"How to avoid complications in aesthetic phlebology", online School of aesthetic phlebology, 25.06.2020/XNUMX/XNUMX.

On June 25, 2020, an online conference from the School of Aesthetic Phlebology cycle was held on the topic: "How to avoid complications in aesthetic phlebology." Messages were presented by some of the best domestic specialists in working with vascular formations:

  • Dmitry Vyacheslavovich Romanov, pediatric surgeon, leading Russian specialist in working with vascular neoplasms in children (Moscow).
  • Vadim Yurievich Bogachev, vascular surgeon, phlebologist, professor, (Moscow).
  • Khachatur Mikhailovich Kurginyan, vascular surgeon, phlebologist, candidate of medical sciences, (Moscow).
  • Anastasia Sergeevna Popova, dermatologist, cosmetologist, (Moscow).
  • Artur Gagikovich Bagdasaryan, vascular surgeon, aesthetic phlebologist, candidate of medical sciences, (Moscow).
  • Matvey Aleksandrovich Parikov, leading phlebologist of the Innovative Vascular Center, (St. Petersburg).
  • Dmitry Aleksandrovich Rosukhovsky, vascular surgeon, phlebologist, candidate of medical sciences, (St. Petersburg)

Dmitry Vyacheslavovich Romanov, pediatric surgeon, leading specialist in the treatment of various vascular neoplasms in pediatric patients, (Moscow), presented the message: “Capillary malformation (port wine stains)”.

Capillary malformation (port wine stains)

“Capillary malformation (port wine stains)” - reports D.V. Romanov. (Moscow)

 

Dmitry Vyacheslavovich turned to one of the most difficult problems in modern aesthetic phlebology. It is no secret that the treatment of port wine stains causes serious difficulties even for experienced specialists in the treatment of vascular skin defects. Dr. Romanov presented his own experience of working with vascular malformations using both separate and combined exposure to a laser with a wavelength (532 and 1064 nm). A Cutera laser platform was used. Dmitry Vyacheslavovich shared the results of this laser and revealed the details of the successful treatment of vascular malformations, including port wine stains, in various categories of patients, both children and adults.

Master class for the removal of vascular formations on the face in children performed by D.V. Romanov

Master class for the removal of vascular formations on the face in children performed by D.V. Romanov

 

In the practical part of the message, Dr. Romanov presented a video of the procedure for removing vascular neoplasms.

Vadim Yuryevich Bogachev, vascular surgeon, phlebologist, professor, (Moscow), presented the message: "Prevention and treatment of complications of sclerotherapy."

Prevention and treatment of complications of sclerotherapy

"Prevention and treatment of complications of sclerotherapy" - reports V.Yu. Bogachev. (Moscow)

 

Vadim Yuryevich shared his expert opinion on a rather pressing problem. The sclerotherapy technique is a very good tool in the hands of an aesthetic phlebologist. Sclerotherapy is effective, affordable, captivating with its seeming simplicity. The demand for both patients and specialists has a downside. Even the small number of complications that we have statistically can significantly complicate the life of an ordinary phlebologist. Patients come to the sclerotherapy procedure for an aesthetic result, and even a clinically insignificant side effect can be perceived as a tragedy. Of course, the best treatment for complications is prevention. The only thing that will truly avoid these moments as much as possible is a good experience and attention to detail. The success of the sclerotherapy procedure largely depends on subtle nuances. Yes, on the surface, the correct selection of the volume and concentration of the drug, the choice of the drug, good contact with the patient. However, this does not always allow avoiding the complications of sclerotherapy. Carrying out the sclerotherapy procedure, an experienced doctor always understands that there is a fine line between obtaining a quick result and the possibility of developing, if not complications, then pronounced side effects. More than 16% of women receive combined oral contraceptives on an ongoing basis. The combination of therapy with these drugs and sclerotherapy is fraught with both the development of matting and non-target obliteration of the venous vessels. Frequent development of matting often occurs in patients with increased body weight. If the abolition of oral contraceptives 4 weeks before the procedure is a completely solvable task, then an adequate decrease in body weight is far from always. And only a good conversation with the patient will help to understand whether she should undergo sclerotherapy in principle. The nuances of the procedure, voiced by Vadim Yuryevich, deserve special attention. Perhaps the most undesirable phenomenon after sclerotherapy is skin necrosis. It is no secret that the main cause of this complication is the sclerosant obliteration of the arteriole feeding this area. Modern research explains this phenomenon quite eloquently. The first signs of arteriole occlusion: whitening, redness or pallor of the skin area. Intensive massage of this locus will practically not increase the duration of the procedure, but with a high degree of probability it will avoid this complication.

Khachatur Mikhailovich Kurginyan, vascular surgeon, phlebologist, candidate of medical sciences, (Moscow), presented the message: “Possibilities of a short-pulse neodymium laser 1064 nm in aesthetic phlebology”.

Possibilities of a short-pulse neodymium laser 1064 nm in aesthetic phlebology

"Possibilities of a short-pulse neodymium laser 1064 nm in aesthetic phlebology" - reports Kh.M. Kurginyan. (Moscow)

 

Khachatur Mikhailovich shared his experience of using a modern short-pulse laser of the Aerolase platform with a wavelength of 1064 nm. Dr. Kurginyan presented good aesthetic results of percutaneous laser coagulation with this device.

Anastasia Sergeevna Popova, dermatologist, cosmetologist, (Moscow), presented the message: "Practical substantiation of the use of the technology of sequential supply of multiwave pulses in the treatment of vascular pathologies."

Practical rationale for the use of the technology of sequential delivery of different-wavelength pulses in the treatment of vascular pathologies

"Practical substantiation of the use of the technology of sequential supply of multiwave pulses in the treatment of vascular pathologies" - reports Popova A.S. (Moscow).

 

Anastasia Sergeevna is one of the leading specialists in the field of laser cosmetology and a practicing clinical trainer at Umetex Aeshtetics (Cynosure). Dr. Popova presented the Multiplex technology, which is the simultaneous action of two different lasers in successive pulses. Multiplex technology consists of the combined flash delivery of a pulsed dye laser (PDL, wavelength 585-597 nm) and a neodymium laser (Nd: YAG, 1064 nm). From the point of view of the principle of selective photothermolysis, it is possible that such a solution will be ideal or tends towards it. We know that telangiectasia is a vascular formation that includes veins of various diameters, and the vessels will not always have only a blue color. Some of them will be red. It is this aspect that was taken into account when developing the Multiplex technology from Cynosure. The simultaneous removal of vessels of different diameters, not only blue, but also red, is a very good solution by Umetex Aeshtetics. This allows you to more fully work out the entire complex of vascular formations in one session and thereby helps to reduce the number of procedures.

Master class for removal of telangiectasias using Multiplex technology from Cynosure performed by A.S. Popova

In the practical part of the report, Dr. Popova demonstrated the removal of telangiectasias using the Multiplex technology from Cynosure.

Artur Gagikovich Bagdasaryan, vascular surgeon, aesthetic phlebologist, candidate of medical sciences, (Moscow), presented the message: “Pigmentation in aesthetic phlebology. Inevitability? "

Pigmentation in aesthetic phlebology. Inevitability?

“Pigmentation in aesthetic phlebology. Inevitability? " - reports A.G. Baghdasaryan (Moscow)

 

Pigmentation after aesthetic procedures remains a significant problem for modern specialists. Artur Gagikovich quite informatively spoke about the reasons and mechanisms for the formation of this undesirable phenomenon. Only a good understanding of the genesis of hyperpigmentation can prevent its occurrence in many patients. Dr. Baghdasaryan spoke about modern tools for the prevention and treatment of hyperpigmentation after aesthetic procedures. Basic principles for the prevention of permanent pigmentation:

  • Photoprotection for the period of treatment.
  • Preliminary elimination of reflux in venous vessels.
  • Precise execution of sclerotherapy.
  • Use of compression hosiery.
  • Use of depigmenting agents after sclerotherapy.
  • Removal of coagulum.
  • Do not perform percutaneous laser coagulation on a fresh tan.
  • Competent calculation of energy parameters.
  • Use of refrigeration during the procedure.
  • The use of steroids and depigmentants after the procedure of percutaneous laser coagulation.
  • Removal of melanin pigment using lasers and pulsed light.

Pigmentation after aesthetic procedures still remains a complex and insufficiently covered topic for the bulk of the phlebological community. And Arthur Gagikovich's report is very important in this context, understanding the essence of the problem, already half of its solution.

Matvey Aleksandrovich Parikov, leading phlebologist of the Innovative Vascular Center, (St. Petersburg), presented the message: “EVLK of extrafascial veins - tactics, risks, features”.

EVLK of extrafascial veins - tactics, risks, features

"EVLK of extrafascial veins - tactics, risks, features" - reports Parikov M.A. (St. Petersburg)

 

Matvey Aleksandrovich shared his own practical experience in performing endovenous laser obliteration of extrafascial located segments of varicose veins. Dr. Parikov spoke about the nuances of the procedure, the selection of patients and the advantages over miniflebectomy in a comparative aspect. Matvey Alexandrovich shared his feelings after working on a new laser with a wavelength of 1940 nm. The doctor noted the following advantages of EVLK on a two-micron device:

  • Vein resorption (resorption) occurs faster.
  • Pigmentation is less both in terms of time and intensity.

Matvey Aleksandrovich also drew the audience's attention to new perspectives that the 1940 nm laser opens up in working with extrafascial segments of veins in the context of aesthetic phlebology.

Dmitry Aleksandrovich Rosukhovsky, vascular surgeon, phlebologist, candidate of medical sciences, (Saint Petersburg), presented two reports. In the first of them: "Laser aesthetic phlebology in a pandemic", the doctor shared the features of practice in our time, which is not the simplest in terms of epidemiological conditions. Also, Dmitry Alexandrovich presented modern data on the COVID-19 infection.

Carrying out EVLK and ERASER (CLACS) simultaneously

"Carrying out EVLK and LASTIC (CLACS) simultaneously" - reports D.A. Rosukhovsky. (St. Petersburg)

 

In the second message: "Conducting EVLK and LASTIC (CLACS) simultaneously", Dr. Rosukhovsky told about the experience of simultaneous laser treatment of varicose veins and the elimination of aesthetically unacceptable telangiectasias. Dmitry Alexandrovich shared the technique and nuances of the combined procedure.