08, 2014!

Radical New Approach for Anti-aging Treatment:

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Biostimulation

Biostimulation with Polydioxanone Threads

FACIAL AGING, A consequence of the inexorable passage of time and the exposure of the skin to lesion causing agents, leaves the skin with visible stigmas of cell damage, like the loss of brightness, shine and smoothness, as well as tone, which favors the emergence of wrinkles and the drooping of tissue. The increasing proportion of women and men interested in skin rejuvenation has created an enormous demand for so-called anti-aging remedies to prevent and rejuvenate aged skin. Nowadays, we can prevent and fight the signs of aging by using the technique of coetaneous biostimulation. With the term biostimulation (or biorevitalization, bioregeneration,biorestructuring, or even facial mesotherapy, or finally “vitamins” or “micro-needling”) we mean a medical technique aimed at improving the quality of the skin.

The skin is an extremely complex organ, with a multiple, varied, cellular composition, that renews itself continually. The renewing cycle of the cutaneous tissues is about 28 to 30 days in young people, but as time goes by it becomes progressively slower, with the fundamental cells of the connective tissue, fibroblasts, losing their capacity to produce the essential substances of the skin, that is, hyaluronic acid, collagen, elastin and all the other molecules that make it up. Moreover, the skin is our organ of contact with the outside environment, and with solar radiation (the first cause of skin aging after one’s own age) together with any pollutant, it is, therefore, submitted to aging and degenerative processes also caused by external factors.

Biostimulation is the medical treatment which aims at increasing those substances into the skin that our organism is able to produce in sufficient quantities, such as hyaluronic acid, collagen and elastin. The decrease of hyaluronic acid in the dermis is one of the important causes of cutaneous aging, as this substance is largely responsible for its hydration, for the reproductive capacity of the fibroblasts and for the synthesis of the collagen. To increase these substances in the skin is to “nourish” the skin. However, the way by which they can be improved is by injections. These substances cannot be taken orally. In fact, if they are taken orally, they are digested and are no longer active in the required place. Administering active substances at the level of the cutaneous metabolism, intracutaneously or subcutaneously, can be compared to taking food supplements, and is capable of inducing rapid and efficient renewal of the skin organ. This type of treatment is usually inserted into a wider corrective program that also includes the use of suitable cosmetics, the use of chemical peels or laser, and the possible use of injectable fillers. Therefore, the treatment is indicated in the prevention of aging (both time- and photo-aging), but also as a complementary therapy in the case of surgical operation or other aesthetic-medical treatments. Biostimulation can be induced by injecting revitalizing active substances that interact synergistically, such as amino acids, vitamins A B C E, hyaluronic acid, co-enzymes, nucleic acids, polydeoxyribonucleotide; or it can be performed by using physical agents, such as lasers. Now there is a radically new approach to biostimulate the skin, especially developed to tighten the skin in a non-surgical way – the injection of resorbable polydioxanone thread. This procedure is officially approved by CE marking, and US FDA (Spring 2013).

What is Polydioxanone?

Polydioxanone is a synthetic absorbable monofilament. Chemically, polydioxanone is a polymer of multiple repeating ether-ester units. It is obtained by ring-opening polymerization of the monomer p-dioxanone, polydioxanone has been used for many years for biomedical applications, particularly in the preparation of surgical sutures. Other biomedical applications include orthopedics, plastic surgery, drug delivery, cardiovascular applications, and tissue engineering. It is non-antigenic and extremely soft and safe. It is degraded by hydrolysis and completely reabsorbed in six to eight months.

How Polydioxanone works?

Polydioxanone threads differ from the other biostimulators because they gradually induce a minimal foreign body reaction, in the place where they are injected and located. This granulation tissue forms a scaffold which supports the sagging tissue and tightens the skin. It acts as a medical face lift by improving fine lines, wrinkles, and nasolabial folds. It also improves skin’s vitality and elasticity. The treatment consists of embedding therapy needle with absorbable polydioxanone suture. It determines very little pain, swelling and injection mark. Patients can put on make-up just after the treatment. Suture dissolves naturally and harmlessly in the skin. The revitalization programs have rare contraindications and are useful for all types of skin and age groups. In fact, this is both a preventive and curative method and is therefore useful in both young people, as prevention against the first signs of aging, and for mature patients (excellent after menopause) in reducing and contrasting already aged skin. The treatment is composed of a series of micro injections, thanks to how polydioxanone threads are inserted into the skin of the area to be treated. In general, at least three sessions are needed depending on a protocol that varies according to the characteristics of the skin (phototype, age, lifestyle, oxidative stress, etc). Only in the case of skin pathologies it is best not to carry out the treatment. The procedure causes slight discomfort, which is normally well tolerated, and bruises are rare due to the injection technique, but still can be expected.

Biostimulation with polydioxanone is compatible with cutaneous filler infiltrations, used for the correction of wrinkles and with Botulinum toxin injections, obviously not done all at the same time in the same area. They can all be done in the same procedure’s section but in the different skin zones. The duration of the benefits from this method vary according to the initial situation and to the patient’s lifestyle (sun, smoking, etc), but generally it is necessary to repeat cycles of treatment in the course of time.

Indications:

• Skin tightening and lifting
• Improvement of fine wrinkles, nasolabial folds and sagging skin
• Biostimulation therapy and bio-restructuring of the dermal matrix
• Indicated to combat skin sagging and stopping signs of aging not only in the face but also of the neck, neckline, inner thigh, arms and abdomen.

Contraindications:

• Active skin infections on area to be treated
• Patients on chemotherapy or radiotherapy
• Coagulating disorders
• Allergic diathesis

Technique:

• A photo must be taken before the procedure
• Skin will be prepared by disinfecting the area.
• A topical anesthetic will be applied on the area.
• Anesthetic is left in place for 30 minutes to 1 hour.
• The topical anesthetic is removed with gauze and an alcohol.
• Injecting of needles on cheeks by one. Threads must be inserted intradermally or subdermally according to the thickness of the skin and to the treated areas. Very minimal bleeders can be present.
• After pulling needles out, the inserted suture stay into the skin.
• At the end of the procedure the area is disinfected again.
• No “down time” for injection.
• Usually, 30 minutes to 1 hour per session.
• One to three sessions usually needed

The effect is subtle immediately after the treatment. It then continuously improves month after month. The duration of the improvement is about eight to ten months and may last up to 3 years depending on the patient’s lifestyle and other external & internal factors.

The biostimulation with polydioxanone threads should not be confused with the suspension thread lift. The suspension thread lift is a minimally invasive surgical technique. With a suspension thread lift, sutures are placed under the skin, through an incision with a scalpel to lift the skin and the underlying muscle. It does not cause any biostimulation reaction. It is performed under local anesthesia with oral sedation. Recovery time is always needed, from a few days up to a week, depending on the extent of the procedure and on the number threads used. On the other hand, polydioxanone threads do not require any incision and they are located into the skin with pain injections. The result is not immediate because it requires skin to react. Fibroblasts are activated several days after the procedure so that tissue remodeling continues from several weeks up to nearly six months after the final treatment. There is no down time and patients can immediately return to their activities after the treatment. The treatment is not, however, affective in contrasting a sagging of a muscular-cutaneous type.

Depending on patient’s condition and request, it is possible to use different variety of threads. In fact, threads are of different length and size and, according to that, the size and length of needles change too.

Conclusion:

The biostimulation with polydioxanone threads is suitable for men and women. It does not require any type of preparation and, after its application, patients immediately return to their social life without any scars, marks or reddening. In fact, it is an ambulatory technique and does not require any scalpels and operating room. This treatment aims to prevent and treat skin aging by activating the patient’s own collagen production. The increased collagen fibers give a support to sagging skin determining a tightening effect. For these reasons, the result is subtle and not immediate but it takes several weeks to show up. Biostimulation with polydioxanone threads has an overall anti-aging effect on wrinkles. Threads are absorbable within six to eight months, and they are harmless (the thickness of a hair) and safe (non-toxic / non-pyrogenic / heavy metal-free).

References

1. Sulamanidze M. et al. – International Journal of Cosmetic Surgery and Aesthetics Dermatology 33:4, 275(2001): Facial Lifting with APTOS Threads.

2. Winkler E. Goldan O. et al. – Plastic and Reconstructive Surgery (2006) 118:6, 1468: Stensen Duct Rupture (Sialocele) and Other Complications of the Aptos Thread Technique.

3. Connell B.F. et al. – Guyuron B, ed. Plastic Surgery: Indications, Operations, and Outcomes. Vol 5. 2000: 2583-2607: Skin and SMAS flaps for facial rejuvenation.

4. Thorn C. et al. – Grabb and Smith’s Plastic Surgery, 1997: 633-649: Aesthetic surgery of the aging face.

5. Boland, Eugene D.; Coleman Branch D.; Barnes Catherine P.; Simpson David.; Wnek gary E.; Bowlin Gary L. (January 2005). “Electrospinning polydioxanone for biomedical applications”. Acta Biomaterialia (Elsevier) 1 (1): 115-123. doi: 10.1016/j.actbio.2004.09.003. PMID 16701785.

6. Middleton, J.; A. Tipton (March 1998). “Synthetic biodegradable polymers as medical devices”. Medical Plastics and Biomaterials Magazine. Retrieved 2007-02-12.

7. Tiberiu Nia (Mar 2001). “Concepts in biological analysis of resorbable materials in oro-maxillofacial surgery”. Rev. chir. Oro-maxilo-fac. implantol. (in (Romanian)) 2 (1): 33-38. ISSN 2069-3850. 23. Retrieved 2012-06-06.

8. Krutmann J. et al. – Photoaging in skin. In: Gilchrest BA, Krutmann J. editors. Skin Aging. New York: Springer-Verlag; 2006-33-43.

9. Garcia J. Victor Gimenez, Gonzalez Nicolas Albandea J.Antonio Tratamiento Del Envejecimiento Cutaneo Mediante Bioestimulacion Con Factores De Crecimiento Autogenos International Journal Of Cosmetic Medicine And Surgery volume 7 – Numero 2 - 2005

10. Requena L, Requena C, Christensen L, Zimmerman US, Kutzner H, Cerroni L. Adverse reactions to injectable soft tissue. J Am Acad Dermatol. 2011;64:1-34.

11. Morganti P, Chenm HD. Skin cell management: the NICE approach. Personal Care. 2011;4:29-36.

12. Morganti P, Duo Chen Hong. Skin cell management: more than a cosmetic approach. The Biomedical Scientist. 2011;55460-464.

13. Larnier C, Ortonne JP, Venot A et al. Evaluation of cutaneous photodamage using a photographic scale. Br J Dermatol. 1994; 130:167-173.

14. Di Pietro A, Fabrizi G, Giaroli U, Tiberi L, Bruno C, Morganti P. Role of hyaluronic acid and vitamin C in photoageing. J Appl Cosmetol. 1998; 16: 125-133.

15. Berardesca E, Distante F, Anthoine P, Rabbiosi G, Aubert L. Clinical and instrumental evaluation of the activity of an anti-wrinkle product on cutaneous relief and aged skin. J Appl Cosmetol. 1997; 15:69-75.

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