Non Surgical Liposculpture The Extracellular matrix factordiamondnaturalbeauty.com/wp-content/uploads/2017/06/Lipo... · 2017-06-26 · • Obesity and Cellulite –Biggest challenge

Non Surgical Liposculpture

The Extracellular matrix factor

Melbourne December 2006

Dr Kee Lee TAN

REJUVENATE

COSMETIC + PLASTIC SURGERY

Unit 8/ 386 South Street, O’Connor, Western Australia

180 Stirling Highway, Claremont, Western Australia

Tel + 618 9337 8420, Fax + 618 9337 8820

email: [email protected]

www.rejuvenatecosmetics.com.au

mailto:[email protected]

Disclosure

• I have no financial interest in Diamond

International and I do not receive any

kickbacks from their sales

• I am not paid to do this presentation

• I paid for my own airfare

Background

• Obesity and Cellulite– Biggest challenge in Medicine

– 22% adult obese rate in USA in 2002 (US Department of Health and Human Services, Centre for disease control and prevention

– The Surgeon General stated in 2000, the obesity cost in USA had reach USD 117 billion a year

• Many treatments– Medical (xenical, reductil,duromine etc)

– Surgical (liposuction, gastric banding)

– Non Surgical (radiofrequency, ultrasound, electrical, pressure, mesotherapy)

– Holistic / Alternative (meditation, acupuncture etc)

Extracellular Matrix

• Current research shows that ECM plays a vital role

• Role of ECM has been neglected previously

• Lately more and more research into role and function of ECM in all aspects of medicine– Drugs interaction

– Immune system

– Cancer research

– Growth factors and various growth factors

• In Cosmetic medicine, doctors have not focus on ECM

• Beautician and Aestheticians has been treating the lymphatics for a long time– Lymphatic drainage

Science of Extracellular Matrix

Prof Sandra G. Velleman

The Ohio State University Department of Animal Sciences

• The extracellular matrix contains a network of macromolecules secreted by the cell.

• The extracellular matrix has been classically described as a structural scaffold containing

– a proteinaceous fiber component (collagen) and

– an "amorphous ground substance" (proteoglycan).

• It is now known that the extracellular matrix is

– a dynamic structure

– which regulates cell behavior through

• the interaction of extracellular matrix molecules with each other,

• interaction with growth factors, and

• through cell-extracellular matrix signal transduction pathways

• The extracellular matrix regulates adhesion, communication, gene expression and other interactions between the cell and its environment

Elements of ECM in animals can be subdivided

into 3 parts

(1) Extracellular matrix proper

– constituted by a complicated scaffold of long linear proteins and polysaccharides.

• Eg of proteins: collagen, fibronectin, laminin, tenascin, perlecan, aggrecan.

– Polysaccharides (known as glycosaminoglycans) are typically long multiples of disaccharide units.

• The most prominent is the huge molecule (millions of daltons) of hyaluronic acid.

– Other polysaccharides (e.g. chondroitin sulfate, dermatan sulfate, keratan sulfate) occur as parts of glycoproteins.

– The meshwork contains also hundreds of enzymes engaged in its modifications: proteinases, glycosylases, sulphatases, etc.


Elements of ECM in animals can be

subdivided into 3 parts

(2) Glycoproteins anchored in the cell membrane form interconnections

between cells and the matrix, and mediate information (signalling)

between the matrix and cell interior, and vice versa.

– Transmembrane receptors

– Such as Syndecans, glypicans, integrins.

(3) Cell-to-cell contacts

– Cell adhesion molecules(proteins) such as connexins, adhesins,

cadherins, lectins etc

Glycoproteins-connecting cells interior to Extracellular matrix

Syndecans-Cell membrane glycoproteins

Intergrins-Cell membrane glycoproteins


• The substance of the Matrix is a network of highly polymer sugar complexes.

• Sugar bonded to proteins called PROTEOGLYCANS

• As well as free sugars called GLYCOSAMINOGYCANS.

• Embedded in this network of sugars are GLYCOPROTEINS called

– Collagen (19 subtypes) and

– Elastin

– Crosslinked GLYCOPROTEINS called Fibrinectin and Lamunin

• Plus an entire network of connective tissue cells

– Fibroblast Fibrocytes Monocytes Macrophages Lymphocytes Granulocytes

• And in fact all the Autonomic nerves end here as well and there is a Direct Connection between

– the Brain the Nerves and the Hormone glands in the matrix


• The EXTRACELLULAR MATRIX

– is in effect a FILTER SYSTEM which sits between Blood

Vessels, Nerves and cells

– it is the fluid surrounding them and the FILTER of all products

going in or out of the cells

• With congestion

– the “eco-system” of ECM is contaminated with TOXINS which

are blocking the filter system of the MATRIX

– leads to congestion and stagnation.

• The MATRIX therefore is where CELLULITE develops from the build

up of congestion around the cells

• Which is believe to leads to the first stage of Cellulite. When toxins

are trapped in the stagnant matrix.


• Imbalances in lymphatic function or ECM can result in fluid accumulation, edema and/or fibrosis (MA Swartz / Advanced Drug Delivery Reviews 50(2001)3-20)

• A study by Guler et al, published at Jpn J Surg (1999) 29:735-740showed that lymphatic blockage resulted in accumulation of endotoxin in portal circulations

• This lead to extensive hepatocellular necrosis

• This study showed that accummulation of toxins have a negative effects on the surrounding tissues

• Rui-Cheng MD Lymphatic Research and Biology Vol 4. Num 2. 2006showed that the lymphatic system is essential for maintenance of normal fluid balance and draining extracellular fluid from tissue to blood circulation

– To provide an environment for immune cells to response to foreign antigens

ECM as an “Eco-system”

• When there is stagnation and blockage of the flow of lymphatics systems, the ECM becomes “clogged”

• “Eco-system” of ECM becomes unhealthy

• Healthy eco-system of ECM plays a vital role in cells hemostasis and growth

• Need to unblocked the ECM to ensure normal environment or “eco-system” for ECM

• Stagnation in the ECM and blockage of lymphatics causes edema and accumulation of toxins.

– This is believed to lead to cellulite formation

• Lysed adipocytes from treatments such as lipolysis or liposuction may not be remove adequately by the body if there is lymphatic blockage and stagnation of ECM eco-system

Eco-system

Diamond Liposculp

In the treatment of ECM

Diamond Liposculpture

• Latest machine from Diamond International

• Focus on the ECM and adipocytes

• Utilizing pressure (pulsing) and suction

– Promote lymphatic drainage

– Relieve lymphatic blockage

– Relieve stagnation of extracellular matrix

– Pressure effects causing mechanical lipolysis

– Promotion of blood flow

– Generate mild heat

• Possibility of collagen stimulation

• Optional attachment of waveform therapy

Diamond Liposculp

• Through its “suction and pushing” effect, it is able to unblocked the “clogged” eco-system of the ECM, via

– Relieving congestion and stagnation of the ECM

– Promoting the flow of lymphatics

• The Diamond Contours suction and pushing effect causes the movement of the MATRIX fluid which helps to relieve the stagnation and congestion.

• It is used with a deeply active CHOCOLATE SLIMMING CREAM

– (a homeopathic formulation of Chocolate, Ivy, Juniper and Dandelion)

– Gives a warm and sensual effect which is beneficial to the MATRIX and

– Has anti-inflammatory effects thus cleansing the toxins,

– Also cause toning of the tissue

• Rawlings stated in the Int J of Cosmetic Science 2006.28.175-190that Herbal extracts such as Ivy is shown to decrease subcutaneous fat thickness

Diamond Liposculp

• Its optional waveform therapy attachment allows further electrical

stimulation of the ECM

• There is a voltage of 240 microvolt in the ECM.

• GAGs are highly negative charge densities. This negative charges

repel each other which in turns establishes interstitial volume and

resist compressive forces ( Swantz / Advanced Drug Delivery

Review 50 (2001)3-50)

• Optional use of electrical waveform therapy can further enhance the

effect of restoring the eco-system

Mechanism

• Over time, cellular debris

accumulate in ground

substance (ECM)

• Cause changes in

osmolarity-edema occurs

• Toxins accumulate and

alters cellular functions

• Suction and Pulsing

effects of Diamond

LIposculpt helps to

cleanse the ECM

Diamond Liposculp

• By focusing our treatment on ECM

– Promote lymphatic drainage

– Relieve congestions of ECM

– Using of patented chocolate cream to “treat” the ECM

– Additional effect of mechanical lipolysis

• Resulting in

– Reduction of edema

– Removal of toxins

– Removal of lysed adipocytes from liposuction or mesotherapy

– Removal of lysed adipocytes from its own mechanical lipolysis

effect

Diamond Body Contour and

Liposculpt

Diamond Liposculp

Operating instruction

Fat / Cellulite Protocol

• Step 1– Prepare machine

– Setting for Grip/Suction and Release/Pulse

– Pulse/Release at 100 to 140kPa

– Suction/Grip at -30kPa

– Test on hand by depressing foot pedal

– Chose the appropriate hand piece for the patient

• Step 2– Clean zone to be treated with cleanser

• Step 3– Apply Chocolate Crème over zone to be treated

– Do not apply excessive amount

– Apply as if applying moisturiser


• Step 4– Glide hand piece over area to be treated

– Glide towards the center, to ensure all crème is “pulse” into the skin

– Repeat this for about 5-10 minutes per zone

• Step 5– Pulse motion when crème almost gone

– Hold hand piece over a specific area

– Allow to pulse for about 5-6 times

– Move to adjacent area, towards the center

– Cover all area in a zone

– Do this for about 5-10 minutes per zone

– Direction of motion is towards the heart


• Step 6

– Reapply chocolate crème and repeat again to

a total of 3-4 times

– Recommended to perform 3-4 times, the

application of crème followed by pulse/suction

• Step 7

– Wipe away excess crème

Recommended treatment times

• Chin and Jowls 20-30 minutes

• Breast 20-30 minutes

• Abdomen 40-60 minutes

• Flanks 20-30 minutes

• Buttocks 40 minutes

• Inner thighs 20-30 minutes

• Outer thighs 20-30 minutes

Fat / Cellulite Treatment

• Recommended to treat

– Every day or

– every second day

• Aim for 5 to 10 treatments

• Maintenance

– Monthly or every 2 months

– Need to continually “flush” the ECM

Adverse reactions

• Most cases pain free

• Occasional pain

– Especially smaller areas such as chin

• Mild erythema (lasting up to 2 hours)

• Bruising when fat cells break

– Especially when treat abdominal fat

• Bruising if patients on NSAIDS

• Occasional swelling when fat cells break

– Swelling subside rapidly

Body Zones

Neck Zones

• Neck

– Left side of neck is

one zone

– Right side of neck is

another zone1 2

Glide over abdomen

Breast Protocol

• Step 1– Prepare machine

– Setting for Grip/Suction and Release/Pulse

– Pulse at zero

– Suction at -30kPa

– Test on hand by depressing foot pedal

– Chose the appropriate hand piece for the patient

• Step 2– Clean zone to be treated with cleanser

• Step 3– Apply a thin layer of gel over zone to be treated

– Do not apply excessive amount

– Apply as if applying moisturiser

Breast Protocol

• Step 4

– Glide hand piece over

area to be treated

– Glide gently and not

press too hard

– Glide towards as

shown in illustration

below

– Spend about 3-4

minutes on each

breast

Breast Protocol

• Step 6

– Reapply gel and repeat again to a total of 3-4

times

– Total treatment time 20-30 minutes

• Step 7

– Wipe away excess gel

Breast Protocol

• Recommended to treat

– Every day or

– every second day

• Aim for 5 treatments

• Maintenance

– Monthly or every 2 months

Diamond Liposculpt Studies

• October 2005

– MRI scans revealed reduction in fat thickness

• December 2005

– Reduction in skin fold pinch test

• August 2006

– Effective in treating jowls, fat under chin

Cellulite

• Is a complex problem involving the microcirculatory system, lymphatics, extracellular matrix and the presence of excess subcutaneous fat that bulges into the dermis (Rawlings. Int J of Cosmetic Science 2006, 28,175-190)

• Approx 85% of women over age of 20 have some degree of cellulite (Harvard Women’s Health Watch:Cellulite meltdown. Harv Health Pub Group5,7(1998)

• Vigorous massage is used to encourage removal of interstitial fluid and improve lymphatic drainage, thus improving cellulite appearance (Rawlings. Int J of Cosmetic Science 2006, 28,175-190)

Cellulite

improve appearance

Cellulite

improve appearance

Cellulite

improve appearance

CelluliteImproved appearance

CelluliteImproved appearance

Superior SIJS

629 mm 625 mm (-4)331 mm 705 mm 321 mm (-10) 703 mm (-2)

Patient 2 Cellulite treatment

Patient 1 Cellulite

Superior SIJS

546 mm 307 mm 653 mm 547 mm 304 mm (-3) 651 mm (-2)

Patient 1 Cellulite

400 mm384 mm400 mm

490 mm470 mm 469 mm (-21)

469 mm (-1)

399 mm (-1) 382 mm(-2)399 mm(-1)

Greater Trochanter

Patient 1 Cellulite

375 mm 375 mm

509 mm 500 mm

373 mm (-2) 356 mm (-19)

460 mm (-49) 425 mm (-75)

Upper Thigh

Cellulite

improve appearance

Cellulite

improve appearance

Cellulite

improve appearance

Inferior SIJS

539 mm 538 mm (-1)590 mm 274 mm 573 mm (-17) 278 mm

Patient 2 Cellulite Treatment

Greater Trochanter


436 mm436 mm

482 mm 482 mm

443 mm486 mm

434 mm (-38) 451 mm (-31)

Lesser Trochanter

582 mm 573 mm

436 mm 391 mm434 mm (-2 ) 390 mm (-1)

577 mm (-5) 548 mm (-25)


Abdominal Fat

Lower Costal Margin (Trans)

212 mm 265 mm 206 mm200 mm (-12) 269 mm 191 mm (-15)

Patient 3 Abdominal fat

Umbilical

377 mm361 mm

377 mm 347 mm (-30 )347 mm (-14)

347 mm (-30)

Patient 3 Abdominal fat

Iliac Crest

Patient 3 Abdominal Fat

338 mm 360 mm 368 mm 338 mm 330 mm (-30) 347 mm (-21)

Lower Costal Margin (Trans)

255 mm 241 mm 262 mm244 mm (-11) 221 mm (-20) 244 mm (-18)


Umbilical

277 mm 228 mm 270 mm

274 mm (-3) 213 mm (-15) 274 mm


Iliac Crest

350 mm 322 mm 336 mm320 mm (-30) 289 mm (-33) 320 mm (-16)


373 mm 309 mm 380 mm

ASIS

350 mm (-23) 289 mm (-20) 350 mm (-30)


X10

Lost 6.2cm

Waist circumferenceReduction of 62mm

X10 Skin Fold Pinch Test

42mm to 31mm

Lost 1kg and 4.6cm

Waist Circumference

reduction 4.6cm

x5

X5

80cm to 76.8cm

1 month later

80cm to 76.8cm to 72.5cm

x5

x5

x10 Skin Fold Pinch Test

60mm to 45mm

Lost 1kg and 16.6cm

Waist Circumference

Reduction 16.6cm

x10 Skin Fold Pinch Test

43mm to 36mm

Lost 1.4kg and 8.5cm

Waist Circumference

Reduction 8.5cm

Abdominal Fat

Lost 5 cm in 5 treatments

5 treatment

118.8cm to 113.5

10 treatments

118.8 to 111.2cm

1 week after last treatment

111.2cm to 109.5cm

1 week vs 2 week after last

treatment

109.5cm to108cm

x5

x5

x5

x5

x5

X5 Above umbilical

80.9cm to 76.9cm

X5 Umbilical

88.1cm to 86.7cm

X5 Below umbilical

95.1cm to 91.5cm

x5

x5

x5

X5

96.5cm to 93.5cm

X4

Patient on warfarin

X4

Patient on warfarin

X4

Patient on warfarin

x4

Chin and Jowls

• Current treatments include liposuction, mesotherapy and thread lifting

• Could jowls and fat in the neck be caused by stagnation of ECM and blockage of lymphatics

• Can these be relieved by the pulsing and suction effects of Diamond Liposculpt?

• Can the fat be broken by the pulsing and suction effect of Diamond Liposculpt?

Jowls and Chin

5 treatments

Jowls and Chin

2 months later

Jowls and Chin

x5 and 2 months later

x5

2 months later

X5 and 2 months later

x5

2 months later


Jowls and Chin

5 treatments

After last treatment vs 1 week after

last treatment

x5


last treatment

x5


last treatment

Jowls and Chin

5 treatments

x5

2 months later


x5

2 months later


x5

2 months later


Chin

5 treatments

x5

x5

x5

Note

• For this patient, her Left side has lesser improvements compared to Right side

• She has had previous injury to her left of her shoulder from a fall.

• Does this means that her lymphatics systems suffered irreversible damage of her left side?

• This then proved the effects of Diamond Liposculp in “unblocking” the lymphatics

Diamond Liposculp

• Truly focus on the extracellular matrix

• Shown to be effective in reduction of

cellulite and fat

• Ideal for small areas such as chin and

jowls

• Ideal for patients who are contraindicated

to medications (mesotherapy) or surgery

(liposuction)

Other Indications

Early days.

Requires more studies

Mesotherapy Combo

• Ideal to use Diamond Liposculp post mesotherapy to

help spread the injected products

– Inject PPC cocktail follow by Diamond Liposculp

• Ideal to use in conjunction with Osmotic lipolysis

– Inject hypotonic saline cocktail followed by Diamond

Liposculp

• Ideal to use Diamond Liposculp post liposuction to

reduce edema, break hematoma and seroma

• Have medical usage in promotion of post surgical

lymphatic drainage

Breast

• Can body contour be use for breast firming, shaping and lifting?

• The resting non-lactating breast consist mainly of fibrous tissue (Last’s Anatomy: McMinn)

• Breast is supported by fibrous tissue strands-Ligaments of Cooper which connect the deep fascia to the dermis

• When Ligaments of Cooper is atrophic, they allow the organs to droop (Last’s Anatomy:McMinn)

• Can Diamond Body Contour machines stimulate the fibrous tissue of the breast to grow? Preventing atrophy of Ligaments of Cooper?

• Massaging effect has been shown in some animal studies to increase collagen synthesis (Rawlings. Int J of Cosmetic Science 2006, 28,175-190)

• In our practice, we offer this modality to patients that are contraindicated to surgery or unable to afford surgery

• Cannot replace the effectiveness of breast surgery

Patient 1

x5

x5

x5

X5

86.1cm to 86.9cm

Patient 2

x5

1 month later

X5 and 1 month later

x5

1 month later


x5

1 month later

x5

X5

77.6cm to 78.6cm


77.6cm to 78.6cm to 79cm

Patient 3

x5

2 months later


x5

2 months later


x5

2 months later



81.9cm to 82.4cm to 83.2cm

Patient 4

x5

x5

x5

X5

91.6cm to 93cm

Patient 5

x2 and 6 weeks later

X2 and 6 weeks later

X2 and 6 weeks later

Patient 6

x5

x5

x5

x5

Wrinkles

• Conventional non surgical treatment of static wrinkle has been with dermal fillers.

• The principal of dermal fillers was to replace the dermal layers with collagen, hyaluronic acids etc

• Could wrinkle appear due to edema?

• Could the edema be caused by factors in the extracellular matrix?

• Can we treat wrinkles by treating the extracellular matrix?

• The composition and organization of the ECM determine the mechanical properties of tissue such as its elasticity, strength and hydration ( Swartz / Advanced Drug Delivery Reviews 50(2001)3-20)

Lines under chin reduced




Labiomento fold reduced




Neck fineline reduced (x1)

Neck fineline reduced (x1)

Post Liposuction

To even out irregularities

Edema

• MA Swantz / Advanced Drug Delivery Reviews 50 (2001)3-20 states that – edema occurs due to blockage of lymph flow, buildup of osmotic

pressures within ECM and changes in the mechanical properties of ECM

– Can be cause by infection, trauma, surgery and many other factors

– Eventually ECM is remodeled with new level of hydration, fibrosis and lipidosis.

– Treatment include drugs and surgical techniques have mostly failed

• Can Diamond Liposculpt with its suction and pulsing effects help to treat this edema and restore the function of ECM?

x3

x4

x3

x4

Conclusion

• More studies are required into the function

of ECM and Lymphatic drainage

• Role of ECM and Lymphatric Drainage

should be considered in treatment of

cellulite, obesity, edema, post surgical

lymphaedema, lines and wrinkles

• Many questions remained unanswered

Thank You

Documents

Non Surgical Liposculpture The Extracellular matrix factordiamondnaturalbeauty.com/wp-content/uploads/2017/06/Lipo... · 2017-06-26 · • Obesity and Cellulite –Biggest challenge