Human skin, together with its undeniable protective role, performs the delicate task of mediating the metabolic and information exchanges between the body and the environment around it.Unfortunately, due to a series of exogenous (eg, ultraviolet radiation) and/or endogenous stressors (eg, endocrine-metabolic diseases) and aided by the inexorable flow of time, it may undergo a sequence of functional alterations and/or structural problems that could prejudice its integrity more or less seriously. 1 This leads to dyschromia, dehydration, loss of elasticity, microvascular changes, etc, which may evolve into a serious esthetic problem if they are found in critical areas, such as face or décolleté. 2,3 For the prevention and treatment of the resulting skin imperfections-first of all wrinkles, but not only these-the approach of "cutaneous biostimulation" has been proposed for some time by cosmetic procedures, based on an injective technique, having the primary purpose to regenerate the normal structure and functions of the skin by a targeted action on

Background: Cellulite is a condition in which the skin has a dimpled lumpy appearance. The main causes of cellulite development, studied until now, comprehends modified sensitivity to estrogens, the damage of microvasculature present among dermis and hypodermis. The differences of adipose tissue architecture between male and female might make female more susceptible to cellulite. Adipose tissue is seen to be deeply modified during cellulite development. Our study tried to understand the overall features within and surrounding cellulite to apply the best therapeutic approach. Methods: Samples of gluteal femoral area were collected from cadavers and women who had undergone surgical treatment to remove orange peel characteristics on the skin. Samples from cadavers were employed for an accurate study of cellulite using magnetic resonance imaging at 7 Tesla and for light microscopy. Specimens from patients were employed for the proteomic analysis, which was performed using high resolution mass spectroscopy (MS). Stromal vascular fraction (SVF) was obtained from the samples, which was studied using MS and flow cytometry. Results: light and electron microscopy of the cellulite affected area showed a morphology completely different from the other usual adipose depots. In cellulite affected tissues, sweat glands associated with adipocytes were found. In particular, there were vesicles in the extracellular matrix, indicating a crosstalk between the two different components. Proteomic analysis showed that adipose tissue affected by cellulite is characterized by high degree of oxidative stress and by remodeling phenomena. Conclusions: The novel aspects of this study are the peculiar morphology of adipose tissue affected by cellulite, which could influence the surgical procedures finalized to the reduction of dimpling, based on the collagen fibers cutting. The second novel aspect is the role played by the mesenchymal stem cells isolated from stromal vascular fraction of adipose tissue affected by cellulite.

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Background Localized adiposity (AL) is the accumulation of subcutaneous adipose tissue, placed in definite anatomic areas, building up an alteration of the body silhouette. The aim of the present clinical and histological study is to assess the effectiveness of an injectable solution containing sodium salt of ascorbic acid 0.24% and surfactant agent at 0.020% ascorbyl-palmitate (SAP) for treating local adiposity. Methods Eighty healthy female adult patients were selected, suffering from local adiposity in the abdominal region. The patients underwent a cycle of 6 sessions, with biweekly treatments, without the addition of any active ingredient. Direct infiltration of pharmacologically active SAP solutions into the adipose tissue with a long needle, very similar to the needles used for spinal anesthesia, was performed. This procedure is quick and painless (does not require any anesthesia) with moderate infiltration speed. Results All the patients treated showed good results with good satisfaction of the circumferential reductions. Before treatment: Waist (cm) 78.8 ± 10.6 and hip 93.6 ± 9.0 with WHR 0.84 ± 0.07. After treatment: Waist (cm) 70.8 ± 9.6 and hip 92.6 ± 8.0 with WHR 0.76 ± 0.06. Indeed, signs of adipocyte apoptosis were observed in subcutaneous skin after injection of SAP. Conclusion The results showed in the present study suggest that the SAP utilized induces apoptosis of adipocytes and could be of use as a safe and effective method with which to eliminate subcutaneous abdominal fat. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

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Background:Reconstruction intralipotherapy is a term commonly used in the field of aesthetic medicine, above all in Europe, which defines a specific injection technique developed for the treatment of localized fat with substances that provoke the lysis of adipocytes by means of an injection directly into the adipose tissue with a long needle. The aim of this study is to define the technique in detail and everything that is associated with it, on the basis of years of multicenter experience by doctors who perform it.Materials and Methods:From January 2010 to December 2014, 3,080 European physicians were trained in intralipotherapy technique, and approximately 152,500 patients were treated. The adipocytolytic agent used is a Conformité Européene-certified device. The technique, equipment, protocol, posology, postoperative management, and adverse events are described below.Results:The intralipotherapy technique combined with the appropriate adipocytolytic agent has been shown to be effective in every zone on the average of 76.7% of the cases. The variability is due to the area treated and the patient. The standardization of the technique, homogeneity of the protocol, and the posttreatment management have been essential for standardizing the results and minimizing any adverse events. The latter occurred only in a small percentage of the cases, while those more serious have been extremely rare.Conclusion:This study shows how the intralipotherapic technique, when performed properly with an appropriate adipocytolytic device and when proper precautions are taken, can be effective and safe for reducing undesirable subcutaneous fat deposits.

The rehabilitation obtained with a megafilling session and further touch-up procedures and that with a gradual build-up of the localized soft-tissue loss seem not to have differences in terms of safety for the patients. However, with a megafilling session satisfaction is achieved earlier and it is possible to reduce hospital costs in terms of gauze, gloves, and other items.

The outcomes of this study confirm that calcium hydroxylapatite dermal filler safely and effectively ameliorates the appearance of patients with HIV-related facial lipoatrophy, and mixing it with local anaesthetic and adrenaline can reduce pain during injection and ecchymosis.