Day 2 :
Academy of Family Physicians of Malaysia, Malaysia
Chandran Rajagopal has completed his Graduation from the Madras Medical College, University of Madras in 1972. After his Graduation from MMC, he served in the Malaysian Health Service in the fields of Psychiatry and General Surgery. He continued his training in Dermatological Surgery in US with the American Academy of Aesthetic and Restorative Surgery in New Orleans, Louisiana under Professor George Farber and became a Fellow of the Academy and later as an International Fellow of the American Academy of Dermatologists.
Introduction: The art and science of chemical peelings represent accelerated exfoliation or skin damage induced by caustic agents that cause controlled damage, followed by the release of cytokines and proinflammatory mediators, resulting in thickening of the epidermis, deposition of collagen, reorganization of structural elements and increases in dermal volume. This process decreases solar elastosis caused by sun damage and results in reorientation of the skin with formation new dermal connective tissue, thus providing an improved clinical appearance of the skin, with fewer fine lines and decreased pigmentary dyschromia. Aim: To provide the science and art of chemical peeling from the breath of my 30 year of experience in using this treatment modality. Methods: Discussion of the science and theory behind chemical peels. In addition, the practical and systematic view of the indication, contraindications, clinical evaluation, techniques and pitfalls in skin peeling. Results: Chemical peels are divided into 3 categories depending on the depth of the wound created by the peel. Superficial peels penetrate the epidermis only, medium-depth peels damage the entire epidermis and papillary dermis and deep peels create a wound to the level of the mid reticular dermis. Cover the use of superficial and medium peels in detail to enable its use in day to day aesthetic practice. Conclusion: The use of chemical peels is limited by the lack of understanding of the basic science of this treatment modality which has shown itself to be an effective and safe treatment in well trained hands. Chemical peeling is a simple yet effective way to rejuvenate the skin. It is here to stay and evolve to various customized peels in years to come.
Aesthetic Academy Asia, Malaysia
Ramamurthy Subramaniam has been practicing aesthetic medicine since year 2000. He has been conducting training program for doctors since 2010 when he was appointed as a Lecturer and later as the Head of Department of a Medical University in Malaysia. He currently chairs Aesthetic Academy Asia. He was awarded the Letter of Credentialing & Privileging (Aesthetic Medicine) on an honorary basis by the Malaysian Ministry of Health in 2013. The esteemed Socrates Almanac Society, Oxford also awarded him for his contributions for the intellectual progress of modern society. He is a Trainer and key opinion Leader for Algeness Dermal Filler, Decoria Dermal Filler, Xeomin Neurotoxin and N-Finders PDO thread lift. He has published papers related to pain management in aesthetic medicine, botulinium toxin, dermal fillers and lasers.
Facial fillers are becoming increasingly popular aesthetic procedures to temporarily reduce facial lines and folds, augment facial features or volumize facial compartments. However, even in the hands of very experienced injectors, there is always the possibility of dangerous complications like vascular injury, vascular occlusion by surrounding filler substance and intravascular injection of filler substance, which may lead to necrosis, blindness or even death. A prudent practitioner should be aware of the steps to minimize the risk of vascular complications, be able to identify the features of such complications promptly and to take the necessary steps to address those complications. It is useful if practitioners can group the steps to minimize the risk as patient factors, product factors and procedure factors. It is also prudent for the injecting physician to understand not only the facial anatomy but also the anatomy of an aging face as well. A detailed cosmetic or surgical history or history of trauma to the injecting site, as well as knowledge of the different concentrations, viscosity, G-prime and indication of the chosen filler is equally important. Though there are so-called claimed danger zones which are more dangerous than other areas, it is safer to adapt a “There is no safe zone” approach. Early detection and interference in the progression of a comprised vessel cannot be underestimated. Several journals claim that early intervention may reverse the complication and prevent necrosis or even blindness. Treatment modality differs for necrosis resulting from obstruction by surrounding fillers and necrosis due to intravascular cannulation. Thus the treatment options and drugs should base on the causative factor. Having an emergency “Filler Rescue Kit” is as important as having the contact details of a plastic surgeon, ophthalmologist and neurologist for referral.