Introduction: Calcium hydroxyapatite is a radiopaque material that was traditionally used to provide radiologic contrast. It has recently been approved for use in cutaneous filling.
Objectives: To define the radiologic characteristics of Calcium hydroxyapatite and its potential to compromise radiologic evaluations.
Methods: Twelve patients received Calcium hydroxyapatite filler in the malar eminence and had radiography of the face (frontal, lateral, mentum-nasal-plaque (Waters), and Hirtz axial incidence technique) 1-8 weeks after the procedure. The X-rays were examined by two radiologists – one of whom was unaware of the filling procedure.
Results: The Hirtz axial incidence technique demonstrated amorphous radiopaque images in the suprazygomatic soft tissues in all cases, in both evaluations. Radiesse® was not detected using the other techniques, and did not illustrate the filler''''''''s position and symmetry. The evaluation of subjacent osseous structures was not compromised by the material''''''''s presence.
Discussion: Calcium hydroxyapatite can be identified in facial radiography when evaluat- ed using a method that avoids overlapping with adjacent osseous structures. Although it does not impair the osseous evaluation, it is recommended that the radiologist or dentist is noti- fied of the material''''''''s presence.
Conclusion: Cutaneous fillings containing Calcium hydroxyapatite can be identified, although not precisely located, using conventional X-ray.

Keywords: FACE, DURAPATITE, X-RAYS

Introduction: The skin is a marker of chronological age and appearance, being important for self-esteem and quality of life. Fractional ablative radiofrequency is one of the treatments aimed at delaying the effects of aging. Objective: To describe the operating principles, methodology, and results of rejuvenation of the lower eyelids when treated with fractional ablative radiofrequency, and the resulting thermal damage observed on histology. Methods: Twenty female patients with aging skin on the lower eyelids were selected for treatment with this method. In one of the patients, who concurrently underwent upper blepharoplasty, ablative fractional radiofrequency was carried out on the skin fragment to be removed from the upper eyelid for anatomical-pathological examination and measurement of thermal damage. The evaluation of clinical results was performed using photographic comparison and analysis of satisfaction questionnaires answered by patients. Results: Photographic comparison showed significant skin retraction effects on the skin of the lower eyelids, while the analysis of questionnaires revealed a significant degree of patient satisfaction. Ten percent of patients experienced reversible local hyperpigmentation as a complication. Ablative and non-ablative damage was observed up to the superficial reticular dermis, with negligible thermal effects on the sides. Conclusion: Fractional ablative radiofrequency was proven safe, effective, and cost-effective in skin rejuvenation, nevertheless further studies should be conducted with the aim of determining the optimal parameters, as well as the ideal number of sessions needed to achieve the best result with the lowest percentage of side effects.

Keywords: PULSED RADIOFREQUENCY TREATMENT; REJUVENATION; SKIN AGING; ABLATION TECHNIQUES; LASER COAGULATION; LASERS.

Introduction: The periorbital subunit is one of the first regions to present signs of aging, resulting in sagging, wrinkles, and pigmentation. Surgical and non-surgical ambulatorial procedures, including chemical peels, lasers, neurotoxins, and cutaneous filling, form an important basis for the rejuvenation of this region. Objective: The objective of this retrospective clinical study was to evaluate the effectiveness of micro-needling assisted radiofrequency for rejuvenating the periorbital region. Methods: Retrospective study of the technique's safety and effectiveness through the evaluation of the results with the application of a satisfaction questionnaire to patients and of the analysis of clinical outcomes by independent dermatologists. Results: Nineteen patients aged between 42 and 67 years who underwent the technique were evaluated. One hundred percent of the patients reported satisfaction with the results, whereas in the comparative evaluation of the photographs carried out by two independent dermatologists the rate of improvement was 50% in 4 patients, 75% in 8 patients, and 100% in 7 patients. Post-inflammatory hyperpigmentation was observed 10 to 15 days after the treatment in 11 patients, though it was reversed after clinical treatment. Conclusion: This new procedure emerges as an alternative treatment for periorbital aging.

Keywords: PIGMENTATION; EYELIDS; PULSED RADIOFREQUENCY TREATMENT; REJUVENATION

Radiofrequency is considered a safe and non-invasive method for treating cutaneous sagging and for improvement of the body and facial contours. It has proven effectiveness, which is however limited in the more serious cases of ptosis. The effects of radiofrequency are based on the volumetric heating of the deep dermis, heating the collagen and elastic fibers. The heat generated by the radiofrequency leads to the contraction of collagen, improving the skin's firmness and elasticity. Furthermore, the heating induces the activation of fibroblasts, leading to neocollagenization (altered in diameter, thickness and frequency), with subsequent tissue remodeling.

Keywords: PULSED RADIOFREQUENCY TREATMENT; COLLAGEN; SKIN AGING

Introduction: Atrophic stretch marks constitute skin disorders characterized by the loss of collagen and elastin in the dermis, and resemble scars. Fractional lasers, microneedling and chemical peels have led to good outcomes in some cases, however there is no ideal treatment.
Objective: The objective of the present retrospective clinical study was to evaluate the effectiveness of Pulsed Radiofrequency with Multineedles (RFPM^®) in late atrophic stretch marks.
Methods: A retrospective study of the safety and effectiveness of the technique was carried out by evaluating outcomes with the application of a patient satisfaction questionnaire and the assessment of clinical results by independent dermatologist physicians.
Results: A total of 8 patients (aged between 22 and 38 years) who underwent the technique were evaluated, of whom 100% reported satisfaction with the outcomes. Additionally, in the comparative evaluation of photographs carried out by two independent dermatologist physicians, the improvement rate was 50% in 2 patients and 75% in 8 patients . Post-inflammatory hyperpigmentation was observed in 10 to 20 days after the treatment in 6 patients, having been reversed after clinical treatment.
Conclusions: The new procedure is an option in the treatment of atrophic stretch marks.

Keywords: STRIAE DISTENSAE; PULSED RADIOFREQUENCY TREATMENT; COLLAGEN

Introduction: Numerous techniques have been described to treat the earlobe aging. Surgical and nonsurgical methods as peelings, CO₂ laser and fillings have been proposed to produce collagen remodeling.
Objective: The objective of this retrospective clinical study was to evaluate the effectiveness of microneedling assisted radiofrequency for earlobe aging.
Methods: Retrospective study of the technique's safety and effectiveness through the evaluation of the results with the application of a satisfaction questionnaire to patients and of the analysis of clinical outcomes by independent dermatologists.
Results: Twelvy patients aged between 48 and 67 years who underwent the technique were evaluated. One hundred percent of the patients reported satisfaction with the results, whereas in the comparative evaluation of the photographs carried out by two independent dermatologists the rate of improvement was 75% in four patients, 100% in eigth patients. Post-inflammatory hyperpigmentation was observed ten to 15 days after the treatment in five patients, though it was reversed after clinical treatment.
Conclusion: This new procedure emerges as an alternative treatment for earlobe aging.

Keywords: EAR CARTILAGE; PULSED RADIOFREQUENCY TREATMENT; REJUVENATION

Introduction: Depressed acne scars always arise as a therapeutic challenge. Fractional lasers, surgical approaches and chemical peels have attempted to offer acceptable aesthetic results, however it is still difficult to determine the ideal treatment. Objective: To evaluate the efficacy of Percutaneous Collagen Induction with needles (IPCA^®) associated with Pulsed Radiofrequency with Multineedles (RFPM^®) in depressed acne scars. Methods: Retrospective study of the safety and effectiveness of the technique through the evaluation of results based on a satisfaction questionnaire answered by the patients and the clinical and photographic assessment carried out by a dermatologist. Results: Thirteen patients (aged between 21 and 37 years) who had undergone the combination treatment were evaluated. All (100%) reported satisfaction with the outcomes, while in the comparative evaluation of photographs yielded an improvement rate of 50% in 2 patients and of 70% in 6 patients. Conclusion: This new therapeutic proposal arises as an alternative in the treatment of depressed acne scars.

Keywords: SCARS; PULSED RADIOFREQUENCY TREATMENT; COLLAGEN

Introduction: Wrinkles, sagging, changes in texture and skin pigmentation in the periorbital region are common complaints in dermatologic practices. Several treatment options, including fractional radiofrequency, which has been shown safe and effective, have been described.
Objective: To compare outcomes and side effects after the use of two types of electrodes coupled to a radiofrequency device, used for rejuvenating the eyelid region.
Methods: A comparative, randomized and blind clinical trial was carried out with patients bearing aging in the periorbital region. The patients were treated with two different electrodes (called standard tip and Lima 8 tip), which can be coupled to the same radioelectrosurgery device. The variables investigated were sagging, wrinkles, texture and firmness of the treated skin, in addition to the presence of adverse effects. Thirty days after the last session, patients answered to a satisfaction questionnaire, having been photographed for clinical assessment.
Results: The patients treated with both tips experienced considerable satisfaction with the improvement of sagging and wrinkles. The variable firmness presented worse satisfaction indices, with a disadvantage for the standard tip. Important edemas emerged after the use of both tips; nevertheless ecchymosis occurred most frequently and lasted longer with the Lima 8 tip. Hyperpigmentation was more frequent and longer lasting with the standard tip, however without statistically significant difference.
Conclusions: The two tips were equally effective for the treatment of sagginess, wrinkles and skin texture in the periorbital region. The patients treated with the Lima 8 tip had higher satisfaction indices regarding the skin’s firmness, experiencing a higher incidence of ecchymosis, as well as a longer duration of that side effect.

Keywords: Eyelids; Pulsed radiofrequency Treatment; Skin aging

A survey on the opinion of specialists regarding skin resurfacing was performed, with the objective of comparing costs and benefits between the techniques: totally ablative CO2 laser, fractional ablative lasers, fractional non-ablative lasers, ablative fractional radiofrequency, microneedling, dermabrasion, medium peels, phenol-croton oil peels. The most effective option for the treatment of static wrinkles was the phenol-croton oil peel, in first place by 71.4% of the experts, followed by totally ablative CO2 laser, by 28.6%. Regarding downtime, procedures ranked as fastest recovery were microneedling and fractional non-ablative lasers, with 42.9% each, followed by ablative fractional radiofrequency, with 14.3%. Complete recovery period for side and adverse effects was perceived as shorter with microneedling by 50% of the experts. Regarding operating costs. The less costly procedure was medium peels, according to the opinion of 71.4% of the experts. Such results point towards a better cost/benefit of procedures such as chemical peels and micro-needling, according to the opinion of 14 Brazilian specialists who answered the questionnaire.

Keywords: Chemexfoliation; Dermabrasion; Lasers; Needles; Phenol; Pulsed radiofrequency treatment

In clinical practice, not all patients seem to benefit from treatment with calcium hydroxyapatite, often due to the improper indication of this procedure for patients who may require an associated surgical approach. In this context, our objective was to describe a practical method for evaluating and selecting the ideal patient for a non-surgical approach to abdominal skin laxity, along with presenting clinical cases treated with the combined use of calcium hydroxylapatite (CaHA) and microneedling with radiofrequency.

Keywords: Durapatite; Radiofrequency Therapy; Abdomen.

The clinical use of combined technologies has been increasing to address the effects of skin aging on the face and other areas of the body. Poly-L-lactic acid is a biocompatible, semipermanent synthetic filler used for volume enhancement through neocollagenesis induction by fibroblast activation. Similarly, energy-based technologies, such as high-intensity focused ultrasound and microneedling radiofrequency devices, promote fat reduction and collagen contraction by heating the deep dermis. This article presents expert panel recommendations and a literature review on the topic.

Keywords: Polylactic Acid-Polyglycolic Acid Copolymer; Radiofrequency Therapy; Collagen Type I; Collagen Type III; Adipose Tissue.