A.V. Saibel’

The article is devoted to a detailed study of the features of topographic anatomy of soft tissues of the upper face (forehead region, temporal region, orbital region) in the context of the application of hyaluronic acid-based fillers for aesthetic correction. The relevance of the work is due to the growing demand for minimally invasive procedures and the need to minimize the risks of severe complications such as vascular embolism and neurological disorders. Injection of fillers based on hyaluronic acid with lidocaine under ultrasonographic control with subsequent anatomical dissection was simulated during the study on 45 biological blocks of human origin, The method allowed to clarify the variability of the key neurovascular structures location in «dangerous» zones, visualize the distribution of filler in tissues according to their rheological properties and estimate the volume capacity of various anatomical spaces. Based on the obtained data, the safest and most efficient injection techniques (by 22G cannula in the subgaleal space of the forehead, supragaleal space of the temporal region, linear anterograde technique in the orbit region) and the selection of a filler with optimal visco-elastic characteristics. It is shown that the unique CPM technology and balanced rheological properties of hyaluronic acid-based fillers ensure their excellent integration into tissues, predictable distribution and high safety profile, which has been confirmed by both anatomical and clinical studies.

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.

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 quality is an important component of a person’s attractiveness. Several layers of tissues including deep layers of skin can affect skin quality. Therefore, multi-layer treatment strategy is preferable to improve skin parameters. Clinicians can determine and justify a long-term plan for aesthetic correction when working with any morphotype of facial aging using this paradigm. At the same time, individual correction algorithms should consider not only gender and age, but also ethnicity of patients. Anatomical features in representatives of different ethnic groups significantly affect aging process. Ethnic parameters and unique markers of aging made it possible to identify special facial phenotypes (Slavic and Slavic-Asian). Anatomical features of Slavic-Asian facial morphotype are contained at all levels of craniofacial structure, i.e. bones, distribution of subcutaneous fat, structure of ligaments and morphology of dermis. The anatomical premises presented in the article explain why Slavic-Asian patients tend to have tired and deformed aging morphotypes, and this is confirmed by survey of 29 expert dermatologists-cosmetologists. The revealed anatomical features determine their nuances when working with Slavic-Asian phenotype and explain high demand for ultra-superficial intradermal injections using the blanching technique with highly cohesive preparations Belotero Soft and Belotero Balance. The article also discusses the benefits of Belotero Soft and Belotero Balance in blanching technique with description of appropriate patients.

В статье представлен обзор особенностей мышц лица и шеи, являющихся мишенями для эстетической ботулинотерапии, детальный анализ анатомической вариабельности мышц в зависимости от пола и возраста, а также демонстрируются современные и актуальные техники инъекций incobotulinumtoxinA (Ксеомин), клинические примеры и результаты наблюдения за пациентами. Анатомическая часть работы проведена в МАСЦ РНИМУ им. Н.И. Пирогова путем диссекции 45 биоблоков человеческого происхождения (замороженный нетрансплантационный биологический материал) имеющий сертификат соответствия Американской Ассоциации Банка Тканей, а также сертификат происхождения торгово-промышленной палаты США.