WORKBOOK FOR DOCTORS

WORKBOOK FOR DOCTORS LFL PDO Protocols and combined techniques Supported by Dr. Lukasz Preibisz PDO_Manual_EN_1506_agh_v17.indd 1 22.12.15 15:22

PDO BY GRAND AESPIO BASIC SCREW BARB II PDO_Manual_EN_1506_agh_v17.indd 2 22.12.15 15:22

Introduction LFL (Lead Fine Lift) PDO threads 6 Advantages of the procedure...8 PDO Threads 3S...8 Areas of application...9 Purpose and indications...10 Contraindications...10 Possible complications...11 1 PDO Threads Techniques Sandwich technique...14 Fan technique...15 Net technique...16 Sewing technique...17 2 Indication Technique Upper Face Upper Face: Eyebrow elevation...20 Upper Face: Muscle relaxation Glabellar folds (Botox-like effect)...21 Upper Face: Eyelid elevation...22 Upper Face: Forehead...23 3 Indication Technique Middle Face Middle Face: Puffi ness reduction...26 Middle Face: Straightening nasolabial folds...27 Middle Face: Correction superfi cial wrinkles...28 Middle Face: Jawline defi nition...29 PDO_Manual_EN_1506_agh_v17.indd 3 22.12.15 15:22

PDO BY GRAND AESPIO BASIC SCREW BARB II PDO_Manual_EN_1506_agh_v17.indd 4 22.12.15 15:22

4 Indication Technique Lower Face Lower Face: Smoker's Lines / Lip contour...32 Lower Face: Double chin reduction...33 5 Indication Technique Body Body: Superfi cial wrinkles Neck...36 Body: Décolleté...37 6 Case Studies Female, Age 35, Eyelid elevation, Cheek elevation...40 Female, Age 55, Jawline defi nition, Superfi cial wrinkles Neck...41 Female, Age 43, Eyebrow Lifting, Jawline defi nition, Double chin reduction...42 Female, Age 40, Forehead smoothing, Eyebrown lifting, Jawline defi nition...43 Female, Age 48, Jawline defi nition...44 7 FAQs FAQs - depending on location...48 General FAQs...50 FAQs complications / solutions...52 8 Product information Product information...56 Notice...58 Notice...60 Princess-App...62 PDO_Manual_EN_1506_agh_v17.indd 5 22.12.15 15:22

Introduction LFL (Lead Fine Lift) PDO threads LFL is a premium lifting thread made of PDO (Polydioxanone) which is absorbed after proliferating collagen and by stimulating fibroblasts. Everyone can experience overall face contouring and skin elasticity. It brings a natural and dramatic effect to face and body after a simple and safe treatment. The superior quality of the Ultra Thin Wall Needle allows treatment to be straightforward, effective and painless. The production process for the LFL product line is automated, modern and clean, resulting in state-of-the-art technology. Mechanism Production of collagen in response to the presence and irritation of a foreign body (thread) plus mechanical injury (by needle) stimulates blood flow and increases metabolism in the treated area. Technology Ultra Thin Wall Needle allows a thicker PDO thread to be inserted into the needle Sharp and neat needle edge, achieved by special new grinding technology Special coating with less resistance enables the needle to be inserted into the skin smoothly Features Ultra Thin Wall High Quality Needle Qualified PDO thread Patented Medical Product - Class III CE Certification Effects Lifting Skin rejuvenation (Tightening, Brightening) Wrinkle Smoothing 6 PDO_Manual_EN_1506_agh_v17.indd 6 22.12.15 15:22

Benefits Safe Easy Effective Short downtime Before the operation it is important to evaluate: Skin (dermatochalasis) Skin thickness The skin texture Skin elasticity The possible presence of permanent implants The possible presence of disease Any ongoing pharmacological therapy The application possibilities shown and described in this document do not conform to the existing medical indication and the intended use of the products (surgical suture material) and are not meant to be instructions for use or application recommendations and have a purely demonstrative and exemplary character. There is a risk of complications and unintended side-effects if the products are applied according to this document (for details and a suggestion how to address such complications, please refer to the corresponding section in this document). All and any application of the products are carried out at the sole risk and danger of the applying physician. There are no clinical studies documenting the successful outcome of the application. All shown application possibilities and complication handling advices were independently developed by Dr. Preibisz (Sinusmedical, ul. Znanieckiego 16 c, 03-980 Warszawa, Poland). Therefore, CROMA and the manufacturer of the products assume no liability for any damages resulting from the application of the products or the handling of complications as demonstrated in this brochure. 7 PDO_Manual_EN_1506_agh_v17.indd 7 22.12.15 15:22

Advantages of the procedure Advantages Safe operation Simple to learn and easy to perform Quick procedure (duration about 20-30 minutes) Instant results High effi ciency Lack of cuts and scars The effect is maintained for more than 1 year The thread is completely absorbed so procedure may be repeated Threads are not visible and are not felt Hardly any side effects and few complications Short recovery period PDO Threads 3S Safe Speed Simple CE certifi cate Absorbable thread Short procedure Immediate result Non invasive procedure Very short down time 8 PDO_Manual_EN_1506_agh_v17.indd 8 22.12.15 15:22

Areas of application On the face 1 2 6 3 4 5 7 8 9 10 01. Vertical and horizontal forehead wrinkles 02. Brow lifting 03. Lower eyelid 04. Malar prominence 05. Pronounced nasolabial fold 06. Glabellar lines 07. Wrinkles on the cheeks 08. Marionette fold 09. Submental fold 10. Drooping cheeks and the area under the lower jaw 11. V-Lifting On the body Folds and wrinkles on the neck and chest Sagging tissue and stretch marks on the buttocks, abdomen, arms and legs Rugged terrain skin and subcutaneous tissue (especially after liposuction / lipolysis) Treatment of superfi cial scars 9 PDO_Manual_EN_1506_agh_v17.indd 9 22.12.15 15:22

Purpose and indications Purpose Eliminate fine wrinkles Smooth deep wrinkles Improve skin colour, elasticity, texture Delay aging process and prevent sagging Increase of skin density, thickness, elasticity Indication Recommended for the prevention and treatment of involution changes due to aging Patients age group 30-55 plus Contraindications Contraindications Various acute infectious diseases of the skin (viral, bacterial, fungal) Other inflammational diseases of the skin Skin cancers Tendency to keloids Haematological diseases with bleeding tendency and blood clotting drugs Autoimmune disease Active granulomatosis disease (like sarcoidosis or annular granoluma) 10 PDO_Manual_EN_1506_agh_v17.indd 10 22.12.15 15:22

Possible complications Complications Swelling, erythema Occasional hemorrhage, hematoma - a hematoma can last up to 2 weeks Temporary irregularities - can take up to 7 days to straighten - if irregularities are severe the skin should be smoothed immediately after treatment to make it smooth Infection as a result of failure to comply with antiseptic procedures - Infection needs medical treatment - Irritation or allergy can also occur towards the antiseptic Translucence of thread in case of abnormally superficial introduction - The thread is no longer visible after 2 weeks Painful to touch or pain on chewing - can last up to 2-7 days after treatment but will then disappear Small bruise depending on individual reaction Formation of small bumps where the thread ends under the skin: Treatment methods 1) Massage + Mesotherapy 2) Triamcinolone 3) Remove the thread 11 PDO_Manual_EN_1506_agh_v17.indd 11 22.12.15 15:22

01 PDO Threads Techniques 12 PDO_Manual_EN_1506_agh_v17.indd 12 22.12.15 15:22

PDO_Manual_EN_1506_agh_v17.indd 13 22.12.15 15:22 13

1.1 Sandwich technique Needles are inserted in the same direction but in different layers of the skin Products: Effect: Indications: Basic; Screw Smoothing of the skin by giving volume Face but also scars and stretch marks 14 PDO_Manual_EN_1506_agh_v17.indd 14 22.12.15 15:22

1.2 Fan technique Needles are inserted in different directions into only one layer of the skin Products: Effect: Indications: Basic; Screw Smoothing of the skin, deep mouth angle, marionette lines Face and body 15 PDO_Manual_EN_1506_agh_v17.indd 15 22.12.15 15:22

1.3 Net technique Parallel insertion of the needles from two different directions Products: Effect: Indications: Basic Volume creation, tissue support, superfi cial cheek wrinkle reduction Face and body 16 PDO_Manual_EN_1506_agh_v17.indd 16 22.12.15 15:22

1.4 Sewing technique Sewing by alternating in between hypodermis layer and deep dermal layer To see if deep dermal layer has been sewn from outer skin, we check if dimple has been created If we sew too superfi cially, there will be much bruising and oedema Regarding hypodermal layer, do not go so deep as to reach muscle Features of the sewing technique Can pull the skin towards whichever direction wanted depending on how many times one sews the deep dermal layer Stimulate skin s stem cell layer to drastically increase the production of fi broblasts Products: Effect: Indications: Basic Smoothing of deep wrinkles Face 17 PDO_Manual_EN_1506_agh_v17.indd 17 22.12.15 15:22

02 Indication Technique Upper Face 18 PDO_Manual_EN_1506_agh_v17.indd 18 22.12.15 15:22

PDO_Manual_EN_1506_agh_v17.indd 19 22.12.15 15:22 19

2.1 Upper Face: Eyebrow elevation Product: Screw 29G / 40mm, 27G / 50mm, 26G / 60mm 20 PDO_Manual_EN_1506_agh_v17.indd 20 22.12.15 15:22

2.2 Upper Face: Muscle relaxation Glabellar folds (Botox-like effect) Product: Screw 29G / 40mm, 27G / 50mm, 26G / 60mm 21 PDO_Manual_EN_1506_agh_v17.indd 21 22.12.15 15:22

2.3 Upper Face: Eyelid elevation Product: Basic 31G / 30mm Product: Basic 31G / 30mm, 29G / 40mm 22 PDO_Manual_EN_1506_agh_v17.indd 22 22.12.15 15:22

2.4 Upper Face: Forehead Product: Basic 29G / 40mm, 29G / 50mm, 27G / 60mm 23 PDO_Manual_EN_1506_agh_v17.indd 23 22.12.15 15:22

03 Indication Technique Middle Face 24 PDO_Manual_EN_1506_agh_v17.indd 24 22.12.15 15:22

PDO_Manual_EN_1506_agh_v17.indd 25 22.12.15 15:22 25

3.1 Middle Face: Puffiness reduction Product: Basic 31G / 30mm, 29G / 40mm 26 PDO_Manual_EN_1506_agh_v17.indd 26 22.12.15 15:22

3.2 Middle Face: Straightening nasolabial folds Soft lift Product: Screw 26G / 60mm Stronger lift Product: Barb II 23G / 60mm, 21G / 60mm 27 PDO_Manual_EN_1506_agh_v17.indd 27 22.12.15 15:22

3.3 Middle Face: Correction superficial wrinkles Product: Basic 29G / 40mm, 29G / 50mm 28 PDO_Manual_EN_1506_agh_v17.indd 28 22.12.15 15:23

3.4 Middle Face: Jawline definition Product: Basic 25G / 90mm Product: Men: Barb II 21G / 90mm Women: Barb II 23G / 90mm 29 PDO_Manual_EN_1506_agh_v17.indd 29 22.12.15 15:23

04 Indication Technique Lower Face 30 PDO_Manual_EN_1506_agh_v17.indd 30 22.12.15 15:23

PDO_Manual_EN_1506_agh_v17.indd 31 22.12.15 15:23 31

4.1 Lower Face: Smoker's Lines / Lip contour Product: Basic 31G / 30mm, 29G / 40mm Product: Basic 31G / 30mm, 29G / 40mm 32 PDO_Manual_EN_1506_agh_v17.indd 32 22.12.15 15:23

4.2 Lower Face: Double chin reduction Product: Basic 29G / 40mm and longer, Screw 29G / 40mm and longer 33 PDO_Manual_EN_1506_agh_v17.indd 33 22.12.15 15:23

05 Indication Technique Body 34 PDO_Manual_EN_1506_agh_v17.indd 34 22.12.15 15:23

PDO_Manual_EN_1506_agh_v17.indd 35 22.12.15 15:23 35

5.1 Body: Superficial wrinkles Neck Product: Basic 29G / 40mm, 29G / 50mm 36 PDO_Manual_EN_1506_agh_v17.indd 36 22.12.15 15:23

5.2 Body: Décolleté Product: Basic 29G / 50mm, 27G / 60mm, 25G / 90mm Product: Screw 29G / 40mm, Basic small medium 37 PDO_Manual_EN_1506_agh_v17.indd 37 22.12.15 15:23

06 Case Studies 38 PDO_Manual_EN_1506_agh_v17.indd 38 22.12.15 15:23

PDO_Manual_EN_1506_agh_v17.indd 39 22.12.15 15:23 39

6.1 Female, Age 35 Eyelid elevation, Cheek elevation Treatments Eyelid elevation (9x per side Basic 31G / 30mm) Cheek elevation (4x per side Barb II 23G / 60mm) before immediately after after two months 40 PDO_Manual_EN_1506_agh_v17.indd 40 22.12.15 15:23

6.2 Female, Age 55 Jawline definition, Superficial wrinkles Neck Treatments Jawline defi nition (2x per Side Barb II 23G / 90mm) Superfi cial wrinkles Neck (5x per Side Basic 27G / 60mm) before immediately after 41 PDO_Manual_EN_1506_agh_v17.indd 41 22.12.15 15:23

6.3 Female, Age 43 Eyebrow Lifting, Jawline definition, Double chin reduction Treatments Eyebrow Lifting (2x Barb II 23G / 60mm) just one side to correct asymmetry Jawline defi nition (2x per side Barb II 23G / 90mm) Double chin reduction (12x Basic 27G / 60mm) before immediately after 42 PDO_Manual_EN_1506_agh_v17.indd 42 22.12.15 15:23

6.4 Female, Age 40 Forehead smoothing, Eyebrown lifting, Jawline definition Treatments Forehead smoothing (8x Basic 25G / 90mm, Basic 27G / 60mm), Eyebrow lifting (1x per side Barb II 23G / 60mm) Jawline defi nition (2x per side Barb II 23G / 90mm) before after two months 43 PDO_Manual_EN_1506_agh_v17.indd 43 22.12.15 15:23

6.5 Female, Age 48 Jawline definition Treatments Jawline elevation (4x per side Barb 23G / 90mm, 1x per side Barb II 23G / 60mm) before after two months 44 PDO_Manual_EN_1506_agh_v17.indd 44 22.12.15 15:23

PDO_Manual_EN_1506_agh_v17.indd 45 22.12.15 15:23 45

07 FAQs 46 PDO_Manual_EN_1506_agh_v17.indd 46 22.12.15 15:23

PDO_Manual_EN_1506_agh_v17.indd 47 22.12.15 15:23 47

FAQs - depending on location UPPER FACE Forehead Does it matter from which side you implement threads to improve forehead horizontal wrinkles? There is no difference whether one introduces threads from the right to left or vice versa. It is important, however, to administer them to the same depth and parallel to the horizontal forehead wrinkles. How deeply one should implement the thread in order to achieve the effect of Botox in the glabellar area? In this case, the thread must be given directly into the frontalis muscle which is below the level of the skin and subcutaneous tissue. The best product seems to be a screw-type thread with a length and a thickness adapted to a specific patient. Eyebrow elevation What is the difference between the use of a screw-type thread and one with hooks? Screw-type threads are used to obtain a softer effect of eyebrow elevation, while the barbed one has a much stronger effect. The lifting effect of one barbed thread corresponds to the effect of at least 4 screw-type threads. MIDDLE FACE Cheeks - superficial wrinkles Which threads and how deep they should be introduced? The best alignment of superficial cheek wrinkles can be achieved by using the basic plain threads of medium length and medium thickness using the net technique. 48 PDO_Manual_EN_1506_agh_v17.indd 48 22.12.15 15:23

LOWER FACE Jaw line How many threads are needed to raise a drooping jaw line? It depends on how great the skin laxity is and the thickness of the skin of the patient. Generally from 2 to 5 barbed threads a side will improve this laxity. Double chin Which threads and what way to implement them? In this case, the type of thread depends on the positioning of the sagging chin. Consider the use of plain and screw threads of medium length; in some cases the barbed threads can also be used. If so, the fixation point for the barbed thread should be as high as possible above the jaw line though the other end of the thread should curve below the jaw line to reach the double chin, this will bring tension to the chin. Neck What to do if a thread becomes visible through the skin on the neck? Neck skin is very delicate and highly translucent; the blue colour of the thread will not last and will dissolve in the skin after about two weeks. So one should wait. Facelift Which threads to choose to obtain a lifting effect for a muscular/big man? If the skin is thicker and slacker, the thicker the barbed threads should be selected. Thread tension can also be increased by working from a single point using the fan-technique. After removing the needle the tension of the threads can be increased by pulling them together, rotating them before final cutting. This will give additional lifting effect in such case. 49 PDO_Manual_EN_1506_agh_v17.indd 49 22.12.15 15:23

General FAQs What to do if a thread goes above the surface of the skin? One should cut the thread as close as possible next to the skin. Before the thread is cut, the skin should be moved downwards by pressing along its course towards the protruding end to obtain the maximum deflection above the surface of the skin. Then cut the thread off. Finally massage the remaining part of the thread in the skin in the opposite direction. Which type and how many threads to buy? Choosing the thread type one should be guided by the characteristics of one's own patients as well as the implementation technique in which you have most experience and confidence. It is worth having a full range of products, because you never know what the expectations of the next patient will be. If the majority of patients require lifting effect - increase the purchase of barbed threads. If, however, the majority of patients have dark circles under the eyes, in this case, you should purchase more short, thin plain threads. When summer approaches, women are more likely to take care of the neck/ décolleté - damaged and destroyed by previous exposures to sunlight. In this case consider purchasing an additional number of medium and long plain threads. Of course, if you feel most confident in a particular procedure, such as eyebrow lifts - you should obviously purchase the short barbed threads. Which threads bring the best outcome? The best outcome is provided by the use of multiple parallel threads implementation techniques in conjunction with HA and botulinum toxin, as a complement to the thread treatment. This gives much greater satisfaction to the patient and allows for regular and long-term planning over the years leading to full patient satisfaction when looking in the mirror. 50 PDO_Manual_EN_1506_agh_v17.indd 50 22.12.15 15:23

How to calculate the cost of a thread treatment: by single threads or by full treatment? We need to know about the cost of the thread in the calculation of the entire operation. Because the price of use of a single barbed thread and plain one are definitely different. When giving the price for the procedure/treatment leave yourself more options in the selection/adaptation of products in the course of the procedure itself. If the price is agreed on the basis of a single thread and during treatment the effect is different from that expected, it is not possible to change the agreed parameters of the procedure. The patient will pay for the expected effect rather than the number of threads. 51 PDO_Manual_EN_1506_agh_v17.indd 51 22.12.15 15:23

FAQs complications / solutions The most common: Hematoma, bruising and swelling after the treatment. These are symptoms that automatically disappear. Swelling is gone within 1-2 days. Hematomas turn into bruises and last up to 2 weeks. If such symptoms occur, topical Arnica ointment and anti-inflammatory drugs like ibuprofen can be used. Asymmetry after the treatment are usually associated with oedema. Wait a week and re-evaluate facial symmetries. If the imbalance persists perform the correction procedure. If overcorrection using barbed threads, then massage along a length of the thread to reduce the tension force. If the effect is too weak, another thread needs to be inserted in this area. Thread out of skin - should be cut as close to the skin as possible Elevation at the injection point of the thread. This is due to the suspension of the thread and the pressure on the skin from the inside. The best solution is a massage of the area1-2 times a day for 5-7 days. Additionally, one can perform gentle/small amount injection of hyaluronic acid. 52 PDO_Manual_EN_1506_agh_v17.indd 52 22.12.15 15:23

The most serious: Infection at the injection site. Usually associated with insufficient antisepsis. Symptomatic treatment as in the case of local skin infections. Allergy to threads - no data. 53 PDO_Manual_EN_1506_agh_v17.indd 53 22.12.15 15:23

08 Product information 54 PDO_Manual_EN_1506_agh_v17.indd 54 22.12.15 15:23

PDO_Manual_EN_1506_agh_v17.indd 55 22.12.15 15:23 55

8 Product information LFL BASIC LFL BASIC is made with Polydioxanone (PDO) suture, which is widely used in skin rejuvenation and local fi rming purposes for various body and face areas. SPECIFICATION GRIP NEEDLE FILAMENT Colour Gauge Length Length USP 31 G 30 mm 30 mm 7-0 29 G 40 mm 50 mm 6-0 29 G 50 mm 70 mm 6-0 27 G 60 mm 90 mm 5-0 25 G 90 mm 150 mm 5-0 PACKAGING 5 pcs/steri pack, 5 steri pack/pouch, 2 pouches/box = Total 50 PDO s LFL SCREW LFL Screw with a spiral shape suture can lead to localised lifting and internal volumising. Due to the shape of the thread, there is a higher concentration of thread material in the applied area. This leads to a higher collagen production. SPECIFICATION GRIP NEEDLE FILAMENT Colour Gauge Length Length USP PACKAGING 29 G 40 mm 52 mm 6-0 5 pcs/steri pack, 27 G 50 mm 70 mm 5-0 5 steri pack/pouch, 2 pouches/box 26 G 60 mm 90 mm 5-0 = Total 50 PDO s 56 PDO_Manual_EN_1506_agh_v17.indd 56 22.12.15 15:23

LFL BARB II LFL Barb II with bi-directional cogs acts to hold the skin like double hooks when the thread is tightened. It is the most powerful option for any specifi c body and face areas. SPECIFICATION GRIP NEEDLE FILAMENT Colour Gauge Length Length 23 G 60 mm 90 mm 90 mm 150 mm 21 G 60 mm 90 mm 90 mm 150 mm USP PACKAGING 4-0 1 pcs/steri pack, 12 steri pack/pouch, 1 pouch/box 3-0 = Total 12 PDO s 57 PDO_Manual_EN_1506_agh_v17.indd 57 22.12.15 15:23

Notice 58 PDO_Manual_EN_1506_agh_v17.indd 58 22.12.15 15:23

PDO_Manual_EN_1506_agh_v17.indd 59 22.12.15 15:23 59

Notice 60 PDO_Manual_EN_1506_agh_v17.indd 60 22.12.15 15:23

PDO_Manual_EN_1506_agh_v17.indd 61 22.12.15 15:23 61

Princess-App All secrets about PDO and fi ller treatments. Learn from experts in HD-Video online classes. More than 40 videos online - wherever you are - get it now! Web version available: www.princess-app.com 62 PDO_Manual_EN_1506_agh_v17.indd 62 22.12.15 15:23

Lukasz Preibisz, M.D. specializes in the fields of dermatology and venereology in Warsaw, Poland. PDO threads have created a new chapter in skin rejuvenation for both my patients and me. You can achieve long lasting aesthetic effects for difficult regions such as décolleté, neck and middle/lower face. Additionally, combining thread lifts with other noninvasive procedures such as anti-wrinkle injections, laser treatments and facial peels, is an effective way to help improve a patient s overall results. 63 PDO_Manual_EN_1506_agh_v17.indd 63 22.12.15 15:23

CROMA PHARMA GmbH Industriezeile 6 2100 Leobendorf Austria Tel.: +43/2262/68468-0 www.princess-lift.com Distributed by: CROMA PHARMA GmbH Industriezeile 6, 2100 Leobendorf, Austria I Tel.: +43/2262/68468-0 I Fax.: +43/2262/68468-165 I E-Mail: derma@croma.at Patented and certified by: GRAND AESPIO INC. 610 Nonhyeon-ro, Gangnam-gu Seoul 135-830 Korea MEDIFIRST 1049-16 Charyeonggogae-Road, Gwangdeok-myeon, Dongnam-gu, Cheonan-si, Chungnam, 330-922, Korea DONGBANG ACUPRIME 1 The Forrest Units Gwangd Hennock Road East Exeter EX2 8RU, UK 33822 PLPDOM000Aa PDO_Manual_EN_1506_agh_v17.indd 64 22.12.15 15:23