Абстракт

Objectives: 1. Review new techniques for pain prevention in EBDs where patient pain impedes series treatment compliance, or results in negative patient experiences and risks facial heat induced lipolysis. 2. Review mechanism of additional benefit of preventing EBD heat induced facial lipolysis, or atrophy. 3. Review protocol enhancing nonsurgical suspensory ligament contraction with EBD energy stacking 4. Review benefit of regenerative approaches applied as final step for EBD energy stacking Introduction: I would like to review a simple technique for anesthetizing the face, (or other area), which give a painless pt experience when stacking EBDs. Benefits beyond pain prevention, include; 1) Prevents heat induced lipolysis by creating aqueous paths of least resistance for energy to travel through adipose. 2) downtime post treatment is minimal 2) Nonsurgical contraction of suspensory ligaments below and above the SMAS, in addition to the SMAS ,are achieved, allowing for greater laxity reduction in addition to dermal contraction and other benefits. Materials / method: This method utilized a version of tumescent local anesthesia (TLA) placed in small blebs around the boarders of face and hairline with a 30 ga needle. Then a 25ga 2" cannula, or similar, was used to infuse approximately 40-60cc total of TLA in thin layers throughout the supra-periostial, sub-SMAS, supra-SMAS, subcutaneous, intra-adipose / deep dermal facial tissue spaces. HIFU, and RF were then sequentially stacked in the tissue from supra-periostial to upper dermal layers to achieve full thickness anesthesia of the face. Results: 28 patients (27 female, 1 male) received this TLA protocol. 0 reported pain beyond the initial bleb's before the TLA. HIFU & RF EBDs were stacked at 12mm, 8mm & 4.5mm (where appropriate), 3.5mm, 3mm, and 1.5mm (HIFU, then RF microneedling at each layer, 2-3 passes each 80-100% max. Photographic comparison at 10weeks, and 6 mo post treatment showed significantly greater laxity reduction, and dermal layer contraction, without lipolysis of facial adipose or other unintended heat injury to tissue. All patients self -reported noting changes at 10 weeks and greater change at 6 months. Conclusion: This simple method resolves pain with EBDs known to be prohibitively painful for patients. Additionally the following significant benefits are also apparent: 1) aqueous pathways created in facial adipose with TLA, likely prevents heat induced lipolysis and other unintended tissue heat injury. 2) SMAS and suspensory ligament contraction appears more significant than isolated EBD approaches. 3) Post procedure PRP, topical SC; POD/1 eliminated redness, & most edema for all patients. 4) Strategic full thickness TLA may reduce pain, facial lipolysis and heat injury while improving outcomes