Background: Knowledge of facial anatomy is essential for professionals intending to inject hyaluronic acid (HA) into that region, but due to the considerable anatomical variations in region, it does not guarantee the complete safety of the procedure.Similarly, procedures widely disseminated among professionals, such as aspiration and the use of cannulas, do not ensure total safety against vascular occlusion events caused by the filler.Objectives: This article describes a technique for injecting hyaluronic acid into the face guided by Doppler ultrasonography (DUS) in order to ensure greater safety against vascular occlusion events secondary to the procedure.
Methods:We describe a Doppler ultrasound-guided filling technique, with an 18 MHZ transducer, consisting of three steps: arterial mapping, real-time ultrasound-guided filling, and assessing the perfusion.
Results:The described technique was performed in 480 patients and can be adopted in the routine of professionals who inject hyaluronic acid, especially in areas at high risk for vascular events. Its use results in greater safety against vascular occlusion events secondary to the procedure, without the need for prior aspiration. We conclude that there is a local vasodilation right after the filling that makes it difficult the possibility of extrinsic compression exerted by the filler on the vessel. Furthermore, the product moves to deep planes even with the bevel facing up (toward the epidermis).
Conclusions:We believe that in the future the use of Doppler ultrasound-guided filling technique will be mandatory for professionals who intend to perform HA injection, to both ensure patient safety and provide legal protection for the professional.
The granuloma faciale is a rare and benign skin disease of unknown etiology,
characterized by chronic leukocitoclastic vasculitis. It is characterized by skin
lesions predominantly facial whose course is chronic and slowly progressive. The
diagnosis is based on clinical features, histopathology and, more recently, in
dermoscopy. We describe the case of a male patient, 40 years old, with a sarcoid
lesion on the malar site, whose histopathological examination revealed a mixed
inflammatory infiltrate with presence of Grenz zone. Dermoscopy revealed a pink
background with white striations. The definitive diagnosis is made by histopathologic
evaluation, and dermatoscopy can be helpful. It is known to be resistant to therapy,
oral medications, intralesional and surgical procedures are options.
To create an individualized predictive tool for the risk of malignancy in solid breast masses, based on echographic and clinical characteristics. Research Ethics Committee approval and informed consent were obtained. This multi-center study included 1,403 solid breast masses prospectively. Each ultrasound feature was analyzed and compared with the definitive diagnosis. The ultrasound results, women's ages and family histories of breast cancer were included in a multivariate logistic regression model. Among the 1,403 lesions included in the study, 1,390 (99.1%) had a conclusive diagnosis: 343 malignant tumors (24.7%), and 1,047 benign masses (75.3%). The odds ratio (and confidence interval) for breast malignancy for each variable included in the model, as calculated by multivariate analysis, were as follows: irregular shape/noncircumscribed margins, 16.02 (7.75-33.09); heterogeneous echo texture, 4.50 (2.42-8.23); vertical orientation (not parallel to the skin), 2.23 (1.04-4.75); anterior echogenic rim, 2.62 (1.09-6.31); posterior shadowing, 2.38 (1.23-4.62); age more than 40 years, 2.19 (1.26-3.81); positive first-degree family history (mother, sister or daughter), 7.50 (2.65-21.18). There was no advantage in including the presence of internal vascularity, presence of thickened Cooper's ligaments or size of the mass, in the model. The predictive tool was named SONOBREAST and it is freely available for medical purposes on the internet site: http://www.sonobreast.com. The probability of malignancy in breast masses can be specified based on their ultrasound features, the woman's age and the family history of breast cancer.
Surgical excision of basal cell carcinoma with minimum margins requires serial
assessment of layers by frozen histopathology in the case of Mohs micrographic
surgery. Evaluation of presurgical tumor margins by in vivo reflectance confocal
microscopy is a potential alternative. We selected 12 basal cell carcinoma
lesions that were analyzed by confocal microscopy to define margins. The lesions
were excised by Mohs surgery. Six tumors showed negative margins in the first
phase of Mohs micrographic surgery. We concluded that reflectance confocal
microscopy can be useful in the preoperative definition of basal cell carcinoma
margins.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.