Este trabalho resultou de uma investigação que objetivou verificar e analisar, do ponto de vista de trabalhadoras que se submeteram a cirurgia plástica estética, se e de que modo o embelezamento físico se mostra como requisito da gestão gerencialista para o exercício do trabalho imaterial. Para tanto a revisão da literatura abrangeu trabalho imaterial, através de autores como Gorz, Grisci e Pelbart, gestão gerencialista, através de autores como Gaulejac e Chanlat, e embelezamento físico, através de autores como Mansano, Bauman e Lipovetsky. Trata-se de uma pesquisa qualitativa e exploratória, e, para sua realização foram entrevistados seis cirurgiões plásticos e seis trabalhadoras, indicadas por estes, que se submeteram a cirurgia plástica estética. As entrevistas ocorreram em três cidades do Rio Grande do Sul. A análise dos dados deu-se segundo os parâmetros de Minayo (2001). As evidências empíricas mostraram que, no caso das trabalhadoras entrevistadas, o embelezamento físico pode ser considerado requisito da gestão gerencialista para o exercício do trabalho imaterial. Além disso, mostraram que características da gestão gerencialista e do trabalho imaterial encontravam-se na narrativa das trabalhadoras estudadas. Mostraram ainda que os cirurgiões plásticos estéticos entrevistados, confirmam a tese de que, no caso, das trabalhadoras analisadas, a cirurgia plástica estética pode ser considerada um elemento de embelezamento físico utilizado a fim de se conseguir retorno no trabalho de cada uma. Por fim, as narrativas revelaram que a cirurgia plástica estética é também um artifício utilizado pelas trabalhadoras entrevistadas na tentativa de manter-se dentro de um determinado padrão de embelezamento físico que pode gerar rendimentos ao trabalho imaterial. / This paper is the result of a study that aimed to verify and analyze, from the point of view of workers that underwent cosmetic plastic surgery, if and how physical beautification is a requirement of managerialism to perform immaterial labor. The literature review included immaterial labor, through authors such as Gorz, Grisci and Pelbart, managerialism, through authors such as Gaulejac and Chanlat, and physical beautification, through authors such as Mansano, Bauman and Lipovetsky. This is a qualitative and exploratory research, and six plastic surgeons and six female workers were interviewed, workers who were referred by the surgeons and had undergone plastic surgery. The interviews took place in three cities of Rio Grande do Sul. Data analysis was performed according to Minayo’s parameters (2001). Empirical evidence has shown that, in the case of female workers interviewed, physical beautification may be considered a requirement of managerial management for the exercise of immaterial labor. In addition, they showed that characteristics of managerialist management and immaterial work were found in the narrative of the workers studied. They also showed that the aesthetic plastic surgeons interviewed confirm the thesis that, in the case of the workers analyzed, cosmetic plastic surgery can be considered as a physical embellishment element used in order to achieve a return in the work of each one. Finally, the narratives revealed that cosmetic plastic surgery is also an artifice used by the workers interviewed in an attempt to keep within a certain pattern of physical beautification that can generate income for immaterial labor.

As cirurgias de reconstrução parcial ou total de orelha são um desafio na medicina, exigindo técnicas complexas e qualificadas, sendo as mais utilizadas àquelas que fazem uso de material autógeno (cartilagem da costela do próprio paciente). Trata-se de um processo artesanal em que o cirurgião deve esculpir manualmente a cartilagem para formar o modelo tridimensional da orelha, denominado framework, dessa forma, o resultado final depende, principalmente, da habilidade do cirurgião plástico. Tendo isso em vista, busca-se, neste trabalho, empregar as tecnologias computacionais utilizadas no Design Virtual para auxiliar o planejamento cirúrgico, utilizando digitalização tridimensional e fabricação digital para aprimorar o resultado da técnica de reconstrução auricular. A metodologia proposta sugere a digitalização tridimensional do paciente e, a partir disso, são projetados templates cirúrgicos para auxiliar a modelagem e o posicionamento do framework. A aplicação cirúrgica valida alguns pontos e possibilita o estudo de melhorias em determinados templates, utilizados então em outras duas reconstruções, obtendo-se resultados positivos. Assim, o uso do Design Virtual mostra-se confiável e útil na cirurgia de reconstrução auricular, levando à melhoria no planejamento e, assim, diminuição do tempo cirúrgico, sem riscos ou complicações ao paciente e com melhores resultados anatômicos. / The partial or total reconstruction of ear is a challenge in plastic surgery, requiring complex and skilled techniques. The most successful reconstructions use autogenous material (cartilage from the patient's own rib). It is a handmade process in which the surgeon must manually sculpt the cartilages to form the three-dimensional model of the ear, usually called as framework. Considering this, the final result depends mainly on the plastic surgeon's skill. In this scenario, the aim of this research is employ computer technologies used in Virtual Design to aid surgical planning, using three-dimensional scanning and digital manufacturing to improve the result of ear reconstruction technique. The proposed methodology suggests surgical templates, based on 3D patient scan, designed to assist the modeling and positioning of the framework. The surgical application validates some points and allows the study of improvements in certain templates, then used in other two surgeries, with positive results. Thus, the use of Virtual Design proves to be reliable and useful in ear reconstruction surgery, leading to improved planning and decreasing surgical time, without any risks or complications for the patient and with better anatomical results.

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No. of bitstreams: 1 Raquel Pereira Quadrado.pdf: 1597585 bytes, checksum: a0bd1546cdd1f4de4534281f0c2811f2 (MD5) Previous issue date: 2012 / Esta tese foi produzida no Programa de Pós-Graduação em Educação em Ciências: Química da Vida e Saúde, na linha de pesquisa "Educação científica: implicações das práticas científicas na constituição dos sujeitos", com o objetivo de investigar, nas comunidades que discutem cirurgias plásticas no site de rede social Orkut, os discursos que atuam na produção dos corpos dos homens, bem como os marcadores de gênero que neles se inscrevem. A ancoragem teórica a partir da qual desenvolvemos esta pesquisa situa-se no campo dos Estudos Culturais, nas suas vertentes pós-estruturalistas, agregando, também, ferramentas conceituais que foram produtivas para o desenvolvimento do processo investigativo, tais como algumas proposições de Michel Foucault - subjetividade, verdade, poder, cuidado de si, entre outras - e o entendimento de bioascese corporal, tomado a partir de Francisco Ortega. Para proceder a pesquisa, analisamos a participação e interação dos homens em setenta e quatro (74) comunidades do Orkut, que têm as cirurgias plásticas como foco das suas discussões, no período de 2009 a 2011. O corpus de análise foi constituído a partir de alguns elementos presentes nas comunidades - nome da comunidade, texto que a descreve e apresenta os seus objetivos, imagem exibida para sua identificação, quem é o/a dono/a (homem ou mulher), número total de participantes, porcentagem de homens e de mulheres participantes - e também pelas postagens dos homens nos fóruns dessas comunidades. No processo de análise dos dados, utilizamos alguns elementos da análise do discurso foucaultiana, especialmente as concepções de discurso e de enunciado. As comunidades selecionadas são representativas dos processos de reconfiguração social contemporâneos, em que os grupos se formam não mais pela proximidade geográfica, mas, sim, por meio dos laços estabelecidos nas interconexões, baseados em interesses e afinidades mútuas, como é o caso das cirurgias plásticas, nesta pesquisa. Dentre as comunidades analisadas, vimos que aquelas que tinham homens como donos contavam com maior participação masculina, sendo que as cirurgias plásticas eram abordadas a partir do discurso médico, apontando para os significados de masculinidade hegemônica que instituem a ciência como um campo masculino. Nas comunidades que tinham mulheres como donas, a participação dos homens era menor e as discussões eram estabelecidas sob o ponto de vista estético, em que os participantes relatavam suas experiências pessoais relativas aos procedimentos que realizaram ou expressavam o desejo de submeterem-se a uma cirurgia plástica. As análises apontam para a existência de discursos e práticas que vêm instituindo os corpos como produtos e mercadorias da cultura de consumo, de modo que a aparência desejada pode ser cirurgicamente esculpida e comprada. Tais práticas têm produzido uma incitação à visibilidade da vida de cada sujeito, promovendo um deslocamento da subjetividade interiorizada em direção a sua exteriorização, num processo de somatização da subjetividade, em que o corpo torna-se a superfície de inscrição dos marcadores sociais, como as masculinidades aqui analisadas, e passa a ser central na experiência de si. As cirurgias plásticas estéticas constituem, nesse contexto, uma estratégia de reinvenção do corpo, uma prática de bioascese, uma vez que possibilitam operar sobre um corpo plástico e maleável a fim de que este exteriorize e expresse o que o sujeito deseja parecer e ser. / This thesis was produced in the Post-Graduate Program in Science Education (Programa de Pós-Graduação em Educação em Ciências: Química da Vida e Saúde), in the research line "Scientific education: implications of scientific practices in the constitution of subjects", in order to investigate, in communities that discuss plastic surgeries in the Orkut social network site, discourses that operate in the production of bodies of men, as well as gender markers inscribed in them. The theoretical grounding from which this research was developed lies in the field of Cultural Studies, in its post-structuralist strands, also adding conceptual tools that have been productive for the development of the investigative process, such as some propositions of Michel Foucault - subjectivity, truth, power, self care, among others - and the understanding of corporal bioasceticism, taken from Francisco Ortega. To conduct the research, it was analyzed the participation and interaction of men in seventy-four (74) communities from the Orkut, which have plastic surgery as a focus of their discussions, in the period 2009 to 2011. The corpus of analysis was made from some elements present in the communities - community name, text that describes it and presents its objectives, the image displayed for identification, who is the owner (man or woman), total number of participants, percentage of participant men and women - and also the posts of men in these communities’ forums. In the process of data analysis, some elements of Foucauldian discourse analysis were used, especially the concepts of speech and statement. The selected communities are representative of processes of contemporary social reconfiguration, in which groups are formed not by geographic proximity, but rather through the links established in the interconnections, based on mutual interests and affinities, as it is the case of plastic surgery in this research. Among the analyzed communities, it was found that those with men as owners counted with greater male participation and plastic surgeries were discussed from the medical discourse, pointing to the meanings of hegemonic masculinity that establish science as a male field. In communities with women as owners, the participation of men was smaller and the discussions were established under the aesthetic point of view, in which participants reported their personal experiences, related to performed procedures or the expressed desire of undergoing a plastic surgery. The analysis point to the existence of discourses and practices that have presented the bodies as products and goods of consumer culture, so that the desired appearance can be surgically sculpted and bought. Such practices have produced an incitement to the visibility of the life of each subject, promoting a shift of the internalized subjectivity toward its exteriorization, in a somatization process of subjectivity, in which the body becomes the surface of social markers’ inscription, such as the masculinities analyzed here, and becomes central in the experience of itself. The aesthetic plastic surgeries are, in this context, a strategy of reinventing the body, a practice of bioasceticism, once they enable operating on a plastic and malleable body so that it externalizes and expresses what the subject wants to look and be.

A abdominoplastia é uma das cirurgias plásticas mais realizadas. A associação entre a lipoaspiração e o descolamento reduzido trouxe uma nova perspectiva em relação à maior preservação da inervação cutânea sensitiva. Novos métodos de avaliação de sensibilidade têm permitido melhor quantificação e uma análise mais completa da evolução pós-operatória. Foi realizado um estudo do tipo caso-controle comparando-se um grupo controle de pacientes não operadas, um grupo de pacientes que realizou abdominoplastia convencional e um grupo que realizou abdominoplastia associada a lipoaspiração e descolamento reduzido. Para a avaliação da sensibilidade, utilizou-se o PSSD (dispositivo específico de sensibilidade de pressão), testes para sensibilidade térmica e dolorosa (agulhas). O PSSD foi aplicado em nove regiões da parede abdominal anterior para determinação do limiar cutâneo de pressão (LCP) em duas modalidades sensoriais: um ponto estático (1PE), para avaliação de fibras de adaptação lenta, e um teste dinâmico (1PD), para avaliação de fibras de adaptação rápida. Quanto maior o LCP, menor a sensibilidade na região. Foram incluídas 46 pacientes nos três grupos. O grupo controle continha 10 pacientes, cujos limiares cutâneos de pressão (LCP) variaram de 0,82 a 0,84 e de 0,77 a 0,79 g/mm2 para 1PE e 1PD, respectivamente. O grupo de abdominoplastia convencional (AC) continha 14 pacientes com medidas em dois momentos de pós-operatório, precoce (5,75 meses) e tardio (17,36 meses). Os resultados demonstraram LCPs entre 1,02 e 39,94 para a medida precoce e 0,79 e 20,07 g/mm2 para a medida tardia. O grupo de abdominoplastia associada a lipoaspiração (LA) continha 22 pacientes com acompanhamento de 5,72 meses (precoce) e 14,91 meses (tardio). Os resultados demonstraram LCPs entre 0,62 e 4,98 para a medida precoce e 0,67 e 1,91 g/mm2 para a medida tardia. A análise estatística usou método de análise de variância com medidas repetidas. O nível de significância adotado foi de 0,05. A análise estatística para a medida de 1PE revelou redução da sensibilidade significante no grupo AC em todas as regiões (precoce e tardia). No grupo LA, houve redução da sensibilidade apenas nas regiões de mesogastro e hipogastro na medida precoce com regularização total na análise tardia. Entretanto, a análise estatística para 1PD revelou, no grupo AC, redução na medida precoce em todas as regiões e redução apenas das regiões centrais (mesogastro e hipogastro) na análise tardia. Já no grupo LA, todas as medidas estavam normalizadas na análise precoce e tardia. A análise da sensibilidade térmica e dolorosa revelou reduções centrais, especialmente nas regiões de mesogastro e hipogastro no grupo AC. O grupo LA revelou áreas de anestesia térmica e dolorosa apenas em pequena área do hipogastro. Concluiu-se que as três modalidades sensoriais (tátil, térmica e dolorosa) são mais preservadas no grupo LA que no grupo AC. A recuperação da medida 1PD é mais rápida que a medida de 1PE / Abdominoplasties are common plastic surgery procedures. New techniques associating lipoaspiration with selective undermining are bringing new perspectives with regard to the preservation of cutaneous sensibility. New methods of evaluation of cutaneous sensibility have allowed researchers to do a more complete analysis. This is a case-control study comparing a control group of patients non operated with one group submitted to conventional abdominoplasty and another group submitted to abdominoplasty associating lipoaspiration with selective undermining. The abdominal surface was divided into nine regions for sensibility evaluation. Superficial tactile sensibility was tested using the Pressure Specified Sensory Device (PSSD) which allows the determination of the cutaneous pressure threshold (static and moving). Tests of pain and thermal sensibility were also performed. A total of 46 patients were divided in three groups. In the control group, with 10 patients, the cutaneous pressure thershold (CPT) oscilated from 0.82 to 0.84 and from 0.77 to 0.79 g/mm2 for one point static and one point moving sensibility evaluations, respectively. The group of patients submitted to conventional abdominoplasty (AC), with 14 patients, was evaluated in two moments of follow-up: early (mean of 5.75 months after surgical procedure) and late (17.36 months). The results showed CPTs betwen 1.02 and 39.94 in the early follow-up, versus 0.79 to 20.07 g/mm2 in the late follow-up. The group submitted to abdominoplasty associated with lipoaspiration and selective underminig (LA) had 22 patients, with a mean follow-up period of 5.75 (early) and 14.91 (late) months. The results showed CPTs betwen 0.62 and 4.98 (early) and 0.67 and 1.91 g/mm2 (late). The statistical analysis was conducted with the analysis of variance with repeated measurements. The level of significance adopted was p < 0.05. The estatistical analysis for one point static showed significant reduction of sensibility in the group AC in all abdominal regions (in the early and late follow-up periods). The group LA presented reduced CPT only in the mesogastric and hypogastric in the early evaluation; the late evaluation was normal. On the other hand, the analisis of one point moving showed, in the group AC, a reduction of early evaluation measurement in all abdominal regions and a reduction only in central regions (mesogastric and hypogastric) in the late. The LA group presented normal in all measurements. The analysis of pain and thermal sensibility shows that the centermost regions of the abdomen, mesogastric and hypogastric, presented the highest anesthesia index in the AC group. The LA group showed just some islands in the hipogastric regions. The recuperation of the 1PD evaluation was faster than the 1PE. In conclusion, the three sensibilities (tactile, thermal and pain) were more preservated in the LA group. Abdominoplasty with lipoaspiration could be considered a better choice than conventional abdominoplasty considering the preservation of cutaneous sensibility

Orientador: Enilson Antonio Sallum / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-26T07:46:02Z (GMT). No. of bitstreams: 1 Moreira_AnaReginaOliveira_D.pdf: 1321672 bytes, checksum: 60276889e2016b79becb459a39f622a9 (MD5) Previous issue date: 2014 / Resumo: O objetivo deste estudo foi avaliar prospectivamente o resultado clínico do tratamento de retrações gengivais localizadas com a técnica de retalho posicionado coronariamente (RPC), associada ou não a enxerto de matriz de colágeno xenógeno (MC) e o efeito nos níveis de biomarcadores angiogênicos no fluido crevicular gengival (FCG). Para tanto, 40 pacientes apresentando retração gengival Classe I ou II de Miller ? 2 mm em caninos ou pré-molares superiores foram selecionados. Os 40 defeitos foram aleatoriamente designados para o grupo RPC ou para o grupo RPC+MC. Os parâmetros clínicos avaliados foram profundidade de sondagem (PS), nível de inserção clínico (NIC), altura da retração gengival (RG), espessura de tecido queratinizado (ETQ) e altura de tecido queratinizado (ATQ). Medidas clínicas foram tomadas no início do estudo (baseline), 6 meses, 1 e 2 anos após a cirurgia. A variável primária do estudo foi redução da retração gengival. FCG foi coletado no baseline, 45 dias, 2, 3 e 6 meses após a cirurgia. Os níveis de fator de crescimento de fibroblastos (FGF-2), fator de crescimento derivado de plaquetas (PDGF-BB), fator de crescimento vascular endotelial (VEGF) e fator estimulador de colônias de macrófagos e granulócitos (GM-CSF) no FCG foram avaliadas por imunoensaio multianalito (Luminex/Magpix, Millipore Corporation, Billerica, MA, EUA). Clinicamente, os dois grupos estudados resultaram em significativa redução da retração gengival, entretanto, o grupo RPC apresentou maior RG residual (1.13±0.49 mm) ao final de 2 anos de acompanhamento, comparado ao grupo RPC+MC (0.85±0.90 mm) (p>0,05). A porcentagem de cobertura radicular reduziu de 77,2±21,20% para 75,70±25,28% no grupo RPC+MC e de 72,11±14,45% para 63,43±14,75% no grupo RPC, sem diferença estatisticamente significante entre os tratamentos (p>0,05). Cobertura radicular completa foi alcançada em 28% (n=5) dos sítios no grupo RPC+MC e 22% (n=4) dos sítios no grupo RPC. No final do estudo, não foi observado ganho estatisticamente significante na ETQ (p>0,05). Adicionalmente, houve um aumento na ATQ em ambos os tratamentos, comparado aos valores de baseline, embora sem diferença estatisticamente significante (p>0,05). Com relação ao perfil imunológico, nenhuma diferença estatisticamente significante foi encontrada na análise intragrupo, para ambos os tratamentos. Os níveis de PDGF-BB e VEGF foram significativamente maiores no grupo RPC+MC quando comparado ao grupo RPC após 2 meses da cirurgia (p<0,05). Diferenças intergrupo não foram observadas para FGF-2 e GM-CSF (p>0,05). Dentro dos limites deste estudo, pode-se concluir que RPC, associado ou não a MC, resultou em significativa redução da retração gengival. Entretanto, quando a matriz foi utilizada, maior estabilidade da margem gengival foi observada após 2 anos de acompanhamento e maiores níveis de biomarcadores angiogênicos FCG foram detectados, sugerindo um papel da matriz de colágeno na modulação da resposta tecidual / Abstract: The aim of this study was to prospectively evaluate the clinical outcome of localized gingival recessions treatment with coronally positioned flap technique (CAF), with or without xenogeneic collagen matrix graft (MC) and the effect on the levels of angiogenic biomarkers in the gingival crevicular fluid (GCF). For this purpose, 40 patients with Miller Class I or II gingival recession ? 2 mm in maxillary canines or premolars were selected. The 40 defects were randomly assigned to either the CAF group or CAF+CM group. The clinical parameters evaluated were probing depth (PD), clinical attachment level (CAL), gingival recession depth (GR), keratinized tissue thickness (KTT) and keratinized tissue width (KTW). Clinical measurements were performed at baseline, 6 months, 1 and 2 years after surgery. The primary endpoint of the study was gingival recession reduction. Gingival crevicular fluid (GCF) was collected at baseline, 45 days 2, 3 and 6 months after surgery. The levels of fibroblast growth factor (FGF), platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF) and granulocyte-macrophage colony-stimulating factor (GM-CSF) were assessed by multiplex immunoassay. Clinically, the two groups resulted in significant recession reduction. However, CAF group presented greater residual gingival recession (1.13±0.49 mm) at the end of 2 years follow-up, compared to CAF+CM group (0.85±0.90 mm) (p>0.05). The percentage of root coverage reduced from 77.2±21.20% to 75.70±25.28% in CAF+CM group, and from 72.11±14.45% to 63.43±14.75% in CAF group, with no statistically significant difference between treatments (p> 0.05). Complete root coverage was achieved in 28% (n = 5) of sites in CAF+CM group and 22% (n = 4) of sites in the CAF group. At the end of the study, no statistically significant difference for KTT was observed for intra- and inter-group analysis (p>0.05). Additionally, gain in KTW was observed in both treatment groups compared to baseline values, although no statistically significant difference have been detected. Regarding immunological profile analysis, no significant difference was found in intra-group analysis for both treatments (p>0.05). The levels of PDGF-BB and VEGF were significantly higher in CAF+CM group compared with CAF alone 2 months after surgery (p<0.05). Inter-group differences were not observed for FGF-2 and GM-CSF (p>0.05). Within the limits of this study, it can be concluded that CAF, with or without CM, resulted in significant gingival recession reduction. However, when the matrix was used, higher stability of the gingival margin was observed after 2 years follow-up and higher levels of angiogenic biomarkers were detected, suggesting a role in modulating tissue response / Doutorado / Periodontia / Doutora em Clínica Odontológica

Contexte: Simuler le comportement du complexe peau/tissu sous-cutané (CPTSC) au cours d'une chirurgie présente de nombreuses difficultés liées principalement à sa complexité anatomique qui génère un comportement mécanique complexe. Les modèles de simulation existants sur ce sujet se présentent majoritairement sous forme d'une mono-couche homogène et isotrope de comportement élastique linéaire. Ils ne prennent jamais en considération les moyens d'union conjonctifs du CPTSC pourtant responsables de la complexité de son comportement mécanique. L'augmentation tissulaire chirurgicale et en particulier l'autogreffe adipocytaire vise à restituer un volume corporel amputé par exemple par un traumatisme ou par une chirurgie carcinologique. A l'heure actuelle, seule l'expérience du chirurgien permet de prévoir l'effet d'une chirurgie d'augmentation tissulaire dans un contexte préopératoire donné. Un outil de simulation et de prévision fiable permettrait d'améliorer l'adhésion des patients à certains protocoles de traitement lourds, d'éviter certaines impasses thérapeutiques ou pourrait servir de support pédagogique.Objectifs: Dans un but de simulation et de prévision chirurgicale, nous avons souhaité développer un modèle mécanique du complexe peau tissu sous-cutané entièrement paramétrable par certaines données morphologiques des patients et adaptable à toute les régions du corps.Patients et méthodes: Afin de confirmer l'existence d'un modèle organisationnel générique du CPTSC, nous avons fait plusieurs acquisitions en IRM 3T de l'ensemble du corps. Ces acquisitions nous ont permis de mettre en évidence une organisation générique du CPTSC qui à été la base d'un modèle géométrique générique paramétrable. Afin de reconstituer l'architecture lobulaire du tissu adipeux et afin de restituer l'effet mécanique des moyens d'unions conjonctifs du CPTSC, nous avons construit de manière procédurale, à l'aide d'une tesselation de Voronoï, l'anatomie lobulaire et les septas inter-lobulaires. Une modélisation mécanique hybride a été réalisée grâce à la plateforme SOFA afin de respecter fidèlement l'organisation complexe du tissu de soutient collagénique. Pour valider le comportement mécanique de notre modèle, nous avons transcrit puis comparer les paramètres de tests d'indentation in vivo à notre modèle générique. Concernant l'augmentation tissulaire, nous avons simulé le phénomène de peau d'orange et les effets de l'autogreffe adipocytaire au dessus et en dessous du plan de fascia superficialis. Nous avons ensuite étudié les conséquences biomécaniques des fasciotomies qui sont utilisées en pratique courante. Nous avons finalement inclus ce modèle générique dans un modèle de face généré à partir des acquisitions IRM afin de simuler une autogreffe adipocytaire au niveau de la face. Résultats: Le modèle générique, paramétré de manière spécifique, nous a permis de transcrire de manière réaliste les tests d'indentation au niveau de l'avant-bras. Les simulations d'injection de graisse autologue ont pu simuler fidèlement les constatations opératoires et nous avons par ailleurs été capable de simuler le phénomène de peau d'orange en s'appuyant sur certaines de ses hypothèses physiopathologique. La simulation des fasciotomies nous a permis d'étudier pour la première fois l'effet mécanique de cette procédure. L'inclusion du modèle procédural dans un modèle géométrique spécifique de la face, acquis à partir de nos images IRM 3T, a pu aboutir à une simulation d'une autogreffe adipocytaire dans la joue. Conclusion: Malgré la mécanique complexe des tissus mous, nous avons pu établir un modèle mécanique fiable qui peut être spécifié de manière paramétrique. Après une phase de validation clinique et certaines améliorations mécaniques, nous souhaitons mettre au point des modèles spécifiques utilisables en simulation chirurgicale. / Background: Simulate the skin / subcutaneous tissue complex behavior presents many difficulties mainly related to its anatomical complexity that generates a complex mechanical behavior. Current simulation models on this subject appear mainly in the form of a homogeneous single layer of isotropic and linear elastic behavior. They never take into account the connective means of union of the skin and subcutaneous tissue which are responsible of the complexity of the mechanical behavior. The surgical tissue augmentation procedures and in particular autologous fat grafting aims to restore corporal volumes after a trauma or a carcinologic surgery. Currently, only the experience of the surgeon can predict the effect of a surgical tissue augmentation in a given preoperative context. A simulation and reliable prediction tool would improve patient adherence to certain protocols of heavy treatment, would avoid certain therapeutic impasses or could be used as a teaching aid.Objectives: As a surgical prevision and simulation tool, we wanted to develop a mechanical model of the skin / subcutaneous complex fully configurable by certain morphological data of patients and adaptable to any parts of the body. Patients and methods: To confirm the existence of a generic organizational model of subcutaneous tissue, we made several acquisitions in 3T MRI of the whole body. These acquisitions allowed us to highlight a generic pattern of organization of subcutaneous tissue that has been the basis of a generic geometric model fully configurable. To reconstruct the lobular architecture of adipose tissue and to restore the mechanical effect of the connective means of union, we constructed in a procedural manner, using a Voronoi tessellation. Hybrid mechanical modeling was performed with the SOFA framework. To validate the mechanical behavior of our model, we parametrized our generic model and transcribed the parameters of an in vivo indentation test and compare the results. Concerning tissue augmentation procedures, we simulated the phenomenon of cellulite and the effects of autologous fat grafting above and below the plane of superficial fascia. We then studied the biomechanical consequences of fasciotomies which are used in current practice. We finally included in our generic model of a face model generated from MRI acquisitions to simulate autologous adipocyte at the level of the cheek. Results: The model, allowed us to transcribe realistically indentation tests at the level of the forearm. Autologous fat injection simulations have faithfully simulate the operative findings and we have also been able to simulate the phenomenon of cellulite relying on some of its pathophysiological hypotheses. The simulation of fasciotomies has allowed us to study for the first time, the mechanical effect of this procedure. The inclusion of procedural model in a specific geometric model of the face result in an acurate simulation cheek fat grafting. Conclusion: Despite the complex mechanics of non visceral soft tissues, we have established a reliable mechanical model that can be specified parametrically. After a phase of clinical validation and some mechanical improvements, we hope to develop specific models used in surgical simulation.

Introduction: The palate is a well-established donor site for obtaining graft tissue in periodontal plastic surgery procedures. However, proximity to the adjacent teeth on the lateral aspect and the greater palatine neurovascular bundle (GPB) on the medial aspect limit the amount of graft tissue that can be obtained from the palate. Previous studies have been concerned with the location of the greater palatine foramen as well as the greater palatine artery (GPA) and have established guidelines on how to estimate the distance between the teeth and the GPB. Traditionally, clinicians follow these guidelines and choose to avoid removing graft tissue in the area close to the GPB out of fear of possible complications such as hemorrhaging and paresthesias. Objectives: The purpose of the present investigation is to locate the position of the greater palatal artery (GPA) in relation to surrounding anatomical landmarks and determine if the tissue thickness covering the GPA is sufficient to permit gingival grafts to be obtained in the area close to the GPB. Materials and methods: Cadaver dissections were performed on a total of ten (n=10) cadaver hemifaces of which 7 were partially and 3 were completely edentulous. From the greater palatine foramen to the incisive foramen, the palatal tissues of the cadavers were dissected into vertical slices of 3 mm in width perpendicular to the median palatine raphe using a double bladed scalpel. On each tissue slice, the distance from the epithelial surface to the superior border of the vessel, the diameter of the vessel, the distance from the inferiorborder of the vessel to the palatal bone, the distance from median palatine raphe to the GPA and the distance from teeth or midline of the alveolar crest to the GPA were measured using both a periodontal probe and a digital caliper. The measurements were correlated to each other, the angle of the palatal vault, an estimate of the palatal depth and the head length of the cadavers. Results: The mean thickness of the tissue above the GPA was 4.30 ± 1.61 mm with a range of 1.92 – 8.72 mm. The tissue thickness decreased consistently from the 3rd molar to the canine area with the thickest mean tissue being in the 2nd molar region with 6.25 ± 1.09 mm and shallowest mean tissue thickness in the region of the lateral incisor with 2.92 ± 0.46 mm. The mean distance of the GPA from the median palatine raphe is 10.34 ± 3.41mm ranging from 13.77 ± 1.67 mm to 6.02 ± 0.83 mm with the greatest distance being from the 3rd molar region and smallest distance being from the lateral incisor area. No statistically significant correlations were found between the angel of the palatal vault, the estimate of the palatal depth and the head length. A significant correlation (R2=0.92) was found between the total palatal tissue thickness and tissue thickness above the GPA. Discussion: There was adequate gingival tissue above the GPA to harvest tissue for free gingival grafts of 1 - 1.5 mm in thickness in the entire palate. Donor tissue for 1.5 mm thick connective tissue grafts with a 1.5 mm epithelial flap could be obtained opposing the 1st molar and posterior to it staying above the GPA. Donor site for palatal grafts can be extended in a medial and posterior direction.A Formula (Tissue Thickness above the GPA = (Total Thickness of palatal tissue - 0.967) x 0.9) has been derived, which accurately locates the GPA based on the thickness of the palatal tissue. Unique to this study were measurements from the median palatine raphe, which will provide the clinician with a new landmark to more reliably locate the GPA at various locations on the palate. Conclusion: This descriptive pilot study on human cadavers provides a formula to locate the GPA within the palate using the total palatal tissue thickness and suggests that graft tissue can be harvested from the tissue above the GPA in the entire palate for FGGs and opposing to the 1st molar and posterior to it for CTGs not exceeding 3 mm in depth.

It has become increasingly more common to promote cosmetic surgery on social media with the help of influencers. A debate about the phenomenon has recently been evoked in Swedish media, where concepts such as power and responsibility are often discussed. The study “Influencers, the ideals and the sponsored cosmetic surgeries” aims to shed light on how power relations and responsibility is portrayed in connection with influencers' marketing of cosmetic surgeries. By analyzing content from a documentary made by SVT, we have been able to distinguish different social actors who are assigned specific roles, where the documentary genre has an impact on how the content is presented which can have effects on the audience. The study's theoretical framework is based on theories of habitus, field and capital as well as the framing theory. The analysis is based on the method multimodal critical discourse analysis, where we have used analysis tools such as lexical choices, attributes and stage environment and social actors as well as Fairclough's three-dimensional model. In the result, we distinguished five distinctive discursive themes, where the result showed discourses about influencers as actors with power who are partially taking responsibility, although influencers being portrayed as victims were most prominent in the documentary. The discourse about society as a collective, platforms and clinics as actors with power was portrayed from a more critical perspective where a big part of the responsibility was placed on those actors, and not on the influencers promoting the surgeries. Another conclusion of the study is that the creators of the documentary have a big role in shaping the portrayals of the actors and the discourses in the documentary.

Plastic surgery has played an integral role in helping people achieve societal expectations of appropriate physical appearance since its inception. Through the story of Carlton Burgan, a Union soldier during the American Civil War, who suffered severe facial trauma by mercury poisoning, this thesis hopes to reconstruct the conversation around plastic surgery’s origins as it is influenced by societal standards of the day. Specifically, this thesis argues that the seminal moments leading to plastic surgery being seen as a worthwhile medical specialty was during the Civil War, not World War I as so many scholars have put forth. Violent acts to the body as a method to advance plastic surgery techniques is explored in relation to acceptable physical appearance. Societal beauty standards on the time are posited to be the force behind the development of plastic surgery techniques, not plastic surgeons themselves. Plastic surgery evolved as the United States grew and began to embrace the Second Industrial Revolution’s influence on attitudes about beauty, leading to changes in societal beliefs about what is suitable in terms of appearance. This thesis argues that the new science of psychology that emerged in parallel to the Second Industrial Revolution is the main strategy for plastic surgery to be reconstructed as a worthwhile medical specialty. The exploration of plastic surgery procedures of the nose, face and genitalia are discussed due to their importance in constructing societal appearance standards. The thesis concludes with a return to the story of Carlton Burgan and his role as a change agent in medicine.

This study explored whether women who have breast augmentation are more vulnerable to negative stereotypes about their intelligence and abilities than women who do not elect to have breast augmentation. Furthermore, whether the motivation for seeking such surgery contributes to stereotypes was also explored. Participants in this study read experimentally manipulated biographies of a fictitious female author, followed by her short story. The only manipulation was one line in the author's biography which varied the reason for the plastic surgery across 4 conditions (for herself, for her significant other, for medical reconstructive reasons, or no surgery). The participants were asked to read and evaluate the author and her work. The results of this study suggest that women who elect to have plastic surgery for herself or her husband are perceived as being less deep. The results also suggest that women who have previously elected to have plastic surgery judged the authors' fictional work more critically when she had plastic surgery for herself or for her husband.