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Objectives: The tightening mechanism of EBD, especially (infra-red) laser is dermal remodeling due to thermal damage. What is the mechanism of tightening by using non-ablative Er:YAG laser?

Introduction: There are various kinds of energy-based devices for rejuvenation. However, visible change is mainly limited to lifting lower facial lines, and the effect on the nasolabial folds and periorbital region are often short-lived or unsatisfactory. Recently, transmucosal & transcutaneous irradiation of Er:YAG laser have been known as useful option of facial rejuvenation. Unlike conventional Er:YAG lasers, which are used for ablation, long pulse & multi-stacking irradiation is non-ablative and give heat damage to deeper layer.

Materials / method: For tightening face, we treated patients by transmucosal& transcutaneous Er:YAG laser irradiation. And to find optimal parameter (fluence, repetition rate, stacking number), experimental study of ex vivo animal tissue was performed.

Results: Patients were satisfied with improvement in appearance. And in experimental study, we found several interesting findings when using lower fluence, higher repetition rate and more stacking.

Conclusion: Er:YAG laser cannot penetrate subcutaneous or submucosal layer such as adipose tissue or expression muscles.
Theoretically, Er:YAG laser energy travel to around 500 µm depth. What is the mechanism of tightening by using Er:YAG laser? We should consider about wavelength characteristic, pulse duration, stacking number, photothermal effect, and heat diffusion. What happens in reality?

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Objectives: Lifting effect using a new type of HIFU, Continuous Micro-Focused Ultrasound (CMFU).
Conventional HIFU makes 17 dots and CMFU make a linear continuous line.
CMFU mode HIFU showed a more powerful lifting effect than conventional HIFU.
CMFU mode HIFU delivers ultrasound energy during both bi-directional reciprocating motions.
CMFU mode HIFU is two times faster than conventional HIFU because of the bidirectional shooting mechanism of ultrasound energy .

Introduction: High-intensity focused ultrasound (HIFU) treatment on the face has emerged in response to the increasing demand for non-invasive procedures for facial lifting and tightening. Traditional HIFU makes small 17 dots in a certain depth, but a new type of HIFU makes Continuous Micro-focused Ultrasound (CMFU) and makes one continuous line.

Materials / method: After a single treatment using CMFU, the amounts of lifting were evaluated by a 3D-photography computer program for more objective reading. 3D-photography system computer program shows detailed length (mm) of lifting amount on each area.
The amounts of facial lifting were analyzed by a 3D-photography computer program before and after a single session of CMFU treatment. Also areas of the face by comparison of standardized photographs obtained before and after treatment. Assessment of subjective satisfaction and adverse effects of treatment were done.

Results: The amounts of facial lifting on the face especially the mid-cheek area showed 2 to 3 mm immediately after a single treatment, and old subjects showed more than 4 mm of lifting result in the mid-cheek area.
Submental drooping also showed about 2mm lifting effect and submental angle improved. The immediate lifting effect decreased after a few month as time goes by, but skin quality improved at 1-month post treatment

Conclusion: Continuous Micro-Focused Ultrasound (CMFU) mode showed dramatic lifting effects on the face. The lifting effects showed immediately after the procedure and the lifting amount decreased slowly after a frew months which caused by the mechanism of collagen shrinkage and shortening.

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Objectives: - perceived age = definition, implication, factors involved
- enlarged pores = causes, impact on quality of life, holistic approach (diet, smoking, sun protection, skin care, Energy Based Devices)
- pigmented lesions = pathogeny, management (prevention, treatment, and mentenance)

Facial cues to health can be divided into two broad classes - facial shape, which is linked to previous health and is relatively fixed; and facial colouration, which changes over the short-term, reflecting current health.

Introduction: Perceived age is predictive of mortality in elderly individuals, and is
associated with a higher risk of both morbidity and mortality (a recent twin study has shown that 'looking old for one's age' is associated with increased mortality).

Skin aging is strongly associated with perceived age, and facial skin aging is the most important parameter for the perceived age

Perceived age is associated with sun damage, pigmented spots, skin wrinkling, skin color homogeneity, skin texture, and lip size.

Materials / method: Seborrhea, loss of skin elasticity and tension, and hair follicle size are most clinically relevant to the pathogenesis of enlarged pores. Other potential factors include genetic predisposition, acne, comedogenic xenobiotics, chronic photodamage, chronic radiodermatitis, and vitamin A deficiency.

Also, skin elasticity have a negative correlation with facial pore size and density, and one night of sleep deprivation worsened the appearance of pores alongside skin hydration, skin barrier, skin elasticity, skin brightness and skin translucency.

Results: Normal human skin coloration is driven overwhelmingly by only 3 components, that is, absorption (and associated spectral modification) by the melanin and hemoglobin chromophores and subsurface scattering by collagen.
The distribution of pigment colour (blood and melanin) in the skin can affect the apparent health, age and attractiveness of human faces
Hyperpigmentation, in the form of postinflammatory dark marks, melasma, or solar lentigines, increases the perception of an aged appearance to a greater degree than wrinkles.

Conclusion: Judgements of a person’s health based on their facial appearance is a daily occurrence. Understanding how these judgements are formed is important because they feed into other social judgements such as attractiveness or leadership ability, which is potentially consequential in terms of real-life outcomes, such as dating and or employment outcomes.

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