Background: Cutaneous leishmaniasis (CL) is an endemic disease in many countries and caused by different species of Leishmania parasite. It results in a deformed scar after a relatively long period. Many therapies have been tried in treatment of this disease.
ObjectiveTo compare the effect of oral zinc sulfate and oral ketoconazole singly and in combination in the treatment of acute cutaneous leishmaniasis.
Patients and Methods: This single, blinded, therapeutic, controlled study was conducted in the Department of Dermatology, Baghdad Teaching Hospital, Baghdad ,Iraq during the period, January 2015-July 2015. In total, 75 patients with acute CL were enrolled in this study. The total numbers of lesions were 327, and the duration of lesions ranged from 4-12(6.9± 0.7) weeks. The diagnosis was confirmed by smear and histopathology. Patients were divided into three groups: 24 patients in Group A were treated with oral zinc sulfate capsules 10mg/kg/day for 6 weeks, 24 patients in Group B were treated with ketoconazole tablets 200mg twice daily for 6 weeks and 27 patients in Group C were treated orally with a combination of zinc sulfate and ketoconazole for 6 weeks. All patients were seen regularly every 2 weeks for 6 weeks of treatment period, then monthly for the next three months as follow up period. Healing of the lesions was assessed by using Sharquieˋs modified Leishmania score to assess the objective response to the topical or systemic therapy.
Results: After six weeks, 75 patients have completed the treatment, 24 patients received zinc sulfate capsule, 24 patients received oral ketoconazole and 27 patients received a combination of both treatments. The cure rate was (60%) in the group receiving oral zinc sulfate capsule and (50%) in the one receiving oral ketoconazole tablet (P=0.146) and ( 96%) in the combination group (p˂ 0.04) .
Conclusion : The combination therapy using oral zinc sulfate and oral ketoconazole gave a high cure rate. The combination therapy is a

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: The aim of the study was to improve the skin's quality and texture using the combination of small-particle hyaluronic acid injected as a skinbooster and a novel thermo-mechanical fractional ablative technology.

Introduction: Patient today are seeking for non-invasive skin procedures, and also understand the need and importance of preventive treatments. We are facing a growing challenge of maintaining a youthful, young look but without loosing the natural appearance. Our patients want an out-patient aesthetic treatment with little side effects and a long term outcome- leading to effective but also natural results with minimal recovery time. The desire for treatments which are not associated with substantial downtime have led us to use multiple combination therapies- that on one hand will be safe

Materials / method: 50 patients were included in the study (ages 43-65), all patients had reduction in skin quality (face and neck)- and wanted to improve the overall appearance of the skin. Treatment protocol included injection of 2cc of small-particle hyaluronic acid injected in small droplets to cover the whole area of the face (without forehead), followed by treatment of the same area by thermal fractional ablative device (based upon direct heat conduction) using the following parameters: 10-12ms/400, one pass.

Results: All patients had improvement in the skin quality: fine wrinkles, pores, tone and overall appearance of the skin with high patient satisfaction rate. The side effects were mild and included: mild bruising, mild edema and transient erythema.

Conclusion: The combination of small-particle hyaluronic acid and thermo-mechanical fractional ablative technology is an effective and safe combination for the improvement of skin's quality and texture; and is not associated with significant downtime or side-effects.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Back ground:
Rhinoplasty is a common surgical procedure to correct nose size or other abnormalities of noses
But many patients have minor bizarre shape or deformities of nose and refuse surgery
So we should find other techniques to correct these unwanted or undesired nose shapes
Objective: To use hyaluronic acid fillers to correct small nose or deformities, and to perform heat dermabrasion to reduce the size of bulky nose. Also to create new alar groove and to remove nose acne or traumatic scarring
Patients and methods: Forty five patients were included: Forty patients with heat dermabrasions, 21 females and 19 males and their ages ranged from 20-50 years. All patients had bulky nose, some had natural nodulation of nose and had acne or traumatic scarring. All patients were treated with heat dermabrasion after local xylocaine anesthesia and patients were received topical antiseptic and oral antibiotics to be seen after 2 weeks.
Five patients were treated with hyaluronic acid filler to increase size of nose, or correct deviation or saddle nose, all females with age range 30-50 year, and then topical corticosteroid was used to prevent post-inflammatory pigmentation.
Results: In all patients with bulky nose were improved and alar groove were created or maximized and gave satisfactory cosmetic results using heat dermabrasion.Post-inflammatory hyperpigmentation was noticed but overtime was gone. In patients with small nose or deviation were corrected by hyaluronic acid filler that gave accepted cosmetic appearance
Conclusion:: volumeplasty are new techniques to reduce size of bulky nose. Also the small nose could be improved by hyaluronic acid

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Background: Facial melanoses are a major cosmetic health problem in dermatological practice especially among dark skinned people. There are many etiological factors incriminated in its etiopathogenesis, singly or in combinations where there is increase in the melanin stores in the epidermis and dermis
Objectives: To study all cases of facial melanoses including clinical evaluation, Wood’s lamp examination and histopathological study and to assess the intensity of melanin stores in the dermis and epidermis.
Patients and Methods: Two hundred cases of facial melanoses were seen during the period from July 2013 -January 2014 in Department of Dermatology,Medical Teaching Hospital,Bahgdad. Clinical assessment was carried out including, Wood’s light examination and skin biopsy was done for histopathological examination.
Results: The following clinical types were recognized with some overlap between melasma and melasma versus butterfly lichen planus actinicus; melasma and melasma like butterfly lichen planus actinicus 122 (61%) patients, frictional melanosis 25 (12.5%), post-inflammatory hyperpigmentation 19 (9.5%) butterfly lichen planus actinicus 16 (8), facial acanthosis nigricans 15 (7.5%), nevus of Ota 2 (1%), phytophotodermatitis 1 (0.5%), Gazelle eyelike facial melanosis 1 (0.5%) and 1(0.5%) patient with hair dye dermatitis. The clinical and histopathological pictures are overlapping between these different variants of facial melanosis but in all of them there is increase in the melanin stores

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives;
The chemical peels may be used to help ameliorate the scars, to destroy premalignant and /or malignant lesions, unsightly pigmentation etc.
The treatment modalities used to produce a controlled injury are dermabrasion, chemical peels and photoepilation (LASER and IPL). Only if the injury is in the proper tissue plane can the desired result be achieved. If too superficial, the results will be disappointing. If too deep, the results can be catastrophic.
Material and Methods;
The senior author have introduced newer formula into the world of chemical peeling according to the depth of peeling agent penetration.
This is a prospective study of 3 years from April 2014 to April 2017. In this study, total number of 216 consecutive chemical peels on 54 patients over a 3-year period were performed. Age distribution ranges from 20 years to 55 years.
Results;
The results achieved with these newer chemical formula are highly satisfactory (80-90%) for almost all skin conditions treated.
Conclusion;
In our office setting practice, we perform approximately four sessions of chemical peel weekly and continue skin lightening/spot protection creams and sun protection. This study corroborate evidence superiority of our selected chemical formula.
Key Words; Chemical, Peel, Munir

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: Improve the approach to nasal reshaping with injectables.

Introduction: Treating the nose with injectables allows the increase in volume and change in shape of the nasal structures. It is therefore especially effective in noses of small dimensions and in cases where increase in volume improves the esthetical harmony. Filling of the hollow radix is among the main indications because it can simulate the presence of a hump.
The evolution of the technique in the last years has widened the indications leading to treat cases that normally require a surgical augmentation rhynoplasty with cartilagineous graft and remodelling sutures.

Materials / method: IPN like technology Hyaluronic acid has been used from 2016 to 2018 in 60 patients to reshape the nose placing it in a structural fashion, just like grafts and remodelling sutures would have been applied. The most frequent treated areas have been the columella (simulation of a columellar strut), the tip (definition, increase in projection) and the dorsum (smoothing, augmentation, correction of depressions). Injections have been carried out using the 27G neddle or the 25G cannula selecting the introduction points and plane of placing in order to reduce the risk of intravascular injection.

Results: Nose reshaping with IPN like HA showed to be effective both in primary cases but also in secondary corrections in patients who had mild defects or did not want to undergo further surgery. Injection with 27G neddle and 25G cannula. No complications have been reported. Frequent side effects have been mild swelling and bruising.

Conclusion: Reshaping of the nose with injectables is particularly effective when a volume increase or a contour smoothing is needed both in the frontal and in the lateral view.Sometimes it is possible to obtain good results in cases where surgery seems to be the only possible choice. What is carried out with injectables is maily a camouflage: the better shape makes the nose appear smaller even if it actually becomes bigger. It is therefore necessary to explain to the patient the real possibilities of the procedure and try to understand when they have unrealistic expectations.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: To evaluate safety and efficacy of two hyaluronic acid fillers with lidocaine (HAL) for facial augmentation in an Asian population, with focus on chin data.

Introduction: Hyaluronic acid fillers are used for restoring facial volume loss and for contouring of facial features. While the majority of studies on safety and efficacy of HAL have been performed in North America and Europe, it is desirable to also collect data from an Asian study population as treatment goals may differ. Objectives of this study (ClinicalTrials.gov ID: NCT02565784) included evaluation of perceived improvement of facial aesthetic appearance, and subject satisfaction with facial appearance and treatment.

Materials / method: Female subjects were treated with 3-5 mL HAL in 2-4 of pre-defined areas; upper cheeks, nasolabial folds, temples, nose, and chin, including at least one of the mandatory areas upper cheeks and nasolabial folds. Touch-up was allowed after 1 month. A second treatment was performed after 12 months in the same treatment areas and with the same product(s) as used at baseline. Subjects were followed for 24 months after initial treatment. Assessments included GAIS, subject satisfaction and safety (adverse events [AEs] and subject diaries for collection of injection-related events).

Results: One hundred subjects, aged 27-49 years were included, of which 84 and 56 subjects were injected in the chin at first and second treatment, respectively (total mean volume: 2.07 mL). The product was most commonly injected in the supraperiosteal plane; ≥95% of injections were performed using a co-packed needle. Tenderness was the most frequently reported injection-related event in the chin; implant-site pain (n=9) and bruising (n=3) were reported as AEs. Subjects and investigators (≥82%) reported overall improvement on the GAIS.

Conclusion: HAL full-face treatment resulted in long-term aesthetic improvement. The chin was the most prioritized treatment area in this Asian study population following the mandatory sites of upper cheeks and nasolabial folds.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
Yes
Please specify entities (individual, company, society): Employed by Galderma

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work is presented thanks to the support of: Galderma

Objectives: To present the efficacy and safety of AbobotulinumtoxinA (ABO) for the treatment of moderate to severe glabellar lines (GLs) using two injection volumes per ABO product (0.05 mL or 0.1 mL per injection point [EU], and 0.05 mL or 0.08 mL per injection point [US]) to deliver the same dose (10 U* per injection point, in a total of 5 injection points).
*Units specific for ABO products

Introduction: In order to provide practitioners with more flexible instructions for use, two reconstitution volumes are now available for ABO products. In the EU, the recommended reconstitution volume for a vial of ABO (125 U) is either 0.63 mL (corresponding to 10 U per 0.05 mL and injection point) or 1.25 mL (corresponding to 10 U per 0.1 mL and injection point). In the US, the recommended reconstitution volume for a vial of ABO (300 U) is either 1.5 mL (corresponding to 10 U per 0.05 mL and injection point) or 2.5 mL (corresponding to 10 U per 0.08 mL and injection point).

Materials / method: We present efficacy and safety data from two multi-centre, randomised, double-blind studies comparing a single treatment with 50 U of ABO for moderate to severe GLs using 0.05 mL or 0.1 mL injection volume per injection point (European study NCT02108158) or 0.05 mL or 0.08 mL injection volume per injection point (US study NCT02718118).

Results: 62 white females (age 30-63 years [mean 49]) participated in the EU study. Both injection volumes achieved early onset of effect, high effectiveness, and long duration of effect. At month 6 ≥55% of subjects still had an improvement in wrinkle severity at rest. Injection pain levels and safety profiles were similar between groups, with no serious AEs.
60 subjects participated in the US study (87% female; 97% white; age 20-64 years [mean 46]). Both injection volumes achieved clinically significant improvements in appearance and severity of GLs with acceptable safety profiles (no serious AEs).

Conclusion: In both studies, the two injection volumes of the 50 U of ABO administered were well-tolerated and effective for treatment of glabellar lines, and there were no significant differences in safety or efficacy between injection volumes.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
Yes
Please specify entities (individual, company, society): I am employed by Galderma.

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work is presented thanks to the support of: Galderma Aesthetics

Association of a single session of platelet rich plasma and micro-focused ultrasound for dermal autologous collagen regeneration. A prospective study on periocular wrinkles.

Backgroung: Transcutaneous micro-focused ultrasound has been proved to be effective for non-invasive skin tightening. It produces termo-coagulation zones where the temperature reach 65 C°. This induces initially tissue contraction (lifting effect) and then autologous collagen regeneration. Platelet-rich plasma (prp) has been used for rapid healing and tissue regeneration in many fields of medicine. In dermatology for the treatment of ulcers and burns and in aesthetic surgery for enhancing stem cell in fat transfer.

Objectives: The goal of our prospective study was to investigate the efficacy of the association of the two procedures performed in a single session.
The rationale was that growth factors could boost the collagen regeneration induced by the micro-focused ultrasound by enhancing dermal fibroblasts activity and by making available regenerative substrates.
Materials: Fifty patients with moderate to severe periocular wrinkles assessed with the FWS (facial wrinkles scales) were recruited for the study. They were analyzed for phototype, moisture, amount of collagen fibers and skin texture by Visia System (canfield) and macro-photographs were also obtained. Wrinkles were assessed by doctors (SSAl - Surgeon satisfaction assessment lifting) and by patients (PSAl- Patient satisfaction assessment lifting). Efficacy and tolerability were assessed at 4 and 12 weeks of treatment.
Methods: Patients were previously treated on the periocular area by by intradermal injection of 4 cc of prp. After the treatment 25 patients of group 2 underwent a single of 300 energy spot lines of micro-focused ultrasound delivered at a frequency of 7 MHz (0.3 J) at 3.0 mm focal depth, able to reach the subcutaneous tissue and at a frequency of 10 MHz (0.25 J) at 1.5 mm focal depth, able to reach the deep dermis

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: The goal of our prospective clinic study is to evaluate the efficacy a a new FDA-cleared tissue stabilized-guided subcision (TS-GS) system for improving the appearance of cellulite dimples on buttocks and posterolateral thighs

Introduction: For improving the appearance of cellulite, in our busy centers for cosmetic surgery in Italy, we have introduced in 2016 a new FDA-cleared tissue stabilized-guided subcision (TS-GS) system which was alleged to be minimally invasive and to stabilize the clinical results for 3 years.

Materials / method: We enrolled on this study only women with stabilized cellulites since at least 5 years. We analyzed patients by digital 2D macro-photographs and by a 3D biomechanical device for quantitative approach to soft tissue change assessment. Patient satisfaction was assessed through physician review of 2D and 3D photography, and the Global Assessment of Improvement Scale (GAIS) at baseline, three and twenty four month post-treatment. Patients that underwent any buttocks aesthetic or surgical procedure in the last 6 months, or presented fat excess or ptosis on buttocks were excluded.

Results: 60 women of average age 39.6 y.o. with a total of 1124 lesions of cellulite received a single treatment to the buttocks and/or posterolateral thighs and completed the follow up at 24 months. 96.8% of patients were satisfied with treatment results and physician evaluations displayed a 1-point improvement in their cellulite grades. Moreover, GAIS scores indicated that all patients had visible improvement in the global appearance of their cellulite. Analysis of 3D imaging yielded 87.6% average improvement in negative volume and 80.6% improvement in minimum heigh of dimples.

Conclusion: The physician ratings, patient satisfaction, and photographic evidence prove the safety and efficacy of the TS-GS system in the management of cellulite in women in the buttocks and posterolateral thighs.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: Audience: Medical Professionals.
Knowledge: Best practice, Predictions, technology.
Understand: Investing in your future growth and legacy.
Apply: Creating solutions for your clients; strategy for digital disruption and prepare for your future workforce.
Evaluate - Key considerations for the successful implementation of customer experience, data analytics, technology and best practice.

Introduction: Medical Aesthetics is evolving at a rapid pace. More people are becoming comfortable in sharing openly about the procedures they’ve undertaken; technology is making non-invasive treatments more accessible and celebrity culture is influencing both men and women to start treatments younger. With digitization and technology's profound impact upon the industry, come the ever increasing risks affecting data, and the significance of the customer experience model. Businesses need to focus on creating their future now or get left behind.

Materials / method: Powerpoint presentation

Results: Powerful incentives from research including:
A study in Patient Care by EY
A report by Allied Market Research, stating that the global surgical robotics market is likely to reach $98,737.0 million by 2024,
Healthcare case study by Blake Morgan (Customer Experience Futurist) l

Conclusion: Data for understanding your demographic is key, and technology (Robotics and Augmented Reality) is advancing the medical aesthetics process; but the human element cannot be replaced. Focusing on customer experiences will ensure your business' future and legacy. It combines the elements of best practice, investing in technology and people.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: To show and demonstrate the major principles of secure thread applications.
Thread trainings should be cover anatomy and patients' management for complications.

Introduction: 6 Years experience with thread applications and last 4 years study in country as complication management author.
How we can prevent doctors and patients from undesirable results.
What are the trouble areas for patients and doctors for thread applications.

Materials / method: More than 1400 thread cases from all over the world, Surveillance, Diagnose, threat and manage of thread patients,

Results: Most of the inappopriate aplications should be prevent by training.
Complex techniques, wrong indications & patients and unexperienced practitioners are common trouble reasons. Practitioners prevent threads related problems and complications.

Conclusion: Thread procedure is a new area for that reason these procedures should be done by certified and experienced practitioners.
Thread trainings should be cover cadaver and live hands on sessions.
Materials, techniques, indications and patients’ assessment should be add to the training.
Main principles of secure thread interventions. How to prevent & avoid, threat and manage undesirable effects. Qualifications of troubles for patient & doctor. Most common troubles; Infections, foreign body reactions, thread visualities & migration,

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: The attendees will be able to understand the psychology and current trends of young male patients seeking cosmetic procedures.

Introduction: Although older male patients feel they need cosmetic procedures to stay competitive at the work force, younger male patients are more adventurous and believe in prevention. In fact, millenials make sure to put money aside for their cosmetic procedures.

Materials / method: Powerpoint presentation describing the most common procedures for male facial enhancement: Frontoplasty, tear through, cheekbones, chin and jaw line.

Results: Level of young male attractiveness increase after cosmetic procedures.

Conclusion: Men comprise about 17% of the aesthetic market, but it is on the rise due to the new generation of Millenials who do not feel they need permission to do aesthetics procedures the way we seen in older aesthetic male patients

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: To illustrate a novel technology that can contour the body by getting rid off unwanted belly fat and at the same time strengthen the core and increase muscle mass.

Introduction: There are many body contouring devices but they have limitations such as:
Only address FAT
Does not affect Muscles
Does not strengthen the core
Superficial procedure in nature
Does not provide non-invasive buttock procedure
May have adverse events due to thermal nature

Materials / method: Presentation of studies showing the safety and efficacy of HIFEM for body contouring and muscle building for abdominal area and buttocks

Results: Most studies showedon average 4.17 circumferential reduction of abdominal area, 19% fat reduction, 16% increase in muscle mass, 11% reduction on diastasis recti. There were also significant improvement on non invasive buttlifting effect.

Conclusion: HIFEM is a novel treatment for those patients that one to get rid off unwanted but also improve their muscle core strength and mass.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: The goal of this presentation is through a detailed preoperative análisis base on a previous 8 preoperative check list. point 8 (check list Beut & Jelks) "arcus marginalis" (A.M.)., Anterior or OUTIE (© jelks) or Posterior INNIE (© jelks)

Introduction: 70% of the population is arcus marginalis anterior. previous analysis faciita the surgical technique, without having to take off the A.M with approach from the upper incision.

Materials / method: previous analysis facilitates the surgical technique, without having to release the A.M with approach from the upper incision. When it is INNIE, through a transconjunctival approach using the "CURTAIN EFFECT" or "CAPSULOPALPEBRAL FASCIA SPARING" technique, the A.M, is released.

Results: video surgery , 3D app available to attendees from Imcas ACADEMY

Conclusion: This technique facilitates the quick recovery of the patient, through “function“ as the most important "result" and “ anatomy” the most important "factor"

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work is presented thanks to the support of: 3dtechomegazeta.com/3dtoz/

Objectives: Darier’s disease is characterized by keratotic papules covering the sebaceous areas of the face and body. Treatment options include topical and systemic retinoid therapy with unsatisfactory results in most cases. Ablative laser treatments are utilized in an effort to induce clearance of lesions but treatment settings must be optimized regarding recurrences and side effects owing to laser therapy .

Introduction: Herein we report a 21-year old female patient with Darier’s disease who is recalcitrant to topical and systemic retinoid treatments.

Materials / method: We applied fractional erbium:YAG laser treatment with topical anesthesia. Two subsequent passes were performed with 6,6 J/cm2 energy, 300 μsn pulse duration and 10 Hz frequency. Laser therapy is followed by the substitution of diclofenac %3 gel twice a day.

Results: A remarkable response was evident including the resolution of all of the lesions on the chin, nose, forehead and neck and about 90% of the lesions on both malar regions. During a follow up period of 6 months, only mild recurrences were noted which were controlled by topical diclofenac gel therapy.

Conclusion: Fractional erbium:YAG laser can be regarded as a less invasive option for this patient with a resistant disease course. The long-lasting effect is debatable since the evidence demonstrates the deeply located infundibular cells to be responsible for recurrences. In addition to the proposed mechanism of ablative lasers on Darier's disease as survival advantage of the wild-type clone over the mutated counterpart, the treatment may be effective by the increased penetrance of diclofenac , a targeted treatment agent for Darier’s disease.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: It is always more desirable to choose the easiest ways to achieve the best results. However, this is not always possible.
The best procedure to achieve the best result should be chosen. We need to realize that sometimes we have huge huge responsibilities in front of the Patient.

Introduction: No doubt nowadays a lot of Aesthetic Surgery patients requires belong to Soft Tissue fillers for Breast/Buttock Augmentation procedures. Regarding the local statistics of Turkish Society of Plastic Reconstructive and Aesthetic Surgeons, daily Aquafilling Google requests quantity is bigger than Breast Augmentation. But do we really know about this treatment, its complications and Can we really explain to our patients all WHYs, risks and alternatives?

Materials / method: Taking my personal professional experience of the foreign patient (first stepper of transitioning procedure man) who had an unfortunate result of Soft Tissue filler injected by another MD as an example, I would like to share my own thoughts, principals, reasons and consideration of this case since probably dearest colleague of mine did a proper short-term treatment when both (Patient/Surgeon) were satisfied and as a result Patient had incredibly bad complications afterwards. This interesting case has forced myself for a research which definitely has been made before.

Results: Male Patient desired to have as bigger breast as possible has been injected with a Polyacrylamide Hydrogel into the Breasts areas and had been extensively infected afterwards. First our step was calling the infection off by the usage of antibiotics and infection’s outflow which took about 1,5 months. After infection has been stopped, by taking huge risk I operated Patient with Breast Revision surgery by cleaning breast pockets from Polyacrylamide Hydrogel and replacement of new breast implants by recreating new healthy implant pockets regarding

Conclusion: It is always more desirable to choose the easiest ways to achieve the best results. However, this is not always possible.
The best procedure to achieve the best result should be chosen. We need to realize that sometimes we have huge huge responsibilities in front of the Patient.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: Tuberous sclerosis angiofibromas may be disfiguring; thus have a negative impact on the quality of life of aspecially young patients. Angiofibromas may be treated by different surgical approaches including electrocauterization, scalpel surgery, vascular and ablative lasers. More recently, sirolimus, as a topical agent has been shown to have substantial effect on angiofibromas.

Introduction: Herein we report our experience with a 42-year old female patient with extensive angiofibroma lesions located on bilateral malar regions, the nose and the chin.

Materials / method: We first applied full-field erbium:YAG laser in order to ablate angiofibroma lesions under fentanyl/midazolam sedoanalgesia. Two months following the procedure, a recurrence tendency was noted; thus, topical sirolimus was introduced to this patient and tolerated in 0,25% concentration. One year following topical sirolimus treatment, the papular lesions completely disappeared and the erythema completely faded except for the tip of the nose still demonstrating some telenjiectatic vessels.

Results: In a follow up period of a year, the treatment result of the combination including one session of full-field erbium:YAG laser therapy and daily topical sirolimus 0,25% treatment was remarkable. We didn't use a vascular laser; still the impact of sirolimus on erythema was remarkable emphasizing its anti-angiogenic property.

Conclusion: The combination of erbium:yag laser and topical sirolimus had the advantage of a rapid treatment response. Also, we could use sirolimus in a 1/4 diluted concentration (0,25%) of the reported dosage of 1% in the literature, thus prevented irritation. The effects of sirolimus on erythema component had a remarkable effect on the final cosmetic result of our patient.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: How to create optimal ablative depth in different type of acne scar
How to maximize collagen production by using ultrapulse laser in acne scar
Introduction: Acne scar can be treated with fractional laser with the mechanism of collagen remodeling. However the results of severe acne scar treatment is sometimes frustrating. Ultrapulse laser with shorter pulse width can ablate scar tissue deeper to induce deeper collagen remodeling with subsequent better result.
Materials / method: Patients with atrophic scar were recruited and treated with ultrapulse laser. Results will be presented
Results: The improvement of acne scar is significant in all patients.
Conclusion: Ultrapulse fractional CO2 laser is safe and effective in the treatment of severe acne scar.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: Every faces are different and needs special individualized reshaping protocols.
Male and female or transgender faces may age in specific sequences.
Introduction: Purpose of Supporting Volumetry is to achieve a reconstruction of lost volume in the strategy supporting-trophic subcutaneous layer (areas) and natural individualized face RESHAPING, REJUVENTAION and BEAUTYFICATION.
•The key-point of Supporting Volummetry is to start revolumising: from upper face level: (1-scalp, 2-temple/forehead), progress to mid-face level: (3-cheeks, zygo and periauricular areas) and finish at the lower-face level: (4-jaw line, chin, perioral (lips) area).
Materials / method: •Supporting Volumetry is a special technique using micro-cannula 25G - 50 mm or 22G - 70 mm to recreate and recotoure the degradation of the subcutaneous fat layer across the entire face.
•4 crutial entry points are located away from the main vessels and nerves and garanty low risk of blood vessel damage (bruising).
•Injection in uper frontal and temple and midface areas have to be injected in sub-SMAS layer.
In lowerface level - in subcutaneous fat layer.
The Supporting Volumetry technique uses cross-linked HA with high viscoelasticity values
Results: The Supporting Volumetry technique improves natural facelift and at the same time gives a natural face reshaping and rejuvenation result.
Conclusion: „Supporting volumetry” – supporting you in aging nicely!

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives:
Is it possible to have natural young look without gravitational effect?
Contemporary aesthetic medicine takes a comprehensive approach to treatment and is innovating at a fast rate. These new techniques focus on natural look. The key features of looking young are skin tension, skin quality and retained face oval.
Our innovative technique resists the gravitational effect of aging without the need for surgical intervention.
We conducted a study involving 20 patients with an age range of 45 to 60, all suffering from a sagging face oval.
Introduction:
With antigravity it is crucial to stress the underlying importance of facial anatomy - in particular the scalp, the forehead, the temples – in the process of a natural non-surgical facelift.
There is a direct correlation between the scalp layer (galea aponeurotica) and SMAS structures, and the interplay of the two help the skin maintain its natural position on the face.
With age, the hollow structures (aponeurosis) lose their resilience. This results in the degradation of deep underlying fat compartments. which causes changes to facial geometry and visible gravitational sagging.

Materials / method:
We use our Volumetric support technique to rebuild the natural face oval without any intervention in its natural shape. The procedure requires special high viscoelasticity hyaluronic acid, a micro cannula of 25G-50mm or 22G – 70 mm.
The treatment requires a special combination of entry points responsible for face lifting. From these points the HA is spread across the subcutaneous skin layer.
Revolumising begins with the upper face level, starting with the scalp and temple, and then progresses to the mid-face level. For optimal results we use 2-4 ml per session.

Results:
The treatment does not interfere with the natural contours of the face and, moreover, adjusts to the natural expressions of the face. A single treatment was needed to accelerate oval lift and moisturize the effect and synthesis of Hyaluronic acid. We recommend that the treatment be repeated every 3-6 months to optimize effects.

Conclusion: Case study - effects
The effectiveness of the procedure was evaluated by comparing before and after photographs. Additionally, patients assessed their satisfaction levels (scale from 1 to 5 where 1 was completely dissatisfied and 5 very satisfied). The results of the satisfaction survey confirmed that all patients were extremely happy.
Conclusion – treatment is very effective with a high level of patient satisfaction
Presentational materials
The presentation demonstrates the whole concept of antigravity procedure with use of antigravity volumetric support technique.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: The perioral, chin and jowl area is the most important part of the face. Wrinkles, sagging face around the lip area, and narrowing lips are leading to a sad and tired expression. Such appearance confirms the age or even adds years to our face.
The aging processes are irreversible, but doctors can slow them down. Up till now doctors have pumped face to lift it and get rid of wrinkles. The newest approach is rather aimed at rebuilding and “rehanging” face instead of pumping it.
The study involved patients at the age 45-60 years with sagging skin and lips in the perioral area.

Introduction: The technique to “rehang” and rebuild the perioral area and the chin and the jowl has been created based on deep anatomy analysis. The technique rebuilds lost volume and elasticity of the anatomical layers of the area, which gives patient a natural lift effect.
The technique is based on a cannula method which precisely recreates volume of subcutaneous fat compartments. The technique shows how to combine injection technique dedicated to individual areas: upper lip, lower lip, nasolabial fold and chin area.

Materials / method: Hyaluronic acid filler with Hi-viscoelastisity values injected with 27 G-50mm cannula was used to accelerate volumising of the retro - orbicularis oris fat and subcutaneoust fat compartments. It is recommended to begin with the reconstruction of the upper part of philtrum followed by remodeling of the upper and lower lips. The final stage of remodeling concerns volumization techniques for the lip–chin area, including the mental fat compartments.

Results: The study shows that we are unable to reproduce, rebuild in a natural way the lip and its surrounding area without a proportioned rebuilt of subcutaneous fat compartments.
The effectiveness of the technique of Bio Nutri Lips concept was evaluated by comparing photographs of patients before and after procedure. The patients were questioned about their satisfaction level with the result of the reconstruction of the perioral area, the chin and the jowl (scale 1 to 5, where 1 is completely dissatisfied and 5 satisfied).

Conclusion: All patients were satisfied with the result of 5 points which indicates the highest level of satisfaction.
Bio Nutri Lips Concept technique- gives a natural perioral area, lips and chin reshaping and rejuvenation result with the shorter recovery time.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: To present the rheological properties of CaHA along with current recommendations for safe clinical application and its use as a bio stimulant.

Introduction: Treating tear trough is challenging because of the numerous consequences of aging and optimal treatment is a topic of debate. Minimally-invasive methods such as HA filler injections directly into the tear trough area have provided a popular alternative. CaHA approved by FDA in 2006 has shown to have an excellent safety profile and due to its rheology and biomodulating properties it has benefits and clinical use that extend beyond that of other HA dermal fillers.

Materials / method: Candidates presented with significant, visible pigmentation of the tear trough area. which were assessed using the GAIS and the MAS for infraorbital hollows. Follow-up were at 2 weeks, 3, 6 and 12 or 18 months. The filler mixture consisted of 0.8ml of CaHA mixed with 0.1ml of 1%-lignocaine for support of the orbital retaining ligament using micro bolus injections, and 0.1ml of this mix was further diluted down with 0.4ml of lignocaine for a subcutaneous biostimulatory wash. Effectiveness endpoints were improvements in scores at a minimum of 4 months from baseline.

Results: 12 patients had their tear trough deformity treated with CaHA. An improvement in the appearance of hyperpigmentation was immediately observed. Patients were followed up for 8-18 months. Over a 4-6 month period, hyperpigmentation and skin tone, thickness and color had all improved noticeably in the treated areas. MAS and GAIS scores by both independent raters and investigators showed that all patients experienced satisfactory post-treatment improvements. Most patients experienced a dull erythema in the injection area which resolved over 8-12 weeks. No incidence of nodules observed.

Conclusion: We describe a novel approach to treat the tear trough deformity that is associated with periorbital pigmentation. Using HA in these patients can give a poor result even though the contour deficit is corrected.The results presented demonstrate CaHA’s unique rheological and biostimulatory properties, and its placement in small quantities beneath a prolapsed tear trough-orbital retaining ligament to lift and support it, without adding excess volume. A wash of CaHA subsequently thickened and improved the appearance of the overlying skin, especially the discolouration.

Disclosures

Did you receive any funding to support your research for this TOPIC?
Yes
Please specify entities (individual, company, society): Merz Asia Pacific

Were you provided with any honoraria, payment or other compensation for your work on this study?
No
Please specify entities (individual, company, society): Merz Asia Pacific

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work is presented thanks to the support of: Merz Asia Pacific

Objectives: Our study reveals the benefit of using kinesiology taping for improving the aspect of scars and reversing low grade ectropion.

Introduction: We speculated that the proprieties of the kinesiologic tapes – good adherence, elasticity, softness, non-allergenicity, could be used for relieving the tension on the skin beneath. By aplying them over the post operatory scars, their aspect should be maximally improved.
We also assumed that an appropriate application of the tape (on the temple and lateral front) might relieve the traction on the lower lid in case of a post operatory ectropion and - if the patient keeps applying the tape long enough, it might reorientate the dermal fibers, resulting in a permanent correction of the ectropion.

Materials / method: We used kinesiologic tapes as follows:
In a lot of 30 patients, aged 31 to 70, 18 males and 22 females with recent post operatory scars, we applied the kinesio tapes with maximal elongation in the middle and without any tension in the ends. We oriented the tape perpendicular to the scar, on all of its lenghts.
In another lot of 2 patients (females, 48 and 60 years) with low grade post operatory ectropion, we applied the tape on the temple and lateral front in order to relieve the traction on the scar of the lower lid and mechanically correct the ectropion.
We changed the tape every 4-7 days.

Results: The evolution of the post operatory scars was very good, with a thin, linear aspect and a soft consistency; the only incidents were contact dermatitis in 2 patients, who rapidly healed with topical steroids.
The ectropion group achieved the complete correction of the ectropion in several weeks, without any incident.

Conclusion: Though the kinesiology tapes were not intended for Plastic, Dermatological or Aesthetic surgery, our team has successfully used these tapes in providing optimal healing (both aesthetic and functional) to the post operatory scars and also in reversing low grade ectropion in the surgeries which impacted the inferior lids. The tapes were well tolerated by the patients, with minimal and rapidly reversible discomfort in 2 cases (contact dermatitis).
Based on these experiments, we consider kinesiology taping as a valuable resource not only for physiotherapy but for our profession as well.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: The aim of this study was to compare the efficacy of this standard treatment with a new technique of intensive dermal redensification performed with a large volume of HA and DRC (3 ml).

Introduction: Dermal redensification with standard volume (1ml) of hyaluronic acid (HA) plus dermorestructuring complex (DRC) and protocol of 4 consecutive sessions every 14 days has shown effective results in the treatment of chronoaged skin.

Materials / method: Patients with moderate-severe skin aging according to Wrinkle Severity Rating Scale (WSRS) were included. The face was divided in 2 symmetric areas and one side was treated with standard protocol (4 sessions every 14 days with 1ml of HA plus DRC, with 30G-12mm needle), the other one with intensive protocol (3ml per session, monthly for 2 consecutive times, with 25G-50mm cannula). Skin improvements were analysed at 12 weeks by WSRS and quantification of wrinkles ≤ 1mm and texture by high-resolution 3Dcamera. All patients underwent a self-assessment questionnaire and GAIS.

Results: 42 patients were included. At 12weeks GAIS was ≥ 2 in 73% and 65% of the subjects treated with intensive and standard protocol respectively. Patients’ perception of amelioration of their skin quality had higher scores in intensive treated side. According to WSRS, fine wrinkles ameliorated by 29% and 25% and deep wrinkles by 56% and 50% in intensively and standard treated side respectively. Intensive treatment resulted in a significant greater reduction in width (1,53±0,09mm versus 1,27±0,09, p<.001) and depth (0,46±0,11 versus 0,12±0,06, p<.001) of wrinkles ≤1mm compared to standard protocol.

Conclusion: Intensive dermal redensification showed a prolonged and greater efficacy compared with standard protocol of redensification with a decrease in number of treatment sessions.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: I define 3 main problems of such patients: 1 tendency to swelling
2 tissue gravitation and sagging, 3 ligament’s weakness and fat compartments changes

Introduction: Patient with heavy face is always complicated to treat. They don’t complain on wrinkles in general. The main demand is to lift the face. But it’s not so easy to lift. The main what can we offer to make the face to look slimmer, to remove shadows on face and make it to look younger

Materials / method: I always start to work with skin layer and fat compartments. We should be carefull in choosing way of treatment at this step because of tendency to swelling.
We have contraindications in using high hydrophylic drugs and especially cross-linked HA. For decreasing swelling I use product with succinic acid in special lymph drainage technique. It helps to activate succinate dependance receptors GPR1 in fat, normalizing microcirculation and consequently decreasing interstitial edema and make face to look smaller
The most effective treatment for such patient is threadlifting. Which helps to solve problems of sagging and reinforce ligaments. We change position of tissues and hook on own ligament structures
To reduce the shadows I use cross linked HA deep on bones to reinforce ligament structure and change projection of folds. I usually use cross linked HA for chin, cheeks for making face longer and slimmer

Results: We see significant changes in heavy faces using different ways of treatments

Conclusion: According to knowledges of aging process we choose the comprehensive approach of such kind of patients at different levels of ageing, always remembering about tendency to swelling

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: We conducted this single center, retrospective chart review to support the utility and safety of the short-pulsed 1064-nm Nd:YAG in treating previously treated and incompletely cleared capillary malformations.

Introduction: Capillary malformations (CM) include port wine stains (PWS), which are characterized by an increased number of ectatic cutaneous vessels. The pulsed-dye laser (PDL) is the standard of care for CMs and while some improvement is common, the vast majority of PWS do not completely clear and frequently recur, even in the setting of multiple PDL laser therapies. The 1064-nm Nd:YAG laser is among the available options for laser therapy and in our experience, using the short pulse high energy Nd:YAG is a useful tool for treating refractory lesions with patients' achieving meaningful results.

Materials / method: A single-center retrospective chart review was conducted of 20 patients with the diagnosis of PWS who had previously failed treatment with pulsed-dye laser therapy (up to 20 years prior). Patients underwent and average of 2-3 treatment sessions with treatment parameters as follows: 1064nm Nd:YAG, 140-170 J/cm2, 3mm spot size, and a 1 millisecond pulse duration. Two blinded dermatologists evaluated the clinical changes by comparing before and after photos of each patient.

Results: All patients were treated with the short pulse high energy 1064nm Nd:YAG laser. Significant improvement was noted in all the patient’s lesions, even years after previous treatment modalities were employed, with no adverse events reported.

Conclusion: Short pulse high energy Nd:YAG laser therapy is a not only safe but an efficacious modality when treating refractory lesions with the majority of patient’s achieving clinically meaningful results without permanent side effects.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: To evaluate our results in 80 patients with cellulite treated in a single session.

Introduction: In October 2016, I started my experience with a new procedure that represents the only FDA-cleared minimally invasive and clinically proven treatment to improve the cellulite blemishes for nearly four years in only one session.

Materials / method: We report our experience in 80 patients (78F; 2M) with cellulite treated in a single session, selected and classified with a simplified Cellulite Severity Scoring (CSS). Outcome measures included subject photographs, Cellulite Severity Scale (CSS) and Global Aesthetic Improvement Scale (GAIS) assessment. Patient’s satisfaction with a 5-point Likert scale and pain rating with Visual Analog Scale (VAS) were also recorded. The treatment takes 45-65 minutes. We have safely treated 6 to 55 sites in one session.

Results: The procedure treated successfully the primary structural cause of cellulite blemishes in all the 80 patients. Transient treatment-related adverse events were mild in severity and the most common side effects reported were soreness and bruising and no serious adverse events were reported.

Conclusion: This revolutionary FDA-cleared procedure combines a proven approach with an innovative technology to treat the primary structural cause of cellulite blemishes in posterior thighs and buttocks.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: To evaluate the results of Endolift Laser and microfocused ultrasound combined in the same session.

Introduction: We evaluate the results after 14 years of Endolift Laser technique for the “soft” rejuvenation of face and body, using a very thin optical fibre connected to a 1470nm diode laser, combined in the last years with microfocused ultrasound which allows in a single session to lift the muscles and the skin.

Materials / method: We report our experience after more than 5000 areas treated with Endolift for the treatment of skin laxity of the face and body. A 200-300 micron fiber is easily inserted, without incisions under the skin directly in the superficial hypo-derma of the face and neck; For the body we use fibers between 300 and 1000 micron. After Endolift, a microfocused ultrasound session is performed.

Results: The areas of skin laxity of the face and the body, can benefits from the possibility that the Endolift Laser has to retract the skin and remodel the derma, activate the collagen production, stimulate the neo-angiogenesis. Microfocused ultrasound helps to obtain the maximum result possible working more deeply the middle and deep hypo-derma up to the muscular fascia, permitting to obtain an immediate and a long-term lifting.

Conclusion: Endolift laser combined with microfocused ultrasound is the the best non-surgical treatment for the areas of muscular and skin laxity of the face and the body.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: To report rare side effects after hyperthermic 1060nm diode laser treatment.

Introduction: The hyperthermic 1060nm diode laser is a non-invasive laser treatment used to target and reduce fat. It is the first FDA approved hyperthermic laser for non-invasive lipolysis on the abdomen, sides of torso, back, inner and outer thighs, and under-the-chin area. 1060 nm wavelength penetrates the skin to heat subcutaneous adipocytes causing cellular disruption.
Few minimal side effects have been reported: swelling, redness, bruising, firmness, deep nodules and tenderness, which were generally transient. They can last from two to four weeks. Nodules lasting several months may occur but rarely. 

Materials / method: At the International Skin Laser Center in Paris (CLIPP), 342 patients have been treated from May 2016 to October 2018 with the hyperthermic 1060 nm laser device. Treatment protocol has consisted of two sessions of 25 minutes each, six weeks apart. Patients have been treated on the abdomen, flanks, back, inner thighs, outer thighs, front side of the thighs and submental area. Follow-up of patients have revealed 6 cases with rare unreported side effects.

Results: - Two cases of aseptic sterile abscesses of the inner part of the thigh in one patient with a history of surgery on the same leg and the back side of the arms in another patient.
 - One case of persistent subcutaneous nodules, for more than a year, on the anterior part of the left thigh in a context of liposuction. MRI has shown nodules of fibrosis.
- Three cases of hyperlipolysis of the lower anterior third of the thighs above the knees for adipose cellulite. One of the 3 patients had a history of thigh liposuction. In one case, MRI has shown hyperlipolysis without fibrosis.

Conclusion: Six patients out of 342 have developed a significant rare side effect. Five of these side effects have occurred on the thigh and in 4 of them on the anterior surface of the thighs. Three of the patients had a history of surgery in the treated area.
According to these data, we suggest not to treat the anterior thigh. Special attention should be given to patients with previous surgery on the area to be treated with the lipolytic 1060 nm diode laser.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: Microneedling has become quite popular as a method of skin rejuvenation. "Cold" non thermal devices are frequently used to introduce chemical or topical biological agents. Thermal needling, usually done with RF needling devices, can also be performed with fractional lasers, as open channels into the dermis are created.
Evidence of better uptake of these topical agents with thermal needling is both histological and clinical. The cost effectiveness of more inexpensive treatments is compared to the more expensive and more therapeutic thermal microneedling options.

Introduction: Microneedling followed by the application of chemical or biological agents has become popular over several years. Evidence shows that mechanical microneedling creates a more narrow channel that closes earlier than thermally induced dermal access ports. Viscosity can be an issue, especially with topical application of PRP. Mechanical nonthermal channels close sooner than thermal ones, so healing is more rapid and downtime is less. However, if product uptake and activation are critical, the use of a thermally mediated device may be a better choice.

Materials / method: Nonthermal microneedling was performed with topical agents including a targeted peptide, hyaluronic acid, bone marrow derived growth factor, and cadaver derived growth factors.Topical agents applied following RF or fractional laser induced needling were the same. PRP was not tested due to clear viscosity concerns.
Evaluation was performed by blinded reviewers. A mathematical formula was applied to treatment regions to see how much more improvement the thermal device added.

Results: With all devices, the more viscous growth factor mixtures showed a clinically lesser outcome. Less viscous topicals had good results, even after a single treatment with nonthermal needling. Mathematical evaluation showed improved wrinkle reduction, tone and texture in both types of applications. Thermal needling did show more measured improvement. However, the computer based measurements did not show ten times more improvement with thermal microneedling over simple mechanical needling.

Conclusion: Both nonthermal and thermal microneedling are effective in creating dermal channels for introducing topical chemical and biological preparations. The increase of uptake of these products when thermal channels are created is well known. However, the thermal devices are costly, resulting in increased charges to the patient. In practices where no laser or RF needling device is present, good results can still be obtained with traditional microneedling if the topical is not viscous.
Thermal needling does not double the subjective or mathematically measured outcome.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Introduction.
Since introduction and widespread of liposuction, one special problem developed: fat embolism, which causes most of the dead’s in this procedure worldwide.
Material and methods.
We reviewed the actual literature related to this problem and cases described.
Results.
We found the cause for the transference from third space into vascular flow, also studied the cases and found difference in fat embolism presentation, a macroscopic and microscopic fat embolism, each one with a very different clinica presentations.
Analysis.
After data evaluation we changed the clinical criteria for diagnosis and also developed prevention measures every surgeon who perform the procedure should know..
Discussion.
Any surgeon should know not only the anatomical basis for avoiding fat embolism, but also it’s different clinical presentations, how to diagnose it and more important, how to prevent it or treat if it happens.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: Overcome skin sagging either post weight loss or post liposuction. Surgeries were the best approach. Now with new skin tightening technology the "energy assisted liposuction", patients can achieve satisfactory results with minimal scarring, less recovery downtime and less complications.

Introduction: For years the only means of skin tightening was performing surgeries. Till now it is the best choice for having an extremely tight skin with perfect results. But some people are afraid of the surgeries, some don’t want scars in their bodies. So the new era of intra-operative machines started with their evolution along the years till the appearance of the newest innovation the “energy assisted liposuction”.

Materials / method: Introducing the new technology of "energy assisted liposuction" post liposuction for skin tightening. Candidates were 15 patients of different ages, body types and degree of sagging skin.

Results: The study was evaluated using the Global Aesthetic Improvement Scale (GAIS):
1 Exceptional improvement: Excellent results
2 Very improved results:Marked improvement, but not completely optimal.
3 Improved patient:Improvement of the appearance, better compared with the initial condition, but a touch-up is advised.
4 Unaltered patient: The appearance substantially remains the same
5 Worsened patient:The appearance has worsened compared with the original condition.
From the 15 patients:
1. 10 patients achieved grade 1
2. 3 patients achieved grade 2
3. 2 patients achieved grade 3

Conclusion: Patients who refuse to undergo surgeries to obtain tightened skin shifted to the minimally invasive techniques in the form laser assisted liposuction, ultrasonic assisted liposuction, radio-frequency assisted liposuction. As they are heat emitting devices sometimes at the hand of inexperienced surgeons they might cause burn or under-treatment. The energy assisted liposuction proved to be a safe, precise and cause tissue tightening by cold helium and RF, and furthermore stimulation of collagen and elastin formation. This device never burn skin, has minimal downtime recovery and overall highly

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: -Understanding the advantages & indications of volume replacement and repositioning for face and neck rejuvenation
-Discuss the different treatment modalities according to each anatomic area and indication
-Treatment planning and patient selection criteria
-Avoiding complications
-Determine good practice standards

Introduction: The face ageing process results from different mechanisms: soft tissue atrophy with volume loss in the deep compartments (bone and fat), volume displacement in the superficial layers mainly due to the loss of skin elasticity and increases compliance. The volume replacement and reposition of these compartments have been the objective of the majority of the surgical and non-surgical face rejuvenation methods. Advances in the technology and the development of better-suited treatment protocols allows an effective treatment.

Materials / method: As the ageing process is multifactorial, the use of combinations treatment modalities has the potential to offer evident improvements and good results, that should be adapted to the patient particularities and should be used only by trained medical professionals with a proper medical practice.

Conclusion: The author proposes a treatment algorithm based on the clinical findings to better address the facial ageing process, safeguarding the patient interests and safety.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: -Classify the different possible complications and distinguish from unwanted effects
-The differential diagnosis for the complications
-Discuss the different treatment modalities according to each group of complications
-Examine the different safety profiles of the most common used soft tissue fillers
-Determine the good practice standards for the use of soft tissue filler in facial rejuvenation

Introduction: Soft tissue fillers are used worldwide to treat several conditions, mostly for facial rejuvenation, to obtain an improved cosmetic appearance. Several substances have been used to replace volume, with different mechanisms of action, duration of the result and different interaction with the host. As a consequence, it can cause several types of adverse effects based on their physical and chemical properties

Materials / method: Besides, there is widespread use of soft tissue fillers by physicians with different backgrounds and training. Most of the adverse effects result from an inappropriate use due to lack of training, inappropriate techniques of injection and mostly, poor understanding of the regional anatomy. These situations can be aggravated by late diagnosis and the consequently delayed therapeutical intervention with obvious consequences, some of them permanent, to the patient.

Conclusion: Will be presenting a classification of the different problems, based on the technical details of injection and the properties of the soft tissue filler, integrating the treatment solutions for the most common problems that can be faced.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: Our objective is to present the clinical characteristics, assessment methods and management of Body Dysmorphic Disorder (BDD) in patients who visit our everyday aesthetic practice. Ethical considerations in the management of BDD are going to be discussed too. After this lecture, treating physicians should be able to recognise BDD and manage accordingly their patients.

Introduction: Body Dysmorphic Disorder (BDD) is a common problem in aesthetic practices, yet the condition still remains under-recognised and under-diagnosed. People suffering from BDD are concerned with minimal or non-existent defects, develop social avoidance and may become housebound or even suicidal. The majority are taking a journey through different aesthetic practitioners, asking for more and more unnecessary treatments for their skin or hair and they are never content with the result.

Materials / method: An up-to-date literature review about body dysmorphic disorder and presentation of our experience in a tertiary specialist psychodermatology clinic. Discussion will also include validated assessment tools for BDD apart from therapeutic management.

Results: The prevalence of BDD in the setting of aesthetic procedures can reach 20%. The patient is preoccupied with a real or imagined defect in his/her appearance, repeatedly seeking cosmetic referral for its correction.The main areas of patient concern include face, skin, breasts, genitals and buttocks. Psychosocial co-morbidities and suicidal ideation are common. Patients often become litigious, after physician's 'failure' to treat their 'defect', and they may even threaten their practitioners.The patients should be informed that this is recognised problem and there is successful treatment.

Conclusion: The majority of patients with BDD may be driven by media pressure in a ‘celebrity’ culture, together with greater availability and popularity of cosmetic procedures. Early recognition of BDD may help to prevent progress of the disease, to improve quality of life of the patient and may even help to save the life of the patient but also the reputation and wellbeing of the practitioner. All aesthetic practitioners should be aware of the disease and should be able to recognise it, offering an holistic approach to their patients.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: This research was conducted to offer the first assessment of tissue adherence in products for minimally invasive facial rejuvenation. An additional goal of this study was to test and compare a novel macroporous, multi-stranded, barbed braid to the data collected from commercially-available products.

Introduction: There is some clinician concern over different barb designs of minimally invasive face lift products and the longevity of results provided. To date, little quantitative research has been performed to assess how different barb configurations grasp and self-adhere to tissue.

Materials / method: Two different gel substrates were used as the in vitro test model; A substrate made from 15% gelatin and a 10% gelatin mimic. A novel 8-stranded barbed braid and a knot and cone motif thread lift device were tested. Barbed PGA-PCL monofilament strands were used as controls. After insertion into the substrate, a digital spring scale was attached to the proximal monofilament of each implant. The implants were pulled with the force required to remove them from the gel. The measurement was recorded in lbs and repeated for a total of n=6 for each implant.

Results: In the 15% gel substrate, the barbed braid required significantly more force to remove from the gel than any other implant type (P =9.7x10-15). The same results were observed in the 10% gel model with the barbed braid requiring significantly more force to remove from the gel than other implants (P =4.5x10-09). Gross visual observations show that the barbed braid left a larger tunnel behind in the gel after removal compared to the knot and cone device which has a similar outer diameter.

Conclusion: The 8-stranded barbed braid required significantly more force to remove from gelatin than the knot and cone thread lift device or control devices. The barbed braid and the knot and cone device have nearly the same outer diameter, meaning that diameter is not responsible for the adherence capabilities of each device.

Disclosures

Did you receive any funding to support your research for this TOPIC?
Yes
Please specify entities (individual, company, society): Surgical Innovation Associates

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
Yes
Please specify entities (individual, company, society): Surgical Innovation Associates

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
Yes
Please specify date...: Patent Pending
and status : 2018

This work is presented thanks to the support of: Surgical Innovation Associates, Inc.

Objectives: Regenerative medicine aims to replace tissue lost due to disease trauma and aging using the body’s own systems, and cutting edge research in aesthetic medicine is already strongly linked to the regenerative medicine movement. In many other fields of medicine, the tools leveraged by aesthetic physicians (eg, calcium hydroxylapatite [CaHA], PRP, and growth factors) are helping to transform the actual architecture of tissues on a molecular and cellular level. Current regenerative medicine approaches focus on modulating 3 different tissue components: stem cells, biochemical cues, and scaffolds.

Introduction: The age of tissues is in part determined by their microenvironment; topical & injected growth factors, CaHA, platelet-rich plasma (PRP) injections, and adipose-derived stem cells are being successfully used to modulate this environment and help skin appear younger by enhancing tissue structure on a molecular and cellular level.

Materials / method: Current regenerative medicine approaches focus on modulating 3 different tissue components: stem cells, biochemical cues, and scaffolds. Although stem cells (in particular those derived from autologous fat) are showing great promise for numerous fields of medicine, the most accessible tools currently are those in the biochemical cues and scaffolds categories. When these substances are supplied exogenously to aging tissues, they can trigger important regenerative changes in the cellular microenvironment (eg, collagen and elastin stimulation, improved hydration, and thickening of the dermis).

Results: CaHA is one of the 'heros' of regenerative medicine due to the large body of scientific evidence demonstrating its effectiveness as a biostimulatory scaffold. CaHA markedly improves collagen and elastin production when injected in tissues containing fibroblasts, and the improvement in fibroblast contractile forces. Recent consensus recommendations on the use of dilute/hyperdilute CaHA underscore its versatility and for tissue restoration and how it can be used as a foundation to explore the innovative uses of CaHA alone and in combination with other techniques for tissue regeneration.

Conclusion: Aesthetic medicine has the distinction of being at the forefront of the regenerative medicine movement, with many practitioners already successfully leveraging regenerative tools in everyday practice.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: The primary objective of this study was to assess overall subject satisfaction of glabellar lines (GL) correction after 3 injection cycles of abobotulinumtoxinA (aboBoNT-A). Secondary objectives included the description of factors associated with subject satisfaction after 2 injection cycles, such as attractiveness, self-esteem, self-perceived age and desire to receive further injections.

Introduction: Hyperfunctional lines are caused by prolonged contraction of facial muscles and can lead to wrinkles, negative facial expressions or an aged appearance. BoNT-A is a potent neurotoxin that can be used to weaken muscle contraction to a therapeutic advantage. The use of BoNT-A injections to smooth GL is the leading non-surgical aesthetic facial procedure. Although the short- and long-term efficacy of aboBoNT-A injections for treating GL is well established in clinical development studies, real-world data regarding patient beliefs and attitudes following long-term aboBoNT-A treatment are limited.

Materials / method: The APPEAL study (NCT02353897) was a multicentre non-interventional, prospective, longitudinal study in subjects with moderate-to-severe GL. Subjects received 3 cycles of aboBoNT-A injections. The decision to receive aboBoNT-A must have been made prior to the decision to participate in the study. The factors associated with subject satisfaction (attractiveness, self-esteem, self-perceived age and desire to receive further injections) were assessed at 3 weeks (±7 days) after each cycle using a satisfaction questionnaire.

Results: Of 150 subjects enrolled, 91% were women (n=137) and 39% were aged 41–50 years (n=58). Across Cycle 1, 2 and 3 (n=135, 112 and 135, respectively): 96–99% were very satisfied/satisfied, 83–92% felt they looked younger, 99–100% felt the outcome looked natural, 93–96% reported improvements in self-esteem and 97–100% were happy to receive the treatment again. According to a multiple-choice question, subjects felt the injections brought them more harmony (45%), self-esteem (42%), youth (40%) and beauty (32%). No subjects were dissatisfied or thought they looked older than before treatment.

Conclusion: In real-life settings, subjects reported extremely positive experiences after injection with aboBoNT-A and the results it produced. These positive beliefs and attitudes were maintained throughout long-term treatment.

Disclosures

Did you receive any funding to support your research for this TOPIC?
Yes
Please specify entities (individual, company, society): Ipsen

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work is presented thanks to the support of: Ipsen

Objectives: The aim of this study is to explore the efficacy and safety of a topical carbon suspension combined with Q-switched YAG laser treatment (carbon peel laser).

Introduction: The interest for improving skin quality with short downtime is increasing. In detail, skin pores reduction, brightness and uniformity of the face are often required.

Materials / method: Clinical evaluation of the patient. Selection of the patient and treatment with carbon peel laser. Combination with other light sources in selected cases.
Inclusion criteria: people aged >18 years old; skin pores; patients asking for skin im-provement
Exclusion criteria: severe diseases
Treatment in single session
Measurement and analysis: standard digital photo.
Evaluation of results and satisfaction of patients.

Results: The treatment with carbon peel was effective in improving the appearance of skin pores, brightness and uniformity and able to satisfy patient expectations with no downtime. The treatment was well tolerated without significant adverse events.

Conclusion: The improvement of skin quality of the face with very short downtime can be challenging. Our protocol has shown good results and an excellent tolerability profile. Combinations with other light sources treatment can be employed. A good selection of patients is man-datory in order to achieve the best result.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Fat grafting for primary breast augmentation is growing in popularity due to its autologous properties and the combination procedure of removing unwanted fat from other areas.
The procedure is still controversial due to ongoing concerns regarding the results and safety, most notably, concerns about breast cancer risk and detection.
Through this work we try to summarize the current knowledge between the safety and the benefit of autologous fat transfer for breast augmentation.
Autologous fat transfer for breast augmentation is not yet standardized. Therefore, the results vary widely, depending on the surgeon's expertise.
The majority of reported complications are of low morbidity, and based on available data, the procedure has a good long-term safety profile. Although there is no evidence that fat grafting increases breast malignancy risk, long-term follow-up is required.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: The aim of the present study was to investigate the effects of different stabilized HA and poly-l-lactic acid-based fillers with and without subsequent additional fractional laser co-treatment on skin morphology and gene expression.

Introduction: Injection of dermal fillers is one of the most frequently performed aesthetic procedures. Hyaluronic acid (HA) fillers are commonly used due to their hygroscopic property, biocompatibility and reversibility. So far, the direct biologicals effects of dermal fillers monotherapy and combination therapy with ablative fractional CO2- or Er:YAG laser irradiation on human skin cells, especially epidermal keratinocytes and dermal fibroblasts are not completely understood.

Materials / method: Experiments were performed on human 3D full-thickness skin equivalents. Different stabilized HA and poly-l-lactic acid-based fillers were injected intradermally into the dermal equivalent of a skin model as a monotherapy and in combination with ablative fractional CO2- or Er:YAG laser irradiation. Biological effects on skin morphology (histological analysis) and gene expression (microarray analysis) were investigated at different time points (d0, d5) after treatment.

Results: Intradermal injection of the different fillers resulted in a significant enhancement of epidermal thickness. Combining HA dermal fillers with ablative fractional CO2- or Er:YAG laser irradiation enhanced this effect. Gene expression profiling revealed an upregulation of modulators of tissue remodeling (e.g. TIMP3, SERPIN E1) and collagens (COL11A1). On the other hand, we detected a downregulation of differentiation markers (e.g. FLG, LOR, KRT1) and proinflammatory cytokines (e.g. IL-36, IL-1). HA-derived products revealed a specific upregulation pattern of chemokines such as CXCL5 and CCL20.

Conclusion: This study aimed at understanding more precisely the biological effects of HA-based fillers, their combination with laser treatment and their differences to poly-l-lactic acid-based fillers. Our data show enhancing effects of dermal fillers on epidermal thickness and prove the proliferating effects of these products on epidermal cells on the molecular level. These findings clearly emphasize supporting effects of fractional ablative laser treatment on HA dermal fillers injection and suggest a combination of both treatments.

Disclosures

Did you receive any funding to support your research for this TOPIC?
Yes
Please specify entities (individual, company, society): Galderma

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work is presented thanks to the support of: Galderma

Objectives: 1. the complexity of diagnosing the causes of delayed complications of filling
2. the influence of somatic status on clinical and anamnestic data
3. identification of comorbidity with delayed complications

Introduction: Delayed complications are one of the topical themes of aesthetic medicine. The difficulty of diagnosing the causes and choosing the optimal treatment for such patients determines the urgency of the problem. An important aspect of such conditions is the burdened somatic status, which in a certain way can influence the course of the inflammatory process.

Materials / method: We have gained some experience in managing patients with delayed complications after injection techniques. During their examination, a certain tendency was revealed to the presence of certain diseases that may affect the state of the immune system, which is crucial for the selection of the optimal treatment regimen.

Results: Immunocompletion is most often inserted against the background of chronic infections of a viral and bacterial nature. With complex treatment of the main state and comorbid background, better results are achieved with longer remissions.

Conclusion: Immunocompromising against the background of chronic infections is one of the important aspects of the pathogenesis of delayed complications, which requires additional examination of patients to determine the optimal treatment strategy for patients.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: HS is a chronic inflammatory disease which is very refractory for any treatment. Typically affects axilla, buttock and groins but the area can also be affected. Hidradenitis suppurativa causes painful bumps under the skin in the hair roots near sweat glands. There is no cure, but treatments and lifestyle changes can help.

Introduction: In the affected areas typically there are scars, fistulas, inflammations, pain and exudate. HS is very painful and destroys significantly the quality of life. Standard therapy is oral antibiotics, isotretinoin, dapsone, biologist, surgery and liposuction. Unfortunately, the standard therapy doesn't t help a lot or it is followed by significant side effects. We must not forget to exclude chronic gut inflammatory diseases.

Materials / method: We want to represent a single procedure under tumescent anaesthesia with no downtime for HS. The idea is to use laser lipolysis sometimes followed by liposuction to destroy the glands and inflammation. We have used 1470 nm laser.

Results: We have treated 30 clients and a single procedure was enough for 28 clients. Only two clients had a second treatment to treat only small lesions.

Conclusion: After 10 months there was no recurrence in all clients. Laser lipolysis represent s promising treatment for HS.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: A lot of women have problems with skin tightening, especially after the birth of a child. Also, the problem with extra skin have the people who lost weight. One of the most demanding procedures for the body is the skin tightening.

Introduction: On the market, there are many devices for skin tightening and shaping. Most of them are energy based devices like optical energy, radio frequency and ultrasound. One of the most demanding procedures for the body is the skin tightening. Unfortunately, most of the devices are limited with the results because they bring the energy transepidermal.

Materials / method: To achieve better results for the body shaping and the skin tightening the energy must be delivered subdermal. Recently on the market came new device which uses plasma for the body shaping and the skin tightening. Actually, it's cold plasma based on helium. Through the tube, the helium passes where radiofrequency produce ionization to produce plasma.

Results: It's minimally invasive single procedure under tumescent anaesthesia. The plasma is delivered subdermal through a cannula. The biggest advantage of this procedure is that is safe, with a minimal downtime and the results can be compared with the surgery. We want to represent this procedure as a noninvasive abdominoplasty.

Conclusion: For the first time, we have an alternative procedure for the abdominoplasty with similar results but minimally invasive.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: The cellulite is not an esthetic disorder, it's now considered as a disease and must be cured. Almost every woman is affected, even professional models. It's not the disorder of the fat cells, it's a disorder of the connective tissue which undergoes through the degenerative process and becomes thickened and stuffed.

Introduction: Disorder of the connective tissue which undergoes through the degenerative process becomes thickened and stuffed. As a result of that process, the microcirculation is compromised. We want to represent laser lipolysis as the most effective method to fight the cellulite. Under local anaesthesia with the cannula, the degenerative tissue is destroyed and replaced with a new collagen.

Materials / method: As a solution to cure the cellulite, we use laser 1470 nm for the laser lypolisis. It is in the ambulance-based procedure under tumescent anaesthesia, only 1 session. 30 female volunteers between 27 to 65 years old were treated only once with laser 1470 nm under local anaesthesia. There was no downtime and any side effects.

Results: 90% of the volunteers are very happy with the result and 10% of them happy.

Conclusion: Laser lipolysis represents the biggest breakthrough for the cellulite with many advantages over other treatments. It's in the office-based procedure under local anaesthesia. Only one session is necessary and the results last up to 5 years.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: 1: Diagnose malar bags;
2: Choose effective method of treatment;
3: Define optimal tailored parameters of ultrasound effect.
4: Achieve the desired result.

Introduction: My office is often visited by middle aged people who complain about malar area swelling and volume expansion.
Such patients typically grow old displaying the deformation and tired face morphotype of ageing. The signs of ageing greatly vary among individuals depending on prevailing ptosis, severity of wrinkles, skin thickness and muscles tone. Bone relief of facial skeleton is of special importance, especially in the malar and mandibular region.
Pronounced cheek bones slow down the soft tissues ptosis while incomplete mandibular development can contribute to the early sagging of facial tissues.
Patients’ fatty tissue in the area of malar arch, nasolabial fold, mental and submental region get hypertrophied while deep buccal fat pads get atrophied.

Materials / method: In my personal practice I correct malar bags using Ulhtera therapy.
Ulhtera therapy applies micro-focused ultrasound with imaging system (MFU-V) for lifting and skin tightening as a result of specific action mechanism.

Results: The treated patients demonstrated significant improvements in periorbital and malar areas after the procedure. They also confirmed notable swelling reduction after sleep.

Conclusion: Application of better optimized parameters (high frequency, multiple passes, various focal depths) allowed for achieving desired effect.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: Oral supplementation with special collagen peptides combined with vitamin C, zinc, vitamin E, and biotin significantly improves skin hydration, skin elasticity, skin roughness and skin density after 12 weeks of intake.
Nutraceuticals containing special collagen peptides and other active ingredients can improve skin physiology and thus promote and support dermatological skin treatments and procedures.

Introduction: Prior studies demonstrated that the oral intake of bioactive collagen peptides induce beneficial effects on human skin structure and functioning. This placebo-controlled study was conducted to assess the impact of an oral intake of a special collagen-complex together with specific synergistically acting dermonutrients provided by a food supplement.

Materials / method: 72 subjects aged 35 years or more with healthy skin participated in this randomized, single-blind, placebo-controlled clinical trial. Subjects received either the test product with 2.5 g collagen peptides, 666 mg acerola fruit extract, 80 mg vitamin C, 3 mg zinc, 2.3 mg vitamin E, and 50 μg biotin per one drinking vial per day or a placebo. The study was registered in the German Clinical Trial Register and the ICTRP (DRKS00015664).
Effectiveness of products was measured objectively after 12 and 16 weeks (follow-up). In addition, self-perception and tolerability was surveyed.

Results: In comparison to placebo, after 12 weeks of intake the test product was significant superior in terms of improved skin hydration, skin elasticity, skin roughness and skin density. Follow up measurement 4 weeks after intake showed sustained effects in the test group. This is supported by the self-perception questionnaires that revealed favourable improvements within the test group. Both products were very well tolerated. Dermatological examinations revealed no adverse effects, i.e. no pathological skin reactions, irritancy reactions or allergic reactions.

Conclusion: This placebo-controlled study demonstrates that oral supplementation with special bioactive collagen peptides combined with other dermonutrients significantly improves skin hydration, skin elasticity, skin roughness and skin density after 12 weeks of intake. These effects could be substantially retained during the follow-up and were confirmed in the self-perception questionnaires.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No
Please specify entities (individual, company, society): QUIRIS Healthcare

Were you provided with any honoraria, payment or other compensation for your work on this study?
Yes
Please specify entities (individual, company, society): QUIRIS Healthcare

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
Yes
Please specify entities (individual, company, society): QUIRIS Healthcare

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work is presented thanks to the support of: QUIRIS Healthcare

Objectives: The aim of this study was to assess the botulinum toxin type A (BoNT-A) agents comparatively for decreased therapeutic effect.

Introduction: Published literature comparing BoNT-A agents for antibody formation, resistance, and loss of effect is lacking. IncobotulinumtoxinA is the only BoNT-A agent that has removed unnecessary proteins, leaving just the 150 kDa active component.

Materials / method: The United States Food and Drug Administration (FDA) adverse event (AE) reporting system (FAERS) database was utilized. The analysis was conducted on data between March and September 2017. BoNT-A cases were included when it was considered the “Primary Suspect” drug. The primary outcome was relative incidence of decreased therapeutic effect (DTE), defined as presence of either ‘therapeutic response decreased’ and/or ‘drug effect decreased’ being reported as an AE, divided by all cases of AEs. This relative rate methodology has been well described previously in the pharmacovigilance literature.

Results: 12,280 BoNT-A cases were included across various cosmetic and therapeutic indications. Presence of AEs involving DTE for incobotulinumtoxinA (2.2%; 15/689) was significantly lower (p < 0.0001 for both) vs onabotulinumtoxinA (11.6%; 1,247/10,733) and abobotulinumtoxinA (9.2%; 79/858). Relative incidence of DTE was significantly higher for patients on >1 year of treatment vs <1 year for onabotulinumtoxinA (19.6% [504/2,577] vs 10.1% [539/5,350]; p < 0.0001) and abobotulinumtoxinA (11.9% [36/302] vs 4.3% [11/257]; p < 0.0001), but not incobotulinumtoxinA (0.0% [0/10] vs 4.5% [13/291]; p=0.63).

Conclusion: IncobotulinumtoxinA adverse events were significantly less likely to be related to decreased therapeutic effect versus the other BoNT-A agents. Based on these preliminary findings, the decrease in BoNT-A therapeutic effect over time and resistance development warrants further study.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
Yes
Please specify entities (individual, company, society): Employee

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: Orally taken collagen peptides are believed to have a stimulatory effect on dermal extracellular matrix metabolism, resulting in positive effects on skin physiology over time. In this study, for the first time, we measured -apart from usual subjective ratings- the impact of specific collagen peptides ingestion on different parameters of skin physiology, such as cutometry, corneometry and roughness, in four different areas within one population.

Introduction: With increasing age, various factors support the decrease of the dermal extracellular matrix. Topical cosmetic treatments are well established to slow down the aging of the skin. However, in the recent years, there is an increased focus on dietary supplements with collagen peptides that are intended to improve skin condition.

Materials / method: In this randomized evaluation, 24 skin-healthy subjects (12 premenopausal and 12 postmenopausal, age 45-60 years) received once daily the test product containing 2.5 g collagen peptides, 666 mg acerola fruit extract, 80 mg vitamin C, 3 mg zinc, 2.3 mg vitamin E and 50 μg biotin for 12 weeks. Skin elasticity, skin hydration, sebum content and skin roughness were determined at lateral region of cheekbone, décolleté, forearm and dorsal region of the thigh. Furthermore, participants filled out questionnaires regarding their subjective satisfaction with product characteristics, performance and

Results: Results show a highly-significant improvement in skin elasticity after intervention: skin firmness (R0), gross elasticity (R2) and net elasticity (R5) improved significantly in all areas measured. Lipid content increased up to normal values after 4 (face) or 8 weeks (décolleté). Further significant improvements were found regarding the skin smoothness (all test regions after 4 and 8 weeks) and skin hydration (cheekbone and forearm after 4 weeks). Moreover, skin roughness was markedly reduced after intervention. Good subject ratings confirmed the objective biophysical measurements.

Conclusion: The intake of special bioactive collagen peptides shows a systemic effect on all relevant skin parameters like skin elasticity, hydration, roughness and fat content. The findings are consistent with subjective assessments. Further placebo-controlled, blinded trials are in progress to investigate the impact of oral collagen-peptides on skin appearance and physiology.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: Hyaluronic acid fillers are a popular choice for the treatment of signs of facial skin aging.

Introduction: The objective of this study was to confirm the performance and safety of a new cohesive polydensified matrix hyaluronic acid filler [(CPM®-HA20, lidocaine-free), Merz Pharmaceuticals GmbH, Frankfurt, Germany] for the treatment of signs of facial skin aging by use of biophysical measurements, as well as subject and investigator satisfaction.

Materials / method: Twenty-five healthy female subjects with signs of facial skin aging were enrolled in the study, and received injections at day 0, week 4, and week 8 of up to 20 micropuncture treatments of 50 µl CPM-HA20. Biophysical assessments were conducted to measure viscoelastic properties of the skin, skin surface roughness, skin elasticity, skin tone and radiance, and skin hydration, at baseline and at all follow up visits up to 36 weeks. Data were also collected for subject safety, and subject and investigator satisfaction.

Results: CPM-HA20 significantly increased skin elasticity (at weeks 9 and 12), skin tone and radiance (both up to 36 weeks), and skin hydration. Significant reduction of skin fatigue (up to 9 weeks), skin roughness (up to 28 weeks), and redness (up to 36 weeks) were also observed. Subjects and blinded investigators were highly satisfied with the treatment outcomes. Moreover, the study data confirmed the good safety profile of the CPM-HA20 filler.

Conclusion: CPM-HA20 is considered to be an effective and safe HA filler for skin revitalization.

Disclosures

Did you receive any funding to support your research for this TOPIC?
Yes
Please specify entities (individual, company, society): Merz Pharmaceuticals GmbH

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work is presented thanks to the support of: Merz Pharmaceuticals GmbH

Objectives: Autolougs conditioned serum (ACS) is a cell-free serum with an increased concentration of anti-inflammatory cytokines and growth factors designed to counteract skin's own inflammatory and aging processes by stimulating neocollagenesis. In this study, the effects of ACS were investigated by biophysical measurements, patient questionnaires and in vitro on human dermal fibroblasts.

Introduction: Extrinsic as well as intrinsic skin aging is related to reduced skin elasticity and a visible increase in wrinkles. Due to decreased activity of dermal fibroblasts collagen neosynthesis is reduced being responsible for the gradual decrease in skin firmness and elasticity.To compensate these deficiencies regenerative treatment procedures adressing fibroblast activity could be of interest.

Materials / method: After four facial treatments with ACS microinjections patients were followed up for 24 weeks. Biophysical measurements were performed on all visits to objectify skin elasticity and skin hydration. Clinical effects were evaluated through Global Aesthetic Improvement Scale by patients themeselves. In vitro, human dermal fibroblasts were incubated with 10% fetal bovine serum (FBS) and cultured to 70-80% confluency. FBS was replaced by ACS to analyze cell viability, procollagen type 1 and TGF-β1 after 2, 6 and 24 h incubation. Incubation with FBS was used as a control group.

Results: Skin hydration did not change significantly throughout the observation period, while skin firmness and net elasticity improved significantly. Patient satisfaction increased from 33% at week 12 to 40% at week 24. Cell vitality increased equally when incubated with ACS. TGF-ß1 was detected only in the samples incubated with ACS, but not in the control group. The highest concentration was found in the sample of a 61-year-old. In the supernatant procollagen type 1 concentration increased with incubation time.

Conclusion: Microinjections with ACS significantly improve viscoelastic properties of the skin. This might be caused by an increase in the activity of dermal fibroblasts as suggested by an increased cell viability, synthesis of TGF-β1 and procollagen after stimulation of human dermal fibroblasts with ACS in vitro in contrast to the control group. Therefore, ACS treatment seems to be an effective autologous approach using skin`s own repair mechanisms to increase skin elasticity and to reverse dermal aging signs.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: To suggest a new technique with some new injection points for a sleeker & contoured appearance of face without volumising it.

Introduction: Although some aspects of facial beauty are universal, aesthetic preferences also vary among ethnic groups as cosmetic concerns differ according to variations in facial bony anatomy, morphology, both in the relatively young & during aging. M.D codes definitely guide the physicians for various injecting points, nonetheless, they need to be tailored as per individual requirements.The structural & morphological features specific to the Indian face & differences from Western Asian populations in skin & soft-tissue aging, necessitate well defined aesthetic treatmment strategies for Indians.

Materials / method: 90 patients within the age range of 21- 45 years were enrolled for the study. All these patients had no history of any prior aesthetic procedures performed on their face.
Total 2 ml of hyaluronic acid based dermal was used, 1 ml being injected on each side. Points on lateral parts on the face were chosen for injection. Total of 0.4 ml was injected in multiple bolus on the forehead along the hairline.
0.2 ml each side, was injected at temporal fusion line. 0.2 ml on CK1 (MD codes) of each cheek. 0.2 ml on Jw1 point ( MD codes) each side & 0.2 ml on mastoid process each side.

Results: Photographs were taken as per global standardised photography & standardized light settings. In all patients, Faces started appearing slimmer and tighter and facial features looked more defined. Their faces now had a smooth ogee curve & did not appeared to be bulky at al, which is a very common problem in Indian patients otherwise. Patients were for followed-up at 1, 3 & 6 months. No aesthetic procedure were performed for 10 months minimum as patient were very satisfied with the results.

Conclusion: In Indians there is a presence of excess soft tissue in the medial part of the face means that restoration of age associated volume deficit is mostly required in the lateral part of the midface. A structurally smaller midface & relatively excess tissue in medial cheek further necessitates that fillers be used in peripheral facial zones to achieve lift & conservatively in the medial zones to avoid adding bulk here.Hence, by injecting on peripheral points including points on forehead & behind ear, provides a remarkably tightened & chiseled appearance of face without adding further volume to it

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: To study the outcome of oral ranitidine in pediatric age group patients.

Introduction: Molluscum contagiosum (MC) is a common and self-limiting viral infection of the skin and mucous membrane, caused by molluscipox virus gene of the poxvirus family. Clinically it appears as small bump on the skin & primarily affects children. It is usually asymptomatic but can present with pain, pruritus, erythema and bacterial superinfection. In children, treatment options are very limited as extraction & TCA, KOH application is not feasible easily. Since it is contagious & can affect family members, it requires to be treated well.

Materials / method: We conducted this study on 100 pediatric age group patients ( less than 12 years of age). Patients were prescribed oral ranitidine in the dose of 5mg/kg twice a day for one month as a stand alone therapy. Global photography was performed under standardised light settings at baseline, & were followed up at a duration of 1 month, 2 months & 3 months. Objective Assessments were performed by 2 neutral dermatologists & Subjective Assessment was performed with the help of self assessment questionnaire filled by the patients and their parents.

Results: Grading in improvement was measured both quantitatively & qualitatively by decrease in number as well as dimension of lesions. There was an "excellent", "good" & "fair" improvement in 32%, 62%, 6% cases on Objective Assessment. Similarly, Subjective Assessment also showed an "excellent", "good" & "fair" improvement in 30%, 55%, 15% patients respectively. None of the cases showed "no improvement" at all. Patients were followed up for a duration of 3 months. 2 % patient showed recurrence at the site of lesion. None of the patients had any adverse effect during the entire course of treatment

Conclusion: To the best of our knowledge this regime of using oral ranitidine has been used first time anywhere & has yielded remarkable results in pediatric age group patients & has hardly shown any recurrence amongst them. The therapeutic effect is appreciable especially because in pediatric age group. the other modalities like tricholoroacetic application, potassium hydroxide application, cryotherapy, cautery are not feasible as easily as in adults. Children very easily consume ranitidine tablets/ syrup forms & it gives an advantage of compliance over other modalities.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: To study the use of Cogged threads for non surgical body contouring

Introduction: Body Contouring has seen exponential growth in last few years. Off late surgical methods for stubborn fat spot reduction have been replaced by non surgical modalities like energy based devices, deoxycholic acid etc. However, despite losing fat volume, skin sagginess remains as a prime concern in significant number of patients after spot reduction. To address this concern, cogged threads for body contouring could be a great option which could provide significantly improved results without any downtime.

Materials / method: 80 patients suffering from skin sagginess with various indications like 1) loose abdominal skin, 2) bat wings( loose arms) 3) loose inner thighs 4) drooping breasts were enrolled in the study. Patients with keloidal tendencies, underlying infections like herpes, uncontrolled diabetes, pregnant/lactating females were excluded from the study. Pre procedural photographs, post procedure photographs immediately, 30 days and 90 days were taken at same light settings as per global photography. Qualitative Analysis was performed both objectively & subjectively

Results: On objective basis, 80%, 15% & 5% patients found their results to be good,satisfactory & not satisfactory.
On subjective basis 75%, 15% &10% patients found their results to be good,satisfactory & not satisfactory.

Conclusion: Thread lift could be exceptionally good option for patients suffering with mild to moderate skin sagging & who are not willing for surgical modalities like abdominoplasty, thigh lift, breast lift etc. Also it provides significant improvement in skin tightening in cases where fat loss has already been occured surgically/ non surgically causing skin sagginess. Thus, it is a good option for body contouring for skin tightening which requires a single session to show good results.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

The purpose of this case is to share a unique case of a patient with Goltz syndrome who developed multiple basal cell carcinomas only within the sites of blashkoid linear, atrophic plaques.

24-year-old male with history of basal cell carcinoma (BCC) on the right nasal bridge status post Mohs Micrographic Surgery (MSS) complicated by recurrence presented for consultation. At this visit, multiple new lesions were biopsied and came back as BCC. His medical history included right sided coloboma, extensive atrophic erythematous patches on right nasal sidewall, right hand, and right lower extremity, premature closure of the growth plate in the right leg, and history of polydactyly of right foot. He was previously told that he may have Goltz syndrome, and was seen by a geneticist at outside hospital but no specific genetic defect was determined. He had no family history of skin cancers.

A full body skin exam was significant for a blashkoid linear, atrophic, erythematous patch on the right dorsal hand extending to the ventral wrist. A pink pearly papule was noted on the base of the fifth finger. There were linearly arranged pits on the right palm. On the right medial ankle there was a blashkoid linear erythematous, atrophic plaque extending to plantar surface of the foot.

Subsequently, given the location of the tumors and history of multiple BCCs in a young patient, MSS was recommended and all the BCCs were excised. Patient was also referred to Genetics and blood was sent for PORCN gene mutation.

In Goltz syndrome, PORCN gene mutation leads to downregulation of Wnt signaling leading to downregulation of ß-catenin. Therefore, theoretically, patients should have a lower risk of developing BCCs, unlike our patient . We hypothesize that there may be an unidentified aberrant signaling of the Wnt pathway, or activation of Hedgehog (HH) signaling within the areas of focal dermal hypoplasia leading to tumor formation.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: We present a clinical case of severe and distressing facial post-inflammatory hyperpigmentation treated effectively with oral and topical combination therapy.

Introduction: Post-inflammatory hyperpigmention is a common adverse event of chemical peeling, which may have a significant impact on the quality of life. Treatment is often difficult and prolonged.
Materials / method: A 40-year old female with Fitzpatrick skin type III and epidermal centrofacial melasma was treated with 25% TCA superficial chemical peel. Subsequently she was referred to our hospital with severe post-inflammatory hyperpigmentation occurred mainly on the forehead. The patient was treated with oral tranexamic acid (250mg twice daily) and a topical serum containing 4-butylresorcinol (applied twice daily) for 3 months. Additionally, a combination of 20% mandelic acid and 10% citric acid peel followed by 35% glycolic acid peel (4 sessions at 3-week intervals) was performed.

Results: Treatment resulted in complete resolution of post-inflammatory hyperpigmentation after 3 months.

Conclusion: Tranexamic acid inhibits plasminogen/plasmin pathway resulting in inhibition of melanin synthesis. Screening for risk factors of thrombosis is necessary before initiating treatment. 4-butylresorcinol is a resorcinol derivative. It inhibits both tyrosinase and tyrosinase-related protein-1. Although chemical peel (especially TCA) may be associated with post-inflammatory hyperpigmentation, superficial chemical peels are used for the treatment of melasma or post-inflammatory hyperpigmentation. As in our case, combination therapies exploit the chances for better efficacy and decreased side effects.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: This abstract is coming to show a combination of Profhilo and energy based device protocol for skin and tissue improvement superior to a stand alone treatment

Introduction: During the aging process, skin physiology undergoes several changes which eventually slow down metabolic processes and normal cellular activities, a process called chrono-aging. One of the first skin aging phenomena is skin laxity (loss of elasticity), which first begins as early as the age of 35, though not becoming evident until later. Laxity is strictly related to a reduction in the production of collagen and elastin and associated with alterations of the extracellular matrix, particularly with a decrease in hyaluronic acid (HA) concentration.

Materials / method: The convential treatment with profhilo is based on A 2 mL of the product to be injected in the subcutaneous layer of the right and left malar/submalar areas. Five injection sites for each side (the BAP technique), Two sessions to be performed, once a month, for 2 months.
parallel to the HA part the patient receive 6 treatments of Clear lift

Results: By using a protocol that combines the two tools for skin tightening, elasticity and tissue improvement, one can give his patient a more string, natural and longer lasting effect, actually treating the process of aging of the skin and underline tissue and not only the results of the process.

Conclusion: The protocol involves a precise plan of treatments combining Profhilo and Clear Lift in order to give safe and better results than when using each tool alone.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: Discussing the need for standardized 2D&3D imaging in consultation process
Reviewing potential benefits for both patients and physicians
Underlining physician concerns
Sharing the impact of adding 2D&3D imaging on a cosmetic dermatology clinic consultation process
Discussing potential consequences on the clinical practice and industry

Introduction: With increasing demand for anti-aging procedures, consultation process by physicians is evolving. It’s becoming more objective and personalized.
It is crucial to clearly understand the expectations of the patient at the beginning of the consultation. It is also the “moment” we communicate with her/him that obtaining and maintaining results is not a “one shot treatment”, it is rather a “journey”. The emerging aspect that connects these two is the advanced imaging techniques supporting expert judgement.

Materials / method: 2&3D images provide objective data on the skin quality, volume deficits and sagging.
Potential benefits (patient):
Improved understanding of the aging process and their current condition
Adjusting expectations realistically based on expert opinion and objective data
Improved trust to physician
Potential benefits (physician):
Facilitating communication with the patients during the “journey” and documentation for legal purposes
Increased ratio of consultation conversion to procedures
Increased # of combined procedures.
Potential physician concerns:
Investment
Space&time need
Underachieving

Results: Results of the inclusion of 2D&3D imaging in my initial consultation process in six month period are:
• Increased patient satisfaction.
• Increased number of first-time consultations by more than 30 %.
• Increased ratio of consultations converted to procedures more than 40%.
• What is more, discussing patient specific data compared with a database smoothened the communication with patients.

Conclusion: Advanced Imaging: Friend or Foe?
• Motivates the physician to perform even better.
• Motivates physicians for combined procedures in order to provide more significant results.
• Discourages the use of materials/devices which effectiveness cannot be shown repeatedly. This aspect may have consequences on the industry over time.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: To examine the clinical response characteristics of abobotulinumtoxinA (aboBoNT-A) in aesthetic clinical trials.

Introduction: AbobotulinumtoxinA is approved in many countries for aesthetic treatment of glabellar lines, caused by procerus and corrugator supercilii muscle activity. Clinical response characteristics (e.g. onset and duration of effect) are known to be important for patient satisfaction with treatment.

Materials / method: We assessed available clinical evidence on duration of response from repeat cycle aboBoNT-A clinical studies in aesthetic indications (glabellar lines and other wrinkles of the upper face), including 2 Phase 3, open-label, studies and 2 routine practice, observational studies. We also investigated data from recent non-clinical investigations into characteristics of BoNT-A products to investigate why differences in duration may be observed.

Results: Data from the Phase 3 trials show that patients treated with aboBoNT-A had a median duration of effect between 88 & 116 days (up to 336 days) when assessed by the investigator and between 84 & 94 days when assessed by the patient. In the observational studies, median duration was between 5.0 & 6.5 months & was relatively constant between cycles. Treatment satisfaction was high (96-100%) across the studies. Non-clinical research found similar molecular activity of BoNT-A products, but more active BoNT-A in aboBoNT-A at total recommended doses (glabellar lines) than onaBoNT-A or incoBoNT-A.

Conclusion: AboBoNT-A offers patients a long duration of response for sustained aesthetic outcomes associated with high rates of patient satisfaction. We hypothesise that the greater amount of active BoNT-A in aboBoNT-A compared with other products may be an important factor to explain the clinically observed long duration of response. The clinical evidence is further supported by a number of head-to-head clinical studies that show a longer duration of response with aboBoNT-A than comparator BoNT-A products.

Disclosures

Did you receive any funding to support your research for this TOPIC?
Yes
Please specify entities (individual, company, society): Ipsen

Were you provided with any honoraria, payment or other compensation for your work on this study?
Yes
Please specify entities (individual, company, society): Ipsen

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
Yes
Please specify entities (individual, company, society): Ipsen

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work is presented thanks to the support of: Ipsen

Objectives: The aim of this systematic review was to analyse current literature on time to onset and duration of effect of aboBoNT-A for aesthetic purposes across published studies.

Introduction: AbobotulinumtoxinA (aboBoNT-A) is a botulinum neurotoxin A (BoNT-A) approved for aesthetic use in treatment of glabellar lines (GL). Current dosing guidelines recommended a minimum treatment interval of 12 weeks; however, aboBoNT-A efficacy in GL has been shown to extend to 4–5 months in several double blind, randomized, placebo controlled studies. After multiple injection cycles, duration of response was up to 6 months for some subjects. As far as onset, aboBoNT A is reported to have a median time to onset of action of 2–3 days, with some patients responding within 1 day.

Materials / method: A systematic review of literature databases (PubMed/MEDLINE, Embase, Cochrane Library, Google Scholar) was conducted to identify English-language publications. The search was structured to deliver results relevant to: population (patients with aesthetic indications [including GL and wrinkles]); interventions (aboBoNT-A); comparators (no restrictions [nothing, placebo, other medications, usual standard of care]); outcomes (efficacy, including onset of action and duration of effect); settings (clinical). Structured data extraction was used to enable inter-study analysis.

Results: Of 280 papers (reviews included), 44 original research papers were relevant to aboBoNT-A onset and duration. Of those assessing efficacy within 1 week (n=21), onset was observed at first assessment: day 1 (n=6 studies), days 2–4 (n=9), within 7 days (n=6). Significant efficacy vs. placebo was observed at 4 months in all studies evaluating this timepoint (n=4/7). In BoNT-A comparator studies, aboBoNT-A had a longer duration (up to 5 months) in 4/16 studies (methodologies may differ). In non-comparator studies, efficacy was observed at ≥4 months in 11/19 studies and at 6 months in 7/19 studies.

Conclusion: Most studies report a rapid onset of action with aboBoNT-A (<4 days) and consistently showed a long duration of action (>4 months). Although the aboBoNT-A product label recommends at least 12 weeks between injections, the duration of efficacy appears to be longer.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work is presented thanks to the support of: Ipsen

Objectives: The major stake of avoiding nutritional deficiencies:
Even before the bariatric surgical operation, people with morbid obesity frequently suffer from nutritional deficiencies, notably in fat-soluble vitamins, folate and zinc. But these deficiencies usually worsen after operation, when this one is done according to the gastric bypass or the sleeve gastrectomy techniques. Other deficiencies also appear. It is due to reduced nutritional intakes as well as a malabsorption of B12, B6 and B1 vitamins – source of very serious neurological manifestation: polyneuritis, encephalopathy –

Introduction: and others in the gastric reduction technique and a malabsorption in interventions such as bypass.
Protein malnutrition, very serious and hard to rectify anaemia due to important iron deficiency, A, D and C vitamin deficiencies, diverse ions, zinc, magnesium, calcium and selenium insufficiencies… These nutritional deficiencies have a consequence that is being tackled increasingly sharply: the post-surgery complications. They indeed impact the rate of complications in plastic, aesthetic and post-bariatric surgeries, as attested by many studies. However, none of these has correlated those rate

Materials / method: of complications with the technique being used for surgery, strictly speaking. According to the scientific literature, patients who have been operated for a bariatric surgery, whether this is done with the sleeve gastrectomy technique or the gastric bypass one, show a highly increased risk of wall complication, compared to patients who underwent a classical surgery, this despite a nutritional supplementation and, hence, normalization of their nutritional markers. an author even noterecently the insufficiency of renutrition traditional measurements for these bariatric patients

Results: in perioperative surgery (1), with more complex post-operational effects regarding trophic troubles (hematomas, bleedings, scars disunity, seepages, cutaneous necrosis, imperfect healings, incomplete vascularisation, infectious episodes etc.)
There are not many scientific publications but they all converge towards a relationship between malnutrition and poor healing. Indeed, as much for the scarring process that for the immune system, sufficient rates in terms of proteins, A C vitamins, arginine, glutamine, zinc and selenium seem to be essential (2). For its part,

Conclusion: The LeGoff technique does not induce any deficiency due to its specific surgical montage of band Gastroplasty with partial stomach plication (GP), creating a significant advantage. This is why, in the absence of any type deficiencies , nutritional trouble, by the absence of a life-long binding supplementation required in bariatric surgery techniques such as sleeve and bypass – by a sustainable slimming , by the decrease of complications and by the healing quality, the GP establishes as a technique of choice for plastic, post-bariatric aesthetic surgery.(method , results of GP presented)

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: The lecture will describe an innovative procedure that combine non surgical lifting of the periocular area & the lower face with a lipolysis effect to get a perfect contouring of the lower face. The study aimed to evaluate the clinical improvement & safety of the combination of Internal real time thermosensing Radiofrequency & External Plasma Ablative Radiofrequency to produce skin contraction & lipolysis in the lower peri-orbital area, lower face & upper neck.

Introduction: Non ablative Radiofrequency has been for many years the only method for producing skin tightening. Nevertheless, the results weren’t always significant when the area treated has also fat excess as the upper neck (double chin), the lower peri-orbital area and the jawline. A new device combining an internal Thermosensing Monopolar Radiofrequency & an external Ablative Radiofrequency with plasma effect was tested to get immediate skin tightening & lipolysis.

Materials / method: 10 patients aged from 42 to 70 years were treated. 3 of them for lower eyelids, 6 of them for lower face lifting and neck skin laxity, and 1 patient was treated for moderate double chin. A local Anestesia was performed at the entry point of the thermal cannula while a simple topical anestesia was performed prior to the external plasma radiofrequency. Standarized digital photographs were obtained preoperatively, after few days, a few weeks and up to 6 months. Safety profiles were also misured at each session. Only the cases of eyes bag and neck skin laxity were treated with combined Treatment

Results: The results showed favorable improvement in the skin laxity & fat deposition. Both investigators’ evaluations & patients’ evaluation showed significant improvement between 12 & 24 weeks. No side effects such infection or burn were observed. The use of the plasma external radiofrequency leaved an epidermal crust (epidermal brown spot with a diameter of 1 millimetre each) which fell spontaneously after 5 days. A skin redness was observed after the external plasma radiofrequency lasting maximum 1 week.

Conclusion: Immediate skin contraction persisting through the immediate intermediate and long-term follow up was found in the vast majority of patients in this study.
The combination of an internal real-time thermosensing monopolar Radiofrequency with external ablative plasma radiofrequency is a very safe & innovative procedure which might become one of the popular treatment option for face lifting & contouring because of the combined effect of new collagen deposition, skin tightening & soft lipolysis due to the radiofrequency heat effects (movement of charge particles within the tissues).

Disclosures

Did you receive any funding to support your research for this TOPIC?
Yes
Please specify entities (individual, company, society): Technolux Company

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
Yes
Please specify entities (individual, company, society): Technolux Company

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work is presented thanks to the support of: Technolux

Objectives: To describe the combination of two procedures performed in the same day to treat corporal skin sagging.

Introduction: There is a current tendency to associate distinct procedures in order to optimize the results and safety of facial treatments. However, literature is still scarse in evaluating combined corporal procedures. Complaints of flaccidity and localized fat have increased in dermatology clinic, either due to improvement of social midia and networking, or to the development of new treatments. Such procedures may be often performed on the same day, improving patient compliance.

Materials / method: We describe two cases in which the combination of macro and microfocus ultrasound (HIFU) and injectable Poly-L-Lactic Acid (PLLA) was performed in the same visit to treat skin sagging , with excelente results. Both patients were female, and treated areas were abdomen in one patient and arms in the other. Sagging was secondary to pos gestation and weight loss, respectively.

Results: Both patients reported excellent improvement of skin sagging three months after the treatment, and so demonstrated photographic evaluation.

Conclusion: PLLA is a synthetic lactic acid polymer which stimulates skin production and deposition of collagen I and III. On the other hand, the wave sounds emited by macro-microfocus ultrasound lead to lipolysis by mechanical and thermal mechanisms, and also promote collagen remodeling. Because they have different mechanisms of action and do not overlap, the association of both techniques proved to be favorable, safe and with additional benefit in the treatment of flaccidity with and without localized fat.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: This study was conducted in order to evaluate the following purposes:
1: To assess the effectiveness and safety of using a 595-nm PDL to treat Iranian pediatric PWS patients.
2: To identify possible factors related to the response rate and the
the ideal number of required sessions.

Introduction: Port wine stain (PWS) is a congenital vascular malformation, which is visible at the birth as red patches, mostly on the face and neck. No optimal treatment modality has been introduced for this malformation yet and just a few studies have shown good efficacy and safety profile of 595-nm pulsed dye laser (PDL) in PWS of children. PDL has not been shown to be an ideal treatment for PWS because complete clearance occurs in less than 30% of patients and adverse effects such as redness, swelling, bruising, purpura, hyper, and hypopigmentation, as well as ocular risks, have been reported.

Materials / method: This was a prospective study to assess the efficacy and safety profile of pediatrics PWS treated with 595-nm PDL. Demographic data, past medical history, previous treatments and phenotypic characteristics of the lesions were recorded. The laser was applied with 4-6 weeks’ intervals and a photograph of the lesion was taken at the baseline and two months after the last session. The response rate was evaluated on the basis of the Investigator Global Assessment (IGA) which was graded by 2 dermatologists comparing the photos and Patient Global Assessment (PGA) graded by the patients’ parents.

Results: Twenty-seven patients, consist of 10 males and 17 females with the mean age was 5.7±2.8 (range 1-13) years old were included.
Fourteen (51.8%) of patients achieved a higher than 75% of improvement; nine (33.3%) patients experienced 50%-75% improvement, four (14.8%) patients experienced a less than 50% improvement.
Children with V1 segment involvement showed a significantly better improvement than the other segments, while the lowest mean improvement was for those with the involvement of only V2 segment.
The most rate of clearance was seen within 4-5 sessions of treatment.

Conclusion: Pulse dye laser seems to be relatively effective and safe modality but not perfect for the treatment of Iranian pediatric PWS patients with Fitzpatrick skin types III and IV.
We also found that V1 involvement and a marked improvement PWS within the first five sessions are the good prognostic factors of the treatment of PWS with PDL

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: 1) To evaluate the efficacy of topical Sirolimus as adjuvant therapy for Pulsed dye laser (PDL) in the treatment of Port-Wine stain (PWS).
2) To evaluate the safety profile of topical Sirolimus as adjuvant therapy for Pulsed dye laser (PDL) in the treatment of Port-Wine stain (PWS).

Introduction: Port wine stain (PWS) is a congenital capillary malformation often appears as a single lesion in the head and neck region. Treatment with the pulsed dye laser (PDL) (585-595 nm wavelength) is the standard method of choice, although it seldom results in complete clearance of the lesion. Vascular endothelial growth factor (VEGF) and hypoxia-inducible factor 1-alpha (HIF-1a) angiogenesis pathways can restrict the effect of PDL in the treatment of PWS. Topical Sirolimus, which is a known angiogenesis inhibitor can theoretically be a proper adjuvant treatment for PDL in the treatment of PWS.

Materials / method: In this randomized clinical trial conducted in Razi hospital, Tehran, Iran, 15 patients with PWS were enrolled. They randomized to receive either PDL laser plus sirolimus 0.2% versus PDL laser plus placebo in each side of the lesion and result after 2, 4, and 6 months were compared across the sides. The assessments of outcomes were done by using high-resolution full face photography device for colorimetric assessment. The changes in the lesion color alterations were analyzed within consecutive photographs with the mentioned colorimetric device.
Clinical trail code: IRCT26398

Results: According to the colorimetric device analysis, the results in the treatment and placebo side showed no significant difference (P > 0.05). However, according to the patient global assessment (PGA)(P=0.041) and the Investigator global assessment (IGA) (P=0.039), there was a significant difference between sirolimus and placebo. Itching and dryness (86.7%) and blister/erosion/crust (13.3%), and allergic contact dermatitis (20%) were the detected adverse effects in topical sirolimus group. There were no adverse effects registered due to placebo.

Conclusion: Despite better improvement within IGA and PGA assessment in sirolimus group, there was no significant difference in colorimetry device between placebo and sirolimus.
In sum, topical sirolimus 0.2 % as an adjuvant to PDL treatment doesn’t appear to improve PWS erythema. However, considering the significantly better PGA and IGA score in the treatment area, we can contemplate that it can improve the appearance of PWS by modifying other factors than erythema.

Disclosures

Did you receive any funding to support your research for this TOPIC?
Yes
Please specify entities (individual, company, society): The drug (Sirolimus) was supported by Behestan Darou company which is the representative of Pfizer company in Iran.

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives:
Melanin quantification of a non-hydroquinone (HQ), multi-action skin tone corrector (ETCS) using a 3D reconstructed skin model. Evaluation of efficacy and tolerability of ETCS alone and in combination with a retinoid/alpha hydroxy acid cream (AHA-Ret) in subjects with mild to severe dyschromia.
Introduction:
Dyschromia caused by photodamage is a common cosmetic concern and often a chief complaint reported to dermatologists by women. Facial hyperpigmentation can have a substantial negative psychosocial impact on self-esteem and quality of life and is challenging to treat. A new, non-hydroquinone, multi-action skin tone correcting cream (ETCS) has been developed to comprehensively inhibit melanin production throughout the cell signaling pathways that affect skin pigmentation without the accompanying adverse effects of melanocyte toxicity.
Materials / method:
In vitro testing of a 3D skin model comprised of human-derived melanocytes were treated for 14 days with 10µL and 2µL of ETCS, or 2µL of 4% HQ with water serving as negative control (NC). A clinical trial assessed twice-daily use of ETCS and ETCS + AHA-Ret (PM only) in subjects with mild to severe Dyschromia. Digital images were obtained and assessed for visible improvements for a variety of qualitative skin parameters at baseline, 4, 8, and 12 weeks. Melanin Index (Mexameter®) and self-assessments were also compiled. A 4-week extension study evaluated use over 16-weeks.
Results:
ETCS inhibited melanin production by 55% and 22% vs. NC (10µL and 2µL; p<0.05); while 4% HQ had 17% inhibition (p<0.05). Mean percent reductions from baseline occurred in Dyschromia for ETCS (n=42) and ETCS + AHA-Ret (n=10) at every timepoint over 12 weeks (p<0.0001, for each). Significant mean Melanin Index reductions occurred in both groups at every timepoint (ETCS: p<0.0001; ETCS + AHA-Ret: p<0.02, 4 weeks; p<0.0001, 8, 12 and 16 weeks). Substantial visible improvements occurred for all categories. Mild, transient AEs were reported.
Conclusion:
ETCS significantly reduced melanin content in a 3D skin model and reductions were numerically greater than 4% HQ (2µL). Use of ETCS led to early, significant reductions in Dyschromia and Melanin Index; the addition of AHA-Ret demonstrated enhanced reductions. ETCS effectively reduced hyperpigmentation, improved overall appearance of skin, and was highly tolerable in subjects with mild to severe dyschromia.

Disclosures

Did you receive any funding to support your research for this TOPIC?
Yes
Please specify entities (individual, company, society): SkinBetter Science study sponsor

Were you provided with any honoraria, payment or other compensation for your work on this study?
Yes
Please specify entities (individual, company, society): SkinBetter Science paid consultant

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work is presented thanks to the support of: SkinBetter Science

Objectives:
To determine the protective effect of an topical antioxidant formulation in protecting a human skin model from the effects of O3.
Introduction: Ozone (O3) is a known source of oxidative stress owing to its effect on lipid peroxidation. This study examined the ability of a comprehensive topical antioxidant serum containing water-soluble, enzymatic and lipid-soluble antioxidants (WEL-DS) to protect skin against O3-mediated damage in a 3D reconstructed human epidermal skin model.
Materials / method:
Utilizing a 3D human skin model, tissues from 4 separate groups (N=6, each) were evaluated: Group 1, untreated and unexposed; Group 2, untreated and exposed to O3 for 4 hours; Group 3, pretreated and unexposed; Group 4, pretreated and exposed to O3. Pretreated tissues were topically treated with 20uL of WEL-DS and incubated for up to 20 hours. All tissues, except Group 1, were then exposed to 0.4 ppm of O3. All samples were evaluated after 24 hours for Reactive Oxygen Species (ROS), hydrogen peroxide (H2O2) production, 4-HNE protein adducts, NFkB response and morphology.
Results:
Pretreatment with WEL-DS prevented ROS formation and H2O2 production in tissues exposed to O3 vs. untreated exposed tissues (p<0.05). Oxidative stress induction in tissues exposed to O3 was confirmed by increased levels of 4-HNE protein adducts, a marker of lipid peroxidation and oxidative stress. Application of WEL-DS prevented this effect in the skin model. WEL-DS prevented tissue damage in pretreated tissues exposed to O3 with no significant changes in epidermal structure. Pretreatment with WEL-DS decreased NFkB transcription factor signal.
Conclusion:
In a reconstructed human epidermal skin model, topical application of WEL-DS, a comprehensive topical antioxidant serum containing water-soluble, enzymatic, and lipid-soluble antioxidants, significantly diminished induction of ozone-induced oxidative damage. This finding suggests that WEL-DS would provide efficient protection against daily pollutant exposure.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
Yes
Please specify entities (individual, company, society): SkinBetter Science paid consultant

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work is presented thanks to the support of: SkinBetter Science

Objectives: We sought to evaluate the expression level of Transient Receptor Potential Vanilloids (TRPVs) in the skin of patients with pigmented contact dermatitis (PCD) aiming at identifying crucial receptors related to inflammation-associated melanogenesis.
Introduction: Pigmented contact dermatitis (PCD) is a skin disorder caused by inflammation-related hyperpigmentation. Little is known of the pathogenesis of PCD, making its treatment quite challenging. Patients with PCD often report pruritus and burning sensation on affected areas. These clinical features suggest the possible role of transient receptor potential vanilloid (TRPV) channels in the pathogenesis of PCD as these calcium-modulating channels participate in diverse processes such as neurogenic inflammation, perception of pain and itch, and even cutaneous melanogenesis.
Materials / method: Immunohistochemical analysis was performed to evaluate cutaneous expression of TRPVs in PCD patients’ lesional skin in comparison to the corresponding peri-lesional skin. The mRNA levels of various melanogenesis-related genes were measured using Next-generation sequencing (NGS). Capsaicin, a potent TRPV1 activator, and AMG9810, a selective TRPV1 inhibitor, were used as TRPV regulators in in vitro assays using normal human melanocytes. The expression of melanogenesis-related proteins was assessed using Western blot assay.
Results: Expressions of TRPVs were increased in the lesions of PCD. Furthermore, Pmel, TYRP1 and S100A8 were increased in the lesions of PCD compared to peri-lesion. qRT-PCR analysis showed that tyrosinase, along with TRPV1 and TRPV3, was up-regulated in patients with PCD. We also demonstrated that TRPV1 regulates melanogenesis in human melanocytes as well as B16 melanoma cells and co-culture. TRPV1 activation promoted melanin synthesis in human melanocytes in vitro, while this effect could be reversed by TRPV1 blockade using AMG9810.
Conclusion: Our findings suggest that elevated expression of TRPVs in the skin links the clinically reported symptoms of PCD to its causative inflammation-related hyperpigmentation. TRPVs, particularly TRPV1, may play a crucial role in the development, aggravation and chronicity of PCD through modulation of ca2+/PKC/tyrosinase activity.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: The objective of this investigation was to study the physical properties flexibility and firmness of commercial HA fillers from two major brands, comparing how firmness and flexibility is balanced for the NASHA/OBT and the Hylacross/Vycross technologies.

Introduction: Many studies on HA fillers have been aimed at their firmness, typically expressed as their rheological G’ value, to estimate their ability to lift and project. However, no investigations have been aimed at the flexibility of HA gels, i.e. their ability to recover after a larger deformation. To study HA fillers in the dynamic mode related to natural animation, a new rheological method to measure gel flexibility was developed.
While soft gels must be flexible to tolerate deformation, firm gels resist deformation, which makes the balance of firmness and flexibility clinically important.

Materials / method: The rheology measurement included a relaxation time of 30 min, a frequency sweep (FS) from 10 to 0.01 Hz at 0.1% strain, followed by an amplitude sweep (AS) from 0.1% to 10000% (0.001 to 100) strain at 1 Hz. The gap was 1 mm using a PP25 measuring system at 25˚C.
The FS was evaluated for G’ at 0.1 Hz as a measure of gel firmness. The AS was evaluated for strain at the cross-over point where G’ and G’’ have the same value (xStrain), as a measure of gel flexibility.
From each technology, three NASHA, five OBT, two Hylacross and four Vycross products were studied.

Results: The range of firmness and flexibility differed between technologies. The NASHA/OBT technologies displayed a G’ ratio of 71 from firmest to softest, and an xStrain ratio of 307, while the Hylacross/Vycross technologies showed a G’ ratio of four and an xStrain ratio of 46.
In addition, the balance between firmness and flexibility differed between technologies. For OBT, the softer the product, the more flexible. For Vycross, the trend was the opposite, the softer the product, the less flexible.

Conclusion: The products from the NASHA/OBT technologies were found to cover a significantly larger range in firmness as well as in flexibility compared to the products from the Hylacross/Vycross technologies.
For OBT products, increased softness was balanced by an increase in flexibility. For Vycross products, softer products showed less flexibility. The difference was attributed to the different technologies. While OBT products differ in crosslinking level, Vycross products differ in HA concentration.

Disclosures

Did you receive any funding to support your research for this TOPIC?
Yes
Please specify entities (individual, company, society): Employee of Galderma

Were you provided with any honoraria, payment or other compensation for your work on this study?
Yes
Please specify entities (individual, company, society): Employee of Galderma

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
Yes
Please specify entities (individual, company, society): Employee of Galderma

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work is presented thanks to the support of: Employee of Galderma

Objectives: A definitive protocol for treatment of melasma in skin of colour using a q switched and prp

Introduction: Melasma remains to be one of the most troublesome dermatological condition with no definitive treatment modality availible here we explore treatment with the q switched usfda approved nanosecond laser and compare our results with oral and topical therapies

Materials / method: Q switched ndyag ; Prp

Results: In 60 percent of the cases remission and improvement of 80 percent was seen
In 20 percent there was 30 percent improvement
In 10 percent there was no improvement
In 10 percent mild worsening was seen which recovered upon stopping the therapy

Conclusion: The q switched ndyag seems to be our best bet in long term treatment of melasma and with time and better sun protection the situation looks promising

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: In India presently dermatophytosis rampant and itraconazole resistance is a grave concern we try to break the biofilm and provide an alternative to the itraconazole resistance cases with the q switched ndyag treatment

Introduction: The q switched treatment shows promising results with 90 percent cases being benefits with the nail matrix being saved and zero down time

Materials / method: Q switched Ndyag laser nanosecond

Results: In 90 percent cases the disease showed improved and in 80 percent cases the nail matrix was saved

Conclusion: The q switched provides a ray of hope in the Indian onychomycosis resistance scenario as soon it can lead to an epidemic of not controlled

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: RESISTANT AND RECALCITRANT ONYCHOMYCOSIS IS FAST BECOMING AN EPIDEMIC IN THE INDIAN SUNCONTINENT WITH EVEN ITRACONAZOLE RESITANCE BEING ENCOUNTEE REGULARLY HERE LASERS SEEM TO BE A RAY OF HOPE AND THE LAST RESORT

Introduction: WE HAVE DEVELOPED A NOVEL PROTOCOL USING 1064 AND 532 CONVENTIONAL AND FREE RUNNING MODES
90 PERCENT PATIENTS HAD SHOWN SATISFACTORY CLINICAL IMPROVEMENT INCLUDING HIGH RISK GROUPS LIKE DIABETICS

Materials / method: WE USED A COHORT OF 30 PATIENTS WITH ITRACONAZOLE RESITANT ONYCHOMYCOSIS WHO HAS SEEKED TREATMENT CONVENTIONALLY EARLIER AND USING QSNL LASERS AND MINIMAL USE OF ANTIFUNGALS HAVE TREATED THE DISEASE

Results: IN 90 PERCENT OF THE PATIENTS EXCELLENT CLINICAL IMPROVEMENT WAS SEEN WITH MINIMAL SIDE EFFECTS

Conclusion: IN THE WAKE OF RECURRENT AND RECALCITRANT ONYCHOMYCOSIS WHERE NO ANTIFUNGALS WORK NOVEL PROTCOLS AND TREATMENT LINES WOULD SOON BE THE NORM AND QSNL TREATMENT HAS NO SIDE EFFECTS AND IS WELL TOLERATED BY THE PATIENTS WITH EXCELLENT RESULTS

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: It is well know that fractional micro needles can be used to treat acne scars. It is also well known that polylactic acid induces collagen production. This study is intended to reveal the efficacy of specially designed fractional radio-frequency micro needle system equipped with drug delivery function which is able to insert polylactic acid mechanically into dermis for treating of acne scar. It was found that acne scars can be treated safely and efficiently with minimal downtime using polylactic acid in addition to fractional micro needle system.

Introduction: Acne occurs in younger ages and leaves various aftereffects, the most serous of which is a depressive scar. Various treatments such as using energy based devices including lasers, chemical peels, surgical excision, dermabrasion, and tissue augmentation with fillers have been used to treat acne scars. This study describes the use of polylactic acid which is know to induce collagen production with fractional micro needle system in acne scar treatment to improve the treatment results.

Materials / method: Polylactic acid was treated with 250 W ultrasound device for 4~8 hours after addition of 6 cc distilled water. And 3 cc of non-cross-linked HA was added to make a total of 9 cc. During insertion of micro needles the cylinder of this system is designed to be able to push liquid materials into dermis mechanically. And the depth of thermal damage can be adjusted between 0.8 and 1.5 mm into dermis with RF energy. Total 42 patients with acne scar on the both cheek were treated with this system, but both cheeks were treated differently with normal saline and polylactic acid as delivered materials.

Results: Scars on both cheeks were improved and the PLA treated side showed better clinical effect. The RF with PLA group showed significantly better efficacy than control group(RF with normal saline) in smoothness of the scars (combination 2.78 and control 2.00 p=0.000), pore size (combination 2.50 and control 2.11 p=0.008), overall improvements (combination 2.72 and control 2.00 p=0.001) and except brightness (combination 2.33 and control 2.11 p=0.946). Polarization microscopy revealed PLA particles in the fractional radio-frequency micro needling treated sites in dermis.

Conclusion: It was found that acne scars can be treated safely and efficiently with minimal downtime using polylactic acid in addition to fractional micro needle system. Drug delivery system of polylactic acid can be an additional new option for acne scar treatment.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: The aim of this systematic review was to analyse current literature to determine levels and durability of subject and physician satisfaction of aboBoNT-A treatment for aesthetic purposes.

Introduction: AbobotulinumtoxinA (aboBoNT-A) is a botulinum neurotoxin A approved for aesthetic use in treatment of glabellar lines (GL). Current dosing guidelines recommend a minimum treatment interval of 12 weeks. Previous studies have included reports of both subject and physician satisfaction, which in some studies have remained high for up to 6 months post-injection.

Materials / method: A systematic review of literature databases (PubMed/MEDLINE, Embase, Cochrane Library, Google Scholar) was conducted to identify English-language publications. The search was structured to deliver results relevant to: population (subjects with aesthetic indications [including GL and wrinkles]); interventions (aboBoNT-A); comparators (no restrictions [nothing, placebo, other medications, usual standard of care]); outcomes (satisfaction, including subject satisfaction and physician satisfaction); settings (clinical). Structured data extraction was used to enable inter-study analysis.

Results: Of 280 papers (reviews included), 31 original research papers assessed subject/physician satisfaction. Of 12 placebo-/comparator-controlled studies, 6 assessed subject satisfaction at Week 2: all showed improved satisfaction from baseline (n=3) or >50% of subjects ‘satisfied’/‘very satisfied’ (n=3). Of 11 studies with assessments at ≥4 months, including 4 at 6 months, all had subjects still reporting satisfaction. In 9 uncontrolled studies (2 weeks–7 months follow-up), subject satisfaction ranged from 66–100%. Physician satisfaction (n=1 uncontrolled study) was also high (90–100%).

Conclusion: High rates of subject satisfaction with aboBoNT-A have been reported within 2 weeks post-injection. Despite the current recommended interval of ≥12 weeks, satisfaction with the aesthetic results of aboBoNT-A therapy are still evident up to 6 months post-injection.

Disclosures

Did you receive any funding to support your research for this TOPIC?
Yes
Please specify entities (individual, company, society): Ipsen

Were you provided with any honoraria, payment or other compensation for your work on this study?
Yes
Please specify entities (individual, company, society): Ipsen

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
Yes
Please specify entities (individual, company, society): Ipsen

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work is presented thanks to the support of: Ipsen

Background: Introduction of biological agents lead to significant advances in the treatment of Psoriasis.
Objectives: To compare effects of biologic agents and conventional drugs on psychologic status of patients with psoriasis.
Methods: Psoriatic (PSO) patients 18 years and older, with biologics (Etanarcept, Adalimumab, Infliximab, Cosntyx), or with conventional therapy (CT), who are in remission were enrolled into the study. Patients were assigned to two groups: (biologics - Gr1, CT – Gr2).
Skin disease was assessed by BSA index, co- existing inflammatory articular disease was evaluated by DAS – 28 score.
Anxiety, somatization, and depression levels were evaluated by Patient health questionnaires (PHQ) – GAD7, PHQ15 and PHQ9 respectively.
Disability is assessed by the HAQ disability index (HAQ).
Results: 30 (mean age 51.7 ±14.9 years, female 50%) PSO patients with biologic, 14 (mean age 62.1±15.9 years, 50% female) patients on CT were enrolled in the study. Patients in both groups were in remission ( BSA <1, and DAS 28 < 2.1). There was no difference in body mass index, body surface area of psoriasis, disease duration and treatment duration between two groups.
The mood questionnaires did not show significant difference in their scoring (GAD 3.2± 3.9 in Gr1, 3.8±2.6 in Gr2, PHQ9 - 4.5±5.4 vs 4.8±2.9, and PHQ15 4.7±3.9 vs. 5.4±3.2). Nevertheless, PHQ15 mean score was higher than 5, showing mild somatisation in the patients of Gr2.
HAQ score was equal in two groups (0.44±0.54, and 0.22±0.31, p=0.17)
We found correlation between mood questionnaires and HAQ (r= 0.5, p<0.001).
The higher percent of patient with mild deprssion, anxiety and somatisation was found in gr2.
Patients in both groups with mood disturbance showed poorer perfomance (p<0.005) in their HAQ.
Patient without mood changes did not show difference in the HAQ between two groups.
Conclusions: Biologicals may provide valuable improvement in psychosocial status of the patients, and in their life.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: TCA-H2O2 disclosed new features, completely different effects and indications, becoming an innovative non-injective biorevitalizer, that is able to give the dermis an effective stimulation without damaging the epidermis and avoiding the subsequent exfoliation.

Introduction: TCA-H2O2 is an internationally patented Medical Device containing Thricloroacetic acid (TCA) , a well-known peeling agent.

Materials / method: It is about a non-invasive, very flexible device, useful for stand-alone treatments or combined protocols with other common and popular procedures in aesthetics medicine.

Results: TCA-H2O2 constitutes an original means, without significant side effects, suitable at any time of the year, very appreciated by patients, that may complement other techniques and be associated with most procedures in aesthetics medicine, and amplify their results.

Conclusion: It is a non-invasive product that allows a biorevitalization without needles.
It works very well as a single treatment, and in associated treatments, the final result is superior to the sum of both.
It is not photosensitizing and give significant results immediately.
Does not leave visible traces, and therefore does not require interrupting daily activities or the patient's social life.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Purpose of the study: to identify improvements in the structure of the epidermis and derma during the procedures performed with the use of the preparation, containg hyaluronic acis and sodium succinate
Relevance: Skin diseases, such as atopic dermatitis, seborrheic dermatitis and eczema during the reconvalescence need the active participation of both a dermatologist and a cosmetologist with the goal of full physiological epithelization, moisturizing and preventing scarring and pigmentation. After the inflammatory dermatoses, we observe not only deeply dehydrated skin, but also changes in the microcirculatory, which manifests itself in the form of impaired tone and vascular permeability. Often during the convalescence of dermatoses, after healing, there remains stable hyperpigmentation or depigmentation, as well as atrophic or hypertrophic scars, which is facilitated by a long process of regeneration at the sites of damage.
MATERIALS AND METHODS: we observed 20 women aged 30 to 40 years in the stage of remission of atopic dermatitis (7 patients), seborrheic dermatitis (7), eczema (6). All women received 3 procedures, using a combined preparation containining sodium succinate (16 mg / ml) and hyaluronic acid (18 mg / ml). The drug was administered intradermally in the technique of papular injections with a 30G needle, 2.0 ml per procedure, at intervals of 1 every 2 weeks.
Results: All patients showed a positive dynamic: a reduction in the intensity of hyperpigmentation, a more active skin regeneration (compared to similar areas in the same patient), improved skin turgor and elasticity, increased skin hydration. After the treatment there was a decrease in the severity of telangiectasia (mean score before treatment - 1.2, after treatment - 0.2), pigmentation (1.7 and 0.9 points), dry skin (1.1 and 0.1 points). A good moisturizing effect was noted in 18 (90%) patients, moderate - in 2 (10%). When studying the skin by the method of KLM, a reduction in the area of ​​the areas of hyperpigmentation, as well as a reduction in its severity, regression of hyperkeratosis, a more even arrangement of the fibrous structures of the dermis, and improvement of microcirculation were observed. There was also an increase in skin thickness due to the above processes. Allergic reactions to drug administration have not been recorded. Absence of effect and negative dynamics during therapy were not revealed.
Conclusion: The protocol of using hyaluronic acid and sodium succinate has a good tolerance, promotes the acceleration of skin regeneration, restoration of normal skin hydration, normalization of pigmentation.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: We will present different clinical cases involving wrinkle treatment, hyperpigmentations (seborrheic keratosis, solar lentigo), benign dermal nevi, acne and dermathocalasis.
Introduction: Plasma exeresis is a new technique to treat several skin conditions: through the ionization of the gases between the point and the tissue, it generates the plasma. The plasma hits the tissue to treat and gives the sublimation. The handpiece can be used in a single spot (for wrinkles and skin laxity) or continuous mode (to remove benign skin lesions).
Materials / method: MATERIAL & METHODS: We used one plasma exeresis medical device. It is a cordless micro-surgical hand operated device. Informed consent form was obtained. Topical anesthesia was applied one hour before on the selected area. After the treatment, the patient applied twice a day, disinfectant solution and covered the defect with foundation. Clinical images were taken before, immediately after and one month after the soft surgery.
Furthermore some patients, treated for dermathocalasis and acne, had confocal microscopy performed on the selected area before and after the plasma exeresis.

RESULTS: The evaluation of clinical images is significant for very good cosmetic result.
Confocal microscopy showed a peculiar reorganization of collagens boundles and neo-collagen formation for skin laxity and the resolution of acneic lesions.
CONCLUSIONS: Plasma exeresis is a good therapeutic options to many different dermatological conditions, without the need of local anesthesia; the post-treatment discomfort for the patient is very short. No major side effects were observed.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: The present report describes 3 cases in which minimally invasive procedures such as muscle relaxation, facial fat remodeling, volume loss correction, and skin and tissue repositioning were used to achieve outstanding results, emphasizing the use of biological recombinant enzymes as a novel tool to facial remodeling prior to use other cosmetic treatments.

Introduction: Loss of skin firmness, facial ptosis due to gravity and bone absorption, as well as facial fat pads ptosis are part of the aging process.
Traditionally these changes were treated with surgical procedures. Nowadays the concept of aesthetics has evolved from a surgical to minimally to non-invasive approach.
Skin resurfacing, muscle relaxation, volume restoration, and skin repositioning are well-known procedures in the aesthetics field. However, in recent years a new minimally invasive treatment has become popular, the use of biological recombinant enzymes for facial remodeling and contouring.

Materials / method: Three patients who once considered undergoing a surgical procedure to improve specific facial areas were selected.
All patients were treated with 3 sessions of an enzymatic cocktail made of hyaluronidase, collagenase, and lipase using a microcannula injection technique. The enzymatic procedures took no longer than 30 minutes per session. Patients referred mild swelling on the treatment area lasted 24 hours without any other major complications.
After the enzymatic treatments were completed, botulinum toxin, polydioxanone threads, and hyaluronic acid fillers procedures were used respectively.

Results: Patients were evaluated before and 3 months after the last treatment. Photographic evidence was taken to compare the outcomes exhibiting an excellent improvement on all the patients. A results satisfaction scale survey was given to all patients. The poll revealed that all 3 subjects were satisfied with the results and would undergo the series of treatments once again when needed, leaving aside the idea of undergoing surgical procedures.

Conclusion: Biological enzymatic therapy has shown promising results as medical aesthetic agents. Lipase helps to decrease facial ptosis by a lipolytic effect on the facial fat pads, collagenase helps improving skin firmness and hyaluronidase increases lymphatic drainage and promotes skin nutrition.
This novel approach used in combination with other cosmetic techniques such as botulinum toxin injections, absorbable polydioxanone threads, and hyaluronic acid fillers could, grant the patients outstanding overall results and delay the time before they need to undergo surgery.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: The objective of this study is to demonstrate the safety of local anesthesia by injectable lidocaine with epinephrine associated with HIFU procedure on the lower face.

Introduction: High intensity focused ultrasounds with visualization (HIFU) is known to be a safe and effective treatment for mild skin tightening in the lower face. Pain management will really improve the patient’s experience during the procedure, and allow the practitioner to offer this technic to his patients easily. To date, there is limited clinical data on this topic.

Materials / method: A questionnaire based-survey regarding the side effects and the patient’s satisfaction was conducted on a panel of 53 patients several weeks or months after a lower face HIFU treatment associated with injectable lidocaine with epinephrine.

Results: Side effects observed were edema (68%), bruising (53.3%), numbness (47%), raised striations (17.6%). All were mild and transient (3 to 10 days on average). We did not noticed unexpected adverse events.
The local anesthesia procedure has not been painful at all or just slightly uncomfortable for more than 60% of patients.
The HIFU procedure has not been painful at all or just slightly uncomfortable for 80% of patients. 82% of patients would restart the HIFU treatment with local anesthesia.

Conclusion: In this serie, side effects after HIFU associated with lidocaine and epinephrine are mild and transient, and seemed to be identical to those usually described without local anesthesia.
However, results are only based on subjective and retrospective patient’s appreciation.
A prospective study must be conducted in order to obtain more reliable results about safety of injectable lidocaine associated with HIFU, and to ensure that local anesthesia does not influence the treatment efficacy by changing the tissues receptiveness to heat absorption.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
Yes
Please specify entities (individual, company, society): Merz Pharma

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work is presented thanks to the support of: Merz Pharma

Objectives: Six case reports of patients who had been treated intraoraly by a monopolar radiofrequency (mRF) for moderate cheek laxity. Retrospectively, safety, tolerability and effectiveness of the device were evaluated.

Introduction: Energy-based noninvasive technologies are commonly used for tissue restructuring functions. These are less effective than surgical procedures but their minimal downtime makes them very attractive. Transcutaneous mRF is well known and used to firm and tighten the skin of the face and the body. Equally, the dramatic efficacy of intravaginal transmucosal mRF delivery on vaginal laxity has been proven. We addressed the question if the intraoral transmucosal mRF delivery improves cheek laxity as well.

Materials / method: A single mRF treatment was performed on each subject. The mRF device creates heat within the submucosal layer of the mucosa while keeping the surface cooled. mRF was delivered at 90 J/cm2. The treatment tip was passed over the entire area of the inner cheeks with a total of 55 pulses of 7.5 seconds each per side. Subjects’ discomfort, pain or potential side effects were documented during and after the procedure for 3 months. 3D-photographs obtained at baseline and 3 months post-treatment were assessed and retrospectively evaluated by 3 blind reviewers.The patients were asked for evaluation.

Results: No adverse events were reported. It was a painless treatment and no sedation and no topical anesthesia were required. 100% of the 3 blind reviewers identified correctly the before-after photos. They observed improvement of skin laxity in the lower face in 100% of the patients. 100% of the patients observed improvement, would repeat the treatment and recommend the treatment to a friend.

Conclusion: The intraoral transmucosal mRF treatment was not painful and well tolerated and showed an excellent 3-month safety profile. Improvement was reported in 100% of the patients and by 100% of the blinded reviewers. These findings warrant the way for future prospective studies.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: The aim of this study was to evaluate hyaluronan based gel effects on muscle rat derived cell proliferation and differentiation as a valid and innovative alternative to common anti-aging procedures with very limited safety concern.

Introduction: In vitro, in vivo investigations beside clinical studies have explored the wide array of potential effects of hyaluronic acid (HA). In the form of hydrogel, scaffold, films, creams and foams, HA proved biologically active in various pathologies. In the dermo-aesthetic field it can be outlined the potential beneficial effect in wound healing, inflammatory disorders with its immune-modulation function, anti-aging and tissue regeneration ability. Thanks to its rheological viscoelastic and hygroscopic properties, HA represents a robust ingredient to hold skin elasticity and turgor.

Materials / method: Comparative analyses were performed using high (H-HA), low molecular weight (L-HA) hyaluronans and commercial hybrid cooperative complexes (HCCs) of hyaluronan obtained through patented Technology. Muscle cells were characterized by immunofluorescence staining for anti-miogenin specific muscle differentiation marker. To evaluate the anti oxidative stress, cells were subjected to H2O2 exposure. SOD-2, COX-2 and iNOS, were evaluated by western blot. The muscle atrophy in vitro model was obtained using TNF-α treated cells for 24 h along with hyaluronan. MuRF-1 and atrogenin were analyzed.

Results: Time Lapse experiments and MTT assay showed that HCCs and H-HA increase cell growth and proliferation respect to L-HA and control. Cell viability is reduced by H2O2 treatments while all hyaluronans preserved viability and influenced differentiation. In particular, HCC had a noteworthy beneficial effect on all of the myo-markers evaluated.

Conclusion: These evidence based outcomes support that HCC, beyond linear HA, is a promising non invasive procedure for skin disorders at multilevel face layers with a specific novel highlight in muscle cell protection against damage/stress.

Disclosures

Did you receive any funding to support your research for this TOPIC?
Yes
Please specify entities (individual, company, society): Ministry of Education (MIUR) and/or Regione Campania (Italy), BIOTEKNET

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No
Please specify entities (individual, company, society): Altergon s.r.l. and IBSA ITALIA

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
Yes
Please specify date...: ISSUED
and status : 2012

This work is presented thanks to the support of: Prof De Rosa and Prof. Schiraldi and her group have been involved in research projects funded by the Ministry of Education (MIUR) and/or Regione Campania involving industrial partners, among which are Altergon s.r.l. and IBSA ITALIA, that also supported B

Objectives: Consensus guidelines and recommendations have recently been developed by a global panel of expert aesthetic physicians to consider best practices for the use of microfocused ultrasound with visualization (MFU-V). A component of this discussion included our clinical experience with a customised management protocol (see-plan-treat).

Introduction: In our clinical practice, we sought to evaluate whether this customised management protocol provides improved efficacy and patient comfort.

Materials / method: Our customised management protocol was designed based on the following rationale: 1) target tissues to determine the best approach using MFU-V anatomy, and 2) customise treatments to access the target using see-plan-treat. We conducted an efficacy and comfort audit to compare the standard treatment protocol vs. the customised management protocol.

Results: Use of the customised protocol resulted in all 50 patients reporting positive results: 63%=“agree” and 37%=“strongly agree” vs. the standard treatment protocol in which 66% had positive results (43%=“agree” and 23%=“strongly agree”); 14% “neither agree nor disagree”; 10% “disagree”; and 5% “strongly disagree” (5% lost to follow-up). As assessed by a 10 point scale, the customised protocol resulted in an average pain rating of 2.3 vs 3.3 using the standard treatment protocol. Results of the treatment using a see-plan-treat approach was demonstrated with before and after case photos at 12 weeks.

Conclusion: Our customised management protocol provides improved efficacy, as well as comfort. Factors affecting MFU-V targeting include facial area, morphology, body fat/BMI, underlying anatomy and tissue health (age and photodamage). Using customised MFU-V patient records for both the SMAS/fibromuscular layer and dermal base to document the scan and plan, and then the treatment, provides a reliable structure to customise one’s approach to treating patients with MFU-V.

Disclosures

Did you receive any funding to support your research for this TOPIC?
Yes
Please specify entities (individual, company, society): This study was supported by a grant from Merz North America, Inc.

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work is presented thanks to the support of: This study was supported by a grant from Merz North America, Inc.

Objectives: The aim of our study was to compare the effectiveness in melanolysis of a single
treatment of the picosecond alexandrite laser with that of the Q-switched Nd:YAG laser using reflectance confocal microscopy imaging of the melasma lesions.

Introduction: Melasma is an acquired type of hyperpigmentation that is characterized by the appearance of scattered light- to dark-brown macules and patches on the face. Recently, several lasers have been proposed as treatment options for melasma. In particular, the picosecond alexandrite laser is an ideal laser for selective photothermal melanolysis.

Materials / method: We performed a spilt-face study using the picosecond alexandrite laser and Q-switched Nd:YAG laser in eight patients with melasma. Both melasma lesions and surrounding normal skin were examined under reflectance confocal microscopy 1 and 24 hours after treatment. The melanin intensity of each skin layer was investigated.

Results: At baseline, melasma has irregular melanin distribution and a higher melanin density than surrounding normal skin under reflectance confocal microscopy.
After a single treatment with either the picosecond alexandrite laser or the Q-switched Nd:YAG laser, both melanin-induced reflectance and melanin index decreased.

Conclusion: Our findings suggest that it is feasible to assess the distribution of melanin by reflectance confocal microscopy and observe the melanolysis in melasma lesion after laser treatment.

Disclosures

Did you receive any funding to support your research for this TOPIC?
Yes
Please specify entities (individual, company, society): This research was supported by the Basic Science Research Program through the National Research Foundation of Korea(NRF) funded by the Ministry of Science, ICT & Future Planning (Project No:NRF-2017R1C1B5076162)

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: This report is unique because most of the intra-arterial occlusions and signs of ischemic skin necrosis occur immediately or within few hours of the filler injection going intravascular. There have been very rare reports of delayed necrosis all over the world following filler injections. In this case patient reported pain only after 48 hours following filler injections which is an important sign of intra-arterial injection. This is a caution for all injectors that signs and symptoms can occur even after 48 hours following injections and one has to be careful and vigilant.

Introduction: Facial fillers are minimally invasive aesthetic procedures done for facial rejuvenation and contouring all over the world. But as all good things have some negative effects, fillers even in the most experienced hands can lead to fatal complications such as vascular complications which need to be managed immediately with the help of hyaluronidase protocols mentioned in literature. We hereby report a case of delayed necrosis (>48 hours) following filler injections in the cheek area , in the infraorbital artery vascular territory which was successfully managed with pulsed dose of Hyaluronidase.

Materials / method: patient was asymptomatic with no signs of vascular occlusion like blanching or poor capillary refill for 48 hours. He came to the clinic more than 48 hours of the filler injection with complaints of pulsating pain in the right infraorbital and nasolabial area. We noticed necrosed microvesicles in the infraorbital artery territory with signs of impending skin necrosis and redness (Livedo reticularis) extending from infraorbital region up to the nasolabial fold and slightly medial to it with tenderness of tissues. He was treated immediately with 3 pulsed doses of hyaluronidase 500 units each.

Results: Skin had completely healed and by 15 days we noticed slight Post Inflammatory Hyperpigmentation (PIH) which was easily managed with Q-switched laser and creams.

Conclusion: We like to conclude by saying fillers though quite lucrative can lead to devastating complications if not managed properly and adequately. Thorough anatomical knowledge of the vascular territories is of utmost importance before venturing into injectables.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: Efficacy and safety was examined for scalp rejuvenation procedure with low cross-linked hyaluronic acid to improve wrinkle severity, skin hydration and elasticity on the male scalp area.

Introduction: Ageing of the skin and the wrinkles process formation is highly documented. Male scalp wrinkles, as a specific gender and skin area, has, however, received little attention. Conventional chemical peels and dermabrasion are the most common approaches to rejuvenating the scalp but does not give an effective rejuvenation in case of wrinkles presence. Most common skin booster indications are dry skin, poor elasticity and poor skin texture, however less common indications as acne scars and superficial or mimic wrinkles also obtain good results with this hyaluronic acid injectable technologies.

Materials / method: A bold male patient was injected in the mid-dermis during a single session with 1mL low cross-linked (<3%) hyaluronic acid (HA), containing 50% 1000kD and 50% 2000kD HA, with a 33G needle, Once the procedure was completed, the injection site cautiously was manually massaged to ensure that the product spreads evenly.

Results: In the present clinical case we observed significant aesthetic improvement on scalp rejuvenation and wrinkle severity compared to baseline. This improvement coupled with amelioration of skin hydration, elasticity and structure. No over correction neither presence of adverse events was observed.

Conclusion: This preliminary results imply that low cross-linked (<3%) hyaluronic acid (HA) is a safe product, and with an easy technique, allows a significant correction of scalp wrinkles.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No
Please specify entities (individual, company, society): IBSA Farmaceutici Italia

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: To understand factors impacting patient satisfaction with BoNT-A treatment.

Introduction: Positive self-image and self-esteem are key drivers for choosing non-surgical treatments. While patient expectations for aesthetic treatment are high, patients generally report a positive experience provided that they are given good quality information, have a good clinician rapport and adequate post-treatment follow-up. Positive experiences are reinforced by satisfaction with results of the treatment and its duration

Materials / method: Two international, web-based patient surveys were conducted to understand participant opinions of aesthetic products and provide physicians with insights that might improve patient satisfaction and clinical practice. Survey 1 was conducted in Colombia, Lebanon, Malaysia, Russia and Turkey and Survey 2 was conducted in Colombia, Russia, Thailand, Turkey and the United Arab Emirates.

Results: In the first survey, patient-ratings of satisfaction with previous aesthetic medical procedures (7 point Likert scale where 0 =very dissatisfied and 6 =very satisfied) ranged from 4.8 to 5.4. In the second survey, patient-ratings of satisfaction with BoNT-A treatment outcome (10 point Likert scale where 1 =not satisfied at all and 10 =completely satisfied) ranged from 7.0 to 8.7. Top reasons for dissatisfaction with treatment outcome were: did not meet expectations (56%), did not look natural (24%), the physician did not set realistic expectations (22%).

Conclusion: Some patients remain dissatisfied with BoNT-A treatment, most commonly by treatment not meeting expectations. It is therefore highly important that factors affecting treatment satisfaction (such as treatment onset, duration of response, realistic outcomes), be discussed with patients when recommending treatments to match their individual expectations.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
Yes
Please specify entities (individual, company, society): Ipsen

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work is presented thanks to the support of: Ipsen

Holistic approach in injectable rejuvenation of nasolabial folds. Assessment and different approaches to deliver optimum total face result and patient satisfaction.
The rejuvenation of a nasolabial folds is one of the most frequently requested option by mature patients. It can be defined as one of the natural structures of the face rather a fold formed as a result of ageing processes.
When planning the treatment of this area, it is important to take into account as patient functional as anatomical features, because it is one of the dangerous areas due the high risk of vascular compromise.
Rejuvenation of the nasolabial folds can be achieved in a different approaches:
by prevention with mesotherapy, PRP and chemical peels treatment;
direct with fillers (superficial or deep injections, needle or cannula) or "mash-threads";
indirect with filler by volumetric augmentation of mid face and temporal area,
lifting with threads, using botulinum toxin or EBD.
Aesthetic analysis of the face, right evaluation and correct indications type of treatment gives the optimum total face result and, of course, patient satisfaction of procedure.
The current report presents tips and tricks of different combination techniques for nasolabial folds rejuvenation treatment.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: We are proposing a novel picosecond fractional ablative Nd:YAG laser resurfacing for treatment of acne scarring. The process is much better tolerated, significantly reduced possibility of any significant side effects compare to CO2 or Er:YAG laser resurfacing procedures with considerable faster recovery time.

Introduction: Fractionated & full beam ablative CO2 or Er:YAG laser resurfacing has been widely used for treatment of boxcar and icepick acne scarring. While the patients receive significant improvement with either treatment, they have to go through a very painful process with an extensive recovery period. The procedures also associated with potential side effects including scarring, post-inflammatory hyperpigmentation and hypopigmentation.

Materials / method: This observational study evaluated 3 patients with Fitzpatrick skin phototypes I–V and mild to severe facial acne scarring receiving one session of treatments with a picosecond fractional ablative Nd:YAG laser.
We used digital photographs to document each patient at baseline, and 4 weeks post treatment. The pre- and post-treatment photographs evaluated by non-treating, blinded independent board-certified dermatologists using a defined weighted scale:

Results: Dr. Mark B Taylor, is a world-renowned cosmetic laser surgeon with extensive experience in applying different laser modalities for acne treatment as well as resurfacing procedures. We have treated 3 patients with moderate acne scar using fractionated ablative Nd:YAG. The patients’ acne scar had demonstrated considerable improvement and patients recovery time on average was much faster than CO2 or Er:YAG resurfacing.

Conclusion: The novel fractionated ablative Nd:YAG could provide a safe alternative to CO2 or Er:YAG resurfacing for treatment of acne scarring in Fitzpatrick I-V skin color patients. The results are comparable to other resurfacing procedures but with significant less down time and significantly reduced complication risks.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Disclosures

Did you receive any funding to support your research for this TOPIC?
Yes
Please specify entities (individual, company, society): TEOXANE

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work is presented thanks to the support of: teoxane

Objectives: Evaluate the treatment of vascular occlusion after facial filling with hyaluronic acid.

Introduction: The American Society of Plastic Surgery said: 2.7 million noninvasive procedures were done in 2017 for skin filling. HA is one of the most used fillers - resorbable, temporary and very well tolerated. Vascular occlusion is a rare complication that can occur by local compression or accidental intraarterial injection of filler. It can happen with any injector, as the face arteries anatomy vary among people. There is no consensus on treatment, which may include early degradation with hyaluronidase (HYAL) so as hygiene, massage and warm compresses for embolus dissolution.

Materials / method: A case series made by the review of medical records of 8 patients who developed vascular occlusion after HA filling. The variables included were sex, age, site of occlusion, HA and HYAL volume, associated medications, time to start treatment and time to resolve the condition.

Results: Total of 6 women and 2 men, mean age: 30,75 y. Affected regions, in descending order of frequency: nasal tip, columella, nasogenian sulcus, nasal dorsum and superior labial region. The patients with HYAL onset in the first 5min had their cases completely resolved in the shortest time: 2h and 72h. For those who HYAL was used in 2h - 6h, resolution was in 24h and 4 days. Cases with HYAL onset after 10h of occlusion had resolution in 4 days (this patient had the lowest AH dose: 0.1 ml), 7 days (two) and 21 days. Different oral medications (OM) were used. All patients had complete resolution.

Conclusion: Early recognition and immediate degradation with HYLA are key points in reestablishing blood flow after vascular occlusion with HA. The sooner HYLA is initiated, the better. HYLA’s dose is not fixed, varying accordingly to the area and amount of HA used. Different OM were associated, which may have influenced the outcomes.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: Fractional CO2 laser, through the induction of thermal damage, leads to neocollagenesis. Autologous mesotherapy (Platelet Rich Plasma) promotes the activation of stem cells, targeting cell rejuvenation and tissue healing. We examined the effectiveness of the combination of these two therapies.

Introduction: Fractional CO2 laser, through the induction of thermal damage, leads to neocollagenesis. Autologous mesotherapy (Platelet Rich Plasma) promotes the activation of stem cells, targeting cell rejuvenation and tissue healing. We examined the effectiveness of the combination of these two therapies.

Materials / method: The therapeutic protocol included 6 combined sessions of fractional co2 laser and PRP every 4 weeks on the face, neck, chest and dorsal surface of the hands. Digital photographs were taken in the beginning, at the end and 2 months after the last session. Fractional co2 laser was regulated as follows: Pulse energy 12-25 mJ, Power 8-10 W, density 81-100 dots/cm2. For PRP, 5ml of blood were taken, followed by double centrifugation, collection of plasma and addition of 0,05 ml calcium chloride/ml. The solution was applied by injections (30G needle) and by micro needling.

Results: We evaluated the results 2 months after the last session. A significant reduction of static and expression wrinkles of up to 80% was noticed. Photoaging skin lesions were improved up to 56%, while atrophic acne scars were reduced by 30%. Nearly all patients mentioned better appearance, skin quality and elasticity. None of them complained about any severe side effects, except for flushing and light roughness of the skin directly after the treatment.

Conclusion: The combination of Fractional laser co2 and PRP is a safe, minimally invasive treatment for acne scars, photoaging signs, and expression wrinkles at the face, neck, chest and dorsal surface of the hands. PRP promotes a faster healing and rejuvenation of the skin.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: Tattoo removal has an increasing demand all over the world and researches for different types of technologies with this purpose are increasing worldwide. Advancements in laser technology with quality-switched (Q-switched) lasers led to a more selective pigment targeting and nowadays the picoosecond-pulse-duration lasers are the mainstays of care in laser tattoo removal. Although nonselective nature of fractional CO2 laser we describe our daily conduct on tattoo removal, showing three great clinical results combining Frational CO2 to picosecond laser.

Introduction: With an increasing demand of Tattoo removal we've seen new technologies emerging through years, like fractional lasers, quality-switched (Q-switched) lasers and Picosecond Laser. This evolution led to a finer selective pigment targeting. Nowadays the picosecond-pulse-duration lasers are the mainstays of care in laser tattoo removal. After the picosecond lasers there's a slight tendency of blistering formation. In this study we combine Fractionated CO2 Ablation right after Picosecond Alexandrite Laser to minimize blister formation, facilitate the pigment drainage and local skin improvement.

Materials / method: All patients tolerated well the procedure after a local anesthesia with Lidocaine 23% cream for 30 minutes in oclusion. The total numbers of sections in all cases were 1 per month during 8 months. Our 3 patients were treated firstly with picosecond laser mean fluence settings of 3.25/2.83/6.37 J/cm2 (respectively) and mean spot size of 2.8 mm. Right after picosecond laser we used The Fractional CO2 laser at the same section with fluence of 5 mJ, with a density of 5%.

Results: The procedure were considered well tolerated by all patients. After every section of combined technologies, patients were analysed by 2 different Dermatologists in order to assess blistering formation/ quality of skin/ bleaching tattoo degree. All three patients didn't show any blistering formation with a good improvement of skin quality and substantial tattoo clearance after each session. Not to mention the better skin recovery after combining these technologies when compared with the Picosecond alone.

Conclusion: This case series shows a significant decrease in blisters formation when fractional CO2 ablation is added to the picosecond Alexandrite laser which is consistent with previous case series. Fractional lasers creates microscopic channels that drains inflammatory exudate decreasing subepidermal edema that leads to blisters formation and decreases healing time. After. With a dramatic blistering formation patient satisfaction is highly increased and willingness to return for future treatments more likely.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: The objective of this study is to analyse the safety and efficacy of mini-invasive, nonsurgical, thread lifting procedure for the upper third of the face, particularly improving eyebrow position.

Introduction: The face is the most informative stimulus for humans: It provides information on the person identity, sex, mood, age, health conditions. Upper third of the face transmit mental states even when are competing with cues perceived from the lower face. Mostly, the periorbital area is the first region affected by age-related changes. Up mentioned causes are reasons of periorbital region rejuvenation demands. There are nonsurgical and surgical rejuvenation procedures which are treating different subunits of eyes and its surrounding structures. Described mini-invasive thread lifting procedures

Materials / method: The methods described in an article were used in 180 patients. The effect lasts up to 5 years depending on thread material.
The thread lifting procedures were performed with unique design medical device. The used medical device represents bidirectionally barbed Poly lactic/Caprolactone (P(LA/CL) 75/25) 500 mm thread USP 2/0, connected to 1.1 mm diameter 120 mm long double sharp pointed needles with both ends. The Procedures were performed under local anesthesia (0.1% lidocaine hydro chloride with 1:100,000 epinephrine).
All manipulations were performed without skin incisions.

Results: The post-procedure distance between lateral cantus and the lateral end of the brow was elongated by 14 %. In case of arch apex formation distance between pupil and the highest point of the arch was increased by 16.2 % during the first year from the procedure. The result lasted more than two years in 80% of patients. According to patient satisfaction survey analysis, up to 50% of patients were very, up to 45% fully, and up 5 % moderately satisfied with results. The 90 % of patients evaluated their appearance as a youthful version of per-procedural appearance.

Conclusion: The thread lifting Method represents a mini-invasive treatment approach intended for facial deformity correction and beautification. It improves not only tissue position but skin color and texture. It enhances self-esteem in all age patients. The thread Method procedures have minimal risk if performed according to recommendations, short procedural and recovery time and provide long-lasting functionally and statically favorable results.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: The paper presents the results of an examination of patients with different forms of acne aged 18-30 years, in whom the level of the 21- hydroxylase enzyme that participates in the cortisol and aldosterone synthesis, was determined.

Introduction: Acne is common dermatological disorder. It affects the psychoemotional state of the patients as well as their social integration, which reiterates the importance of the problem and the demand for new effective ways of treatment.When examining over 1000 students at the age of 15-18, Emerson and Straus discovered that 80 per cent of the participants showed signs of acne, equally present in both males and females.Acne reportedly affects up to 30 per cent of people aged 25 and older.Acne is caused by hyperproduction of sebum with hyperplastic sebaceous glands, which then results in inflammation

Materials / method: The following patients participated in the research:acne of grade III (n-11), acne of grade IV (n=8), and a control group consisting of acne free participants.The samples were stained with 21-hydroxylase monoclonal antibodies.The calculation was carried out based on the number of positively stained cells per 100sebocytes,or100 epidermis cells when studying the epidermis.The comparison of the three patient groups was conducted based on the Kruskal-Wallis test, the other two independent groups were assessed by the Mann-Whitney test.The significance level of the hypothesis is p=0,05.

Results: A high increase of 21-H was discovered in the epidermis of the patients grade III and IV acne,as compared to the control group.Maturing and disintegrating sebocytes,whose secretion rate is high,show 3 times the amount of 21-H in patients with all grades acne compared to the control group.The same was for the enzyme levels in basal sebocytes–its amount was increased fourfold.Since it’s been provede that the 21-H deficiency leads to its lower activity as its production in the adrenal glands,it might be assumed that the enzyme encoding genes of the examined group of patients were not defective.

Conclusion: To summarize, the amounts and distribution of the 21-hydroxylse enzyme in the skin of patients with acne was described in the research for the first time. Significantly higher amounts of 21-hydroxylase were registered in the cells of epidermis and oil glands compared to the skin of acne-free patients.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: Determine the utility of recombinant enzymes hyaluronidase, collagenase and lipase injected along with High-intensity focused ultrasound for facial and neck rejuvenation to obtain a better results in less time for skin tightening.

Introduction: Skin laxity is a common cosmetic concern in middle age. High-intensity focused ultrasound is a non-invasive option with safe and effective improvement in 73% to 90% of skin laxity and tightening. Otherwise there are minimally invasive options, the recombinant enzymes hyaluronidase, lipase and collagenase first used in body contouring, focal lypolisis, correction of hyaluronic acid fillers. Thanks to the tissue remodeling and anti-inflamatory activity, they used in facial rejuvenation with a significant improvement. According to these results we decided to combine both modalities.

Materials / method: Patients with mild to severe skin laxity according with facial laxity rating scale were participated. We excludede patients receiving other facial rejuvenation recently or with severe medical condition. Baseline photos were taken. A vial of each enzyme diluted in 3 ml of saline solution was mixed in a syringe and then injected the face, emphasizing the areas with greater skin laxity. HIFU was performed 15 days after enzymes, and a second application of enzymes was performed to patients with a severe skin laxity in lower third and neck. Patients were reassessed after a month and 6 month basis.

Results: A significant improvement was observed. The most notorious result was in lower third and neck. Side effects reported as follows; moderate pain during enzymes application, sligth discomfort with HIFU, bruises and slight edema. Besides the skin tightening, we observed skin brightening, pore reduction, in patients with “droopy face” also having an important reduction in fat tissue, with also improvement in scars, as well in fine and deep wrinkles. The skin looked hydrated and healthier in comparison with patients received only HIFU. Improvement continued within the next 6 months of follow-up.

Conclusion: HIFU is a non invasive option por skin tightening that coagulates in the superficial musculo-aponeurotic system heating up 70 degrees,which induces induces skin regeneration by the collagen denaturation of dermal layer. improving skin texture and tightening. This effect can be enhanced by the combination with recombinant enzymes collagenase, lipase and hyaluronidase whose main functions are wound healing, proliferation and migration of fibroblasts, angiogenesis and lipolysis, improving results for facial and neck rejuvenation in less time with few side effects.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
Yes
Please specify entities (individual, company, society): Company

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work is presented thanks to the support of: Jeisys Medical Inc.

Objectives: Various treatment modalities including invasive and non invasive methods such as fractional lasers, microdermabrasion, peelings, HIFU and high power radiofrequency (RF) needling are used for skin tightening via neocollagenesis.
Most of these treatments lead to temporary short or long lasting side effects like edema, erythema, scaring, hypo- or hyperpigmentation.

Introduction: Based on our experience of more than 4,500 RF treatments, we developed a novel method using low fluence, almost no side effects and no downtime. As there is limited inflammation, this method is effective also in the treatment of various fibroblast- and seborrhea-related skin disorders and leads to dermal and subdermal-related volume augmentation.

Materials / method: Patients received facial treatments with alterning sessions of low power Fractora(c) RF microneedling and non-invasive Fractora Forma(c) over 3 month. Side by side comparison of pre- and post-treatment photographic assessment was taken both at their first visit and 6 month after the last treatment session.

Results: Improvement of skin tightening was visualised over the whole treatment area, especially in perioral and periorbital zones.
We noticed an important reduction of surgical- and acne-scars.
Surprisingly, we observed important volume augmentation of the zygomaticus and lateral cheek area leading to changes of the face shape which can be less explained by dermal neocollagenesis, but rather by changes in the subdermal layers.
What is more, this leads to reduction of sebaceous gland activity and can hence be used for treatment of pore refinement, oily skin, and seborrhea-related skin disorders.

Conclusion: Fractional RF treatment with low power is as effective for skin tightening as with high fluences - but has lower side effects. This method is a multi-tool in the treatment of various skin- and aesthetic disorders.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability