The décolleté: the point on the last therapy from the site Dottorbellezza.it. (07.04.2005)

Journalist Brunella Paciello’s interview to the Doctor Raffaella Sommariva from Genova

An important point of woman’s beauty can be the fulcrum for an operation of “total” beauty. But let us call upon the expert to speak: the Doctor Raffaella Sommariva, plastic surgeon from Genova.

The décolleté is a very particular and important anatomic district from the point of view of aesthetics because, on one side it confines with the neck and the breast, and we know that a “good health” of the décolleté skin can contribute to the mammary tone, and on the other side it often presents signs of photoaging earlier than in other photodisplayed zones such as the face, the neck and the back of the hands, less uncared from our daily cares! In fact the décolleté is particularly exposed to the harmful action of the sun rays, not only at the beach or during summer time (solar erythemas!) but during the whole year, especially on the people with pale skin and who do not like “low necked dressed”..

Doctor Raffaella Sommariva, plastic surgeon from Genova, explains to us: “A medical rejuvenation of the face and the neck can not be apart from interests also this very important zone in order not to create antiaesthetic differences and reveal the age! To set a therapeutic program of rejuvenation of the décolleté through the association of mini–invasive techniques, from the practical point of view, is useful to refer to a classification – according to Rubin – who distinguish the “photo induced” damage in three levels of deepness.”

Let us see it in details..

The photoaging of the décolleté

The I°) level of the photoaging is characterized by the superficial alteration of the skin: only for the epidermis, that conditions the faults of the pigmentation (freckles, solar lentigo) and of the cutaneous filling that appears “rough” and “dark” for the increased thickness of the horny layer.

In the II°) level the damage deepens in the superficial part of the epidermis: it interest the epidermis and the papillary skin. The seborrhoea and the actinic keratosis are associated with the slight blemishes of the previous level, and the skin starts to wrinkle in thin, vertical wrinkles, starting from the intramammary groove and accentuated by the medial movements of the arms.

In the III°) level of the photoaging the alterations extend also to the deepest part of the epidermis and deep, fixed wrinkles, which diverge in fan-shaped from the intramammary groove or spider-web, are associated to the clinic signs of the two previous levels and the skin becomes loose, papery, yellowish with rough weft.

Rejuvenation of the decolleté

The combination, personalized for each clinic case, of medical-aesthetic methods, such as specific domiciliary therapies, chemical peeling, bio-revitalizations and laser-therapy, allows us to improve the compactness and the turgidity, smooth down the signs of the time and erase the lentigo and keratosis.

Preliminary evaluation

The moment of the visit – Doctor Sommariva still explains – is fundamental to set the therapy, the evaluation of the phototype of the patient (based on the colour of the skin, hair and the colour of the eyes and so his capability of defence from the solar rays), the level of the actinic damage and so the quality and the type of present cutaneous lesions, the iperchromism, the habits of the patient’s everyday life (“carelessness” and excess of sun without suitable protection) and his expectations of results.

DOMICILIARY THERAPY

Raffaella Sommariva adds: “Also in this case is fundamental the daily “maintenance” of the patient. In fact we can not forget to apply on the décolleté also the moisturizing agents that we use on the face and on the neck such as hyaluronic acid, antioxidant vitamins and lipoid acid; the photoprotection has to be daily (in fact the light of the whole year make our skin old) and higher during summer time. Then the doctor prescribes a specific cosmetics in conformity of the cases based on depigments (kogic acid, phytic acid, tioctic acid, vitamin C), and/or active principles that exfoliate and stimulate the cell turnover with “repairing” action (glycolic acid, retinoic acid, polyhydroxy acid such as gluconlactone and/or lactobionic acid particularly suitable in case of sensible and iperreactive skin).”

THE BIOSTIMULATIONS

Through the dispensing of hyaluronic acid’s precursory (glucosamine), that are injected in the epidermis thanks to superficial microinjections, we provide the fibroblast (the cell that produces collagen, elastin and hyaluronic acid) with the necessary resources to work on, and we activate its function”. The effects of this cell “biostimulation” – Doctor Sommariva clarifies – immediately consist on an improvement cutaneous hydration, by the time goes by then (at least 4 sessions) also the tone and cutaneous compactness will improve. With the biostimulation we have one key more to take care and prevent the slight blemish due to the aging: the treatment can be just located on the décolleté or interests the face, the neck and the décolleté but it depends on the case. The sessions are at least 4 with a weekly cadence, then 2 or 4 every 15 days with following maintenances every 2-3 months in conformity with the individual response”.

THE REVITALIZATION

To improve the skin hydration and “to stretch out” wrinkles, you can use a new type of hyaluronic acid from the group NASHA (steady hyaluronic acid not from animal origin) that represents a supplement of hyaluronic acid, which the natural resource already starts to reduce in the adult, if injected with microdrops in the deep epidermis. This “Hydro Reserve” hyaluronic acid– Sommariva explains –is not metabolized, for a light stabilization of the molecule, in few hours but it remains in the epidermis for a month sometime, it recalls water in the injection spot and then an hydrant, antioxidant, long action besides an action of immediate “distension” of the wrinkles with the aesthetic and pleasant effect; especially very appreciated by the patient”.

THE CHEMICAL PEELING

It is useful to smooth the cutaneous skin, to improve dyschromias, and to remove the antiaesthetic lentigo and solar keratosis on the décolleté. It is possible to execute a cycle (4-5 sessions) of soft peeling and it is best if it is combined, that is to say that they use more types of low power acids to reinforce the result at the maximum avoiding the collateral effects. In fact on the décolleté, like other body zones different from the face, we can execute superficial skin peeling, because in this place the skin does not have the repairing capability that the face has, and deeper peelings expose at the risk of scars and permanent bruise. The peeling is also preferably applied on the face, neck and décolleté during the same session. A type of soft peeling sets up with a mix of acids that act between them in a synergistic way with the effect of stimulant on the cell turnover and on the activity of the fibroblast, is the HPP (High Potency Peel) based on glycolic, acetic and pyruvic acid.

“It can be applied by itself or after a layer of Jessner’s solution – Doctor Sommariva says – to enforce the keratolytic and fading effect. The qualitative improvement of the photoaged epidermis results evident and if after the cycle of peeling still remains deep lentigo and keratosis, the LASERTHERAPY can occur”.

The combination of the different therapies, perfectly integrable one with the other, is personalized based on the cases during the course of the preliminary evaluation.

Brunella Paciello

www.Dottorbellezza.it 07.04.2005