Introduction: Intradermotherapy with poly-revitalization is an additional therapeutic option for the treatment of photodamage. Objective: To evaluate the efficacy of intradermotherapy treatment and skin rejuvenation results due to the use of injectable poly-revitalizing substance constituted of antioxidants, vitamin complexes, amino acids, coenzymes, and hyaluronic acid without crosslinking. Method: A retrospective, monocentric, open and non-comparative clinical study with 30 female patients who underwent 5 applications of injectable poly-revitalizing substance in the face. The photographs were analyzed and compared by blinded investigators and the medical professional who applied the treatment. Dermal thickness and density were analyzed and compared through ultrasonography. Result: Increased dermal thickness and density verified through ultrasonography. Clinical improvement was observed through pre- and post-application photographs. Conclusion: Intradermotherapy with the studied poly-revitalizing substance was proven to be a good therapeutic option for the treatment of photodamage.

Keywords: SKIN AGING; MESOTHERAPY; ULTRASONOGRAPHY.

Poly-L-lactic acid (PLLA) is a biocompatible, re-absorbable, immunologically inert polymer that induces neocollagenesis through a subclinical inflammatory response. It is indicated for restoration of facial volume associated with facial lipoatrophy in immunocompetent or HIV-immunodeficient patients. In addition there are cosmetic indications for extra facial areas. For more than three decades it has been used in medical devices such as plates, screws, intraosseous and soft tissue implants, and as a biodegradable vector for drugs, in sutures and stents. The present article is aimed at presenting a literature review on the indications, application method, and complications of the use of PLLA.

Keywords: COLLAGEN; SKIN AGING; REJUVENATION

In the literature there is significant confusion between the terms hypodermis and subcutaneous adipose tissue, which are often used interchangeably. They are however two distinct and independent structures, with independent metabolic responses. The distinction between these two layers and the knowledge of their behavior is of crucial importance for choosing the appropriate treatment. The objective of the present study was to review the existing literature on the topic, in order to demonstrate the anatomical and histological differences between the two tissues.

Keywords: SUBCUTANEOUS FAT; ADIPOSE TISSUE; SUBCUTANEOUS TISSUE.

Introduction: Discoloration and grooves are common in the lower eyelid and tend to give the bearer's appearance - even at a young age - an effect of tiredness, advanced age, and deepening of the eyeballs. Aimed at correcting these visual effects, cutaneous filling for local volume restoration has been currently indicated as a treatment, with the proposition of a number of products and techniques. Objective: To describe and evaluate the superficial application technique with the use of a fluid monophasic polydensified hyaluronic acid. Materials and methods: Sixty patients being treated between 2011 and 2014 underwent the technique. The evaluation was carried out by an applicator physician through the comparison of photographs and through questionnaires based on the Hirmand's classification answered by the patients. Results: The applicator physician rated the treatment as excellent (35% of cases), very good (50%) or good (15%), whereas for patients the results were excellent (30%), very good (50%) or good (20%). There were no reports of significant or long-term adverse effects. Conclusion: This superficial subdermal technique is easy to perform, has few adverse effects, and yields good results, leading to a high degree of patient satisfaction.

Keywords: SKIN AGING; HYALURONIC ACID; HYPERPIGMETATION

Cellulite or gynoid lipodystrophy in its various degrees is extremely common in the female population, setting on between the ages of 15 and 45 years of age, which corresponds to a woman's reproductive phase. Around 95% of women will present some degree of cellulite at some point in their lives. Despite being highly prevalent, only a few studies have been published in the international literature - many with contradictory conclusions - making it difficult to choose the appropriate treatment regimen.
The present study discusses anatomical differences in the hypodermis of men and women, the complex physiopathology of gynoid lipodystrophy, and mechanisms involved in its development.
Gynoid lipodystrophy is a skin disorder, which can only be controlled and not fully cured due to the fact that it is not a true disease, but rather a predisposition. Nevertheless, persistent or more advanced cases should be considered pathological, and be treated and controlled, given that they are indicative of peripheral vascular insufficiency.

Keywords: ADIPOCYTES; LYMPHATIC SYSTEM; LIPODYSTROPHY

A range of treatment options is available to restore and increase dermal collagen. The purpose of the present review, based on articles selected on PubMed database, is to study the histological effect of four methods for skin rejuvenation: Intense Pulsed Light, non-ablative fractional laser, ablative fractional laser and percutaneous collagen induction. The therapeutic implications of each type of treatment will depend on the induced collagen type and its ability to elicit a regenerative healing response versus a fibrotic scarring response. Intense Pulsed Light and the percutaneous collagen induction produced regenerative healing response with increased collagen type I.

Keywords: INTENSE PULSED LIGHT; LASER THERAPY; COLLAGEN; REJUVENATION; SKIN AGING

Introduction: The treatment of sagging skin in body areas is still a big challenge, as there are few aesthetic procedures aiming to improve it.
The poly-L-lactic acid (PLLA) is an injectable synthetic polymer of the alpha-hydroxy acids family, which injection into the deep dermis or superficial hypodermis induces a local and gradual reaction, with synthesis of new collagen by the fibroblasts and consequent increase of dermal thickness.
Purpose: Evaluate the effects of poly-L-lactic acid on the sagging skin of the body.
Methods: Fourteen patients with sagging in gluteal region underwent two applications of poly-L-lactic acid with a 45 days interval between them. We performed an initial clinical evaluation and after six months of the second application, photos before and after six months of treatment, questionnaires answered by the patient and by the evaluating physician and ultrasound examination of all patients to assess the increase of dermal thickness. The adverse effects observed were also evaluated.
Results: In patient's opinion, 85% presented improvement of general appearance of the skin and 71% noticed improvement of sagging. For the evaluating physician, 100% of patients presented improvement of general appearance of the skin and improvement of sagging, but in different degrees and not proportional to the initial degree of severity. There was no significant side effects in the period evaluated.
Conclusions: The results are promising and should be confirmed with studies with a larger sample size.

Keywords: CUTIS LAXA; SKIN; BUTTOCKS

The concept of facial rejuvenation currently includes a three-dimensional perspective, which recognizes as signs of aging not only the loss of the skin's texture and the emergence of expression wrinkles, but also the volumetric losses secondary to bone remodeling and redistribution of facial fat. This article was aimed at reviewing the literature on poly-L-lactic acid for facial rejuvenation – including its indications, injection techniques, expected results and possible adverse effects – and offer practical guidelines, based on the authors' 12-year experience with the product.

Keywords: SKIN AGING; INJECTIONS; COLLAGEN

INTRODUCTION: During aging, the skin undergoes structural, cellular, and molecular changes that alter its mechanical properties as well as its biological and physiological functions.These changes manifest as loss of elasticity, and turgor, with consequent appearance of fine wrinkles, lines, and creases that are difficult to resolve, being considered a therapeutic challenge.
OBJECTIVE: To describe the technique of applying cohesive polydensified matrix hyaluronic acid for the treatment of superficial wrinkles.
MATERIALS AND METHODS: In this retrospective and observational study, the technique of superficial and transverse application to superficial wrinkles with cohesive polydensified matrix hyaluronic acid was performed in women with this type of wrinkles in the perioral, periorbicular and lateral regions of the face, which did not disappear after treatment with botulinum toxin, facial volumization with fillers and technology.The study was conducted over 22 months between 2016 and 2018.The degree of improvement was assessed by a questionnaire applied to the patients who observed paired standardized photographs taken in the previous period and one month after the treatment.
RESULTS: The technique was performed on 40 women aged 55 to 80 years, whose response to the evaluation questionnaire was improved between 90% and 100% after one month of treatment.
CONCLUSIONS: The technique of superficial and transverse application to wrinkles with cohesive polydensified matrix hyaluronic acid proved to be an excellent option for the treatment of affected areas, without significant adverse events and/or Tyndall effect, with a high degree of patient satisfaction.

Keywords: Hyaluronic acid; Skin aging; Skin care

INTRODUCTION: Melasma is an acquired pathology secondary to hypermelanosis, recurrent, and often refractory to therapy, despite several treatment options. Microneedling is mainly indicated for refractory cases since it is an invasive method with the mechanism of action not yet fully understood for this indication.
OBJECTIVE: To compare the response to melasma treatment between a group that received only microneedling and another treated with microneedling combined with drug delivery.
METHODS: Twenty patients participated in the study: seven received only microneedling and 13 received microneedling followed by drug delivery of lightening serum in three sessions, with monthly intervals. The results between the groups were compared regarding improvement of the Melasma Area and Severity Index (MASI), texture and reduction of skin pore diameter; presence of erythema, crusting and peeling; improvement of melasma extension and tone.
RESULTS: The group that received microneedling combined with drug delivery had the most favorable results in improving texture, decreasing skin pore diameter, and improving melasma extension and tone. MASI improvement occurred in both groups, in similar percentages.
CONCLUSIONS: According to the present study, both therapies are promising for melasma treatment.

Keywords: Comparative study; Therapeutic approachs; Treatment outcome; Evaluation of results of therapeutic interventions

Skin quality and function drastically reduces with age due to chronological aging, photoaging, environmental factors and hormonal deficiencies. Decreased menopausal estrogen levels play a role in cutaneous atrophy, collagen and water content, loss of elasticity, skin wrinkling and deficiency of wound healing. Much research has been done to elucidate the beneficial effects of topical estrogen, which would have a more localized action on the skin without systemic side effects. The objective of this study was to review the relevant literature, demonstrating that this may be a safe and effective alternative for the treatment of women's skin in perimenopause.

Keywords: Estrogens; Phytoestrogens; Skin aging; Collagen; Antioxidants

In the skin aging process, both intrinsic alterations, secondary to cell regeneration capacity loss resulting from chronological action, and extrinsic alterations, caused by to ultraviolet radiation exposure, can be observed. Treatments that restore collagen production and stimulate fibroblasts to synthesize and organize extracellular matrix are critical for morphogenesis, angiogenesis, and skin healing. Potential uses of products that stimulate collagen production, a component that plays a fundamental role in the extracellular matrix, represents a promising perspective for improving skin quality and its mechanical properties by introducing a new concept of therapeutic approach when treating changes caused by skin aging.

Keywords: Collagen; Hydroxyapatite; Skin Aging

Microinfusion of drugs into the skin (MMP^®) is a technique described by Arbache in 2013. It uses a tattoo machine to infuse drugs to treat skin diseases. This study aims to review the literature and list the indications already published on this technique, the medications used in the procedure, and this technique’s safety profile. Despite being widespread among dermatologists, microinfusion of drugs into the skin (MMP^®) requires careful analysis, as many indications lack scientific literature. Even though it is a promising technique, it needs further studies to consolidate its indications and assess its safety profile.

Keywords: Infusions, Intralesional; Research and New Techniques; Tattooing

Since antiquity, chemical peelings are still widely used to treat skin aging. There are a variety of substances, techniques, and considerations for each type of peeling. However, this case series aims to present a non-described form of application of trichloroacetic acid (TCA) and retinoic acid to treat fine static wrinkles on the face. The technique consists of applying the TCA peeling directly to the facial rhytids and, subsequently, retinoic acid peeling all over the face for 6 hours.

Keywords: Chemexfoliation; Trichloroacetic acid; Skin aging; Chemical abrasion