Brow Lift Through The Upper Blepharoplasty Incision: Prospective Clinical Study.

BACKGROUND: Eyebrow tail ptosis is usually associated with dermatochalasis of the upper eyelid, and it is necessary to treat them together. For these associated procedures to be incorporated as a routine in upper eyelid surgeries, they should preferably be less invasive with consequent fewer complications. OBJECTIVE: We describe a minimally invasive technique for the correction of mild-to-moderate eyebrow tail ptosis corrected together with superior dermatochalasis through the blepharoplasty incision. METHODS: A phase 2 clinical trial was conducted from February 2020 to December 2021. A total of 50 patients underwent conventional upper blepharoplasty surgery associated with the proposed eyebrow lift technique: internal pexia in the periosteum, dissection, and posterior fixation of the orbicularis muscle to the arcus marginalis, removal of the lateral part of the orbicularis muscle, and loosening of the orbital retention ligament. Evaluation of the height of the eyebrow tail was performed with digital photography in the initial consultation and at 30-90 days postoperatively and analyzed with ImageJ software. RESULTS: Mean difference in brow height at 1-month and 3-month postoperative evaluations compared to the preoperative period was 3.45-3.33 mm, respectively. CONCLUSION: Our study demonstrated a minimally invasive surgical technique for the treatment of mild-to-moderate eyebrow ptosis with significant eyebrow tail lift results that remained stable during the study period. LEVEL OF EVIDENCE II: 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 .

Prevention of necrosis in ischemic skin flaps using hydrogel of Rhizophora mangle.

INTRODUCTION: Necrosis in ischemic cutaneous flaps (ISF) is a type of surgical failure more feared among surgical complications. Currently, synthetic drugs are applied during the treatment of necrosis in ISF and although several substances show improvement in viability, some require application at high systemic doses, which can produce important side effects. Therefore, the search for natural substances with fewer side effects is constant. The use of medicinal plants that stimulate angiogenesis is commonly mentioned in previous studies and in this case Rhizophora mangle L. (R. mangle) highlights that among its main compounds have tannins and flavonoids that are very chemically reactive in various biological activities. This study aimed to associate a natural hydrogel to the 5% extract of R. mangle and to evaluate its potential in the prevention of tissue necrosis in distal portions of ISF in rats, using the model proposed by Macfarlane, et al. (1965). METHODS: Ischemic skin flaps were made in the thin dorsal skin area of 28 Wistar rats and divided into 4 groups, group A: received only saline, group B where the aqueous extract of R. mangle was applied, group C received the 1.5% hydrogel of xanthan gum (XG) + placebo and group D was applied the hydrogel associated with 5% R. mangle extract. Morphometric analyses of the areas of tissue necrosis were performed from photographic records using the software Photoshop® and ImageJ®. In addition, 5 photomicrographs were taken from each histological sample of each animal for histomorphometric analysis that obtained the count of fibroblasts and blood vessels. RESULTS: The mean percentage of necrotic areas was: group (A) - 50,66%, group (B) - 40,49%, group (C) - 37,44% and group (D) - 34,25%. The statistical analysis, using the Kruskal-Wallis test, showed a significant difference (p < 0.001).