The authors describe an easy to make and apply rule for local tumescent anesthetic solution in dermatologic surgical procedures. They attest the safety and simplicity of the rule, based on ambulatory surgery practice for over 20 years and 8 years usage of the solution in more than a thousand procedures.

Keywords: TUMESCENT LOCAL ANESTHESIA

Introduction: Needle infi ltration of local anesthetic is a painful procedure, thus, a topical anesthetic is a comfortable alternative; however, it is difficult to deliver transcutaneous polar drugs. Iontophoresis is a noninvasive technique that uses electrical current for releasing electrically charged drugs through biological membranes. Objective: To evaluate the anesthesia induced by iontophoresis of lidocaine for a standardized painful stimulus. Material and methods: Randomized, controlled, double-blind study, involving 10 volunteers under the anesthetic effects of topical application of lidocaine gel 2% and noradrenaline 1:50,000, with or without iontophoresis of 1.85 milliamps for 13 minutes. Pain sensitivity was evaluated by the prick of a 21G needle in the arms posterior region, using a visual numerical scale. Results: Patients mean age was 50.8 ± 11.4 years. Nine of them were women. All had previously received infi ltrative anesthesia. Iontophoresis was well tolerated by volunteers. The median pain scores were 0 and 3 for the arm that received the iontophoresis and for the one that did not receive, respectively (p < 0.01). Conclusion: The anesthetic effect in the region subjected to iontophoresis suggests an effi cient and comfortable method for promoting local anesthesia in the surgical approach of pediatric, hyperalgic, or needlephobic patients.

Keywords: ANESTHESIA, LIDOCAINE, AMBULATORY SURGICAL PROCEDURES, IONTOPHORESIS

Introduction: The use of topical anesthetics, has increased in recent years.While they are undoubtedly useful when recommended appropriately by a dermatologist, the improper use of topical anesthetics may result in complications, mainly due to inadequately applying them to wounded or inflamed skin; use on large areas of the body or mucus membranes; or use by high-risk patients. Adverse reactions can include transient local effects, allergic and/or irritative reactions, or more severe (though rare) effects, such as methemoglobinemia, arrhythmias, and cardiorespiratory failure. This paper discusses the commercial formulations of topical anesthetics currently available, their history, pharmacology, clinical use, and potential side effects.

Keywords: ANESTHETICS, ANALGESIA, LIDOCAINE, PRILOCAINE, TETRACAINE

Introduction: Local anesthesia is the most common form of anesthesia used in cutaneous surgery. Some patients have comorbidities that put them at risk for general anesthesia.Tumescent anesthesia is the technique of injecting a large amount of dilute local anesthesia into the subcutaneous plane of the skin.Tumescent anesthesia can minimize discomfort, aid in hemostasis, and contribute to the ease of closing large surgical defects that would otherwise be challenging. Objective: To discuss the pros and cons of using tumescent anesthesia in dermatologic surgery. Conclusion: Tumescent anesthesia is a viable option that can aid in cutaneous reconstructive surgery, especially when removing tissue in the deeper subcutaneous fat or fascia.Tumescent anesthesia is also associated with good results and few adverse reactions.

Keywords: ANESTHESIA, SKIN NEOPLASMS, MOHS SURGERY

Introduction:The treatment of cutaneous aging with fractional non-ablative lasers has been intensely studied in the last few years, yet the number of publications describing specific equipments is limited.
Objective: To describe patient and dermatologist satisfaction after treatment with the Lux 1540®laser.
Methods: Retrospective study of patients (n=16) who have undergone facial rejuvenation therapy with Lux 1540® laser. Photographic assessments were performed by a dermatologist not involved in the treatments. Patient satisfaction was analyzed before treatment and after three sessions. The study variables were spots, sagging, wrinkles, enlarged pores, telangiectasias, and general satisfaction.
Results: In the dermatologist''''''''s evaluation, good or excellent improvement was found in the majority of the patients, for all studied variables. Regarding the improvement in the patients'''''''' general appearance, 82% were rated good or excellent. Regarding patients'''''''' opinions, 63% expressed good to excellent general satisfaction.
Conclusions: Treating cutaneous aging with Lux 1540® laser yields satisfactory results and maybe a good option for patients that do not want or cannot undergo more aggressive treatments.

Keywords: LASERS, SKIN AGING, LASER THERAPY

Introdução: The increase in the demand for cosmetic procedures has in turn stimulated the search for effective and safe analgesia.Topical anesthetics are an alternative to infiltrative anesthesia, and promote an appropriate analgesia without inducing adverse effects. Objective: To compare the pain ratings of two topical lidocaine formulations in patients undergoing fractional CO2 laser therapy. Methods: Eight patients underwent a single fractional CO2 laser session after applying a commercial formulation of 4% lidocaine on the right side of the face and a dispensed 30% lidocaine formulation combined with 7% tetracaine on the left side of the face.The intensity of the pain was assessed using the visual analogue pain intensity scale at the end of the procedure. Results: No significant statistical differences were detected between the formulations. Conclusions: Formulations with high concentrations of anesthetics are not more effective than commercial products in producing analgesia.

Keywords: ANESTHETICS, ANESTHESIA AND ANALGESIA, LASERS

Introduction: Liposuction is a cosmetic procedure that removes undesired body fat. More recently, it has been associated with complications and deaths, raising concerns about the risk involved in the procedure. Since the tumescent technique was described by Jeffrey Klein, surgeons from around the world have contributed to the development of the technique, making liposuction with microcannulas and local anesthesia a safe and effective procedure that achieves its objective. Nevertheless, severe complications and deaths are described in the literature when the procedure is performed under general anesthesia or with IV drugs, or when there is a breach of the protocols recommended for local tumes- cent anesthesia. Therefore, it is necessary to establish protocols for liposuction procedures that use local tumescent anesthesia, to promote safety.
Objective:To demonstrate that using local tumescent anesthesia in liposuction is safe.
Methods: Retrospective study of medical records of 568 patients who underwent 1,107 liposuction procedures assisted by local tumescent anesthesia between 1998 and 2004.
Results: There were no deaths or complications that required hospitalization.
Conclusions: When standardized protocols are observed, liposuction assisted exclusively by local tumescent anesthesia was shown to be a safe procedure.

Keywords: LIPECTOMY, ANESTHESIA, LOCAL, SAFETY

Tattooing has existed in humankind's culture since the onset of civilization. Tattoo removal attempts are also very ancient. The following current methods are reported for the removal of tattoos: dermabrasion, surgical excision, and laser procedures. The most commonly used lasers for tattoo removal are: QS-Nd:YAG (1,064 and 532nm), QS-Ruby (694nm) and QS-Alexandrite (755nm). The present review is aimed at studying the action mechanism of lasers for tattoo removal and the correct indication for each type of pigment, in addition to describing complications and the best manner of preventing them.

Keywords: LASERS; LASER THERAPY; TATTOOING.

Introduction: Acne is one of the most prevalent skin conditions, representing a constant challenge to dermatologists, especially in severe cases as nodulocystic acne, which can be resistant to medicament based treatment. Traditional therapy includes topical and oral drugs that are not always effective and often lead to bacterial resistance and side effects. The use of lasers in the treatment of inflammatory acne has increased lately due to the ease, clinical efficacy, and minimal side effects of this type of therapy. Objective: To evaluate the effects of fractional laser in patients with nodulocystic acne resistant to treatment with isotretinoin. Methods: Application of laser therapy sessions with Nd:YAP in 9 patients. Assessment of the degree of patient satisfaction and comparison of photographs taken before and after treatment by dermatologists not linked to the study. Results: Average reduction of 65% in inflammatory lesions, satisfaction of all patients who underwent treatment, and approval in the assessment carried out by dermatologists. Conclusions: The fractional Nd:YAP laser was proven effective in the treatment of inflammatory acne and may represent a new therapeutic option for this pathology, especially for patients who do not respond to conventional treatment.

Keywords: ACNE VULGARIS; LASERS; LASER THERAPY.

True gynecomastia is a benign proliferation of the glandular tissue of the male breast. In general, management is conservative, however if there is development of fibrosis after the inflammatory phase, surgery is recommended. The present article describes a case of true gynecomastia with symmetrical enlargement of the breasts since adolescence. In light of this diagnosis, corrective surgery was performed with tumescent anesthesia and exeresis in block of the mammary gland.

Keywords: GYNECOMASTIA; AMBULATORY SURGICAL PROCEDURES; DERMATOLOGY; ANESTHESIA, LOCAL.

Deep phenol chemical peeling with the Baker-Gordon formula is indicated for the treatment of severe facial aging. A review of pertinent literature on its main limiting factor-pain-was carried out with searches on two databases (PubMed and Cochrane Library) using the following keywords: chemexfoliation, peel, peeling, and phenol, also cross-referencing with the terms anesthesia and analgesia. The search resulted in 151 articles that contributed little to clarifying what would be the ideal approach for managing pain when using a deep chemical peel with the Baker-Gordon formula. As a result, for this procedure, the authors basically relied on the expert experience-in this case, that of the anesthesiologist-which has been described. Therefore, further studies should be carried out in order to achieve a higher level of scientific evidence.

Keywords: CHEMEXFOLIATION; PHENOL; ANESTHESIA; ANALGESIA.

Introduction: Hidradenitis is a chronic inflammatory disease that has a negative impact on the patient's quality of life but which has few effective therapeutic options. Currently, the use of laser technology has been standing out as a treatment. Objective: To evaluate the use of 1,340nm ND:YAP laser (Neodimiun:Ytrium Aluminum Perovskite) to treat hidradenitis. Methods: Performing 4 1,340nm ND:YAP laser sessions in 3 patients bearing hidradenitis. Results: All patients had a clinically and histologically evidenced reduction of inflammatory lesions. Conclusions: In the present study, the 1,340nm ND:YAP laser was effective in the treatment of hidradenitis, and can potentially become a new therapeutic option.

Keywords: HIDRADENITIS; LASERS; LASER THERAPY

Introduction: Managing pain during the performance of dermatological procedures is a challenge. Several topical anesthetics are available for use prior to carrying out minimally invasive treatments.
Objective: To evaluate the efficacy of topical anesthetics for reducing the pain during dermatological procedures and to compare the effectiveness of two different anesthetics using the visual numeric pain scale.
Methods: Twenty-five patients underwent facial dermatological procedures after the application of two commercial preparations: one containing 7% lidocaine and 7% tetracaine (applied in one hemiface) and the other containing 4% lidocaine. Each of the preparations was applied in one hemiface. Pain intensity was assessed using the Visual Numeric Pain Scale (VNS) at the end of the procedure.
Results: Eighty-four percent of the patients reported a lower pain score in the hemiface that received the commercial preparation containing 7% lidocaine and 7% tetracaine. The mean pain score in the hemifaces that received the 4% lidocaine preparation was 7.3, while that computed for the hemifaces that received the 7% lidocaine and 7% tetracaine preparation was 5.3.
Conclusions: Topical anesthetics are effective and safe for pain reduction in dermatological procedures, with the commercial preparation containing 7% lidocaine and 7% tetracaine was more effective than the one containing 4% lidocaine.

Keywords: Anesthesia; Anesthesia, local; Dermatologic surgical procedures; Minimally invasive surgical procedures; Pain perception; Pretreatment

INTRODUCTION: The treatment of hypochromic scars is challenging, and the techniques used so far show unsatisfactory results. Bimatoprost, an analog of prostaglandin F2-alpha, has been used as a topical pigment agent, and its application as drug delivery can optimize its delivery to the dermis and potentiate pigmentation.
OBJECTIVE: To evaluate the safety and efficacy of Ablative Fractional Laser (AFL) treatment associated with bimatoprost 0.03% drug delivery in hypopigmented scars.
METHODS: The patients were submitted to the AFL, followed by the application of bimatoprost 0.03% in 4 sessions with biweekly intervals. Clinical evaluations and standardized photographs were performed. Patients’ satisfaction was assessed using a 5-question questionnaire.
RESULTS: All patients had clinical improvement in the treated areas. The degree of patient satisfaction agreed with the clinical evaluation and photographic records.
CONCLUSION: The application of AFL associated with bimatoprost 0.03% drug delivery can be a potentially effective and safe treatment for hypochromic scars.

Keywords: Lasers; Hypopigmentation; Laser Therapy

Q-switched lasers are widely used for tattoo removal. A 48-year-old-woman with a black tattoo on the left thigh was submitted to ten sessions of Q-switched Nd:YAG 1064nm laser associated with fractional CO2 laser, performed every two months. Six months after treatment end, we observed almost complete tattoo removal, besides improvement in skin texture. Q-switched lasers promote tattoo removal by a photoacoustic phenomenon. The association with fractional ablative lasers is an option for intensely pigmented tattoos or for tattoos with several colors, which are hard to remove.

Keywords: Laser Therapy; Lasers; Tattooing