Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Laser Resurfacing, Dermabrasion, Chemical Peel In The Asian Ethnic Clientele

2,511 views

Published on

Laser Resurfacing, Dermabrasion, Chemical Peel in the East Asian Clientele
Philip A Young, MD Aesthetic Facial Plastic Surgery, PLLC
Face to Face
Ho Chi Minh City, Vietnam 2014

http://www.drphilipyoung.com/procedures/laser-resurfacing/

Published in: Health & Medicine
  • About 2 years ago, I developed a severe case of vaginal yeast infection that would not let up. The itching, burning and swelling of my labia were simply unbearable. I have purchased several over-the-counter treatments, including Monistat cream to subside the symptoms. While it worked initially, eventually things wore off and left me with an even worse infection than before. The same goes for the antibiotics I took with the advice of my doctor. I felt horrible. After doing some research online, I guessed I had a yeast infection and purchased your program. The results were almost instantaneous. In less than 7 hours, I felt a tremendous relief. Two weeks later and I became completely free from the unbearable vaginal itching, burning, swelling and discharge. Using your methods, I have kept my chronic yeast infection at bay ever since. No more drugs or OTC�s for me. ◆◆◆ https://tinyurl.com/y4uu6uch
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • After years of suffering from a myriad of symptoms, going from doctor to doctor, with no light at the end of the tunnel, I finally got the relief I dreamed of after following your Yeast Infection No More program... ➤➤ https://tinyurl.com/y3flbeje
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here

Laser Resurfacing, Dermabrasion, Chemical Peel In The Asian Ethnic Clientele

  1. 1. Laser Resurfacing, Dermabrasion, Chemical Peel in the East Asian Clientele Philip AYoung, MD Aesthetic Facial Plastic Surgery, PLLC Face to Face Ho Chi Minh City,Vietnam 2014
  2. 2. 1. East Asia is a subregion of Asia that comprises about 12% of the Asian continent including more than 1.5 billion people and 1/5 of the people in the world 2. China, Japan, Korea, Mongolia 3. Southeast Asia can further categorize countries such as Cambodia, Laos, Malaysia, Philippines, Singapore,Thailand,Vietnam 4. SkinTypes 3-5 5. Tendency Pigmentary versus Wrinkling. 1-2 decades for Age Matched Caucasians 6. Most important part of discussion is hyper and hypopigmentation 7. Melasma, Ephelides, Lentigines, PIH most common conditions What is Beauty? The East Asian Patient 1. Beauty is ordered presentation of objects in the face 2. Subtleties are paramount from one element to the next 3. The appearance of our skin and the presentation of uniformity in color, texture and the reflection of light in a smooth and non-abrupt manner as it flows from one anatomical location to another plays a major role in facial beauty1 4. Theory on Facial Beauty called the Circles of Prominence
  3. 3. Resurfacing Methods: 1. Chemical Peels 2. Dermabrasion: Rotary, Dermasanding, Dermarolling, 3. Laser Resurfacing: CO2, Erbium, Fractional Technology 4. Non Ablative Resurfacing (Non Resurfacing)
  4. 4. Ablative versus Non-Ablative 1. NonAblative 500-2000nm:Avoiding Epidermal Ablation while targeting deeper elements: pigments, blood vessels, non specific heating. Radiofrequency, Ultrasound. - Advantage: non invasive, quicker recovery, less invasive - Disadvantage: multiple treatments, hyper | hypopigmentation, inferior results to ablative techniques, inability to treat both wrinkling and pigmentation 1. Ablative 2940nm-10600nm Erbium:YAG and Co2: - Advantage: Can treat both pigmentary disorders and wrinkling | skin tightening,One treatment, Decreased risk for skin cancers - Disadvantage: Long recovery time, Pain, Prolonged Redness, Increased complication rate, Hypo | Hyperpigmentation
  5. 5. Ablative Simple Rules: • Level of depth of penetration = amount of down time, amount of results
  6. 6. Selective Photothermolysis: -Electromagnetic Spectrum -Visible Light: Roygbiv -list of lasers:http://en.wikip edia.org/wiki/List_of _laser_types -515 nm Argon -532 nm Nd:Yag -588-590 nm Pulse Dye Laser (Copper Vapor Laser) -695 nm Ruby - 755 nm Alexandrite - 810 nm Diode Laser -1064 Nd:Yag -1550 nm Erbium Doped Fraxel Laser, etc -2940 ErbiumYag -10600nm co2 laser
  7. 7. Pretreatment: 1. Antiobiotics? Keflex Clinda? 2. 4-6 weeks Retinoic Acid, Hydroquinone | Azelaic Acid, Hydrocortisone 3. Studies showing lack of effectiveness with Hyperpigmentation 4. More rapid epithelization, More Even penetration?? 5. AcyclovirValcyclovir starting 2-3 days and continued until epithelialization
  8. 8. Chemical Peels: 1. Chemical peels: alpha hydroxy (fruit acid), beta hydroxy, jessner’s, retinoic acid, trichloroacetic acid, phenol 2. Skin preparation: Retin A, Hydroquinone, Hydrocortisone. Does it really work? 3. Asian Patient Pretreatment from 2-6 weeks 4. Alpha Hydroxy Acid: Citric, Glycolic (10-70%), Lactic, Malic,Tartaric 5. Beta Hydroxy Acid: SalicylicAcid 6. Combo Peel: most common Jessner’s 14% weight volume salicylic 14g, resorcinol14g, lactic acid 88% 14ml in ethanol 7. TrichloroaceticAcid Peels 10-35%, Gary Monheit Medium Depth with Jessner’s 8. Phenol Peels
  9. 9. Precautions with Resurfacing: • A current or history of skin cancer, especially malignant melanoma, or recurrent non- melanoma skin cancer, or pre-cancerous lesions such as multiple dysplastic nevi. • Any active skin infection • Disease which may be stimulated by light at 560nm to 1200nm, such as history of recurrent Herpes simplex, systemic lupus erythematosus, or porphyria. • Use of photosensitive medication and / or herbs that may cause sensitivity to 560-1200m light exposure such as Isotretinoin, tetracycline, or St John’s Wort. Accutane could warrant 1-2 years cessation before deep skin ablation methods. • Immunosuppressive disease, including AIDS and HIV infection, or use of immunosuppressive medications. • Patient history of hormonal or endocrine disorders, such as polycystic ovary syndrome or diabetes, unless under control. • History of bleeding coagulopathies, or use of anticoagulants. • History of keloid or hypertrophic scarring. • Very dry skin or conditions that would create healing issues in post procedure phase. • Exposure to sun or artificial tanning during the 3-4 weeks prior to treatment. Sunblock should be applied 2 weeks or more before any ablative procedure using a product that is sensitive for the skin and contains titanium dioxide or zinc oxide-containing sunblock. • Skin types 5-6 • Pregnancy and nursing. • Ectropion, outward turning of the lower eyelid and excessively dry eyes, previous lower Blepharoplasty. • Koebnerizing diseases, prior radiation therapy leading to a loss of adnexal structures, extensive fibrosis resulting from prior cosmetic treatments (e.g., dermabrasion, deep chemical peels, silicone injections).
  10. 10. Chemical Peel Anatomy: Variables: Pink,White, Grey Epidermal Sliding
  11. 11. Skin Anatomy:
  12. 12. Results: Gary Monheit Medium Depth Peel Jessner’s andTCA30% with DermabrasionTechinques
  13. 13. Results: Gary Monheit Medium Depth Peel Jessner’s andTCA30% with DermabrasionTechinques
  14. 14. Results: Jessner’s 2 passes: level 2
  15. 15. Laser Resurfacing: 1. ErbiumYag 2940 nm (late 1990): -threshold for ablation 1.5J/cm2, thermal relaxation time 50 microsec, thermal injury is 5-10 micrometers -advantages: less thermal injury, dermis transudate allows deeper resurfacing without increased thermal damage -disadvantages: less collagen tightening, no coagulation of vessels – bloody, treating deeper wrinkles lead to more bleeding and cumbersome | messy (need more passess, higher fluences, new technology have been developed. 1. Co2 Laser Resurfacing 10600 nm (1990): -threshold for ablation 4-5J/cm2, thermal relaxation time 1000 microsec, 1 millisec, thermal injury is 20-60 micrometers -advantages: More versatile, deeper treatment, faster, much less bleeding, proven effective, long history -disadvantages: healing, complications, long post operative course,
  16. 16. Laser Resurfacing: 1. Fractional co2 laser resurfacing of photoaged facial and non-facial skin: histologic and clinical results and side effects.gordon h. sasaki, heather m. travis & barbara tucker. Journal of Cosmetic and LaserTherapy, 2009; 11: 190–201. This is a must read
  17. 17. Average skin thickness, adnexal structures
  18. 18. Average Parameters for Fractional Resurfacing
  19. 19. Fluence Changes and Depth of Penetration: J/cm2
  20. 20. Deep FX
  21. 21. Intra Op: 2 passes and dermabrasion in progress: Pinpoint Bleeding End point
  22. 22. Traditional Resurfacing: • 1. Face 1st pass 100mj den 5, 2nd pass 90mj den 4 • 2. Eyelids 70-90 mj den 4, 60-80 den 3 • 3. Neck and Body Fractional 80-100mj den 1, 15-20mj den 1 • 4. Clinical End Points: 1.The elimination of the scar, lesion, or wrinkle; 2. A yellow-brown discoloration (or chamois-brown); or 3. No further shrinkage.
  23. 23. Results: Fractional Resurfacing Deep 10mj den2 Active 100mj density 2-3
  24. 24. Results: Fractional Resurfacing Deep 10mj den2 Active 100mj density 2-3
  25. 25. Results: Traditional Resurfacing 100mj den 5; 90 mj den 4; dermabrasion
  26. 26. Results: Traditional Resurfacing 100mj den 5; 90 mj den 4; dermabrasion Previous Facelift
  27. 27. Results: Traditional Resurfacing 100mj den 5; 90 mj den 4; dermabrasion
  28. 28. Results: Traditional Resurfacing 100mj den 5; 90 mj den 4; dermabrasion Prior SubcisionTechinques
  29. 29. Results: Traditional Resurfacing 100mj den 5; 90 mj den 4; dermabrasion Previous Facelift
  30. 30. Results: Traditional Resurfacing 100mj den 5; 90 mj den 4; dermabrasion
  31. 31. Results: Traditional Resurfacing 100mj den 5; 90 mj den 4; dermabrasion
  32. 32. Results: Traditional Resurfacing 100mj den 5; 90 mj den 4; dermabrasio n
  33. 33. Dermabrasion:
  34. 34. Dermasanding Indicators:
  35. 35. Dermasanding Indicators:
  36. 36. Results: Traditional Resurfacing 100mj den 5; 90 mj den 4; dermabrasion
  37. 37. Results: Traditional Resurfacing 100mj den 5; 90 mj den 4; dermabrasion
  38. 38. Results: Traditional Resurfacing 100mj den 5; 90 mj den 4; dermabrasion

×