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1 21st WORLD CONGRESS OF AESTHETIC MEDICINE 21. DÜNYA ESTETIK TIP KONGRESI October / Ekim 2017 Hilton Bosphorus İstanbul Convention Center ABSTRACT BOOK BİLDİRİ ÖZETİ KİTABI i e d s e I O N rnationa N U te l n e e medecin e u t h e t i q w w w.wc am 2017.co m 1

2 ABSTRACT TITLE / ÖZET BAŞLIĞI Complications of Body Fillers Medical Male Gluteoplasty and Gluteopexy without volume augmentation Chemistry of Peels and Classification of A.Tenenbaum About the Medical Belongings of Aesthetic Decorations Terms in Medical Aesthetics and Aesthetic Medicine, the only book in this field in the world, has been published in China PRESENTER / SUNUCU Alain Tenenbaum Alain Tenenbaum Alain Tenenbaum Qingxing Peng Hong Wei Liu Efficacy evaluation of Dysport (a botulinum toxin type A) in treatment of hyperhydrosis Elena Albertovna Sanchez Adipose derived mesenchymal stem cells promote the survival of fat grafts via crosstalk between the Nrf-2 and TLR4 pathways Regenerative Soft Thread Lift Regenerative Endo Lift Carbon Dioxide Laser Treatment of Rhinophyma - The doctor nose best! Emulsiolipolisys A Novel Approach in Face Engineering using Threads and Filling Technique: The Column-Beam-Cement Technique Mesotherapy - skin quality becoming a major player Top 5 minimally invasive procedures: Almost no expensive machines necessary Xiaosong Chen Pier Antonio Pab Bacci Pier Antonio Pab Bacci Frank Conroy Elma Bunar Ibrahim Devrim Gürsoy Jacobus Van Niekerk Jacobus Van Niekerk Striae rubra treatment after pregnancy using Laser Erbium Yag: One case Shadya Waheeda Ramdjan The essential role of hydrogen peroxide, from dawn of life to tissue restoration A new approach to laser epilation Progressive Physio-Regeneration from the Epidermis: just open the door Rossana Castellana Dr. Serkan Öztürk George Virginio Oskarbski Do physical and chemical triggers in association amplify the regenerative cutaneous response? Francesco Paolo Alberico 2 3

3 TCA modulated with hydrogen peroxide in a new concept of dermal stimulation Gut Microbiota, Obesity and popular diets Francesco Paolo Alberico Prof. Dr. Banu Çaycı KOZMETİK VAJİNAL CERRAHİDE LASER UYGULAMALARI Redermalizasyon: Mezoliftingde süksinik asid ve süksinik asidin antioksidanve antiaging üzerine etkisi Op.Dr. Ayşe Konaç Dr. Ayşegül Girgin Liquid Rhinoplasty Ibrahim El Achkar Medikal estetikte vasküler lezyon tedavilerinde sklero terapi Dr. Aslı Şimşek Azlar Ciltaltı yağ dokusunun azaltılmasında kullanılan metodlar:soğuk lipoliz, radyofrekans, mezoterapi:hangi hastada hangi metod daha efektif? Full face treatment (tüm ayrıntıları ile yüz tedavisi) Tüm yüzün medical estetik olarak klinik ve görsel tedavisi Yüz estetiğinde kaşın önemi Italian Phlebology 2.0- New curative method of varicose veins with visual disappearance-trap Prof. Dr. Banu Çaycı Beril Özlem Leylek Claudio Rosco İNSANLARI KANDIRMADAN DA KAZANABİLİRSİNİZ DARK CIRCLES AND THE ORBITAL RIM: A CHALLENGE FOR CORRECTION, A REAL INDICATION FOR REGENERATION THE FUTURE OF BIOSTIMULATION: AURIGRAFT Telomere Lengthening - Resetting the Clock of Aging KOZMETİK JİNEKOLOJİDE RADYOFREKANS KULLANIM ALANLARI Ayşen Özkul Emanuele Bartoletti Emanuele Bartoletti William H. Andrews, Ph.D Op.Dr. Burçin Demirel Novel method of delivery of essential micro-elements across the skin barrier. Minerals balance and its impact on the skin health, immunity and appearance Our approach in management of filler complicantions Saç estetiğinde vizyonel yaklaşım, saç mezoeterapisi ve PRP ile beraber microblading uygulanımı Hair aging and specific anti-aging therapy: a therapeutic proposal for the exlusive use of the doctor Led technology in hair growth. Four years of experience Mazen Raydan Alessandra Veronesi Beril Özlem Leylek Alessandra Timotei Camporese Antonio Soverina FIBROBLAST BIOSTIMOLATION BY NOT CROSS-LINKED HYALURONIC ACID (FRAGMENTS), AMINOACIDES, ANTIOXIDANTS ADIPOSE TISSUE: A HIGHLANDER Facial Danger Zones - Avoiding the Danger Zones When Injecting Fillers Genital Bölge Dolgusu ve PRP Lazerle Noninvaziv Genital Rejuvenasyon Carla Mazzini MD Catherine Marsili MD Assist. Prof. Dr. Cüneyt BOZER Jinekolog Op. Dr. Didem Kurban Jinekolog Op. Dr. Didem Kurban Don t let the congenital anomaly define you! Behind a syringe Ebtisam Elghblawi Genital Estetik Tıp a Genel Bakış Dr. Süleyman Eserdağ Aesthetic Facial Anatomy Prof. Dr Ali YILMAZ Labioplasti, Cerrahi Vajinal Daraltma ve Perineoplasti Dr. Süleyman Eserdağ New Techniques and Trends in Dermal Fillers Alp Mamak MD Vajinismus ve Disparoni Tedavisinde Uygulanan Cerrahi Tedaviler Dr. Süleyman Eserdağ MESOTHERAPY COLLAGEN Prof.Andrea Corbo Genital RF Uygulamaları Dr. Şenay Eserdağ The Hair Clock - Estrone and Hair Andrea Marliani MD The Canadian Experience with ATX-101 Dr. Julia Carroll AESTHETIC MEDICINE IN ONCOLOGY NAHYCO TECHNOLOGY. The BAP (Bio Aesthetic Points) technique and other applications: the new edge in biorejuvenation Efficacy of a medical aesthetic path, in a cohort of elderly patients: a pilot study. Annalisa Beatini, M.D. Annalisa Beatini, M.D. Annarosa Catizzone Popüler Diyet Akımları Güncesi: Kişiye özel beslenmek için genlerinize mi bağırsaklarınıza mı kulak vermelisiniz yoksa vücut dengesini mi sağlamalısınız? METHODS OF ACNE TREATMENT WITH LOCAL RETINOIDS KELOIDS: INFILTRATIVE THERAPIES Dyt. Eda Ağıllı Akın E.Ugrekhelidze M.D. DR. EMANUELE VERGA 4 5

4 Mesotherapy and regenerative medicine ESTETİK TIP AÇISINDAN GENİTAL ANATOMİ Laser-assisted drug delivery: a new concept in the transdermal therapy AESTHETIC MEDICINE EDUCATION AND TRAINING: PRESENT STATUS AND FUTURE PERSPECTIVES Minimally invasive procedures: any news Integration between PDRN, HA free and TCA peeling on aging face. Proposal for guidelines. Dr. Erkan Özgün Dr. Evin Nil Uğurlu Florian C. Heydecker Francesco Amenta Fulvio Tomaselli, MD Fulvio Tomaselli, MD CHOOSING PATIENT AND FACTORS EFFECTS SUCCESSFUL OPERATION IN HAIR TRANSPLANT ECCHYMOSIS: THERAPY BY GLUCOSE SOLUTION 5% Biostimulation of eyelash growth by topical application of bimatoprost. A clinical trial COSMETIC PHLEBOLOGY SYNERGY OF TREATMENS FOR THE IMPERFECTIONS PHLEBOLOGICA THE TRIPLEX METHOD AND DRAINAGE DERMO \ HYPODERMIC (IN AREAS WITH PANICOLOPATIA) İnsülin direnci ve kronik inflamasyon Dr. Özlem Biçer Paola Mannelli MD Rossella Petese MD Prof. Sotiris Davlouros Dr. Süreyya Şahinoğlu UPDATES CONCERNING A METHODOLOGY FOR THE TREATMENT OF ATROPHIC STRIAE AND MORE Peculiarities of Correction of Ethnic Faces in Central Asian region New method of skin laxity treatment with endodermal radiofrequency. Non surgical lifting with absorbable threads: form reconstructive medicine to aesthetic practice. The ego and its skin. Aesthetic medicine, affective life, and psychosomatic disorders. Last Trend Hair Treatments and Regenerative Hair Treatments The Distribution of the Ink Tattoo With Laser Alberti Giovanni Gulnar Zhumatova Prof. Irina Poleva Prof. Irina Poleva Prof. Maria Malucelli Dr. Mehmet Faruk Yavuz Dr. Mercedes Campoy HYMENOPLASTİ Botulinum toksin ve mezolifting MANUAL FOLLICULAR UNIT EXTRACTION PDO THREADS A VALID ALTERNATIVE IN THE TREATMENT OF SKIN FLACITY. Five years of experience using autofibroblasts in skin rejuvenation. Alt yüz kaslarında toksin uygulaması yoluyla yüz kontürü düzeltilmesi ve belirginleştirilmesi FIBROBLAST BIOSTIMOLATION BY NOT CROSS-LINKED HYALURONIC ACID (FRAGMENTS), AMINOACIDES, ANTIOXIDANTS Dr. Tamer Gültekin Dr. Tamer Küçük O.TAYFUN OGUZOGLU, MD Dr. Viveka Tinoco-Kirby Tsepkolenko V.A. Dr. Yasemin Savaş Carla Mazzini MD VAJİNAL RELAKSASYONDA CERRAHİ ÇÖZÜMLER VAJİNOLASTİ PERİNEOPLASTİ OP.DR. MURAT EMANETOĞLU CLINICAL VALUE OF TELOMER MEASURMENT AND TELOMERE LENGHTENING STUDIES ON TA-65 Prof. Dr. Hakan CANGUL Yeni Nesil Moulding COG Aski LABİOPLASTİ - HOODOPLASTİ Localized Use of Chlorine E6 Derivative in Photodynamic Therapy for Aging Skin: Long-term Results and Analysis Dr. Nejat Can Op. Dr. Nurdan Leylek Dr. Olga Panova DNA Damage and DNA Repair Mechanisms. Reverse-Aging by DNA Repair a New Approach to Well Being, Beyond Anti-aging. Intense Pulsed Light Therapy for Solar Lentigines of Hands; Clearance in just One Session Dr. Yaman Er Sezin Fıçıcıoğlu, MD Kollojen uyarıcı dolgu sistemleri, uygumama alanları ve PCL ve PLA dinamik ip askı yöntemleriyle kombinasyon uygulamaları. Dr. Osman BAŞ NEW APPROACH IN THE TREATMENT OF MELASMA AND PIH THULİUM DR. ÖZGE AYDIN GENİTAL İP UYGULAMALARI OP.DR. ÖZGÜR LEYLEK 6 7

5 COMPLICATIONS OF BODY FILLERS Alain Tenenbaum International Peelings Society IPSC All fillers can lead to irreversible huge complications and fillers used for body are used nore and more frequently with rate of complications higher. Also fat autograft filling can lead to some complications but in low rate. Resorbable fillers like HA in big quantities are not only expensive but also dangerous. ( forbidden in France since some years).. Not resorbable fillers which are cheap have been used long time ago, where complications as geleomas, migration, necrosis,fistulas,amputation,nodules,infections are frequent and create a non stop nightmare for the physician as for the patient, even after surgery.in many cases 5-6 surgeries are not enough and don t stop the evolution of complications. The risk factors in the Classification of A.TENENBAUM are the presence of hydrogel,monomers,mixed biphasic fillers,sterilisation else than by gamma rays,the biofilm, the metallic ions.such risk factors are highly correlated specific complications. To avoid to use fillers in the body, we do recommend 3 methods not dangerous and quite safe as fat grafting, prosthesis for volume augmentation and endopeel techniques for projection without volume augmentation. Keywords: fillers, geleoma, biofilm, migration, granulomas, nodules, fat grating, silicon, PMMA, hyaluronic acid MEDICAL MALE GLUTEOPLASTY AND GLUTEOPEXY WITHOUT VOLUME AUGMENTATION Alain Tenenbaum SACDAM Mostly sporty males ( 18-55years old) are increasing too quickly their gluteal muscular mass for a good defined muscular or slim body.this is the case of footballers,gym addicted guys,muscular photomodels and so on. Such male patients are taking care about their body, and especially their pectorals,six packs and butts. The quick increase of gluteal muscular mass provoke not only oblique stretch marks but also their butts are falling down, what can be even easily seen when these models wear fashion jeans. In such case the demand is to reshape their butts, without any volume augmentation, by increasing or maintening the gluteal projection. The unique technique as products developped by A.TENENBAUM and M.TIZIANI is called improperly,endopeel, which is a 3D non surgical reshaping of the muscles by chemical myoplasty and myopexy. Such technique doesn t affect the functions of the muscles. ( contraction..) The 3 D Technique is not standard and has to be adapted to each patient working on tightening, projecting and lifting the butts following even the jeans fashion collections. As it is a 3D technique, vectors and tensors are the most important for the marking. The effect is immediate, without complications,scarless. In our studies no necrosis and no infections have been recorded. This technique can be applied also to gluteal amyotrophy, reshaping the gluteal muscles for ex after a post traumatic accident or a paralysis and has many applications in pathology as cosmetic dermatology and surgery. Keywords: gluteoplasty, gluteopexy, butts reshaping, endopeel, male buttocks, sporty butts, gluteal myoplasty, gluteal repositioning, muscle reposition, male aesthetic medicine 8 9

6 CHEMISTRY OF PEELS AND CLASSIFICATION OF A.TENENBAUM ABOUT THE MEDICAL BELONGINGS OF AESTHETIC DECORATIONS Alain Tenenbaum Qingxing Peng IPSC aesthetic medical school, Yichun university, Jiangxi, China Chemical Peels are widely used especially by facial plastic surgeons and dermatologists since long time. The knowledge comes from experience and clinical properties of acids but unfortunately the basic chemistry is not studied by physicians. Basic chemistry of peels help a lot in fact. Also a new classification ( Classification of A.Tenenbaum) is proposed, based only on chemistry. Benefits and Advantages of this communication Each physician should look just at the Classificationof A.TENENBAUM to choose a peel and to modulate it Parameters MD have just to have the following parameters in mind: 1. Parameters to choose an acid: Constant parameters 1. The pka which is correlated to the aggresivity of the acid and which is a constant 2. The number of reactions ( monoprotic, diprotic, triprotic): A triprotic acid is less dangerous than a monoprotic one. 3. The raw ingredients ( purity) Ex The water solution ( bidistilled, with metallic ions is quite bad, under vacuum with H2 and O2 is perfect ) In China, since 2002, tatoo of eyebrow, eyeline and lip line etc originated from civic groups were belonged to medical aesthetic technical programm. These techniques are not allowed to be conducted in non-medical aesthetic institutions. During the development of medicine, lots of medical technologies are originated from civic groups instead of medicine. During mid-century, sugery was mainly war surgery and it was mastered by barbers etc. Surgery was deprived from the barbers careers, who are not real doctors but technicians. Modern sugery as a discipline was formed along with development of society. Aesthetic decorations flowed with the law of the medical development. This is the natural law of human needs and the development of technology. Keywords: Aesthetic decoration, China, belongings, surgery 2. Parameters where the MD can interfere: Variable parameters Physicians can modulate themselves the chosen parameters after having elected an acid. Main variable parameter is The ph which is synonym for us of penetration of the acid (ph can be modulated by concentration., number of coats, duration which are our 3 variable parameters) Keywords: Classification of Peels of A.Tenenbaum, pka peel, ph peel, fruit acids, TCA, monoprotic acids, peelings, peels, desquamation, corneocytes

7 TERMS IN MEDICAL AESTHETICS AND AESTHETIC MEDICINE, THE ONLY BOOK IN THIS FIELD IN THE WORLD, HAS BEEN PUBLISHED IN CHINA EFFICACY EVALUATION OF DYSPORT (A BOTULINUM TOXIN TYPE A) IN TREATMENT OF HYPERHYDROSIS Hong Wei Liu 1, Long Fei Feng 2, Yu Feng Ai 3, Lin Bo Liu 4, Lun He 5 Elena Albertovna Sanchez 1 School of Foreign Languages, Yichun University 2 School of Aesthetic Medicine, Yichun University 3 Huamei Beauty Hospital of Chendu 4 The First Affiliated Hospital of Zhengzhou University 5 Dongmei Medical Aesthetics and Aesthetic Technique Department of Southeast University of Nanjing Objective of the Study: To introduce the book Terms in Medical Aesthetics and Aesthetic Medicine. With 2067 professional and disciplinary terms and definitions in medical aesthetic and aesthetic medicine, it was published in China in 2015 and has been translated into English. At the same time, to call for experts and scholars all over the world to publish the English version of the book in their own countries or translate it into other languages. Materials-Methods: Definitions of twelve major terms from ten parts are exemplified and explained in the paper. Results: Terms in Medical Aesthetics and Aesthetic Medicine is the only book on professional and disciplinary terms of medical aesthetics and aesthetic medicine in the world. Conclusion: Terms in Medical Aesthetics and Aesthetic Medicine will definitely lay a good foundation for the global construction and development of medical aesthetics and holistic aesthetic medicine. It s very important to publicize it all over the world and publicate it in different languages. Keywords: terms, definitions, medical aesthetics, aesthetic medicine Russian Society of Aesthetic Medicine, Moscow, Russia Severe forms of hyperhidrosis suffers from 1 to 5% of the population, among them the majority are young adults. Pathological sweating often leads to the development of a number of dermatological diseases and development of psycho-emotional disorders, affects professional and social human activity. In this report, will be reflected and demonstrated in the video, the method for the treatment of primary local hyperhidrosis axillary, Palmar, plantar, and in more rare applications of BTA (inguinal, gluteal, etc, consisting in the intradermal administration of botulinum toxin type A (drug Dysport ). Will be shown videos where anesthesia aid in the treatment of Palmar and plantar hyperhidrosis. A fundamentally new approach to the treatment of local hyperhidrosis has become possible after the advent of botulinum toxin type A. Currently allocated seven serotypes of botulinum toxins, called respectively the letters of the alphabet from A to G. The mechanism of action of botulinum toxins is the presynaptic blockade of acetylcholine release in nerve-muscle endings of the motor nerves, as well as in all other cholinergic synapses, the level of which determines the severity of sweating. When using the introduction in the area of hyperhidrosis the drug Dysport (botulinum toxin type A) blocks the transport of acetylcholine, which is the main mediator of the sympathetic neurotransmission of the sweat glands. As a result, decreases or completely stops the sweating in the period from 6 to 12 months. Keywords: hyperhidrosis, botulinum toxin type A, Dysport

8 ADIPOSE DERIVED MESENCHYMAL STEM CELLS PROMOTE THE SURVIVAL OF FAT GRAFTS VIA CROSSTALK BETWEEN THE NRF-2 AND TLR4 PATHWAYS REGENERATIVE SOFT THREAD LIFT Pier Antonio Pab Bacci Xiaosong Chen, Liu Yan, Ying Chen, Xiangyu Li Director Beauty and Medical School of Tuscany - Aezzo - Italy Department of Plastic Surgery, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, Fujian, , China Autologous fat grafting is an effective reconstructive surgery technique; however, its success is limited by inconsistent graft retention and an environment characterized by high oxidative stress and inflammation. Adipose-derived stem cells (ADSCs) increase the survival of fat grafts, although the underlying mechanisms remain unclear. Here, TLR4- /- and Nrf2-/- mice were used to explore the effects of oxidative stress and inflammation on the viability and function of ADSCs in vitro and in vivo. Enrichment of fat grafts with ADSCs inhibited inflammatory cytokine production, enhanced growth factor levels, increased fat graft survival, downregulated NADPH oxidase (NOX)1 and 4 expression, increased vascularization, and reduced ROS production in a manner dependent on toll like receptor (TLR)-4 and nuclear factor erythroid 2-related factor 2 (Nrf2) expression. Immunohistochemically analysis showed that exposure to hypoxia enhanced ADSC growth and promoted the differentiation of ADSCs into vascular endothelial cells. Hypoxia-induced inflammatory cytokine, growth factor, and NOX1/4 upregulation, as well as increased ROS production and apoptosis in ADSCs were dependent on TLR4 and Nrf2, which also modulated the effect of ADSCs on promoting endothelial progenitor cell migration and angiogenesis. Western blot analyses showed that the effects of hypoxia on ADSCs were regulated by crosstalk between Nrf2 antioxidant responses and NF-κB and TLR4 mediated inflammatory responses. Taken together, our results indicate that ADSCs can increase the survival of fat-transplants through the modulation of inflammatory and oxidative responses via Nrf2 and TLR4, suggesting potential strategies to improve the use of ADSCs for cell therapy. Face-lifting combined to cosmetic medicine methodologies provides us to rejuvenate the face in the majority of cases, ever without complications and interruption of job. One of the aims of mini invasive cosmetic surgery is that of pursuing the best aesthetic results without scars or with least scar visibility. Facial rejuvenation must follow a determined line: skin excess with SMAS alteration, lypoatrophie and réduction of the skin s trophysm. Using different absorbable threads, we can make an interesting traction of Smas and dermoepidermic tissue, along different traction s vectors. In patient with more ptosis, we can add to threads a little incision among the ear, with a 2-3cm separation, to make a suture of the SMAS, according to ideal traction lines. We can after eliminate the excess of the skin and harmonise the result in the midface and zygomatic region, improving jaw line and neck. Very interesting is the association with connective micrografts or microlipofilling, weel using to complete beautification of the face contour and stimulation new life of the cells. The use of this Regenerative Soft Threads Lift is very interesting and with fast good results for initial case of prolapse. Keywords: Laser, Suspension threads, Regenerativr Medecine Keywords: autologous fat transplantation, ADSCs, Nrf2, TLR4, knockout mouse

9 REGENERATIVE ENDO LIFT Pier Antonio Bacci Director Beauty and Medical School of Tuscany - Arezzo - Italy Biorivitalisation is an interesting strategy to make the prevention and to take care of the initial signs of aging. We can recover face tissues introducing chemical drugs or using different methodologies, but we can stimulate microcirculation and new collagen using laser and physical treatments too. Sure, we can improve beauty of the face but we cannot stop the youth, we can instead reduce the speed of the life until old age using different integrate treatments. From many years, our experience shows interesting results with very few complications using a mini invasive strategy, named Regenerative Endo Lift. We start session irradiating face skin by a not ablative diode laser scanner 1470 nm to activate mithocondrial activity and skin oxygenation. After we create a subcutaneous net of light laser energy without needles, using the same laser connected with a microfibra of microns. Our experiences suggest 2-3 sessions for years, any 2-3 months, and we can add a treatment with connective micrografts or microlipofilling, weel using to complete face s beautification and to stimulate a new life of the cells. Using this protocol in treatments for cellulitis and lipodysthropy, we have had interesting results demonstrating by biopsies and clinical studies. CARBON DIOXIDE LASER TREATMENT OF RHINOPHYMA THE DOCTOR NOSE BEST! Frank Conroy 1, Nik Manoloudakis 2 1 Department of Plastic Surgery, The American Hospital Dubai, Dubai, UAE 2 Department of Plastic Surgery, Bedford Hospital, Bedford, UK Rhinophyma is a severe complication of the relatively common dermatological condition of rosacea. The term is derived from the greek rhis: nose and phyma: growth. The condition is characterized by a disfiguring, gradually progressing hypertrophy of the sebaceous tissues of the nose, with prominent crypts and sulci. Rhinophyma has a predilection to Caucasian males of middle age and above, whilst it can affect women it is highly unusual to do so (12:1). The appearance of rhinophyma can cause sufferers considerable social embarrassment, particularly with the associated connotation of alcoholism. Patients are often keen to seek treatment for their problem and have been offered numerous procedures over the years. In this presentation I describe the evolution of the treatment for this condition, from the use of a hot steel rod to the rather more refined Carbon Dioxide LASER. The presentation highlights the steps in treating the condition with the Carbon Dioxide LASER, the refinements I have introduced and my outcomes. I also advise on the pitfalls to avoid in order to maximize your results. Keywords: Laser, Biostimulation, Aesthetic medecine, Laser-resurfacing Keywords: Rhinophyma, carbon dioxide LASER, LASER, rosacea

10 EMULSIOLIPOLISYS Elma Bunar Aesthetic studio AEVUM, Opatija, Croazia Emulsiolipolisy Emulsiolipolisy is a new intraadipocite therapy based on the application of hypotalamic phospholipids, carnitine to obtain a lipolitic effect. These phospholipids are acting like phospholipids in biliar secretion in the process of normal digestion. They are fragmenting big fat globulus into small pieces, through aprocess called micellisation.this action happens when small pieces of fat reacts with phospholipids, those small drops of fat have negative electricityin their external part, lipophobic, they reject each other and with the other side which is positive electricity, lipofilic part, they attract each other and they make miccelle. This process stabilizes the emulsion and activates the lypasis, the enzyme which is inside of the adipocite, by the increase of superficial fat, so it can penetrate in the citoplasma and start the lipolitic process. After this phase, there is fat demolition by the oxidation of fat,with energy production. This phase takes place in the mitochondria, so molecules of fat are directed to mitochondrias with a carrier that is carnitine. There are three therapeutic stages: First there is an iniection of hypotalamic phospholipids, carnitin and saline solution Second therapeutic stage time is movement of the tissue of the infiltrated area that favorisse emulsioning and macellation \like peristaltic movement/ Third therapeutical stage consists in optimisation of micellisation of triglyceride and energy dispersion by physical activity of minimum 20 min Contraindication: steatosis hepatica. Conclusion: injection of hypothalamic phospholipids, carnitin and saline solution in the fat tissue is very useful and efficient, without complications. A NOVEL APPROACH IN FACE ENGINEERING USING THREADS AND FILLING TECHNIQUE: THE COLUMN-BEAM-CEMENT TECHNIQUE Ibrahim Devrim Gürsoy MD, PhD Introduction: Non-operative face lifting procedures include less invasive methods like grafts, threads, botulinum injections, and fillers. This report is about our own approach that we call column-beam-cement technique, that incorporates thread lifting and filling techniques in facial rejuvenation. In this approach, we use 8 to 14 cog threads for structural framing and lifting effect (the Columns), 40 to 60 other threads for strengthening lifting effect and collagen synthesis (the Beams), and fillers for strengthening lifting effect and augmentation (the Cement). Methods: One hundred seven patients were admitted for column-beam-cement procedures between May-December 2016 at our clinic. The schematic presentation of this technique is shown in Figure 1, and all applications and procedures were performed by an experienced medical esthetician physician. Pre-procedural interventions included local disinfection, topical antibiotic application, and patients were prescribed to use prophylactic antibiotics following the procedure. A sample case with pre- and post-procedural images is shown in Figure 2. Results: Patient group included women with an age range between 30 to 70 years. All patients were followed up for at least 1 month, and no post-procedural complications were observed, and patients reported satisfactory outcomes at follow-up visits. Conclusion: Our single-center experience that reported in this study consists the largest number of cases in Turkey that treated with thread lifting and filling procedures, and all patients treated with our novel column-beam-cement approach. This new method is a promising way of non-surgical face-lifting almost without complications, and high rates of efficiency and patient satisfaction. Keywords: threads, column beam cement technique, non-operative face lifting, filling Keywords: miu, miu,

11 Pre-procedural and post-procedural images of a sample of column-beam-cement technique MESOTHERAPY - SKIN QUALITY BECOMING A MAJOR PLAYER Jacobus Van Niekerk AAMSSA - Aesthetic and Anti-aging Medicine Society of South Africa - Dr Cobus van Niekerk The quality of Aesthetic Patient s skins are becoming more important to be successful in treating further concerns. A lot of different and new fillers, product and a combination of procedures are developed to improve skin quality. From Mesotherapy, Skin Boosters and Redermalisation combined with PRP and Micro- Needling as well as Combination Phenol peels are becoming more prevalent in Aesthetic Medicine. Skin quality should become a concern to treat before or whilst considering Fillers, Neuromodulators and Threads to optimise Ideal Patient Outcomes. The Column-Beam-Cement technique Keywords: Mesotherapy, Redermalisation, Skin Quality, Elasticity, Hyperpigmentation, Rhytids, Combination therapies

12 STANDARDISED APPROACHES IN AESTHETIC MEDICINE Jacobus Van Niekerk AAMSSA - Aesthetic and Anti-aging Medicine Society of South Africa - Dr Cobus van Niekerk Standardised approaches in Aesthetic Medicine will make the practice Internationally more acceptable and make our subspecialty more acceptable in developing countries where Aesthetic Medicine is not acknowledged to exist. No guidelines, minimum qualifications or even procedures are set up especially in countries in Africa with regards to Aesthetic Medicine. Standard Operational Procedures will be discussed together with Written Informed Consent and Medico-legal and Ethical aspects that should be standardised regardless of where or how one practices Aesthetic Medicine. The Outcomes of the patient treatment should be managed accordingly, where realistic expectations should be discussed before embarking on any aesthetic interventions. Keywords: Standardisation, Ethics, Standard Operational Procedures, Written Informed Consent, Patient Autonomy, Treatments, Aesthetic Treatments TOP 5 MINIMALLY INVASIVE PROCEDURES: ALMOST NO EXPENSIVE MACHINES NECESSARY Jacobus Van Niekerk AAMSSA - Aesthetic and Anti-aging Medicine Society of South Africa - Dr Cobus van Niekerk When Aesthetic Doctors start in the Practice of Aesthetic Medicine all the products and procedures can be quite daunting and they could possibly not know where and when to start. My Objective is to give guidelines for New Aesthetic Doctors about the start of practising Aesthetic Medicine without spending hundreds of thousands of Dollars or Euros to start practising in the art of aesthetic medicine. I will show the that the top treatments does not require expensive Machines or Lasers or Lights initially to start an Aesthetic Practice. I will also show the rise in Minimally Invasive Aesthetic/Cosmetic Treatments both in popularity as well as monetary value and touch briefly on the decline in Surgical Procedures making Aesthetic Medicine such a popular subspecialty that can keep you and your patients enthusiastic about Anti-Aging and Aesthetic Medicine... Keywords: Aesthetic Medicine, Minimally Invasive Procedures, Surgical Procedures, Beginners, Cosmetic Medicine, Enthusiasm, Neuromodulators, Fillers, Peels, Microdermabrasion

13 STRIAE RUBRA TREATMENT AFTER PREGNANCY USING LASER ERBIUM YAG: ONE CASE THE ESSENTIAL ROLE OF HYDROGEN PEROXIDE, FROM DAWN OF LIFE TO TISSUE RESTORATION Shadya Waheeda Ramdjan, Iñaki De Tejada Rossana Castellana, Francesco Paolo Alberico Centro Clinico Profesional Caracas self-employed professional Objetives of the investigation.striae rubra are cutaneous atrophies due to the thinning and subsidence located in the epidermis.they are visible and have a differentiated color that may be violaceous, pink or pearly. Now a days treatment options do not offer a significant improvement so far.for this reason we are testing the application of Laser Erbium Yag in the treatment of Striae rubra. Clinical Case.20 years-old patient who had a cesarean section 15 days after coming to office because she had Striae rubra in inflammatory phase on the abdominal region. One session laser was applied. The parameters used were as follow: Laser Erbium Yag 2940 nm. A 400 mj. Striae rubra treatment after pregnancy using Laser Erbium Yag One case. short pulse with 50% of overlapping pass. Spot:7mm. During the treatment the patient did not use topical medication and did not receive any other procedure.photographic evaluation was performed with subjective satisfaction scale. This scale was as follows: Deterioration:-1 No improvement:0 partial improvement:1 frank improvement:2 Results.The patient attributed the Striae rubra appearance to the pregnancy.with regard to the clinical results we observed significant improvement after the very first laser session. Laser Erbium Yag showed to be a safe therapy, with no complications and highly effective. For these reason we strongly recommend it use in the Striae rubra treatment. Discussion. Now a days there is no standardize treatment for this disorder and its treatment comes out to be a challenge.more studies are needed to clarify the role of each one of the therapeutics options. Four billion years ago, when life is thought to have begun, Urkaryota microorganisms living in an environment without oxygen received energy from fermentation of organic substances. Later, mutant Urkaryota gave origin to early Prokaryota, who invented oxygen. However oxygen could have been toxic to every life form, if any mechanisms hadn t occurred to neutralize the damage caused by oxidative catabolism Inevitably, oxygen generated free radicals and hydrogen peroxide, which has been responsible for gene expression and metabolism regulation for over a billion years. In order to deactivate hydrogen peroxide and transform it into water, Cyanobacteria developed two important enzymes: catalase and glutathione peroxidase. By talking about hydrogen peroxide we can notice different metabolic behaviour of this molecule at different concentrations: high concentration H2O2 (3-5 %), used in antisepsis, and low concentration H2O2 (0,1-0,3 %). Low concentrated H2O2 is physiologically produced in the tissues and performs important functions in cell regulation and protection, acting on metabolic regulation and tissue repair processes. An Italian patented product is capable of transporting low concentration H2O2 through an intact skin and makes it possible to reinforce endogenous H2O2 activity and enhance tissue regeneration mechanisms from an outside source Keywords: peroxide hydrogen, TCA/H2O2, tissue regeneration Keywords: Striae rubra, Laser Erbium Yag, One case

14 A NEW APPROACH TO LASER EPILATION Dr. Serkan Öztürk gazi university Game Changer innovation refers to large technological advances that propel an existing product or service ahead of competitors. This is often the result of research and development, who are striving for the next patentable formula, device and technology to 5 sessions only for permanent hair removal. less number of sessions needed to perform permanent hair removal compared to the standard single lasers (only Alexandrite or only Nd:YAG). 2. More efficacy on brighter and thinner hair. Once the concentration of melanin becomes lower, the hemoglobin absorption becomes relevant to perform efficient hair removal. 3. The only possible way to treat darker skin types. The melanin is contained by the skin also, then the efficacy of the selective phototermolysis is dramatically reduced since the concentration of melanin is increased. Only the ND:YAG allows the Doctor to treat those kind of skins. 4. Don t forget the SUN! What if the skin type is bright but the sun power is strong? What about the places located at the seaside? Again point Nd:YAG: the gold standard for the vascular lesions treatment. With more advantages: 1. Less sessions for better results = more revenues and shorter time 2. More efficacy on brighter and thinner hair = increase the number of Patients 3. The only possible way to treat darker skin types = increase the number of Patients 4. Don t forget the SUN! = work for more months in a year 5. Nd:YAG: the gold standard for vascular lesions treatments PROGRESSIVE PHYSIO-REGENERATION FROM THE EPIDERMIS: JUST OPEN THE DOOR George Virginio Oskarbski Polish Society of Aesthetic and Anti-Aging Medicine Background: The skin undergoes continual rejuvenation through homeostasis and wound repair in response to injury, in an every day cellular turnover, and this continual cell replacement is required for life. It is not the specificity of a stimulus that induces the production of the substances, but the real needs of the tissue. Epidermal Adult Stem Cells, which reside on the basement membrane of Epidermis, in the adult hair follicles, sebaceous and sweat glands, unlike stem cells from internal tissues, show little response to aging, thus it is of prime importance maintaining a pristine epidermal stem cell population, even during aging. Methods, Materials: a- Gentle needling (0.2 mm deep), b-a set of acids in a controlled amount poli-ha as Lactobionic, Gluconolactone, AHA, BHA, opening the epithelial surface, promotes the external application and absorption of actives, maintaining intact the effect of skin barrier and photoprotection: Percutaneous Bio-mimetic Peptides, cosmetic active ingredients, expressing a biological response, effective to minimize loss of hydration in the outer layers of skin, to protect the skin against the penetration of harmful substances, to reduce the rough, dry skin, to strengthen the skin barrier, to protect against free radicals, to improve elasticity. Conclusions: It is a new approach and a turning point, by clinical trials and demonstrations in dedicated literature: cell proliferation of fibroblasts and keratinocytes, re-organizing structure of the ECM, wrinkle reduction, firmness, elasticity, protection from enzymatic degradation, production of important proteins of the basal membrane, matrix metalloproteinases inhibition, real anti ageing regeneration. Keywords: physiological, progressive, regeneration, and the way of introduction Keywords: laser, epilation, hair removal

15 DO PHYSICAL AND CHEMICAL TRIGGERS IN ASSOCIATION AMPLIFY THE REGENERATIVE CUTANEOUS RESPONSE? TCA MODULATED WITH HYDROGEN PEROXIDE IN A NEW CONCEPT OF DERMAL STIMULATION Rossana Castellana, Francesco Paolo Alberico Rossana Castellana, Francesco Paolo Alberico none, professional practiser none, professional practiser Regenerative medicine is becoming always more relevant, gradually refining its techniques and identifying new ones. Softer and less aggressive techniques, that can stimulate tissue regeneration, are increasingly preferred to invasive surgery, totally ablative lasers, bloodier procedures, etc. The oldest regeneration techniques are definitely the peelings, carried out in the past with often rudimentary products, which caused protein precipitation. This way skin regeneration could take place only at the cost of important tissue damage. Today, the research provides new and more manageable products and, among these, specially TCA/ H2O2 that, despite its high TCA percentage (33%), does not cause frost, but is still able to stimulate neocollagenogenesis, as each TCA of equal concentration. Even non-ablative lasers, radio-frequencies and skin micro-perforation technique as well, long known for its improving effect on tropism and skin texture, have largely evolved and diversified, and offer now new use opportunities, especially in combination with other methods. The Authors present a review of their cases, which would seem to demonstrate that combined treatments applying different kind of stimulations (for example chemical and physical or mechanical) can give better results than each of these procedures, used alone. The AAs compared some associations they just proposed in the past; for correct and complete evaluation of the results, as well as the patient satisfaction degree, related iconography has been acquired. Images have been captured both with digital photographic equipment and an innovative device for 3D Multi-spectral skin analysis, able to detect skin texture and its melanin and hemoglobin contents Keywords: Fractional radiofrequency, needle radiofrequency, TCA/H2O2 Biorevitalization consists in various procedures for skin rejuvenation, well-known for many years now, that often use injectable solutions or chemical peels applied to remove the epidermal layers. These are effective treatments, but sometimes unplaesant for people who are afraid of needles or don t accept a downtime interrupting their social and working life. In the last years patients require even more rejuvenation treatments, but even less invasive. In response to these increasing needs a new product, named TCA/H2O2 was developed. It consists of an innovative formulation based on trichloroacetic acid in a complex with hydogene peroxide. TCA/H2O2 allows to increase the dermostimulating action due to TCA activity, but prevents the peeling effect: hydrogen peroxide acts in sinergy with TCA, reducing the acid s aggressiveness on epidermis, but enhancing its activating effect on fibroblasts. TCA/H2O2 application is an effective treatment for skin rejuvenation of the face and cleavage, for atrophic scars, melasma and postinflammatory hyperpigmentations. The route of TCA/H2O2 administration is trancutaneous, with no needles, and that makes the product especially appropriate for treatments on the most sensitive skin areas, such as periocular and perioral regions, neck and hands. TCA/H2O2 is not photosensitizing, therefore can be used all year round, in any season; moreover, TCA/H2O2 doesn t induce hyperpigmentations after treatment. For all the above mentioned reasons TCA modulated with H2O2 is a new very interesting approach to take care of the skin, in a simple and natural way, without any traumas and complications. Keywords: TCA, hydrogen peroxide, TCA/H2O2, fibroblast stimulation

16 GUT MICROBIOTA, OBESITY AND POPULAR DIETS LIQUID RHINOPLASTY Prof. Dr. Banu Çaycı Ibrahim El Achkar Gazi Üniversitesi Tıp Fakültesi Tıbbi Biyokimya A.D.,Ankara Saint Joseph University of Beirut Lebanon Gut microbiota affect energy balance, inflammation state and gut barrier function, as well as integrate peripheral and central food intake regulatory signals leading to an increase in body weight. Prolonged consumption of a high-fat diet do changes on gut microbiota and induces gut dysbiosis. The consumption of a diet high in carbohydrate but low in fat resulted in a marked increase in the faecal Bifidobacterium spp. numbers. High carbohydrate together with a high glycemic index diet showed a correlation with an increase in faecal Bacteroidetes, High-fat diets modulate the microbiome composition to increase circulatory lipopolysaccharides coinciding with general inflammation.general dysbiosis within the gut is associated with a high level of plasma endotoxin and inflammation that eventually promotes metabolic disorder.the gut microbiota that digests complex dietary carbohydrates produces many monosaccharides and short- chain fatty acids (SCFAs) such as acetate, propionate, and butyrate which are an important energy source and nutrition of the intestinal epithelium. SCFAs act in the gut as signaling molecules and are specific ligands for at least two G protein-coupled receptors, GPR41 and GPR43, mainly expressed in intestinal epithelial cells. Activation of GPR41 increases production of peptide YY (PYY), an enteroendocrine cell hormone that normally inhibits gut motility, increases intestinal transit rate and reduces extraction of energy from the diet, thus affecting peripheral glucose utilization. Recent study has shown that Gpr43 / mice are resistant to diet-induced obesity and insulin resistance, at least partly due to Gpr43-regulated energy expenditure. LIQUID RHINOPLASTY Natural sculpturing of the nose is the goal of every rhinoplasty surgeon; in this study we expose the indications of Liquid Rhinoplasty. Between January 2013 and 2016 around 500 Liquid Rhinoplasty. In this study we discuss the use of fillers in the treatment of the: Dorsum Tip Mid third Columella Several other parts of the nose Secondary Rhinoplasty Touch up Rhinoplasty The use of fillers (depending on the indications) in primary and secondary rhinoplasty provides an outcome of a natural nose shape. Keywords: Rhinoplasty, hyaluronic acid, fillers, touch up, redo Keywords: Microbiota, diet, prebiotics, probiotics

17 CILTALTI YAĞ DOKUSUNUN AZALTILMASINDA KULLANILAN METODLAR:SOĞUK LIPOLIZ, RADYOFREKANS, MEZOTERAPI:HANGI HASTADA HANGI METOD DAHA EFEKTIF? FULL FACE TREATMENT (TÜM AYRINTILARI ILE YÜZ TEDAVISI) TÜM YÜZÜN MEDICAL ESTETIK OLARAK KLINIK VE GÖRSEL TEDAVISI YÜZ ESTETIĞINDE KAŞIN ÖNEMI Banu Çaycı Gazi Üniversitesi Tıp Fakültesi Tıbbi Biyokimya A.D.,Ankara VKI si 25 altında olup yağ oranı % 30 üstünde olan kişilerde bölgesel yağ fazlalığı sıkça rastlanan bir sorundur.yağ kitlesi azaltmaya yönelik yapılan diyetler, çoğu zaman bölgesel incelme konusunda başarısız olmaktadır.soğuk lipoliz metodu yağ hücrelerinin soğuğa maruz kaldığı zaman soğuk kaynaklı panikülit olarak da ifade edilen programlanmış hücre ölümüne (apoptozis) girerek ortadan kaldırıldığı bir metotdur.%20-40 oranında yağ dokusu kaybıyla giden etkin bir tedavi yöntemidir. Radyofrekans uygulaması ile cilt ve cilt altı dokularda ısı artışı sağlanır. Isı etkisiyle bağ dokuda fibroblastlar uyarılır eskiyen ve yıpranan kolajen liflerinde yenilenme olur. Dolaşım düzenlenir. dokular canlanır. Böylece cilt sıkılaşır, toparlanır, çizgiler azalır.bölgesel yağ birikimlerinin giderilmesi amacıyla kullanılan temel mezoterapi etkenleri; L-Karnitin, PPC (Fosfatidilkolin), Deoksikolat, Kollajenaz, Hyaluronidaz, Kafein, Enginar Ekstraktı ve Melilotus (tıbbi yonca) Ekstraktı, Hamamelis ve Ruscustur. Bölgesel yağ yıkımında en çok kullanılan bir diğer etken ise Fosfatidilkolin (PPC) dir. Ancak Fosfatidilkolinin (PPC) ürününün mutlaka Deoksikolat içermesine ve en az 100mg/ml konsantrasyona sahip olmasına özellikle dikkat edilmelidir.tüm bu yöntemlerin olumlu sonuç oluşturması için hangi metodu hangi hastaya uygulayacağımızı iyi değerlendirmemiz gerekir. Beril Özlem Leylek Özel Mesoest Estetik poliklinikleri 1. Full face treatment protokolümde yüz için bütünsel olarak yaptığımız tüm tedavi tekniklerine ek ve eş değer estetik katan kaş tasarımı 2. KAŞ tasarımının önemi ve yüze göre şekil ve estetiğin belirlenmesi 3. KAŞ için estetikte yapılacak tedavi ve teknikler..( kaş dolguları, ip askı teknikleri,kaş kontru belirginleştirme ve eksiği yerine koyma, yeni bir tasarım yapma, microblading tekniği) 4. Geri dönüşlü ve geri dönüşsüz teknikler 5. Microblading de tasarımın önemi, UYGULAYICI hekim vizyonu 6. Full face aesthetic treatment yapılmış ve yapılmamış hasta görünütülerine eklenen kaş tasarım tedavilerinin eklenmesi ile oluşan farklar 7. Yeni bir kaş tasarımının diğer tedavilerin sonucunu artırıcı etkisi 8. KAŞ tasarımının bir yüz için yapılan bir çok medikal estetik uygulamaya eş değer anti aging görsel etkisini önce sonra fotoğraflar ile anlatılması Anahtar Kelimeler: fullface, tümyüz, microblading, micropigmentasyon, kaştasarımı, antiaging, sonnokta, yenibirbakış, thenewest, trendtecnics tedavi öncesi ve sonrası Anahtar Kelimeler: bölgesel incelme, soğuk lipoliz, radyofrekans, mezoterapi full face treatment adı verdiğim kendi tekniğimde kullandığım tüm uygulamalara ek olarak yaptığım kaş tasarımı ile alınan sonuç.. kadın hasta tedavi öncesi ve sonrası full face treatment adı verdiğim kendi tekniğimde kullandığım tüm uygulamalara ek olarak yaptığım kaş tasarımı ile alınan sonuç.. erkek hasta

18 ITALIAN PHLEBOLOGY 2.0- NEW CURATIVE METHOD OF VARICOSE VEINS WITH VISUAL DISAPPEARANCE-TRAP TRAP technique with transcutaneous illuminator Claudio Rosco, Lucia Raco Italian Society of Phlebology Title: Italian Phlebology 2.0 A New curative treatment of varicose veins with visual disappearance TRAP Authors: Claudio ROSCO Lucia RACO Abtract: The diseases affecting the superficial venous circulation of the lower limbs have a clearly visible impact. However the clinical implications go beyond the field of aesthetics. Over the past few years, different techniques have been used to treat this condition. All these methods entail the occlusion or the destruction of the visibly diseased veins using physical (laser, radio frequency, steam) or chemical (sclerotherapy, glue) methods. However, recent advances in the understanding of the physiopathology and haemodynamics of chronic vein insufficiency, have challenged such methods. Furthermore new insights in the interactions between inflammation of the vein wall and haemodinamic hypertension have been gained. This new knowledge has allowed to develop a targeted treatment for the disease. This new approach, restores the anatomical and functional integrity of the vein wall compromised by the chronic inflammation present in venous diseases. This results in a true healing process which, in addition, makes the visible reticular veins disappear. The technique is not limited in his application to varicose veins but it can also be applied to the treatment of the haemorrhoids and pelvic varicocele. This approach represents an evolution from traditional phlebology hence: Flebology 2.0 The technique at the core of this approach is TRAP (Tridimensional Restorative Ambulatory Phlebotherapy). Here we present background, pharmacological rationale and methods. Transillumination allows injecting and treating all veins of the superficial circular Ultrasound of a vein treated with TRAP Compact venous wall and thickened Varicose vein ultrasound Inhomogeneity of the venous wall Varicose vein-post TRAP vein Keywords: Inflammation-, Hemodynamic hypertension-, TRAP- Left: damaged medium tonka, loss of adventitious tonsil, endothelial damage, inflammatory cell infiltration. Right: after TRAP

19 NOVEL METHOD OF DELIVERY OF ESSENTIAL MICRO-ELEMENTS ACROSS THE SKIN BARRIER. MINERALS BALANCE AND ITS IMPACT ON THE SKIN HEALTH, IMMUNITY AND APPEARANCE Mazen Raydan 1, Julia Nashchekina 2, Julia Nashchekina 3 1 AionBiotech, Bierut, Lebanon 2 Institute of Cytology RAS, St-Petersburg, Russia 3 Chemical Faculty St.-Petersburg State University, Saint-Peterburg, Russia Objective of the study Minerals play a very important role that is crucial to cell activity and function. They activate mineral dependant enzymes, transport across cell membranes, cellular differentiation and proliferation etc. Many factors impact skin mineral balance and to maintain it in the skin is not an easy task. In order to deliver non soluble ions across the skin barrier such as Magnesium, Calcium, Iron etc, remains problematic due to their poor solubility in comparison to soluble ions such as sodium and potassium. The current study introduces new method to extract minerals, deliver non soluble ions, asses their impact on fractioning water clusters, conductibility and ability to neutralize anion minerals. It investigates the impact of the developed ionized minerals on fibroblast cellular activity and skin. Materials and methods Mineral processing and modified fermentation method; MNR spectroscopy, MTT deoxidization method, Fibroblast cultivation, mass spectrometry analysis, Immunohistochemical analysis Results The study shows good penetration rate of minerals reaching 70 %; developed mineral complex have good anion neutralizing effect reaching 62.5 %; moisture evaporation from the skin was decreased with the mineral complex 27,6 % while untreated skin 73,9 %; fibroblast activity and proliferation was enhanced by 35 %. Conclusion OUR APPROACH IN MANAGEMENT OF FILLER COMPLICANTIONS Alessandra Veronesi, Silvia Giannasi, Valeria Bandi, Luca Maione, Valeriano Vinci, Andrea Lisa, Marco Klinger Unità di Chirurgia Plastica, Dipartimento di Medicina Traslazionale BIOMETRA Humanitas Research Hospital, Scuola di Chirurgia Plastica Ricostruttiva ed Estetica, Università degli Studi di Milano, Rozzano, Milano. Objective of the Study Filler injection is an aesthetical medical procedure extremely diffused which is not free from complications. These complications may be related to the operator, to the patient or to the quality of the filler itself. There are precautions that the operator needs to know to reduce the occurrence of these complications. Complications related to the use of fillers are divided between minor ones such as edema, bruising, discoloration and more severe such as the development of hypersensitivity, nodules, vascular compromise, development of bacterial infection or granulomatous inflammation. Material and Methods We report our clinicial experience regarding complications filler injection related observed in 50 patients who come to our attention from March 2013 to March 2017 in Humanitas Research Hospital. In each patient we analyzed presenting symptoms from minor to major complications and each specific treatment protocol. Results In our study population we observed 82% minor complications (edema, bruising, discoloration) and 18% of major complications such as hypersensitivity (0 patients), nodules(4 patients), vascular compromise (4 patients), development of bacterial infection (1 patient) or granulomatous inflammation (0 patients). Conclusion The operator must know carefully these conditions to minimize their occurrence with careful evaluation before the procedure. It is also essential a rapid diagnosis of complications eventually present in order to rapidly address these events properly. Keywords: Filler, complications, management Modified fermentation technique and delivery method enhanced the noninvasive delivery of non-soluble ions across the skin. Mineral complex boosted cellular activity helped preserve moisture level and increased fibroblast turnover. Good mineral balance is very crucial to maintain good skin quality, fresh look and reduced signs of ageing. Keywords: Mineral balance, ionized minerals, non-soluble ions, fermentaion technique

20 SAÇ ESTETIĞINDE VIZYONEL YAKLAŞIM, SAÇ MEZOETERAPISI VE PRP ILE BERABER MICROBLADING UYGULANIMI Beril Özlem Leylek Dr. Beril Özlem Leylek 1. Saç estetiğinde hastaya genel yaklaşım 2. Saç tasarımı ile ilgili bilgilendirme, 3. Saç mezoterapisi ve saça PRP tedavilerine ek uygulamalar 4. Tasarıma uygun seyrek ve az alanlara microblading kıl tekniği ile görsel saç görüntüsü verme, 5. Yapacağımız destekleyici tedavilerin sonucunu alana dek hastaya görsel tatmin sağlamak 6. Medical tedavilerden oluşacak sonucu desteklemek 7. Ekonomik ve kolay olan bu tedaviyi medikal tedavilere eklemek 8. tamamlayıcı tekniklerde ki görsel farklılık ve hasta memnuniyeti HAIR AGING AND SPECIFIC ANTI-AGING THERAPY: A THERAPEUTIC PROPOSAL FOR THE EXLUSIVE USE OF THE DOCTOR Alessandra Timotei Camporese Alessandra Camporese The anti-aging medicine approach focused mainly on skin appearance, proposing various methods to erase wrinkles, give volumes a, forgetting that the face frame is represented by the hair and that they over time, as part of skin appendages, undergo inevitable aesthetic changes too. Hair-aging goes along with skin-aging: in addition to extrinsic damages we should not forget the slowing of cellular turnover and hormonal changes. In women, the first hair changes may occur from the age of 35, with a follicle growth cycle slowdown and worsen around years due to hormonal changes. The hair become ever thinner, dull and, in widespread or localized manner, less dense. Furthermore we should not forget the seasonal fall or states of stress, where sometimes the amount of hair loss lead patient to great distress and depression condition. The introduction in aesthetic medicine of an injectable solution specifically formulated and registered for the treatment of the scalp and hair, we may also intervene on this district to counteract the thinning and hair loss, as well as to counteract the dandruff formation or dryness of the scalp. The solution is composed by natural HA complex (6 vit. B group, 5 amino acids and zinc. The effectiveness of this therapy is supported by two international multi center studies. Keywords: Hair, aging, alopecia Anahtar Kelimeler: saç, tasarım, kellik, microblading, kıltekniği, doldurma, yeni, newtecnics, dolgussaç, sıkgörünüm

21 LED TECHNOLOGY IN HAIR GROWTH. FOUR YEARS OF EXPERIENCE DON T LET THE CONGENITAL ANOMALY DEFINE YOU! BEHIND A SYRINGE Antonio Soverina Studio Medico dr. Antonio Soverina - Via Mario Greco, Catanzaro (CZ) - Italy Hair loss is a common disorder that affects more than half the world s population. Androgenetic alopecia is the most common form of hair loss. Currently, topical Minoxidil and oral finasteride are the standard treatments recognized and with the highest level of scientific evidence. The aim of the study is evaluate the LED s efficacy and safety in the treatment of androgenetic alopecia, either as monotherapy or as concomitant therapy to traditional treatments. This work includes a review of international scientific literature and a personal series evaluated at our medical office. First, the technology was evaluate in monotherapy, enrolling 11 persons with androgenetic alopecia. LED technology had used at a later time in combination with traditional medical therapies, in 100 patients with androgenic defluvium. Check-up visits had scheduled at 12 and 24 weeks and had evaluated the overall picture of the patient and the tricoscopic images of the same area, previously marked with a temporary tattoo. Clinical studies examined had showed that LED stimulates the hair growth in males and females. In the various mechanisms proposed, the main mechanism suggested seems to be stimulation of the epidermal stem cells of the hair follicle buldge and the shifting of the follicles in the anagen phase. From our own observations, that we share with author, we believe that the combination of LED with topical minoxidil and oral finasteride, they could act in synergy to enhance hair growth representing a safe and effective treatment option for patients affected to Androgenetic Alopecia. Ebtisam Elghblawi Private practice and independent researcher. Lips and eyes boost facial beauty as the lip is the focal centre of the lower face, and they have been highlighted since ancient. Face depicts a sculpture and a voluptuous lip is often portrayed as a symbol of youth. The lip region is an extremely important area when it comes to facial aesthetic enhancement. Both eyes and lips are considered to be the most beautiful sections of both genders. A lady born with a cleft lip, presented for aesthetic options for her asymmetrical upper lips with a vertical scar on the left side. The first proposal given was the fractional laser to mitigate and improve the vertical scar texture followed by a filler injection. Styleage M was proposed. Objective To minimize the upper lip scar and repair the upper lip volume on the left side. Procedure and treatment strategy The best approach to lip augmentation depends on the nature of the defect and the subject s aesthetic desires. However for pure cosmetic enhancement of lips, superficially placed filler with emphasis on the white roll and expansion of the vermilion is ideal. The patient had increased lip volume on the left side, with lip line definition, and improved Cupid s bow. Fraxal Co2 laser was delivered with a gap of a month. Results A satisfying result was instantly examined, and the patient was appreciating. Conclusion Lips are considered to be a sensual attractive sign of a face. Simple measures can have a huge satisfying impact on patients. Keywords: Fractional laser, Co2 fractional laser, dermal fillers, surgical lip, lip augmentation, cosmetic fillers, Injection technique, needles Keywords: androgenetic alopecia, trichologist, thrichology, hair loss, led therapy Before. A baseline upper photo frontal view- vertical scar and asymmetry upper lip left and after correction lower photo. Amazing results of the lip construction with mitigated vertical scar [Copyright: 2017 Elghblawi]

22 AESTHETIC FACIAL ANATOMY NEW TECHNIQUES AND TRENDS IN DERMAL FILLERS Prof. Dr Ali YILMAZ, MD, PhD Alp Mamak M.D. Trakya University, Medical Faculty, Department of Anatomy, EDİRNE Aesthetic Medicine Physician In aesthetic medicine, the key to success is following a proven process of patient assesment development of an individualized injection strategy, and proper injection technique. Underlying this process is a foundation based on an understanding of facial anatomy (Bone structure,nerve and vascular system, fat pads, and muscles.) and how it changes with aging, as well as how to use neuromodulators and soft tissue fillers alone and in combination to obtain beatiful and natural results. Safe and effefctive injection relies on clear knowledge and understanding of facial anatomy. With the widespread use of Dermal Fillers, the trend changes into Holistic approach and to biologic re-volumetry; which includes a bios-stimulation for the collagen stimulus at the dermal layer and which volumise the loss at the fat and boney layers. Every field has trends and fashions. Trends come for a reason. At end of the 90 s, the trend was to treat the glabellar lines and crow s feet lines for the Aesthetic Medicine Treatments. This trend starts with the discovery of the Botulinum toxin serotype A (BoNT/A) use at the upper face muscles to treat the wrinkles. The trend tends to cross Nasolabial Fold and Lip Enhancement Treatments with the widespread use of Hyaluronic asid fillers, and lip augmentation. By the years and with the common use of dermal fillers and BoNT/A we see that the lines and folds are because of the fat and bone loss. 10 years ago the trend turns to upper and mid-face resurfacing and volumising. This treatment trend mainly tends to solve the folds and wrinkles. Within all these treatment plans, we saw it s still very hard to solve the jowl sagging, pre-jowl sulcus and to maintain & define a straight jaw-line that underlines the youthful face. By time we understand to solve all these difficult aging signs can be just solved by supporting the loss beneath; at the fat and boney layers which accompanied by a biostimulation to support the upper dermal layers. More than a decades worth of experience with real patients has gone into the development of these treatment solutions. If you follow the trends and fashion in a field, also you became a trend and fashion. All the others will follow your footsteps. A new era in the Aesthetic Medicine Field! Conclusion: With the widespread use of Dermal Fillers we understand to solve all these difficult aging signs can be just solved by supporting the loss beneath; at the fat and boney layers which accompanied by a biostimulation to support the upper dermal layers which includes a biosstimulation for the collagen stimulus at the upper dermal layer and which volumise the loss at the fat and boney layers. Which is called Bio-Ri-Volumetria; which is the New Era in Dermal Fillers

23 MESOTHERAPY COLLAGEN THE HAIR CLOCK - ESTRONE AND HAIR Prof.Andrea Corbo Rome (Italy) Andrea Marliani MD For more than thirty years, the regenerating power of Heterologous Collagen Type I has been known and exploited in medicine. For a few years, the same molecule is available for intradermal injection procedures. The Heterologous Collagen is able to act as growth factor on fibroblasts, and also represents for them a powerful stimulus for biosynthetic activities, in particular for neocollagenenis. The substantial novelty of this approach lies therefore in the induction of fibroblastic replication, with the increase in the number of such cells in the dermis. For this reason we are talking about bio-regeneration (which is based on mitosis) instead of bio-simulation (which is based only on induction of cell anabolism). Authors present new uses of the injectable product that overcome the classic role in dermal biostimulation and find new indications and new application areas. It will be possible to treat many problems such as nonpathological gingival retraction, skin laxity, stretch marks, aging of the external genitals, acne scars and others. The treatment shows strong efficacy both alone and in combination with other methods, with which it is perfectly compatible. Firenze Dihydrotestosterone inhibits the adenylyl cyclase enzyme while estrone increases the adenylyl cyclase enzyme. When adenilyl cyclase is active the hair grows and DHT is produced but DHT deactivates the adenylyl cyclase and so the hair falls and estrone is produced, when estron is produced activates adenylyl cyclase and the hair regrows : this is the hair cycle. We know a true Androgenetic alopecia, (common in males and rare in women) depends on the conversion of testosterone to dihydrotestosterone but we also theorize an alopecia due to inadequate estrone activity (frequent in women and rare in men): Low Local Estrone Alopecia. Estrone activates hair anagen phase and so Estrone deficiency is a problem for hair such as excess of dihydrotestosterone. If the assumption on the importance of estrone on the physiology of the hair cycle are correct the topical use of the same estrone should give good therapeutic results. We treated and followed more than 3,000 women between 16 and 70 years of age. Duration of monitoring: 15 years. Follow-up: 6 12 months. The galenic preparation that we used, containing estrone and hydrocortisone, was applied on the upper part of the scalp in a 3 ml dose at least three times a week. and the effects after a year s treatment are evident, if the physician or the patient takes a photograph at the start of the therapy. We have an impressive photographic archive

24 AESTHETIC MEDICINE IN ONCOLOGY Annalisa Beatini, M.D., Roberta Tartarini, Biologist, Ospedale Civile di Carrara - Italy NAHYCO TECHNOLOGY. THE BAP (BIO AESTHETIC POINTS) TECHNIQUE AND OTHER APPLICATIONS: THE NEW EDGE IN BIOREJUVENATION In Rome, at San Giovanni Calibita s Hospital, in the Tiber Island, there is the head office of the Fatebenefratelli Foundation s International Aesthetic Medicine School. Until 1977 his founder, Carlo Alberto Bartoletti, President of the Italian Society of Aesthetic Medicine, thought that Aesthetic Medicine accomplishes a program of Social Medicine which includes preventive, curative and rehabilitative medicine in order to Serve the community: its aim is the construction and the reconstruction of the physical equilibrium of the individual ( La Medicina Estetica, 1977; 1,1:1-2). Nowadays, Aesthetic Medicine is direct not only to healty but to sick persons too, to relieve the discomfort due to the disease or to the necessary therapeutic treatments. Since 2004, in the Tiber Island s Hospital, has started a cooperation between the Dipartments of Aesthetic Medicine and Oncolology, and, in 2006, was officially born the Aesthetic Medicine Service in Oncolology, afterwards opened in 2007 also in Carrara s Hospital in Tuscany. The aim of this Service is to take care of skin disorders due to cancer therapies ( chemotherapy, radiotherapy and target therapy), with the basic philosophy of the overall care of the patient. The Authors will describe their activity in both the Hospitals and show treatment protocols for the most frequent problems they meet. As they take care of the body in changing, so they drive the patients, at the end of the oncological therapy, along the way to recovering beauty right. Beatini Annalisa M.D. General Surgeon SIME - AIdME Italy, The author speaks about her personal experience with a natural hyaluronic acid obtained by a new patented production technology, based on stabilized hybrid complexes of HA at high (H-HA) and low (L-HA) molecular weights. The new product contains 32mg H-HA + 32 mg L-HA in 2ml ( in pre-filled syringe) per a total of 64mg di HA. A high concentration that before has never been found in a medical device for this kind of treatment. This high concentration of hyaluronic acid (32mg/ml) with maximum manageability is injectable with a 29G TW needle and has an elevated product diffusibility. The combined action of the stabilized hybrid complexes of high and low mw HA synergize and maximizes the trophic bio-regenerative effect of L-HA on the dermis (Hydro effect) and the remodeling action of the dermis (Lift effect) played by H-HA. This product has an high purity (HYALURONIC ACID SODIUM SALT), is preservative and free of cross-linking agents. It has a proven resistance to hyaluronidase (BTH) eight times greater than that of high molecular weight natural hyaluronic acid (> 1000kDa), without the use of cross-linking agents Owing to these characteristics, it was made possible to create an innovative protocol, compared to traditional biostimulation methods. The injection points of the BAP ( Bio Aesthetic Points ) technique were carefully chosen based on 2 criteria: minimize the risks and maximize the product diffusion in the malar and submalar areas predisposed to dermal atrophy caused by the aging phenomena. The new protocol requires less sessions, 2 treatments with a 1 month interval, followed by 1 maintenance treatment 2 months after the 2nd treatment, resulting in a better patient compliance. It s possible to treat with very good results also neck, décolletage, hands, upper arms and legs. The pictures will show the exceptional results in the bioremodeling of middle and lower face and in the other districts

25 EFFICACY OF A MEDICAL AESTHETIC PATH, IN A COHORT OF ELDERLY PATIENTS: A PILOT STUDY. Annarosa Catizzone, Manola Sarmati, Loredana Cavalieri, Emanuele Bartoletti Italian Society of Aesthetic Medicine, Rome, Italy Objectives: The search for beauty in different aspects of life is the commitment of the aesthetic doctor who interprets the beauty not only in reference to the physical appearance but in a broader integrated concept of philosophical and humanistic principles. So how harmonious relationship with themselves, with others and with life. In this context, the authors, encouraged by the many news stories on the abuses, ill-treatment and violence, in other words about the ugliness, that occur in nursing homes for the elderly, want to bring the beauty in a geriatric clinic. The goal of this study is to demonstrate that a recovery of ancient gestures of daily cosmetics, skin care, being invited to look themselves in the mirror to assess the attractiveness of the products and the effect on the skin, can awaken the memory of self, the relationship with your body and with life. The nursing home that has joined this initiative, Villa Sorriso Marano sul Panaro, can be considered a role model not only for the efficiency, but also for the attention and care dedicated to every single guest, for initiatives entertainment, social and cultural stimuli, the empathic relationship between the staff and guests. The authors found an ideal setting for this project. Material and Methods: 25 women were selected in geriatric patients, between 65 and 103 years, guests of Villa Sorriso. The inclusion criterion was the evaluation test of the MMSE (Mini-Mental State Examination) had a value greater than 14, so as to ensure the ability to give consent to join the project and to the treatment of data and images, and give an assessment of the cosmetic effects. The patients were subjected to anamnesis, medical examination and skin check-up, according to the protocol of the International Aesthetic Medicine School, Fatebenefratelli Hospital, Rome. Two products were prescribed: one cream in the morning and an oil in the evening, provided by a company that produces eco biological cosmetics The administration of the creams was carried out in total autonomy for 12 people while for 7 patients it was necessary to remember them the creams and for 6 patients was needed the help of the paramedical assistants also for the application. The evaluations were performed at the then T0 to T1 (after a month from the use of cosmetics) and T2 (after 3 months). Results: The skin check-up carried out the controls showed an improvement of hydration, smoothness and brightness of the skin. During this study, which lasted a total of four months, the two Occupational Therapists of the clinic reported the growing interest in the creams, the satisfaction with the results and how the comments on cream had become a new source of aggregate, with exchanges of experience and sensations. Conclusions: Patients liked this project almost entirely from the first meeting. Some, more reluctant or unwilling, were involved from the first ladies who have been visited, which described a very pleasant meeting with aesthetic doctors with whom it has established, right now, an empathic relationship. The project confirmed the hypothesis of the authors because, in addition to having generated some enthusiasm and attention to the face, the presence of wrinkles, skin smoothness, has recreated a moment of contact with the world of femininity and beauty these elderly ladies had forgotten. KOZMETİK VAJİNAL CERRAHİDE LASER UYGULAMALARI Op.Dr. Ayşe Konaç Kadın Hast. Ve Doğum Uzm. Kozmetik Jinekolog ESAG Bilimsel Komite Üyesi Laser uygulaması bir süredir Estetik Cerrahide ve Dermatolojide yüz ve vücut estetiğinde yaygın olarak kullanılmakta iken artık tüm dünyada kozmetik vajinal cerrahide de gittikçe artan bir şekilde yaygın non invazif bir teknik olarak kullanılmaya başlanmıştır. Son yıllarda hızla gelişen bilim ve teknoloji laser cihazlarına da yansıdıkca ve cihaz özellikleri gittikçe daha etkili ve güvenilir oldukça laserlerin kullanımı daha da yaygınlaşmıştır. Genital alanda özellikle Vajinal Sıkılaştırma (Tightening), Vajinal Atrofi, Stres Incontinans ( SUİ), Koterizasyonlar, Genital renk açma ( Bleeching) ve İnvaziv Uygulamalar gibi pek çok işlemde rahatlık ve güvenle kullanılmaktadır. Non invazif bir teknik olması ve hastaların bu yöntemin farkındalığının artması ile birlikte özellikle hastalar tarafından da kabul görmekte ve talep artmaktadır

26 REDERMALIZASYON: MEZOLIFTINGDE SÜKSINIK ASID VE SÜKSINIK ASIDIN ANTIOKSIDANVE ANTIAGING ÜZERINE ETKISI MEDIKAL ESTETIKTE VASKÜLER LEZYON TEDAVILERINDE SKLERO TERAPI Dr. Ayşegül Girgin Dr. Aslı Şimşek Azlar Süksinik asid ve hyaluronik asid kombinasyonunun kullanımı ile yapılan mezolifting tekniği olan redermalizasyon nedir? Venöz genişlemelerde medikal estetik alanındaki tedaviler, skleroterapi ve diğer tedavilerle kombinasyonu. Tedavi prensipleri, diğer mezolifting yöntemlarinden farkı nedir? Skleroterapide en sık görülen erken ve geç komplikasyonlar komplikasyon yönetimi ve tedavisi. İçeriğindeki süksinik asidin önemi ; medikal estetikte ve dermatolojide süksinik asit kullanımının önemi ve sonuçları. Konuyla ilgili 1 yıllık vaka ve tecrübe paylaşımları

27 İNSANLARI KANDIRMADAN DA KAZANABİLİRSİNİZ. Ayşen Özkul Sosyal medya, kısa sürede yarattığı potansiyel ile bir çok sektörde olduğu gibi sağlık alanında da oldukça önemli bir yere sahip. Davranışlarımıza, tüketim alışkanlıklarımıza, kararlarımıza, hatta duygularımıza bile yön veren bir mecranın tam odağında yaşıyoruz. Herşey o kadar hızlı ve o kadar anlık ki, bu yoğun trafiğin gerisinde kalmayı hiç istemiyoruz. Cep telefonunuzu nasıl tuttuğunuzu bir an aklınıza getirin lütfen. Beynimiz başparmak ve işaret parmağını, insanoğlunun var olduğu hiçbir dönemde bu kadar yoğun olarak kullanmamıştı. Tüm bu koşulların arkasında oluşan bir duygu var; paylaştığımız sürece iyi hissediyoruz. Sağlık sektörünü diğer sektörlerden ayıran net ve tartışmasız en önemli farkı, insanın odağında olmasıdır. Bu da bir hekimin veya bir sağlık kuruluşunun böylesi bir ortamda yapılan tanıtım faaliyetlerinde ne kadar hassas sınırlar içerisinde olduğunu ve hareket alanının diğer sektörlerden çok daha dar olduğunu göstermektedir. En ufak bir hata onarılması güç itibar kayıplarına ve hatta icra edilen mesleği tehlikeye atabilecek durumlara neden olabilmektedir. Artık sosyal medya dinamiğinin içinde duygularımızı ifade etmekte sakınca görmediğimiz bir yaşam şeklimiz var. İnsanlar burada. Ben onlarla nasıl bir iletişim kurabilirim? Onlara bir doktor veya sağlık kuruluşu olarak verdiğim hizmetleri nasıl sunabilirim? Tüketim odaklı bir mecrada verdiğimiz hizmeti ticari bir algı yaratmadan, doğru kişilere nasıl gösterebilirim? DARK CIRCLES AND THE ORBITAL RIM: A CHALLENGE FOR CORRECTION, A REAL INDICATION FOR REGENERATION Emanuele Bartoletti The dark circles treatment has always been a challenge in the field of Aesthetic Medicine. In fact dark circles and the orbital rim certainly are peculiar and delicate anatomical districts. We have always tried to pinpoint the most adequate and safe treatment. But what makes these peculiar districts so hard to treat is the fact that any performed medical treatment could cause side effects, even serious ones. We must remember that before performing any treatment in these districts, we need to make an accurate diagnosis analyzing both anatomical and clinical patient situation. Author will present his own experience describing the anatomical study at the base of the treatment, performed methods and the choice of the right product based on the clinical situation of the patient. In particular the author will focus the audience s attention on the results achieved by performing the so called Aurigraft technique (implantation of emulsified adipose tissue combined with PRP). Sosyal medya karşılıklı iletişimin en etkili olunabileceği tek mecra. İkinci bir alternatifi yok diyebiliriz. Ama burada Sağlık Etiği ni hiçe sayarak, rekabetçi bir tutum sergilemek fazlasıyla ticari görünecektir. FAKE BOOST yani şişirilmiş hesaplardan tanıtım yapmak, gerçek insanların olmadığı bot takipçilerin ve gerçek izlenme oranlarını yansıtmayan izlenme trafiğinin markanıza veya hizmetinize en ufak bir katkısı olmayacaktır. Peki; bu kadar riskleri barındıran bir ortamda doğru bir iletişim nasıl yapılır? Bizim buradan en öncelikli önerimiz, güçlü bir marka imajı yaratmak için internet varlığınızı tamamen organik temelli bir oluşum üzerine planlamanız. Sabırlı ve istikrarlı olmanız. Bol bol içerik üretmeniz. Benzersiz içerikler üretin. İçeriklerinizi göz alıcı, yaratıcı görsellerle güçlendirin ve paylaşın. Oluşturduğunuz her kaliteli içerik mutlaka pozitif olarak size dönecektir

28 THE FUTURE OF BIOSTIMULATION: AURIGRAFT TELOMERE LENGTHENING - RESETTING THE CLOCK OF AGING E. Bartoletti, Roma, M. Vignoli, F. Vignoli, F. Alviano, Bologna William H. Andrews, Ph.D. Biostimulation represents one of the most performed treatments of Aesthetic Medicine and is incredibly relevant in the prevention of skin aging. Some years ago we could only use biocompatible heterologous substances such as PDRN or Hyaluronic Acid. However, thanks to a recent study performed on adipose tissue we discovered the presence of steam cells inside its vascular stroma. We began to treat the adipose tissue in a different way from the usual, i.e. lipofilling, and to use it as a substance for biostimulation. The clock of aging is found at the tips of our chromosomes, called telomeres. Studies in mice have shown that old mice can be made young again in every way imaginable simply by reversing the ticks on their clocks utilizing an enzyme called telomerase. I will be discussing ways that people can slow down their clocks now, as well as, our research that is underway to stop, and even reverse their clocks in the near future. Treatments for reversing aging in humans are sooner than you think. Inspired by Dr. Tonnard s articles, the authors started a personal experience in the treatment of biostimulation with adipose tissue collected with micro-hole cannula and then centrifuged and emulsified. First results were so encouraging that the Authors tested some technical variations which could substitute the graft. The results were even better than they thought. Besides, in cooperation with the Department of Specialistic, Diagnostic and Experimental Medicine of Bologna University, the Authors carried out biological studies with different protocols on typification and vitality of cells in extracted tissue samples, because there were still no exhaustive studies on types of extracted and implanted cells. The obtained results are very interesting and make us hope that this experience can bring some clarification in a field where empiricism and rationalism are still too much important

29 KOZMETİK JİNEKOLOJİDE RADYOFREKANS KULLANIM ALANLARI Op.Dr. Burçin Demirel Kadın Hast. ve Doğum Uzm. Kozmetik Jinekolog ESAG Üyesi Vajinal doğumlar, kilo alıp verme dönemleri, yaşlanma ve menopozdaki hormonal değişiklikler gibi birçok fizyolojik durum vajinal kanalın elastikiyetini bozar, pelvik tabanda hasar oluşturur ve vajinal mukoza tonusunu azaltır. Bu değişiklikler kadının öz güveni azaltabilecek, yaşam kalitesini ve cinselliğini etkileyebilecek sorunlara yol açabilir. Ancak, bu kaçınılmaz fizyolojik değişiklikler kadınlar ve hekimler arasında nadiren konuşulur. Kozmetik jinekolojideki teknolojik değişilikler sayesinde estetik tıpta uzun zamandır kullanılan radyofrekans enerjisinin bu sorunların çözümü için güvenli ve etkili olarak kullanılması ve son 10 yılda bu konuda konuşan ve çözüm arayan kadın sayısının artmasıyla radyofrekans ile genital gençleştirme alternatif tedaviler arasında hızla yerini almıştır. Radyo frekans enerjisi ile bağ dokusunun terapötik olarak güvenli ve etkili ısı değerleri olan C ye kadar ısıtılmasıyla kollajen kontraksiyonu, neokollejenizasyon, vaskülarizasyon ve growth faktor infilitrasyonu oluşturarak genital bölgede özellikle cilt gençleşmesi, vajinal mukozanın canlanması, elastikiyetinin restore edilmesi, nemliliğinin arttırılması amaçlanmaktadır. FIBROBLAST BIOSTIMOLATION BY NOT CROSS-LINKED HYALURONIC ACID (FRAGMENTS), AMINOACIDES, ANTIOXIDANTS Carla Mazzini MD*, Vincenzo Varlaro MD** * Cosmetic Aesthetic Medicine International Group (CAMIG), Torino (Italy) ** University of Camerino (Italy) CD44 is the major receptor for hyaluronic acid (HA) expressed on cells. It has a certain role in the intake of HA in the cell through an endocytosis process. Endocytosis is not the only molecular model with which HA penetrates into the cell. In fact, others like macropinocytosis and others are still largely unaware. Studies on fibroblasts and human alveolar macrophages revealed a molecular model of endocytosis of hyaluronic acid. HA binds to the CD44 receptor (adhesion protein) forming the HA / CD44 complex. Thus, an endocytosis process of the HA / CD44 complex begins with the formation of a vesicle containing the HA / CD44 complex. In the cytosol, then, HA and CD44 are released. CD44 is hydrolyzed by proteases while hyaluronic acid is degraded by specific enzymes, endocellular hyaluronidases that, in physiological situations, are not secreted in the extracellular environment. The structure of the CD44 receptor, with an Hyaluronan Binding Domain (HBD), a transmembrane domain and an intracellular domain remembers the structure of many molecular signal transducers. The cytoplasmic tail of the receptor, however, does not possess any intrinsic activity, either as phosphatase or as tyrosinchinase, so that transduction of the signal within the cytosol occurs in a similar manner to the signaling of the integrin, i.e., by mediation of associated signal proteins. The CD44 receptor is a polymorphic protein composed of 177 amino acids. Different isoforms are the basis of complex and complex molecular models. The responses summoned within the cell by the link between HA and the CD44 receptor, in fact, are manifold. CD44 receptors are adhesion proteins that allow fibroblast to dial with various ligands such as HA, such as HA fragments. An effect of such a dialogue is the endocytosis of the AHA that is CD44 dependent

30 Two cell cultures were compared: one of fibroblasts, one of the alveolar macrophages. The alveolar macrophages have a CD44 receptor kit larger than that of fibroblasts. The fibroblasts and the alveolar macrophages were incubated separately with HA labeled with a radioactive isotope. The degradation of the marked HP was evaluated by gel permeation chromatography (GPC): a physical separation technique used primarily for the analysis of polymeric high molecular weight materials. The gels used today for packing the columns work with with the principle of the molecular sieve: the solute passing through the column undergoes a slowdown proportional to the particle size and the pore size. Since there is no type of chemical bond between solute and gel (or at least no binding that is strong enough to cause further separation), the order of the output peaks varies from molecules of higher molecular weight (which do not pass through Pores and therefore, they go out quickly) to those of lower molecular weight that cross the paths created by the porosity of the gel, they take longer to go through the column. It has been observed that alveolar macrophages (with a greater expression of cell membrane CD44 receptors) degrade HA marked faster than fibroblasts (with a lesser expression of cell membrane CD44 receptors). The marked endocytosis of HSA was therefore faster in alveolar macrophages for the highest number of CD44 expressed in cell membrane level. In addition, the marked endocytosis process was inhibited by the use of anti-cd44 antibodies and this admitted that CD44 receptors play a pivotal role in the endocytosis of the AHA and its degradation. The endocellular response of the fibroblast is definitely conditioned by the size of the a molecule that binds the CD44 receptor. ADIPOSE TISSUE: A HIGHLANDER Catherine Marsili MD*, Vincenzo Varlaro MD** * Cosmetic Aesthetic Medicine International Group (CAMIG), Cremona (Italy) ** University of Camerino (Italy) Life also replaces death within the fat body. If a fat cell dies, it is regularly replaced by another. The discovery was made by studying the levels of radioactive isotopes found in the adipocytes of people who lived during the Cold War period ( ) in those places where several nuclear experiments were carried out. Not all cells have exposed radioactive isotopes despite their exposure to radioactivity, and this is because adipose cells that have met apoptosis over time have been regularly replaced by new adipocytes. Swedish research has confirmed that the number of adipocytes in the body of an adult man remains constant throughout his life. So even if it slows down, the number of adipocytes remains the same. Obesity is the result of a combination of the number of fat cells (established by the genetic heritage of the individual) and hypertrophy of adipocytes. Adipocyte hypertrophy is certainly related to the obesogenous hypercalorie diet but also to the genetic heritage of the individual. The famines that have afflicted humanity over the centuries have allowed the selection of genes that determine the rapid expansion of adipocytes. It was a genetic selection for the survival of man. Today, there is plenty of food and unfortunately man is a carrier of genes that determine an easy and rapid expandability of adipocytes that can increase their volume by 6-7 times. Hence the reflection that it is perhaps better to reduce the volume of adipocytes rather than eliminating them physically and that amethic doubt can only be resolved in a single direction. To treat localized adiposity: lipoclastic and lipoapoptotic or lipolytic treatments? If procuring the death of an adipose cell for necrosis (radiofrequency, ultrasonic hydrolysis, oxygenosis, ozonotherapy, cryotherapy) or apoptosis (lipoapoptosis) means then replacing it with a healthier adipocy perhaps it is better to treat localized adiposity, refer to lipolytic treatments: lipolytic mesotherapy (glucagon, organic silicon, ), emulsiolipolysis, carboxytherapy

31 FACIAL DANGER ZONES - AVOIDING THE DANGER ZONES WHEN INJECTING FILLERS Assist. Prof. Dr. Cüneyt BOZER Trakya University, Faculty of Medicine, Department of Anatomy, Balkan Campus, 22030, Edirne, TURKEY Facial filler injections for soft tissue augmentation andrejuvenation has increased in recent years. These proceduresare well accepted and widely performed because of theconvenience, pleasing outcomes, and favorable safety. However, there are some rare but destructive adverse effectslike sudden vision loss (iatrogenic blindness) and stroke. GENITAL BÖLGE DOLGUSU VE PRP Jinekolog Op. Dr. Didem Kurban Yaşlanma süreci yüz, boyun, dekolte, eller ve bacaklarda belirginken genital bölge de bu durumdan etkilenmektedir lerde kollajenin öneminin anlaşılması ile minimal invaziv prosedürler yaygınlaşmaya başlamıştır larda Kollajen yerini Hyaluronik Asit dolgularına bırakmaya başlar. Yüz bölgesine yapılan noninvaziv uygulamalarda FDA onaylı uygulamalar; The vascular anatomy of the face is highly complex. The facehas a wide range of vascular variations and anastomoses. Foravoiding adverse effects, a decent level of anatomy knowledgeis required. Hands on fresh cadaver courses are the bestmethod to study the detailed anatomy of the face forphysicians who perform aesthetic medicine treatments. Otolog yağ Kollajen ( Evolence,Cosmoderm,Fibrel,Zplast,Zyderm) Hyaluronik Asit ( Restylane-L, Restylane silk, Juvederm xc, Juvederm voluma xc, Belotero balance, Prevelle silk, Perlane) Polylactic acid ( PLLA, Sculptra,) Calcium hydroxyl apatite( Radiesse) Polymethyl methacrylate ( Bellafill, Artefill) dir. Genital bölge için en sık kullanılan dolgular; 1.DESIRIA: Tescil edilmiş iki endikasyonda kullanım hakkı var -Disparoni -Labia Majora Atrofisi ve G noktası Büyütme 2.NEAUVİA Genital Bölge Dolguları hakkında genel bilgiler verecek olursak; Genital bölge dolgularının diğer dolgulardan farkı; normalde dolgular dermal tabakanın altına enjekte edilirken, burada dolgu lip dartosla (derinin altındaki düz kaslar) fibröz tunik arasına enjekte edilir. Hayvansal kaynaklı olmayan cross linked mannitollü hyaluronik asit önerilmektedir. Mannitol efektif bir antioksidandır ve hyaluronik asidin bozulmasını engellemekte ve iskemik sorunlardan korumaktadır. Hafif hipotrofi varlığında 19 mg/ml konsantrasyondaki hyaluronik asit kullanılırken;orta ya da ağır hipertrofi varlığında 21 mg/ml HA kullanılmaktadır

32 PRP Nedir? LAZERLE NONINVAZIV GENITAL REJUVENASYON (Trombositten zengin plazma )kişinin kendi kanı alınarak, kandaki plazma trombosit sayısının konsantrasyonu 4 kata çıkacak kadar yüksek olacak şekilde özel bir sistemle hazırlanmasıdır. Trombositler içinde alfa granüller mevcuttur. Alfa granüller trombositlerin içinde inaktif olarak paketlenmiş growth faktörler içermektedir. Bunlardan bazıları; PDGF, TGF BETA, EGF, VEGF, FGF dür. Trombositlerden salınan büyüme faktörleri; yara iyileşmesinin hızlanması, doku yenilenmesi, ameliyat sonrası daha az kan kaybı, kemik ve kıkırdak yenilenmesinin hızlanması gibi avantajlar sağlar. PRP tıpta bir çok alanda aktif olarak kullanılmaktadır. Ortopedi (Spinal cerrahi, kıkırdak tedavileri, doku defektleri, tendinit, osteoartrit) - Spor tıbbı (Travmalar) - Diş Hekimliği - KBB-Maksillofasial cerrahi-üroloji - Dermatoloji ve kozmetik - Anestezi bunlardan sadece birkaçıdır. Genital bölgede ise; kırışıklık, gevşeklik, sarkma ve hiperpigmentasyon tedavileri (Vulvar rejuvenasyon), vulvar Vestibulit ve disparoni tedavileri, epizyotomi skarları, vajinal sıkılaştırma ve rejuvenasyonda G Noktası enjeksiyonu, orgazm tedavileri veya introital sıkılaştırma,mesane boynu ve periüretral PRP, menapozda ve vajinal atrofi ve kuruluk tedavisinde kullanılmaktadır. PRP nin kontrendike olduğu durumlar ise; gebelik, trombositopeni, pıhtılaşma problemleri, antikoagülan tedaviler,hiv pozitifliği, kanser, immunsüpresif ilaç kulanımı gibi durumlardır. Jinekolog Op. Dr. Didem Kurban Genital rejuvenasyon; vajina ve etrafındaki dokuları düzeltmek ve restore etmek için yapılan estetik ve fonksiyonel prosedürleri kapsayan bir terimdir. Bir ucunda non-invaziv olarak vajinal atrofi ve kuruluğu düzeltmek, vajinayı sıkılaştırmak ve gençleştirmek ve inkontinans için kullanılırken; diğer tarafta jinekolojik- plastik cerrahlar tarafından labia minora, labia majora ve vajinoplasti operasyonlarında da kullanılmaktadır. Genital rejuvenasyonda C0₂ bazlı veya Erbium: Yttrium, Aluminyum, Garnet (Er:YAG) lazerler ve radyo frekans (RF) bazlı cihazlar kullanılır. Lazer ya da RF dalgaları ile vajina duvarındaki bağ dokusu ısıtılmaktadır. Bu durumda amaç; kollajen kontraksiyonu, neo-kollajenez, vaskülarizasyon ve vajinal mukozaya büyüme faktörü infiltrasyonudur. Genital Bölgede lazer; vajinal rejuvenasyon ve sıkılaştırma, stres üriner inkontinans, menapozal genitoüriner sendrom ve atrofi tedavileri, Labia majora renk açma tedavisi, Labia majora cilt düzleştirme, genital siğil tedavileri, genital bölge ameliyatlarında kesme işlemlerinde kullanılmaktadır. CO2 ve ER:YAG lazerler; lazer enerjisini infrared ışık spektrumuna çevirerek sadece hedef dokuyu etkiler, etraf dokulara zarar vermez. (Gambacciani at al.-salvatore at al.) Lazer; mikroskopik termal nekroz yapmaktadır. (Karcher at al. 2016) Epidermis ve dermisi içeren mikroskopik tedavi zonları yara iyileşme kaskadını başlatarak yeni kollajen ve elastin fibrillerin oluşumunu sağlar. Epitelial hücrelerde glikojen depolanmasını arttırır. Fibroblast aktivasyonu ve ekstracellular matrix neosentezini sağlar. Yapılan çalışmalara göre; Yeni kollajen ve elastik fibril üretimi artar (Gasper at al 2011) Normal vajinal asidite sağlanır, genital ve üriner enfeksiyonlarda azalma olur. Vajinal lubrikasyon artar Vajinal daralma ve yenilenme sağlanır Prolapsus hissi azalır Seksüel hazda artış olur(salvatore at al 2015) Postmenapozal yanma, kaşıntı, kuruluk, disüri ve disparoni azalır (Salvatore at al.- Perino at al. 2015) Lazerle Vajinal Rejuvenasyon sonrası hastalar, hemen günlük hayata dönebilirler. İstirahate gerek yoktur. NSAID ilk birkaç gün kullanılabilir.10 gün kadar sulu akıntı hafif ödem normaldir. Hijyene dikkat edilmesi önerilir.cinsel ilişkiden ve tampon kullanımından 7 gün uzak kalınması önerilmektedir

33 GENITAL ESTETIK TIP A GENEL BAKIŞ LABIOPLASTI, CERRAHI VAJINAL DARALTMA VE PERINEOPLASTI Dr. Süleyman Eserdağ Dr. Süleyman Eserdağ Genital estetik operasyonları, tüm dünyada en hızla artan estetik operasyonlar arasındadır. Uygulanan cerrahi ve cerrahi dışı (non-invaziv) uygulamalarda estetik kazançlar yanında, medikal, hijyenik, psikolojik, sosyal ve seksüel yararlar da bulunmaktadır. Labioplasti operasyonları; kadınlarda iç ve dış dudakların küçültülmesi, simetrisitenin sağlanması ve estetik olarak daha iyi bir görünüm kazandırılması amaçlarıyla yapılmaktadır. Estetik yararlar haricinde medikal, psikolojik ve hijyenik faydaları da mevcuttur. Genital estetik içindeki cerrahi ameliyatlar arasında labioplasti (iç ve dış dudak estetiği), vajinal daraltma (vajinoplasti), perine düzeltme (perineoplasti), klitoral hud estetiği (klitoral hudoplasti), himen onarımı (himenoplasti) ve otolog yağ dolgu operasyonları başta gelmektedir. Hastalar tarafından en sık tercih edilen ameliyatlar arasında labioplasti ve cerrahi vajina daraltma ameliyatları yer almaktadır. Labioplasti tüm dünyada, genital bölge estetiği içerisinde en sık tercih edilen ameliyatlar arasındadır. Labial hipertrofi ve asimetri kadınlarda en fazla doğuştan gelmekte ve ergenlik döneminde artan hormon seviyeleri ile daha da belirginleşmektedir. Ayrıca kronik irritasyonlar, sık vajinitler, venöz ve lenfatik dolaşım bozuklukları, bisiklete veya ata binme gibi aktiviteler de sorunun ortaya çıkmasındaki diğer faktörler arasındadır. Cerrahi olmayan uygulamalar arasında ise lazerle vajina yenileme, dış genital bölge renk açma ve sıkılaştırma, genital radyofrekans, genital PRP ve hyaluronik asit genital dolgu işlemleri yer alır. Genital HIFU, ip uygulamaları, mezoterapi ve karboksiterapi de diğer yeni uygulamalar arasındadır. Genital estetik sorunları ile hekime başvuran hastaların öncelikle iyi bir jinekolojik değerlendirmeden geçirilmesi, detaylı şekilde geçmiş obstetrik ve jinekolojik anamnezinin alınması, buna göre hasta beklentilerinin net olarak saptanması son derece önemlidir. Daha sonrasında en ideal operasyonel prosedüre geçilmelidir. Operasyonlar hasta dokusu ve beklentisine uygun şekilde dizayn edilmelidir. Doğru teknik ile yapıldığında hem estetik hem de fonksiyonel pek çok kazanımlar söz konusudur ve hasta tatmin düzeyleri de oldukça yüksektir. Genellikle vajinal doğumlara bağlı olarak gelişen vajinal genişleme, sarkma ve perine düzensizliklerinde rekonstrüksiyon amacıyla cerrahi vajina daraltma ve perineoplasti operasyonları yapılmaktadır. Nitekim kadınlarda vajinal genişleme, vajina aksının bozulması, rugaların düzleşmesi, koital inkontinans ve kötü estetik görünüme bağlı özgüven kayıpları cinsel haz sorunlarını da beraberinde getirmektedir. Gebelikler, iri bebek veya pelvik darlığa bağlı olarak gelişen zor doğumlar, doğum yırtıklarının fazlalığı, evde yapılan doğumlar, doğum sonrası epizyo dikişlerinin açılması veya enfeksiyonu, artan yaş, kolajen bağ dokusunun genetik olarak kötü olması, sigara, alkol kullanımı ve malnütrisyona bağlı kolajen azlığı gibi sebepler vajinanın normalden daha geniş olmasına neden olabilmektedir. Tüm bu sebeplerle yapılan vajina daraltma operasyonları estetik görünümden çok fonksiyonel amaçlara yöneliktir. Komplikasyon risklerini azaltmak ve en iyi sonuçları elde etmek için, genital bölge ile ilgili tüm operasyonlar bu konuda tecrübe sahibi cerrahlar tarafından yapılmalıdır

34 VAJINISMUS VE DISPARONI TEDAVISINDE UYGULANAN CERRAHI TEDAVILER Dr. Süleyman Eserdağ Vajinismus ve Disparoni, kadınlarda herhangi bir cinsel soruna bağlı olarak en sık hekime gelme sebebidir yılında yapılan DSM V sınıflamasına göre Genitopelvik ağrı ve Penetrasyon bozukluğu sınıfında yer almaktadır. Yapılmış olan bir çalışmaya göre ülkemizdeki prevalansı %10 dolayındadır. Vajinismusun en güncel tanımı; kadının kendi arzusuna rağmen, vajina içerisine eşinin penisi, fitil, tampon, parmak gibi yabancı bir cismi alamaması olarak tarif edilmektedir. Sorun genellikle psikolojik orijinlidir, ancak bazı doğuştan gelen veya sonradan kazanılmış fiziksel problemlere bağlı olarak da ortaya çıkabilmektedir. Kızlık zarının doğuştan yüksek kenarlı, yarım ay, ara bölmeli, kribriform ve rijit yapıları cinsel ilişkiye girememe sorununa neden olabilir. Ayrıca vajina içindeki septumlar, bartholin kistleri, vajina içi myomlar, dev kondilomlar ve vajinal enfeksiyonlar da cinsel ilişki sorunlarına yol açabilmektedir. Bu nedenle cinsel sorunların tümünün teşhisi ve doğru tedavi şeklinin belirlenmesi için öncelikle iyi bir jinekolojik değerlendirme şarttır. Jinekolojik değerlendirmede organik patoloji saptandığı takdirde nedene yönelik tedavi veya cerrahi operasyon uygulanmalıdır. Her hangi bir organik patoloji yoksa davranışsal- bilişsel terapiler ile çözüm yolları aranmaktadır. GENITAL RF UYGULAMALARI Dr. Şenay Eserdağ Genital bölge rejuvenasyonu konusunda son yıllardaki teknolojilerden birisi de genital RF cihazlarıdır. Temel prensibi monopolar, radyo ve TV sinyallerine ile aynı frekansta, 3 Hz ile 3000 Ghz arası elektrik akımının cilt altı dokuda suyla karşılaştıktan sonra ısı üretmesi ve bu termal etkinin fibroblastları uyarmasıdır. Cilt altı ısısının 42 C geçmesi ile kolajen remodelling başlamakta ve rejuvenasyon gerçekleşmektedir. Günümüzde bu amaçla farklı teknolojiler geliştirilmiştir. Genital RF uygulamaları hem işlevsel hem de estetik amaçlarla yapılmaktadır. Bazı teknolojiler hem dış hem de iç genitalyaya uygulanabilmektedir. İç genital radyofrekansı vajina gençleştirme, sıkılaştırma (rejuvenasyon), idrar kaçırma problemlerinin giderilmesi, cinsel hazzın arttırılması, orgazm fonksiyonunun kolaylaştırılması gibi amaçlara yöneliktir. Dış genitalyada ise rejuvenasyon, yüzeyin düzeltilmesi (resurfacing), parlaklığın sağlanması, laksitenin azaltılması, kırışıklık ve sarkmaların giderilmesi hedeflenmektedir. Genital radyofrekans uygulama seansları ortalama olarak dakika kadar sürer. Nonablazivdir ve şu ana kadar her hangi bir majör komplikasyon bildirilmemiştir. Anestezi gerektirmez ve tamamen ağrısızdır. İşlemden sonra ilişki kısıtı da yoktur. Kolajen lif üretiminin tam olarak sağlanması için genellikle bir ay arayla 3-4 uygulama önerilmektedir. Uygun hasta grubunda oldukça tatminkar sonuçlar vermektedir. Disparoni ise kadınlarda cinsel ilişkide ağrı, yanma, batma gibi hoşnutsuzlukları içeren bir cinsel sorundur. Çoğu zaman vajinismus problemi ile iç içedir. Vajinismusta olduğu gibi, daha önceden itibaren veya sonradan ortaya çıkmış (kazanılmış) olabilir. Ağrı yüzeyde veya derinde olabilir. Yüzeyel disparoni en çok Vulvar Vestibulit e bağlı gelişmektedir. Vestibuler mukozanın kronik irritasyon ve hassasiyetinin etiyolojisi konusunda günümüzde halen net bir görüş birliği yoktur. Yine de, uygulanan medikal tedaviler sonuç vermediği takdirde yapılan vulvar vestibulektomi operasyonu ile sorun giderilebilmektedir

35 THE CANADIAN EXPERIENCE WITH ATX-101 Dr. Julia Carroll, MD FRCPC FAAD POPÜLER DIYET AKIMLARI GÜNCESI: KIŞIYE ÖZEL BESLENMEK IÇIN GENLERINIZE MI BAĞIRSAKLARINIZA MI KULAK VERMELISINIZ YOKSA VÜCUT DENGESINI MI SAĞLAMALISINIZ? Dermatologist Founder & Dermatologist - Compass Dermatology Director of Dermatology - The Medcan Clinic Lecturer - Department of Medicine, University of Toronto ATX-101 (deoxycholic Acid [DCA] injection) is a proprietary formulation of pure synthetic DCA. When injected into subcutaneous fat, ATX-01 results in focal adipocytolysis, the targeted destruction of fat cells. While injectable adipocytosis has been performed for decades, this is the first commercially prepared product available in North America, with Kybella launching in the US in 2015 and Belkyra launching in Canada in This presentation discusses the Canadian experience with ATX-01 including the presenter s clinical experience. Dyt. Eda Ağıllı Akın Birçok insanın çeşitli hastalık ve kilo problemleri; bazı besinleri tüketmeleri ile birlikte, vücutta sindirilememesi ya da sahip oldukları farklı gen yapıları üzerinde besinlerin farklı etki göstermesi ya da vücut kimyası göz önünde bulundurularak besinler ile metabolik denge sağlanması gibi klasik beslenme yöntemlerin dışında bir arayış başlamıştır. Artan beden algısının yanı sıra kaliteli yaşamın da önem kazandığı günümüzde insanlar ideal ağırlığın kalıcı korunması ile birlikte yaşam kalitesini maksimum seviyeye taşımayı hedeflemektedir. Bu bağlamda yüksek ilgi uyandıran yöntemler; besin intolerans testleri, genetik yapıya göre beslenme, metabolik balance diyetleridir. Besin intoleransı (Bİ), besinlere karşı immünolojik olmayan reaksiyonlar olup, gerçek besin allerjileri ile karıştırılır. Besin intoleransı, kişilerin vücudunda tükettikleri besine karşı oluşan immunoglobülin G ye bağlı olarak reaksiyon gösteren bir duyarlılıktır. Bu durum geçici veya kalıcı olabilmektedir. Vücudumuz sindirilemeyen besinlere karşı savunma sistemini harekete geçirmekte ve oluşan enflasyon sonucunda CRP düzeyleri artmaktadır. Halsizlik, metabolizmanın yavaşlaması ve bağırsak problemini de yanında getirmektedir. Gelişen teknolojiyle yapılan besin intolerans testleri, parmak ucundan alınan birkaç damla kan ile vücudumuza zarar veren hatta kilo alımına neden olan bu yiyecek içecekleri kısa süre içinde belirlemeye yardımcı olmaktadır. Genetik test, kişinin genetik yapısı doğrultusunda, kişiye özel beslenme programı oluşturmak için geliştirilmiş nutri-genetik analizler bütünüdür. Beslenme programını kişinin genotipine uygun bir biçimde hazırlamaya yardımcı bir yöntemdir. Test kapsamında kişinin antioksidan, detoks ihtiyacı, beslenme programının glisemik yükü, inflamasyondan korunma ihtiyacı, farklı yağ türlerine olan ihtiyacı, tuz, alkol, kafein duyarlılığı, laktoz ve gluten intoleransı, tüm vitamin ve mineral ihtiyacı ve egzersiz düzeyi kişinin genlerinin yönlendirmesi ile belirlenebilmektedir. Genetik test uygulaması yanak içi mukozasından alınacak doku örneğinin analiz edilmesiyle yapılmaktadır. Metabolik balans, vücut kimyası göz önünde bulundurularak kişiye özel planlanmış beslenme programlarıyla vücudun insülin seviyesini normalleştirerek metabolik dengenin oluşturulmasını hedeflemektedir. Metabolizmayı düzenleyen gıdalar kan değerleri ve kişisel verilere göre belirlenir. Bu belirleme sırasında gıdaların kalorilerinden çok, glisemik yükleri ve kişinin metabolizma özellikleri dikkate alınır. Amacı metabolizmayı eğiterek dengelemeyi öğretmektir. Dünyada sadece tıp doktorları tarafından uygulanan Metabolik Balans Sistemi saatlik açıktan sonra alınan detaylı kan tahlili sonuç raporuna göre sağlıklı beslenme kurallarını hayata geçirmeyi hedeflemektedir. Bu derlemede; klasik diyet yöntemlerinin dışında yoğun ilgi gören besin intolerans testleri, genetik yapıya göre beslenme ve metabolik balans diyeti ile ilgili çalışmalar incelenmiş hangi profilde hangi diyet yönteminin uygulanması gerektiği ile ilgili bakış açısı oluşturmak amaçlanmıştır

36 METHODS OF ACNE TREATMENT WITH LOCAL RETINOIDS KELOIDS: INFILTRATIVE THERAPIES E.Ugrekhelidze M.D. Dermatovenereologist; Chemis; The head of Clinik of aesthetic medicine JUVENTA; Lecturer of TSMU Dermatovenereology Department Prof.A.Katsitadze Dermatovenereologist; Head of TSMU Dermatovenereology Department Acne is a chronic skin disease involving inflammation of the sebaceous glands and hair follicules. The disease is closely associated with increased production of sebum, increased proliferative activity in the hair follicle area, as well as with intensive and excessive colonization of the skin and appendages of Propionbacteriunum acnes with the formation of an inflammatory reaction. In turn, hypersecretion of sebum is directly related to the level of androgens. Their main targets in the skin are sebum glands,hair follicles, epidermis, fibroblasts and melanocytes. Depending on the severity of the process, systemic or external therapy is used to eliminate etiopathogenetic factors. The use of antibiotics to treat acne can be cause of an already serious resistance to antibiotics. Studies have shown that the resistance of pyogenic streptococci colonizing the oropharynx is due to the use of antibacterial therapy in patients with acne. Currently, retinoids are one of the most effective group of drugs, their introduction into practice has become a turning point in the therapy of some chronic dermatoses such as psoriasis, ichthyosis, lichen planus and etc. In our practice for treatment, Retinol balm therapy is used. Therapy is extremely effective, since it probably affects primary or secondary the etiologic factors of the disease: sebum production, comedogenesis and colonization by Propionibacteriunm acnes. Balm is used for both severe nodular and cystic acne and for less severe forms of the disease. There is regression of various elements of the rash, and after the pigmentation. There are no side effects, the most common for local retinoids, like: local skin irritation - erythema, peeling, dryness, sensations of tension and burning. The balm also contains soybean oil, lauryl, oleic and glycolic acids. The average duration of therapy is from one tothree months. The absence of side effects and contraindications allow to use balm during the long time. DR. EMANUELE VERGA Keloids are benign fibrocitic skin tumors due to an abnormal skin re-sponse to different types of trauma: chemical (burns, chemical peel-ings), physical (piercing, tattoos, abrasions, not absorbable fillers), sur-gery, infectious (acne, chicken pox). Keloids can occur in all healing processes, also in first intention process and sometimes, spontaneous-ly. The evolution of a skin lesion scar is regulated by two factors nor-mally equilibrated with each other: TGF-b (cytochine transforming growth factor b) and NO (nitric oxide), both able to stimulate the produc-tion of collagen. The high occurrence rate of keloids in high skin photo-types seems to be related to oxidative stress, mainly by ultraviolet radi-ation, in skin cells that have a genetic mutation. Moreover, keloids more frequently occur in young than elderly patients, in part because younger dermis has greater collagen synthesis and contains more elas-tic fibers, causing more skin tension. Keloid has hard texture and is characterized by the overflow than the primary lesion and is considered acellular, compared to hypertrophic scars. Inside Keloids, indeed, are found fibroblasts, which show altered anabolic activity but also a high production of collagen, due to an increase in collagenase inhibitors and more new microvessels. The expression of a gene mutation is up-stream of these conditions, although not yet well identified but support-ed by expression of familiarity. The most affected skin areas are chest, above the sternum and ear pinnas. Once developed, keloids are diffi-cult to treat, and have a high rate of recurrence regardless of treatment adopted. Intralesional infiltrative therapies are currently considered safe and more effective. Here is reported a clinical case of keloid scar of the sternal region, in which is tested the effectiveness of some drugs intro-duced more recently as a possible therapeutical approach for keloids (verapamil, netilmicin, and 10% glucose solution), compared to the most used for long time, such as triamcinolone acetonide

37 MESOTHERAPY AND REGENERATIVE MEDICINE ESTETİK TIP AÇISINDAN GENİTAL ANATOMİ Dr. Erkan Özgün Dr. Evin Nil Uğurlu Regenerative medicine is the conductor, maestro of all regeneration technics for revitalization of the body. There are so many repairing mechanisms in the body. To be activeted these mechanisms can be possible to be used cells and/ or cell-free products. The stemcells are not a magic, but the effects of them are like a miracle. When you study with the cells inside, you see a miracle of the nature. If all the systems of the body works healthy, the stemcells do their works that keep the body alive as healthy. You can only say that the human body is programmed not to die. Mesotherapy is a most effective way to give many necessary pharmaceuticals and supplements in to the body. More less, more effective and for direct use of the lession area. Mesotherapy used for treatment since a long time. Now we focused it to use for rejuvenation. Is it enough? While it is possible to make regeneration, is it enough to try to do rejuvenation? Shall we focus how we create regeneration? We can get at the regeneration easily using the mesotherapy technics. Who knows? All newest methods may be secreted in the past? Kozmetik Jinekoloji nin temeli iyi bir anatomi bilgisinden geçmektedir. Çalışacağımız alanı çok iyi tanımalı, hakim olmalıyız.yapacağımız invaziv ve noninvaziv işlemlerde çalışacağımız dokuların karakterini bilmek başarılı olmak için esastır. Genital organları iç ve dış genital organlar olarak ayrı ayrı değerlendireceğiz. İç genitaller: vajina, uterus, overler ve tubalar iken, dış genitaller: mons pubis, labia majora, labia minora, klitoris, vestibulum, vestibular bulb, büyük ve küçük vestibular bezlerdir. Genital organların yapısına geçmeden evvel bu organların yer aldığı pelvisi ve pelvisin elemanlarını da tanımak gerekmektedir. Pelvis; pelvik kemikler, kemikler arasında eklem ve ligamentler, kaslar, damar ve sinirler ve pelvik viserayı içerir. Pelvisin yapısını bilmek temel cerrahi prensipleri bilmek açısından çok önemlidir. Dış genitallerin yer aldığı perine bölgesi kozmetik jinekoloji için asıl önemli alandır. Kozmetik jinekolojide en çok çalıştığımız alanlar; vajina, klitoris, labialar (majora ve minora) ve mons pubistir. Mons pubisin fonksiyonu, alttaki pubik kemiği, kasları ve diğer dokuları korumaktır. Mons pubis redüksiyonu ile bu bölgenin hacmini küçültülmekte, varsa dengesizlikler düzeltilmektedir. Vajina daraltma en çok talep edilen operasyonlardandır. Zor doğumlar, menopoz, yaşlılık, genetik yapı gibi nedenlerle vajina yapısı bozulmakta, anatomisi değişmektedir- ki bu da cinsellikten alınan hazzı azaltmaktadır. Labia majoraların fonksiyonu: - Cinsel ilişki sırasında sürtünmeyi engellemek. - Bu bölgeye gelebilecek mekanik darbelere karşı yastık görevi görmektir. Labia majoralara, şikayete göre redüksiyon veya labia augmentasyonu yapmaktayız. Lazerle beyazlatma, radyofrekans veya lazerle sıkılaştırma işlemleri de uygulanabilmektedir Labia minoraların fonksiyonu: - İşeme esnasında idrarın akış yönünü düzenlemek - Vajinayı kurumaya karşı korumaktır. Labial hipertrofi için labia redüksiyonları ve/veya labial asimetri için labiaminoraplastiler Estetik Genital Cerrahi nin günümüzde en sık talep edilen ve gerçekleştirilen operasyonlarıdır

38 LASER-ASSISTED DRUG DELIVERY: A NEW CONCEPT IN THE TRANSDERMAL THERAPY AESTHETIC MEDICINE EDUCATION AND TRAINING: PRESENT STATUS AND FUTURE PERSPECTIVES Florian C. Heydecker Director of Dermo Laser Clinic in Vimercate (MB) Lecturer at the Milan School of Aesthetic Lasertherapy and Medicine Agorà INTRODUCTION, OBJECTIVES, PURPOSE OF THE STUDY The topical use of dermal-active substances to prevent and contrast intrinsic and extrinsic skin ageing stands for a crucial element in Aesthetic Medicine. Before reaching an effective dermal bioavailability, the corneal layer must be penetrated, as it represents a compact barrier to the passage of molecules which are spread on the skin. Many strategies have been developed to increase the penetration of active principles, such as chemical modification, liposome preparations, occlusion, iontophoresis, electroporation and ultrasound carrying. MATERIALS AND METHODS Ablative fractional lasers CO2 or Er:YAG (AFXL) represent a new method to go through the dermal-epidermal barrier in a precise and controlled way. It creates vertical microscopic ablation zones (MAZs) where bridges of intact tissues are preserved, usually >50%, which allow for a complete skin recovery. Topical active principles, given right after an AFXL treatment, go beyond the corneal layer through the MAZs and sit in the deeper skin layers where they reach effective levels of bioavailability, based on the laser-assisted drug delivery principle (LADD). RESULTS A number of different skin ageing clinical conditions have been treated, such as melanic and red dyschromias, skin texture alterations and superficial wrinkling of the periocular area. Also, post-acne or post traumatic scars can be treated. According to the specific treatment needs, the substances to introduce may change: hyaluronic acid (HA), collagen and nucleotides for tissue stimulation, anti-oxidation C and E vitamins, bleaching phytic and kojic acid, Platelets-rich Plasma (PRP) with a regenerating effect and botulinum toxin with a muscle-relaxant effect. Encouraging results have been achieved, thanks to the use of triamcinolone suspensions and/or botulinum toxin solutions on hypertrophic or keloid scars. CONCLUSIONS The Author shall present the protocols developed and the results obtained with the LADD method for the clinical indications more recurrent in the daily medical practice. KEYWORDS: Laser assisted drug delivery Fractional laser Skin ageing Scars Francesco Amenta, Antonio Guida, Vincenzo Varlaro School of Medicinal and Health Products Sciences, University of Camerino, Camerino, Italy The increasing diffusion of aesthetic medicine and surgery practice requires adequate levels of protection for patients undergoing aesthetic treatment. Patient protection should be obtained with specific regulations belonging to the responsibility of single countries. Regulation of aesthetic medicine practice is a quite complex task as it involves several professional and technical aspects. Level of competency and training of health professionals practicing aesthetic medicine is still not defined. Aesthetic medicine is not inserted in the training curriculum of medical students and therefore future physicians may not have knowledge of it. In some countries doctors start aesthetic medicine activity after following workshops or short courses organized by manufacturers/suppliers of aesthetic devices or products. Such an approach is risky as these practitioners may have learned some technical skills but not ethical and cultural aspects supporting aesthetic medicine practice. Just a few countries have regulated to some extent aesthetic medicine practice. In European Union countries a main reference is represented by the European Standard FprEN Aesthetic medicine services - Non-surgical medical treatments. The standard recommends that a practitioner undertaking aesthetic medical treatments shall be trained in the respective treatment and this training shall be in compliance with the national competent authority s rule. In Italy lacking governmental initiatives in the field, some registers of physicians issued specific recommendations for aesthetic medicine. For being included in the list of expert aesthetic medicine physicians, candidates should follow specific courses managed by universities or by private schools recognized by health authorities. In this frame the International Master in Aesthetic Medicine and Therapeutics of the University of Camerino probably represents the first Italian initiative dedicated to the training of internationally qualified professionals and could probably serve as a basis for an agreed aesthetic medicine European standard. The future of high quality aesthetic medicine will require joint efforts between regulatory (governmental) authorities, universities and qualified scientific societies. These efforts should be aimed at providing in a cross border reality as the delivery of aesthetic medicine a regulatory framework guaranteeing patients of an adequate care by qualified professionals

39 MINIMALLY INVASIVE PROCEDURES: ANY NEWS Fulvio Tomaselli, MD SIME Honorary President Roma, Italy In the history of medicine a concept has always been important: primum not nocere On this imperative the search for lesser aggression on the human body has stimulated researchers at all times. In the field of regenerative medicine the possibility of being little or nothing invasive for better compliance is very much felt by the public and doctors. Today there are many methods that allow for results that in the past required an invasive approach, let s talk about radiofrequency, peeling, thermal therapies, pulsed light, established for years and constantly evolving, to move to the latest Pharmaforesi (an evolution Of Electrophoresis), of Complex Magnetic Fields (evolution of magnetotherapy with complex multifrequency magnetoelectric fields) of cryo therapy, using thermal chock to stimulate skin regeneration and whole body response. The most recent methodologies and their possibilities are described. INTEGRATION BETWEEN PDRN, HA FREE AND TCA PEELING ON AGING FACE. PROPOSAL FOR GUIDELINES. Fulvio Tomaselli, MD SIME Honorary President Roma Italy The improvement of aging face requires both restoring treatments that corrective ones. The last are based on dermal response to damage capable of inducing a restoring process with new formation of collagen type I (fibrotic). The fibrotic collagen has the ability to retract and this, at dermal level, induces a cutaneous tension which improves the aesthetics of the face. Various active ingredients are able to induce the fibrotic neocollagenogenesis and, among these, the PDRN, hyaluronic acid and peeling. The PDRN is a component (nucleic acid) normally intracellular. This, introduced in the dermis, informing the fibroblast of a biological damage, by the activation of CD39, induce the production of fibrotic collagen. Hyaluronic acid, not cross-linked, if in excessive amounts, induces the activation of dermal metal proteinase (hyaluronidase) with damage of the collagen matrix and neoformation of I type. The peeling, particularly those using strong acids such as TCA, create dermal irritation and acidification of the matrix with new formation of fibrotic collagen. In our protocol, the combined use of these products allows better fibrotic response tension (lifting effect) of the skin areas of the face treated. The Protocol shall apply on patients who no longer respond to restorative treatments or in some parts of the face and / or body requiring a purely aesthetic surgery

40 UPDATES CONCERNING A METHODOLOGY FOR THE TREATMENT OF ATROPHIC STRIAE AND MORE PECULIARITIES OF CORRECTION OF ETHNIC FACES IN CENTRAL ASIAN REGION Alberti Giovanni Gulnar Zhumatova The term Striae Atrophicae histologically highlights the degenerative nature of the socalled stretch marks, which are characterised by the decrease of skin thickness, atrophy of dermal collagenous fibres and a reduction of elastic fibres that become thinner and diminish near the sides of the stretch mark, resulting in scar-like striae. They are also known as Striae Distensae, a term coined by the American gynaecologist Johann Georg Röderer in Women appear to be the most affected (70%); with striae occurring on various areas, but mainly on the abdomen, breasts and thighs, whereas in men the striae usually affect the lumbosacral, pectoral and deltoid areas. They appear as a consequence of changes in the body during adolescence, pregnancy, weight gain after dieting or increase in muscle mass, but also in case of hormonal issues such as adrenal gland disorders and thyroid diseases. The striae s colour varies depending on their evolution stage: at first, there is mainly an inflammatory, pseudohypertrophyc component, and their colour can vary from pink to purple-red to blue; the next stage is scarring, where colour becomes pearly white, as they become thinner, hollow to the touch and, as they are lacking vascularisation, they absorb the light spectrum of colours. Various types of treatment were used in order to solve the stretch marks issue, e.g. peeling, laser, radiofrequency etc. but results did not satisfy neither the medical- scientific world, nor patients affected by such problem that, as seen, it is a true skin pathology. In recent years, along those therapies, came a combined methodology that is giving very good results. Since the early sessions it is possible to see striae lifting, skin reconstructing and tonifying thanks to revascularisation and melanin generation, which will later lead to tanning, making striae similar to the healthy skin that surrounds them. Several national and international scientific researches have already validated this methodology, which was initially tested in the Universities of Pisa and Pavia. With this study we wish to provide a personal contribution by demonstrating its efficacy not just in the stretch marks treatment, but also in the tonification of skin areas such as breasts, abdomen, gluteus, as well as facial anti-aging. Professor, President of the Association of Aesthetic Medicine and Plastic Surgery (Kazakstan, Almaty) Some factors to be considered during the Protocols of Aesthetic Procedures: age, еthnic type, gender * Anthropological type of Kazakh population: mongoloids 70%, Europeans 30 % * People of the Central Asian region are characterized by: round faces, the structure of the skeleton - high cheekbones, flat forehead, temple deepening, as well as in the middle part of the face and in the bridge area. * Asian type of skin is more dense comparing to Europeans, does not form small superficial wrinkles, has less mimic wrinkles and has more fibroblasion characteristics. Eyes are widely located with the expressed epicanthus, and often there is an overhang of a fold of an upper eyelid * Fatty deposits are well expressed in the field of an eyelid, cheeks and around the lower jaw, well expressed chewing muscles. The massive and twisted bounds in face muscles * The size of the upper and the lower lip is usually the same *Asian type of face is characterized by deformational type of aging. There are changes in the smoothness, roundness of the contours of the face within age. * Muscle and skin tonus is lowering, ptosis of soft tissues progresses, and there is a disposition subcutaneous fat, deformation of the lower third face is often observed. As a result the change of the oval and face relief, appearance of flew of the face, fat hernia emerging in the eyelid area, supra orbital ptosis, tissue deepening in subacute and cheek bone areas * Skin has thick subcutaneous fat layer, loses a strong collagenous framework, it dries down. * Often there is a ptosis of the lateral margin of the eyebrow, which is manifested by the sagging of the skin of the temporal region. * The volume of fat accumulates in the nasolabial zone, on the lateral surfaces of the lower jaws and lateral sections of the cheeks, which contributes to the early appearance of gravitational ptosis, deep nasolabial folds, double chin, but small wrinkles are not expressed, hyperpigmentation, cuperosis and edemas are often observed. So, we need to consider all these ethical factors when using protocols of esthetic medicine

41 NEW METHOD OF SKIN LAXITY TREATMENT WITH ENDODERMAL RADIOFREQUENCY. NON SURGICAL LIFTING WITH ABSORBABLE THREADS: FORM RECONSTRUCTIVE MEDICINE TO AESTHETIC PRACTICE. Prof. Irina Poleva Prof. Irina Poleva Lately we observe growing request of the patients for mini invasive treatments with very short downtime. In order to satisfy this request the aesthetic industry provides many new materials, new devices and new techniques. One if the newest approach in skin laxity treatment and skin lifting represents by endodermal radiofrequency. Radiofrequency is well known treatment based on energy delivery to the skin surface in order to induce collagen production. It s a pretty efficient method. The limits of this method are the difficulty to control the temperature of dermal layer, where exactly we need the heat, and the risk of epidermal damage induced by high temperature. Endodermal radiofrequency overcomes this problem using the cannula which deliver the heat in subdermal layer. In this way we could heat dermis up to degree with very evident effect on collagen denaturation and skin retraction followed by long lasting stimulation of collagen production. Non surgical lifting with absorbable threads has settled down in our everyday practice. The author analyses the origins of thread lifting method with absorbable threads in copolymer of PLLA and caprolactone. This method was invented in order to help the patients with palsy to regain the symmetry of the face with consequent improvement of psychological and functional balance. Experience gained in reconstructive field was applied in aesthetic practice in order to fight against the skin ptosis, one of the first signs of aging to appear and the most difficult to treat. Clinical cases discussion. The author presents personal experience with this innovative device

42 THE EGO AND ITS SKIN. AESTHETIC MEDICINE, AFFECTIVE LIFE, AND PSYCHOSOMATIC DISORDERS. LAST TREND HAIR TREATMENTS AND REGENERATIVE HAIR TREATMENTS Prof. Maria Malucelli Professor of Clinical Psychology Specialist in Individual Cognitive Psychotherapy Couple and Evolutionary Age Psycotherapy Specialist in Psychogenic Eating Disorders Consultant of the Tavistock Institute of Human Relations London The skin is the instrument of adhesion to the world, of a two-way communication. The body is the most complete, intriguing and mysterious evolutionary experience. It is a proof of how much nature can love us. Dr. Mehmet Faruk Yavuz ACELL +PRP ilk defa Amerika da 2008 yılında kullanılmaya başlanmış bir saç uygulamasıdır.türkiye de ilk defa 2015 yılında benim tarafımdan kullanılmaya başlandı. Yaklaşık olarak 1800 e yakın hastaya uyguladığım ACELL +PRP saç sorunlarının tedavisinde kullanılmak üzere geliştirilen, hücreler arası bağlantıyı sağlayan ekstraselüler matriks, vitamin ve PRP kombinasyonundan oluşan özel bir formüldür. -Ekstraselüler matriks; kök hücrenin modelleme yöntemi ile yeniden doku üretimini tetikleyen bir materyaldir.ekstraselüler Matriks; Amerika nın en önemli onay merkezi, FDA tarafından plastik ve rekonstrüktif cerrahide güvenle kullanımı için, 510K özel sertifikası ile onaylanmıştır. Bu da etkin ve güvenlidir anlamına gelir. It is a sign that shows we are programmed to take care of it, to respect, to know, to nourish this gift otherwise we will go through pains, unwanted psychophysical sufferings often unconsciously created. The ego is our superiority over other species on earth. Our ability to attribute a meaning to things, the story we tell ourselves and others. Psychosomatic disorder is a physical disorder whose nature can only be evaluated when emotional disturbances (ie psychological factors) are examined simultaneously with physical disturbances (ie somatic factors). The physical alterations of psychosomatic diseases are currently sustained and recognized through the so-called stress adaptation syndrome. - Prp ; Trombositten zengin plazma - D vitamini ACELL +PRP kimlere uygulanır? Saç dökülmesi olanlara Saçında incelme ve zayıflama olanlara Saç Kıran olanlarda Saçını korumak ve önlem almak isteyenlere Saç Ekiminde destek tedavi olarak Psychosomatic disorders can be associated with the gastrointestinal tract, cardiovascular system, skin disorders, and all those organic disorders in which the emotional component plays a significant role. Therefore I prefer to emphasize and reflect on the psychosomatic disturbances of the gastrointestinal tract and skin disorders

43 THE DISTRIBUTION OF THE INK TATTOO WITH LASER Dr. Mercedes Campoy To create a tattoo, the dermo epidermal barrier must be penetrated. The tattoo technique eliminates the epidermal structure and leaves a hyperpigmented scar injury. Ink is not injected (the needles are solid), but deposited. It is impossible to estimate how much ink is deposited in a tattoo. Ink penetrates gradually. Tattoos stability lies in the extracellular matrix (ECM) Our lasers act as initiators of the process, but removal depends on the dermis biology and biochemistry. Pigments can only be removed through the lymphatic system and transepidermal elimination. We must consider people s health, advocate for healthier inks and stricter rules, and improve our methods. VAJİNAL RELAKSASYONDA CERRAHİ ÇÖZÜMLER VAJİNOLASTİ PERİNEOPLASTİ OP.DR. MURAT EMANETOĞLU KADIN HAST VE DOĞUM UZM. KOZMETİK JİNEKOLOG ESAG BİLİMSEL KOMİTE ÜYESİ Pelvis tabanı, kas yapı ve bağ-destek dokuları ile pelvis kemiğinin oluşturduğu çerçeveye tutunur. Batın boşluğunu alttan kapatır, pelvise lokalize organların alttan tutunduğu, destek olduğu bir yapı oluşturur. Pelvik tabanın disfonksiyonuna (PTD) ilişkin şikayetler, kadının sosyal yaşantısını, aile içi ilişkilerini, fiziksel aktivitelerini ve iş hayatını olumsuz etkiler. Vajinal Relaksasyon, PTD nun bir parçası-sonucu olarak oluşur de yapılam bir çalışmada PTD saptanan hastaların % 30,9 unda anksiyete, % 20,3 ünde depresyon riski olduğu tespit edilmiştir. Özellikle, idrar kaçırmaya, pelvik organ prolapsusu, cinsel disfonksiyon da eşlik ediyorsa, tedaviye başvuru oranlarının çok düşük olduğu belirtilmektedir. Kadınların utanma, mahcubiyet, tedaviler hakkında bilgi eksikliği, nereye başvuracağını bilememe, tedavinin yararlarına inanmama, cerrahi tedaviden korkma ve hekimin yardım edemeyeceğini düşünme gibi nedenler en uygun tedavi ve bakımı almalarının önünde engel oluşturabilmektedir. Vajinal Relaksasyonun non-invaziv tedavi seçenekleri yanında, bunlarla yeterli sonuçlar alınamayan hastalarda cerrahi tedavi kaçınılmazdır

44 YENI NESIL MOULDING COG ASKI LABİOPLASTİ - HOODOPLASTİ Dr. Nejat Can Op. Dr. Nurdan Leylek Organik Ip Estetigi uygulamalarinda guclu yenilik. Kadın Hastalıkları ve Doğum Uzm. Yeni Teknoloji Kalıp İçerisinde Preslenerek Üretilenyep yeni aski COG ipligi Moulding Cog. Kozmetik Jinekolog Yüksek Çekiş Gücü ve Yüksek Sabitleme Gücüne Sahiptir. Uzun Süren Etki Minimum 2 Yıl. Minimum Doku Hasarı ve Reaksiyonu. Moulding COG Üzerinde Etkili ve Sabitleyici 42 Adet Çift Yönlü Koni Bulunur. Moulding COG İpliklerinin, Klasik Kesim COG İpliklerine Göre 3 Kat Daha Fazla. Sabitleme ve Çekiş Gücü ne Sahip Olduğu Klinik Çalışmalarla Kanıtlanmıştır. Ayrica tum aski Cog uygulamalerindan farkli olarak Moulding Cog ust noktasindan deri altina fikslenebilmektedir. İnternetin yayılması ile birlikte bilgi paylaşımı, görsel paylaşım ve dünyanın her yeri ile olan anında iletişim arttı.bu bilgi paylaşımı sağlık sektöründe de hızla gelişti.görsel paylaşımlar, sağlık siteleri, doktor ve hastanelerin web siteleri sayesinde kadınların farkındalıkları arttı; kendi organlarını tanıyıp diğer insanlarla kıyaslamalar arttı ve bununla birlikte norm kazanan genital şekiller oluştu. Eskiden tıbbı amaçlı gereklilik halinde yaptığımız genital cerrahi estetik operasyonlar artık sıklıkla kozmetik ve cinsel amaçlı olmaya başladı. Labioplasti ve hoodoplasti operasyonlarında da klasik bazı teknikler olmakla beraber her insanın yaratılışı farklı olduğu için yapılan operasyonların da kişiye, bedene özgü olması gerekmektedir. Yüz estetiğinde nasıl farklı tedaviler uyguluyorsak genital estetik tedavilerinde de kişiye özel çözümler üretmeliyiz

45 LOCALIZED USE OF CHLORINE E6 DERIVATIVE IN PHOTODYNAMIC THERAPY FOR AGING SKIN: LONG-TERM RESULTS AND ANALYSIS Dr. Olga Panova, Dr. Elena Sanches (Moscow, Russia) Photodynamic therapy, in which light energy selectively destroys tissues using chemical reaction, remains one of the most advanced and promising methods in fighting aging processes. In the period of twenty months (from November 2014 through July 2016), the doctors of Dermatological Oncology and Laser Surgery Center of the Russian Academy of Sciences Central Clinical Hospital and the doctors and researchers of Eklan Medical Aesthetics Clinic (in Moscow and Nizhny Novgorod, Russia) conducted clinical and laboratory studies and developed a method using local application of photosensitizing REVIXAN-DERMA gel for photodynamic therapy in treatment of aging skin and acne. Results of the clinical studies and treatment have shown safety and efficacy of the method in treatment of face and hands. This therapy is non-invasive, has shown to have no to minimal side effects and minimal rehabilitation time, is well tolerated by patients and produces stable long-term effect. This therapy can be used as a mono-therapy and in combination with other methods by aesthetic practitioners in outpatient settings. Presentation will cover proposed treatment methodology and provide analysis of long-term treatment results. KOLLOJEN UYARICI DOLGU SISTEMLERI, UYGUMAMA ALANLARI VE PCL VE PLA DINAMIK IP ASKI YÖNTEMLERIYLE KOMBINASYON UYGULAMALARI. Dr. Osman BAŞ Kollojen uyaran dolgular, etki mekanizmaları, uygulama yöntem ve alanları, klasik hyaluronik asid dolgulardan farkları Uygun olgularda face lifting macıyla PCL ve PLA dinamik ip askı uygulamalarıyla kombinasyomları ve uyumu

46 NEW APPROACH IN THE TREATMENT OF MELASMA AND PIH THULİUM DR. ÖZGE AYDIN The 1927 nm fractionated non-ablative thulium laser targets epidermal pigment with greater efficacy than is seen with the 1550 nm laser alone, due to its higher absorption coefficient for water. By targeting water as its chromophore the laser induces a dence array of microscopic, columnar thermal zones of tissue injury, and subsequent melanin shuttling of underlying epidermal and dermal pigment coupled with remodeling of the pathologic dermis has been proposed as a possible mechanism. İn a study, a statisticaly significant %29 reduction in the MASI score was observed after three consecutive 1927 nm thulium fractional laser treatments. Considering that most melasma treatment modalities are related with slow clinical respons and long -term,repeated application. GENİTAL İP UYGULAMALARI OP.DR. ÖZGÜR LEYLEK KADIN HAST.VE DOĞUM UZM. KOZMETİK JİNEKOLOG ESAG ÜYESİ Uzak Doğu da uzun yıllardan beri özellikle yüzde askılama ve rejuvenasyon amacıyla kullanılan ipler, zamanla, aynı amaçlarla vücudun diğer bölümlerinde de kullanılmaya başlandı. Genital bölgede de hem cilt rejuvenasyonu hem de vajinal perineal sıkılaştırma amaçları ile kullanılmaktadır. Her ne kadar henüz yeterli sayıda karşılaştırılmalı çalışma sonuçları bulunmasa da, giderek artan deneyimler ve paylaşımlar, özellikle cerrahi istemeyen hastalarda ya da cerrahinin kontrendike olduğu durumlarda, cerrahiye alternatif olabilme bakımından giderek artan önem kazanmaya başlamıştır. The quick therapeutic onset of the 1927 nm fractional laser can be a strong avantage in the treatment of melasma. Of interest is the low rate of PIH. The relatively low rate of PIH development in fractional 1927 nm laser resurfacing can be due to the low penetration depht of the 1927 nm wavelenght laser. At this presentation, the efficacy and complications of 1927 nm laser melasma treatment were reviewed

47 CHOOSING PATIENT AND FACTORS EFFECTS SUCCESSFUL OPERATION IN HAIR TRANSPLANT Dr. Özlem Biçer A-Who is ideal patient for hair transplantation? B-What is the definition of the succsesful hair transplantation? C- What is the criterion of succsesful operation? D The success according to the doctor ECCHYMOSIS: THERAPY BY GLUCOSE SOLUTION 5% Paola Mannelli MD*, Vincenzo Varlaro MD** * Cosmetic Aesthetic Medicine International Group (CAMIG), Prato (Italy) ** University of Camerino (Italy) The bruises are an adverse event frequently in aesthetic medicine. They can speed up their resolution by glucose solution 5% injections. A clinical case will be presented. E-The success according to the patient F-Golden rules of successfull operation

48 BIOSTIMULATION OF EYELASH GROWTH BY TOPICAL APPLICATION OF BIMATOPROST. A CLINICAL TRIAL Rossella Petese MD*, Vincenzo Varlaro MD** COSMETIC PHLEBOLOGY SYNERGY OF TREATMENS FOR THE IMPERFECTIONS PHLEBOLOGICA THE TRIPLEX METHOD AND DRAINAGE DERMO \ HYPODERMIC (IN AREAS WITH PANICOLOPATIA) * Cosmetic Aesthetic Medical International Group (CAMIG), Roma (Italy) ** University of Camerino (Italy) Hypertrichosis of eyelashes, characterized by excessive eyelash growth, is a regular phenomenon associated with ophthalmic prostaglandin and prostamide analogs for the treatment of ocular hypertension. The prostamide bimatoprost (Lumigan) has been originally approved in the therapy of glaucoma. The FDA on december 2008, approved Latisse (bimatoprost 0.03% solution), identical to the ophthalmic solution for glaucoma treatment, for increasing eyelash length, thickness and darkness in patients with hypotrichosis of the eyelashes. When prostaglandin and prostamide analogs interact with the prostanoid receptors in the hair follicle, this most likely stimulates the resting follicles (telogen phase) to growing follicles (anagen phase). Prostaglandin and prostamide analogs may also prolong the anagen phase of eyelashes, leading to an increase of eyelash length. Bimatoprostinduced stimulation of melanogenesis appears to result in darker lashes and, at the same time, appears to increase the size of the dermal papilla and hair bulb. Dermally applied bimatoprost appears to be associated with a lower incidence of adverse effect than administration of the medication as an eye drop. This clinical trial has been performed, on seventeen healthy female subjects who applied daily bimatoprost 0.03% on the upper eyelid for six weeks. The results were evaluated with GEA scale. All subject had an improvement of at least one degree. Prof. Sotiris Davlouros University of Camerino Master of Aesthetic Medicine and Terapy \ Phlebology Specialist in Vascular Surgery, University of Pavia Specialist in General Surgery University of Pavia It is communicated to a 5-year experience with the personal approach Triplex on a series of patients, with an average of 3 \4sessions for leg: For a total of more than trattamenti. La TRIPLEX is a useful method to treat chronic venous insufficiency and ectasia of venous vessels in the lower limbs (telangiectasias and reticular veins). Objective of recovering such vessels from the physiological point of view with a Shrinkage of the lumen and then, with an aesthetic appearance of the optimization of the lower limbs. In areas with paniculopatia, treatment is divided into two phases in the same session PHASES A) Vacuum treatment: Drainage dermo\hypodermic, a lipomassage: to facilitate the progression of the injected substance, mobilizing adipocyte lobules and draining the interstitial fluid, releasing the capillares strangled. PHASE B) The TRIPLEX Method consists of three different steps: 1 «Shrinkage of microperforanti, perforating veins and suckler veins and capillaries 2 Ultrasound guided injection of foam of larger gauge piercing 3 Use of a vascular laser and \ or soft foam for the finittage of the capillaries Mandatory study morphofunctional with venous mapping pre and during treatment with ultrasound examination, visualization with Vein Viewer or transilluminator, the perforating veins and saphenous reentry if you need to treat for breaking First step: Shrinkage consists of a sweet sclerotherapy which narrows the lumen (shrinkage) without venous occlusion. Si realizes to the vein wall level, affecting the intimate with the average thickening you have the fibrotic collagen formation and thus, consolidation structure of the vein wall. It has a eufibrosi without obliteration. For shrinkage is used as

49 the sclerosing substance salicylate sodio 3% (at minimum concentration), Glycerol sodium 10% with the aim of only ridure venous caliber: in fact, is not evident with the evaluation instrumental diagnostics using eco-color-doppler and istologic examination, the closure of the treated vessel. İNSÜLIN DIRENCI VE KRONIK INFLAMASYON Dr. Süreyya Şahinoğlu With the shrinkage reduces the abnormal pressure of the perforating veins with recovery of continence, decreased vascular diameter, pressure balance between the superficial and deep venous system, disappearance of spider veins, decreased capacitance, improving hemodynamics and reduced medium mousse to be injected if necessary in the more piercing, the absence of discoloration, no matting. Second step: Injecting foam in to perforating veins, the thicker gauge where we have not had functional Shrinkage. Using foam prepared according to the method of the tourbillon Tessari while the incontinent perforating vein is detected by Doppler ultrasound Tip 2 şeker hastalığı tanısı konmadan yaklaşık yıl kadar önce, insülin direncinin saptanması hayatı ciddi etkileyebilir. Sadece şeker hastalığıyla değil başka birçok hastalıkla ilişkisi gösterilmiştir. Yağ dokusu kökenli sitokinler kronik inflamasyona neden olabilir. Kronik inflamatuar hastalıklar arasında insülin direnci, tip 2 diabet, atheroskleroz, romatoid artrit, kalp damar hastalıkları, yüksek kolesterol, Alzheimer ve böbrek yetmezliği sayılabilir. İnflamasyonla ilişkili insülin direncinin mekanizmaları tartışılmaktadır Third step: for the finittage of residues capillaries, using the vascular laser, or soft foam or sclerosing liquid. The laser is indicated for the matting, in patients (phototype -2) and for fear needle patients. The soft foam is a mixture of foam with large bubbles and liquid sclerosing solution. İnsülin direnci erken tanısı önemlidir. Bunun için önerilen çeşitli testler vardır. Moreover, shrinkage can be used for upper limbs of the limbs, which are not varicose but exclusively for Aesthetic

50 HYMENOPLASTİ BOTULINUM TOKSIN VE MEZOLIFTING Dr. Tamer Gültekin Dr. Tamer Küçük Kadın Hast ve Doğum Uzm. Barcode çizgileri yanaklardaki gülme çizgileri ve ince çizgilerde botulinum toksin kullanımı Kozmetik Jinekolog mezo botoks ve hya botoks ve mikro botoks uygulamaları Hymen, anatomik ve fizyolojik herhangi bir fonksiyonu net olarak tanımlanamamış olan ve embriyolojik bir artık olarak değerlendirilmesine rağmen, sosyolojik nedenlerden dolayı, özellikle belli toplumlarda varlık nedeninden daha fazla önem arz etmektedir. Cinsel ilişki sonrası oluşan sosyal nedenler dışında nadir olarak da travma sonrası hymen yırtıkları oluşabilir. Hymenoplasti, bu nedenlerden dolayı ihtiyaç duyulan, minimal invaziv cerrahi bir prosedürdür. Bu prosedür hastanın durumuna, isteklerine ve koşullara göre farklılar içerir. Günümüzde tanımlanmış olan yaklaşık 7 cerrahi teknik bulunmaktadır. Cerrahi tekniğin seçiminde, hekimin deneyimi ve hastanın durumu ön planda rol oynar

51 MANUAL FOLLICULAR UNIT EXTRACTION O.TAYFUN OGUZOGLU, MD Manuel FUE is a technique that in use for a long time period. Follicular unit extraction (FUE) was first described by Masumi Inaba in Japan in 1988 who introduced the use of a 1-mm needle-punches for extracting follicular units PDO THREADS A VALID ALTERNATIVE IN THE TREATMENT OF SKIN FLACITY. Dr. Viveka Tinoco-Kirby Flaccidity of the skin cause sagging tissue which is not a matter exclusively of the integument but also of muscle hypotonicity, bone resorption and tooth loss. FUE was successfully conducted on public patients by Dr Ray Woods in Australia, 1989,In 2002 it was first described in the medical paper by William R. Rassman and Robert M. Bernstein in their publication Follicular Unit Extraction: Minimally Invasive Surgery for Hair Transplantation I was start first FUE surgery in 2004,Our Main Objective of FUE is to remove FU from the skin without damaging, we have Priciples for Manual FUE, That are for simple and fast result 1- Choosing the right patient; If you are not have enough experience, 2-I strongly recommend to use the FOX test.what is FOX test; You can extract 10 grafts from the patient with FUE punch and see number of the intact graft. If the number of grafts are between 7-10 patient is suitable for FUE, if the numbers are between 5-7 you should reconsider and think again, if the numbers are below 5 then you should consider the FUT technique And if we want to obtain an overall result we must treat each of the causes, that is why no product replaces the other, all are tools in the art to delay the signs of aging. The treatment with PDO threads consists in the implantation of multiple small threads that are arranged in the form of vectors that are going to constitute a network, the same ones that stimulate the production of collagen around each thread. Although the application of threads as a method of support is not new, what it is, is the material that has the particularity of being absorbable avoiding future complications. They are applied in the superficial dermis and can be placed by combining them with anchor threads in the middle to deep dermis. A number of factors contribute to the achievement of satisfactory results and among them are the number of threads placed and the periodicity with which it is done. Important Tips of Manual FUE Many hair surgeons faced the same problems when they were start FUE. Because only 50 to 70 % of the transplanted grafts will be re-growth. The biggest reason is manual FUE grafts did not have enough peripherial tissues as FUT grafts and they are drying faster. Surgeons must choose best and most suitable punch size for increase survival rate of the FUE grafts, you can left them enough peripherial tissue without damaging of grafts. For example, In Western Europe and US people s hair are thin and small, for these situations you can use mm Punch,For Eastern Europe and Turkey mm Punch is suitable.for Middle east and sometimes 1.50 mm punches are suitable But mostly surgeon that use manual FUE with mm punches in the World

52 FIVE YEARS OF EXPERIENCE USING AUTOFIBROBLASTS IN SKIN REJUVENATION. ALT YÜZ KASLARINDA TOKSIN UYGULAMASI YOLUYLA YÜZ KONTÜRÜ DÜZELTILMESI VE BELIRGINLEŞTIRILMESI Tsepkolenko V.A., Tsepkolenko A.V. Dr. Yasemin Savaş Institute of Plastic Surgery «Virtus» Odessa, Ukraine Cell technologies application of autologous dermal fibroblasts, autologous platelet rich plasma, stem cells, extracted from fat tissue etc., revealed new horizons in skin regeneration. Application of autologous dermal fibroblasts now represents one of the most perspective methods of correcting involution-dystrophic changes. Platisma, maseter kasına yapılan toksin uygulama yöntemleriyle yüz ovalinin düzeltilmesi, çene ucu toksin uygulamaları ile çene ucu görüntüsünün netleştirilmesi, maskülenize yüzlerde maseter kası küçültülmesi yoluyla yüze oval ve feminen bir görüntü kazandırılması. Tedavi protokolleri, komplikasyonları, diğer medikal estetik tedavilerle kombinasyonları The Objective of this work is the evaluation of effectiveness of the developed algorithm aimed at intensification of skin regeneration processes by means of cell technologies. Materials and methods We examined and treated over 300 patients women at the age of y/o. The inspection protocol prior to the treatment, 3 months and 1 year after the treatment, included standardized photo, skin sonography, evaluation of cutaneous bloodflow, dermatoscopy, the Patient Satisfaction Scale. Depending on the degree of the patient s problem intensity, we performed intradermal administration of autologous fibroblasts from 30 to 60 mln in one session. The group with pronounced ageing changes was treated in 2 sessions with 1-month interval between administrations. Results By means of evidence based medicine (skin sonography, dermatoscopy, morphological studies) we demonstrated the efficiency of the suggested algorithm, resulted in the reconstruction of dermal structure and skin immunity function shown in the improved appearance

53 FIBROBLAST BIOSTIMOLATION BY NOT CROSS-LINKED HYALURONIC ACID (FRAGMENTS), AMINOACIDES, ANTIOXIDANTS Carla Mazzini MD*, Vincenzo Varlaro MD** * Cosmetic Aesthetic Medicine International Group (CAMIG), Torino (Italy) ** University of Camerino (Italy) CD44 is the major receptor for hyaluronic acid (HA) expressed on cells. It has a certain role in the intake of the HA in the cell through an endocytosis process. Endocytosis is not the only molecular model with which HA penetrates into the cell. In fact, others like macropinocytosis and others are still largely unaware. Studies on fibroblasts and human alveolar macrophages revealed a molecular model of endocytosis of hyaluronic acid. HA binds to the CD44 receptor (adhesion protein) forming the HA / CD44 complex. Thus, an endocytosis process of the HA / CD44 complex begins with the formation of a vesicle containing the HA / CD44 complex. In the cytosol, then, HA and CD44 are released. An effect of such a dialogue is the endocytosis of the AHA that is dependent CD44. Two cell cultures were compared: one of fibroblasts, one of the alveolar macrophages. The alveolar macrophages have a CD44 receptor kit larger than that of fibroblasts. The fibroblasts and the alveolar macrophages were incubated separately with HA labeled with a radioactive isotope. The degradation of the marked HP was evaluated by gel permeation chromatography (GPC): a physical separation technique used primarily for the analysis of polymeric high molecular weight materials. The gels used today for packing the columns work with the principle of the molecular sieve: the solute passing through the column undergoes a slowdown proportional to the particle size and the pore size. Since there is no type of chemical bond between solute and gel (or at least no binding that is strong enough to cause further separation), the order of the output peaks varies from molecules of higher molecular weight (which do not pass through Pores and therefore, they go out quickly) to those of lower molecular weight that cross the paths created by the porosity of the gel, they take longer to go through the column. The CD44 is hydrolyzed by proteases while hyaluronic acid is degraded by specific enzymes, endocellular hyaluronidases that, in physiological situations, are not secreted in the extracellular environment. It has been observed that alveolar macrophages (with a greater expression of cell membrane CD44 receptors) degrade HA marked faster than fibroblasts (with a lesser expression of cell membrane CD44 receptors). The structure of the CD44 receptor, with an Hyaluronan Binding Domain (HBD), a transmembrane domain and an intracellular domain remembers the structure of many molecular signal transducers. The cytoplasmic tail of the receptor, however, does not possess any intrinsic activity, either as phosphatase or as tyrosinchinase, so that transduction of the signal within the cytosol occurs in a similar manner to the signaling of the integrin, i.e., by mediation of associated signal proteins. The marked endocytosis of HSA was therefore faster in alveolar macrophages for the highest number of CD44 expressed in cell membrane level. In addition, the marked endocytosis process was inhibited by the use of anti-cd44 antibodies and this admitted that CD44 receptors play a pivotal role in the endocytosis of the AHA and its degradation. The endocellular response of the fibroblast is definitely conditioned by the size of the a molecule that binds the CD44 receptor. The CD44 receptor is a polymorphic protein composed of 177 amino acids. Different isoforms are the basis of complex and complex molecular models. The responses summoned within the cell by the link between HA and the CD44 receptor, in fact, are manifold. CD44 receptors are adhesion proteins that allow fibroblast to dial with various ligands such as HA, such as HA fragments

54 CLINICAL VALUE OF TELOMER MEASURMENT AND TELOMERE LENGHTENING STUDIES ON TA-65 Prof. Dr. Hakan CANGUL DNA DAMAGE AND DNA REPAIR MECHANISMS. REVERSE-AGING BY DNA REPAIR A NEW APPROACH TO WELL BEING, BEYOND ANTI-AGING. Head of Medipol University Genetic Sciences Istanbul Dr. Yaman Er Telomeres are the protective tips of the chromosomes and major counter of cellular aging. With each replication of the cell, telomeres get shorter. At the begining of life there is certain length of telomeres defined by genetic characters of the parents. But besides normal metabolic shortening, life style, nutrition, excercise, mindfullness can effect the speed of the telomere shortening causing premature aging. And telomere shortening is the root cause of cellular aging resulting tissue and organ deterioration. In the last 10 years there are more than scientific papers showing telomeres have relation with many major diseases. By measuring the leucocyte telomers length, we can define the biologic age of the individual which is one of the certain biomarker for age related diseases such as cancer, cardiac failures, alzheimer s, parkinson, diabetes etc. Telomere measurment concludes speed of aging, revealing the health risks for age managent medicine. Telomere lengtening can be achived by life style correction in the long term. But since 2000 s there is highly investigated, safe food supplement named TA-65 have been shown to lenghtening the telomeres by telomerase activation. This unique molecule can increase the telomere length by +533 ( ± 183 ) bp in comparison to placebo loss of telomeres by -288 ( ± 101) bp in 12 months according to a study conducted in Spain. In reference to recent studies, telomere biology became solid scientific topic and has a great potential to cure aging for prevention of age related disesases and increasing healthy and functional longevity. DNA is the main code which is essential for proper cell and organizm development. DNA is also the blueprint for accurate genomic data regulating metabolic and biological reactions which ensures optimal cell and organism biologic reactions. It has been shown, DNA damage starts from the first moment of life when the zygote is formed. DNA damage is external and internal. Ironically, metabolism itself, essential to living biological structures, produces DNA damaging free radicals from the first moments of the life. It has been calculated there are at least DNA damages per day in each cell in the human body. DNA damage occurs in nuclear and mitochondrial DNA. Cancer, degenerative, autoimmune, progressive inflamatory disorders, mutations and stem cell senescence, occurs when the critical DNA damage load is exceeded in both the nuclear and mitochondrial DNA. It is not possible to live a disease free life while transferring healthy genomic code without DNA repair. Daily DNA damage is the cuase of aging. Antioxidants when taken regularly, provide a defensive shield against free radicals. Even with this protective shield, DNA is still subject to damage. However, DNA repair enzymes form an efficient repair system which in turn, corrects genetic damage before they develop into genomic code mutations. Therefore, enhancing the DNA repairing capacity is more effcient in supporting the integrity of DNA and protecting correct genomic information in the cell. This also means a healthy living and transferring as less defected genomic code as possible to the next generation. Anti-aging is only possible if DNA repair occurs. Studies have shown certain compounds possess the capacity to enhance DNA repair. These compounds including; selenium and selenomethioninine, Carboxyalkyl esters (Active ingredient in AC-11(R)) and dimericine. Selenium and AC-11 may be administered orally, Dimericine and AC-11 can be used topically, only AC-11 can be administered both orally and topically. Correction of nucleotide sequence and mismatches as well as corrupted DNA requires coordination of more than 20 proteins, which together.enhancing DNA repair both systemically and topically is so important, because DNA is harmed due to the external and internal sources. Beyond anti-aging, Reverse aging is possible when the accumulated DNA damages are corrected

55 INTENSE PULSED LIGHT THERAPY FOR SOLAR LENTIGINES OF HANDS; CLEARANCE IN JUST ONE SESSION Sezin Fıçıcıoğlu, MD Trakya University Medical Faculty Dermatology Department, Edirne, Turkey Intense pulsed light (IPL) has been widely used for lentigines. Even if it seems to be less effective than the lasers, IPL has no downtime which makes it preferable. Besides selective photothermolysis IPL stimulate a rapid differentiation of keratinocytes, accompanied by an upward transfer of melanocytes and produces only photothermal effects which leads to decreased risk of postinflammatory hyperpigmentation. We want to present our patient who had solar lentigines on the backs of both hands and just one session of IPL resulted marked improvement. Parameters of the treatment was 16 J/cm² fluence with the peak wavelenght of 580nm. The temperature of the treatment window was 20 C and we thought that less cooling aided the photothermal effects of IPL and resulted such a prominent response without any complication. 108

56 21 st WORLD CONGRESS OF AESTHETIC MEDICINE 21. DÜNYA ESTETIK TIP KONGRESI October / Ekim 2017 Hilton Bosphorus İstanbul Convention Center ABSTRACT BOOK BİLDİRİ ÖZETİ KİTABI U N I O N internationale e d e m e d e c i n e s t h e t i q u e

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T.C. SÜLEYMAN DEMİREL ÜNİVERSİTESİ FEN BİLİMLERİ ENSTİTÜSÜ ISPARTA İLİ KİRAZ İHRACATININ ANALİZİ T.C. SÜLEYMAN DEMİREL ÜNİVERSİTESİ FEN BİLİMLERİ ENSTİTÜSÜ ISPARTA İLİ KİRAZ İHRACATININ ANALİZİ Danışman Doç. Dr. Tufan BAL YÜKSEK LİSANS TEZİ TARIM EKONOMİSİ ANABİLİM DALI ISPARTA - 2016 2016 [] TEZ

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