Fundaments: chemical peelings represent damage to the skin or an accelerated form of exfoliation induced by caustic agents, having several indications; they are classified as superficial, medium-depth, and deep. The number of publications on the subject is elevated, but critical analysis are necessary to achieve objective conclusions.
Objectives: verifying the efficacy and safety of chemical peelings through a systematic review of the literature.
Methods: from January 5 to February 15, 2009, searches in three data bases were performed: Cochrane Library, MEDLINE (1966 – 2009), and LILACS. Criteria for study selection were established, with emphasis on methodological quality. The best comparative or controlled studies were described individually. The remaining review articles and descriptive and experimental studies were analyzed together.
Results: we found 414 publications and reviewed 165; 129, or 78%, corresponded to descriptive (82), review (37), or experimental (10) studies. The remaining 36 (22%) represented controlled or comparative studies, of which 19 (53%) were randomized and only four had the ideal delineation, i.e., placebo-controlled, randomized, and blind. Agents mentioned more often included: glycolic acid, salicylic acid, trichloroacetic acid (TCA), and phenol. Few studies evaluated the histologic effects and/or used quantitative parameters to determine their efficacy and safety.
Limitations: the heterogeneity of the studies; few studies with good methodological quality.
Conclusions: there are no doubts related to the the benefits of chemical peelings, which are demonstrated more by the clinical experience than by well-conducted and reproducible studies that are fundamental for the elaboration of new conduct guidelines.

Introduction: The botulinum toxin is a valuable option for the treatment of dynamic facial wrinkles. The Lanzhou botulinum toxin type A (LBTX-A) was introduced in China in the early 90’s and approved in Brazil in 2003. Objective: Evaluate the efficacy and tolerability of LBTX-A for the cosmetic treatment of dynamic wrinkles of the upper face. Material and Methods: In a prospective, open-label, multicenter study, 110 subjects of both sexes (aged from 25 to 65 years) were treated with a total of 53 U of LBTX-A each, distributed in fi fteen sites in the frontal, corrugator, procerus, orbicular ocular lateral muscles. The patients were reviewed 7 times within 180 days. Efficacy was assessed by electromyography, photographic analysis and the investigator’s and patient’s opinions. Tolerability was assessed by the incidence of adverse events.Results: Two weeks post-injection, 94% of the treated patients considered the result as good or excellent. Results lasted 90 days in most cases. After injection, most patients reported mild or no pain, and minimal and reversible side effects as facial edema (6 patients), stuffiness feeling (3 patients) and eyelid ptosis (2 patients). Conclusions: We conclude that LBTX-A is effi cient and well tolerated for the treatment of dynamic facial lines.

Keywords: BOTULINUM TOXIN TYPE A, INJECTABLES, WRINKLES, FACIAL DYNAMIC LINES

The aim of this report is to highlight and warn cosmetic dermatologists about the need of a complete and careful examination of any patient that looks for our evaluation, even when they ask only for cosmetic treatments and/or procedures. This is nowadays a very important concern as people and some physicians are involved in an exaggerated search for eternal beauty. This represents a very profitable practice for dermatologists and plastic surgeons. But we should never forget that a dermatologic consultation can be an opportunity to discover an unnoticed dermatosis or signs related to systemic diseases.

Keywords: ANEURYSM, CAROTID ARTERY, EXTERNAL, ESTHETICS

Introduction: The use of dermal filling techniques for soft tissue augmentation has greatly increased in recent years.Hyaluronic acid is one of the most used temporary dermal fillers in the treatment of facial wrinkles, furrows, and folds due to its effectiveness and safety. Objective: To evaluate the efficacy and safety of Perfectha®, a new hyaluronic acid filler, for nasolabial folds and lip correction. Methods: Open, multicenter study comprising 87 women. Efficacy was evaluated by the Global Aesthetic Improvement Scale and the Wrinkle Severity Rating Scale. Safety was evaluated through observation and the reporting of side effects. Results: One week after the injection of the filler, improvement in nasolabial folds and lips was observed in 86% and 89% of the women,respectively. Mild or moderate transient inflammatory reaction and ecchymoses occurred in 15% and 9% of patients, respectively, mainly in nasolabial folds. Two patients presented labial herpes simplex after treatment of the lips.The good results were maintained in 76% and 57% of women for nasolabial folds and in 72% and 45% of women for lips after 3 and 6 months, respectively. Conclusion: Perfectha® was effective and safe for these indications.

Keywords: HYALURONIC ACID, SKIN, INFLAMMATION

Introduction: The interest in minimally invasive procedures for facial rejuvenation fos- tered the development of the cutaneous filling technique to treat wrinkles and folds. Hyaluronic acid is one of the most popular fillers,as it is considered the least immuno- genic and safest in its category.
Objective: To evaluate and compare the efficacy,safety and duration of effect after the application of the filler CRMDex® in nasolabial folds,in one session versus two sessions.
Methods: Open clinical trial,with the randomization of nasolabial folds and comparison between two techniques.Women,aged 30 to 60 years old (n=30),presenting with accen- tuated symmetric nasolabial folds of minor to moderate degrees were subjected to intra- dermal injections of the same volume of CRMDex®.Three independent dermatologists evaluated the effectiveness of the treatment using the Wrinkle Severity Rating Scale.
Results: There was no difference in treatment effect for one versus two sessions.Both groups achieved a reduction of at least one degree according to the severity scale,and had a similar duration of the filling effect.The more frequent local adverse events (pain,ery- thema and edema) occurred during the injection and improved spontaneously.
Conclusions: There was no improvement in therapeutic response with the injection of smaller volumes per session.It seems that higher filler volumes may increase the risk of local adverse events.

Keywords: HYALURONIC ACID, BIOLOGICAL REACTIONS, DERMIS, CICATRIX

Introduction: Although there are differences arising from diverse formulations, botulinum toxin type A is widely marketed in Brazil.
Objective: To compare the efficacy and tolerability of two botulinum toxin type A formulations registered in Brazil: Botulinum toxin type A (Toxin 1) and Onabotulinumtoxin A (Toxin 2), in the treatment of glabellar expression lines through a multicenter prospective, comparative, randomized, double-blind study.
Methods: One hundred fifty-seven patients were randomized at a 1:1 (Toxin 1: Toxin 2) ratio for receiving 20U toxin for the treatment of the glabella's dynamic wrinkles. Photographic records were taken at maximum frowning in five protocol visits by independent evaluators. The assessment of results included: i) percentage of patients with improvement > 1 point in the four-point facial wrinkles scale, at maximum frowning, fifteen days after the treatment; ii) improvement in the static glabellar wrinkles; iii) pain and iv) duration of effect of the toxin.
Results: According to the independent evaluators, two weeks after injection, the rate of response at maximum frowning was 98.4% in the group treated with Toxin 1 and 98.2% in the group treated with Toxin 2. For individuals who received Toxin 1, the authors found an effect's duration of 84.5 ± 38.8 days, while for those who received Toxin 2, the effect's duration was 89.9 ± 41.1 days (p = 0.4303).
Conclusions: Botulinum toxin type A (Toxin 1) and Toxin 2 have similar effectivenesses in the treatment of dynamic glabellar wrinkles. Both preparations were well tolerated.

Keywords: BOTULINUM TOXIN TYPE A; WRINKLES; PROSIGNE; BOTOX

BACKGROUND: The SARS-CoV-2 infection has spread worldwide rapidly since its identification at the end of 2019. Globally, until April 2021, there have been more than 150 million confirmed cases of Covid-19, including over 3 million deaths. Therefore, a race was promptly started to produce an effective vaccine against the new virus. Botulinum toxin injection remains the leading non-surgical cosmetic procedure worldwide, with a high rate of efficacy and patient satisfaction.
AIMS: This study aims to analyze the association between the SARS-CoV-2 vaccine and the immediate botulinum toxin response.
MATERIALS AND METHODS: This was an observational, retrospective, and multicenter study. Data were collected between April and June 2021, and a medical record review of 71 patients from 27 to 76 years old treated with botulinum toxin injection.
RESULTS AND CONCLUSION: There were no meaningful changes in the immediate outcome of patients vaccinated for Covid-19 and botulinum toxin. However, it is vital to underline that follow-up and further studies are needed to define whether the Covid-19 vaccine can alter the duration of effect and efficiency of the botulinum toxin.

Keywords: Covid-19; Botulinum toxins type A; Vaccination