Introduction: Diverse anatomical characteristics and varied kinetic spectra determine the specific contraction patterns of individuals'''''''' frontal facial musculature.
Objective: To identify and classify the frontal facial musculature contraction patterns in patients who sought care for treating frontal facial wrinkles.
Methods: Retrospective analysis of pictures taken from 83 patients.The muscular contraction pattern was classified according to the predominant hyperkinetic area that was observed in the picture in the frontal muscle''''''''s maximum contraction.
Results: Three contraction patterns were identified: total, medial and lateral. In 50.6% of cases, the total pattern was observed: the horizontal rhytids present in the center of the forehead extend laterally beyond the mediopupillary line, up to the end of the brows.The medial pattern was observed in 25.3% of cases: the horizontal rhytids are concentrated in the central region of the forehead, predominantly contained between the mediopupillary lines.The lateral pattern was observed in 24% of the cases: the horizontal rhytids prevail on the sides of the forehead, mainly occurring laterallyto the mediopupillary line.
Conclusions: The identification and classification of Frontalis muscle contraction patterns provides an individualized approach for each patient, which is one of the most important pillars of a successful treatment plan.

Keywords: A BOTULINUM TOXIN TYPE, MUSCLE CONTRACTION, CLASSIFICATION

The use of botulinum toxin and cutaneous filling techniques has encouraged a renewed interest in the study of facial anatomy.An assessment of the influence of facial structures in the aging process requires an in-depth understanding of the constitution of the epidermis, dermis and subcutaneous tissue. It is also essential to study the boundaries of facial segments and bones, the musculature, vascularization, sensory and motor innervation, and the lymphatic drainage of the face.A broad understanding of facial anatomy will help perfect cutaneous filling and botulinum toxin techniques.

Keywords: ANATOMY, BOTULINUM TOXIN TYPE A, INTRADERMAL INJECTIONS

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

Introduction: The use of fractional ablative lasers has optimized the results of photorejuvenation treatments by decreasing the number of complications and reducing the post-procedure recovery time.Methods: The authors evaluated a modification in the classic ablative resurfacing technique with CO2 laser, in which the operator has visual control of the fractioning, allowing healthy skin to be left alone between treated areas. Nine volunteers (aged 38-73), with moderate to severe photodamage, received visual fractioning in the perioral (three sessions) and periocular regions (two sessions). Photographic evaluations were conducted by two non-medical professionals, the operator physician, and the patients.Results: In the periorbicular region, four patients (44%) presented considerable improvement, and five (56%) moderate improvement. Of the four patients who underwent treatment of the perioral region, three (75%) reported considerable improvement and one (25%) reported moderate improvement. The photographic evaluation of the non-medical professionals was identical to patient-reported outcomes. In the physician''''''''s assessment for the perioral region, three (33%) presented considerable improvement and six (67%) had moderate improvement. For the perioral region, two presented moderate improvement and two had slight improvement. The skin fully recovered within 15-30 days, with erythema the most persistent symptom.Conclusion: The technique is a good option for the improvement of perioral and periorbicular wrinkles.

Keywords: SKIN AGING, LASER THERAPY, CO2 LASER

Introduction: For some patients, pain during the injection of botulinum toxin can represent a limitation for performing the procedure. There are doubts about whether the use of topical anesthetic decreases pain or interferes with the treatment's efficacy and duration of effect. Objectives: To study the effect of 4% lidocaine cream in controlling pain during BoNT-A - Speywood Unit botulinum toxin application, comparing it to the vehicle. In addition, the study was aimed at verifying whether the cream influences the treatment's outcome and duration. Methods: An experimental, prospective, double-blind, randomized study was carried out. The pain was assessed through a compartmentalized numerical rating scale (CNRS). The effect was assessed through a four-point contraction qualitative scale. Results: After evaluating the pain scale, higher values were observed in the placebo group when compared to the group that used anesthetic, with statistical significance. Furthermore, there was no statistical difference in the efficacy and duration of effect over weeks 4, 8, 12, and 16. Conclusions: BoNT-A - Speywood Unit toxin was effective and safe for the treatment of glabellar and frontal wrinkles. The use of topical anesthetics (4% lidocaine cream) reduced the pain during the procedure. In addition, there was no interference in the toxin's efficacy and effect duration.

Keywords: BOTULINUM TOXIN TYPE A, LIDOCAINE, PAIN, THERAPY.

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.

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: 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

The width of the lower third of the face is mainly determined by the size and shape of the jawbone, the thickness of the masseter muscle and the volume of adjacent subcutaneous tissue. The ideal, culturally recognized pattern for a male face corresponds to a wider lower third and a mandibular angle tending to 90º, while a female face should have a more oval appearance or the shape of a heart, and the middle third wider than the lower third. In order to achieve these aesthetically ideal proportions, botulinum toxin type A (BoNTA) has been successfully applied in the masseter muscle, which is one of the determinates of the lower face's width. Te present article reviews the current literature on the use of botulinum toxin for this purpose, offering the experience of the authors in this practice, aiming at achieving a more harmonious facial contour.

Keywords: BOTULINUM TOXINS, TYPE A; MASSETER MUSCLE; HYPERTROPHY

This study demonstrated the clinical and histologic result of the treatment of one disseminated superficial actinic porokeratosis patient with non-ablative fractional laser. The patient was treated with seven sessions of 1340-nm Nd:YAP laser, with 4 or 5 week-intervals. Biopsies and photographs were performed before and after treatment, which was well tolerated and lead to improvement in the erythema and texture of the lesions. There was a 1-year follow-up. Histopathologic examination after treatment revealed little changes in the cornoid lamella.

Keywords: Biopsy; Laser Therapy; Lasers; Porokeratosis

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

INTRODUCTION: Patients often request anti-aging treatments of the perioral and periorbital regions. Most of the time, it is necessary to use a combination of procedures, so the result meets the patient’s expectations.
OBJECTIVE: This is a prospective, single-center, and comparative study assessing the rejuvenation of the perioral and periorbital regions after treatment with medium depth chemical peel using phenol 88% with or without the previous application of botulinum toxin.
METHODS: Sixteen patients underwent regional peel with phenol 88%; eight received botulinum toxin application two weeks before. The assessment was conducted using standard photographs and evaluation scales by doctors and patients.
RESULTS: The overall evaluation by doctors and patients on the 45th day was considered excellent or good for all patients, with little advantage for combined treatment in the periorbital region.
CONCLUSION: Combining these two relatively low-cost procedures, often overlooked by dermatologists, resulted in a significant improvement in the changes related to aging in these areas.

Keywords: Botulinum toxins type A; Chemexfoliation; Phenol; Rejuvenation

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

Case study of exceptional response to treatment of recurrent xanthelasma palpebrarum with an ablative laser. The patient underwent a single session of laser Erbium: Yttrium-aluminum-garnet (Fotona^®) 2940 nm, and we performed photographic records with Vectra^® H2 2019 before and after the procedure. Satisfactory clinical results were reported, with good pain tolerability and early recovery compared to surgical procedures and, consequently, less time away from work activities.

Keywords: Lasers; Laser therapy; Laser coagulation; Xanthelasma palpebraum