Objectives: The origins of ESCAD
For many years in Europe cosmetic dermatology was not taught as a subject in its own right. Dermatologists only learnt the subject by apprenticeship and by attending congresses. In the last 50 years, life expectancy has increased considerably and people have become much more concerned with their appearance. Dermatologists are the best trained people to meet these new needs.

Introduction: In 1997, three dermatologists and longstanding friends, Pierre André from Paris, Leonardo Marini from Trieste and Christopher Rowland Payne from London, felt there was a need for a scientific Society which would gather together research scientists from the fields of cosmetics and skin ageing together with clinicians specialized in the therapeutic techniques of cosmetic dermatology.
The idea of the European Society for Cosmetic and Aesthetic Dermatology (ESCAD) was born.

Materials / method: The New ESCAD
ESCAD is a democratic, non-commercial, non-profitmaking medical scientific Learned Society, registered in Paris. It consists in a President and an Executive Board.

In order to meet the present challenges and to support the need of scientific knowledge of its 6,000 members, ESCAD was refunded in Copenhagen in October 2015 and gave birth to New ESCAD. The Society is at the service of its members and of the industry to collaborate and contribute to the well-being of patients all over the world.

Results: The most important scientific event promoted by ESCAD is the Annual Scientific Meeting that takes place on the occasion of the European Academy of Dermatology and Venereology (EADV) Congress. This mutual collaboration strongly stresses the synergy between ESCAD and EADV. As a matter of fact over the last two years, ESCAD Board members have been actively involved in the scientific organization of the EADV Congress. Many ESCAD members are part of the EADV Board.

Conclusion: An international Scientific Committee, which includes members from Europe and other continents, supports ESCAD: during these years, the group has been raising up a strong network of cooperation with other international and national cosmetic dermatological societies.
ESCAD aims at fostering the highest standards of patient care in cosmetic and aesthetic dermatology, at facilitating continuing professional development and offers a friendly forum for the sharing of scientific research and innovative techniques.

Declaraciones

¿Ha recibido algún tipo de financiamiento para realizar su investigación sobre esta temática?
No

¿Ha recibido algún pago, honorario u otra compensación por su trabajo acerca de esta investigación?
No

¿Tiene vínculos financieros con alguna entidad que podría llegar a competir estrechamente con los medicamentos, materiales o instrumentos tratados en su investigación?
No

¿Posee o ha solicitado una patente relacionada a los materiales, productos o instrumentos utilizados en su investigación?
No

Este trabajo no cuenta con el apoyo de ningún financiamiento directo o indirecto. El autor asume plena responsabilidad sobre el mismo.

Objectives: To improve the safety of filler treatments

Introduction: Most used fillers today are known for a reliable safety profile, but all fillers may give rise to complications, even serious vascular adverse events. The use of ultrasound is being promoted as it is a non-invasive imaging modality that provides a good definition for studying the skin and deeper layers in real time, including blood flow. The use of ultrasound has also been recommended for imaging soft tissue fillers in a growing number of publications during the last decade.

Materials / method: Ultrasound examination was used to image all different types of fillers and their possible complications.

Results: • All fillers are visible with ultrasound, including their location, depth and size
• Previous (permanent) filler treatments can be brought in to sight
• Before a filler treatment is performed, vascular mapping can be performed to detect any variation in the course of vessels
• In case of adverse events, management and therapy are more accurate as overcorrection, migration, abscesses, and vascular adverse events can be seen.
• In case of hyaluronic acid fillers, under ultrasound guidance, hyaluronidase can be injected directly into the filler deposit.

Conclusion: Ultrasound examination can be an important tool to improve the safety
of filler treatments

Declaraciones

¿Ha recibido algún tipo de financiamiento para realizar su investigación sobre esta temática?
No

¿Ha recibido algún pago, honorario u otra compensación por su trabajo acerca de esta investigación?
No

¿Tiene vínculos financieros con alguna entidad que podría llegar a competir estrechamente con los medicamentos, materiales o instrumentos tratados en su investigación?
No

¿Posee o ha solicitado una patente relacionada a los materiales, productos o instrumentos utilizados en su investigación?
No

Este trabajo no cuenta con el apoyo de ningún financiamiento directo o indirecto. El autor asume plena responsabilidad sobre el mismo.

Objectives: To understand the current and future legislation for filler to acquire CE mark and the way this change will affect a physicians practice

Introduction: Having learned from many problems with non-resorbable (= permanent) implants, the European Legislator has been working on a new set of rules, named European Medical Devices Regulation (MDR). This has been approved in May 2017 and will be fully applied from May 26, 2020 in all EU countries.

Materials / method: The principal difference with regard to fillers will be the emphasis on clinical evidence of efficacy and safety. Until now it has been sufficient to demonstrate equivalence to a legacy device, being an approved filler with the same ingredients.

Results: Under MDR, new fillers can only enter the market after being tested clinically. Also, an intense focus will be placed on post-marketing clinical follow up. This will lead to increased costs for the manufacturers and possibly higher consumer prices of fillers. Also, the companies will cooperate more intensely with doctors as they need data generate in treatments. Much is still unclear about how MDR is going to work out in practice. There will be a need for expert panels to give their expert opinions about the fillers, another opportunity for doctors. Also it is expected that the Notified Bodies

Conclusion: MDR is generally viewed as a major step ahead leading to better and safer filler materials that benefits both patients and doctors.

Declaraciones

¿Ha recibido algún tipo de financiamiento para realizar su investigación sobre esta temática?
No

¿Ha recibido algún pago, honorario u otra compensación por su trabajo acerca de esta investigación?
No

¿Tiene vínculos financieros con alguna entidad que podría llegar a competir estrechamente con los medicamentos, materiales o instrumentos tratados en su investigación?
No

¿Posee o ha solicitado una patente relacionada a los materiales, productos o instrumentos utilizados en su investigación?
No

Este trabajo no cuenta con el apoyo de ningún financiamiento directo o indirecto. El autor asume plena responsabilidad sobre el mismo.

Objectives: 1: Distinguish side effect from complication
2: Vascular compromise is a severe complication which every treating physician should be able to recognise and be able to deal with, but we should not overdo it to warn from it
3: Severe complications are very rare and surveys with big number of patients are lacking. The incidence is around 0.05%

Introduction: Augmentation with fillers is one of the top five non-surgical aesthetic face treatments worldwide. The voluminisation particularly with hyaluronic acid is a very safe procedure. However, severe side effects can occur. With increasing knowledge of the anatomy of the soft tissue of the face, physicians get alert of mainly vascular complications. Less experienced physician in the beginning of the learning curve, tend to refrain from injecting patients in fear for disastrous complications.

Materials / method: We have to distinguish side effects from complications. Side effects are an effect next or beyond the desired results. They are in most of the cases mild and temporary. Complications however lead to a secondary disease or a condition aggravating an already existing one. Therefore, complications are much severer to deal with. Whereas side effects are common when treating patients with injectables, complications are very rare. However the interpretation of complication is relative as in aesthetic dermatology minor side effect (i.e. bruising or swelling) are mainly considered as complications.

Results: With increasing knowledge about the anatomy of the soft tissue of the face, we are aware of the fine and extensive network of the arteries and the anastomosis. Case reports of very severe complications such as vascular occlusion leading to skin necrosis or blindness are published. However, retrospective studies with high number of cases are rare. A survey of complications during 10 years (2003 – 2013) including 14’355 treatments showed 8 patients with vascular compromise (0.05%). All cases resolved fully.

Conclusion: Vascular occlusion leading to skin necrosis or blindness are disastrous complications and therefore should be taken very seriously. Each treating physician should have the skills to recognise and manage the situation when this complication occurs. However those complications are very rare and we should not overdo it with warning from these exquisite complication. Further we should distinguish moderate side effects from serious complication, however in aesthetic treatments minor issues tend to be aggravated to sever complications.

Declaraciones

¿Ha recibido algún tipo de financiamiento para realizar su investigación sobre esta temática?
No

¿Ha recibido algún pago, honorario u otra compensación por su trabajo acerca de esta investigación?
No

¿Tiene vínculos financieros con alguna entidad que podría llegar a competir estrechamente con los medicamentos, materiales o instrumentos tratados en su investigación?
No

¿Posee o ha solicitado una patente relacionada a los materiales, productos o instrumentos utilizados en su investigación?
No

Este trabajo no cuenta con el apoyo de ningún financiamiento directo o indirecto. El autor asume plena responsabilidad sobre el mismo.

Objectives: “Beauty is in the eyes of the beholder” wrote Margaret Wolfe Hungerford (1855-1897) in Molly Bawn (1878) her best known novel. This idiom could not be more appropriate to describe one of the most important issues in life. A beholder is an observer: someone who gains awareness of things through the senses, especially sight. If beauty is in the eye of the beholder, then the person who is observing gets to decide what is beautiful.

Introduction: The wide availability of safe and effective non-permanent fillers and the relative simplicity of their placement under the skin has made their use extremely popular among different branches of medical and surgical professionals, not limited to physicians. Preliminary evaluation of skin texture and tone + static and dynamic subcutaneous volumes distribution are extremely important when aesthetic physicians act as professional “beholders”. Sometime perception of anatomical features on their own faces as experienced by patients seeking aesthetic counseling does not concur with the opinion of

Materials / method: examining physicians. Differences in clinical perception of beauty may lead to “complex” discussions where counseling physicians try to convince patients to accept what they advise to obtain credibly balanced, natural results.

Results: Should this kind of “debates” not reach what could be seen as a keen compromise and patients prevail, the risk of achieving a wrong and disproportionate distribution of injectables is quite high particularly when physicians accept to perform procedures with the aim of matching patients’ desires.

Conclusion: Aesthetic physicians should have artistic sensibility besides being experts in choosing and injecting fillers keeping always in mind that sometimes it is more ethical and beneficial for the profession to refuse performing procedures they are not comfortable to do. Art should never be compromised for the sake of vanity.

Declaraciones

¿Ha recibido algún tipo de financiamiento para realizar su investigación sobre esta temática?
No

¿Ha recibido algún pago, honorario u otra compensación por su trabajo acerca de esta investigación?
No

¿Tiene vínculos financieros con alguna entidad que podría llegar a competir estrechamente con los medicamentos, materiales o instrumentos tratados en su investigación?
No

¿Posee o ha solicitado una patente relacionada a los materiales, productos o instrumentos utilizados en su investigación?
No

Este trabajo no cuenta con el apoyo de ningún financiamiento directo o indirecto. El autor asume plena responsabilidad sobre el mismo.

Declaraciones

¿Ha recibido algún tipo de financiamiento para realizar su investigación sobre esta temática?
No

¿Ha recibido algún pago, honorario u otra compensación por su trabajo acerca de esta investigación?
No

¿Tiene vínculos financieros con alguna entidad que podría llegar a competir estrechamente con los medicamentos, materiales o instrumentos tratados en su investigación?
No

¿Posee o ha solicitado una patente relacionada a los materiales, productos o instrumentos utilizados en su investigación?
No

Este trabajo no cuenta con el apoyo de ningún financiamiento directo o indirecto. El autor asume plena responsabilidad sobre el mismo.

Declaraciones

¿Ha recibido algún tipo de financiamiento para realizar su investigación sobre esta temática?
No

¿Ha recibido algún pago, honorario u otra compensación por su trabajo acerca de esta investigación?
No

¿Tiene vínculos financieros con alguna entidad que podría llegar a competir estrechamente con los medicamentos, materiales o instrumentos tratados en su investigación?
No

¿Posee o ha solicitado una patente relacionada a los materiales, productos o instrumentos utilizados en su investigación?
No

Este trabajo no cuenta con el apoyo de ningún financiamiento directo o indirecto. El autor asume plena responsabilidad sobre el mismo.

Objectives: How to deal with a patient who had a complication after a cosmetic procedure .

Introduction: Neuromodulators, fillers, sclerotherapy, chemical peels, lasers energy based devices, lipo sculpture are some of a long list of cosmetic procedures.
Like all therapeutic interventions, these cosmetic dermatologic procedures are not risk free .

Materials / method: Cosmetic dermatologists and aesthetic surgeons should evaluate patients psychologically before undergoing any procedure .
They have to understand what is the impact of complications on the emotional state of patient.

Results: When the inside and outside mesh, the results are more satisfying.
Aesthetic procedures require technical , psychological and ethical approaches

Conclusion: Successful aesthetic procedures means both patient satisfaction and no complications
If complications do happen how to handle those patients require very special management .

Declaraciones

¿Ha recibido algún tipo de financiamiento para realizar su investigación sobre esta temática?
No

¿Ha recibido algún pago, honorario u otra compensación por su trabajo acerca de esta investigación?
No

¿Tiene vínculos financieros con alguna entidad que podría llegar a competir estrechamente con los medicamentos, materiales o instrumentos tratados en su investigación?
No

¿Posee o ha solicitado una patente relacionada a los materiales, productos o instrumentos utilizados en su investigación?
No

Este trabajo no cuenta con el apoyo de ningún financiamiento directo o indirecto. El autor asume plena responsabilidad sobre el mismo.

Declaraciones

¿Ha recibido algún tipo de financiamiento para realizar su investigación sobre esta temática?
No

¿Ha recibido algún pago, honorario u otra compensación por su trabajo acerca de esta investigación?
No

¿Tiene vínculos financieros con alguna entidad que podría llegar a competir estrechamente con los medicamentos, materiales o instrumentos tratados en su investigación?
No

¿Posee o ha solicitado una patente relacionada a los materiales, productos o instrumentos utilizados en su investigación?
No

Este trabajo no cuenta con el apoyo de ningún financiamiento directo o indirecto. El autor asume plena responsabilidad sobre el mismo.