Background Hyaluronic acid fillers are the second-most commonly performed nonsurgical procedure. Arterial thrombosis is their most devastating complication. Recent research shows that along hyaluronic acid thrombi, a platelet/fibrin thrombus forms in the site of injection. This is not addressed by current management protocols, which focus on perivascular hyaluronidase plus adjuvant strategies to increase blood flow. We experimented with an animal model utilizing both hyaluronidase and a thrombolytic agent for treatment of occlusion. Objectives The authors sought to evaluate the efficacy of a combined treatment of hyaluronidase with a thrombolytic agent applied perivascularly to an artery occluded with hyaluronic acid. Methods After direct intravascular injection into the femoral artery, rats were randomized to receive one of the following perivascular solutions: saline, hyaluronidase, alteplase, or hyaluronidase + alteplase. Reperfusion, distal bleeding, and microscopic findings were evaluated 4 hours after intervention. Results None of the subjects in the control group showed signs of reperfusion. In the hyaluronidase group, 60% reperfused, 10% completely, the rest only partially. In the alteplase group, 50% reperfused partially. In the hyaluronidase + alteplase group, 50% had partial and 50% complete prepermeabilization. Kruskal-Wallis test showed a P < 0.0001 favoring hyaluronidase + alteplase. Microscopic findings were compatible with bleeding rates. Conclusions Both hyaluronic acid and red thrombi play a role in the occluded vessel. Perivascular application of hyaluronidase with a thrombolytic agent seems to achieve greater reperfusion rates than either one alone. If proven safe in humans, this strategy could make treatment more effective while still being suitable for an outpatient setting.

BACKGROUND Carpal tunnel syndrome is the most common peripheral neuropathy affecting patients at productive age and has an important economical impact on those who suffer it. This study assessed the diagnostic performance of carpal tunnel syndrome´s signs and described the epidemiology at a tertiary care center in Mexico City. METHODS All patients diagnosed with carpal tunnel syndrome during a fiveyear period were included. Demographic data, electromyography results, positive clinical signs and the severity score according to the Italian scale were recorded. Diagnostic accuracy of Tinel and Phalen´s signs were calculated via odds ratio. RESULTS Totally, 650 patients were diagnosed and treated during a fiveyear period, 84% were female and 16% male, and the mean age was 55.8 years. The associated comorbidities were trigger finger (36.1%), thyroid disease (25.6%) and diabetes (20%). Diagnosis yielded for Phalen and Tinel signs were variable in each of the study groups (males and females) and showed to be beneficial in diagnosis of the disease. CONCLUSION Carpal tunnel syndrome is a complex disease in which clinical signs remain the cornerstone of diagnosis. Extension studies are useful to assess the severity of the disease.

Upper eyelid blepharoplasty is one of the most frequently performed surgeries by plastic surgeons worldwide. A prospective observational study was conducted to describe the anthropometric measurements of the upper eyelid and eyebrow in a Mexican population. The researcher measured the anthropometry of the eyelids and eyebrows to establish the diagnosis and surgical plan according to the checklist created and applied by the plastic and reconstructive surgery service. In anatomical position with a caliper instrument, the marginal reflex distance (MRD1), the tarsal thickness, the length of the vertical and horizontal slit, and finally the distance at which the external canthus is located with respect to the internal canthus were measured in millimeters. For the anthropometry of the eyebrows, the distance from the eyebrows to the hairline, the position in millimeters of the orbital rim with respect to the eyebrow, and the angle of its apex were measured. A sample of 210 patients was obtained, of which 65 were male and 145 females, divided by age groups. It was observed that in the three age groups, females presented a vertical palpebral fissure with a higher mean than males. Similar is the case of tarsal thickness, in which the difference was significantly greater in the female of the three age groups. On the other hand, it was observed that the horizontal slit in males was higher than that of females, while the MDR1 was similar in both sexes. Finally, it was identified that in the group of 41 to 50 years old significant decreases are observed both in the vertical cleft, tarsal thickness

Wound healing and cicatrization is a process that involves several phases. The main goal of a surgeon and specially the plastic surgeon is to achieve the best cosmetic results and avoid complications. Several tools are available to achieve the best result. One of the tools recently studied is the use of Botulinum toxin. The use of Botulinum toxin has showed to be a useful aid by improving macroscopic cosmetic changes, as histopathologic ones. The increase of the tensile strength is also one of the positive changes that come with the use of botulinum toxin.

Background: Neurofribromatosis type 1 (NF1), also known as von Recklinghausen disease, is the most common type of neurogenetic disorder with a worldwide incidence of between 1 in 2,600 and 1 in 3,000. The approach and treatment of NF1 must be multidisciplinary because of the complexity of the disease. There is no specific treatment for NF1. Plastic surgeons are frequently involved in the surgical management of patients with head and neck involvement.Case presentation: A 42-year-old man patient presents with the diagnosis of NF1. A multidisciplinary approach was carried out. MRI ruled out CNS involvement. Due to the extension of the plexiform neurofibromas and the absence of donor areas for skin grafts, surgical resection of neurofibromas that compromised facial aesthetic subunits, as well as those in the larger joint and fold sites, was performed. The procedure was performed with two teams of plastic surgeons, performing an immediate reconstruction. The patient was discharged without complications.Discussion: NF1 is the most common variant and represents up to 97% of all diagnosed neurofibromatosis. Neurofibromas are benign tumors, and most of them begin to appear near puberty, and their location can affect any anatomical site. The craniofacial area and the neck are affected in more than 10% of all cases and are the most affected by plexiform neurofibromas. There is no effective treatment to prevent disease progression. Patients' priority from the point of view of plastic surgery is a functional and aesthetic correction, avoiding facial and body disfigurements. Today, there is no accepted gold standard surgical technique.Conclusion: The approach and treatment of these patients must be through a multidisciplinary group due to their high complexity. The plastic surgeon's treatment should focus on the restoration of function as a priority and restoration of aesthetics as a secondary goal. Careful and individualized pre-surgical planning must be done.