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Sparavigna. Plast Aesthet Res 2020;7:14 I http://dx.doi.org/10.20517/2347-9264.2019.73 Page 5 of 6

hyaluronic acid, made denser and chemically modified by crosslinking agents) which actually fills the
tissue with immediate results compared to natural hyaluronic acid, but with lower biological activity [22,23] .

It should be highlighted that the use of dermal fillers does not exclude treatment with hyaluronic acid and
[24]
vice versa. Often, a combination of treatment strategies allows one to easily achieve the desired results .
Fibrous proteins of the dermis, such as collagen and elastin, are characterized by a specific aminoacid
composition. With age, the ability of fibroblasts to synthesize collagen is reduced. Furthermore, alteration
of collagen fibers imparts increasing stiffness and decreased elasticity to skin, with a consequent loss
of tone and softness. An anti-aging treatment should therefore, always have, among others, the ability
to increase the quantity and quality of collagen fibers. This can be achieved through specific cosmetic
treatments capable of stimulating the production of collagen (peptides, retinol, vitamin C), food
supplements containing specific amino acids or compounds capable of stimulating fibroblasts activity (i.e.,
collagen, amino acids and specific peptides), and even bio-revitalizing injections. In fact, in the absence of
adequate amounts of amino acids, cells react by blocking catabolism. As a result, proteins age and become
[25]
less efficient. “Old” proteins, whether enzymes, structural or contractile, become increasingly fragile .

CONCLUSION
Various factors associated with an individual’s genetic background and physical environment can affect
one’s skin in different ways with regards to skin aging. Previously, skin aging was thought of as physiological
or chrono-aging, and environmental or photo-aging. Other external factor have now been recognized to
influence the skin aging process including gravity, environmental pollution, climate, and smoking. In order
to provide a personalized treatment plan, a thorough analysis of an individual’s aging processes will be
required. For example, the shape of the face is of utmost importance - overtime, round faces tend to sag
while thin and elongated faces have a tendency to become hollow. In the former, lifting would be required
while in the latter, volumizing would be necessary. Treatment choice should be based on demonstrated
safety and efficacy while injection technique is very important for delivery and stems from an in-depth
[26]
knowledge of the anatomy and physiology of the treatment sites . To illustrate, by specifically defining
injection points or by combining injections with facial lymph node drainage, results will be immediately
[27]
visible and continue to improve over the ensuing weeks and months . Treatment protocols (number
of sessions, frequency, maintenance, mix of introduced substances, combination with cosmetics, and
nutraceuticals even) have to be individualized in order to suit the patient’s needs. Aesthetic dermatology is
perhaps the first medical discipline dedicated towards studying the properties of ECM and its treatment but
[28]
has increasingly, gained the attention of other clinical fields such as orthopedics, dentistry, pulmonology
and gastroenterology. We believe that in the near future, the ECM will be recognized as a master element of
many organs and body systems, overcome the barriers and concepts of current specialty fields, and improve
our mechanistic understanding of the many internal and external dysfunctions and disease states for better
treatment.

DECLARATIONS
Authors’ contributions
The author contributed solely to the article.

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
The author declared that there are no conflicts of interest.