Live from FACE 2014 | Plastic Surgery Practice August 2014

Lewis_WendyBy Wendy Lewis

London was the place to be in late June for the international FACE 2014, the Facial Aesthetic Conference & Exhibition, where experts from across the globe discussed, debated, and demonstrated the latest advances in hair restoration, injectables, and energy-based rejuvenation technologies.

FACE 2014 offered registrants seven parallel agendas, more than 30 workshops spanning 3 full days, plus 75 exhibitors. “This year, the main agenda featured injectables, equipment, skin care, business, hair, and threads, and a separate track designated for aestheticians. The theaters were full of eager and interested delegates, and practical demonstrations of new techniques were highlighted live on stage,” said FACE LTD Chairman David Hicks.

HAIR TODAY

The hair restoration sessions debuted this year, and the rooms were bursting at the seams. The special 1-day symposia was devoted to exploring the many different nonsurgical and surgical treatment options available for the treatment of androgenetic alopecia. The day was chaired by hair restoration surgeon Bessam Farjo, MD, of London’s Farjo Hair Institute.

UK dermatologist Vishal Madan, MD, covered the medical treatments for both males and females, including Minoxidil and Finasteride, Dutasteride, and Ketoconazole. Madan added that Latanoprost and Bimatroprost are being investigated for their hair growth potential.

Nilofer Farjo, MD, also of London’s Farjo Hair Institute, discussed the growing body of evidence to support the use of low-level laser therapy and the variety of devices available. Dawn Forshaw, co-owner and managing director of Finishing Touches in the UK, explored the increasingly popular scalp micropigmentation technique.

London plastic surgeon Greg Williams, FRCS, shared his insights on the evolution of hair restoration surgery since the beginning of the 20th century. Dr Bessam Farjo lectured on hair transplant surgery and how to achieve optimum results in different patients. Edward Ball, MD, of Ziering Medical in London discussed the modern age of robotic hair transplant surgery with the ARTAS® System from Restoration Robotics. Kuwait dermatologist Manal Sheta shared her experience with synthetic hair implantation from the Biofibre Hair Implant System, which is especially useful in patients who are not good candidates for hair transplantation, she said.

FACE TIME

FACE featured a two-part Merz Aesthetics Symposium presenting varied opinions on the aging process as well as approaches and treatments that have the greatest effect on the visual signs of aging. Martina Kerscher, MD, a professor of dermatology in Hamburg, Germany, joined New York City plastic surgeon Michael Kane, MD, to present 20 years worth of data on Botulinum toxin, which concluded that optimized outcomes are possible when using the toxin as part of a unique solution for each patient’s specific needs.

North Carolina dermatologist Timothy Flynn, MD, offered an ultrastructural analysis using scanning electron microscopy that compared the qualities of Restylane®, Juvéderm®, and Belotero®. His research found that all Hyaluronic Acid (HA) fillers contain oxygen, carbon, and sodium, but with uneven distributions. Irregular particulate matter was present in Restylane, but Belotero and Juvéderm were largely particle-free. Spacing was more uniform in Belotero than Juvéderm, and Juvéderm was more uniform than Restylane.

Nicholas J. Lowe, MD, a London dermatologist, gave a comprehensive talk on finessing fillers. “Volume replacement and more recent filler ‘facelifting’ techniques combining different categories of dermal filler address facial lines, subcutaneous atrophy, and sagging that are signs of frequent facial aging,” he said. “A vast array of soft-tissue fillers available outside the US ranges from non-biodegradable, permanent to biodegradable, more transient fillers. These fillers have variable risk of adverse events, which partly results from the skill level of the injector, but also the intrinsic properties of the filler.”

Lowe characterized fillers according to their source. Autogeneic: fat, autologous plasma, autologous collagen, platelets; Allogeneic: human cadaver tissue, human fibroblast cell culture; Xenogeneic: collagen-derived, usually from bovine or porcine sources, HA-based products derived from animal or animal sources, or results of bacterial fermentation; Synthetic products: Silicone, Polymethyl Methacrylate (PMMA), Hydroxyapatite; and Combined Xenogeneic: HA plus Synthetic PMMA.

There was much discussion on the proliferation of HA fillers in Europe, including a presentation from British Association of Aesthetic Plastic Surgeons President and London plastic surgeon Rajiv Grover, MD, FRCS, on how HA fillers can slow down facial aging. In addition, Dusseldorf, Germany-based dermatologist Said Hilton gave a workshop on Galderma’s Emervel® range of HA dermal fillers.

Beverly Hills facial plastic surgeon Raj Kanodia, MD, shared his personal techniques for nonsurgical nasal contouring. “Fillers are another very important tool in correcting minor indentations and asymmetries as well as augmenting the dorsum of the nose,” he says.

LASER LIGHT SHOW

Syneron Candela introduced the new facial contouring application for the VelaShape® III system, and its new VelaFACE treatment, designed for lower facial contouring harnessing the high power radiofrequency near infrared (NIR) and vacuum of the new VelaShape® III. There was also a lot of excitement around the application of Sublative technology for stretch marks.

Maria Gonzalez, MD, a dermatologist from Cardiff, London, led a workshop called, “When To Say No,” on how to determine which patients are not appropriate for laser skin rejuvenation. Medications, tanning habits, lifestyle, and skin reactivity all play an important role in selecting the right wavelength for the right patient, she added. Underlying medical conditions may also affect treatment efficacy and patient outcomes. She cautioned attendees to familiarize themselves with the depth of penetration by wavelength and to maintain a healthy respect for the absorption spectrum of the energy they are using to stay out of trouble.

Q-Medical Technologies Ltd introduced the UK to the new PelleFirm (Ellman International), a noninvasive, comfortable radiofrequency treatment for the body, resulting in firmer skin and temporary improvement in the appearance of cellulite. PelleFirm is powered by the Pellevé® S5 RF Generator, which also powers the Pellevé Wrinkle Reduction handpieces for facial skin tightening. London cosmetic doctor Jashed Masani demonstrated his technique removing moles without leaving scars using the Ellman system.

There were numerous interesting discussions and debates over lasers and light-based systems. For example, Denver dermatologist Steven Eubanks, MD, discussed his experience with the Regenlite® laser (Chromogenex) to treat acne and rosacea using bio-stimulation to deliver long-lasting remission.

Israeli-based Tavger Ltd introduced a new technology called Affinity, used for drug delivery into human skin via the pores to treat melasma, eczema, hyperpigmentation, and aging skin. Because the procedure leaves the epidermis untouched and intact, it is safe for all skin types and colors.

SKIN CARE SOLUTIONS

An all-day European Symposium for ZO® Skin Health featuring Zein Obagi, MD, and his international faculty highlighted the best products and techniques for how to generate long-lasting results and enhanced patient satisfaction.

Dublin dermatologist Raechel Eckel, MD, discussed the most effective therapies for rosacea. “As a result of its multifarious nature (especially between ethnicities) and characteristic relapses and remissions, the diagnosis of rosacea is complex,” she said. “Currently, clinicians are only identifying the advanced, more obvious forms of rosacea. In practice, however, milder states prevail, and their markers are soft—especially early on.”

Physicians were encouraged to improve their rosacea diagnostic capabilities by actively searching for discrete clues that precede the advanced states. “In this way,” she continued, “treatment will be proactive rather than reactive. With novel insight into disease pathogenesis, therapeutic choices should remain holistic to optimally achieve skin health, while also incorporating these advancements.”

Skin care advancements for treating rosacea included the use of topical Mirvaso® (Galderma) to reduce redness as well as the use of neurotoxins. “The latter is a particularly interesting development because rosacea is a disease of neuropeptide gene dysregulation. By targeting the neurogenic component with superficial injection of toxin, an improvement in vascular dysfunction, inflammation, and hypersebacious activity can be granted,” Eckel said.

Additionally, FACE featured a comprehensive workshop on the Epionce® range hosted by Indiana dermatologist and creator Carl Thornfeldt, MD.

Minneapolis dermatologist Elizabeth Briden, MD, headed up a multidisciplinary team of experts on methods to combat facial aging, maintaining glycation and hyperpigmentation, and the newest formulations from the NeoStrata® and Exuviance® ranges.

Colorescience® made its UK debut with its signature Sunforgettable® products, primers, and good-for-your-skin makeup range. Another new skin care line, de_Cure from Sweden, features an innovative range that boasts a high concentration of active ingredients and antioxidants.

Dermatologist Mukta Sachdev, MD, of Bangalore, India, presented on the treatment of scars in Asian skin using microneedling, lasers, radiofrequency, and other approaches. “Acne scars are a problem in all skin types, but postinflammatory hyperpigmentation is a common complication in skin of color.”

On the laser front, Sachdev presented her experience with fractional radiofrequency. “This is a newer nonablative treatment for rejuvenation that is rapidly gaining popularity in darker skin types as there appears to be a reduced risk of complications,” she said. “In addition, combination technologies are now proving to be a safer option, especially in darker skin types.”

Of note, Tranexamic Acid was discussed as an oral agent in the form of tablets and syrup to block the breakdown of blood clots. It has also been shown to decrease tyrosinase activity, and therefore may be useful in treating melasma and pigmentation in some patients, Sachdev said.

BY A THREAD

The concept of the use of different types of threads and barbed sutures for facial and body areas has been in development since the late 1990s. Since their introduction, many types of suspension devices and fine suture devices have been actively promoted to the aesthetic community with some hits and some misses along the way. A special FACE workshop explored the latest data evaluating the efficacy and long-term safety of techniques for facial rejuvenation, as well as the technical issues surrounding optimal placement of threads and sutures. Attendees were mixed about whether or not threads have a place in modern aesthetic surgery.

FACE OF THE FUTURE

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Myoscience unveiled a new tip for its Iovera® Focused Cold Therapy at FACE 2014.

Myoscience® introduced an update to its Iovera® Focused Cold Therapy, touted as “The World’s First Toxin-Free Dynamic Wrinkle Treatment.” The new 1 x 55 mm Round Smart Tip is a blunt tip cannula designed for atraumatic intradermal injections of fluids. The advantages over the original device are minimal discomfort and bruising, a higher safety profile, less risk of side effects, and more predictable outcomes for a wider range of patients. According to Geneva plastic surgeon, Kai-Uwe Schlaudraff, MD, the treatment time has also been reduced by 50% with the new single insertion technique.

There was some discussion about the use of Aqualyx®, a CE-marked adipocytolitic solution from the deoxycholate family. By creating a slow-release, sugar-based system, the biological half-life is reduced, which results in fewer side effects, according to the manufacturer. It is intended for injection into localized fat deposits in areas such as thighs, abdomen, hips, submental areas, and knees, to liquefy and permanently destroy fat cells.

All in all, FACE 2014 did not disappoint. Mark your calenders for FACE 2015. faceconference.com. See you there.

Wendy Lewis is president of Wendy Lewis & Co Ltd, Global Aesthetics Consultancy, www.wendylewisco.com, founder/editor in chief of beautyinthebag.com, and a contributing editor to Plastic Surgery Practice. She can be reached at wl@wlbeauty.com.

Original citation for this article: Lewis W. London calling. Plastic Surgery Practice. 2014;(8),22-24.