The Power of Combination Therapy
Transcript of The Power of Combination Therapy
![Page 1: The Power of Combination Therapy](https://reader034.fdocuments.net/reader034/viewer/2022042109/625727f65a073c0f03214ec4/html5/thumbnails/1.jpg)
skinworks.ca
Dr. Frances Jang, MD FRCPC Cosmetic Dermatologist
The Power of Combination Therapy
![Page 2: The Power of Combination Therapy](https://reader034.fdocuments.net/reader034/viewer/2022042109/625727f65a073c0f03214ec4/html5/thumbnails/2.jpg)
skinworks.ca
2007 Stats on Cosmetic Surgery- ASAPS
- 11.5 million surgical & non-surgical cosmetic procedures - 83% non-surgical/17% surgical
- Since 1997, 446% increase in number of cosmetic procedures - Non-surgical procedures increased by >700%
- Women had 91% of cosmetic procedures, age 35-55
![Page 3: The Power of Combination Therapy](https://reader034.fdocuments.net/reader034/viewer/2022042109/625727f65a073c0f03214ec4/html5/thumbnails/3.jpg)
skinworks.ca
- Botox- 2.8 million
- Hyaluronic acid fillers -1.4 million
- Laser hair removal-1.4 million
- Microdermabrasion
- Laser skin resurfacing
2007 Top 5 Cosmetic Procedures
![Page 4: The Power of Combination Therapy](https://reader034.fdocuments.net/reader034/viewer/2022042109/625727f65a073c0f03214ec4/html5/thumbnails/4.jpg)
skinworks.ca
-
2007 Top 5 Surgical Cosmetic Procedures
- Breast Augmentation
- Liposuction
- Abdominoplasty
- Eyelid surgery
- Breast reduction
![Page 5: The Power of Combination Therapy](https://reader034.fdocuments.net/reader034/viewer/2022042109/625727f65a073c0f03214ec4/html5/thumbnails/5.jpg)
skinworks.ca
Aging Face
- Intrinsic aging - Extrinsic aging
![Page 6: The Power of Combination Therapy](https://reader034.fdocuments.net/reader034/viewer/2022042109/625727f65a073c0f03214ec4/html5/thumbnails/6.jpg)
skinworks.ca
Intrinsic Aging
Several theories but common to them all:
- Free radicals interact with cells at the molecular level causing damage to skin and other organs
- Antioxidants quench or neutralize free radicals
- As we age, we lose the ability to completely eliminate free radicals
![Page 7: The Power of Combination Therapy](https://reader034.fdocuments.net/reader034/viewer/2022042109/625727f65a073c0f03214ec4/html5/thumbnails/7.jpg)
skinworks.ca
Extrinsic aging
- Sun exposure
- Air pollution or other environmental toxins
- Poor nutrition lacking in antioxidants
- Stress
- Excess alcohol, smoking
![Page 8: The Power of Combination Therapy](https://reader034.fdocuments.net/reader034/viewer/2022042109/625727f65a073c0f03214ec4/html5/thumbnails/8.jpg)
skinworks.ca
Extrinsic Aging: Photo-aging - Sun damage through excessive exposure to UVA & UVB
- Increased generation of free radicals cumulative
- Daily use of photo protection SPF 30!!!
![Page 9: The Power of Combination Therapy](https://reader034.fdocuments.net/reader034/viewer/2022042109/625727f65a073c0f03214ec4/html5/thumbnails/9.jpg)
skinworks.ca
Type I. Mild (ages: 20s to 30s)
• No keratoses
• Little to no discoloration or wrinkling
• Minimal or no makeup needed
Glogau Classification Photo-Aging
![Page 10: The Power of Combination Therapy](https://reader034.fdocuments.net/reader034/viewer/2022042109/625727f65a073c0f03214ec4/html5/thumbnails/10.jpg)
skinworks.ca
Type II. Moderate (ages: 30s to 40s)
• Early actinic keratoses
• Slight yellowish discoloration or brownish cast with increasing freckling
• Early wrinkling, especially with motion
• Light makeup usually worn (to cover skin color irregularities
Glogau Classification Photo-Aging
![Page 11: The Power of Combination Therapy](https://reader034.fdocuments.net/reader034/viewer/2022042109/625727f65a073c0f03214ec4/html5/thumbnails/11.jpg)
skinworks.ca
Type III. Advanced (ages: 50s)
• Visible actinic keratoses
• Sallow, yellowish skin discoloration with telangiectases
• Visible wrinkles all the time
• Heavier makeup always worn to even skin color, but can accentuate deeper wrinkles
Glogau Classification Photo-Aging
![Page 12: The Power of Combination Therapy](https://reader034.fdocuments.net/reader034/viewer/2022042109/625727f65a073c0f03214ec4/html5/thumbnails/12.jpg)
skinworks.ca
Type IV. Severe (ages: 60s to 70s)
• Actinic keratoses and skin cancers
• Almost no pink color at all
• Heavy wrinkling •Makeup cakes and cracks, not usable
Glogau Classification Photo-Aging
![Page 13: The Power of Combination Therapy](https://reader034.fdocuments.net/reader034/viewer/2022042109/625727f65a073c0f03214ec4/html5/thumbnails/13.jpg)
skinworks.ca
New Research
Canadian women feel on average 14 years younger on the inside
They think they look on average 3 years older on the outside
Almost three quarters of Canadian women hold negative feelings about their wrinkles
![Page 14: The Power of Combination Therapy](https://reader034.fdocuments.net/reader034/viewer/2022042109/625727f65a073c0f03214ec4/html5/thumbnails/14.jpg)
skinworks.ca
How Women Want to Look Canada’s New Age Gap is not about change, it’s about
getting just a few years back…
Women want:
to look natural
to have radiant looking skin
to feel more attractive
to feel energized
![Page 15: The Power of Combination Therapy](https://reader034.fdocuments.net/reader034/viewer/2022042109/625727f65a073c0f03214ec4/html5/thumbnails/15.jpg)
skinworks.ca
Pigmentation Matters
- Evolutionary biologists, Grammer & Fink
- Digital morphing software to "drape" study participant's skin over a universal face in order to isolate the impact of facial tone on perception of age
![Page 16: The Power of Combination Therapy](https://reader034.fdocuments.net/reader034/viewer/2022042109/625727f65a073c0f03214ec4/html5/thumbnails/16.jpg)
skinworks.ca
Pigmentation Matters: Pigment Study Conclusions Pigment concentration and distribution has a major influence on the perception of female facial age, attractiveness, and health.
Frances Jang, MD
![Page 17: The Power of Combination Therapy](https://reader034.fdocuments.net/reader034/viewer/2022042109/625727f65a073c0f03214ec4/html5/thumbnails/17.jpg)
skinworks.ca
Dermatologic Therapies 2008
Skincare - Correction, adjunctive, maintenance, prevention (CAMP)
Botox - Dynamic wrinkles of facial expression, prevention
Fillers (Restylane/Juvederm/Sculptra) - Grooves, facial shaping, retexturizing/lifting
![Page 18: The Power of Combination Therapy](https://reader034.fdocuments.net/reader034/viewer/2022042109/625727f65a073c0f03214ec4/html5/thumbnails/18.jpg)
skinworks.ca
Dermatologic Therapies 2008
IPL - Correction of colour, tone & texture
Thermage - firming, retexturizing, lifting
Fractional Technologies (Fraxel/Plasma) - correction of colour, tone, retexturizing with addition of wrinkle reduction & lifting
![Page 19: The Power of Combination Therapy](https://reader034.fdocuments.net/reader034/viewer/2022042109/625727f65a073c0f03214ec4/html5/thumbnails/19.jpg)
skinworks.ca
Skincare: Correction, Adjunctive, Maintenance, and Protection Products
- Sunscreens - Exfoliants - Tretinoin
- Antioxidants - vitamin C
- vitamin E - Peptides
- Soy - DNA repair
CAMP
![Page 20: The Power of Combination Therapy](https://reader034.fdocuments.net/reader034/viewer/2022042109/625727f65a073c0f03214ec4/html5/thumbnails/20.jpg)
skinworks.ca
Corrective
- Exfoliants
- Tretinoin
- Bleaching agents
Skincare
Frances Jang, MD
![Page 21: The Power of Combination Therapy](https://reader034.fdocuments.net/reader034/viewer/2022042109/625727f65a073c0f03214ec4/html5/thumbnails/21.jpg)
skinworks.ca
Skincare-Adjunctive
- Tretinoin
- Hydroquinone
- Exfoliants
- Peptides
![Page 22: The Power of Combination Therapy](https://reader034.fdocuments.net/reader034/viewer/2022042109/625727f65a073c0f03214ec4/html5/thumbnails/22.jpg)
skinworks.ca
- Sunscreens
- Antioxidants
- Tretinoin
- Exfoliants
- Peptides
Skincare- Maintenance and Prevention
![Page 23: The Power of Combination Therapy](https://reader034.fdocuments.net/reader034/viewer/2022042109/625727f65a073c0f03214ec4/html5/thumbnails/23.jpg)
skinworks.ca
Botox Cosmetic: The Science
- Prescription drug-Allergan
- Administered only through MD
- Relaxes muscles; degree and duration dose-related
- Results wear off slowly over period of several months
- Maintenance required but often lower doses over time
![Page 24: The Power of Combination Therapy](https://reader034.fdocuments.net/reader034/viewer/2022042109/625727f65a073c0f03214ec4/html5/thumbnails/24.jpg)
skinworks.ca
- Medically proven- >500 peer-reviewed journal articles with established medical safety record of over 10 years cosmetic use
- Increasing medical indications for non- cosmetic diagnoses
- Botox is often "entry level" treatment for aging upper third of face
Botox Cosmetic: The History
![Page 25: The Power of Combination Therapy](https://reader034.fdocuments.net/reader034/viewer/2022042109/625727f65a073c0f03214ec4/html5/thumbnails/25.jpg)
skinworks.ca
Identical Twin Study - One twin injected forehead and glabellar lines with Botox 2-3 times a year for 13 years
- Treated twin does not show wrinkles compared with untreated twin "aging naturally"
Treated Untreated
![Page 26: The Power of Combination Therapy](https://reader034.fdocuments.net/reader034/viewer/2022042109/625727f65a073c0f03214ec4/html5/thumbnails/26.jpg)
skinworks.ca
Identical Twin Study
Treated Untreated
Conclusion: Regular botox injections will PREVENT the formation of wrinkles
![Page 27: The Power of Combination Therapy](https://reader034.fdocuments.net/reader034/viewer/2022042109/625727f65a073c0f03214ec4/html5/thumbnails/27.jpg)
skinworks.ca
Botox Cosmetic-The Art - Artful placement and dosage to ensure natural looking results Face will look less stressed, less tired and more healthful
- If treatments are stopped, lining will gradually reappear but progression of wrinkling will be stopped for the duration of time that Botox is employed
![Page 28: The Power of Combination Therapy](https://reader034.fdocuments.net/reader034/viewer/2022042109/625727f65a073c0f03214ec4/html5/thumbnails/28.jpg)
skinworks.ca
New Generation of Fillers 2008 (Restylane, Juvederm & Sculptra)
- Safe, effective, long lasting, with results 6 months plus
- Natural looking
![Page 29: The Power of Combination Therapy](https://reader034.fdocuments.net/reader034/viewer/2022042109/625727f65a073c0f03214ec4/html5/thumbnails/29.jpg)
skinworks.ca
Hyaluronic Acid (HA) is…
A naturally occurring sugar found in most tissues of the human body, such as skin and cartilage
Immediate results
![Page 30: The Power of Combination Therapy](https://reader034.fdocuments.net/reader034/viewer/2022042109/625727f65a073c0f03214ec4/html5/thumbnails/30.jpg)
skinworks.ca
Signs of the Aging Face HA depletion results in loss of volume:
- Thinning of the skin
- Loss of fullness of the lips
- Sunken eyes with fullness and brow droop
- Flattening and descent of cheeks
- Wrinkles
- Jowls
![Page 31: The Power of Combination Therapy](https://reader034.fdocuments.net/reader034/viewer/2022042109/625727f65a073c0f03214ec4/html5/thumbnails/31.jpg)
skinworks.ca
Sculptra - Poly -L-lactic acid
- Stimulates dermal collagen
- Gradual improvement- 2 to 4 sessions required
- Lifting, recontouring, smoothing, thickening of dermis
![Page 32: The Power of Combination Therapy](https://reader034.fdocuments.net/reader034/viewer/2022042109/625727f65a073c0f03214ec4/html5/thumbnails/32.jpg)
skinworks.ca
Fraxel (2008) IPL Quantum (2004) Lightsheer Hair Removal (2007) Plasma/ Portrait ( New at Skinworks ) (2008) Sciton Hair Removal & Erbium Ablative (2006) Sciton (Profractiona)l (2008) SmoothBeam (2004) Thermage (2008) V Beam (2004) Vela (2006) Ultrashape: 2007
Skinworks: 11 Laser & Energy-Based Technologies
![Page 33: The Power of Combination Therapy](https://reader034.fdocuments.net/reader034/viewer/2022042109/625727f65a073c0f03214ec4/html5/thumbnails/33.jpg)
skinworks.ca
- Non-invasive, broad band light (not laser)
- 5 FF treatments q4 weeks
- Gradual, "natural" improvement
- All age ranges
- Face, neck, hands, chest
Intense Pulsed Light
Frances Jang, MD
![Page 34: The Power of Combination Therapy](https://reader034.fdocuments.net/reader034/viewer/2022042109/625727f65a073c0f03214ec4/html5/thumbnails/34.jpg)
skinworks.ca
Photodynamic Therapy
- 5-aminolevulinic acid (5-ALA) photosensitizer
- Levulan Kerastick – 20% ALA
- “Photodynamic” rejuvenation
- Enhances effects of IPL – actinic keratoses (precancers)/acne “IPL Boost”
![Page 35: The Power of Combination Therapy](https://reader034.fdocuments.net/reader034/viewer/2022042109/625727f65a073c0f03214ec4/html5/thumbnails/35.jpg)
skinworks.ca
Thermage - Cleared by HPB and FDA for non-invasive mild to moderate
skin firming
- Single treatment, no recovery time, "color blind“, safe for skin of color or those with tan
Frances Jang, MD
![Page 36: The Power of Combination Therapy](https://reader034.fdocuments.net/reader034/viewer/2022042109/625727f65a073c0f03214ec4/html5/thumbnails/36.jpg)
skinworks.ca
Thermage- How does it work? - Novel delivery of radiofrequency energy creates a heating effect in mid and deep layers of skin
- Temperature rise causes both immediate and delayed contraction of collagen fibers with neocollagenesis over several months
![Page 37: The Power of Combination Therapy](https://reader034.fdocuments.net/reader034/viewer/2022042109/625727f65a073c0f03214ec4/html5/thumbnails/37.jpg)
skinworks.ca
Thermage- Who is a Candidate?
- Not a facelift!
- Excellent adjunctive procedure for someone already using Botox and fillers
- Mild to moderate skin laxity for mild to moderate skin firming
- Age 35-50+
- Safe for all skin types
![Page 38: The Power of Combination Therapy](https://reader034.fdocuments.net/reader034/viewer/2022042109/625727f65a073c0f03214ec4/html5/thumbnails/38.jpg)
skinworks.ca
- Fraxel-nonablative Erbium summer 2006
- Fraxel ablative CO2 fall 2008
- Profractional ablative erbium
- Deep FX, Active FX ablative CO2
- Plasma
Fractionated Technologies
![Page 39: The Power of Combination Therapy](https://reader034.fdocuments.net/reader034/viewer/2022042109/625727f65a073c0f03214ec4/html5/thumbnails/39.jpg)
skinworks.ca
Plasma – New @ Skinworks - Novel technology utilizing Nitrogen Gas; PSR technology
- Excellent for tightening eye area
- Reduction of wrinkles 40-70%
- Reduction of acne scare 35%
- Skin tightening 10-15%
![Page 40: The Power of Combination Therapy](https://reader034.fdocuments.net/reader034/viewer/2022042109/625727f65a073c0f03214ec4/html5/thumbnails/40.jpg)
skinworks.ca
- Gold standard for acne scarring
- Melasma
- White scars
- Stretch marks
- Facial rejuvenation-pore reduction, sun damage
BUT not a lot of tightening or wrinkle reduction
Fraxel Nonablative Erbium
![Page 41: The Power of Combination Therapy](https://reader034.fdocuments.net/reader034/viewer/2022042109/625727f65a073c0f03214ec4/html5/thumbnails/41.jpg)
skinworks.ca
Fraxel Nonablative Erbium
- "Pixellated" laser wounds separated by untreated skin
- Faster healing by surrounding untreated skin
- Skin appears reddened/sun burnt for a few days, no oozing
- Followed by "bronzed" and flaking skin corresponding with extrusion of microthermal zones (MTZ) for a week
![Page 42: The Power of Combination Therapy](https://reader034.fdocuments.net/reader034/viewer/2022042109/625727f65a073c0f03214ec4/html5/thumbnails/42.jpg)
skinworks.ca
The Power of Combination Therapy
- No one technology or procedure addresses all aging concerns
- Visual impact of several carefully selected treatments is more powerful than single therapies
- Incorporate patient's desires, lifestyle, and budget
- More harmonious and natural appearing
![Page 43: The Power of Combination Therapy](https://reader034.fdocuments.net/reader034/viewer/2022042109/625727f65a073c0f03214ec4/html5/thumbnails/43.jpg)
skinworks.ca
The Power of Combination Therapy
- Maintenance treatments in conjunction with well selected skincare as adjunct
- Continued relationship with Dermatologist to oversee long term treatment plans as skin matures
- 50% of Skinworks’ patients do combination treatments (defined as more than one kind of non surgical treatment)
*all patients were of more than one year duration
![Page 44: The Power of Combination Therapy](https://reader034.fdocuments.net/reader034/viewer/2022042109/625727f65a073c0f03214ec4/html5/thumbnails/44.jpg)
skinworks.ca
- Multiple treatment options can be confusing for patients/clients
- New and evolving treatments in aesthetic dermatology
- Establish relationship with experienced, reputable dermatologist to achieve optimum benefits as well as value
- Be aware that careful selection of treatment and maintenance options including skincare will achieve the best aesthetics results/outcomes
Some Final Words