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Multiprocedural Synchronous Facial Rejuvenation

Introducing the DUBLiN method

Dr. Patrick J. TreacyMedical DirectorAilesbury Clinics Ltd

SKIN CANCERSKIN CANCER

SALLOW SKINSALLOW SKIN COARSE

RHYTIDS

COARSE RHYTIDS

FINE RYTHIDS

THREAD VEINSTHREAD VEINS PIGMENTATION

PIGMENTATION

TitleTitlePHOTOAGEING

WRINKLESWRINKLES

ECTROPION ECTROPION ENTROPION

ENTROPION

FATPROTRUSION

EPIPHORA EPIPHORA SKIN LAXITY

SKIN LAXITY

TitleTitleCHRONOAGEING

Treating Facial Ageing

A great variety of stand alone facial rejuvenation treatments are presently available including Botox©,Dermaroller©, RioBlush©,Radiofrequency Devices Syneron Polaris©RF, Thermage© InfraRed Titan©, CO2 fractionalised resurfacing AFX© SmartXide© Fraxel Repair©,

WRINKLESWRINKLES

TEAR TROUGH TEAR TROUGH WRINKLES

WRINKLES

FATPROTRUSION

PIGMENTATION PIGMENTATION SKIN LAXITY

SKIN LAXITY

TitleTitleCOLLAGEN

FAT PROTRUSION

SALLOW SKINSALLOW SKIN THREAD VEINS

THREAD VEINS

COARSE RYTHIDS

FINERHYTIDS

PIGMENTATIONPIGMENTATION

TitleTitlePositive

CO2 FRSL

• Patient CM 2 passes under R eye with obvious reduction in rhytides and neocollogenesis

MarionetteLines

Eyebrow HeightEyebrow Height Youthful Look

Youthful Look

Nasolabial Lines

CheekAugmentation

Volume loss Volume loss

TitleTitleNegative

CO2 FRSL

New Collagen

Fibroblast Stimulatio

CO2 Laser

Although, many feel that ultrapulsed fractionalised

CO2 laser skin resurfacing is the best treatment option for photo aged facial skin, could we improve on this

modality.

The DUBLiN method uses different methods and technologies in order to activate fibroblasts and direct them towards neocollogenesis. It also uses low level pulsed lasers to reduce skin laxity, accelerate growth factors and cause tightening.

The DUBLiN method incorporates

D Dermaroller

U Ultrapulse Laser

B Blood Factors

Li Light – 633nm

N Neurotoxin

Induction of FIBROBLASTS

A fibroblast is a type of cell that synthesizes the extracellular matrix and collagen, the structural framework (stroma) for animal tissues, and plays a critical role in wound healing. Fibroblasts are the most common cells of connective

tissue in animals.

Comparative study over three months

• Over 3 months, 15 patients (Group 1) received FLSR at normal settings

• Results were compared to 29 patients (Group 2) received low energy FLRS + adjunctive treatments

• Both group received BTXA one week prior to other treatments

Group 2 received a 3-phase combination

multi-rejuvenation technique over 3 weeks.

• Phase I included Dysport® at dilution 3.5:1 in 3 areas

• Phase 2 introduced intense fibroblast

stimulation and modification through microneedling, PRP growth factor induction and near-red phototherapy.

• Phase 3 included low–level (CO2) Ultrapulse laser with settings (Energy) 100 mJ (Rate) 14w CPG 3/5/2 and adjunct near-red 633nm phototherapy.

Near Red Light 633Near Red Light 633

Dermaroller Dermaroller

TitleTitleFibroblast Generation

PHASE 2 multi-combination technique

PRP Growth Factor Signals

TitleTitleFibroblast Activation

PHASE 2a fibroblast activation

TitleTitleFibroblast

Stimulation

PHASE 2b fibroblast stimulation

DERMAROLLER

Keratinocyte GF Keratinocyte GF

Vascular Endothelial GFVascular Endothelial GF Fibroblast GF

Fibroblast GF

Transforming GF-BTransforming GF-B

Connective Tissue GF Connective Tissue GF

Platelet Derived GFPlatelet Derived GF

TitleTitleCOLLAGEN

BLOOD FACTORS

GROWTH FACTORS

The efficacy of certain growth factors in forming collagen and healing various injuries is the theoretical basis for the use of PRP in tissue repair. The platelets collected in PRP are activated by the addition of thrombin and calcium chloride. This induces the release of these factors from alpha granules

LiGHT 633nm

Migrating cells exert forces against the substrate to move forward. These forces are part of the contraction phase of migration in which the rear of the cell is detached from the substrate and the body of the cell is moved forward.

Post NTa Post NTa

TitleTitleCollagen

Synthesis

PHASE 2

Co2 Laser

ULTRALASE LASER

Laser specialists non-sequential fractionalised CO2 laser ablation is the most effective modality for repairing photo damaged skin

The benefits are more precise control of ablation depth, faster recovery time and reduced risk of post procedural problems

WSRS = Wrinkle Severity Rating Scale

5 Extreme Extremely deep and long folds, detrimental to facial appearance.

2-4mm Visible V-shaped fold when stretched

Unlikely to have satisfactory correction with injectable implant alone.

4 Severe Very long and deep folds; prominent facial feature.

Less than 2mm visible fold when stretched.

Significant improvement is expected from injectable implant.

3 Moderate Moderately deep folds.

Clear facial feature visible at normal appearance but not when stretched.

Excellent correction is expected from injectable implant.

2 Mild Shallow but visible fold with a slight indentation; minor facial feature.

Implant is expected to produce a slight improvement in appearance.

1 Absent No visible fold, continuous skin line.

GAIS = Global Aesthetic Improvement Scale

5 Very Much Improved Optimal cosmetic result for the implant in this patient.

4 Much Improved Marked improvement in appearance but not completely optimal for this patient. A touch-up would slightly improve the result.

3 Improved Obvious improvement in appearance from the initial condition, but a touch-up or re-treatment is indicated.

2 No Change The appearance is essentially the same as the original condition.

1 Worse The appearance is worse than the original condition.

DUBLIN Lift Periorbital Area

Dover Photoageing Scale

Wrinkle Severity Rating Scale

% Patient satisfaction

Wrinkle Severity Rating Scale

% Patient satisfaction

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