Fillers is a generic term to define an injectable product that fills a depression in the body. They can be divided into: permanent, semi-permanent and absorbable. Unlike the past, the last ones are nowadays the safest and most used. Inside the cathegory of the absorbable ones the most used are Hyaluronic acid, polylactic acid and autologous fat.
Hyaluronic acid is mainly used for wrinkles, face, cheeks and lower eyelid filling. Polylactic acid is mainly used for cheeks. Lipofilling is an innovative technique using autologous fat graft to augment a volume in the body. The great advantage is that fat tissue comes from the patient Him/Herself with no risks of foreign body reactions. This procedure combines liposuction, fat tissue processing and fat tissue transplantation to the body. The careful harvesting (gentle low vacuum liposuction technique) and processing (usually centrifuge) of the mature adipocyte tissue is topical. Autologous fat is then injected using blunt cannulas in small aliquots to the cheeks, buttocks, depressed scars or inside the vagina. This technique allows the transplanted fat tissue to remain viable, where it provides the previous anatomical structure and function.
The main disadvantage of the technique is the need of appropriate amount of fat tissue that is sometimes, in a very thin young female, difficult to be harvested. On the contrary, some patients can take advantage from liposuction at the same time of lipofilling. Second reported disadvantage is the partial resorption of the grafted fat (usually from 30-80%) so this procedure must be performed several times or there is the need for a primary hypercorrection. Moreover It’s not possible to inject a great amount of fat tissue due to the high risk of secondary necrosis and low rate of neo-vascularization.
It has been used since 15 years ago in many fields of medicine.
Botulinum toxin is a peptidase blocking the release of acetylcholine at the level of parasympathetic postganglionic synapses; all this results in a drastic reduction of the production of sweat and of the muscular tone of the small facial muscles that is the main factor leading to wrinkles. The Botulinum toxin injection is a fast and almost pain-free office-procedure performed with fine needles. Immediate recovery from activities of daily living is possible. In 3-7 days from the injection the result is visible and usually lasts 6-9 months, depending on many factors. Wrinkles in the forefront, in the glabella or around the eyes as well as the typical vertical bands in the neck are the best indications for Botulinum injection.
Side effects (headache, eyelid ptosis or local small hematomas) are rare and transient.
LASER AND CAPILLARY VESSELS
Capillary vessels are small unaesthetic structures bringing blood from the deeper to the more superficial anatomical regions. They appear as reddish or bluish spots or cords and can increase in volume depending on excessive body weight, pregnancy, exposure to hot temperatures or to the sun. The lack of sports activities or standing for a long period of time without walking are also risk factors. A US Doppler evaluation can reveal the presence of a deep venous thrombosis or other causes of capillary volume increase.
The use of late-generation and dedicated vascular lasers has represented a real revolution in aesthetic medicine, being able to make a selective resorption of capillary vessels with no damage of normal skin. With 3-4 sessions only, the best and long-lasting result can be obatained.
Hyperhidrosis is a particular condition appearing during childhood or adolescence characterized by increased sweat production compared to the amount useful to maintain adequate body temperature. Among the forms of localized hyperhidrosis it is worsened by stress-emotional and /or thermal stimuli.
It often causes embarrassment and not secondary difficulties while working with loss of self-esteem, and although it may involve all body surfaces, two of the most affected region are the axilla and the hand.
Over time, there have been proposed conservative treatments with really little or no benefits.
It has recently been suggested that botulinum toxin type A is an effective treatment. Botulinum toxin is a peptidase blocking the release of acetylcholine at the level of parasympathetic postganglionic synapses; all this results in a drastic reduction of the production of sweat.
The effect of botulinum toxin, in some particular points of the axilla and palms, is transient and lasts about 6 months, but it is a safe and easy solution with an improvement in quality of life and relationships. Other more invasive procedures (surgical deafferentation) represent a permanent solution but require a thoracoscopy under general anesthesia and the cut of a small nerve inside the chest wall.