Impaired wound healing is one of the unsolved problems of modern medicine, affecting patients’ quality of life and causing serious economic losses. Impaired wound healing can manifest itself in the form of chronic skin wounds or hypertrophic scars. Research on the biology and physiology of skin wound healing disorders is actively continuing, but, unfortunately, a single understanding has not been developed. The attention of clinicians to the biological and physiological aspects of wound healing in the skin is necessary for the search for new and effective methods of prevention and treatment of its consequences. In addition, it is important to update knowledge about genetic and non-genetic factors predisposing to impaired wound healing in order to identify risk levels and develop personalized strategies for managing such patients. Wound healing is a very complex process involving several overlapping stages and involving many factors. This thematic review focuses on the extracellular matrix of the skin, in particular its role in wound healing. The authors analyzed the results of fundamental research in recent years, finding promising potential for their transition into real clinical practice.

One of the most important functions of the skin, i.e., protection from mechanical damage, is ensured by collagen fibers and their interaction with other elements in the extracellular matrix. Collagen fiber turnover is a complex multi-stage process. At each stage, a disruption may occur, leading to a decrease in the mechanical properties of the connective tissue. Clinically, collagen formation disorders manifest themselves as increased flabbiness and looseness of the skin and as early signs of facial aging. In addition to the clinical picture, it is important for cosmetologists and dermatologists to understand the etiology and pathogenesis of collagenopathies. In our review, we summarized and systematized the available information concerning the role of genetic and epigenetic factors in skin collagen fiber turnover. Furthermore, we focused on the functions of different types of collagens present in the skin. Understanding the etiology of impaired collagen formation can allow doctors to prescribe pathogenetically based treatments, achieve the most effective results, and minimize adverse reactions.

In the practice of a cosmetologist and a dermatologist, the functional features of the skin are of extremely important. At the same time, monogenic connective tissue disorders (hereditary connective tissue dysplasia) that underlie hereditary syndromes have been known for a long time, but in recent years more attention has been paid to genetic defects that, together with other internal and external factors, lead to manifestations of connective tissue dysfunction. Such disorders are called multifactorial, as a result, a general clinic of connective tissue dysplasia can develop. It is important for dermatologists and cosmetologists to diagnose the presence and risk of connective tissue pathology in time, since these disorders require special features in the clinical management of such patients. To date, there is a slight difference in the understanding of connective tissue pathology in Russia and abroad. Thus, the purpose of this review was to integrate ideas about connective tissue dysplasia in Russia and abroad, as well as to provide dermatologists and cosmetologists with an algorithm for diagnosing and managing patients with connective tissue dysfunction.

Currently, thread lifting in aesthetic facial rejuvenation is not the top priority, but nevertheless its popularity continues to gain momentum. In connection with increasing popularity, the number of issues related to thread lifting and its undesirable side effects also increases. In this publication, an analysis of Russian and international databases was carried out, including MedLine, PubMed, elibrary.ru, Wiley Online Library, Web of Science, over the period from 2010 to 2020 (10 years). In the search, the following keywords were used both in Russian and English: threads, thread lifting, rhytidoplasty, face rejuvenation, face lift, cog threads, Aptos, suture material. As a result, of all available publications, 51 articles were left for further analysis, on the basis of which the nuances of thread classification, histological changes in tissues in response to thread implantation, along with anatomical basics and features during the procedure of thread lifting were analyzed. The effectiveness and duration of the thread lifting effect is still subject to debate. Hence, sometimes, it is possible to identify the duration of the effect in the same study ranging from 1 month to 2 years. Despite the long history of thread lifting, there are still unresolved issues that need to be covered.

At the present time, the 4P concept (predictive, preventive, personalised and participatory) is a prospective trend in development of clinical medicine. The concept is being actively introduced into diff erent medical specialities. However, the development of personalised approach in medical cosmetology as a speciality at the intersection of medical sciences (dermatology, maxillofacial surgery, plastic surgery, restorative medicine, general practice, psychiatry, clinical pharmacology, etc.) is at the stage of discussion. The concept of 4P medicine suggests, among other things, analysis of genetic risks and development of preventive procedures based thereon that would decrease the risk of cosmetological complications development. The review includes analysis of literature dated 2010-2020. The following databases in Russian and foreign languages were searched using the keywords and advanced search builders: E-Library, PubMed, Springer, Clinicalkeys, Google Scholar. In this paper, we introduce a novel compilation of the known gene polymorphisms that may be used for determination of the genetic risks in cosmetological patients.

Our study aimed to develop a comprehensive approach to the management of patients with involutional skin changes, considering the predictors of premature skin aging. The study included two stages, whereby 78 women with no history of aesthetic procedures that could have affected their perceived age were examined. In the first stage, we examined factors associated with premature skin aging. In the second stage, a blind, comparative placebo-controlled study of the effectiveness of intradermal injections for the treatment of involutional skin changes was conducted. Parameters reflecting skin aging were identified. The sum of these parameters could be used to diagnose premature skin aging in patients with no history of aesthetic treatment. For other patients, we developed indicators that can be applied to determine whether there is a risk of premature skin aging. Patients with premature aging have an increased risk of adverse events, such as impaired regeneration and wound healing, postprocedural hematomas, etc. For the correction of involutional skin changes in patients with premature aging, the collagen product (Collost) had the greatest clinical efficiency and the greatest patient satisfaction. A complex product based on HA (Teosyal Redensity 1) had comparable efficiency, with slightly less patient satisfaction. The product based on native HA (Hyon 1.8%) had low efficiency in the group of patients with premature aging and high efficiency in the group of patients with normal aging.