3rd International Conference,   September 15 – 18, 2010

LaserInnsbruck: Europe’s Answer to the Controversies Meeting!

The surreal Austrian location of Innsbruck was home to the third international meeting of the same name (originally LaserBarcelona) founded by Gabriel Buendia MD, Albert Nemeth MD, and Katherina Russe-Wilflingseder MD.  A world class faculty including dermatologists and plastic surgeons presented the very latest in tissue engineering and remodeling technologies. This forum provided an international environment of intellectual sharing, and was very well attended by physicians, researchers, and the laser industry.

Tissue Copying, Remodeling and Regeneration.

The work performed by R. Rox Anderson MD and colleagues at the Wellman Labs relating to tissue copying is nothing short of sensational. The concept is in some way related Anderson and Dieter Manstein’s work relating to fractional ablative laser surgery. “If one can ablate tiny cylinders of tissue from the skin, and have the donor sites heal up quickly and without scarring, then one should be able to harvest similar sized cylinders of tissue surgically, and utilize this tissue for regenerative and other purposes”. Anderson has now demonstrated this hypothesis in vivo, and it would seem that there is no limit to the applications. “Consider this”, he says, “one could remove 50% of the skin of the face, have the treated site heal up in five days without serious sequelae, and then use the micro harvested tissue to reconstitute large areas of entirely normal new skin, perhaps for patients with severe burns or other skin conditions.”

This presentation dovetailed with other novel presentations concerning the treatment of burn scars. These were all very timely, given the number of armed forces personnel who have survived frequently horrific injuries, only to be left with harrowing and limiting contractures. Elizabeth Russe MD discussed some of the new surgical techniques for improving such scarring. Christine Dierickx MD and Gottfried Wechselberger MD described fractionated laser techniques popularized by Jill Waibel MD and others, which appear to generate new collagen and elastin in tissue devoid of these elastic tissues, and which have made significant functional improvements in those treated.  Consider then what benefit Dr Anderson’s tissue regenerative techniques might have when adapted to deliver normal skin elements in a fractionated manner into scarred tissue. Early evidence indicates that structurally relevant components such as follicular and other adnexal tissues regenerate when distributed in this manner. Watch this space carefully, for the developments are likely to be astounding.

“Dora’s Q4 Technique”: Innovative and Newly Described Technique for Removing Tattoos

Just when you thought that tattoo removal was all ‘old news’, the LaserInnsbruck’s attendees were treated to a most intriguing presentation. Like the jam in a cream puff at an English tea house, Dora Kossida MD served up a delicious study, so simple in its design and yet so insightful, pertaining to the laser removal of tattoos. This rising European star of laser surgery, who studied with Rox Anderson for the past two years, has laid ajar a method to remove tattoos more quickly and more effectively than previously possible.

The concept is based on quadruple laser therapy (Q4) wherein the tattoo is treated four times (in this case with the Q-switched Alexandrite laser) with 20 minute intervals to allow the immediate skin frosting to dissipate. It takes at least this time for the in situ water vapor ‘bubbles’ to be reabsorbed, which otherwise would interfere with the transmission of the subsequent laser pulses. Many of us have treated such tattoos with double treatments, but the Q4 protocol is the first reported series first in pigs and then in humans to be described. Patients were noted to have much faster clearing of their tattoos in comparison to standard single Q-switched laser (Q1) pulsing. The Dora Q4 technique is sure to be a mainstay of future laser therapy for tattoo removals.

Further innovative treatments were described including Suzie Kilmer’s technique of combining Q1 laser therapy and fractionated ablative laser treatment. Originally unimpressive when used alone in the treatment of tattoos, fractionated ablative laser immediately following Q1 laser treatment results in considerable leakage of pigment through the epidermis and is said to hasten the disappearance of the tattoos.

Some of the faculty had the opportunity to visit Ötzi (pronounced ‘oetsi’) the Iceman after the confernce.  Ötzi is the well-preserved natural mummy of a man who lived about 5,300 years ago, who was found in September 1991 in the Schnalstal glacia near Hauslabjoch on the border between Austria and Italy, and who since the discovery remains preserved in essentially the same glacial environment as for the last five thousand years.  Plainly visible on his right lateral ankle were the black tattoos which were possibly part of an ancient therapeutic ritual for chronic arthritic problems. Were he alive today, he might be one of many presenting to their local laser specialist for laser tattoo removal. And these would be recognized as amateur tattoos likely to respond well to multiple laser treatments with one of the three available Q-switched lasers. And should he demand scarless removal with fewer treatments (because of a hasty escape across the Ötztal Alps), what might he now be offered?  Maybe Dora’s Q4 technique!

Personal Thoughts About Teaching, Learning, and Discovering

It is imperative that those of us who teach residents and students encourage exploration in every sense of the word.  The excitement of learning is infectious. But the natural curiosity of our students and residents is thwarted by traditional medical school and residency.  We hammer it out of them. The free exchange of ideas, of customs and traditions make for a richer life personally, academically. Those who risk the rigors of travel and exchange of ideas will find discovery. Profound deductions can be made from simple observations, and there is so much yet to be discovered, probably right in front of our eyes.

Innovation is inhibited when the free mind is obstructed by bureaucracy.   In the United States we are often obstructed by a constipated administration with formality and regulations. LaserInnsbruck 2010 allowed us to show up and have an honest, full and invigorating discussion without having to worry about transgressing some bureaucratic organization whose job it was to make our academic and professional lives complicated. The pendulum has swung too far, and it’s time for some common sense.

That so many innovative concepts were delivered at ‘LaserInnsbruck’ is a great compliment to this meeting and to its organizer Katherina Russe MD, the well known Austrian plastic surgeon, who with her family managed and organized all aspects of the meeting. The touchy feely atmosphere of the LaserInnsbruck meeting was unique among academic meetings, and Dr Russe is to be congratulated for bringing together so many from so far.  In some ways, when I think of this meeting, I am reminded of “The Little Engine that Could”,  for so much goodwill and so many novel therapeutic ideas were created in these few days with such little fanfare. And so, we say “bravo Katherina!”

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Dr. Christopher Zachary, chairman of the UCI Department of Dermatology, said, “I’m pretty sure that many of us will be using these products from the get go. The convenience and comfort afforded by Juvederm XC and Restylane-L will make this transition a no brainer ”

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Saturday, January 30, 2010 

It’s unusual in Italy for laser specialists to have such an open discussion about laser and aesthetic surgery.  Gathered in Catania at the Monastero dei Benedettini, an ancient Benedictine monastery, in a cozy circular room with high ornate ceilings, thick limestone walls, arched doorways, and 800 years of history, this Sicilian gathering of Italian laser surgeons spilled their guts and told all their laser secrets.  Wide ranging and very interactive, these often reticent specialists were sufficiently at ease to start sharing their techniques, unafraid to lose their control over their proprietary methods.  Dr Christopher Zachary led the discussion with a review of some new technologies after which the floor opened to a wide ranging discussion.  Well informed and well represented, these guys (and ladies) are developing their skills and technology in a competent and thoughtful manner. It’s not necessarily appreciated by the traditional Italian medical dermatologists though, who don’t appreciate that aesthetic and laser medicine is here to stay.

Many of these surgeons have ‘special techniques’ that they have personally assumed, and for which they expect a certain recognition of ownership.  My Italian colleagues tell me that the average Italian patient will not accept time off work with redness, swelling, and other side effects of laser surgery.  Dr Zachary retorted that, while he thought the concept of ‘no redness, no result’ was a bit outdated, that maximal results required some downtime.

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You really want longer eyelashes?  If you want to bat your eyelashes …. you need something to bat ….

http://inyourface.freedomblogging.com/2009/07/23/are-longer-eyelashes-really-worth-1400-a-year/8157/

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http://www.ocregister.com/articles/zachary-23103-laser-skin.html

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Cryolipolysis is now available at The Dermatology Center! 

Remarkable technique which works by heat extraction induces ‘apoptosis’ or programmed cell death giving rise to impressive reduction in fat, particularly in the love handles and abdominal regions.

Approved in in the US for skin cooling, the Zeltiq device is simple to apply, and allows the patient to spend the treatment reading, working or chatting on the phone.  The treatment takes about one hour per area, and is not associated with any downtime. Dr Zachary who was involved in the early research with this device considers it one of the few treatments that really work for localized fat reduction. This is for people who are of normal weight who just can’t lose that love handle or excessive fatty tire on their abdomens.

http://inyourface.freedomblogging.com/2009/12/17/lipo-rival-zeltiq-aims-to-freeze-away-fat/13699/

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http://inyourface.freedomblogging.com/2009/12/21/meryl-streeps-wish-for-new-nose/13749/

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Dr Zachary has been in the business of designing and developing lasers for 20 years. He has performed translational work on many systems including the erbium YAG, the fractionated systems, and the use of radiofrequency and cryolipolysis for body shaping.

Dr Zachary is also a major force in the aesthetic world, including the use of botulinum toxins, fillers, chemical peels, and other aesthetic methods. He is currently embarked on a 100 site nationwide educational program to bring information concerning new neuromodulators to specialists. He is also a lead investigator on the Artefill 5 year safety project.

For more information go to http://www.drzachary.net/services/cosmetic-aesthetic-services/improving-your-appearance/

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Predictable, painless, and non-invasive, localized fat reduction by cryolipolysis is now available at The Dermatology Center! 

Significant fat loss

Remarkable technique which works by heat extraction induces ‘apoptosis’ or programmed cell death giving rise to impressive reduction in fat, particularly in the love handles and abdominal regions. 

Approved in in the US for skin cooling, the Zeltiq device is simple to apply, and allows the patient to spend the treatment reading, working or chatting on the phone.  The treatment takes about one hour per area, and is not associated with any downtime. Dr Zachary who was involved in the early research with this device considers it one of the few treatments that really work for localized fat reduction. This is for people who are of normal weight who just can’t lose that love handle or excessive fatty tire on their abdomens. 

Watch the Zeltiq Technique video

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