How to improve facial skin: practical recommendations

Vladlena Averina , dermatovenerologist at the Feofaniya Clinical Hospital, scientific coordinator of the training center "Academy of Scientific Beauty" (Ukraine)

The main tasks of autumn correction are increasing tone and elasticity, eliminating hyperpigmentation, leveling the relief, restoring the epidermal barrier, improving microcirculation and lymphatic drainage, eliminating local lipodystrophy (double chin), creating a frame and tension lines, eliminating facial stress on individual areas. To achieve these goals, aesthetic and medical cosmetic procedures are used. Moreover, the success of the latter depends on the consistency and consistency of their implementation.

The basis of the corrective approach is the now widely used classification of morphotypes of aging, proposed in the 70s of last year by I. I. Kolgunenko. In our opinion, the popularity of the classification is due to the fact that it provides an excellent opportunity to take a holistic approach to the aesthetic correction of age-related skin changes. Using pathogenetically based principles, we can select a comprehensive individual program that will provide both quick and long-term results, and will also allow us to predict and prevent further age-related changes.

Let me remind you that, according to the classification of aging morphotypes used, “tired”, finely wrinkled, deformed, and muscular morphotypes are distinguished. In women over 55 years of age, these morphotypes are mixed, and, as a rule, we can already talk about a combined type with a predominance of one or another morphotype and a late type of aging.

In the magazine “Les Nouvelles Esthetiques Ukraine” there were many articles describing each of them (for example, in No. 3 (91) / 2015, p. 32, etc. - Ed. ), so we will not go into detail again Let’s stop with the analysis and move straight to the possibilities of correction.

REMOVAL + ALIGNMENT + STIMULATION

Peels cope well with this task. Depending on the method of tissue removal (mechanical, chemical, physical peeling) and the depth of exposure, the most effective peeling can be selected for each morphotype.

For the “ tired” morphotype, glycolic 50−70% (Filorga), combined glycolic-salicylic (Dermaceutic), milk 30% (Mesoesthetic), almond, trichloroacetic (Easy TCA 15%, Skin Tech) chemical peels, as well as microdermabrasion, vacuum are effective hydropeeling (HydraFacial), fractional photothermolysis (Palomar).

For the finely wrinkled type, glycolic peels 20−50%, combined glycolic with kojic and phytic acids, lactic 20%, TCA peels, vacuum hydropeeling, fractional photothermolysis are indicated.

For the deformation type of aging, you can prescribe glycolic 70%, combined glycolic-salicylic, salicylic, retinol, almond peels, TCA 15-20%, vacuum hydropeeling.

The muscular type tolerates glycolic 50−70%, combined glycolic-salicylic, milk 30%, almond peels, microdermabrasion, vacuum hydropeel, combined glycolic with kojic and phytic acids, salicylic, retinol, almond, TCA 15−20%.

RESTORATION + FILLING + LIFTING

The injection type of reinforcement with mesopreparations is of interest from the point of view of technical accessibility to a wide range of injection specialists, and is characterized by low risks of complications and side effects, and a short rehabilitation period. When reinforcing with biorevitalizants and multicomponent drugs, the clinical effect is achieved through the implementation of two effects: pharmacological and actual puncture .

Let us consider the mechanisms of this effect.

Reinforcement of the skin is, of course, a traumatic effect during which a wound conglomerate is formed. Wound healing is a complex mechanism that includes processes such as:

• acute inflammation;
• migration and proliferation of connective tissue cells;
• synthesis of extracellular matrix proteins;
• restructuring of connective tissue components;
• collagenization;
• primary tension.

It is on these mechanisms that the puncture effect of skin reinforcement is based, providing active compression of the dermal flap (Fig. 1).

Rice. 1. Various recommended techniques for administering RRS drugs

Realization of the pharmacological effect when reinforcing the skin of aesthetically significant areas is possible with an adequate choice of drug. In recent years, to solve a wide range of aesthetic problems, the use of polyrevitalizants (skin boosters), which are distinguished by a complex multicomponent composition, has been updated. Polyrevitalizants are a fundamentally new class of drugs that combine the advantages of biorevitalizants (high molecular weight native hyaluronic acid) and mesotherapy cocktails that have a complex restructuring effect. Such preparations are specially designed for biorevitalization and correction of superficial wrinkles, increasing tone, skin turgor and muscle corset, have a rapid lifting effect, provide a high level of hydration and a visible effect of smoothing the skin texture. In our practice, we use the drug RRS HA Tensor Lift ( Aesthetic Dermal , Spain) , which is a composition of high molecular weight hyaluronic acid (1.5 million Da) at a concentration of 6 mg/ml and a special biostimulating complex (DMAE, amino acids, trace elements, coenzymes, vitamins , antioxidants, flavonoids), so the reinforcement scheme will be presented using his example (photos 1–4).

Photos 1–4. Various correction schemes with RRS Tensor Lift

Indications for use:

• fine-wrinkled type of aging (whole face);
• “tired” type (middle and lower third);
• deformational type of aging with implicit signs of gravitational ptosis (combination with lipolytic drugs is possible);
• muscular type of aging in the neck area;
• signs of skin atony caused by rapid weight loss;
• reinforcement of individual zones.

It is very important that polyrevitalizants are registered as medical products intended for intradermal administration (CE Class III Injectable), as this is evidence of their high effectiveness and safety.

For general anti-age mesotherapy, active cocktails that regenerate and stimulate the work of fibroblasts are used, improving the quality of the skin. Preference is given to cocktails containing:

• hyaluronic acid at a concentration of 5−15 mg/ml;
• vitamins (C, A, B5);
• trace elements (silicon, zinc, copper, selenium);
• vasoactive ingredients (nicotinamide, gingko biloba..)
• nucleic acids and amino acids;
• antioxidants;
• peptides;
• coenzymes.

These meso-cocktails are introduced using the “nappage” technique, papulally and linearly. The course consists of 4-8 procedures, once a week or according to the scheme.

You can also use autoplasma (PRP) with platelet-derived growth factors, and the drug is injected deep into the tissue and superficially papularly. Course of procedures: 3-6 sessions with an interval of 1 time every 2-3 weeks.

To correct hyperpigmentation in finely wrinkled and muscular morphotypes of aging, we recommend using whitening cocktails with tyrosinase inhibitors (for example, RRS HA Whitening, Shine Mesoline), which are introduced using a mesoscooter with needles 1 mm long and papularly directly into the area of the pigment spot. The course consists of 6-8 procedures with an interval of 1 time per week.

In the lower third (especially with deformed and tired morphotypes), not only the usual tightening, but also lipolytic ready-made cocktails containing silicon, hophytol, caffeine, L-carnitine, phosphatidylcholine and deoxycholic acid are used, as well as ready-made cocktails for the treatment of local lipodystrophy (for example, Cellutrix RRS, Bodyfirm Mesoline). When injecting, the skin is folded so that the solution goes directly into the hypodermis. Depending on the chosen cocktail, correction will require from 4 to 6 procedures, carried out once every 7-10 days, or 2-4 procedures with an interval of 10-14 days.

RELAXED SKIN WITH DECREASED MUSCLE ACTIVITY

Not so long ago, mesotherapy drugs with botulinum-like effects appeared on our market. Thanks to the content of hyaluronic acid and the innovative Bonta 568 complex (pentapeptide, hexapeptide, octapeptide), they provide the effect of filling the dermis and relaxing muscles. The use of such meso-cocktails is especially justified for patients who, for certain reasons, do not want or cannot carry out botulinum therapy. Also, these procedures prolong the effect of botulinum toxin drugs.

The administration regimen is the same as for botulinum toxin, but it can be administered according to the “mesobotox” principle. Depth of administration: intramuscular and intradermal. The course of procedures is 4-6 sessions with an interval of 1 time per week (Fig. 2).

Rice. 2. Scheme of application of RRS HA Relax with
BONTa 568

MICRONEEDLING: PATHOGENETIC IMPACT ON AGING PROCESSES

In my professional arsenal, the mesoscooter has long taken one of the leading places. But today its relevance is increasing - this is evidenced by European aesthetic trends (at AMEC-2015 a large number of reports were presented on the use of this tool). In addition, the feasibility of its use in our conditions is dictated by the economic situation in our country.

In Chinese traditional medicine, the reflex mechanical effect of such devices has been used for a long time. It consists of superficial multiple acupuncture of certain areas and biologically active points (reflex reaction) and micromassage of the skin and underlying tissues. The local reaction is expressed in changes in the blood supply to the skin area, temperature, and sensitivity.

During the microneedling procedure, the following occurs:

• stimulation of collagen induction;
• improvement of microcirculation;
• formation of microholes for the introduction of bioactive drugs;
• relief leveling;
• stimulation of reparative processes.

That is, the use of a mesoscooter has a pathogenetic effect on the aging process or on those structural changes that occur in the skin with age.

Microneedle therapy is especially effective in patients with the “tired” morphotype of aging.

Before the procedure, local anesthesia with Emla cream is performed for 20-30 minutes. After appropriate treatment of the skin with antiseptic solutions, a needling procedure is performed with a mesoscooter in the vertical, horizontal and diagonal direction in the area of the face, neck and décolleté. The length of needles for anti-age correction of the face is 1-1.5 mm, for the correction of post-acne scars - 1.5-2 mm.

The procedure can be performed either with or without the introduction of mesotherapy cocktails. After the procedure, hyperemia is observed for 24–48 hours, about which the patient must be warned. If another procedure is needed, it can be done after 4 weeks.

First published in Les Nouvelles Esthetiques 2015/№4

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