During the natural aging process of the human body, several organs and tissues undergo a large anabolic phase (during the first 3 decades of life) and they soon develop into a catabolic phase, which is slower and irreversible (from the 4th to the final decades of life). In the anabolic phase the skin is shiny, silky, has elasticity and a large turgor.
There is a large volume of toned muscular mass. The catabolic phase starts in the fourth decade of life and accelerates during seventh decade until the end of life.
In this phase there is an absence of skin sheen and the appearance of wrinkles and senile spots (the dermal layer also starts to show signs of weakness, and this occurs because of the decrease of the proteins that make up the skins elastic system, such as collagen and glycosaminoglycan / GAG).
Muscular mass loses its volume and tone progressively, causing the body to show visible signs of aging. Probably a high protein diet may be responsible for the final quality of our organs and tissues during the anabolic phase causing the body to be more resistant and durable. This high protein diet, when applied during the catabolic phase, can maintain a better skin quality and improved muscular mass.
Excessive exposure to the sun appears to be the principal cause of aging caused by modem mans life style. It is normal that after every period of vacations many people seek the help of Dermatologists or Plastic Surgeons.
The usual symptoms that are seen in the doctors office are the increases in hyperchromatic staining, and the appearance of new small wrinkles around the eyes, as well as the skin being more difficult to moisturize. This appears to be a natural occurrence because we all know that the human skin, when exposed to the sun’s radiation for hours on end over several days, is attacked, invisibly, by ultraviolet radiation (UVA and UVB) and this type of radiation can cause perioxidation of lipids in the cellular membranes, leading to the generation of free radicals, which can stimulate melanocytes to produce excess melanin.
Sunscreen that block primary ultraviolet - B radiation (290 - 320 µm) are unsatisfactory because longer wavelengths (ultraviolet-A and visible radiation 320 - 700µm) will also stimulate the melanocytes to produce melanin. To revitalize the human skin and always keep it fresh and radiant, has for a long time, been the objective of medical professional and the cosmetic industry.

We will now analyze three different therapeutic proposals:

FACIAL REVITALIZATION WITH MINIMUM EXFOLIATION. (YELLOW PEEL SYSTEM)
Figs: 1A – 1B

YELLOW PEEL is the latest, and weaker chemical peeling, which can promote the elimination of the epiderm, at different depths, and it can also be tailored to the type of lesion. This peeling uses the retinal action together with the action of three substances, (Phytic Acid, Kojic Acid and Azelaic Acid) which block the synthesis of Melanin. It can be used for the treatment of Epidermal Melasma, Benign Hyperchromic Lesions of the Epidermis, Superficial Wrinkles and Acne Sequels. Its easy to apply, and when repeated, can provide the same benefits as the more aggressive peelings. YELLOW PEEL should be used in a thin and continuous layer all over the face, or only in the area that needs treating. After a superficial peeling using ALPHA BETA COMPLEX PEEL; (the objective of which is to prepare the stratum corneum for a perfect and uniform penetration of the YELLOW PEEL). YELLOW PEEL should be left on the skin for a continuous period of 1 hour and then removed with a neutral soap. Normally this treatment can be repeated for other periods of 1 hour, depending on the type of skin being treated or as recommended by the physician. During the treatment of Epidermal Melasma, this should only be repeated 2 – 3 times, it is enough to provoke a superficial epidermal peel, offering the minimum inflammatory process, which is the ideal for Epidermal Melasma therapy.
For the treatment of wrinkles, acne sequels and photoaged skin, it is possible to re-apply the YELLOW PEEL for 5 or 6 applications of 1 hour, causing a large irritation of the skin, promoting an epidermal peeling (renewal of the epidermis at different depths according to the irritation), also, with this stimulation of the dermis, superior benefits can obtained in the treatment of acne sequels and medium depth wrinkles.
The post peel period which occurs after the application of the YELLOW PEEL should be treated with Vaseline® or Hydrocortisone ointment, applied various time during the day, until the skin looses the epidermal layer (3 to 5 days). After the skin looses the epidermal layer it should be moisturised for at least 3 more days.
At the end of this period, a skin lightener can be used, without Retinoic or Glycolic Acids (eg: STAND BY C CREAM OR FACIAL C LOTION / Mene Moy System which does not contain Hydroquinone). The use of an efficient chemical free sunblock is required to avoid recidive of the lesions. Recent studies into skin photoprotection show that the 30 SPF sun blocks, that use Titanium dioxide and Zinc Oxide, reflect the suns rays, avoiding penetration into the skin, are classed as Physical solar protectors and are Chemical Free. These modern solar protectors are associated in the formula, with known antioxidants which can reduce the residual inflammatory process caused by the sun and protect the various structures and molecules which make up the human skin (Vitamin C, Pycnogenol, Phytic Acid and Vitamin E) and prevent the premature aging of the skin.

(FACIAL C SUN BLOCK)
TREATMENT OF THE AGED LIPS, WITHOUT
THE USE OF INJECTABLE PRODUCTS
(YELLOW PEEL BALM SYSTEM)
Fig 2A – 2B

The aging of the lips is probably one of the biggest concerns of men and women at the beginning of this new millennium. The keratinized stratified squamous epithelium is very sensitive, with a lot of blood vessels near to its surface and very few sebaceous glands. Unlike facial skin, the lips have a rapid rate of epithelial renewal, almost daily, unlike the renewal of other skin (about every 25-28 days). Because of a constant flow of air from the breathing process, it is not surprising that the lips become dry and split.
The thin skin of the lips becomes even thinner and age quicker than the rest of the body. In the catabolic phase, the lips lose volume and muscular mass and the absorption of the adipose tissue of this area, by way of the atrophy of the vascular system and by the natural aging process of the lip’s skin.
A low protein diet, excessive sun exposure and smoking, can speed up the aging of the lips.
Our proposals to recover the natural volume of the lips, without using injectable products, are:
1.The stimulation of the circulatory blood vessels (surface microcircle).
2. Increase the oxygenation of the tissue.
3. The renewal of the keratinized stratified squamous epithelium.
4. An increase of the level of proteins in the skins dermal layer, mainly glicosaminoglicana (GAG) (with the increase of GAG we retain a larger volume of water in the lip tissue and consequently, a natural increase of the lips volume).
The protocol for lip stimulation uses a creamy formulation (YELLOW PEEL BALM) which contains; Vitamin C, Guarana Extract, DNHTM Oil, Shea Butter, Retinal, and other ingredients. The stimulation phase is achieved by the hourly application of the cream directly to the labial mucous membrane, for 4 to 6 applications.
The treatment should be stopped when the desired volume is obtained. The next phase is the moisturization phase, to avoid natural drying, apply in abundance, especially at bedtime. To maintain the desired volume the stimulation phase may be applied 2 - 3 times over the weekend, but this depends on each individual clinical case.

TREATMENT OF EYE CONTOUR AGING,
WITHOUT SURGERY,
USING INTENSIVE SERUM W –
INTENSIVE SERUM P – ANTI WRINKLE
FINELINE REDUCING FORMULA (SKIN RENU SYSTEM)
Fig 3A – 3B,

4A – 4B,

5A – 5B

The aging of the periocular region is probably what has most worried men and women from the beginning of the century. The skin in this anatomical region is thin, sensitive and susceptible to pigmentation. The subcutaneous cellular tissue is very thin and this entire group of skin and subcutaneous cellular tissue is supported over a muscle which is a very delicate periorbital orbicular muscle. Another part of the anatomy is fatty bags that help to support the eyeball (bulbus oculi)
For many years, plastic surgery was the only treatment used in the aging of the eye contours. This treatment, on its own, brings good results in the short term, from the point of view of the removal of excess skin and baggy eye lids. In the medium and long term the quality of the skin becomes important and other complementary treatments could be needed for the perfect recovery of the structure of the eye contour. Blepharoplasty took on a new direction after the introduction of the laser as a surgical tool.
The final quality of the skin is far superior after treatment by laser skin resurfacing. Bleeding almost never occurs and the recovery time is vastly reduced. For younger patients, with a lesser degree of age damage, there are different techniques that can adequately repair this anatomical area without the need for surgery.
By way of a chemical, non exfoliating, stimulation program, it is possible to develop a large amount of a structural protein called glycosaminoglycans (GAG’s) which are responsible for the retaining the intradermal water, which is fundamental to keep the skin turgid, flexible and showing an attractive sheen.
This procedure should be repeated every 15 days; because of the life cycle of the GAG’s and between each non exfoliating stimulation the skin should receive daily antioxidant treatment, having a low renewal capacity of the superficial stratum corneum. When there is a large activity of the orbicular muscle and this leads to the formation of wrinkles which are increased upon muscular contraction (Dynamic Wrinkles), the best treatment is the apply botulinum toxin, which is injected into the muscle, to allow temporarily relaxation.
This treatment is very popular at the moment, but its cost, and the trauma caused by the needle, scares a lot of people away. A new, revolutionary, product has been released in the US is a topical product containing a hexapeptide, which is capable of penetrating the skin.
This also relaxes the muscle, similar to the effect obtained with the botulinum toxin. Together with this effect, the hexapeptide proposal also restores the lipidic layer. This recovery is very important in maintaining the quality of the skin, as the skin has suffered a lot, over the years, by the loss of this group of natural lipids, which are found in young skin. Another therapeutic possibility is the topical use of a serum

(INTENSIVE SERUM P, from Skin Sciences Inc. – SkinRenu – USA) which is applied to the area around the eyes, 2 to 3 times per day.
This formulation has show excellent clinical results (Figs: 4A – 4B, 5A – 5B) and appears to reduce the volume of the under eye bags, acting on the allergic inflammatory process and the venous (microcircle deficiency) which are normally involved in under eye puffiness.

Romulo Mene
Specialista in plastica ricostruttiva e chirurgia estetica
Societŕ Brasiliana di medicina e chirurgia laser (SBLMC).
Direttore internazionale del SBLMC.