Understanding the Physiology

The neck and décolleté area is important in the overall aesthetic patient’s portrait. Thinner skin, plenty of blood vessels and a high rate of skin aging make it difficult to perform aesthetic procedures here and explain a longer rehabilitation.

In general, the mechanism of skin aging of the décolleté zone can be compared with chronic inflammation. It’s characterized by an increased level of proinflammatory cytokines IL-1, IL-6, IL-18 and TNF-alpha, and the presence of matrix metalloproteinases that destroy the matrix of the dermis. In this view, inflation management is a regulated process that we can influence. Therefore, we face the challenge of reducing the number of proinflammatory mediators. When working with the décolleté zone, we understand that to achieve a good result, we must set a course comparable in volume to that for the face. This doubles the cost of procedures and dictates the need to endure double pain. Not every patient is prepared for this morally and physically ... The most common set of complaints on the décolleté area, presented by patients, includes vertical wrinkles, decreased turgor and elasticity, hyperpigmentation.

Combined Treatment: Redermaneurolifting

A combined technique of rejuvenating décolleté area simultaneous use of botulinum toxin, hyaluronic acid and sodium succinate we call “redermaneurolifting”. Redermaneurolifting is aimed at combating various links in the pathogenesis of aging:
- Botulinum toxin promotes gentle relaxation of myofibrils of the skin, affecting the reduction of wrinkles in the décolleté zone, resulting from the wearing of tight clothing and deformation of the skin during sleep.
- High-molecular hyaluronic acid interacts with the receptors of CD-44, which leads to the formation of a ligand-antagonist of pro-inflammatory cytokines, and activates mediators that reduce inflammatory responses: arg-1, IL-10, mrc-1. It also helps to reduce the concentration of matrix metalloproteinase 9, which destroys collagen and elastin. In addition, hyaluronic acid improves the hydration of the dermis, being a powerful acceptor of moisture, as a result, the skin tone and elasticity increase, the intercellular matrix is restored, and the process of chronic inflammation of the dermis decreases.
- Sodium succinate eliminates the energy deficit of fibroblasts and reduces the content of matrix metalloproteinase 2, which destroys elastin and extracellular matrix proteins.

As a consequence, the architecture of the dermis is restored and the synthesis of collagen is activated, due to the activation of fibroblasts. Upon contact with the skin, succinate reversibly blocks tyrosinase, the enzyme responsible for the synthesis of pigment-melanin. As a result, the chain of melanin formation breaks down, and the intensity of its color decreases: the pigment passes from the darker oxidized eumelanin to the lighter reconstituted pheomelanin. Accordingly, the manifestation of the intensity of the pigment becomes less noticeable, and the skin color is more even.

The Clinical Study Review

Objective
To study the effectiveness of technology combined use of botulinum toxin, hyaluronic acid and sodium succinate for delicate correction of the décolleté.

Materials and methods
The study involved 23 volunteers (35 - 55 years old) with various age-related changes of décolleté and neck area 2 – 3 levels on a scale Glogau. Injections were performed intradermal micro papules with a 30 G needle according to a specific markup. During the procedure 40-50 Un of botulinum toxin (500 Un) and 1 ml of hyaluronic acid and sodium succinate were mixed in one syringe. The procedure was performed a single time, and can be repeated after 3 – 4 months. The procedures results were recorded after 2 weeks on the device Antera 3 D.

Results
When comparing photographs on the device Antera 3D before and 2 weeks after the procedure, we found an improvement in the skin’s texture by more than 20%, reducing the wrinkle’s depth by more than 25%. These indicators can be considered an indicator of the effectiveness of the procedure.

Conclusion
Redermaneurolifting can be successfully used for quick delicate correction of age-related changes in the décolleté zone. This technique can be supplemented by the introduction of the filler for a more pronounced correction effect. Redermaneurolifting can also be used in the forehead and eyebrow area to achieve a natural and delicate correction result.