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Letters to the Editor - Year2023 - Volume38 - Issue 1

We read, with great enthusiasm, the article ‘’Complications in orofacial harmonization procedures: a systematic review’’ by Manganaro et al. (2022)1, published in issue 37(2) of the Brazilian Journal of Plastic Surgery. The manuscript was very well prepared, and we congratulate the authors. However, we consider it important to highlight some reflections:

Regarding facial fillers, the material of choice is hyaluronic acid. Unfortunately, complications arising from using hyaluronic acid have been occurring, mainly due to the performance of non-medical health professionals. The dental surgeon and co-author of this letter (RRC) considered the hyaluronic acid application in her nose by another dental surgeon for aesthetic purposes. In a few days, the immediate ischemia evolved into necrosis, causing deformity caused by scar retraction (Figure 1A). Seven surgical repair procedures have already been performed by Plastic Surgery without, however, achieving the expected results2 (Figure 1B).

Figure 1 - A: Nasal necrosis after 6 days of hyaluronic acid application; B: Current appearance, after the 7th reparative plastic surgery.

Our study group has been presenting on possible complications of other orofacial harmonization procedures performed by dental surgeons3 4 5. In addition to the possible complications, we have warned about the judicialization of these complications at the ethical-administrative level and the civil, consumer, and criminal actions involved in these situations6. Considering the possible complications arising from these procedures, which are mostly treated by Plastic Surgery, we, the authors of this Letter to the Editor, are against the performance of orofacial harmonization by dental surgeons.

1. Instituto Bottoxindent, São Paulo, SP, Brazil

Corresponding author: Irineu Gregnanin Pedron Rua Flores do Piauí, 508, São Paulo, SP, Brazil Zip code: 08210-200 E-mail:


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