1.New Modalities in Anti AgingDr. Juliana Ghaben, MD . DermatologistConsultant Trainer with SPECTRONIX

2. Dr. Juliana GhabenMD , Specialist Dermatologist ( Skin , Aesthetic and Laser)Visiting Fellowship in Laser Skin Surgery ,ThailandBoard Certified in Aesthetic Medicine by American AcademyConsultant and Trainer with SPECTRONIX 3. New modalities in Anti agingI would like to Share the following technologies in thispresentationCarboxy Therapy with Crabotech F650Secret Microfractional Radio FrequencyQ Switch ND YAG Laser 4. What is Carboxy Therapy ?Carboxy Therapy is a procedure verysimilar to MesotherapyIt consists of intradermal or subcutaneousinjections of medical grade co2 using 30 Gneedles.Treatments are rapid, comfortable andeffective for a high percentage of patients 5. Common IndicationsCellulite 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 BodyVasodilation The Bohr Effect ( Co2 +H20 = H + HCO3 Simulation of Collagen synthesis Neo Angiogenesis effect Suspected Melanocyte Pigment synthesisStimulation Receptor activation and Lipolysis improvement 7. Strong vasodilatory effect (causes dilation of blood vessels) on thecapillaries 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 builtup fluid from between the cells.Carboxytherapy. How it works? 8. Administration for Fat 9. Direct pressure causes trauma to adipositiesBlood flow increases and Bohr effect bringsMore oxygen to adiposities leading to an optimized physiological lipolysis.CO2 injection stimulates the synthesis ofCollagen . This property is used to improve atrophic scars byincreasing the quantity of collagen below the atrophyRestores skin laxity and colour and speeds upThe wound healing process . It is interesting procedurefor white thyroidectomy , caesarean and appendectomy and other scars ingeneral.It works in three ways on old white stretch Marksa) Neo-angiogenesis below the mark , which adds a pinkcolourb) Melanin Stimulation caused due to increased Oxygen inthe tissuec) Collagen synthesis which reduces the creased appearanceAesthetic IndicationsStretch MarksLocalized FatAcne ScarsSurgical Scars 10. Because it stimulates Collagen synthesisAnd local lypolytic action helps ineye rejuvenation and fat depositsThe dorsal side of the hands may be treatedWith intradermal injections . The Expected effectAre tightening after four or more sessionsSome physicians use CDT for Psoriasis and we have Goodbefore after pictures documented by Manufacturing companyThere are not any published studies on indication and can beconsidered experimentalAesthetic IndicationsEye WrinklesLower Lid Fat deposits andUnder-eye circlesRejuvenation ofhandsDecolletage and NeckPsoriasisNasogenian FoldsAnd Peri-OralWrinklesCDT is an alternative to fillers in some cases ,especially for patients with contradiction to fillers Co2has progressive improvement over few sessionswhereas fillers have immediate results 11. Needle PhobiaStress , with history of vagal uncounciousnessSevere heart failure , congestive heart diseaseRecent heart infarction or instable anginapectroisRestrictive pulmonary disease , chronicobstructive lung diseaseSleep apneaRenal failure , dialysisRecent cerbrovascular accidentUncontrolled blood pressureEpilipsyRecent phlebilitis or pulmonary embolismUncontrolled DiabitiesChemotherapy , CancerBacterial Infection : Dermatitis, CellulitisForeign Body in the area to be treated( Jewellery implants in the area and soon )Herpes simplex in acutae phase andother acute skin viral infectionSkin disease with abnormally increasedlocal circulationFacial RosaceaPoikiloderma of CivatteRed necks and Red decolletagePregnancyLactationAnticoagulation ,Recent asprin or anti-inflimatory drugs intakeAcute skin infectionOther Aesthetic proceduresor skin traumatism less than15 daysCONTRADICTIONSGENERALCONTRAINDICTIONSLOCALCONTRAINDICTIONSTEMPERORYCONTRAINDICATIONS 12. The end result is fewer fat cellsand firmer subcutaneous tissue.Fig 1- Histological appearance of the dermisbefore CO2 treatment.Fig. 2. Patient 1. After CO2 treatment,thickening of the dermis and rearrangement ofcollagenous fibers is shown.Carboxytherapy End Results 13. CarboTech (Europe-US) ONLY FDA APPROVEDMACHINES40 CC PER MINUTE / 80 CC PER MINUTEMinimal discomfort. Less painful. Best Technique for CO2infiltrationSave Time with dual output modeSure Fire technique killing fat cellsInitial Start up AutoTesting + Color Led screenFunctionality in a simple an easy to use form-factorLatest valve technology / Timer / Pressurization System /watchAnodized Satin white ultra light aluminum casing220v or 110v selectorDo not generate heat 30 wattCarbotech 14. 1) Axt Welcome - Test2) Please open the valve (15psi-28psi)- Ideal pressure 22psi3) Open the valve of the gas tube- 22psi4) Input- Pressure low/high5) If pressure high- Close the gastube valve- Purge6) Please select program (if 15psi-22psi)7) Press Program I (40cc) or ProgramII (80cc)8) Please enter volume in cm3(1cm3-999 cm3)- Enter-Pressurization9) Ready to start with .cm310) Start with the procedure CO2 OUTPUTPEDAL SWITCHCO2 INPUTKEYBOARDCarboxytherapy in 10 steps 15. CO2 ADMINISTRATIONSubcutaneous Syringe - 45 Degree 15cc-50cc per sector Speed 40cc per minute 16. Body- Sector Diagram 17. 50cc-80 cc20cc-50 ccAbdomen 20cc-50cc per areaAbdomen 18. 50-60 cc20-30 ccMore painful areasLegs 19. 15-50 ccArms 20. Tube- Carboxytherapy 21. Before AfterUnder Eye BagsRejuvenation 22. Before AfterStretch Marks 23. BEFORE AFTERPSORIASIS 24. BEFORE AFTER 25. CARBOXY THERAPY IS: 26. SECRET MICROFRACTIONAL RFMinimally invasive FractionalRadiofrequency Microneedls(FRM) deviceis recently introduced.The device gives selective heating in thedermis using bipolar RF (or monopolar RF)through microneedles. 27. IntroductionPrevious generation Ablative Skin Resurfacing laserdevices were effective, but many of them could notavoid the problems of long down time and patientpain. On the contrary, Non-ablative Skin Rejuvenationlaser devices reduced pain and adverse effects, butthese devices could not make dramatic effects. In themiddle of 2000s, fractional technology opened newgeneration overcoming previous problems. But thefractional treatment was limitedly used because itcould not control penetration depth and it gavedamage on the epidermis. 28. Common IndicationsNon Surgical Face Lift Wrinkle Reduction Skin tightening Skin Rejuvenation Pore Reduction Scars Acne scars Stretch Marks 29. What is Microfractional RF ? 30. How It WorksCollagen Regenerationand elasin productionMicroneedleCatridge is Placd on skin surfaceMicro-needle penetratesinside the skinBipolar RF Energy is delivereddirectly to targeted areaA precisely controlled BipolarRF is delivered at depthbetween 0.5mm to 3.5mmdepending on the symptoms 31. Fractional Laserand Microfractional RF 32. BEFORE / AFTER 33. BEFORE / AFTER 34. BEFORE / AFTER 35. BEFORE / AFTER 36. BEFORE / AFTER 37. BEFORE / AFTER 38. BEFORE / AFTER 39. ConclusionMicrofrcational RF treatment has beenshown to provide consistent and meaningfulimprovement in facial scar and laxity withoutcomplications and adverse effects. Theaverage improvement seen following a singletreatment was approximately 93.3%. Theresult may become an important option forscar and facial laxity treatment 40. A new Modality in Antiging treatmentsSkin ToningPore ReductionPigments treatmentQ switch ND YAG 41. - Principal of Epidermal LesionCOSJET TRWith 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) 42. Treatment Process of Epidermal LesionPigmentFreckle, Age spotCaf-au-lait LentigoSelective Photothermolysis532nmLaserEpidermalDermalPhoto acoustic effect 43. - 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 PigmentBefore Right After After 5minNormal WhiteningWhitening 44. - COSJET TR Clinical Case (1)Cosjet TR532nm / 0.9JFreckleRight after Whitening 1 week after Treatmentwith 532nm 45. - COSJET TR Clinical Case (2)Cosjet TR532nm/0.8JSolar Lentigo2 weeks after Treatmentwith 532nm 46. - COSJET TR Clinical Case (3)Cosjet TR532nm/0.9JFreckles2 weeks after Treatment(1 time)with 532nm 47. - COSJET TR Clinical Case (4)Before treatment 2 weeks after IPL treatmentCosjet TR532nm/0.9JFreckleswith 532nm 48. Treatment Process of Dermal LesionPigmentTattoo Ink, Melasma,ABNOM, Nevus of Ota,Selective photothermolysis1064nmLaserEpidermalDermalPhoto acoustic effect 49. MicrophageselectivityphotothermolysisPigment Lesion in Dermal (1064nm)Radiate Laser Pigment ResolvingPigment RemovalRight after After 4~8weeksThere maybe bleeding fromAcoustic damage 50. - COSJET TR Clinical Case (1)Cosjet TR1064nm/4.5JTatto2 weeks after Treatment(1 time)with 1064nm 51. - ERASER TR Clinical Case (2)Cosjet TR1064nm/7.5JNevus of Ota6 weeks after Treatment(1 time)with 1064nm 52. - COSJET TR Clinical Case (3)Cosjet TR1064nm/6.0JAmateur Tatto6 weeks after Treatment(1 time)with 1064nm 53. - What is Soft Peel & Genesis?Soft Peel & GenesisSOFT PEEL (New concept using carbon cream) + Genesis for dermal remodeling1064nm6ns8-10hz1.5J1064nm0.3ms8-10Hz10-14JHeatingCarbon oilexplodes andpeels off deadskinQ/SW ModeQuasiLong pulse Fast resultNo down timeNo painNo side effectPore sizeWrinkleSkin ToneAcne improvementCharacteristics 54. - Process of Soft Peel & GenesisSoft Peel & GenesisStep 1. CleansingClean skin surface toremove sebum, etc.For better result,cleansing mask orscrub can be used. 55. - Process of Soft Peel & GenesisSoft Peel & GenesisStep 2. Carbon creamApply carbon cream usinggauze.Wait for about 10min untilcarbon cream is absorbedwell in pores.Tip: Shake carbon creambefore using. Place tapeson eyebrows to protectthem during the laseroperation.Apply carbon cream After 10~15min 56. - Process of Soft Peel & GenesisSoft Peel & GenesisStep 3. Absorption of carbonAfter 20min, removecarbon cream with cottongauzeTip: Remove carbon creamon skin surface but leavethem in pores. 57. - Process of Soft Peel & GenesisSoft Peel & GenesisStep 4. Laser operationWhen operating laser, always wear safety goggles and treatment lab must have warning signs out at theentrance. 58. - Process of Soft Peel & GenesisSoft Peel & GenesisStep 5. Genesis TechniqueMode : 1064 FR ModeFluence : 10-14 JFrequency : 8-10 HzSpot Size : 3-4mm300FR ModeheatingTransmission of thermal energy to dermallesionCollagen remodelingApplicationsWrinkle/pore size/whiteningAfter soft peel, concentrate laser radiationaround nose, forehead and eye fringes.Allow patients to feel heating of skin.The end point is erythema. 59. Clean with cleansing cream toremove remaining carboncream. Remaining oil andcarbon can cause skin trouble.Notice . Do not use coolingpack or cool washing untilheating temperature ondermal skin returns to normalthrough Genesis technique.- Process of Soft Peel & GenesisSoft Peel & GenesisStep 6. Finalize 60. - Carbon Cream for Soft PeelSoft Peel & GenesisHigh Quality Carbon CreamIn comparison to other products(20~40 Micron with irregularcombination), carbon cream used byWon Technology consists of 10 Micronwith regular combination. Stable andsafe to use, Won Technologys carboncream leads to great results whenused with laser. 61. - Soft Peel & Genesis Clinical Case (1)AfterSoft Peel (2.2J) with Carbon8Hz / 6mm8 week interval X 3 timesSoft Peel & Genesis 62. - Soft Peel & Genesis Clinical Case (2)AfterSoft Peel(2.2J) & Genesis8Hz / 2.0J / Collimated H/P6 week interval X 2 timesSoft Peel & Genesis 63. - Soft Peel & Genesis Clinical Case (3)AfterSoft Peel (2.0J) with Carbon8Hz / 2.0J / Collimated H/P5 week interval X 2 timesSoft Peel & Genesis 64. - Soft Peel & Genesis Clinical Case (4)AfterCosjet Laser Toning (2.2J) + Soft Peel (2.0J)8Hz / Collimated H/P6 week interval X 5 timesSoft Peel & Genesis 65. - Soft Peel & Genesis Clinical Case (5)AfterCosjet Laser Toning (2.2J) + Genesis (14J)8Hz / 6mm / 4mm12 week interval X 8 timesSoft Peel & Genesis 66. - Soft Peel & Genesis Clinical Case (6)AfterSoft Peel(1.8J) + Genesis(14J)8Hz / Collimated H/P / 4mm4 week interval X 2 timesSoft Peel & Genesis 67. Suggestions for Pre/Post-TreatmentPre-TreatmentAvoid suntan beforetreatment.Shave hair in order toprevent energy loss and colorfixation.Avoid to take photo-sensitizer.Apply sun block beforetreatment.Post-TreatmentApply antibiotics and ointmentprescribed by clinic.When washing face, be careful not todisturbtreated areas.Avoid excessive exercise, sauna andswimming untilscab peels off naturally.Apply sun block (higher than SPF 30)after scabfalls off in order to prevent PIH. 68. ConclusionQ switch Nd yag is an effective and safe device for Skinrejuvenation and Skin lightening in all skin types .Combining different modalities is the best way to achievehighly desirable result . 69. THANK YOU