Dr shuba dharmana presentation

Dr Shuba Dharmana M.B.B.S, M.R.C.G.P,
D.F.F.P,
D.P.D ( U.K)
Cosmetic Dermatologist Laser specialist
Hair Transplantation Surgeon
5th Annual Pharmaceutical Leadership Summit & Business
Leadership Awards 2012, Friday, 21st Sept, Mumbai, India

Concept of Beauty
Queen Nefertiti – 1350 BC

Concept of Beauty
Leonardo da Vinci- vitruvian man 1490

Concept of Beauty
Fibonacci Sequence: Mathematically unique numbers in a sequence in which
each number equals the sum of the two preceding numbers.
0, 1, 1, 2, 3, 5, 8, 13, 21, 34, 55,.. etc
the ratio between the succeeding numbers approaches the golden proportion.
Golden proportion. Golden number= 0.618 . Concept of proportion of parts to
the whole. Proportion most pleasing to the eye
present in nature in spirals of sunflower head, spiral in snail shells, animal horns

Concept of Beauty

Ageing
Intrinsic: Genes, Decrease in oestrogen
Extrinsic: Photo damage ( 80%), smoking, stress, poor nutrition, pollution,
excess alcohol
Signs begin late 20’s
Wrinkles, fine lines
Thinner skin with volume loss
Decreased elasticity of skin
Spider veins
Freckles, moles, melasma
Decreased hair follicles, sweat glands, sebaceous glands
Dryer skin
Enlarges pores
Skin cancers

Ageing

the Non-invasive v/s invasive fight
Little or no downtime
Wont break your bank
Less side effects and complications
Safe as well as efficient
Lunch-time procedures
Less painful
Not as taboo as plastic surgery.
No need for anesthesia. Local numbing sufficient

Botox injections
Botulinum injections: Botox, Neuronox, Azalure, Dysport, Xeomin. Finds use in
upper face, mid face and lower face rejuvenation. Forehead lines, crows feet,
frown lines, bunny lines, drooping corners of mouth, jowls, smokers lines,
maseter correction, vertical neck bands, excessive sweating
Only FDA approved use in Cosmetic field- frown lines. Finds Off-label uses.
Complications, legal issues to be kept in mind. Documentation, consent
important.
New: Mesobotox, Breast lift
FDA approved its use in chronic migraines in 2010

Botox injections

Botox boob Lift

Fillers
Indications in upper face augmentation: frown lines, crows feet, eyebrow lift,
tear trough filling, temporal hollows
Mid face: Cheek contouring and augmentation, naso labial folds, reshaping of
nose
Lower face: Lift Jowls, jaw definition, chin augmentation, lip augmentation,
drooping corners of the mouth
Dermal Fillers:
Permanent- silicon oil. Aquamid, Artefill (bovine collagen) allergy tests needed.
Late onset adverse events, granulomas, displacement. Technique sensitive.
semi-permanent-poly-l-lactic acid ( sculptra), Calcium hydroxyapatite (
Radiesse). Long lasting , 3 dimensional corrections. Stimulate collagen
neogenesis.
Non-permanent Collagen fillers: human collagen-Cosmoderm, Cosmoplast. lack
of longevity and their potential for a bumpy, irregular outcome Porcine collagen-
Evolence (18 months).
Hyaluronic acid containing-Juvederm, restylane, varioderm, Esthelis, Belotero.
Last 1 year.

What's new
Several fillers, several sources, different material and different compositions.
Fillers are combined with lidocaine. Less painful
Fat transfer. Inexpensive and abundant. No allergic reactions. Advances in
preparation, harvesting and injecting techniques yield better outcomes
Macrolane offers new possibility in body shaping. Large volumizing, breast
augmentation.
Use in hand rejuvenation, décolletage rejuvenation. Foot pad enhancement
Injecting with blunt tip micro cannula. Less trauma, bruising, pain, swelling.
Faster recovery. Single port. Lesser punctures.

Peels
Earliest use- Egyptians. Cleopatra used sour milk
Peels cause damage to the outer layers of the skin thereby inducing controlled
peeling. More evenly distributed melanin and lesser melanin causes bleaching
effect.
Uses: hyper pigmentation, melasma, fine lines & wrinkles, acne, acne scars,
sun damage. Improvement in tone ,texture of skin & imparts healthy glow.
Promote product penetration
Superficial, medium depth and deep peels, combination peels.
Superficial- Glycolic, Mandelic, Salicylic, Pyruvic, Lactic, lactobionic, malic
Medium depth -Dark skin types may need preparation. TCA , Cosmelan, Obagi
blue peel
Deep Peels- phenol. Complications, higher recovery and pigmentary problems

What’s new
Newer agents, newer peels
Combination peels- lesser side effects
Advanced Super peels- combination peels. Hydrating moisturizing masks are
used. Utilize Product ingredient penetration. No visible peeling, no downtime.
Sensitive skin
Used in combination treatments with microdermabrasion, with other peels
Dermabrasion with TCA- stretch marks, acne scars. For smoother, even, softer
look
Pilar keratosis- dermabrasion with TCA

Before & After Cosmelan peel

Obagi Blue Peel- Before, during and after

Skin Exfoliating Treatments
Microdermabrasion/Skin polishing: mechanical removal of the top layer of dead
cells of the skin
Acne scars, fine lines, hyperpigmentation, stretch marks, uneven skin tone &
texture, sun damaged skin, blocked pores
Ancient Egyptians- used alabaster and pumice stone in 1500 BC

What’s new
Salt –Aluminium salts, sodium chloride. Sandpapering effect
Diamond Microdermabrasion- tip of the hand piece has tiny diamonds.
Hydrafacial- Liquid dermabrasion. Exfoliation, extraction of impurities and
hydration.
Combination treatment: enzyme paste, peels, laser treatments, electroporation
Dermabrasion- surgical procedure with deeper controlled removal of upper
layers of skin.

Dermaroller treatment
Micro-medical skin-needling, a procedure that stimulates the skin to regenerate
and repair itself naturally and safely
Induces collagenesis, improves acne scars, hyperpigmentation, fine lines, sun
damage , ageing skin, stretch marks
New uses- used on scalp in Growth Factor treatments for hair loss
Promotes product ingredient penetration-used with mesotherapy solutions

Role of lasers
Laser Hair Removal: Laser light absorbed by melanin in the hair shaft
and is destroyed. Permanent hair reduction in 6-8 sittings. Re growth is finer
and lighter. E.g.: Nd:yag, ruby, alexandrite, IPL, diode, elos
Appropriate fluence selection enables to treat all areas of skin.
Latest technological advances in lasers like elos combines 2 modalities and is
suitable for dark skinned with little or no side effects.

Fractional resurfacing
C02 Laser resurfacing: continuous wave- high rate of complications like
scarring- e.g.: ultra pulse co2, er:yag
Fractional c02 resurfacing- microscopic columns of energy delivered cause
microscopic wounds. Untreated skin between helps in quicker regeneration with
lesser complications.
Uses- acne scarring, photo aging, improvement in texture and color, reduction of
wrinkles and skin tightening
Complications- 5-7 days downtime. Pigmentary disorders in Asians, rebound
pigmentation (PIH).
Non-ablative fractional Lasers- erbium glass laser. Painless and lesser adverse
effects
Sublative fractionated bipolar RF- fractionated beam of RF. Minimal epidermal
injury. Lesser side effects and suitable for dark skinned.

Before & After 3 Fractional RF

Pigmentation & Lasers
Non-ablative Lasers-
IPL- improves pigmentation and vascularity, collagenesis
Infra red- Q switched Nd:yag, nd:yag, erbium:glass. Improvement in lines
Radiofrequency- electrical energy. Unipolar, bipolar. Firming and skin
tightening
Combination modalities.
Tattoo removal- Q-switched nd:yag, Q-switched ruby, Q-switched Alexandrite.
Vascular lasers- Pulse dye laser ( PDL). Birth marks, vascular lesions, thread
veins.

Medlite C6
Photoacoustic energy. Q-switched nd:yag with more sophisticated engineering
Combination therapy with lightening Creams
Effective against stubborn melasma
5-10 sessions required
No downtime, No discomfort
Clears , does not cure
Side effects – mottled hypo pigmentation
Uses- wrinkle reduction, scar reduction,
skin resurfacing, improvement in
pigmentation, vascular lesions,
tattoo removal, hair removal

Non-surgical lipo
Radiofrequency: heating of dermal layers by electrical energy causes tissue
tightening. Can cause reduction in circumference. Unipolar, bipolar, tripolar
Ultrasonic waves: uses deep focused ultrasonic waves to destroy fat cells and
tighten the skin. Multiple sittings ( 6-8) required. Helps reduce circumferential
girth in areas of localized fat. Overall 2 inches reduction or more can be
achieved.
Cool Sculpting: FDA-cleared, patented procedure .Cools & freezes the target
fat cells underneath the skin, crystallizing them . Only fat cells are frozen. Once
crystallized, the fat cells die and are naturally eliminated from your body
Fewer sittings required. Upto 2 inches reduction can be achieved.
Combination Technology- combination of Bi-Polar Radiofrequency (RF),
Infrared Light Energy, plus Vacuum and Mechanical Massage. For reshaping,
reduction of cellulite. E.g.; Velashape
Lipomassage: e.g.. Endermologie uses motorised rollers for rolling and
massaging fat deposits. Stimulates lymphatic circulation and firms skin,
improves cellulite.

Before and After Ultralipo

Hair transplantation
FUE ( Follicular Unit Extraction):
Follicular units are extracted individually by means of an FUE machine from the
back of the head and are placed where they are required
No cuts or stitches.
There is no linear scar at the back of the head so can wear short hair styles
Less painful
Quicker recovery
Useful in young people who need small amount of grafts
Useful for body hair and beard hair extraction in those who do not have good
donor area
Other Trends- Robotic hair transplantation. Sapphire sphere tipped blades for
implantation minimize trauma, are sharper. Power FUE machines, Neograft
machines, magnifying microscopes, advanced video imaging techniques flood
Indian market. Advances in techniques, better anesthetics, better medication,
better handling of grafts, knowledge about post-op care all improve results
achieved.

Before and After FUE

Cosmeceuticals
Cosmetic products with biologically active ingredients purporting to have
medical or drug-like benefits
Applied on the skin to improve appearance of skin
cosmeceuticals claim to improve skin tone, texture, pigmentation, fine lines, dull
skin
Hydroxy acids – lactic acid, glycolic acid, salicylic. Improve skin texture
Vitamins- Vit A derivatives( retinol, tretinoin)- antioxidants, acne, photo
damaged skin. Vit B3 ( niacinamide, nicotinamide)-improves skin barrier,
reduces redness. Vit C- esterified forms of L-ascorbic acid are stable. Skin
lightening, collagen production . Vit E- acts as a sunscreen, antioxidant, softens
skin and moisturizes.
Lightening agents-hydroquinone, retinoids, mequinol, azelaic acid, arbutin,
kojic acid, aleosin, licorice extract, ascorbic acid, soy proteins, and N ‐acetyl
glucosamine.
Sunscreens- physical and chemical. chemical sunscreens mainly based on
para‐amino benzoic acid, its derivatives, cinnamates, various salicylates
andbenzophenones, dibenzoylmethanes, anthraline derivatives, octocrylene
homosalate, Zinc oxide and titanium dioxide
Moisturizing agents- Humectants like Glycerol, Mineral oil, Lanolin,
cyclomethicone to maintain fluidity, ceramides, soy extract, and vitamins A and
E, hyaluronic acid

Thank you...
Any Questions...
Views & Opinions ex pressed in this Presentation are
purely based on my research & practice.

Dr shuba dharmana presentation

Recommended

Recommended

More Related Content

Similar to Dr shuba dharmana presentation

Similar to Dr shuba dharmana presentation (20)

More from pharmaleaders

More from pharmaleaders (20)

Recently uploaded

Recently uploaded (20)

Dr shuba dharmana presentation