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CONFERENCE BOOK
ANTI-AGING MEDICINE & MEDISPA
Claude Dalle,
Anti-Aging Practitioner, France
Claude Chauchard, Anti-Aging Practitioner, Hong-Kong
Takuji Shirasawa, Genetician, President JAAM, Japan
Xiaoyan Jiang,
Prof. Biology & Genetics, Canada
Mario Krause,
Anti-Aging Practitioner, Germany
David Lai,
Anti-Aging Practitioner, Hong-Kong
Pakpilai Thavisin, Derm. & AA Practitioner, Thailand
Ruxiang Wang,
President of Shenyang Academy
of Anti-Aging Medicine, China
Bernard Weber,
Prof. of Biology, Luxembourg
Claude
Dalle
Takuji
Shirasawa
L
IONA
NAT
R
E
INT
SCIENTIFIC ADVISOR
Y
AESTHETIC DERMATOLOGY
BOA
RD
SCIENTIFIC COORDINATION
Vincent Yeow, Plastic Surgeon, Singapore
Colin Tham, Plastic Surgeon, Singapore
Vanessa Phua, Aesthetic Practitioner, Singapore
Claude
Chauchard
Vincent Yeow
Xiaoyan
Jiang
Mario
Krause
David
Lai
Pakpilai
Thavisin
Ruxiang
Wang
Bernard
Weber
Colin Tham
Andreas Katsambas, Former President EADV, Greece
Nopadon Noppakun,
Dermatologist, Thailand
Pravit Asawanonda,
Dermatologist, Thailand
Ashraf Badawi,
Dermatologist, Egypt
Sohail Mansoor,
Dermatologist, UK
Hervé Raspaldo,
Facial Plastic Surgeon, France
Marco Stabile,
Plastic Surgeon, Italy
Rataporn Ungpakorn,
Dermatologist, Thailand
Ines Verner,
Dermatologist, Israel
Andreas
Katsambas
Nopadon
Noppakun
Pravit
Asawanonda
Ashraf
Badawi
Sohail
Mansoor
Hervé
Raspaldo
Rataporn
Ungpakorn
Ines
Verner
Vanessa Phua
Marco
Stabile
FACULTY
Vali A. Abbaspour, Plastic Surgeon, Iran
Satish Arolkar, Plastic Surgeon, India
Pravit Asawanonda, Dermatologist, Thailand
Frederik Berne, Plastic Surgeon, Sweden
James Betz, CEO Biotivia Bioceuticals LLC, USA
Elisabeth Briden, Dermatologist, USA
Fabrizio Castagnetta, Plastic Surgeon, Italy
K.R. Chandvania, Dermatologist, India
Claude Chauchard, Anti-Aging Practitioner France/Hong-Kong
Peng Chuan, Traditional Chinese Medicine, China
Claude Dalle, Anti-Aging Practitioner, France
Luc Dewandre, Anti-Aging Practitioner, France
Anne Evans, Cosmetic Surgeon & Phlebologist, Australia
Deborah Fortescue-Merrin, CEO Nucelle, Canada
Adrian Gaspar, Cosmetic Surgeon, Argentina
Apratim Goel, Cosmetic Dermatologist & Laser Surgeon, India
Sawako Hibino, Dermatologist, Japan
Tatsuo Ichinohe, Ass. Prof. Hematology & Oncology, Japan
Eugenio Luigi Iorio, Biochemist, Italy
Andreas Katsambas, Dermatologist, Greece
Mohamad Khan, Plastic Surgeon, Saudi Arabia
Jeong Eun Kim, General Practitioner, South-Korea
Kew Ho Kim, Plastic Surgeon, South Korea
Peter C. Konturek, Prof. Internal Med/Gastrology, Germany
Yoshiaki Kumamoto, Prof. of Urology & Andrology, Japan
David Lai, Anti-Aging Practitioner, Hong Kong
Sun Ho Lee, Surgeon, South Korea
Stefan Lipp, Aesthetic Practitioner, Germany
David Loh, Aesthetic Practitioner, Singapore
Grace Lopez, Dermatologist, Philippines
Venue
MARINA BAY SANDS
1 Bayfront Avenue
Singapore 018971
www.marinabaysands.com
Lieguang Ma, Prof. Traditional Chinese Medicine, China
Gabriela Machalova, CEO Cosmederm, Slovakia
Sohail Mansoor, Dermatologist, UK
Woraphong Manuskiatti, Dermatologist, Thailand
Jun Matsuyama, Chairman of Japanese Society of AA Medicine, Japan
Masaaki Muramatsu, Prof. Genomics - Epidemiology, Japan
Nopadon Noppakun, Dermatologist, Thailand
Noel Thomas Patton, Founder of T.A. SCIENCES®, USA
Chariya Petchngaovilai, Dermatologist, Thailand
Vanessa Phua, Aesthetic Practitioner, Singapore
Savardekar Preeti, Dermatologist, India
Jinda Rojanamatin, Dermatologist, Thailand
Elena Rumyantseva, Dermatologist, Russia
Eva Schaeufele, Psychanalist, Germany
Takuji Shirasawa, Prof. in Aging Control Medicine, Japan
Marco Stabile, Plastic Surgeon, Italy
Nalinee Sutthipisal, Dermatologist, Thailand
Elias Tam, Aesthetic Practitioner, Singapore
SK Tan, Aesthetic Practitioner, Singapore
Pakpilai Thavisin, Dermatologist and Anti-Aging Practitioner, Thailand
Patana Teng-Umnuay, Nephrologist, Thailand
Colin Tham, Plastic Surgeon, Singapore
Huu Hanh Tran, Anti-Aging Practitioner, Vietnam
Rataporn Ungpakorn, Dermatologist, Thailand
Ines Verner, Dermatologist, Israel
Xanya Sofra Weiss, CEO Arasys Perfector, USA
Vincent Yeow, Plastic Surgeon, Singapore
Yun Zhao, Ass. Prof. of Hematology, China
Sabine Zenker, Dermatologist, Germany
International Organisation
IIR ASIA PACIFIC
205 Henderson Road, 03-02A
Henderson Industrial Park, Singapore
EUROMEDICOM
29 Boulevard de la République
92250 La Garenne-Colombes, France
Tel. +(65) (6) 3192668
Fax. +(65) (6) 3192669
Tel. +33 (0)156 837 800
Fax. +33 (0)156 837 805
www.AestheticsAsia.com
www.euromedicom.com
SCHEDULE AT-A-GLANCE - AESTHETICS ASIA 2010
All lectures are conducted in English
AESTHETIC DERMATOLOGY
ANTI-AGING MEDICINE
MEDICAL SPA
Room 2
Room 1
8:30 am
10:30 am
9:00 am
11:00 am
Coffee Break
11:00 am
ENHANCING THE SKIN - Part 1
1:00 pm
1:00 pm - 2:00 pm
Lunch Break
2:00 pm
4:00 pm
FAT TISSUE
2:30 pm
4:30 pm
Coffee Break
LATEST TRENDS
IN BOTULINUM TOXIN
& INJECTABLES FOR ASIA!
4:30 pm
6:30 pm
5:00 pm
6:30 pm
AESTHETIC DERMATOLOGY
ANTI-AGING MEDICINE
MEDICAL SPA
Room 2
SATURDAY SEPTEMBER 18th
Room 1
7:30 am
4:30
SKIN FITNESS
4:30
MEDICA
AESTHETIC
SURGERY ISAPS
Room 3
TEOXANE
AESTHETIC WORKSHOPS
Room A
Room B
Registration & Badging
AESTHETIC MEDICINE
TECHNIQUES
Coffee Break
INJECTABLES:
11:00 am
LATEST UPDATES
1:00 pm
AND TECHNIQUES
1: 00 pm - 2:00 pm Lunch Break
9:00 am
AESTHETIC BREAST
SURGERY 1
NUTRITION
11:00 am
10:30 am - 11:00 am
2:00 pm
YENA
Coffee Break
3:00
4:00
Coffee Break
ANTI-AGING & PREVENTION
Heart, bones, metabolic syndrome,
sexuality, vision…
4:30 pm - 5:00 pm
CYNOSURE
NEOASIA
NEOSTRATA
2:00
BURN OUT SYNDROME & STRESS
MANAGEMENT IN MEDISPA
4:00 pm - 4:30 pm
10:30 am
Room B
SKIN AGING
The best for prevention and
treatment
11:00 am - 11:30 am Coffee Break
STEM CELLS & GROWTH
11:30 am
FACTORS:
1:30 pm
Real clinical applications
1:30 pm - 2:30 pm Lunch Break
FACIAL REJUVENATION
WITH INJECTABLES
10:30 am - 11:00 am
8:30 am
Room A
Registration & Badging
11:00 am - 11:30 am
11:30 am
LASERS, LIGHTS AND
RELATED TECHNOLOGIES
4:00 pm
4:00 pm - 4:30 pm Coffee Break
ENHANCING THE SKIN
4:30 pm
1:30 pm
UPDATE IN
ANTI-AGING MEDICINE IN JAPAN
1:30 pm - 2:30 pm
2:30 pm
4:30 pm
4:30 pm - 5:00 pm
5:00 pm
11:00 MESOESTETIC
PERIOCULAR
PART 1 12:00 PROFESSIONAL
LOWEREYELID
DIETETICS
2:00
NEOASIA ZELTIQ
3:00
4:00
INDIBA
SANOFI
Coffee Break
SURGICAL FACIAL
4:30
REJUVENATION
5:30
NEOASIA / DEKA
Lasers
RHINOPLASTY
Coffee Break
6:30 pm
AESTHETIC
SURGERY ISAPS
Room 3
International Accreditation: 18 CME CREDITS
The Aesthetics Asia is accredited by the European Accreditation
Council for Continuing Medical Education (EACCME) to provide the
following CME activity for medical specialists. The EACCME is an institution
of the European Union of Medical Specialists (UEMS). Please check the
website for any further information: www.uems.net. In Europe, this
accreditation concerns all the specialists, who should turn to their national
authorities in order to validate the CME points in their home European
countries. In America, EACCME credits are recognized by the American
Medical Association towards the Physician’s Recognition Award (PRA). To
convert EACCME credit to AMA PRA category 1 credit, contact the AMA
through their website : www.ama-assn.org . At the end of the conference, you
will receive your Certificate of Attendance (Diploma). Keep it as this is the
first step to accreditation!
7:30 am
9:00 am
YENA
CU SKIN
AESTHETIC WORKSHOPS
Room A
Room B
Registration & Badging
PERIOCULAR
PART 2
9:30
UPPEREYELID
REJUVENATION
11:00 am
Coffee Break
APIRA SCIENCE
Coffee Break
10:30
11:30 am
FACIAL AND BODY
CONTOURING
1:30 pm
2:30 pm
4:30 pm
Elite Sponsors
Lunch Break
1:00
MENOPAUSE / ANDROPAUSE
SANOFI
REJUVENATION
Lunch Break
DETOXIFICATION IN MEDISPA
PART 2
6:30 pm
Coffee Break
SUNDAY SEPTEMBER 19th
FRIDAY SEPTEMBER 17th
7:30 am
AESTHETIC WORKSHOPS
Lunch
AESTHETIC BREAST
SURGERY 2
NEOASIA/ DEKA
Lasers
12:00 SOLTA MEDICAL
11:00
1:00
2:00
3:00
SANOFI
INDIBA
Lunch
MEDICA
SANOFI
Gold Sponsor
Silver Sponsor
FRIDAY 17th
September 2010
7:00 am
Aesthetics Asia
REGISTRATION
AND
8:30 am
FACIAL REJUVENATION WITH INJECTABLES
9:00 am
10:30 am
Chair: Marco Stabile & Inès Verner
11:00 am
Anatomy for injections
MARCO STABILE, ITALY
Aesthetic design in facial rejuvenation
JINDA ROJANAMATIN, THAILAND
Global facial shaping with Calciumhydroxylapatite
SABINE ZENKER, GERMANY
Fullface balance with non animal stabilized hyaluronic acid - Tratment possibilities
with the pix’L microcanula
FREDRIK BERNE, SWEDEN
Facial rebalancing by fillers and injection lipolysis
INES VERNER, ISRAEL
Tear trough - The dual plan technique - High predictability, low frequency of
FREDRIK BERNE, SWEDEN
adverse events, long duration & high patient satisfaction
Lips and perioral rejuvenation
INES VERNER, ISRAEL
Treatment of lips and perioral region with fillers
STEFAN LIPP, GERMANY
10:30 am - 11:00 am
11:00 am
1:00 pm
COFFEE BREAK IN THE EXHIBIT HALL
Chair: Andreas Katsambas & Rataporn Ungpakorn
2:00 pm
4:00 pm
11:00 am - 11:30 am
11:30 am
COFFEE BREAK IN THE EXHIBIT HALL
STEM CELLS & GROWTH FACTORS
Chair: David Lai
Clinical studies of HLA-haploidentical hematopoietic stem cell
transplantation
TATSUO ICHINOHE, JAPAN
Intra umbilical cord stem cell therapy & high dose IV
JUN MATSUYAMA, JAPAN
Vitamin C therapy
Impact of genetic transcriptome profile research on normal
and cancer stem cells
YUN ZHAO, CHINA
Controversies in regenerative medicine, does PRP really work?
SABINE ZENKER, GERMANY
Practical clinical applications
PATANA TENGUMNUAY, THAILAND
1:30 pm - 2:30 pm
LUNCH OFFERED IN THE EXHIBIT HALL
LUNCH OFFERED IN THE EXHIBIT HALL
FAT TISSUE
Chair: Adrian Gaspar
New approaches in subcutaneous laser treatment: Which wavelength and Why?
ADRIAN GASPAR, ARGENTINA
Tripolar radiofrequency for body contouring & cellulite reduction
WORAPONG MANUSKIATTI, THAILAND
Power assisted lipoplasty
AYAD HASHEM, EGYPT
Available technologies in body contouring
SATISH AROLKAR, INDIA
Lipografting and stem cells
ADRIAN GASPAR, ARGENTINA
Awake breast augmentation with autologous fat using the bodyjet technique
FREDRIK BERNE, SWEDEN
Initiation into stem cell fat autologus transfer
SATISH AROLKAR, INDIA
Endolaser hands and fingers tightening technic
MOHAMED GHOZ, EGYPT
4:00 pm - 4:30 pm
COFFEE BREAK IN THE EXHIBIT HALL
LATEST TRENDS IN BOTULINUM TOXIN
AND INJECTABLES FOR ASIA!
Chair: Chariya Petchngaovilai & David Lai
Presentation of the SST® (Skin Sculpting Technique) with DERMASCULPT™
Microcannula
LUC DEWANDRE, FRANCE
Wrinkles reduction by placenta injection
SAWAKO HIBINO, JAPAN
Treating calf and nose reduction with Botulinum Toxin
CHARIYA PETCHNGAOVILAI, THAILAND
Breast lift with Botulinum Toxin
DAVID LAI, HONG KONG
Promised eyebrow elevation by Botulinum toxin and/or filler
NALINEE SUTTHIPISAL, THAILAND
Skin enhancement with “plant stem-cells”
DAVID LOH, SINGAPORE
6:30 pm
How to improve skin by food
CLAUDE DALLE, FRANCE
Skin and photoprotection: Why it is important?
SOHAIL MANSOOR, UK
Nutraceutical supplements for skin PATANA TENGUMNUAY, THAILAND
Role of hormones in skin rejuvenation
SOHAIL MANSOOR, UK
Skin Melatonin system
PETER C. KONTUREK, GERMANY
ENHANCING THE SKIN PART 1
1:00 pm - 2:00 pm
6:30 pm
SKIN AGING
Chair: Sohail Mansoor & Peter C. Konturek
1:30 pm
New trends in peeling procedures: The state of art in 2010
SOHAIL MANSOOR, UK
New trends in pigmentary disorders therapies
ANDREAS KATSAMBAS, GREECE
Management of post-inflammatory hyperpigmentation and melasma
RATAPORN UNGPAKORN, THAILAND
Why & when the treatment of acne fails & what to do ? ANDREAS KATSAMBAS, GREECE
Fractional ErYAG vs fractional CO2 Laser: Which is better for acne scars
WORAPHONG MANUSKIATTI, THAILAND
Combination Therapy of AHA peels and various procedures M. ELISABETH BRIDEN, USA
Mandelic Acid: A new generation acid peel for dark, sensitive skin types
DEBORAH FORTESCUE-MERRIN, CANADA
Post laser care
ELIAS TAM, SINGAPORE
4:30 pm
BADGING
COCKTAIL RECEPTION IN THE EXHIBIT AREA
2:30 pm
4:30 pm
MEDICAL SPA
BURNOUT SYNDROME & STRESS MANAGEMENT
Chair: Eva Schaeufele
Clinical approach in Burn out patient PATANA TENG-UMNUAY, THAILAND
The alternative treatment for Burn Out PAKPILAI THAVISIN, THAILAND
Epigenetics: The power of the individual to manage stress
before burning out!
EVA SCHAEUFELE, GERMANY
4:30 pm - 5:00 pm
COFFEE BREAK IN THE EXHIBIT HALL
5:00 pm
6:30 pm
ANTI-AGING & PREVENTION
Chair: Claude Dalle
Successful bone aging and low risk of fracture: The anti-aging
solution
HUU HANH TRAN, VIETNAM
Power of signalling in Anti-Aging: You can build new proteins
by changing the instructions at the genome
XANYA SOFRA WEISS, USA
Sexual problems and Traditional Chinese Medicine (TCM)
LIEGUANG MA / PENG CHUAN, CHINA
Solutions
Human clinical trials elucidate the health benefit of Resveratrol
JAMES BETZ, USA
Anti-Aging pill targets Telomeres at the end of chromosomes
NOEL THOMAS PATTON, USA
SATURDAY 18th
September 2010
7:00 am
Aesthetics Asia
REGISTRATION
AND
8:30 am
AESTHETIC MEDICINE TECHNIQUES
9:00 am
10:30 am
Chair: Vanessa Phua & Sohail Mansoor
11:00 am
Non invasive skin rejuvenation using radiofrequency
INES VERNER, ISRAEL
Carboxytherapy for skin rejuvenation and strech marks SABINE ZENKER, GERMANY
The latest trends in combination peels
VANESSA PHUA, SINGAPORE
Extracorporeal shock wave therapy for body contouring by cavitation effect
JEONG EUN KIM, SOUTH KOREA
Gastrocnemius muscle volume reduction by radiofrequency-induced
coagulation for an improvement in calf contour
SUN HO LEE, SOUTH KOREA
Exogenous ochronosis: A complication of hydroquinone therapy
is more common than you think
SK TAN, SINGAPORE
10:30 am - 11:00 am
COFFEE BREAK IN THE EXHIBIT HALL
INJECTABLES: LATEST UPDATES AND TECHNIQUES
11:30 am
1:00 pm
1:30 pm
2:00 pm
4:00 pm
Chair: Ines Verner & Nopadon Noppakun
Study comparing fractional radiofrequency resurfacing to chemical peels
INES VERNER, ISRAEL
Fractional CO2: Tip and trick for maximum success NALINEE SUTTHIPISAL, THAILAND
A different view to laser hair removal
VALI A. ABBASPOUR, IRAN
Hair rejuvenation with diode laser hood
K.R. CHANDVANIA, INDIA
Vaginal rejuvenation with laser
ADRIAN GASPAR, ARGENTINA
4:30 pm
6:30 pm
COFFEE BREAK IN THE EXHIBIT HALL
UPDATE IN AA MEDICINE IN JAPAN
Chair: Takuji Shirasawa
Evaluation of aging and its risk factors in body and skin
TAKUJI SHIRASAWA, JAPAN
Lifestyle and Japanese diet as contributing factors to the
longevity in Japan
TAKUJI SHIRASAWA, JAPAN
Medical aesthetic acupuncture methods in Japan
SAWAKO HIBINO, JAPAN
Sleep-related Erection as funamental male physiology
And Significance of its aging change
YOSHIAKI KUMAMOTO, JAPAN
1:30 pm - 2:30 pm
LUNCH OFFERED IN THE EXHIBIT HALL
LUNCH OFFERED IN THE EXHIBIT HALL
LASER, LIGHTS & RELATED TECHNOLOGIES
4:00 pm - 4:30 pm
Chair: Eugenio Luigi Iorio
11:00 am - 11:30 am
Chair: Chariya Petchngaovilai & Sabine Zenker
1:00 pm - 2:00 pm
NUTRITION & NUTRIGENETICS
Nutrition to improve hair
MOHAMAD KHAN, SAUDIA ARABIA
Oxidative stress prevention by food
EUGENIO LUIGI IORIO, ITALY
Food for sleep and brain
CLAUDE DALLE, FRANCE
Nutrition for sexuality
CLAUDE CHAUCHARD, HONG-KONG
Nutrigenomics of metabolic syndrome: Gene-environment
MASAAKI MURAMATSU, JAPAN
interaction
Nutrigenomics, a motivation to a Health- Conscious
lifestyle
EVA SCHAEUFELE, GERMANY
11:00 am
Local Anaesthesia for facial rejuvenation
MARCO STABILE, ITALY
Botulinum Toxin injection: The art of the science
CHARIYA PETCHNGAOVILAI, THAILAND
Face shaping & volumetry with HA: Update on newest developments
Cannula technique and bolus injection
STEFAN LIPP, GERMANY
Innovative filling techniques for hyaluronic acid thank to a new way of
HA-injections: Objective analysis of the new automatic injection technique
SABINE ZENKER, GERMANY
Innovative treatment for skin trouble (Melasma, Acne, Freckle etc.) using
non-cross HA and toxin by new drug delivery system with negative pressure and
multi-needle
KEW HO KIM, SOUTH KOREA
Study on hand rejuvenation with Radiesse
INES VERNER, ISRAEL
Complications of permanent/semi permanent fillers
FABRIZIO CASTAGNETTA, ITALY
A focus on global facial rejuvenation with injectable Poly-L-lactic Acid
ANNE EVANS, AUSTRALIA
BADGING
2:30 pm
4:30 pm
MEDICAL SPA
DETOXIFICATION
Chair: Pakpilai Thavisin
Detoxification, a way to wellness
PAKPILAI THAVISIN, THAILAND
Detoxification prescription: The 5 steps that make it safe
and effective
HUU HANH TRAN, VIETNAM
Skin, hair and detoxification: Why? GABRIELA MACHALOVA, SLOVAKIA
Colon Hydrotherapy
PAKPILAI THAVISIN, THAILAND
The integrated approach of Redoxomics and its implications
in aesthetics and anti-aging medicine
EUGENIO LUIGI IORIO, ITALY
COFFEE BREAK IN THE EXHIBIT HALL
ENHANCING THE SKIN PART 2
Chair: Grace Lopez & Pravit Asawanonda
Mechanisms and clinical signs of aging skin
GRACE LOPEZ, PHILIPPINES
Autointoxication and skin health
PAKPILAI THAVISIN, THAILAND
Asian face rejuvenation
APRATIM GOEL, INDIA
How to improve and prolong results of aesthetics procedures
with Amino Acids
ELENA RUMYANTSEVA, RUSSIA
Herbal remedies for baldness
PRAVIT ASAWANONDA, THAILAND
Asian face: Treating pigmentation & hollowing of peri orbital area
SAVARDEKAR PREETI, INDIA
Chemical peels in Asians
APRATIM GOEL, INDIA
4:30 pm - 5:00 pm
COFFEE BREAK IN THE EXHIBIT HALL
5:00 pm
6:30 pm
MENOPAUSE / ANDROPAUSE
Chair: Claude Chauchard
Rules for menopause in 2010
SPEAKER TBA
Andropause Management
CLAUDE CHAUCHARD, HONG KONG
HRT risk at Menopause
CLAUDE DALLE, FRANCE
HRT risk at Andropause
CLAUDE CHAUCHARD, HONG KONG
PLASTIC SURGERY PROGRAM
PLASTIC SURGERY SCIENTIFIC BOARD
DR VINCENT YEOW, PLASTIC SURGEON, SINGAPORE
DR COLIN THAM, PLASTIC SURGEON, SINGAPORE
DR HARRY FOK, PLASTIC SURGEON, SINGAPORE
DR HONG SOO WAN, PLASTIC SURGEON, SINGAPORE
DR TAN YING CHIEN, PLASTIC SURGEON, SINGAPORE
DR POR YONG CHEN, PLASTIC SURGEON, SINGAPORE
INVITED SPEAKERS LIST :
SATISH AROLKAR, PLASTIC SURGEON
CHUA JUN JIN, PLASTIC SURGEON
MARCO FARIA CORREA, PLASTIC SURGEON
MOHAMED GHOZ, PLASTIC SURGEON
AYAD HASHEM, PLASTIC SURGEON
MARTIN HUANG, PLASTIC SURGEON
LOKESH KUMAR, PLASTIC SURGEON
LIU CHUN JUN, PLASTIC SURGEON
ANNA LEE, PLASTIC SURGEON
LEE HEE YOUNG, PLASTIC SURGEON
FLORENCIO LUCERO, PLASTIC SURGEON
YOSHINORI NAGUMO, PLASTIC SURGEON
INDIA
SINGAPORE
SINGAPORE
EGYPT
EGYPT
SINGAPORE
INDIA
CHINA
SOUTH KOREA
SOUTH KOREA
PHILIPPINES
JAPAN
REXON NGIM, PLASTIC SURGEON
CHARLES RANDQUIST, PLASTIC SURGEON
VIJAY SHARMA, PLASTIC SURGEON
YUSUKE SHIMIZU, PLASTIC SURGEON
SHIN YONG HO, PLASTIC SURGEON
MARCO STABILE, PLASTIC SURGEON
TAN YING CHIEN, PLASTIC SURGEON
WALTER TAN, PLASTIC SURGEON,
TSAI FENG CHOU, PLASTIC SURGEON
GEORGE WENG CHAU JIN, PLASTIC SURGEON
WONG CHIN HO, PLASTIC SURGEON
SATURDAY 18th
SINGAPOR
SWEDEN
INDIA
JAPAN
SOUTH KOREA
ITALY
SINGAPORE
SINGAPORE
TAIWAN
TAIWAN
SINGAPORE
SUNDAY 19th
9:00 am - 11:00 am
9:00 am - 11:00 am
Chairman Opening Speech: PROF WALTER TAN
AESTHETIC BREAST SURGERY I
Chair: DR ANDREW KHOO
Hybrid technique of augmentation mammoplasty (Transaxillary
breast augmentation without endoscope)
YOSHINORI NAGUMO
Achieving predictable outcome in breast augmentation
CHARLES RANDQUIST
Endoscopic transaxillary breast augmentation
Lipotransfer with water-assisted liposuction
11:00 am - 11:30 am
LIU CHUN JUN
MARCO STABILE
COFFEE BREAK IN THE EXHIBIT HALL
PERIOCULAR REJUVENATION II - UPPER EYELID
Chair: A/ PROF COLIN SONG
Non-incisional ptosis repair
Oriental blepharoplasty
Lower blepharoplasty
FLORENCIO LUCERO
Media and lateral canthoplasty in Oriental people
Secondary upper eyelid deformities
SHIN YONG HO
GEORGE WENG CHAU JIN
Avoid pitfalls in aesthetic surgery
11:00 am - 11:30 am
REXON NGIM
COFFEE BREAK IN THE EXHIBIT HALL
11:30 am - 1:30 pm
11:30 am - 1:30 pm
PERIOCULAR REJUVENATION I - LOWER EYELID
Chair: PROF WALTER TAN
YUSUKE SHIMIZU
FACIAL AND BODY CONTOURING
Chair: DR LESLIE KUEK
Minimal invasive zygoma and mandible reduction
LEE HEE YOUNG
MARTIN HUANG
Augmentation rhinoplasty with fat gel and scaffolds LEE HEE YOUNG
Periocular rejuvenation: Lower lid
ANNA LEE
Routine midcheek lift with lower blepharoplasty in Asians
WONG CHIN HO
Selective neurectomy and liposuction for leg sculpture TSAI FENG CHOU
1:30 pm - 2:30 pm
LUNCH OFFERED ON SITE
2:30 pm - 4:30 pm
Facial contouring
SHIN YONG HO
Reparing secondary abdominoplasties
MARCO FARIA CORREA
Otoplasty
RHINOPLASTY
Chair: DR SEAH CHEE SENG
Oriental rhinoplasty
TSAI FENG CHOU
Asian rhinoplasty
WONG CHIN HO
Non-Aptos nose tie suture thread surgery technique MOHAMED GHOZ
4:30 pm - 5:00 pm
COFFEE BREAK IN THE EXHIBIT HALL
5:00 pm - 6:30 pm
SURGICAL FACIAL REJUVENATION
Chair: DR HARRY FOK
MACS Lift in non-Caucasian patients
FLORENCIO LUCERO
Office midface lift using Endothine(R) fixation
CHUA JUN JIN
Facial enhancement with fat transfer to nasolabial fold
and cheek
SATISH AROLKAR
Volumetric facelift and reversible rhinoplasty
VIJAY SHARMA
TAN YING CHIEN
Nasal and chin augmentation using silicone prefabricated implants
SATISH AROLKAR
1:30 pm - 2:30 pm
LUNCH OFFERED ON SITE
2:30 pm - 4:30 pm
AESTHETIC BREAST SURGERY II
Chair: DR POR YONG CHEN
Nipple eversion using SmartLipo
MOHAMED GHOZ
Subfascial plane in breast augmentation
AYAD HASHEM
Surgery for male breast
LOKESH KUMAR
WORKSHOPS
ROOM B
ROOM A
FRIDAY September 17th
FRIDAY September 17th
2:00 pm - 3:00 pm
2:00 pm - 3:00 pm
NEO ASIA / NEO STRATA COMPANY inc.
CYNOSURE
New Antiaging technologies including derivatives of sugar compounds
ELISABETH BRIDEN, USA
My clinical experience with laser lipolysis
4:00 pm - 4:30 pm
Coffee Break
3:00 m - 4:00 pm
YENA
4:30 pm - 5:30 pm
SKIN FITNESS
The world's first sublative treatment for acne scar in Asia
WORAPHONG MANUSKIATTI, THAILAND
ECOSkin advanced photodynamic imaging system and the treatment of
melasma with YELLO TONING technology
JONG JU NA, KOREA
4:00 pm - 4:30 pm
5:30 pm - 6:30 pm
MEDICA
GERARD TAN, SINGAPORE
Coffee Break
4:30 pm - 5:30 pm
TEOXANE
A new treatment protocol for abdominal circumference reduction using
combined Bi Polar RF, infrared light and mechanical manipulation
technology
JAMES CHAN, HONG-KONG
Update on actual techniques in facial softfilling with TEOSYAL
monophasic hyaluronic acid gels: cannula and bolus technique
STEFAN LIPP, GERMANY
SATURDAY September 18th
SATURDAY September 18th
11:00 am - 12:00 pm
MESOESTETIC
Effective Combination of cosmeticeuticals, LEDs and radiofrequency for
the treatment of skin tightening
IVAN TAN, SINGAPORE
11:00 am - 12:00 pm
SANOFI
Sculptra advanced techniques
1:00 pm - 2:00 pm
12:00 pm - 1:00 pm
PROFESSIONAL DIETETICS
Skin revitalization with Jalupro: an innovative injectable treatment based
on a special cluster of amino acids
ELENA RUMYANTSEVA, RUSSIA
1:00 pm - 2:00 pm
ANNE EVANS, AUSTRALIA
Lunch
2:00 pm - 3:00 pm
YENA
SCARLET: The ultimate shock free µ- Needle RF technology
JONG JU NA, SOUTH KOREA
Lunch
3:00 pm - 4:00 pm
2:00 pm - 3:00 pm
SANOFI
Succeed with Succeev
NEO ASIA / ZELTIQ™
CoolSculpting-Cryolipolysis for non-invasive fat reduction
DIETER MANSTEIN, USA
SCOTT MC LENNAN, AUSTRALIA
4:00 pm - 4:30 pm
Coffee Break
4:30 pm - 5:30 pm
3:00 pm - 4:00 pm
INDIBA
CU SKIN
Proionic Body Care System INDIBA Medical Technology: Foundations and
its interest in medical aesthetics applications. Practical implementation
of an anti-aging face protocol
SEBASTIAN SENDROS, SPAIN
4:00 pm - 4:30 pm
Anti-Aging - Vitamin U
6:30 pm - 8:30 pm
Room 4D/E - Level 4
Coffee Break
4:30 pm - 5:30 pm
NEO ASIA / DEKA LASERS
Duolite QS for pigment and tatto removal
NICOLA ZERBINATI, ITALY
WON-SER KIM, SOUTH KOREA
Product Launch sponsored by GENICK STEMTECH AND AESTHETICS
Evercell Stem Cell Therapy for Aesthetics Use
DONG HYUN KIM, HYUN MIN CHUNG, SANGJIN KANG,
SOUTH KOREA
SUNDAY September 19th
SUNDAY September 19th
9:30 am -10:30 pm
11:00 am - 12:00 pm
APIRA SCIENCE
Laser hair restoration
DAVID MELAMED, USA
SANOFI
Succeev: Simple is the new smooth
SCOTT MC LENNAN, AUSTRALIA
10:30 am - 11:00 am Coffee Break
11:00 am - 12:00 pm
INDIBA
NEO ASIA / DEKA LASERS
V²LR vulvo & vaginal LASER reshaping with SmartXide DOT CO2
fractional laser
ADRIAN GASPAR, ARGENTINA
SOLTA MEDICAL
1:00 pm - 2:00 pm
Experience with the New Comfort with the New Thermage CPT-comfort
with even better efficacy now!
JOYCE LIM, SINGAPORE
MEDICA
Visagel - Fix & Lift
Proinonic Body Care System by INDIBA medical technology in medical
aesthetics: Clinical relevant guidelines and applications. Practical
implementation of an abdominal protocol
SEBASTIAN SENDROS, SPAIN
12:00 pm - 1:00 pm
1:00 pm - 2:00 pm
12:00 pm - 1:00 pm
SANOFI
3:00 pm - 4:00 pm
Combining HA fillers with Sculptra
Lunch
2:00 pm - 3:00 pm
ELIAS TAM, SINGAPORE
Lunch
JOYCE LIM, SINGAPORE
SOME OF THE FAMOUS SPEAKERS OF AESTHETICS ASIA 2010
Satish Arolkar, MD, qualified as Plastic Surgeon in the year 1982 from
Grant Medical College Bombay with Dr. N.H Antia FRCS, FACS as guide.
Completed Fellowship in Aesthetic Surgery in Paris with Dr. Daniel Marchac
MD in 1985 with Y.G Illouz in same Hospital. Locum consultant in
Rotterdam - The Netherlands with Dr. J C van der Meulen in 1986. Been conducting
International Tutorials in Aesthetic Surgery in India with colleagues for the past 5
years as Organising Faculty in several cities in India for innumerable seminars and
workshops/ demonstrations.
Pravit Asawanonda, MD, is Associate Professor in Dermatology - Dpt. of
Medicine, Faculty of Medicine at the King Chulalongkorn Memorial
Hospital in Bangkok, Thailand. He is active member of many scientific
societies, as The Dermatological Society of Thailand and the Royal
College of Physicians. He is also author of many publications in dermatology.
Frederik Berne, MD is Surgeon in Stockholm, Sweden. He is a member of
the Member of Swedish Surgical Society. He works at the Spektrakliniken
Gothenburg/Stockholm Sweden, Department of Breast Surgery SÄS.
M. Elisabeth Briden, MD is board certified Dermatologist in Edina,
Minnesota, US. At present, Dr Briden is CEO and medical director of
Advanced Dermatology & Cosmetic Institute, P.A., and of the Spa Medique
in Edina. She is also Adjunct Associate Clinical Professor, Department of
Dermatology - University of Minnesota Medical School, Minneapolis, MN. and
President-Elect & founding Board of Directors, American Society of Cosmetic
Dermatology & Aesthetic Surgery.
Fabrizio Castagnetta, MD is plastic surgeon freelance graduated in 1980
and specialized in plastic surgery at the S.Cruz Institute of Plastic Surgery
Sao Paulo, Brazil directed by J.M.Mélega. He introduced liposuction in
southern Italy in 1983. Author of several works, he is operating between
Rome and Palermo
K.R. Chandvania, MD is Dermatologist and laser specialist working in
the Pallavi Laser Center in Pune, India.
Claude Chauchard MD, obtained his doctorate in Endocrinology, Biology
and Sports Medicine from the University of Montpellier, France. He is the
founder of the International Institute for Preventive Anti-ageing Medicine
and was an Assistant Professor at the University of Montpellier. He is also
one of the world's top specialists in preventive medicine for ageing, and the first one
to introduce this concept in Asia. Over one million copies of his thirteen books written
on the ageing process have been sold. He gives regular lectures and seminars in Paris,
Milan, Barcelona, and other major cities around the world.
Marco Feria Correa, MD - As a worldwide pioneer in endoscopic plastic
surgery he first came to Singapore for the purpose of transferring
knowledge, and conducting workshops and surgical demonstrations in
1996. In 2000, he was invited again by the Singapore Association of Plastic
Surgery to present his techniques in "Refinements in Liposculpture with patient in
Standing Position" as well as updating on "Endoscopic Plastic Surgery. During this
time, Dr Marco Feria Correa was already attracting many overseas patients into
Singapore for surgery. Under the Singapore "Hunting for Talents" programme, Dr
Marco Feria Correa was invited to work in Singapore to attract more international
patients and to make Singapore a Plastic & Cosmetic Surgery Hub.
Peng Chuan, MD, is an attending physician of master of clinical integrated
traditional and western medicine,major in clinical research and treatment of
spleen-stomach & hepato-biliary syndrome in TCM as well as the Clinical
Application of TCM'S traditional techniques of health care and disease
prevention. At present, he is Ph.D student under professor Ma direction at Basic
Medical College of Chengdu University of Traditional Chinese Medicine. Peng Chuan
has taken apart in writing several works, such as "Five-Minute Technique of Family
Health Care", "Huangdi neijing--Bible of Health Preservation", "The Guidance to
Reading TCM Classics Series: Plain Questions of Huang Di's Internal Classic","The
Guidance to Reading TCM Classics Series: Miraculous Pivot of Huang Di's Internal
Classic", etc.; Is the editors in Chief and academic secretary of "Health Protecting and
Care of TCM" which is the National Chinese Medicine Administrative bureau's plan
textbook of TCM education.
Claude Dalle, MD, is Anti-Aging Practitioner in Paris, France. He is President
of the French Society of Anti Aging Medicine, Secretary of the International
Hormone Society and President of the European Association for Active
Aging. He is also member of the World Society of Anti-Aging Medicine
Luc Dewandre, MD is one of the world leaders and Pioneer of Aesthetic
Mesotherapy. He is a pioneer, with other French experts, of the new filler's
injection technique with flexible non traumatic intradermal microcanula.
He has developed the skin sculpting technique concept. He is also an
internationally renown specialist of chemical peels and Botulinum toxin. He has
contributed twice to the edition of procedures in cosmetic dermatology series:
chemical peels. (By Mark Rubin, MD, The Lasky Clinic, Beverly Hills, CA, USA)
Anne Evans MD, graduated from her medical degree at Flinders
University, Adelaide, Sth Australia in 1982 and after a short time in
general practice started in cosmetic medicine in 1989. This was initially
in microsclerotherapy and lasers. As new techniques and products
became available these were added to her practice. She practices full time in her
own clinic and is involved in teaching of cosmetic procedures.
Tsai Feng Chou, MD is Plastic Surgeon. 2003~now Chief, Division of
Plastic Surgery, Department of Surgery, Taipei Medical University
Hospital Taiwan- 2000~2003 Attending Physician, division of plastic surgery, Chang Gung Medical Hospital
Deborah Fortescue-Merrin, President and CEO Nucelle, Canada
Adrian Gaspar, MD is OB Gyn Cosmetic Surgeon in Mendoza, Argentina. He
is member of the American Academy of Cosmetic Surgery and Chairman in
Argentina of the IUL- International Union of Lipoplasty. He is also Director
of the International Academy of Cosmetic Gynaecology
Mohamed M. Ghoz, MD, is Plastic Surgeon and Professor of Dermatology
and laser surgery -Cairo University-School of Medicine-Dermatology
Department. He is also member Egyptian Society of Dermatology
&Venerology, member of the American Academy of Aesthetic and
Reconstructive Surgery, Charter Member and of the American Society of laser in
Medicine and surgery.
Apratim Goel, MD, DNB, is an expert in the field of non-surgical cosmetic
enhancement. She is nationally recognized for her pioneering work in lasers.
She is also certified national trainer for Fillers & Botox and Consultant
Dermatologist at L'oreal Paris and Jet Airways. Dr Goel appears regularly on
television and writes frequently in newspapers and magazines. She runs her own
state-of-the-art treatment centre, Cutis Klinic, in Mumbai India.
Ayad Hashem, MD Plastic Surgeon, is Professor of Plastic and
Reconstructive Surgery & the head of the department Tanta Faculty of
Medicine, Egypt. Member of the Egyptian Society of Plastic and
Reconstructive Surgery and the ISAP. The Pan Arab and Pan African
Societies of Plastic and Reconstructive Surgery.
Sawako Hibino, MD is Chair Professor of Dept. of Anti-Aging Medical
Research Center at the Doshisha University in Japan, Scientific Coordinator
of World Society of Anti-aging Medicine, Executive Director of Japanese
Society of Anti-aging Medicine (JAAM), Vice-president, International
Medical Science Society (IMSS). She is a specialist in anti-aging and life extension
medicine. She is also one of the pioneers in Anti-Aging Medicine in Japan and in
research on placental extract and aging. Her current research focuses on the effect of
human placental extract as applied to dermatology and the anti-aging field.
Martin Huang, MD is Professor and Chairman, Department of Plastic
Surgery, Affiliated Hospital to Nanjing University of Traditional Chinese
Medicine, member of Medical Aesthetic Cosmetology Chinese Medical
Association, Vice Director of Medical Aesthetic Cosmetology of Jian Su
Province. Major practice: Facial Contouring Aesthetic Surgery and Facial
Rejuvenation
SOME OF THE FAMOUS SPEAKERS OF AESTHETICS ASIA 2010
Tatsuo Ichinohe, MD, Faculty of Medicine, Kyoto University, Kyoto, Japan.
Ph.D., Graduate School of Medicine, Kyoto University Assistant Professor of
Medicine, Department of Hematology and Oncology, Graduate School of
Medicine, Kyoto University, Kyoto, Japan.
Eugenio Luigi Iorio, MD, PhD, passed professor of Clinical Biochemistry at
University of Naples (Italy). Researcher in oxidative stress, genomics and
lipidomics.
Andreas D. Katsambas, MD, is Professor and Chairman of Dermatology &
Venereology at the A. Sygros Hospital, University of Athens, Greece. He is
President of the European Academy of Dermatology & Venereology and
Author of more than 230 publications in international journals, editor of 2
books translated into Greek, Italian, and Russian.
Mohamad Khan, MD, FRCS©, CFCRPE is Chairman of plastic surgery
department Kingdom Hospital and consulting clinics Riyadh. Affiliate of La
Clinique de Paris, Saudi Arabia. Visiting consultant for congenital
malformations and ear reconstruction, King abdulaziz Medical city, Riyadh
Kew Ho Kim, MD, is a clinical professor of College of Medicine at the Yonsei
University, and a Key Doctor of Woorhi Trading. He is a member of the
Korean Society of Plastic and Reconstructive Surgeons and the Korean
society for Aethetic Plastic Surgery.
Jeong Eun Kim, is Medical director of 365MC clinic network Sinchon
center Seoul, South Korea. He is President of 365MC obesity institute
and Adjunct professor of Kyunghee Medical University in Seoul.
Peter C. Konturek, MD is Professor of Internal Medicine/Gastroenterology
at 1st Dept. of Medicine, University Erlangen-Nuremberg in Erlangen,
Germany. Since 2000 Head of Gastroenterology Research Group at the same
place. Since 2006 Head of Nutrition Division and since 2008 Deputy Head
of Endoscopy Unit. Current research interests include mechanisms of protection and
healing of gastrointestinal mucosa, role of melatonin in gastrointestinal tract and
molecular mechanisms of gastrointestinal carcinogenesis. Member of American
Gastroenterological Association (AGA) and German Association of Gastroenterology.
ChunJun Liu, MD is Attending Surgeon of Plastic Surgery at the Plastic
Surgery Hospital - Peking Union Medical College (PUMC) and Chinese
Academy of Medical Sciences (CAMS). His clinical interests are Aesthetic
and Reconstructive Breast Surgery and Cosmetic Surgery. His research
interests: application of 3D computer-aided technology in plastic surgery.
Grace Lopez, MD graduated Doctor of Medicine in the Philippines in 1991
finished her residency training in the field of Dermatology in 1996. She's an
active dermatology consultant where she hold's various community clinics
as well as hospitals in the Philippines. She's a member of International
Society of Dermatology, Obesity Society in the United States, World Society of AntiAging Medicine, International Hormone Society, an active fellow of Philippine Leprosy
Society and international alumni member at National Skin Center, Singapore.
Florencio Lucero, MD has been in Plastic Surgery since 1979 having been
duly certified by the Philippine Board of Plastic Surgery since 1980 - The
only Board recognized by the Philippine College of Surgeons to certify
Plastic surgeons. He is also the National Secretary for the Philippines in two
international medical societies namely: ISAPS (International Society of Aesthetic
Plastic Surgery) and OSAPS (Oriental Society of Aesthetic Plastic Surgery). He had
been president of the Philippine Association of Plastic Reconstructive and Aesthetic
Surgeons. He is currently a Professor of Surgery at the University of the Philippines
College of Medicine and was the past chief of the Division of Plastic Surgery of the
university for the past 17 years. He is an international speaker in plastic and antiaging conferences, a plastic surgeon, a teacher to about 40 plastic surgeons. His
special clinical interests include Asian eyes and noses, minimally invasive facial
rejuvenation using a combination of surgery and injectibles, Botox, body sculpture,
full and partial face lifts and contour augmentation. He speaks fluent English , Filipino
and conversational Fookien.
Lieguang Ma is a Professor of Traditional Chinese Medicine and director of
PhD program at the Chengdu University. He holds high positions in several
international associations like "International Association on Oriental
Medicinal Food Therapy", "Health Preserving B. of China Association for
Traditional Chinese Medicine"… He is the academic consultant to "Japanese Nature
Therapy Association" and "Toyobo Academic Press". He is The lead deputy editor of
"America Chinese Medical Journal of Chinese Edition", the invited chief editor of
"Health Preserving Journal of Life Digest". He has been engaged in clinical teaching
and research work of "Huang Di's Internal Classic" and "Health Preservation of TCM"
for more than 30 years with great attainment; He has had more than 60 research
papers published in domestic and foreign academic journals and several books.
Yoshiaki Kumamoto MD, PhD is president of the Japanese Medical Society
of Mens' Health and director of the Japanese Institute of Clinical Andrology.
Prof. Kumamoto is Professor Emeritius of the Sapporo Medical University
(Urology & Andrology). He is also honorary president of the Japanese
Foundation for Sexual Health Medicine and adviser of the Japanese Society of AntiAging Medicine and Adrescentology.
Sohail Mansoor, MD MBBS, DTM, DRCP.Derm, MSc.Derm, FAAD, FASDS,
ABAAM is Dermatologist & Lead Dermatologic Surgeon in London, UK. He
is one of new generation of Specialists practising holistic approach in
combining Dermatology, Cosmetic Surgery and Anti-Ageing Medicine to
enhance the quality and quantity of life. He is currently working in Barnet NHS
Associated University of London Hospital and practising cosmetic surgery and antiLokesh Kumar, MB MS MCh FICS is Senior Consultant Plastic Surgeon at ageing medicine in his private practices in Harley Street, Amersham and BUPA
the Indraprastha Apollo Hospital & Delhi Aesthetic Clinic. He is member of Hospitals. His interest lies in facial rejuvenation has lectured extensively in both
professional and public settings.
the International College of Surgeons Chicago USA FICS (Plastic Surgery).
David Lai, MD is Anti-aging, Preventive & Aviation Medicine Practitioner in
Hong-Kong, China. He is also Scientific Committee member and scientific
coordinator of the AMWC congress and other Anti-Aging conferences.
Sun Ho Lee, MD, is Medical director, Kangnam Center, 365MC Clinic
Network Seoul, South Korea. He is also and Adjunctive professor, Kyunghee
medical university, Seoul, South Korea
Stefan Lipp, MD is Aesthetic Practitioner based in Dusseldorf, Germany. He
serves as expert and teacher for Teoxane. At present, Dr Lipp is director and
CMO of Aesthetic Center Gmbh & Co KG with Clinics in Dortmund,
Mühlheim, Köln and Düsseldorf. He is also member of International Society
of Aesthetic Medicine and teacher of the certified course organized by the German
Society of Aesthetic Botulinum Toxin.
Woraphong Manuskiatti MD is currently an Associate Professor of
Dermatology and Head of Siriraj Skin Laser Center at Faculty of Medicine
Siriraj Hospital, Mahidol University, Bangkok, Thailand. He received his
Dermatology specialty training at Mahidol University, Bangkok, in 1995. He
subsequently completed the prestigious dermatologic laser surgery fellowship under
the auspices of Dr. R. Rox Anderson at Wellman Center for Photomedicine, Boston,
USA in 1997 and Drs. Richard E. Fitzpatrick and Mitchel P. Goldman at Dermatology
Associates of San Diego County, Inc., San Diego, USA in 1998.
Jun Matsuyama, MD PhD, is the president and chairman of the Japanese
Society of Clinical Anti-Aging Medicine (JSCAM), president of Study Group
of Rejuvenation Treatment in Japan, vice president at Matsuyama Hospital,
Director of Anti-Aging Medicine, Medical Corporation Kikyougahara
Hospital. Dr. Matsuyama is a member of the American Academy of Anti-Aging
Medicine, member of Japan Medical Association, Japanese Society of Menopausal
Medicine, Japan Society of Oriental Medicine, Japanese Society of Sports Medicine,
and received board certification in Sports Medicine, Aesthetic Surgery, Pathology, and
SPA Rehabilitation.
SOME OF THE FAMOUS SPEAKERS OF AESTHETICS ASIA 2010
Masaaki Muramatsu, MD, PhD is Professor of Genome Epidemiology in
Department of Molecular Epidemiology - Medical Research Institute at the
Tokyo Medical and Dental University in Japan.
Yoshinori Nagumo, MD is Plastic Surgeon in Tokyo, Japan. Since 1988 he
has also been the director of his own plastic surgery clinic, the Nagumo
clinic, in Tokyo. His clinical interests are in breast plastic surgery and breast
surgery. Dr Nagumo also contributes to the advancement of his field,
through a variety of Japanese and international medical and scientific societies. He is
the founder of the Japanese Association of Mammary Prosthesis, as well as an active
member of the Japanese Society of Plastic Surgery and Japanese Society of Aesthetic
Surgery. Currently serving an appointment as co-president of the International OncoPlastic Breast Surgery society, he is the President of the Asian Symposium of Breast
Plastic Reconstructive Surgery 2010.
Elena Rumyantseva, MD, PhD, dermatologist of Preventive Medicine Vallex
M Clinic, a scientific consultant of the aesthetic medicine, trainer of
aesthetic methods. Graduated from the famous Moscow Medical Academy
(MMA) named after I.M. Sechenov, Elena has completed the clinical
internship at the Department of Skin and Venereal Diseases of the MMA and practiced
as dermatocosmetologist and dermatopathologist in advanced Russian Institutes.
Elena is an experienced trainer of chemical peels and mesotherapy, an international
trainer of fillers injections (Q-MED, Sweden), a certified trainer for botulinum toxin
injections (Ipsen, France), and the professor of dermatology and cosmetology at the
Department of Aesthetic Medicine of RUDN (Moscow).
Vijay Sharma, MD, is Board certified plastic surgeon in Mumbai, India. He
is Member of American Academy of Cosmetic Surgery, Member European
Academy of Cosmetic Surgery and member of many other international
medical societies.
Rexon Ngim, MD, Plastic Surgeon, graduated in 1977, completed
training in plastic cosmetic and reconstructive in Singapore 1986.
Fellowship training was in USA in 1986 and cosmetic surgery fellowship
in Japan 1993. He is Senior Consultant Plastic Surgeon at Aesthetic
Plastic Reconstructive Surgery, Singapore.
Eva Schaeufele, MD, Germany studied medicine, psychology and literature.
Coaching managers made her realize how important preventive medicine is
for business professionals today. She specialized in genetics and, in 2007,
started a study on "Motivation and Compliance". Dr. Schaeufele has
developed a motivation system for dietary and exercise behavior based on
Nopadon Noppakun, MD, is president of the Dermatological Society of nutrigenetics.
Thailand. He is also Assoc Prof of Dermatology - Division of Dermatology,
Department of Medicine at the King Chulalongkorn Memorial Hospital,
Takuji Shirasawa, MD & Ph.D is Professor in Ageing Control Medicine at
Bangkok, Thailand.
the Juntendo University in Tokyo, Japan. Prof. Shirasawa is Director of the
Japan Anti-Aging Association, of Japan Biogerontology and of the
Noel Thomas Patton, founder of T.A. SCIENCES® - His interest in Telomere
Biorehabilitation Association. His scientific interests are: Molecular Biology
Biology began in 1999, when upon learning about telomeres he contacted
leading edge California biotech company Geron. His interest lead to his of Aging & Gerontology, Molecular Genetics of Alzheimer's Diseases and Analysis of
becoming an investor in Geron, and as such, he witnessed Geron, in Athletic Gene.
collaboration with the University of Science and Technology in Hong Kong, discover
the cellular rejuvenation properties of the single molecule which is now called TA-65.
Yusuke Shimizu, MD is board certified plastic surgeon working in Plastic
and Reconstructive Surgery Department at the Keio University Hospital,
Chariya Petchngaovilai, MD is Dermatologist at the Bumrungrad
Tokyo, Japan.
International Hospital, the Vichaiyut Hospital and Clinicare (private
practice) in Bangkok, Thailand. Her skills and qualifications are Botulinum
Toxin and Filler injections. She is also member of the International Scientific
Marco Stabile, MD is Specialist in Plastic Surgery, faculty of Plastic and
Advisory Board and Scientific Coordinator of the AMWC Congress.
Reconstructive Surgery, Parma, Italy. He is Titular Member of S.I.C.P.R.E.,
Soc.F.C.P.R.E., E.A.S.A.P.S., I.S.A.P.S., I.P.R.A.S. Staff Plastic Surgeon since
Vanessa Phua, MD is Aesthetic Practitioner in Singapore. She is currently
2001, Unit of Plastic Surgery and Burns Hospital of Pisa Italy. His Teaching
consultant aesthetic physician at the Department of Aesthetics and Plastics activity: Professor in Faculty of Plastic and Reconstructive Surgery University of
Asia Healthpartners. Dr Phua is member of the International Academy of Parma, courses in Plastic Surgery in France, USA, Brasil
Cosmetic Dermatology, member of the American Society of Laser Medicine
and Surgery and Committee Member of the Society of Aesthetic Medicice of
Elias Tam, MD is Aesthetic Practitioner in Singapore. He is Director of Rias
Singapore (SAM)
Holding(s) Pte Ltd providing medical services to Medi-ceuticals Surgery
Clinic @ Vivo & Lucky Plaza, Surgical privilege at Novena Surgery Center &
Savardekar Preeti, MD is a practicing dermatologist & cosmetologist since
Orchard Day Surgery Center. He is also Director of Eden Healthcare Pte Ltd/
7 years. She is Consultant cosmetologist at Kaya Skin Clinic - an
Eden
Aesthetic
Pte Ltd.
international concept in India with 90 clinics all across the country. She is
also a Professor of dermatology at a reputed coaching institute in Mumbai
since 5 years. Dr. Preeti has been on TV for numerous interviews from local star tv
channels to international BBC. Has few publications in the I J D VL - Indian Journal of
Dermatology & many articles in magazines & newspapers.
SK Tan, MD, is Aesthetic Practitioner in Singapore. Dr Tan is affiliated
with Singapore Medical Association, Dermatological Society of
Singapore, Fellow of American Academy of Dermatology, Society of
Investigative Dermatology, Pan-American Society for Pigment Research
Charles Randquist, MD, has been a Board certified Plastic surgeon since and many others medical societies.
1996 and received his degree at Karolinska Institute and Karolinska
University Hospital, Stockholm and Sahlgrenska University Hospital,
Pakpilai Thavisin, MD is the founder of S Medical Spa, the award winning
Gothenburg. Sub specializing in Microsurgery. Since 2005 Dr Randquist has
medical spa in the heart of Bangkok, Thailand. She has worked extensively
been offering Master classes/ Preceptorships in "How to run your best breast practice"
as a dermatologist, anti-aging doctor and practitioner in integrative holistic
sharing his experience on cohesive gel implants, with live surgery, combining surgical
health. She has written pocketbooks and contributed in well-known local
technique & practice management, in Victoriakliniken, Stockholm, Sweden. He is
publications
(i.e Marie Claire) for more than 15 years.
currently Co-Chairman of the Allergan Asia Council on Breast Aesthetics (AACE),
however has declined any financial compensation and holds no financial interest in
any medical companies who's products or devices he talks about.
Patana Tengumnuay, MD PhD is Nephrologist in Bangkok, Thailand.He is
consulting physician for S Medical Spa, Villa Medica (Thailand) and Phyathai
Jinda Rojanamatin, MD, is dermatologist in Bangkok, Thailand. He is at
2 Hospital, Thailand and advisor, Greater Pharma Stem Cell for Life Co. Ltd.,
present Head of Dermatosurgery and Laser Department. Dr Rojanamatin is
Thailand. He obtained his PhD degree in Cell Biology Program at the
also member of Dermatological Society of Thailand, member of Royal University of Florida, USA and Diplomat of American Society of Anti-aging and
College of Physician Thailand and international member of the American Regenerative Medicine. He is member of many international scientific societies and
Academy of Dermatology.
author of a great number of publications.
SOME OF THE FAMOUS SPEAKERS OF AESTHETICS ASIA 2010
Huu Hanh Tran, MD, Ph.D, Eng.D, obtained his Doctorate of Medicine,
Doctorate of Science, and Doctorate of Engineering from the University of
Nantes, France. He was Associate Professor at the Nantes Engineering High
School, and Clinical Assistant Professor at the Nantes Hospital University of
Nantes, France. He is currently Anti-Aging and Sports Medicine Practitioner at the FV
Saigon Clinic, HCMC, Viet Nam.
Rataporn Ungpakorn, MD, is Dermatologist at the Skin Laser Center Bumrungrad International Hospital in Bangkok, Thailand. He is member of
Deramatological Society of Thailand.
Ines Verner, MD is Dermatologist in private practice in Israel. She is
President of the Israel Society for Dermatologic Surgery and is editor in
chief of the Israeli Journal of Dermatologic Surgery and Dermatology. She is
the author of several book chapters and she lectures and teaches cosmetic
dermatology worldwide.
Xanya Sofra Weiss, PhD is CEO Arasys Perfector, LLC / Ion Magnum, LLC
/ Ion Genius, LLC. International Director of Research and Training and
CEO, Creative arts Center, Inc in Honolulu (Hawai), USA
George Weng Chau Jin, MD, is Director, Private Clinic Center, Taipei,
Taiwan. Chief, Department of Plastic Surgery at Chung San General
Hospital, Taipei, Taiwan
Wong Chin Ho, MD, is board certified Plastic Surgeon at the Singapore
General Hospital - Department of Plastic, Reconstructive & Aesthetic
Surgery. He is a member of the Singapore Association of Plastic Surgeons.
Shin Yong Ho, MD, Ph.D is board certified Plastic Surgeon and Director of
BK Dongyang clinic in Seoul, South Korea and adjunct professor of the
medical college at Han-lim University. He is full-time member of the Korean
Society of Plastic and Reconstructive Surgeons and of the Korean Society
for Aesthetic Plastic Surgery, Member of Korea cleft Palate-Craniofacial Association.
Dr Shin Yongho is also academic director of the Korean Association of Clinical Plastic
Surgeons.
Yun Zhao, MD, received his PhD in Molecular Biology & Biochemistry from
Shanghai Institute of Biochemistry, Chinese Academy of Sciences in 2001,
Shanghai, China. He switched to study human leukemic, especially CML in
the postdoctoral program supervised by Dr. Connie J. Eaves in Terry Fox
Laboratory, Vancouver, British Columbia, Canada. He utilized serial analysis of gene
expression (SAGE) to profile the gene expression of lin-CD34+CD38- CML cells, which
enriched the leukemic stem cells; at the same time, he carried on the function studies
of genes involved CML maintenance, such as the newly identified hematopoietic
regulator TWIST2. Interestingly, TWIST2 is involved in the response of CML
stem/progenitor cells towards matinib mesylate as well, which might suggest novel
combinational therapy with Imatinib. He currently holds a PI position in CyrusTang
Hematology Center, Soochow University and he continues his curiosity to unlock the
mystery of the leukemic stem cells.
Sabine Zenker, MD is Dermatologist in Munich, Germany. In 2004 she
established a private dermatology practice specializing in aesthetic
dermatology. She is Consultant for Anteis, PerfAction, Johnson & Johnson,
RegenLab, Bioform Medical, Merz, Laserwelt, Ipsen Pharma, Galderma,
Filorga, L`Oréal Paris. Dr Zenker has been speaker at a number of national and
international medical conferences, author of scientific publications and presentations
and member of many medical associations.
Abstracts
Aesthetic and Dermatology
Vali A. Abbaspour
A Different view to laser hair removal
Laser, Lights and related technologies
Nowadays, using LASER in medicine is one of the competent and workable methods of removing undesirable hairs. In ordinary method, the hair is shaved
most of the times. In this approach, large part of the hair remains in the hair channel; thus, much more LASER energy is consumed by this hair and LASER
is radiates to the melanin content of epiderm cells and damage them.
In the proposed method, which is scarcely tested and experienced, the hair is not shaved, but instead it is uprooted. Based on the anatomic location of
the hair, the opportunity for growing again (2 to 3 days). Thus, the activity of follicles and melanocytes increase while simultaneously the hairs move to
anagen phase. Up to this time, the hairs have not been grown such long that could come to the outer layer of skin, and the volume of hairs shaft and
amount of melanin molecol are less.
The mentioned stage can be carried out in three methods:
1. direct radiation of LASER (the method which seems to be most applicable, effective, and most easy to use),
2. radiation of LASER to "bulb" via the core of a narrow needle, which is sent to the hair channel,
3. reverse radiation from under the skin towards epiderm and hair's root by using special tools and follicle.
Decreasing LASER radiated energy to the skin, especially in second and third methods, and the unique competent destruction of hairs more than the
ordinary methods are the advantages of the suggested method.
Fredrick Berne
Facial rejuvenation with injectables
Facial volume - Tear Trough implant technique - Transdermal blunt and sharp Cheek & Chin Augmentation with non-animal
stabilized hyaluronic acid gel (NASHA)
Abstract: The evolution of non-animal stabilized hyaluronic acid (RestylaneTM) to eleven different tissue tailored products, has given the possibility to
create custom made implants in the face and body to augment our patients. This can be done with high predictability, short or no downtime and no long
lasting adverse effects. Nonsurgical correction of the tear trough has been considered an advanced treatment compared to other areas.(1, 2) I will here
present the implant technique of the tear trough, which will give high patient satisfaction and few adverse effects. The transdermal technique for the
cheeks and the chin with large-particle stabilized hyaluronic acid (Restylane SubQTM) is also described, which gives us the possibility to rejuvenate or
remodel our patients in a 30 minutes treatment.
Introduction: Facial beauty is important to all of us. It's important in finding our life partner, in our work success and other relationships in life.(3)
"Personal beauty is a greater recommendation than any letter of reference", Aristotle said 300 B.C. we can all agree that facial beauty is important, and
when working with facial aesthetics it is important to understand beauty.
Beauty is more than the opinion of a person or a group. As Immanuel Kant said, "If he proclaims something to be beautiful, then he requires the same
liking from others; he then judges not just for himself but for everyone, and speaks of beauty as if it were a property
o
f
.
Aesthetic beauty is said to consist of five main characteristics; Health, youthfulness, symmetry, averageness and
complexion, which all together give signals of a strong genome. This is also found in nature where banana flies with
symmetric wings get to mate more often.(4)
Facial beauty is timeless and cross-cultural. We can se the resemblance of Nefertiti, and a beautiful Asian, Caucasian
or black woman. All with a perfect fit to the beauty mask. (Pic 1a,b) If we look at the characteristics of the beauty
mask we find high cheeks, defined jaw line, balanced chin, proportionate nose and an enhanced positive triangle of
the face.(5)
Facial aging is something that we try to prevent in our everyday work and
something that most of our patients seek our knowledge for. The aging of the face
can be divided into subsurface and surface changes and is a result of uneven loss
of volume, decreased tissue elasticity, gravity and photo aging. The subsurface
changes show themselves in redistribution of the volume and change of
contours.(6) The surface changes are noticed in the change of pigmentation and
texture. The most important area of volume loss in the face is the midface.(6) Loss
of volume in the midface together with gravity will move the malar and cheek fat
pads downcloser to the nasolabial fold. This results in the creation and
enhancement of the tear trough, the nasolabial fold, the perioral commissure and
finally the chin laxity, which all are signs of aging.
Volume is important; giving back volume will reinflate the facial balloon. Adding
volume in the cheek will affect all areas, but addressing all areas including the
cheeks will take the rejuvenation even further. The key areas to address when
rejuvenating our patients are the tear trough, cheeks, nasolabial fold, perioral commissure and the jaw line (pic 2a,b).
Three important and sometimes difficult areas to treat are the tear trough, cheeks and chin. I will here propose an
easy way to address these areas in a safe and predictable way with a low frequency of adverse effects. As volume
in the upper part of the face will affect the lower I always start treating the more cranial areas first.
12
The Tear Trough - Implant technique
The tear trough is a small area located at the centre of the face. Small changes in this area
make a big impact on how we interpret our state of being.(1) With movements in our upper
and lower eyelids we show a great part of our emotions. The eyes are an aesthetically very
important area.(1,7)
The periorbital skin is the thinnest skin on the body, 0,5 mm (average2 mm). Together with the
high muscle activity in the periorbital area the eyes tend to age earlier. For patients over 35,
blepharoplasty was the single most popular cosmetic surgical procedure in USA 2008,
surpassing liposuction, breast augmentation, rhinoplasty and facelift. Dark circles could be a
result of aging (pic 3) or hereditary. (Pic 4)
The most difficult area around the eyes to attend to with surgery is the tear trough. There are different surgical techniques to address this as insertion
of silicon implants, ePTFE (expanded polytetrafluoroethylene)(8) or treatment with autologous fat(9, 10, 11), which is today's surgical golden standard.
These procedures give long lasting results but are associated with high incidence of adverse effects, low predictability, no flexibility and a long learning
curve for the physician.
With the introduction of non-animal stabilized hyaluronic acids in 1996 (Restylane) there was a possibility to treat the tear trough in an easy manner.
Different techniques have been presented and it's considered an advanced treatment compared to other areas with more adverse effects such as long
lasting haematomas, periorbital oedema and irregularities (12-17). The risk of occlusion of the optic artery through retrograde migration has also
contributed to make aesthetic doctors hesitate treating the tear trough.(18-21)
I would like to present the implant
technique, which gives the opportunity
to treat the tear trough with a low
frequency of haematomas and
periorbital oedema, high predictability,
smooth results, and without risking
artery occlusion.
Anatomy: To treat the tear trough we
need to understand the anatomy and
definition of it. The tear trough was defined and named by Robert Flowers in 1993. The outside landmark is where the tears will fall. This means that the
tear trough has its beginning at the medial commissure and continues down to the midface. The cranial border of the tear trough consists of the three
lower eyelid fat pads but mainly the central and the nasal. These tend to herniate with age enhancing the tear trough. The lower definition of the tear
trough consists of the malar and cheek fat pads, which lose volume and fall down with age also resulting in an enhancement of the tear trough deformity.
So we have a lack of volume between these two anatomically different regions (pic 5). Under the dermis we find the Orbicularis Occuli muscle, which
hang like a hammock tight connected to the periost on the orbicular rim in its most medial and lateral part (7,22).
The tear troughs contribution to dark circles under the eye consists of mainly two parts.
The first is the actual depression enhanced by a shadowing effect. The other has its
origin in superficial blood vessels in the area, which together with the thin transparent
skin produces a bluish tint. The correcting of the tear trough with hyaluronic acid will
elevate the area and treat the depression taking away the shadowing effect. By
increasing the distance from the veins to the skin the bluish tint will also diminish.
Technique - The implant plane technique for the tear trough: As we now understand
the anatomy, the goal of the treatment is to replace the volume deficit between the
orbital fat pads and the malar fat. When doing the treatment we have to take the
dynamics of the orbital fat pads in consideration. When the gaze is put upwards the
orbital fat pads will protrude and enhance the tear trough deformity. In the same
manner when the patient's gaze is put downwards the orbital fat pads will follow the
eye and lessen the tear troughs depths. If we would do a full correction with the
patients gaze straight we have a risk of overcorrection and this will show when the
patient move the eyes downward. This needs to be explained to the patient, and is best done with the patient looking at their tear trough in a mirror,
looking upwards and downwards. Hence the goal is not a 100% correction because this would mean an overcorrection when looking down, but an
enhancement of the area. Patient selection is important. Patients with skin abundance, poor elasticity and/or great excess of orbital fat are poor
candidates and a treatment will result in limited improvement.
Since the treatment is done in a sub dermal plane, I only recommend doing the treatment with Restylane PerlaneTM or with Restylane SubQTM when
treating the cheeks with Restylane SubQTM at the same session. Both are tissue tailored NASHA gel for sub dermal treatment. In this paper I will only
attend to the technique treating the area with Restylane PerlaneTM.
Pic 6a-d
- To define the tear troughs anatomical landmarks, ask the patient to move her eyes up and down, at the same time explain why a 100% correction should
not be the goal.
- Use topic anaesthesia. This will contract the small capillaries of the skin and reduce haematomas.
- Clean the skin with antibacterial solution.
- The insertion point should be outside the tear trough deformity, either lateral or below. This is to avoid injection of hyaluronic acid to superficially at
the injection point that could result in a bluish colouring (The Tyndall effect) but also to avoid injection into the orbital fat pads.
- Before injection stretch the skin to easier identify the superficial capillaries and the sub dermal blood vessels in the area,
there by choosing an entry point reducing the risk of haematomas.
13
- Keep the eye of the needle ventral since this gives you better control. Use a 27G 13 mm needle and insert it in
a perpendicular angle through the skin. Change the angle and move up to the medial part of the tear through
going below the orbicularis occuli muscle but avoiding hitting the periost, as this is painful for the patient.
- When you have reached about 5-8 mm from the medial commissure with the end of the needle keep the needle
still and wait 5 seconds. By doing this you will reveal any artery interaction that will show in a fast evolving
haematoma. If this occurs abort the treatment and take the patient back 2 weeks later for a new treatment. With
this technique you should have no risk of injecting in an artery and also no risk of retrograde migration of the
hyaluronic acid.
- Lift the needle to confirm sufficient depths below the orbicularis occuli muscle, and in the same time loosen the muscle from the periost creating space
for the hyaluronic acid. In this way you will have better control of the treatment as the hyaluronic acid will follow the principles of less resistance when
injected. This will also increase the durability of the treatment.
- Inject the hyaluronic acid deep to avoid the Tyndall effect. Start with injecting a small amount of hyaluronic acid, and then continue the injection as
the needle is withdrawn. You will feel when you leave the sub muscular plane, here you continue to inject a small amount. Stop injection 2 mm before
you reach your entry point. This technique will deploy hyaluronic acid in a dual plane. A sub muscular injection is done to correct the main part of the
tear trough. Medially it is difficult to make a good correction sub muscular as the orbicularis occuli muscle is very tight to the orbital rim close to the
medial canthus. In this area the volume will be given above the muscle and still with good
tissue cover.
- Now you have deployed hyaluronic acid medially below the orbicularis occuli muscle and
laterally above. This gives you the material to create a perfect implant for the tear trough.
- With your finger sculpt rate the hyaluronic acid medially all the way to the medial cantus.
You will notice how the hyaluronic acid above the muscle easily will move past the sub
muscular hyaluronic acid and correct the most medial part.
Adverse effects: This technique reduces the risk of haematoma. One injection, done slowly
will reduce the risk of vascular injury. By stretching the skin the physician will have the
possibility to avoid traumatizing the capillaries, and small haematomas from these will be
reduced to about 5%. When the needle is injected deep and slowly you will only have about
2% of deeper vessel injury and big haematomas. The risk of artery injection is avoided by
waiting 5 seconds to reveal artery interaction. By smoothing the hyaluronic acid implant out
against the orbital rim the risk of irregularities is very small. If an overcorrection is done you can easily sculpt the hyaluronic acid in a lateral and caudal
manner down to the midface area where it won't be noticed. The larger the volume injected the higher the risk of periorbital oedema. By placing 85-90%
of the hyaluronic acid below the orbicularis occuli muscle where the tissue pressure is high you will reduce the risk of periorbital oedema. Eyelid surgery
should be avoided three months before and after the treatment to reduce the risk of oedema. There is a high durability of the treatment with results up
to 24 months (pic 7a-c).
Technique - Cheeks - Chin transdermal injection with Restylane SubQTM : The cheek and chin is two of the most important areas creating balance in
the face for both rejuvenation and remodelling(5). With the introduction of large-particle stabilized hyaluronic acid gel (Restylane SubQTM) in 2004 we
were given the possibility to give our patients an alternative to cheek and chin implants. In contrary to silicon implants or ePTFE, hyaluronic acid gives
maximum flexibility, short or no downtime and no long lasting adverse effects, where we actually can reverse the treatment in 48 hours with
hyaluronidase (23). We now have the possibility to create a perfect cheek or chin implant with maximum patient adaption in a 30 minutes treatment.
Technique: When large-particle stabilized hyaluronic acid gel (Restylane SubQTM) was introduced we started doing the treatments transorally with blunt
needle. By instead using the transdermal technique we are given the opportunity to have higher control in creating our augmentation using different
injection techniques. The latest development has given us the possibility to treat our patients transdermal with blunt flexible cannulas witch gives less
bruising and more comfort for the patient (24)
One of the most important questions is where volume should be given. There isn't any answer to this that will fit all patients. The aesthetic mind of the
doctor together with some guidelines will make it possible to create an augmentation with high patient satisfaction. In augmenting the cheek it's
extremely important to understand the desires and expectations that our patients have. By analyzing how your patient put on their makeup you will be
able to notice if the patient try to enhance the cheeks by feminizing them or to smooth them out. Do they want a rejuvenating treatment, a remodelling
of the cheeks or just an enhancement of what they have? When planning the injection there are different methods of grids to use. The one I'd like to
recommend is Hinder lines. (Pic 8) Draw one line from the ala to the tragus and one from the oral commissure to the lateral cantus. This gives you a grid
of four areas for each side of the face. By analyzing and comparing the sides you can now easily visualize asymmetries prior to treatment. Asymmetries
could be different level of the ears, different sizes of the cheeks, different distances between ala and tragus, and much more, all this much more easily
visualized with Hinders lines drawn. Take advantage of the lines when doing the planning for the hyaluronic acid implant. Giving volume to the lateral
upper quadrant with a high angle of the implant will feminize the patient. This is a more usual location for younger patients seeking a remodelling
treatment (pic 9ab). In general the more medial and the lower the angle the more the augmentation becomes rejuvenating and will change the patients
appearance less. Of course you have to consider the gender of the patient. Most women prefer volume more lateral with higher angle, and the men more
medial. If the patient is uncertain you can offer them a chance to visualize the effect by injection of saline solution. This shouldn't be done in the same
session, as it will affect the treatment.
There are three different types of anaesthesia, local, regional and topic. I prefer to use local anaesthesia at the entry points, one lateral of the planned
implant and one caudal. We have most of our nociceptors in the dermis and in the sub dermal plane we mainly feel uncomfort from pressure.
14
- Start cleaning the skin with antibacterial solution.
- Draw the Hinder lines.
- Mark the area for augmentation - at this moment you also have the possibility to show the patient what you have
planned.
- Administer local anaesthesia 0,1 ml where you have planned your entry points, the anaesthesia should be given very
superficial in the dermis. Use anaesthesia with epinephrine to reduce small bruises at the entry points.
- With the blunt transdermal injection with Pix`L cannula make your entry point with sharp needle same or larger gauge.
- Insert the needle in a perpendicular manner with the eye of the needle facing upwards.
With the sharp technique I prefer to use 23G 40 mm needles, with the blunt transdermal
technique I prefer the 21 G Pix´L cannula. The depths should be below the orbicularis muscle
in the upper part and above the deeper muscles, sub dermal in the lower part. In this plane
above the superficial musculoaponeurotic system (SMAS) you will not risk injuring the facial
nerve. You should always be available to move the needle sideway in the correct plane, not
getting stuck in dermis or SMAS.
- Use the fanning technique and start at the upper part of the planned implant border
injecting when withdrawing. Continue with injection from the medial entry point where you
also have the possibility to correct the tear trough deformity.
- If we consider the nature of the sub dermal plane it's easy to understand that it is very difficult to create a perfectly shaped and smooth implant with
the injection. The tissue is looser, which gives us the opportunity to sculpt rate it after injection, which is not possible in a dermal plane. Use antibiotic
cream to lower the friction and prevent small haematomas and sculpt rate the implant to desired aesthetical result. In this way you now have created a
hyaluronic acid custom made mid face implant
Adverse effects: The Restylane SubQTM transdermal technique allows greater precision and gives the physician higher control. This reduces the risk of
administrating too much. With a steady and controlled injection technique the risk of bruising is about 5%. The tissue pressure in the mid face in younger
patients is high resulting in low risk of oedema. When administrating large volumes to elderly patients with loose tissue the risk is higher. To avoid this
more than 2 ml of hyaluronic acid should not be injected in the same area at the same session. If the patient desires further augmentation let the
treatment settle and continue the treatment two weeks later. By working in a sub dermal plane with sharp needle above the SMAS in the mid face you
won't risk injuring the facial nerve, with the blunt cannula the risk of bruising and nerve damages is greatly diminished. I recommend my patients to sleep
on their back for the first 3-4 four days, hard pressure can redistribute the hyaluronic acid and give an unwanted result. Touch ups can be done two weeks
after the treatment.
Technique - Chin transdermal injection with Restylane SubQTM : The chin balances up the lower third of the facial triangle. By augmenting the chin using
hyaluronic acid you can alter the underlying structure of the face and provide a better balance to the face. Good patients for chin augmentations are
patients with weak or receding chins (pic 10), but also men with more average chins who want to masculinise their facial contour (pic 11). As a
rejuvenating treatment hyaluronic acid can be used to reduce the appearance of the chin laxity.
- Start cleaning the skin with antibacterial solution.
- Make your planning with the patient in a supine position, as gravity will affect the chin laxity.
- With the blunt transdermal injection with Pix`L cannula make your entry point with sharp needle same or larger gauge.
- Insert the needle in a perpendicular manner with the eye of the needle facing upwards. With the sharp technique I prefer to use 23G 40 mm needles,
with the blunt transdermal technique I prefer the 21 G Pix´L cannula.
When doing a remodelling augmentation of the chin the injection should be done deep beneath musculus depressor anguli ori and mentalis. I don't create
a pocket even though the tissue pressure could be really high here.
- When doing a rejuvenating treatment to the chin laxity I also inject in a sub dermal plane.
- In the jaw line and the chin it is important not to inject to caudal as this might enhance the chin laxity. The hyaluronic acid is easier to sculpt rate
down the mandibular border than up.
- When the hyaluronic acid is deployed I sculpt rate it to create the desired shape.
Adverse effects: Adverse effects are rare in this area. High tissue pressure gives very low risk of oedema. Injection related haematomas is a little more
common and can be seen in about 10% of the cases with the sharp needle but not with the blunt technique.
Conclusion: I find the implant technique of the tear trough logical and atraumatic. It gives good control of the procedure, high predictability, low
frequency of adverse effects and high patient satisfaction. The tear trough should be treated in a sub dermal plane and I therefore only use NASHA tissue
tailored for this (Restylane PerlaneTM and Restylane SubQTM). The durability is up to 24 months using these stabilized hyaluronic acids. Using largeparticle stabilized hyaluronic acid (Restylane SubQTM) with the transdermal technique gives us the possibility to reshape our patients face. The
introduction of blunt flexible micro cannulas makes it possible to lower downtime and extend our treatments in a safe way. This method let us lift the
aging face giving back lost volume or remodel the younger faces in a safe and predictable way. Downtime is small adverse effects are rare and flexibility
is high. The dermal filler treatments have shifted from just filling lines to a three-dimensional approach where the fact that volume is important is focused
upon.
15
Picture legends
1a,b - The Beauty mask presented by Stephen R. Marquardt
2a,b - Treating all these areas will give a full face repair.
3 - 0,7 ml of Restylane PerlaneTM on each side
4 - 0,4 ml of Restylane PerlaneTM on each side
5 - We can see the close relation between the tear trough and the cheek which often need to be attended together
6a - start injecting deep
6b - The NASHA is deployed
6c - sculpt rate to create the smooth implant
6d - By increasing the distance from the blood vessels to dermis the bluish tint will disappear
7a text - before treatment
7b immediately after
7c 18 months after treatment
8 - the Hinder lines will help you create symmetry
9 ab Volume to the cheek will not only rejuvenate but can also feminize the face when given in the upper lateral quadrant
10 - 4 ml of Restylane SubQTM
11 - 6 ml of Restylane SubQTM
References
1. H. Hirmand Anatomy and Nonsurgical correction of the tear trough deformity Plast Reconstr Surg. 2010 Feb;125(2):699-708
2. Klein AW. Technique issues in non-surgical filling of the peri-orbital hollows. Aestet Surg J. 2007;27:294-295
3. Gerard A. Pfann, Jeff E. Biddle, Daniel S. Hamermesh, Ciska M. Bosman "Business Success and Businesses' Beauty Capital," Economics Letters, 2000
4. AP Moller, Sexual selection, viability selection and developmental stability in the domestic fly, Evolution, 50(2), 1996 746-752
5. Bashour M. An objective system for measuring facial attractiveness. Plast Reconstr Surg. 2006 Sep;118(3):757-74; discussion 775-6.
6. Glasgold MJ, Glasgold RA, Lam SM Volume restoration and facial aesthetics. Facial Plast Surg Clin North Am. 2008 Nov;16(4):435-42, vi.
7. Goldberg RA. The three perorbital hollows: A paradigm for periorbital rejuvenation. Plast Reconstr Surg: 2005;116:1796-1804
8. Flowers RF. Tear trough implants for correction of thear trough deformity. Clin Plast Surg. 1193;20:403-415
9. Yasaman Mohadjer, John B Holds Cosmetic Lower Eyelid Blepharoplasty with fat repositioneing via intra-soof dissection: surgical technique and initial outcomes
Opthalmic Plastic and reconstructive surgery 2006;22:409-413
10. Hamra ST. The role of orbital fat preservation in facial aesthetic surgery. A new concept. Clin Plast Surg 1996;23:17-28
11. Eder H. Importance of fat conservation in lower blepharoplasty. Aest Plast Surg 1997;21:168-74
12. Berros P. Periorbital contour abnormalities: hollow eye ring management with hyalurostructure. Orbit. 2010 Apr;29(2):119-25
13. Morris, Carrie L. M.D.; Stinnett, Sandra S. Dr. Ph.; Woodward, Julie A. M.D. Patient-Preferred Sites of Restylane Injection in Periocular and Facial Soft-Tissue
Augmentation Ophthalmic Plastic & Reconstructive Surgery:
14. Goldberg RA, Fiaschetti D. Filling the periorbital hollows with hyaluronic acid gel: initial experience with 244 injection. Ophtal Plast Reconstr Surg
2006;22:335-41
15. Airan LE, Born TM Nonsurgical lower eyelid lift. Plast Reconstr Surg 2005;116:1785-92
16. Steinsapir KD, Steinsapir SM. Deep-fill hyaluronic acid for the temporary treatment of the naso-jugal groove: a report of 303 consecutive treatments. Ophtal
Plast Reconstr Surg 2006;22:344-8
17. Kane MA. Treatment of tear trough deformity and lower lid bowing with injectable hyaluronic acid. Aesthetic Plast Surg. 2005 Sep-Oct;29(5):363-7.
18. Coleman S. Avoidance of arterial occlusion from injection of soft tissue fillers. Aestet Surg J. 2002;22:555-557
19. Coulter VL, Holds JB, Anderson RL. Avoiding complications of orbital surgery: the orbital branches of the infraorbital artery. Ophtalmic Surg 1990;21:141-143
20. Peter S, Mennel S. Retinal bransch artery occlusion following injection of hyaluronic acid (Restylane). Clin Experiment Ophtalmol 2006;34:363-4
21. Schanz S, Schippert W, Ulmer A, et al. Arterial embolization caused by injection of hyaluronic acid (Restylane). Br J Dermatol 2002;146:928-9
22. Sullivan PK: The anatomic basis for the tear trough and crescent deformity at the lower eyelid-cheek junction. Plastic Surgery 2003. San Diego, CA oct 28,
2003
23. Vertanian AJ, Frankel AS, Rubin MG. Injected hyaluronidase reduces Restylane-mediated cutaneous augmentation. Arch Facial Plast Surg 2005;7:231-7
24. Niamtu J 3rd Dermatol Surg. 2009 Dec;35(12):2005-8. Filler injection with micro-cannula instead of needles.
Fredrick Berne
Facial rejuvenation with injectables
Tear trough the implant technique - high predictability, low frequency of adverse events, long duration and high patient satisfaction
The most difficult area around the eyes to attend to with surgery is the tear trough. There are different surgical techniques to address this as insertion
of silicon implants, ePTFE (expanded polytetrafluoroethylene) or treatment with autologous fat, which is today's surgical golden standard. These
procedures give long lasting results but are associated with high incidence of adverse effects, low predictability, no flexibility and a long learning curve
for the physician.
With the introduction of non-animal stabilized hyaluronic acids in 1996 (Restylane) there was a possibility to treat the tear trough in an easy manner.
Different techniques have been presented and it's considered an advanced treatment compared to other areas with adverse effects such as long lasting
haematomas, periorbital oedema and irregularities. The risk of occlusion of the optic artery through retrograde migration has also contributed to make
aesthetic doctors hesitate treating the tear trough.
I would like to present the implant technique, which gives the opportunity to treat the tear trough with a low frequency of haematomas and periorbital
oedema, high predictability, smooth results, and without risking artery occlusion. The implant technique has been widely accepted in Europe and treatment
is enhanced by attending to the midface area.
16
Fredrick Berne
Awake breast augmentation with autologous fat - Bodyjet method - Technique - Clinical results.
Fat Tissue
Breast augmentation through volume today rests on a trio of treatments, implants, large particle hyaluronic acid (Macrolane) and autologous fat. With
the introduction of Bodyjet/WAL (Water Assisted Liposuction) it is now possible to harvest large volume of fat for autologous transplantation with high
survival of the fatcells and probably a high concentration of regenerative cells and stemcells. All done on awake patient. Here will be presented technique
and results of 100 clinical cases.
Elisabeth M. Briden
Combination therapy of AHA peels and varius procedures
Advanced Dermatology & Cosmetic Institute, P.A., Edina, MN USA
Enhancing the skin Part 1
Forty years have passed since the first benefits of AHAs were published, demonstrating their nearly miraculous, 'normalizing' effects on severe, dry skin
and ichthyosis by dermatologist, Dr. Eugene J. Van Scott, and skin biochemist, Dr. Ruey J. Yu in the early 1970s.
Today, AHAs reputation as exfoliants, antiaging ingredients and skin brighteners has placed them a lead position in the market, well ahead of many other
competitive technologies. AHAs remain an ingredient with unsurpassed clinical and scientific evidence that they can reverse the signs of dermatological
aging. Newer bionic acid compounds (such as Lactobionic Acid and Maltobionic Acid) and N-Acetyl Glucosamine are being used in effective topical skin
care products. These new ingredients provide the anti-aging and skin smoothing effects of AHAs with many additional benefits which will be discussed.
In addition, the effective use of AHA chemical peels in combination with other procedures to treat various skin conditions will be discussed.
Luc Dewandre
Latest trends in botulinum toxinand injectables for Asia
®
Presentation of the SST (Skin Sculpting Technique) with DERMASCULPT™ Microcannula
The author will discuss & illustrate how this new revolutionary technique of injection for dermal fillers dramatically improves the approach of filling the
skin. It involves no bruising and practically no pain for the patient even when used in the lips.
Videos will be shown to illustrate the technique used in the main indications of the face: Volume of the lips, tear valley and dark circles, nasolabial and
bitterness fold, temples, cheeks and cheekbones.
Fabrizio Castagnetta
Complications of permanent/semi permanent fillers
Injectables: Latest Updates and Techniques
Background:
Filler classifications concerning persistence and reactions
Classifications of the foreign-bodies reactions
Material and methods:
Case histories during 10 years
24 complications out of 180 patients with permanent or semi permanent fillers
Kind of infiltrations
Kind of anesthesia
After injections reactions
Applications areas
Results:
Patients' satisfaction
Foreign-bodies granulomas and others complications concerning different bodies areas
Conclusion
What is the ideal filler?
To estimate the importance of the aesthetic problem
To choose a safe product
Informed consent the more exhausting possible
The patient must be informed and involved in the chosen of the filler knowing for and against.
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K. R. Chandvania
Hair rejuvenation with diode laser hood
Lasers, Lights and related Technologies
Background: Male pattern baldness & female pattern baldness are quite common now a days even in young age. To regrow the original hair back apart
from medical treatments like minoxidil & mesotherapy, a need for low level laser stimulation of hair roots was awaited. The present study is for use of
small group of diode lasers in hood that covers the scalp.
Patients, Material and methods: 50 patients consisting of 40 males & 10 females were taken for this novel laser therapy. After doing trichology check
up, patients were put on laser scanning twice a week for 6 weeks & once a week for 6 weeks. Male patients were advised to remove or cut short the hair
prior to starting laser therapy to have proper absorption of laser.
Results: In young patients, almost 100 percent regrowth was possible. In older patients, hair fall was arrested apart from having some regrowth. Results
were better in male patients than female patients. Tiny regrowth can be confirmed with the help of trichology scanning machine. Simultaneous use of
medical treatments can have synergetic effect.
Conclusion: So at last we could find total solution for hair fall. We can combine medical treatment along with this novel laser therapy.
Deborah Fortescue-Merrin
Mandelic Acid: A new generation of acid peel for dark, sensitive skin types
Enhancing the skin - Part 1
David Lai M.D., B.Sc.(UBC) Consultant - Asia - NuCèlle Inc.
A new generation of acid peel for dark, sensitive skin types Mandelic Acid (derived from the hydrolysis of an extract of bitter almonds) was first used in
facial treatment formulations due to its antimicrobial action, a characteristic helpful in the use of acid peels for the treatment of acne prone skin.
A review of the biochemical structure of Mandelic Acid as compared to other Alpha Hydroxy Acids reveals the basis for why Mandelic Acid has shown
great efficacy with all skin types. As a result, a remarkable difference has been seen in the treatment of darkly pigmented skin types of Asian, African and
Hispanic origin.
A comparison between the Mandelic Acid and Glycolic Acid molecules reveals there is a notable absence of post inflammatory hyperpigmentation with
Mandelic Acid. There is also a distinct lack of skin irritation and erythemea that often accompanies 30% to 70% glycolic peel preparations. This lack of
hyperpigmentation allows for a superior treatment outcome.
The medical origin of Mandelic Acid as an antiseptic provides the basis of its superior properties in the treatment of trouble prone/acneic skin conditions.
The use of Mandelic Acid as a key component in dermatological procedures stems from its proven efficacy with ALL skin types. The large size of the
molecule allows for a slow, even absorption through the epidermis. The accelerated exfoliation process results in new epidermal layers, which are
consistently exposed to reveal a fine, smooth surface minimizing the appearance of wrinkles, age spots, and hyperpigmentation, even in darker, pigmented
skin types.
Adrian Gaspar
New approaches in subcutaneous laser treatment: Which wavelength and why?
Fat Tissue
Addamo G, Brandi H, Gómez Diez V.
Cosmetogynecology and Laser Surgery Department,
Faculty of Medicine, University of Mendoza, Argentina.
Today, there is a great and increasing demand for minimally invasive procedures for body shaping on the part of our patients. Laser lipolysis is one of the
most required interventions for this purpose in the world. In our opinion, as physicians we see ourselves constantly besieged by companies with new and
different technologies for laser body shaping treatment. A tremendous conflict of interest may arise.
We consider of prime importance that we are the most responsible party at the time of the offering and delivering demanded medical treatment based
on the evidence. The object of this work is describe the different equipment and technologies for laser lipolysis that are the most available on the market,
and at the same time offer other practical and valid therapeutic considerations, so that the physician can base his practice on current evidence at the
time of selecting and offering the determined technology.
In conclusion, we are convinced that that we are able to determine what laser wavelength to use and why, and that it is vitally important to have serious
scientific reports done with valid procedures in order to determine this.
Adrian Gaspar
Lipografting and stem cells
Fat Tissue
Addamo G, Brandi H, Gómez Diez V.
Cosmetogynecology and Laser Surgery Department,
Faculty of Medicine, University of Mendoza, Argentina.
Human fat tissue contains totipotent cells (primitive or Stem Cells) identified by markers (CD34, CD45, CD90, CD105, CD146) capable of proliferating and
differentiating themselves in distinct cellular types without limitations. Further, they are able to elaborate various growth factors (bFGF - basic fibroblastic
growth factor; VEGF - endothelial growth factor; PDGF - platelet derived growth factor). It has been suggested that these cells have the virtue of favouring
the survival of transplanted fat tissue; not only for promoting the regeneration of new fat tissue, but also for improving the blood flow for transplanted
tissue, resulting in the formation of neovascularisation. We believe that natural hypoxia of the transplanted material associated with the lower perfusion
for the receptive tissue, could be one of the stimuli that would favour not only the replication of these cells but also the growth factor action associated
with angiogenesis. In conclusion, the use of Stem Cells to promote the survival of a fat tissue lipografting is today a reality. Although the researches on
animals and humans are very promising, we believe that further and better evidence is needed to establish the long-term clinical benefits of this
procedure.
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Adrian Gaspar
Vaginal fractional co2 laser: a minimally invasive option for vaginal rejuvenation
Laser, Lights and related technologies
Brandi H; Addamo G; Salvatore G.
Gynecology Department and Laser Surgery, Mendoza University, Mendoza, Argentina.
Urogynecology Department, Insubria University, Varese, Italy.
Objective: The objective of this study was to provide evidence that the use of fractional CO2 laser in combination with platelet rich plasma locally in the
vagina mucous, and pelvic floor exercises, would have effects of greater impact, in the three layers of the vagina (epithelium, lamina propia, and
muscularis), including effects on sexual function, rather than only effects on the epithelium, as achieved with estrogens.
Materials and method: This pilot study has evaluated the effects of monthly application of intravaginal fractional CO2 laser with PRP (Platelet Rich
Plasma) for three sessions on the vaginal mucous, in association with an intensive training program of physical exercises of the pelvic floor, to improve
not only vagina histology, but also sexual disorders (dyspareunia, dryness, burning, local irritation) and orgasm, in13 medically healthy women (8 in the
premenopausal period and 5 in the postmenopausal period), with moderate symptoms of vaginal atrophy. The patients were put under pelvic stretching
exercises, administered through a perineometric software, through sessions of half an hour duration, at the rate of four times per week the first month,
three times per week the second month, and twice per week the third and last month of training. Patients with stress urinary incontinence, as well as
patients with damage of the rectovaginal fascia and/or fascia of Halban, were excluded from this protocol. The equipment used was a CO2 laser of the
Italian Company DEKA, which designed a vaginal scanner able to fractionize the CO2 laser and able to be inserted in the vagina. Three applications of
PRP (one per month) one week previous to the laser, was used, administered in an average concentration per session of 1,100,000 platelets per mm3
(between 700,000 and 1,500,000). In our protocol, the plasma was activated previous to its vaginal application, with 10% calcium chloride.
Results: An important improvement of sexual function and vaginal mucous histology was observed in every patient, compared with the control group,
who did not receive the CO2 laser treatment and the PRP (only pelvic floor exercises). This has been evaluated with a sexual questionnaire and vaginal
biopsies. In 34% of the cases, we also observed an improvement in chronic discharge. Arousal and lubrication improved 41%, dryness during intercourse
improved 59%, and approximately 70% achieved important improvement in orgasm. Sexual problems that these women reported before the treatment
were clearly solved after it. We argue that after these findings, the criteria for sexual disorders treatments due to vaginal hypotrophism in medically
healthy women who are in their menopausal transition, and whenever a lack of estrogens has happened, are now in need of revision.
Conclusion: The local use of vaginal fractional CO2 laser and PRP, (applied every 30 to 40 days in three sessions), in association with pelvic floor exercises,
in perimenopausal women with minimal to moderate symptoms of vaginal atrophy, exerts beneficial effects in the three layers of the vagina and sexual
function. Although these findings suggest the possibility of the use of a new non-hormonal treatment for prevention of uro-vaginal atrophy and for
achieving benefits in quality of life, more data will be needed to better address the use of this new procedure.
Apratim Goel
Asian (Indian) face rejuvenation
Enhancing the skin - Part 2
Background: Asian skin (especially Indian skin) exhibits increased dermal thickness, collagen, and melanin content when compared with Caucasian skin.
As a result the aging pattern of Asian skin, is very different from the west. It is characterized more by pigmentation changes rather than fine, facial
wrinkles, and it has an increased tendency toward pigmentary dyschromia (hypopigmentation as well as hyperpigmentation) after treatment. We have
been dealing mainly with skin type IV to VI, pertinent to the Indian subcontinent.
Objective: To evaluate the clinical efficacy and safety of Q switched NdYAG, fractional erbium laser, peels, fillers, botulinum toxin and microdermabrasion
in Indian patients.
Methods: Indian patients of age group, 21-50 years, were subjected to various non surgical skin rejuvenation modalities like laser, peels, botulinum, fillers,
dermaroller and microdermabrasion. Multiple treatments sessions were used in combination. Fitzpatrick skin types IV and V were treated for improving
their dyschromia, wrinkles, skin texture, and skin laxity.
Results: Most of the patients showed improvement in skin pigmentation and texture with reduced pore size. However the incidence of Post inflammatory
hyperpigmentation was high. Improvement was also observed in wrinkles and skin laxity as well as skin texture and fine lines.
Conclusion: All facial skin rejuvenation techniques may not be applicable toward this selected population. We would like to highlight the various skin
rejuvenation techniques that balance safety and efficacy and are most suitable toward treating the aging Indian face.
Apratim Goel
Chemical peels in Asians
Enhancing the skin - Part 2
Background: The use of chemicals for facial rejuvenation and acne scars has been explored since ancient times. The main clinical indications for chemical
peeling in darker skin include acne vulgaris, acne scars, postinflammatory hyperpigmentation, melasma, scarring, photodamage and other dyschromias.
Proper patient selection, skin priming, and postpeel care are of utmost importance in ensuring a satisfactory outcome. Chemical peels are combined with
other rejuvenating treatments like microdermabrasion, dermaroller and lasers for best results.
Objective: In the Indian subcontinent, due to prevalence of skin type IV and V, we restricted the use of peeling agents to glycolic acid, retinoic acid,
jessners peel, salicylic acid and a combination of the above. The main indications were skin pigmentation, acne scars and melasma.
Methods: 20 patients, males as well as females, of age group varying from 18 to 55 years were given chemical peel treatment. The number of treatments
was 2 - 4. Two patients were treated for acne scars on back as well. Patients after written consent, were photographed digitally. The peeling was done
once a month.
Results: Most of the patients showed improvement in the clinical condition even after first sitting. However the peeling down time was not tolerated by
most. There was up to 30% pigment reduction after a single peel. The oral medical treatment was continued however the topicals were stopped for 1
week during the peeling time. A small percentage (4%) developed side effects like erythema and post inflammatory hyperpigmentation. However, melasma
did not show consistent results and there was recurrence.
Conclusions: It was concluded that chemical peels is an extremely safe, effective as well as economical modality of skin rejuvenation in Indian skin types.
However melasma did not respond satisfactorily. The side effects and failure chances are very low and it caters to a variety of pigmentary conditions.
Hence chemical peels is an indispensable tool for any cosmetic practice.
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Mohamed Ghoz
Endolaser hands and finger tightening technique
Fat Tissue
Laser treatment became an essential tool for dermatologists to fulfill their work efficiently for various skin and cosmetic indications. Not only external
lasers but also endolasers can help in covering a lot of procedures for dermatologic surgeons e.g. varicose veins, liposuction, striae distensae, face lift, and
others.
Among endolasers commonly used in this particular indications are surgical diode and YAG lasers which constitute a great weapon for derm. surgeons to
fulfill a lot of tasks with great success and very low downtime with almost rare side effects.
One of new indications for endolaser treatment is tightening of dorsum of hands and knuckles under local tumescent anaethesia with a very nice and
fast results compared with fillers or chemical peel.
Ayad M. Hashem
Power assisted lipoplasty
Fat Tissue
Lipoplasty becomes the most frequently performed aesthetic procedure worldwide. In the public mind much confusion remains about the benefits and
safety of liposuction.
The training and competency of plastic surgeon is not only the important factors in successful outcome, but also the fluid infiltrated, the power assistance
and the type of canula.
Safety of liposuction depends on physcian qualifications, facilities, preoperative evaluation, the type of anesthesia employed, Surgical technique, Interoperative & postoperative monitoring.
Patients and Methods: I used the Vibro system in 50 patients for liposuction. The routine investigations before and after surgery were done. The complete
system permits to do a quantitative infiltration with vibration and also a vibroliposculpture.
Results and conclusion: The advantages include - Less oedema - No lumps (Bumpy Roads) - Better and fast recovery - Less pain - Fast, smaller anesthetic
time - Less traumatic (less formation of hematomes, echymoses) - Better aspect of the skin (specificity) - Post-operative treatments are shorter - Easier
work and less tiring - The access to treat difficult zones (back, fibrous areas…) - Treatment of delicate zones (knees, calves, buttock) with great precision
- More homogenous infiltration with permanent control of the infiltrated quantities per zone - Possibility to work on zones already infiltrated and/or
aspirated.
Andreas D Katsambas
Melasma: Pathogenesis and treatment
Enhancing the skin - Part 1
Melasma is a cosmetic problem that sometimes causes great emotional suffering. The two most important causative factors are sunlight and genetic
predisposition. Moreover, natural and synthetic estrogens, the use of certain drugs and the use of cosmetics with certain components have been
implicated as etiologic factors.
There are quite a variety of treatments that have been developed for the management of melasma. Prescriptive options will, however, be dedicated by the
nature of the patient's skin, so cases may vary in their treatment and results.
Generalizations that can be made about melasma include the fact that sunlight and oral contraceptives exacerbate this condition; daily use of a broadspectrum sunscreen is needed fro an indefinite period of time and female patients should discontinue oral contraception. Additionally, pregnant women
should be counselled that melasma often fades without any treatment after birth.
In the arena of prescribing compounds, Hydroquinone (HQ) remains the most effective topical hypopigmenting agent. HQ must be administered carefully,
as the results from the various formulations range widely. For example, 2% HQ can be ineffective and is recommended for maintenance therapy, 3% to
4% HQ can achieve good depigmentation and 5% to 10% is even more effective but can also be irritating. Prolonged treatment with >3% preparation
may rarely cause ochronosis in black skin individuals. A very effective combination is the use of HQ 2% to 5% with tretinoin 0.05%, with or without
corticosteroids.
Treatment options outside the topical hypopigmenting formulations remain limited. While chemical peeling, alone or in combination with other
depigmenting agents, can be effective in selected cases, laser therapy cannot be recommended for treatment of melasma at present.
The table below summarizes the treatment options of melasma.
Summary of treatment options:
- Sunlight exacerbates melasma. Daily use of broad-spectrum sunscreen is needed for an indefinite period of time.
- Female patients must stop oral contraception
- Pregnant women must be patient because often melasma fades without treatment after pregnancy.
- Two percent HQ alone is sometimes ineffective. It is recommended for maintenance therapy.
- Good depigmentation can be achieved with 3%-4% HQ.
- Five percent to 10% HQ is very effective but can be irritating.
- A very effective combination is the use of hydroquinone 2%-5%, with or without corticosteroids.
- The prolonged treatment with >3% HQ preparation may cause ochronisis
- Lasers are NOT recommended for the treatment of melasma at present
- Chemical peeling alone or in combination with other depigmenting agents is effective in selected cases.
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Kew-Ho Kim
Injectables: Latest updates and techniques
Innovative treatment for skin trouble (Melasma, Acne, Freckle etc) by non-cross linked HA and dermal toxin using new injection
method
Melasma is a cosmetic problem that sometimes causes great emotional suffering. The two most important causative factors are sunlight and genetic
Background: There are some papers describing that mid-dermal replacement of Hyaluronic Acid on the face has rejuvenating effect by increasing the
hydration and elasticity which are the main factors in maintaining the youth. But, the conventional linear injection method has many disadvantages by
causing lump, ecchymosis, redness, tissue damage, pain and the waste of Hyaluronic Acid.
The new injection method using DermaQueen System aimed at eliminating the disadvantages of traditional linear injection method.
Material: Non-crosslinked Hyaluronic Acid, IAL-System, from Fidia, Italy is highly viscous solution in 1.1ml prefilled syringe.
Patient and Study Design: Eligible 16 female with age variation from 26 to 54 were selected. Each patient received Hyaluronic Acid Injection on whole
face except nose in three sessions: at the start of study, after 4 weeks and after 8 weeks.
Injections were done intra-dermally (approximately at the level of mid-dermis) by using Meso-Gun installed with 2x2 multi-needles. Averagely 100 shots
(400 shots singlely) were needed to cover the whole face, and each shot contained 0.0055 ml of Hyaluronic Acid.
Biophysical Evaluation: During each visit (second visit was 1 week after 1st injection), Hydration and Elasticity were measured with skin Test. Device,
Soft 5.5 from Callegari s.p.a., Italy.
Safety: Amongst 16 patients, 1 patient showed redness on the injection sites which disappeared after 3 days spontaneously.
Results: Skin hydration increased from 26.5 before treatment to 51 at visit 4 (just before 3rd injection) which means 92 % increase of hydration, the
elasticity changed from 5.2 to 9.6 during that period(85% increase). All the patient rated the therapeutic success as very good (85%), and good (15%) at
visit 4. Even expect for treatment of Melasma, Neck-Wrinkle soon
Conclusion: This study showed that intradermal Hyaluronic Acid injection improved the skin hydration and elasticity. Treatment using Injector with 2x2
multi-needles in vertical way could avoid the probable and undesirable complications and save the injection time and prevent waste of injection material.
Jeong Eun Kim
Extracorporeal shock wave therapy for body contouring by the cavitation effect
Aesthetic Medicine Techniques
Background: Despite the success of liposuction, there is the general trend toward more non-invasive procedures. Extracorporeal shock wave therapy
(ESWT) is an effective non-invasive procedure of body contouring. Extracorporeal shock wave creates compression cycles that exert positive pressure and
expansion cycles that exert negative pressure. This pushing and pulling effect can lead to rupture of fat cells and eventually cavitation.
Patients, materials, methods: The treatment group was forty-one women who had the purpose to reduce their thigh circumference for aesthetic
improvement. They were treated with ESWT twice a week for 4 weeks. The gluteal and femoral regions were treated with an air cylinder type- applicator.
The power was 5 bars and the frequency was 10Hz. The number of applied pulses per patient was 10,000. Treatment was performed by scanning the
treatment region with the applicator by moving the applicator both horizontally and vertically over the treatment region. The change in the fat level was
evaluated by measuring the circumference of the thighs and ultrasound. All patients were asked the score of subjective satisfaction with aesthetical
change. Every time of each procedure, all patients were monitored by one clinician to assess the complications.
Result: The loss of thigh circumference in treatment group was 1.97±0.85cm. The percentage of the loss to initial thigh girth was 3.41±1.43%. There was
significant change in ultrasound image before and after the treatment. The mean of the score of subjective satisfaction was 3.04±0.196 (range; 0~5).
Adverse reaction was absolutely zero percentage in this treatment group.
Conclusion: In this study, extracorporeal shock wave therapy is an effective method to improve a body contour by reduction of the volume of
subcutaneous fat. Moreover, this non-invasive treatment doesn't make any discomfort and doesn't need any down time.
Sun Ho Lee
Aesthetic Medicine Techniques
Gastrocnemius muscle volume reduction by radiofrequency-induced coagulation for an improvement in calf contour
Background: In Asian women, muscularly prominent calves, caused mainly by hypertrophy of the gastrocnemius muscle, are common aesthetic problem.
Procedures of Gastrocnemius muscle reduction that can achieve an aesthetical improvement include Botulinum toxin A injection, selective neurectomy
and radiofrequency-induced coagulation. This study was performed to evaluate the effectiveness and safety of gastrocnemius muscle reduction by
radiofrequency-induced coagulation.
Patients, material, methods: Gastrocnemius muscle reduction by radiofrequency was performed in 52 patients from June of 2006 through December of
2007. The operations were performed under local anesthesia. The radiofrequency energy (mean power, 25W±10%, mean frequency 470KHz) was delivered
via bipolar RF needle electrode inserted into gastrocnemius muscle layer. The expected target temperature was 60~80?. We ablated large portions of the
muscles by creating 10*5-mm-sized spots of coagulation. The numbers of spots created in each calf were 60 to 100 according to their volumes and
thickness. One week later, in a triamcinolone injection group (n=32), triamcinolone was injected into the coagulated muscles to induce a resolution of
postoperative edema. The patients visited the clinic regularly to check postoperative reactions for 5 weeks after the procedure. The results of the
procedures were evaluated in each case by comparative study of pre and postoperative clinical photographs, the measure of calf circumferences and the
score of subjective satisfaction with aesthetical change. We evaluated functional test including motor power, sensory change and range of motion.
Result: The mean of the reduction in calf circumferences at their thickest levels was 1.377±0.08cm. The mean of the score of subjective satisfaction was
3.04±0.196 (range; 0~5) (Figure1). Particularly, in a triamcinolone injection group (n=32), the result was better than a control group (non-injection group,
n=21) (Table 1). The reduction of calf circumference in a triamcinolone injection group was significantly higher than that of a non-injection group
(1.616±0.47 vs 1.024±0.54, P=0.001). There was no functional disability.
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Figure1. Clinical photographs representing a change of calf contour: (a) Preoperative photo , (b) Postoperative photo
Conclusion:
Gastrocnemius muscle reduction by radiofrequency is effective method to improve a calf contour with no functional disability. In this study, rapid
resolution of edema by a triamcinolone injection was a significant factor to achieve favorable results.
Grace M Lopez
Mechanisms and clinical signs of aging
Enhancing the skin - Part 2
Aging is an inevitable process which will happen to all of us. Aging skin refers to a whole spectrum of intrinsic (Chronological aging) and extrinsic
(photoaging) changes that occur as the individual grows older. The skin starts to age from the moment we are born. Pigmentary changes and wrinkles
are commonly seen in aging skin and other problems includes sagging, sallowness, coarseness, loss of fullness, skin growth, skin fragility and visible blood
vessels. Sun exposed areas of the skin, such as face, neck, upper chest, hands and forearms are the sites where these changes occur most often.
The molecular changes of photoaging are considered to be an augmentation and amplification of the molecular changes associated with chronologic skin
aging.
In this lecture will focus on review on aging and photoaging. Mechanisms which underline these processes. Newer techniques and Restorative cosmetic
procedures available for skin rejuvenation which aimed at removing or reducing the problem and reverse the existing damage associated with aging skin
will be discuss.
Chariya Petchngaovilai
Botulinum toxin injection: The art of the science.
Injectables: Latest updates and Techniques
As times passes, the concept of botulinum toxin injection has been greatly evolved. At the current stage, it is not only employed as a wrinkle reduction
nor facial rejuvenation, but also as a technique to retain a "natural appearance". In order to achieve this pleasing outcome, it is significant to retain some
muscle function to allow expression. The intradermal injection technique, a variation of conventional intramuscular technique, is an efficient procedure
to minimize wrinkling while maintaining the muscle function. The technique inhibits only the superficial part of the muscle that inserts in the skin and
allows the deeper part to function. This technique, either by implementing individually or by combining with a conventional intramuscular technique, is
able to bring out the satisfiable outcome.
Savardekar Preeti
Asian Face: Treating pigmentation & hollowing of peri orbital Area.
Enhancing the skin - Part 2
Background: Traditionally, Asians Age more gracefully than Caucasians. The resistance to ageing being credited to a thicker dermis with more collagen
& darker pigment which protects against photoageing. However, due to being subjected to a greater amount of gravitational force because of a weaker
skeletal support, heavier soft tissue, larger amount of malar fat, thicker skin & weaker chin, most asians are seen to have peri orbital pigmentation & infra
orbital rim hollows as they age. This is also partly due to the hypoplastic nature of the malar bone, lower nasal bridge & more superficial orientation of
the orbital socket. With ageing, there is upper cheek fat loss with secondary sagging of upper cheek muscles (midface descent). The age of an asian is
easily guessed from examination of the peri orbital area.
Method: 25 patients with dark circles & prominent nasojugal folds around the eyes were included in the study. Patients with asthama & allergies were
excluded. Eye gel containing Haloxyl was used daily at night by the patients. Lactic acid (90%) & Glycolic acid (20% and 35%) peels were performed
every 10 days on the peri orbital areas. For infra orbital hollows- tear trough - hyaluronic acid fillers were injected below the skin around the orbitomalar
22
ligament to lift up the tissues making the tear trough appear shallower.
Results: The treatments were well tolerated & were virtually painless as numbing local anaesthetic cream was used before injections. Patients noticed
visible lightening of dark circles after 6-8 sessions of peels and the hollowness being filled up with hyaluronic acid fillers made the tear trough look
rejuvenated inspite of deep setting of eyes & hereditary predisposition.
Conclusion: Dark circles appear with thinning of skin & loss of collagen under the eyes due to ageing, stress, anemia, heredity & shadowing of the brows.
Plumping up of under eye skin with peels, dissolving hemosiderin pigment with the use of Haloxyl & filling up of tear trough folds with hyaluronic acid
injections can lead to complete eye rejuvenation without any surgery or side effects.
Worapong Manuskiatti
Fractional RF for treating acne scars in Asians
Enhancing the skin - Part 1
The application of skin laser resurfacing in dark-skinned individuals remains a challenge. Selection of appropriate laser systems and treatment parameters
is important for obtaining the optimal clinical results with limited morbidity. Ablative laser resurfacing (ALR) with high-energy pulsed CO2 and Er:YAG
lasers has been shown to be an effective treatment of acne scars, although when resurfacing patients with skin type IV or above, the almost universal
appearance of transient PIH necessitates prompt and persistent intervention.
Fractional laser resurfacing technique based on the principle of fractional photothermolysis (FP) has recently been introduced to address the drawbacks
of both ALR with its significant side effects and nonablative dermal remodeling with its limited efficacy. The first device to implement the FP concept
utilized a 1,550-nm erbium-doped fiber laser to thermally coagulate microscopic columns of dermal tissue in regularly spaced arrays over a fraction of
the skin surface with little to no ablative effect on the epidermis. With absence of significant epidermal disruption, this technique has been classified as
non ablative fractional resurfacing (NAFR). Although NAFR has a patient-friendly advantage, the outcomes of most NAFR lasers still leave much to be
desired in the treatment of photodamaged skin, rhytides, and atrophic scars.
Ablative fractional resurfacing (AFR) using CO2 and erbium:YAG laser systems represents a novel choice in the available skin resurfacing spectrum
modalities by offering the ability to ablate the epidermis and heat the dermal tissue at a deeper level. Recent studies have shown favorable outcomes for
atrophic acne scars and photoaged facial skin, following CO2 and erbium:YAG AFR. However, this novel resurfacing technique still requires at least one
week of recovery time and is also associated with some adverse effects, especially in dark-skinned phototypes.
Fractional bipolar radiofrequency energy has recently been introduced to address some limitation of ablative and non ablative fractional laser resurfacing.
RF-based technologies are capable of producing higher volumetric heating via tissue impedance with subsequent heat diffusion to deeper tissue compared
to laser-based technologies. Efficacy and safety of a novel fractional bipolar radiofrequency system for treatment of atrophic acne scars in Asian patients
will be discussed.
Worapong Manuskiatti
TriPolar radiofrequency for body contouring and cellulite reduction
Fat Tissue
Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok Thailand
Background: A wide variety of treatments for circumference reduction and cellulite are available, but most procedures offer suboptimal clinical effect
and/or delayed therapeutic outcome.
Objective: To determine the safety and efficacy of the TriPolar radiofrequency device for cellulite treatment and circumference reduction.
Methods: Thirty-nine females with cellulite received eight weekly TriPolar treatments. Treatment areas included the abdomen, thighs, buttocks and arms.
Subjects were evaluated using standardized photographs and measurements of body weight, circumference, subcutaneous thickness, and skin elasticity
of the treatment sites at baseline, immediately after and 4 weeks after the final treatment. Physicians' evaluation of clinical improvement scores using a
quartile grading scale was recorded.
Results: Thirty-seven patients (95%) completed the treatment protocol. There was significant circumference reduction of 3.5 and 1.7 cm at the abdomen
(P = 0.002) and thigh (P = 0.002) regions, respectively. At 4 weeks after the last treatment, the average circumferential reductions of the abdomen and
thighs were sustained. No significant circumferential reductions of the buttocks and arms at the last treatment visit compared to baseline were
demonstrated (P = 0.138 and 0.152, respectively). Quartile grading scores correlating to approximately 50% improvement in cellulite appearance were
noted.
Conclusion: Tripolar radiofrequency provided beneficial effects on the reduction of abdomen and thigh circumference. These effects of treatment
appeared to be prolonged. Maintenance treatments may be necessary to further enhance the clinical results achieved.
Vanessa Phua
The latest trends in combination peels
Aesthetic Medicine Techniques
Chemical peels are used as a single treatment modality, or an adjunct to skin rejuvenation. Combination peels have multiple functions as they contain
different acids that target different cutaneous disorders ranging from acne, melasma and photodamage, all of which have a regenerative mode of action.
Jinda Rojanamatin
Aesthetic design in facial rejuvenation
Facial rejuvenation with injectables
Department of Dermatosurgery and Laser, Institute of Dermatology, Bangkok, Thailand
Aging is a biological process of tissue involution resulting in the appearance of rhytides, blotchy discolorations, subdermal atrophy and sagging skin. The
physicians must appreciate the changes associated with aging and have a sense of beauty to assess the condition and quality of skin, soft tissue including
supportive structures in these patients.
The basis for these analyses rests in the proportion of the face, muscle tone, volume of subcutaneous tissue and quality of healthy skin. In order to restore
youthful features of the face, the physicians must consider the changes in facial shape and proportion produced over the time as well as altered quality
of the skin and substructure associated with aging. To achieve a good practice in cosmetic dermatosurgery, the physicians need to know characteristics
23
of a perfect face. Generally, we separate the face into three parts as upper, middle and lower parts. Each part has its own characteristics. In addition, it
is necessary to understand the value and application of facial analysis. Through an integrated model of aging, the physicians can interpret age-related
changes in the context of a patient's unique facial features and design a purpose of treatment plan that can promote proper beauty of each person.
Elena E. Rumyantseva
Enhancing the skin - Part 2
A new concept of revitalization of the skin with a particular cluster of Amino Acids: how to improve and prolong results of aesthetic
procedures.
Almost all aesthetic procedures which should be dedicated to aging skin treatment can be functionally divided into 2 groups: stimulation and replacement.
During the first type of procedures like peels, fractional laser, radio frequency lifting, IPL, injections of stabilized HA all rejuvenation potency of the skin
correlates with activity of fibroblasts and possibility of collagen synthesis. Second group includes volumazing injections, synthetic implants, threads, stem
cells, etc. There is a special anti-aging treatment which provides both activities - amino acids (AA). These unique molecules are the only substrate really
necessary for promoting the synthesis of any protein. The adequacy of type and number of AA required for protein synthesis can be predicted on the basis
of the quality and quantity of AA present in each protein. But collagen synthesis is different because some of its AA should be provided in the precursor
form to activate the synthetic drive by fibroblasts. Therefore, collagen synthesis is efficiently maintained only when those specific AA are continuously
available and present in a specific ratio.
A functional cluster of AA that is suitable for collagen synthesis promotion is protected by patents and is widely available in Europe in the form of dietary
supplement (Proglyme® - beauty drink -) and for topical use (Vulnamin® - chronic wounds treatment, Scaramin® - small wounds & cuts, Mucosamin® irradiation damage care, Aminogam® - lesions & inflammation, periodontal disease, Proglyme® - cosmeceuticals) and for intradermal use (Jalupro®).
Three Amino Acids (Glicine, L-Proline, L-Lysine), which are contained in these products are essential to form collagen and to compensate the reduced
fibroblasts activity. Important that the local injections of this formulation of AA provide a chemotaxis of fibroblasts. So the choice of the injection site
allows the physician to drive fibroblasts to the target area where the promotion of the collagen synthesis is required (for instance, wrinkles, stretch marks,
etc).
Furthermore, a dermis from a wrinkle distinguishes from other skin: an activity of MMPs (MMP1, MMP9) significantly increases, a migration capacity and
a contractile activity significantly decreases. According to this data the injections of AA are a part of the pathogenetical treatment of aging skin.
Delivery of proper AA for fibroblasts feeding stimulates also production of growth factors (TGFß) and multiplication of fibroblasts, thus, activating all
those complex balances of the catabolic-anabolic pathways that restore a normal structure of dermis.
I our clinical practice we use several combined protocols which allow us to get better and longer results. Most valid combinations is with superficial and
TCA peels, fractional laser, radiofrequency tightening and rejuvenation treatment.
In case of thin and loose skin the course of AA injections should done before any kind of peels.
For other indications: superficial peel make just before injections of AA during first 4 procedures or on complete recovery skin after the course of TCA
peels.
AA therapy is a necessary addition to a course of revitalization with non animal stabilized hyaluronic acid injections. Jalupro injection is recommended 2
weeks before and after the NASHA procedures or in 4-6 months after the whole course to support the function of fibroblasts and prolong the result.
Proglyme should be prescribed daily per os during 2-3 months.
Combination with medical devices provides quicker and better result during anti-age treatment.
Intradermal implants (Jalupro) is recommend to inject twice (15/30 days) before laser resurfasing and 6 times after treatment. During fractional laser
rejuvenation (we use Sellas, Dinona Inc., South Korea) which consist of 3-5 procedures each month Jalupro should be injected in 2 weeeks after every
procedure. Proglyme per os 2 vials a day for the week before laser, 1 vial a day for 4 months after laser in both cases. 2 intradermal implants (Jalupro)
before Thermage (15/30 days before RF) and 6-8 intradermal implants (every 30 days) after treatment. Proglyme 2 vials a day one week before treatment,
1 vial a day for 6 months after procedure. It's also possible to combine these products with plastic surgery and IPL treatment
Therefore, described cluster of AA is an indispensable nutritional basis for the mono therapy or like a part of complex anti-aging treatment.
SK Tan
Aesthetic Medicine Techniques
Exogenous ochronosis: A complication of hydroquinone therapy is more common than you think
Hydroquinone is universally accepted to be the most effective skin-lightening ingredient available. However, it is not without complications. Exogenous
ochronosis is one of them and, previously thought to be rare outside of Africa, has been diagnosed in our cohort of patients.
With this presentation we hope to make doctors aware of this condition and, hopefully, to be able to recognise and differentiate it from other
hyperpigmented conditions of the face as an early diagnosis necessitates immediate discontinuation of hydroquinone, rather than increasing the
concentration in an attempt to clear the hyperpigmentation.
Pakpilai Thavisin
Autointoxication and Skin Health
Enhancing the skin - Part 2
S Medical Spa, Thailand
Autointoxication is the poisoning of the body, or some part of the body, by toxic matter generated inside the body particularly colon, causing "Toxic Colon".
Modern diet consisting of high saturated fat, high animal protein, highly processed carbohydrate and less fiber, causes constipation, toxin accumulation,
acidity and imbalance of the normal flora in bowel with yeast overgrowth.
Intestinal constipation increases the workload of other excretory organs such as kidneys, liver, lungs, lymph and SKIN and causes cellular constipation.
Cellular constipation causes sluggish metabolism, delayed repair and growth, increase inactive and dead cell, decline tissue and organ functions which
show thru skin appearance.
Autointoxication symptoms includes: skin rash, blemishes, dullness, chronic inflammation, seborrheic dermatitis, allergic reaction, frequent colds, CFS,
PMS, malabsorption, overweight and many other systemic symptoms.
24 To treat some skin problems effectively we need to consider the gut health and eliminate the autointoxication.
Ines Verner
Facial Rebalancing by Fillers and Injection Lipolysis
Facial rejuvenation with injectables
The youthful face is rounded and convex, has many light reflecting arcs, highlights and rare shadows. This is mainly due to abundant subcutaneous fat
with an even distribution and a dermis full of dense collagen and elastic fibers.
The aging face is angular and concave, has flattened arcs, few highlights and many shadows. This is due to loss of fat tissue with uneven fat distribution
and a dermis with damaged collagen and elastic fibers. We see many "valleys and hills" wherein the valleys are areas of fat atrophy and the hills are areas
of fat excess.
Fat atrophy may be seen in the upper face, the midface and the lower face (e.g. malar area, nasolabial fold and prejowl sulcus) whereas fat hypertrophy
is mainly seen in the lower face (jowl and submental area). With increased body fat, we may also see fat hypertrophy in the midface (e.g. lateral to the
nasolabial folds).
A possible approach to facial rejuvenation is to redistribute facial volume to patterns seen in the youthful face by removing volume from the hypertrophic
areas and adding volume to the atrophic areas.
This can be achieved by removing the excessive fat by liposuction from the hypertrophic areas and filling in the atrophic areas by fat transplantation.
However removing and transplanting fat tissue still represents a major procedure which has variable results. In recent years with the development of the
newer fillers it has become possible to fill up the atrophic facial areas by soft tissue fillers with excellent results.
Recently it has also become possible to reduce excessive facial fat by injection lipolysis with phosphatidylcholine and deoxycholate.
In this presentation I will present the combination of using fillers for the atrophic facial areas and injection lipolysis for the hypertrophic areas of the
face.
The combination of these advanced non invasive cosmetic procedures will be discussed and patient cases will be presented.
Ines Verner
Lips and perioral rejuvenation
Facial rejuvenation with injectables
The lips are the aesthetic focus of the lower face. When they are full and well defined they convey health, beauty and attractiveness. With aging the lips
and perioral area change and lose their volume and shape.
But even though, many of our younger and older patients seek lip enhancement, very little information on the aesthetic characteristics of the lips has
been published in the dermatologic and plastic surgery literature. As no apparent guidelines for lip enhancement were available, many have used their
personal taste. Thus a lot of attention has been paid to volume and not so much to the right shape of the lips leading many times to improper,
unsatisfactory lip enhancement with artificial results.
Above all, the lips and perioral area should have a natural look and the enhancement should not be apparent.
To be able to achieve a natural looking lip it is important to be familiar with the desired lip architecture, the different suitable fillers available and with
the right technique to achieve the desired result.
In this lecture I will discuss lip and perioral area anatomy together with the suitable fillers and the different technique for rejuvenation.
Ines Verner
Non invasive skin rejuvenation using radiofrequency
Aesthetic Medicine Techniques
Many changes are seen on our skin due to aging. The main changes are dyspigmentation, rough surface, solar lentigines, teleangiectasia, wrinkles and
skin laxity.
The histological changes that accompany these clinical changes are found mainly in the epidermis and upper dermis and are therefore amenable to skin
resurfacing.
Skin resurfacing, traditionally performed by chemical peels and light sources (lasers or IPL's), has evolved rapidly over the past two decades. As a rule,
ablative resurfacing can give excellent results but the massive injury to epidermis and dermis is associated with a high risk for complications and a
prolonged recovery requiring downtime. Non-ablative resurfacing on the other hand has a low risk for complications, very few side effects but the clinical
results are very modest.
More recently fractional radiofrequency (RF) resurfacing has been introduced. In this form of resurfacing fractional ablative radiofrequency is used to
ablate and heat tissue and to thus achieve new collagen formation with tissue tightening and overall skin rejuvenation.
In this presentation we will discuss the newer RF technologies for skin rejuvenation. Clinical studies showing remarkable skin rejuvenation, high safety
and minimal downtime with a new fractional ablative RF device (eMatrix by Syneron Medical Ltd) will be presented and discussed.
Ines Verner
Study on hand rejuvenation with Radiesse
Injectables: Latest Updates and Techniques
Background and Aims: Growing attention is paid to the aging hand in recent years. In the aging hand we see disappearance of subcutaneous fullness
(volumetric changes) with the appearance of prominent veins, tendons and joints and deepening of the intermetacarpal spaces. We may also see
dyspigmentation, solar lentigines and wrinkles (photoaging changes). Numerous treatments are available for the changes induced by photoaging (e.g.
chemical peels, IPL's, lasers, liquid nitrogen and others) but only few options are available for the volumetric changes. Volumetric changes can be either
treated by fat transplantation, a surgical procedure with variable results) or by fillers. One of the fillers that have been suggested to have a good durability
and safety is Radiesse. The aim of this study was to evaluate the durability and safety of Radiesse after injection to the back of the hands.
Materials and Methods: Females with noticeable skin thinning & loss of subcutaneous fullness of the dorsal hands received Radiesse diluted lidocaine
injections in multiple points to the back of both hands. Patients were assessed clinically and photographically directly after, at one month, at three months
at six months and at twelve months after injection. Each time patient and physician satisfaction were assessed (GAIS scale).
25
Results: 10 females aged 49-73 (M=59.4) completed the study. The mean volume injected per hand was 1.0 cc of Radiesse. Remarkable improvement was
seen in all patients directly after the treatment. At 3, 6 and 12 months 4 patients were satisfied and 6 patients were extremely satisfied. The physician
satisfaction rating was much improved in 3 cases and very much improved in 7 of the cases. Except from one patient who had subcutaneous hematoma
and swelling that resolved within 2 weeks no considerable side effects were seen.
Conclusions: Radiesse is very effective for volumetric hand rejuvenation, has a good durability, good safety profile and a high patient satisfaction.
Ines Verner
Study comparing fractional radiofrequency resurfacing to chemical peels
Laser, Lights and related technologies
Ruthie Amir, Ulrich Toft, Boris Vaynberg
Background & Aims: Skin resurfacing, traditionally performed by chemical peels and light sources (lasers or IPL's), has evolved rapidly over the past 2
decades. As a rule, ablative resurfacing can give excellent results but the massive injury to epidermis and dermis is associated with a high risk for
complications and a prolonged recovery requiring downtime. Non-ablative resurfacing on the other hand has a low risk for complications, very few side
effects but the clinical results are very modest. More recently fractional radiofrequency (RF) resurfacing has been introduced. In this form of resurfacing
fractional ablative radiofrequency is used to heat tissue and to thus achieve tissue changes due to heating and new tissue (collagen) formation. The aim
of this study was to compare a new fractional RF resurfacing device (eMatrix by Syneron Medical Ltd.) to traditional 20% TCA chemical peels.
Materials & Methods: In a split face study each patient received 3 treatments with the eMatrix on one side of the face and 3 treatments with 20% TCA
chemical peel on the other side of the face. The interval between the treatments was 3-5 weeks. Patients were followed up for 6 weeks after completing
the treatment protocol. Subjects were evaluated clinically and photographically by the Fitzpatrick elastosis scale and separately for skin tightness,
brightness, smoothness, fine lines and wrinkles and dyspigmentation.
Results: Eighteen patients with a mean age of 53 completed the study. We observed a significant improvement in the Fitzpatrick elastosis scale from a
mean score of 5 (moderate elastosis) to 3.4 (mild elastosis) on the eMatrix side vs a slighter improvement from 5 to 4.1 (moderate elastosis) on the TCA
peel side. Tightness improved remarkably only on the eMatrix side and not at all on the TCA peel side. Skin tone, brightness and dyspigmentation improved
about equally on both sides. The mean patients satisfaction (GAIS scale) for the eMatrix was 3.4 (satisfied to very satisfied) and 2.4 (moderately satisfied
to satisfied) for the 20% TCA side. Both treatments were well tolerated, the downtime was minimal and no complications were seen.
Conclusions: It can be concluded that three facial treatments with the eMatrix were superior to three treatments with a 20% TCA chemical peel.
Fractional RF resurfacing by the eMatrix is a very safe treatment that leads to remarkable skin rejuvenation with minimal downtime.
Sabine Zenker
Global facial shaping with calciumhydroxylapatite
Facial Rejuvenation with Injectables
Background: Over the last decades, augmentation of facial lines and folds and the restoration of facial volume loss due to aging have become more
accessible and socially acceptable. Longer durable global facial volume restoration is the main goal of treatment, providing a more youthful appearance
and reduction of the prominence of lines, folds and fat loss.
Calciumhydroxylapatite is a resorbable, biodegradable, longlasting filler ideal especially for global facial volumisation. It has shown an increasing use in
the aesthetic treatment regimen world-wide for soft tissue augmentation certainly of the face and the hands, in part due to the lifting- and volumizing
capacity of the products. We started using this product as a line filler but have progressed to use as a facial reshaping agent.
Objective: Data will be presented on measurements of the intrinsic capacity to volumize and provide tissue-lifting as compared to several commonly used
dermal fillers.
Moreover, the effects of adding an anaesthetic agent to the CaHA-product will be discussed in relation to pain reduction during the treatment and to
avoid local tissue infiltration or nerve blocks. Practical guidelines how to inject CaHA are shown via short video sessions.
Conclusion: Calciumhydroxylapatite advanced to be the longest lasting biodegradable filler for global facial augmentation. It`s lifting and volumizing
capacity fullfills the needs for a longlasting aesthetic result.
Sabine Zenker
Carboxytherapy for skin rejuvenation and stretch marks
Aesthetic Medicine Techniques
Background: Carboxytherapy consists in the therapeutic use of carbon dioxide (CO2) on its gaseous state, either transcutaneous or by subcutaneous
injection.
When administered sub-cutaneously, CO2 immediately diffuses at the cutaneous and muscular microcirculatory level. At the vascular level, CO2 increases
vascular tone and produces active vasodilatation at the microcirculatory level. In addition, this promotes Bohr's effect, a mechanism that allows tissular
CO2 transfer to lungs and lung O2 transfer to tissues through the oxy-hemoglobin dissociation curve. When administered through an external route, CO2
promotes this mechanism, resulting in a higher tissular oxygenation and neoangiogenesis.
Carboxytherapy already proofed it`s efficacy and safety widely in the medical field.
The administration of CO2 for aesthetic indications is still an emerging and very promising tool combinable with all other modes already existing for
skinrefining.
Objective: This workshop is dedicated to explain, summarize and finally show common clinical applications of medical carbondioxide for aesthetic
indications such as skinrejuvenation, rythides and dark circles round the eyes, stretchmarks and scars.
Conclusion: The injection of medical CO2 gas is simple, efficient and encounters low risk.
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Sabine Zenker
Injectables: Latest updates and techniques
Innovative filling techniques for hyaluronic acid thanks to a new way of ha-injections: Objective analysis of the new automatic
injection system
Introduction: The development of new methods of delivering fillers such as hyaluronic acid will represent a big step forward for physicians and their
patients as pain, bruising and swelling can be reduced as well as the precision and finally the aesthetic outcome can be improved by using new injection
techniques thanks to an automated HA-delivery-system.
Objective: To show and visualise these benefits claimed, as well as seen in any clinical case and after assessing the patients on subjective scales, a clinical
investigation was performed to visualise the effects of the two modes of injection. A patient was injected with Fortelis extra on nasolabial folds, vermillion
border of the upper lip as well as corners of the mouth. The same 27G needle was used, as well as the same amount of material on both injection sides.
A split-face technique was performed: the right side was by standard injection, the left side by AIS-injection.
To assess the effect objectively after implantation of the HA, the Canfield-3D-Vectra-System was used. We matched the pre- and post-pictures together
to compare the difference in terms of tissue reaction between the both injection sides.
Result: The imaging system shows that the tissue reaction on the AIS-side is less disruptive and significantly less in terms of oedema. Furtheron, the
aesthetic result is far more subtle, smoother and the placement of the implant is far more targeted and better controlled.
Conclusion: All these benefits seem to come from a proprietary technology of regulating flow speed and pressure while injecting an HA with an
automated system. Apparently this does lead to a far-less traumatic injection of hyaluronic acid. This is the first time this significant difference in terms
of dermal effects and tissue reaction has been shown objectively by 3D-analysis.
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Abstracts
Anti-Aging Medicine
James Betz
Human clinical trials elucidate the health benefit of Resveratrol
Anti-aging and prevention
Since about 1989, in vitro studies and investigations of resveratrol's properties and bio kinetics have been undertaken by hundreds, if not thousands, of
researchers and research organizations in Asia, Europe and the US. These studies have produced a substantial record of consistent replicable data and
conclusions pertaining to the effects of this compound and the various modalities via which it operates in cells and tissue. The missing link however has
been reliable human clinical trial data which bridges the gap between the laboratory work and the potential health effects of resveratrol in the human
organism.
Just over the past several months some very encouraging clinical trial results have been published which finally begin to elucidate the mechanisms and
processes by which resveratrol regulates human biological functions, and, by inference, may have remarkable preventative and therapeutic potential visa-vis the major age and obesity related diseases which are an unfortunate consequence of our 21st Century life style.
This talk explores the biological, epigenetic, and biochemical effects of resveratrol and describes their potential benefits with respect to diabetes, cancer,
inflammatory diseases, longevity and neurological protection.
Tatsuo Ichinohe
Clinical studies of HLA-haploidentical hematopoietic stem cell transplantation
Stem Cells and Growth Factors
Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University
Background: Recent studies in mice and humans have suggested that the detection of microchimeric fetal or maternal nucleated cells in peripheral
circulation, a consequence of feto-maternal bidirectional cell traffic during pregnancy, may be an indicator of acquired immunologic hyporesponsiveness
to inherited paternal histocompatibility antigens (IPA) in mothers or non-inherited maternal antigens (NIMA) in their progeny. Although transplanted
immune cells from an HLA-haploidentical donor frequently cause severe graft-versus-host disease (GVHD) in the setting of allogeneic hematopoietic stem
cell transplantation (HSCT), selection of a microchimeric related donor for the corresponding IPA- or NIMA-mismatched recipient may prevent this from
happening. Therefore, we performed a prospective study to evaluate the safety and efficacy of T-cell replete HSCT from HLA-haploidentical family
members harboring long-term fetal or maternal microchimerism.
Methods: A total of 12 patients with high-risk or chemorefractory leukemia who lacked an immediate access to conventional hematopoietic stem cell
sources were enrolled from 8 centers. They had a median age of 23 (range, 14-49). After administration of myeloablative conditioning consisted of highdose chemoradiotherapy, bone marrow (n=6) or G-CSF-mobilized peripheral blood (n=6) grafts collected from their mother (n=5), NIMA-mismatched
sibling (n=6), or daughter (n=1) were infused without ex vivo T-cell depletion. All patients received tacrolimus and short-term methotrexate for GVHD
prophylaxis.
Results: Hematopoietic engraftment was achieved in all but one patient who experienced early death from pneumonia. Of these 11 patients, 5 developed
grade II-IV acute GVHD: grade II in 1 and grade III in 4. Extensive chronic GVHD was observed in 4 of 9 evaluable patients. With a median follow-up of
43 months, 6 patients were alive in remission 17 to 52 months after transplantation.
Conclusions: HLA-haploidentical HSCT from microchimeric NIMA-mismatched family members conferred promising long-term survival rates in patients
with high-risk or advanced leukemia, although further efforts are warranted to reduce the risk of severe GVHD and to evaluate its efficacy in a larger
clinical trial.
Eugenio Luigi Iorio
The integrated approach of Redoxomics and its implications in Aesthetics and Anti-aging Medicine
Detoxification
International Observatory of Oxidative Stress. Salerno (Italy)
The systematic evaluation in biological samples of primary oxidant chemical species (OCS), like free radicals, and their derivatives, like hydroperoxides, as
well as the dosing of antioxidant compounds/activities, like selenium and glutathione peroxidase, respectively, are not a terminal "ring" in the diagnostic
chain of informational flow in biological systems (DNA->RNA->PROTEINS->METABOLITES->OXIDANTS) but should take a "central" place compared to
genomics, transcriptomics, proteomics and metabolomics (1).
For this reason recently we introduced the novel concept of "redoxomics" (2) (a term previously and ambiguously used to identify only some oxidised byproducts in the field of proteomics) (3).
Redoxomics is a novel branch of "applied biochemistry" and "molecular diagnostics" having the following aims:
- to analyse the structure, the physiological role and the distribution of oxidant and antioxidant systems in a living organism;
- to identify the reciprocal interactions of oxidant and antioxidant systems - in the general flow of information - in a biological system (cell, tissue,
organ, apparatus, system, whole organism) in a defined step of its development, in basic conditions as well as after potentially stressful stimuli;
- to evaluate the implications of these findings by the view-point of epidemiology, patophysiology, clinics, pharmacology and so on (4).
The ambitious goal of redoxomics (as well as for other "-omics" in other fields) is "to map" dynamically - by means of all the available and sophisticated
analytical techniques, from electron spin resonance to imaging - the whole oxidative-antioxidant repertoire, i. e. the "redoxoma" of a living unit in
different conditions (5).
This "integrated" approach by allowing to monitor every qualitative/quantitative changes of oxidative balance can help the clinicians to find the optimal
and the "personalised" solution to correct any eventual abnormality of redox status associated to human diseases, especially in the field of Aesthetics and
Anti-aging Medicine (6).
28
References
1. Iorio EL, Ferreri C. Lipidomics [original title "Lipidomica"]. In Italian Treatise of Laboratory Medicine [original title "Trattato Italiano di Medicina di Laboratorio"].
Eds Angelo Burlina, Piccin, Padua (Italy). 2009. 341-360.
2. Iorio EL, Marin MG. Redoxomics. An integrated and practical approach to genomics, metabolomics and lipidomics to manage oxidative stress. 2008. Gen-T. 2:
67.
3. Dalle-Donne I, Scaloni A, Butterfield DA. Redox proteomics: from protein modifications to cellular dysfunction and diseases. 2006. Wiley Press, New York.
4. Iorio EL. New perspectives in oxidative stress research: the Redoxomics. Proceedings International Conference on Advances in Free Radicals Research, Natural
Products, Antioxidants and Radioprotectors in Health - Ninth Annual Meeting of the Society of Free Radical Research India. January 11th-13th, 2010. Hyderabad
(India). 2010. 26-27.
5. Iorio EL. The novel field of Redoxomics. Proceedings BIT Life Sciences' 3rd Annual PepCon-2010. March 21th-23th , 2010. Beijing (China). 2010. 283.
6. Iorio EL, Balestrieri ML. The oxidative stress [original title "Lo stress ossidativo"]. In Italian Treatise of Laboratory Medicine [original title "Trattato Italiano di
Medicina di Laboratorio"]. Eds Angelo Burlina, Piccin, Padua (Italy). 2009. 533-549.
Eugenio Luigi Iorio
Selected articles and published studies on oxidative stress
Nutrition and Nutrigenetics
International Observatory of Oxidative Stress. Salerno (Italy)
1. Iorio EL. Courses of food education in the schools: to eating well - to eating safely [original title "Corsi di educazione alimentare nelle scuole: mangiare
bene - mangiare sicuro"]. Scientific Nutrition Today. 2000. 2: 17.
2. Iorio EL. Mediterranean diet and oxidative stress [original title "Dieta mediterranea e stress ossidativo"]. Proceedings Conference "The Mediterranean
Diet". April 7-9, 2000. Salerno, Italy. 2000. Pp. 4-5.
3. Liotti F, Maselli R, De Prisco R, Iorio EL, De Seta C, Sannolo N. Oxidant agents in work environment and professional bronchopneumopathies [original
title "Agenti ossidanti in ambiente di lavoro e broncopneumopatie professionali"]. Proceedings Meeting "Giornate Scientifiche della Facoltà 2000". May
17-19, 2000. Second University of Naples. Naples, Italy. 2000. Pp. 555-556.
4. Capunzo M, Iorio EL, Cavallo P. Correlation between oxidative stress and plasma lipids levels: results of a preliminary study [original title "Correlazione
fra stress ossidativo e livello di lipidi plasmatici: risultati di uno studio preliminare"]. I Quaderni dell'Università di Salerno. 2001. 91-102.
5. De Prisco R, Attianese P, Lione D, Balestrieri C, Iorio EL. Oxidative stress and serum lipids. Proceedings 10th Congreso Italo-latinoamericano de
Etnomedicina. September 23-28, 2001. Isla de Margarita, Venezuela. 2001.
6. Iorio EL, Carratelli M, Quagliuolo L, Caletti G. Oxidative stress evaluation in athletes Proceedings 2nd International Conference on Oxidative Stress and
Aging. April 2-5, 2001. Maui, Hawaii (USA). 2001. P. 60.
7. Iorio EL, Carratelli M, Alberti A. A simple test to monitor the oxidative stress by evaluating total serum hydroperoxides. Proceedings 2nd International
Conference on Oxidative Stress and Aging. April 2-5, 2001. Maui, Hawaii (USA). 2001. P. 25.
8. Iorio EL, Escalona M, De Prisco R, Attianese P, Carratelli M. Impairment of redox balance in obesity. Proceedings 10th Congreso Italo-latinoamericano
de Etnomedicina. September 23-28, 2001. Isla de Margarita, Venezuela. 2001.
9. Iorio EL, Quagliuolo L, Carratelli M. The d-ROMs test: a method to monitor oxidative stress in vascular diseases [original title "d-ROMs test: metodo di
monitoraggio dello stress ossidativo nelle patologie vascolari"]. Minerva Cardioangiologica. 2002. 50 (6, Suppl. 1): 143-144.
10. Iorio EL. Oxidative stress as a health risk factor. The role of environment factors. [original title "Lo stress ossidativo quale fattore di rischio per la salute.
Il ruolo dei fattori ambientali"]. Proceedings Giornate Medico-Chirurgiche Romane "Ambiente: salute o malattia". October 31, 2003. Rome, Italy. 2003.
11. Iorio EL. The global assessment of oxidative stress [original title "La valutazione globale dello stress ossidativo"]. Il Patologo Clinico. 2003. 5/6: 155159.
12. Iorio EL, Boccellino M, Balestrieri P, De Prisco, R, Quagliuolo L. d-ROMs test and oxidative stress assessment. Rendiconti e Atti della Accademia di
Scienze Mediche e Chirurgiche. 2003. 157: 49-61.
13. Balestrieri ML, De Prisco R, Nicolaus B, Pari P, Schiano Moriello V, Strazzullo G, Iorio EL, Servillo L, Balestrieri C. Lycopene in association with ?tocopherol or tomato lipophilic extracts enhances acyl-platelet-activating factor biosynthesis in endothelial cells during oxidative stress. Free Radical
Biology & Medicine. 2004. 36 (8): 1058-1067.
14. Carratelli M, Iorio EL. Potential usefulness of oxidative stress in nutrition and food supplementation. Proceedings IV Greek Congress on Free Radicals
and Oxidative Stress. October, 7-10, 2004. Larissa, Greece. 2004. P. 15.
15. Iorio EL. d-ROMs test and global assessment of oxidative stress [original tile: "Il d-ROMs test e la valutazione lobale dello stress ossidativo"]. Diacron
International Eds. Grosseto, Italy. 2004.
16. Iorio EL. d-ROMs test in sport. Cosmetic News. 2004. 157: 272-275.
17. Iorio EL. Oxidative stress and nutrition. Proceedings VI Macedonian Nutrition Congress. November 19-21, 2004. Thessaloniki, Greece. 2004. Pp. 143144.
18. Iorio EL. Oxidative stress and nutrition [original title "Stress ossidativo ed alimentazione"]. In "Comunicazione ed educazione alimentare". III Edizione
a cura della Centrale del Latte Salerno (Salerno, Italy). 2005. 13-16.
19. Iorio EL. Oxidative stress, sport trauma and rehabilitation. New proposals for an integrated approach. Proceedings XIV International Congress on Sports
Rehabilitation and Traumatology "The accelerated rehabilitation of the injured atlete". April 9-10th, 2005. PP 127. Bologna, Italy.
20. Iorio EL. The global evaluation of oxidative stress. The role of the laboratory [original title "La valutazione globale dello stress ossidativo. Il ruolo del
laboratorio"]. Proceedings Congress "Reactive oxygen species: biochemistry, pathology, prevention, laboratory". Palermo, Mondello Palace Hotel. May 25th,
2005. Palermo, Italy. 2005. P. 27.
21. Iorio EL. Thermal medicine and oxidative stress. Rev Latinoamer Quim. 2005. 33 (suplemento especial): 63.
22. Iorio EL, Balestrieri ML. d-ROMs test and POX ACT test. Comparison impossible. Clinical Chemistry Laboratory Medicine. 2005. 43(4): 457-458.
23. Iorio EL, Cinquanta L, Pisano R. A diagnostic algorithm for the oxidative stress [original title "Un algoritmo diagnostico per lo stress ossidativo"]. Italian
Journal of Laboratory Medicine. 2005. 1 (3): 137.
24. Rosolia A, Di Leo T, Iorio EL, Lipartiti T. The d-ROMs test automation: analytical performances and clinical applications [original title "Automazione
29
del d-ROMs test: performance analitiche ed applicazioni cliniche"]. Italian Journal of Laboratory Medicine. 2005. 1 (3): 172.
25. Banfi G, Malavazos A, Iorio EL, Dolci A, Doneda L, Verna R, Corsi MM. The iron-o-dianisidine/xylenol orange assay in comparative oxidative stress
assessment. Some possible shortcomings. Eur J Appl Physiol. 2006. 96 (5): 506 - 508.
26. Carratelli M, Iorio EL, Bianchi L. Methods to measure the oxidative stress [original title "Metodi di misurazione dello stress ossidativo"]. ADI Magazine.
2006. 4 (10): 405 - 414.
27. Corsi MM, Pagani D, Iorio EL, Dogliotti G, Verna R, Sambataro G, Pignataro L. Blood reactive oxygen metabolites (ROMs) and total antioxidant status
(TAS) in patients with laryngeal squamous cell carcinoma after surgical treatment. Clin Chem Lab Med. 2006. 44(8): 1047-1048.
28. Iorio EL. Hypoxia, free radicals and antioxidants. The "Deutrosulfazyme®" paradox. Hypoxia Medical J. 2006. 1-2: 32.
29. Iorio EL. Oxidative stress assessment in Animals. Actuality and perspectives [original title "La valutazione dello stress ossidativo negli animali. Attualità
e prospettive"]. Proceedings "67° Convegno Nazionale Unione Zoologica Italiana". Napoli (Italy). 2006, September 12nd-15th. Pp. 28.
30. Iorio EL, Cinquanta L, Pisano R. A diagnostic algorithm to manage oxidative stress. Australasian J Cosmet Surg. 2006. 2 (1) : 26-30.
31. Iorio EL, D'Amicantonio T. The oxidative stress in Odontology. From the basic research to the clinical practice [original title "Lo stress ossidativo in
odontoiatria. Dalla ricerca di base alla pratica clinica"]. Proceedings III Congresso ANMCO. 2006. Rome, October, 13.
32. Iorio EL. Oxidative stress and ageing: diagnosis, causes, effects, and treatments [original title "Stress ossidativo e invecchiamento: diagnosi, cause,
effetti, terapie"]. Proceedings "Giornate Siciliane di Medicina Estetica". Palermo (Italy). 2006, March 17th-19th. Pp. 10-11.
33. Iorio EL, Bianchi L, Storti A. Deutrosulfazyme®: a powerful antioxidant [original title "Deutrosulfazyme®: un potente antiossidante"]. La Medicina
Estetica. 2006. 30 (1): 115 - 116.
34. Iorio EL. Carratelli M, D'Amicantonio T. Oxidative stress and diseases [original title "Stress ossidativo e malattia"]. ADI Magazine. 2006. 4 (10): 399 404.
35. Cavallini M, Iorio EL. Effect of training and antioxidant supplementation on oxidative balance in martial arts. Journal of Molecular and Clinical
Pathology. 2007. 2: 14-15.
36. Cornelli U, Iorio EL. Antioxidants. Therapeutic and diagnostic aspects [original title: Antiossidanti. Aspetti terapeutici e diagnostici]. 2007. GUNA Eds.
Milan.
37. De Bernardi Di Valserra M, Iorio EL, Tripodi S, Pedroni F, Dogliotti G, Galliera E, Corsi MM. Peripheral arterial occlusive disease and CO2 balneotherapy:
effect on free radicals release (ROMs) and total antioxidant status (TAS). Journal of Molecular and Clinical Pathology. 2007. 4: 27-31.
38. Iorio EL. Oxidative stress and sport [original title: "Stress ossidativo e sport"]. European Journal of Health, Sport and Nutrition. 2007. 1: 102-103.
39. Iorio EL. Oxidative balance and nutritional supplementation in chronic and degenerative disorders [original title: "Bilancio ossidativo ed integrazione
nutrizionale nelle patologie cronico-degenerative"]. Proceedings 3° Congresso Internazionale Nutrizione e malattie cronico-degenerative. 2007, June 2nd
and 3rd, Ponzano Veneto (TV), Italy. 2007. 34-39.
40. Iorio EL, D'Amicantonio T, Nardi GM. Nutrition and oxidative stress. From biochemistry to the clinical practice [original title: "Alimentazione e stress
ossidativo. Dalla biochimica alla pratica clinica"]. ADI MAGAZINE. 2007. 92-97.
41. Iorio EL, Ferreri C, Cozzolino R, Manara S, Ferreri R. Plasma total oxidant status and erythrocyte plasmamembrane lipidomics. A preomising sinergy in
the molecular diagnostics of anti-aging. Proceedings 9th International Congress of Aesthetic Medicine. 2007, October 11th -13th Milan, Italy. 2007. Pp.
145.
42. Melillo G, Iorio EL, Giuliano F, Balzano, Melillo EM. Oxidative stress in patients with chronic obstructive pulmonary disease: validation of a new
photometric test (exhalation test) for the measurement of hydrogen peroxide in exhaled breath condensate. Rassegna di Patologia dell'Apparato
Respiratorio. 2007. 22: 98-104.
43. Pasquini A, Luchetti E, Marchetti V, Cardini G, Iorio EL. Analytical performances of d-ROMs test and BAP test in canine plasma. Definition of the normal
range in healthy Labrador dogs. Vet Res Commun. 2008. 32 (2): 137-143.
44. Regano N, Iorio El, Guglielmi A, Mazzuoli S, Francavilla A, Fregnan S, Leogrande G, Guglielmi Fw. The assessment of oxidative stress in clinical practice
and its importance in nutrition. Nutritional Therapy & Metabolism. 2008. Vol. 26 no. 4, pp. 149-162
45. Mandas A, Congiu MG, Balestrieri C, Mereu A, Iorio EL. Nutritional status and oxidative stress in an elderly Sardinian population. Mediterr J Nutr
Metab. 2008. DOI 10.1007/s12349-008-0016-1.
46. Banfi G, Iorio EL, Corsi MM. Minireview: oxidative stress, free radicals and bone remodeling. Clin Chem Lab Med. 2008. Oct 10. [Epub ahead of print].
PMID: 18847368.
47. Iorio EL. The laboratory in oxidative stress study [original title "El laboratorio en el studio del estrés oxidativo"]. Consejo General de Colegios Oficiales
de Farmacéuticos. Plan Nacional de Formation Continuada. Análisis Clinicos II. Modulo II. 2008. 1-28.
48. D'Amicantonio T, Polizzi E, Iorio EL, Gherlone E. Free radicals and antioxidants in the oral cavità [original title "Radicali liberi e antiossidanti nel cavo
orale. Un delicato equilibrio"]. Prevenzione odontostomatologica. 2009. 1: 3-15.
49. Iorio EL, Balestrieri ML. The oxidative stress [original title "Lo stress ossidativo"]. Trattato Italiano di Medicina di Laboratorio, di Angelo Burlina, Ed.
Balestrieri C, Piccin, Padua, Italy. 2009. 533-549.
50. Mandas A, Iorio EL, Congiu MG, Balestrieri C, Mereu A, Cau D, Dessì S, Correli N. Oxidative imbalance in HIV-1 infected patients treated with
antiretroviral therapy. Journal of Biomedicine and Biotechnology. 2009. Article ID 749575, 7 pages. doi:10.1155/2009/749575.
51. Landoni G, Mariani E, Oriani G, Donarini C, Guerrerio T, Iorio EL. Improvement of antioxidant status in women conventionally treated for breast cancer
after 12 months of a cow milk whey-based supplementation. A preliminary study. Mediterranean Journal of Nutrition and Metabolism. 2009. 2(2): 127131.
52. Iorio EL. New perspectives in oxidative stress research: the Redoxomics. Proceedings International Conference on Advances in Free Radicals Research,
Natural Products, Antioxidants and Radioprotectors in Health - Ninth Annual Meeting of the Society of Free Radical Research India. January 11th-13th,
2010. Hyderabad (India). 2010. 26-27.
53. Iorio EL. The novel field of Redoxomics. Proceedings BIT Life Sciences' 3rd Annual PepCon-2010. March 21th-23th , 2010. Beijing (China). 2010. 283.
30
Peter C. Konturek*, SJ Konturek**
Skin melatonin system
Skin Aging
* Department of Internal Medicine, Thuryngia-Clinic Saalfeld, Teaching Hospital of University of Jena, Germany; ** Department of Physiology, Jagiellonian
University Cracow, Poland
Melatonin (MT) is an indole originating from L-tryptophan (L-Trp) which was discovered by Lerner et al in pineal gland. Initially, pineal gland was
considered as the sole source of circulating hormone, but more recently MT was found to be an ubiquitous molecule produced at various extrapineal sites,
particularly in gastrointestinal tract (GIT) and liver.
Additionally, recent studies revealed that human skin possess a fully functioning melatoninergic system. MT synchronizes circadian activities and is a
potent scavenger of reactive oxygen species (ROS) and highly effective protector of various tissues against damaging effect of ROS. MT participates in
many vital processes and its secretion falls gradually over the life-span. Unlike MT production in pineal gland that remains under photoperiodic control,
the release of MT in GIT is related to food intake. Since changes in skin represent a major form of adaptation to changing environmental challenges, it is
not surprising that MT impacts on mammalian skin physiology. MT is involved in many important skin functions including keratinocyte and fibroblast
growth, pigmentation, endocrine signalling and hair follicle biology. As a strong anti-oxidant it protects skin against pressure-, thermal- or UV-induced
skin injury. MT not only operates as a potent direct free scavenging molecule, but also enhances the activity of anti-oxidative enzyme systems in various
organs including skin.
There is also an evidence that MT enhances tumor immunosurveillance, counteracts carcinogenic stimuli and / or exerts tumor growth inhibitory properties
in humans skin in vivo. MT may serve as a major skin protectant by topical and/or systemic administration in different skin diseases including wound
healing, vitiligo, atopic eczema, psoriasis vulgaris, carcinoma, melanoma. Whether MT can indeed slow or even revert human skin aging is still not known
and has to be investigated in randomized, double-blind, well-controlled prospective trials. We conclude that:
1) Cutaneous melatoninergic antioxidative system exerts important protective function in the skin and other extrapineal organs, especially
gastrointestinal tract ;
2) Decrease of circulating MT due to aging may be responsible for the increased susceptibility of skin to damaging factors.
3) Supplementation with exogenous MT or topical therapy with MT or its precursor L-Trp may have beneficial effects on skin functions.
Gabriela Machalova
Skin, Hair and Detoxification: WHY?
Detoxification
The most interesting experiences of my detoxification (and aesthetic) praxis: why, where and when can be the detoxification very useful and makes the
effects of the treatment stable and long-lasting. Some case reports.
Jun Matsuyama
Intra umbilical cord stem cell therapy and high dose IV Vitamin C therapy
Stem Cells and Growth Factors
This presentation will give a brief overview of current Japanese Anti-Aging and Integrative Medical clinics and its procedures. IVC (High Dose IV Vitamin
C Therapy) for Cancers and Umbilical cord Stem Cell Therapy for anti-aging and regenerative diseases will also be discussed.
Key wards: Anti-Aging Medicine, VitaminC, umbilical cord, stem cell
Patana Tengumnuay
Nutraceutical supplements for skin
Skin Aging
Skin, just like every cell in the body, needs nutrients. Deficiency of certain vitamins such as vitamin A, vitamin B, and essential fatty acids can cause skin
diseases. These important nutrients need to come from food and some are produced by the body. Most of them can not be replenished by applying onto
the skin directly due to poor absorption. Moreover, it will be impractical and too expensive to provide the essential nutrients for the entire body by topical
administration.
Oxidative stress and inflammation are two major mechanisms of aging that effect the body as a whole as well as the skin. Nutraceutical supplements
that delay these mechanisms will also have a beneficial effect for the skin. Although proper nutrition may slow down physiological aging, it can not
protect the skin entirely from photo-aging. As a result, the use of broad spectrum sunscreen is recommended. The practice can lead to vitamin D
deficiency, a condition known to be associated with increased risks of fracture, diabetes, impaired immune function, and cancer. So, it may be wise to
have vitamin D as an essential part of our daily supplementation. The damaging effect of sunlight is contributed to singlet oxygen, one of the reactive
oxygen species. It helps explain why oral anti-oxidant supplements such as astaxanthin and tocotrienols, that can reach very high levels in the skin, have
shown to significantly reduce signs of aging. Some other anti-oxidants including co-enzyme Q-10 and alpha-lipoic acid have shown to improve skin
conditions when applied topically. All of these anti-oxidants, when used as nutraceutical supplements, will have a number of additional health benefits.
To protect our body form inflammation, we need an optimal nutrition with the lowest amount of high glycemic index and sufficient amounts of whole
grains and fish. Fish oils (EPA and DHA) are anti-inflammatory fatty acids that being sold as a supplement and have been proven for preventing
cardiovascular diseases as recommended both by cardiologists, and anti-aging practitioners. Finally, gut inflammation may lead to atopic dermatitis and
skin inflammation. Pro-biotic supplementation has become an alternative choice for treatment of these conditions. These good bacteria also help us
making essential vitamins and nutrients that are important for skin health.
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Patana Tengumnuay
Practical Stem Cell Therapy
Stem Cells and Growth Factors
Since the identification and characterization of stem cells, a great deal of interest has been given to their potential roles in regenerative medicine. Stem
cells can proliferate, migrate, and differentiate to form new tissues. Embryonic stem cells (ESC), isolated from the inner cell mass within the blastocyst,
can develop into more than 200 different cell types. However, transplanted ESC can result in teratoma due to uncontrolled cellular differentiation. Also,
the possibility of being rejected and requirement of long-term treatment with immunosuppressive drugs have turned scientist attention to another kind
of stem cells: adult stem cells.
Human bone marrow is the major source of adult stem cells including both hematopoietic and non-hematopoietic stem cells. Hematopoietic stem cells
(HSC) are the first stem cells that have been used successfully for transplantation in patients with hematologic disorders. In addition, the role of bone
marrow stem cells has been demonstrated in patients with myocardial infarction. Clinical studies have shown a varying degree of improvement in cardiac
functions using autologous bone marrow derived stem cells.
Bone marrow also contains non-hematopoietic stem cells, commonly known as mesenchymal stem cells (MSC). MSC can be easily isolated and expanded
from bone marrow. It produces cytokines that support hematopoiesis and have been used as an adjunctive treatment in hematopoietic stem cell transplant
to enhance the marrow recovery prevent graft-versus-host disease. Besides bone marrow, MSC can be isolated and culture expanded from a wide variety
of tissues including adipose tissue, umbilical cord, and placenta. Recently, adipose derived stem cell isolation from liposuction procedure has been used
for breast augmentation. Dysfunctions of MSC have been reported in aging, obesity, hematologic disorders, and cardiovascular diseases. These findings
lead to stem cell banking service for people who want to have their young and healthy stem cells stored for the future.
Because of their abilities to differentiate into other types of tissues including bone, cartilage, fat, liver, heart, and neuron, MSC have been investigated
for their efficacy as a clinical therapeutic tool in patients with stroke, myocardial infarction, and metabolic bone diseases. In addition to their ability to
replacing injured tissue, MSC exert their effects by generating certain cytokines, chemokines, and growth factors. Their functions are regulated by the
microenvironment and interactions with neighbor cells.
When injected intravenously, MSC preferentially home to bone marrow and spleen. However, following stimuli including tissue injury, inflammation,
infection, and cancer, MSC will migrate to sites of injury where they can enhance wound healing and support tissue regeneration. MSC is known to have
strong immunosuppressive properties and have been clinically tested for treatments of auto-immune disorders such as Crohn's disease and rheumatoid
arthritis.
One of the most important characteristics of MSC is that they are non-immunogenic. MSC exhibit low expression of histocompatibility complex (MHC)
class I, negative for MHC class II, and do not express T cell co-stimulating molecules. These findings imply the lack of need for HLA matching and
therapeutic application in autologous as well as heterologous transplantation. Phase I clinical studies show that MSC infusion is safe and the production
of ectopic tissue has not been observed. Because of these impressive characteristics, various biotechnology companies have focused on developing and
commercializing patented formulations of MSC in the emerging field of regenerative medicine.
Noel Thomas Patton
Anti-Aging pill targets telomeres at the ends of chromosomes
Anti-Aging and Prevention
Could the secrets to anti-aging be at the tips of our chromosomes?
By Mandy Kendrick
Peter Pan stayed forever young in Neverland. In real life, some scientists are looking at telomeres, or regions of repetitive DNA at the ends of our
chromosomes, to try to arrive at something like a real version of this story.
Telomeres consist of up to 3,300 repeats of the DNA sequence TTAGGG. They protect chromosome ends from being mistaken for broken pieces of DNA
that would otherwise be fixed by cellular repair machinery. But every time our cells divide, the telomeres shrink. When they get short enough, our cells
no longer divide and our body stops making those cells. Over time, this leads to aging and death. New York-based T.A. Sciences claims to be the only
company in the world manufacturing a supplement in a pill form that has been lab tested and shown to stop telomeres from shortening, in hopes of
halting the aging process. The product, TA-65, comes from extracts of the Chinese herb astragalus, which has been used for medicinal purposes for more
than 1,000 years, says Noel Patton, chief executive officer of the company.
TA-65 is produced at very low levels in the astragalus plant, but the company purifies and concentrates the substance, which is thought to "turn on" the
enzyme telomerase (hTERT) that acts to maintain or lengthen telomeres. hTERT is usually "off" in adult cells, except in immune, egg and sperm cells, and
in malignant cancer-forming cells.
The TA-65 pill requires no approval from the U.S. Food and Drug Administration because it is marketed as a supplement and not a drug. Therefore, T.A.
Sciences cannot make claims about the drug's efficacy at curing disease. But Patton and Calvin Harley, the chief scientific officer at Geron-the company
that discovered TA-65-go on to note that researchers have found a correlation between telomere length and susceptibility to certain aging-related
diseases.
T.A. Sciences did five years of testing on TA-65, beginning in 2002. Results from an anti-aging trial can be found at the company's Web site. Patton says
he has been taking the supplement for two years and that everyone at T.A. Sciences over the age of 40 takes the product.
William Andrews has worked on telomere biology for the past 15 years. He is the chief executive officer of Sierra Sciences, LLC, a rival company that is
screening for chemicals to activate telomerase, but also a T.A. Sciences client for the past two-and-a-half years. He thinks that "taking a telomerase
inducer is safer than driving my car to work" but acknowledges that there are some unknown risks with taking the product. For example, telomerase is
the same enzyme that allows cancer cells to stop aging or to become immortal, so there is a chance that TA-65 could keep alive cancer cells that would
otherwise die, notes Andrews.
However, telomerase activation should keep all telomeres longer in the first place, and that actually reduces the chances of cells becoming cancerous,
Andrews notes. He also says that the enzyme should keep immune cells, which can fight off most cancerous cells, alive longer.
Another problem facing telomere science is that no suitable model organism is available for testing. Animals do not age through telomere shortening in
the same way that humans do, Harley notes, adding that "not even mice or monkeys have the same telomere aging system. The best system to ultimately
test is going to be the human." The potential benefits of the supplement seem to outweigh the risk for patients like Andrews. "People such as myself who
elect to take TA-65 and look forward to taking even stronger telomerase inducers in the future must act totally on gut feelings," Andrews notes.
For those who are less adventurous, other researchers have identified lifestyle changes that can help optimize telomerase activity, without the $14,000per-year price tag of the TA-65 treatment.
32
Eva Schaeufele
Nutrigenomics, a motivation to a health- Conscious lifestyle
Anti-Aging and Prevention
The inter-individual differences in gene sequences that result in differential responses to environmental factors, such as diet, lifestyle habits, and exposure
to environmental toxins, have been one of the key discoveries of the Human Genome Project. The discipline of nutrigenomics studies how naturally
occurring constituents of the diet alter the molecular expression of genetic information in individuals. Insight into the interaction between the
environment and our genes and their expression is introducing a new era for nutritional counselling and medicine. Integrating this knowledge into
personalised motivation programmes promotes sustained compliance with lifestyle recommendations. Substances in the diets of various cultures have
been exerting profound influence on gene expression and the resulting proteome for thousands of years. Genetic differences between individuals are due
to single nucleotide polymorphisms (SNPs). Motivating clients to adjust their lifestyles to their particular SNPs should prove to be an important
contribution to public health. For instance, genetic studies have found that in as much as 20% of Caucasian females, dietary animal fats are more likely
to prevent cardiovascular disease (CVD) than vegetable fats with polyunsaturated acids. Nutrigenetic testing therefore could reduce the increasing rate
of myocardial infarction in women over 50 observed in this decade (in Germany, from 89 (2003) to 131 per 1,000 (2007)). The three-year study presented
here demonstrates how genetic testing can motivate clients to adopt health-conscious lifestyles and maintain compliance in the long term.
References (selected):
Nicklas BJ, Ferrell RE, Bunyard LB, Berman DM, Dennis KE, Goldberg AP
Effects of apolipoprotein E genotype on dietary-induced changes in high-density lipoprotein cholesterol in obese postmenopausal women. Metabolism. 2002 Jul;
51(7):853-8.
Subbiah MT.Understanding the nutrigenomic definitions and concepts at the food-genome junction. OMICS. 2008 Dec;12(4):229-35.
Bazzano AT, Zeldin AS, Diab IR, Garro NM, Allevato NA, WRC, Project Oversight Team.
The Healthy Lifestyle Change Program: a pilot of a community-based health promotion intervention for adults with developmental disabilities.American Journal
of Preventive Medicine . 2009 Dec; 37(6 Suppl 1): S201-8.
Takuji Shirasawa
Evaluation of aging and its risk factors in body and skin
Anti-Aging and Prevention
Yoshikazu Yonei, Anti-Aging Medical Research Center, Doshisha University
Lecture presented by Prof. Takuji Shirasawa
The purpose of anti-aging medicine is to prevent the physical and mental deterioration caused by aging, and to maintain a high quality of life (QOL), i.e.
"optimal health." The representative researches of the centenarians emphasize the importance of uniformly and well-balanced aging. Thus for diagnosis
of functional aging, the anti-aging clinics check the muscle age, blood vessel age, neurological age, hormone age, and skeletal age in order to find out
weak points of the patients. For the risk factors for aging, we check the immunological function, oxidative stress, mental stress, life styles, and metabolic
function. Recently we added the skin diagnosis system, using skin image analyzers, elasticity tests, and moisture tests. The skin aging is evaluated based
on the mother data of healthy Japanese men and women, so that we can calculate the functional age such as wrinkle age, spot age, moisture age, or
glycation age, whatever apparatus you use including Roboskin (Inforward), VISIA (Canfield), Aphrodite (PSI), or Mexameter (Courage & Khazaka), or AGE
Reader (DiagnOptics).
This system for the anti-aging clinics was established by the Anti-Aging Medical Research Center. The program runs on the web which gives results as a
pentagram chart and helps us to advise to the patients. Now more then 200 clinics use this system in Japan and Taiwan. The number of collected data
is now more than 10000 cases, and these data provide us precious information for developing the anti-aging medicine.
Takuji Shirasawa
Lifestyle and Japanese diet as contributing factors to the longevity in Japan
Anti-Aging and Prevention
When we discuss advances in longevity research during lectures and seminars, the question of the deciding factor for longevity often comes up. Even
without looking at examples of research in molecular biology research, it is obvious to most that genetics play a major factor in longevity. The longestlived human recorded was a French woman named Jeanne Calment, who died at age 122. All her family was long-lived. The quest for the identification
of longevity genes by studying centenarian families has been explored for a decade, but no bona-fide longevity gene was identified. The environmental
factors influencing the lifespan of human beings, such as nutrition, physical exercise, and mental relaxation play an important role in the determination
of an individual lifespan. The mortality rates of lifestyle-related diseases such as heart disease, stroke, and cancer becoming getting higher and higher in
Japan as well as in western countries where much of the population is graying. The preventive measures for lifestyle-related diseases such as nutritional
intervention or regular physical exercise should be introduced for further extension of the healthy lifespan. Caloric restriction in experimental animals
has been shown to extend the lifespan of animals with the decreased frequency of age-related diseases. Regular physical exercise stimulates the adipose
tissues to secrete beneficial adipose hormones, such as adiponectin that suppress the progression of atherosclerosis and insulin resistance in type II DM
and metabolic syndrome. In the lecture, I will focus on the Japanese-style diets, physical exercises, and challenging spirit towards life, we, which were
implicated from active Japanese centenarians enrolled in the study.
Xanya Sofra Weiss
Anti-Aging and Prevention
Power of signalling in Anti-aging: You can build new proteins by changing the instructions at the genome
Introduction: RNA carries the instructions used in formation of Proteins. TRNA translates the four nucleic acids (uracil, adenine, cytosine and guanine)
in the RNA strand) into the 21 amino acids that form Proteins.
Viral research has shown us how viruses inject their own RNA in the cell that results in the making of viral proteins with the ultimate purpose to spread
the virus and overpower the immune system. Some viruses such as HIV first inject a viral RNA into the cell, then they use a reverse transcriptase enzyme
to make DNA based on the viral RNA template thus forcing the normal machinery of the cell to produce viral proteins. Other research has shown us how
33
certain therapies increase RNA content as well as the expression of new genes in human bodies. An example is the research of Goldspink et al (London
University, U.K. Biochem Soc Trans. 1991) who found that Ion technology produces rapid hypertrophy which is the result of changes in gene expression
(detected by analysing the RNA). This very rapid hypertrophy was found to be associated with an increase of up to 250% in the RNA content of the
muscles. These investigators also found an abrupt change in the species of RNA produced from fast type IIB genes to slow type skeletal genes that are
associated with overload, stretch and physical exercise. From 1991 till today, a number of other investigators have validated and substantiated these
results.
Objectives:
1. Describe the signaling DNA - RNA - Protein Synthesis signaling pathways in health disease and aging.
2. Explain the significance of signaling mechanisms in disease and aging and how changing RNA can result in healthier bodies and overall rejuvenation
3. Present ample evidence from a number of research studies of why and how resonating biological signaling causes permanent genetic changes with
dramatic anti-aging results recorded clinically.
4. Identify Ion Channels as Proteins that dominate all signaling processes.
5. Assert how the electron can amplify the energy at Ion Gates, thus increasing their efficiency.
6. Address aging as the sum total of increasing imbalances and the progressive cellular damage resulting from the energy driven oxidation process and
present solutions to this inherent biological problem on the basis of increased protein content.
Conclusion:
1. Resonating biological signaling in a new technology that does not interfere with the harmony of the body offering far more dramatic results than
Laser and Radiofrequency technology which are known to interfere with the overall body functioning.
2. This new technology results in energy amplification at ion channels.
3. A number of studies have shown RNA increase leading to new protein synthesis, or increased Protein Synthesis as shown after measuring Protein
content.
4. Increased ATAase proteins and the electron driven proton motive force significantly increase biological energy without the assistance of glucose
aerobic oxidation that leads to radical species. This mega anti-oxidant process is directly related to Anti-Aging.
Pakpilai Thavisin
Detoxification: a Way to Wellness
Detoxification
S Medical Spa, Thailand
Detoxification is the process that the body rid itself of any unwanted chemicals. Detoxification handles waste not only from the environment but also
from every process in all the organs and systems of the body.
Though the body has its natural ways of detoxification thru skin-perspiration, kidneys-urination, lungs-exhalation, colon-defecation, liver-lymphatic flow
and immune system, the body is overloaded with excess toxins from the polluted environment, the contaminated food and drink, the household synthetic
chemicals, the modern diet full of processed, less natural, high GI, high protein and fat but low fiber content. The body's systems are unable to cope with
the daily poisonous assaults because the toxins accumulate in the body faster than they can be eliminated. This results in "Bioaccumulation" and
"Autointoxication" which can cause cell and tissue breakdown, weakens the body and cause diseases.
Detoxification therapy is aimed to enhance toxin elimination while reduce toxin intake. Detoxification can be done in many ways such as "Chelation",
"Fasting", "Detox Diet", Detox supplements", "Herbal Steam", "Lymphatic drainage Massage", and "Colon Hydrotherapy".
Detoxification can help eliminate allergic reaction, reduce inflammation and enhance immune system and body functions. Detoxification is a good way
to a healthier body.
Pakpilai Thavisin
Colon Hydrotherapy: Trick or Treat?
Detoxification
S Medical Spa, Thailand
Over 400 millions dollars is spent each year on laxatives in USA and there are new cases of colorectal cancer each year. Colon cancer is also 2nd leading
cancer killer in USA.
Colon main functions are absorption of water and minerals and the formation and elimination of feces, help eliminate toxins from digestive tract. Colon
also contains millions micro-organism, "the forgotten organ", to help digestion, vital nutrient production, maintain pH, enhance immunity and prevent
proliferation of pathogen. Colon health is affected by modern diet comprised of refined, processed foods, high in saturated fat, sugar, food additives and
low in fiber. This results in less than natural movements, 2-3 times/day in healthy colon and causes lots of health problems such as constipation, allergic
reaction, lower immunity and frequent infections and organs inflammation.
Colon Hydrotherapy can help relieve constipation, allergic reaction, inflammatory skin problems such as acne, seborrheic dermatitis and eczema and
chronic inflammation including arthritis. Colon hydrotherapy is a much more natural way to treat dermatitis and inflammation without using steroid.
Learn how to help patients thru the proper way of colon hydrotherapy.
Huu Hanh Tran
Successful bone aging and low risk of fracture: The Anti-Aging solution
Anti-Aging and Prevention
One of the cardinal manifestation of old age is the locomotor apparatus deterioration.
First, a review of the current understanding on the pathophysiology of bone aging, and the biomechanical concept of fractures. And then, deduction to
the anti-aging solution, that is the lifestyle recommendations for delaying bone aging and preventing bone fractures.
1- Current understanding
(a) The pathophysiology of bone aging is shown in the schematic representation of the servosystem that maintains bone mass at the steady-state levels.
Physiologic and pharmacologic stimulators and inhibitors of bone formation and resorption are listed. It shows clearly the role of nutrition, exercise,
hormones, and micronutrient supplements in maintaining optimal bone mass. This schematic representation also highlights the risk factors for developing
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low bone mass.
(b) The biomechanical approaches of fractures enable us: (1) to explain how physical exercise (mechanical stresses), by piezo-electric transduction, can
influence the bone remodeling; and (2) to compare the osteoporotic fractures (fragility fracture, insufficiency fractures) with the stress fractures
(fatigue fracture by repetitive cyclic loading). Stress raisers in osteoporotic perforations, calculated by Finite Element Method are given. Risk factors of
fall are discussed.
2- Deduction to the anti-aging solution:
The anti-aging solution for bone health and low risk of fracture include the combination of nutrition, exercise, hormones, and micronutrients
supplements.
(a) Nutrition: this should include the nutritional recommendations from the acid-base balance diet, the anti-inflammatory diet, and the DASH diet.
Should be incorporated into the diet: Ca-rich and vit K-rich cruciferous vegetables, omega-3 fatty acid-rich foods, and fermented soy products. Other
micronutrient supplements are given.
(b) Exercise program should include aerobic, weight-bearing, resistance, and balance exercise. This should be supplemented with Yoga or Tai Chi to
enhance postural balance.
(c) Eventually, consider hormone replacement therapy.
(d) Pharmaceuticals: Consider bisphosphonate therapy, parathyroid therapy.
Conclusion
- The winning anti-aging team for bone health and low risk of fracture is the combination of Nutrition + Exercise + Hormones, and supplements.
Exercise plays a key role in prevention.
- The prevention should be implemented as early as possible, and be continued as far as possible to maintain bone health and low risk of fracture.
Huu Hanh Tran
Detoxification prescription: the 5 steps that make it safe and effective
Detoxification
Toxins are everywhere: exotoxins in air, food, water, and soil (heavy metals, chemicals, bacteria and yeast); endotoxins from human process (metabolism
byproducts)
Compromised detoxification capacity has for consequence an accumulation of toxins in the body that can lead to many health problems (chronic diseases,
hormone dysruption, cancers..), and can also accelerate the aging process (premature aging)
Understand the detoxification processes to enhance them.
Current understanding of detoxification processes
1- Liver detoxification: 2 phases of toxin metabolism: Phase 1: Cytochrome P450 enzymes or Preconjugation; Phase 2: Conjugation reactions.
2- Diet detoxification: Consider diet rich in fresh foods, poor in processed foods (countaining preservatives and/or additives); Avoid foods containing
pesticides, dyes, xenobiotics; Be careful with farmed salmon, swordfish, that accumulate toxins (mercury).
3- Fasting: Toxins are stored in the adipose tissue, and are released into the blood during the detoxification process. Caution should be used in a fast
more than 5 days (glutathione liver depletion)
4- Exercise detoxification: Exercise increases the liberation of stored toxins from the adipose tissue. Cardiovascular exercise enhances detoxification
through sweating.
5- Sauna detoxification: Sauna mobilizes toxins from fat tissue into the bloodstream, with elimination through the liver's 2-phase detoxification.
6- Renal detoxification: Drink abundant amount of water: water as a carrier for the neutralized toxins, and a booster of production of urine and
movement of feces.
7- Intestine detoxification: By colon hydrotherapy: Controlled cleansing of the colon, providing improved function, and removal of waste products.
Detoxification prescription: the 5 steps that make it safe and efficacy
(1)- Reducing toxic exposures
- Home and work environments as free of pollutants as possible.
- Diet: organic (toxin-free) whole food.
(2)- Improving the metabolism of toxins and antioxidation
- Liver protectants (botanicals)
- Liver protection from free radicals
(3)- Increasing excretion
- Bile: Bile flow stimulants (botanicals)
- Urine: Water
- Sweat: Exercise + Sauna
- Intestine: High fiber food, Colon hydrotherapy
(4)- Using oral or intraveinous chelating agents for corresponding toxins
(5)- Protocol of the 10-day Detoxification
Conclusion
Detoxification is a multifactorial approach.
The two main measures of detoxification include: reducing toxic exposures, and enhancing the body's ability to detoxify.
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Sabine Zenker
Controversies in regenerative medicine - Platelet Gel: Does it really work?
Stem Cells and Growth Factors
Background: Many technologies have been developed to address the issue of skin aging and its aesthetic implications: Improving skin appearance is one
of the main goals of past and current modalities in dermatology and aesthetic medicine. The Regenerative Medicine is one of the new therapeutic
approaches finalised by the biologic regeneration of the cells and tissues instead of their replacement. The woundhealing process taking place in injured
living skin can be compared with the happenings in tissue regeneration in ageing skin. This process is complex and -in a prominent role- driven by the
action of the platelets: The platelets release cytokines and growth factors who actually initiate and accelerate tissue regeneration by chemoattraction
and deposition of extracellular matrix.
There are many aspects on the quality of the PRP itself due to different harvesting methods, different issues on the concentrating process, different
aspects on platelet-recovery-rates, different approval-status on the available delivery-kits, different clinical protocols, controversary aspects on stem cells
in PRP and last but not least a lack of large-scale approved clinical trials.
Anyway, it is clinically proven, that PRP has a broad acceptance in the medical and now finally in the aesthetic field.
Method: This regeneration process can be accelerated and optimized by concentrating the platelets and therewith concentrating the working agents: For
this purpose, the patient`s own blood is centrifuged to gain a high concentrated gel in both, platelets and plasma. This platelet gel than can be applied
to the skin by injections into the skin superficially in terms of mesotherapy and deeply intradermally as filler injections and volumizing therapy. Recent
techniques for the autologous concentrating process have been streamlined with the result that now platelet gels are clinically accessible to any
physician.
Results: There is lots of clinical proof that PRP works: The clinical response to this biostimulation technique is tissue regeneration due to increased
fibroblast cells proliferation with a visible increase of the synthesis of collagen and the increase of the fundamental substance. The purpose and focus of
this technique is to reduce and ameliorate facial skin wrinkles, together with enhancement of texture, colour and secretions. Platelet Gel can be applied
as predominantly primary facial rejuvenation procedure or as adjunct to any conventional anti-wrinkle- and skin-rejuvenation-procedure.
Although the scientific data is rare, there is lots of data on some delivery-kits as well as the quality of their PRP such as e.g, for MyCells®.
Conclusion: My experience with Platelet Rich Plasma (PRP) demonstrates, this modality may well be an alternative or an adjunctive therapy for tissue
regeneration to any of the existing therapies. Its biostimulation is dedicated to create an immediate and a long lasting volumetric result, is easy to perform
and is a cost-effective procedure with high levels of patient satisfaction.
Anyhow, there are many issues on quality for reproducible results and safety of PRP due to the different kits for PRP-harvesting on the market. In my
opinion, kits for PRP-harvesting should be selected following strict criterias eg approval of the bloodtake-tubes for reinjection, technical and regulatory
approvals etc.
Yun Zhao
Stem Cells and Growth Factors
Impact of genetic transcriptome profile research on normal and malignant hematopoietic stem cells
Hematopoietic stem cells are cells with both self-renewal capacity and multiple-lineage differentiation potentials, which maintain the blood supply for
the life-long span. However, when genetic alterations hit these important cells it is likely to cause various blood malignancies. Unfortunately due to the
rarity of normal and malignant cells, the specific cell surface markers for us to isolate them or the molecular mechanisms which might allow us to
specifically target the malignant stem cells were poorly understood.
In the era of post-genome, global gene expression provided us a unique opportunity to gain molecular insights of these cells. Initially, specific methods
were developed and validated to deal with small amount of materials. Then multiple research laboratories have identified novel cell surface markers to
purify hematopoietic stem cells, such as EPCR and SLAM; others contributed to pinpoint the novel targets for eradicate the malignant hematopoietic cells
but spare their normal counterpart, including antibodies against CD44 and CD123a.
Together, the transcriptome research has largely re-shaped our understanding of the normal and malignant hematopoietic stem cells and the strategy to
fight the hematopoietic malignancies.
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Abstracts
Plastic surgery
Marco Faria Correa
Repairing secondary abdominoplasties
Facial and Body contouring
The presenter will discuss a comprehensive understanding about abdominoplasty, teaching and discussing about what to do, what not to do, common
mistakes and sharing a series of cases of repaired secondary abdominoplasties. He will analysis the errors and mistakes, how to correct and preventing
these mistakes. He will also discuss on preliminary abdominoplasties step by step.
Luan Jie, Mu Dali, Liu Chunjun
Aesthetic Breast Surgery - Part 1
Endoscopic transaxillary breast augmentation: Optimizing outcomes and avoiding risks
Backgrounds: The axillary approach has been widely used in China because of patients' preference. Dissatisfactory results and complications were
reported frequently, such as malpostion and hematoma. The problems for this approach are mostly the uncontrollable pocket dissecting and the risk of
bleeding. To get better control in this approach and to optimize postoperative outcomes, we try to perform dual plane breast augmentation by axillary
approach with assistant of endoscope.
Methods: The submuscular pockets were separated through a 4-cm transverse incision in the axilla. The pectoralis major muscles were split from the
costal margin with the help of a 10mm, 30°endoscope and endoscopic diathermy scissors. Bleeding during surgery was kept to the minimum. Highcohesive gel microtextured anatomic style silicone implants ranging in size from 185 to 315g were placed through the axillary incision. The vacuum drains
are routinely left in place for 3-5 days.
Results: 326 patients experienced a quick recovery benefited from both subglandular and submuscular planes. Postoperative analgesia requirements were
reduced because of strength releasing of the muscle. The follow-up period was 6 to 24 months, with favorable results. All the patients had aesthetically
natural outcome, with the nipple at the most projected part of the breast. No rippling, lateral displacement, double-bubble deformity, or muscle
contraction-associated deformities were seen. There were no complications such as capsular contracture, hematoma, hypertrophic scar, and infection.
Conclusions: Dual plane augmentation using textured silicon gel implant can be completed with the assistant of endoscope through the axillary incision.
The technique combined retromammary and partial retropectoral pocket locations to optimize the benefits of each pocket location while limiting the
drawbacks,eliminated the needed for an incision on the breast, and created an incision far from the breast for completion of the procedure. Most of all,
it provides accurate control of the pocket dissection and exactly control of bleeding, thus optimized outcomes of the augmentation and reduced risks of
complications.
Mohamed Ghoz
Non-Aptos nose tie suture thread surgery technique
Rhinoplasty
Thread surgery is a new era of cosmetic surgery that enhances esthetic results to our patients with fast recovery period. Many types of threads are known
to do the job like aptos, gold and others but all of them do not last that long or associated with some side effects that necessitate removal by the surgeon.
The good thing about such surgeries is that they can be performed under local anaesthesia in outpatient clinic under sterile conditions and performed in
a very short time compared to cold steel surgery for face lifting. Many indications can be encountered under this specialty such as brow, cheek, neck,
breast lift.
None of those threads can be applied for nose surgery either for cosmetic problems or to correct deformities or post -steel surgery complications. Tie
suture long absorbable threads can be used successfully for nose surgery or other similar indications in easier and long lasting results.
Long absorbable sutures for nose surgery need good knowledge of nose anatomy, skills and good planning for more sessions if needed. It can be performed
under local anaesthesia with immediate long lasting results without side effects commonly seen after traditional cold-steel surgery.
Mohamed Ghoz
Nipple retraction using lipolaser technique
Aesthetic Breast Surgery Part 2
Lipolaser for breast liposuction is considered a new and safe technique for breast reduction compared to surgical intervention. It is performed under local
tumescent anesthesia in an outpatient premises, with the patient calm and secure. Laser was added to the normal procedure of liposuction to enhance
results for patients and afford less fatigue to the surgeons.
Laser tightening is another advantage in breast liposuction where more firmness is achieved after surgery together with breast tissue support.
Another indication for breast laser intervention is its use for nipple retraction and elevation by inducing good fibrous tissue formation at the cephalic end
of nipples.
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Ayad Hashem
Sub facial plane in Breast augmentation
Aesthetic Breast Surgery - Part 2
Background: Graf RM, ET, AL., 2003 and O. D.Ventura and A.B.Aires 2005 Used the subfacial plane with many benefits including: Avoiding implant
deformity or distortion. Leaving additional soft tissue between the implant and the skin Minimizing implant edge prominence. More over it avoids the
disadvantages of other techniques.
Patients, material, méthods: I used the subfacial plane in 196 patients during last 5 years for breast augmentation. The implant is placed completely
beneath the fascia that covers the pectoralis major, the serratus anterior, the lateral oblique and the rectus muscle.
Results: The results are satisfactory for shape, volum and complications are less.
Conclusion: The sub facial plane is a useful technique for breast augmentation. It has the advantages of submuscular plane and the submammary one.
There is less edema, faster recovery and no rippling in the upper half.
Lokesh Kumar
Surgery for Male Breast
Aesthetic Breast Surgery - Part 2
In today's scenario of glamour scoring, looks and showing matter a lot. To have a great looking body not only boost your self esteem but also it helps in
you having that extra edge over your peers. When we talk of male body, a flat chest and prominent abs catch the immediate attention.
Gynecomastia (from the Greek word for "woman-like breasts") is the development of abnormally large mammary glands in males resulting in breast
enlargement. It can occur physiologically in neonates (due to female hormones from the mother), in adolescence, and in the elderly. Even though this
condition is not talked about, it is extremely common. Gynaecomastia affects approximately 40-60% of the male population. This is the commonest
cosmetic procedure done in men worldwide. Public embarrassment while wearing tight fitting clothes, going to the gym, for swimming, peer pressures
are the reasons, patients consult a plastic surgeon. Gynaecomastia surgery can enhance a patient's self-confidence tremendously.
Breast enlargement is usually noted during childhood and puberty. Most of the times, it's a combination of excessive fat and the enlargement of the
glands. However, in many cases, it disappears by the late teens or early twenties. Patients are usually advised to wait until their bodies have fully matured
before undergoing surgery. Most of the time, the cause is idiopathic (no identifiable cause). Occasionally this may be a side effect of certain medications
or hormonal problems.
Surgical intervention usually involves liposuction for the fatty tissue as well as excision of glandular tissue. On rare occasions the gynaecomastia is purely
excessive fatty tissue and all that is required is liposuction. Liposuction in any other areas especially waist, love handles and other cosmetic procedures
such as a nose job, eyelid surgery can easily be combined with this surgery.
The surgical procedure can be conveniently done under local anesthesia with mild sedation.
Before anesthesia is given, a surgical marking pen is used to draw a detailed "map" on the chest. After tumescent anesthesia is given small ports, usually
two are made to do liposuction and then the gland is excise through an intraareolar incision and finally liposuction is done again to blend the tissues
with each other. Fine sutures are placed for skin closure and a bulky dressing and a compression garment is given. Patient remains fairly alert and can go
home same evening with a friend or family member.
Some soreness occur for the first few days. Most patients are back to work in 3-5 days. Most patients may drive a car after one week. Strenuous exercise
is avoided for three to four weeks following surgery.
A small compression vest will be worn under clothes for about three weeks to reduce the amount of swelling, to re-adhere the skin to the chest area, and
to reduce any fluid accumulation. Medications are given for about five days. Pain is usually minimal. Patient can start taking shower after about two days.
Stitches are removed on the 5th post op day and the garment is continued till three weeks. Pressure garment is easily concealed under routine clothes
and there is no problem from the stand point of going into the public and getting noticed.
When male breast-reduction surgery is performed by qualified plastic surgeon, the complications are rare. The incisions are small. Scars are inconspicuous.
Minor irregularities, some fluid collection which may need to be drained can occur rarely.
Patient should have realistic expectations Gynaecomastia results are permanent; however, weight gain and/or the use of certain drugs may cause the
condition to reoccur
Yoshinori Nagumo
Trans-axillary sub-pectoral augmentation mammaplasty without endoscope
Aesthetic Breast Surgery - Part 1
In augmentation mammaplasty, the selection of implant type (surface, contents, and shape) and surgical procedure (incision and dissection) are puzzled
for plastic surgeons. It is well known that textured surface prevents capsule contracture by causes a disruption the alignment of collagen around the
implant in the capsule formation. And the textured implant doesn't move and rotate in the capsule, because capsule size is same as implant size. It is also
said that cohesive gel doesn't easily migrate into the surrounding tissue, even if an implant ruptures. Cohesive gel implant has a breast-shaped anatomical
profile, because it does not change the form by physical position. And anatomical implant requires textured surface to prevent the mal-rotation of the
implant.
Therefore, textured, cohesive, and anatomical implant is the optimum combination and called as "stable concept". Stable implant doesn't move in capsule,
fells firm, doesn't change its shape, and difficult to be inserted from incision of axilla or small areola. The infra-mammary fold incision provides correct
and sufficient dissection, absolute hemostasis, and easy insertion of stable implant. The combination of stable implant and infra-mammary fold incision
is the mainstream in Europe. However, the Asian whose wound is easy to become hypertrophic tends to choose axillary incision. From axillary incision,
only the smooth, soft cohesive and round implant can be inserted. This combination of implant provides mobile, soft, shape-changeable breast if without
capsule contracture, and named as "mobile concept". But if with capsule contracture, it turns into firmness, deformity, and upper deviation. Because the
dissection from axillary incision isa blind procedure, the dissection is incorrect and insufficient, and the hemostasis is impossible. Recently, I have
advocated hybrid concept which combines the direct vision technique via armpit incision and insertion of textured round implant beneath superficial
abdominal fascia.
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Rexon Ngim
Avoiding Pitfalls in Aesthetic Surgery
Periocular Rejuvenation Part 2 - Upper Eyelid
In the quest to look attractive some fundamentals of surgical practice must not be overlooked.
Failure to take into account of these fundamental principals may lead to disaster or unwanted sequelae.
These include the following:
1) When any injection is given, an anaplylactic kit must be at hand.
2) A "mole" may not be a mole but is actually a skin cancer. Recurrent moles need to be excised and histologically examined.
3) Beware of nutritional supplements and herbal preparation especially in mega doses of garlic pills, Tanakan and Tangkuei. These may contribute to
post-operative bleeding.
4) The teaching of "Dog ears will go away" is incorrect. "Dog ears" will actually go away with the patient to see another doctor to have them removed.
5) It is important to evaluate pre existing scars and healing response prior to surgery.
Two important tests to evaluate scars are:
a) Downlight test
b) Compression test
6) Mortality in aesthetic surgery is an absolute disaster everyone wants to avoid.
7) Morbidity of pain, swelling, bleeding and scars can be minimised with understanding of anatomy and surgical techniques. These are aided by newer
surgical instruments such as the bevelled tip scissors and injection with size 32G needles. Some tips and pointers to performing dermato-plastic
surgical operations as painlessly, as bloodlessly and as scarlessly are given with illustrated cases.
These pitfalls can be avoided with awareness of the above factors.
Charles Randquist
Achieving predictable outcome in breast augmentation
Aesthetic Breast Surgery Part 1
This lecture shares my experience, concepts and refinements for primary breast augmentation with highly cohesive gels, and its consequences regarding
complications and reoperation based on data from 1126 primary breast augmented patients having had the same kind of surgery.
In order for a breast augmentation practise to advance and improve, its surgeon must constantly strive towards fewer complications and reoperations,
predictable long-term results and a better experience for the patient. The surgeon must be attentive in the communication with the patient and adhere
to certain principles, both during implant selection and surgery.
These principles can be summarized by the following "five P:s":
- Patient selection/ education is the most crucial and requires an attentive and thorough surgeon as well as well trained staff.
- Preoperative planning with implant selection and marking is critical in order to gain a predictable result and should be based on a careful assessment
of the patient's measurements and features. Respecting the patient´s base width is an important guidance when choosing implants. Lowering of the
inframammary fold is often a must when positioning the implant understanding the concept of controlled tissue expansion.
- Proportional thinking during implant selection, taking the patient's height and the characteristics of her hips, waist, chest and shoulders into
consideration leads to attractive results. Understanding the Matrix and concept of volume distribution.
- Performance during surgery is pivotal. Bloodless, swift and a traumatic surgery with a precise design of the implant pocket and without using sizers or
drains lessens the risk of complications. This also assures a cosmetically controlled long-term result.
- Postoperative care with early mobilization, having the patients spend one postoperative night at the clinic and with responsible follow-ups by the
surgeon ads safety and increases the patient's confidence and overall satisfaction.
The authors outline a set of pre-established principles for breast augmentation with highly cohesive textured implants. In the speakers' clinical experience,
the strict adherence to these principles during surgery and preoperative planning leads to a result that is predictable, reliable and highly satisfying.
Yusuke Shimizu
Non-incisional ptosis repair
Periocular Rejuvenation Part 2 - Upper Eyelid
Back ground & Aim of the study: The common operation currently used for ptosis includes aponeurosis repair, levator tucking, and levator resection.
Most of them are performed through a skin or conjunctival incision of upper palpebra. We developed a new technique for ptosis repair that does not
require a skin or conjunctival incision. We will present some of the pre and postoperative photographs and show our operative procedure in the movie.
Methods:
1. Before the operation we must confirm that the patient can gaze downward properly in spine position on operative table. (If the patients can't do so,
he/she must practice)
2. Turn over the upper eyelid and 5-0 nylon suture is placed at upper border the upper tarsus as a traction suture.
3. Pull this traction suture upward and let the patient gaze downwards as much as possible, thus the conjunctiva cul-de-sac is easily exposed.
4. One side of the double arm needle 7-0 nylon suture is placed from the conjunctival cul-de-sac (point A) to upper border of the tarsus (point B),
scooping up the conjunctiva and Muller's muscle.
5. This suture is then placed from the same point of tarsus (point B) through to desired double fold line of the skin eyelid (point C)
6. The other side of the double arm needle 7-0 nylon suture is placed from point A through point B to point C in the same manner.
7. Both of the suture ends are ligated subcutaneously.
8. Procedure 3 to 7 should be done using another double arm needle 7-0 nylon suture in different point.
Results: From June 2003 to June 2010 we applied our new technique to 422 patients with mild to moderate ptosis. Majority of patients were satisfied
with results soon after the operation. However, some of the patients needed revision because of the disappearance of the intended effect.
Discussion: Most operations for ptosis repair require skin or conjunctival incision of upper palpebra. This incision usually induces prolonged postoperative
eyelid swelling for a few weeks. In addition, these operations are sometimes associated with difficulty in secondary correction. On the other hand, our
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method does not need skin or conjuncitval incision. The advantages of this non-incisional ptosis repair include; easy to perform, no visible operative scar
on eyelid skin, reducing the postoperative edema, shortening the downtime, easy to remove the suture if the patient is not satisfied with the result and
no difficulty in secondary correction. The disadvantages of this method include: hard to decide the accurate degree of advancement before the operation
and disappearance of the operative effect in some patients because the correction is done by only nylon suture. By the way some of the patients with
sunken eyelid and entropion are good candidates for this procedure, too.
Conclusion: Although our method has several disadvantages, our method is easy and simple to perform especially for cosmetic patients who are afraid
of skin incision.
Marco Stabile
Lipotransfer water jet assisted
Aesthetic Breast Surgery - Part 1
Background & Aim of the study: Successful transplant of fat is possible in principle, and this was described as long ago as 1893 (Neuber). The barrier
to its realization until now has predominantly been the rate of survival of the fat cells transplanted and the absence of a facility for harvesting large
quantities in realistic surgery times.
Coleman (U.S.A.) has developed a protocol since 1980 with optimal results. From the recent literature we know that the adipose tissue is the greatest
source of stem cells easy available in the human body.
Materials & Methods: Since the 2008 we have used this new technique that takes the advantage of the ability to a gently water jet in order to capture
the cells without damaging them and through a controlled aspiration they are deposited in a lipocollector purposely predisposed with a thin filter. A
continuous washing helps to remove the fluid in excess and the cells of the blood, holding the adipose tissue within. The fat cells are immediately ready
for the transplant without centrifugation.
Results: This surgical procedure is fast and it is carried out in smart times under local anesthesia with sedation. In our experience they have been dealt
pathologies like pectus escavatum, breast asymmetry, breast reconstruction and enlargement.
Conclusions: This technique is easy, smart for the fat graft in large quantity and is also applied to increase the dimension of the breast and buttocks with
effective and natural result without complications.
Feng-Chou Tsai
Analysis of nasal periosteum and nasofrontal suture with clinical implications for dorsal nasal augmentation
Rhinoplasty
Backgrounds: Subperiosteal placement of the nasal implant was widely performed for dorsal nasal augmentation in Asia. I not only built up the
foundation of subperiosteal augmentation rhinoplasty, but introduced anatomical and biomechanical studies to investigate the influence of the
periosteum on the subperiosteal technique.
Methods: Nasal periosteum on twenty cadavers was investigated by hematoxylin and eosin staining as well as biomechanical methods. Nasal profiles
(n=160) and motility test (n=1317) were used to analyze patients that underwent augmentation rhinoplasty between 2003 and 2008. An alternative highsplit subperiosteal technique was developed for higher placement of the nasal implant.
Results: In the cadaver study, my novel finding showed that the periosteum and bone were bound together by Sharpey's fibers below the nasion (1.3 0.6
mm) that penetrated into the nasofrontal suture. The nasal periosteum above the nasofrontal suture (1.77 0.19mm) was thicker than the one below the
suture (0.83 0.15mm) (p<0.001). Male adults had relatively thicker periosteum (1.41 0.49mm) compared to females (1.18 0.5mm) with a statistical
significance (p<0.001). Motility testing for clinical cases revealed that there was higher percentage of the mobilized implant in females than in males
(p=0.042). When compared to the subperiosteal with subcutaneous technique, analysis of Poisson's ratio for the periosteum (0.33 0.02) indicated a
stronger strength than the subcutaneous tissue (0.45 0.02). The alternative high-split subperiosteal technique significantly shortened radix-to-glabella
distance, increased radix height and made nasofrontal angle more obtuse than the conventional subperiosteal technique (p<0.001, p<0.001, p=0.02
respectively).
Conclusion: The periosteum and bone are bound together by Sharpey's fiber to form a periosteal pocket. Analysis of the nasal periosteum provided
scientific support for developing various subperiosteal techniques in rhinoplasty.
This paper has been published by the Plastic and Reconstructive Surgery 2010.
Feng-Chou Tsai
Facial and Body contouring
Analysis of total leg sculpture (1500 cases) with basic researches of denervation (Selective neurectomy and Botulinum Toxin-A
(BoNT-A) injection)
Backgrounds: In addition to the conventional methods used to improve leg contours, total leg sculpture, including liposuction, selective neurectomy, and
transilluminated powered phlebectomy, provides a one-time solution of leg contours. I presented basic researches of denervation (BoNT-A injections and
selective neurectomy) with clinical implications, and determined any correlation between the leg variables and body mass index. The biomathematical
features of surface complexities and integrins were also studied.
Methods: 1500 female patients who underwent total leg sculpture between 2005 and 2010 with prospective analysis of the patients' data were
performed. Local measurement variables and body mass index (BMI) were recorded, and the correlation between them was determined by Pearson's
correlation and regression analysis. A rat skeletal muscle model through repeated or dose-adjusted BoNT-A injections and neurectomy, and mathematical
diffusion equations were established.
Results: Selective neurectomy (transection of nerves to medial gastrocnemius and soleus muscle) effectively resolved the calf hypertrophy. There were
significant differences between preoperative and postoperative measurements of all variables for total leg sculpture. There was a significant positive
correlation between the BMI and variables related to the buttocks and upper thigh. The satisfactory postoperative leg variables were buttocks
circumference (87.85 cm), thigh circumference (44.20 cm), maximal calf circumference (32.24 cm), and calf ratio (0.78). Each preoperative BMI increment
represents a 0.3 percent circumference improvement around the buttocks. Moreover, molecular expressions and muscle weight reduction showed a
coherent and biphasic pattern with a peak at 4 (BoNT-A) and 8 (neurectomy) weeks. AIF (apoptosis-inducing factor): p-Akt ratio persisted even at 26
weeks in the neurectomy group. Surface complexities of tissues are significantly correlated with the integrin expressions.
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Conclusion: Total leg sculpture provides a combined aesthetic solution for improving limb contours with minimal morbidity. The biological surface
topology interacts coherently with related integrins, which recruit multiple signaling pathways. AIF-medicated caspase-independent apoptosis was
significantly different between neurectomy and BoNT-A injection.
This subject has been published by the Plastic and Reconstructive Surgery 2008, 2009; Aesthetic Plastic Surgery 2010, Journal of Trauma 2010 and Journal
of Neurotrauma 2010.
Chau-Jin Weng
Secondary upper blepharoplasty deformities
Periocular Rejuvenation - Part 2 - Upper Eyelid
Background: Upper blepharoplasty is one of the most frequently performed procedures by the plastic surgeons in the field of aesthetic plastic surgery in
Asian countries. The purpose of this procedure is to create a pair of authentic supratarsal fold that fit the individual patients. The good results can really
change patients' appearance and enhance their self-esteem. However, once in a while, patients came to clinic and asking for help to correct their
deformed upper eyelids which had been performed eyelid surgery by physicians, both plastic surgeons and, far more frequently, none-plastic background
physicians. This presentation is aimed to correct most of the cases that has been treated. The causes of deformities has been analyzed and classified
according to individual peri orbital anatomy, surgical technique and other factors that might contribute to the unfavorable surgical outcome.
Revision of secondary eyelids deformities were mostly revised according to clinical findings and its pathogenesis.
Materials and Methods: Collection of 254 cases of secondary upper blepharoplasty deformities were seen and revised at author's clinic. The types of
deformities, the procedures selected by the original surgeons has been reviewed and categorized. The patients' surgical histories were also reviewed.
The finding of the causes of deformities and its correlated anatomical foci will be deferred as references for later surgical correction of each case of eyelid
deformity.
Results: The findings of the secondary upper blepharoplasty deformities from those 254 cases can be categorized according to the type of deformity and
its frequency of happening as: asymmetry, fading of supratarsal fold, exaggeratedly high supratarsal folds, supratarsal depression and postoperative ptosis.
The causes of these deformities have been traced back to the original surgical techniques. And, also the surgical findings from the revision surgery are
the tribute to our clinical findings of each category of deformity. Most of the secondary deformities were from technical errors, mostly due to incomplete
apprehension of anatomy and the surgical technique.
Most of these cases of secondary eyelid deformities were underwent surgical revision and have got satisfactory results, although some of them need to
have one or two additional minor revisions.
Conclusion: Upper blepharoplasty for the Oriental people is one of the most popular aesthetic surgical procedures among the Asian countries. The
procedure is armed to create a pair of symmetrical supratarsal fold to enhance the appearance for the persons who do not or only have a narrow lid fold.
Careful estimate the anatomy of a person come asking for this procedure is mandatory to avoid pitfall of any possible uncovered problems. Also, the
choice of procedure you are most familiar with, or the correct techniques for the patients will also the key to achieve good results. Any neglect of
individual anatomic variations or select the wrong techniques would possibly end-up disaster results. Knowing different techniques and master each
procedures will ensure to achieve a pair of sound supratarsal folds.
A good result of upper blepharoplasty not only changes the appearance of patients but also enhances the esteem of patients. Both patients and surgeons
will also get reward from the satisfactory results of surgery.
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Posters
Yavuz Demir, Nurten Turhan Haktanir
Combined V-Y advancement and perichondrioplasty technique for the surgical treatment of constricted ear deformity.
Afyon Kocatepe University, School of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery, Afyonkarahisar, Turkey
Introduction: Constricted ear has been defined as a deformity affecting upper third of auricular structures in varying degrees with different classification
methods. The deformity is classified as according to the most commonly used Tanzer classification system with respect to the presence of lidding, cupping,
involvement of auricular structures and decreased ear size Different surgical approaches were reported for the repair of the deformity, but it is still a
surgical challenge to treat moderate to severe degrees of constriction.
Patients, materials, methods:
Case 1: A 10 year-old female patient presented with auricular deformity. Physical examination revealed helical lidding and cupping. Scaphoid fossa was
broader and superior crus and triangular fossa was missing in the upper third (Type IIB deformity according to Tanzer classification system). The affected
ear size was decreased and the vertical height was 13mm lower compared to the normal side. The deformity was corrected using a combined procedure
including increasing the vertical height by elongating the free margin of the helix and repair of the cupping deformity by perichondrioplasty technique.
With this combined technique, 8mm lengthening in the vertical height was gained.
Case 2: A 8 year-old female patient presented with severe cupping and lidding deformity of the right ear. The affected ear was 12mm shorter compared
to the non-affected ear. Same procedure using combined V-Y advancement of helix crus and perichondrioplasty for antihelical fold creation was
performed. With this technique 8mm lengthening in the vertical height was gained.
Results: Using this combined technique, satisfactory result was obtained postoperatively for both the patient and surgeon.
Conclusion: In the correction of cup-ear deformity, for mild anomalies with minimal skin and cartilage deficiency, creation of antihelical fold may be
sufficient, however, in moderate to severe forms, lidding deformity cannot be corrected, so, additional procedures should be performed to gain in vertical
length. The main reason in the lidding is the shortness of the free margin of the helix so lengthening of the free margin by V-Y advancement of the crus
of the helix can result in satisfactory lengthening without additional need for helical and scaphal cartilage refashioning. Addition of the
perichondrioplasty to create antihelical fold in the upper third has also a positive effect on lengthening the vertical height as the sutures in the upper
pole will have an additional eversion effect on the lidded free margin. In the surgical treatment severe cupping, combination of V-Y advancement of the
crus helix and perichondrioplasty technique for creation of the antihelical fold can be used to achieve satisfactory outcome without additional need for
cartilage grafting and procedures.
Dalila SF Gomes
Monopolar radiofrequency skin-tightening procedure with new Comport Pulse Technology (CPT) in a private clinic - Macau
SPA Director/Aesthetic Medicine Malo Clinic - Health and Wellness Macau and Thermage - CPT
Background: Monopolar radiofrequency skin tightening procedure becomes highly recommended for patients who do not prefer a traditional facelift
surgery. The need for such treatment becomes popular due to its non-invasive characteristic. A new advanced model of monopolar radiofrequency device,
called Thermage CPT system, has the following three key features: 1) new energy delivery algorithm with pulsed RF and cooling mechanism; 2) a redesigned treatment tip which enhances thermal distribution and uniformity and 3) a new vibrating and tunable handpiece that improves patient comfort.
These features work synergistically to maximize patient comfort to an unparalleled degree while improving the overall heating profile in order to deliver
consistent and efficacious skin tightening and contouring treatments.
Methods: All subjects received a single full face treatment and were returned for follow up visits at one, three, and six months after treatment. The study
focused on patient comfort level and satisfaction during treatment with the use of the new vibration hand piece and the improved pulsed RF technology.
In the study, nine patients (N=9) with 8 females and 1 male, have been received treatment for facial uplift and skin tightening. Ages ranged from 30 to
58 years old. Skin types range from Fitzpatrick skin types III-V, including Asians, Europeans, and Africans.
Subjects have to report their comfort levels during treatments. Refer to Table 1.
Subjects were asked to provide their subjective ratings of improvement and satisfaction at one, three and six months after the treatment. Refer to table
2.
Photos were taken at baseline before treatment, immediately post-treatment, and at one, three and six months post- treatment respectively.
Table 1. Comfort score rating scale
Comfort Scale Rating
0 - No Warmth
1 - Warm
2 - Moderately Hot
3 - Very Hot
4 - Intense
Table 2. Satisfaction score rating scale
1- Not satisfied
2- Moderate satisfaction
3- Very Satisfied
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Results: All patients (N=9) were satisfied with the post-treatment effects.
Subjective feedbacks include slight improvement of nasolabial fold, crows feet wrinkles, tightness of the skin, and the overall comfort of the treatment.
Comfort result is reflected from the vibration comfort score of 2 (moderately hot) compared to a non-vibration comfort score of 3 (very hot). This
difference was statistically significant.
Expected post-treatment erythema was found in 8 patients. It was settled by application of a topical steroid (hydrocortisone) for 5 minutes immediately
after procedure. No side effects were seen or recorded.
Overall improvement was rated in the range of mild to moderate by subjects.
Skin laxity assessments were made at baseline and at 1, 3 and 6 months post-treatment visits. The pictures prove results.
All of the patients (N=9) were satisfied (7 Patients - Very satisfied, 2 patients - moderately satisfied) and desire to repeat the same skin tightening
treatment. Patients can well be tolerated thorough the full procedure. As a combination treatment with several other plastic surgery procedures, such as
blepharoplasty, partial face-lifts surgery, and other facial injection procedures such as fillers and botulinum toxin, Thermage CPT can be considered as an
ideal combination procedure due to its minimal downtime.
Conclusion: The three advancements in Thermage CPT system, innovative pulsed RF and cooling mechanism, enhanced treatment tip thermal distribution,
and a vibration hand piece increase significantly on patient comfort, efficacy and patient satisfaction. It is regarded as a significant evolution in the use
of monopolar radiofrequency for skin tightening.
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TOP 8 THINGS-TO-DO
Take in a free performance at the Esplanade - Theatres on the Bay
Sip a cocktail at the bar in the Raffles Hotel
Visit the Hindu-Buddhist gallery at the Asian Civilisations Museum
Enjoy the peace and quiet in Fort Canning Park
Catch a bumboat ride down the Singapore River
Watch the Crazy Horse Paris Cabaret Show at Clarke Quay
Ride on the G-Max Reverse Bungy at Clarke Quay
Shop at Suntec City, Marina Square and Millenia Walk
Merlion
The merlion is a statue with the head of a lion and
the body of a fish. Its name comes from a
portmanteau of mermaid and lion. The merlion was
designed by Fraser Brunner for the Singapore
Tourism Board in 1964 and was used as its logo up
to 1997. The Merlion continues to be its trademark
symbol. It also appears frequently in STB-approved
souvenirs. The original Merlion statue stands at the
opening of the Singapore River while a taller replica
can be found on Sentosa Island.
Chinatown
Nearly two centuries after Sir Thomas Stamford
Raffles first set foot in Singapore, the island is still
governed from the colonial nucleus he established
on the east bank of the Singapore River. A walk in
this Colonial District, which is the heart of colonial
Singapore, is essentially a stroll down memory lane,
featuring sights and monuments that reflect the
city-state's rich historical past, especially the
mythical Raffles hotel which dates from 1899.
Singapore's Chinatown is an ethnic neighbourhood
featuring distinctly Chinese cultural elements and a
historically concentrated ethnic Chinese population.
Chinatown is located within the larger district of
Outram.
As the largest ethnic group in Singapore is Chinese,
composing approximately 75% of the population,
Chinatown is considerably less of an enclave than it
once was. However, the district does retain
significant historical and cultural significance. Large
sections of it have been declared national heritage
sites officially designated for conservation by the
Urban Redevelopment Authority.
Keong Saik Road was once a red light area in
Chinatown in the 1960s, but has since been
transformed into a street with many boutique hotels.
Thian Hock Keng Temple
Arab Street & Little India
Its name translates as Temple of Heavenly Bliss,
which is entirely apt given the gorgeous decoration
of this temple, the oldest and most important
Hokkien temple in Singapore. It was built between
1839 and 1842 on the site of the shrine to Ma-ChuPo, Goddess of the Sea, who reputedly could calm
rough waters and rescue those in danger of
drowning. This place was once the favourite landing
point of Chinese sailors (believe it or not, Telok Ayer
Street used to run along the shoreline). It was here
that seafarers and immigrants from the Fukien
Province set up a joss house in gratitude for their
safe arrival after their long voyage from China in the
1820s.
More in the North, the Indian and Moslem
communities took up residence in the district of
Little India and Arab Street. In both main arteries of
Serangoon Road and Arab Street, we can even there
stroll, by being allowed guide by its nose and its
curiosity. Between the numerous shops of Indian
products, the displays of silk trades, batiks, sarongs
or diverse fabrics, we shall not miss to
stop(arrest) to taste(savour) of delicious
Tamil specialities. To the Muslim
shopping mall Mustapha Centre in
the district of Little India, you will
find absolutely everything: jewels,
clothes, electronics, food. On Arab
Street, the Malay district, admire the
magnificent Sultan mosque.
Colonial District
Singapore Botanic Gardens
Singapore Botanic Gardens, a block from Tanglin
Mall, past Gleneagles Hospital, is an excellent place
to wind down. This is the mother of all Singapore
parks. You can't beat the Singapore Botanic Gardens
as a spot to recover from your jet lag, have a picnic
or just lie around forgetting you're in a large
metropolis. Spacious and beautifully landscaped,
44
with paved walkways winding around the luscious
greenery, the Singapore Botanic Gardens, which
cover a 53-hectare (130-acre) spread, are popular
for family picnics, jogging or strolling.