Eyebrow ptosis presents a significant challenge for cosmetic professionals. Minimally invasive procedures can improve eyebrow positioning; however, a thorough understanding of its varied etiologies is essential. The primary causes include skin laxity, muscular dysfunction, and tissue deflation, with the latter subdivided into frontal, temporal, and superciliary deflation. A precise diagnosis allows for the appropriate indication of microfocused ultrasound, botulinum toxin, biostimulators, and hyaluronic acid-based fillers, either as standalone treatments or in combination. At the end of this review, a treatment algorithm for eyebrow ptosis is proposed.

Keywords: Dermal Fillers; Botulinum Toxins; Eyebrows; Aesthetic Equipment.

A narrative review was performed to clarify the ontogenesis of Merkel-cell carcinoma. It is hypothesized that the cells are derived from the embryonic neural crest, skin stem cells, epithelial cells, pre-/pro-B cells, dermal fibroblasts, or metastatic cells from other types of carcinomas. The influence of epigenetics was also considered. Methodologically, to prepare the summary articles were selected from the PubMed and SciELO databases and cited references. The results suggest that it is more likely that Merkel-cell carcinoma has multiple origins, possibly from poorly differentiated cells.

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A narrative review was performed to clarify the ontogenesis of Merkel-cell carcinoma. It is hypothesized that the cells are derived from the embryonic neural crest, skin stem cells, epithelial cells, pre-/pro-B cells, dermal fibroblasts, or metastatic

The clinical use of combined technologies has been increasing to address the effects of skin aging on the face and other areas of the body. Poly-L-lactic acid is a biocompatible, semipermanent synthetic filler used for volume enhancement through neocollagenesis induction by fibroblast activation. Similarly, energy-based technologies, such as high-intensity focused ultrasound and microneedling radiofrequency devices, promote fat reduction and collagen contraction by heating the deep dermis. This article presents expert panel recommendations and a literature review on the topic.

Keywords: Polylactic Acid-Polyglycolic Acid Copolymer; Radiofrequency Therapy; Collagen Type I; Collagen Type III; Adipose Tissue.

INTRODUCTION: Multiple treatments that promise to prevent or treat skin aging act on cellular functions, reducing skin aggression mechanisms, or even on the loss of skin barrier properties. Silicone adhesives appear to have a positive effect on barrier function and modulation of inflammation, but their clinical effects have not yet been documented.
OBJECTIVE: To evaluate the effectiveness of silicone adhesives in reducing the signs of periorbital aging.
METHODS: 33 patients between 35 and 55 years old with a clinical diagnosis of aging in the periorbital region were selected; Of these, 23 underwent hydration measurements (corneometry) and skin relief (prophylometry). All participants used the patches daily for a period of 30 days.
RESULTS: After four weeks of use, the application of silicone adhesives provided a significant improvement in hydration levels and the skins microrelief, making it smoother. The clinical and subjective evaluation corroborated these findings, and also showed a relevant improvement in clinical and subjective parameters such as hydration, softness, texture, and expression lines.
CONCLUSION: The continued use of silicone adhesives demonstrated a beneficial effect on some signs of aging, possibly related to improved hydration and modulation of inflammation.

Keywords: Skin Aging; Epidermis; Silicone Elastomers.

INTRODUCTION: Hair restoration treatments for alopecia using existing medications are not always effective, highlighting the need for new therapeutic options.
OBJECTIVE: This study aimed to evaluate the effects of a topical gel containing ethyl-methyl-hydroxypyridine succinate (EMHPS) on hair regrowth and biochemical and histological skin parameters in animals following chemical depilation.
METHODS: Experiments were conducted on 50 adult male Wistar rats. Alopecia was induced using a commercial depilatory product containing potassium thioglycolate. A 5% EMHPS gel (125 mg/kg) was applied daily to the depilated skin. Trichoscopy, biochemical analysis, and histological examination of skin samples were performed on days 3, 9, and 21 of treatment.
RESULTS: The EMHPS gel demonstrated a tendency to accelerate hair regrowth, reduce lipid peroxidation, normalize antioxidant enzyme activity, and restore hydroxyproline and glycosaminoglycan levels in the treated skin compared to the untreated pathology control.
CONCLUSIONS: The EMHPS gel primarily influences skin biochemical parameters and may be beneficial for treating forms of alopecia associated with oxidative stress.

Keywords: Hair; Hair Removal; Skin.

INTRODUCTION: Advanced glycation end products (AGEs) are stable compounds formed by nonenzymatic reactions between amino groups of biomacromolecules and carbonyl groups of reducing sugars. AGEs are known to play a role in various diseases such as diabetes, cardiovascular diseases, and neurodegenerative disorders, as well as contributing to premature skin aging. Decarboxy carcinine HCl, a stable analogue of carnosine, has demonstrated potential in reducing the effects of glycation.
OBJECTIVE: To evaluate the effects of oral supplementation with Glycoxil^®, a patented decarboxy carcinine HCl molecule, on signs of skin aging in participants with mature skin.
METHODS: This randomized, double-blind, placebo-controlled study involved 30 participants aged 30-50 years, with skin phototypes I to IV and clinical signs of skin aging (e.g., rhytids). Participants were divided into two groups: one received Glycoxil^® 300 mg daily for 90 days, while the other received a placebo. Standardized skincare products were provided, and participants underwent evaluations using Visia^® and Focco^® imaging systems at baseline (T0), 45 days (T45), and 90 days (T90). Statistical analysis was conducted using RStudio, with ANOVA and Wilcoxon tests. Significance was set at p<0.05.
RESULTS: Of the 30 participants, 18 were analyzed with Focco^® and 22 with Visia^®. Objective evaluations showed no statistical differences between groups in rhytid improvement at T0, T45, or T90. However, slight improvements were observed in the treatment group at T45 and T90. Blinded dermatologists noted improvements in hydration, firmness, and texture in both groups, with some participants in the treatment group reporting "improved" or "much improved" appearance. No adverse effects were reported.
CONCLUSIONS: Although no statistically significant differences were found between the groups, the findings suggest that Glycoxil^® may contribute to minor improvements in skin-aging signs, corroborating existing literature on anti-glycation strategies. Further studies with larger sample sizes, extended follow-up periods, and advanced analytical methods are recommended to confirm these preliminary results.

Keywords: Glycation End Products, Advanced; Antiglycation Agents; Maillard Reaction.

INTRODUCTION: Parry-Romberg syndrome and linear scleroderma en coup de sabre are disorders within the scleroderma spectrum, a disease that presents therapeutic challenges.
OBJECTIVES: We treated three patients with this condition using poly-L-lactic acid (PLLA) with the aim of alleviating facial asymmetries and evaluated the real improvement of scleroderma lesions with high-resolution ultrasound.
METHODS: The patients underwent two to four sessions of biostimulation with PLLA over a 12-month period.
RESULTS: The results were promising, demonstrating favorable cosmetic outcomes with increased thickness of the dermis and hypodermis as evidenced by high-resolution ultrasound.
CONCLUSIONS: Biostimulation with PLLA is a safe and effective treatment option for these patients when administered by trained professionals.

Keywords: Facial Hemiatrophy; Scleroderma, Localized; Dermal Fillers; Ultrasonography.

ABSTRACT

INTRODUCTION: Adult female acne (AFA) affects women over 25 years old. Although there are no solid data in the Brazilian literature, genetic, hormonal, and environmental factors are believed to contribute to its pathogenesis.
OBJECTIVE: To assess the prevalence of AFA and its possible risk factors in a sample of the Brazilian population.
METHODS: A cross-sectional clinical study was conducted with 258 women aged 25 to 55 stratified by race and age according to the Brazilian population (2010 census). The study analyzed their demographic, clinical, psychological, and exposure-related information.
RESULTS: Acne complaints were reported by 41.1% of participants, ranging from 15% in those aged 50–55 to 60% in those aged 25–29. Clinical examination confirmed lesions in 36.6% of women. In 70% of cases, acne had persisted since adolescence, and 13.2% of participants were undergoing treatment. Acne was significantly associated with age, race, age at menarche, hirsutism, smoking, oily skin, and makeup use (p<0.05).
CONCLUSIONS: Acne was a prevalent issue, especially before age 40, and was more common in Black and mixed-race individuals, those with clinical signs of hyperandrogenism, and makeup users. However, it was inversely associated with smoking.

Keywords: Acne Vulgaris; Adult; Hyperandrogenism.

BACKGROUND: Reconstructive surgery remains the primary approach for treating facial skin cancer, aiming to restore both anatomy and aesthetics. Local flaps are commonly preferred for facial reconstruction.
OBJECTIVE: To describe the clinical and subclinical characteristics of facial skin cancer and evaluate treatment outcomes using local flaps.
METHODS: A descriptive cross-sectional study with clinical intervention, without a control group, was conducted on 84 patients diagnosed with facial skin cancer and treated at Can Tho City Oncology Hospital from May 2021 to April 2023.
RESULTS: Outcomes were assessed during hospitalization and 6 months postoperatively. Among the 84 patients, 68 had basal cell carcinoma, and 16 had squamous cell carcinoma. The nose was the most frequently treated site, accounting for 43 cases. Lesions smaller than 2 cm comprised 70.2% of cases. After 6 months, 65 out of 84 flap sites (77.4%) exhibited minimal scarring that could be concealed, with an aesthetic success rate of 73.8%.
CONCLUSIONS: Key factors influencing surgical outcomes include the surgeon's experience, lesion location and size, tumor invasion extent, and skin elasticity.

Keywords: Facial Dermatoses; Surgical Flaps; Southeast Asian People.

INTRODUCTION: Oxidative stress, characterized by an imbalance between the production of reactive oxygen species (ROS) and antioxidant defense, seems to be the main process that worsens skin aging, and the mitochondria is an important source of ROS. There is increasing evidence that oral administration of functional nutrients can protect the skin from oxidative damage.
OBJECTIVE: To evaluate the effectiveness of an oral supplement with collagen peptides and other nutrients in reducing the signs of photoaging.
METHODS: In vitro studies evaluated the antioxidant and antiglycant effects under UV light, as well as the synthesis of extracellular dermal matrix components; then, a clinical trial was developed with women between 35 and 60 years old, for 12 weeks. Hydration (corneometry) and skin firmness (cutometry) measurements were performed.
RESULTS: The supplement showed antioxidant and antiglycant properties under the stress generated by UV radiation, as well as the ability to induce synthesis of extracellular dermal matrix elements; There was an improvement in all clinical parameters of aging. Significant improvement in hydration and firmness and elasticity were also observed.
CONCLUSION: Collagen peptides and nutrients association demonstrated an effect in some mechanisms involved in the photoaging process, leading a clinical improvement.

Keywords: Collagen; Exposome; Oxidation; Skin Aging; Glycation End Products, Advanced; Dietary Supplements.

INTRODUCTION: An 85% phenol and 4% croton oil solution (SFC) has cytotoxic effect on the epithelium; however, it has not been evaluated in the treatment of anogenital warts (AGW).
OBJECTIVE: To evaluate the effectiveness of SFC in the treatment of penile AGW in immunocompetent patients.
METHODS: Open, uncontrolled clinical trial (proof-of-concept), involving patients with penile AGW treated with SFC and reevaluated after 28 days.
RESULTS: We evaluated 16 treatments in 9 participants. SFC promoted total clearance of the lesions in 25% (95% CI 2-48%) of treatments.
CONCLUSIONS: Although well tolerated, SFC caused insufficient rates of total clearance.

Keywords: Condylomata Acuminata; Phenol; Papillomavirus Infections; Sexually Transmitted Diseases.

Postoperative bleeding from the vascular pedicle of the paramedian flap is a common complication. We describe the use of simple sutures on the raw lateral surface of the pedicle as an alternative method to reduce this risk.

Keywords: Surgical Flaps; Carcinoma Basal Cell; Mohs Surgery; Hemorrhage.

Autologous fat grafting is a common option for the correction of facial asymmetry. Recently, therapies using injectable substances that promote lipolysis have emerged to reduce undesired fat volume, offering an alternative to surgical removal of adipose tissue. We report an experimental case in which fat-dissolving injections were used to correct facial asymmetry following fat grafting, demonstrating satisfactory results with a minimally invasive procedure.

Keywords: Facial Asymmetry; Adipose Tissue, Subcutaneous; Mesotherapy.

Folliculitis decalvans (FD) is a neutrophilic cicatricial alopecia characterized by erythematous follicular papules and pustules associated with follicular hyperkeratosis and tufted folliculitis. Here, we report the case of a 35-year-old man with recalcitrant FD successfully treated with Erbium-Yag (Er:YAG) laser, showing a rapid response and no hair loss. The effects on fibroblasts, skin microbiota, immune cascade, and angiogenesis are mechanisms through which the Er:YAG may improve FD, promoting hair growth and reducing hyperkeratosis. Nonetheless, further clinical studies are needed to investigate and better define its benefits.

Keywords: Laser Therapy; Folliculitis; Solid-State Lasers.

Z-plasty, a versatile surgical technique, skillfully addresses diverse needs in dermatological surgeries, especially the lengthening, dispersion, and realignment of scars through relaxed skin tension. We report a case of two synchronous defects after excising nasal squamous cell carcinomas using the Z-plasty technique, highlighting its simplicity, adaptability and esthetics.

Keywords: Carcinoma Squamous Cell; Surgical Flaps; Nose; Case Reports.

Histological data on microscopic treatment zones are essential for evaluating procedure safety and effectiveness. To date, no studies have histologically compared low-temperature plasma with other techniques. In this study, two square areas on the patient's abdomen, referred to as area A and area B, were with low-temperature plasma and fractional CO2 laser, respectively. A biopsy was taken immediately after treatment. When applied to thinner skin regions, plasma technology appears to result in fewer complications, a faster recovery, and fewer side effects during the application period. However, further studies are needed to confirm these findings.

Keywords: Laser Therapy; Histology Comparative; Plasma Skin Regeneration; Gas Lasers.

Three-dimensional facial analysis is the basis for planning appropriate treatment. We evaluated the face in thirds. The distance from the hairline to the glabella, from the glabella to the subnasale and from the subnasale to the menton must be equal. Some conditions such as androgenetic alopecia can cause a greater distance from the hairline to the glabella. We report the case of a 48-year-old patient with androgenetic alopecia and basal cell carcinoma in the right hairline in which forehead reduction surgery was performed in association with tumor excision, simultaneously providing esthetic improvement and resolving the oncological issue.

Keywords: Carcinoma, Basal Cell; Esthetics; Surgical Oncology.

This case report describes a complication following the use of a filler composed of hyaluronic acid and calcium hydroxyapatite mixed in the same syringe, resulting in vascular occlusion of the right transverse facial artery. The patient developed hypopigmented macules, followed by a reticulated pattern and pustules. Treatment included prednisone, enoxaparin, and hyaluronidase. Due to worsening symptoms, including arterial obstruction confirmed by ultrasound, ultrasound-guided hyaluronidase injection and hyperbaric oxygen therapy were administered. The patient showed a favorable recovery, with regression of vascular complications. This case underscores the importance of early identification and intervention to minimize complications associated with vascular occlusion in aesthetic procedures.

Keywords: Dermal Fillers; Hyaluronoglucosaminidase; Arterial Occlusive Diseases.

Necrotizing soft tissue infections (NSTIs) are severe infections affecting the skin, subcutaneous tissue, superficial fascia, deep fascia, and musculature, often leading to extensive and permanent tissue loss. Such infections may originate in the skin and subsequently spread to deeper tissues. Cosmetic procedures, such as manicures and pedicures, are becoming increasingly popular. However, they involve disruption of soft tissue integrity, which can increase the risk of localized infections. We present the case of a 41-year-old woman who developed NSTI following a nonsterile pedicure. She was successfully treated with broad-spectrum antibiotics, surgical intervention, and vacuum-assisted closure (VAC) therapy.

Keywords: Soft tissue infections; Fasciitis, Necrotizing; Cosmetics.

Discoid lupus erythematosus (DLE) causes chronic lesions that can heal with dyschromic patches. We report a clinical case showing success in the treatment of achromic lesions using a combination of surgical techniques, including excision, punch grafting, and full-thickness skin grafting.

Keywords: Lupus Erythematosus, Discoid; Cicatrix; Surgical Procedures, Operative.

INTRODUCTION: Temporal triangular alopecia (TTA) is a nonscarring, noninflammatory, permanent form of alopecia with an unknown etiology, often misdiagnosed as other types of alopecia.
CASE REPORT: A 27-year-old woman presented with triangular patches of alopecia in the temporal regions, resembling male pattern alopecia. Dermoscopy revealed normal follicular openings. Histopathological analysis showed only vellus follicles, with no telogen or terminal follicles, intact sebaceous glands, and no inflammatory infiltrate.
DISCUSSION: Dermoscopy is a valuable diagnostic tool, and histopathology may be performed in selected cases. There is no definitive treatment for TTA. Management options include topical minoxidil, hair transplantation, or surgical excision.

Keywords: Alopecia; Temporal Distribution; Hair Diseases.