Reconstructions of the auricular pavilion are complex, especially when there is a loss of cartilaginous support. A case of chondrocutaneous defect reconstruction, after the exeresis of a basal cell carcinoma in the upper third of the auricular pavilion, is reported. Silicone fiber was used to model and provide support for the ear. The technique of using cartilage or compound grafts in the auricular pavilion is described.

Keywords: EAR CARTILAGES, SURGERY, PLASTIC, EAR DEFORMITIES, ACQUIRED, EAR, PROSTHESES AND IMPLANTS

Introduction: The lower eyelid is often the site of basal cell carcinomas, with Mohs micrographic surgery (which allows precise histological control with maximum tissue preservation) being the ideal method for their treatment. Tumors that invade the posterior lamella cause full-thickness defects of the lower eyelid, for which several reconstruction techniques have been described with composite grafts. However, few authors use the helix of the ear as a donor area. Objective: To describe the applicability of ear helix composite grafts in the reconstruction of the lower eyelid. Methods: Retrospective study of a series of 6 cases of basal cell carcinoma in the lower eyelid, with tarsal invasion, operated through Mohs micrographic surgery in a private specialist service in the city of Rio de Janeiro, Brazil. All patients had full-thickness defects, and had undergone reconstruction of the posterior lamella through chondroperichondrial graft of the ear helix. The anterior lamella was reconstructed with the remaining eyelid tissue mobilization or with an advancement flap. Patients were assessed for functional capacity and aesthetics. Results: There was complete adaptation of the perichondrium to the conjunctiva, after contact with the eyeball for 8 weeks. All patients with mild escleral show without ectropion. Conclusions: Despite the small sample, all patients had excellent cosmetic and functional results.

Keywords: EYELID NEOPLASMS; CARCINOMA, BASAL CELL; MOHS SURGERY; EAR CARTILAGE.

Introduction: Successful restoration of form and function of the nose after Mohs surgery requires thoughtful reconstructive planning. Nasal defects that are deep and extensive, especially those located on the ala, may require a cartilage graft to help restore nasal function, anatomy, and cosmesis. Objectives: To evaluate the usefulness of auricular cartilage grafts in nasal reconstruction after Mohs micrographic surgery, as well as to describe a cartilage graft harvesting technique. Methods: Retrospective study of patients with nasal defects following Mohs surgery who were submitted to an auricular cartilage graft. Results: Ten patients were included in the study. The cartilage graft was harvested from the scaphoid fossa/antihelix in six (60%) patients, and from the concha in four (40%) patients. All scaphoid fossa/antihelix cartilage grafts were harvested through anterior incision, while conchal grafts were removed through posterior incision. One patient developed a hematoma, which drained spontaneously. Conclusions: auricular cartilage grafts are a versatile, reliable, and predictable method of providing structural support in nasal restoration. It is crucial to identify patients who can benefit from this technique. Through careful planning and adequate execution, ear cartilage grafts help to improve nasal reconstructions results in selected cases.

Keywords: MOHS SURGERY; EAR CARTILAGE; SURGICAL FLAPS; NOSE NEOPLASMS; BASAL CELL CARCINOMA

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

The reconstruction of nasal surgical defects, especially when there is total thickness bilateral simultaneous involvement of the nasal ala, tip, and dorsum, is complex. Several surgical options are described, and most authors recommend ear cartilage graft or chondro-mucous flap of the nasal septum, associated with the frontal median flap in order to lend structural rigidity to the nasal ala, preventing it from collapsing during inspiration. The authors describe an alternative reconstruction technique without the use of cartilage through the combination of hinge flaps from the nasogenian fold, associated with a frontal paramedian flap.

Keywords: MOHS SURGERY; CARCINOMA, BASAL CELL; NOSE NEOPLASMS; SURGICAL FLAPS; NASAL CARTILAGES

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

In search of a perfect aesthetic, facial filling procedures have been widely used. The presence of animal proteins or synthetic substances in some cutaneous fillers can cause serious allergic reactions, especially when performed by untrained professionals. There are not ideal, pure and free of side effects substances available in the marketplace. The present article is aimed at reporting a case where a facial filling was performed by a non-medical professional, resulting in foreign body reaction and severe skin infection, leading to deformities caused by the procedure carried out. The complications entailed invasive procedures for removal of the material used, and treatment with corticosteroids.

Keywords: MOHS SURGERY; CARCINOMA, BASAL CELL; NOSE NEOPLASMS; SURGICAL FLAPS; NASAL CARTILAGES

The basal cell and squamous cell carcinomas are known as non-melanoma skin cancers, having amounted to 98,420 new cases in men and 83,710 in women in Brazil in 2014. The reconstruction of surgical defects in the nose is a challenge for dermatologic surgeons regarding good functional and aesthetic results, since its structure is rigid and of little mobility. The authors introduce an interesting reconstruction method of a large nasal defect after excision of a basal cell carcinoma, using auricular cartilage graft and unipedicled advancement flap from the lower cheek.

Keywords: CARCINOMA, BASAL CELL; NOSE NEOPLASMS; NASAL SURGICAL PROCEDURES; EAR CARTILAGE; SURGICAL FLAPS

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

Reconstruction of the nasal area is a challenge due to its vascularization and abundance of fibrotic tissue. Graft in a large defect in the nasal area has a high risk of necrosis and often produces deformity and color mismatch. We report the case of a 65-year-old man with basal cell carcinoma in the left nasal ala. Mohs surgery was performed, obtaining free margin. The final defect measured 2 cm in diameter with partial loss of skin thickness. The combination of a melolabial interpolation flap and an ear cartilage graft was used, with excellent results. This combination led to good structural and aesthetic results.

Keywords: Surgical Flaps; Bone transplantation; Ear cartilage; Carcinoma, Basal cell

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.