the art of non surgical skin rejuvenation. multiple approaches
TRANSCRIPT
PowerPoint Presentation
MSI Resurfacing (Rejuvenation) PEEL
The Art of Non Surgical
Skin Rejuvenation
By
Prof Osama B Moawad
MSI Anti-aging Program
What is the problem ?
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The First step for any successful anti-aging program is to diagnose the skin problems (dark spots, red spots, pimples, scars, wrinkles or skin folds)
MSI- Diagnostic Tools
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Woods light
Polarized Light
Dermatoscopy
Video Dermatosopy
Venoscope
Woods Light is essential to detect skin Pigmentation in photoaging
Polarized Light
Polarized Light is used to detect red and dark skin spots
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Abnormalities of Hair, Nail and skin thousands times
Video-Dermatoscopy
White Heads
Black Heads
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Examination is a Must!!!
To Detect Blood Vessels
Is a mole Harmless?
Veinscope
Dermatoscope
Or pigmented laser surgery is indicated
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MSI Skin Rejuvenation Program?
What Is
It is a comprehensive Non Surgical skin care program that uses the state of art in aesthetic medicine tailored to your condition , need and expectation
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These are weapons at our hands to fight aging
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Non Ablative Treatment
Minimally ablative
Surgical Treatment
PDT
Superficial chemical Peel
Ablative Treatment
Laser
Radiofrequency
Light
Local Therapy
Skin Care Products
Oxygen Therapy
Fractional Ablative CO2 Laser
Medium Depth Chemical Peel
Lifts
Tucks
HT
Meso-lifts
Liposuction
Fat Transfer
Dermal Fillers
Ablative CO2
Dermabrasion
Diamond Peel
Minimally Ablative FR CO2
Botox
Ultrasound
MSI Anti-aging Program
The concept of MSI peel start with prevention of sun damage with sun avoidance, wearing protective clothing and sun block and using, home skin care products with aim to treat
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Steam
Ultrasonophoresis
Diamond Peel
Laser, Light, RF
Mesolift, Vampire Face Lift
Chemical Peels
Fractional CO2 Laser
Am I a Good Candidate?
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Active Acne
Distensible Scars
Aging
Dark Spots
Red Spots
Moderate Skin Laxity
Wrinkles
Stretch Marks
How Should I Prepare?
One month preparation with tailored MSI skin care products with or without Dermal Roller especially in Dark Skinned Patients
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Home Skin Care Products
Retinoid is the second cost effective tool we have to prevent photo aging and treat aging, antioxidants. Estrogen, cytokines and growth factors are all promising
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Before
During
After
Retinoids
Anti-oxidants
Growth -Factors
Anti-Acne
Whitening
Cleanser
Moisturizer
Sun Block
Sun Protection is A Must!!
Avoiding photoaging is more cost effective than trying to reverse the sign of photoaging
Sun protection should include attitude to avoid sun exposure espeically form 10-4pm ,one should wear protective clothing and apply sun block every 2hours
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Before
During
After
Free dead cells, dirt, and bacteria
It moisture and softens.
Eliminate Toxins
Stimulate blood circulation
Open pores
Better absorption of skin care products
This process helps to free any dead cells, dirt, bacteria or other trapped matter that could be causing breakouts, It moisture softens the surface layer of dead skins cells. The warm humidity from steaming may also increase perspiration and stimulate blood circulation and eliminate toxins through sweating It open pores to allow better absorption of topicals
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Ultra-sonophoresis
Deep Skin Cleansing & Better Absorption
Deep Skin Cleansing
Ultra-sonophoresis cleanse the skin deeply in addition increases skin permeability, thousands times
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Diamond or Crystal Peel
Removes 35% of stratum corneum and dead cells.
Accelerate skin renewal and enhance collagen production reducing fine wrinkles and superficial scars and pigmentation
Removes 35% of stratum corneum and dead cells. Accelerate skin renewal and enhance collagen production reducing fine wrinkles and superficial scars and pigmentation
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Superficial
Chemical Peel
Minimal Ablative Resurfacing
Minimally Ablative superficial chemical peel
Salicylic Acid Peel
Do you need to start a resurfacing programs to agument result obtained with home care programs try diamond with or without
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Acne Excoriee
Salicylic Acid Peel
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Comedon Extraction
Blackheads are not caused by dirt, sweat and poor hygiene (this is a myth that people spread) but are caused by the formation of a plug in pores due to abnormal skin cell growth which gets oxidized by sunlight and turns black.
Comedone Extraction
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Manual Needling, Skin Rolling, Micro-needling or Derma Pen
Dermal roller is used for those suffering from open pores, acne scars, fine wrinkles, stretch marks and even hair-loss
Dermal rollers not only allow the passage of active ingredients deep into the skin but also works by producing thousands of microscopic needle holes in the dermis, which prompts the skin to produce new collagen and elastin
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Mesotherapy / Meso-lift
Not only we improve how we deliver active ingredients by mesogun and dermal roller but also we improve what we deliver by injecting a mixture of antioxidant, vitamins, minerals and amino acids. The skin looks tighter and revitalized after these procedures
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Vitamines:
2. Amino acids:
3. Minerals:
4. Coenzymes:
6. Cytokines: EGF, bFGF
7. Peptide: Copper Peptide
5. Nucleic acids: DNA, RNA
Vampire Face Lift (PRP)
PLATELETS RICH PLASMA
PRP drawn from your own blood containing numerous growth and healing factors are put back into the skin to regrew hair and to rejuvenate or heal the face rapidly
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Meso-Botox
We reconstituted BTA (100 unit) with 10 mL of sterile, preservative-free saline to achieve a concentration of 10 U/mL., A 30-guage needle was used to inject the materials intradermally. The end point of the injection was a subepidermal wheal-like swelling.Total dose of BTA for each person was 2025 U. nterestingly, BTA showed moderate but significant wrinkles-soothing effect, Without obvious side effects on the lower face
Mesolift to which we add 1015U of BOTOX, for full face and neck. It is not indicated in cases of heavy or lax skin. The use of 0.2 ml of xylocaine with adrenaline allows precise action and the diffusion of mesobotox within marked areas
Mesoliftwith BOTOX combination, 10U BOTOX diluted in a 5-ml syringe (procaine +vitamin C or hyaluronic acid+multivitamins
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Energy Based Skin Rejuvenation
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Wake Up Skin !!!!!!!!!!
Removing Injured collagen and elastic fibers and stimulates new Collagen and elastic fibers synthesis by local, surgical or energy based devices
What doctors trying to do is to give a wake up call to your skin by removing injured collagen and elastic fibers ,encouraging your fibroblast to synthesis new extracellular proteins. Mainly we can do that with locally, surgically and with help of energy based devices. These procedures target both intrinsic and extrinsic types of aging
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Non Ablative Skin Rejuvenation
Delivers the laser/light/RF/Ultrasound energy through skin to reverse the signs of aging skin
Non-invasive and minimally invasive skin rejuvenation, also referred to as subsurface remodeling, include a wide spectrum of non-ablative techniques to improve and reverse the signs of aging skin without disruption of skin integrity, minimize downtime and relatively low risk factors
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Non Ablative Skin Resurfacing
Non-ablative technology replaced traditional ablative systems such as carbon dioxide lasers. Experience with non-ablative lasers and light sources has proven that tissue enhancement without epidermal disruption (thereby limiting adverse effects and virtually eliminating postoperative recovery)
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Vascular
Pulsed KTP 532
Pulsed dye 585
LP PDL 595nm
532nm (ns)
IPL
Elos
Nd:YAG 1064nm &
Diode 1450
Erubium glass 1540
Pigmented
1064nm (ns, usec )
1320nm
Mid Infra red Lasers
Photorejuvenation
Non ablative light based technology are indicated for those patients with early photodamage with fine lines, patients who dont desire ablative treatment or those need maintenance therapy after successful ablative one.T hey have modest expectation and tolerate multiple treatments
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Indications of Non Ablative Skin Resurfacing
Early photodamage with fine lines
Patients who dont desire ablative laser treatment/downtime
As maintenance after successful ablative resurfacing
Modest Expectation
Tolerate Multiple treatments
Atrophic scars (Acne or others)
PhotoDynamic Therapy is performed in conjunction with a topical application of ALA, or Levulan (aminolevulinic acid) to treat skin damage in a softer, gentler way. PhotoDynamic Therapy delivers specific wavelengths of intense light through very specific filters to the skin.
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Photosensitizer
Red light
Infra-red light
LED
Laser
IPL
Photodynamic Therapy
Soft Laser Peel
We use Q-Switched Nd YAG laser 1064nm with Carbon Lotion in induce mild peeling and some dermal remodeling
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Light Emitted Diode(LED)
Red LED for
Photo-rejuvenation
Blue LED
of Acne
LED, or Light emitting diodes, is a non-ablative procedure that activates skin cells with pulses of low-level, non-coherent and non-thermal light energy. LED red and infrared light delivers powerful therapeutic benefit to living tissue. The action is potentiated if combined with photosensitizer in photodynamic Therapy
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Photo-Rejuvenation:
Activates skin cells with pulses of low-level, non-coherent and non-thermal light energy
Infrared radiation may have beneficial effects on skin texture and wrinkles by increasing collagen and elastin contents from the stimulated fibroblasts. It helps to reduce inflammation during skin healing
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Photo-Rejuvenation-Elight or ELOS
Improvement in telangiectasia, pigmentation , pores sizes and overall skin texture
Photo-Rejuvenation
Improvement in telangiectasia, pigmentation , pores sizes and overall skin texture
Selective Non Ablative LASER:
Pigmented
Skin Laser
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Age spots
532nmQ-switch Nd YAG
Pigmented Laser Surgery
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Pigmented Laser Surgery
532nmQ-switch Nd YAG
Freckles
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Pigmented Laser Surgery
Lentigens
532nmQ-switch Nd YAG
Pigmented Laser Surgery
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Pigmented Laser Surgery
DPN
532nmQ-switch Nd YAG
Pigmented Laser Surgery
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Pigmented Laser Surgery
Periorbital Darkening
Vascular Laser Surgery
Selective Non Ablative LASER
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Vascular Laser Surgery
Facial Telangiectasia
Vascular Laser Surgery
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Vascular laser such as pulsed dye laser and pulsed 52nm KTP laser alone or in conjunction of 1064nm AND
Vascular Laser Surgery
Facial Erythema
Longer wavelengths 1320nm,1450nm and1540nm lasers using water as a chromophore demonstrated mild but reproducible improvement in wrinkles reduction
Non Ablative Laser Skin Rejuvenation
Acne Scars
Non Ablative Laser Skin Resurfacing
Longer wavelengths 1320nm,1450nm and1540nm lasers using water as a chromophore demonstrated mild but reproducible improvement in wrinkles reduction
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Acne scar with non ablative
RF-Mono-polar
Non Surgical Skin Tightening
Generating local heat in the tissue by high frequency electrical current.
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Radiofrequency
Monopolar
Bipolar
Fractional
Dual
Tripolar
Who will benefit from Radio-lift?
Tissue tightening is not meant to replace surgical procedures such as face, eyelid and neck lifts, but it is good option for people who have mild to moderate changes and who understand that the results are noticeable but modest or those patients who are afraid of a major surgery, those who are still too young for it, and those who are poor surgical candidates.
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Patient with Mild to Moderate skin changes
Patient with Modest Expectation
Patient afraid from surgery
Patient too young for it
Patients who are poor surgical candidate
Before
At the End
3ms after
J Am Acad Dermatol 2011;64:524-35.
Significant clinical improvement of skin tightening and wrinkles reduction
All 6 volunteers completed the monopolar RF study, and showed clear clinical improvement of skin tightening and rhytides reduction. At each end point before, at the end of, and 3 months after treatment),
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Before
At the End
3ms after
Significant improvement in skin tightening and
reduction in the nasolabial folds
The same for nasolabial folds At each end point (before, at the end of, and 3 months after treatment),
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Radiolift: Non Surgical Skin Tightening
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Radiolift: Non Surgical Skin Tightening
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Radiolift: Non Surgical Skin Tightening
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Radio-lift: Skin Tightening
Non Surgical Neck Lift
Intrinsic aging
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Ablative Skin Resurfacing (Rejuvenation)
Ablative techniques broadly grouped as mechanical, chemical, and laser or thermal abrasion. First, the outer layers of damaged skin are stripped away. It result in upper to mid-dermal wound. Then, as new cells form during the healing process, a smoother, tighter, younger-looking skin surface appears.
.
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Dermabrasion
Chemical Peel
Ablative Laser
Spot Dermabrasion
It is effective procedure for the treatment of photodamage, acne scarring, and scarring from surgery or trauma
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Spot Dermabrasion
Acne Scars
Ablative Medium Depth TCA-Chemical Peel
One Week Post Op
2 days Post Op
Stage III TCA
Ablative Medium Depth TCA-Chemical Peel
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Freckles
Medium Depth TCA Peel
Melasma
Medium Depth TCA Peel + PRP
Medium Depth TCA Peel + PRP
Melasma
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Medium Depth TCA Peel
Post Acne
Freckles
Medium Depth TCA Peel
CROSS TCA Peel
Acne and chicken pox scars
Application of TCA to the skin causes precipitation of proteins and coagulative necrosis of cells in the epider mis and necrosis of collagen in the papillary to upper reticular dermis. Over several days the necrotic layers slough and the skin re-epithelializes from the adnexal structures that were spared from chemical damage. Dermal collagen remodeling after chemical peel may continue for several months.
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CROSS TCA 50%
Acne Scars
Ablative CO2 Laser Resurfacing
Acne Scars
Multiple modalities have been described for skin photorejuvenation, including ablative, non-ablative and fractional laser resurfacing which fills the gap between the ablative and non-ablative modalities
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Ablative Laser Skin Resurfacing
Ablative Laser Skin Resurfacing
Ablative Laser Skin Resurfacing
Acquired Moles
Ablative Laser Skin Resurfacing
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Ablative Radiosurgery
DPN
Thermally alter a fractions of the skin , leaving intervening areas of normal skin untouched giving results similar to ablative laser resurfacing in less down time
Fractional Laser Skin Resurfacing
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Ablative Fractional Laser Skin Resurfacing
Ablative Fractional Laser Skin Resurfacing
Fractional Ablative Laser Resurfacing
Ablative Fractional Laser Resurfacing +PRP
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Ablative Fractional Laser Resurfacing+ PRP
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Ablative Fractional Laser Skin Resurfacing+ PRP
Faster healing time and fewer side effects on the expense of degree of improvement in photo-damage when compared with ablative CO2
This is type of result you can get with fractional ablative co2 laser
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It is time to dive into your skin
Transdermal Drug Delivery System
Transdermal Drug
Delivery System
No needle mesotherapy or Electroporation
It creates spaces (pores) between the cells that allow the passage of active ingredients (anti-acne, whitening) painlessly
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No needle mesotherapy or Electroporation
It creates spaces (pores) between the cells that allow the passage of active ingredients (anti-acne, whitening) painlessly
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No needle mesotherapy or Electroporation
No needle mesotherapy or Electroporation
Post inflammatory hyperpigmenation
No needle mesotherapy or Electroporation
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MSI Skin Rejuvenation Program
It time to Sooth, Calm and Moisturize
and Apply Sunblock
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Oxygen Therapy
Reduce the effects of aging by actually nourishing the skin with essential vitamins, minerals, amino acids, enzymes, and pure oxygen.
It can be used post surgery to speed healing process.
Oxygen levels in the skin decrease with age which results in the appearance of fine lines, wrinkles and poor skin elasticity. Oxygen Therapy replenishes lost levels by pulsing oxygen deep into the skin, rejuvenating and restructuring skin
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Are made to suit different skin types (e.g., oily or dry), and different skincare goals or needs (e.g., moisturizing, cleansing, exfoliating).
Facial Masks
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Photo-Rejuvenation
A non-ablative procedure that activates skin cells with pulses of low-level, non-coherent and non-thermal light energy. LED red helps to calm the skin after cosmetic procedures
LED
LED, or Light emitting diodes, is a non-ablative procedure that activates skin cells with pulses of low-level, non-coherent and non-thermal light energy. LED red and infrared light delivers powerful therapeutic benefit to living tissue. The action is potentiated if combined with photosensitizer in photodynamic Therapy
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Facial Erythema
LED
Facial Erythema
LED
MSI Rejuvenation
Complimentary Procedures
Botox
FILLERS
Threads
Fat
The Art of Liquid Face Lift
Botox
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BoNTA-ONA; Botox, Botox Cosmetic, Allergan, Vistabel, Vistabex
What to Inject?
BoNTA is available as onabotulinumtoxinA (BoNTA-ONA; Botox, Botox Cosmetic,, Vistabel, Vistabex) contains the 900-kD a neurotoxin complex protein.
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Where to inject?
Glabella (frown Lines )
Supraciliary wrinkles
Crows feet
Bunny Lines
Lip and Perioral
Nasolabial fold
Dimpled chin
Forehead
Nefertiti
Neck (platysma)
Small intramuscular or intradermal doses of BTX-A eliminated hyperkinetic facial lines for approximately 6 months. These include forehead lines, glabellar lines, supraciliary wrinkles, lateral canthal wrinkles (crows feet), bunny lines, lip and perioral wrinkles, nasolabial fold, dimpled chin, neck lift and platysmal bands elimination
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B
Forehead
A
B
Glabella or Frown Lines
A
B
Bunny Lines or Nasal Wrinkles
A
B
A
Chemical Brow Lift
A
B
Chemical Brow Lift
A
B
Crows Feet
Lower Eyelids Wrinkles and Widening Eye Aperture
1-BTX Smoothens Inferior Wrinkles
2-Widens Eye Aperture
3-Treat Dennie Morgan Folds
The injection of BT-A into the inferior pretarsal orbicularis can smooth this inferior wrinkles and widen the eyelid aperture Furthermore, benefit may lie in the reduction of stigmatizing Dennie Morgan folds in subjects with atopic dermatitis
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B
Widening Eye Aperture
Medical Rhinoplasty
2U-4U on the nasal spine deep injection
often with fillers at nasolabial fold
Droop Nose Tip
Surgery
Botox
Fillers
Upper Lip Wrinkles
Rosebud Mouth
1-U at Four Points 1.5cm Away from the Corner of the Mouth Superficial at the vermillion. Treat the lower lip on the same session. Better in Combination with Filler and Resurfacing
PERIORAL LIP RHYTIDES
The lips are central to the appearance of the lower face. During aging, the lateral portions of the lips recede, resulting in a rosebud mouth. At the same time, the distance between the columella and the vermilion border of the upper lip increases and the substance of the vermilion rolls inside, producing the thin and disappointed lips that are characteristic of old age.
Vertical lines of the upper lip are a strong sign of aging. These vertical lines are commonly labeled as smokers lines but can also result from heredity, photodamage, playing a musical instrument that requires embouchure, or even whistling. Patients often are disturbed by the increased vertical length of the cutaneous lip and by the radial upper lip lines that can cause lipstick to bleed upward from the lip and blur the outline of the lip
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Contouring of the Lower Face
1-5 sites total 18U-30U IM with 30 gauge needle
With volumizing filler at mid face
1-Hyper trophy of Masseter Muscle
Not an MSI patient
Two or three horizontal necklace lines of skin indentation are caused by the superficial musculoaponeurotic system attachments in the neck. We feel that the simplest approach is to dance along the lines injecting small doses of botulinum toxin over multiple sites. Aliquots of 1 to 2U are injected in the deep intradermal plane avoiding the deeper venous perforators that can bleed and the underlying cholinergic muscles of deglutition, at approximately 1-cm intervals along the horizontal neck lines to soften and erase them. Not more than 10 to 20U is injected in one treatment session If the neck is gently massaged afterward, the skin usually does not bruise
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Nefertiti Face Lift
2-3 BTX along and under each mandible and to Upper part of
the post platysmal band for a totoal of 15-20 U each side
Neck Enhancement
Platysmal Bands
Click to edit Master text styles
Second level
Third level
Fourth level
Fifth level
Fat Transfer
The Art Of Liquid Face Lift
By
Prof. Osama B Moawad
120
The Fact is as we Age.
Fat Redistribute
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To Revers Ageing
We have to fill the volume loss and remove the fat excess
Using fat grafting cosmetic units are smoothed and lost balance between skin and underlying fatty tissue can be restored by rebuilding primary youthful arc and convexities. However, hypertophic fatty deposits in jowls and sub-mental areas are managed with microliposuction
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Numerous natural, synthetic, and mixture materials have been utilized as adipose tissue substitutes
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Permanent
Fillers
Temporary
Fillers
What to Fill (Volume Surgery)
Fat
Transfer
Autologus
Plenty
Low cost
Expensive
Unforgivable
Immune
Reaction
Expensive
Temporary
?Permanent
Superficial
Implants
Non dynamic
Hard
Gaunt Look
Non Living
Filler is deposited Superficially
The Art of Liquid Face Lift. Fat vs Fillers?
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Fat is Deposited Deep.
Unlike other fillers successful fat grafting is grafting of Living Tissue.
The Art of Liquid Face Lift. Fat vs. Fillers?
Filler
Fat
Wrinkles
Soft Tissue defect
Correct the defect with its appropriate weapon
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While synthetic fillers can smooth out wrinkles and folds (superficial), it cannot restore fullness (deep)
The Art of Liquid Face Lift. Fat vs. Fillers?
The Art of Liquid
Face Lift
Dermal Fillers
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What to Inject?
FDA Approved Fillers
12/18/2009
MSI Rejuvenation
130
Where to Inject?
I reserve the use of temporary fillers to lips and nose and sometime as a quick fix before important occasion with no time for fat grafting
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Dermal Fillers
Eye Bags
Dermal Fillers
B
Post Blepharoplasty
Dermal Fillers
Dark Circles
Dermal Fillers
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Buccal Recess
Dermal Fillers
Dermal Fillers
Non Surgical Nose Job
Dermal Fillers
Non Surgical Nose Job
B
Aging Lips
Lip Augmentation
B
Lip Augmentation
Ageing Hands
Dermal Fillers
A
B
Acne Scars
Dermal Fillers
Fat Transfer
The Art Of Liquid Face Lift
By
Prof. Osama B Moawad
144
What is Fat Transfer, Fat Injection, Fat Graft and Autologous Fat?
Getting rid of your own fat and then injecting it in your wrinkles to eliminate them does sound like the best of all world!!!
145
A
The Art of Liquid Face Lift. Fat
The Art of Liquid Face Lift. Fat
A
The Art of Liquid Face Lift. Fat
The Art of Liquid Face Lift. Fat
The Art of Liquid Face Lift. Fat
A
The Art of Liquid Face Lift. Fat
The Art of Liquid Face Lift. Fat
Acne Scars
Moreover Fat can be injected in large quantities not only as a filler but as a natural lifting material in nearby sagging . We can achieve the same results for six-nine months using synthetic material costing him more than 20.000 pound
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12/17/2009
Acne Scar
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The Art of Liquid Face Lift. Fat
Acne Scars
The Art of Liquid Face Lift. Fat
The Art of Liquid Face Lift. Fat
The Art of Liquid Face Lift. Fat
The Art of Liquid Body Lift. Fat
Thread Fat Lift
The Art of Non Surgical Face Lift
It is time to Relax..
Patient Instructions
The patient is given post procedural instructions
according to his tailored program
Botulinum toxin products have been approved by FDA for one or more of the following uses: temporary improvement in the appearance of glabellar lines (frown lines), treatment of strabismus (crossed eyes), blepharospasm (abnormal tics and twitches of the eyelids), cervical dystonia (involuntary sustained or repetitive contraction of the neck muscles), and Primary axillary hyperhidrosis (severe underarm sweating). BoNT-A is widely used today for both cosmetic and non-cosmetic purposes.
161
Sun Protection is a Must!!!!!
Avoiding photoaging is more cost effective than trying to reverse the sign of photoaging
Sun protection should include attitude to avoid sun exposure espeically form 10-4pm ,one should wear protective clothing and apply sun block every 2hours
162
Home Skin Care Products
Retinoid is the second cost effective tool we have to prevent photo aging and treat aging, antioxidants. Estrogen, cytokines and growth factors are all promising
163
Retinoids
Antioxidants
Growth factors
Cytokines
Estrogen
Whitening
Moisturizer
MSI Skin Rejuvenation Program is
A High Tech Comprehensive
Age Reversing Program Tailored to your Needs
and Goals