Professional skin care, especially with pronounced age-related changes, should be carried out by the joint efforts of specialists from different branches of aesthetic medicine, since at each stage of involutional changes, the patient's skin type, the degree of wrinkles or ptosis, and skin texture must be taken into account. The optimal tactics for the treatment of age-related skin changes should be developed jointly by a cosmetologist, dermatologist and plastic surgeon in order to obtain the best result of facial rejuvenation.
Algorithms for the joint work of a surgeon and a cosmetologist
(continued)
Vladimir Aleksandrovich Tsepkolenko
MD, Professor, General Director of the Institute of Plastic Surgery and Aesthetic Medicine "Virtus"
In the previous article we reviewed some of the most commonly used classifications of age-related skin changes. They allow you to choose the most optimal tactics of therapeutic measures, as well as strategies for the prevention of involutional skin changes, greatly facilitating the work of a practitioner.
For many years, one of the most commonly used in cosmetology was the classification of I.I. Kolgunenko. More than 40 years have passed since its creation, in connection with which this classification required more detail.
Based on the severity of wrinkles, ptosis, and changes in skin texture O.S. Panova in 2000 proposed a more practical classification of involutional changes in the skin of the face into classes (which we have fully quoted from the previous article). Each of the classes, in turn, is divided into 3 subclasses, reflecting the initial, medium and deep severity of involution-dystrophic changes in the skin in its class. Depending on this, further tactics of prevention and treatment are determined.
Choosing the tactics of therapeutic measures in accordance with the classification of facial wrinkles
|
Nature of change Class I |
Age |
Methods corrections |
|
A. Superficial mimic wrinkles |
18-25 |
Home care according to skin type |
|
B. Mimic and superficial static wrinkles |
25-30 |
|
|
S. Mimic and superficial static wrinkles, initial changes in skin texture |
25-35 |
|
|
Nature of change Class II |
Age |
Methods corrections |
|
A. Mimic and static wrinkles of moderate severity; initial skin texture changes |
30-35 |
Professional care according to skin type, supplemented with home care according to the recommendations of a cosmetologist. Professional care includes:
|
|
B. Deep mimic, static wrinkles of moderate severity against the background of changes in skin texture |
33-42 |
Cosmetological therapy for age-related changes: Regular visits to a cosmetologist. Cosmetic treatment includes: Hardware cosmetology
Surgery as indicated: eyelid surgery, endoscopic brow lift, endoscopic facelift
Pretreatment may minimize doses of botulinum toxin and fillers |
|
Nature of change Class III |
Age |
Methods corrections |
|
A. Deep mimic, static medium and deep wrinkles; pronounced changes in skin texture |
39-47 |
Cosmetological therapy of age-related changes. Regular visits to a cosmetologist. Cosmetic treatment includes: Hardware cosmetology
Pretreatment may minimize doses of botulinum toxin and fillers |
|
B. Deep mimic, static medium wrinkles, pronounced changes in skin texture, slight excess skin |
43-55 |
Surgery according to indications: eyelid surgery, endoscopic brow lift, endoscopic facelift or classic facelift in combination with laser resurfacing of the forehead and perioral area. Individual cosmetology program based on morphological skin typing |
|
C. Deep mimic, static deep wrinkles; significant excess skin, gross changes in skin texture |
47 and older |
All types of plastic surgeries on the face and neck to eliminate excess skin in combination with laser resurfacing of the entire face Individual cosmetology program based on morphological skin typing |
As you can see from the tables above, the only way to achieve optimal treatment results in the second and third grades is through the joint work of a cosmetologist and a plastic surgeon.
In an effort to individualize the treatment tactics as much as possible, I proposed a classification of skin types, taking into account the characteristics of somatic health. Based on the biochemical, endocrine and functional characteristics of the body, as well as the histological characteristics of the skin, it was 4 morphofunctional types of involution-dystrophic changes (IDI) of the skin were identified: hypoestrogenemia, hyperplastic, vascular and atopic. This made it possible to create a substantiated system of differential approaches to the correction of IDI of different types of skin.
The process of complex correction of various types of IDI skin takes place in three to four stages, each of which takes 2-3 weeks.
We will describe in detail about the complex correction of each type of IDI skin in the following materials
.
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