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we will describe the various options available&#44; depending on the areas the patient wishes to improve&#46; Although most of these technique can be used on people from any geographical area&#44; this article is based on our daily experience treating patients who mostly have Fitzpatrick I to IV phototypes&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Skin Quality</span><p id="par0020" class="elsevierStylePara elsevierViewall">The best approach to improving skin quality involves an assessment by a dermatologist&#44; who establishes a cosmetic protocol and identifies the problems that can be modified or treated&#58;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The first step is never to forget that sunscreen is the best cosmetic&#46; The daily use of a sunblock to protect the skin will prevent photoaging as well as having other beneficial effects&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">6</span></a> In addition to the regular use of sunscreen&#44; 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we recommend alexandrite or Q-switched laser therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">8</span></a> In the case of telangiectasias and erythema we use vascular lasers&#44; including 595<span class="elsevierStyleMonospace">-</span>nm pulsed dye laser&#44;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">9</span></a> 1064-nm neodymium&#58;yttrium-aluminum-garnet laser&#44;<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">10&#44;11</span></a> and medical intense pulsed light&#46;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">12</span></a> To treat severe photodamage&#44; particularly in patients with poikiloderma&#44; we used a combination of several light sources&#58; intense pulsed light&#44; stain removal lasers&#44; as well as vascular and nonablative fractional lasers&#44; such as 1550-nm erbium&#58;glass and 1927-nm thulium&#46;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">13</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">In patients with melasma&#44; we have observed better responses to treatment in our clinic with low energy lasers &#40;such as 1927-nm thulium&#41;<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">14</span></a> or gentle exfoliating procedures<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">15</span></a> in combination with the application at the patient&#39;s home of depigmenting formulas containing retinoic acid and hydroquinone&#46;<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">16</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">For the treatment of irregularities in the form of lines and wrinkles &#40;in particular the vertical barcode lines on the upper lip and crow&#39;s feet around the eyes&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">17</span></a> scars &#40;like those caused by acne or surgical procedures&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0405"><span class="elsevierStyleSup">18&#44;19</span></a> and open pores&#44;<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">20</span></a> we recommend using fractional ablative technologies&#44; such as carbon dioxide lasers&#46; These have been shown to be better than classic lasers in terms of patient tolerance and the occurrence of adverse effects&#46;<a class="elsevierStyleCrossRefs" href="#bib0420"><span class="elsevierStyleSup">21&#44;22</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">To enhance skin luminosity&#44; we mainly use mesotherapy with hyaluronic acid &#40;multiple microinjections of this substance into the area of the face&#44; neckline&#44; or back of the hands to be treated&#41;<a class="elsevierStyleCrossRefs" href="#bib0430"><span class="elsevierStyleSup">23&#44;24</span></a> and platelet-rich plasma &#40;PRP&#41;&#46; PRP involves drawing blood from the patient&#44; separating the growth factors contained in the platelets by centrifugation&#44; activating the platelet membranes&#44; and intradermal injection of the resulting PRP in the form of mesotherapy&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0440"><span class="elsevierStyleSup">25&#8211;27</span></a> Radiofrequency devices have also been used for many years to make skin more luminous&#59; they also have a slight firming effect&#46;<a class="elsevierStyleCrossRefs" href="#bib0455"><span class="elsevierStyleSup">28&#44;29</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">If facial skin has atrophied or thinned&#44; PDO mini threads can be implanted by injection into the deep dermis to induce neocollagenesis&#46;<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">30</span></a></p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Expression Lines</span><p id="par0065" class="elsevierStylePara elsevierViewall">Botulinum toxin is the technique that has revolutionized nonsurgical rejuvenation methods&#46; It is a safe and effective technique that provides natural results when used carefully&#46; The use of botulinum toxin alone without other treatments is not an ideal approach because it only improve wrinkles&#59; in most patients the best results are obtained when it is used in combination with other techniques to obtain more harmonious results&#46;<a class="elsevierStyleCrossRef" href="#bib0470"><span class="elsevierStyleSup">31</span></a><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> lists the 10 commandments for optimum use of botulinum toxin in facial rejuvenation&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Unwanted Fat</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Importance of Submental Fullness in Facial Rejuvenation</span><p id="par0070" class="elsevierStylePara elsevierViewall">Several non-invasive procedures used to treat body fat can also be used to treat a double chin by reducing submental fat&#46; The appearance of a double chin is an age-related change that worries a large number of patients and is sometimes neglected by aesthetic dermatologists&#46; Treating submental fullness produces a strong emotional impact and improves the patient&#39;s self-image&#46;<a class="elsevierStyleCrossRef" href="#bib0475"><span class="elsevierStyleSup">32</span></a> In a study of 600 men recently published by an American team&#44; the double chin was the third most likely motive for treatment cited by the respondents&#46;<a class="elsevierStyleCrossRef" href="#bib0480"><span class="elsevierStyleSup">33</span></a> In our experience&#44; it could be the leading reason for consultation among men and a very common motive among women if the possibility of nonsurgical treatment were more generally known&#46; Until relatively recently&#44; surgical liposuction was the only effective way to eliminate submental fat&#46; Today&#44; there are 2 other safe and effective methods for eliminating submental fat&#58; cryolipolysis with the Coolsculpting<span class="elsevierStyleSup">&#174;</span> device and injection with deoxycholic acid &#40;marketed in Europe for this indication as Belkyra<span class="elsevierStyleSup">&#174;</span>&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Submental Fat Elimination With Cryolipolysis</span><p id="par0075" class="elsevierStylePara elsevierViewall">Selective cryolysis of subcutaneous fat &#40;or cryolipolysis&#41; involves the application on an area of the skin of a device that pulls the skin in by suction and cools it to induce inflammation &#40;initially leading to lobular panniculitis&#41; and the specific destruction of adipocytes&#46; Given the greater sensitivity to cold of fat cells&#44; the treatment does not damage the epidermis or other structures&#46;<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">34</span></a> For the treatment of localized fat&#44; the Coolsculpting<span class="elsevierStyleSup">&#174;</span> device is the technology that has been most validated&#46; It was the first cryolipolysis system to be developed and approved by the regulatory agencies and its effectiveness has been demonstrated&#46; Although other treatments&#44; such as other cryolipolysis systems and devices based on radiofrequencies or focused ultrasound&#44; can be considered&#44; Coolsculpting<span class="elsevierStyleSup">&#174;</span> is the only device that has been shown to be safe and effective for this indication&#59; it achieves predictable results and a high degree of patient satisfaction&#46; Coolsculpting<span class="elsevierStyleSup">&#174;</span> is a simple technique&#58; no anesthesia is required and there is no downtime after treatment&#46; The Coolsculpting<span class="elsevierStyleSup">&#174;</span> device can also be used to treat other areas of the body&#44; including the abdomen&#44; flanks&#44; back&#44; as well as the inner aspect of the thighs and arms&#46; Many authors have reported on the use of Coolsculpting<span class="elsevierStyleSup">&#174;</span> to eliminate submental fat&#46; The mean reduction achieved was 2&#160;mm of subcutaneous fat per session&#44; as measured by ultrasound&#44;<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">35</span></a> or 33&#37; of the fatty fold&#44; as measured by a pleximeter after 2 sessions&#46;<a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">36</span></a> A new method requiring shorter sessions of about 35&#160;minutes in duration has been developed based on a redesigned applicator&#46;<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">37</span></a> In our experience&#44; an approximate improvement of 20&#37; can be observed in 1 session&#46; Ideal candidates for this technique are patients whose weight is within the normal range and who have modestly pronounced fat deposits that are difficult to eliminate through diet or exercise&#46; There is no limit to the number of sessions a patient can undergo&#44; but in general we recommend 2 sessions separated by an interval of at least 1 month&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Deoxycholic Acid Injections</span><p id="par0080" class="elsevierStylePara elsevierViewall">The other nonsurgical technique that should be considered when treating submental fat is deoxycholic acid&#46;<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">38</span></a> This is available in 2-mL vials of a 10-mg&#47;mL solution &#40;marketed as Belkyra&#174; in Spain and Kybella&#174; in the United States&#41;&#46; The product was launched in Spain in 2017 and 2 years earlier in the United States&#46;<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">38</span></a> Before administration&#44; the injection sites &#40;1<span class="elsevierStyleHsp" style=""></span>cm apart&#41; are marked on the area to be treated using a template&#46; Then the treatment is administered in subcutaneous injections of 0&#46;2<span class="elsevierStyleHsp" style=""></span>mL up to a maximum infiltration volume of 15&#160;mL per session&#46; The injections can be somewhat painful&#44; making it advisable to use local anesthesia&#44; cold&#44; and analgesia&#46; After infiltration&#44; pain&#44; swelling and bruising in the treated area is not uncommon&#46; The most feared complication of this technique &#40;rare when the injection sites are properly marked&#41; is the accidental injection of the product into the marginal mandibular branch of the facial nerve&#44; causing paralysis on 1 side of the mouth lasting for some months&#46; Patients can undergo a maximum of 6 separate sessions separated by intervals of at least 1 month&#46;<a class="elsevierStyleCrossRef" href="#bib0510"><span class="elsevierStyleSup">39</span></a> The usefulness of this technique has been demonstrated in men&#44; in whom it is recommended that a larger surface area be treated at the first session to obtain the best outcome&#46;<a class="elsevierStyleCrossRef" href="#bib0515"><span class="elsevierStyleSup">40</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Volume Loss</span><p id="par0085" class="elsevierStylePara elsevierViewall">In the 1980s&#44; the rise of cosmetic surgery led to a growing trend in surgical facelifts&#44; a technique that was very effective in reducing visible wrinkles but tended to produce unnatural results&#46; The use of dermal fillers first started to become generalized at the end of the 1990s&#46; This was the first technique to address the problem of creating facial volume to compensate for the loss of volume secondary to changes in facial fat and bones&#46;<a class="elsevierStyleCrossRef" href="#bib0520"><span class="elsevierStyleSup">41</span></a> While some aesthetic protocols continue to include permanent fillers such as silicone&#44;<a class="elsevierStyleCrossRef" href="#bib0525"><span class="elsevierStyleSup">42</span></a> the most widely used fillers today are non-permanent products based on hyaluronic acid&#44; calcium hydroxyapatite&#44; and polylactic acid&#46; The results obtained are constantly improving as a result our of greater understanding and knowledge of age-related anatomical changes and the way the products available should be applied&#46;<a class="elsevierStyleCrossRef" href="#bib0530"><span class="elsevierStyleSup">43</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">To properly apply a dermal filler&#44; the first thing we must address is the diagnosis of the area to be treated&#46; Over time&#44; some of the facial convexities characteristic of childhood are lost&#44; giving rise to areas of shadow around the eyes and mouth&#44; which can give rise to an appearance of tiredness&#46; The best way to correct these changes is with the prudent use of fillers&#46; Another aspect that should be taken into account in any rejuvenation protocol is the so-called &#8220;triangle of youth&#8221;&#58; the face of a young person is shaped like a triangle with the base across the forehead and the apex pointing downwards&#46; With age&#44; the triangle is inverted and the base moves to the lower part of the face&#58; the face becomes wider and less oval&#46; Consequently&#44; adding volume to the lower third of the face should be avoided&#46; Hyaluronic acid is our dermal filler of choice&#46; It has the added advantage that an &#8220;antidote&#8221; exists in hyaluronidase&#44; although the effect of the antidote may vary depending on the hyaluronic acid filler used&#46;<a class="elsevierStyleCrossRef" href="#bib0535"><span class="elsevierStyleSup">44</span></a> In Spain&#44; hyaluronidase can only be obtained as a customized compound for off-label use&#59; our protocol for its use can be found in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; The other dermal filler we use is calcium hydroxyapatite&#44; although the effect in this case is more collagen-inducing than filling&#46; Currently we do not use any other fillers in our practice&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">In our opinion&#44; the replacement of facial volume is secondary compared to other goals&#44; such as improved skin quality&#44; in the aesthetic patient&#46; Even when the fillers used are temporary in nature&#44; they should be used with caution because it has been observed that&#44; in the long-term&#44; excessive treatment or &#8220;filler fatigue&#8221; can give rise to an inharmonious appearance&#46; Filler fatigue is caused by a decrease in skin elasticity&#44; fibrosis&#44; and the creation of an unnaturally wide face&#46; All of these changes can occur not only because of excessive use of collagen-inducing fillers such as calcium hydroxyapatite &#40;which induces fibrosis and may persist in the treated area for years<a class="elsevierStyleCrossRef" href="#bib0540"><span class="elsevierStyleSup">45</span></a>&#41; but also owing to overuse of hyaluronic acid &#40;which triggers an increase in profibrotic growth factors and collagen fibers types I and III&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0545"><span class="elsevierStyleSup">46</span></a> It has also been observed that fillers that have a greater degree of cross-linkage and the use of techniques such as superperiosteal injections can lead to more long-term effects<a class="elsevierStyleCrossRef" href="#bib0550"><span class="elsevierStyleSup">47</span></a> and increase the likelihood of adverse events&#46;<a class="elsevierStyleCrossRefs" href="#bib0555"><span class="elsevierStyleSup">48&#44;49</span></a> Fillers are&#44; therefore&#44; a useful tool provide they are used in moderation and applied by someone who has a great deal of knowledge about facial anatomy and in combination with other&#44; complementary&#44; techniques&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Flaccidity</span><p id="par0100" class="elsevierStylePara elsevierViewall">The 2 nonsurgical techniques we currently use to treat skin flaccidity without increasing volume are ultrasound &#40;using either high-intensity focused ultrasound &#91;HIFU&#93; or microfocused ultrasound&#41; and thread lifting&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Ultrasound</span><p id="par0105" class="elsevierStylePara elsevierViewall">There are several devices on the market designed to reduce skin laxity&#46;<a class="elsevierStyleCrossRef" href="#bib0565"><span class="elsevierStyleSup">50</span></a> While non-ablative techniques based on external radiofrequency may have some tightening effect&#44;<a class="elsevierStyleCrossRef" href="#bib0570"><span class="elsevierStyleSup">51</span></a> in our clinical experience the actual clinical effect is minimal&#46; In recent years&#44; therefore&#44; we have opted to use HIFU devices&#44; which apply focused ultrasound waves at various depths&#46; A device with the broadest range can focus the power at 1&#46;5&#44; 3&#44; and 4&#46;5&#160;mm&#44; modulating the frequency to 10&#44; 7 and 4&#46;5&#160;MHz&#41;&#46; This device can produce small thermal coagulation points in fat and fibromuscular tissue that have a tightening effect&#59; tolerance is good and the procedure has very few side effects &#40;infrequent bruising&#44; tingling&#44; or temporary muscle weakness&#41;&#44; which resolve within a few days or weeks&#46;<a class="elsevierStyleCrossRef" href="#bib0575"><span class="elsevierStyleSup">52</span></a> While rare&#44; more serious adverse effects may occur<a class="elsevierStyleCrossRef" href="#bib0580"><span class="elsevierStyleSup">53</span></a>&#59; these could be related to poor technique or inappropriate use&#44; underscoring the importance of proper training in the technique and an extensive knowledge of facial anatomy&#46; This technique is ideal for patients with mild to moderate laxity or sagging along the jawline&#44; on the neck&#44; and around the eyes&#46; It is particularly appropriate for correcting infraorbital laxity and for closing up the infrapalpebral space&#44; where the edema that gives rise to &#8220;bags&#8221; accumulates&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0585"><span class="elsevierStyleSup">54</span></a> It achieves unobtrusive results within a month of treatment&#46; The results are cumulative and can have a preventive effect&#44; which is why some plastic surgeons have called HIFU a &#8220;facelift by installments&#8221;&#46; For best results the procedure can be repeated every 6 to 12 months&#46; HIFU can be combined with other noninvasive treatments&#46;<a class="elsevierStyleCrossRefs" href="#bib0590"><span class="elsevierStyleSup">55&#44;56</span></a></p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Thread Lift</span><p id="par0110" class="elsevierStylePara elsevierViewall">Thread lifting is an interesting resource in any global approach to facial rejuvenation&#46; The threads are easy to apply and do not add volume &#40;making them ideal for use in the lower third of the face&#41;&#46; Their tightening and firming effect can be used to reposition loose or sagging tissue&#46;<a class="elsevierStyleCrossRef" href="#bib0600"><span class="elsevierStyleSup">57</span></a> There are many types of lifting threads on the market &#40;monothreads&#44; barbed threads&#44; cone threads&#44; etc&#46;&#41;&#46; They can be grouped into 2 basic types&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">On the one hand&#44; we have simple&#44; monofilament strands of polydioxanone &#40;PDO&#41; &#40;monothreads&#41;&#44; which are used to increase skin density&#46; These threads are inserted with a needle into the deep dermis&#44; where they trigger the formation of collagen and produce a revitalizing effect that can last between 3 and 9 months&#46; The areas most often treated are the jawline&#44; cheeks &#40;to reduce the nasolabial folds&#41;&#44; neck&#44; and the neckline or d&#233;colletage&#46; Other areas that can be treated using this technique include the eyebrows&#44; arms&#44; legs&#44; and buttocks&#46;<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">30</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">On the other hand&#44; we have PDO or poly-L-lactic acid &#40;PLLA&#41; threads with barbs&#44; cones&#44; and other kinds of hooks&#46; These have a greater tightening effect because they facilitate anchoring&#44; traction&#44; and repositioning of the tissue as well as having collagen inducing properties&#46; These threads are inserted into the hypodermis&#46; They produce visible effects that last up to 1 year&#46; The areas most often treated include the jawline and neck&#44; although they can also be used to treat the cheeks and eyebrows&#46;<a class="elsevierStyleCrossRefs" href="#bib0465"><span class="elsevierStyleSup">30&#44;58</span></a> A mild and transient side effect of the insertion of both types of threads is bruising and edema at injection sites&#46;</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Final Reflections</span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">The Art of the Aesthetic Consultation</span><p id="par0125" class="elsevierStylePara elsevierViewall">The doctor-patient relationship established in the initial consultation is the key to the clinician&#39;s empathy or &#8220;connection&#8221; with the patient&#46; In <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#44; we list a series of suggestions we consider should be taken into account by any physician treating aesthetic patients with a view to attaining the optimum results for each patient&#46; Following this advice can have a remarkably positive effect on patient satisfaction and loyalty as well as on adherence to the treatment&#46; If we&#44; as doctors&#44; give greater importance to the art of the aesthetic consultation&#44; we will feel more comfortable with ourselves and provide a reason why we can never be replaced by machines or robots&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Innovation in Aesthetic Dermatology</span><p id="par0130" class="elsevierStylePara elsevierViewall">In the field of dermatology and aesthetic medicine&#44; we believe that there has been an absence of major innovations in recent years&#46; In other words&#44; there has been no revolution comparable to those that have transformed other areas&#44; such as on-line shopping&#44; urban mobility&#44; the consumption of audiovisual content&#44; information search&#44; and interpersonal communication&#46; In the field of aesthetics&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0135" class="elsevierStylePara elsevierViewall">Retinoic acid&#44; which is still the most effective anti-aging ingredient in creams&#44; has been on the market for over 40 years&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0140" class="elsevierStylePara elsevierViewall">Research on the effects of nutricosmetics<a class="elsevierStyleCrossRef" href="#bib0610"><span class="elsevierStyleSup">59</span></a> has not&#44; as yet&#44; provided evidence of extraordinary benefits that would justify their routine use&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0145" class="elsevierStylePara elsevierViewall">Technology has not yet led to any disruptive innovations&#46; The laser devices we use today for vein treatment&#44; hair removal&#44; photorejuvenation&#44; and spot removal are similar&#44; despite progressive optimization&#44; to those we were using 15 years ago&#46; While the new radiofrequency devices&#44; intense pulsed light&#44; and focused ultrasound have not offered exponential advances&#44; we believe that cryolipolysis and the use of microwaves for the treatment of hyperhidrosis represent qualitative leaps in the technology in recent years&#46;</p></li></ul></p><p id="par0150" class="elsevierStylePara elsevierViewall">Having had occasion to try most of the technologies currently used&#44; many dermatologists involved in the treatment of aesthetic patients have come to the conclusion that the last truly disruptive innovation in this field was introduced over 15 years old&#58; the liquid facelift&#44; that is&#44; the use of a combination of injectables &#40;essentially botulinum toxin&#44; dermal fillers&#44; collagen inducers&#44; and lifting threads&#41; in a prudent and intelligent way&#46; The term <span class="elsevierStyleItalic">liquid facelift</span> was coined by Mauricio de Maio&#44; a Brazilian plastic surgeon who has been one of the promoters of the use of a combination of injectables to relax expression lines&#44; compensate for loss of volume&#44; and induce collagen productio&#46;<a class="elsevierStyleCrossRef" href="#bib0615"><span class="elsevierStyleSup">60</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">In our clinic&#44; we classify liquid lifting techniques into 5 types depending on the complexity of the technique &#40;from lower to higher complexity&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; In patients who can benefit from this approach&#44; after a meticulous physical examination and after assessing and discussing the patients expectations&#44; we decide on what level of liquid facelift is appropriate and will achieve the most natural results and satisfy the patient&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">The Importance of the Emotional Domain</span><p id="par0160" class="elsevierStylePara elsevierViewall">Generally&#44; when patients are informed about what can be achieved with rejuvenation techniques&#44; the information they are given is usually framed in terms of objective outcomes &#40;the reduced visibility of the wrinkle&#44; the removal of a mark or discoloration&#44; and so on&#41;&#46; It is vital&#44; however&#44; for the clinician not only to clinically assess the individual patient but also to gain a better understanding of their emotions&#44; values and expectations in order to achieve the highest possible degree of satisfaction&#46; The patient will understand the message better if rather than saying that the procedure will improve a wrinkle&#44; the physician explains that the aim of the technique is to eliminate a facial expression associated with annoyance&#44; fatigue&#44; or sadness&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Using these minimally invasive techniques&#44; dermatologists can achieve an improvement in the patient&#39;s mood and quality of life&#46;<a class="elsevierStyleCrossRef" href="#bib0620"><span class="elsevierStyleSup">61</span></a> Messages like those exemplified in the previous paragraph reinforce the positive feedback loop between the result obtained&#44; what the patient perceives&#44; and what was discussed in the initial consultation&#46; For example&#44; it has been reported that patients who cannot look sad may experience an improvement in mood&#46;<a class="elsevierStyleCrossRef" href="#bib0625"><span class="elsevierStyleSup">62</span></a></p></span></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conclusions</span><p id="par0170" class="elsevierStylePara elsevierViewall">To conclude&#44; let us reflect on the messages that summarize the global approach we propose to patients who consult us for aesthetic procedures&#58;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">1&#41;</span><p id="par0175" class="elsevierStylePara elsevierViewall">Skin quality is the first thing that should be improved&#46; Removal of pigmented stains and spots&#44; vascular lesions&#44; and scars as well as brightening the skin is a priority in any facial rejuvenation protocol&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">2&#41;</span><p id="par0180" class="elsevierStylePara elsevierViewall">The best results can be achieved by using a combination of different treatments&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">3&#41;</span><p id="par0185" class="elsevierStylePara elsevierViewall">We recommend using only low doses of botulinum toxin on the face&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">4&#41;</span><p id="par0190" class="elsevierStylePara elsevierViewall">Excessive use of fillers should be avoided as it can lead to an unnatural appearance in the medium and long term&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">5&#41;</span><p id="par0195" class="elsevierStylePara elsevierViewall">Techniques that tighten the skin are recommended for the lower third of the face&#46; Techniques designed to add volume should be minimized in this area because the aging process leads to an accumulation of tissue in this region&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">6&#41;</span><p id="par0200" class="elsevierStylePara elsevierViewall">Reducing submental fat should be considered in facial rejuvenation&#46; This can be achieved using effective and minimally invasive techniques&#44; such as cryolipolysis and injection lipolysis with deoxycholic acid&#46;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">7&#41;</span><p id="par0205" class="elsevierStylePara elsevierViewall">Every patient who visits an aesthetic dermatologist should be made aware that less is more and that the most natural results are achieved by making a series of discreet changes&#46;</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">8&#41;</span><p id="par0210" class="elsevierStylePara elsevierViewall">Since aging is an ongoing process&#44; antiaging techniques also have to be repeated regularly to ensure a continuous process&#46;</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">9&#41;</span><p id="par0215" class="elsevierStylePara elsevierViewall">We treat people and not areas of the body&#46; The key to our practice is an empathetic approach based on the patient&#39;s psychological and emotional health&#46;</p></li></ul></p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflicts of Interest</span><p id="par0220" class="elsevierStylePara elsevierViewall">The authors have a private practice and regularly use the technologies and products described&#46; However&#44; the authors have no commercial or advertising links with the suppliers of any of these products&#46;</p></span></span>"
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          "titulo" => "Skin Quality"
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              "titulo" => "Expression Lines"
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          "titulo" => "Unwanted Fat"
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              "titulo" => "Submental Fat Elimination With Cryolipolysis"
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              "titulo" => "Innovation in Aesthetic Dermatology"
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            0 => "Botulinum toxins"
            1 => "Hyaluronic acid"
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            0 => "Toxinas botul&#237;nicas"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Aesthetic dermatology offers many minimally invasive therapies that can help our patients age gracefully and discreetly&#46; Because it is hard to systematize these treatments to make patients aware of the options they have for the area of the face they want to improve&#44; at Cl&#237;nica Dermatol&#243;gica Internacional&#44; we have developed the Skin Age Management &#40;SAM&#41; protocol&#46; In this article&#44; we describe this protocol designed to help doctors and patients to better understand and plan available treatments&#44; underlining the advisability of combining techniques with the goal of achieving discreet changes to obtain what we consider to be optimum results&#44; based on our experience at our center&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La dermatolog&#237;a est&#233;tica hoy en d&#237;a contempla m&#250;ltiples tratamientos m&#237;nimamente invasivos que pueden ayudar a envejecer a nuestros pacientes con elegancia y discreci&#243;n&#46; Dado que puede resultar dif&#237;cil sistematizarlos para que el paciente sea consciente de las posibilidades que tiene en funci&#243;n del &#225;rea que quiere mejorar&#44; desde Cl&#237;nica Dermatol&#243;gica Internacional hemos elaborado el protocolo <span class="elsevierStyleItalic">Skin Age Management</span> &#40;SAM&#41;&#46; En este art&#237;culo describimos este protocolo &#8212;dirigido a ayudar a m&#233;dicos y pacientes a conocer mejor y planificar los tratamientos disponibles&#44; que refuerza el mensaje de la idoneidad de la combinaci&#243;n de t&#233;cnicas con la filosof&#237;a de lograr cambios discretos para obtener los resultados que consideramos &#243;ptimos&#8212;&#44; basado en la experiencia de nuestro centro&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Ruiz-Rodriguez R&#44; Martin-Gorgojo A&#46; Abordaje facial global del paciente est&#233;tico&#58; protocolo Skin Age Management&#46; Actas Dermosifiliogr&#46; 2019&#59;110&#58;197&#8211;205&#46;</p>"
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Diagram of the Skin Age Management &#40;SAM&#41; Protocol<span class="elsevierStyleItalic">&#46;</span> At the center of the wheel are recommendations for a healthy lifestyle&#44; a vital component of any treatment intended to achieve elegant and discreet aging&#46; The outer ring shows the different treatments available for each indication&#46; Any approach to facial aging should start with skin quality&#44; then address expression lines&#44; and continue&#44; if necessary&#44; with the other treatment options indicated&#46; HIFU indicates high-intensity focused ultrasound&#46;</p>"
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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Description of the treatments in each level of the liquid facelift &#40;nonsurgical facial rejuvenation&#41;&#46;</p> <p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">NCHA indicates non-crosslinked hyaluronic acid&#46;</p> <p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The collagen inducer we use is calcium hydroxyapatite &#40;Radiesse<span class="elsevierStyleSup">&#174;</span>&#41;&#46;</p>"
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                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1&#46; Botulinum toxin or &#8220;botox&#8221; reduces expression lines&#46; It is an ideal treatment for controlling expression lines&#44; such as the glabellar lines between the brows&#44; periocular crow&#39;s feet&#44; and frown lines on the forehead&#46; The aim is to relax the expression in order to conceal accumulated tension&#46; Loss of volume&#44; poor skin quality and laxity should be treated using other dermatological techniques&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2&#46; Botulinum toxin is safe&#46; In over 50&#37; of cases it is used for medical purposes&#44; such as the treatment of migraine headaches&#44; excessive sweating&#44; nervous tics&#44; strabismus&#44; etc&#46; Due to its excellent safety profile&#44; the treatment is often used in children to treat abnormal muscle movements&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3&#46; Be careful with the dose&#46; Appropriate doses must be used to achieve natural results and preserve the patient&#39;s facial expressivity&#46; The muscles should be relaxed rather than paralyzed with excessively high doses&#46; Conversely&#44; excessively low doses can lead to an overly short durations of effect&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">4&#46; Botulinum toxin prevents the formation of wrinkles&#46; It has a preventive effect on aging because it &#8220;educates&#8221; the facial muscles&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">5&#46; Every patient is different&#46; Not all patients require the same injection technique&#46; Since the anatomy of every patient&#39;s face is different&#44; the injection sites and the dose used must be adjusted in each case to achieve natural results&#46; The injection technique for men and women is totally different&#46; For example&#44; the gull wing shape of the eyebrow in women is totally different from the shape of the male eyebrow&#44; which tends to be straighter and situated closer to the eyelid&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">6&#46; Treatment with botulinum toxin must be repeated&#46; We recommend repeating treatment every 4 to 6 months&#46; Repeat treatment should take place before the effect of the previous administration disappears&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">7&#46; The approach must be global&#46; The only way to achieve natural results is by treating the face as a whole&#46; Consequently&#44; the entire face should be treated to relax all the &#8220;depressor&#8221; muscles that configure facial expression&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">8&#46; Botulinum toxin treatment can make us feel better&#46; When properly injected the treatment reduces the appearance of worry and sadness&#46; It has been shown that this effect on our facial expression also improves our mood&#46; We feel happier because we look happier&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">9&#46; Bad results are due to bad technique&#46; Botulinum toxin is like a scalpel&#58; the results can be good or bad depending on the technique&#46; Grotesque outcomes are the result of misuse&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">10&#46; Less is more&#46; The most elegant results are achieved through discreet changes&#46; If someone asks you &#8220;What have you done&#63;&#8221;&#44; change your doctor&#46; The goal is for everyone to notice that you look better without realizing that you have had treatment&#46;&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The Ten Commandments of Botulinum Toxin<a class="elsevierStyleCrossRef" href="#bib0630"><span class="elsevierStyleSup">63</span></a></p>"
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                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8226; A 300 UI vial of lyophilized hyaluronidase should be ordered from a compounding pharmacy &#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8226; When required&#44; the 300&#160;UI vial should be diluted in 2&#160;mL of physiological saline &#40;such that every 0&#46;1&#160;mL contains 15&#160;UI&#41;&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8226; Injection must be done slowly using a 32-gauge needle&#44; with volumes of 0&#46;05 to 0&#46;1&#160;mL per injection site &#40;a dose of 7&#46;5-15&#160;UI&#41;&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8226; A pre-treatment test on the patient&#39;s forearm is recommended &#40;although some authors argue that the test is the use of minimal doses&#41;&#44; because of the possibility that some patients may be allergic or have an anaphylactic reaction&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8226; It is generally recommended that patients should be seen a week after administration to assess the need to repeat the treatment&#46;&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Protocol for Hyaluronidase Treatment&#46;</p>"
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                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1&#46; Prepare for the consultation before seeing the patient&#46; Ensure that the patient knows that you are waiting for them&#44; that you are aware of the reason for their visit&#44; and that they have your full attention&#46; You only have one opportunity to create a good first impression&#44; Don&#769;t waste it&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2&#46; Focus all your attention on the consultation&#46; The patient must feel that they are the center of your attention&#46; Avoid interruptions from cell phones&#44; conversations with staff or colleagues about other topics or other patients and make sure that no one comes in and out of your office&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3&#46; Be aware of your body language&#58; do not sit too far away from the patient&#44; look directly into his or her eyes&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">4&#46; Obtain a complete medical history to rule out diseases or drugs that might influence the results of aesthetic treatments&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">5&#46; Ask the patient what cosmetic treatments &#40;surgical or nonsurgical&#41; they have undergone previously&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">6&#46; Take pictures of a range of positions and different expressions&#46; After undergoing a procedure&#44; patients look much more closely at their faces and may&#44; in some cases&#44; blame the treatment for a pre-existing flaw or lack of symmetry&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">7&#46; Be genuine&#46; A patient will always know whether you really care or not&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">8&#46; Use the power of touch&#46; It is important to explore the patient&#39;s face sensitively with your hands so that they will feel that the evaluation has been complete&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">9&#46; Give the patient a mirror and ask them to indicate what areas they would like to improve&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">10&#46; Carefully assess the patient&#39;s expectations to ascertain whether they are realistic&#46; If a patient has unrealistic expectations&#44; be honest with them and do not recommend any treatment&#46; The formula is as follows&#58; satisfied patient &#61; good aesthetic results &#8211;prior expectations&#46; A patient who has unrealistically high expectations will never be satisfied&#46; One sign that should ring alarm bells is a patient who complains about all the doctors who have previously treated them&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                    0 => array:2 [
                      "titulo" => "Consensus recommendations for combined aesthetic interventions in the face using botulinum toxin&#44; fillers&#44; and energy-based devices"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Carruthers"
                            1 => "C&#46; Burgess"
                            2 => "D&#46; Day"
                            3 => "S&#46;G&#46; Fabi"
                            4 => "K&#46; Goldie"
                            5 => "M&#46; Kerscher"
                          ]
                        ]
                      ]
                    ]
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                    0 => array:2 [
                      "doi" => "10.1097/DSS.0000000000000754"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dermatol Surg&#46;"
                        "fecha" => "2016"
                        "volumen" => "42"
                        "paginaInicial" => "586"
                        "paginaFinal" => "597"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27100962"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0325"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Consensus recommendations for combined aesthetic interventions using botulinum toxin&#44; fillers&#44; and microfocused ultrasound in the neck&#44; decolletage&#44; hands&#44; and other areas of the body"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;G&#46; Fabi"
                            1 => "C&#46; Burgess"
                            2 => "A&#46; Carruthers"
                            3 => "J&#46; Carruthers"
                            4 => "D&#46; Day"
                            5 => "K&#46; Goldie"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/DSS.0000000000000869"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dermatol Surg&#46;"
                        "fecha" => "2016"
                        "volumen" => "42"
                        "paginaInicial" => "1199"
                        "paginaFinal" => "1208"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27668925"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0330"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Zen and the art of living mindfully&#58; The health-enhancing potential of Zen aesthetics"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "T&#46; Lomas"
                            1 => "N&#46; Etcoff"
                            2 => "W&#46; van Gordon"
                            3 => "E&#46; Shonin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s10943-017-0446-5"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Relig Health&#46;"
                        "fecha" => "2017"
                        "volumen" => "56"
                        "paginaInicial" => "1720"
                        "paginaFinal" => "1739"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28718052"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0335"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cosmetics&#44; diet&#44; and the future"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Z&#46;D&#46; Draelos"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1529-8019.2012.01500.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dermatol Ther&#46;"
                        "fecha" => "2012"
                        "volumen" => "25"
                        "paginaInicial" => "267"
                        "paginaFinal" => "272"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22913445"
                            "web" => "Medline"
                          ]
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                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0340"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A holistic approach to antiaging as an adjunct to antiaging procedures&#58; A review of the literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46;S&#46; Saluja"
                            1 => "S&#46;G&#46; Fabi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/DSS.0000000000001027"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dermatol Surg&#46;"
                        "fecha" => "2017"
                        "volumen" => "43"
                        "paginaInicial" => "475"
                        "paginaFinal" => "484"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28359075"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0345"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ultraviolet radiation and the skin&#58; Photobiology and sunscreen photoprotection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46;R&#46; Young"
                            1 => "J&#46; Claveau"
                            2 => "A&#46;B&#46; Rossi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaad.2016.09.038"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Am Acad Dermatol&#46;"
                        "fecha" => "2017"
                        "volumen" => "76"
                        "numero" => "Suppl&#46; 1"
                        "paginaInicial" => "S100"
                        "paginaFinal" => "S109"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28038885"
                            "web" => "Medline"
                          ]
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                    ]
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                ]
              ]
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            6 => array:3 [
              "identificador" => "bib0350"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Anti-aging cosmetics&#58; Facts and controversies"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46; Ramos-e-Silva"
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                            2 => "S&#46; Ramos-e-Silva"
                            3 => "A&#46;P&#46; Fucci-da-Costa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.clindermatol.2013.05.013"
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                        "tituloSerie" => "Clin Dermatol&#46;"
                        "fecha" => "2013"
                        "volumen" => "31"
                        "paginaInicial" => "750"
                        "paginaFinal" => "758"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24160281"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0355"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Laser eradication of pigmented lesions&#58; A review"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "K&#46;D&#46; Polder"
                            1 => "J&#46;M&#46; Landau"
                            2 => "I&#46;J&#46; Vergilis-Kalner"
                            3 => "L&#46;H&#46; Goldberg"
                            4 => "P&#46;M&#46; Friedman"
                            5 => "S&#46; Bruce"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1524-4725.2011.01971.x"
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                        "tituloSerie" => "Dermatol Surg&#46;"
                        "fecha" => "2011"
                        "volumen" => "37"
                        "paginaInicial" => "572"
                        "paginaFinal" => "595"
                        "link" => array:1 [
                          0 => array:2 [
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                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0360"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Vascular lasers"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "T&#46; Michaud"
                          ]
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0151-9638(09)72540-2"
                      "Revista" => array:7 [
                        "tituloSerie" => "Ann Dermatol Venereol&#46;"
                        "fecha" => "2009"
                        "volumen" => "136"
                        "numero" => "Suppl&#46; 6"
                        "paginaInicial" => "S320"
                        "paginaFinal" => "S324"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19931692"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0365"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparative effectiveness of nonpurpuragenic 595-nm pulsed dye laser and microsecond 1064-nm neodymium&#58; Yttrium-aluminum-garnet laser for treatment of diffuse facial erythema&#58; A double-blind randomized controlled trial"
                      "autores" => array:1 [
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                          "etal" => true
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                            2 => "M&#46; Warycha"
                            3 => "D&#46; Whiting"
                            4 => "M&#46; Nodzenski"
                            5 => "S&#46; Yoo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaad.2013.04.015"
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                        "tituloSerie" => "J Am Acad Dermatol&#46;"
                        "fecha" => "2013"
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                        "paginaInicial" => "438"
                        "paginaFinal" => "443"
                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23688651"
                            "web" => "Medline"
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                ]
              ]
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              "identificador" => "bib0370"
              "etiqueta" => "11"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Laser use for cutaneous vascular alterations of cosmetic interest"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "P&#46;L&#46; Bencini"
                            1 => "A&#46; Tourlaki"
                            2 => "V&#46; de Giorgi"
                            3 => "M&#46; Galimberti"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1529-8019.2012.01463.x"
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                        "tituloSerie" => "Dermatol Ther&#46;"
                        "fecha" => "2012"
                        "volumen" => "25"
                        "paginaInicial" => "340"
                        "paginaFinal" => "351"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22950561"
                            "web" => "Medline"
                          ]
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              "identificador" => "bib0375"
              "etiqueta" => "12"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Split-face randomized treatment of facial telangiectasia comparing pulsed dye laser and an intense pulsed light handpiece"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "E&#46;A&#46; Tanghetti"
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/lsm.21151"
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                        "tituloSerie" => "Lasers Surg Med&#46;"
                        "fecha" => "2012"
                        "volumen" => "44"
                        "paginaInicial" => "97"
                        "paginaFinal" => "102"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22180317"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            12 => array:3 [
              "identificador" => "bib0380"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Single-session combination treatment with intense pulsed light and nonablative fractional photothermolysis&#58; A split-face study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "C&#46; Kearney"
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                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1524-4725.2012.02401.x"
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                        "tituloSerie" => "Dermatol Surg&#46;"
                        "fecha" => "2012"
                        "volumen" => "38"
                        "paginaInicial" => "1002"
                        "paginaFinal" => "1009"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22574965"
                            "web" => "Medline"
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                ]
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                    0 => array:2 [
                      "titulo" => "Treatment of melasma using a novel 1&#44;927-nm fractional thulium fiber laser&#58; A pilot study"
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                          "etal" => false
                          "autores" => array:2 [
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                  "host" => array:1 [
                    0 => array:2 [
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                        "volumen" => "38"
                        "paginaInicial" => "199"
                        "paginaFinal" => "206"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22093448"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0390"
              "etiqueta" => "15"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparison between 1&#37; tretinoin peeling versus 70&#37; glycolic acid peeling in the treatment of female patients with melasma"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
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                            2 => "A&#46;H&#46; Siadat"
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Drugs Dermatol&#46;"
                        "fecha" => "2011"
                        "volumen" => "10"
                        "paginaInicial" => "1439"
                        "paginaFinal" => "1442"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22134569"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dermocosmetic management of hyperpigmentations"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "D&#46; Guerrero"
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                      "Revista" => array:7 [
                        "tituloSerie" => "Ann Dermatol Venereol&#46;"
                        "fecha" => "2012"
                        "volumen" => "139"
                        "numero" => "Suppl&#46; 4"
                        "paginaInicial" => "S166"
                        "paginaFinal" => "S169"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23522633"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0400"
              "etiqueta" => "17"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fractional carbon dioxide laser resurfacing of rhytides and photoaged skin -- a prospective clinical study on patient expectation and satisfaction"
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                        0 => array:2 [
                          "etal" => true
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                            5 => "S&#46; Karrer"
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                        "paginaFinal" => "119"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25652114"
                            "web" => "Medline"
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                ]
              ]
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              "etiqueta" => "18"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Fractional carbon dioxide laser of recent surgical scars in the head and neck region&#58; A split-scar&#44; evaluator-blinded study"
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                          "etal" => true
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                            3 => "H&#46; Lapeere"
                            4 => "W&#46; Huvenne"
                            5 => "H&#46; Vermeersch"
                          ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/DSS.0000000000000963"
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                        "tituloSerie" => "Dermatol Surg&#46;"
                        "fecha" => "2017"
                        "volumen" => "43"
                        "paginaInicial" => "S75"
                        "paginaFinal" => "S84"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28009692"
                            "web" => "Medline"
                          ]
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              "identificador" => "bib0410"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fractional CO<span class="elsevierStyleInf">2</span> lasers for the treatment of atrophic acne scars&#58; A review of the literature"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "L&#46;R&#46; Magnani"
                            1 => "E&#46;S&#46; Schweiger"
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                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3109/14764172.2013.854639"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Cosmet Laser Ther&#46;"
                        "fecha" => "2014"
                        "volumen" => "16"
                        "paginaInicial" => "48"
                        "paginaFinal" => "56"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24131097"
                            "web" => "Medline"
                          ]
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                ]
              ]
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            19 => array:3 [
              "identificador" => "bib0415"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical and histological evaluations of enlarged facial skin pores after low energy level treatments with fractional carbon dioxide laser in Korean patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "H&#46;H&#46; Kwon"
                            1 => "S&#46;C&#46; Choi"
                            2 => "W&#46;Y&#46; Lee"
                            3 => "J&#46;Y&#46; Jung"
                            4 => "G&#46;H&#46; Park"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/DSS.0000000000001313"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dermatol Surg&#46;"
                        "fecha" => "2018"
                        "volumen" => "44"
                        "paginaInicial" => "405"
                        "paginaFinal" => "412"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28902036"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            20 => array:3 [
              "identificador" => "bib0420"
              "etiqueta" => "21"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical outcomes and complications associated with fractional lasers&#58; A review of 730 patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;R&#46; Cohen"
                            1 => "A&#46; Goodacre"
                            2 => "S&#46; Lim"
                            3 => "J&#46; Johnston"
                            4 => "C&#46; Henssler"
                            5 => "B&#46; Jeffers"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00266-016-0767-x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Aesthetic Plast Surg&#46;"
                        "fecha" => "2017"
                        "volumen" => "41"
                        "paginaInicial" => "171"
                        "paginaFinal" => "178"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28032173"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            21 => array:3 [
              "identificador" => "bib0425"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The role of the CO<span class="elsevierStyleInf">2</span> laser and fractional CO<span class="elsevierStyleInf">2</span> laser in dermatology"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "T&#46; Omi"
                            1 => "K&#46; Numano"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.5978/islsm.14-RE-01"
                      "Revista" => array:6 [
                        "tituloSerie" => "Laser Ther&#46;"
                        "fecha" => "2014"
                        "volumen" => "23"
                        "paginaInicial" => "49"
                        "paginaFinal" => "60"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24771971"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0430"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mesotherapy for facial skin rejuvenation&#58; A clinical&#44; histologic&#44; and electron microscopic evaluation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46;P&#46; Amin"
                            1 => "R&#46;G&#46; Phelps"
                            2 => "D&#46;J&#46; Goldberg"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1524-4725.2006.32353.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dermatol Surg&#46;"
                        "fecha" => "2006"
                        "volumen" => "32"
                        "paginaInicial" => "1467"
                        "paginaFinal" => "1472"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17199654"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            23 => array:3 [
              "identificador" => "bib0435"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hyaluronic acid plus mannitol treatment for improved skin hydration and elasticity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46; Taieb"
                            1 => "C&#46; Gay"
                            2 => "S&#46; Sebban"
                            3 => "P&#46; Secnazi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1473-2165.2012.00608.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Cosmet Dermatol&#46;"
                        "fecha" => "2012"
                        "volumen" => "11"
                        "paginaInicial" => "87"
                        "paginaFinal" => "92"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22672272"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            24 => array:3 [
              "identificador" => "bib0440"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Efficacy of autologous platelet-rich plasma combined with hyaluronic acid on skin facial rejuvenation&#58; A prospective study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "B&#46; Hersant"
                            1 => "M&#46; SidAhmed-Mezi"
                            2 => "J&#46; Niddam"
                            3 => "S&#46; La Padula"
                            4 => "W&#46; Noel"
                            5 => "K&#46; Ezzedine"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaad.2017.05.022"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol&#46;"
                        "fecha" => "2017"
                        "volumen" => "77"
                        "paginaInicial" => "584"
                        "paginaFinal" => "586"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28807118"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0445"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Biorejuvenation&#58; Theory and practice"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46; Iorizzo"
                            1 => "M&#46;P&#46; de Padova"
                            2 => "A&#46; Tosti"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.clindermatol.2007.09.011"
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                        "tituloSerie" => "Clin Dermatol&#46;"
                        "fecha" => "2008"
                        "volumen" => "26"
                        "paginaInicial" => "177"
                        "paginaFinal" => "181"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18472058"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0450"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Benefits of plasma rich in growth factors &#40;PRGF&#41; in skin photodamage&#58; Clinical response and histological assessment"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "B&#46; Diaz-Ley"
                            1 => "J&#46; Cuevas"
                            2 => "L&#46; Alonso-Castro"
                            3 => "M&#46;I&#46; Calvo"
                            4 => "L&#46; Rios-Buceta"
                            5 => "G&#46; Orive"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/dth.12228"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dermatol Ther&#46;"
                        "fecha" => "2015"
                        "volumen" => "28"
                        "paginaInicial" => "258"
                        "paginaFinal" => "263"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25864463"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0455"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Thermage&#58; The nonablative radiofrequency for rejuvenation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46;A&#46; Sukal"
                            1 => "R&#46;G&#46; Geronemus"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.clindermatol.2007.09.007"
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                        "tituloSerie" => "Clin Dermatol&#46;"
                        "fecha" => "2008"
                        "volumen" => "26"
                        "paginaInicial" => "602"
                        "paginaFinal" => "607"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18940540"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0460"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The use of hybrid radiofrequency device for the treatment of rhytides and lax skin"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46;J&#46; Friedman"
                            1 => "L&#46;T&#46; Gilead"
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                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1524-4725.2007.33112.x"
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                        "tituloSerie" => "Dermatol Surg&#46;"
                        "fecha" => "2007"
                        "volumen" => "33"
                        "paginaInicial" => "543"
                        "paginaFinal" => "551"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17451576"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0465"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Outcomes of polydioxanone knotless thread lifting for facial rejuvenation"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "D&#46;H&#46; Suh"
                            1 => "H&#46;W&#46; Jang"
                            2 => "S&#46;J&#46; Lee"
                            3 => "W&#46;S&#46; Lee"
                            4 => "H&#46;J&#46; Ryu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/DSS.0000000000000368"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dermatol Surg&#46;"
                        "fecha" => "2015"
                        "volumen" => "41"
                        "paginaInicial" => "720"
                        "paginaFinal" => "725"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25993611"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ten mistakes to avoid when injecting botulinum toxin"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "R&#46; Ruiz-Rodriguez"
                            1 => "A&#46; Martin-Gorgojo"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Actas Dermo-Sifiliogr&#46;"
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                        "volumen" => "106"
                        "paginaInicial" => "458"
                        "paginaFinal" => "464"
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                    ]
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                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0475"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Efficacy&#44; patient-reported outcomes and safety profile of ATX-101 &#40;deoxycholic acid&#41;&#44; an injectable drug for the reduction of unwanted submental fat&#58; Results from a phase III&#44; randomized&#44; placebo-controlled study"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
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                            1 => "K&#46; Hoffmann"
                            2 => "P&#46; Walker"
                            3 => "S&#46; Lippert"
                            4 => "U&#46; Wollina"
                            5 => "B&#46; Havlickova"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/jdv.12377"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Eur Acad Dermatol Venereol&#46;"
                        "fecha" => "2014"
                        "volumen" => "28"
                        "paginaInicial" => "1707"
                        "paginaFinal" => "1715"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24605812"
                            "web" => "Medline"
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                    ]
                  ]
                ]
              ]
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            32 => array:3 [
              "identificador" => "bib0480"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Facial treatment preferences among aesthetically oriented men"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
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                            2 => "V&#46; Narurkar"
                            3 => "J&#46; Kolodziejczyk"
                            4 => "C&#46;J&#46; Gallagher"
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                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/DSS.0000000000000876"
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                        "tituloSerie" => "Dermatol Surg&#46;"
                        "fecha" => "2016"
                        "volumen" => "42"
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                        "paginaFinal" => "1163"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27661428"
                            "web" => "Medline"
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                ]
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              "identificador" => "bib0485"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Selective cryolysis&#58; A novel method of non-invasive fat removal"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "D&#46; Manstein"
                            1 => "H&#46; Laubach"
                            2 => "K&#46; Watanabe"
                            3 => "W&#46; Farinelli"
                            4 => "D&#46; Zurakowski"
                            5 => "R&#46;R&#46; Anderson"
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                        ]
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/lsm.20719"
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                        "tituloSerie" => "Lasers Surg Med&#46;"
                        "fecha" => "2008"
                        "volumen" => "40"
                        "paginaInicial" => "595"
                        "paginaFinal" => "604"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18951424"
                            "web" => "Medline"
                          ]
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                      ]
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                  ]
                ]
              ]
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              "identificador" => "bib0490"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Safety and efficacy of cryolipolysis for non-invasive reduction of submental fat"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46;L&#46; Kilmer"
                            1 => "A&#46;J&#46; Burns"
                            2 => "B&#46;D&#46; Zelickson"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/lsm.22440"
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                        "tituloSerie" => "Lasers Surg Med&#46;"
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                        "paginaInicial" => "3"
                        "paginaFinal" => "13"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26607045"
                            "web" => "Medline"
                          ]
                        ]
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                    ]
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                ]
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            35 => array:3 [
              "identificador" => "bib0495"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Noninvasive submental fat reduction using colder cryolipolysis"
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                          "etal" => false
                          "autores" => array:5 [
                            0 => "H&#46; Leal Silva"
                            1 => "E&#46; Carmona Hernandez"
                            2 => "M&#46; Grijalva Vazquez"
                            3 => "S&#46; Leal Delgado"
                            4 => "A&#46; Perez Blanco"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/jocd.12383"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Cosmet Dermatol&#46;"
                        "fecha" => "2017"
                        "volumen" => "16"
                        "paginaInicial" => "460"
                        "paginaFinal" => "465"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28901051"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            36 => array:3 [
              "identificador" => "bib0500"
              "etiqueta" => "37"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prototype coolcup cryolipolysis applicator with over 40&#37; reduced treatment time demonstrates equivalent safety and efficacy with greater patient preference"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "S&#46;L&#46; Kilmer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/lsm.22550"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lasers Surg Med&#46;"
                        "fecha" => "2017"
                        "volumen" => "49"
                        "paginaInicial" => "63"
                        "paginaFinal" => "68"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27327898"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib0505"
              "etiqueta" => "38"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Results from a pooled analysis of two European&#44; randomized&#44; placebo-controlled&#44; phase 3 studies of ATX-101 for the pharmacologic reduction of excess submental fat"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46; McDiarmid"
                            1 => "J&#46;B&#46; Ruiz"
                            2 => "D&#46; Lee"
                            3 => "S&#46; Lippert"
                            4 => "C&#46; Hartisch"
                            5 => "B&#46; Havlickova"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Aesthetic Plast Surg&#46;"
                        "fecha" => "2014"
                        "volumen" => "3"
                        "paginaInicial" => "849"
                        "paginaFinal" => "860"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            38 => array:3 [
              "identificador" => "bib0510"
              "etiqueta" => "39"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Early experience in 100 consecutive patients with injection adipocytolysis for neck contouring with ATX-101 &#40;deoxycholic acid&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "S&#46;M&#46; Shridharani"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/DSS.0000000000001133"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dermatol Surg&#46;"
                        "fecha" => "2017"
                        "volumen" => "43"
                        "paginaInicial" => "950"
                        "paginaFinal" => "958"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28448317"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            39 => array:3 [
              "identificador" => "bib0515"
              "etiqueta" => "40"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "S225 S230"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "ATX-101 &#40;deoxycholic acid injection&#41; treatment in men&#58; Insights from our clinical experience"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46;M&#46; Shridharani"
                            1 => "K&#46;L&#46; Behr"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Dermatol Surg&#46;"
                        "fecha" => "2017"
                        "volumen" => "43"
                        "numero" => "Suppl&#46; 2"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            40 => array:3 [
              "identificador" => "bib0520"
              "etiqueta" => "41"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dermal fillers&#58; Types&#44; indications&#44; and complications"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "I&#46; Sanchez-Carpintero"
                            1 => "D&#46; Candelas"
                            2 => "R&#46; Ruiz-Rodriguez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Actas Dermo-Sifiliogr&#46;"
                        "fecha" => "2010"
                        "volumen" => "101"
                        "paginaInicial" => "381"
                        "paginaFinal" => "393"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            41 => array:3 [
              "identificador" => "bib0525"
              "etiqueta" => "42"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Synthetic fillers for facial rejuvenation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;C&#46; Lee"
                            1 => "Z&#46;P&#46; Lorenc"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.cps.2016.03.002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Plast Surg&#46;"
                        "fecha" => "2016"
                        "volumen" => "43"
                        "paginaInicial" => "497"
                        "paginaFinal" => "503"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27363763"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            42 => array:3 [
              "identificador" => "bib0530"
              "etiqueta" => "43"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "872e e889"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Current applications of facial volumization with fillers"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46;J&#46; Wilson"
                            1 => "A&#46;J&#46; Taglienti"
                            2 => "C&#46;S&#46; Chang"
                            3 => "D&#46;W&#46; Low"
                            4 => "I&#46; Percec"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "Plast Reconstruct Surg&#46;"
                        "fecha" => "2016"
                        "volumen" => "137"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            43 => array:3 [
              "identificador" => "bib0535"
              "etiqueta" => "44"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Reversing facial fillers&#58; Interactions between hyaluronidase and commercially available hyaluronic-acid based fillers"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "V&#46; Rao"
                            1 => "S&#46; Chi"
                            2 => "J&#46; Woodward"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Drugs Dermatol&#46;"
                        "fecha" => "2014"
                        "volumen" => "13"
                        "paginaInicial" => "1053"
                        "paginaFinal" => "1056"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25226005"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            44 => array:3 [
              "identificador" => "bib0540"
              "etiqueta" => "45"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Calcium hydroxylapatite tissue filler discovered 6 years after implantation into the nasolabial fold&#58; Case report and review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "P&#46;R&#46; Shumaker"
                            1 => "E&#46;L&#46; Sakas"
                            2 => "M&#46;H&#46; Swann"
                            3 => "H&#46;T&#46; Greenway Jr&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1524-4725.2008.01050.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dermatol Surg&#46;"
                        "fecha" => "2009"
                        "volumen" => "35"
                        "paginaInicial" => "375"
                        "paginaFinal" => "379"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19207328"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            45 => array:3 [
              "identificador" => "bib0545"
              "etiqueta" => "46"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The hyaluronic acid fillers&#58; Current understanding of the tissue device interface"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;J&#46; Greene"
                            1 => "D&#46;M&#46; Sidle"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.fsc.2015.07.002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Facial Plast Surg Clin North Am&#46;"
                        "fecha" => "2015"
                        "volumen" => "23"
                        "paginaInicial" => "423"
                        "paginaFinal" => "432"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26505539"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            46 => array:3 [
              "identificador" => "bib0550"
              "etiqueta" => "47"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "s45 s47"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The tower technique and vertical supraperiosteal depot technique&#58; Novel vertical injection techniques for volume-efficient subcutaneous tissue support and volumetric augmentation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "G&#46; Sattler"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "J Drugs Dermatol&#46;"
                        "fecha" => "2012"
                        "volumen" => "11"
                        "itemHostRev" => array:3 [
                          "pii" => "S0140673604154895"
                          "estado" => "S300"
                          "issn" => "01406736"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            47 => array:3 [
              "identificador" => "bib0555"
              "etiqueta" => "48"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hyaluronic acid&#58; The scientific and clinical evidence"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46;D&#46; Price"
                            1 => "M&#46;G&#46; Berry"
                            2 => "H&#46;A&#46; Navsaria"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Plast Reconstruct Aesthetic Surg&#46;"
                        "fecha" => "2007"
                        "volumen" => "60"
                        "paginaInicial" => "1110"
                        "paginaFinal" => "1119"
                      ]
                    ]
                  ]
                ]
              ]
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            48 => array:3 [
              "identificador" => "bib0560"
              "etiqueta" => "49"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dermal filler complications&#58; A clinicopathologic study with a spectrum of histologic reaction patterns"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46; El-Khalawany"
                            1 => "S&#46; Fawzy"
                            2 => "A&#46; Saied"
                            3 => "M&#46; Al Said"
                            4 => "A&#46; Amer"
                            5 => "B&#46; Eassa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Ann Diag Pathol&#46;"
                        "fecha" => "2015"
                        "volumen" => "19"
                        "paginaInicial" => "10"
                        "paginaFinal" => "15"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            49 => array:3 [
              "identificador" => "bib0565"
              "etiqueta" => "50"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "&#171;Deep heating&#187; noninvasive skin tightening devices&#58; Review of effectiveness and patient satisfaction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46; Chilukuri"
                            1 => "J&#46; Lupton"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Drugs Drmatol&#46;"
                        "fecha" => "2017"
                        "volumen" => "16"
                        "paginaInicial" => "1262"
                        "paginaFinal" => "1266"
                      ]
                    ]
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                ]
              ]
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            50 => array:3 [
              "identificador" => "bib0570"
              "etiqueta" => "51"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Radio frequency energy for non-invasive and minimally invasive skin tightening"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "R&#46;S&#46; Mulholland"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.cps.2011.05.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Plast Surg&#46;"
                        "fecha" => "2011"
                        "volumen" => "38"
                        "paginaInicial" => "437"
                        "paginaFinal" => "448"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21824541"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            51 => array:3 [
              "identificador" => "bib0575"
              "etiqueta" => "52"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Noninvasive skin tightening&#58; Focus on new ultrasound techniques"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "S&#46;G&#46; Fabi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Clin Cosmet Invest Dermatol&#46;"
                        "fecha" => "2015"
                        "volumen" => "8"
                        "paginaInicial" => "47"
                        "paginaFinal" => "52"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            52 => array:3 [
              "identificador" => "bib0580"
              "etiqueta" => "53"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Complications from microfocused transcutaneous ultrasound&#58; Case series and review of the literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "D&#46;P&#46; Friedmann"
                            1 => "G&#46;P&#46; Bourgeois"
                            2 => "H&#46;H&#46;L&#46; Chan"
                            3 => "A&#46;C&#46; Zedlitz"
                            4 => "K&#46;J&#46; Butterwick"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/lsm.22768"
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                        "tituloSerie" => "Lasers Surg Med&#46;"
                        "fecha" => "2018"
                        "volumen" => "50"
                        "paginaInicial" => "13"
                        "paginaFinal" => "19"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29154457"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            53 => array:3 [
              "identificador" => "bib0585"
              "etiqueta" => "54"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Safety and efficacy of ulthera in the rejuvenation of aging lower eyelids&#58; A pivotal clinical trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "C&#46;S&#46; Pak"
                            1 => "Y&#46;K&#46; Lee"
                            2 => "J&#46;H&#46; Jeong"
                            3 => "J&#46;H&#46; Kim"
                            4 => "J&#46;D&#46; Seo"
                            5 => "C&#46;Y&#46; Heo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00266-014-0383-6"
                      "Revista" => array:6 [
                        "tituloSerie" => "Aesthetic Plast Surg&#46;"
                        "fecha" => "2014"
                        "volumen" => "38"
                        "paginaInicial" => "861"
                        "paginaFinal" => "868"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25099495"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            54 => array:3 [
              "identificador" => "bib0590"
              "etiqueta" => "55"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Combination of intense pulsed light&#44; Sculptra&#44; and Ultherapy for treatment of the aging face"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
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                            1 => "S&#46;G&#46; Fabi"
                            2 => "M&#46;P&#46; Goldman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/jocd.12093"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Cosmet Dermatol&#46;"
                        "fecha" => "2014"
                        "volumen" => "13"
                        "paginaInicial" => "109"
                        "paginaFinal" => "118"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24910274"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            55 => array:3 [
              "identificador" => "bib0595"
              "etiqueta" => "56"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "180S 187S"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Current concepts in the use of PLLA&#58; Clinical synergy noted with combined use of microfocused ultrasound and poly-l-lactic acid on the face&#44; neck&#44; and decolletage"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "D&#46;R&#46; Hart"
                            1 => "S&#46;G&#46; Fabi"
                            2 => "W&#46;M&#46; White"
                            3 => "R&#46; Fitzgerald"
                            4 => "M&#46;P&#46; Goldman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Plast Reconstruct Surg&#46;"
                        "fecha" => "2015"
                        "volumen" => "136"
                        "numero" => "5 Suppl&#46;"
                      ]
                    ]
                  ]
                ]
              ]
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                    0 => array:2 [
                      "titulo" => "Carotenoids and polyphenols in nutricosmetics&#44; nutraceuticals&#44; and cosmeceuticals"
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              ]
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                    0 => array:2 [
                      "titulo" => "The minimal approach&#58; An innovation in facial cosmetic procedures"
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                        0 => array:2 [
                          "etal" => false
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15529203"
                            "web" => "Medline"
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                  "contribucion" => array:1 [
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                      "titulo" => "Assessing improvement of facial appearance and quality of life after minimally-invasive cosmetic dermatology procedures using the FACE-Q scales"
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                        0 => array:2 [
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                        "link" => array:1 [
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                        "paginaFinal" => "26"
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Practical Dermatology
Integral Facial Management of the Aesthetic Patient: The Skin Age Management Protocol
Abordaje facial global del paciente estético: protocolo Skin Age Management
R. Ruiz-Rodriguez
Autor para correspondencia
ricardo@ricardoruiz.es

Corresponding author.
, A. Martin-Gorgojo
Clínica Dermatológica Internacional, Madrid, España
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        "titulo" => "Abordaje facial global del paciente est&#233;tico&#58; protocolo <span class="elsevierStyleItalic">Skin Age Management</span>"
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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Description of the treatments in each level of the liquid facelift &#40;nonsurgical facial rejuvenation&#41;&#46;</p> <p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">NCHA indicates non-crosslinked hyaluronic acid&#46;</p> <p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The collagen inducer we use is calcium hydroxyapatite &#40;Radiesse<span class="elsevierStyleSup">&#174;</span>&#41;&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Background</span><p id="par0005" class="elsevierStylePara elsevierViewall">Modern aesthetic dermatology offers a broad range of minimally invasive treatments that can help our patients to age elegantly and with discretion&#46; It can be difficult to present our patients a systematic overview of these treatments so as to ensure that they are aware of all of the options available to them in the areas they want to enhance&#46; At Cl&#237;nica Dermatol&#243;gica Internacional we have developed a structured protocol to address this need&#46; The aim is to help physicians and their patients to better understand the options and to decide on a treatment plan&#46; It also reinforces the message that the ideal approach can often be found in a combination of different techniques<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">1&#44;2</span></a> and reflects our philosophy that the results we consider optimum are obtained by implementing a series of discreet changes&#46; Our name for this this protocol is SAM&#8212;an acronym for Skin Age Management&#46; When patients come to our dermatology office to consult us on how they can improve their appearance&#44; we show them the SAM diagram&#44; which summarizes the options available and allows us to organize our recommendations and plan the treatments &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">In the central panel&#44; we underscore the fact that the most important factor in aging with elegance and discretion is to maintain a positive mental attitude<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">3</span></a> and a healthy lifestyle&#44; including a varied and balanced diet &#40;a skin healthy diet<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">4</span></a>&#41;&#44; not smoking&#44; and engaging in moderate physical exercise every day&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In this article&#44; we will describe the various options available&#44; depending on the areas the patient wishes to improve&#46; Although most of these technique can be used on people from any geographical area&#44; this article is based on our daily experience treating patients who mostly have Fitzpatrick I to IV phototypes&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Skin Quality</span><p id="par0020" class="elsevierStylePara elsevierViewall">The best approach to improving skin quality involves an assessment by a dermatologist&#44; who establishes a cosmetic protocol and identifies the problems that can be modified or treated&#58;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The first step is never to forget that sunscreen is the best cosmetic&#46; The daily use of a sunblock to protect the skin will prevent photoaging as well as having other beneficial effects&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">6</span></a> In addition to the regular use of sunscreen&#44; we also often recommend cosmeceutical products that contain molecules with proven antiaging properties&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Retinoic acid is the most effective of these ingredients and we generally recommend its application 2 or 3 nonconsecutive nights a week&#44; adjusting the regimen in patients with sensitive skin or when there are specific environmental factors&#46; Other ingredients that have shown some efficacy include vitamin C&#44; alpha hydroxy acids &#40;such as glycolic acid&#41;&#44; and other vitamin A derivatives&#44; such as retinol&#44; etc&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">7</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The current trend is to offer each patient an individualized cosmetic protocol including personalized cosmetics adapted to the characteristics of their skin&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">If the patient has solar lentigines or other signs of photoaging&#44; we recommend alexandrite or Q-switched laser therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">8</span></a> In the case of telangiectasias and erythema we use vascular lasers&#44; including 595<span class="elsevierStyleMonospace">-</span>nm pulsed dye laser&#44;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">9</span></a> 1064-nm neodymium&#58;yttrium-aluminum-garnet laser&#44;<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">10&#44;11</span></a> and medical intense pulsed light&#46;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">12</span></a> To treat severe photodamage&#44; particularly in patients with poikiloderma&#44; we used a combination of several light sources&#58; intense pulsed light&#44; stain removal lasers&#44; as well as vascular and nonablative fractional lasers&#44; such as 1550-nm erbium&#58;glass and 1927-nm thulium&#46;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">13</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">In patients with melasma&#44; we have observed better responses to treatment in our clinic with low energy lasers &#40;such as 1927-nm thulium&#41;<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">14</span></a> or gentle exfoliating procedures<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">15</span></a> in combination with the application at the patient&#39;s home of depigmenting formulas containing retinoic acid and hydroquinone&#46;<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">16</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">For the treatment of irregularities in the form of lines and wrinkles &#40;in particular the vertical barcode lines on the upper lip and crow&#39;s feet around the eyes&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">17</span></a> scars &#40;like those caused by acne or surgical procedures&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0405"><span class="elsevierStyleSup">18&#44;19</span></a> and open pores&#44;<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">20</span></a> we recommend using fractional ablative technologies&#44; such as carbon dioxide lasers&#46; These have been shown to be better than classic lasers in terms of patient tolerance and the occurrence of adverse effects&#46;<a class="elsevierStyleCrossRefs" href="#bib0420"><span class="elsevierStyleSup">21&#44;22</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">To enhance skin luminosity&#44; we mainly use mesotherapy with hyaluronic acid &#40;multiple microinjections of this substance into the area of the face&#44; neckline&#44; or back of the hands to be treated&#41;<a class="elsevierStyleCrossRefs" href="#bib0430"><span class="elsevierStyleSup">23&#44;24</span></a> and platelet-rich plasma &#40;PRP&#41;&#46; PRP involves drawing blood from the patient&#44; separating the growth factors contained in the platelets by centrifugation&#44; activating the platelet membranes&#44; and intradermal injection of the resulting PRP in the form of mesotherapy&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0440"><span class="elsevierStyleSup">25&#8211;27</span></a> Radiofrequency devices have also been used for many years to make skin more luminous&#59; they also have a slight firming effect&#46;<a class="elsevierStyleCrossRefs" href="#bib0455"><span class="elsevierStyleSup">28&#44;29</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">If facial skin has atrophied or thinned&#44; PDO mini threads can be implanted by injection into the deep dermis to induce neocollagenesis&#46;<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">30</span></a></p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Expression Lines</span><p id="par0065" class="elsevierStylePara elsevierViewall">Botulinum toxin is the technique that has revolutionized nonsurgical rejuvenation methods&#46; It is a safe and effective technique that provides natural results when used carefully&#46; The use of botulinum toxin alone without other treatments is not an ideal approach because it only improve wrinkles&#59; in most patients the best results are obtained when it is used in combination with other techniques to obtain more harmonious results&#46;<a class="elsevierStyleCrossRef" href="#bib0470"><span class="elsevierStyleSup">31</span></a><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> lists the 10 commandments for optimum use of botulinum toxin in facial rejuvenation&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Unwanted Fat</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Importance of Submental Fullness in Facial Rejuvenation</span><p id="par0070" class="elsevierStylePara elsevierViewall">Several non-invasive procedures used to treat body fat can also be used to treat a double chin by reducing submental fat&#46; The appearance of a double chin is an age-related change that worries a large number of patients and is sometimes neglected by aesthetic dermatologists&#46; Treating submental fullness produces a strong emotional impact and improves the patient&#39;s self-image&#46;<a class="elsevierStyleCrossRef" href="#bib0475"><span class="elsevierStyleSup">32</span></a> In a study of 600 men recently published by an American team&#44; the double chin was the third most likely motive for treatment cited by the respondents&#46;<a class="elsevierStyleCrossRef" href="#bib0480"><span class="elsevierStyleSup">33</span></a> In our experience&#44; it could be the leading reason for consultation among men and a very common motive among women if the possibility of nonsurgical treatment were more generally known&#46; Until relatively recently&#44; surgical liposuction was the only effective way to eliminate submental fat&#46; Today&#44; there are 2 other safe and effective methods for eliminating submental fat&#58; cryolipolysis with the Coolsculpting<span class="elsevierStyleSup">&#174;</span> device and injection with deoxycholic acid &#40;marketed in Europe for this indication as Belkyra<span class="elsevierStyleSup">&#174;</span>&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Submental Fat Elimination With Cryolipolysis</span><p id="par0075" class="elsevierStylePara elsevierViewall">Selective cryolysis of subcutaneous fat &#40;or cryolipolysis&#41; involves the application on an area of the skin of a device that pulls the skin in by suction and cools it to induce inflammation &#40;initially leading to lobular panniculitis&#41; and the specific destruction of adipocytes&#46; Given the greater sensitivity to cold of fat cells&#44; the treatment does not damage the epidermis or other structures&#46;<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">34</span></a> For the treatment of localized fat&#44; the Coolsculpting<span class="elsevierStyleSup">&#174;</span> device is the technology that has been most validated&#46; It was the first cryolipolysis system to be developed and approved by the regulatory agencies and its effectiveness has been demonstrated&#46; Although other treatments&#44; such as other cryolipolysis systems and devices based on radiofrequencies or focused ultrasound&#44; can be considered&#44; Coolsculpting<span class="elsevierStyleSup">&#174;</span> is the only device that has been shown to be safe and effective for this indication&#59; it achieves predictable results and a high degree of patient satisfaction&#46; Coolsculpting<span class="elsevierStyleSup">&#174;</span> is a simple technique&#58; no anesthesia is required and there is no downtime after treatment&#46; The Coolsculpting<span class="elsevierStyleSup">&#174;</span> device can also be used to treat other areas of the body&#44; including the abdomen&#44; flanks&#44; back&#44; as well as the inner aspect of the thighs and arms&#46; Many authors have reported on the use of Coolsculpting<span class="elsevierStyleSup">&#174;</span> to eliminate submental fat&#46; The mean reduction achieved was 2&#160;mm of subcutaneous fat per session&#44; as measured by ultrasound&#44;<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">35</span></a> or 33&#37; of the fatty fold&#44; as measured by a pleximeter after 2 sessions&#46;<a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">36</span></a> A new method requiring shorter sessions of about 35&#160;minutes in duration has been developed based on a redesigned applicator&#46;<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">37</span></a> In our experience&#44; an approximate improvement of 20&#37; can be observed in 1 session&#46; Ideal candidates for this technique are patients whose weight is within the normal range and who have modestly pronounced fat deposits that are difficult to eliminate through diet or exercise&#46; There is no limit to the number of sessions a patient can undergo&#44; but in general we recommend 2 sessions separated by an interval of at least 1 month&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Deoxycholic Acid Injections</span><p id="par0080" class="elsevierStylePara elsevierViewall">The other nonsurgical technique that should be considered when treating submental fat is deoxycholic acid&#46;<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">38</span></a> This is available in 2-mL vials of a 10-mg&#47;mL solution &#40;marketed as Belkyra&#174; in Spain and Kybella&#174; in the United States&#41;&#46; The product was launched in Spain in 2017 and 2 years earlier in the United States&#46;<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">38</span></a> Before administration&#44; the injection sites &#40;1<span class="elsevierStyleHsp" style=""></span>cm apart&#41; are marked on the area to be treated using a template&#46; Then the treatment is administered in subcutaneous injections of 0&#46;2<span class="elsevierStyleHsp" style=""></span>mL up to a maximum infiltration volume of 15&#160;mL per session&#46; The injections can be somewhat painful&#44; making it advisable to use local anesthesia&#44; cold&#44; and analgesia&#46; After infiltration&#44; pain&#44; swelling and bruising in the treated area is not uncommon&#46; The most feared complication of this technique &#40;rare when the injection sites are properly marked&#41; is the accidental injection of the product into the marginal mandibular branch of the facial nerve&#44; causing paralysis on 1 side of the mouth lasting for some months&#46; Patients can undergo a maximum of 6 separate sessions separated by intervals of at least 1 month&#46;<a class="elsevierStyleCrossRef" href="#bib0510"><span class="elsevierStyleSup">39</span></a> The usefulness of this technique has been demonstrated in men&#44; in whom it is recommended that a larger surface area be treated at the first session to obtain the best outcome&#46;<a class="elsevierStyleCrossRef" href="#bib0515"><span class="elsevierStyleSup">40</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Volume Loss</span><p id="par0085" class="elsevierStylePara elsevierViewall">In the 1980s&#44; the rise of cosmetic surgery led to a growing trend in surgical facelifts&#44; a technique that was very effective in reducing visible wrinkles but tended to produce unnatural results&#46; The use of dermal fillers first started to become generalized at the end of the 1990s&#46; This was the first technique to address the problem of creating facial volume to compensate for the loss of volume secondary to changes in facial fat and bones&#46;<a class="elsevierStyleCrossRef" href="#bib0520"><span class="elsevierStyleSup">41</span></a> While some aesthetic protocols continue to include permanent fillers such as silicone&#44;<a class="elsevierStyleCrossRef" href="#bib0525"><span class="elsevierStyleSup">42</span></a> the most widely used fillers today are non-permanent products based on hyaluronic acid&#44; calcium hydroxyapatite&#44; and polylactic acid&#46; The results obtained are constantly improving as a result our of greater understanding and knowledge of age-related anatomical changes and the way the products available should be applied&#46;<a class="elsevierStyleCrossRef" href="#bib0530"><span class="elsevierStyleSup">43</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">To properly apply a dermal filler&#44; the first thing we must address is the diagnosis of the area to be treated&#46; Over time&#44; some of the facial convexities characteristic of childhood are lost&#44; giving rise to areas of shadow around the eyes and mouth&#44; which can give rise to an appearance of tiredness&#46; The best way to correct these changes is with the prudent use of fillers&#46; Another aspect that should be taken into account in any rejuvenation protocol is the so-called &#8220;triangle of youth&#8221;&#58; the face of a young person is shaped like a triangle with the base across the forehead and the apex pointing downwards&#46; With age&#44; the triangle is inverted and the base moves to the lower part of the face&#58; the face becomes wider and less oval&#46; Consequently&#44; adding volume to the lower third of the face should be avoided&#46; Hyaluronic acid is our dermal filler of choice&#46; It has the added advantage that an &#8220;antidote&#8221; exists in hyaluronidase&#44; although the effect of the antidote may vary depending on the hyaluronic acid filler used&#46;<a class="elsevierStyleCrossRef" href="#bib0535"><span class="elsevierStyleSup">44</span></a> In Spain&#44; hyaluronidase can only be obtained as a customized compound for off-label use&#59; our protocol for its use can be found in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; The other dermal filler we use is calcium hydroxyapatite&#44; although the effect in this case is more collagen-inducing than filling&#46; Currently we do not use any other fillers in our practice&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">In our opinion&#44; the replacement of facial volume is secondary compared to other goals&#44; such as improved skin quality&#44; in the aesthetic patient&#46; Even when the fillers used are temporary in nature&#44; they should be used with caution because it has been observed that&#44; in the long-term&#44; excessive treatment or &#8220;filler fatigue&#8221; can give rise to an inharmonious appearance&#46; Filler fatigue is caused by a decrease in skin elasticity&#44; fibrosis&#44; and the creation of an unnaturally wide face&#46; All of these changes can occur not only because of excessive use of collagen-inducing fillers such as calcium hydroxyapatite &#40;which induces fibrosis and may persist in the treated area for years<a class="elsevierStyleCrossRef" href="#bib0540"><span class="elsevierStyleSup">45</span></a>&#41; but also owing to overuse of hyaluronic acid &#40;which triggers an increase in profibrotic growth factors and collagen fibers types I and III&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0545"><span class="elsevierStyleSup">46</span></a> It has also been observed that fillers that have a greater degree of cross-linkage and the use of techniques such as superperiosteal injections can lead to more long-term effects<a class="elsevierStyleCrossRef" href="#bib0550"><span class="elsevierStyleSup">47</span></a> and increase the likelihood of adverse events&#46;<a class="elsevierStyleCrossRefs" href="#bib0555"><span class="elsevierStyleSup">48&#44;49</span></a> Fillers are&#44; therefore&#44; a useful tool provide they are used in moderation and applied by someone who has a great deal of knowledge about facial anatomy and in combination with other&#44; complementary&#44; techniques&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Flaccidity</span><p id="par0100" class="elsevierStylePara elsevierViewall">The 2 nonsurgical techniques we currently use to treat skin flaccidity without increasing volume are ultrasound &#40;using either high-intensity focused ultrasound &#91;HIFU&#93; or microfocused ultrasound&#41; and thread lifting&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Ultrasound</span><p id="par0105" class="elsevierStylePara elsevierViewall">There are several devices on the market designed to reduce skin laxity&#46;<a class="elsevierStyleCrossRef" href="#bib0565"><span class="elsevierStyleSup">50</span></a> While non-ablative techniques based on external radiofrequency may have some tightening effect&#44;<a class="elsevierStyleCrossRef" href="#bib0570"><span class="elsevierStyleSup">51</span></a> in our clinical experience the actual clinical effect is minimal&#46; In recent years&#44; therefore&#44; we have opted to use HIFU devices&#44; which apply focused ultrasound waves at various depths&#46; A device with the broadest range can focus the power at 1&#46;5&#44; 3&#44; and 4&#46;5&#160;mm&#44; modulating the frequency to 10&#44; 7 and 4&#46;5&#160;MHz&#41;&#46; This device can produce small thermal coagulation points in fat and fibromuscular tissue that have a tightening effect&#59; tolerance is good and the procedure has very few side effects &#40;infrequent bruising&#44; tingling&#44; or temporary muscle weakness&#41;&#44; which resolve within a few days or weeks&#46;<a class="elsevierStyleCrossRef" href="#bib0575"><span class="elsevierStyleSup">52</span></a> While rare&#44; more serious adverse effects may occur<a class="elsevierStyleCrossRef" href="#bib0580"><span class="elsevierStyleSup">53</span></a>&#59; these could be related to poor technique or inappropriate use&#44; underscoring the importance of proper training in the technique and an extensive knowledge of facial anatomy&#46; This technique is ideal for patients with mild to moderate laxity or sagging along the jawline&#44; on the neck&#44; and around the eyes&#46; It is particularly appropriate for correcting infraorbital laxity and for closing up the infrapalpebral space&#44; where the edema that gives rise to &#8220;bags&#8221; accumulates&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0585"><span class="elsevierStyleSup">54</span></a> It achieves unobtrusive results within a month of treatment&#46; The results are cumulative and can have a preventive effect&#44; which is why some plastic surgeons have called HIFU a &#8220;facelift by installments&#8221;&#46; For best results the procedure can be repeated every 6 to 12 months&#46; HIFU can be combined with other noninvasive treatments&#46;<a class="elsevierStyleCrossRefs" href="#bib0590"><span class="elsevierStyleSup">55&#44;56</span></a></p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Thread Lift</span><p id="par0110" class="elsevierStylePara elsevierViewall">Thread lifting is an interesting resource in any global approach to facial rejuvenation&#46; The threads are easy to apply and do not add volume &#40;making them ideal for use in the lower third of the face&#41;&#46; Their tightening and firming effect can be used to reposition loose or sagging tissue&#46;<a class="elsevierStyleCrossRef" href="#bib0600"><span class="elsevierStyleSup">57</span></a> There are many types of lifting threads on the market &#40;monothreads&#44; barbed threads&#44; cone threads&#44; etc&#46;&#41;&#46; They can be grouped into 2 basic types&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">On the one hand&#44; we have simple&#44; monofilament strands of polydioxanone &#40;PDO&#41; &#40;monothreads&#41;&#44; which are used to increase skin density&#46; These threads are inserted with a needle into the deep dermis&#44; where they trigger the formation of collagen and produce a revitalizing effect that can last between 3 and 9 months&#46; The areas most often treated are the jawline&#44; cheeks &#40;to reduce the nasolabial folds&#41;&#44; neck&#44; and the neckline or d&#233;colletage&#46; Other areas that can be treated using this technique include the eyebrows&#44; arms&#44; legs&#44; and buttocks&#46;<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">30</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">On the other hand&#44; we have PDO or poly-L-lactic acid &#40;PLLA&#41; threads with barbs&#44; cones&#44; and other kinds of hooks&#46; These have a greater tightening effect because they facilitate anchoring&#44; traction&#44; and repositioning of the tissue as well as having collagen inducing properties&#46; These threads are inserted into the hypodermis&#46; They produce visible effects that last up to 1 year&#46; The areas most often treated include the jawline and neck&#44; although they can also be used to treat the cheeks and eyebrows&#46;<a class="elsevierStyleCrossRefs" href="#bib0465"><span class="elsevierStyleSup">30&#44;58</span></a> A mild and transient side effect of the insertion of both types of threads is bruising and edema at injection sites&#46;</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Final Reflections</span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">The Art of the Aesthetic Consultation</span><p id="par0125" class="elsevierStylePara elsevierViewall">The doctor-patient relationship established in the initial consultation is the key to the clinician&#39;s empathy or &#8220;connection&#8221; with the patient&#46; In <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#44; we list a series of suggestions we consider should be taken into account by any physician treating aesthetic patients with a view to attaining the optimum results for each patient&#46; Following this advice can have a remarkably positive effect on patient satisfaction and loyalty as well as on adherence to the treatment&#46; If we&#44; as doctors&#44; give greater importance to the art of the aesthetic consultation&#44; we will feel more comfortable with ourselves and provide a reason why we can never be replaced by machines or robots&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Innovation in Aesthetic Dermatology</span><p id="par0130" class="elsevierStylePara elsevierViewall">In the field of dermatology and aesthetic medicine&#44; we believe that there has been an absence of major innovations in recent years&#46; In other words&#44; there has been no revolution comparable to those that have transformed other areas&#44; such as on-line shopping&#44; urban mobility&#44; the consumption of audiovisual content&#44; information search&#44; and interpersonal communication&#46; In the field of aesthetics&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0135" class="elsevierStylePara elsevierViewall">Retinoic acid&#44; which is still the most effective anti-aging ingredient in creams&#44; has been on the market for over 40 years&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0140" class="elsevierStylePara elsevierViewall">Research on the effects of nutricosmetics<a class="elsevierStyleCrossRef" href="#bib0610"><span class="elsevierStyleSup">59</span></a> has not&#44; as yet&#44; provided evidence of extraordinary benefits that would justify their routine use&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0145" class="elsevierStylePara elsevierViewall">Technology has not yet led to any disruptive innovations&#46; The laser devices we use today for vein treatment&#44; hair removal&#44; photorejuvenation&#44; and spot removal are similar&#44; despite progressive optimization&#44; to those we were using 15 years ago&#46; While the new radiofrequency devices&#44; intense pulsed light&#44; and focused ultrasound have not offered exponential advances&#44; we believe that cryolipolysis and the use of microwaves for the treatment of hyperhidrosis represent qualitative leaps in the technology in recent years&#46;</p></li></ul></p><p id="par0150" class="elsevierStylePara elsevierViewall">Having had occasion to try most of the technologies currently used&#44; many dermatologists involved in the treatment of aesthetic patients have come to the conclusion that the last truly disruptive innovation in this field was introduced over 15 years old&#58; the liquid facelift&#44; that is&#44; the use of a combination of injectables &#40;essentially botulinum toxin&#44; dermal fillers&#44; collagen inducers&#44; and lifting threads&#41; in a prudent and intelligent way&#46; The term <span class="elsevierStyleItalic">liquid facelift</span> was coined by Mauricio de Maio&#44; a Brazilian plastic surgeon who has been one of the promoters of the use of a combination of injectables to relax expression lines&#44; compensate for loss of volume&#44; and induce collagen productio&#46;<a class="elsevierStyleCrossRef" href="#bib0615"><span class="elsevierStyleSup">60</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">In our clinic&#44; we classify liquid lifting techniques into 5 types depending on the complexity of the technique &#40;from lower to higher complexity&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; In patients who can benefit from this approach&#44; after a meticulous physical examination and after assessing and discussing the patients expectations&#44; we decide on what level of liquid facelift is appropriate and will achieve the most natural results and satisfy the patient&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">The Importance of the Emotional Domain</span><p id="par0160" class="elsevierStylePara elsevierViewall">Generally&#44; when patients are informed about what can be achieved with rejuvenation techniques&#44; the information they are given is usually framed in terms of objective outcomes &#40;the reduced visibility of the wrinkle&#44; the removal of a mark or discoloration&#44; and so on&#41;&#46; It is vital&#44; however&#44; for the clinician not only to clinically assess the individual patient but also to gain a better understanding of their emotions&#44; values and expectations in order to achieve the highest possible degree of satisfaction&#46; The patient will understand the message better if rather than saying that the procedure will improve a wrinkle&#44; the physician explains that the aim of the technique is to eliminate a facial expression associated with annoyance&#44; fatigue&#44; or sadness&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Using these minimally invasive techniques&#44; dermatologists can achieve an improvement in the patient&#39;s mood and quality of life&#46;<a class="elsevierStyleCrossRef" href="#bib0620"><span class="elsevierStyleSup">61</span></a> Messages like those exemplified in the previous paragraph reinforce the positive feedback loop between the result obtained&#44; what the patient perceives&#44; and what was discussed in the initial consultation&#46; For example&#44; it has been reported that patients who cannot look sad may experience an improvement in mood&#46;<a class="elsevierStyleCrossRef" href="#bib0625"><span class="elsevierStyleSup">62</span></a></p></span></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conclusions</span><p id="par0170" class="elsevierStylePara elsevierViewall">To conclude&#44; let us reflect on the messages that summarize the global approach we propose to patients who consult us for aesthetic procedures&#58;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">1&#41;</span><p id="par0175" class="elsevierStylePara elsevierViewall">Skin quality is the first thing that should be improved&#46; Removal of pigmented stains and spots&#44; vascular lesions&#44; and scars as well as brightening the skin is a priority in any facial rejuvenation protocol&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">2&#41;</span><p id="par0180" class="elsevierStylePara elsevierViewall">The best results can be achieved by using a combination of different treatments&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">3&#41;</span><p id="par0185" class="elsevierStylePara elsevierViewall">We recommend using only low doses of botulinum toxin on the face&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">4&#41;</span><p id="par0190" class="elsevierStylePara elsevierViewall">Excessive use of fillers should be avoided as it can lead to an unnatural appearance in the medium and long term&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">5&#41;</span><p id="par0195" class="elsevierStylePara elsevierViewall">Techniques that tighten the skin are recommended for the lower third of the face&#46; Techniques designed to add volume should be minimized in this area because the aging process leads to an accumulation of tissue in this region&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">6&#41;</span><p id="par0200" class="elsevierStylePara elsevierViewall">Reducing submental fat should be considered in facial rejuvenation&#46; This can be achieved using effective and minimally invasive techniques&#44; such as cryolipolysis and injection lipolysis with deoxycholic acid&#46;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">7&#41;</span><p id="par0205" class="elsevierStylePara elsevierViewall">Every patient who visits an aesthetic dermatologist should be made aware that less is more and that the most natural results are achieved by making a series of discreet changes&#46;</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">8&#41;</span><p id="par0210" class="elsevierStylePara elsevierViewall">Since aging is an ongoing process&#44; antiaging techniques also have to be repeated regularly to ensure a continuous process&#46;</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">9&#41;</span><p id="par0215" class="elsevierStylePara elsevierViewall">We treat people and not areas of the body&#46; The key to our practice is an empathetic approach based on the patient&#39;s psychological and emotional health&#46;</p></li></ul></p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflicts of Interest</span><p id="par0220" class="elsevierStylePara elsevierViewall">The authors have a private practice and regularly use the technologies and products described&#46; However&#44; the authors have no commercial or advertising links with the suppliers of any of these products&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Aesthetic dermatology offers many minimally invasive therapies that can help our patients age gracefully and discreetly&#46; Because it is hard to systematize these treatments to make patients aware of the options they have for the area of the face they want to improve&#44; at Cl&#237;nica Dermatol&#243;gica Internacional&#44; we have developed the Skin Age Management &#40;SAM&#41; protocol&#46; In this article&#44; we describe this protocol designed to help doctors and patients to better understand and plan available treatments&#44; underlining the advisability of combining techniques with the goal of achieving discreet changes to obtain what we consider to be optimum results&#44; based on our experience at our center&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La dermatolog&#237;a est&#233;tica hoy en d&#237;a contempla m&#250;ltiples tratamientos m&#237;nimamente invasivos que pueden ayudar a envejecer a nuestros pacientes con elegancia y discreci&#243;n&#46; Dado que puede resultar dif&#237;cil sistematizarlos para que el paciente sea consciente de las posibilidades que tiene en funci&#243;n del &#225;rea que quiere mejorar&#44; desde Cl&#237;nica Dermatol&#243;gica Internacional hemos elaborado el protocolo <span class="elsevierStyleItalic">Skin Age Management</span> &#40;SAM&#41;&#46; En este art&#237;culo describimos este protocolo &#8212;dirigido a ayudar a m&#233;dicos y pacientes a conocer mejor y planificar los tratamientos disponibles&#44; que refuerza el mensaje de la idoneidad de la combinaci&#243;n de t&#233;cnicas con la filosof&#237;a de lograr cambios discretos para obtener los resultados que consideramos &#243;ptimos&#8212;&#44; basado en la experiencia de nuestro centro&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Ruiz-Rodriguez R&#44; Martin-Gorgojo A&#46; Abordaje facial global del paciente est&#233;tico&#58; protocolo Skin Age Management&#46; Actas Dermosifiliogr&#46; 2019&#59;110&#58;197&#8211;205&#46;</p>"
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Diagram of the Skin Age Management &#40;SAM&#41; Protocol<span class="elsevierStyleItalic">&#46;</span> At the center of the wheel are recommendations for a healthy lifestyle&#44; a vital component of any treatment intended to achieve elegant and discreet aging&#46; The outer ring shows the different treatments available for each indication&#46; Any approach to facial aging should start with skin quality&#44; then address expression lines&#44; and continue&#44; if necessary&#44; with the other treatment options indicated&#46; HIFU indicates high-intensity focused ultrasound&#46;</p>"
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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Description of the treatments in each level of the liquid facelift &#40;nonsurgical facial rejuvenation&#41;&#46;</p> <p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">NCHA indicates non-crosslinked hyaluronic acid&#46;</p> <p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The collagen inducer we use is calcium hydroxyapatite &#40;Radiesse<span class="elsevierStyleSup">&#174;</span>&#41;&#46;</p>"
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                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1&#46; Botulinum toxin or &#8220;botox&#8221; reduces expression lines&#46; It is an ideal treatment for controlling expression lines&#44; such as the glabellar lines between the brows&#44; periocular crow&#39;s feet&#44; and frown lines on the forehead&#46; The aim is to relax the expression in order to conceal accumulated tension&#46; Loss of volume&#44; poor skin quality and laxity should be treated using other dermatological techniques&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2&#46; Botulinum toxin is safe&#46; In over 50&#37; of cases it is used for medical purposes&#44; such as the treatment of migraine headaches&#44; excessive sweating&#44; nervous tics&#44; strabismus&#44; etc&#46; Due to its excellent safety profile&#44; the treatment is often used in children to treat abnormal muscle movements&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3&#46; Be careful with the dose&#46; Appropriate doses must be used to achieve natural results and preserve the patient&#39;s facial expressivity&#46; The muscles should be relaxed rather than paralyzed with excessively high doses&#46; Conversely&#44; excessively low doses can lead to an overly short durations of effect&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">4&#46; Botulinum toxin prevents the formation of wrinkles&#46; It has a preventive effect on aging because it &#8220;educates&#8221; the facial muscles&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">5&#46; Every patient is different&#46; Not all patients require the same injection technique&#46; Since the anatomy of every patient&#39;s face is different&#44; the injection sites and the dose used must be adjusted in each case to achieve natural results&#46; The injection technique for men and women is totally different&#46; For example&#44; the gull wing shape of the eyebrow in women is totally different from the shape of the male eyebrow&#44; which tends to be straighter and situated closer to the eyelid&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">6&#46; Treatment with botulinum toxin must be repeated&#46; We recommend repeating treatment every 4 to 6 months&#46; Repeat treatment should take place before the effect of the previous administration disappears&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">7&#46; The approach must be global&#46; The only way to achieve natural results is by treating the face as a whole&#46; Consequently&#44; the entire face should be treated to relax all the &#8220;depressor&#8221; muscles that configure facial expression&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">8&#46; Botulinum toxin treatment can make us feel better&#46; When properly injected the treatment reduces the appearance of worry and sadness&#46; It has been shown that this effect on our facial expression also improves our mood&#46; We feel happier because we look happier&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">9&#46; Bad results are due to bad technique&#46; Botulinum toxin is like a scalpel&#58; the results can be good or bad depending on the technique&#46; Grotesque outcomes are the result of misuse&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">10&#46; Less is more&#46; The most elegant results are achieved through discreet changes&#46; If someone asks you &#8220;What have you done&#63;&#8221;&#44; change your doctor&#46; The goal is for everyone to notice that you look better without realizing that you have had treatment&#46;&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The Ten Commandments of Botulinum Toxin<a class="elsevierStyleCrossRef" href="#bib0630"><span class="elsevierStyleSup">63</span></a></p>"
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                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8226; A 300 UI vial of lyophilized hyaluronidase should be ordered from a compounding pharmacy &#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8226; When required&#44; the 300&#160;UI vial should be diluted in 2&#160;mL of physiological saline &#40;such that every 0&#46;1&#160;mL contains 15&#160;UI&#41;&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8226; Injection must be done slowly using a 32-gauge needle&#44; with volumes of 0&#46;05 to 0&#46;1&#160;mL per injection site &#40;a dose of 7&#46;5-15&#160;UI&#41;&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8226; A pre-treatment test on the patient&#39;s forearm is recommended &#40;although some authors argue that the test is the use of minimal doses&#41;&#44; because of the possibility that some patients may be allergic or have an anaphylactic reaction&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8226; It is generally recommended that patients should be seen a week after administration to assess the need to repeat the treatment&#46;&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Protocol for Hyaluronidase Treatment&#46;</p>"
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                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1&#46; Prepare for the consultation before seeing the patient&#46; Ensure that the patient knows that you are waiting for them&#44; that you are aware of the reason for their visit&#44; and that they have your full attention&#46; You only have one opportunity to create a good first impression&#44; Don&#769;t waste it&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2&#46; Focus all your attention on the consultation&#46; The patient must feel that they are the center of your attention&#46; Avoid interruptions from cell phones&#44; conversations with staff or colleagues about other topics or other patients and make sure that no one comes in and out of your office&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3&#46; Be aware of your body language&#58; do not sit too far away from the patient&#44; look directly into his or her eyes&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">4&#46; Obtain a complete medical history to rule out diseases or drugs that might influence the results of aesthetic treatments&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">5&#46; Ask the patient what cosmetic treatments &#40;surgical or nonsurgical&#41; they have undergone previously&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">6&#46; Take pictures of a range of positions and different expressions&#46; After undergoing a procedure&#44; patients look much more closely at their faces and may&#44; in some cases&#44; blame the treatment for a pre-existing flaw or lack of symmetry&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">7&#46; Be genuine&#46; A patient will always know whether you really care or not&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">8&#46; Use the power of touch&#46; It is important to explore the patient&#39;s face sensitively with your hands so that they will feel that the evaluation has been complete&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">9&#46; Give the patient a mirror and ask them to indicate what areas they would like to improve&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">10&#46; Carefully assess the patient&#39;s expectations to ascertain whether they are realistic&#46; If a patient has unrealistic expectations&#44; be honest with them and do not recommend any treatment&#46; The formula is as follows&#58; satisfied patient &#61; good aesthetic results &#8211;prior expectations&#46; A patient who has unrealistically high expectations will never be satisfied&#46; One sign that should ring alarm bells is a patient who complains about all the doctors who have previously treated them&#46;&nbsp;\t\t\t\t\t\t\n
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      "titulo" => "References"
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          "identificador" => "bibs0015"
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            0 => array:3 [
              "identificador" => "bib0320"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Consensus recommendations for combined aesthetic interventions in the face using botulinum toxin&#44; fillers&#44; and energy-based devices"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Carruthers"
                            1 => "C&#46; Burgess"
                            2 => "D&#46; Day"
                            3 => "S&#46;G&#46; Fabi"
                            4 => "K&#46; Goldie"
                            5 => "M&#46; Kerscher"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/DSS.0000000000000754"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dermatol Surg&#46;"
                        "fecha" => "2016"
                        "volumen" => "42"
                        "paginaInicial" => "586"
                        "paginaFinal" => "597"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27100962"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0325"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Consensus recommendations for combined aesthetic interventions using botulinum toxin&#44; fillers&#44; and microfocused ultrasound in the neck&#44; decolletage&#44; hands&#44; and other areas of the body"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;G&#46; Fabi"
                            1 => "C&#46; Burgess"
                            2 => "A&#46; Carruthers"
                            3 => "J&#46; Carruthers"
                            4 => "D&#46; Day"
                            5 => "K&#46; Goldie"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/DSS.0000000000000869"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dermatol Surg&#46;"
                        "fecha" => "2016"
                        "volumen" => "42"
                        "paginaInicial" => "1199"
                        "paginaFinal" => "1208"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27668925"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0330"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Zen and the art of living mindfully&#58; The health-enhancing potential of Zen aesthetics"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "T&#46; Lomas"
                            1 => "N&#46; Etcoff"
                            2 => "W&#46; van Gordon"
                            3 => "E&#46; Shonin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s10943-017-0446-5"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Relig Health&#46;"
                        "fecha" => "2017"
                        "volumen" => "56"
                        "paginaInicial" => "1720"
                        "paginaFinal" => "1739"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28718052"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0335"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cosmetics&#44; diet&#44; and the future"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Z&#46;D&#46; Draelos"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1529-8019.2012.01500.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dermatol Ther&#46;"
                        "fecha" => "2012"
                        "volumen" => "25"
                        "paginaInicial" => "267"
                        "paginaFinal" => "272"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22913445"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0340"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A holistic approach to antiaging as an adjunct to antiaging procedures&#58; A review of the literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46;S&#46; Saluja"
                            1 => "S&#46;G&#46; Fabi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/DSS.0000000000001027"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dermatol Surg&#46;"
                        "fecha" => "2017"
                        "volumen" => "43"
                        "paginaInicial" => "475"
                        "paginaFinal" => "484"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28359075"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0345"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ultraviolet radiation and the skin&#58; Photobiology and sunscreen photoprotection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46;R&#46; Young"
                            1 => "J&#46; Claveau"
                            2 => "A&#46;B&#46; Rossi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaad.2016.09.038"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Am Acad Dermatol&#46;"
                        "fecha" => "2017"
                        "volumen" => "76"
                        "numero" => "Suppl&#46; 1"
                        "paginaInicial" => "S100"
                        "paginaFinal" => "S109"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28038885"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0350"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Anti-aging cosmetics&#58; Facts and controversies"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46; Ramos-e-Silva"
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                            2 => "S&#46; Ramos-e-Silva"
                            3 => "A&#46;P&#46; Fucci-da-Costa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.clindermatol.2013.05.013"
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                        "tituloSerie" => "Clin Dermatol&#46;"
                        "fecha" => "2013"
                        "volumen" => "31"
                        "paginaInicial" => "750"
                        "paginaFinal" => "758"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24160281"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0355"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Laser eradication of pigmented lesions&#58; A review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "K&#46;D&#46; Polder"
                            1 => "J&#46;M&#46; Landau"
                            2 => "I&#46;J&#46; Vergilis-Kalner"
                            3 => "L&#46;H&#46; Goldberg"
                            4 => "P&#46;M&#46; Friedman"
                            5 => "S&#46; Bruce"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1524-4725.2011.01971.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dermatol Surg&#46;"
                        "fecha" => "2011"
                        "volumen" => "37"
                        "paginaInicial" => "572"
                        "paginaFinal" => "595"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21492309"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0360"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Vascular lasers"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "T&#46; Michaud"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0151-9638(09)72540-2"
                      "Revista" => array:7 [
                        "tituloSerie" => "Ann Dermatol Venereol&#46;"
                        "fecha" => "2009"
                        "volumen" => "136"
                        "numero" => "Suppl&#46; 6"
                        "paginaInicial" => "S320"
                        "paginaFinal" => "S324"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19931692"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0365"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparative effectiveness of nonpurpuragenic 595-nm pulsed dye laser and microsecond 1064-nm neodymium&#58; Yttrium-aluminum-garnet laser for treatment of diffuse facial erythema&#58; A double-blind randomized controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Alam"
                            1 => "N&#46; Voravutinon"
                            2 => "M&#46; Warycha"
                            3 => "D&#46; Whiting"
                            4 => "M&#46; Nodzenski"
                            5 => "S&#46; Yoo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaad.2013.04.015"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol&#46;"
                        "fecha" => "2013"
                        "volumen" => "69"
                        "paginaInicial" => "438"
                        "paginaFinal" => "443"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23688651"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0370"
              "etiqueta" => "11"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Laser use for cutaneous vascular alterations of cosmetic interest"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "P&#46;L&#46; Bencini"
                            1 => "A&#46; Tourlaki"
                            2 => "V&#46; de Giorgi"
                            3 => "M&#46; Galimberti"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1529-8019.2012.01463.x"
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                        "tituloSerie" => "Dermatol Ther&#46;"
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                        "volumen" => "25"
                        "paginaInicial" => "340"
                        "paginaFinal" => "351"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22950561"
                            "web" => "Medline"
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                  ]
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              ]
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              "identificador" => "bib0375"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Split-face randomized treatment of facial telangiectasia comparing pulsed dye laser and an intense pulsed light handpiece"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "E&#46;A&#46; Tanghetti"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/lsm.21151"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lasers Surg Med&#46;"
                        "fecha" => "2012"
                        "volumen" => "44"
                        "paginaInicial" => "97"
                        "paginaFinal" => "102"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22180317"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0380"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Single-session combination treatment with intense pulsed light and nonablative fractional photothermolysis&#58; A split-face study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "C&#46; Kearney"
                            1 => "D&#46; Brew"
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1524-4725.2012.02401.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dermatol Surg&#46;"
                        "fecha" => "2012"
                        "volumen" => "38"
                        "paginaInicial" => "1002"
                        "paginaFinal" => "1009"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22574965"
                            "web" => "Medline"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Treatment of melasma using a novel 1&#44;927-nm fractional thulium fiber laser&#58; A pilot study"
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                          "etal" => false
                          "autores" => array:2 [
                            0 => "K&#46;D&#46; Polder"
                            1 => "S&#46; Bruce"
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                    0 => array:2 [
                      "doi" => "10.1111/j.1524-4725.2011.02178.x"
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                        "tituloSerie" => "Dermatol Surg&#46;"
                        "fecha" => "2012"
                        "volumen" => "38"
                        "paginaInicial" => "199"
                        "paginaFinal" => "206"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22093448"
                            "web" => "Medline"
                          ]
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                      ]
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                ]
              ]
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              "identificador" => "bib0390"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparison between 1&#37; tretinoin peeling versus 70&#37; glycolic acid peeling in the treatment of female patients with melasma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "G&#46; Faghihi"
                            1 => "A&#46; Shahingohar"
                            2 => "A&#46;H&#46; Siadat"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Drugs Dermatol&#46;"
                        "fecha" => "2011"
                        "volumen" => "10"
                        "paginaInicial" => "1439"
                        "paginaFinal" => "1442"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22134569"
                            "web" => "Medline"
                          ]
                        ]
                      ]
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                  ]
                ]
              ]
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dermocosmetic management of hyperpigmentations"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "D&#46; Guerrero"
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0151-9638(12)70130-8"
                      "Revista" => array:7 [
                        "tituloSerie" => "Ann Dermatol Venereol&#46;"
                        "fecha" => "2012"
                        "volumen" => "139"
                        "numero" => "Suppl&#46; 4"
                        "paginaInicial" => "S166"
                        "paginaFinal" => "S169"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23522633"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0400"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fractional carbon dioxide laser resurfacing of rhytides and photoaged skin -- a prospective clinical study on patient expectation and satisfaction"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            2 => "M&#46; Koller"
                            3 => "F&#46; Zeman"
                            4 => "L&#46; Groesser"
                            5 => "S&#46; Karrer"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/lsm.22326"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lasers Surg Med&#46;"
                        "fecha" => "2015"
                        "volumen" => "47"
                        "paginaInicial" => "111"
                        "paginaFinal" => "119"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25652114"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
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                ]
              ]
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              "identificador" => "bib0405"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Fractional carbon dioxide laser of recent surgical scars in the head and neck region&#58; A split-scar&#44; evaluator-blinded study"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Buelens"
                            1 => "A&#46;S&#46; van Hove"
                            2 => "K&#46; Ongenae"
                            3 => "H&#46; Lapeere"
                            4 => "W&#46; Huvenne"
                            5 => "H&#46; Vermeersch"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/DSS.0000000000000963"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dermatol Surg&#46;"
                        "fecha" => "2017"
                        "volumen" => "43"
                        "paginaInicial" => "S75"
                        "paginaFinal" => "S84"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28009692"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0410"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fractional CO<span class="elsevierStyleInf">2</span> lasers for the treatment of atrophic acne scars&#58; A review of the literature"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3109/14764172.2013.854639"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Cosmet Laser Ther&#46;"
                        "fecha" => "2014"
                        "volumen" => "16"
                        "paginaInicial" => "48"
                        "paginaFinal" => "56"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24131097"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
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            19 => array:3 [
              "identificador" => "bib0415"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical and histological evaluations of enlarged facial skin pores after low energy level treatments with fractional carbon dioxide laser in Korean patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "H&#46;H&#46; Kwon"
                            1 => "S&#46;C&#46; Choi"
                            2 => "W&#46;Y&#46; Lee"
                            3 => "J&#46;Y&#46; Jung"
                            4 => "G&#46;H&#46; Park"
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                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/DSS.0000000000001313"
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                        "tituloSerie" => "Dermatol Surg&#46;"
                        "fecha" => "2018"
                        "volumen" => "44"
                        "paginaInicial" => "405"
                        "paginaFinal" => "412"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28902036"
                            "web" => "Medline"
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                    ]
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                ]
              ]
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            20 => array:3 [
              "identificador" => "bib0420"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical outcomes and complications associated with fractional lasers&#58; A review of 730 patients"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;R&#46; Cohen"
                            1 => "A&#46; Goodacre"
                            2 => "S&#46; Lim"
                            3 => "J&#46; Johnston"
                            4 => "C&#46; Henssler"
                            5 => "B&#46; Jeffers"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00266-016-0767-x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Aesthetic Plast Surg&#46;"
                        "fecha" => "2017"
                        "volumen" => "41"
                        "paginaInicial" => "171"
                        "paginaFinal" => "178"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28032173"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0425"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The role of the CO<span class="elsevierStyleInf">2</span> laser and fractional CO<span class="elsevierStyleInf">2</span> laser in dermatology"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.5978/islsm.14-RE-01"
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                        "tituloSerie" => "Laser Ther&#46;"
                        "fecha" => "2014"
                        "volumen" => "23"
                        "paginaInicial" => "49"
                        "paginaFinal" => "60"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24771971"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0430"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mesotherapy for facial skin rejuvenation&#58; A clinical&#44; histologic&#44; and electron microscopic evaluation"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
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                            1 => "R&#46;G&#46; Phelps"
                            2 => "D&#46;J&#46; Goldberg"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1524-4725.2006.32353.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dermatol Surg&#46;"
                        "fecha" => "2006"
                        "volumen" => "32"
                        "paginaInicial" => "1467"
                        "paginaFinal" => "1472"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17199654"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            23 => array:3 [
              "identificador" => "bib0435"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hyaluronic acid plus mannitol treatment for improved skin hydration and elasticity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46; Taieb"
                            1 => "C&#46; Gay"
                            2 => "S&#46; Sebban"
                            3 => "P&#46; Secnazi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1473-2165.2012.00608.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Cosmet Dermatol&#46;"
                        "fecha" => "2012"
                        "volumen" => "11"
                        "paginaInicial" => "87"
                        "paginaFinal" => "92"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22672272"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0440"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Efficacy of autologous platelet-rich plasma combined with hyaluronic acid on skin facial rejuvenation&#58; A prospective study"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            1 => "M&#46; SidAhmed-Mezi"
                            2 => "J&#46; Niddam"
                            3 => "S&#46; La Padula"
                            4 => "W&#46; Noel"
                            5 => "K&#46; Ezzedine"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaad.2017.05.022"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol&#46;"
                        "fecha" => "2017"
                        "volumen" => "77"
                        "paginaInicial" => "584"
                        "paginaFinal" => "586"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28807118"
                            "web" => "Medline"
                          ]
                        ]
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                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0445"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Biorejuvenation&#58; Theory and practice"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
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                        "tituloSerie" => "Clin Dermatol&#46;"
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                        "volumen" => "26"
                        "paginaInicial" => "177"
                        "paginaFinal" => "181"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18472058"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0450"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Benefits of plasma rich in growth factors &#40;PRGF&#41; in skin photodamage&#58; Clinical response and histological assessment"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "B&#46; Diaz-Ley"
                            1 => "J&#46; Cuevas"
                            2 => "L&#46; Alonso-Castro"
                            3 => "M&#46;I&#46; Calvo"
                            4 => "L&#46; Rios-Buceta"
                            5 => "G&#46; Orive"
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                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/dth.12228"
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                        "tituloSerie" => "Dermatol Ther&#46;"
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                        "volumen" => "28"
                        "paginaInicial" => "258"
                        "paginaFinal" => "263"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25864463"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0455"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Thermage&#58; The nonablative radiofrequency for rejuvenation"
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                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46;A&#46; Sukal"
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                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.clindermatol.2007.09.007"
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                        "tituloSerie" => "Clin Dermatol&#46;"
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                        "volumen" => "26"
                        "paginaInicial" => "602"
                        "paginaFinal" => "607"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18940540"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0460"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The use of hybrid radiofrequency device for the treatment of rhytides and lax skin"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46;J&#46; Friedman"
                            1 => "L&#46;T&#46; Gilead"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1524-4725.2007.33112.x"
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                        "tituloSerie" => "Dermatol Surg&#46;"
                        "fecha" => "2007"
                        "volumen" => "33"
                        "paginaInicial" => "543"
                        "paginaFinal" => "551"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17451576"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0465"
              "etiqueta" => "30"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Outcomes of polydioxanone knotless thread lifting for facial rejuvenation"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "D&#46;H&#46; Suh"
                            1 => "H&#46;W&#46; Jang"
                            2 => "S&#46;J&#46; Lee"
                            3 => "W&#46;S&#46; Lee"
                            4 => "H&#46;J&#46; Ryu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/DSS.0000000000000368"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dermatol Surg&#46;"
                        "fecha" => "2015"
                        "volumen" => "41"
                        "paginaInicial" => "720"
                        "paginaFinal" => "725"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25993611"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0470"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ten mistakes to avoid when injecting botulinum toxin"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "R&#46; Ruiz-Rodriguez"
                            1 => "A&#46; Martin-Gorgojo"
                          ]
                        ]
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Actas Dermo-Sifiliogr&#46;"
                        "fecha" => "2015"
                        "volumen" => "106"
                        "paginaInicial" => "458"
                        "paginaFinal" => "464"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0475"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Efficacy&#44; patient-reported outcomes and safety profile of ATX-101 &#40;deoxycholic acid&#41;&#44; an injectable drug for the reduction of unwanted submental fat&#58; Results from a phase III&#44; randomized&#44; placebo-controlled study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "B&#46; Ascher"
                            1 => "K&#46; Hoffmann"
                            2 => "P&#46; Walker"
                            3 => "S&#46; Lippert"
                            4 => "U&#46; Wollina"
                            5 => "B&#46; Havlickova"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/jdv.12377"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Eur Acad Dermatol Venereol&#46;"
                        "fecha" => "2014"
                        "volumen" => "28"
                        "paginaInicial" => "1707"
                        "paginaFinal" => "1715"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24605812"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0480"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Facial treatment preferences among aesthetically oriented men"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46; Jagdeo"
                            1 => "T&#46; Keaney"
                            2 => "V&#46; Narurkar"
                            3 => "J&#46; Kolodziejczyk"
                            4 => "C&#46;J&#46; Gallagher"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/DSS.0000000000000876"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dermatol Surg&#46;"
                        "fecha" => "2016"
                        "volumen" => "42"
                        "paginaInicial" => "1155"
                        "paginaFinal" => "1163"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27661428"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0485"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Selective cryolysis&#58; A novel method of non-invasive fat removal"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "D&#46; Manstein"
                            1 => "H&#46; Laubach"
                            2 => "K&#46; Watanabe"
                            3 => "W&#46; Farinelli"
                            4 => "D&#46; Zurakowski"
                            5 => "R&#46;R&#46; Anderson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/lsm.20719"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lasers Surg Med&#46;"
                        "fecha" => "2008"
                        "volumen" => "40"
                        "paginaInicial" => "595"
                        "paginaFinal" => "604"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18951424"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib0490"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Safety and efficacy of cryolipolysis for non-invasive reduction of submental fat"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46;L&#46; Kilmer"
                            1 => "A&#46;J&#46; Burns"
                            2 => "B&#46;D&#46; Zelickson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/lsm.22440"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lasers Surg Med&#46;"
                        "fecha" => "2016"
                        "volumen" => "48"
                        "paginaInicial" => "3"
                        "paginaFinal" => "13"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26607045"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib0495"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Noninvasive submental fat reduction using colder cryolipolysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "H&#46; Leal Silva"
                            1 => "E&#46; Carmona Hernandez"
                            2 => "M&#46; Grijalva Vazquez"
                            3 => "S&#46; Leal Delgado"
                            4 => "A&#46; Perez Blanco"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/jocd.12383"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Cosmet Dermatol&#46;"
                        "fecha" => "2017"
                        "volumen" => "16"
                        "paginaInicial" => "460"
                        "paginaFinal" => "465"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28901051"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib0500"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prototype coolcup cryolipolysis applicator with over 40&#37; reduced treatment time demonstrates equivalent safety and efficacy with greater patient preference"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "S&#46;L&#46; Kilmer"
                          ]
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/lsm.22550"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lasers Surg Med&#46;"
                        "fecha" => "2017"
                        "volumen" => "49"
                        "paginaInicial" => "63"
                        "paginaFinal" => "68"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27327898"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib0505"
              "etiqueta" => "38"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Results from a pooled analysis of two European&#44; randomized&#44; placebo-controlled&#44; phase 3 studies of ATX-101 for the pharmacologic reduction of excess submental fat"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46; McDiarmid"
                            1 => "J&#46;B&#46; Ruiz"
                            2 => "D&#46; Lee"
                            3 => "S&#46; Lippert"
                            4 => "C&#46; Hartisch"
                            5 => "B&#46; Havlickova"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Aesthetic Plast Surg&#46;"
                        "fecha" => "2014"
                        "volumen" => "3"
                        "paginaInicial" => "849"
                        "paginaFinal" => "860"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            38 => array:3 [
              "identificador" => "bib0510"
              "etiqueta" => "39"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Early experience in 100 consecutive patients with injection adipocytolysis for neck contouring with ATX-101 &#40;deoxycholic acid&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "S&#46;M&#46; Shridharani"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/DSS.0000000000001133"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dermatol Surg&#46;"
                        "fecha" => "2017"
                        "volumen" => "43"
                        "paginaInicial" => "950"
                        "paginaFinal" => "958"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28448317"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            39 => array:3 [
              "identificador" => "bib0515"
              "etiqueta" => "40"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "S225 S230"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "ATX-101 &#40;deoxycholic acid injection&#41; treatment in men&#58; Insights from our clinical experience"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46;M&#46; Shridharani"
                            1 => "K&#46;L&#46; Behr"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Dermatol Surg&#46;"
                        "fecha" => "2017"
                        "volumen" => "43"
                        "numero" => "Suppl&#46; 2"
                      ]
                    ]
                  ]
                ]
              ]
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            40 => array:3 [
              "identificador" => "bib0520"
              "etiqueta" => "41"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dermal fillers&#58; Types&#44; indications&#44; and complications"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "I&#46; Sanchez-Carpintero"
                            1 => "D&#46; Candelas"
                            2 => "R&#46; Ruiz-Rodriguez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Actas Dermo-Sifiliogr&#46;"
                        "fecha" => "2010"
                        "volumen" => "101"
                        "paginaInicial" => "381"
                        "paginaFinal" => "393"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            41 => array:3 [
              "identificador" => "bib0525"
              "etiqueta" => "42"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Synthetic fillers for facial rejuvenation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;C&#46; Lee"
                            1 => "Z&#46;P&#46; Lorenc"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.cps.2016.03.002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Plast Surg&#46;"
                        "fecha" => "2016"
                        "volumen" => "43"
                        "paginaInicial" => "497"
                        "paginaFinal" => "503"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27363763"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            42 => array:3 [
              "identificador" => "bib0530"
              "etiqueta" => "43"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "872e e889"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Current applications of facial volumization with fillers"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46;J&#46; Wilson"
                            1 => "A&#46;J&#46; Taglienti"
                            2 => "C&#46;S&#46; Chang"
                            3 => "D&#46;W&#46; Low"
                            4 => "I&#46; Percec"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "Plast Reconstruct Surg&#46;"
                        "fecha" => "2016"
                        "volumen" => "137"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            43 => array:3 [
              "identificador" => "bib0535"
              "etiqueta" => "44"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Reversing facial fillers&#58; Interactions between hyaluronidase and commercially available hyaluronic-acid based fillers"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "V&#46; Rao"
                            1 => "S&#46; Chi"
                            2 => "J&#46; Woodward"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Drugs Dermatol&#46;"
                        "fecha" => "2014"
                        "volumen" => "13"
                        "paginaInicial" => "1053"
                        "paginaFinal" => "1056"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25226005"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            44 => array:3 [
              "identificador" => "bib0540"
              "etiqueta" => "45"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Calcium hydroxylapatite tissue filler discovered 6 years after implantation into the nasolabial fold&#58; Case report and review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "P&#46;R&#46; Shumaker"
                            1 => "E&#46;L&#46; Sakas"
                            2 => "M&#46;H&#46; Swann"
                            3 => "H&#46;T&#46; Greenway Jr&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1524-4725.2008.01050.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dermatol Surg&#46;"
                        "fecha" => "2009"
                        "volumen" => "35"
                        "paginaInicial" => "375"
                        "paginaFinal" => "379"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19207328"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            45 => array:3 [
              "identificador" => "bib0545"
              "etiqueta" => "46"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The hyaluronic acid fillers&#58; Current understanding of the tissue device interface"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;J&#46; Greene"
                            1 => "D&#46;M&#46; Sidle"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.fsc.2015.07.002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Facial Plast Surg Clin North Am&#46;"
                        "fecha" => "2015"
                        "volumen" => "23"
                        "paginaInicial" => "423"
                        "paginaFinal" => "432"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26505539"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            46 => array:3 [
              "identificador" => "bib0550"
              "etiqueta" => "47"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "s45 s47"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The tower technique and vertical supraperiosteal depot technique&#58; Novel vertical injection techniques for volume-efficient subcutaneous tissue support and volumetric augmentation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "G&#46; Sattler"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "J Drugs Dermatol&#46;"
                        "fecha" => "2012"
                        "volumen" => "11"
                        "itemHostRev" => array:3 [
                          "pii" => "S0140673604154895"
                          "estado" => "S300"
                          "issn" => "01406736"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            47 => array:3 [
              "identificador" => "bib0555"
              "etiqueta" => "48"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hyaluronic acid&#58; The scientific and clinical evidence"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46;D&#46; Price"
                            1 => "M&#46;G&#46; Berry"
                            2 => "H&#46;A&#46; Navsaria"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Plast Reconstruct Aesthetic Surg&#46;"
                        "fecha" => "2007"
                        "volumen" => "60"
                        "paginaInicial" => "1110"
                        "paginaFinal" => "1119"
                      ]
                    ]
                  ]
                ]
              ]
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            48 => array:3 [
              "identificador" => "bib0560"
              "etiqueta" => "49"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dermal filler complications&#58; A clinicopathologic study with a spectrum of histologic reaction patterns"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46; El-Khalawany"
                            1 => "S&#46; Fawzy"
                            2 => "A&#46; Saied"
                            3 => "M&#46; Al Said"
                            4 => "A&#46; Amer"
                            5 => "B&#46; Eassa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Ann Diag Pathol&#46;"
                        "fecha" => "2015"
                        "volumen" => "19"
                        "paginaInicial" => "10"
                        "paginaFinal" => "15"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            49 => array:3 [
              "identificador" => "bib0565"
              "etiqueta" => "50"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "&#171;Deep heating&#187; noninvasive skin tightening devices&#58; Review of effectiveness and patient satisfaction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46; Chilukuri"
                            1 => "J&#46; Lupton"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Drugs Drmatol&#46;"
                        "fecha" => "2017"
                        "volumen" => "16"
                        "paginaInicial" => "1262"
                        "paginaFinal" => "1266"
                      ]
                    ]
                  ]
                ]
              ]
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            50 => array:3 [
              "identificador" => "bib0570"
              "etiqueta" => "51"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Radio frequency energy for non-invasive and minimally invasive skin tightening"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "R&#46;S&#46; Mulholland"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.cps.2011.05.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Plast Surg&#46;"
                        "fecha" => "2011"
                        "volumen" => "38"
                        "paginaInicial" => "437"
                        "paginaFinal" => "448"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21824541"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            51 => array:3 [
              "identificador" => "bib0575"
              "etiqueta" => "52"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Noninvasive skin tightening&#58; Focus on new ultrasound techniques"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "S&#46;G&#46; Fabi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Clin Cosmet Invest Dermatol&#46;"
                        "fecha" => "2015"
                        "volumen" => "8"
                        "paginaInicial" => "47"
                        "paginaFinal" => "52"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            52 => array:3 [
              "identificador" => "bib0580"
              "etiqueta" => "53"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Complications from microfocused transcutaneous ultrasound&#58; Case series and review of the literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "D&#46;P&#46; Friedmann"
                            1 => "G&#46;P&#46; Bourgeois"
                            2 => "H&#46;H&#46;L&#46; Chan"
                            3 => "A&#46;C&#46; Zedlitz"
                            4 => "K&#46;J&#46; Butterwick"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/lsm.22768"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lasers Surg Med&#46;"
                        "fecha" => "2018"
                        "volumen" => "50"
                        "paginaInicial" => "13"
                        "paginaFinal" => "19"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29154457"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            53 => array:3 [
              "identificador" => "bib0585"
              "etiqueta" => "54"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Safety and efficacy of ulthera in the rejuvenation of aging lower eyelids&#58; A pivotal clinical trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "C&#46;S&#46; Pak"
                            1 => "Y&#46;K&#46; Lee"
                            2 => "J&#46;H&#46; Jeong"
                            3 => "J&#46;H&#46; Kim"
                            4 => "J&#46;D&#46; Seo"
                            5 => "C&#46;Y&#46; Heo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00266-014-0383-6"
                      "Revista" => array:6 [
                        "tituloSerie" => "Aesthetic Plast Surg&#46;"
                        "fecha" => "2014"
                        "volumen" => "38"
                        "paginaInicial" => "861"
                        "paginaFinal" => "868"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25099495"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            54 => array:3 [
              "identificador" => "bib0590"
              "etiqueta" => "55"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Combination of intense pulsed light&#44; Sculptra&#44; and Ultherapy for treatment of the aging face"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46;P&#46; Friedmann"
                            1 => "S&#46;G&#46; Fabi"
                            2 => "M&#46;P&#46; Goldman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/jocd.12093"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Cosmet Dermatol&#46;"
                        "fecha" => "2014"
                        "volumen" => "13"
                        "paginaInicial" => "109"
                        "paginaFinal" => "118"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24910274"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            55 => array:3 [
              "identificador" => "bib0595"
              "etiqueta" => "56"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "180S 187S"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Current concepts in the use of PLLA&#58; Clinical synergy noted with combined use of microfocused ultrasound and poly-l-lactic acid on the face&#44; neck&#44; and decolletage"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "D&#46;R&#46; Hart"
                            1 => "S&#46;G&#46; Fabi"
                            2 => "W&#46;M&#46; White"
                            3 => "R&#46; Fitzgerald"
                            4 => "M&#46;P&#46; Goldman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Plast Reconstruct Surg&#46;"
                        "fecha" => "2015"
                        "volumen" => "136"
                        "numero" => "5 Suppl&#46;"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            56 => array:3 [
              "identificador" => "bib0600"
              "etiqueta" => "57"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lifting the lower face with an absorbable polydioxanone &#40;PDO&#41; thread"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "K&#46; Karimi"
                            1 => "A&#46; Reivitis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Drugs Dermatol&#46;"
                        "fecha" => "2017"
                        "volumen" => "16"
                        "paginaInicial" => "932"
                        "paginaFinal" => "934"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28915290"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            57 => array:3 [
              "identificador" => "bib0605"
              "etiqueta" => "58"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Investigation on the cutaneous change induced by face-lifting monodirectional barbed polydioxanone thread"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46; Kim"
                            1 => "Z&#46; Zheng"
                            2 => "H&#46; Kim"
                            3 => "K&#46;A&#46; Nam"
                            4 => "K&#46;Y&#46; Chung"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/DSS.0000000000000925"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dermatol Surg&#46;"
                        "fecha" => "2017"
                        "volumen" => "43"
                        "paginaInicial" => "74"
                        "paginaFinal" => "80"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27748691"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            58 => array:3 [
              "identificador" => "bib0610"
              "etiqueta" => "59"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Carotenoids and polyphenols in nutricosmetics&#44; nutraceuticals&#44; and cosmeceuticals"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "T&#46;P&#46; Anunciato"
                            1 => "P&#46;A&#46; da Rocha Filho"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1473-2165.2011.00600.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Cosmet Dermatol&#46;"
                        "fecha" => "2012"
                        "volumen" => "11"
                        "paginaInicial" => "51"
                        "paginaFinal" => "54"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22360335"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            59 => array:3 [
              "identificador" => "bib0615"
              "etiqueta" => "60"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The minimal approach&#58; An innovation in facial cosmetic procedures"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "M&#46; De Maio"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00266-004-0037-1"
                      "Revista" => array:6 [
                        "tituloSerie" => "Aesthetic Plast Surg&#46;"
                        "fecha" => "2004"
                        "volumen" => "28"
                        "paginaInicial" => "295"
                        "paginaFinal" => "300"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15529203"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            60 => array:3 [
              "identificador" => "bib0620"
              "etiqueta" => "61"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Assessing improvement of facial appearance and quality of life after minimally-invasive cosmetic dermatology procedures using the FACE-Q scales"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "B&#46;P&#46; Hibler"
                            1 => "J&#46; Schwitzer"
                            2 => "A&#46;M&#46; Rossi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Drugs Dermatol&#46;"
                        "fecha" => "2016"
                        "volumen" => "15"
                        "paginaInicial" => "62"
                        "paginaFinal" => "67"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26741383"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            61 => array:3 [
              "identificador" => "bib0625"
              "etiqueta" => "62"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Botulinum toxin cosmetic therapy correlates with a more positive mood"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46;B&#46; Lewis"
                            1 => "P&#46;J&#46; Bowler"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1473-2165.2009.00419.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Cosmet Dermatol&#46;"
                        "fecha" => "2009"
                        "volumen" => "8"
                        "paginaInicial" => "24"
                        "paginaFinal" => "26"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19250162"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            62 => array:3 [
              "identificador" => "bib0630"
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                  "referenciaCompleta" => "As&#237;n M&#44; Landa N&#44; Alonso V&#44; Gonz&#225;lez J&#44; Ruiz-Rodriguez R&#46; Dec&#225;logo del b&#243;tox&#46; 2016 &#91;cited 11 December 2018&#93;&#46; Available from&#58; <a id="intr0005" class="elsevierStyleInterRef" href="http://www.clinicadermatologicainternacional.com/en/tratamiento/botox">http&#58;&#47;&#47;www&#46;clinicadermatologicainternacional&#46;com&#47;en&#47;tratamiento&#47;botox</a>"
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              ]
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