PEER-REVIEW | COMBINATIONAL AESTHETIC APPROACHES |
Focused ultrasound Intense ultrasound (IUS) represents a rather novel approach of aesthetic medicine employing energy that can propagate through tissue, resulting in selective thermal coagulative changes within the focal region of the beam while leaving the remaining regions unaffected37
. The ultrasound field vibrates tissues,
causing friction between molecules and secondary generation of heat, resulting in histologic evidence of collagen denaturation in the dermis and sparing the overlying epidermal layer37,38
. A recently published study
investigating the safety and efficacy of this device for facial skin tightening demonstrated that a single treatment of the forehead produced an average brow height elevation of approximately 2 mm39
. Side-effects in
Figure 4 (A) 33-year old patient with some skin laxity looking for improvement of jawline and aiming for a more masculine look. (B) Results are shown after six sessions of microneedling around 4 weeks apart (1.5 to 2 mm needle length) combined with two sessions of injection lipolysis 8 weeks apart with moderate amounts of compound to decrease fatty deposits and provide some additional skin tightening, followed by injection of 6 cc’s of Radiesse in the masseter area
the scientific concept of creating microscopic thermal
wounds deep in the surface of the skin, which allow for tissue contraction, stimulation of collagen, and rapid wound healing31,32
. Both, ablative and non-ablative
fractional lasers have been well studied for indications such as improvement of photoageing, periorbital wrinkles, and atrophic acne scars. Effects vary among studies and respective devices and are mainly based on the general concept of collagen remodelling and associated with modulation of heat shock proteins, matrixmetalloproteinases
and transforming growth factor (TGF)-beta3 .
Radiofrequency Radiofrequency (RF) technology has become a standard treatment in aesthetic medicine with many indications due to its versatility, efficacy, and safety33
. It differs
from lasers in that it uses an electric current rather than a light source to deliver electrical energy directly to the skin causing heat due to impedance of the tissue, which results in collagen contraction and thereby immediate skin tightening3,34,35 subsequent
as well as remodelling,
reorientation of collagen bundles and formation of new collagen36
. Devices are
classified as unipolar, bipolar, or multipolar depending on the number of electrodes used33
.
Additional modalities include fractional RF, sublative RF, phase- controlled RF, and combination RF therapies that apply light, massage, or pulsed electromagnetic fields33
48 ❚ . March 2015 |
prime-journal.com
Chemical peeling Chemical peels are used for exfoliation procedures causing controlled destruction of upper parts of the skin followed by skin regeneration and are indicated for skin rejuvenation and resurfacing, scar and pigmentary disorders treatments, as well as acne therapy. Results depend, in large part, on the experience of the clinician. Since the chemical peel is one of the oldest aesthetic procedures there are many peeling agents on the market to date. Based on the active substance and its
concentration, they can be divided according to the histological depth of necrosis that follows after the peel. The most frequently used peeling agents include alpha hydroxy acids, glycolic acid (30–70%),
lipo-hydroxy acid, lactic acid, bicarboxylic acid, tricarboxylic acid, betahydroxy acids, salicylic acid (20– 30%), trichloroacetic acid (10–50%), alphaketo acids, resorcinol, Jessner’s solution, retinoic acid, phenol, and their combinations44,45
.
this study included transitory mild erythema and oedema. Suh et al, described beneficial skin-tightening effects on infraorbital laxity, lacking any permanent or serious adverse events40
. Another study in an Asian
cohort of 49 patients elucidated the side-effect profile of IUS for the treatment of facial skin laxity and concluded in favour of this procedure. Importantly, the authors recorded severe pain during the procedure in 54.4% of treatment sessions, however, no topical anesthesia was employed41
. Radiofrequency
technology has become a standard treatment in aesthetic medicine with many indications due to its versatility, efficacy, and safety.
Microneedling Percutaneous collagen induction therapy, also known as microneedling, was first described in 1997 and was soon established as a simple and fast method for improving superficial wrinkles and (atrophic) scars42,43
. It involves repeated puncturing of the skin
with fine needles leading to thousands of micro traumas associated with subsequent induction of endogenous production of collagen. As opposed to ablative laser treatments, the epidermis remains intact and is not damaged, thus procedures are usually tolerated well, with moderate downtimes and results depending on the respective needle length.
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