Dr. Mathew Avram
Dr. Ashish Bhatia
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Tissue Microcoring: A New Non-laser Approach to Skin Laxity and Rhtyides: Is This a Game Changer?
Dr. Ashish Bhatia and Dr. Mathew Avram discussed tissue microcoring during an informative back-to-back session on Friday at Masters of Aesthetics. Dr. Bhatia offered insight into how microcoring technology came to exist, from its earliest iterations. He even showed his own experience as one of the first patients to have the procedure done on his thigh! Since its inception, the technology has come a long way. Both Dr. Bhatia and Dr. Avram discussed that tissue microcoring offers an intermediate option between other minimally invasive procedures and surgical interventions. They discussed that while microcoring results are not comparable to surgery, they can have a distinct impact. Dr. Bhatia mentioned that he typically recommends patients undergo at least 2 microcoring treatments before assessing final results. Other considerations included optimal ways of achieving core clearance, such as the vacuum suction built into the device and removal of cores using manual traction with sterile towels. They discussed that the ideal technique is holding the skin taut and flush, and placing the device on the skin with minimal push or tension. They emphasized that gentle pressure against the skin is best. They also discussed that while currently the procedure is indicated for the face only, there are future opportunities to treat other body sites, such as the abdomen.
Dr. Ava Shamban
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Exosomes, Microbiome, and the Skin: What's the Truth?
This presentation discusses the skin microbiota, which consists of millions of bacteria, fungi, and viruses that play essential roles in protecting against pathogens, signaling to the immune system, and breaking down natural products. The skin microbiome is second only to the gut in terms of bacterial density and is characterized by four dominant phyla. The microbiome is composed of both resident and transient microbes, with spatially distinct communities dictated by cutaneous topography. The diversity of species within the microbiome is compared to different global regions, with different areas of the skin resembling different environments. Exosomes are gaining attention in the field of dermatology and cosmetics due to their regenerative and anti-inflammatory properties. They have been found to stimulate collagen production, repair skin damage, and improve overall skin texture by plumping and hydrating the skin. Exosomes have therapeutic potential in various skin conditions, including wound healing, skin flap reconstruction, systemic lupus erythematosus, psoriasis, atopic dermatitis, systemic sclerosis, vitiligo, and hair growth. In vitro studies have shown that exosomes derived from umbilical cord mesenchymal stem cells can promote dermal fibroblast migration and upregulate the expression of collagen 1, fibronectin, and elastin genes. ​
Dr. Victor Ross
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Winning the Scar Wars: Treating Scars and Keloids with Lasers & Laser-Assisted Drug Delivery
This presentation discusses the utility of using laser and laser-assisted drug delivery for the treatment of keloids and hypertrophic scars. Many different lasers may be used to treat scars, and the correct laser is based on the features of the scar. The most important lasers for scar treatment are fractional ablative and non-ablative lasers. Vascular lasers are useful for scar erythema. In addition, scars often require multiple different types of laser for effective treatment. It is important not to forget to use intralesional steroids and 5-FU and use them topically with laser-assisted drug delivery. Some scars that are more difficult to treat include sternal scars, hypopigmented scars, and self-harm scars. ​
Dr. Andrew Alexis
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Strategies and Treatment Pearls for Safe and Effective Cosmetic Treatments for Skin of Color
This presentation discusses the use of cosmetic procedures in individuals with Fitzpatrick skin types IV-VI. These patients have structural and functional differences in their skin that predispose them to post-inflammatory hyperpigmentation (PIH). Device selection and parameter settings are key to minimizing the risk of PIH. For laser hair removal in skin of color, longer wavelengths, lower fluences, longer pulse durations, and increased epidermal cooling are important. Resurfacing can be done in skin of color, but it has a higher risk of complications. Resurfacing should be done with lower treatment levels (density), and prophylactic use of hydroquinone. In addition, sunscreen and clobetasol may be used to minimize the risk of PIH. Treatment of hyperpigmentation of skin of color is recommended to be treated with the nonablative fractional 1927-nm diode or the 650 microsecond pulsed Nd:Yag. ​
Dr. Mathew Avram
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​Treating Acne with Lasers
Dr. Mathew Avram discussed the new 1726-nm laser for acne treatment. The goal of this laser is to decrease sebum production by targeting the sebaceous glands directly. This laser has a narrow margin of absorption advantage of sebum to water at 1726 nm, which allows for selective damage to the sebaceous gland. The laser system includes features such as air-cooling, real-time temperature monitoring, and a software safety mechanism to automatically stop treatment if an excessive skin temperature is reached. The system also has Enhanced Temperature Control (ETC), which allows for a target skin temperature to be set and the software adjusts power to achieve that temperature. The technology involves a multi-pulse protocol to cool and heat the sebaceous gland, providing the best opportunity for selective damage. Histologic analysis demonstrates selective targeting of the sebaceous gland. After treatment, Inflammatory lesion count reduction, the median improvement was 79%, 68%, 75%, and 90% at 12, 26, 39, and 52 weeks following the last treatment.