Background: Calcium hydroxyapatite (CaHA) is a well-established collagen stimulator. In recent years, it has been increasingly used in hyperdiluted form as a biostimulatory agent rather than a volumizing filler to improve skin quality and firmness in both facial and corporal areas. However, guidelines on the techniques required to achieve optimal results are still lacking. The objective of this study was to develop a consensus recommendation for the safe and effective use of hyperdiluted CaHA for face and body biostimulation. Methods: A team of 10 experts with extensive experience in dermal fillers and biostimulatory treatments for facial and body rejuvenation convened for a live meeting. Consensus was defined as approval by 70%–89% of all participants, whereas agreement of ≥90% denoted strong consensus. Results: For most items, the group achieved a majority consensus. Recommendations have been provided for the face, neck, décolletage, buttocks, thighs, arms, abdomen, knees, and elbows with detailed injection techniques, providing information on insertion points, dosages, and volumes for both needle and cannula injections as well as the number of treatment sessions and intervals. Conclusions: The expert consensus supports and provides guidance for the use of CaHA as a biostimulatory agent for face and body rejuvenation. However, further clinical studies are necessary to provide physicians with the best evidence for the best treatment practices.
The development of treatments using stem cells has drawn the attention of researchers to fat deposits given the fact they represent an almost unlimited reservoir of such cells, which can be accessed through minimally invasive techniques. However, the standardization of these studies has been made difficult because of the controversies of nomenclature regarding the many components of adipose tissue. Despite their distinct and independent structures with different metabolic responses, the terms hypodermis and subcutaneous adipose tissue are many times used as synonyms. However, the correct distinction between these two layers, the knowledge of their behavior and an uniformity of these terminologies are of utmost importance.Thus, the purpose of this study was to make a bibliographic review on the theme, aiming to show the anatomical, histological and metabolic differences between these two tissues and standardize their nomenclature.
<p class="SectionHeading1"><span lang="EN-US">Necrobiosis Lipoidica (NL) is a chronic degenerative disease of the collagen with higher incidence on the anterior part of lower extremities, especially the tibial area. There were a number of proposed treatments, but none is 100% effective. We present a case of a fifty-year-old female patient with a suspected diagnosis of necrobiosis lipoidica, confirmed by histopathological examination. After two years of treatment with topical corticosteroids and weekly applications of Psoralen and ultraviolet A radiation (PUVA), there were no signs of improvement and we decided to perform a treatment with intense pulsed light therapy. Over a period of 14 months, a total of 13 sessions were carried out and a satisfactory treatment result was obtained.</span></p>
Background There is substantial interpersonal variation in the patterns of muscular contraction that substantiates the use of personalized points of application and dosages in clinical practice to achieve optimal results. Nevertheless, there has been no real-life therapeutic series with botulinum toxin for aesthetic treatment of the face in which the subjects were systematically followed to assess its long-term benefit. Purpose To assess the performance and length of the treatment of glabellar and forehead lines with IncobotulinumtoxinA in a real-life setting. Patients and Methods We enrolled 20 adults with indications for the treatment of upper facial dynamic lines (glabella and forehead) with botulinum toxin. The protocols of injection points were personalized by the injectors. The participants were photographed under maximum facial contraction before the application (D0) and after 15, 90, 120, and 180 days. The photos were randomly assessed by two blinded experienced raters to consensually grade the dynamic lines according to the Merz Aesthetics Scales (MAS). Efficacy was defined as the reduction in the MAS score. Results At D15, 18 (90%; 95% CI: 80%–100%) participants reached the zero score, or a 2-point reduction on the MAS score from the forehead and 16 (80%; 95% CI: 65–90%) reached that reduction for the glabella. These values from D90 were 14 (70%; 95% CI: 55–85%) for both sites. At D120, these values were 11 (55%; 95% CI: 35–75%) and 8 (40%; 95% CI: 25–55%) for the forehead and glabella. At D180, 10 (50%; 95% CI: 30–70%) participants presented a MAS score for forehead or glabella dynamic lines lower than the score assessed at D0. Conclusion As much as 70% of the patients sustained a reduction of scores after 120 days of the treatment for dynamic glabellar and forehead lines. Half of the patients evidenced prolonged benefit at 180 days.
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