Abstracts of lectures in scientific sessions

We encourage you to read the abstracts of lectures that will be presented during the 18th International Congress of Aesthetic and Anti-Aging Medicine. This list is not complete, but it's still growing.

We believe that access to their content may facilitate you, among others preparation for the meeting "Oko w Oko" with lecturers, which will be held in the MR7 room at the M2 level.

A customized approach for a new concept of biostimulation.

In past bio-revitalization was considered an esthetic medicine technique for improving skin characteristics, by dermal and sub-dermal injection of compounds, leading to human fibroblast modulation. The improved understanding of the structural changes involved in face aging has shifted the focus of this treatment from just concentrating on isolated problem to multiple cell lines, molecules, facial areas, for a global effect. Today Bio-revitalization is a wider technique since, in addition to modulate the fibroblasts, induces other selective activities on different structures and cell lines.

Actually different categories of active ingredients are used for biostimulation with different purposes. The use of these depends on skin and superficial soft tissue features of each individual patient. A proper diagnosis and mapping of imperfections to be treated are necessary to a proper planning of customized treatment.

Update on chemical reduction of unwanted localized adiposities

The use of solutions containing sodium deoxycholate to reduce unwanted fatty deposits is a procedure that has been used in aesthetic medicine for about 30 years. Over the years, there have been numerous adipocytic solutions characterized by different chemical compounds but which however show deoxycholic acid as the sole agent able to bring about effective treatment5–7 by means of cell damage through the emulsification of the phospholipids and therefore, solubilization of biological membranes (citoplasmic, nuclear, of the organelles) with resulting unprogrammed cell death (adipocyte necrosis). From the first solutions referring to the so-called Natterman formula, containing also phosphatidylcholine, incorrectly considered as the active ingredient in reducing fat deposits under the skin, we have passed to those of the second generation, which are more effective, where phosphatidylcholine has been eliminated and the concentration of deoxycholate acid has been reduced to mitigate the aggressiveness of its action. The study evaluates targets, solutions, techniques, results and adverse events linked to the procedure.

Surgical treatment of cellulite

Cellulite can be seen on the skin in widespread alterations of the skin surface and dimpling. The purpose of this study is to evaluate surgical treatment for dimpling.

The multi-centre observational study of 2 years treated cellulite for different dimpling, using different types of subcision. Aesthetic outcomes and adverse events were evaluated by the authors and the patients assessed satisfaction levels. Results and adverse events were reported.

Extracellular matrix in superficial subcutaneous adipose tissue shows great differrences between men, women without cellulite and women with cellulite. MRI has confirmed that cellulite depressions are associated with the presence of hypertrofic underlying subcutaneous fibrous septa. Subcision has immediate results since it eliminates traction on the skin by the retracting septa, redistributing subcutaneous tension forces, mitigating fat protrusion, and reallocating fat lobules into the spaces created by the procedure. This also creates haematoma that in turn boost the formation of new connective tissue.

The study has shown the effectiveness and safety of subcision in the treatment of dimpling. Specially designed devices showed better results and less incidence of adverse events.

Rejuvenation of periorbital area in Aesthetic Medicine

Aesthetic Medicine patients are usually very interested in the treatment of periorbital area. Indeed, in this particular area we can find many blemishes, due to several physiological causes. Those are linear wrinkles, evidence of tear trough, protrusion of orbital margin, depressed temporal region.

We can achieve optimal results thanks to the synergy between treatments of Aesthetic Surgery and Aesthetic Medicine. A prior complete diagnostic evaluation, however, is needed. As long as an objective examination of static and dynamic and a correct scheduled program of planned treatments.

The author will present his own experience in the treatment, both surgical and medical, of this anatomical area.

Safety of polyethylene glycol (PEG)

Polyethylene glycol (PEG), an ethylene oxide polymer, is used for the synthesis of pegylated biological agents to increase the product half-life, extend dosing intervals and reduce the immunogenicity of active substances. PEG is considered to be a low toxicity substance for all routes of administration, there is an approximate 600-fold difference between the maximum load of PEG present in medical preparations and the PEG doses causing side effects in humans. In vitro studies have shown that PEG administered together with hyaluronic acid (HA) or additionally with calcium hydroxyapatite to the keratinocytes of human HaCat cell line does not change cell morphology, is not cytotoxic and does not affect their viability. It stimulates human fibroblasts of the PEU cell line to increase collagen production and does not work cytotoxically.

Tests carried out on human material collected 8 weeks after the injection of hyaluronic acid with PEG showed an excellent integration of the filler with extracellular matrix components, and no segregation, encapsulation or structural changes in immune system were observed. Ultrastructural studies have indicated the activation of fibroblasts in the field of collagen synthesis. Injection of HA with PEG to the subcutaneous tissue of the labia majora caused temporary pain of labia and transient minimal swelling persisting for 3 to 5 days after injection, while no side effects after 6 months of observation. In summary, available data indicate the lack of toxicity of PEG administered with HA, which indicates its safety in the field of aesthetic medicine applications.

Update of the complete skin regeneration protocol

The regeneration of the skin allows to restore of the original sizes of the skin tissue that loses consistency and volume with aging.

The current protocol provides:

  • differentiation of the quiescent stem cells in young fibroblasts
  • proliferative and metabolic stimulation of the newly formed fibroblasts
  • Insertion of a scaffold, made with autologous fibrin, to improve the regeneration in specific districts
  • Normalization of the matrix pH to facilitate the reticular collagen synthesis
  • Addition of aminoacids, precursors of the matrix components in order to optimize the new formation

Finally, in completing the aesthetic improvement of the face, regeneration of the adipose tissue is carried out with a lipogenetic solution which, by stimulating adipocyte hypertrophy, allows adipocyte hyperplasia with normalization of the adipose tissue by stem cell activation subcutaneous.

Medical treatments of aesthetic ginecology

Recently it’s opened a new professional space with the genitalia aesthetic improvement.

It is proposed that medical protocols that allow:

  • the vaginal regeneration, to normalize the lubrication of the mucosa and improve the orgasm
  • the reduction of small lips in the cases of hypertrophy of the same
  • the increase in large lips with reduction of vaginal meat
  • the vaginal bleaching
  • the Mount of Venus reduction

Is it possible to increase collagen and hyaluronic acid production internally through the ingestion of nutraceuticals?

Skin health boosting drinks are becoming increasingly popular adjunctive therapy in medical skin clinics today because of their potential to complement and optimise treatment outcomes. The sudden growth in nutraceuticals may also be attributed to the more holistic approach towards anti-ageing demanded by patients and adopted by many practitioners today.

This presentation will focus on interim and established clinical data supporting the efficacy of pharma-grade nutraceutical supplementation to improve skin health by directly stimulating fibroblast production and collagen synthesis as well as increasing natural levels of hyaluronic acid within the dermis. Dr Beata will examine ingredient absorption and utilization levels and their effectiveness in promoting collagen type I, II and III and cartilage tissue throughout the body, with a focus on both aesthetic and physiologically supported benefits shown through medical studies.

Picocare – new ways to treat pigments and skin

Traditional laser modalities for pigment and tattoo removal operate on pulse durations in the nanosecond domain, which is too long to effectively break all ink colours and particle sizes into small enough particles. Picosecond (10-12) lasers -due to their shorter pulse lengths - lead to quicker heating of the target and consequently, more effective tattoo clearance.

The picosecond laser offers a much shorter pulse duration of just 1012 seconds and combines photothermal with photomechanical effects on the target tissue with higher effects and less side effects due to heat. This allows to treat some complicated indications better than with nano second technology. In classic indications like black, brown, dark blue pigment and tattoos PicoCare hits the targets in two ways: photothermally chromophore specific plus photmechanically . This combination allows a much faster and more complete clearing in fewer sessions with less pain than the with ns lasers.

Multicolour tattoos usually need various wavlengths and multiple sessions and still might not clear completely. A recent study demonstrated the use of a 1,064-nm wavelength Nd:YAG picosecond laser for the successful removal of blue, black, and purple ink while 532-nm was used for red and yellow ink. These variable wavelengths allow for the more effective treatment of difficult-to-remove colors. In several studies the picosecond laser achieved 75-percent clearance in just 1 or 2 treatments instead of 5-10 sessions.

Hyperpigmentation in skin of colour after laser treatment, sclerotherapy or minocycline can be treated with Pico laser technology . A retrospective analysis of 13 Asian patients with Fitzpatrick scores of III (n=1) and IV (n=12) with Nevus of Ota, café au lait patches, solar lentigines, and other pigmentary issues treated with a 755-nm picosecond laser reported fair to complete resolution of their lesions, with only two patients (4.8%) developing transient hypopigmentation and no reports of postinflammatory hyperpigmentationA recent case series reported the use of a picosecond laser in treating minocycline-induced pigmentation (MIP). Patients had significant to complete resolution of their MIP after just 1 to 2 treatments with the picosecond laser.Picosecond laser technology continues to evolve with the addition of newer wavelengths allowing for more indications. Wavelengths of 670, 650 or 585 allow the treatment of vascular disorders respectively indications where vessels are involved. This is true for mixed melasma with increased vascularisation or Verrucae planae and vulgares, Mollusca contagiosa and their Vascularisation below or in combination with 1064 nm the use in nail fungus.

The focused destruction with less thermal diffusion also allows to treat nail fungus , resulting in less active fungus in the nail and if pigmented in clearing the annoying darkening of the infected nail.Among new indications are Laser toning, PIH treatment, Melasma, Onychomelanosis, Nevus Ota and Becker and superficial vessels that give dark and red colour to the skin.

The toning effect with low fluence and high frequency multiple shot and multiple pass laser energy delivery of mainly 1064nm in combination with the picosecond pulse provides dual benefits. For epidermal pigmentation, this device both heats and fractures melanosomes in order to diminish unwanted pigmentation. Part of the effects is the production of laser induced optical breakdown (LIOB) i.g. 1064 nm in upper and middle dermis, 532 nm in epidermis. These cavitartions are tiny injuries comparable to those caused by fractional ablation, however wothout any damage of the epidermal barrier but with similar results.

Histologic studies revealed localized areas of intraepidermal injury in which the surrounding epidermal cells about the basal layer and the cornified layer of the skin remain intact. The surrounding epidermal cells and melanocytes show no obvious areas of histological injury.

After a series of treatments there is decreased epidermal pigmentation as well as an increase in dermal collagen, elastin and mucin. This mechanism allows to use Pico laser devices with less side effects for indications, which we used to treat with fractinal ablative lasers such as rejuvenation, acne scars, hypotrophic scars or the reduction of large pores by ageing or in seborrhoic patients.In summary and conclusion advanced Pico lasers like the PicoCARE do improve chromophore related treatments like in pigmentation and tattoos in less sessions, with more complete clearing and less side effects and in addition they are effective in new indications including rejuvanation, scars or nail fungus, In summary : PicoCare is a tool which is effective and cost effective.These examples show new prospects for the picosecond laser and as the use of these lasers become more widespread we will find more ways of establishing their potential.

The use of blood concentrates in aesthetic medicine

In aesthetic medicine there exist many different concepts for facial and skin rejuvenation. Notably, the use of autologous blood concentrates gained increasing importance in the last decade. The main aim is to use patients’ own regenerative capacity in the form of a blood concentrate to support skin regeneration and rejuvenation by means of the bioactive release of cytokines and growth factors. Different concepts were introduced including Platelet Rich Plasma (PRP), Plasma Rich Growth Factors (PRFG), Autologous Antiaging Serum (AAS) and Platelet Rich Fibrin (PRF).

These concepts reveal many differences in their bioactivity, components, technical preparation protocols and application techniques. Therefore, it is important to understand the composition of each system and compare them with further fillers that are widely used in aesthetic medicine such as hyaluronic acid-based fillers to outline advantages and disadvantages for each indication field and provide an optimized treatment protocol for each indication in the field of aesthetic medicine.

A cadaver study investigating planes of injection in micrograft, hyaluronic acids, calcium hidroxylapatite, PRP and threads

Background: The aim of the study is to analyze the facial layers in which the product is released in the most common practices in aesthetic medicine, such as volume augmentation by means of hyaluronic acid, calcium hydroxylapatite, PRP, threads and micro/nanograft.

Materials and methods: 40 cadavers head have been injected using several techniques imitating procedure on common practice in aesthetic medicine to properly restore age related volume loss. During the simulated procedures different materials have been used: hyaluronic acid, calcium hydroxylapatite, human fat harvested from cadavers, threads and saline solution simulating PRP. Different colors have been used for the different materials in order to identify them at the dissection.

The injection of hyaluronic acid has been executed using both 27 gauges blunt cannulas and 30 gauges sharp needles. Calcium hydroxylapatite has been injected using both 27 gauges blunt cannulas and 28 gauges sharp needles. Micrograft has been injected using 22 gauges blunt cannulas and 21 gauges sharp needles, while nanograft using both 22 gauges blunt cannulas and 25 gauges sharp needles.

The colored saline used to imitate PRP has been injected using 22 gauges blunt cannulas and 30 gauges sharp needles. The threads has been placed using 18 gauge needle to insert them under the skin.

After the injections and threads placements all cadavers head have been dissected creating 5 anatomical layers: 1-skin, 2-superficial fat compartments, 3-SMAS, 4-deep fat compartments and masticatory muscle , 5 –bone. Colored materials has been searched along the layers.

Results: Hyaluronic acid has been placed in layer 2 for 93% of the volume injected, calcium hydroxilapatite has been injected in 92% of the cases in the layer 4, Micrograft has been injected for 93% in the layer 3, nanograft for the 83% in layer 2 e 17% in layer 3; PRP has been injected for 89% in layer 2; threads have been placed for 92% along layer 2.

Conclusion: Cadaver dissection offers various insights over injections in aesthetic medicine, focusing the relationships between anatomical structures and injectables. The analysis of facial layers offers opportunity to optimize facial injection in order to have better aesthetic results.

Comparing protocols: single stage microfat vs integrated protocol of lipofilling and monthly executed biorevitalization to restore vulvar age related volume loss

Objective: To compare effectiveness and subjective satisfaction of two protocols to execute mini invasive lipofilling (microfat) to restore vulvar age related volume loss. During a period of time of 12 months, one group of patient underwent a single stage microfat session on the vulva and vaginal great lips , while a second group underwent a second microfat session at least 3 months after the first, furthermore undergoing once a month a session of vulvar biorevitalization.

Materials and methods: Between 1/1/2014 and 11/30/2017 23 patients underwent microfat to restore vulvar age related volume loss; 12 of them underwent a single stage microfat under local anesthesia; the remaining 11 patients underwent a second session of microfat at least 3 months after the first session; furthermore the patients of the second group underwent every month a session of vulvar biorevitalization. Both the groups underwent the lipofilling by means of a new conception closed system, with a patented cannula. The following vulvar area have been treated: mons pubis and labia majora. The session of biorevitalization have been executed using 2,5 cc of a mix of lyophilized amino acids and sodium jaluronate. All the patients have been evaluated by means of standard photographies and echography before the treatment and after 1, 3, 6 and 12 months. The patients have been asked to express their satisfaction about the treatment by means of a simple questionnaire.

Results: The patients of the multiple session lipofilling and biorevitalization group expressed a significant bigger satisfaction about the treatment, in particular 6 months after the treatment (86% against 42%). Photographic and echographic exams showed a bigger and more stable on the mid-long term correction of the age related vulvar volume loss on the group of patient who underwent the multiple lipofilling sessions.

Pathomorphological Criteria of the Use Efficiency of Resorbable and Permanent Implants in Aesthetic Medicine and Cosmetic Dermatology

Much has been said of the use of Resorbable sutures and threads in providing cosmetic patients a non-surgical “lift” from these implantable medical devices. A histologic study was undertaken to evaluate the results of collagen formation with these implants. As well, some new data with regard to absorbable sutures will also be presented showing that collagen formation over time is real and in fact, how these materials give the clinical results that are seen.

Radiofrequency (RF) in Aesthetic and Dermatologic Treatments

The use of RF devices in dermatology and aesthetic medicine has gained popularity in recent years. In this presentation, RF technology will be reviewed, from bulk heating RF devices for skin tightening, to RF pins and needles for the treatment of wrinkles and scars. The use of these technologies has greatly enhanced the quality offerings that we are able to offer to our patients to make the skin better, to make scars improve, and to enhance our patients’ quality of life.

Botulinum toxin: what can go wrong and how to avoid it

Mimic facial rebalancing and fine tuning has become one f the most popular and successful treatment modality in aesthetic medicine. Best results are achieved with repetitive treatments which require exact reproducibility and safety. Hence quality management and avoiding pitfalls is critical for success. Side effects associated with botulinum toxin can be categorized into three types:

  • procedure-specific such as pain, bleeding, infection etc. which can minimized by optimal techniques,
  • product specific which depend on the exact placement and dose of botulinum toxin injection which requires sound anatomical knowledge and reliable composition of dosing according to the individual needs of the patient.
  • others which may include illnesses that occur unrelated but in a close time window after the injection and are therefore perceived as a result of the injection. In such situations stringent diagnostic procedures as well as dedicated guidance of the patient is the key to successful management

We have developed a step-by-step approach to ensure continued patient satisfaction treatment. Starting with a complete medical history ruling out hazardous conditions or unrealistic expectations followed by professional photo documentation and planning of injection points and doses. Use of anatomical landmarks to place neuromodulators exactly where they were planned to work and consequent follow-up visits to ensure patient satisfaction at the highest level. Following this procedure has proven a highly effective and time sparing approach for excellent and reproducible results with neuromodulators.

Botulinum toxin: fine tuning the dose & treatment intervals for optimal results

The effect of a single treatment with neuromodulators / botulinum-toxin (BTx) disappears after 4-6 months, initially, when muscle activity recurs due to sprouting of new nerve endings and restoration of the neuromuscular junction. Therefor repeated treatments are the key to maintain and even extent the initial effect.

Serial photography of treated faces over several years have demonstrated significant long term improvement of skin quality and facial radiance, provided that patients continue to be treated regularly. So far, long term patients receiving repetitive BTx injection for up to three decades have shown no signs of muscular atrophy or permanent muscular disabilities.

However, recent studies using magnetic-resonance-imaging (MRI) after BTx-induced chemo-denervation reveal a persistent reductions in facial muscle volume. This effect persists even after full facial expression has returned to baseline indicating subtle but persistent changes of muscular plasticity. Especially, patients receiving repeated BTx-injection into the frontalis muscle have a higher risk for brow ptosis over time and therefor need dose-adjustments in terms of lower doses and/or longer treatment intervals. Also, patients treated for brow asymmetry due to unilateral frontalis muscle hyperactivity, need dose adjustments with repetitive treatments when asymmetry resolves so that both sides of the frontalis can be treated equally after 2-4 treatment session.

In conclusion, continuously repeated BTx injections are safe and more effective to improve overall facial appearance than occasional ones. Treatment intervals in the upper face, especially the frontalis muscles should be increased over time according to individual dose-responses, while retaining brow mobility without marked frontal lines is considered an optimal dose-response. Consequently, facial wrinkles can be erased, without erasing facial expressiveness.

Photography in Plastic Surgery

Films and photographs are an important  part of medical records in plastic and aesthetic surgery.  In the USA and EU there are few regulations in medical photography. Before  taking a photographs patients are asked to complete consents forms, usually consent form consist of 3 parts. Medical journals requests from patients additional specific consent form  patients.

A new regulation in Poland (RODO) introduced in May 2018 described how patients data, medial photographs  should be storage and published. The new regulation is extremely important regarding medical pictures use in social media and  marketing. In presentation we will explain the new regulations  in Poland and how to consent patient for medical pictures.

HIFU – what we know about its efficacy and safety based on literature review? Goals

The aim of this systematic review was evaluation of published data on efficacy and safety of HIFU, medical device being popular in skin contouring.

Materials and methods: Between 15th of April and 10th of May 2018 a systematic review was performed in the PubMed.gov. Searching clauses were used: high intensity focused ultrasound AND skin AND safety followed by limitation to: humans, clinical trials, publication date 10 years.

Results: After Pubmed.com searching with a clause: high intensity focused ultrasound – 3391 publication have been found. After searching with clause: high intensity focused ultrasound AND skin – 201 items have been found. When limiting to humans, 125 items left. After limiting to Clinical Trials only 26 papers have been found. Finally, after limiting to last 10 years of publication date, only 20 items remained. After review of 20 publications, authors of this review have stated that only 6 are connected with skin lifting and contouring. Following search with addition of safety clause, only 13 papers were found and one was only relevant.

Conclusion: Based on this systematic review authors suggest less enthusiasm and questioning attitude to HIFU commercial materials and reserved optimism when offering patient this technology due to limited data and lack of long term treatment outcomes.

Search for harmony continues...

Everybody knows, how attractive face is important - in social life, even

on the job market. "Attractive people have easier life" - is a fact known since the beginning of mankind.

In today's world ruled by tabloids, the quest for beaty is far more popular, than even before. Tabloid press reports about new - always revolutionary - methods and instruments, that "guarantee' beauty and happiness more frequent, than currencies fluctuations happen. Medial fame find those, who we can only decribe as victims of incompetence.

In real medical world complications do happen. Even those best among us had faced it. Sometimes a patient is to blame, for not following our instructions and warnings (i.e. holiday in the tropics after a surgery). But, such situations we are trained to handle.

The face is not only a part of our body. It is a multifunction organ. Facial harmony is much more, than (so very important) attractive appearance. Harmony means proper functions : speech, breathing, eye sight, occlusion and functions of temporo-mandibular joints.

To create, or re-create this harmony is everyday task of maxillofacial surgeon. Our patients come to us because of facial trauma, tumors (malignant and benign), TMJ dysfunctions, congenital or acquired facial deformities.

The list of maxillofacial surgeries is nearly 800 pocedures long. Please be invited for a journey in the search for harmony

The patient with „red face syndrome” in aesthetic practice. Differential diagnosis and new therapeutic proposals

The „Red face syndrome” is one of the most easily recognizable clinical symptom in dermatologic patients, however, the corresponding diagnosis and etiology are not always so straightforward. The „red face” is a result of coexisted erythema and inflammation in the course of different cutaneous and/or systemic diseases and requires careful differential diagnosis.

Before implementing treatment for the red face it is essential to establish a correct diagnosis and to understand the underlying pathophisiologic factors. This review presents the clinical spectrum of „red face syndrome” and new therapeutic proposals.

Which is the quality of the fat tissue that we used for Lipografting?

The transplantation of fat from one area of the body to another is a safe and effective procedure (small and big areas) in good hands and following the guidelines of the lipografting. There has been controversy concerning, the manner of collecting fat, Injecting the fat, cleansing the fat and the effectiveness of the fat transfer.

But until today nobody talks about the quality of the fat tissue from the donor areas. Studies made in France and USA show us that the quality of the fat tissue is not so good that we thought. We have new researches about the pathophysiology of the fat tissue and the presence of fibrosis, with the devastating action over the biologic action of the fat tissue. More, the new research from Japan confirm the difficult to find a lipograft for a good clinical result

About the fat transplant survival, we know nowadays which areas of fat are more likely to be retained, adipocytes with more alpha 2 receptors (antilipolytic action) and more lipoproteinlipase action. The Fat transplant survival depends on the instrumentation used for harvesting and for injection as well, also the survival of the fat tissue are related with the preparation of the donor and receipt area.

The survival of the fat transplant is in relationship with the presence of blood in the fat injected because stimulates macrophage activity to remove the cells, for that reason is important washing the cells in a physiological solution prior to injection, Diminish the presence of lidocaine in the fat cell is important for the survival of the lipografting

For a good result in our lipografting we need find how we can help the fat tissue for recovery his normal biological function, I present different therapeutic alternatives for recovery the physiology of the fat tissue during the lipografting.

Biostimulation the bottom line in aesthetic treatments

In the last years, the concept of Anti-Aging Medicine has been rapidly gaining in importance, both in terms of its container (name and spreading) and contents (diagnostic, preventive and therapeutic specific procedures). Today, we all know that the Anti-Aging Medicine seeks to improve the quality of life throughout the physiological aging process, focusing on skin aging among other purely cosmetic aspects.

Recently, the WHO defined “active aging” as the process that "optimizes the chances of physical, social and mental well-being throughout lifetime aimed at increasing a healthy life expectancy, productivity and quality of life in the old age". It is important to highlight the idea of optimization, the rationale for our exposition in this presentation.

Numerous technological breakthroughs (laser, intense pulsated light, radiofrequency, etc.) have enabled new approaches to skin aging. These techniques have been sometimes miss considered simplistic (“anyone” can be trained in their use), disregarding the complexity common to any medical act, that includes evaluation, diagnosis, assessment of therapeutic alternatives, analysis of pros and cons, treatment selection agreed with patients, the treatment itself, follow-up, detection and solution of complications.

It is time for a return to a more personalized medicine, in which technology is just a tool and physicians recover their prominent role, making good use of readily available resources that sometimes are overlooked. There are four treatment groups for skin aging, and probably for any aestheticism: the preventive, restitute, curative, and palliative treatments.

In this presentation, we will focus on the restitute treatments, defined as the procedures aimed at restoring (back to normal) skin metabolism and function. The most important restitute treatment is biostimulation.

Fat grafting and breast cancer

In the 2015 in the USA, more than 25,000 cases of mammary Lipografting were performed and the number increase in 2017. The use of adipose tissue for aesthetic recovery of the breast, aesthetic indications or recoveries for oncological surgery has acquired importance in recent times, as well as controversies regarding use in patients after the oncological procedure in the breast. We present the current techniques and controversies that have developed in this last few and the conclusions.

The non-surgical treatment in the urogenital syndrome. New alternatives.

The urinary Genito syndrome of the GSM menopause and SVR Vaginal relaxation syndrome share certain symptoms such as vaginal dryness, dyspareunia, irritation, tenderness that are aggravated by Vulvo vaginal VVA atrophy. These symptoms produce in the patients sensitive alterations in their way of life with the loss of the quality of life.

In recent years the cosmetic gynecology has progressed and have developed techniques of non-invasive treatment based on early diagnosis and used of validated questionnaires. Laser and radio frequency equipment’s have made an important marketing to show the virtues of their equipment in the treatment of symptoms and signs of VVA. Nowadays there are other treatments (nanofat, PRP, inyectable and transcutaneous Carboxytherapy, Photobiomodulation), that work in synergistic form, are more economic for the doctor and by logic for the patient and give the same results as the expensive techniques. Several Histopathologic studies are presented showing that these treatments can be performed in isolation or associated with the application of laser or radiofrequency.

Complications in buttocks lipografting

You have two statistics that call attention, the number of references on the Internet on treatment of increased buttocks with the use of adipose tissue (more than 1.600.00) and the increase of serious complications in the Lipografting’s buttock among the increased of the mortality from this type of cosmetic surgery.

It presents the causes that lead to these complications, the current consensus at the level of the societies of aesthetic surgery and cosmetic surgery with respect to the changes that are indicated to avoid these serious complications.

How to improve results with HA monophasic fillers - A novel technique to reconstitution and advanced injection.

Although hyaluronic acid filler is mainly reabsorbed in less than 8 months maintained results can last for more than 1 or 2 years. Some studies demonstrates that the total volume is maintained long-term by replacing part of the injected hyaluronic acid filler with autologous tissues.

Hyaluronic acid filler acted as a scaffold for autogenous tissue replacement by means of fibroblast migration and proliferation, collagen induction, and may promote differentiation of adipose tissue derived stem cells.

Dilution of HA filler leads to distribute more easily around stromal cells, which could to induce fibroblast-myofibroblast differentiation and collagen production, particularly in the subcutaneous fat septae where mesenchymal stem cells are known to occur.

Dilution (reconstitution) of HA with anesthetic promote greater patient comfort, less swelling and bruising and potentially lower risk of vascular complications. Finally, as concentration reduces, allows for more superficial placement into mid-dermis with fine 30G needle.

Gas dissection and hyaluronic acid fillers in the treatment of facial wrinkles

Hyaluronic acid filler is the gold standard for soft tissue augmentation, however it’s difficult to obtain long term highly satisfied patients when we treat wrinkles and folds.

During anatomical dissections we can observe different types of subcutaneous fatty arrangement. Medial of the labiomandibular and nasolabial sulcus (including all the danger triangle of the face) we find fibrous white adipose tissue corresponding to Ghassemi-type 2 and laterally structural white adipose tissue corresponding to Ghassemi-type 1. It’s difficult to precise injection a HA filler in Ghassemi-type 1 fat.

Carbon dioxide injection promotes a mechanical microdivision injury that creates a virtual place to place the filler, as well as synergic contributes to improves quality and elasticity of the dermis. We presented a new, safe and clinically effective treatment for facial wrinkles with sequential intradermal injections of carbon dioxide and reconstituted hyaluronic acid. Also it can be used to extend results on the nasolabial fold treatment.

Some studies demonstrates that the total volume is maintained long-term by replacing part of the injected hyaluronic acid filler with autologous tissues. As CO2 injection improves tissue oxygenation, it can contribute for this fact. Finally CO2 injection enhances the inflammatory response which contributes for patient comfort and less or no downtime.

The Use Of Polarized and Hyperpolarized Light in Aesthetic and Anti-Aging Procedures

This presentation explains the experience of using linearly polarized light, spectrum 480-3400 nm after aesthetic interventions and anti-aging procedures.It also explains the preliminary results of the biophysical state of the tissue, collagen, water and basal membrane, using opto-magnetic imaging spectroscopy, after application hyperpolarized light on forehead zone.

Anti-Aging and Rejuvenation effect of Fasting Mimicking Diet

The research on human aging has focused in the last decades on the molecular basis of the age related decline in order to find new strategies to modulate such decline and extend healthspan as well as lifespan. Seminal papers have shown this is due to evolutionary conserved pathways activated by fasting, as an adaptation to enable organisms to survive periods of food scarcity and wait for periods of abundance to reproduce. These data have shown that in humans fasting and fasting mimicking diet result in a number of healthy effects, such as reduced glucose, insulin, total cholesterol, inflammatory parameters, as well as enhanced neurogenesis, cognition and autophagy and, finally, in the mobilization of fatty acid.

Growth hormone/IGF1 has been identified as a major regulator axis of human as well as model organism longevity. IGF1 is significantly reduced with a chronic protein restriction and with few days of fasting mimicking diet. It has been proposed that this hormone may play a key role in the aging process and in the incidence of degenerative diseases. This idea is reinforced by the observation that people defecting the growth hormone receptor do not develop cancer and type II diabetes (Guevara-Aguirre et al. 2015).

Recent papers have also demonstrated the positive effect of fasting mimicking diet during chemotherapy. Therefore it appears that fasting and the more feasible fasting mimicking diet can have many application as a preventative approach to aging-related degenerative disease and in connection with standard therapies.

Telomere length affecting facial regeneration with platelet-rich fibrin based on the low-speed centrifugation concept

Genetic biomarkers are being routinely investigated in modern medicine as a personalized method that may be utilized to optimize regenerative protocols. Telomere length (TL) is a well-known indicator of biologic age and a potential biomarker for several conditions. Skin aging is a complex process and a wide variety of invasive and non-invasive protocols and their modifications have been proposed for facial aesthetics and skin regeneration. However, these treatment protocols lack standardization. In addition, biomarkers of skin aging may prove useful tool to investigate the treatment success and the evaluation of treating protocols.

Autologous concentrations of human platelets, such as platelet-rich plasma (PRP) and platelet-rich fibrin (PRF), have been used in aesthetic medicine for dermal stimulation and augmentation. Facial regeneration utilizing autologous platelet growth factors is considered a natural approach to restore dermal degeneration in contrast to exogenous growth factors and biodegradable substances. Moreover, platelets preparations, apart from their bulking effects as fillers, release numerous growth factors, cytokines and extracellular matrix proteins upon their activation, such as fibrin, fibronectin, and vitronectin, that bind to their specific cellular receptors and enhance or modify the various intracellular processes that relate to cell proliferation and production of additional extracellular matrix proteins.

Platelet-rich fibrin (PRF) and platelet-rich plasma (PRP) are the most commonly employed platelet preparations. There are numerous studies (observational, in vitro, animal models, and clinical trials) suggesting a tangible effect of both topical and injectable applications of platelet concentrates on cellular changes and facial regeneration.

Plasma - the non invasive labiaplasty tool

The aim of the study was to evaluate the safety and efficacy of non-invasive labiaplasty with Plexer device.

Women with labia minora hypertrophy were eligible to be included in this study. Assessments at baseline and after 4 weeks after treatment, were conducted. Analog Scales were used to grade the hypertrophy by patient. Participant satisfaction was measured on 5-point Likert scales (1 = very dissatisfied, 5 = very satisfied).

One plexer therapy was applied. Outcomes were evaluated at baseline and 1 month following the therapy. 33 women (mean age 36 ± 7.5 years), were included in this study. Average improvement in Visual Analog Scale scores for hyeprtrophy was statistically significant at end point. Patients were satisfied with the treatment in 90% cases.

Plexer is a good treatment option for standard labiaplasty.

PROFHILO renewal of skin and subcutaneous adipose tissue to enhance the differentiation and viability of human adipocytic stem cells

The regenerative processes in the skin require the presence of a hyaluronic acid with two ranges of molecular mass: heavy HMW-HA and light LMW-HA. Each of these chain lengths specifically affects CD44, TLR and RHAMM receptors present, e.g. on keratinocytes, fibroblasts, or macrophages, supporting separation, differentiation and secretion functions necessary for the preservation of tissue homeostasis. Hyaluronic acid is used in most medical or aesthetic dermatology preparations, showing various biological effects depending on the physical and chemical properties. PROFHILO, which was inaugurated by the pharmaceutical company IBSA in 2015, is a modern preparation manufactured using the innovative NAHYCO technology. During the patented process of thermal stabilization, a complex of heavy 1100-1400kDa and light 80-100kDa chains of hyaluronic acid connected together via hydrogen bonds was selected with the emphasis on regenerative processes, all of that without the presence of any additional chemical networking substances (without BDDE).

Thanks to unique characteristics, with its very high Ha concentration of 64 mg/2ml in the pre-filled syringe, PROFHILO is easy to dose, expresses optimal diffusion and tissue integration, allowing for a 10-point technique of administration with the effect on the whole face, neck or other treatment areas. The effectiveness of the tissue remodelling process, which was proved in a number of published clinical studies, is based on the influence on all 3 layers of external tissue coating: the epidermis, dermis and the subcutaneous tissue. The direct stimulation of keratinocytes and fibroblasts, with a very small inflammatory response, leads to the production of collagen, elastin, and Ha. However, the most important thing for the achievement of the full bio-remodelling effect is the fact that PROFHILO is the only product that has an influence on the longevity, differentiation and HASCs (Human Adipose-derived Stem Cells) of the subcutaneous adipose tissue confirmed by a comparative study. This unique quality makes it possible to achieve the full three-layer improvement of tightness, density and hydration – with the lifting effect even after two interventions per month.

Preserving the capital of youthful appearance in the skin: progressive physio-regeneration and tricks

Background: Among many therapeutic proposals it is important to recover the concepts of physiology that allow the constant regeneration of the skin. The accent predominates on the Adult Stem Cells of the germinative layer of epidermis and on fibroblasts, of the dermis able to produce the components of the extracellular matrix..

Materials and methods: Respectful treatments of the epidermis able to penetrate lightly through the horny layer with strategies of buffered soft peeling complex, electro-ionized water, and better with very superficial Needling, allow the penetration of a targeted Biomimetic Peptide Complex, that is dedicated to talk, to provide messages to optimize, reconstruction , defense, hydration, and through the epidermal germinative layer above the dermo-epidermal junction, to reach the dermis inducing also the fibroblastic proliferation Adding by the injective mesotherapeutic technique, Amino acids,Hyaluronic Acid Fragments between 20 and 38 monomers, able to bind to CD4 fibroblast receptors, we stimulate the production of collagen III, hyaluronic acid, elastin, the sol vital state, possibly reinforcing with antioxidant action. If we want a more aggressive action for an immediate result (waw effect) it is possible, according to the cases, a mild physical injurious lesion with very small delicate burns, well spaced and localized in healthy tissue by the Plasma (electrocution with ionized gas). Some weekly sessions are held. Long-term home care follows with Peptdes and Antioxidants in cream. In the hypodermis we use the recovery of the volumes or firmness of the skin by different HA or deep RF.

Conclusions: The different levels of skin aging, can be treated with innovative but well known techniques. The synergistic methods are able to counteract skin laxity, while recovering the barrier function of the surface. Once the roof of the skin system has been recovered, and they are antiaging Physioregeneration, the restructuring methods in the hypoderm will become efficient.

Comparison between fillers with different induction of Collagen

It’s been some years since Aesthetic Medicine is interested to Anti-Aging Medicine. This phenomenon is modifying even our clinical treatments, whenever it’s possible, personalizing procedures at the ages and situation, ie menopausal transformation, that give even very good results.

That’s possible because we can use new devices with amazing yield. Now we are using, more and more a filler based on PolyCaproLactone (PCL), Polylactic Acid (PLLA), CalciumHydroxilApatite (CaHA) that have a large safe reports, tissues renovation and reintegration by Neo-collagenesis Process. In order to their particular characteristics of viscosity and elasticity and not at the least his longevity due to the products.

Finally treatment offers a versatile, nonsurgical option for soft tissue augmentation, suspension and contouring with a multitude of potential aesthetic applications. Moreover our purpose is not only a limited to use an advanced filler to generate volume and collagen but finally the goal is the combinations of treatments to get the harmony of the face that depends on the proportion between concavities and convexities with lifting effect.

Introduction – The use of PCL, PLLA, CaHA Dermal Filler is began a goal standard for rejuvenation of the Face especially in mature Skin.

Materials and Methods – A blend of Poly-Capro-Lactone, Calcium Hidroxyl Apatite microsfere transmitted by a gel of carboxymethylcellulose, glycerine, and saline solution - Poly-Lactic Acid (PLLA) were used in combination for stimulation, restoring and contouring the face.The treatments were carried out in a suitable ambulatory environment, using multiple injections in several ways, depending on the specific defect we want restore, linear tread, fanning technique, cross-hatching.

Conclusions – These combination of procedures are simple and safe, it does not interrupt the patient’s normal social life or working activity, and the results are highly satisfying, even with a single application, plus it’s repeatable.

PRP, SVF and Microfat  for a natural rejuvenation

The concept of body’s own rejuvenation is gaining more and more attention in aesthetic and anti-aging medicine. PRP, Microfat and SVF are natural substances that can be quickly prepared and applied on an outpatient basis.

This contribution features the presentation of a minimally invasive technique using the Arthrex ACP Double Syringefor preparation / injection of Microfat , SVF and PRP. Moreover the scientific background and clinical applications ofthese three autologous products is presented. PRP and SVF are powerful tools for indications that focus on repair andhealing (eg, treatment of alopecia, scars, actinic elastosis, skin rejuvenation), while Microfat is a biological filler that hasregenerative effects on the surrounding tissue

Enhanced face attractiveness after aesthetic treatment.

Aesthetic medical treatment should improve attractiveness of the patient. The aim of the study was to measure the enhancement of patient’s face attractiveness after aesthetic treatment. We have used metod of collective intelligence to estimate the difference of face attractiveness before and after the treatment. Study was performed using photographic documentation „before-after” of four most important aesthetic treatments like: face-lift, blepharoplastic, botulinum toxin, lips enhancement with filler. Every treatment had 26 entire documentations „before-after”. Photographs were evaluated by 167 independent, untrained observers.

Results have show that blepharoplastic produces highest, statistically significant improvement of face attractiveness (32.79 AU). Degree of reproducibility of the results, was estimated using Spearmann’s correlations rang factor. The highest effects were fund in cases of face-lift (0.24) and botulin toxine (0.22). Dispersion diagramms and tables are showing dependence between estimation before and after the treatment.

Odległe powikłania po zastosowaniu wypełniacza nieznanego pochodzenia po powiększaniu piersi

Pacjentka lat 35 zgłosiła się z licznymi miejscowymi i ogólnymi dolegliwościami, powstałymi na skutek wprowadzenia do obu piersi wypełniacza. Zabieg został wykonany w 2014 roku, do każdej piersi podano 140 ml wypełniacza. Od ponad 3 lat pacjentka zgłasza się do licznych placówek medycznych z wielopostaciowymi dolegliwościami (ropne przetoki, stany zapalne, olbrzymie torbiele, deformacja obu piersi, migracja wypełniacza poza obszar piersi, gorączka). We wnioskach autorzy proponują własny algorytm postępowania.

The lower jaw and the neck: non surgical reshaping

The lower jaw and the neck during the aging process, as for other facial areas, changes dramatically and a loss of definition of the lower border of the mandible, of the cervico mental angle and of the neck give an unpleasing appearance. The main changes of the neck and the lower jaw, during the aging process, are represented by pre platismal fat enlargement, neck skin ptosis and mandible resorption, in fact surgical correction of this conditions is performed trough several techniques such as neck liposuction, neck lift and, quite often, chin and mandibular implants placement.

Non surgical correction of this areas is challenging and a lot of energy based devices (EBD), such as HIFU, have been introduced to get a “non surgical lift”, however it doesn’t exist one EBD able to restore completely the appearance of an aging lower jaw and neck, a more complete approach could be achieved using different techniques. Actually there are several techniques proposed and performed to reshape the lower area of the head, the Author will focus about non surgical corrections of the lower jaw and the neck performed only with injectables, represented by hyaluronic acid injections to get the right projection of the mandible and by sodium deoxycholate injections to reduce pre platismal fat enlargement and get also neck skin tightening.

Non-surgical correction of the lower eyelid and lateral canthus zone using fillers.

Relevance. Traditionally main method of a rejuvenascence of periorbital area is the surgical blepharoplasty. But its frequent insufficient efficiency in the delayed prospect, and increase in interest in low-invasive procedures do an injection blepharoplasty by an important method of correction of a lower eyelid. The delayed adverse effects of correction of the tear trough and injection camouflage of prominent orbital fat of a lower eyelid are important. They are: accumulation of HA-filler out of tear trough, enlargement of hernia of a lower eyelid, puffiness of a periorbital zone, short and insufficient effect of correction.

Materials and methods. The author's clinical classification of aging changes in the lower eyelid area for correction by the HA-filler is presented. The methods of tear trough and palpebromalar groove correction, depending on the existence and expression of prominent orbital fat of the lower eyelid using the НА-filler. The method of injection lifting of the zone of the lateral canthus.

Conclusion. Correction with HA-filler of lower eyelid has to be perfomed with consideration of anatomic features of every patient, especially existence and expression of prominent orbital fat of a lower eyelid.

Optimal use of combined botulinum toxin and fillers

Facial aging involves the loss of volumen and skin elasticity, dynamic lines due to muscle action, and the appearance of static rhytids. Botulinum toxin and fillers  have been shown as the best non-surgical solution to eliminate wrinkles and remodel the face. Both techniques are the most worldwide performed in the field of aesthetic medicine and cosmetic dermatology. In most cases they are complementary techniques. The botulinum toxin has shown the best results at the facial upper third level where even the surgery didn’t get good results.

Adverse events associated with injections are typically mild, easily managed injection pain, followed by redness, swelling, and bruising. Asymmetry, nodules, ptosis, and intravascular occlusion are less common.

For optimal results, the treatment with both techniques should be done sequentially as It will shown in this presentation of Dr.Jose Serres.

Study on “spot reduction” obtained from chronormophodiet through the comparison of anthropometric parameters

Nowadays the “Spot Reduction” is still a very active topic. The aim of this study, conducted on gynoid women, was to prove that the Spot Reduction through the COM Diet is possible.

Gynoid women tend to accumulate fat in the gluteal-femoral area and triceps. Their feature is an estrogenic predominance that, in these body’s parts, stimulates the production of Perilipin: a protein that encloses the Adipocyte interfering with lipolytic process. In addition, α-adrenergic receptor expression increases in the gluteus and thigh and adrenaline and noradrenaline, produced by exercise, bind to these receptors inhibiting lipolysis. The COM Diet is an integrated approach that takes the Chronobiology of Hormones and the Morphology of Humans into account.

METHOD: The case-control study started in September 2017 and lasted two months.35 gynoid women participated in the study by completing the search path. We divided women in a control group and in a case group: 19 case gynoid women and 16 control gynoid women.

People in control groups followed the COM Diet and people in case groups followed a “standard” diet with the same percentage of macronutrients compared to the control group, but with a different distribution during the day.

They also did regular workouts, 1 hour for 3 times a week. We assigned case groups a specific circuit training to improve circulation, control groups followed a workout of equal volume, but with different settings: they started with anaerobic exercises training large muscles first and subsequently small ones, and then ended up with 20 minutes of aerobic activity.

RESULTS: At first sight the bioelectrical impedance analysis In Body shows us that both groups had similar results in terms of weight loss, visceral fat, fat mass and free fat mass, but a very different result is emerged from singular skinfolds. Even if they had a similar loss of total fat, skinfolds showed us that they lost fat in a different way. Gynoid women who followed the COM Diet lost, on average, 4,7mm from triceps (20,3%) and 4,6mm from thigh (13,8%); gynoid case women lost only 2,6mm from triceps (10,7 %) and 0,1mm from thigh (-0,4%), two revealing data.

CONCLUSIONS: Although there are numerous diets and all of them can bring benefits in terms of weight loss, it is important to use specific approaches depending on the individual biotypes in order to get the best results. Fat distribution is strongly influenced by the hormonal structure and nutrition has the ability to affect hormones. This study confirms that Spot reduction is possible through the COM Diet which focuses on the various biotypes and hormonal imbalances.

Thread lifting, expectation and reality: view of doctor and patient.

Introduction: In recent years, thread lifting methods are more frequently applied in practice of specialists in dermatology and aesthetic surgery. As of today, there are offered dozen and even hundreds of different threads and methods for face and body rejuvenation. Frequently, the companies not even trouble themselves to teach the doctors and offer them to purchase the products- threads not even thinking about any possible consequences. Precisely for this reason, doctors and patients have wrong expectations, but reality of thread lifting is totally different.

Materials and methods: Advices offered by the author are based on application of thread lifting methods by group of doctors during 20 years. There were researched results of different methods procedures for more than 300 patients in order to evaluate the given techniques effectiveness. During many years the technique of thread placing subcutaneously has been modified for more safe and effective methods application.

Results: As a result of longstanding work the author succeeded to gather all the features and details of threads application for face and body rejuvenation, to differentiate and to structure thread lifting process and to offer the colleagues practical advices and techniques in order to understand what doctor and patient could expect from these procedures.

Discussion and conclusion: Aim of this paper is to increase safety of thread lifting application, satisfaction of patients, quality of the derivable results and to facilitate doctor’s work.

It… could… work! Looking for a real antiaging drug

In Western countries, the population is getting older. This trend opens a series of worrying economic, social and health problems: in the near future, people in working age will have to bear the heavy financial and welfare burden necessary to ensure an acceptable living standard to a growing array of retired people in need of care. The sophisticated techniques of modern medicine are able to prolong the survival of even very old individuals, who in other times would have been destined to die, but in order to achieve this, long and costly treatments are needed, which attenuate, but do not solve, the usual overlapping of chronic pathological states, not completely curable. In the research laboratories all over the world, huge resources are invested in the continuous attempt to develop increasingly incisive treatments against the morbid conditions typical of old age. However, among scientists and decision makers, awareness of the need for a change in strategy begins to spread: rather than therapeutic intervention on individual geriatric diseases, it would not be more productive to try to slow down or even stop, the progressive degradation of the tissues and biological processes that is the common pathogenic denominator?

This objective does not seem unattainable, having already been repeatedly achieved in experimental animals. In mammals, the vertebrates that are genetically closest to us, a significant increase in the maximum duration of life (from 5 to 40%), associated with a considerable reduction of age-associated diseases, was obtained with a plurality of interventions.

Such an approach, in addition to being more effective from a clinical point of view, could, in the medium to long term, be economically very advantageous for the community and also for the pharmaceutical industry. In fact recent years have seen an exponential growth in investments in the biotechnology sector dedicated to anti-aging. In March 2016, an article in the American magazine Fortune illustrated the most striking aspects of this new frontier of big finance, revealing the enormous funding that the sector of research on aging therapies has recently received, even from the Silicon Valley giants, among which Facebook, Oracle, PayPall, Amazon and, first of all, Google: Alphabet Inc., holding the famous search engine, is pouring over a billion dollars in the creation of Calico, a biotechnological company explicitly dedicated to the development of new therapeutic ways to increase the longevity of the human species.

The American FDA, which has long stubbornly refused to treat senescence as a morbid condition susceptible to a therapeutic approach, forbidding the experimental verification of any ventilated anti-aging pharmacological activity, finally, in 2016 gave the clearance for the launch of a randomized trial explicitly aimed at evaluating the effectiveness of a drug against the signs of aging.

The planned launch of phase III phase controlled experiments on other compounds potentially capable of providing additional years to life has given impetus to the attempts to develop an aging markers panel to evaluate the results of future trials using end-points different from lifespan, too long, in man, to be compatible with the needs of scientific research.

The identification of these biomarkers will be useful also in order to direct and support the clinical activity of Anti-aging Medicine, a new branch of medical science that, thanks to the acquisition of these modern tools, begins to take more practical contours.

Here, in a nutshell, some of the sectors in which research is more active in order to develop therapies able to increase the longevity of the human species:

  • Qualitative and quantitative regulation of the macronutrient intake
  • Modulation of nutrient sensing receptors
  • Tissue cleaning of senescent cells
  • Implementation of proteostasis cellular device
  • Restoration of the epigenetic alterations of aging
  • Replacement or reactivation of stem cells

In particular, the experiments conducted on animals in order to eliminate senescent cells from tissues seem to open up real prospects for a future clinical use in humans.

Cell euthanasia for skin aging

There are biological mechanisms that, in order to limit neoplastic proliferations, prevent cells from multiplying indefinitely: telomeres, namely non-coding segments at the ends of chromosomal filaments, undergo curtailment at each mitotic cycle. When their shortening reaches a critical level, the genome destabilizes, triggering a DNA damage response. This leads to the activation, via p53 protein, of p21 and p16 factors, cyclin-dependent kinase inhibitors, resulting in a definitive and irreversible mitotic arrest; the cells also interrupt much of their physiological activities and enter into a sort of "retirement age", defined as cell senescence, characterized by dysfunctional behaviour that occurs in the secretion of cell damaging and pro-inflammatory substances (SASP, or Senescent Associated Secreted Proteins.

Cellular senescence is found in post-mitotic tissues too, which are not the site of replication activity, because it may be induced, with or without simultaneous telomere shortening, also by sub-lethal events of various nature, such as extensive genomic damage, oxidative stress, protein denaturation and strong inflammatory or oncogenic stimuli.

Recent data suggests that senescent cells can perform some useful functions, especially during embryogenesis and wound healing. However, since they are resistant to apoptosis and also owing to the decline in specific immune-surveillance, with age progression their number increases in tissues, where these cells exert a highly damaging action; indeed, the prolonged exposure to SASP products cause morphological and functional alterations, inducing senescence in other cells, promoting a chronic inflammatory state and favouring the onset of systemic pathologies, among which, paradoxically, even cancer. Thus, cellular senescence contributes to determining the gradual age-related functional decay, as demonstrated by the finding of an inverse relationship between the length of telomeres in blood leukocytes and the incidence of many age-associated diseases; moreover, studies concerning centenary subjects have shown that these and their cognates are characterized by a slow-down in telomere reduction. Such a slowdown was also found in those who regularly carry out physical activity or reduce calorie intake or have a diet rich in vitamins or omega-3 fatty acids.

It was been shown that the selective elimination of the senescent cells is capable of increasing the average mice lifespan, reducing the age-related incidence of tumours and preserving the functionality of many tissues.

Some substances, such as quercetin (flavonoid present in chamomile, hypericum, Ginkgo biloba, green tea, bilberry, etc.), fisetine (flavonol contained in strawberries, apples, persimmon, onions, cucumbers), piperlongumine (natural product extracted from "long pepper", a spicy Indian plant), navitoclax (tyrosine kinase inhibitor) and some BCL-2, BCL-w and BCL-xL proteins (anti-apoptotic factors) exert selective toxicity on senescent cells, whose elimination accompanies, in the animal, the regression of many aging manifestations.

Recently, a similar result was obtained by infusing a synthetic oligopeptide capable to penetrate within the senescent cells and to interfere with the apoptosis preventing mechanisms, because it interrupts the inhibitory action that the FOXO4 factor exerts on the p53 protein.

Therapies aimed at eliminating senescent cells, defined as senolytic, are currently among the most promising prospects of Anti-Aging Medicine; researches on this topic are receiving an impressive amount of funding, especially in the US.

An alternative approach, by someone defined senomorphic, involves the use of drugs capable of acting not against senescent cells but counter to their secretion products125,126 also through blocking the metabolic pathways that induce SAPS release and function.

Currently available senolityc substances have a tissue-specific activity, so none of them is able to eliminate senescent cells from all the body districts. It is therefore likely that the first senolityc therapies available for clinical use in humans will have an effectiveness limited to particular organs or tissues.

The skin will perhaps be the first target of these therapies, for two reasons. In fact, the skin is one of the organs in which the presence of senescent cells tends to increase more, as it is subjected to the aggression of environmental factors, primarily UV rays, which damaging the genome, induce cellular senescence: in the dermis of the highly photo-exposed subjects more than 60% of fibroblasts present the characteristics of senescent cells and the existence of a close correlation between the number of these cells and the clinical signs of skin aging has been clearly demonstrated. The second reason is related to the possibility of using topical senolityc drugs, in order to minimize any systemic adverse effects. It should also be noted that some of the substances with a known senolytic activity are of vegetable origin and already used, with various purposes, as ingredients of cosmetic products. The selective killing of senescent cells will probably be the basis for the next skin aging therapies.

Spider veins in the region of the ankle and foot – cosmetic problem or severe disease?

The presence of the spider veins (telangiectasie) at the ankle level and below is recognized by many patients as a severe cosmetic defect. Similarly to the other spider veins, some treatment options including percutaneous laser or sclerotherapy can be proposed. Before any treatment the precise evaluation of the superficial as well as deep vein system should be performed. The possibility of the saphenous vein incompetence, perforator or other major vein incompetence should be always evaluated and excluded. The special attention should be paid on the patients in which the foot and ankle level spider veins are the part of the corona phlebectatica pathology.

In most of this cases, more complex approach to the proper treatment should be proposed. In the lecture the pathophysiology, as well as the potential diagnostic and therapeutic difficulties related to the management of the patients with foot and ankle level telanagiectasias will be presented. The practical aspect of the sclerotherapy as well as compression therapy treatment in this region will be discussed with the vein system hemodynamics of this lower leg area together. The potential factors related to the treatment failure will be also presented.

What is new in the invasive treatment of the superficial vein incompetence?

The technical progress as well as the better understanding of the pathology of the chronic venous disease led to the significant changes in treatment of the superficial vein incompetence which also full fill the expectations of many patients with this kind of diseases. The good clinical as well as cosmetic results of the minimal invasive approach have the positive influence on the wide implementation of the endovenous treatment of the superficial vein incompetence by the means of the thermal or non-thermal ablation methods. For the years, the most commonly used endovenous procedure was the foam sclerotherapy. In the last decades in many centres, surgery as well as saphenous vein sclerotherapy was replaced by endovenous laser or radiofrequency ablation.

The further technical progress led to the MOCA (mechano-chemical ablation), SVS (steam vein sclerosis) and recently also glue (cyanoacrylate ) based technology. In the current literature, the long term results after endovenous laser as well as radiofrequency ablation and sclerotherapy can be obtained, whereas for the other methods (MOCA, Glue) the early and mid term results are available. The critical evaluation of the available results suggest the high efficacy of the majority of the above mentioned methods showing some differences concerning the particular technologies (eg. lower long term occlusion rate in the cases of sclerotherapy). In the lecture an update of the role of the endovenous ablation in the saphenous vein incompetence treatment will be presented including the new technology achievements.

Histological and clinical effect of Picosecond fractional laser skin

Introduction: A new therapeutic approach to acne scarring and skin rejuvenation based on fractional picosecond laser is now becoming increasingly popular because of high quality outcomes and really low risk of developing Post Inflammatory Hyperpigmentation (PIH).

Material and Methods: In order to investigate the mechanism of action of this new therapeutical approach, we have analyzed the histological effects of the picosecond skin irradiation using a fractional handpiece with a microarray lens which is able to augment the fluence delivery into each microbeam to up to 40 J/cm2 .

Results: We analyzed in ex-vivo human skin test with the fractional handpiece. Laser-induced optical breakdown (LIOB) in the dermis is observed starting at the fluence of 0.3J/cm2. With the increase of fluence, the laser-induced optical breakdown (LIOB) occurs deeper in the dermis. At 1J/cm2, localized vesicles are observed in the dermis while collagen bundles in the deep dermis. Vacuoles of about 20 to 60 micrometer in diameter. Epithelial ablation occurs starting from 1J/cm2, at about 200 micrometer wide.

Discussion: In this study we try to explain the correlations between the clinical results and the laser-induced optical breakdown from superficial to mid dermis and the focal effacement of the epidermis.

Histological and clinical results of a new microwaves device for the body contouring

Introduction: A new therapeutic device with body shape and contouring indication is been presented in the market in the past months . The new energy device works in the range of the microwaves emission and claim a therapeutic interaction with the fat and connective dermis tissue:

Material and Methods: In order to investigate the mechanism of action of this new therapeutic device , we have analyzed the histological effects of the microwaves skin irradiation using two different engineerized hand pieces able of different penetration and different tissue target interaction

Results: We analyzed in ex-vivo human skin test the histological damage of the adipocyte membrane and their histologic behavior after the elettromagnetic irradiation. With different fluence and different deep penetration we evaluate an interaction with the collagen compartment of the of the fat layer that is well expressed with histologic and hymmunochemic evaluations. The microscopic evidences are in correlation with the ultrasound results and clinical outcames

Discussion: In this study we try to explain the correlations between the clinical results and the microwaves skin emission and their effect on the

Nutritional support/testing to improve quality of the operation.

Essential nutrients are considered to be essential for human life. Vitamins and minerals are cofactors of enzymes. Amino acids are part of the all proteins including the immune system. Essential nutrients also perform many important other functions in the human body such as wound healing. A deficiency of a few of the more then 40 essential nutrients may already reduce wound healing.

Optimal recovery of an operation and wound healing may require higher needs then normal for certain nutrients. However most people consume to less essential nutrients to reach RDA’s (Recommended Daily Intakes) and have already deficiencies before the operation.

In order to get the best optimal recovery of the operation it is needed to analyze the status of the essential nutrients as soon as possible when an operation is planned. A better nutrition should also be started as soon as possible and as soon as the laboratory results become available a further individualized improvement of the diet including supplements. This analysis of the status of the essential nutrients can also be considered to be part of an Anti-Aging check-up.

Furthermore the nutrient status is not only important in the preoperative stage, but also during and after the operation. Examples of important nutrients such as arginine, taurine, magnesium, zinc, copper, selenium, vitamin A, B, C, E,CoQ10, carotenoids, lycopene, lutein, zeaxanthine and EPA/DHA from the scientific literature will be given. Almost all nutrients are involved in the immune system. Important to prevent infections. Attention to optimal nutrition before, during and after the operation results in reduced stay (clinic/hospital), less complications and recovery and a reduction in healthcare costs.

Also practical formula’s to use the support wound healing will be given.

Additional Improvement of skin quality with nutritional support/testing

Essential nutrients are considered to be essential for human life. Vitamins and minerals are cofactors of enzymes. Amino acids are part of the all proteins including the skin and immune system. Essential nutrients also perform many important other functions in the human body. The skin has a high frequency of cell renewal causing a high demand for nutrients.

A deficiency of a few of the more then 40 essential nutrients may cause already dermal problems or diseases. However most people consume to less essential nutrients to reach RDA’s (Recommended Daily Intakes) and have deficiencies causing increased risk for skin problems.

In order to get the best optimal recovery of a skin problem or disease it is needed to analyze the status of the essential nutrients because the exact deficiencies or disbalances are unknown and each person has unique needs. It is expected that most severe deficiencies found in the laboratory report of a certain person have the best changes for treatment. This can also be the start of an Anti-Aging check-up.

Examples of important nutrients such as arginine, taurine, other amino acids, magnesium, zinc, copper, manganese, selenium, vitamin A,B, C, E and EPA/DHA, GLA, flax-seed from the scientific literature will be given. This includes acne, dermatitis, eczema, psoriasis, urticaria, edema and wound healing. Almost all nutrients are involved in the immune system which is important to reduce infections causing the skin problems/diseases. Based on the obtained laboratory results a very specific individualized nutrient therapy can be started consisting of foods and supplements.