Fractional CO2 laser resurfacing is a surgical technique used for the improvement of facial wrinkles and the treatment of skin imperfections such as post-acne scars. The laser emits an intense beam of light that instantly vaporizes tissues and skin. This action is so precise and selective at the point of impact of the beam that the surrounding tissue is only mildly affected.

What is radio frequency?

It is a minimally invasive method for treating skin aging and sagging of the face and body, providing a more "youthful and refreshed" appearance without ablating the skin or using injections. Electromagnetic energy produced by specialized electromedical devices penetrates the dermis and reaches the superficial muscle layer. As it passes through the tissues, it encounters resistance, which is converted into thermal energy capable of inducing skin restructuring.

The use of absorbable threads inserted beneath the skin can serve a dual purpose: that of stimulation (as an alternative to injections) or that of tissue suspension.

Biostimulation threads

Biostimulation is carried out using PDO (polydioxanone) threads, which are positioned through carrier needles to stimulate and revitalize the skin, resulting in a mildly lifting effect. These are monofilament synthetic suture threads composed of polydioxanone (a derivative of glycolic acid), which are employed in surgery for subcutaneous and deep structure suturing. Characterized by their prolonged durability and low bacterial colonization, they encourage collagen production and undergo a gradual and complete absorption. Due to these properties, PDO threads are indicated for the non-invasive or minimally invasive treatment of skin sagging on both the face and body, for both prevention and correction purposes. For this intent, they can be inserted in various areas including the forehead and brow region, periocular area, zygomatic/malar region, cheek, jawline, and chin. They can also be applied on the neck, décolletage, inner arms and thighs, and generally on the body's skin wherever the indication arises.

Microthreads are inserted into very fine needles and implanted into the dermis, following the natural lines of skin tension. This arrangement creates a network that tightens the tissue and partially repositions sagging skin. However, the intended effect of these threads is not a lifting one; rather, it aims to gradually enhance the skin's firmness over time. After an initial improvement of around 30-50%, there is an additional 20-30% enhancement in the following 2-3 months. Roughly after 4-6 months, the threads completely dissolve due to hydrolytic action, but thanks to significant endogenous stimulation, the benefits remain visible for a longer period.
Generally, the procedure is well-tolerated and minimally painful, but local anesthetics can be applied if needed. Following the treatment, patients can immediately return to their daily activities; any potential bruising can be concealed with camouflage.
Therapeutic approach: Typically, an initial treatment is performed, followed by a second one after 4-6 months, and a possible touch-up after 1 year.
Major risks and complications: Technically, there are no significant risks or complications. However, it's important to avoid treating individuals with acute infectious diseases, those undergoing active tumor treatments, blistering skin disorders, known allergies or intolerances to the product (extremely rare).

Possible side effects include bruising, hematomas, or minor local inflammations, which typically resolve spontaneously within a few days. Any potential asymmetries might necessitate follow-up checks. In rare instances, a thread might become slightly visible beneath the skin for a period ranging from a few days to 2-3 weeks. It is also possible for a local infection to occur, requiring the use of antibiotics.

Suspension threads

In the case of suspension threads, the insertion of absorbable threads beneath the subcutaneous layer aims to lift and reposition facial tissues that are starting to sag (jawline, neck, cheekbones), in a non-invasive manner and for an extended duration. 

The threads are inserted through punctiform incisions, which require a few days to heal. Discomfort or pain might be felt during the treatment. It's necessary to sleep in a supine position for the first three nights after the procedure. Applying cold compresses to the treated areas is recommended. Facial movements should be minimized in the first week; caution is still required in the following three weeks. Throughout this period, excessive chewing and forcibly opening the mouth should also be avoided.

Side effects and complications are not common and may include: bruising, swelling, infection, and bleeding. As the treatment is superficial, it is unlikely to cause damage to deeper structures like nerves, blood vessels, or muscles. Complications can be exacerbated by smoking and alcohol use, which should therefore be suspended.

During the healing process, it's possible that the treated area might temporarily appear lighter or darker. Therefore, appropriate sun protection is advised during the post-operative period. Minor asymmetries, redness, or visibility of sutures might necessitate further treatments or the removal of the sutures themselves.

Chemical peels allow for the removal of the outer layers of the skin through the localized application of substances, especially organic acids, capable of breaking the bonds that hold the cells together.

In aged skin, the turnover of epidermal cells slows down, and there is a relative increase in the thickness of the stratum corneum. The skin takes on a dull, grayish appearance, loses elasticity, becomes rough to the touch, melanin is produced unevenly, and spots appear. Chemical peeling, when performed regularly, improves the appearance of the epidermis and, through specific biochemical signals that reach the underlying dermis, revitalizes its functions, and stimulates the synthesis of new collagen.

Based on the strength of the keratolytic agent used, chemical peels can be superficial, medium, or deep, depending on the layer of skin they target. The most used chemical peels in Aesthetic Medicine are superficial and medium-superficial, also known as soft peels. These peels, by removing the stratum corneum, immediately make the skin brighter and smoother, improving all conditions associated with skin aging. This therapy needs to be part of a broader program tailored to the patient's specific skin issues, identified through a skin check-up. This diagnostic process should precede any corrective treatment. The facial skin should be normalized with appropriate cosmetics, and chemical peels enhance their effectiveness by facilitating the penetration of active ingredients. In dermatology, some peels also contribute to the improvement of acne.

Procedure

Chemical peels are performed in individual sessions with intervals of about 15-30 days between treatments. The number of sessions varies depending on the desired outcome, the chemical agent used, and individual response. During the session, the acid is applied with a cotton ball or swab, and the patient may experience a burning sensation of varying intensity depending on their individual sensitivity. This sensation disappears when the acid is neutralized, leaving a feeling of warmth due to local vasodilation. Discomfort is usually well-tolerated.

With a chemical peel, you can expect:

• Improved skin brightness, smoothness, and elasticity.
• Slight reduction in the diameter of follicular openings.
• Enhanced skin color uniformity with a reduction in hyperpigmentation (especially when peels are repeated and combined with the use of depigmenting products at home).
• Softening of fine wrinkles.

The extent of improvement is not predictable because the quality of the response and the number of treatments needed to achieve it depend on various factors, such as the initial condition of the skin, age, individual reactivity, environmental conditions, and lifestyle.

Are there any contraindications to peelings?

Certainly, an absolute contraindication exists in the case of a confirmed allergy to the chosen acid or excipients.
Acids are substances with aggressive properties for the skin and mucous membranes, potentially capable of producing lesions of a certain severity if used in incorrect locations, manners, or timings.
After the peeling, areas of redness and peeling may appear, sometimes with scabs that spontaneously resolve in a few days or, in very rare cases of greater severity, with appropriate treatment.
It is also possible, in the days following the peeling, for small pustular lesions to appear, or in predisposed individuals, manifestations of Herpes Simplex.
Due to their exfoliating action, acids can increase water loss through evaporation, accentuating, in some cases, the feeling of skin dryness.

Finally, with deeper peels, persistent redness and hyperpigmentation may occur (especially in dark phototypes, because of inflammatory complications and inadequate sun protection of the treated areas), which can be resolved with appropriate therapy.

What should one do, or not do before a peeling?

Optimal and well-hydrated skin responds better to peeling, and side effects are less common. It is therefore advisable to precede the peeling with a skin check-up and a preparation and normalization phase, lasting at least 15 days, to be carried out at home with the cosmetics prescribed by the doctor.

In general, it is preferable to postpone the treatment in the presence of active herpes simplex, skin disorders, ongoing or healing inflammatory lesions, surgical wounds, recent peeling with other substances, outcomes of dermabrasion, cryotherapy, diathermocoagulation, sunburn, shaving, waxing, and any other skin irritations. In any case, the doctor will evaluate the amount of time necessary before performing a peeling.

What should one do, or not do, after a peeling?

The day the peeling is performed, and the following day, the patient is advised to only use prescribed skin products, to speed up the process of cellular renewal and reduce dryness.

The stratum corneum is an important instrument to protect against sun radiation: peelings reduce its thickness, making the skin more sensible to UV rays. It is therefore important to avoid exposure to sunlight or tanning lamps for at least four weeks, and constant sun protection is necessary. This is all due to the risk of inflammation post-peeling which could manifest as more pigmentation, and insufficient care might highlight pre-existing blemishes, or create new ones.

In addition, in the treated areas, abrasive products, alcohol-based toners, soapy or particularly harsh syndet cleansers should not be used. Depilation should be avoided, and the skin should not be scratched or rubbed, nor should any scabs be removed.

The most commonly used acids in Aesthetic Medicine are: mandelic, glycolic, pyruvic, salicylic, trichloroacetic:

• Mandelic acid: It belongs to the alpha-hydroxy acid family, a wide group of compounds found in nature, also known as "fruit acids," from which many are derived. In particular, mandelic acid, extracted from bitter almonds, manages to be effective without inducing immediate skin burning or redness. Its action varies depending on its concentration, promoting cellular turnover, and it also possesses antibacterial and depigmenting properties. It is suitable for treating sensitive skin and is often used in combination with other chemical agents.
• Glycolic acid: It is an alpha-hydroxy acid found in sugarcane. It is available in various formulations that act differently depending on their concentration, the degree of unbuffered acidity (i.e., not neutralized), and the duration of application on the skin. At low concentrations (4-15%), when applied daily as a cosmetic, glycolic acid removes the superficial corneal flakes that are already partially detached, contributing to the optical effect of brightness. Furthermore, cosmetics with low concentrations of glycolic acid increase the ability of epidermal proteins to retain water, improving skin hydration. At high concentrations (30-70%), glycolic acid causes the detachment of deeper epidermal cells and is used for medical peels.
• Pyruvic acid: It is a highly lipophilic alpha-keto acid, which allows it to penetrate the sebaceous hair follicle, the site of acne. Although it has a superficial action, it produces a desquamating effect on the corneal level. It also stimulates the cells of the germinative layer, initiating the skin renewal process. Additionally, due to its antimicrobial properties, pyruvic acid is particularly suitable for the treatment of active acne.
• Salicylic acid: Salicylic acid is a molecular analog of acetylsalicylic acid, better known as aspirin. Despite its superficial action, it has a desquamating effect on the corneal level that is superior to any other chemical agent. It stimulates the cells of the germinative layer, initiating the skin renewal process. Salicylic acid also possesses antimicrobial properties, allowing for effective treatment of active acne cases.
• Trichloroacetic acid (TCA): TCA is a chemical exfoliating agent capable of chemically destroying the superficial cells of the epidermis, stimulating the deeper layers to replace the desquamated cells. The skin "renews" itself in about 15 days. When repeated at short intervals and used at higher concentrations, it acts more deeply, promoting collagen remodeling in the months following the treatment.

Peeling PRX-T33

This is a high-concentration trichloroacetic acid-based peel, but it's not aggressive thanks to the presence of hydrogen peroxide, which modulates its action. It stimulates the dermis and works on chrono and photoaging, counteracting the loss of firmness in the face, neck, and décolleté. It's also indicated for the treatment of acne-prone skin. With the Reverse peel formulation, which includes other exfoliating agents in addition to trichloroacetic acid, melasma, a skin hyperpigmentation condition characterized by brown patches with irregular borders, can be effectively treated.

This is a high-concentration trichloroacetic acid-based peel, but it's not aggressive thanks to the presence of hydrogen peroxide, which modulates its action. It stimulates the dermis and works on chrono and photoaging, counteracting the loss of firmness in the face, neck, and décolleté. It's also indicated for the treatment of acne-prone skin. With the Reverse peel formulation, which includes other exfoliating agents in addition to trichloroacetic acid, melasma, a skin hyperpigmentation condition characterized by brown patches with irregular borders, can be effectively treated.

Retinol peel

It is a medical peel that contains 3% Retinol, a precursor of retinoic acid, and a complex of substances (citric acid derivatives, amino acid derivatives, vitamin E, bisabolol). It stimulates collagen production, reduces the activity of collagenases, exfoliates, improves the appearance of fine lines, promotes even skin tone, and makes the skin more radiant. The peel also works on acne lesions.

The product is applied to the skin by the doctor, and after an observation period of about 10 minutes, the patient can leave the clinic. The substance is rinsed off at home after a number of hours of application indicated by the doctor, depending on the skin's condition and sensitivity. In the days following the application, there may be a slight increase in redness and a feeling of skin tightness. Exfoliation begins after 2-3 days and continues for about a week. In addition to proper hydration with prescribed cosmetics, photoprotection is essential, with sunscreen creams applied several times a day. The use of exfoliating products should also be avoided.