how to combine chemical peels with lasers & ebds · microscopic patterns of thermal injury....

How to Combine Chemical Peels with Lasers & EBDs

Prof Ines Verner 5CC 2018 I Aug 30 - Sep 2 Barcelona

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President European Society of Cosmetic & Aesthetic Dermatology - ESCAD Professor of Dermatology @ Rome Marconi University Contact me personally: Ines.verner@gmail.com

5CC 2018 I Aug 30 - Sep 2 Barcelona

Non-invasive Cosmetic Dermatology & Medicine Doctors

• Injectors

• Laser surgeons/ dermatologists • Technology & devices

• Peelers • Medium depth & deep peels

5CC 2018 I Aug 30 - Sep 2 Barcelona

Non-invasive Cosmetic Dermatology & Medicine Doctors

• Injectors

• Laser surgeons/ dermatologists

• Technology & devices

• Peelers

• Medium depth & deep peels

Why not to combine?

5CC 2018 I Aug 30 - Sep 2 Barcelona

Fractional CO2 laser combined with chemical peels

Ageing

Wrinkles

Dyspigmentaion

Solar lentigines

Rough skin surface

Sagging

Volumetric changes

Solar keratosis

5CC 2018 I Aug 30 - Sep 2 Barcelona

Fractional CO2 laser combined with chemical peels

Histological Changes

Mainly in epidermis & upper dermis

Loss of epidermal polarity & orderly maturation of keratinocytes

Keratinocyte atypia

DE junction flattening

Fragmented collagen & degraded elastin fibers

Amenable to skin resurfacing

5CC 2018 I Aug 30 - Sep 2 Barcelona

Resurfacing

Traditionally Chemical Peels

Medium & deep

Light sources

Lasers

IPL

Radiofrequency

Recently Fractional lasers & fractional RF

5CC 2018 I Aug 30 - Sep 2 Barcelona

Fractional CO2 laser combined with chemical peels

Resurfacing 1998 CO2 laser Chemical peels IPL

5CC 2018 I Aug 30 - Sep 2 Barcelona

Medium depth chemical peel

5CC 2018 I Aug 30 - Sep 2 Barcelona

Deep chemical peel

Modified Baker Gordon – 3 months

I. Verner: Phenol and other peels, Royal Society of Medicine, Feb 2008, London, UK

5CC 2018 I Aug 30 - Sep 2 Barcelona

Deep chemical peel

Modified Baker Gordon – 2 years

I. Verner: Phenol and other peels, Royal Society of Medicine, Feb 2008, London, UK

5CC 2018 I Aug 30 - Sep 2 Barcelona

Deep chemical peel Permanent Hypopigmentation

I. Verner: Phenol and other peels, Royal Society of Medicine, Feb 2008, London, UK

5CC 2018 I Aug 30 - Sep 2 Barcelona

Resurfacing 2017-where do we stand

Deep Chemical Peel

Great results but:

• Difficult procedure - general anesthesia & cardiac

monitoring

• Difficult healing time

• Downtime • Risk for scarring & hypopigmentation

I. Verner: Phenol and other peels, Royal Society of Medicine, Feb 2008, London, UK

5CC 2018 I Aug 30 - Sep 2 Barcelona

Fractional Revolution Fractional resurfacing

Cells migrate not only from wound edge & adnexa but also from non-treated areas

Faster healing

Less risk for side effects – scarring & hypopigmentation

Possibly true tissue regeneration

I. Verner: Phenol and other peels, Royal Society of Medicine, Feb 2008,

London, United Kingdom I. Verner: Phenol and other peels, Royal Society of Medicine, Feb 2008,

London, United Kingdom

5CC 2018 I Aug 30 - Sep 2 Barcelona

Resurfacing 2017-where do we stand Fractional Revolution - 2004

Fractional Photothermolysis: A New Concept for Cutaneous Remodeling Using Microscopic Patterns of Thermal Injury. Dieter Manstein et al Lasers in Surgery and Medicine 34:426–438 (2004)

I. Verner: Phenol and other peels, Royal Society of Medicine, Feb 2008,

London, United Kingdom I. Verner: Phenol and other peels, Royal Society of Medicine, Feb 2008,

London, United Kingdom

5CC 2018 I Aug 30 - Sep 2 Barcelona

Fractional Revolution

I. Verner: Phenol and other peels, Royal Society of Medicine, Feb 2008,

London, United Kingdom I. Verner: Phenol and other peels, Royal Society of Medicine, Feb 2008,

London, United Kingdom

Fr a ct ion a l R esu r f a cin g by CO2R E &

th e N ew Er a of Sk in R ej u ven at ion Fr act ion a l R esu r f acin g - M an stein

x x x x

x x x x

x x x x

x x x x

xx

xx

xx x

x

=

25% 25%

Tissue regeneration - back to normal

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Fractional Resurfacing

In Vivo Histological Evaluation of a Novel Ablative Fractional Resurfacing Device B. Hantash et al. Lasers Surg Med 2007;39:96-107 Higher energies => deeper & larger MTZ

Immediately after 5 mJ Immediately after 20mJ

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Fractional Resurfacing In Vivo Histological Evaluation of a Novel Ablative Fractional Resurfacing Device B. Hantash et al. Lasers Surg Med 2007;39:96-107 Reepithelization after 2 days Neocollagenesis after 3 months

2d after 20mJ Re-epithelization

3m after 20mJ Neocollagenesis

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Fractional Resurfacing

In Vivo Histological Evaluation of a Novel Ablative Fractional Resurfacing Device B. Hantash et al. Lasers Surg Med 2007;39:96-107 Diffuse spread of HSP47 at 3m levels correlate with collagen synthesis levels

Hsp47 at 1m Hsp 47 at 3m

5CC 2018 I Aug 30 - Sep 2 Barcelona

Fractional ablative CO2 laser:CO2RE

• No need for general aesthesia

• Easier healing time

• Downtime of 5-6 days

• Redness 1 months after procedure

• Much lower risk for side effects: scarring & hypopigmentation

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Ab

lati

ve

No

n-a

bla

tive

P/N 1000043 Rev. B

5CC 2018 I Aug 30 - Sep 2 Barcelona

Fractional CO2RE –10600nm

CO2 B & A

CO2 B&A

5CC 2018 I Aug 30 - Sep 2 Barcelona

Fractional CO2 – CO2RE • Easier procedure

• Easier healing time

• Shorter downtime (5-6 days)

• Much lower risk for side effects: scarring & hypopigmentation

• Results are great!!!

• But – Results less impressive then with total ablation

• Sometimes pigmentary abnormalities (SL) & surface irregularities do not disappear completely

5CC 2018 I Aug 30 - Sep 2 Barcelona

Combine fractional CO2 & chemical peel

• Chemical peel – Superficial to medium (TCA 25-35%)

• Improve dyspigmentaion

• Improve surface irregularities

• Fractional CO2 laser

• Treat dermis

• tissue tightening & wrinkle reduction

5CC 2018 I Aug 30 - Sep 2 Barcelona

Fractional CO2 + TCA peel Before & after 6 days

5CC 2018 I Aug 30 - Sep 2 Barcelona

Before & 6 days after fractional CO2

5CC 2018 I Aug 30 - Sep 2 Barcelona

Before & 6 days after fractional CO2 + TCA peel

5CC 2018 I Aug 30 - Sep 2 Barcelona

Fractional CO2

5CC 2018 I Aug 30 - Sep 2 Barcelona

Fractional CO2 laser + chemical peels Conclusions

• Fractional CO2 lasers offer us fantastic resurfacing

results with minimal downtime & minimal risk for side effects

• Combining fractional CO2 laser with chemical peels improves even more surface irregularities and dyspigmentation

• Training & experience are needed

5CC 2018 I Aug 30 - Sep 2 Barcelona