STRIAE DISTENSAE TREATMENT IN ACCORDANCE WITH THEIR DEPTH AND CLASSIFICATIONTRAITEMENT DES VERGETURESPHILIPPE DEPREZ(SPAIN)Until now, all the treatments of stretch marks have been disappointing, because of their complete or relative inefficiency or high risk ofside effects. New technologies are nevertheless available that allow to show good results in all types of striae distensae.Stages 1 and 2A could be enhanced by simple treatments combining a superficial abrasion of corneal layer and further topicalapplication of mixtures compounded of vitamins, trace elements, reparing and stimulating compounds mixed with hyaluronic acid.Abrasion allows a deep dermal penetration of active products, after what, non thermogenic monopolar radiofrequences applicationbrings the actives into the cytoplasm, through cells membranes and allow a maximal action of active repairing molecules.From stage 2B and further ones, chemical peelings will be a more effective treatment for these old and/or atrophic stretch marks butit has to penetrate very deeply in the skin to possibly enhance or (partially) remove striae distensae.So, as a precaution, we'll be careful selecting indications and depth of the protocol.This chemical treatment is a versatile combination of 3 techniques: sandbrasion to a precise level, followed by the application of EasyTCA peel solution and occlusion of the post peel mask of this peeling during a period of 12 to 24 hours. Any physician using thisprotocol should have a good experience of deep peels to be able to assume a difficult follow up. The patient should be followed up atdays 1,3 and 6 after the procedure and benefit of a prevention of PIH. (bleaching-blending cream and sun screen SPF 50 + HSPinducers). The number of necessary sessions depends on the depth and atrophy degree of the marks (between 2 to 6 sessions, oncea month ). The results depend on the depth of the treatment and the number of sessions. In the majority of cases of old atrophic stretchmarks, the patient considers that the skin is progressively better after each session.Conclusions: Different types of striae distensae can be progressively but definitively enhanced by different depths of treatments.AESTHETIC DERMATOLOGY & SURGERYCOMPARATIVE STUDY OF HYALURONAN GELS AT D0 AND D14ETUDE COMPARATIVE DES GELS HYALURONIQUES À D0 ET D14PATRICK MICHEELS(SWITZERLAND)Summary: Since 1996, we inject hyaluronic acid (HA) in our patients face. But, do we know exactly what we do, what we inject, whereH.A. is deposited, how it is digested, what we induce in the dermis after those injections?When you ask colleagues those questions, most of them will answer no!The aim of this presentation is to resume what we know about different gels of HA, present on the market, on the bio-chemical field,and more specially on the histological one. This histology is realised at D0, T0, just after injection and D 14.This is an introduction to a bigger study, not yet finished, in collaboration with the HCU Geneva, a long-term study on human patients,with human biopsies. Those universitary study results are not yet available.Introduction: Hyaluronic acid (HA), a natural component of the extracellular matrix is used since more than 11 years in the field ofAethetic Medicine.Because of its specific nature (natural sugar without any specificity of species or organ), H.A. seems to be the best wrinkles filler.In the skin, its natural half-live is very short (3 days). To obtain a long lasting effect, HA had to be cross-linked.Most often is BDDE used, the less toxic cross-linking agent, but other molecules may be used, like Di-Epoxy Octane.In the cross-linking process, there are 3 initial classic steps, described since more than 20 years.The manufacturers have tried to have a better cross-linking technology for a longer lasting effect.The result of the reactions gives gels different properties.We were schemed by some reactions we have observed since 11 years, and wanted to know better the products we inject in thepatients face.What we don't know exactly is :1. How does each gel take place in the dermisa. just after the injection?b. is there a immediate inflammatory reaction?c. after a short and a long time?d. what do those fillers induce in the dermis?Method: First of all, we have asked the companies to explain as best as possible the different techniques they use to cross-link thenatural HA.We have asked to the "Ecole Nationale Supérieure de Chimie" of Mulhouse-France and a private laboratory to examine some samplesof HA syringes of the swiss market.Bio-chemical composition, pH, Osmorarity, rheological propreties etc were subjects of investigation by different techniques.Some tests of elasticity, by simple traction of the gels with a Adson pliers and cohesivity, by mixing the gels into physiological serumwith some alcohol drops, were realised very simply in our own office.Some patients have agreed to have biopsies by punch of 3 mm after intradermal injection tests of 0.2 ml of different gels on thebuttocks, 10 cm outside the spinal line, and sometimes at 12 cm.The following gels were injected :NASHA ®HYLACROSS ® 24 HV from Europe and USAMatrice 3 D ® 24 XPCPM ®The biopsies, realised under local anesthesia with lidocaïne 1% were examinated by an independent histopathologist in a wellknownprivate laboratory of Geneva.The different colourations were classic, specially Alcian Blue and Colloïdal Iron stain. We have shown some biopsies at the HCUGeneva, were they also were examinated, specially by Colloidal Iron stain.41
Results:Thanks "Ecole Nationale Supérieure de Chimie" of Mulhouse-France and a private laboratory, we know that:A. Bio-chemically, all the H.A. fillers on the market are nearly the same.B. There are, for the moment, 2 types of gels : mono- and biphasique.AESTHETIC DERMATOLOGY & SURGERYBy the little experimentation in our office, we know that:A. some gels are cohesive, other non cohesiveB. some gels are elastic, other non-elasticC. some gels are changing from one year to another oneThe differences are essentially:1. the control of Osmolarity2. the cross-linking level, the technique of cross-linking and the calculation of this level.3. the nature of the gel : a. bi- or monophasic gelb. cohesive or non cohesive gelc. mono- or polydensified gel.BiopsiesAt D0, we may say that:1. There is no inflammatory reaction just after injection.2. There are, at D0, 3 different ways of diffusion-placement of the gels.3. This is probably a consequence of the different cross-linking processes.At D 14, no visible changes with all the different used colourationsConclusion: If there are some differences in cross-linking techniques, bio-chemical properties, final nature of hyaluronic acid gels, themost important thing to know, when we inject them, is to remember that, because of those differences, gels diffuse and are placed inthe dermis on different ways.Possibly, dermis structures also have an influence in the repartition of the different gels.There is, for the moment, we have a partial answer to questions c and no answer to question d. The results of the long-termcomparative study at HCU Geneva will probably give the answers we are waiting for.THE 4 R'S OF FACIAL REJUVENATIONLES 4 "R" DU RAJEUNISSEMENT FACIALSAM ASSASSA(USA)The 4 R'S of Facial RejuvenationIn order to achieve the best results in facial rejuvenation we need to understand and properly analyze the aging face. My presentation willcover the etiology of face aging, how to restore facial symmetry and create overall harmony of the face without causing any major in 3 Dapproach.This is an educational presentation to help attendees understand the aging process of face, put together a proper plan of action, by usingan integrated approach that combines proprer analysis of aging face and applying the 4RS of Face Rejuvenation to symmetry andharmony.The vertical temporal lifting: A short pre-capillary scarTHE VERTICAL TEMPORAL LIFTING: A SHORT PRE-CAPILLARY SCARLE LIFTING TEMPORAL VERTICAL : UNE PETITE CICATRICE PRÉ-CAPILLAIREJOHN CAMBLIN(FRANCE)EnglishPreceded by a liposuction of the oval and neck, this surgical technic gives satisfactory results in a simple manner and with quicksurgical cares.The skin is undermined to the corner of the mouth and the excess obtained by a strict vertical traction is resected : threedermoaponevrotic stitches of a non absorbable thread, malar, jugal and temporal are tied, giving a more lasting result. On the DVD,the patient has the facial ageing stigmas which necessitate a conventional face lifting. However, the vertical temporal lifting with a shortprecapillary scar gives the same effect and, perhaps, a more natural look.FrançaisLe lifting vertical temporal -Une incision précapillaire courte.Précédée d'une liposuccion de l'ovale et du cou, cette technique chirurgicale simple donne des résultats satisfaisants et des suitesopératoires rapides. La peau est décollée jusqu'à la commissure buccale et l'excédent obtenu par une traction strictement verticaleest alors réséqué : trois points de fil non résorbable, malaire, jugal et temporal, prenant le derme et l'aponévrose sous-jacente sontfaits, apportant un résultat durable.Sur le DVD, la patiente présente tous les stigmates du relâchement cutané facial et un lifting classique en est l'indication. Cependant,le lifting vertical temporal avec incision précapillaire courte donne un résultat identique et, peut être, un aspect plus naturel.permanent anesthesia of the scalp that can accompany Coronal and Trichophytic lifts. (More then 800 Patients)42