To get the best esthetic nzsult in Dermatologic surgery, we need to use combined procedures. The resurfacing whirh a CO2 or/and Erbium yag laser is the best way to treat wrinkles and actinic damages of the face but will not be effective on Ptosis and dynamic folds. The Botox is a very effective procedure to treat glabellar and frontal folds. The liposuction of the neck is a good procedure to eliminate the skin ptosis of the inferior part of the face. Inliltmtion of hyaluronic acid or goretex implant can improve the esthetic aspect of the naso labial fold. In conclusion, it is better to choose and combine the right procedures for the right patient. [ Cl -6 1 Chemical
peeling
of type IV Caucasian
skin
Julian Sanchez Conejo-Mir. Ween &I Rocio Utri1rrsir.v Hospital, Facctlty of Medicine. Seville, Sp(Gt Background: Chemical peel has been used to improve the texture of the skin since Sir Harold Gilles, an otolaryngologist, began using phenol as an agent for eradication of increased elasticity of eyelid skin. Up to now, seveml chemical agents have been used, including retinoid acid, alpha hidmxy acids, vitamin-C, adapalene. 20% resorcinol. salicylic acid, trichloroacetic acid (TCA). B-naphthol and phenol (carbolic acid). Actually, we can classify the chemical peelings in three groups: a) Superfitial chemical peeling: ac. salicylic acid, alpha hidroxy acids, resorcinol. retinoid acid and TCA 20%. b) Medium chemical peeling: TCA 35%. c) Deep chemical peeling: Phenol. Indications of the different chemical agents are condicionated for the skin phototype and severity of aging. Caucasian skin phototype have notable differences about the response to the chemical peeling agents than 1-H skin phototypes. Material and Methods: We present our experience of chemical peeling in mediterranean patients affected of photoaging and post-acne scars. in the following groups: (a) Alpha hidroxy acids: 50 patients with photoaging. (b) 20% Resorcinol: IS patients with solar kemtosis (c) 35% TCA: 29 patients with acne scars of medium severity. Results: -a) Excellent results: 5% of cases; midle results: 60%: poor results: 35% of cases. b) Excellent results: 70%: midle results: 25%; Poor results: 5%. c) Excellent results: 15% of cases; midle results: 75%; poor results: 10% of cases. Hyperpigmentation was observed in the 15% of the patients included in the group (b) and in the 25% of the gmup (c). Conclusion: Chemical peeling are effective in mediterranean people, in particular TCA 35%. Main indications are photoaging skin damage and post-acne scars. Nevertheless, hyperpigmentation is the most frequent complications.
ICl -7
Fat implant
L. Rusciani, S. Petraglia. Department University
of Sacred
Heart,
Rome,
of Dermatolog~l
Catholic
Italy
The introduction of liposuction in clinical practice for the surgical treatment of;local adiposities has lead to consider the idea of using aut6logous fat obtained by liposuction as filling material for local loss of substance and defects. The major problem
connected with this technique is the possibility of survival of the implanted fat tissue in recipients sites. In fact the results of the studies conducted on this subjects are controversial. We discuss the technical modalities of esecution of this surgical procedure and its indications, showing also some of our results in the correction of the facial profile with the use of fat implant. ElCl -8 Liposuction Sanja Schuller-Petmvic. Graz.
University
Clinic
of Dermatology,
Austria
Liposuction is the aesthetic removal of undesirable localized collections of subcutaneous adipose tissue. In the last 10 years liposuction advanced to a very sophisticated and safe method. Since the 1970s when the technique was developed in Italy and France liposuction changed from a major operation. performed under geneml anesthesia in a hospital, to a safe and effective outpatient procedure. The older dry and wet techniques were associated with blood loss and hematomas, sometimes necessitating blood tmnsfusions. The most recent refinement of the procedure is the tumescent liposuction. The advantages are minimal bleeding, less postopemtive pain, possibility to use small sized canulas. and no risks from general anesthesia. The indications for liposuction are cosmetic body irregularities and deseases of the fat tissue like lipomas, benign lipomatosis. lipedema and other kinds of lipodystmphy. The physician performing liposuction should be well trained rmd should have knowledge of the pathophysiology of the skin and subcutaneous tissue. The potential complications of the procedure are mre but can include bleeding, infection, nerve damage, intmperitoneal or intmthomcic perforation and pulmonary emboli. Nail surgery I Cl-9 R. Baron. 42, Rae des Serbes
06400
Cannes,
France
Nail surgery facilitates diagnosis when a biopsy is indicated, alleviales pain, treats infection, COIT~CISdeformities, removes local tumors and insure the best cosmetic results. All the nail structures may be involved in isolation or not. Examples of the most common surgical disorders will be presented and their treatment demonstrated. Cl-10 C. Clara. de Lisboa,
A common
problem:
A. Picoto. Cents, Lisboa,
Ingrown
de Dermatologia
toenails Medico
Cinirgica
Portagal
Despite multiple existing therapeutic techniques, the treatment of ingrown toenails is still a challenge for the dermatologist. Laser treatments for nail pathology have been increasingly reported, but little is known about it’s efficacy, when compared with more traditional methods. We compare two groups of patients treated for ingrown toenails with carbon dioxide laser ablation/vaporisation or nail matrix phenolization. The surgical techniques are described. Post-operative pain, time required for complete wound healing and recurrence rates are evaluated among other pammeters.