Yana Aleksandrovna Yutskovskaya

Objective. To evaluate the long-term efficacy and safety of hyaluronic acid fillers using a comprehensive assessment of laboratory and ultrasound markers of the immune and inflammatory response, tissue integration and biodegradation of the material, as well as aesthetic improvements according to standardized scales. Material and methods. This 12-month single-center, prospective, non-comparative study included healthy female volunteers aged 25–55 years (n=20) with clinical indications for the nasolabial fold correction. Participants received injections of a hyaluronic acid filler (24 mg/mL) in a total volume of 1–2 mL. Efficacy and safety outcomes were evaluated at several time points using a number of methods, such as 3D facial scanning, ultrasound imaging, laboratory diagnostics, etc. Results. Ultrasound imaging after filler injection revealed an increase in the total soft tissue thickness and subcutaneous fat layer thickness, both of which gradually returned to baseline over the follow-up period as the filler progressively resorbed. No inflammatory or infiltrative changes were detected at any follow-up point. According to the GAIS scores, the most pronounced aesthetic improvement was noted both by physicians (4.0) and participants (3.9) immediately after the procedure, followed by a gradual reduction in effect over the follow-up period. At all timepoints (7 days, 1, 6, and 12 months), no clinically significant inflammatory changes or pathological immune responses were detected based on immunological parameter assessment. Conclusion. Injection of a hyaluronic acid filler into the nasolabial fold area showed high efficacy and safety, without significant changes in the immune and inflammatory status of the participants.

Background. Age-related skin changes are caused by complex interaction of exogenous and endogenous factors affecting all layers of the soft tissues. In this regard, combined aesthetic techniques aimed at correcting various signs of aging demonstrate greater efficacy than monotherapy. Objective. Development of consensus guidelines on optimal combination and sequence of calcium hydroxylapatite application (considering its morphological characteristics) in combination with hardware methods in aesthetic medicine. Material and methods. In order to develop consensus under the leadership of Ya.A. Yutskovskaya, 51 expert commentaries were collected. Consensus was considered to be reached when the provisions were approved by 85—94% of the participants, and it was considered that full consensus had been reached with the agreement of more than 95% of the experts. Results. For optimal correction of the age-related facial changes, it is important to start with the patient’s history taking and drawing up a personalized treatment plan. Correctly selected interval between procedures and compliance with the correction stages allow to minimize side effects and achieve pronounced results. It is important to perform most hardware techniques before the administration of calcium hydroxylapatite in cases of combined application of procedures within a single session. Conclusion. The expert consensus confirmed that a combined approach using calcium hydroxylapatite and hardware methods in a regulated sequence in compliance with recommended time intervals ensures safe and effective correction of age-related facial skin changes.

The purpose of this literature review is to provide relevant research results on the efficiency and validity of the platelet-rich plasma in various fields of medicine as well as to cover some unresolved issues and problems in this area. If one searches the keywords such as «platelet-rich plasma», «safety», «effects» in the Scopus and PubMed databases, 590 publications will be found over the past 5 years, most of which are in the field of orthopedics, gynecology and dermatology.Autologous plasma enriched with platelets is widely used today in various fields of medicine. The platelet-rich plasma is so widely used because it releases numerous chemokines, cytokines, and growth factors that stimulate angiogenesis, extracellular matrix remodeling, and cell differentiation and proliferation. Numerous studies have shown positive local effects of the platelet-rich plasma: earlier vascularization, epithelialization, remodeling and tissue regeneration. However, current studies on the clinical efficiency of the platelet-rich plasma are not conclusive and homogeneous. The heterogeneity of the platelet-rich plasma specimens (different preparation methods, various concentrations of platelets and growth factors, the influence of age, sex, concomitant pathology of the patient) complicates the interpretation of the existing literature and limits the ability to give definitive recommendations on the clinical efficiency of the platelet-rich plasma. Presently, there is no comprehensive standard algorithm for the platelet-rich plasma preparation as well as no definite criteria for establishing indications for this procedure. The following issues remain unresolved: finding an effective method to prepare the platelet-rich plasma, determining the optimal concentration of platelets and growth factors, having insufficient knowledge about all molecular mechanisms of the platelet-rich plasma to promote tissue regeneration and systemic reactions to the introduction of the platelet-rich plasma. Further research is required to address all the issues raised.

Today, the use of autologous platelet-rich plasma expands the horizons of its use in medicine. However, to uncover the key factors of plasma effectiveness, more data is required, describing in detail the method of plasma preparation, the amount of material introduced, as well as data on a comparative analysis of various methods of its administration. The purpose of this review was to search for data on the use of autologous plasma in the fields of Anti-Age medicine, plastic surgery and dermatology with a description of the methodology, as well as local and general effects. Publications of foreign and domestic authors in the Scopus and Pubmed databases were analyzed. When searching using the keywords: platelet rich plasma, safety, effects, dermatology, cosmetology, surgery, melasma, acne, 570 publications were found. Taking into account the depth of the search (the last 5 years), the language of publications (Russian, English), 32 full-text articles were included in the analysis. The presence of a large number of studies demonstrates the high interest of scientists from all over the world in studying the properties and effectiveness of plasma. Positive results of using plasma were presented in the field of plastic surgery, cosmetology, and dermatology. However, the lack of a detailed description of the methodology of the procedure, and moreover, a unified standard algorithm for the procedure and criteria for admission to receiving plasma, creates difficulty in comparability of results, both positive and negative. Therefore, additional larger studies are required to help answer these unresolved questions.

The purpose of this research was to assess the effectiveness of PRP injections into facial skin and to identify which of the studied blood parameters can affect the effectiveness of the procedure. The research involved 50 women aged 20 to 52 years who received intradermal PRP injections into facial skin. A general examination, complete blood count, and d-dimer, estradiol, and insulin in the blood serum were measured before the procedure, and assessment of the skin’s condition using a facial skin analyzer, assessment of midface volume changes using the Midface Volume Deficit Scale, assessment of aesthetic improvement by the doctor and the patient (Global Aesthetic Improvement Scale, GAIS) before and 1 month after the procedure were conducted for all the subjects involved in the research. According to the GAIS, both from the doctor’s and the patients’ perspectives, the majority noted some improvement in the skin condition after the procedure; however, according to the skin analyzer data, there were no statistically significant changes. A total of 56% of the patients displayed improvement in the midface volume, and this was observed in patients with a lower blood platelet count (≤259 × 10⁹/L) and a higher level of estradiol (>99 pg/mL) before the procedure. No undesirable effects were detected after the procedure.

Objective. To evaluate clinical effectiveness and patient satisfaction with diluted Radiesse injections and Light&Bright procedure in correction of chronological skin aging and photoaging of the face and décolleté. Material and methods. Pilot open prospective randomized clinical study with immunohistochemical analysis involved 42 healthy females aged 35—45 years with skin phototype Fitzpatrick type 1-2 and initial and middle stages of photoaging (Glogau type 1-2). Patients were divided into 3 groups (1:1:1): group 1 — four Light&Bright procedures with an interval between procedures of 1 month; group 2 — 4 procedures with an interval between procedures of 1 month and 2 injections of diluted calcium hydroxyapatite (CaHA) (Radiesse) with an interval of 3 months; group 3 — a single dose of diluted CaHA. The primary endpoint was patient satisfaction (GAIS score). Secondary endpoints included morphological assessment based on collagen type I, III and elastic fibers. Results. There were higher clinical effectiveness and patient satisfaction after diluted CaHA injections and Light&Bright procedure as evidenced by morphological analysis. Conclusion. Open-label prospective pilot randomized clinical trial confirmed higher clinical efficacy (lifting effect) and patient satisfaction following combined use of diluted CaHA injections, narrowband pulsed light technologies (Selective Waveband Technology — SWT) and Frax 1550 non-ablative fractional photothermolysis (Light&Bright procedure) in patients with signs of chronological skin aging and photoaging of the face and décolleté.

Skin has important barrier functions against a variety of exogenous factors and pathogenic microorganisms, as well as plays an important role in thermoregulation, metabolic processes and sensory perception. In addition, the aesthetic component of the skin is also important. Currently, people are increasingly concerned about age-related facial skin changes (wrinkles and pigmented spots appearance, sagging, dull and dry skin, uneven skin tone). There are many cosmetic and treatment procedures that help to improve the condition of aging skin. Nevertheless, their effectiveness is often assessed subjectively, namely how the patient and doctor are visually satisfied with the treatment results. Therefore, the issue of objective evaluation of these procedures’ effectiveness is relevant. We have considered non-invasive hardware methods of skin condition diagnosis (dermoscopy, skin elasticity measurement, mexametry, assessment of transepidermal water loss, confocal microscopy, sebumetry, spectroscopy), which are used not only for the primary diagnosis of skin condition, but also for the objective evaluation of cosmetic and treatment procedures’ effectiveness. Repeatability, efficiency and interpretability are critical aspects for the device to be considered valid and reliable.

The aging process of the face is multifactorial and occurs as a result of changes in all layers, soft tissues and the underlying skeleton, which occur at different rates in different people. Facial aging should be analyzed by thirds, because not all thirds age at the same time. Diagnostics of aging based on morphogeometric changes of the face, evaluated by thirds, can become a new approach that guarantees effective and long-term correction of age-related changes using minimally invasive strategies of aesthetic medicine. Correction of the lower third of the face is a complex interdisciplinary task that requires the interaction of doctors of different specialties: dermatologists, cosmetologists, orthodontists and plastic surgeons in order to develop an optimal diagnostic algorithm and correction protocol. In this article, the authors presented a paradigm for determining the aging of the lower third of the face, not from the standpoint of visualizing obvious changes, but from the standpoint of a comprehensive assessment in accordance with the proposed parameters, including recommendations of cosmetological, orthodontic and surgical treatment protocols. The development of an individual algorithm for working with a patient is based on a comprehensive assessment of the anthropometric and psychological characteristics of the patient, the morphotype of aging, the anatomical geometry of the face, bite, Ricketts line, incisor exposure, lip profile according to Korkhaus, the severity of the angle of the lower jaw and the cervical-chin angle, as well as on the use of the Merz Aesthetics scale and the Becker scale. The use of the proposed assessment tools can help the clinician choose the optimal treatment methods.

Botulinum neuroprotein injections are the leading among whole cosmetic procedures, they are on the first place by occurrence frequency of the whole non-surgical techniques for rejuvenation among both women and men. It was a break point in 2021 year because of patients under the age of 45, who became the main treated category in comparison with patients 50+. There is a hypothesis, that vaccination against SARS-CoV-2 negatively affects the duration of botulinum toxin effects: the average interval between injections of botulinum toxin type A was significantly shorter after vaccination than before it. It means that crossed immunostimulation by vaccine and preparation of botulinum toxin is possible. The prevention problem of age-related changes is made worse by the fact that Slavic and Asian phenotypes (46% of population) are the most common in the Russian Federation. The tendency to a facial edema, hypoplasia of deep and hypertrophy of superficial fat pads and gravity-induced ptosis are the aging features. Currently, the procedure of choice for young patients of Slavic and Asian morphotypes is botulinum toxin therapy in lifting techniques. For example, «Nefertiti-lift» is a minimally invasive, effective and acceptable alternative for patients, who are looking for a good way to delay the surgical intervention.