Objectives: Develop an approach to the patient consultation for body contouring concerns.
Review the most popular body contouring procedures and the ideal candidate for each.
Understand new and emerging technologies and how they can be incorporated into your practice.

Introduction: Body contouring procedures continue to increase in popularity, and we are amidst a wave of new technologies and procedures to offer our patients improved results. Common body contouring concerns involve volume restoration, reduction of adiposity, enhanced muscle toning, lifting and tightening of tissue, and addressing skin laxity.

Materials / method: Technologies employed for body contouring include: radiofrequency and ultrasound devices, cryolipolysis / laser lipolysis / injectable lipolysis, muscle toning devices, tissue micro-coring, injectable fillers and biostimulators, and buttock augmentation and cellulite treatment.

Results: Some of the most common patient concerns include facial revolumization and skin tightening, jawline contouring and reduction of submental adiposity, abdominal toning and fat reduction, and gluteal augmentation and cellulite treatment. Combination treatments can be utilized to provide superior patient outcomes.

Conclusion: We are seeing increasing demand for minimally-invasive body sculpting procedures, and have numerous safe, low-downtime options which are customizable to patients concerns and body type. It is important to gauge patient expectations appropriately.
Minimally-invasive treatments have little to no downtime, but do not provide surgical results. Combination treatment with various mechanisms of action may yield best results. Further long-term studies on efficacy, longevity of results, and maintenance regimens are needed.

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Objectives: To resent effective protocols for the treatment of bite wounds of the face, formed on the basis of own experience

Introduction: A dog is a friend of a man, but a man is not always a friend to a dog, which bites are a serious medical and social problem, since they require a multi-complex emergency approach in the treatment of a patient, which is not always possible. A bite wound inflicted by a dog is itself a risk factor for rabies, tetanus, and purulent fusion of tissues; the scars that form after the completion of treatment often become a pronounced psycho-traumatic factor for the victim. But here is still no single integrated approach to the treatment of these specific wounds.

Materials / method: Patients with different bitten wounds on the face area was admitted to the clinic, where everyone of them underwented combined wound treatment in order to minimize the formation of cicatricial deformities of the face.
Based on the literature reviews on the current studies of wound healing using various hardware techniques, we chose a neodymium laser for wound healing in our patients as a main method in treatment protocol for 100% of patients because of its photobiomodulation effect. Other methods included injections of collagen, BTA, bleomicin, GCS, lipofilling - depending from type of damage

Results: the results are presented in 5 clinical cases with a full analysis of every case treatment from the moment of the dog bite. All of patients received complex treatment, as a result of which they achieved good aesthetic parameters. In process of treatment of one patient with full-thikness wound of upper lip bad and slow regeneration was observed because of damage of microvascular system and unsufficient blood supplying, bud finally all of patients were received good or excellent results.

Conclusion: Animal bites, in particular dog bites, are widespread among unreported recipients of patients in health facilities for the delivery of immigration medical assistance;
The magnitude and importance of treatment varies widely and matters;
In the absence of widespread professional management of the postoperative period, wounds in the facial area follow the formation of rough scars;
Thanks to the development of regenerative medicine, including LLLT, in clinical practice, there are available tools for the qualitative examination of wounds and the prevention of serious scarring.

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Objectives: To demonstrate clinical and ultrasound evidence of the effectiveness of a multi-layer application of high-intensity microfocused ultrasound for the treatment of sagging and fat in the submental region.

Introduction: Double chin is the result of changes in the skin, subcutaneous tissue (fat) and muscles of the submental region. The use of microfocused ultrasound in multiple layers in this region theoretically allows the treatment of these alterations that are at different depths. Clinical evaluation with the aid of three-dimensional and ultrasound imaging systems can be objective tools to confirm the effectiveness of this treatment.

Materials / method: Twelve individuals with CR-SMFRS 2 to 4 were selected, all female. Patients underwent a single session of microfocused ultrasound with the association of linear applicators and pen. The treatment was performed in multilayers: 800 shots with the 7.0mm pen (1.2J), 45 lines of 4.5mm (1.2J), 45 lines of 3.0mm (0.6J) and 800 shots with the 2.0mm pen (0.5 J). Three-dimensional photographs and ultrasound examination were repeated at 6 weeks. In the ultrasound evaluation, an average measurement of preplatysmal fat was used at 9 standardized points in the submental region.

Results: All subjects showed improvement in double chin 6 weeks after the single session of microfocused ultrasound. Ultrasound evaluation demonstrated a mean reduction of 1.2cm (0.3 - 2.34%) in submental fat. The percentage reduction ranged from 6 to 27% (average of 16%). Analysis of the three-dimensional images identified an improvement of one degree in CR-SMFRS in 8 patients and of two degrees in 4 of them. Only mild adverse effects (erythema and local pain) were observed.

Conclusion: The application of multi-layer microfocused ultrasound demonstrated efficacy for the treatment of double chin through three-dimensional clinical images and ultrasound evaluation of preplatysmal fat.

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Objectives: Aims:
1) to systematically review the literature on the safety and effectiveness of combination radiofrequency (RF) microneedling with fractional ablative carbon dioxide (CO2) laser for acne scar treatment.

2) to assess safety and effectiveness in a multi-centre case series.

Introduction: The last five years has seen the use of combination radiofrequency (RF) microneedling with fractional ablative carbon dioxide (CO2) laser for acne scarring, aiming to provide optimal outcomes whilst minimising risks and recovery time.

In this article we aim to: 1) systematically review the literature on the safety and effectiveness of combination RF microneedling and fractional CO2 laser for acne scarring; 2) assess the safety and effectiveness of this combination approach in a multi-centre case series.

Materials / method: Systematic review (PRISMA guidelines followed): Articles that assessed the safety and effectiveness of combination RF microneedling and fractional CO2 laser for acne scarring were included and quality assessed using the Downs and Black checklist.

Case series: Patient records were reviewed from 2 clinics, one in London, UK and the other in Washington D.C., US, to identify patients who underwent a single treatment with RF microneedling and fractional CO2 laser for acne scarring. Outcome assessment was via the Scar Global Assessment (SGA) scale.

Results: Systematic review: Three articles were included and reported improvements in acne scar severity. Adverse effects included erythema, oedema, pain, post inflammatory hyperpigmentation (PIH) and acne flare. Quality scores ranged from 14-15 (maximum of 21).

Case series: Twenty-six patients were included. Mean SGA Score was 3.0 at baseline and 1.3 at follow-up. All patients had an improved SGA score. Adverse effects included erythema, pain, oedema, skin crusting, PIH and acne flare. All patients resumed normal activities within 7-days of treatment.

Conclusion: Combination RF microneedling and fractional CO2 laser appears a safe and effective treatment for patients with acne scarring. A single treatment can result in noticeable improvements in acne scar severity with a short recovery time.

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Objectives: This study was aiming to asses and to compare the efficacy and safety of QSNDY and microneedling in treatment of wide pores

Introduction: Wide facial pores are one of the most common cosmetic problems that are difficult to treat. Many factors contribute to the pathogenesis of wide pores and different modalities have been used to treat them with variable degrees of success.

Materials / method: Forty patients with wide pores were treated by1064 QSNDY laser with topical carbon suspension on one side of the face and the other side was treated with microneedling for six sessions 2weeks apart.

Results: Forty patients with wide pores were treated by1064 QSNDY laser with topical carbon suspension on one side of the face and the other side was treated with microneedling for six sessions 2weeks apart.

Conclusion: Both QSNDY and microneedling appear to be safe and effective for the reduction of facial pore size. Both techniques show comparable results, well tolerated and have mild side effects and low down time.

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Objectives: Our objective was to determine the safety and efficacy of combining photo acoustic and thermal treatment for skin rejuvenation.

Introduction: Skin aging is influenced by multiple genetic and environmental factors that can
manifest in the form of wrinkles, pigmentation, skin laxity. Skin rejuvenation is effectively treated by ablative laser proceduresbut at the price of patient discomfort, substantial downtime, and adverse events.Alternative treatments using non-ablative fractionated laser are increasingly preferred due to their minimal down-time.But no study compared the effect of combining the photoacoustic and
photothermal effect for skin rejuvenation vs the photothermal effect alone.

Materials / method: Patients with mild to moderate facial aging who were treated in our clinic for facial
rejuvenation were decided into 2 groupd. Group A received nonfractional microsecond pulsed ND:YAG laser, Group B received both Q-switched ND:YAG laser and nonfictional microsecond pulsed ND:YAG laser. Standardized high-resolution digital photography of the treatment area was performed for each patient at baseline, before each treatment, on each visit, and at the 2-month follow-up visit, as well as a digital scan using a novel 3D skin vision imaging platform for evaluation and grading.

Results: Twenty one female patients’ ages 44-67 (mean 55 years) completed the treatment and follow-up period, in both groups.Group A showed an overall mild improvement in facial wrinkle surface area (mean improvement of 18% ), as well as a mild improvement in overall pores surface area. Whereas Group B showed a mild-moderate improvement in facial wrinkle surface area ( mean improvement of 27%), with a great improvement in pores depth and surface area. Patient satisfaction was much higher in Group B.

Conclusion: The combination of the QSF-Nd:YAG laser and non-fractional microsec- ond pulsed technology, using a single Nd:YAG 1064 nm laser platform, was found safe and effective as a non-ablative modality for facial rejuvenation, as demonstrated by a novel 3D imaging modality.

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Objectives: Objectives of this study have been patient satisfaction evaluation and side effects in 360-degree photo-rejuvenation with combined Er:YAG and Nd:YAG treatment in Asian patient.

Introduction: Main targets in face laser treatment are the following:
- surface (scars, pores, wrinkles)
- color (spots, angiomas, telangiectasias)
- volume (localized adipose tissue, tissue laxity and atrophy)
The authors have an extended experience with Asian patients. According to the Asian beauty standards, the main Asian patient requirements are to eliminate skin discoloration, enlarged pores, reduce local adipose fat pads, and to obtain lifting and tightening effect. Different protocol Er:YAG and Nd:YAG combination allows to improve all the targets in the same treatment session.

Materials / method: Subjective satisfaction and side effects have been evaluated in 20 patients treated with the combined protocol.
Patients with keratosis, major hyperpigmentations, traumatic scars have been excluded.
Each treatment session, performed monthly for 4-6 times, includes 4 steps:
1 - 2940 nm Er:YAG Smooth intraoral for collagen stimulation in the nasolabial fold area
2 - 1064nm Nd:YAG Short pulse for discolorations and tightening
3 - 1064nm Nd:YAG Long pulse for fat pad reduction and tightening
4 - 2940 nm Er:YAG cold ablative for enlarged pores, scars and discolorations.

Results: 18 out of 20 (90%) treated patients, were higly satisfied with the results. 2 out of 20 patietns (10%) were satisfied, however, requested some extra treatments for skin discolorations and scars. No major adverse reactions have been reported.

Conclusion: Asian patients are extremely difficult to treat with lasers for post-inflammatory hyperpigmenation higher risk. Combined Er:YAG and Nd:YAG treatment allows to obtain satisfying results with low risk of side effects.

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Objectives: Assess the safety and efficace of microfocused ultrasuond in collagen rejeneration and face and neck lifting.

Introduction: Recent studies have shown autologous collagen regeneration, efficacy on face and neck lifting and safety of transcutaneous micro-focused ultrasound procedures. Despite this, guidelines on clinical indications and technical aspects such as the proper number of energy spots to be delivered to the patients are lacking. For this reason, I set up a clinical protocol to maximize clinical effectiveness and safety.

Materials / method: I treated 925 women with a mean age of 51,3 years (range 33 – 64 years) in my cosmetic medical center in Milan (Italy), which presented soft to severe skin ptosis of the face according to APSS (Araco Ptosis Scale System). They received and average of 1.060 spots of micro-focused ultrasound as sole treatment.
I assessed patients with digital photographs, anthera skin analysis and 3d reconstructions with VectraH2.

Results: All patients completed the follow-up after 12 months and no major side effects were reported and good results were recorded.
There were no long-term complications.

Conclusion: The microfocused ultrasuonds represent an excellent clinical method to obtain collagen regeneration and face and neck lifting in certain clinical conditions. The best indication is for mild to moderate facial displacements. Greater clinical efficacy is achieved with a sufficient number of spot delivedered.

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Objectives: In this study, conducted at my clinic, I aimed to determine the efficacy of a fractional non ablative laser (wavelength1550 nm) on improving lip definition, color, volume, perioral skin texture, lip and perioral appearance and reducing nasolabial folds, perioral wrinkles and lines.

Introduction: As far as we can tell, the lips and the perioral area are of outstanding importance in youthful appearance, attractiveness, and beauty. The perioral region is the subunit of the face where aging transformation plays a significant role in someone’s characteristics, appearance, and it has always been associated with youth and beauty. Facial aging is accompanied by perioral hard and soft tissue changes leading to wrinkles, folds, and loss of elasticity. This becomes more pronounced in elderly subjects. The perioral region is subject to a myriad of different treatments for rejuvenation.

Materials / method: For the purpose of this study, 14 women and 1 man were treated every 4 weeks for a total of 3 treatments. They had an anesthetic cream one hour prior to the treatment. The evaluations were performed based on standardized photographs images and measurements of the length of the philtrum before and at the end of the protocol. Improvement was measured in a follow-up visit a month after the final treatment by patient-satisfaction questionnaire and physician evaluation (Likert scale 1-5).

Results: The outcomes confirmed that the patients achieved meaningful aesthetic improvement in lip color (80% of patients), volume (40%), texture (100%), overall lip appearance (100%), and overall perioral aspect (50%). Moreover, 40% of the patients experienced a 3mm decrease in the philtrum’s length, while 30% of them had 2mm decrease and 30% had less than 2mm philtrum’s length decrease. Furthermore, 100% of the patients were satisfied with treatment results. As for the physician evaluation, the results indicated 100% satisfaction.

Conclusion: Therefore, laser treatment using a 1550 fractional non ablative laser on lips and perioral area is a safe, minimally invasive procedure to restore and revitalize the perioral area.

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Objectives: Review the five FDA-approved non-invasive body contouring modalities: cryolipolysis, laser, high-intensity focused electromagnetic field, radiofrequency and high-intensity focused ultrasound.

Introduction: Non-invasive body contouring is a rapidly growing field in cosmetic dermatology. Non-invasive contouring devices improve the body's appearance through the removal of excess adipose tissue, particularly in areas in which fat persists despite optimal diet and exercise routine. The technology can also be used for skin tightening.

Materials / method: literature review

Results: These devices have emerged as a popular alternative to surgical body contouring due to their efficacy, favourable safety profile, minimal recovery time and reduced cost. Although they do not achieve the same results as liposuction, they are an attractive alternative for patients who do not want the risks or costs associated with surgery.

Conclusion: When used appropriately and correctly, these devices have demonstrated excellent clinical efficacy and safety.

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