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 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.

Ultrasound-guided poly-l-lactic acid nodule excision: The importance of the injector ultrasonographic experience.

The possibilities for facial and body treatments are wide, but when it comes to treatment for the cervical region, the options are more restricted and among them, the use of poly-l-lactic acid (PLLA) stands out. PLLA is used for collagen biostimulation and improvement of skin turgor with good results; however this procedure is not free of complications, and for the treatment of these, a correct diagnosis is essential. As it is esthetic medicine, the guarantee of results requires that complications are not tolerated, and thus, any resource that enriches the diagnostic and therapeutic arsenal is of great value. The objective of this study is to report the diagnosis of a PLLA nodule with the help of high-frequency ultrasound, establishing a clinical, radiological, and histopathological correlation, in a patient submitted to PLLA injection for esthetic improvement of the cervical region. We present a case in a female patient presenting a nodule in the cervical region after the application of PLLA, where we performed the excision guided by high-frequency ultrasound. Mastering the diagnostic technique with high-frequency ultrasound can play a valuable role in indicating early surgical exeresis, also contributing to complete patient care. It allows the application of the product, monitoring, diagnosis of the complication, and treatment to be carried out dynamically and precisely by the injector.

Effect of the aging process on columella-labial, naso-mental and facial angles and how to apply it in clinical practice.

BACKGROUD: Aging is the result of the interplay of changes occurring in the facial skeleton, ligaments, muscles, adipose tissue, and skin (1), and these changes befall each mentioned structure at a different pace, start in each individual at a different age, and differ between ethnic background. (4) It changes directly the measurements of the face angles, making the face more concave and flattened aspect, while the young face presents a more convex and rounded aspect. Female skulls had an increase in all transverse facial widths and depth of the middle face with increasing age. Therefore, aging is consequence of progressive changes through intrinsic and extrinsic factors (5) and different methods can be used to assess and diagnose these changes. AIMS: The aim of the study is to evaluate facial angles and their aging changes. METHODS: A retrospective study was performed with a total of 1213 Caucasian female patients in the author's private clinic. The angles evaluate age-related changes were analyzed: facial, naso-mental, and columella-labial angle. Photograph analysis program Vectra 3D (Canfield) was used to perform the anthropometric assessment of the angles, and after data collection, the analysis was performed statistics. RESULTS AND CONCLUSION: We could conclude angles analyzed change with age, while two angles increase (naso-mental and facial angle), the other decreases (columella-labial angle). The study reinforces the principle of an objective clinical anthropometric assessment of facial angles as a relevant guide for a more appropriate treatment plan for the doctor to perform aesthetic procedures in order to restore a youthful face.

Definition of the Mandibular Angle Using Botulinum Toxin Type A: A New Technique for the Improvement of Mandibular Contour and Definition.

While the injection of botulinum toxin type A (BoNTA) in the neck area, for face contouring through the blockade of the platysmal bundles, and in the mandibular body line has previously been explored, reports of its application for the demarcation of the mandibular angle are more limited. This article described a new technique of BoNTA injection in the mandibular angle for the improvement of contour and definition. At roughly 15 days after application in 30 patients, better visualization of the mandibular angle and its contours was evident and, consequently, smoothing of the appearance of sagging around the mandible with no adverse effects was noted. Further investigation of this technique is warranted.

Use of Hyaluronic Acid Fillers to Correct Scleral Show: A Review of Technique.

Generally, the shape of women's eyes are distinctly different in intercatal height from that in men. Ideally, in a woman, the lateral intercostal point is positioned above the medial intercostal point, which gives the eyes a cat-like appearance that culturally suggests youth and health. Because of aging and/or physiological changes, this area can be altered with the inversion of the lateral intercantal line lower than the medial intercantal line, producing a tired and/or sad looking appearance. Hyaluronic acid is a quick and safe method of elevating the lateral intercantal area of the eye. This article describes a technique for using hyaluronic acid for the treatment of scleral show.

Evaluation and Proportion in Nasal Filling with Hyaluronic Acid.

The nose is an essential feature when considering the aesthetic appeal of the face. As aesthetic preferences vary from person to person, the concept of the "ideal" nose must be applied on a case-by-case basis, with respect to the classical patterns of anthropometry, sex, ethnic group, and psychosocial factors. Interest in less invasive procedures for nasal correction has increased considerably, among which is the emerging use of hyaluronic acid for nonsurgical rhinoplasty. In this article, the authors present an objective review of the anatomy of the nasal region, the evaluation and indications of nasal filling with hyaluronic acid, a description of the technique, and brief discussion of associated complications.

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.

Tratamento de cicatriz de queimadura com luz intensa pulsada e laser ablativo fracionado Erbium: YAG / Treatment of burning scars with intense pulsed lip and fractionated ablative laser Erbium: YAG / Tratamiento de cicatrices por quemaduras con luz intensa pulsada y láser ablativo fraccionado Erbio: YAG

Cicatrizes decorrentes de queimadura acarretam grandes danos físicos e emocionais aos pacientes. Seu tratamento permanece um desafio na prática clínica. O uso atual de tecnologias a laser e luz, como o laser ablativo fracionado e a luz intensa pulsada (LIP), tem se mostrado eficaz na recuperação estética e funcional da pele acometida. Este trabalho tem por objetivo a demonstração do resultado do tratamento de cicatriz de queimadura extensa com LIP e laser ablativo fracionado Erbium: YAG a partir do relato de caso de uma paciente de 38 anos vítima de queimadura por chama direta aos 6 anos de idade. A paciente apresentou melhora clínica significativa no aspecto estético e funcional da lesão. O uso desses métodos combinados apresenta resultados favoráveis para o tratamento desses casos.

Scars resulting from burning causes great physical and emotional damage to patients. Its treatment remains a challenge in clinical practice. Current use of laser and light technologies, such as fractional ablative laser and intense pulsed light (ILP), have been shown to be effective in aesthetic and functional recovery of affected skin. This work aims to demonstrate the results of the treatment of extensive burn scarring with ILP and fractional ablative laser Erbium:YAG relating the case report of a 38-year-old female victim of direct flame burn at 6-years-old. The patient presented significant clinical improvement in the aesthetic and functional aspect of the lesion. The use of these combined methods presents favorable results for the treatment of these cases.

Las cicatrices resultantes de quemaduras causan grandes daños físicos y emocionales a los pacientes. El tratamiento sigue siendo un reto en la práctica clínica. El uso actual de tecnologías láser y de luz, tales como el láser ablativo fraccionado y la luz pulsada intensa (LPI) han demostrado ser herramientas eficaces para la recuperación estética y funcional de la piel afectada. Este trabajo tiene como objetivo mostrar el resultado del tratamiento de una cicatriz extensa por quemadura usando LPI y láser ablativo fraccional Erbio:YAG a partir del caso clínico de una paciente de 38 años de edad víctima de quemaduras por fuego directo (llama) a los 6 años de edad. La paciente mostró una mejoría clínica significativa en el aspecto estético y funcional de la lesión. El uso de estos métodos combinados mostró resultados favorables para el tratamiento de este tipo de casos.