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      Rol de la carboxiterapia en la mejora de la calidad de piel antes de ritidoplastia Translated title: Role of carboxitherapy in improving skin quality prior to rhythidoplasty

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          Abstract

          RESUMEN Introducción y objetivo. Los cambios anatómicos faciales que resultan como consecuencia del envejecimiento son uno de los principales motivos de consulta en Cirugía Estética facial. Nos proponemos determinar los cambios histológicos secundarios a la aplicación de carboxiterapia previa a la ritidoplastia, tomando en cuenta la aceptación de los pacientes en relación a mejora en la calidad de su piel facial tras el tratamiento. Material y método. Aplicamos 10 sesiones de carboxiterapia facial 5 semanas antes de la intervención quirúrgica de ritidoplastia. Infiltramos el dióxido de carbono por vía percutánea alrededor de cara y cuello a excepción de las regiones pre y postauriculares derechas. La ritidpolastia fue realizada por diferentes cirujanos y codificamos y analizamos las muestras de piel tomadas de las áreas pre y postauriculares Resultados. Llevamos a cabo el estudio en 7 pacientes. Histología: la disposición de las fibras de colágeno fue en espiral y nódulos en la zona preauricular derecha (área no tratada), mientras que en la zona preauricular izquierda la disposición de colágeno fue lineal, diferencia estadísticamente significativa (p=0.0052). La proliferación de tejido celular subcutáneo en la zona preauricular izquierda disminuyó de una manera evidente (p=0.03), mientras que el área postauricular no presentó este fenómeno (p=0.10). Conclusiones. La carboxiterapia previa a la cirugía de ritidoplastia es un procedimiento seguro, que en nuestro estudio no prolongó el tiempo quirúrgico ni aumentó la respuesta inflamatoria. Los cambios histológicos hallados demostraron cambios en la disposición del colágeno en las áreas tratadas, con mayor elasticidad de la piel. Hubo también disminución en la proliferación celular en el área que recibió carboxiterapia sin alteración de la estructura de la dermis.

          Translated abstract

          ABSTRACT Background and objective. Anatomical facial changes as a result of aging are one of the main reasons for consultation in Facial Aesthetic Surgery. We propose to determine the histological changes secondary to the application of carboxytherapy prior to rithidoplasty, taking into account the acceptance of patients in relation to improvement in the quality of their facial skin after treatment. Methods. We applied 10 sessions of facial carboxytherapy 5 weeks before the surgical procedure of rhithidoplasty, infiltrating carbon dioxide percutaneously around the face and neck except for the right pre and post-auricular regions. Rhithidoplasty was performed by different surgeons and we encode and analyze the skin samples taken from the pre and post-auricular areas Results. The study was conducted on 7 patients. Histology: the arrangement of the collagen fibers was spiral and nodules in the right preauricular zone (untreated area), while in the left preauricular zone the collagen arrangement was linear, statistically significant difference (p=0.0052). Proliferation of subcutaneous cellular tissue in the left preauricular area decreased in an evident way (p=0.03), while the postauricular area did not present this phenomenon (p=0.10). Conclusions. Carboxitherapy prior to rhythidoplasty surgery is a safe procedure, that in our study did not prolong surgical time or increase the inflammatory response. The histological changes found showed variations in the arrangement of collagen in the treated areas, with greater elasticity of the skin. There was also a decrease in cell proliferation in the area that received carboxytherapy without altering the structure of the dermis.

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          The role of fibroblasts in tissue engineering and regeneration.

          Fibroblasts are mesenchymal cells that can be readily cultured in the laboratory and play a significant role in epithelial-mesenchymal interactions, secreting various growth factors and cytokines that have a direct effect on epidermal proliferation, differentiation and formation of extracellular matrix. They have been incorporated into various tissue-engineered products such as Dermagraft (Advanced BioHealing, La Jolla, CA, U.S.A.) and Apligraf (Novartis, Basel, Switzerland) and used for a variety of clinical applications, including the treatment of burns, chronic venous ulcers and several other clinical applications in dermatology and plastic surgery. In this article we review the cell biology of dermal fibroblasts and discuss past and current experience of the clinical use of cultured fibroblasts.
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            Fibroblasts in mechanically stressed collagen lattices assume a "synthetic" phenotype.

            Fibroblasts are subjected to changes of the mechanical force balance during physiological as well as pathological situations, such as wound healing, development of hypertrophic scars, and fibrogenesis. However, the molecular response and the changes in fibroblast gene expression upon mechanical stimulation remain poorly understood. As an in vitro model, human dermal fibroblasts were cultured within a three-dimensional network of fibrillar collagen either under high (stressed) or low tension (relaxed). cDNA microarray technology in combination with Northern blot analysis led to identification of mechano-responsive genes coding for extracellular matrix proteins, fibrogenic growth factors, protease inhibitors, components of focal adhesions, and the cytoskeleton. Application of biaxial strain to fibroblasts cultured on flexible silicone membranes revealed that the type of strain as well as the properties of the substrate induced different patterns of gene regulation. The transcriptional profile of mechanically induced genes in collagen lattices suggests that mechanical stimuli lead to a "synthetic" fibroblast phenotype characterized by induction of connective tissue synthesis while simultaneously inhibiting matrix degradation.
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              Mechanoregulation of gene expression in fibroblasts.

              Mechanical loads placed on connective tissues alter gene expression in fibroblasts through mechanotransduction mechanisms by which cells convert mechanical signals into cellular biological events, such as gene expression of extracellular matrix components (e.g., collagen). This mechanical regulation of ECM gene expression affords maintenance of connective tissue homeostasis. However, mechanical loads can also interfere with homeostatic cellular gene expression and consequently cause the pathogenesis of connective tissue diseases such as tendinopathy and osteoarthritis. Therefore, the regulation of gene expression by mechanical loads is closely related to connective tissue physiology and pathology. This article reviews the effects of various mechanical loading conditions on gene regulation in fibroblasts and discusses several mechanotransduction mechanisms. Future research directions in mechanoregulation of gene expression are also suggested.
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                Author and article information

                Journal
                cpil
                Cirugía Plástica Ibero-Latinoamericana
                Cir. plást. iberolatinoam.
                Sociedad Española de Cirugía Plástica, Reparadora y Estética (SECPRE) (Madrid, Madrid, Spain )
                0376-7892
                1989-2055
                March 2020
                : 46
                : 1
                : 99-106
                Affiliations
                [3] orgnameInnovare Otorrinolaringología México
                [2] orgnameInnovare Cirugía Plástica México
                [1] orgnameInstituto Jalisciense de Cirugía Reconstructiva Dr. Guerrerosantos México
                Article
                S0376-78922020000100014 S0376-7892(20)04600100014
                10.4321/s0376-78922020000100014
                aadfa4f4-090c-43ef-a497-c3c75e503aa5

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

                History
                : 10 January 2020
                : 07 November 2019
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 17, Pages: 8
                Product

                SciELO Spain

                Categories
                Tratamientos no quirúrgicos

                Aging,Carboxiterapia,Calidad piel,Envejecimiento,Ritidoplastia,Carboxitherapy,Skin quality,Rhithidoplasty

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