Hair transplant is a common procedure worldwide, and the method of extracting follicular units is currently the most used. This technique is used not only for androgenetic alopecia but also for other areas such as eyebrows and beard. It is essential to observe the angle of the incisions and implantation of the hairs to conduct the eyebrow transplant so the result is as natural as possible. However, in addition to being rigorous with the design of the shape and position of the eyebrow, care must be taken with the preparation from the receiving site.

Keywords: Transplants; Alopecia; Hair follicle

Hair transplantation is an option for anyone with Androgenetic Alopecia, including transgender patients who want to align their appearance with their gender identity. Thus, hair transplantation can help transform appearance and boost self-esteem, especially if hair loss is a source of gender dysphoria. We report two cases of hair transplantation in transgender patients with good results, using the Follicular Unit Extraction and Follicular Unit Transplantation techniques. Due to the scarcity of specific articles about hair transplantation in this population, we report these cases for a better understanding of the specific needs of these patients.

Keywords: Hair; Transplants; Transgender People; Gender Dysphoria; Gender Identity; Feminization.

Polydioxanone (PDO) threads have been used as a non-surgical alternative to treat skin laxity. This article describes the technique of applying mono, twin, and screw PDO threads around the umbilical scar forming a support mesh on the abdominal wall, to pull the skin in this region in the opposite direction to gravity. The authors present the results obtained with the technique one and four months after the procedure, showing the improvement of tissue connection with the repositioning of the abdominal scar and general aesthetic improvement.

Keywords: Scar; Esthetics; Cosmetic Techniques; Skin; Polydioxanone; Methods

Facial erythema after phenol peeling is one of the expected effects of the healing process and collagen formation. Intense Pulsed Light (IPL) therapy is one of the forms used as a treatment accelerating recovery, reducing redness, inflammation, and itching symptoms that may occur after peeling. IPLT can also be used to treat hypertrophic scars, which is also one of the adverse events that can happen with deep peeling. We report a successful case of IPLT treatment in a patient who presented facial erythema and hypertrophic scarring after undergoing phenol peeling.

Keywords: Phenol; IPL treatment; Hypertrophic Scar.

Rhinophyma is characterized by chronic inflammation of the tissues of the nose, resulting in irregular exophytic growth and telangiectasias. The disease progresses with hyperplasia and hypertrophy of the nasal sebaceous glands, associated with fibrosis and dilation of local blood vessels and connective tissue. These changes can lead to complete nose deformity and compromise the patients' quality of life. There are different treatment methods, such as laser, microdermabrasion, chemical exfoliation, cryosurgery, surgery with skin graft, and electrosurgery, with varying results and costs. We report two cases of rhinophyma treated with electrosurgery with very satisfactory results.

Keywords: Rhinophyma; Electrosurgery; Case Reports; Acquired Nasal Deformities.

Syringomas are benign adnexal neoplasms that develop from eccrine sweat ducts. They are mostly found in early adulthood, with a female gender predominance. They typically occur on the face, particularly the periorbital region, which has a high demand for cosmetic enhancement. Management of periorbital syringomas is challenging, with no consistently effective treatment available. Intradermal injection of botulinum toxin A (BTX-A) is a new treatment modality for periorbital syringoma. We present a 53-year-old female patient with periorbital syringoma who was successfully treated with intradermal BTX-A monotherapy as a painless, cost-effective treatment that produced better long-term results than carbon dioxide laser.

Keywords: Botulinum Toxins, Type A; Syringoma; Carbon Dioxide

Extramammary Paget’s disease (EMPD) is a rare malignancy and is quite difficult to diagnose. We report a case of a 51-year-old female patient with perianal EMPD. Because experience with this disease is still very limited, we searched international databases for similar publications. After consultation with an oncologist, the treatment was wide excision without adjuvant therapy. This treatment option was curative.

Keywords: Paget Disease, Extramammary; Surgery, Plastic; Anal Gland Neoplasms.

INTRODUCTION: Non-ablative fractional lasers are well-known effective treatments for skin rejuvenation. However, the high incidence of post-inflammatory hyperpigmentation increases the risk of complications, especially in higher skin phototypes. Caviar phospholipid supplementation has been used successfully to reduce the inflammatory process, which may be beneficial to manage post-inflammatory hyperpigmentation after laser.
OBJECTIVE: To compare the incidence of post-inflammatory hyperpigmentation in high phototypes after caviar phospholipid supplementation.
METHODS: 20 patients underwent a non-ablative fractional laser session (Nd:YAP 1340nm, Zye Vydence, Brazil), and 10 of them used 200 mg of caviar phospholipid orally daily for 15 days before treatment and 40 days after. Patient images were evaluated before and after 40 days of laser application. Clinical assessment was based on the presence or absence of post-inflammatory hyperpigmentation. Statistical analysis was performed using the Z test.
RESULTS: We observed no cases of post-inflammatory hyperpigmentation in the experimental group; however, the control group presented 30%.
CONCLUSIONS: Caviar phospholipid may be an option for preventing post-inflammatory hyperpigmentation after non-ablative fractional lasers, aiming to avoid adverse events.

Keywords: Lasers; Skin; Rejuvenation; Fatty Acids; Omega-3.

This study compared the effectiveness of secretome delivery using microneedling versus laser-assisted drug delivery for facial skin rejuvenation. The review included seven studies that demonstrated that both approaches were effective in delivering secretomes. However, microneedling had a higher patient satisfaction rate and fewer reported adverse events. We concluded that micro needling may be a more patient-friendly and safer option for facial rejuvenation. Further studies with larger sample sizes and extended follow-up periods are needed to confirm these results.

Keywords: Secretome; Laser Therapy; Systematic Review; Skin.

Hand rejuvenation has become increasingly popular in recent years. Knowledge of the layered anatomy of the hand is crucial for better aesthetic results. In this context, ultra-high-frequency ultrasound (UHFUS) has been used in minimally invasive procedures all over the body, including the hands. To the best of our knowledge, this is the first study to correlate UHFUS evaluation of the dorsal aspect of the hand before, during, and after injectable procedures. We discuss the layered local anatomy of the hand, whose knowledge is crucial for performing safe and effective aesthetic treatments for rejuvenation, and the correlation of the imaging aspects of different procedures and products, as well as its possible complications.

Keywords: Ultrasonography; Rejuvenation; Hand; Anatomy.

Damage caused by chemical, physical, and thermal procedures can disrupt the natural morphological characteristics of the hair, causing the strands to become dry, dull, weak, and brittle. The objective of this article was to update dermatologists on the methods available for assessing hair shaft damage. The main laboratory (microscopy, tensile strength, structural assessment, physical and mechanical properties) and outpatient (diagnostic tests and patient history) diagnostic methods for evaluating the quality of the hair shaft are presented.

Keywords: Hair; Dermatology; Keratins.

Syringoma is a rare benign adnexal tumor of the intraepidermal eccrine duct of unknown etiology. It is typically characterized by multiple, bilateral, yellow-brownish or skin-colored papules measuring 1-5 mm. Syringomas predominantly affect the face but can also be found in gluteal, pubic, vulvar, or thoracic regions. In this article, we report two cases of vulvar papules with a confirmed diagnosis of syringoma by histopathological analysis, which were successfully treated with carbon dioxide (CO₂) laser therapy. The selected treatment approach was easy to implement and resulted in a favorable clinical response, including improvement of itching after the first session.

Keywords: Syringoma; Vulvar Diseases; Pruritus Vulvae; Adenoma; Sweat Gland; Lasers

Schwannomas are benign nerve sheath tumors derived from Schwann cells. The sites most often involved are the head and neck (25-48%), with only 1% occurring in the oral cavity. Most schwannomas occur in adult individuals between the third and fifth decades of life. Lip involvement is extremely rare during childhood and adolescence, with few reports in the literature. The prognosis is favorable and surgical excision is the treatment of choice. We report an interesting case of upper lip schwannoma in an adolescent with successful surgical treatment and no evidence of recurrence after 4 years.

Keywords: Neurilemmoma; Lip; Neoplasms; Schwann Cells.

The incidence of hypersensitivity reactions to dermal fillers with hyaluronic acid is between 0.3 and 4.5% being mediated by T lymphocyte. Influenza-like illnesses can trigger immunological reactions at the site of the filler. The authors report a case of a patient who presented a hypersensitivity reaction to the filler concomitant with a SARS-COV-2 infection. With the large-scale growth of procedures with fillers, there has been an increase in allergic reactions, making their identification essential for adequate treatment, minimizing the deleterious consequences to the patient.

Keywords: Hypersensitivity; Hyaluronic Acid; Coronavirus.

Esthetic dermatology is a growing field, and different noninvasive therapies are gaining attention. The objective of this narrative review was to update current evidence-based knowledge about recombinant enzymes. The PubMed, SciELO, Cochrane Central, and Imbiomed databases were searched for meta-analyses, systematic reviews, randomized controlled clinical trials, observational registries, and preclinical data published in English, Spanish, and Portuguese. Effectivity, safety, and tolerability of recombinant hyaluronidases, lyases, collagenases, and lipases, including their combinations, were evaluated and confirmed in diverse indications. Further research could increase current knowledge on this constantly developing and promising therapeutic area.

Keywords: Liases; Colagenase microbiana; Hialuronoglucosaminidase; Lipase.

Exosomes are small extracellular vesicles, released by different types of cells, that play roles in intercellular communication. In the skin, exosome-mediated information transfer and intercellular communication are necessary for the maintenance of cellular function and tissue homeostasis. Recently, several studies have demonstrated the involvement of exosomes in skin diseases and rejuvenation, including potential therapeutic uses. In this context, we address recent research on exosomes in dermatology by reviewing the role of exosomes in skin diseases and rejuvenation.

Keywords: Exosomes; Skin; Rejuvenation.

Despite the therapeutic success described by recent studies, the procedure of labia majora augmentation lacked systematization in order to achieve more assertive and reproducible results. To this end, we developed the vulvar anatomical vector technique, in which we mapped five anatomical structures of the vulva where the injection of hyaluronic acid is capable of promoting coaptation, augmentation, reduction of prolapse, and/or improvement of the skin quality of the labia majora. This technique has allowed us to precisely define the sites to be injected and estimate the adequate volume and type of hyaluronic acid to achieve the intended results.

Keywords: Hyaluronic Acid; Vulva; Dermal Fillers; Rejuvenation; Female Genitalia.

Facial volumization techniques have been widely discussed by several authors. However, there is a dearth of publications on techniques for patient assessment. In this article, we describe how we assess, in our clinical practice, the anatomical changes associated with facial aging in a practical and didactic way, as it is a fundamental step when choosing products and filling techniques.

Keywords: Dermal fillers; Skin; Collagen; Inflammation; Blindness; Necrosis.

The rapid expansion of the cosmetics industry has been accompanied by an increasing demand for innovative and customized products based on scientific base. One of the innovative products is a nanotechnology-based product. This article discusses any potential risks associated with nanotechnology-based cosmetics use, how the government should regulate the product to protect the public and promote public understanding. The government should create effective regulations, but these regulations must not be detrimental to manufacturers. The government has an essential role in establishing effective regulations for both consumers and producers. In addition, the government should encourage manufacturers to provide rational claims and effective advertising.

Keywords: Cosmetics; Nanotechnology; Safety; Pharmacovigilance.

Neck aging encompasses intrinsic and extrinsic factors that need to be understood in order to achieve good treatment outcomes in the area. Minimally or noninvasive methods for neck rejuvenation have gained popularity because they provide individualized, natural, and safe results with no downtime. However, few studies have debated the need for global neck treatment or have offered suggestions and ways to combine different methods in single or multiple sessions.
We report here a novel protocol with the combined use of injectables and technologies in a single session, which act on laxity, fine lines, wrinkles, and skin quality.

Keywords: Neck; Rejuvenation; Combined Modality Therapy.

INTRODUCTION: The use of potassium titanyl phosphate (KTP) crystals for second-harmonic generation of 532nm waves from a 1064nm source is presented as a more efficient method for removing residual tattoo pigments with lasers. It is crucial to measure the actual performance of the available technologies on the market, which has not been done to date.
OBJECTIVE: To assess the performance of laser systems available on the Brazilian market by measuring the amount of energy from the fundamental wavelength (1064nm) that is effectively converted to 532nm.
METHODS: The 532nm wavelength was measured on Etherea MX, Spectra XT, Inkie, Ladybug and Deltalight equipment using the metrological standard of the National Institute of Metrology of China, model NIM-1000
RESULTS: The results were unsatisfactory for most of the analyzed systems.
CONCLUSIONS: The findings suggest potential photonic design flaws in the equipment and methodological deficiencies in the conformity assessment by product certification bodies, compromising the desired clinical outcomes.

Keywords: Lasers; Solid-State; Coloring Agents; Tattoo Removal; Lasers, Dye.

A patient with dissecting folliculitis of the scalp who did not respond to antibiotic therapy received four monthly sessions of intradermal administration of 100 IU of botulinum toxin A. Four months after treatment, a complete recovery of the affected area of the patient's scalp was observed. A biopsy taken from the affected area showed the presence of Staphylococcus lugdunensis and Staphylococcus aureus resistant to erythromycin. Botulinum toxin A had no effect on the viability or biofilm production of the Staphylococcus strains, indicating that the healing effect of the toxin was associated with the host response alone.

Keywords: Botulinum Toxins Type A; Folliculitis; Alopecia; Staphylococcus aureus; Staphylococcus lugdunensis.

Histopathology reports are the pathologist's description of a microscopic morphological image, which can be understood as long as the basic elements of the histological structures are known. However, actually viewing the morphological image can be more helpful in understanding what is really being described, similar to the examination of radiograms, which is directly performed by the orthopedist despite the report being made by the radiologist. This article discusses this scenario, with the aim of encouraging surgeons to view and inspect morphological images to improve their understanding of the clinical-surgical status and their analysis of the state of the surgical margins or the histological subtype.

Keywords: Mohs Surgery; Official laboratory; Pathology; Reoperation; Skin Neoplasms

Arterial pseudoaneurysm is a rare complication caused by damage to the arterial wall, resulting in a locally confined hematoma connected to the lumen of the artery. We report the case of a patient on anticoagulants who developed nodules at the surgical wound site after Mohs micrographic surgery for basal cell carcinoma. The initial clinical suspicion was the formation of a simple hematoma. However, Doppler ultrasound examination revealed the presence of pseudoaneurysms in the bilateral supratrochlear arteries. We believe this is the first reported case of supratrochlear artery pseudoaneurysm following dermatologic surgery.

Keywords: Aneurysm, False; Carcinoma; Basal Cell; Ultrasonography, Doppler, Color

The 1064-nm Nd:YAG laser in Q-switched and micropulsed modes has been used in rejuvenation, pore reduction, skin texture improvement, and wrinkle reduction. The aim of this study is to evaluate the combination of 1064-nm Nd:YAG laser in micropulsed and Q-switched modes in the same session for global facial treatment. Thirty female patients underwent six treatment sessions every two weeks. Three blinded dermatologists evaluated the results through clinical photographs and Visia^® or Focco^® images obtained before and 30 days after the last treatment session. The parameters of interest were solar melanosis, telangiectasias, wrinkles, dilated pores, melasma and skin texture. Three patients had face biopsies before and 30 days after the end of treatment. Most patients showed improvement in all evaluated parameters, except for two patients who had worsening of melasma. An increase in collagen was observed in two of the three histological examinations performed after treatment. The combination of laser modes studied herein offers a safe treatment that can improve wrinkles, skin texture, and laxity with minimal downtime.

Keywords: Lasers; Skin Aging; Rejuvenation

Eccrine spiradenoma is a rare benign epithelial neoplasm derived from the ductal and secretory portions of the eccrine sweat glands. It is characterized by slow growth and may, in some cases, undergo malignant transformation. This report describes a case involving a male patient with a painful, slow-growing lesion present for 3 years. The nodular, lobulated lesion was located on the left frontal region. Due to the left. On account of location, size, and vascularization of the lesion, as well as the need to preserve the facial musculature and ensure complete tumor removal of the tumor with minimal functional damage, Mohs surgery was chosen as the treatment technique.

Keywords: Mohs surgery; Skin; Sebaceous Glands

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.

In recent years, the use of probiotics in dermatology and cosmetology has been demonstrating a notable rise, offering both preventive and therapeutic benefits for the skin. The intestinal microbiota plays crucial roles, including enzymatic degradation of dietary fiber, starch, proteins, and fats, as well as the synthesis of vitamins B, K, nicotinic acid, amino acids, and various metabolites. The use of multicomponent probiotics composed of strains of the genus Bacillus is a promising way to optimize the positive effects of these microorganisms in dermatological and cosmetic practice and avoid their undesirable effects.

Keywords: Bacillus; Probiotics; Dermatology; Cosmetic Microbiology.

The posterior surface of the ear is an uncommon site for skin cancer. It has anatomical and cutaneous characteristics that make local reconstruction difficult using standard surgical techniques. We present a case of reconstruction of a defect on the posterior surface of the ear secondary to excision of a basosquamous carcinoma, using an interpolation flap.

Keywords: Carcinoma, Basosquamous; Ear; Surgical Flaps

Fibromyxosarcoma is a rare subtype of soft tissue sarcoma characterized by the presence of spindle cells and myxoid matrix. We report the case of an older patient who presented with progressive growth of a nodule in the interscapular region, and further investigation confirmed the diagnosis of high-grade fibromyxosarcoma. Notably, this neoplasm more commonly occurs in the lower limbs and may exhibit recurrence associated with increased histological grade. Therefore, early diagnosis and treatment are crucial for mitigating morbidity and mortality. We emphasize the significance of diagnosing an atypical case and providing timely therapeutic intervention, contributing to the optimization of clinical outcomes.

Keywords: Sarcoma; Neoplasms, Connective and Soft Tissue; Solitary Fibrous Tumors

Cylindroma is a rare benign neoplasm of probable origin in the eccrine sweat glands and is characterized by papular and nodular, painless, slow-growing lesions, generally located on the head, neck and scalp. When multiple, they can be part of hereditary syndromes. The authors report the case of a patient with a solitary nodulation on the scalp, presenting pathological examination compatible with cylindroma. The lesion was excised, with satisfactory results and no recurrence.

Keywords: Sweat Gland Neoplasms; Skin Neoplasms; Deubiquitinating Enzyme CYLD.

Extramammary Paget's disease is a slow-progressing, cutaneous adenocarcinoma of the apocrine glands with an uncertain etiology. The standard treatment is surgical removal of the tumor. However, the usual surgical methods - wide local excision and Mohs micrographic surgery - pose challenges and high recurrence rates. Often, these are extensive lesions with poorly defined boundaries located in critical anatomical regions. Additionally, they exhibit unpredictable subclinical intraepithelial spread. We present a case of a recurrent extramammary Paget's disease successfully treated with peripheric Mohs micrographic surgery associated with rapid immunohistochemistry for CK8/18.

Keywords: Paget Disease, Extramammary; Mohs Surgery; Immunohistochemistry

Although primary cutaneous amyloidosis (PCA) is prevalent worldwide, it is underdiagnosed. Among the subtypes, nodular amyloidosis (NA) is the rarest. There is no consensus in the literature; treatment is challenging, and no therapy has been proven effective. The authors report the case of a patient with a nodule in the nose, whose anatomopathological examination was compatible with amyloidosis, with no evidence of systemic disease. It was then classified as nodular PCA. The lesion was excised satisfactorily. It was concluded that surgical removal is an effective therapy for the treatment of NA.

Keywords: Amyloidosis; Amyloid; Congo Red

Piebaldism is a rare, autosomal dominant dyschromia characterized by circumscribed poliosis and triangular achromia in the frontal region in 90% of affected individuals, with no other systemic involvement. The incidence of dyschromia in this Dermatology Department, in a short space of time, and with plenty of images, motivated the presentation of this series of cases. We show two families with piebaldism, treated at the same Dermatology Department in 2021: the first family, with a mother and son presenting achromic macules on the trunk and poliosis in the frontal region since birth; the second family, with a grandmother, aunt, mother, and son showing the same characteristics described.

Keywords: Piebaldism; Pigmentation Disorders; Skin Diseases; Genetic

BACKGROUND: Keloids are abnormal proliferations of scar tissue that do not regress spontaneously. Studies on the quality of life in patients with auricular keloids are rare. This condition is a frequent complaint, occurring in a highly visible area.
OBJECTIVE: To assess the impact of auricular keloids on the quality of life of affected individuals, demonstrating that psychological and physical symptoms are common and significantly affect patients.
METHODS: This is a cross-sectional, observational analytical study conducted in São Paulo. Patients with auricular keloids completed the QualiFibro questionnaire, a validated tool specific for assessing quality of life in individuals with auricular keloids.
RESULTS: Seventeen patients with auricular keloids were analyzed. The questionnaire revealed that most participants experienced some degree of physical impairment (76% reported itching, and 58% reported pain in their keloids). All participants showed psychological distress to varying degrees.
DISCUSSION: Patients often associate their keloids with feelings of shame and low self-esteem. We believe that raising awareness of the negative psychological impact of this condition can help dermatologists better understand these patients’ concerns and provide empathetic support, aiming to make them feel more comfortable in their own skin.

Keywords: Keloid; Quality of Life; Ear Auricle.

Brassiere strap groove is a common aesthetic deformity in women with breast hypertrophy, resulting from chronic pressure exerted by brassiere straps on the soft tissues over the trapezius muscle, causing local tissue depression. This condition is typically treated with fat grafting, often performed simultaneously with breast reduction surgery or lipoabdominoplasty. We report the case of a patient with recurrent brassiere strap groove following prior fat grafting, successfully corrected with hyaluronic acid filler.

Keywords: Hyaluronic Acid; Dermal Fillers; Dermatology.

A 76-year-old woman presented with facial edema and nodules in the front glabellar region and nasal dorsum that clinically resembled leonine facies. A facial ultrasound showed deposits of permanent facial filler with a "snowstorm" aspect characteristic of silicone oil, and an anatomopathological examination suggested a granulomatous reaction to the exogenous substance. Permanent fillers, such as silicone, behave like foreign bodies and cause a chronic granulomatous reaction. Although dermal fillers have been increasingly used, there is still no consensus on the management of their complications. In the present case, a good response to dapsone was observed.

Keywords: Silicones; Dermal Fillers; Granulomatous Disease, Chronic; Foreign-Body Reaction.

The globular dermoscopic pattern in pigmented lesions of basal cell carcinoma can cause diagnostic confusion, especially in cases in which other more commonly observed structures are absent. Therefore, the use of refletance confocal microscopy becomes important to determine the diagnosis and eliminate the need for biopsies.

Keywords: Carcinoma, Basal Cell; Dermoscopy; Microscopy, Confocal.