Más Dermatología, n.º 36

artículo de revisión Dermatología estética facial. Una visión holística Más Dermatol. 2021;36:7-19 doi:10.5538/1887-5181.2021.36.7 8 ABSTRACT Aesthetic dermatology complements clinical dermatology, enhancing its effectiveness by adding the «well-being» parameter to skin health concept, also including the idea of «looking good». For this reason, we consider the dermaesthetic patient in the diag- nosis and treatment as a whole, in an integral or holistic vision. This often requires the participation of specialists in nutrition, psychology, ultrasonography and many other areas, in search of the concept of health in all its aspects, not only the biological one. In the diagnosis and treatment in current aesthetic dermatology, high frequency skin ultrasound is becoming increasingly important, an in-office imaging technique that allows objectifying the evaluation of aging and the treatments performed, reducing the incidence of complications, and improving results and the patient’s confidence in the process. Likewise, we analyze how this holistic view of the patient leads us more and more frequently to diagnostic protocols based on the external signs of emotional attributes, transmitted by the patient, but produced by identifiable anatomical changes and that convey emotions that are not congruent with those felt by the patient himself (sadness, anger, tiredness, flaccidity). We take care of those attributes from the first anamnesis, whether the patient comes for dermatological pathology with aesthetic repercussions, or he is looking for beautification or for rejuvenation. We describe how the treatment of those emotional attributes can induce aesthetic improvement, integrated into the health of the individual, and perceived as «natural», in addition to secondarily improv- ing their emotional health. Within our holistic vision of aesthetic dermatology, we analyze the role of the expo- some, defined as the set of extrinsic factors to which the individual is exposed from birth to death, specifically those that show evidence in accelerating skin aging, such as some chemical products, radiation, heat/cold, stress, toxic habits, and especially nutri- tion. And regarding the latter, we analyze recent reviews that show signs of extrinsic aging mediated by oxidative stress, in a form and pathways similar to that due to photo- aging, but triggered by quantitative and qualitative harmful nutritional guidelines. We describe how we include nutritional treatment as part of aesthetic dermatological treat- ment, including, when necessary, pharmacological support such as the existing one for the control of overweight and obesity, such as orlistat, or especially liraglutide, for the improvement of the patients’ health, which redounds in the aesthetic aspect of their skin. Key words: holistic aesthetic dermatology, well-being, aesthetic skin ultrasound, expo- some, emotional attributes, nutrition, oxidative stress, liraglutide. Varias son las características que, en nuestra opi- nión, definen y ayudan a entender la realidad de la dermatología estética actual en nuestro entorno. La primera es que el dermatólogo estético, «como dermatólogo», diagnostica y trata enfermedades cutáneas y, «como estético», va más allá de alcanzar la ausencia de enfermedad: promueve el óptimo estado de salud cutánea, con la visión de que una piel sana es una piel estética. Esta visión, donde la dermatología estética complementa a la dermato-