Glossary of Aesthetic Medicine

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Aesthetic Medicine is born from the intuition that man is healthy when he is in harmony with the different phases of life, with his social and environmental integration. 
The intuition comes from a philosophical conception of an integral human whose global nature must be promoted, defended and valued.

This philosophy must increasingly permeate medicine, which, being inspired by it, can guarantee the health of the individual as a whole, both thanks to the coordination and integration of the most diverse specialist activities, and through the promotion of articulated and up-to-date scientific research. 
Aesthetic Medicine interprets this need by combining the two principles identified by its very name: Medicine and Aesthetics, for a specific program of physical, mental and social well-being.

Modern living makes man pay a very high price in terms of damage from global wear and tear.

The changed conditions of civilisation no longer allow us, on the other hand, to ignore the growing interest accorded to the physical aspect and to the psychic equilibrium, to social presentability, to environmental harmony.

The psychological gratification and the “public” weight of a pleasing appearance and of a healthy and harmonious personality are very important.

To live today you need to feel “good in yourself” at any age and the medicine is increasingly sought by patients who are looking to improve their appearance, balance and overall harmony in a search for personal security, but also a professional necessity and a profound spiritual need.

The function of Aesthetic Medicine is therefore linked to a specific requirement of the community, playing a fundamental role in the field of social medicine.

To achieve an optimal result,  Aesthetic Medicine implements a multidisciplinary collaboration using all the knowledge of the fundamental sciences (biophysics, biochemistry, physiology, pathology …), the acquisitions of general medicine, surgery and some of their specialisations (internal medicine). , endocrinology, dietology, dermatology, angiology, orthopaedics, physiatrics, plastic surgery …), and the contributions of numerous human disciplines (anthropology, philosophy, pedagogy, psychology, sociology, ecology and communication …).

 Aesthetic Medicine has the goal of the solution of imperfections, but its ultimate purpose is broader as it tends to promote and stimulate the construction and reconstruction of a harmony and individual balance through the activation of a program of educational, social, preventive and corrective, curative and rehabilitative medicine.

In the preventivephase, which represents the fundamental aspect of the discipline, doctors teach how to ” know” and “accept” the inherited physical structures, to protect and manage them according to the rules of hygiene of life: nutritional, physical, cosmetological, psychological and behavioural.

In the correctiveone, the program makes use only of official methodologies and techniques: medical, kinesi-, thermal and cosmetic therapies.

Aesthetic Medicine therefore leads to a healthy, harmonious individual who fully embraces his own age and knows how to recognise and accept himself, who works hard to improve himself and is able to regard and love himself more.

It is in fact a medical discipline that acts across the board in favour of quality of life, interpreting fully what the WHO (World Health Organisation) has been declaring for years: health must be considered not as absence of disease but as psycho-physical well-being.

This is the philosophy which should be instilled in those who turn to Aesthetic Medicine.

This is, therefore, the dictate of the Italian Society of Aesthetic Medicine and its current didactic expression represented by the International School of Aesthetic Medicine, promoted by the International Fatebenefratelli Foundation in Rome.

Biostimulation is a medical treatment that consists of intravenously injecting pharmacological substances or using an  injectable medical device    that stimulates the activity of fibroblasts of the dermis, with a consequent increase in the production of collagen, hyaluronic acid and elastin in the skin.

For this purpose, active ingredients are used with different characteristics and purposes: hyaluronic acid, polydeoxyribonucleotide (PDRN) and amino acid precursors of collagen. In association with these substances, antioxidants, mineral salts and vitamins may be present.

To these injecting substances, the possibility of resorting to the insertion of absorbable threads in PDO (polydioxanone), through carrier needles, for a stimulating, revitalising and slightly-lifting effect in the skin has recently been added. These are monofilament synthetic suture threads used in the prevention and non-invasive or minimally invasive treatment of cutaneous relaxation. They can be used in the face (frontal and above-eyebrow, periocular, zygomatic/malarial, cheek, mandibular edge, under-chin), in the neck, in the decollete, under the arms and on the inner-thighs, and in general on the skin of the body where indicated.

In the field of Aesthetic Medicine, the main indications for skin biostimulation are represented by skin ageing phenomena (chrono- and photo-ageing) and by dehydration due to lack of tissue water. Biostimulation is usually included in a wider therapeutic-corrective programme that includes the use of adequate cosmetics, and targeted treatments such as chemical peels (promote cell renewal) and fillers (fillers, such as hyaluronic acid).

The latest frontier of biostimulation is represented by regenerative medicine that involves stimulation of the dermis with infiltration of the plasma enriched in the patient’s own platelets.

Used for many years in other fields of medicine with regenerative effects, in recent years it has also found broad usage in the field of Aesthetic Medicine for biostimulation and skin rejuvenation, as it encourages and stimulates, through the release of numerous growth factors, resulting in the repair and regeneration of tissue with an absolutely natural result.

Botulinum toxin is a substance produced by the bacterium Clostridium Botulinum. Due to its heightened tolerability and the reduced rate of side effects, this medicine is used with therapeutic effects in treating over 40 diseases. 

The first use of Botox in the therapeutic field was in the treatment of some eye diseases (strabismus, blepharospasm), facial tics, some types of headaches, mycial torticollis, bladder hyperreflexia, some forms of chronic pain such as the post-herpetic one, etc. 

In Aesthetic Medicine, botulinum toxin is a safe and effective drug that not only reduces expression wrinkles due to the contraction of the muscles responsible for facial expressions, but also prevents the formation of new wrinkles.

The duration of the effect is about 4-6 months; to maintain the result, simply repeat the treatment.

The uses in aesthetic medicine concern the treatment of glabellar and periocular wrinkles.

There are many expression muscles in the lower two thirds of the face are many that are quite close to each other and play an important motor function (such as the lips, mouth, etc.) that must be respected. The results are less evident and the possibility of blemishes and complications is higher. 

Before subjecting the patient to treatment with botulinum, the doctor will have to ascertain his or her state of health and the absence of certain diseases that conflict with its use:

muscular, neurological diseases, antibiotic-type aminoglycoside, previous surgery (such as blepharoplasty, facelift, etc.), albumin allergy or intolerance, pregnancy or lactation. 

After evaluating the patient’s expressions, microinections are carried out on specific points identified. Treatment is generally well tolerated and the patient can only perceive a mild and transient burning during the injection. After treatment, a slight swelling and redness of rapid resolution may occur (for a few hours), and a little bruising may occur. If the entire frontal region is treated, a slight sense of heaviness may appear for a few days.

In the first hours after treatment, it is necessary to refrain from sporting activity, avoid laying down completely and manipulations in the treated area.

Botulinum toxin will start to take effect 2-3 days after treatment and the final result will be seen in about 15 days; the effect will gradually vanish within a few months, with a total recovery of muscle function but with a slower reappearance of wrinkles. Improving expression wrinkles can become permanent if recurrent treatments are regularly performed, which will in any case be performed only after complete recovery of muscle function.

In general, the complications related to the use of Botox in the aesthetic field are local, very rare and always reversible within a few weeks. An allergic reaction due to the presence of albumin, present in the injectable botulinum, can be had in predisposed subjects.

Another completely reversible complication may be due to the action of the drug on a muscle adjacent to the one being treated: this may happen due to a technical injection error or, more often, because the treated area has been subjected to manipulation or pressure.

The term “Camouflage” derives from the French given by the merger of two words:  camoufler (disguise) e maquillage (trick) indicating a corrective makeup technique used to hide different types of skin imperfections of the face and other locations of the body.

Cosmetic products for Camouflage were developed by plastic surgeons during the Second World War to cover the burns presented by the fighter pilots. Today, the field of application of camouflage is vast and one can take action to cover: posthumous signs of plastic surgery operations, both reconstructive (cleft lip, angiomas, tumours, etc.), and aesthetics (rhinoplasty, blepharoplasty, facelift, etc.), vascular lesions (flat angiomas, couperose, telangiectasia, etc.), skin discoloration (hypo- and hyper-traumatic or congenital pigmentation), dermatological lesions (vitiligo, acne, etc.), scars and tattoos.

Camouflage is taught to patients by health professionals and can be used both by women and by men.

This corrective make-up  results in an immediately positive response on an emotional, psychological and social level, since it considerably reduces the discomfort felt by the affected subject.

The main objectives of Camouflage are:

1. (temporarily) masking and cancelling out blemishes
2. creating a natural effect on the skin
3. guaranteeing to be long-lasting

With Camouflage, colour theory is at the base of masking imperfections: one works with opposite or complementary colours to cancel or reduce the chromatic effect to be cancelled out.  If dealing with a discolouration:

• Tending towards red (such as couperose), the concealer must be green• Tending towards blue (such as dark circles), the corrector needs to be orange• Tending towards violet (as in hematomas), the corrector will need to be yellow• Tending towards Brown (for sunspots, age spots, etc.), the corrector should be pale orange.

For the execution of camouflage make-up, one needs: a primer, a coloured camouflage cream, a corrector (neutraliser), a foundation and one fixing powder.

The cosmetics used must: 

1. have a high degree of coverage, with a concentration of pigments so as to neutralise the abnormal shades.
2. ensure they stay on the skin for at least 12-24 hours
3. be water-resistant
4. contain a UV filter

They must also be hypoallergenic and non-comedogenic, preferably without perfume and preservatives.

The application technique must be quick and easily reproducible so that it can be performed by the patient anywhere and whenever needed.

Carboxytherapy was founded in 1932 in France, in the Royat spa for the treatment of vascular diseases, in particular arteriopathies of the lower limbs, via the percutaneous administration of carbon dioxide through bathing.

Subsequently, the technique of gas administration was refined, introducing it subcutaneously through the use of dedicated equipment, able to deliver CO2 in a controlled manner with well-defined times and dosages.

Carbon dioxide is a colourless and odourless gas and causes vasodilation with increased blood flow velocity, allowing for greater oxygen availability to the peripheral tissues. The action of CO2 on adipose tissue is lipolytic (reduction of the volume of fat cells) linked to the enhancement of the Bhor effect, which increases the bioavailability of oxygen with consequent metabolic activation of the adipocyte. At a dermal level, CO2 results in the optimisation of fibroblast activity with a consequent increase in hyaluronic acid, collagen and elastic fibres that make the skin more toned, brighter and more compact.

The fields of use for carboxytherapy in the field of Aesthetic Medicine involve diseases with a genesis by way of microcirculation defect such as:

– Dermopanniculosis deformans, more commonly known as Cellulite.

-Venous-lymphatic insufficiency of the lower limbs.

Other diseases that can be treated with carboxytherapy are:

– Adiposity localised in the abdominal, trochanteric and hip regions

– Skin ageing of the face

– Stretch marks

Carboxytherapy sessions are carried out on a weekly basis for around 10 sessions, with gas delivery times of about 20 minutes. By introducing a 30 Gouge thin needle into the subcutaneous tissue connected to a certified device, a medical gas is delivered to the patient in a controlled manner. Treatment is free from serious complications such as pulmonary embolism or toxicity. The undesirable effects relate to the transient pain felt at the time of gas supply, the formation of any small haematomas where the needle enters, and the presence of slight subcutaneous cracking. The injection points do not have a well-defined site, but are inoculated in succession in such a way as to cover the whole affected area.

Cavitation is a physical phenomenon known and already exploited for years outside the medical field, which consists in lowering the local pressure inside a fluid, with the formation of vapour bubbles, which, subsequently, implode releasing energy.

How does medical cavitation take place?

By means of a machine, equipped with a special handpiece, low frequency ultrasounds are conveyed into the subcutaneous fat mass, with particular and appropriate characteristics, which induce thermal, mechanical and “cavitation” phenomena:

• the thermal effect increases micro-circulation and the volume of fat cells;
• the mechanical effect is achieved through micro-oscillations towards areas with lower pressure, and variations in the permeability of the fat cell membrane;
• the cavitation effect causes, finally, the formation of micro-bubbles inside the adipocytes, which upon imploding destroy the cell membrane and encourage the escape of fatty acids (triglycerides), which pass through the lymphatic pathways and reach the liver, which metabolises them like any alimentary fat.

As already mentioned, adipose cells destroyed by cavitation free fat waste, which the body will have to eliminate. To facilitate this process, and to minimise the impact on the metabolism, it is necessary to encourage the opening of the lymphatic stations and to perform a lymphatic drainage massage.

Cleansing is an act of cosmetic hygiene that is performed daily, indeed several times a day to remove so-called “dirt”, composed of exogenous and/or endogenous substances, from the surfaces of our body (skin, pseudomucose, mucous, hair).

The exogenous substances derive from environmental contamination, whilst the endogenous substances are represented by tissue debris and sebaceous secretions.

The so-called exogenous “dirt” settles on and in the hydrolipidic film and, therefore, cleansing must necessarily remove part of the hydrolipidic film, the first skin barrier necessary for the maintenance of protection, plasto-elastic properties and hydration of the skin.

Excessive and aggressive cleaning may damage the hydrolipidic film, exposing the skin to irritations, external substances and overinfections. It is therefore essential that the detergent respects the skin, whilst simultaneously removing dirt.

Ideal cleansing should allow the hydrolipidic film to be saved by removing it from the stratum corneum only in a small part.

There are two different methods of cleaning: the common detergents and the so-called affinity cleansing.

The latter is carried out by removing the fat of the skin with similar, lipophilic substances.

The choice of the various products for a proper cleansing is subordinated both to the type of skin problem being addressed and the anatomical area.

To date, cleaning products are available include:

– for the face (cleansing, tonic, exfoliating, cleansing cream, make-up remover wipes, traditional soap, etc.)

– for the eye contour (cleansing milk, specific product, specific make-up wipes)

– for the oral cavity (toothpaste and mouthwash)

– for the body (bath gel, shower gel, oily detergents, etc.)

– for intimate areas (specific detergent and traditional soap)

– for the hands (traditional soap)

– for hair and scalp (shampoo, oily detergents, etc.)

In addition to the subdivision of detergents for specific areas, it is possible to find detergents for specific skin conditions, such as the skin of newborns and children, those with senescent skin, sensitive or allergy-prone skin, skin with cutaneous changes.

In order for the act of cleansing to give the greatest benefit and to avoid negative effects as much as possible, it is advisable to choose the most suitable product at the suggestion of the trained aesthetic doctor, who thoroughly understands the physiological mechanisms that regulate the aesthetic qualities of the skin, followed by an accurate cutaneous check-up.

Cosmetologists are professionals who have successfully completed a Degree in Cosmetological Sciences and Technologies. They are professionals who have learnt the fundamental principles of chemistry and biology and the fundamental knowledge of pharmaceutical chemistry, pharmacology, physiology, biochemistry and pharmaceutical techniques for the correct and complete interpretation of the cosmetology sector.

Thanks to their deep and complete knowledge of cosmetic products, they assist the Aesthetic Medicine doctors with the most appropriate cosmetic prescription for the patient as part of a Aesthetic Medicine consultation following the skin assessment. 

Cosmetology

The term ‘cosmetics ‘ derives from the Greek words kósmos  (order, ornament) e kósmesis (adorning) and indicates, in its broadest sense, the treatments and techniques of a chemical, biochemical, physical or surgical nature aimed at caring for the body, with reference to the aesthetic standards of the current era.

Therefore, cosmetology is one of the most dynamic and innovative disciplines at the service of man that meets the needs of increasingly large sections of the population. Its mission is to help maintain and prolong a healthy appearance, thus facilitating the achievement of greater psycho-physical well-being.

In this regard, it is necessary to underline the significance that healthy skin has in the equilibrium of an individual.

Aesthetic Medicine, since its emergence in Italy more than 40 years ago, has focused on the preventive aspect of skin normalisation, keeping up with and indeed anticipating the process of renewal in which current medicine has been projected.

Its main task is dealing with prevention and therefore to provide the patient with a whole series of cosmetic rules as well as food, physical, psychological and behavioural hygiene for the achievement and maintenance of psycho-physical well-being.

Therefore, Aesthetic Medicine cannot disregard a competence towards healthy skin and its control. It does this by using two instruments of overlapping importance: skin assessment and the use of cosmetics.

The assessment of the skin is done through a check-up. The next step is to formulate a cosmetic programme aimed at skin hygiene (cleansing, hydration, sunscreen) or the normalisation of any alteration of the physiological parameters.

Thus, cosmetics are part of the products necessary for a full well-being of the person.

According to Italian law, cosmetics do not have and cannot boast therapeutic impact, but in reality many products are also equipped with pharmacological activity.

In light of this consideration and given the importance of the multidisciplinary collaboration between Aesthetic Medicine and Cosmetology, SIME considers the existence of a professional and complete training path for the preparation of the professional figure of the Cosmetologist to be fundamental. This is why, since the 1980s, SIME has collaborated scientifically with the three-year Degree Course in cosmetology sciences and technologies of the Catholic University of the Sacred Heart of Rome, established within the Faculty of Medicine and Surgery. This path aims to perfect the training of expert technical operators, who know how to interpret the multidisciplinarity approach of the cosmetology sector competently, becoming figures of reference also for the Aesthetic Medicine patient.

(According to the Bartoletti-Ramette method) 

Prevention and control of skin ageing, in particular that caused by exposure to the sun, is now an indispensable need in today’s society, which calls for psycho-physical well-being at any age. To maintain a nice appearance throughout the years, keeping the skin in the best condition possible, it is essential to understand and manage it correctly. To this end, the Società Italiana di Medicina Estetica (SIME – Italian Society of Aesthetic Medicine) uses a dermo-cosmetological dossier for skin check-ups, according to a protocol developed in the late-1970s by Bartoletti and Ramette.

The aesthetics of the skin depends on the normalisation of the main physiological parameters of the skin. To achieve this standardisation, a basic skin check-up is an excellent prerequisite for achieving an optimal evaluation and the correct choice of aesthetic medicine treatments, being essential for a correct cosmetic prescription.

The skin check-up is an essential procedure for understanding your own “Cutaneous Biotype” (for example, dry skin, oily or seborrheic skin, sensitive skin), to establish the degree of ageing of the skin under examination and to prevent or contrast it with what aesthetic medicine can offer, to formulate a cosmetic prescription suitable to normalise any alterations determined throughout the examination and to subsequently evaluate the effectiveness of the proposed treatments, with control measurements established by the doctor.

The skin check-up foresees an interview on the cosmetic habits and an objective examination of the skin in the cold light and under a Wood’s lamp, which will be followed by measurements of the parameters related to the cutaneous sebum (Sebometry), to skin hydration (Corneometry) and skin tests  for dermographism and sensitivity (lactic acid test according to Ramette).

When should a skin check-up be undertaken? 

An assessment of the state of the skin is useful at any age to formulate a targeted cosmetic treatment plan. The aim is to prevent the signs of ageing, especially those related to atmospheric agents. It would be preferable to do it at a young age, following puberty, in order to be informed as soon as possible about the skin type and its defences, along with putting in place a hygienic-preventive programme in a timely manner.  Another time in which a skin check-up can be very useful is around menopause, when the production of sebum decreases due to hormonal reasons (the same effect is produced by the assumption of estroprogestinic associations). This is the perfect time to review and modify the cosmetic programme. The examination should be performed every two years at a young age, before passing to an annual check-up as menopause approaches.

Preparation for the check-up

In the week that precedes the check-up, do not have a facial done by a beautician; do not expose the skin to the sun and/or tanning lamps.

In the 3 days prior to the check-up, do not shampoo your hair.

The evening prior , it is possible to take a shower or a bath. Cleanse your face with commonly-used cleaning products. Do not use night creams on the face and/or body.

On the morning of the check-up, do not take a shower or a bath; do not wash with water or cleanse your face and body; do not apply creams; do not wear make-up. Only lipstick, mascara, deodorants and cleaning of the intimate areas is permitted .

Cutaneous pH indicates the degree of acidity or alkalinity of the skin and has the function of counteracting the proliferation of pathogenic microorganisms: a weak acid pH favours the activity of the skin enzymes that ensure the survival of protective cutaneous microflora, essential for the defence of the skin on the body.

The pH value in healthy skin must have range from between 4.2 and 5.6 and is determined by the substances present in the hydrolipidic film, including the fatty acids that determine its acidity. This value varies according to the area of the body and is influenced by several factors that can be exogenous and endogenous.

Of the endogenous factors, the most important are:

• hydrolipidic film: the pH varies in each individual according to the hydrolysis of skin lipids in free fatty acids;
• sweating, and therefore mineral salts, lactic acid, urea and the ammonium dissolved in it;
• the loss of water due to perspiratio insensibilis;
• sebaceous secretion. The latter varies according to sex: men have a greater production of sebum than women, hence they have a more acidic pH. Furthermore, the cutaneous pH in women varies according to the phase of the menstrual cycle.

The pH also varies according to age – a child’s skin and that of the elderly has, in fact, a pH closer to neutrality.

Exogenous factors:

• Environmental climate
• Air pollution
• Nutrition
• Application of topical medications
• Certain pathologies
• Cosmetics and detergents used

The use of soaps at neutral pH, increasing the pH of the skin, can favour the development of pathogenic microorganisms and therefore fungal infections and bacteria.

To treat skin hyperchromia and prevent it from recurring, it is necessary to reduce the amount of melanin produced by the melanocytes. For this reason, besides shielding from UV rays and superficially exfoliating the skin, cosmetics containing depigmenting substances are used, being molecules able to inhibit the melanin synthesis process inside the melanocytes.

Amongst the substances with a depigmenting effect most commonly used in cosmetic products we find:

Arbutin: a  glycosylated hydroquinone that blocks the enzyme tyrosinase by binding to the active site in place of the DOPA (dihydroxyphenylalanine). Unlike hydroquinone, it is well tolerated by the skin. It is used in dosages ranging from 1% to 10%.

Kojic Acid: blocks the enzyme tyrosinase by binding (chelating) the copper ion, essential for the passage of the enzyme. It is used in dosages ranging from 1% to 3%.

Azelaic acid: acts as a competitive inhibitor of tyrosinase. The molecule has a good skin tolerability and is not photosensitising, therefore it can be advantageously used in the summer.

Vitamin C: its lightening action is mainly linked to the degradation of melanin due to its strong antioxidant power. It is used in concentrations between 5% and 10%.

Besides the synthetic substances, there are also different botanical extracts with depigmenting properties. Among these are kakyoku (Pyracantha fortuneana) belonging to the family of rosaceae, which acts as an inhibitor of tyrosinase.

The polyphenolic ellagic acid has been identified as a functional lightening substance in very different plants including liquorice, strawberry, eucalyptus and geranium.

Although since 1982 the word Cellulite has been scientifically defined and framed in the concepts of District Adiposity or PEFS, in current language it continues to be used to identify any imperfection of the lower part of the female body: a “little hole”, a “little bump”, a “little wrinkle”.

Let us try to clarify:

District Adiposity is a quantitative excess of healthy adipose organ accumulated in some areas of the body such as thighs, hips, lower part of the abdomen due to genetic, constitutional, hormonal and nutritional causes. It does not respond to the common slimming treatments or, in any case, much less than other areas of the body (face, breasts, etc.): the diet, therefore, amplifies the disharmony between the upper and lower parts of the body.

The Fibrosclerotic Edema Panniculopathy (PEFS) is a pathology in which there is initially a degeneration of the connective portion of the adipose organ even in the presence of normal quantities of the latter. Over time this suffering, due to poor venous and lymphatic circulation, directly involves the fat cells (adipocytes) that are found to be surrounded, first in small groups (micro-nodules) then in larger volume groups (micro-nodules), from the connective tissue being degenerated, losing the normal metabolic capacity.

PEFS requires medical treatment

Localised Adiposity and PEFS can coexist in some subjects with relative prevalence of one or the other form.

Filler, from English ‘to fill’, is an injectable substance that enters into the dermis or subcutaneous tissue for: 

• filling out lines and depressions typical of ageing
• correcting nasolabial furrows or folds
• giving shape and volume to the cheekbones, chin and forehead
• reshaping the lips or increasing the volume and correcting asymmetries                     

Filler injections are performed in the clinic; infiltration techniques sometimes require truncated anaesthesia or require the use of topical anaesthetics.

Injection of a filler generally does not involve any side effects and the patient can return to normal daily activities immediately afterwards. Sometimes, small hematomas can form that usually reabsorb in a few days and can be camouflaged with make-up.                   

Fillers can be classified according to their chemical composition in: absorbable fillers, semi-permanent fillers and permanent fillers.                                                               

The former are composed of biocompatible molecules and are completely reabsorbed after a certain period of time (e.g., hyaluronic acid, polylactic acid); they have a limited duration, generally of 3-4 months, even if there is an extreme variability of permanence of the filler in the dermis, differing from subject to subject and influenced by the degree of skin hydration, smoking, the consumption of alcohol, exposure to the sun, etc.

The semi-permanent fillers and the permanent ones, on the other hand, are not completely reabsorbed and remain permanently in the skin.

Filler injection is not dangerous, but is not without complications; moreover, since this is a medical act, fundamental rules must be respected. It is therefore important to contact a specialist doctor who works under the right conditions, choosing the type of product best suited to the imperfection that needs to be corrected.

Free Radicals are highly reactive chemicals due to the presence of one less electron in the outer orbits. The absent electron pushes the molecules, in search of chemical stability, to bind with other free radicals or with electrons of other nearby molecules, encouraging a chain reaction. Under normal conditions, the production of free radicals is balanced by the antioxidants present in the organism, but when these radicals are in excess, oxidative stress is created.

These molecules are the ones most responsible for skin ageing: by altering the amount of cellular energy they reduce the exchange between cell membranes and the extracellular environment, they destroy phosphates, sugars, enzymes, proteins present in them and even damage cellular DNA.

It is therefore necessary to prevent free radical damage with a healthy lifestyle that includes healthy eating, regular physical activity, the use of sunscreen and specific food supplements.

Glycolic acid is an alpha hydroxy acid, derived from the fermentation of sugar cane.

It is a versatile peeling, which in its highest percentages (50% and 70%) is absolutely for medical use only, since it is an acid that easily penetrates the dermis and only an experienced and trained professional knows when to block its action.

Its use is indicated for the treatment of skin ageing and for the control of seborrhea in acne, treatment that can therefore be very useful in controlling the formation of comedones encouraging the exfoliation of keratin caps responsible for the formation of pustules.

Also useful, in combination with other acids and other methods, for the treatment of skin hyperchromia.

Hyaluronic acid, a natural element of connective tissues in humans and many species of animals, is a fundamental component of the viscous matrix in which the elastic fibres and the collagen fibres of the skin dermis are immersed. It is a very large molecule, of a polysaccharide nature (that is, belonging to the same class as sugars) that act in the tissues as a scaffolding for even larger and more complex substances, proteoglycans. Amongst the most important functions of hyaluronic acid in the skin is to give volume, turgidity and tone due to its ability to bind large quantities of water molecules (equal to one hundred times its dry weight). Growing older, the amount of hyaluronic acid is reduced in terms of skin ageing and this contributes to the decay of the mechanical properties of the skin.

The superficial stratum corneum is coated with a microscopic hydro-lipid film consisting of a fine water-in-oil emulsion (W/O). The lipid phase consists of the sebum (with a high percentage of squalene and unsaturated fatty acids), of the lipids of epidermal origin (cholesterol and its esters), of the lipids of the apocrine sweat. The aqueous phase, rich in salts, comes from perspiration and perspiratio insensibilis.

The hydrolipidic film has an isolation function and tends to maintain the hydration of the stratum corneum. The water content of the epidermis decreases from the deep to the superficial layers (90% in the basal layer; about 8% in the corneum).

The hydration of the corneum is subordinated to the water content and humidity of the external environment.

Once produced, the hydrolipidic film forms an almost continuous layer on the skin, distributing itself across the skin surface, flowing into the furrows. However, distribution does not occur homogeneously due to the different concentration of the sweat and sebaceous glands.

In this way, more hydrolipidic film zones and fewer zones with reduced protection.

Given the importance of the hydrolipidic film in maintaining skin emolliency, the areas of the skin that are less enriched with this coating retain a smaller quantity of water, thus increasing the tendency to desquamation.

For a correct approach to the Aesthetic Medicine patient and an appropriate evaluation of the skin, it is necessary to have a perfect understanding of the anatomy and physiology of the skin organ, with particular reference to the balance between the factors of a lipid nature that ensure the correct structuring of the cutaneous barrier, including the superficial hydrolipidic film.

During the Aesthetic Medicine check-up, through the use of appropriate measuring equipment, the doctor will also evaluate the extent of the fat component of the hydrolipidic film in order to draw up the most suitable cosmetic prescription for the patient in question.

It is very important to pay attention to the treatment of the hydrolipidic film in everyday cosmetics.

In fact, as described prior, the hydrolipidic film is composed of the exogenous substances that are deposited on the skin and by organic substances that are degraded by the skin bacteria. It is then removed from the skin daily at the time of cleansing, as part of normal cleaning.

However, the hydrolipidic film is a shield against environmental factors and dehydration. Its excessive removal therefore risks depriving the skin of an important form of protection from external aggression.

It would be ideal to have removal undertaken in a means compatible with fatty substances that dissolve impurities without destroying the film.

International Nomenclature of Cosmetic Ingredients

Within the EU area, the ingredients of cosmetic products listed on the label must be cited with the common nomenclature provided by the INCI (International Nomenclature of Cosmetic Ingredients). The name INCI was developed in cooperation between the authorities and industry in the EU and the USA. It is currently used in other countries such as Russia, Brazil, Canada and South Africa.

In the list, the constituents preceded by the term “ingredients” are shown in descending order of concentration at the time of incorporation into the cosmetic. Whereby below 1%, the ingredients are listed in random order.

The INCI nomenclature contains mostly chemical terms in English.  The terms in Latin are used to indicate the ingredients in the official Pharmacopoeia (trivial name) and the names of the plant of origin for derivatives and plant extracts, followed by the type of derivative and the part of the plant used.

Dyes are indicated with the Colour Index (CI) number (such as CI 77891/Titanium Dioxide)

The odourant and aromatic compounds are indicated by the term “parfam” or “aroma“

The ingredients contained in the form of nano materials are clearly indicated in the list with the word “nano”, which follows the INCI name of the substance.

The INCI does not denote the effectiveness, functionality, nor the purity of a cosmetic ingredient.

Its primary purpose is for the consumer in any part of Europe and the world to be able to identify easily and in advance the possible presence of an ingredient to which he or she may be allergic, before its use.

Today, with a view to increasing consumer protection, two elements appear on the product packaging. The first is the so-called PAO (Period After Opening) represented by a number printed inside the container that indicates the number of months for optimal conservation of the product after opening. This is mandatory for products with a duration of less than 30 months.

The second innovative element for the labelling is represented by the obligation to report the wording of that  contained in the product followed by a list of the 26 substances identified by the SCCP (Scientific Committee on Consumer Products) as potential and more frequent allergens, whereby present in concentrations higher than 1%.

This procedure uses a pulsed light energy source (Intense Pulsed Light, IPL) which, unlike lasers, is not coherent, not collimated and is broad-spectrum – it is this last feature that justifies its wide use.

IPL can be used to treat:

• Photoepilation: through the process of selective photothermolysis (absorption by the hair’s melanin), the thermal destruction of the follicle is determined without damage to the surrounding tissues.
• Photorejuvenation: the pulsed light packages that meet the skin stimulate the fibroblasts in a non-invasive way, inducing the production of new collagen fibres.
• Skin marks: the thermal stimulus of pulsed light causes the destruction of the melanin in the deep layers of the epidermis.
• Teleangectasie, Couperose, Rosacea, Small angiomas: the increase in temperature of the vessel leads to capillary thrombosis and subsequent closure.
• Acne: the pulsed light blocks the process of altered keratinisation of the sebaceous gland.
• Stretch marks: the pulsed light reduces the thickness of the margins striae distensae.

The side effects of this procedure are limited to a slight itching and a transitory erythema in the treated area.

Side effects: treatments with pulsed light should be avoided if the areas are affected by eczema, excoriations, atopic dermatitis or viral infections (such as from herpes).  It is however preferable not to submit patients to this methodical if they are taking photosensitising drugs such as estrogen/progestin and antibiotics. Use during pregnancy is not recommended.

Laser resurfacing uses an intense light beam to treat certain skin blemishes. It is commonly used to treat wrinkles, acne scars, age spots, facial imperfections, stretch marks, scars, damage from photo-ageing, skin relaxation and hyper-pigmentation.

Ablative and non-ablative lasers

Lasers can be classified into two categories: ablative lasers and non-ablative lasers.

Ablative lasers are more invasive and act by removing the superficial epidermal layer. Immediately after treatment, and for a few days, the skin will appear reddened, slightly swollen and discreet exfoliation may be visible. The subsequent skin repair processes will then lead to the desired results being obtained.

Non-ablative lasers are less invasive, using the heat produced by the light source used to stimulate the dermal cells to produce neo-collagens, with consequent improvement of skin tone and elasticity.

Since non-ablative lasers do not act by removing the superficial skin layers, in the following days there will be a slight swelling, a slight reddening and the recovery times will be much shorter.

Fractional lasers

Fractional lasers represent a further classification of the two previous categories. The difference between fractional lasers and non-fractional lasers is represented by the different modality with which the beam of light is emitted which, in the case of fractional lasers, is fragmented into micro “columns” of light that cause vaporisation of very small skin areas, alternating with areas of healthy skin, from which the restorative processes start. As a result, treatments with fractional lasers tend to require shorter recovery times while still offering remarkable aesthetic results.

In general, any type of laser resurfacing transmits thermal energy to the collagen fibres of the dermis, encouraging it to contract and producing a lifting effect of the treated tissues.

Localised fat refers to the accumulation of adipose tissue in a given area of ​​the body. It can typically appear in women after puberty in the trochanters. It is a type of adiposity, in fact, which is heavily influenced by hormonal influence and genetic characteristics.

Typical of this type of fatty accumulation is the presence of excess fat cells (increased number of fat cells or “hyperplasia”) and for this reason localised adiposity responds better to treatments aimed at reducing the number of adipose cells (lipoclassic or liposuction treatments) and not particularly to hypocaloric diet therapy.

Manual lymphatic drainage was pioneered in the thirties thanks to the brilliant intuition of a Danish biologist, Emil Vodder.

His journey began in an institute of physical treatment in Cannes; this centre specialised in the treatment of chronic respiratory diseases of the respiratory tract (sinusitis, pharyngitis, rhinitis, etc.). Vodder noticed that some swollen and hard lymph nodes could be palpated in all patients. He sensed that with a gentle massage of these lymph nodes he could improve the health of these patients, which was widely confirmed in practice.

Emil Vodder was the first to standardise a precise technique. In fact, it is a method based on rigorous scientific principles which, due to its therapeutic efficacy, is indicated for the treatment of various diseases of the lymphatic system.
The technique is performed with emptying manoeuvres carried out with a pressure not higher than 30/40 mm Hg; this allows an acceleration of the lymphatic flow without making the vessels collapse.  

The manoeuvres are based on: 

– a rigidly programmed sequence of manipulation.                                                          

– a slow rhythm.                                            

– direction of the pressure that must respect the direction of evacuation –                                    

– emptying of the arrival stations to which the lymph is brought back.                                              

– sufficiently long application time  

– absolute prohibition of causing pain and cutaneous hyperemia                                                            

INDICATIONS:

Lymphoedema                                                          

Phlebedema                                                  

Post-traumatic edema                              

Post-surgery edema (vascular, plastic, orthopaedic surgery).                      

Phlebolymphatic ulcer.                                              

Fibrosclerotic Edema Panniculopathy (PEFS)                                                    

Lipedema.                                      

CONTRAINDICATIONS:                    

Heart and renal insufficiency.                                                    

Phlebitis.                                                          

Deep vein thrombosis (DVT)

Lymphatics and / or erysipelas                                

Systemic infectious processes                                                                      

A course of treatment provides a number of about 10 sessions and each session lasts about 1h. The cadence can be weekly as for example in the treatment of “cellulitis” (PEFS) or in the veno-lymphatic insufficiency; every two or three weeks in the treatment of the face (e.g. eyelid edema, after blepharoplasty, lifting, rhinoplasty etc.), or more intensive in the treatment of some lymphedemas such as in post-mastectomy lymphedema.

Endermology or LPG is a patented non-invasive technique of mechanically assisted massage, which combines the effects of passive and negative pressure on the cutaneous and subcutaneous connective tissue.

The method was developed in the seventies, by Louis Paul Guitay, from which the acronym LPG derives, in order to standardise physiotherapy on trauma scars and burns and make it more effective and faster, making the scars and burns softer and improving muscle function.

Soon, however, the operators found that treatment on patients affected by cellulite (PEFS – PannicolopatiaEdematoFibroSclerotica) and localised adiposity, improved the appearance of the area affected by dysmorphism and modified the distribution of subcutaneous adipose. As a result, the device was used and developed especially for aesthetic treatments.

Over the years numerous studies have been carried out to verify the modifications produced by the LPG on the tissues (epidermis, dermo-epidermal junction, dermis).

It has been demonstrated that with its two motorised rollers, which work together with the suction (vacuum effect), the treatment combines the advantages of a lymphatic drainage with those of massage therapy, creating, from a physiological point of view, various benefits:

– increase in the production and restructuring of the collagen fibres, due to the “stretching” effect, on the connective tissue;

– increase of the blood flow in the skin and in the subcutis, therefore greater cellular oxygenation, which improves skin elasticity;

– evident mobilisation of fluids with improvement of superficial and deep lymphatic circulation;

– positive stimulation of skin exfoliation, thus eliminating dead cells and revitalising the skin (face-body);

– stimulation of lipolysis, at various levels of the adipose tissue, and better redistribution of subcutaneous fat (body contouring)

– modification of hematic levels of estradiol, with interesting implications for women in menopause.

 THERAPEUTIC APPLICATIONS

– scars

– burns

– lymphatic and venous stasis

– cellulite (PEFS) and localised adiposity

– muscular contractures

– muscular hypotonia, after periods of illness, sedentary periods, pregnancies (with Endermogym program) – scleroderma (immune system disease that attacks tissues and causes thickening of the skin)

Endermology is also frequently used as an integrated treatment, in cases of plastic surgery and liposculpture.

In the preoperative phase it is useful to improve the vascularisation of tissues and drain excess fluids, in the postoperative phase it accelerates the healing and recovery process, speeding up the reabsorption of edema and bruising and contributing considerably to restoring firmness to tissues.

 PROTOCOLS

The protocols, the mechanical manoeuvres, the frequencies and the powers used for the treatment are chosen both according to the morphotype of the patients and the age, both for the specific pathology and for the sites to be treated. The sessions are performed one to three times a week, each lasting 35-40 minutes for a total of 14-20 sessions.

In order to consolidate the results obtained, in agreement with the patient, it is advisable to follow a maintenance program, inserting it into a healthy lifestyle and a correct diet.

CONTRAINDICATIONS

– Serious and evolutionary pathologies

– Phlebitis

– obvious varices

– diffuse telangiectasias

– pregnancy

 COMPLICATIONS

In general, treatment is well tolerated, but, since it is largely operator dependant, any mishaps, pain and bruising should be avoided by a correct clinical diagnosis and a serious and professional training of personnel using the machine.

The colour of the skin depends on the presence of cells called melanocytes that have an organelle in their cytoplasm, being melanosome, responsible for the synthesis and accumulation of melanin.

Melanocytes, which are found in the basal layer of the epidermis, transfer the pigment-rich melanosomes in other cells towards the skin surface. The pigmentation protects the skin from the aggression of the sun’s UV rays and the quantity of accumulated melanosomes determines the colouring of the skin.

The movement of melanosomes, which contain melanin, occurs through a very sophisticated system, governed by proteins that alter with ageing. Ultraviolet rays stimulate melanogenesis but, at the same time, interfere with intercellular communication. This causes the melanosomes to erroneously fall towards the basal cells that do not need protection, instead of moving in the direction of the suprabasal keratinocytes of the surface. The keratinocytes above the basal, if left without protection, stimulate the melanocytes to undergo further melanin production by triggering a loop that leads to the formation of melanin accumulations at depth, being skin spots.

Melasma is a hyper-pigmentation of the skin of the face that frequently affects the females.

The conditions that predispose the appearance of this imperfection are:

• pregnancy (chloasma gravidarum)
• taking the combined oral contraceptive pill
• replacement therapy during menopause
• taking certain medicines
• thyroid dysfunction
• stress

Melasma is accentuated by sun exposure and manifests itself in the form of tan-brown hyperchromasia, often overlapping, with irregular and not always symmetrical contours. The zygomatic areas, the preauricular regions, forehead, nose, chin and upper lip may be affected.

Histologically, melasma can be epidermal, with an increase of melanin in the basal layer, or dermal, with the presence of macrophages in the papillary layer of the dermis that engulf the melanin coming from the epidermal layer.

The differential diagnosis between the two histological types is done using a Wood’s lamp.

The pathogenesis of melasma is due to functional alterations of the melanocytes with consequent increase in the synthesis and transfer of melanin to the keratinocytes of the basal layer or to the macrophages of the dermis.

Stress promotes melasma through the hypersecretion of endogenous opioids, endorphins and enkephalins, capable of inducing overproduction of melanin by excitation of nerve endings in certain cutaneous areas.

In the treatment of melasma, it is necessary to suspend the intake of any drugs that may favour its appearance, limit sun exposure, constantly apply the sunscreen and use creams with depigmenting active ingredients and/or with tretinoin.

Outpatient treatment includes the use of chemical and laser peels.

Mesotherapy: this is a method that consists of intradermal injection of pharmacological substances near the site of the pathology. The advantages are greater local action and the use of a reduced amount of pharmaceuticals.

This is a technique that involves the use of a particular device, called an electro-stimulator, which stimulates muscle contraction through electrical impulses.

This technique was pioneered in the seventies in re-habitation and physiotherapy, but today it is also used in the field of aesthetics and sports.

Benefits

In rehabilitation and physiotherapy, electrostimulation is used to improve muscle tone and trophism to speed up recovery.

In aesthetic medicine it is used to lose weight, firm up and fight cellulite. In fact, muscle contraction encourages lipolysis (a process that allows the body to burn fat), tonicity and drainage of liquids.

In sports it is used by athletes to improve muscle tone. 

Contraindications

Like any treatment, electrostimulation can also be unsuitable in some particular cases:

– subjects with pacemakers

– tumours

– pregnancy

– epilepsy

– hypertension

– capillary fragility 

Sessions and duration

The treatment cycle includes a minimum of 10 sessions, lasting 45 minutes, twice a week.

Non-ablative radio frequency is a modern, safe, effective and painless method to counter numerous face and body imperfections.

The treatment consists of the use of particular medical instruments that carry electromagnetic waves on the skin surface, causing an increase in the temperature of the treated tissues.

The resulting endogenous heating is responsible for the beneficial effects of this aesthetic medical treatment.

Generally, ten weekly sessions are required to achieve the desired aesthetic improvements. Each single treatment lasts about 15-20 min. and allows an immediate resumption of the social life.

The indications for the face are:

sagging skin, seborrhoeic skin, acne and over filler

The indications for the body are:

skin relaxation, localised adiposity, cellulitis and strie rubre.

Obesity it is a chronic disease characterised by an excessive accumulation of body fat in relation to lean mass.

There are different methods to evaluate fat mass and its distribution:

– Anthropoplicometric Measurements: the plicometry, the circumference of the waist and the statural and ponderal index;

– Bioelectrical impedance analysis;

– Magnetic resonance;

– Dexa;

– Others.

The World Health Organisation defines obesity through the BMI (Body Mass Index), a datum that  is obtained by dividing the weight (expressed in Kg) by the square of the height (expressed in metres).

The weight classes indicated by the BMI are:

• <18.5 underweight
• 18.5 – 24.9 normal weight
• 25 – 29.9 overweight
• 30 – 34.9 Obesity I degree or mild
• 35 – 39.9 Obesity grade II or moderate
• = or> 40 Obesity grade III or severe

However, this calculation has some limitations that must be taken into account. Firstly, there is gender, given that with the same BMI, women tend to have more body fat than men. Age comes into account, hence it is not a usable parameter for growing individuals, and we must also take into account that older people have less muscle mass than younger people. People who do  a lot of sports have more developed muscle mass, therefore they weigh more.

BMI is an epidemiological index, with its increase being related to the rise in morbidity (risk of disease) and mortality, whilst health problems can also arise if the value is too low.

The word peeling comes from the English to peel. 

Chemical peeling is a medical procedure used to improve specific skin conditions by removing the superficial corneal layer.

The goal is to physiologically alter the appearance of the skin through the regeneration of a new epidermis. It is a very effective technique, quite easy to execute, in that removing the epidermal cells and encouraging their renewal can achieve the specific results in prevention and control, treating and alleviating some skin diseases or blemishes, such as fine wrinkles and skin spots. It also allows the skin to be prepared to receive topical treatments of different kinds that stimulate the metabolism of the dermis. 

Peeling is classified as superficial, medium and deep.

This classification is made based on the penetration level. The superficial peeling stops at the epidermis, while the medium involves the epidermis, papillary dermis and superficial reticular. Deep peeling reaches the medium reticular dermis.

For surface peeling, the most commonly used acids are Trichloroacetic acid (TCA) at 10-20-30%, alpha-hydroxy acids, (for example glycolic, lactic, mandelic acid) and beta-hydroxy acids (for example salicylic acid). It is performed by applying a solution containing one or more chemical agents (glycolic acid, silicilic acid, trichloroacetic acid – TCA) to the skin, using a cotton swab or glove. The duration of treatment is variable (usually a few minutes) and depends both on the characteristics of the patient’s skin and on the product used.

At the end of the procedure a soothing cream is applied. After treatment, the patient should not expose himself to sunlight and must apply photo-protection. The treatment cycle includes 3-4 sessions at intervals of about 15/20 days.

Post-recovery times are generally very rapid in superficial and medium peeling and easy for the patient to manage alone with home-based treatments recommended by the doctor.

Classes in which the different types of skin are divided according to various parameters – from the colour of the eyes and skin, to the predisposition to the appearance of erythema and the response to tanning.

The phototype identifies the type of skin response to solar radiation.

Phototype 

Thanks to the  dermocosmetic check-up,  according to Bartoletti and Ramette, it is possible to identify the skin biotype and phototype of the subject in question, in order to formulate a preventive programme generally and aimed at the treatment of the blemishes, which includes rules of life and food hygiene, physical, psychological, behavioural and cosmetological.

The phototype is determined by the quality and quantity of melanin present in the basal conditions of the skin, indicating the reactions of the skin to exposure to ultraviolet radiation and the type of tan that can be obtained.

The American Fitzpatrick and the French Cesarini have built two analogous scales on the basis of which it is possible to grade the constitutional characteristics of the reaction that every skin manifests to photo exposure. Today, we know that the skin’s sensitivity to sunlight is a function of the overall efficiency of a large number of protective factors, ranging from the ability to oppose the penetration of radiation, the prevention and/or neutralisation of the harmful effects of the same, through to the repair of genetic and epigenetic damage.

According to Fitzpatrick, the phototype is characterised by skin complexion, sensitivity to the sun, the colour of the eyes and hair, the number of freckles, the frequency of sunburn as a result of sun exposure, the type of tan and the time taken to achieve a tan.

Classification according to Fitzpatrick:

Type I – very light complexion, red or blonde hair, light eyes, lots of freckles, always burns and never tans

Type II – light complexion, red or blonde hair, generally light eyes, many freckles, burns easily and tans with difficulty (slightly golden tan)

Type III – intermediate characteristics amongst the two previous phototypes, presents some ephelides, can burn and tans on average 

Type IV – olive skin, brown or dark brown hair, burns rarely and tans easily

Type V – dark skin, black hair, does not burn, tans a lot

Type VI – very dark or black skin, intense tanning

Usually a certain colour of skin is accompanied by a certain colour of eyes and hair, but obviously this is not always the case. In the case whereby the colour of the skin and that of eyes and hair do not fit into a single category of the Fitzpatrick table, the most determining factor of the skin type is definitely skin complexion.

Knowing your phototype is the starting point for preserving the health of your skin and to behave correctly during exposure to ultraviolet radiation from sunlight.

The peeling, in the form of a liquid solution, is applied with a cotton swab over the entire face avoiding the most sensitive areas (eyes and lips).

With the application of acetylsalicylic acid, the patient will feel a slight burning sensation lasting a few minutes (3-4 minutes), in which time the alcohol component evaporates completely with consequent inactivation of the peeling.

The whole face will be covered with a white powder (due to the deposit of salicylic acid) which will then be removed with water, followed by a lenitive cream and a sun screen.

In the following days the patient will be advised to use a lenitive cream and a total protection sunscreen and not to be exposed to the sun; the skin may become red and sometimes a fine defoliation may take place which is resolved in a few days.

A therapeutic cycle includes 3 to 4 peelings every three weeks.

or striae distensae, being linear depressions often oriented perpendicularly to the cutaneous tension lines; the most frequent causes of onset are pregnancy, obesity, physical sports activity, medical therapy with corticosteroids, or excessive and sudden weight loss.

Stretch marks, resulting from a weakness in the elastic fibres of the skin, appear above all on the abdomen, thighs, breasts, hips, buttocks and arms.

 Initially, they are red-violet and are called striae rubrae. The red-violet colour is due to the cutaneous transparency that reveals the hyperemia caused by the inflammatory state. Subsequently, in the phase called cicatricial, the striae assume a pearly-white colour and are called striae albae.

The arrangement of striae varies according to the areas of the body: on the breasts, they are arranged in a radial pattern, vertical on the abdomen and oblique on the buttocks and inner thighs.

Semi-permanent make-up or tattooing consists of using sterile disposable needles to introduce CEE certified pigments into the intradermal zone.

The Tattoo can be of a reconstructive or purely aesthetic nature. The reconstructive tattoo consists of the reconstruction of the mammary areola following surgery or of covering existing scars.

The aesthetic tattoo consists of tattooing an eyebrow arch or asymmetric lips or in improving the shape of the eye through the eyelid rim. 

Semi-permanent make-up (TSP) consists of using sterile disposable needles to introduce CEE certified pigments into the intradermal zone and not into the DERMA. This is why in the classic Tattoo the pigments are trapped between the fibres and the tattoo becomes permanent, in the TSP the pigments will be inserted between the cells and the makeup will be lasting but not permanent. This is why, after about two years, retouching the colour is envisaged. When quality pigments are used the colour lightens but never turns red or purple-blue.

The Tattoo can be of a reconstructive or purely aesthetic nature. The reconstructive tattoo consists of the reconstruction of the mammary areola removed after surgery and the nipple (with 3D effect) or of covering scars, stretch marks or hypochromic areas also of traumatic origin which are pigmented with a very colour similar to the complexion, which is able to cover the imperfection present.

The aesthetic tattoo (but it could also be reconstructive) consists of tattooing the eyebrow arch (using techniques chosen according to the client’s requirements: scratched, tribal, orderly or irregular skin), asymmetric lips even using the exclusive technique of full lip, in improving the shape of the eye through the palpebral fissure and finally with the particular Tricopigmentation it is possible to cover the hairless areas of the scalp or beard.

The semi-permanent makeup session has a total duration of about 2 hours and is divided into 3 phases: 1) patient’s medical history and informed consent signature 2) planning where the work is to be carried out that, once approved by the patient, will be immediately tattooed with the relative colour choice.

The treatment is performed in two sessions about one month apart from each other.

Once the work is finished, a post-treatment soothing ointment will be applied with the instructions to be followed for a correct healing of the dermo-pigmentation.

The limits to the tattoo are determined by the patient’s allergies, to haemo-coagulative or cardiovascular diseases, to hepatitis, to diabetics and to scarring problems such as the formation of keloids. Furthermore, tattooing is not carried out when pregnant or breastfeeding.

Teleangectasia is a frequent problem in women.

The regions most often affected are the lower limbs, followed by the face.

The causes are manifold:

– Familiarity

– Hormonal imbalances

– Presence of cellulite

– Lifestyle (e.g.: sedentary lifestyle, type of working activity)

In fact, people who are on their feet for many hours or near a source of heat are particularly affected.

Good prevention rules:

Adopt a balanced diet, rich in vitamins, fibres, etc.

Perform physical activity (even just walking 20 min a day)

Avoid high heels and tight fitting clothing

Wear elastic stockings if spending a lot of time on the feet

Care of capillaries

An accurate diagnosis is an essential step. Once carried out, we move on to the actual treatment. Among the safest and most effective methodologies today are sclerotherapy and laser therapy.

Treating the capillaries using sclerotherapy

The technique used most often for the lower limbs consists of injecting specific substances that cause irritation and fibrosis of the vessel making it no longer visible. A number of treatments may be required.

Treating the capillaries using laser therapy

Capillaries can be treated with the use of laser light.

Both methods are performed on an outpatient basis. After the treatment we recommend the application of creams.

It will be up to the doctor to choose the most appropriate treatment for the individual patient.

For the treatment of diseases and disorders that have to do with hair loss, the first step is to undergo a trichological examination.

The trichological examination

 The trichological examination is aimed at the diagnosis of diseases of the hair and scalp and their treatment with medical therapies also supported by injected solutions and latest generation treatments.

The first part of the examination consists of the collection of detailed information, which means all the information on the patient and his or her family that may be useful from the trichological point of view, followed by a direct conversation with the patient about the various complications that accompany the problem (pruritus, tricodynia etc.), to understand its nature and history and to obtain an initial classification of the pathology. 

The next phase of the examination includes the local objective examination of the scalp and the instrumental examination in video-dermatoscopy using a high resolution micro-camera, a quick and non-invasive examination that allows the scalp’s health to be analysed in patients presenting problems of baldness, alopecia or of another nature. The examination allows various aspects of the hair to be evaluated: the diameter, the follicular density, the thickness of the fibre etc.

The examination concludes with a pharmacological prescription and if necessary further investigations are requested (blood analysis, specialist consultation etc.).

The control examination however is used to assess the patient’s clinical situation after the period of therapy prescribed by the doctor and to establish the next phase of treatment.

Different treatments can also be pursued:

Scalp bio-stimulation

Haircare is an injected solution of hyaluronic acid and vitamins specified in the treatment and attenuation of symptoms related to various problems of the scalp.
It is recommended in cases of dehydration and hair loss for any reason, brittle hair, presence of dandruff.
Treatment is recommended for both men and women.
After the treatment there are many visible results. The scalp is deeply hydrated and the dandruff is eliminated for a long time, the hair follicle is restructured and strengthened, slowing down the loss of hair, which thus regains softness, body and shine.

Carboxytherapy

This is a safe and non-toxic therapy, and consists of the subcutaneous administration of medical carbon dioxide, through local micro-injections using very thin needles.

The carbon dioxide is controlled directly by the equipment which used customised and standardised programs to supply the gas flow guaranteeing its purity and sterility.

Action on the scalp: the trophic action on the tissues of the scalp is reflected in the development of the skin appendages. 

It increases the rhythm and the quality of hair regrowth and at the same time the phenomena of apoptosis that lead to premature hair loss are partially inhibited. 
Also the physiology of the sebaceous glands shows a significant response in the normalisation of the quantity and quality of the sebum produced and in the resolution of seborrhoeic dermatitis and psoriasis.

PRP (Platelet-Rich Plasma) 

This is a source of growth factors that support the growth of various tissues. Numerous studies have shown that even at the level of the hair bulb there are stem cells equipped with receptors for growth factors. PRP is an excellent source of growth factors, so it was decided to use it to stimulate these stem cells.
It is obtained by concentrating the autologous platelets (i.e. of the patients themselves) and deriving from them the platelet growth factors (PDGF: Platelet Derived Growth Factors).

Evaluation of the patient’s platelet count is important before performing the treatment.

The most significant and visible imperfection of the face are wrinkles, a sign of the transition from youth to senescence, represented by those furrows on the skin.

If, from the clinical point of view, the wrinkle is the sign of ageing, from the histopathological point of view, it is a real lesion that is produced due to the overall effects of chronoageing and photoageing.

CHRONOAGEING is biological ageing, being that which depends on the passage of time, producing a series of involutional processes in all areas of the human body (therefore, also at the cutaneous level), resulting in that complex biological event that is ageing, which continues until the subject’s death. Throughout the course of life, therefore, there is a progressive reduction in the ability of the tissues to regenerate: the synthesis of DNA is reduced, the mechanisms of DNA repair become less efficient, there is a decrease in fibroblasts, the cells responsible for the synthesis of collagen, of elastic fibres and glucosaminoglycans (including hyaluronic acid).

Amongst the environmental factors responsible for skin ageing, the one with the greatest impact is exposure to sunlight (UVA and UVB but also visible and infrared radiation) that produces an authentic histological subversion at the level of the dermis (the deep layer of the skin) that is the basis of photoageing.

The damage from photo-exposure, when accumulated, make the texture of the skin, having been present since birth but not visible in the newborns, increasingly evident.

Other extrinsic factors contribute to skin ageing:

tobacco smoke, pollution, an unbalanced diet, stress, chronic diseases, incongruous cosmetic treatments that alter the barrier function of the skin, facial expressions (especially if exagerated).

Over the years, due to chronoageing and photoageing, the other lines that characterise the skin surface and those of the face in particular are also accentuated. As collagen and elastic tissue lose their functionality, they are no longer able to counteract the force of gravity. The subcutaneous adipose tissue loses its turgidity and the muscle mass relaxes. The disintegration of the elastic network then causes the folds of muscle-cutaneous laxity to be highlighted.

Wrinkles, therefore, as a result of a complex degenerative process, are not all the same.

There are several classifications of wrinkles. Amongst these, the Kligman classification distinguishes as:

– linear wrinkles, also called expression lines because they are the result of facial expressions (periocular, perilabial, transverse of the forehead).

– glyphic wrinkles, those that derive from the marked accentuation of the texture of the skin and give the appearance of a “wrinkled fabric” in the most advanced stages of life (for example, on the cheeks).

– creases, also called “sleep folds”, that are highlighted by the nocturnal posture and which, in the young, disappear quickly, tending to become permanent over time.

– Nose-labial lines that are not wrinkles as they are determined by the meeting of muscle masses with a different orientation but that, when the tissues lose functionality, are highlighted thanks to the force of gravity.

– Ripples, present on the surface of the arms, thighs and hips, due to the retraction of the elastic network and collagen