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

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.

Dermoscopy of lentigo maligna on the face has reliable and well-tested parameters for its diagnosis. However, some benign lesions such as pigmented actinic keratoses have dermoscopic aspects that are common in malignant lentigo, making the correct diagnosis difficult. This fact often leads to unnecessary excisions of benign lesions. The present article discusses these morphological parameters in light of the dermoscopic analysis of the commonalities between lentigo maligna and pigmented actinic keratosis, also touching upon the aspects already described for the diagnosis of pigmented actinic keratoses.

Keywords: DERMOSCOPY; HUTCHINSON'S MELANOTIC FRECKLE; KERATOSIS, ACTINIC; FACE.

Structural alterations resulting from the aging process of the face are related to muscular action, skin sagging, loss of bone support, and decrease in the volume of facial fat compartments-all inducing alterations in facial contour over the years. The authors have carried out a review of the main causes linked to the so-called facial contour alteration in aging and defined a new denomination for this process: "facial squaring", the process through which the shape of the face-which is that of an inverted trapezoid in youth-becomes that of a square over time.

Keywords: REJUVENATION; SKIN; FACIAL MUSCLES.

The observation of mucous membranes should be part of a dermatological examination. It is known that early diagnosis is critical for the prognosis of patients with malignant melanocytic lesions. Nevertheless, integrating this step into the examination routine and performing a differential diagnosis between benign and malignant mucosal lesions with only clinical signs, are great challenges. Dermoscopy is still seldom-used for pigmented lesions of mucous membranes, however recent studies have shown its potential. In light of a case of melanoma of the lip, the authors provide tips and data from the literature that highlight the usefulness of the technique, and support the use of dermoscopic examination in the dermatologist's routine.

Keywords: DERMOSCOPY; HUTCHINSON'S MELANOTIC FRECKLE; KERATOSIS, ACTINIC; FACE.

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

The association of cysts and comedones in chronically sun-damaged skin characterizes the Favre-Racouchot syndrome. The authors report a case of a 64 year-old male patient with a history of smoking and tillage work activity. The patient had lesions in the malar, zygomatic and mandibular regions bilaterally, constituted by slightly erythematous cysts and large comedones in thickened skin with deep grooves. The condition was diagnosed as Favre-Racouchot syndrome, and treated by means of surgical excision. The objective of the present study is to describe an exuberant presentation of the syndrome, and its treatment via surgical excision.

Keywords: Facial dermatoses; Photosensitivity disorders; Skin aging

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

Nodular fasciitis is a benign tumor resulting from the reactive proliferation of fibroblastic or myofibroblastic cells presenting rapid growth and rich cellularity. In adults, the extremities’ involvement is more frequent; however, other regions can be affected. In this report, we present the case of a 40-year-old woman with a nodular lesion on the forehead. The histopathology confirmed the diagnosis of nodular fasciitis. The reported case highlights its rare location and alerts the clinical dermatologist in its inclusion among the differential diagnoses of tumor lesions on the face.

Keywords: Facial Dermatoses; Fasciitis; Forehead

INTRODUCTION: The use of botulinum toxin has become one the essential cosmetic procedures performed in the world.
OBJECTIVE: To identify patterns of muscle contraction of the forehead, glabellar complex, and orbicularis oculi muscle in patients from southern Brazil, establishing their epidemiology and possible associations between them.
METHODS: One hundred and one patients who sought treatment with botulinum toxin for the forehead, glabella, and periocular lines between 2012 and 2016 were included. Analyzes were made using digital photographs taken during a medical consultation before applying the products., The subjects received with different brands of botulinum toxin, according to the patients’ or the doctors’ preference
RESULTS: The most common contraction patterns were complete frontal, glabellar in converging arrows, and complete periocular. Women represented 94.1% of patients. Most patients were between 31 and 50 years old, with an average of 44.57 years. More frequent patterns in each area were more frequently associated.
CONCLUSIONS: The study shows the main muscle contraction patterns of the upper third of the face in 101 patients, as well as their clinical characteristics, comparing them with previously published articles. Studies on muscle contraction patterns can assist in the safer and more rational use of the products available, avoiding waste and complications.

Keywords: Muscle contraction; Skin aging; Face; Facial muscles; Botulinum toxins type A