Microplasma Treatment versus Negative Pressure Therapy for Promoting Wound Healing in Diabetic Mice.

The delayed healing response of diabetic wounds is a major challenge for treatment. Negative pressure wound therapy (NPWT) has been widely used to treat chronic wounds. However, it usually requires a long treatment time and results in directional growth of wound healing skin tissue. We investigated whether nonthermal microplasma (MP) treatment can promote the healing of skin wounds in diabetic mice. Splint excision wounds were created on diabetic mice, and various wound healing parameters were compared among MP treatment, NPWT, and control groups. Quantitative analysis of the re-epithelialization percentage by detecting Ki67 and DSG1 expression in the extending epidermal tongue (EET) of the wound area and the epidermal proliferation index (EPI) was subsequently performed. Both treatments promoted wound healing by enhancing wound closure kinetics and wound bed blood flow; this was confirmed through histological analysis and optical coherence tomography. Both treatments also increased Ki67 and DSG1 expression in the EET of the wound area and the EPI to enhance re-epithelialization. Increased Smad2/3/4 mRNA expression was observed in the epidermis layer of wounds, particularly after MP treatment. The results suggest that the Smad-dependent transforming growth factor ß signaling contributes to the enhancement of re-epithelialization after MP treatment with an appropriate exposure time. Overall, a short-term MP treatment (applied for 30 s twice a day) demonstrated comparable or better efficacy to conventional NPWT (applied for 4 h once a day) in promoting wound healing in diabetic mice. Thus, MP treatment exhibits promise for treating diabetic wounds clinically.

Tratamiento seriado con plasma rico en plaquetas en rejuvenecimiento facial. Cambios histopatológicos y clínicos / Serial treatment with platelet rich plasma in facial rejuvenation. Hystopathological and clinical changes

INTRODUCCIÓN Y OBJETIVO: El envejecimiento facial sigue siendo una causa frecuente de consulta en Cirugía Plástica y una de las inquietudes predominantes es cómo detener o revertir este fenómeno biológico sin que implique mayores sacrificios. El plasma rico en plaquetas (PRP), ha sido ampliamente utilizado en nuestra especialidad como coadyuvante de muchos procedimientos, para mejorar el contorno facial y como terapia antienvejecimiento, sin embargo, hace falta recopilar mayor evidencia histológica y clínica que soporte las bases de diseño de un tratamiento bioestimulador para la región facial. El objetivo del presente estudio es aplicar un tratamiento seriado con PRP para rejuvenecimiento facial y demostrar su efectividad a través de los cambios histopatológicos y clínicos. MATERIAL Y MÉTODO: Estudio prospectivo comparativo de tipo autocontrol entre febrero y octubre de 2017. La muestra estuvo representada por 14 pacientes con ritidosis, a quienes se le tomó biopsia de piel facial para describir las características histopatológicas previas; se realizaron 3 sesiones de PRP en 3 meses y nueva toma de biopsia a los 6 meses; posteriormente se llevó a cabo ritidectomía con una tercera toma de biopsia, y se establecieron comparaciones. Asimismo, se hizo registro fotográfico, evaluación clínica y test de apreciación personal para valorar los cambios ocurridos. RESULTADOS: Evidenciamos un incremento estadísticamente significativo de fibroblastos y colágeno a los 3 meses de tratamiento, con una media de 95.71 X mm2 y 75.71 X mm2 respectivamente; un aumento notable del espesor de la dermis con una media de 1.22 mm entre los 3 y los 6 meses; y un incremento significativo en el colágeno con valores medios del 69.28% antes del tratamiento en comparación con un 78.92% a los 6 meses. CONCLUSIONES: En base a nuestros resultados y metodología de aplicación, consideramos que la terapia de rejuvenecimiento facial con PRP es efectiva, tanto desde el punto de vista histopatológico como clínico

BACKGROUND AND OBJECTIVE: Facial aging remains a frequent cause for consultation in Plastic Surgery and one of the predominant concerns is how to stop or reverse this biological phenomenon without implying greater sacrifices. Platelet Rich Plasma (PRP) has been widely used in as an adjunct to many procedures, to improve facial contouring and as an anti-aging therapy, however, it is necessary to collect more histological and clinical evidence that supports the basis for designing of a biostimulator treatment in the facial region. Our objective is to apply a serial treatment with PRP for facial rejuvenation and demonstrate its effectiveness through histopathological and clinical changes. METHODS: A prospective comparative self-control study was carried out between February and October 2017. The sample was represented by 14 patients with ritidosis, who were taken skin biopsy of the facial region to describe the previous histopathological characteristics, then 3 monthly sessions of PRP and a new skin biopsy after 6 months; then, rhytidectomy was performed with a third biopsy, and thus establish comparisons. Likewise, a photographic registry, clinical evaluation plus a personal assessment test were carried out to show the changes. RESULTS: There was a statistically significant increase in the number of fibroblasts and collagen at 3 months of treatment with a mean of 95.71x mm2 and a mean of 75.7171x mm2 respectively; a significant increase in the thickness of the dermis was found with a average of 1.22 mm between 3 and 6 months and a significant increase in collagen with average values of 69.28% before treatment compared with 78.92% at 6 months. CONCLUSIONS: Based on our results and application methodology, we consider that facial rejuvenation therapy with PRP is effective both from a histopathological and clinical point of view

Helium Plasma Skin Regeneration: Evaluation of Skin Tissue Effects in a Porcine Model and Comparison to Nitrogen Plasma Skin Regeneration.

BACKGROUND AND OBJECTIVES: Helium plasma skin regeneration (PSR) is a novel skin rejuvenation technology with significant differences compared with nitrogen PSR technology but that may exert similar skin tissue effects. Study objectives included a comparison of acute and chronic skin tissue changes among the two plasmas in a porcine animal model. STUDY DESIGN/MATERIALS AND METHODS: In this study, both helium and nitrogen gas plasmas were used to treat the dorsal skin of Yorkshire cross mini pigs with 20% (8.6 J/cm2 ) and 40% (17.8 J/cm2 ) power helium plasma single pass treatment (4 liter gas flow, continuous energy delivery, and linear non-overlapping passes) compared with high energy nitrogen plasma double pass treatment (PSR3 @ 14.1 J/cm2 : 4.0 J, 2.5 Hz pulse rate, overlapping horizontal, and vertical passes). Acute and chronic skin contraction, maximum acute depth of injury and chronic reparative healing depth were assessed along with representative histopathology in each treatment paradigm. RESULTS: High-energy nitrogen plasma treatment exhibited greatest mean depth of acute tissue injury 4 hours post-treatment whereas helium plasma treatment exhibited greater acute skin tissue contraction. Then, 20% and 40% power helium plasma treatment results were each very similar among animals as a percentage of nitrogen plasma treatment results for both depths of acute tissue injury and acute skin tissue contraction. Mean depths of reparative tissue healing were similar among treatment paradigms 30 days after treatment with significant intra- and inter-animal variability observed within each treatment paradigm. Thirty-day mean skin tissue contraction was greater for helium plasma treatment; however, the data varied significantly between animals in all paradigms. Histopathologic tissue evaluation after 30 days showed similar findings among the treatment paradigms with epidermal hyperplasia, flattening of rete ridges and with regenerative granulation tissue expanding the superficial and papillary dermis. CONCLUSIONS: This study demonstrates modestly reduced depth of the thermal effect, greater skin tissue contraction and similarity of acute and chronic histopathological findings for helium plasma when compared with nitrogen plasma in a porcine animal model. © 2019 The Authors. Lasers in Surgery and Medicine published by Wiley Periodicals, Inc.

Renuvion/J-Plasma for Subdermal Skin Tightening Facial Contouring and Skin Rejuvenation of the Face and Neck.

The Renuvion/J-Plasma helium based plasma device from Apyx Medical has technological features that result in a unique and effective method of action for the contraction of subdermal soft tissue. The device achieves soft tissue contraction by instantly heating tissue to temperatures greater than 85°C for between 0.040 and 0.080 seconds. The tissue surrounding the treatment site remains at much cooler temperatures resulting in rapid cooling of the tissue through conductive heat transfer. Compared to bulk tissue heating devices, this method of action results in effective soft tissue contraction with a lower risk of injury to surrounding tissue.

Injeção de agregados plaquetários no rejuvenescimento facial: uma revisão sistemática / Injection of platelet aggregates in facial rejuvenation: a systematic review

Introdução: Essa revisão sistemática foi conduzida para avaliar se a associação da aplicação da injeção de agregados plaquetários quando comparada a outras terapias faciais favorece no rejuvenescimento facial em pacientes adultos. Métodos: A pesquisa buscou ensaios clínicos randomizados que compararam uso de técnicas de rejuvenescimento facial isoladas com as mesmas técnicas aliadas à injeção de agregados plaquetários. A busca foi realizada em bases de dados indexadas e literatura cinzenta. A ferramenta de risco de viés da "Cochrane Collaboration" foi aplicada para a avaliação da qualidade dos estudos. Resultados: Foram identificados 7137 artigos. Apenas quatro estudos permaneceram na síntese qualitativa, e os demais foram considerados com risco indefinido de viés nos domínios chaves. Conclusão: Existem poucos estudos na literatura que comparam o uso de agregados plaquetários em rejuvenescimento facial e os que estão disponíveis têm risco de viés "indefinido" ou "alto". Há necessidade de realizar mais estudos clínicos bem delineados que comparem o uso de injeção de agregados plaquetários associados ou não às técnicas de rejuvenescimento facial.

Introduction: This systematic review was conducted to assess whether the use of a platelet aggregate injection with or without associated facial rejuvenation techniques favors facial rejuvenation in adult patients. Methods: Randomized clinical trials that compared the use of techniques for facial rejuvenation alone with the same techniques coupled with the injection of platelet aggregates were searched. The search was performed in indexed databases and in the gray literature. The Cochrane Collaboration bias risk tool was applied to assess the quality of the studies. Results: In total, 7137 articles were identified. Only four studies remained in the qualitative synthesis, and the others were considered as having undefined bias risk in the key domains. Conclusion: There are few studies in the literature that compare the use of platelet aggregates in facial rejuvenation and those that are available have a risk of "undefined" or "high" bias. There is a need for more well-designed clinical studies comparing the use of platelet aggregate injection with or without associated facial rejuvenation techniques.

The effects of Antimicrobial Peptides and Hyaluronic Acid compound mask on wound healing after ablative fractional Carbon Dioxide laser resurfacing.

Background: Fractional carbon dioxide laser resurfacing (FxCR) is a routine treatment of Dermatology while many patients suffered the damage of skin barrier function after FxCR. Objective: To evaluate the benefits of antimicrobial peptides (AMPs) and hyaluronic acid (HA) compound mask on wound healing after FxCR on human and mouse skin. Methods: Twenty-four subjects were treated with FxCR on the bilateral cheeks. AMPs and HA compound mask was applied on the FxCR-treated area of left cheek. The erythema index (EI), melanin index (MI), transepidermal water loss (TEWL) of FxCR-treated areas on both cheeks were measured. By HE staining, immunohistostaing and western blotting, we analyzed epidermal thickness, FLG, IVL expression and protein levels of cramp in FxCR treated dorsal mice skin. Results: The EI, MI, and TEWL in the AMPs and HA compound mask-treated area of left cheek were significantly lower than those in the untreated area of right cheek. Topically application of AMPs and HA compound mask reduced thickening of mouse skin and also result in an increase in the production of FLG, IVL and cramp. Conclusion: Application of AMPs and HA compound mask is an effective method for enhancing wound healing after FxCR, by reducing transient adverse effects such as erythema, hyperpigmentation, and increased TEWL.

Application of plasma-combined regeneration technology in managing facial acne scars.

BACKGROUND AND OBJECTIVES: Plasma skin regeneration (PSR) and platelet-rich plasma（PRP） have gained popularity in the treatment of acne scars due to their efficacy and improved tolerability. The objective of this investigation was to evaluate the synergistic effect of PRP plus PSR (plasma-combined regeneration technology, PCRT) in managing facial acne scars. METHODS: From March 2015 to June 2017，a total of 25 cases with facial atrophic acne scars were treated with PCRT treatment for three to five times. Treatments were repeated at an interval of 8 weeks．Treatment parameters were titrated to an immediate end point of moderate erythema. The clinical end point for cessation of treatment was the attainment of satisfactory clinical results. Results were monitored photographically up to 6 months after treatment. The efficacy and adverse effects were evaluated by using the following outcome parameters： the duration of edema,erythema and crusting; the degree of hyperpigmentation, hypopigmentation and scarformation; subjective effective rate was evaluated by patients and physicians. RESULTS: 22 of 25 participants completed the study, and were followed up for 6-12 months. After three to five treatments, evaluation by patients showed that the total effective rate was 90.91%. Evaluation by two physicians showed that the total effective rate was 86.36%. Treatment was well tolerated by all participants. The total duration of side effects was 6.7 ± 1.7 days of edema, 8.1 ± 2.3 days of erythema,6.5 ± 1.8 days of crusting, respectively. No hyperpigmentation, depigmentation, and worsening of scarring were observed by the conclusion of the follow-up period． Conclusion: These results provide initial evidence for the safety and effectiveness of PCRT as a well-tolerated modality for the treatment of acne scars. PCRT is an ideal treatment for facial acne scars with minimal side effect．.

Cool Atmospheric Plasma (J-Plasma) and New Options for Facial Contouring and Skin Rejuvenation of the Heavy Face and Neck.

Treating patients with heavy or thick features comes with challenges not present in those patients lacking these physical characteristics. The authors report our experience with cool atmospheric plasma for facial contouring and skin rejuvenation of the heavy face and neck including rhinophyma. Cool atmospheric plasma is generated by running helium gas over radiofrequency energy. The resulting plasma is a fourth state of matter and has enhanced clinical effects for ablation and thinning of skin and soft tissues as well of contouring and tightening of deeper soft tissues and fascia. Cool helium plasma has been a very effective tool for skin rejuvenation and skin tightening as well as using it as a tool for nonexcisional microinvasive face and neck rejuvenation. Future research may indicate that it can help treat primary or recurrent superficial cutaneous malignancies.

Randomized, Split-Face/Décolleté Comparative Trial of Procedure Enhancement System for Fractional non-Ablative Laser Resurfacing Treatment.

INTRODUCTION: A topical proprietary procedural enhancement system (PES) containing a combination of active ingredients including a tripeptide and hexapeptide (TriHex Technology™, Alastin Procedure Enhancement Invasive System, ALASTIN Skincare™, Inc., Carlsbad, CA) has been used successfully to aid in healing and improve symptomatology following resurfacing procedures.

METHODS: PES (Gentle Cleanser, Regenerating Skin Nectar with TriHex Technology™, Ultra Nourishing Moisturizer with TriHex Technology™, Soothe + Protect Recovery Balm, Broad Spectrum 30+ Sunscreen) was compared to a basic regimen (Aquaphor™, Cerave™ cleanser, Vanicream™, Alastin Broad Spectrum 30+ Sunscreen) in a split face/ décolleté trial following fractional non-ablative thulium-doped resurfacing treatment to the face or décolleté. The skin was pre-conditioned and treated during and after the procedure using the two regimens.

RESULTS: A blinded investigator rated the PES statistically superior to the basic regimen on healing post-laser treatment on day 4 based on lentigines, texture, and Global Skin Quality. Subjects also reported 'better looking and feeling' skin on the PES side.

CONCLUSION: PES appears to improve healing post-non ablative thulium-doped resurfacing treatment to the face/décolleté in comparison with standard of care.

J Drugs Dermatol. 2017;16(7):707-710.

Fractional CO2 Laser: From Skin Rejuvenation to Vulvo-Vaginal Reshaping.

BACKGROUND: The CO2 laser has become the gold standard treatment in dermatologic surgery for the treatment of a large number of skin and mucosal lesions. The introduction of the fractional micro-ablative technology represented an integration to the ablative resurfacing technique, reducing the healing time and the side effects. OBJECTIVE: Vaginal rejuvenation performed with this technique is a minimally invasive procedure that stimulates internal tissues of the female lower genital tract to regenerate the mucosa, improving tissue trophism and restoring the correct functionality. METHODS: In our experience, 386 menopausal women affected with vulvo-vaginal atrophy (VVA) were treated with three section of fractional micro-ablative CO2 laser. RESULTS: After three treatments, patients reported a complete improvement of the symptoms (59.94% dryness, 56.26% burn, sensation, 48.75% dyspareunia, 56.37% itch, 73.15% soreness, and 48.79% vaginal introitus pain). CONCLUSIONS: Fractional micro-ablative CO2 laser seems to reduce symptoms related to vaginal atrophy. The beneficial effects were reported just after the first session and confirmed 12 months after the last session.

Haptotatic Plasma Polymerized Surfaces for Rapid Tissue Regeneration and Wound Healing.

Skin has a remarkable capacity for regeneration; however, with an ever aging population, there is a growing burden to the healthcare system from chronic wounds. Novel therapies are required to address the problems associated with nonhealing chronic wounds. Novel wound dressings that can encourage increased reepithelialization could help to reduce the burden of chronic wounds. A suite of chemically defined surfaces have been produced using plasma polymerization, and the ability of these surfaces to support the growth of primary human skin cells has been assessed. Additionally, the ability of these surfaces to modulate cell migration and morphology has also been investigated. Keratinocytes and endothelial cells were extremely sensitive to surface chemistry showing increased viability and migration with an increased number of carboxylic acid functional groups. Fibroblasts proved to be more tolerant to changes in surface chemistry; however, these cells migrated fastest over amine-functionalized surfaces. The novel combination of comprehensive chemical characterization coupled with the focus on cell migration provides a unique insight into how a material's physicochemical properties affect cell migration.

Ablative Fractional Laser Resurfacing: A Promising Adjunct to Surgical Reconstruction.

Ablative fractional laser resurfacing (AFLR) is emerging as a safe and effective treatment option for the mitigation of cosmetic and functional deficits resulting from traumatic scars and scar contractures. Military centers of excellence engaged in the multidisciplinary rehabilitation of wounded warriors have been instrumental in the widening acceptance of the technique in both the military and civilian realms. Despite the end of large-scale combat operations, AFLR remains a promising complement to surgical reconstruction and a novel option in challenging clinical situations that defy resolution with traditional methods. Herein, we present the case of a man in his 50s who underwent extensive genital and perineal debridement related to Fournier's gangrene. Despite successful reconstruction including extensive skin grafting, the patient suffered from intractable discomfort related to developing scar contractures that responded rapidly to a course of AFLR. This case serves to highlight the potential benefits of AFLR for postoperative wound management, and the importance of a multidisciplinary approach for the care of complex injuries.

Efficacy and Safety of OnabotulinumtoxinA Treatment of Forehead Lines: A Multicenter, Randomized, Dose-Ranging Controlled Trial.

BACKGROUND: Various onabotulinumtoxinA doses are effective in treating forehead lines (FHL), with a trend toward lower doses. OBJECTIVE: To evaluate efficacy and safety of onabotulinumtoxinA dose-ranging treatment of FHL when the frontalis area and glabellar complex are treated together. MATERIALS AND METHODS: Adults with moderate-to-severe FHL received onabotulinumtoxinA 40 U (FHL, 20 U; glabellar lines [GL], 20 U), 30 U (FHL, 10 U; GL, 20 U), or placebo. Response was assessed at weeks 1, 2, day 30, and monthly to day 180. Coprimary efficacy end points were investigator- and subject-assessed Facial Wrinkle Scale scores of none or mild (day 30). Patient-reported outcomes, onset/duration of effect, and adverse events (AEs) were evaluated. RESULTS: Responder rates (investigator/subject, respectively) were 40-U group, 91.2%/89.5%; 30-U group, 86.4%/81.4%; placebo, 1.7%/5.1%. OnabotulinumtoxinA resulted in significantly greater responder rates than placebo (p < .001). Adverse events were mild to moderate and similar between groups (most common AEs: nasopharyngitis [4.6%] and headache [4.0%]). CONCLUSION: Treatment of FHL with onabotulinumtoxinA 40 and 30 U (in frontalis and glabellar complex muscles) was tolerable, effective, and sustained. Both doses significantly reduced FHL severity; however, the 40-U dose demonstrated a trend toward greater sustained benefit and longer duration of effect versus the 30-U dose, with similar AE rates.

Analysis of epidermal/dermal temperature changes according to the different cryogen spray cooling conditions.

This study measured epidermal and dermal temperatures under different cryogen spray cooling (CSC) conditions to determine the optimum cooling conditions for skin rejuvenation. For this purpose, CSC conditions were applied before a laser transmission for varying spurt times of 50, 150, and 200 ms with delay times of 150 and 200 ms. A long-pulsed 1,064 nm Nd:YAG laser irradiated the skin surface of a pig with a condition of fluence of 26 J/cm2 and a spot diameter of 8 mm. The pulse duration was set to 30 ms during all experiments. This study found that all employed CSC conditions significantly decreased internal-external skin temperatures. Moreover, skin temperatures were influenced more by variations in spurt time of CSC compared with the delay times. Based on these experimental results, two spurt times were selected as the optimum CSC conditions for skin rejuvenation: 50 ms with delay time of 150 and 200 ms and 150 ms with a delay time of 150 and 200 ms.

[Plasma medicine in dermatology: Mechanisms of action and clinical applications]. / Plasmamedizin in der Dermatologie : Wirkmechanismen und Anwendungsmöglichkeiten.

Plasma medicine has developed into an innovative field of research showing high potential. Since the establishment of cold atmospheric plasma, new, multifaceted medical treatment opportunities have become available. Within a short time a multidisciplinary special interest group of medical scientists, physicists, and biologists was created, aiming to understand plasma medicine and answer clinical as well as scientific questions. In dermatology, new horizons are being opened for wound healing, tissue regeneration, treatment of skin infections, and tumor therapy. A major task will be the introduction of plasma into clinical medicine and, simultaneously, the further investigation of the mechanisms of action of plasma at the cellular level. Only then can the safety of plasma treatment in patients be assured.

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Plasma rico en plaquetas: aplicaciones en dermatología / Platelet-Rich Plasma: Applications in Dermatology

La aplicación del plasma rico en plaquetas ha experimentado un notable auge en los últimos años en una amplia variedad de enfermedades y situaciones clínicas. Su empleo en dermatología va más allá de su asociación con el envejecimiento facial. En la literatura se pueden encontrar series de casos y estudios controlados que muestran buenos resultados en aplicaciones diversas, como las úlceras cutáneas y, más recientemente, la alopecia. Sin embargo, estas indicaciones no están reconocidas en la ficha técnica en el momento actual, a falta de poder demostrar sus beneficios reales con mayor evidencia científica. Ante la expansión en el uso de esta técnica resulta fundamental el conocimiento de sus fundamentos biológicos y la evaluación de la calidad y de los resultados de los trabajos que estudian su aplicación en diferentes enfermedades cutáneas

In recent years, the use of platelet-rich plasma has increased notably in a range of diseases and settings. Uses of these products now go beyond skin rejuvenation therapy in patients with facial ageing. Good outcomes for other dermatological indications such as skin ulcers and, more recently, alopecia have been reported in case series and controlled studies. However, these indications are not currently included in the labeling given that stronger scienti- fic evidence is required to support their real benefits. With the increased use of these products, dermatologists need to become familiar with the underlying biological principles and able to critically assess the quality and outcomes of the studies of these products in different skin diseases

Ritidoplastia: sutura del sistema SMAS-Platisma e importancia de la filosofía de la naturalidad / Rithydoplasty: SMAS-Platisma suture and the importance of naturality concept

La ritidoplastia ha pasado por incontables cambios técnicos en relación a los colgajos cutáneos o a los musculares involucrados en el procedimiento. Inicialmente solo se realizaba la tracción de la piel con resultados muy variables; con el tiempo y con un mejor conocimiento de la anatomía facial, los resultados han evolucionado hasta la estandarización de la tracción de las estructuras faciales que en la actualidad es mucho más muscular, realizando sobre la piel solamente el ajuste de la cobertura al nuevo contorno facial. El objetivo de este artículo es demostrar la eficacia de la sutura simple del sistema SMAS-Platisma y la importancia de considerar una filosofía de la naturalidad que será la base de una técnica moderna de ritidoplastia. Revisamos un total de 617 pacientes, todas de sexo femenino, que se sometieron a ritidoplastia simple o combinada con otras cirugías en el periodo comprendido entre enero de 1992 a diciembre del 2010. La edad osciló entre los 37 y 75 años. Las cirugías combinadas incluyeron: reducción mamaria, mastopexia, abdominoplastia, implantes mamarios, cirugía de los párpados, rinoplastia, liposucción, cirugía vascular y cirugías ginecológicas. El número de pacientes en las que solo se realizó la ritidoplastia fue 326. Los índices de complicaciones estuvieran entre el 0,16 % y 1,13 % con relación a cada complicación estudiada, siendo el total del 4,03 %. El estudio retrospectivo mostró la eficiencia de la sutura simple del sistema SMAS-Platisma y los resultados naturales que se pueden obtener incluso con las cirugías combinadas. Todas las pacientes quedaron satisfechas con los resultados y consideramos que los índices de complicaciones estuvieron en niveles aceptables. A nuestro juicio, la ritidoplastia, por encima de otras cirugías estéticas, necesita de una rutina técnica eficiente y de un concepto filosófico basado en la más pura naturalidad, que necesita ser independiente de las modas, de las exigencias de la industria y de la mente insatisfecha de las pacientes. Es muy importante que los cirujanos plásticos sean firmes y conduzcan la cirugía con el único propósito de obtener un resultado natural

Rithydoplasty has been done with standards and new procedures for the last years with great changes in its results. In the beginning, only the skin strength was done with poor results. With a better knowledge about facial anatomy the results has gotten better and changed with a major standards and strengths are done over the muscular framework. The skin, now, only has the cover function over the new facial contouring. The purpose in this paper, is to show the efficiency of SMAS-Platisma suture and the importance of a natural philosophy that it be the basis over a modern rithydoplasty technique. A total of 617patients underwent rithydoplasty, all of them female. The surgeries were either alone or combined with additional surgery, between January 1992 and December 2010. The age ranged between 37 and 75 years old. Combined surgeries included: breast reduction, mastopexy, abdominoplasty, breast implant, blepharoplasty, rhinoplasty, lipoplasty, vascular surgery, hysterectomy and other gynecology surgeries. Three hundred twenty six patients underwent rithydoplasties alone. Complication rates were between 0,16 % to 1,13 % according each complication founded and 4,03 % in total. This review showed the efficiency of a SMAS-Platisma suture and the importance of philosophy of naturality that should be the basis over the technique and the natural results that can be achieved even with combined surgeries. All the patients were satisfied with the outcomes and the post- operatory complications were in acceptable levels. In our opinion, rhytidoplasty beyond the other aesthetic surgeries, needs a philosophical concept based over the most pure naturality that also needs to be independent from de fashion, the demands from de industry and from the unsatisfied minds of the patients. It is very important that the plastic surgeons have strong routines and guide de procedure with the only purpose to obtain a natural result

The effect of conditioned media of adipose-derived stem cells on wound healing after ablative fractional carbon dioxide laser resurfacing.

OBJECTIVE: To evaluate the benefits of conditioned medium of Adipose-derived stem cells (ADSC-CM) on wound healing after fractional carbon dioxide laser resurfacing (FxCR) on human skin. MATERIALS AND METHODS: Nineteen subjects were treated with FxCR on the bilateral inner arms. ADSC-CM was applied on FxCR site of one randomly selected arm. Transepidermal water loss (TEWL), skin color, and gross-elasticity of FxCR site on both arms were measured. Skin samples were taken by biopsy from three subjects 3 weeks after treatment for histopathological manifestations and mRNA expressions of procollagen types I and III, elastin genes were noted. RESULTS: The index of erythema, melanin, and TEWL of the ADSC-CM-treated skin were significantly lower than those of the control side. The mRNA expression of type III procollagen in ADSC-CM-treated group at 3 weeks posttreatment was 2.6 times of that of the control group. CONCLUSION: Application of allograft ADSC-CM is an effective method for enhancing wound healing after FxCR, by reducing transient adverse effects such as erythema, hyperpigmentation, and increased TEWL.

Low-temperature atmospheric plasma increases the expression of anti-aging genes of skin cells without causing cellular damages.

Efforts to employ various types of plasma in the field of skin care have increased consistently because it can regulate many biochemical reactions that are normally unaffected by light-based therapy. One method for skin rejuvenation adopted a high-temperature plasma generator to remove skin epithelial cells. In this case, the catalyzing effects of the plasma were rarely used due to the high temperature. Hence, the benefits of the plasma were not magnified. Recently, many types of low-temperature plasma devices have been developed for medical applications but their detailed functions and working mechanisms are unclear. The present study examined the effect of low-temperature microwave plasma on skin cells. Treatment with low-temperature plasma increased the expression of anti-aging genes in skin cells, including collagen, fibronectin and vascular endothelial growth factor. Furthermore, the plasma treatment did not cause cell death, but only induced slight cell growth arrest at the G2 phase. Although the cells treated with low-temperature plasma showed moderate growth arrest, there were no signs of thermal or genetic damage of skin cells. Overall, this low-temperature microwave plasma device induces the expressions of some anti-aging-related genes in skin cells without causing damage.