Athena Health & Research Journal
type: channel
description: Athena - Health & Research Journal of Escola Superior de Saúde Fernando Pessoa is an open access quarterly peer review publication dedicated to scientific dissemination of health care related scientifc knowledge. Its mission is to disseminate emerging research and development produced by the entire academic and scientific community, which is original and innovative, highlighting the pedagogical and scientific development of the Health Sciences in response to the needs of the person, family and community. ISSN: 3051-6013
publisher: Escola Superior de Saúde Fernando Pessoa
language: en-US
publication name: Athena Health & Research Journal
issn: 3051-6013
copyright: Copyright of published papers is assigned to the Journal, but all content is licensed under the terms of Creative Commons Non-comercial 4.0 International License. Thus users are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
items: Radiofrequency and dermal rejuvenation
items: Phased lip and perioral augmentation with hyaluronic acid: effects on facial esthetics in a 38-year-old female patient
items: Ethics and deontology in facial harmonization and orofacial therapeutics: listening to decide
items: Orofacial harmonization: variation of the cervico-mental angle with age
items: Non-surgical treatment of gummy smile with botulinum toxin: clinical case
items: Is botulinum toxin effective in all muscle groups of the perioral region? clinical study
items: Integrated facial harmonization with orthodontics: correction of gummy smile after orthodontic treatment
items: The role of ultrasound in orofacial harmonization: a literature review
items: Masseter hypertrophy: how does botulinum toxin revolutionize treatment?
items: Jawline rejuvenation and mental artery: high-risk injection sites
items: Orofacial harmonization and longevity: a new cephalometric approach for jowl measurement – an observational study
items: The role of exosomes in the biology of aging: a literature review
items: Midface support as a prerequisite for lower face reconstruction: clinical case
items: Regenerative medicine using plant- and animal-derived exosomes: how to decide?
items: Facial rejuvenation in a patient aged 50+ using multiple orofacial harmonization techniques: a clinical case
items: Bridging knowledge and collaboration: The role of global scientific dialogue and interdisciplinary research in health sciences

Radiofrequency and dermal rejuvenation
type: item
description: Introduction: Facial aging is a progressive phenomenon that affects multiple layers of the face, including the skin, adipose tissue, muscles, and bony structure. Loss of muscle tone, particularly in the elevator muscles, contributes to tissue laxity, wrinkle formation, and the degradation of collagen and elastin, which compromises skin firmness and elasticity. External factors such as sun exposure, smoking, and pollution can accelerate this process. Radiofrequency, a technology that generates an alternating electrical current, induces molecular vibrations in tissues and, when applied at lower temperatures, triggers an inflammatory response, stimulating neocollagenesis and neoelastogenesis, thereby promoting regeneration and facial rejuvenation. Objective: This study aims to provide a detailed overview of the therapeutic applications of radiofrequency, as well as the underlying mechanism of action in skin and adipose tissue remodeling. Additionally, it examines safety considerations, criteria for evaluating treatment outcomes, and specific factors to consider during radiofrequency therapy to ensure effective treatments while minimizing patient recovery time and adverse effects. Methodology: A literature search was conducted using the PubMed and ScienceDirect databases, employing the following keywords: “collagen,” “elastin,” “skin aging,” “skin laxity,” “dermal rejuvenation,” and “radiofrequency therapy.” Inclusion criteria were articles published between 2014 and 2024, containing the keywords in the title or abstract, and available in full text. Exclusion criteria included duplicate articles and publications whose content did not align with the proposed topic. Results: Neocollagenesis, the synthesis of new collagen fibers, is stimulated by thermal energy between 37°C and 44°C, triggering an inflammatory response that activates fibroblasts to produce type I and III collagen, promoting dermal firmness and renewal. Neoelastogenesis is a more complex and less active pro…
creator: Beatriz Loibl
creator: Teresa Sequeira
creator: Lara Lustosa
creator: Maria Inês Guimarães
creator: Francisco Veiga
creator: Augusta Silveira
rights: Copyright (c) 2025 Athena Health & Research Journal https://creativecommons.org/licenses/by-nc/4.0
license: https://creativecommons.org/licenses/by-nc/4.0
date: 2025-11-20
publication date: 2025-11-20
volume: 2
number: Suppl. 2
doi: 10.62741/ahrj.v2iSuppl. 2.104

Phased lip and perioral augmentation with hyaluronic acid: effects on facial esthetics in a 38-year-old female patient
type: item
description: Introduction: The lips, as the central element of the lower third of the face, play a fundamental role in emotional expression, social interactions, and the definition of individual identity. Objective: To demonstrate the importance of combining perioral filling techniques to achieve a harmonious and long-lasting outcome in patients presenting signs of aging. Methodology: The treatment followed a phased approach to ensure progressive and safe results: 1) Botox® botulinum toxin was injected into the depressor anguli oris muscles (2 units), the mentalis (4 units), and the platysma muscle at the level of the mandibular contour (3 points per side of the face, 2 units each), aiming to reduce muscle contraction. The plan included a full-face approach using 56 units of Botox®, with 20 units applied to the lower third. 2) Lip filling was performed in two sessions (January 27, 2024, and July 6, 2024), using a volumizing technique with a 25G cannula and lip contour definition with a 27G needle. In the first session, 1 ml of hyaluronic acid was applied. In the first session, lip contouring was not performed, only volumization using a retroinjection technique and perioral restructuring using a bolus technique in the infracommissural region, distributed in deep and superficial subcutaneous layers, to restore structural support. In the second session, the combined retroinjection technique was used, combined with bolus application in the lower lip, concluding with lip contouring and philtrum definition. Results: The comparative analysis between pre- and post-treatment stages revealed a progressive and significant improvement in lip volume, accompanied by the preservation of naturalness and facial proportion balance. Cephalometric evaluation demonstrated adequate maintenance of the labiomentonian relationship, with preservation of the nasolabial and labiomental angles, which are essential for the aesthetic harmony of the facial profile. These parameters confirm that the volumetric …
creator: Ludmila Favaretto
creator: Maria Teixeira Santos
creator: Sofia Lopes
rights: Copyright (c) 2025 Athena Health & Research Journal https://creativecommons.org/licenses/by-nc/4.0
license: https://creativecommons.org/licenses/by-nc/4.0
date: 2025-11-20
publication date: 2025-11-20
volume: 2
number: Suppl. 2
doi: 10.62741/ahrj.v2iSuppl. 2.111

Ethics and deontology in facial harmonization and orofacial therapeutics: listening to decide
type: item
description: Introduction: Orofacial harmonization and therapeutics is currently distinguished as an area closely connected with Dental Medicine and structured around the application of clinical procedures, aiming to promote both aesthetic and functional balance. The principles of ethics and deontology inherent to health theories and practices apply to orofacial harmonization and therapeutics and encompass concepts designed to ensure patient well-being. It is crucial that professionals possess up-to-date and detailed knowledge, perform comprehensive and individualized clinical assessments, prioritize ethics and deontology, and inform patients about the risks and benefits of each procedure. Objective: This study aimed to describe the phases involved in constructing a questionnaire for Dentists and 5th-year students of the Integrated Master’s in Dental Medicine, to explore concerns regarding ethics and deontology related to the clinical practice of orofacial harmonization and therapeutics. Methodology: This research is based on the development of a Measurement Instrument directed at Dentists (Portugal) / Dental Surgeons (Brazil) and final-year students of the Integrated Master’s in Dental Medicine (Portugal) / Dentistry (Brazil), addressing ethics and deontology and Professional Practice in orofacial harmonization and therapeutics. Initially, the construct and the dimensions to be assessed were defined, followed by the development of a set of items and the type of scale to be used for evaluation. A content analysis was conducted with recognized experts in this field, who provided feedback on dimensions, item formulation, comprehensibility of the instrument’s questions, degree of pertinence, relevance, and the scales used. The questions comprising the “ethics and deontology” dimension of the questionnaire, already submitted and approved by the Ethics Committee, are presented. A new landmark, the Jowl point (Jw), was determined by palpation of the anterior portion of the masseter an…
creator: Ana amorim
creator: Vitória Campos
creator: Virgínia Santos
creator: Inês Almeida Castro
creator: Augusta Silveira
creator: Maria Inês Guimarães
rights: Copyright (c) 2025 Athena Health & Research Journal https://creativecommons.org/licenses/by-nc/4.0
license: https://creativecommons.org/licenses/by-nc/4.0
date: 2025-11-20
publication date: 2025-11-20
volume: 2
number: Suppl. 2
doi: 10.62741/ahrj.v2iSuppl. 2.102

Orofacial harmonization: variation of the cervico-mental angle with age
type: item
description: Introduction: Cephalo and profilometric studies are essential for facial analysis based on objective and clear criteria that can support clinical decision-making in orofacial harmonization. Objective: This study aims to analyze the results of research on the variation of the cervico-mental angle with age, dependent on the lower third of the face and the cervical region. Methodology: Observational, cross-sectional, prospective research study, approved by the Ethics Committee of Fernando Pessoa University (number FCSPI/528/24). Fifty women were evaluated, divided into five age groups (18–24; 25–34; 35–44; 45–54; >55). Each participant voluntarily signed three informed consent forms (participation in the study, performance of the cephalometric radiograph, and use of photographs in dental medicine). The cervico-mental angle evaluated in the cephalometric analysis, using cephalometric radiographs and photographic analysis, is formed by the intersection of line A (perpendicular to the plane formed between the articulare and gonion points with the line tangent to the menton) and line B (joining the gnation and cervical points). It is classified as grade I (normal; <20°), grade II (21°–40°), grade III (41°–60°), and grade IV (>60°). Inclusion criteria were: age over 18 years, agreement with the terms and consents, and completion of the radiograph and photographic analysis. Exclusion criteria included prior aesthetic treatments, medical conditions limiting exposure to radiation, deformities in the analyzed region, or any other condition preventing the use of the methodology Results: Using cephalometric analysis (Nemoceph) and Excel, it was possible to calculate and compare the variation of the cervico-mental angle. In this sample, an increase in the angle with age was observed, with the youngest group (18–24 years) classified as grade I and the oldest group (>55 years) as grade II. In addition to aging, this variation is also influenced by increased weight (leading to greate…
creator: Inês Almeida Castro
creator: Mónica Pinho
creator: Virgínia Santos
creator: Maria Inês Guimarães
creator: Maria Gabriel Queirós
creator: Augusta Silveira
rights: Copyright (c) 2025 Athena Health & Research Journal https://creativecommons.org/licenses/by-nc/4.0
license: https://creativecommons.org/licenses/by-nc/4.0
date: 2025-11-20
publication date: 2025-11-20
volume: 2
number: Suppl. 2
doi: 10.62741/ahrj.v2iSuppl. 2.109

Non-surgical treatment of gummy smile with botulinum toxin: clinical case
type: item
description: Introduction: Gummy smile, or excessive gingival display, is defined as the exposure of more than 2–3 mm of gingival tissue when smiling, with the aesthetic threshold generally starting at 3 mm. This condition affects approximately 10% to 30% of the general population and its perception can vary significantly depending on cultural and individual factors. The causes of gummy smile are multifactorial, involving skeletal, dentoalveolar, and muscular components. Objective: This clinical case of gummy smile treatment using botulinum toxin, aiming for a minimally invasive and effective aesthetic solution. Methodology: Botulinum toxin (Botox®) was applied to the upper lip elevator muscles, specifically at the Yonsei point, the confluence of the levator labii superioris alaeque nasi, levator labii superioris, and zygomaticus minor muscles (doses are described in the legend of each clinical case), following an assessment of hyperactivity in the upper lip elevator muscles. After application, patients were instructed not to massage the area and to avoid intense physical activity for the next 24 hours. A follow-up evaluation appointment was scheduled 15 days after the procedure. Photographs were taken at rest and during maximum smile both before the procedure and at the evaluation visit. Results: The application of botulinum toxin at the Yonsei point in each of the three clinical cases reduced gingival display to levels highly satisfactory for the patients, without altering lip dynamics or aesthetics at rest or during smiling. Regardless of whether excessive vertical maxilla or altered passive eruption was the main cause of the gummy smile, the patients preferred to continue using botulinum toxin as the sole treatment to correct excessive gingival exposure. Discussion Botulinum toxin is an effective, minimally invasive alternative for gummy smile correction, offering consistent aesthetic results while avoiding the risks and recovery associated with surgical interventions. Concl…
creator: Virgínia Santos
creator: Soraya Dieb
creator: Sara Marques
creator: Claúdia Ferreira
creator: Aline Raybolt
creator: Augusta Silveira
rights: Copyright (c) 2025 Athena Health & Research Journal https://creativecommons.org/licenses/by-nc/4.0
license: https://creativecommons.org/licenses/by-nc/4.0
date: 2025-11-20
publication date: 2025-11-20
volume: 2
number: Suppl. 2
doi: 10.62741/ahrj.v2iSuppl. 2.116

Is botulinum toxin effective in all muscle groups of the perioral region? clinical study
type: item
description: Introduction: Botulinum toxin is widely used to modulate muscle activity in the perioral region for the treatment of orofacial dysfunctions, gummy smile, and to reduce dynamic or static wrinkles. Its application aims to relax muscles such as the levator of the upper lip, orbicularis oris (upper portion), mentalis, and depressor anguli oris, providing both aesthetic and therapeutic benefits. Objective: The results of the research study are presented, comparing the clinical outcomes with those described in the literature following the application of botulinum toxin protocols. Methodology: Cross-sectional research study, approved by the Ethics Committee of Fernando Pessoa University. A total of 41 individuals were evaluated. Initially, muscle alterations resulting in a gummy smile or dynamic/static wrinkles in the region of the orbicularis oris (upper portion), depressor anguli oris, or the mentalis area were observed. For the application of botulinum toxin, four groups were considered: gummy smile (botulinum toxin in the levator labii superioris and zygomaticus minor muscles to reduce gingival exposure greater than 3 mm), Menton (botulinum toxin in the mentalis muscle to reduce the “orange peel” effect), depressor anguli oris (botulinum toxin in this muscle to reduce marionette lines), and orbicularis oris (upper portion) (botulinum toxin in this muscle to reduce “barcode” wrinkles). After validation by the patient, data collection included a clinical questionnaire, photographic records, and application of botulinum toxin protocols. At the follow-up visit, 10 to 15 days after the procedure, photographic records were repeated. Inclusion criteria were: individuals aged between 20 and 70 years; residents in Portugal; without cognitive impairments and/or psychiatric disorders. Exclusion criteria were: patients with contraindications for botulinum toxin application, generalized muscle disease, or infection/ inflammation at the intervention site. Results: A statistically si…
creator: Frederica Laporta
creator: Teresa sequeira
creator: Emanuel Machado
creator: Francesco Palazzo
creator: Inês Almeida Castro
creator: Augusta Silveira
rights: Copyright (c) 2025 Athena Health & Research Journal https://creativecommons.org/licenses/by-nc/4.0
license: https://creativecommons.org/licenses/by-nc/4.0
date: 2025-11-25
publication date: 2025-11-25
volume: 2
number: Suppl. 2
doi: 10.62741/ahrj.v2iSuppl. 2.107

Integrated facial harmonization with orthodontics: correction of gummy smile after orthodontic treatment
type: item
description: Introduction: Facial esthetics is intrinsically linked to the smile, which is shaped by the interaction between teeth, gingiva, and lips. A harmonious smile requires a balanced proportion among these elements, with gingival exposure limited to 3 mm. When gingiva is excessively exposed during smiling, it is characterized as a gummy smile, a condition that may have a significant psychological impact and impair patients’ social interactions. The higher prevalence in females can be explained by the fact that male patients typically present with a lower smile line. Objective: To demonstrate, through a clinical case, the effectiveness of integrating facial harmonization procedures with previous orthodontic treatment, focusing on the minimally invasive and predictable correction of gummy smile. Methodology: This is a clinical case report. The patient underwent a detailed assessment after completing orthodontic treatment, including anamnesis, photographic records, panoramic radiograph, lateral cephalometric radiograph, and cephalometric analysis. Based on the clinical and functional findings, an individualized treatment protocol was established: 19 Gingivoplasty: Performed on teeth #13, #12, #22, and #23 to increase the height of the clinical crowns and achieve more balanced proportions; 29 Botulinum Toxin: Application of 2.5 U of botulinum toxin (Botox®) diluted in 2 ml of saline solution at each point of the levator labii superioris muscles (right and left) and at two points on the menta Results: The initial and final images demonstrate the effectiveness of the treatment in harmonizing the gummy smile and improving the aesthetics of the lower third of the face. There was a reduction in the gingival band present in the smile, with consequent aesthetic gain, due to the increase in clinical crowns and the impossibility of a more active contraction by the levator labii superioris muscle after the application of botulinum toxin. Discussion: The improvement observed in the redu…
creator: Sofia Lopes
creator: Augusta Silveira
creator: Maria Teixeira Santos
creator: Ludmila Favaretto
rights: Copyright (c) 2025 Athena Health & Research Journal https://creativecommons.org/licenses/by-nc/4.0
license: https://creativecommons.org/licenses/by-nc/4.0
date: 2025-11-20
publication date: 2025-11-20
volume: 2
number: Suppl. 2
doi: 10.62741/ahrj.v2iSuppl. 2.114

The role of ultrasound in orofacial harmonization: a literature review
type: item
description: Introduction: The use of ultrasound in orofacial harmonization has revolutionized treatments, providing greater safety and precision for healthcare professionals. This technology enables real-time visualization of internal facial structures, reducing risks and optimizing clinical practice in orofacial harmonization. Consequently, the use of ultrasound enhances outcomes and increases the predictability of treatments. Objective: To analyze the effectiveness of ultrasonography in facial procedures for orofacial harmonization, highlighting its valid use as a precision tool for diagnosis, planning, execution, and postoperative follow-up. Methodology: A literature review was conducted using articles from the PubMed, B-On, and Google Scholar databases, limited to the period 2015–2025. The keywords used were: “Ultrasound,” “Orofacial Harmonization,” “Orofacial Anatomy,” and “Diagnosis.” Inclusion criteria were the presence of these keywords in the publication, and full-text articles published in English or Portuguese. Exclusion criteria included duplicate articles and publications whose content did not correspond to the proposed topic. Results: The use of ultrasonography increases the accuracy of diagnosis and treatment planning, improves the prevention of complications, and optimizes outcomes and safety in clinical procedures. Ultrasonic images are produced by ultrasonic pulses transmitted to the tissues through a probe, generating a piezoelectric effect, whereby different tissues reflect varying degrees of sound. Ultrasound in orofacial harmonization allows for comprehensive facial mapping, including skin and subcutaneous thickness, tendons, muscles, joints, vessels, and organs. It is therefore an important tool for analyzing maxillofacial fractures, periapical lesions, and cervical lymphadenopathies, as well as for evaluating the masticatory and cervical muscles, temporomandibular joint, and salivary glands. Moreover, ultrasound is essential for identifying high-risk ana…
creator: Carolina Mota
creator: Maria Inês Guimarães
creator: Inês Almeida Castro
creator: Ana Amorim
creator: Francisca Silva
creator: Augusta Silveira
rights: Copyright (c) 2025 Athena Health & Research Journal https://creativecommons.org/licenses/by-nc/4.0
license: https://creativecommons.org/licenses/by-nc/4.0
date: 2025-11-20
publication date: 2025-11-20
volume: 2
number: Suppl. 2
doi: 10.62741/ahrj.v2iSuppl. 2.105

Masseter hypertrophy: how does botulinum toxin revolutionize treatment?
type: item
description: Introduction: Masseter hypertrophy is a rare clinical condition characterized by excessive development of the masseter muscle, which can compromise both facial aesthetics and masticatory function. Its etiology remains undefined, although factors such as parafunctional habits, temporomandibular joint dysfunction, and congenital predisposition are frequently implicated. Treatment may include surgical and non-invasive approaches, with botulinum toxin type A being a safe and effective option. By blocking acetylcholine release, it induces temporary paralysis of the masseter, promoting muscle atrophy. Objective: This study aims to analyze the effects of botulinum toxin on reducing the volume of the masseter muscle in patients with masseter hypertrophy. It also seeks to evaluate the impact of the toxin on masticatory function and associated symptoms. Furthermore, it intends to describe and discuss the properties of botulinum toxin, understanding how these characteristics justify its application in the treatment of masseter hypertrophy. Methodology: A literature search was conducted in the PubMed, ScienceDirect, B-on, and Elsevier databases using the keywords: Masseter, Hypertrophy, Botulinum Toxin, Anatomy, Treatment, covering the period between 2015 and 2025. Articles published in English and Portuguese were considered, without exclusion based on methodology. Inclusion criteria were the presence of the keywords in the publication and full-text availability in English or Portuguese. Exclusion criteria included duplicate articles and publications not directly related to the proposed topic. Results: The findings show that botulinum toxin type A is an effective intervention for reducing masseter muscle volume in these patients. Reduction in muscle thickness is most evident between 12 weeks and 6 months after injection, with treatment response depending on the administered dosage, requiring periodic reassessment to maintain results. Ultrasound-guided injection demonstrates adv…
creator: Madalena Silva
creator: Sandra Gavinha
creator: Inês Almeida Castro
creator: Maria Inês Guimarães
creator: Cristina Silva
creator: Augusta Silveira
rights: Copyright (c) 2025 Athena Health & Research Journal https://creativecommons.org/licenses/by-nc/4.0
license: https://creativecommons.org/licenses/by-nc/4.0
date: 2025-11-20
publication date: 2025-11-20
volume: 2
number: Suppl. 2
doi: 10.62741/ahrj.v2iSuppl. 2.112

Jawline rejuvenation and mental artery: high-risk injection sites
type: item
description: Introduction: Mandibular line rejuvenation is an aesthetic procedure that enhances facial contouring, providing a more youthful and harmonious appearance. However, the mandibular region presents high-risk areas for injectable techniques, particularly due to the presence of the mental artery and its branches. Objective: The aims of the present study are to identify the main complications arising from orofacial harmonization procedures associated with the presence of the mental artery, as well as to determine the risk zones related to mandibular line rejuvenation techniques. Methodology: A literature search was conducted in PubMed and B-On using as inclusion criteria articles published between 2019 and 2025 that contained the keywords in the title/abstract and provided free access to the full abstract. Duplicate articles and/or those whose content did not correspond to the proposed topic were excluded Results: The mental artery is a terminal branch of the inferior alveolar artery, which originates from the first portion of the maxillary artery. It divides into incisive branches (supplying the anterior mandibular region, anterior teeth, and dental alveoli) and mental branches. The mental artery exits through the mental foramen, where it communicates with the inferior labial artery and the submental artery. Injuries to the mental artery may cause hemorrhage near the mental foramen and the chin. With aging, skin layers become thinner, leading to delayed wound healing, increased skin fragility, and reduced cellular turnover, with consequent impact on tissue remodeling. In the mental artery, blood flow decreases, which may be an etiological factor for alveolar bone atrophy. The intersection between the mandibular body and the ramus forms the mandibular angle, which tends to increase with aging as the cortical bone becomes thinner, porous, and demineralized. The definition of the mandibular angle and the chin are the main areas targeted for rejuvenation of the lower third o…
creator: Beatriz Guedes
creator: Maria Inês Guimarães
creator: Inês Almeida Castro
creator: Hugo Ferraz
creator: Beatriz Loibl
creator: Augusta Silveira
rights: Copyright (c) 2025 Athena Health & Research Journal https://creativecommons.org/licenses/by-nc/4.0
license: https://creativecommons.org/licenses/by-nc/4.0
date: 2025-11-20
publication date: 2025-11-20
volume: 2
number: Suppl. 2
doi: 10.62741/ahrj.v2iSuppl. 2.103

Orofacial harmonization and longevity: a new cephalometric approach for jowl measurement – an observational study
type: item
description: Introduction: Aging is a process that affects the entire facial structure. With advancing age, an accumulation of tissue appears along the mandibular line, known as jowls (the “bulldog” appearance), resulting from volume loss, skin laxity, and the downward displacement of fat compartments toward the lower third of the face. These changes compromise jawline definition, giving the face a squared appearance. Measuring this phenomenon may assist in planning treatments in orofacial harmonization. Objective: To present preliminary results of a research study analyzing soft profile points from facial photographs to identify and measure the degree of jowl ptosis associated with aging. Methodology: A cross-sectional and prospective observational study, approved by the Ethics Committee of Fernando Pessoa University (FCS/MED 401/23-2). Twenty-five women participated, divided into five age groups (18–24, 25–34, 35–44, 45–54, and over 55 years), between April and May 2023, in Figueiró, Santiago, Portugal. Inclusion criteria: age over 18 years, anamnesis, and informed consent. Exclusion criteria: previous aesthetic treatments, deformities in the study area, or conditions that could compromise results. Frontal and profile photographs were obtained for manual marking of cephalometric points. A new landmark, the Jowl point (Jw), was determined by palpation of the anterior portion of the masseter and the position of the mandibular ligament. The lowest point between these two structures was defined as Jw. Based on the cutaneous cephalometric points gonion (Go’) and menton (Me’), a new angle (Go’-Jw-Me’) was proposed to measure jowl ptosis. Statistical analysis was performed in Excel, considering mean, standard deviation, minimum, and maximum values. Results: A classification of ptosis was developed, using the values from the youngest group as reference (normal: 180°–170°, with no unaesthetic signs). Additional categories were defined: mild (169°–160°), moderate (159°–150°), and severe…
creator: Kátia Fredel
creator: Mónica Pinho
creator: Miguel Fernandes
creator: Virgínia Santos
creator: Inês Almeida Castro
creator: Augusta Silveira
rights: Copyright (c) 2025 Athena Health & Research Journal https://creativecommons.org/licenses/by-nc/4.0
license: https://creativecommons.org/licenses/by-nc/4.0
date: 2025-11-25
publication date: 2025-11-25
volume: 2
number: Suppl. 2
doi: 10.62741/ahrj.v2iSuppl. 2.110

The role of exosomes in the biology of aging: a literature review
type: item
description: Introduction: The skin, the largest organ of the human body, is vital for separating the internal environment from the external, maintaining internal homeostasis, and protecting the organism from environmental factors that may disrupt this functional balance. Over time, genetic and epigenetic factors contribute to the aging process. The skin is the first to show signs of aging, increasing the demand for aesthetic treatments. One of the procedures that has shown promising results in slowing down aging is exosome therapy. Objective: Thus, this study aimed to analyze the importance of using these vesicles in promoting skin longevity. Methodology: Articles were selected according to inclusion and exclusion criteria and their relevance between 2022 and 2024 through a bibliographic search on PubMed and B-On. Keywords used included: “Aging,” “Cosmetics,” “Exosomes,” “Regenerative Medicine,” “Skin,” and “Tissue Regeneration.” Results: The skin is composed of an epithelial tissue, the more superficial layer (epidermis), and a connective tissue, the deeper layer (dermis). The epithelium is a stratified keratinized squamous tissue, with keratinocytes being the most abundant cell population, responsible for keratin formation and skin barrier function. The connective tissue is organized into a looser, vascularized papillary dermis and a deeper, fibrous reticular dermis. Several cell populations are present in this tissue, with fibroblasts playing a key role in producing and maintaining the extracellular matrix, including collagen and elastic fibers, which provide structure, integrity, and elasticity to the skin. Over time, changes occur in both epithelial and connective tissues, including keratinocyte atrophy and decreased skin hydration, as well as reduced fibroblast metabolism, leading to alterations in the abundance and organization of elastic and collagen fibers. Among the various aesthetic procedures used to combat aging, exosome therapy stands out. Exosomes are small extra…
creator: Hugo Ferraz
creator: Maria Teresa Sequeira
creator: Maria Inês Guimarães
creator: Inês almeida Castro
creator: Inês Lopes Cardoso
creator: Augusta Silveira
rights: Copyright (c) 2025 Athena Health & Research Journal https://creativecommons.org/licenses/by-nc/4.0
license: https://creativecommons.org/licenses/by-nc/4.0
date: 2025-11-20
publication date: 2025-11-20
volume: 2
number: Suppl. 2
doi: 10.62741/ahrj.v2iSuppl. 2.108

Midface support as a prerequisite for lower face reconstruction: clinical case
type: item
description: Introduction: Facial aging involves bone resorption and loss of deep fat layers, which, together with migration of superficial fat pads and excess skin, leads to tissue ptosis from the midface onto the lower face. The result is an excess of tissue volume in the lower third, often perceived by patients as aging limited to this area. Consequently, they seek filler treatments that frequently disrupt facial balance and overload the lower third. Objective: This clinical case aims to highlight the importance of a sequential approach in orofacial harmonization, starting with the midface, to achieve more natural and balanced aesthetic results in the lower face and to reduce the risk of overfilling this area. Methodology: A detailed review of the planning and execution of the orofacial harmonization procedures was carried out. The focus was on filler techniques applied to the midface, using hyaluronic acid to lift and support the malar and zygomatic areas. Product selection was based on the patient’s specific needs, considering the viscosity and expected duration of the fillers. Two 1.2 ml syringes of ArtFiller® Volume (Fillmed) were used. A total of 0.5 ml was injected at each Ristow point, with the remaining 0.7 ml from each syringe placed laterally to cover the zygomatic region. After supporting the midface, an additional 1.2 ml syringe of ArtFiller® Volume (Fillmed) was applied, 0.6 ml in each labiomental fold, to eliminate shadowed areas and illuminate and rejuvenate the lower face. Results were evaluated using before-and-after photographs, complemented by detailed patient feedback. Results: A 64-year-old female patient, smoking 20 cigarettes per day, not currently taking any medication, dissatisfied with the accentuation of her nasolabial folds. The malar and zygomatic regions lacked support, with pronounced bone resorption around the orbital areas and visible infraorbital fat pads, in addition to depression of the labiomental region. Patient photographs demonstrated s…
creator: Virgínia Santos
creator: Márcia Costa
creator: Andreia Morais
creator: Sofia Athaide Motta
creator: Inês Almeida Castro
creator: Augusta Silveira
rights: Copyright (c) 2025 Athena Health & Research Journal https://creativecommons.org/licenses/by-nc/4.0
license: https://creativecommons.org/licenses/by-nc/4.0
date: 2025-11-20
publication date: 2025-11-20
volume: 2
number: Suppl. 2
doi: 10.62741/ahrj.v2iSuppl. 2.115

Regenerative medicine using plant- and animal-derived exosomes: how to decide?
type: item
description: Introduction: Exosomes are vesicles secreted by animal and plant cells, measuring 30 to 150 nm in diameter. They play a fundamental role in intercellular communication, enabling the modulation of cellular activity, including regeneration. Thus, they are considered promising strategies in the context of Regenerative Medicine, particularly in Orofacial Harmonization. Both types of exosomes - animal and plant-derived - present clinically significant advantages with distinct applications, which can be strategically adapted to therapeutic needs, individual patient profiles, and ethical preferences. Objective: To analyze the therapeutic potential and decision-making factors in using animal- or plant-derived exosomes for regenerative applications in orofacial harmonization. Methodology: This narrative review was conducted through a comprehensive search of PubMed, B-On, Science Direct, and Scielo using the keywords: "exosomes," “animal-derived,” “plant-derived,” "extracellular vesicles," "skin rejuvenation," and "aesthetic medicine," combined with Boolean operators ("AND" and "OR") to refine and expand results. Studies, reviews, and clinical trials with full-text access in English, published from 2024 to the present, were included. Exclusion criteria were duplicate articles, restricted-access publications, and studies not aligned with the proposed topic. Results: Animal-derived exosomes, from mesenchymal stem cells, demonstrate high biocompatibility with human tissues and strong efficacy in intensive regenerative treatments. They contain high concentrations of growth factors, cytokines, and microRNAs essential for cellular regeneration, stimulate fibroblast proliferation, promote neocollagenesis and elastogenesis, and reduce inflammation and oxidative stress. These effects contribute to repairing aged or damaged skin, improving firmness, elasticity, and hydration. While minimally invasive and with low risk of adverse reactions compared to conventional treatments, strict pur…
creator: Catarina Teixeira Alves
creator: Teresa Sequeira
creator: Soraya Dieb
creator: Sofia Lopes
creator: Virgínia Santos
creator: Augusta Silveira
rights: Copyright (c) 2025 Athena Health & Research Journal https://creativecommons.org/licenses/by-nc/4.0
license: https://creativecommons.org/licenses/by-nc/4.0
date: 2025-11-20
publication date: 2025-11-20
volume: 2
number: Suppl. 2
doi: 10.62741/ahrj.v2iSuppl. 2.106

Facial rejuvenation in a patient aged 50+ using multiple orofacial harmonization techniques: a clinical case
type: item
description: Introduction: The face is an anatomical unit of great aesthetic and functional relevance, playing a central role in facial harmony, individual expressiveness, and the perception of orofacial esthetics, where the aging process becomes most evident. Objective: To illustrate a clinical case of facial rejuvenation in a 51-year-old female patient using different orofacial harmonization techniques. The aim was to achieve natural and harmonious results through a sequential and individualized therapeutic approach. Methodology: The treatment was performed as part of the Facial Harmonization Course at Face Design Academy® in partnership with Instituto de Reabilitação Oral do Norte Education. Results: This clinical case describes the therapeutic approach in a 51-year-old female patient who reported dissatisfaction with her aged facial appearance and a constantly tired and saddened expression. Although healthy, the patient was a smoker and had never undergone any previous facial esthetic procedures. After a detailed anamnesis and comprehensive facial assessment, a diagnosis was established, and an individualized treatment plan was designed to promote three-dimensional facial restructuring by sequentially addressing the different anatomical planes, ensuring a harmonious and natural outcome. Discussion The facial aging process results from the complex interaction between intrinsic factors, such as genetic predisposition, production of reactive oxygen species, and hormonal changes (with estrogen levels peaking in the mid to late 20s in women, then decreasing by 50% by the age of 50, and dropping even further after menopause), and extrinsic factors, including skin damage and the cumulative impact of lifestyle choices such as excessive sun exposure, smoking, and poor nutrition. The combination of these factors leads to reduced skin thickness, sagging, and wrinkle formation. Conclusions: Facial aging is an individual process resulting from the interaction between genetic and epigenet…
creator: Sofia Lopes
creator: Maria Teixeira Santos
creator: Ludmila Favaretto
rights: Copyright (c) 2025 Athena Health & Research Journal https://creativecommons.org/licenses/by-nc/4.0
license: https://creativecommons.org/licenses/by-nc/4.0
date: 2025-11-20
publication date: 2025-11-20
volume: 2
number: Suppl. 2
doi: 10.62741/ahrj.v2iSuppl. 2.113

Bridging knowledge and collaboration: The role of global scientific dialogue and interdisciplinary research in health sciences
type: item
description: In the contemporary landscape of Health Sciences, the role of academic research and scientific dialogue is paramount to advance the understanding of complex health issues. As the demands on public health systems increase, fostering a comprehensive and inclusive research environment is essential to address the multifaceted challenges of healthcare. Academic publication serves as the cornerstone of scientific communication, enabling the dissemination of novel findings and facilitating critical discourse among scholars and practitioners across the globe. Through rigorous peer-reviewed publications, researchers contribute to the global pool of knowledge, ensuring that scientific progress is not only shared but also critically evaluated, thus advancing both theoretical and practical aspects of health-related fields. The importance of these publications extends beyond mere dissemination; they represent the synthesis of evidence, translating scientific inquiry into actionable knowledge that can inform and guide policy, clinical practices, and public health strategies. Science recognizes the importance of engaging students as early-stage researchers, cultivating their analytical skills, and encouraging their active participation in scientific inquiry. Early exposure to research not only enhances the educational experience but also fosters a sense of responsibility and ownership over the scientific process. By nurturing a culture of curiosity and critical thinking, we equip students with the tools necessary to become the next generation of healthcare researchers, leaders, and innovators. Furthermore, the inclusion of multiple generations in research teams enriches the scientific process. The intergenerational exchange of knowledge and experience fosters mentorship, enhances the transfer of tacit knowledge, and ensures that research efforts remain dynamic and forward-looking. The collaboration between experienced researchers and emerging scholars ensures the continuity of exp…
creator: Augusta Pureza Silveira
rights: Copyright (c) 2025 Athena Health & Research Journal https://creativecommons.org/licenses/by-nc/4.0
license: https://creativecommons.org/licenses/by-nc/4.0
date: 2025-11-25
publication date: 2025-11-25
volume: 2
number: Suppl. 2
doi: 10.62741/ahrj.v2iSuppl. 2.101