Chapters authored
Helium Plasma-Driven Radiofrequency in Body Contouring By Diane Irvine Duncan
Consumer demand for a minimally invasive alternative to dermolipectomy-based excisional procedures has been driven by interest in risk reduction, reduced scarring in the treatment region, and significant lessening of recovery time. While minimally invasive liposuction is a common approach, limitations can include residual skin laxity and irregular skin contour. The current literature suggests that radio frequency energy is superior in achieving non-excisional soft tissue and skin shrinkage without surgical skin resection. Monopolar and bipolar radiofrequency-based devices have been available for 10 years. Recently, a plasma-driven radiofrequency device, Renuvion, was introduced and FDA cleared for soft tissue coagulation. The device uses a pressurized helium tank to drive radiofrequency energy into a hollow cannula. As measured skin temperature rarely exceeds 38?C, the safety profile of the device is optimized. The use of helium-driven plasma energy is a new and promising resource for achieving non-excisional soft tissue and skin tightening. Because the device rapidly heats subcutaneous collagen, strong immediate contraction is generated within fractions of a second. This treatment is followed by very visible improvement at the 24 hour post-op mark. Results can continue to improve over a year, as infiltration of new collagen within the adipose stroma occurs.
Part of the book: The Art of Body Contouring
Combining Helium Plasma-Driven Radiofrequency with Nanofat for Contouring By Diane Irvine Duncan
Many energy sources have been utilized to optimize tissue behavior following traditional liposuction. Peer-reviewed data to date show that radiofrequency has been shown to cause more skin and soft tissue contraction than other energy sources. While external RF can improve skin quality and create new collagen formation, tissue contouring has not been successful with topical energy application. However, the use of subdermal RF has been utilized to generate directional shaping and contouring in addition to skin tightening. An understanding of the way soft tissue contracts over time as collagen fibers develop is based on both the science of soft tissue energy response and experience in treating large numbers of patients. The Apyx Renuvion device is 510(k) cleared for soft tissue coagulation. In most cases of facial and body contouring, the ability to add volume in specific regions is as important as the skill to remove it. Since some liposuction is commonly performed as a part of the Renuvion contouring process, frequently this lipoaspirate is used to augment focal depressions or areas of soft tissue atrophy. The recent development of mechanical processing of macrofat into smaller particles, as well as nanofat, has widened the scope of the use of adipose-derived tissue.
Part of the book: Cosmetic Surgery
Combining PDO Threads with Exosomes for Microlifting By Diane Irvine Duncan
A recent survey of practicing plastic surgeons showed that regenerative medicine is the current top interest of esthetic consumers worldwide. Patients are frequently requesting correction of small regions, instead of opting for an all-encompassing procedure associated with prolonged recovery time. Thus, the field of “microlifting” has emerged. This is a new approach in which minimally invasive procedures can be utilized to accomplish outcomes formerly reserved for traditional surgery. The combination of polydioxanone (PDO) threads and topical exosomes is a method of treating both underlying soft tissue laxity and the surface of aging skin. The application of exosomes can deliver topical growth factors and targeted peptides to assist in rapid skin surface healing. More than a simple delivery vesicle, exosomes communicate with cells at the recipient site and can induce cellular change. PDO threads can be used subcutaneously as both a suspension device and regenerative biostimulatory device. Usually resorbed at 6 months post-insertion, these threads leave behind a linear network of collagen and elastin fibers that remains long after the polydioxanone is gone. Combination therapies can target several concerns when performed simultaneously. This regenerative method is well accepted by patients due to minimal cost and recovery time.
Part of the book: Cosmetic Surgery
Non-invasive Alternatives for Liposuction By Diane Irvine Duncan, Suneel Chilukuri, David Kent, Klaus Hoffmann and Lim Tingsong
Body dissatisfaction due to an increased amount of subcutaneous fat, muscle laxity and/or skin imperfection poses a great concern for today’s society. Invasive surgical procedures intended for an immediate improvement of body contour such as liposuction were perceived as a means of restoring the optimum body shape. However, the invasive nature of liposuction plus a certain amount of discomfort and downtime leads to increasing popularity in the noninvasive esthetic procedures. This chapter aims to emphasize the use of latest noninvasive technologies as a viable alternative to the liposuction. Three patient cases with different levels of treatment outcomes were reviewed. Patients received treatments either with high-intensity focused electromagnetic field (HIFEM) procedure or a combination of HIFEM and synchronized radiofrequency (RF), optionally followed by the simultaneous therapy by targeted pressure energy (TPE) plus monopolar RF. HIFEM alone resolves muscle laxity, reduces the separation of abdominal muscles and reduces abdominal adipose tissue. When combined with synchronized RF, the effect on muscle and fat tissue is enhanced. Concomitant use of monopolar RF and TPE shows considerable improvements in skin quality, including diminished skin laxity or cellulite. The use of HIFEM, RF and TPE technologies can be a good noninvasive liposuction alternative.
Part of the book: Enhanced Liposuction
Perspective Chapter: Development of Exosomes for Esthetic Use By Byong Seung Cho and Diane Irvine Duncan
While there are thousands of peer-reviewed papers on exosomes, most of the work has been done in the medical field. Studies and clinical trials on exosome-related products for the esthetic industry have just begun to be a regular occurrence. One of the reasons for this is a lack of regulatory approval for any exosome use. The FDA does not regulate topical cosmetic use, while only a few exosomes are registered on the International Cosmetic Ingredient Dictionary (ICID) of the Personal Care Product Council (PCPC), so most esthetic providers are utilizing exosomes in this manner. Clinical uses for exosomes in esthetic practice include the treatment of burns, active acne, atopic dermatitis, and chronic skin irritations. When used in combination with energy-based device treatment, exosomes reduce inflammation and redness, improve the rapidity of healing for laser and microneedling patients, and reduce the tendency for fibrosis and thick hypertrophic scar formation when used topically. Byong Cho is the CEO & CTO of ExoCoBio, one of the four largest exosome companies globally. He has developed a large research, development, and GMP manufacturing facility just south of Seoul, Korea. His topic, the development of exosomes for clinical esthetic use, will take us through the process of developing a safe and cost-effective biological regenerative product while staying in line with regulatory limitations.
Part of the book: Exosomes
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