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.

1. Multiprocedural
Synchronous
Facial Rejuvenation
Introducing the DUBLiN method
Dr. Patrick J. Treacy
Medical Director
Ailesbury Clinics Ltd

3. SKIN CANCER
SALLOW SKIN COARSE
RHYTIDS
FINE
RYTHIDS
THREAD VEINS
PIGMENTATION
TitlePHOTOAGEING

4. WRINKLES
ECTROPION ENTROPION
FAT
PROTRUSION
EPIPHORA
SKIN LAXITY
TitleCHRONO
AGEING

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. WRINKLES
TEAR TROUGH WRINKLES
FAT
PROTRUSION
PIGMENTATION
SKIN LAXITY
TitleCOLLAGEN

7. FAT
PROTRUSION
SALLOW SKIN THREAD VEINS
COARSE
RYTHIDS
FINE
RHYTIDS
PIGMENTATION
Title
Positive
CO2
FRSL

8. Patient CM 2 passes under R eye with obvious reduction in rhytides and neocollogenesis

10. Marionette
Lines
Eyebrow Height Youthful Look
Nasolabial
Lines
Cheek
Augmentation
Volume loss
Title
Negative
CO2
FRSL

11. New Collagen
Fibroblast
Stimulation
CO2 Laser
Botox
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.

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. Near Red Light 633
Dermaroller
Title
Fibroblast
Generation
PHASE 2 multi-combination
technique
PRP Growth Factor Signals

18. Near Red Light 633
Dermaroller
Title
Fibroblast
Activation
PHASE 2a fibroblast activation
PRP Growth Factor Signals

19. Near Red Light 633
Dermaroller
Title
Fibroblast
Stimulation
PHASE 2b fibroblast stimulation
PRP Growth Factor Signals

20. DERMAROLLER

21. Keratinocyte GF
Vascular Endothelial GF
Fibroblast GF
Transforming GF-B
Connective Tissue GF
Platelet Derived GF
TitleCOLLAGEN
BLOOD FACTORS

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. Near Red Light 633
Post NTa
Title
Collagen
Synthesis
PHASE 2
Co2 Laser

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

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.
3 Moderate Moderately deep folds.
Clear facial feature visible at normal appearance but not when stretched.
Excellent correction is expected from injectable implant.
2 Mild Shallow but visible fold with a slight indentation; minor facial feature.
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.

29. DUBLIN Lift Periorbital Area

32. Dover Photoageing Scale

33. Wrinkle Severity Rating Scale
% Patient satisfaction
BTX

34. Wrinkle Severity Rating Scale
% Patient satisfaction
PRP

35. www.ailesburyclinic.ie

36. Спасибо!