1. WHAT IS REGENERATIVE MEDICINE
2.5 RADIOTHERAPY DYSTROPHIC SKIN (BREAST)
WHAT IS REGENERATIVE MEDICINE?
Regenerative Medicine encompasses many medical fields – Orthopedics and Spine Surgery, Sports Medicine, Gynecology, Urology, Oncology, Dermatology, Plastic surgery, Vascular Surgery, Cardiac surgery, etc.
Regenerative Medicine is the branch of medicine that develops methods to regrow, repair or replace damaged or diseased cells, organs or tissues. Regenerative medicine includes the generation and use of therapeutic stem cells, tissue engineering and the production of artificial organs. It uses autologous blood, bone marrow or adipose components to stimulate the body’s own repair processes. A common source for regenerative cells and growth factors are bone marrow aspirate concentrate (BMAC), platelet rich plasma (obtained from one’s own blood) and adipose derived stem cells.
TEAR TROUGH CORRECTION
A tear trough is a deep crease between the lower eyelid and upper cheek. It can cast a shadow below your eyes, resulting in a tired appearance. Some people think their tear troughs make them look older.
In certain individuals, tear troughs are an inherited trait. In others, tear troughs become more prominent with age. That’s because facial tissues lose volume as you get older.
The goal of a tear trough filler is to reduce the depth of a tear trough. A trained medical professional injects a dermal filler into the area, making the skin look fuller and tighter. It’s a nonsurgical method of facial rejuvenation.
However, like other types of facial fillers, tear trough fillers have pros and cons. It’s important to understand the procedure and potential complications before getting the treatment. Tear trough fillers aren’t FDA approved and their use is considered off-label.
What is a tear trough filler?
A tear trough filler is an injectable treatment that’s used under the eyes. Its purpose is to add volume beneath the eyelids.
The product most often used in this area is one typically made of hyaluronic acid, although other ingredients may be used. Hyaluronic acid is a gel-like substance that naturally exists in your body. When injected into the skin, hyaluronic acid increases fullness and decreases indentations.
Are tear trough fillers safe?
Tear trough fillers are relatively safe. They’re also less invasive than tear trough surgeries, which include fat grafting and fat repositioning.
The effects of tear trough fillers are temporary, though. They only last about 1 year. You’ll need repeated treatments to maintain long-term results.
Sometimes, tear trough fillers are used with other procedures like:
- Botox injection
- laser resurfacing
- fat grafting
- fat repositioning
DEEP FOLD VOLUMIZATION
Removing nasolabial fold wrinkles
The nasolabial fold is the line that runs from the side of your nose to the corners of your mouth. Due to hereditary factors, the condition of the skin and age, the line can become deeper. The groove or wrinkle that develops, gives an unnecessarily tired expression, sometimes even at a young age. A deep nasolabial fold can occur in both men and women.
Nasolabial fold treatment with fillers
The wrinkle at the nasolabial fold can be treated safely using fillers. The groove is often caused by a loosening of the cheeks. Loss of volume causes the cheeks to ‘hang’ somewhat from the cheekbones, deepening the groove. In addition, it’s possible to fill the nasolabial fold itself. Fillers give an increase in volume. The nasolabial fold will disappear.
FINE WRINKLES CORRECTION
What are wrinkles?
Although wrinkles can signify wisdom, or at least some level of maturity, there is no question that newly born infants also have wrinkles. The real concern that most of us have is that certain types of wrinkling are associated with the aging process. In our current “pop” culture, people do not view aging positively. Generally, the treatment of normal skin aging that does not result in a functional abnormality is termed “cosmetic.” Most cosmetic procedures are not covered by health insurance.
Many products and procedures promise to reduce wrinkles. Some do little or nothing (like the products that claim they reduce “the appearance of fine lines,” which means that they don’t reduce the lines themselves). Others can achieve a fair amount of success.
Although all of our skin ages, sun exposure dramatically enhances the rate at which this occurs. Changes brought on by sun damage (photoaging) include dry skin (really roughness), sagginess, skin growths like keratoses, lentigos (“liver spots”), and wrinkles. Just compare the skin on the face and neck of a poorly pigmented farmer to the skin of his buttocks.
Most wrinkles associated with aging appear on the parts of the body where sun exposure is greatest. These sites are the face, neck, the backs of the hands, and the tops of the forearms. Wrinkles come in two categories: fine surface lines and deep furrows related to muscular contraction. Some deep furrows are anatomical in nature and have little to do with aging.
Generally, it is only the aging wrinkles that really bother people. There are two basic approaches to the amelioration of these signs of aging: prevention and treatment.
Topical wrinkle treatments are, in general, much more effective for fine lines. Deeper creases may require more invasive techniques, such injection of fillers, local muscle paralysis, or plastic surgery.
There is a special form of wrinkling called “cellulite” that produces a “cottage cheese-like” appearance to the skin. Cellulite most commonly appears in the hips and buttocks of women and is due to fat deposition in certain anatomical areas in the dermis.
FULL FACIAL REGENERATION
In recent years, cosmetic anti-aging procedures have gained mainstream acceptance. And while many women start with less invasive treatments, like injections and dermal fillers, at a certain point, some women consider facial rejuvenation surgery, or a face-lift, for longer-lasting and more dramatic results.
What is a face-lift?
A face-lift is a procedure to lift and tighten sagging skin on the face and neck. Surgeons perform the surgery in the operating room while the patient is often completely asleep under general anesthesia. During the procedure, surgeons make small incisions around the earlobes to help hide any surgical scarring, which is minimal. They lift and pull back loose facial and neck skin and connective tissue, removing excess skin before closing the incisions. The procedure addresses problem areas, such as:
- Jowls that occur on the jawline
- Loose neck skin
- Nasolabial folds, also known as marionette lines, between the nose and mouth
- Midface drooping
- Double chin
How long does it take to recover?
According to Ishii, one common misconception around a face-lift is recovery time. “Generally, people think recovery will be worse than it actually is,” she says. “They expect recovery to take six weeks, when in reality it only takes 10 to 14 days for most people.”
During recovery, people can expect some swelling and bruising while incisions heal. Your surgeon will provide detailed postsurgical care instructions and pain relief recommendations to speed your healing.
What are the benefits of a face-lift?
Not surprisingly, the primary benefits of a face-lift are increased satisfaction with your appearance and having others see you as more youthful and attractive. “People want what they feel on the inside to be reflected in the mirror,” says Ishii. “They also want to know that people around them are thinking positive thoughts about them.”
Ishii’s group has conducted new research to measure the impact of face-lifts from the perspective of a casual observer. That research involved showing before-and-after photos of face-lift patients to a group of nearly 500 online survey participants.
The participants estimated the age of the women in the photos and rated them according to attractiveness, perceived success and overall health. The survey results showed that casual observers saw the women who had undergone high-quality face-lifts as younger, more attractive, more successful and healthier.
What are the risks and drawbacks of a face-lift?
As with any surgical procedure, there are risks people should consider before heading to the operating room. General anesthesia poses a risk for some people, including older adults and people with health conditions such as obesity and diabetes.
Some people also have an increased risk of bleeding during surgery. These patients include smokers and people who take anti-clotting medications, such as warfarin.
If general anesthesia isn’t an option, Ishii says it’s possible to do the procedure under local anesthesia that numbs the facial area.
Will people be able to tell?
Some people worry that their faces will looked stretched out or that it will otherwise be obvious that they had surgery. Ishii says this shouldn’t be the case with the right surgeon. “If the surgery is performed well, the result will be natural in appearance,” she says. “Nobody will be able to tell.”
The key is to find a plastic surgeon with a track record of high-quality results. You can ask the doctor for before-and-after photos of patients so you can get a sense of the quality of their procedures. One important question to ask is whether the surgeon collects data on outcomes, specifically patient satisfaction. If a high percentage of people are extremely happy with the results after five years, you’re more likely to have a successful procedure.
RADIOTHERAPY DYSTROPHIC SKIN
Breast fat necrosis exhibits various profiles according to the process of nonpurulent inflammation and absorption. Intimal arterial damage caused by radiation exposure combined with surgical damage may result in tissue necrosis directly or indirectly (4).
Mammographically, the presence of a radiolucent oil cyst, round opacity, asymmetrical opacity, heterogeneity of the subcutaneous tissue, dystrophic calcification, clustered pleomorphic microcalcification or the presence of a spiculated mass is noted (Fig. 5). An ultrasound (US) examination can demonstrate the presence of a solid or anechoic mass with posterior acoustic shadowing or enhancement and can demonstrate the presence of a cyst with a mural nodule or internal echo or increased echogenicity of the subcutaneous tissue. On positron emission tomography (PET) imaging, fat necrosis may be seen with variable metabolic activities according to the process of inflammation. Therefore, a lesion with hypermetabolic activity can mimic tumor recurrence. As seen on magnetic resonance imaging (MRI), fat necrosis is characterized by the presence of a fatty signal intensity mass, often containing a fat-fluid level that exhibits variable enhancement following the administration of gadolinium contrast material. The presence of central fat signal intensity is the key to differentiate fat necrosis from tumor recurrence, as breast cancers do not contain central fat.
The radiation-induced breast changes may be seen in either dedicated breast imaging or CT chest performed for follow-up of other thoracic malignancies.
- skin thickening
- commonly seen within 6 months of the completion date
- slowly resolve until a certain point where a fibrotic thickening may persist
- interstitial oedema
- diffuse trabecular thickening representing engorged lymphatics
- oil cysts/fat necrosis
- dystrophic calcifications
- focal skin retraction
- glandular atrophy
- asymmetry of the glandular parenchyma noted when compared to contralateral breast
- decreased breast size
- breast fibrosis
- radiation-induced breast cancer
Treatment and complications
Radiation-induced breast malignancy is rare 1-3 and possible induced tumours include:
Differential diagnosis is mainly considered in those patients treating breast cancer, as it may be difficult to distinguish the above-mentioned breast changes from:
- local breast recurrence
- inflammatory breast cancer
- breast infection
David J. Gerth, MD; Bethany King, MD; Lesley Rabach, MD; Robert A. Glasgold, MD; and Mark J. Glasgold, MD
The science behind autologous fat grafting
Elisa Bellini, Michele P. Grieco, Edoardo Raposio