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1.
Dermatol Online J ; 30(2)2024 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-38959928

RESUMO

Large defects on the face after Mohs surgery have posed significant reconstructive challenges. A 90-year-old man presented with melanoma in situ of the central forehead, which resulted in a 4.5cmx4.3cm defect after multiple stages of Mohs surgery. Although different approaches for forehead repair with nasal root involvement are possible, we demonstrate that the V-Y advancement flap and subsequent Burrow graft for nasal root repair represents a viable closure technique for large circular defects of the central forehead.


Assuntos
Testa , Melanoma , Cirurgia de Mohs , Neoplasias Cutâneas , Retalhos Cirúrgicos , Humanos , Masculino , Testa/cirurgia , Idoso de 80 Anos ou mais , Melanoma/cirurgia , Melanoma/patologia , Neoplasias Cutâneas/cirurgia , Neoplasias Cutâneas/patologia , Neoplasias Faciais/cirurgia , Neoplasias Faciais/patologia
2.
J Dermatolog Treat ; 35(1): 2359511, 2024 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38880494

RESUMO

Botulinum toxin type A (BoNT-A) was first isolated in 1946, and since then, several formulations have been developed and widely used to treat wrinkles by inducing muscle paralysis. This multicenter, double-blind, randomized, parallel-group, active-controlled phase 3 clinical trial was designed to evaluate the efficacy and safety of a newly developed BoNT-A formulation, BMI2006, in improving moderate to severe glabellar wrinkles and to compare with existing onabotulinumtoxin A (OBoNT) injections. A total of 276 subjects were enrolled and received 20 units of the randomized material, which was intramuscularly injected into five different locations on the forehead. The primary endpoint, assessed at 4 weeks, showed no statistically significant difference in the improvement rate of glabellar wrinkles between the two groups, with BMI2006 demonstrating non-inferiority to comparator BoNT-A. Secondary endpoints, evaluated by both treating investigators and independent investigators, also exhibited similar improvement rates throughout the study period. Both groups reported high levels of satisfaction with no statistical difference between the two groups. Safety evaluations indicated mild and transient adverse events, with no serious reactions observed. In conclusion, BMI2006 is an effective and safe BoNT-A for treating glabellar wrinkles with an expected duration of action between 8 and 12 weeks.


Assuntos
Povo Asiático , Toxinas Botulínicas Tipo A , Testa , Fármacos Neuromusculares , Envelhecimento da Pele , Humanos , Toxinas Botulínicas Tipo A/administração & dosagem , Toxinas Botulínicas Tipo A/efeitos adversos , Método Duplo-Cego , Envelhecimento da Pele/efeitos dos fármacos , Feminino , Pessoa de Meia-Idade , Masculino , Adulto , Resultado do Tratamento , Injeções Intramusculares , Fármacos Neuromusculares/administração & dosagem , Fármacos Neuromusculares/efeitos adversos , Satisfação do Paciente
4.
Facial Plast Surg Clin North Am ; 32(3): 383-390, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38936995

RESUMO

After reading this article, one should better understand the anatomy of the forehead, brow, and eyelid complexes in the male patient. A thorough history and physical examination allows the facial plastic surgeon to properly select male patients in whom blepharoplasty and brow lift may be indicated. Specific surgical approaches to upper and lower blepharoplasty are discussed in detail. Surgical techniques and indications for each approach to brow lift in men, including direct, midforehead, coronal, pretrichial, endoscopic, temporal, and transblepharoplasty are explicitly outlined.


Assuntos
Blefaroplastia , Sobrancelhas , Testa , Ritidoplastia , Humanos , Blefaroplastia/métodos , Masculino , Sobrancelhas/anatomia & histologia , Testa/cirurgia , Testa/anatomia & histologia , Ritidoplastia/métodos , Pálpebras/cirurgia , Pálpebras/anatomia & histologia , Rejuvenescimento
5.
Am J Case Rep ; 25: e943098, 2024 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-38736220

RESUMO

BACKGROUND Sinonasal rhabdomyosarcoma (RMS) is a rare malignancy in children and adolescents. It is aggressive and locally invasive, and can require local postoperative radiotherapy. This report presents the case of a 16-year-old girl with a sinonasal-cutaneous fistula following excision and radiotherapy for rhabdomyosarcoma, which required reconstructive surgery using an expanded forehead flap. CASE REPORT We report the case of a16-year-old girl who was referred to our clinic with sinonasal-cutaneous fistula. Prior to presentation at our department, she presented with bilateral intermittent nasal congestion 3 years ago. At a local hospital, orbital computed tomography and nasal endoscopic biopsy revealed an embryonal rhabdomyosarcoma (ERMS). One month later, skull base tumor resection, nasal cavity and sinus tumor resection, and low-temperature plasma ablation were performed at a local hospital. Two weeks after the operation, the patient received intensity-modulated radiation therapy for a total of 50 Gy. Chemotherapy started 15 days after radiotherapy, using a vincristine, dactinomycin, and cyclophosphamide (VAC) regimen. Approximately 1 month later, an ulcer appeared at the nasal root and the lesion gradually expanded. The patient was referred to our hospital due to the defect. Firstly, a tissue expander was implanted at the forehead for 7 months. Then, the skin around the defect was trimmed and forehead flap was separated to repair the lining and external skin. The flap survived well 1-year after the operation. CONCLUSIONS This report highlights the challenges of post-radiation reconstructive surgery and describes how an expanded forehead flap can achieve an acceptable cosmetic outcome in a patient with a sinonasal-cutaneous fistula.


Assuntos
Fístula Cutânea , Testa , Retalhos Cirúrgicos , Humanos , Feminino , Adolescente , Fístula Cutânea/etiologia , Fístula Cutânea/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Neoplasias dos Seios Paranasais/cirurgia , Neoplasias dos Seios Paranasais/radioterapia , Rabdomiossarcoma/cirurgia , Rabdomiossarcoma/radioterapia , Rabdomiossarcoma Embrionário/cirurgia , Rabdomiossarcoma Embrionário/radioterapia , Neoplasias Nasais/cirurgia , Neoplasias Nasais/radioterapia , Complicações Pós-Operatórias
6.
Acta Chir Plast ; 66(1): 16-21, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38704232

RESUMO

In this article we would like to present, to our best knowledge, the very first published replantation of a forehead/part of a forehead as a single unit. The patient is a 57-year-old male smoker who sustained an avulsion forehead injury after a dog bite. Replantation was performed using microanastomosis of the supratrochlear vessels with restoration of good blood circulation after the procedure. Unfortunately, 5 days after the surgery, ischemia of the flap occurred followed by successful acute revision surgery. Nevertheless, the day after the ischemia reoccurred due to the time that passed, circumstances and unfavorable conditions affecting the sutured vessels, no further revision surgery was indicated. Observation continued and eventual wound necrosis after demarcation was left to be treated with skin grafting or per secundam intentionem. Only partial necrosis of the flap occurred, approximately 50%, which was subsequently treated with a full-thickness skin graft with very good results leading to the satisfaction of the patient.


Assuntos
Testa , Microcirurgia , Reimplante , Humanos , Masculino , Pessoa de Meia-Idade , Reimplante/métodos , Microcirurgia/métodos , Testa/cirurgia , Mordeduras e Picadas/cirurgia , Animais , Cães
7.
Aust J Gen Pract ; 53(5): 317-318, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38697064
8.
Aesthetic Plast Surg ; 48(12): 2239-2245, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38691173

RESUMO

BACKGROUND: In recent years, soft tissue materials have been applied as forehead fillers. Some filling materials need to be removed or refilled in a timely manner in certain situations; therefore, it is important to develop a method to identify the location and type of filling materials. This study summarizes the imaging findings of different filling materials under high-frequency ultrasound, providing a reference for clinical treatment. METHODS: We screened facial ultrasound images performed at the Plastic Surgery Hospital of the Chinese Academy of Medical Sciences from April 2015 to July 2023 and classified and summarized the types of frontal filling materials and their imaging results. RESULTS: This study included ultrasound imaging results from 114 patients, including 39 with hyaluronic acid (HA) filling, 45 with polyacrylamide hydrogel (PAG) filling, 14 who received autologous fat transplantation, 2 who received prosthesis implantation, 2 who received both HA and PAG filling, and 12 who received silicone oil filling. HA mainly manifests as an anechoic zone on ultrasonography, with images divisible into four types. PAG primarily presents as fine punctate echoes, divisible into five types. Fat transplantation presents as a low-echo area with uneven density, divisible into five types. Finally, the silicone oil-filling material appears as a cloud-like high echo on the forehead, visible throughout the entire skin layer, and unclear imaging in deep tissues. CONCLUSION: High-frequency ultrasound is a safe and reliable method to evaluate the type and position of forehead filling materials, which can be easily applied in clinical practice. LEVEL OF EVIDENCE IV: 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 .


Assuntos
Resinas Acrílicas , Preenchedores Dérmicos , Testa , Ácido Hialurônico , Ultrassonografia , Humanos , Testa/diagnóstico por imagem , Testa/cirurgia , Preenchedores Dérmicos/administração & dosagem , Feminino , Adulto , Ácido Hialurônico/administração & dosagem , Pessoa de Meia-Idade , Masculino , Ultrassonografia/métodos , Técnicas Cosméticas , Estudos Retrospectivos , Estética , Óleos de Silicone , Envelhecimento da Pele , Estudos de Coortes
9.
J Med Case Rep ; 18(1): 230, 2024 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-38693549

RESUMO

BACKGROUND: Melanotic neuroectodermal tumor of infancy (MNTI) is a rare clinically benign, pigmented, tumor of neural crest origin which commonly occurs in the maxilla. It is a rare tumor that may pose difficulty in differentiating from other malignant round cell tumors. CASE PRESENTATION: A 5-month-old Ethiopian infant presented with a mass on his forehead. A wide excision of the lesion was done and subjected to histopathologic evaluation. The histologic and immunohistochemistry for synaptophysin studies confirmed that the infant was having MNTI. The patient was followed and there was no sign of recurrence at the 6th and 9th months of follow-up. CONCLUSION: MNTI should be considered as a differential diagnosis for tumors occurring in the head region in infants and prolonged follow-up may be needed to check for possible recurrence of the tumor.


Assuntos
Tumor Neuroectodérmico Melanótico , Humanos , Tumor Neuroectodérmico Melanótico/patologia , Tumor Neuroectodérmico Melanótico/cirurgia , Tumor Neuroectodérmico Melanótico/diagnóstico , Lactente , Masculino , Diagnóstico Diferencial , Testa/patologia , Resultado do Tratamento
10.
J Cosmet Dermatol ; 23(7): 2373-2379, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38757429

RESUMO

BACKGROUND: Recent research introduced the concept of the "line of convergence" as a guide for injectors to enhance precision and avoid complications when treating the frontalis muscle with toxins. However, currently, no pre-injection ultrasound scanning is employed to increase precision and reduce adverse events when searching for the line of convergence. OBJECTIVE: To explore the feasibility and practicality of implementing pre-injection ultrasound scanning into aesthetic neuromodulator treatments of the forehead. METHODS: The sample of this study consisted of n = 55 volunteers (42 females and 13 males), with a mean age of 42.24 (10.3) years and a mean BMI of 25.07 (4.0) kg/m2. High-frequency ultrasound imaging was utilized to measure the thickness, length, and contractility of the frontal soft tissue and to determine the precise location of the line of convergence during maximal frontalis muscle contraction. RESULTS: The results revealed that the line of convergence was located at 58.43% (8.7) of the total forehead height above the superior border of the eyebrow cilia without a statistically significant difference between sex, age, or BMI. With frontalis muscle contraction, the forehead shortens in males by 25.90% (6.5), whereas in females it shortens only by 21.74% (5.1), with p < 0.001 for sex differences. CONCLUSION: This study demonstrated the feasibility and practicality of pre-injection ultrasound scanning for facial aesthetic neuromodulator treatments. Knowing the location of the line of convergence, injectors can determine precisely and on an individual basis where to administer the neuromodulator deep or superficial or when the injection location is at risk to cause eyebrow ptosis.


Assuntos
Técnicas Cosméticas , Músculos Faciais , Estudos de Viabilidade , Testa , Ultrassonografia , Humanos , Feminino , Masculino , Adulto , Pessoa de Meia-Idade , Músculos Faciais/diagnóstico por imagem , Músculos Faciais/efeitos dos fármacos , Técnicas Cosméticas/efeitos adversos , Ultrassonografia/métodos , Contração Muscular/efeitos dos fármacos , Toxinas Botulínicas Tipo A/administração & dosagem , Toxinas Botulínicas Tipo A/efeitos adversos , Envelhecimento da Pele/efeitos dos fármacos , Injeções Intramusculares/métodos
11.
J Craniomaxillofac Surg ; 52(6): 692-696, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38729846

RESUMO

The psychological effects of staged nasal reconstruction with a forehead flap were prospectively investigated. Thirty-three patients underwent nasal reconstruction with forehead flaps between March 2017 and July 2020. Three questionnaires were used to assess psychosocial functioning before surgery (time 1), 1 week after forehead flap transfer (time 2), 1 week after forehead flap division (time 3), and after refinement procedures (time 4). The patients were categorized into three groups according to the severity of nasal defects. Between- and within-group comparisons were conducted. All patients reported increased satisfaction with their appearance during nasal reconstruction. For most patients, levels of distress and social avoidance were highest before reconstruction (time 1). Both levels decreased as reconstruction advanced, and were significantly improved by times 3 and 4. The stage of reconstruction had a greater effect on these levels than did severity of nasal defect. Nasal reconstruction with forehead flap is beneficial physically and psychologically. Psychological evaluation before and after surgery facilitates patient-surgeon interactions and further enhances outcomes.


Assuntos
Testa , Rinoplastia , Retalhos Cirúrgicos , Humanos , Estudos Prospectivos , Masculino , Feminino , Testa/cirurgia , Pessoa de Meia-Idade , Retalhos Cirúrgicos/cirurgia , Rinoplastia/psicologia , Rinoplastia/métodos , Adulto , Idoso , Ajustamento Emocional , Inquéritos e Questionários , Neoplasias Nasais/cirurgia , Neoplasias Nasais/psicologia , Satisfação do Paciente , Adaptação Psicológica
12.
J Plast Reconstr Aesthet Surg ; 93: 203-209, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38703712

RESUMO

BACKGROUND: Direct browlift is useful but leaves a scar above the brow. We proposed a dual-plane browlift to avoid facial scarring while effectively resolving brow ptosis in young and young adult patients. METHODS: Seven patients with facial palsy underwent dual-plane browlift between July 2018 and June 2022. The mean postoperative follow-up period was 31.9 months. Skin resection at the hairline was combined with subcutaneous dissection down to the inferior margin of the brow to "lift" the brow. Fascia lata strips were fixed to the dermis just inferior to the eyebrow to "hold" the brow, and the strips were suspended upward through the subperiosteal tunnel and fixed to the periosteum. Brow height was compared before and after the procedure and with the contralateral side. RESULTS: The reported complications included slight hematoma at the recipient site, temporary difficulty in closing the eye, and seroma at the fascia donor site. The paralyzed side showed significant differences between the preoperative period and postoperative months (POM) 3, 6, and 12, but differences were not shown in the intervals between POM 3 and 6, 6 and 12, or 3 and 12. The difference in eyebrow height between the paralyzed and nonparalyzed sides was significant preoperatively but not at POM 3, 6, or 12. All scars matured well, and the fascia silhouette was not visible in the forehead region. CONCLUSIONS: Dual-plane browlift enables rigid suspension using the fascia lata and excises flaccid skin without leaving facial scars, yielding excellent cosmetic quality and stable long-term outcomes.


Assuntos
Blefaroptose , Sobrancelhas , Paralisia Facial , Ritidoplastia , Humanos , Feminino , Paralisia Facial/cirurgia , Masculino , Blefaroptose/cirurgia , Ritidoplastia/métodos , Adulto , Adulto Jovem , Fascia Lata/transplante , Testa/cirurgia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Blefaroplastia/métodos
13.
J Drugs Dermatol ; 23(4): 262-267, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38564403

RESUMO

BACKGROUND: Full thickness defects of the ala, soft triangle, and nasal tip involving the nasal lining have traditionally been repaired with the three-stage folded paramedian forehead flap (FPFF), with a cartilage graft for support. For similar defects, the authors utilize the two-stage FPFF without cartilaginous support which provides reproducible functional and aesthetic results.  Objective: To describe the authors’ experience with the two-stage FPFF, including outcomes, complications, and design modifications to enhance functional and aesthetic success.  Methods: An IRB-approved retrospective database review of FPFF was performed at two sites. Using postoperative photographs, outcomes were assessed by blinded non-investigator dermatologist raters using a modified observer scar assessment scale. RESULTS: Thirty-five patients were reconstructed using the two-stage FPFF without cartilage grafts. Subjective assessment of scar vascularity, pigment, relief, and thickness by 3 independent reviewers yielded an overall cosmesis score of 8.4±1.9 (out of 40). CONCLUSION: The two-stage FPFF without cartilage grafts is a reliable, cosmetically elegant repair that can provide optimal functional and aesthetic results for complex unilateral distal nose defects.J Drugs Dermatol. 2024;23(4): doi:10.36849/JDD.7358.


Assuntos
Neoplasias Nasais , Rinoplastia , Humanos , Rinoplastia/métodos , Retalhos Cirúrgicos , Estudos Retrospectivos , Testa/cirurgia , Cicatriz/patologia , Nariz/cirurgia , Cartilagem/transplante , Neoplasias Nasais/cirurgia , Neoplasias Nasais/patologia
14.
Facial Plast Surg Clin North Am ; 32(2): 211-219, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38575279

RESUMO

In this review, the paramedian forehead flap indications and uses are reviewed, specifically examining clinical situations where patient selection is important. In these settings, a preoperative discussion with a patient regarding surgical expectations and goals in the setting of their defect is paramount. The authors review the literature regarding the psychosocial aspects of major nasal reconstruction and review preoperative discussion points that are key to a well-informed patient and improved patient satisfaction through the nasal reconstructive process.


Assuntos
Neoplasias Nasais , Rinoplastia , Humanos , Retalhos Cirúrgicos , Testa/cirurgia , Nariz/cirurgia , Neoplasias Nasais/cirurgia , Tomada de Decisões
15.
Facial Plast Surg Clin North Am ; 32(2): 221-227, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38575280

RESUMO

Defects over 2.0 to 2.5 cm may often require repair with a multistaged forehead flap. However, in some such defects, other options may be available. In this article, the author will review some of these options.


Assuntos
Rinoplastia , Retalhos Cirúrgicos , Humanos , Testa/cirurgia , Nariz/cirurgia
16.
Facial Plast Surg Clin North Am ; 32(2): 239-246, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38575282

RESUMO

A successful nasal reconstruction relies heavily on a stable internal lining. Larger defects pose unique challenges for internal lining reconstruction as obtaining tissue of adequate size while maintaining airway patency is difficult. The prelamination technique uses a staged skin graft to the paramedian forehead flap prior to transfer. As such, a composite flap can be later transferred to reconstruct internal and external nasal defects concomitantly. This article reviews the current background, techniques, and clinical considerations in the use of the prelaminated forehead flap for nasal lining reconstruction in partial to total nasal defects.


Assuntos
Neoplasias Nasais , Rinoplastia , Humanos , Rinoplastia/métodos , Testa/cirurgia , Neoplasias Nasais/cirurgia , Nariz/cirurgia , Retalhos Cirúrgicos
17.
Facial Plast Surg Clin North Am ; 32(2): 247-259, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38575283

RESUMO

Total nasal reconstruction is a complex challenge due to the need to establish new internal lining, internal structural support, and external skin covering that is both functional and esthetic. The medial femoral condyle corticoperiosteal free flap represents an innovative option for restoration internal structure and internal nasal lining. When used in conjunction with a paramedian forehead flap, acceptable results in both function and esthetics can be achieved.


Assuntos
Neoplasias Nasais , Rinoplastia , Humanos , Retalhos Cirúrgicos , Neoplasias Nasais/cirurgia , Testa/cirurgia , Rinoplastia/métodos , Nariz/cirurgia
18.
Facial Plast Surg Clin North Am ; 32(2): 271-279, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38575285

RESUMO

The forehead flap is a time-tested and robust resurfacing flap used for nasal reconstruction. Owing to its excellent color and texture match, acceptable donor site morbidity, and robust and independent blood supply that can support both structural and internal lining grafts, this flap remains the workhorse flap for resurfacing large nasal defects. Various nuances of this technique relating to defect and template preparation, flap design, flap elevation, flap inset, donor site closure, and pedicle division are discussed in this article. These nuances are the guiding principles for improved outcomes using a forehead flap for the reconstruction of large nasal defects.


Assuntos
Neoplasias Nasais , Rinoplastia , Humanos , Rinoplastia/métodos , Testa/cirurgia , Nariz/cirurgia , Retalhos Cirúrgicos/irrigação sanguínea , Neoplasias Nasais/cirurgia
19.
Facial Plast Surg Clin North Am ; 32(2): 291-302, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38575287

RESUMO

Nasal reconstruction remains one of the most challenging surgeries for facial plastic and reconstructive surgeons. The addition of defects extending beyond the nose adds a layer of complexity to an already technically demanding surgery. This article will focus on the management of composite defects extending beyond the boundaries of the nose. Surgeons need to have a variety of techniques at their disposal. These complex defects often require multiple local flaps, multiple stages, and, in select cases, free tissue transfer.


Assuntos
Neoplasias Nasais , Procedimentos de Cirurgia Plástica , Rinoplastia , Humanos , Nariz/cirurgia , Retalhos Cirúrgicos , Face/cirurgia , Neoplasias Nasais/cirurgia , Rinoplastia/métodos , Testa/cirurgia
20.
Facial Plast Surg Clin North Am ; 32(2): 281-289, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38575286

RESUMO

Reconstructing the nose poses considerable challenges, even for the most skilled surgeons. Significant nasal reconstructions often require later revisions to address persistent issues in both form and function, and it is crucial to discuss this possibility with the patient before embarking on the reconstructive process. Minor revisions can often be managed by making direct incisions between nasal subunits, coupled with soft tissue sculpting or the use of structural grafts for augmentation. When minor adjustments prove insufficient, the initial reconstruction may need to be entirely revised with a second forehead flap.


Assuntos
Neoplasias Nasais , Rinoplastia , Humanos , Retalhos Cirúrgicos , Testa/cirurgia , Nariz/cirurgia , Neoplasias Nasais/cirurgia
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