Abstracts of lectures in scientific sessions

We encourage you to read the abstracts of lectures that will be presented during the 19th 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 "Face to Face" with lecturers, which will be held in the BoardRoom room at the M1 level.

Prospective non-randomized observational study of female subjects treated with a FDA-cleared tissue stabilized-guided subcision (TS-GS) system for cellulite.

BACKGROUND: For improving the appearance of cellulite, in our busy centers for cosmetic surgery in Italy, we have introduced in 2016 a new FDA-cleared tissue stabilized-guided subcision (TS-GS) system which was alleged to be minimally invasive and to stabilize the clinical results for 3 years. The goal of our prospective is to evaluate the efficacy of TS-GS and the level of patient satisfaction associated with the procedure.

METHODS: We enrolled on this study only women with stabilized cellulites since at least 5 years. We analyzed patients by digital 2D macro-photographs and by a 3D biomechanical device for quantitative approach to soft tissue change assessment. Patient satisfaction was assessed through physician review of 2D and 3D photography, and the Global Assessment of Improvement Scale (GAIS) at baseline, three and twenty four month post-treatment. Patients that underwent any buttocks aesthetic or surgical procedure in the last 6 months, or presented fat excess or ptosis on buttocks were excluded.

RESULTS: Sixty women of average age 39.6 years with a total of 1124 lesions of cellulite received a single treatment to the buttocks and/or posterolateral thighs with the study device and completed the follow up at 24 months. 96.8% of patients were satisfied with treatment results and physician evaluations revealed that on average, patients displayed a 1-point improvement in their cellulite grades. Moreover, GAIS scores indicated that all patients had visible improvement in the global appearance of their cellulite. Analysis of 3D imaging yielded 87.6% average improvement in negative volume and 80.6% improvement in minimum height of dimples.

CONCLUSIONS: The physician ratings, patient satisfaction, and photographic evidence prove the safety and efficacy of the TS-GS system in the management of cellulite in women in the buttocks and posterolateral thighs.

Retrospective study on clinical indications and technical aspects of micro-focused ultrasound on a large cohort of patients.

Introduction: Recent studies have shown autologous collagen regeneration, efficacy on face and neck lifting and safety of transcutaneous micro-focused ultrasound procedures. Despite this, guidelines on clinical indications and technical aspects such as the proper number of energy spots to be delivered to the patients are lacking. For this reason, we have conducted an independent retrospective study on these issues.

Materials and methods: We reviewed 925 women with a mean age of 51,3 years (range 33 – 64 years), treated at our cosmetic medical center in Milan (Italy), which presented soft to severe skin ptosis of the face according to APSS (Araco Ptosis Scale System), received and average of 1.060 spots of micro-focused ultrasound as sole treatment.

The first statistical analysis was conducted on the differences in the number of spots delivered in different homogeneous groups. The first group of 56 patients received an average of 486 lines; the second group of 73 patients received an average of 1.126 lines and the third group of 66 patients received an average of 1460 lines. The second analysis was conducted on the differences in clinical indication according to APSS in three different homogeneous groups. The first group of 175 patients was on APSS 2; the second group of 193 patients on APSS 3 and the third group of 184 patients on APSS 3. Standardised digital photographs and 3d reconstructions with VectraH1, before and 6 months after treatment were assessed by two blinded independent doctors (F.A.; M.A.) which scored photographs from 1 to 20 according to the SASS (Surgeon Assessment Scoring System). The reduction of at least 4 set points was considered a significant difference. A patient satisfaction questionnaire (PSQ) were given to patients that scored they results from 0 to 10. The reduction of at least 2 set points was considered a significant difference.

Result: All patients completed the follow-up after 6 months and no major side effects were reported. Result on energy lines delivered: Only groups 2 and 3 reached the statistical significative difference according to SASS and PSQ. Result on face ptosis groups: Only groups 1 and 2 reached the statistical significative difference according to SASS and PSQ.

Conclusion: Our retrospective study showed that in order to stimulate collagen regeneration and tissue contraction (lifting effect), it’s necessary to deliver a significant number of energy micro-focused ultrasound lines and choose the right patient indication.

A prospective randomized study on topic Prp vs. placebo for dermal regeneration and periorbital wrinkles reduction.

Introduction: Lateral (Crown’s feet) and lower lid wrinkles are among the first visible sign of skin ageing. Platelet rich plasma (Prp) has proved to be effective and safe on tissue regeneration in dermatology and reconstructive surgery. Despite this, guidelines on clinical indications and some technical aspects such its use (topical, intradermal, subdermal) or its frequency of treatments are lacking. The goal of our prospective randomized study was to assess the efficacy of the topical Prp on reducing superficial eye wrinkles (lifting effect) and restoring the dermal matrix.

Materials and methods: 50 women with moderate to severe periorbital wrinkles on a four-points facial wrinkles scale (FWS) were enrolled on the study. Two vacutainer tubes of 9 mm of peripheral blood each, with separator gel and anti-coagulant were centrifugated for 5 minutes at 1800 rpm. Eight ml of Prp were collected from the upper part of the tube in a sterile matter and placed inside a formulation of 8 ml of poloxamer, a non-ionic block copolymer that not negatively interact with the biomolecules of the Prp. Patients were previously treated on the periorbital region by a single session of fractional CO2 laser in order to expose the dermal-epidermal junction. For post laser treatment patients were randomized in two homogeneous groups: 25 (group 1) applied 5 drops of topical Prp stored inside the poloxamer formulation twice a day for 12 weeks, and 25 (group 2) applied gentamicin and betamethasone twice a day for the first week and then hyaluronic acid gel for the following 11 weeks. Photo type, quantitative analysis of texture, wrinkles, pores and visual assessments were addressed by Visia and digital macro-photographs. Two independent doctors (FA and MA) individually assessed the wrinkle reduction with the FWS and SSAl (Surgeon satisfaction assessment lifting scale). Patients were also given a self-assessment scale (PSAl - Patient satisfaction assessment lifting). Efficacy and tolerability were assessed at 12 weeks and 6 months of treatment. The primary efficacy end point was the skin quality assessed by Visia on both groups at 12 weeks. The second efficacy end point was the wrinkles reduction and the lifting effect assessed by the panel of two doctors and by patients from standardized digital photographs according to the SSAl and PSAl. Patient with an improvement of at least one point in global assessment were classified as “responders”.

Result: Group 1: texture (5.8% Vs 14,3%; p<0.001), wrinkles (38% Vs 64%; p<0.001), pores (32,6% Vs 46,2%; p<0.001), PSAl (3.88 Vs 8.2, p <0.001) and SSAl (2.88 Vs 6.; p <0.001) improved significantly. Group 2: texture (5.3% Vs 6,2%; p:NS), wrinkles (42% Vs 54%; p:NS), pores (34,2% Vs 49,6%; p:NS), PSAl (4,2 Vs 6,2 p:NS) and SSAl (3,1 Vs 5,6 p:NS) improved but failed to reach significative difference. Conclusion: Our prospective study proves that Prp reduces superficial periorbital wrinkles and restore dermal matrix when used topically for a period of at least 12 weeks.

Thread Lift Facial Treatment. No Downtime Technique.

Keywords: Thread lift, Face lift, Facial rejuvenation, PDO barbed threads, Barbed sutures

Tread lifting is one of the most effective minimally invasive procedure for the correction of age-related facial changes caused by loss of volume and soft tissues sagging. Its effectiveness is determined by the ability to create a significant lifting by reposition and fixation of the ptotic tissues. However, despite good long-term aesthetic outcomes, its use is limited due to relatively long recovery time. The author have propose a modification of the facial thread lift technique performed using dissolvable barbed PDO threads, which allows to achieve a significant and uniform lifting with a shorter downtime and social adaptation of patients. The absence of such adverse events as skin irregularities, swilling, skin punctures and bruising, usually associated with facial thread lift procedure, allows patients to return to their usual lifestyle immediately after procedure.

The author have no financial interest to declare in relation to the content of this article.

Inflammaging and the exposome

It is increasingly acknowledged that low-grade chronic inflammation (LGCI) is an important cause of various chronic degenerative conditions, such as metabolic syndrome, type 2 diabetes, cardiovascular disease, cancer, osteoporosis, sarcopenia, depression, and neurodegenerative diseases. Of notice, these diseases and disorders are considered age-related conditions, and human aging is characterized by LGCI, which led to the term “inflammaging”. Interestingly, the main cause of inflammaging appears to be the lifetime exposure to a variety of environmental stressors (the so called exposome), which includes disrupted circadian rhythms, physical inactivity, pollutants, smoking, psychological stress, and unhealthy dietary patterns.

Efficacy and Safety of Animal Injectable Collagen in Anti Aging; 2018 Clinical Research Study

Efficacy and safety of injectable 7% collagen was studied in prospective observational comparative study. Efficacy was evaluated using professional efficacy scales, instrumentation methods and 3D photography. Collagen demonstrated  superior efficacy in ultrasound study; patients’ skin was statistically significantly more elastic. Good results were proven in microcirculation and lymphatic circulation, collagen has shown high safety profile. Other categories of medical devices containing collagen or promoting collagen production were also studied. Research results were registered with clinicaltrials.gov database.

Rhyno-Filler: A Personal Approach

Rhinofiller was born as a single procedure: the correction of nasal hump. Today it has evolved to a whole new group of treatments. Aesthetical defects of the nasal piramid, that can be treated vary from boxy tip, to (surgical) over-correction of the dorsum, from narrow nose to retraction of alar rim and more…

Furthermore, POST-SURGICAL deformities of the nose represent a huge bunch of challenging defects that can be effectively tackled and treated with Hyaluronic Acid. In fact, many patients who underwent rhinoplasty, previously, end up with small to medium “shape imperfections”. Until a few years ago they could only be treated with another surgical procedure, with all the risks, costs and every other connected discomfort. Rhynofiller is indeed a new frontier, that can deal with those defects, offering patients fast and visible results. On the other hand, post-surgical cases(in comparison with primary treatments) involve a different problem: the scar.

Soft tissues are “sticked” together and it is often difficult to use micro-cannula, forcing physician to use needle, even in the lateral walls of the piramid or other anatomical areas where it is harder to identify the exact location of blood vessels. This can lead to an enhanced risk of embolism and, therefore, if we want to perform Rhynofiller it is mandatory we all learn to use properly hyaluronidase!

Evidence Based Hormonal Treatments (DHEA and Testosterone) in Anti-Aging

The Endocrine System ​​changes with age and many of our hormones decrease. The body also changes with age and many of the changes might be related to these hormonal decreases. Replacement treatments of some of the hormones reverse many of these changes.

Many clinical studies (of different qualities and duration) in respected Journals show interesting and convenient effects of hormonal treatments. Few studies show secondary effects, of these hormonal treatments, if appropriately indicated - adequate patient – without contraindications and using the correct doses. Anyway, it is essential a closed control of the patient. I will limit the presentation to the evidence for using DHEA and Testosterone treatments for healthy aging. With this purpose, I searched PubMed and Cochrane Library using combinations of DHEA/TESTOSTERONE and Supplementation/Treatment and Aging and Clinical Trials and Humans and Adverse Effects and Systematic Reviews and/or Meta-Analysis. Although I did not find many systematic reviews and meta-analysis demonstrating significant differences of the hormonal treatments with placebo and that I found few Cochrane revisions and clinical studies in favor of some hormonal treatments (neither against), anyway, there are enough Systemic Reviews and some Meta-Analysis that support the use of DHEA and Testosterone replacement treatments to help our patients age well and, if appropriately indicated, with the adequate doses and with a close follow-up, almost without risks. As some of these treatments are off-label we must explain our patients the interest of the treatments-the positive changes they might expect- and the potential risks and must obtain the informed consent, including their commitment to be closely followed, both clinically and with the appropriate lab studies.

As conclusion, in my opinion, there is enough evidence for using DHEA and Testosterone treatments to help our patients age in better conditions and with little risk.

Update on Blindness Associated with Dermal Fillers:

Following thissession you will be updated on current research on blindness associated with fillers.  You will be able to recognize the signs and symptoms of filler-associated blindness as well as be aware of treatments and reported outcomes. You will also be informed on the current research specifically around retrobulbar injection of hyaluronidase.  After the session, you will be able to formulate a plan to deal with blindness associated with dermal fillers.

2008-2018: Ten Years Of Experience In A Complete Programme-System Of Well-Being-Lifestyle. Role Of Health And Aging, The New Way Of Future?

BACKGROUNG: Population aging is a powerful and transforming demographic force with increase of diabetes mellitus, cardiovascular diseases, cancer, depression, obesity, hypertension, asthma. In this study proposing a combinated program-system (Carulli’s system well- being/lifestyle) in ten years ,followed 1500 persons. The key inclusion criteria were Male or Female 45years old till over 80years old, applying a program-combinated of physical activity (hydrotherapy, aqua-fitness soft, Qi-Quong, Yoga, Tai-Chi), Nutritional program personalized, Complementary and Alternative Medicine, Meditation, Face and Body treatments of medicine aesthetic. The key exclusion criteria were System Diseases (Lupus, Rheumatoid Arthritis, Multiple Sclerosis, etc).

AIMS: The aim of this study is to evaluate the efficacy of the constant combinated treatments for to prevent chronic lifestyle diseases, promoting health, longevity and can positively modulate mind and body, cognitive performance, reducing cardiovascular diseases, cancer, obesity, hypertension, diabetes and depression risk, for a best vision of the future.

METHODS: For this study I follow in 10 years about 1500persons divided in groups: Group A aged 45-60 years old, Group B aged 60-80years old, Group C over 80years old and a Group D of “control”. All Groups are follow a weekly program with physical activity (4 time a week) and a personalized diet and supplements (Resveratrolo, Omega3, VitaminD3, Echinacea, Magnesium, Selenium) and personalized medicine aesthetic- cosmetology treatments. Follow-up every 3-6months laboratory tests for liver, kidney, stress and infiammatory markers, lipid profiles, tyroid and ultrasound control.

RESULTS: The Groups A-B-C that follow the programme-system keep a good performance of physical activity, more cognitive performance, more social engagement, less infection, less hypertension, less cardiovascular diseases. The Doctor of the Future will no give medicine, but will do Prevention!

Aging and Nutrition: parallel pathway

Cutaneous signs such as dermatitis, cheilite, perleche, alopecia and depigmentation observed during certain nutritional deficiencies, highlight a link between nutrition and skin. In addition, dietary factors and nutritional supplements may influence skin aging. A diet rich in anti-oxidants may delay aging effects and twins who avoid excessive alcohol intake have a younger perceived age. In an epidemiological study higher vitamin C intake was associated with a lower likelihood of wrinkled appearance, while higher fat and carbohydrate intake were associated with higher likelihood of wrinkled appearance. Another study investigated Anglo-Celtic, Greek and Swedish people living either in Australia or their native country. A high intake of vegetables, olive oil, and legumes appeared to be protective against cutaneous actinic damage; a high intake of meat, dairy and butter appeared to be adverse. In a cross-sectional survey conducted in 131 healthy Japanese females, a significant correlation was found between coffee consumption and a decrease in pigmented scores but not in wrinkling scores. However, in two other studies in a Mediterranean population, no correlation was found between coffee consumption and wrinkling or solar elastosis; pigmentation was not evaluated. Consuming too much sugar is assumed to cause wrinkles. At blame is a natural process that's known as glycation, in which the sugar in the bloodstream binds to proteins to form harmful new molecules called Advanced Glycation End products (AGEs). The more sugar consumed, the more AGEs developed and the more glycation occurs (Maillard reaction). In the skin, AGEs deposits have been observed in fibronectin, laminin, elastin and collagen. Glycation arises in the dermis after 35 years of age and UV exposure increases crosslinking in the skin. Endogenous glycation occurs when consumed sugar products bind to protein and lipids. Exogenous glycation occurs when food containing AGEs formed at high temperatures by roasting, grilling or frying is ingested. Food-derived AGEs produced by grilling roasting and frying can induce inflammation and oxidation. Vitamins, flavonoids, carotenoids and tocopherols have been reported to have antioxidant properties and they are therefore used in oral supplements with the aim of prolonging youthful skin appearance. However, clinical data demonstrating a visible effect are missing. Therefore the balance between Oxygen Free Radicals (ROS) and anti-oxidants, for each particular physiological or pathological condition needs to be understood as well as whether antioxidants should be acquired from the diet or nutritional supplements. It is worth noting that beta-carotene (30 mg) and retinyl palmitate (25 000 UI) taken by subjects over a long period of time have been associated with an increased incidence of lung cancer (28%), increased incidence of death (17%) and a higher rate of mortality due to cardiovascular disease compared to the placebo group. Furthermore, in the SU.VI.MAX study, women taking an oral daily capsule of antioxidants (120 mg vitamin C, 30 mg vitamin E, 6 mg beta-carotene, 100 mg selenium, and 20 mg zinc) had a higher incidence of melanoma. The best strategy to achieve a proper ROS/anti-oxidant balance is to consume fruits and vegetables. Supplementation is a strategy only in case of deficiency. Together these studies provide compelling evidence that nutrition is an exposomal factor relevant for skin aging. The exact extent to which nutrition contributes to skin aging is currently not known. In this regard, it has been estimated that nutrition may account for up to 30% of wrinkle formation in Japanese women. According to what has been said so far, it is increasingly clear that skin health comes from the inside and, therefore, skin wellbeing is part of the individual’s wellbeing in its entirety. By virtue of this, the link between nutrition and skin health, or rather the effect of nutrition on skin aging, has been an interesting field of research for scientists but also a common field of interest for humans in the years, from ancient time till nowadays. For these reasons, the first medical aesthetic examination, according to the Italian Society of Aesthetic Medicine (SIME) recommendations, consists of an anamnestic investigation and a clinical examination, traditional and aimed at the clinical demand, with a series of morphological and functional evaluations. This approach allows to investigate also lifestyle and nutritional habits and this is the first step to formulate a preventive project and then a correction plan.

Vulval aesthetics from dermatology perspective

Facial aesthetic treatments do not need introduction and include: skin care to treat different skin problems, injectable treatments using dermal fillers, regenerative techniques such as PRP & iPRF, chemical peels, laser skin resurfacing, skin tightening and collagen stimulation modalities using radiofrequency, non-ablative and minimally ablative laser techniques, microfocussed ultrasound and photobiomodulation to diminish the appearance of the signs of ageing.

Aesthetic gynaecology has been focusing on vaginal treatments using energy devices such as: radiofrequency and lasers to treat vaginal laxity and atrophy and to improve sexual function and satisfaction.

Aesthetic treatments of external genital skin mirror facial aesthetic treatments. Common concerns include skin laxity, hyperpigmentation, too much hair, loss of volume, painful sex, post episiotomy scarring, stretchmarks, benign skin lesions such as: genital warts, seborrheic keratosis, skin tags, pearly penile papules, sebaceous cysts or chronic inflammatory skin conditions such as lichen sclerosus and atrophicus. Main treatment outcomes apart from aesthetic and functional improvement include an improved body image and improvement of sexual relationships.

Non – surgical cosmetic procedures which have been used to treat the above conditions range from hyaluronic acid injections, platelets rich plasma or fibrin, carboxytherapy, radiofrequency and ablative and non-ablative laser treatments. Procedures such as O shot, P shot, vulval puff as well as vulval bleaching have been documented and offered to are available. This presentation will focus on main aesthetic concerns and their treatment using non-surgical aesthetic methods.

Sendeng-4 induce programmed cell death of melanoma cell A375

Sendeng-4 was a Mongolian medicine, clinical indications of which includes rheumatism, gout, joint yellow water disease, arthralgia and edema. Our recent in vitro studies have shown that Sendeng-4 can effectively inhibit the proliferation of melanoma cell A375. Furthermore, we found that high concentration of Sendeng-4 could effectively induce apoptosis of A375 cells. With the increase drug concentration, the early and late apoptotic cells were increased significantly by Annexin/PI flow cytometry. In addition, Sendeng-4 can effectively induce the autophagy level of A375, which is manifested in the transformation of LC3, a marker protein of autophagy, from type I to type II with the increase of drug concentration. Sendeng-4 also regulates the signaling pathway of cell pyroptosis, which is manifested by the cleavage of Caspase-1, a marker protein of cell pyroptosis. In order to explore the molecular mechanism, several signaling pathways related to cell proliferation and apoptosis were detected. The specific results showed that Sendeng-4 could inhibit the phosphorylation activation of AKT and ERK signaling pathways. And it had significant regulatory effects on JNK and P38. Conclusively, it has great clinical value to study the specific molecular mechanisms inducing apoptosis, autophagy and pyroptosis of Sendeng-4. And it can provide theoretical and practical basis for the clinical application of Sendeng-4 in anti-cancer.

Key words: Sendeng-4, Mongolian medicine, Melanoma cell, Apoptosis, Autophagy, Pyroptosis

Harmonic Acid? Antiaging and antiinflammatory orchestration via endogenous and exogenous molecular systems of hyaluronic acid

Local therapeutic effects of HA are widely described in many areas of medicine, including aesthetic field. Yet few studies are describing the systemic HA effect via immuno-signaling cascades, regulation of key inflammatory cytokines (IL-10, TNF) and general proliferative function on the cellular and tissue level. New findings are revealing the role of trans-membrane receptors (CD44,TLR-4) in regulation of systemic inflammatory process including skin and complex antiaging properties via binding systemic HA. Metabolic functions of intestinal microbiome in connection with HA chains represent future perspective area of the research.

Facial Contouring by Using Dermal Fillers and Botulinum Toxin A: A Practical Approach

The perception of an attractive face is largely subjective. The purpose of this presentation is to provide an insight and a practical approach to facial contouring management with hyaluronic acid (HA) implants and botulinum toxin A. This study is presenting the clinical experience of the authors regarding facial contouring. After a careful medical history, patients underwent an exhaustive aesthetic assessment that includes photographs and videos. Realistic treatment goals were discussed and agreed with the patient. Comprehensive treatment strategies for facial contouring, including HA implants and/or botulinum toxin A injections, were selected according to the patient needs. These treatment strategies have been adapted to nine different basic categories of facial shapes, namely round, square, triangle, inverted triangle, rectangle, oval, heart, diamond and oblong faces. The incidence of complications was low and, in all the cases, was mild (edema, erythema and local ecchymosis), of limited duration, and was resolved without sequela. The current exposition presented the personal experiences of the author on a specific subject, and this fact should be considered when interpreting data. As other aesthetic treatments, facial contouring should be focused on the patient needs and to select a specific aesthetic approach according to different facial shapes. Finally, it is essential to have a good understanding of the potential associated complications, because it will help the specialist to take the necessary precautions to prevent them, and if they ever arise, to be able to deal with them effectively.

Oriental Anti-aging Base - Yichun in China

Abstract Yichun is a place full of negative oxygen ions with the number of 70 thousands to 150 thousands per cubic meters. So it is given the name of oriental Oxygen resort. The Hotspring in Yichun is full of anti-aging minerals, like Selenium and Metasilicic acid. We have made the scientific explanation to negative oxygen ions, Selenium and Metasilicic acid respectively to show the anti-aging evidence of Yichun resort in China.

Key words: Yichun, anti-aging, minerals

Nowa frakcyjna termo-mechaniczna technologia resurfacingu oraz systemu dostarczania leków.

Tixel to frakcyjny system rewitalizacji skóry oparty na technologii ablacji termomechanicznej (TMA) przekazujący energię cieplną do skóry poprzez krótki kontakt gorącej tytanowej końcówki. Opatentowana końcówka wykonana jest z biokompatybilnego, odpornego na wysoką temperaturę stopu tytanowego. Jej powierzchnia pokryta matrycą niewielkich piramidek osiąga temperaturę 400°C. Energia jest precyzyjnie przekazywana do obszaru leczenia poprzez krótki kontakt wierzchołków piramidek ze skórą. Zabieg nie wymaga rekonwalescencji. Tixel stosowany jest w zabiegach resurfacingu skóry oraz jako system dostarczania leków. Opublikowanych zostało wiele prac na temat wykorzystania systemu w prowadzeniu leczenia uzupełniającego.

A Novel Fractional Thermo Mechanical Technology for Resurfacing and Drug Delivery

Tixel is a thermal fractional skin rejuvenation system powered by Thermo-Mechanical Action (TMA) technology. Tixel employs a hot titanium tip which transfers direct heat to the upper dermis. The proprietary tip is constructed of biocompatible temperature resistant titanium alloy. The tip consists of an array of tiny pyramids which are heated to a temperature of 400°C . The apex of the pyramids transfers energy to skin by very brief controlled contact. Healing is fast and down time short. Tixel is used for resurfacing and drug delivery. Multiple combination treatment papers have been published.

Carboxytherapy today: up to date

Carboxytherapy is a treatment in which carbon dioxide is administered subcutaneously through localized micro injections. It originated in 1932 and performed at the Royat Clermont–Ferrand spa. Over the past 20 years, the method has been widespread, especially in the field of aesthetic medicine.  In this presentation i'll show the new therapeutic possibilities  that the clinical studies have been demonstrated, including skin rejuvenation, in the treatment of certain types of scars, in particular atrophic ones, stretch marks, so-called cellulite, adhesions  after liposuction and in the treatment of hair loss and different types of alopecia. The method is "natural" which makes it attractive to many patients; however, the treatment itself can be a little painful

A Novel Fractional Thermo Mechanical Technology for Resurfacing and Drug Delivery.

Tixel is a thermal fractional skin rejuvenation system powered by Thermo-Mechanical Action (TMA) technology. Tixel employs a hot titanium tip which transfers direct heat to the upper dermis. The proprietary tip is constructed of biocompatible temperature resistant titanium alloy. The tip consists of an array of tiny pyramids which are heated to a temperature of 400°C . The apex of the pyramids transfers energy to skin by very brief controlled contact. Healing is fast and down time short. Tixel is used for resurfacing and drug delivery. Multiple combination treatment papers have been published.

New Proposal for Melasma Treatment: from in vitro to in vivo.

Introduction: Melasma, a common acquired hyperpigmentation disorder, represents a deterioration in the quality of life, being a frequent reason for consultation that represents a challenge for the attending physician considering the complexity of its pathogenesis. Due to this, the search for conjugated assets that allow to control and modulate the hyperactive melanocytes, under an integral action structure represents a therapeutic alternative. The objective of the work was to assess the efficacy and safety of a therapeutic scheme for melasma, and the permanence of the results over time.

Key words: melasma, depigmenting active ingredients, treatment of melasma.

Development or material and methods: in vitro work was carried out to determine mechanism of action and cellular alterations, and an in vivo protocol in 14 patients where MASI was used as diagnostic and monitoring tools, colorimetry with Skin-Colorimeter® Probe CL 400, Courage -Khazaka, and a skin scaner. Initial diagnosis and follow-up were performed at 30 days, 60 days, 180 days and 12 months. The treatment consisted of a topical application product accompanied by a superficial controlled chemoexfoliation whose main assets are: melanocortin receptor melanostatin-5 agonist for αMSH; lipoic acid that decreases tyrosinase transcription; tranexamic acid, which controls the inflammatory effect on the melanocyte; arbutin that inhibits DOPA oxidation, kojic acid that produces inhibition of tyrosinase activity by chelation; phenylethyl resorcinol with reducing properties; and retinoids with the ability to modify epidermal cell turnover.

Discussion or conclusions: the in vitro results showed a lack of toxicity and a good therapeutic activity to reduce the synthesis of melanin and to control the tyrosinase enzyme transcription. In vivo, the MASI index showed a very high statistical significance (<0.0001), with a difference between the averages of 12.71 points. The results of the variable L * were consistent with the MASI, pre-treatment is 6030.71 and the post-treatment is 6387.29 (P value: 0.0012). The results of the variable "ITA" confirmed the results moving in the same direction as the variables MASI and L *. The active mixture pursues the use of small doses that enhance each other, whose action mechanisms allow controlling elements of the pre-synthesis, synthesis and post-synthesis of the pigment. The evaluated products demonstrate an effectiveness and safety in the treatment of melasma, and an adequate control over time which leads to the permanence of the results. Bibliografía: Briganti S, Camera E, Picardo M. Chemical and Instrumental Approaches to Treat Hyperpigmentation. Pigment Cell Res. 2003; 16: 101–110. En Hyung Kim, You Chan Kim, Eun-So Lee, Hee Young Kang. The vascular characteristics of melasma. Journal of Dermatological Science. 2007; 46, 111—116. Hakozaki T, Minwalla L, Zhuang J, et al. The effect of niacinamide on reducing cutaneous pigmentation and suppression of melanosome transfer. Br J Dermatol. 2002; 147:20–31. Kazuhisa Sugimoto, Takahisa Nishimura, Koji Nomura, Kenji Sugimoto, Takashi Kurika. Inhibitory Effects of a-Arbutin on Melanin Synthesis in Cultured Human Melanoma Cells and a Three-Dimensional Human Skin Model. Biol. Pharm. Bull. 2004; 27(4) 510—514. Lemic-Stoicevic L, Nias AH, Breathnach AS. Effect of azelaic acid on melanoma cell in culture. Exp Dermatol. 1995; 4:79–81. Leong HJ, Jang I, Hyun KS, et al. Preparation of alpha-bisabolol and phenylethyl resorcinol TiO2 hybrid composites for potential applications in cosmetics. Int J Cosmet Sci. 2016; 38 (5), 524-534. Li D, Shi Y, Li M, Liu J, Feng X. Tranexamic acid can treat ultraviolet radiation-induced pigmentation in guinea pigs. Eur J Dermatol. 2010; 20(3):289–92. Lu C, Kim B-M, Chai KY. Design, synthesis and evaluation of PEGylated lipoic acid derivatives with functionality as potent anti-melanogenic agents. Eur J Med Chem. 2011; 46: 5184–5188. Villarama CD, Maibach HI. Glutathione as a depigmenting agent: An overview. Int J Cosmet Sci. 2005;27:147–153.

SEFFI, MicroSEFFI and SEFFILLER: new studies and  protocols in  Regenerative Aesthetic Medicine

Recent studies of  physiology of the aging face proved that the loss of volume and the aging of the tissue are the most important factors involved in facial aging. In the light of this evidences, the regenerative medicine plays a central role in the facial rejuvenation.

I standardized and published SEFFI (Superficial Enhanced Fluid Fat Injection) ,  MicroSEFFI and SEFFILLER techniques;  these techniques represent my approach to obtaining volume restoration and tissue regeneration.

Such techniques consist in selecting  the small dimension of the tissue cellular clusters  during the  harvesting procedure  and avoiding manipulation when it is prepared: it is our conviction that any manipulation, both mechanical and chemical, of the harvested tissue can damage the viable cells thus undermining the effectiveness of the engraftment.Our studies proved that in the tissue harvested  by the SEFFI and MicroSEFFI techniques we found adipocytes viability, good amount of SVF cellularity , ADSCs and the mesenchymal differentiation of ADSCs towards adipogenic, osteogenic and condrogenic lineage.

Regenerative aesthetic medicine is a very promising branch of aesthetic medicine. Recent studies have demonstrated the effectiveness of regenerative medicine using SVF and ADSCs in various applications in Aesthetic medicine. New devices meant for Aesthetic Physicians allow these therapies to be performed safely and effectively.

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.

A new weapon in the treatment of melasma

Hyperpigmentation of the skin is a common issue of patients in the aesthetic medicine clinic. A new effective treatment reducing melasma and mixed hyperpigmentation. The treatment consists of three stages. The first one is based on TCA activity combined with hydrogen peroxide and kojic acid. In the second stage, a peeling with a high concentration of lactic acid and phytic acid is used. The third phase is based on peeling on the basis of hydroxyacids and phytic acid. The patient should continue the therapy at home using a brightening serum containing, among other ingredients, tranexamic acid. A treatment designed for all phototypes, and its intensity can be changed depending on the patient's tolerance.

Nowa broń w leczeniu melasmy

Przebarwienia skóry są częstym problemem pacjentów gabinetów medycyny estetycznej. Nowy skuteczny zabieg redukującym melasmę i skórno-naskórkowe przebarwienia. Zabieg składa się z trzech etapów. Pierwszy oparty jest na działaniu TCA połączonym z nadtlenkiem wodoru oraz kwasem kojowym. W drugim etapie wykorzystuje się peeling o wysokim stężeniu kwasu mlekowego i kwasu fitowego. Natomiast faza trzecia oparta jest na peelingu na bazie hydroksykwasów i kwasu fitowego. Pacjent powinien kontynuować terapię w domu stosując serum rozjaśniające zawierające m.in kwas traneksamowy. Zabieg przeznaczony do wszystkich fototypów, a jego intensywność można zmieniać w zależności od stopnia tolerancji pacjenta.

Safe Chemical Lipolysis

Also known as adiposis, liposolution or liporeduction without surgery or chemical lipolysis, it is a treatment focused on removing clusters of adipose tissue by subcutaneous injections. Traditionally, the drugs used with Sodium Deoxycholate and Phosphatidylcholine had excellent results with downsizing , but their side effects such as pain, inflammation, long-term results and especially the risk of producing necrosis, have been the reasons why many Professionals stopped using it. Therefore, to reduce the risk, swelling and pain associated with Sodium Deoxycholate and Phosphatidylcholine, combinations of formulas with substances associated with Sodium Deoxycholate and Phosphatidylcholine have been found, which has resulted in a more effective chemical lipolysis, without inflammation, without pain, positive short-term results and above all: safer. This combination allows the use of Sodium Deoxycholate and Phosphatidylcholine with greater compatibility, facilitating the use by the tissue, with significant reduction of side effects; the downsizing is noticeable from the first session.

Liposuction with the ultrasound-controlled VaserLipo3D method

The main focus will be placed on the treatment of lower limbs steatosis – the so called lipedema. The author intends to determine if effective liposuction can be possible on highly vascularized areas such as lower limbs, and especially shanks. The presentation includes the effects of treatments carried out so far and a detailed description of postoperative recovery procedure of the patient together with postoperative procedures aimed at best visual effects.

Liposukcja pod kontrolą USG : pierwsze efekty rzeźbienia nóg metodą VaserLipo3D

Celem prezentacji multimedialnej jest przedstawienie liposukcji metodą VaserLipo3D pod kontrolą Ultrasonografii. W szczególności skupiono się na leczeniu obrzęku stłuszczeniowego kończyn dolnych - tzw. lipodemii.  Podstawowe pytanie jakie zadaje autor prezentacji dotyczy tego czy jest możliwe skuteczne liporzeźbienie okolicy bogato unaczynionej jaką są kończyny dolne ze szczególnym uwzględnieniem podudzi. 
Zaprezentowane są dotychczasowe efekty przeprowadzonych zabiegów oraz opisany jest dokładnie przebieg rekonwalescencji pozabiegowej pacjenta wraz z postępowaniem pozabiegowym celem uzyskania jak najlepszych efektów wizualnych.

Effectiveness and safety of HIFU technology - presentation of the study results on the Polish population

There is a growing interest of patients in the field of minimally invasive procedures, with visible immediately after the procedure permanent effects and lack of healing period. HIFU technology meets these expectations. Between May and September, a group of 9 patients with an average age of 52 years underwent two HIFU treatments at 4-week intervals. One month after the second procedure, a 69% reduction on the WSRS scale was obtained for the upper 1/3 face and a 73% improvement on the Merz scale for 2/3 of the lower face. Patients observed a 1.78-fold increase in skin tone (from 4.5 to 8 on a 10-point VAS scale) resulting in a 46% reduction in tissue sagging (reduction from 6.22 to 3.77 in VAS scale). Immediately after the second procedure, patients rated treatment effects at 4 in the GAIS scale and healing at a maximum level of 3. In summary, the available publications and clinical experience confirm the safety of HIFU technology. Before starting treatment, particular attention should be paid to the proper qualification of patients.

Keywords: HIFU effectiveness, HIFU safety, HIFU study.

Jalupro amino acids replacement therapy - could we live with or without you?

Skin aging is a multidirectional process caused by exogenous and endogenous factors. Endogenous aging is associated with the passage of time and has an individual character. The skin's aging process is also significantly influenced by external factors, e.g. UVB and UVA radiation. At the epidermis level, this process leads to increased stem cell apoptosis, which is manifested by epidermal atrophy, pigmentation disorder, and slow healing. In the dermis, the aging process is manifested by a decrease in the type I collagen content in the extracellular matrix. The Jalupro family is an amino acid replacement therapy given by mesotherapy, available in over 40 countries. Many years of market presence, a high number of clinical trials and over a million therapies confirm Jalupro's effectiveness and safety. Hyaluronic acid contained in the product deeply moisturizes the skin and the composition of specially selected amino acids effectively rebuilds collagen. The current study of Jalupro in combination with Jalupro HMW has shown that facial wrinkles are reduced, oval and skin tension are improved. Patients undergoing Jalupro therapy highly rated the effects of treatment, willingly recommended this procedure and also did not observe side effects except mild erythema, in individual single cases.

Human adipose tissue: Structure, physiology and function.

Human adipose tissue (AT) is both a target and a tool in aesthetic medicine. AT is constituted of structural units termed lobules, containing hundreds of adipocytes. Lobules exhibit depot- specific architecture with marked fibrous septa. Lobules are composed of two extracellular matrix compartments, i.e. septa and stroma delineating niches of adipogenic and myofibroblasts progenitors (1). Vessels, capillaries and sympathetic nerves are coursing among fat lobules, adipocytes and connective tissue. AT, in addition to lipid storage, exerts endocrine actions (i.e. mainly with leptin and adiponectin) and possess protective actions through sequestration of numerous lipophilic organic pollutants (i.e. xenobiotics). Mature adipocytes communicate with capillary microvascular endothelial cells and immune cells that are resident in AT (i.e. macrophages and lymphocytes). Increment in fat cell number is issued from progenitor’s proliferation leading to preadipocytes and the mature adipocyte pool which can undergo cell size variations (i.e. hypertrophy). Remodelling of extracellular matrix components and appearance of new vessels and capillaries (i.e. angiogenesis/vasculogenesis) represent important events in AT development. Various points concerning major physiologic functions of AT and recent results on multipotent cells (2) originating from adipose tissue will be considered.

The regeneration hidden in fat

Adipose tissue (AT) has a turnover but the mature adipocyte does not proliferate. Physiological turnover of human adipocytes is # 10% per year. AT is able to regenerate after lipectomy, liposuction or other adipoclastic procedures. Three cell types coexisting in fat deposits (i.e. adipocyte progenitors (APs), (ADSCs for some authors), microvascular endothelial cells of capillary networks and immune cells) contribute to AT recovery Adipogenesis and angiogenesis are interconnected. Using immunoselection/depletion with magnetic nanobeads, native CD45-/CD34+/ CD31- cells isolated from the stroma vascular fraction (SVF) of human AT have previously been described as human APs. Using two additional cell surface markers, MSCA1 (tissue nonspecific alkaline phosphatase) and CD271 (nerve growth factor receptor), three subsets of cells were obtained from the CD45-/CD34+/CD31- population and their role was clarified in two recent papers (1). The recent definition of human lobule organization in specific progenitor subsets domains was clarified (2). Human SVF was recently shown to self-organize to form vascularized AT in 3D cultures; AT spheroids could be implanted in mice (3). These later points will be discussed.

Superficial Chemical Peelings - Applications On The Daily Practice

KEYWORDS: chemical peeling, chemoabrasion, acne, photoaging, pigmentary disorders.

INTRODUCTION: Chemical peels are resurfacing treatments performed to remodel and rejuvenate the appearance of skin through targeted histologic changes. Over the past two decades, skin rejuvenation procedures overall have experienced a nearly 42 percent increase in the USA. Superficial peels target the epidermis and the epidermal-dermal interface causing partial or complete necrosis. These are the most common peelings used on the daily practice, because of its safety, easiness of managing, minimal down-time and minimal complications. Recent studies have shown the influence of chemical peelings on the biological responses of the skin. With an upsurge in popularity and the continued advancement of chemexfoliation techniques, it is important to recognize the most used peeling agents, its effect on the skin and new techniques and applications.1

MATERIALS AND METHODS: A review on new methods of application and use of superficial peeling on the daily practice is exposed, including some special considerations on the use of chemical peelings in ethnic skin, male patients and periorbital melanosis. Through a search on pubmed, the most relevant and recent publications regarding the subjects were selected for a bibliographic review.

DISCUSSION: Superficial peels exfoliate the skin from the stratum corneum down to the papillary dermis at a depth of 60 lm. They work by causing decreased corneocyte adhesion, epidermolysis and increased dermal collagen deposition. This results in the thinning of the stratum corneum, increased epidermal thickness and a more even distribution of melanin. Superficial peels are suitable for all Fitzpatrick skin phototypes and may be used on extra-facial sites such as the upper limbs, neck and chest. Serial application is often required2. Recent studies have shown the influence of chemical peeling on the skin stress response system, proving that chemical peelings don´t promote skin change only by epidermolysis, but also by inducing biological changes on the skin3. Major indications for superficial chemical peelings on aesthetic medicine are acne, photoaging, melasma and skin tightening4. The skin stress response system (SSRS) is manner of response of the skin to local stress, restricting the tissue damage and restoring local homeostasis. It´s function is equivalent to the hypothalamic- pituitary-adrenal axis, but in this case restricted to the skin, locally producing CRH and POMC in response to stressors. It has been shown that the TCA presence on the skin activates the skin stress response system, resulting in fibroblast and keratinocyte proliferation and enhancement of skin turnover. The use of TCA with neutralizing substances like hydrogen peroxide (H2O2) inhibits the cytotoxic effect of the acid, preventing protein denaturation and epidermolysis, but maintaining the biological response ( activation of SSRS)3. Some special considerations should be made regarding special skin types, such as ethnic skin (skin of colour – phototypes IV-VI), periorbital hyperpigmentation and men. On ethnic skins the higher risk of postinflammatory dyschromias and abnormal scarring makes peels potentially disfiguring. Although darker skin confers the advantage of added photoprotection, it is the often unpredictable response of melanocytes to injury that can cause disfiguring postinflammatory pigmentary changes 5,6. On male patients the main indication of chemical peelings is the treatment of acne. Men may require more treatments or higher concentrations of peeling agents than do women because of the higher proportion of sebaceous skin and higher density of hair follicles. They also tolerate more aggressive degreasing, greater volume of peeling agents, and more aggressive clinical pressure when applying the peeling solution, which correlate with a deeper and more effective chemical peel7. The treatment of peri orbital hyperpigmentation (POH) is challenging due to its complex pathogenesis and etiology8. The most commonly used for POH are alpha hydroxyacids (AHAs) and tricholoroacetic acid (TCA). Cheemical peelings with TCA at 3.75% and lactic acid at 15% once a week for 5 weeks have shown to be as effective as carboxitherapy in a group of patients in Egipt8.

CONCLUSION: Chemical peels remain a rapid, safe and cost-effective technique for cutaneous rejuvenation, particularly in photodamaged population. They are also a useful treatment option for certain dermatological conditions such as acne vulgaris, melasma, etc. Successful chemical peeling is reliant on the proper selection of patients and peels.

Liplush analysis. Dimensional static and dynamic analysis of the lower third of the face during the redefinition procedures and lip augmentation with hyaluronic acid.

The lips strongly contribute to the individual beauty and represent the most characterising element of the lower third of the face. Their redefinition and their volumetric increase, by injection of hyaluronic acid, represents one of the most requested and performed aesthetic medical treatments. From the technical point of view the injective treatment of the lips with hyaluronic acid can result, especially for the most expert operators, an easy procedure; but in order to obtain an harmonious, beautiful and elegant result it’s extremely important to carry out a correct and complete analysis of the face proportions and in particular of the lower third part of the face. The analysis must not considered exclusively, as already described several times, the height of the upper lip and the lower lip but must also pay attention on the mental furrow distance-pogonion and on the identification of any transverse deficits or excesses and anteroposterior of the lower third of the face. The static evaluation described must always be linked with a dynamic evaluation in order to quantify the correct quantity of volume to inject according to the most appropriate methods. A deep analysis structured in this way, provides a crucial information on the various anatomical proportions that must be respected and on the various injection modalities to follow. The goal is to instruct the operator to make a correct and complete analysis of the lower third of the face, illustrating the anatomical proportions  that must be respected and the most suitable injective methods to gain an optimal final result.

KEYWORDS: lips, dimensional analysis, hyaluronic acid, filler.

Correct steps to improve the result of a safe adipose tissue grafting

In recent times has increased significantly the transplant of fat tissue, from the mini grafts for facial rejuvenation (volume and regeneration) to the macro grafts for buttock or female breast. News devices for harvesting the fat, cleaning and placement, sophisticated device, which they intend to improve the results at the expense of knowledge medical surgical. But for this technique of regenerative surgery, because the use of adipose tissue, if it is done properly involves a regenerative treatment of tissues, you need an adipose tissue in good condition or in physiological conditions. And according to recent studies, that ill present at this Conference, the adipose tissue from where we get the adipose tissue for the transplant is not in proper biological conditions, means that their biological capacity is decreased and its regenerative capacity as well. So that after analyzing the alterations suffered by the adipose tissue in the donor area, and the stress that is exposed during the grafting I present various alternatives that increase the biological capacity of adipose tissue and allowing his survive to provide filling in affected areas of the body and face and regenerating action mediated by the ASC. In conclusions, until today many physicians working in lipografting but don’t know the fat tissue physiology. Follow the new researches we know what happen in the fat tissue, which are the alterations in the fat tissue that produce the decrease of the biological functions of the fat and how we can help the fat tissue to recovery the normal biology and physiology.

Vulvo Vagina Regeneration in 2019

Rejuvenation or vaginal vulvo regeneration or restructuring involves a group of procedures that improve anatomy and vaginal vulvo functionality to improve aesthetics or achieve more pleasurable sex. External vaginal procedures are defined as those performed on the female genitalia outside the vaginal introit, with important structures such as the labio Majora, Mons pubis, labio minora, clitoris hood, and introitus. Internal vaginal procedures are defined as those performed inside the vagina, extending from the introitus to the cervix. The prevalence of elective vaginal vulvo regeneration procedures has increased in recent years, a trend that can be attributed to increased exposure through the media, including television reality and pornography. In a survey of 482 women undergoing labiaplasty, almost all had heard of "rejuvenation" procedures in the past 2.2 years, and 78% had received their information through the media. In addition, genital self-image can have a considerable effect on sexual behavior and relationships. Genital dissatisfaction has been associated with decreased sexual activity, while positive genital self-image correlates with increased sexual desire and less sexual distress or depression. The big question of 2019 is whether it is necessary to use only one equipment, call it Laser or radio frequency or according to the pathophysiology of aging that leads to vaginal vulvo atrophy, it is necessary to associate other types of treatments. It is my opinion that today we can perform very good treatments of vaginal vulvo regeneration without using laser or radio frequency as a sine qua non condition, for which I will present various non-invasive techniques that are associated to achieve a good therapeutic outcome in patients.

Facial Mesotherapy In Menopausal Skin. Split Face Study Of The Improvement Of Cutaneous Elasticity.

Keywords : Menopause. Polynucleotides. Organic Silicon. Mesotherapy. Elasticity and firmness.

Introduction: Menopause is the time in a woman's life characterized by the cessation of menstrual periods due to the loss of ovarian function. According to the Spanish Association for the Study of Menopause, it is around 51.4 years. Due to the aging of the general population, the number and proportion of menopausal women has increased.1 The dermis is formed predominantly by connective tissue and blood vessels. In dermic connective tissue we mainly find collagen and elastin fibers. Collagen fibers, (especially types I and III) are produced by fibroblasts, providing tensile strength of the skin. The elastin fibers create a subepidermal network that provides elasticity to the skin.2 Estrogens stimulate the production of glycosaminoglycans and sebum, promote water retention, improve the barrier function of the stratum corneum and optimize the surface area of corneocytes.2 After menopause, because of estrogen deficiency, many women detect an acceleration in the aging process of the skin; This becomes thinner with a reduced collagen content, there is decreased elasticity, increased wrinkles and dryness. 3 We also found depolymerization of glycosaminoglycans and a degeneration and granular fragmentation of elastin.

Objective: Knowing that mesotherapy "per se" produces a cutaneous biostimulation and an increase in collagen synthesis. The author wanted to check the effectiveness of the combination between polynucleotides and organic silicon, against the physiological saline solution. Development or material and methods: Between July 2018 and January 2019 a prospective study was carried out. We included 8 volunteers, with established menopause of 4 or more years of evolution, without hormone replacement therapy, or intake of phytoestrogens or substances with estrogenic effect. The author performed 5 sessions of mechanized mesotherapy, with an interval of 15 days between each session, injecting a dose of 0.05 ml per puncture of the selected substances at a programmed depth of 3 mm. On the right side of the face, 4 ml of physiological saline was injected and on the left side a combination of 2 ml of polynucleotides5 combined with 2 ml of organic silicon was injected.6 To assess the effectiveness of the combination of polynucleotides and organic silicon versus physiological serum. The author carried out a study of skin elasticity and firmness at predetermined points on the face, before treatment, before the fourth session, 15 days after the last treatment and 45 days later using a Cutometer probe ®(Courage - Khazaka Electronic).

Discussion: To assess the results of the study, the author used the data provided by the probe Cutometer® evaluating the firmness and elasticity from day 0 to day 120. As well as a survey of satisfaction to the volunteers. There was an improvement in elasticity and firmness on both sides of the face, the data provided by the probe Cutometer® were better on the side treated with the combination between polynucleotides and organic silicon than on the side treated with physiological saline. The Likert survey of satisfaction of the volunteers with the treatment, provided important results in terms of improving the quality of the skin, very positive results in terms of tolerance to the mesotherapy technique and 100% agreed that it had not produced any type of aesthetic disability at a social or professional level.

Security: Some undesired effects have been reported such as ecchymosis at some point of injection, erythema of a few hours of evolution, and sensation of local heat, all of them lasting less than a week.

Conclusions: The combination of polynucleotides and organic silicon has shown greater efficacy than physiological saline in the treatment via mesotherapic7 of cutaneous elasticity in menopausal women. Evaluations of the evolution of the treatment in a longer period of time are lacking, as well as increasing the sample of volunteers. The author considers that the combination of polynucleotides and organic silicon used with the mesotherapy technique can be considered useful within the different cutaneous rejuvenation treatments that can be performed on menopausal patients.

Hyperglycemia:An Innegligible Aspect in Anti-aging

Hyperglycemia, a state of abnormally high blood sugar, is due to the degradation of pancreatic β-cell, the reduction or desensitization of insulin receptors. At present, studies have shown that the correlation between hyperglycemia and aging. There are four widely accepted theories about hyperglycemia and cell senescence, Hexosamine pathway theory, Polyol pathway theory, Advanced glycation end products theory and Protein kinase C pathway theory.

Cell senescence is the basis of aging of body. Frequent or ongoing high blood sugar will gradually destroy the homeostasis of the intracellular environment and trigger a series of pathological reactions such as oxidative stress, inflammatory reaction, energy metabolism disorder. The micro-environment of high glucose could accelerate the process of cell senescence, which cause damage to one’s nerves, blood vessels, bone marrow stem cells and lead to aging of brain, heart, skin, kidney, pancreas and other organs.

The study of the anti-aging effect of metformin, a classical hypoglycemic drug, provided new idea and clues for development of new anti-aging drugs. To regulate blood sugar homeostasis may be of great significance to delay the process of aging. The aspect deserve particular attention in subsequent studies of anti-aging.

Key words: hyperglycemia; anti-aging; cell senescence; glycosylation; oxidative stress;

Ketogenic diet by correct amino acid supplements. Strong evidence of pub-med literature against false nutritional myths

Introduction: Obesity plays a pathophysiological role in the development of health problems. Losing weight is therefore important and the principal element is the choice of a weight loss diet therapy. Losing weight is not sufficient , but the real challenge is weight loss by losing fat body mass.

Materials and methods: There are many diet programs that involve weight loss. However, only a few are actually effective and very few are successful also in the long term. Alongside the loss of fat body mass, the muscle mass which represents the body's true driving force must be preserved and as it is particularly rich in mitochondria, it is directly responsible for the basal metabolism. From this point of view, a ketogenic protocol is ideal. It has been shown that a very low-carbohydrate ketogenic diet (VLCKD) was more effective than a highly restrictive low-calorie diet (VLCD), as evidenced by the study: Very-low calorie ketogenic diet with amino acid supplement versus very low-calorie diet for preserving muscle mass during weight loss: a pilot double-blind study (Merra G, Miranda R, Barrucco S, Gualtieri O, Mazza M, Moriconi E, Marchetti M, Chang TF, De Lorenzo, Di Renzo L., where two diet therapies are compared: VLCD and VLCKD.

Results: The results show distinctly that, unlike a normal hypocaloric protocol, the VLCKD diet therapy can make you lose weight by losing only fat body mass and ensuring the maintenance of lean body mass, raising the value of the basal metabolism. But it is important to remember that during the phase of re-introduction of carbohydrate foods the Mediterranean-type diet is the best possible nutrition, from all points of view.

Conclusions: This diet therapy is characterized by its short duration, efficacy and safety for the patient, who loses weight through a correct protein intake without causing the loss of lean body mass and the results, in terms of weight loss, are visibly seen with body reshaping.

Man In Aesthetic Medicine

Men are a growing part of patients in aesthetic medicine. Statistics from the Society of American Plastic Surgeons (ASAPS) showed a 24% increase in men undergoing aesthetic procedures in the United States between 2000 and 2015. 1.2 million cosmetic procedures were conducted in 2015 in men, approximately of these, 84% were minimally invasive.

One of the main points is to understand the specific concerns and propose the available treatment options that are able to meet their needs.

There are features that make a man's face less masculine, such as a retracted jaw or a sharp chin, features that are more related to a soft, feminine face. Once men realize that they can change more feminine facial features with the help of dermal fillers then minimally invasive treatments are more ready to plan treatment. After all, dermal fillers injected into the right places can give men a stronger, more masculine jaw and a much more defined chin.

25 patients were treated with full face approach and hyaluronic acid filler. All patients were treated with glabellar and periocular wrinkles with botulinum toxin and the lower third we subjected to infiltration of hyaluronic acid. Above all the regions most taken into consideration were the temporo-mandibular joint and the chin area. The definition of the aforementioned areas made it possible to make some faces with a rounded shape decidedly more masculine, above all by marking the maxillary angle.

The Author presents the personal reports with a description of the timing of the intervention by location, the injection technique and the results obtained.

Holistic approach to skin aging

Modern Aesthetic industry has a lot of options to fulfill needs of patients. Major trend of last decade is moving from full scale surgery towards chemical and non-oblative lasers and biotech products use including fat transfer, stromal-vascular fraction on site use, biologically active substances, including product of stem cells metabolism or destruction, PRP etc. Considering that there are two major reasons for skin aging - photoaging and chronoaging. Additionally to external care the other trend for aesthetic physicians is internal care: anti-aging issues, including sports, food and other healthy life style counceling. Modern aesthetic physician has to be able not only to choose the right cosmetic procedure for the patients but also give general recommendations on life style. This approach not only shows patients that you care but also shows that you have broad knowledge on related issues. That builds up credibility and loyalty of patients. We find it very important for aesthetic physician to have at least basic knowledge on advances on as on novel external treatments so on internal anti-aging strategies including major theories of aging, geroprotectors and senolytics understanding.

Microvesicles based regenerative technologies

Biologics are playing more and more important role in modern medicine including aesthetics. After discovery of fat derived mesenchymal stem cells properties, stem cells based therapy became quite popular in different aspects of regenerative care. The principal difference between aesthetic methods based on proinflammatory actions and biologics is regenerative pathway of the later. Last decade a lot of attention was given to the new generation of biologics – so called conditioned medium - stem cells produced bioactive substances. It turned out that not cells themselves but metabolites are the driving force of the regenerative potential. Considering concerns related to stem cells use especially the allogenic ones ,an opportunity to use cells free biologics is quite exciting. More over new data presented shows that microvesicles are not only the major regenerative particles of stem cells based therapy but also they stay relatively long at site of injection and that explains the regenerative effect through the prolonged stimulation of local metabolism. Further development of the stem cells products based technology lies at the field of targeted therapy with microvesicles loaded with medicines.

Wound healing and skin cell proliferation with liquid Platelet Rich Fibrin

In aesthetic medicine, different filler materials are used for superficial and deep soft-tissue augmentation. Natural filling materials include collagen and hyaluronic Acid. However, regenerative medicine is towards developing natural concepts without the use of external biomaterials. Microneedling is a very simple, safe, effective, and minimally invasive therapeutic technique. It was initially introduced for skin rejuvenation, however, now it is being used for a very wide range of indications including acne scar, acne, post-traumatic/burn scar, alopecia, skin rejuvenation, drug delivery, hyperhidrosis, stretch marks, and many more. Moreover, during the last 10 years, many new innovations have been made to the initial instrument, which was used for microneedling. The creation of microchannels induces a controlled skin injury with minimal epidermal damage and stimulates the dermal wound healing cascade (inflammation, proliferation, and remodeling) to take place. This leads to the release of platelet-derived growth factor, fibroblast growth factor (FGF), and transforming growth factor alpha and beta (TGF- a and TGF-b). Neovascularization and neocollagenesis occur secondary to fibroblast proliferation and migration. After the cutaneous injury, a fibronectin network is created, providing a matrix for collagen type III deposition, which is eventually replaced by Type I collagen. This transition can occur over weeks to months, resulting in clinical skin tightening and rhytide reduction. In addition to the increased gene and protein expression for Type I collagen, there is also up-regulation of glycosaminoglycans and various growth factors including vascular endothelial growth factor, FGF-7, and epidermal growth factor. Based on histologic analyses 1 year after a series of microneedling sessions, increased collagen deposition in the reticular dermis with a normal lattice architecture, increased elastic fiber deposition, a thickened epidermis (granular layer hyperplasia), and a normal stratum corneum and rete ridges have been shown. This technique can be combined with other surgical techniques to provide better results. Further autologous concepts that gained a lot of attention in regenerative medicine in the last years is the use of blood concentrates. Among others Platelet-rich-Fibrin (PRF) is an autologous blood concentrate system that is produced by the centrifugation of patients own peripheral blood without any additional anticoagulants. Liquid PRF includes platelets, leukocytes and their subgroups and growth factors in a suspension of fibrinogen and further plasma proteins. The development of the so-called low speed centrifugation concept (LSCC) allowed the preparation of highly regenerative PRF-matrices. The release of cytokines associated to the niche of mesenchymal stem activate as well the regenerative process and angiogenesis for better oxygenation of the skin, in order to convert the stem cells in mature cells. This procedure begins the production of collagen and elastin fibers which is helped by the fibrin matrix produced naturally from the soluble fibrinogen. Moreover, the plasma contains proteins, minerals, vitamins and other nutritional substances, which lead to skin rejuvenation through the enhancement of wound healing.

Rosacea – a matter of life and death.

Rosacea is a very common skin disease even though it´s prevalence differs vastly in different studies. It has a well-documented psychosocial impact on their sufferers. The disease is often stigmatizing causing problems such as low self-esteem, anxiety and depression. In order to give the best help it is important to diagnose which subtype of Rosacea the patient is suffering of.

  1. Erythematotelangiectatic rosacea (ETR)
  2. Papulopustular rosacea (PPR)
  3. Phymatous rosacea (PR).
  4. Ocular rosacea.

Cutera Excel V+ efektywna terapia trądziku różowatego.

Terapia farmakologiczna może łagodzić objawy trądziku różowatego takie jak  grudki i krosty, jednak zaczerwienienie i  teleangiektazje wymagają leczenia laserowego.
Najlepsze rezultaty leczenia trądziku różowatego uzyskuję poprzez łączenie stosowania leków z zabiegami laserowymi KTP.

Aesthetic Medicine in the Golden years

“Wrinkles should merely indicate where smiles have been” Mark Twain The geriatric patient is your next aesthetic patient! With increasing longevity there is a rapid increase in the elderly adult demographic. The 65 and older age group presents with unique skin, hair, and nail issues. As the field of Aesthetic Medicine grows and becomes more available and recognised, men and women of all ages will want their skin to reflect their attitude, not their age. When patients present with six or seven decades of ageing it is not possible to practice preventative aesthetics, and where there are often budgetary constraints, it is more feasible to focus on the one or two most bothersome issues instead of a global approach to the face. Elderly patients most often have realistic expectations and are delighted with very little intervention. For example the removal of seborrheic wart or double chin can make bring great delight. There are several common conditions that aesthetic practitioner needs to manage in the older patient including skin barrier conditions such as xerosis , vascular conditions such as telangiectasia, rosacea and cherry angioma’s, hyperkeratosis, sebaceous hyperplasia, non-melanoma skin lesions including Basal Cell and Squamous Cell Carcinoma, folliculitis and alopecia. A thorough knowledge of the underlying bony, muscular and fat pad changes in the face with age is imperative in order to effectively treat the ageing face. Healthy grooming and self-care are important aspects to a healthy lifestyle in the older patient as they reflect a healthy attitude to mind and body. Older patients don’t necessarily concern themselves with wrinkles or sun spots that are an entrenched and accepted as part of who they are. There is less expectation of perfection and more of a need to address specific issues that are bothering an individual patient. Perceptions are different in the older patient. Crow’s feet are perceived as laugh lines. Cheek corrugations bring memories of having smiled a lot. A softer body makes for a cuddlier grandmother, and these natural changes should be celebrated and valued.

Post Graduate Journal Club Programme for Aesthetic Medical Practitioners In South Africa: a valuable tool

Sir William Osler founded the first formal journal club in 1877 and since then journal clubs have survived over a century in a rapidly changing medical world and have become a medical institution. It’s impossible for a modern doctor to keep up with relevant medical literature, especially in the rapidly changing field of Aesthetic Medicine. Yet it is imperative that the Aesthetic practitioner remain vigilant with constant updates in the field. Journal clubs increase the exposure to evolving medical literature and promote adherence to evidence based medicine. Journal clubs offer rare and protected teaching time through interactive peer group discussion, providing a unique opportunity to promote evidence based decision making, discussion and debate. The latest guidelines for journal clubs emphasise a move away from biostatistics and epidemiology and more emphasis on sharing of relevant case studies with critical appraisal . A journal club is also a platform for mentoring of doctors new to the field providing encouragement and increased confidence. The modern Journal club should be dynamic and interactive, improve reading habits and enthusiasm for medical literature. This presentation describes the development, by AAMSSA (Aesthetic and Anti-Aging Medicine Society of South Africa), of a successful Journal club programme for its members across all major centres in South Africa.

Memory decline. Associated Reversible factors

We have seen an increasing incidence on memory decline in patientes under 65 years old, most of them associated to reversible factors like nutrient deficiencies, endocrine pathology, metabolic methylated situations, high levels of stress, or disautonomic syndrome. How to make diagnosis, and the therapies involved for a good prognosis

Subclinical mineral and vitamin deficiencies related to chronic degenerative aging

Some clinical situations like stress involve hormones that depend on certain minerals like zinc, chromium, vanadium, vitamin E, vitamin C, vitamin D and vitamin K among others to be produced In chronic situations constant use of these nutrientes as enzymatic cofactors can induce, hypoganadism, subclinical hipothyrodism, metabolic syndrome, arteriosclerosis among others. We will analyze how these nutrients interact in the epigenomic pathway increasing the possibility of genomic expression.

Cosmeceutical: quality cosmetics for therapeutic purposes

Background: Albert Kligman in 1984 discovering that a form of Vitamin A could reduce acne and wrinkles coined the term “Cosmeceutical”, ("cosmetic" and "pharmaceutical"), to describe topical substances offering both cosmetic and therapeutic benefits. However, according to the U.S. the Food, Drug, and Cosmetic Act "does not recognize any such category as "cosmeceuticals", this term has no meaning under the law".

Methods: A review of a comprehensive literature search was conducted using Pubmed (J Drugs Dermatol. 2017. J Cosmet Dermatol. 2018 ) to identify and grade the anti-aging , antimelanogenic, antitumor efficacy for popular ingredients. assessments in aesthetic clinical practice considering that a number of anti-aging treatments, such as laser treatments and microneedling, exert their anti-aging effects by creating a wound healing response

Objective: Snail slime, i. e., used since ancient times, is a mixture of active substances transformed into gel or cream and is considered a real cure-all for the treatment of stretch marks, acne, to reduce scars and acne scars, skin blemishes, redness, burns, post-depilation irritations, skin rash and skin eczema. It is rich in mucopolysaccharides, allantoin, glycolic acid, vitamin A, E, collagen, elastin, peptides. It has powerful antioxidant, regenerating and healing effects on the skin, lacked of cytotoxicity, induces cell proliferation and migration, could treat melanogenesis but also anti-tumoral activity against human melanoma cells, has the potential to become a substitute for the commonly used antibiotics, may modulate growth and development of colorectal cancer cells and of breast cancer,

Results and conclusions: Snail mucin have been found surprising anti-aging benefits. There are, however, some ethical and animal-welfare concerns regarding the extraction techniques used to collect snail mucin for real quality level in skincare products.to open new horizons to consider some natural extracts more than useful additives in current cosmeceutical products.

Keywords: cosmeceuticals, snail slime, anti-aging , antimelanogenic, antitumor efficacy, quality extraction.

Platelet- rich plasma (PRP) and Platelet-rich fibrin (PRF) what's new and where are we going? Evidence-based medicine.

Autologous platelet-rich plasma (PRP) has attracted attention in various medical fields, including dermatology and plastic surgery, for its ability to regenerate and to promote wound healing. The therapeutic use of autologous platelet-rich plasma constitutes a biotechnology that has been a breakthrough in the stimulation and acceleration of soft-tissue and bone healing. The efficiency of this process lies in the local and continuous delivery of a wide range of growth and differentiation factors from activated platelets mimicking the needs of the physiological wound healing and reparative tissue processes. Consequently, the application of platelet-rich plasma has been extended to any different fields, including dentistry, orthopedics, sports medicine, and periodontal medicine and cosmetic, plastic and maxillofacial surgery. The aim of the presentation is to evaluate the different injection protocols, the differences between the offered tubes and between PRP and platelet-rich fibrin PRF (I-PRF, S-PRF ext.).

“Claimant patient”: a nightmare of aesthetic doctor. How to recognize such a patient in our practice in order not to ruin your own business?

There are 6-15% body dysmorphic disorder (BDD) patients among all those who come to aesthetic medicine clinics. These are patients who are not able to get satisfied from the treatment. BDD pts perform demanding attitude to personnel and have unreal expectation from medical procedures. These patients pose a challenge to doctors in their daily routine. BDD is a major contraindication for aesthetic medicine. Unfortunately, aesthetic doctor has no efficient tools to detect BDD patient in an office. All kinds of BDD tests require high skills in analyzing and they are time consuming. The presentation gives a guideline how to detect a patient with BDD model of behaving in the physician’s waiting room, describe psychological profile and the way how to communicate with such kind of BDD patients.

Enzyme products (hyaluronidase, collagenase and lipase) and its use in dermatology: Literature Review

One of the advances in procedures with lipolytic effect has been the use of enzymes. In cosmetic level, making certain enzymes are useful tools such as hyaluronidase, collagenase and lipase. Its applications usually require small amounts of enzymes highly purified, nevertheless thanks to the development of molecular biology; it has been possible to synthesize proteins known as recombinant enzymes. The main advantages are that they can be obtained, from one or more proteins, quickly in large quantities and in high purity. The issue proposed for the World Aesthetic Congress include an overview of the world experience in the use of enzymes in aesthetics procedures. A molecular description and the mechanism of action both at the cellular and tissue level is reviewed. From more than 1 million cases carried out with recombinant enzymes, a selection of the most relevant clinical cases is presented in this congress.

Keywords: Hyaluronidase, collagenase, lipase, aesthetics

Hyaluronic Acid: component of the Endothelial Glycocalyx and physiological promoter of lymphangiogenesis

Endothelial Glycocalyx ( E.G. ) is an extracellular structure that covers the endovasal side of endothelial cells, including those that form the lymphatic vessels . It has a thickness between 50 and 500 nm and is composed of P.G. (proteoglycans), glycoproteins, glycolipids and glycosaminoglycans including heparan sulfate (H.S.), chondroitin sulfate (C.S.), sialic acid (S.A.) and in particular acid hyaluronic acid (H.A.). This structure conditions also the Starling Principle that is appropriately revisited including the value of the oncotic pressure of the E.G. The main function of this structure is filter fluids, small molecules and proteins, with the exception of macromolecules; then adjusting the capillary lumen filtration rate. The fundamental role of hyaluronic acid is to facilitate the barrier function of E.G. for macromolecules. The amount of H.A. is regulated by HYAL 1 (hyaluronidase 1), the most active endogenous hyaluronidase. H.A. also presents a specific endothelial receptor LYVE-1 (Lymphatic Vessel Endothelial Hyaluronan Receptor 1 ) currently object of careful study. It has been suggested can be directly involved in lymphangiogenesis and expressed almost entirely level of the initial lymphatic vessels and of the lymph node endothelium. Another specific peculiarity of H.A. , in particular the low molecular weight H.A. (L.M.W.H.A.), is to promote the increase of lymphatic endothelial cell proliferation (LECs), their migration and the formation of tubular-like structures. Recent studies carried out on secondary lymphedema induced in murine model have led to the conclusion that the management of lymphedema can obtain a valid contribution from the use of hyaluronidase as a regulator of hyaluronic acid. Moreover in secondary lymphedema induced in murine model has been demostrated that the management of lymphedema can obtain a valid contribution from the use of hyaluronidase as a regulator of hyaluronic acid. In pathological situations is necessary adjuste the accumulation of H.A. In particularly the high molecular weight one (H.M.W.H.A.), in the testing phase this was possible through the use of hyaluronidase which "fragments" HMWHA into LMWHA (low molecular weight hyaluronic acid).

Up To Date In Treating The Periorbital Area

The periorbital region is the first to show the signs of aging; it is also responsible for the tired and sad look on aging faces. It is actually the most important part of a facial treatment, and yet it is the most difficult one. It is the area with the higher rate of complications such as oedema and nodules. For this reason the periorbital area should only be treated by expert physicians, as the slightest mistake will be magnified due to the thinness of the skin and underlying planes. Until quite recently most fillers were contraindicated in the periorbital region. But new products have been developed that can obtain good and safe results on this area. We must always use products designed specifically for this area. However we must bear in mind that even with these new products complications may and will occur if the technique isn´t little less than perfect. In this lecture we shall study the latest techniques for treating the periorbital region and the structures most related to the success or failure of treatments in this area. Whether we are treating the lower or the upper eyelid, we aim to establish an easy and safe approach to the treatment of the periorbital area and to help understand how to treat each kind of defect in the safest and most efficient way.

Italian nutrigenetics and lipidomics in anti – aging

In Italy, nutrigenetics studies have been carried out in the anti-aging area to provide better nutritional advice to the public generally, genetic subgroups and individuals. Because nutrigenetics and nutrigenomics require a deep understanding of nutrition, genetics and biochemistry and ever new ‘omic’ technologies, they are strictly related to anti-aging strategies covering topics such as detoxification and antioxidation, metabolism of key vitamins- microelements, metabolism of proteins, carbohydrates and fats, food hypersensivity, intolerance and diet-related diseases. Along with nutrigenetics, lipidomics, which focuses on the global study of molecular lipids in cells, tissues, and biofluids, has been advancing rapidly over the past decade. Recent developments in MS and computational methods enable the lipid analysis with high throughput, resolution, sensitivity, and ability for structural identification of several hundreds of lipids. In nutrition research, lipidomics can be effectively used to elucidate the interactions between diet, nutrients, and human metabolism. Lipidomics can also be applied to optimize the effects of food processing on the dietary value, and in the evaluation of food-related health effects. The aim of the presentation is to show the association of genes expression with inflammation caused by a deficiency of fatty acids and their impact in the anti – aging area.

Algorithms Of Hypermelanoses Management In Patients With Different Skin Phototypes

Keywords: melasma, PIH, hyperpigmentation, vitamin D, azelaic acid.

115 patients with facial hypermelanoses were examined. Methods: Wood’s lamp (Everplus skin analyzer B-601 16W) + dermoscopy (FotoFinder Handyscope 20x). Blood tests: CBC, liver function tests (bilirubin, AST, ALT, alkaline phosphatase, GGT, total blood protein, albumin, globulin), thyroid hormones (TSH, FT3, FT4), reproductive system hormones (FSH, LH, progesterone, prolactin, estradiol, testosterone free and total), ACTH, iron levels in blood serum, vitamins B12 and D levels (vitamin D 25-OH, total). The study has shown significant biochemical disturbances in patients with all types of hypermelanoses, in males and in females, disturbances in sex hormones levels, deficiency and insufficiency of vitamin D in 71 (61,7%) of patients with hypermelanoses, which should be taken into consideration in management, treatment and rehabilitation of such patients. Depending on the method of treatment patients were divided into 2 representative groups (by sex, age and type of hypermelanosis). 1 group (main group) – 80 patients, who received the proposed treatment protocol; 2 group (comparative group) – 35 patients, who received the traditional therapy. The proposed treatment protocol was oral cholecalciferol for 3 months, dosage 1000-4000 IU depending on body mass and level of 25(OH)D in blood serum. In case of vitamin D blood serum levels: lower than 20 ng/ml – 4000 IU of cholecalciferol every 24 hours, 20-30 ng/ml – 2000 IU every 24 hours, 30-50 ng/ml – 800 IU every 24 hours. After 3 months 25(OH)D levels in blood serum were re-evaluated and if the patient reached 25(OH)D level 30-50 ng/ml, the supporting dose – 800 IU every 24 hours was prescribed. Topically: morning – SPF cream, evening – 20% azelaic acid cream. The results of treatment were evaluated by MASI, DLQI and improvement of vitamin D levels.

Conclusions: The proposed method has shown significant improvement in 62,2% of melasma cases and 58,5% of PIH cases. Hormonal imbalance is an important factor of melasma development. The question of hormonal imbalance and vitamin D deficiency in melasma, and in facial hypermelanoses in general, is especially relevant and poorly studied. Further studies with larger amount of patients are needed in order to develop the recommendations concerning screening and normalizing of hormone levels, liver function tests and vitamins as a part of management of patients with melasma.

Oriental Anti-aging Base — Yichun in China

Yichun is a place full of negative oxygen ions with the number of 70 thousands to 150 thousands per cubic meters. So it is given the name of oriental Oxygen resort. The Hotspring in Yichun is full of anti-aging minerals, like Selenium and Metasilicic acid. We have made the scientific explanation to negative oxygen ions, Selenium and Metasilicic acid respectively to show the anti-aging evidence of Yichun resort in China.

Keywords: Yichun; anti-aging; minerals;

Clinical Study On The Effectiveness And Tolerability Of Preformed Growth Factors Vehiculated Through Ionophoresis On Patients With Androgenetic Alopecia

Introduction: Androgenetic alopecia is characterized by a progressive miniaturization of hair follicles usually occurring in a pattern distribution in genetically predisposed individuals. The main objectives of treatments are prevention or improvement of the hair miniaturization and prolongation of the anagen phase, in order to normalize the follicular cycle. Recent studies have shown that the different cellular components that compose the hair bulb undergo to an apoptosis process induced by the alteration of cellular control mechanisms, especially triggered by the caspases cascade within the DNA of the dermal papillae. It is also described how stimulation of the microcirculation and local blood circulation increases hair growth or delays the atrophy of the hair bulb.

Objective: Evaluation of the efficacy and tolerability of a combined therapy: preformed growth factors vehiculated through iontophoresis in the treatment of androgenetic alopecia.

Materials & Methods: We performed the treatment on 20 patients with androgenetic alopecia. The total number of sessions was 4 every 3 weeks. Researcher clinical evaluation, global photography and trichoscopy with measurement of the Density / cm2 ratio by Trichoscan® were collected at every session of therapy. All patients filed out a brief questionnaire fo self-assessment.

Results: Results of our study were very promising, with improvement in most of patients seen with both global photography and trichoscopy. All patients definied the treatment as “painless and pleasant” and all were satisfied of the clinical result.

Conclusions: The use of growth factors associated with ionophoresis technique is a useful treatment for treating and preventing androgenetic alopecia, through a cold / hot thermal stress that stimulates the blood microcirculation, improving the tropism of the hair bulb.

Epigenetics of skin ageing and its applications in anti-ageing medicine

Keywords: epigenetics, genetics, anti-ageing

Epigenetic mechanisms, represented by DNA methylations, histone modifications, microRNAs and chromatin remodeling, are becoming recognized as one of the most important factors in skin ageing. These mechanisms act by modifying the expression of genes involved in various cellular processes including collagen synthesis, fibroblasts activity and DNA repair. Importantly, epigenetic mechanisms are comprising both heritable and environment-related components, making them an interesting target for anti-ageing therapies. DNA methylations, the best studied epigenetic mechanism, are associated with gene expression silencing. It was shown that sun exposure causes hypermethylation of genes, resulting in a poor turnover of epidermal cells and thinning of the epidermal layer. Products containing Himalayan red rice can decrease DNA methylation levels and induce increased expression of selected genes, resulting in improvement of skin quality. Another example of epigenetic mechanisms, potentially involved in skin ageing, are histone modifications. These mechanisms act in the cell nuclei, making the DNA more accessible to transcription factors and increasing the expression of genes. It was shown that histone deacetylase enzyme, Sirtuin-1 (SIRT1), regulating cellular stress response, metabolism and ageing, may be a promising target for new dermatological agents. In summary, application of epigenetic-related products in skin anti-ageing market is undoubtedly the future of dermatology. Some new products based on these mechanisms are already available. However, the field is still relatively new and needs further investigation.

The Treatment Of Skin Texture Irregularities Using Patting Technology Associated With Iontophoresis , Vacuum And Led Light

Introduction: Skin patting works as a collagen induction therapy trough a handpiece equipped with 5 double cone bumps made of surgical steel. A controlled microdermal incision is performed, creating multiple microtraumas to stimulate dermal repair and collagen production. Furthermore the associated acoustic (pressure) wave stimulates the local microcirculation through an energy release

Objective: verify the skin effect compared to placebo and to different patterns of use. Evalue the type of collagen production, the lenght of the elastic fibers and the function of the cellular matrix.

Materials and Methods: 90 patients with skin texture irregularities were enrolled: 30 in the placebo group, 30 treated with skin patting + iontophoresis ( using a silicone gel specifically produced for the device) and the last 30 also treated with LED and vacuum. A weekly session for 6 weeks running was performed. A biopsy punch after 0, 30,60 and 90 days followed by histologic and immunohistochemical evaluation was carried out.

Results: following GAIS scale 30 patients didn’t have any improvement and they were the ones included in the placebo group. After 90 days the patients of the second and third group showed a good improvement in the skin quality, 25 to 75% , according to the scale. About histological examination after 30 days the 2 treated groups showed collagen formation , partially disorganized and unbundled but more and more thick and organized with fibers of larger volume after 60 days. At 90 days elastic fibers were detectable and the organized fibers were composed of type 3 collagen. Histochemical patterns showed an increasing of the basal layer of epidermidis and beginning of parakeratosis process to lead to formation of keratine.

Conclusions: Skin patting promotes a collagen induction in the damaged tissues which become softer and more elastic, reducing the fibrotic pattern and improving skin texture.

Nodules as dermal filler complications: treatment guidelines

Dermal fillers are used for the correction of skin defects or wrinkles. They are medical device, not subjected to the preliminary drug regulation, even if they are not completely inactive substances. Fillers can determine adverse events, related not only to their chemical – physic and biological characteristics, but even to unexpected reactions of the organism guest. The growth of more different dermal filler in the market and of the operators of the sector has determined an increase of the incidence of filler complications. This has made necessary to constitute a centre of excellence that represents a point of reference on the territory for the management of these complications. One of the more important complications is represented by the presence of nodules, whose therapy asks for an accurate diagnosis (inflammatory, non inflammatory, single, multiple etc). In this structure, the patient is clinically examinated, submitted to dermal US (to characterize damage and material). In some cases further investigations (blood test, CT, MR) can be prescribed. The patient is treated with specific therapy (pharmacological, surgical) up to the resolution of the case and submitted to follow up.

EGFR inibithor and skin toxicity

Revision of the literature on the prevention and management of the EGFR inibithor skin toxicity and proposal of skin index diagnostic evaluation and cosmetic prescription in patient in treatment with anti EGFR. Treatment with Epidermal Growth Factor Receptor inhibitor in patients having cancer can cause skin toxicities, an acneiform rash is one of the commonest. Although the exact pathophysiology of this rash is unknown, some Authors have noted that egfri induced skin toxicity might be partly associated with sebaceous gland function, others support the thesis that the keratinocytes of the basal layer of the epidermis react to EGFR inhibition by secreting cytokines that trigger an inflammatory response that eventually causes loss of skin barrier protection and secondary skin infections involving mainly the hair follicles.

Anti aging treatments at different ages. Personal approach

Aesthetic medicine is a field which develops day by day. There are many anti-aging procedures that are offered to patients - physiotherapeutic, minimally invasive and non-invasive. Choosing of procedures in a particular case depends on some conditions- patient age, skin type, skin condition, genetic factor and etc. The reduction in collagen synthesis due to fibroblast aging appears in 25-29 years. At these ages the skin has all the resources that we can use, activate with non-invasive procedures and get the desired effect. It does not make sense to saturate the skin by injection with the same synthesized substances while it itself contains them in sufficient quantities own production. Physiotherapeutic procedures are the best solution in such cases, in particular microcurrent therapy and galvanization. In some cases, when the genetic factors ,the wrong lifestyle or other exogenous factors affect the skin - injection therapy is carried out as an indication. After 30s collagen production in the skin is reduced significantly, number of elastin fibers and fibroblasts decreases. Skin losses its elasticity and firmness. Involutionary processes are developed in the skin layers, muscles and in bone structures as well. We are unable to change bone structures but we can improve the condition of the skin layers and tone of muscles by different methods including a combination of non-invasive , minimally invasive procedures and microcurrent therapy.

African Skin - a different approach than European skin.

I would like to discuss the difference in approach in African Skin Types, especially compared with European Skin Types. When we start our aesthetic journeys we may be under the illusion that African skin is 'stronger skin' but in reality fitzpatrick skintypes 5 and 6 is probably the most difficult skin types to treat. A lot of Aesthetic Treatments need to be modified, or is even contra-indicated in dark skin types, with a higher risk of Post-Inflammatory Hyperpigmentation, Alopecia, Keloid Scarring etc. I will discuss the different problems that African skin-types struggle with, and how to approach African skin treatments to be effective but also to remain safe.

500 Cryo-adipolysis procedures: what I really learned

Targets: The cryo-adipolysis procedure has undergone enormous development over the last 5 years. There are several medical machines on the market. This communication examines my personal experience in the choice of machinery and the clinical results achieved after 500 procedures.

Materials and methods: The 500 procedures were performed with the same machinery in two different surgeries but with the same settings and using the same handpiece models. 272 procedures were performed in the abdominal area. 117 procedures were performed in the lumbar region. 63 procedures were performed in the peritrochanteric area The remaining 38 procedures were carried out in different locations but without reaching an adequate number to be able to appreciate a result. The dimensions of the fat folds were measured and the pre-treatment photographs were taken. The follow up was set monthly for the duration of 3 months, with repetition of the fat fold and post-treatment photographs.

Results: Of the 500 procedures performed, the data of 320 of them were processed. I can say that 75% of them showed a average reduction of localized fat of 2 cm.

Conclusions: The cryo-adipolysis method is a very effective and non-invasive technique in the reduction of localized adiposity. The selection of the patient and the correct planning of the sessions and the management of expectations are important.

Reduction of non-surgical sub-mental adipose tissue: personal experience on 20 patients with the ATX-101 Molecule. Success or illusion?

Reduction of non-surgical sub-mental adipose tissue: personal experience on 20 patients with the ATX-101 Molecule. Success or illusion?

Targets: In 2015, the ATX-101 molecule (1% deoxycolic acid) was approved by the FDA as an injectable drug to improve the appearance of the neck region by creating a lipo-necrosis in the adipose tissue located in the sub-mental area. To date it is the first and only authorized drug as a lipolytic for that region.The Italian Drug Agency authorized its use in May 2017.Two years after his authorization I present my case history.

Materials and methods: 20 patients (3 men and 17 women) were involved, to whom 0.2 cc of drug were administered for each point on the grid proposed by the producing company, in order to standardize the treatment. In 10 patients a pre-anesthesia was performed with lidocaine injected into the sub-mental region 30 min before treatment. The follow-up was monthly for the next three months each session. In 2 patients 3 sessions were performed. In 8 patients 2 sessions were performed In 10 patients 1 session was performed.

Results: In 12 patients there was a marked reduction in sub-mental adipose tissue with an aesthetic improvement of the neck region, without highlighting any further cutaneous laxity or irregularity. There was no improvement in 8 patients.No significant adverse effects were found.

Conclusions: ATX-101 for the reduction of sub-mental adipose tissue is a therapy that presents many limits of indication and therapeutic efficacy and its use is limited to a few indications.

Micro-focused ultrasound (HI-FU):Review of the literature and review of my 14 months of experience with this technology, 70 patients treated. Why get passionate about it and what are the real indications

Targets: The technology that uses micro-focused ultrasound (HI-FU) for the regeneration of human tissues has had a great development in recent years. This communication aims to be an accurate review of the scientific literature present at this time on the site www.ncbi.nlm.nih.gov/pubmed/ comparing the various studies present in order to obtain an overview of the indications present so far for this technology in aesthetic medicine. In addition, my personal experience, lasting 14 months, will be presented in a preliminary form, including 70 patients treated, using this technology and an analysis, only iconographic, of the results achieved. This is a preliminary work, which will continue in the coming years, with collection of Imaging data in order to establish a real effectiveness in the treated tissues.

Lips the art of semplicity

Introduction: For women, lip aesthetics, always and at all ages, represent the essence of the beauty of the entire face. In fact, it is one of the most requested beauty treatment in recent years.It is very important, in aesthetic medicine, to respect the proportions, so as to obtain natural results.

Objective: The main objective is to obtain beautiful lips, soft, symmetrical, proportionate in the static and dynamic phase, of adequate volume and natural appearance, minimizing the pain of treatment and complications.

Methods: HA with TriHyal Technology of 20 and 25 mg/dl.

Multi-point technique with intradermic microboles with 30G x 4mm needle.

For reshape contouring with 27 or 30G needle x 12mm retrograde injections along the vermilion border.

For volume enhancement in the upper lip, microboles were performed just a few millimeters above the vermilion border and microboles for the lower lip just a few millimeters below the vermilion border. Small boluses close together, inserting completely the needle from the vermilion border.

The clinical outcome was evaluated through objective photographic assessment and analysis of GAIS and VAS scales, and recording of complications and side effects.

Results: Between November 2017 and May 2019, 131 female patients underwent non-surgical lip remodeling through injections of dermal fillers.

GAIS Results: GAIS I 91%, GAIS II 7%, GAIS III 2% SEA Results: VAS I-III 70%, VAS IV-VI 27%, VAS VIII 3% . No serious complications were noted.

Conclusions: This technique represents an advantage in reducing the pain of treatment and minimizes the risk of vascular complications, edema, erythema and ecchymoses. It allows to obtain lips with a more natural effect.

Nanoemulsion Preparation And External Usage Of Sendeng-4 Decoction

Background: The main research direction to address this issue is to study and develop traditional medicines. Especially, misinterpreted crude drugs and traditional medicinal formulas that are less studies in pharmacology lead to meaning confusion and this confusion causes bad influence in the treatment result. It is impossible to supply growing demand of traditional medicine among the population and expand categories of medicines and develop traditional medical sector efficiently without interpreting raw materials of traditional medical medicines with correct meaning and identifying its usage and benefit accurately.

Research goal: Determine the effects of nanoemulsion preparation and external usage of Sendeng-4 decoction to treat skin diseases and skin beauty.

Research method: 1. We use nanotechnology in order to produce nanoemulsion. Then add from appropriate proportion of shendeng-4 decoction into nanoemulsion.

2. We would like to study an external usage of traditional formula Sendeng-4 to treat skin diseases and skin beauty. First, thoroughly soak the herbal medicines in clean water. Second, add 200-250 ml water and bring the water to boiling point with strong heat, then shift to gentle heat and simmer for another 10-15 minutes. Finally, strain the decoction when it is ready.

Result: Proper decoction methods should be based on the properties of the traditional medicines and the patient’s clinical condition. The instructions of the traditional medicine practitioners should be followed before preparing herbal decoctions. The nanoemulsion reparation and external usage forms of Sendeng-4 cream, Shendeng-4 ointment, and Sendeng-4 bath are known that the forms of this medicine is very effective in all kinds of skin diseases (psoriasis, ichthyosys, circumscribed scleroderma, etc.), disc hernia, gout, gout after delivery, hemiplegia and so on.

Conclusion: As a result of this experiment, we got a very satisfactory result. The nanoemulsion reparation and external usage of sendeng-4 decoction can play an important role to treat skin diseases and skin beauty.

Keyword: Nanoemulsion, sendeng-4, skin beauty, skin disease