INTRODUCTION

Palmieri et al, in 2017, defined biostimulation as a technique specific to aesthetic medicine consisting of injecting different drugs such as nucleotides, antioxidants and glycosaminoglycan precursors into the dermis to improve the anabolic function of dermal fibroblasts, that is, to activate protein synthesis, replication and production of extracellular matrix (ECM) components ².

The dermal ECM provides strength and elasticity to the skin. The ECM consists mainly of type I collagen fibrils, produced by fibroblasts. The binding of fibroblasts to collagen fibrils generates mechanical forces that regulate cell morphology and function. With aging, collagen fragmentation reduces the binding of fibroblasts to the ECM and mechanical forces, causing fibroblasts to reduce their functions, including collagen production³. Aging is a natural, dynamic and multifactorial phenomenon that occurs in all human beings ⁴. The skin also goes through the aging process, which is characterized by cellular degradation, fatty atrophy, relaxation and repeated muscle contraction and decreased vascularization, resulting in the appearance of visible signs, such as wrinkles and other less evident signs, such as loss of texture, color, tone and shine, all of which cause functional and aesthetic deterioration⁵.

CLINICAL CASE

60-year-old female patient with a history of abdominal liposuction complicated by secondary fibrosis approximately 2 years ago, and multiple cosmetic procedures (lymphatic drainage, massages, ultrasound, abdominal radiofrequency) for a year and a half, which were performed on multiple occasions for the treatment of abdominal flaccidity. She comes to the consultation for aesthetic medical treatment for moderate to severe flaccidity and folds in the abdominal region, so upon diagnosis a session with a calcium hydroxyapatite-type collagen biostimulator 1.5 ml plus 2.0 ml of physiological solution plus 0.5 ml of 2% lidocaine with a retrograde linear fan technique in a subdermal plane at the level of each 10*10cm quadrant, 0.025 ml per vector with a 25G cannula is suggested. Multipolar radiofrequency therapies were indicated one month after treatment and photographic follow-up for reassessment, demonstrating efficacy, safety, good tolerability and significant correction of approximately 60% in the correction of folds as well as at the level of sagging, turgor, tone and appearance of the skin in the anterior abdominal region, returning a more natural appearance of the area and long-lasting results.

CONCLUSIONS

Collagen and elastin are components of the extracellular matrix that confer important biomechanical properties and structures to the skin, with collagen type I and III being the main dermal components, representing 77% of the fat-free net weight of adult skin⁶. These collagen subtypes provide tensile strength and structural support to the skin⁶. In older patients, augmentation that mimics both bone and soft tissue is often needed. The tissue response to any insult is inflammation, if controlled and self-limited, which will lead to the desired biostimulation effect; but if it becomes chronic or the inflammatory response is excessive, an adverse effect will occur. The combination of materials at different levels must be adapted to the age and conditions of each patient and thus consider the results to be stable, safe, natural and highly effective.

REFERENCES
1. Revista científica de la Sociedad Española de Medicina Estética, Revista Nº 73. Publicado 08/11/2022. DOI: 10.48158/MedicinaEstetica.073.02
2. Palmieri A, Avantaggiato A, Cura F, Papalia R, Casale M, Bressi F, Scapoli L. Effect of biostimulation on oral fibroblast: a pilot study. J Biol Regul Homeost Agents. 2017 Dec 27;31(4 Suppl 2):139-145.
3. Quan T, Wang F, Shao Y, Rittié L, Xia W, Orringer JS, Voorhees JJ, Fisher GJ. Enhancing structural support of the dermal microenvironment activates fibroblasts, endothelial cells, and keratinocytes in aged human skin in vivo. J Invest Dermatol. 2013 Mar;133(3):658-667. https://doi.org/10.1038/jid.2012.364
4. Alvarado A, Salazar A. Análisis del concepto de envejecimiento. Gerokomos. 2014; 25(2): 57-62
5. Ruiz M, Morales M. Aproximación al tratamiento del envejecimiento cutáneo. Ars Pharm. 2015; 56(4): 183-191
6. Yutskovskaya Y, Kogan E y Lehunov E. A Randomized, Split- Face, Histomorphologic Study Comparing a Volumetric Calcium Hydroxylapatite and a hyaluronic Acid- Based Dermal Filler. . 2014; 13(9), 1047-52.