Objetivo: Identificar as intercorrências vasculares mais prevalentes pela injeção de ácido hialurônico em harmonização orofacial e descrever as estratégias de intervenção para tratamento dessas complicações. Revisão bibliográfica: A embolização e compressão vascular são as formas mais graves de intercorrência na harmonização orofacial ocasionadas por grandes quantidades de material injetado, desenvolvendo-se quadros de isquemia, necrose e até mesmo cegueira. A aplicação hialuronidase ainda continua off label para degradar ácido hialurônico nos casos de oclusão/compressão vascular, no entanto, esta enzima é até o momento a única opção eficiente para reverter essas complicações, onde seu efeito é incontestável nas melhores evidências disponíveis. Apesar dos preenchedores de ácido hialurônico ser bem tolerados, a compreensão adequada dos critérios clínicos e protocolos de tratamento, domínio e competência técnica para correção das intercorrências são elementos fundamentais para segurança do ácido hialurônico nas harmonizações orofaciais. Considerações finais: O conhecimento da anatomia, o planejamento adequado do tratamento, bem como o diagnóstico precoce e tratamento correto das complicações vasculares (compressão e embolização arterial, necrose, cegueira) faz com que procedimentos em harmonização facial tenham resultados previsíveis e eficientes.
Introduction: Melasma is a very common and difficult to treat hypermelanosis because it usually responds poorly to therapies, negatively affecting the quality of life of patients. Objective: to know and analyze the scientific evidence related to the treatment of patients with facial melasma treated with niacinamide. Method: a literature review was performed based on a data search in BIREME, PubMed, SciELO and ScienceDirect. Articles indexed in these electronic journals were included in the time frame from 2011 to 2019. Results: Evidence analyzes revealed a major impact on the appearance of facial melasma after niacinamide treatment. Well, the studies (100%) concluded improvement of the spots with the treatment time, improving the appearance of the skin. Conclusion: Evidence shows that niacinamide has a lightening property in adult women with improvement of melanic hyperpigmentation caused by melasma. However, there is very little evidence published in the last decade using pure niacinamide for increased pigmentation in melasma.
Hyaluronic acid-based dermal fillers are the most used materials in cosmiatry, and their clinical implications are linked to their viscoelastic properties. This study aimed to determine the rheological behavior of HA products used in Brazil by changing specific physicochemical characteristics under different test frequencies. Laboratory analyses of 0.9 mL of samples were performed in a TA-Instruments AR-1500ex Rheometer at 25 °C, at oscillation frequencies of 100, 10, 1, and 0.1 radians/second, considering the measurements of G′, G′′, and Tan δ. The value of G' increased as the oscillation frequencies were increased. In parallel, the changes in G" were the ones that varied the most for frequencies 0.1 and 1 radian/second. The maximum G' was observed with Hialurox Ultra Lift® 26 mg/g (793.45; 554.06; 423.44 Pa, 100, 10 and 1 rad/s, respectively). While the lowest G' values were obtained with Rennova Ultra Deep® (43.01; 19.75; 10.75 and 10.42 Pa at 100, 10, 1, 0.1 rad/sec, respectively). The changes that occurred in the investigated properties indicated that hyaluronic acid-based fillers vary when subjected to different conditions of shear rate, which should be considered in their clinical indication for choosing the most appropriate material according to the region to be treated.
The knowledge of facial anatomy and its correlation with ultrasonography has been gaining ground in the clinical practice of several professionals. Therefore, the knowledge of facial anatomical structures through dynamic ultrasonography images must be understood as a critical element for the clinical practice of guided esthetic facial procedures. In this pictorial essay focuses on discussing unprecedented anatomical details Temporal Extension of Bichat Fat correlating the anatomy with routine ultrasonography images. Knowledge of the US features of the temporal and buccal extensions of Bichat's fat will help narrow the differential diagnosis and guide clinical decision-making through spatial resolution and the ability to assess these structures using muscle contraction dynamically.
To analyze and describe the viscosity and the stress in relation to the shear rate of eleven facial fillers of four commercial HA brands with authorized use in Brazil through the flow sweep rheological analysis method. The rheological parameter of viscosity (η) was analyzed by rheometry tests through flow sweep. The behavior of shear stress showed that Rennova Fill Lido® and Lift Lido® have higher viscosity ratios (ƞ = 336 Pa.s and ƞ = 406 Pa.s, respectively). In contrast, Hialurox® brand fillers showed the lowest viscosity value (ƞ) (Hialurox Ultra Soft 8 mg/g® ƞ= 9 Pa.s, Fine 16 mg/g ƞ= 29 Pa.s, Fill 24 mg/g ƞ= 36 Pa.s, Lift 26 mg/g ƞ= 50 Pa.s). The flow sweep showed variations in the viscosity (ƞ) of the eleven HA dermal fillers. Rennova Fill Lido® and Lift Lido® have a lower degree of spreadability and are less susceptible to shear forces and yield strength, making them ideal candidates for the intended treatment.
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