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Multiprocedural
Synchronous
Facial Rejuvenation

      Introducing the DUBLiN method




           Dr. Patrick J. Treacy
           Medical Director
           Ailesbury Clinics Ltd
PIGMENTATION
    THREAD VEINS




SKIN CANCER
                       Title
                     PHOTOAGEING            FINE
                                           RYTHIDS




       SALLOW SKIN                     COARSE
                                      COARSE
                                       RHYTIDS
                                      RHYTIDS
SKIN LAXITY
                            SKIN LAXITY
     EPIPHORA




WRINKLES
WRINKLES
                  Title
                  CHRONO
                   AGEING
                                       FAT
                                      FAT
                                   PROTRUSION
                                  PROTRUSION




      ECTROPION               ENTROPION
Treating Facial Ageing



A great variety of stand alone facial
rejuvenation treatments are presently
available including
Botox©,Dermaroller©,
RioBlush©,Radiofrequency Devices
Syneron Polaris©RF, Thermage©
InfraRed Titan©, CO2 fractionalised
resurfacing AFX© SmartXide© Fraxel
Repair©,
SKIN LAXITY
  PIGMENTATION




WRINKLES
                    Title
                   COLLAGEN             FAT
                                    PROTRUSION




     TEAR TROUGH                WRINKLES
PIGMENTATION
                                PIGMENTATION
         FINE
       RHYTIDS




                     Positive
     FAT
    FAT
 PROTRUSION
PROTRUSION           Title
                       CO2               COARSE
                                        COARSE
                                         RYTHIDS
                                        RYTHIDS
                       FRSL




       SALLOW SKIN                THREAD VEINS
                                 THREAD VEINS
Patient CM   2 passes under R eye with obvious reduction in rhytides and neocollogenesis
Volume loss
                                  Volume loss
        Cheek
     Augmentation




                       Negative
Marionette
Marionette
   Lines
  Lines                Title
                          CO2
                         FRSL
                                          Nasolabial
                                         Nasolabial
                                             Lines
                                            Lines




      Eyebrow Height                Youthful Look
                                   Youthful Look
Botox


CO2 Laser                               Although, many feel that
                                        ultrapulsed fractionalised
                                      CO2 laser skin resurfacing is
                                      the best treatment option for
                                      photo aged facial skin, could
                                      we improve on this modality.
 Fibroblast
 Stimulation


                       New Collagen
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.
The DUBLiN method incorporates

       D Dermaroller
       U Ultrapulse Laser
       B Blood Factors
       Li Light – 633nm
       N Neurotoxin
Induction of 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.
Comparative study over three months




•   Over 3 months, 15 patients
    (Group 1) received FLSR
    at normal settings
•   Results were compared to
    29 patients (Group 2)
    received low energy FLRS
    + adjunctive treatments
•   Both group received BTXA
    one week prior to other
    treatments
Group 2 received a 3-phase combination
                  multi-rejuvenation technique over 3 weeks.




•   Phase I included Dysport® at dilution
    3.5:1 in 3 areas

•   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.
PHASE 2 multi-combination
        technique

                    PRP Growth Factor Signals




       Fibroblast
        Title
       Generation
                             Dermaroller
                            Dermaroller




                     Near Red Light 633
                    Near Red Light 633
PHASE 2a fibroblast activation


                      PRP Growth Factor Signals




        Fibroblast
         Title
        Activation
                              Dermaroller
                             Dermaroller




                      Near Red Light 633
                     Near Red Light 633
PHASE 2b fibroblast stimulation


                     PRP Growth Factor Signals




       Fibroblast
        Title
       Stimulation
                              Dermaroller
                             Dermaroller




                      Near Red Light 633
                     Near Red Light 633
DERMAROLLER
BLOOD FACTORS


                                        Platelet Derived GF
Connective Tissue GF




Keratinocyte GF
                              Title
                             COLLAGEN               Transforming GF-B




                                            Fibroblast GF
   Vascular Endothelial GF
GROWTH FACTORS




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
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.
PHASE 2


                  Co2 Laser




       Collagen
          Title
      Synthesis
                            Post NTa
                           Post NTa




                   Near Red Light 633
                  Near Red Light 633
ULTRALASE 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
WSRS = Wrinkle Severity Rating Scale
5    Extreme    Extremely deep and long folds, detrimental to facial appearance.
                2-4mm Visible V-shaped fold when stretched
                Unlikely to have satisfactory correction with injectable implant alone.

4    Severe     Very long and deep folds; prominent facial feature.
                Less than 2mm visible fold when stretched.
                Significant improvement is expected from injectable implant.
                Moderately deep folds.
3    Moderate   Clear facial feature visible at normal appearance but not when stretched.
                Excellent correction is expected from injectable implant.
                Shallow but visible fold with a slight indentation; minor facial feature.
2    Mild       Implant is expected to produce a slight improvement in appearance.

1    Absent     No visible fold, continuous skin line.
GAIS = Global Aesthetic Improvement Scale



5 Very Much Improved   Optimal cosmetic result for the implant in this
                       patient.


4 Much Improved        Marked improvement in appearance but not
                       completely optimal for this patient. A touch-up
                       would slightly improve the result.

3 Improved             Obvious improvement in appearance from the initial
                       condition, but a touch-up or re-treatment is
                       indicated.

2 No Change            The appearance is essentially the same as the
                       original condition.


1 Worse                The appearance is worse than the original
                       condition.
DUBLIN Lift Periorbital Area
Dover Photoageing Scale
Wrinkle Severity Rating Scale
    % Patient satisfaction



         BTX
Wrinkle Severity Rating Scale
    % Patient satisfaction



              PRP
www.ailesburyclinic.ie

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Dublin LIft IMCAS

  • 1. Multiprocedural Synchronous Facial Rejuvenation Introducing the DUBLiN method Dr. Patrick J. Treacy Medical Director Ailesbury Clinics Ltd
  • 2.
  • 3. PIGMENTATION THREAD VEINS SKIN CANCER Title PHOTOAGEING FINE RYTHIDS SALLOW SKIN COARSE COARSE RHYTIDS RHYTIDS
  • 4. SKIN LAXITY SKIN LAXITY EPIPHORA WRINKLES WRINKLES Title CHRONO AGEING FAT FAT PROTRUSION PROTRUSION ECTROPION ENTROPION
  • 5. Treating Facial Ageing A great variety of stand alone facial rejuvenation treatments are presently available including Botox©,Dermaroller©, RioBlush©,Radiofrequency Devices Syneron Polaris©RF, Thermage© InfraRed Titan©, CO2 fractionalised resurfacing AFX© SmartXide© Fraxel Repair©,
  • 6. SKIN LAXITY PIGMENTATION WRINKLES Title COLLAGEN FAT PROTRUSION TEAR TROUGH WRINKLES
  • 7. PIGMENTATION PIGMENTATION FINE RHYTIDS Positive FAT FAT PROTRUSION PROTRUSION Title CO2 COARSE COARSE RYTHIDS RYTHIDS FRSL SALLOW SKIN THREAD VEINS THREAD VEINS
  • 8. Patient CM 2 passes under R eye with obvious reduction in rhytides and neocollogenesis
  • 9.
  • 10. Volume loss Volume loss Cheek Augmentation Negative Marionette Marionette Lines Lines Title CO2 FRSL Nasolabial Nasolabial Lines Lines Eyebrow Height Youthful Look Youthful Look
  • 11. Botox CO2 Laser Although, many feel that ultrapulsed fractionalised CO2 laser skin resurfacing is the best treatment option for photo aged facial skin, could we improve on this modality. Fibroblast Stimulation New Collagen
  • 12. 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.
  • 13. The DUBLiN method incorporates D Dermaroller U Ultrapulse Laser B Blood Factors Li Light – 633nm N Neurotoxin
  • 14. Induction of 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.
  • 15. Comparative study over three months • Over 3 months, 15 patients (Group 1) received FLSR at normal settings • Results were compared to 29 patients (Group 2) received low energy FLRS + adjunctive treatments • Both group received BTXA one week prior to other treatments
  • 16. Group 2 received a 3-phase combination multi-rejuvenation technique over 3 weeks. • Phase I included Dysport® at dilution 3.5:1 in 3 areas • 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.
  • 17. PHASE 2 multi-combination technique PRP Growth Factor Signals Fibroblast Title Generation Dermaroller Dermaroller Near Red Light 633 Near Red Light 633
  • 18. PHASE 2a fibroblast activation PRP Growth Factor Signals Fibroblast Title Activation Dermaroller Dermaroller Near Red Light 633 Near Red Light 633
  • 19. PHASE 2b fibroblast stimulation PRP Growth Factor Signals Fibroblast Title Stimulation Dermaroller Dermaroller Near Red Light 633 Near Red Light 633
  • 21. BLOOD FACTORS Platelet Derived GF Connective Tissue GF Keratinocyte GF Title COLLAGEN Transforming GF-B Fibroblast GF Vascular Endothelial GF
  • 22. GROWTH FACTORS 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
  • 23. 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.
  • 24. PHASE 2 Co2 Laser Collagen Title Synthesis Post NTa Post NTa Near Red Light 633 Near Red Light 633
  • 25. ULTRALASE 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
  • 26.
  • 27. WSRS = Wrinkle Severity Rating Scale 5 Extreme Extremely deep and long folds, detrimental to facial appearance. 2-4mm Visible V-shaped fold when stretched Unlikely to have satisfactory correction with injectable implant alone. 4 Severe Very long and deep folds; prominent facial feature. Less than 2mm visible fold when stretched. Significant improvement is expected from injectable implant. Moderately deep folds. 3 Moderate Clear facial feature visible at normal appearance but not when stretched. Excellent correction is expected from injectable implant. Shallow but visible fold with a slight indentation; minor facial feature. 2 Mild Implant is expected to produce a slight improvement in appearance. 1 Absent No visible fold, continuous skin line.
  • 28. GAIS = Global Aesthetic Improvement Scale 5 Very Much Improved Optimal cosmetic result for the implant in this patient. 4 Much Improved Marked improvement in appearance but not completely optimal for this patient. A touch-up would slightly improve the result. 3 Improved Obvious improvement in appearance from the initial condition, but a touch-up or re-treatment is indicated. 2 No Change The appearance is essentially the same as the original condition. 1 Worse The appearance is worse than the original condition.
  • 30.
  • 31.
  • 33. Wrinkle Severity Rating Scale % Patient satisfaction BTX
  • 34. Wrinkle Severity Rating Scale % Patient satisfaction PRP