Report written by Dr. Borna Pavičić
Very interesting case of management of granuloma secondary to the application of PCL biostimulator. As biostimulators are very often used today in anti-age and aesthetic medicine, and Polycaprolactone (PCL) is frequently used because it is a biodegradable aliphatic polyester and it is used for volume replacement and collagen biostimulator. And belongs to the group of semi-permanent injectables. In this case, patient noticed few days after procedure that the product was stiff and little mobile, and after six weeks total deformation with inflammation and increased volume on placement sites. After 3 months the biopsy was performed and pathology report showed granuloma. As we can see form everything mentioned above, the management with such deformity is not easy and is challenge for every physician who performes this procedures. In this case, after the biopsy results, the tretment started with 5ml collagenase intralesionally on each side with 25G dermal cannula with technique of subinscision.
Hyperpigmentations are very common , and patients often visit dermatologist to find a solutions for their removal. As various therapeutic options are not often succesful, and some of them are expensive and long lasting , botanical and natural ingredients are popular as alternative depigmenting products. On the other hand, they are numerous ingredients and products that promise good results so we have to be careful with the choice and reccomendations. Several natural ingredients showed efficacy as depigmenting agents, including azelaic acid, niacinamide, mulberry, lignin peroxidase, ascorbic acid iontophoresis, arbutin, ellagic acid and licorice extracts.
They show us promise as natural treatments for patients with hyperpigmentations, and also provide researchers to further characterize the pathogenesis of dyschromia. And of course, these products do not replace standard therapeutic options, but can be additional value in management of this very often dermatologic problem.
Acne scars are the most challenging skin problem that annoy most of patients, as weel as gives challenge to all of us who works with that kind of patients. Today, there are numerous treatment solutions (lasers, growth factors, micro punch excision, microneedeling, RF, threads and biostimulaton) and the outcome depends on skin type, scars type and depth of scars. Here presented experiences treatment in 3 steps – 1. subcesion under local anaesthesia, fractional laser; GF or PRP for 3-6 sessions; 2.double or triple screw threads – two session in 3 months; 3. filler biostimulator.
This experience confirmes that the best treatmen approach for such a delicate problem as scars is combination treatment. The results are excellent and better than with single treatment option.
What the doctor starts 1st in the tretament depends on his experience and knowledge and recent development of non-ablative lasers, RF devices as well as different uses of fillers and toxins have broadened our solutions in management of scars.
The “lid snap test” should be performed prior to treatment. If positive: risk of developing ectropion. Fully ablative resurfacing should be avoided. Prior lower blepharoplasty also a contraindication.
Fully ablative
