3. PHOTOAGEING
Photoageing refers to the damage that
is done to the skin from prolonged
exposure, over a person's lifetime, to
UV radiation. Most of the skin changes
that occur as we get older are
accelerated by sun exposure.
Examples of skin changes from
photoageing include:
4. PERIORBITAL AGEING
The periorbital region is a
immediate barometer of a
patient’s chronological and
environmental age. It tells its
own history of ultraviolet light
exposure and the wish for
aesthetic rejuvenation
treatments
5. SKIN CANCER
SALLOW SKIN COARSE
RHYTIDS
FINE
RYTHIDS
THREAD VEINS
PIGMENTATION
TitlePHOTOAGEING
6. CHRONOLOGICAL AGEING
Anatomical changes include
laxity of the eyelid skin,
prominent infra-orbital fat
pads, hypertrophic orbicularis
oculi muscle, and even
descent of the forehead,
eyebrows and mid-face
23. Your Text here Your Text hereYour Text hereMETHOD• Every patient being treated in the perioral area is given Valtrex
(valcyclovir) 500 mg bd for 8 days starting three days before surgery. This
is increased if there is a break out of Herpes.
• If the patient has active acne, we prescribe ByMycin (Doxycycline)
100mgs for 7 days, starting one day prior to procedure.
• If the patient has evidence of prolonged erythema we prescribe Lamasil
250mgs for one week.
PROHPYLAXIS
28. Your Text here Your Text hereYour Text hereMETHOD
Topical Anaesthesia
BLT ® : (Amethocaine; Propitocaine; Lignocaine) as topical anaesthetic
to the entire facial area for 45mins.
Regional Anaesthesia
Typically, we gave regional anaesthesia during the procedure including
•Supraorbital and Supratrochlear Nerve Block
•Infraorbital Nerve Block
•Mental Nerve Block
ANAESTHESIA
30. Patient CM 2 passes under R eye with obvious reduction in rhytides and neocollogenesis
31.
32. • All skin biopsies in this study show effect of thermal treatment with
thermal coagulation of epidermis and superficial dermis consistently
getting below 100 µm. Many studies show the zone of residual
thermal (coagulative) damage can extend a further 20 to 120 µm,
depending on the particular laser variables used
33. This was particularly evident in Patient C where
the thermal effect appears to be more diffuse
than focal and the evidence of effect was still
measured at 700 microns, although this
reflected a vague diffuse thermal effect as
compared with the more localized usual effect.
Because the various CO2 lasers currently
available differ in their biophysical properties,
their documented depth of histological ablation
and thermal effects vary
BIOPSY
Patient C
37. The DUBLiN method uses different
methods and technologies in order
to activate fibroblasts and direct
them towards neocollogenesis. It
also uses low level pulsed lasers to
reduce skin laxity, accelerate growth
factors and cause tightening.
38. The DUBLiN method incorporates
D Dermaroller
U Ultrapulse Laser
B Blood Factors
Li Light – 633nm
N Neurotoxin
39. Tissue Repair -FIBROBLASTS
A fibroblast is a type of cell that
synthesizes the extracellular matrix
and collagen, the structural
framework (stroma) for animal
tissues, and plays a critical role in
wound healing. Fibroblasts are the
most common cells of connective
tissue in animals.
41. ULTRALASE LASER
Laser specialists non-sequential
fractionalised CO2 laser ablation
is the most effective modality for
repairing photo damaged skin
The benefits are more precise
control of ablation depth, faster
recovery time and reduced risk of
post procedural problems
43. Tissue Repair –GROWTH FACTORS
Platelet Rich Plasma, also
known as PRP is a component
of whole blood that contains a
concentrated amount of
growth factors. This video
describes the basic science of
injecting PRP.
44. Tissue Repair –Platelet Rich Plasma
The efficacy of certain growth
factors in forming collagen and
healing various injuries is the
theoretical basis for the use of PRP
in tissue repair. The platelets
collected in PRP are activated by
the addition of thrombin and calcium
chloride. This induces the release of
these factors from alpha granules.
45. LiGHT 633nm
Migrating cells exert forces
against the substrate to
move forward. These forces
are part of the contraction
phase of migration in which
the rear of the cell is
detached from the
substrate and the body of
the cell is moved forward.
46. LiGHT 633nm
Migrating cells exert forces
against the substrate to
move forward. These forces
are part of the contraction
phase of migration in which
the rear of the cell is
detached from the
substrate and the body of
the cell is moved forward.
47. Near Red Light 633
Dermaroller
Title
Fibroblast
Activation
PHASE 1
PRP Growth Factor Signals
48. Near Red Light 633
Post NTa
Title
Collagen
Synthesis
PHASE 2
Co2 Laser
49. Induction of FIBROBLASTS
A fibroblast is a type of cell that
synthesizes the extracellular matrix
and collagen, the structural
framework (stroma) for animal
tissues, and plays a critical role in
wound healing. Fibroblasts are the
most common cells of connective
tissue in animals.
50. Comparative study over three months
• Over 3 months, 15 patients
(Group 1) received FLSR
at normal settings
• Results were compared to
29 patients (Group 2)
received low energy FLRS
+ adjunctive treatments
• Both group received BTXA
one week prior to other
treatments
51. Group 2 received a 3-phase combination
multi-rejuvenation technique over 3 weeks.
• Phase I included Dysport® at dilution
3.5:1 in 3 areas
• Phase 2 introduced intense fibroblast
stimulation and modification through
microneedling, PRP growth factor
induction and near-red phototherapy.
• Phase 3 included low–level (CO2)
Ultrapulse laser with settings (Energy)
100 mJ (Rate) 14w CPG 3/5/2 and
adjunct near-red 633nm
phototherapy.
52. Near Red Light 633
Dermaroller
Title
Fibroblast
Generation
PHASE 2 multi-combination
technique
PRP Growth Factor Signals
53. Near Red Light 633
Dermaroller
Title
Fibroblast
Activation
PHASE 2a fibroblast activation
PRP Growth Factor Signals
54. Near Red Light 633
Dermaroller
Title
Fibroblast
Stimulation
PHASE 2b fibroblast stimulation
PRP Growth Factor Signals
57. GROWTH FACTORS
The efficacy of certain growth
factors in forming collagen and
healing various injuries is the
theoretical basis for the use of PRP
in tissue repair. The platelets
collected in PRP are activated by
the addition of thrombin and calcium
chloride. This induces the release of
these factors from alpha granules
58. LiGHT 633nm
Migrating cells exert forces
against the substrate to
move forward. These forces
are part of the contraction
phase of migration in which
the rear of the cell is
detached from the
substrate and the body of
the cell is moved forward.
59. Near Red Light 633
Post NTa
Title
Collagen
Synthesis
PHASE 2
Co2 Laser
60. ULTRALASE LASER
Laser specialists non-sequential
fractionalised CO2 laser ablation
is the most effective modality for
repairing photo damaged skin
The benefits are more precise
control of ablation depth, faster
recovery time and reduced risk of
post procedural problems
67. WSRS = Wrinkle Severity Rating Scale
5 Extreme Extremely deep and long folds, detrimental to facial appearance.
2-4mm Visible V-shaped fold when stretched
Unlikely to have satisfactory correction with injectable implant alone.
4 Severe Very long and deep folds; prominent facial feature.
Less than 2mm visible fold when stretched.
Significant improvement is expected from injectable implant.
3 Moderate Moderately deep folds.
Clear facial feature visible at normal appearance but not when stretched.
Excellent correction is expected from injectable implant.
2 Mild Shallow but visible fold with a slight indentation; minor facial feature.
Implant is expected to produce a slight improvement in appearance.
1 Absent No visible fold, continuous skin line.
68. GAIS = Global Aesthetic Improvement Scale
5 Very Much Improved Optimal cosmetic result for the implant in this
patient.
4 Much Improved Marked improvement in appearance but not
completely optimal for this patient. A touch-up
would slightly improve the result.
3 Improved Obvious improvement in appearance from the initial
condition, but a touch-up or re-treatment is
indicated.
2 No Change The appearance is essentially the same as the
original condition.
1 Worse The appearance is worse than the original
condition.