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(BQ) Part 2 book Cosmetic medicine & surgery has contents: Intense pulsed light, photobiomodulation and light-emitting diodes, laser and pigmented (melanotic) lesions, photodynamic therapy for aesthetic indications,.... and other contents.
Copyright Material – Provided by Taylor & Francis Review Copy – Not for Redistribution MEDpress-Inform Publishers, 1-3-4/H, build.1, Kochnovsky proezd, RC "Aerobus", 125319 Moscow, Russia 37 Intense pulsed light Hugues Cartier, A Le Pillouer-Prost, and Saib Norlazizi TECHNICAL ASPECTS Principle of Operation: Light, Laser, and Intense Pulsed Light For practical purposes, we can use a color coding system to identify optical filters to be used for specific indications (Figure 37.4): Electrical Energy and Optical Spectrum The main difference between a laser and an intense pulsed light (IPL) is physics: the first one emits a coherent, monochromatic light (one wavelength measured in nanometers [nm]), whereas the second emits a polychromatic, noncoherent light (a spectral band, e.g., from 550 to 950 nm) The wavelength of a laser can be drawn as one color, whereas the spectral band of IPL is composed of all the colors of the rainbow (Figure 37.1) Flashlamps or IPLs are discharge lamps of high intensity filled with a noble gas, mostly xenon, most rarely krypton These light sources produce an optical radiation when an electric current is passed through the ionized xenon gas at high pressure IPLs are very efficient and convert over 70% of electrical energy into light, compared to the best laser efficiency of 17% produced by CO2 lasers The intense radiation of these lamps has been utilized in various medical and nonmedical applications: optical pumping of laser systems (Nd:YAG, dye lasers, Q-switched lasers, frequency-doubled lasers 532 nm, etc.), simulation of solar radiation, absorption measurement or fluorescence, photocopy units, stroboscopes, and IPLs themselves The glass or quartz of the flashlamp is made up of cerium or titanium dioxide The two triggering electrodes are embedded in the flashlamp structure and polarized (anode +, cathode −) Optoelectronic detection systems are used to determine the emission spectrum in a qualitative and quantitative manner Apart from the use of optical filters, spectral emission varies according to the electrical energy inducing the intense light emission Low electrical energies generate a high predominance of infrared (IR) light peaks within the spectral emission Higher electrical energies induce a progressive shift towards light peaks located within the shorter wavelengths of the spectral emission All flashlamps modify their light emission according to their progressive decay; therefore,regular device service maintenance is recommended IPL systems need to limit their emissions to interact with selective skin targets Specific cutoff optical filters can be used to reduce spectral bands suitable for selective indications (Figure 37.2) The short-wavelength filters are generally used for vascular targets (Figure 37.3) such as thin and light-colored hairs, light-pigmented lesions, etc Higherwavelength filters are used for epilation particularly in darker skin types • • • • • Blue—acne Green—vascular and pigmented (short-wavelength filter will be more selective on lighter and superficial targets such as sunspots or very thin veins, but this filter has the highest risk for burning and is therefore harder to handle) Yellow—vascular and pigmented (may be a little less efficient but safer, especially for beginners) Orange—vascular or pigmented (photorejuvenation and epilation of light skin types and scars) Orange red—epilation and scars Laser beams are collimated and can concentrate a high intensity of specific photons in relatively small areas The same light–tissue interaction can be applied to larger areas when scanners are used IPL systems are able to irradiate relatively large anatomical areas (up to cm2) with a noncollimated multiwavelength spectral band able to interfere with multiple targets at the same time The light source needs to be positioned as close as possible to the skin surface to optimize clinical effects Clinical effects depend on modulation of IPL emission Proper pulse durations, pulse repetitions, and interpulse delays need to be selected to generate specific photothermal effects IPL timings range from 0.5 to 100 ms, and the tissue effects are only of two orders: photothermal or photochemical with low irradiance The tissue interactions are based on the principle of selective photothermolysis, which does not require a monochromatic irradiation but only an incident beam that can be selectively absorbed by the target chromophore To juggle effectively with the pulse durations, the pulse train, and the pulse delays, we must have some basis and understand well the notion of thermal relaxation time (TRT) of biological targets and surrounding tissue to use the principle of photothermolysis As a refresher, TRT corresponds to the time required for heat to conduct away from a directly heated tissue region It represents the time taken for heated tissue to lose 50% of its maximum heat through diffusion The parameter settings are therefore the same as for lasers: the adaptation of the pulse widths and pulse delays to the respective TRT of the target chromophores and surrounding tissue for a selective action and safeguard of surrounding tissue The aim of the pulse train is to improve the selectivity; therefore, instead of emitting a single wide flash of light, we progressively increase, in steps, the temperature of the target tissue and at the same time protect the adjacent tissue that has a different TRT and cools faster between pulses This is even more important for darker skin type (Figure 37.5) Copyright Material – Provided by Taylor & Francis Review Copy – Not for Redistribution MEDpress-Inform Publishers, 1-3-4/H, build.1, Kochnovsky proezd, RC "Aerobus", 125319 Moscow, Russia 4 3.5 3.5 3 2.5 2.5 Intensity Intensity 378 AESTHETIC AND COSMETIC PRACTICE 1.5 1.5 1 0.5 0.5 600 700 800 Wavelength (nm) 900 1000 Figure 37.1 IPL spectrum is a polychromatic irradiation and not monochromatic like laser Technical innovations are always developed and implemented in IPL technologies The most recent focused on the following: Stabilization of electrical pulsing, obtainable when partial discharge of the capacitors is activated This important technical achievement can be generated only when high 800 900 1000 Figure 37.3 Typical spectral response of light emission by a green filter 495–950 nm Figure 37.2 IPL handpieces (size 5–22 cm2) and six different filters New Technologies 700 Spectral repsonse— 495 pulsar filter • Even if the mode of operation of IPL technology is univocal, the systems commercialized for medical applications are very diverse, with multiple, more or less, differences making them totally incomparable The most common technical variations can be found in the lamp arc length, gas pressure, electrode quality and shape, glass material (Figure 37.6), thickness of the quartz, power, sealed or nonsealed joints, filters, and cooling system (water or air cooled), water cooling does indicate that far-IR wavelengths are blocked at the lamp end and the tissue effect could be totally different between the two systems of this category 600 Wavelength (nm) Spectra • • • • • voltages and high electric bank capacitors are used The end result will consist in a more stable spectral band emission during each IPL pulse Some manufacturers prefer keeping these specifications and not stabilize the electrical pulsing Optical filters The quality of filters is important; dichroic filters tend to deteriorate with use and are prone to develop hot spots (where the optical coating comes off), thus exposing partial segments of the exposed isolated spots irregularly distributed on the target area to the full spectrum of light of the lamp and therefore to superficial burns (Figure 37.7) Plain glass filters can break or become cloudy, thus the need to check the filter visually or test it using photosensitive paper (Figure 37.8) The spectral band used for each treatment is chosen spanning from UV to IR, which is lamp emission, except “fluorescent” filters The use of fluorescent polymer filters helps convert short and more deleterious wavelengths into more useful light We can therefore reduce the voltage applied to the lamp while keeping an intense emission in the desired area of the spectrum and prolonging the lamp life and efficiency (30%–50% of the unusable shorter wavelengths can be “reconverted” by the use of these filters) Calibration Most of the new IPLs are equipped with a system of calibration (Figure 37.9) This is particularly important as we have, for a long time, blamed these lamps for their lack of reproducibility in time, but some end users (practitioners) prefer investing in a calibration system outside the IPL, which is more reliable and covers the totality of the crystal The handpieces From large to small Pulse delivery: single pulse, pulse train, pulse delays Cooling systems Before the advent of efficient cooling systems, it was practical to use thick layers of cold gel The thickness of the layer of gel and the force applied by the user with the applicator on the treatment area could result in significant variations in the light energy transmitted to the area treated The emergence of sapphire-based cooling system or special quartz (BK7) (Figure 37.7), via cryospray or pulsed cold air, is one of the major improvements to Copyright Material – Provided by Taylor & Francis Review Copy – Not for Redistribution MEDpress-Inform Publishers, 1-3-4/H, build.1, Kochnovsky proezd, RC "Aerobus", 125319 Moscow, Russia Intense pulsed light 379 Short wavelengths UV Blue Long wavelengths Green 515 nm Yellow Orange Red 610 nm 550 nm Infrared 950 nm Hair removal Photorejuvenation Vascular and pigmented Capacitor voltage Energy (J) Figure 37.4 Spectrum of flashlamp emission High energy Medium energy T1 T2 500 V 400 V Time (ms) 100 V drop only Time (ms) T1 = Time ON (from ms) T2 = Time OFF (from ms) Figure 37.5 Multipulse radiation for an optical light emission and the drop of voltage and energy delivery by a capacitor CLINICAL ASPECTS It is difficult to give “overall” results because we have widely detailed earlier that IPLs are very different in their specifications (make) and their results are not comparable Depilation Field Figure 37.6 Deteriorate dichroic filter IPLs (+++ improvement ratio: efficiency/safety) Of course, the filter quality, the spectral range, the energy conversion and the pulse duration, and pulse train/delay are to be considered all around Some machines privilege the diversity of filters for best absorption to the target area, while others concentrate on the setting of pulse number and duration Some IPLs both, but this means the end user has to be specially trained on the particular machine they are going to use, to ensure the total understanding of the IPL and ensure the repeatability of the treatments from one patient to another Some machines use a skin analyzer to set the treatment parameters automatically for the application Recognized and authorized by the FDA since 1997, epilation by IPL has largely proved itself clinically For the parameters, after analyzing the hair type (thickness, color), skin type, and area of treatment, we use different energy densities, ranging from to 20 J/cm2 for some IPLs, 30 to 45 J/cm2 for others, 15 to 40 ms for pulse durations depending on the thickness of the hair to a single pulse or by a train of pulses (3–7 pulses with delays of 1.5–50 ms), etc All these possible settings permit a high precision and adaptation possibilities for each patient and for the repeat treatments for the patient to the miniaturization and lightening of the hair The first filter of choice depends on the skin type and color of the hair; we select shorter-wavelength filters for light hair on light skin (between 500 and 550 nm) and higher-wavelength filters (550–755 nm) and/or fractional pulses for darker skin types In fact, lighter hair contains essentially pheomelanin, which has an absorption curve shifted toward the shorter wavelengths compared to eumelanin in darker hair/skin type When using shorter-wavelength filters on lighter skin–type patients, of course, we can expect some very good results from blondes and mousy blondes or those who were blonde/mousy blonde when they were children In general, we not treat skin types higher than IV, but some clinical publications have shown the possibility to treat higher skin types V and dark Asians by using filters above 645 nm and to fractionize the pulses with long pulse delays Finally, while Copyright Material – Provided by Taylor & Francis Review Copy – Not for Redistribution MEDpress-Inform Publishers, 1-3-4/H, build.1, Kochnovsky proezd, RC "Aerobus", 125319 Moscow, Russia 380 AESTHETIC AND COSMETIC PRACTICE 100 90 80 Transmission (%) 70 60 25°C d.t at 15 µm 50 40 30 20 10 300°C 0.1 0.2 0.3 0.6 1.0 Wavelength (µm) UV grade fused silica, mm Semiconductor grade fused quartz, mm Germanium, mm at 25°C and 300°C Soda lime (BK7), mm Borosilicate, mm Sapphire, mm Acrylic, mm Figure 37.7 Different types of quartz to filter light emission Figure 37.8 Plain glass filter the actual mode of operation was leaning toward high-energy densities to stop the regrowth of simply miniaturized hair, recent publications question again the possibility of using energy densities [1] To optimize the results on lighter hairs, we can use IPLs that are combined with radio frequency (RF); the publication results are optimistic at the moment but rare and with very low levels of proofs The French Laser Group User’s opinion seems quite homogenous: interest for light, thin hairs, and small areas as the handpieces are small but no results on thick white hairs It appears to be a good tool in complement to a laser or a depilation IPL of reference For the results, the average session for long-lasting (durable) depilation varies between and depending on the skin type, hair color, treatment area, age, sex, and, of course, hormonal status Maximum efficiency is achieved mainly in the first three treatments (Figure 37.11) After one treatment, all hair types and skin types all mixed, literature numbers indicate an average reduction of hair of 52% at 12 weeks for IPLs, maintained around 40%–75% at or 12 months depending on the equipment The clinical cases or short tests reported after multiple sessions Figure 37.9 Calibration system on the back of an IPL device of photoepilation by IPL give a very interesting and lasting result of 75%–80% efficiency, after five sessions on average We will not detail all these series, but we will specify two female patients who suffer from hirsutism and have shown recently the efficiency of IPLs [2,3], and two other comparisons with laser (with correct scale) have not displayed significant difference between the Copyright Material – Provided by Taylor & Francis Review Copy – Not for Redistribution MEDpress-Inform Publishers, 1-3-4/H, build.1, Kochnovsky proezd, RC "Aerobus", 125319 Moscow, Russia Intense pulsed light 381 machines [4,5] The comparative study of Mc Gill in 2007 was, by contrast, much in favor of alexandrite laser compared to IPL used [6] It is therefore difficult to conclude scientifically A Part: IPL and Medical Indications of Depilatory Lasers Approved trials, supporting small sets, have also been made available for applications that are more medical: pseudofolliculitis of the beard, hidradenitis suppurativa, prevention of recurring cyst of the pilonidal sinus, depilation of grafted or torn areas, or depilation après surgical removal of melanocytaire naevus As with other depilation lasers, the emphasis is at the end of the literature, for an overall takeover of medical patient’s care, with a better understanding of hyperandrogenism The consensus concerning the assessments to be achieved and the therapeutic management of hirsutism must be known by the medical staff practicing laser depilation The concomitant prescription of metformin, strongly recommended in the prevention of metabolic problems associated with polymicrocystic ovary syndrome, seems to increase the success of depilation as this has been reported for the first time by an Iranian team using IPL [7] Among the patients with polymicrocystic ovary syndrome, obesity is correlated with the severity of hirsutism, and these obese patients had needed more depilation treatments with IPL than the nonobese ones; from a recent second lot of patients [8], this can help us in a better way of informing our patients In practice, the treatment area has to be shaved, and a clear ultrasound gel is applied to the area to help with the light transmission A small pressure is applied to the skin with the crystal, and the handpiece is moved with an overlap to the adjacent area for the next treatment and again till all the area has been treated The immediate effect that we are looking for is an expulsion of the hair or at least a modification of the hair (dilation of the stem) and, in a few minutes, the appearance of follicular papules The pulling of the hair with a pair of tweezers without any skin resistance is enough to prove the inefficiency of the light pulse The patients feel a brief heat sensation or burning sensation that diminishes in the following few minutes (otherwise we need to reduce the energy) The eventual immediate effects of harmful burn for the tests are delayed; we therefore need to wait several minutes (watch in hand 7–10 minutes) to judge the validity of the parameters used Contraindications are basically suntanning and spray tanning and dark skin types that increase the risk of burns and their resulting scarring (scars, dyschromia) Photosensitizing medication is contraindicated if there is a dermal accumulation with a peak absorption corresponding to the spectral range used In other words, there is no contraindication for photoepilation on a patient taking cyclin, for example, as his/her peak absorption will be in the UV and not in the visible light spectrum emitted by IPLs Treatment of pregnant women is regularly discussed in our French congresses, and there is no more risk of paradoxical regrowth or risk of light diffusion for the baby in utero with regard to the penetration of the photons that are absorbed by the skin and cannot go beyond the hypoderm and even less in the uterine muscle or amniotic fluid There are two types of specific secondary effects in depilatory condition: Leukotrichia The study of Radmanesh [9] on 821 patients treated for unwanted hairs by intense flashlamp finds only 29 cases of leukotrichia, 0.04%, which is very low compared to lasers Paradoxical stimulation But very little studies or reports are certainly possible, as with lasers, in the literature Always inquire about hormonal anomalies beforehand and spot patients at risk (hirsutism, polymicrocystic ovary syndrome, hyperandrogenism in general, back of young men, period of hormonal instability of women, and, therefore, surely not during pregnancy because the production of oestroprogestatifs protects them against this situation) A recent article reported a paradoxical stimulation rate of 5% on 991 patients, of overall high skin type as these were Iranian women with hirsutism; this looks quite low taking into context the hormonal side [9] In conclusion, the great adaptability to different skin types, hair color, and hair thickness is one of the major key features of IPL compared to lasers in the field of depilation For the same patient, we can start with a medium filter and long pulses and then change during the next sessions to a shorter-wavelength filter and smaller pulses to adjust to the progressive miniaturization of the hair By using highly adapted filters and fractionizing the pulses, we can treat skin types I–V, instead of having to use several lasers In one of its latest publications Laser versus IPL: Competing Technologies in Dermatology, Ross, in 2006, identified the advantages and disadvantages of each of the two technologies, laser and IPL, and the chosen example in the discussion to show that they can be interchanged with lasers in certain fields is epilation” [10] This is what we have focused on in France for many years It is later recognized by North American experts, and IPLs have started to outmatch poor man’s lasers (Figures 37.10 and 37.11) Vascular Field For the theory, with a filter called “vascular” that is determined by a spectral range from 500 to 1000 nm, there are more than 500 monochromatic light lasers that are used Unfortunately, physics is not the medical clinic, and it happens to be difficult to obtain reproducible results with IPLs than with vascular lasers A mathematical model study by Wolfgang and colleagues in 2007 is, however, very contributory [11], with a filtered band of Figure 37.10 Neck depilation with IPL 610–950 nm triple pulse 20 J/cm2 Copyright Material – Provided by Taylor & Francis Review Copy – Not for Redistribution MEDpress-Inform Publishers, 1-3-4/H, build.1, Kochnovsky proezd, RC "Aerobus", 125319 Moscow, Russia 382 AESTHETIC AND COSMETIC PRACTICE Figure 37.11 Neck depilation after three sessions of IPL 500–1000 nm, 15–30 J/cm2, and veins of 60–500 µm diameter, situated at a depth of 1.2 mm: • • • • • It is difficult to go over the 70°C necessary for the veins inferior to 60 µm It is therefore easier to treat with an IPL the telangiectatic vessels that are diffused by erythrosis For the vessel smaller than 150 µm, we need pulse durations inferior to 10 ms and energy densities of at least 15 J/cm2 The thinner the vein, the smaller the pulse and the higher the fluence For larger veins over 500 µm, we need a longer pulse of 10–30 ms and a fluence of at least adapted fluency It is better to use at first short-wavelength filters around 500 nm for thin veins and filters a little longer (more than 550 nm, even near IR) for larger vessels Integrated cooling systems protect the skin from burns but reduce the efficiency of the treatments by IPL the more the vessel is thin The IPL indications in this field are those of vascular lasers in general; a large number of publications dating back over a decade talk of good to very good results on all type of couperosis, ruby spots, stellar angiomas, and planar angiomas particularly thicker and older For poikiloderma of Civatte or erythrosis colli, IPLs are equally referred to in many publications With a new pulse delay less than 1.5 ms or new double broadband of wavelengths, it is now possible to approach the result of the vascular gold standard represented by pulsed dye laser (PDL) Faurschou et al have published a comparative study of PDL versus IPL on planar angiomas They concluded that the lightening with PDL is superior to 65% against 30% with IPL but mentioned, however, that IPL is perhaps more interesting on thicker angiomas or nodular forms Thanks to its wide spectral band and long wavelengths, IPL permits a stronger penetration and a stronger thermocoagulation effect on deeper vessels [12] In a 2009 study comparing many machines (alexandrite, Nd:YAG LP 1064, IPL) for the treatment of resistant planar angiomas, IPLs were in a very good position, taking into consideration the ratio efficacy/safety obtained [13] Nuehaus and colleagues compared PDL with IPL for erythrocouperosis rosaceiform on 22 patients, sessions monthly spaced, and the results using spectrophotometric measurements of the erythema did not show statistically significant difference between the types of machines; besides the decrease in erythema, they report an improvement in skin texture, itchiness, and flushes The patients indicated a preference to the PDL in the majority of cases relating to the treatment of pain as new PDLs are equipped with cooling tips, but the preference does not relate to posttreatment or results [14] For us, these series stay isolated, and it is admitted by a large majority of practitioners that vascular lasers are king in their field and that it is much more difficult to obtain reproducible results by laser with IPLs, especially in the hands of a new user It takes the use of a “powerful” machine, with many filters, and a lot of experience with the machine to set the optimal parameters A test patch allows a quick estimation for the achievable result of the indicated condition But be careful; this is only true for light skin type, and it is virtually impossible to treat vascular disorders on skin types above III with IPL without the risk of skin blistering We notice as well an improvement in skin said to be reactive, often affected with seborrheic dermatitis and rosacea, probably by various mechanisms (reduction of the lymphocytic infiltrate, reshuffle of procollagen III, reduction of vascular network, or the destruction of Demodex) In phlebology, the results are unpredictable Some studies show certain interest for IPLs, but the majority of the authors agree to writing of sclerosis, and the Nd:YAG stays the valued one IPLs can sometimes finish off the treatments for the following: • • Thin red vessels or violet ones with no evident connections with nearby reticular veins The “red socket” syndrome (Figure 37.12) It is necessary to be careful when working with the inside of the thigh and on the knees as the skin is very thin, and it is very difficult not to cause a mechanical vasoconstriction during treatment In practice, avoid pressing the crystal onto the skin when in vascular treatments (in epilation, we actually press down onto the skin) and just touch the skin, thus avoiding the mechanical vasoconstriction This is harder to achieve with heavy handpieces You just have to juxtapose the area of flash and be flat on the skin Ideally, even slightly lift the skin, which is stuck via the gel to the crystal (this is called floating) Some systems supply handpieces with smaller crystals (pointy) for an easy access to the curve areas of the face and reduce the pain (Figure 37.13) It is important as well to avoid Figure 37.12 Specific triangular IPL handpiece for ruby spot Copyright Material – Provided by Taylor & Francis Review Copy – Not for Redistribution MEDpress-Inform Publishers, 1-3-4/H, build.1, Kochnovsky proezd, RC "Aerobus", 125319 Moscow, Russia Intense pulsed light 383 Figure 37.13 IPL 495–950 15 cm2 20 ms spot 10 mm2 for a treatment of leg red sock Figure 37.15 Dramatic improvement of couperosis weeks after one session of IPL Figure 37.14 Major face couperosis before treatment with green filter 495–950 nm 11 J/cm2 10 ms monopulse vasoconstriction of the topical anesthesia and ice packs; these reduce as much “red target”; some use local anesthesia, a cooled handpiece, or a cold spray For example, look at the reduction in one session by IPL of a major telangiectasia couperose (Figures 37.14 and 37.15) or improvement of a more classic facial telangiectasia (Figures 37.16 and 37.17) And you can expect an improvement on a papule rosacea after few sessions with IPL, and IPL is also well known to be the gold standard for erythrosis colli (Figures 37.18 through 37.25) Figure 37.16 Couperosis before treatment with green filter 495–950 nm 11 J/cm2 monopulse 10 ms Pigmented Field Before the advent of lasers, pigmented lesions were treated by cryotherapy, medium peels, or aggressive mechanical/chemical dermabrasion It has turned out that IPLs are a credible alternative to Q-switched or frequency-doubled (Nd:YAG), alexandrite, or ruby lasers We must pay attention when using IPL on certain skin types, particularly Asians, and be prepared for noticeable/expected secondary effects due to postinflammatory hyperpigmentation but also severe complications of achromatic type of scars, and we advise variable spectral ranges (450–950/1200 nm) with 2–3 pulses and variable pulse durations depending on the machine (5–10 ms, sometimes fractioned into pulses) much longer than the TRT of the melanosomes and nearer the TRT of the epidermis (10 ms) If in theory IPLs are much less adapted than Q-switched lasers because their pulse duration varies from to 10 ms, while the TRT of melanosomes is 50–280 ms [15]), in clinical practice, we manage to go round the physics principle with fractioned pulses, efficient cooling systems of the epidermis, and the choice of a good spectral band (Figures 37.26 through 37.31) A fundamental controlled study was conducted in 2006 with sophisticated Copyright Material – Provided by Taylor & Francis Review Copy – Not for Redistribution MEDpress-Inform Publishers, 1-3-4/H, build.1, Kochnovsky proezd, RC "Aerobus", 125319 Moscow, Russia 384 AESTHETIC AND COSMETIC PRACTICE Figure 37.20 The result year after one session of IPL on facial erythrosis Figure 37.17 Dramatic improvement weeks after one session for a couperosis on phototype I Figure 37.21 Rosacea before IPL 515–950 nm 15 J 15 ms Figure 37.18 Classic erythrosis and rosacea before IPL Figure 37.19 The result 10 weeks after one session of IPL 495–950 nm 18 J 15 ms on facial diffuse erythrosis Figure 37.22 Rosacea before second session with IPL 495–950 nm 15 J 15 ms Copyright Material – Provided by Taylor & Francis Review Copy – Not for Redistribution MEDpress-Inform Publishers, 1-3-4/H, build.1, Kochnovsky proezd, RC "Aerobus", 125319 Moscow, Russia Intense pulsed light 385 Figure 37.23 The result weeks after the second session of IPL on a papulorosacea Figure 37.25 The result after one session of IPL 515–950 nm 18 J/cm2 on erythrosis colli Figure 37.24 Erythrosis colli before IPL treatment noninvasive methods (optical confocal microscopy and optical coherent tomography) to understand the action of dynamic mechanisms of intense pulsed lights on pigmented lesions The images obtained show that the melanosomes of the basal areas of the epidermis migrate rapidly to the surface of the epidermis to be suppressed On the other hand, melanocytes of the lesions are intact and their hyperactivity starts again after the treatment The authors therefore concluded that IPLs are efficient for the treatment of lesions, presenting an increase in the melanosome density in the basal layers of the epidermis, but that, when there exists melanocyte hyperactivity, we need to combine topical treatments such as hydroquinone or Q-switched lasers [16] And these works are fully coherent with the results of our clinical trials that we bring: around 75% of the improvement of lentigines from our trials published in 2000 and the comparative study of Wang [17] on 32 Asian patients of skin type III or IV (15 with ephelides, 17 with lentigines), one cheek treated by Q-switched alexandrite laser (QSAL), the other cheek treated Figure 37.26 Solar lentigo before treatment of yellow filter 515–950 nm double pulse 15 J/cm2 with IPL, followed up for 2, 4, 8, and 12 weeks (6 months, if secondary pigmented problems) All patients improved significantly by the treatments For the lentigines, the efficacy was similar after one session of QSAL and IPL For the ephelides, the QSAL gave a superior significant improvement of scores compared to the IPL, one or two sessions A postinflammatory hyperpigmentation reaction was noted in cases (28%) treated by QSAL (more on patients having lentigines than settling ephelides in 3–6 months) and nothing in cases treated by IPL [18] A few sessions of IPL are managed equally to lighten the Copyright Material – Provided by Taylor & Francis Review Copy – Not for Redistribution MEDpress-Inform Publishers, 1-3-4/H, build.1, Kochnovsky proezd, RC "Aerobus", 125319 Moscow, Russia 386 AESTHETIC AND COSMETIC PRACTICE Figure 37.30 Destruction of solar lentigo on the dorsum of the hand with IPL 515–950 nm Figure 37.27 Dramatic improvement 10 weeks after one session for solar lentigo on the cheek Figure 37.31 The result 3 months after one session of IPL for solar lentigo on the dorsum of the right hand pigmented scars For melasma, the results are very inconsistent for IPLs to be a valuable proposition, and there is a necessity of the use of aftercare depigmenting products Hints and Tips Figure 37.28 Treatment of solar lentigo with IPL 550–950 double pulse 18 J/cm2 on the dorsum of the hand Figure 37.29 The perfect result 2 months after one session of IPL To optimize the result on epidermal spots that are too light to be sufficiently photoabsorbed or small, thin seborrheic keratosis, it is viable to paint them with a permanent brown or black pen (marker) and fire a single low fluence flash with any filter This gives us an instant photoablation (this technique is called AbraLight ®) similar to erbium:YAG technique Otherwise, in our experience, the sign of a good light absorption (“end point” as the English speakers would call it) is achieved when the pigmented lesion darkens (“graying” or an increase of pigmentation by at least one tone of the treated lesions) on top of moderate erythema, showing a reddish halo around the lesions Lightening, by fragmentation of the crust formed, will take 8–10 days with the application of a scar repair cream or soothing cream An interval of 4–8 weeks is required between sessions and obviously sun block that has a sun protection factor of 30 or higher is used The photos enclosed personal cases illustrating efficacy of treatments in one session, which is sometimes sufficient for aged patients, they not desire important demarcation compared to the untreated areas We sometimes need two or three iterative sessions to get the desired results or the application beforehand of 5-metyl aminolevulinate for 1–2 hours on the Copyright Material – Provided by Taylor & Francis Review Copy – Not for Redistribution MEDpress-Inform Publishers, 1-3-4/H, build.1, Kochnovsky proezd, RC "Aerobus", 125319 Moscow, Russia Copyright Material – Provided by Taylor & Francis Review Copy – Not for Redistribution MEDpress-Inform Publishers, 1-3-4/H, build.1, Kochnovsky proezd, RC "Aerobus", 125319 Moscow, Russia Index Ablative fractional lasers, 241, 361, 364, 373, 455 Ablative laser skin resurfacing complications acneiform eruptions, 365 anesthesia toxicity, 366 contact dermatitis, 366 delayed purpura, 366 eruptive keratoacanthomas, 366 erythema, 365–366 heat-induced recall phenomenon, 366 infections, 365 pigmentary alteration, 366 scarring, 366 drug delivery, 366 history, 357 home fractionated devices, 366 indications acne scar, 358 benign lesions, 360 dermal lesions, 360 hypertrophic scars, 358 melasma, 358–359 photoaging, 358 pigmented lesions, 359 premalignant and malignant skin cancer, 359 rhinophyma, 359 traumatic scar, 358 varicella scar, 358 mechanism CO2 laser, 357–358 Er:YAG, 358 patient selection, 365 postoperative course, 365 preoperative management and anesthesia, 365 tattoo removal, 366 Ablative photodecomposition, see Photoablative effect Abnormal scars management acne scars box scar, 242–243 chemical peels, 241 depigmented atrophic scar, 240, 244 hypertrophic scar, 240, 244 ice-pick scar, 242–243 laser ablation, 241–242 mechanical dermabrasion, 241 microneedling, 241 qualitative grading, 240 rolling scars, 242–243 artificial scars, 242–243 clinical features, 233–234 definition, 233–231 erythematous scars, 242 extraordinary therapeutic options, 244 hyperpigmented scars, 242 hypertrophic and keloid scars ablative lasers, 238 algorithm, 237 cryotherapy, 238 excision, 239 intralesional treatment, 238 nonablative lasers, 238 PDT, 238 surgery plus compression, 239 surgery plus 5-FU, 239 surgery plus imiquimod, 239 surgery plus radiation, 240 surgical procedures plus steroid injection, 239–240 topical treatments, 237–238 treatment, 242 prevention nonsurgical prevention strategies, 235 NPWT, 235–236 serial excision, 236 risk factors, 233–234 scar variants, 233–234 stretching/dehiscence of scars, 236 Abrasive techniques anesthesia, 325 anterior chemoabrasion, 324 bismuth subgallate, 325 definition, 324 depth selection, 325 grade II abrasion, 325 occlusion, 325 perform and preparation, 325 posterior chemoabrasion, 324 prepeel skin conditioning, 325 sandpaper, 325 skin preparation, 325 Acne-induced postinflammatory erythema, 363 Acne scars, 492 box scar, 242–243 chemical peels, 241 depigmented atrophic and hypertrophic scar types, 240 ice-pick scar, 242–243 laser ablation, 241–242 mechanical dermabrasion, 241 microneedling, 241 qualitative grading, 240 rolling scars, 242–243 Acquired dermal hypermelanocytosis, 474–475 Actinic keratoses, 21–23, 512 Adipocytolysis clastic, 540 phagocytic, 540–541 Adipose-derived stem cells (ASCs), 39–40, 47–49 Adipose tissue (AT) BAT, 43–44 blood flow regulation, 46 cell type heterogeneity, 47–49 classification and distribution of, 43–44 development of, 46–47 fat cell precursors macrophages and endothelial cells, 49 preadipocyte progenitors, 47–49 fat deposition and fat mobilization, 49–53 histogenesis and fine structure, 45 productions, 53–55 routine liposuction, 44–45 WAT, 43–45 Adipose tissue blood flow (ATBF), 46 ADSO, see Advanced dermatological surgery office 795 Advanced dermatological surgery office (ADSO), 193 Advanced encryption standard (AES), 772 Advanced hybrid clinical-surgical units (AHCSUs), 192, 194 AES, see Advanced encryption standard Aesthetic consultation appointment confirmation, 67 arrival, clinic, 67 cost, 70 diagnosis, 69 discontented patients complaining or litigious patients, 73–74 difficult-to-please patient, 73 prevention, 74 doctor-patient relationship medical model, 71 mutual understanding, 71 placebo response, 71 professionalism, 71 trust and confidence, 70–71 easy-to-please patient, 73 less easy-to-please patient, 73 managing the day, 67 medical report or letter, 70 meeting preparation, 67 meeting the patient, 67–68 patient examination, 68–69 patient expectations, 70 patient history, 68 patient’s direct contact, 67 patient selection, 70 psychological considerations anxiety, 72 BDD, 72 depressed patients, 73 depression, 72 OCD, 72 patient’s expression, 71 psychiatrist or a clinical psychologist, 73 symptoms and signs, 71 referrals, 67 reputation, 67 treatment, 69–70 Aesthetic field burns and scars, 392 innocuousness, 392–393 ocular risks, 393 pain, 391–392 pathological scars and scar prevention, 391–392 photodynamic photorejuvenation, 389, 391 prolonged hyper/hypopigmentations, 392 tattoos, 391–392 Aesthetic measure, Aesthetic nail surgery anesthesia, 288–291 big toenail, 290–293 chronic paronychia, 300–301 distal nail avulsion, 300–301 double nail, 289–290, 292 ingrown nails, 294–296 laterally localized tumors, 299–300 longitudinal melanonychia, 298–299 myxoid pseudocyst, 298–299 Copyright Material – Provided by Taylor & Francis Review Copy – Not for Redistribution MEDpress-Inform Publishers, 1-3-4/H, build.1, Kochnovsky proezd, RC "Aerobus", 125319 Moscow, Russia 796 Index onychopapilloma, 299 patient preparation, 287–288 patient selection, 287 postoperative care, 289 proximal nail avulsion, 301 proximal nail fold, 300 retronychia, 296–297 split nail deformity, 292–294 toenails, 295–297 tourniquet, 289 trapezoid nails, 290, 293 traumatically damaged nail, 301–302 ungual fibrokeratomas, 298 vertically implanted nail, 290, 293 viral warts, 297–298 Aesthetic suture techniques buried sutures buried backstitch suture, 213 butterfly suture, 213 running intradermal sutures, 213–214 simple buried stitches, 213 tacking/anchoring (pexing) sutures, 214 dressing, 216 localization, 207 needles, 208 particular wound healing characteristics, 207 percutaneous sutures epidermal suture, 209 half-buried vertical suture, 210–211 horizontal mattress sutures, 210–211 running locked sutures, 210, 212 simple interrupted stitches, 210 simple running suture, 210, 212 vertical mattress sutures, 210 pitfalls, 217 pulley sutures, 214 skin closure tapes, 209 staples, 209 suture material and wound closure materials absorbable sutures, 207–208 nonabsorbable sutures, 208 suture removal, 216–217 suture techniques, 209 tissue adhesives, 208 tissue-sparing techniques, 214–217 wound condition, 207 wound direction, 207 Aging facial prevention, 759 preventive treatment, 759 skin preservation, 760 SMAS, 760 treatment plans, 759 ultrasound and radio-frequency machines, 760 heaviness, 739–741 morphological modeling, 739 sagging, 739–741 skeletonization, 739, 741 AHCSUs, see Advanced hybrid clinical-surgical units Allergic contact dermatitis, 101–103, 122, 140–141, 143, 182, 241 Allergic reactions application and cumulative effects, 101 composition concentration of ingredients, 99–100 purity of ingredients, 99–100 contact time, 101 cosmetic contact allergens, 101–103 cosmetic ingredients, pharmaceuticals, 100 cosmetovigilance, 103–104 cross sensitivity, 100 diagnosis, 103 frequently usage, 99 immunologic contact urticaria, 103 penetration-enhancing substances, 100 photocontact allergens, 103 sensitive skin products, 103 skin condition, 100–101 American barbed threads, continuous cosmetic suture, 677, 679 Aminolevulinic acid (ALA), 354, 504 Anal and vaginal disorders, 550–551 Androgenetic alopecia digital phototrichogram, 257–258 female androgenetic alopecia, 259–261 male androgenetic alopecia, 257–260 multifactorial classification, 257 transsexuals, 261 Androgenic alopecia concoction, 614 definition, 611 frequency, 614 hair life cycle, 612–614 material, 614 medicines, 614 technique of nappage, 614–615 Antiadhesive dressings advantages, 221 disadvantages, 221 examples, 221 uses, 220 Antiaging effect, 26, 78–79, 114, 116, 406 Apocrine chromhidrosis, 550, 552 Apocrine sweat glands, 159, 163 Aptos cog (barbed) threads continuous cosmetic suture, 677, 679 lifting of soft tissues, 677, 679 memory-retaining polypropylene, 678, 681–682 Aptos thread lifting absorbable threads for armoring, 678, 682 brow lifting, 688 opposite direction barbs, 678, 682 patients, soft lifting, 686, 688 Aptos Nano, 678, 682 brow lifting, 688 needleless Aptos threads and methods, 678 neocollagenesis, 678 nonabsorbable second-generation, cheekbone area lifting, 687–688 Visage sutures, 678 Aquagenic keratoderma, 552 Aquatic bicycle, 531 Arterial vascularization deep network, internal carotid artery, 714 face’s venous system, 714 internal maxillary artery, 714 ophthalmic artery, 714 superficial network, external carotid artery, 714 superficial temporal artery, 714 Artificial nails nail gels, 147–150 preformed, 143–146 sculptured, 146–147 ASCs, see Adipose-derived stem cells Astaxanthin, 114–115 AT, see Adipose tissue ATBF, see Adipose tissue blood flow AT expandability theory, 47 Atopic dermatitis (AD), 122, 166 Autologous adipose grafting, see Fat grafting technique Axillary hyperhidrosis, 166–168 Axillary sweat gland excision, 163 “Bar code” wrinkles, 20 Basal cell carcinoma, 513 BDD, see Body dysmorphic disorder Beauty, 2–5 Bichat’s fat pad, 736 Big toenail, 290–293 Biodegradable products bovine collagen, 593 human collagen allograft, 593–594 autograft, 594 porcine collagen, 594 Biplane bayonet technique., 723 Blepharoplasty adjunctive procedures botox injection, 702 deep sulcus, 702 lipofilling, 702 superficial resurfacing, 702 volume injection, 702 canthopexy, 702 lower eyelid blepharoplasty, 697–701 palpebral and upper face examination, 691–692 palpebral, lower and midface examination, 691, 693, 697 upper eyelid blepharoplasty, 692–697 Blepharoptosis correction, 582–583 of left eye, 582 Blue rubber bleb nevus syndrome, 484–485, 488 Body dysmorphic disorder (BDD), 558 aesthetic consultation, 72 causes neurobiological, neuropsychological, psychoanalytic approach, 7–8 psychosocial, clinical aspects, diagnostic criteria, epidemiology, prevention, prognosis, psychiatric disorders, treatment, 8–9 Yale Brown Obsessive Compulsive Scale Modified, Body hair growth alopecia beard and mustache, 264 eyebrows, 261, 263 eyelashes, 261, 263 pubic hairs, 264 Body piercings (BP) complications acute infections, 180 blood-transmitted infections, 181 edema and transient hematoma, 181 infective endocarditis, 181 nonspecific complications, 181 oral/genital piercings, 181 primary inoculation, 180 corset piercings, 179 embedded upper lip piercing, 182 epidemiology, 179 forceps/clamps, 180 healing times, 180 hypertrophic reaction, 182–183 industrial piercing, large keloids, 183–184 “intimate” piercings, 179 lip piercing, gingival recession, 183, 185 microdermal piercings, 179 navel scar, young woman, 182–183 orofacial piercings, 179 pocketing, 179 Q-switched laser, 183 site-specific complications, 183, 185–186 Copyright Material – Provided by Taylor & Francis Review Copy – Not for Redistribution MEDpress-Inform Publishers, 1-3-4/H, build.1, Kochnovsky proezd, RC "Aerobus", 125319 Moscow, Russia Index 797 soft earlobe piercing, earlobe split, 183, 185 surface piercings, 179, 182 Bone morphogenetic proteins (BMP), 47 Botulinum (BTX) toxin medicinal uses anal and vaginal disorders, 550–551 apocrine chromhidrosis, 550 aquagenic keratoderma, 552 axillary hyperhidrosis, randomized controlled trials, 548–549 benign eccrine tumors and cysts, 551 in Bullous disease, 550 CNS effects, 548 cutaneous leiomyomas, 552 effects on exocrine glands, 547–548 evidence level, 552 facial flushing, 551 focal hyperhidrosis, 549 Frey’s syndrome, 549 granulosis rubra nasi, 552 immune effects, 548 inflammatory disorders, 550 intertrigo, 552 itch, 548 muscular atrophy, 547 neurogenic pruritus, 551 osmidrosis, 550 pachydermoperiostosis, 551 pain relief, 548 palmar hyperhidrosis, randomized controlled trials, 549 pruritus, 548 scar management, 551 severe hyperhidrosis, 548 SNAP-25, 547 treatment aesthetic indications, 558 aftercare, 579 Azzalure injection sites, 559 blepharoptosis, 561 brands and storage, 558 bruising minimization, 559 conventional teaching, 559 discomfort minimization, 559 facial asymmetries, 558–559 focal hyperhidrosis, 557 history, 557 license-based practice, 559 migraine, 557 M-M BTX (see Multi-mini botulinum) mode of action, 557 pretreatment consultation, 558 psychological considerations, 558 skin quality, 557 stimulated nerve endings, 557 stratum corneum hydration, 557 technique controversies, 559 tension headache, 557 unit equivalence, 558–559 wrinkles and rhytids, 557–558 Botulinum toxin (BTX)-A anesthesia, Palms after Kreyden, 169 for axillary hyperhidrosis, 166–168 BTX type-A-purified neurotoxin complex, 165 history, 165 hyperhidrosis of anogenital, 170 of forehead, 169 sporadic sweating, 170 of submammary, 170 minor starch test, 165–166 for palmoplantar hyperhidrosis, 168–169 Bowen’s disease (SCC in situ), 512–513 BP, see Body piercings Brown adipose tissue (BAT), 43–44 Brow ptosis aging, 583–584 BTX treatment, 582 eyelid rubbing/pulling habits, 583 facial expression muscles, 583 gravity, 583 natural progression, 583 sleeping, 583–584 Bullous disease, 550 Buried backstitch suture, 213 Buried parallel pulley suture, 214–215 Buried sutures buried backstitch suture, 213 butterfly suture, 213 running intradermal sutures, 213–214 simple buried stitches, 213 tacking/anchoring (pexing) sutures, 214 Butterfly suture, 213 Capillary malformations (CM), 485–488 Cardiac arrhythmias, 315, 318 Cellulite anticellulite diet, 534 assessment, 526–527 causes and mechanisms, 526 classification, 525, 608–609 clinical appearance, 526 definition, 525 diagnosis, 526 etiopathogeny, 526 evolution and monitoring, 534 fibrous, 530 food tips, 534 hydrotherapy treatments, 531 Liposcore® test, 527–528 medical treatment cryolipolysis, 533 focused ultrasound system, 533 ice-shock lipolysis, 533 infrared lipolysis, 533 injection lipolysis, 531–532 laser lipolysis, 532–533 lipolaser, 532–533 LLLT, 533 mesotherapy, 533–534 microlipolyse, 533 radio-frequency lipolysis, 533 technical ML3, 533 morphological features, 525 paramedical treatment Bodysculptor®, 530 Cellu-M6® device, 530 Cellusonic®, 530 electrolipolysis method, 530 electrotherapy, 531 inovo body, 530 luxopuncture, 530 manual lymphatic drainage, 530 SPA jet, 530 Starvac, 531 Technical Alice®, 530 Vacu-Step®, 530 physiopathology, 608 adipose, 525 fibrose, 525–526 lipogenesis, 525 water retention, 525 surgical treatments, 534 therapeutic protocols, 610–611 therapeutic strategy, 527, 529 treatment with mesotherapy, 608–609 visual observations, 525 water retention index, 527 Cervico-facial lift technique, 712 anatomical marks, 717 anesthesia and installation, 717–718 cervical subcutaneous detachment, 717–718 cutaneous resection and closure fat dressing 24 hours., 720 final periauricular scar, 720 pre auricular skin resection, 719–720 and scar migration, 719–720 skin excess, 719 skin suture, silk/prolene, 719–720 sub-SMAP face lifting, 720–721 face lifting installation, 717–718 incision’s outline, 717–718 mapping, landmarks and periauricular incision., 717–718 retroauricular detachment, 717 SMAP flap detachment, 717, 719 SMAP traction and suture, 718–719 subcutaneous detachment, 717 Chemical peels abrasive techniques anesthesia, 325 anterior chemoabrasion, 324 bismuth subgallate, 325 definition, 324 depth selection, 325 grade II abrasion, 325 occlusion, 325 perform and preparation, 325 posterior chemoabrasion, 324 prepeel skin conditioning, 325 sandpaper, 325 skin preparation, 325 AHA and TCA association glycolic acid, 319 indication, 319 post-peel treatment, 320 TCA applications, 319–320 carbon dioxide application, 320 complications, 303–304 contraindications, 303 deep/phenol peel, 304 fillers, 319 history, 303 indications, 303 Jessner Peel association, 320–321 laser pixel peel/fraxpeel, 321–322 medium-depth peel, 304 mesotherapy, 319 microneedling pixel peel, 322–324 mosaic peel, 319 penetration enhancement combinations, 319 phases, 304 pixel peel, 319 superficial peels, 303–304 Chronic paronychia, 140, 300–301 Chronic venous insufficiency EVLT bruising and pain, 269 DVT, 269 indication, 267 induration and pigmentation, 268–269 materials and methods, 267–268 paresthesias, 268 pulmonary embolism, 269 foam sclerotherapy deep venous thromboembolism, 271 follow-up, 270 materials, 270 methods, 270 neurologic events, 270 results, 270 skin necrosis, 271 skin pigmentations, 271 middle-sized and spider veins chromated glycerin, 272 complications, 272–273 Copyright Material – Provided by Taylor & Francis Review Copy – Not for Redistribution MEDpress-Inform Publishers, 1-3-4/H, build.1, Kochnovsky proezd, RC "Aerobus", 125319 Moscow, Russia 798 Index matting, 274–275 pigmentation, 273–274 polidocanol, 272 superficial reflux, 272 systematized and nonsystematized network, 271 tetradecyl sulfate, 272 therapeutic result, 271 procedure selection, 267 radio frequency complications, 269 hematomas, 269 hypoesthesias, 269 indications, 269 materials and methods, 269 matting, 269–270 paresthesias, 269 pigmentation, 269 results, 269 thromboembolism, 269 therapeutic strategy, 267 Chronological aging, 17–18 Clinic management aesthetic treatment, 779 clinic staff, roles, 780 cosmetic consultation, 780–781 information overload, 779 and marketing, 782–786 well-appointed clinic, 779 Clinic marketing blog posts, 783–784 clinic brand, 782 Email marketing, 784 Facebook, 785 fee structure, 782 Google+, 785 high quality of care, 782 inbound marketing, 782–783 mobile platforms, 783 open house events, 784 patient reward programs, 784 PR, 786 search engine optimization, 783 social media platforms, 784–785 Twitter, 785 unique selling point, 782 value proposition, 782 website development, 783 WordPress, blog, 783–784 YouTube, 785 Closure® technique, 268 Colloid milium, 21, 127, 364 Contact dermatitis, 318 Corset piercings, 179 Cosmeceuticals antioxidants, 81, 83 α-lipoic acid, 79 niacinamide, 79 plant materials, 79–80 vitamin C, 78–79 vitamin E, 79 cell regulators, 81, 83 growth factors, 81 polypeptides, 80–81 retinol/vitamin A and derivatives, 80 signal peptides, 81–83 Hamburg skin aging score, 84–85 innovative vehicles DMS, 77 moisturizing creams, 78 nanodisperse systems, 78 skin aging scale, 84 treatment options, skin aging stage, 84, 86 Cosmetic botulinum blepharoptosis, 582–583 brow ptosis, 582–584 clown sign, 584, 586 complications, 581 correction methods, 581 natural recovery, 581 strengthening exercises, 581 treatments, 581 depressor labii inferioris weakness, 588–589 dosage and antibody considerations, 581 femme fatale, 584–585 “frozen” face, 581 intraorbital fat herniation, lower eyelids, 586–588 malar festoons, 588 malar mounds, 588 Mephisto-Ascher sign, 584–585 pathogenesis, 581 playground sign, 584, 586 “puffy lower eyelids”, 586–588 “puffy pommettes”, 588 residual eyelid wrinkles, 586–587 scleral show, 586–587 “Tell-Tail” sign, 584–585 therapeutic ratio, 581 vacuous expression, 581–582 Cosmetic consultation clinical photography, 782 informed consent, 781 patient privacy, 781–782 patient screening, 781 Cosmetic tattooing, see Permanent makeup Cosmetovigilance, 103–104 Cross-tunneling technique, 665–666 Crumpling wrinkles, 20 Cryolipolysis adipocytolysis, 540–541 apoptosis and necrosis, 540 clinical interaction adverse effects, 544–545 contraindications, 544 indication, 544 late-onset pain, 545 heat extraction, 538 heat transfer conduction (thermal conductivity), 537 convection, 537 cooling power, 538 history, 537 lipid crystallization, 541–543 lipolysis, 540 nomenclature, 537 patient expectations, 545 protocol, 545 vacuum adverse effects, 539 coloring, 539 friction, 539 immobility, 539 pain, 539 Curcumin, 80, 116 Cushing syndrome, 109 Cybermedicine, 776 Daidzein, 116 DDSO, see Dermatological day surgery office Deep peels cardiac arrhythmias, 318 complications, 316 contact dermatitis, 318 contraindications, 315 croton oil, 313 different phenol formulas, 314 histological studies, 314 history, 313 indications, 314–315 infections, 318 occlusion, 314 paradoxical effect, 313 phenol characteristics, 313 phenol toxicity, 313 pigmentary changes, 317 post-peel, 316–317 pre-peel, 315 procedure, 315–316 prolonged erythema, 317 scarring, 317–318 septisol, 313 type IV Glogau’s classification, 313–314 unoccluded Baker’s formula, 314 Depilation field medical indications of depilatory lasers, 381–382 pigmented field, 383, 385–386 three sessions, 380, 382 vascular field, 381–385 Dermabrasion anesthesia, 328 Bell Hand Engine®, 329 Boxcar and rolling type scars, 331–332 dermabrader tips, 329 facial skin surface, 331, 333, 335 fullface wire brush dermabrasion, 330–331 full-thickness donor punches, 331, 333 full-thickness punch excision, 331, 333 history, 327 ice pick and boxcar scars, 331–332 indications, 327–328 intraoperative wire brush dermabrasion, 330 laboratory studies, 328 larger and wider full-thickness punch graft, 331, 333 NoKor needle, 330–331 patient’s history, 328 postoperative considerations and adverse reactions, 331–332, 334–338 postoperative medications, 328 preoperative medications, 328 preoperative view, 329 RAM® engine, 329 revolutions per minute, 329 scientific background, 327 Dermal-epidermal junction (DEJ), 11 Derma membrane structure (DMS), 77 Dermatitis artefacta (DA), 242–243 Dermatological day surgery office (DDSO), 193 Dermatological offices ADSO, 193 classification, 193–194 class IV laser systems, 194, 197 clean activity service functional unit, 194–195 DDSO, 193 dirty activity service functional unit, 194–195 functional units definition, 192 main functional units, 192–193 service functional units, 192–193 size, 192 IPPL sources, 98, 194, 197 pre- and post-operative recovery room, 194, 196 SDSO, 193 surgical hand-washing unit, 194–195 surgical nurse station, 194, 196 Dermatoporosis, 22–23 Diet carotenoids, 114–115 polyphenols and flavonoids, 115–116 polyunsaturated fatty acids, 116 pre- and probiotics, 116–117 vitamin B6, 114 Copyright Material – Provided by Taylor & Francis Review Copy – Not for Redistribution MEDpress-Inform Publishers, 1-3-4/H, build.1, Kochnovsky proezd, RC "Aerobus", 125319 Moscow, Russia Index 799 vitamin C, 114 vitamin D, 115 vitamin E, 114 Direct patient-provider medical consultation, 775 Distal nail avulsion, 300–301 Double nail, 289–290, 292 Dressing systems antiadhesive dressings advantages, 221 disadvantages, 221 examples, 221 uses, 220 closed dressings, 220 “lunchtime” cosmetic procedures, 219 occlusive dressings foam dressings, 222–223 hydrocolloids, 221–222 hydrogels, 222 polymer films, 221 open dressings advantages, 219 disadvantages, 219 examples, 219 uses, 219 tapes, 223 Dynamic wrinkles, 20 Eccrine sweat glands, 157–159 E-health and M-health communication, 772 Elastotic creases, 20 Electrical energy and optical spectrum deteriorate dichroic filter, 377, 379 flashlamp emission, 377, 379 IPL handpieces, 377–378 multipulse radiation, 377, 379 polychromatic irradiation, 377–378 typical spectral response, 377–378 Electrolipolysis method, 530 Electronic data encryption, 773 Electrotherapy, 531 Email marketing, 784 Embedded upper lip piercing, 182 E-medical consultation antiaging and age-preventive strategies, 774 care delivery platform, 775 congenital and acquired skin defects, 774 live interactive teledermatology, 775 store and forward teledermatology, 775 Endoscopic brow lift technique, 731 Endovenous laser ablation (EVLA), 495 Endovenous laser treatment (EVLT) bruising and pain, 269 DVT, 269 indication, 267 induration and pigmentation, 268–269 materials and methods, 267–268 paresthesias, 268 pulmonary embolism, 269 Epidermal stem cells, 38 Epidermal suture, 209 Erythrosis, 21–22 Erythrosis interfollicularis colli, see Poikiloderma of civatte Estrogen aging skin, 14 menopause-induced skin aging, 18 EVLT, see Endovenous laser treatment Extracellular matrix (ECM), 11 Eye cosmetics for eyebrow, 135–136 for eyelash camouflaging, 135 eyeliner, 134–135 mascara, 134 for eyelids dyspigmentation, 134 powder eye shadows, 133 texture-modifying agents, 133 Eyelid ptosis (blepharoptosis), 561 Face pigmented lesions, 21–22 texture colloid milium, 21 Favre and Racouchot syndrome, 20–21 kinds of wrinkles, 20 senile sebaceous hyperplasia, 21 solar elastosis, 19–20 trichostasis spinulosa, 21 vascular lesions, 21–22 Face and body epilation beard pseudofolliculitis, 505–506 contraindications, 504–505 groin pseudofolliculitis, 505 hormone imbalances, 505 hypertrichosis, 505 indications and efficacy, 504 medical history assessment, 504 post treatment, 504–505 pretreatment hirsutism, 504–505 sunlight exposure, 505 Face and eyelid cosmetic surgery negative aspects cutaneous and neural scarring, 757 subcutaneous detachments, 757–758 positive aspects identity reconstruction, 758 rebirth, patient feeling, 758 “technical” and static result quality, 758 Face and neck soft tissue lifting, 677 Facelift age perception codes modifications, 705 age-related reconstruction, 706 excess skin treatment, 759 facial aging, 759 fat autografts, 759 identity reconstruction (restoration), 706 indications, 759 invasive suture-based repositioning, 759 medical procedures, 759 mutilating procedures, 705 patient’s appearance, 705–706 posture education, 760 practical anatomy arterial vascularization, 714 cutaneous ligaments, 713 deep aponeurotic structures, 713 dermal hypodermic aging, 708–709 dermal muscles and muscular and aponeurotic structures, 711–712 facial innervation, 714–715 fat tissue, 708–711 planes of motion, 712–713 prevention, 759 return on investment, 706 sustainable stitching systems, 759 technical quality, 706 therapeutic and non-invasive approaches, 705 treatment plans, 759 Facial fat tissue cervicofacial region, 711 deep fat, 708 embryological origin, 711 melting and ptosis, 708 MRI view, 708–709 periorificial craniofacial region, 708 subcutaneous, 711 superficial fat, 708 Young cadaver dissection, 708–709 Facial innervation anastomoses, 714–715 great auricular nerve, 715 live dissection, facial nerve, 714 motor, 714–715 sensory, 715 trigeminal nerve, 715 Facial redness AD, 122 contact dermatitis, 122 eczema, 122 psoriasis, 122 rosacea, 120–121 seborrheic dermatitis, 121 sensitive skin, 119–120 skin barrier, 119 Factors Affecting the Protection Provided by Sunscreens, 92 Facultative technical equipment (FTE), 192 Fat grafting technique adipocyte grafts, 655 adipocytes, early cell death and replacement, 751–752 autologous adipose tissue graft, 655–656 body breasts, 660–661 buttocks, 658–660 genital organs, 660 hand, 658 breast augmentations, 655 breast hypoplasia, 655 centrifugation, 656 clinical application, 752–754 concave-shaped faces, 658 epinephrine serum infiltration, 657 harvesting, 656 indications, 657 isolated use, face cheekbones and tear troughs, 657 chin and jawline, 658 lip, 658 nasolabial folds and marionette lines, 657 upper eyelid and temple, 657 lipostructure, 656 of full face, 752–754 jawline, 752–754 physiological description, 655–656 physiology, 656 platelet-rich plasma, 751 postinjection blindness, 657 regenerative medicine, 751 reinjection, 657 screening quality, 655 tissue engineering, 655 Fat mobilization catecholamines, 52 and deposition biological functions, 49–50 de novo lipogenesis, 49 hormones and factors, 49–50 human fat cell lipolysis, 49, 53 LCFAs, 49, 52 lipid deposition and lipid mobilization, 49, 51 lipoprotein lipase transfer, 49, 51 triacylglycerol (TAG), 49, 53 lipolysis, 52 Favre and Racouchot syndrome, 20–21 Field cancerization/multiple NMSC, 513 Filler adverse side effects acrylic hydrogel, 633–636 autologous fat, 629 autologous human collagen, 629 bioplastique, 638 CHA, 632–633 Copyright Material – Provided by Taylor & Francis Review Copy – Not for Redistribution MEDpress-Inform Publishers, 1-3-4/H, build.1, Kochnovsky proezd, RC "Aerobus", 125319 Moscow, Russia 800 Index dextranomer beads, 632 granulomatous swelling, 632 HA, 630–631 histopathology, 638–639 mineral oil and lipid derivatives, 637 nonhuman collagens, 630 PAAG, 633–634 paraffin, 637 PMMA, 634, 637 polyalkylimide gel, 633 poly-L-lactic acid, 632 polyvinylhydroxide microspheres, 633 silicone, 637 silicone elastomer suspension, 638 classification, 627 early complications, 627 immediate reactions, 627 irreversible, 627 late complications, 627–628 long-lasting fillers, 629–630 permanent (irreversible) fillers, 629 prevention, 639 reversible, 627 soft-tissue fillers, 628–629 treatment, 639–640 Fitzpatrick skin-type scale, 764 Fluid management, 665–666 Fluorescence-activated cell sorter analysis (FACS), 49 Foam dressings, 222–223 Foam sclerotherapy deep venous thromboembolism, 271 follow-up, 270 materials, 270 methods, 270 neurologic events, 270 results, 270 skin necrosis, 271 skin pigmentations, 271 Focal hyperhidrosis compensatory hyperhidrosis, 171 endoscopic thoracic sympathectomy, 171 Frey Syndrome, 170 LUH, 171 primary, 156–157 Ross syndrome, 170–171 secondary, 155–156 Focal ultrasound, 518, 520 Focused ultrasound lipolysis, 533 Focused ultrasound system, 533 Follicular unit extraction (FUE) advantages, 253–254 aspects, 253, 255 Choi implanter, 253, 256 disadvantages, 254 indications, 253 stick and place process, 253 technique, 252, 254–255 Follicular units with long hair (FUL) advantages, 250–251 after segmentation, 250–251 disadvantages, 251 donor area, 251–252 postoperative aesthetic embarrassment, 250–251 recipient area, 252–253 Fractional ablative technology, 361 Fractional laser skin resurfacing ablative systems, 360–361 complications acneiform eruptions, 365 anesthesia toxicity, 366 contact dermatitis, 366 delayed purpura, 366 eruptive keratoacanthomas, 366 erythema, 365–366 heat-induced recall phenomenon, 366 infections, 365 pigmentary alteration, 366 scarring, 366 drug delivery, 366 history, 360 home fractionated devices, 366 indications acne scarring, 362–364 photoaging, 361–362 pigmentary disorders, 364 posttraumatic scar, 364 striae distensae, 364 surgical scar, 364 vascular disorders, 364 mechanism, 360 nonablative systems, 360–361 patient selection, 365 postoperative course, 365 preoperative management and anesthesia, 365 tattoo removal, 366 Fractional nonablative lasers density, 373–374 different types of, 373 efficacy, 373 indication, 374 irradiance, 374 tissue effects, 373 treatment strategies, 374–375 wavelength, 374 Fractional resurfacing (FR), 128 Frey’s syndrome, 170, 549 FU, see Functional units FUE, see Follicular unit extraction FUL, see Follicular units with long hair Functional units (FU) definition, 192 main functional units, 192–193 service functional units, 192–193 size, 192 Genistein, 116 German barbed threads, Achilles tendon rupture, 677–678 Glogau classification, 21 Glogau photoaging classification, 764 Glycosaminoglycan (GAG), 11 Granuloma telangiectaticum, 490 Granulosis rubra nasi, 552 Gravitational wrinkles, 20 Groin pseudofolliculitis, 505 HA, see Hyaluronic acid Hailey–Hailey disease, 550 Hair follicle bulge, 38 Hair follicle destruction laser pulse width (exposure duration), 503–504 optimal pulse duration, 504 photochemical destruction, 504 photomechanical hair destruction, 504 photothermal destruction, 501, 503 thermal conduction, 504 Half-buried vertical suture, 210–211 Hamburg skin aging score, 84–85 Heliodermic wrinkles, 20 Hemangioma, 485 Hemorrhoidectomy, 551 Hereditary hemorrhagic telangiectasia (HHT), 490 HHT, see Hereditary hemorrhagic telangiectasia HIFU, see High-intensity focused ultrasound High-intensity focused ultrasound (HIFU), 427 Horizontal mattress sutures, 210–211 Hormone replacement therapy (HRT), 109 Hormones endocrine disruptors, 110 endocrine functions, 107–108 endocrinopathies, 109 gender-independent endocrine aging, 107–108 gender-influenced endocrine aging, 108–109 HRT, 109 neuroendocrine compounds, 107–108 HRT, see Hormone replacement therapy Hutchinson-Gilford progeria syndrome, 13 Hyaluronic acid (HA), 11 for body hyaluronidase, 624 Macrolaner (galderma), 623–624 skin testing, 624 contraindications, 617–618 discovery, 617 indications, 618 injections (see Injections, HA) pretreatment, 618 science of, 617 Hydrocolloids, 221–222 Hydrogels, 222 Hyperandrogenism, 18–19 Hyperpigmentary disorders acquired pigmentations, 125–126 chemical peelings, 128 melasma, 125–126 new injection treatments, 128 physical treatments intense pulsed light, 128 lasers, 127 topical and cosmetic treatments arbutin/arbutoside, 127 azelaic acid, 127 hydroquinone, 127 Kojic acid (KA), 127 4-n-butylresorcinol, 127 retinoic acid, 127 steroids, 127 tretinoin, 127 Hyperpigmentation, 109 Hyperpigmented lesions adverse reactions, 477 scientific basis, 473 treatment acquired dermal hypermelanocytosis, 474–475 Becker nevus, 474 Cafe-au-lait macules, 474 dark rings, 476 Freckles, 474 giant congenital nevus, 475 ito nevus, 474 lentigines, 474 LWNH, 475–476 melasma, 476–477 nevus spilus, 474–475 ota nevus, 474 postinflammatory hyperpigmentation, 476 solar lentigines, 474 vitiligo, 477 Hypertrichosis, 505 Hypertrophic and keloid scars, 513–514 ablative lasers, 238 algorithm, 237 cryotherapy, 238 excision, 239 intralesional treatment, 238 nonablative lasers, 238 Copyright Material – Provided by Taylor & Francis Review Copy – Not for Redistribution MEDpress-Inform Publishers, 1-3-4/H, build.1, Kochnovsky proezd, RC "Aerobus", 125319 Moscow, Russia Index 801 PDT, 238 surgery plus compression, 239 surgery plus 5-FU, 239 surgery plus imiquimod, 239 surgery plus radiation, 240 surgical procedures plus steroid injection, 239–240 topical treatments, 237–238 treatment, 242 Hypertrophic scar, 311 Hypomelanosis guttatae, 22 Ice-shock lipolysis, 533 Illouz’ s wet technique, 673 Implantable medical devices features, 742 high malar suspension fixation, 742, 744 implanted medical devices, 742 inferior palpable skin resection, 742 sutures, 742 tension/conical threads, 742 Indirect referring provider-distant consultant medical consultation, 775 Induced pluripotent stem cells, 31–32 Industrial piercing, 183–184 Inflammatory disorders, 550 Infrared light, 521 Infrared lipolysis, 533 Ingrown nails, 294–296 Injection lipolysis, 531–532 Injections, HA crow’s feet, 619 eyebrows, 619 forehead, 619 glabellar area, 619 lower face chin remodeling, 622 jawline, 622 lip augmentation, 622 low cross-linked HA, 622 Marionette lines, 622 nasolabial crease filling procedure, 620, 622 non-cross-linked glycerol added HA, 622–623 upper lip, 622 nose, 620–621 sunken eyes, 619–620 tear trough, 620–621 temples, 619 zygomatic arch, 620 Intense polychromatic pulsed light (IPPL) sources, 194, 197–198 Intense pulsed light (IPL), 483 abralight technique, 386–387 acne, 389–390, 492 acquired vascular alterations, 485 aesthetic field burns and scars, 392 innocuousness, 392–393 ocular risks, 393 pain, 391–392 pathological scars and scar prevention, 391–392 photodynamic photorejuvenation, 389, 391 prolonged hyper/ hypopigmentations, 392 tattoos, 391–392 blue rubber bleb nevus syndrome, 488 calibration system, 378, 380 capillary malformations, 485–488 congenital lesions, 485 cooling systems, 378–380 depilation field medical indications of depilatory lasers, 381–382 pigmented field, 383, 385–386 three sessions, 380, 382 vascular field, 381–385 devices, 483 electrical energy and optical spectrum deteriorate dichroic filter, 377, 379 flashlamp emission, 377, 379 IPL handpieces, 377–378 multipulse radiation, 377, 379 polychromatic irradiation, 377–378 typical spectral response, 377–378 electrical pulsing stabilization, 378 granuloma telangiectaticum, 490 handpieces, 378 hemangioma, 485 HHT, 490 leg veins, 490 Nordlys system, 484 optical filters, 378, 380 patient preparation, 484–485 photodynamic therapy, 389–390 poikiloderma of civatte, 490 practical applications, 484 pulse delivery, 378 red or hypertrophic scars, 492 rejuvenation and collagen “remodeling”, 387–389 rosacea, 491–492 senile angioma, 488–489 spider angioma, 490 telangiectasias, 489–490 treatment guidance, 484 venous lakes, 492 venous malformation (VM), 488 Intense pulsed lights (IPLs), 511 Internal marketing, 784 International Society for Cellular Therapy, 34 Internet and e-consultation consumers’ access, health-care information, 774 equipment failure malpractice, 777 E-revolution and E-health, 771–772 European Convention on Human Rights, 772–773 health-care systems, 771 human communication, 771 information and communication, 771 insurance policies, 777 licensure and liability coverage, 776 medical consultations, 774 medical data security, 772–773 medical records, conventional and electronic, 773 mobile health (M-health), 772–773 physician-patient relationship, 776 privacy and confidentiality, 776 privacy and informed consent, 776–777 record management, 771 standard of care, 776 telemedicine, 772 “Intimate” piercings, 179 Intrinsic skin aging, 113 IPL, see Intense pulsed light Koebner phenomenon, 174 Laser-assisted lipolysis (LAL) advantages, 675 dosimetry, 675 limited global development, 675 liposuction LAL, 673 PAL, 673 SAL, 673 localized adiposity, 673 mathematical model of Mordon, 673–674 mechanisms of action, 675 photoacoustic effects, 675 photomechanical effects, 675 photothermal effects, 675 41-laser dermatology absorption Beer-Lambert law, 343–344 coefficient g, 346 energy gaps, 343 ground state, 343 human skin, 346 Jablonski diagram, 343 light, 344–346 scattering and transport mean free path, 347 singlet states, 343 tissue scattering structures, 346 triplet states, 343 electromechanical effect, 341 penetration of light, 347–349 photoablative effect, 341, 353 photochemical/photodynamic effect, 341 choice of wavelength, 354 electromechanical effect, 355 mechanisms of type I, 353 mechanisms of type II, 354 molecule and different pathways, 353 reflection refractive index, 342 scattered, 341–342 specular, 341–342 variation, 342 thermal effect, 341 heat transfer, 350–351 light-heat conversion, 350 mechanisms of action, 349–350 tissue denaturation, 351–353 Laser epilation, 501 Laser lipolysis, 532–533 Lasers and intense pulsed light beard removal, in men, 506 classical methods, 501 face and body epilation beard pseudofolliculitis, 505–506 contraindications, 504–505 groin pseudofolliculitis, 505 hormone imbalances, 505 hypertrichosis, 505 indications and efficacy, 504 medical history assessment, 504 post treatment, 504–505 pretreatment hirsutism, 504–505 sunlight exposure, 505 hair follicle destruction laser pulse width (exposure duration), 503–504 optimal pulse duration, 504 photochemical destruction, 504 photomechanical hair destruction, 504 photothermal destruction, 501, 503 thermal conduction, 504 optimal hair removal method, 501 patient expectations and outcome, 505–506 postprocedural complications, 507–508 potential risks, 507 preoperative and postoperative care, 506–507 types, 501–503 unwanted hair removal, in women, 506 Laser treatment acne, 492 acquired vascular alterations, 485 background, 481 Copyright Material – Provided by Taylor & Francis Review Copy – Not for Redistribution MEDpress-Inform Publishers, 1-3-4/H, build.1, Kochnovsky proezd, RC "Aerobus", 125319 Moscow, Russia 802 Index blue rubber bleb nevus syndrome, 488 blue veins, 496–498 capillary malformations, 485–488 complications, 498–499 congenital lesions, 485 cutaneous vessels treatment, 498 devices, 483 endovenous laser ablation, 495 facial telangiectasias, 493 fluence/energy level, 446 granuloma telangiectaticum, 490 hemangioma, 485 HHT, 490 history, 481 leg veins, 490 mobile macrophages, 446–447 Nordlys system, 484 patient evaluation clinical considerations, 444 contraindications, 444 Kirby–Desai scale, 444 professional polychromatic decorative tattoo, 444–445 treatment sessions, 444 patient preparation, 484–485 perforator veins, 495 poikiloderma of civatte, 490 posttreatment, 447–448 practical applications, 484 pretreatment, 445–446 pulse width/duration, 446 red or hypertrophic scars, 492 red veins, 496–497 rosacea, 491–492 selective photothermolysis fluence, 482–483 pulse time, 482 spot size, 483 wavelength, 481–482 senile angioma, 488–489 side effects and complications allergic reactions, 448–449 dyspigmentation and textural changes, 448 epidermal debris, 449 ink darkening, 449 spider angioma, 490 spot size, 446–447 telangiectasias, 489–490 telangiectatic and reticular leg veins, 495–497 treatment effect, 498 treatment guidance, 484 varicose veins, of leg causes, 494 chronic venous disease, 493–494 classic symptoms, 494 cost-effective, 494 incidence, 494 prevalence, 494 risk factors, 494 treatment options, 494–495 ultrasound examination, 494 vascular, 493–494 venous lakes, 492 venous malformation (VM), 488 wavelength, 446 Laterally localized tumors, 299–300 Leg veins, 490 Levator labii superioris and alaeque nasi, 25 Levator palpebrae superioris (LPS), 561 Light-emitting diode (LED) devices, 14, 511 Linear and whorled nevoid hypermelanosis (LWNH), 475–476 Lip cosmetics camouflaging, 132–133 color correction, 133 lip liners, 132–133 lipstick opaque, 131–132 polymer, 131–132 sun protection, 131–132 Lipectomy, conjunctival approach, 699–700 Lipid crystallization contrast lipocryolysis, 543 nucleation, 541, 543 postlipocryolysis, 541 sample analysis, 541–542 structure, 541 temperature treatment patterns (TTPs), 543 Lipodystrophy, see Cellulite Lipofilling techniques, 657 Lipolaser, 532–533 Lipolysis, 540 Liposcore® test, 527–528 Liposonix, 429 Liposuction anesthesia, 665 of arms, 669 description, 663 evolution, 671 fluid management, 665–666 hip/flanks, 669 infiltration, 665 informed consent process, 664 instrumentation and current devices cannula shaft lengths, 666 LAL, 667 mercedes-tip design liposuction cannulas, 666 power-assisted cannulas, 666 RFLAL, 667 SAL, 666 UAL, 666 knees treatment, 670 lateral gluteal fold, 669 markings, surgical marker, 664 in neck region, 667–668 operative technique, 665 patient selection, 663 pertinent anatomy, 663 physical examination, 664 positioning, 664 postoperative care, 670–671 preoperative planning, 663–664 prevention of complications, 670–671 risks and complications, 671 subcutaneous abdominal fat, 669 subcutaneous fat and skin, back, 669 thighs and buttocks, 669–670 wetting solutions, types, 665 Lip piercing, gingival recession, 183, 185 Live interactive teledermatology, 775 LLLT, see Low-level laser therapy Local anesthesia (LA) clinical use agents, 228 nerve blocks, 229–230 perilesional infiltration, 229 topical application, 228 history, 225 iontophoresis, 228 nervous driving mechanism anatomy, 225–226 biochemistry, 226 chemical agents, 227 cryoanesthesia, 228 mechanisms of action, 226–227 physiology, 225–226 vasoconstrictor agents, 227–228 side effects, 230 Localized unilateral hyperhidrosis (LUH), 171 Long-chain fatty acids (LCFAs), 49, 52 Longitudinal melanonychia, 298–299 Long-lasting fillers, 629–630 Lower eyelid blepharoplasty by anterior approach premuscular cutaneous approach, 698–699 subciliary and retromuscular approach, 697–698 with fat repositioning, infraorbital edge, 700 and hyperlaxity full-thickness resection, eyelid’s free edge, 700 lateral canthoplasty, 700–701 lipectomy conjunctival approach, 700 skin excision, 700 and Malar bags classic subcutaneous anterior lower blepharoplasty, 701 midface lift, 701 transconjunctival, 699–700 Lower transconjunctival blepharoplasty, 699–700 Low-level laser therapy (LLLT), 533 Lymphatic aquadrainage, 531 Makeup techniques camouflaging cosmetics, 136–137 eyes (see Eye cosmetics) facial foundation, 136–137 for lips (see Lip cosmetics) pigmentation defects, 137 Malar lifting deep fat pad, 736 dissection, 736 SOOF pad, 736 Matrix metalloproteinases (MMP), skin aging, 12 Matting risk factors, 274–275 treatment, 275 Medium-depth peels action, 309 body peels, 312 complications, 310–312 contraindications, 309 depressed acne scars, 308 histological aspects, 310 history, 309 melasma, 308 photoaging, 308 preparation, 309 TCA, 311 technique, 310 Melanocytic stem cells, 38 Melanotic lesions, see Hyperpigmented lesions Menopause-induced skin aging estrogenic deficiency signs, 18 hyperandrogenism, 18–19 Mesenchymal stem cells (MSCs) adipose-derived stem cells, 37–38 bone marrow–derived MSCs, 34–36 clinical trials, 29–30 criteria, 34 dermal/adipose stem cells, 33–34, 37 MesoGlow, see MesoLift MesoLift composition, 605–606 definition, 603 epidermal mesotherapy, 603–604 equipment, 603 fine lines before/after treatment, 606 indications, 605 Copyright Material – Provided by Taylor & Francis Review Copy – Not for Redistribution MEDpress-Inform Publishers, 1-3-4/H, build.1, Kochnovsky proezd, RC "Aerobus", 125319 Moscow, Russia Index 803 intradermal technique, 604 medicines Papaverine, 605 Pentoxifylline, 605 meso-canulla, 605 mixture and techniques, 606 non-cross-linked hyaluronic acid, 605 oval and nasolabial fold, 606–607 oval face, 606–607 papula technique, 604 regeneration rate of skin, 606 techniques and depths of injection, 603 Mesotherapy alopecia (see Androgenic alopecia) cellulite, 608–611 description, 599 history, 599–602 hypertrophic scars and keloids, 615 indications, 602 psoriasis, 615 stretch marks, 615 viral warts, 615 Vitiligo, 615 Methyldibromo glutaronitrile, 101 Microdermal piercings, 179 Microepidermal necrotic debris (MEND), 360 Micrografts androgenetic alopecia digital phototrichogram, 257–258 female androgenetic alopecia, 259–261 male androgenetic alopecia, 257–260 multifactorial classification, 257 transsexuals, 261 body hair growth alopecia beard and mustache, 264 eyebrows, 261, 263 eyelashes, 261, 263 pubic hairs, 264 preauricular alopecia, 261–262 pseudopeladic alopecia, 261 scarring alopecia, 261–262 traction alopecia, 261–262 Microlipolyse, 533 Micropigmentation, see Permanent makeup Middle-sized and spider veins, sclerotherapy chromated glycerin, 272 complications, 272–273 matting, 274–275 pigmentation, 273–274 polidocanol, 272 superficial reflux, 272 systematized and nonsystematized network, 271 tetradecyl sulfate, 272 therapeutic result, 271 Midface lift anatomy definition, 733–734 features, 733 malar region, 733 orbital region, 733–734 structures, 734 zygomatic region, 733 clinical cases, 746–748 descriptive anatomy, 733 functional anatomy, 733 implantable medical devices, 742, 744 indications, 744 low malar lifting, 739 modeling, aging, 733 morphology, 733 side effects and complications, 744–745 skeleton and deep muscles, 734–735 skin traction, 733 superficial planes facial muscles, 735–736 fascia and ligaments, 737 fatty tissue planes, 736 horizontal histological section, 737–738 malar fat pad, 736 OOM, 736 surgical approaches gingival, 742 palpable, 742–743 tissue aging, 733 tissue stratification, 734 treatment overview, 745 upper malar lifting, 740 Minor starch test, 165–167 Mobile communication technology, 772–773 Mobile-health authentication, 773 Mobile VPNs, 773 Morbus–osle syndrome, see Hereditary hemorrhagic telangiectasia Multi-mini botulinum (M-M BTX) brow elevator, 567 bunny lines, 570 corrugator depressor supercilii complex, 566–567 insertions, 563, 565–566 origin, 563–564 at Corrugator Superciliaris, 560–561 crow’s feet, 568 depressor anguli oris (DAO), 574–575 depressor septi nasi, 572–573 dilator naris, 572–573 disadvantages, 559 early jowling, 576–577 eyebrow elevation, frontalis muscle, 560 eyebrow ptosis, 561 eyebrow tail, 569 eyebrow “Tell-Tail” sign, 569 frontalis, 567 injection dose, 562 Levator Labii Superioriset Alæque Nasi, 571–572 lower eyelid margin, 570–571 lower sand point, 568 Masseter BTX, 575–576 Mentalis, 575 migraine and tension headache, 579 multiple mini-dose injections, 559 Nefertiti lift, 576 at OO, 561–562 orbicularis oculi bands, 571–572 Orbicularis Oris, 572, 574 “Owwee” point, 570–571 placement and dose, 560 platysmal bands, 576, 579 procerus, 562–563 sand point, 567–568 venus rings, 576, 578 Multiple legal issues, cosmetic procedure clinical guidelines and innovation, 790–791 complications, physician, 791–792 cutaneous laser surgery, 789, 793 health-care law, 789 laser centers, 790 standard of care, 789, 791–793 Muscle aging characterization, 24 neck and platysmal cords, 25–26 nose, 25 peribuccal area, 25 periorificial fronto-orbital area, 24–25 Muscular and aponeurotic structures buccolabial region, 712 depressor supracilii muscle, 711 epicranial aponeurosis, 711 eyebrow’s lowering muscular complex, 711 eyelid orbicular muscles, 711 eyelids’ orbicular muscle, 711 galea aponeurotica, 711 McGregor patch, 712–713 muscular aponeurotic complex, 711 pars orbicularis, 711 pars palpebralis, 712 pyramid muscle/procerus, 711 Myxoid pseudocyst, 298–299 Nail adornment lacquered nail resting, 150 nail piercing, 151 stick-on nail dressings, 150 Nail gels acrylic light-cured gels, 147 allergic hazards, 150 benefits, 149 composition, 147 ethyl cyanoacrylate gels, 147 infectious hazards, 150 light-cured gel, 147–148 polymerization, 147 screening patch tests, 150 stickers, 147, 149 technical and mechanical hazards, 149 Nail lacquers additives, 141 advantages, 142 allergic hazards, 142–143 camouflaging, 142 categorisation base coats, 141 gel polish, 141–142 hardeners, 141 hypoallergenic, 141 ridge fillers, 141 top coats, 141 UV-curing nail lacquers, 141–142 cosmetic, 142 film formers, 140 film modifiers, 140 pigments and colorants, 141 plasticizers, 140–141 protection, 142 solvents, 141 technical and mechanical hazards keratin granulations, 142 nail brittleness, 142 severe nail damages, 142 yellow-orange staining, 142 thinners, 141 thixotropic agents, 141 Nail manicure allergic hazards, 140 benefits, 140 buffing, 139 chronic paronychia, 140 creams for brittle nails, 139 cuticle removers, 139 cuticle softeners, 139 cutting and filing, 139 infectious hazards, 140 mechanical hazards, 140 microtraumatisms, 140 nail lacquers, 140–143 nail polish remover, 139 Nail prosthesis, 151 Nail repair composition, 143 nail mending, 143 Nail surgery anatomic and physiologic considerations arterial blood supply, 287, 289 cuticle formation, 287–288 hyponychium and nail isthmus, 287–288 matrix and nail layers, 287–288 Copyright Material – Provided by Taylor & Francis Review Copy – Not for Redistribution MEDpress-Inform Publishers, 1-3-4/H, build.1, Kochnovsky proezd, RC "Aerobus", 125319 Moscow, Russia 804 Index nail growth, 287, 289 sagittal section, 287–288 anesthesia, 288–291 big toenail, 290–293 chronic paronychia, 300–301 distal nail avulsion, 300–301 double nail, 289–290, 292 ingrown nails, 294–296 laterally localized tumors, 299–300 longitudinal melanonychia, 298–299 myxoid pseudocyst, 298–299 onychopapilloma, 299 patient preparation, 287–288 patient selection, 287 postoperative care, 289 proximal nail avulsion, 301 proximal nail fold, 300 retronychia, 296–297 split nail deformity, 292–294 toenails, 295–297 tourniquet, 289 trapezoid nails, 290, 293 traumatically damaged nail, 301–302 ungual fibrokeratomas, 298 vertically implanted nail, 290, 293 viral warts, 297–298 Natural tattoos, see Traumatic tattoos Negative-pressure wound therapy (NPWT), 235–236 Nevus araneus, see Spider angioma Niacinamide, 79 Nominal scoring, skin aging, 63 Nonablative lasers evolution, 371 fractional lasers density, 373–374 different types of, 373 efficacy, 373 indication, 374 irradiance, 374 tissue effects, 373 treatment strategies, 374–375 wavelength, 374 remodeling lasers aftereffects, 372 dermal remodeling, 372 fibroblast stimulation, 372 histological studies, 372 indications, 372 mechanisms, 372 platelet factors, 372 principles, 372 Nonbotulinum treatment, primary hyperhidrosis anticholinergic medications, 161–162 antitranspirants, 161 cholinergic pathway, 161 parasympatholytics, 161–162 surgical treatments axillary sweat gland excision, 163 minor starch test, 164 sweat gland suction and curettage, 163–164 thoracic endoscopic sympathectomy, 164 TWI, 162–163 Noncollagenic agents calcium hydroxyapatite, 595–596 Lutrol F 127, 594–595 poly-L-lactic acid, 595 Nonsurgical fat destruction, cellulite, see Cellulite Nonsurgical skin tightening focal ultrasound, 518, 520 infrared light, 521 nonablative Er:YAG laser, 521–522 radiofrequency, 518–519 skin laxity causes, 517 managment, 517–518 Nutricosmetic ingredient, 113–114 Obsessive-compulsive disorder (OCD), 7–9, 72 Occlusive dressings foam dressings, 222–223 hydrocolloids, 221–222 hydrogels, 222 polymer films, 221 OCD, see Obsessive-compulsive disorder Office surgery accreditation, 192 certification, 192 facultative technical equipment, 205–206 PPP, 192 primary technical equipment advanced clinical–surgical hybrid tables, 201–204 audio system, 205 cabinets, 204 ceiling lights, 201 electrosurgical units, 204 Mayo stands, 202 operating room tables, 201–204 photographic equipment, 205 refrigerator, 204 resuscitative equipment, 203–204 surgical carts, 202 surgical clock, 205 surgical lights, 201 surgical stools, 202 surgical suction and gases, 202 vital functions monitoring equipment, 202–203 waste disposal, 205 x-ray film viewer, 205 quality of care, 192 risk management, 192 safety, 192 surgical environment aims and requirements, 191 definition, 191 dermatological offices, 192–196 ergonomics, 196–201 Olfactory beauty, Onychopapilloma, 299 Orbicularis labii oris, 25 Orbicularis oculi muscle (OOM), 734–735 Orofacial piercings, 179 Osler–Weber–Rendu syndrome, see Hereditary hemorrhagic telangiectasia Osmidrosis, 550 Palmoplantar hyperhidrosis, 168–169 Palpebral and upper face examination dermochalasis, Caucasian woman, 691–692 eyebrow ptosis, 691–692 forehead–facial region, 691–692 medical examination record, 691–692 upper eyelid, 691–692 Palpebral, lower and midface examination jugal (cheek) region, 691 lid/cheek junction, 691 lower eyelid, 691 standard ophthalmological assessment, 691 Papulopustular rosacea, 120 Paradoxical hypertrichosis, 507–508 Parallel pulley suture, 214–215 Partial androgen decline in the aging male (PADAM), 108–109 Participation, aesthetic technician aesthetic patient, 768–769 assistant laserist, 769 delegated acts, 769 education and skills hosting, 768 telephone reception, 768 instrumentation, 770 medical activities, 767 status and training, 767 surgical assistant, 769–770 team management, 767–768 Patient privacy protection (PPP), 192 PDT, see Photodynamic therapy Perifollicular edema, 506 Perioral dermatitis, 311–312 Periorbital skin tightening, nonablative Er:yag laser, 521–522 Periorificial fronto-orbital area, 24–25 Permanent (irreversible) fillers, 629 Permanent makeup (PMU) acute complications cutaneous infections, 174–175 hypersensitivity reactions, tattoo pigments, 175 PEH, 176 sarcoidal granuloma, 175–176 skin cancers, PMU, 176 systematic sarcoidosis, 175–176 blepharopigmentation, 176 decorative tattooing, 173 fake “freckles”, 174 laser treatment, 176 local legislation, 173 MRI, 176 progressive fading, eyebrow tattoos, 174 “semipermanent”, 173 Permanent products complications, 593 mineral oil injections, 591 polyacrylamide gel, 592–593 polyalkylimide gel, 593 polyethyl-methacrylate microparticles, 592 polymethyl-methacrylate microspheres, collagen, 592 polytetrafluoroethylene implant, 593 silicone injections, 591–592 Permanent vertical frontal wrinkles, 20 Personal privacy protection (PPP), 772 Phenol peels, see Deep peels Phlebectomy adverse reactions, 282–283 contraindications, 277 history, 277 indications curettage of telangiectasias, 284 dilated veins, 284–285 posttraumatic dilatation, 284–285 Ramelet’s hook, 284 superficial thrombophlebitis, 284–285 vein biopsy, 285 preoperative requisites, 278 procedure dressing, 280–281 instruments and equipment, 279–280 local anesthesia, 278–279 operations, 279–281 postoperative course, 281–282 preoperative/peroperative sclerotherapy, 278–279 varicose veins, marking of, 278–279 results, 282–283 scientific basis, 277 Copyright Material – Provided by Taylor & Francis Review Copy – Not for Redistribution MEDpress-Inform Publishers, 1-3-4/H, build.1, Kochnovsky proezd, RC "Aerobus", 125319 Moscow, Russia Index 805 Photoablative effect, 353 Photobiomodulation (PBM) bystander cell theory, 402 clinical practice, 401 device, 401–402 forward biased/direction, 395–396 indications biofilm, 405–406 cicatrization process, 403–406 hair growth, 406–408, 411–412 inflammation, 403–405 persistent psoriasis, 404, 410 photobiomodulable clinical forms, 406, 410 physiopathological hypotheses, 406 propionibacterium acnes, 404–405 stretch marks, 404, 407, 409 interpulse/dark period, 402 Joules and power density, 403, 404 light/energy absorbtion, 397 photon energy, 395, 397 pigmentation biological clock and retinohypothalamic–sympathetic pathway, 408 melanocyte network, 411 melasmas and postinflammatory pigmentations, 412 postinflammatory pigmentation, 412 visible light, 412 visual transduction, 408 vitiligo, 412–413 PN and depletion zone, 395–396 pre-injury/illness level of activity, 395 semiconductivity cellular cross-talk, 396 citric acid cycle, 399 dermoepidermal cross-talk, 396, 398 electron transport chain, 399 glycolysis, 399 inflammation, 396 Keloid scar appearance, 396, 399 molecular switch, 400 proliferation, 396 remodeling, 396 retrograde, 399 tiny impurities, 395 wound healing, 396 speaking light hypothesis, 402 Photobiomodulation rejuvenation process, 403, 405 Photochemical destruction, 504 Photodynamic therapy (PDT), 353 actinic keratoses, 512 adverse events, 512 basal cell carcinoma, 513 Bowen’s disease (SCC in situ), 512–513 field cancerization/multiple NMSC, 513 hypertrophic and keloid scars, 513–514 photorejuvenation, 514 photosensitizing drug, 511 topical, 511–512 Photomechanical hair destruction, 504 Photooxidative stress, 113 Photoprotection risk of burning, 89–90 skin aging, 14 solar ultraviolet index, 89–90 sun protection clothing and hats, 90–91, 93 optical filters, 91 shade, 89–92 sunscreens core ingredient, 91 sun protection factor, 91–92, 94–96 sunscreen–sunburn paradox, 93–94 wavelengths of UV radiation, 93 ultraviolet age, 96–97 Photorejuvenation, 514 Photothermal destruction, 501, 503 Physical peels, 308 Pillow wrinkles, 20 Platelet-rich plasma (PRP), 751 aesthetic dermatology, 645 in aesthetics applications, 648 centrifugation, 649 clinical approach, 648 coagulation, 649 fractional ablative CO2 laser resurfacing, 648–649 harvesting kits, 649 human dermal fibroblasts, 648 mesotherapy-like injections, 648 platelet concentration, 649 purity, 649 centrifugation, 645 controlled GF release over time, 646, 648 definition, 645 long-term collagen remodeling effect, 651 lower eyelid left before therapy, 651–652 in medicine, 647–648 multiple modalities, skin rejuvenation, 645–646 nasolabial left before therapy, 651–652 protocols, 649–650 for rejuvenation, 645 for skin regeneration, 645 whole face approach, 649–651 Platelets alpha and dense granules, 645 growth factors, 645 life span, 645 in wound healing chemical process of, 645–646 factors, 645, 647 fibroblast role, 645, 647 Poikiloderma of civatte, 490 Polymer films, 221 Postinflammatory hyperpigmentation (PIH), 476 Postlaser erythema, 506 Postlaser perifollicular edema, 506–507 Power-assisted lipoplasty (PAL), 667, 673 Practical anatomy, facelifts, see Facelift Preadipocyte progenitor cells, 47–49 Preauricular alopecia, 261–262 Preformed plastic nails composition, 143–144 guillotine clipper, 144–145 mechanical hazards, 147 procedure, 144 Premuscular cutaneous approach, 698–699 Primary hyperhidrosis BTX-A, 165–171 clinical appearance, 156–157 diagnostic procedures, 157 focal hyperhidrosis, 157–158 of groin, 157, 159 nonbotulinum treatment, 160–164 sub- and intermammary hyperhidrosis, 157, 159 therapy modality, 157 Primary technical equipment (PTE), 192 Proctalgia fugax, 551 Provoked vestibulodynia, 551 Proximal nail avulsion, 301 Proximal nail fold, 300 Pseudoepitheliomatous hyperplasia (PEH), 176 Pseudopeladic alopecia, 261 Psoriasis, 122 Public Relations (PR), 786 Pulsed dye laser (PDL), 493 vs NAFP, 364 scar prevention, 236 Purse string suture, 216 Pyogenic granuloma, see Granuloma telangiectaticum Q-switching, 440 Quadratus labii superioris (QLS), 734–735 Radio frequency (RF) acne scarring, 419, 421 bipolar configuration, 417–418 cellulite, 421–422 complications, 269 by conductivity, 417 hair growth stimulation, 422 hematomas, 269 hypoesthesias, 269 indications, 269 lipolysis, 533 “low-frequency” RF energy, 417 materials and methods, 269 matting, 269–270 monopolar configuration, 417–418 Nonsurgical skin tightening, 518–519 paresthesias, 269 pigmentation, 269 by radiation, 417 results, 269 striae, 421 surgical, 419 thromboembolism, 269 tissue interaction, 418 tissue tightening and rejuvenation, 419–420 unipolar configuration, 417 Radio frequency–assisted liposuction (RFLAL) energy, 667 Ramelet’s hook technique, 284 Regenerative medicine, fat grafting technique, 751 Remodeling lasers aftereffects, 372 dermal remodeling, 372 fibroblast stimulation, 372 histological studies, 372 indications, 372 mechanisms, 372 platelet factors, 372 principles, 372 Removal techniques chemical tissue destruction methods, 437–439 mechanical methods dermabrasion, 436–437 hypertrophic scarring/keloid formation, 436 radical one-time removal, 437–438 salabrasion, 436 sandpaper, 436–437 surgery, 436, 438 surgical removal, 437 thermal methods laser pulses, 439–440 pigment molecules, 439 QS alexandrite laser, 446 QS Nd:YAG laser, 441–443 QSRL, 440–441 Q-switching, 440–442 Repigmentation essay, 408 Restorative dental bonding, 147 Resveratrol, 116 Retinol, 115 Retronychia, 296–297 Copyright Material – Provided by Taylor & Francis Review Copy – Not for Redistribution MEDpress-Inform Publishers, 1-3-4/H, build.1, Kochnovsky proezd, RC "Aerobus", 125319 Moscow, Russia 806 Index Rosacea, 120–121, 491–492 Ross syndrome, 170–171 Routine liposuction, 44–45 Running horizontal intradermal suture, 213–214 Running intradermal sutures, 213–214 Running locked sutures, 210, 212 Running spiral intradermal suture, 214 Saphenous vein insufficiency, 267 Scalp follicular unit transplantation anterior frontal line, 249–250 automatic system, 256–257 Choi implanter, 256 FUE, 252–254 FUL, 250–253 FUT, 252 goals, 249–250 history, 249 local anesthesia, 250 Minoxidil effect, 255 platelet growth factors (PRP), 256 postoperative course, 254–255 preoperative stage, 249 principles, 249 robotic system, 257 micrografts androgenetic alopecia, 257–261 body hair growth alopecia, 261, 263–264 preauricular alopecia, 261–262 pseudopeladic alopecia, 261 scarring alopecia, 261–262 traction alopecia, 261–262 Scarring alopecia, 261–262 Sculptured artificial nails, mechanical hazards, 147 Seborrheic dermatitis, 121 Secondary hyperhidrosis, 155–156 Selective serotonin reuptake inhibitors (SSRIs), 8–9 Senile angioma, 488–489 Senile sebaceous hyperplasia, 21 Silymarin, 116 Simple buried stitches, 213 Simple dermatological surgery office (SDSO), 193 Simple hybrid clinical–surgical units (SHCSUs), 192–193 Simple interrupted stitches, 210 Simple running suture, 210, 212 Skin aging biology, 59–60 clinical scoring, 63 environmental factors body, 22–23 face, 19–22 photoaging, 19 smoke-induced skin aging, 23 extrinsic factors, 24 facial aging, 27 factors, 59–60 instrumentation dark complexion, 61–63 elasticity decrease, 59–60 menopause, sebaceous gland activity, 60 rougher and anisotropic, 61–62 transparency and dryer, 60–61 wound healing, 60–61 intrinsic factors chronological aging, 17–18 general and psychiatric diseases, 19 menopause-induced skin aging, 18 nutrition and effect, 113 pathophysiology aging and genomic analysis, 13 infrared and visible radiations, 13 matrix metalloproteinases, 12 mtDNA, 12 neutrophils and mast cells, 13 reactive oxygen species, 13 rejuvenation strategies, 13–14 structural and functional changes, 11 telomere shortening, 13 prevention of, 113 underlying structures bony atrophy, 26–27 fat ptosis and atrophy, 26–27 muscle aging, 24–26 Skin aging and wrinkles, see MesoLift “Skin-Ego”, Skin laxity causes, 517 managment, 517–518 SMAP, see Superficial musculoaponeurotic plane Smoke-induced skin aging, 23 Social media, 784–785 Soft earlobe piercing, 183, 185 Soft-tissue augmentation autologous fat transplantation, 596 biodegradable products, 593–594 “lipofilling” technique, 591 noncollagenic agents, 594–596 permanent products, 591–593 Soft-tissue fillers, 628–629 Soft tissue lifting, suspension sutures, see Suture lifting technique Solar elastosis, 19–20 Solar lentigines, 21 SPF, see Sun protection factor Spider angioma, 490 Split nail deformity, 292–294 Squamous cell carcinoma in situ, 512–513 Status cosmeticus, 119–120 Stem cells and growth factors adipose-derived stem cells, 39–40 clinical applications, 31, 33 embryonic stem cells, 29, 31 epidermal stem cells, 38 follicular bulge, 29–30 hair follicle bulge, 38 induced pluripotent stem cells, 31–32 melanocytic, 38 MSCs, 29–30, 33–38 plasticity and transdifferentiation, 29–31 totipotent stem cells, 29 transient amplifying cell, 29–30 Store and forward teledermatology, 775 Stroma-vascular fraction (SVF), 47 Subciliary and retromuscular approach, 697–698 Subcutaneous detachments major and irreversible damage, 757 necrosis, 758 scarring process, 757 stiffening and retraction, 757 tissue thinning, 758 Sublative rejuvenation, 419 Suborbicularis oculi fat (SOOF) pad, 736 Sub-SMAP face lifting with BTX, platysma muscle, 720–721 and mental fat injection, 720, 722 with submental lipoaspiration, 720–721 Suction-assisted lipoplasty (SAL), 666–667, 673 Sunpleated wrinkles, 20 Sun protection factor (SPF) application technique, 94 application thickness, 94 reapplication, 95–96 SFP15 sunscreen, 92 SPF30 sunscreen, 92 sunscreen formulation, 94–95 Superficial musculoaponeurotic plane (SMAP) aponeurotic and muscular layer, 712 deep aponeurotic plane, 713 deep dissection plane, 713 fixation, resorbable sutures, 718–719 flap detachment, 717, 719 McGregor patch, 713 sub-SMAS pre parotidien dissection, 717, 719 traction and suture, 718–719 Superficial musculoaponeurotic plane technique, see Cervico-facial lift technique Superficial musculoaponeurotic system (SMAS), 518, 760 Superficial peels acne, 305 AHA fundamentals, 307 histology, 307 history, 307 indications, 307 technique, 307–308 definiton, 304 melasma, 304–305 photoaging, 304 PIH, 305 TCA histological aspects, 306 Jessner’s solution, 306–307 Obagi Blue Peel, 306 salicylic acid, 307 technique, 305 Unna paste, 306 Surface piercings, 179, 182 Surgical rejuvenation autologous adipose grafting (see Fat grafting technique) endoscopic brow lift, 731 modeling, aging (see Midface lift) superficial musculoaponeurotic plane technique (see Cervico-facial lift technique) temporal lift (see Temporal lifting) Suspension sutures flabby buccolabial fold, 677 soft tissue lifting (see Suture lifting technique) suture lifting technique, 677 Suture lifting technique American barbed threads, 677, 679 aptos cog (barbed) threads, 677, 679 barbed thread, soft tissues without skin mobilization, 677, 680 classic suture material, 683 clinical considerations, 683 contraindications, 683 double-blind placebo-controlled investigation, 678 double-edged needle barbed suture, 678, 681 smooth suture, 678, 681 elastic spiral Aptos threads, 677, 681–682 by Excellence Visage, 683, 688 face and neck soft tissue lifting, 677 first-generation Aptos thread insertion needle, 677, 680 lifting soft tissues, 677, 680 German barbed threads, 677–678 histological investigations, 682–683 insertion, subcutaneous, 682–683 Copyright Material – Provided by Taylor & Francis Review Copy – Not for Redistribution MEDpress-Inform Publishers, 1-3-4/H, build.1, Kochnovsky proezd, RC "Aerobus", 125319 Moscow, Russia Index 807 markings, mid-face-lifting, 677, 680 operative, 684–685 patent ed second-generation Aptos thread, 677, 681, 687 postoperative, 684, 688 preoperative marking, 683–684 skin, antiseptic processing, 684–685 thread lifting procedures, 683–684 Sweat glands apocrine, 159 eccrine, 157–159 physiology secretory activity, 160 thermoregulation, 159–160 suction and curettage, 163–164 Swinehart’s technique, 307 Tacking/anchoring (pexing) sutures, 214 Tap water iontophoresis (TWI) description, 162 palmoplantar hyperhidrosis, 162 physical therapy, 163 side effects, 163 time-saving therapy, 162 treatment modality, 163 Tattoos atypical mycobacteria infections, 455, 468 black tattoo, 454–455, 462–463, 466 cosmetic tattoo, 454, 460–461 eczema/granular lesions, 455, 469 elimination, 433–434 forearm decorative tattoo, 433–434 fractional resurfacing, 452 guidances, 469 history of, 433 imiquimod, 453 laser tattoo ink interaction, 453 Maghreb ritual tattoo, 454, 458 Mali ritual tattoo, 454, 458 modulated imaging technique, 450 monochromatic black, 453–454 monochromatic professional, 455, 464–465 monochromatic ritual Ethiopian, 454, 459 new tattoo inks, 453 picosecond lasers, 452 polychromatic, 454–456, 463, 466 postinflammatory hyperpigmentation risk, 455, 466–468 professional monochromic tattoo, 454, 456 professional polychromatic tattoo, 454, 457 professional tattoo, deep ink, 454–455 QS lasers, 450–451 reactive erythema and edema, 454 removal techniques chemical tissue destruction methods, 437–439 mechanical methods, 436–438 thermal methods, 437–444 “R20” method, 449 sculpture-like tattoo, 455, 466 Senegal ritual tattoo, 454, 459–460 superficial pigment professional tattoo, 453 types of amateur tattoos, 434 cosmetic tattoos, 434–435 medical tattoos, 435 professional tattoos, 434 random/well-structured layers, 433, 435 traumatic tattoos, 434, 436 Youlaser Quanta System, 455, 464 TCA, see Trichloroacetic acid Team management, aesthetic technician care quality and safety, 767–768 consultation process, 768 protocols, 768 Telangiectasias, 21–22, 489–490 Telemedicine consultation, 775 remote surgical assistance, 772 store and forward systems, 772 teleconsulting, 772 telephone consultation, 772 videoconferencing systems, 772 Temporal lifting bayonet technique, 723 biplane bayonet technique., 723 deep subperiosteal lifting, midface undermining, 723, 725–726, 729 deep/superficial, 723–724 extended deep temporal lift, 726, 728 external blepharochalasis, 726 incisions, anatomic considerations, 723, 726–727 preoperative and permanent postoperative neutralization, muscles, 727 superficial undermining (subcutaneous), 723 surgical solutions, 723 Temporary henna tattoos, 104 Textural anomalies, 311 Theory of phyllotaxis, Therapeutic planning cosmetic “problem” rectification, 707 fragile and depressed patients, 707 operative planning, 707 patient’s data, 707 patient’s identity, 707 patient’s psychological strength, 707 psychological and physical information, 707–708 Thermal relaxation time (TRT), 377 Thermal transfer theory, 503 Thoracic endoscopic sympathectomy, 164 Thyroid disorders, 109 Tissue inhibitor of metalloproteinases (TIMP) genes, 12 Tissue-sparing sutures, 216 Tobacco-induced skin aging, 23 Toenails, 295–297 Totipotent stem cells, 29 Traction alopecia, 261–262 Training, aesthetic and cosmetic dermatology annual maintenance cost, 765 cutaneous biology and pathology., 763 dermatological counseling, 764 dermatologic societies, 764 equipments, 765 materials, 765 medical procedure, 765 methods and procedures, 763 methods and protocols, 765 patient assessment, 764 physiology and anatomy, 763 regulations, programs, 764 skin care, 764 standardized lighting, 765 training algorithm, 763–764 treatment outcome, 765 Transitional destruction, 757 Trapezoid nails, 290, 293 Traumatically damaged nail, 301–302 Traumatic tattoos, 434, 436 Trichloroacetic acid (TCA) atrophic acne scars, 241 chemical peelings, 128 histological aspects, 306 Jessner’s solution action, 306 contraindications, 307 indications, 306 technique, 306 Obagi Blue Peel, 306 salicylic acid, 307 technique, 305 Unna paste, 306 Trichostasis spinulosa, 21 Triple pulley suture with tissue-sparing effect, 216–217 UltraShape, 428 Ultrasound acoustic energy, 426 body contouring cellulite, 429–430 circumference reduction, 427–429 invasive sources, 431 light energy, 426 noninvasive focused, 427, 430 nonfocused therapeutic, 426–427 skin tightening, 430 sources, 426 terminology and principles, 425–426 Ultrasound-assisted lipoplasty (UAL), 431, 673 Ultraviolet index (UVI), 89 Unfractionated ablative lasers, 375 Ungual fibrokeratomas, 298 Upper eyelid blepharoplasty Dacryopexy treatment, 696 eyebrow ptosis correction, internal brow lift, 696 involutional ptosis aponeurosis repositioning, 695 levator aponeurosis disinsertion, 695 operative technique, 695–696 lachrymal gland prolapse, 696 Lion’s-wrinkle, blepharoplasty approach, 696 operative techniques conventional blepharoplasty, 693–694 external palpebral cutaneous resection, 695 eyelid’s levator aponeurosis, 695 neuroleptic analgesia, 693 skin integument, 694 skin suture, 695 palpebral fold, 692–693 palpebral fold (superior eyelid crease), 696–697 ptosis, 692–693 vertical and glabellar wrinkles treatment, 696 Upper malar lifting, 745 Varicose veins, leg causes, 494 chronic venous disease, 493–494 classic symptoms, 494 cost-effective, 494 incidence, 494 prevalence, 494 risk factors, 494 treatment options, 494–495 ultrasound examination, 494 Venous lakes, 492 Venous malformation (VM), 488 Vertically implanted nail, 290, 293 Vertical mattress sutures, 210 Copyright Material – Provided by Taylor & Francis Review Copy – Not for Redistribution MEDpress-Inform Publishers, 1-3-4/H, build.1, Kochnovsky proezd, RC "Aerobus", 125319 Moscow, Russia 808 Index Vertical wrinkles, 20 Vibration amplification of sound energy at resonance (VASER), 431 Viral warts, 297–298 Virtual private network (VPN), 772 Visual scoring, skin aging, 63 WAT, see White adipose tissue Web marketing, 783 White adipose tissue (WAT) autonomic innervation, 45 denervation and accumulation, 45 functions, 43–44 sensory innervation, 45 TAG deposition, 49 Yale Brown Obsessive Compulsive Scale Modified for BDDs, ... diodes 403 Unknown area Power density 20 0 mW/area (cm2) cm2 20 0 mW/cm2 From 5°C to 10°C cm2 100 mW/cm2 Safe area From 2 C to 4°C WHAT ARE THE INDICATIONS? 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