação de retalho dorsal nasal associado a retalho de transposição. As reconstruções de defeitos sincrônicos na face representam desafios aos cirurgiões dermatológicos, especialmente quando uma das lesões se localiza no nariz. Nos casos que envolvem defeitos relativamente pequenos e não tão distantes entre si, há a possibilidade de se realizar um retalho único para fechamento de ambos os defeitos.

There are a few descriptions in the literature on surgical techniques for the closure of synchronous facial defects. We report three cases of patients with synchronous lesions on the face, which were reconstructed using the following types of flaps: Yin-Yang double-opposing rotation; Burrow's triangle advancement; and a combination of the dorsal nasal flap with the transposition flap. Reconstructions of synchronous facial defects represent challenges to dermatologic surgeons, especially when one of the lesions is located in the nose. In cases involving relatively small defects and not so far apart, there is the possibility of a single flap to close both defects.

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.

Manejo de cicatrizes com uso de placas e gel de silicone / Management of scars with the use of silicone gel and sheets

A formação de cicatriz é a resposta de cura natural da pele para restabelecer a integridade dérmica após uma lesão. As cicatrizes, além de inestéticas, podem ainda apresentar-se hipertróficas ou queloidianas, tornando o tratamento difícil e, por vezes, insatisfatório. A etnia e a localização da ferida desempenham um papel importante na gênese dos tipos de cicatriz, mas nem sempre podemos prever o resultado final. O uso do silicone tópico tem sido uma opção para o manejo da cicatriz e alvo de diversas publicações ao longo dos anos. Acredita- se que o uso precoce possa prevenir o desenvolvimento de cicatrizes anormais e tratar cicatrizes existentes.

Scar formation is the natural healing response of the skin to reestablish dermal integrity after an injury. Besides being unsightly, the scars can also be hypertrophic or keloids, which makes treatment challenging and many times unsatisfactory. Ethnicity and site of the lesion have an important role in the formation of scar types, but it is not always possible to predict the final result. The use of topical silicone has been an option for scar management and the target of many publications over the years. It is believed that its early use can prevent the development of abnormal scars and treat existing scars.

Anatomia da região periorbital / Anatomy of the periorbital region

Um estudo cuidadoso da anatomia da órbita é muito importante para os dermatologistas, mesmo para os que não realizam grandes procedimentos cirúrgicos, devido à elevada complexidade de estruturas envolvidas nos procedimentos dermatológicos realizados nesta região. O conhecimento detalhado da anatomia facial é o que diferencia o profissional qualificado, seja na realização de procedimentos minimamente invasivos, como toxina botulínica e preenchimentos, seja nas exéreses de lesões dermatológicas, evitando complicações e assegurando os melhores resultados, tanto estéticos quanto corretivos. Trataremos neste artigo da revisão da anatomia da região órbito-palpebral e das estruturas importantes correlacionadas à realização dos procedimentos dermatológicos.

A careful study of the anatomy of the orbit is very important for dermatologists, even for those who do not perform major surgical procedures. This is due to the high complexity of the structures involved in the dermatological procedures performed in this region. A detailed knowledge of facial anatomy is what differentiates a qualified professional-whether in performing minimally invasive procedures (such as botulinum toxin and dermal fillings) or in conducting excisions of skin lesions-thereby avoiding complications and ensuring the best results, both aesthetically and correctively. The present review article focuses on the anatomy of the orbit and palpebral region and on the important structures related to the execution of dermatological procedures.