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Quest’anno Agorà, con l’obiettivo della ricerca di un costante miglioramento e progresso scientifico, ha voluto approfondire la bibliografia di riferimento per le tematiche delle Sessioni Coordinate e metterle disposizione dei partecipanti alla Sessione in Sede Congressuale.

In questa pagina troverete a disposizione gli abstract degli articoli che Agorà ha selezionato come bibliografia di riferimento per la sessione coordinata "COMBO-TREATMENTS IN BODY CARE: AESTHETIC MEDICINE AND SOFT SURGERY". I Soci Agorà avranno inoltre la possibilità di scaricare gli articoli originali in versione integrale.



Aesthetic Plastic Surgery

2021 October; 45(5):2317-2325

PMID: 33515083

A prospective study determining patient satisfaction with combined cryolipolysis and shockwave therapy treatment for noninvasive body contouring

Alain Michon

BACKGROUND: With an increased interest in nonsurgical and minimally invasive body fat reduction and body contouring procedures with limited side effects and downtime, cryolipolysis has emerged as a compelling and safe alternative to surgical fat removal methods. A massage of the treated areas generally follows cryolipolysis treatment to improve blood circulation and increase apoptotic fat cells' removal. In this study, following cryolipolysis, we used shockwave therapy instead of massage to enhance the results of the body contouring treatment and improve the patient's comfort. We then assessed patients' comfort and satisfaction using the combination of cryolipolysis and shockwave therapy in reducing fat volume.

METHODS: We conducted a prospective study of 30 patients who underwent at least one cryolipolysis therapy cycle followed by shockwave treatment. Subjects were given a posttreatment questionnaire to assess the patient's comfort and satisfaction degree with the combination of cryolipolysis and shockwave therapy for fat reduction. Answers were recorded on a five-point Likert-style scale, entered into a database and were analyzed.

RESULTS: We found an overall high satisfaction rate for most patients when treated with shockwave therapy after cryolipolysis treatment. The majority of patients described the discomfort associated with treatment as minimal or tolerable (76.7%) and were prepared to recommend cryolipolysis treatment followed by shockwave therapy to friends (68.9%). Overall, 76.7% of patients found the combination therapy comfortable, 68.3% were satisfied with the results, 57.7% said the results met their expectations.

CONCLUSION: The most important aspects of body contouring methods is a patient's safety, comfort, satisfaction and self-image improvement. In this study, we report a high level of patient satisfaction when using a combination of fat reduction procedures of cryolipolysis followed by shockwave therapy. The majority of cases report being satisfied or extremely satisfied with the treatment and found this body contouring combination method comfortable. Cryolipolysis combined with shockwave treatment appears to be a safe and efficient way of reducing the size of localized and stubborn fat deposits for subjects who desire nonsurgical localized fat reduction.

Journal of Oral and Maxillofacial Surgery

2020 May; 78(5):813-820

PMID: 31838095

Thread-lift sutures: anatomy, technique and review of current literature

Steven Halepas, Xun Joy Chen, Elie M. Ferneini

ABSTRACT: The use of thread-lift sutures as an alternative to traditional surgical rhytidectomy or neck lifting is becoming a more common practice among surgeons. The Silhouette InstaLift (Sinclair Pharma, London, UK) is marketed as a minimally invasive procedure that immediately lifts and tightens the skin while stimulating fibroblast activation and collagen production. The evidence in the literature to support thread-lift sutures for facial augmentation is limited, with many studies having various degrees of bias. Our intention is to educate the oral and maxillofacial surgeon on the thread-lift suture materials, techniques, and relevant facial anatomy, as well as review the current limited data available. Using thread-lift sutures for facial augmentation is a relatively low-risk procedure that surgeons familiar with facial anatomy can offer patients either as an alternative to or in conjunction with other facial esthetic procedures such as facial filler treatment, neuromodulator treatment, or surgical procedures.

Aesthetic Plastic Surgery

2015 April; 39(2):203-208

PMID: 25631787

Laser lipolysis using a 924 and 975 nm laser diode in the lower extremities

Elena Bravo Branas, Javier Moreno Moraga

ABSTRACT: Brachial ptosis is one of the consequences of massive weight loss. At an early stage, brachial ptosis can be corrected by liposuction, dermolipectomy and liposuction, or minibrachioplasty while the most advanced stage requires extended brachioplasty. Since brachioplasty was first described, various techniques have been proposed in the management of upper extremity contour deformities. Modifications to the original technique were mainly made to shape arm contour, to obtain good morphological reconstruction with attention directed toward improving and refining the resulting scar. We describe a modified approach to the "fish incision" technique defining a preoperative marking procedure that permits the reduction of overcorrection problems to reshape and improve the contour of the armpit with camouflage of scar sequelae. Our modifications to the original technique focus on incision placement along the medial bicipital groove and armpit, based on the the drawings of the tails following dynamic lines of the armpit contour established by the underlying muscles. We drew the tails slightly with a 60° angle between the tails and the width depending on patient's arm contour and on the excess of the skin in the armpit to be removed. The modified technique has obtained satisfactory results for patients and may be considered as a new surgical approach in the management of brachial ptosis.

Aesthetic Plastic Surgery

2012 June; 36(3):666-679

PMID: 22042359

Synergistic effects of cryolipolysis and shock waves for noninvasive body contouring

G. A. Ferraro, F. De Francesco, C. Cataldo, F. Rossano, G. Nicoletti, F. D'Andrea

BACKGROUND: Excess body fat, localized adiposity, and cellulite represent important social problems. To date, techniques using radiofrequencies, cavitation and noncavitation ultrasound, and carbon dioxide have been studied as treatments for noninvasive body contouring. Ice-Shock Lipolysis is a new noninvasive procedure for reducing subcutaneous fat volume and fibrous cellulite in areas that normally would be treated by liposuction. It uses a combination of acoustic waves and cryolipolysis. Shock waves, used normally in the treatment of renal calculi and musculoskeletal disorders, are focused on the collagen structure of cellulite-afflicted skin. When used on the skin and underlying fat, they cause a remodeling of the collagen fibers, improving the orange-peel appearance typical of the condition. Cryolipolysis, on the other hand, is a noninvasive method used for the localized destruction of subcutaneous adipocytes, with no effects on lipid or liver marker levels in the bloodstream. The combination of the two procedures causes the programmed death and slow resorption of destroyed adipocytes.

METHODS: In this study, 50 patients with localized fat and cellulite were treated with a selective protocol for the simultaneous use of two transducers: a Freezing Probe for localized fatty tissue and a Shock Probe for fibrous cellulite.

RESULTS: The procedure significantly reduced the circumference in the treated areas, significantly diminishing fat thickness. The mean reduction in fat thickness after treatments was 3.02 cm. Circumference was reduced by a mean of 4.45 cm. Weight was unchanged during the treatment, and no adverse effects were observed. Histologic and immunohistochemical analysis confirmed a gradual reduction of fat tissue by programmed cell death. Moreover, the reduction in fat thickness was accompanied by a significant improvement in microcirculation, and thus, the cellulite. The safety of the method also has been highlighted because it is accompanied by no significant increase in serum liver enzymes or serum lipids.

CONCLUSION: The study aimed to observe the effects of the new technique in the treatment of localized fat associated with cellulite in order to assess adipose tissue alterations, cellular apoptosis, and levels of serum lipid or liver markers. The findings show that the action of Ice-Shock Lipolysis is a safe, effective, and well-tolerated noninvasive procedure for body contouring. In particular, the authors believe that this could be an ideal alternative to liposuction for patients who require only small or moderate amounts of adipose tissue and cellulite removal or are not suitable candidates for surgical approaches to body contouring.

Dermatologic Surgery

2020 March; 46(3):386-394

PMID: 31188150

Poly-L-lactic acid for minimally invasive gluteal augmentation

Matthew J. Lin, Danielle P. Dubin, Hooman Khorasani

BACKGROUND: There is increased emphasis on the importance of the gluteal region in the perception of beauty. Biodegradable fillers provide a nonsurgical method of augmenting and rejuvenating this area.

OBJECTIVE: To review pertinent aspects of anatomy, patient evaluation, injection technique, and complications for gluteal augmentation using injectable biodegradable fillers.

METHODS: The authors review the literature for poly-L-lactic acid-based gluteal augmentation.

RESULTS: Like many aesthetic procedures, there is a paucity of literature on this emerging treatment modality (Level 4, Centre for Evidence-Based Medicine, Oxford). However, the collective clinical experience is that poly-L-lactic acid fillers are an effective treatment for patients seeking noninvasive gluteal enhancement with minimal downtime. Physicians must understand gluteal anatomy and avoid injecting deeply in the danger triangle to prevent intravascular injection into the gluteal vessels or injury to the sciatic nerve. Other safety elements include the use of blunt cannulas, reduced pressures, smaller volumes, and retrograde delivery.

CONCLUSION: Gluteal augmentation with fillers can safely and effectively improve gluteal firmness, shape, proportion, and projection. Practitioners injecting fillers in the gluteal region must be aware of appropriate patient selection, regional anatomy, and safe injection techniques. Given the increasing demand for this procedure, further high-quality studies are needed.

Aesthetic Plastic Surgery

2022 October; 46(5):2438-2449

PMID: 35648192

PMCID: PMC9159040

Body contouring using a combination of pulsed ultrasound and unipolar radiofrequency: a prospective pilot study

Fernando Urdiales-Gàlvez, Sandra Martin-Sànchez, Mònica Maìz-Jimènez, Esther Viruel-Ortega

OBJECTIVE: To assess the efficacy and safety of a new non-invasive body contouring device in patients with localized fat in abdomen or in abdomen and hips. Additionally, we also evaluated the patient satisfaction with the procedure.

METHODS: Prospective and non-randomized open label study. The patients underwent four sessions, separated by 1 week each, with the Alma PrimeX, a non-invasive body contouring device that combines pulsed non-focus ultrasound and a Unipolar radiofrequency. The primary end point was the mean change in fat tissue thickness, assessed by diagnostic ultrasound, from baseline to 3-months after the last treatment-session.

RESULTS: Fifteen subjects were evaluated. As compared to pre-treatment thickness, Hodges-Lehmann median difference (95% CI) was - 85.3 (- 107.5 to - 62.0) mm, p = 0.0001; - 70.3 (- 95.0 to - 48.5) mm, p = 0.0001; - 100.0 (- 140.5 to - 49.5) mm, p = 0.0039; and - 71.8 (- 132.5 to - 23.0) mm, p = 0.0078 in infraumbilical, supraumbilical, right hip, and left hip, respectively. Pretreatment fat volume was significantly reduced from 32.9% to 31.2%, p = 0.0006. The median (interquartile range) degree of patient satisfaction was 4.0 (1.0-5.0), with 13 (86.7%) patients being "Highly satisfied" or "Satisfied" with the treatment results. The most common adverse event was discomfort, followed by erythema. All the adverse events were mild and were successfully resolved without treatment.

CONCLUSIONS: Combine therapy of a Pulsed non-focus ultrasound and Unipolar radiofrequency using the non-invasive device Alma PrimeX was an effective and safe treatment for reducing fat tissue thickness in abdomen and hips in patients with localized fat. Patients' satisfaction with the procedure was high.

Aesthetic Plastic Surgery

2021 June; 45(3):1282-1293

PMID: 33474574

Striae distensae: in vitro study and assessment of combined treatment with sodium ascorbate and platelet-rich plasma on fibroblasts

Simone La Padula, Barbara Hersant, Chiara Pizza, Christophe Chesnè, Agnes Jamin, Ismail Ben Mosbah, Concetta Errico, Francesco D'Andrea, Umberto Rega, Paolo Persichetti, Jean Paul Meningaud

INTRODUCTION: Striae distensae (SD) appear clinically as parallel striae, lying perpendicular to the tension lines of the skin. SD evolve into two clinical phases, an initial inflammatory phase in which they are called "striae rubrae" (SR) and a chronic phase in which they are called striae albae (SA). Fibroblasts seem to play a key role in the pathogenesis of stretch marks. This study was aimed at describing and analyzing stretch marks-derived fibroblasts (SMF), the differences between SR- and SA-derived fibroblasts (SRF, SAF), testing two treatments in vitro (sodium ascorbate and PrP) on SAF.

MATERIAL AND METHODS: To characterize the SMF, the expression of alpha smooth muscle actin (alpha SMA) was investigated. Type I collagen expression was measured in SAF, before and after adding different PrP concentrations and sodium ascorbate in the culture medium. Results were processed through statistical analysis models using the Student's t-test.

RESULTS: A significant increase in alpha SMA (P <0.001) was observed in SRF. SAF treated with PrP and sodium ascorbate showed a resumption of their metabolic activity by an increase in collagen type I production and cell proliferation. After 24 h of incubation with PrP 1% and PrP 5% + sodium ascorbate, cell viability was increased by 140% and 151% and by 156 and 178% after 48 h, respectively, compared to the control.

CONCLUSION: Our study shows that a biologically mediated improvement in SMF metabolic activity is possible. Our promising results require further trials to be able to confirm the reproducibility of this combined treatment, particularly in vivo.

Dermatologic Surgery

2020 October; 46(1):S46-S53

PMID: 32976171

Poly-L-lactic acid for gluteal augmentation found to be safe and effective in retrospective clinical review of 60 patients

Kalpna K. Durairaj, Lara Devgan, Alexandria Lee Bs, Nooneh Khachatourian Bs, Vivian Nguyen Bs, Thomas Issa Bs, Omer Baker

BACKGROUND: Poly-L-lactic acid (PLLA) is a well-established biostimulator that induces neocollagenesis, allowing for volume loss correction. Although PLLA is FDA approved to treat mid-to-lower facial wrinkling, it has grown increasingly popular as a nonsurgical, minimally invasive procedure for soft-tissue volume augmentation of other extremities. However, research detailing PLLA buttock injections is still lacking.

OBJECTIVE: The purpose of this study is to determine the safety and efficacy of PLLA for buttock augmentation.

MATERIALS AND METHODS: A clinical retrospective review of 60 patients (ages 23-54 years) were followed for 2 years by 2 investigators. Patients underwent 1 to 3 treatments, spaced 4 to 6 weeks apart, and received 2 to 12 vials per session (based on the patient budget). Pretreatment and post-treatment photographs were assessed by the primary and secondary investigator in blinded and double-blinded surveys, respectively. The Global Aesthetic Improvement Scale was used to quantify improvements in volume, skin texture, and cellulite dimpling.

RESULTS: Poly-L-lactic acid allows for visible volume amplification, improved skin texture, and softened cellulite dimpling in the buttocks when at least 20 vials are used.

CONCLUSION: Poly-L-lactic acid is safe and effective for overall aesthetic enhancement of the buttocks if used in adequate quantity (minimum 20 vials) for all women, independent of age or the number of sessions.

Aesthetic Plastic Surgery

2021 January; 20(1):124-131

PMID: 32463169

Combined microwaves and fractional microablative CO2 laser treatment for postpartum abdominal laxity

Paolo Bonan, Alice Verdelli

BACKGROUND: Postpartum abdominal changes represent a major esthetic concern affecting women. As the abdomen stretches during pregnancy and some of the muscles lose tone, there is an increased skin laxity and a loss of abdominal elasticity. As a result, the abdomen becomes saggy.

AIMS: To evaluate the performance of a combined microwaves and fractional microablative CO2 laser treatment for reshaping and improvement of abdomen texture/laxity and striae distensae in postpartum women.

PATIENTS/METHODS: Fifteen women (median age 38 years) received three monthly abdomen treatments with a new microwaves platform, the ONDA Coolwaves® (DEKA) system, followed by a treatment with fractional microablative CO2 laser (SmartXide2; DEKA) a month thereafter. We followed up each patient's weight and nutritional habits. Outcome was assessed using reproducible circumference and abdominal measurements, digital and 3D photography, the laxity score as well as patient satisfaction index.

RESULTS: The overall mean circumferences reduction was 3.6 ± 1.2 cm. Significant improvement in skin laxity and tightening was noted by physicians and patients as well as a reduction of striae distensae. Interestingly, as a result of skin remodeling, repositioning of the umbilicus was also demonstrated. Treatments were well tolerated with no side effects.

CONCLUSIONS: Our data showed a sustainable reduction in circumference and improvement in appearance of abdomen in postpartum women, without compromising patients' safety.

Journal of Cosmetic and Laser Therapy

2014 April; 16(2):89-95

PMID: 24215421

The use of infrared radiation in the treatment of skin laxity

Marco Felici, Pietro Gentile, Barbara De Angelis, Livia Puccio, Aldo Puglisi, Aldo Felici, Pamela Delogu, Valerio Cervelli

BACKGROUND: Cosmetic surgery and medicine are extremely interesting fields for a plastic surgeon. Lasers and lights determine ablation, contraction and regenerating stimulus in skin tissues. The aim of this study is to examine the use of infrared lights in treating facial and body skin laxity.

METHODS: Between 2007 and 2011, in the Department of Plastic and Reconstructive Surgery at the Hospital San Camillo-Forlanini, 303 patients were enrolled in the study and underwent laser therapy. The laser operates in wavelength from 1100 to 1800 nm. The treated areas are: face, neck, eyebrows, abdomen, legs and buttocks.

RESULTS: We have noticed no systemic complications. A case of a patient with a three days lasting erythema on both lower eyelids caused by laser therapy healed without any pharmacological therapy. Neither hyper- nor hypopigmentation of the skin was found. The satisfaction degree of patients has been: facial, neck and eyebrow lifting "very satisfactory" for 70% of the patients, "satisfactory" for 10%, "unsatisfactory" for 20%; for the other areas it was "very satisfactory" for 40%, "satisfactory" for 20% and "unsatisfactory" for 40%.

CONCLUSION: The use of infrared radiation represents a valid alternative to surgical lifting, but cannot replace it. The infrared light technique used has turned out to be useful in contrasting skin laxity of the face and other parts of the body. The absence of scars and surgical risk makes this technique useable for a large number of patients.



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