The term ‘filler’ refers to those substances which, introduced through a needle in the skin or immediately below it, have the purpose of ‘filling’ the tissues. The main use of these products is for aesthetic purposes. Fillers are widely used for the correction of wrinkles, furrows or depressions of the face or simply to increase the volume of some anatomical areas such as lips or cheekbones. The active ingredients of fillers are numerous but, for purposes of simplicity, we divide them into two large families: resorbable substances and permanent substances. The resorbable fillers are the most widespread biomaterials as they are characterised by a greater ease of use, a greater naturalness and fewer complications. The main elements of this family are hyaluronic acid and hydroxyapatite. The treatment is performed once or twice a year and is practically free of contraindications except for the proven allergy to the product. Permanent fillers, as the name suggests, once injected into the body, are, at least in theory, perennial. This assumption brings advantages and disadvantages. The advantages are linked to the fact that the patient is subjected only once to the implantation of the substance while the disadvantages are related to the inevitable risks that the introduction of these materials causes. If fact the body recognises them as extraneous and tries to eliminate them by triggering a continuous inflammatory reaction at the site of the implant. Another thing that should be remembered is that the physiognomy of the face and body evolves with advancing age and the injected filler, if permanent, does not always follow the processes of tissue ageing in a harmonious way, and there is a risk that it may turn into a blemish after some years. The parent substance of this family, which is no longer in use, was liquid silicone and today its successors are products based on polyacrylamide. Sometimes the use of fillers is not only indicated in facial beautification therapies, in fact, even reconstructive surgery has made use of these products to fill tissue deficits caused by loss of substance deriving from trauma or congenital malformations.
Botulinum toxin is a protein produced by a microorganism and medicine uses its paralysing power as an active ingredient in a drug used for the treatment of numerous diseases such as strabismus, blepharospasm and some forms of spasticity. When using botulinum toxin for these purposes, it was noticed that the wrinkles in the areas where the drug was used were reduced, so that, after further studies and clinical trials, it was also used for aesthetic purposes. Some face wrinkles are real lines of expression as they represent signs on the skin of continuous facial contractions, so it is evident how a partial and selective reduction of some muscles can induce a progressive regression of these wrinkles. The areas of the face that most benefit from the botulinum toxin are the forehead and the contour of the eyes but, in expert hands, it can also be used in other areas of the face such as the contour of the mouth, chin and neck. It is justified to think that a reduction in the motility of mimic muscles can reduce the patient’s expressiveness, but it will be the doctor’s job to make sure that all this does not happen. On the contrary, the facial expression can be improved in many cases. It is not a definitive treatment because, after a few months, the muscles resume over time the normal activity they had initially. Its effect is not immediately visible but the action begins to manifest itself after a couple of days. It is a treatment for both sexes and in every age group with very few contraindications and limitations. In fact, it is one of the most widespread cosmetic medicine procedures in the world.
Ageing of the skin is linked on one hand to constitutional factors (chronoaging) depending on the normal biological involution process that characterises all our tissues and, on the other hand, is influenced by environmental factors such as exposure to ultraviolet rays (photoageing), smoking, dehydration, inadequate cosmetic protection, wrong nutrition and stress. Over time, the skin undergoes changes in its formation that lead to the appearance of spots, loss of elasticity, thinning and dryness. The patient complains of less toned and dull skin and observes the gradual and unstoppable appearance of superficial and medium depth wrinkles. Antiageing medicine has studied pharmacological protocols of biostimulation and biorevitalization to reduce, limit and prevent skin ageing. The assumption of the use of these products provides multiple fronts of action including hydration, the reintegration of the lost skin constituents and stimulation of the cells responsible for the production of collagen. From a pharmacological point of view, the active ingredients most used in aesthetic medicine for this purpose are hyaluronic acid, vitamins, amino acids, coenzymes and minerals, glucosamine sulfate, pyridoxine, phospholipids, amino acids and polydioxyribonucleotide. The aesthetic doctor performs micro injections in the most superficial layers of the skin with a frequency dependent on the needs of the individual patient. There are many areas of interest: the face, the hands, the neck, the décolleté or where it is needed.
PRP is the acronym of platelet-rich plasma and is a technique used in aesthetic medicine for the rejuvenation of skin tissues. The platelets are among the essential constituents of the blood and their main function is haemostatic, that is to stop the loss of blood following small lesions allowing the start of the wound repair processes. Besides the coagulation potential, the platelets contain granules rich in substances essential for the repair and regeneration processes that are defined as growth factors capable of promoting important biological processes such as angiogenesis, that is the formation of new blood vessels, the migration of macrophages and the proliferation of fibroblasts with production of collagen and hyaluronic acid. For many years, the regenerative properties of platelet growth factors have been utilised in orthopaedic surgery, maxillofacial surgery and in dentistry and in plastic surgery for the treatment of chronic skin ulcers. More recently, aesthetic medicine has also used this technique in some skin biorevitalization protocols. After having performed a simple blood collection, the blood is centrifuged in suitable times and ways to obtain the separation of the corpuscular component containing red and white blood cells from the liquid component containing plasma and platelets. This fraction is injected with micro needles into the dermis of the areas to be treated. The anatomical districts interested in skin rejuvenation with PRP are the face and the neck with the décolleté. A session lasts from 15 to 30 minutes depending on the extent of the areas to be treated and is performed 2 or 3 times a year alone or in association with other biorevitalization methods with a protocol depending on cutaneous chronoaging.
Fractional lasers are used, that is devices that allow the laser radiation to be distributed selectively on the cutaneous surface. This made it possible to substantially reduce recovery times and sequelae. The laser beam produces micro ablation channels that stimulate the neo-regeneration of the skin, giving the patient much more thick and luminous skin. It is possible to reduce and later eliminate skin imperfections such as wrinkles or scars. The laser at our disposal is the YOU LASER MT (Quanta System), which is able to combine two wavelengths: 10600 nm (carbon dioxide) and 1540 nm (Erbium Glass) in a fractional or sequential emission (Mixed Technology). The imperfections associated with skin ageing, such as wrinkles and pigmentations, as well as scars, can be effectively treated with this technology. The synergistic use of the two wavelengths allows to achieve visible improvements even after only one session, with minimal discomfort for the patient. Laser treatments generally last from 10 to 40 minutes, depending on the clinical condition. Usually, as in the case of scars or wrinkles, one or two sessions are required. The final results are visible no earlier than 2-3 months.
Two-wavelength lasers are used for the treatment of vascular cutaneous lesions: 755 nm long pulse alexandrite and 1064 nm neodymium laser: Long and short pulse YAG. The combination of two wavelengths (755 and 1064 nm) in a single simultaneous or sequential emission allows the removal of neoplasms of vascular origin such as angiomas or capillaries.
Peeling is a regenerative technique of the skin that is carried out with topical application of irritating chemicals. Depending on the needs of the patient and individual anatomical variability, different acids are used, with concentrations and application times that can be modulated (glycolic acid, trichloracetic acid, salicylic acid, phenol or peeling composites). Peeling is a term that indicates exfoliation of the skin induced by the application of a chemical substance. In aesthetic medicine, peeling is a regenerative technique of the skin. The functioning of a chemical peel includes some specific mechanisms of action, typical of the different substances used, and a common method of action. Exfoliation involves the removal of the most superficial horny layer, eliminating all the skin problems present at this level, such as slight hypercromies or keratoses of modest size. Furthermore, chemical aggression induces an increase in cell turnover and an inflammatory reaction that stimulates fibroblasts to the production of collagen and elastin. The intensity and duration of the exfoliation are dependent on numerous factors such as the type of substance used, its concentration, the application time and the characteristics of the patient’s skin. The more aggressive a peeling is, the more aftertreatment will be involved, from a banal exfoliation to scabs for deep peels. In relation to the aggressiveness of its components peelings are classified into superficial, medium and deep for simplicity but there are currently many substances in use: glycolic acid, trichloroacetic acid, salicylic acid, pyruvic acid, phenol and many others solutions that include a set of more chemical agents. A peel can be indicated for skin rejuvenation or for the correction of some problems such as keratoses, dyschromia or post-acne scars. It is up to the doctor to evaluate the patient’s request and after having carefully evaluated the skin, if there is an indication, direct them towards the most suitable therapy.
Needling is a regenerative dermatology technique born a few years ago that consists in treating the skin with special micro needles in order to induce a cellular stimulus that increases the production of collagen and elastin. Originally, needling was performed by the doctor through a roller (dermaroller) equipped with micro needles and manually scrolled repeatedly in the areas to be treated. In the modern version, an electromedical device is used that accurately modulates the depth of action, the penetration vector and speed. Compared to the old devices, the advantages are that the extreme speed of vibration makes the procedure painless and the control of the penetration vector allows a homogeneous and effective treatment. The mode of action of needling is based on the cell stimulation of the epidermis and of the dermis as a result of which coagulation factors and inflammatory cytokines are released, which induce an increase in the production of new collagen and elastic fibres. The skin regenerates and becomes more turgid with a clear reduction of the finest roughness. In aesthetic medicine, skin needling is one of the possible treatment tools for the reduction of photoaging and chronoaging skin damage. Its more specific functions include the treatment of post-acne scars, stretch marks and the most hostile wrinkles of the upper lip and the décolleté. The treatment is performed in the clinic with the support of a topical anaesthetic and the session has an indicative duration of 15 minutes and leaves redness at the end of the session which lasts a few days.