DR Juliana Ghaben http://www.drjulianaghaben.com spoke on new modalities on antiaging at CME for KAYA skin CLinics . She is Board certified in Aesthetic Medicine and a trainer with SPECTRONIX . She spoke on Carboxytherapy , SECRET MICROFRACTIONAL RF AND Q SWITCH ND YAG , ALL MACHINES COURTSEY ; SPECTRONIX . http://spectronixglobal.com/

1. New Modalities in Anti Aging
Dr. Juliana Ghaben, MD . Dermatologist
Consultant Trainer with SPECTRONIX

2. Dr. Juliana Ghaben
MD , Specialist Dermatologist ( Skin , Aesthetic and Laser)
Visiting Fellowship in Laser Skin Surgery ,Thailand
Board Certified in Aesthetic Medicine by American Academy
Consultant and Trainer with SPECTRONIX

3. New modalities in Anti aging
I would like to Share the following technologies in this
presentation
•Carboxy Therapy with Crabotech F650
•Secret Microfractional Radio Frequency
•Q Switch ND YAG Laser

4. What is Carboxy Therapy ?
Carboxy Therapy is a procedure very
similar to Mesotherapy
It consists of intradermal or subcutaneous
injections of medical grade co2 using 30 G
needles.
Treatments are rapid, comfortable and
effective for a high percentage of patients

5. Common Indications
•Cellulite
• Face Wrinkles
• Under Eye Dark Circles
• Skin Laxity ( Hands , neck , submentonian area,
Decolletage area )
• Old Stretch Marks
• Hair Loss
• Recent Scars and acne scars
• Psoriasis

6. Effects of Co2 Injection in the Body
•Vasodilation
• The Bohr Effect ( Co2 +H20 = H + HCO3
• Simulation of Collagen synthesis
• Neo Angiogenesis effect
• Suspected Melanocyte Pigment synthesis
Stimulation
• Receptor activation and Lipolysis improvement

7. • Strong vasodilatory effect (causes dilation of blood vessels) on the
capillaries in the area.
Wider vessels mean bigger and stronger blood flow to the area,
which means more oxygen.
The increase in oxygen is important because it eliminates the built
up fluid from between the cells.
Carboxytherapy. How it works?

8. Administration for Fat

9. Direct pressure causes trauma to adiposities
Blood flow increases and Bohr effect brings
More oxygen to adiposities leading to an optimized physiological lipolysis.
CO2 injection stimulates the synthesis of
Collagen . This property is used to improve atrophic scars by
increasing the quantity of collagen below the atrophy
Restores skin laxity and colour and speeds up
The wound healing process . It is interesting procedure
for white thyroidectomy , caesarean and appendectomy and other scars in
general.
It works in three ways on old white stretch Marks
a) Neo-angiogenesis below the mark , which adds a pink
colour
b) Melanin Stimulation caused due to increased Oxygen in
the tissue
c) Collagen synthesis which reduces the creased appearance
Aesthetic Indications
Stretch Marks
Localized Fat
Acne Scars
Surgical Scars

10. Because it stimulates Collagen synthesis
And local lypolytic action helps in
eye rejuvenation and fat deposits
The dorsal side of the hands may be treated
With intradermal injections . The Expected effect
Are tightening after four or more sessions
Some physicians use CDT for Psoriasis and we have Good
before after pictures documented by Manufacturing company
There are not any published studies on indication and can be
considered experimental
Aesthetic Indications
Eye Wrinkles
Lower Lid Fat deposits and
Under-eye circles
Rejuvenation of
hands
Decolletage and Neck
Psoriasis
Nasogenian Folds
And Peri-Oral
Wrinkles
CDT is an alternative to fillers in some cases ,
especially for patients with contradiction to fillers Co2
has progressive improvement over few sessions
whereas fillers have immediate results

11. Needle Phobia
Stress , with history of vagal uncounciousness
Severe heart failure , congestive heart disease
Recent heart infarction or instable angina
pectrois
Restrictive pulmonary disease , chronic
obstructive lung disease
Sleep apnea
Renal failure , dialysis
Recent cerbrovascular accident
Uncontrolled blood pressure
Epilipsy
Recent phlebilitis or pulmonary embolism
Uncontrolled Diabities
Chemotherapy , Cancer
Bacterial Infection : Dermatitis
, Cellulitis
Foreign Body in the area to be treated
( Jewellery implants in the area and so
on )
Herpes simplex in acutae phase and
other acute skin viral infection
Skin disease with abnormally increased
local circulation
Facial Rosacea
Poikiloderma of Civatte
Red necks and Red decolletage
Pregnancy
Lactation
Anticoagulation ,
Recent asprin or anti-
inflimatory drugs intake
Acute skin infection
Other Aesthetic procedures
or skin traumatism less than
15 days
CONTRADICTIONS
GENERAL
CONTRAINDICTIONS
LOCAL
CONTRAINDICTIONS
TEMPERORY
CONTRAINDICATIONS

12. The end result is fewer fat cells
and firmer subcutaneous tissue.
Fig 1- Histological appearance of the dermis
before CO2 treatment.
Fig. 2. Patient 1. After CO2 treatment,
thickening of the dermis and rearrangement of
collagenous fibers is shown.
Carboxytherapy End Results

13. CarboTech (Europe-US) ONLY FDA APPROVED
MACHINES
40 CC PER MINUTE / 80 CC PER MINUTE
Minimal discomfort. Less painful. Best Technique for CO2
infiltration
Save Time with dual output mode
Sure Fire technique killing fat cells
Initial Start up AutoTesting + Color Led screen
Functionality in a simple an easy to use form-factor
Latest valve technology / Timer / Pressurization System /
watch
Anodized Satin white ultra light aluminum casing
220v or 110v selector
Do not generate heat – 30 watt
Carbotech

14. 1) Axt Welcome - Test
2) Please open the valve (15psi-
28psi)- Ideal pressure 22psi
3) Open the valve of the gas tube- 22
psi
4) Input- Pressure low/high
5) If pressure high- Close the gas
tube valve- Purge
6) Please select program (if 15psi-
22psi)
7) Press Program I (40cc) or Program
II (80cc)
8) Please enter volume in cm3
(1cm3-999 cm3)- Enter-
Pressurization
9) Ready to start with …….cm3
10) Start with the procedure CO2 OUTPUT
PEDAL SWITCH
CO2 INPUT
KEYBOARD
Carboxytherapy in 10 steps

15. CO2 ADMINISTRATION
Subcutaneous
• Syringe - 45 Degree
• 15cc-50cc per sector
• Speed 40cc per minute

16. Body- Sector Diagram

17. 50cc-80 cc
20cc-50 cc
Abdomen 20cc-50cc per area
Abdomen

18. 50-60 cc
20-30 cc
More painful areas
Legs

19. 15-50 cc
Arms

20. Tube- Carboxytherapy

21. Before After
Under Eye Bags
Rejuvenation

22. Before After
Stretch Marks

23. BEFORE AFTER
PSORIASIS

24. BEFORE AFTER

26. CARBOXY THERAPY IS:

27. SECRET MICROFRACTIONAL RF
Minimally invasive Fractional
Radiofrequency Microneedls(FRM) device
is recently introduced.
The device gives selective heating in the
dermis using bipolar RF (or monopolar RF)
through microneedles.

28. Introduction
Previous generation Ablative Skin Resurfacing laser
devices were effective, but many of them could not
avoid the problems of long down time and patient
pain. On the contrary, Non-ablative Skin Rejuvenation
laser devices reduced pain and adverse effects, but
these devices could not make dramatic effects. In the
middle of 2000s, fractional technology opened new
generation overcoming previous problems. But the
fractional treatment was limitedly used because it
could not control penetration depth and it gave
damage on the epidermis.

29. Common Indications
•Non Surgical Face Lift
• Wrinkle Reduction
• Skin tightening
• Skin Rejuvenation
• Pore Reduction
• Scars
• Acne scars
• Stretch Marks

30. What is Microfractional RF ?

31. How It Works
Collagen Regeneration
and elasin production
Microneedle
Catridge is Placd on skin surface
Micro-needle penetrates
inside the skin
Bipolar RF Energy is delivered
directly to targeted area
A precisely controlled Bipolar
RF is delivered at depth
between 0.5mm to 3.5mm
depending on the symptoms

32. Fractional Laser
and Microfractional RF

33. BEFORE / AFTER

34. BEFORE / AFTER

35. BEFORE / AFTER

36. BEFORE / AFTER

37. BEFORE / AFTER

38. BEFORE / AFTER

39. BEFORE / AFTER

40. Conclusion
Microfrcational RF treatment has been
shown to provide consistent and meaningful
improvement in facial scar and laxity without
complications and adverse effects. The
average improvement seen following a single
treatment was approximately 93.3%. The
result may become an important option for
scar and facial laxity treatment

41. A new Modality in Antiging treatments
Skin Toning
Pore Reduction
Pigments treatment
Q switch ND YAG

42. - Principal of Epidermal Lesion
COSJET TR
With deep skin penetration depth, 1064nm treats pigment lesion in dermal
(Nevus of Ota, ABNOM, Tattoo, Melasma)
With high melanin absorption, 532nm treats pigment lesion in epidermal
(Melasma, Freckle, Age spot, Lentigo)
Anti-aging improvement using Genesis Technique (FR MODE)
(Wrinkle, Pore size, Whitening)

43. Treatment Process of Epidermal Lesion
Pigment
Freckle, Age spot
Café-au-lait Lentigo
Selective Photothermolysis
532nm
Laser
Epidermal
Dermal
Photo acoustic effect

44. - Whitening (Frosting)
Ideal Whitening Response
- Shallow whitening is observed right after treatment.
- Erythema is observed around pigment but the pigment point remains same as before.
Vaporization from Pigment
Before Right After After 5min
Normal Whitening
Whitening

45. - COSJET TR Clinical Case (1)
Cosjet TR
532nm / 0.9J
Freckle
Right after Whitening 1 week after Treatment
with 532nm

46. - COSJET TR Clinical Case (2)
Cosjet TR
532nm/0.8J
Solar Lentigo
2 weeks after Treatment
with 532nm

47. - COSJET TR Clinical Case (3)
Cosjet TR
532nm/0.9J
Freckles
2 weeks after Treatment
(1 time)
with 532nm

48. - COSJET TR Clinical Case (4)
Before treatment 2 weeks after IPL treatment
Cosjet TR
532nm/0.9J
Freckles
with 532nm

49. Treatment Process of Dermal Lesion
Pigment
Tattoo Ink, Melasma,
ABNOM, Nevus of Ota,
Selective photothermolysis
1064nm
Laser
Epidermal
Dermal
Photo acoustic effect

50. Microphage
selectivity
photothermolysis
Pigment Lesion in Dermal (1064nm)
Radiate Laser Pigment Resolving
Pigment Removal
Right after After 4~8weeks
There maybe bleeding from
Acoustic damage

51. - COSJET TR Clinical Case (1)
Cosjet TR
1064nm/4.5J
Tatto
2 weeks after Treatment
(1 time)
with 1064nm

52. - ERASER TR Clinical Case (2)
Cosjet TR
1064nm/7.5J
Nevus of Ota
6 weeks after Treatment
(1 time)
with 1064nm

53. - COSJET TR Clinical Case (3)
Cosjet TR
1064nm/6.0J
Amateur Tatto
6 weeks after Treatment
(1 time)
with 1064nm

54. - What is Soft Peel & Genesis?Soft Peel & Genesis
SOFT PEEL (New concept using carbon cream) + Genesis for dermal remodeling
1064nm
6ns
8-10hz
1.5J
1064nm
0.3ms
8-10Hz
10-14J
Heating
Carbon oil
explodes and
peels off dead
skin
Q/SW Mode
Quasi
Long pulse Fast result
No down time
No pain
No side effect
Pore size
Wrinkle
Skin Tone
Acne improvement
Characteristics

55. - Process of Soft Peel & GenesisSoft Peel & Genesis
Step 1. Cleansing
Clean skin surface to
remove sebum, etc.
For better result,
cleansing mask or
scrub can be used.

56. - Process of Soft Peel & GenesisSoft Peel & Genesis
Step 2. Carbon cream
Apply carbon cream using
gauze.
Wait for about 10min until
carbon cream is absorbed
well in pores.
Tip: Shake carbon cream
before using. Place tapes
on eyebrows to protect
them during the laser
operation.
Apply carbon cream After 10~15min

57. - Process of Soft Peel & GenesisSoft Peel & Genesis
Step 3. Absorption of carbon
After 20min, remove
carbon cream with cotton
gauze
Tip: Remove carbon cream
on skin surface but leave
them in pores.

58. - Process of Soft Peel & GenesisSoft Peel & Genesis
Step 4. Laser operation
When operating laser, always wear safety goggles and treatment lab must have warning signs out at the
entrance.

59. - Process of Soft Peel & GenesisSoft Peel & Genesis
Step 5. Genesis Technique
Mode : 1064 FR Mode
Fluence : 10-14 J
Frequency : 8-10 Hz
Spot Size : 3-4mm
300㎲
FR Mode
heating
Transmission of thermal energy to dermal
lesion
Collagen remodeling
Applications
Wrinkle/pore size/whitening
After soft peel, concentrate laser radiation
around nose, forehead and eye fringes.
Allow patients to feel heating of skin.
The end point is erythema.

60. Clean with cleansing cream to
remove remaining carbon
cream. Remaining oil and
carbon can cause skin trouble.
Notice . Do not use cooling
pack or cool washing until
heating temperature on
dermal skin returns to normal
through Genesis technique.
- Process of Soft Peel & GenesisSoft Peel & Genesis
Step 6. Finalize

61. - Carbon Cream for Soft Peel
Soft Peel & Genesis
High Quality Carbon Cream
In comparison to other products
(20~40 Micron with irregular
combination), carbon cream used by
Won Technology consists of 10 Micron
with regular combination. Stable and
safe to use, Won Technology’s carbon
cream leads to great results when
used with laser.

62. - Soft Peel & Genesis Clinical Case (1)
After
Soft Peel (2.2J) with Carbon
8Hz / 6mm
8 week interval X 3 times
Soft Peel & Genesis

63. - Soft Peel & Genesis Clinical Case (2)
After
Soft Peel(2.2J) & Genesis
8Hz / 2.0J / Collimated H/P
6 week interval X 2 times
Soft Peel & Genesis

64. - Soft Peel & Genesis Clinical Case (3)
After
Soft Peel (2.0J) with Carbon
8Hz / 2.0J / Collimated H/P
5 week interval X 2 times
Soft Peel & Genesis

65. - Soft Peel & Genesis Clinical Case (4)
After
Cosjet Laser Toning (2.2J) + Soft Peel (2.0J)
8Hz / Collimated H/P
6 week interval X 5 times
Soft Peel & Genesis

66. - Soft Peel & Genesis Clinical Case (5)
After
Cosjet Laser Toning (2.2J) + Genesis (14J)
8Hz / 6mm / 4mm
12 week interval X 8 times
Soft Peel & Genesis

67. - Soft Peel & Genesis Clinical Case (6)
After
Soft Peel(1.8J) + Genesis(14J)
8Hz / Collimated H/P / 4mm
4 week interval X 2 times
Soft Peel & Genesis

68. Suggestions for Pre/Post-Treatment
Pre-Treatment
Avoid suntan before
treatment.
Shave hair in order to
prevent energy loss and color
fixation.
Avoid to take photo-
sensitizer.
Apply sun block before
treatment.
Post-Treatment
Apply antibiotics and ointment
prescribed by clinic.
When washing face, be careful not to
disturb
treated areas.
Avoid excessive exercise, sauna and
swimming until
scab peels off naturally.
Apply sun block (higher than SPF 30)
after scab
falls off in order to prevent PIH.

69. Conclusion
Q switch Nd yag is an effective and safe device for Skin
rejuvenation and Skin lightening in all skin types .
Combining different modalities is the best way to achieve
highly desirable result .

70. THANK YOU