Thursday April 10 / Jeudi 10 AvrilABSTRACTSAESTHETIC DERMATOLOGY & SURGERYBLUE AUDITORIUM / AMPHI BLEUAESTHETIC DERMATOLOGY & SURGERYSESSION 12.00 pm / 14h00TWENTY YEARS OF BOTULINUM TOXIN : WHERE ARE WE TODAY ?VINGT ANS DE TOXINE BOTULIQUE : OÙ EN EST-ON AUJOURD’HUI?CHAIR: ANTHONY BENEDETTO DERMATOLOGIST (PHILADELPHIA, USA)OLIVER KREYDEN DERMATOLOGIST (MUTTENZ, SWITZERLAND)ANATOMY OF THE FACE: THE BASICS TO KNOW PRIOR TO INJECTING BOTULINUM TOXINANATOMIE DU VISAGE : LES BASES À CONNAÎTRE AVANT D'INJECTER DE LA TOXINE BOTULIQUEHERVÉ RASPALDO(FRANCE)HOW TO MAKE BOTULINUM TOXIN-A BETTER?COMMENT RENDRE LA TOXINE BOTULIQUE DE TYPE A MEILLEURE ?ANDREAS KATSAMBAS(GREECE)The cosmetic use of Botulinum Toxin-A continues to increase since its approval some years ago. Despite the fact that more than 80%of patients using Botulinum Toxin-A are satisfied with the results, there still remains the 20% of patients who express dissatisfactionwith the final outcome.Moreover, even in successfully treated patients, there is still room for improvement.Some of the reasons for dissatisfaction include: inadequate dosing, lack of consultation and poor injection techniques.The reason for such unsuccessful treatments and the various ways of improving the degree of satisfaction will be discussed in furtherdetail.HOW TO AVOID THE PITFALLS WHILST TREATING THE UPPER FACE?COMMENT ÉVITER LES EFFETS SECONDAIRES DANS LE TRAITEMENT DU HAUT DU VISAGE ?ANTHONY BENEDETTO(USA)Rejuvenating the face with Botulinum toxin (BTX) has become a new and rewarding way to eliminate facial wrinkles in a minimallyinvasive manner that is relatively quick and easy to perform. The key to a successful treatment of a patient's facial rhytides with BTXis the proper pre-treatment evaluation of a patient's problems. Recently, injections of BTX of the face has complemented other facialrejuvenation techniques, by relaxing hyperkinetic muscles that either have caused excessive wrinkling at rest or distortion andasymmetry of a particular area of the face during animation. When planning a patient's facial remodeling with BTX, one should payparticular attention to the eyes, which usually reflect a patient's inner feelings and emotions to the casual observer. The perioculararea has four depressor muscles and one large levator muscle, which act in unison or in opposition to each other, intentionally orinvoluntarily to protect the eyes or express an emotion. It can be therefore somewhat challenging to produce a unified effect of theperiocular area with BTX injections without occasionally disturbing the symmetry of the upper face. Treating periocular rhytides withBTX requires an expert knowledge of the muscles in this area. An in depth evaluation of the patient and a corresponding managementplan using BOTOX ® to rejuvenate the face by reducing facial wrinkling and correcting asymmetries will be presented using clinicalexamples.HOW TO AVOID THE PITFALLS WHILST TREATING THE LOWER FACE AND THE NECK?COMMENT ÉVITER LES EFFETS SECONDAIRES DANS LE TRAITEMENT DU BAS DU VISAGE ET DU COU ?PHILLIP LEVY(SWITZERLAND)WHICH DIFFERENCES BETWEEN BOTOX ® , DYSPORT ® AND OTHER BOTULINUM TOXINS?QUELLES DIFFÉRENCES ENTRE BOTOX ® , DYSPORT ® ET LES AUTRES TOXINES BOTULIQUES ?DIDIER VOCHELLE(BELGIUM)35
TREATING THE WHOLE FACE WITH BOTULINUM TOXINTRAITER L’ENSEMBLE DU VISAGE AVEC LA TOXINE BOTULIQUECHARIYA PETCHNGAOVILAI(THAILAND)AESTHETIC DERMATOLOGY & SURGERYTreating the whole face with Botulinum toxin is a simple procedure for rejuvenation. Besides wrinkle reduction, Botulinum toxin createsface reshaping. By injecting the toxin into the muscles, the dynamic wrinkles are minimized. By injecting the toxin to adjust the balancebetween those two groups of facial muscles that counteract, the elevators to lift up and the depressors to pull down, face reshapingis achieved. Both conventional intramuscular and intradermal injection are applied in combination. Intramuscular injection isconsidered to block the muscle bundle while intradermal technique is applied to block only some of the superficial parts of the muscleand leave its deeper parts to compensate for performing its function. With this combination, strengthening and weakening of thedesignated muscles can be performed and the facial muscles are allowed to work in harmony, resulting in mini-facelift effect.NON AESTHETIC INDICATIONS OF BOTULINUM TOXIN: COMMON AND UNCOMMON INDICATIONS IN FOCAL HYPERHIDROSISINDICATIONS NON ESTHÉTIQUES DE LA TOXINE BOTULIQUE : INDICATIONS COMMUNES ET RARES DE L’HYPERHIDROSEOLIVER KREYDEN(SWITZERLAND)In dermatology botulinum toxin (BTX) became famous due to its aesthetic indications to treat wrinkles. However treatment for focalhyperhidrosis excists almost as long as the aesthetic indications. It was Bushara in 1996 who was the first to discover an anhidroticeffect on the cheek after treating patients for blepharospasm. Meanwhile BTX can be considered as the treatment of choice for axillaryhyperhidrosis. However, very little is known on the technique of rare indications such as palmoplantar, frontal, inguinal or submammaryHH or gustatory sweating after parotid surgery (Frey Syndrome). This session will cover the most important advanced indication in thefield of focal HH. Before treatment HH should be assessed objectively with the Minor stark test. The dilution of BTX should be 5ml -10ml per vial to achieve most possible diffusion. Since the diffusion capacity of BTX is about 1.0 - 1.5 cm in diameter the injections(2U/injection site) should be performed at a distance of approx. 1.5 cm to cover the whole hyperhidrotic area. While for axillary HH noanaesthetic treatment is necessary BTX-injections for palmoplantar HH need anaesthesia. Due to many side effects of nerve blocks(painful, incompletely block, impairment of motor activity, risk of nerve injury, vasovagal syncopal episodes, anaphylactic shocks) manytrials of regional anesthesia have been reported with different results. With a combination of iontophoretic administration of 2 percentlidocaine for fi hour (15 min. each extremity) and spraying of a controlled amount of liquid nitrogen cryotherapy injections can beperformed painless. Frey Syndrome is a common complication following parotid gland surgery or infection and can be treated veryeffectfully with BTX. However the clinic can differ from patient to patient which causes problems for the right documentation of thehyperhidrotic area. This problem can be solved by asking the patient to mark the hyperhidrotic area on a tracing paper at home oralternatively to perform a Minor Stark Test and document it on a plastic transparency during the consultation hour. Both documentationtechniques have the advantage that they can be recorded in the patient history or can be enclosed to the correspondence.SESSION 24.30 pm / 16h30FACIAL REJUVENATION: DO THE SOFT TECHNIQUES REALLY WORK?RAJEUNISSEMENT DE LA PEAU : LES TECHNIQUES DOUCES MARCHENT-ELLES VRAIMENT ?CHAIR: ILARIA GHERSETICH PROFESSOR OF DERMATOLOGY (FLORENCE, ITALY)PETER BJERRING PROFESSOR OF DERMATOLOGY (VEJLE, DENMARK)COSMECEUTICALS: FROM SCIENCE TO CLINICAL RESULTSCOSMÉCEUTIQUE : DE LA SCIENCE AUX RÉSULTATS CLINIQUESILARIA GHERSETICH(ITALY)Intrinsic and extrinsic aging of the skin follow different pathways, but the end result is similar. Treatment options includecosmeceuticals. Wrinkles now have a greater social impact because people live longer. Science and hedonism overlap in the searchfor causes, treatments and prevention of wrinkles.The cosmetic approach to wrinkles includes: Cleansing. Idratation and Photoprotection Active ingredients go well beyond simplemoisturisers and exert a more complex activity in protecting skin from external injuries, nourishing it and removing its superficial layers.Transport systems and excipients are increasingly effective. Functional agents currently include, retinoids, anti-enzymatic agents,antioxidants (including ascorbic acid, topic genistein, N.furfuryl Adenina, ursolic acid, vegetable isoflavones, green the, vitamin E,coenzyme Q10, lipoic acid, resveratorol, l-carnosine and taurine) as well as agaricic acid and various plant extracts...Cosmetics are becoming closer to drugs in preventing and treating wrinkles.The use of topical antioxidants is gaining favor amongdermatologists because of their broad biologic activity. Many are not only antioxidants but also have antiinflammatory andanticarcinogenic activities. Thus for dermatologists these cosmeceuticals have many potential applications. In general, topicalantioxidants exert their effects by down-regulating free radical mediated pathways that damage skin.The present study will describe the science behind some of the newest topical antioxidants and outline how they can be used as partof a comprehensive skin care regimen. Growth factors play an important role in reversing the effects of skin aging mediated bychronological and environmental factors.Excessive oxidation of intra- and extracellular components result in breakdown of collagen and elastin network in the dermis andproduce the effect of facial aging. Topical application of human growth factors in multiple clinical studies has been shown to reducethe signs and symptoms of skin aging, including statically significant reduction in fine lines and wrinkles and increase in dermalcollagen synthesis. More double-blind and controlled studies are needed to confirm the preliminary clinical effects of growth factorproducts, and more controls on product quality and stability need to be established.We present an update of the following categories of cosmeceuticals: antioxidants, growth factors, peptides, antiinflammatories/botanicals,polysaccharides, and various plant extracts.36
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