A MEDICAL AND AESTHETIC CHECK-UP FOR THE EVALUATION
OF STATE OF HEALTH FROM THE AESTHETIC MEDICINE POINT OF VIEW
C.A. BARTOLETTI, M. D.
Italy
President of the Italian Society of Aesthetic Medicine
Director of International School of Aesthetic Medicine, International Foundation
Fatebenefratelli, Rome
Scientific Director of the Aesthetic Medicine Out-Patient Service of “S. Giovanni
Calibita Fatebenefratelli” General Hospital, Isola Tiberina, Rome
Aesthetic Medicine has by now gained its own scientific configuration and plays a role of social
medicine, so meeting the community’s wishes: “beauty” as expression of health and individual
“wellness” at any age are notions linked to sociological and psychological modified needs of
users.
The main task of the Aesthetic Medicine, a subject of internistic and humanistic origin, is the
development of a physical and psychological balance of those people who daily live their life in
a state of embarrassment due to a quite unaccepted blemish, thus taking up the
recommendation by the World Health Organization that state of health has to be considered as
psychophysical well-being, not as absence of sickness.
Nowadays Aesthetic Medicine is requested, above all, to give useful pieces of advice with a
view to improving the quality of life at different ages and to keeping oneself in the best physical
and mental conditions. Therefore, it undertakes the role of preventive medicine without loosing
track of the correction of wailed blemish.
The medical and aesthetic check-up proposed by the Scuola Internazionale di Medicina
Estetica, International School of Aesthetic Medicine, of the Fatenebenefratelli International
Foundation of Rome (educational expression of the Società Italiana di Medicina Estetica,
Italian Society of Aesthetic Medicine), and therefore carried out in the relevant health care
centres at the hospitals in Rome, Milan, Castrocaro Spa, Catanzaro, consists in:
1. Diagnostic approach:
• traditional anamnesis, focused on the request;
• traditional and targeted physical examination;
• morphologic and functional evaluations for the purposes of aesthetic medicine:
• psychological evaluation, consisting in a number of tests. Performed during an interview,
it aims at the definition of a global psychological profile of the user. It will highlight the
emotional response caused by the blemish in question, also as to its socio-environmental
reactions;
• morpho-anthropo-plicometric evaluation. Knowledge of patient ponderal history, of his
subjective ideal weight, of the lean tissue mass, of the total water quantity, through
technical methods for measuring the body composition, such as plicometry and bodyimpedence analysis, that allow to identify possible weight targets or localized treatments.
Also the prescription of dietary plans aiming at a metabolic and ponderal recovery of the
person falls within the morpho-anthropo-plicometric evaluation;
• postural evaluation, emphasizing any possible trouble in the body position on a base
plane, under dynamic or static conditions, through direct observation and the help of a
plantar-scope or a podograph;
• evaluation of physical capacity, giving the chance to assess the person capacity to work,
measuring his maximum oxygen consumption, the articular strength and flexibility, with the
help of a cycle ergometer, of a graduated stick and a goniometer;
• angiologic evaluation of the lower limbs. With a medical semiotics and the help of an
Acoustic Doppler;
• echographic evaluation of hypodermis. To distinguish a localized adiposity from an
edematous-fibrosclerotic panniculopathy at its different stages of evolution;
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•
•
skin evaluation. Clinical examination and measurement of basic physiological parameters
performed with the help of a corneometer, a sebumeter, a pHmeter and a thermometer;
haemato-chemical evaluation. General clinical tests and tests focused on the clinical
indication.
2. Request for specialized counselling, in case performed evaluations pointed out a
condition that is beyond a physiological or a para-physiological state.
3. Diagnostic determination of reported clinical blemish.
4. Formulation of a global balance.
5. Formulation of a preventive general and targeted hygienic programme (dietary,
physical, cosmetological, psychological and behavioural hygiene)
6. Formulation of a corrective programme according to competence.
In former years only privileged classes resorted to Aesthetic Medicine. Nowadays the profile of
the typical patient of Aesthetic Medicine portrays a person who is more and more aware that
this Medicine is neither a “medicine for the summer season”, nor a medicine catering only to
wealthy people. Today those who apply to an aesthetic specialist, besides the solution of the
declared blemish, demand a prescription that is useful “to feel at ease with themselves”, and
belong mainly to a wider age bracket, to various less elitist social backgrounds. They do not
ask for being restored to youth, and on the contrary – even before correcting the reported
blemish - wish to learn the rules for improving quality of life pertaining to their age and to keep
their psycho-physical well-being over the years.
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CERVICO-FACIAL LIPOPLASTIA: DIFFICULT CASES
UNCONVENTIONNEL BOTOX
RHINODELAGE
LIFT EFFECT FAVOUR THE LIPOPLASTIA
LIPOFILLING WITH A NEEDLE
JEANPIERRE AMSELLEM
Pessac
France
SUMMARY LIPOFILLING:
The lipofilling was developed by Fournier and ameliorated by Klein; today we witness a
considerable evolution.
The tendency is to make only one taking away but repeated injections approximately 2 a 3 in
order to obtain a different pseudo definitive result. Nozzles have been invented for the injection
with good results but the new needle foams of 21g give remarkable results with a minimum of
side effects due to the diameter of the opening.
This makes it possible to treat in an effective way and without hematoma of difficult zones like
the lower eyelids and by minimizing the side effects in an obvious way. This technique is not
improvised and a good training is necessary in order to optimise the results.
SUMMARY: CERVICO FACIAL LIPOPLASTY: DIFFICULT CASES
CFL in patients over the age of sixty is made difficult by the frequent changes in skin condition,
potentially resulting in significant slackening of the skin, at times without surplus tissue,
however often accompanied by dehydration.
A number of precautions must be taken in order to achieve an optimal outcome:
• The use of local anaesthetic particularly in patients who use multiple medications;
• Hydrotomy needs to be applied in high doses to enhance the adipose lip - on average 300
cc of Klein solution;
• Latency period: at least 30 minutes in order to achieve a perfect vasoconstriction;
• Multiple entry sites: 2 maxillary ones, 1 under the chin and 2 at the nasal level. The use of
multiple entry sites allows the crossing of the various tunnels in 1/3 of the face, as well as
in the cervical area right up to the sub-clavicular hollow.
• A post operative ungwing is crucial and bloody;
• There is no need for any dressing;
• Manually applied lymphatic drainage needed on the second day postop.
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DELEGATION OF CHINA ACADEMY OF AESTHETIC MEDICINE
Aesthetic Medical School of Yichun University,
YCHUN CITY 336000, Jiangxi Province
President: Q. X. PENG
Fenglongfei0000@163.com
Tianwen Gao
Department of Dermatology, Xijing Hospital, Fourth Military Medical University. Xi’an, 710033,
Shaanxi, China
Chunying Li
Department of Dermatology, Xijing Hospital, Fourth Military Medical University. Xi’an, 710033,
Shaanxi, China
Yuanhong Li
Department of Dermatology, No.1 Hospital of China Medical University, Shenyang, China
Yufeng Ai
Sichuan Huamei Aesthetic & plastic Hospital. Chengdu, China
Rongya Yang
Department of Dermatology, General Hospital of Beijing Military of PLA
Beijing 100700, P. R. China
Xiaozhong Zhao
Laser center, General hospital of Air Force, Beijing 100036, China
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CURRENT STATE OF VITILIGO THERAPY IN CHINA
Chunying Li, Tianwen Gao
Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi’an,
Shaanxi’
People’s Republic of China
Correspondence: Tianwen Gao, Email: gaotw@fmmu.edu.cn
Vitiligo is a common skin disorder with a worldwide prevalence ranging from 0.5% to 4%. In
China, the incidence rate of vitiligo is rapidly increasing in the past ten years. Vitiligo is very
common to occur in the face and cause the cosmetic problems especially in the young people.
However, because the precise cause of this disease is still unknown, the therapy of vitiligo is
challenging for the dermatologists in China as well in other countries all over the world.
The Conservative therapies in China include photochemotherapy, phototherapy with UVB
radiation systemic steroids and pseudocatalase. Here in this study, we summarized the
current state of vitiligo therapy in China based on our work and literatures. Recently, the
modern therapeutic options include treatment with topical immunomodulators (tacrolimus,
pimecrolimus), analogues of vitamin D3, excimer laser and surgery/transplantation,narrow
band UVB 311 nm,and Chinese traditional herbs. We found when put together, The face and
neck respond best to all therapeutic approaches, while the acral areas are least
responsive.For generalized vitiligo, phototherapy with UVB radiation is most effective with the
fewest side effects; PUVA is the second best choice.Topical corticosteroids are the preferred
drugs for localized vitiligo. They may be replaced by topical immunomodulators which display
comparable effectiveness and fewer side effects. Surgical therapy can be very successful, but
requires an experienced surgeon and is very demanding of time and facilities, thus limiting its
widespread use. Chinese traditional herbs therapy appears effective on the generalized
vitiligo. No single therapy for vitiligo can be regarded as the most effective as the success of
each treatment modality depends on the type and location of vitiligo.
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EFFICACY AND SAFETY OF A NEW IPL DEVICE
IN THE TREATMENT OF PHOTOAGING
Li YH, Wu Y, Chen ZS, * Gao XH, Chen HD
Department of Dermatology, No.1 Hospital of China Medical University, Shenyang,
People’s Republic of China; *Sheftel Associates Dermatology, Tucson, AZ, USA
BACKGROUND: Intense pulsed light (IPL) technology has been applied in the treatment of
photoaging skin for 14 years. But traditional IPL devices have energy peak and decline, which
limit their application. To avoid such adverse effects, a new IPL device with “squared-off”, even
distributed pulse shape has been tried in this pilot study.
OBJECTIVE: To evaluate the efficacy and safety of a new IPL device in the treatment of
photoaging skin in Asian patients.
METHODS: One hundred and fifty-two Chinese women with photoaging skin were enrolled in
this open-labeled study. Subjects received a total of four IPL treatments at a 3- to 4-week
interval. Changes of photoaging were evaluated using a global evaluation, an overall selfassessment, a Mexameter and a Corneometer.
RESULTS: One hundred and thirty-nine of 152 patients (91.44%) experienced a score
decrease of 3 or 2 grade, according to the dermatologist. One hundred and thirty-six of 152
patients (89.47%) rated their overall improvement as excellent or good. The mean MI and EI
values decreased with each session. MI on forehead and EI on cheilion decreased most
significantly. Adverse effects were limited to mild pain and transient erythema.
CONCLUSION: IPL treatment is a safe and effective method for photoaging skin in Asian
patients. Adverse effects were minimal and acceptable.
Keywords: intense pulsed light; photoaging; melanin index; erythema index.
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THE WORLD AND THE DEVELOPMENT OF
CHINESE AESTHETIC MEDICINE DISCIPLINE
Qingxing Peng, Rongya Yang, Longfei Feng, Tianwen Gao
People’s Republic of China
Chinese aesthetic medicine discipline started from the commencement of nongovernmental academic exchange at July, 1986 since 21 years ago, Chinese aesthetic
medicine has gone through 3 stages:
1. Discipline gestation and academy establishment
2. Substantial development of the whole discipline and its relative projects
3. Converging with the world.
This passage analyzed the common and different points between Chinese and foreign
aesthetic medical discipline’s development and revealed main points that China should learn
from the world as well as five advantages of Chinese aesthetic medical discipline prior to other
countries on the basis of above three points. The writer hopes that, with the help of UIME,
CAAM will exchange views on a wide range with all other countries and learn with an open
mind as well as develop together with all over the world.
Key words: medical aesthetics, aesthetic medical whole discipline.
Chinese Aesthetic Medicine discipline has a history of 21 years since the nongovernmental academic exchange happened in July, 1986.
Since 21 years ago, Chinese aesthetic medicine has gone through 3 stages: discipline
gestation and academy establishment; consistent development of the whole discipline and its
relative projects; new stage of converging with the world.
First, discipline gestation and academy establishment（1986.4.～～1994.7.）
Prof. Qiu Ling-zhi and Prof. Peng Qing-xing started to advocate compiling a textbook
entitled Medical Aesthetics in the Cooperative Meeting of Medical Universities in China
Eastern Part held in Fuzhou city, Fujian province.
In April, 1986, the first “Aesthetic Surgery Hospital “in china, named “Beijing Huangsi
Aesthetic Surgery Hospital”, was set up in Beijing.
The national symposium on skin beauty, hosted by Guo Ding-jiu and Ou-yang Heng, was
held in Hengshan, Hunan province, china.
In July, 1986, the Preparatory Committee of Chinese Academy of Aesthetic Medicine was
established on the national symposium on skin beauty held in Hengshan, Hunan province,
china.
In October 1986, in the Coordination Meeting of the National Health Management & Teaching
held in NanNing, china, Huang Yong-chang, former chief of scientific educational section in
Ministry of Health P.R.China, identified Prof. Qiu Ling-zhi and Prof. Peng Qing-xing to edit a
textbook entitled “Medical Aesthetic”.
In 1988, more than 10 publications were published, such as Medical Aesthetics edited by
Qiu Ling-zhi and Peng Qing-xing, Practical Aesthetic Operations edited by Gao Jing-heng,
Compendious Aesthetic Surgery Science edited by Wang Da-mei and Xia Zhao-ji, etc..
Feb, 1989, Research Institute of Medical Aesthetics, Yichun University was established.
April 1989, The Preparatory Committee of Chinese Academy of Medical Aesthetics
was established in HeFei, Anhui province.
July 1989, The Preparatory Committee of Chinese Academy of Medical Aesthetics
established in HeFei and The Preparatory Committee of Chinese Academy of Cosmetology
established in HengShan three years ago were combined to be “Preparatory Committee of
Chinese Academy of Aesthetic Medicine”; Since then the prelude of Chinese discipline of
aesthetic medicine was opened.
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Dec, 1989, Practical Aesthetic & Plastic Surgery Journal was established in Shengyang,
Liaoning Province.
Chinese Academy of Aesthetic Medicine (CAAM) was set up on November 1990, Wuhan
city, china. The next day, Shanghai Science and Technology Publishing House dispatched
people to Wuhan urgently to ask CAAM to write a monograph, Medical Aesthetics, which was
finally completed by Zhang Qi-liang together with more than other 50 top experts in china,
1996. This monograph is academically valuable since it builds firstly the rudiment of aesthetic
medicine; namely, great foundation for the establishment and development of whole
disciplinary system of Chinese aesthetic medicine.
1992, Aesthetics and stomatological Medical Aesthetics edited by SunLian was published by
Beijing University Publishing House.
Since 1993, Yichun University, Dalian Medical University, Chengdu University of Traditional
Chinese Medicine, etc have established college, undergraduate, post graduate such kind of
educational careers successively.
Second, Consistent development of the whole discipline and its relative projects.
（1994.7.～）
During this stage, Chinese aesthetic medical whole discipline together with its related
careers was completely developed. The main characteristics were:
1. “Building and Development Symposium of Chinese Modern Medical Aesthetics and
Cosmetology Discipline” was held in Kunming in 1994. With the guidance of China Health
Ministry, serious of “items” of state documents was discussed and the primary information for
scientific decision-making was provided for China Health Ministry in this symposium. It was the
great sign of the co-development of the whole discipline together with its related careers.
2. A large number of academic monographs of high levels, which reflected the
development of Chinese aesthetic medical discipline, were published successively.
Representatives are:
Stomatological Medical Aesthetics edited by Sun Shao-xuan was published by AnHui Science
and Technology Publishing House in 1994.
Aesthetic Medcial Psychology edited by Helun and Fang Zhang-lin was published by BeiJing
Publishing House in 1998.
6 of “Aesthetic Medicine Series of New Century” edited by Peng Qing-xing: 《Basis of
Aesthetic Medicine》,《Aesthetic Surgery》,《Aesthetic Dentistry》,《Aesthetic Dermatology》,
《Aesthetic TCM》,《Aesthetic Medical Care Technology》,with 2 million words totally, was
published by Scientific Publishing House from 1999—2001, collected all the achievement of
modern Chinese aesthetic medicine.
Aesthetic Surgery edited by Gao Jing-heng, 1.5million words totally, was published by BeiJing
Science and Technology Publishing House in 2003, which collected all the achievement of
Chinese aesthetic surgery.
3. A series of professional journals and scientific publications were established: besides
Chinese Aesthetic & Plastic Surgery Journal (Shengyang), there are Chinese Aesthetic
Medical Journal(Xi-An), Medical Aesthetic·Cosmetology(Xi-an), Clinical Medical Aesthetic
Journal(Hefei), Chinese Medical Aesthetic Cosmetology Journal(Beijing), etc.
4. Basic terms of the discipline were approved. Oct, 1996, with the guidance of China
National Committee for Terms in Sciences and Technologies, “disciplinary basic terms” of
medical aesthetic and aesthetic medicine were conducted to approve, totally with 619 pieces,
which was finished on April, 2001 and published by Scientific Press on May at the same year.
5. Medical aesthetic professional team and the serving plants grew up. Some medical
aesthetic professional team and the serving plants appeared in 1990s all over the country and
became prosperous in 2000, so it is urgent to strengthen the administration of these medical
aesthetic medical services. In April, 2001, China Health Ministry entrusted CAAM with the
work of drafting out the Managements of Medical aesthetics and its supporting documents
including Aesthetic Medical Specifications for Clinical Technology and Operation, Basic
Standards for Medical Aesthetic Bodies (Trial), Medical Aesthetic Items., all of which are
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successfully completed on Jan, 2002 and issued by China Health Ministry as rules of law,
which is the initial “Aesthetic Medical Rules of Law” issued by government in the world.
6. Aesthetic Medical Specifications for Clinical Technology and Operation editied by Gao Jingheng and Peng Qing-xing was published by People’s Military Medical Publishing House on
March, 2004.
7. Aesthetic medical educational careers are making progress in the exploration and develop
steadily.
Obviously, above words reflect the characteristics of the development of the whole discipline,
1. All branches of Aesthetic medicine grew up;
2. The system of whole discipline and its serving industries was brought to completion.
3. Published a large number of academic monographs of high levels.
4. Reflecting the developing trend of Chinese aesthetic medical discipline.
“Contemporary Medical Aesthetics and Aesthetic Medicine” and its related projects in China
begin to develop into a standardized and legalized system, and become more and more
mature.
Third, new stage of converging with the world（ 2005.5. ～ ）
The above two stages confirm the academic foundation of Chinese national aesthetic
medicine. But how to converge with the world is still in the gestation. The great sign at the
beginning of the gestation is “The 2nd International Medical Aesthetic & Cosmetology
Congress” held in Beijing in July, 2002.The topic of this congress is “Advance Hand in Hand to
Create Vigorous Beauty of Human Being’s Life”, which was applauded by hundred of experts
from ten different countries. The strategy thinking of globalization for the disciplinary
development happened.
May 2005, Dr. Wangguanghu and I joined the “15th World Congress of Aesthetic Medicine”
held in Rome, Italy and began to connect with the international organization----UIME, which we
had applied to join in. Thereby, we begin to cognize the world, hold the world and the
academic confidence, pride were rationally sublimed as well as globalization strategic thinking
of aesthetic medical discipline development. Nov, 2005, a great aim was raised in “15th
Anniversary Congress of Chinese Academy of Aesthetic Medical”, that is “carrying forward the
cause of the past and forge ahead into the future, keep pace with the times and advance into
the world”.
Through academic exchange, we know that the content of aesthetic medicine in world are
very rich and a lot of good things deserve learning by china. In other countries, aesthetic
medicine includes a very rich content, such as aesthetic surgery, aesthetic dermatology,
aesthetic dentistry, laser, skin care, aesthetic psychology, anti-aging and so on, which is very
similar to Chinese discipline either on scope or in content. Furthermore, the aesthetic medicine
in anti-aging are better than china, especially, the appliance of Meso-therapy.
However, Chinese aesthetic medicine has five characteristics that are different from others:
1. Systematic research and application of medical aesthetic theories and skills.
2. Researches on disciplinary basic problems such as object, concept, structure etc.
3. Clinic research of traditional medical aesthetics.
4. Sorting the whole discipline of aesthetic medicine.
5. Standardization medical aesthetic bodies, professional skills, professional education,
disciplinary terms and so on.
In a general perspective, they are also different:
Other countries:
Marketing demand→experts assemblage spontaneously →academic exchange →theories
sublimation
== Appearance of professional group →career → academic exchange
China:
Academic exchange→disciplinary theories→overall assemblage and inspiring the selfconsciousness of the expert →serving the market
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==academic exchange →appearance of the professional group →career →academic
exchange
2006，Raul Pinto, the honorary president of UIME visited China twice. He signed with
emotion at the first visit that “On Medical Aesthetics and aesthetic medicine theories, the
research is in an expanding stage in other countries of the world and we can learn from
China." At the second visit, he said:" We have to interchange knowledge between East and
West”. The summary signed both by Raul Pinto and Peng Qingxing after their talks said that
“Aesthetic Medicine in its recent developments has a positive and major contribution to the
well-being and positive lifestyle of the people, and is the newest jewel on the crown. Besides
treating the patients on disease, we can also meet the demand of the humankinds on
aesthetic medicine with the newest medical achievement”.
April 2007, in the Presidents Meeting of UIME held in Buenos Aires, We are so lucky that
we were enrolled as the member of UIME after our presentation in the meeting. Therefore, we
start the new milestone of the aesthetic medical discipline. The writer hopes that, with the help
UIME, Chinese aesthetic medical discipline will exchange views on a wide range with all other
countries, learn with an open mind and develop together.
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MODERN PLASTIC SURGERY & CONTEMPORARY AESTHETIC SURGERY
Qionghua Hu, ZhijunWang, Qingxing Peng, Longfei Feng
People’s Republic of China
This article demonstrates the inevitability from modern plastic surgery to contemporary
aesthetic surgery through three aspects, disciplinary development, trend of professional
clinics, social demand. Base on this, four new concepts of Chinese scholars were indicated
further, definition and characteristics of aesthetic surgery, similarities and differences of
aesthetic surgery and plastic surgery, the development of aesthetic surgery and Chinese
aesthetic medical whole discipline, the importance of cultivating the comprehensive
accomplishment. Chinese scholars consider that, it is an essential condition and technical
base for aesthetic surgery doctors that mastering the plastic surgical technology. Besides
strengthen the practice of plastic surgery, it is very important to strengthen the
accomplishment of aesthetics and arts in order to wholly improve the comprehensive
accomplishment. Conclusion: new generation of aesthetic surgery is the production of the
combination of plastic surgery, aesthetics and arts.
Key words: modern plastic surgery; contemporary aesthetic surgery; aesthetic medical whole
discipline
There is Chinese folk saying: ”Everybody loves beautiful things”. The technologies of Plastic
surgery originated from wars were taken to meet the demands of the humankind’s aesthetic
pursuit, for which aesthetic surgery was formed gradually. Chinese scholars have cognized the
new concept of aesthetic surgery gradually since Chinese contemporary aesthetic surgery
established 30 years ago.
1. The inevitability of the disciplinary development: from modern plastic surgery to
contemporary aesthetic surgery.
a. the inevitability from the aspect of disciplinary development course.
Recently, Dr, Zhang disheng, 92 ages, one of ancestors of Chinese plastic surgery,
Contemporary Chinese aesthetic surgery Father, Academician of Chinese academy of
engineering, wrote in his book:” plastic surgery is a medicine which is about repair, which is a
‘phoenix’ produced in wars; especially during the first and second world wars, many injuries
needed the cure from plastic surgery. So, plastic surgery becomes a booming medical subject.
Along with the fast development of plastic surgery, aesthetic surgery appeared and became an
essential demand with the progress of economy, society and human life.” From the aspect of
disciplinary development, these words objectively reflected the inevitability development of
modern plastic surgery to contemporary aesthetic surgery. These words are the most incisive
demonstration of the formation and the history of contemporary aesthetic surgery
development.
The organization structure of academy is one of the performances of disciplinary formation.
Some aesthetic surgery groups in some countries have separated from plastic surgery
association and have been to independent academic organizations; although some are still in
plastic institutes, aesthetic surgery divisions have been established; some include aesthetic
surgery to the whole frame of “aesthetic medical whole discipline” and set up aesthetic surgery
division group in it.
Aesthetic medicine in china is no longer belonged to plastic surgery, but combine with
aesthetic dermatology, aesthetic dentistry, aesthetic TCM (traditional Chinese medicine) and
such related subjects, all of which belong to “Aesthetic medicine”. Recently, we got from
Kazakhstan “4th NATIONAL CONGRESS OF AESTHETIC MEDICINE AND PLASTIC
SURGERY” that there is an “and” in this congress, which embodies the relationship between
Aesthetic surgery and Plastic surgery. It is indicated that Kazakhstan also includes aesthetic
surgery into the whole discipline of Aesthetic Medicine, just like china. We really appreciate it.
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b. the inevitability from the aspect of professional clinic trend.
The formation of aesthetic surgery is not only reflected in the history of disciplinary
development but also reflected in the data of clinics. According to the statistics from 1984～
2004 by Plastic & Reconstructive Institute of Shanghai 9th People’s Hospital, the increasing
rate of aesthetic surgery in these ten years is 40%. There is no exception for the developed
country. According to the statistics from 2000-2005 by US, the increasing rate of aesthetic
surgery in these five years is 48% and the average rate per year is 9.6%.
c. the inevitability from the aspects of increasing social demand.
Since the open policy in china, the medical aesthetic enterprises have developed very fast. In
April, 1986, the first “Aesthetic Surgery Hospital “in china, named “Beijing Huangsi Aesthetic
Surgery Hospital”, was set up in Beijing. Since then, medical aesthetic faculties in different
hospital were set up successively. Now, there are more than 9000 aesthetic medical
enterprises in the whole countries, among which there are two thirds enterprises are private.
There are 30000 aesthetic doctors with the license as well as more than 70000 medical
aesthetic technicians (including nurses).
2. about the definition and characteristics of aesthetic surgery discipline.
Early in 1992, the Chinese scholars began to seek for the definition and characteristics of
“aesthetic surgery” discipline. Dr, Xiazhaoji considered that aesthetic surgery is a medical
discipline, with the theoretical base of human formal beauty, with the measure of the
combination of medical aesthetics and surgery technology, to reconstruct and shape the
normal defects within the scope of human physiology and anatomy, with the aim to enhance
the form aesthetic feelings. It is not only the new branch of surgery but also the vital part of
aesthetic medicine with the aim of pursuing the human overall coordination beauty.
On the origin of the disciplinary development, there are countless connection between
aesthetic surgery and plastic surgery, but aesthetic surgery absorbed the technical nutrients of
craniofacial surgery, ophthalmology, ENT, skin surgery, abdominal surgery, external
reproductive system surgery, orthopedics, microsurgery and so on inevitably during the
process of formation, development and improvement. So the definition is it is not only the new
branch of surgery but also the vital part of aesthetic medicine with the aim of pursuing the
human overall coordination beauty instead of it is not only the new branch of plastic surgery
but also the vital part of aesthetic medicine with the aim of pursuing the human overall
coordination beauty. This thought is basic on that the future of aesthetic surgery cannot be
limited within the scope of plastic surgery.
Chinese scholars think that the characteristics of contemporary aesthetic surgery are: the
surface anatomical site or organ are reconstructed with the effort to get close to or reach the
psychological and aesthetic formalism in the ideal state through taking the basic technology of
surgery, especially plastic surgery and by the measures of filling augmentation, excision
reduction, lift and suspension. During the process of augmentation, lifting and suspension, the
rules that anatomy normal position corresponding to biomechanics position should be
followed. In other words, the proper force determine the proper position. On the contrary,
proper force should be applied if proper position being got.
3. Cosmetic surgery promotes the development of whole discipline of aesthetic
medicine in China.
Medical aesthetics, published in 1988, edited by Qiu linzhi and
Peng qingxin put forward two new concepts "Human beauty enclosed with vitality and health
in real life" and” whole discipline " .In July 1989, the branches academic organizations of
Chinese aesthetic medicine(four branches academic organizations such as dermatology,
Dentistry, aesthetic surgery and medical aesthetics), were merged as “ preparatory committee
of Chinese Academy of Aesthetic Medical". In November 1990, Chinese Academy of Aesthetic
Medicine (CAAM) was formally established, thus marked the formation of the overall discipline
of aesthetic medical science.
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For 18 years, China whole aesthetic medical disciplines like aesthetic surgery, aesthetic
dermatology, aesthetic dentistry, aesthetic TCM(traditional Chinese medicine)has been under
going comprehensive development, in particular aesthetic surgery has been growing fastest.
Compared with the early 1990s, great change occurs, for example:
At that time, the plastic surgeon were only in a few major hospitals, with the total number of
mere several hundreds throughout the country, while today there are aesthetic medical
institutions across the country ,both large and small towns, aesthetic surgeons amounts to
tens of thousands.
With regards to professional academic journals, at that time there was only one combined
journal called the magazine " Chinese Journal of Plastic Surgery and Burns ",while today there
are four professional publications: "China Aesthetic & Plastic Surgery Journal", “Chinese
Medical Aesthetics & Cosmetology Journal", “Chinese Aesthetic Medical Journal", “Chinese
Plastic Surgery Journal" .
In the aspect of aesthetic surgery academic monographs, at that time the only book was
“Practical Aesthetic Surgery", edited by Dr. Gao jingheng, while today there are at least
hundreds of various aesthetic surgery books introduced to the market.
Concerning to technical projects of aesthetic surgery, there were only dozens of simple and
rough projects at that time, but today guided by the theory of medical aesthetics, aesthetic
medical psychology, there are hundreds of aesthetic surgery technical projects.
We feel that the development of aesthetic surgery has promoted the development of the
science of aesthetic dermatology, aesthetic dentistry, aesthetic TCM (traditional Chinese
medicine), and has contributed to the overall development of aesthetic medical discipline.
CAAM is developing actively towards a thriving future.
4. Focus on training the comprehensive quality of a new generation aesthetic surgeons.
“Aesthetic surgeon”, contains the word “aesthetic”, meaning something beautiful. A real
aesthetic surgeon should be good at applying aesthetic knowledge to the clinical practice.
Theoretically speaking, such person should be called "aesthetic surgeon", what is more
accurate. It is necessary for aesthetic surgeon to study and master the aesthetics and medical
aesthetic knowledge. Therefore, it is justified by Zhang Disheng academician noting that
"aesthetic surgery is the combination of surgery and aesthetics". Chinese scholars Dr.He lun
also said: "Science, Technology and aesthetics are the three elements of aesthetics surgery."
He took "rhinoplasty" for an example to clarify his viewpoint.
Science, Technique and Aesthetic Elements of Rhinoplasty
Category
Content
Scientific aspect
structure of nasal anatomy, nose shape anthropology,
stability of prosthesis
surgical style, path, surgical techniques (separation
periosteum, install the periosteum)
aesthetics of nasal form, judgment of nose shape
defects, design of the fake nose
Technical
aspects(prosthesis)
Aesthetic aspects
From the table about rhinoplasty, we can see that scientific, technical and aesthetic elements
are necessary in aesthetic medical science, if keeping only scientific and technical elements,
the so-called aesthetic surgery or aesthetic medicine is not in accordance with the name. I
believe that mastering of plastic surgery technique is necessary for an aesthetic surgeon.
However, when we strengthen technical training of plastic surgery, we must strengthen the
training in aesthetic and art aspect, comprehensively improving their overall quality. The
Conclusion is: aesthetic surgeon of a new generation is a combination of mastering plastic
surgery skills, aesthetics and art.
13
THE LIGHT THERAPY, SKIN PROPERTY TEST AND ADJUNCTIVE THERAPY OF ACNE
Rongya Yang, Yang Xu, Yanlei Mu
Department of Dermatology, General Hospital of Beijing Military of PLA
Beijing 100700
People’s Republic of China
Introduce the light therapy, skin property test and adjunctive therapy of acne.
1. The visible light therapy of acne
(1) Utraviolet(UV) therapy UV can disinfect bacteria, promote blood and lymph fluid
circulation, and improve immunity. Midwave UV (290-320nm) and long wave UV (320-400nm)
have some therapeutic effects to acne. Its latent carcinogenesis can’t be excluded yet. (2)
Blue light therapy Endogenous porphyrin in Propionibacterium acnes (P.acne) can act as
chromophore, the absorption blue light which peaks appeared at 320nm or 415nm, in colour of
amethyst and visible. After activation, endogenous porphyrin with blue visible light leads to
photoexcitation of bacterial porphyrins, singlet oxygen production and injure cellular
membrane, eventually bacterial destruction. (3) Red light therapy The absorption spectra
characterization of porphyrin showed that there is a absorption peaks at 630nm. Study
suggested that when porphyrin was exposed 660nm red light and appropriate energy,
produced photodynamic reaction and cytotoxic process. While red light induce macrophage to
release some cytokines and stimulate fibroblast to produce growth factor, accelerate the
recovery course of injury. (4) Blue-red light therapy Blue light can penetrate 0.5mm beneath
epiderm, red light reach 10mm beneath epiderm. Compared with blue light, red light have
minor photodynamic effects, deeper penetrates, and better therapeutic effects to profound
lesions.. The combined therapy of blue and red light have good therapeutic effects to
moderate and serious acne. (5) Photodynamic therapy of acne Blue light and external
application of 5-ALA can be applied to the patients who have no response to single photo
therapy. ALA-PDT combined with multiple colour light may have more therapeutic effects to
moderate and serious acne.
2. The skin property test f acne patient in blue light therapy
The visible light treatment of acne could accelerate the regression of the lesions, and
improve the property of face skin. The results of the blue light therapy on 120 cases of acne
patients and the test of the skin property showed that the sebum secretion decreased
obviously, the follicular orifice contract, the elasticity of skin had improved greatly, but the
water content of skin have insignificant deviation with that of pretherapy. The results of sebum
secretion rate (SER) between pre-treatment and pro-treatment of the blue light therapy on 120
cases of acne patients, with the methods of Lookingbill and Cunliffe, indicated that SER of 120
cases of acne patients decreased significantly after the treatment of the blue light.
3. The illumination experiment of Malassezia furfur
Selected bacterial strains of Malassezia furfur were chosen for irradiation with the blue
light, and compared with red light. The morphology and number of colony formation unit (CFU)
of the bacteria were observed before and after the irradiation. There didn’t have coenobium of
Malassezia furfur when the time of irradiation with the blue light exceeded 3.5 minutes.
Disinfection rate was 85% with the red light in the similar condition. It provided the
experimental evidences to blue-red light therapy of acne.
4. Adjunctive therapy
(1)Other adjunctive therapy Cleaning acne, washing face, external application anti–
Infection drug; the problem of cold spurting, rehydration, removalling red; The problem about
essential general drug treatment. (2)Chinese crude drug therapy Determine the treatment
based on differentiation of symptoms and signs, combination of oral and external use,
acupuncture and moxibustion, cupping glass, hydrotherapy of Chinese crude drug. (3)IPL
therapy about acne imprinting We selected IPL to deal with the imprinting of acne so that
to improve the integer skin condition. (4)Laser therapy about acne scar We selected Pixel
laser to deal with the depressed scar of acne.
14
THE COMPREHENSIVE DIAGNOSIS AND THERAPY
OF THE NASAL AESTHETIC SURGERY
Sheng-hai Mu
People’s Republic of China
The nasal aesthetic surgery at its most commonplaces is rhinoplasty; the common
symptoms in the clinic are that the patient’s nasion and nasal bridge are flat besides the other
shortages such as the nasal tip bulbous, wide, droopy, excessive high, the nasal wing
hypertrophy, excessive wide, posteromedial notch, large nostril, asymmetry, short collumella,
deviated collumella. The pure rhinoplasty fails to get to the aim of aesthetics; we must use the
comprehensive diagnosis and treatment to the nose.
Clinic data
There are 480cases, among them 234cases about pure L-shaped silicone gel prosthesis
implantation, 138cases about pure reshaping nasal tip, 12cases about lengthening collumella
and deflating nasal tip, 7cases about dermis-fat pad reconstruction, 16cases about fat injection
to lift nasal tip,12cases about shortening collumella and removing hooked nose, 8cases about
deflating nostril, 3cases about rectifying nostril deformity, 6cases about lifting the subsided
nose wing at the secondary period of cleft lip,18cases about autogenous ear cartilage
implantation and lifting the collumella, 7cases about sinlicone gel prosthesis and dermis fat
pad augmenting nasal tip, 7cases about stitching wide nose wing.
Surgery means:
1. Rhinoplasty
The rhinoplasty is one of the common aesthetic plastic surgeries, but it is difficult to get to
the aim of perfection. Design the surgery project and choose the material according to the
concrete complexion of the patient, such as the facial characteristics, the ratio of the five
sense organs, occupation, age, combined with the aesthetic standard of the nose and the selfnasal qualification. The usual materials are silicone gel prosthesis, dermis fat pad, ear
cartilage and nasal septum cartilage. The key point of the rhinoplasty is the prosthesis carving
(especial silicone gel).
Take the silicone as the instance, carve the L-shaped prosthesis, the length of the long
arm should be about 1centimeter on the nasion.
The perfect width is 6-8 millimeters; it should be carved thin to incarnate the radian of the
nosofrotal angle completely. Adjust the short arm when implant it, it is perfect that there is no
strain when touch it. The transect of the long arm ventral side should anastomose with the
transect of the double nasal bones, the edge of transects should be thin. The angle between
the long arm and the short arm must be adjusted on the basis of the amount of the nasal tip
tissue and the nasal tip height.
2. The rectification and treatment principle of the wide and flat nasal tip (including the
cracked nasal tip) is to shrink and lift the nasal tip. Apply the V-Y incision or the butterfly
shaped incision at the collumella edge and discover the double nose wing cartilage. (1) Bring
together, stitch and fix the arch roof and the inner foot of the cartilage, or cut off and lift the
inner foot of the nose wing, then stitch it. (2) Cut off the skin and subcutaneous tissue, stitch
nose wing cartilage layer by layer. The suture method is applied to the cracked nose wing
gently; the removing cartilage method is applied to the serious cracked nose wing. Remove
the fat and fiber tissue between the double nose wing cartilages before stitching and fixing the
cartilage.
3. Rectifying the hypertrophy of the nasal tip
Usually bring nose wing cartilage together and suture them, at the same time cut off the fat
and fiber tissue in the nasal tip and among cartilages.
4. Rectifying the flat nasal tip
15
(1) The method of lengthening collumella, stitching cartilage, cutting cartilage and stitching,
or suture the double cartilage in the bottom the collumella or block up the bottom cartilage.
(2)Implant the ear cartilage, nasal septum or L-shaped prosthesis to the nasal tip. (3) Apply
the dermis or dermis fat-strip about 6-8 millimeters in the buttocks or abdomen, the dermis
surface attaches to the cartilage surface.
5. Rectifying the upturned nose
When rectify the flat nasal tip, pull and push the nasal tip strongly. Remove and loosen the
mucous membrane on the nose, peel off the upper edge of the nose wing cartilage and fix it
on the nose prosthesis after shifting. For the serious one, implant the self-cartilage or dermis
fat-strip in the upper edge impairment area of the nose wing, shift the nose tip to downwards.
6. Rectifying the excessive high nasal tip
Choose the Y-V-shaped incision, remove the nose wing cartilage and the arch roof
cartilage intersected with the inner crus, and suture the cartilage at the edge of the incision,
cut off some part of cartilages in the cartilage surface to lower the height of the nasal tip,
remove the surplus of the nasal tip skin.
7. Rectifying the droopy nasal tip
For the patient whose nasal tip is gently droopy while not have to remove cartilage, suture
the double nose wing cartilage upwards, fix it on nasal dorsum cartilage and upper edge of the
nasal bridge; or cut off part of upper edge of the nose wing cartilage and nasal septum
cartilage, rectify the droopy nose by suspension and fixation. For the serious patient, remove
the nasal septum muscle on the upper side of the tooth fossa of the maxillary bone attached
by the orbicular muscle of mouth.
8. Rectifying the deviating nasal tip
For the deviating nasal tip caused by the curved nasal septum, deviating nose or
deformation collumella, we should rectify the original reasons at first. For the one caused by
the nose wing cartilage or bad combination, peel off the double nose wing cartilage
completely, reposit and fix the affected cartilage on the healthy side, at the same time, implant
the self cartilage into the collumella and the upper side of the affected nose wing cartilage,
strengthen the hypogenetic cartilage.
9. Rectifying the wide and large nose wing
If only the nose wing bottom is excessive wide, cut a small incision about 1-2 centimeter in
the lateral side of the double nose wing bottom, suture until the other side, then return and
ligate the incision. There must be across the periosteum or deep fascia when suture for fixated
and firm. Shrink the nose wing through the remove some outside tissue of the nose wing.
10. Rectifying the droopy nose wing
The droopy nose wing usually combines with the collumella shrinked. It is difficult to rectify
pure shrinked collumella, but it is quite changed after finishing the lifting nose wing surgery.
The method: cut off the lateral bottom skin of the nose wing till the upper edge of the lateral
sulcus of the nose wing, cut off the nose cartilage which is close to the nostril, make the
nasolabial skin misalighment and lift and fix it on the nose wing cartilage, suture the nose
wing. It can lift 3-5millimeters up by the method.
11. Rectifying the large and asymmetry nostril
Rectify the large nostril through removing part of lateral edge of the nostril or the tissue in
the bottom of the nose. For the cleft lip and asymmetry nostril, we could peel off the nose wing
cartilage and suture it on the healthy nose wing cartilage, or take the ear cartilage to fill and
strengthen the affected nose wing cartilage.
12. Rectifying the collumella
Excessive short or long collumella, subsidence or droopy collumella will affect the nose
shape largely. Apply the ear cartilage or nose septum cartilage to the excessive short or
droopy collumella, and support and fix it with a cleat to lengthen collumella. Remove part of
skin and cartilage in the upper edge of the double nostril if there are many skin tissues in the
triangle area under the nasal tip, suture and lengthen the collumella layer by layer, or push
and suture skin and lengthen collumella by the V-Y shaped. For the excessive long collumella,
droopy and hooked nose, we can make a cut-through incision out of the nose and Y-shaped
16
incision in collumella, remove part of cartilage in the collumella and the inner crus of nose wing
and suture the skin through V-shaped.
Result
There are 480cases, 192cases about pure L-shaped silicone gel prosthesis implantation,
180cases about pure reshaping nasal tip, 24cases about lengthening collumella and deflating
nasal tip, 7cases about dermis-fat pad reconstruction, 16cases about fat injection for lifting
nasal tip,12cases about shortening collumella and removing hooked nose, 8cases about
deflating nostril, 3cases about rectifying nostril deformity, 6cases about lifting the subsidence
nose wing in the secondary period of cleft lip,18cases about autogenous ear cartilage
implantation and lifting the collumella, 7 cases about sinlicone gel prosthesis and dermis fat
pad augmenting nasal tip, 7cases about stitching wide nose wing. The follow-up investigation
time is 6months to 2years, except 1 case taken out the prosthesis because of exclusion,
2cases about lack of perfect appearance. The patient are satisfied after twice repairs, the
other cases without complications are successful.
Discussion
The nose lies at the centre of the face, it is crucial to the facial aesthetics. Pure rhinoplasty
fails to get to the ideal aesthetic effect, the patient’s original conditions are most important to
finish a nose aesthetic surgery successfully according to my clinic experience.
(1) At the beginning design the surgery project tallied with the patient’s facial feature. (2)
Apply the silicone gel prosthesis rhinoplasty to the suitable nose tip tissue and but flat nasal
bridge.(3) For the flat nasal tip and less tissue, suture the nose wing cartilage, heighten nasal
tip with ear cartilage and nasal setum, dermis fat pad; inject and heighten nasal tip with
acentric self fat .(4)For the excessive short collumella and much tissue in the soft triangle area
of the nasal tip, we can remove the skin cartilage in the nostril and suture and heighten nasal
tip, or strengthen collumella through cleat implantation, lengthen the skin tissue through V-Y
shaped incision. (5) For the large and bulbous nasal tip, we can remove some subcutaneous
tissue and the fat and fiber tissue in the inner crus of the nasal cartilage, bring together and
suture the nose wing cartilage. (6) For the pure flat nasal tip, suitable fat but the nose wing
sulcus is not distinct, we can reshape the nose wing sulcus and nasal tip through suturing. (7)
For the nose wing hypertrophy, we can remove the tissue below the nose wing and bring
together and suture nose wing. (8) For the excessive long collumella and hooked nose, we
can remove part of nose wing and collumella cartilage through the lateral incision of the nose;
for the serious one, we can peel off the nose wing cartilage and suture and fix it on the nose
cartilage.(9) For the large nostril, we can remove the inner side of the nose wing foot and skin
tissue in the nostril bottom, bring together and suture the nose wing. (10) For the flat nasal tip
and hypogenesis maxilla collumella, we can make an incision in the mouth; fill up the front and
lateral side of nose wing with the silicone gel. (11) The rectifying upturned nose is one of the
most difficult surgeries, we can peel and push down the nosewing cartilage when rectify the
flat nasal tip, fix the cartilage in the middle. Fill up the inner notch of the nose wing with the
cartilage and dermis. (12) For the droopy nosewing and subsidence collumella, we can inject
fat into the collumella and lift and fix the lateral side of the nose wing. In conclusion we can
strengthen the nasal aesthetics through the comprehensive therapy of the nasal aesthetic
surgery; the patients are satisfied with the effect.
Conference literature
(1) Dongxue Zheng written weimin yin translated 《 the Modern Korean Nasal Aesthetic
Surgery》
(2) Jinguangshan Hongshenri - Chinese Journal of Aesthetic and Plastic
Surgery》2006、17（2）36—38
17
FATAL BACTERIA GRANULOMA AFTER TRAUMA:
A NEW DISEASE THE COSMETOLOGISTS SHOULD BE ALERTED ABOUT
Tianwen Gao, Chunying Li, Dongjie Sun, Xianlong Qi
Department of Dermatology, Xijing Hospital, Fourth Military Medical University. Xi’an,
710033, Shaanxi, People’s Republic of China
*Correspondence: Tian Wen Gao MD PhD. E-mail: Gaotw@fmmu.edu.cn
Purpose:
In the past 25 years, dermatologists in different areas of China have noticed more than 30
cases of a type of facial granulomatous disease. Almost all the patients died within 1–4 years
after the onset of this disease in spite of many kinds of treatment. Since the skin lesions
mainly initiate from the face, part patients went to the beauty parlor for help at first. However,
this disease is very severe and the beauty-specialists should be very cautious to deal with it,
therefore, we report this disease here to give the beauty-specialists some reference and cause
more attention.
Methods:
Our previous study had confirmed it as a bacterial infectious disease because we had found
bacterial under the electron microscopy, however, we did not well document the pathogen at
that time because the method for bacterial isolation from the tissue was not successfully
established. Since the pathogen is the key to reveal the mechanisms of the bacteria infected
disease, we performed further study to identify the characteristics of the bacterial and further
explore the possible mechanisms of this new disease. We supplied anaerobic circumstance to
establish the bacterial isolation and culture from the patients skin lesion biopsy tissue.
Biochemistry analysis was used to classify the bacteria. Then we sequenced the 16srRNA of
the bacteria and blasted the sequence in the pub Medline. Next, we used the DNA hybrid
assay to confirm the bacteria genus. PCR was used to amplify the bacterial DNA 16srRNA in
the skin and the cerebrum lesions. Finally, we used the cultured bacteria on rabbit to establish
animal model.
At the same time, we tried many ways to save the patients in the clinic. When we found the
antibiotics alone not work well, we combined the IFN-γadministration and operation to remove
the lesions in the cerebrum.
Results: We successfully cultured the bacteria isolated from the skin lesion under an
anaerobic circumstance. It was identified as Propionibacterium. acnes by biochemistry
analysis.16sRNA sequencing and DNA hybrid with the standard Propionibacterium. Acnes
confirmed this result [94% genome DNA was consistent with the standard Propionibacterium.
Acnes (in general, more than 70% consistent are considered as the same genus)]. The same
16sRNA fragment was amplified both from the skin and cerebrum lesions of the patients with
this disease. The Propionibacterium. Acnes injected rabbit exhibited similar skin lesions,
pathological characteristics as the human patients.
The patients have good responses to IFN-γand antibiotics therapy. One patient accepted the
operation treatment and resulted in very good response.
Conclusion: We revealed that Fatal bacteria granuloma after trauma, the new disease, was
caused by Propionibacterium. Acnes and the bacteria from the skin to the cerebrum caused
the death of these patients. Although Propionibacterium. Acne, which is resident in normal
skin, is a common anaerobic bacterial that usually cause acne, it can cause lethal disorders
and the dermatologists should be alert to this disease, although the precise mechanisms of
this new disease is still unclear and need further study. Because the patients with FBGT
probably go to the beauty parlor for help, all the people who are doing the cosmetology job
should know this disease and refer the patients to go and see the dermatologists when
necessary.
18
THE USE OF RADIOFREQUENCY DEVICE FOR FACE REJUVENATION
AND THE TREATMENT OF ACNE VULGARIS
Xiaozhong Zhao, Yuhua Han, Yanlin Ji, Yanzhe Song
Laser center, General hospital of Air Force, Beijing 100036
People’s Republic of China
Objective:
The objective was to assess the efficacy and safety of RF device for facial rejuvenation and
the treatment of acne vulgaris.
Methods:
Thirty females who claim to improve their skin texture and thirty patients with acne vulgaris
were treated with RF device. Patients received five treatments with the time interval of 1 to 2
weeks. Photographs were assessed 1 month after the last treatment.
Results:
For facial skin texture improvement, the total improvement were scored 90%. For acne
vulgaris, the total improvement reached 80%. Conclusion The RF device is an effective and
safe modality for the improvement of skin texture, and a novel modality for the treatment of
acne vulgaris.
Key words:
Radio frequency; cosmetic correction, acne vulgaris.
19
TECHNOLOGICAL IMPROVEMENT IN GONIOPLASTY – A TEN YEAR STUDY
Yufeng Ai
Sichuan Huamei Aesthetic & Plastic Hospital
People’s Republic of China
Purpose:
To compare the advantages and disadvantages of different ways in gonioplasy. To summarize
the complications and their preventions of osteotomy.
Methods:
According to different techniques, we give out the improvements in techniques and
instruments as well. Clinical materials: 1083cases of mandible angle osteotomy by various
pattern with 10 years. 48 intraoral cases, 386 cases with post-ear incision, 416 cases by
positioner and mould.
Result:
Satisfactory rate reaches to 73% (35/48) in intraoral cases, 92.3% (356/386) with post-ear
incision, 93.5% (389/416) in mould-aided intraoral cases, 97% ( 226/233) positioner-aided
intraoral cases.
Conclusion:
Simply intraoral way has the disadvantages of limited scope and poor positioning accuracy.
With post-ear incision, we can do the osteotomy within direct scope safely. But it will cause
obvious long scar. With the aid of mould, we can improve the symmetry. It is quite
inconvenient for osteotomy mount is limited by small, median and large these three sizes of
moulda. With adjustable positioner, we can adjust the osteotomy mount according to
panoramic, thus improve the security and reduce the complications.
20
THE SURVEILLANCE OF COSMETIC DERMATOLOGIC COMPLAINTS IN CHINA
Annual report of 2007
Yuanhong Li, Tianwen Gao, Wei Liu, Xuemin Wang, Wei Lai
People’s Republic of China
The year 2007 witnessed an increase of cosmetic dermatologic complaints (CDC). A total
of 1517 cases were reported from the 13 surveillance centers (Beijing, Tianjin, Shenyang,
Dalian, Shandong, Xi’an, Chengdu, Chongqing, Shanghai, 2 centers in Nanjing, Fujian,
Guangzhou).
Among the cases, female patients overwhelmed the male patients at a ratio of 1420/97.
Most patients had a medium-level education (middle school 15.7%, high school 25.8%, college
22.6% and university 27.2%). Maybe they were also the majority of cosmetic products
consumers. Ironically, both low-educated people (complimentary primary school or below:
2.1%) and high-educated people (master degree or above: 4.0%) had similar low rate of CDC.
Concerning the correlation between professions and cosmetic dermatologic disorders, there
seemed to have no predominance. The youngest patient was only 3 months old. While the
oldest was 85 yrs. Most patients were aged between 16 and 50. The diagnosis were: cosmetic
contact dermatitis (1205), cosmetic acne (59), cosmetic hair disorders (6), cosmetic
photoallergic dermatitis (4), cosmetic pigmentation disorders (37), cosmetic nail disorders (1),
others (205). Altogether, 2228 different cosmetic products were patch tested with fin chamber.
They turned out to be: week positive (+653), positive (++56), strong positive (+++18),
uncertain (114), negative (1307). Among the positive causative products, half are native
brands (350 ordinary cosmetic products and 44 special cosmetics products), and the other
half are imported brands (361 ordinary cosmetic products and 31 special cosmetics products).
The skin care creams (462) were the most frequently complaint CDC, comes after with
emollient, sunscreen, anti-aging products. Need to mention that some home-made cosmetic
products available in the beauty incurred 103 cases of CDS (18 positive after patch test). 26
cases were diagnosed as steroid dermatitis. Thus more attention should be paid to the abuse
use of corticosteroid in cosmetics.
21
THE POISON FROM CHILOPODIA AND NIR RAYS
FOR THE REJUVENATING EFFECT OF HUMAN SKIN
LORENZO MARTINI
University of Siena
Italy
martini36@unisi.it
Since it is well known that Traditional South Korean Medicine entrusts in water solutions of
poisons extracted from Scolopendra Gigantea in order to heal severe burns and wounds in
man, I have tried to harvest the most possible of this zootoxin directly from Chilopodes, which
are notoriously infestant, solitaire and nocturne arthropodes. I encouraged the females of
these arthropodes, nursed in culture, to strenuously fight in order to pick up hugest quantities
of toxin that is generally spread during and after the fatal match. The poison results extremely
rich in histamin and serotonin. Ramakrishnan, K.M. and Jayaraman, V. referred (San Diego,
1994), that wound healing and the rejuvenating effect of drugs depend strictly on the rate of
hystamine and serotonine, for the fact that serotonine increases vascular permeabilization
meanwhile hystamine causes reversible oedema swelling and production of GAGs thanks to
the activity of fibroblasts. The results of my research demonstrate the excellent corneometric
values after application of moistures containing zootoxin from Chilopodium and exposure to
NIR rays at fixed times.
22
CLINICAL STUDIES ON THE FRACTIONAL VISIBLE LIGHT TREATMENT OF THE SKIN
C. SOLOVAN, MARIA IORDACHE, IOANA FRENTIU
Derma Light Center
Timisoara
Romania
Since 2-3 years ago when the Fraxel laser was launched for skin rejuvenation many variants
were developed. It is known that the skin absorbed predominantly at the wavelength of:
1925nm, 1540nm, 1430nm and 410nm. Experimentally the visible pulsed light in form of
fractional principle (Photomatrix by Photonova) produced at high level of energy, lesions
similarly to that of Fraxel lasers. The degrees of the lesions were high at the dermo-epidermal
junction and underneath. The histopathologic lesion consists of degeneration of epidermis and
the upper dermis with stimulative effect of new collagen synthesis beneath, decolation of the
epidermis from the upper dermis. On human skin the effect was prompt in 24 ours and with
remission in 5 days. We have performed a clinical study with PLS3 (fractional skin resurfacing
with IPL-Photomatrix) PM450, at high energy level, with filter at 400. The patients treated in
one session were aged 34-64. The evaluation was performed at 2 weeks by means of
photographs and evaluated by patients and two dermatologists. Tthe scale was:
0=none; 1=subtle; 2=important; 3=astonishing).
The Photomatrix system has proven to be an effective device for Fractional Resurfacing of the
skin.The use of visible light enables the operator to select different filters or parameters to
induce resurfacing, coagulative necrosis or thermal stimulation. The observation of visible
results after one session may prove this device will be a useful, cost effective, versatile and
friendly to use fractional skin therapy.
STUDIU CLINIC ASUPRA TRATAMENTULUI PIELII
CU TEHNICA FRAXEL A LUMINII VIZIBILE
De acum 2-3 ani cind s-a lansat laserul cu tehnologia Fraxel pentru resurfacing-ul pielii, s-au
dezvoltat mai multe variante. Se cunoaste faptul ca pielea absoarbe predominant la lungimile
de unda de:1925nm, 1540nm, 1430nm si 410nm. Experimental lumina intens pulsata in forma
principiului Fraxel (Photomatrix by Photonova) produce, la un nivel ridicat de energie, leziuni
similare cu cele ale laserului de tip Fraxel. Leziunile au avut amploarea cea mai mare la
jonctiunea dermo-epidermica si imediat subiacent in dermul superior. Leziunile histopatologice
constau in degenerarea epidermului si a dermului superior cu effect stimulativ pe sinteza de
colagen adiacenta, dar si decolarea focala a epidermului fata de dermul subiacent. Pe pielea
umana efectul a fost prompt in 24 de ore cu remisie in 5 zile.
Studiul nostru a fost efectuat cu platforma PLS3 (fractional skin resurfacing with IPLPhotomatrix) PM450, cu energie inalta si filtru la 400nm. Pacientii cu virsta cuprinsa intre
34-64 ani au fost supusi unei singure sedinte. Evaluarea s-a efectuat la 2 saptamini si a
constat in fotografii si evaluari de catre pacient si 2 dermatologi (scara a fost dupa cum
urmeaza: 0=fara; 1=subtil; 2=important; 3=excelent).
Sistemul Photomatrix s-a dovedit a fi un sistem eficient pentru resurfacingul pielii. Utilizarea
luminii vizibile permite operatorului sa selecteze diferite filtre si parametri spre a induce
resurfacing-ul pielii, necroza de coagulare sau stimularea termica. Observarea de rezultate
vizibile inca dupa prima sedinta demonstreaza ca unitatea este utila, cost-efectiva, versatila si
usor manevrabila intre sistemele de tratament de tip Fraxel ale pielii.
23
THE N.O.T.E.S. SURGERY, A NEW CHALLENGE FOR THE AESTHETIC MEDICINE
L. Belusica, C. Copaescu, R. Gherghinoiu, C. Uleia, A. Nedelcu
Bucharest
Romania
The work paper introduces a brief presentation about the new degree of the laparoscopic
surgery in the entire world and in Romania, with the mention of the celioscopy function in the
aesthetics domain.
Based on the short experience of Natural Orifice Transluminal Endoscopic Surgery and on the
beginnings of this kind of surgery in Romania, we describe the indications, the equipment and
the surgical technique of N.O.T.E.S., with special mention of the role of this new procedure in
the aesthetics surgery domain and in the concept of minimum invasive surgery.
CHIRURGIA N.O.T.E.S., O NOUA PROVOCARE PENTRU MEDICINA ESTETICA
Lucrarea prezinta succint stadiul actual al chirurgiei laparoscopice in lume si in Romania cu
referiri la rolul chirurgiei celioscopice in estetica. Pe baza scurtei experiente de chirurgie
transorificiala (tehnica N.O.T.E.S. - Natural Orificial Translumenal Endoscopic Surgery) si a
inceputurilor acestei chirurgii in Romania, sunt descrise pe larg aparatura, indicatiile si tehnica
operatorie, cu referire expresa la rolul in estetica al acestei chirurgii noi inclusa in conceptul
larg de chirurgie minim invaziva.
24
NEW FLAPS IN NASAL RECONSTRUCTION AFTER CUTANEOUS TUMORS
Mihaela Leventer, Konstantinos Koutsioukis, Ana-Maria Dumitrescu,
Valentina Rosca, Diana Placintescu, Sanda Achim
Dermastyle Clinic, Bucharest
Romania
Closure of defects after the excision of cutaneous tumors from the nasal area is possible by
the use of different random or pedicled flaps or by the placement of cutaneous or composite
grafts.
The increased incidence of cutaneous tumors on these areas characterised by an increased
rate of recurrence, as well as the continuous progress of dermatologic surgery have developed
a large number of standard, recommended surgical solutions. In some cases an alternative
choice is necessary in order to find the best option in individual cases, because of the large
primary defect, the presence of multiple individual lesions at the same time, the extension in
adjacent nasal subunits, the concave and multi-dimensional nasal shape, for aesthetic
considerations and the beauty of a simple, uncomplicated surgical method.
We present cases in which the surgical options were unconventional for the common flaps or
grafts using different variations of rotation flaps (Dog-ear rotation flap, Spiral flap, Peng and
Anchor flaps), combined transposition flaps and rotation-advancement flaps for adjacent
nasal defects.
LAMBOURI NOI IN RECONSTRUCTIA NASULUI DUPA TUMORI CUTANATE
Inchiderea defectelor cutanate dupa excizarea tumorilor din zona nazala este posibila prin
folosirea diverselor lambouri, ori prin aplicarea de grefe cutanate sau compozite.
Incidenta in crestere a tumorilor cutanate din aceste zone, caracterizate printr-o mare rata de
recurenta, ca si progresele neincetate ale chirurgiei dermatologice au dus la dezvoltarea a
numeroase solutii chirurgicale standard recomandate. In unele cazuri este necesara o
optiune alternativa pentru gasirea celei mai bune solutii in cazuri individuale, datorita
defectului primar prea mare, a prezentei simultane a mai multor leziuni, a extinderii in
subunitatile nazale invecinate, a formei concave si multidimensionale a nasului, din
considerente estetice dar si a frumusetii unei metode simple si necomplicate.
Prezentam cazuri in care optiunile chirurgicale au fost neconventionale in ceea ce priveste
lambourile comune sau grefele, prin folosirea diverselor combinatii de lambouri de rotatie
(lambou de rotatie ureche de ciine, lambou spirala, lambou Peng sau lambou ancora),
lambouri de alunecare combinate cu lambouri de rotatie-avansare pentru defecte nazale
adiacente.
25
FRAXEL – CONVENTIONAL AND UNCONVENTIONAL INDICATIONS
Ana Maria Dumitrescu, Kostas Kotsioukis, Mihaela Leventer, Diana Placintescu
Dermastyle Clinic, Bucharest
Romania
Most of the lasers used in dermatologic procedures will effectively treat the wounded skin area
but at the same time will cause a certain amount of damage to the healthy surrounding tissue,
thus leading to a medium to long recovery time. Fraxel technology (fractional
photothermolysis) represents the latest and the least invasive method in the field of skinoriented laser therapy. It is unique because it has the ability to set in motion a rapid process of
cutaneous regeneration that consists of reepithelialization and remodeling of collagen fibers.
At present the approved indications for this procedure are: acne scars, melasma, dyschromia
(lentigos, actinic keratosis) and also periorbital wrinkles.
This paper presents our experience with two “labeled” indications – acne scars and melasma –
including parameters, results and short and long term side effects. The second part of the
paper will address some unconventional applications of the Fraxel procedure in the case of
post burn and surgical scars as well as on stretch marks, with emphasis on dimension, color
and texture changes.
We conclude that fractioned light therapy offers the dermatologist the chance to approach a
diverse pathology, which until now had either no real chance of improvement or required a
long healing time and also very careful medical attention.
FRAXEL – INTRE CONVENTIONAL SI NECONVENTIONAL
Majoritatea laserelor utile in interventii dermatologice trateaza zona tegumentara lezata insa
determina totodata si afectarea tegumentului indemn perilezional cu recuperare ulterioara de
durata medie sau lunga.
Tehnologia Fraxel (fototermoliza fractionata) reprezinta cea mai noua abordare minim invaziva
in cadrul acestei linii terapeutice. Interventia este unica prin antrenerea unui process rapid de
regenerare cutanata ce implica reepitelizare si remodelare a fibrelor de colagen.
In prezent indicatiile aprobate pentru terapia cu lumina fractionata sunt : cicatricile de acnee,
melasma, discromiile (lentigine, keratoze actinice) si ridurile periorbitale.
Lucrarea prezinta in prima parte experienta clinicii in ceea ce priveste terapia melasmei si a
cicatricilor de acnee, urmarind parametrii folositi, rezultatele obtinute si efecte secundare
observate in cursul interventiei si la distanta. In cea de-a doua parte a lucrarii ne vom axa pe
doua indicatii neconventionale si anume cicatricile post arsura sau interventii chirurgicale
cutanate si vergeturile, pentru evidentierea modificarilor de dimensiune, culoare si textura. In
concluzie tratamentul cu lumina fractionata ofera dermatologului sansa de a aborda o
patologie diversa care pana in prezent fie nu beneficia de interventii eficace, fie necesita timp
de recuperare si ingrijiri medicale amanuntite.
26
ADVERSE REACTIONS IN FILLERS
Kostas Kotsioukis, Mihaela Leventer, Diana Placintescu, Ana Maria Dumitrescu
Dermastyle Clinic, Bucharest
Romania
Biodegradable and non-biodegradable fillers represent today an important element among
numerous non-invasive methods in aesthetic medicine. The initial indications (wrinkles,
contour and lip augmentation) and the volumetric principles result in the availability of a great
variety of distinct fillers for an “easy and fast” non-invasive facial remodeling. The popularity of
these techniques is proved by numerous publications in medical journals and reports that
discuss the favorable results and the possible adverse reactions by fillers. In this presentation
we make a review of medical articles published recently in different journals; regarding the
unfavorable results, the “wrong” patient, and the choice of an inadequate quantity, a wrong
type of filler or a “bad” technique. This effort is made in order to avoid the adverse reactions
with negative impact on filling procedure, on the specialist and on his or her patient.
REACTII ADVERSE IN FOLOSIREA SUBSTANTELOR DE AUGMENTARE
Substantele de augmentare biodegradabile si nonbiodegradabile reprezinta astazi un element
important din arsenalul metodelor non-invazive in medicina estetica. In afara indicatiilor initiale
(riduri, contur si augmentare a buzelor), principiile volumetrice au condus la aparitia unei mare
varietati de substante cu calitati distincte, cu scopul de a servi la realizarea “remodelarii faciale
non-invazive”, relativ usor si rapid. Popularitatea acestor tehnici a crescut semnificativ, tinand
cont multitudinea articolelor in publicatiile de specialitate. Multe rapoarte discuta despre
rezultatele favorabile dar si despre reactiile adverse intalnite in folosirea substanelor de
augmentare. Cu aceasta ocazie trecem in revista articole publicate in ultimii ani in literatura de
specialitate, privind reactii adverse, greseli in alegerea pacientului, ale materialului injectabil,
ale cantitatii injectate si a tehnicii folosite, in scopul de a evita efectele adverse ce pot avea un
impact negativ asupra imaginii procedurii, asupra specialistului care le efectueaza si nu in
ultimul rand, asupra pacientului.
27
THE ROLE OF AESTHETIC UNITS ON OPTIMAL SCAR HEALING
IN DERMATOLOGIC SURGERY
Kostas Kotsioukis, Mihaela Leventer, Diana Placintescu, Ana Maria Dumitrescu
Dermastyle Clinic, Bucharest
Romania
The distinct character of dermatologic oncology forced the continued development of
dermatological surgery, done in our days by specialists with great knowledge about the clinical
and biological behavior of skin tumors. The increased incidence of skin cancer and the marked
decrease of its occurrence at the medium-aged make clear the need for methods with
adequate cure rates and in the same time the need for surgical solutions with superior
aesthetic results. These two elements mentioned above are obvious for the facial site and for
this purpose it is necessary to respect several pre- and postoperative principles. With this
occasion we discuss the importance of facial units and subunits and their relationship with
relaxed skin tension and postoperative cicatrisation. We are trying to explore the dynamic
mobilization of skin tissue regarding different postoperative defects and reconstruction options
(undermining, suspension sutures, flaps and grafts) for facial aesthetic units and subunits with
postoperative results of optimal wound healing.
ROLUL UNITATILOR ESTETICE IN CICATRIZAREA OPTIMA IN DERMATOCHIRUGIE
Caracterul distinct al dermatooncologiei a impus dezvoltarea continua a dermatochirurgiei,
efectuata astazi de specialisti cunoscatori ai naturii clinico-biologica a tumorilor cutanate.
Cresterea incidentei cancerului cutanat si scaderea semnificativa a mediei de varsta in aparitia
lui, necesita abordarea unor metode cu rate curative adecvate si in aceleasi timp alegerea
unor solutii chirurgicale cu aspecte estetice superioare. Aceste doua elemente mentionate mai
sus devin evidente, mai ales in cazul tumorilor faciale ce obliga la respectarea unor principii
pre- si postoperatorii stricte. Cu aceasta ocazie discutam importanta unitatilor si subunitatilor
faciale in interactiunea cu liniile tegumentare de relaxare precum si rolul lor in cicatrizarea
post-operatorie. Incercam sa identificam dinamica mobilizarii tesutului cutanat in diferite
defecte post-operatorii si optiuni reconstructive (decolare, suturi de suspensie, lambouri si
grefe) prin prisma unitatilor si subunitatilor faciale in scopul obtinerii unei cicatrizari postoperatorii optime din punct de vedere estetic.
28
LASER HAIR REMOVAL – PAST, PRESENT AND FUTURE
Diana Placintescu, Mihaela Leventer, Kostas Kotsioukis, Ana Maria Dumitrescu
Dermastyle Clinic, Bucharest
Romania
Hair removal with lasers was a revolution in an utmost important field of aesthetics. Initially
clamored as definitive, the effect of the laser beams on natural evolution of the pilous follicle
was a subject of controversy for a long time.
Different types of lasers beaming different wavelengths are presented historically, with
emphasis on their advantages and disadvantages. Present times are dominated by
professional equipment generating high pulsed light, but global marketing needs imposed
already the manufacture of recent household appliances for long-term hair removal. To guess
upon the future market of medical services for hair removal in this context is at least a bleak
venture.
EPILAREA LASER – TRECUT, PREZENT SI VIITOR
Epilarea laser a produs o revolutie intr-un domeniu estetic deosebit de important. Clamate
initial ca definitive, efectele radiatiei laser asupra evolutiei naturale a folicului pilos au fost mult
timp subiect de controverse.
Diferitele tipuri de laser care emit radiatii cu diverse lungimi de unda sunt prezentate in ordinea
istorica, insistind asupra avantajelor si dezavantajelor fiecaruia.Prezentul este dominat de
aparatele profesionale care emit lumina inalt pulsata, dar tendintele marketingului global au
dus deja la aparitia recenta a aparatelor de uz casnic pentru epilare de lunga durata.
Prognosticul asupra pietei serviciilor medicale de epilare pare, in acest context, destul de
sumbru.
29
C03: Pre-Congress course / Curs pre-congres C03
Moderator / Indrumator: Dr. Diana Placintescu
HOW TO START A PRIVATE PRACTICE IN DERMATOLOGY
(MANAGEMENT OF THE CLINIC, LEGAL FRAMEWORK)
Health services are a lucrative business anywhere in the world. The peculiar feature of having
a double subordination, both to civil legislation and to medical deontology, makes it hard to
manage so as the need for profit does not break ethic rules or the other way around. This
workshop will help you survive in the jungle of the Romanian legislation, will teach you a few
simple rules of management and marketing in medical services and how to balance the act
between a nice profit and the Hippocratic oath.
CUM SA DEMARAM UN CABINET PRIVAT DE DERMATOLOGIE
(MANAGEMENT, LEGISLATIE)
Serviciile de sanatate sunt o afacere profitabila oriunde in lume. Particularitatea de a se
supune atat legislatiei civile cit si legilor deontologice medicale face ca uneori sa fie dificil de
condus astfel incit profitabilitatea sa nu duca la incalcarea eticii sau viceversa. Acest atelier de
lucru va va ajuta sa va descurcati in hatisul legislativ romanesc, va va invata citeva reguli
simple de management si marketing al serviciilor si cum sa echilibrati profitul cu juramintul lui
Hipocrat.
30
BOTULINUM TOXIN, THE MAIN COMPLICATIONS AND PREVENTION
Xavier MARTIN, MD, FEBO, FMH
President of the SSME
Lausanne
Switzerland
The purpose of this presentation is to recall the main immunological and clinical complications
of Botulinum Toxin injections in Aesthetic Medicine and to explain how it is possible to prevent
their occurrence.
Strategies to prevent therapy failure and management of some frequent complications will be
emphasize.
Finally, psychological and ethical advices to avoid wrong behavior of the therapist in front of
the patient will be proposed.
31
LASER TREATMENT OF THE TELANGIECTASIAS OF THE FEET
Jean-Pierre Titon
Venous Diseases Research Institute of Paris
74 avenue Paul Doumer, 75116 Paris
France
The blue and red varicose veins of the feet represent a true cosmetic problem especially in the
summer time when people wear sandals.
This research-work presents a treatment procedure which will have the ability to whiten the
“red socks” or “blue feet”.
After a thorough clinical exam and having identified the location of all the varicose veins and
spider veins of the lower limbs by Color Triplex Echo-Doppler and Transillumination, a
therapeutic process will be supplied ; a decision should be made whether to proceed with
surgery or not. It includes sclerotherapy of varicose veins in order to remove the venous
stasis.
Blue telangiectasias of the feet respond well to a Nd yag Laser therapy ( wavelength 1064mm,
spot diameter 2 to 3 mm – fluence 300 to 400 joules),with spectacular efficacy.
Then the red spider veins will also be treated by Nd yag Laser (spot diameter 1 to 1.5 mm –
fluence 600 to 700 joules).
The Pulsed dye Laser (wavelength 585 to 599mm) and the KTP Laser (wavelength 532mm)
may also be used on “red socks”.
It is compulsory to perform that laser therapy with a cooling system to avoid any risk of burning
The patients should undergo that treatment twice to obtain this effectiveness. Results should
be achieved in 3 to 6 months.
Since 4 years, 360 patients have been treated by this Laser treatment.
We got good results (real improvement with patient satisfaction, or and, no more
telangiectasias) at 6 months:
- with Nd yag (with cooling) for 78% of the patients for spider veins, and 88 % of the
patients for blue telangiectasias
- with KTP (with cooling) for 82% of the patients for spider veins
- with Pulsed dye Laser for 70% of the patients for spider veins.
In addition, with the new Nd Yag Lasers (with cooling) the procedure is easier to perform,
safer, painless, with no burns, no bleeding, and no allergy.
For the télangiectasias of the feet, “red socks”, “blue feet”, a thorough and accurate ScleroLaser treatment will provide high-quality and lasting results, with a surveillance program every
year (Chronic Venous Insufficiency context).
32
AESTHETIC CORRECTION OF THE LIPS – HOW TO AVOID ANY MISTAKES?
Andrzej Ignaciuk
Poland
Aesthetic Medicine Section of Polish Medical Society
Lips and their regions around are one of the most important facial regions considering
aesthetical aspects. This is also a region which is ageing because of many reasons relatively
fast. Therefore, aesthetical correction of lips is one of the most desired aesthetical treatments
by patients. Perfectly done, this type of aesthetical procedure gives a gratification to a desire
to the patient and a lot of satisfaction to the doctor. Unfortunately, all doctor’s mistakes are
visible relatively for a long time (using only non-permanent fillers) and hard to hide. To avoid
this unpleasant experience, there is necessary to remember about certain rules regarding
patients’ selection and treatment’s protocol in addition to essential knowledge and experience.
A purpose of this presentation is to present all above mentioned advices based on many
years’ experience.
33
BOTULINUM TOXIN: PRESENT REALITY.
Emanuele Bartoletti
Plastic Surgeon
Secretary General of the Italian Society of Aesthetic Medicine
International School of Aesthetic Medicine - International Fatebenefratelli Foundation
Italy, Rome
After the worldwide authorization for botulinum toxin use in aesthetic, in the last years the
botox treatment increased and in the same way increased the number of the injectors and
their experience.
Nowadays we know much more on how optimize the results obtained with this treatment for all
the expression lines in the face. But many of us, feeling skilled and safe from the botox safety,
tried with success to use it in other part of the face like the lower third. And after some initial
uncertainty, we reached now a golden standard in this particular treatment too.
The Author will describe his personal technique and will share his experience on how to obtain
the best results and avoid complications.
AESTHETIC MEDICINE AND AESTEHETIC PLASTIC SURGERY:
INTERVENTION PROTOCOLS
Emanuele Bartoletti
Plastic Surgeon
Secretary General of the Italian Society of Aesthetic Medicine
International School of Aesthetic Medicine - International Fatebenefratelli Foundation
Italy, Rome
The results of the treatment of skin aging must provide the correction of both the amount
(surgical) and the quality (aesthetic medicine) of the skin. A face lift performed on a face with
evidence of photoaging will only give an incomplete result: it will not produce any improvement
on the photoaged appearance of the skin. This will only be improved by aesthetic medicine
treatment (e.g. peeling, laser, bleaching agents, cosmeceuticals, etc).
More, aesthetic medicine, for its educational aspect, allows to manage in the best way the
medico-surgical outcome and let it last longer and better.
One more important advantage of the aesthetic medicine-surgery interaction is that a previous
diagnostic approach with aesthetic medicine allows to prepare the skin to face the operation
and to prepare it to heal in the most physiologic and plain way.
We always have to keep in mind that patients asking for aesthetic surgery are healthy patients
who undergo an operation, always aggressive even if with a soft approach, exclusively to
improve their appearance. I think that based on this concept, it should be a ethic and moral
duty for the surgeon to use all the tricks and the techniques that contribute to achieve the best
and long lasting result.
34
SURGICAL APPROACH FOR THE CORRECTION OF THIGH LIPODYSTROPHY
IN OBESE PATIENTS
Loredana Cavalieri, A. Felici
Plastic Surgery Operative Unit – Hospital Institution “San Camillo-Forlanini”,
Multidiscipline Centre for the Treatment of Obese Patients – Rome, Italy
Obesity is a serious problem, mainly rooted in our century. In our time this disease has
grown at a speed of 35%. The therapeutic approach to this pathology must be multispecialistic: the patient must loose weight, by means both of an appropriate low-calory diet
and, eventually, of bariatric surgery; he/she must exercise regularly in order to increase the
basic body metabolism; and he/she must undergo regular clinic and endocrinologic check-ups.
The plastic surgeon’s role is to improve the body line of the patient, without altering his/
her metabolic homeostasis, by making interventions mainly in those parts of the body which
present problems from both a physical and an aesthetic point of view.
During the last five years, in the Plastic Surgery Operative Unit of San Camillo-Forlanini
Hospital Institution in Rome several obese patients have been hospitalized: they had
undergone gastric-banding surgery, but they still presented walking problems both because of
the huge fat building in the thighs (this lipodystrophy hadn’t decreased together with the weight
loss) and because of the extensive dermal-epidermal ptosis.
The authors presented their surgery strategy, which included liposuction and/or skinlifting, bearing in mind that the surgery approach, in order to be effective and safe, needs the
global multidiscipline knowledge of dietitians, internists, surgeons and psychologists.
Particular attention was paid to after-surgery care: the patients could soon get up and
walk, being careful not to open or bend their legs; proper medications were administered and
all patients were treated with manual lymphatic drainage massage.
In summary, our view is that the role of the plastic surgeon in the treatment of obesity
should be complementary to the combined work of a team of specialists, who work together
towards the physical, clinic-metabolic and psychological improvement of the patient.
35
ENDERMOLOGIE®: IMPROVEMENT OF IN SITU LIPOLYTIC RESPONSIVENESS OF
SUBCUTANEOUS ADIPOSE TISSUE TO ISOPROTERENOL IN WOMEN WITH CELLULITE
Dr. Philippe Blanchemaison
Ancien attaché des Hôpitaux de Paris, Chargé d’enseignement à la Faculté de Médecine
Université Paris VI
Introduction: Gynoid lipodystrophy (cellulite) is an extremely common female clinical condition
affecting 85 – 89% of post – pubertal females of all races. This frequent feature manifests as
orange peel aspect of the skin seen most commonly in gluteo femoral area, abdomen, breast
and buttocks although cellulite can be located in any area of the body that contains
subcutaneous adipose tissue and can be classified in different ways1. Despite its high
prevalence, there have been few scientific investigations into the physiology of cellulite. Four
leading hypotheses exist to describe this phenomenon: sexually dimorphic skin architecture,
altered connective tissue septae, vascular changes and inflammatory factors. 2 Whatever the
initial mechanism, this disorder is associated with adipocyte hypertrophy (herniation of the
dermo hypodermal junction), fibrosis of connective tissue and circulatory deteriorations.3
Among the different treatments for cellulite described in literature, the LPG Technique
(Endermologie®, Lipomassage®) has proven its efficacy in numerous studies4,5,6,7,8,9. However,
none of these studies explored what happens at the adipocyte level. Using a microdialysis
technique in subcutaneous adipose tissue, a study was carried out to test the in situ incidence
of the LPG Technique in terms of adipocyte responsiveness10.
Methods: Nine healthy women volunteers with cellulite (grade > 2) were included and received
12 sessions of LPG Technique (1-month treatment). Microdialysis has been carried out in the
femoral adipose tissue in order to assess lipolytic responsiveness via glycerol determination
following perfusion of a lipolytic agent (0.1, 1 and 10 µM isoproterenol). Clinical evaluations
(measurements of waist, thighs, skinfold and cellulite grade) were carried out in parallel. All
evaluations were performed before and after LPG treatment.
Results: LPG Technique lowered resting dialysate glycerol levels in femoral adipose tissue.
The lipid-mobilizing effect of isoproterenol was enhanced after one month of treatment. In
addition, a manifest clinical improvement of cellulite is observed after one month of treatment
with a clear decrease of morphometric measurements (Mean decrease on thighs: 3.1 to 3.3
cm) and cellulite grade (-31.8%, p<0.01).
Conclusion: These results suggest an increase in the lipolytic responsiveness of femoral
adipose tissue (known to be metabolically “silent”) in women with cellulite having undergone the
LPG Technique, possibly by the stimulation of the adypocites metabolism via a mechanical
force-induced signal transduction in adypocites.
1.
2.
3.
4.
Nurnberger F, Mullr G. So-called cellulite: an invented disease. J Dermatol Surg Oncol 1978; 4 : 221-9.
Avram M.M. Cellulite: a review of its physiology and treatment. J Cosmet Laser Ther 2004; 6: 181-185.
Rossi AB, Vergnanini AL. Cellulite: a review. J Eur Acad Dermatol Venereol 2000; 14: 251-62.
Adcock D., Paulsen S., Jabour K., Davis S., Nanney LB., Bruce Shack R. Analysis of the Effects of Deep
Mechanical Massage in the Porcine Model. Plast. Reconstr. Surg. 2001 Jul., 108 (1); 233-40.
5. Watson J. , Fodor PB., Cutcliffe B., Sayah D., Shaw W. Physiological effects of Endermologie® : A
Preliminary Report. Aesthetic Surg J 1999, 19 (1) ; 27-33.
6. Innocenzi D., Balzani A., Montesi G., La Torre G., Tenna S., Scuderi N., Calvieri S. Evidenza delle
modificazioni cutanee indotte dalla Tecnica LPG® mediante analisi d’immagine . DermoCosmetologiaanno II- numero 1- gennaio-marzo 2003, p.9-15.
7. Innocenzi D., Balzani A., Panetta C., Montesi G., Tenna S., Scuderi N., Calvieri S. Alterazioni
morfologiche della cute indotte con la Tecnica LPG®. DERMOtime Settembre-Ottobre 2002, anno XIV, n
°7/8 ; p. 25-27.
8. Kinney B. Liposuction surgery and the use of Endermologie. Journal of Cutaneous Laser Therapy 2001;
3: 13-50
9. Ortonne J.P. et al. Treatment of cellulite: effectiveness and sustained effect at 6 months with
Endermologie demonstrated by several quantitative evaluation methods. Nouv. Dermatol.; Vol. 23, n° 5,
Mai 2004; p. 261-269
36
10. Lafontan M et al. Use of the microdialysis technique to assess lipolytic responsiveness of femoral
adipose tissue after 12 sessions of mechanical massage technique. Journal of Cosmetic Dermatology (in
press)
37
A NEW APROACH OF ACNE VULGARIS TREATMENT BY COMBINATION OF LED
(LIGHT EMITING DIODES – BLUE 420 NM AND RED 625 NM FROM REVITALIGHT SKIN
CARE SYSTEM) THERAPY AND RADIOFREQUENCY(ELLMAN SURGITRON® IEC
DEVICE). (CASE REPORT)
Ecaterina Petre, Grigore Morcov, Olga Tsurcan, Vera Malcoci
Clinic of aesthetic medicine «Laboratorul Frumusetei»
Chisinau, Moldova
Acne has been estimated to affect over 90% of the human population at some point in their
lives. It has been found to have a profound impact in the quality of life of many affected
individuals. Moderate and severe acne vulgaris usually require a regimen of systemic and/or
topical medications, which are given for several months or even years and frequently require
multiple visits to the physician office. Many patients fail to respond adequately to treatment or
develop side effects, therefore, there is a growing demand for a convenient, low risk and
efficacious therapy.
Since 410-nm blue light has been shown to kill Propionibacterium acnes (P. acnes) cells and
radiofrequency (RF) energy has been shown to reduce sebum production, these modalities in
combination should be a highly effective treatment of acne vulgaris with little or no downtime
or risk. Blue light (407-420 nm) and red light (633- 660 nm) are promoted for the treatment of
acne. They work by exciting high amounts of intracellular porphyrins naturally generated by
Propionibacterium acnes (P. acnes).
These endogenous porphyrins (mainly coproporphyrin III[1]) photosensitize the bacterium and,
upon illumination, result in the formation of singlet oxygen, which combines with cell
membranes to destroy the P. acnes. This process is dependent on the rate of production of
excited porphyrin molecules, which is influenced by the concentration of porphyrins, the
concentration of photons, the temperature, and the wavelength of the photons.
This case report describes the efficacy and safety of used in combination LED (Light emiting
diodes – blue 420 nm and red 625 nm from Revitalight skin care system in a total power of
4200 mw and 80mw/cm2 or 7.2 joules per 90 seconds) therapy and radiofrequency(Ellman
Surgitron® IEC device utilized energy in the range of 12-25J/cm2) to treat grade 2 cystic acne
and acne scars in an 21 year old woman of skin type II. The results were considered excellent
by both investigators and the patient. Further research is in progress to evaluate this treatment
modality in a larger number of patients.
METODA NOUA DE TRATAMENT A ACNEEI VULGARE PRIN COMBINAREA TERAPIEI
CU DIODE CE EMIT LUMINA (ALBASTRA 420 NM, ROSIE 625 NM DE LA REVITALIGHT
SKIN CARE SYSTEM) SI RADIOFRECVENTA (ELLMAN SURGITRON® IEC DEVICE)
(CAZ CLINIC)
Se cunoaste ca acnea afecteaza mai mult de 90% din populatie. Este dovedit ca ea are un
impact profund in calitatea vietii persoanelor afectate. Acnea vulgara moderata si severa ca de
obicei necesita tratament sistemic si sau local, care este prescris timp de citeva luni, sau chiar
ani, si necesita adresarea multipla la medic. Multi din pacienti nu raspund adecvat la tratament
sau apar efecte secundare, creste necesitatea in tratament efectiv, convinabil, cu risc minim
de efecte secundare.
De cind s-o dovedit ca lumina albastra (420nm) are capacitatea de a distruge celulele de
Propionbacterium acne, si ca radiofrecventa micsoreza producerea sebumului, combinarea
acestor modalitati va fi efectiva in tratamentul acneei vulgare, cu risc minim de efecte
secundare. Lumina albastra 420 nm si rosie 625 nm excita cantitati mari de porfirine
intracelulare, care sunt produse de propionbacterium acne. Aceste porfirine endogene (mai
ales coproporfirin III) fotosensibilizeaza bacteria si sub iluminare stimuleza formarea
radicalelor liberi, care distrug P. Acne. Acest proces este dependent de rata de producere a
38
moleculelor excitate ale porfirinilor, care este dependenta de concentratia lor, de temperatura
si unda fotonilor.
Acest caz clinic descrie eficacitatea combinarii terapiei cu Diode ce Emit Lumina (Light Emiting
Diodes – albastra 420 nm and rosie 625 nm de la Revitalight skin care system in puterea
totala de 4200 mw si 80mw/cm2 sau 7.2 joules pe 90 sec.) si radiofrecventei (Ellman
Surgitron® IEC ce utilizeaza energia de 12-25J/cm2) pentru trament a acneei vulgare cistice
de gradul II si cicatricilor postacne la femeia 21 de ani, fototip II.
39
PHOTODYNAMIC THERAPY OF ACNE VULGARIS USING RADACHLORIN
Ecaterina Petre, Grigore Morcov, Olga Tsurcan, Vera Malcoci
Clinic of aesthetic medicine «Laboratorul Frumusetei»
Chisinau, Moldova
Inflammatory acne vulgaris is very common condition, particularly in adolescents and young
adults, and new effective and well-tolerated treatments are needed. PDT is characterized by
the use of visible light in conjunction with the topical application of a photosensitizer.
Objectives: To evaluate the efficacy and tolerability of Radachlorine-based photodynamic
therapy in patients with moderate to severe facial acne vulgaris.
Methods: Ten patients Fitzpatrick skin types II–III, received 4 treatments, weeks apart and
were evaluated 4, and 12 weeks after treatment. The treatment method consists of a
photosensitizer (Radachlorine+Dimethilsulfoxide) aplication under the oclussive dressing and
illumination with LED (Light emiting diodes – blue 420 nm and red 625 nm from Revitalight
skin care system in a total power of 4200 mw and 80mw/cm2 or 7.2 joules per 90 seconds)
therapy. Efficacy evaluation included changes from baseline in numbers of noninflammatory
and inflammatory lesions, changes from baseline in global acne severity grade and clinical
assessments of clinical improvement by patient and evaluating dermatologist. Pain scores
during treatment and local adverse effects were also evaluated.
Results: Twelve weeks after treatment the treatment group showed 67% reduction from
baseline in inflammatory lesions and 20% reduction in number of noninflammatory lesions
after treatment.
There was no pain or adverse effects during and after treatment.
Conclusions: Radachlorine - PDT proved to be an efficient treatment for inflammatory acne.
For noninflamatory lesions needs – needs to be in combination with other treatments.
TERAPIA FOTODINAMICA A ACNEEI VULGARE CU FOLOSIREA RADACHLORINULUI
Acnea vulgara este o boala forte raspindita mai ales la adolescenti si adulti tineri, si sunt
necesare metode noi de tratament, efective si bine tolerate. Terapia fotodinamica este
caracterizata prin folosirea luminii vizibile in combinatie cu aplicarea topica a
fotosensibilatorului.
Obiective: a evalua eficacitatea si tolerabilitatea terapiei fotodinamice bazate pe radachlorin la
pacienti cu acnea vulgara faciala, moderata si severa.
Metode: Zece pacienti cu pielea Fitzpatrick tip II–III, au primit 4 tratamente, la interval de o
saptamina si au fost evaluati dupa 4 si 12 saptamini de la tratament. Metoda de tratament
consta in aplicarea fotosensibilatorului (Radachlorine+Dimetilsulfoxide) sub pansament
oclusiv, si illuminarea cu Diode ce Emit Lumina (Light Emiting Diodes – albastra 420 nm and
rosie 625 nm de la Revitalight skin care system in puterea totala de 4200 mw si 80mw/cm2
sau 7.2 joules pe 90 sec.)
Evaluarea eficacitatii a inclus:
•schimbarea numarului de elemente inflamatorii si neinflamatorii
•schimbarea gradului de severitate a acneei
•eficacitatea clinica evaluata de medic si de pacient
•durerea si effecte adverse
Rezultate: Douasprerece saptamini dupa tratament, pacienti au aratat reducerea elementelor
inflamatorii cu 67%, si noninflamatorii cu 20%. La 70 % din pacienti gradul de severitate au
fost schimbat de la sever la moderat.
Durerea si effecte advese n-au fost accentuate.
Concluzii: Au fost dovedit ca terapia fotodinamica bazata pe radahlorin este eficienta in acnea
inflamatorie. Pentru acnea neinflamatorie este necesar de a combina terapia fotodinamica cu
alte metode.
40
THERMALIFTING NONSURGICAL TIGHTENING OF SKIN LAXITY
BY RADIOFREQUENCY
Vera Malcoci, Grigore Morcov, Olga Tsurcan, Ecaterina Petre
Clinic of aesthetic medicine «Laboratorul Frumusetei»
Chisinau, Moldova
It is difficult to achieve an improvement in skin laxity without surgical procedures.
Radiofrequency (RF) treatment is used to heat skin and promote tissue tightening and
contouring. Radiofrequency technology produces an electric current that generates heat
through resistance in the dermis and subcutaneous tissue. When heated, collagen fibrils will
denaturate and contract, which is believed to lead to the observed tissue tightening.
Methods: Our study included twenty patients ranging in age from 40 to 75 with mild to
moderate laxity. The Surgitron Dual Frequency (Ellman International) was used to treat skin
laxity.
Results: Patients noticed an immediate microlifting in the treated tissues. There were no
significant side effects and the patients went back to their daily activity immediately after the
procedure.
THERMALIFTING- REJUVENARE NON-CHIRURGICALĂ
Întroducere: Restabilirea non invazivă a elasticitatii cutanate este dificil de realizat.
Radiofrecvenţa reprezintă o alternativă de rejuvenare prin încălzirea colagenului la nivelul
pielii şi îmbunătăţirea laxitaţii tegumentelor. Tehnologia prin radiofrecvenţă produce un
curent electric care generează căldură prin rezistenţă în derm şi ţesutul subcutanat. Efectul
termic depinde de conductibilitatea ţesutului tratat. La acţiunea agentului termic fibrele de
colagen se contractă şi se denaturează, ceea ce şi determină sporirea elasticitaţii.
Metode: Studiul a inclus douăzeci pacienţi cu elasticitatea scăzută uşor şi mediu. Aplicarea
energiei prin radiofrecvenţă (Radiowave technology, Ellman International) a fost efectuată în
condiţii de ambulator .
Rezultate: Pacienţii au observat un micrilifting imediat după procedură pe suprafeţele
tratate. Reacţii adverse semnificative nu sau determinat iar pacienţii sau reîntors la
activitaţile cotidiene imediat după procedură.
41
RADIOFREQUENCY- FOR THE TREATMENT OF FACIAL VEINS
Vera Malcoci, Grigore Morcov, Olga Tsurcan, Ecaterina Petre
Clinic of aesthetic medicine «Laboratorul Frumusetei»
Chisinau, Moldova
Background: Radiosurgery (the surgitrons patented technology) uses the frequencies of 4,0
MHz which is a pure radiosignal range. Absorbtion of this frequency is by the water component
of cells and cuts the tissue with minimal alteration of the surrounding cells. The term
”radiosurgery”is used because the frequency is higher than AM radios, but lower than the
frequency of television.
Radoisurgery makes very fine, precise, gentle punctures. A thin microinsulated wire is
gentlyinserted into the unwanted vein. Only the tissue cells immediately adjacent to the
electrode are affected.
Facial vein often look like spider veins . They can be the result of sun damage, extreme
environments or hereditary factors. These veins can be eliminated from the face using
radiosurgery. There is a minimal recovery time and the results are immediate.
Methods: ten patients ranging in age from 25 to 65 with facial veins and veins on the legs
participated. The regime of working was on hemo 3 on the face and 5 on legs. Two sessions
were done on 4 patients with facial veins at 2 weeks interval and three sessions on 6 patients
with veins on the legs at 3 weeks interval. Follow-up ranged from 1 to 3 months.
Results: excellent results was seen in 3 patients after 2 sessions one month after the last
sesssion with no scars. One patient presented an erythema after 2 session because the veins
were spreaded all over the face. Good results were remarked in 6 patient with veins on the
legs with a local erythema after one month and a completely recovery after 3 months.
Conclusion: radiofrequency is a minimal invasive method of treatment of facial veins. The
benefits are: No bleeding, minimal risk of scarring, minimal damage to surrounding skin,
enhanced healing, minimal operative discomfort.
RADIOFRECVENŢA - ÎNLĂTURAREA TELEANGIECTAZIILOR
Introducere. Radiochirurgia foloseste o frecventa inalta de unde radio de 4.0 (MHz) .
Semnalul radio de inalta frecventa produce o incizie neintrerupta si fara sa fie necesara o
presiune, cu hemostaza simultana si minima vatamare a tesutului.
Radiofrecvenţa reprezintă înţepături fine, precise la nivelul capilarului cu colabare şi
hemostază concomitentă a acestuia. Se afectează doar celulele adiacente electrodului.
Vinişoarele faciale asemănătoare unei plase de păianjen adesea sunt consecinţa expunerii
solare, factorilor ereditari sau de mediu.
Metode: Studiul a cuprins un număr de zece pacienţi, cu vîrsta cuprinsă între 25-65 ani
prezentînd vinişoare (teleangiectazii) pe faţă şi picioare. Regimul de lucru a fost hemo 3 la
faţă şi 5 la picioare. Au fost efectuate 2 proceduri la 4 pacienţi cu capilare faciale şi 3
proceduri la 6 pacienti cu capilare la nivelul picioarelor avînd în vedere numărul şi diametrul
mai mare al acestora. Urmărirea a durat între 1-3 luni.
Rezultate: s-a determinat un rezultat excellent la 3 pacienţi după 2 proceduri la faţă după o
lună de la procedură cu dispariţia vinişoarelor fără cicatrici . rezultate bune au fost la 6
persoane cu capilare la picioare cu un eritem uşor local după o lună şi dispariţia cvasicompletă
la un interval de 3 luni.
Concluzii: Radiofrecvenţa este o metodă minim invazivă de tratament a vinişoarelor faciale cu
următoarele beneficii: Fără sîngerare, risc minim de cicatrizare, afectarea minimală a
ţesuturilor înconjurătoare, regenerare rapidă, se efectuează în condiţii de ambulator.
42
AESTHETIC DERMATOLOGY AND INFORMATION COMMUNICATION TECHNOLOGIES
Oana Andreia Coman1, Laurenţiu Coman2, Marilena Ianculescu3, Monica Pârvan3
1
Dermatovenerology, Clinical Hospital of Dermatovenerology, 216, Calea Serban
Voda andreiacoman@yahoo.com
2
Department of Physiology, UMF “Carol Davila”, 8 Eroilor Sanitari Blvd, Bucharest,
laurentiucoman@yahoo.com
3
National Institute for R&D in Informatics (ICI), 8-10 Maresal Averescu Blvd,
manina@ici.ro / parvan@ici.ro
Bucharest, Romania
Health is profoundly affected by the application of Information Communication Technology
(ICT), which change the way people can access knowledge and the way they communicate
with one another. The tremendous development and use of the ICT in the dermatology domain
have demonstrated how easy, fast and cost-efficiency the information needs of patients and
health professionals can be offered using interactive web-based applications.For
disseminating information and knowledge in the aesthetic dermatology domain, health
informatics systems - interactive websites providing tailored health information and other
services to users - are becoming more and more used.
“Informational Center of Dermatology” (CID) is a health informatics system that facilitates the
access to the updated information and knowledge in the domain, in order to make the users
familiar with the latest approaches and trends in dermatology. CID aims to increase the level
of quality in the dermatological diagnostic protocols and treatments. Having at their disposal
an informatics system with authorized access and reliable information, the physicians can
establish efficacious dialogues and collaborations. Among the CID’s modules the “Cosmetic
Dermatology” one provides information about aesthetic methods, techniques and products
currently used in dermatological and aesthetic care. It primarily focuses on the way the skin,
hair and nails should be taking care of, emphasizing the major mistakes that must be avoided.
“For Specialists” module creates an environment for information and collaboration, dedicated
to the specialists so that they can find out news in dermatological medication, scientific events,
various clinical cases; “Medical Publications” is a library with articles, reviews and books;
“Campaigns” promotes the preventing dermatological diseases campaigns. CID also provides
basic information on dermatological organizations, hospitals, clinics and physicians.ICT,
mainly the health informatics systems that concentrate in a single point the medical
necessities and the patients' wishes, can smooth some of the challenges to which the
specialists working in aesthetic dermatology are submitted nowadays.
DERMATOLOGIA COSMETICA SI TEHNOLOGIA INFORMATIEI SI COMUNICARII
Sanatatea este profund influentata de utilizarea Tehnologiei Informatiei si Comunicarii (TIC)
care schimba modul in care oamenii pot avea acces la cunostinte si in care comunica unul cu
altul. Imensa dezvoltare si utilizare a TIC in domeniul dermatologiei a demonstrat cat de usor,
rapid si eficient din punct de vedere al costurilor se poate acoperi necesarul de informatii ale
pacientilor si specialistilor prin folosirea aplicatiilor interactive bazate pe web. Pentru
diseminarea informatiilor si cunostintelor in domeniul dermatologiei cosmetice, sistemele
informatice de sanatate – website-uri interactive care furnizeaza utilizatorilor informatii care ii
intereseaza, precum si alte tipuri de servicii – devin din ce in ce mai des intalnite.
“Centru informational de dermatologie” (CID) este un sistem informatic care faciliteaza accesul
la informatii si cunostinte de specialitate actualizate pentru a-i familiariza pe utilizatori cu
ultimele abordari si tendinte din dermatologie.
CID are drept scop cresterea nivelului calitatii in protocoalele si tratamentele dermatologice de
diagnosticare. Avand la dispozitie un sistem informatic cu acces autorizat si informatii de
incredere, specialistii pot stabili dialoguri si colaborari eficiente. Printre modulele CID, cel de
“Dermatologie cosmetica” furnizeaza informatii despre metodele, tehnicile si produsele
43
cosmetice utilizate in mod curent in dermatologie. Pune accent in principal pe modul in care
trebuie ingrijite pielea, parul si unghiile, scotand in evidenta greselile majore care trebuie
evitate. Modulul “Pentru specialisti” creaza un mediu de informare si colaborare privind
noutatile in medicatia dermatologica, manifestarile stiintifice, diverse cazuri clinice; “Publicatii
medicale” este o biblioteca cu articole, reviste si recenzii de carti; “Campanii” promoveaza
campaniile de prevenire a bolilor dermatologice. CID furnizeaza informatii si coordonate ale
organizatiilor de dermatologie cosmetica, spitale, clinici si medici din domeniu. TIC, prin
sistemele informatice de sanatate care concentreaza intr-un singur punct necesitatile
medicale si dorintele pacientilor, poate constitui o rezolvare pentru unele din provocarile la
care specialistii care lucreaza in domeniul dermatologiei cosmetice sunt supusi in zilele
noastre.
44
RECONSTRUCTION MODALITIES IN THE SKIN TUMORS SURGERY OF THE FACE
Rodica Cosgarea, Simona Şenilă, Veronica Moisil, Loredana Ungureanu
Department of Dermatology,
University of Medicine and Pharmacy”Iuliu Haţieganu”Cluj-Napoca
In most cases, the surgical pathology of the face is represented by malignant tumors. The
oncological rationale is the most important aspect we have to take into account when we
excise a tumor and the reccurences are sometimes seen when the Mohs’ Surgery is not used
for the face, because of the too economical excision edges. The esthetical and functional
aspects are also very important when we choose the type of wound closure.
We present patients with different types of reconstruction of wound deffects after the excision
of malignant skin tumors on the face. The transposition flaps are the most used type of wound
closure and they can offer a very good solution to cover the defect without functional problems
or distorsion of the eyelids, lips. The advanced flap with the O-T plasty is also a type of wound
closure for the median defects of the face, forehead or nose. The rotation flap and the island
flap represent other modalities for reconstruction of face surgical defects. In most cases, the
esthetical results were very good. Placing the sutures parallel with the relaxing skin lines and
without any distortion of the skin, are very important aspects in the face skin defects
reconstruction. It is also very important to take into account the cosmetic units of the face, their
components and the boundaries of these units.
45
AESTHETICAL CHEEK RECONSTRUCTION-A TRIDIMENSIONAL APPROACH
Viorel Trifu,Monica Darmanescu, Cristina Cotruta ,Dragos Popescu,Andreea
Dumitriu ,Rodica Sotcan,Ludmila Diaconiuc
Central Clinical Emergency Military Hospital
Spitalul Clinic de Urgenta Militar Central, Bucuresti,Romania
Bucharest,Romania
The cheek is the broadest subunit of the face, in close proximity to aesthetically important
regions such as eyelids ,nose and mouth.
We review the principles of cheek reconstruction, from the simplest option(primary closure) to
more complex methods(grafts, flaps),with special considerations to specific reconstructive
options .An essential principle of cheek reconstruction is to provide an accurate skin color and
thickness match with locally recruited tissues ,avoiding distortion of the facial free
margins(lower eyelid, upper lip and oral commissure).
Each case must be approached with a unique plan for the defect and the patient, with a nongeometrical and tridimensional design for every case in order to achieve excellent aesthetic
and functional outcomes.
RECONSTRUCTIA ESTETICA A OBRAZULUI –ABORDARE TRIDIMENSIONALA
Obrazul reprezinta cea mai mare subunitate cosmetica a fetei, invecinandu-se cu regiuni
estetice importante ,cum ar fi pleoapele,piramida nazala,gura.
Trecem in revista ,analizand cateva cazuri clinice,principiile de reconstructie la nivelul
obrazului,plecand de la metode simple (per primam) pana la complicate(grefe,lambouri).Un
principiu esential in reconstructia obrazului este adaptarea tipului de piele si a grosimii
lamboului la defectul de reconstruit,cu evitarea distorsiunilor la nivelul marginilor libere
anatomice (pleoapa inferioara,buza superioara,comisura bucala).
Abordul reconstructiv la nivelul obrazului, non-geometric si tridimensional adaptat fiecarui
defect si pacient in parte, permite obtinerea unor rezultate estetice si functionale excelente.
46
ANATOMICALLY ADAPTED REPAIR OF A LARGE ALAR DEFECT
Viorel Trifu ,Monica Darmanescu, Cristina Cotruta,Dragos Popescu,Andreea
Dumitriu,Cecilia Enescu
Central Clinical Emergency Military Hospital
Spitalul Clinic de Urgenta Militar Central,Bucuresti,Romania
Bucharest,Romania
Reconstruction of nasal alar defects is a difficult task because of the complex anatomy of the
region. The closure technique depends on many different variables like size ,location, depth of
the defect ,as well as the availability of donor tissues.
We describe a reconstructive option adapted to the anatomical characteristics of the patient.
The modified superiorly based nasolabial or cheek flap,turned over on itself to recreate the
alar rim is a good approach ,restoring the initial “bulky” appearance of the ala. Discussions
regarding preoperative planning ,closure technique and postoperative secondary revision to
recreate the natural grooves are presented.
This modified nasolabial flap can be used elegantly to repair an alar defect by turning it under
on itself to recreate the alar rim .The three dimensional shape of the nose was recreated with
good cosmetic and functional result.
SOLUTIE RECONSTRUCTIVA ADAPTATA LA PARTICULARITATE ANATOMICA
IN DEFECTUL ARIPII NAZALE
Avand in vedere anatomia complexa a piramidei nazale tridimensionale,defectele la nivelul
aripii nazale necesita o abordare inteleapta.Tehnica reconstructiva aleasa trebuie sa ia in
consideratie cativa factori esentiali,cum ar fi localizarea,marimea,profunzimea defectului de
reconstruit, cat si disponibilitatea si calitatea tesuturilor adiacente potential donoare.
Descriem o tehnica reconstructiva in cazul unui defect de aripa nazala,adaptata
particularitatilor anatomice ale pacientului. Lamboul de transpozitie nazolabial superior,prin
fixarea la planurile profunde la nivelul santului alar superior si plicaturarea inferioara
recreeaza marginea libera alara si o aripa nazala simetrica celei contralaterale.Aducem in
discutie planificarea preoperatorie,tehnica de sutura si revizia secundara cu refacerea
santurilor naturale.
Lamboul nazolabial superior permite reconstructia defectelor de aripa nazala,adaptandu-se
particularitatilor anatomice tridimensionale individuale la acest nivel,cu rezultate excelente
functionale si estetice .
47
AESTHETIC MESOTHERAPY IS DEAD. LET’S NOW TALK ABOUT ECTOPLASTY.
Luc Dewandre
Paris, France
For years we have been talking about aesthetic mesotherapy as an important part of the
practice of aesthetic medicine.In fact the procedure that we still name “aesthetic mesotherapy”
today is not mesotherapy at all!
What is different is the mode of action, the products that we inject, the quantities ( dosage ),
even the depth and finally the frequency of injections.
Even the mesoderm (the embryological tissue known to give birth to the skin) is NOT
concerned as it only gives birth to internal tissues. Skin actually derives from the ectoderm.
Let us stop being wrong! We are aesthetic doctors performing aesthetic multi-injections into all
layers of the skin and the subcutaneous tissue & the fat; we are not “mesotherapists”.
The author is describing the evolutions and new achievements in the field of aesthetic
multiinjections that he would like to call “ectoplasty”.
48
MIND - BODY CONNECTION IN AESTHETIC DERMATOLOGY.
REALISTIC AND NON-REALISTIC EXPECTATIONS
Gloria Suciu
University of Medicine and Pharmacy
Bucharest, Romania
Every human being consists of three distinct bodies: physical, mental and emotional. The
three are intimately connected and changes in one will produce changes in the others.
Skin does more than present one’s “face” to the world; it plays a vital role in the maintenance
of physical and mental health.
Aesthetic Dermatology has evolved a lot during past decades; it makes peoples’ dreams come
true. But these “dreams” have to be precisely defined both for minor or major procedures. The
patient’s appearance changes, sometimes drastically and sometimes minimally, within a short
period of time. But is the patient ready to deal with this change? Cosmetic surgeries can help
patients re-contour or reshape their appearance, but expecting surgery to completely change
your life or take the place of exercise and attention to diet is simply unrealistic. We will revue
realistic and possible non-realistic expectations for different procedures.
49
THE MODIFIED BILATERAL ADVANCEMENT FLAP
Marwali Harahap, M.D.
Department of Dermatology,
University of North Sumatra,
Medan. Indonesia
BACKGROUND. Bilateral Advancement flaps are commonly used in the closure of circular
skin defects because of their ease of execution and satisfactory result. However, the limited
sliding capacity of these flaps has always been a problem.
OBJECTIVE. The modified bilateral advancement flap maximizes the amount of tissue that
can be brought into the defect. It relies on both advancement and transposition principles and
borrows tissue from two planes. Thus the length of the flap could be shortened for increased
flap survival.
METHODS. Bilateral transposition flaps are created from tissue on both sides of the wound.
These are then approximated and sutured together to form a single, new tip (apex), which is
then advanced and sutured into the concave base of the opposing advancement flap at its
midpoint.
RESULTS. The modified bilateral advancement flap has been used effectively to close defects
in the temporal, cheek, forehead, and lower eyelid, among 11 patients, providing a well
contoured and aesthetically pleasing reconstruction.
CONCLUSION. This method extends the capacity of the bilateral advancement flap to
reconstruct and improves its applications and advantages.
AESTHETIC REPAIR OF FACIAL SKIN DEFECT WITH LOCAL FLAP
This paper presents the techniques of reconstruction of facial skin defects with several flaps.
Local flaps have their greatest application in repair of large skin defects after excision of skin
lesion. They are also quite useful in areas where it is necessary to change the geometry of the
wound, where an elliptical excision would distort the anatomical structure. The properly
designed flap takes advantage of the inherent elasticity of the skin,, making it possible to close
most defects primarily. Several flaps are discussed which have the most application in
dermatologic surgery: the rhomboid flap, the transposition flap and a new designed flap.
With the proper use of these flaps almost all skin defects resulting from excision of skin lesions
can be closed. These flaps are an important part of the dermatologist’s armamentarium.
50
AESTHETICAL CORRECTION OF LIPS – HOW TO AVOID ANY MISTAKES
Andrzej Ignaciuk
Poland
Lips and their regions around are one of the most important facial regions considering
aesthetical aspects. This is also a region which is ageing because of many reasons relatively
fast. Therefore, aesthetical correction of lips is one of the most desired aesthetical treatments
by patients. Perfectly done, this type of aesthetical procedure gives a gratification to a desire
to the patient and a lot of satisfaction to the doctor. Unfortunately, all doctor’s mistakes are
visible relatively for a long time (using only non-permanent fillers) and hard to hide. To avoid
this unpleasant experience, there is necessary to remember about certain rules regarding
patients’ selection and treatment’s protocol in addition to essential knowledge and experience.
A purpose of this presentation is to present all above mentioned advices based on many
years’ experience.
51
TEN YEAR-EXPERIENCE OF RESTYLANE®. RESTYLANE®’s EFFECT ON
BIOMECHANICAL PROPERTIES OF LIPS: RESULTS OF ADVANCED PILOT STUDY
Panova Olga, Clinic for Aesthetic Dermatology and Plastic Surgery “Eklan”; Gubanova
Elena, dermatologist clinic of preventive medicine "Vallex Med"; Sances Elena, Clinic
for Aesthetic Dermatology and Plastic Surgery “Eklan”, Lapatina Natalya, dermatologist
clinic of preventive medicine "Vallex Med"; Sharova Alisa, dermatologist clinic of
preventive medicine "Vallex Med" (all – Moscow, Russia)
Approximately 90% of dermal fillers used in Russia are hyaluronic acid-based products, with
Restylane® being the leader. It is the first biodegradable filler to be approved by the Ministry of
Health for use in Russia in 1998. In the past ten years, popularity of hyaluronic-acid-based
fillers is due to expanding the area of application (face, body, chest), to the 3-D approach to
facial rejuvenation and its new requirements (cheek and chin augmentation, nasolabial folds
and nasal correction, brow lift, etc.), as well as emerging new techniques (“the Fern Pattern
Technique”, “Orchid Technique”, "Ribs Technique", "Mona Lisa"). Ability to use a number of
products within one group (for example, Restylane®) for preventative treatment and treatment
of aging skin presents a significant benefit and allows the doctor to develop staged and
comprehensive rejuvenation programs.
High safety profile of NASHA (non-animal stabilized hyaluronic acid), many years of positive
clinical experience and patients’ dedication have allowed the leading aesthetic experts of
Russia to name Restylane® the “gold standard’ of augmentation techniques (IV International
Conference on Injectable Fillers, Moscow, 2007). Analysis of documented side effects and
complications (less than 0.01%) has shown the main causes to be human error (injecting
excessive amount of the filler, neglecting contraindications), improper patient behavior, and
the risks associated with the injection itself (entering a blood vessel in glabellas area).
Development of Restylane® Vital in 2005 and its proven stimulating effect on skin’s elasticity
and moisture content (Keshler, 2007) has expanded our understanding of Restylane®’s
positive effect on skin’s viscosity and elasticity. The “Hydro Reserve” program has become
one of the most popular treatments for dry and aging skin at aesthetic medicine clinics. Proven
neocollagenesis stimulation (using NASHA example, + 2007), confirms our clinical experience
of extended correction (Restylane® effect lasts up to two and more years with repeat
nasolabial fold injections).
In the recent years, patients’ interest towards lip augmentation has grown. Our data shows
that the sensual, plump lips are especially attractive to young women; 18-30 years of age
(70%). They prefer to have Angelina Jolie’s lips (50%). Another group of young women want to
plump their thin lips (22%), and less frequently – to correct asymmetry (8%). Precise, minimal
injection into the lips and perioral area in order to correct aging (restore volume, contour,
eliminate wrinkles, elevate corners of the mouth) is the main objective of women older than 40.
We have conducted an advanced study of Restylane® lip injections on 27 Russian women in
2007 (mean age 41.55 13,36). The study has shown that Restylane® positively affects
viscosity and elasticity of lips, raising elasticity by 23-30% (Ballistometer, BLS 780), reducing
transepidermal water loss (TEWL) by 8% (Vapometer, Courage-Khazaka), with the lip
moisturizing trend increasing by 18% (Monaderm, Courage-Khazaka and SkinChip, L'Oreal).
The results were statistically accurate relative to the control group at 2 and 4 months, and
returned to initial levels at 6 months following the injection. High level of satisfaction with the
procedure (8.04 1.0 out of maximum 10) and improved esthetics of the lips (1.6 increase)
remained quite high throughout all six months of the study. In six months, following the
completion of the study, about 60% of women were willing to repeat the procedure.
Ten years of clinical experience and safety of use of Restylane®, as well as proven positive
effect on viscosity and elasticity of skin of the lips allow us to recommend Restylane® widely in
comprehensive facial rejuvenation programs. Considering that skin is an elastic material,
which viscosity increases and elasticity decreases with aging, Restylane® injections provide a
therapeutic effect by preventing the aging of facial and lip skin.
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SUR LES PATHO-PHÉNOMÈNES CUTANÉS APRÉS LA CINQUANTAINE
Dr. Stelu J. PETRICU
Dr. Marie-Jeanne PETRICU
Institut National de Gériatrie et Gérontologie Ana Aslan
Bucarest, 2008
La question suivante : Naturel ou bien Pathologique? Compte tenu de l`évolution lente
ey bénigne de la plupart des lésions nous considérons que l`apparition des complications /
souffrances définie l`état pathologique. C`est en rélation avec l`evolution chronologique, les
microtraumatismes, les vices d`hygiéne, la négligence / ignorance.
Actuellement on reconnait un vieillissement cutané “intrinsèque”, telle que l`atrophie
sénile simple et un autre “extrinsèque” modulépar le milieu extérieur, U.V. surtout. Ainsi, la
peau des partes découverstes vieillit prématurément. Dans cette conjoncture on peut
distinguer des entités cliniques : la Dermohéliose, l`Elastoilose, l`Hypertrophie dégénérative,
“cutis romboidalis nucae”.
L`école roumaine de gériatrie propose “efflorescence cutanée sénile”. Efflorescence
cutanée sénile est la totalité des lésions, multicolores et polymorphes, aves une étiologie et
hystologie variée qui se trouvent sur le tegument sénil. Elle comprend:
• Lésions d`origine vasculaire : angiomes (pionts rubis), lacs sanguines, microvarices,
télangiectasies, purpura (Bateman), angiokératomes
• Lésions d`origine virale : papillomes, verrues séborrhéignes (les plus nombreuses)
• Précancéroses : kératose actinique, lentigo sénile, certaines taches “café-au-lait”
• Tumeurs bénignes (de rétention) : comèdons, chloasma, fibromes en pastille,
kystes.
Du point de vue thèrapeutique l`évolution du cas se fera suivent trois critères :
• le type de la lésion
• l`âge et l`état général du patient
• le résultat esthétique attendu
En fonction des éléments ci-dessus on aura le choix entre : curetage,
electrocoagulation et cauterisation (laser), excision, cryothérapie, radiothérapie, etc
La médicine esthétique nous offre un riche arsenal pour combattre les affections
cutanées exogene soit biologique ( microbiennes, virales, mycotiques, parasitaires) soit
physio-chimiques (photodermies, etc)
Consideratii asupra patofenomenelor cutanate la varsta a III-a
Ce este natural sau patologic la nivelul tegumentului in curs de imbatranire? Tinand
cont de evolutia lenta si benigna la majoritatea cazurilor de leziuni cutanate, aparitia
complicatiilor si/sau suferintelor ne determina sa definim stari patologice. Acestea sunt in
legatura si cu microtraumatisme, vicii de igiena, neglijenta si ignoranta.
Se recunoaste actualmente o imbatranire cutanata “intrinseca”, de etiologie genetica si
hormonala (spre exemplu atrofia senila simpla) si o alta imbatranire, “extrinseca” modulata de
mediul exterior, mai ales radiatiile U.V. Astfel pielea zonelor descoperite imbatraneste
prematur. In aceasta ultima conjunctura, se disting mai multe entitati clinice – Dermatohelioza,
Elastoidoza faciala, Hipertrofia degenerativa cutanata, “Cutis romboidalis nucae”.
Scoala romana de geriatrie propune “ Eflorescenta Cutanata Senila”. Aceasta este
totalitatea leziunilor multicolore si polimorfe, de etiologie si histologie variata, care se poate
inventaria pe tegumentul senil. Ea cuprinde :
• leziuni de origine vasculara : fibroangioame, lacuri sanguine, microvarice,
telangiectazii, angiokeratoame genitale, purpura (Bateman)…
• leziuni de origine virala : papiloame filiforme, veruci seboreice (cele mai
numeroase)…
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•
precanceroze : keratozele actinice, cornul cutanat, unele macule “café-aulait” (lentigo-ul senil)…
• tumori benigne (de retentie) : comedoane, chloasma, fibroame in pastila,
chiste….
Din punct de vedere terapeutic, evaluarea fiecarui caz se face urmarind 3 criterii : tipul
de leziune, varsata si starea generala a pacientului si rezultatul estetic asteptat.
In functie de aceste elemente, avem o panoplie de mijloace terapeutice : chiuretajul,
minichirurgia, electrocoagularile si cauterizarile, laserele, crioterapia, radioterapia,etc
Medicina estetica ofera un bogat arsenal terapeutic pentru combaterea afectiunilor
cutanatate exogene, fie biologice (microbiene, virala, micotice, parazitare) ,fie fizico-chimice
(fotodermite, dermite de contact, dermite combustiforme, etc)
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MANAGEMENT OF ATOPIC DERMATITIS
Catalin Popescu, Raluca Popescu
University Hospital Colentina
Bucharest, Romania
Atopic dermatitis begins almost always in infancy and, frequently, continues throughout life.
Even though the symptoms improve in time, 60% of the patients continue to have cutaneous
symptoms that may range from skin dryness to episodes of moderate to severe dermatitis.
Managing atopic dermatitis can be achived by controlling the dryness of the skin,
preventing the inflammatory episodes, controlling the itching and controlling and treating the
complications.
The most common aggravating factor is xerosis, its importance in preventing dermatitic
flares being frequently underestimated. Another aggravating factor, very little studied, is the
patients’ compliance to the treatment.
Simple measures to control those two factors can have a significant impact on the
evolution of atopic dermatitis and will be the subject of this presentation.
MANAGEMENTUL DERMATITEI ATOPICE
Dermatita atopica debuteaza aproape intotdeauna in primii ani de viata si, adesea, continua
tot restul vietii. Chiar daca majoritatea pacientilor se amelioreaza odata cu inaintarea in varsta,
peste 60% continua sa aiba manifestari cutanate, a caror severitate poate varia de la simpla
xeroza la episoade eczematoase medii/severe.
Managementul dermatitei atopice presupune: combaterea xerozei, prevenirea
episoadelor inflamatorii, controlarea puritului, controlul si tratamentul complicatiilor.
Cel mai frecvent intalnit factor de agravare a dermatitei atopice este xeroza cutanata, a
carei importanta in prevenirea agravarilor dermatitei atopice este adesea subevaluata. Un alt
factor de agravare, pana nu demult mai putin studiat, este complianta pacientilor la tratament.
Masuri simple de control a acestor doi factori pot avea un impact pozitiv major asupra
vietii pacientilor cu dermatita atopica si aceasta prezentare se va axa pe acestea.
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CRYOTHERAPY: A COSMETIC ALTERNATIVE THERAPY
FOR BASAL CELL CARCINOMA ON THE FACE IN ELDER PATIENTS
Anca Purcaru, MD, Dermatology
“Regina Maria” Emergency Military Hospital Ambulatory
Brasov, Romania
Basal cell carcinoma is the most frequent tumor of the skin. It appears more often in
sunny geographical areas. Fair-complexion is more exposed, generally in fair-haired and redhaired elder people. Open-air professions predispose to this kind of cancer. Cryotherapy is a
therapeutic alternative for tumors smaller than 2 cm in diameter, very well draw. No anesthesia
in needed, the procedure is rapid and needs a small number of visits to the physician, many
tumors can be treated in the same session, complications are rare and healing rate is high in
eligible cases, with excellent cosmetic results.
I present 3 fair-haired female patients with mean age of 68, with sun-exposure history,
with 4 basal cell carcinoma of the face (superficial, nodular and ulcerate kind). They were
treated with liquid nitrogen by spray technique in 2 and respective 3 sessions.
It were done on every session 2 freeze-thaw cycles with 30 sec/freeze with an interval
between cycles of 5 minutes. The lesions were frozen with borders of 3 mm in the healthy
tissue. Each time I looked after complete thawing of the lesions. The sessions were repeated
after 10 days and the healing was with excellent aesthetic results.
CRIOTERAPIA: O ALTERNATIVĂ TERAPEUTICĂ COSMETICĂ
PENTRU EPITELIOMUL BAZOCELULAR PE FAŢĂ LA VÂRSTNICI
Epiteliomul bazocelular este cel mai frecvent dintre tumorile maligne ale pielii. Are
prevalenta crescuta în zonele geografice însorite. Rasa albă este mai expusă, predominant
blonzii şi roşcaţii, cu maximum de incidenţă la adultul vârstnic. Profesia exercitată în aer liber
are rol predispozant. Crioterapia este o alternativă terapeutică pentru tumorile mai mici de 2
cm diametru, cu margini bine delimitate. Nu necesită anestezie locală, este rapidă, necesită un
minim de vizite la medic, mai multe tumori pot fi tratate în acelaşi timp, complicaţiile sunt rare,
rata de vindecare este foarte mare în cazuri selecţionate, cu rezultate cosmetice excelente.
Prezint 3 paciente cu vârsta medie de 68 ani, blonde, cu istoric de expunere la soare având 4
leziuni diagnosticate ca epitelioame bazocelulare (superficial, nodular şi ulcerat), pe faţă, care
au fost tratate prin pulverizare cu azot lichid în 2 şi respective 3 şedinţe. S-au efectuat câte 2
cicluri îngheţ-dezgheţ/şedinţă, la un interval de 5 min între îngheţuri şi timpul de menţinere a
îngheţului de 30 sec. Leziunile au fost îngheţate cu margini de aprox. 3 mm în ţesut sănătos.
De fiecare dată s-a urmărit dezgheţarea completă a leziunii. Şedinţele s-au efectuat la interval
de 10 zile. S-a obţinut vindecarea cu rezultate cosmetice excelente.
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CRYOTHERAPY: AN EXCELLENT METHOD FOR SYNOVIAL CYST TREATMENT
Anca Purcaru, MD, Dermatology
“Regina Maria” Emergency Military Hospital Ambulatory
Brasov, Romania
Synovial cyst is an abnormal growth with semi-liquid content developed on the anterior
side of the articular or tendinous synovium, near a joint, usually on the dorsal side of the hand
or foot. It is usually connected with articular cavity. Frequently appears after traumatisms. It
can reach 3-5 cm in diameter. It looks like a firm, elastic, deeply fixed tumor, mobile under the
skin, usually painless. It has an important negative aesthetic impact. The treatment is
generally surgical.
I present the case of a 77 years old male patient with a relapsed synovial cyst after
surgical ablation 2 years ago, localized on the distal inter-phalanx joint of the right toe. He
refused surgery for removing the cyst. He was proposed to perform cryotherapy like procedure
as an alternative. I applied liquid nitrogen with a 4 mm diameter cryosurgical probe in 2
sessions. I repeated on every session 2 freeze-thaw cycles with 20 sec/freeze and I looked
after complete thawing. The probe was applied with some pressure on the lesion. The
sessions were repeated after 10 days with excellent aesthetic results.
CRIOTERAPIA: O METODA EXCELENTA PENTRU
TRATAMENTUL CHISTULUI SINOVIAL
Chistul sinovial este o formaţiune cu conţinut semi-lichid dezvoltată pe faţa anterioară a
sinovialei articulare sau tendinoase, în vecinătatea unei articulaţii, de obicei pe faţa dorsală a
mâinii sau piciorului. În general comunică cu cavitatea articulară. Apare frecvent după
traumatisme. Poate ajunge la dimensiuni de 3-5 cm. Se prezintă ca o tumoră fermă, elastică,
fixă profound, neaderentă la tegument, de obicei nedureroasă. Are un efect estetic negativ
important. Tratamentul este de obicei chirurgical.
Prezint cazul unui pacient vârstnic, 77 ani, cu un chist sinovial recidivat după excizia
chirurgicală în urmă cu 2 ani, localizat la nivelul articulaţiei interfalangiene distale police drept
(φ 6/7mm), dureros, în tensiune. A refuzat intervenţia chirurgicală pentru extirparea chistului. I
s-a propus ca alternativă criochirurgia. S-a aplicat azot lichid cu ajutorul unei sonde
criochirurgicale cu φ 4 mm în 2 şedinţe. S-au repetat câte 2 cicluri îngheţ-dezgheţ de câte 20
sec/îngheţare la fiecare şedinţă, urmărindu-se de fiecare dată dezgheţarea completă a leziunii.
Sonda s-a aplicat cu presiune pe leziune. Şedinţele s-au repetat la interval de 10 zile, cu
rezultate estetice excelente.
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LOWER FACE AREA RECONSTRUCTION AFTER LARGE MANDIBLECTOMY
IN A CASE OF SQUAMOUS CELL CARCINOMA (SCC)
Dr. Vlad Petrescu-Seceleanu, medic specialist chirurgie maxilo-faciala(1)
Prof.dr. Viorel Ibric-Cioranu, medic primar chirurgie maxilo-faciala(2)
Dr. Stefan Luchian, medic primar chirurgie plastica(3)
P.F.A.-practica privata
Spitalul Titan –Judetean Ilfov
Spitalul SRI –“Prof.Dr.Agrippa Ionescu”
Bucuresti, Romania
Pacient de sex masculin,in varsta de 54 ani s-a prezentat in urma cu 6 ani pentru
tratament de specialitate in cazul unui epiteliom spinocelular de buza inferioara cu invadarea
arcului mentonier mandibular.
Plastia defectului osos postmandibulectomie s-a realizat cu ajutorul unui lambou liber
transferat fibular.
Evolutia favorabila dupa 5 ani determina continuarea reconstructiei prin tratament
implanto-protetic avand ca scop restabilirea functionala a aparatului dento-maxilar.
Concluzie: Pentru tratamentul in limite oncologice al unui carcinom spinocelular aflat
intr-un stadiu avansat ,pentru plastia reconstructiva si tratamentul implanto-protetic ce aduc o
finalitate estetica si functionala ,este necesara o colaborare intre medici dermatologi,chirurgi
plastici si chirurgi maxilo-faciali.
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TREATMENT OF INCIPIENT DEGREE PRESSURE ULCERS
WITH PULSATILE GALVANIC STIMULATIONS
Dr. Argentina Vidrascu, Conf. Dr. Patricia Cristodor
LIPOLINE
Cluj-Napoca, Romania
Study premises
The costs for prolong home hospitalization / care of patients with sloughs are very high,
because of the specific dressings necessary for the treatment, postoperatory infections –
prolong hospitalization, recidivations, specific maintenance devices for immobilized patients.
This study is based on the proved fact that epithelial cells migrate in the electric field moving
toward cathode. According to this, the superposition of an external electric field (exogene) will
influence, generally, the process of granulation and epithelization of decubitus lesions.
The purpose of the study
We proposed to demonstrate that decubitus lesions of II-III degree granulate and epithelizate
in a shorter period of time if they are treated with SPG than in cases of classical conservatory
treatment with occlusive dressings and Betadine solution.
Material and methods
To patients with incipient lesions – II A-III B degree, that didn’t necessitate surgical treatment
were applied Pulsatile Galvanic Stimulations at the level of ulcers by sterile electrodes with
hydrophile gel;
Results
The maximum number of healled lesions was in 2 weeks after the start of treatments for the
group with PGS application treatment. For the group with application of the Betadine solution
treatment the maximum number of healled lesions was in 4 weeks.
Discussions
Pulsatile Galvanic Stimulations represents a treatment method of incipient decubitus lesions
more effective than classical methods. This type of treatment allows stopping the unfavorable
evolution of decubitus lesions, shorting the hospitalisation period, decreasing the treatment
costs by replacing the absorbent dressings that have a high price.
Key words: Pulsatile Galvanic Stimulations, decubitus lesions, electrodes.
STUDIUL NOILOR METODE DE TRATAMENT CONSERVATOR CU STIMULĂRI
PULSATILE GALVANICE (SPG) AL LEZIUNILOR DE DECUBIT
Premisele studiului
Costurile pentru spitalizarea / îngrijirea prelungită la domiciliu a pacienţilor cu escare sunt
foarte ridicate, din cauza pansamentelor specifice necesare tratamentului, suprainfecţiilor
postoperatorii – spitalizare prelungită, a recidivelor, dispozitivelor specifice de susţinere a
pacienţilor imobilizaţi.
Acest studiu are ca bază faptul deja demonstrat că celulele epiteliale migrează în câmpul
electric deplasându-se spre catod. Prin urmare, suprapunerea unui câmp electric extern
(exogene) va influenţa, în general, procesul de granulare şi de epitelizare a leziunilor de
decubit.
Scopul studiului
Ne-am propus să demonstrăm că leziunile de decubit de gradul II-III granulează şi epitelizează
într-o perioadă mai scurtă dacă sunt tratate cu SPG decât în cazul tratamentului conservator
clasic cu pansamente ocluzive şi soluţie Betadine.
Material şi metode
Pacienţilor cu leziuni incipiente – gradul IIA-III B, care nu necesitau tratament chirurgical s-au
aplicat Stimulări Pulsatile Galvanice la nivelul plăgilor prin intermediul electrozilor sterili cu gel
hidrofil;
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Rezultate
Numărul maxim al leziunilor vindecate a fost în 2 săptămâni după debutul tratamentelor în
cazul lotului cu tratament prin aplicarea SPG . În cadrul lotului cu aplicarea tratamentului cu
soluţie Betadine numărul maxim de leziuni vindecate au fost la intervalul de 4 săptămâni.
Discutii
Stimularile Pulsatile Galvanice reprezinta o metoda de tratament a leziunilor de decubit de
grad incipient mai eficienta decat metodele clasice. Acest tip de tratament permite stoparea
evolutiei nefavorabile a leziunilor de decubit, scurtarea perioadei de spitalizare, scaderii
costurilor de tratament prin inlocuirea pansamentelor absorbante care au cost ridicat.
Cuvinte cheie: Stimulari Pulsatile Galvanice, leziuni de decubit, electrozi.
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RADIOFREQUENCY: SURGICAL AND NON-ABLATIVE TECHNIQUES
Dr. Argentina Vidrascu, Conf. Dr. Patricia Cristodor
LIPOLINE
Cluj-Napoca, Romania
Case presentations. Treatment indications.
RF utilization in minimal invasive Plastic Surgery, as well as in Surgical Dermatology becomes
more and more frequent. This treatment method becomes popular because the incisions
realized with the electrode – needle or lock type are very delicate and with a minimal thermal
degradation of the tissue that is in contact with the electrode.
The postintervention perilesional edema is minimal, and the bleeding of the operatory ulcer is
much reduced if the work program “cutting-coagulation” is applied. Another important
advantage is that the scalpel isn’t used anymore for incisions and with the utilization of active
electrode at the level of tegument the application of pressure isn’t necessary, and the incision
can be made only by an easy touch of the tegument by the electrode. It is important the fact
that the tissue on which the RF active electrode is applied must be continuously moistened
with physiological serum, and the work electrode must be maintained without residues of
coagulated tissue. In the conditions of an ulcer without bleedings the work is more accurate.
Most frequent treatment indications in minimal invasive Plastic Surgery and Surgical
Dermatology are:
- Tangential excision of pigmentary nerves and of pediculated formations;
- Coagulation of vascular stars, couperose, venectasis;
- Xanthelasmas, blepharoptosis;
- Dermocontracture;
- Rhynophyma
- Cystic formations of the labia;
- Fulguration of verrucous formations;
RADIOFRECVENTA: APLICARI CHIRURGICALE MINIM- SI NON-INVAZIVE
Prezentari de caz. Indicatii de tratament
Utilizarea RF în Chirurgia Plasticã minim invazivã, precum si în Dermatologia chirurgicalã
devine tot mai frecventã. Aceastã metodã de tratament câstigã teren gratie faptului cã inciziile
efectuate cu electrodul - ac sau cu cele tip buclã sunt foarte fine si cu o minimã degradare
termicã a tesutului care intrã în contact cu electrodul. Edemul perilezonal postinterventie este
minim, iar sângerarea la nivelul plãgii operatorii este mult redusã dacã se aplicã regimul de
lucru: „tãiere-coagulare”. Un alt avantaj important este cã nu se mai foloseste bisturiul pentru
excizii si în momentul utilizãrii electrodului activ la nivelul tegumentului nu este necesarã
aplicarea presiunii pe tegument, ci incizia se poate efectua doar prin atingerea usoarã a
tegumentului cu electrodul. Important este de retinut faptul cã tesutul pe care se aplicã
electrodul activ de RF trebuie umectat continuu cu ser fiziologic, iar electrodul de lucru trebuie
mentinut fãrã resturi de tesut coagulat. În condiþiile unei plãgi fãrã sângerãri se lucreazã cu
mai multã acuratete.
Indicatiile de tratament cele mai frecvente în Chirurgia Plasticã minim invazivã si Dermatologia
chirurgicalã sunt:
- Excizia tangentialã a nevilor pigmentari si a formatiunilor pediculate;
- Coagularea stelutelor vasculare, cuperozã, venectazii;
- Xantelasme, ptozã palpebralã;
- Dermocontractura;
- Rhinofima
- Formatiuni chistice ale labiilor;
- Fulguratia formatiunilor verucoase.
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