Injection enzyme therapy in the practice of a cosmetologist

Galina Krinskaya , cosmetologist, clinical pharmacologist, brand trainer PBSerum, BioRePeelCI3, IBSA

Main indications for injection enzyme therapy:

- elimination of hyaluronic acid filler in case of immediate or delayed complications or overcorrection;

- drainage effect aimed at reducing swelling in the area of hypertrophy of subcutaneous fat;

- correction of the lower, middle third and submental zone for tired and deformational morphotypes of aging with an edematous component;

- correction of pathological scars (atrophic, hypertrophic post-acne and striae, neuropathic syndrome after surgery);

- various forms of lipodystrophy (cellulite) and local fat “traps”;

- complications after liposuction.

Certified drugs must be used for injection. And among the two main factors - safety and effectiveness - safety should take first place.

To correct complications after contour plastic surgery and drainage action, hyaluronidase 1500 units is used. It can be testicular and recombinant. Features of testicular hyaluronidase are the content of bovine albumin and, accordingly, the risk of allergic reactions, and non-selective hydrolysis of proteoglycans and, accordingly, the possibility of obtaining “minus tissue”.

Recombinant hyaluronidase does not contain endotoxins and destroys exclusively hyaluronic acid.

The volume and frequency of administration of hyaluronidase solutions depends on each individual case. For example, a filler in a volume of 1 ml in a hypercorrection can be destroyed by the injection of 600-1500 units. If the issues of partial hypercorrection are being resolved, then hyaluronidase can be administered in small volumes until the desired result is achieved.

In the case of tissue ischemia as a complication caused by compression of the vessel with filler, it makes sense to immediately administer 1500 units. If there are any altered areas of tissue after contouring and the procedure was carried out quite a long time ago, and if the drug is also unknown, it is recommended to undergo an ultrasound examination of soft tissues for an accurate diagnosis. Since the formation of fibrotically altered tissues is possible against the background of filler, hyaluronidase as a single drug will not cope with the task.

A combination of hyaluronidase and collagenase must be used.

For a long period of time, mainly hyaluronidase preparations were used to destroy excess extracellular matrix. It is quite clear that these drugs act mainly on the polysaccharide component of the extracellular matrix; for this reason, monotherapy with hyaluronidase has significant limitations. In addition to the fact that intact collagen fibers remain in the scar mass, such therapy in some cases can provoke scar growth. This happens for the following reason.

Fibroblasts ( myofibroblasts), “inhabiting” the scar, respond to changes in the composition of the extracellular matrix surrounding them (its polysaccharide component) with additional production of glycosaminoglycans and proteins. For this reason, there is a need to combine collagenase and hyaluronidase preparations. In this case, hyaluronidase not only destroys one of the components of the excess extracellular matrix - glycosaminoglycans, due to this, a kind of “loosening” of the matrix is achieved, which significantly facilitates the penetration of collagenase molecules into the scar mass. Scar therapy is based on this. There are various techniques for working with scars. For atrophic scars, it is important to carry out subcision - cutting the bottom of the scar and parallel intradermal microbolus administration of the drug. For atrophic striae scars, scar separation and simultaneous blanching will be effective. Hypertrophic scars need to be treated in volume and depth, including surrounding tissues.

From the point of view of the cosmetologist-client or doctor-patient relationship, it is important to correctly focus on the timing of achieving results. Scars do not form quickly, and tissue reorganization also takes time.

In the correction of facial contours, various forms of cellulite, and local fat deposits, lipase, collagenase and lyase are used in combination. Lipase, hydrolyzing triglycerides of fatty acids to monoglycerides, reduces the volume of adipose tissue. Collagenase hydrolyzes “aging” collagen that loses its properties and stimulates the production of new elastic and structural collagen by fibroblasts. Lyase, acting as a diffusion factor, hydrolyzes the polysaccharide chain of hyaluronic acid to oligosaccharides, which, in turn, attach to the CD-44 protein receptors, which synthesizes the production of hyaluronate synthetase, and we come to a direct stimulation of the production of new hyaluronic acid, which also has pronounced anti-edematous effect.

Since we are faced with dermal stimulation, the effect of lifting and improving skin quality will also be observed. In cases of correction of hypertrophied subcutaneous fat against the background of normal skin turgor, injections are performed at the level of the subcutaneous fatty acid. If the problem of increasing the volume of adipose tissue and ptosis is accompanied by reduced dermal tone, then it makes sense to act on two targets - the pancreas and the dermis itself. Injections are carried out in one procedure in two stages - deep boluses of larger volume with a greater distance between injections and intradermal microboluses with greater frequency.

Contraindications for injection enzyme procedures:

- acute diseases and exacerbations of chronic diseases;

- taking anticoagulants and antiplatelet drugs;

- uncompensated diabetes mellitus;

- autoimmune diseases (collagenosis, vasculitis, rheumatoid diseases);

- burdened allergy history;

- taking antibiotics and non-steroidal anti-inflammatory drugs.

Science does not stand still, research in aesthetic medicine is being carried out very actively, lifestyles are changing, we are more socialized, busier, travel more often and do not always have time for a rehabilitation period away from society; As the requirements for cosmetic products and cosmetic procedures change, we strive for quick, maximally physiological, visually effective results without the risk of complications.

Since enzyme preparations in cosmetology are as close as possible to the golden mean in terms of safety and effectiveness, they are steadily striving to become leaders among cosmetic procedures.