ActiveFx Lecture

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Dr. Patrick J. Treacy

Lecture by Dr. Patrick Treacy to Lumenis User Group Dublin about ActiveFx CO2 resurfacing laser

Health & Medicine Entertainment & Humor

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A 23-year-old Siberian female patient presented with a changing lesion on her abdomen. The patient stated the lesion was present for about two years and it started off from within a freckle, which started to grow larger and somewhat darken in appearance. It had the clinical appearance of a melanoma and the dermoscopy three-point checklist (designed to allow non-experts not to miss detection of melanomas) was used to determine whether this had a high likelihood of malignancy. It included: Asymmetry: asymmetry of colour and structure in one or two perpendicular axes Atypical network: pigment network with irregular holes and thick lines Blue-white structures: there was some evidence of blue- white veil and regression structures

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Synthetic biodegradable hyaluronic acid fillers are widely used as relatively safe injectable methods of lip augmentation but their duration is limited to only four months. Because of this many physicians use alternative non-biodegradable materials like polyacrylamide gels and polyvinyl acid, to create a longer lasting ‘semi-permanent’ product. Bio in Blue (Polymekon, Brindisi, Italy) is high purity polyvinyl alcohol (8%) and water (92%). Polyvinyl alcohol is a non-toxic substance used in medicine as a drug-carrier and a substitute for human plasma expander. Retrospective Study of nine cases requiring surgical correction of product migration of semi-permanent lip fillers Bio-Alcamid and Bio in Blue over 2 year period. Nine female patients in otherwise good health were referred to the author by aesthetic doctors in the UK and Ireland with moderate nodular swellings in their labial area over a period of two years. They all reported a history of their lips having being injected with the cosmetic filler Bio in Blue or Bio-Alcamid at the site of the swelling to correct and project the labial profile. Four of the patients had previously been injected with another type of HLA filler prior to the use of these semi-permanent type fillers. The labial swellings were each worsening in appearance as time passed and the patients were emotionally distressed. Numerous doctors had treated the patients with injections of Dexamethasone (40mgs/ml) or Triamcinolone (40 mg/ml) at intervals, with no resolution of the swelling. There was no relevant medical history and the patient did not have any clinical evidence of autoimmune or allergic diseases. On palpation, each patient presented with firm longitudinal swellings measuring 3 cm × 2 cm along the lines of filler implant in each patient. The nodules were prominent anteriorly and projected from inside the oral cavity. The patients were all were willing to accept surgical correction and histological evaluation of their problem. Surgical excisions were carried out by direct use of a size 11 scalpel blade, usually without the use of local anaesthesia, allowing the nodules to point under digital manipulation. The wound was cleaned and the vermillion tissues approximated in some cases with 5-0 Vicryl Rapide sutures (Ethicon, Inc) to achieve closure or haemostatis. The operation sites healed well and most had healed within few days with no infection. Excision biopsies showed no evidence of foreign body giant cells or irregular crystalline structures and stopped The wound was cleaned and the vermillion tissues approximated in some cases with 5-0 Vicryl Rapide sutures (Ethicon, Inc) to achieve closure or haemostatis. The operation sites healed well and most had healed within a few days with no infection. Excision biopsies showed no evidence of foreign body giant cells or irregular crystalline structures and stopped

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The Multi-synchronous Facial rejuvenation study was done in 3-phases over a period of three weeks. Phase I included Dysport® at dilution 3.5:1 in 3 areas, glabellar, frontalis and periorbital. 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. The study evaluated post procedural aesthetic results at two weeks, four weeks and twelve weeks. The length of downtime, patient discomfort and adverse side effects were noted for each phase. Clinical assessment of patients in each grouping was made at 2 weeks, I month and 3 months postoperatively in the presence of two aesthetic staff. The degree of improvement in photoageing was based on the degree of re-epithelialization rate, reduction of rhytides, reduction of tactile roughness and loss of hyperpigmentation and telangiectasias. The efficacy of treatment was evaluated using a variation of the five-point scale originally suggested by Dover et al.. Investigators and patients evaluated efficacy using palpability assessments and change from baseline score at 0, 6 and 12 weeks. A total global score was recorded in each patient based on the addition of points obtained from six photodamage variables. The degree of perceived improvement in overall aesthetic effect reflecting chronological age was assessed separately by patients and physicians using the Wrinkle Severity Rating Scale and the Global Aesthetic Improvement Scale. The WSRS is recognised as a valid and reliable instrument for quantitative assessment of facial skin folds, with good inter- and intra-observer consistency]. Wrinkle severity is measured by using a wrinkle severity rating scale with 1 being absent and 5 being extreme. By allowing objective grading of data, these proved useful clinical tools for assessing the effectiveness of facial volumisation with PRP and MN-633.

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A 53-year-old Irish female presented with an intractable trigeminal neuralgia pain in the region of her left maxillary nerve (V2) who did not respond to pharmacotherapy including pregabalin 300mgs bd and gabapentin 300mgs bd. She had been admitted to hospital for one month for intravenous oxycodone hydrochloride. She had also more than fifty nerve blocks in the previous years and had undergone stereotactic gamma knife radiosurgery which had work for five months but later resulted in uncontrollable dysesthesia pain in the region of her left maxillary nerve. She defined this as a continual unpleasant sensation of something 'crawling' under her skin in her left periorbital. There was a sensation of intense pain in her left external nasal area and that of electric shock, burning, and pins and needles and left mental area.

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Dr Patrick Treacy shares some of his most challenging cases. This month he talks about treating Cutaneous Malignant Melanoma. Melanoma, also known as malignant melanoma, is a type of cancer that develops from the pigment-containing cells known as melanocytes. They typically occur in the skin but may rarely occur in the mouth, intestines, or eye. In women they most commonly occur on the legs, while in men they are most common on the back. Sometimes they develop from a mole with concerning changes including an increase in size, irregular edges, change in color, itchiness, or skin breakdown

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Dr Patrick Treacy shares some of his most challenging cases. This month he talks about treating cutaneous warts. Warts appear in various forms on different sites of the body and include common warts (verruca vulgaris), plane or flat warts, myrmecia, plantar warts, coalesced mosaic warts, filiform warts, periungual warts, anogenital warts (venereal or condyloma acuminata), oral warts and respiratory papillomas.

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This paper looks at the possibility of combining five established therapies in an attempt to address common concerns related to facial ageing. The therapies included microneedling, low dose Ultralase laser, (PRP) plasma rich protein growth factors, Omnilux 633 light and neurotoxins. The technique is called the DUBLiN face-lift as an acronym of the procedures involved. D Dermaroller U Ultralase Laser B Blood growth factors Li Light (near red 633) N Neurotoxin. The author compared this method to fractionalised laser skin resurfacing (FLSR) in terms of reduction of photoageing and overall aesthetic effect. Neurotoxin was used in both studies.

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At present, there’s a paucity of literature regarding both the prevention and management of serious events, despite the fact that these complications are the very things that patients and physicians both continually fear. Many physicians, (including myself), feel that corporate prefer not to address these issues and they are driven underground. Over the years, many of my colleagues have referred me their more serious problems and I consequently have developed a certain experience in this area. This insight into complications of dermal filler use will serve to highlight both of these problems and try to help one manage these complications if they should ever happen to you.

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