THE LASER RAYS
In the medical field, laser technology has significantly advanced throughout recent years. It has served to be very useful in various endoscopic surgeries, and for the removal of intra-renal stones.
Aesthetic medicine has emerged as a powerful tool to improve skin texture, inhibit scars, treat hemangiomas and more recently, the Spectra allows us to remove tattoos, treat facial marks, chloasma from pregnancy, mycosis of nails, congenital nevus etc. It has gone beyond improving the resistance of the skin, by also making it appear younger.
While laser has not substituted plastic surgery, it has become an extended feature and important complementary weapon. It can certainly delay and protect someone from the unwanted signs of aging, particularly with younger patients who have experienced early signs of aging.
There are several types of lasers. The Spectra was earlier mentioned due to its modern and excellent dermatological and cosmetic results, covering a large range of flaws, mainly the spots of the face and other parts of the body, as well as allowing a positive effect of rejuvenation.
In other cases of deeper skin alterations, the Co2 Laser acts safely, with more depth; with its main side effect being hyperemia (excess blood filling of vessels) of the treated region. Which may persist for a few months, but always regresses.
DEPILATION: This is another way of treating through the form of energy. When applied over the hair, the heat is absorbed by the INTENSE PULSED LIGHT and this energy is transmitted to the bulb (root), in turn eliminating it. It is an extremely interesting and efficient process in order to eliminate some hairs or all hairs from a region that are intended to become glabrous.
One of the greatest challenges for the plastic surgeon is to fill depressions or hollow areas of the body surface.
We classify filler substances into alloplastic substances (synthetic materials extraneous to the body) that may be non-absorbable or absorbable, or autologous ones (tissues of the patient’s own body, such as fat, fascia, etc.).
Non-Absorbent Alloplastic Fillers
The attempt to use liquid silicone injection in the past was abandoned due to a series of complications such as local inflammations, etc.
Then, PMMA (polymethylmethacrylate) surfaced, a product that also is non-absorbable and very interesting. Besides being supposedly inert in the body, it did not spread to neighboring regions causing the inflammatory reactions like the liquid silicone. PMMA was widely used and with good results, since it was used within a consensus technique that limited the amount injected to small doses, and applied deeply. These were the limitations we knew.
However, the use of PMMA spread rapidly and was used by estheticians, and as well as experts from other health specialties. Unfortunately, this led to several similar products appearing on the market, and being sold with “generics” as PMMA, and eventually some complications, and some of them serious, were reported.
There has been quite a lot of debate on this issue as some have questioned whether these complications surged from the substance POLYMETHYMETHRACYLATE (PMMA) itself, or whether it was due to inadequate techniques of its use, possibility associated with use of poor quality product. While this doubt persists still, it is only long and costly studies by the pharmaceutical industry that would allow some sort of conclusion. In examining this matter, however, and certainly in favor of this extremely useful and effective product, PMMA substances produced in the USA with adequate quality control have not shown the same complications as have been reported elsewhere.
Today, PMMA continues to be registered with ANVISA, and we have confidence that it comes directly from the manufacturer with adequate quality control. If used in small quantities and with good technique (deep insertion in the area being treated), it is an excellent resource to correct smaller defects in the different regions of the face, forehead, nose, genital region, etc.
It can also be used to restore the volume of the cheeks that have drastically sunken in patients with AIDS, and can be combined with treatment for retroviruses. It is indicated at times as an alternative to hydroxy apatite, which is also a good product that is non-absorbable, and widely used in several other countries
Absorbable Alloplastic Fillers
The non-absorbable products, once placed intimately in the tissues, are difficult to extract because they are so entrenched. For this reason, alternative substances have been developed, which temporarily fill the voids of the body surface, are enduring for a reasonable duration, and can be replaced when absorbed.
Then came several natural and/or synthetic products, that began with Hyaluronic Acid, which is still used today. It has the ability to be applied superficially or even intradermally to fill voids and depressions such as wrinkles of the “nasoganiano region” (from the nose down), or grooves known as “Chinese mustache”, as well as the fine wrinkles that affect the lips or crow’s feet area of the eyes. This product has been used for more than 30 years. Allergic reactions, although rare in patients, should be treated immediately if there are any adverse symptoms.
Subsequent of these discoveries, new products appeared that were indicated for the same purpose. These had more durability, lasting from one to two years. But with this longer duration, one could already plan and schedule various additional procedures, such as the increase of the cheekbones, filling the “valley of tears”, enlargement of the jaw, etc. Indeed, the precise indications of which product to use, when, and the planning of these various procedures – must be made by the plastic surgeon or by a dermatologist, together with the plastic surgery service, when they are studying each particular patient.
Human tissues are taken from the individual in order to fill depressions, irregularities, creases due to aging, etc. However, everything has become obsolete since, currently, the FAT GRAFTS are still in full use.
Fat Grafts are actually a wonderful sub product of liposuction. This technique, developed by the French surgeon Yves Gérard Yllouz, produced large amount of fat, that, when it was removed, was automatically discarded. In the age of stem cells, it was discovered that the fatty tissue was very rich source of these cells. Fat tissue was an abundant source of stem cells.
Fat grafts were then used for almost everything, since we had fat as the sub product of lipo-suction, and there were no contraindications.
The process of preparation was developed utilizing this fat in the pre-injection, so that there was less absorption. What became important was the discovery that even when there was absorption of the grafted fat, it was not completely absorbed. In other words, part of it was always aggregated to the organism, suggesting that consecutive applications would lead to a bigger and more definitive filling.
From this widespread clinical practice, scientific reports, discussion, and conferences, it was confirmed that fat injected under the skin had a toning and rejuvenating effect on the skin; if injected under hard scars, it softens the scars. It has become a further resource for improvement of burn scars, serves to recover the volumes that have been lost in the face with age, in filling of cheekbones, the “Chinese mustaches”, the wrinkles of the corner of the mouth, improving the thickness and quality of the skin of the lips, etc.
Autologous fat grafts have a very low risk of complication and are now a great tool for rejuvenation and a great hope for the future, due to its richness in stem cells.