By Professor Yana Yutskovskaya and by Doctor Alexandra Sukhanova
Skin ageing, is mainly related to atrophic changes in dermis and hypodermis. Destructive changes take place in fibroblasts. Lipofuscin and fat, which are underoxidized products of metabolism, begin to accumulate. Besides this, destructive and degenerative changes occur in macrophagocytes, where breakdown products of hemoglobin can store up.
Glycosaminoglycan redistribution takes place in ground substance. In addition to this, glycosaminoglycans undergo quality changes [1,2]. The level of glycoprotein and fibronectin, in particular, decreases. Fibronectin plays a decisive role in the interaction between fibroblasts and collagen fibers. The fibers themselves atrophy and become less dense. Collagen fibrils can lose their periodic striation and a maturation delay can be observed in their development. Elastic fibers become coarse and become subject to partial fragmentation. They begin to concentrate in some areas, especially, under epidermis (senile elastosis) [1].
In this case hypodermis plays the main role, as it is hypodermis that participates in constitution of granulation tissue which is an important morpho-functional element of regeneration process. It contains a storage pool of poorly differentiated young and mature fibroblasts and fibro-clusters. It equally contains collagen, elastic and reticular fibers [2,3].
In our practice we use Radiesse product during meso-tecnic treatment according to Yutskovskaya method in order to prevent and treat skin laxity, sun elastosis, poor skin turgor and elasticity [3].
The essence of this method lies within subdermal injection of the product not in form of a gel (in main concentration), but in form of a sol (dissolved in 0,9% saline solution). The product is injected between dermis and hypodermis. The aim if the technic is to stimulate fibroblasts’ synthetic activity.
Protocol of the procedure:
- Syringe Radiesse 1.5ml
- Syringes 10ml – 2 pcs.
- 0.9% saline solution (depending on volume)
- Lidocaine (ubisestin) 1-2ml (0,25/0,15/0,03ml)
Interface component: Needles 28G x 19mm 6 – 8 pcs. (a new needle is used for each area) or a canula 25G x 50mm.
To make the procedure comfortable it is preferable to use application anesthesia (Emla). The exposure time is 40 minutes. To eliminate hyperkeratosis follicularis and create antibacterial protection, we carry out controlled dermabrasion followed by 25% glycolic pilling on gel basis just before the procedure.
Step 1: Taking patient’s full-face picture and picture at a 45° and 90° angle before the procedure in order to file the results before and after.
Step 2: Patient’s skin preparation by applying 0,05% chlorhexidine solution, carrying out controlled dermabrasion and applying 25% glycolic pilling; exposure time is 5 minutes. Applying 5% application anesthesia “Emla”; exposure time is 40 minutes.
Step 3: Application of marking on the lower third part of the face, neck and decollete area. Marking is done along skin tension lines (Langer’s lines).
Step 4: Preparation of Radiesse product for meso-therapy injection technic. The ratio of the product and saline can be 1:1 – 1:2 (gel), 1:3 – 1:4 (gel/sol), 1:6 – 1:8 (sol). In the given case it is important to consider thixotropic character of the product – its capacity to restore its structure spontaneously after mechanical destruction (in our case after introduction of a needle). Gel is a dispersive system with liquid dispersive environment, where dispersed phase particles form a steric structural grid. Gel has a thixotropic nature. Sol is a suspensoid of hard matter particles in liquid. Sol differs from gel as it stays liquid and doesn’t solidify, therefore, doesn’t have thixotropic capacity.
Before filling each syringe for injection, it is necessary to stir the product thoroughly, because its particles deposit on syringe walls.
Step 5: In linear retrograde technic we primarily prepare the lower third part of the face, submental area, neck and, afterwards, decollete area.
Step 6: In order to ensure a better redistribution of the product after the procedure a vigorous massage with application of Traumeel ointment is carried out. Contouring can be observed after the procedure, but no “whitishness” is admissible.
For a faster regeneration, it is recommended to apply bio-recovery a cream with SPF factor “Bio-cream NEOCUTIS” that possesses calming and repairing effect.
The injections are made along equally spaced lines from the sides to the centre, from top downward.
The needle is introduced full-length subdermally at a minimal angle with its bevel turned upwards. The needle’s steel cannot be seen, but dimpling are observed.
Professor Yana Yutskovskaya
Yutskovskaya Y.A. M.D., professor, high-level certificate physician, owner of a network of clinics “ The Yutskovskiys’ Professor Clinic” (Vladivostok) and “Professor Yutskovskaya Clinic” (Moscow), founder of the project “Professor Yutskovskaya School”, Head of Gender Medicine Specialists Association, editor in chief of “Cosmetics and Medicine” magazine
Doctor Alexandra Sukhanova
STD and skin specialist at “The Yutskovskiys’ Professor Clinic” (Moscow)
