Modern possibilities of using contour plastics in aesthetic medicine

Contour plasty is of great interest to patients, as it allows for a significant correction of the appearance and at the same time does without deep surgical interventions. Currently, there are many effective methods and drugs for the correction of age-related skin changes, as well as the elimination of aesthetic defects after diseases and injuries. In aesthetic medicine, peeling and polishing, radio wave lifting, fractional thermolysis, laser rejuvenation, injection methods, plasma therapy and minor surgery are used.

Injectable non-permanent soft tissue contouring materials are well tolerated and can be safely used in virtually all patients who present for facial contouring.

The use of adipose tissue in facial contouring

The first injectable implant was autologous adipose tissue. Despite the fact that it has been used for contouring since the end of the 19th century, at present, the methods of its introduction have changed significantly, improved, and autologous adipose tissue transplantation has regained popularity. Adipose tissue completely replenishes the volume in any part of the face: it is used to correct nasolabial folds, marionette lines, hollows on the cheeks, as well as plastic correction of the lips. However, due to the high viscosity and volume of fat, it is not used to correct crow's feet and post-acne. This method does not cause allergic reactions, since the patient's own tissue is used for transplantation. Usually, autologous fat cells are injected gradually (over 4-8 treatments).

The introduction of own adipose tissue is indicated for severe signs of aging, usually at the age of 35 years and older. These procedures are performed under local anesthesia.

The advantage of injecting autologous fat cells into soft tissues is that patients look naturally rejuvenated, there is no effect of a stretched face, as after surgical plastic surgery.

The disadvantage of this method is that it is not always possible to gain the required amount of fat from the patient.
After these procedures, edema and bruising may develop for 2 weeks, aseptic fatty cysts, post-inflammatory pigmentation. More severe complications are also possible: abscess formation, cerebrovascular accident, blindness.

Contraindications for autologous fat grafting:

• pronounced photodamage of the skin (after microliposuction, skin roughness due to elastosis remains in the places where the fat was taken);
• lack of adipose tissue;
• severe diseases of internal organs;
• acute infectious diseases;
• blood clotting disorders.

Injectable collagen in contouring

Injectable collagen is widely used in aesthetic medicine for contouring various skin profile defects (wrinkles, folds), as well as for modeling lips, cheekbones, chin, and is especially effective in the treatment of hypotrophic and atrophic post-acne scars. Collagen injections can be considered as an etiopathogenetic therapy for age-related changes. The migration of fibroblasts into the zone of introduction of collagen implants and an increase in their synthetic activity have been proven. This is manifested by an increase in the amount of newly synthesized own collagen and glycosaminoglycans.

Different preparations of injectable collagen differ in its origin, nature of processing, percentage. One of the first collagen preparations was bovine collagen. Currently, preparations from the skin of calves are used. The composition of these drugs in 95% includes type 1 collagen. As a rule, these drugs are quite viscous, so they are recommended to be injected into the papillary dermis until the skin turns white. Some drugs are administered with hypercorrection, since they contain saline, which is subsequently absorbed. A high degree of purification, weak immunogenicity determines the safety of the use of bovine collagen preparations in aesthetic medicine. A feature of their use is the need to conduct skin allergy tests twice in order to avoid the development of an allergic reaction.

Recently, preparations based on homologous human collagen have begun to be used, the administration of which does not require skin testing. Such collagen is obtained by synthesizing a culture of fibroblasts.

Pig collagen is also used, which is obtained by synthesis from pig tendons, pig skin. When collagen is synthesized, the immunogenic telopeptide is removed from it. Pork collagen is closer to human, less immunogenic than bovine; development of allergic reactions to the drug was not observed. The cosmetic effect lasts from 3 to 6 months (sometimes even up to 12 months, depending on the injection site). These drugs are able to activate the blood coagulation system, and therefore, when they are used, bruising is not formed.

The use of collagen preparations for the correction of scars (post-acne, stretch marks, atrophic scars) is highly effective. First, it is necessary to “cut” the scar with a needle, and then inject the drug. The use of collagen preparation injections in the treatment of atrophic and normotrophic cosmetic scars has a number of undeniable advantages. With its intradermal administration, the correction zone is mechanically filled, fibroblast migration is enhanced, the synthesis of its own young collagen is triggered, and the structure and function of the connective tissue are restored. The therapeutic and cosmetic effect is noticeable after 3-6 sessions.

Stretch marks are corrected depending on the age of the pathological process. Treatment can begin when the striae are just forming and are reddish or purple in color. The following method of administering collagen preparations is used: 3-4 sessions 1 time in 2 weeks, then maintenance sessions 1 time in 1.5 months; total for the course - 8-10 procedures. If you have to deal with formed striae, then the same drugs are used, but more sessions are needed. The therapy procedure covers both the striae themselves and the area around them. The depth of drug injection is 4 mm. If the patient has striae, the width of which exceeds 5 mm, regardless of the duration of their existence, injections are carried out only along their contour for 3 sessions. Subsequently, the tactics of managing such patients does not differ from the tactics of correcting all striae. The preferred technique for administering the drug is tunneling, as it maximally stimulates the regenerative processes in the body in such a way that its own collagen fibers begin to be synthesized at the intervention site.

Hyaluronic acid in contour plastic

The use of injectable implants based on hyaluronic acid has become a real breakthrough in aesthetic medicine. It is obtained by biotechnological methods from chicken combs or bacteria.

Hyaluronic acid is a polysaccharide consisting of alternating residues of D-glucuronic acid and N-acetyl-D-glucosamine, found in connective tissue in the extracellular matrix, in the vitreous body of the eye, synovial fluid and other tissues. Its chemical structure is the same in all organisms, so hyaluronic acid is not immunogenic. The use of hyaluronic acid preparations does not require skin allergy tests.

In aesthetic medicine, polymeric derivatives of hyaluronic acid are used, which contain cross-links and have great stability. Such hyaluronic acid can bind a significant amount of water and perform the functions of hydrating the skin, ensuring its elasticity and firmness. Hyaluronic acid preparations are widely used to correct age-related changes in the face, static wrinkles, marionette lines, lip shape, oval modeling, and elimination of facial defects.

The action of hyaluronic acid lasts an average of 8 months, but in the nasolabial folds it can weaken after 6 months. Injectable materials are used to model the cheekbones, eyebrows and chin, correct nasolabial folds, marionette lines, lip wrinkles, post-acne scars, wrinkles in the glabella area, to fill the nasolabial and nasopharyngeal grooves. Various techniques are used: linear (tunnel), point injection, fan, “lattice” technique.

Contraindications for the administration of hyaluronic acid-based products:

• pregnancy and lactation;
• under 18 years of age;
• hypersensitivity to the components of the drug;
• autoimmune disorders;
• skin infection or swelling of the skin;
• predisposition to develop hypertrophic scars;
• taking anti-clotting drugs;
• implantation to increase the volume of the mammary glands, implantation in muscles, bones, tendons, blood vessels.

Conditions in which the introduction of drugs based on hyaluronic acid is not indicated:

• dynamic wrinkles;
• expressed facial wrinkles;
• deep scars, stretch marks and stretched postoperative scars;
• lip photodamage.

Side effects after administration of hyaluronic acid preparations: erythema, swelling, edema, bruising, itching and soreness at the injection site. However, more severe complications are possible: allergic reactions (including angioedema), the formation of granulomas; embolism of arteries and veins, necrosis at the injection site, varicose veins of the lips; bluish spots on the skin and red border of the lips; face lipoatrophy, reactivation of herpetic infection.

Injectable implants in facial contouring

Injectable implants with polymethyl methacrylate granules have been used in aesthetic medicine relatively recently. Granules of polymethyl methacrylate are stored in the skin and lead to the growth of connective tissue. The preparations consist of a suspension of polymethyl methacrylate microspheres in a collagen solution and a 0.3% lidocaine solution. After the injection, the collagen is absorbed, and the polymethyl methacrylate granules remain in the soft tissues, stimulate the synthesis of endogenous collagen and fibrosis.

The effect of these implants lasts for several years, they are widely used to correct deep wrinkles, including nasolabial folds and marionette lines.
2-3 injections are carried out over several weeks or months. The drugs are injected into the uppermost layers of the subcutaneous adipose tissue (not injected into thin skin, lips, intradermally, intramuscularly) gradually and without hypercorrection, the result is evaluated after 3 months. Before using the drug, it is necessary to carry out skin allergy tests twice (since bovine collagen is included in the composition).

The following complications are possible after the insertion of implants with PMMA granules:

• development of granulomas;
• formation of papules;
• appearance of uneven skin surface.

In order to avoid the development of the above complications, it is necessary to administer the drugs in parts, slowly, with a large interval between injections.

It is not recommended to use polymethyl methacrylate to correct the shape of the lips, as there is a high probability of unevenness of their surface.

Recently, an injectable material based on biosynthesized calcium hydroxyapatite has been developed, designed to increase the volume of soft tissues, stimulate regeneration and correct various cosmetic defects. Introduced into the tissue particles of the specified drug form a cell frame and activate the synthesis of its own collagen. Hydroxyapatite is the main inorganic component of bone tissue. In aesthetic medicine, biosynthesized calcium hydroxyapatite is used, which is identical to that which is part of human teeth and bones. The drug does not contain protein impurities, and therefore it is hypoallergenic and does not require prior tolerance testing.

The drug is used for non-surgical correction of the nose, chin augmentation, treatment of lipoatrophy in various areas (including the correction of HIV-associated facial lipoatrophy), correction of nasolabial folds, marionette lines, correction of the cheekbones and cheek area, as well as for restoration oval face.

The cosmetic effect is noticeable 6–8 weeks after administration and persists for 6–9 months. The drug is administered without hypercorrection, very accurately, since its base is replaced by cells. Hydroxyapatite is not recommended for use on the lips due to the potential for uneven surfaces.

A side effect of calcium hydroxyapatite administration is the formation of knots on the oral mucosa during the correction of radial wrinkles around the mouth. Often there are transient erythema, edema, small hemorrhages.

The use of silicone as an implant often leads to the formation of inflammatory nodes, granulomas, it is also possible to become infected, reject and extrude from tissues, drug migration and other reactions to silicone as a foreign body. The microdrop method of introducing silicone is promising, especially for extensive and deep skin defects. These drugs are used to correct nasolabial folds, marionette lines, post-acne scars, facial lipoatrophy in HIV infection

When using the technique of serial microdroplet injections, the drug is injected into the subcutaneous fat with an interval of 2–5 mm at an angle, without hypercorrection. The interval between injections is initially 1 month, and then 2-6 months.

Injectable implant based on carboxymethyl cellulose and polyethylene oxide is a high molecular weight polysaccharide similar in action to cross-linked hyaluronic acid. The drug is safe and effective when used to correct nasolabial folds. An injectable implant based on carboxymethyl cellulose and polyethylene oxide is more homogeneous than hyaluronic acid and does not cause skin irritation.

Possible side effects: redness, swelling, hemorrhage, induration at the injection site.
Injectable synthetic implants are also used to effectively correct facial soft tissue defects, especially in HIV-associated lipodystrophy. The cosmetic effect is noticeable immediately and lasts from 7 to 18 months. The introduction of drugs does not require skin allergy tests.

While these drugs have been proven to be effective and safe, the following side effects may include hard knots, pain, persistent redness, and tissue damage at the injection site.

Plasmotherapy in contouring

In recent years there has been a growing interest in natural injectable techniques, such as autologous fat transfer and a relatively new method of aesthetic medicine - plasma therapy. In aesthetic medicine, autologous platelet rich plasma (PRP - platelet rich plasma) has been used.

The method of its use for skin rejuvenation and correction of age-related changes - Autologous Cell Rejuvenation - has become a real breakthrough in rejuvenation medicine.

It is one of the most popular aesthetic procedures in leading clinics in Japan, Great Britain, Spain, other European countries, including Ukraine.

The procedure is convenient for both the patient and the doctor, is performed on an outpatient basis and takes less than an hour. To obtain PRP, about 15 ml of blood is taken from a patient's vein and placed in a centrifugation system, where red blood cells, white blood cells and excess plasma are separated. As a result, the concentration of platelets in plasma increases by 4–5 times compared to their number in the initial material taken from the patient. In addition, there are stem cells in the plasma, which subsequently, in the process of maturation, are transformed into the cells needed by the body, first of all, new vascular and skin cells.

Enriched plasma is injected intradermally into the face, neck, décolleté and hands. Millions of platelets delivered to the skin are activated and, having reacted with fibrin, build a “frame” in the skin of biologically active fibrin chains (this is the essential difference between bioactive plasma and synthetic gels - wrinkle fillers).

In addition, platelets help trigger growth factors and attract an additional number of stem cells from the depot to the area of ​​microtrauma. Growth factors in turn stimulate the production of new collagen. As for stem cells, some of them turn into fibroblasts, and some give life to new vessels and fat cells, giving the skin the necessary volume and turgor.

The "framework" formed in the skin is filled with new collagen fibers, intercellular matrix and newly formed small blood vessels over time. This process leads to the activation of local immunity, physiological revitalization and improvement of the skin structure - its natural rejuvenation. The use of platelet-rich plasma in adipose tissue transplantation accelerates the formation of blood vessels, promotes the active organization of the graft and its integration into surrounding tissues.

Skin rejuvenation using SmartPReP technology includes 2–3 sessions with an interval of 1.5–2 months. This technique can be combined with other cosmetic procedures. SmartPReP-therapy is recognized as an absolutely safe, effective, hypoallergenic method of aesthetic medicine.

Indications for plasma therapy:

• age-related changes in the skin - photoaging, fine mimic wrinkles;
• reduction of the elastic properties of the skin - skin tone, prevention of prolapse of the soft tissues of the face;
• stretch marks - due to changes in body volume, postpartum, after lactation (on the skin of the mammary glands);
• allergic reactions during traditional mesotherapy;
• acne;
• Auxiliary method after plastic surgery or after laser therapy.

Contraindications for plasma therapy:

• temperature response;
• exacerbation of chronic somatic pathology;
• herpetic infection in the acute stage;
• local inflammatory conditions;
• blood diseases.

Complications after the procedure: bruising, bruising, pain at the injection site.

Skin rejuvenation procedures with contour plastics are becoming more and more popular in aesthetic medicine. For their implementation, cosmetologists, dermatologists, and surgeons use a huge range of modern injectable implants, both biodegradable and partially resorbable. Most of the implants used are of high quality and safe to use. However, the abundance of fillers with different mechanisms and duration of action on soft tissues requires the doctor to know their composition and properties. The right choice of an injectable implant will minimize the risk of undesirable consequences, complications and achieve a good cosmetic effect.

According to kiai.com.ua

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