AESTHETIC DERMATOLOGY AND LASER Dra. Soledad Sáenz

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2 AESTHETIC DERMATOLOGY AND LASER Dra. Soledad Sáenz

3 European society for cosmetic and aesthetic dermatology European society laser dermatology

4 An approach to fillers complications Early-onset complications Inyection site reaction: erythema, discomfort, edema, hematoma (Bromelain) Hypersensitivy racction Bruising Non-inflamatory nodules Tyndall effect Infections Herpes reactivation Vascular occlusion Pain Blanching Mottled livedoid discolouration

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6 An approach to fillers complications TREATMENT OF VASCULAR OCCLUSION Warm compresses/massage the area Aspirin Hyaluronidase: multiple injections until clearance Oral prednisolona PDE4 inhibitors

7 Controversial issues in cosmetic dermatology and dermatologic surgery ALOPECIA Finasteride: POST FINASTERIDE SYNDROME: Loss of libido, erectile dysfunction, depression, suicidal ideation, anxiety, panic attacks, Peyronie s disease, gynecomastia, muscle atrophy. BIOFIBRE: automatic hair implant: Faster cicatization Best aesthetic result and immediante psycological benefit fibers, every days. MINOXIDIL: sulfotranferase enzyme activity

8 Oral antioxidants Negative effect in cancer prevention and in total ROS production Vitamin C megadosis: antagonizes the cytotoxic effect of antineoplastic drugs Vitamin E: With other antioxidants increase mortality risk Reduces blood coagulation Concern in subjects with vit K deficiency Concern in subjects taking warfarin and similar drugs

9 Step by step approach to keloids and hypertrophic scars Intralesional treatment: triamcinolone, FFU, bleomycin, verapamil PREVENTION: Wet semi-occlusive dressing for rapid reepithelization Minimun tension Appropriate splinting of tissue Imiquimod Interferon α 2b Pressure garments

10 Soft to firm keloids Intralesional treatment + silicon gel dressing Firm to hard keloids Pulsed dye/ QS Nd: Yag laser/ imiquimod cream + intralesional treatment

11 Early non ablative fractional laser exposure to improve scar appearance Laser types: PDL KTP Diodo laser Non ablative fraccional laser Ablative fraccional laser Full ablation YAG NAFL treatment at low to medium fluence 1 day prior or in the early phases of wound healing optimize scar formation

12 What s new in energy based devices? Radiofrecuency microneedling: Hair growth simulation by RF Ecchymoses by IPL Body contouring by US Skin laxity Wrinkles Dyspigmentation Rough skin surface Acne scar/active acne Enlarged pores Striae

13 What s new in energy based devices? Radiofrecuency microneedling: Hair growth simulation by RF Ecchymoses by IPL Body contouring by US HAIR LUX DEVICE: 10 times Less hair shedding More hair volume Increase in hair counts

14 What s new in energy based devices? Radiofrecuency microneedling: Hair growth simulation by RF Ecchymoses by IPL Body contouring by US Adipocyte apoptosis Phagocytosis of dead fat cell Epidermal cooling

15 Microwave technology in the treatment of unwanted sweat, hair and odor Heating deep tissue: sweat odor: 93% apocrine gl. hair, included light hair

16 Physical pretreatment with microdermoabrasion an ablative fractional laser prior to daylight PDT Compare efficacy and safety of MD pads vs AFXL prior daylight PDT FU weeks Improve in number of QA in AFXL group Improve in texture and dyspigmentation in AFXL group

17 Light emitting fabric (LEF) for phtodynamic treatment of actinic keratosis Develoment of a flexible ligth source would offer an alternative to conventional illuminator or LED panel Reduces incubation time Irrandiance 45 mw/cm2 High homogeneity Similar results at 6 months Lower pain

18 The beauty of multilayer spotless rejuvenation technique in skin rejuvenation Combined different treatements to improve from dermis to stratum corneum: 1064 nm short pulse laser QS 532 spot hunting photoacoustic ablation nm IPL colour uniform pass 2940 nm Er: yag or CO2 fractional laser 15-20% TCA chemical peel Complications Pain Herpes simplex Prolonged erythema PIH

19 Combining CO2 laser resurfacing with chemical peels Superficial to medium peel TCA 20-35% Improve dyspigmentation and superficial irregularities Fraccional CO2 laser Treatment dermis: tissue tightening and wrinkles improve. CONCLUSION Results similar to a total ablative laser or a deep peel (to mid reticular dermis) but without these technic complications

20 Pixel stamping marks: a novel reported complication of fractional carbon dioxide laser Developes in 9,4% of scar patients Darker scar color Long standing burn scars Histopathological findings: thick collage bundles perpendicular to skin surface with local loss of elastic tissue, a triangular focus os fibroblastic proliferation and a depression in the stratum corneum

21 Fractional carbon dioxide laser vs low dosis UVA 1 phototherapy for treatment of localized scleroderma: a clinical an immune-histochemical randomised controlled study Fractional CO2 laser Collagen degradation: MMP1, UVA 1 Collagen degradation: MMP1 Apoptosis of inflammatory cells MMP3, 9 and 13 Heat Shok protein Mechanical ablation Burnt out atrophic lesion

22 Fractional carbon dioxide laser vs low dosis UVA 1 phototherapy for treatment of localized scleroderma: a clinical an immune-histochemical randomised controlled study Better results with fractional CO2 laser with less number of treatments Fractional CO2 laser Pain Not practical in multiple lesions PUVA -1 Multiple visits Practical in multiple lesions HIP

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