Download - Mexico 2013
Multiprocedural Synchronous Facial Rejuvenation
Introducing the DUBLiN method
Dr. Patrick J. TreacyMedical DirectorAilesbury Clinics Ltd
PHOTOAGEING
Photoageing refers to the damage that is done to the skin from prolonged exposure, over a person's lifetime, to UV radiation. Most of the skin changes that occur as we get older are accelerated by sun exposure. Examples of skin changes from photoageing include:
PERIORBITAL AGEING
The periorbital region is a immediate barometer of a patient’s chronological and environmental age. It tells its own history of ultraviolet light exposure and the wish for aesthetic rejuvenation treatments
SKIN CANCERSKIN CANCER
SALLOW SKINSALLOW SKIN COARSE
RHYTIDS
COARSE RHYTIDS
FINE RYTHIDS
FINE RYTHIDS
THREAD VEINSTHREAD VEINS PIGMENTATION
PIGMENTATION
TitleTitlePHOTOAGEING
CHRONOLOGICAL AGEING
Anatomical changes include laxity of the eyelid skin, prominent infra-orbital fat pads, hypertrophic orbicularis oculi muscle, and even descent of the forehead, eyebrows and mid-face
WRINKLESWRINKLES
ECTROPION ECTROPION ENTROPION
ENTROPION
FATPROTRUSION
FATPROTRUSION
EPIPHORA EPIPHORA SKIN LAXITY
SKIN LAXITY
TitleTitleCHRONOAGEING
Treating Facial Ageing
A great variety of stand alone facial rejuvenation treatments are presently available including Botox©,Dermaroller©, RioBlush©,Radiofrequency Devices Syneron Polaris©RF, Thermage© InfraRed Titan©, CO2 fractionalised resurfacing AFX© SmartXide© Fraxel Repair©,
PERIORBITAL AGEING
A variety of novel periorbital rejuvenation treatments are available such as retinol topical creams, Dermaroller ©, Botox ©, Thermage ©, Fraxel ©, RioBlush ©, Polaris © RF, SmartXide ©, AFX © CO2 fractionalised resurfacing
WHY LASER RESURFACING?
Thermal effect at 100 µm seen histologically using haematoxylin & eosin
Treacy Dublin
3 months post
WRINKLESWRINKLES
TEAR TROUGH TEAR TROUGH WRINKLES
WRINKLES
FATPROTRUSION
FATPROTRUSION
PIGMENTATION PIGMENTATION SKIN LAXITY
SKIN LAXITY
TitleTitleCOLLAGEN
FAT PROTRUSION
FAT PROTRUSION
SALLOW SKINSALLOW SKIN THREAD VEINS
THREAD VEINS
COARSE RYTHIDS
COARSE RYTHIDS
FINERHYTIDS
FINERHYTIDS
PIGMENTATIONPIGMENTATION
TitleTitlePositive
CO2 FRSL
• Patient CM 2 passes under R eye with obvious reduction in rhytides and neocollogenesis
MarionetteLines
MarionetteLines
Eyebrow HeightEyebrow Height Youthful Look
Youthful Look
Nasolabial Lines
Nasolabial Lines
CheekAugmentation
CheekAugmentation
Volume loss Volume loss
TitleTitleNegative
CO2 FRSL
New Collagen
Fibroblast Stimulatio
n
CO2 Laser
Botox
Although, many feel that ultrapulsed fractionalised
CO2 laser skin resurfacing is the best treatment option for photo aged facial skin, could we improve on this
modality.
ULTRAPULSE
CONSULTATION
PROPHYLAXIS
PROCEDURE
Conclusion
11
22
33
44 DUBLIN
CONSULTATION
CONSULTATION
PROPHYLAXIS
PROCEDURE
Conclusion
11
22
33
44 DUBLIN
Your Text here Your Text hereYour Text hereMETHOD• Every patient being treated in the perioral area is given Valtrex (valcyclovir) 500 mg bd for 8 days starting three days before surgery. This is increased if there is a break out of Herpes.
• If the patient has active acne, we prescribe ByMycin (Doxycycline) 100mgs for 7 days, starting one day prior to procedure.
• If the patient has evidence of prolonged erythema we prescribe Lamasil 250mgs for one week.
PROHPYLAXIS
Herpetic Infection post laser resurfacing
CONSULTATION
PROPHYLAXIS
PROCEDURE
Conclusion
11
22
33
44 DUBLIN
PROCEDURE
Your Text here Your Text hereYour Text hereMETHOD
Topical Anaesthesia
BLT ® : (Amethocaine; Propitocaine; Lignocaine) as topical anaesthetic to the entire facial area for 45mins. Regional Anaesthesia Typically, we gave regional anaesthesia during the procedure including •Supraorbital and Supratrochlear Nerve Block•Infraorbital Nerve Block •Mental Nerve Block
ANAESTHESIA
Active Fx Settings
• Patient CM 2 passes under R eye with obvious reduction in rhytides and neocollogenesis
• All skin biopsies in this study show effect of thermal treatment with thermal coagulation of epidermis and superficial dermis consistently getting below 100 µm. Many studies show the zone of residual thermal (coagulative) damage can extend a further 20 to 120 µm, depending on the particular laser variables used
This was particularly evident in Patient C where the thermal effect appears to be more diffuse than focal and the evidence of effect was still measured at 700 microns, although this reflected a vague diffuse thermal effect as compared with the more localized usual effect. Because the various CO2 lasers currently available differ in their biophysical properties, their documented depth of histological ablation and thermal effects vary
BIOPSY
Patient C
New Collagen
Fibroblast Stimulatio
n
CO2 Laser
Botox
Although, many feel that ultrapulsed fractionalised
CO2 laser skin resurfacing is the best treatment option for photo aged facial skin, could we improve on this
modality.
FAT PROTRUSION
FAT PROTRUSION
SALLOW SKINSALLOW SKIN THREAD VEINS
THREAD VEINS
COARSE RYTHIDS
COARSE RYTHIDS
FINERHYTIDS
FINERHYTIDS
PIGMENTATIONPIGMENTATION
TitleTitleLASER
WRINKLESWRINKLES
TEAR TROUGH TEAR TROUGH WRINKLES
WRINKLES
FATPROTRUSION
FATPROTRUSION
PIGMENTATION PIGMENTATION SKIN LAXITY
SKIN LAXITY
TitleTitleCOLLAGEN
The DUBLiN method uses different methods and technologies in order to activate fibroblasts and direct them towards neocollogenesis. It also uses low level pulsed lasers to reduce skin laxity, accelerate growth factors and cause tightening.
The DUBLiN method incorporates
D Dermaroller
U Ultrapulse Laser
B Blood Factors
Li Light – 633nm
N Neurotoxin
Tissue Repair -FIBROBLASTS
A fibroblast is a type of cell that synthesizes the extracellular matrix and collagen, the structural framework (stroma) for animal tissues, and plays a critical role in wound healing. Fibroblasts are the most common cells of connective
tissue in animals.
DERMAROLLER
ULTRALASE LASER
Laser specialists non-sequential fractionalised CO2 laser ablation is the most effective modality for repairing photo damaged skin
The benefits are more precise control of ablation depth, faster recovery time and reduced risk of post procedural problems
Keratinocyte GF Keratinocyte GF
Vascular Endothelial GFVascular Endothelial GF Fibroblast GF
Fibroblast GF
Transforming GF-BTransforming GF-B
Connective Tissue GF Connective Tissue GF
Platelet Derived GFPlatelet Derived GF
TitleTitleCOLLAGEN
BLOOD FACTORS
Tissue Repair –GROWTH FACTORS
Platelet Rich Plasma, also known as PRP is a component of whole blood that contains a concentrated amount of growth factors. This video describes the basic science of injecting PRP.
Tissue Repair –Platelet Rich Plasma
The efficacy of certain growth factors in forming collagen and healing various injuries is the theoretical basis for the use of PRP in tissue repair. The platelets collected in PRP are activated by the addition of thrombin and calcium chloride. This induces the release of these factors from alpha granules.
LiGHT 633nm
Migrating cells exert forces against the substrate to move forward. These forces are part of the contraction phase of migration in which the rear of the cell is detached from the substrate and the body of the cell is moved forward.
LiGHT 633nm
Migrating cells exert forces against the substrate to move forward. These forces are part of the contraction phase of migration in which the rear of the cell is detached from the substrate and the body of the cell is moved forward.
Near Red Light 633Near Red Light 633
Dermaroller Dermaroller
TitleTitleFibroblast Activation
PHASE 1
PRP Growth Factor Signals
Near Red Light 633Near Red Light 633
Post NTa Post NTa
TitleTitleCollagen
Synthesis
PHASE 2
Co2 Laser
Induction of FIBROBLASTS
A fibroblast is a type of cell that synthesizes the extracellular matrix and collagen, the structural framework (stroma) for animal tissues, and plays a critical role in wound healing. Fibroblasts are the most common cells of connective
tissue in animals.
Comparative study over three months
• Over 3 months, 15 patients (Group 1) received FLSR at normal settings
• Results were compared to 29 patients (Group 2) received low energy FLRS + adjunctive treatments
• Both group received BTXA one week prior to other treatments
Group 2 received a 3-phase combination
multi-rejuvenation technique over 3 weeks.
• Phase I included Dysport® at dilution 3.5:1 in 3 areas
• Phase 2 introduced intense fibroblast
stimulation and modification through microneedling, PRP growth factor induction and near-red phototherapy.
• Phase 3 included low–level (CO2) Ultrapulse laser with settings (Energy) 100 mJ (Rate) 14w CPG 3/5/2 and adjunct near-red 633nm phototherapy.
Near Red Light 633Near Red Light 633
Dermaroller Dermaroller
TitleTitleFibroblast Generation
PHASE 2 multi-combination technique
PRP Growth Factor Signals
Near Red Light 633Near Red Light 633
Dermaroller Dermaroller
TitleTitleFibroblast Activation
PHASE 2a fibroblast activation
PRP Growth Factor Signals
Near Red Light 633Near Red Light 633
Dermaroller Dermaroller
TitleTitleFibroblast
Stimulation
PHASE 2b fibroblast stimulation
PRP Growth Factor Signals
DERMAROLLER
Keratinocyte GF Keratinocyte GF
Vascular Endothelial GFVascular Endothelial GF Fibroblast GF
Fibroblast GF
Transforming GF-BTransforming GF-B
Connective Tissue GF Connective Tissue GF
Platelet Derived GFPlatelet Derived GF
TitleTitleCOLLAGEN
BLOOD FACTORS
GROWTH FACTORS
The efficacy of certain growth factors in forming collagen and healing various injuries is the theoretical basis for the use of PRP in tissue repair. The platelets collected in PRP are activated by the addition of thrombin and calcium chloride. This induces the release of these factors from alpha granules
LiGHT 633nm
Migrating cells exert forces against the substrate to move forward. These forces are part of the contraction phase of migration in which the rear of the cell is detached from the substrate and the body of the cell is moved forward.
Near Red Light 633Near Red Light 633
Post NTa Post NTa
TitleTitleCollagen
Synthesis
PHASE 2
Co2 Laser
ULTRALASE LASER
Laser specialists non-sequential fractionalised CO2 laser ablation is the most effective modality for repairing photo damaged skin
The benefits are more precise control of ablation depth, faster recovery time and reduced risk of post procedural problems
Patient A
Patient B
Patient C
Patient D
www.ailesburyclinic.ie
WSRS = Wrinkle Severity Rating Scale
5 Extreme Extremely deep and long folds, detrimental to facial appearance.
2-4mm Visible V-shaped fold when stretched
Unlikely to have satisfactory correction with injectable implant alone.
4 Severe Very long and deep folds; prominent facial feature.
Less than 2mm visible fold when stretched.
Significant improvement is expected from injectable implant.
3 Moderate Moderately deep folds.
Clear facial feature visible at normal appearance but not when stretched.
Excellent correction is expected from injectable implant.
2 Mild Shallow but visible fold with a slight indentation; minor facial feature.
Implant is expected to produce a slight improvement in appearance.
1 Absent No visible fold, continuous skin line.
GAIS = Global Aesthetic Improvement Scale
5 Very Much Improved Optimal cosmetic result for the implant in this patient.
4 Much Improved Marked improvement in appearance but not completely optimal for this patient. A touch-up would slightly improve the result.
3 Improved Obvious improvement in appearance from the initial condition, but a touch-up or re-treatment is indicated.
2 No Change The appearance is essentially the same as the original condition.
1 Worse The appearance is worse than the original condition.
DUBLIN Lift Periorbital Area
Dover Photoageing Scale
Wrinkle Severity Rating Scale
% Patient satisfaction
BTX
Wrinkle Severity Rating Scale
% Patient satisfaction
PRP
www.ailesburyclinic.ie