Fabrizio Melfa

A New Office Based Protocol to Reverse AGA Miniaturization at Early and Advanced Stages

Journal of surgery and research, Dec 31, 2022

Introduction: Several types of hair loss diseases have been identified and classified over the pa... more Introduction: Several types of hair loss diseases have been identified and classified over the past decades, and Androgenetic Alopecia (AGA) represents the most common condition among these. It can affect both sexes with an aesthetic and psychological impact that goes from moderate to severe. Several medical treatments, topical and systemic, have been proposed for it, with different degrees of response. Objective: To analyze the efficacy and outcome of an innovative therapeutic protocol, which combined the effect of the autologous regenerative treatment performed by medical device SEFFIHAIR™ and six sessions of TRICHOBIOLIGHT®, a combination of mesotherapy directly performed on the scalp with a subsequent photobiostimulation session with red LED light (630nm). Methods: Forty patients (12 women and 28 men, mean age 36,4 year-old) with clinical and trichoscopic diagnosis of AGA have been enrolled during our private practice and have all been treated with the combination of SEFFIHAIR™ and TRICHOBIOLIGHT®. Results: All patients responded to the treatment with an impressively excellent outcome reached in the 82,5% of patients (33/40) and with good results for the other 7 patients (17,5%). Conclusions: The combination of SEFFIHAIR™ and TRICHOBIOLIGHT® has proved to be a very promising protocol for reversing the miniaturization process of follicles induced by AGA, in the absence of adverse effects. This synergy of actions has determined an acceleration of hair growth and thickening of the hair shaft, thus resulting in a consistent aesthetic result and a substantial psychological improvement.

Integration of Lipofilling with Blepharoplasty to Optimize Periorbital Rejuvenation: A Retrospective Study

Journal of skin and stem cell, Jul 2, 2024

Characterization of Adipose-Derived Mesenchymal Stem Cells from tissue harvested with the guided SEFFI technique and co-cultured with calcium hydroxyapatite

Journal of applied cosmetology, Jun 22, 2023

Increased interest in regenerative medicine in the last few years was registered. In parallel, a ... more Increased interest in regenerative medicine in the last few years was registered. In parallel, a progressive increase in injectable calcium hydroxylapatite (CaHA) applications has been observed due to its applications in skin rejuvenation. This study combined micro fragmented fatty tissue (FAT) grafting with the CAHA filler procedure to observe the biological effect on FAT. Each sample of micro fragmented adipose tissue harvested using the guided Superficial Enhanced Fluid Fat Injection (guided SEFFI) technique were collected from 5 patients. The 5 samples were divided into aliquots to create two different experimental conditions: FAT and FAT combined with CaHA (FAT + R). Afterwards, the cellularity of mesenchymal phenotype and the in vitro differentiation capacity in mesenchymal lineages were assessed in both experimental conditions, FAT and FAT+R. Despite low cellularity observed for FAT+R compared to FAT, isolated cells could grow and expand in culture in both experimental conditions, thus proving their proliferative ability. Cells were proved to differentiate towards mesenchymal lineages, expressing mesenchymal markers by flow cytometry analysis. Combining emulsified harvested tissue prepared with guided SEFFI technique with CaHA products can be exploited to counteract the loss of volume and skin ageing of the human face and body. This approach to regenerative aesthetic treatment is a promising treatment for facial antiaging therapy.

Histopathological Features of Tissue Alterations Induced by Cryolipolysis on Human Adipose Tissue

by Fabrizio Melfa and Eliano Cascard

Aesthetic Surgery Journal, Feb 6, 2020

Background: Adipose tissue cooling, under controlled conditions, induces physical effects on subc... more Background: Adipose tissue cooling, under controlled conditions, induces physical effects on subcutaneous tissue called cryolipolysis (CLL), which has been proposed as a method to reduce noninvasively the amount of adipose tissue. Although CLL has been widely utilized in clinical practice and many favorable results have been reported in clinical studies, very few published studies have dealt with the effects of such therapies on human adipose tissue. Objectives: The aim of this study was to evaluate, through histopathological examination, the in vivo effects of CLL on human adipose tissue. Methods: Six patients to be submitted to abdominoplasty were enrolled in the study. Samples were taken from the surgical patch, respectively, 15 days (2 pts), 45 days (2 pts), and 60 days (2 pts) after a single standard session of CLL. Control samples were derived from the nontreated areas of the surgical patch. Results: Disruption of the adipocytic membranes was evident in all treated areas, with a reduction of cell dissolution in the 60-day samples. Focal dissolution and homogenization of the collagen fibers was evident, resulting in the dissolution of the interlobular fibrous septa. A mild inflammatory response was observed in the 15-and 45-day samples. Neocapillarizzation was observed in the 45-and 60-day samples. Conclusions: The lesions demonstrated in adipocytes confirm the theoretical premises of a usefulness of CLL in the treatment of localized adiposis. The alterations in the connective stroma could lead to a structural reorganization and consequently to the in vivo external appearance of the treated areas.

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Characterization of Adipose-Derived Mesenchymal Stem Cells from tissue harvested with the guided SEFFI technique and co-cultured with calcium hydroxyapatite

Journal of Applied Cosmetology

Increased interest in regenerative medicine in the last few years was registered. In parallel, a ... more Increased interest in regenerative medicine in the last few years was registered. In parallel, a progressive increase in injectable calcium hydroxylapatite (CaHA) applications has been observed due to its applications in skin rejuvenation. This study combined micro fragmented fatty tissue (FAT) grafting with the CAHA filler procedure to observe the biological effect on FAT. Each sample of micro fragmented adipose tissue harvested using the guided Superficial Enhanced Fluid Fat Injection (guided SEFFI) technique were collected from 5 patients. The 5 samples were divided into aliquots to create two different experimental conditions: FAT and FAT combined with CaHA (FAT + R). Afterwards, the cellularity of mesenchymal phenotype and the in vitro differentiation capacity in mesenchymal lineages were assessed in both experimental conditions, FAT and FAT+R. Despite low cellularity observed for FAT+R compared to FAT, isolated cells could grow and expand in culture in both experimental condi...

Guided Superficial Enhanced Fluid Fat Injection (SEFFI) Procedures for Facial Rejuvenation: An Italian Multicenter Retrospective Case Reports

A new injective protocol for the treatment of frontal lines with botulinum toxin type A

Journal of biological regulators and homeostatic agents, 2019

Comparison of Harvesting and Processing Technique for Adipose Tissue Graft: Evaluation of Cell Viability

by Fabrizio Melfa and Alessandro Gennai

International Journal of Regenerative Medicine, 2021

Background: Clinical studies demonstrated the efficacy of therapies based on the autologous graft... more Background: Clinical studies demonstrated the efficacy of therapies based on the autologous grafting of adult mesenchymal stem cells to accelerate the healing and regenerative processes of the skin and mesenchymal tissues; therefore, it is considered a valuable approach in the aesthetic rejuvenation treatment to give volumization and skin regeneration effects. Objective: The aim of the project consisted of the control of cell viability of adipose tissue (AT) harvested using the two types of cannulas having 0.8 mm and 1 mm side port holes. The results were compared with tissue harvested with a standard liposuction technique and processed with a standard procedure consisting of enzymatic digestion (collagenase). Methods: This study was performed on adipose tissues harvested from 7 patients (6 females and 1 male) with an average age of 48.5 years with 3 different techniques. We compared the cell vitality of every sample at T0 and T72. Results: Lipoaspirate tissue-derived by 0.8- and 1 ...

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Combined laser treatment for ear keloids: Case series

by Matteo tretti clementoni and Fabrizio Melfa

Journal of Cosmetic Dermatology

An Italian experience of a new personalized injective protocol (Botutouch) for botulinum toxin application in aesthetic medicine

Botulinum toxin typeA (BoNTA) is widely used in aesthetic medicine as primary treatment to reduce... more Botulinum toxin typeA (BoNTA) is widely used in aesthetic medicine as primary treatment to reduce facial wrinkles. Major unmet needs in the field of the injection techniques include dilution factor, injected volume and site. Since 2013, an innovative protocol has been developed in our clinic that works on a double dilution volume, identifies the injection site according to the specific anatomical‐functional characteristics of each patient's musculature and applies a gentle massage to the injected area to optimize the toxin spread in the muscle. We retrospectively retrieved medical records of subjects that underwent aesthetic treatments in our outpatient Italian clinics from 2013. In cobotulinum toxin A was used in double dilution (100 AU in 5 mL of physiologic solution) and followed by a gentle massage after the injection to increase the distribution into the muscle. 197 subjects, most of them drug‐naïve (81.7%), underwent 869 BoNTA treatments. On average, higher total units and...

Evaluation of the Number, Biophysical and Multipotent Characteristics of Adipose Derived Stem Cells Harvested by SEFFI Procedure and Interaction with Different Type of Hyaluronic Acids

International Journal of Regenerative Medicine, 2021

Background: Injection of autologous adipose-derived stem cells (ADSCs) and a stromal vascular fra... more Background: Injection of autologous adipose-derived stem cells (ADSCs) and a stromal vascular fraction (VSF) into dermal and subdermal layers promises regenerative advantages by improving skin volume and rejuvenation. Injectable hyaluronic acid (HA) is a temporary dermal filler that, by improving skin hydration, reduces the appearance of fine lines and wrinkles, facial folds and creates structure and volume to the face and lips. This study combined the grafting of micro fragmented fatty tissue with the hyaluronic acid filler procedure, using three different types of HA. Methods: Each sample of micro fragmented adipose tissue harvested using the superficial enhanced fluid fat injection (SEFFI) technique collected from 8 patients were equally divided into two specimens. One of these (EMU specimens) was emulsified by gently applying ten back-and-forth passages from one syringe to another to fluidify the tissue. The other one was not emulsified (Ctrl/NON-EMU specimen). Both EMU and NON-...

Combined laser treatment for ear keloids: Case series

by Fabrizio Melfa and Matteo tretti clementoni

Journal of Cosmetic Dermatology

Attitudes, Concerns, and Expectations of Consumers of Aesthetic Medicine and Surgery During the COVID-19 Outbreak: An Italian Online Survey

Aesthetic Surgery Journal Open Forum

As a consequence of the coronavirus disease 2019 (COVID-19) emergency, Italian physicians working... more As a consequence of the coronavirus disease 2019 (COVID-19) emergency, Italian physicians working in the field of aesthetic medicine and surgery considered appropriate to stop their activity in order to preserve patients’ safety. This drastic measure obviously had an important impact on the medical aesthetic market causing growing concerns. To catch the current attitudes of the Italian consumers toward the aesthetic medicine and surgery, a medical advisory board devised an online survey; 216 clinicians finally participated in this survey and sent the online link through e-mail. A total of 8080/8640 (93.5%) questionnaires were returned, while 70 were removed. Approximately 49.0% (n = 3944) did not feel influenced in their desire for aesthetic treatments in spite of the pandemic emergency. Being influenced was not correlated with the uneven situation experienced on the Italian territory (r = −0.30, P = 0.196); 45.4% (n = 3636) declared to be ready for rescheduling their visit, and 60....

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At-home Cosmeceutical Application and Outpatient Treatments: A 3D Stepwise Facial Rejuvenation Approach

Open Access Macedonian Journal of Medical Sciences

BACKGROUND: Aging affects the 3-dimensional structure of all the facial tissues: Bones, muscles, ... more BACKGROUND: Aging affects the 3-dimensional structure of all the facial tissues: Bones, muscles, ligaments, adipose tissue, and skin. AIM: To customize minimally invasive treatments for facial rejuvenation, we present a standardized holistic approach characterized by at-home treatments in associations with outpatient procedures. METHODS: Forty-four patients underwent 3-dimensional stepwise facial rejuvenation and were evaluated prospectively. Each patient received a customized treatment plan based on a clinical examination and consultation. Treatment outcomes were evaluated from patient photographs with and skin analysis was performed with an A-One Smart automated skin analysis system. RESULTS: The mean age of the patients was 41.7 years and the approximate mean duration of treatment was 160 days. Patients applied cosmeceuticals such as retinoic acid. Outpatient procedures included the delivery of botulinum toxin or dermal fillers, thread lifting, chemical peels, etc. Upon treatment...

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Histopathological features of tissue alterations induced by low frequency ultrasound with cavitational effects on human adipose tissue

by Fabrizio Melfa and E. Guarino

International journal of immunopathology and pharmacology

Low frequency, high energy level ultrasound (US) induces physical effects on tissues called ultra... more Low frequency, high energy level ultrasound (US) induces physical effects on tissues called ultrasonic cavitation (UC). Endermic US therapy has recently been proposed as a method to reduce non-invasively the amount of adipose tissue. Very few published studies have dealt with the biological effects of such therapies on human adipose tissue. The aim of this study is to evaluate, through histopathological examination, the effects of various levels of ultrasonic radiation on supravital human adipose tissue. Four ex vivo human tissue samples were treated as follows: sample 1: no US radiation; sample 2: US radiation 2,5 W/cm2 for 15 minutes; sample 3: US radiation 5 W/cm2 for 15 minutes; sample 4: infiltration of 30 ml physiological saline and US radiation, 5 W/cm2 for 15 minutes. For lower levels of ultrasonic energy, interruption of the adipocytic membranes was evident both in the surface and in the deeper cutaneous and subcutaneous layers, with focal dissolution and homogenization of ...

Histopathological Features of Tissue Alterations Induced by Low Frequency Ultrasound with Cavitational Effects on Human Adipose Tissue

by Fabrizio Melfa and E. Guarino

International Journal of Immunopathology and Pharmacology

Low frequency, high energy level ultrasound (US) induces physical effects on tissues called ultra... more Low frequency, high energy level ultrasound (US) induces physical effects on tissues called ultrasonic cavitation (UC). Endermic US therapy has recently been proposed as a method to reduce non-invasively the amount of adipose tissue. Very few published studies have dealt with the biological effects of such therapies on human adipose tissue. The aim of this study is to evaluate, through histopathological examination, the effects of various levels of ultrasonic radiation on supravital human adipose tissue. Four ex vivo human tissue samples were treated as follows: sample 1: no US radiation; sample 2: US radiation 2,5 W/cm2 for 15 minutes; sample 3: US radiation 5 W/cm2 for 15 minutes; sample 4: infiltration of 30 ml physiological saline and US radiation, 5 W/cm2 for 15 minutes. For lower levels of ultrasonic energy, interruption of the adipocytic membranes was evident both in the surface and in the deeper cutaneous and subcutaneous layers, with focal dissolution and homogenization of the surface dermal fascia. For higher levels of ultrasonic energy, alterations of the adipocytes and of the collagen fibers were greater, resulting in the dissolution of the cells and of the interlobular fibrous septa. Both effects were amplified by tumescent saline infiltration. The histological lesions demonstrated in adipocytes confirm the theoretical premises of a possible usefulness in the treatment of localized adiposis. The alterations observed in the connective stroma could have positive effects on the structural re-organization and consequently on the in vivo external appearance of the treated areas.

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