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OBJECTIVE: To translate and validate the Facial Feminization Surgery Outcomes Evaluation in Brazilian Portuguese. METHODS: A standard back-translation method was applied to obtain the final Brazilian Portuguese language version. In total, 21 Brazilian native Portuguese speakers transgender women with surgical intent and 21 Brazilian native Portuguese speakers transgender women without surgical intent were included in the study. The FFSOE was administered to both groups and all patients underwent a test-retest two weeks later. RESULTS: The FFSOE showed a high internal consistency with Cronbach's alpha greater than 0.8. The test-retest reliability was high with repeated measures being highly correlated in all items, except for item 3, where the difference was significant (p =  0.027). CONCLUSION: The FFSOE showed reliability, internal consistency and reproducibility in the evaluations. It is easy to understand and quick to apply, making it a simple tool for pre- and post-operative assessment in facial feminization surgeries. THE OXFORD 2011 LEVELS OF EVIDENCE: Level 4.

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South America is a vast territory; its people were made from all parts of the world. The miscegenation made a unique population comprised of Indian, Asian, Caucasian, African, Mestizo, Mulatto, and Zambo. The South American patients tend to have a wider face with a skin-soft tissue envelope (S-STE) that is thicker, heavier, and has less elasticity than the Caucasian patient. Upper eyelids may hood easily. In the same way, malar eminences and round face look are more prominent. The chin can be a little retracted. With aging, the S-STE tends to sag more, making nasolabial folds and jowl area more prominent, and redundant neck skin will appear loose and heavy. Facelift is popular in South American patients. They have peculiar characteristics like heavy dark sebaceous skin which lead to peculiarities in face lifting. It is usually a procedure designed to rejuvenate all thirds of the face. In the forehead, skin excision in temporal incisions is usually necessary. Midface subperiosteal lift is a possibility for heavy skin patients who need great improvement in the center of the face. The neck lift is almost indispensable to the rejuvenation of the lower third. Extended superficial muscular aponeurotic system or deep plane dissection is commonly performed so the soft tissues of the midface, the jowls, and the neck can be lifted to reestablish their youthful relationship with the underlying skeleton.

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Forehead rejuvenation goals are to raise the eyebrow, attenuate forehead wrinkles, and decrease glabellar frown lines. Endoscopic forehead lift represents a significant progress, even replacing the classic coronal and pretriquial techniques. The transpalpebral eyebrow lift allows safe direct visualization of anatomic structures comparable to the allowed by the endoscopic-assisted technique but dispenses the endoscopic instrumentation, is less expensive, and takes less time to learn. Transpalpebral eyebrow lift is a technique that produces satisfactory results in mild-to-moderate eyebrow ptosis improving eyebrow lateral third ptosis and glabellar wrinkles.

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INTRODUCTION: Leprosy, whose etiologic agent is M. leprae, has its clinical manifestations correlated with distinct immunologic forms. The mechanism of infectivity and dissemination of the disease are not completely known, although the nasal mucosa is supposed to have an important role in pathogenesis. OBJECTIVE: To correlate the clinical and bacteriological parameters with that of nasal biopsy and immunological tests, such as lepromin and ML-Flow results, in untreated leprosy patients. MATERIAL AND METHOD: Two hundred and twenty-two patients were evaluated, clinically classified and subjected to skin smear, nasal biopsy, ML-Flow, and Mitsuda test. RESULTS: 689% of the cases were borderline cases. Nasal biopsy revealed 91.4% positivity in those who had specific antibodies against M. leprae on blood sample. Lepromatous leprosy cases were 100% positive on ML-flow test, had a large involvement in the nasal mucosa (91%), positive skin smears (100%) and negative Mitsuda test. Nasal bacillary index showed a good correlation with ML-Flow and had similar results when compared to skin smear. The tests agreement was good, revealing that nasal biopsy can be reliable in the diagnosis of multibacillary clinical forms and in the evaluation of the immunological status of leprosy patients. CONCLUSION: The presence of disseminated bacilli in the nasal mucosa was similar to skin involvement, when correlated with Mitsuda test and ML-Flow. As a result, the role of nasal bacillary index may play an important role in the clinical and immunologic characterization of leprosy patients.

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INTRODUÇÃO: A prévia avaliação da anatomia do paciente é fundamental para atingir uma ponta nasal bem definida em rinoplastia. A espessura do tecido subcutâneo é essencial para a harmonia estética dessa região. Técnicas de mensuração dessas estruturas no paciente "in vivo" não estão padronizadas na literatura. OBJETIVO: Avaliar a variabilidade interobservador do método ultrassonográfico para medida da espessura do tecido subcutâneo da ponta nasal por de ultrasonografia. MÉTODO: 47 voluntários submeteram-se a ultrasonografia da ponta nasal por dois especialistas em radiologia que utilizaram a mesma técnica de exame com transdutor eletrônico linear na frequência de 5 a 9 MHz. Avaliou-se a espessura do tecido subcutâneo através da medida do ponto de maior projeção do domo da cartilagem alar maior até a pele. Estudo prospectivo. RESULTADOS: As médias das medidas do tecido subcutâneo da ponta nasal obtidas pelos examinadores não apresentaram diferenças estatisticamente significante (p = 0. 5303). Na análise da reprodutibilidade entre examinadores encontrou-se coeficiente de correlação interclasse r (Pearson) 0,9333, isto é, uma excelente reprodutibilidade interobservadores. CONCLUSÃO: A ultrassonografia demonstrou-se reprodutível e excelente concordância entre os examinadores para avaliação da espessura do tecido subcutâneo da pele, auxiliando o cirurgião na análise pré-operatória do paciente e na escolha da melhor técnica cirúrgica para cada caso.

INTRODUCTION: The previous evaluation of the patient's anatomy is crucial to achieve a sharp nasal tip in a rhinoplasty. The thickness of the subcutaneous tissue is indispensable for the esthetical harmony of the area. Techniques to measure such structures on the patient 'in vivo' are not found in literature. OBJECTIVE: Evaluate the inter-observer inconsistency of the ultrasound method to measure the thickness of the subcutaneous tissue of the nasal tip by way of an ultrasound. METHOD: 47 volunteers were submitted to a nasal tip ultrasound performed by two radiology specialists, who used the same exam technique with a linear electronic transducer at a frequency between 5 and 9 MHz. The thickness of the subcutaneous tissue was evaluated by measuring the point with the highest protrusion of the largest alar cartilage dome towards skin. Prospective study. RESULTS: The measurement averages of the subcutaneous tissue of the nasal tip achieved by the examiners did not show statistically significant differences (p = 0. 5303). When analyzing the reproducibility between examiners, an interclass 'r'correlation coefficient (Pearson) 0. 9333, i. e. , an excellent inter-observer reproducibility was found. CONCLUSION: The ultrasound proved to be reproducible and examiners satisfactorily agree about evaluating the thickness of the subcutaneous tissue of the skin, thus helping the surgeon perform the pre-surgical analysis and find the best surgical technique for each case.

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UNLABELLED: Complications in blepharoplasty are uncommon and, when they occur, they are usually mild and transient, such as hematomas and chemosis. However, sometimes they can be severe, such as blindness, or they might require surgical correction, such as ectropion. OBJECTIVE: To evaluate the results and complications of transcutaneous blepharoplasty performed in the same procedure, discussing how to treat and how to avoid them. METHODS: A retrospective study of 200 medical records of consecutive patients that underwent transcutaneous blepharoplasty from January 2007 to January 2009. The variables analyzed were age, gender, complications, clinical outcome, patient satisfaction, and photographic documentation. RESULTS: The incidence of complications was 9.5% (19 patients). The complications were 1 hematoma, 12 cases of chemosis and 13 patients who underwent canthoplasty, 6 patients with malposition of the lower eyelid (5 retractions and 1 ectropion). Medical treatment was performed in 12 patients and revision surgery in 7 cases of all the patients who had complications. CONCLUSIONS: We demonstrated that blepharoplasty is a procedure with a high satisfaction and a low complication rate, and it is an excellent surgical procedure, when properly indicated.

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Complications in blepharoplasty are uncommon and, when they occur, they are usually mild and transient, such as hematomas and chemosis. However, sometimes they can be severe, such as blindness, or they might require surgical correction, such as ectropion. OBJECTIVE: To evaluate the results and complications of transcutaneous blepharoplasty performed in the same procedure, discussing how to treat and how to avoid them. METHODS: A retrospective study of 200 medical records of consecutive patients that underwent transcutaneous blepharoplasty from January 2007 to January 2009. The variables analyzed were age, gender, complications, clinical outcome, patient satisfaction, and photographic documentation. RESULTS: The incidence of complications was 9.5 percent (19 patients). The complications were 1 hematoma, 12 cases of chemosis and 13 patients who underwent canthoplasty, 6 patients with malposition of the lower eyelid (5 retractions and 1 ectropion). Medical treatment was performed in 12 patients and revision surgery in 7 cases of all the patients who had complications. CONCLUSIONS: We demonstrated that blepharoplasty is a procedure with a high satisfaction and a low complication rate, and it is an excellent surgical procedure, when properly indicated.

As complicações em blefaroplastia não são comuns e quando ocorrem são geralmente discretas e transitórias, como hematoma e quemose. Entretanto, algumas vezes podem ser definitivas, como cegueira, ou necessitarem de novas abordagens cirúrgicas para correção, como ectrópio. OBJETIVO: Avaliar resultados e complicações das blefaroplastias transcutâneas realizadas em um mesmo serviço, demonstrando como tratá-las e evitá-las. CASUÍSTICA E MÉTODO: Estudo retrospectivo de 200 prontuários de pacientes consecutivos submetidos à blefaroplastia transcutânea entre o período de janeiro de 2007 a janeiro de 2009 em um mesmo serviço. As variáveis analisadas foram: idade, sexo, complicações, evolução clínica, grau de satisfação e documentação fotográfica. RESULTADOS: A incidência de complicações foi de 9,5 por cento (19 pacientes). As complicações encontradas foram: 1 hematoma, 12 casos de quemose, sendo que esta ocorreu em 61,5 por cento dos 13 pacientes que realizaram cantoplastia, 6 pacientes com mau posicionamento de pálpebra inferior, sendo que, destes, 5 correspondem à retração e 1 ao ectrópio. Foi realizado tratamento clínico com acompanhamento ambulatorial em 12 pacientes e cirurgia revisional em 7 casos do total de pacientes com complicações. CONCLUSÕES: Demonstrou-se que a blefaroplastia é uma cirurgia com alta taxa de satisfação e baixo número de complicações, sendo um excelente procedimento cirúrgico, quando corretamente indicada.

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