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: [email protected]

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


Non-invasive Cosmetic Dermatology & Medicine Doctors

• Injectors

• Laser surgeons/ dermatologists

• Technology & devices

• Peelers

• Medium depth & deep peels

Why not to combine?


Fractional CO2 laser combined with chemical peels

Ageing

Wrinkles

Dyspigmentaion

Solar lentigines

Rough skin surface

Sagging

Volumetric changes

Solar keratosis



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


Resurfacing

Traditionally Chemical Peels

Medium & deep

Light sources

Lasers

IPL

Radiofrequency

Recently Fractional lasers & fractional RF



Resurfacing 1998 CO2 laser Chemical peels IPL


Medium depth chemical peel


Deep chemical peel

Modified Baker Gordon – 3 months

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


Deep chemical peel

Modified Baker Gordon – 2 years



Deep chemical peel Permanent Hypopigmentation



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



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


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)





Fractional Revolution




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


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


Fractional CO2RE –10600nm

CO2 B & A

CO2 B&A


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


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


Fractional CO2 + TCA peel Before & after 6 days


Before & 6 days after fractional CO2


Before & 6 days after fractional CO2 + TCA peel


Fractional CO2


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

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

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