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COSMETIC MEDICINE, 34.

JAHRGANG, 2013, ISSN 1430-4031

SUPPLEMENT

MEDIZIN

KOSMETISCHE

2013
ORGANSCHAFTEN: Arbeitsgemeinschaft Assoziierter Dermatologischer Insitute e.V. Austrian Academy of Cosmetic Surgery & Aesthetic Medicine Cosmetic Dermatology Society of India Deutsche Gesellschaft fr sthetische Botulinumtoxin-Therapie e.V. Deutsche Gesellschaft fr sthetische Dermatologie Network-Globalhealth sterreichische Gesellschaft fr Kosmetische Dermatologie und Altersforschung Vereinigung fr sthetische Dermatologie und Lasermedizin e.V.

ABSTRACTS 3rd 5 Continent Congress


18.21. September 2013, Cannes

ENTDECKEN SIE CANNES! DISCOVER CANNES!


Um 5 Uhr morgens aufstehen und in der Bucht von Cannes eine Runde schwimmen! Kytesurfen, Parasailing, Tretboote, Jetski, Tauchen oder einfach nur am Strand spazieren gehen ... in der Big Blue kann man viel erleben...! Getting up at 5 oclock in the morning and taking a swim in the bay of Cannes! Kytesurfing, parasailing, pedal boats, jetski, diving or just strolling along the beach in the Big Blue you can experience a lot! ILES DE LRINS ILE SAINTE-MARGUERITE In kurzer Entfernung von Cannes bieten die Lrins-Inseln ein erstaunliches Naturreservat, Geschichte und Spiritualitt. In einer idyllischen, unberhrten Natur bieten die Inseln den Besuchern eine mediterrane Flora und Fauna und eine einzigartige Geschichte kombiniert die Geheimnisse der Zisterziensermnche. Alles hier wartet darauf, entdeckt zu werden. LIle Ste-Marguerite ist eine der zwei Lrins-Inseln, Cannes Juwelen. Der Duft der Aleppo-Kiefern gemischt mit Myrte, Zitronen, Rosen, Clematis usw. ist betrend! Das westliche Ende wartet mit einem groen Vogelschutzgebiet auf. Der Wald von Lrins ist die Heimat vieler Tierarten wie Fasane, Montpellier Schlange, Eule, Steinkauz, Turmfalke, Igel... In short distance to Cannes the islands of Lrins offer an astonishing natural reserve, history and spirituality. In an arcadian, intact nature the islands present visitors Mediterranean flora and fauna and the unique history combines the secrets of the Cistercian monks, awaiting to be discovered. LIle Ste-Marguerite is one of the two Lrins Islands, a jewel of Cannes. The scent of the Aleppo pine trees mixed with myrrh, lemons, roses, clematis and many more is enchanting! The western end of the island has a big bird sanctuary and the forest of Lrins is home to many animals, such as pheasants, the Montpellier snake, owl, little owl, kestrel, hedgehog

Welcome Note Kosmetische Medizin

5 Continents Congress September 1821, 2013 Cannes, France


The goal of the 5 Continents Congress (5CC) is to provide a global conference dedicated to all aspects of aesthetic medicine. To fulfill this mission, the 5CC Board, which itself spans several continents, has gathered leading speakers and researchers from around the globe. The 2013 meeting boasts over 100 cosmetic dermatologists and plastic surgeons from 30 countries. The program is both broad in its coverage and in-depth analysis of current non-invasive cosmetic treatments. The scientific content has been specifically geared toward assessing the aesthetic needs of diverse cultures, treating skin of different ethnicities, and enhancing facial structures from various parts of the world. In complement, the registered attendees come from all corners of the globe. The 5CC in 2009 focused on lasers and energy-based devices. The 2013 meeting has significantly expanded coverage of topics in cosmetic dermatology and plastic surgery, to include extensive emphasis on fillers and neuromodulators, with the aim of teaching clinicians the most up-to-date techniques and presenting the key studies that shape our everyday practice. Furthermore, this years scientific sessions add focused analysis of cutting edge topics such as stem cells and biocellular therapies, LED and photomodulation, cosmeceuticals, and nanotechnology. Additional sessions are designed to facilitate approaches that combine home device-based treatments, minimally-invasive procedures, topicals, and injections. Other sessions are devoted to debate and controversy, including the popular Fact or Fiction session. The abstracts printed in the pages that follow highlight the material presented at the 2013 5CC meeting. For those of you reading this in beautiful Cannes at the 5CC, we are delighted that you have joined us. We do invite you to read these abstracts in advance and to use them as a detailed map of the scientific session. For our readers who receive the abstracts after the meeting, we hope that you will be able to learn from these abstracts, and perhaps to use this as a springboard for further reading on the topics in manuscripts subsequently published by the presenters.

DAVID GOLDBERG MD JD President, 5CC 2013

SHLOMIT HALACHMI MD PHD Scientific Program Chair, 5CC 2013

IMPRESSUM | IMPRINT

SCIENTIFIC PROGRAMME

KOSMETISCHE MEDIZIN/COSMETIC MEDICINE Organschaften/Official Publication of: Arbeitsgemeinschaft Assoziierter Dermatologischer Insitute e.V. Austrian Academy of Cosmetic Surgery & Aesthetic Medicine Cosmetic Dermatology Society of India Deutsche Gesellschaft fr sthetische Botulinumtoxin-Therapie e.V. Deutsche Gesellschaft fr sthetische Dermatologie Network-Globalhealth sterreichische Gesellschaft fr Kosmetische Dermatologie und Altersforschung Vereinigung fr sthetische Dermatologie und Lasermedizin e.V. 34. Jahrgang, Supplement 1, 2013 Volume 34, Supplement 1, 2013 ISSN 1430-4031 Verlag/Publishing House gmc Gesundheitsmedien und Congress GmbH Kaiser-Friedrich-Strae 90, 10585 Berlin www.gmc-medien.de Schriftleitung/Editor-in-Chief Prof. Dr. med. Uwe Wollina Hautklinik des Krankenhauses Dresden-Friedrichstadt Friedrichstrae 41, 01067 Dresden Telefon: 03 51/4 80 12 10 Redaktion/Editor-in-House/Marketing Douglas Grosse / Antje Himmel Telefon: 0 30/88 67 49-10 /-11 Fax: 0 30/88 67 49-99 grosse@gmc-medien.de himmel@gmc-medien.de Mitarbeiter der Redaktion Andr Haase, Dr. Peter Thomsen, Sandra Umbreit Anzeigenpreise/Advertising Rates Nach Tarif Nr. 30 vom 01.01.2013 Tarif Jan. 1, 2013 Abonnements und Vertrieb/ Subscriptions and Distribution Telefon: 0 30/88 67 49-10 Fax: 0 30/88 67 49-99 Bezugspreise Deutschland 85, jhrlich zzgl. 15, Versand Fr Mitglieder der Organschaften im Mitgliedspreis enthalten. Subscription rates outside Germany 90, plus 17,50 Surface mail, plus 40, Airmail For members of affiliated societies included in the membership dues. Erscheinungsweise/Frequency 6 x im Jahr / 6 x per Annum Layout www.peschel-design.de Druck/Printing Spreedruck GmbH, Berlin gmc Gesundheitsmedien und Congress GmbH

WEDNESDAY SEPTEMBER 18 TH 2013 Special Pre-Conference Session Home Use Devices Symposium ESLD Fostering Course Advance Module I: Vessels Vascular Lesions Management 4 4

THURSDAY SEPTEMBER 19 TH , 2013 (09:00 11:00) Update in the Management of Vascular Lesions Chemical Peels Lasers in Medical Dermatology Focus Session: Optimizing Filler Results Fractional Laser: When? The Roles of Different Fillers Lasers in the Treatment of Benign and Malignant Neoplasms Focus Session: Which Toxin, When? 5 6 7 8 10 10 11 12

THURSDAY SEPTEMBER 19 TH , 2013 (11:45 13:45) New Approaches for Old Indications HA and non-HA fillers in 2013 Scars and Keloids Device-based Approaches to Acne and Hidradenitis Skin Tightening on and off the Face Toxins in 2013 PDT: Medical Indications Approach to Scars 14 15 15 15 16 16 17 17

THURSDAY SEPTEMBER 19 TH , 2013 (15:15 17:15) IPL vs. Laser Focus Session: Body Contouring Fractional Laser: Medical Indications Updates in Melasma Analyzing Beauty: The Face Ultrasound in Aesthetics Injections: Good Outcomes and Bad Updates in RF Updates in the Approach to Actinic Keratoses Tips and Tricks: Filler and Toxins 18 18 20 20 21 21 22 23 23 24

FRIDAY SEPTEMBER 20 TH , 2013 (09:00 11:00) New Technologies Permanent and Durable Fillers: Safety and Outcomes Nanodermatology Ethnic Skin and Beauty 25 25 26 26

Die Zeitschrift wird in EMBASE Excerpta Medica Scopus sowie im Institut de lInformation Scientifique et Technique (INIST) des Centre National de la Recherche Scientifique (CNRS) gelistet.

SCIENTIFIC PROGRAMME

FRIDAY SEPTEMBER 20 TH , 2013 (11:45 13:45) Ablative vs. Non-ablative Treatment Fat-Targeting Treatments Tips and Tricks: Expand the Use of Your Device Pigmented Lesions Home Use Devices Stem Cells and Biocellular Therapies Hair Restoration and Regrowth 26 27 28 28 29 31 31

Redaktionskollegium / Editorial council


Prof. Dr. med. Uwe Wollina, Dresden (Schriftleitung) Dr. med. Klaus Fritz, Landau

Wissenschaftlicher Beirat / Editorial Board (national)


Dr. med. Gisela Albrecht, Berlin; Dr. med. Tim Blazejak, Willich; Prof. Dr.med. Ulrike Blume-Peytavi, Berlin; Dipl. Soz. Iris Cremers, Dresden; Dr. med. Peter Dorittke, Mnchengladbach; Dr. med. Oliver Drzapf, Augsburg; Prof. Dr. med. Peter Elsner, Jena; Prof. Dr. med. Alina Fratila, Bonn; Dr. med. Matthias Herbst, Heidelberg; PD Dr. med. Thomas Jansen, Essen; Dr. med. Bernd Kardorff, Mnchengladbach; Prof. Dr. med. Martina Kerscher, Hamburg; Dr. med. Marian Mackowski, Hamburg; Prof. Dr. med. Hagen Tronnier, Witten/Annen; Dr. med. Michael Weidmann, Augsburg; Prof. Dr. med. Johannes Wohlrab, Halle

FRIDAY, SEPTEMBER 20 TH , 2013 (15:15 17:15) Fact or Fiction? Injection Therapies: Off the Face Laser Hair Removal: Updates Hyperhidrosis: Device-based Approaches Cosmeceuticals Biomodulation with LED and Laser Sclerotherapy 31 32 32 33 33 35 35

Wissenschaftlicher Beirat / Editorial Board (international)


Dr. med. Mohamed Amer, Kairo; Dr. med. Anthony V. Benedetto, Philadelphia; Prof. Hong-Duo Chen, Shenyang; Dr. med. Zoe Draelos, High Points; Dr. med. Alberto Goldmann, Porto Alegre; Dr. med. Harald Gerny, Zrich; Prof. Dr. med. Eva Kokoschka, Wien; Dr. med. Moshe Lapidoth, Herzelia Pituach; Dr. med. Thada Piamphongsant, Bangkok; Prof. Dr. med. Christopher Rowland Payne, London; Dr. med. Matthias Sandhofer, Linz; Dr. med. Georges Stergiou, Zrich; Dr. med. Rekka Sheth, Mumbai; Prof. Dr. Franz Trautinger, St. Plten; Dr. med. Hanna Zelenkova, Svidnik; Dr. med. Zoran Zgaljardic, Zagreb.

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SATURDAY, SEPTEMBER 21, 2013 (09:00 11:00) Awards and Plenary: Whats on the Horizon? Management of Adverse Events: Devices Skin Tightening Liposuction Striae 36 36 36 37 37

Urheber- und Verlagsrecht

SATURDAY, SEPTEMBER 21 TH , 2013 (11:45 13:45) Body Contouring: I Lids and Lashes Alternatives to Toxins What do Patients Want? Body Contouring: II Lip Service The Interface of Cosmetic Surgery and Non-surgical Approaches Patient Management from Marketing to Post-Treatment 37 37 37 39 39 40 40 40

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SATURDAY, SEPTEMBER 21, 2013 (15:15 16:45) Advanced Rejuvenation Methods The Homogeneously-Toned Face The Cutting Edge FREE COMMUNICATIONS 40 42

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The use of names, trademarks and the like in this journal does not entitle to the presumption that such names can be used by anybody, since they often concern registered trademarks, even when they are not labelled as such.

KOSMETISCHE MEDIZIN ABSTRACTS SCIENTIFIC SESSIONS

Wednesday September 18th 2013


SPECIAL PRE-CONFERENCE SESSION HOME USE DEVICES SYMPOSIUM CHAIR G. TOWN

Advancing Capabilities of Home Use Fractional Laser: Beyond Periorbital Wrinkles I. YAROSLAVSKY Efficacy & Safety of home-use devices for hair removal and skin rejuvenation TOM NUIJS Clarisonics Home Use Devices R. ACKRIDGE Home Use of Intense Therapy Ultrasound (ITU): Principals and Clinical Applications M. SLAYTON International Progress in Standards and Regulation for Light-Based Home Use Devices G. TOWN Home Use IPL and Laser Hair Removal Devices: End-to-End Human Safety J. NASH

raphy was used for qualitative assessment of lesion counts. Severity of cyclic breakouts, improvement in skin appearance, and subject satisfaction was recorded at 1, 2, 4, 8, 12 weeks. Results: Inflammatory lesion counts reduced by 50.02 % in treatment group and increased 2.45% in control group. The reduction was most observed in the first 3 weeks after start of treatment. Treatment is pain and side effect-free. Conclusion: Home-use blue light therapy improves inflammatory facial acne three weeks after first treatment with no serious adverse effects. The blue light device offers a valuable alternative to antibiotics and potentially irritating topical treatments. The onset of the effect was observable at week 3, and maximal between weeks 8 and 12. Blue light phototherapy using a narrowband LED light source appears to be a safe and effective additional therapy for mild to moderate acne. Safety, Efficacy and Acceptability Testing of Home Use Devices with a CRO R. PETERSEN Is Light the New Drug for OTC Applications? S. DARCY

ESLD FOSTERING COURSE ADVANCE

Module I: Vessels Vascular Lesions Management Vascular Lesions Management, Vascular Malformations and tumors Treatment State of the Art AGNETA TROILIUS
Associate Professor, Laser & Vascular Anomalies, Dept of Dermatology, Skne University Hospital, Malm (Sweden)

03:30 pm 03:45 pm Afternoon Tea

Home Use Efficacy and Safety Study for Mild to Moderate Acne CAERWYN ASH
Dezac Group, Cheltenham (UK) caerwynash@yahoo.co.uk

Background: Treatment of Acne vulgaris is a challenge to the dermatologist and causes emotional anxiety for the patient. Treatment of Acne vulgaris may be well suited to home-use application where sufferers may be too embarrassed to seek medical treatment. Objective: This study is designed to quantify the effectiveness of using a blue light device in a combination therapy with proprietary creams in a self-treat regimen investigation. Method: 41 adults with mild-to-moderate facial inflammatory acne were recruited. Subjects were randomly assigned to combination blue light therapy (n = 26) or control (n = 15). Photog-

Laser and IPL are good therapeutic adjunctive tools for congenital and acquired vascular lesions. Technological advances in lasers have reduced the adverse effects and increased the efficacy. In order to choose the optimal laser treatment for a given lesion it is more important to have a thorough understanding of the available technology as well as understanding of each individual vascular lesion. The physician should have adequate background training in lasers and adequate knowledge of the lesion being treated, depth and nature, different machines, parameters, cooling, safety and after care. Lasers have been sometimes given an unjustified criticism in some articles and one of the reasons could be that e.g. infantile hemangiomas and capillary malformations have not been sub classified as they need to be, to be able to compare results. Vascular lesions can be treated by a variety of vascular specific lasers (Pulsed dye laser = PDL) which has a high specificity of hemoglobin, diode, long pulsed YAG and intense pulsed light (IPL). When treating deeper and more hypertrophic lesions long pulsed PDL and IPL are not always enough and then one can use Nd:YAG laser at 1064 nm that has a high penetration depth of up to 56 mm. It is selectively absorbed by oxyhemoglobin (but less than the traditional vascular lasers

Kosmetische Medizin

at 530650 nm) and poorly absorbed by water. It is a higher risk of persistent side effect as atrophic scarring and pigmented changes. Therefore one has to choose the lesions carefully and the patients should be fully aware of the risk of scarring. Cases when scarring can be accepted e.g painful venous malformations on the body that cannot be treated with excision or embolization, bleeding granuloma telangiectatic. Clinical endpoints can be shrinkage and blanching of the lesions as well as the popping sound if the lesions are smaller than a pea size. Propranolol is a selective beta blocker that has since 2008 been used in the treatment of especially larger more difficult infantile hemangiomas (IH) with revolutionary good results and few side effects. The shrinkage of the tumor in itself has improved the penetration of the Laser or IPL light. Start as early as possible 23 mg/kg and treat around 6 months all depending of the individual lesion. Very few side effects have been reported. Classification: 1. Vascular tumors (arise by endothelial hyperplasia). Infantile Hemangioma - Proliferating - Involuting RICH= rapid involuting hemangioma NICH= non involuting hemangioma Hemangioendoteliomas Angiosarcoma Miscellaneous 2. Vascular Malformations (arise by dysmorphogenesis and exhibit normal endothelial turnover). a. b. Fast Flow Aneurysm, ectasia, stenosis Arteriovenous fistula (AVF) Arteriovenous malformation (AVM) Slow flow Capillary Malformation (CM) Venous Malformation (VM) Lymphatic Malformation (LM) - Macrocystic - Microcystic

Thursday September 19th, 2013 09:00 11:00


UPDATE IN THE MANAGEMENT OF VASCULAR LESIONS CHAIR: J. S. NELSON

Update in the Management of Vascular Lesions J. STUART NELSON, MD, PH.D.


Beckman Laser Institute and Medical Clinic, University of California Irvine (USA)

The concept of selective photothermolysis applicable to the laser treatment of cutaneous lesions was first introduced in 1983. Using this approach, a target can be selectively destroyed by using the appropriate laser wavelength, pulse duration, and energy. Relationships between laser parameters and their effect on port wine stain (PWS) treatment outcome are complex and continue to be incompletely understood. PWS are often treatment-resistant to pulsed dye laser (PDL), and new methodologies of treatment are urgently needed to optimize absorption of laser light by hemoglobin, heat transfer into the entire vessel wall, and coagulation of the blood vessel wall. The vast heterogeneity in terms of PWS blood vessel size and depth along with revascularization make it very difficult to eradicate lesions completely with current PDL technology. Increased understanding of interactions between PWS and PDL has led to the development of new therapeutic modalities. Larger prospective, comparative, and controlled clinical studies, however, are still needed to better define the role of combination therapies for the treatment of PWS. Newer approaches will hopefully lead to better solutions for ineffective PWS treatment and lesion recurrence. Lasers for Non-Hemangioma Vascular Lesions THIERRY PASSERON, MD, PHD
Department of Dermatology & INSERM U1065, team 12, C3M University Hospital of Nice (France)

Combined

Background: Lasers are an effective approach for treating vascular lesions. Aim: To review the indications and limitations of lasers for treating non-hemangioma vascular lesions. Materials and methods: Critical analysis of the literature. Results: The effectiveness of lasers for treating port-wine (PWS) stains is clearly demonstrated. Pulsed-dye laser (PDL) remains the gold standard treatment. However the interest of other wavelengths and the use of external dye have been recently reported. The neoangiogenesis observed after laser

KOSMETISCHE MEDIZIN ABSTRACTS SCIENTIFIC SESSIONS

treatment explains some unsuccessful laser treatments. The ongoing researches to target this neoangiogenesis and the recent report of the gene responsible for PWS should provide progresses in the near future. The treatment of spider angiomas, facial telangiectasias, rosacea, venous lakes and leg veins has also been improved by the use of lasers. Although rare, venous or lymphatic malformations are difficult to treat. The use of lasers can also be of interest in these vascular malformations. Conclusion: Laser treatment can provide significant improvement of non-hemangioma vascular lesions. A precise diagnosis is mandatory to assess if a laser approach can be useful and to determine the optimal parameters. Combination treatments with laser and external dyes or anti-angiogenic agents could improve actual results, but they still warrant additional investigations. Laser for Vascular Lesions in Asians HENRY HL CHAN MD, PHD, FRCP,
Hon. Clin Professor, University of Hong Kong

CHEMICAL PEELS CHAIR: M. LANDAU

Medical Indications for Peels M. LANDAU, MD Chemical Peels in Skin of Colour MUKTA SACHDEV, MD (DERM), DPD, DD, DIP DERM (UK)
Professor and Consultant Department of Dermatology, Manipal Hospital, Bangalore (India)

Background: The use of laser and light source have gained much popularity in recent years, Asians with higher epidermal melanin context are more prone to develop adverse effect Aim: To review the safety and efficacy of laser and IPL when used among dermatological conditions in Asians Method: literature review looking at the use of laser and IPL for the dermatological application in Asians. Result: while both laser and IPL can be used among skin of color, IPL does carry greater potential risk of complication Conclusion: Laser is more superior in the treatment of dermatological conditions in Asians Future Trends in the Treatment of Vascular Anomalies GERD KAUTZ, MD
Am Markt 3, 54329 Konz (Germany)

Cosmetic Dermatology is the newest and most popular subspecialty of Dermatology. Chemicalpeelsare one of the most commonly performed cosmetic office procedures. Peeling in skin of colour presents unique challenges of its own. Peelcomplications can be avoided or minimized when the cosmetic dermatologist has a thorough understanding of the principles of cosmetic dermatological procedures as well as a sound understanding of facial and body anatomy.The discussion will focus on the newer peels available for skin of colour with common indications, individual case discussions, prevention of complications and proper diagnosis and management of problems when they occur. Emphasis is placed on how to safely use and combine these newer peels in order to achieve the best cosmetic results, especially in skin of colour. Complications in chemical peel techniques with skin of colour are still commonly encountered and a brief overview of the common complications will be highlighted. Peels in Rosacea and Pigmentation CLAUDIA BORELLI, MD
Aesthetic and Laser Unit, Dept. of Dermatology, University of Tbingen (Germany) claudia.borelli@med.uni-tuebingen.de

Since 17 years now we are treating very successfully all kinds of vascular malformations with different laser and IPL systems. The introduction of propranolol has decreased the indication of treatment for hemangioma significantly. The IPL- and laser systems represent the Gold standard for rosacea, teleangiectasia, and other vascular diseases. Even with a few treatment cycles you can achieve outstanding results with minor side effects. The patients should be informed extensively about the fact that it could come to recurrences with vascular malformation before the first treatment. A consistent sunscreen before and after the therapy is useful, as with all laserand IPL-treatments.

The past years it was common knowledge, that peeling should not be performed in patients suffering from rosacea. The delicate skin of these patients, together with flushing and blushing and the stinging and burning sensations that they were feeling made peeling impossible. This paradigm has now changed: Peeling of rosacea patients is a new treatment option. The peeling should not irritate the skin, which has been f. e. made possible through a new peeling (peel Nr. 2 sensitive, Dermasence P and M cosmetics, Mnster, Germany) containing glycolic and salicylic acid, as well as boswellia serrata as ingredient. Pigmentary disorders of the face are quite common and a real therapeutic problem. Too aggressive treatments will make the skin even worth than before and lead to additional postinflammatory hyperpigmentation. Chemical peeling with glycolic and salicylic acid in combination with other therapies can improve Melasma or hyperpigmentation. My Experience in Chemical Peels L. WIEST, MD

Kosmetische Medizin

LASERS IN MEDICAL DERMATOLOGY CHAIR: K. FRITZ

External Forces for Dermal Drug Delivery UWE PAASCH, M.D.


Universittsklinikum Leipzig AR, Klinik fr Dermatologie, Venerologie und Allergologie

Pulsed Dye Laser: New Indications KLAUS FRITZ, MD


Dermatology and Laser Centers Landau (Germany) and Bern (Switzerland), Osnabrck (Germany) and Bucharest (Romania)

PDL is accepted as first-line therapy for vascular disorders including port-wine stains, telangiectasia, and hemangiomas. PDL causes selective photothermolysis of dermal vasculature. This mechanism also allows it to be applicable for disorders of other etiologies. Recent studies suggest that the PDL may induce cytokine expression and collagen formation, further increasing its applicability in dermatology. FDA approved indications and conditions less commonly treated with PDL are: Benign epidermal pigmented lesions, benign cutaneous vascular lesions, angioma serpiginosum, glomus tumor, unilateral nevoid telangiectasia, angiokeratoma of Fordyce, dermatomyositis (poikilodermatous erythema), angiofibromas, keratosis pilaris rubra/keratosis pilaris atrophicans faciei, benign cutaneous lesions like atopic dermatitis, granuloma faciale, granuloma annular, dermatomyositis (Gottron papules), molluscum contagiosum. Off-label (non-FDA approved) indications are actinic keratosis, actinic cheilitis, Bowens disease, Basal cell carcinoma Melasma, Lupus erythematodes, acne, granuloma facial, granuloma anulare. Newer-generation PDLs offer higher fluences, larger spot sizes, longer pulse widths, and cryogen and air cooling. For selective photothermolysis to occur, certain requirements must be met. Specifically, the chromophore target needs to absorb the wavelength that the laser emits, the pulse duration should be equal to or less than the thermal relaxation time of the target, and a sufficient fluence is needed to reach temperatures capable of damaging the target. Possible side effects after PDL treatment include erythema, purpura, edema, pigmentary changes, and rarely, scarring, however they rarely occur and are usually self-limited. The review shows that pulsed dye lasers have by far more indications than just vascular and may be used especially in resisting dermatoses where this laser technology offers additional benefits when classic therapies are not efficient. Monochromatic Excimers for Vitiligo F. XIANG, MD

Background: Delivery of drugs to the epidermal and dermal compartment may be difficult with respect to the molecular properties of the molecules. Previous studies showed a possible intensification of photodynamic therapy after injection of the photosensitizer or its application post ablative fractional lasers. In addition fillers, steroids as well as other substances are subjected into the skin for many purposes trying to treat up large surface areas. Sonoporation and hydroporation are new technologies that allow the application of liquids and low viscous substances into the skin without any needle injection. Aim: The purpose of the study is to examine the capabilities of these systems to place molecules of various sizes into the dermal and epidermal compartment. Patients and Methods: Using a human skin explant model as well as unprocessed pig skin the ability of the hydroporation technique (Jetpeel, TavTec, Israel) and a sonoporation device (Impact, Alma Lasers, Israel) to treat the skin mechanically and to provide molecules of various sizes and viscosities into the skin compartments were tested. For this purpose 0.9 % saline and liquid preparations of photosensitizers for PDT, low and high viscous hyaluronic acid for volume augmentation, vitamin A, B and C-solutions for anti-aging, glycolic acid for peeling, and triamcinolone to treat scars have been used. Results: The sonoporation and the hydroporation technique enables the operator to subject the skin to mechanical forces using 0.9 % saline ranging from simple massage effect, peeling of superficial layers up to full ablation and even fractional ablation patterns. On top of this, comedones can be easily removed. Subjecting liquid preparations of photosensitizers for PDT, low and high viscous hyaluronic acid for volume augmentation, vitamin A, B and C-solutions for anti-aging, glycolic acid for peeling, and triamcinolone via hydroporation to the skin explants results in homogenous to bulk placement of the molecules into skin up to 2mm deep. Conclusion: The new technologies of sonoporation and hydroporation are effective for various purposes from skin peeling up to deep and uniform drug delivery into human and pig skin. Clinical studies are needed to demonstrate its in-vivo efficacy. Intense Blue Light: Indications N. FOURNIER, MD Background: The utilization of a nonthermal blue (405425 nm) lamp in aesthetic and medical dermatology fields is now a common way of practicing. Various indications have been described. Aim: To review and to analyze the good indications for a blue lamp in current practice. Material and Methods: Review of the literature and an analysis of a clinical experience of ten years of utilization of a non-

KOSMETISCHE MEDIZIN ABSTRACTS SCIENTIFIC SESSIONS

thermal blue light (405425 nm) for indications such as acne, neurotic prurigo, scarring, melasma, rosacea, post inflammatory hyperpigmentation, and also on aesthetic indications such as post laser healing, post aesthetic surgery, pore reduction, greasy skin. Results: The utilization of a non-thermal blue light (405425 nm) brings various degrees of improvement due to the patient himself and to the pathology itself. Determining the indication before including a patient in a procedure increases better results. Summary: Blue lamp is a safe, comfortable, and efficacious device for many medical and aesthetic indications, very well accepted by patients. Combining Fractional Laser and Topicals V. NARURKAR, MD

Results: A nonsurgical nose job enables gratifying results as a viable alternative to primary rhinoplasty in selected cases. Its role as an alternative to cartilage grafts will be analyzed thereby addressing both form and function. Conclusion: Minimally invasive augmentation type rhinosculpturing adds to the armamentarium of the rhinoplasty surgeon. It is an easy to perform, anatomic procedure that might spare additional surgery, with a high patient satisfaction rate. Although much has been achieved by minimally invasive techniques in rhinoplasty, one must be cognizant of the fact that when selecting alternatives to address specific deformities, detailed systematic analysis of the anatomical variables, proper patient selection, artistic perception and precise execution are of paramount importance. Midface Augmentation: East vs. West NARK-KYOUNG RHO, MD

FOCUS SESSION: OPTIMIZING FILLER RESULTS CHAIR: N. RHO

Leaders Aesthetic Surgery and Cosmetic Laser Center, Seoul (Korea)

Do Fillers, Techniques, and Equipment Influence Results? W. PRAGER, MD Deep vs. Superficial Volume D. VLEGGAAR, MD Non-Surgical Rhinoplasty SARIT COHEN, MD, RAMAT GAN (ISRAEL) Background: Minimally invasive facial aesthetic procedures have gained widespread popularity during the last decade. Purported advantages over traditional surgeries include no scars, minimal downtime, less pain and is a lower cost alternative. The nose, the most prominent aesthetic feature of the facial profile, is likewise amenable to minimally invasive techniques. Material and Methods: Fifty-seven patients underwent minimally invasive rhinosculpturing. Indications, encompassing augmentation type primary rhinoplasty (rhinosculpuring), correction of post-rhinoplasty contour defects, treating the aging nose and correction of selected functional impairments, will be thoroughly demonstrated in a systematic manner, dividing the nose and the nasal skeleton into thirds: Upper third low radix, widened bony pyramid, bony contour irregularities. Middle third low dorsum, dorsal contour irregularities, saddle nose deformity, inverted V deformity. Lower third inadequate tip projection, underrotated tip, external valve incompetence. Acquaintance with nasal aesthetics is of paramount importance and will be discussed. Special emphasis will be placed on the interplay between interrelated architectural structures. Injection technique will be presented along with pre-treatment and post-treatment photography.

Background: The unique aspects of East Asian beauty concept and the nuances of treating their skin require products, procedures, and protocols tailored specifically to the patient. Even in East Asia each country, for example, Korea, Japan, Taiwan, Hong Kong, and China, has a different standard of beauty. All people have preferences on their own concept of beauty. There is a concept in cultural studies about cultural relativism (different cultural groups think, feel, and act differently) and ethnocentrism (ones own culture is superior to that of other cultures). But there is no scientific standard for considering one group as intrinsically superior or inferior to another. Aim: The difference in the concept of midface rejuvenation between Caucasians and East Asians is one of the most interesting topics in the field of the international cosmetic surgery. This lecture aims to provide a basic concept of the midface beauty in East Asian countries and the filler injection techniques to get a what-people-want appearance in Korea. Materials and methods: Anatomical characteristics of the East Asian midface structure will be presented. Not only the authors personal experience but also the general consensus of the Korean experienced injectors will be provided. Results: According to the recent studies, the younger Koreans prefer the lozenge and inverted triangle shape contour whereas the Koreans over 40 of age prefer the egg shape contour. In chin and zygoma contour, Koreans at the age of 20 prefer distinctly small chin and relatively small lower face. On the other hand, the Koreans over 40 of age prefer the distinct zygoma. The preferred proportion of upper, middle, lower face is 1 : 1 : 1 in general. Koreans now prefer protruding forehead and small (not distinct) and V-shaped mandible-chin in frontal view. The statistical evidence from many Korean studies suggests that the harmony and balance of facial aesthetic subunits make attractive and beautiful face. Because the majority of the East Asian younger females dont like their prominent, laterally and superiorly-set cheekbones, the basic concept of cheek augmentation in this population is to soften the prominent zygoma and fill medial aspects of the midface, to make a

BRAUCHEN SIE NOCH EIN SPIRITUELLES ZWISCHENSPIEL? DO YOU NEED A SPRITUAL INTERLUDE?
Cannes ist ein natrliches Paradies, so Jean Cocteau. Verpassen Sie daher nicht einen Besuch im Kloster von St. Honorat Iles de Lrins, einem Ort der Spiritualitt. Eine kurze Fahrt von der Croisette, gegenber der Bucht von Cannes und die Lrins-Inseln begren Sie. Cannes is a natural paradies, said Jean Cocteau. So dont miss a visit to the monastery of St. Honorat Iles de Lrins, a place of spirituality. A short trip from the Croisette, across the bay of Cannes and the Lrins Islands await you.

Trans Cte dAzur Boat trip | WWW.TRANS-COTE-AZUR.COM

CANNES GOURMET
Die Kche von Cannes ist wie ein Stck Sonne auf einem Blatt des blauen Meeres. Stephen Ligeard (Erfinder des Begriffs Riviera) Ein Sandstrand, eine Sonnenterrasse, Luft aus Grand Bleu und eine GourmetKche - la dolce vita erfordert kstliche Aromen! Knackige Salate, frisches Gemse Olivenl bringt Geschmack und Leichtigkeit. Mediterrane Kstlichkeiten sorgen bei Gourmets fr den Genuss: Dorade oder Rotbarbe mit einem Glas Wei- oder Roswein aus der Provence genossen versprechen glckliche Augenblicke. TIPP: Gourmets sollten unbedingt die Spezialitten von Cannes probieren, die auf den Lrins-Inseln oder auf der Ile Saint Honorat produziert werden.

The kitchen of Cannes is like a slice of the sun on a leave of the blue sea. Stephen Ligeard (inventor of the term Riviera) A sandy beach, a sun terrace, air from Grand Bleu and Gourmet kitchen La dolce vita requires exquisite aromas! Crispy salads, fresh vegetables olive oil brings flavour and easiness.

Mediterranean delicacies provide for Gourmet pleasure: Dorade (gilthead) or red mullet together with a glas of white wine or ros from the Provence, promise very happy moments. TIP: Gourmets should absolutely try the Cannes specialties, that are produced on the islands of Lrins and Saint Honorat. WWW.EXCELLENCEDELERINS.COM

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KOSMETISCHE MEDIZIN ABSTRACTS SCIENTIFIC SESSIONS

younger looking face. Injectable fillers are now rapidly replacing the traditional fat grafting procedure. The use of a blunttipped micro cannula is recommended. Conclusion: Even though many Caucasians have small and slim faces, it doesnt mean East Asians want to look like Caucasians. Small jaws and cheekbones are the current beauty concept of the East Asian young females, unlike the Caucasians preference. The filler injection should be performed in different fashion when managing East Asian females.

1.

Hantash BM, Bedi VP, Chan KF, and Zachary CB, Ex vivo histological characterization of a novel ablative fractional resurfacing device, Lasers Surg. Med., vol. 39, no. 2, pp. 87-95, Feb.2007. Bedi VP, Chan KF, Sink RK, Hantash BM, Herron GS, Rahman Z, Struck SK, and Zachary CB, The effects of pulse energy variations on the dimensions of microscopic thermal treatment zones in nonablative fractional resurfacing, Lasers Surg. Med., vol. 39, no. 2, pp. 145-155, Feb. 2007

2.

FRACTIONAL LASER: WHEN? CHAIR: S. MORDON

Combined Fractional Ablative and Non-ablative Treatments L. BASS, MD Fractional Technology in Asian Skin HENRY HL CHAN MD, PHD, FRCP,

Numerical Simulation of Fractional Photothermolysis SERGE R. MORDON, PHD AND MOHAMAD FERAS MARQA, PHD
INSERM (French National Institute of Health and Medical Research), U703, Lille University Hospital, CHRU, Lille (France) serge.mordon@inserm.fr

Hon. Clin. Professor, University of Hong Kong

Background: Laser Fractional Photothermolysis (FP) is one of the innovative techniques of skin remodeling and resurfacing. During treatment a Microscopic Thermal Zones (MTZs) are created which are presented by columns of thermal damage. The control of the necrosis dimensions (MTZ) versus the pulse energy requires knowledge of various parameters in detail that govern the heat transfer process. Aim: This Study aimed to elaborate a mathematical model to simulate the effect of the pulse energy variations on the dimensions of MTZs. Methods: The mathematical model was based on finite element method (FEM) to solve the light distribution, bioheat, and thermal damage equations. Two series of simulations for ablative (30 W, 10.6 m CO2) and non-ablative (30 W, 1.550 m Er:glass) lasers systems were performed. In each series, simulations were carried for the following pulses energies: 5, 10, 15, 20, 25, 30, 35, and 40 mJ. Results of simulations are validated by histological analysis images of MTZs sections reported in Hantash et al. [1] and Bedi et al. [2] works. Results: MTZs dimensions were compared between the histological images section and the corresponding data from simulation model using a fusion technique for both ablative FP and non-ablative FP treatment methods. Depths and widths estimated from simulations are usually deeper (typically 21 2 %) and wider (typically 12 2 %) when compared to histological analysis data. Conclusion: The differences can be easily explained by the shrinkage effect due to the fixation of biological tissues. When considering this effect on histological measurements, a good correlation can be established between the results of simulation and the histological analysis results.

Background: The theory of fractional photothermolysis has revolutionized skin rejuvenation and among Asians the main potential complication is post-inflammatory hyperpigmentation Aim: To review the safety and efficacy of the use of non-ablative and ablative skin rejuvenation in Asians. Method: literature review on the use of non-ablative and ablative fractional laser resurfacing in the density and energy chosen Result: The risk of PIH is associated with the density and energy used with density being particular relevant. Conclusion: Fractional laser resurfacing is effective and safe among skin of color with the appropriate parameters are used.

THE ROLES OF DIFFERENT FILLERS CHAIR: S. WEINKLE

Soft Tissue Augmentation S. WEINKLE, MD Measuring Volumizing Fillers N. LOWE, MD Synthetic Fillers and Autologous Fat Augmentation An Anatomic Algorithm SUZAN OBAGI, MD
Associate Professor of Dermatology Associate Professor of Plastic Surgery Director, The Cosmetic Surgery and Skin Health Center University of Pittsburgh Medical Center (USA)

Background: The role of injectable fillers is becoming more important as we recognize the importance of facial volume rebalancing. There are a multitude of synthetic fillers on the market and many more in the pipeline. Aim: Understanding the anatomic changes with aging (bony, muscular, and adipose), the physical properties of the fillers themselves (G prime), and the proper evaluation of each patient are key factors to successful rejuvenation.

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Materials and Methods: The author will present an anatomic algorithm in which the proper patient evaluation and filler selection hinges on the anatomic area being treated and if indicated, how to mix and match fillers to achieve balance. Results: Case examples will be shown utilizing a variety of fillers to re-balance the face in a natural appearing manner. Conclusion: Successful and aesthetically pleasing filler results can be achieved by properly evaluating the patient and selecting the proper filler based on anatomic location and the physical properties of the selected filler. Biophysical Measurements for Objective Evaluation of Filler Results MARTINA KERSCHER, MD
University of Hamburg, department chemistry, cosmetic science

The use of hyaluronic acid fillers has been mainly confirmed to the treatment of lines, folds and for skin rejuvenation over more than a decade. Aging skin is a multifactorial process, resulting from the interaction of a number of different factors, both intrinsic and extrinsic. According to reactive oxygen species which affect matrix metalloproteinase, degradation of collagen and reduction of collagen synthesis are affected in intrinsic aged as well in photoaged skin. Moreover skin aging is associated with loss of skin moisture. The main molecule involved in skin moisture is hyaluronic acid which belongs to the extracellular matrix molecules. Dermal hyaluronic acid attracts water molecules; create tugor and is also though to affect cell integrity, mobility, and proliferation. The reduction of hyaluronic acid results in a reduced ability to bind water and contributes to some typically aging signs like wrinkles or loss of volume. Moreover hyaluronic acid can stimulate dermal fibroblast and therefore increase the collagen neosynthesis. Therefore evaluation on skin physiology and clinical appearance has become a main focus on cosmetic and dermatology research. To determine whether hyaluronic acid fillers have an impact on skin physiology and clinical appearance, biophysical measurements like stratum corneum hydration, cutaneous elasticity, skin density and thickness and surface parameters like skin roughness or wrinkle deepness are used.

Materials and Methods: Many benign skin growths can be treated with CO2 laser: actinic and seborrheic keratosis, warts, moles, skin tags, epidermal and dermal nevi, xanthelasma. Other conditions that have been shown to respond favorably to CO2 laser resurfacing include rhinophyma, severe cutaneous photodamage (observed in Favre-Racouchot syndrome), sebaceous hyperplasia, adenoma sebaceum (seen in Pringle-Bourneville syndrome), syringomas, actinic cheilitis, angiofibroma, scars, keloids, skin cancer, neurofibroma and diffuse actinic keratoses. Lasers and non-coherent intense pulse light sources (IPLS) are based on the principle of selective photothermolysis and can be used for treatment of many vascular skin lesions. Results: A variety of lasers has recently been developed for the treatment of congenital and acquired vascular lesions which incorporate these concepts into their design. The list is a long one and includes pulsed dye (FPDL, APDL) lasers (577 nm, 585 nm and 595 nm), KTP lasers (532 nm), long pulsed alexandrite lasers (755 nm), pulsed diode lasers (in the range of 800 to 900 nm), long pulsed 1064 nm Nd:YAG lasers and intense pulsed light sources (IPLS, also called flash-lights or pulsed light sources). Different lasers systems are used at different fluences, pulses and spot sizes to treat the same vascular lesions. Lasers and IPLS are the treatment of choice for the following vascular conditions: vascular tumours, vascular malformations, congential vascular lesions and acquired vascular alterations. Good clinical results are seen after CO2 and Er: YAG laser treatment of benign growths such as seborrheic and senile keratoses and scars in age-related skin followed by fullface resurfacing. Conclusion: Laser treatment shows good results in the management of benign skin tumors and represents an alternative of surgical methods. Long pulsed PDL for Hemangioma T. KONO, MD Combination of ablative fractional and q-switched ruby laser to treat field cancerisation UWE PAASCH, M.D.
Universittsklinikum Leipzig AR, Klinik fr Dermatologie, Venerologie und Allergologie

LASERS IN THE TREATMENT OF BENIGN AND MALIGNANT NEOPLASMS CHAIR: M. KADURINA

Laser Treatment of Benign Tumors M. KADURINA


Department of Dermatovenerology and Allergology, Military Medical Academy Sofia, Bulgaria

Background and Aim: Over the past decade, advances in laser technology have allowed dermatologists to improve the appearance of scars and wrinkles and to remove benign skin proliferations using ablative and nonablative lasers.

Background: Fractional ablative laser therapy (AFXL) is known to be able to stimulate epidermal and dermal remodelling. Recently its efficacy in non-melanoma white skin cancer (WSC) in conjunction with pain associated photodynamic therapy (PDT) has been demonstrated in cases of field cancerisation (FC). Along with a specific spatio-temporal wound healing sequence pigmented microscopic epidermal necrotic debris (MEND) is expulsed. Recently the painless removal of pigmented MEND by application of a q-switched ruby laser therapy (QSRL) has been proposed. Aim: This pilot study aims on testing the efficacy and safety of a sequential application of AFXL and QSRL in patients with FC refusing to have a surgery or PDT clinically, by 3D photography and by means of histology.

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KOSMETISCHE MEDIZIN ABSTRACTS SCIENTIFIC SESSIONS

Patients and Methods: The concept of sequential AFXL and QSRL treatments has been proved in three male patients having FC on their heads using a fractional CO2 laser (10.600nm Exelo2, Alma Lasers, Erlangen, Germany, pulse duration 2ms, 60J/cm, paintbrush-mode) followed three days later by QSRL (694nm Sinon, Alma Lasers, Erlangen, Germany, 3.54J/cm, 6mm spot size, one pass). Results: In all patients there was a significant improvement clinically. The number of actinic keratosis has been reduced and using specific software filters to demonstrate vascularization and pigmentation a reduction in inflammation was visible. A complete clearance however could not be demonstrated after a single treatment. Histologically the perfect targeting of MEND by QSRL has been confirmed. The pain level was significant lower than in conventional PDT. Conclusion: The sequential AFXL and QSRL therapy might be an alternative to other treatments of WSC in case of FC especially when PDT is too painful. However, efficacy as estimated by this pilot trial with low patient numbers needs to be confirmed in larger study populations. Quasi-ablative Laser for Actinic Keratoses SHLOMIT HALACHMI MD PHD, M. ADATTO MD, AND MOSHE LAPIDOTH MD MPH
Rabin Medical Center, Petach Tikva, Israel, and Skinpulse Dermatology & Laser Center, Geneva, Switzerland

FOCUS SESSION: WHICH TOXIN, WHEN? CHAIR: J. DOVER

Combining Toxins in Clinical Practice J. DOVER, MD The Role of Complexing Proteins in the Treatment with Botulinum Toxin Products DR JRGEN FREVERT
Merz Pharmaceuticals GmbH, Hermannswerder Haus 15, D-14473 Potsdam

Background: Actinic keratoses (AK) are increasingly treated with methodologies that seek to address field cancerization rather than targeting discrete clinically-evident lesions. Ablative lasers could be used as a modality for such treatments. Aim: To assess the safety and efficacy of treating AK with a classically non-ablative fractional laser whose application has been modified to exert an ablative effect on the epidermis. Materials and Methods: Seventeen patients with AK underwent laser treatments with fractional 1540 nm erbium glass laser at fluences of 75 mJ, 15 ms pulse duration, and 10 mm spot size in non-contact mode. Blinded assessors and participants evaluated the clinical improvement at 3 month using a quartile grading scale (no improvement = 0, 125 % improvement = 1, 2650 % = 2, 5175% = 3, and 76100 % = 4). Results: Three months after the last treatment the mean level of improvement was 3.4 0.72. Adverse events were limited to moderate erythema, mild edema, erosions, and mild desquamation. No scarring or post-inflammatory pigmentary changes occurred. Conclusion: 1540 nm fractional erbium glass laser in non-contact mode provides a safe and effective treatment option for AK.

Three Botulinum toxin type A products are marketed on the European and US market: Botox/Vistabel (Allergan), Dysport/ Azzalure (Galderma/Medicis) and Xeomin/Bocouture (Merz Pharmaceuticals GmbH). Whereas Botox/Vistabel and Dysport/ Azzalure contain additional bacterial proteins (complexing proteins), Bocouture only contains the 150 kD Neurotoxin which is the sole active substance in all product. The complexing proteins do not play any role in the mechanism of action. In the early days of botulin toxin therapy it was claimed that the complexing proteins are required to stabilize the neurotoxin and even to preserve the structure of the active molecule which was assumed to be a labile protein. In contrast it was demonstrated that in an appropriate formulation the neurotoxin is stable even at room temperature for four years and does not lose any activity when stored at 60C for one month. Interestingly the complexing proteins containing products must be stored at 28C. In several preclinical and clinical studies it was demonstrated that complexing proteins do not influence the spread of the neurotoxin into adjacent muscles. This can easily be explained by the finding that a complex does not exist in reconstituted products. The complexing proteins dissociate from the neurotoxin and cannot inhibit the migration of the neurotoxin. In preclinical studies it was found that complexing proteins bind to lymphocytes which in contrast to the 150kD Neurotoxin. Binding to immune cells is the prerequisite for activation of the immune system. It can be concluded that complexing proteins bear the risk of a higher immunogenic potential. Complexing proteins can help to elicit antibodies to the neurotoxin which terminate the therapy with the botulinum toxin. Use of Different BTX-A Products W. PRAGER, MD

NIZZA: CHOCOLATIER MAISON AUER NICE: CHOCOLATIER MAISON AUER


Lassen Sie Ihre Kindheitserinnerungen wieder auftauchen: Das Bild von ser Schokolade aus hausgemachter Herstellung. Thierry AUER, Meister-Chocolatier und Confiseur, whlt mit viel Liebe nur die Zutaten aus, die mit beispielloser Kontinuitt, eine gleichbleibende Produktqualitt erzielen und dabei traditionell hergestellt werden. Ungewhnliche Aromen wie Aprikose, rosa Grapefruit, Erdbeere, Mandarine mit Schale und sogar Oliven knnen eine nette Auswahl sein, die Gro und Klein begeistern. Das langfristige Know-how der Familie wird der neuen Generation stndig weitergegeben. Es wird nur Kakaobutter in den Pralinen verwendet, diese garantiert die unwiderstehliche Qualitt. Rekindle your childhood memories: the

picture of homemade sweet chocolate. Thierry AUER, master chocolatier and confiseur, chooses with great care only those ingredients, that obtain with unequalled continuity consistent product quality and that are produced the old fashioned way. Out of the ordinary aromas such as apricot, pink grapefruit, strawberry, mandarin with peel and olives can be a nice selection that inspire young and old. The know-how of the family is given

from generation to generation. Only real cocoa butter is used in the pralines guaranteeing their irresistible quality.

MAISON AUER 7 RUE SAINT-FRANOIS DE PAULE 06300 NICE TL. +33 (0)4 93 85 77 98 CONTACT@MAISON-AUER.COM WWW.MAISON-AUER.COM

CANNES KULTUR CANNES CULTURE


Die franzsische Riviera war seit jeher eine unerschpfliche Quelle der Inspiration. Nicht nur die Knstler des 20. Jahrhunderts wie Mir, Matisse und Picasso genossen dieses renommierte Haus, auch zeitgenssische Ausstellungen finden hier statt. Mitte September bis Mitte April geffnet.

CANNES NIGHTLIFE
The French Riviera has always been a unfailing source of inspiration. Not only the artists of the 20th century such as Mir, Matisse und Picasso enjoyed this renowned house, also contemporary exhibitions take place here. Open from the middle of September until the middle of April. LEcrin is a real jewel. The well known interior designer Miguel Cancio-Martins (Buddha-Bar New Yorck and Paris) was assigned to build a unique beach location. LEcrin ist ein echtes Juwel. Hierfr wurde eigens der bekannte Interior-Designer Miguel Cancio-Martins (Buddha-Bar New Yorck und Paris) beauftragt, eine einmalige Beach-Location in Cannes zu errichten.

CENTRE DART LA MALMAISON WWW.CANNES.COM

WWW.ECRINPLAGE.COM

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KOSMETISCHE MEDIZIN ABSTRACTS SCIENTIFIC SESSIONS

Thursday September 19th, 2013 11:45 13:45


NEW APPROACHES FOR OLD INDICATIONS CHAIR: J. DOVER

Split Foot Onychomycosis Laser Treatment Study to Compare the Efficacy and Safety of 1064 and 980 nm UWE PAASCH 1 AND HARTMUT PAASCH 2
1 2 Universittsklinikum Leipzig AR, Klinik fr Dermatologie, Venerologie und Allergologie Hautarztpraxis Dr. Hartmut Paasch, Lindenstrasse 20, 04838 Gotha, Germany

Laser Treatment of Pigmentary Disorders PR. THIERRY PASSERON, MD, PHD


Department of Dermatology & INSERM U1065, team 12, C3M University Hospital of Nice (France)

Background: Variations of skin pigmentation are mostly due to quantitative or qualitative defects of melanin pigments (eumelanin and pheomelanin). However, dyschromia can also result from an abnormal increase or decrease of other endogenous pigments (hemoglobin, bilirubin ) or from the deposit of exogenous pigments (heavy metals, cosmetic tattoos ). This leads to a heterogeneous group with numerous causes. The laser devices have markedly improved the treatment of hyperpigmentary disorders. Aim: To review the indications and limitations of lasers for treating pigmentary disorders. Materials and Methods: Critical analysis of the literature. Results: Actinic lentigo, lentigines, and congenital or acquired dermal hypermelanocytosis can be effectively treated with Qswitched lasers. Dark rings, poikiloderma of Civatte, linear and whorled nevoid hypermelanosis, Becker nevus, and nevus spilus can also benefit from laser approaches. However, relapses or worsening of the lesions are observed when treating caf-au-lait macules, post-inflammatory hyperpigmentation, or melasma and strongly limit the use of lasers in these indications. Conclusion: Laser treatment can provide significant improvement of some pigmented lesions, but it can also worsen others. A precise diagnosis is mandatory to assess if a laser approach can be useful and to determine the optimal parameters. New Approaches to Tattoos J. DOVER, MD

Introduction: New trends of dermatological laser treatments include the treatment of onychomycosis by means of infrared laser light. It is assumed that the eradication effect is mediated by heat. To date, many laser systems operate at various wavelengths and rather diverse parameter settings. Comparative laser application studies evaluating the potential to eradicate fungi and spores over longer terms are missing. Aim: This study aimed on measuring the area of temporary increase in clear nails clinically after four laser treatments during a 12 month follow up. Laser treatment was performed using a 1064 nm vascular Nd:YAG-laser and a 980-nm linear scanning diode hair removal laser. Material and Methods: 22 study subjects (10 male, 12 female, and aged 58.6 11.3) were enrolled into the study to receive four laser treatments four weeks apart. The left foot was treated using the 1064nm laser, 70J/cm2, 40ms pulse duration, 5mm spot size, 3 passes, contact cooling. At the right foot 980 nm linear scanned, 30 J/cm2, 12 ms pulse duration, 12x12mm spot size, 3 passes were applied. Pain was recorded using a VAS scale. Follow-up was performed on week 4, 8, 12, 24, 36, and 52. Results: All together 152 nails have been treated. In mean 47.7 pulses (653.7 J) have been applied at the left side whereas on the right side always three pulses per nail were applied. Pain was recorded as 6.2 (1064nm) and 7.0 (980nm). Clearance of nails was evaluated by subjective estimation and photo documentation as (1064nm vs. 980nm): W4: 28.5 29.5 vs. 28.5 29.5; W8: 35.9 38.9 vs. 38.9 29.6; W12 53.8 27.6 vs. 53.4 27.6; W24 63.3 29.8 vs. 58.9 29.2; W36 75.4 24.2 vs. 75.4 24.2; W52 83.3 22.6 vs. 79.3 21.4. Side effects recorded next to pain were discoloration, subungual hematoma and heat sensations. Conclusion: Infrared nail laser treatment using long pulsed 1064nm and linear scanned 980nm laser have been found to be equivalent in safety and efficacy with long term follow up of 12 month. With regard to the pain future studies should aim on protocol optimization by means of measuring of heat propagation. 1064 nm Nd:YAG for Onychomycosis A. CAMPO-VOEGELI, MD

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HA AND NON-HA FILLERS IN 2013 CHAIR: L. BASS

SCARS AND KELOIDS CHAIR: M. ADATTO Fractional Lasers for Fresh Surgical Scars M. ADATTO, MD Fractional Lasers for Burn Scars M. HAEDERSDAL, MD Treatment with Fractional Lasers HIROTAKA AKITA, M.D., PH.D.
Department of Dermatology, Fujita Health University School of Medicine Toyoake, Aichi 470-1192 (Japan) hakita@fujita-hu.ac.jp

Combining Injectables JULIUS FEW, MD


The Few Institute, Chicago (USA)

According to American Society for Aesthetic Plastic Surgery statistics, dermal fillers represent one of the fastest growing procedures in aesthetic medicine. It has become more important than ever to consider all of the available options for facial rejuvenation with injectables. A concise presentation and reproducible approach will be presented on composite injectable use in the face. An emphasis will be placed on product selection and depth of placement. Consideration will be given to associated procedures, such as surgical and non surgical face-lifting, with or without laser resurfacing. The author feels it is vital to fill soft tissue defects before resurfacing. It is also vital to do repositioning of ptotic tissue before filling, as will a facelift or focus Ultrasound lift. Facial Volumizing: Anatomy and Technique L. BASS, MD How Safe Are Injectable Fillers? R. BARLOW, MD Nasal Contouring with Fillers: Structural and Cosmetic Correction MILES GRAIVIER, MD
The Graivier Center for Plastic Surgery, Roswell, Georgia (USA)

Background: Patients are increasingly asking for non-surgical alternatives or adjuncts to rhinoplasty. Fillers injected into proper tissue planes can offer immediate correction of defects, asymmetries, and even add structural support to the nose. Proper placement and preparedness for tissue compromise is essential when using fillers in the nose. Aim: To present methods for nasal augmentation, post- rhinoplasty correction, and structural correction off the nose with fillers. Avoidance and preparedness for complications is also presented. Materials and Methods: Selection, placement, and treatment of complications using patient cases and diagrams will be shown. Results and Conclusions: Fillers in select instances can be used safely and effectively to correct both cosmetic and structural defects of the nose.

Aim: ToevaluatetheefficacyandsafetyofCO2 laser withfractionaldeviceforthe treatmentofscar. Subjects and Methods: 35 Japanese patients received five consecutive fractional CO2 laser (Deep FXTM: Lunemis) treatmentsataround 8-weekintervals.Outcome assessments were done by digital photography, physician evaluation, and questionnaire of subjects satisfaction. 7% lidocaine topical anesthetic cream was used for pain. Results: 35Japanesepatients (7 cases of surgical scar, 24 cases of post operative scar, 4 cases of burn scar, and one self-mutilation scar) was done by this treatment. As an adverse reaction, 6 cases of post-inflammatory hyper pigmentation and 3 cases of erythema were occurred. Subject self-assessment was superior to the physician assessment. Conclusion: FractionalCO2 treatmentistending to be an effective and safe treatment for many kinds of scars. Although it may be difficult to cure scars completely, self-assessments and satisfaction scores were high rated. Therefore, our data also suggested fractional CO2 treatment is one of the treatment methods for scars. Lasers and Hypopigmented Scars A. LE PILLOUER, MD

DEVICE-BASED APPROACHES TO ACNE AND HIDRADENITIS CHAIR: E. V. ROSS

Best Ways to Target Sebaceous Glands E. V. ROSS, MD ALA-PDT in the Treatment of Acne F. XIANG, MD Laser Lipolysis in Hidradenitis A. FATEMI, MD Device-based Treatment of Acne G. MUNAVALLI, MD

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KOSMETISCHE MEDIZIN ABSTRACTS SCIENTIFIC SESSIONS

Combining Laser and Peels for Acne M. LANDAU, MD

SKIN TIGHTENING ON AND OFF THE FACE CHAIR: N. LOWE

Radiofrequency Experiences N. LOWE, MD RF and Ultrasound for Skin Tightening R. WEISS, MD Minimally Invasive Fractional Bipolar RF M. ADATTO, MD RF and Ultrasound Facial Contouring W. PRAGER, MD

paper. Although numerous studies are published with different ratios for Botox: Dysport a fixed ratio is not determined, yet. The ratio is possibly dependent on the actual conditions of the study. The load of bacterial proteins was claimed to have an impact on the immunogenic potential of the products. But it is not the protein load per se but the presence of complexing proteins in Botox and Dysport which influences the risk of an immune reaction. These proteins are not simple clostridial remnants but they can bind to lymphocytes/dendritic cells to activate the immune cells to produce antibodies against the active substance. Fake Injectables Around the World MICHAEL H. GOLD, M.D.
Medical Director: Gold Skin Care Center, Tennessee Clinical Research Center Assistant Clinical Professor, Dept. of Medicine, Division of Dermatology Vanderbilt University School of Medicine, Vanderbilt University School of Nursing Adjunct Assistant Professor, Meharry Medical College,School of Medicine

TOXINS IN 2013 CHAIR: A. PICKETT

US Toxin Update 2013 A. PICKETT, MD Differences in Botulinum Toxin Products DR JRGEN FREVERT
Merz Pharmaceuticals GmbH, Hermannswerder Haus 15, D-14473 Potsdam

Botulinum toxin type A products contain different bacterial proteins. Three botulinum toxin type A products are marketed on the European and US market: Botox/Vistabel (Allergan) is claimed to contain the purified 900 kD botulinum complex, Dysport/Azzalure (Medicis/Galderma/Ipsen) contains besides the 150 kD neurotoxin a different set of complexing proteins, which complex they form is not known. Besides the 150 kD neurotoxin, the active substance, there are no other bacterial proteins present in Xeomin/Bocouture. The products are manufactured by different technical processes: Vistabel by vacuum drying leaving a thin film as the final product whereas Azzalure and Bocouture are produced by lyophilisation. The manufacturing process and the content of different excipients might have an effect on the stability of the products. Bocouture has demonstrated the highest stability allowing storage at room temperature in contrast to the other Vistabel and Azzalure which must be stored in the refrigerator. All products show a similar spread from the injected muscle provided that the dose is equivalent and the injection conditions are similar. It can be concluded that differences in composition of different bacterial proteins do not influence the migration of the active substance. Thus, the profile of adverse events should be comparable. Several head-to-head studies have demonstrated a 1 :1 ratio between Botox and Vistabel confirmed in a recent Consensus

Background: Over the past several years, a number of fake neurotoxins have found their way into practitioners hands. These non-approved or regulated toxins are easily obtained through the Internet. Aim: The aim of this presentation is to identify these toxins and the potential dangers associated with them. Materials and Methods: From web site searches to personal discussions with colleagues from all over the world, fake toxins are identified. Results: There is an abundance of fake toxins readily available to clinicians and clinicians purchasing them for use. Conclusions: The fake toxin market has grown significantly over the past several years and clinicians need to be aware that only approved toxins are to be used in the daily care of patients. Vancouver Consensus on Btx-A N. FOURNIER, A. CARRUTHERS, J. CARUTHERS, T.C. FLYNN, P. HUANG, M. A. C. KANE, M. KERSCHER, S.D. KIM, J. RUIZ-AVILA, N. SOLISH,A. TRINDADE DE ALMEIDA, G. KAEUPER Background: Three BoNTA formulations are the most widely used worldwide and FDA approved for aesthetic use. A review and discussion of differences between practicing methods, and the effect that these differences may have on clinical results. Aim: To review the publications on current and emerging applications of BoNTA in aesthetic practices and to compare international expert viewpoints to provide a consensus about the available BoNTAs on the market approved by the FDA for aesthetic use. Methods and Materials: 11 expert aesthetic physicians from different countries (Canada, Germany, Mexico, Brazil, USA, Taiwan, Korea and France) had discussions and consensus in a meeting in Vancouver (Canada) to provide an up-to-date review of treatments strategies to improve patients results. Following points were discussed: patient management, assessment, documentation and consent, aesthetic scales grading, injections strategies, dilution, dosing and adverse effects.

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Results: An educational consensus for practicing was established. Conclusion: A range of product and patient specific factors influence the treatment plan. Optimized outcomes are possible only when the treating physician has the requisite knowledge and experience to use BoNTA for each patients specific need.

PDT: MEDICAL INDICATIONS CHAIR: M. HAEDERSDAL

clinical improvement to be greater than 50 % at 6 months compared to baseline photography. Conclusion: Use of a microneedle roller to pre-treat prior to application of ALA appears to be well tolerated and allows for even absorption and perhaps deeper penetration of ALA following a defined incubation period. Use of red light and broadband pulsed light allowed for deeper activation of ALA, potentially accounting for marked clinical improvement in photoaging.

Daylight Topical PDT on the Riviera A. Le Pillouer, MD 413 nm Krypton PDT for Port Wine Stains G. ZHOU, MD PDT with Ablative Fractional Lasers M. HAEDERSDAL, MD PDT with Microneedling MATTEO TRETTI CLEMENTONI 1 , MD GIRISH MUNAVALLI 2 , MD MARC B. ROSCHER 3 , MD
1 2 Istituto Dermatologico Europeo, Milano, Italy Dermatology, Laser & Vein Specialists of the Carolinas, Charlotte, North Carolina and Department of Dermatology, Wake Forest University, Winston Salem, NC Skin and Laser Centre, Durban, South Africa

APPROACH TO SCARS CHAIR: R. FITZPATRICK

Laser Treatment of Scars ELISABETH TANZI, MD A variety of lasers and light sources can be used to treat scars effectively. It is of paramount importance that the type of scar be properly classified on initial evaluation to guide the choice of the most appropriate laser. Proper classification of the scar also allows the laser surgeon to discuss the anticipated response to treatment with the patient. Traditionally, the 585 or 595 nm pulsed dye laser (PDL) has been used to improve the color, texture, pliability and thickness of hypertrophic, erythematous, and traumatic scars. However, additional improvements can be achieved through advanced protocols using nonablative or ablative fractional skin resurfacing. Atrophic scars are best treated with ablative or non-ablative fractional resurfacing, whereas pigmented scars benefit from pigment-specific lasers such as QS alexandrite or Nd:YAGlaser treatments. Using a full range of lasers, the laser surgeon can significantly impact the function and appearance of scars to improve greatly the quality of life for patients. An Integrated Approach to Scars R. Barlow, MD Treatment of Keloids with Internal Cryotherapy MILES GRAIVIER, MD
The Graivier Center, Roswell, Georgia, 30076 (USA)

Background: High efficacy and safety, coupled with in-office, short contact protocols have made photodynamic therapy (PDT) with aminolevulenic acid (ALA) for the treatment of actinic keratoses a mainstay option over the last decade. Clinical improvement in photo aged skin has also been reported to accompany PDT treatments. Aim: The study objective was to maximize epidermal penetration and subsequent activation of ALA for the treatment of photodamaged facial skin, utilizing a microneedle roller prior to incubation and combined irradiation with red light and broadband pulsed light in a single treatment. Materials and Methods: A full-face treatment of 77 patients was performed with 630 nm light and broadband pulsed light after multiple passes with a microneedle roller and 1-hour ALA incubation. The primary endpoint was clinical improvement, scored during two separate live assessments by three physicians blinded to previous scores, using a 5-point standardized photoaging scale. The secondary endpoint was evaluation of patient satisfaction based on a quartile scale comparing baseline to 6-month post-treatment photography. Results: Statistically significant improvement was seen in the global photoaging scores, as well as sub-components of the scale (fine lines, mottled pigmentation, sallowness, tactile roughness, and telangiectasias) at 3 months as compared with baseline live assessment, and at 6-month live assessment compared with the 3 months. In addition, 90 % of patients judged

Background: Keloids and thick, irritated hypertrophic scars can be disfiguring as well as have symptoms of pruritus, pain or discomfort, and continued enlargement. Many treatment options have been attempted with varying success. Internal cryotherapy offers a new, effective , often single treatment for keloids and thick hypertrophic scars. Aim: To describe cellular changes in histology of keloids and demonstrate clinical cases of internal cryotherapy use in keloids. Material and Methods: Demonstration of placement of intralesional needle and delivery of internal cryotherapy will be shown as well as case examples of tissue reaction and patient results.

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Results and Conclusion: Intralesional cryotherapy results in changes in collagen structure and organization of keloids. It offers a new, effective, often single treatment regimen for treatment of keloids and thick, hypertrophic scars.

Thursday September 19th, 2013 15:15 17:15


IPL VS. LASER CHAIR: H. CHAN

maintenance treatments very helpful to maintain good result. Furthermore, many PWS that respond well initially to PDL treatment may reach a response plateau, becoming unresponsive to further PDL treatments, a phenomenon termed treatment resistance. Based on the theory of selective photothermolysis, vessels in such lesions may also be specifically targeted with a deeper penetrating 755 nm alexandrite laser that has selectivity for deoxyhemoglobin as well as oxyhemoglobin. Laser and IPL Adjuvant Therapies AGNETA TROILIUS, MD
Laser & Vascular Anomaly, Dep of Dermatology, Skne University Hospital, Malm (Sweden)

Laser vs. IPL in Asians Skin: Is One Safer? H. CHAN, MD IPL and ND:YAG in Vascular Malformations and Tumors A. CAMPO-VOEGELI, MD Optimizing Parameters for Treatment of Vascular Lesions Based on Biology J. STUART NELSON, M.D., PH.D.
Beckman Laser Institute and Medical Clinic, University of California Irvine (USA)

Research has provided information on laser-tissue interactions and led to the development of many lasers light sources for a variety of vascular skin lesions. Treatment of superficial hemangiomas in children remains controversial, because the vast majority of lesions regress spontaneously by the age of 7. Treatment of symptomatic hemangiomas and those that produce functional impairment, however, is not in question. The pulsed dye laser (PDL) is effective for treating superficial hemangiomas. The risk/benefit ratio is favorable, and at least for symptomatic hemangiomas (e.g., hemangiomas that bleed or ulcerate with trauma) and those that cause functional impairment (e.g., perioral or vulvar hemangiomas or those that block the eye or nose), treatment with the PDL appears to be appropriate. Caveats for PDL treatment of hemangiomas include: 1) flat, smooth lesions less than 3 mm thick; 2) low energy densities (< 5 J/cm2) should be used; 3) large spot sizes (1012 mm); 4) epidermal cooling is essential; 5) repeat treatments every 24 weeks; and 6) experience treating infants and young children is essential. Treatment of port wine stains (PWS) by pulsed dye laser (PDL) remains the standard of care for infants and young children. Caveats for PDL treatment of PWS: 1) begin treatment at as young an age as possible and treat aggressively every 4 weeks; 2) due to PWS blood vessel heterogeneity in terms of depth and size, multiple wavelengths and pulse durations should be used; 3) strict sun precautions are essential; and 4)

Introduction and Objectives: Since the concept of selective photo thermolysis was published in 1983 by Rox Andersson, exciting new techniques have developed and still are. Modern aesthetic laser and IPL technology treatment options offer minimally invasive, more affordable alternatives to traditional cosmetic surgery, with the promise of reduced downtime for the patient. Laser therapy can significantly improve the appearance of the skin; however, these procedures sometimes have a limited effect and we need to develop them and / or optimize their effect. That will sometimes carry risks. Clinical pearls and pitfalls are presented, as well as cutting-edge techniques and technologies are discussed in order to enable the laser and IPL practitioner to optimize outcomes. Conclusions: Employing the appropriate device and technique does not always guarantee a successful outcome. Practitioners must educate their patients in detail regarding the process of and reasonable post-treatment expectations in order to create a therapeutic alliance. We always have to try to improve our methods and to search for optimization of our laser and IPL treatments. Work closely to the engineer and it will give you new ideas and possibilities and it is very rewarded in all aspects. Never ever give up if you have a difficult case!

FOCUS SESSION: BODY CONTOURING CHAIR: K. RUSSE-WILFLINGSEDER

Is Cryolipolysis Hot? D. MANSTEIN, MD Body Contouring with Focused Ultrasound R. WEISS, MD Body Contouring Targeting Skin, Fat and Cellulite KATHARINA RUSSE-WILFLINGSEDER, ELISABETH RUSSE
Plastische Chirurgie und Laserzentrum Innsbruck Haydnplatz 4, 6020 Innsbruck (Austria), katharina@russe.at

Background: Nowadays there is a high demand for technologies enhancing the aesthetic outcome and minimizing post-

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operative recovery for the treatment of cellulite. The purpose of this study is to assess the safety and efficacy of a single minimally invasive laser treatment for cellulite followed by a noninvasive treatment to minimize post-operative recovery. Methods: 15 patients with lipodystrophy of the thigh and associated skin laxity and cellulite were included in the study. In tumescent solution ( 10 cc / 1 cm2) a single treatment was performed using the 1440 nm laser with the Smartlipo Triplex workstation (Cynosure Inc.). Additionally to that a 1000 m side firing fiber (Cellulaze) was used for the deeper bulk lipolysis, skin indurations and for shallow heating of collagen fibers within the dermis. After the procedure, patients were scheduled for six Photomology treatments (SmoothShapes Cynosure Inc.), a dual wavelength system (650 nm LED and 915 nm diode laser) with vacuum suction and mechanical massage. All six treatments were performed within 4 weeks after the laser treatment using the SmoothShapes XV hand piece for 10 minutes per 148 210 cm at 15 W with a vacuum setting of 12. Results: All patients tolerated treatments well. No unanticipated side effects were noted. Both physician and patient reported high satisfaction with the combination of treatments. Conclusions: The use of a 1440 nm wavelength laser along with a unique fiber allows the ability to focus on the anatomical deficiencies that cause cellulite. In addition, the combination of a non-invasive laser treatment as adjunct therapy enhances the post-operative recovery period through the reduction of edema and ecchymosis. In our experience, this is a safe and effective treatment option for body contouring and its associated skin deformities. Non-invasive RF Therapy for Contactless Body Contouring and Circumferential Reduction KLAUS FRITZ, M.D 1 , MUDR. KATERINA FAJKOOV 2 , PRIM. MUDR. ALENA MACHOVCOV, PH.D., MBA 3
1 2 3 Dermatology and Laser Centers Landau, Germany Formositas, Aesthetic Medicine Clinic, Prague, Czech Republic The Motol University Hospital, Prague, Czech Republic

lower abdomen and love handles. The study protocol consists of one treatment administered each week with a duration of 30 minutes each over a four week time period. Exclusion criteria were lack of fat or implants especially of metal. The Vanquish system (produced by BTL Aesthetics). is engineered to focus the energy specifically into fat layer, while limiting the delivery to the skin and muscles. A selective RF applicator shapes the energy field to optimize the penetration and maximize the treatment area. Mild changes of body weight, water, and fat percentage were observed however without any statistical significance. Body circumference measurements of the abdomen/love handles were taken in the umbilicus area, 5 cm above, and 5 cm below and photographed. Girth measurements of abdomen were taken using a standard spring loaded tape meter before the first treatment and after the last session. After the last treatment all participants completed the self-evaluation questionnaires and rated their level of satisfaction using a 15 scale. All subjects tolerated the treatment well. The only treatment side effect reported was mild to moderate erythema in the treatment area which resolved within up to 60 minutes. No adverse events occurred during this research. All subjects found the treatment comfortable or very comfortable. Three of four subjects showed significant circumferential reduction, one subject showed no change. The average circumferential reduction in the abdominal / love handles zone for all those four cases was 5 cm after 4th session. The non-responding subject might not have responded to the treatment, because the subcutaneous fat layer was not thick enough. A significant body reshaping effect was observed on all responding cases. An objective improvement was in correlation with the patient satisfaction rate. The results of this pilot evaluation indicate that the device is safe and efficacious for noninvasive body contouring and circumferential reduction, patients tolerate nicely the treatment sessions.

RF technology offers unique advantages for non-invasive selective heating of relatively large volumes of subcutaneous adipose tissue. A properly induced electric field results in greater heating of fat than heating of skin and muscle. Heating in the fat is greater than in skin when the electric field is perpendicular to the skin fat interface. Radiofrequency devices are able to achieve greater depths of thermal damage with tissue penetration to the level of the dermis and subcutanous layer without producing thermal burns. Adipose tissue apoptosis might happen but has not yet been extensively studied, and it should be further investigated. The recent clinical study focused on the effects of Vanquish system on fat tissue of Vietnamese swine proved the efficacy of Vanquish system in the subcutaneous fat reduction based on the process of apoptosis. A prospective, non-randomized clinical study of 45 healthy male and female subjects with age ranging from 18 to 70 years, showing significant subcutaneous fat tissue on the

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KOSMETISCHE MEDIZIN ABSTRACTS SCIENTIFIC SESSIONS

FRACTIONAL LASER: MEDICAL INDICATIONS CHAIR: M. HAEDERSDAL

Laser-assisted Drug Delivery M. HAEDERSDAL, MD Laser-assisted Delivery to Skin A. LE PILLOUER, MD Fractional CO2 in Burns MATTEO TRETTI CLEMENTONI, MD
Istituto Dermatologico Europeo Milano - Italy

Near Infrared, IPL and Fractional Laser Combination Therapy for Asian Skin Rejuvenation: A Prospective Multi-Center Study in China JIAQIANG WU 1 , LI TAO 1 , HUI QIAN 1 , ZHONG LU 1 , YUANHONG LI 2 ,WEIZHEN WANG 3 , XIAOZHONG ZHAO 4 , PING TU 5 , RUI YIN 6 , LEIHONG XIANG 1
1 Huashan Hospital, Fudan University, Shanghai, China, 2 First Hospital, Chinese Medical University, Shenyang, China, 3 Wuhan No.1 Hospital, Hubei Province, China, 4 Air Force Hospital, Beijing, China, 5 First Hospital, Peking University, Beijing, China, 6 Xinan Hospital,the Third Military Medical University, Chongqing, China Correspondence to Dr. Leihong XIANG: flora_xiang@vip.163.com

Background: Advances in burn treatment has dramatically increased survival of severely burned patients. The increase of survival of burn patients has resulted in an increased demand to treat the resulting scars. In addition to impairing selfesteem and body image, these scars severely limit functional recovery, compromise activities of daily living, and prevent return to work. Aim: The aim of this study is to present preliminary clinical results obtained on severe burn scars after treatments performed with a new high power fractional ultrapulsed CO2 laser. Material and Methods: From September 2010 to May 2013, twenty six patients presenting with severe burn scars have been subjected to an ultrapulsed fractional CO2 regimen of treatments. Settings were: with a spot size of 120 microns: 35150 mJ; 300 Hz of frequency, density 1%10 %; with a spot size of 1300 microns: 50150 mJ, 300 Hz of frequency, density 60140 %. The average number of sessions for each patient was 2,25 with an intervalof time between sessions neverless than 2 months. All patients were clinically and photographically evaluated, in addition their subjective evaluations of the treatment were recorded. Results: Nearly every patient in this preliminary case series had a favorable response, with a high degree of patient and provider satisfaction. Overall, we have observed impressive improvement in pliability, retraction, restricted range of motion (ROM), height, and pigmentation of the scars. No adverse effects were noted. Conclusions: The precise mechanism of action of ablative fractional laser therapy is still under investigation. Benefits observed immediately and over the first few days after treatment likely result from photomechanical fenestration of the fibrotic scar sheet. Early reports indicate that ablative fractional lasers modulate collagen production and remodelling over the ensuing weeks and months by generating an orchestrated wound healing response that involves the initial up regulation of cytokines, Heat shock Proteins, matrix metalloproteinases, and other factors. Ultrapulsed Fractional CO2 laser treatments can be now considered as part of an entire medical and surgical armamentarium and gave us clinically significant results when all the other procedures could no longer be used.

Background: The skin resurfacing, or chemical peeling was limited for Asian skin rejuvenation due to PIH and long down time. The NIR and IPL was non-invasive, and fractional laser had focal selective photothermolysis effect to induce collagen remodeling in the dermis. Objective to investigate the efficacy and safety of applying IPL/NIR with fractional laser combination therapy for skin rejuvenation in Asian people Methods: One hundred and thirteen patients were recruited in the study, which is sixteen to twenty patients each center at six centers nationalwide in China. In each center, half patients were in full face group, while the other half patients were in split-face group (combo vs mono side). The full face was treated with IPL, NIR, and fractional Er:YAG laser. In split-face group, half face was treated by APT, and half face was treated with IPL, NIR, and fractional Er:YAG laser combination therapy. There were total five treatment sessions during 90 days, with interval 1530 days. Then, patients were followed up at 1 mon and 3 mon after last treatment. Results: There were 58 patients in full face group, and 53 patients in split-face group. In full face group, the skin color and telangiectasia (32.91%), skin texture (31.90 %), pore size (28.07 %), and wrinkle (28.52 %) got improved. The global improvement was 28.96% at 3 months after the last treatment. In split face group, the improvement rate at the combo side and mono side was 35.33 % and 22.85% respectively. The clinical pictures would show the improvements of photoaging signs. Conclusion: The combination of IPL, NIR and fractional laser treatment is safe, and effective for Asian skin rejuvenation.

UPDATES IN MELASMA CHAIR V. BUCAY

Treatment Strategies for Melasma V. BUCAY, MD Hyperpigmentation: Melasma Therapies in China Y. LI, MD

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Laser Treatment of Melasma PR. THIERRY PASSERON, MD, PHD


Department of Dermatology & INSERM U1065, team 12, C3M University Hospital of Nice (France)

ANALYZING BEAUTY: THE FACE CHAIR: D. VLEGGAAR

Background: Melasma is an acquired, symmetrical hypermelanosis of the face. The pathogenesis of melasma is complex and the treatment remains challenging. The evolution of melasma is chronic for 10 to 20 years and without a strict avoidance of sunlight, the relapses are almost constant. Genetic background, exposure to ultraviolet radiation, and female sex hormones are classical influencing factors. To the light of the recent literature, other factors could promote melasma lesions. Histological and laser confocal microscopy studies showed that additionally to the increase in pigmentation, melasma lesions have more elastosis and vascularization, as compared to the perilesional skin. Aim: To review the indications and limitations of lasers for treating melasma. Materials and Methods: Critical analysis of the literature. Results: Ablative and non-ablative fractional lasers have been reported to improve melasma. However, such approach, although interesting, is not superior to conventional therapies, and results at 6 months are not significantly different to sun protection alone. Q-switched lasers, even used with low fluencies, induce almost constant PIH and frequent relapses. Thus, such lasers are usually not recommended for the treatment of melasma. Intense pulsed light (IPL) have shown some efficacy in the treatment of melasma. The risk of PIH remains important but appears to be lower than the one observed with Q-switched lasers. More recently, positive results have been reported with the 1927 nm fractional thulium laser. A prospective study comparing this new laser approach to Kligmans trio is clearly needed. Targeting the vascular component of melasma with pulsed dye laser (PDL) or copper bromide laser showed promising encouraging results. These pilot studies clearly need to be confirmed, but they both underline the potential interest of targeting the vascular component for treating melasma. Conclusion: The gold standard treatment for melasma remains topical bleaching agents. Laser approaches can be discussed as a second line treatment but patients have to be warned of the risk of worsening and relapse. Q-switched Nd:YAG in Melasma G. ZHOU, MD

What Is Beauty and Does It Matter? D. VLEGGAAR, MD Understanding Beauty: Facial Anatomy S. WEINKLE, MD Evolution of the Asian Look RUNGSIMA WANITPHAKDEEDECHA, M.D., M.A., M.SC.
Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok (Thailand)

Background: Botulinum toxin type A and fillers injections have been commonly used to improve facial and non-facial aesthetics. Objectives: To determine the roles of botulinum toxin type A and fillers injections in the response of patients demand for beauty. Materials and Methods: While botulinum toxin type A can smooth hyperkinetic and dynamic lines, including glabella frown lines, horizontal forehead lines, and crows feet, fillers have been used for smooth facial static lines, and correct volume loss. Results: Nowadays, the cosmetic use of botulinum toxin and fillers is not limited to improve static or dynamic wrinkles and volume loss. It becomes increasingly popular to patients seeking for non-invasive facial contouring procedures. Higher patients satisfaction can be achieved with combination treatment with botulinum toxin and fillers. Conclusion: The beauty trend in Asians has been changed. Current approaches to botulinum toxin and fillers cosmetic therapy for both wrinkles reduction and facial contouring have been evolved over time to achieve highest patients satisfaction.

ULTRASOUND IN AESTHETICS CHAIR: R. WEISS

Current Research HIFU A. FATEMI, MD Intense Therapy Ultrasound (ITU) M. SLAYTON, MD Non-Surgical Face Lifting and Tightening using Focused Ultrasound (Ulthera): Current Trends in Korea NARK-KYOUNG RHO, MD
Leaders Aesthetic Surgery and Cosmetic Laser Center, Seoul, Korea

Background: Unlike laser or radiofrequency, ultrasound can be delivered arbitrarily deep (35 mm) into the skin and subcutaneous tissue and can reach target areas without causing any significant injury to the surface of the skin, unlike other forms

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of energy used in dermatology and cosmetic surgery. With further evolution and development of therapeutic ultrasound technology, guided ultrasound treatments better differentiate and more precisely target specific structures in the dermis and subcutaneous tissue, resulting in more consistent treatments with more predictable cosmetic outcomes. The Ulthera System is a noninvasive ultrasound device designed for fullface and neck skin-tightening treatments and is currently the only device of its kind approved by the FDA for lift indications (eyebrows and neck). Aim: To provide a basic understanding of the system and the authors experience during the last 4 years. Materials and methods: Results of the authors study evaluating the long-term efficacy of the device for lifting and tightening in the context of a procedure treating the full face and neck skin will be provided with relevant anatomical correlations. Results: The percentage of subjects responding with an improvement was 82 % at 1 month, 87 % at 3 months, 79 % at 6 months, and 65% at 9 months following treatment. Objective assessment at 3 months showed significant improvement for eyebrow position (85%), midface laxity (81%), jawline definition (77 %), mentolabial folds (68%), infraorbital folds and wrinkles (64%), cervicomental angle (62 %), and nasolabial folds (44%). Assessment at 6 and 9 months revealed that midand lower face improvement lasted longer than the upper third of the face. Other than slight transient erythema and edema immediately post-treatment, generally, there were no major adverse effects noticed. Conclusion: The micro-focused ultrasound technique is a safe and effective treatment for lifting and tightening facial soft tissue in Koreans. The study showed that in Korean subjects, treatment of the mid- and lower face showed more patients satisfaction and longer lasting effects than upper face treatment. Fractional Ultrasound: Now and the Future M. GOLD, MD

not look better. Often, over-injection resulted in an unnatural result. European and Canadian injectors have led the way in our understanding of global rejuvenation. American injectors do not have as many tools, but are gradually improving their understanding, patient assessments, and injection techniques and are poised to take the next steps as better lifting and volumizing agents are released in the United States. Aim: To review techniques and methods that result in more natural results using injectable fillers and neuromodulators. Materials and Methods: United States FDA approved dermal fillers and neuromodulators, varying gauge and length needles and cannulas. Results: Even with limited products available, American cosmetic injectors are improving in both their understanding of facial aging and their techniques of injections. Conclusion: American physicians will continue to learn and improve as they learn from their foreign colleagues and as better products become legal in the US. Combining Collagen Stimulators, and Neuromodulators D. VLEGGAAR, MD Anticipating, Detecting, and Managing Adverse Events SUZAN OBAGI, MD
Associate Professor of Dermatology Associate Professor of Plastic Surgery Director, The Cosmetic Surgery and Skin Health Center University of Pittsburgh Medical Center

INJECTIONS: GOOD OUTCOMES AND BAD CHAIR: S. OBAGI

Injecting Outside the Lines: How Americans can be more like the Europeans MARY P LUPO MD,
FAAD, Clinical Professor of Dermatology, Tulane University Health Science Center (USA)

Background: Complications are an inevitable part of any procedure that is performed. As a physician performs more procedures, the chances of encountering complications at some point increases. Aim: The most common and uncommon complications, diagnosis, and management will be covered. Materials and methods: A review of the literature will be presented covering recognition and management of complications from cosmetic procedures. These will range from the most common to the uncommon and rare. Results: Complications that require early recognition and intervention include skin infections (bacterial, viral, fungal), embolus, allergic reactions, asymmetry, and scarring. Conclusion: The difference between a complication and a disaster is based on anticipation of complications, early detection, and early intervention. Understanding and Managing Necrosis J. COHEN, MD

Background: The evolution of injectable dermal fillers has evolved from line and fold filling to global restoration of shape and lifting depressions to result in a more youthful reflection of light off the surface of the face. Facial assessment, understanding loss and shift of facial fat pads has been shown to be critical to natural-looking results. Old techniques may have made the nasolabial fold look better, but the patient herself did

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UPDATES IN RF CHAIR: V. ROSS

Fractional RF Technology Advances V. ROSS, MD Multipolar RF for Post-Surgical Optimization J. FEW, MD The ability to combine multipolar Radiofrequency (RF) with electromagnetic (EM) fields offer a powerful tool to enhance skin/tissue tightening after plastic surgery and offers a tool to enhance wound healing in early postoperative settings. There is extensive scientific literature showing the benefit of electromagnetic fields on wound healing, including conditions such as chronic wounds. We will show clinical examples that show the benefit of combined RF and EM in head and neck plastic surgery as well as body contouring with liposuction. The use of RF therapy has been applied to more than 300 cases and we see long term enhancement that exceeds what would be traditionally seen, including cases that would traditionally require much more invasive surgical techniques. In conclusion, the combination of RF with surgical approaches offers outcomes that are better than either one alone. RF: Whats in, Whats Out? M. LAPIDOTH, MD Fractional Bipolar RF on the Asian Face HIROTAKA AKITA, M.D., PH.D.
Department of Dermatology Fujita Health University School of Medicine Toyoake, Aichi 470-1192 (Japan) hakita@fujita-hu.ac.jp

fat atrophy, vesiculation, scarring, and infection were not observed. Conclusion: Fractional bipolar RF treatment is an effective and safety treatment for facial photodamage and natural aging in Japanese females. Although mild erythema and / or edematous erythema occurred a few days in all patients, selfassessments and satisfaction scores were high rated because of their concealing with make-up. RF for Hand Wrinkles V. BUCAY, MD

UPDATES IN THE APPROACH TO ACTINIC KERATOSES CHAIR: P. BJERRING

PDT as Skin Cancer Prevention? P. BJERRING, MD PDT to Prevent Skin Cancer M. HAEDERSDAL, MD Fractional Radiofrequency in the treatment of actinic keratoses KLAUS FRITZ, MD
Dermatology and Laser Centers Landau (Germany) and Bern (Switzerland), Osnabrck (Germany) and Bucharest (Romania) and George Sorin Tiplica, University Carol Davila Bucharest (Romania)

Aim: Toevaluatetheefficacyandsafetyofanovelbipolar RF-based fractional device for the treatment of photoagedAsianfaces. Subjects and Methods: 10Japanesewomen(meanage58.6,skinphototype III-IV) received three consecutive fractional bipolar RF (eMatrixTM: Syneron-Candela) treatments at around 6weekintervals.Outcome assessments were done by standardized photography with VisiaTM, physician evaluation (fine line, wrinkle, laxity), and questionnaire of subjects satisfaction. Cooling was used instead of topical anesthetic cream and make-up was used from Day 1 after treatment. Results: This RF treatments produced improvements in each category of physician and subjects evaluation. Especially, the improvement of laugh lines and nasolabial fold were evaluated. Subject self-assessment almost paralleled the physician assessment. But we could not get the entirely efficacy of forehead in this study. Although mild and/or edematous erythema developed in all patients for an average of 3.1 days after irradiation as an adverse reaction, severe adverse reactions such as

The currently available treatments for actinic damage and keratoses include a number of active ingredients, most of them ablating the skin or causing long term erosion and irritation as well as ablative and non-ablative laser treatments, full and fractional, chemical peels from light to deep and PDT. Ablative lasers also in fractional mode cannot avoid downtime but are effective in clearing damaged skin areas. Radiofrequency plays an increasing role in heating the dermis and ablating the epidermis with less downtime. Bipolar Fractional Radiofrequency treatment Induces Neoelastogenesis and Neocollagenesis initiated by a wound healing response. Material and methods: The E-Matrix (Syneron) uses the Matrix RF (Syneron) applicator, a bipolar RF-based device delivering RF energy that is tunable for ablation, coagulation and heating. The thermal energy is delivered to the skin in a non-homogenous fractional manner via an array of multi-electrode pins. The Matrix RF is a hand-held applicator which is fitted with a disposable tip at its distal edge. The tip consists of parallel rows of bipolar-arranged electrode pins, forming an array of positively and negatively charged electrodes for RF energy delivery. An energy level limit of 20 Joules can be delivered at either 5 or 10 % coverage rate via 64 equally spaced electrode pins; each pin has a diameter of ~200 microns. We treated 10 patients with actinic keratoses type 1 and 2, aged 6476, 6 male, 4 female, using 23 passes of ematrix.

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Before RF we used topical lidocaine (EMLA) for 1 hour, cleaned the skin with disinfectants, applied a Jessner peel to remove dry and scaly skin, moisturized the dry skin with moist pads in order to improve the RF conduct and then treated with fractional RF. Results: This procedure resulted in superficial epidermal ablation and the device gave selective heating to the dermis, however without any wounds or down time. 13 days after treatment a mild to moderate erythema and some inflammation was observed, however caused no downtime. After 14 and 28 days and after 6 months the treated area showed no or only few keratoses of type 1. As the result of 3 months follow-up, all patients did not have any problems during the period and any adverse events or complications werent observed. Patient satisfaction was high with 83.3 %. Self-assessment of clinical outcome showed significant improvement. Conclusion: Fractional RF with e-Two can clear actinic damage and keratoses with little downtime and helps to avoid erosion or long term inflammation compared to other pharmaceutical or ablative laser treatments. Light Emitting Fabrics for Photodynamic Therapy of Actinic Keratosis SERGE MORDON 1, 3 , CDRIC COCHRANE 2, 3 , JEAN CLAUDE LESAGE 1, 3 , VLADAN KONCAR 2, 3
1 2 3 INSERM U 703, F-59120 Loos, France ENSAIT, GEMTEX, F-59100 Roubaix (France) Univ. Lille Nord de France, F-59000 Lille (France) serge.mordon@inserm.fr

Conclusion: LEF meets the basic requirements for PDT: homogeneous light distribution and flexibility. It can be easily produced by automatic weaving and no post treatment of POF is required. LEF can be connected to any diode laser: 405 nm, 635 nm, 655 nm, etc. Moreover LEF can be easily manufactured in large series and can be used on skin, but also in peritoneal or pleural cavities. They can be designed to perform PDT of actinic keratosis on the face and scalp.

TIPS AND TRICKS: FILLER AND TOXINS CHAIR: M. LANDAU

Vectorial Facial Sculpturing: A Novel Approach to Non-invasive Pan-facial Rejuvenation SARIT COHEN, MD
Plastic Reconstructive and Aesthetic Surgeon, Ramat Gan, Israel sariti@zahav.net.il

Background: A homogeneous and reproducible fluence rate delivery during clinical PDT plays a determinant role in preventing under- or overtreatment. In Dermatology, light sources do not deliver a uniform light distribution on the skin due to the morphology and the complexities of the human anatomy. Aim: This study aims at the production of large, flexible and homogenous light emitting fabrics (LEF) based on POF weaving. The homogeneous light side-emission from the fabric is obtained by controlling the bending angles of POF inside the LEF due to specific architecture generated by weaving of textile structures Materials and Methods: LEF is developed using POF (250 m, weft direction) and Polyester yarns (330 dtex, warp direction). POF macrobendings are predetermined to obtain side emission of light since the critical angles are exceeded in a controlled way. In order to overcome the decrease of side-emitted radiation intensity along the fabric and achieve homogeneous light all over the LEF surface, both POF bundled ends are coupled to diode lasers. Characteristics of this LEF are determined in terms of light emission, flexibility, etc. Results: LEF of 21.5 cm 5.0 cm is woven. The LEF thickness is typically 1 mm. When connected to a 5 W diode laser (635 nm), the average light emission is 18.2 mW.cm- (i.e. 3.64 mW.cm-.W-1) with heterogeneity of 2.5 mW.cm- (13.7 %) at any point of the LEF. The temperature elevation remains below 1 C for a 10 minutes illumination.

Background: Minimally invasive facial procedures have gained widespread popularity during the last two decades. First generation procedures focused on filling of wrinkles/furrows in a two-dimensional manner. The importance of volume enhancement in facial rejuvenation paved the path to procedures that highlight the third dimension in facial rejuvenationvolume. Second generation techniques focused on augmentation of facial zones (i.e. malar area, temple) Acquaintance with the impact of the attenuated ligaments on the aging face along with the significant rejuvenative effect while surgically mobilizing facial tissues in a superolateral vectors (counteracting the infero-medial tissue sagging) have led to the fourth tenet in facial sculpturing-direction. Aim: The aim is to present the vectorial facial sculpturing-an innovative approach for noninvasive restoration of youthful facial contour by vectorial repositioning of the sagging tissues and to prove it by applying mathematical concepts and in accordance with Newtons third law of motion of classical mechanics. Material and Methods: Special emphasis will be put on the reciprocal relationship between the attenuation of the orbital, zygomatic, masseteric and submental retaining ligaments in causation of a droopy eyebrow, deepening nasolabial fold, jowl, and loss of cervical/jawline contour, respectively. By rotating the orbital, zygomatic, masseteric and submental retaining ligaments in a superolateral direction with vectors pointing toward the glabella, lateral cheek, temple and infralobular region, one can reposition (reverse) the sagging tissues in the lateral brow, nasolabial, jowl and cervical/jawline region, respectively. Injection technique will be presented along with pre-treatment and post-treatment photography. Conclusion: In this manner, one can truly sculpt the face thus creating a harmonious, youthful facial shape and contour, rather than merely visually blur the sagging tissues via conventional injection techniques. Thorought acquaintance with facial anatomy, artistic perception and proper patient selection are of paramount importance.

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A Bimodal Tri-vector Approach to Volumetric Face Filling N. SADICK, MD Perfecting the Smile And the Pout M. LANDAU, MD Combining Fillers and Toxins M. KOSMADAKI, MD

PERMANENT AND DURABLE FILLERS: SAFETY AND OUTCOMES CHAIR: S. GHANNAM

Soft Tissue Augmentation SAHAR F. GHANNAM


Consultant Dermatologist (Kuwait) Assistant Professor of Dermatology Alexandria University (Egypt)

Friday September 20th, 2013 09:00 11:00


PLENARY: TOXINS AND FILLERS: HISTORY, DEVELOPMENT AND DIFFERENCES

The field of facial aesthetic surgery is experiencing explosive growth in non-invasive and minimally invasive procedures especially related to skin aging. Nowadays, hyaluronic acid based fillers are the cornerstone in tissue augmentation. Yet fillers such as Polylactic acid and carboxy hydroxylapatite which provide soft tissues augmentation through stimulation of an inflammatory tissues response with subsequent collagen deposition were introduced. These fillers are not permanent but biodegradable. The physical characteristics of these fillers; together with the author clinical experience with hyaluronic versus non hyaluronic acid fillers will be discussed. Vascular Compromise with Deep Injection: How to Avoid and Treat D. VLEGGAAR, MD Protocols for Filler Complications: Biofilms, Granulomas, Vascular Compromise: An Algorithmic Approach MILES GRAIVIER, MD
The Graivier Center for Plastic Surgery, Roswell, Georgia (USA)

Plenary: The Evolution of Fillers S. WEINKLE, MD Plenary: The New Botulinum Toxins N. LOWE, MD

NEW TECHNOLOGIES CHAIR: C. ZACHARY

TRASER Technology C. ZACHARY, MD Beyond Selective Photothermolysis V. NARURKAR, MD Hyperefficient Diode Arrays C. ZACHARY, MD Picosecond Technology R. WEISS, MD

Background: Injection of Fillers and Neurotoxins have become the number one non-invasive cosmetic procedures in the world today. Early and late adverse events related to injection are well documented, and every injector will be faced with these events at some point. Injectors must be familiar with these adverse events and be prepared to treat them immediately as this can affect the outcome. Aim: To identify and type the complication of the injection and present an algorithmic approach to the treatment of these adverse events. Recommendations for prevention as well as treatment protocols will be presented. Material and Methods: Delineation of types of complications with patient examples will be shown. Treatment algorithms for each type of complication will then be presented as well as outcomes. Results and Conclusions: Injectors can minimize potential complications with preventative measures and good technique. However, adverse events must be correctly identified and appropriate treatment instituted as soon as possible. Injectors should be prepared to treat the complications. Following the algorithms presented should lessen the potential sequelae of these complications.

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NANODERMATOLOGY CHAIR: A. NASIR

Nanotechnology in Dermatology A. NASIR, MD Topical Nanotechnology Delivery for Toxins and Fillers M. NESTOR, MD ETHNIC SKIN AND BEAUTY CHAIR: M. SACHDEV Radiofrequency in Skin of Colour MUKTA SACHDEV, MD (DERM), DPD, DD, DIP DERM (UK)
Professorand Consultant Department of Dermatology, Manipal Hospital, Bangalore (India)

Advanced concepts of centrofacial structural support and practical pearls and pitfalls of filler and toxin use will be presented. Conclusion: The botulinum toxin and injectable filler combination is particularly relevant in the nonsurgical rhinoplasty in East Asian population. Basic knowledge of the anatomical and histological characteristic of the East Asian nose is mandatory to get elegant results and avoid vascular complications.

Friday September 20th, 2013 11:45 13:45


ABLATIVE VS. NON-ABLATIVE TREATMENT CHAIR: S. GHANNAM

Use oflasersand RF devices forskintightening is now a recommended part of anytreatmentregimen. Newer RF technologies will be discussed for the management ofskintightening, with a focus on skin of colour. An evidence based approach on the colour blind approach using RF will be discussed. Common complications with RF devices post inflammatory hyperpigmentation in darkerskintypes will be discussed and potential merits and demerits of radiofrequency technologies when using these systems in skin of colour will be highlighted. Whats New in Hyperpigmentation M. AMER, MD Fillers for East Asian Nose: How-tos, Tips, Tricks, and Beyond NARK-KYOUNG RHO, MD
Leaders Aesthetic Surgery and Cosmetic Laser Center, Seoul, Korea

Fractional CO2 Rejuvenation MATTEO TRETTI CLEMENTONI, MD


Istituto Dermatologico Europeo Milano Italy

Background: The refinement of techniques to restore facial volume with dermal fillers, and widely available botulinum injections to treat dynamic facial rhytids, has led to a surge in demand for non-surgical rejuvenation procedures. This procedure is now quite frequently performed in East Asian countries, especially in Korea, but only a few studies have been published in English literature. Aim: To provide basic concepts of the East Asian nonsurgical rhinoplasty using various injectable filler materials, along with the adjuvant use of botulinum toxins. Materials and methods: Not only the authors personal experience but also the general consensus of the Korean experienced injectors will be presented. Results: Nose bridge and suptra tip of the nose can be nicely augmented by biodegradable fillers and the adjuvant use of botulinum toxin will block the depressor of the nasal septum, which will limit the downward pulling of the nose tip and thus enhance the tip projection. Moreover, toxin injection on the nose will limit the filler migration and lengthen its duration.

Background: Laser skin resurfacing has shifted over the past two decades from standard ablative resurfacing to non-ablative resurfacing and most recently, to fractional laser resurfacing. Depending on the patient and the severity of the skin condition, the author customizes each treatment combining superficial and deep ablation. This technique was called combined or multi-layer technique. Aim: The aim of this study is to evaluate the efficacy, adverse side effects, and long-term results (2 years) of the combined technique using a fractional ultrapulsed CO2 laser on a large population with photodamaged facial skin. Materials and Methods: 927 patients with aging facial skin were treated. Each patient received one treatment customizing the deep and superficial ablation on the skin features. Assessment of laser efficacy was made using two modalities: blinded physician clinical photographic assessment (using a 4 point VAS scale) and a 3D analysis system device (that can calculate, merging the before and after pictures, the improvement of the skin pigmentation and texture). Results: 95,14% of the patients presented an improvement higher than 75% in a 4 point VAS scale. These data are confirmed by a 3D analysis system comparison. 94,06% would recommend this treatment to others. No long lasting adverse effects or infections were noted. Prolonged erythema and transitory hyperpigmentations were noted in less than 1% of the patients. Conclusions: Ultrapulsed CO2 treatment must be considered as extremely effective on facial aging.

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Non Ablative Rejuvenation SAHAR F. GHANNAM


Consultant Dermatologist (Kuwait) Assistant Professor of Dermatology Alexandria University (Egypt)

FAT-TARGETING TREATMENTS CHAIR: G. STEVENS

Non Ablative treatment of skin laxity has been made possible by devices that create uniform heating of the dermis and underlying tissue, while providing cooling of the epidermis. This controlled determined thermal damage will lead to collagen remodeling, resulting in a tightened smooth skin under an undamaged outer layer, thus improving its appearance. These devices range from Lasers, IPL to Radiofrequency devices either Unipolar or Bipolar technologies, most of these devices will be discussed with emphasis on the authors clinical experience. Combining Ablative and Non-ablative Light Sources for Scar Revision M. KADURINA
Department of Dermatovenerology and Allergology, Military Medical Academy Sofia, Bulgaria

Lipolysis of the Neck and Arms K. HOFFMAN, MD Cryolipolysis using the Treatment to Transformation Approach W. GRANT STEVENS, MD, FACS Background: Cryolipolysis is a safe and effective method to non-surgically reduce subcutaneous fat and improve body contour. Since its commercial introduction in 2009, the clinical application of cryolipolysis (CoolSculpting, ZELTIQ Aesthetics, Pleasanton, CA) has evolved to achieve more comprehensive aesthetic results. Aim: This presentation explores the Treatment to Transformation (T2T) strategy, a customized treatment plan focused on optimizing patient satisfaction. A global approach is applied, targeting all problem areas with repeat cycles delivered to the same targeted areas, as needed. The goal of the presentation is to demonstrate cryolipolysis efficacy for contouring the whole body. Materials and Methods: The assessment and planning procedure will be demonstrated, showing the available cryolipolysis applicators and how they can be positioned to effectively target and treat fat in different parts of the body. Body marking and applicator placement will be shown for treatment of fat in the flanks, upper and lower abdomen, back, chest, arms, and inner thighs. Standard 60-minute treatment cycles were used to treat all intended areas. Repeat treatments were performed, as needed, to effectively contour the body. Results: Clinical before/after photographs will be shown to demonstrate efficacy of cryolipolysis using the T2T approach. Visible fat reduction can be achieved non-surgically via cryolipolysis. Aesthetically pleasing outcomes and high patient satisfaction were attained by treating multiple anatomic sites, often with repeat cycles. Conclusion: Global fat reduction was achieved by delivering cryolipolysis treatment cycles to multiple sites such as the abdomen, flanks, chest, arms, inner thighs, and back. With careful treatment planning and applicator placement, cryolipolysis can achieve excellent body contouring. Cryolipolysis: Maximizing Results L. BASS, MD Lipolysis with Injectables: a 2013 Overview BENJAMIN ASCHER, MD
Plastic Surgeon, Paris (France), Lecturer & Clinical Assistant, Paris Academy IMCAS Congresses Scientific Director

Background and Aim: Scars are common complications of the wound healing process. They develop as a result of various procedures and pathological processes and pose psychological, cosmetic and physical implications on the affected patients. Various treatment modalities have been employed over the past century such as intralesional corticosteroids, topical retinoic acid, surgical excision and/or grafting, cryosurgery, etc. Materials and Methods: Currently ablative and non- ablative laser devices are introduced in the treatment of scars. Clinical differences in scars features determine the treatment protocol. Colour, texture and morphology of the scar, as well as previous treatment, influence the laser parameters and the number of sessions required for optimal result. Results: Combination of ablative resurfacing (Er: YAG laser, Fractional CO2 laser), non-ablative dermal remodeling (IPL, Long- pulse- 1064 nm- Nd: YAG laser) and fractional photothermolysis (fractional Er: glass 1540 nm laser) is used for better efficiency and minimization of the side effects. Conclusion: The changes occurring in tissue during scar formation are in multiple directions: changes in skin texture, loss or extra production of collagen, changes in skin pigmentation and vascularization. The choice of laser depends on the predominance of one or another feature. The combination laser therapy allows more than one target to be influenced and offers greater possibility to treat the scars. Algorithm with Devices, Injections and Topicals A. CAMPO-VOEGELI, MD Role of Traditional CO2 Resurfacing S. R. WALDMAN, MD

Fat reduction using injectables is not a real alternative to liposuction for major lipodystrophies, but injectable treatments have been used since 2000 as a non-surgical means of treat-

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ing localized fat accumulations. Although previously a mixture of phosphatidylcholine (PC) and sodium deoxycholate (DC) was used, cell culture experiments and small-scale clinical trials, particularly thoseby Adam Rotunda published in 2004, have shown that DC was the major and principal active component responsible for fat cells lysis. Unapproved injectable preparations of PC/DC have not been tested in large-scale randomized clinical trials and formulations are not well defined. Rigorous clinical trials are demonstrating a favourable product profile using a pharmaceutical grade formulation of deoxycholic acid (ATX-101) that will be submitted for regulatory approval. ATX-101 is a proprietary formulation of synthetically derived deoxycholic acid and is the first adipocytolytic therapy to undergo robust clinical evaluation for the reduction of unwanted submental fat (SMF). ATX-101 was compared with placebo in two European phase III clinical trials. At 12 weeks after the final treatment, clinicians reported significant reductions in SMF with ATX-101. Patients were significantly more satisfied with their appearance in association with their face and chin and significantly more satisfied with their treatment compared with placebo, as well as reporting significant improvements in the visual and psychological impact of their SMF after ATX-101 treatment. ATX-101 was well tolerated; most adverse events occurred at the injection site, were mild or moderate in intensity and transient. These results offer evidence that ATX-101 may offer a new pharmacological option for reduction of unwanted SMF. Injectable treatments are convenient for patients who do not wish to undergo any or further invasive treatments. Careful selection of appropriate patients with localized limited lipodystrophy and a realistic and motivated attitude is required. Combination therapy with surface treatments (e.g. infra-red, radiofrequency) or other devices (e.g. ultrasound) may improve overall results, but this is not currently under investigation with ATX-101. Cryolipolysis for Gynecomastia G. MUNAVALLI, MD Legal Aspects of Cryotherapy R. BRINKMANN, MD

TIPS AND TRICKS: EXPAND THE USE OF YOUR DEVICE CHAIR: M. LAPIDOTH

5 Ways I Use Devices Outside the Box M. LAPIDOTH, MD How to Increase Profitability of the Q-switched Laser A. BADAWI, MD How I Maximize My Devices C. DIERICKX, MD

PIGMENTED LESIONS CHAIR: T. KONO

Treatment of Congenital Nevi T. KONO, MD Confocal Microscopy in Facial Pigmentation HIROTAKA AKITA, M.D., PH.D.
Department of Dermatology Fujita Health University School of Medicine Toyoake, Aichi 470-1192 (Japan) hakita@fujita-hu.ac.jp

Background: To know the mechanism of pigment removal by IPL or Q-switched lasers irradiation, solar lentigines after treatment of these devices were analyzed using techniques of skin physiological examinations and a non-invasive instrument for pigmentation in this study. Study and Methods:Ten healthy Japanese subjects, presenting with solar lentigo on the face, were measured with melanin concentration (Mexameter). In vivo confocal microscopy (Vivascope 1000 or 3000) was also used to visualize pigmented lesions non-invasively. We used IPL device (LimelightTM, Cutera Inc, Brisbane, CA, USA) or Q-switched laser (Q-switched Ruby laser, Model IB 101, Niic co ltd, Tokyo, Japan). The pigment spot of subjects received three consecutive of IPL treatments at 3-week intervals or one Q-switched Ruby laser treatment . Results: After IPL irradiation and Q-switched laser treatment, skin physiological examinations were improved. The images of RCM showed that the melanosomes in the epidermal basal layer rapidly migrated to the skin surface. It was concluded that IPL and Q-switched laser irradiation effectively removed the dense melanosomes in the epidermal basal layer. IPL treatment does not destroy melanosomes, rather it removes accumulated melanin from the epidermis and reduces the contrast between epidermal lesions and normal tissue. Conclusion: Not only IPL but also Q-switched laser are effective for treating for solar lentigines. But the mechanisms of pigment removal by IPL or Q-switched lasers irradiation were totally different.

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Acquired Bilateral Nevus of Ota-like Macules (ABNOMs) W. MANUSKIATI, MD Q-switched Laser in Skin of Color M. SACHDEV, MD

Conclusion: Home devices for consumers based on high frequency intense therapy ultrasound are feasible and may yield beneficial safety and efficacy profiles. Advancing Capabilities of Home Use Fractional Laser: Beyond Wrinkles ILYA YAROSLAVSKY
Cynosure Inc, 15 Network Dr, Burlington MA (USA) iyaroslavsky@cynosure.com

HOME USE DEVICES CHAIR: G. TOWN

Home Use of Intense Therapy Ultrasound (ITU) MICHAEL H. SLAYTON, PH.D., GTS
Guided Therapy Systems, Mesa, AZ 85202 (USA)

Background: Ultrasound as an energy source has been increasingly used in medical and aesthetic fields of medicine for the past several decades. Commercialized professional use of high intensity high frequency ultrasound fields has found successful applications in cosmetic medicine. (e.g. Liposonics, Ulthera, Ultrashape) While home use of intense, high frequency ultrasound is in its initial stages; considerable amount of work has been done especially in thermal applications of ultrasound. Aim: The goals of the studies described below were as follows: Establish technical and scientifically robust approach to hand held devices with safety and efficacy profiles useable at home. Execute pre-clinical and clinical studies providing safe and efficacious set of parameters to achieve unmet clinical needs. Materials and Methods: Simulations of Intense Therapy Ultrasound (ITU) of fields in homogeneous and inhomogeneous media were executed and optimized. Measurements of ITU by Schlieren method were performed and served as a source of the design parameters for the probes design. ITU probes for several clinical applications were designed and fabricated. Preclinical and clinical studies for treatments of mild to moderate form of acne vulgaris and facial tissue tightening and rejuvenation were conducted with the fabricated probes. Results: Feasibility and pivotal trials, IRB approved, were conducted at Harvard University and Arizona State University respectfully utilizing fabricated ITU probes. Total of 41 patients were treated showing excellent safety profile; only transient erythema and edema were noted. Efficacy of the studies showed statistically significant (p < .05) 30 % improvement in completely cleared rate for the treated sites with over 80 % satisfaction rate with self-assessment evaluations. Facial tissue tightening and rejuvenation 2 separate studies, IRD approved and conducted by CRO were performed on 72 subjects. Efficacy of the daily treatments done over 4 weeks regimen was independently clinically assessed. It yielded response rate based efficacy ranging between 82 % and 98% for lifting, firmness and fine line improvements between the studies. Safety of the treatments was confirmed by only the transient erythema and edema resolved in less than 212 hours.

Background: Home-use non-ablative fractional lasers (NAFLs) are used successfully to treat facial rhytides. Expansion of the treatment benefits to other skin conditions is of high interest. Aim: In this work, we investigated feasibility of at-home use of non-ablative fractional lasers for treatment of solar lentigines and improvement in skin dyschromia. Materials and Methods: A prototype NAFL device operating at mid-IR wavelength range with variable energies up to 30 mJ per microbeam was investigated. Two separate studies, one targeting discrete lesions (33 subjects recruited) and the other targeting diffuse hyperpigmentation / general skin tone improvement (50 subjects recruited), were conducted. Subjects treated themselves for 4 or 16 weeks, respectively, and were followed up to 3 months. Evaluations included standardized digital photography with subsequent grading of the lesions or overall skin tone, respectively, by blinded evaluators. Results: Treatments were well-tolerated with trace-to-moderate erythema being the most typical side effect. Majority of blinded evaluators correctly identified the post-treatment image as noticeably better for 233 of 275 (84%) treated lesions in the discrete lesions study and for 17 of 42 (41%) treated faces in the diffuse hyperpigmentation study. There was high degree of grading uniformity between the evaluators. Conclusion: The novel home-use NAFL device is a safe and effective modality to treat solar lentigines. Home-use IPL Hair Removal: End-to-End Human Safety Assessment J F. NASH, M. KOCK, I. GREIG AND B. FISCHER
Procter & Gamble Company (USA)

Background: Light-based hair removal (LHR) has been part of dermatological practice for the past 20 years and is the leading device in the emerging home-use market. Based on the principle of selective photothermolysis, coherent, i.e., laser, or noncoherent, i.e., Intense Pulsed Light or IPL, light delivered to the skin will result in reduced hair growth that is fluencedependent. The energy from the light source is absorbed by melanin, the primary chromophore concentrated in hair follicles, converted to heat, leading to follicular damage/destruction or, at low fluence, conversion of the follicle from active (anagen) to resting (telogen) phase. In either case, there is a reduction in hair re-growth. Aim: Determine accuracy of pre-market adverse event prevalence estimates derived from mechanism of action, i.e., selective photothermolysis, clinical studies, published literature and

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expert opinion on post-market safety surveillance program for a low-fluence, home-use IPL hair removal device. Materials and Methods: An IPL device (wavelength 5301100nm, pulse duration 2575 msec, fluence 710 J/cm2, treatment area 3 cm2) engineered with skin contact and tone sensors has been marketed in Western Europe for slightly more than 1-year. Prior to marketing, estimates of the prevalence of adverse events (AE) were part of the pre-market human safety assessment. These estimates were used to design a post-market surveillance program to collect health-related comments from consumers. Results: The most frequent AEs reported by consumers using the IPL device for hair removal were: discrete burns, pain and lasting (i.e., > 24 hr.) erythema. Low reported prevalence (< 0.01%) events included hyperpigmentation, itching/rash, pimples, and paradoxical hair growth. The reported prevalence of these AEs was accurately predicted from the pre-market human safety assessment for this IPL device. Conclusion: Reported prevalence of in-market AEs associated with IPL-hair removal device were consistent with pre-market estimates based on clinical literature, device parameters, i.e., spectral range, pulse duration, fluence, and expert opinion. From these data, this IPL device is considered safe for homeuse hair removal. International Progress in Standards and Regulation for Light Based Home Use Devices GODFREY TOWN 1 , WOLFRAM GORISCH 2
1 2 University of Wales Trinity Saint David, Swansea, SA1 6ED, UK. Laser Protection Consultant, 81929 Munich, Germany

conceivably be employed in home-use devices for certain applications (e.g. acne therapy). If this new laser classification is approved, the vertical standards will specify the appropriate design, engineering, reliability, test methods, labelling and instructional controls required for safe consumer use. This paper gives an overview of the recent state of development of a vertical standard which includes lasers categorized laser Class 1C, in the IEC 60335 series.
ILSC 2013 Conference Program Proceedings. Copyright 2013, Laser Institute of America.

Development of a New Cosmetic Category Sonic Skincare ROBB AKRIDGE, GLOBAL GENERAL MANAGER
Clarisonic, 17275 NE 67th Court, Redmond, WA 98052 (USA)

The initial concept to cleanse the skin by using the skins natural elasticity in conjunction with sonic technology has resulted in the creation of one of the top skincare brands (Clarisonic) and a new skincare category sonic skincare. During this presentation you will see how the Clarisonic Sonic Cleansing System was developed, how it functions, and the clinical methods used to determine the safety and efficacy of the device. Based on several fluorescent and makeup removal assays, sonic cleansing has been shown to be 6 times more effective than manual cleansing. As a result of excessive use studies, the Clarisonic Sonic Cleansing System was determined, based on Transepidermal Water Loss measurements, to be gentle enough for daily use. Why sonic cleansing is so successful and the future of at-home skincare devices will be discussed. Efficacy & Safety of Home-use Devices for Hair Removal and Skin Rejuvenation TOM NUIJS
Philips Research, High Tech Campus 34, 5656 AE Eindhoven (The Netherlands)

The recent development of light-based laser and intense light devices for consumer use with or without physician direction has raised new challenges in safety standards and regulatory requirements for these appliances. Home-use laser products have emission levels from embedded lasers that would ordinarily result in their having laser hazard classifications of 3B or 4, but because of design features and interlocks, cannot emit radiation which is hazardous to the eye when the product is in contact with the skin. When not in contact with the skin, emission is normally disabled anyway. With no outside emission, safety control measures in current horizontal standards do not make much sense. The International Electrotechnical Commission (IEC) has therefore defined a new laser Class 1C in its draft revisions to IEC standard 60825-1. Since laser appliances of laser Class 1C are diverse products, safety requirements may be too general if contained in the horizontal laser safety standard. Therefore, the general IEC 60825-1 only allows laser Class 1C to be attributed by a manufacturer to its product when a vertical safety standard exists which contains specific safety requirements which cover eye and skin hazards posed by the respective product (such as appliances for hair removal and skin rejuvenation). Whilst no equivalent ocular hazard generally arises with home-use intense light sources (ILS), higher Risk Group embedded ILS sources which pose a risk for the skin could

Over the last five years various light-based devices have become available that consumers can use at home to remove unwanted hair or improve the appearance of their skin. These devices were developed out of their professional counterparts and are based on the same well-known principle of selective photothermolysis. However, the fluence levels of home-use devices are generally lower in view of safety. A logical consequence is then that we cannot expect to see the same efficacy from professional and home-use devices. This difference is partially counteracted by the more frequent use of home devices. Photoepilation devices for home use are generally based on Intense Pulsed Light (IPL) as technology. Available devices differ in spectral cut-off, pulse duration, and fluence levels, which has an effect on efficacy, safety profile, and addressable skin types. Reduction of hair density is generally significant following regular treatment. The latest home-use skin rejuvenation devices target the skin in a fractional way, creating Micro Thermal Zones (MTZs) of coagulated tissue surrounded by skin that has not been tar-

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geted. Both the energy per MTZ and the skin coverage with MTZs are substantially lower than offered with professional fractional systems. Nevertheless significant improvements in skin appearance can be realized under repetitive use. Home Treatments with Fractional Lasers P. BJERRING, MD What Are the Practical Options for Testing J. TYRER, MD Under the Proposed Vertical Part 2 Standard? Safety in Home Use Appliances: Engineering D. SLINEY, MD

HAIR RESTORATION AND REGROWTH CHAIR: M. GOLD

Automated Hair Transplantation MICHAEL H. GOLD, M.D.


Medical Director: Gold Skin Care Center, Tennessee Clinical Research Center Assistant Clinical Professor: Dept. of Medicine, Division of Dermatology Vanderbilt University School of Medicine, Vanderbilt University School of Nursing Adjunct Assistant Professor, Meharry Medical College,School of Medicine

STEM CELLS AND BIOCELLULAR THERAPIES CHAIR: J. POZNER

Autologous Fibroblasts for Acne Scars


G. Munavalli, MD

Efficacy of Platelet Rich Plasma in Eyelid and Neck Rejuvenation BRUCE E. KATZ, M.D.
Clinical Professor, Mt. Sinai School of Medicine Director, Juva Skin & Laser Center Director, Cosmetic Surgery & Laser Clinic, Mt. Sinai Medical Center New York, N.Y. (USA)

Background: Hair transplantation continues to grow and the procedures for hair transplantation also have changed into a more automated mode. Aim: The aim of this presentation is to describe the NeoGraft System of automation for hair transplantation. Materials & Methods: The procedure of automated individual follicular unit extraction and implantation will be reviewed and clinical results will be reviewed. Results: Individual follicular unit hair transplantation, performed with the NeoGraft automated system, has revolutionized the hair transplant procedure. Conclusions: Individual follicular unit hair transplantation works and works well. Cell Therapy for Hair Growth N. SADICK, MD

Platelet rich plasma (PRP) is a novel approach to eyelid and neck rejuvenation. It involves drawing the patients blood and removing its platelets so that growth factors can be expressed and injected into the target tissues. In this pilot study, 10 patients had their PRP injected into tear troughs below their eyes and followed for 6 months. Digital photographs and 3-dimensional imaging was used to evaluate changes in the depth, volume, and texture of tear troughs. Significant improvement in the depth, volume and texture of treated tear troughs was found at the end of the 6 month follow-up period. PRP appears to be an effective modality for improving the appearance of tear troughs. It has also been used for neck skin rejuvenation and this data will be presented as well. Laser-assisted Delivery of Live Cells D. MCDANIEL, MD ASPS Taskforce on Regenerative Medicine J. POZNER, MD

Friday September 20th, 2013 15:15 17:15


FACT OR FICTION? CHAIR: C. ZACHARY

Hair Removal in Dark Skin Is Safe MUKTA SACHDEV, MD (DERM), DPD, DD, DIP DERM (UK)
Professorand Consultant Department of Dermatology, Manipal Hospital, Bangalore (India)

Laserhairremovalhas become one of the most common cosmetic procedures performed worldwide. A variety oflasersand light sources have been developed that may be employed in laser hair removal. The procedure was originally described to be performed on dark hair on lightskin; newer technologies have made the procedure safer for patients with darkerskinand those of colour. Various types oflasersare utilized withlaserhairremoval the most common of which are

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alexandrite, diode, Neodymium YAG and intense pulsed light sources. An overview of thelasersused in India on darker skin and the newer technologies available with their safety profiles will be discussed. Safety parameters and complications encountered inskinof colour will be highlighted and newer recommendations forhairremovaltreatments inskinofcolour will be proposed. Does Science Support Non-invasive Body Contouring? C. ZACHARY, MD Laser Lipolysis Requires a Fat-specific Laser D. MANSTEIN, MD It is Safe to Perform Procedures After Isotretinoin M. LANDAU, MD

LASER HAIR REMOVAL: UPDATES CHAIR: W. PRAGER

Diode Laser Hair Removal Updates W. PRAGER, MD Comparative Comfort of Hair Removal Lasers D. DAY, MD Laser Hair Removal SEAN LANIGAN, MD FRCP DCH
Chairman of Medical Standards Committee Responsible Officer

INJECTION THERAPIES: OFF THE FACE CHAIR: B. ASCHER

Use of Fillers Off the Face B. ASCHER, MD Injections Off the Face J. COHEN, MD Use of Toxins Off the Face A. PICKETT, MD New Technical Advances with Blunt Cannulas for the Hands MILES GRAIVIER, MD
The Graivier Center for Plastic Surgery, Roswell, Georgia (USA)

Background: Fillers have gained popularity for use in dorsal hand rejuvenation. Injection of a filler can camouflage the prominent dorsal veins and extensor tendons that become more obvious with aging. The earliest method used was injection with a needle into the proximal dorsal base of the hand and then aggressive massage to distribute the filler along the distal hand. This technique while successful, was not precise and could lead to irregular filler distribution. Sharp needle insertion occasionally led to bleeding. Aim: To demonstrate a more precise, less traumatic method of dorsal hand augmentation using blunt cannulas. Materials and Methods: Discussion and video demonstration of blunt cannula techniques for dorsal hand augmentation will be presented. Results and Conclusions: Use of blunt cannulas for filler injection in the dorsum of the hand has made the procedure virtually painless, less traumatic, and a more precise method of dorsal hand augmentation. A Multi-Faceted Approach to Hand Rejuvenation N. SADICK, MD

Background: Hair reduction by lasers has been achieved primarily by selective photothermolysis of pigment in hairs using lasers such as the long pulsed ruby (694 nm) and alexandrite (755 nm) lasers. These wavelengths are well absorbed by melanin and have been shown to produce permanent hair reduction in dark hair in fair skin. Multiple treatments are required and in general a 6070 % reduction in hair growth can be achieved in this way. Alternatives to these lasers are the diode laser operating around 810 nm, the long pulsed Nd:YAG laser at 1064 nm and flashlamps, which are broadband light sources. The longer wavelengths of light are less avidly absorbed by melanin and penetrate more deeply. Some studies suggest that lasers are superior to IPLs in their depilating efficacy. Aim: The aim of this presentation is to provide an update on recent developments in hair removal and management of side effects. Materials and Methods: Skin is by far the largest provider of laser hair removal in the UK with approximately 150,000 treatments each year. Part of the treatment process includes an ongoing assessment of patient progress including percentage hair reduction. In addition a vigorous and comprehensive Clinical Incident process captures all adverse events and an Incident Team analyses trends and introduces interventions to improve practice. Results: Data relating to hair reduction using different lasers on different phototypes and body sites will be presented. Clinical cases of adverse events will serve as learning points for attendees. Conclusion: Laser hair removal is a successful and safe treatment of unwanted hair. Recording clinical outcomes and adverse events in a very large population receiving treatment provides valuable information on this form of treatment. Hair Removal With High Power Diode M. ADATTO, MD High Repetition Rate Alexandrite A. CAMPO-VOEGELI, MD

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Low Fluence Laser Hair Removal MOSHE LAPIDOTH MD MPH, MAURICE ADATTO MD, SARIT COHEN MD, DAN BEN-AMITAI MD AND SHLOMIT HALACHMI
Rabin Medical Center, Petach Tikva, Israel and Skinpulse Dermatology & Laser Center, Geneva, Switzerland

Background: Laser hair removal is the most common laser procedure in young adults and continues to be a major segment in aesthetic treatments. However, the classic approach of using the highest tolerated fluence has been reconsidered. Aim: To review and evaluate the newer approaches to laser hair removal. Materials and Methods: Four devices with non-traditional technological approaches were examined. One low-fluence diode laser was compared to a traditional laser handpiece in a contralateral non-inferiority clinical study in 14 healthy patients. The benefit of low-fluence diode lasers was also examined in Beckers nevi, a challenging clinical target. Results: With appropriately chosen parameters, low fluence devices provided efficacy comparable to traditional handpieces and safety and tolerability that was superior to traditional laser hair removal handpieces. Conclusion: Low fluence devices offer efficacy and improved safety and tolerability when used with appropriate settings. These approaches may provide an option for situations in which standard laser hair removal is not possible.

squares to determine amount of energy to be delivered, which resulted in an average of 6000 J/axilla. Gravimetric measurement, starch iodine test and pictures (digital image software analysis) were performed before and 3 months after the treatment and will be repeated after 6 months. Results: All patients reported an average improvement of 3.1 at 3 months follow up. Gravimetric measurements showed an improvement of 81.2 % at 3 months follow up. Patients satisfaction at 3 months follow up was rated as 80.83 %. Typical side effects like numbness, swelling, etc. were reported after treatment. Conclusions: Minimally invasive treatment with a 1440 nm Nd:YAG laser, side-firing fiber is an effective and safe option for the treatment of Primary Focal Axillary Hyperhidrosis. Additional follow up will be done to confirm long-term results. Lasers and Microwave for Hyperhidrosis D. GOLDBERG, MD Ultrasound for Hyperhidrosis M. NESTOR, MD Laser-assisted Sweat Gland Reduction A. FATEMI, MD Device Treatment of Hyperhidrosis G. MUNAVALLI, MD

HYPERHIDROSIS: DEVICE-BASED APPROACHES CHAIR: D. GOLDBERG

COSMECEUTICALS CHAIRS: C. DIERICKX, M. GOLD

Hyperhidrosis Treatment using the Nd:YAG 1440 nm Laser with a Sidefiring Fibre SideLaze800 ALINA A.M. FRATILA MD, MARINA RECKMEYER, MD
Jungbrunnen-Klinik Dr. Fratila GmbH, Bonn (Germany)

The Role of Cosmeceuticals in a Laser Practice: EU C. DIERICKX, MD The Role of Cosmeceuticals in a Laser Practice: US MICHAEL H. GOLD, M.D.
Medical Director: Gold Skin Care Center, Tennessee Clinical Research Center Assistant Clinical Professor: Dept. of Medicine, Division of Dermatology Vanderbilt University School of Medicine, Vanderbilt University School of Nursing Adjunct Assistant Professor, Meharry Medical College,School of Medicine

Background: Primary Focal Hyperhidrosis is a chronic disorder presenting as excessive underarm sweating. Quality of life can significantly decrease by impacting emotional well-being, social interactions, and occupational duties. Current treatment methods for Primary Focal Hyperhidrosis are limited in duration and efficacy. Aim: The purpose of this study is to evaluate the efficacy and safety of a minimally invasive laser treatment using a delivery system for smaller anatomic areas. A 1440 nm Nd:YAG wavelength and a 800 m sidefiring fiber inserted through a 150 mm handpiece was used (Precision Tx, Cynosure Inc., Westford, MA). Material and Methods: 13 patients (12 women and 1 man) with an average age of 31.4 years old, presenting a pre-treatment 4 point Hyperhidrosis Disease Severity Score Scale (HDSS) score of 3 or greater, received a single treatment. From 13 patients, 10 patients have been already evaluated after 3 months. The amount of tumescent anaesthesia in each axilla was 200 cc. The area treated, was divided into four 5 x 5 cm

Background: Cosmeceuticals are an important part of the aesthetic scene and need to be part of any laser procedure. Aim: The aim of this presentation is to identify clinical trials that have been performed with cosmeceuticals to improve cosmetic outcomes with aesthetic laser procedures. Materials and Methods: From the authors own clinical research to other published reports; data will be presented showing how incorporating cosmeceuticals into ones laser practice can enhance results. Results: Cosmeceutical studies with lasers show how well the two modalities work together, how they complement each other.

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Conclusions: The use of cosmeceuticals greatly enhances laser procedures in the aesthetic field and should be used routinely by clinicians using lasers in their clinical practices. Product Innovation: Changing the Way We Treat Aging Skin PATRICIA K FARRIS, M.D.
Tulane University School of Medicine Private Practice, Metairie, Louisiana (USA)

Cosmeceuticals in Addition to Minimally Invasive Procedures MARTINA KERSCHER, MD


University of Hamburg, department chemistry, cosmetic science

Cosmeceuticals remain one of the fastest growing segments of the skin care market. These specially designed skin care products contain active ingredients that provide benefits beyond moisturization. Although many remain skeptical about the value of these products, recent innovations have resulted in cosmeceuticals that can deliver significant benefits for treating a variety of skin problems. In clinical practice, cosmeceuticals are now used to prevent and treat photodamage, lighten hyperpigmentation, treat skin disorders such as acne and rosacea and to improve outcomes from in-office procedures. Development of these specially designed skin care products includes identification of novel ingredients, in vitro studies to delineate biologic effects and clinical testing to confirm efficacy. In this lecture, we will explore the latest innovations in cosmeceutical skin care including identifying unique cellular and molecular targets that can be used to improve skin aging. Ingredients that can affect DNA repair and mitochondrial biogenesis will also be discussed. Novel cosmeceuticals that provide targeted treatment to areas such as deep lines and wrinkles, dynamic rhytides, and under eye puffiness represent a new generation of topical skin care. Cosmeceuticals such as these will change our treatment paradigms allowing us to offer effective topical solutions for cosmetic problems that previously could be treated only with procedures. Managing Hyperpigmentation E. MOIRAND, MD DNA Repair with Cosmeceuticals? V. BUCAY, MD Efficacy of Resveratrol in Protection from Photo-Aging Y. LI, MD Cosmeceutical Botanicals: What every Dermatologist should know SAHAR F GHANNAM
Consultant Dermatologist (Kuwait) Assistant Professor of Dermatology Alexandria University (Egypt)

Aging of the face and neck involves both dynamic and static changes in bone, musculature, fat, and skin. It is a multiple process, resulting from the interaction of numbers of different factors, both intrinsic and extrinsic. As youth and perception of beauty are considered to be of great importance, an increasing number of topically, invasive and non-invasive methods have been developed in recent years. Today treatment can be individualized and directed toward the most pronounced changes, which are unique to each person. Due to the demand of less invasive procedures and for preventative intervention, minimal invasive treatments have become very popular over the last two decades. The cosmetic dermatologists have a number of tools and techniques to achieve a nonsurgical rejuvenation of the aging face. Multiple treatments like chemodenervation with botulinum toxin or the use of dermal filler prolong skin aging especially when it is combined with cosmeceuticals. For example cosmeceuticals like topically anitoxidants can reduce free radicals damage to the skin, stimulate collagen production, improve skin surface and reduce fine lines. Moreover the regular use of sunscreens prevents visual signs on aging skin. With proven topical agents, patients are increasingly able to improve the results of minimal invasive treatments. New Cosmeceutical Delivery Systems MUKTA SACHDEV, MD (DERM), DPD, DD, DIP DERM (UK)
Professor and Consultant Department of Dermatology, Manipal Hospital, Bangalore (India)

Transepidermal drug delivery devices are one of the newer treatment methodologies for various indications in skin rejuvenation and dermatological conditions. An overview of the science and technology of the treatment devices with indications will be discussed. Potential complications and benefits will be reviewed anda highlight on darker Indian skin types will be reviewed to allow for evidence based medical approach to management using newer technologies. The future of these devices and their potential place in the dermatologists armamentarium of treatment options will be discussed with all relevant implications.

Botanicals form the largest category of cosmeceutical additives found in the marketplace today. They are plant extracts from the leaves, roots, fruits, stems, and flowers. Now over 60 different botanicals are integral components of cosmeceutical products. It is therefore important for every dermatologist to have a working knowledge of these botanicals to provide optimal medical care, to know their uses and myths and be able to answer patients questions.

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BIOMODULATION WITH LED AND LASER CHAIR: J. L. VIGNERON

Photodynamic Therapy with Low Irradiance LED A. CAMPO-VOEGELI,MD Daily LED: Clinical Effects J. L. VIGNERON, MD The Science of LED Photobiomodulation D. MCDANIEL, MD Excimer and Vitiligo KLAUS FRITZ, MD, LANDAU (GERMANY) Vitiligo is a common disorder. Therapy for vitiligo is challenging. A variety of approaches have been proposed, including topical and systemic steroids, topical calcineurin inhibitors, phototherapy, and surgical intervention including graft and melanocyte transplant. Phototherapy can be delivered as broad band UVB, narrow band (NB) UVB, PUVA and targeted phototherapy using light sources or excimer lasers and lamps. Phototherapy enhances the migration and proliferation of melanocytes resulting in repigmentation and has further an impact on the immune response. In the past decade, an increasing number of reports have highlighted the value of the excimer (excited dimer) in the management of vitiligo. 308 nm excimer lasers and excimer lamps allow targeted phototherapy at high doses of 308 nm wavelength, which is close to 311 nm, that was proven to be most effective. It has the advantage of enabling also the treatment of small, inaccessible or resistant areas when compared to ordinary phototherapies. NB UVB units irradiate both diseased and normal skin, whereas targeted sources deliver high intensity lights to depigmented areas. Rapid therapeutic responses have been reported after targeted phototherapy that may contribute to the reduction of the cumulative UV dose. Sessions are performed 23 times a week. Initial doses are determined either by minimal erythema dose MED like 70 % of MED or constant at 100 200 mJ depending on area and indication. The maximum dose usually reaches 23 j/cm2. For the treatment of vitiligo, the initial dose varies and depends on the body site: Perioral 100 mJ/cm2 Face 150 mJ/cm2 Trunk and arms 200 mJ/cm2 Wrist 250 mJ/cm2 Elbow 300 mJ/cm2 Knee 350 j/cm2 Hand and foot 400 mJ/cm2 Toe and finger 600 mJ/cm2.

The subsequent dose should be based on duration of erythema. First repigmentation can start after 4 treatments and 2 weeks in Asian skin (type 4) on the face and approximately after 8 treatments on the extremities. Onset of repigmentation was reported after an average of 13 treatments in lesions located on the face, trunk, arm, and/or leg, locations that are known as high responder areas and after 22 treatments in lesions located on the elbow, wrist, dorsum of the hand, knee and dorsum of the foot ,known as low responder locations. The poor response on the hands and feet could be due to the low density of hair follicles there, since repigmentation usually originates from outer root sheet melanocytes in hair follicles. The number of sessions per week play an important role in both: total efficacy and onset of response. Zhu et al found > 75% repigmentation in 0 % treated every 14 days, 26% treated 2 times/week; 32 % treated 3 times/week. More frequent treatments show better results. However more side effects were noticed with excimer laser therapy given three times a week. The available studies provide strong evidence that the excimer laser represents the most effective approach to treat vitiligo compared to ordinary phototherapy. Excimer laser is relatively safe and effective for localized disease. UV sensitive areas respond best as well as a short duration of the disease, more frequent treatments achieve better results. Compared to other treatment modalities, Excimer laser most likely constitutes the treatment of choice for localized vitiligo. Its efficacy can be further improved in combination with other therapies such as corticosteroids, pimecrolimus, or tacrolimus. Based on an increasing numbers of reports and studies indicating the value of Excimer laser in the management of vitiligo, we critically review the published literature and provide recommendations based on the available evidence.

SCLEROTHERAPY CHAIR: R. WEISS

Updates in Sclerotherapy R. WEISS, MD When Sclerotherapy? When Laser? M. WEISS, MD Endovenous Radiofrequency Obliteration FAST Closure A. FRATILA, MD

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Saturday, September 21, 2013 09:00 11:00


AWARDS AND PLENARY: WHATS ON THE HORIZON? AWARD PRESENTATION: 5CC PRESIDENT

with close postoperative supervision cannot be overemphasized. If complications are recognized quickly, early intervention minimizes the risk of long-term adverse sequelae. Complications with Energy Based Systems MICHAEL H. GOLD, M.D.
Medical Director: Gold Skin Care Center, Tennessee Clinical Research Center Assistant Clinical Professor: Dept. of Medicine, Division of Dermatology Vanderbilt University School of Medicine, Vanderbilt University School of Nursing Adjunct Assistant Professor, Meharry Medical College,School of Medicine

Whats on the Horizon in Cosmeceuticals? PATRICIA K. FARRIS, MD (See page Product Innovation: Changing the Way We Treat Aging Skin) Whats on the Horizon in Nanotechnology? A. NASIR, MD Whats on the Horizon in Injectables? J. COHEN, MD Whats on the Horizon in Devices? D. GOLDBERG, MD Whats on the Horizon in Cosmetic Surgery? B. ASCHER, MD

Background: The use of energy based therapies for the treatment of cosmetic and medical uses has increased greatly over the past several years. With it, many new devices have recently been introduced to clinicians claiming to be the best of the best and also the safest of all. Aim: The aim of this presentation is to review that adverse events do happen with lasers and light sources and we need to know that even with the best of the best, these adverse events can be seen. Materials and Methods: From the authors personal 25 year laser history to my colleagues sharing their cases, we have identified adverse events with every kind of energy based therapy. Results: All energy-based therapies have the capabilities of having an adverse outcome. Conclusions: Using energy based therapies for our patients results in great results the majority of times; we must be aware that adverse events can occur, will occur, and that one must be aware of them and how to treat them if they occur. Laser Resurfacing Complications J. POZNER, MD Applying Cutting Edge in Wound Healing Research to Optimize Post-treatment Care T. PHILLIPS, MD

MANAGEMENT OF ADVERSE EVENTS: DEVICES CHAIR: W. MANUSKIATI

Laser-induced Pigmentation W. MANUSKIATTI, MD Laser Complications ELISABETH TANZI, MD Lasers and light-sources were developed based on the theory of selective photothermolysis first outlined by Anderson and Parrish in 1983. According to the theory, lasers and light sources are capable of destroying specific tissue targets whilst minimizing the risk of dyspigmentation or scarring. Full realization of the theory is accomplished through the delivery of a wavelength and pulse duration that is best absorbed by the specific targeted chromophore. However, not all laser and light sources or common treatment protocols adhere to this principle. Despite significant advances in cutaneous laser surgery over the past 4 decades, lasers can produce side effects and complications, particularly when improper patient or laser selection, intraoperative technique or post-treatment care is evident. The importance of preoperative patient screening and education, as well as accurate laser selection and application

SKIN TIGHTENING CHAIR: N. SADICK

Skin Tightening with the 1440 nm Lipolysis Laser K. HOFFMANN, MD Overview of Techniques for Tissue Tightening C. DIERICKX, MD FR for Tissue Tightening and Surgical Procedures D. DAY, MD Whole Body Skin Tightening: Separating Myth from Reality N. SADICK, MD

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LIPOSUCTION CHAIR: G. SATTLER

Laser Lipolysis and Liposuction G. SATTLER, MD Ultrasound-assisted Liposuction with Abdominoplasty C. INGLEFIELD, MD Laser Lipolysis: With or Without Aspiration D. GOLDBERG, MD Complications of Laser Lipolysis A. FATEMI, MD

STRIAE CHAIR: M. ADATTO

My Fractional Approach to Striae M. ADATTO, MD Rational Treatment Approach to Striae D. MCDANIEL, MD RF for Striae K. FRITZ, MD Treatment of Striae R. WEISS, MD

Aim: Numerous non-surgical body contouring methods have been evaluated at Marina Plastic Surgery. This presentation will discuss non-surgical systems employing cryolipolysis, high-intensity focused ultrasound, infrared light, laser, massage, RF energy, and vacuum. Materials and Methods: Safety, efficacy, and tolerability of the various methods will be presented, based upon evaluations by me, my staff, and my patients. Clinical efficacy for skin tightening, cellulite minimization, and fat reduction will be demonstrated by before and after photographs. An overview of a wide variety of body contouring systems will be shown, including Thermage, Exilis, Zerona, SmoothShapes, VelaShape, truSculpt, Liposonix, i-Lipo, Vanquish, Venus Freeze, and CoolSculpting. Results: A large number of non-surgical body contouring systems have been purchased and evaluated at my practice. One system has been consistently utilized and required me to purchase 6 systems to keep up with demand. The system that has shown the highest efficacy, patient tolerability, and business growth potential has been CoolSculpting. Representative clinical photographs and business growth results will be discussed. Conclusion: Many non-surgical body contouring systems are available. This presentation will review the advantages and disadvantages of several commercially-available systems for nonsurgical body contouring. The safety, efficacy, consistency in results, tolerability, and profitability of the CoolSculpting system make it the best available non-surgical body contouring system. Efficacy of HIFU in Body Contouring BRUCE E. KATZ, M.D.
Clinical Professor, Mt. Sinai School of Medicine Director, Juva Skin & Laser Center Director, Cosmetic Surgery & Laser Clinic, Mt. Sinai Medical Center New York, N.Y. (USA)

Saturday September 21, 2013 11:45 13:45


BODY CONTOURING: I CHAIR: G. STEVENS

Non-Surgical Body Contouring W. GRANT STEVENS, MD, FACS Background: Modern liposuction techniques were introduced in the 1980s and rapidly gained popularity in aesthetic medicine. Today, liposuction remains among the most popular cosmetic surgery procedures and the gold standard for body contouring. Demand has grown, however, for non-surgical techniques with lower risk and less downtime.

High intensity focused ultrasound (HIFU) has been a subject of interest in medical research since 1942, when the first work to consider potential applications of HIFU was published. HIFU relies on the same principles as conventional ultrasound and deposits heat energy in a very well-defined volume, propagating harmlessly through surrounding tissues. HIFU for fat reduction provides a non-invasive alternative to traditional invasive body sculpting approaches, which are associated with morbidity and side effects. HIFU for body sculpting allows focused ultrasound energy to be delivered at specific depths in subcutaneous adipose tissue, preventing exposure and damage to tissues outside of the focal zone. The intensity is brought to a sharp focus in the subcutaneous fat to destroy adipocytes. Recent clinical work indicates HIFU treatment reduces waist circumference, and is a safe and effective method for noninvasive body sculpting. This presentation will review the latest evidence based clinical data on the efficacy of HIFU and most effective protocols for use of this technology in body contouring.

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Innovations in LLLT M. NESTOR, MD Cryolipolysis Outcomes: Tailoring Treatment J. DOVER, MD

ALTERNATIVES TO TOXINS CHAIR: K. FRITZ

Focused Cold Therapy G. SATTLER, MD Focused Cold Therapy for Dynamic Facial lines KLAUS FRITZ, GEORGE SORIN TEPLICA
Haut und Laserzentrum Landau, University Carol Davila Bucharest

LIDS AND LASHES CHAIR: J. FEW

Upper Blepharoplasty and Brow Suspension with One Incision JULIUS FEW, MD, THE FEW INSTITUTE CHICAGO (USA) Traditional brow lifting has been on the decline over the past 5 years according to statistics published by the American Society for Aesthetic Plastic Surgery. One reason is the enhanced use of neurotoxins for cosmetic enhancement to the forehead. Another reason has been consumer concern about over elevation of the brow. We know that many cases of upper eyelid skin excess is due to undiagnosed brow ptosis but patients are unwilling to consider simultaneous browlift. We present an easily reproducible technique to enhance and preserve upper eyelid aesthetic after upper blepharoplasty by using transpalpebral brow suspension. We have successfully applied this approach in more than 500 cases to achieve stable brow position and preservation of improved symmetry while avoiding early return of blepharochalasis. In conclusion, a single incision is highly safe and effective rejuvenate the upper eyelid and brow at the same time. Is the End of Blepharoplasty in Sight? C. INGELFIELD, MD Deep Ablative Periorbital Resurfacing J. POZNER, MD Bimatoprost Review and Update J. COHEN, MD Eyelid Rejuvenation with Fillers L. BASS, MD Treatments of Eyelid Lesions A. CAMPO-VOEGELI, MD

Similar to the treatment with Botulinum toxin focused cold therapy (loveraTM) targets dynamic facial lines such as crows feet and furrows. Cryoneuroablation, also known as cryoanalgesia or cryoneurolysis, is a specialized technique for providing tong-term pain relief in interventional pain management settings. Now it also can be used for the temporal branch of the facial nerve in the treatment of dynamic wrinkles caused by mimic muscles. The application of cold to tissues creates a conduction block. Cryotherapy depending on depth of cooling disrupts the nerve structure and creates wallerian degeneration, but leaves the myelin sheath and endoneurium intact. After pretreatment with local anesthesia, needles cooled with liquid nitrogen are jabbed into the parietal treatment area, the nerves are cooled down to minus 20 degree Celsius for 45 to 120 seconds. Immediate block of nerve activity can be observed. This technology is now used for nerves responsible for muscles causing glabella and frontal wrinkles. Compared to the treatment with Botulinum toxin the effect of focused cold therapy acts immediately and lasts for about two to four months Low temperature treatment of minus 20 degrees on motor nerves causing 2nd degree Wallerian degeneration does not result in any permanent or long term changes to function and structure of the nerves. This technology allows patients, who want to avoid Botulinum toxin or who are resistant to the toxin a new way of treatment. Focused Cold Therapy A New Treatment to Reduce Dynamic Forehead Lines KAI-UWE SCHLAUDRAFF, MD
Concept-Clinic Geneva (Switzerland)

Background/Aim: Introducing the worlds first toxin free wrinkle treatment delivering immediate results based on Focused Cold TherapyTM (FCT) to targeted facial nerve branches. FCT has been shown to be a safe and effective means to inhibit motor nerve conduction via a mechanism called cryoneuromodulation. Materials and Methods: A handheld device (myoscience, Redwood City/USA) delivers controlled low temperatures via a triple microneedle probe and reversibly inhibits motor nerve conduction without injecting any chemicals into the tissue. Results: Clinically, FCT induces a physiological response to cold that is known as 2nd degree Wallerian degeneration and caused by an axonal degeneration and demyelinization, while leaving the endoneurium, epineurium, and perineurium

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intact. This allows for an immediate relaxation of dynamic forehead lines while ensuring the guided regeneration and full functional recovery even after multiple treatments. Histologically, regenerating axons are observed by 8 weeks with further maturation and re-myelinization observed at later time points.There are no systemic side effects and the surrounding structures like sweat glands, sebaceous glands, hair bulbs, and adipose tissue remained intact. Conclusion: FCT allows for efficient treatment of dynamic forehead wrinkles - with an immediate effect visible for the patient and comparable duration as compared to the usual treatment options.

BODY CONTOURING: II CHAIR: B. KATZ

3-D Evaluation of 1440nm Nd:YAG in Cellulite Treatment BRUCE E. KATZ, MD


Clinical Professor, Mt. Sinai School of Medicine Director, Juva Skin & Laser Center Director, Cosmetic Surgery & Laser Clinic, Mt. Sinai Medical Center New York, N.Y. (USA)

WHAT DO PATIENTS WANT?

What Docs Need to Know MICHAEL H. GOLD, M.D.


Medical Director: Gold Skin Care Center, Tennessee Clinical Research Center Assistant Clinical Professor: Dept. of Medicine, Division of Dermatology Vanderbilt University School of Medicine, Vanderbilt University School of Nursing Adjunct Assistant Professor, Meharry Medical College,School of Medicine

Background: Social Media has become very prevalent in 2013. Aim: The aim of this presentation is to share how social media and internal advertising helps docs market their practices. Materials and Methods: Marketing of ones practice is commonplace in most countries. The use of internal marketing and todays social media has helped many in spreading the attributes of ones clinical practice. Results: Internal marketing and social media are important marketing tools. Conclusions: With the proper use of internal marketing and social media, one can increase awareness that can lead to an increase in the number of patients one sees in clinical practice. Market Trend Analysis M. MORETTI Branding: How Will Clients Know What You Offer? W. LEWIS, MD

Background: Cellulite is a cosmetic problem that affects over 80 % of women. To date, there have been no technologies that have had significant lasting benefits for cellulite. Methods: In this IRB approved study, 15 women had cellulite of the thighs treated with a novel 1440 nm Nd:YAG laser with a sidelight 3D optical fiber that transmits energy bi-directionally. Follow-up was at 1 week, 1, 3 and 6 months after a single treatment and results were monitored by digital photography, patient and physician questionnaires and histologic evaluation. A Vectra 3-Dimensional surface imaging system was used to measure qualitative and quantitative changes in skin topography at each follow-up visit compared to baseline. The Sidelight 3D optical fiber was used to thermally subcise subcutaneous septa, deplane fat cells and heat dermal tissue to promote skin thickening and tightening. Results: 68% of subjects showed significant improvement in cellulite by photographic evaluation and 65% with Vectra 3D surface imaging. Patient & physician evaluations revealed good-excellent results in 76% & 69 % of cases, respectively. Except for mild ecchymoses and edema lasting less than one week, no adverse events were noted. Conclusion: A novel sidelight 3-dimensional optical fiber and 1440 nm Nd:YAG laser appear to have long lasting benefits in the treatment of cellulite. AWT in Cellulite and Volume Reduction M. ADATTO, MD Cellulite Management SAHAR F. GHANNAM
Consultant Dermatologist (Kuwait) Assistant Professor of Dermatology Alexandria University (Egypt)

Cellulite is a clinical and aesthetic condition affecting most women, who are not cachectic. Clinically, the skin acquires an orange peel or mattress appearance. In this condition alterations occur to the adipose tissues and microcirculation that result from blood and lymphatic disturbances causing fibrosclerosis of the connective tissues. It is considered a noninflammatory degenerative phenomenon that provokes alterations to the hypodermis producing irregular undulations on the skin overlying the affected area. It is imperative to understand the pathophysiology of this condition in order to meet the increasing female demands to get rid of this unaesthetic condition. The search for a treatment for this condition has

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been going on for decades. A review of the treatment options available will be mentioned with emphasis on the newer technologies. RF and Ultrasound for Body Contouring K. FRITZ, MD

Toxins for the Lower Face J. COHEN, MD

THE INTERFACE OF COSMETIC SURGERY AND NON-SURGICAL APPROACHES CHAIR: S. J. POZNER

LIP SERVICE CHAIR: J. COHEN

Combining Surgery and Injections B. ASCHER, MD Multispecialty Practice J. POZNER, MD Isolated Submentoplasty: The Poor Mans Facelift S. R. WALDMAN, MD

Quest for the Natural Lip S. R. WALDMAN, MD Lip Augmentation: Maximize Results, Minimize AE J. COHEN, MD Radial Lip Line Treatment MILES GRAIVIER, MD
The Graivier Center, Roswell, Georgia, 30076 (USA)

PATIENT MANAGEMENT FROM MARKETING TO POST-TREATMENT CHAIR: D. GOLDBERG

Background: The treatment of radial lip lines is problematic for the patient and practitioner. A variety of treatment options can be chosen with varying success as well as variations in recovery. Neurotoxins, resurfacing with lasers, dermabrasion or deep peels, and use of other energy devices have been used. Fat and fillers is an option with limitations on results often based on level of injection. Hyaluronic acid fillers have been most commonly used, but fear of Tyndall effect from placement in the superficial dermis is limiting. A study was designed to look at use of Belotero balance injected into the superficial dermis to try to achieve some correction of the radiai lip lines. Aim: This study is designed to determine the efficacy of Belotero Balance for perioral rejuvenation. Especially it is to determine the ability of Belotero to correct radial lip lines of the upper and lower lips, corner of mouth lines, and other fine lines in the perioral region. The study will determine if Belotero with CPM binding technology will allow better correction of these areas with avoidance of Tyndall effect, lumpiness, or other adverse events more commonly associated with superficial and mid-dermal placement of other NASHA products. Materials and Methods: The study was performed on 10 patients with grade 2 to 4 radial lip lines at rest using the Merz lip line scales. The patients had standardized, close up AP view photography in the relaxed state. They were treated with injectable Belotero Balance only. They returned for elective touchup injection at 2 weeks if necessary. Standardized photographic evaluation was performed at 2 weeks, 4 weeks, 6 weeks, 8 weeks, and 12 weeks after injection. The patients rated themselves using the GAIS system and the photographs were compared at each interval to pre-injection photos. Results and Conclusions: All patients had an improvement in Merz scale rating of 1 grade for the 12 weeks of the study. An average volume of Belotero Balence including touch-up at 2 weeks was 1.1 cc. No incidence of Tyndall effect was noted.

The Impact of Patient Psychology on Cosmetic Dermatology Practice A. BADAWI, MD How Does the Patient Perceive You, and How Do You Wish to Be Perceived? W. LEWIS, MD The Psychology of Lawsuits: Non-medical Risk Factors D. GOLDBERG, MD

Saturday, September 21, 2013 15:15 16:45


ADVANCED REJUVENATION METHODS CHAIR: S. DAHAN

Sublative Fractional Bipolar Radiofrequency Combined Treatments with Light and Bipolar RF for Acne Scars and Rejuvenation SERGE DAHAN, MD
Clinique St Jean Languedoc, Toulouse, France

Objectives: The combination of bipolar radiofrequency and sublative radiofrequency is a safe and effective treatment for

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acne scars and rejuvenation with minimal downtime and no significant side effect. This study evaluates the safety and efficacy with the association of light (IPL: 470980 nm) , bipolar radiofrequency and sublative fractional bipolar radiofrequency to improve our results. First photo rejuvenation with light (470980 nm). second skin tightening (RF and IPL 7002000 nm). RF fluence from 70 to 100 J/cm2. third sublative fractional bipolar radiofrequency; sublative fluence from 50 to 64 j/cm2. 3 treatments, 1 month intervals, treating all the face scars. Results are evaluated before each treatment, 1 month, and 3 months after the 3rd treatment . Results: Results improved significantly since the first treatments and this improvement persits for at least 3 months after thr 3rd treatment. Adverse events were limited to transient erythema and edema. Conclusion: The combination of light with bipolar radiofrequency and sublative radiofrequency is a safe and effective treatment for acne scars and rejuvenation with minimal downtime and no significant side effect. All subjects found the treatment to be comfortable and were satisfied with the results of the treatment. Higher improvement with treatment progress for color, texture, and wrinkles. Interaction between Injections and laser, and related technologies B. PUSEL, MD
Villabianca 718, Boulevard Pierre Sauvaigo 06570 Saint Paul de Vence (France)

A review of the interaction between laser and fillers/botulinum toxin will give some advice on the eventually better schedule to perform the different procedures for a better result. Combining Lasers, PDT and Fillers for Facial Aesthetics TANJA FISCHER, MD Combination Therapy for Skin Rejuvenation SUZAN OBAGI, MD
Associate Professor of Dermatology Associate Professor of Plastic Surgery Director, The Cosmetic Surgery and Skin Health Center University of Pittsburgh Medical Center (USA)

In 2010, the most popular cosmetic surgical procedures were: rhinoplasty, facelift, and blepharoplasty. The most frequent cosmetical non-surgical procedures were botulinum toxin, and hyaluronic acid. Many others technologies are also used for facial rejuvenation, including lasers, lights and radiofrequency. Treatment with these devices has proved beneficial in the improvement of rhytidesand scars. It is now a common practice to propose laser therapy before or after injections of fillers or botulinum toxin and combined technologies are used frequently to increase final result. Anecdotal reports allege that use of laser/light/RF devices after injection of fillers might substantially reduce the effect of the filler implant or lead to rapid degradation of the product. It is largely based on the fear of denaturation of the material through heat generated in the dermis by the laser/light/RF devices. There is few data with experimental clinical studies about this possible interaction between fillers and lasers and others procedures. Concerning botulinum toxin, the adequate procedure is an injection into the muscle, and formally far from the depth reached by the lasers/lights and RF treatments. Combination treatments have even showed synergistic effects for facial rejuvenation, and in particularly in the challenge of the treatment of the upper lip.

Background: Skin rejuvenation is essential to the overall cosmetic enhancement of a patients appearance. Patients are reluctant to undergo procedures in which they will have a prolonged recovery period, especially if they have to have several treatments. There is, to date, no proper algorithm for safely combining skin rejuvenation procedures. Aim: To teach participants which procedures can be combined and the proper order in which to combine them. Materials and Methods: This lecture will cover the proper method to assess, plan, and perform multiple treatments including lasers (vascular, pigment, acne scars, ablative /nonablative, fractionated), electrodessication, and chemical peels in one procedure. Results: Case examples will be used to show the proper patient evaluation, skin preparation, planning, and the performance of one to many skin rejuvenation procedures during one visit so as to maximize a patients recovery time. Conclusion: The safety and success hinges on the proper order in which these procedures are performed. Non-laser, Non-ablative Facial Rejuvenation using a Transfollicular Drug Delivery System (Affinite) NARK-KYOUNG RHO, MD
Leaders Aesthetic Surgery and Cosmetic Laser Center, Seoul (Korea)

Background: The hair follicles and sebaceous glands are increasingly recognized as potentially significant elements in the percutaneous drug delivery paradigm. Interest in pilosebaceous units has been directed towards their use as depots for localized therapy, particularly for the treatment of folliclerelated disorders such as acne or hair loss. Considerable attention has also been focused on exploiting the follicles as transport shunts for systemic drug delivery. Aim: To provide a basic and current concepts of the transfollicular drug delivery and introduce a novel developments in this field. Materials and Methods: Review of the various key facets of this field including; relevant aspects of pilosebaceous anatomy and physiology, and the advantages and disadvantages of the current follicle-targeting modalities, along with the introduction of a novel non-ablative transfollicular drug delivery system (Affinite), will be presented.

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Results: Transfollicular drug delivery is a fantastic treatment tool in dermatology but its therapeutic value is still under question using current technology. It appears that this delivery route is quite complex in nature and that drug transport through the appendages is probably modulated by an array of different variables. To date, most of the work in this field has been focusing on the formulation of the drugs. Clearly, only a few researches were performed to make a hair follicle-specific drug delivery tool. Affinite is one of the few novel systems based on the concept transfollicular drug delivery. The device uses carbonated water under high pressure through ultra-thin openings in the single-use tip. Because the diameter of the stream (50 microns) is smaller than the inlet diameter of the pores, a sort of lock-in process happens during the alignment between the pores and the stream, and a portion of the solution is transfused from the tip into the pore. The author uses the device to restore the (photo)aged skin manifesting fine wrinkles, prominent pores, uneven skin tones, dyschromias, etc. The procedure is not related with pain, downtime, or significant side effects, and can be used safely even on the sensitive skin. The meaningful clinical improvement is achieved after a series of weekly treatment sessions. Conclusion: The use of a novel non-invasive transfollicular drug delivery system is a safe and effective treatment in Korean patients. Further researches are recommended in terms of the new clinical applications, use of a different infusing solution, and so on.

Conclusion: Improvement of redness that is the result of rosacea or sun damage can be improved. Long term results are dependent on patient compliance and occasional supplemental treatments. Efficacy and Safety of Topical Cosmeceutical for Rosacea C. INGLEFIELD, MD Treatment of Melasma with Q-switched Laser and/or Intense Pulsed Light PAULO R. CUNHA, MD, PHD
Jundiai Medical School So Paulo (Brazil)

THE HOMOGENEOUSLY-TONED FACE CHAIR: M. LUPO

Management of Facial Redness: Devices, Topical and Oral Therapies MARY P LUPO MD, FAAD
Clinical Professor of Dermatology, Tulane University Health Sciences Center

Background: Facial dyschromia, including brown and red discoloration, is a source of great concern to patients. The red face is a source of embarrassment and is associated with social stigma. Chronic redness ages the appearance of the face. Patients are seeking treatment options to improve facial redness. Dermatologists and other cosmetic physicians must be able to understand the etiology for the redness and outline treatment protocols. Aim: to discuss various devices, including laser, intense pulsed light, and chemical peels as well as oral medications that may improve episodic flushing and topical prescription and cosmeceutical agents that improve the appearance and severity of the red face. Treatment strategies outlined. Material and Methods: 532 and vascular lasers, broadband, intense, pulsed light devices, salicylic acid peels, various cosmeceuticals, and prescriptions agents. Results: Redness, whether from rosacea, other inflammation, or sun damage can be improved with comprehensive protocols that may incorporate various devices and therapies.

Background: Melasma remains a therapeutic challenge, especially in woman, in which the condition is most prevalent, with major social and emotional consequences. Treatment options include topical, chemical peels and device-based therapies (CO2 laser, Q-switched Nd: YAG, QSAL, erbium: YAG laser and intense pulsed light (IPL). Aim: Showing a series of cases, we report our results demonstrating marked improvement on refractory melasma after the simultaneous combined treatment with Nd-Yag Q-switched non-ablative fractionated 1064 nm, 20 ns and IPL therapy (Alma Laser). Materials and Methods: Participants received treatment with Nd-YAG Q-switched non-ablative fractionated 1064 nm, 20 ns and/or IPL therapy (Alma Laser). All participants received 3 applications, with an interval of a month from each session. Six patients underwent an exam with Wood light, a biopsy was collected from a melasma affected area, and their MASI index was calculated. At the end, the MASI index was once again calculated. Pre and post treatment pictures were taken. Results: All patients in the study, showed a significant improvement of melasma. Only one patient presented an hypochromic area after laser application. However, this side effect had small impact, since the hypochromic improved after 20 days. Conclusion: We encourage dermatologist to consider the new technology Nd-YAG Q-switched non ablative fractionated 1064 nm, 20 ns as a treatment option for refractory melasma unresponsive to other treatment modalities. It applies a selective photothermolysis at the subcellular level and offers good results. The observed adverse post treatment events were minimum and temporary. The Use of Sunscreen Starting on the First Day after Ablative Fractional Skin Resurfacing RUNGSIMA WANITPHAKDEEDECHA, M.D., M.A., M.SC., RUJEE PHUARDCHANTUK, M.D., WORAPHONG MANUSKIATTI, M.D.
Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

Background: The most common side effect of ablative fractional skin resurfacing in Asians is post-inflammatory hyperpigmentation (PIH). Various attempts have been made to

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reduce the occurrence of PIH after laser treatment including sun avoidance, the use of preoperative and postoperative treatment regimens, and treatment using conservative energy settings and epidermal protection. Objectives: To determine whether the use of board-spectrum sunscreen with anti-inflammatory agents starting on the first day after fractional CO2 laser skin resurfacing reduces the incidence of post-laser PIH. Materials and Methods: Thirty patients were treated with ablative fractional CO2 resurfacing on both sides of their faces at 10 mJ and 10% density. Each subject was randomly treated on one side of the face with petrolatum ointment 4 times a day for the first week after laser treatment and on the other side of the face with petrolatum ointment 4 times a day plus boardspectrum sunscreen with anti-inflammatory agents in the morning starting on the first day after laser treatment. Transepidermal water loss was recorded at baseline and every day for 1 week. Melanin and erythema indexes were measured at baseline, 1-, 2-week, 1-, 2-, and 3-month post treatment. Results: Of the 30 patients involved in the study, 26 received treatment and attended 1-, 2-week, 1-, 2-, and 3-month posttreatment visits. Four patients were withdrawn from the study because they could not attend every follow-up visit. There was no statistically significant difference in transepidermal water loss at baseline, immediately after laser treatment, or at the D1 to D7 follow-up visits. Erythema index had no significantly statistical difference at baseline, 1-, 2-, and 3-month after laser treatment. Furthermore, there was a statistically significant difference in melanin index at 1-week post laser treatment between both sides (p = 0.001). Melanin index at the 1-week follow-up visit on the side treated with broad-spectrum sunscreen with anti-inflammatory agents starting on the first day after laser treatment was significantly less than the control side. Conclusion: The use of board-spectrum sunscreen with antiinflammatory agents starting on the first day after ablative fractional skin resurfacing can decrease the incidence of PIH after laser treatment at 1-week post-op.

THE CUTTING EDGE CHAIR: M. GOLD

Combining Laser and Cosmeceuticals W. PRAGER, MD New Platform Technologies M. GOLD, MD Fractional RF with Microneedling vs. Fractional Laser A. BADAWI, MD Updates in Laser Tissue Tightening Non-Surgical Face Lift: Minimally Invasive 1440 nm Laser Tissue Tightening on Face and Neck KATHARINA RUSSE-WILFLINGSEDER, ELISABETH RUSSE
Plastische Chirurgie und Laserzentrum Innsbruck Haydnplatz 4, 6020 Innsbruck, Austria katharina@russe.at

Background: Aging results in loss of collagen and elastin which causes excessive skin laxity from the age of 40 onward. In addition, jowling along the mandibular border and prominence of platysmal banding can occur. Laser technology provides additional benefits when treating the reticular-dermal and fibro-fascial-platysma layer of the neck. Objectives: The authors evaluate a minimally invasive approach to treat unwanted skin laxity and fat in the lower face, mandibular and submandibular areas with a new treatment modality that delivers laser energy to the dermal-hypodermal interface. Methods: Patients between 40 to 65 years with unwanted skin laxity and fat received a single treatment using the 1440 nm laser with the Smartlipo Precision Tx workstation (Cynosure Inc. Westford MA) for fat reduction and tissue tightening. In tumescent solution (3050 cc per 5 cm2) laser energy was emitted with an 800 m side-firing fiber (SideLaze 3D) through three small incisions below the chin and at the base of each earlobe. Approximately 1200 Joules were delivered per 5 cm2 through a temperature-sensing cannula with treatment temperatures set to 4547C. The treated fat was removed through vacuum aspiration using a 2 mm cannula. Results: Patients tolerated treatment well with minimal bruising and swelling. A highly targeted delivery of thermal energy resulted in thickening and tightening of skin. Highly satisfactory results were achieved. Outcomes continue to improve through six months. Conclusion: This new approach is safe and effective for the treatment of skin laxity in the lower third of the face and neck, as well as subcutaneous fat in the submandibular area. Side effects and downtime is minimal, especially in comparison to other procedures.

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Pearls and Pitfalls in Laser-assisted Blepharoplasty ALINA A.M. FRATILA, MD


Jungbrunnen-Klinik Dr. Fratila GmbH, Bonn, Germany

Esthetic blepharoplasty of the lower eyelid is not so widelyaccepted and frequently-performed cosmetic procedure like the upper eyelid blepharoplasty. Im giving the unnatural operated look and the frequent side effects like scleral show and rounded eye, as a reason for that. The operation technique must be tailored to the individual and demands a precise preoperative evaluation. In lower eyelid blepharoplasty the following changes related to senescence have to be analyzed and improved concurrently: herniation of orbital fat pads, drooping of the lateral canthus, ectropion, suborbicularisoculi fat (SOOF) hypertrophy or hypotrophy, and actinic elastosis with progressive development of fine rhytides, crows feet, or even festoons. TransconjunctivalUltraPulse CO2laser-assisted blepharoplasty is the technique of choice when only herniated fat pads need to be removed from the lower eyelid. When dermatochalasis and wrinkling of the lower eyelid are a concern as well, transconjunctival lower eyelid blepharoplasty needs to be combined with periorbital traditional or fractional laser skin resurfacing (LSR), to correct the skin laxity. The best tightening result is achieved when performing traditional UltraPulse CO2 LSR, but prolonged downtime and erythema last longer than after fractional laser skin resurfacing (F LSR). I recommend combiningDeepFXTM as a fractional tightening procedure with ActiveFXTM as a fractional resurfacing procedure called TotalFXTM to achieve a better tightening effect on the infraorbital skin. The choice of accurate parameter is mandatory for a short down time. These procedures are more effective if combined at least two weeks preoperatively with the use of botulinum toxin type A for the treatment of dynamic periorbital wrinkles. Considerable dermatochalasis on the lower eyelid may also require a pinch blepharoplasty, this means asubciliary excision of the infraorbital skin but, if very pronounced dermatochalasis or even festoons are present, a transcutaneous subciliary approach may be the method of choice. If lower eyelid laxity is present, a simultaneous lateralcanthopexyor even a canthoplastyshould be additionally performed at the time of surgery in order to avoid lower eyelid retraction with rounded eye and scleral show. Botulinum Toxin for Headaches EMEL GNGR, MD
Associate Professor Acbadem University Dermato-Venereology Department, Istanbul (Turkey) emel.gungor@acibadem.edu.tr

headaches. Because of the high prevalence, it is inevitable to meet many headache patients who come to dermatologists for cosmetic procedures, especially, for BoNTA injections. Although there are many preventive therapies available for headache, there is also great demand for alternative preventive therapies that are effective and well-tolerated with limited systemic effect. According to the patients headache localization and type, BoNTA injection points are selected. For headaches that are primarily localized at the frontal area, the regular injection points and doses are used as for glabellar and frontal hyper functional lines. If the headache is primarily localized around the neck area, the injection points are directed to the splenius capitis, semispinalis and trapezius muscles, 10 U BoNTA for each muscle group. The patients that are treated for cosmetic procedures who also suffer from headaches reported significant reduction in headache frequency, pain intensity, and use of analgesics. As headaches are neurologic disorders, it is best they are treated by specialized neurologists. In some selected patients, BoNTA injections may be an alternative or adjuvant therapeutic option for migraine and tension type headache.

1st hour Free Communications

Treatment of Dermatosis Papulosa Nigra with 1064 nm Nd: YAG Laser in Patients with Fitzpatrick IV-VI skin types ASHRAF BADAWI 1,2 , FAYZA AL ALI 3 , MOHAMED TOME 4
1 2 3 4 National Institute of Laser Enhanced Sciences, Cairo University, Egypt Dermatology and Allergeology Department, Faculty of Medicine, Szeged University, Hungary Rashed Hospital, Directory of Health, Dubai, UAE Department of Dermatology, Faculty of Medicine, Al Ribat University, Khartoum, Sudan

Botulinum neurotoxin type A (BoNTA) was first reported as a potential therapeutic agent for headache by Binder et al. in 1991. Their patients who received BoNTA injections for facial hyper functional lines experienced relief of their headache symptoms. Headaches, particularly migraine and chronic tension type headaches are the most frequent cause of disabling, recurring

Background: Dermatosis papulosa nigra (DPN) is a benign cutaneous condition common among blacks. It is typically distinguished by multiple, small, hyperpigmented, asymptomatic papules on the face and neck of black adults. The condition may be cosmetically unpleasant to some patients. No treatment is generally indicated for DPN unless lesions are cosmetically undesirable. Aggressive therapeutic modalities have been complicated by postoperative hyperpigmentation, hypopigmentation or scarring. Keloid formation is another potential complication. Objective: To evaluate the safety and long term efficacy of the 1064nm Nd:YAG laser in treatment of DPN through retrospective photographic analysis. Methods: A retrospective analysis was conducted for all patients (n = 60) who received 2 sessions of 1064 nm Nd:YAG laser treatments 3 weeks apart. Patients recruited were diagnosed to have DPN and of Fitzpatrick skin types IV-VI. The parameters used for treatment were; 1064 nm wavelength,

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100120 J/cm2 Fluence, 3 mm spot size and 2 stacking pulses were fired on each lesion. Skin cooling before and after the laser pulses was done. Patients were requested to return for evaluation 3 months and 12 months after the second and last session to assess any side effects and the recurrence rate as well as to complete an improvement scale questionnaire. Blinded photographic assessments were performed by three independent dermatologists using unlabeled photos for before and after and arranged in non-chronological order. Reviewers were asked to determine before and after photos and the degree of improvement in the lesions. Degree of improvement was graded using a four point scale: 1 = Adverse effects (Pigmentary changes, textural changes or scarring), 0 = No improvement, 1 = Mild improvement, 2 = Marked improvement. Results: Based on blinded photo assessments by three independent Dermatologists, all the three reviewers had correctly identified the before and after photos. Clinically significant improvements were reported by all the reviewers. Some patients suffered of scabbing for 57 days which was followed up by temporary hypopigmentation for a maximum of 3 weeks. No long term adverse effects were observed neither clinically during the follow up visits nor during the photo evaluation of the photographs. Conclusion: DPN can be treated in type IV-VI Fitzpatrick skin patients using the Nd:YAG 1064 nm laser with long term efficacy and safety. Comparison of Ruby Laser and Alexandrite Laser in the Removal of Amateur Tattoos in Arabic patients IQBAL A. BUKHARI
Professor and Consultant Dermatologist, Dermatology Department, University of Dammam and King Fahad Hospital of University, Dammam (Saudi Arabia)

Comparison of Hair Removal Efficacy and Safety: Nd:YAG vs. IPL GEORGINA SZIMA, EDINA BODNR, VA REMENYIK
University of Debrecen, Medical and Health Science Centre, Department of Dermatology

Background: Photothermal destruction of hair shaft melanin with red and near-infrared wavelengths long-pulse Nd:YAG and IPL, has become an effective treatment in hair removal. Aim: To compare satisfactory levels, safety, side effects and efficacy of Nd:YAG and IPL in hair reduction. Materials and Methods: This was a prospective randomized intra-patient, right-left, assessor-blinded, comparison of Nd:YAG vs IPL. 36 volunteers (skin phototype IIIII) were recruited. Three sessions (4- to 6-week intervals) were performed. Hair counts at both sides were compared before and after the treatments. The efficacy and side effects were scored. Results: Initially there was no significant difference between the number of hair follicles (Nd:YAG: 74.3 47.33; IPL: 79.8 50.67; p = 0.21). After the first treatment, the hair reduction was significant for both systems: Nd:YAG 43 29 %, IPL: 55 33 % (p = 0.0013, p = 0.0001). IPL compared to the Nd:YAG was significantly more effective (p = 0.046). 4 weeks after the second treatment the significant hair reduction was 43 30 % (Nd:YAG) and 52 35% (IPL) (p = 0.0001, p = 0.0001). There were statistically lower side effect scores on the IPL treated side (p < 0.0001) Higher erythema on the Nd:YAG treated side (p = 0.002.), statistically lower pain scores on the IPL side (p < 0.0001). Conclusion: Hair reduction can be achieved by both systems safely and effectively; however, IPL was more effective and had less side effects. Longer treatment and follow up is in progress. In Silico Hair-Skin Model for Efficacy Prediction in Photoepilation: Relation Between Pulse Duration and Follicular Thickness and Depth to Clinical Efficacy MOUNIR ZEITOUNY, MARIJKE VAN VLIMMEREN, TOM NUIJS, NATALLIA E. UZUNBAJAKAVA
Philips Research, High Tech Campus 34, 5656 AE Eindhoven, The Netherlands

Aim: Tattoos in our Arabic society used to have a cosmetic importance in the face of woman. They are usually amateur tattoos done by non-professional women in the tribe. Nowadays, Laser removal of tattoos has become very effective. Here, we report our experience in the removal of tattoos for skin types IIIIV. Using either the Q-switched Alexandrite laser or Ruby laser. Methods: 40 female subjects aged 3550 years from similar racial and ethnic background with amateur tattoos were treated using either the Q-switched Alexandrite or Ruby laser. System settings, number of sessions till complete resolution, and immediate and late side effects were recorded. Results: Effective removal of blue to black tattoos on our patients with Fitzpatrick skin types IIIIV was accomplished. On the average, patients required 3 sessions to completely remove the tattoo by Alexandrite laser as compared to 6 sessions with Ruby laser. No major side effects occurred. Conclusions: Tattoo removal by Q-switched Alexandrite laser was superior to Ruby laser with no side effects which gave a high patient satisfaction.

Background and Objectives: Opto-thermal modeling is a powerful tool to predict hair removal efficacy that makes use of physical parameters as a function of hair-skin optical and geometrical properties. Predictive power is still heavily dependent on the pre-defined hair geometrical properties and on the choice of physical predictors. The objective of this work was to investigate (in a systematic way) how the geometrical and optical properties of a hair follicle influence predictive power of opto-thermal modeling for a range of pulse durations. Methods: We developed a versatile hair-skin model that enables the calculation of thermal profiles at various locations in the hair and skin during light treatment. Essential is realism in representation of follicular compartments; based on relevant histological data, including melanin-containing matrix,

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non-absorbing germinative matrix, and dermal papilla, and scalability of the model. Clinical trials were performed using several consumer- and professional photoepilation devices. The key optical and geometrical hair properties, including thickness, color and number per cm2, were measured before and after each treatment. Device parameters such as the optical spectrum, fluence, pulse duration and shape of each photoepilation device were measured. The device parameters and the hair properties of each volunteer were fed into the opto-thermal model. Results and Conclusions: Critical-to-quality (CTQ) parameters of the opto-thermal model, including peak temperature in follicular compartments and the damage integral, were correlated to clinical efficacy. The influence of pulse duration and follicle geometry on these CTQs was investigated. For various hair shaft thicknesses, follicle dimensions and depths, the thermal relaxation time was derived and results are correlated to in-vivo clinical efficacy results. We obtained a significant correlation between CTQs of the opto-thermal model and clinical data. Considering scalable hair shaft thickness and hair depth significantly improved the predictive power of opto-thermal model. Dual Impact for Treating Striae Distensae (Alba) Using Fractional 1565nm Non-Ablative Laser CLEMENTONI Background: Various fractional non-ablative laser wavelengths are in use for treatment of striae. All deliver energy per depth of lesion and aim at targeting the water in the dermis in a fractional manner for promoting demarcated wound healing. Clinically, it results in elevation and shortening of striae furrow due to collagenesis and contracture. Aim: To evaluate the effectiveness of dual impact for targeting different skin striae components within same session. It is hypothesized that the demarcated deep impact together with the diffused shallow impact will improve both textural and color aspects of striae. Materials and Methods: Two treatments were performed under topical anesthesia on 10 female subjects between the ages of 3055, and having striae alba on various body anatomies (abdomen, breasts, buttocks, thighs). Each striae (besides non treated controls) has been treated for dual impact first deep and dense impact using rectangular shaped coolscanning inside and in parallel to the long axis of the striae, thereafter shallow and loose hexagonal shaped coolscanning large enough to impact inside and laterally to the margins of the striae. Regular as well as 3D pictures were taken at baseline and at follow-up. Results: The laser treatments were well tolerated and there were no treatment associated adverse events. Improvement of striae texture and color was recorded already after 1st treatment. It became significant after the 2nd treatment showing 3D increase in striae volume as well as enhanced mode of pigmentation as compared to the before and the non-treated controls.

Conclusion: The 1565 nm ResurFX modality, used in the dual impact mode, has good impact of the pigmentation and textural appearance of striae. Multimodality Imaging of Cellulite Characterization of Non-Thermal Focused Ultrasound for Non-Invasive Selective Fat Cell R. BARD, MD Aim: To compare the accuracy of 3-D Doppler high resolution sonography mapping and high resolution small field 3 Tesla MRI imaging of cellulite. Material and Methods: Over a 2 year period 199 consecutive patients with palpable lower extremity subcutaneous nodules were preoperatively scanned with a Gevoluson E-9 unit employing linear 18 MHz probe with 3-D angio and glass body power doppler image reconstruction and 3.0 t MRI small field of view within one week. All images were compared with histologic sections. Results: With the use of 2270 MHz probes areas of cellulite were imaged as part of a study using antioxidant therapies to reduce disfiguring areas. MRI had no diagnostic value in cellulite evaluation although it accurately depicted fat compartments. Additionally, Doppler ultrasound blood flow analysis using 15 MHz Doppler showed abnormal flows in the regions of greatest cellulite architectural distortion. The depth of the subcutaneous fat may be measured and the penetration of the cellulite may be assessed with 3-D volumetric dermal/subdermal imaging. Conclusions: 3d multiplanar ultrasound imaging appears to be significantly more accurate than MRI in diagnosing cellulite and may facilitate laser ultrasound guided treatments. Pre visual treatment improvement may be noted by decrease in inflammatory neovascularity. Characterization of Non-Thermal Focused Ultrasound for Non-Invasive Selective Fat Cell Disruption AMIR Background: There is growing demand for non-invasive body contouring technologies in the aesthetic market. A new device has been developed that uses non thermal focused ultrasound for fat reduction. There has been a lack of preclinical data supporting the safety and efficacy of noninvasive focused ultrasound. Methods: A series of in vivo experiments were performed using this new body contouring device on a porcine model. Safety, selectivity, and efficacy were evaluated by histological staining of excised skin and subcutaneous fat specimens. Results: Histologically stained specimens of skin and subcutaneous fat excised from porcine animal model following treatments demonstrated fat cell lysis. There was no evidence of cellular destruction of adjacent blood vessels, nerves and connective tissue. Furthermore, no epidermal or dermal changes were observed clinically or histologically. Conclusions: The delivery of noninvasive focused ultrasonic energy has been validated and supported by the preclinical

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data presented. Future studies will investigate various treatment regimens for improved body contouring results. Anti-Aging Effects of Adipose-Derived Stem Cells on the Skin SAAD AL SOGAIR, MD The skin is one organ which is prone to aging. While agerelated changes are inevitable, they are not universally embraced. Thus, various treatment options for skin aging exist. One of the newer options with high potential for efficacy is the use of adipose-derived stem cells. Adipose derived stem cells are mesenchymal stem cells from adipose tissue. It has the ability to self-renew and to differentiate along multiple lineage pathways. It can be safely and effectively transplanted to either an autologous or allogeneic host and can be given as a subcutaneous injection. The effects of adipose-derived stem cells in aging skin are numerous. These cells have the capability of producing various cytokines such as vascular endothelial growth factor (vEGF), hepatocyte growth factor (HGF), insulin-like growth factor (IGF), platelet derived growth factor (PDGF) and transforming growth factor-beta (TGF-b). These growth factors activate human dermal fibroblasts to increase collagen synthesis, dermal thickness, collagen density, fibroblast number, angiogenesis, procollagen type I protein and mRNA expression. Adipose derived stem cells can also reduce UVB-induced apoptosis. They also have antioxidant properties that can protect human dermal fibroblasts from oxidative stress. They have whitening effects through inhibition of melanin synthesis and through the downregulation of tyrosinase and TRP1 expression. Numerous studies have focused on these anti-aging effects. Indeed, adipose derived stem cells have the ability to defy skin aging. Histological Validation of a Numerical Model of Laser Fractional Photothermolysis in Human Skin JONATHAN A. PALERO 1 , CHARLES-ANTOINE MIGNON 2 AND MARTIN JURNA
1 Care and Health Applications Group, Philips Research Europe, High Tech Campus 34, 5656 AE Eindhoven (The Netherlands) 2 Institut dOptique KTH jonathan.palero@philips.com

molysis based skin rejuvenation systems specifically home-use skin treatment devices. Phototherapy in the Treatment of Acne Vulgaris ARTUR BANI, MD 1 , LIBERTA LABINOTI, MD 2
1 Regional Hospital of Berat (Albania) 2 Hygea Hospital of Tirana (Albania)

Laser fractional photothermolysis is modelled using phase Monte Carlo and Finite Difference Methods. Defining the lesions using an Arrhenius integral model for thermal necrosis, we validated our numerical results with ex vivo human skin histological measurements using various laser parameters in a home-use skin rejuvenation device. Indeed the numerical results on the lesions, using different laser parameters, are in agreement with the histological measurements, validating the numerical model. Thus, the numerical model can be used as a tool for predicting lesion creation by laser photothermolysis in skin. We further investigated numerically the improvements in the creation of lesions in terms of depth and diameter. Overall, the results show that the model can be used for optimization in terms of increasing safety and efficacy of fractional photother-

Background: Acne vulgaris is a common skin disease that affects an estimated 80 % of the population at some time in their lives. The presence of P acnes promotes inflammation and stimulates it by producing pro-inflammatory mediators that diffuse through the follicle wall. It's an obvious target for acne phototherapy due to the inflammatory process that causes. Objectives: To evaluate the effectiveness of pulsed light and heat energy (LHE) for the treatment of mild, moderate, severe forms of acne, and to investigate the role of LHE in clearing inflammatory and non-inflammatory elements of acne, in one month, without additional treatment. Materials and Methods: In a 3 year period we treated 80 patients with acne vulgaris, chosen randomly and voluntarily: 51 with moderate and 29 with mild forms. The patients age ranged between 1426 years. The average age was 19. They had Fitzpatrick skin types II, III, and IV. All patients were treated with the Skin Station machine and received 8 sessions, twice weekly, using 4301100 nm light at 3.5 J/cm2, 35 ms. The effectiveness was based on reduction in inflammatory and non-inflammatory lesions count after two, four, six, and eight sessions and one month after the last treatment. Results: All patients completed the trial. There was no significant effect in the first two sessions, but significant reduction was seen after 4 sessions. After 8 sessions of treatment, a statistically significant difference was seen between inflammatory and non-inflammatory elements, in comparison with pre-treatment. At baseline, the mean inflammatory and non-inflammatory lesions count was 23.6 and 19. After 8 sessions lesions count was 53 % (inflammatory) and 51% (non-inflammatory) of baseline. The clearing of inflammatory and non-inflammatory elements was 52 % in total. One month after the treatment, the clearing of inflammatory elements reached 66.5 % and of non-inflammatory elements 59.7 % and the clearing of inflammatory and non-inflammatory elements was 63.1% in total. Conclusion: The treatment of acne vulgaris with phototherapy LHE as mono-therapy, is a medical alternative which gives good clinical results in a relatively short period of time (one month) and with minimal side effects.

2nd hour Free Communications

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KOSMETISCHE MEDIZIN ABSTRACTS SCIENTIFIC SESSIONS

Effect of Topical Corticosteroids on the Incidence of Postinflammatory Hyperpigmentation after Treatment of Atrophic Acne Scars in Asians with Ablative Fractional CO2 Laser Resurfacing WORAPHONG MANUSKIATTI, M.D.
Professor of Dermatology Faculty of Medicine Siriraj Hospital, Mahidol University Bangkok (Thailand)

Novel Micro-Needle Skin Remodeling RF System for Acne Scars, Wrinkles, and Deep Dermal Lesions KLAUS FRITZ, MD 1, 2, 3 GEORGE SORIN TIPLICA 3 , CARMEN SALAVASTRU 3
1 2 3 Dermatology and Laser Centers, Landau, Germany, University Osnabrck (Germany), Bern (Switzerland) and University Bucharest (Romania)

Topical vs. Intradermal Autologous PRP Following Fractional Ablative CO2 in Acne Scars HEBATALLA ISMAIL GAWDAT Background: Acne scarring causes problems cosmetically and psychologically. The efficacy of a fractional ablative CO2 laser in treatment of acne scars has been documented. Nonetheless, it is associated with lengthy erythema and edema. Platelet-rich plasma (PRP) has recently attracted attention for its ability to promote wound healing. Aim: Compare the efficacy of topical and intradermal autologous PRP combined with fractional CO2 laser in the treatment of atrophic acne scars. Patients and Methods: Thirty patients with atrophic acne scars were enrolled in the study. They were randomly assigned into two equal groups (n = 15): group 1 underwent split face therapy; where one cheek was treated with fractional CO2 laser followed by intradermal injection of autologous PRP, while the other cheek was treated with fractional CO2 laser followed by intradermal injection of normal saline. Group 2 underwent split face therapy, where one cheek was treated with the fractional CO2 laser followed by intradermal injection of autologous PRP, while the other cheek was treated with fractional CO2 laser followed by topical application of autologous PRP. Each patient received three treatment sessions with monthly intervals. Patients digital photographs and Optical Coherence Tomography images were taken at baseline and after 6 months for evaluation. Results: Areas treated with PRP-fractional CO2 laser combination showed significantly; better response (p = 0.03), less side effects and shorter downtime (p = 0.02) than area treated with fractional CO2 laser alone. However, areas treated with intradermal injection and topical application of PRP, did not show significant difference regarding degree of response and downtime (p = 1). Conclusion: Topical PRP -fractional CO2 laser combination is an effective modality in the treatment of atrophic acne scars, through acceleration of healing and augmentation of the degree of response to laser therapy.

Background: Optimal skin remodeling requires a thermal effect on both epidermis and dermis. An optimal solution will combine three types of effects Minimal superficial coagulation on the surface for textural improvement, controlled dermal coagulation for tissue renewal and overall volumetric heating for collagen stimulation. Most existing fractional laser devices are either too aggressive and are associated with high level of patient discomfort, downtime and high adverse effect rate, or lack the ability to generate full volumetric heating for collagen remodeling. The Objective: Objective of this study was to assess the effectiveness of a novel Micro-needle RF system (Micro-needle Skin Remodeling INTENSIF handpiece, EndyMed Medical, Caesarea, Israel) for targeted skin remodeling and for deep, stubborn skin lesions such as acne scars, deep facial wrinkles, striae and dilated pores. This device uses an array of 25 gold plated, non-insulated, tapered micro-needles that penetrate up to 3.5 mm into the skin, delivering RF energy to create controlled coagulation zones through the dermis. The tested system proprietary hardware and software allow for the first time constant energy delivery independent of individual tissue impedance. In contrast to other RF Micro-needle systems on the market the new INTENSIF offers enhanced volumetric heating mode with full hemostasis, eliminating pin-point bleeding spots. Methods: Eight (20) patients with moderate to deep skin lesions were treated using the INTENSIF handpiece. Patients were photographed using standard methods. Each patient underwent between one and three treatment sessions. Different parameters such as treatment comfort, safety and effectiveness were measured using dedicated questionnaires. Results: All subjects experienced mild to moderate edema and erythema as an immediate response to treatment. Edema resolved after up to 24 h post treatment and erythema lasted up to 3 days. Invisible micro-coagulation in the form of skin roughness was reported up to 3 days post treatment. Patients before and after photos, were graded according to standard evaluation methods. Conclusions: The presented results describe, for the first time, a novel treatment that offers a minimal downtime combination of RF controlled coagulation zones and deep volumetric dermal heating for simultaneous and fast epidermal and dermal skin remodeling effect.

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Long-Pulsed Nd:YAG 1064 nm Laser in the Treatment of Onychomycosis HODA AHMED MONIEB, MD 1 , DR. MARY FIKRY MATTA MIKHAIL 2 , EMAN MOHAMED AKMAL AHMAD, M.B. B.CH 3
1 2 3 Dermatology and Venerology, Department, Ain-Shams University Lecturer in Dermatology and Venerology Department, Ain-Shams University Faculty of Medicine, Ain-Shams University

Onychomycosis is both a cosmetic and medical problem and its systemic treatment has many limitations. The aim of this clinical study was to explore and evaluate the use of long-pulsed Nd:YAG laser 1064 nm (Candela, Wayland, MA, USA) in the treatment of onychomycosis. Twenty Egyptian patients (1860 years old) with 65 nails affected by onychomycosis were recruited consecutively from the Dermatology outpatient clinic at Ain-Shams University Hospitals over a period of 6 months. We excluded patients on topical or systemic anti-fungal therapy in the preceding 6 months, permanent or semi-permanent discoloration of the nail plate, any generalized skin disease, immunosuppressed patients and pregnant patients. Mycological examination of nail scrapings by direct KOH (20 %) and culture was done together with photographing the nails before, one month and 3 months after treatment. Distal and lateral subungual onychomycosis was the commonest clinical type (85%) and yeasts represented 90 % of the isolated fungi. Each patient received 4 laser sessions spaced 1 week apart. We used a fluence of 50 J/cm2, a pulse duration of 30 ms, spot size 3 mm and the cryospray was switched off. The nail plate was fully covered with laser irradiation 3 times in each session. After one month, 15 (75%) patients turned mycologically negative while 5 (25%) remained positive. However, 3 out of the 5 mycologically positive patients turned negative at the 3 months follow-up visit. This means that 90 % of the patients and 52 (80 %) of the nails achieved mycological clearance. Only mild pain was reported by all patients during and shortly after the sessions. This study concludes that long-pulsed Nd:YAG 1064 nm is a safe and effective treatment for single and multiple finger or toe nail onychomycosis. Effective Treatment of Onychomycosis Using Laser: Mode of Action CONSTANTINOS DEMETRIOU, MD
(Cyprus)

delivery speed of one shot per second until the patient sensed warmth or withdrew. All patients received Laser sessions until the diseased part of the nail was rejected. In this study clinical efficacy was shown up to 90 %. Investigation of the mode of action of the Laser was also performed by irradiating nail cultures, dermatophytic skin infections and performing a model nail experiment using a real nail. Temperature measurements over and under the nail revealed that 585 nm can pass through the nail and be absorbed by the rich vascular network under the nail transformed into heat trapped under the nail bed. Mycelia are very sensitive to heat (solarization). Results: Irradiation of dermatophytic cultures and skin infections failed. A topical greenhouse effect was suspected for the high cure rate achieved and that was verified by measuring temperatures over and under the nail during treatment. Conclusion: PDL and IPL 585 nm is effective in treating onychomycosis and also very selective as it locates the heat under the nail and sterilizes it. Since spores survive the heat, treatment has to be continuous until fungal load is rejected. Superior Photorejuvenation by Mixing Wavelengths CONSTANTINOS DEMETRIOU, MD
(Cyprus)

Background: Although scientific data has shown some effectiveness of lasers in the treatment of onychomycosis there is no complete work on the matter. I have been treating more than 300 onychomycosis patients since 2005 using Pulsed dye laser (PDL) and IPL with a 585 nm filter with a success rate of more than 90 %. Objective: Demonstrating the effectiveness of PDL Laser and IPL 585 nm and investigating mode of action. Material and Methods: 300 onychomycosis patients were treated with PDL and IPL 585 nm once a week. Infected nails were subjected to 310 passies with dye laser or IPL, with a

Background: Elements of skin ageing may be present as, abnormal pigmentation, loss of collagen, vascular changes, disorders of keratinization, lack of normal immune response and premalignancies. All these parameters may appear on the skin as solitary lesions or, in combination. One method using light to improve all these parameters is IPL (Intense Pulsed Light) Photorejuvenation. IPL exploits wavelengths 6001200 nm delivered in the same pulse. Objective: To study the effectiveness of one mixed session of Q-switched Nd:YAG 1064 nm and KTP 532 nm on parameters of aging. As a source of the two wavelengths, an AL-114 Qswitched Laser by FB Medical Technology Co. China was used. This low cost Laser was originally designed for tattoo removal. Both wavelengths target parameters of aging selectively thus allowing avoidance of potentially unnecessary wavelengths as these are delivered by IPL, thus maximizing rejuvenation and reducing side effects. Patients and Methods: More than 500 patients within a period of 5 years presenting various parameters of aging, like pigmentation, vascular damage, wrinkles, disorders of keratinization, and premalignancies, were subjected to one session of Nd:YAG 1064 nm following KTP 532 nm. Lesions were evenly and repeatedly scanned with both wavelengths until light graying, slight pain or purpura presented itself. Results: All patients improved significantly in all parameters of ageing, within a period of 20 days, after just one session lasting 30 sec to 10 min. The procedure is almost painless with minimum irritation, no down time, at low cost and excellent cosmetic outcome. Post Inflammatory Pigmentation appeared in less than 1%. Conclusion: The use of a mixed Nd:YAG 1064 nm and 532 nm Laser session proves very effective as it selectively targets all

50

KOSMETISCHE MEDIZIN ABSTRACTS SCIENTIFIC SESSIONS

parameters of ageing. It can be a fast, painless and simple office procedure with no down time and minimum discomfort for the patient. Contribution of LED-Photobiomodulation to Wound Healing Management MICHELE PELLETIER AOUIZRATE, MD
President LED Academy

Photobiomodulation is the process by which specific wavelengths are absorbed by chromophores in a selective way. This triggers signaling processes in biological cells. This process occurs naturally (natural photobiomodulation (PBM)), when walking outside for example. It is also a natural dynamic phototherapy. The process is modulated by many parameters that include irradiance, optimal combination of wavelengths, their mode of continuous or pulsed emission and in this case its transmission frequency, moment of day, etc. We briefly discuss some clinical cases for which the PBM was used alone or in combination. We discuss the prospects that are very promising. LED Academy is a non profit organization with a membership open to physicians, physicists, cell-biologists, optoelectronic engineers, concerned with photobiological mechanisms and treatments related to the use of LED or Low Level Lasers. LED Academy welcomes benefactor members from pharmaceutical or medical device companies.Its goal is therefore dedicated to the promotion of research, education, and clinical applications in photobiology. Non-Ablative 1540 Fractional Laser to Help Injection Lipolysis and Dermal Fillers in Lower Face Rejuvenation REHAB HEGAZY, MD 1 , TAHRA LEHETA, MD 1 , YEHIA EL GAREM, MD 2 , RANIA ABDEL HAY, MD 1 , DALIA ABDEL HALIM, MD 1
1 Dermatology Department, Faculty of Medicine, Cairo University (Egypt) 2 Dermatology Department, Faculty of Medicine, Alexandria University (Egypt)

metic results. Whereas in group B their PS level reached its maximum at the final assessment (month 13), where 75% of the patients (n = 9) felt they achieved optimal cosmetic results. Overall the treatment was well tolerated by all patients in both groups and anesthesia was never required. Conclusion: This study further documents the importance of combination therapy in facial rejuvenation, offering a treatment protocol combining injection lipolysis and hyaluronic acid as an effective, safe, short term therapeutic option in lower face rejuvenation. The addition of 1540 nm non-ablative fractional laser to the protocol offers a higher efficacy with longer-term effects and no adverse events.

3rd hour Free Communications

A Holistic Approach to Aesthetics BARAD Background: Physicians and cosmetic surgeons learn in initial consultations their patients stated objectives then apply experience, artistic eye, medical and technical knowledge to developing a treatment plan. Patients self-perception and selfworth are integrated into this process. Applied Kinesiology (Muscle Testing) is an accurate, novel, painless and inexpensive assessment tool to determine whether patients know what they want and are satisfied with the results. Aim: Physicians seeking a holistic medical experience can incorporate muscle testing at no cost to the practice or patient. The methodology gets to the heart of patients internal motivation for cosmetic intervention and measures ultimate satisfaction. Materials and Methods: Only knowledge of muscle testing technique is needed to incorporate it into the treatment procedure and plan. It is based on the premise that ones inherent muscle strength is only as strong as ones internal unconscious belief system. Therefore, a persons muscle will stay strongunder applied pressure when they believe in their statement or visualization. The muscles of those whose unconscious beliefs do not comport with their statements, will succumb to pressure. Using muscle testing in my initial consultation and posttreatment provides empirical support in determining what patients actually need to attain their treatment objectives and to gauge their level of satisfaction post-procedure. The presentation will show how to muscle test patients to assess their self-image and belief that cosmetic intervention will help them feel better pre-treatment and then assess the results posttreatment. Results: This technique increases and measures patient satisfaction. Patients report that muscle testing helps them identify their objectives and helps them be comfortable with their treatment options. Conclusion: This interactive presentation provides insight into a cost-free holistic approach to cosmetic surgery and aesthetics that increases patient satisfaction and helps identify patients with BDD.

Background: Rejuvenation of the lower face can be challenging and no single modality can accomplish all its complex events. Patients and Methods: This 18 month study included 24 female patients with a primary complaint of lower face aging signs. They were randomly allocated to either group A who received injection lipolysis and hyaluronic acid dermal filler, or group B who in addition received non ablative 1540 fractional laser. The improvement evaluation score used was the global aesthetic improvement scale (GAIS). Patients satisfaction level (PS) was also recorded. Both were repeated at months 6, 13 and 18. Meticulous reporting of any adverse events was carried out. Results: At all evaluations, laser group showed higher degree of improvement. Interestingly, at short term evaluation (6 month), there was no significant difference between both groups (P > 0.05), however the laser group improvement in comparison to the other group became significant in the longterm evaluations (13 and 18 months) (P < 0.05). In group A the PS was maximum in the pre-final assessment (month 6), where 50 % of the patients (n = 6) felt they achieved optimal cos-

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3-D Imaging of the Facial Nerve and Artery R. BARD, MD


Director, Biofoundation for Angiogenesis

Aim: To demonstrate the appearance of facial nerve and artery with 3-D power Doppler sonography in pretreatment planning of facial laser therapy. Material and Methods: Over 12 years normal subjects were prospectively scanned with a ge voluson e-8 unit employing linear 1118 MHz probe with conventional 3-D/4-D imaging using 3-D angio and glass body power doppler image reconstruction. Images were compared with contrast enhanced CT scans and DCE MRI in many instances. Results: 3-D PDS showed vascularity that correlated with CT and vascular imaging studies. Conclusions: 3-D power Doppler imaging is a noninvasive modality that can preoperatively map the facial nerves and arteries in many patients possibly reducing intra-operative trauma. Calcium Hydroxylapatite in Prejowl Sulcus Enhancement: Results and Complications MARIO GOISIS Aim: To describe long-term results and safety of calcium hydroxylapatite for correction of prejowl sulcus. Material and Methods: 98 patients were included in this study. Calcium hydroxylapatite was injected in the deep dermis and/or subdermal plane. The images of the patient were acquired by standard camera system and evaluated 8 and 12 months after treatment. Results: In 68 cases the immediate and long-term aesthetic results very classified as very good, in 8 as good, in 16 as fairly good and in 6 as inadequate. Conclusion: The use of Calcium hydroxylapatite can provide an efficient correction the prejowl sulcus. On 98 patients there were 12 minor adverse events. All 12 were resolved with local treatment. 8 patients had inflammation and edema, which was resolved with oral prednisone. 4 patients experienced subcutaneous nodules, which were successfully treated with triamcinolone injection (1 mg injected into each lesion). Efficacy of Onabotulinum vs. Abobotulinum in Treatment of Primary Palmer Hyperhidrosis Using a Conversion Factor of 1 : 2.5 HANAN EL KAHKY, HEBA DIAB, DALIA GAMAL ALY Introduction: Two preparations of botulinum A toxin (BTX-A) are commercially available for the treatment of palmar hyperhidrosis (PPH); Botox (Allergan; 100 U/vial) and Dysport (Ipsen Limited; 500 U/vial), which are not bioequivalent. Different studies tried to find an appropriate conversion factor between them but results remain controversial. Objectives: To compare the efficacy of Botox and Dysport in PPH using a conversion factor of 1 : 2.5. Methods: Eight patients with severe PPH received intra-dermal injections of Botox in one palm and Dysport in the other in the

same session. Clinical assessment was performed at baseline and post-treatment at 3, 8, 13 weeks, 6 and 8 months using Minors iodine starch test, Hyperhidrosis Disease Severity Scale (HDSS), and Dermatology Life Quality Index (DLQI) test, to state disease severity, and disease related impairment of quality of life. Results: The mean SD dose injected per palm was 50 6 U Botox, and 125 15 U Dysport. At 3 weeks, a significant decrease in sweating for both preparations was noted that was more pronounced with Dysport compared with Botox (Mean SD of PSA score was 1.38 0.52 vs. 2 0 respectively, P-value < 0.05). Nevertheless, at 8 weeks, this difference turned insignificant and the decrease in sweating area remained satisfactory and was equal for both palms. Continued evaluation showed similar improvement in both palms with non-significant difference at 13 weeks, 6 and 8 months. The effect remained efficient up to 8 months. Patients with longer disease duration were more liable to relapse. Conclusion: The efficacy and safety of Botox and Dysport injections were similar using a conversion factor of 1 : 2.5. There was a trend towards a more rapid action after Dysport treatment but without significant importance. The Efficacy of Botulinum Toxin Type A in the Treatment of Keloids EMAN SHAARAWY, MD, REHAB HEGAZY, MD AND RANIA MOUNIR ABDELHAY, MD
Dermatology Department, Faculty of Medicine, Cairo University, Egypt.

Background: Intralesional (IL) corticosteroid therapy is regarded by many to be first-line therapy in treatment of keloids. The efficacy of IL Botulinum toxin type A (BTA) has been postulated in such an indication with controversial reports. Aim: Compare efficacy, safety of IL BTA to the well documented IL corticosteroid therapy in treatment of keloids. Patients and Methods: 24 female patients with keloids were randomly divided into 2 equal groups, receiving IL steroid injection repeated every 4 weeks for 6 sessions (group 1), and IL BTA injection 5 IU/cm3 repeated every 8 weeks for 3 sessions (group 2). Objective parameters (hardness, elevation, redness), subjective complaints (itching, pain, tenderness), patient satisfaction and side effects were evaluated. Follow-up continued 1 year post-treatment. Results: Significant improvement in objective parameters of both groups was documented, with non-significant differences between them. All patients documented significant reduction of their subjective complaints, but more significantly in group 2 who also showed higher satisfaction. Skin atrophy and telangectasia were evident in 3 patients of group I. Conclusion: This is the first RCT to compare IL BTA to IL steroids in treatment of keloids. It establishes the possible effective and safe "off-label" use of IL BTA in such indication.

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KOSMETISCHE MEDIZIN ABSTRACTS SCIENTIFIC SESSIONS

The Sensor Signal Hypothesis of the Role of Interleukin-1 Alpha for Skin PETER SCHOCH AND IGOR POMYTKIN
United Cosmeceuticals GmbH Zurich (Switzerland)

Oral Supplementation with Collagen as an Anti-Aging and Skincare Treatment RITZ Treatment of Postburn Facial Hyperpigmentation with Vitamin C Iontophoresis SO YOUNG JI, MD, JI WON LEE, MD
Dong-Kang General Hospital, Plastic and Reconstructive Surgery, Ulsan (Korea)

Background and Hypothesis: The epidermis, especially the stratum corneum, is rich in intracellular interleukin-1 alpha (IL-1a). This cytokine is constitutively expressed by keratinocytes, subject to positive feedback control (IL-1a stimulates the expression of IL-1a). IL-1a has been shown to stimulate dermal fibroblasts to produce connective tissue (including collagen and elastin) and to release several growth and differentiation factors acting on the epidermis. Based on these findings we propose the hypothesis that IL-1a accumulating in the stratum corneum acts as sensor to injury by being released from corneocytes upon mechanical, chemical or UV impact. Once released it stimulates the expression and release of IL-1a by adjacent keratinocytes, thus generating a cascade of IL-1a reaching eventually the dermis. The stimulation of dermal fibroblasts by IL-1a leads then to the replenishment of collagen and elastin as well as the strengthening of the epidermis by mesenchymal/epithelial interactions. Aim: To demonstrate an enrichment of collagen and elastin in the dermis by topical administration of IL-1aonto skin. Materials and Methods: Placebo-controlled pilot study on the collagen and elastin content in the dermis by two-photon fluorescence microscopy after topical application of a gel with and without IL-1a (dermatopoietin) onto the forearm of volunteers with signs of skin aging. Results: The study showed almost a doubling of collagen and elastin content after 4-week administration of IL1a compared to placebo and baseline. Conclusion: IL-1a, which due to its size of 18kD cannot penetrate skin, leads to a remote effect in the dermis as demonstrated by a significant increase of collagen and elastin. This finding supports the sensor signal hypothesis of IL-1as role for maintaining the structural and functional integrity of skin.

Purpose: Vitamin C has important physiologic effects on skin, including inhibition of melanogenesis. The purpose of this study is to evaluate the effectiveness of Vitamin C iontophoresis for the treatment of postburn hyperpigmentation. Material and Methods: The authors performed a retrospective analysis of 93 patients from February 2008 through February 2010. 51 patients were treated with Vitamin C iontophoresis to control postburn hyperpigmentation and 42 patients were not. Experimental group was chosen 20 of 51 patients who had Vitamin C iontophoresis and had normal facial skin on the comparable contralateral aesthetic unit. Control group was chosen 20 of 42 patients who were not treated with Vitamin C iontophoresis and had also contralateral normal aesthetic unit. Using a digital scale color analysis, the results were analyzed with Wilcoxon signed rank test. Results: Analysis revealed significant improvement of hyperpigmentation in the experimental group compared to control group. The difference of initial value and 6 month later value showed significant change. Mean of experimental group was 11.61 and control group was 7.23. Therefore, Vitamin C iontophoresis revealed significant improvement of hyperpigmentation in the experimental group compared with control group. Conclusion: Vitamin C iontophoresis is an effective treatment modality for post burn hyperpigmentation.

Mandatory Reading for Aesthetic Practitioners


Now completely in English Online
INTERNATION AL ISSUE OF THE JOURNA L KOSMETISCH

Cosmetic Medicine the new international issue of Kosmetische Medizin, the leading German language publication in Aesthetic Dermatology and its adjoining fields, is now available online in the English language. The journal covers with its reviews, originals, application studies and case reports the whole spectrum of modern Aesthetic Medicine. The peer reviewed contents serve the aesthetic professional as a supportive measure for continuing and further education.

E MEDIZIN,

C MEDICINIE

COSMET

34. JAH RGA NG,

201 3, ISSN 1430-403

Official publ ication of the Academy of following socie Asso ties: Austrian Acad ciated Dermatologic Institutes (AAD emy of Cosm Austrian Socie etic I) ty of Dermatolo Surgery and Aesthetic Federation Medicine (AAC gic Cosmetics of Aesthetic S) and Research Derm German Socie on Aging (OGD ty of Aesthetic atology and Laser Med KA) German Socie icine (VDL) ty of Aesthetic Botulinum Toxin Therapy Network Glob (DGBT) Dermatology alhealth (DGAED)

1.2013

Official publication of the following societies: - Academy of Associated Dermatologic Institutes (AADI) - Austrian Academy of Cosmetic Surgery - Austrian Society of Dermatologic Cosmetics and Research on Aging - Cosmetic Dermatology Society of India (CDSI) - DGD German Society of Aesthetic Dermatology - DGBT German Society for Aesthetic Botulinumtoxin-Therapy - Network Globalhealth - VDL Federation of Aesthetic Dermatology and Laser Medicine

Frequency: 4 x per annum

NEW TRE NDS IN RHI NO PLA STY ETH NIC CON SID ERATIO NS FOR THE AES THE TIC FAC IAL USE S OF BOT ULI NUM TOX IN: AN ASI AN PER SPE CTI VE BODY DYS MO RPH IC DIS ORD AN UND ERE ERS : STI MATED PRO BLE M AES THE TIC WIT HIN DER MATOL OG Y PAT IEN ABS TRA CTS TS 3. ME COS ME TIC SUR GER Y AND ETI NG OF THE WO RLD ACA DEM Y OF ANN UAL ME ACA DEM Y OF ETI COS ME TIC SUR GER Y AND NG OF THE AUS TRI AN AES THE TIC ME DIC INE

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