Office-based Restorative Systems.

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Office-based Corrective Systems. Glen T. Watchman, MD David C. Teller, MD College of Texas Medicinal Branch at Galveston Dept. of Otolaryngology January 2005. Office-based Corrective Techniques. Laser applications Extreme beat light Compound peels Dermabrasion Microdermabrasion
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Office-based Cosmetic Procedures Glen T. Doorman, MD David C. Teller, MD University of Texas Medical Branch at Galveston Dept. of Otolaryngology January 2005

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Office-based Cosmetic Procedures Laser applications Intense beat light Chemical peels Dermabrasion Microdermabrasion Botox infusion Injectable fillers Aesthetician-gave strategies

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Laser— nuts and bolts L ight A mplification by S timulated E mission of R adiation Coherent photons in stage transiently/spatially Collimated tight shaft, parallel ways Monochromatic one wavelength

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Monochromatic Coherent Collimated

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Laser- - nuts and bolts Fluency = vitality per territory J/cm2 Power thickness = vitality rate J/second Frequency = wavelength nm Light can be: Reflected (skips off) Scattered (arbitrary dispersal) Transmitted (goes through unaltered) Refracted (alter in course) Absorbed (maximal clinical advantage)

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Laser – outflow modes Continuous Uninterrupted pillar Relatively consistent force Pulsed/Superpulsed (microsec) Higher vitality/shorter term beats Q-exchanged (nanosec) Extremely high vitality/short heartbeat span

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Laser – tissue communication Each tissue contrasts in retention qualities and unwinding (time important to discharge half of vitality) Pulse width <relaxation time = chromophore focused with minimal insurance spread of vitality Cutaneous chromophores: water, melanin, hemoglobin Penetration is impacted by target chromophore (more ingestion = less infiltration)

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Laser range

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Laser range Laser Wavelength (nm) Application Er:YAG 294 Skin reemerging Argon 488/514 Vascular injuries KTP:YAG 532 Vascular sores Copper vapor 578 Vascular sores FLPPD 585 Vascular sores Long pulse 595-600 Leg veins Ruby, Q-switched 694 Tattoo evacuation Long pulse 694 Hair evacuation Q-exchanged Alexandrite 755 Tattoo evacuation Nd:YAG 1064 Deep vascular Q-exchanged YAG 1064 Tattoo evacuation CO2 10600 Cut/coag/resurf

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I ntense P ulsed L ight Noncoherent Multiple wavelengths (500-1200nm) Different handles with distinctive extents utilized for vascular sores and hair removal Some reports demonstrate skin fixing impact Well endured as outpatient May oblige cooling

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Laser - vascular sores Telangiectasias: all together of inclination/adequacy Diode laser (variable-beat width 532nm)- as successful as beat color without puerperal beat color laser (puerperal results) IPL Hemangiomas beat color laser (585nm wavelength) 2-10 medications divided 6-8 weeks separated Port-wine stains Pulsed-color laser (585nm) 2-12 medicines divided 6-8 weeks separated shallow sores, red sores, more youthful than 10, head and neck sores react better

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Laser – shallow pigmented sores Superficial sores (for the most part shorter-wave-length frameworks) Freckles: Q-exchanged 532nm Nd:YAG laser repeat regularly Cafã©-au-lait sores: Q-exchanged Nd:YAG lasers hard to treat, repeat frequently Lentigos: Q-exchanged Nd:YAG lasers CO2, Erbium, KTP repeat exceptional Peels, topicals

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Laser – shallow pigmented sores Nevi: biopsy if suspicious Q-exchanged Nd:YAG 532, 694, 755nm lasers react inside of 1-3 medicines Melasma: Q-exchanged Nd:YAG laser hormonal control fading operators sun shirking have a tendency to repeat Rosacea: topicals (anti-infection agents, tretinoin) oral abx IPL KTP laser

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Laser - profound pigmented sores Deep sores more profound, along these lines treated better with longer wavelength (goes more profound): can utilize ruby, alexandrite, and Nd:YAG blue nevi: 1064 nm Nd:YAG laser nevus of ota and ito: Q-exchanged 1064nm Nd:YAG laser various medicines repeat is surprising

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Laser - hair evacuation Goal = removal of hair unit Wavelengths somewhere around 600 and 1000 nm best Generally need spot size bigger than the objective\'s profundity being dealt with - 5mm to 1 cm for hair Optimal circumstance is dim hair with light skin Thermal unwinding time is key: epidermis = 3-10 ms, hair follicle = 80-100 ms. Utilization of heartbeat span < 10 millisecond targets hair without skin. May require longer for darker cleaned people.

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Laser - hair evacuation Ruby, alexandrite, diode, 1064nm YAG, IPL Ruby (Fitzpatrick skin sorts I-III) Diode 810nm can treat darker cleaned patients (III-IV) 1064 nm YAG most secure for skin sorts IV-VI. IPL seems similarly as powerful in skin sorts IV-VI IPL can be utilized as a part of all skin sorts Different range tools

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Laser - hair evacuation Anagen Catagen Telogen Hair follicle must be available Good result = erythema/edema around follicle, copying of hair Bad result = whitening or “graying” of skin Facial hair- - for the most part obliges 5-6 medications (button and upper lip) rehashed at 4 week interims Body hair- - rehashed at 6-8 week interims 60-95% evacuation at 6 months. Regrowth typically better and lighter

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Soft tissue enlargement – injectable fillers 1899 Gersuny – paraffin Problems with almost every infused filler: Inflammatory reaction Foreign body response Allergy

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Soft tissue expansion – infused substances Synthetics Silicone – banned in 1991 Polymethylmethacrylate dabs (Artecoll) Injected into subdermis for more profound rhytids Fibroblastic ingrowth/embodiment Skin test obliged Permanent Xenografts Bovine collagen ( Zyderm, Zyplast ) Requires skin test Lasts 3-4 months Zyderm obliges overinjection by 30-60% Hyaluronic corrosive subordinates Does not oblige skin test (indistinguishable crosswise over species) Cock’s brush (Hylaform) Microbial society ( Restylane , Perlane) Lasts 9-12 months

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Soft tissue increase – injectable fillers Homografts Cadaveric dermal tissues (Dermalogen, Cymetra, Cosmoderm) Acellular (minimal cross-reactivity) Overcorrection obliged (20-30%) No skin testing obliged No studies on long haul impacts Autografts Fat Inconsistent survival volume Fibroblasts (Isologen, Autologen) Requires skin harvest (up to 2cm2 for 1 ml injectable) Delay of 4-6 weeks for cell development Expensive 75-100% volume at 5 years No skin test

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Soft tissue growth – injectable fillers 30-gage needle Most rhytids destroyed by infusion into mid-reticular dermis Deeper rhytids oblige subdermal or profound dermal infusion. May oblige lysis of profound attachments (deformities which will straighten with pressure normally don\'t have profound grips) 2 systems for infusion: Serial infusion (glabella) Threading (lips) Many product offerings arrive in an assortment of molecule sizes. Littler particles can be infused in more shallow planes. This can destroy shallow rhytids or be utilized to tweak the impacts of more profound infusions.

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Soft tissue enlargement – injectable fillers Restylane

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Dermabrasion Time-regarded technique for skin reemerging Abrasive brushes and friezes to mechanically evacuate shallow layers of the skin Results like laser/compound peels Requires experience to perform well—felt to have expanded occurrence of scarring hypopigmentation Still the best application for profound scarring, profound rhytids, skin inflammation related pits/scars Requires sedation, associate, assurance from organic liquids Learning focuses: Hand dermabrasion of sensitive ranges Carry dermabrasion crosswise over vermillion fringe Rotation of brush/frieze ought to be toward close-by indispensable structures to abstain from tearing of tissues

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Dermabrasion - results

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Microdermabrasion Aluminum oxide precious stones pumped at high speeds toward skin surface. Suction connected to evacuate gems and trash. Less administrator dependant than dermabrasion Consistent profundity of tissue misfortune (flexible) Less blood presentation than dermabrasion Usually two goes to uproot epidermis (pinpoint dying) Results not as sensational, may require a few medications Erythema determines following 24 hours Risks of hyper/hypopigmentation and scarring low Indicated for minor degrees of sun harm, wrinkling, skin break out scarring, mixing of treatment limits Little result information accessible

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Microdermabrasion - results

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Peels Chemical cutaneous damage to particular level Limitations of facial peeling: Cannot diminish pore size, dispose of telangiectasias, take out profound scars, destroy profound wrinkles Can enhance appearance of sun-harmed skin, straighten mellow scarring, smooth out rhytids, decimate epidermal injuries, help with skin inflammation, evacuate pigmented sores, mix different mediations Lower preoperative Fitzpatrick’s sort deciphers into lower danger of pigmentation issues History of Accutane treatment in most recent 6 months, XRT, past facial restorative surgery, irregular scar arrangement, rosacea, seborrheic dermatitis, atopic dermatitis, psoriasis ought to give stop

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Peels Multiple definitions with varying peel profundities: Superficial = epidermal misfortune Medium = harm to shallow dermis Deep = mid-dermal damage Depth of peel managed by level of skin maturing Patients with extreme maturing changes generally best treated with surgical intercession

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Peels – preoperative intercession Superficial peel: No intercession important Medium/Deep peel Antiviral operators (proceeded with x 10d-2wk) Weak tretinoin arrangement 1-2 wks before 4-8% hydroquinone gel for patients with Fitzpatrick skin sorts III or higher Evaluate for cardiovascular status, kidney sickness

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Peels Superficial Very light Injure stratum corneum 10-20% TCA Jessner’s Tretinoin Salicylic corrosive Light Injure whole epidermis 70% glycolic corrosive (must be flushed) 25-35% TCA Solid CO2 slush Medium 35% TCA + Jessner’s versus 70% glycolic corrosive versus CO2 Risk of scarring with half TCA Deep Baker-Gordon arrangement Phenol, water, septisol, croton oil Phenol heart lethality precautionary measures Diluent Taped versus untaped Laser

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