The author's master class by Professor Daniel Cassuto was held on the topic "Innovative approach to restore facial tissues and volume using PROFHILO and ALIAXIN preparations". Those present at the event, organized by the "Cosmetic Group" company, had the opportunity to get acquainted with the author's methods of Daniel Cassuto using preparations of the IBSA Farmaceutici brand.
After the master class, Professor Cassuto in an interview for estet-portal.com spoke about the peculiarities of working with Profhilo and Aliaxin preparations, the results and the possibilities of combining them with other products.
What are the main differences between the Aliaxin line and other HA-based fillers
DK: The main difference between Aliaxin and other HA-based fillers is excellent tissue integration. I don't know of any other drug that distributes and integrates better into tissues than Aliaxin. Maximum tissue integration ensures higher bioavailability of the molecules. This improves the regeneration effect of hyaluronic acid, in particular, the stimulation of the synthesis of new collagen and elastin.
Do you combine Profhilo with calcium hydroxyapatite
DK: Calcium Hydroxyapatite has proven itself with over 10 years of use as a reliable product that delivers natural results. However, mistakes made when injecting calcium hydroxyapatite are more difficult to correct than when working with hyaluronic acid. In fact, at the moment there is no way to quickly eliminate CaH in case of improper administration of the drug.
In this regard, Profhilo has the advantage of – with uneven administration, the drug is perfectly distributed and integrated into the tissues. Profhilo and calcium hydroxyapatite behave differently. And despite the lack of comparative studies, the data we have on Profhilo to date suggests that this product is a stronger stimulant than CaHa.
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DK: According to preliminary results, Profhilo activates both fibroblasts and adipocytes. At the same time SaNa – a good fibroblast activator, however, as far as I know, there are no data on the effect of this drug on adipocytes. Since Profhilo injections can stimulate a wider range of cells, this drug allows you to achieve excellent results without any combination.
That's why I don't use a combination of Prodhilo and SaNa in my practice. However, I combine Profhilo with other products based on hyaluronic acid, because one of the features of Profhilo is to improve the quality of the subcutaneous tissue.
In the case of increased fibrosis, age-related changes or lack of subcutaneous fat in patients, Profhilo allows you to restore this layer of tissue, which simplifies and increases the effectiveness of the introduction of fillers. Personally, I prefer to use this product with hyaluronic acid, but Profhilo can be combined with other high-quality absorbable fillers.
What is the maximum amount of the drug that can be injected into the neck
DK: Injection of Profhilo into the neck produces excellent results. However, to maintain their stability, it is necessary to repeat the procedure. This applies not only to volumes, but also to the quality of fabrics. Since tissue stimulation does not increase with an increase in the amount of the injected product, in this case it is not the amount of the drug that is more important, but its good and uniform integration.
That's why I usually inject 2 ml of Profhilo into each side of the neck in one session and then let it spread. It is simply amazing how evenly the drug is distributed in the tissues after a few hours or even the next morning after administration.
Then after 1.5-2 months I do repeated injections of the drug. I believe that such a scheme of work is more appropriate than the introduction of a large amount of the drug in one session. The same applies to injections of any hyaluronic acid into any area of the face.
Is it possible to inject Aliaxin into the lower jaw area and Profhilo – in the neck in one session
That's what I usually do. Aliaxin EV (for men and young women), Aliaxin GP and FL (for older patients) – a very good way to restore the lost volume in the lower jaw area. And the Profhilo preparation in the central and lower part of the face complements and harmonizes the result, and also creates a thin layer of subcutaneous fatty tissue, which is the basis for further procedures.
Do you think that photoaging and, as a result, elastosis complicates work in the neck
Photoaging causes more thinning of the skin than natural aging. Sun damage and elastosis thin the skin. In this case, the introduction of hyaluronic acid or any other filler becomes much more complicated, and therefore, as a rule, all that we can do – conduct biostimulation of facial tissues.
It is interesting that Profhilo simultaneously provides temporary volume, biostimulation of subcutaneous fat and improves skin condition without the need for direct injection of the drug into the skin.
Do you think cannula is better than bolus
Since 2010, I have been using the cannula technique for all subcutaneous injections, mainly for safety reasons. Patient safety – doctor's top priority. Of course, other factors such as pain are also taken into account, but safety always comes first.
Today, there is no doubt that the use of a 22-23 gauge blunt cannula, compared with a pointed needle, significantly reduces the risk of intravascular injection of the drug. There are many other reasons why large bore blunt cannulae are recommended: patient comfort, reduction in the number and frequency of bruising.
As you know, if you use a needle, bruising may occur a few days after the subcutaneous injection. The risk of bruising, pain and other side effects can be reduced by carefully and slowly injecting the drug using a blunt cannula.
Of course, the work of the doctor also plays an important role, since if the technique of working with cannulas is not followed, adverse effects characteristic of the introduction of drugs with a needle can occur. Because the cannula technique – it is, firstly, safety, and secondly, comfort. And, importantly, especially when injecting fillers that do not integrate perfectly into the tissues, the cannula technique, unlike the bolus technique, allows us to properly distribute the drug under the skin.
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