abstracts from 5cc cannes conference

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KOSMETISCHE MEDIZIN ORGANSCHAFTEN: Arbeitsgemeinschaft Assoziierter Dermatologischer Insitute e.V. Austrian Academy of Cosmetic Surgery & Aesthetic Medicine Cosmetic Dermatology Society of India Deutsche Gesellschaft für Ästhetische Botulinumtoxin-Therapie e.V. Deutsche Gesellschaft für Ästhetische Dermatologie Network-Globalhealth Österreichische Gesellschaft für Kosmetische Dermatologie und Altersforschung Vereinigung für ästhetische Dermatologie und Lasermedizin e.V. COSMETIC MEDICINE, 34. JAHRGANG, 2013, ISSN 1430-4031 2013 ABSTRACTS 3 rd 5 Continent Congress 18.–21. September 2013, Cannes SUPPLEMENT

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Page 1: Abstracts from 5CC Cannes Conference

KOSMETISCHEMEDIZIN

ORGANSCHAFTEN: Arbeitsgemeinschaft Assoziierter Dermatologischer Insitute e.V.Austrian Academy of Cosmetic Surgery & Aesthetic MedicineCosmetic Dermatology Society of IndiaDeutsche Gesellschaft für Ästhetische Botulinumtoxin-Therapie e.V.Deutsche Gesellschaft für Ästhetische DermatologieNetwork-GlobalhealthÖsterreichische Gesellschaft für Kosmetische Dermatologie und AltersforschungVereinigung für ästhetische Dermatologie und Lasermedizin e.V.

COSMETIC MEDICINE, 34. JAHRGANG, 2013, ISSN 1430-4031

2013

ABSTRACTS3rd 5 Continent Congress

18.–21. September 2013, Cannes

SUPPLEMENT

Page 2: Abstracts from 5CC Cannes Conference

Um 5 Uhr morgens aufstehen und in der

Bucht von Cannes eine Runde schwim-

men! Kytesurfen, Parasailing, Tretboote,

Jetski, Tauchen oder einfach nur am

Strand spazieren gehen ... in der Big

Blue kann man viel erleben...!

Getting up at 5 o’clock 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 LÉRINS –

ILE SAINTE-MARGUERITE

In kurzer Entfernung von Cannes bieten

die Lérins-Inseln ein erstaunliches Natur-

reservat, Geschichte und Spiritualität.

In einer idyllischen, unberührten Natur

bieten die Inseln den Besuchern eine

mediterrane Flora und Fauna und eine

einzigartige Geschichte kombiniert die

Geheimnisse der Zisterziensermönche.

Alles hier wartet darauf, entdeckt zu

werden.

L’Ile Ste-Marguerite ist eine der zwei

Lérins-Inseln, Cannes Juwelen.

Der Duft der Aleppo-Kiefern gemischt

mit Myrte, Zitronen, Rosen, Clematis

usw. ist betörend! Das westliche Ende

wartet mit einem großen Vogelschutz-

gebiet auf. Der Wald von Lérins ist die

Heimat vieler Tierarten wie Fasane,

Montpellier Schlange, Eule, Steinkauz,

Turmfalke, Igel...

In short distance to Cannes the islands

of Lérins 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.

L’Ile Ste-Marguerite is one of the two

Lérins 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 Lérins is home to many animals,

such as pheasants, the Montpellier snake,

owl, little owl, kestrel, hedgehog…

ENTDECKEN SIE CANNES!DISCOVER CANNES!

Page 3: Abstracts from 5CC Cannes Conference

Welcome Note Kosmetische Medizin 1

5 Continents CongressSeptember 18–21, 2013

Cannes, France

The goal of the 5 Continents Congress (5CC) is to provide a global conference dedicated to all aspects ofaesthetic medicine. To fulfill this mission, the 5CC Board, which itself spans several continents, hasgathered leading speakers and researchers from around the globe. The 2013 meeting boasts over 100cosmetic dermatologists and plastic surgeons from 30 countries. The program is both broad in its cove-rage and in-depth analysis of current non-invasive cosmetic treatments. The scientific content has beenspecifically geared toward assessing the aesthetic needs of diverse cultures, treating skin of differentethnicities, and enhancing facial structures from various parts of the world. In complement, the registe-red attendees come from all corners of the globe.

The 5CC in 2009 focused on lasers and energy-based devices. The 2013 meeting has significantly expan-ded coverage of topics in cosmetic dermatology and plastic surgery, to include extensive emphasis on fil-lers and neuromodulators, with the aim of teaching clinicians the most up-to-date techniques and pre-senting the key studies that shape our everyday practice. Furthermore, this year’s scientific sessionsadd focused analysis of cutting edge topics such as stem cells and biocellular therapies, LED and photo-modulation, cosmeceuticals, and nanotechnology. Additional sessions are designed to facilitateapproaches that combine home device-based treatments, minimally-invasive procedures, topicals, andinjections. 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 scientificsession. For our readers who receive the abstracts after the meeting, we hope that you will be able tolearn from these abstracts, and perhaps to use this as a springboard for further reading on the topics inmanuscripts subsequently published by the presenters.

DAVID GOLDBERG MD JD SHLOMIT HALACHMI MD PHDPresident, 5CC 2013 Scientific Program Chair, 5CC 2013

Page 4: Abstracts from 5CC Cannes Conference

WEDNESDAY SEPTEMBER 18TH 2013

Special Pre-Conference Session Home Use Devices Symposium 4ESLD Fostering Course AdvanceModule I: Vessels Vascular Lesions Management 4

THURSDAY SEPTEMBER 19TH, 2013 (09:00 – 11:00)

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

THURSDAY SEPTEMBER 19TH, 2013 (11:45 – 13:45)

New Approaches for Old Indications 14HA and non-HA fillers in 2013 15Scars and Keloids 15Device-based Approaches to Acne and Hidradenitis 15Skin Tightening on and off the Face 16Toxins in 2013 16PDT: Medical Indications 17Approach to Scars 17

THURSDAY SEPTEMBER 19TH, 2013 (15:15 – 17:15)

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

FRIDAY SEPTEMBER 20TH, 2013 (09:00 – 11:00)

New Technologies 25Permanent and Durable Fillers: Safety and Outcomes 25Nanodermatology 26Ethnic Skin and Beauty 26

SCIENTIFIC PROGRAMMEIMPRESSUM | IMPRINT

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 für Ästhetische

Botulinumtoxin-Therapie e.V.• Deutsche Gesellschaft für Ästhetische Dermatologie• Network-Globalhealth• Österreichische Gesellschaft für Kosmetische

Dermatologie und Altersforschung• Vereinigung für ästhetische Dermatologie und

Lasermedizin e.V.

34. Jahrgang, Supplement 1, 2013 Volume 34, Supplement 1, 2013ISSN 1430-4031

Verlag/Publishing Housegmc – Gesundheitsmedien und Congress GmbHKaiser-Friedrich-Straße 90, 10585 Berlinwww.gmc-medien.de

Schriftleitung/Editor-in-ChiefProf. Dr. med. Uwe WollinaHautklinik des Krankenhauses Dresden-FriedrichstadtFriedrichstraße 41, 01067 DresdenTelefon: 03 51/4 80 12 10

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Anzeigenpreise/Advertising RatesNach Tarif Nr. 30 vom 01.01.2013Tarif Jan. 1, 2013

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

Page 5: Abstracts from 5CC Cannes Conference

FRIDAY SEPTEMBER 20TH, 2013 (11:45 – 13:45)

Ablative vs. Non-ablative Treatment 26Fat-Targeting Treatments 27Tips and Tricks: Expand the Use of Your Device 28Pigmented Lesions 28Home Use Devices 29Stem Cells and Biocellular Therapies 31Hair Restoration and Regrowth 31

FRIDAY, SEPTEMBER 20TH, 2013 (15:15 – 17:15)

Fact or Fiction? 31Injection Therapies: Off the Face 32Laser Hair Removal: Updates 32Hyperhidrosis: Device-based Approaches 33Cosmeceuticals 33Biomodulation with LED and Laser 35Sclerotherapy 35

SATURDAY, SEPTEMBER 21, 2013 (09:00 – 11:00)

Awards and Plenary: Whats on the Horizon? 36Management of Adverse Events: Devices 36Skin Tightening 36Liposuction 37Striae 37

SATURDAY, SEPTEMBER 21TH, 2013 (11:45 – 13:45)

Body Contouring: I 37Lids and Lashes 37Alternatives to Toxins 37What do Patients Want? 39Body Contouring: II 39Lip Service 40The Interface of Cosmetic Surgery and Non-surgical Approaches 40Patient Management from Marketing to Post-Treatment 40

SATURDAY, SEPTEMBER 21, 2013 (15:15 – 16:45)

Advanced Rejuvenation Methods 40The Homogeneously-Toned Face 42The Cutting Edge

FREE COMMUNICATIONS 44

SCIENTIFIC PROGRAMME

Redaktionskollegium / Editorial councilProf. 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, Mönchengladbach; Dr. med. OliverDörzapf, 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, Mönchengladbach; 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

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. HaraldGerny, Zürich; Prof. Dr. med. Eva Kokoschka, Wien; Dr. med. MosheLapidoth, Herzelia Pituach; Dr. med. Thada Piamphongsant, Bangkok;Prof. Dr. med. Christopher Rowland Payne, London; Dr. med. MatthiasSandhofer, Linz; Dr. med. Georges Stergiou, Zürich; Dr. med. RekkaSheth, Mumbai; Prof. Dr. Franz Trautinger, St. Pölten; Dr. med. HannaZelenkova, Svidnik; Dr. med. Zoran Zgaljardic, Zagreb.

Redaktionshinweise

Mit Namen gekennzeichnete Beiträge geben nicht unbedingt die Meinung der Redaktion wieder. Anzeigen und Fremdbeilagen stellendie Meinung der darin enthaltenen Auftraggeber dar. Dosierungsan-weisungen und Applika tions formen erfolgen außerhalb der Verant-wortung der Redaktion und des Verlages und sind vom Anwender zuprüfen. Beiträge in den Sektionen „Praxis Service“ und „Für Sie refe-riert“ unterliegen nicht der inhaltlichen Verantwortung des Schriftlei-ters und der wissenschaftlichen Redaktion. Redaktionsschluss liegtsechs Wochen vor Erscheinen einer Ausgabe.

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Page 6: Abstracts from 5CC Cannes Conference

Wednesday September 18th 2013

SPECIAL PRE-CONFERENCE SESSION HOME USE DEVICES SYMPOSIUMCHAIR – 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 rejuvenationTOM NUIJS

Clarisonic’s 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 DevicesG. TOWN

Home Use IPL and Laser Hair Removal Devices: End-to-End Human Safety J. NASH

03:30 pm – 03:45 pm Afternoon Tea

Home Use Efficacy and Safety Study for Mild to Moderate AcneCAERWYN ASHDezac Group, Cheltenham (UK)

[email protected]

Background: Treatment of Acne vulgaris is a challenge to thedermatologist and causes emotional anxiety for the patient.Treatment of Acne vulgaris may be well suited to home-useapplication where sufferers may be too embarrassed to seekmedical treatment.Objective: This study is designed to quantify the effectivenessof using a blue light device in a combination therapy with pro-prietary creams in a self-treat regimen investigation.Method: 41 adults with mild-to-moderate facial inflammatoryacne were recruited. Subjects were randomly assigned to com-bination blue light therapy (n = 26) or control (n = 15). Photog-

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% intreatment group and increased 2.45% in control group. Thereduction was most observed in the first 3 weeks after start oftreatment. Treatment is pain and side effect-free.Conclusion: Home-use blue light therapy improves inflamma-tory facial acne three weeks after first treatment with no seri-ous adverse effects. The blue light device offers a valuablealternative to antibiotics and potentially irritating topicaltreatments. The onset of the effect was observable at week 3,and maximal between weeks 8 and 12. Blue light phototherapyusing a narrowband LED light source appears to be a safe andeffective 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. D’ARCY

ESLD FOSTERING COURSE ADVANCE

Module I: Vessels Vascular Lesions ManagementVascular Lesions Management, Vascular Malformations andtumors – Treatment State of the ArtAGNETA TROILIUSAssociate Professor, Laser & Vascular Anomalies, Dept of Dermatology,

Skåne University Hospital, Malmö (Sweden)

Laser and IPL are good therapeutic adjunctive tools for con-genital and acquired vascular lesions. Technological advancesin lasers have reduced the adverse effects and increased theefficacy. In order to choose the optimal laser treatment for agiven lesion it is more important to have a thorough under-standing of the available technology as well as understandingof each individual vascular lesion. The physician should haveadequate background training in lasers and adequate knowl-edge of the lesion being treated, depth and nature, differentmachines, parameters, cooling, safety and after care. Lasershave been sometimes given an unjustified criticism in somearticles and one of the reasons could be that e.g. infantilehemangiomas and capillary malformations have not been subclassified as they need to be, to be able to compare results.

Vascular lesions can be treated by a variety of vascular spe-cific lasers (Pulsed dye laser = PDL) which has a high speci-ficity of hemoglobin, diode, long pulsed YAG and intensepulsed light (IPL). When treating deeper and more hyper-trophic lesions long pulsed PDL and IPL are not always enoughand then one can use Nd:YAG laser at 1064 nm that has a highpenetration depth of up to 5–6 mm. It is selectively absorbedby oxyhemoglobin (but less than the traditional vascular lasers

KOSMETISCHE MEDIZIN ABSTRACTS SCIENTIFIC SESSIONS4

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at 530–650 nm) and poorly absorbed by water. It is a higherrisk of persistent side effect as atrophic scarring and pig-mented changes. Therefore one has to choose the lesions care-fully and the patients should be fully aware of the risk of scar-ring. Cases when scarring can be accepted e.g painful venousmalformations on the body that cannot be treated with exci-sion or embolization, bleeding granuloma telangiectatic. Clini-cal endpoints can be shrinkage and blanching of the lesions aswell as the popping sound if the lesions are smaller than a peasize.

Propranolol is a selective beta blocker that has since 2008been used in the treatment of especially larger more difficultinfantile hemangiomas (IH) with revolutionary good resultsand few side effects. The shrinkage of the tumor in itself hasimproved the penetration of the Laser or IPL light. Start asearly as possible 2–3 mg/kg and treat around 6 months alldepending of the individual lesion. Very few side effects havebeen 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 andexhibit normal endothelial turnover).

a. Fast Flow• Aneurysm, ectasia, stenosis• Arteriovenous fistula (AVF)• Arteriovenous malformation (AVM)b. Slow flow• Capillary Malformation (CM)• Venous Malformation (VM)• Lymphatic Malformation (LM)

- Macrocystic- Microcystic

Combined

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

UPDATE IN THE MANAGEMENT OF VASCULAR LESIONSCHAIR: J. S. NELSON

Update in the Management of Vascular LesionsJ. STUART NELSON, MD, PH.D.Beckman Laser Institute and Medical Clinic,

University of California Irvine (USA)

The concept of selective photothermolysis applicable to thelaser treatment of cutaneous lesions was first introduced in1983. Using this approach, a target can be selectively destroyedby using the appropriate laser wavelength, pulse duration, andenergy.

Relationships between laser parameters and their effect onport wine stain (PWS) treatment outcome are complex andcontinue to be incompletely understood. PWS are often treat-ment-resistant to pulsed dye laser (PDL), and new methodolo-gies of treatment are urgently needed to optimize absorptionof laser light by hemoglobin, heat transfer into the entire ves-sel wall, and coagulation of the blood vessel wall. The vast het-erogeneity in terms of PWS blood vessel size and depth alongwith revascularization make it very difficult to eradicatelesions completely with current PDL technology. Increasedunderstanding of interactions between PWS and PDL has led tothe development of new therapeutic modalities. Largerprospective, comparative, and controlled clinical studies, how-ever, are still needed to better define the role of combinationtherapies for the treatment of PWS. Newer approaches willhopefully lead to better solutions for ineffective PWS treatmentand lesion recurrence.

Lasers for Non-Hemangioma Vascular LesionsTHIERRY PASSERON, MD, PHDDepartment of Dermatology & INSERM U1065, team 12, C3M

University Hospital of Nice (France)

Background: Lasers are an effective approach for treating vas-cular lesions. Aim: To review the indications and limitations of lasers fortreating 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 ofother wavelengths and the use of external dye have beenrecently reported. The neoangiogenesis observed after laser

5Kosmetische Medizin

Page 8: Abstracts from 5CC Cannes Conference

treatment explains some unsuccessful laser treatments. Theongoing researches to target this neoangiogenesis and therecent report of the gene responsible for PWS should provideprogresses in the near future. The treatment of spiderangiomas, facial telangiectasias, rosacea, venous lakes andleg veins has also been improved by the use of lasers. Althoughrare, venous or lymphatic malformations are difficult to treat.The use of lasers can also be of interest in these vascular mal-formations. Conclusion: Laser treatment can provide significant improve-ment of non-hemangioma vascular lesions. A precise diagnosisis mandatory to assess if a laser approach can be useful and todetermine the optimal parameters. Combination treatmentswith laser and external dyes or anti-angiogenic agents couldimprove actual results, but they still warrant additional investi-gations.

Laser for Vascular Lesions in AsiansHENRY HL CHAN MD, PHD, FRCP, Hon. Clin Professor, University of Hong Kong

Background: The use of laser and light source have gainedmuch popularity in recent years, Asians with higher epidermalmelanin context are more prone to develop adverse effectAim: To review the safety and efficacy of laser and IPL whenused among dermatological conditions in AsiansMethod: literature review looking at the use of laser and IPLfor the dermatological application in Asians.Result: while both laser and IPL can be used among skin ofcolor, IPL does carry greater potential risk of complicationConclusion: Laser is more superior in the treatment of derma-tological conditions in Asians

Future Trends in the Treatment of Vascular AnomaliesGERD KAUTZ, MDAm Markt 3, 54329 Konz (Germany)

Since 17 years now we are treating very successfully all kindsof vascular malformations with different laser – and IPL sys-tems. The introduction of propranolol has decreased the indi-cation of treatment for hemangioma significantly. The IPL- andlaser systems represent the Gold standard for rosacea,teleangiectasia, and other vascular diseases. Even with a fewtreatment cycles you can achieve outstanding results withminor side effects. The patients should be informed extensivelyabout the fact that it could come to recurrences with vascularmalformation before the first treatment. A consistent sun-screen before and after the therapy is useful, as with all laser-and IPL-treatments.

CHEMICAL PEELSCHAIR: M. LANDAU

Medical Indications for Peels M. LANDAU, MD

Chemical Peels in Skin of ColourMUKTA SACHDEV, MD (DERM), DPD, DD, DIP DERM (UK)Professor and Consultant

Department of Dermatology, Manipal Hospital, Bangalore (India)

Cosmetic Dermatology is the newest and most popular sub-specialty of Dermatology. Chemical peels are one of the mostcommonly performed cosmetic office procedures. Peeling  inskin of colour presents unique challenges of its own. Peel com-plications can be avoided or minimized when the cosmetic der-matologist has a thorough understanding of the principles ofcosmetic dermatological procedures as well as a sound under-standing of facial and body anatomy. The discussion will focuson the newer  peels  available for skin of colour with commonindications, individual case discussions, prevention of compli-cations and proper diagnosis and management of problemswhen they occur. Emphasis is placed on how to safely use andcombine these newer  peels  in order to achieve the best cos-metic results, especially in skin of colour.  Complicationsin  chemical  peel  techniques with skin of colour are still com-monly encountered and a brief overview of the common com-plications will be highlighted.

Peels in Rosacea and PigmentationCLAUDIA BORELLI, MD Aesthetic and Laser Unit, Dept. of Dermatology,

University of Tübingen (Germany)

[email protected]

The past years it was common knowledge, that peeling shouldnot be performed in patients suffering from rosacea. The deli-cate skin of these patients, together with flushing and blushingand the stinging and burning sensations that they were feelingmade peeling impossible. This paradigm has now changed:Peeling of rosacea patients is a new treatment option. Thepeeling should not irritate the skin, which has been f. e. madepossible through a new peeling (peel Nr. 2 sensitive, Der-masence P and M cosmetics, Münster, Germany) containingglycolic and salicylic acid, as well as boswellia serrata asingredient.

Pigmentary disorders of the face are quite common and areal therapeutic problem. Too aggressive treatments will makethe skin even worth than before and lead to additional postin-flammatory hyperpigmentation. Chemical peeling with glycolicand salicylic acid in combination with other therapies canimprove Melasma or hyperpigmentation.

My Experience in Chemical PeelsL. WIEST, MD

KOSMETISCHE MEDIZIN ABSTRACTS SCIENTIFIC SESSIONS6

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LASERS IN MEDICAL DERMATOLOGYCHAIR: K. FRITZ

Pulsed Dye Laser: New Indications KLAUS FRITZ, MDDermatology and Laser Centers Landau (Germany)

and Bern (Switzerland), Osnabrück (Germany) and Bucharest (Romania)

PDL is accepted as first-line therapy for vascular disordersincluding port-wine stains, telangiectasia, and hemangiomas.PDL causes selective photothermolysis of dermal vasculature.This mechanism also allows it to be applicable for disorders ofother etiologies. Recent studies suggest that the PDL mayinduce cytokine expression and collagen formation, furtherincreasing its applicability in dermatology. FDA approved indi-cations and conditions less commonly treated with PDL are:

Benign epidermal pigmented lesions, benign cutaneous vas-cular lesions, angioma serpiginosum, glomus tumor, unilateralnevoid telangiectasia, angiokeratoma of Fordyce, dermato-myositis (poikilodermatous erythema), angiofibromas, kerato-sis pilaris rubra/keratosis pilaris atrophicans faciei, benigncutaneous lesions like atopic dermatitis, granuloma faciale,granuloma annular, dermatomyositis (Gottron papules), mol-luscum contagiosum.

Off-label (non-FDA approved) indications are actinic kerato-sis, actinic cheilitis, Bowen’s disease, Basal cell carcinomaMelasma, Lupus erythematodes, acne, granuloma facial, gran-uloma anulare. Newer-generation PDLs offer higher fluences,larger spot sizes, longer pulse widths, and cryogen and aircooling. For selective photothermolysis to occur, certainrequirements must be met. Specifically, the chromophore tar-get needs to absorb the wavelength that the laser emits, thepulse duration should be equal to or less than the thermalrelaxation time of the target, and a sufficient fluence is neededto 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 moreindications than just vascular and may be used especially inresisting dermatoses where this laser technology offers addi-tional benefits when classic therapies are not efficient.

Monochromatic Excimers for VitiligoF. XIANG, MD

External Forces for Dermal Drug DeliveryUWE PAASCH, M.D.Universitätsklinikum Leipzig AöR, Klinik für Dermatologie, Venerologie

und Allergologie

Background: Delivery of drugs to the epidermal and dermalcompartment may be difficult with respect to the molecularproperties of the molecules. Previous studies showed a possi-ble intensification of photodynamic therapy after injection ofthe photosensitizer or its application post ablative fractionallasers. In addition fillers, steroids as well as other substancesare subjected into the skin for many purposes trying to treat uplarge surface areas. Sonoporation and hydroporation are newtechnologies that allow the application of liquids and low vis-cous substances into the skin without any needle injection. Aim: The purpose of the study is to examine the capabilities ofthese systems to place molecules of various sizes into the der-mal and epidermal compartment.Patients and Methods: Using a human skin explant model aswell as unprocessed pig skin the ability of the hydroporationtechnique (Jetpeel, TavTec, Israel) and a sonoporation device(Impact, Alma Lasers, Israel) to treat the skin mechanically andto provide molecules of various sizes and viscosities into theskin compartments were tested. For this purpose 0.9% salineand liquid preparations of photosensitizers for PDT, low andhigh viscous hyaluronic acid for volume augmentation, vitaminA, 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 techniqueenables the operator to subject the skin to mechanical forcesusing 0.9% saline ranging from simple massage effect, peelingof superficial layers up to full ablation and even fractionalablation patterns. On top of this, comedones can be easilyremoved. Subjecting liquid preparations of photosensitizers forPDT, low and high viscous hyaluronic acid for volume augmen-tation, vitamin A, B and C-solutions for anti-aging, glycolic acidfor peeling, and triamcinolone via hydroporation to the skinexplants results in homogenous to bulk placement of the mole-cules into skin up to 2 mm deep. Conclusion: The new technologies of sonoporation andhydroporation are effective for various purposes from skinpeeling up to deep and uniform drug delivery into human andpig skin. Clinical studies are needed to demonstrate its in-vivoefficacy.

Intense Blue Light: Indications N. FOURNIER, MD

Background: The utilization of a nonthermal blue (405–425 nm)lamp in aesthetic and medical dermatology fields is now acommon way of practicing. Various indications have beendescribed.Aim: To review and to analyze the good indications for a bluelamp in current practice.Material and Methods: Review of the literature and an analy-sis of a clinical experience of ten years of utilization of a non-

7Kosmetische Medizin

Page 10: Abstracts from 5CC Cannes Conference

thermal blue light (405–425 nm) for indications such as acne,neurotic prurigo, scarring, melasma, rosacea, post inflamma-tory hyperpigmentation, and also on aesthetic indications suchas post laser healing, post aesthetic surgery, pore reduction,greasy skin.Results: The utilization of a non-thermal blue light (405–425 nm)brings various degrees of improvement due to the patient him-self and to the pathology itself. Determining the indicationbefore including a patient in a procedure increases better results. Summary: Blue lamp is a safe, comfortable, and efficaciousdevice for many medical and aesthetic indications, very wellaccepted by patients.

Combining Fractional Laser and Topicals V. NARURKAR, MD

FOCUS SESSION: OPTIMIZING FILLER RESULTS CHAIR: N. RHO

Do Fillers, Techniques, and Equipment Influence Results? W. PRAGER, MD

Deep vs. Superficial VolumeD. VLEGGAAR, MD

Non-Surgical RhinoplastySARIT COHEN, MD, RAMAT GAN (ISRAEL)

Background: Minimally invasive facial aesthetic procedureshave gained widespread popularity during the last decade.Purported advantages over traditional surgeries include noscars, minimal downtime, less pain and is a lower cost alterna-tive. The nose, the most prominent aesthetic feature of thefacial profile, is likewise amenable to minimally invasive tech-niques.Material and Methods: Fifty-seven patients underwent mini-mally invasive rhinosculpturing. Indications, encompassingaugmentation type primary rhinoplasty (rhinosculpuring), cor-rection of post-rhinoplasty contour defects, treating the agingnose and correction of selected functional impairments, will bethoroughly demonstrated in a systematic manner, dividing thenose and the nasal skeleton into thirds:

Upper third – low radix, widened bony pyramid, bony contourirregularities.Middle third – low dorsum, dorsal contour irregularities, sad-dle nose deformity, inverted V deformity.Lower third – inadequate tip projection, underrotated tip,external valve incompetence. Acquaintance with nasal aesthet-ics is of paramount importance and will be discussed. Specialemphasis will be placed on the interplay between interrelatedarchitectural structures. Injection technique will be presentedalong with pre-treatment and post-treatment photography.

Results: A nonsurgical „nose job“ enables gratifying results asa viable alternative to primary rhinoplasty in selected cases.Its role as an alternative to cartilage grafts will be analyzedthereby addressing both form and function. Conclusion: Minimally invasive augmentation type rhino-sculpturing adds to the armamentarium of the rhinoplasty sur-geon. It is an easy to perform, anatomic procedure that mightspare additional surgery, with a high patient satisfaction rate.Although much has been achieved by minimally invasive tech-niques in rhinoplasty, one must be cognizant of the fact thatwhen selecting alternatives to address specific deformities,detailed systematic analysis of the anatomical variables,proper patient selection, artistic perception and precise execu-tion are of paramount importance.

Midface Augmentation: East vs. WestNARK-KYOUNG RHO, MDLeaders Aesthetic Surgery and Cosmetic Laser Center, Seoul (Korea)

Background: The unique aspects of East Asian beauty conceptand the nuances of treating their skin require products, proce-dures, and protocols tailored specifically to the patient. Even inEast Asia each country, for example, Korea, Japan, Taiwan,Hong Kong, and China, has a different standard of beauty. Allpeople have preferences on their own concept of beauty. Thereis a concept in cultural studies about cultural relativism (differ-ent cultural groups think, feel, and act differently) and ethno-centrism (one’s own culture is superior to that of other cul-tures). But there is no scientific standard for considering onegroup as intrinsically superior or inferior to another. Aim: The difference in the concept of midface rejuvenationbetween Caucasians and East Asians is one of the most inter-esting topics in the field of the “international” cosmetic sur-gery. This lecture aims to provide a basic concept of the mid-face beauty in East Asian countries and the filler injectiontechniques to get a “what-people-want” appearance in Korea.Materials and methods: Anatomical characteristics of the EastAsian midface structure will be presented. Not only theauthor’s personal experience but also the general consensus ofthe Korean experienced injectors will be provided.Results: According to the recent studies, the younger Koreansprefer the lozenge and inverted triangle shape contourwhereas the Koreans over 40 of age prefer the egg shape con-tour. In chin and zygoma contour, Koreans at the age of 20 pre-fer distinctly small chin and relatively small lower face. On theother hand, the Koreans over 40 of age prefer the distinctzygoma. The preferred proportion of upper, middle, lower faceis 1 : 1 : 1 in general. Koreans now prefer protruding foreheadand small (not distinct) and V-shaped mandible-chin in frontalview. The statistical evidence from many Korean studies sug-gests that the harmony and balance of facial aesthetic sub-units make attractive and beautiful face. Because the majorityof the East Asian younger females don’t like their prominent,laterally and superiorly-set cheekbones, the basic concept ofcheek augmentation in this population is to soften the promi-nent zygoma and fill medial aspects of the midface, to make a

KOSMETISCHE MEDIZIN ABSTRACTS SCIENTIFIC SESSIONS8

Page 11: Abstracts from 5CC Cannes Conference

„Cannes ist ein natürliches Paradies“, so

Jean Cocteau. Verpassen Sie daher nicht

einen Besuch im Kloster von St. Honorat

Iles de Lérins, einem Ort der Spiritualität.

Eine kurze Fahrt von der Croisette,

gegenüber der Bucht von Cannes und die

Lérins-Inseln begrüßen Sie.

„Cannes is a natural paradies“, said Jean

Cocteau. So don’t miss a visit to the

monastery of St. Honorat Iles de Lérins, a

place of spirituality. A short trip from the

Croisette, across the bay of Cannes and the

Lérins Islands await you.

BRAUCHEN SIE NOCH EIN SPIRITUELLESZWISCHENSPIEL?DO YOU NEED A SPRITUAL INTERLUDE?

CANNES GOURMET

Trans Côte d’Azur Boat trip | WWW.TRANS-COTE-AZUR.COM

„Die Küche von Cannes ist wie ein

Stück Sonne auf einem Blatt des blauen

Meeres.“ Stephen Liégeard

(Erfinder des Begriffs Riviera)

Ein Sandstrand, eine Sonnenterrasse,

Luft aus Grand Bleu und eine Gourmet-

Küche - la dolce vita erfordert köstliche

Aromen! Knackige Salate, frisches

Gemüse – Olivenöl bringt Geschmack

und Leichtigkeit. Mediterrane Köstlich-

keiten sorgen bei Gourmets für den

Genuss: Dorade oder Rotbarbe – mit

einem Glas Weiß- oder Roséwein aus

der Provence genossen versprechen

glückliche Augenblicke. TIPP: Gour-

mets sollten unbedingt die Spezialitä-

ten von Cannes probieren, die auf den

Lérins-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 Liégeard

(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 rosé from the Provence, promise

very happy moments. TIP: Gourmets

should absolutely try the Cannes special-

ties, that are produced on the islands of

Lérins and Saint Honorat.

WWW.EXCELLENCEDELERINS.COM

Page 12: Abstracts from 5CC Cannes Conference

KOSMETISCHE MEDIZIN ABSTRACTS SCIENTIFIC SESSIONS10

younger looking face. Injectable fillers are now rapidly replac-ing the traditional fat grafting procedure. The use of a blunt-tipped micro cannula is recommended.Conclusion: Even though many Caucasians have small andslim faces, it doesn’t mean East Asians want to look like Cau-casians. Small jaws and cheekbones are the current beautyconcept of the East Asian young females, unlike the Cau-casian’s preference. The filler injection should be performed indifferent fashion when managing East Asian females.

FRACTIONAL LASER: WHEN?CHAIR: S. MORDON

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)

[email protected]

Background: Laser Fractional Photothermolysis (FP) is one ofthe innovative techniques of skin remodeling and resurfacing.During treatment a Microscopic Thermal Zones (MTZs) are cre-ated which are presented by columns of thermal damage. Thecontrol of the necrosis dimensions (MTZ) versus the pulseenergy requires knowledge of various parameters in detail thatgovern the heat transfer process. Aim: This Study aimed to elaborate a mathematical model tosimulate the effect of the pulse energy variations on thedimensions of MTZs. Methods: The mathematical model was based on finite ele-ment method (FEM) to solve the light distribution, bioheat, andthermal damage equations. Two series of simulations for abla-tive (30 W, 10.6 µm CO2) and non-ablative (30 W, 1.550 µmEr:glass) lasers systems were performed. In each series, simu-lations were carried for the following pulses energies: 5, 10, 15,20, 25, 30, 35, and 40 mJ. Results of simulations are validatedby histological analysis images of MTZs sections reported inHantash et al. [1] and Bedi et al. [2] works. Results: MTZs dimensions were compared between the histo-logical images section and the corresponding data from simu-lation model using a fusion technique for both ablative FP andnon-ablative FP treatment methods. Depths and widths esti-mated from simulations are usually deeper (typically 21 ± 2%)and wider (typically 12 ± 2%) when compared to histologicalanalysis data. Conclusion: The differences can be easily explained by theshrinkage effect due to the fixation of biological tissues. Whenconsidering this effect on histological measurements, a goodcorrelation can be established between the results of simula-tion and the histological analysis results.

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.

2. 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

Combined Fractional Ablative and Non-ablative TreatmentsL. BASS, MD

Fractional Technology in Asian SkinHENRY HL CHAN MD, PHD, FRCP, Hon. Clin. Professor, University of Hong Kong

Background: The theory of fractional photothermolysis hasrevolutionized skin rejuvenation and among Asians the mainpotential complication is post-inflammatory hyperpigmentationAim: To review the safety and efficacy of the use of non-abla-tive and ablative skin rejuvenation in Asians.Method: literature review on the use of non-ablative and abla-tive fractional laser resurfacing in the density and energy chosenResult: The risk of PIH is associated with the density andenergy used with density being particular relevant.Conclusion: Fractional laser resurfacing is effective and safeamong skin of color with the appropriate parameters are used.

THE ROLES OF DIFFERENT FILLERS CHAIR: S. WEINKLE

Soft Tissue AugmentationS. WEINKLE, MD

Measuring Volumizing FillersN. LOWE, MD

Synthetic Fillers and Autologous Fat Augmentation – An Anatomic AlgorithmSUZAN OBAGI, MDAssociate 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 moreimportant as we recognize the importance of facial volume“rebalancing”. There are a multitude of synthetic fillers on themarket and many more in the pipeline.  Aim: Understanding the anatomic changes with aging (bony,muscular, and adipose), the physical properties of the fillersthemselves (G prime), and the proper evaluation of eachpatient are key factors to successful rejuvenation. 

Page 13: Abstracts from 5CC Cannes Conference

11Kosmetische Medizin

Materials and Methods: The author will present an anatomicalgorithm in which the proper patient evaluation and fillerselection hinges on the anatomic area being treated and ifindicated, how to mix and match fillers to achieve balance.Results: Case examples will be shown utilizing a variety offillers to re-balance the face in a natural appearing manner. Conclusion: Successful and aesthetically pleasing filler resultscan be achieved by properly evaluating the patient and select-ing the proper filler based on anatomic location and the physi-cal properties of the selected filler.

Biophysical Measurements for Objective Evaluation of Filler ResultsMARTINA KERSCHER, MDUniversity of Hamburg, department chemistry, cosmetic science

The use of hyaluronic acid fillers has been mainly confirmed tothe treatment of lines, folds and for skin rejuvenation overmore 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 oxygenspecies which affect matrix metalloproteinase, degradation ofcollagen and reduction of collagen synthesis are affected inintrinsic aged as well in photoaged skin. Moreover skin agingis associated with loss of skin moisture. The main moleculeinvolved in skin moisture is hyaluronic acid which belongs tothe extracellular matrix molecules. Dermal hyaluronic acidattracts water molecules; create tugor and is also though toaffect cell integrity, mobility, and proliferation. The reductionof hyaluronic acid results in a reduced ability to bind water andcontributes to some typically aging signs like wrinkles or lossof volume. Moreover hyaluronic acid can stimulate dermalfibroblast and therefore increase the collagen neosynthesis.Therefore evaluation on skin physiology and clinical appear-ance has become a main focus on cosmetic and dermatologyresearch. To determine whether hyaluronic acid fillers have animpact on skin physiology and clinical appearance, biophysicalmeasurements like stratum corneum hydration, cutaneouselasticity, skin density and thickness and surface parameterslike skin roughness or wrinkle deepness are used.

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

Laser Treatment of Benign TumorsM. KADURINADepartment of Dermatovenerology and Allergology,

Military Medical Academy Sofia, Bulgaria

Background and Aim: Over the past decade, advances in lasertechnology have allowed dermatologists to improve theappearance of scars and wrinkles and to remove benign skinproliferations using ablative and nonablative lasers.

Materials and Methods: Many benign skin growths can betreated with CO2 laser: actinic and seborrheic keratosis, warts,moles, skin tags, epidermal and dermal nevi, xanthelasma. Otherconditions that have been shown to respond favorably to CO2

laser resurfacing include rhinophyma, severe cutaneous photo-damage (observed in Favre-Racouchot syndrome), sebaceoushyperplasia, adenoma sebaceum (seen in Pringle-Bournevillesyndrome), syringomas, actinic cheilitis, angiofibroma, scars,keloids, skin cancer, neurofibroma and diffuse actinic keratoses.Lasers and non-coherent intense pulse light sources (IPLS) arebased on the principle of selective photothermolysis and can beused for treatment of many vascular skin lesions. Results: A variety of lasers has recently been developed for thetreatment of congenital and acquired vascular lesions whichincorporate these concepts into their design. The list is a longone and includes pulsed dye (FPDL, APDL) lasers (577 nm, 585nm and 595 nm), KTP lasers (532 nm), long pulsed alexandritelasers (755 nm), pulsed diode lasers (in the range of 800 to900 nm), long pulsed 1064 nm Nd:YAG lasers and intensepulsed light sources (IPLS, also called flash-lights or pulsedlight sources). Different lasers systems are used at differentfluences, pulses and spot sizes to treat the same vascularlesions. Lasers and IPLS are the treatment of choice for the fol-lowing vascular conditions: vascular tumours, vascular malfor-mations, congential vascular lesions and acquired vascularalterations. Good clinical results are seen after CO2 and Er:YAG laser treatment of benign growths such as seborrheic andsenile keratoses and scars in age-related skin followed by full-face resurfacing. Conclusion: Laser treatment shows good results in the man-agement of benign skin tumors and represents an alternativeof surgical methods.

Long pulsed PDL for HemangiomaT. KONO, MD

Combination of ablative fractional and q-switched ruby laserto treat field cancerisationUWE PAASCH, M.D. Universitätsklinikum Leipzig AöR, Klinik für Dermatologie, Venerologie und

Allergologie

Background: Fractional ablative laser therapy (AFXL) is knownto 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 healingsequence pigmented microscopic epidermal necrotic debris(MEND) is expulsed. Recently the painless removal of pig-mented MEND by application of a q-switched ruby laser ther-apy (QSRL) has been proposed.Aim: This pilot study aims on testing the efficacy and safety ofa sequential application of AFXL and QSRL in patients with FCrefusing to have a surgery or PDT clinically, by 3D photographyand by means of histology.

Page 14: Abstracts from 5CC Cannes Conference

Patients and Methods: The concept of sequential AFXL andQSRL treatments has been proved in three male patients hav-ing FC on their heads using a fractional CO2 laser (10.600nmExelo2, Alma Lasers, Erlangen, Germany, pulse duration 2 ms,60 J/cm², paintbrush-mode) followed three days later by QSRL(694 nm Sinon, Alma Lasers, Erlangen, Germany, 3.5–4 J/cm²,6 mm spot size, one pass).Results: In all patients there was a significant improvementclinically. The number of actinic keratosis has been reducedand using specific software filters to demonstrate vasculariza-tion and pigmentation a reduction in inflammation was visible.A complete clearance however could not be demonstrated aftera single treatment. Histologically the perfect targeting ofMEND by QSRL has been confirmed. The pain level was signifi-cant lower than in conventional PDT.Conclusion: The sequential AFXL and QSRL therapy might bean alternative to other treatments of WSC in case of FC espe-cially when PDT is too painful. However, efficacy as estimatedby this pilot trial with low patient numbers needs to be con-firmed in larger study populations.

Quasi-ablative Laser for Actinic Keratoses SHLOMIT HALACHMI MD PHD, M. ADATTO MD, AND MOSHE LAPIDOTH MD MPHRabin Medical Center, Petach Tikva, Israel, and Skinpulse Dermatology

& Laser Center, Geneva, Switzerland

Background: Actinic keratoses (AK) are increasingly treatedwith methodologies that seek to address field cancerizationrather than targeting discrete clinically-evident lesions. Abla-tive lasers could be used as a modality for such treatments.Aim: To assess the safety and efficacy of treating AK with aclassically non-ablative fractional laser whose application hasbeen modified to exert an ablative effect on the epidermis.Materials and Methods: Seventeen patients with AK under-went laser treatments with fractional 1540 nm erbium glasslaser at fluences of 75 mJ, 15 ms pulse duration, and 10 mmspot size in non-contact mode. Blinded assessors and partici-pants evaluated the clinical improvement at 3 month using aquartile grading scale (no improvement = 0, 1–25% improve-ment = 1, 26–50% = 2, 51–75% = 3, and 76–100% = 4). Results: Three months after the last treatment the mean levelof improvement was 3.4 ± 0.72. Adverse events were limited tomoderate erythema, mild edema, erosions, and mild desqua-mation. No scarring or post-inflammatory pigmentary changesoccurred. Conclusion: 1540 nm fractional erbium glass laser in non-con-tact mode provides a safe and effective treatment option for AK.

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

Combining Toxins in Clinical PracticeJ. DOVER, MD

The Role of Complexing Proteins in the Treatment with Botulinum Toxin Products DR JÜRGEN FREVERTMerz Pharmaceuticals GmbH, Hermannswerder Haus 15, D-14473 Potsdam

Three Botulinum toxin type A products are marketed on theEuropean and US market: Botox/Vistabel (Allergan), Dysport/Azzalure (Galderma/Medicis) and Xeomin/Bocouture (MerzPharmaceuticals GmbH). Whereas Botox/Vistabel and Dysport/Azzalure contain additional bacterial proteins (complexingproteins), Bocouture only contains the 150 kD Neurotoxin whichis the sole active substance in all product. The complexing pro-teins do not play any role in the mechanism of action. In theearly days of botulin toxin therapy it was claimed that the com-plexing proteins are required to stabilize the neurotoxin andeven to preserve the structure of the active molecule whichwas assumed to be a labile protein. In contrast it was demon-strated that in an appropriate formulation the neurotoxin isstable even at room temperature for four years and does notlose any activity when stored at 60°C for one month. Interest-ingly the complexing proteins containing products must bestored at 28°C.

In several preclinical and clinical studies it was demon-strated that complexing proteins do not influence the spread ofthe neurotoxin into adjacent muscles. This can easily beexplained by the finding that a complex does not exist in recon-stituted products. The complexing proteins dissociate from theneurotoxin and cannot inhibit the migration of the neurotoxin.In preclinical studies it was found that complexing proteinsbind to lymphocytes which in contrast to the 150kD Neuro-toxin. Binding to immune cells is the prerequisite for activationof the immune system. It can be concluded that complexingproteins bear the risk of a higher immunogenic potential. Com-plexing proteins can help to elicit antibodies to the neurotoxinwhich terminate the therapy with the botulinum toxin.

Use of Different BTX-A ProductsW. PRAGER, MD

KOSMETISCHE MEDIZIN ABSTRACTS SCIENTIFIC SESSIONS12

Page 15: Abstracts from 5CC Cannes Conference

Lassen Sie Ihre Kindheitserinnerungen

wieder auftauchen: Das Bild von süßer

Schokolade aus hausgemachter Herstel-

lung. Thierry AUER, Meister-Chocolatier

und Confiseur, wählt mit viel Liebe nur

die Zutaten aus, die mit beispielloser

Kontinuität, eine gleichbleibende Pro-

duktqualität erzielen und dabei traditio-

nell hergestellt werden. Ungewöhnliche

Aromen wie Aprikose, rosa Grapefruit,

Erdbeere, Mandarine mit Schale und

sogar Oliven können eine nette Auswahl

sein, die Groß und Klein begeistern. Das

langfristige Know-how der Familie wird

der neuen Generation ständig weiterge-

geben. Es wird nur Kakaobutter in den

Pralinen verwendet, diese garantiert die

unwiderstehliche Qualität.

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, straw-

berry, 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 guar-

anteeing their irresistible quality.

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NIZZA: CHOCOLATIER MAISON AUERNICE: CHOCOLATIER MAISON AUER

CANNES KULTURCANNES CULTURE

Die französische Riviera war seit jeher eine

unerschöpfliche Quelle der Inspiration.

Nicht nur die Künstler des 20. Jahrhunderts

wie Miró, Matisse und Picasso genossen

dieses renommierte Haus, auch zeitgenös-

sische Ausstellungen finden hier statt.

Mitte September bis Mitte April geöffnet.

The French Riviera has always been a

unfailing source of inspiration. Not only

the artists of the 20th century such as

Miró, Matisse und Picasso enjoyed this

renowned house, also contemporary

exhibitions take place here. Open from

the middle of September until the middle

of April.

CENTRE D’ART LA MALMAISON

WWW.CANNES.COM

CANNES NIGHTLIFEL’Ecrin ist ein echtes Juwel. Hierfür wurde

eigens der bekannte Interior-Designer

Miguel Cancio-Martins (Buddha-Bar New

Yorck und Paris) beauftragt, eine einmalige

Beach-Location in Cannes zu errichten.

L’Ecrin 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. WWW.ECRINPLAGE.COM

Page 16: Abstracts from 5CC Cannes Conference

Thursday September 19th, 201311:45 – 13:45

NEW APPROACHES FOR OLD INDICATIONSCHAIR: J. DOVER

Laser Treatment of Pigmentary DisordersPR. THIERRY PASSERON, MD, PHDDepartment of Dermatology & INSERM U1065, team 12, C3M

University Hospital of Nice (France)

Background: Variations of skin pigmentation are mostly due toquantitative or qualitative defects of melanin pigments (eume-lanin and pheomelanin). However, dyschromia can also resultfrom an abnormal increase or decrease of other endogenouspigments (hemoglobin, bilirubin …) or from the deposit ofexogenous pigments (heavy metals, cosmetic tattoos …). Thisleads to a heterogeneous group with numerous causes. Thelaser devices have markedly improved the treatment of hyper-pigmentary disorders.Aim: To review the indications and limitations of lasers fortreating pigmentary disorders.Materials and Methods: Critical analysis of the literature.Results: Actinic lentigo, lentigines, and congenital or acquireddermal hypermelanocytosis can be effectively treated with Q-switched lasers. Dark rings, poikiloderma of Civatte, linear andwhorled nevoid hypermelanosis, Becker nevus, and nevusspilus can also benefit from laser approaches. However,relapses or worsening of the lesions are observed when treat-ing café-au-lait macules, post-inflammatory hyperpigmenta-tion, or melasma and strongly limit the use of lasers in theseindications.Conclusion: Laser treatment can provide significant improve-ment of some pigmented lesions, but it can also worsen others.A precise diagnosis is mandatory to assess if a laser approachcan be useful and to determine the optimal parameters.

New Approaches to TattoosJ. DOVER, MD

Split Foot Onychomycosis Laser Treatment Study to Comparethe Efficacy and Safety of 1064 and 980 nmUWE PAASCH1 AND HARTMUT PAASCH2

1 Universitätsklinikum Leipzig AöR, Klinik für Dermatologie,

Venerologie und Allergologie

2 Hautarztpraxis Dr. Hartmut Paasch, Lindenstrasse 20, 04838 Gotha,

Germany

Introduction: New trends of dermatological laser treatmentsinclude the treatment of onychomycosis by means of infraredlaser light. It is assumed that the eradication effect is mediatedby heat. To date, many laser systems operate at various wave-lengths and rather diverse parameter settings. Comparativelaser application studies evaluating the potential to eradicatefungi and spores over longer terms are missing.Aim: This study aimed on measuring the area of temporaryincrease in clear nails clinically after four laser treatments dur-ing a 12 month follow up. Laser treatment was performed usinga 1064  nm vascular Nd:YAG-laser and a 980-nm linear scan-ning 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 receivefour laser treatments four weeks apart. The left foot wastreated using the 1064 nm laser, 70 J/cm2, 40 ms pulse dura-tion, 5 mm spot size, 3 passes, contact cooling. At the right foot980  nm linear scanned, 30  J/cm2, 12  ms pulse duration,12 x 12 mm spot size, 3 passes were applied. Pain was recordedusing 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 47.7pulses (653.7 J) have been applied at the left side whereas onthe right side always three pulses per nail were applied. Painwas recorded as 6.2 (1064 nm) and 7.0 (980 nm). Clearance ofnails was evaluated by subjective estimation and photo documen-tation as (1064 nm vs. 980 nm): 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 topain were discoloration, subungual hematoma and heat sen-sations.Conclusion: Infrared nail laser treatment using long pulsed1064 nm and linear scanned 980 nm laser have been found tobe equivalent in safety and efficacy with long term follow up of12 month. With regard to the pain future studies should aim onprotocol optimization by means of measuring of heat propagation.

1064 nm Nd:YAG for OnychomycosisA. CAMPO-VOEGELI, MD

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

Combining InjectablesJULIUS FEW, MD The Few Institute, Chicago (USA)

According to American Society for Aesthetic Plastic Surgerystatistics, dermal fillers represent one of the fastest growingprocedures in aesthetic medicine. It has become more impor-tant than ever to consider all of the available options for facialrejuvenation with injectables. A concise presentation andreproducible approach will be presented on compositeinjectable use in the face. An emphasis will be placed on prod-uct selection and depth of placement. Consideration will begiven to associated procedures, such as surgical and non sur-gical face-lifting, with or without laser resurfacing. The authorfeels it is vital to fill soft tissue defects before resurfacing. It isalso vital to do repositioning of ptotic tissue before filling, aswill a facelift or focus Ultrasound lift.

Facial Volumizing: Anatomy and TechniqueL. BASS, MD

How Safe Are Injectable Fillers?R. BARLOW, MD

Nasal Contouring with Fillers: Structural and Cosmetic CorrectionMILES GRAIVIER, MDThe Graivier Center for Plastic Surgery, Roswell, Georgia (USA)

Background: Patients are increasingly asking for non-surgicalalternatives or adjuncts to rhinoplasty. Fillers injected intoproper tissue planes can offer immediate correction of defects,asymmetries, and even add structural support to the nose.Proper placement and preparedness for tissue compromise isessential when using fillers in the nose. Aim: To present methods for nasal augmentation, post- rhino-plasty correction, and structural correction off the nose withfillers. Avoidance and preparedness for complications is alsopresented. Materials and Methods: Selection, placement, and treatmentof complications using patient cases and diagrams will beshown. Results and Conclusions: Fillers in select instances can beused safely and effectively to correct both cosmetic and struc-tural defects of the nose.

SCARS AND KELOIDSCHAIR: M. ADATTO

Fractional Lasers for Fresh Surgical ScarsM. ADATTO, MD

Fractional Lasers for Burn ScarsM. HAEDERSDAL, MD

Treatment with Fractional LasersHIROTAKA AKITA, M.D., PH.D.Department of Dermatology, Fujita Health University School of Medicine

Toyoake, Aichi 470-1192 (Japan)

[email protected]

Aim: To evaluate the efficacy and safety of CO2 laser with frac-tional device for the treatment of scar.Subjects and Methods: 35  Japanese  patients received  fiveconsecutive fractional CO2 laser (Deep FXTM: Lunemis) treat-ments at around 8-week intervals. Outcome assessments weredone by digital photography, physician evaluation, and ques-tionnaire of subject’s satisfaction. 7% lidocaine topical anes-thetic cream was used for pain.Results: 35 Japanese patients (7 cases of surgical scar, 24 casesof post operative scar, 4 cases of burn scar, and one self-muti-lation scar) was done by this treatment. As an adverse reac-tion, 6 cases of post-inflammatory hyper pigmentation and 3cases of erythema were occurred. Subject self-assessment wassuperior to the physician assessment.Conclusion: Fractional CO2 treatment is tending to be an effec-tive and safe treatment for many kinds of scars. Although itmay be difficult to cure scars completely, self-assessments andsatisfaction scores were high rated. Therefore, our data alsosuggested fractional  CO2 treatment is one of the treatmentmethods for scars.

Lasers and Hypopigmented ScarsA. LE PILLOUER, MD

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

Best Ways to Target Sebaceous GlandsE. V. ROSS, MD

ALA-PDT in the Treatment of AcneF. XIANG, MD

Laser Lipolysis in HidradenitisA. FATEMI, MD

Device-based Treatment of AcneG. MUNAVALLI, MD

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Combining Laser and Peels for AcneM. LANDAU, MD

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

Radiofrequency ExperiencesN. LOWE, MD

RF and Ultrasound for Skin TighteningR. WEISS, MD

Minimally Invasive Fractional Bipolar RF M. ADATTO, MD

RF and Ultrasound Facial ContouringW. PRAGER, MD

TOXINS IN 2013CHAIR: A. PICKETT

US Toxin Update 2013A. PICKETT, MD

Differences in Botulinum Toxin Products DR JÜRGEN FREVERTMerz Pharmaceuticals GmbH, Hermannswerder Haus 15, D-14473 Potsdam

Botulinum toxin type A products contain different bacterialproteins. Three botulinum toxin type A products are marketedon the European and US market: Botox/Vistabel (Allergan) isclaimed to contain the purified 900 kD botulinum complex,Dysport/Azzalure (Medicis/Galderma/Ipsen) contains besidesthe 150 kD neurotoxin a different set of complexing proteins,which complex they form is not known. Besides the 150 kD neu-rotoxin, the active substance, there are no other bacterial pro-teins present in Xeomin/Bocouture. The products are manufac-tured by different technical processes: Vistabel by vacuumdrying leaving a thin film as the final product whereas Azzalureand Bocouture are produced by lyophilisation. The manufac-turing process and the content of different excipients mighthave an effect on the stability of the products. Bocouture hasdemonstrated the highest stability allowing storage at roomtemperature in contrast to the other Vistabel and Azzalurewhich must be stored in the refrigerator. All products show asimilar spread from the injected muscle provided that the doseis equivalent and the injection conditions are similar. It can beconcluded that differences in composition of different bacterialproteins 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 ratiobetween Botox and Vistabel confirmed in a recent Consensus

paper. Although numerous studies are published with differentratios for Botox: Dysport a fixed ratio is not determined, yet.The ratio is possibly dependent on the actual conditions of thestudy. The load of bacterial proteins was claimed to have animpact on the immunogenic potential of the products. But it isnot the protein load per se but the presence of complexing pro-teins in Botox and Dysport which influences the risk of animmune reaction. These proteins are not simple clostridialremnants but they can bind to lymphocytes/dendritic cells toactivate the immune cells to produce antibodies against theactive 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

Background: Over the past several years, a number of “fake”neurotoxins have found their way into practitioner’s hands.These non-approved or regulated toxins are easily obtainedthrough the Internet.Aim: The aim of this presentation is to identify these toxinsand the potential dangers associated with them.Materials and Methods: From web site searches to personaldiscussions with colleagues from all over the world, fake toxinsare identified.Results: There is an abundance of fake toxins readily availableto clinicians and clinicians purchasing them for use.Conclusions: The fake toxin market has grown significantlyover the past several years and clinicians need to be aware thatonly approved toxins are to be used in the daily care of patients.

Vancouver Consensus on Btx-AN. 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 DEALMEIDA, G. KAEUPER

Background: Three BoNTA formulations are the most widelyused worldwide and FDA approved for aesthetic use. A reviewand discussion of differences between practicing methods, andthe effect that these differences may have on clinical results.Aim: To review the publications on current and emerging applica-tions of BoNTA in aesthetic practices and to compare internationalexpert viewpoints to provide a consensus about the availableBoNTAs on the market approved by the FDA for aesthetic use.Methods and Materials: 11 expert aesthetic physicians fromdifferent countries (Canada, Germany, Mexico, Brazil, USA, Tai-wan, Korea and France) had discussions and consensus in ameeting in Vancouver (Canada) to provide an up-to-datereview of treatments strategies to improve patients’ results.Following points were discussed: patient management, assess-ment, documentation and consent, aesthetic scales grading,injections strategies, dilution, dosing and adverse effects.

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Results: An educational consensus for practicing was estab-lished.Conclusion: A range of product and patient specific factorsinfluence the treatment plan. Optimized outcomes are possibleonly when the treating physician has the requisite knowledgeand experience to use BoNTA for each patient’s specific need.

PDT: MEDICAL INDICATIONSCHAIR: M. HAEDERSDAL

Daylight Topical PDT on the RivieraA. Le Pillouer, MD

413 nm Krypton PDT for Port Wine Stains G. ZHOU, MD

PDT with Ablative Fractional LasersM. HAEDERSDAL, MD

PDT with MicroneedlingMATTEO TRETTI CLEMENTONI1, MD – GIRISH MUNAVALLI2, MD – MARC B. ROSCHER3, MD 1 Istituto Dermatologico Europeo, Milano, Italy

2 Dermatology, Laser & Vein Specialists of the Carolinas, Charlotte,

North Carolina and Department of Dermatology, Wake Forest University,

Winston Salem, NC

3 Skin and Laser Centre, Durban, South Africa

Background: High efficacy and safety, coupled with in-office,short contact protocols have made photodynamic therapy(PDT) with aminolevulenic acid (ALA) for the treatment ofactinic keratoses a mainstay option over the last decade. Clini-cal improvement in photo aged skin has also been reported toaccompany PDT treatments.Aim: The study objective was to maximize epidermal penetra-tion and subsequent activation of ALA for the treatment of pho-todamaged facial skin, utilizing a microneedle roller prior toincubation and combined irradiation with red light and broad-band pulsed light in a single treatment.Materials and Methods: A full-face treatment of 77 patientswas performed with 630 nm light and broadband pulsed lightafter multiple passes with a microneedle roller and 1-hour ALAincubation. The primary endpoint was clinical improvement,scored during two separate live assessments by three physi-cians blinded to previous scores, using a 5-point standardizedphotoaging scale. The secondary endpoint was evaluation ofpatient satisfaction based on a quartile scale comparing base-line to 6-month post-treatment photography.Results: Statistically significant improvement was seen in theglobal photoaging scores, as well as sub-components of thescale (fine lines, mottled pigmentation, sallowness, tactileroughness, and telangiectasias) at 3 months as compared withbaseline live assessment, and at 6-month live assessment com-pared with the 3 months. In addition, 90% of patients judged

clinical improvement to be greater than 50% at 6 months com-pared to baseline photography.Conclusion: Use of a microneedle roller to ‘‘pre-treat’’ prior toapplication of ALA appears to be well tolerated and allows foreven absorption and perhaps deeper penetration of ALA fol-lowing a defined incubation period. Use of red light and broad-band pulsed light allowed for deeper activation of ALA, poten-tially accounting for marked clinical improvement inphotoaging.

APPROACH TO SCARSCHAIR: R. FITZPATRICK

Laser Treatment of ScarsELISABETH TANZI, MD

A variety of lasers and light sources can be used to treat scarseffectively. It is of paramount importance that the type of scarbe properly classified on initial evaluation to guide the choiceof the most appropriate laser. Proper classification of the scaralso allows the laser surgeon to discuss the anticipatedresponse to treatment with the patient. Traditionally, the 585or 595 nm pulsed dye laser (PDL) has been used to improve thecolor, texture, pliability and thickness of hypertrophic, erythe-matous, and traumatic scars. However, additional improve-ments can be achieved through advanced protocols using non-ablative or ablative fractional skin resurfacing. Atrophic scarsare best treated with ablative or non-ablative fractional resur-facing, whereas pigmented scars benefit from pigment-specificlasers such as QS alexandrite or Nd:YAGlaser treatments. Usinga full range of lasers, the laser surgeon can significantlyimpact the function and appearance of scars to improvegreatly the quality of life for patients.

An Integrated Approach to ScarsR. Barlow, MD

Treatment of Keloids with Internal CryotherapyMILES GRAIVIER, MDThe Graivier Center, Roswell, Georgia, 30076 (USA)

Background: Keloids and thick, irritated hypertrophic scarscan be disfiguring as well as have symptoms of pruritus, painor discomfort, and continued enlargement. Many treatmentoptions have been attempted with varying success. Internalcryotherapy offers a new, effective , often single treatment forkeloids and thick hypertrophic scars.Aim: To describe cellular changes in histology of keloids anddemonstrate clinical cases of internal cryotherapy use inkeloids. Material and Methods: Demonstration of placement ofintralesional needle and delivery of internal cryotherapy willbe shown as well as case examples of tissue reaction andpatient results.

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Results and Conclusion: Intralesional cryotherapy results inchanges in collagen structure and organization of keloids. Itoffers a new, effective, often single treatment regimen fortreatment of keloids and thick, hypertrophic scars.

Thursday September 19th, 201315:15 – 17:15

IPL VS. LASERCHAIR: H. CHAN

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 LesionsBased on BiologyJ. STUART NELSON, M.D., PH.D.Beckman Laser Institute and Medical Clinic, University of California Irvine (USA)

Research has provided information on laser-tissue interactionsand led to the development of many lasers light sources for avariety of vascular skin lesions. Treatment of superficialhemangiomas in children remains controversial, because thevast majority of lesions regress spontaneously by the age of 7.Treatment of symptomatic hemangiomas and those that pro-duce functional impairment, however, is not in question. Thepulsed dye laser (PDL) is effective for treating superficialhemangiomas. The risk/benefit ratio is favorable, and at leastfor symptomatic hemangiomas (e.g., hemangiomas that bleedor ulcerate with trauma) and those that cause functionalimpairment (e.g., perioral or vulvar hemangiomas or those thatblock the eye or nose), treatment with the PDL appears to beappropriate. Caveats for PDL treatment of hemangiomasinclude: 1) flat, smooth lesions less than 3 mm thick; 2) lowenergy densities (< 5 J/cm2) should be used; 3) large spot sizes(10–12 mm); 4) epidermal cooling is essential; 5) repeat treat-ments every 2–4 weeks; and 6) experience treating infants andyoung children is essential.

Treatment of port wine stains (PWS) by pulsed dye laser(PDL) remains the standard of care for infants and young chil-dren. Caveats for PDL treatment of PWS: 1) begin treatment atas young an age as possible and treat aggressively every 4weeks; 2) due to PWS blood vessel heterogeneity in terms ofdepth and size, multiple wavelengths and pulse durationsshould be used; 3) strict sun precautions are essential; and 4)

maintenance treatments very helpful to maintain good result.Furthermore, many PWS that respond well initially to PDLtreatment may reach a response plateau, becoming unrespon-sive to further PDL treatments, a phenomenon termed “treat-ment resistance.” Based on the theory of selective photother-molysis, vessels in such lesions may also be specifically targetedwith a deeper penetrating 755 nm alexandrite laser that hasselectivity for deoxyhemoglobin as well as oxyhemoglobin.

Laser and IPL Adjuvant TherapiesAGNETA TROILIUS, MDLaser & Vascular Anomaly, Dep of Dermatology, Skåne University Hospital,

Malmö (Sweden)

Introduction and Objectives: Since the concept of selectivephoto thermolysis was published in 1983 by Rox Andersson,exciting new techniques have developed and still are. Modern aesthetic laser and IPL technology treatment optionsoffer minimally invasive, more affordable alternatives to tradi-tional cosmetic surgery, with the promise of reduced downtimefor the patient. Laser therapy can significantly improve theappearance of the skin; however, these procedures sometimeshave a limited effect and we need to develop them and / oroptimize their effect. That will sometimes carry risks. Clinicalpearls and pitfalls are presented, as well as cutting-edge tech-niques and technologies are discussed in order to enable thelaser and IPL practitioner to optimize outcomes.Conclusions: Employing the appropriate device and techniquedoes not always guarantee a successful outcome. Practitionersmust educate their patients in detail regarding the process ofand reasonable post-treatment expectations in order to createa therapeutic alliance. We always have to try to improve ourmethods and to search for optimization of our laser and IPLtreatments. Work closely to the engineer and it will give younew ideas and possibilities and it is very rewarded in allaspects. Never ever give up if you have a difficult case!

FOCUS SESSION: BODY CONTOURINGCHAIR: K. RUSSE-WILFLINGSEDER

Is Cryolipolysis Hot?D. MANSTEIN, MD

Body Contouring with Focused Ultrasound R. WEISS, MD

Body Contouring – Targeting Skin, Fat and CelluliteKATHARINA RUSSE-WILFLINGSEDER, ELISABETH RUSSEPlastische Chirurgie und Laserzentrum Innsbruck

Haydnplatz 4, 6020 Innsbruck (Austria), [email protected]

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

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operative recovery for the treatment of cellulite. The purposeof this study is to assess the safety and efficacy of a single min-imally invasive laser treatment for cellulite followed by a non-invasive treatment to minimize post-operative recovery. Methods: 15 patients with lipodystrophy of the thigh and asso-ciated skin laxity and cellulite were included in the study. Intumescent solution (Ø 10 cc / 1 cm2) a single treatment was per-formed using the 1440 nm laser with the Smartlipo Triplex™workstation (Cynosure Inc.). Additionally to that a 1000 µmside firing fiber (Cellulaze™) was used for the deeper bulklipolysis, skin indurations and for shallow heating of collagenfibers within the dermis. After the procedure, patients werescheduled for six Photomology treatments (SmoothShapes™Cynosure Inc.), a dual wavelength system (650 nm LED and915 nm diode laser) with vacuum suction and mechanical mas-sage. All six treatments were performed within 4 weeks afterthe laser treatment using the SmoothShapes XV hand piece for10 minutes per 148 × 210 cm at 15 W with a vacuum setting of 1–2.Results: All patients tolerated treatments well. No unantici-pated side effects were noted. Both physician and patientreported high satisfaction with the combination of treatments. Conclusions: The use of a 1440 nm wavelength laser alongwith a unique fiber allows the ability to focus on the anatomi-cal deficiencies that cause cellulite. In addition, the combina-tion of a non-invasive laser treatment as adjunct therapyenhances the post-operative recovery period through thereduction of edema and ecchymosis. In our experience, this is asafe and effective treatment option for body contouring and itsassociated skin deformities.

Non-invasive RF Therapy for Contactless Body Contouring and Circumferential ReductionKLAUS FRITZ, M.D1, MUDR. KATERINA FAJKOŠOVÁ2, PRIM. MUDR. ALENA MACHOVCOVÁ, PH.D., MBA3

1 Dermatology and Laser Centers Landau, Germany

2 Formositas, Aesthetic Medicine Clinic, Prague, Czech Republic

3 The Motol University Hospital, Prague, Czech Republic

RF technology offers unique advantages for non-invasiveselective heating of relatively large volumes of subcutaneousadipose tissue. A properly induced electric field results ingreater heating of fat than heating of skin and muscle. Heatingin the fat is greater than in skin when the electric field is per-pendicular to the skin – fat interface. Radiofrequency devicesare able to achieve greater depths of thermal damage with tis-sue penetration to the level of the dermis and subcutanouslayer without producing thermal burns. Adipose tissue apopto-sis might happen but has not yet been extensively studied, andit should be further investigated. The recent clinical studyfocused on the effects of Vanquish™ system on fat tissue ofVietnamese swine proved the efficacy of Vanquish system inthe subcutaneous fat reduction based on the process of apop-tosis.

A prospective, non-randomized clinical study of 45 healthymale and female subjects with age ranging from 18 to 70years, showing significant subcutaneous fat tissue on the

lower abdomen and love handles. The study protocol consistsof one treatment administered each week with a duration of 30minutes each over a four week time period. Exclusion criteriawere lack of fat or implants especially of metal. The Vanquish™system (produced by BTL Aesthetics). is engineered to focusthe energy specifically into fat layer, while limiting the deliveryto the skin and muscles. A selective RF applicator shapes theenergy field to optimize the penetration and maximize thetreatment area.

Mild changes of body weight, water, and fat percentagewere observed however without any statistical significance.Body circumference measurements of the abdomen/love han-dles were taken in the umbilicus area, 5 cm above, and 5 cmbelow and photographed.

Girth measurements of abdomen were taken using a stan-dard spring loaded tape meter before the first treatment andafter the last session. After the last treatment all participantscompleted the self-evaluation questionnaires and rated theirlevel of satisfaction using a 1–5 scale.

All subjects tolerated the treatment well. The only treatmentside effect reported was mild to moderate erythema in thetreatment area which resolved within up to 60 minutes. Noadverse events occurred during this research. All subjectsfound the treatment comfortable or very comfortable.

Three of four subjects showed significant circumferentialreduction, one subject showed no change. The average circum-ferential reduction in the abdominal / love handles zone for allthose four cases was 5 cm after 4th session. The non-respond-ing subject might not have responded to the treatment,because the subcutaneous fat layer was not thick enough. Asignificant body – reshaping effect was observed on allresponding cases. An objective improvement was in correlationwith the patient satisfaction rate. The results of this pilot eval-uation indicate that the device is safe and efficacious for non-invasive body contouring and circumferential reduction,patients tolerate nicely the treatment sessions.

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FRACTIONAL LASER: MEDICAL INDICATIONSCHAIR: M. HAEDERSDAL

Laser-assisted Drug DeliveryM. HAEDERSDAL, MD

Laser-assisted Delivery to SkinA. LE PILLOUER, MD

Fractional CO2 in BurnsMATTEO TRETTI CLEMENTONI, MD Istituto Dermatologico Europeo – Milano - Italy

Background: Advances in burn treatment has dramaticallyincreased survival of severely burned patients. The increase ofsurvival of burn patients has resulted in an increased demandto treat the resulting scars. In addition to impairing self-esteem and body image, these scars severely limit functionalrecovery, compromise activities of daily living, and preventreturn to work. Aim: The aim of this study is to present preliminary clinicalresults obtained on severe burn scars after treatments per-formed 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 havebeen subjected to an ultrapulsed fractional CO2 regimen oftreatments. Settings were: with a spot size of 120 microns:35–150 mJ; 300 Hz of frequency, density 1%–10%; with a spotsize of 1300 microns: 50–150 mJ, 300 Hz of frequency, density60–140%. The average number of sessions for each patientwas 2,25 with an intervalof time between sessions neverlessthan 2 months. All patients were clinically and photographi-cally evaluated, in addition their subjective evaluations of thetreatment were recorded. Results: Nearly every patient in this preliminary case serieshad a favorable response, with a high degree of patient andprovider satisfaction. Overall, we have observed impressiveimprovement in pliability, retraction, restricted range ofmotion (ROM), height, and pigmentation of the scars. Noadverse effects were noted. Conclusions: The precise mechanism of action of ablative frac-tional laser therapy is still under investigation. Benefitsobserved immediately and over the first few days after treat-ment likely result from photomechanical fenestration of thefibrotic scar sheet. Early reports indicate that ablative frac-tional lasers modulate collagen production and remodellingover the ensuing weeks and months by generating an orches-trated wound healing response that involves the initial up reg-ulation of cytokines, Heat shock Proteins, matrix metallopro-teinases, and other factors. Ultrapulsed Fractional CO2 lasertreatments can be now considered as part of an entire medicaland surgical armamentarium and gave us clinically significantresults when all the other procedures could no longer be used.

Near Infrared, IPL and Fractional Laser Combination Therapyfor Asian Skin Rejuvenation: A Prospective Multi-Center Study in China JIAQIANG WU1 , LI TAO1, HUI QIAN1, ZHONG LU1, YUAN-HONG LI2,WEIZHEN WANG3, XIAOZHONG ZHAO4, PINGTU5, RUI YIN6, LEIHONG XIANG1

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: [email protected]

Background: The skin resurfacing, or chemical peeling waslimited for Asian skin rejuvenation due to PIH and long downtime. The NIR and IPL was non-invasive, and fractional laserhad focal selective photothermolysis effect to induce collagenremodeling in the dermis. Objective to investigate the efficacyand safety of applying IPL/NIR with fractional laser combina-tion therapy for skin rejuvenation in Asian peopleMethods: One hundred and thirteen patients were recruited inthe study, which is sixteen to twenty patients each center at sixcenters nationalwide in China. In each center, half patientswere in full face group, while the other half patients were insplit-face group (combo vs mono side). The full face wastreated with IPL, NIR, and fractional Er:YAG laser. In split-facegroup, half face was treated by APT, and half face was treatedwith IPL, NIR, and fractional Er:YAG laser combination therapy.There were total five treatment sessions during 90 days, withinterval 15–30 days. Then, patients were followed up at 1 monand 3 mon after last treatment.Results: There were 58 patients in full face group, and 53patients in split-face group. In full face group, the skin colorand telangiectasia (32.91%), skin texture (31.90%), pore size(28.07%), and wrinkle (28.52%) got improved. The globalimprovement was 28.96% at 3 months after the last treatment.In split face group, the improvement rate at the combo sideand mono side was 35.33% and 22.85% respectively. The clini-cal pictures would show the improvements of photoaging signs.Conclusion: The combination of IPL, NIR and fractional lasertreatment is safe, and effective for Asian skin rejuvenation.

UPDATES IN MELASMACHAIR V. BUCAY

Treatment Strategies for MelasmaV. BUCAY, MD

Hyperpigmentation: Melasma Therapies in China Y. LI, MD

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Laser Treatment of MelasmaPR. THIERRY PASSERON, MD, PHDDepartment of Dermatology & INSERM U1065, team 12, C3M

University Hospital of Nice (France)

Background: Melasma is an acquired, symmetrical hyperme-lanosis of the face. The pathogenesis of melasma is complexand the treatment remains challenging. The evolution ofmelasma is chronic for 10 to 20 years and without a strictavoidance of sunlight, the relapses are almost constant.Genetic background, exposure to ultraviolet radiation, andfemale sex hormones are classical influencing factors. To thelight of the recent literature, other factors could promotemelasma lesions. Histological and laser confocal microscopystudies showed that additionally to the increase in pigmenta-tion, melasma lesions have more elastosis and vascularization,as compared to the perilesional skin. Aim: To review the indications and limitations of lasers fortreating melasma.Materials and Methods: Critical analysis of the literature.Results: Ablative and non-ablative fractional lasers have beenreported to improve melasma. However, such approach,although interesting, is not superior to conventional therapies,and results at 6 months are not significantly different to sunprotection alone. Q-switched lasers, even used with low fluen-cies, induce almost constant PIH and frequent relapses. Thus,such lasers are usually not recommended for the treatment ofmelasma. Intense pulsed light (IPL) have shown some efficacyin the treatment of melasma. The risk of PIH remains importantbut appears to be lower than the one observed with Q-switchedlasers. More recently, positive results have been reported withthe 1927 nm fractional thulium laser. A prospective study com-paring this new laser approach to Kligman’s trio is clearlyneeded. Targeting the vascular component of melasma withpulsed dye laser (PDL) or copper bromide laser showed promis-ing encouraging results. These pilot studies clearly need to beconfirmed, but they both underline the potential interest of tar-geting the vascular component for treating melasma.Conclusion: The gold standard treatment for melasma remainstopical bleaching agents. Laser approaches can be discussedas a second line treatment but patients have to be warned ofthe risk of worsening and relapse.

Q-switched Nd:YAG in MelasmaG. ZHOU, MD

ANALYZING BEAUTY: THE FACECHAIR: D. VLEGGAAR

What Is Beauty and Does It Matter?D. VLEGGAAR, MD

Understanding Beauty: Facial AnatomyS. WEINKLE, MD

Evolution of the Asian LookRUNGSIMA 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 havebeen commonly used to improve facial and non-facial aesthetics. Objectives: To determine the roles of botulinum toxin type Aand fillers injections in the response of patient’s demand forbeauty.Materials and Methods: While botulinum toxin type A cansmooth hyperkinetic and dynamic lines, including glabellafrown lines, horizontal forehead lines, and “crow’s feet”, fillershave been used for smooth facial static lines, and correct vol-ume loss.Results: Nowadays, the cosmetic use of botulinum toxin andfillers is not limited to improve static or dynamic wrinkles andvolume loss. It becomes increasingly popular to patients seek-ing for non-invasive facial contouring procedures. Higherpatients’ satisfaction can be achieved with combination treat-ment with botulinum toxin and fillers.Conclusion: The beauty trend in Asians has been changed.Current approaches to botulinum toxin and fillers cosmetic ther-apy for both wrinkles reduction and facial contouring have beenevolved over time to achieve highest patient’s satisfaction.

ULTRASOUND IN AESTHETICSCHAIR: R. WEISS

Current Research HIFUA. FATEMI, MD

Intense Therapy Ultrasound (ITU)M. SLAYTON, MD

Non-Surgical Face Lifting and Tightening using FocusedUltrasound (Ulthera): Current Trends in KoreaNARK-KYOUNG RHO, MDLeaders Aesthetic Surgery and Cosmetic Laser Center, Seoul, Korea

Background: Unlike laser or radiofrequency, ultrasound can bedelivered arbitrarily deep (3–5 mm) into the skin and subcuta-neous tissue and can reach target areas without causing anysignificant injury to the surface of the skin, unlike other forms

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of energy used in dermatology and cosmetic surgery. With fur-ther evolution and development of therapeutic ultrasoundtechnology, “guided” ultrasound treatments better differenti-ate and more precisely target specific structures in the dermisand subcutaneous tissue, resulting in more consistent treat-ments with more predictable cosmetic outcomes. The UltheraSystem is a noninvasive ultrasound device designed for full-face and neck skin-tightening treatments and is currently theonly device of its kind approved by the FDA for lift indications(eyebrows and neck).Aim: To provide a basic understanding of the system and theauthor’s experience during the last 4 years.Materials and methods: Results of the author’s study evaluat-ing the long-term efficacy of the device for lifting and tighten-ing in the context of a procedure treating the full face and neckskin will be provided with relevant anatomical correlations.Results: The percentage of subjects responding with animprovement was 82% at 1 month, 87% at 3 months, 79% at 6months, and 65% at 9 months following treatment. Objectiveassessment at 3 months showed significant improvement foreyebrow position (85%), midface laxity (81%), jawline defini-tion (77%), mentolabial folds (68%), infraorbital folds andwrinkles (64%), cervicomental angle (62 %), and nasolabialfolds (44%). Assessment at 6 and 9 months revealed that mid-and lower face improvement lasted longer than the upper thirdof the face. Other than slight transient erythema and edemaimmediately post-treatment, generally, there were no majoradverse effects noticed.Conclusion: The micro-focused ultrasound technique is a safeand effective treatment for lifting and tightening facial soft tis-sue in Koreans. The study showed that in Korean subjects,treatment of the mid- and lower face showed more patientssatisfaction and longer lasting effects than upper face treat-ment.

Fractional Ultrasound: Now and the Future M. GOLD, MD

INJECTIONS: GOOD OUTCOMES AND BADCHAIR: S. OBAGI

Injecting Outside the Lines: How Americans can be more like the EuropeansMARY P LUPO MD, FAAD, Clinical Professor of Dermatology, Tulane University Health Science

Center (USA)

Background: The evolution of injectable dermal fillers hasevolved from line and fold filling to global restoration of shapeand lifting depressions to result in a more youthful reflection oflight off the surface of the face. Facial assessment, under-standing loss and shift of facial fat pads has been shown to becritical to natural-looking results. Old techniques may havemade the nasolabial fold look better, but the patient herself did

not look better. Often, over-injection resulted in an unnaturalresult. European and Canadian injectors have led the way inour understanding of global rejuvenation. American injectorsdo not have as many tools, but are gradually improving theirunderstanding, patient assessments, and injection techniquesand are poised to take the next steps as better lifting and volu-mizing agents are released in the United States.Aim: To review techniques and methods that result in morenatural results using injectable fillers and neuromodulators.Materials and Methods: United States FDA approved dermalfillers and neuromodulators, varying gauge and length needlesand cannulas.Results: Even with limited products available, American cos-metic injectors are improving in both their understanding offacial aging and their techniques of injections.Conclusion: American physicians will continue to learn andimprove as they learn from their foreign colleagues and as bet-ter products become legal in the US.

Combining Collagen Stimulators, and Neuromodulators D. VLEGGAAR, MD

Anticipating, Detecting, and Managing Adverse EventsSUZAN OBAGI, MDAssociate Professor of Dermatology

Associate Professor of Plastic Surgery

Director, The Cosmetic Surgery and Skin Health Center

University of Pittsburgh Medical Center

Background: Complications are an inevitable part of any pro-cedure that is performed.  As a physician performs more proce-dures, the chances of encountering complications at somepoint increases.  Aim: The most common and uncommon complications, diagno-sis, and management will be covered.  Materials and methods: A review of the literature will be pre-sented covering recognition and management of complicationsfrom cosmetic procedures. These will range from the most com-mon to the uncommon and rare.Results: Complications that require early recognition andintervention include skin infections (bacterial, viral, fungal),embolus, allergic reactions, asymmetry, and scarring.  Conclusion: The difference between a complication and a dis-aster is based on anticipation of complications, early detec-tion, and early intervention.  

Understanding and Managing NecrosisJ. COHEN, MD

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UPDATES IN RFCHAIR: V. ROSS

Fractional RF Technology AdvancesV. ROSS, MD

Multipolar RF for Post-Surgical OptimizationJ. FEW, MD

The ability to combine multipolar Radiofrequency (RF) withelectromagnetic (EM) fields offer a powerful tool to enhanceskin/tissue tightening after plastic surgery and offers a tool toenhance wound healing in early postoperative settings. Thereis extensive scientific literature showing the benefit of electro-magnetic fields on wound healing, including conditions such aschronic wounds.

We will show clinical examples that show the benefit ofcombined RF and EM in head and neck plastic surgery as wellas body contouring with liposuction. The use of RF therapy hasbeen applied to more than 300 cases and we see long termenhancement that exceeds what would be traditionally seen,including cases that would traditionally require much moreinvasive surgical techniques. In conclusion, the combination ofRF with surgical approaches offers outcomes that are betterthan either one alone.

RF: What’s in, What’s Out?M. LAPIDOTH, MD

Fractional Bipolar RF on the Asian FaceHIROTAKA AKITA, M.D., PH.D.Department of Dermatology

Fujita Health University School of Medicine

Toyoake, Aichi 470-1192 (Japan)

[email protected]

Aim: To  evaluate  the  efficacy  and  safety  of  a  novel  bipo-lar    RF-based    fractional    device    for    the treatment  of  pho-toaged Asian faces. Subjects and Methods: 10 Japanese women (mean age 58.6, skin pho-totype  III-IV) received  three consecutive fractional bipolar RF(eMatrixTM: Syneron-Candela) treatments  at  around 6-week intervals. Outcome assessments were done by standard-ized photography with VisiaTM, physician evaluation (fine line,wrinkle, laxity), and questionnaire of subject’s satisfaction.Cooling was used instead of topical anesthetic cream andmake-up was used from Day 1 after treatment.Results: This RF treatments produced improvements in eachcategory of physician and subjects evaluation. Especially, theimprovement of laugh lines and nasolabial fold were evalu-ated. Subject self-assessment almost paralleled the physicianassessment. But we could not get the entirely efficacy of fore-head in this study. Although mild and/or edematous erythemadeveloped in all patients for an average of 3.1 days after irradi-ation as an adverse reaction, severe adverse reactions such as

fat atrophy, vesiculation, scarring, and infection were notobserved.Conclusion: Fractional    bipolar  RF  treatment  is  an  effectiveand safety treatment for facial photodamage and naturalaging  in Japanese females. Although mild erythema and / oredematous erythema occurred a few days in all patients, self-assessments and satisfaction scores were high rated becauseof their concealing with make-up.

RF for Hand WrinklesV. BUCAY, MD

UPDATES IN THE APPROACH TO ACTINIC KERATOSESCHAIR: P. BJERRING

PDT as Skin Cancer Prevention?P. BJERRING, MD

PDT to Prevent Skin CancerM. HAEDERSDAL, MD

Fractional Radiofrequency in the treatment of actinic keratosesKLAUS  FRITZ,  MDDermatology and Laser Centers Landau (Germany)

and Bern (Switzerland), Osnabrück (Germany) and Bucharest (Romania)

and George Sorin Tiplica, University Carol Davila Bucharest (Romania)

The currently available treatments for actinic damage and ker-atoses include a number of active ingredients, most of themablating the skin or causing long term erosion and irritation aswell as ablative and non-ablative laser treatments, full andfractional, chemical peels from light to deep and PDT. Ablativelasers – also in fractional mode – cannot avoid downtime butare effective in clearing damaged skin areas. Radiofrequencyplays an increasing role in heating the dermis and ablating theepidermis with less downtime. Bipolar Fractional Radiofre-quency treatment Induces Neoelastogenesis and Neocollagen-esis initiated by a wound healing response. Material and methods: The E-Matrix (Syneron) uses theMatrix RF (Syneron) applicator, a bipolar RF-based devicedelivering RF energy that is tunable for ablation, coagulationand heating. The thermal energy is delivered to the skin in anon-homogenous fractional manner via an array of multi-elec-trode pins. The Matrix RF is a hand-held applicator which is fit-ted with a disposable tip at its distal edge. The tip consists ofparallel rows of bipolar-arranged electrode pins, forming anarray of positively and negatively charged electrodes for RFenergy delivery. An energy level limit of 20 Joules can bedelivered at either 5 or 10% coverage rate via 64 equallyspaced electrode pins; each pin has a diameter of ~200microns. We treated 10 patients with actinic keratoses type 1and 2, aged 64–76, 6 male, 4 female, using 2–3 passes of e-matrix.

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Before RF we used topical lidocaine (EMLA) for 1 hour,cleaned the skin with disinfectants, applied a Jessner peel toremove dry and scaly skin, moisturized the dry skin with moistpads in order to improve the RF conduct and then treated withfractional RF.Results: This procedure resulted in superficial epidermal abla-tion and the device gave selective heating to the dermis, how-ever without any wounds or down time. 1–3 days after treat-ment a mild to moderate erythema and some inflammationwas observed, however caused no downtime. After 14 and 28days and after 6 months the treated area showed no or onlyfew keratoses of type 1. As the result of 3 months follow-up, allpatients did not have any problems during the period and anyadverse events or complications weren’t observed. Patient sat-isfaction was high with 83.3%. Self-assessment of clinical out-come showed significant improvement. Conclusion: Fractional RF with e-Two can clear actinic damageand keratoses with little downtime and helps to avoid erosionor long term inflammation compared to other pharmaceuticalor ablative laser treatments.

Light Emitting Fabrics for Photodynamic Therapy of Actinic KeratosisSERGE MORDON1, 3, CÉDRIC COCHRANE2, 3, JEAN CLAUDE LESAGE1, 3, VLADAN KONCAR2, 3

1 INSERM U 703, F-59120 Loos, France

2 ENSAIT, GEMTEX, F-59100 Roubaix (France)

3 Univ. Lille Nord de France, F-59000 Lille (France)

[email protected]

Background: A homogeneous and reproducible fluence ratedelivery during clinical PDT plays a determinant role in pre-venting under- or overtreatment. In Dermatology, light sourcesdo not deliver a uniform light distribution on the skin due tothe morphology and the complexities of the human anatomy. Aim: This study aims at the production of large, flexible andhomogenous light emitting fabrics (LEF) based on POF weav-ing. The homogeneous light side-emission from the fabric isobtained by controlling the bending angles of POF inside theLEF due to specific architecture generated by weaving of tex-tile structures Materials and Methods: LEF is developed using POF (250 µm,weft direction) and Polyester yarns (330 dtex, warp direction).POF macrobendings are predetermined to obtain side emis-sion of light since the critical angles are exceeded in a con-trolled way. In order to overcome the decrease of side-emittedradiation intensity along the fabric and achieve homogeneouslight all over the LEF surface, both POF bundled ends are cou-pled to diode lasers. Characteristics of this LEF are determinedin terms of light emission, flexibility, etc.Results: LEF of 21.5 cm × 5.0 cm is woven. The LEF thickness istypically 1 mm. When connected to a 5 W diode laser (635 nm), theaverage light emission is 18.2 mW.cm-² (i.e. 3.64 mW.cm-².W-1)with heterogeneity of ± 2.5 mW.cm-² (13.7%) at any point ofthe LEF. The temperature elevation remains below 1°C for a 10minutes illumination.

Conclusion: LEF meets the basic requirements for PDT: homo-geneous light distribution and flexibility. It can be easily pro-duced by automatic weaving and no post treatment of POF isrequired. LEF can be connected to any diode laser: 405 nm,635 nm, 655 nm, etc. Moreover LEF can be easily manufac-tured in large series and can be used on skin, but also in peri-toneal or pleural cavities. They can be designed to performPDT of actinic keratosis on the face and scalp.

TIPS AND TRICKS: FILLER AND TOXINSCHAIR: M. LANDAU

Vectorial Facial Sculpturing: A Novel Approach to Non-invasive Pan-facial RejuvenationSARIT COHEN, MDPlastic Reconstructive and Aesthetic Surgeon, Ramat – Gan, Israel

[email protected]

Background: Minimally invasive facial procedures havegained widespread popularity during the last two decades.First generation procedures focused on filling of wrinkles/fur-rows in a two-dimensional manner. The importance of volumeenhancement in facial rejuvenation paved the path to proce-dures that highlight the third dimension in facial rejuvenation-volume. Second generation techniques focused on augmenta-tion of facial zones (i.e. malar area, temple) Acquaintance withthe impact of the attenuated ligaments on the aging face alongwith the significant rejuvenative effect while surgically mobi-lizing facial tissues in a superolateral vectors (counteractingthe infero-medial tissue sagging) have led to the fourth tenetin facial sculpturing-direction. Aim: The aim is to present the vectorial facial sculpturing-aninnovative approach for noninvasive restoration of youthfulfacial contour by vectorial repositioning of the sagging tissuesand to prove it by applying mathematical concepts and in accor-dance with Newton’s third law of motion of classical mechanics.Material and Methods: Special emphasis will be put on thereciprocal relationship between the attenuation of the orbital,zygomatic, masseteric and submental retaining ligaments incausation of a droopy eyebrow, deepening nasolabial fold,jowl, and loss of cervical/jawline contour, respectively. Byrotating the orbital, zygomatic, masseteric and submentalretaining ligaments in a superolateral direction with vectorspointing toward the glabella, lateral cheek, temple andinfralobular region, one can reposition (reverse) the saggingtissues in the lateral brow, nasolabial, jowl and cervical/jaw-line region, respectively. Injection technique will be presentedalong with pre-treatment and post-treatment photography.Conclusion: In this manner, one can truly sculpt the face thuscreating a harmonious, youthful facial shape and contour,rather than merely visually blur the sagging tissues via conven-tional injection techniques. Thorought acquaintance with facialanatomy, artistic perception and proper patient selection areof paramount importance.

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A Bimodal Tri-vector Approach to Volumetric Face Filling N. SADICK, MD

Perfecting the Smile And the PoutM. LANDAU, MD

Combining Fillers and ToxinsM. KOSMADAKI, MD

Friday September 20th, 201309:00 – 11:00

PLENARY: TOXINS AND FILLERS: HISTORY, DEVELOPMENT AND DIFFERENCES

Plenary: The Evolution of FillersS. WEINKLE, MD

Plenary: The New Botulinum ToxinsN. LOWE, MD

NEW TECHNOLOGIESCHAIR: C. ZACHARY

TRASER TechnologyC. ZACHARY, MD

Beyond Selective PhotothermolysisV. NARURKAR, MD

Hyperefficient Diode ArraysC. ZACHARY, MD

Picosecond TechnologyR. WEISS, MD

PERMANENT AND DURABLE FILLERS: SAFETY AND OUTCOMESCHAIR: S. GHANNAM

Soft Tissue Augmentation SAHAR F. GHANNAMConsultant Dermatologist (Kuwait)

Assistant Professor of Dermatology – Alexandria University (Egypt)

The field of facial aesthetic surgery is experiencing explosivegrowth in non-invasive and minimally invasive proceduresespecially related to skin aging. Nowadays, hyaluronic acidbased fillers are the cornerstone in tissue augmentation. Yetfillers such as Polylactic acid and carboxy hydroxylapatitewhich provide soft tissues augmentation through stimulationof an inflammatory tissues response with subsequent collagendeposition were introduced. These fillers are not permanentbut biodegradable.

The physical characteristics of these fillers; together withthe author clinical experience with hyaluronic versus nonhyaluronic acid fillers will be discussed.

Vascular Compromise with Deep Injection: How to Avoid and TreatD. VLEGGAAR, MD

Protocols for Filler Complications: Biofilms, Granulomas,Vascular Compromise: An Algorithmic ApproachMILES GRAIVIER, MDThe Graivier Center for Plastic Surgery, Roswell, Georgia (USA)

Background: Injection of Fillers and Neurotoxins have becomethe number one non-invasive cosmetic procedures in the worldtoday. Early and late adverse events related to injection arewell documented, and every injector will be faced with theseevents at some point. Injectors must be familiar with theseadverse events and be prepared to treat them immediately asthis can affect the outcome.Aim: To identify and type the complication of the injection andpresent an algorithmic approach to the treatment of theseadverse events. Recommendations for prevention as well astreatment protocols will be presented. Material and Methods: Delineation of types of complicationswith patient examples will be shown. Treatment algorithms foreach type of complication will then be presented as well asoutcomes. Results and Conclusions: Injectors can minimize potentialcomplications with preventative measures and good tech-nique. However, adverse events must be correctly identifiedand appropriate treatment instituted as soon as possible.Injectors should be prepared to treat the complications. Fol-lowing the algorithms presented should lessen the potentialsequelae of these complications.

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NANODERMATOLOGYCHAIR: A. NASIR

Nanotechnology in DermatologyA. 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)Professor  and Consultant

Department of Dermatology, Manipal Hospital, Bangalore (India)

Use of lasers and RF devices for skin tightening is now a recom-mended part of any treatment regimen. Newer RF technologieswill be discussed for the management of skin tightening, with afocus on  skin  of colour. An evidence based approach on the„colour blind“ approach using RF will be discussed. Commoncomplications with RF devices post inflammatory hyperpig-mentation in darker skin types will be discussed and potentialmerits and demerits of radiofrequency technologies whenusing these systems in skin of colour will be highlighted.

What’s New in HyperpigmentationM. AMER, MD

Fillers for East Asian Nose: How-to’s, Tips, Tricks, and BeyondNARK-KYOUNG RHO, MDLeaders Aesthetic Surgery and Cosmetic Laser Center, Seoul, Korea

Background: The refinement of techniques to restore facialvolume with dermal fillers, and widely available botulinuminjections to treat dynamic facial rhytids, has led to a surge indemand for non-surgical rejuvenation procedures. This proce-dure is now quite frequently performed in East Asian countries,especially in Korea, but only a few studies have been publishedin English literature.Aim: To provide basic concepts of the “East Asian” nonsurgicalrhinoplasty using various injectable filler materials, along withthe adjuvant use of botulinum toxins.Materials and methods: Not only the author’s personal experi-ence but also the general consensus of the Korean experiencedinjectors will be presented.Results: Nose bridge and suptra tip of the nose can be nicelyaugmented by biodegradable fillers and the adjuvant use ofbotulinum toxin will block the depressor of the nasal septum,which will limit the downward pulling of the nose tip and thusenhance the tip projection. Moreover, toxin injection on thenose will limit the filler migration and lengthen its duration.

Advanced concepts of centrofacial structural support andpractical pearls and pitfalls of filler and toxin use will be pre-sented.Conclusion: The botulinum toxin and injectable filler combina-tion is particularly relevant in the nonsurgical rhinoplasty inEast Asian population. Basic knowledge of the anatomical andhistological characteristic of the East Asian nose is mandatoryto get elegant results and avoid vascular complications.

Friday September 20th, 201311:45 – 13:45

ABLATIVE VS. NON-ABLATIVE TREATMENTCHAIR: S. GHANNAM

Fractional CO2 RejuvenationMATTEO TRETTI CLEMENTONI, MDIstituto Dermatologico Europeo – Milano – Italy

Background: Laser skin resurfacing has shifted over the pasttwo decades from standard ablative resurfacing to non-abla-tive resurfacing and most recently, to fractional laser resurfac-ing. Depending on the patient and the severity of the skin con-dition, the author customizes each treatment combiningsuperficial and deep ablation. This technique was called “com-bined or multi-layer technique”.Aim: The aim of this study is to evaluate the efficacy, adverseside effects, and long-term results (2 years) of the “combinedtechnique” using a fractional ultrapulsed CO2 laser on a largepopulation with photodamaged facial skin. Materials and Methods: 927 patients with aging facial skinwere treated. Each patient received one treatment customiz-ing 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 4point VAS scale) and a 3D analysis system device (that can cal-culate, merging the before and after pictures, the improvementof the skin pigmentation and texture). Results: 95,14% of the patients presented an improvementhigher than 75% in a 4 point VAS scale. These data are con-firmed by a 3D analysis system comparison. 94,06% wouldrecommend this treatment to others. No long lasting adverseeffects or infections were noted. Prolonged erythema and tran-sitory hyperpigmentations were noted in less than 1% of thepatients. Conclusions: Ultrapulsed CO2 treatment must be considered asextremely effective on facial aging.

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Non Ablative Rejuvenation SAHAR F. GHANNAMConsultant Dermatologist (Kuwait)

Assistant Professor of Dermatology – Alexandria University (Egypt)

Non Ablative treatment of skin laxity has been made possibleby devices that create uniform heating of the dermis andunderlying tissue, while providing cooling of the epidermis.This controlled determined thermal damage will lead to colla-gen remodeling, resulting in a tightened smooth skin under anundamaged outer layer, thus improving its appearance. Thesedevices range from Lasers, IPL to Radiofrequency devices eitherUnipolar or Bipolar technologies, most of these devices will bediscussed with emphasis on the author’s clinical experience.

Combining Ablative and Non-ablative Light Sources for Scar RevisionM. KADURINADepartment of Dermatovenerology and Allergology,

Military Medical Academy Sofia, Bulgaria

Background and Aim: Scars are common complications of thewound healing process. They develop as a result of variousprocedures and pathological processes and pose psychological,cosmetic and physical implications on the affected patients.Various treatment modalities have been employed over the pastcentury such as intralesional corticosteroids, topical retinoicacid, surgical excision and/or grafting, cryosurgery, etc.Materials and Methods: Currently ablative and non- ablativelaser devices are introduced in the treatment of scars. Clinicaldifferences in scars’ features determine the treatment proto-col. Colour, texture and morphology of the scar, as well as pre-vious treatment, influence the laser parameters and the num-ber 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 pho-tothermolysis (fractional Er: glass 1540 nm laser) is used forbetter efficiency and minimization of the side effects. Conclusion: The changes occurring in tissue during scar for-mation are in multiple directions: changes in skin texture, lossor extra production of collagen, changes in skin pigmentationand vascularization. The choice of laser depends on the pre-dominance of one or another feature. The combination lasertherapy allows more than one target to be influenced andoffers greater possibility to treat the scars.

Algorithm with Devices, Injections and TopicalsA. CAMPO-VOEGELI, MD

Role of Traditional CO2 ResurfacingS. R. WALDMAN, MD

FAT-TARGETING TREATMENTSCHAIR: G. STEVENS

Lipolysis of the Neck and ArmsK. HOFFMAN, MD

Cryolipolysis using the Treatment to Transformation Approach W. GRANT STEVENS, MD, FACS

Background: Cryolipolysis is a safe and effective method tonon-surgically reduce subcutaneous fat and improve body con-tour. Since its commercial introduction in 2009, the clinicalapplication of cryolipolysis (CoolSculpting, ZELTIQ Aesthetics,Pleasanton, CA) has evolved to achieve more comprehensiveaesthetic results. Aim: This presentation explores the Treatment to Transforma-tion (T2T) strategy, a customized treatment plan focused onoptimizing patient satisfaction. A global approach is applied,targeting all problem areas with repeat cycles delivered to thesame targeted areas, as needed. The goal of the presentationis to demonstrate cryolipolysis efficacy for contouring thewhole body.Materials and Methods: The assessment and planning proce-dure will be demonstrated, showing the available cryolipolysisapplicators and how they can be positioned to effectively tar-get and treat fat in different parts of the body. Body markingand applicator placement will be shown for treatment of fat inthe flanks, upper and lower abdomen, back, chest, arms, andinner thighs. Standard 60-minute treatment cycles were usedto treat all intended areas. Repeat treatments were performed,as needed, to effectively contour the body. Results: Clinical before/after photographs will be shown todemonstrate efficacy of cryolipolysis using the T2T approach.Visible fat reduction can be achieved non-surgically via cry-olipolysis. Aesthetically pleasing outcomes and high patientsatisfaction were attained by treating multiple anatomic sites,often with repeat cycles. Conclusion: Global fat reduction was achieved by deliveringcryolipolysis treatment cycles to multiple sites such as theabdomen, flanks, chest, arms, inner thighs, and back. Withcareful treatment planning and applicator placement, cry-olipolysis can achieve excellent body contouring.

Cryolipolysis: Maximizing ResultsL. BASS, MD

Lipolysis with Injectables: a 2013 OverviewBENJAMIN ASCHER, MDPlastic Surgeon, Paris (France), Lecturer & Clinical Assistant, Paris Academy

IMCAS Congresses Scientific Director

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

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ing localized fat accumulations. Although previously a mixtureof phosphatidylcholine (PC) and sodium deoxycholate (DC)was used, cell culture experiments and small-scale clinical tri-als, particularly thoseby Adam Rotunda published in 2004,have shown that DC was the major and principal active compo-nent responsible for fat cells lysis. Unapproved injectablepreparations of PC/DC have not been tested in large-scale ran-domized clinical trials and formulations are not well defined.Rigorous clinical trials are demonstrating a favourable productprofile using a pharmaceutical grade formulation of deoxy-cholic acid (ATX-101) that will be submitted for regulatoryapproval. 

ATX-101 is a proprietary formulation of synthetically deriveddeoxycholic acid and is the first adipocytolytic therapy toundergo robust clinical evaluation for the reduction ofunwanted submental fat (SMF). ATX-101 was compared withplacebo in two European phase III clinical trials. At 12 weeksafter the final treatment, clinicians reported significant reduc-tions in SMF with ATX-101. Patients were significantly moresatisfied with their appearance in association with their faceand chin and significantly more satisfied with their treatmentcompared with placebo, as well as reporting significantimprovements in the visual and psychological impact of theirSMF after ATX-101 treatment. ATX-101 was well tolerated;most adverse events occurred at the injection site, were mild ormoderate in intensity and transient. These results offer evi-dence that ATX-101 may offer a new pharmacological optionfor reduction of unwanted SMF.

Injectable treatments are convenient for patients who donot wish to undergo any or further invasive treatments. Carefulselection of appropriate patients with localized limited lipodys-trophy and a realistic and motivated attitude is required.  Com-bination therapy with surface treatments (e.g. infra-red,radiofrequency) or other devices (e.g. ultrasound) may improveoverall results, but this is not currently under investigationwith ATX-101.

Cryolipolysis for GynecomastiaG. MUNAVALLI, MD

Legal Aspects of CryotherapyR. BRINKMANN, MD

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

5 Ways I Use Devices Outside the BoxM. LAPIDOTH, MD

How to Increase Profitability of the Q-switched LaserA. BADAWI, MD

How I Maximize My DevicesC. DIERICKX, MD

PIGMENTED LESIONSCHAIR: T. KONO

Treatment of Congenital NeviT. KONO, MD

Confocal Microscopy in Facial PigmentationHIROTAKA AKITA, M.D., PH.D.Department of Dermatology

Fujita Health University School of Medicine

Toyoake, Aichi 470-1192 (Japan)

[email protected]

Background: To know the mechanism of pigment removal byIPL or Q-switched lasers irradiation, solar lentigines aftertreatment of these devices were analyzed using techniques ofskin physiological examinations and a non-invasive instrumentfor pigmentation in this study.Study and Methods:Ten healthy Japanese subjects, presentingwith solar lentigo on the face, were measured with melaninconcentration (Mexameter). In vivo confocal microscopy (Vivas-cope 1000 or 3000) was also used to visualize pigmentedlesions 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 subjectsreceived three consecutive of IPL treatments at 3-week inter-vals or one Q-switched Ruby laser treatment .Results: After IPL irradiation and Q-switched laser treatment,skin physiological examinations were improved. The images ofRCM showed that the melanosomes in the epidermal basallayer rapidly migrated to the skin surface. It was concludedthat IPL and Q-switched laser irradiation effectively removedthe dense melanosomes in the epidermal basal layer. IPL treat-ment does not destroy melanosomes, rather it removes accu-mulated melanin from the epidermis and reduces the contrastbetween epidermal lesions and normal tissue.Conclusion: Not only IPL but also Q-switched laser are effec-tive for treating for solar lentigines. But the mechanisms of pig-ment removal by IPL or Q-switched lasers irradiation weretotally different.

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Acquired Bilateral Nevus of Ota-like Macules (ABNOMs) W. MANUSKIATI, MD

Q-switched Laser in Skin of ColorM. SACHDEV, MD

HOME USE DEVICES CHAIR: G. TOWN

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

Background: Ultrasound as an energy source has beenincreasingly used in medical and aesthetic fields of medicinefor the past several decades. Commercialized professional useof high intensity high frequency ultrasound fields has foundsuccessful applications in cosmetic medicine. (e.g. Liposonics,Ulthera, Ultrashape) While home use of intense, high fre-quency ultrasound is in its initial stages; considerable amountof work has been done especially in thermal applications ofultrasound.Aim: The goals of the studies described below were as follows:Establish technical and scientifically robust approach to handheld devices with safety and efficacy profiles useable at home.Execute pre-clinical and clinical studies providing safe and effi-cacious set of parameters to achieve unmet clinical needs.Materials and Methods: Simulations of Intense Therapy Ultra-sound (ITU) of fields in homogeneous and inhomogeneousmedia were executed and optimized. Measurements of ITU bySchlieren method were performed and served as a source ofthe design parameters for the probes’ design. ITU probes forseveral clinical applications were designed and fabricated.Preclinical and clinical studies for treatments of mild to moder-ate form of acne vulgaris and facial tissue tightening and reju-venation were conducted with the fabricated probes. Results: Feasibility and pivotal trials, IRB approved, were con-ducted at Harvard University and Arizona State Universityrespectfully utilizing fabricated ITU probes. Total of 41patients were treated showing excellent safety profile; onlytransient erythema and edema were noted. Efficacy of thestudies showed statistically significant (p < .05) 30% improve-ment in “completely cleared” rate for the treated sites withover 80% satisfaction rate with self-assessment evaluations.Facial tissue tightening and rejuvenation 2 separate studies,IRD approved and conducted by CRO were performed on 72subjects. Efficacy of the daily treatments done over 4 week’sregimen was independently clinically assessed. It yieldedresponse rate based efficacy ranging between 82% and 98%for lifting, firmness and fine line improvements between thestudies. Safety of the treatments was confirmed by only thetransient erythema and edema resolved in less than 2–12 hours.

Conclusion: Home devices for consumers based on high fre-quency intense therapy ultrasound are feasible and may yieldbeneficial safety and efficacy profiles.

Advancing Capabilities of Home Use Fractional Laser:Beyond WrinklesILYA YAROSLAVSKYCynosure Inc, 15 Network Dr, Burlington MA (USA)

[email protected]

Background: Home-use non-ablative fractional lasers (NAFLs)are used successfully to treat facial rhytides. Expansion of thetreatment benefits to other skin conditions is of high interest.Aim: In this work, we investigated feasibility of at-home use ofnon-ablative fractional lasers for treatment of solar lentiginesand improvement in skin dyschromia. Materials and Methods: A prototype NAFL device operating atmid-IR wavelength range with variable energies up to 30 mJper microbeam was investigated. Two separate studies, onetargeting discrete lesions (33 subjects recruited) and the othertargeting diffuse hyperpigmentation / general skin toneimprovement (50 subjects recruited), were conducted. Sub-jects treated themselves for 4 or 16 weeks, respectively, andwere followed up to 3 months. Evaluations included standard-ized digital photography with subsequent grading of thelesions or overall skin tone, respectively, by blinded evaluators. Results: Treatments were well-tolerated with trace-to-moderateerythema being the most typical side effect. Majority ofblinded evaluators correctly identified the post-treatmentimage as “noticeably better” for 233 of 275 (84%) treatedlesions in the discrete lesions study and for 17 of 42 (41%)treated faces in the diffuse hyperpigmentation study. Therewas high degree of grading uniformity between the evaluators. Conclusion: The novel home-use NAFL device is a safe andeffective modality to treat solar lentigines.

Home-use IPL Hair Removal: End-to-End Human Safety AssessmentJ F. NASH, M. KOCK, I. GREIG AND B. FISCHERProcter & Gamble Company (USA)

Background: Light-based hair removal (LHR) has been part ofdermatological practice for the past 20 years and is the lead-ing device in the emerging home-use market. Based on theprinciple of selective photothermolysis, coherent, i.e., laser, ornoncoherent, i.e., Intense Pulsed Light or IPL, light delivered tothe skin will result in reduced hair growth that is fluence-dependent. The energy from the light source is absorbed bymelanin, the primary chromophore concentrated in hair folli-cles, converted to heat, leading to follicular damage/destruc-tion or, at low fluence, conversion of the follicle from active(anagen) to resting (telogen) phase. In either case, there is areduction in hair re-growth.Aim: Determine accuracy of pre-market adverse event preva-lence estimates derived from mechanism of action, i.e., selec-tive photothermolysis, clinical studies, published literature and

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expert opinion on post-market safety surveillance program fora low-fluence, home-use IPL hair removal device. Materials and Methods: An IPL device (wavelength 530–1100nm,pulse duration 25–75 msec, fluence 7–10 J/cm2, treatment area3 cm2) engineered with skin contact and tone sensors has beenmarketed in Western Europe for slightly more than 1-year. Priorto 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 surveil-lance program to collect health-related comments from con-sumers.Results: The most frequent AEs reported by consumers usingthe IPL device for hair removal were: discrete burns, pain andlasting (i.e., > 24 hr.) erythema. Low reported prevalence (< 0.01%)events included hyperpigmentation, itching/rash, pimples, andparadoxical hair growth. The reported prevalence of these AEswas accurately predicted from the pre-market human safetyassessment for this IPL device.Conclusion: Reported prevalence of in-market AEs associatedwith IPL-hair removal device were consistent with pre-marketestimates 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 home-use hair removal.

International Progress in Standards and Regulation for LightBased Home Use DevicesGODFREY TOWN1, WOLFRAM GORISCH2

1 University of Wales Trinity Saint David, Swansea, SA1 6ED, UK.

2 Laser Protection Consultant, 81929 Munich, Germany

The recent development of light-based laser and intense lightdevices for consumer use with or without physician directionhas raised new challenges in safety standards and regulatoryrequirements for these appliances.

Home-use laser products have emission levels from “embed-ded” lasers that would ordinarily result in their having laserhazard classifications of 3B or 4, but because of design fea-tures and interlocks, cannot emit radiation which is hazardousto the eye when the product is in contact with the skin. Whennot in contact with the skin, emission is normally disabled any-way. With no outside emission, safety control measures in cur-rent horizontal standards do not make much sense. The Inter-national Electrotechnical Commission (IEC) has thereforedefined a new laser Class 1C in its draft revisions to IEC stan-dard 60825-1. Since laser appliances of laser Class 1C arediverse products, safety requirements may be too general ifcontained in the horizontal laser safety standard. Therefore,the general IEC 60825-1 only allows laser Class 1C to be attrib-uted by a manufacturer to it’s product when a vertical safetystandard exists which contains specific safety requirementswhich cover eye and skin hazards posed by the respective prod-uct (such as appliances for hair removal and skin rejuvenation).

Whilst no equivalent ocular hazard generally arises withhome-use intense light sources (ILS), higher Risk Group„embedded“ ILS sources which pose a risk for the skin could

conceivably be employed in home-use devices for certainapplications (e.g. acne therapy).

If this new laser classification is approved, the vertical stan-dards will specify the appropriate design, engineering, reliabil-ity, test methods, labelling and instructional controls requiredfor safe consumer use. This paper gives an overview of therecent state of development of a vertical standard whichincludes lasers categorized laser Class 1C, in the IEC 60335series.

ILSC® 2013 Conference Program Proceedings.

Copyright 2013, Laser Institute of America.

Development of a New Cosmetic Category – Sonic SkincareROBB AKRIDGE, GLOBAL GENERAL MANAGERClarisonic, 17275 NE 67th Court, Redmond, WA 98052 (USA)

The initial concept to cleanse the skin by using the skin’s natu-ral elasticity in conjunction with sonic technology has resultedin the creation of one of the top skincare brands (Clarisonic)and a new skincare category – sonic skincare. During this pres-entation you will see how the Clarisonic Sonic Cleansing Sys-tem was developed, how it functions, and the clinical methodsused to determine the safety and efficacy of the device. Basedon several fluorescent and makeup removal assays, soniccleansing has been shown to be 6 times more effective thanmanual cleansing. As a result of excessive use studies, theClarisonic Sonic Cleansing System was determined, based onTransepidermal Water Loss measurements, to be gentleenough for daily use. Why sonic cleansing is so successful andthe future of at-home skincare devices will be discussed.

Efficacy & Safety of Home-use Devices for Hair Removal and Skin RejuvenationTOM NUIJSPhilips Research, High Tech Campus 34, 5656 AE Eindhoven

(The Netherlands)

Over the last five years various light-based devices have becomeavailable that consumers can use at home to remove unwantedhair or improve the appearance of their skin. These devices weredeveloped out of their professional counterparts and are basedon the same well-known principle of selective photothermolysis.However, the fluence levels of home-use devices are generallylower in view of safety. A logical consequence is then that wecannot expect to see the same efficacy from professional andhome-use devices. This difference is partially counteracted bythe more frequent use of home devices. Photoepilation devicesfor home use are generally based on Intense Pulsed Light (IPL)as technology. Available devices differ in spectral cut-off, pulseduration, and fluence levels, which has an effect on efficacy,safety profile, and addressable skin types. Reduction of hairdensity is generally significant following regular treatment.

The latest home-use skin rejuvenation devices target theskin 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 withMTZs are substantially lower than offered with professionalfractional systems. Nevertheless significant improvements inskin appearance can be realized under repetitive use.

Home Treatments with Fractional LasersP. BJERRING, MD

What Are the Practical Options for TestingJ. TYRER, MD

Under the Proposed Vertical Part 2 Standard?Safety in Home Use Appliances: EngineeringD. SLINEY, MD

STEM CELLS AND BIOCELLULAR THERAPIESCHAIR: J. POZNER

Autologous Fibroblasts for Acne ScarsG. Munavalli, MD

Efficacy of Platelet Rich Plasma in Eyelid and Neck RejuvenationBRUCE 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)

Platelet rich plasma (PRP) is a novel approach to eyelid andneck rejuvenation. It involves drawing the patient’s blood andremoving its platelets so that growth factors can be expressedand injected into the target tissues.

In this pilot study, 10 patients had their PRP injected intotear troughs below their eyes and followed for 6 months. Digi-tal photographs and 3-dimensional imaging was used to evalu-ate changes in the depth, volume, and texture of tear troughs. Significant improvement in the depth, volume and texture oftreated tear troughs was found at the end of the 6 month fol-low-up period.

PRP appears to be an effective modality for improving theappearance of tear troughs. It has also been used for neck skinrejuvenation and this data will be presented as well.

Laser-assisted Delivery of Live CellsD. MCDANIEL, MD

ASPS Taskforce on Regenerative MedicineJ. POZNER, MD

HAIR RESTORATION AND REGROWTHCHAIR: M. GOLD

Automated Hair TransplantationMICHAEL 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: Hair transplantation continues to grow and theprocedures for hair transplantation also have changed into amore automated mode.Aim: The aim of this presentation is to describe the NeoGraftSystem of automation for hair transplantation.Materials & Methods: The procedure of automated “individual”follicular unit extraction and implantation will be reviewed andclinical results will be reviewed.Results: Individual follicular unit hair transplantation, per-formed with the NeoGraft automated system, has revolution-ized the hair transplant procedure.Conclusions: Individual follicular unit hair transplantation worksand works well.

Cell Therapy for Hair GrowthN. SADICK, MD

FridaySeptember 20th, 201315:15 – 17:15

FACT OR FICTION?CHAIR: C. ZACHARY

Hair Removal in Dark Skin Is SafeMUKTA SACHDEV, MD (DERM), DPD, DD, DIP DERM (UK)Professor  and Consultant

Department of Dermatology, Manipal Hospital, Bangalore (India)

Laser hair  removal has become one of the most common cos-metic procedures performed worldwide. A variety of lasers andlight sources have been developed that may be employedin  laser hair  removal. The procedure was originally describedto be performed on dark hair on light skin; newer technologieshave made the procedure safer for patients withdarker skin and those of colour. Various types of lasers are uti-lized with laser hair removal – the most common of which are

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alexandrite, diode, Neodymium YAG and intense pulsed lightsources. An overview of the lasers used in India on darker skinand the newer technologies available with their safety profileswill be discussed.

Safety parameters and complications encountered in skin ofcolour will be highlighted and newer recommendationsfor hair removal treatments in skin of colour will be proposed.

Does Science Support Non-invasive Body Contouring? C. ZACHARY, MD

Laser Lipolysis Requires a Fat-specific LaserD. MANSTEIN, MD

It is Safe to Perform Procedures After IsotretinoinM. LANDAU, MD

INJECTION THERAPIES: OFF THE FACECHAIR: B. ASCHER

Use of Fillers Off the FaceB. ASCHER, MD

Injections Off the FaceJ. COHEN, MD

Use of Toxins Off the FaceA. PICKETT, MD

New Technical Advances with Blunt Cannulas for the HandsMILES GRAIVIER, MDThe Graivier Center for Plastic Surgery, Roswell, Georgia (USA)

Background: Fillers have gained popularity for use in dorsalhand rejuvenation. Injection of a filler can camouflage theprominent dorsal veins and extensor tendons that becomemore obvious with aging. The earliest method used was injec-tion with a needle into the proximal dorsal base of the handand then aggressive massage to distribute the filler along thedistal hand. This technique while successful, was not preciseand could lead to irregular filler distribution. Sharp needleinsertion occasionally led to bleeding. Aim: To demonstrate a more precise, less traumatic method ofdorsal hand augmentation using blunt cannulas.Materials and Methods: Discussion and video demonstrationof blunt cannula techniques for dorsal hand augmentation willbe presented. Results and Conclusions: Use of blunt cannulas for filler injec-tion in the dorsum of the hand has made the procedure virtu-ally painless, less traumatic, and a more precise method ofdorsal hand augmentation.

A Multi-Faceted Approach to Hand RejuvenationN. SADICK, MD

LASER HAIR REMOVAL: UPDATESCHAIR: W. PRAGER

Diode Laser Hair Removal UpdatesW. PRAGER, MD

Comparative Comfort of Hair Removal LasersD. DAY, MD

Laser Hair Removal SEAN LANIGAN, MD FRCP DCHChairman of Medical Standards Committee

Responsible Officer

Background: Hair reduction by lasers has been achieved pri-marily by selective photothermolysis of pigment in hairs usinglasers such as the long pulsed ruby (694 nm) and alexandrite(755 nm) lasers. These wavelengths are well absorbed bymelanin and have been shown to produce permanent hairreduction in dark hair in fair skin. Multiple treatments arerequired and in general a 60–70% reduction in hair growthcan be achieved in this way. Alternatives to these lasers arethe diode laser operating around 810 nm, the long pulsedNd:YAG laser at 1064 nm and flashlamps, which are broad-band light sources. The longer wavelengths of light are lessavidly absorbed by melanin and penetrate more deeply. Somestudies suggest that lasers are superior to IPLs in their depilat-ing efficacy.Aim: The aim of this presentation is to provide an update on recentdevelopments in hair removal and management of side effects.Materials and Methods: Skin is by far the largest provider oflaser hair removal in the UK with approximately 150,000 treat-ments each year. Part of the treatment process includes anongoing assessment of patient progress including percentagehair reduction. In addition a vigorous and comprehensive Clini-cal Incident process captures all adverse events and an Inci-dent Team analyses trends and introduces interventions toimprove practice.Results: Data relating to hair reduction using different laserson different phototypes and body sites will be presented. Clini-cal cases of adverse events will serve as learning points forattendees.Conclusion: Laser hair removal is a successful and safe treat-ment of unwanted hair. Recording clinical outcomes andadverse events in a very large population receiving treatmentprovides valuable information on this form of treatment.

Hair Removal With High Power DiodeM. ADATTO, MD

High Repetition Rate AlexandriteA. 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 HALACHMIRabin Medical Center, Petach Tikva, Israel and Skinpulse Dermatology

& Laser Center, Geneva, Switzerland

Background: Laser hair removal is the most common laser pro-cedure in young adults and continues to be a major segment inaesthetic treatments. However, the classic approach of usingthe highest tolerated fluence has been reconsidered.Aim: To review and evaluate the newer approaches to laserhair removal.Materials and Methods: Four devices with non-traditionaltechnological approaches were examined. One low-fluencediode laser was compared to a traditional laser handpiece in acontralateral non-inferiority clinical study in 14 healthypatients. The benefit of low-fluence diode lasers was alsoexamined in Becker’s nevi, a challenging clinical target.Results: With appropriately chosen parameters, low fluencedevices provided efficacy comparable to traditional hand-pieces and safety and tolerability that was superior to tradi-tional laser hair removal handpieces.Conclusion: Low fluence devices offer efficacy and improvedsafety and tolerability when used with appropriate settings.These approaches may provide an option for situations inwhich standard laser hair removal is not possible.

HYPERHIDROSIS: DEVICE-BASED APPROACHESCHAIR: D. GOLDBERG

Hyperhidrosis Treatment using the Nd:YAG 1440 nm Laserwith a Sidefiring Fibre SideLaze 800ALINA A.M. FRATILA MD, MARINA RECKMEYER, MDJungbrunnen-Klinik Dr. Fratila GmbH, Bonn (Germany)

Background: Primary Focal Hyperhidrosis is a chronic disorderpresenting as excessive underarm sweating. Quality of life cansignificantly decrease by impacting emotional well-being,social interactions, and occupational duties. Current treatmentmethods for Primary Focal Hyperhidrosis are limited in dura-tion and efficacy.Aim: The purpose of this study is to evaluate the efficacy andsafety of a minimally invasive laser treatment using a deliverysystem for smaller anatomic areas. A 1440 nm Nd:YAG wave-length and a 800 µm sidefiring fiber inserted through a 150 mmhandpiece 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-treat-ment 4 point Hyperhidrosis Disease Severity Score Scale(HDSS) score of 3 or greater, received a single treatment. From13 patients, 10 patients have been already evaluated after 3months. The amount of tumescent anaesthesia in each axillawas 200 cc. The area treated, was divided into four 5 x 5 cm

squares to determine amount of energy to be delivered, whichresulted in an average of 6000 J/axilla. Gravimetric measure-ment, starch iodine test and pictures (digital image softwareanalysis) were performed before and 3 months after the treat-ment and will be repeated after 6 months. Results: All patients reported an average improvement of 3.1at 3 months follow up. Gravimetric measurements showed animprovement of 81.2% at 3 months follow up. Patients’ satis-faction at 3 months follow up was rated as 80.83%. Typicalside effects like numbness, swelling, etc. were reported aftertreatment.Conclusions: Minimally invasive treatment with a 1440 nmNd:YAG laser, side-firing fiber is an effective and safe option forthe treatment of Primary Focal Axillary Hyperhidrosis. Addi-tional follow up will be done to confirm long-term results.

Lasers and Microwave for HyperhidrosisD. GOLDBERG, MD

Ultrasound for HyperhidrosisM. NESTOR, MD

Laser-assisted Sweat Gland Reduction A. FATEMI, MD

Device Treatment of Hyperhidrosis G. MUNAVALLI, MD

COSMECEUTICALSCHAIRS: C. DIERICKX, M. GOLD

The Role of Cosmeceuticals in a Laser Practice: EUC. 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: Cosmeceuticals are an important part of the aes-thetic scene and need to be part of any laser procedure.Aim: The aim of this presentation is to identify clinical trialsthat have been performed with cosmeceuticals to improve cos-metic outcomes with aesthetic laser procedures.Materials and Methods: From the author’s own clinicalresearch to other published reports; data will be presentedshowing how incorporating cosmeceuticals into one’s laserpractice can enhance results.Results: Cosmeceutical studies with lasers show how well thetwo modalities work together, how they complement eachother.

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Conclusions: The use of cosmeceuticals greatly enhances laserprocedures in the aesthetic field and should be used routinelyby clinicians using lasers in their clinical practices.

Product Innovation: Changing the Way We Treat Aging SkinPATRICIA K FARRIS, M.D.Tulane University School of Medicine

Private Practice, Metairie, Louisiana (USA)

Cosmeceuticals remain one of the fastest growing segments ofthe skin care market. These specially designed skin care prod-ucts contain active ingredients that provide benefits beyondmoisturization. Although many remain skeptical about thevalue of these products, recent innovations have resulted incosmeceuticals that can deliver significant benefits for treatinga variety of skin problems. In clinical practice, cosmeceuticalsare now used to prevent and treat photodamage, lightenhyperpigmentation, treat skin disorders such as acne androsacea and to improve outcomes from in-office procedures.

Development of these specially designed skin care productsincludes identification of novel ingredients, in vitro studies todelineate biologic effects and clinical testing to confirm effi-cacy. In this lecture, we will explore the latest innovations incosmeceutical skin care including identifying unique cellularand molecular targets that can be used to improve skin aging.Ingredients that can affect DNA repair and mitochondrial bio-genesis will also be discussed. Novel cosmeceuticals that pro-vide targeted treatment to areas such as deep lines and wrin-kles, dynamic rhytides, and under eye puffiness represent anew generation of topical skin care. Cosmeceuticals such asthese will change our treatment paradigms allowing us to offereffective topical solutions for cosmetic problems that previ-ously could be treated only with procedures.

Managing HyperpigmentationE. 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 knowSAHAR F GHANNAMConsultant Dermatologist (Kuwait)

Assistant Professor of Dermatology – Alexandria University (Egypt)

Botanicals form the largest category of cosmeceutical additivesfound in the marketplace today. They are plant extracts from theleaves, roots, fruits, stems, and flowers. Now over 60 different botan-icals are integral components of cosmeceutical products. It is there-fore important for every dermatologist to have a working knowledgeof these botanicals to provide optimal medical care, to know theiruses and myths and be able to answer patients’ questions.

Cosmeceuticals in Addition to Minimally Invasive ProceduresMARTINA KERSCHER, MDUniversity of Hamburg, department chemistry, cosmetic science

Aging of the face and neck involves both dynamic and staticchanges in bone, musculature, fat, and skin. It is a multipleprocess, resulting from the interaction of numbers of differentfactors, both intrinsic and extrinsic. As youth and perception ofbeauty are considered to be of great importance, an increasingnumber of topically, invasive and non-invasive methods havebeen developed in recent years. Today treatment can be indi-vidualized and directed toward the most pronounced changes,which are unique to each person. Due to the demand of lessinvasive procedures and for preventative intervention, minimalinvasive treatments have become very popular over the lasttwo decades. The cosmetic dermatologists have a number oftools and techniques to achieve a nonsurgical rejuvenation ofthe aging face. Multiple treatments like chemodenervationwith botulinum toxin or the use of dermal filler prolong skinaging especially when it is combined with cosmeceuticals. Forexample cosmeceuticals like topically anitoxidants can reducefree radicals damage to the skin, stimulate collagen produc-tion, improve skin surface and reduce fine lines. Moreover theregular use of sunscreens prevents visual signs on aging skin.With proven topical agents, patients are increasingly able toimprove the results of minimal invasive treatments.

New Cosmeceutical Delivery SystemsMUKTA 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 newertreatment methodologies for various indications in  skin reju-venation and dermatological  conditions. An overview of thescience and technology of the treatment devices with indica-tions will be discussed.

Potential complications and benefits will be reviewed and ahighlight on darker Indian skin types will be reviewed to allowfor evidence based medical approach to management usingnewer technologies. The future of these devices and their poten-tial place in the dermatologist’s armamentarium of treatmentoptions will be discussed with all relevant implications.

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BIOMODULATION WITH LED AND LASERCHAIR: J. L. VIGNERON

Photodynamic Therapy with Low Irradiance LEDA. CAMPO-VOEGELI,MD

Daily LED: Clinical EffectsJ. L. VIGNERON, MD

The Science of LED PhotobiomodulationD. MCDANIEL, MD

Excimer and VitiligoKLAUS FRITZ, MD, LANDAU (GERMANY)

Vitiligo is a common disorder. Therapy for vitiligo is challeng-ing. A variety of approaches have been proposed, includingtopical and systemic steroids, topical calcineurin inhibitors,phototherapy, and surgical intervention including graft andmelanocyte transplant.

Phototherapy can be delivered as broad band UVB, narrowband (NB) UVB, PUVA and targeted phototherapy using lightsources or excimer lasers and lamps. Phototherapy enhancesthe migration and proliferation of melanocytes resulting inrepigmentation and has further an impact on the immuneresponse.

In the past decade, an increasing number of reports havehighlighted the value of the excimer (excited dimer) in themanagement of vitiligo. 308 nm excimer lasers and excimerlamps allow targeted phototherapy at high doses of 308 nmwavelength, which is close to 311 nm, that was proven to bemost effective. It has the advantage of enabling also the treat-ment of small, inaccessible or resistant areas when comparedto ordinary phototherapies.

NB UVB units irradiate both diseased and normal skin,whereas targeted sources deliver high intensity lights to depig-mented areas. Rapid therapeutic responses have beenreported after targeted phototherapy that may contribute tothe reduction of the cumulative UV dose.

Sessions are performed 2–3 times a week. Initial doses aredetermined either by minimal erythema dose MED like 70 % ofMED or constant at 100 200 mJ depending on area and indica-tion. The maximum dose usually reaches 2–3 j/cm2. For thetreatment of vitiligo, the initial dose varies and depends on thebody 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 ery-thema.

First repigmentation can start after 4 treatments and 2weeks in Asian skin (type 4) on the face and approximatelyafter 8 treatments on the extremities. Onset of repigmentationwas reported after an average of 13 treatments in lesionslocated on the face, trunk, arm, and/or leg, locations that areknown as high responder areas and after 22 treatments inlesions located on the elbow, wrist, dorsum of the hand, kneeand dorsum of the foot ,known as low responder locations. Thepoor response on the hands and feet could be due to the lowdensity of hair follicles there, since repigmentation usuallyoriginates from outer root sheet melanocytes in hair follicles.

The number of sessions per week play an important role inboth: total efficacy and onset of response. Zhu et al found > 75%repigmentation in 0% treated every 14 days, 26% treated 2times/week; 32% treated 3 times/week. More frequent treat-ments show better results. However more side effects werenoticed with excimer laser therapy given three times a week.

The available studies provide strong evidence that theexcimer laser represents the most effective approach to treatvitiligo compared to ordinary phototherapy. Excimer laser isrelatively safe and effective for localized disease. UV sensitiveareas respond best as well as a short duration of the disease,more frequent treatments achieve better results. Compared toother treatment modalities, Excimer laser most likely consti-tutes the treatment of choice for localized vitiligo. Its efficacycan be further improved in combination with other therapiessuch as corticosteroids, pimecrolimus, or tacrolimus.

Based on an increasing numbers of reports and studies indi-cating the value of Excimer laser in the management of vitiligo,we critically review the published literature and provide rec-ommendations based on the available evidence.

SCLEROTHERAPYCHAIR: R. WEISS

Updates in SclerotherapyR. WEISS, MD

When Sclerotherapy? When Laser?M. WEISS, MD

Endovenous Radiofrequency Obliteration – FAST Closure A. FRATILA, MD

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Saturday, September 21, 201309:00 – 11:00

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

What‘s on the Horizon in Cosmeceuticals?PATRICIA K. FARRIS, MD(See page “Product Innovation: Changing the Way We TreatAging Skin”)

What‘s on the Horizon in Nanotechnology? A. NASIR, MD

What‘s on the Horizon in Injectables?J. COHEN, MD

What‘s on the Horizon in Devices?D. GOLDBERG, MD

What‘s on the Horizon in Cosmetic Surgery?B. ASCHER, MD

MANAGEMENT OF ADVERSE EVENTS: DEVICESCHAIR: W. MANUSKIATI

Laser-induced PigmentationW. MANUSKIATTI, MD

Laser Complications ELISABETH TANZI, MD

Lasers and light-sources were developed based on the theoryof selective photothermolysis first outlined by Anderson andParrish in 1983. According to the theory, lasers and lightsources are capable of destroying specific tissue targets whilstminimizing the risk of dyspigmentation or scarring. Full real-ization of the theory is accomplished through the delivery of awavelength and pulse duration that is best absorbed by thespecific targeted chromophore. However, not all laser and lightsources or common treatment protocols adhere to this princi-ple. Despite significant advances in cutaneous laser surgeryover the past 4 decades, lasers can produce side effects andcomplications, particularly when improper patient or laserselection, intraoperative technique or post-treatment care isevident. The importance of preoperative patient screening andeducation, as well as accurate laser selection and application

with close postoperative supervision cannot be overempha-sized. If complications are recognized quickly, early interven-tion minimizes the risk of long-term adverse sequelae.

Complications with Energy Based SystemsMICHAEL 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: The use of energy based therapies for the treat-ment of cosmetic and medical uses has increased greatly overthe past several years. With it, many new devices have recentlybeen introduced to clinicians claiming to be the best of thebest and also the safest of all.Aim: The aim of this presentation is to review that adverseevents do happen with lasers and light sources – and we needto know that even with the best of the best, these adverseevents can be seen.Materials and Methods: From the author’s personal 25 yearlaser history to my colleagues sharing their cases, we haveidentified adverse events with every kind of energy based ther-apy.Results: All energy-based therapies have the capabilities ofhaving an adverse outcome.Conclusions: Using energy based therapies for our patientsresults in great results the majority of times; we must be awarethat adverse events can occur, will occur, and that one must beaware of them and how to treat them if they occur.

Laser Resurfacing ComplicationsJ. POZNER, MD

Applying Cutting Edge in Wound Healing Research to Optimize Post-treatment CareT. PHILLIPS, MD

SKIN TIGHTENINGCHAIR: N. SADICK

Skin Tightening with the 1440 nm Lipolysis LaserK. HOFFMANN, MD

Overview of Techniques for Tissue TighteningC. DIERICKX, MD

FR for Tissue Tightening and Surgical ProceduresD. DAY, MD

Whole Body Skin Tightening: Separating Myth from Reality N. SADICK, MD

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LIPOSUCTIONCHAIR: G. SATTLER

Laser Lipolysis and LiposuctionG. SATTLER, MD

Ultrasound-assisted Liposuction with Abdominoplasty C. INGLEFIELD, MD

Laser Lipolysis: With or Without AspirationD. GOLDBERG, MD

Complications of Laser LipolysisA. FATEMI, MD

STRIAECHAIR: M. ADATTO

My Fractional Approach to StriaeM. ADATTO, MD

Rational Treatment Approach to StriaeD. MCDANIEL, MD

RF for Striae K. FRITZ, MD

Treatment of StriaeR. WEISS, MD

SaturdaySeptember 21, 201311:45 – 13:45

BODY CONTOURING: ICHAIR: G. STEVENS

Non-Surgical Body ContouringW. GRANT STEVENS, MD, FACS

Background: Modern liposuction techniques were introducedin the 1980’s and rapidly gained popularity in aesthetic medi-cine. Today, liposuction remains among the most popular cos-metic surgery procedures and the gold standard for body con-touring. Demand has grown, however, for non-surgicaltechniques with lower risk and less downtime.

Aim: Numerous non-surgical body contouring methods havebeen evaluated at Marina Plastic Surgery. This presentationwill discuss non-surgical systems employing cryolipolysis,high-intensity focused ultrasound, infrared light, laser, mas-sage, RF energy, and vacuum. Materials and Methods: Safety, efficacy, and tolerability ofthe various methods will be presented, based upon evaluationsby me, my staff, and my patients. Clinical efficacy for skintightening, cellulite minimization, and fat reduction will bedemonstrated by before and after photographs. An overview ofa wide variety of body contouring systems will be shown,including Thermage, Exilis, Zerona, SmoothShapes, VelaShape,truSculpt, Liposonix, i-Lipo, Vanquish, Venus Freeze, andCoolSculpting.Results: A large number of non-surgical body contouring sys-tems have been purchased and evaluated at my practice. Onesystem has been consistently utilized and required me to pur-chase 6 systems to keep up with demand. The system that hasshown the highest efficacy, patient tolerability, and businessgrowth potential has been CoolSculpting. Representative clinicalphotographs and business growth results will be discussed.Conclusion: Many non-surgical body contouring systems areavailable. This presentation will review the advantages and dis-advantages of several commercially-available systems for non-surgical body contouring. The safety, efficacy, consistency inresults, tolerability, and profitability of the CoolSculpting sys-tem make it the best available non-surgical body contouringsystem.

Efficacy of HIFU in Body ContouringBRUCE 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)

High intensity focused ultrasound (HIFU) has been a subject ofinterest in medical research since 1942, when the first work toconsider potential applications of HIFU was published. HIFUrelies on the same principles as conventional ultrasound anddeposits heat energy in a very well-defined volume, propagat-ing harmlessly through surrounding tissues. HIFU for fat reduc-tion provides a non-invasive alternative to traditional invasivebody sculpting approaches, which are associated with morbid-ity and side effects. HIFU for body sculpting allows focusedultrasound energy to be delivered at specific depths in subcu-taneous adipose tissue, preventing exposure and damage totissues outside of the focal zone. The intensity is brought to asharp focus in the subcutaneous fat to destroy adipocytes.Recent clinical work indicates HIFU treatment reduces waistcircumference, and is a safe and effective method for noninva-sive body sculpting. This presentation will review the latest evi-dence based clinical data on the efficacy of HIFU and most effec-tive protocols for use of this technology in body contouring.

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Innovations in LLLTM. NESTOR, MD

Cryolipolysis Outcomes: Tailoring TreatmentJ. DOVER, MD

LIDS AND LASHESCHAIR: J. FEW

Upper Blepharoplasty and Brow Suspension with One IncisionJULIUS FEW, MD, THE FEW INSTITUTE CHICAGO (USA)

Traditional brow lifting has been on the decline over the past 5years according to statistics published by the American Societyfor Aesthetic Plastic Surgery. One reason is the enhanced useof neurotoxins for cosmetic enhancement to the forehead.Another reason has been consumer concern about over eleva-tion of the brow. We know that many cases of upper eyelid skinexcess is due to undiagnosed brow ptosis but patients areunwilling to consider simultaneous browlift. We present aneasily reproducible technique to enhance and preserve uppereyelid aesthetic after upper blepharoplasty by usingtranspalpebral brow suspension. We have successfully appliedthis approach in more than 500 cases to achieve stable browposition and preservation of improved symmetry while avoid-ing early return of blepharochalasis. In conclusion, a singleincision is highly safe and effective rejuvenate the upper eyelidand brow at the same time.

Is the End of Blepharoplasty in Sight?C. INGELFIELD, MD

Deep Ablative Periorbital ResurfacingJ. POZNER, MD

Bimatoprost Review and UpdateJ. COHEN, MD

Eyelid Rejuvenation with FillersL. BASS, MD

Treatments of Eyelid LesionsA. CAMPO-VOEGELI, MD

ALTERNATIVES TO TOXINSCHAIR: K. FRITZ

Focused Cold TherapyG. SATTLER, MD

Focused Cold Therapy for Dynamic Facial linesKLAUS FRITZ, GEORGE SORIN TEPLICAHaut und Laserzentrum Landau, University Carol Davila Bucharest

Similar to the treatment with Botulinum toxin focused coldtherapy (loveraTM) targets dynamic facial lines such as crow’sfeet and furrows. Cryoneuroablation, also known as cryo anal-gesia or cryoneurolysis, is a specialized technique for provid-ing tong-term pain relief in interventional pain managementsettings. Now it also can be used for the temporal branch of thefacial nerve in the treatment of dynamic wrinkles caused bymimic muscles. The application of cold to tissues creates aconduction block. Cryotherapy depending on depth of coolingdisrupts the nerve structure and creates wallerian degenera-tion, but leaves the myelin sheath and endoneurium intact.After pretreatment with local anesthesia, needles cooled withliquid nitrogen are jabbed into the parietal treatment area, thenerves are cooled down to minus 20 degree Celsius for 45 to120 seconds. Immediate block of nerve activity can beobserved. This technology is now used for nerves responsiblefor muscles causing glabella and frontal wrinkles. Compared tothe treatment with Botulinum toxin the effect of focused coldtherapy acts immediately and lasts for about two to fourmonths Low temperature treatment of minus 20 degrees onmotor nerves causing 2nd degree Wallerian degeneration doesnot result in any permanent or long term changes to functionand structure of the nerves. This technology allows patients,who want to avoid Botulinum toxin or who are resistant to thetoxin a new way of treatment.

Focused Cold Therapy – A New Treatment to Reduce Dynamic Forehead Lines KAI-UWE SCHLAUDRAFF, MDConcept-Clinic Geneva (Switzerland)

Background/Aim: Introducing the world’s first toxin free wrin-kle treatment delivering immediate results based on FocusedCold TherapyTM (FCT) to targeted facial nerve branches. FCThas been shown to be a safe and effective means to inhibitmotor nerve conduction via a mechanism called cryoneuro-modulation. Materials and Methods: A handheld device (myoscience, Red-wood City/USA) delivers controlled low temperatures via atriple microneedle probe and reversibly inhibits motor nerveconduction – without injecting any chemicals into the tissue. Results: Clinically, FCT induces a physiological response tocold that is known as 2nd degree Wallerian degeneration andcaused by an axonal degeneration and demyelinization, whileleaving the endoneurium, epineurium, and perineurium

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intact.  This allows for an immediate relaxation of dynamicforehead lines while ensuring the guided regeneration and fullfunctional recovery – even after multiple treatments. Histologi-cally, regenerating axons are observed by 8 weeks with furthermaturation and re-myelinization observed at later timepoints. There are no systemic side effects and the surroundingstructures like sweat glands, sebaceous glands, hair bulbs, andadipose tissue remained intact.  Conclusion: FCT allows for efficient treatment of dynamic fore-head wrinkles - with an immediate effect visible for the patientand comparable duration as compared to the usual treatmentoptions.

WHAT DO PATIENTS WANT?

What Docs Need to KnowMICHAEL 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 mediaand internal advertising helps docs market their practices.Materials and Methods: Marketing of one’s practice is com-monplace in most countries. The use of internal marketing andtoday’s social media has helped many in spreading the attrib-utes of one’s clinical practice.Results: Internal marketing and social media are importantmarketing tools.Conclusions: With the proper use of internal marketing andsocial media, one can increase awareness that can lead to anincrease in the number of patients one sees in clinical practice.

Market Trend AnalysisM. MORETTI

Branding: How Will Clients Know What You Offer?W. LEWIS, MD

BODY CONTOURING: IICHAIR: B. KATZ

3-D Evaluation of 1440nm Nd:YAG in Cellulite TreatmentBRUCE 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)

Background: Cellulite is a cosmetic problem that affects over80% of women. To date, there have been no technologies thathave had significant lasting benefits for cellulite. Methods: In this IRB approved study, 15 women had cellulite ofthe thighs treated with a novel 1440 nm Nd:YAG laser with asidelight 3D optical fiber that transmits energy bi-directionally.Follow-up was at 1 week, 1, 3 and 6 months after a single treat-ment and results were monitored by digital photography,patient and physician questionnaires and histologic evalua-tion. A Vectra 3-Dimensional surface imaging system was usedto measure qualitative and quantitative changes in skin topog-raphy at each follow-up visit compared to baseline. The Side-light 3D optical fiber was used to thermally subcise subcuta-neous septa, deplane fat cells and heat dermal tissue topromote skin thickening and tightening.Results: 68% of subjects showed significant improvement incellulite by photographic evaluation and 65% with Vectra 3Dsurface imaging. Patient & physician evaluations revealedgood-excellent results in 76% & 69% of cases, respectively.Except for mild ecchymoses and edema lasting less than oneweek, no adverse events were noted.Conclusion: A novel sidelight 3-dimensional optical fiber and1440 nm Nd:YAG laser appear to have long lasting benefits inthe treatment of cellulite.

AWT in Cellulite and Volume ReductionM. ADATTO, MD

Cellulite Management SAHAR F. GHANNAMConsultant Dermatologist (Kuwait)

Assistant Professor of Dermatology – Alexandria University (Egypt)

Cellulite is a clinical and aesthetic condition affecting mostwomen, who are not cachectic. Clinically, the skin acquires anorange peel or mattress appearance. In this condition alter-ations occur to the adipose tissues and microcirculation thatresult from blood and lymphatic disturbances causingfibrosclerosis of the connective tissues. It is considered a non-inflammatory degenerative phenomenon that provokes alter-ations to the hypodermis producing irregular undulations onthe skin overlying the affected area. It is imperative to under-stand the pathophysiology of this condition in order to meetthe increasing female demands to get rid of this unaestheticcondition. The search for a treatment for this condition has

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been going on for decades. A review of the treatment optionsavailable will be mentioned with emphasis on the newer tech-nologies.

RF and Ultrasound for Body ContouringK. FRITZ, MD

LIP SERVICECHAIR: J. COHEN

Quest for the Natural LipS. R. WALDMAN, MD

Lip Augmentation: Maximize Results, Minimize AEJ. COHEN, MD

Radial Lip Line Treatment MILES GRAIVIER, MDThe Graivier Center, Roswell, Georgia, 30076 (USA)

Background: The treatment of radial lip lines is problematicfor the patient and practitioner. A variety of treatment optionscan be chosen with varying success as well as variations inrecovery. Neurotoxins, resurfacing with lasers, dermabrasionor deep peels, and use of other energy devices have been used.Fat and fillers is an option with limitations on results oftenbased on level of injection. Hyaluronic acid fillers have beenmost commonly used, but fear of Tyndall effect from placementin the superficial dermis is limiting. A study was designed tolook at use of Belotero® balance injected into the superficialdermis to try to achieve some correction of the radiai lip lines. Aim: This study is designed to determine the efficacy ofBelotero® Balance for perioral rejuvenation. Especially it is todetermine the ability of Belotero® to correct radial lip lines ofthe upper and lower lips, corner of mouth lines, and other finelines in the perioral region. The study will determine ifBelotero® with CPM binding technology will allow better cor-rection of these areas with avoidance of Tyndall effect, lumpi-ness, or other adverse events more commonly associated withsuperficial and mid-dermal placement of other NASHA products.Materials and Methods: The study was performed on 10patients with grade 2 to 4 radial lip lines at rest using the Merzlip line scales. The patients had standardized, close up AP viewphotography in the relaxed state. They were treated withinjectable Belotero® Balance only. They returned for electivetouch–up injection at 2 weeks if necessary. Standardized pho-tographic evaluation was performed at 2 weeks, 4 weeks, 6weeks, 8 weeks, and 12 weeks after injection. The patientsrated themselves using the GAIS system and the photographswere compared at each interval to pre-injection photos. Results and Conclusions: All patients had an improvement inMerz scale rating of 1 grade for the 12 weeks of the study. Anaverage volume of Belotero® Balence including touch-up at 2weeks was 1.1 cc. No incidence of Tyndall effect was noted.

Toxins for the Lower FaceJ. COHEN, MD

THE INTERFACE OF COSMETIC SURGERYAND NON-SURGICAL APPROACHES

CHAIR: S. J. POZNER

Combining Surgery and InjectionsB. ASCHER, MD

Multispecialty PracticeJ. POZNER, MD

Isolated Submentoplasty: The Poor Man’s FaceliftS. R. WALDMAN, MD

PATIENT MANAGEMENT FROM MARKETING TO POST-TREATMENTCHAIR: D. GOLDBERG

The Impact of Patient Psychology on Cosmetic Dermatology PracticeA. 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, 201315:15 – 16:45

ADVANCED REJUVENATION METHODSCHAIR: S. DAHAN

Sublative Fractional Bipolar Radiofrequency CombinedTreatments with Light and Bipolar RF for Acne Scars andRejuvenationSERGE DAHAN, MDClinique St Jean Languedoc, Toulouse, France

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

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acne scars and rejuvenation with minimal downtime and nosignificant side effect. This study evaluates the safety and effi-cacy with the association of light (IPL: 470–980 nm) , bipolarradiofrequency and sublative fractional bipolar radiofrequencyto improve our results.

• First photo rejuvenation with light (470–980 nm).• second skin tightening (RF and IPL 700–2000 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 3months after the 3rd treatment .Results: Results improved significantly since the first treat-ments and this improvement persits for at least 3 months afterthr 3rd treatment. Adverse events were limited to transient ery-thema and edema.Conclusion: The combination of light with bipolar radiofre-quency and sublative radiofrequency is a safe and effectivetreatment for acne scars and rejuvenation with minimal down-time and no significant side effect. All subjects found the treat-ment to be comfortable and were satisfied with the results ofthe treatment. Higher improvement with treatment progressfor color, texture, and wrinkles.

Interaction between Injections and laser, and related technologiesB. PUSEL, MD Villabianca – 718, Boulevard Pierre Sauvaigo – 06570 Saint Paul de Vence (France)

In 2010, the most popular cosmetic surgical procedures were:rhinoplasty, facelift, and blepharoplasty. The most frequentcosmetical non-surgical procedures were botulinum toxin, andhyaluronic acid. Many others technologies are also used forfacial rejuvenation, including lasers, lights and radiofrequency.Treatment with these devices has proved beneficial in theimprovement of rhytidesand scars.

It is now a common practice to propose laser therapy beforeor after injections of fillers or botulinum toxin and combinedtechnologies are used frequently to increase final result. Anec-dotal reports allege that use of laser/light/RF devices afterinjection of fillers might substantially reduce the effect of thefiller implant or lead to rapid degradation of the product. It islargely based on the fear of denaturation of the materialthrough heat generated in the dermis by the laser/light/RFdevices. There is few data with experimental clinical studiesabout this possible interaction between fillers and lasers andothers procedures.

Concerning botulinum toxin, the adequate procedure is aninjection into the muscle, and formally far from the depthreached by the lasers/lights and RF treatments. Combinationtreatments have even showed synergistic effects for facial reju-venation, and in particularly in the challenge of the treatmentof the upper lip.

A review of the interaction between laser and fillers/botu-linum toxin will give some advice on the eventually betterschedule to perform the different procedures for a better result.

Combining Lasers, PDT and Fillers for Facial Aesthetics TANJA FISCHER, MD

Combination Therapy for Skin RejuvenationSUZAN OBAGI, MDAssociate Professor of Dermatology

Associate Professor of Plastic Surgery

Director, The Cosmetic Surgery and Skin Health Center

University of Pittsburgh Medical Center (USA)

Background: Skin rejuvenation is essential to the overall cos-metic enhancement of a patient’s appearance.  Patients arereluctant to undergo procedures in which they will have a pro-longed recovery period, especially if they have to have severaltreatments. There is, to date, no proper algorithm for safelycombining skin rejuvenation procedures.  Aim: To teach participants which procedures can be combinedand the proper order in which to combine them.Materials and Methods: This lecture will cover the propermethod to assess, plan, and perform multiple treatmentsincluding lasers (vascular, pigment, acne scars, ablative/non-ablative, fractionated), electrodessication, and chemical peelsin one procedure.Results: Case examples will be used to show the properpatient evaluation, skin preparation, planning, and the per-formance of one to many skin rejuvenation procedures duringone visit so as to maximize a patient’s recovery time.  Conclusion: The safety and success hinges on the proper orderin which these procedures are performed. 

Non-laser, Non-ablative Facial Rejuvenation using a Transfol-licular Drug Delivery System (Affinite)NARK-KYOUNG RHO, MDLeaders Aesthetic Surgery and Cosmetic Laser Center, Seoul (Korea)

Background: The hair follicles and sebaceous glands areincreasingly recognized as potentially significant elements inthe percutaneous drug delivery paradigm. Interest in piloseba-ceous units has been directed towards their use as depots forlocalized therapy, particularly for the treatment of follicle-related disorders such as acne or hair loss. Considerable atten-tion has also been focused on exploiting the follicles as trans-port shunts for systemic drug delivery.Aim: To provide a basic and current concepts of the transfollic-ular drug delivery and introduce a novel developments in thisfield.Materials and Methods: Review of the various key facets ofthis field including; relevant aspects of pilosebaceous anatomyand physiology, and the advantages and disadvantages of thecurrent follicle-targeting modalities, along with the introduc-tion of a novel non-ablative transfollicular drug delivery sys-tem (Affinite), will be presented.

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Results: Transfollicular drug delivery is a fantastic treatmenttool in dermatology but its therapeutic value is still underquestion using current technology. It appears that this deliveryroute is quite complex in nature and that drug transportthrough the appendages is probably modulated by an array ofdifferent variables. To date, most of the work in this field hasbeen focusing on the formulation of the drugs. Clearly, only afew researches were performed to make a hair follicle-specificdrug delivery tool. Affinite is one of the few novel systemsbased on the concept transfollicular drug delivery. The deviceuses carbonated water under high pressure through ultra-thinopenings in the single-use tip. Because the diameter of thestream (50 microns) is smaller than the inlet diameter of thepores, a sort of lock-in process happens during the alignmentbetween the pores and the stream, and a portion of the solu-tion is transfused from the tip into the pore. The author usesthe device to restore the (photo)aged skin manifesting finewrinkles, prominent pores, uneven skin tones, dyschromias,etc. The procedure is not related with pain, downtime, or sig-nificant side effects, and can be used safely even on the sensi-tive skin. The meaningful clinical improvement is achievedafter a series of weekly treatment sessions.Conclusion: The use of a novel non-invasive transfolliculardrug delivery system is a safe and effective treatment inKorean patients. Further researches are recommended in termsof the new clinical applications, use of a different infusing solu-tion, and so on.

THE HOMOGENEOUSLY-TONED FACECHAIR: M. LUPO

Management of Facial Redness: Devices, Topical and Oral TherapiesMARY P LUPO MD, FAADClinical Professor of Dermatology, Tulane University Health Sciences Center

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

Conclusion: Improvement of redness that is the result ofrosacea or sun damage can be improved. Long term results aredependent on patient compliance and occasional supplemen-tal treatments.

Efficacy and Safety of Topical Cosmeceutical for Rosacea C. INGLEFIELD, MD

Treatment of Melasma with Q-switched Laser and/or Intense Pulsed LightPAULO R. CUNHA, MD, PHDJundiai Medical School – São Paulo (Brazil)

Background: Melasma remains a therapeutic challenge, espe-cially in woman, in which the condition is most prevalent, withmajor social and emotional consequences. Treatment optionsinclude topical, chemical peels and device-based therapies(CO2 laser, Q-switched Nd: YAG, QSAL, erbium: YAG laser andintense pulsed light (IPL).Aim: Showing a series of cases, we report our results demon-strating marked improvement on refractory melasma after thesimultaneous combined treatment with Nd-Yag Q-switchednon-ablative fractionated – 1064 nm, 20 ns and IPL therapy(Alma Laser™).Materials and Methods: Participants received treatment withNd-YAG Q-switched non-ablative fractionated – 1064 nm, 20ns and/or IPL therapy (Alma Laser™). All participants received3 applications, with an interval of a month from each session.Six patients underwent an exam with Wood light, a biopsy wascollected from a melasma affected area, and their MASI indexwas calculated. At the end, the MASI index was once again cal-culated. Pre and post treatment pictures were taken. Results: All patients in the study, showed a significantimprovement of melasma. Only one patient presented anhypochromic area after laser application. However, this sideeffect had small impact, since the hypochromic improved after20 days.Conclusion: We encourage dermatologist to consider the newtechnology Nd-YAG Q-switched non – ablative fractionated –1064 nm, 20 ns as a treatment option for refractory melasmaunresponsive to other treatment modalities. It applies a selec-tive photothermolysis at the subcellular level and offers goodresults. The observed adverse post treatment events were min-imum and temporary.

The Use of Sunscreen Starting on the First Day after AblativeFractional Skin ResurfacingRUNGSIMA WANITPHAKDEEDECHA, M.D., M.A., M.SC.,RUJEE PHUARDCHANTUK, M.D., WORAPHONG MANUSKI-ATTI, M.D.Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol

University, Bangkok, Thailand

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

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reduce the occurrence of PIH after laser treatment includingsun avoidance, the use of preoperative and postoperativetreatment regimens, and treatment using conservative energysettings and epidermal protection.Objectives: To determine whether the use of board-spectrumsunscreen with anti-inflammatory agents starting on the firstday after fractional CO2 laser skin resurfacing reduces the inci-dence of post-laser PIH.Materials and Methods: Thirty patients were treated withablative fractional CO2 resurfacing on both sides of their facesat 10 mJ and 10% density. Each subject was randomly treatedon one side of the face with petrolatum ointment 4 times a dayfor the first week after laser treatment and on the other side ofthe face with petrolatum ointment 4 times a day plus board-spectrum sunscreen with anti-inflammatory agents in themorning starting on the first day after laser treatment.Transepidermal water loss was recorded at baseline and everyday for 1 week. Melanin and erythema indexes were measuredat baseline, 1-, 2-week, 1-, 2-, and 3-month post treatment.Results: Of the 30 patients involved in the study, 26 receivedtreatment and attended 1-, 2-week, 1-, 2-, and 3-month post-treatment visits. Four patients were withdrawn from the studybecause they could not attend every follow-up visit. There wasno statistically significant difference in transepidermal waterloss at baseline, immediately after laser treatment, or at the D1to D7 follow-up visits. Erythema index had no significantly sta-tistical difference at baseline, 1-, 2-, and 3-month after lasertreatment. Furthermore, there was a statistically significantdifference in melanin index at 1-week post laser treatmentbetween both sides (p = 0.001). Melanin index at the 1-weekfollow-up visit on the side treated with broad-spectrum sun-screen with anti-inflammatory agents starting on the first dayafter laser treatment was significantly less than the control side.Conclusion: The use of board-spectrum sunscreen with anti-inflammatory agents starting on the first day after ablativefractional skin resurfacing can decrease the incidence of PIHafter laser treatment at 1-week post-op.

THE CUTTING EDGECHAIR: M. GOLD

Combining Laser and CosmeceuticalsW. PRAGER, MD

New Platform TechnologiesM. GOLD, MD

Fractional RF with Microneedling vs. Fractional Laser A. BADAWI, MD

Updates in Laser Tissue TighteningNon-Surgical Face Lift: Minimally Invasive 1440 nm LaserTissue Tightening on Face and NeckKATHARINA RUSSE-WILFLINGSEDER, ELISABETH RUSSEPlastische Chirurgie und Laserzentrum Innsbruck

Haydnplatz 4, 6020 Innsbruck, Austria

[email protected]

Background: Aging results in loss of collagen and elastinwhich causes excessive skin laxity from the age of 40 onward.In addition, jowling along the mandibular border and promi-nence of platysmal banding can occur. Laser technology pro-vides additional benefits when treating the reticular-dermaland fibro-fascial-platysma layer of the neck.Objectives: The authors evaluate a minimally invasiveapproach to treat unwanted skin laxity and fat in the lowerface, mandibular and submandibular areas with a new treat-ment modality that delivers laser energy to the dermal-hypo-dermal interface.Methods: Patients between 40 to 65 years with unwanted skinlaxity and fat received a single treatment using the 1440 nmlaser with the Smartlipo Precision Tx™ workstation (CynosureInc. Westford MA) for fat reduction and tissue tightening. Intumescent solution (30–50 cc per 5 cm2) laser energy wasemitted with an 800 m side-firing fiber (SideLaze 3D™)through three small incisions below the chin and at the base ofeach earlobe. Approximately 1200 Joules were delivered per 5 cm2

through a temperature-sensing cannula with treatment tem-peratures set to 45–47°C. The treated fat was removedthrough vacuum aspiration using a 2 mm cannula.Results: Patients tolerated treatment well with minimal bruis-ing and swelling. A highly targeted delivery of thermal energyresulted in thickening and tightening of skin. Highly satisfac-tory results were achieved. Outcomes continue to improvethrough six months.Conclusion: This new approach is safe and effective for thetreatment of skin laxity in the lower third of the face and neck,as well as subcutaneous fat in the submandibular area. Sideeffects and downtime is minimal, especially in comparison toother procedures.

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Pearls and Pitfalls in Laser-assisted BlepharoplastyALINA A.M. FRATILA, MDJungbrunnen-Klinik Dr. Fratila GmbH, Bonn, Germany

Esthetic blepharoplasty of the lower eyelid is not so widely-accepted and frequently-performed cosmetic procedure likethe upper eyelid blepharoplasty. I’m giving the unnatural oper-ated look and the frequent side effects like scleral show androunded eye, as a reason for that. The operation techniquemust be tailored to the individual and demands a precise pre-operative evaluation. In lower eyelid blepharoplasty the fol-lowing changes related to senescence have to be analyzed andimproved concurrently: herniation of orbital fat pads, droopingof the lateral canthus, ectropion, suborbicularisoculi fat(SOOF) hypertrophy or hypotrophy, and actinic elastosis withprogressive development of fine rhytides, crow’s feet, or evenfestoons. TransconjunctivalUltraPulse® CO2laser-assisted ble-pharoplasty is the technique of choice when only herniated fatpads need to be removed from the lower eyelid. When derma-tochalasis and wrinkling of the lower eyelid are a concern aswell, transconjunctival lower eyelid blepharoplasty needs to becombined with periorbital traditional or fractional laser skinresurfacing (LSR), to correct the skin laxity. The best tighteningresult is achieved when performing traditional UltraPulse® CO2

LSR, but prolonged downtime and erythema last longer thanafter fractional laser skin resurfacing (F LSR). I recommendcombiningDeepFXTM as a fractional tightening procedure withActiveFXTM as a fractional resurfacing procedure calledTotalFXTM to achieve a better tightening effect on the infraor-bital skin. The choice of accurate parameter is mandatory for ashort down time. These procedures are more effective if com-bined at least two weeks preoperatively with the use of botu-linum toxin type A for the treatment of dynamic periorbitalwrinkles. Considerable dermatochalasis on the lower eyelidmay also require a pinch blepharoplasty, this means asubcil-iary excision of the infraorbital skin but, if very pronounceddermatochalasis or even festoons are present, a transcuta-neous subciliary approach may be the method of choice. Iflower eyelid laxity is present, a simultaneous lateralcan-thopexyor even a canthoplastyshould be additionally per-formed at the time of surgery in order to avoid lower eyelidretraction with rounded eye and scleral show.

Botulinum Toxin for HeadachesEMEL GÜNGÖR, MDAssociate Professor

Acıbadem University Dermato-Venereology Department, Istanbul (Turkey)

[email protected]

Botulinum neurotoxin type A (BoNTA) was first reported as apotential therapeutic agent for headache by Binder et al. in1991. Their patients who received BoNTA injections for facialhyper functional lines experienced relief of their headachesymptoms.

Headaches, particularly migraine and chronic tension typeheadaches are the most frequent cause of disabling, recurring

headaches. Because of the high prevalence, it is inevitable tomeet many headache patients who come to dermatologists forcosmetic procedures, especially, for BoNTA injections.Although there are many preventive therapies available forheadache, there is also great demand for alternative preven-tive therapies that are effective and well-tolerated with limitedsystemic effect.

According to the patients’ headache localization and type,BoNTA injection points are selected. For headaches that areprimarily localized at the frontal area, the regular injectionpoints and doses are used as for glabellar and frontal hyperfunctional lines. If the headache is primarily localized aroundthe neck area, the injection points are directed to the spleniuscapitis, semispinalis and trapezius muscles, 10 U BoNTA foreach muscle group.

The patients that are treated for cosmetic procedures whoalso suffer from headaches reported significant reduction inheadache frequency, pain intensity, and use of analgesics.

As headaches are neurologic disorders, it is best they aretreated by specialized neurologists. In some selected patients,BoNTA injections may be an alternative or adjuvant therapeu-tic 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 BADAWI1,2, FAYZA AL ALI3, MOHAMED TOME4

1 National Institute of Laser Enhanced Sciences, Cairo University, Egypt

2 Dermatology and Allergeology Department, Faculty of Medicine,

Szeged University, Hungary

3 Rashed Hospital, Directory of Health, Dubai, UAE

4 Department of Dermatology, Faculty of Medicine, Al Ribat University,

Khartoum, Sudan

Background: Dermatosis papulosa nigra (DPN) is a benigncutaneous condition common among blacks. It is typically dis-tinguished by multiple, small, hyperpigmented, asymptomaticpapules on the face and neck of black adults. The conditionmay be cosmetically unpleasant to some patients. No treat-ment is generally indicated for DPN unless lesions are cosmeti-cally undesirable. Aggressive therapeutic modalities have beencomplicated by postoperative hyperpigmentation, hypopig-mentation or scarring. Keloid formation is another potentialcomplication.Objective: To evaluate the safety and long term efficacy of the1064nm Nd:YAG laser in treatment of DPN through retrospec-tive photographic analysis.Methods: A retrospective analysis was conducted for allpatients (n = 60) who received 2 sessions of 1064 nm Nd:YAGlaser treatments 3 weeks apart. Patients recruited were diag-nosed to have DPN and of Fitzpatrick skin types IV-VI. Theparameters used for treatment were; 1064 nm wavelength,

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100–120 J/cm2 Fluence, 3 mm spot size and 2 stacking pulseswere fired on each lesion. Skin cooling before and after thelaser pulses was done. Patients were requested to return forevaluation 3 months and 12 months after the second and lastsession to assess any side effects and the recurrence rate aswell as to complete an improvement scale questionnaire.

Blinded photographic assessments were performed by threeindependent dermatologists using unlabeled photos for beforeand after and arranged in non-chronological order. Reviewerswere asked to determine before and after photos and thedegree of improvement in the lesions. Degree of improvementwas graded using a four point scale: –1 = Adverse effects (Pig-mentary changes, textural changes or scarring), 0 = Noimprovement, 1 = Mild improvement, 2 = Marked improvement.Results: Based on blinded photo assessments by three inde-pendent Dermatologists, all the three reviewers had correctlyidentified the before and after photos. Clinically significantimprovements were reported by all the reviewers. Somepatients suffered of scabbing for 5–7 days which was followedup by temporary hypopigmentation for a maximum of 3 weeks.No long term adverse effects were observed neither clinicallyduring the follow up visits nor during the photo evaluation ofthe photographs.Conclusion: DPN can be treated in type IV-VI Fitzpatrick skinpatients using the Nd:YAG 1064 nm laser with long term effi-cacy and safety.

Comparison of Ruby Laser and Alexandrite Laser in the Removal of Amateur Tattoos in Arabic patientsIQBAL A. BUKHARIProfessor and Consultant Dermatologist,

Dermatology Department, University of Dammam and King Fahad Hospital

of University, Dammam (Saudi Arabia)

Aim: Tattoos in our Arabic society used to have a cosmetic impor-tance in the face of woman. They are usually amateur tattoosdone by non-professional women in the tribe. Nowadays, Laserremoval of tattoos has become very effective. Here, we report ourexperience in the removal of tattoos for skin types III–IV. Usingeither the Q-switched Alexandrite laser or Ruby laser.Methods: 40 female subjects aged 35–50 years from similarracial and ethnic background with amateur tattoos weretreated 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 ourpatients with Fitzpatrick skin types III–IV was accomplished.On the average, patients required 3 sessions to completelyremove the tattoo by Alexandrite laser as compared to 6 ses-sions with Ruby laser. No major side effects occurred.Conclusions: Tattoo removal by Q-switched Alexandrite laserwas superior to Ruby laser with no side effects which gave ahigh patient satisfaction.

Comparison of Hair Removal Efficacy and Safety: Nd:YAG vs. IPL GEORGINA SZIMA, EDINA BODNÁR, ÉVA REMENYIKUniversity of Debrecen, Medical and Health Science Centre,

Department of Dermatology

Background: Photothermal destruction of hair shaft melaninwith red and near-infrared wavelengths long-pulse Nd:YAG andIPL, has become an effective treatment in hair removal. Aim: To compare satisfactory levels, safety, side effects andefficacy of Nd:YAG and IPL in hair reduction.Materials and Methods: This was a prospective randomizedintra-patient, right-left, assessor-blinded, comparison ofNd:YAG vs IPL. 36 volunteers (skin phototype II–III) wererecruited. Three sessions (4- to 6-week intervals) were per-formed. Hair counts at both sides were compared before andafter the treatments. The efficacy and side effects were scored.Results: Initially there was no significant difference between thenumber of hair follicles (Nd:YAG: 74.3 ± 47.33; IPL: 79.8 ± 50.67;p = 0.21). After the first treatment, the hair reduction wassignificant for both systems: Nd:YAG 43 ± 29 %, IPL: 55 ±33 % (p = 0.0013, p = 0.0001). IPL compared to the Nd:YAGwas significantly more effective (p = 0.046). 4 weeks after thesecond treatment the significant hair reduction was 43 ± 30%(Nd:YAG) and 52 ± 35% (IPL) (p = 0.0001, p = 0.0001). Therewere statistically lower side effect scores on the IPL treatedside (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 systemssafely and effectively; however, IPL was more effective and hadless 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 EfficacyMOUNIR ZEITOUNY, MARIJKE VAN VLIMMEREN, TOM NUIJS, NATALLIA E. UZUNBAJAKAVAPhilips Research, High Tech Campus 34, 5656 AE Eindhoven,

The Netherlands

Background and Objectives: Opto-thermal modeling is a pow-erful tool to predict hair removal efficacy that makes use ofphysical parameters as a function of hair-skin optical and geo-metrical properties. Predictive power is still heavily dependenton the pre-defined hair geometrical properties and on thechoice of physical predictors.

The objective of this work was to investigate (in a system-atic way) how the geometrical and optical properties of a hairfollicle influence predictive power of opto-thermal modeling fora range of pulse durations. Methods: We developed a versatile hair-skin model thatenables the calculation of thermal profiles at various locationsin the hair and skin during light treatment. Essential is realismin representation of follicular compartments; based on rele-vant histological data, including melanin-containing matrix,

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non-absorbing germinative matrix, and dermal papilla, andscalability of the model.

Clinical trials were performed using several consumer- andprofessional photoepilation devices. The key optical and geo-metrical hair properties, including thickness, color and numberper cm2, were measured before and after each treatment.Device parameters such as the optical spectrum, fluence, pulseduration and shape of each photoepilation device were meas-ured. The device parameters and the hair properties of eachvolunteer were fed into the opto-thermal model. Results and Conclusions: Critical-to-quality (CTQ) parametersof the opto-thermal model, including peak temperature in fol-licular compartments and the damage integral, were corre-lated to clinical efficacy. The influence of pulse duration andfollicle geometry on these CTQs was investigated. For varioushair shaft thicknesses, follicle dimensions and depths, the ther-mal relaxation time was derived and results are correlated toin-vivo clinical efficacy results.

We obtained a significant correlation between CTQs of theopto-thermal model and clinical data. Considering scalablehair shaft thickness and hair depth significantly improved thepredictive power of opto-thermal model.

Dual Impact for Treating Striae Distensae (Alba) Using Fractional 1565nm Non-Ablative LaserCLEMENTONI

Background: Various fractional non-ablative laser wave-lengths are in use for treatment of striae. All deliver energy perdepth of lesion and aim at targeting the water in the dermis ina fractional manner for promoting demarcated wound healing.Clinically, it results in elevation and shortening of striae furrowdue to collagenesis and contracture. Aim: To evaluate the effectiveness of dual impact for targetingdifferent skin striae components within same session. It ishypothesized that the demarcated deep impact together withthe diffused shallow impact will improve both textural andcolor aspects of striae.Materials and Methods: Two treatments were performedunder topical anesthesia on 10 female subjects between theages of 30–55, and having striae alba on various bodyanatomies (abdomen, breasts, buttocks, thighs). Each striae(besides non treated controls) has been treated for dual impact –first deep and dense impact using rectangular shapedcoolscanning inside and in parallel to the long axis of thestriae, thereafter shallow and loose hexagonal shapedcoolscanning large enough to impact inside and laterally to themargins of the striae. Regular as well as 3D pictures weretaken at baseline and at follow-up. Results: The laser treatments were well tolerated and therewere no treatment associated adverse events. Improvementof striae texture and color was recorded already after 1sttreatment. It became significant after the 2nd treatment –showing 3D increase in striae volume as well as enhanced modeof pigmentation as compared to the before and the non-treatedcontrols.

Conclusion: The 1565 nm ResurFX modality, used in the dualimpact mode, has good impact of the pigmentation and tex-tural appearance of striae.

Multimodality Imaging of CelluliteCharacterization of Non-Thermal Focused Ultrasound for Non-Invasive Selective Fat CellR. BARD, MD

Aim: To compare the accuracy of 3-D Doppler high resolutionsonography mapping and high resolution small field 3 TeslaMRI imaging of cellulite. Material and Methods: Over a 2 year period 199 consecutivepatients with palpable lower extremity subcutaneous noduleswere preoperatively scanned with a Gevoluson E-9 unitemploying linear 18 MHz probe with 3-D angio and glass bodypower doppler image reconstruction and 3.0 t MRI small fieldof view within one week. All images were compared with histo-logic sections. Results: With the use of 22–70 MHz probes areas of cellulitewere imaged as part of a study using antioxidant therapies toreduce disfiguring areas. MRI had no diagnostic value in celluliteevaluation although it accurately depicted fat compartments.Additionally, Doppler ultrasound blood flow analysis using 15MHz Doppler showed abnormal flows in the regions of greatestcellulite architectural distortion. The depth of the subcutaneousfat may be measured and the penetration of the cellulite may beassessed with 3-D volumetric dermal/subdermal imaging.Conclusions: 3d multiplanar ultrasound imaging appears to besignificantly more accurate than MRI in diagnosing celluliteand may facilitate laser ultrasound guided treatments. Previsual treatment improvement may be noted by decrease ininflammatory neovascularity.

Characterization of Non-Thermal Focused Ultrasound for Non-Invasive Selective Fat Cell DisruptionAMIR

Background: There is growing demand for non-invasive bodycontouring technologies in the aesthetic market. A new devicehas been developed that uses non thermal focused ultrasoundfor fat reduction. There has been a lack of preclinical data sup-porting the safety and efficacy of noninvasive focused ultra-sound.Methods: A series of in vivo experiments were performed usingthis new body contouring device on a porcine model. Safety,selectivity, and efficacy were evaluated by histological stain-ing of excised skin and subcutaneous fat specimens.Results: Histologically stained specimens of skin and subcuta-neous fat excised from porcine animal model following treat-ments demonstrated fat cell lysis. There was no evidence ofcellular destruction of adjacent blood vessels, nerves and con-nective tissue. Furthermore, no epidermal or dermal changeswere observed clinically or histologically.Conclusions: The delivery of noninvasive focused ultrasonicenergy has been validated and supported by the preclinical

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data presented. Future studies will investigate various treat-ment regimens for improved body contouring results.

Anti-Aging Effects of Adipose-Derived Stem Cells on the SkinSAAD AL SOGAIR, MD

The skin is one organ which is prone to aging. While age-related changes are inevitable, they are not universallyembraced. Thus, various treatment options for skin aging exist.One of the newer options with high potential for efficacy is theuse of adipose-derived stem cells.

Adipose derived stem cells are mesenchymal stem cells fromadipose tissue. It has the ability to self-renew and to differenti-ate along multiple lineage pathways. It can be safely and effec-tively transplanted to either an autologous or allogeneic hostand can be given as a subcutaneous injection.

The effects of adipose-derived stem cells in aging skin arenumerous. These cells have the capability of producing variouscytokines such as vascular endothelial growth factor (vEGF),hepatocyte growth factor (HGF), insulin-like growth factor(IGF), platelet derived growth factor (PDGF) and transforminggrowth factor-beta (TGF-b). These growth factors activatehuman dermal fibroblasts to increase collagen synthesis, der-mal thickness, collagen density, fibroblast number, angiogene-sis, procollagen type I protein and mRNA expression. Adiposederived stem cells can also reduce UVB-induced apoptosis.They also have antioxidant properties that can protect humandermal fibroblasts from oxidative stress. They have whiteningeffects through inhibition of melanin synthesis and through thedownregulation of tyrosinase and TRP1 expression. Numerousstudies have focused on these anti-aging effects. Indeed, adi-pose 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. PALERO1, CHARLES-ANTOINE MIGNON2

AND MARTIN JURNA1 Care and Health Applications Group, Philips Research Europe,

High Tech Campus 34, 5656 AE Eindhoven (The Netherlands)

2 Institut d’Optique – KTH

[email protected]

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

molysis based skin rejuvenation systems specifically home-useskin treatment devices.

Phototherapy in the Treatment of Acne VulgarisARTUR BANI, MD1, LIBERTA LABINOTI, MD2

1 Regional Hospital of Berat (Albania)

2 Hygea Hospital of Tirana (Albania)

Background: Acne vulgaris is a common skin disease thataffects an estimated 80% of the population at some time intheir lives. The presence of P acnes promotes inflammationand stimulates it by producing pro-inflammatory mediatorsthat diffuse through the follicle wall. It's an obvious target foracne phototherapy due to the inflammatory process thatcauses.Objectives: To evaluate the effectiveness of pulsed light andheat energy (LHE) for the treatment of mild, moderate, severeforms of acne, and to investigate the role of LHE in clearinginflammatory and non-inflammatory elements of acne, in onemonth, without additional treatment. Materials and Methods: In a 3 year period we treated 80patients with acne vulgaris, chosen randomly and voluntarily:51 with moderate and 29 with mild forms. The patients’ ageranged between 14–26 years. The average age was 19. Theyhad Fitzpatrick skin types II, III, and IV. All patients weretreated with the Skin Station machine and received 8 sessions,twice weekly, using 430–1100 nm light at 3.5 J/cm2, 35 ms.The effectiveness was based on reduction in inflammatory andnon-inflammatory lesions count after two, four, six, and eightsessions and one month after the last treatment.Results: All patients completed the trial. There was no signifi-cant effect in the first two sessions, but significant reductionwas seen after 4 sessions. After 8 sessions of treatment, a sta-tistically significant difference was seen between inflammatoryand non-inflammatory elements, in comparison with pre-treat-ment. At baseline, the mean inflammatory and non-inflamma-tory lesions count was 23.6 and 19. After 8 sessions lesionscount was 53% (inflammatory) and 51% (non-inflammatory)of baseline. The clearing of inflammatory and non-inflamma-tory elements was 52% in total. One month after the treat-ment, the clearing of inflammatory elements reached 66.5%and of non-inflammatory elements 59.7% and the clearing ofinflammatory and non-inflammatory elements was 63.1% intotal.Conclusion: The treatment of acne vulgaris with phototherapyLHE as mono-therapy, is a medical alternative which givesgood clinical results in a relatively short period of time (onemonth) and with minimal side effects.

2nd hour Free Communications

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Effect of Topical Corticosteroids on the Incidence of Postinflammatory Hyperpigmentation after Treatment of Atrophic Acne Scars in Asians with Ablative Fractional CO2 Laser ResurfacingWORAPHONG MANUSKIATTI, M.D.Professor of Dermatology

Faculty of Medicine Siriraj Hospital, Mahidol University

Bangkok (Thailand)

Topical vs. Intradermal Autologous PRP Following FractionalAblative CO2 in Acne Scars HEBATALLA ISMAIL GAWDAT

Background: Acne scarring causes problems cosmetically andpsychologically. The efficacy of a fractional ablative CO2 laserin treatment of acne scars has been documented. Nonetheless,it is associated with lengthy erythema and edema. Platelet-richplasma (PRP) has recently attracted attention for its ability topromote wound healing.Aim: Compare the efficacy of topical and intradermal autolo-gous PRP combined with fractional CO2 laser in the treatmentof atrophic acne scars.Patients and Methods: Thirty patients with atrophic acnescars were enrolled in the study. They were randomly assignedinto two equal groups (n = 15): group 1 underwent split facetherapy; where one cheek was treated with fractional CO2 laserfollowed by intradermal injection of autologous PRP, while theother cheek was treated with fractional CO2 laser followed byintradermal injection of normal saline. Group 2 underwent splitface therapy, where one cheek was treated with the fractionalCO2 laser followed by intradermal injection of autologous PRP,while the other cheek was treated with fractional CO2 laser fol-lowed by topical application of autologous PRP. Each patientreceived three treatment sessions with monthly intervals.Patients’ digital photographs and Optical Coherence Tomographyimages were taken at baseline and after 6 months for evaluation.Results: Areas treated with PRP-fractional CO2 laser combina-tion showed significantly; better response (p = 0.03), less sideeffects and shorter downtime (p = 0.02) than area treatedwith fractional CO2 laser alone. However, areas treated withintradermal injection and topical application of PRP, did notshow significant difference regarding degree of response anddowntime (p = 1).Conclusion: Topical PRP -fractional CO2 laser combination isan effective modality in the treatment of atrophic acne scars,through acceleration of healing and augmentation of thedegree of response to laser therapy.

Novel Micro-Needle Skin Remodeling RF System for AcneScars, Wrinkles, and Deep Dermal LesionsKLAUS FRITZ, MD1, 2, 3

GEORGE SORIN TIPLICA3, CARMEN SALAVASTRU3

1 Dermatology and Laser Centers, Landau, Germany,

2 University Osnabrück (Germany), Bern (Switzerland) and

3 University Bucharest (Romania)

Background: Optimal skin remodeling requires a thermaleffect on both epidermis and dermis. An optimal solution willcombine three types of effects – Minimal superficial coagula-tion on the surface for textural improvement, controlled dermalcoagulation for tissue renewal and overall volumetric heatingfor collagen stimulation. Most existing fractional laser devicesare either too aggressive and are associated with high level ofpatient discomfort, downtime and high adverse effect rate, orlack the ability to generate full volumetric heating for collagenremodeling. The Objective: Objective of this study was toassess the effectiveness of a novel Micro-needle RF system(Micro-needle Skin Remodeling – INTENSIF handpiece, EndyMedMedical, Caesarea, Israel) for targeted skin remodeling and fordeep, stubborn skin lesions such as acne scars, deep facialwrinkles, striae and dilated pores. This device uses an array of25 gold plated, non-insulated, tapered micro-needles that pen-etrate up to 3.5 mm into the skin, delivering RF energy to cre-ate controlled coagulation zones through the dermis. Thetested system proprietary hardware and software allow for thefirst time constant energy delivery independent of individualtissue impedance. In contrast to other RF Micro-needle systemson the market the new INTENSIF offers enhanced volumetricheating mode with full hemostasis, eliminating pin-pointbleeding spots.Methods: Eight (20) patients with moderate to deep skinlesions were treated using the INTENSIF handpiece. Patientswere photographed using standard methods. Each patientunderwent between one and three treatment sessions.Different parameters such as treatment comfort, safety andeffectiveness were measured using dedicated questionnaires.Results: All subjects experienced mild to moderate edema anderythema as an immediate response to treatment. Edemaresolved after up to 24 h post treatment and erythema lastedup to 3 days. Invisible micro-coagulation in the form of skinroughness was reported up to 3 days post treatment. Patientsbefore and after photos, were graded according to standardevaluation methods.Conclusions: The presented results describe, for the first time,a novel treatment that offers a minimal downtime combinationof RF controlled coagulation zones and deep volumetric der-mal heating for simultaneous and fast epidermal and dermalskin remodeling effect.

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Long-Pulsed Nd:YAG 1064 nm Laser in the Treatment of OnychomycosisHODA AHMED MONIEB, MD1, DR. MARY FIKRY MATTAMIKHAIL2, EMAN MOHAMED AKMAL AHMAD, M.B. B.CH3

1 Dermatology and Venerology, Department, Ain-Shams University

2 Lecturer in Dermatology and Venerology Department, Ain-Shams

University

3 Faculty of Medicine, Ain-Shams University

Onychomycosis is both a cosmetic and medical problem and itssystemic treatment has many limitations. The aim of this clini-cal study was to explore and evaluate the use of long-pulsedNd:YAG laser 1064 nm (Candela, Wayland, MA, USA) in thetreatment of onychomycosis. Twenty Egyptian patients (18–60years old) with 65 nails affected by onychomycosis wererecruited consecutively from the Dermatology outpatient clinicat Ain-Shams University Hospitals over a period of 6 months.We excluded patients on topical or systemic anti-fungal ther-apy in the preceding 6 months, permanent or semi-permanentdiscoloration of the nail plate, any generalized skin disease,immunosuppressed patients and pregnant patients. Mycologi-cal examination of nail scrapings by direct KOH (20%) and cul-ture was done together with photographing the nails before,one month and 3 months after treatment. Distal and lateralsubungual onychomycosis was the commonest clinical type(85%) and yeasts represented 90% of the isolated fungi. Eachpatient received 4 laser sessions spaced 1 week apart. We useda fluence of 50 J/cm2, a pulse duration of 30 ms, spot size3 mm and the cryospray was switched off. The nail plate wasfully covered with laser irradiation 3 times in each session.After one month, 15 (75%) patients turned mycologically nega-tive while 5 (25%) remained positive. However, 3 out of the 5mycologically positive patients turned negative at the 3months follow-up visit. This means that 90% of the patientsand 52 (80%) of the nails achieved mycological clearance.Only mild pain was reported by all patients during and shortlyafter the sessions. This study concludes that long-pulsedNd:YAG 1064 nm is a safe and effective treatment for singleand multiple finger or toe nail onychomycosis.

Effective Treatment of Onychomycosis Using Laser: Mode of ActionCONSTANTINOS DEMETRIOU, MD (Cyprus)

Background: Although scientific data has shown some effec-tiveness of lasers in the treatment of onychomycosis there is nocomplete work on the matter. I have been treating more than300 onychomycosis patients since 2005 using Pulsed dye laser(PDL) and IPL with a 585 nm filter with a success rate of morethan 90%.Objective: Demonstrating the effectiveness of PDL Laser andIPL 585 nm and investigating mode of action.Material and Methods: 300 onychomycosis patients weretreated with PDL and IPL 585 nm once a week. Infected nailswere subjected to 3–10 passies with dye laser or IPL, with a

delivery speed of one shot per second until the patient sensedwarmth or withdrew. All patients received Laser sessions untilthe diseased part of the nail was rejected. In this study clinicalefficacy was shown up to 90%. Investigation of the mode ofaction of the Laser was also performed by irradiating nail cul-tures, dermatophytic skin infections and performing a modelnail experiment using a real nail. Temperature measurementsover and under the nail revealed that 585 nm can pass throughthe nail and be absorbed by the rich vascular network underthe nail transformed into heat trapped under the nail bed.Mycelia are very sensitive to heat (solarization). Results: Irradiation of dermatophytic cultures and skin infec-tions failed. A topical greenhouse effect was suspected for thehigh cure rate achieved and that was verified by measuringtemperatures over and under the nail during treatment.Conclusion: PDL and IPL 585 nm is effective in treating ony-chomycosis and also very selective as it locates the heat underthe nail and sterilizes it. Since spores survive the heat, treat-ment has to be continuous until fungal load is rejected.

Superior Photorejuvenation by Mixing Wavelengths CONSTANTINOS DEMETRIOU, MD(Cyprus)

Background: Elements of skin ageing may be present as,abnormal pigmentation, loss of collagen, vascular changes,disorders of keratinization, lack of normal immune responseand premalignancies. All these parameters may appear on theskin as solitary lesions or, in combination. One method usinglight to improve all these parameters is IPL (Intense PulsedLight) Photorejuvenation. IPL exploits wavelengths 600–1200nm delivered in the same pulse. Objective: To study the effectiveness of one mixed session ofQ-switched Nd:YAG 1064 nm and KTP 532 nm on parameters ofaging. As a source of the two wavelengths, an AL-114 Q-switched 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 thusallowing avoidance of potentially unnecessary wavelengths asthese are delivered by IPL, thus maximizing rejuvenation andreducing side effects.Patients and Methods: More than 500 patients within aperiod of 5 years presenting various parameters of aging, likepigmentation, vascular damage, wrinkles, disorders of kera-tinization, and premalignancies, were subjected to one sessionof Nd:YAG 1064 nm following KTP 532 nm. Lesions were evenlyand repeatedly scanned with both wavelengths until light gray-ing, slight pain or purpura presented itself.Results: All patients improved significantly in all parametersof ageing, within a period of 20 days, after just one sessionlasting 30 sec to 10 min. The procedure is almost painless withminimum irritation, no down time, at low cost and excellentcosmetic outcome. Post Inflammatory Pigmentation appearedin less than 1%. Conclusion: The use of a mixed Nd:YAG 1064 nm and 532 nmLaser session proves very effective as it selectively targets all

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parameters of ageing. It can be a fast, painless and simpleoffice procedure with no down time and minimum discomfortfor the patient.

Contribution of LED-Photobiomodulation to Wound HealingManagementMICHELE PELLETIER AOUIZÉRATE, MDPresident LED Academy

Photobiomodulation is the process by which specific wave-lengths are absorbed by chromophores in a selective way. Thistriggers signaling processes in biological cells. This processoccurs naturally (natural photobiomodulation (PBM)), whenwalking outside for example. It is also a natural dynamic pho-totherapy. The process is modulated by many parameters thatinclude irradiance, optimal combination of wavelengths, theirmode of continuous or pulsed emission and in this case itstransmission frequency, moment of day, etc. We briefly discusssome clinical cases for which the PBM was used alone or incombination. We discuss the prospects that are very promising.

LED Academy is a non profit organization with a member-ship open to physicians, physicists, cell-biologists, optoelec-tronic engineers, concerned with photobiological mechanismsand treatments related to the use of LED or Low Level Lasers.

LED Academy welcomes benefactor members from pharma-ceutical or medical device companies.Its goal is therefore dedi-cated to the promotion of research, education, and clinicalapplications in photobiology.

Non-Ablative 1540 Fractional Laser to Help Injection Lipoly-sis and Dermal Fillers in Lower Face Rejuvenation REHAB HEGAZY, MD1, TAHRA LEHETA, MD1, YEHIA EL GAREM, MD2, RANIA ABDEL HAY, MD1, DALIA ABDEL HALIM, MD1

1 Dermatology Department, Faculty of Medicine, Cairo University (Egypt)

2 Dermatology Department, Faculty of Medicine, Alexandria University (Egypt)

Background: Rejuvenation of the lower face can be challengingand no single modality can accomplish all its complex events.Patients and Methods: This 18 month study included 24 femalepatients with a primary complaint of lower face aging signs.They were randomly allocated to either group A who receivedinjection lipolysis and hyaluronic acid dermal filler, or group Bwho in addition received non ablative 1540 fractional laser. Theimprovement evaluation score used was the global aestheticimprovement scale (GAIS). Patients’ satisfaction level (PS) wasalso recorded. Both were repeated at months 6, 13 and 18. Metic-ulous reporting of any adverse events was carried out.Results: At all evaluations, laser group showed higher degreeof improvement. Interestingly, at short term evaluation (6month), there was no significant difference between bothgroups (P > 0.05), however the laser group improvement incomparison to the other group became significant in the long-term evaluations (13 and 18 months) (P < 0.05). In group A thePS was maximum in the pre-final assessment (month 6), where50% of the patients (n = 6) felt they achieved optimal cos-

metic results. Whereas in group B their PS level reached itsmaximum at the final assessment (month 13), where 75% ofthe patients (n = 9) felt they achieved optimal cosmetic results.Overall the treatment was well tolerated by all patients in bothgroups and anesthesia was never required.Conclusion: This study further documents the importance ofcombination therapy in facial rejuvenation, offering a treat-ment protocol combining injection lipolysis and hyaluronicacid as an effective, safe, short term therapeutic option inlower face rejuvenation. The addition of 1540 nm non-ablativefractional laser to the protocol offers a higher efficacy withlonger-term effects and no adverse events.

3rd hour Free Communications

A Holistic Approach to AestheticsBARAD

Background: Physicians and cosmetic surgeons learn in initialconsultations their patients’ stated objectives then apply expe-rience, artistic eye, medical and technical knowledge to devel-oping a treatment plan. Patients’ self-perception and self-worth are integrated into this process. Applied Kinesiology(Muscle Testing) is an accurate, novel, painless and inexpen-sive assessment tool to determine whether patients know whatthey want and are satisfied with the results. Aim: Physicians seeking a holistic medical experience canincorporate muscle testing at no cost to the practice or patient.The methodology gets to the heart of patients’ internal motiva-tion for cosmetic intervention and measures ultimate satisfaction. Materials and Methods: Only knowledge of muscle testingtechnique is needed to incorporate it into the treatment proce-dure and plan. It is based on the premise that one’s inherentmuscle strength is only as strong as one’s internal unconsciousbelief system. Therefore, a person’s muscle will stay strongun-der applied pressure when they believe in their statement orvisualization. The muscles of those whose unconscious beliefsdo not comport with their statements, will succumb to pres-sure. Using muscle testing in my initial consultation and post-treatment provides empirical support in determining whatpatients actually need to attain their treatment objectives andto gauge their level of satisfaction post-procedure. The presen-tation will show how to muscle test patients to assess theirself-image and belief that cosmetic intervention will help themfeel better pre-treatment and then assess the results post-treatment. Results: This technique increases and measures patient satis-faction. Patients report that muscle testing helps them identifytheir objectives and helps them be comfortable with their treat-ment options. Conclusion: This interactive presentation provides insight intoa cost-free holistic approach to cosmetic surgery and aesthet-ics that increases patient satisfaction and helps identifypatients with BDD.

KOSMETISCHE MEDIZIN ABSTRACTS SCIENTIFIC SESSIONS50

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3-D Imaging of the Facial Nerve and ArteryR. BARD, MDDirector, Biofoundation for Angiogenesis

Aim: To demonstrate the appearance of facial nerve and arterywith 3-D power Doppler sonography in pretreatment planningof facial laser therapy.Material and Methods: Over 12 years normal subjects wereprospectively scanned with a ge voluson e-8 unit employinglinear 11–18 MHz probe with conventional 3-D/4-D imagingusing 3-D angio and glass body power doppler image recon-struction. Images were compared with contrast enhanced CTscans and DCE MRI in many instances.Results: 3-D PDS showed vascularity that correlated with CTand vascular imaging studies. Conclusions: 3-D power Dopplerimaging is a noninvasive modality that can preoperatively mapthe facial nerves and arteries in many patients possibly reduc-ing intra-operative trauma.

Calcium Hydroxylapatite in Prejowl Sulcus Enhancement:Results and ComplicationsMARIO GOISIS

Aim: To describe long-term results and safety of calciumhydroxylapatite for correction of prejowl sulcus.Material and Methods: 98 patients were included in thisstudy. Calcium hydroxylapatite was injected in the deep dermisand/or subdermal plane. The images of the patient wereacquired by standard camera system and evaluated 8 and 12months after treatment. Results: In 68 cases the immediate and long-term aestheticresults very classified as very good, in 8 as good, in 16 as fairlygood and in 6 as inadequate. Conclusion: The use of Calcium hydroxylapatite can provide anefficient correction the prejowl sulcus. On 98 patients therewere 12 minor adverse events. All 12 were resolved with localtreatment. 8 patients had inflammation and edema, which wasresolved with oral prednisone. 4 patients experienced subcuta-neous nodules, which were successfully treated with triamci-nolone injection (1 mg injected into each lesion).

Efficacy of Onabotulinum vs. Abobotulinum in Treatment of Primary Palmer Hyperhidrosis Using a Conversion Factorof 1 : 2.5HANAN EL KAHKY, HEBA DIAB, DALIA GAMAL ALY

Introduction: Two preparations of botulinum A toxin (BTX-A)are commercially available for the treatment of palmar hyper-hidrosis (PPH); Botox (Allergan; 100 U/vial) and Dysport (IpsenLimited; 500 U/vial), which are not bioequivalent. Differentstudies tried to find an appropriate conversion factor betweenthem but results remain controversial.Objectives: To compare the efficacy of Botox and Dysport inPPH using a conversion factor of 1 : 2.5.Methods: Eight patients with severe PPH received intra-dermalinjections of Botox in one palm and Dysport in the other in the

same session. Clinical assessment was performed at baselineand post-treatment at 3, 8, 13 weeks, 6 and 8 months usingMinor’s iodine starch test, Hyperhidrosis Disease SeverityScale (HDSS), and Dermatology Life Quality Index (DLQI) test,to state disease severity, and disease related impairment ofquality of life. Results: The mean ± SD dose injected per palm was 50 ± 6 UBotox, and 125 ± 15 U Dysport. At 3 weeks, a significant decreasein sweating for both preparations was noted that was morepronounced with Dysport compared with Botox (Mean ± SD ofPSA score was 1.38 ± 0.52 vs. 2 ± 0 respectively, P-value < 0.05).Nevertheless, at 8 weeks, this difference turned insignificantand the decrease in sweating area remained satisfactory andwas equal for both palms. Continued evaluation showed simi-lar improvement in both palms with non-significant differenceat 13 weeks, 6 and 8 months. The effect remained efficient upto 8 months. Patients with longer disease duration were moreliable to relapse.Conclusion: The efficacy and safety of Botox and Dysportinjections were similar using a conversion factor of 1 : 2.5.There was a trend towards a more rapid action after Dysporttreatment but without significant importance.

The Efficacy of Botulinum Toxin Type A in the Treatment of KeloidsEMAN SHAARAWY, MD, REHAB HEGAZY, MD AND RANIAMOUNIR ABDELHAY, MDDermatology Department, Faculty of Medicine, Cairo University, Egypt.

Background: Intralesional (IL) corticosteroid therapy isregarded by many to be first-line therapy in treatment ofkeloids. The efficacy of IL Botulinum toxin type A (BTA) hasbeen postulated in such an indication with controversialreports. Aim: Compare efficacy, safety of IL BTA to the well docu-mented IL corticosteroid therapy in treatment of keloids.Patients and Methods: 24 female patients with keloids wererandomly divided into 2 equal groups, receiving IL steroidinjection repeated every 4 weeks for 6 sessions (group 1), andIL 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 satis-faction and side effects were evaluated. Follow-up continued 1year post-treatment.Results: Significant improvement in objective parameters ofboth groups was documented, with non-significant differencesbetween them. All patients documented significant reductionof their subjective complaints, but more significantly in group 2who also showed higher satisfaction. Skin atrophy andtelangectasia were evident in 3 patients of group I. Conclusion: This is the first RCT to compare IL BTA to ILsteroids in treatment of keloids. It establishes the possibleeffective and safe "off-label" use of IL BTA in such indication.

51Kosmetische Medizin

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The Sensor – Signal Hypothesis of the Role of Interleukin-1 Alpha for SkinPETER SCHOCH AND IGOR POMYTKINUnited Cosmeceuticals GmbH Zurich (Switzerland)

Background and Hypothesis: The epidermis, especially the stra-tum corneum, is rich in intracellular interleukin-1 alpha (IL-1a).This cytokine is constitutively expressed by keratinocytes, sub-ject to positive feedback control (IL-1a stimulates the expres-sion of IL-1a). IL-1a has been shown to stimulate dermal fibrob-lasts to produce connective tissue (including collagen andelastin) and to release several growth and differentiation fac-tors acting on the epidermis. Based on these findings we pro-pose the hypothesis that IL-1a accumulating in the stratumcorneum acts as sensor to injury by being released from cor-neocytes upon mechanical, chemical or UV impact. Oncereleased it stimulates the expression and release of IL-1a byadjacent keratinocytes, thus generating a cascade of IL-1areaching eventually the dermis. The stimulation of dermalfibroblasts by IL-1a leads then to the replenishment of collagenand elastin as well as the strengthening of the epidermis bymesenchymal/epithelial interactions. Aim: To demonstrate an enrichment of collagen and elastin inthe dermis by topical administration of IL-1aonto skin. Materials and Methods: Placebo-controlled pilot study on thecollagen and elastin content in the dermis by two-photon fluo-rescence microscopy after topical application of a gel with andwithout IL-1a (dermatopoietin) onto the forearm of volunteerswith signs of skin aging.Results: The study showed almost a doubling of collagen andelastin content after 4-week administration of IL1a comparedto placebo and baseline. Conclusion: IL-1a, which due to its size of 18kD cannot pene-trate skin, leads to a remote effect in the dermis as demon-strated by a significant increase of collagen and elastin. Thisfinding supports the sensor – signal hypothesis of IL-1a’s rolefor maintaining the structural and functional integrity of skin.

Oral Supplementation with Collagen as an Anti-Aging and Skincare Treatment RITZ

Treatment of Postburn Facial Hyperpigmentation with Vitamin C IontophoresisSO YOUNG JI, MD, JI WON LEE, MDDong-Kang General Hospital, Plastic and Reconstructive Surgery,

Ulsan (Korea)

Purpose: Vitamin C has important physiologic effects on skin,including inhibition of melanogenesis. The purpose of thisstudy is to evaluate the effectiveness of Vitamin C iontophore-sis for the treatment of postburn hyperpigmentation.Material and Methods: The authors performed a retrospectiveanalysis of 93 patients from February 2008 through February2010. 51 patients were treated with Vitamin C iontophoresis tocontrol postburn hyperpigmentation and 42 patients were not.Experimental group was chosen 20 of 51 patients who hadVitamin C iontophoresis and had normal facial skin on the com-parable contralateral aesthetic unit. Control group was chosen20 of 42 patients who were not treated with Vitamin C ion-tophoresis and had also contralateral normal aesthetic unit.Using a digital scale color analysis, the results were analyzedwith Wilcoxon signed rank test.Results: Analysis revealed significant improvement of hyper-pigmentation in the experimental group compared to controlgroup. The difference of initial value and 6 month later valueshowed significant change. Mean of experimental group was11.61 and control group was 7.23. Therefore, Vitamin C ion-tophoresis revealed significant improvement of hyperpigmen-tation in the experimental group compared with control group.Conclusion: Vitamin C iontophoresis is an effective treatmentmodality for post burn hyperpigmentation.

KOSMETISCHE MEDIZIN ABSTRACTS SCIENTIFIC SESSIONS52

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„Cosmetic Medicine“ the new international issue of

„Kosmetische Medizin“, the leading German language

publication in Aesthetic Dermatology and it’s adjoining fields,

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case reports the whole spectrum of modern Aesthetic Medicine.

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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)

- DGÄD German Society of Aesthetic Dermatology

- DGBT German Society for Aesthetic Botulinumtoxin-Therapy

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- VDL Federation of Aesthetic Dermatology and Laser Medicine

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Mandatory Reading for Aesthetic PractitionersNow completely in English – Online

C O S M E T I CMEDICINE Official publication of the following societies:Academy of Associated Dermatologic Institutes (AADI)Austrian Academy of Cosmetic Surgery and Aesthetic Medicine (AACS)

Austrian Society of Dermatologic Cosmetics and Research on Aging (OGDKA)

Federation of Aesthetic Dermatology and Laser Medicine (VDL)

German Society of Aesthetic Botulinum Toxin Therapy (DGBT)

German Society of Aesthetic Dermatology (DGAED)Network Globalhealth

INTERNATIONAL ISSUE OF THE JOURNAL KOSMETISCHE MEDIZIN, 34. JAHRGANG, 2013, ISSN 1430-4031

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NEW TRENDS IN RHINOPLASTYETHNIC CONSIDERATIONS FOR THE FACIAL AESTHETIC USES OF BOTULINUM TOXIN: AN ASIAN PERSPECTIVE

BODY DYSMORPHIC DISORDERS: AN UNDERESTIMATED PROBLEM WITHIN AESTHETIC DERMATOLOGY PATIENTSABSTRACTS 3. MEETING OF THE WORLD ACADEMY OF

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