PHITOGEN HOLDING | Beauty | Cosmetic Surgery

PEELINGS AND SKIN
1. What is chemical peeling?
2. What happens when an acidic substance comes into contact with the skin?
3. Why should a patient undergo one or more peelings?
4. What intensity of peeling?

BIO-REVITALIZATION
5. What is meant by cutaneous bio-revitalization?
6. What is hyaluronic acid?
7. With what mechanisms does hyaluronic acid help to stop cutaneous aging?
8. With what methods is cutaneous bio-revitalization carried out?
9. Are there contraindications?
10. How much does cutaneous bio-revitalization cost?

DERMAL FILLER
11. What is a filler and how many types of filler exist?
12. How long does the corrective effect last?
13. What results do fillers give?
14. How long will it be before the patient is able to take up normal daily activities after the treatment?
15. What is the treatment like?
16. How much does treatment cost?

1.
D: What is chemical peeling?
R: Chemical peeling is the exfoliation on a more or less superficial level of the skin due to the action of caustic substances. On the basis of the depth of the treatment we can distinguish four principle categories of peeling:
Very superficial peeling: this type of peeling only removes the superficial horny layer.
Superficial peeling: this type of peeling creates necrosis of a part or all of the epidermic layer and can arrive at the basal layer of the epidermis.
Medium depth peeling: this type of peeling creates necrosis of the epidermis and of part of the papillary derma.
Deep peeling: this type of peeling creates necrosis of the epidermis, of the papillary derma and can extend to the reticular derma.

2.
D: What happens when an acidic substance comes into contact with the skin?
R: When one or more acidic substances come into contact with the skin, two events take place: one immediate, one delayed.
The IMMEDIATE EFFECT consists in the structural alteration and consequent elimination of a part of the skin of a thickness which is determined by the strength of the acidic substances used (from the simple removal of the horny layer to the deeper flaking of the superior reticular derma).
The DELAYED EFFECT is represented by the stimulation, and hence the activation, of the macrophagic-fibroblastic system which will cause a renewing of the dermic matrix. This is principally due to the liberation of cytokines induced by the chemical inflammation.

3.
D: Why should a patient undergo one or more peelings?
R: On the basis of the action of the acids it is possible to improve or resolve many imperfections of the skin caused by aging ( thick skin, fine wrinkles, possible pigmentations, etc ) by active and cicatricial acne and by hyper-pigmentations.
The more or less complete removal of the epidermis will cause the renewal of the horny layer, the thickening of the granulous layer, the mitotic activation of keratinocytes and the removal of the pigmentary deposits present in excess.
The stimulation of fibroblasts will cause a greater production of the structural elements of the derma ( collagen, elastin, hyaluronic acid ) with a renewal of its architecture.
The skin will become brighter, more uniform, compact and elastic.

4.
D: What intensity of peeling?
R: On the basis of the action of the acids it is possible to improve or resolve many imperfections of the skin caused by aging ( thick skin, fine wrinkles, possible pigmentations, etc ) by active and cicatricial acne and by hyper-pigmentations.
The more or less complete removal of the epidermis will cause the renewal of the horny layer, the thickening of the granulous layer, the mitotic activation of keratinocytes and the removal of the pigmentary deposits present in excess.
The stimulation of fibroblasts will cause a greater production of the structural elements of the derma ( collagen, elastin, hyaluronic acid ) with a renewal of its architecture.
The skin will become brighter, more uniform, compact and elastic.

5.
D: What is meant by cutaneous bio-revitalization?
R: Cutaneous bio-revitalization consists in injecting natural bio-interactive hyaluronic acid into the level of the superficial derma. Very fine needles are used so there is very little or no sensation of pain. The acid is perfectly bio-compatible and totally re-absorbable and has the function of re-equilibrating the normal cutaneous physiology by thoroughly hydrating the skin and stimulating the migration and the proliferation of the cells of the derma, including the fibroblasts responsible for the production of collagen and elastic fibres and glucosaminoglycans, molecules which form the fundamental extra-cellular substance of the dermic tissue.

6.
D: What is hyaluronic acid?
R: Hyaluronic acid is a polysaccharide capable of binding great quantities of water: it is the molecule responsible for the hydration and cutaneous turgidity typical of young skin. Moreover, its presence is fundamental for the stabilization of the network of collagen and elastic fibres immersed in the intercellular substance, for metabolic exchanges, and for the processes of repair and remodelling of the cutaneous tissue.

7.
D: With what mechanisms does hyaluronic acid help to stop cutaneous aging?
R: A preparation of bio-synthetic hyaluronic acid is used for cutaneous bio-revitalization treatments. It is not chemically modified and is of a high concentration ( 40-70 times higher than the endogenous concentration ) so it is therefore capable of binding an enormous quantity of water. This product, as well as carrying out a restructuring and intensely hydrating action on the dermic intercellular substance, also has an effect of bio-interactivity on the fibroblasts: it stimulates them to produce collagen, elastin and further endogenous hyaluronic acid, at the same time protecting them from the harmful action of the free radicals which are continually formed, in particular during exposure to sunlight.

8.
D: With what methods is cutaneous bio-revitalization carried out?
R: There are two methods of cutaneous re-vitalization: the “Cross-linked” technique and the “Picotage” technique (serial puncture).
The former, used in the prevention and cure of cutaneous aging, consists in carrying out vertical and horizontal linear intra-dermal infiltrations which intersect each other to form a network of hyaluronic acid on large areas of the face (particularly useful for cheeks and the periocular regions). It involves an initial course of about 2-3 treatments only about 15 days apart and then maintenance sessions every two months.
The latter is useful for young people who want to prevent and block cutaneous aging caused by exposure to sunlight or tanning lamps and it represents the best technique for the treatment of the neckline and décolleté: numerous very superficial, practically painless micro-injections are carried out on the face, neck and décolleté, distanced one centimetre one from another: microponfi of hyaluronic acid are formed and in a short time the acid is uniformly distributed in the derma, binding water, and it is possible to clearly see a better degree of hydration and turgidity of the skin.

9.
D: Are there contraindications?
R: The substance is totally re-absorbable and does not lead to allergy problems. It can be combined with other treatments, like fillers based on reticulate hyaluronic acid, in order to prolong the corrective effect. The treatment does not generally leave marks and any rashes, caused by the micro-injections, are usually very slight and heal very quickly.

10.
D: How much does cutaneous bio-revitalization cost?
R: The cost of treatment generally varies from 100 to 200 euros.

11.
D: What is a filler and how many types of filler exist?
R: A filler is a material which is synthetic or of natural origin and which, when implanted or inoculated through a syringe, has the effect of filling . Fillers can be classified as re-absorbable, semi-permanent and permanent.
Re-absorbable fillers, of natural or bio-synthetic origin, are principally constituted of reticular hyaluronic acid or collagen. They are progressively and slowly metabolised by the subject, so it is necessary to repeat the treatment after 6-8 months. In particular fillers based on reticular hyaluronic acid are those mostly used today as their safety and reliability is upheld by considerable scientific literature.
Semi-permanent fillers are those constituted by a re-absorbable part like hyaluronic acid or collagen and a permanent part formed by materials like methacrylates or polyacrylamide. Today there is not enough data to be able to establish their total safety.
Permanent fillers are formed by materials which once injected or implanted are not degraded by the organism. Even if, for some of these products, the literature speaks of a fairly low incidence of complications (1-2 out of 1000), this is still possible. One of the most feared is the formation of granuloma of varying size, due to the local immune reaction. Moreover, the correction with permanent fillers is not reversible, so, in the case of treatment mistakes, it is extremely difficult to restore the initial condition.

12.
D: How long does the corrective effect last?
R: The corrective effect varies according to various factors like the type of product used, the age of the patient, the area of implantation. In the case of the use of hyaluronic acid its duration can vary from 4 to 10 months.

13.
D: What results do fillers give?
R: The results vary from person to person and depend on the initial condition of the skin. In some patients the filled wrinkles disappear completely, in others it is necessary to carry out future treatments. To prolong the corrective action of a filler it is possible to carry out bio-revitalizing treatments with bio-interactive hyaluronic acid.

14.
D: How long will it be before the patient is able to take up normal daily activities after the treatment?
R: It is becoming ever more possible to obtain evident results without causing traumas to the face. In some cases there can be local reddening or edema which disappear within a few hours; for this reason the most recent rejuvenation treatments are defined “lunch break treatments”: the patient is ready to go back to the office straight after the treatment.

15.
D: What is the treatment like?
R: Normally the treatment is carried out on the same day as the specialist appointment, for fillers which do not require allergy tests. According to the type of wrinkles to be treated ( position and depth ), the most suitable filler will be chosen; these vary in composition, density and permanence. Then, using a very thin needle, the doctor will begin to inoculate the product into the superficial or deep level of the derma, depending on the case. There is very little pain. The duration of the session varies according to the extent of the area to be treated, in average no more than 30 minutes. After the treatment the patient will be able to return to normal activities almost immediately.

16.
D: How much does treatment cost?
R: The cost of treatment with re-absorbable fillers varies on average between 250 and 500 euros, and depends on the type of filler and the doctor’s fees.