Rinomodelação ou rinoplastia não-cirúrgica: uma abordagem segura e reprodutível / Rhinomodelation or non-surgical rhinoplasty: a safe and reproducible approach

Introdução: A rinoplastia é uma cirurgia que muitas vezes apresenta resultados imprevisíveis, mesmo em mãos de cirurgiões experientes. Neste sentido, a rinomodelação com preenchedores é um procedimento não-cirúrgico para corrigir pequenas alterações externas nasais em casos específicos. Métodos: Os autores descrevem a técnica de aplicação de preenchedores (ácido hialurônico ou hidroxiapatita de cálcio) para modelação nasal. Foram incluídos todos os pacientes submetidos ao preenchimento nasal, entre 2009 e 2012. Foi avaliado o edema da ponta nasal, a dor e o grau de satisfação dos pacientes com o resultado. Resultados: Foram incluídos 39 pacientes no estudo. Com relação aos desfechos analisados com ácido hialurônico: 52% apresentaram edema leve; 74% tiveram dor leve; 15% se mostraram muito satisfeitos e 74% satisfeitos com o resultado. Com relação aos pacientes submetidos à rinomodelação com hidroxiapatita de cálcio: 67% apresentaram edema moderado; 50% dor moderada; 17% dor intensa e 84% se mostraram satisfeitos com o resultado. Conclusão: A rinomodelação com preenchedores reabsorvíveis é um procedimento simples, com resultados estéticos aceitáveis, sendo necessário um profundo conhecimento anatômico para diminuir o risco de complicações.

Introduction: Rhinoplasty often leads to unpredictable results, even in the hands of experienced surgeons. However, in specific cases, rhinomodelation with fillers, a non-surgical procedure to correct minor nasal external changes, can be used. Methods: This study describes the application technique of fillers (hyaluronic acid or calcium hydroxyapatite) for nasal modeling. Patients undergoing nasal filling between 2009 and 2012 were included. Edema of the nasal tip, pain, and the degree of patient satisfaction with the outcome were assessed. Results: Thirty-nine patients were included in the study. Regarding the outcomes of rhinomodelation with hyaluronic acid, 52% patients presented with mild edema, 74% had mild pain, 15% were very satisfied, and 74% were satisfied with the result. For the outcomes of rhinomodelation with calcium hydroxyapatite, 67% patients presented with moderate edema, 50% had moderate pain; 17% had severe pain, and 84% were satisfied with the result. Conclusion: Rhinomodelation with resorbable fillers is a simple procedure with acceptable esthetic results. However, a deep anatomical knowledge is necessary to decrease the risk of complications.

Short Mood and Feelings Questionnaire for screening children and adolescents for plastic surgery: cross-cultural validation study

ABSTRACT CONTEXT AND OBJECTIVE: Patient-reported outcome measurements assessing the emotional state of children and adolescents who seek plastic surgery are important for determining whether the intervention is indicated or not. The aim of this study was to cross-culturally adapt and validate the Short Mood and Feelings Questionnaire (child/adolescent and parent versions) for Brazilian Portuguese, test its psychometric properties and assess the emotional state of children and adolescents who seek plastic surgery. DESIGN AND SETTING: Cross-cultural validation study conducted in a plastic surgery outpatient clinic at a public university hospital. METHODS: A total of 124 consecutive patients of both sexes were selected between September 2013 and February 2014. Forty-seven patients participated in the cultural adaptation of the questionnaire. The final version was tested for reliability on 20 patients. Construct validity was tested on 57 patients by correlating the Short Mood and Feelings Questionnaire (child/adolescent and parent versions) with the Strengths and Difficulties Questionnaire and the Rosenberg Self-Esteem scale. RESULTS: The child/adolescent and parent versions of the Short Mood and Feelings Questionnaire showed Cronbach's alpha of 0.768 and 0.874, respectively, and had good inter-rater reliability (intraclass correlation coefficient, ICC = 0.757 and ICC = 0.853, respectively) and intra-rater reliability (ICC = 0.738 and ICC = 0.796, respectively). CONCLUSIONS: The Brazilian-Portuguese version of the Short Mood and Feelings Questionnaire is a reproducible instrument with face, content and construct validity.The mood state and feelings among children and adolescents seeking cosmetic surgery were healthy.

Short Mood and Feelings Questionnaire for screening children and adolescents for plastic surgery: cross-cultural validation study.

CONTEXT AND OBJECTIVE: Patient-reported outcome measurements assessing the emotional state of children and adolescents who seek plastic surgery are important for determining whether the intervention is indicated or not. The aim of this study was to cross-culturally adapt and validate the Short Mood and Feelings Questionnaire (child/adolescent and parent versions) for Brazilian Portuguese, test its psychometric properties and assess the emotional state of children and adolescents who seek plastic surgery. DESIGN AND SETTING: Cross-cultural validation study conducted in a plastic surgery outpatient clinic at a public university hospital. METHODS: A total of 124 consecutive patients of both sexes were selected between September 2013 and February 2014. Forty-seven patients participated in the cultural adaptation of the questionnaire. The final version was tested for reliability on 20 patients. Construct validity was tested on 57 patients by correlating the Short Mood and Feelings Questionnaire (child/adolescent and parent versions) with the Strengths and Difficulties Questionnaire and the Rosenberg Self-Esteem scale. RESULTS: The child/adolescent and parent versions of the Short Mood and Feelings Questionnaire showed Cronbach's alpha of 0.768 and 0.874, respectively, and had good inter-rater reliability (intraclass correlation coefficient, ICC = 0.757 and ICC = 0.853, respectively) and intra-rater reliability (ICC = 0.738 and ICC = 0.796, respectively). CONCLUSIONS: The Brazilian-Portuguese version of the Short Mood and Feelings Questionnaire is a reproducible instrument with face, content and construct validity.The mood state and feelings among children and adolescents seeking cosmetic surgery were healthy.

Aesthetic Plastic Surgery Checklist: A Safety Tool.

INTRODUCTION: About one in ten patients experiences iatrogenic events, and more than half of these occur in the perioperative environment. The objective of this study was to develop a complete and functional checklist for aesthetic plastic surgery and test it in patients who would undergo elective plastic surgeries. METHODS: Patient data were collected from a general hospital and the particular clinic between October 2013 and October 2015, through history, physical examination, diagnosis, laboratory tests, pre-, during, and postoperatively, and complications. An expanded safety checklist was developed and optimized for aesthetic plastic surgery based on the model presented by the WHO in 2009 with reference to the information related to the prevention of more frequent complications in this specialty. RESULTS: The tool was applied to 486 patients, of whom 430 (88 %) were women and 56 (12 %) were men. The most frequently performed procedure was liposuction with 30 % of cases, and the most widely used type of anesthesia (39 %) was local anesthesia + sedation. The greater adherence of professionals to the checklist was the group of residents (98 %). The observed complications were seromas (7 %), other complications unrelated to the wound (3 %), and hematoma (0.2 %) in only one patient who underwent facelift. CONCLUSION: The use of the checklist in addition to allowing data collection and the identification of potential risks promoted favorable changes in the attitudes of some professionals and generated interest in patient safety and teamwork. LEVEL OF EVIDENCE IV: This journal requires that the 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 .

Prevalence of Body Dysmorphic Disorder Symptoms and Body Weight Concerns in Patients Seeking Abdominoplasty.

BACKGROUND: Body dysmorphic disorder (BDD) is one of the most common psychiatric conditions found in patients seeking cosmetic surgery, and body contouring surgery is most frequently sought by patients with BDD. OBJECTIVES: To estimate the prevalence and severity of BDD symptoms in patients seeking abdominoplasty. METHODS: Ninety patients of both sexes were preoperatively divided into two groups: patients with BDD symptoms (n = 51) and those without BDD symptoms (n = 39) based both on the Body Dysmorphic Disorder Examination (BDDE) and clinical assessment. Patients in the BDD group were classified as having mild to moderate or severe symptoms, according to the BDDE. Body weight and shape concerns were assessed using the Body Shape Questionnaire (BSQ). RESULTS: The prevalence of BDD symptoms was 57%. There were significant associations between BDD symptoms and degree of body dissatisfaction, level of preoccupation with physical appearance, and avoidance behaviors. Mild to moderate and severe symptoms of BDD were present in 41% and 59% of patients, respectively, in the BDD group. It was found that the more severe the symptoms of BDD, the higher the level of concern with body weight and shape (P < .001). Patients having distorted self-perception of body shape, or distorted comparative perception of body image were respectively 3.67 or 5.93 times more likely to show more severe symptoms of BDD than those with a more accurate perception. CONCLUSIONS: Candidates for abdominoplasty had a high prevalence of BDD symptoms, and body weight and shape concerns were associated with increased symptom severity.

Flap and abdominal wall washing and debridement using dressings to prevent seromas and hematomas in abdominoplasty / Lavagem e desbridamento do retalho e da parede abdominal com compressas como prevenção de seromas e hematomas em abdominoplastia

Seroma formation remains a common complication of abdominoplasty. The use of drain, flap fixation points, and fibrin glue has been described to reduce the incidence of seroma formation. The authors present herein an easyto- reproduce technique to decrease the risk of bleeding and eliminate the devitalized tissue caused by the detachment. The proposed strategy consists of washing and debridement, which was conducted with mechanical friction using moist flap and abdominal wall dressings.

A formação de seroma após uma abdominoplastia continua sendo uma complicação frequente. O uso de dreno, os pontos de fixação do retalho e o uso da cola de fibrina foram descritos com a finalidade de diminuir a sua incidência. Os autores apresentam uma técnica de fácil reprodução para reduzir o risco de sangramento, bem como para eliminar o tecido desvitalizado decorrente do descolamento. A tática proposta constitui-se de lavagem e desbridamento por meio da fricção mecânica com compressas umedecidas do retalho e da parede abdominal.

As bases da reformulação da presença digital da Sociedade Brasileira de Cirurgia Plástica / A basis for a reformulation of the digital presence of the Brazilian Association of Plastic Surgery

INTRODUÇÃO: Com o crescimento exponencial da internet, observou-se o grande potencial da rede como ferramenta eficaz no provimento de informações e acesso difundido. Desenvolver portais que respondam as necessidades informacionais de seus associados e usuários configuram uma preocupação das sociedades de classe. O objetivo deste estudo foi reavaliar a estrutura do portal da Sociedade Brasileira de Cirurgia Plástica, além da necessidade de implementação de uma nova dinâmica de interação de seus associados e usuários. MÉTODO: Realizou-se pesquisa qualitativa com seus associados e formadores de opinião previamente selecionados. RESULTADOS: As considerações mais frequentes foram: aporte de melhor conteúdo científico, necessidade de atualização do portal, divulgação de pesquisas, acesso a periódicos e instrumento de treinamento e/ou aperfeiçoamento. CONCLUSÃO: Essa pesquisa possibilitou a modernização do portal da Sociedade Brasileira de Cirurgia Plástica, além de definir diretrizes de sua presença contínua nas redes sociais.

INTRODUCTION: The exponential growth of the Internet has revealed its great potential as an effective tool for providers to access information. The development of websites that meet associates' and other users' needs to be informed is a concern of professional associations. This study aimed to assess the structure of the SBCP website and the need to implement a new dynamic interaction between associates and other users. METHOD: A qualitative study was conducted by surveying previously selected associates and opinion makers. RESULTS: The most common considerations were as follows: (1) the need to improve scientific content, (2) update the website, (3) disseminate research, (4) access journals, and (5) training and/or development of tools. CONCLUSION: This study promoted the modernization of the SBCP website and defined guidelines for its ongoing presence in social networks.

A simplified method for smile enhancement: botulinum toxin injection for gummy smile.

The authors studied and provided treatment to patients with the complaint of gummy smile. Between October of 2009 and January of 2011, 52 unaesthetic smiles were evaluated and treated with onabotulinum toxin A. Botulinum toxin injection was an effective treatment, with an average satisfaction level of 9.75 on a 10-point scale. The levator labii superioris alaeque nasi is the ideal muscle for injection, and lopsided smiles could be resolved also with onabotulinum toxin A asymmetric injection. Gummy smile treatment with onabotulinum toxin A into the levator labii superioris alaeque nasi muscle is an effective method, with minimum risk of complications and very high patient satisfaction.