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Background: Limited long-term safety data are published on HA/CaHA/L, a hybrid dermal filler combining hyaluronic acid (HA), calcium hydroxyapatite (CaHA), and lidocaine (L). Methods: This retrospective multicenter study assessed treatment-emergent adverse events (TEAEs) in adults treated with HA/CaHA/L. The full analysis set (FAS) included eligible consented adults (N = 403); the long-term safety analysis (LTSA) set included FAS participants with greater than or equal to 12-months HA/CaHA/L exposure (n = 243). Results: Participants were majority female (94.0%), with Fitzpatrick skin phototypes II/III (80.1%) and a mean age of 50.1 years. Most participants (86.4%) received one HA/CaHA/L treatment. The median time between participants' first HA/CaHA/L treatment and chart review was 15.4 months. Participants received a mean of 2.2 mL (0.5-8.9 mL) filler per treatment. Treated areas were predominantly malar (71.2%) and mandible (69.7%) regions. Most participants (95.0%) had one or more aesthetic treatments other than HA/CaHA/L [eg, other dermal fillers (84.1%), botulinum toxin (63.3%)]. Nineteen (4.7%) FAS participants had 20 documented TEAEs; most (3.5%, n = 14 participants) were mild in severity. Twelve TEAEs in 11 participants (2.7%) were related to HA/CaHA/L: induration (three, 0.7%), edema (3, 0.7%), and implant site nodules (five, 1.2%), which were noninflammatory and likely related to product placement. Among the LTSA, 15 (6.2%) participants had 16 documented TEAEs (six edema, five implant site nodules, one inflammation, three skin induration, one hypersensitivity); most were mild in severity. Nine TEAEs in eight participants (3.3%) were HA/CaHA/L-related. No treatment-emergent serious AEs were reported. Conclusion: The data from this noninterventional retrospective study support the favorable longer term (>12 month) safety profile of HA/CaHA/L.

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INTRODUCTION: Enhancing and altering body contours has increasingly been the focus of new technologies and techniques in aesthetic treatments. The buttocks are seen as a symbol of beauty, sensuality, and attraction. PATIENTS AND METHODS: The authors described a technique for female and male gluteal augmentation. It uses a special marking, a safe plan, and a specific product. The patients chosen for this technique wanted to have an augmentation or projection effect on the buttocks, but were not willing to undergo surgery. The product used was Sofiderm Subskin Aeskins. The plan of injection was the subcutaneous as no major blood vessels were found. RESULTS: The authors report good aesthetic results with the proposed technique. The patients reported a high degree of satisfaction. DISCUSSION: The product chosen has a high G prime and a larger molecule size, which accounts for resistance to deformation and a high lifting power. Thus, result can be visible in a large body area. As the anatomy between male and female buttocks are different, different techniques were used for each gender. CONCLUSION: The LL body contour technique for gluteal augmentation proved to be a minimally invasive technique, with quick results, without major risks and downtime.

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The lower third is very important for the pleasant appearance of the face. A well-contoured jawline is desirable in men and women, giving a perception of beauty and youth. It is also key to sexual dimorphism, defining masculine and feminine characteristics. The nonsurgical rejuvenation and beautification of the lower third of the face is becoming more frequent. Injectable fillers can reshape the jawline, lift soft tissues, and improve facial proportions, effectively improving the appearance of the area. It is paramount to understand the facial anatomy and perform a good facial assessment in order to propose a proper aesthetic treatment plan. The aesthetic goal of the rejuvenation approach is to redefine the mandibular angle and line. In young patients, beautification can be achieved through correction of constitutional deficit or enhancement of the contour of the face, improving the facial shape. It is very important to possess knowledge of facial anatomy and of the aging process in order to deliver effective and safe results. In this article, we discuss the anatomy of the lower third of the face, facial assessment, aging process, and treatments of the chin, prejowls and mandibular line and angle with injectable fillers. The authors' experience in the approach of this area is discussed.

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Introduction The facial beauty is not easy to define, yet it is paramount to assess the needs of each patient to propose an appropriate treatment plan that will provide beautification or rejuvenation in a natural-looking fashion. One of the beauty aspects easily recognized is the face shape, which can give a perception of age, gender, and attractiveness, and reflects the facial anatomical structure. Because addressing the structure of the face is the basis for the aesthetic approach with dermal fillers, we find the identification of the patient's face shape to be a very good starting point in the facial assessment. Objective To discuss important aspects of facial beauty, the characteristics of the different facial shapes (oval, heart, round, and angular), and a method of planning the aesthetic treatment with injectable fillers based on the strengths and weaknesses of each morphology of the face, that is called the AB face technique. Methods In this study, we describe seven clinical cases: two cases each of oval, heart, and round, and one case of angular shape. Results The evaluation of the face shape can help us define the priorities of the aesthetic approach, determining the areas that need to be restored in the aging face, as well as which areas could be enhanced in the younger patient. Conclusion This approach can be helpful in proposing the aesthetic treatment plan with injectable fillers to provide beautification, rejuvenation, and enhancement of the facial structure, which may benefit facial contours through aging.

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The determination of the chronological order of crossing ink lines is a difficult problem in the examination of Questioned Documents. Modern methodologies are based on non-destructive chemical and physical analysis. However, the determination of the chronological sequence of crossing ink lines remains visual and subjective. This manuscript describes a study where Raman hyperspectral imaging is associated with different chemometric techniques and a novel method is applied for the objective determination of the chronological order of gel pen ink crossings. Eight blue and black gel pens of different brands were used to prepare 56 crossings on white paper. Raman mapping analyzed the entire crossing and the hyperspectral images were treated with k-means, Multivariate Curve Resolution - Alternating Least Squares (MCR-ALS) and Partial Least Squares - Discriminant Analysis (PLS-DA). The order of crossings was determined visually and using a novel method that consisted in calculating the relative quantity of pixels of each ink in the crossing region that were equal or higher than an established threshold. Different thresholds were tested using mean and standard deviation. The MCR-ALS and the thresholds mean minus 1,96 of the standard deviation and the mean minus 2575 of the standard deviation determined correctly more than 70% of the crossings. This method proved to be more efficient than microscopy examination and more objective since no inconclusive determinations were obtained. The methodology is promising for entirely objective and highly effective determination of the chronological sequence of crossing ink lines.

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The determination of the chronological sequence of crossing ink lines is a recurrent issue in the forensic examination of questioned documents. This manuscript intends to evaluate the potential of hyperspectral imaging in the near infrared range (HSI-NIR) combined with multivariate data analysis for rapid, objective and nondestructive analysis of crossing ink lines made with black pens. Twenty-one black gel and ballpoint pens from different brands and models were employed to prepare crossing combinations in both orders in white office paper. An initial pre-selection and extraction step using the Principal Components Analysis (PCA) scores plot arranged as histograms was necessary for extracting the inks spectra. Then, Partial Least Squares-Discriminant Analysis (PLS-DA) was applied for selection of the most important variables. Multivariate Curve Resolution-Alternating Least Squares (MCR-ALS) in the augmented form was performed using both the raw and the pre-processed spectra. However, the pre-processing of spectra resulted in incorrect identification of pixels in the inks distribution maps. The MCR-ALS results obtained using the raw spectra allowed the correct determination of the order of crossings in only one pair of gel-gel pen crossings. The remainder were either impossible to discriminate ink from paper or the skipping of one pen ink line led to incorrect determinations in one of the orders. In spite of the practical advantages of the HSI-NIR for document examination and the different chemometric approaches considered for surpassing some of the spectral limitations, the results obtained demonstrate the difficulties of using this technology for application in real forensic cases.

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Determining the chronological order of crossed lines is a recurrent problem in forensic analysis of documents. One of the most important requirement of these analyses is the use of non-destructive techniques to maintain the integrity of the documents for further analysis as judicial evidences. Thus, this work proposes an objective, non-destructive, easy-to-execute analysis protocol for forensic analysis, using the hyperspectral mode of the VSC6000®, which is an equipment found in most laboratories of questioned documents. Seven blue ballpoint pens of different brands were used to make crossings on white paper, a total of 49. The spectra were obtained from 400 to 1000 nm, and analyzed with HYPER-Tools. Initially, univariate analysis was used, selecting discriminating wavelengths to visualize the images and determine the chronological order of the crossings, and then, when necessary, a multivariate approach using Multivariate Curve Resolution - Alternating Least Squares (MCR-ALS) was applied. The interpretation of the order was made visually, taking into account characteristics of the strokes, such as the continuity and amount of ink. In this way, it was possible to determine the chronological order of 31/49 crossings, which corresponds to an overall rate of 63% accuracy. The method was validated by performing a double-blind test with 8 crossings, which indicated only a small influence of the analyst. The method was also applied to the analysis of a police inquiry, which was provided by the Federal Police and compared with the routine analyzes. The results were concordant but the proposed method provided a more objective analysis than the ones currently in practice at the Police.

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Introdução: Na última década, o uso do preenchimento com ácido hialurônico para aprimoramento facial aumentou na América Latina. O preenchimento com ácido hialurônico é considerado seguro com baixa incidência de eventos adversos. Como eventos adversos são pouco observados na prática clínica ou têm sido possivelmente sub-relatados são necessárias mais orientações para diagnosticar e tratar eventos adversos relacionados ao ácido hialurônico. Objetivo: Compreender melhor os eventos adversos relacionados ao ácido hialurônico e propor recomendações para o diagnóstico e tratamento. Métodos: Reunião em painel de 25 especialistas médicos multidisciplinares da América Latina foi realizada em São Paulo, Brasil, para discutir o que se conhece sobre eventos adversos relacionados ao ácido hialurônico e fornecer conhecimentos baseados na experiência clínica. Por meio de consenso, foram desenvolvidos recomendações e algoritmos. Resultados: O painel categorizou eventos adversos relacionados ao ácido hialurônico baseado em três momentos de início (imediato, precoce e tardio) e propôs um novo termo para eventos adversos que apresentam edema tardio intermitente persistente ("Etip"). Foram criados algoritmos para diagnóstico e tratamento em cada momento. Conclusões: Novos algoritmos consensuais para diagnósticos e tratamentos associados ao momento de início dos eventos adversos relacionados ao ácido hialurônico orientarão melhores práticas no uso clínico do preenchimento com ácido hialurônico.

Introduction: In the last decade, the use of hyaluronic acid fillers for facial enhancement has increased in Latin America. Hyaluronic acid fillers are considered relatively safe with a low incidence of adverse events. Because adverse events are not seen frequently in clinical practice or have been potentially underreported, there is a need for more guidance on the diagnosis and treatment of Hyaluronic acid-related adverse events. Objecti ve: To provide an enhanced understanding of hyaluronic acid-related adverse events and to propose recommendations for their diagnosis and treatment. Methods: A 25-member multi-disciplinary expert panel meeting of Latin-American physicians was convened in Sao Paulo, Brazil to discuss what is known about hyaluronic acid-related adverse events and to provide insights based on clinical experience. Recommendations and algorithms were developed through a consensus process. Results: The panel categorized hyaluronic acid-related adverse events based on 3 time frames of onset (immediate, early and Late) and proposed a new term for adverse events that display persistent, intermittent, delayed Swelling (PIDS). Algorithms were created for diagnosis and treatment for each time frame. Conc lusions: The new consensus algorithms for time-related diagnosis and treatment of hyaluronic acid-related adverse events will provide guidance for best practices in the clinical use of hyaluronic acid fillers.

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With aging, anatomical changes are observed in the face. In the lower third, these changes are expressed as ptosis of the angle of the mouth, lip enhancement groove mentalis; decrease in concavity between the jaw and neck and very noticeable platysmal banding. The repeated contraction of muscles of the lateral-chin together with the band platysmal side form what are called a marionette groove. Treating the whole lateral-chin area can result in a more harmonious aspect of the face when compared with treatment of a marionette groove in isolation. In this paper we describe combined treatment of the lateral chin area using botulinum toxin and fillers.

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With aging, anatomical changes are observed in the face. In the lower third, these changes are expressed as ptosis of the angle of the mouth, lip enhancement groove mentalis; decrease in concavity between the jaw and neck and very noticeable platysmal banding. The repeated contraction of muscles of the lateral-chin together with the band platysmal side form what are called a marionette groove. Treating the whole lateral-chin area can result in a more harmonious aspect of the face when compared with treatment of a marionette groove in isolation. In this paper we describe combined treatment of the lateral chin area using botulinum toxin and fillers.

Com o envelhecimento observamos mudanças anatômicas na face. No terço inferior essas mudanças se expressam como ptose do ângulo da boca; acentuação do sulco lábio mentoniano; diminuição da concavidade entre a mandíbula e o pescoço e formação de bandas platismais bem evidentes. A contração repetida dos músculos da região latero-mentoniana juntamente com a banda platismal lateral, forma o que chamamos de sulco de marionette. Ao tratarmos toda região latero-mentoniana conseguimos um resultado mais harmônico, quando comparado com o tratamento isolado do sulco de marionette. Nesse artigo apresentamos o tratamento combinado da região latero mentoniana com o uso de toxina botulínica e preenchedores.

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As técnicas de preenchimento do sulco nasojugal com ácido hialurônico são amplamente discutidas pelos dermatologistas, cirurgiões plásticos e oftalmologistas, inexistindo, entretanto, consenso a esse respeito nas recentes revisões bibliográficas. Pelo fato de o sulco nasojugal localizar-se em topografia de pele delgada, próxima ao globo ocular, e ser em região muito vascularizada, a aplicação de ácido hialurônico com agulhas, pode trazer complicações indesejáveis como: injeção intravascular, equimoses e hematomas. Assim, desenvolvemos técnica inovadora de preenchimento com ácido hialurônico nessa área, em retroinjeção e com microcânula 30G, sempre após criteriosa avaliação do paciente.

The techniques for filling the nasojugal fold with hyaluronic acid are widely discussed by dermatologists, plastic surgeons, and ophthalmologists but lack consensus in the recent literature reviews. Due to the location of the nasojugal fold ­ in a topographic region that has thin skin, is close to the eye, and is intensely vascularized ­ the application of hyaluronic acid with needles can cause undesired complications such as intravascular injection, echymoses, and hematomas. Thus, an innovative hyaluronic acid filling technique for this area was developed based on the careful evaluation of patients: retroinjection with the 30G microcannula.

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Trata-se da descrição de técnica de preenchimento labial com ácido hialurônico utilizando microcânulas, que diminui muito o número de pertuitos necessários ao método convencional com agulhas e reduz a possibilidade de injeção intravascular do produto, além de restringir o risco de ruptura de estruturas nobres, como vasos e nervos, devido à ponta romba. Os resultados encontrados confirmam a menor ocorrência de efeitos indesejáveis e alto grau de satisfação de médicos e pacientes.

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Introdução: Características anatômicas distintas e espectros cinéticos variados determinam padrões de contração da musculatura frontal peculiares a cada pessoa.Objetivo: Identificar e classificar os padrões de contração da musculatura frontal de pacientes que procuraram atendimento para tratamento de rugas frontais. Métodos: Análise retrospectiva de fotografias de 83 pacientes. O padrão de contraçãomuscular foi classificado de acordo com a área hipercinética predominante, observada na fotografia em contração máxima do músculo frontal.Resultados: Foram identificados três padrões de contração: total, medial e lateral. O padrão total foi observado em 50,6% dos casos.As rítides horizontais presentes no centro da fronte avançam lateralmente além da linha mediopupilar, até o final da cauda das sobrancelhas. O padrão medial foi observado em 25,3% dos casos.As rítides horizontaisconcentram-se na região central da fronte, contidas predominantemente entre as linhas mediopupilares. O padrão lateral foi observado em 24% dos casos.As rítides horizontais predominam nas laterais da fronte, a maioria ocorrendo após a linha mediopupilar. Conclusões: A identificação e classificação dos padrões de contração do músculo frontal permitem avaliação mais individualizada de cada paciente, o que é um dos pilares mais importantes para um plano terapêutico bem-sucedido.