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: Patients (n = 56) received incobotulinumtoxinA for the treatment of dynamic facial wrinkles.
Objective: To test the efficacy of incobotulinumtoxinA in correcting facial wrinkles.
Methods: The toxin was applied in in the usual doses and regions.
Results: Only 38 patients returned for evaluation after treatment. Of those, 19 complained about the low efficacy, short duration or absence of effects of the toxin. The total dose applied in patients who expressed satisfaction with the outcome (19 patients) was 872 units, while in the dissatisfied group (19 patients) it was 748 units – which was later increased by an additional 30.62% (229 units) of the initial dose.
Conclusion: Although some clinical studies demonstrate that this botulinum toxin has an efficacy similar to others available, this study has not succeeded in reproducing that fact.

Keywords: BOTULINUM TOXINS, FACE, THERAPEUTICS

Introduction: Alexander Limberg created the Limberg flap in 1946 to repair rhomboid defects. The great advantage of using local flaps on the face is the similarity of color and texture of the tissues to the location of the defect to be repaired. Objective: To evaluate the advantage of using a Limberg flap to reconstruct facial defects created by the resection of tumors. Methods: Retrospective analysis of 12 cases in which Limberg flaps were used to reconstruct defects resulting from tumor resections in the face. Results: There were two epitheliosis cases; one developed partial necrosis of the flap, and both patients healed well with conservative treatment and daily changes of dressing. In one of the cases, the patient developed a post-operative hematoma requiring surgical drainage and flap repositioning, which resolved well, with only minor scar retraction. Discussion: The design of the flap requires precision. The main difficulty is the need to draw equal sides with accurate angles of 60 and 120 degrees. Conclusions: Limberg flaps are versatile and can produce good results in several areas of the face.

Keywords: FACE, SURGICAL FLAPS, SKIN NEOPLASM, RECONSTRUCTION

This article describes the case of a female hepatitis C patient who presented with a foreign body granuloma in the nasolabial folds and glabella five years after receiving an application of permanent dermal filler. The patient used interferon and ribavirin for treating hepatitis C for six months, and the granulomas appeared 30 days after the end of the treatment. Treatment with oral steroids was carried out, with a gradual improvement in the appearance of the skin.

Keywords: GRANULOMA, POLYMETHYL METHACRYLATE, FACE

Pyogenic granuloma is a common vascular proliferation that can be found on skin and mucous membranes. Its clinical presentation is that of a nodular, friable and erythematous lesion, with fast growth history. The nail bed pyogenic granuloma is generally related to onychocryptosis and trauma, being very painful in that site. There are several treatment options, including surgical excision, cryotherapy, electrocautery, curettage, lasers, application of trichloroacetic acid, imiquimod and microembolization. The present study reports a case of bilateral pyogenic granuloma in the halluces with exuberant growth, leading to the occlusion of the nail plate. The surgical excision of the lesion was performed with good cosmetic results.

Keywords: PYOGENIC GRANULOMA, SURGERY, TRICHLOROACETC ACID, CRYOTHERAPY.

Photography is an essential tool in the dermatologist's daily practice and can be used in various ways. From simple records of lesions verified in dermatological examinations to illustrations of a treatment's result, photographs document more clearly and concisely what is seen due to the utterly descriptive nature of this medium. Nevertheless, it is important to note that the present article refers specifically to what is known as Medical Photography, a type of photography that reproduces subject matter with maximum detail and relevant information. To achieve this, it is necessary to master the basics of photographic technique, including knowledge of available equipment and the fundamentals of digital technology, and also to establish a photographic routine that includes the standardization of the images.

Keywords: PHOTOGRAPHY, DERMATOLOGY, FACE, SURGICAL PROCEDURES

Introduction: Filling techniques are an important procedure in modern therapeutic approaches to rejuvenation, and are currently in wide use. Objective: To assist the practice of dermal filling procedures and reduce associated risks. Method: Division of the face into 22 regions in which filling procedures are indicated, providing detailed description of the nervous and vascular structures of each. Results: This didactic, practical, and detailed new division of the regions of the face highlights the possible risks related to anatomical features, thereby facilitating implementation, and reducing the risks and complications of filling techniques, such as the widely-feared amaurosis and tissue necrosis. Conclusion: Only a thorough knowledge of facial anatomy enables the safe realization of dermal filling procedures.

Keywords: ANATOMY, RISK ZONE, FACE.

p>Pyogenic granuloma is a common, benign, vascular proliferation, usually secondary to other events, such as cutaneous trauma. It is known that some lesions can mimic melanoma and vice versa, and it is recommended that the lesion be surgically removed and analyzed histologically. The advent of technologies-such as dermoscopy-that amplify the image recognized by the eye through the identification of certain structures and specific patterns, can facilitate this differentiation and assist in decision-making. In rare situations, its clinical presentation is unusual. The current article is aimed at demonstrating this fact and reviewing the medical literature on the subject, focusing on dermoscopic findings.

Keywords: PYOGENIC GRANULOMA, DERMOSCOPY, MELANOMA.

Description of a case where a female patient who received facial filling with polymethylmethacrylate developed late formation of a nodule and ipsilateral trigeminal neuralgia. The authors question whether there is a possible link between the two morbidities, which could have a common triggering factor or a causal relationship with each other.

Keywords: GRANULOMA; POLYMETHYLMETHACRYLATE; TRIGEMINAL NEURALGIA

Adverse reactions associated with drugs presenting cutaneous manifestations are among the most common, expressing itself with multiple clinical aspects and causing significant morbidity. The fixed drug eruption (FDE) is a common adverse reaction with cutaneous involvement and is associated with the use of numerous drugs. Dipyrone is a drug with analgesic and antipyretic effects prescribed widely used in Brazil, however, it is known for its potential to triggering adverse reactions, including the FDE. This report shows an EMF case related to the use of dipyrone, with unique clinical presentation and correlate the clinical, histopathological and dermatoscopic found.

Keywords: DERMOSCOPY; FACE; PATHOLOGY

Introduction: Currently there is a growing demand for non-invasive therapies aimed at treating facial aging. Non-ablative fractional lasers lead to excellent outcomes, with reduced side effects. Objective: To evaluate the facial rejuvenation achieved by 1,340nm non-ablative fractional laser using a single pass at high energy versus three passes at medium energy, through a prospective comparative study. Methods: Twenty patients with facial aging were treated with 2 or 3 laser sessions with 4-week intervals. The right hemiface was treated with three passes of 1,340nm non-ablative fractional laser at a fluence of 90 mJ, pulse duration of 5ms and 100 mtz/ cm2. The left hemiface was treated with a single pass of the same laser at a fluence of 120 mJ, pulse duration of 5ms and 100 mtz/cm2. The evaluated variables were spots, wrinkles, porphyrins and overall appearance. Results: The patients (n = 20) were evaluated during 6 to 24 months. The photographic evaluations demonstrated a significant improvement of the spots on the right hand side and wrinkles on the right and left hand sides. Eighteen of the 20 patients reported satisfaction with the treatment. Conclusion: 1,340nm non-ablative fractional laser was proven as a modern, safe and effective alternative for facial rejuvenation. For spots, the triple passes at medium energy protocol led to a superior response. However, regarding wrinkles there was no difference between the single pass at high energy and triple pass at medium energy protocols.

Keywords: LASER; REJUVENATION; FACIAL AGING; FACE

Sarcoidosis is a non-infectious granulomatous disease of unknown etiology in which environmental, infectious, immunological, and genetic factors appear to be correlated. Clinical manifestations can occur in any organ, however there is predominance in the lungs and in intrathoracic lymph nodes. The cutaneous involvement of the disease occurs in roughly 25% of cases, with cutaneous filling procedures figuring as a potential trigger. The authors of the present article report a case of a patient who had granulomatous lesions on the face following cutaneous filling with hyaluronic acid. In the investigation of cutaneous lesions, the patient presented diagnostic criteria for sarcoidosis, with extensive pulmonary involvement.

Keywords: sarcoidosis; granuloma; hyaluronic acid

Facial hemiatrophy, or Parry-Romberg syndrome, is characterized by the progressive atrophy of the tissues of half of the face, affecting skin and subcutaneous tissue. Its clinical manifestations are very varied. Preferred therapeutic strategies for the treatment of the syndrome were not yet completely established. The authors describe a case of mild facial hemiatrophy, in which the patient underwent lipofilling (autologous fat grafting), progressing with satisfactory result. Treatment alternatives, its advantages and disadvantages are widely discussed in the study, with fat grafting emerging as an excellent therapeutic option due to its safety, low cost and replicability.

Keywords: Face; Facial hemiatrophy; Transplantation, autologous

Sclerosing lipogranuloma is a chronic granulomatous reaction in response to the injection of non-medical substances such as paraffin, silicone, or mineral oil into the skin. This report describes one case of a large defect on the penis following sclerosing lipogranuloma excision surgery that was successfully closed by a double reverse V- Y-plasty reconstruction. The surgery aimed to remove all affected tissue as soon as possible, preventing the persistent granulomatous process that leads to necrosis and severe penile deformity. The double reverse V- Y-plasty is a simple, single-stage procedure useful to reconstruct of a large defect on the penis.

Keywords: Granuloma; Sclerosing solutions; Surgery.

Foreign body granuloma can occur after injection of filling substances into the dermis. We report a case of a 35-year-old woman who performed a self-injectable injection of a commercial serum for exclusively topical use containing hyaluronic acid in the region of the dark circles for aesthetic reasons. After the procedure, she presented a nodule in the lower right eyelid, which she judged to be an accumulation of product. Then she injected betamethasone + hyaluronidase ointment (Postec^®), evolving into a foreign body granuloma.

Keywords: Granuloma; Dermal fillers; Hyaluronic acid