Objectives: With the recent interest in lower face augmentation, the development and validation of a 4-grade photonumeric chin retrusion scale is presented.

Introduction: The chin is essential for perception of attractiveness. The 4-grade photonumeric chin retrusion scale (GCRS) was developed to fill the need for a scale where each grade constitutes a clinically distinct degree of chin retrusion, representing subjects suitable for treatment with hyaluronic acid (HA) filler. A combination of morphed images and photographs from different individuals of various ethnicities were included. The entire face of the individuals was shown in profile, with vertical distribution of photographs constituting the same degree of chin retrusion.

Materials / method: To validate the GCRS, subjects reflecting the whole range of the scale from no (0) to severe (3) chin retrusion, were assessed independently by three evaluators at two separate occasions. Evaluations included the ability of each evaluator to reproduce their grade for a specific subject from the first evaluation at the second evaluation (intra-observer agreement) and the degree to which evaluators independently provided identical grades for the same subject (inter-observer agreement). Pre-defined success criteria to justify validation were established based on kappa coefficient statistics.

Results: Seventy-two subjects, aged 20 to 70 years were included in the GCRS validation. The majority of the subjects were women (57%). There were 43 White subjects (60%), 14 Asian subjects (19%), and 15 subjects (21%) in a pooled Hispanic, Latin, Black or African American group. All Fitzpatrick skin types were represented. The outcome of the validation was substantial agreement, both from intra-observer agreement (between the two evaluations), and inter-observer agreement (between the three evaluators).

Conclusion: Pre-defined success criteria pertaining to intra-observer and inter-observer agreement in the scale validation were met. Thus, the 4-grade GCRS is a validated assessment tool suitable for clinical use to evaluate treatment effect of chin augmentation with HA fillers. Indeed, the GCRS is currently applied in clinical studies evaluating effectiveness of HA fillers for correction of chin retrusion, comparing response rates defined by at least 1-grade improvement on the scale. To ensure consistency in evaluations, practitioners should receive adequate training on the GCRS prior to implementation.

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请注明日期: Iran`s patent is done and US patent is pending
和审阅情况: 2013 in Iran and 2016 in US

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Objectives: This short lecture provides information on legal challenges for 3D printing done by physicians in private practice or hospitals.

Introduction: Using 3D printing within the context of medical treatments may result in some legal challenges for the physicians applying ying such technology.

Materials / method: Based on European medical device law this presentation provides an overview of the existing legal framework conditions.

Results: Physicians may manufacture medical devices when applying 3D printing. The devices manufactured must meet certain criteria set forth in the medical device regulation.

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Objectives: Objectives:
1. Verify replicability of the body shaping results that were reported in initial studies on high-intensity focused electromagnetic technology
2. Compare observed results with previously published evidence
3. Formulate recommendations how to position this technology in aesthetic practices

Introduction: Introduction
High-intensity focused electromagnetic technology (HIFEM) was introduced in early 2018 as a non-thermal alternative to existing non-invasive fat removal devices, while also being able to strengthen the patient’s musculature. Multiple studies published in US showed consistent results in fat reduction and muscle growth. Lacking European experience represents an obstacle to further acceptance of the technology.

Materials / method: Materials / method
As one of the first medical centers with HIFEM technology in Europe, we treated patients on both the abdomen and buttocks and collected objective as well as subjective data before and 3 months after the treatments (ultrasound scans of abdominal fat thickness, waist size measurements, weight, patient satisfaction, and blinded photography scoring).

Results: Results
Results of our male and female patients from the past 6 months show simultaneous abdominal muscle growth and overall reduction in tummy fat. Abdominal treatments were also accompanied with improved posture and enhanced core firmness. All this translated into a significantly improved aesthetic appearance. Post-treatment photography of buttocks showed visible changes in the gluteal contours, resulting in a more lifted appearance. Patient satisfaction was high. Lower-BMI and medium-BMI patients seem to have responded much more profoundly to the treatments when compared to obese individual

Conclusion: Conclusion
On our patients treated so far, we have observed results which correlate with the initial HIFEM studies in terms of muscle strengthening and fat layer reduction. This suggests replicable efficacy of the technology. Patient satisfaction was high due to the simultaneous improvement in both tissues. The technology is not suitable for targeting of localized fat pockets, but represents a promising body shaping solution for patients with few extra kilograms of weight whose aesthetic problem is also driven by the underlying musculature laxity.

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Objectives: The objectives of the presentation are to:
1. Provide an overview of di-rhamnolipid (RR) characteristics
2. Compare cytolytic activity of deoxycholate (DC) with RR
3. Provide preclinical data supporting the hypothesis that reduced activity of DC on macrophages can explain increased propensity of exaggerated immune response in a subgroup of DC patients. The results of a diet induced obese (DIO) mouse model will be compared with DC data reported in a non-obese mouse model utilizing the same injection sites, initial concentrations and volumes of DC. (Thuantong R. Dermatologic Surgery 2010)

Introduction: DC injections into subcutaneous adipose tissue (SAT) are associated with increased and protracted inflammatory reactions in a subgroup of patients. Obesity is associated with a substantial increase in macrophage accumulation in subcutaneous adipose tissue, and these macrophages acquire a pro-inflammatory (M1) orientation.
Upon injection of DC in overweight or obese clients, the increased number of resident M1 macrophages at time point of injection may predispose to an exaggerated inflammatory response. A DIO mouse model was used to compare DC and RR to explore this hypothesis.

Materials / method: A standard ex vivo assay using human adipocytes (3 female donors, mean BMI 28.1) compared concentration dependent effect of RR vs DC on adipocyte viability. The assay was performed in duplicate.
DIO (C57/BL6J) mice received injections at recommended DC concentration of 1% into right gluteal fat pads and into tails on d1. Following exaggerated inflammatory response, left gluteal fat pads were injected with 0.5% on d5.
Results were compared to a study which assessed DC injections in non-obese mice.
A literature review was done regarding cytolytic activity of RR and DR against macrophages.

Results: Mean EC50 concentration (w/v) of adipocytes was 0.01% for RR vs. 0.03% for DC.
DIO mice could not receive the planned repeated 1% injections into right gluteal fat pads due to excessive inflammatory responses. Injections of 0.5% DC into left gluteal fat pads resulted in 5 of 5 DC mice presenting with excessive inflammatory reactions versus 0 of 5 mice injected with 0.5% RR. Injected tails showed within-compartment cell lysis by both RR and DC.
Cytolysis of macrophages is achieved by RR at 0.001% (McClure 1992) and 0.05% for DC (Tsunawaki S, Nathan CF. JBC 1984).

Conclusion: Differences in cytolytic profile of RR compared with DC can explain the superior tolerability of RR in a mouse model of obesity. These data indicate that overweight and obese clients injected with DC may have increased propensity to present with exaggerated inflammatory responses.
Further development of RR (RPI-500) for body sculpting and cellulite is warranted. Tolerability and cytolytic profile of RR indicate that a combined ise with devices is feasible and could demonstrate significant synergies in efficacy, thus reducing number of necessary sessions and time to visible benefit.

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请注明日期: US patent granted May, 18, 2018; EU patent pending
和审阅情况: US patent filed August 14, 2015

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Objectives: In this lecture, I will introduce a new novel skin care regiment, which can be associated to many therapeutic technologies to treat, not only the clinical signals of aging, but also to avoid, repair, and enhance the skin quality, rejuvenating the cutaneous tissue, because of cellular disorders and biochemical alterations that occur along the life cycle, and can be measured by aging hall-markers.

Introduction: Due to the advancements in technology, the average of global life expectancy is rapidly increasing day by day. The population of this century has 10 times more expectancy to reach 100 years old than they used to in a recent past. Although the technology gave us the possibility of living longer, it could not stop the natural multi factorial process that involves a general decline in many physiological functions and a deterioration in the maintenance of homeostatic processes over time.

Materials / method: The products were formulated based in three pillars: antioxidant action is the key basis, hallmarks of the aging process, such as genomic instability, telomere shortening, epigenetic alteration, loss of proteostasis, caloric restriction, mitochondrial dysfunction, steam cell exhaustion, cellular senescence, altered intercellular communication and science behind the beauty. The majority of the products available are responsible to treat anti-aging skin process focusing on clinical signals already evident, such as wrinkles, heterogeneous texture, sagginess, face of contour and dyschromia.

Results: However, this new novel skin care brand has more than one hundred scientific studies which verified that the products acts, not only on the evident signals, but also on the cellular lifespan, production of collagen and elastin, promotion of cellular detoxification, control of oxidized proteins and peroxidation lipids, stimulation of the action of telomerase, and reduction of inflammatory process and oxidative stress.

Conclusion: In conclusion, this new purpose of treatment achieve the main cause of the aging process, recovering the homeostasis, the physiological and biochemical reactions, achieving the best results, which can be proved by several studies with cell culture, measurement instruments, and clinical evaluation of patients.

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请注明名称（个人，公司，学会等等）: consultant

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Objectives: OBJECTIVES; Successful treatment of acne scars is uniquely challenging especially in patients with darker skin types because of the concern for pigment disruption with aggressive treatments necessary to achieve significant improvement. In this study the safety and efficacy of a combined treatment protocol including tumescent anesthesia, subcision, trichloracetic acid peel and fractional erbium laser resurfacing was evaluated.

Introduction: Acne is common in ethnic skin. It is controversial whether acne severity in general is more severe in ethnic vs. Caucasian skin types1. Severe inflammatory acne is the cause of rolling acne scars that are characterized by depressed skin attached to a scar band extending from the dermis into the subcutaneous tissue. Subcision and ablative fractional laser treatments have been shown to improve the appearance of rolling acne scars.2-16 A single treatment of rolling acne scars in dark skin with any one modality results in variable improvement. The author has previously published on the tre

Materials / method: METHODS This is a retrospective study of 56 patients (22 females and 34 males) with predominantly rolling acne scars and Fitzpatrick skin types IV – VI who were treated using a combination of tumescent anesthesia, extensive subcision, fractional ablative erbium laser and a blending 20% trichloracetic acid (TCA) peel.

Results: RESULTS The mean improvement after a single treatment, assessed by 3 blinded observers, was 2.78 on a scale of 1 to 4 with an average of 69.5%. Minor adverse effects included temporary post treatment, bleeding, serous transudate, erythema, dermal nodules and hyperpigmentation. There were no cases of permanent pigment. There were no permanent adverse effects.

Conclusion: CONCLUSIONS The combination of tumescent anesthesia, extensive subcision, fractional ablative erbium laser resurfacing and a blending 20% TCA peel (combined procedure) is both safe and effective in the treatment of rolling acne scars in darker skin types with acceptable temporary adverse effects.

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请注明名称（个人，公司，学会等等）: Fotona - discounted laser equipment. Taylor Liberator - I own the patent

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请注明日期: Pending
和审阅情况: Patent pending on "Taylor Liberator" acne scar subcision instrument.

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Objectives: Overcoming the limitations of conventional clinical photography commonly based on a high-resolution camera, standardised illumination sources and a controlled facial posture setup which are well able to capture reproducible photographs with a high level of detail. However, the actual sensitivity to pick up on delicate skin surface appearance details with such technologies is low. The objective was to develop a "digital appearance dissection" and analysis technology linked to the way the facial appearance is build up.

Introduction: Facial beauty can be considered to be the overall perception of the genotypic and phenotypic qualities of the bearer. Throughout evolution, humans have developed a strong socio-cognitive sensitivity when it comes to assessing beauty and attractiveness. The interpretation of someone’s appearance, age and attractiveness is a complex neurological and physiological process in which many different features are intuitively evaluated.

Results: Using various light sources that sequentially illuminate areas of the skin at various angles while capturing the face with a high-resolution camera system, images are obtained exposing all areas of the face in lights while even subtle facial details are captured. This sequence of images is then processed into three images virtually representing a dissection of the facial appearance which separates the facial morphology, the skin surface topography and the dermal texture: slightest appearance change resulting from a treatment can be independently evaluated in each of these categories.

Conclusion: These recent innovations in skin imaging and computer sciences provide the step stones revolutionizing the way the medical aesthetics industry can visualise and proof the effects of treatments.

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Objectives: 1: Skin aging concept, regualtion of aging by neuroimmuneendocrine system
2: Bioactive molecules of neuroimmuneendocrine system in the skin, their caracteristic and properties
3: Alterations in expression of molecules during senescence
4: Future prospects in delay of aging by changin endogenius expression of molecules of neuroimmuneendocrine system.

Introduction: It is well known that the main fundamental processes determining the constancy of the structural and functional organization cell renewal, cytodifferentiation and cell death. Coordination of biosynthesis, exchange and reproduction of genetic information in different cell populations of the epidermis and dermis implemented by classic regulatory systems of the body - nervous, immune and endocrine, forming a local neuroimmuneendocrine system of the skin (NIESS).

Materials / method: Material of the study was cell cultures of human keratinocytes and fibroblasts and skin biopsy of eyelid of women of different age (taken during operation of blepharoplasty). To study the expression of signal molecules during senescence in cell culture we used 4th and 15th passages. With immunofluorescent method we studied expression of pro-collagen type-1, AP-1, sirtuin-1, sirtuin-6, TNFalpha, VEGF, TERF1, calreticulin, MTH-1 in cell cultures and skin biopsies.

Results: We found decreased expression of elastin, MTH-1, pro-collagen type I, sirtuin-1, sirtuin-6, TERF1, calreticulin in senescent cell culture. While expression of AP-1 and TNFα was unregulated. Expression of molecules in skin of women of middle age (40-50) was different compare to expression of senior age (51-60).

Conclusion: We found the alterations in expression of molecules, which regulate neuroimmunoendocrine communications in the skin during senescence. For example, declining with age of calreticulin leads to deterioration of control of protein quality, which leads to destructive changes in aging process. MTH-1 protects against reactive oxygen species and is connected to lifespan. The lack or absence of TERF1 in the cells leads to DNA damage and cellular aging. To delay aging we should find the way to up regulate this factors. One of the possibilities is administration of biomimetic peptides.

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