New modalities in antiaging by Dr. Juliana Ghaben Specialist Dermatologist .
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New modalities in antiaging by Dr. Juliana Ghaben Specialist Dermatologist .



DR Juliana Ghaben spoke on new modalities on antiaging at CME for KAYA skin CLinics . She is Board certified in Aesthetic Medicine and a trainer with SPECTRONIX . ...

DR Juliana Ghaben spoke on new modalities on antiaging at CME for KAYA skin CLinics . She is Board certified in Aesthetic Medicine and a trainer with SPECTRONIX . She spoke on Carboxytherapy , SECRET MICROFRACTIONAL RF AND Q SWITCH ND YAG , ALL MACHINES COURTSEY ; SPECTRONIX .



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New modalities in antiaging by Dr. Juliana Ghaben Specialist Dermatologist . New modalities in antiaging by Dr. Juliana Ghaben Specialist Dermatologist . Presentation Transcript

  • New Modalities in Anti AgingDr. Juliana Ghaben, MD . DermatologistConsultant Trainer with SPECTRONIX
  • Dr. Juliana GhabenMD , Specialist Dermatologist ( Skin , Aesthetic and Laser)Visiting Fellowship in Laser Skin Surgery ,ThailandBoard Certified in Aesthetic Medicine by American AcademyConsultant and Trainer with SPECTRONIX
  • New modalities in Anti agingI would like to Share the following technologies in thispresentation•Carboxy Therapy with Crabotech F650•Secret Microfractional Radio Frequency•Q Switch ND YAG Laser View slide
  • What is Carboxy Therapy ?Carboxy Therapy is a procedure verysimilar to MesotherapyIt consists of intradermal or subcutaneousinjections of medical grade co2 using 30 Gneedles.Treatments are rapid, comfortable andeffective for a high percentage of patients View slide
  • Common Indications•Cellulite• Face Wrinkles• Under Eye Dark Circles• Skin Laxity ( Hands , neck , submentonian area,Decolletage area )• Old Stretch Marks• Hair Loss• Recent Scars and acne scars• Psoriasis
  • Effects of Co2 Injection in the Body•Vasodilation• The Bohr Effect ( Co2 +H20 = H + HCO3• Simulation of Collagen synthesis• Neo Angiogenesis effect• Suspected Melanocyte Pigment synthesisStimulation• Receptor activation and Lipolysis improvement
  • • Strong vasodilatory effect (causes dilation of blood vessels) on thecapillaries in the area.Wider vessels mean bigger and stronger blood flow to the area,which means more oxygen.The increase in oxygen is important because it eliminates the builtup fluid from between the cells.Carboxytherapy. How it works?
  • Administration for Fat
  • Direct pressure causes trauma to adipositiesBlood flow increases and Bohr effect bringsMore oxygen to adiposities leading to an optimized physiological lipolysis.CO2 injection stimulates the synthesis ofCollagen . This property is used to improve atrophic scars byincreasing the quantity of collagen below the atrophyRestores skin laxity and colour and speeds upThe wound healing process . It is interesting procedurefor white thyroidectomy , caesarean and appendectomy and other scars ingeneral.It works in three ways on old white stretch Marksa) Neo-angiogenesis below the mark , which adds a pinkcolourb) Melanin Stimulation caused due to increased Oxygen inthe tissuec) Collagen synthesis which reduces the creased appearanceAesthetic IndicationsStretch MarksLocalized FatAcne ScarsSurgical Scars
  • Because it stimulates Collagen synthesisAnd local lypolytic action helps ineye rejuvenation and fat depositsThe dorsal side of the hands may be treatedWith intradermal injections . The Expected effectAre tightening after four or more sessionsSome physicians use CDT for Psoriasis and we have Goodbefore after pictures documented by Manufacturing companyThere are not any published studies on indication and can beconsidered experimentalAesthetic IndicationsEye WrinklesLower Lid Fat deposits andUnder-eye circlesRejuvenation ofhandsDecolletage and NeckPsoriasisNasogenian FoldsAnd Peri-OralWrinklesCDT is an alternative to fillers in some cases ,especially for patients with contradiction to fillers Co2has progressive improvement over few sessionswhereas fillers have immediate results
  • Needle PhobiaStress , with history of vagal uncounciousnessSevere heart failure , congestive heart diseaseRecent heart infarction or instable anginapectroisRestrictive pulmonary disease , chronicobstructive lung diseaseSleep apneaRenal failure , dialysisRecent cerbrovascular accidentUncontrolled blood pressureEpilipsyRecent phlebilitis or pulmonary embolismUncontrolled DiabitiesChemotherapy , CancerBacterial Infection : Dermatitis, CellulitisForeign Body in the area to be treated( Jewellery implants in the area and soon )Herpes simplex in acutae phase andother acute skin viral infectionSkin disease with abnormally increasedlocal circulationFacial RosaceaPoikiloderma of CivatteRed necks and Red decolletagePregnancyLactationAnticoagulation ,Recent asprin or anti-inflimatory drugs intakeAcute skin infectionOther Aesthetic proceduresor skin traumatism less than15 daysCONTRADICTIONSGENERALCONTRAINDICTIONSLOCALCONTRAINDICTIONSTEMPERORYCONTRAINDICATIONS
  • The end result is fewer fat cellsand firmer subcutaneous tissue.Fig 1- Histological appearance of the dermisbefore CO2 treatment.Fig. 2. Patient 1. After CO2 treatment,thickening of the dermis and rearrangement ofcollagenous fibers is shown.Carboxytherapy End Results
  • CarboTech (Europe-US) ONLY FDA APPROVEDMACHINES40 CC PER MINUTE / 80 CC PER MINUTEMinimal discomfort. Less painful. Best Technique for CO2infiltrationSave Time with dual output modeSure Fire technique killing fat cellsInitial Start up AutoTesting + Color Led screenFunctionality in a simple an easy to use form-factorLatest valve technology / Timer / Pressurization System /watchAnodized Satin white ultra light aluminum casing220v or 110v selectorDo not generate heat – 30 wattCarbotech
  • 1) Axt Welcome - Test2) Please open the valve (15psi-28psi)- Ideal pressure 22psi3) Open the valve of the gas tube- 22psi4) Input- Pressure low/high5) If pressure high- Close the gastube valve- Purge6) Please select program (if 15psi-22psi)7) Press Program I (40cc) or ProgramII (80cc)8) Please enter volume in cm3(1cm3-999 cm3)- Enter-Pressurization9) Ready to start with …….cm310) Start with the procedure CO2 OUTPUTPEDAL SWITCHCO2 INPUTKEYBOARDCarboxytherapy in 10 steps
  • CO2 ADMINISTRATIONSubcutaneous• Syringe - 45 Degree• 15cc-50cc per sector• Speed 40cc per minute
  • Body- Sector Diagram
  • 50cc-80 cc20cc-50 ccAbdomen 20cc-50cc per areaAbdomen
  • 50-60 cc20-30 ccMore painful areasLegs
  • 15-50 ccArms
  • Tube- Carboxytherapy
  • Before AfterUnder Eye BagsRejuvenation
  • Before AfterStretch Marks
  • SECRET MICROFRACTIONAL RFMinimally invasive FractionalRadiofrequency Microneedls(FRM) deviceis recently introduced.The device gives selective heating in thedermis using bipolar RF (or monopolar RF)through microneedles.
  • IntroductionPrevious generation Ablative Skin Resurfacing laserdevices were effective, but many of them could notavoid the problems of long down time and patientpain. On the contrary, Non-ablative Skin Rejuvenationlaser devices reduced pain and adverse effects, butthese devices could not make dramatic effects. In themiddle of 2000s, fractional technology opened newgeneration overcoming previous problems. But thefractional treatment was limitedly used because itcould not control penetration depth and it gavedamage on the epidermis.
  • Common Indications•Non Surgical Face Lift• Wrinkle Reduction• Skin tightening• Skin Rejuvenation• Pore Reduction• Scars• Acne scars• Stretch Marks
  • What is Microfractional RF ?
  • How It WorksCollagen Regenerationand elasin productionMicroneedleCatridge is Placd on skin surfaceMicro-needle penetratesinside the skinBipolar RF Energy is delivereddirectly to targeted areaA precisely controlled BipolarRF is delivered at depthbetween 0.5mm to 3.5mmdepending on the symptoms
  • Fractional Laserand Microfractional RF
  • ConclusionMicrofrcational RF treatment has beenshown to provide consistent and meaningfulimprovement in facial scar and laxity withoutcomplications and adverse effects. Theaverage improvement seen following a singletreatment was approximately 93.3%. Theresult may become an important option forscar and facial laxity treatment
  • A new Modality in Antiging treatmentsSkin ToningPore ReductionPigments treatmentQ switch ND YAG
  • - Principal of Epidermal LesionCOSJET TRWith deep skin penetration depth, 1064nm treats pigment lesion in dermal(Nevus of Ota, ABNOM, Tattoo, Melasma)With high melanin absorption, 532nm treats pigment lesion in epidermal(Melasma, Freckle, Age spot, Lentigo)Anti-aging improvement using Genesis Technique (FR MODE)(Wrinkle, Pore size, Whitening)
  • Treatment Process of Epidermal LesionPigmentFreckle, Age spotCafé-au-lait LentigoSelective Photothermolysis532nmLaserEpidermalDermalPhoto acoustic effect
  • - Whitening (Frosting)Ideal Whitening Response- Shallow whitening is observed right after treatment.- Erythema is observed around pigment but the pigment point remains same as before.Vaporization from PigmentBefore Right After After 5minNormal WhiteningWhitening
  • - COSJET TR Clinical Case (1)Cosjet TR532nm / 0.9JFreckleRight after Whitening 1 week after Treatmentwith 532nm
  • - COSJET TR Clinical Case (2)Cosjet TR532nm/0.8JSolar Lentigo2 weeks after Treatmentwith 532nm
  • - COSJET TR Clinical Case (3)Cosjet TR532nm/0.9JFreckles2 weeks after Treatment(1 time)with 532nm
  • - COSJET TR Clinical Case (4)Before treatment 2 weeks after IPL treatmentCosjet TR532nm/0.9JFreckleswith 532nm
  • Treatment Process of Dermal LesionPigmentTattoo Ink, Melasma,ABNOM, Nevus of Ota,Selective photothermolysis1064nmLaserEpidermalDermalPhoto acoustic effect
  • MicrophageselectivityphotothermolysisPigment Lesion in Dermal (1064nm)Radiate Laser Pigment ResolvingPigment RemovalRight after After 4~8weeksThere maybe bleeding fromAcoustic damage
  • - COSJET TR Clinical Case (1)Cosjet TR1064nm/4.5JTatto2 weeks after Treatment(1 time)with 1064nm
  • - ERASER TR Clinical Case (2)Cosjet TR1064nm/7.5JNevus of Ota6 weeks after Treatment(1 time)with 1064nm
  • - COSJET TR Clinical Case (3)Cosjet TR1064nm/6.0JAmateur Tatto6 weeks after Treatment(1 time)with 1064nm
  • - What is Soft Peel & Genesis?Soft Peel & GenesisSOFT PEEL (New concept using carbon cream) + Genesis for dermal remodeling1064nm6ns8-10hz1.5J1064nm0.3ms8-10Hz10-14JHeatingCarbon oilexplodes andpeels off deadskinQ/SW ModeQuasiLong pulse Fast resultNo down timeNo painNo side effectPore sizeWrinkleSkin ToneAcne improvementCharacteristics
  • - Process of Soft Peel & GenesisSoft Peel & GenesisStep 1. CleansingClean skin surface toremove sebum, etc.For better result,cleansing mask orscrub can be used.
  • - Process of Soft Peel & GenesisSoft Peel & GenesisStep 2. Carbon creamApply carbon cream usinggauze.Wait for about 10min untilcarbon cream is absorbedwell in pores.Tip: Shake carbon creambefore using. Place tapeson eyebrows to protectthem during the laseroperation.Apply carbon cream After 10~15min
  • - Process of Soft Peel & GenesisSoft Peel & GenesisStep 3. Absorption of carbonAfter 20min, removecarbon cream with cottongauzeTip: Remove carbon creamon skin surface but leavethem in pores.
  • - Process of Soft Peel & GenesisSoft Peel & GenesisStep 4. Laser operationWhen operating laser, always wear safety goggles and treatment lab must have warning signs out at theentrance.
  • - Process of Soft Peel & GenesisSoft Peel & GenesisStep 5. Genesis TechniqueMode : 1064 FR ModeFluence : 10-14 JFrequency : 8-10 HzSpot Size : 3-4mm300㎲FR ModeheatingTransmission of thermal energy to dermallesionCollagen remodelingApplicationsWrinkle/pore size/whiteningAfter soft peel, concentrate laser radiationaround nose, forehead and eye fringes.Allow patients to feel heating of skin.The end point is erythema.
  • Clean with cleansing cream toremove remaining carboncream. Remaining oil andcarbon can cause skin trouble.Notice . Do not use coolingpack or cool washing untilheating temperature ondermal skin returns to normalthrough Genesis technique.- Process of Soft Peel & GenesisSoft Peel & GenesisStep 6. Finalize
  • - Carbon Cream for Soft PeelSoft Peel & GenesisHigh Quality Carbon CreamIn comparison to other products(20~40 Micron with irregularcombination), carbon cream used byWon Technology consists of 10 Micronwith regular combination. Stable andsafe to use, Won Technology’s carboncream leads to great results whenused with laser.
  • - Soft Peel & Genesis Clinical Case (1)AfterSoft Peel (2.2J) with Carbon8Hz / 6mm8 week interval X 3 timesSoft Peel & Genesis
  • - Soft Peel & Genesis Clinical Case (2)AfterSoft Peel(2.2J) & Genesis8Hz / 2.0J / Collimated H/P6 week interval X 2 timesSoft Peel & Genesis
  • - Soft Peel & Genesis Clinical Case (3)AfterSoft Peel (2.0J) with Carbon8Hz / 2.0J / Collimated H/P5 week interval X 2 timesSoft Peel & Genesis
  • - Soft Peel & Genesis Clinical Case (4)AfterCosjet Laser Toning (2.2J) + Soft Peel (2.0J)8Hz / Collimated H/P6 week interval X 5 timesSoft Peel & Genesis
  • - Soft Peel & Genesis Clinical Case (5)AfterCosjet Laser Toning (2.2J) + Genesis (14J)8Hz / 6mm / 4mm12 week interval X 8 timesSoft Peel & Genesis
  • - Soft Peel & Genesis Clinical Case (6)AfterSoft Peel(1.8J) + Genesis(14J)8Hz / Collimated H/P / 4mm4 week interval X 2 timesSoft Peel & Genesis
  • Suggestions for Pre/Post-TreatmentPre-TreatmentAvoid suntan beforetreatment.Shave hair in order toprevent energy loss and colorfixation.Avoid to take photo-sensitizer.Apply sun block beforetreatment.Post-TreatmentApply antibiotics and ointmentprescribed by clinic.When washing face, be careful not todisturbtreated areas.Avoid excessive exercise, sauna andswimming untilscab peels off naturally.Apply sun block (higher than SPF 30)after scabfalls off in order to prevent PIH.
  • ConclusionQ switch Nd yag is an effective and safe device for Skinrejuvenation and Skin lightening in all skin types .Combining different modalities is the best way to achievehighly desirable result .