WWW.5-CC.COM

ABSTRACT JOURNAL

ABSTRACTS of the 11TH 5-CONTINENT-CONGRESS AUGUST 29 – SEPTEMBER 1, 2019 CONTENT WELCOME NOTE

THURSDAY The meeting covers all aspects of medical derma- AUGUST 29, 2019 DAY 1 TEACHING COURSES AND RESIDENTS & FELLOWS DAY 4 tology, energy-based systems, injectable fillers, 9.00 - 11.00h Keeping an Open Mind Series: What Is Homeopathy and Can It Help My Aesthetic Practice? 5 WELCOME 9.00 - 11.00h Residents & Fellows Day 5 neurotoxins, as well as other facets of aesthetics 11.30 - 13.30h New Aspects in Female & Male Rejuvenation 6 to the abstract journal of – from peels to scars to photodynamic therapy. In 14.30 - 16.30h Digital Marketing & Social Media Strategies for Aesthetic Clinics 6 14.30 - 16.30h Vascular Laser Procedures 6 the 11th 5CC conference. addition, we have courses on the business of me- 14.30 - 16.30h Residents & Fellows Day 7 The 5CC is officially dicine – from social media to practice management FRIDAY known as Lasers & Aest- and everything in between. In other words, there AUGUST 30, 2019 DAY 2 SCIENTIFIC SESSIONS 13 hetic Medicine on five is something for everyone at the 5CC, and we are 9.00 - 11.00h Anatomy to Avoid Complications (in collaboration with IMCAS) 14 continents. Over time it thrilled to be once again hosting the 2019 edition in Focus Sessions Medical Dermatology: Psoriasis 15 the beautiful city of Barcelona, Spain. My Body Is My Castle 15 has become known as Future-forward Thoughts on Aging & Aesthetics 18 the 5CC. Since the on- Cosmeceuticals, Skin Care & Home-use Devices (in collaboration with HUD Working Group) 21 set, we have strived to In addition to many new programs and initiatives, 11.45 - 13.45h Fillers – Science & Non-surgical Facial Reshaping 22 make our meetings the we are pleased to release all of the abstracts that Focus Sessions Medical Dermatology: General Dermatology 23 several of our wonderful 5CC faculty have shared Lasers & EBDs – The Sky Is the Limit! 24 most prominent in the Hair – Too Little, Too Much, Never Enough 25 global aesthetic com- with us in this journal. Abstracts, which showcase 14.45 - 16.45h Fillers – From Perioral to Hands 27 munity. As we prepare for the 2019 edition of the the stories and talents of our esteemed faculty and Focus Sessions Medical Dermatology: Androgenic Alopecia & Atopic Dermatitis 28 5CC, we are confident that we have achieved our guests from all over the globe. New „Old“ Trends in Chemical Peelings (in collaboration with IPS) 28 Lasers & EBDs – Newer Technologies = Fewer Complications? 29 objectives, in striving to make each year better. We want this abstract journal to showcase aesthe- 15.45 - 16.45h Ethnic Skin & Global Beauty Symposium (in collaboration with SOCS) 31 There will be new educational developments, soci- tic medicine – from all reaches of the globe, and in 17.15 - 18.30h Anything New in Toxins? 32 al activities, initiatives in learning, and informational Focus Sessions Medical Dermatology: Skin Cancer & Precancerous Skin Conditions 32 technology to keep up with the changing pace and doing so we can share our incredible journeys with Microneedling & Radiofrequency – Dream Team? 33 face of aesthetics around the globe. one another and share our love of dermatology Scars Wars 34 and aesthetic medicine. SATURDAY Planning and organizing an international congress AUGUST 31, 2019 ABSTRACT AWARD & SCIENTIFIC SESSIONS 36 DAY 3 is not easy and finding new ways to teach and ex- Best regards 9.00 - 11.00h Free Communication: Abstract Award 37 plore the various facets of our business remains a 9.00 - 11.00h Defying Gravity – Cosmetic Threading On & Off the Face 43 challenge for everyone associated with meetings Clinical Dermatology – Indications for Lasers & EBDs 44 Decoding the Future of AI & Deep Learning in Dermatology and Aesthetic Medicine 45 and congresses, no matter where they are from. MICHAEL H. GOLD, MD 11.45 - 13.45h Facial Rejuvenation – Don´t Forget the Neck! 46 The 5CC has achieved a global reach and that will Congress President 11.45 - 12.45h What´s on the Horizon in Acne & Acne Scarring? 47 always be one of our prime focuses – to have lea- Partner Country Update: Brazil 48 ding clinicians from all over the globe present cut- 12.45 - 13.45h Partner Country Update: Russia 49 ting edge technology and science. We are pleased

14.45 - 16.45h Hacks for Periocular Rejuvenation & Nose Reshaping 50 to announce that in 2019 we will have over 200 Winning Combinations From Head to Toe 52 incredible dermatologists, plastic and facial plas- 17.15 - 18.30h Aesthetic Treatments for Our Millennium Generation – Options for Young Patients 53 tic surgeons, and aesthetic experts from over 80 (in collaboration with ISDS) Perfect Skin – Keeping the Promise 53 countries worldwide.

SUNDAY SEPTEMBER 1, 2019 DAY 4 SCIENTIFIC PARTNER DAY 55 9.00 - 11.00h IS4AC – Global Approach to Aesthetic Complications 56 GROUPE LASER DE LA SFD – Acne Scars: Treatments & Combinations 57 GSAAM & ESAAM International Anti-aging Symposium 58

11.30 - 16.00h DASIL Dermatologic & Aesthetic Surgery Course 2019 60

11.30 - 13.30h TDA – New Advances in Aesthetics and Dermatology: An Asian Perspective 62

14.00 - 16.00h AFRAD Advances in African Dermatology 64 Reconstructive & Cosmetic Surgery Panel – Face, Breast & Body 64

3 TEACHING COURSES AND RESIDENTS & FELLOWS DAY

9.00 - 11.00h INTRODUCTION Fake news is a type of propaganda that consists of de- TEACHING COURSES AND KEEPING AN OPEN MIND SERIES: WHAT IS liberate disinformation or hoaxes spread via traditional RESIDENTS & FELLOWS DAY HOMEOPATHY AND CAN IT HELP MY AESTHETIC PRACTICE? print and broadcast news media or online social media. Although Fake news makes headlines today, it is actually nothing new and has been present for centuries.

 KEEPING AN OPEN MIND SERIES: WHAT IS MATERIALS / METHOD HOMEOPATHY AND CAN IT HELP MY AESTHETIC PubMed, web and social media searches using key PRACTICE? words specific to the topic of this lecture. Lawrence Chukwudi Nwabudike  Romania THURSDAY RESULTS omplementary and alternative (CAM) medicine Fake news has received fresh political attention since the AUGUST 29, 2019 C use is on the rise amongst patients. A number of last US presidential election, but all domains are subject therapies have become part of mainstream medicine. to it. Healthcare is far from exempt and the situation to- day has even been referred to as “The Fake News Epi- Homeopathy is met with skepticism by the medical es- demic in Health”. On one hand it’s never been easier to tablishment, as its principles appear to contradict mo- get health information; on the other it’s never been so dern mainstream medicine. This same reticence builds misleading. In this lecture, after reviewing the current distrust between patients and their physicians, contribu- threats and contributing factors, we will discuss counter- ting to significant numbers of patients using homeopathy measures. and CAM without informing their physicians. CONCLUSION In this course, held by 5CC Abstract Award winner 2018 Doctors have decades of experience fighting Fake LAWRENCE CHUKWUDI NWABUDIKE , the history, pu- news. Evidence-based medicine and the Peer Review tative mechanisms of action, areas of use in dermatolo- process are tools that help to debunk misinformation, gy and cosmesis will be explained. Finally, a few prescrip- but nowadays evidence alone is not enough. Doctors tions that physicians can try for themselves will be offered. are also needed on social media where they can have a unique role in educating the public, promoting good At the end of the session, the physician should be know- practice and pushing back misinformation. Efforts need ledgeable of to be part of a holistic movement.

¡ the principles of homeopathy, ¡ its mechanisms of action,  I’VE GRADUATED… SO NOW WHAT… ¡ possible areas of use Jay A. Shorr  USA and will feel in a better position to hold meaningful dialo- gues with her/his patient, thus building better trust. Also, HOW TO PROPERLY NEGOTIATE YOUR EMPLOYEE her/he may feel able to try some simple prescriptions, AGREEMENT thereby enlarging the scope of therapies on offer in her/ aking the decision to venture out on your own can his practice. M be the key to your future and stressful all at the same time. Knowing the proper steps to take and nego- tiating the terms and conditions of your new employee/ associate/partnership agreement can make or break 9.00 - 11.00h you. RESIDENTS & FELLOWS DAY This session will share the top steps you need to be awa- D A Y re of prior to accepting what is placed in front of you. We will list the top items you should be negotiating, and how  FAKE NEWS you rank amongst your peers. Dominique Du Crest  France WHAT TO INCLUDE IN YOUR PRACTICE’S BUSINESS PLAN? OBJECTIVES Every practice should have a mapped out plan for future xplain what can be the role of each doctor to de- growth. Whether you are opening a brand new practice E bunk misinformation. (and the bank requires a pro forma or business plan) or 1 you are projecting for the future, you must have a plan.

THURSDAY  AUGUST 29, 2019 5 TEACHING COURSES AND RESIDENTS & FELLOWS DAY TEACHING COURSES AND RESIDENTS & FELLOWS DAY

Learn how to create and plan for future goals, objecti- the literature and focus on this highly successful novel biological response. clinical practice to achieve a very large number of highly ves and direction. We will show you how to develop this method of treatment. ¡ Analyze a vascular lesion to establish its biological cha- effective treatment effects, from all of the many aspects roadmap, which items are necessary before you start, racteristics. of wound healing in both acute and chronic wounds of and tips and tricks of what you’ll find along the way. all aetiologies, in both soft and hard tissues, to the ga- ¡ Establish the most appropriate wavelength and light mut of pain control in all its myriad facets. LED-LLLT can source to be applied in every vascular condition. THE BENEFITS OF PROPER EMPLOYEE SELECTION 14.30 - 16.30h also be applied noninvasively to treat acne vulgaris and Training, Retaining and Motivating Your Most Valuable ¡ Select the most appropriate parameter combination DIGITAL MARKETING & SOCIAL MEDIA is proving really useful in managing other difficult-to-treat for a specific vascular lesion. Employees: In the beginning, a brand new practice sur- STRATEGIES FOR AESTHETIC CLINICS skin conditions, with light only or in combination with ap- vives on the same motto as any other business: doing ¡ Adjust the treatments conditions to the response of propriate pharmaceutical agents. more with less. However, with success must come the vessels and tissue. growth. One of the most common questions received Photobiomodulation, underpinning LED-LLLT, is real,  SOCIAL MEDIA FOR AESTHETIC CLINICS – ¡ Know, prevent and treat the possible complications of is this: “When is it time to hire another team member?” and really works. Searching the term LLLT in PubMed STRATEGIES FOR SUCCESS 2019 vascular laser procedures. Understand the benefits and pitfalls of proper/improper will bring up over 5,700 hits. LED-LLLT for the clinician is Wendy Lewis  USA employee selection, as well as the costs associated with COURSE PROGRAM here, and is here to stay … no hype, only hope! recruiting, hiring, training, incentives and retention… in 1. Introduction to the physics of light-tissue interaction. n this comprehensive workshop, New York City-based other words, how to get (and keep!) your new favorite 2. Light sources for vascular lesions: protocols and global marketing consultant and digital media maverick employee from the start. Having issues with handling in- I indications.  LASER & IPL; BASICS AND SAFETY WENDY LEWIS, author of Aesthetic Clinic Marketing in the fectious employees? We’ve been there! Learn the pro- 3. Case discussion: before, treatment video and after. Godfrey Town  United Kingdom Digital Age (CRC Press), will share her personal experien- per and legal methods of eliminating them as well. ce and most useful tips for how to be effective on social asers and intense light sources (ILS) are subject to media. This intensive digital marketing workshop will fo- THE TOP 6 NEGOTIATING TIPS EVERY BUSINESS PERSON L standards and regulatory controls because of the SHOULD KNOW: cus on best practices for creating shareable content, ele- 14.30 - 16.30h unique potential hazard they pose to tissues of the eye ¡ Does the thought of asking for things on your terms vating your profile, building a loyal fan base, and growing and skin, including the risk of blindness and skin burns. make your stomach do back flips? your brand on Instagram. Examples for what to do and RESIDENTS & FELLOWS DAY what to avoid, social media posts and planning calendar, ¡ Do you hate the thought of having to ask for the This talk reviews the progress of the new EC Medical De- content and engagement strategies for the most relevant dollars you know should already be in your pocket? vice Directive (MDD) and Regulations (MDR) first publis- platforms for aesthetic practices shall be provided. This  EMITTINPHOTOBIOMODULATION WITH LIGHT- hed in May 2017 which comprise requirements related workshop promises to generate a lively debate, with extra EMITTING DIODES (LED-LLLT) Learn how to properly negotiate everything in your busi- to the safety and performance of medical devices and time for questions and discussion from attendees. R. Glen Calderhead  South Korea ness, including office space, supplies, equipment, ban- which replace the current Directive (93/42/EEC). Due king and credit cards, accounting/legal, financing terms for full implementation by May 2020, the MDR captures ften at best poorly understood, and far too often and staff pay and incentives. We’ll give you real life exam- both medical devices and appliances without a medical simply ignored, photobiomodulation is possibly the ples of the benefits and pitfalls of proper negotiation, and O purpose emitting high intensity electromagnetic radia- 14.30 - 16.30h most exciting avenue to excellence in the medicine of each attendee will walk away with the understanding of tion in the wavelength range 180-3000 nm used by pro- the 21st century. Photobiomodulation is the approved how to be a better negotiator. VASCULAR LASER PROCEDURES fessional practitioners and consumers to perform skin term applied to describe the effect of light energy on an treatments such as hair and tattoo removal. organism at cellular and subcellular levels, resulting in some form of activation or deactivation. The actual cli-  VASCULAR LASER PROCEDURES A first draft of an Implementing Regulation on common nical indications based on photobiomodulation compri- 11.30 - 13.30h Antonio Campo Voegeli  Spain specifications (CS) for devices without an intended medi- se low level light therapy, LLLT, and the most common NEW ASPECTS IN FEMALE & cal purpose has been developed by European Commis- light source now used for this is the humble light emitting MALE REJUVENATION n this course, Dr. Campo will first review the physics of sion COM service in collaboration with Member States diode, or LED, giving LED-LLLT. When one activates the light-tissue interaction and the application of these prin- and issued in February 2019 for public consultation and I accelerator of a car it moves faster, and when one acti- ciples in the management of vascular lesions. He will di- will be considered by MDCG subgroups before publicati- vates the brake, it moves more slowly. The ideal speed scuss how to evaluate the patients to decide the most on. The talk reflects on likely impact on laser and ILS ma-  LI-SWT FOR ERECTILE REJUVENATION of a car is modulated by these two actions depending on appropriate wavelength to be used in every case as well nufacturers and distributors and the effect on marketing David J. Goldberg  USA conditions, which is a good analogy for the modulation of as the algorithm to select the ideal treatment parameters of both professional devices and home-use light-based cellular activity to acieve a specific clinical effect, so the and how to adjust them according to the immediate tis- appliances to the general public. ow Intensity Shockwave Therapy has been FDA clea- correct understanding of LED-LLLT is essential when ap- sue response. L red for the treatment of cellulite. Because the me- plying photobiomodulation to restore an ideal balance, A review will be provided of relevant recent standards chanism of action is one of inducing micro-trauma, new and deal with the problem being treated. vessels are formed post-treatment. This treatment has This theoretical training will then be applied to the discus- including particular requirements for consumer laser sion of cases which will be showed with before and after products and the development of educational standards now been shown to be highly effective for vascular in- This presentation on LED-LLLT will offer the attendee a pictures as well as with treatment video. and requirements for users of lasers and IPL. duced erectile dysfunction irrespective to the response solid, but hopefully interesting, background to the pho- to PDE5i oral agents. This approach represents a radical tobiological basics behind LED-LLLT, but will also illust- At the end of this course the attendees will be able to: new, simple, approach to promote erectile rejuvenation rate how these basic principles can be applied in actual and enhanced male sexual wellness. This talk will review ¡ Understand how light acts on the tissues to induce a

6 THURSDAY  AUGUST 29, 2019 THURSDAY  AUGUST 29, 2019 7 TEACHING COURSES AND RESIDENTS & FELLOWS DAY TEACHING COURSES AND RESIDENTS & FELLOWS DAY

 LASERS IN DARK SKIN creases [FIGURE 1,2]. The palmar and digital crease LASER SCIENCE TABLE 1 Eduardo Weiss  USA color hue is a way to predict the propensity of various The main principle describing the use of laser therapy Fitzpatrick phototypes to experience post-inflammatory is the concept of the target chromophore [FIGURE 3]. LASERS THAT TARGET VASCULATURE COSMETIC LASER PROCEDURES IN PATIENTS hyperpigmentation. The scale ranges from 0 to 3, with A chromophore is a substance which absorbs specific Pulsed dye laser (585, 590, 595, 600nm) WITH MIXED SKIN TONE the highest number indicating a darker skin tissue res- wavelengths depending on its absorption coefficient. ABSTRACT ponse despite skin phototype [3]. In general, a provider The three main endogenous chromophores targeted in Intense pulsed light (400 to 1200nm) ispanics/Latinos are one of the fastest growing must be cognizant of their patients with mixed color tone lasers procedures are melanin, hemoglobin, and water. Neodymium:yttrium aluminum garnet H segment in the skin of color population in the Uni- in order to properly consult and discuss realistic expec- Melanin and hemoglobin are major chromophores for (Nd:YAG) (532, 1064nm) ted States. Utilization of lasers especially in people with tations as well of potential risks. visible & near-infrared light while water is a major chro- Long-pulsed alexandrite (755nm) skin of color requires a thorough understanding of laser mophore for far-infrared spectrum. For tissue damage to Long-pulsed diode laser (810nm) physics and laser tissue interactions. In this article, we will ensue, a wavelength should be preferentially absorbed outline the different lasers used in our practice based on by the chromophore in the target tissue and not the sur- each chromophore. Pretreatment recommendations as rounding tissue which may cause undesired effects (ie. PULSED DYE LASER well as management of complications will also be shortly dyspigmentation, scarring). To ensure maximized heat The pulsed dye laser (PDL) is a treatment of choice for discussed. Our goal is for the readers to grasp the im- delivery to the target chromophore and the least risk to vascular lesions such as telangiectasias. The 585nm portance of proper device selection, understand the surrounding tissue, the wavelength delivered in a pulse wavelength pulsed dye laser penetrates to a desired concept of selective photothermolysis and the various duration should be less than or equal to the thermal rela- depth of approximately 1.2 millimeters (mm). The longer treatment parameters required for optimal safety and xation time (TRT) of the target, a principle known as se- 595nm wavelength allows for a slightly deeper penetra- efficacy. lective photothermolysis [4]. There are several laser pa- tion; however, the absorption coefficient of oxyhemog- FIGURE 1 rameters that when taken in consideration can attenuate lobin is 3 times higher at 585nm than 590nm. In our opi- DEFINING SKIN OF COLOR the risk of hyperpigmentation and scarring, especially nion, the 585nm pulsed dye laser is superior in treating Definingskin of color in the Latino population can be par- in mixed color tones. These parameters include longer the vascular lesions such as port wine stains. In addition, ticularly challenging as it encompasses several cultural wavelengths, longer pulse duration, lower fluence, lower both wavelengths are suitable for lighter complexioned and historical aspects. In general, skin of color identifies densities (MTZ/cm2), efficient cooling (pre, concurrent, skin tones (phototype IV and lighter). For darker photo- racial groups with darker skin hues other than that of whi- post) and smaller spot size. types V and VI, longer wavelengths should be utilized for te skin. The five racial categories defined by the US Cen- treatment of vascular lesions. In addition, longer pulse sus Bureau are American Indian or Alaska Native; Asian; durations should be used as it is safer in darker-skinned Black; Native Hawaiian or Pacific Islander; and White. The individuals. Treatment recommendation for rosacea Hispanic population is estimated to rise from 55 million in with telangiectasias include 515nm with pulse duration 2014 to 119 million in 2060, an increase of 115 percent. By FIGURE 2 between 12-15 (milliseconds) ms or higher. Alternatively, 2060, 29 percent of the United States is projected to be rosacea with telangiectasias and pigmentation require Hispanic—more than one-quarter of the total population 570nm with pulse duration between 12-15ms or 500- [1]. This increase in population becomes pertinent as it PRETREATMENT 600nm with pulse duration between 12-15ms. follows with an increase in demand by people with mixed Safe treatment starts with a thorough pretreatment. We color tones for dermatologic laser procedures. Most of believe it is better to avoid laser procedures during the INTENSE PULSED LIGHT the current medical literature on cosmetic laser proce- summer, when skin is at its darkest and there is a higher While there are many Intense Pulsed Light (IPL) devices dures have been devoted to individuals with fair skin to- risk for sun exposure after treatment. A thorough history available, the newer generation of IPL devices are as safe nes (skin phototypes < III). One study determined that is obtained including history of hyperpigmentation due to and effective as lasers in the management of skin con- the most common skin problems affecting this group are other traumas, allergy to lidocaine, personal or family his- FIGURE 3 ditions in darker skin tones. The patient’s skin phototype photoaging, facial melasma, hyperpigmentation, acne tory of photosensitizing conditions (ie. lupus erythemato- and skin condition will determine the choice of suitable vulgaris, and eczema/contact dermatitis [2]. The Latino sus), herpes simplex, and recent intake of tetracycline or cut-off filters and therefore the spectrum of wavelengths population runs the gamut of Fitzpatrick phototypes isotretinoin. Strict photo avoidance is discussed as well CHROMOPHORE: HEMOGLOBIN to be emitted. The same principles that apply to lasers and must be considered as a “one size does not fit all as protective measures including application of > SPF60 Vascular lasers, when used at the appropriate setting, to reduce the risk of hyperpigmentation after treatment approach”. Several ways to define skin of color as well and oral sun protective supplement intake such as He- can treat both light and dark skin tones in the Latino po- are also true with IPL. FIGURE 4 depicts improvement predict higher risk patients have been described. We will liocare, an oral extract of the Polypodium leucotomos pulation. The main vascular chromophore is oxyhemog- of vascular and pigmented lesions using the IPL device. refer to the Fitzpatrick phototypes throughout the artic- fern. We also recommend a 6-week regimen aimed at lobin. Darker phototypes (IV – VI) have more epidermal le. Although general skin tone color may provide a good lightening the area to be treated. The pretreatment regi- melanin that acts as a competitive chromophore against prediction about the potential for hyperreaction to lasers, men includes the application of hydroquinone 4-8%, the hemoglobin and oxyhemoglobin, therefore caution must we also use a simple, yet effective additional screen in Miami Peel (modified Jessner’s with kojic acid and hy- be taken when targeting vascular lesions. Table 1 outli- the office: palmar and digital crease pigmentation. First droquinone), and/or Kligman’s formula. A test-spot with nes the lasers we use in our practice for vascular lesions described by Hector G. Leal-Silva, MD, of the Institute of follow-up in 2-4 weeks is also encouraged one month following with a discussion of selected lasers and skin Dermatology and Cosmetic Surgery, Monterrey, Mexico, prior to treatment. Lastly, antiviral and antibiotic therapy is conditions. the screen divides patients into four groups, depending prescribed to the patient depending on laser device and on the concentration of pigment present in their palmar treatment location. FIGURE 4

8 THURSDAY  AUGUST 29, 2019 THURSDAY  AUGUST 29, 2019 9 TEACHING COURSES AND RESIDENTS & FELLOWS DAY TEACHING COURSES AND RESIDENTS & FELLOWS DAY

CHROMOPHORE: MELANIN Although there is no difference in the melanocyte den- TABLE 2 TABLE 3 sity between Fitzpatrick phototypes, there is certainly LASERS RECOMMENDATIONS FOR MELASMA RESURFACING LASERS THAT TARGET WATER an increase in the number and size of melanin granules IPL 570-580nm Fractional within the basal layer keratinocytes in darker-skinned in- • Low fluence, internal and external cooling, long • Fractionated 1550-nm erbium doped fiber laser dividuals. This large amount of melanin within the epider- pulse duration (6-8 j/cm2-15ms) Nonablative mis of darker skin types competitively absorbs laser light Fraxel 1550nm • Nd:YAG 1064 nm targeted for other chromophores. Subsequently, with • Low fluence, few passes, more sessions Ablative the broad absorption spectrum of melanin, ranging from • The density used varies from 2000 to 2500 • CO 10,600 nm 250 to 1200nm, greater care and diligence must be ta- MTZ/cm2 and energy levels 6 to 10mJ/ms. 2 ken when using lasers on Latino skin. A selective window The treatment sessions vary from 2 to 6 at an FIGURE 5 for targeting melanin lies between 630 and 1100 nano- interval of 1-4 weeks SKIN REJUVENATION meters (nm), where there is desired skin penetration and Ablative pixelated Er:YAG 2940nm Traditionally, ablative lasers, such as the carbon dioxide preferential absorption of melanin over oxyhaemoglobin. MELASMA (CO2) and Erbium:YAG have been the gold standard in Affirm MPX Dual Fractional Laser 1320/1440nm Absorption for melanin decreases as the wavelength Melasma treatment is one of the most difficult and frust- rejuvenation but can cause several unwanted side ef- increases, but a longer wavelength allows deeper skin rating conditions to manage and unfortunately a very Picosecond 1064nm Laser fects in Latino skin. Specifically, it has been described to penetration. Shorter wavelengths (<600 nm) damage common condition among Latinos. The origin of hyper- cause hyperpigmentation in 31% of all skin types increa- pigmented cells with lower energy fluencies, while lon- pigmentation can be epidermal, dermal, junctional or a sing to 50% in type III Fitzpatrick skin phototypes [5]. In ger wavelengths (>600 nm) penetrate deeper but need combination. A wood’s lamp can be used to determine addition, there can be a delayed onset of hypopigmen- more energy to cause melanosome damage. A longer the depth. Given melasma has a hormonal component tation and transient erythema lasting months. The in- pulse duration delivers slower laser light resulting in mit- and is essentially caused by ultraviolet light exposure, it is crease in adverse effects when resurfacing patients with igated epidermal heating. Consequently, epidermal co- expected to almost always return after treating. It is im- skin of color makes pre-treatment and patient selection oling is more effective thereby reducing rapid heating portant to counsel patients that treatment does not cure important in order to reduce these outcomes. Some and damage to the melanosomes. The calculated TRT their melasma. We generally turn to a laser when the more appropriate treatment alternatives for darker skin of melanosomes is less than 1 microsecond correspon- case is resistant to more conservative treatment, which types include non-ablative infrared, micro needling, and ding to 250 to 1000 nanoseconds. As previously discus- includes topical skin lighteners including Kligman’s formu- radiofrequency devices. sed, a pulse duration less than the TRT will decrease risk la, and/or light peels, or oral tranexamic acid. In general of damage to the melanosome. lasers have revolutionized the treatment of dermatolo- The newer category of micro-ablative resurfacing lasers gical disorders but its place in the management of me- (fractional CO , fractional Erbium, and the 2790nm Ytt- FIGURE 6 2 HAIR REMOVAL lasma and post inflammatory hyperpigmentation (PIH) rium Scandium Gallium Garnet [YSSG]), offers a safer With the advent of lasers with longer wavelengths, lon- is still controversial. The QS-Nd:YAG is the most widely modality with which to treat Fitzpatrick skin type IV and ger pulse durations, and efficient cooling devices, all skin used laser for the treatment of melasma. Our parame- above. Compared to the older generation resurfacing types can be treated with lasers for hair removal with re- ter recommendation includes fluence less than 5 Joules/ CHROMOPHORE: WATER lasers the micro- ablative lasers minimize the amount duced risk of adverse outcomes. Caution must be taken cm2, spot size 6 mm, and frequency of 10 Hz. Heat can Water is the targeted chromophore in most resurfacing and duration of erythema and edema which can last just when performing laser treatments in patients with a tan, exacerbate melasma, therefore a single pass should be procedures. Ablative resurfacing creates a controlled three to four days. A recent retrospective study of Chi- in fact, it should be avoided to prevent adverse effects performed on each area to be treated prior to additional partial-thickness damage down to the dermis, therefore nese patients treated with the 1,550nm erbium-doped as seen in FIGURE 5. As the provider, it is important to passes. Specifically, up to three passes are performed, use in phototypes V and VI is usually not indicated due fractional laser (Fraxel 1550, Solta Medical) found that ensure that the handpiece is perpendicular to the skin allowing the tissue to properly cool between passes. to the risk of dyspigmentation and scarring. The emer- using fewer passes per treatment, but increasing the to- surface and to avoid overlapping during pulses. It is also The toning procedure will utilize low fluence with a large gence of the nonablative resurfacing lasers has allowed tal number of treatments was associated with a lower essential to confirm the cooling device to functioning spot size. The number of treatment sessions varies from people of darker skin tones an opportunity to treat pig- risk of post-inflammatory hyperpigmentation without properly before starting the procedure. We believe two 5 to 10 at 1-week intervals. Rebound hyperpigmentation mented skin condition, rhytides as well as skin texture compromising efficacy [6]. wavelengths are generally appropriate for use in dark could be due to the multiple sub threshold exposures with less risk of side effects. Fractional or pixelated re- Latino skin which include the Diode laser 810nm at low that can stimulate melanogenesis in some areas, and/ surfacing is another safe nonablative device that can be MANAGEMENT OF COMPLICATIONS fluence and high repetition rate “in motion” (up to photo- or inflammation with secondary PIH. Monthly or quarterly used for resurfacing in people with skin of color. We out- One of the most common malpractice lawsuit is laser types V) and Nd:YAG 1064nm (up to phototypes VI). maintenance is performed to maintain results. The use of line the lasers we use in our practice for resurfacing in complications. It is important to ensure that all laser prac- pulsed dye laser (PDL) for the treatment of melasma is TABLE 3. titioners are certified and that providers have reviewed FIGURE 5 based on the theory that skin vascularization plays an im- laser laws their state. Pre and post-treatment photos are Patient has been treated with multiple sessions with no portant role in the pathogenesis of melasma. Particularly, essential. It is also important to document settings and complications but was vacationing and tanned prior to it is known that melanocytes express vascular endothe- informed consent. If an issue arises, the provider should the below session. The patient developed post-inflam- lial growth factor receptors which cause the telangiecta- make themselves available 24/7 and prepare for a lot of matory hyperpigmentation. sias. TABLE 2 outlines the lasers we use to treat melas- hand holding. The best treatment for complications is ma. FIGURE 6 depicts a Latina patient treated with two prevention. TABLE 4 outlines acute and chronic compli- sessions with the Picosecond 1064nm laser two weeks cation management that we practice in our office. apart.

10 THURSDAY  AUGUST 29, 2019 THURSDAY  AUGUST 29, 2019 11 TEACHING COURSES AND RESIDENTS & FELLOWS DAY

REFERENCES TABLE 4 1. U.S. Census Bureau (2015). Projections of the Size and ACUTE Composition of the U.S. Population: 2014 to 2060. Retrieved from https://www.census.gov/content/dam/Census/libra- SCIENTIFIC SESSIONS Superficial erosions/bullae ry/publications/2015/demo/p25-1143.pdf. • Clean with a mild soap 2. Sanchez MR. Cutaneous diseases in Latinos. Dermatol • Silver sulfadiazine Clin 2003;21:689–97. Infectious (bacterial and viral) 3. Rossi AM, Perez MI. Laser therapy in Latino skin. Facial • Treat accordingly with antibacterial or antivirals Plast Surg Clin North Am. 2011 May;19(2):389-403. Erythema/Pruritus 4. Anderson RR, Parrish JA. Selective thermolysis; precise • Control inflammation with a short pulse of a microsurgery by selective absorption of pulsed radiation. potent topical corticosteroid Science 1983;220:524–7 • Intralesional 5FU/Kenalog 5. Tan KL, Kurniawati C, Gold MH (2008) Low risk of post- FRIDAY CHRONIC inflammatory hyperpigmentation in skin types 4 and 5 after Pigmentation treatment with fractional CO2 laser device. J Drugs Derma- AUGUST 30, 2019 • Hyperpigmentation tol 7(8):774–777 • Hydroquinone 8-10% cream 6. Battle E. Cosmetic laser treatments for skin of color: a • Lasers: IPL or qsNd:YAG focus on safety and efficacy. J Drugs Dermatol:January • Sunscreen, SPF60 2011;10(1):35-38 • Hypopigmentation • Moisturization • Latisse • Sun exposure • Scarring • Short pulses of potent topical steroid, Intralesional 5FU/Kenalog

• Fractionated Er:YAG or CO2 • PDL and IPL at 515nm

CONCLUSION The use of lasers in people with skin of color requires an understanding of laser physics and laser tissue interac- tions. It is very important to be familiar with the laser de- vice as not all energy based devices work similarly. The Latino population encompasses the range of all photo- types and therefore one rule cannot apply to all Latinos. Proper selection of device, wavelength, and treatment parameters are essential for safety and efficacy. In addi- tion, Pre-and post-treatment protocols are pivotal in the prevention of dyspigmentation and scarring.

D A Y 2

12 THURSDAY  AUGUST 29, 2019 SCIENTIFIC SESSIONS SCIENTIFIC SESSIONS

9.00 - 11.00h THE MIDDLE PLANE WITH 7 MUSCLES HAS A CONVEN- 9.00 - 11.00h 9.00 - 11.00h TIONAL COLOUR IN GREEN: ANATOMY TO AVOID COMPLICATIONS 1. ZYGOMATICUS MAJOR FOCUS SESSIONS MEDICAL MY BODY IS MY CASTLE (IN COLLABORATION WITH IMCAS) 2. LEVATOR LABII ALAQUE NASI DERMATOLOGY: PSORIASIS 3. LEVATOR LABII SUPERIORIS 4. DEPRESSOR LABII INFERIORIS  ELECTROMAGNETIC FIELD APPLIED TO  3 PLANES OF MIMIC MUSCLES PREREQUISITE 5. ORBICULARIS Oris  NON-BIOLOGIC SYSTEMICS FOR PSORIASIS ABDOMINAL FAT REDUCTION FOR FACIAL INJECTIONS 6. RISORIUS Thomas Dirschka  Germany Ghislaine Beilin  France Roger E. Amar  Spain 7. PLATYSMA soriasis represents a chronic, immune mediated INTRODUCTION o learn the origin and insertion of the 16 muscles THE SUPERFICIAL PLANE WITH 5 MUSCLES HAS A CON- P systemic disease characterized by erythematous, ccording to various researches, abdominal obesity T in a half face is becoming mandatory to the doc- VENTIONAL COLOUR IN BLUE: inflammatory pruritic plaques of the skin. Several pro-in- A increases health risks. tors who wants to improve their skills in Botox and filler 1. FRONTALIS flammatory cytokines serve as inflammatory drivers of to make safe injections and/or to use the adipose stem 2. PROCERUS skin and systemic inflammation leading not only to skin RECOMMENDED PROTOCOL cells for rejuvenation and repair. 3. ORBICULARIS OCULI plaques but also to comorbidities. 12 sessions of 30-45 min (2 sessions/week) 4. ZYGOMATICUS MINOR METHODS The face is typically divided into six layers. Moving from 5. DEPRESSOR ANGULI ORIS Systemic disease requires systemic treatment approa- Several studies were made: superficial to deep, these include the skin, superficial fat ches. Current treatment algorithms on psoriasis very ¡ a double-blind randomized study performed on 28 compartments, SMAS, superficial facial muscles, deep To make these plans easy to memorize, we have pain- much focus on administration of biologics which directly patients with a waistline >88 cm/35 inches for women fascia and deep fat compartments, and the retaining li- ted the muscles in their conventional colour on the white interfere with pathogenetic inflammatory cytokines. and >102 cm/40 inches for men for a period of 6 gaments that anchor the overlying structures to the pe- face of a MIME. It became easier to remember the weeks riosteum of the facial bones. muscles responsible for each facial expression. APART FROM BIOLOGICS THERE ARE NON-BIOLOGICS SYSTEMIC TREATMENTS APPROVED FOR CHRONIC ¡ a functional analysis on DNA chips performed on 11 PLAQUE PSORIASIS: Classically the mimic muscles are organized into six patients showing proven overweight Methotrexate has been used for plaque psoriasis since groups based on their common insertion sites as the up-  ANATOMY TO AVOID TOXIN TREATMENT ¡ a functional study on fertility of overweight female the 1960s. At a dose of 17.5mg qwk a PASI 75 can be per and lower lips, at the nose, at the two orbits and at COMPLICATIONS patients performed on 38 patients candidate for an reached in 51% of patients. PASI 90 can be achieved in the scalp. Hugues Cartier  France IVF (1st or 2nd attempt) with a BMI > 25 Kg/m2 for a 29% of patients at good safety profile. period of 6 weeks BACKGROUND As long as it is a matter of enumerating the facial muscles ¡ a scanner imaging study performed on 20 patients he use of botulinum toxin is so simple. Nonetheless, Cyclosporine is characterized by rapid onset of action during this way to classify the 30 mimic muscles may be accep- showing a decrease of total abdominal fat of 12% in it is also simple to obtain a bad result in the upper the induction phase of treatment. Toxicity (e.g. kidney, blood table, but when it comes to injecting these muscles, an T average (visceral 8,2% and subcutaneous 4,1%) pressure elevation) impacts its long-term use. Fumaric acid anatomical expertise is necessary to avoid the destruc- face as in the lower face, which that area more complex. derivatives have been used in Germany since the 1990s. In tion of different muscles in different planes. The anatomy of the face is complex, as the muscles are RESULTS 2017 dimethyl fumarate has been approved for plaque pso- very close together and interface at different levels and Following our studies after a 12-session cure, clinical riasis by the EMA. Relatively slow onset of action, flushing Therefore, in the early 2000 years, after dissection of depths to perform heterogeneous functions with anta- pregnancy rates after IVF in an obese infertile population and gastrointestinal adverse events are characteristics of more than 50 half-faces, and hundreds of live injections gonist function. of 55.55% has been observed and CT scans showed this class of drugs. Efficacy with regard to PASI 75 is higher with FAMI cannulas, I described the 3 planes of theses an average decrease in the visceral fat of 8,2% and to METHODS than methotrexate but lower than biologics. muscles according to their functions, the facial expres- a lesser extent a decrease of subcutaneous fat of 4,1%. Based on the anatomical knowledge of each muscle of sions. Apremilast is an oral anti-psoriatic medication with a high the face provides recommendations and guidelines to CONCLUSIONS perform botulinum toxin injection safely. The review of safety profile. Lab tests are not required before and du- A deep structural plan for muscles that stick on the sur- Facing an alarming increase in overweight and obesity each muscle with its relevant anatomy and relationship ring treatment. Efficacy is lower than in the aforemen- faces of the skull. The Middle plane for smile and speech and considering the current therapeutic gear offering va- of this three-dimensional anatomy with the cutaneous tioned drug classes, however, nail psoriasis has been and the superficial plane showing our emotions. rious results, it seems interesting to focus on health be- plane gives as possible the exact position of injectable shown to be targeted effectively. nefits of BioMagnetic field, also called BioStimology. The THE DEEP PLANE WITH 4 MUSCLES HAS A locations. clinical studies demonstrated a positive impact on oo- CONVENTIONAL COLOUR IN RED: Acitretin is approved for psoriasis, however, apart from genesis that might be in certain circumstances an ans- CONCLUSION 1. CORRUGATOR pustular forms of psoriasis it does not play a major role in wer to overweight-related infertility issues and a positive Static anatomy is a preamble to the injection, but the fa- 2. LEVATOR ANGULI ORIS the systemic treatment armamentarium any more. effect on metabolic syndrome, weight loss, visceral fat cial expression in life is necessary to avoid complications. 3. BUCCINATOR and waistline reduction of overweight or obese individu- CONCLUSIONS 4. MENTALIS als. The clinical studies demonstrated the safety and effi- Apart from biologic treatment approaches non-biologic ciency of the devices. systemics are still of relevance in psoriasis. Especially with regard to costs they offer a good alternative, espe- cially if compensation for psoriasis treatments are not provided by health insurances.

14 FRIDAY  AUGUST 30, 2019 FRIDAY  AUGUST 30, 2019 15 SCIENTIFIC SESSIONS SCIENTIFIC SESSIONS

 CRYOLIPOLYSIS AND COMBINATIONS: NEW the treatments and weekly for 3 more weeks results in hypothesis is supported by the publicly available studies, CONCLUSION WAYS FOR EFFECTIVE AND SAFE FAT REDUCTION better results: Cryo side 4 ,2 cm and HIFU side 5,1 cm but more work is needed to completely understand the Lipolysis associating PPC and DOC is a very efficient Klaus Fritz  Germany reduction. role of HIFEM in fat reduction. treatment for small fat deposits with very moderate side effects. Good complimentary method to liposuction or ue to its high efficiency and safety various tech- Depending on location , type and amount of fat and level cryolipolysis. D nologies of heating biological tissue are broadly of skin ageing and due to the patient to accept more or  LIPOLYSIS WITH PHOSPHATIDYLCHOLINE AND practiced in the dermatological field for various aesthetic less invasive procedures we can either choose one sin- DEOXYCHOLATE applications, including skin tightening, skin lifting, body gle procedure for bodycontouring or combine 2 to 3 in Sylvie Lederlé  France  BODY FILLER AND MORE: BEST COMBINATIONS contouring and cellulite reduction. In body contouring ra- a suitable way. Sonja Sattler  Germany diofrequency, Lasers and High intensity ultrasound play CHEMICAL ADIPOLYSIS an increasing role in heating the dermis. Reduction of larger amounts of fat mainly can be achie- ince the development of liposuction, there have fter the unlucky era of the first body fillers, most- ved by liposuction, cryolipolysis or injection lipolysis, mo- S been successive attempts to develop treatments A ly for the aim of breast augmentation, has calmed Both – ultrasound and RF are used as a single techno- derate fat pads can be reduced by Radiofrequency, HIFU to reduce localized adipose tissue deposits. Lipolysis is down, body filling specially with hyaluronic fillers, seemed logy or in combinations in order to achieve sufficient or FRM and tightening and smoothening of contours a technique of dissolving stored fat, using Phosphatidyl- to become unpopular. In our patients the need of filling heating of the dermis. Based on the simultaneous de- needs RF, shock waves or Endermology. A combina- choline (PPC) in association with Deoxycholate (DOC) in and shaping in different body areas is unbroken. There livery of monopolar RF and ultrasound energy through tion of fat decrease plus tightening technology delivers order to achieve a sculpting effect by non-surgical me- are only a few filling substances available beside auto- a single handpiece the monopolar RF reduces fat cells. better results.It takes a few weeks for the adipocytes to ans. It can only be of use on small fat deposits. logous fat. In some countries body hyaluronic acid fillers The applicator tip is continuously cooled throughout the break down and begin absorbing. For this reason there are available again. treatment to protect the skin and permits effective hea- is a 2-month wait before a second treatment can be car- MODE OF ACTION ting of the subdermal fat layers. Re-shaping and volume ried out. The findings show that the action of HIFU as well DOC together with PPC activates lipases inducing mem- Despite this fact the aim of our patient for body treat- reduction are achieved through targeted energy ab- as Cryolipolipolysis are safe, effective, and well-tolera- brane breakdown. The released lipid particles are emul- ments is raising. The body has become the second face sorption and subsequent initiation of lipolytic processes ted noninvasive procedure for body contouring and can sified, dissolved, and transported by high-density lipo- and patients are aiming for the same young appearance and collagen remodeling. This is improved by combining both be improved by a combination with shock waves. proteins (HDL) to the liver. on the body as on the face. Beside the breast augmen- shock waves simultaneously. Studies show better result tation with a filling agent, the gluteal area, the genitalia, INDICATIONS for combined procedures. Lasers have become more popular and with various wa- like Labia Majora are common areas for body filling. Body Any localization where fat can be pinched between two velengths available the fat tissue can be heated and re- fillers also help after an unlucky outcome of liposuction fingers. On the Body mainly abdominal fat, but also hips, Since three years new system was launched using RF duced via heat, with similar good results. surgery with irregularities, mostly included in a combina- innner thigh, knees, inner arms, lower part of the but- for a whole abdomen Radiofrequency for circumference tion therapy. tocks… On the face mainly double chin, but also lower reduction and a RF monopolar system delivered by a tip part of the cheeks and face contour… that applies shock waves simultaneously, a new method  HIGH-INTENSITY FOCUSED ELECTROMAGNETIC A new era has started in body skin aesthetics, with well- especially for cellulite treatment and smoothening of the (HIFEM) TECHNOLOGY IN BODY CONTOURING: known filling agents like Calciumhydroxylapatite diluted. TREATMENT MODALITIES skin. THE PRINCIPLES AND MECHANISM OF ACTION First results are very promising. Here the use of collagen Injections must be performed in the fat layer, below 5 David J. Goldberg  USA stimulants on the body skin together with energy-based mm and up to 15 mm below the skin, depending on the These new technologies allow better tightening than la- devices seem to potentiate the tightening effect and are thickness of the fat deposit. A grid pattern from 1- to 1.5- sers and have enlarged the portfolio of available proce- IFEM technology has recently become a widely an option for the treatment of body skin elastosis and cm between the injection points is recommended. PPC dures in aesthetic medicine. discussed tool used in body contouring due to its maybe even cellulite. First investigations will be presen- H acts over the course of more than 8 weeks, which me- dual effect on muscle and fat. Yet its mechanism is still ted in this lecture. ans that there should be a two-month interval between Hifu is now available in a few devices with transponders often confused with radiofrequency, electrical muscle sessions on the same area. that allow a penetration as deep as 13 mm. This results stimulation and other established body contouring mo- in tiny and numerous coagulations in the fat layer which dalities. Although HIFEM directly stimulates muscle it has POST-OPERATIVE OUTCOME  NON-SURGICAL SKIN TIGHTENING can be shrinked and reduced in volume allowing to ob- also been found to affect subcutaneous fat. The aim Edema, along with mild pain and redness, lasting from Zamira Yanine  Colombia tain a reduction of circumference plus tightening effect. of this lecture is to elucidate how, according to availa- 1-4 days and bruises are common. Paresthesia, small We performed a comparison study with the objective to ble literature, HIFEM induces intensive muscle contrac- temporary nodules, and site infections have been repor- inimally and non-invasive skin tightening procedu- find out if deep HIFU treatments achieve the same re- tions and triggers a metabolic response in fat. Further, ted. M res for the face and the neck are highly desired sults as cryolipolysis .One side of the body on the hips the differentiation of HIFEM technology from other body among aging patients, as sagging skin accompanies the was treated twice with 45 min cryolipolysis 6 weeks contouring modalities will be outlined. HIFEM technology SIDE EFFECTS aging process almost in a universal manner. Outside of apart , the other side with 13 mm dep HIFI 2x 6 weks uses a wound coil to induce an electrical field in the un- Cases of necrosis have been seen due to injections neurotoxins and fillers, skin tightening is one of the most apart in 8 patients without and 6 with additional shock derlying tissue, where it depolarizes motor neurons and being performed too superficially. With higher quantities sought-after cosmetic noninvasive treatments, espe- wave treatment . We found as a mean reduction in fat thus causes muscle contraction. Using a high pulse fre- than recommended, nausea, diarrhea, light-headed- cially for women, at any age. Patients want tighter and thickness 2 months after the treatments of 3 cm on the quency, the muscle is contracted to levels not achievable ness, and headaches have been reported. No signs of smoother skin without having to go through big surgeries cryo side and 4.45 cm reduction on the HIFU side, there voluntarily, triggering hypertrophic effect in the muscle inflammation, or any change has been detected in blood or long recoveries, and seek non-invasive treatments to in addition less laxity of the tissue. and metabolic responses in fat in order to supply energy work post treatment, such as increased glycemia, cho- obtain a natural skin tightening. When to consider non- to the muscle. The hypothesis of stress reaction leading lesterol, or lipid values. surgical skin tightening? Patients with mild to moderate 3-minute acoustic wave treatments immediately after to breakdown of fat cells will be explored. The presented loose skin and laxity, who want improvement in the qua-

16 FRIDAY  AUGUST 30, 2019 FRIDAY  AUGUST 30, 2019 17 SCIENTIFIC SESSIONS SCIENTIFIC SESSIONS

lity of the skin or who are unable or unwilling to under-  MEDICAL PROPHYLAXIS TREATMENT AND TISSUE is widely accepted as a non-physician therapy and ap- SPECIFIC SEQUENCE OF INTIMATE TREATMENTS FOR go a more invasive, surgical procedure to correct skin REENGINEERING: TWO EMERGING FORMATS plied this format to dermatology. The tasks and pro- INTIMATE TISSUE REGENERATION: laxity. Another growing population interested in non-in- Dirk-Harald Gröne  Germany cedures performed by the dental hygienist are clearly ¡ Inspection with a standardized 3D imaging proce- vasive skin tightening are the younger patients who are defined. The patient is aware of the advantages a) for dure for intimate symptoms, body shape, scars, beginning to notice early signs of aging and want to pre- ractice management is an ongoing process which better cleansing, b) polishing, c) reversing inflammation, stretch marks, cyst formation, vitiligo and assess- vent laxity of the skin. The drawback of these safer and P requires continuous efforts. Just as the healthca- d) maintenance and supervision of ongoing therapies, e) ment of the pelvic floor and vaginal laxity (e.g. per-i non-ablative skin tightening methods when compared re industry has embraced the concept of regenerative recalls for post procedure documentation and medical neometry). to the invasive and ablative treatments is that the results medicine and the innate potential of the human body to appointments. ¡ Peeling, if necessary, removal of ingrown hair follicles are often: modest and less reliable, inconsistent duration heal wounds and rebuild damaged tissue, physicians are in the genital region and laser epilation. THE PROCESS OF MEDICAL PROPHYLAXIS IN of the benefits, in need of multiple treatments, individual working on ways to apply this concept to the develop- ¡ Connective tissue treatment with radiofrequency DERMATOLOGY variation in responsiveness, volume loss in and around ment of evidence-based applications centered on cell and ultrasound (e.g. BTL Excilis Elite) first on the ex- ¡ Inspection with a standardized imaging procedure the treated area and sometimes transitory numbness in restoration, tissue replacement or rejuvenation for anti- ternal genitals, then perineal and intravaginally. the treated area. Also, it is often difficult the follow up and aging purposes. This new medical landscape in lifestyle ¡ Manual cleaning and removal of cosmetic residues ¡ Introduction to the use of HUD´s for transvaginal most of the treatments work over a long period of time. medicine offers patients potential breakthrough thera- with Sonic Skin brush muscle stimulation pies allowing patients to rely on their own biologies to ¡ Microdermabrasion against impurities, deposits and ¡ Raise awareness on comorbidities Why to go in a non-ablative manner? With the newer maintain a youthful natural look and live and feel better dilated pores technologies available like micro-focused Ultrasound, ¡ Information on further medical treatments and follow – even during turbulent times, hospitalization or chronic ¡ Connective tissue massage and manual lymph drai- performed every 12 to 18 months, tissue contraction up´s. diseases. Dermatologists and plastic surgeons are the nage with air pressure and ultrasound and dermal remodeling are possible while minimizing main players in the business. Nonetheless, addressing ¡ Supervision of breast cancer patients with Tamoxi- ¡ Non-ablative laser for conditioning the application of undesirable epidermal injury. Due to minimal or absent these new minimal invasive therapies to the patient and fen, or after radiation, laser therapies and intimate photosensitizers epidermal injury, a wider range of skin types can be trea- arousing interest for rejuvenation therapies poses quite surgery. ted allowing for safer treatments. Downtime is minimized a challenge. ¡ Light protection consultation and information on the with a fast post-procedure healing, allowing the patients implementation of the Day light PDT (Ameluz and to proceed with regular activities shortly after treatment. In this talk, I will present and discuss 2 emerging formats, Luxerm) SUMMARY AND ADVANTAGES OF BOTH FORMATS There is also a reduction of the risk of adverse events which, to my understanding, facilitate the implementa- ¡ Process coaching ¡ Standardized pre- and post-treatment by non-physi- compared with either ablative resurfacing, or more inva- tion of regenerative medicine into the practice setting, cian staff sive surgical procedures. smoothly introducing the philosophy of „natural“ anti- ¡ Introduction of the patient to further medical measu- aging, early skin cancer detection and treatment to the THE FORMAT OF INTIMATE TISSUE PHYSIOTHERAPY res, some of which are also necessary from a surgi- outdoor patient. BACKGROUND cal point of view very 3rd woman in the age of 40 + suffers from inti- 9.00 - 11.00h THE MEDICAL PROPHYLAXIS FORMAT E mate symptoms as dyspareunia, incontinence, laxi- ¡ Scientific information and cross marketing on tumor surgery, laser assisted PDT, Botox, filler, skin resurfa- FUTURE-FORWARD THOUGHTS ON BACKGROUND ty, and increased incidence of vulvar atrophy and irritati- cing, intimate surgery, liposuction, fat grafting, cell AGING & AESTHETICS io of Europeans have undergone non melanoma ve genital symptoms. Not all women feel confident with transfer and other rejuvenation techniques. M skin cancer surgeries in last decay or destructive Local therapies, Kegel, Biofeedback and pelvic exerci- therapies (Apalla Z 2017). Early preventive treatments ses prescribed by their urogynecologist though those ¡ Double appointments with doctor for diagnostics may delay surgeries and raise awareness for maintenan- physiotherapies are widely accepted to help the patients and a „pleasant“ cosmetic therapy  SKIN MICROBIOME AND AGING ce. Porphyrin-based Daylight PDT has been shown very by: a) exercise, b) electric muscle stimulation c) biofeed- ¡ Pretense to medical standards of non-medical ser- Andre Berger  USA efficient against early cell alterations in field cancerization back and supervision. Early preventive vaginal laser, EBD vices under medical guidance and setting them apart (Grigalavicius M 2017) and acts even stronger if com- and regenerative treatments may delay surgeries and from lay cosmetics his presentation will address how skin microbiota bined with neoadjuvant administration of 5 FU, laser or raise awareness for comorbidities, maintenance thera- are commonly involved in dermatologic conditions ¡ Connection and adherence through direct contacts, T microneedle facial pretreatments (Suarez-Valladares M pies and self-care power (Valadarez A 2019). that impact patients’ appearance and aging and to un- social media and recall 2016, Soleymani T 2017, Choi S 2017). Unfortunatly these derstand conditions, both external and internal, in which ¡ Billing via GOÄ (German Medical Fee Scale) procedures are often regarded as medical wellness or INTENTION the skin microbiota become disrupted. Attendees will cosmetic adjunctive and costs are not reimbursed. Introduce female rejuvenation with Lasers and EBD to ¡ Supervision by a medical specialist learn how to use an integrative approach to modulate the patients, changing the attitude of those patients to ¡ Uncovering communication gaps and patient sensi- skin microbiota composition to restore host-microbiota INTENTION see the dermatologist with intimate symptoms earlier tivities homeostasis and address aesthetic and aging concerns then currently and not only on referral by the other me- Early Use of the medical and cosmetic potential of Day- ¡ Maintenance and post procedure services for excel- of the skin. dical disciplines. light PDT and LLLT´s against signs of ageing and actinic lent results skin damage in a favorable cosmetic setting. This should CONCEPT be regarded as a first step of regenerative medicine and CONCLUSION We adopted the routine of pelvic physiotherapy which skin cancer prevention. Laser, EBD and LED´s are energy-based physical thera- is widely accepted by the patients to a laser assisted pies with a high regenerative potential. The painless im- and device dependent dermatologic Physiotherapy. The CONCEPT plementation and usually a rapid success lead to a high tasks and procedures performed are clearly defined. We adopted the format used in dental prophylaxis which popularity among patients, especially for wound treat-

18 FRIDAY  AUGUST 30, 2019 FRIDAY  AUGUST 30, 2019 19 SCIENTIFIC SESSIONS SCIENTIFIC SESSIONS

ment after surgical interventions or in addition to other CONCLUSIONS the nucleotide sequence of the DNA. It is aimed to 9.00 - 11.00h therapies. This applies without restriction to both facial A standardized approach to the thorough assessment regulate metabolic processes in the body to be able COSMECEUTICALS, SKIN CARE & and body treatments. Our 2 formats are an offer to the of the face improves its quality and allows to make a rea- to cope with late acne, dry skin at all levels of the skin, HOME-USE DEVICES patient to “get an idea” of these treatments. Often the sonable individual treatment plan, more to evaluate the restore the barrier and moisture-saving function (IN COLLABORATION WITH patient is not ready for invasive therapies and favors a effectiveness of the correction by the dynamics of para- of the skin, correct degenerative changes in the der- physician’s independent position to initiate the consul- meter values before and after treatment. mis, eliminate oxidative stress, inflammation, regulate HUD WORKING GROUP) tation and to address intimate symptoms. The success blood-lymphatic circulation, lymph-sanation, adjust of this new concept is strongly dependent on practice work neuro-vascular dysfunctions, remove metabo- management, patient flow and the attitude of the staff  BIOHACKING AS AN INTEGRAL PART OF lic products from the intercellular space, adjust cellu-  REGENERATIVE MEDICINE: FACTS AND FICTIONS GROWTH FACTORS: HARNESSING HEALING POWER, towards an interdisciplinary setting and trustful relation MODERN AESTHETIC MEDICINE lar communications. FROM RESTORATION TO REJUVENATION between the patient and the responsible doctor. Elena Molokova  Russia ¡ Detox programs, stress management, normalization Ahmed Al-Qahtani  USA of the bowels, metabolic processes, nutritional, work or a long time, the offer on the market was limited to with somatic problems. ince the Nobel Prize-winning discovery of nerve  ALGORITHM OF AESTHETIC EVALUATION OF grooming procedures, simple manipulations in the F ¡ Dietology, aimed at the preparation of individual nu- growth factor (NGF) and epidermal growth factor THE FACE doctor‘s office such as cleansing, facials, massages, and S trition programs, taking into account the dysfunctions (EGF) in 1986, scientists and physicians alike have sought Natalia Kalashnikova  Russia customer needs were simply driven into buying the best of the body. to understand and apply the physiological benefits of cream that would solve all the problems at once. We call growth factors. In both healing and rejuvenation, tissue BACKGROUND this aesthetic medicine 1.0. ¡ Communication technologies to build the doctor- remodeling and systemic restoration, strides have been he aging process is complex and multilayer, affec- patient relationships, engage them into the treat- made in this regard. While the activity of growth factors ting all tissues of the face. Therefore, the use of a With the development of technology the era of aesthetic ment process and establish long-term follow-up. T and other elements of the cell secretome in response combined approach in aesthetic correction is more rea- medicine 2.0 has come when all kinds of tools and in- to acute wound damage are becoming increasingly well sonable and effective. The combination of aesthetic in- jection procedures appeared in the arsenal of aesthetic But we also need to be aware of the phenomenon of known, it remains a novelty to many that similar principles terventions should be individual for each patient and ba- medicine physician that could successfully fix the exter- pseudo-biohacking with the uncontrolled intake of vi- of restoration and remodeling repair can be employed sed on a thorough preliminary assessment of the face. nal level of problems, and clients began to ask to get an tamins, dietary supplements, frequent check-ups and for the sake of cosmeceutical rejuvenation. Within this Currently, there are no accepted clinical guidelines for „injection of youth“ and to make their visits to a specialist other unreasonable procedures that lead to psychosis domain, topical serums containing an intricate balance aesthetic facial assessment. as less frequent as possible. rather than health. of growth factors, cytokines and other peptides have proven effective in reversing the signs of extrinsic aging. PURPOSE However, things have changed nowadays, the approach Those engineered peptides are now patented (U.S. Pat. Develop clinical recommendations for a thorough aest- of solving aesthetic problems is different as well as the  COMPLEMENTARY MEDICINE IN DERMATOLOGY: 8,518,819). hetic assessment of the face, including constitutional needs of the modern patient. Customers want to be ANOTHER APPROACH TO COSMESIS factors and age-related changes of multiple layers of the healthy to prevent age-related changes not only on the Lawrence Chukwudi Nwabudike  Romania This study corroborates the idea that the topical appli- face. external level but also on the internal one. n contemplating cosmetic dermatology surgery and cation of growth factors and cytokines are beneficial in MATERIAL AND METHODS reducing the signs of skin aging of the face, including the The value of health and youth for a modern person is a I lasers come to mind. A major component of skin di- Evaluation of previous and current used assessment area around the eyes. Moreover, growth factors have necessary condition for the quality of life and a resour- sease is its aesthetic aspect. Many skin disorders lead scales of aging and constitutional factors by doctors of been shown to restore hair growth and slow down the ce for adapting to changes and development. It can be to reduced quality of life. This diminished quality of life is various specialties: dermatologists, plastic surgeons, progression of Androgenetic alopecia. Our study esta- observed only in a complex and at all levels: structure, often associated with the aesthetic aspect of these der- dentists and neurologists. Selections of parameters af- blished the effectiveness of naturally occurring growth biochemistry, thoughts, and emotions. matoses. fecting to the aesthetic status of the patient and their ac- factors for anti-aging, skin rejuvenation, wound healing cumulation in a single algorithm. and for the first time in the treatment of hair loss. Biohacking as a phenomenon is an integrated approach Recent evidence points to the role of nutrition, exerci- for preventing, controlling and combating age-related se, mind-body interventions, homeopathy, acupuncture RESULTS changes in order to improve the quality of life and pro- and herbs in the therapy of skin disease. Their use is gai- Conclusion of thorough assessment of the face is a set  HOME-USE DEVICES: THE CHALLENGE OF MASS long active longevity. An integrated approach reflects the ning popularity, meaning there is a growing market for of constitutional parameters (geometric proportions MARKET ACCEPTANCE concept of 5Ps medicine: personalization, predictability, such products and services. Yet the physician’s primary and anatomical-morphological factors) and the available David Bean  USA prevention, precision, participation. task is to do no harm. age-related changes (cutaneous and structural aging) of the patient. Each of the parameters includes a set criteria ozens of home-based medical devices are CE cer- To fulfill all these conditions dominated by modern needs An understanding of these methods, together with a that determine the degree of its severity. The proposed tified and FDA-cleared for over-the-counter sale and technologies we use in our work: compassionate view, which also helps patients unders- D algorithm allows to assess the harmony of facial propor- tand their disease and therefore cope with it, reducing to the general public. Yet, no medical device has achie- tions, the degree of age-related changes, to make an ¡ Genetic testing which allows you to identify a predis- the demand for unnecessary – expensive – interventi- ved mass-market acceptance. Many other industries individual scenario of aging and a prospective prognosis position to certain diseases as well as to predict pos- ons may be a future direction to cosmetic medicine. This have seen equipment transition from professional use of the correction results. sible complications. would fit the injunction to “first do no harm”. to mass-market consumer acceptance. This presen- ¡ Transdermal epigenetic anti-age therapy that can tation will analyze the key factors required to transition affect the functioning of a gene without changes in a product category from professional use to consumer mass-market acceptance. Next, the presentation will ap-

20 FRIDAY  AUGUST 30, 2019 FRIDAY  AUGUST 30, 2019 21 SCIENTIFIC SESSIONS SCIENTIFIC SESSIONS

ply these required factors to the medical beauty device ment of patients are facial morphology (oval, round, 11.45 - 13.45h BETTER UNDERSTANDING OF ACNE PATHOPHYSIOLOGY space and project where the industry may go to achieve square, triangle, inverted triangle oroblong), balance and HAS BROUGHT UP SOME NEW TREATMENT OPTIONS FOCUS SESSIONS MEDICAL DERMA- mass-market acceptance and provide some examples symmetry. The lower third of the face, that includes the Topical trifarotene cream represents a novel topical reti- TOLOGY: GENERAL DERMATOLOGY where good progress is being made towards this end. chin and the jaw, plays a key role in facial attractiveness noid in moderate facial and truncal acne. In two-phase III and must be considered in our facial assessment. double blind, randomized, vehicle-controlled studies of once-daily trifarotene cream versus vehicle in subjects  WHAT’S NEW IN ROSACEA?  AUTOPHAGY: THE GREATEST BREAKTHROUGH Over the past years, the demanding of less invasive aged nine years or older, it showed significant reduction Thomas Dirschka  Germany IN SKIN CARE SINCE TOPICAL ANTIOXIDANTS aesthetic procedures such us dermal filling and botuli- in inflammatory and noninflammatory lesion counts in fa- Dendy Engelman  USA num toxin have largely increased. Juvederm Volux™ (Al- vor of trifarotene when compared with the vehicle. Inte- osacea is a chronic inflammatory facial disease lergan plc, Dublin, Ireland) is a new hyaluronic acid (HA) restingly, trifarotene cream represents the first acne topi- characterized by a variety of clinical signs and sym- ruly innovative technologies in skincare and age injectable gel with lidocaine with a high concentration (25 R cal that has been studied in truncal acne. Apart from new ptoms including erythema, inflammatory lesions and prevention are a rarity. Since the discovery of the mg/mL) with crosslinking technology. Its higher elastic topical retinoids photodynamic therapy (PDT) and use T phymata. Ocular symptoms can accompany facial sym- 2016 Nobel Prize winning concept of autophagy, we modulus (G‘) and higher cohesivity are expected to pro- of different light sources have been published for acne. ptoms or ever occur as mono-symptomatic ocular ro- have come to understand ways to activate this process vide improved volumizing and lift capacities as well as ALA-PDT has demonstrated efficacy in moderately se- sacea. through lifestyle, nutrition, and topical skincare. Autopha- appropriate resistance to shear and compression defor- vere inflammatory acne. Over-the counter light therapy gy activation allows for cells to behave more efficiently mation. Juvederm Volux™ is designed for subcutaneous for acne has emerged as another potential treatment THE DIVERSITY OF THE CLINICAL REPRESENTATION OF option and induced strong public interest. However, only prolonging their efficiency and longevity. It is the next and/or supraperiosteal injection for sculpting, shaping, ROSACEA REQUIRES AN ADAPTED TREATMENT a limited number of clinical trials have been published to frontier of age prevention through skincare! contouring and projection the treatment areas. APPROACH TARGETING DIFFERENT PATHOGENETIC DRIVERS better understand mode of action of such light devices. By using the MD Codes™ developed by Mauricio De Maio Ivermectin 1% cream has demonstrated high efficacy CONCLUSIONS  HOME-USE DEVICES: CONSUMER PERSPECTIVE and the appropriate Juvederm™ HA, we can easily create in inflammatory rosacea lesions with superior efficacy After many years of standstill in new acne treatments Laurence Newman  United Kingdom different treatment strategies depending on facial contour compared to topical metronidazole. Brimonidine 0.33% new substances have been approved and need to be and gender. We will describe different treatment plans, gel is approved for erythematous rosacea. Concomitant integrated in adapted treatment algorithms. s one of the fastest growing trends in the beauty focusing on the innovative Juvederm Volux™ to shape use of ivermectin 1% cream and brimonidine 0.33% gel A industry, home use devices are gaining popularity and contour the lower third of men and women. also demonstrated superior efficacy over topical me- with customers as a way of complementing their sa- tronidazole and azelaic acid regarding erythema and in-  DERMOCOSMETICS FOR ACNE AND ROSACEA lon and spa treatments. Our research has shown that Recent advances in HA technology, such as Juvederm™ flammatory lesions. Vanesa Piquero-Casals  Spain customers often favour anecdotal content and personal Volux combined with MD Codes™ provide aesthetic recommendations over studying clinical trials when de- doctors with a valuable tool to optimize patient outco- Combination of ivermectine 1% cream and doxycycline cne and Rosacea are affected by the inappropriate ciding on a new device. This has also led to the return mes. Thanks to these treatment approach we can easily 40mg modified-release capsules demonstrated to lead use of Dermocosmetics. of omni-channel, diffusing products into an offline space create an appropriate treatment strategy for patients, to fast responses, improve response rates and increase A to showcase the available options and build consumer depending on their gender and facial contour. patient satisfaction in severe rosacea compared to iver- Dermocosmetics are part of the treatment; especially in trust. mectin 1% creme alone. the maintenance of Acne and Rosacea erythematosa. In this session, we will explore the current product distri-  NON-SURGICAL FACE LIFT WITH FILLERS CONCLUSIONS At this explanation, we will talk about cleansing, toning bution landscape, the rising popularity of beauty devices Ekaterina Gutop  Russia Combination treatments in rosacea involving ivermecti- and thermal water, sunscreens, camouflage, makeup, in Asia and how the influencer era has changed the way ne 1% cream, doxycycline 40mg modified-release cap- emollients and moisturizers, mask, serums, domiciliary we purchase. on-surgical lifting with fillers based on characteris- sules and brimonidine 0.33% gel offer symptom-adap- peels, and active ingredients used in both problems and tics of ligaments to create the support for soft tissu- ted approaches to treat rosacea. N how to guide our patients about it. es. Peculiarities of zygomatic, mandibular, platysma-au- ricular and orbicularis retaining ligament can be used to The Dermocosmetics should evolve with the Dermato- 11.45 - 13.45h achieve the effect of non-surgical lifting with fillers.  WHAT’S NEW IN TOPICAL AND ORAL ACNE MEDICINES? logist. Likewise, to differentiate when we can manage FILLERS – SCIENCE & NON-SURGICAL these pathologies only with Dermocosmetics and when These characteristics should be taken into account when Thomas Dirschka  Germany FACIAL RESHAPING we must associate more or less strong medications ac- upper, mid and lower face treatment is being performed cording to the case. sequentially with appropriate techniques and amounts cne vulgaris represents one of the most common of product. Analyzing ligaments like a system when has skin diseases worldwide. Treatment is still a chal-  SCULP IT, NEW APPROACH FOR THE A effect on one part of this system leading to the division lenge due to high chronicity, a variable, unpredictable TREATMENT OF THE LOWER FACE for the others the best aesthetic result by the treatment course of disease, frequent relapses, and unwanted side Lisandro Farollch  Spain can be obtained. effects of available treatment options. Antibiotic use is most likely to decline as concerns about resistance plays he perception of an attractive face is largely subjec- Using cannula or needle is at the prerogative of the doctor. an increasing role. tive, depends on ethnicity, age, gender, culture etc. T By this strategy of the treatment effect of the non-surgi- Three fundamental aspects when doing facial assess- cal lifting with visible natural result can be achieved.

22 FRIDAY  AUGUST 30, 2019 FRIDAY  AUGUST 30, 2019 23 SCIENTIFIC SESSIONS SCIENTIFIC SESSIONS

11.45 - 13.45h dermis, reaching an almost constant value. The Tixel is solid-state 589nm laser. Delivered fluences were 10-15 se effects, yet 2 patients developed punctuate transient a non-laser thermomechanical system which transfers J/cm2 with a 46 msec pulse duration using a scanning hypopigmentation, which improved upon subsequent LASERS & EBDS – THE SKY IS THE LIMIT! thermal energy to the skin, dehydrates the stratum cor- handpiece. Participants then returned for follow-up one follow-up. neum and superficial epidermis and creates micropo- month after the 4th treatment. Efficacy was evaluated res, thus, enhancing drug delivery. Recent studies of Ti- by investigator and participant assessments of facial ery- CONCLUSIONS  COMBINATION OF EBDS FOR SKIN TEXTURE xel-assisted drug delivery for different common and rare thema utilizing a scale from 0 to 4 (0 = no erythema; 4 = Both the QS Ruby laser and the novel picosecond 1064- AND SCARS dermatological and aesthetic indications will be shared. severe erythema).Digital photographs were obtained at nm laser were found to be effective in treating Nevus of Lehavit Akerman  Israel each visit. Safety was assessed by compiling investiga- Ota. tor-reported side effects throughout the study. split case comparison of body hair removal with a  IPL TECHNOLOGY: WHAT WE KNOW FROM large spot, three wavelength diode versus a small A RESEARCH FROM LONG-TERM ANALYSES RESULTS spot, single wavelength diode. Michael H. Gold  USA All subjects received at least one level of improvement. 11.45 - 13.45h No complications were noted. HAIR – TOO LITTLE, TOO MUCH, Hair removal laser technology has been clinically esta- ntense pulsed light (IPL) devices really revolutionized NEVER ENOUGH blished over the past few decades. 755nm, 810nm & the EBD market when they arrived over 25 years ago. CONCLUSION 1064nm wavelengths comprise the majority of hair re- I IPL technology was developed to treat vascular lesions, A new 589nm solid state, non-rhodamine dye, solid state moval device technology in use today. However, there is laser represents a novel approach for the treatment of found to work well on pigment, and then on collagen  HAIR LOSS AND HORMONE REPLACEMENT still a growing demand for reduced procedure time and vascular lesions. and elastin itself, giving us the first real EBD treatment for  improved coverage without scarifying safety and effecti- Andre Berger USA photorejuvenation. veness for all skin types. his presentation will address the potential significant Over the years, the IPL technology became more and  TREATMENT OF NEVUS OF OTA BY USING A We conducted a study which included 12 patients (ages T potential complication for androgen hormone re- more sophisticated and we are now at a time and place PIGMENT SPECIFIC LASER 23-45yr), skin type I-IV, comparing a new combined dio- placement in both men and women to cause hair loss. that the IPLs of today are safe, sophisticated, and pre- Assi Levi  Israel de wavelength (755-810-1064nm) technology (Large An understanding of this complication and both its pre- dictable in giving our patients the results that we all want spot size = 4cm2) with a single 810nm wavelength diode BACKGROUND vention and management is required to remove a major for their skin. What’s even more impressive is that, in a (spot size =2cm2). Treatment included 4 sessions with 6 evus of Ota, a condition characterized by dermal compliance barrier for androgen replacement therapy, review of the largest clinical trial for IPL use over 10 ye- weeks intervals, targeting various treatment areas (back, melanocytosis, responds well to a Q-switched and to ethically prepare these patients for a potential ars, those patients who had yearly IPL treatments had N abdomen or legs). Treatment area was divided equally Ruby laser (QSL). A novel picosecond (PS) 1064-nm side effect and various treatment options currently avai- continued improvement in their skin, actually showing a and treated with either the combined three wavelengths Neodymium-Doped Yttrium Aluminium Garnet (Nd:YAG) lable for them. lowering of their actual age when photographic analyses (755-810-1064nm) large spot size (Soprano Titanium, laser is also currently available for this purpose. The num- were made by blinded investigators. This important clini- Alma Lasers, Israel) or with a single wavelength (810nm) ber of sessions required for complete clearance and the cal trial will be reviewed in detail.  CURRENT AND EMERGING TREATMENT STRATE- small spot size (Soprano Ice, Alma Lasers, Israel). Hair re- interval between sessions has so far, not been clearly GIES FOR HAIR LOSS IN WOMEN OF COLOR duction efficacy was evaluated by visual scoring of three defined, yet multiple sessions are generally necessary.  independent evaluators. Valerie Callender USA  TREATMENT OF FACIAL ERYTHEMA WITH A OBJECTIVES 589/1319 NM LASER The aim of this study was to evaluate procedure time and To report our experience treating Nevus of Ota using air loss is common in women of color and is as- David J. Goldberg  USA coverage improvement of the newly introduced techno- either a QSL or a PS 1064nm laser. H sociated with significant psychosocial complaints. Early clinical recognition and prompt initiation of interven- logy while maintaining safety and efficacy standards. BACKGROUND & OBJECTIVES PATIENTS AND METHODS tion with medical treatment is critical to halt the disease or several decades, the gold standard for the laser We present a retrospective case series of 20 patients process. This presentation will review the clinical presen- treatment of vascular lesions has been the lar 595nm F with Nevus of Ota who were treated by a QS Ruby laser tations of nonscarring and scarring alopecia in women  MECHANO-THERMAL ASSISTED DRUG DELIVERY pulsed dye laser. This laser, although highly effective, has (694 nm) or a PS 1064-nm laser. The baseline and most of color, use of dermoscopy for early recognition of the FOR VARIOUS DIFFERENT DERMATOLOGICAL required cumbersome and costly maintenance require- recent standardized photographs were assessed by two disease process, and medical, procedural, and surgical AND AESTHETIC INDICATIONS ments to replenish the dye medium. A brand new, novel independent dermatologists and graded on a scale of 0 interventions. In conditions that result in scarring alope- Ofir Artzi  Israel solid-state laser that emits light at 589nm has the po- (exacerbation) to 5 (95%-100% improvement). Adverse cia, such as late-stage traction alopecia, frontal fibrosing tential to effectively treat vascular conditions without the events and Patient’s satisfaction were also recorded. alopecia or central centrifugal cicatricial alopecia, pati- opical therapeutics demonstrate poor total absorp- maintenance issues that come with the PDL. This study ents may benefit from procedural interventions, such as T tion and cutaneous bioavailability, with only 1-5% examines the safety and efficacy of a 589nm solid-state RESULTS hair transplantation, low-level laser therapy, platelet rich being absorbed into the skin. Several physical techni- laser used for treatment of facial erythema. Twenty patients were included in this study. Seventeen plasma injections or micropigmentation. ques were developed to perforate the stratum corneum, patients were treated with the QS Ruby laser and 3 in order increase the uptake of topically applied drugs. STUDY DESIGN/MATERIALS AND METHOD patients by the picosecond 1064-nm laser. Number of The importance of the water content of the stratum cor- This study is a single-center prospective cohort study of treatment sessions ranged from 8 to 12. Sixteen patients neum in determining its properties is well documented. 30 subjects, 18 years of age or older, Fitzpatrick Skin Ty- achieved complete clearance. Average improvement Skin water content gradually increases, going from the pes I to IV, with varying degrees of facial erythema.. Each was 4.76 on the scale of improvement. Patients’ satis- upper layer of the stratum corneum to the viable epi- subject received 4 full face monthly treatments with a faction was high. Most patients experienced no adver-

24 FRIDAY  AUGUST 30, 2019 FRIDAY  AUGUST 30, 2019 25 SCIENTIFIC SESSIONS SCIENTIFIC SESSIONS

 NOVEL FACIAL CREAM PROTECTS AGAINST topical minoxidil. Due to the limited number of effective 14.45 - 16.45h ferent expectations and aesthetic goals. The technique PONYTAIL INDUCED FRONTAL HAIR LOSS therapies for AGA, platelet-rich plasma (PRP) has beco- allow to achieve very accurate effect, but needs good FILLERS – FROM PERIORAL TO HANDS Andy Goren  USA me an effective alternative treatment. PRP is an autolo- training and experience in using this kind of filler. gous concentration of platelets in plasma with numerous rontal hair loss is a frequent feature in female pa- growth factors that contribute to hair regeneration.  HAND REJUVENATION tients who wear their hair in a ponytail. In a recent  HOW TO MAKE THICK ASIAN LIPS BECOME F Medhat Abdel Malek  Jordan study, 79% of women presenting with frontal hair loss re- The growth factors contained within the alpha granules of SMALLER BY FILLER INJECTION ported wearing their hair in a ponytail four or more days platelets act on stem cells in the bulge area of the hair fol- Peter Peng  Taiwan he increase in facial cosmetic procedures impo- per week for an average period of 10 years. Frontal hair licles and stimulate the development of new follicles along ses an increasing trend and demand on hand re- loss is a subset of traction alopecia, hair loss that occurs with neovascularization. PRP now has become a promi- T he lip is very important for feminine beauty. A full pair juvenation treatments. Dermal filler is one treatment after persistent pulling on the roots of hair over time. nent treatment modality for AGA, Diffuse hair loss and as of lips makes a face young and attractive. modality, which can be used by dermatologist to reju- T Each hair follicle in the scalp contains an arrector pili in our studies in Alopecia Areata and Telogen Effluvium venate hands. The lecture will demonstrate the referred muscle that, when contracted, erects the hair. Previous- but standardization for PRP preparation and administra- Just as Asian skin differs from Caucasian skin, so do the approach and method for effective hand rejuvenation ly we have demonstrated that stimulating contraction of tion as well as a method to evaluate results have not been lips. Asian lips are generally fuller than Caucasian ones, using fillers. Additionally, the presentation illustrates the the arrector pili muscle can increase the threshold of the established yet which is its major drawback. This talk is with thicker upper and lower vermilion lips. As a result, lip relevant hand anatomy and potential complications that force required to pull hairs by approximately two-fold. In about various methods, our method and evaluation of the sculpting for Asians may differ from in Caucasians. may arise from filler – specific techniques commonly em- this communication, we report a novel facial cream that effectiveness of PRP for hair loss and restoration therapy. ployed by dermatologists. when applied to the forehead, near the hairline, can si- In this presentation, I will introduce the concept and milarly increase the force required to pull hairs. In our co- practical way for adding volume to make thick Asian lips hort of 21 healthy women, the topical cream increased  NON-MEDICINE SYSTEMIC ANTI-ALOPECIA look smaller.  ORIGINAL TECHNIQUE OF LIP AUGMENTATION the force required to pull hairs by an average of 189%. COMPOUNDS: IS IT POSSIBLE? AND ENHANCEMENT USING NON-PERMANENT We believe this new treatment may help reduce the like- Jaime Piquero-Casals  Spain FILLERS lihood of developing frontal hair loss in women who fre-  CHIN AUGMENTATION TECHNIQUE FOR Waldemar Jankowiak  Poland quently wear ponytails. air loss, mainly represented by acute Telogen Ef- BEAUTIFICATION fluvium in women and androgenetic Alopecia in Sonja Sattler  Germany H ver the past years, fuller lips have been conside- men, is a frequent reason for dermatology consultation. red a desirable trait. Many younger patients are  THE EFFECT OF DAILY ASPIRIN USE ON TOPICAL Two active pharmacological ingredients are approved by O pecially in the last years the chin area has become presenting for lip augmentation to achieve an attractive MINOXIDIL TREATMENT FOR PATTERN HAIR LOSS the FDA for the treatment of AGA, finasteride and mino- more and more important, since the all over easy look. Rejuvenation of the lips plays a key role in restoring S Andy Goren  USA xidil. Both drugs have side effects and are effective in photography with mobile phones, no matter if as selfie a more youthful appearance. A lot of therapeutic options less than 50% of the patients. Some people are intimi- or not, has made everyone’s insight in their profile easily exist for aesthetic lip enhancement, various injectable fil- hile topical minoxidil has an excellent safety re- dated by the pharmacological approach to treat a non-li- possible and the awareness of facial proportions have lers and inserted materials have been used, ranging from cord, its efficacy in the treatment of AGA is limi- fe-threatening disease such as alopecia. Food supple- raised in our patients tremendously. W temporary and permanent fillers to other surgical techni- ted by the sulfotransferase enzymes activity in ORS of ments are a non-pharmacological approach that is easy ques, bur no one represents an ideal solution. hair follicles. The same enzyme is significantly inhibited to fit into everyday routine without significant side effects The chin area is in all ages female or male harmonizing in the human liver by another OTC drug used by millions to treating this sometimes emotionally taxing condition. the facial proportions. We can differentiate the genetical- Objective of evaluation is find accurate injection technique of men: aspirin. In this study, we demonstrated that low Cosmeceuticals are oral or topically applied products ly small chin from the aged chin area, where bony struc- using one of the most popular fillers – hyaluronic acid. dose oral aspirin negatively inhibits the activity of sulfo- that do have a physiological effect on the skin. The term tures get lost during the aging process. transferase enzymes in the human hair follicle. Therefo- was coined by Kligman 30 years ago and is not recog- Over 1500 patients were subjected to lips enhancement re, chronic use of low dose aspirin is likely to reduce the nized by the FD&C Act. Designed to deliver beauty and Some years ago, the only possible approach to build up with original submucosal lap inverted multiple fan tech- efficacy of topical minoxidil treatment. healthy aging benefits with particular emphasis on skin, and project the chin more individually has been possible nique (SLIM fan) using medium viscoelasticity hyaluronic hair and nails. Nutricosmetic sales (beauty supplements with chin implants. Today we have several filler products acid. These patients underwent over 4000 procedures To the best of our knowledge, this is the first study to ex- and tonics/beverages) reached $3.3 billion in global sales which can augment and project the chin similarly. during 2001-2019. plore the relationship between long-term aspirin use and in 2015. Oral supplements are a practical option for per- its effect on topical minoxidil treatment. sons wanting to address alopecia but without the side Beautifying this area with a filler agent asks from us The author is of opinion that lip augmentation and en- effects associated with drugs. Topical drugs and cosme- doctors a very high sensitivity for individuality as well as hancement using nonpermanent fillers with technique tics can provide a safe alternative or adjuvant to syste- ethnic group knowledge and is never a 1 injection point of submucosal multiple inverted lap fan (SLIM fan) gives  PRP FOR HAIR LOSS mic drug treatment, reducing the potential side effects. approach. Wrong injection techniques can feminize or very good, precision result: fuller, shapely lips and natural Rahul Pillai  India The right combination, targeting the multifactorial causes muscularized patients in an unwanted way. look with minimum volume of material. This procedure of hair loss, can improve penetration and achieve faster is especially usefull for using medium viscoelasticity hya- ndrogenetic alopecia (AGA) is a common hair loss results. Systemic treatments or surgical options may be The favorable injection technique will be presented, luronic acid. The material is well tolerated, safe, without disorder caused by genetic and hormonal factors unsuitable or undesirable due to potential side effects, which can be adapted in each patient for an individual A complications if properly injected and lasts about 12 that are characterized by androgen-related progressive expense, or invasiveness. Topical drugs and cosmetics beautiful result. Similar to the patient group for beautifi- months. As a result, lip enhancement with this technique thinning of scalp hair in a defined pattern. U.S. FDA ap- can provide a safe alternative or adjuvant to systemic cation this technique can also be used in the aged chin appeals to a wide spectrum of patients with various dif- proved treatments for AGA include oral finasteride and drug treatment, reducing the potential side effects. area in all other patients.

26 FRIDAY  AUGUST 30, 2019 FRIDAY  AUGUST 30, 2019 27 SCIENTIFIC SESSIONS SCIENTIFIC SESSIONS

14.45 - 16.45h 14.45 - 16.45h acids actuation. This can be done by using the same che- termine the time to neutralize and for safety, every trea- mical peel in slowly repeated “touch” technique, stopp- ting physician eventually develops his or her own met- FOCUS SESSIONS MEDICAL NEW „OLD“ TRENDS IN CHEMICAL ing application when a grey-white color appears: this is hods as they expertise in it. Having perfumed more than DERMATOLOGY: ANDROGENIC PEELINGS (IN COLLABORATION WITH IPS) a focal peeling up to superficial reticular dermis. Due to 6000 peels on darker skin types, this talk is based on my ALOPECIA & ATOPIC DERMATITIS the small size peeled, (less than 1 cm diameter) there method of peeling and information regarding performing is no healing problem. We do not recommend the use peels on darker skin types.  FROM THE OLD PEELING GENERATION TO of stronger acid solutions, since these would be prone  WHAT`S NEW IN TOPICAL RX FOR ATOPIC PHOTOACTIVATED PEELING to induce side effects. DERMATITIS? Ghislaine Beilin  France Thomas Dirschka  Germany Hands, forearms and décolleté skins are much less per- 14.45 - 16.45h he old concept of peelings creating an epidermal meable than facial skin and will need a more concentra- topic dermatitis (AD) is a chronic inflammatory skin and dermal exfoliation to induce a new collagen in LASERS & EBDS – NEWER TECHNO- T ted TCA peel. We recommend in these areas a combi- disease affecting up to 15% of children and adults order to fight aging have evolved. LOGIES = FEWER COMPLICATIONS? A nation of a focal deep peeling used in “touch” technique in western societies. Due to extreme pruritus often as- (Only TOUCH – class IIA medical device, 45% m/m TCA), sociated with AD it has profound effects on quality of life The Photo Dynamic Therapy (P.D.T) to treat skin cancer exactly on lentigos, and up to reticular dermis. The end of patients and their social surrounding. Most commonly and actinic keratosis has opened new fields for the de-  A RETROSPECTIVE PHOTOGRAPHIC REVIEW point is a grey color, always keeping the skin elasticity used topical treatments comprise topical corticosteroids velopment of photoactivated treatments. OF NON-TATTOO INDICATIONS TREATED BY when pinching the skin. and topical calcineurin inhibitors. Vast progress has been PICOSECOND LASER: A CASE SERIES OF 233 made to better understand pathophysiology of AD lea- Low concentration of 5ALA can induce a controlled and PATIENTS But large lentigos rarely come alone, they are surroun- ding to a variety of new systemic and topical treatment safe rejuvenation of the skin. Presenter: Ofir Artzi  Israel ded by small ones. In this case, large lentigos are focally approaches. Authors: Ofir Artzi  Israel touched by Only Touch peel, when the full area receives New different components with a chromophore activa- Firas Al-Niaimi  United Kingdom Easy TCA (PC) at the end for treating small lentigos. Crisaborole is a benzoxaborole, nonsteroidal, topical ted by light have been developed to target pigmentation, Joseph N. Mehrabi  Israel ointment which inhibits phosphodiesterase 4 (PDE4), erythroses, acne and rejuvenation. This combination associates pretty good results to a lower downregulating proinflammatory cytokine production. icosecond laser technology has been in clinical use social eviction, pain and side effects risks compared to a In clinical trials crisaborole has shown moderate efficacy The treatments are based on interaction of chromopho- for the treatment of tattoos and a variety of derma- deep full area peeling. Attention has to be paid to diagno- P in short-term trials. Positioning of crisaborole ointment res activated by selected length wave of light. This fluo- tological disorders, mainly pigmentary, since 2012. The se lentigos larger than 1 cm diameter since these could in the treatment algorithm of AD is still problematic as rescence will penetrate in the different layers of the skin purpose of this retrospective study was to evaluate the be in phase of cancerous degeneration and on the other head-to-head trials with topical corticosteroids and topi- and activate cells metabolism. safety profile and efficacy of the dual zoom and fractio- hand, a local deep peeling on a large area (more than 1 cal calcineurin inhibitors are missing so far. As treatment nal 532nm and 1064nm Nd:YAG picosecond laser in the cm diameter) could induce pathologic scarring problems. of AD always basis on skin care with emollients, restau- The different clinical protocols will be introduced. treatment of other selected dermatological conditions. ration of skin barrier function, topical treatments to con- Five hundreds seventeen four dual Nd:YAG picosecond trol inflammation and, in severe cases, systemic treat- laser treatments performed in a single laser specialty  WHAT TO CONSIDER WHEN PEELING DARKER ments further efforts must be taken to adapt the new  HANDS AND FACE SUN LENTIGOS: DIFFERENT center from April 2014 to October 2017 on 202 subjects SKIN TYPES? armamentarium to diverse clinical situations. On the long LEVELS OF EASY TREATMENTS USING PEELINGS with Fitzpatrick skin types II-VI were evaluated. Improve- Rahul Pillai  India run, treatment of AD will include an individual approach to Philippe Deprez  Spain ment was assessed by two blinded physician evaluators the specific genetic and clinical presentation of patients as percentage of problem clearance. Subject assess- hemical peeling is one of the most commonly done affected. kin usually suffers sun lentigos as a result of exces- ment of efficacy, satisfaction, and adverse events was cosmetic procedure and done with the intention to sive sun exposure. These lentigos are also called C performed using a questionnaire survey. Solar lentigines S have controlled destruction of a part of or the entire epi- Conclusions: For many years pharmaceutical compa- “liver spots” and appear mainly at the level of scalp, face, was the most commonly treated indication, followed by dermis, with or without the dermis, leading to exfoliation nies have avoided investments in research on AD. We décolletage, hands and forearms. The back also shows melasma, hyperpigmented scars, café-au-lait macules and removal of superficial layer of the skin which leads have now entered a new era of profound understanding often lentigos. Small size recently appeared lentigos and verrucous epidermal nevus. Other indications in- to regeneration of new epidermal and dermal tissues. A of AD pathophysiology paving the road for new treat- usually are quite superficially structures, when “old” and cluded periorbital darkening, post-inflammatory hyper- peel is a versatile armamentarium in a treating physici- ment approaches. larger lentigos can send deep structures into the deep pigmentation, congenital nevus, nevus of Ota, Becker‘s ans hands which is popular, simple, affordable and result dermis. nevus, nevus spilus, tattoos, skin rejuvenation, periorbital oriented. It is also perhaps the most lucrative procedure wrinkling and acne scars. Different indications resulted in for any physician performing it too hence becomes one On the other hand, facial skin is more permeable to pee- different levels of improvement ranging from poor–to-fair of the first cosmetic procedures to expertise by any no- lings compared to body or hand skin. Treatments will (acne scars, skin rejuvenation) to excellent–to-complete vel practitioner. also differ depending on the area to be treated.Recently (Solar lentigines, tattoos, nevus of Ota, café-au-lait ma- appeared small size ( less than 5 mm) facial lentigos can cules and verrucous epidermal nevus). Most of the pa- Treating dark skin types can however be challenging easily be treated by using Easy TCA ( classic or PC – both tients required an average of 3.4 sessions until maximal due to the unpredictability of peels especially when using are class IIa medical devices) peel, up to frosting clouds, improvement (range 1-8). All side effects were tempo- deep peels or higher concentration on darker skin types. resulting in a “GRENZ ZONE” penetration of the acids. rary and resolved within one month, and there were no Although various parameters as Time, Concentration Larger and possibly deeper facial lentigos need a deeper long-term complications. and Erythema are taken as standard parameters to de-

28 FRIDAY  AUGUST 30, 2019 FRIDAY  AUGUST 30, 2019 29 SCIENTIFIC SESSIONS SCIENTIFIC SESSIONS

 ETIOLOGY OF LASER COMPLICATION & spot (1.4-mm diameter) up to 49 spots covering an area of complaints that turn into allegations of negligence is 15.45 - 16.45h PREVENTIVE APPROACH of 1 cm2. Additional features include adjustable fluence certainly on the increase [1,2]. and many aesthetic prac- ETHNIC SKIN & Natalia Kalashnikova  Russia (0–52 J/cm²), scan patterns (line, square, hexagon) and titioners may not be aware of how vulnerable they can GLOBAL BEAUTY SYMPOSIUM pulse length (10–100 ms). be to such allegations. This talk will explain how aesthetic (IN COLLABORATION WITH SOCS) BACKGROUND practitioners using lasers and other energy-based de- he use of laser technologies in aesthetic medicine This Yellow laser has been compared to a traditional vices can ensure they can mitigate their chances of a T and dermatology is increasing every year. The ab- green KTP laser for the treatment of facial telangiectasia claim being held against them, as well as defend them-  CHALLENGES IN AESTHETIC TREATMENT solute number of complications of laser therapy is also in terms of the treatment outcomes (primary objective). selves should they be faced with a claim. IN ETHNIC SKIN increasing. The secondary objective was to assess the functionality Cheryl Burgess  USA and reliability of this new Yellow laser from the perspec- All aesthetic professionals have a ‘duty of care’, which PURPOSE tive of the user. (ClinicalTrials.gov Identifier: NCT03472859) is a legal obligation not to cause a patient injury while in iological differences along with cultural differences To evaluate of cause-associated factors of complicati- their care [3]. To mount a legal case successfully against are important considerations that impact the use ons that had arisen in practice and develop a step-by- The study was a randomized split-face double-blinded a clinic, a breach of duty, often referred to as negligence, B and results of cosmetic procedures. Aside from patient’s step preventive algorithm improving the safety of laser study. One or two treatments were given based on the must be suggested by the circumstances surrounding goals and expectations, there are numerous factors that treatment for the patients. response of the first treatment. The improvement of te- the patient‘s concern. Contrary to popular perception, affect the success of cosmetic procedures in skin of co- langiectasia was graded according to a 7-point Telang- the legal test of negligence is actually quite hard to achie- MATERIAL AND METHODS lor. The discussion will familiarize the clinician of the most iectasia Grading Scale (TGS) by the subjects and blin- ve, as a direct act or culpable omission by the defendant The analysis of the causes included the evaluation of pu- common adverse events. ded physicians. The subjects assessed the amount of has to be demonstrated. This must result in injury to the blished case studies and 20 years of practical experien- pain during the treatments using Visual Analogue Scale claimant as a reasonably foreseeable consequence of ce of the network of clinics of laser cosmetic dermatolo- (VAS), and evaluated adverse effects 2-3 days after the the act or omission of the defendant. Sometimes insu- gy “Linline” in Russia.  UNDERSTANDING THE AFRICAN AMERICAN treatment(s) using a self-assessment form. At least 50% rers will resolve cases by simple negotiation or as a result FACIAL AESTHETIC PATIENT improvement was seen in 15/18 subjects after the first of mediation on what are called ‘settlement terms’ rather RESULTS Valerie Callender  USA Yellow laser treatment, and a similar result was observed than by a court, so as to limit their exposure to costs [4]. The performed analysis made it possible to develop an for KTP, as assessed by the blinded physicians (p= 0.29). etiological classification of complications of laser derma- INTRODUCTION In the subjects‘ assessment, 7/18 subjects had at least The incidence of complaints that turn into allegations of tologic surgery. We systematized the complications and nderstanding the facial aging patterns, aesthetic 50% improvement after the first Yellow laser treatment, negligence is increasing and practitioners are often un- were able to identify six groups of causes. Five groups concerns, and treatment priorities unique to Af- whereas at least 50% improvement was observed for aware of their vulnerability to potential litigation. Com- U of them are in the area of doctor’s control and respon- rican American women may enhance clinician-patient 10/18 subjects in the KTP side, the difference being signi- pliance with regional regulation and licensing provisions sibility. communication and optimize aesthetic outcomes in this ficant (P = 0.008). The amount of pain was higher with the will confer a level of protection for the operator, should patient population. CONCLUSIONS Yellow laser compared to KTP (67.7 vs. 34.6, p < 0.001). a complaint arise. Valid patient consent and the practi- There was no difference in the frequency of erythema, tioner’s duty to be honest and open with patients is vital, Increased doctor’s control of the treatment at each OBJECTIVE crusting or purpura between the devices, but more blis- stage of treatment improves safety and reduces errors. as any demonstrated misrepresentation may invalidate Two online studies were performed to gain insights tering and less edema were seen after the yellow laser A detailed analysis of each group of etiological classifica- consent and expose the practitioner to the risk of prose- into facial aging characteristics and treatment priorities treatment (p < 0.05). Treatment with the Yellow laser was tion of complications of laser dermatologic surgery was cution for battery. among African Americans. the basis for the creation and implementation of a step- evaluated to be 4.7-fold faster than with KTP and the 1 by-step preventive algorithm. Yellow laser system was more compact, narrower, light- [ ] NHS Annual Report and Accounts 2018 https://resolution. MATERIAL AND METHODS er, and easier to carry than KTP. This new Yellow laser nhs.uk/annual-report-and-accounts-201617/ In Study one, 714 participants in the US, Canada, UK, and enables significantly faster treatments, providing a similar [2] Jalian HR, Jalian CA, Avram MM. Common causes of in- Australia (aged 18 - 75 years) self-assessed facial aging  VECSEL-BASED 590-NM LASER SYSTEM WITH clinical outcome in the treatment of facial telangiectasia. jury and legal action in laser surgery. JAMA Dermatol. 2013; using a photonumeric scale of line/wrinkle severity for 8 W OF OUTPUT POWER FOR THE TREATMENT 149(2):188-193. 10 facial areas. In Study two, 401 US-based participants 3 OF VASCULAR LESIONS Karppinen T, Kantola E, Karppinen A, Rantamäki A, Kauti- [ ] Ferrari F. Donoghue v Stevenson’s 60th Anniversary An- (aged 30 - 65 years) identified most bothersome facial Serge Mordon  France ainen H, Mordon S, Guina M. Treatment of telangiectasia nual Survey of International & Comparative Law 1994; 1:1: areas as well as their relative treatment priorities using a on the cheeks with a compact yellow (585 nm)semicon- Article 4. evaluated. 4 sions, such as telangiectasia and port wine stains. The Mar;51(3):223-229. [ ] ACAS Settlement Agreements: A Guide. 2013; Compared with other racial/ethnic groups, African Ame- emerged as an attractive alternative to solid-state and  HOW TO SELECT EFFICIENT DEFENSIVE ricans reported “moderate-to-severe” signs of facial dye lasers due to their enhanced functionality and broad STRATEGIES IN A LITIGIOUS ENVIRONMENT aging later, not until 50 - 79 years of age. And at ages wavelength coverage. This innovative yellow laser is ca- Godfrey Town  United Kingdom 70 - 79, over 70% were still without moderate-to-seve- pable of delivering up to 8 W of output power at ~590 nm re perioral lines, lip fullness loss, or midface volume loss. and includes a handheld scanner for an easy delivery of he practice of defensive medicine is not a new African Americans were most bothered by their tear light onto skin. The scan area can be varied from a single T concept to the medical profession. The incidence trough and submental areas, which were also among

30 FRIDAY  AUGUST 30, 2019 FRIDAY  AUGUST 30, 2019 31 SCIENTIFIC SESSIONS SCIENTIFIC SESSIONS

the most likely to be prioritized in future treatment. Areas  BOTULINUM TOXIN INJECTION FOR MASSETER  PHOTODYNAMIC THERAPY OF ACTINIC KERA- used in investigations of new AK treatments is the com- least likely to prioritize were perioral lines and lips. African MUSCLE HYPERTROPHY TOSIS USING LIGHT EMITTING FABRICS (LEF) plete clearance rate of lesions. Although this end point is Americans expressed the lowest consideration rate for Adolfo Napolez  USA Serge Mordon  France easy to measure and detect, and it is often challenging injectable treatment options. A primary reason for con- to achieve, may be confounded by the appearance of sidering injectables was wanting to “look good for their he masseter muscle is a quadrangular muscle that hotodynamic therapy (PDT) is an effective conser- subclinical lesions during treatment, and most patients age”; although cost, safety, and possible side effects T covers the mandibular Ramus and coronoid pro- P vative treatment for actinic keratoses (AK). Howe- and physicians would consider a reduction in lesions as were cited as the greatest barriers. cess. It has both superficial and deep heads. The re- ver, pain and heterogeneous illumination from rigid panels treatment success. duction of the superficial head of the masseter muscle impede the treatment. To provide a more homogeneous CONCLUSIONS improves the contour of the lower face while having a illumination, we have developed a Light-Emitting Fabric Management should be directed at individual lesions and African American women reported the slowest onset minimal effect on the mastication or temporomandibular (LEF), called Phosistos®. A randomized, controlled, mul- over all the affected area. Field-based treatment can act to and least severe signs of facial aging. Common areas of joint function. Injection of Botulinum toxin into the mas- ticentre, intra-individual clinical study was conducted to manage a range of actinic changes and topical therapies, concern were aligned with treatment priorities, highlight- seter muscle results in a chemical denervation at the compare this new device (P-PDT) to the conventional chemicals peels and photodynamic therapy are suitable. ing the tear trough and submental areas. For clinicians, neuromuscular junction. The ensuing muscle atrophy re- PDT using a LED Panel (C-PDT). Forty-six patients with Usually, focal destructive therapies such as curettage and evaluation of these areas as well as addressing the safe- duces the bulkiness of the lower lateral face and gives a grade I-II actinic keratosis of the forehead and scalp cautery or cryotherapy are limited to lesion treatment. ty/side effects of injectables during the consultation may soft round contour to the lower face. were treated with P-PDT on one area (n=280 actinic ke- provide valuable guidance for patients and broaden their ratosis) and with C-PDT on the contralateral area (n=280 Another useful treatment is use fractional ablative laser range of treatment considerations. BIOGRAPHY: actinic keratosis). The primary endpoint was the lesion as CO2 and Erbium Yag 2940nm alone or combined Dr. Napolez attended Southern Illinois University School of complete response rate at three months with an abso- with Photodynamic therapy (PDT) and a photosensiti- Medicine followed by a general surgery residency at West lute non-inferiority margin of -10%. Secondary endpoints zing chemical substance as Methyl aminolevulinate or Penn Hospital in Pittsburgh, PA. He subsequently comple- included patient-reported pain scores, emergence of aminolevulinic acid. In this presentation we make a brief 17.15 - 18.30h ted fellowships in Burn Surgery and Cosmetic Surgery. new actinic keratosis, incidence of adverse events and summary of treatments using new technologies. ANYTHING NEW IN TOXINS? cosmetic outcome. Results show that at 3 month follow He has published articles in five different medical journals up, the lesion complete response rate with P-PDT was as well as a chapter author in a textbook on Asian cos- non-inferior to that with C-PDT (79.3% vs. 80.7%). Mo- metic surgery.  ASSISTED BOTULINUM TOXIN DELIVERY FOR reover, the patient-reported pain score was significantly 17.15 - 18.30h RARE AND COMMON DERMATOLOGICAL lower with P-PDT compared to C-PDT (mean ± stan- MICRONEEDLING & RADIOFREQUENCY – He has been honored as top Doctor in Plastic Surgery INDICATIONS dard deviation: 0.3 ± 0.6 vs. 7.4 ± 2.3; p<0.0001). At six DREAM TEAM? Practice Magazine in 2010. As well as being honored Ofir Artzi  Israel months, the lesion complete response rate with P-PDT by the Consumer Council of America as a top Cosme- was non-inferior to that with C-PDT (94.2% vs. 94.9.7%). tic Surgeon. He most recently spoke at the 5 Continent There was a lower incidence of new actinic keratosis for otulinum toxin (BTX) blocks the release of the neu-  FACIAL AND BODY REJUVENATION USING Congress in Cannes, France September 2015. the area treated by P-PDT compared to C-PDT (8.6% of B rotransmitter acetylcholine from peripheral nerves RADIOFREQUENCY WITH MICRONEEDLES patients vs. 39.1%). In conclusion, PDT with the innovati- and thus might alter cutaneous vasodilatation. Due to Virginia Benitez Roig  Spain its characteristics and high molecular weight, BTX can- ve LEF device is similar in terms of efficacy than C-PDT in treating actinic keratosis of the forehead and scalp while not penetrate the highly impermeable stratum corneum any of the patients interested in improving the qua- 17.15 - 18.30h leading to much lower pain scores and fewer adverse while applied to bare skin. Disruption of the outer stra- M lity of the skin on the face, neck, and other areas events. ( ClinicalTrials.gov Identifier: NCT0307689) tum corneum by mechanical, chemical, or physical ap- FOCUS SESSIONS MEDICAL of their body come to the consultation well informed and proaches increases skin permeability. Selective thermal DERMATOLOGY: SKIN CANCER & demanding effective treatments that can be carried out Mordon S, Vignion-Dewalle AS, Abi-Rached H, Thecua E, ablation of stratum corneum dramatically increased skin PRECANCEROUS SKIN CONDITIONS in a few sessions and with minimum recovery time. permeability for transdermal drug delivery Above 360ᴼC, Lecomte F, Vicentini C, Deleporte P, Béhal H, Kerob D, Hom- mel T, Duhamel A, Szeimies RM, Mortier L. The conventio- transdermal flux increased by many orders of magnitu- Among the different EBD (Energy Based Devices, the nal protocol versus a protocol including illumination with a de. The Tixel is a non-laser thermomechanical system  SRT FOR NON-MELANOMA SKIN CANCER acronym in English) we select a bipolar radiofrequency fabric-based biophotonic device (the Phosistos protocol) in which transfers thermal energy to the skin, dehydra- David J. Goldberg  USA device with microneedles that permits control of the photodynamic therapy for actinic keratosis: a randomized, tes the stratum corneum and superficial epidermis and temperature in real time to create fractional thermal da- controlled, non-inferiority clinical study. creates micropores, thus, enhancing drug delivery. This uperficial Radiation Therapy (SRT) of Non-melano- mage in the dermis. study aimed to assess the safety and efficacy of a novel S ma Skin Cancer (NMSC) has become a very popu- Br J Dermatol. 2019 Apr 25. doi: 10.1111/bjd.18048. non-laser thermal resurfacing system of increasing skin lar non-surgical approach to the treatment of non-mela- We show the results in different body areas using the permeability for botulinum toxin type A in rare (example noma skin cancer. With increasing time and experience, two handpieces available. These have needles of the  USE OF LASERS AND OTHER DEVICES TO Hailey Hailey disease) and in common (example Rosa- the pros and cons of this approach has become clear. same length (6mm), but different angles of penetration, TREAT CANCERIZATION FIELD cea) dermatological conditions. Recently published Consensus Guidelines have allowed which causes the depth and results to vary. for an organized science-based approach to the treat- Jaime Piquero-Casals  Spain ment of NMSC. This talk will focus on the role of SRT, We show clinical results and histological studies that de- ctinic keratosis (AK) lesions are surrounded by among other techniques in the treatment of skin cancer monstrate the increase in collagen and elastin after the areas of subclinical, non-visible sun damage cal- with an emphasis on and review of the recently publis- A treatments. hed guidelines. led field cancerization. The primary endpoint commonly

32 FRIDAY  AUGUST 30, 2019 FRIDAY  AUGUST 30, 2019 33 SCIENTIFIC SESSIONS SCIENTIFIC SESSIONS

 NOT ALL RF IS CREATED EQUAL: FIELD RF FOR 17.15 - 18.30h Four treatment sessions at 3-week intervals prove to be CIRCUMFERENTIAL REDUCTION an effective treatment, as it has been published. Studies SCARS WARS R. Glen Calderhead  South Korea conducted on acne scars demonstrate significant im- provement, both on the face and on the back and shoul- adiofrequency (RF) is a major energy-based medi- ders.  LIGHT-BASED DEVICES COMBINATION FOR cal technology which has made a large contribution R THE TREATMENT OF SCARS in clinical practice in the last two decades. Clinical uses A treatment with the Legato® device mixed RF with ult- Didac Barco  Spain of RF do not use actual radio waves, but simple electrici- rasounds permits to introduce drugs to enhance results ty which is frequency modulated to achieve frequencies of treated scars. This has been proved by staining with car tissue production has different pathogenic pha- of over 250 Hz which do not disrupt biological tissues fluorescein the above-mentioned drugs noticing its ef- ses with several chromophores to be targeted by compared to the potentially fatal 60 or so Hz of domes- S fective deposit into the dermis. light-based devices in each of them, especially during tic mains electricity. When electricity meets resistance the first month after the injury that caused the wound. it creates heat, so called Joule heating, and contact RF The intensity of dermal fluorescence in treated samples The time of application of the treatment is key to take uses this property to create electrothermal damage in containing the drugs, when compared to that of auto- advantage of every pathogenic step in scar formation target tissue to start the wound-healing process and fluorescence controls demonstrates significant differen- and early use of light-based devices permits to guide the tighten lax skin, smooth out lines and wrinkles and remo- ces. Transepidermal delivery procedure of drugs carried process of wound healing and reduce the probability of del a variety of hypertrophic and atrophic scars. Contact out by RF and ultrasounds facilitates prolonged and ef- the emergence of a keloid or a hypertrophic scar. RF at frequencies of from 250 Hz to 5 MHz can be deli- fective dermal effects when treating scar tissue. vered in a number of ways from electrodes on the skin, We will focus on when and which light-based devices to electrodes actually in the skin such as the more recent The bimodal procedure presented is safe and effective are suggested to be applied during the scar tissue for- microneedle electrodes. Contact RF depends entirely in reducing scarring tissue, representing a good thera- mation, highlighting the importance of an early approach on tissues which can conduct electricity, i.e., skin. Fat on peutic alternative of great interest. to target haemoglobin during the first weeks (with PDL, the other hand is a very poor conductor and therefore KTP, LBO, Nd:YAG or IPL) in combination with fractional cannot respond to contact RF because fatty tissue is a non-ablative and ablative lasers to aim collagen produc- dielectric, a poor conductor of electricity, which contains tion. millions of randomly arranged units called dipoles. Howe- ver, with an electromagnetic (EM) field at much higher Early approach and combination of different devices is frequencies selective dipole heating occurs in a dielec- currently accepted to be the most convenient tactic to tric such as fat. A specific EM frequency, 27.12 MHz, has enhance therapeutic response and decrease the likeli- been used in diathermy medicine to selectively heat tis- hood of an unpleasant scar. sues of low conductivity, properly termed poor permitti- vity, such as tumors. Noncontact field RF is a novel met- hod of delivering an oscillating EM field from an irradiator  RF, ULTRASOUND AND TOPICAL MEDICATION not in contact with skin, which can selectively heat only FOR SCAR TISSUE TREATMENT fat and cause gentle apoptosis of adipocytes, resulting in Mario A. Trelles  Spain effective circumferential reduction. Thus all RF systems are not created equal, and have different targets. cars are a consequence of a tissue repair from inju- S ries of different etiologies. Scar tissue degree varies from moderate to severe. The skin affected by post-ac-  RF SKIN TIGHTENING AND RF MICRONEEDLING: ne scarring has an abnormal contour, with most scars NEW CONCEPTS being depressed below the adjacent normal skin. Many Michael H. Gold  USA treatment methods have been developed for scar im- provement, but in general, all of them have disadvan- he use of RF energy for skin tightening has beco- tages because of being either too mild and ineffective or me a mainstay in many aesthetic practices. This T too aggressive and complicated. presentation will review the myriad of devices that are currently available and show the differences between This presentation reviews various techniques which monopolar and bipolar RF and how some use multiple have been used by the author, together with his actual “poles” to achieve their effects. The presentation will also modality that is successfully used for treating scars. The show how this technology is incorporated into one’s cli- achieved experience using unipolar fractional ablative nical practice. radiofrequency technology used with acoustic pressure ultrasound guided dermal injection of Retin A or Triam- cinolone, through RF Pixel fractionated micro-channels.

34 FRIDAY  AUGUST 30, 2019 FRIDAY  AUGUST 30, 2019 35 FREE COMMUNICATION: ABSTRACT AWARD

9.00 - 11.00h sed FFA levels indicating a rapid lipolytic reaction, and by FREE COMMUNICATION: reduced pH levels due to the increased acidity in the fat FREE COMMUNICATION: ABSTRACT AWARD tissue. Further research is required to explore the poten- ABSTRACT AWARD tial of non-thermal induction of apoptosis fully. CATEGORY: ENERGY-BASED DEVICES

 NEEDLE SHEIKHING TREATMENT OF VITILIGO: A  BIOCHEMICAL PERSPECTIVE OF FAT PHYSIO- STUDY OF NEEDLING AND UVB FOR VITILIGO LOGY AFTER APPLICATION OF HIFEM FIELD Mohammad Iftikhar Sheikh  Pakistan TECHNOLOGY: ADDITIONAL INVESTIGATION OF FAT DISRUPTION EFFECTS IN A PORCINE STUDY INTRODUCTION SATURDAY Presenter: Yael Halaas  USA itiligo is an ever-increasing problem in all age Authors: Yael Halaas  USA V groups. Different regimens in practice are sun ex- AUGUST 31, 2019 Jan Bernardy  Czech Republic posure, UVR and psoralens. My paper presents an ori- ginal study where NEEDLING is combined with narrow BACKGROUND band UVB. Our hypothesis is that epidermal cells in the ultiple studies reported fat tissue reduction after skin around the vitiligo patch can be pushed from normal application of the High-Intensity Focused Elec- M skin into the vitiligo patch and subsequent UVB induced tromagnetic (HIFEM) field technology, yet cellular level melanogenesis treats vitiligo. evidence of the exact mechanisms remains scarce. This study aims to verify or refute previous single-study histo- METHODS logical evidence and further investigates the proposed A 31G needle is softly pushed through the normal skin mechanism of apoptosis induction. into the vitiligo patch at level of dermo-epidermal junc- tion parallel to skin. This needle push called NEEDLING MATERIALS AND METHODS pushes epidermal cells including melanocytes into the The thigh of four Large White pigs were treated with HI- vitiligo patch as micro inoculation to produce multiple FEM for 30 minutes. Subcutaneous fat punch biopsies small populations of melanocytes, which is then expo- were then collected from the application area before, sed to increasing doses of UVB to cause melanogenesis immediately after and 8 hours post-treatment. Control and hence repigmentation of the area. Multiple need- samples were taken from the abdomen immediately af- le pushes are made through the edge one centimeter ter and 8 hours post-treatment. The histological samples apart. All patients having needling once weekly and UVB were used for the detection of pro-apoptotic DNA mar- 3 times a week. This study was done over 170 patients kers (BAX, BCL-2, TXNIP, MMP9, TNFα) and measure- in both sexes in different age groups from July 2009 to ments of the level of free fatty acids (FFA). The pH of the July 2013.A comparison was also done with UVB alone. fat tissue was also measured at the biopsy site. Photos of all patients taken at the start and then every 3 weeks. Biopsy of few patients performed to observe the RESULTS effects of needling. The levels of FFA in the treated fat tissue increased in all treated animals on average by 127.1% immediately RESULTS post-treatment and by 134.1% eight hours post-treat- This combination treatment has proved very safe and ment, indicating a rapid breakdown of lipids. In the same effective against vitiligo as compared to UVB alone in region, the average fat pH changed from 7.30±0.12 at all age groups. All patients had fast repigmentation. The baseline to 6.60±0.07 immediately post-treatment, and best results are on face with more than 90% repigmen- then to 7.19±0.12 eight hours post-treatment. The levels tation. Repigmentation is good but slower towards pe- of BAX, TXNIP, MMP9, and TNFα increased post-treat- ripheral parts. Repigmentation specially noted to start ment while BCL-2 expression decreased. Control sam- from edge of vitiligo patch (where needling is done) as ples showed constant levels of pH and pro-apoptotic D A Y tiny black dots and further needling through these dots markers. The FFA in control samples increased on ave- gradually repigmented the central areas. Repigmenta- rage between 41.6% and 51.4%. tion is also good over areas with grey hair with this tech- nique as needling uses melanocytes of the surrounding CONCLUSION skin rather than the follicular cells. This further strengthe- Through observation of the increase in pro-apoptotic ned the idea of needling. markers, we managed to replicate the previously repor- ted signs of elevated fat apoptosis induced by HIFEM 3 technology. These effects were accompanied by increa-

SATURDAY  AUGUST 31, 2019 37 FREE COMMUNICATION: ABSTRACT AWARD FREE COMMUNICATION: ABSTRACT AWARD

 TREATMENT OF NON-ATOPIC DERMATITIS WITH window of 10x30 cm and wavelength range of 520-1100 linum toxins early on to new wounds to prevent the de- POLARIZED UV FREE POLYCHROMATIC LIGHT: A nm at three cut off filters of 520, 560 and 580 nm and velopment of keloid or hypertrophic scars. CASE REPORT their respective pulse width of 2-12, 12-30, and 30-60 Presenter: Alberto Leguina-Ruzzi  Czech Republic ms. The fluence range used was 12-27 J/cm2. We com- Authors: Alberto Leguina-Ruzzi  Czech Republic bine the use of Nd: YAG 1064 nm laser system in micro-  MICROTIA-ATRESIA REPAIR WITH HEARING Kishan Rajnikant Raichura  United Kingdom second mode to complement the therapeutic effects of IMPROVEMENT SURGERY Sarah Karis Tonks  United Kingdom IPL. The Nd YAG 1064 nm provide a volumetric specific Ashesh Bhumkar  India Semira Kwabi  United Kingdom heat to deeper skin layer which cannot be achieved by IPL wavelength. urgical Repair To Improve Natural Hearing Plus Au- CASE 1  KNEE PITS topic dermatitis is a common inflammatory condi- S ricular Reconstruction Using Autologous Rib Carti- A tion, which is potentially debilitating and can com- RESULTS lage Or *Medpore – A Single Stage Surgery By A Single promise life quality. Pruritus is the common presenting There was an improvement of skin photodamage or Surgeon. symptom leading to scratching that results in secondary photoaging in all cases with elimination or significant re- skin changes. Current treatments are based on topical duction of pigmented lesions, diffuse redness and the BASIS preparations, immunomodulating drugs and UV photo- improvement in skin texture with reduction of elastosis, Advances In Understanding “Natural Hearing” its totality, therapy; however, the adherence and success of the- fine wrinkles and pore size which were observed in situ which is way beyond the conventional Puretone Audio- se remain limited, and eczema remains a bothersome and before and after photos, by patients, doctors and gram. The 3 Dimensional aspect of the hearing is import- chronic condition which can significantly impact on our independent observers. After each session patient sho- ant for a person’s sense of physical position in spatial patients’ quality of life. wed mild to moderate erythema and swelling lasting 2 orientation. to 3 hours. Pigmented lesions darkened, forming fine crusts that fell at 7 to 10 days. Advances in Imaging – CT Temporal Bone. The 0.3mm Polychromatic/non-coherent UV-free light is used as CASE 2  HAND PALMS therapeutic option for the treatment of several muscu- study of temporal bone is able to show the stapes ossic- loskeletal disorders and skin conditions. However, it has le in its entirety, including its size and shape. Plus it is able not as yet been tested in the management atopic der- to show the footplate in great detail. matitis. CATEGORY: (AESTHETIC) DERMATOLOGY & (AESTHETIC) PLASTIC SURGERY Additionally, this CT Scan is able to show the entire In this case report we present a 67-year-old female pa- course of the Facial Nerve in its 3 dimensional course. tient who has suffered with moderate atopic dermatitis for the last 20 years, and had undergone multiple treat-  KELOID SCARS BETWEEN TRIAL AND These above factors have brought higher safety to atre- ments in that time, without significant improvement or RESISTANT NATURE sia surgery for hearing improvement. relief from her symptoms. She was treated for six weeks ITCHINESS DRYNESS SCORE Zainab J. Albanna  Jordan with daily polarized light therapy (PLT) applications (10 MRI study to accurately predict the presence of real minutes/area). Our results showed that light therapy of- bnormal wound healing after dermal injury resulting Middle Ear Cholesteatoma versus an external canal cho- fered a significant reduction in erythema of the affected  COSMETIC TREATMENT OF SKIN PHOTO- A in formation of keloid scars is a challenging condi- lesteatoma has made pre-op decision making sharper zones with a concomitant reduction in pruritis and de- DAMAGE WITH IPL AND ND:YAG 1064 NM LASER tion to both patients and physicians. Up to this date there and predictable. hydration of the skin, without side effects or discomfort. Lázaro Pérez  Spain is, still, no single satisfactory treatment option with pre- Conclusions: in this study, six weeks of PLT reduced ery- dictable results. In our practice, we apply a multi-modali- CT Scan study of the rib cartilage has made selection thema and lesion size in the hands and popliteal fossae. INTRODUCTION ty approach. This approach showed the best results. of the side of harvesting accurate. It allows the surgeon However, in the popliteal fossae, we observed an early kin photodamage is one of the most frequent rea- to plan the skin incision to be precise and as smallest in increase on redness and its size, but this was not as- S sons of consultation in dermatology, medicine and During this presentation, we will go through the ancient length as possible. sociated with active vesicles or flakes, and moreover cosmetic surgery. The skin submitted under a chronic history of keloids, in addition to literature review of previ- resolved after the third week of PLT. In general, a signi- and excessive exposure to ultraviolet radiation and its cu- ously used treatments, and their mechanism of action. Study of the vascular architecture of the skin of the de- ficant reduction in itchiness and dryness was observed, mulative effect, among others agents as environmental formed ear & the periauricular skin by means of advan- increasing the patients comfort and overall adherence to factors, toxic habits; nutritional, endocrine and metabolic Advances in the understanding of wound healing pro- ced Doppler and CT Angiograms allows the surgeon to the non-pharmacological treatment. disorders; drugs and medications side effects; genetic cess lead to the focus on new treatment options, such plan the skin incision and creation of the skin pocket with and emotional factors, contribute to a chronic „cascade as; calcium channel blockers, topical Imiquimoid, botuli- the least possible disruption to the vascular supply. This More clinical studies are needed to understand the the- of defensive events“ that ends in skin aging. num toxins, hyaluronidase, PDL laser, fractional laser, and enables healthier wound healing which impacts greater rapeutic properties of PLT and to acknowledge its bene- fractional radiofrequency, or the combination of the pre- quality outcomes. fits, even though our findings suggest encouraging pos- MATERIAL AND METHOD viously mentioned treatments. sibilities for the use of PLT as management strategy for 1110 patients have been treated with age between 24 The Rib Cartilage Sculpting & Creating the framework recurrent moderate dermatitis. and 81 years old and I-IV Fitzpatrick skin photo-type, who In this presentation will share with you some of our actual are already standardized by now. presented various types of benign pigmented and diffu- patient cases for whom we used a combination treat- se vascular lesions on the skin. We used an Intense Pul- ment, with emphasis on the resistant nature of keloids, This talk will present our algorithm of decision making sed Light device with cooled (5 -10 or 20 oC) sapphire with great emphasis on the prevention with using botu- and our special experience based skin approach in Au-

38 SATURDAY  AUGUST 31, 2019 SATURDAY  AUGUST 31, 2019 39 FREE COMMUNICATION: ABSTRACT AWARD FREE COMMUNICATION: ABSTRACT AWARD ricular Reconstruction. More importantly, it will cover the of the horizontal V-Y advancement flap as a simple and CATEGORY: INNOVATIONS MATERIALS AND METHOD aspects of improvement in Natural Hearing, which is ea- most reliable alternative to repair moderate-size lower This study is a clinical, prospective and longitudinal trial sily possible in a large percentage of children, that too, in eyelid defects with satisfactory functional and aesthetic on 25 adult female patients between age ranges 24 to the same stage as auricular reconstruction – with Rib or results in the long term.  THE NEW PLASMA DEVICE FOR THE FACE 67. The research was carried out from September 2018 with Medpore. REJUVENATION to March 2019. Dinko Kaliterna  Croatia  THE MANY FACES OF PYOGENIC GRANULOMA Evaluation controls were done before, 2 weeks and 4  RECONSTRUCTION OF LOWER EYELID DEFECTS Presenter: Efrat Solomon Cohen  Israel he plasma is the fourth matter of state. We want to months after treatment with BoNT-A. WITH MODIFIED HORIZONTAL V-Y ADVANCE- Authors: Efrat Solomon Cohen  Israel T represent the plasma device which uses argon and MENT FLAP: SERIES OF 60 CASES Moshe Lapidoth  Israel nitrogen gas. The treatment is noninvasive with no or mi- Examination protocol in the trial included digital photo- Presenter: Mehdi Shiri  Iran Michael Moshe  Israel nimal downtime. The plasma has a strong rejuvenating graphy, Smith and Knight Tooth wear index (TWI), Ortho- Authors: Mehdi Shiri  Iran, Javad Rahmati  Iran Daniel Mimouni  Israel, Assi Levi  Israel effect on the skin. The idea is to produce coagulation pantomography (OPG), Magnetic Resonance Imaging Hadi Shiri  Iran, Farideh Bahrami  Iran with no epidermal damage. (MRI). Measurements of bigonial diameters were taken Saeedeh Shiri  Iran, Deyaar Tehrani  Iran INTRODUCTION by calliper, at rest and during contraction, and the thick- Zahra Shiri  Iran, Ghazaleh Ebrahimi  Iran yogenic granulomas can develop at any age but are The treatment is noninvasive with no or minimal down- ness of each masseter muscle was also evaluated, in the P more common in children and young adults. The time. The plasma has a strong rejuvenating effect on the same conditions, by ultrasound at every control. BACKGROUND lesion usually presents as a solitary red papule or polyp skin. During the treatment, we combine two different ga- ower eyelid malignancies, specifically basal cell car- that grows rapidly over the course of weeks or months, ses: argon and nitrogen. RESULTS L cinomas (BCC) are not uncommon. Excision of such stabilizes and then may spontaneously decrease in size. As a result after BoNT-A treatment, 24% of the patients were free of bruxism, while the remaining 76% obtained lesions creates reconstructive challenges due to fewer As a tertiary laser clinic many pyogenic granuloma dia- The skin is not only significantly rejuvenated but also very a significant improvement. Patients had few and transi- surgical options and compromises in the dynamic ex- gnosed lesions are referred to us. However, other va- tighten after the treatment. Also, the quality and appea- ent adverse effects. pressivity and facial aesthetic appearances. Direct clo- scular or non-vascular lesions should always be taken rance of the skin are significantly improved. The treat- sure is often restricted and it increases the incidence of into consideration in the differential diagnosis. ment is safe for all skin types and can be done all year CONCLUSION ectropion if the lesion is more than 0.5 cm. This clinical around. The result is right seen after the treatment and AIM BoNT-A can be used to protect oral-facial structures – study aims to present a novel reconstructive technique gets better over time. This treatment represents a real To present our experience with various lesions clinically such as teeth, jaw muscles, temporomandibular joint, and to report the authors’ experiences of full-thickness alternative over the fractional lasers and is much more mimicking a pyogenic granuloma. from excessive forces and harmful damage caused by lower eyelid defects after tumor resection. safe, especially for the people with darker skin. bruxism, and to relieve accompanying pain and related PATIENTS AND METHODS METHODS complaints by decreasing the muscle forces exerted du- 60 cases, 35 men and 25 women, ranged from 45 to Through case series and systematic literature reviews ring contraction.  BRUXISM TREATMENT WITH BOTULINUM TOXIN 73 years underwent surgical resection of lower eyelid tu- we present the many faces of PG-like lesions along with TYPE A. PROSPECTIVE STUDY mors between May 2014 and December 2015.On initial three representative cases from our clinic. These three Presenter: Liza Mhkitaryan  Spain histology, 40 of the patients were affected from nodular patients were referred to our clinic due to a diagnosis Authors: Liza Mhkitaryan  Spain BCC, 10 from pigmented BCC,6 from micronodular BCC, of a pyogenic granuloma. Following further evaluation Justo M. Alcolea  Spain 3 cases of BCC Morpheic variant, and one from partially one patient was diagnosed with an omphalomesenteric duct remnant protruding through his umbilicus, one was excised Squamous Cell Carcinoma(SCC).The average INTRODUCTION diagnosed with an amelanotic malignant melanoma, and diameter of the defects were 1.5 cm and immediately ruxism is defined as grinding or clenching of teeth, the third one was diagnosed with GVHD-associated an- repaired by an island pedicle flap(V-Y advancement flap) involuntarily and intensely, due to hypertrophy and/ giomatosis. B with high height-to-width ratio horizontally shaped from or contraction of muscles related to chewing, with par- beneath the lateral canthus to the medial lower lid de- ticular involvement of masseter muscles. This situation CONCLUSION fect. The mean procedure was 30 minutes and the pa- can happen during sleep or wakefulness indistinctly. tients followed for 18 months on average. Given the potential complications of misdiagnosed PG- like lesions, keeping in mind the differential diagnosis and Different treatments are intended to limit destructi- RESULTS acquiring histologic samples are at the utmost import- ve effects of bruxism on different biological structures, Advancement of lower eyelid subunit by means of a re- ance. especially on the temporomandibular joint. Treatments latively long horizontal V-Y flap was performed without are variable and range from irreversible occlusion, inter- post-operative complications, the development of ec- position of splints, pharmacological therapies or cogniti- tropion, and nearly unremarkable scar on the follow-up ve-behavioral approaches. period. The aesthetic results were judged excellent by both the patients and the blinded panel of independent The aim of this study was to investigate the relaxation ef- dermatosurgeons. No recurrences were reported. fect of botulinum toxin type A (BoNT-A) injection in mas- seter muscles and its relation to the relief of symptoms in CONCLUSION patients with bruxism. In this study, the authors reported a modified technique

40 SATURDAY  AUGUST 31, 2019 SATURDAY  AUGUST 31, 2019 41 SCIENTIFIC SESSIONS

9.00 - 11.00h EXCLUSION CRITERIA autoimmunitary disease, extremely big breast and 4th DEFYING GRAVITY – COSMETIC degree phtosis. SCIENTIFIC SESSIONS THREADING ON & OFF THE FACE RESULTS Technique is really new and results till now are positive  THREADS AND FILLERS: HOW, WHERE with patient satisfaction. AND WHEN? Beatriz Beltran  Spain CONCLUSION Elastic thread breast reshaping is the only non-invasive ccording to recent statistics from ASAPS US the technique that permits to obtain good results without SATURDAY A number of surgical lifts were 125.000 while the implants, without evident incision, without scars and wit- number of non-surgical procedures were more than 8 hout tissue undermining. AUGUST 31, 2019 and a half million. This means a lot of patients don’t want surgical procedures and often surgery doesn’t live up to KEY WORDS their expectations. I will explain how to combine threads Elastic thread “Elasticum”, two tipped needle, breast re- and fillers. It is one of the best alternatives to surgery. It is shaping. effective, non-invasive and has long lasting results. It per- mits a patient to continue with their normal life after visi- ting the clinic. It is based on combining fillers and sutures.  BUTT LIFTING WITH SPIDER WEB TECHNIQUE Bülent Cihantimur  Turkey THERE ARE THREE STEPS: First step is restore volume. It replaces changes to the ging of skin and also sagging buttock is an unavoi- bone and lost of volume in deep fat compartment. I inject A dable process. Classical buttock lifting is invasive, fillers on strategic points working with facial proportions, so it is difficult to recommend it to patients especially to it permits a lifting of the face without getting too much those who do not have severe gluteal ptosis. In addition, volume. the gluteal area is a large area change among the joints. Therefore, this surgery can cause pain during hip flexion Secondly I restore the superficial fat compartments after lifting using a conventional thread. Spider Butt Lift using threads, I will explain the most effective patterns of using a thread with high satisfaction from patients. All pa- sutures for achieving amazing results. tients underwent lifting of both buttocks using threads. Drew a circle along the outer edge of the buttock like Third step is restoring the mobile area like nasolabial spider web image and put the threads. With the effect and marionette area and small depression with AH with of threads, lifting was done. With these threads specifi- high cohesivity. The results are natural, long lasting and cally, because the sutures are largely composed of PO- without downtime. Getting efficient results on a smaller LYDIOXANONE (PDO), a bio-stimulatory effect occurs in budget ultimately improves client satisfaction. the skin with the production of both Type 1 and 3 colla- gen. This collagen increase leads to a volumizing effect that continues for up to two years, enhancing the qua-  DIFFERENT POSSIBILITIES FOR MINIMAL- lity of the skin in the long run. Spider Butt Lift is effective INVASIVE AESTHETIC BREAST REMODELING BY in pre-ptosis to moderate gluteal ptosis because of the ELASTIC THREAD elasticity of the thread, postoperative pain is low on hip Maurizio Berlanda  Italy flexion, so the lifting is done naturally. Also people want bigger butts. However traditional procedures for butt INTRODUCTION, AIM OF THE WORK lifting and enlargement have multiple disadvantages. uthor describes a minimal-invasive technique to In this case with Spider Butt Lift, we used an innovative D A Y A reshape photic breast (as natural as with implant) technique combining thread lift with fat transfer to but- without scars nor tissue undermining. tocks. The goal of Spider Butt Lift is to improve the ante- roposterior projection of the gluteal region. The advan- MATERIAL AND METHODS tages of the technique are its simplicity, that it produces The technique consists of using a two components elas- no traumatic effects, and that it is performed with local tic thread with double tips needle to be placed in diffe- anesthetic, reducing surgical time. Recovery is rapid and rent concentric circling into subcutaneous tissue, under usually produces only mild discomfort. It is possible to 3 local anesthesia. combine this procedure with liposuction techniques. As

FRIDAY  AUGUST 31, 2018 SATURDAY  AUGUST 31, 2019 43 SCIENTIFIC SESSIONS SCIENTIFIC SESSIONS

far as I’m concerned, the aim is to tighten the buttocks and bleaching agents, besides surgery and drugs. Many reduction in size, pain and colour (from red to brown). The Er;Cr:YSGG laser was used at 9 W in 1-2 treatment as well as the overlying skin. Spider Butt Lift has the ad- practices may already perform this kind of early cosme- sessions. During irradiation laser energy was delivered at vantage of lifting the desired parts of buttocks without tic treatments, but do not realize the perspective of de- Cooled vacuum assistance with high energy delivery 10 Hz by 10 fractional micro-beams, without necessity of scar, under local anesthesia, with little downtime and mi- vice dependent regenerative medicine and the benefit when stacked gives rise to significant reduction of acne. anesthesia due to the aid of water and compressed air nimal discomfort and complications as it is a minimally for the patient with intimate symptoms. The reality is that No side effects are visible. With careful patient selection sprayed by the device. Patients received partial or total invasive procedure. cosmetic findings and underlying medical diseases often resistant localized and persistent acne vulgaris can be facial treatment and the clinical efficacy, tolerance, ad- appear as one. With this talk I want to raise awareness controlled. It can also be combined with fractional erbium verse effects, complications, and tissue changes were

for the widespread intimate concerns and skin conditi- for superficial scarring, fractional CO2 for deep scarring evaluated.  COMPLICATIONS DURING THE APPLICATION ons parallel to genitoanal diseases. This what happened or Pico QSW laser for PIH. OF TENSIONING THREADS: WHAT TO DO? with facial esthetics some years ago is happening with No patient presented significant complications. Epider- Susana Misticone  Venezuela regenerative (body) treats. Developing a multi specialist The combination of cryothermal with erbium glass the- mis and dermis changes, as result of treatment, were team for specialized stem cells injections that helps with rapy sequentially in the same sitting constitutes an im- found beneficial. Not only the pigment disorder but the DO threads are a very effective lifting technique atrophic scars, intimate surery against vaginal relaxation portant protocol in treatment of moderate to severe overall facial skin condition experienced a notable impro- P and easy to execute if the patients are well chosen or laserspecialists against post inflammatory hyperpig- inflammatory acne patients who do not respond to con- vement. The mean reduction of basal skin pigment befo- and you have manual skill when placing them. There are mentation is not farfetched. If you look at the value for ventional topical, oral antibiotics and isotretinoin therapy. re treatment was 70 to 80% from the first treatment ses- multiple complications ranging from traumatic, infectious the patients and the profitability in that field, it is not un- sion. Patients were satisfied or very satisfied and would and the most feared are that the threads become evi- usal to see upwards of 50% of the revenue in a derm recommend the combined laser-derm-cosmeceuticals dent or foreign bodies reactions. I will present how to re- clinic coming from vaginal rejuvenation, fat grafting, sub-  PROCEDURES IN MELASMA AND transepidermization treatment. solve these complications; it is very important to resolve cisions, photoderm or PRP. This is because the per unit HYPERPIGMENTATION DISORDERS them as soon as possible and be aware that they always profitability of those therapies is high, as with any new Jaime Piquero-Casals  Spain Results show an excellent safety/efficacy profile for this have duration proportional to the half-life of the thread; procedure that comes to market allowing you to charge method of treatment which, based on observed results this is why the technique is quite safe. a premium. elasma represents a frequent disorder of pigmen- related to the use of chemicals and laser treatment (2), M tation that mainly affects women with genetic pre- is consider improves results achieved by standard facial Conclusion: It is important to do an overall comprehensi- disposition as of 35 years of age. The main treatment peels or laser treatments, particularly on dark skin patients. ve analysis including lithotomy position (Steinschnittlage) modalities include prevention of sunlight, depigmenting 09.00 - 11.00h on someone who comes in with intimate concerns and topical agents, chemical peels and lasers. However, it is (1) The antipigment formula use is a combination of Hydro- CLINICAL DERMATOLOGY – INDICATIONS for treatment of genitoanal disease. Patients with Vitiligo, common to observe incomplete results and frequent re- quinone, Dexamethasone, and Retinin A FOR LASERS & EBDS lichen sclerosus or pruritic skin benefit from full medical currences that make melasma and other hyperpigmen- (2) Trelles MA. et al. J Drugs Dermatol. 2010 Apr;9(4):315-22. services. tation disorders a frustrating condition.

There is a growing interest in oral treatment with trane-  EMERGING THERAPIES IN GENITOANAL  NODULAR ACNE: SEQUENTIAL USE OF xamic acid and in oral supplements with extract of Poli- 09.00 - 11.00h DISEASES AND VULVAR SKIN CONDITIONS FREEZE-THAW podium leucotomos. Chemical peels are procedures wi- Dirk-Harald Gröne  Germany DECODING THE FUTURE OF AI & DEEP Ganesh S. Pai  India dely used in the daily practice of the dermatologist. The LEARNING IN DERMATOLOGY AND patient must be chosen carefully and perform a pre-tre- he field of Genitoanal Diseases is often reduced to AESTHETIC MEDICINE ryothermal therapy can be used to treat hyperacti- atment preparation to avoid undesirable effects. Several STD and venerology. Many women rather consult T ve glands of the body, specifically those associated laser devices as Tulium, Picosecons and fraccionated the gynecologist or proctologist than to see the derma- C with acne & hyperhidrosis. Freezing the water within the Q-Switch are excellent alternatives to improve results. In tologist.  AI THAT KNOWS YOUR SKIN: WHAT IS THE sebaceous glands diminishes its function. Treatment in this presentation, most of these alternatives with phar- TECHNOLOGY BEHIND IT? three cycles at two week intervals leads to considera- maceutical and cosmeticeutics are proposed. This forgotten subspecialty of dermatology gains new Anastasia Georgievskaya  Russia ble reduction in nodular acne. There are three phases momentum in view of laser medicine, photo dermatolo- of therapy, pre-therapeutic, therapeutic and thawing gy and minimal invasive intimate surgery. omputer Vision Methods powered by AI-techno- phase, lasting a total of 10 minutes. The main therapeutic  TREATMENT OF DIFFICULT PIGMENT DISORDERS logies are becoming extremely popular in medical phase maintains the skin temperature at 0o centigrade IN DARK SKIN PHOTOTYPES WITH LASER TRANS- C In this talk we review our perspective on that field and imaging while AI Technology itself is propagating at a high for 8 minutes. EPIDERMIZATION OF COSMECEUTICALS share some thoughts on minimal invasive patient thera- pace to our daily Life. The potential for Skin Health Indus- Mario A. Trelles  Spain pies in a gyn chair and lithotomy position. This change try is vast, starting from Skin Health and beauty assess- Infrared lasers of 1540nm erbium glass penetrates deep in the setting towards a more gynecologic examination ment to generation of skin images to simulate the effects into dermis targeting water as the chromophore. The his prospective clinical study reports on the effica- routine facilitates the dermatologist’s view on area de- of the Treatment. Combination of Computer Vision, Data sebaceous gland contains water. 1540nm erbium glass cy and safety of a method of facial skin treatment pendent symptoms of common skin diseases including T Analytics, chatbots and cloud can simplify and bring to has been found to have long standing effects with three using a 2780 nm Er;Cr:YSGG laser in combination with a Psoriasis inversa, lichen sclerosus, intertriginous ekze- the next level the diagnostics processes. Still, Methods treatments at intervals of two weeks. Thus the gland is antipigment chemical-formula (1). Treatment was perfor- ma, acne inversa, perineal scars, Vitiligo or cellulite – just have limitations and challenges which one should be rendered dysfunctional and shows reduced activity. In- med in 30 patients presenting moderate to severe signs to name a few. Working tools are Excimer, PDT, PUVA, aware of to make most of the implementation of AI to flammation is controlled significantly. The persistent no- of benign facial pigmentary disorders. PRP, Cell transplants, microinjections, lasers, chemical daily Practice. dules of grade III & grade IV acne showed remarkable

44 SATURDAY  AUGUST 31, 2019 SATURDAY  AUGUST 31, 2019 45 SCIENTIFIC SESSIONS SCIENTIFIC SESSIONS

 COMPUTER VISION FOR ADVANCED SKIN 11.45 - 13.45h  PAN-FACIAL REJUVENATION: 11.45 - 12.45h DIAGNOSTICS THE LATEST TECHNIQUES FACIAL REJUVENATION – DON´T FORGET WHAT´S ON THE HORIZON IN ACNE & Anastasia Georgievskaya  Russia Dendy Engelman  USA THE NECK! ACNE SCARRING?

omputer vision-based Diagnostics enables Cos- n the aesthetic rejuvenation of the face, the techni- metics and Dermatology industry to set-up accu- que of merely “filling lines” is an antiquated one that C  THE PINCHED NECK LIFT I  SURGICAL AND LASER COMBINATION rate, fully-automated processes for skin analysis with re- should be avoided. Novel approaches to pan-facial re- Roger E. Amar  Spain TECHNIQUES FOR ACNE SCARRING sults comparable in time. juvenation – including frontalis elevation, temple volume Didac Barco  Spain replacement, zygomatic volume restoration, mandibular s we age, gravity causes the skin on the lower part The approach is not only limited to medical Conditions, support, and submental/ neck rejuvenation – will be in- of the face to sag, causing blurring of the jawline, ne of the main features of acne scarring is the but it also allows to assess skin parameters related to A structed. the appearance of a double chin and laxity on the neck. richness in morphology: there are several types of beauty and healthy look with qualitative and quantitati- O acne scars, and each of them has distinctive pathologi- ve metrics. Among the tasks computer vision can solve Dr. Roger Amar has been performing conventional neck cal characteristics. This is the rationale to use different now is skin parameters recognition, skin concerns seg-  TONE, TIGHTNESS, TEXTURE: ADDRESSING lift and various types of face liftings with SMAS trimming techniques to specifically target every clinical feature of mentation and generation of skin images with defined YOUR PATIENTS’ CONCERNS IN TOTAL FACIAL for many years, but as his understanding of the ageing each acne scar. parameters. The lecture is giving an overview of basic AESTHETIC THERAPY process has developed, he has constantly innovated computer vision tasks in skin research, its Challenges Michael H. Gold  USA new techniques and procedures that tackle the root We will highlight the necessity to choose between eve- and Applications. cause of ageing, with procedures less invasive. ry surgical technique or light-based device based on the ncreasingly effective technology is bringing a host of clinical and pathological features of every acne scar type. non-surgical options for facial rejuvenation to patients The last improvement developed on cadavers in 2010 I We will discuss the indications of subcision, punch exci-  THE BEAUTY OF AI: INTELLIGENT SOLUTIONS who are reticent or unable to take the downtime for in- is the lift of the Platysma muscle in the neck. It is possib- sion, CO laser, non-ablative fractional laser and vascular FOR DECISION SUPPORT IN AESTHETIC MEDICINE vasive procedures. 2 le now to separate this muscle from its SMAS insertion, lasers and their possible combinations in every treat- Marius Khan  Germany holding it behind the ears to lift the whole area, and re- ment session to enhance the response, reduce the risk Many devices and modalities only address one concern, moving the neck bands by the contra-incision under the of complications and the downtime for the patient. oday, the vast amount of data produced daily by but it is the comprehensive structure, appearance, and chin. users worldwide and the development of powerful quality of the skin that needs to be considered for com- T An early and complete therapeutic approach based on hardware components like Graphics Processing Units plete facial rejuvenation. Addressing the tone, tightness, Good candidates for a Pinch Neck Lift procedure are clinical examination, pathology foundations and surgical (GPU), realized the current renaissance of artificial intel- and texture of the skin in one treatment has shown su- those that have a degree of skin laxity in the neck area. and laser expertise will lead to the best results. ligence (AI). perior results compared to only treating skin with one If there is some excess skin or fat, then this can also be modality alone. excised during the same procedure. First, Dr. Amar cuts Health care is becoming rapidly an important domain of a U-shaped incision around the earlobe, through which  ACNE AND ACNE SCARS TREATED WITH A AI, since medical examinations and treatments are get- he can hold up a strip of SMAS and platysma muscle to 589/1319 NM LASER ting more data-intensive. Recent work show promising  TREATING FLACCIDITY ON THE NECK AND restore the normal tension laterally. A double chin or ten- Michael H. Gold  USA results in the field of clinical imaging (e.g. early diagnosis LOWER THIRD OF THE FACE USING se platysma bands can also be tackled during the same of Alzheimer from brain MRIs, classification of skincan- RECOMBINANT ENZYMES precision by making a tiny incision just underneath the cne is the most common dermatologic disorder cer), genomics or the classification of diseases based on Susana Misticone  Venezuela chin to release the platysma muscle. that dermatologists see on a regular basis in our Electronic Health Records. However, the application of AI A offices. Dermatologists are fortunate to have some new in aesthetic medicine is still an open research and indus- here are three PB serum recombinant enzymes: In some cases, on important sagging on men, it is not topical and systemic therapies which work extreme- try topic. Selecting the best solution, i.e. therapy, for the hyaluronidase, collagenase and lipase. They are ob- necessary to make the ear ‘incisions. The submental T ly well but some patients need more, and this is where patient in aesthetic medicine depends strongly on the tained by genetic recombination from bacteria. These fat is excised and the medial platysma bands extended EBD’s may play a significant role. These devices work physician’s experience. come freeze-dried and can be used separately or in com- through a z-plasty. It is called the “reverse Pinched Lif- mainly by targeting the P. acnes bacteria found in the pi- binations (cocktails). Lipase acts by digesting triglycerides ting”. losebaceous gland. Our goal is to support physicians in aesthetic medicine from adipocytes, collagenase digests collagen and hyal- with the assistance of intelligent solutions to select the uronidase acts as a diffuser of the two previous ones by These procedures are performed in theatre, under local Clinical studies showing the efficacy of several new de- best therapy for an individual patient. In clinical studies digesting polysaccharides from fibrous septa allowing anaesthetic with slight sedation. This is minimally invasive vices will be reviewed, including the short-pulsed 1064 we collect data from patients before and after their the- them all to reach their substrates better and making their surgery so the patient can return home, fully recovered, nm laser and the combination 589-1319 nm laser. This rapy. The obtained data serves as training data for a effect; by decreasing the size of the adipocytes and sti- the same day. presentation will show how these devices can be incor- deep neural network, which predicts the efficiency of mulating the production of new collagen, skin thinning and The follow up is uneventful and the stiches are removed porated into one’s clinical practice. possible therapies for a specific patient. lifting is obtained. The cocktail is prepared according to in two sessions. The scars are inconspicuous and the the requirement of the patient. I will present my experien- patients show a high rate of satisfaction. During the talk we present our approach, show exam- ce of 2 years using it through injections for flaccidity of the ples of where AI can enhance the selection of therapies neck and lower third of the face with very good results, in aesthetic medicine and list main challenges to face observed 15 days after the injection and have a variable when combining AI with aesthetics. duration of months to years depending on the patient.

46 SATURDAY  AUGUST 31, 2019 SATURDAY  AUGUST 31, 2019 47 SCIENTIFIC SESSIONS SCIENTIFIC SESSIONS

 ACNE SCARS: COMBINATION TREATMENT WITH Poly-L-lactic acid is then injected into the medial gluteal juvenation of the face and neck, mimicking a face and  MODERN PROTOCOLS IN INTEGRATED PICOSECOND LASER AND FILLER INJECTION region at a dilution of 20 ml using a NERO cannula, which neck lift surgery, in only two sessions of a non-invasive TREATMENT WITH LASERS Peter Peng  Taiwan has a tapered tip that can also cut the fibrotic septa of procedure, that demands no down time. Comparing the Ekaterina Pozdeeva  Russia cellulite. clinical cases before and after, all the patients demon- cne is one of the most common skin diseases seen strated satisfaction and the parameters of facial analysis ace aging is a complex process which includes skin A in dermatological practices all over the world. In co- This technique allows the treatment of cellulite and sag- and diagnostic systems demonstrated overall improve- F aging and structural aging, therefore complex cor- lored populations, acne scars and pigmentary sequelae ging in a single session, while also promoting buttock lift. ment of the treated area. rection is necessary. can affect more than 50% of the population. The approach optimizes the patient‘s time, providing the convenience of a single application. It is necessary to work with the quality of the skin, then The stimulatory filler can induce new collagen forma- reduce the skin flap, increase the tone of the ligamen- tion and improve skin texture and volume loss atrophic 12.45 - 13.45h tous apparatus and fill up the lost volumes. areas. The application of stimulatory filler over atrophic  PNEUMATIC TECHNIQUE PLATFORM TO PARTNER COUNTRY UPDATE: RUSSIA acne scars had been proved to be effective by some PROMOTE KINETIC FACE AND NECK LIFT But modern lifestyle dictates its own rules. Saving time reports and the author’s clinical experience. Claudia Marçal  Brazil is the main motto of the modern world! Modern peop- le want everything done at once in just one visit to the  „HEAVY FACES“: EFFECTIVE PROTOCOLS Clinically, the 755nm picosecond laser with focus lens his lecture demonstrates a new technique that beauty expert. WITH EBD AND FILLERS can induce new collagen formation and is effective in promotes kinetic face lift through specific punctu- T Antonina Gorskaya  Russia Asian patients with acne scars, with a high safety profile res applied to the epidermis, forehead region, zygoma- I decided to find out how effective simultaneous applica- even in dark skin types, and a high satisfaction rate. tic area, mandibular arch, SMAS region, temporal area, tion of various procedures and treatments can be, find he “heavy” face morphotype is predominant in the ocular and periocular areas and anterior cervical area. some patterns, understand the best order and time of Slavic peoples. As a rule, these are the patients who In this session, I will present my experience about the This platform is an innovative system of pneumatic de- T application. I found a lot of research on this topic that I require surgical correction, especially when the degree combination of stimulatory filler and picosecond laser to livery using hyaluronic acid cross linked diluted in saline would like to present to you. Plus, my own pilot mini re- of ptosis is 3 and 4 according to Becker. In therapeutic treat atrophic acne scars in Asian. solution introduced by a high-pressure jet in the dermis search on the application of contour plastic and laser correction, the most effective methods are with using with assertiveness. The procedure provokes microtrau- procedures with short intervals. As an impact method, combination of lasers, EBD and injections. We distingu- mas on the dermic structure, stimulating neocollagen- we chose ER laser and a special SMA module. ish 2 subtypes of a “heavy” face morphotype with and esis on a wide range, improving the thickness, elasticity without an excess of subcutaneous-fat pads. Different 11.45 - 12.45h and density, plus remodeling the contour of the face and The conclusions of my research are as follows: subtypes require different methods of correction and the neck. PARTNER COUNTRY UPDATE: BRAZIL may differ when considering ‘first-choice’ methods. The ¡ After applying SMA-method, biodegradation of the main target layers for EBD and lasers are surface fat filler is observed even with supraperiostal adminis- The parameters of the injection pressure and the applied pads and ligaments with SMAS; for injection methods, tration. filling can be adjusted according to each specific case,  USE OF MACRO-FOCUSED ULTRASOUND AND the target areas are deep fat pads for fillers and musc- allowing a punctual introduction of the fluid via epidermis ¡ There have been no complications during the imple- POLY-L-LACTIC ACID FOR THE GLUTEAL AREA: les for botulinum toxins. The most effective EBD and la- with minimal entry area. Immediately after the injection mentation of the combined approach. THE STARBURST BUTT LIFT TECHNIQUE sers methods when working with this morphotype can in the skin, a bump must be observed measuring 0.6 to ¡ No pronounced loss of volumes leading to deterio- Maria Paula del Nero  Brazil be HIFU, photothermal reconstruction using ER: Yag and 1cm in virtue of the hyaluronic acid spreading in a 1cm ration of the clinical picture was marked. Nd: Yag, as well as various RF methods. The key area for radial form, verifying that the technique was ministered he gluteal area plays an important role in sexual at- using fillers can be found in the middle third of the face. ¡ Satisfaction with the results of the correction of both efficiently. T traction and an increasing number of women are When working with BTA, it is necessary to consider the doctors and patients has increased seeking aesthetic treatments for gluteal enhancement. peculiarities of this morphotype and the doses should be According to my personal protocol, exposed in this lec- consequently reduced. When working with skin to select Studying this topic is not easy, because it all depends on ture, the sum of all the treated points promotes indirect Over the past 7 years, many articles have been publis- a method, the key issue is the presence or absence of ¡ the type of filler and BTA stimulation of SMAS and temporal fascia, leading to an hed internationally reporting the use of Poly -L- lactic excess skin. It is also necessary to consider the inconsis- increase of the circulation in these areas, bettering the ¡ depth of the placement of the injected product acid, a collagen biostimulator for treating body skin laxity. tency of the microcirculation and the impaired lympha- tonus. Also, this technique causes a re-densification of ¡ peculiarities of the physical and biological effects of In this lesson, we demonstrate the Brazilian STARBURST tic flow, which is characteristic of this morphotype and the existing collagen, contributing to an immediate effect the machine method and the depth of impact of the BUTT LIFT TECHNIQUE used with micro and macro-fo- requires very careful use of damaging methods when of firmness and elasticity. physical agent cused ultrasound for buttock lift and contouring. working with the skin. ¡ confirmation of safety and efficiency of each combi- The totality of the patients treated in my office with the This technique involves applying macro-focused ultra- nation requires research pneumatic technique were submitted to two sessions, sound to the infragluteal fat pad region with a 2 MHz, 13, ¡ further study and accumulation of reliable evidence with an interval of 30 days and 10ml of a compound com- 9 or 6mm depth transducer to first treat excess fat. The base of the combined approach in correction is posed by 1ml of hyaluronic acid cross linked, 40 units of treatment is then complemented using a 4 MHz, 4.5- necessary. toxin botulinum and 8.2ml of saline solution was used. mm depth transducer to boost collagen production and treat sagging. In conclusion, it was possible to observe a new and mo- dern technique, with no side effects, that promotes re-

48 SATURDAY  AUGUST 31, 2019 SATURDAY  AUGUST 31, 2019 49 SCIENTIFIC SESSIONS SCIENTIFIC SESSIONS

 KELOIDS, HETEROTROPHIC AND ATROPHIC 14.45 - 16.45h  RHINOFILLER FOR NON-SURGICAL NOSE There are multiple lasers and radiofrequency devices to SCARS – WHAT‘S NEW IN TREATMENT CORRECTION: STEP BY STEP TECHNIQUE manage acne scars & rhinophyma. Their uses differ ac- HACKS FOR PERIOCULAR TECHNOLOGIES Maurizio Berlanda  Italy cording to the nature of the scar. Optimising scar therapy REJUVENATION & NOSE RESHAPING Olga Zabnenkova  Russia depends on choice of wavelength and sequence of ap- I NTRODUCTION, AIM OF THE WORK plication. For example, a novel way to treat a deeper pit INTRODUCTION he non-surgical nose correction by Hialuronic Acid is to pass fractional CO2 energy into the base of the scar.  LATERAL EYE REJUVENATION WITH THREADS, Scars are an inevitable and natural part of the healing T injection has become popular and frequently per- 8 weeks later, the crater of the pit is filled with chondroitin TOXIN AND FILLERS process for most dermal wounds - they are a normal formed but not all patients are good candidate for this sulphate and a 4mm erbium laser is used to bring down Ibrahim Ashary  Saudi Arabia consequence of the body‘s physiological healing res- procedure. Author describes guidelines to optimize re- the shoulder of the scar to the level of the base. ponse. sults. yes are windows to one’s soul. One of the regions Conversely if it is a hypertrophic nodular nasal scar, there that shows first the signs of aging is the periocular Most scars do not produce poor cosmetic or functional E MATERIAL AND METHODS is the option of ablating with a fractional CO or a 4mm area. It includes, static and dynamic rhytids as well as 2 results. The original scar tissue is gradually replaced du- Ideal Hialuronic Acid needs to be high G prime, high den- aperture erbium laser. With a fractional CO , the density subcutaneous volume loss. The complex anatomy and 2 ring the end phase of healing resulting in a reduction in sity, injected caudo-cranial direction, as by needle as by and the energy have to be fifty per cent higher than that dynamic underlying muscles of facial expression make redness, elevation and firm consistency of the tissue to cannula. applied to box, ice pick and rolling scars, as the intention this region particularly difficult to treat. Botulinum toxins produce a flat, soft, pale scar that is level with the adja- is to ablate the scar and not stimulate new collagenosis. and fillers, especially when used in combination, offer an RESULTS cent skin. The ability to control the depth of ablation is superior with excellent approach to minimally invasive rejuvenation of Following correct injection technique results are positive, the erbium laser as visibility is high, whereas predictability If, however, the delicate balance is not achieved during this area. lasting about 6 months, with patient satisfaction. of the depth is uncertain with the CO2 laser. the healing process, the resulting scar may display ab- The periorbital region is particularly vulnerable to the ef- CONCLUSION normalities. Such types of abnormal scars are hypertrop- Aggressive parameters on a hypertrophic scar may give fects of aging. For one, eyelid skin is among the thinnest Rhinofiller in selected patients, is an effective technique hic, keloid and atrophic scars. rise to a depressed scar. The hypertrophic tissues of rhi- in the body, at around 0.3-0.5 mm. It lacks underlying as for primary profile correction as after not perfect sur- nophymas are best ablated by fractional CO . The va- subcutaneous fat to mitigate the contour defects and gical procedure. 2 Various options are available for the treatment of keloid scularity of the structures would require adrenaline-soa- fat prolapse attendant with age. The delicate nature of and hypertrophic scars including: surgical revision, laser ked gauze to control oozing of blood. surgery, steroid therapy, pressure garments, silicone this tissue also readily transmits underlying pigments, including blood products, muscle, and vessels. There is  PERIORBITAL DARK CIRCLES: WHAT TO DO? gel sheets. BoTN in scar treatment is a new approach, The lumpy bumpy nose can be reshaped successfully less collagen and elastin than surrounding skin, rende- Susana Misticone  Venezuela which efficiently helps to reduce scar growing without plastic surgery. ring periorbital skin less resilient and prone to early rhytid eriorbital dark circles are a very frequent reason for Chemical peels, laser resurfacing are most prevalent formation. In addition, eyelid and periocular skin is dyna- mic and subject to constant tension from the surroun- consultation in the dermatological practices with methods of treatment. Anyway new technique such as P  EYE BAGS: INJECT OR SURGERY? ding muscles of facial expression including the orbicularis not many effective treatments. I present my experien- RF, subsission, filler & collagen injections can dramatical- CONSIDERATIONS AND INJECTION TECHNIQUES oculi, corrugators, and procerus, which likely accelerate ce using hyaluronic acid fillers with cannulas to treat the ly improve skin resurfacing. Peter Peng  Taiwan sinking in combination of fractional Q-Switched laser to rhytid development. Moreover, the sun, various extrinsic and environmental factors also contribute to fasten the treat the darkening of the area with very good results. MATERIAL he tear trough is one of the most commonly re- development of aging in this region. 10 males & femals with keloids & hypertrophic scars 25 T quested areas for treatment among Asian patients, femals & males with postacne atrophic scars yet it is also one of the most challenging to treat via fillers. Methods used to improve this area includes surgery (i.e.,  SHAPING THE LUMPY BUMPY NOSE: THE HOW, In addition to tear troughs, many patients will also pre- CONCLUSION blepharoplasty, brow lift with threads or surgery), injecta- WHEN AND WHY OF USING ABLATIVE LASERS sent with eye bags (pseudoherniation of infraorbital fat), BoTN is a new trend in keloid scars treatment. It efficient- bles (botulinum toxin, dermal filler), laser resurfacing and Ganesh S. Pai  India which significantly complicates treatment, especially with ly helps to reduce growing and itching of keloids scars. photo-rejuvenation, and topical therapy. The aim of re- minimal-invasive approaches. Also can be used as a preventive methods for keloids juvenation is to specifically focus on the techniques and ultiple lasers and devices form the mainstay of formation. indications for use of toxins and fillers in the periocular management of acne scars and rhinophyma. M Several factors contribute to the formation of eye bags, region in order to prevent or lessen the signs of aging in Scars vary in nature and size, from boxcar, atrophic, ice- including tear troughs, laxity of the orbicularis oculi musc- RF technique is a new approach in postacne scars treat- this area. pick and rolling scars. Remoulding of dermal scar tissue le and lower eyelid skin, and lack of support from the ma- ment. HA and collagen filler injections can be recom- needs a different set of lasers depending on extent of xilla and deep cheek fat pads. While severe cases often mended for treatment deep atrophic scars. scarring, size of pits, age of the patient and Fitzpatrick require surgical intervention, minimal-invasive procedu- type of colour of skin. Greater density and energy are res are commonly requested as well. applied to thick contracted and fibrotic scars while mi- nimal density and energy are used on soft and superfi- The treatment for severe eye bags formation usually re- cial scars. The bugbear of the post inflammatory hyper- quires surgical intervention. However, there are a lot of pigmentation is inevitable in skin of colour and managed requests for nonsurgical treatments for eye bags. with sunscreens and skin lightening agents.

In this presentation, I will focus on evaluation of the tear

50 SATURDAY  AUGUST 31, 2019 SATURDAY  AUGUST 31, 2019 51 SCIENTIFIC SESSIONS SCIENTIFIC SESSIONS

trough, considerations between surgery and injection, derate facial ptosis, mild/moderate cervical-facial ptosis, characteristics and cannula injection technique are pre- beautiful skin. We are now treating young patients with and simulate possible results achievable through filler in- in the months of September 2018-January 2019. For the ferable for the safe correction in periorbital area. a more prophylactic approach than a regenerative ap- jection. I will also discuss a guide for treating tear troughs treatment, the following were used in the same session proach. In this lecture treatment options for topicals as and eyebags with injectables. on a sequential basis: filler with cross-linked hyaluronic By EBD, such as minimally invasive RF, tightening and well as minimal invasive filler treatments with filler will be acid 20 mg/ml and 25 mg/ml, at a dose of 1 to 2 ml, injec- contraction of the skin, renovation of ligaments and im- discussed for this patient group. ted in the deep dermis as multiple injections following the provement in fat compartments can be achieved by in- vectors marked; microdoses of about 0.02 to 0.04 cc dividual treatment protocols. 14.45 - 16.45h were applied per injection point, subsequently applying 17.15 - 18.30h WINNING COMBINATIONS FROM by mesotherapy with the nappage technique 5 ml of ac- Best results can be obtained by using BTX, fillers and mi- HEAD TO TOE tive ingredients based on organic silicon, vitamin C, non- nimally invasive RF treatment in combination in stages. PERFECT SKIN – KEEPING THE PROMISE cross linked sodium hyaluronate at a concentration of 2.5 mg/ml and polynucleotides. In the second and third treatment sessions, mesotherapy was applied using the  COMBINATION THERAPIES AND MEDICAL  COMBINATION THERAPIES FOR THE UPPER LIP  COMBINED TREATMENTS FOR STRIAE DISTENSAE same technique and products. SHAPING FOR THE EYEBROWS Medhat Abdel Malek  Jordan Vanesa Piquero-Casals  Spain Sonja Sattler  Germany Safety was evaluated in each session and 15 days after he upper lip is considered to be a pivotal facial com- triae or „stretch marks“ are linear bands of atrophic the control session. Efficacy was evaluated at two cont- trend of shaping, filling and tattooing eyebrows ponent that defines facial attractiveness. Ageing of or wrinkled skin, like a form of dermal scarring. Trig- T rol visits (after two sessions and two weeks after the end has reached the whole world. The eyebrow style S the upper lip is affected by the maxillary bone and teeth. A gering factors: mechanical, endocrine and genetics. of treatment) by photography, satisfaction survey and has become an aesthetic movement like hair style and Aging of the cutaneous part can be aggravated by dif- using a cutometerTM probe (Courage – Khazaka Elec- hair colors. Looking into the history styles change over ferent factors. This includes solar radiation and smoking. At the beginning, the stretch marks are red, due to the tronic). decades and changes are already programed for the fu- This lecture will spot the light on different minimally inva- dermal inflammation and dilated capillaries mark the initial ture also for eyebrows. sive modalities to correct the aging signs of the upper lip. and are easier to treat. But later, striae appear hypopig- RESULTS This encompasses using Q-switched Ruby laser for pig- mented and fibrotic, alba stretch mark, more difficult to After one treatment session plus one control session Our patients are consulting in for eyebrow reasons usu- mentation, Erbium fractional laser for rejuvenation, non- treat but not impossible. with cross-linked hyaluronic acid filler plus mesother- ally first non-doctors (aesthetician/ permanent makeup cross-linked Hyaluronic acid for plumping and Botox for apy, it was concluded that skin elasticity improved up to artists etc.) and we doctors are then facing their com- the eversion of the upper lip. Although the improvement in white striae is more difficult, 19.3%, and firmness up to 25.4%. In both, 85% of the vo- plications. they can be treated with ablative lasers or non-ablative, lunteers evidenced a clear improvement in fine wrinkles microneedles, chemical peels, among others, reducing and skin hydration. As an aesthetic doctor you should not only know how to  MIRROR LIFT BOOSTER: SEQUENCED FILLERS their thickness, elasticity and size in more than 50%. correct these complications but also know what we can AND MESOTHERAPY FOR FACIAL REJUVENATION CONCLUSIONS offer as safe treatments to our patients for their eyebrow WITH LIFTING EFFECT In this presentation we will show data from the literature The combination of the technique of filler with cross-lin- style in a safe way. Different techniques and treatment Fernando Galcerán  Spain and our own cases, especially evident when we make ked hyaluronic acid and mesotherapy sequentially in the options will be discussed. same session has been shown to be safe and effective, the similarity with that of an old scar. INTRODUCTION as a clear quality improvement was seen in the skin trea- The “mirror lift” concept was developed on the basis of ted, while no unexpected side effects were seen. the experience of the medical team with the patients, in particular females, who ask at clinics for facial rejuvena- 17.15 - 18.30h tion, the rejuvenation they feel when they create a slight  PERIORBITAL REJUVENATION: FILLERS, BTX AND AESTHETIC TREATMENTS FOR OUR facial lifting effect with their hands. A combined protocol EBD FOR THE OPTIMAL RESULTS MILLENNIUM GENERATION – OPTIONS is proposed that includes fillers with cross-linked hyalu- Ekaterina Gutop  Russia FOR YOUNG PATIENTS ronic acid and mesotherapy with different active ingre- (IN COLLABORATION WITH ISDS) dients injected sequentially in the same session. The aim ndividual variations in the eye region, aesthetic prob- is to reinforce the internal structures that have lost ton- lems and anatomical characteristics should be con- icity while reproducing the “mirror lift” effect and gene- I sidered when planning the treatment in the safest and  IS PROPHYLAXIS BETTER THAN REGENERATION? rating force lines that will cause the lifting effect. most efficient way. KEEPING A BEAUTIFUL SKIN IN YOUNG PATIENTS Sonja Sattler  Germany OBJECTIVE Treatment with BTX is one of the most frequently used To recover the oval of the face modified by ptosis and in aesthetic practice. Individuality in points, doses and ver decades the treatment approach for aesthe- atrophies or hypertrophies of the tissues and reduce correction technique should be based on the individual O tic reasons usually has been regeneration, turning gravitational wrinkles. peculiarities of the muscles and their activity. back what has been lost during the aging process.

MATERIAL AND METHODS Today we are facing a young generation living in a world The study included ten Caucasian women aged 30 to By treatment with fillers, improvement in volumes and of picture taking with a high focus on a beautiful face with 65 years, with Glogau scale grade 2 or higher, mild/mo- contours should obtained. Fillers with low hydrophilic

52 SATURDAY  AUGUST 31, 2019 SATURDAY  AUGUST 31, 2019 53 SCIENTIFIC SESSIONS

 CELLULITE: WHEN TO CHOOSE WHICH DEVICE AND/OR COMBINATION Sonja Sattler  Germany SCIENTIFIC PARTNER DAY ellulite is an all over problem for many female pa- C tients worldwide. The discussion if cellulite is a di- sease or only a genetical circumstance of life based skin condition in female is ongoing. The unknown pathophy- siology and the difficulty in describing the different se- venties of cellulite show the uncertainties doctors are facing in treating cellulite. SUNDAY In this lecture new anatomical findings and treatment op- tions for smoothening out of irregularities in cellulite will SEPTEMBER 1, 2019 be described. The nowadays most common possibilities to treat cellulite are energy-based devices, collagen sti- mulators as well as the standardized guided subcision technique will be described. Latest data on long lasting results will be shared.

Treatment results will be shown and when to use which treatment option will be discussed.

D A Y 4

54 SATURDAY  AUGUST 31, 2019 SCIENTIFIC PARTNER DAY SCIENTIFIC PARTNER DAY

9.00 - 11.00h  COMPLICATIONS IN CONTOUR PLASTY: cessary. The complications occurred after using HA im- occurs. In these circumstances, retrobulbar injections of METHODS OF TREATMENT AND PREVENTION plants, better responded to treatment and the results hyaluronidase may help but have not been consistently IS4AC – GLOBAL APPROACH TO Albina Kajaia  Georgia largely depended on the presence of the antidote-hyal- effective. AESTHETIC COMPLICATIONS uronidase. For the rest of the drugs: partially degraded INTRODUCTION passed into the stage of remission, and non-destructible Procedures using fillers is the most popular around the ones were subjected to surgical treatment.  DELAYED INFLAMMATORY REACTION TO world for more than 30 years. It’s confirmed by the re- 9.00 - 11.00h HA-BASED FILLER: AN INTERNATIONAL PANEL sults of the annual statistics ISAPS. According to The CONCLUSION GROUPE LASER DE LA SFD – ACNE SCARS: CONSENSUS International Study on Aesthetic/Cosmetic Procedures To prevent complications after introducing fillers, import- TREATMENTS & COMBINATIONS Ofir Artzi  Israel Performed 2016, procedures using hyaluronic acid are ant to use only certified products, including biodegrada- on the second place (25.5%) after Botulotoxin injections ble products based on hyaluronic acid and apply only elayed-type hypersensitivity reactions seconda- (37.3%) in accordance to popularity. The same statis- the methods recommended by manufacturers. In case  ACNE SCARS, LASERS & EBDS, FILLERS & D ry to HA-based dermal fillers can be classified ac- tics shows, that the following injection materials are fre- of complications, necessary measures should be taken TOXINS: WHEN, WHY, WHERE? FOR WHICH cording to the time of appearance post-procedure and quently used: 1. Hyaluronic acid (3,372,445 performed urgently to eliminate them. COMBINATION? may present as discoloration, nodules, solid edema and procedures and 18% increase compared to 2015; Hugues Cartier  France disfiguration. Our study aimed to assess the knowledge 2. Poly-L-Lactic acid (79,664, which is 17% more than in and experience regarding the management of late-on- 2015); 3. Calcium Hydroxyapatite (164,911, compared to  UPDATE ON INJECTABLE NECROSIS AND BACKGROUND set procedural complications among physicians in Israel 2015 the number of procedures decreased by 10%). BLINDNESS ach scar type has a different structural cause war- who inject HA-based dermal fillers. The heterogenic and Ramtin Kassir  USA ranting a customized approach. Many cosmetic op- incorrect approach regarding the management of delay- A stable increase in the number of procedures (compa- E tions exist to address these changes individually, but little ed type reactions to HA-base filler injections, reflected in red to 2015 and 2016) is an indicator of the popularity of njectable necrosis and blindness secondary to filler literature exists about the safety and efficacy of combi- our study, illustrates the existing ambivalence in current this technique, both among doctors and patients. Howe- treatments are rare but catastrophic complications of I ning such procedures and devices as hyaluronic acid, literature regarding the management and therapy of late ver, along with the increased demand for injectable fillers, soft tissue augmentation with filler agents. They usually botulinum toxin and laser. onset complications. Following the study an international doctors increasingly disregard the recommendations of occur as a result of injection of filler directly into an artery; panel of experts united to discuss and challenge the de- manufacturers: they use unregistered drugs and gels of they can also result from compression or injury. METHODS finition, incidence and management of these reactions unknown origin, inject fillers into the „off-label“ zones. All A Medline search was performed on combination treat- and in order to offer a clear approach upon encountering these factors inevitably lead to an increase in the number In 2015, 98 published cases of blindness after filler injec- ments because it relates, and results are summarized. In these complications. of complications. tion were reported and another 48 have been reported a personal practical application for these combinations since then. of procedures are also discussed. MATERIALS AND METHODS  HOW TO TRAIN YOUR STAFF FOR MANAGING Our clinic „Total Charm“ (Tbilisi, Georgia) is the leading All facial filler treatments carry some risk of vascular ad- CONCLUSION COMPLICATIONS one in the country, that’s why patients are sent to us in verse events (AEs). There are no safe zones on the face, Review of the literature revealed multiple single options Beatriz Beltran  Spain all complicated cases. In the period between 2015 and only higher and lower risk areas. The highest risk sites for scar treatment with minimal evidence in the literatu- mid-2018, we got patients with the following complicati- are the nasal region, glabella, forehead, and nasolabial re found on the safety and efficacy of combining such through understanding of the Complications, early ons associated with injections of fillers: fold. Hyaluronic acid filler was the cause of this compli- procedures and devices. The authors‘ experience is that A Identification and acute response, decreases the cation in the majority of cases. Vision loss, pain, ophthal- combining treatment techniques can be performed sa- risk of long term sequelae. Our Staff has to be well trai- ¡ Hyaluronic acid (HA) - more than 37 people; moplegia, and ptosis were the most common reported fely and synergistically with optimal patient outcomes. ned in case of having a complication. They are the first ¡ Calcium hydroxyapatite - 4; symptoms. Skin changes and central nervous system person who receive call phones and it is mandatory to ¡ Permanent implants (Silicone, PAAG) - 29; complications have also occurred. Less than 20% had be well trained to select and detect when it is a compli- ¡ Vitamin E - 12; complete recovery of vision. Management strategies  ACNE, ACNE SCARS AND PHOTOBIO- cation. ¡ Implants of unknown origin - 12. varied greatly and there were no treatments that were MODULATION shown to be consistently successful. Christine Noe  France I will explain how to train your Staff in the best way for in- RESULTS The following complications were mostly observed: volving in our Job and helping to manage complications. Although the risk of blindness from fillers is rare, practitio- hotobiomodulation (PBM) with LED and / or LLLT is ners who inject filler should have a thorough knowledge based on the interaction of some wavelengths of ¡ Hyper-correction (more than 55%); P Guidelines to avoid, identify and manage different Com- of this complication including prevention and manage- the visible and IR spectrum with cellular receptors. By im- ¡ Granulomas (20%); plications will be explain. ment strategies. In order to avoid serious, potentially pacting cellular metabolism, it causes anti-inflammatory, ¡ Puffiness at the injection site (5%); irreversible complications, all physicians should ideally immunoregulatory effects, and can affect cell differentia- ¡ necrosis and embolism (3%); avoid high risk areas such as the nose, glabella, forehead tion and / or proliferation. ¡ infection (5%). and nasolabial folds and have a heightened awareness of the possibility of vascular compromise when using fil- PBM is an innovative approach in the management of DISCUSSION lers. They should specifically look for a regional blanch, acne and its effectiveness is demonstrated. Since the Depending on the origin of the implant, patients under- sudden loss of vision, and have an established treatment 2000s, numerous publications provided strong argu- went therapy and surgical treatment, where it was ne- algorithm in place if a blanch is suspected or loss of vision ments in favor of this treatment and also made possible

56 SUNDAY  SEPTEMBER 1, 2019 SUNDAY  SEPTEMBER 1, 2019 57 SCIENTIFIC PARTNER DAY SCIENTIFIC PARTNER DAY

to specify the protocols to be favored. Studies show that flammatory atrophy of the adipose panniculus (stea- gonadal Peptide on Telomere. ally of any cancer. These two aspects of chronic inflam- the combination of red and blue wavelengths is syner- to-necrosis). mation, are constantly overlapping. gistic and that this choice should be preferred becau- ¡ « U » shaped scars are depressed scars with a coo- Comparing with all the previous published studies and clini- se it allows the elimination of about 75% of inflammatory kie cutter. cal results, the result of this preliminary study, we can con- Moreover, the major trigger of inflammation is stress, and lesions. A more recent publication concludes at a level clude that Telomere Index is a biological indicator of age its major antidote is endogeneous cortisol release. In re- B recommendation. The severe inflammatory and rebel- MANY INTERVENTIONAL TREATMENTS ARE OFFERED and has to be tested in our biological evaluation of age. sponse to recurrent mental stress, the brain organizes lious acnes constitute the best indication of PBM. The INCLUDING itself first to calm down by setting up a rewarding me- development of home-use devices that seems to be ¡ Subcision is a subcutaneous incision with a sharp be- chanism by increasing the secretion of dopamine, a neu- as effective as medical LEDs could change our habits in vel needle. It is done under local or loco-regional an-  PREJUVENATION rotransmitter produced by the brain, intestine and cer- managing patients with acne. LEDs can also be combi- esthesia for all fibrous and adherent scars, especially Ghislaine Beilin  France tain strains of microbiota. In a second stage, certain brain ned with photosensitizing gels for dynamic phototherapy Rolling scars. It acts by the adhesions section and by pathways connecting to the periphery are activated and with interesting results. an induction of neo-collagenesis. volution of the society, development of safe, tech- adrenal glands are stimulated to pour into circulation the ¡ TCA-CROSSis an easymethod of application. Trichlo- E nology in aesthetic medicine and new knowledge powerful anti-inflammatory hormone cortisol. For a while, The remodeling effects of PBM improve scars and can roaceticacid (TCA), 65 to 100%, isapplied to the bot- on genes and anti-aging have increased the number of any inflammatory reaction is thus controlled. However, if be used even (and especially) during progressive out- tom of the scar. The purpose of this violent but ver- procedures for patients more and more young. the stress persists, this hyper-cortisolemia will have dele- breaks. PBM also reduces the discomfort of aggressive ylocalizedaggressionis to induceaneo-collagenesist- terious effects especially on the intestinal barrier. In short, procedures: laser peels, radiofrequency and corrective hatwillraise the bottom of the scar. We can already offer to our elderly women and men pro- when over-stimulated, the anti-inflammatory hormone surgery while improving their effectiveness. The para- ¡ Recovery of depressed scars is also done under local tocols that not only slowdown aging but stop aging, and eventually produces chronic inflammation. meters are those used in „skin repair“. or loco-regionalanesthesia. With the aid of a punch of even reverse time. diameter greater than the scar size, there is a cut- Indeed, today a lot of research indicates that a continu- The place of LEDs within the therapeutic arsenal of acne aneous cylinder which will be fixed conventionally by On young patients Millennial Generation, we actually ous inflammatory state accelerates cells senescence, remains to be defined but it is obvious that there is suf- the coagulum. At best we will put a suture transfixing do protocol to prevent skin, body, collagen and genes under the influence of cortisol. From « leaky gut » to « ficient levels of proof to propose this treatment in the the dermis of the cutaneous cylinder and play the aging. sickness disease » inflammation has knocked out the in- same way as the more conventional therapies with an role of leverage. This improved technique avoids the dividuum resulting in « chronic fatigue syndromes », de- beneficial effect on inflammatory attacks but also on hy- possibility of failure and secondary retraction that can This is the new concept of Prejuvenation. pression, anxiety, sleeplessness and « burn-outs ». perseborrhoea and scars. LEDs are also an effective and be seen with the conventional technique. safe alternative in cases of contraindications to allopathic But even in its chronic version, inflammation can be ad- treatments, especially pregnant women or patients who CONCLUSION  THE YIN AND YANG OF THE INFLAMMATORY dressed, removing its major detrimental side effects, are reluctant to conventional treatment. The correction of acne scars is not just about lasers. REACTION through repair of the gut barrier and conversion of inco- Let‘s not forget our crafty, clever and efficient methods, Patrizia Anna D‘Alessio  France ming stress to a stimulating experience instead of ipsei- which allow us to optimize our laser techniques. ty hijacking. Nutragenics and the development of body  SURGICAL TREATMENT OF ACNE SCARS nflammation, the most ancient mechanism involved in awareness are thereby probably the major epigenetic Khaled Turki  Tunesia I species survival has shaped our direct contact with the regulators. environment. While inflammatory episodes resolve and INTRODUCTION 9.00 - 11.00h allow a return to homeostasis, the basic immuno-surveil- efore treatment with energy-based device (EBD) GSAAM & ESAAM lance takes over the relay, thus reducing further noisy en-  TELOMERE BIOLOGY: THE KEY TO LONGEVITY? depressed or atrophic acne scars, surgical treat- B INTERNATIONAL ANTI-AGING SYMPOSIUM counters with the environment. Nonetheless, in our con- Bernd Kleine-Gunk  Germany ment is often required. temporary society, inflammation with its five signs « calor dolor, rubor, tumor, functio lesa », has changed - with the f you want to treat aging, you first have to understand THE CONSULTATION FOR ACNE SCARS disappearance of the majority of strictly physical or infecti- the aging process. Many “Hallmarks of Ageing” have  CLINICAL STUDY EFFECT OF DNA PEPTIDE ON I It is necessary to have the history of the disease and the ous constraints - into a chronic phenomenon that we now been identified during the recent years, among them are LENGTH OF TELOMERES patient (herpes, keloid). call « low grade inflammation » or « silent inflammation » oxidative stress, low level inflammation and glycation. Ghislaine Beilin  France whose characteristic aspect instead relies in its chronicity. However – the shortening of telomeres seems to be of One must evaluate the psychological stability of the pa- special importance. Telomeres really work as “biological NA Peptide have shown effect on longevity and tient, its objectives and the expected results. Yet inflammation has its virtues, including restoration. In- clocks” in each and every of our cells. Their length is a can even recover damaged DNA. D deed, a « good inflammation », functioning as a punctual valid marker of biological age. By stimulating the enzyme Also we need to know the last oral treatments as: isotre- warning system, alternates with a « chronic » inflamma- telomerase, we even have the opportunity to restore te- Professor Vladimir KHAVINSON has already demonstra- tinoin, cyclines, or others. tion, the consequences of which, over time, will result lomere length and “rewinding our biological clock”. ted in immunofluorescence DNA repair using DNA Pep- in a profound dysregulation of all the body systems, di- tide. A careful examination of the scars will help to classify the gestive, cardio-metabolic, neuronal ... even replicative While reducing oxidative or inflammatory stress or avoi- different types of atrophic scars. It will eliminate hyper- senescence. In chronic inflammation the secretory phe- ding glycation is mainly “preventive medicine”, restoring We performed a preliminary biological study on Index Te- trophic scars or keloids. notype, SASP, of senescent cells will be privileged, main- the telomere length with the help of telomerase activa- lomere with CERBA PASTEUR BIOPREDIX laboratory to taining dysfunctions and paving the way to increasing tors really is a step into the new area of “regenerative ¡ « Icepick » scars are secondary to dilated follicular ostia. evaluate the incidence of an oral complex of fish DNA ¡ « W » scars are depressions associated with post-in- organ failure. Chronic inflammation is also the intimate medicine”.

58 SUNDAY  SEPTEMBER 1, 2019 SUNDAY  SEPTEMBER 1, 2019 59 SCIENTIFIC PARTNER DAY SCIENTIFIC PARTNER DAY

11.30 - 16.00h ¡ Faith in the doctor  THE LATEST RESEARCH ON HIFEM TECHNO- This results in numerous coagulations in the fat layer ¡ Hope that the treatment can work LOGY: COMPREHENSIVE SUMMARY OF NEW which can be shrinked and reduced in volume allowing DASIL DERMATOLOGIC & AESTHETIC ¡ Charity with himself to accept the compliance of STUDIES INVESTIGATING THE EFFICACY OF to obtain a reduction of circumference plus tightening ef- SURGERY COURSE 2019 a hard and prolonged treatment HIFEM IN BODY CONTOURING fect. The pinpoint injuries in the fat and fascia layers are Nathalie Fournier  France based on a modified technology of HIFU, called macro Personally, this is the focus that I use with my patients focused Ultrasound which uses 8 times larger coagula-  PERSPECTIVES ON SCARS AND STRETCH MARKS that usually come to me looking for an expert. My treat- igh-Intensity Focused Electromagnetic (HIFEM) tion spots than micro focused ultrasound in depth of 6. TREATMENTS WITH A NEW 1,340NM ND:YAP ment can be prescribed by any dermatologist, but it technology was introduced in early 2018 as an 9 or 13 mm, usually doing 2 passes with 2 penetrations LASER FRACTIONAL H could be difficult to obtain nice results without following innovative modality for non-invasive aesthetic medici- depths. Valeria Barretto Campos  Brazil the recommendations mentioned previously. ne, claiming to simultaneously strengthen muscles and Lasers have become more popular and with various wa- reduce fat. Since then, various investigators published velengths available the fat tissue can be heated and re- he efficacy and safety of non-ablative fractional la- What is the basic treatment for me? Taking it as a starting multiple studies and new studies are continuously being duced via heat, with similar good results. sers for stretch marks and scars treatments have T point, the treatments must suit the patient and not only published, presented or registered. The aim of this work been described in several studies. The Nd:YAP Laser the illness. is to review existing studies on HIFEM and summarize 1,340nm is a wavelength very successfully used in Brazil their outcomes.  INTENSE PULSED LIGHT FOR THE TREATMENT for different skin conditions. It is a non-ablative fractiona- I personally manage the following: OF ROSACEA ted laser which penetrates deeply into the tissue up to In total 14 studies were published or presented. Various Jaime Piquero-Casals  Spain two times more when compared to traditional techno- ¡ Tacrolimus evaluation methodologies have been used such as MRI, logies like 1,540nm wavelength. In my class I will show ¡ Topical khellin CT or ultrasound, and three of them evaluated changes raditional treatments do not help in the erythema the results of more than 10 years of experience with ¡ Oral antioxidants on the histological level. The trials include approximate- and telangiectasia of patients with rosacea. Also, 1,340nm in the treatment of stretch marks and scars - ¡ UVB-NB or Sun light T ly 340 patients and they documented changes in the patients claim to improve texture, shine and seborrhea. parameters, results and tips will be presented. thickness of muscle tissue (15-19% bulking) and subcut- In Rosacea, which presents papules and pustules, rapid aneous fat (19-27% reduction). resolution alternatives are sought. Patients with rosacea,  PERSPECTIVES ON SCARS AND STRETCH MARKS particularly the erythrotelangiectatic form, are conside-  LATEST INNOVATIONS IN BODY CONTOURING TREATMENTS WITH A NEW 1,340NM ND:YAP Patients affected by diastasis recti showed improvement red good candidates for treatment with lasers and light Dendy Engelman  USA LASER FRACTIONAL NON-ABLATIVE LASER in the condition. Authors of histological studies described therapies. Oxyhemoglobin in the blood absorbs light WAVELENGTH observation of changes in fat apoptotic levels, fat meta- from lasers at wavelengths of 595 nm (pulsed dye laser) e seem to be living in the Brave New World era Valeria Barretto Campos  Brazil bolism indicators, lipid profile, as well as increased musc- and 532 nm (KTP laser), creating heat that helps destroy where physical appearance can be significant- W le tissue density through fiber hypertrophy. Long-term capillaries that contribute to the appearance of rosacea. ly improved while the patient is awake and exerting no he safety and efficacy of the non-ablative fractional follow-up studies investigated what portion of the clinical Over a period of 3-4 weeks, the vessels are resorbed, voluntary effort. The latest innovation in approaches to Lasers in stretch marks and scars treatment have T improvement can be maintained after a year period. In and facial redness diminishes. Double-filter Intense pul- extremity sculpting, abdominal muscle enhancement, been described in several studies and clinical trials. The summary, studies showed that HIFEM have direct clinical sed light (IPL) is another modality for treating rosacea. adipose reduction, and cellulite amelioration will be pre- Nd: YAP LASER 1,340-nm is a promising wavelength effect on both fat and muscle tissues of treated patients As with lasers, the mode of action is heating of certain sented. Also to be reviewed, are the technique, mecha- which has been extensively used in Brazil on the treat- and can be part of useful body contouring devices. structures and chromophores, causing their destruc- nism of action, duration and frequency of treatments, ment of scars and stretch marks. It is a non-ablative tion and resorption, but unlike lasers, IPL output is broad expected results, side effects and limitations. fractionated Laser able to deeply penetrate into the tis- spectrum and can be modified using filters. With IPL, the sue - up to nine times more when compared to more  SKIN TIGHTENING AND BODY CONTOURING endpoint is transient purpural change, just a fleeting peri- traditional technologies such as the Er:Glass 1,540-nm WITH NEW HIFU TRANSFORMERS od of some black and blue, or vessel clearance. With IPL,  HOW I TREAT VITILIGO wavelength. Klaus Fritz  Germany too much pressure can compress vessels and blanch Agustín Alomar Muntañola  Spain the skin, resulting in a less effective treatment. If is noted Dr. Campos will present the 10-year results and detailed ue to its high efficiency and safety various tech- tissue graying, whitening, or contraction, could indicates hen evaluating vitiligo, the dermatologist must guidelines for Nd:YAP 1,340-nm LASER in the treatment nologies of heating biological tissue are broadly overly aggressive treatment, with the risk of scarring. bear in mind that although not a serious health of striae and scars. D W practiced in the dermatological field for various aesthetic The 15% overlapping is important to obtain uniform re- risk, it does have a great psychological impact, which is applications, including skin tightening, skin lifting, body sults. In this presentation will show several techniques why he must be proactive and be motivated to convince contouring and cellulite reduction. In body contouring ra- and tips of the IPL for rosacea treatment. This procedure the patient to carry out the treatment. diofrequency, Lasers and High intensity ultrasound play significantly reduces erythema and telangiectasia of ro- an increasing role in heating the dermis. sacea patients. As with any dermatological process which does not guarantee a total cure and with a long-term yet simple Both – ultrasound and RF are being used as a single treatment perspective which despite being uncomfort- technology or in combinations in order to achieve suffi- able has very rare side effects, the vitiligo-dedicated der- cient heating of the dermis. Hifu is now available in a few matologist must know how to transmit to the patient the devices with transponders that allow a penetration as three following virtues: Faith, Hope and Charity. deep as 13 mm.

60 SUNDAY  SEPTEMBER 1, 2019 SUNDAY  SEPTEMBER 1, 2019 61 SCIENTIFIC PARTNER DAY SCIENTIFIC PARTNER DAY

11.30 - 13.30h 785 nm wavelengths. laser-induced optical breakdown (LIOB) can take pla- symptoms, post-inflammatory hyperpigmentation, or ce. Below this threshold, only condensed nuclei with scarring after treatment. Patients were all satisfied with TDA – NEW ADVANCES IN AESTHETICS As we know, USA and Taiwan FDA have approved the perinuclear halo were observed in some keratinocytes, the results. AND DERMATOLOGY: AN ASIAN indications for picosecond laser systems as follows: tat- without any cavitation. On the other hand, biopsies of PERSPECTIVE toos, benign pigmented lesions removal, wrinkles and 1064nm wavelength showed that LIOB can take place In conclusion, the novel 585nm fractional yellow laser acne scars. With the advent of picosecond laser pulses, at very low fluence. can treat the facial erythema and flushing of erythrote- it is now possible to safely generate laser induced optical langiectatic rosacea with good results, almost no downt-  INNOVATIVE ACNE SCAR TREATMENT WITH breakdown (LIOB) in tissues, leading to a novel approach The occurrence of LIOB means there is rupture of the ime, and no purpura. 755NM PICOSECOND LASER COMBINED WITH to facial rejuvenation that has little to no downtime and keratinocytes, and the melanin in the keratinocytes then INJECTABLE POLY-L-LACTIC ACID greatly reduced risk for complications. has the possibility of dropping into the dermis through Hui-Wen Cheng  Taiwan the defective basement membrane, which is one of the  NEW HORIZON OF FILLER INJECTION: Pulsed dye laser (PDL) has been successfully used to pathomechanism of melasma. The possible melanin in- MYOMODULATION cne scar is a common disorder encountered in treat vascular conditions for years. It is regarded as the continence can then make melasma worsened. Peter Peng  Taiwan dermatological practice. Different scar types in one A standard treatment for vascular and erythematous lesi- area make it difficult to treat in one way. Prolonged re- ons, such as port wine stain, rosacea, red acne scar and We suggest that the use of fractional 532nm beam in the njectables are very popular since more than one de- covery time also make patients hesitate about the treat- unilateral nevoid telangiectasia by targeting underlying sub-LIOB range is beneficial for the treatment of melas- cade ago due to its immediate and long-lasting results, ment. Combination with 755nm Picosecond laser and I feeding vessels. ma. Higher fluence above the LIOB threshold may have minimal invasive and limited downtime. Poly-L-Lactic acid in a holistic approach and treatment higher chance of worsening of melasma. technique make the treatment of acne scar more ele- In my daily practice, I encounter many patients who suf- Recently, injectable fillers not only limited to volumization gant and leisurely. fer from multiple skin problems, such as pigmented and but also show some reshaping, “lifting” and skin rejuve- erythematous lesions. In my speech, I will share my per-  TREATMENT OF FACIAL ERYTHEMA OF nation and hydration effects. sonal experiences in combination treatments and tips for ERYTHROTELANGIECTATIC ROSACEA BY A  HOW TO OPTIMIZE COMBINED TREATMENT lowering side effects and maximizing patients’ satisfac- NOVEL 585NM FRACTIONAL YELLOW LASER In the past, if we want to modify the muscle activity, EFFECTS OF FACIAL SKIN TIGHTENING WITH tion. Jeng-Hsien Lin  Taiwan especially the facial muscle activity, we had to injection INJECTABLES BY AGE SEGMENTATION botulinum toxin to reduce to hyperactive muscle activity. Wei-Chih Ko  Taiwan osacea is a facial skin disorder characterized by We do not have methods to increase muscle activity.  HISTOLOGICAL STUDY OF THE PICOSECOND central facial erythema, which can fluctuate in in- acial aging is a dynamic process involving the aging R LASER, AND ITS IMPLICATION IN THE TREAT- tensity, telangiectasia, and in some cases papulopustu- After injection of filler such as hyaluronic acid (HA), the of soft-tissue and even bony structures. Epidermal F MENT OF MELASMA lar lesions and/or phymas. It poses heavy psychological hypothesis of modification muscle activity (myomodula- thinning and the decrease in collagen and elastin cause Jeng-Hsien Lin  Taiwan burden on patients’ self-esteems, and may give rise to tion) effects identified recently. This approach can inhibit skin to lose its elasticity. Fat atrophy, coupled with gravity possible social withdrawal. or enhance the muscle activity by placement the filler ab- and muscle over-contraction, leads to wrinkling and the elasma is a troublesome pigmentary disorder be- ove, inside or below the specific facial muscles. formation of dynamic and static lines. These factors con- cause of its frequent recurrence and resistance Besides traditional treatment, new medications such as tribute to the formation of facial folds and the sagging M to treatment. Multiple possible pathomechanisms were topical ivermectin can handle papulopustular rosacea I will introduce this recent emerge new concept and its appearance of aged facial skin. proposed in many studies. Some topical and oral medi- very well. However, facial erythema is still a very difficult clinical implications and potentials. cations as well as some energy-based devices are used problem to cope with, and topical brimonidine gel and To reverse the aging signs, the rejuvenation strategies to treat melasma. oxymetazoline cream can only control the erythema 1, de Maio M. Aesthetic Plast Surg. 2018 Jun;42(3):798-814. should be made according to the target signs. Combi- temporarily for less than 12 hours. Myomodulation with Injectable Fillers: An Innovative Appro- nation therapy of injectables and non-invasive skin tight- The picosecond laser is a novel treatment modality for achto Addressing Facial Muscle Movement ening devices offer satisfactory results and acceptable tattoo removal. The short pulse duration in the picose- Vascular lasers such as 585nm and 595nm pulsed dye 2, Peng PH, Peng JH. Dermatol Surg. 2018 Feb;44(2):296- downtime. During the talk, I will share the tools and tips of cond domain makes it exert more photomechanical lasers have been used to treat facial erythema of rosa- 298. Adding Volume for Reduction of Thick Lips in the Asian this combination therapy by age segmentation. than photothermal effect, resulting in stronger power cea. The treatment endpoint has, for less downtime, Patient. to fracture the pigment with less chance of side effects evolved from purpuric to sub purpuric by longer pulse 3, Hsien-Li Peng P, Peng JH. Dermatol Surg. 2019;45(3); such as post-inflammatory hyperpigmentation. duration. 478-480 Treating the Gummy Smile With Hyaluronic Acid  TREATING MULTIPLE SKIN PROBLEMS IN THE Filler Injection. SAME VISIT: COMBINING PICOSECOND LASER The picosecond lasers have been used to treat melas- We used a novel solid state 585nm laser to treat facial AND PULSED DYE LASER FOR OPTIMAL RESULTS ma in some studies. However, there is still no universal erythema of rosacea. The fractional technology allows IN ASIANS protocol to treat melasma perfectly. By the way, there slow heating of the blood vessels far beyond the thermal Wei-Chih Ko  Taiwan has been no detailed histological study of the picose- relaxation time, without causing purpura. cond laser to optimize the parameters for melasma. icosecond laser system intended to treat skin con- The pain during treatment and the downtime were both ditions with high pulse energy and extremely short P We did an in vivo histological study of the fractional minimal. Gradual improvement of facial erythema, toge- duration in the range of 300-500 picoseconds (ps). The 532nm and 1064nm handpieces with serial fluences. In ther with less episodes of flushing, was observed after device is capable of operation at 1064 nm, 532 nm and 532nm wavelength, there is a threshold above which several sessions. There was no exacerbation of rosacea

62 SUNDAY  SEPTEMBER 1, 2019 SUNDAY  SEPTEMBER 1, 2019 63 SCIENTIFIC PARTNER DAY

14.00 - 16.00h rative to forget the misconceptions: use the laser at least 6 to 12 months after surgery! AFRAD ADVANCES IN AFRICAN DERMATOLOGY

14.00 - 16.00h  TREATMENT OF FRESH SURGICAL SCARS WITH RECONSTRUCTIVE & COSMETIC SURGERY FRACTIONAL CO2 LASER Khaled Turki  Tunesia PANEL – FACE, BREAST & BODY

I NTRODUCTION he bibliography on the treatment of scars by laser,  FUNCTIONAL RECONSTRUCTION OF T is very rich. CONGENITAL AND ACQUIRED FACIAL PARALYSIS Presenter: Andreas Kehrer  Germany We work on a pilot Korean study, which compares the Authors: Andreas Kehrer  A. Anker effectiveness of non-ablative fractional laser and ablative S. Engelmann  M. Rüwe  L. Prantl fractional laser in the prevention of thyroidectomy scars. This is a comparative study between a non-ablative 1550 INTRODUCTION nm and ablative fractional laser 2940 nm on a series of ysfunction of the VII. cranial nerve is stigmatizing in seven recent thyroidectomy scar patients. D a psychosocial fashion. Irreversible facial paralysis may be seen after infection, trauma, surgery or have on- The scar is improved by both types of laser. They also cological, congenital and idiopathic reasons. Partial or noted the superiority of the ablative one. The remodeling complete dysfunction may cause severe functional and effect by fractional lasers improves cicatricial quality. aesthetic impairments. Symptoms are hypolacrimation, synkinesia, mimic contractures, conjunctivitis, muscular Two mechanisms are suggested: Decreased cytokine weakness, dysarthria, oral incontinence, asymmetry and and growth factors secretion, which prevents the forma- impaired spontaneity of facial expression. In the following tion of excessive scar tissue. paper, the international gold standard of functional re- construction will be outlined. SELECTION OF PATIENTS 20 patients of all skin types with: PATIENTS AND METHODS Functional reconstruction has to differentiate between ¡ Recent surgical scars (Day 10 to Day 15) early irreversible types and chronic forms of facial para- ¡ Old scars recovered surgically lysis. Clinical examination and modern scoring systems ¡ After removal of tumors provide orientation. Relevant clinical aspects are illustra-

PROTOCOL ted presenting an extensive anatomical and histological facial nerve study at the University of Regensburg. In ad- ¡ Fractional C02: 2 sessions 15 days a part ¡ In heating mode: low power and long exposure time dition, all major operation techniques are demonstrated 1. 30mj / MTZ (10w -3ms) to 45mj / MTZ with patient cases. (15w - 3ms) RESULTS 2. 0.8mm spacing (25% to 30%) Nerve transfers and cross-face-nerve-grafts (CFNG) ¡ Prescription of a healing cream or silicone gel have become important key elements in reconstruction ¡ Clinical surveillance and assessment of results: of early irreversible cases in many centers. Free func- at 4months, 6months and 1year tional muscle transplantation has been established as a ¡ Photographic surveillance: 4 months, 6 months, 1 year. gold standard in facial reanimation of long standing fa-

RESULTS: HARD TO QUANTIFY cial paralysis. Add-op procedures may further improve ¡ at 4months: obvious improvement in all patients symmetry and aesthetics. Every mode of treatment is ¡ at 6months: 70% to 90% improvement in 15 patients presented with actual cases from our patient series. ¡ at 1 year: the scar continues to improve but less clear CONCLUSION than the first 6 months. It is remarkable in all patients Irreversible facial paralysis may be successfully treated CONCLUSION with a differentiated, staged functional surgical recons- The aesthetic results are very satisfactory in the early truction. management of surgical wounds by the laser. It is impe-

64 SUNDAY  SEPTEMBER 1, 2019