Master Medicina Estetica e del Benessere

The forehead/brow complex, the temporal region, the upper eyelid, the zygomatic area, the lower eyelid, and the cheek comprise the periocular esthetic unit. The combination of variable degrees of tissue descent and fat deflation of the component parts of the unit determine its appearance with age. The authors report the results of tissue repositioning through a minimal incisions vertical endoscopic lift and volume restoration used in combination to restore the natural youthful appearance of the periocular esthetic unit. Methods: The authors retrospectively reviewed the charts of patients who underwent minimal incisions vertical endoscopic lift and fat grafting over a 12-year period in 3 different centers. Patients results were evaluated with standardized pre-and postoperative pictures graded by masked observers in a scale from poor, fair, satisfactory, to very satisfactory results. Patient satisfaction was self-graded in the same manner. Results: The study consists of 400 patients, of whom 337 (85%) were women and 63 (14.8%) were men, with a mean age of 46 years (range 38-67) for women and mean age of 53 years (range 48-65) for men. Mean follow up was 16 months (range 6 months-8 years); in 180 patients follow up was 2 years or longer. Additional procedures included lower blepharoplasty in 205 patients (51%), neck lift in 102 patients (26%), upper blepharoplasty in 63 patients (15.7%), lateral canthoplasty in 9 patients (2.3%), and upper eyelid ptosis in 6 patients (1.5%). The results were graded as satisfactory or very satisfactory by 95% of patients and by 91% of observers. Conclusions: On the basis of the anatomical changes that occur in the periocular esthetic unit, tissue repositioning is indicated to address the descent of the superior complex and in minor part of the inferior complex, while volume restoration is indicated to address the volume depletion of the inferior and the lateral complexes and for refinements of the superior complex. The authors propose a systematic combination of lifting and filling to naturally restore the youthful appearance of the periocular esthetic unit. Conservative blepharoplasty can be associated in selected cases for result optimization.

Although recent research on micro fat has shown the potential advantages of superficial implantation and high stem cell content, clinical applications thus far have been limited. The authors report their experience with superficial enhanced fluid fat injection (SEFFI) for the correction of volume loss and skin aging of the face in general and in the periocular region. The finer SEFFI preparation (0.5 mL) was injected into the orbicularis in the periorbital and perioral areas, and the 0.8-mL preparation was injected subdermally elsewhere in the face. The records of 98 consecutive patients were reviewed. Average follow-up time was 6 months, and average volume of implanted fat was 20 mL and 51.4 mL for the 0.5-mL and 0.8-mL preparations, respectively. Good or excellent results were achieved for volume restoration and skin improvement in all patients. Complications were minor and included an oil cyst in 3 patients. The smaller SEFFI quantity (0.5 mL) was well suited to correct volume lo...

Background: Adipose-derived stromal and stem cells (ADSC) in autologous fat promises regenerative advantages, and injected into the dermal and subdermal layers, enhances rejuvenation and volume. However, extremely superficial fat injection with current techniques is limited. Objectives: Efficacy and viability evaluation of fat harvested with extremely small side port (0.3 mm) cannulae without further tissue manipulation for the correction of aging/thin skin in the periocular and perioral regions. Methods: Micro-superficial enhanced fluid fat injection (M-SEFFI) harvests adipose tissue with a multi-perforated cannula (0.3 mm), and autologous platelet rich plasma (PRP) is added. The tissue is injected into the dermal region of the periocular and perioral zones. Efficacy and viability were evaluated by histological and cell culture analysis. Clinical assessment included retrospective evaluation according to 1 = no effect, 2 = fair effect, 3 = good effect, 4 = excellent effect. Results: Between June 2014 and July 2015, 65 patients (7 men; mean age 49.7 years) were treated with M-SEFFI. No intraoperative complications or visible lumpiness were recorded. Analysis demonstrated mature, viable adipocytes with a strong stromal component. Following PRP addition, there was a greater proliferation noted in the M-SEFFI compared to the SEFFI (0.5 mm). Mean follow-up was 4.1 months. Clinical assessment by surgeons and patients at 1 month was 3.52 and 3.74, and 6 months 3.06 and 2.6 respectively. Conclusions: M-SEFFI is effective and viable for lump free skin rejuvenation and volume enhancement, through the extraction of smoother ADSC rich, autologous fat tissue that does not require further tissue manipulation, to correct skin aging.

Background Demand for short recovery and less invasive correction for moderate skin and soft tissue neck laxity is increasing, especially among younger patients. The current study aims to evaluate the feasibility of a short recovery and minimally invasive technique of polytetrafluoroethylene (PTFE) bands and minimal skin excision for moderate platysma and skin laxity. Methods Following periauricular incision, PTFE bands of dual mesh are customized for suture to the platysma and anchored to the mastoid, creating a neck artificial ligament (NAL). NAL is buried into the muscle and tightened, without modifying the superficial musculoaponeurotic system and platysma. Young patients with moderate platysma and skin laxity were enrolled. Outcome was measured in terms of complications, recovery time, and patient and clinician satisfaction (1 = very dissatisfied, 2 = dissatisfied, 3 = satisfied, and 4 = very satisfied). Results A population of 107 consecutive patients (94% female) was treated, January 2013-January 2017. Average patient age was 51 years (46-56). Complications were rare: 1 case of superficial epidermolysis (healed within 21 days) and 1 case of mild band infection (treated with antibiotics). At a mean follow-up of 16 months, average patient and clinician evaluations were satisfactory (average satisfaction: patient 3.2, clinician 3.1). Conclusions In young patients with moderate platysma and skin laxity, minimally invasive NAL avoids deep modifications of the superficial musculoaponeurotic system and platysma. Despite the relative short follow-up of this study, the low rate of complications, short recovery time, and acceptable patient and clinician satisfaction seem promising. Level of Evidence: Level IV, therapeutic study.

The ageing process starts in the centre of the face in the periocular region and around the mouth, with a combination of volume loss and tissue descent. It is a logical approach to assess all these problems at once. The combination of minimal incisions vertical endoscopic lifting combined with superficial enhanced fluid fat injection can be an integral approach to facial rejuvenation.

Aim: The purpose of this article is to prove the possibility to transfer a good amount of cells of the SVF (and ADSCs) in the infranatant portion of microfragmented adipose tissue. Method: The adipose tissue harvesting procedure is performed under local anaesthesia. The adipose tissue was harvested with a 2 mm diameter microperforated cannula with 1 mm side port holes, mounted inside the special patented guide. Both cannula and guide are included in the SEFFIHAIR™ medical device. Once the adipose tissue is harvested, it is gently washed, and it was divided in two specimens: (EMU) the tissue was emulsified with 20 passages from one syringe to another and (CTRL) the tissue didn’t undergo any emulsification. Results: The emulsification procedure liberated alive and proliferating cells and we observed that the specimens derived with a 1 mm side port hole cannula and then emulsified (EMU) showed a higher number of cells in the infranatant part compared to the one derived from the control...

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....

The skin aging and the loss of volume are the most involved processes in facial aging; the injection treatment with viable adipocytes and AdiposeDerived Stromal and stem Cells (ADSC) promises to restore the volume and regenerate the skin. To achieve a higher adipocytes engrafting rate and a skin regenerative effect by ADSC the small tissue clusters must be injected superficially into the dermal and subdermal layers. The Authors describe SEFFI and MicroSEFFI techniques which through an innovative harvesting procedure provide three different kinds of injectable tissue with tissue clusters of different size: these three different tissues are injected in the dermal and subdermal layers of the different face areas that have different skin and subdermal thickness thus minimizing the risks of visibility and lumpiness.

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-...

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 ...

Background: Collagen and elastin play a crucial role in skin traction; their deterioration contributes to causing skin sagging and laxity with time. Soft tissue ptosis modifies the mandibular profile in addition to enhancing the nasolabial folds, lines of puppets and lateral eyebrow area; moreover, skin atrophy and volume loss are major factors involved in facial aging, contributing to the formation of facial rhytids, skeletonization, and pseudo-descent of the midface. Non-surgical face and neck rejuvenation lift with resorbable suspension threads and Superficial Enhanced Fluid Fat Injection (SEFFI) can be used as a temporary procedure until the aging appearance requires a more radical approach. Methods: Retrospective analysis from January 2019 to February 2022 of a 232 cases series of patients seeking a rejuvenation of the lower frame of the face (jowls and jawline) included in the study. The cases were performed in the base-office medical suites of some of the Authors. All of them...

Background: The aging process starts in the center of the face, in the periocular region and around the mouth, with a combination of volume loss, tissue descent, deepened wrinkles, and the loss of skin structure and quality. Recently, several studies have demonstrated the efficacy of therapies based on autologous adipose tissue grafting, which leverages the properties of stromal vascular fraction (SVF) and adipose-derived mesenchymal stem cells (ADSCs) to accelerate the regenerative processes of the skin. This study aims to verify the ability of guided superficial enhanced fluid fat injection (SEFFI) in the facial area to correct volume loss and skin aging, proving that this standardized procedure has a very low rate of complications. Methods: We retrospectively collected data from 2365 procedures performed in Italian centers between 2019 and 2021. Guided SEFFI was performed alone or combined with cosmetic treatments, including the use of hyaluronic acid filler, suspension threads, ...

Background Demand for short recovery and less invasive correction for moderate skin and soft tissue neck laxity is increasing, especially among younger patients. The current study aims to evaluate the feasibility of a short recovery and minimally invasive technique of polytetrafluoroethylene (PTFE) bands and minimal skin excision for moderate platysma and skin laxity. Methods Following periauricular incision, PTFE bands of dual mesh are customized for suture to the platysma and anchored to the mastoid, creating a neck artificial ligament (NAL). NAL is buried into the muscle and tightened, without modifying the superficial musculoaponeurotic system and platysma. Young patients with moderate platysma and skin laxity were enrolled. Outcome was measured in terms of complications, recovery time, and patient and clinician satisfaction (1 = very dissatisfied, 2 = dissatisfied, 3 = satisfied, and 4 = very satisfied). Results A population of 107 consecutive patients (94% female) was treated, January 2013-January 2017. Average patient age was 51 years (46-56). Complications were rare: 1 case of superficial epidermolysis (healed within 21 days) and 1 case of mild band infection (treated with antibiotics). At a mean follow-up of 16 months, average patient and clinician evaluations were satisfactory (average satisfaction: patient 3.2, clinician 3.1). Conclusions In young patients with moderate platysma and skin laxity, minimally invasive NAL avoids deep modifications of the superficial musculoaponeurotic system and platysma. Despite the relative short follow-up of this study, the low rate of complications, short recovery time, and acceptable patient and clinician satisfaction seem promising. Level of Evidence: Level IV, therapeutic study.

Background: Collagen and elastin play a crucial role in skin traction; their deterioration contributes to causing skin sagging and laxity with time. Soft tissue ptosis modifies the mandibular profile in addition to enhancing the nasolabial folds, lines of puppets and lateral eyebrow area; moreover, skin atrophy and volume loss are major factors involved in facial aging, contributing to the formation of facial rhytids, skeletonization, and pseudo-descent of 2

The forehead/brow complex, the temporal region, the upper eyelid, the zygomatic area, the lower eyelid, and the cheek comprise the periocular esthetic unit. The combination of variable degrees of tissue descent and fat deflation of the component parts of the unit determine its appearance with age. The authors report the results of tissue repositioning through a minimal incisions vertical endoscopic lift and volume restoration used in combination to restore the natural youthful appearance of the periocular esthetic unit. Methods: The authors retrospectively reviewed the charts of patients who underwent minimal incisions vertical endoscopic lift and fat grafting over a 12-year period in 3 different centers. Patients results were evaluated with standardized pre-and postoperative pictures graded by masked observers in a scale from poor, fair, satisfactory, to very satisfactory results. Patient satisfaction was self-graded in the same manner. Results: The study consists of 400 patients, of whom 337 (85%) were women and 63 (14.8%) were men, with a mean age of 46 years (range 38-67) for women and mean age of 53 years (range 48-65) for men. Mean follow up was 16 months (range 6 months-8 years); in 180 patients follow up was 2 years or longer. Additional procedures included lower blepharoplasty in 205 patients (51%), neck lift in 102 patients (26%), upper blepharoplasty in 63 patients (15.7%), lateral canthoplasty in 9 patients (2.3%), and upper eyelid ptosis in 6 patients (1.5%). The results were graded as satisfactory or very satisfactory by 95% of patients and by 91% of observers. Conclusions: On the basis of the anatomical changes that occur in the periocular esthetic unit, tissue repositioning is indicated to address the descent of the superior complex and in minor part of the inferior complex, while volume restoration is indicated to address the volume depletion of the inferior and the lateral complexes and for refinements of the superior complex. The authors propose a systematic combination of lifting and filling to naturally restore the youthful appearance of the periocular esthetic unit. Conservative blepharoplasty can be associated in selected cases for result optimization.