Patients with scars often seek dermatologists for improving the symptoms (pruritus, pain), aesthetics and functionality (for example, to improve the range of motion in the joints). After anamnesis and description of the scar, the patient should be informed about the best repair techniques, based on scientific evidence and the physician's personal experience. The authors describe the main surgical techniques to treat scars, such as Z-plasty, W-plasty, dermabrasion, among others

Keywords: CICATRIX; SURGERY; DERMABRASION

Introduction: The dorsum of the hands is a visible part of the body and needs special attention regarding rejuvenation treatments. The combination of different techniques in this area is important to increase the effectiveness of the treatments.
Objective: This study was aimed to evaluate the clinical efficacy of a fractional non-ablative laser (1,340nm Nd:YAP) combined with intense pulsed light (IPL) for rejuvenating the hands.
Methods: A prospective comparative study evaluated 11 patients complaining of aging on hands, for 90 days. Two sessions were carried out with a two-week interval using IPL and 1,340nm Nd:YAP laser. The left hand was treated with 1,340nm Nd:YAP laser associated with IPL and the right hand with isolated IPL. The improvement was rated using scores from 1 to 4, evaluating the parameters: wrinkles, pigmentation, brightness, keratosis and overall rejuvenation observing the elasticity and filling of visible structures such as bones, tendons and vessels.
Results: By analyzing the frequencies of the categories of the variables, it was possible to observe that there was a higher frequency of improvement in the left hand. For the comparative analysis of the studied variables, the mean value of each variable computed for each hand, evidenciated that the variable overall rejuvenation and the left hand showed more marked improvements for the studied characteristics. Ten among 11 patients had a higher satisfaction degree with the combined treatment, with absence of significant adverse effects.
Conclusion: The association of 1,340nm laser to the IPL was shown to be safe and more effective than isolated intense pulsed light in the rejuvenation of the hands.

Keywords: LASERS; REJUVENATION; HAND

Introduction: Rhinophyma is the final stage of rosacea. It leads to the stigmatization of the patient.
Objective: To establish the safety and efficacy of dermachemabrasion in the treatment of rhinophyma.
Methods: The method, which consists of tangential excision and dermabrasion with sandpaper followed by 30% trichloroacetic acid on the previously sanded area, was prospectively applied in 7 patients. The excised material was histologically studied aiming at detecting hidden neoplasias. Safety and efficacy were evaluated clinically and through standardized photographic records.
Results: The patients' ages ranged from 57 to 68 years (6 men, 1 woman). The complete reepithelialization occurred within 7 to 14 days. The 7 patients progressed without infection, with satisfactory reepithelialization and results from the aesthetic point of view, with absence of dyschromias or scarring. The histological analysis revealed the presence of a hidden neoplasia (superficial basal cell carcinoma) in one case.
Conclusion: Dermachemabrasion is a low cost, simple to execute and effective treatment that leads to excellent cosmetic results in addition to having the advantage of the possibility of histological analysis, which is extremely important, since there are reports of hidden malignancy in rhinophyma.

Keywords: RHINOPHYMA; TREATMENT OUTCOME; DERMABRASION; TRICHLOROACETIC ACID

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

Introduction: Despite the existence of well-established therapeutic approaches, static glabellar wrinkles arise as a challenge. The subincision is a technique commonly used for the improvement of these lesions.
Objectives: The present article proposes a new methodology for the undermining of static glabellar wrinkles termed and registered by the author as Dermal Tunneling (TD^®).
Methods: Twelve patients who underwent dermal tunneling carried out by the same physician, according to the same methodology, were retrospectively assessed through direct observation, photographic analysis and self-assessment questionnaires.
Results: All patients reported that the results were good or very good. The evaluation carried out by two independent dermatologists, based on before and after photographs, showed that two patients had regular outcomes (25% improvement), five had good outcomes (50% improvement) and five had very good outcomes (75% improvement).
Conclusion: Dermal Tunneling (TD^®) can be considered an effective, safe and reproducible treatment.

Keywords: WRINKLE; SKIN; THERAPEUTICS

Introduction: Modern life in large urban centers exposes its residents to new factors related to extrinsic aging, such as pollution, poor diet and emotional stress. Treatments proposed for this cause of aging include the use of cosmeceutical products with antioxidant action.
Objective: To evaluate a formulation containing antioxidant substances in the treatment of skin affected by the effects of urban life.
Methods: Prospective clinical study evaluating 33 volunteers residing in urban centers. Clinical and instrumental measurements were carried out through the use of specific questionnaires and images captured using a VISIA device at baseline and twenty-eight days after using the product twice a day, in combination with sunscreen.
Results: The comparison of the data obtained from questionnaires applied in the initial and final visits showed a statistically significant improvement in most of the analyzed variables. There was a reduction of 15.78% in the extrinsic aging score. The image analysis demonstrated a statistically significant improvement (p <0.05) for the variables color uniformity and reduction of pores.
Conclusions: The use of the combination of active antioxidant substances led to an improvement in clinical and instrumental parameters of extrinsic aging caused by the phenomena linked to urban life ("urban damage"), arising as an alternative for this new indication.

Keywords: COSMETICS; ANTIOXIDANTS; ENVIRONMENTAL POLLUTION

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

The acquired perforating dermatosis is constituted by a group of diseases whose main characteristic is the transepithelial elimination of altered dermal material. It has the clinical appearance of crateriform papules or nodules, with central keratotic plug, which may suggest some kind of transepithelial purging; nevertheless the final diagnosis is histologic. The dermoscopic examination is a useful tool that helps to exclude similar dermatoses, such as nodular prurigo and hypertrophic lichen planus. The present article discusses the clinical and dermoscopic correlation of this dermatosis.

Keywords: DERMOSCOPY; PRURIGO; DIAGNOSIS, DIFFERENTIAL

The lips are a preferred site for carcinomas. Roughly 95% of tumors in the lips involve the lower lip, with 90% being squamous cell carcinomas. Surgery is the treatment of choice and has a good prognosis when diagnosis is performed early. Defects involving less than half of the lower lip can be closed using the edge-to-edge technique, whereas larger defects require greater technical complexity of methods and have increased risk of complications. The present article describes a straightforward technique for reconstructing these defects, using edge-to-edge suture, without necessity ofV or W shaped excisions, and with good aesthetic and functional outcomes.

Keywords: CARCINOMA, SQUAMOUS CELL; LIP NEOPLASMS; RECONSTRUCTIVE SURGICAL PROCEDURES

Lesions in difficult locations within the auricular pavilion have been a major challenge for dermatologic surgeons, since access to their surgical approach tends to be complicated. In this article, the authors describe a case of basal cell carcinoma affecting the lower part of the left auricular concha that was resected by Mohs micrographic surgery, whose approach proved to be challenging. The authors describe a tactic to gain better access and visibility of the surgical field and facilitate the implementation of the procedure.

Keywords: EAR AURICLE; MOHS SURGERY; CARCINOMA, BASAL CELL

The subungual melanoma is considered a rare subtype of melanoma. It emerges in the ungual matrix, however can involve all components of the nail apparatus. This tumor is often underdiagnosed, which leads to a delay in proper treatment, resulting in a poorer prognosis. The final diagnosis should be confirmed by histology. Conservative surgery in the treatment of subungual melanoma (when in the early stages) is presently recognized by the international literature and offers an effective and curative treatment to the patient, preserving the functional ability. This article describes a case of subungual melanoma successfully treated with conservative surgery, with the preservation of the hallux.

Keywords: MELANOMA; NAIL DISEASES; AMBULATORY SURGICAL PROCEDURES

Tumoral melanosis is a histological term used to refer to a nodular accumulation of melanophages in the dermis, which clinically arises as a pigmented lesion. It is usually associated with the regression of melanomas or of other melanocytic lesions. The authors present the case of a 45-year old man/woman with a pigmented macule on his/her left leg. The lesion was completely excised and diagnosed as a tumoral melanosis.

Keywords: MELANOMA; SKIN NEOPLASMS; DERMATOSCOPY

Having the mastery of surgical techniques, ability to deal with complications and the capacity to train residents in those skills are crucial to the good practice of a dermatologic surgeon. Furthermore, the transmission of clear and objective guidelines to patients has a direct impact on the outcomes of skin surgeries. The present article describes the case of the exeresis of a basal-squamous carcinoma in the scalp with the proposed closure by second intention that developed with infection and necrosis, requiring the team's knowledge and skills to work around the situation. The result of the combination of techniques was satisfactory, showing that proper training is key for a good surgical practice.

Keywords: SKIN NEOPLASMS; RECONSTRUCTIVE SURGICAL PROCEDURES; BLOODLESS MEDICAL AND SURGICAL PROCEDURES; INTERNSHIP AND RESIDENCY

The granular cell tumor, also known as Abrikossoff tumor, is a rare neoplasm with controversial etiology that usually arises as a solitary benign lesion. The authors describe a case of multicentric granular cell tumor in a 13-year old patient treated with surgical excision.

Keywords: GRANULAR CELL TUMOR; NEOPLASMS, SOFT TISSUE NEOPLASMS; S100 PROTEINS

Primary cutaneous nodular amyloidosis is a rare form of amyloidosis. The authors report the case of a 44-year old woman with nodules and plaques on the legs with three years of development and increase in the number and size of lesions. Clinical, histological and laboratory investigation dismissed the possibility of systemic amyloidosis, and the diagnosis of nodular amyloidosis was established. A decision was made for the surgical approach, using curettage and cauterization with good response to the proposed treatment.

Keywords: AMYLOIDOSIS; CURETTAGE; CAUTERY

Pyogenic granuloma or lobular capillary hemangioma is a benign skin and mucous membranes lesion whose etiology is not yet explained. The authors report an atypical and exuberant clinical case of this benign dermatologic condition, clinically simulating malignancy.

Keywords: GRANULOMA, PYOGENIC; SCALP DERMATOSES; HEMANGIOMA, CAPILLARY; MELANOMA