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<hr />Natalia Mikhailova , dermatologist, cosmetologist, member of the American Academy of Dermatology (AAD) and the American Society of Laser Medicine and Surgery (ASLMS), certified trainer of Bioscientific Trading LTD (France) and Cynosure (USA), chief physician of the Reforma clinic (Russia )<hr /> Classic biorevitalizants intended for true rejuvenation have been discussed more than once on the pages of this magazine. However, in the practice of cosmetologists, there are often cases when biorevitalization alone is clearly not enough, and it is too early to use “heavy artillery”. How to choose the right tactics in such cases? Let&#39;s look at clinical examples. 30 years old: dry skin Young woman, 30 years old, hypersthenic build. Complaints: dry skin, gray, “sallow” complexion, “tired” appearance, wrinkles under the eyes, oval folds when tilting the head. The extreme rhythm of life and living in a polluted metropolis played a negative role in this. Both work and leisure time are spent at the computer. Upon examination, the following is revealed: grayish-pink skin color, turgor is slightly reduced, drooping corners of the mouth, emerging nasolabial folds, a fine network of wrinkles on the lower eyelid. A cosmetologist diagnoses a “tired” morphotype of aging against the background of dehydrated skin. What tactics will be successful in this case? A hydration program is mandatory for such a client. The main course is 4 biorevitalization procedures with an interval of 14 days. The periorbital area is necessarily treated, using the “micropapule” technique (their diameter should not exceed 1 mm), and the lower eyelid – not reaching 0.5 cm from the ciliary edge. Even if only biorevitalization is performed, the client will undoubtedly be satisfied with the result: after a course of such procedures, wrinkles are smoothed out, skin turgor increases, and the face looks younger. But the emerging decrease in tone, especially noticeable when tilting the head to the side, will not be overcome soon when choosing such tactics. The fact is that biorevitalizants only create conditions for collagen synthesis in the skin. From the moment the skin is saturated with moisture to a noticeable, visible “tightening” caused by neocollagenogenesis, it takes from 4 to 10 weeks. And unfortunately, the patient does not always associate the improvement that occurs after completing the course with the work of the cosmetologist. We often hear how the merits of injection therapy are attributed to certain “miracle” creams. What course of therapy should our patient undergo to satisfy her desire for ideal skin? In addition to the hydration course, carry out “light” bioreparation - tighten the skin and give it a fresh, rested look. The best solution to solve this problem is a drug based on hyaluronic acid, “cross-linked” with vitamins (for example, vitamin C) and amino acids (valine, glycine, cysteine), which eliminates sagging skin and increases its elasticity. And its use using the “surface nappage” technique allows you to improve the color and microrelief of the skin. The drug is administered between biorevitalization sessions, with an interval of 1 week. The general course – 4 sessions of biorevitalization and 3 sessions of “light” bioreparation – ensures lasting results. A repeat course is carried out after six months. 30 years: hyperpigmentation It is necessary to mention one more problem that often occurs at a young age. This is hyperpigmentation. Fascinated by solariums and vacations in hot countries, such patients try to protect their face with photoprotective creams and get rid of already acquired age spots. As a rule, the skin also suffers from dehydration and even dryness, and proper attention is not paid to hydration and nutrition. At the same time, the choice of cosmetics, at best, occurs according to the principle “a consultant in a boutique advised.” As a result, we see skin in which not only the moisturizing layer is damaged (due to ultraviolet irradiation), but also the hydrolipid layer (due to exposure to aggressive cosmetics). For the purpose of hydration, we use biorevitalizant preparations in a course of at least 4 procedures (once every 2 weeks). And in order to lighten the skin, restore nutrition and (for such skin this is extremely important) antioxidant protection and prevent premature aging, we use a biorepair with hyaluronic acid, vitamin C, cysteine, glutathione. The peculiarity of “lightweight” bioreparation procedures is that the biorevitalizant and the bioreparant are used in one procedure, but using different techniques. Biorevitalization is carried out according to the classical scheme, using the “tubercles” technique, with mandatory treatment of the periorbital area with “micropapules”, as described above. Bioreparation: pigment spots are treated using the “papules” technique, and then the whole procedure is completed with treatment using the “median nappage” technique. In the intervals between such combined procedures, “lightweight” bioreparation is carried out in a single form. Bioremediation injections are carried out using the following techniques: “classical” and “median nappage” (the entire area is diffusely treated), “papules” (pigment spots are treated). 35+: “I want to look younger!” After 35 years, the signs of aging become more clearly visible. The “tired” morphotype rarely persists in its classical manifestation. The main signs are already being outlined that make it possible to say whether aging will follow the fine-wrinkle or deformation type. Timely diagnosis and the correct choice of therapeutic agents will allow patients to maintain youth and quality of their skin for a long time. Let us examine an appeal from a 38-year-old patient to a cosmetologist with the demand “I want to look younger.” The clinical picture includes a predominance of signs of dehydration, dryness, thinning of the skin and decreased tone, a network of small wrinkles of various locations (smile, cheek, around the eyes). This is an ideal patient for a combined course of biorevitalization and bioreparation. We performed 2 procedures on this patient using biorevitalizant with an interval of 2 weeks, but such a number of sessions is not a dogma. In this case, 2 weeks after the second procedure, when the patient came for the third, the question of choosing a drug was decided based on the results of the examination and morphometry. It was clear that to achieve the rejuvenation effect, the course must be continued. But which drugs to choose? Clinical and instrumental diagnostics made it possible to establish that skin hydration increased and its turgor increased. Now sagging, atony, and insufficient skin density have come to the fore. It was decided to limit the saturation of the skin with moisture using biorevitalizant to two procedures. And from the third to the end of the course, further rejuvenation is carried out by tightening the skin, lifting and smoothing out wrinkles. To solve the problem, a bioremediation drug was chosen, which coped with the task in the best possible way. And this is not surprising. It contains hyaluronic acid (14 mg/ml), modified with vitamin C, and amino acids that make up collagen (glycine, proline, lysine). Thus, the building material in this case is amino acids, protected from destruction by the most powerful antioxidant, vitamin C, and located in the skin for a long time in optimal, if not ideal, microenvironmental conditions created by modified hyaluronic acid. As a result, to achieve the effect of true rejuvenation, only three (!) additional procedures were sufficient. The techniques used to administer the drugs were “tubercles” and “papules”, as well as a linear technique in the area of the bony edge of the orbit and the labiomental fold. 45+: consequences of menopause Work to correct the signs of deformation type aging requires the doctor to especially carefully select correction means. In clinical practice, patients in the age group 40–45 years are quite often encountered. While their peers struggled with wrinkles around the eyes and dry skin, the happy owners of normal, and in their youth even oily skin were accustomed to looking quite young and attractive. And suddenly, almost immediately, as one patient, an architect by training, said, a “collapse” occurred. Indeed, the changes that such skin undergoes during initial menopause are characterized by processes that can be interpreted as “collapse of the skin framework.” Outwardly, this is manifested by sagging of the lower third of the face: the blurriness of the oval is disturbing, but does not yet look critical. The skin fold extends beyond the boundaries of the bony edge of the lower jaw, and “wrinkles of grief” are formed. The general weight gain is also reflected in a change in the profile of the face: fat deposits form mainly above the nasolabial folds, making them heavier and forming an aesthetic defect in the submental area - a double chin. This is a period in a woman’s life when timely and adequate assistance from a cosmetologist will help delay for many years the appearance of irreversible signs of aging that can be predominantly surgically corrected. Before the advent of drugs that had the ability to trigger their own rejuvenation processes, such patients were subjected to biorevitalization, and... the situation worsened. Answering the question posed in the title of the article, we note: our experience allows us to assert that in the case of developing gravitational ptosis, biorevitalization is contraindicated. Then which drug to choose? At the level of the dermis and hypodermis, collagen fibers fragment and lose their elastic properties; the activity of fibroblasts and their ability to synthesize young collagen decreases. To eliminate these age-related changes, bioremedies are needed. The duration of the course in different patients varied from 3 to 5 procedures, the application regimen remained the same. The entire “face/neck/décolleté” area was diffusely treated using the “papule” technique to create a depot of the drug and its uniform diffuse distribution in the dermis. Using the “tubercle” technique, the parotid region, the angle between the edge of the sternocleidomastoid muscle and the clavicle, was additionally processed. The corners of the mouth were reinforced linearly using the “mesh” technique. The key point of the procedure is the introduction of a bioremediation drug into the fat deposits, containing L-carnitine, widely known in aesthetic medicine, and hyaluronic acid (14 mg/ml), modified with vitamin C. The drug is injected into the hypodermis to a depth of 4–6 mm using the “infiltration” technique. in order to activate metabolic processes, mobilize fat from fat depots, and drainage action. When introduced into the dermis, it accelerates metabolic processes, activates hypodermal fibroblasts, provides the skin with physiological repair and true rejuvenation. As a result of the described course of procedures, the nasolabial folds began to look less deep without additional correction, the double chin “gone away,” and the skin tone improved. In general, the results of the course of procedures in this group of patients can be characterized as follows: rejuvenation, lifting, correction of gravitational ptosis and prevention of premature aging of the deformation type. 45+: violation of facial architecture And if this group of patients was lucky and the course of bioreparation was carried out in the early stages of strain aging, then the clinical picture of the later stages deserves separate consideration. Often such patients come to us not with complaints, but with a ready-made prescription-demand: to “fill” the nasolabial, labiomental, etc. folds with filler... And over time, when the ptosis intensifies, but the filler is still “standing”, they are surprised: why did it get worse? And really, why? Patients of this age are characterized by a network of fine wrinkles, deep wrinkles and excess skin of the lower eyelid, nasolabial and labiomental folds merging into “jowls”, as well as loss of volume of the upper and middle third of the face, accentuation of the nasolacrimal groove, increased deformation of the oval of the face, deep dividing angle “cheek/chin”, redistribution of skin and fat accumulations in the lower third of the face and in the neck area with the formation of a “turkey chin”. All these changes are called a violation of facial architecture. By injecting a fairly large amount of filler (usually at least 3 ml) into the lower third of the face, we add it to the excess fat, excess skin and interstitial fluid that is concentrated there. The result is known. In fact, it does not matter whether age-related changes accumulated according to the fine wrinkle or deformation type. At this stage, therapeutic tactics will be determined by the degree of skin hydration, loss of volume in the midface and the presence or absence of fat deposits. Course protocols will vary depending on the combination of clinical manifestations, such as:<ul><li> loss of volume in the middle third of the face in patients with dehydrated skin and fat accumulations in the area of the nasolabial folds and double chin;</li><li> loss of volume in the middle third of the face in patients with normally hydrated skin and fat accumulations in the area of the nasolabial folds and double chin;</li><li> loss of volume in the middle third of the face in patients with normally hydrated skin and no fat deposits.</li></ul> Replenishment of volumes with fillers is a necessary condition for rejuvenation of patients, and they were used in all three groups. Additionally, for the first group, biorevitalizants and bioreparants were used according to the schemes described above. In the second group, filler and bioreparant were used, in the third - only volumetric modeling with filler. These procedures made it possible to achieve a pronounced rejuvenating effect in such aged patients. The secret is that when determining therapeutic tactics, the pathogenetic mechanisms of changes in facial architecture were taken into account. Its proportions were naturally reconstructed: excess fat in the displaced deposits was “dissolved” by lipolytics, and the tissue volume lost as a result of involutional changes was restored with filler; the epidermis is moisturized and protected, and the dermis itself is sealed with bioremedies.<hr /> Injection cosmetology is one of the most actively developing areas of aesthetic medicine. More and more highly effective drugs are appearing. It is very important to understand the mechanisms of action, take into account the priority indications and capabilities of each of them. The combination of properties and mechanisms of action of biorevitalizants and bioreparants allows you to get quick results, have a comprehensive effect on several problems at once, and maintain the effect for a long time.<hr /> First published : Les Nouvelles Esthetiques Ukraine, No. 6 (82), 2013

Biorevitalization. Bioreparation. Alternative or supplement?