PowerPoint Presentation
MSI Resurfacing (Rejuvenation) PEEL
The Art of Non Surgical
Skin Rejuvenation
By
Prof Osama B Moawad
MSI Anti-aging Program
What is the problem ?
The First step for any successful anti-aging program is to
diagnose the skin problems (dark spots, red spots, pimples, scars,
wrinkles or skin folds)
Woods light
Polarized Light
Dermatoscopy
Video Dermatosopy
Venoscope
Woods Light is essential to detect skin Pigmentation in
photoaging
Polarized Light
Polarized Light is used to detect red and dark skin spots
Abnormalities of Hair, Nail and skin thousands times
Video-Dermatoscopy
White Heads
Black Heads
Examination is a Must!!!
To Detect Blood Vessels
Is a mole Harmless?
Veinscope
Dermatoscope
Or pigmented laser surgery is indicated
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MSI Skin Rejuvenation Program?
What Is
It is a comprehensive Non Surgical skin care program that uses
the state of art in aesthetic medicine tailored to your condition ,
need and expectation
These are weapons at our hands to fight aging
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Non Ablative Treatment
Minimally ablative
Surgical Treatment
PDT
Superficial chemical Peel
Ablative Treatment
Laser
Radiofrequency
Light
Local Therapy
Skin Care Products
Oxygen Therapy
Fractional Ablative CO2 Laser
Medium Depth Chemical Peel
Lifts
Tucks
HT
Meso-lifts
Liposuction
Fat Transfer
Dermal Fillers
Ablative CO2
Dermabrasion
Diamond Peel
Minimally Ablative FR CO2
Botox
Ultrasound
The concept of MSI peel start with prevention of sun damage with
sun avoidance, wearing protective clothing and sun block and using,
home skin care products with aim to treat
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Steam
Ultrasonophoresis
Diamond Peel
Laser, Light, RF
Mesolift, Vampire Face Lift
Chemical Peels
Fractional CO2 Laser
Active Acne
Distensible Scars
Aging
Dark Spots
Red Spots
Moderate Skin Laxity
Wrinkles
Stretch Marks
How Should I Prepare?
One month preparation with tailored MSI skin care products with
or without Dermal Roller especially in Dark Skinned Patients
Retinoid is the second cost effective tool we have to prevent
photo aging and treat aging, antioxidants. Estrogen, cytokines and
growth factors are all promising
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Before
During
After
Retinoids
Anti-oxidants
Growth -Factors
Anti-Acne
Whitening
Cleanser
Moisturizer
Sun Block
Sun Protection is A Must!!
Avoiding photoaging is more cost effective than trying to
reverse the sign of photoaging
Sun protection should include attitude to avoid sun exposure
espeically form 10-4pm ,one should wear protective clothing and
apply sun block every 2hours
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Before
During
After
Free dead cells, dirt, and bacteria
It moisture and softens.
Eliminate Toxins
Stimulate blood circulation
Open pores
Better absorption of skin care products
This process helps to free any dead cells, dirt, bacteria or
other trapped matter that could be causing breakouts, It moisture
softens the surface layer of dead skins cells. The warm humidity
from steaming may also increase perspiration and stimulate blood
circulation and eliminate toxins through sweating It open pores to
allow better absorption of topicals
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Ultra-sonophoresis
Deep Skin Cleansing & Better Absorption
Deep Skin Cleansing
Ultra-sonophoresis cleanse the skin deeply in addition increases
skin permeability, thousands times
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Diamond or Crystal Peel
Removes 35% of stratum corneum and dead cells.
Accelerate skin renewal and enhance collagen production reducing
fine wrinkles and superficial scars and pigmentation
Removes 35% of stratum corneum and dead cells. Accelerate skin
renewal and enhance collagen production reducing fine wrinkles and
superficial scars and pigmentation
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Superficial
Chemical Peel
Minimal Ablative Resurfacing
Minimally Ablative superficial chemical peel
Do you need to start a resurfacing programs to agument result
obtained with home care programs try diamond with or without
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Acne Excoriee
Salicylic Acid Peel
Comedon Extraction
Blackheads are not caused by dirt, sweat and poor hygiene (this
is a myth that people spread) but are caused by the formation of a
plug in pores due to abnormal skin cell growth which gets oxidized
by sunlight and turns black.
Comedone Extraction
Manual Needling, Skin Rolling, Micro-needling or Derma Pen
Dermal roller is used for those suffering from open pores, acne
scars, fine wrinkles, stretch marks and even hair-loss
Dermal rollers not only allow the passage of active ingredients
deep into the skin but also works by producing thousands of
microscopic needle holes in the dermis, which prompts the skin to
produce new collagen and elastin
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Not only we improve how we deliver active ingredients by mesogun
and dermal roller but also we improve what we deliver by injecting
a mixture of antioxidant, vitamins, minerals and amino acids. The
skin looks tighter and revitalized after these procedures
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Vitamines:
2. Amino acids:
3. Minerals:
4. Coenzymes:
6. Cytokines: EGF, bFGF
7. Peptide: Copper Peptide
5. Nucleic acids: DNA, RNA
Vampire Face Lift (PRP)
PLATELETS RICH PLASMA
PRP drawn from your own blood containing numerous growth and
healing factors are put back into the skin to regrew hair and to
rejuvenate or heal the face rapidly
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We reconstituted BTA (100 unit) with 10 mL of sterile,
preservative-free saline to achieve a concentration of 10 U/mL., A
30-guage needle was used to inject the materials intradermally. The
end point of the injection was a subepidermal wheal-like
swelling.Total dose of BTA for each person was 2025 U.
nterestingly, BTA showed moderate but significant wrinkles-soothing
effect, Without obvious side effects on the lower face
Mesolift to which we add 1015U of BOTOX, for full face and neck.
It is not indicated in cases of heavy or lax skin. The use of 0.2
ml of xylocaine with adrenaline allows precise action and the
diffusion of mesobotox within marked areas
Mesoliftwith BOTOX combination, 10U BOTOX diluted in a 5-ml
syringe (procaine +vitamin C or hyaluronic acid+multivitamins
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Energy Based Skin Rejuvenation
Wake Up Skin !!!!!!!!!!
Removing Injured collagen and elastic fibers and stimulates new
Collagen and elastic fibers synthesis by local, surgical or energy
based devices
What doctors trying to do is to give a wake up call to your skin
by removing injured collagen and elastic fibers ,encouraging your
fibroblast to synthesis new extracellular proteins. Mainly we can
do that with locally, surgically and with help of energy based
devices. These procedures target both intrinsic and extrinsic types
of aging
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Non Ablative Skin Rejuvenation
Delivers the laser/light/RF/Ultrasound energy through skin to
reverse the signs of aging skin
Non-invasive and minimally invasive skin rejuvenation, also
referred to as subsurface remodeling, include a wide spectrum of
non-ablative techniques to improve and reverse the signs of aging
skin without disruption of skin integrity, minimize downtime and
relatively low risk factors
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Non Ablative Skin Resurfacing
Non-ablative technology replaced traditional ablative systems
such as carbon dioxide lasers. Experience with non-ablative lasers
and light sources has proven that tissue enhancement without
epidermal disruption (thereby limiting adverse effects and
virtually eliminating postoperative recovery)
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Vascular
Pulsed KTP 532
Pulsed dye 585
LP PDL 595nm
532nm (ns)
IPL
Elos
Nd:YAG 1064nm &
Diode 1450
Erubium glass 1540
Pigmented
1064nm (ns, usec )
1320nm
Mid Infra red Lasers
Photorejuvenation
Non ablative light based technology are indicated for those
patients with early photodamage with fine lines, patients who dont
desire ablative treatment or those need maintenance therapy after
successful ablative one.T hey have modest expectation and tolerate
multiple treatments
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Indications of Non Ablative Skin Resurfacing
Early photodamage with fine lines
Patients who dont desire ablative laser treatment/downtime
As maintenance after successful ablative resurfacing
Modest Expectation
Tolerate Multiple treatments
Atrophic scars (Acne or others)
PhotoDynamic Therapy is performed in conjunction with a topical
application of ALA, or Levulan (aminolevulinic acid) to treat skin
damage in a softer, gentler way. PhotoDynamic Therapy delivers
specific wavelengths of intense light through very specific filters
to the skin.
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Photosensitizer
Red light
Infra-red light
LED
Laser
IPL
Photodynamic Therapy
We use Q-Switched Nd YAG laser 1064nm with Carbon Lotion in
induce mild peeling and some dermal remodeling
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Light Emitted Diode(LED)
Red LED for
Photo-rejuvenation
Blue LED
of Acne
LED, or Light emitting diodes, is a non-ablative procedure that
activates skin cells with pulses of low-level, non-coherent and
non-thermal light energy. LED red and infrared light delivers
powerful therapeutic benefit to living tissue. The action is
potentiated if combined with photosensitizer in photodynamic
Therapy
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Photo-Rejuvenation:
Activates skin cells with pulses of low-level, non-coherent and
non-thermal light energy
Infrared radiation may have beneficial effects on skin texture
and wrinkles by increasing collagen and elastin contents from the
stimulated fibroblasts. It helps to reduce inflammation during skin
healing
36
Photo-Rejuvenation-Elight or ELOS
Improvement in telangiectasia, pigmentation , pores sizes and
overall skin texture
Photo-Rejuvenation
Improvement in telangiectasia, pigmentation , pores sizes and
overall skin texture
Selective Non Ablative LASER:
Pigmented
Skin Laser
Age spots
532nmQ-switch Nd YAG
Pigmented Laser Surgery
Pigmented Laser Surgery
532nmQ-switch Nd YAG
Freckles
Pigmented Laser Surgery
Lentigens
532nmQ-switch Nd YAG
Pigmented Laser Surgery
Pigmented Laser Surgery
DPN
532nmQ-switch Nd YAG
Pigmented Laser Surgery
Pigmented Laser Surgery
Periorbital Darkening
Vascular Laser Surgery
Selective Non Ablative LASER
Vascular Laser Surgery
Facial Telangiectasia
Vascular Laser Surgery
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Vascular laser such as pulsed dye laser and pulsed 52nm KTP
laser alone or in conjunction of 1064nm AND
Vascular Laser Surgery
Facial Erythema
Longer wavelengths 1320nm,1450nm and1540nm lasers using water as
a chromophore demonstrated mild but reproducible improvement in
wrinkles reduction
Non Ablative Laser Skin Rejuvenation
Acne Scars
Non Ablative Laser Skin Resurfacing
Longer wavelengths 1320nm,1450nm and1540nm lasers using water as
a chromophore demonstrated mild but reproducible improvement in
wrinkles reduction
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Acne scar with non ablative
RF-Mono-polar
Non Surgical Skin Tightening
Generating local heat in the tissue by high frequency electrical
current.
Radiofrequency
Monopolar
Bipolar
Fractional
Dual
Tripolar
Who will benefit from Radio-lift?
Tissue tightening is not meant to replace surgical procedures
such as face, eyelid and neck lifts, but it is good option for
people who have mild to moderate changes and who understand that
the results are noticeable but modest or those patients who are
afraid of a major surgery, those who are still too young for it,
and those who are poor surgical candidates.
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Patient with Mild to Moderate skin changes
Patient with Modest Expectation
Patient afraid from surgery
Patient too young for it
Patients who are poor surgical candidate
Before
At the End
3ms after
J Am Acad Dermatol 2011;64:524-35.
Significant clinical improvement of skin tightening and wrinkles
reduction
All 6 volunteers completed the monopolar RF study, and showed
clear clinical improvement of skin tightening and rhytides
reduction. At each end point before, at the end of, and 3 months
after treatment),
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Before
At the End
3ms after
Significant improvement in skin tightening and
reduction in the nasolabial folds
The same for nasolabial folds At each end point (before, at the
end of, and 3 months after treatment),
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Radiolift: Non Surgical Skin Tightening
Radiolift: Non Surgical Skin Tightening
Radiolift: Non Surgical Skin Tightening
Radio-lift: Skin Tightening
Non Surgical Neck Lift
Ablative Skin Resurfacing (Rejuvenation)
Ablative techniques broadly grouped as mechanical, chemical, and
laser or thermal abrasion. First, the outer layers of damaged skin
are stripped away. It result in upper to mid-dermal wound. Then, as
new cells form during the healing process, a smoother, tighter,
younger-looking skin surface appears.
.
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Dermabrasion
Chemical Peel
Ablative Laser
Spot Dermabrasion
It is effective procedure for the treatment of photodamage, acne
scarring, and scarring from surgery or trauma
Spot Dermabrasion
Acne Scars
Ablative Medium Depth TCA-Chemical Peel
One Week Post Op
2 days Post Op
Stage III TCA
Ablative Medium Depth TCA-Chemical Peel
Freckles
Medium Depth TCA Peel
Melasma
Medium Depth TCA Peel + PRP
Medium Depth TCA Peel + PRP
Melasma
Medium Depth TCA Peel
Post Acne
Freckles
Medium Depth TCA Peel
CROSS TCA Peel
Acne and chicken pox scars
Application of TCA to the skin causes precipitation of proteins
and coagulative necrosis of cells in the epider mis and necrosis of
collagen in the papillary to upper reticular dermis. Over several
days the necrotic layers slough and the skin re-epithelializes from
the adnexal structures that were spared from chemical damage.
Dermal collagen remodeling after chemical peel may continue for
several months.
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Ablative CO2 Laser Resurfacing
Acne Scars
Multiple modalities have been described for skin
photorejuvenation, including ablative, non-ablative and fractional
laser resurfacing which fills the gap between the ablative and
non-ablative modalities
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Ablative Laser Skin Resurfacing
Ablative Laser Skin Resurfacing
Ablative Laser Skin Resurfacing
Acquired Moles
Ablative Laser Skin Resurfacing
Ablative Radiosurgery
DPN
Thermally alter a fractions of the skin , leaving intervening
areas of normal skin untouched giving results similar to ablative
laser resurfacing in less down time
Fractional Laser Skin Resurfacing
Ablative Fractional Laser Skin Resurfacing
Ablative Fractional Laser Skin Resurfacing
Fractional Ablative Laser Resurfacing
Ablative Fractional Laser Resurfacing +PRP
Ablative Fractional Laser Resurfacing+ PRP
Ablative Fractional Laser Skin Resurfacing+ PRP
Faster healing time and fewer side effects on the expense of
degree of improvement in photo-damage when compared with ablative
CO2
This is type of result you can get with fractional ablative co2
laser
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It is time to dive into your skin
Transdermal Drug Delivery System
Transdermal Drug
Delivery System
No needle mesotherapy or Electroporation
It creates spaces (pores) between the cells that allow the
passage of active ingredients (anti-acne, whitening) painlessly
No needle mesotherapy or Electroporation
It creates spaces (pores) between the cells that allow the
passage of active ingredients (anti-acne, whitening) painlessly
No needle mesotherapy or Electroporation
No needle mesotherapy or Electroporation
Post inflammatory hyperpigmenation
No needle mesotherapy or Electroporation
MSI Skin Rejuvenation Program
It time to Sooth, Calm and Moisturize
and Apply Sunblock
Oxygen Therapy
Reduce the effects of aging by actually nourishing the skin with
essential vitamins, minerals, amino acids, enzymes, and pure
oxygen.
It can be used post surgery to speed healing process.
Oxygen levels in the skin decrease with age which results in the
appearance of fine lines, wrinkles and poor skin elasticity. Oxygen
Therapy replenishes lost levels by pulsing oxygen deep into the
skin, rejuvenating and restructuring skin
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Are made to suit different skin types (e.g., oily or dry), and
different skincare goals or needs (e.g., moisturizing, cleansing,
exfoliating).
Facial Masks
Photo-Rejuvenation
A non-ablative procedure that activates skin cells with pulses
of low-level, non-coherent and non-thermal light energy. LED red
helps to calm the skin after cosmetic procedures
LED
LED, or Light emitting diodes, is a non-ablative procedure that
activates skin cells with pulses of low-level, non-coherent and
non-thermal light energy. LED red and infrared light delivers
powerful therapeutic benefit to living tissue. The action is
potentiated if combined with photosensitizer in photodynamic
Therapy
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MSI Rejuvenation
Complimentary Procedures
Botox
FILLERS
Threads
Fat
The Art of Liquid Face Lift
Botox
BoNTA-ONA; Botox, Botox Cosmetic, Allergan, Vistabel,
Vistabex
What to Inject?
BoNTA is available as onabotulinumtoxinA (BoNTA-ONA; Botox,
Botox Cosmetic,, Vistabel, Vistabex) contains the 900-kD a
neurotoxin complex protein.
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Where to inject?
Glabella (frown Lines )
Supraciliary wrinkles
Crows feet
Bunny Lines
Lip and Perioral
Nasolabial fold
Dimpled chin
Forehead
Nefertiti
Neck (platysma)
Small intramuscular or intradermal doses of BTX-A eliminated
hyperkinetic facial lines for approximately 6 months. These include
forehead lines, glabellar lines, supraciliary wrinkles, lateral
canthal wrinkles (crows feet), bunny lines, lip and perioral
wrinkles, nasolabial fold, dimpled chin, neck lift and platysmal
bands elimination
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B
Glabella or Frown Lines
B
Bunny Lines or Nasal Wrinkles
Lower Eyelids Wrinkles and Widening Eye Aperture
1-BTX Smoothens Inferior Wrinkles
2-Widens Eye Aperture
3-Treat Dennie Morgan Folds
The injection of BT-A into the inferior pretarsal orbicularis
can smooth this inferior wrinkles and widen the eyelid aperture
Furthermore, benefit may lie in the reduction of stigmatizing
Dennie Morgan folds in subjects with atopic dermatitis
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Medical Rhinoplasty
2U-4U on the nasal spine deep injection
often with fillers at nasolabial fold
Droop Nose Tip
Surgery
Botox
Fillers
Upper Lip Wrinkles
Rosebud Mouth
1-U at Four Points 1.5cm Away from the Corner of the Mouth
Superficial at the vermillion. Treat the lower lip on the same
session. Better in Combination with Filler and Resurfacing
PERIORAL LIP RHYTIDES
The lips are central to the appearance of the lower face. During
aging, the lateral portions of the lips recede, resulting in a
rosebud mouth. At the same time, the distance between the columella
and the vermilion border of the upper lip increases and the
substance of the vermilion rolls inside, producing the thin and
disappointed lips that are characteristic of old age.
Vertical lines of the upper lip are a strong sign of aging.
These vertical lines are commonly labeled as smokers lines but can
also result from heredity, photodamage, playing a musical
instrument that requires embouchure, or even whistling. Patients
often are disturbed by the increased vertical length of the
cutaneous lip and by the radial upper lip lines that can cause
lipstick to bleed upward from the lip and blur the outline of the
lip
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Contouring of the Lower Face
1-5 sites total 18U-30U IM with 30 gauge needle
With volumizing filler at mid face
1-Hyper trophy of Masseter Muscle
Not an MSI patient
Two or three horizontal necklace lines of skin indentation are
caused by the superficial musculoaponeurotic system attachments in
the neck. We feel that the simplest approach is to dance along the
lines injecting small doses of botulinum toxin over multiple sites.
Aliquots of 1 to 2U are injected in the deep intradermal plane
avoiding the deeper venous perforators that can bleed and the
underlying cholinergic muscles of deglutition, at approximately
1-cm intervals along the horizontal neck lines to soften and erase
them. Not more than 10 to 20U is injected in one treatment session
If the neck is gently massaged afterward, the skin usually does not
bruise
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Nefertiti Face Lift
2-3 BTX along and under each mandible and to Upper part of
the post platysmal band for a totoal of 15-20 U each side
Neck Enhancement
Platysmal Bands
Click to edit Master text styles
Second level
Third level
Fourth level
Fifth level
Fat Transfer
The Art Of Liquid Face Lift
By
Prof. Osama B Moawad
The Fact is as we Age.
Fat Redistribute
To Revers Ageing
We have to fill the volume loss and remove the fat excess
Using fat grafting cosmetic units are smoothed and lost balance
between skin and underlying fatty tissue can be restored by
rebuilding primary youthful arc and convexities. However,
hypertophic fatty deposits in jowls and sub-mental areas are
managed with microliposuction
122
Numerous natural, synthetic, and mixture materials have been
utilized as adipose tissue substitutes
123
Permanent
Fillers
Temporary
Fillers
What to Fill (Volume Surgery)
Fat
Transfer
Autologus
Plenty
Low cost
Expensive
Unforgivable
Immune
Reaction
Expensive
Temporary
?Permanent
Superficial
Implants
Non dynamic
Hard
Gaunt Look
Non Living
Filler is deposited Superficially
The Art of Liquid Face Lift. Fat vs Fillers?
Fat is Deposited Deep.
Unlike other fillers successful fat grafting is grafting of
Living Tissue.
The Art of Liquid Face Lift. Fat vs. Fillers?
Filler
Fat
Wrinkles
Soft Tissue defect
Correct the defect with its appropriate weapon
126
While synthetic fillers can smooth out wrinkles and folds
(superficial), it cannot restore fullness (deep)
The Art of Liquid Face Lift. Fat vs. Fillers?
The Art of Liquid
Face Lift
Dermal Fillers
What to Inject?
FDA Approved Fillers
12/18/2009
MSI Rejuvenation
130
Where to Inject?
I reserve the use of temporary fillers to lips and nose and
sometime as a quick fix before important occasion with no time for
fat grafting
130
B
Post Blepharoplasty
Dermal Fillers
Dark Circles
Dermal Fillers
Dermal Fillers
Non Surgical Nose Job
Dermal Fillers
Non Surgical Nose Job
B
Aging Lips
Lip Augmentation
A
B
Acne Scars
Dermal Fillers
Fat Transfer
The Art Of Liquid Face Lift
By
Prof. Osama B Moawad
What is Fat Transfer, Fat Injection, Fat Graft and Autologous
Fat?
Getting rid of your own fat and then injecting it in your
wrinkles to eliminate them does sound like the best of all
world!!!
A
The Art of Liquid Face Lift. Fat
The Art of Liquid Face Lift. Fat
A
The Art of Liquid Face Lift. Fat
The Art of Liquid Face Lift. Fat
The Art of Liquid Face Lift. Fat
A
The Art of Liquid Face Lift. Fat
The Art of Liquid Face Lift. Fat
Acne Scars
Moreover Fat can be injected in large quantities not only as a
filler but as a natural lifting material in nearby sagging . We can
achieve the same results for six-nine months using synthetic
material costing him more than 20.000 pound
152
12/17/2009
Acne Scar
153
The Art of Liquid Face Lift. Fat
Acne Scars
The Art of Liquid Face Lift. Fat
The Art of Liquid Face Lift. Fat
The Art of Liquid Face Lift. Fat
The Art of Liquid Body Lift. Fat
Thread Fat Lift
The Art of Non Surgical Face Lift
Patient Instructions
The patient is given post procedural instructions
according to his tailored program
Botulinum toxin products have been approved by FDA for one or
more of the following uses: temporary improvement in the appearance
of glabellar lines (frown lines), treatment of strabismus (crossed
eyes), blepharospasm (abnormal tics and twitches of the eyelids),
cervical dystonia (involuntary sustained or repetitive contraction
of the neck muscles), and Primary axillary hyperhidrosis (severe
underarm sweating). BoNT-A is widely used today for both cosmetic
and non-cosmetic purposes.
161
Sun Protection is a Must!!!!!
Avoiding photoaging is more cost effective than trying to
reverse the sign of photoaging
Sun protection should include attitude to avoid sun exposure
espeically form 10-4pm ,one should wear protective clothing and
apply sun block every 2hours
162
Retinoid is the second cost effective tool we have to prevent
photo aging and treat aging, antioxidants. Estrogen, cytokines and
growth factors are all promising
163
Retinoids
Antioxidants
Growth factors
Cytokines
Estrogen
Whitening
Moisturizer
MSI Skin Rejuvenation Program is
A High Tech Comprehensive
Age Reversing Program Tailored to your Needs
and Goals
