You are on page 1of 119

LES TRAITEMENTS «MÉDICAUX»

À VISÉE ESTHÉTIQUE
Dr Ghislaine BEILIN
Vice présidente FSMEA

Fédération Syndicale des Médecines Esthétiques et
Anti-Age

DIU de chirurgie de la main et du membre supérieur -Paris le 23 Avril 2016

Aesthetic medical treatments
Hyperpigmentation

IPL + Peeling

Restore volume

Hyaluronic acid
Radiesse

Wrinkle

Ostroarticular

Mesotherapy
HA + vitamines
HA + glycerol
HA + Mannitol
HA + Sorbitol
HA + Aminoacids
PRP

Radiofrequency

Hand Aging and Photoaging
• Changes in skin texture
• Skin atrophy
• Actinic keratosis
• Solar lentigines
• Skeletonization
• Prominent veins
• Joint deformation
• Artrosis

Sun Damage Mechanism

UVB
UVA

Oxidative Stress
Reactive Oxygen Species (ROS)
modify and damage nucleic acids,
proteins, and lipids
Epidermis
Dermis
Subcutaneous
Tissue

Photoaging damages
Skin cancer

Hand Aging and Damaging : Sun Damage
Man 60 years old. Golf player

Hand chronically exposed to sunlight

Hand protected

Physiological aging + photoaging

Physiological aging

Classification du vieillissement des mains

Hand grading scale – Carruthers MD & Coll

Dr. Ghislaine BEILIN – Paris France

HAND
PHOTOREJUVENATION

IPL
Dr Ghislaine BEILIN
Médecine Esthétique – Paris

DIU de chirurgie de la main et du membre supérieur -Paris le 23 Avril 2016 – Dr

Pigmented Lesions
• Short pulse (Nd: YAG Q-switched,
RD 1200):

Explosion of melanosomes

Damage to melanocytes thermomechanical
• Long pulse (MaxG):

Warm melanocytes by thermal
diffusion of melanosomes

Thermal damage to melanocytes

MaxG Specifications
The MaxG
• Wavelength: 500-670 nm and
870-1200 nm
• Pulse Width: 5-100 ms
• Spot Size: 10 x 15 mm
• Energy: Up to 80 J/cm2

IPL



Improve solar lentigines
Skin texture
Spots, redness
Stimulate de production of collagen

Solar lentigo Before Treatment

Solar lentigo 6 Days After Treatment

Solar Lentigo 14 Days After Treatment

14J/cm²

IPL 

Treatment of solar lentigines

Before

6 days after treatmet

14 days after treatmet

Solar Lentigo

Before treatment

31 days after treatment

Solar Lentigo
Before treatment

31 days after treatment

HAND REJUVENATION
WITH PEELING
Dr Ghislaine BEILIN
Médecine Esthétique – Paris

DIU de chirurgie de la main et du membre supérieur -Paris le 23 Avril 2016– Dr

The use of chemical peels
• Remove targeted cutaneous layers:
• Chemical peels penetrate deeper compared to regular exfoliants.
• Stimulate deep skin layers regeneration mechanism:
• It boosts collagen production;
• The skin looks healthier and younger. 
• Improve active ingredients penetration:
• Without peel agents, active ingredients do not penetrate the
skin.

You need to know in which skin layers observed anomalies are
located before using a peel: how deep do you want to go?

Superficial Peel



Improve solar lentigines
Skin texture
Spots, redness
Stimulate de production of collagen

Note: * hormonal pigmentation can only be treated with chemical peels (sensitive

Type of chemical peels
Type of chemical peels

What for?

Very superficial
peels

• Used for thinning the stratum corneum.

Superficial peels

• Performed to obtain keratinocyte
desquamation (not deeper than epidermis).

Medium peels

• Selected to renew the epidermis and
stimulate part of the papillary dermis.

HAND FORBIDDEN
Deep peels

• Intend to renew the epidermis and papillary
dermis.

Skin stimulation depend on peel depth

Type of chemical peel agents

Example of
chemical peel
agent
Very superficial
peels

AHA
BHA

TCA Phenol Besides chemical peel agent, 

impact on the skin depends also
on:

• Concentration used;
• Number of coats applied;

Superficial peels
Medium peels

HAND FORBIDDEN
Deep peels

• Duration of contact with the
skin;
• Patient skin type and
conditions;
• Skin preparation and
aftercare.

Doctors should choose the adequate peel agent to obtain desired results
Many other parameters impacting peel agent penetration should be taken
into account by doctors

Potential side effects depending on skin types

Type of
chemical
peels

ST 1

ST 2

ST 3

ST 4

ST 5

ST 6

Very
superficial
peels

Desquamation (patient doesn’t expect this type of reaction)

Superficial
peels

Desquamation (patient doesn’t expect this type of reaction)
Potential pigmentary reaction in rare cases (if the concentration is too
high)

Medium
peels

TCA peels: potential pigmentary reaction in
case of frosting

HAND FORBIDDEN

Deep peels

Persistent redness
Hypochromia for older patients
Scaring

Side effects are prevented if the products are used correctly and the skin well
prepared

Skin Tech

Complication Peel TCA 15%

Hyperpigmentation problems
❑ Across the diversity of skin colours across the globe, there
are many disorders of the pigmentary system.
❑ Hyperpigmentation problems including post inflammatory
hyperpigmentation,solar lentigos and melsama occur widely
in the population.
❑ There is a clear consumer desire of uniformity of skin colour
and a need for effective pigmentation control agents

Epidermis Melanocytes
❑ The melanocytes are cells situated
in the basal layer of the epidermis.
❑ The melanocytes synthesise
melanin, the pigment which
protects against UV radiation.
❑ Melanin is transported to the
keratinocytes by specialised
organelles, the melanosomes.
❑ It is the quantity and quality of
these melanin particles around the
keratinocytes which determine our
skin colour.

Illustration of
melanocytes

Genomoic and proteomics of pigmentation
production
The pigmentary process is highly complex with approximately 1500 gene
proteins involved in all the developmental processes of the
melanonsomes, melanocytes and keratinocytes

Superficial Peel

Before

After

Innovation Concept peel

Before and after Innovation Concept Peel to ageing spots on the hands

Hand Peeling - Combination treatment protocols
Peeling protocols are the perfect enhancement combination
treatment for…

• Depigmentation laser
• Rejuvenation laser
• Radiofrequency
• Wrinkle filler
• Mesotherapy treatments

Combination treatment protocols: Peel + Hyalauronic
acid
Femme, 61 ans

Combination treatment protocols: Peel + Restylane Vital


Before

After

Conclusions
- The use of Peeling on hand limits deep pigmentation
maximum medium peel for security.
- Perfect enhancement combination treatment for…

• Depigmentation laser
• Rejuvenation laser
• Radiofrequency
• Wrinkle filler
• Mesotherapy treatments

HAND REJUVENATION
WITH
HYALURONIC ACID
INJECTION

Dr Ghislaine BEILIN
Médecine Esthétique – Paris

DIU de chirurgie de la main et du membre supérieur -Paris le 23 Avril 2016– Dr

HA : Products
Hyaluronic acid:
ALLERGAN:
TEOXANE:
FILORGA:
SINCLAIR:
MERZ:
Q-MED:
ALLERGAN:
GALDERMA:
VIVACY:
GALDERMA:
CROMA:

Surgiderm®, Juvederm®,
Teosyal Meso®, Teosyal Global action ®, Teosyal Deep
Lines®, Teoxane Redensity®
Art Filler®
Perfecta®
Belotero Balance®, Intense®, Volume®
Restylane® Lidocaine, Restylane Perlane® Lidocaine
Juvederm Utra®, Surgiderm®
Emervel classique, Deep, Volume, Touch
Stylage® S, M, L, Hydro
Emervel classique, Deep, Volume, Touch
Princess Filler®,Princess Volume®, Princesse Rich ®

Products
Others :


Calcium Hydroxyapatite:
Polylactique Acid:
Collagen :



Caprolactone :
PRP
Lipofilling

FUTURE:

Radiesse.
Sculptra, New fill
Bovine-> Zyderm, Zyplast
Porcine-> Evolene
Ellansé

Stems cells

Chronological evolution (II) : stabilized AH
© Dr. Stefanie Williams, Dermatologist

Week 0

Week 4

Week 8

Week 12

Clinically proven results





1. Kerscher M et al: Rejuvenating
Improves skin elasticity 1,2,3
influence of a stabilized
hyaluronic acid-based gel of
Reduces skin roughness 1.3
nonanimal origin on facial skin
aging. Dermatol Surg 2008;
34:1-7
Improves elasticity and smoothness of
2. Distante F et al: Stabilized
the skin 2
Hyaluronic of Non-animal Origin
for Rejuevnating the Skin of the
Improves skin hydration 2.3
Upper Arm, Dermatol. Surg
2009; 35:389-394
Reduces transepidermal water loss 3 3. Williams S et al: Changes in skin
physiology and clinical
Strong effects on the clinical
appearance after microdroplet
appearance and biophysical
placement of hyaluronic acid in
parameters of HA compared with
aging hands, Journal of
Cosmetic Dermatology, 2009; 8:
non-stabilized 3
216-225

Injection techniques

Nappage
Mesotherapy

Multipuncture

Bolus technic

The anterotracing technique : fingers
HA + Lidocaine

Canula if fibrosis

Mesotherapy
Woman 62 years

Before
DR BEILIN

After 4 sessions

Mesotherapy
Woman 60 years

Before

DR BEILIN

After 2 treatment HA

Restylane Vital

Before

After

DR BEILIN

Before

Immediatly after

Hyaluronic Acid
Woman 60 years

Before

DR BEILIN

Immediatly after

Before

Immediatly after

Video injection - Hyaluronic Acid - Canula

Dr. Ghislaine BEILIN – Paris France

Video injection - Hyaluronic Acid - Canula

Dr. Ghislaine BEILIN – Paris France

Video injection : Acide Hyaluronique

RADIESSE

BEFORE

IMMEDIATELY AFTER

AFTER 1 WEEK

Video injection : Radiesse – Bolus
technique

Complication: wrong techniques

Complication: necrosis
Wrong product + Wrong
technique

Complication: necrosis
Wrong product

HANDS REJUVENATION
WITH

RADIOFREQUENCY
Dr Ghislaine BEILIN
Médecine Esthétique – Paris

DIU de chirurgie de la main et du membre supérieur -Paris le 24 Avril 2016 – Dr

RF in Medicine & Aesthetics



Radio Frequency (RF) has been used in medicine for
over 30 years, for minimally invasive surgery
RF means to apply High Frequency

electrical current to the skin via electrodes
RF current heats skin tissue due to the

skin’s electrical resistance
In the past few years various aesthetic
applications were developed

Skin Tightening & Rejuvenation
Fat Reduction & Body Sculpting

Two RF technologies existed until

recently



1st generation - Mono-Polar

(requires Return Pad)
2nd generation - Bi-Polar
3rd generation – Tri-polar and Multi-polar
4th generation – Fractional RF

Collagen remodeling
Before TriPollar Treatment

After TriPollar Treatment

Courtesy of Dr. S. Boisnic
Pitie Salpetriere hospital in Paris

3D Skin Mapping
Before TriPollar treatment
Skin is rough and wrinkled

After TriPollar treatment
Skin is smooth and no-wrinkles

Long Term Results
Hand Skin Tightening after 4 treatments
Before

After

Pollogen in house collection – Tel Aviv, Israel

Long Term Results
Hand Skin Tightening after 4 treatments
Before

Pollogen in house collection – Tel Aviv, Israel

After

Long Term Results
Top of the Hands Skin Tightening
Picture taken 10 days after 5th treatment
Significant tightening and improvement in skin texture
Before

After

Courtesy of Sharon Friedman - Afula, Israel

Mid Term Results
Before

Female, 82 yrs.
Hand Skin Tightening after 2
treatments
Reduction of osteoarthritis pain.

Courtesy of Ms. Sharon Friedman - Afula, Israel

After

Radiofrequency for deforming digital
osteoarthrits

The INTENSITY of heating tissues depends on their resistance, varies according
to the tissue. More resistance, the higher the heating is strong with the RF.
Cartilage has a high resistance to electric current, using this contraindication
on neck treatment; we select it as a target on hands and fingers. The
treatment is safe controlled repeated, and after 10 sessions result in reduction
of digital osteoarthritis deformation and tightening of skin hand as dorsal
veins.

Radiofrequency for deforming
digital osteoarthrits

Decreasing ORDER of the resistance of tissues
Cartilage
>

RESISTANCE
RESISTIVIDAD

>

HEATING

TRIPOLLAR

Before

Hand not Treated

Treated hand
After 10 sessions

Woman 53 years old.
Right-handed
Dr Beilin

TRIPOLLAR
Finger
Treated

Finger not
Treated

Finger not
Finger
Treated
Treated

Dr. Ghislaine Beilin

TRIPOLLAR
Finger not
Treated

Finger
Treated

Finger not
Treated

Finger
Treated

Dr. Ghislaine Beilin

Long Term Results
Female, 65 yrs.
Hand Skin Tightening after 5 treatments
Reduction of osteoarthritis deformity
Before

After

Pollogen in house collection – Tel Aviv, Israel

Hand Rejuvenation
with
Fractional
Radiofrequency
Dr Ghislaine BEILIN
Médecine Esthétique – Paris

DIU de chirurgie de la main et du membre supérieur -Paris le 23 Avril 2016– Dr

Maximus TriLipo MED
Treats 4 layers of tissue

VESSELS

Dr. Ghislaine BEILIN

What is TriFractional RF?

Micro-resurfacing that stimulates skin rejuvenation.
Fractional energy delivers microscopic RF energy that creates tiny
wounds which trigger the body’s natural healing response
mechanism.
• Untreated zones function as healing centers of treatment area.
• TriFractional uses 3 pulses of RF energy that DEEPLY penetrate the
skin for effective results with minimal discomfort.
Epidermal layer
3 Pulse
is smoother after
treatment
Fractional RF
Dermal layer is
Technology
thicker after
treatment

1st Pulse
Epidermal
ablation

2nd Pulse
Intermediate
Heating

3rd Pulse
Deep
heating

Dr. Ghislaine BEILIN

2 Types of TriFractional Tips
Standard 7 x 7 Tip

7 x 7 Tip
Less dense coverage
Deeper penetration to mid
dermis
More gentle treatment with
slightly less downtime

Optional 10 x 10 Tip

10 x 10 Tip
More dense coverage
Epidermal effect with
penetration to upper dermis
More moderate treatment with
slightly more downtime

• A box of (10) 7x7 Tips is part of the TriFractional Kit.
• 10x10 Tips are optional, an accessory that can be purchased
separately.
Dr. Ghislaine BEILIN

Dr. Ghislaine BEILIN

Histological Evidence
Histopathology of abdominal porcine skin following TriFractional
treatment at high parameters.
Epidermal and upper dermal thermal
effect is observed

Elongation of nuclei in all levels of
epidermis
Condensation of upper dermal collagen
fibers (the shrinkage effect)

(H&E stain, magnification x200 )

Dr. Ghislaine BEILIN

Histological Evidence

Histopathology of abdominal porcine skin following TriFractional
treatment at high parameters.

0.5mm
0.5mm

Epidermis: Areas of thermal damage with elongated epidermal nuclei at both
sides (area under electrodes). In between at ~0.5mm width, effect is moderate.

At bottom of skip area elongated nuclei are seen due to penetrated heat
dispersion effect

Condensation of upper dermis

Depth of injury ~ 0.5mm

(H&E stain, mag.x100 – left, x200 - right)

Minute crust present on the surface
Dr. Ghislaine BEILIN

Immediate Skin Reaction

After TriFractional treatment

Dr. Ghislaine BEILIN

TriLipo MED - Dramatically Visible Results
Wrinkles reduction – PRIMOS 3D analysis

Before

After 2 treatments

Same patient as previous slide
Dr. Ghislaine BEILIN

TriLipo MED - Dramatically Visible Results
29% reduction in volume of large wrinkles

After

Before

Wrinkle depth reduction at marked area
Dr. Ghislaine BEILIN

Trilipo 3RF treatment protocol : 

1 3RF + 1 Maximus
Age:

54

55

56

Before

2010

Photos courtesy of Dr. BEILIN

2011
HA injection
Radiofrequency Tripollar

2012
HA injection
Radiofrequency Tripollar
Fractional Radiofrequency
Dr. Ghislaine BEILIN

Trilipo 3RF treatment protocol : 

1 3RF + 1 Maximus
Age:

54

2010

Photos courtesy of Dr. BEILIN

55

56

2011
2012
HA injection
HA injection
Radiofrequency
Tripollar
Radiofrequency Tripollar
Dr. Ghislaine
BEILIN
Fractional Radiofrequency

Hand rejuvenation

Hyaluronic Acid Injection 

and Fractional Radiofrequency
Global treatment of aging of soft tissu
Combining :
• Hydrobalance of the skin
• Volumetry treatment,
• Dermal skin tightening
• Vessel tightening

Dr. Ghislaine BEILIN

Conclusion
Hyaluronic Injection

Fractional RF
Epidermal

HA
Injection

Dermal
Skin tightening
Vessels
tightening

Hybrid Energy
Technology

TM

Dermis
Hypodermis
Muscle

Hybrid Energy

Epidermis

TriFractional

Hybrid Energy and TriFractional skin effect

Hybrid Energy™ Technology
• Hybrid Energy (HE) is composed of a unique
combination of two types of energy, Hot &
Electrical Invisible Micro Ablation (IMA).
• The Biphasic energy application provides a dual effect,


both on the outside (Epidermis) & inside (Dermis) of
the skin with major impact on the dermis. Dermal
volumizing & Natural filler effect.
HE technology affects skin areas in a fractional
manner, leaving healthy unaffected tissue (“skip”
areas) which function as healing centers.
Hybrid Energy tip has a special design of micro Pins
penetrating the skin in a unique manner.

Hybrid Energy™ Technology (Cont.)
1. First Action: Hot IMA* 

Facilitates smooth and painless
penetration of micro pins via the
sophisticated mechanism accompanied
by gentle vibration to target the
dermis.
*Invisible Micro Ablation

Hybrid Energy™ Technology (Cont.)
2. Second Action: Electrical
IMA*

Selectively ablates the target area using
safe non-thermal energy, enhancing
the effect, creating micro-wounds in
the dermis, triggering the natural
wound-healing process.
*Invisible Micro Ablation

Ex-vivo Histology

Ex-vivo UV aged human skin histology samples in survival medium
(H&E stain, magnification: x200 Left, x100 Right)

Left- immediately after treatment with HE. Micro ablation effect is visible into
upper dermal layer.
Right- After 2 days in survival medium. Healing process including collagen
regeneration and epithelialization is demonstrated
Courtesy of Dr. Boisnic, France

Hybrid Energy™

Advantages Summary

• Hybrid Energy optimizes natural refill of dermal volume.
• Hybrid effect creates the optimal conditions for:
− Collagen regeneration
− Auto production of Hyaluronic acid
− Elastin growth





Clinically proven long-lasting results.
Downtime – minimal to none .
Pain – minimal to none.
Bleeding – minimal to none.
Optimally tailored treatment for each patient`s individual needs.

• Result: skin rejuvenation achieved in a simple procedure
minimizing pain and downtime.

Hybrid Energy™

Non traité

2 traitements

• Stimulation collagénique
• Rétraction cutané
• Veine moins visible

PRP 

FOR

HAND REJUVENATION

Dr Ghislaine BEILIN
Médecine Esthétique – Paris

DIU de chirurgie de la main et du membre supérieur -Paris le 27 mars 2014 – Dr

What is PRP ?
• PRP = Platelet Rich Plasma
• Produced from patient’s own blood (autologous) by
separation of its components through centrifugation
process
• The aim is to recover in a plasmatic phase functional
platelets and leukocytes, which will release growth
factors in their biological determined ratio to stimulate
tissue regeneration
• PRP contains also electrolytes, vitamins, antiantioxydative enzymes, adhesion, haemostatic and
signalization proteins

What is PRP ?
Before centrifugation

Post centrifugation

Biostimulation by PRP

Platelets aggregation
Fibrin polymerisation
Release of growth
factors

Chemoattraction

Stem cells stimulation

New matrix synthesis

- Leucocytes

-Proliferation

Regeneration of the

- Stem Cells

-Differentiation

- Macrophages

new tissue

Process of cell stimulation by platelets during tissue repair

Growth factors: effects and regulation
• Mechanism of action: paracrine, autocrine, juxtacrine
• Effects: agonist, antagonist and synergistic for:



Chemoattraction
Proliferation
Differentiation
synthesis of the ECM

• Regulation:
• Synthesis level of the different growth factors
• Expression of membranes binding receptor
• Binding with plasmatic receptor (agonist, storage, antagonist)

So we could talk about PRP not only as a
biostimulator but also as a regulator

THE MAIN GROWTH FACTORS

IN AESTHETICS AND SURGERY

Platelet-Derived Growth Factor (PDGF)
• Origin: platelets, macrophages, endothelial cells,
fibroblasts…
• Interest of PDGF:
– chemoattraction and proliferation of fibroblasts and
cells of mesenchymal origin
– Stimulation of fibroblast production of the ECM
components

• Regulation: synthesis induced by IL1, IL6, TNFα, TGF-β and EGF.

Epidermal Growth Factor (EGF)
• Origin: platelets and various organs cells
• Interest of EGF :
– controls, chemoattracts and stimulates the proliferation
of epidermal and epithelial cells, including fibroblasts.
– Co-stimulates angiogenesis (mitogenic for endothelial
cells).
– Influences the synthesis and turn-over of proteins of
the ECM: fibronectin, collagens, laminin, and GAGs.

Insuline-like Growth Factor (IGF)
• Interest of IGFs:
– mitogenic in vitro for a number of mesodermal cell
types
• Adipocytes
• Fibroblasts




Metabolism of chondrocytes,
epithelial cells,
muscle cells
stimulate osteoblast activity and the production of
collagen
– Inhibits lipoprotein lipase in adipose tissue (lipolysis)

Transforming Growth Factor (TGF)
• Origin : platelets, macrophages and
keratinocytes
• Interest of TGF:
– TGF-α, biological activities like those of EGF since
both factors bind to the same receptor
– TGF-β
• stimulates the synthesis of the major ECM proteins (collagen,
proteoglycans, GAGs, fibronectin, integrins)
• the most potent known growth inhibitor for epithelial cells,
endothelial cells, fibroblasts, neuronal cells and keratinocytes

Vascular Endothelial Growth Factor (VEGF)
• Origin : macrophages
• Interest of VEGF:
– highly specific mitogen for vascular endothelial cells
– Synergism with bFGF

VEGF is mandatory for angiogenesis
and so cell and tissue survival

Fibroblast Growth Factor (FGF)
• Origin: macrophages, fibroblasts, endothelial cells
• KGF = FGF7
• Interest of FGF:
– bFGF stimulates the growth of fibroblasts, myoblasts,
osteoblasts, neuronal cells, endothelial cells, keratinocytes,
chondrocytes
– Stimulate angiogenesis in early phase of acute healing
– The mitogenic action of bFGF for endothelial cells can be
potentiated by thrombin

Skin regeneration

Cho JM and al., Effect of platelet-rich plasma on ultraviolet b-induced skin wrinkles in nude mice. J Plast Reconstr Aesthet Surg. 2011 Feb;
64(2):e31-9.

Tissue transplantation
• Fat, skin, hairs
• Stimulation of angiogenesis to enhance survival
of grafted cells by diminution of ischemia and
necrosis
• Stimulation of cells expansion, especially stem
cells
- Kakudo N and al., Proliferation-promoting effect of platelet-rich plasma on human adipose-derived stem cells and human dermal fibroblasts. Plast Reconstr Surg. 2008 Nov;122(5):1352-60.
- Kakudo N and al., Platelet-rich plasma promotes epithelialization and angiogenesis in a splitthickness skin graft donor site. Med Mol
Morphol. 2011 Dec;44(4):233-6.
- Pires Fraga MF & al., Increased survival of free fat grafts with platelet-rich plasma in rabbits. J Plast Reconstr Aesthet Surg. 2010
Nakamura S and al., Platelet-rich plasma (PRP) promotes survival of fat-grafts in rats. Ann Plast Surg. 2010 Jul;65(1):101-6.
- Schade VL, Roukis TS. Use of platelet-rich plasma with split-thickness skin grafts in the high-risk patient. Foot Ankle Spec. 2008 Jun;
1(3):155-9.

AND THE COSMETIC?

HAND COSMETIC:

Sunscreen

Whitening cream

Anti aging cream

DIU de chirurgie de la main et du membre supérieur -Paris le 27 mars 2014 – Dr

Anti-aging cream :
Dermatoporosis

Anti-aging cream :
Dermatoporosis
Hyaluronique fragment
(1%)
Retinaldehyde (0,01%)
Emolliente base (27%)
Avène thermal spring
water (5%)

Whitening cream
CEBELLA* –
Dépigmentant
Renforcé*
MELASCREEN* Ducray*

Cebella

GLOBAL CONSESUS
•Photorejuvenation : Pigmented Lesions

IPL
•Rejuvenate: moisturizing Peeling

Hyaluronic acid
Mesotherapy
PRP
•Refill: Volume →

Hyaluronic acid
Calcium hydroxyapatite

DIU de chirurgie de la main et du membre supérieur -Paris le 27 mars 2014 – Dr

Recommendations
Hyperpigmentation
• Avoid skin ablation
• Risk of scars

IPL

Restore volume
• Risk of infection
Wrinkle
Intradermic

•Hyaluronic acid
•Radiesse
•Aseptia !
Mesotherapy
HA + vitamines
HA + glycerol
HA + Mannitol
HA + Sorbitol
HA + Aminoacids
PRP

Recommendations

Pigment lesions

IPL

FILLERS
– Asepsy and antisepsis
– Characteristics of product:
• Viscoelasticity appropriate for hands
• Avoid ‘volumators” products.
– Volume of injection
– Injection technique
– Anesthesia

Use in combination with other procedures

Complications
• Specificity of anatomy of hand
– No Subcutaneous Tissue
– Distal area
– Functionality of hand

Inflammation Allergy

All fillers are associated with the risk of both early
• Early side effects : Swelling, redness and bruising : occur
after intradermal or subdermal injections.
• Adverse events that last longer than 2 weeks can be
attributable to technical shortcomings (e.g., too
superficial an implantation of a long-lasting filler
substance).
• Late adverse events also include immunologic
phenomena such as late-onset allergy and nonallergic
foreign body granuloma.

Inflammation Allergy

• Allergies and inflammatory reaction
• Mesotherapy
– Use of only « CE » products
– Danger of « home cocktails »
– Pharmacokinetic change if more than 3
products mixed

CONCLUSION
❑ Safety for hand
❑ Risk of fonctionality of the hand
• No subcutaneous, no hypodermis
• No cebaceous glands and few hairs folicules

Healing process

❑ Avoid :
deep peels - skin ablation - volumatric product
❑ Use safe technique

THANK YOU
FOR
YOUR ATTENTION
Dr Ghislaine BEILIN
Président ESAAM

European Society of Preventive and Anti-Aging
Medecine

Vice présidente FSMEA

Fédération Syndicale
des Médecines Esthétiques et Anti-Age
gis.beilin@orange.fr
www.drbeilin.fr

DIU de chirurgie de la main et du membre supérieur -Paris le 24 Avril 2016– Dr