2. 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.
3. The DUBLiN method incorporates
D Dermaroller
U Ultrapulse Laser
B Blood Factors
Li Light – 633nm
N Neurotoxin
4. PERIORBITAL AGEING
Periorbital region is a
immediate barometer of a
patient’s chronological and
environmental age. It tells its
own history of ultraviolet light
exposure and wish for
aesthetic treatments
5. PERIORBITAL 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
6. PERIORBITAL AGEING
Clinically photo-aged skin is
wrinkled, blotchy and
leathery. Eyelid laxity can
cause both ectropion and
entropion or eiphoria and
laxity of the medial and
lateral canthal tendon.
13. 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.
14. Tissue Repair -FIBROBLASTS
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.
16. 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.
17. Near Red Light 633
Dermaroller
Title
Fibroblast
Activation
PHASE 1
PRP Growth Factor Signals
18. Mouse fibroblasts are starved
for serum factors like PDF and
IGF-1. Then, serum is added
back and time lapse inverted
phase contrast images are
taken every 1 sec. Watch the
ears of a cell, at the tips of a
thin blanket of cytoplasm called
"lamellipodium".
Blood Growth Factors
20. Near Red Light 633
Low level Laser
Title
Fibroblast
Activation
PHASE 2
AGERA Prolifersyn ®
21. LOW LEVEL 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
31. • A clinical assessment of each patient regarding the overall level of
photoageing was made initially and at 2 weeks, I month and 3 months
postoperatively in the presence of two physicians.
• Positive scoring was based on the degree of re-epithelialisation
rate, reduction of rhytides, loss of hyperpigmentation and
telangectasias and reduction of tactile roughness.
• The prolongation and severity of erythema as well as the presence of
negative side effects (such as herpes were also recorded by both the
patient and the doctor). The degree of photoageing and the efficacy of
treatment were evaluated using a five-point scale originally suggested
. by Dover et al.
32. Score 0 1 2 3 4
Fine Lines None Rare Several Moderate Many
Pigment None Patchy Moderate Heavy Severe
Facial Veins None Rare Several Heavy Severe
Coarse Lines None Rare Several Moderate Many
Efficacy of treatment + scoring system
33. Score 0 1 2 3 4
Touch Even Rare Mild Moderate Severe
Complexion Pink Pale Grey
Partial
Yellow
Grey
Distinct
Yellow
Grey
Efficacy of treatment + scoring system
35. Score 0 1 2 3 4
Erythema None Rare Several Moderate Severe
Crusting None Rare Several Moderate Severe
Pain None Rare Several Moderate Severe
Herpes None Rare Several Moderate Severe
Efficacy of treatment - scoring system
37. Your Text here Your Text hereYour Text hereMETHOD
• If the patient has a strong history of HSV, we initially prescribed Famvir
(Famciclovir) 750mgs daily for 10 days or Valtrex (valcyclovir) 500 mg bd for
10 days starting three days before surgery. This was adjusted during the study
to commence one week before and to be used for one week after.
• If the patient has a strong history of acne, we prescribe an antibiotic ByMycin
(Doxycycline 100mgs daily) Augmentin Duo, (Amoxil Clavulinic Acid) Keflex
(Cephalexin 500 mg bd) for 7 days, starting the day of surgery).
• If the patient has a strong history of frequent yeast infections, we prescribe
Diflucan (Fluconazole 150mgs), starting on the 4th post-operative day and
taken once orally every other day
PROHPYLAXIS
38. Your Text here Your Text hereYour Text hereMETHOD
Topical Anaesthesia
Anestop® : (Amethocaine; Propitocaine; Lignocaine) as topical
anaesthetic to the entire facial area for 45mins. Astra Zeneca
Regional Anaesthesia
Typically, we gave regional anaesthesia during the procedure including
•Supraorbital and Supratrochlear Nerve Block
•Infraorbital Nerve Block
•Mental Nerve Block
ANAESTHESIA
39. Biopsy Staining Histology
Histology was
performed to
determine the
amount of tissue
ablation, residual
thermal
damage, inflammati
on and
neocollagenesis
Lesion
penetrative
dimensions
were assessed
histologically
using
haematoxylin
& eosin
Skin biopsies
were obtained
from 5 patients
intraoperatively
from each
side, after one
laser pass, and
at 3 months
postop.
42. Patient CM : Right Eye SmartXide treated (Power) 30W Dot Mode Spacing 200 μm Scanning well Time 500
μS 2 passes under R eye with obvious reduction in rhytides and neocollagenesis
43.
44. • The two CO2 lasers (Lumenis ActiveFx Deka SmartXide)
appeared to produce equivalent clinical improvement of
lesions and rhytides. Re-epithelialisation occurred in all laser
treated areas by both devices by day 7and this appeared to be
similar for both lasers. Mean duration of reepithelialisation was
6.9 days after resurfacing (range, 4-10 days).
• Residual erythema remained for a period of 14 days but this
was minimal (mean decreased from 4.1 on day 3 to 0.9 at day
14). Postoperative erythema was most intense in the areas
treated by SmartXide whenever the dwell time was increased
up to 1ms. This effect was also noted with the ActiveFx at the
energy level above 125Mj.
RESULTS
45. • All skin biopsies in this study show effect of thermal treatment with
thermal coagulation of epidermis and superficial dermis in a depth
ranging from 85 to 113 microns. This was similar in both lasers with
the SmartXide 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
46.
47. 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
48. • The global score for photoageing for both devices improved
from 13.8 at baseline to 9.6 at Day 30. The score for fine lines
was the most significant reduction dropping form 3.6 at
baseline to 1.4 at Day 30. The score for sallowness was the
most difficult to interpret at Day 30 as the patients still had
some mild erythematous effect. Scores for reduction of coarse
wrinkles (3.2 at baseline to 2.2 at Day 30) was also difficult to
interpret in this heterogeneous age grouping with older patients
requiring the deeper penetrating ‘harder’ MaxFx rather than the
‘softer’ ActiveFx and it is apparent that Lumenis are presently
working on a combination therapy to solve this problem.
RESULTS
49. • If fractionalised laser skin resurfacing (FLSR) with minimal
downtime is now considered the new method of softly treating
patients for minor skin conditions such photoageing then the
SmartXide DOT has cost advantages to the operator. It has yet
to be established whether this will be in multiple sessions or
not. If the physician requires to treat patients with deeper facial
rhytides or other pathology in a one off session then the
ActiveFx appears to have these advantages.
CONCLUSION
