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Plast should not be tightly shut; there is no need for a subcutane- Reconstr Surg 2:481 11 buy 3 ml lumigan mastercard medications hydroxyzine. Plast Reconstr Surg 2:358 single everting skin sutures buy 3 ml lumigan fast delivery symptoms uterine cancer, which allow for the draining of 12 lumigan 3ml otc treatment improvement protocol. Plast Reconstr Surg 15: Such compression is obtained by using an abundant amount 411–418 of cotton wool and by avoiding application of the gauze 14 buy lumigan 3 ml on line medicine 9312. Br For a good outcome from the surgical procedure patient J Plast Surg 16:268 information must be understandable, clear, and detailed. Caouette-Laberge L, Guay N, Bortoluzzi N, Belleville C (2000) the surgical procedure as well as the behavioral rules which Otoplasty: anterior scoring technique and results in 500 cases. Plast Reconstr Surg 105:504–515 can be followed in order to facilitate a satisfactory outcome. He Plast Surg 10:29–33 or she has to consider himself or herself not just a sculpture 21. Lissia M, Farace F, Di Giulio S, Figus A (2004) A broken forceps to be shaped, but an active element of the remodeling and for anterior scoring: a cheap and simple device for anterior scoring. Riv Ital Chir according to the guidelines issued by the Italian Society of Plast 31:35–39 Reconstructive and Aesthetic Plastic Surgery and it is in part 23. Scuderi N, Tenna S, Bitonti A, Vonella M (2007) Repositioning of posterior auricular muscle combined with conventional otoplasty: a personal technique. Associazione e Rivista Italiana di Studi e Ricerche sulle Medicine Antropologiche 1. Matsuo K, Hayashi R, Kiyono M, Hirose T, Netsu Y (1990) Otolaryngol 10:97 (reprinted Plast Reconstr Surg 1968;42: Nonsurgical correction of congenital auricular deformities. Mazzola 1 Introduction 2 Use of Cosmetics: A Historical Overview Humankind has always been concerned by death and old age, something unavoidable in life. It is no wonder that people seek much has been written about use of cosmetic remedies alone and try to invent items and solutions that stop aging or reverse or in combination, beginning from ancient Egypt, where aging. The question is, exists somewhere the Fountain of Youth facial wrinkles, a consequence of excessive exposure to the (Fig. The legend goes back wax-based blend containing gum of frankincense, moringa to at least fifth century B. Removal wrote of such a fountain, which contains a special type of water of upper layer of the skin for maintaining a youthful look in the land of the Macrobians, which gives the Macrobians their was by honey, red natron, and salt of the North pulverized exceptional longevity. According to a Marinelli (sixteenth century) published the first textbook popular anecdote, Ponce de León discovered Florida while entirely devoted to the beauty of women and how to preserve searching for the Fountain of Youth, a magical water source it with creams, ointments, and other remedies [2 ]. In this chapter, we De Decoratione, an account on cosmetics where he demon- will review their evolution. On a completely opposite advice cosmetic/medical treatments, or surgical methods, in other was the English physician John Bulwer (1606–1656). While terms noninvasive procedures like creams, ointments, mini- appreciating the perfection of the woman face, he was strongly mally invasive like chemical peeling, dermabrasion, fillers, or against any sort of cosmetic remedy (Fig. The technology-dependent options such tion of the body, unless provided by nature, what he called as radiofrequency and laser, introduced in a relatively recent “the artificial changling” had to be condemned. Mazzola 4 Fillers The history of injectables, often disseminated by disastrous and sometimes tragic results, is very instructive. Leonard Corning (1855–1923), a New York City neu- rologist, the discoverer of spinal anesthesia and the Viennese physician Robert Gersuny (1844–1924) began to experiment with paraffin in the late nineteenth century apparently simul- taneously and independently [7]. Leonard Corning used paraffin to prevent reunion of nerves after subcutaneous neu- rotomy and to enhance the antalgic effect of cocaine on some nerves of the sensibility [8], whereas Gersuny to solve fea- tural imperfections, urinary incontinence, velo-pharyngeal incompetence, Romberg disease, etc [9]. But one of the most common indications was correction of saddle nose deformity due to cartilage reabsorption, very frequent problem for the diffusion of syphilis. With a melting point between 46 and 68 °C (115 and 154 °F), paraffin could be introduced without incisions either alone or, at different times, according to Gersuny, in combi- nation with Vaseline, or Vaseline alone, or Vaseline with olive oil. The armamentarium was easy obtainable: the paraffin in pearls or in cubes, a pot for melting the wax (Fig. They began to advertise in newspapers, Hebra (1816–1880), founder of the Vienna School of yellow pages, and to give demonstrations in beauty salons Dermatology. Paraffin represented the panacea for a variety ton oil, nitric acid in various cautious combination for treat- of cosmetic and functional applications without the need for ing freckles and skin irregularities. News of this apparently ideal substance dermatologist Paul Gerson Unna (1850–1929) reported the began to spread through the medical community. Since then chemical peeling has mity was great and the immediate outcome particularly been largely employed, obtaining consistent results mainly favorable (Fig. The new miracle began to Dermabrasion represents another option for skin resurfac- fade. In 1905, the German dermatologist Ernst Kromayer specifically named “paraffinomas”, due to wax, oil and (1862–1933) invented an electrically powered instrument Vaseline penetrated within the tissues was the most com- that rotates a burr which could remove the superficial skin mon event almost impossible to solve, but also causing pul- layers at various depths [6]. Removing paraffin laser resurfacing, interest for dermabrasion has been par- proved to be more difficult than injecting it (Fig. Despite this, paraffin continued to be injected mainly into the nose, face, and breast until the 1960s. Diffuse James Franklin Hyde (1903–1999), an American chemist is facial paraffinomas with attempted removal (From: Loeb [40] ) credited with the launch of the silicone industry in the 1930s. His work led to the formation in 1943 of Dow Corning Corporation cre- victim of the paraffin, the Duchess of Marlborough, who, in ated to pioneer the development of silicone products as a 1935, had paraffin and wax introduced into her face and result from the alliance between the Corning Glass Works forehead, causing an incredible number of bumps and and the Dow Chemical. She was completely disfigured, becoming a Because of their low toxicity, pure silicones presented a recluse for the rest of her life and saw only close friends, small risk of unfavorable biological reactions and had despite she was considered one of the most beautiful obtained widespread recognition and popularity among the women of the planet, before the event occurred. In the 1960s, a new miraculous filler appeared on the mar- ket: the liquid silicone, an amazing chemical product – man- ufacturers advertised – that could turn old faces into young, 4. Considered an inert material that ing them to correct depressions, crow’s feet, nasolabial could be easily sterilized, the liquid was injected directly grooves, and saddle noses. He asserted that these stuffs were into women’s breasts, or into the face for augmenting lips inert, well tolerated and particularly effective. The “procedure” spread out special syringe with barrel to introduce the material so rapidly that silicone available for implantation was dif- subcutaneously. History of Facial Rejuvenation 845 However, after an initial honeymoon period, dramatic a complications such as discoloration, infections, migration, granulomas formation, the so-called siliconomas, hardening of tissues, were soon being documented. There is an extensive literature on facial treat- ments, particularly lips, frown lines, crow’s feet, cheeks, etc. Patients are seeking more and more quick recovery and minimally invasive nonsurgical proce- dures. Fillers in aesthetic facial improvement represent one of the most popular minimally invasive cosmetic procedures [14]. Nowadays, fillers can achieve spectacular results, but may give rise to numerous dramatic complications (e. The lesson drawn from their use, often uncontrolled, indicates that physicians must always carefully develop a Fig. In particular, sion of a piece of skin along the hairline and the natural Holländer injected fat into the face to minimize the conse- folds of the ageing wrinkles and I rejuvenated the drooping quences of facial atrophy (Fig. Miller , con- long term due to unpredictable reabsorption rate, tendency sidered by some the “father of modern cosmetic surgery”, to form cysts and become fibrotic.

The large size of these molecules mens include signal peptides buy 3ml lumigan with amex treatment dynamics florham park, carrier peptides discount lumigan 3ml mastercard treatment of scabies, and limits is penetration through the stratum corneum order lumigan 3ml otc symptoms 0f low sodium. The ability of these large-molecular-weight compounds are popularly used in over-the-counter antiaging regimens discount lumigan 3ml visa medications xarelto. Peptides are sequences of amino acids that mimic the amino acids in collagen and 1. Proteins are agents developed to improve skin and hair elastin and are believed to increase collagen and elastin syn- hydration thesis. One caveat of peptide use in skin products is the inability of these large- molecular-weight compounds to Protein when applied topically has the unique ability to penetrate the stratum corneum. Similar to a humectant, the There are three types of peptides used in cosmeceuticals: ability to hold water improves the appearance of aged skin signal peptides, carrier peptides, and neurotransmitter- by providing hydration and assisting in barrier repair. Proteins have also been added to many hair conditioners to Signal peptides are short-chain amino acids that augment restore hair shaft fractures induced by aging and repeated communication between cells. An alternative peptide, tyro- 23 Antiacne Agents sine-tyrosine-arginine-alanine-aspartic-alanine, inhibits pro- collagen C-proteinase, an enzyme that cleaves C-propeptide Many of the products previously mentioned in this chapter from procollagen-I and thereby decreases collagen break- including retinoids, salicylic acid, and azelaic acid are useful down. Alternatively, lysine-threonine-threonine-lysine-serine in the management of acne [194]. Azelaic acid is a Carrier peptides are peptides with an ability to deliver met- naturally occurring botanical with mild antimicrobial and als to the skin. Copper is a cofactor for lysyl ceuticals include niacinamide, which increases desquama- oxidase, the enzyme needed for collagen synthesis. Topical preparations containing 1–10% sulfur are mild peptide known as Argireline® (acetyl-glutamyl-glutamyl- keratolytics and bacteriostatic agents against P. Sodium methoxyl-glutaminyl-arginyl-arginylamide) function similar sulfacetamide is also a bacteriostatic agent with activity to botulism toxin. Argireline mimics the N-terminal domain against both gram-positive and gram-negative bacteria. Johns wort water based lotions Ginkgo biloba Abrasive scrubs Evening Primrose oil Toners Tea tree oil Astringents Allantoin Acetone Aloe vera Propylene glycol Panthenol Glycerin Bisabolol Glycolic acid Salicylic acid Lactic acid Fragrances Dyes 24 Anti-redness Agents 25 Irritancy Facial redness is multifactorial. Irritant and allergic dermatitis is common with over-the- lation and inflammation can be reduced by skin care products counter skin care products. Fragrances, preservatives, and vehicles are common cul- Product ingredients used for erythema include soothing agents prits of irritancy or hypersensitivity. Patient education regarding product ingredients and their and anti-inflammatory agents such as green tea [195]. Moisturizers proper use can enhance compliance and decrease skin and cosmetics have also been developed with green tinted color- irritation. Patients with facial redness should avoid products containing harsh acids such as salicylic Contact dermatitis, either irritant or allergic, is seen com- acid. Products with fragrance enhance irritancy and can poten- monly with cosmeceuticals [196]. Although many natural or synthetic products are potent skin developed to quantify skin firmness, blood flow, and skin sensitizers or irritants, the vehicles in which these products are hydration. These instruments are now in widespread use to made also contain preservatives, fragrances, and colorings that quantify and measure objective parameters, and will be use- can cause irritant or allergic contact dermatitis [197]. Conclusion Additionally, chemicals such as benzyl alcohol and benzyl In 2006, the cosmeceutical market rose to nearly eight bil- aldehyde, often used as a fragrance, can be added to products lion dollars in profits in the United States alone. These prod- development, use, and marketing of these products will ucts are routinely used in “fragrance free” cosmetics. Similarly, designed, randomized placebo-controlled trials and basic products labeled as “unscented” do not imply that no fra- science research is lacking. Vehicles containing these preser- vatives are so widespread that it is often challenging for the patient who has developed an irritant or allergic reaction to these agents to effectively depict the culprit ingredient. Bibliography Patch testing is recommended for any patient with contact dermatitis. Food and Drug about product ingredients is imperative, particularly when an Administration Center for Food Safety and Applied Nutrition unknown or treatment recalcitrant contact hypersensitivity Office of Cosmetics and Colors Fact Sheet. Cosmet Toilet 108:37–38 The increasing demand for cosmeceuticals and rapid growth 5. Exp Dermatol 15(7): need for improved methods to evaluate the safety and effi- 483–492 cacy of these products in well-controlled trials. A report from the Standardization Group of the European Society of Contact thered our knowledge and understanding of topical products Dermatitis. Skin color changes can also be objectively differentiation and barrier homeostasis. Skin Pharmacol Appl measured using tools such as tristimulus colorimeters that Skin Physiol 14 Suppl 1:28–34 11. Exp Dermatol envelope: an important marker of stratum corneum maturation in 16:490–499 healthy and dry skin. Loden M (2003) Role of topical emollients and moisturizers in the relates of the epidermal permeability barrier. Piacquadio D, Kligman A (1998) The critical role of the vehicle to barrier repair lipids alleviate childhood atopic dermatitis: changes therapeutic efficacy and patient compliance. J Am Acad Dermatol in barrier function provide a sensitive indicator of disease activity. Semin Cutan model for assessing the damaging effects of soaps and surfac- Med Surg 20:209–214 tants on human stratum corneum. Int J Dermatol izers to reduce dry skin and irritation and to prevent their return. Exp Dermatol 8(4): Divergent mechanisms for correction of permeability barrier dys- 261–266 function. Bikowski J (2001) The use of therapeutic moisturizers in various Influence of aging and malignant transformation on keratinocyte dermatologic disorders. Ludwig A, Dietel M, Schäfer G, Müller K, Hilz H (1990) Am Acad Dermatol 39:S2–S7 Nicotinamide and nicotinamide analogues as antitumor promoters 60. Dermatol Surg anisms of intrinsic skin aging and retinoid-induced repair and 31(7 Pt 2):860–865; discussion 865 reversal. J Am Acad Dermatol 54:507–512 of photodamaged skin after therapy with tretinoin emollient 84. J Am Acad Dermatol 25(2 Pt 1):231–237 photocarcinogenesis by topical nicotinamide. Coderch L, De Pera M, Fonollosa J, De La Maza A, Parra J (2002) 199(Suppl 1):57–60 Efficacy of stratum corneum lipid supplementation on human 66. Creidi P, Humbert P (1999) Clinical use of topical retinaldehyde 31(7 Pt 2):814–817; discussion 818 on photoaged skin. Joyeux M, Lobstein A, Anton R, Mortier F (1995) Comparative tene cream for the treatment of photodamage: a 12-month multi- antilipoperoxidant, antinecrotic and scavenging properties of ter- center, randomized trial. Scharffetter-Kochanek K, Wlaschek M, Brenneisen P (1997) tion topical antioxidants vitamin C and vitamin E. Arch Biochem pigmentation and skin cancer induced by ultraviolet irradiation in Biophys 397:377–383 Skh:2 hairless mice. J Am effect of superoxide-scavenging antioxidants against ultraviolet Coll Nutr 20(6):591–598 radiation-induced chronic skin damage in the hairless mouse.

Atrophic vaginitis typically occurs in menopausal women purchase 3 ml lumigan overnight delivery treatment guidelines, but it can also occur in women at any age who have a decrease in estrogenic stimulation to this area of the genitalia cheap lumigan 3 ml with amex medicine 524. In premenopausal women 3 ml lumigan with mastercard treatment plan goals and objectives, hypoestrogenic settings include postpartum 3ml lumigan mastercard medications 6 rights, lactation, and during administration of antiestrogenic drugs. Vaginal atrophy that follows the gradual decline of estrogen production is often associated with manifestations and at other sites including the bladder floor and urethra. Accordingly, urethral and bladder symptoms may be a manifestation of estrogen deficiency including dysuria. The loss of estrogen also has an effect on the bladder lining facilitating the development of bacterial cystitis in aging women. Another impact of estrogen deficiency relates to the loss of muscle tone and dilatation of the vaginal introitus, as well as contributing to the development of prolapse of bladder, uterus, and rectum. Clinical Manifestations The earliest effects of estrogen deficiency are progressive atrophy and diminished vaginal secretions 910 manifesting as vaginal dryness experienced during intercourse. While early symptoms may be relieved in part by the use of vaginal lubricants, invariably, progressive estrogen deficiency will not be compensated for by the use of such lubricants. Ultimately, adequate vaginal lubrication for pain-free intercourse will require adequate estrogenic effect on the vaginal epithelium. Vaginal dryness is often experienced by women long before the onset of amenorrhea or the development of systemic vasomotor symptoms and is followed by dyspareunia. Dyspareunia is initially superficial or entry in nature, but with progression of the vaginal atrophy, the discomfort and pain will be experienced throughout and following intercourse with discomfort and irritation and even itching, lasting for several days after intercourse. With advanced atrophy, patients may complain of postcoital bleeding as a result of the susceptibility of the thinned vaginal epithelium to the effects of local friction and trauma. Diagnosis Vaginal atrophy and estrogen deficiency can be easily diagnosed without the use of sophisticated testing. The elevated pH is a consequence of the loss of the lactic and other organic acid producing bacteria. Lactic acid–producing bacteria are replaced in part by gram-negative organisms, usually coliform, which in their own right are not pathogenic. On wet mount microscopy, the paucity of the typical rod-shaped bacterial morphotypes is apparent. Another important diagnostic feature is the appearance of parabasal epithelial cells reflecting a lack of maturation of basal and parabasal cells in the absence of adequate estrogen stimulation to achieve full maturation effect. Increase in the number of parabasal cells will confirm the diagnosis in the presence of elevated pH and altered bacterial flora. Neither does receipt of oral nor transcutaneous estrogen products preclude the development of vaginal atrophy. Treatment One of the most remarkable biological miracles is the reversible nature of vaginal atrophy. Following adequate estrogen replacement, especially by the vaginal route, a rapid transformation can be anticipated with reversal of the vaginal thinning together with reconstitution of healthy, protective bacterial flora with a dominant lactobacillus morphotype as well as the return to normal vaginal pH and accompanied by the disappearance of parabasal cells [37]. This dramatic change can be expected within 4–6 weeks of adequate estrogen replacement therapy. These include intravaginal estradiol as creams or vaginal suppositories of estradiol. Not infrequently, vaginal atrophy continues and progresses in the presence of systemic estrogen therapy. A more recent alternative is the use of the estrogen releasing vaginal rings of which several varieties are available. One can anticipate a return to vaginal health within 1–2 months although the use of lubricants during intercourse may still be required. These symptoms are indistinguishable from those of infectious syndromes but are most commonly confused with those of acute Candida vaginitis (e. There is an enormous list of topical factors that are responsible for local inflammatory reactions and symptoms, and many more have yet to be defined. Unfortunately, given the anticipated 20% colonization rates in normal asymptomatic women, a positive yeast culture sometimes reflects the presence of an “innocent 911 bystander” organism rather than the cause of a patient’s vulvovaginal symptoms. The only logical way of establishing the role of Candida in this context is to treat the patient with an oral antifungal agent and assess the clinical response. Once a local chemical, irritant, or allergic reaction is suspected as the cause of vaginitis and/or vulvitis, a detailed inquiry into possible causal factors is essential. Offending agents or behaviors should be eliminated whenever possible, including the avoidance of chemical irritants and allergens (e. The immediate management of severe vulvovaginal symptoms of noninfectious etiology should not rely on topical corticosteroids, which are rarely the solution to such symptoms; moreover, high-potency steroid creams often cause intense burning. Local relief measures include sodium bicarbonate sitz baths and oral antihistamines. Effect of lactobacillus in preventing post-antibiotic vulvovaginal candidiasis: A randomised controlled trial. Mannose-binding lectin gene polymorphism, vulvovaginal candidiasis and bacterial vaginosis. Effects of recent sexual activity and use of a diaphragm on the vaginal microflora. Recurrent vulvovaginal candidiasis: Results of a cohort study of sexual transmission and intestinal reservoir. Oral versus intravaginal imidazole and triazole anti-fungal treatment of uncomplicated vulvovaginal candidiasis (thrush). Clinical practice guidelines for the management of candidiasis: 2009 update by the infectious Diseases Society of America. Single oral dose fluconazole compared with conventional clotrimazole topical therapy of Candida vaginitis. Treatment of complicated Candida vaginitis: Comparison of single and sequential doses of fluconazole. Treatment of Candida glabrata vaginitis: A retrospective review of boric acid therapy. Prevalence of Candida glabrata and its response to boric acid vaginal suppositories in comparison with oral fluconazole in patients with diabetes and vulvovaginal candidiasis. Maintenance fluconazole therapy for recurrent vulvovaginal candidiasis, N Engl J Med 2004;351:876–883. Individualized decreasing-dose maintenance fluconazole regimen for recurrent vulvovaginal candidiasis (ReCiDiF trial). Molecular analysis of the diversity of vaginal microbiota associated with bacterial vaginosis. The role of bacterial vaginosis and vaginal bacteria in amniotic fluid infection in women in preterm labor with intact fetal membranes. Vaginal lactobacilli, microbial flora, and risk of human 912 immunodeficiency virus type 1 and sexually transmitted disease acquisition. Association between acquisition of herpes simplex virus type 2 in women and bacterial vaginosis.

Syndromes

• Not enough oxygen to the brain (heart stopped, stopped breathing, complications from anesthesia)
• Hematoma (blood accumulating under the skin)
• Endoscopy
• Iliotibial band syndrome -- a hip disorder from injury to the thick band that runs from your hip to the outside of your knee
• Hydrogen peroxide
• CT scan of the chest

The achievement of an optimal aesthetic outcome can require several months 3ml lumigan with mastercard symptoms quiz, which are necessary for the production of col- lagen discount lumigan 3ml mastercard symptoms 8 days after ovulation, however purchase lumigan 3ml with amex treatment brown recluse spider bite, when the reddening fades away the patient is already able to notice an evident improvement of skin quality lumigan 3ml visa medicine pictures. Despite the high degree of precision of the laser, not all the wrinkles or skin irregularities can be solved with one treatment and in many cases several treatments are needed in order to reach the desired results. It is important to know that the obtained result is not permanent because the new skin will not be unaffected by the aging processes. There is also the possibility of delayed skin healing processes, with the presence of pathological scars and areas of irrevers- ible hypopigmentation, usually due to an excessive depth of treatment. I give consent to be photographed before, during and after surgery with the aim of clinical documentation and possible sci- entific use. Perego Believing of having received clear and precise information on every detail of the surgical procedure I wish to undergo, I undersigned: S urname…………. A n d his co-workers to perform the surgical procedure of:… U n der anesthesia…………in date………………………….. Patient’s signature………………………………………… (or legally authorized representative) S urgeon’s signature……………………………………….. Despite not being considered as part The exploitable fluence varies from 3 to 90 J/cm2. The of the laser family (given the non-collimated and non-coherent spot, which corresponds to the size of the crystal in contact nature of their emission) they have proved their efficacy in with the skin, usually of a rectangular shape, is 10–50 mm interacting with tissues and are still subject to careful and long. Over the patient’s characteristics and of the lesion to be treated in years a number of innovations followed, which allowed to order to avoid complications and adverse effects. Various manufacturers offer different filters as unsuited to light source treatment. The wavelength can be mod- 2 Treatment ulated according to the depth of the targeted tissue; longer waves consent a deeper penetration into the dermis [41 ]. Energy can be conveyed into a single pulse or whether performing skin rejuvenation, epilation, or vascular multiple pulses with delay times of 1–500 ms. A written consent form will be presented, to be read by the patient and possibly M. It is always Dipartimento di Chirurgia , Università di Roma advisable to take photos to document the pretreatment “Sapienza”, Policlinico Umberto I, Rome , Italy e-mail: mariagiuseppina. A test spot will be done in an inconspicuous thema, associated or not with rosacea may appear (Figs. Of course, treatment must necessarily anesthetic creams 20 min in advance may be useful with be preceded by dermatological examination in order to hypersensitive patients. The size and the maneuverability of the handpiece are of crucial importance in the facial treatment, especially on irregular surfaces, like the nose dorsum or the upper lip. Commonly, one pass is sufficient to treat the selected area; however, if required, it is possible to deliver more passes with a different orientation of the handpiece. At the end of the treatment, an erythematous reaction develops, which lasts 2–48 h. To minimize this reaction, zinc oxide ointments are generally used right after or in the fol- lowing hours [37 ]. More sessions are usually necessary according to the pathology to treat, at intervals of 3–4 weeks. The great flexibility of this tech- nique allows simultaneous intervention on all the marks of photoaging [1, 11–13 ] (Fig. This pathology is due to the combined action of two groups of concomitant factors: intrinsic ones (age, genetic disposition, phototype, etc. C l a ssically, a photo-damaged skin shows alterations in skin texture, mainly depletion of the dermis and dehydra- tion. Normally treatment is followed by the appearance of a diffuse erythema and a gradual darkening of hyperpigmentations, which may increase in the next days, to resolve spontaneously in exfoliation of the area. A ccording to the patient’s characteristics, treatment is per- formed with energy at 30–50 J/cm2 with double or triple pulses of 2. The handpieces 4 Vascular Anomalies and Pathologies commonly used are the 570 and 590 nm ones. Treatment is normally delivered on the whole face to obtain a uniform Vascular anomalies and pathologies (flat angiomas, telangi- result. Application of a treatment of vascular lesions using hemoglobin (oxidized or chilled gel will make the procedure totally painless. Fioramonti the various aesthetic aspects they present, they are called fl a t (known as port-wine stains), tuberous (because of their bulge), subcutaneous or cavernous, mixed (tuberous and subcutaneous), and stellar angiomas. The different evolution of these lesions must be taken into consideration, as some cases, after a first swelling, tend to regress spontaneously, while others tend to a progressive thickening with the emer- gence of intralesional nodules [32 ]. They are more frequent on the face, often located on the cheeks and on the nose wings. According to their aspect, they are classed into 4 main types: simple or linear, arborized, spider and punctiform, or papular. Erythrosis is defined as a permanent and lasting condition of redness and erythema. Rosacea is a quite common dermathosis tending to chronicize and locate in the central portion of the face. Clinically, it has various evolutive phases, but it gener- ally tends to worsen if left untreated. Rarely, it is present just for a few months and regresses spontaneously; more often it evolves into an intense congestion of the tissues Fig. Initially it appears with a sudden and typical redness (flushing) in the central face, which can be produced by a trivial temperature swing advantages due to greater speed in delivering treatment, because of weather change or an emotional shock. The first lowering of possible scarring risks, and, most of all, reduced lesions clinically noted are small expansions of superficial appearance of posttreatment purpura on exposed areas. Etiology is still unknown up to this day, even if the importance of familiarity, hormones, occupation, 4. Poikiloderma of Civatte is, instead, a chronic disease Two filters are normally used. For telangiectasias and thin- due to prolonged exposures to sunlight and characterized ner lesions, the 550 nm filter can be used, double pulse of by tiny dilated capillaries on the face and décolleté, which 2. Bigger lesions can be treated with 590 nm fil- small multiple stains of a light brown color, appear next to ters, double pulse of 2. An essential point when speaking of epilation is to distin- guish between final and permanent. Final epilation means a total loss of hair in the area under treatment, but it is an unachievable goal. More practically, Dierickx suggests to call it permanent when there is a meaningful decrease in the number of hair, after a set number of treatments, which is stable over a period of time longer than the full cycle of the hair follicle in the treated area [5–6 ]. Olsen suggested to consider a longer period adding 6 months to Dierickx’s estimation. Patients can consider a treatment permanent when its effects last for their whole life. For that reason, the informative talk during the first visit is extremely important. Despite the varia- tions in length, growth phases, and type, all hair has a cyclic growth.

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