THE 4T REJUVENATION: ASSOCIATION OF PAN-FACIAL PMMA FILLING, FRACTIONAL CARBON DIOXIDE LASER, RADIOFREQUENCY, AND BOTULINUM TOXIN

Introduction: The use of associated less invasive techniques can be an alternative skin rejuvenation treatment. Objective: To demonstrate the efcacy and safety of the 4T treatment. Methods: Retrospective study of patients that underwent rejuvenation treatment using 4 different techniques simultaneously: polymethylmethacrylate (PMMA) lling, fractional CO laser, 2 radiofrequency, and botulinum toxin. More than 1,400 patients who underwent this treatment between December 2009 and July 2019 were analyzed. Results were very good in all patients submitted to the 4T technique as documented by pic Results: tures, assessment of the medical team and by the patients. Follow-up was similar to the single use of CO2 laser with edema for 2-3 days, additional 3-4 days until complete skin scaling and decrease of the swelling (downtime 5-7 days). It was possible to reestablish the natural volumetric loss caused by ageing and there were no complications in any patient. Conclusion: Treatment with the 4T technique is effective and safe for facial rejuvenation and can enhance a good aesthetic result as assessed by physicians and patients.

Management of Ala Columella Disproportion in South East Asian Noses

South East Asian noses have a characteristic ala and columella disproportion and mostly manifest as hanging ala. Simultaneous correction during rhinoplasty is recommended to achieve a good aesthetic result. Since hanging ala is a common feature, a classification system is presented as a guide for surgical management. The classification is based on the frontal view showing the alar rim connecting to the columella lobule area simulating the wings of a gull in gentle flight. A mild deformity has the gull's wing in the horizontal direction. A moderate deformity has the gull's wing in a slight inferior direction. A severe hanging deformity has the gull's wing in the inferior direction, ending below the columella lobule area, and this is mostly accompanied by retracted columella. There are various techniques for the surgical correction of hanging ala. The author has made a modification of the internal approach called “sail excision” using the groove within the lateral nasal vestibule as a landmark. The author terms this area as the vestibular groove. Sail excision involves removal of a triangular portion of tissue anterior to this vestibular groove. Another aesthetic deformity noticed in South East Asian noses is that the alar rim base is lower than the columellar base. In correcting hanging ala with involvement of the alar rim base, the sail excision is extended posteriorly following the vestibular groove as its guide to the amount to be excised. To enhance the overall aesthetic outcome, the acute columella labial angle seen in South East Asian noses has to be made fuller through surgery. This is accomplished using septal extension graft for tip projection, with preservation of the posterior angle of the caudal septum. Plumping grafts are used as filler material in the premaxillary area.

TREATMENT OF PROGRESSIVE HEMIFACIALATROPHY (PARRYROMBERG SYNDROME) WITH POLYMETHYL METHACRYLATE: A CASE REPORT.

Progressive hemifacial atrophy, also called Parry-Romberg Syndrome (PRS), is a craniofacial disorder that typically involves the subcutaneous layer of one side of the face.This article We reports a case of a patient treated with polymethylmethacrylate for tissue augmentation and facial volume recovering asymmetry. Polymethylmethacrylate is effective and safe for treating progressive hemifacial atrophy and can leads a good aesthetic result.

A Rare Case of Parietal Skull Fibrosarcoma: Reconstruction with Free Myocutaneous Flap and Infrared Thermography Monitoring

Fibrosarcoma of the skull is an extremely rare condition. We report a case of a male patient surgically treated by radical tumor excision and plastic reconstruction with a free myocutaneous latissimus dorsi flap. Revascularization on the side of the intervention was verified intraoperatively by using an infrared thermography camera in the follow-up period to evaluate flap vitality in addition to standard clinical monitoring. We observed no complications and achieved a good aesthetic result.

Local facial flaps: a workhorse for reconstruction of facial malignancies defects

<p class="abstract"><strong>Background:</strong> Face represents complete personality of a human being, so adequate cosmetic correction of facial defects arising due to skin malignancy is very important. After excision, treatment option varies according to size and location of defect for small- or moderately-sized circular defects. In our study, we have evaluated versatility of local flap of face.</p><p class="abstract"><strong>Methods:</strong> We have included 30 cases of skin malignancy on face in our Institute within the period of June 2016 to May 2018. 20 patients (66.6%) were male and 10 patients (33.3%) were female, in age group from 45 to 65 years. 17 cases had basal cell carcinoma, 10 cases had squamous cell carcinoma and 3 cases had malignant melanoma. Tumours were excised with safe margins and defects reconstructed with local facial flaps. We evaluated the early postoperative complications and after 6months, cosmetic outcome and patient satisfaction was evaluated. </p><p class="abstract"><strong>Results:</strong> 30 patients with small to medium-sized defect (3-6 cm), 8 cases were managed with V-Y advancement flap, 7 cases nasolabial flap, 8 cases forehead flap and, 4 cases Limberg flap, 4 cases cheek advancement flap. Postoperatively none of the cases had complications and the functional and aesthetic outcomes were quite acceptable. Aesthetic results were excellent in 15 patients (50%), while in 8 patients good results (27%) and 5 patient fair results (17%) after 6 month.</p><p class="abstract"><strong>Conclusions:</strong> Local facial flaps are the simple and best option to reconstruct the small to medium size facial malignancies defects and provides excellent skin colour and texture match with gives good aesthetic result.</p>

Extended Hueston Flap: New Solution for Primary Closure

Thumb tip injuries are very common in hand trauma, and several flaps are available to restore the defect. One of them is the Hueston flap. It is very simple and quick to harvest, but it could lead to donor site problems. The variant “radial extended” of this flap, proposed in this article, allows a primary closure of donor site avoiding making scar on contact areas subject to frequent use. We performed this technique in a clinical case that presented a distal thumb amputation with good aesthetic result and satisfactory function.

Parotidectomy by Periauricular Incision

Objective. According to the literature, periauricular combined with submandibular or cervical incision is used in nearly every parotidectomy. The aim of this study was to present the results of the use of only periauricular incision in parotid surgical procedures. Design. A case series with planned data collection. Setting. Patients of the author were operated on at the Hospital Santa Casa de Misericórdia de Belo Horizonte, Brazil. Subjects and Methods. Forty-one consecutive partial or total parotidectomies (27 cases of pleomorphic adenoma, 9 of other benign tumors, 3 of parotid cysts, and 2 of chronic parotiditis) were performed using only periauricular incision. Results. The parotid tumors were removed in all cases with no need for any further skin procedures, as the incisions produced a good aesthetic result. All patients presented temporary hypoesthesia in the area that had been operated on for no more than 6 months. Ear discomfort was reported by 18 patients for a short period of time. Local infection occurred in 1 case successfully treated with systemic antibiotics. Conclusion. The results of the present study indicate that periauricular incision is a high-quality and highly aesthetic option for surgical procedures concerning benign conditions of the parotid gland.

The Use of an Autogenous Free Gingival Graft in the Combined Orthodontic and Periodontal Management of a Buccally Ectopic Maxillary Canine

A case is reported in which an unerupted maxillary canine, situated buccally above the level of the mucogingival junction, was exposed surgically in conjunction with a free gingival graft. Alignment was achieved using the edgewise appliance. An adequate width of attached gingiva was maintained out of retention, with a good aesthetic result. The problems associated with radical exposure of buccally misplaced teeth are discussed.