aqualyx - cosmedicalsolutions.com · 5. aqualyx clinical evidences •dr.raffaele rauso...
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AQUALYX LIPOSUCTION WITH-OUT THE USE OF
SCALPELS
NON SURGICAL REDUCTION OF LOC ALIZED FAT DEPOSITS
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INTRALIPOTHERAPYAQUALYX
Contents
1. Historical review
2. Composition
3. Mode of action
4. Histological evidence
5. Clinical evidence
6. Indications
7. Contra-indications
8. Safety data
9. Protocol of injection
10. Pricing recommendation
11. before & after Photo-Gallery
12. Medical training and intralipotherapycourse
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1. Historical review of non surgical treatments
past
• Meso-therapy
• Electro-lipolyse
• O2O3-therapy
Recent past
• Ultrasound “cavitation”
• Phosphatidylcholine preparations
present
• Laserlysis
• Aqualysis “Intralipo-therapy”
• Cryo-lipolysis
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Phosphatidylcholine ,Misconception and calrification“ Lipostabil _ Lipolight _ Lipodisolve _ Lipolyse _ Lipomelt _ Flabjap”
COMPOSITION
Phosphatidylcholine
Sodium deoxycholate
Benzilic alchol
Tocopherol
saline
MISCONCEPTION
Phosphatidylcholine as active ingredient.
Lipolysis as functional activity.
Meso-therapy as injection technique.
CLARIFICATION
Deoxycholate as active ingredient.
Adipocytolysis as functional activity.
Intralipo-therapy as injection technique.
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Phosphatidylcholine“lipostabil”
• On 1966 , germany approve the use of lipostabil(5% phosphatedylcholine , 4.75% deoxycholate) as intravenous infusion for the treatment of intravascular fat embolism, dyslipidemia and liver cirrhosis).
• Few years later, a growing trend of off-label usage of lipostabil in reduction of infra-orbital fat without any clinical evidence.
• Few years later, many generics to lipostabil introduced commercially to the market under different names such as: lipodissolve , lipolight , lipolyse.
• 2010, FDA take restrictive action against these formulations which used for the treatment of localized adiposity after increasing reports of permanent scarring , skin deformations , deep painful nodules.
• Now, phosphatedylcholine is totally banned in Europe.
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2. AQUALYX Composition
aqueous micro-gelatinous solution containing a polymer of
3:6-anhydro-l-galactose and D-galactose, buffer systems,
3,12-Dihydroxy-5-24-oico Cholanic Acid sodium Salt, physiologic solution
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2. AQUALYX Composition cont.,
• Aqueous micro gelatinous solution with a slowly released, short half life time, biocompatible, fat selective and re-absorbable system of modified detergent compound; “ sodium deoxycholate”.
• The adipocytolytic action is enhanced by associated use of external ultrasound.
• AQUALYX must be injected exclusively and only by lipoinject needles with an injection technique called intralipotheraby .
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3. AQUALYX mode of action
• The biocompatible , short half life time , highly selective sodium deoxycholate _without PC_ selectively destroy fat cell membrane initiating the process of adipocitolysis and liberating:
1. the water “absorbed by blood vessels and then excreted through urine”
2. triglycerides “ absorbed by lymphatic drainage system toward the liver where it excreted through stools”.
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3. AQUALYX mode of action cont.,
Sodium Deoxycholate’s biocompatibility
DC is endogenous bile salt ,in the same time a compatible detergent
….. HOW !!?• Metabolically inert
• Excreted in same formula in which they are administrated
• Tissue specific activity
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3. AQUALYX mode of action cont.,
Sodium Deoxycholate’s fat selectivity
DC preferentially targets fat tissue while sparing non fat tissues ... ….. WHY !!!?
• Albumin is a physiological protein, show very high affinity to Deoxycholate , bind to DC forming inactive complex ,absorbed by blood vessels, carry DC. to liver where it rejoins the endogenous bile acid pool.
• Albumin physiological levels in adipose tissue is 0.7% while 1.3% in muscle tissue & 4% in plasma “the sufficient level to completely deactivate the instantly cytotoxic level of DC.”.
• The physiological conc. of albumin in protein rich tissues such as “skin , muscles , vessels and plasma” deactivates DC-mediated cell lysis , while protein poor tissues “fat” is highly sensitive to DC. Cause of low albumin level.
• The rapid neutralization of DC. Into DC-albumin inactive complex , rapid absorption prevents DC. From accumulation in injection site and produces extensive tissue lysis.
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3. AQUALYX mode of action cont.,
Sodium Deoxycholate’s fat selectivity
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4. AQUALYX Histological Evidence
Histological studies performed ex-vivo show how AQUALYX is capable of producing adipose tissue alterations such as :
• Rupture of fat cell wall
• Homogenization of cytoplasmic vacuoles
• Liberation of triglycerides
A_ normal adipose tissue.
B_1% DC treated adipose tissue.
C_ foamy macrophages “grey arrows”.
D_ free lipid droplets “blue arrow” & remnants of
destroyed adipocytes “black arrow” .
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4. AQUALYX Histological Evidence cont.,
Histological section under high power electronic microscope
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INTRALIPOTHERAPY
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5. AQUALYX clinical evidences
• Dr.Raffaele Rauso
• Dr.Antonio Rusciani
• Dr.Giuseppe CuringaAUTHOR
• Maxillo-Facial Surgery ,Centro Polispecialistico Santa Apollonian, Italy.
• University Of Foggi, Foggia , Italy.
• Department Of Plastic Surgery, La Sapienza, University Rome, Italy.
• Skinlaser, Plastic Surgery Center, Rome, Italy.
• Venuslab, Plastic Surgery Center, Rome, Italy.
LOCATION
• Journal Of Drugs In Dermatology , October2014, Volume 13 , Issue 10.
• Dr.raffaele rauso……………………………[email protected].
PUPLICATION
&
Author
correspondence
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5. AQUALYX clinical evidences CONT.,
•Dr. Hernan Pento
•Dr. Carlota Hernandez
•Dr. Cinara Turra
•Dr. Marisa Manzano
•Dr. Laura Salvador
•Dr. Paloma Tejero
AUTHOR
• Instituto de Investigaciones para las Especialidades Esteticas y del Envejecimiento , Barcelona , Spain.
• Clinica Arts Medica, Valencia, Spain.
• Beyou Medical Group, Malaga, Spain.
• Antiaging Group, Barcelona, Spain.
• Clinica Mediestetic, Toledo, Spain.
LOCATION
• Journal Of Drugs In Dermatology , December 2014, Volume 13 , Issue 12.
• Dr.Hernan Pento……………………………………………[email protected]
PUPLICATION
&
Author Correspondence
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5. AQUALYX clinical evidences CONT.,
• Dr. Giovanni Salti.
• Dr. Pasquale Motolese.AUTHOR
• Instituto Medilight, Florence, Italy.
• Professor FORMEST university of ferrara, Italy.LOCATION
• The European Journal of Aesthetic Medicine and Dermatology, Feb. 2012.
• Dr. Giovanni Salti…………………………[email protected].
PUPLICATION
&
Author Correspondence
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5. AQUALYX clinical evidences CONT.,
• Dr. Hernan Pinto
• Dr. Graciela Melamed
• Dr.Luca Fioravanti
AUTHOR
• Age back, Barcelona
• MEG Group, Buenos Aires
• Thermalift Centre, PaviaLOCATION
• The European Journal of Aesthetic Medicine and Dermatology, Feb. 2012.
• Dr.Hernan Pento………………………………….…………[email protected].
PUPLICATION
&
Author Correspondence
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5. AQUALYX clinical evidences CONT.,
• Dr. Raffaele RausoAUTHOR
• Consultant Aesthetic & Maxillo-Facial Surgery, Centro Polispecialistico Santa Apollonia, S.M.C.V (CE), ItalyLOCATION
• The European Journal of Aesthetic Medicine and Dermatology, Jan. 2011.
• Dr.Raffaele Rauso………………………….…………[email protected].
PUPLICATION
&
Author Correspondence
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5. AQUALYX clinical evidences CONT.,
• Dr. El Kamshoushy A.
• Dr. Adel Maksoud R.
• Dr. El Mahdy N.
AUTHOR
• Department of Dermatology , Venereology and Andrology , Faculty of Medicine , University of Alexandria , Egypt. LOCATION
• Journal of Clinical and Experimental Dermatology Research , 2012 Volume 3 Issue 2.
PUPLICATION
&
Author Correspondence
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5. AQUALYX clinical evidences CONT.,
• Dr. Rattapon Thuangtong
• Dr. Jason J. Bentow
• Dr. Kristeene Knopp
• Dr. Nader A. Mahmood
• Dr.Nathaniel E. David
• Dr. Michael S. Kolodney
AUTHOR
• Department of Dermatology , Harbor-University of California at Los Angeles Medical Center and Los Angeles Biomedical Research Institute , Torrance , California.
LOCATION
• the American Society for Dermatologic Surgeries , 2010 , Published by Wiley Periodicals Inc..
• Dr. Michael S. Kolodney……………………………………………………[email protected]..
PUPLICATION
&
Author Correspondence
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5. AQUALYX clinical evidences CONT.,
• Dr. Adam M. RotundaAUTHOR
• Department of Dermatology , Harbor-University of California at Los Angeles Medical Center and Los Angeles Biomedical Research Institute , Torrance , California.
LOCATION
• the American Society for Dermatologic Surgeries , 2009 , Published in Dermatologic Surgery May 2009 Volume 35 Issue.
PUPLICATION
&
Author Correspondence
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5. AQUALYX clinical evidences CONT.,
• Dr. Roberto Amore
• Dr. Kostas Gritzalas
• Dr. Domenico Amuso
• Dr.Loredana Tanzarella
• Dr. Vincenza Leonardi
AUTHOR
• Department of Dermatology , University of Palermo , Italy . LOCATION
• the European Journal of Aesthetic and Dermatology , Dec. 2015 Volume 3.
• Dr. Roberto Amore…………………[email protected].
• Dr. Kostas Gritzzalas……………………[email protected].
PUPLICATION
&
Author Correspondence
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6. AQUALYX Indications
• The best results can be obtained in patients with an average body weight or slightly over weight with local accumulation of fat , AQUALYX not indicated for obese patients .
• Same as liposuction target areas ; “over the knee, under the jaw” .
• Indicated areas are :
1. Buffalo hump
2. Sub mental fat “double chin”
3. Knee fat
4. Humero tricipital fat “arm fat”
5. Pseudo gynecomastia
6. Inner & outer thighs
7. Thoracic folds
8. Love handles “bananas”
9. Abdomen
10. Culottes de cheval
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7. AQUALYX Contraindications
1. Pregnant and breast feeding woman.
2. Auto-Immune diseases.
3. Serious systemic diseases “kidney , hepatic failure”.
4. Acute or chronic pathologies in the skin of treated area.
5. Positive history to anaphylactic reaction.
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8. AQUALYX Safety data
• AQUALYX is registered as medical device “ class 3 medical device CE0373” for the reduction of localized adipose deposits through the use of intralipotherapy technique.
• Sold in more than 50 countries worldwide including : UK , RUSSIA , GERMANY , SPAIN , ITALY , GREECE , ….
• Locally registered in GCC .
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9. AQUALYX & Intra lipotherapy
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9. AQUALYX protocol of injection
• No dermal and muscular tissue involvement ( safe ).
• Rapid .
• Non painful .
• Limited number of injections .
• Secure (selective)
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9. AQUALYX protocol of injection cont.,
• Patient measurements
All patients measurements and zones marking should be done on upright stand position.
• 3 Dimensional Dose calculation
Tota
l do
se If skin pinch test less than 3 cm
One vial for each 100 cc
Example: area of 25 cm * 10 cm = 250 cc “needs 2.5 vials”
If skin pinch test more than 3 cm
One and half vial for each 100 cc
Example: area of 25 cm* 10 cm = 250 cc “needs 3.75 vial”
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9. AQUALYX protocol of injection cont.,
• Maximum dose per areaT h e t o t a l i n j e c t e d d o s e s h o u l d n o t e x c e e d 6 v i a l s / t r e a t e d a r e a .
• Maximum dose per session T h e t o t a l i n j e c t e d d o s e s h o u l d n o t e x c e e d 6 v i a l s / s e s s i o n , i n c a s e o f i n j e c t i o n o f m o r e
t h a n o n e a r e a i n t h e s a m e s e s s i o n .
• Level of injectionT h e i n j e c t i o n m u s t b e d o n e i n t h e d e e p f a t t i s s u e n o t s u p e r f i c i a l ; w h e r e t h e p h y s i c i a n c a n n o t v i s u a l l y r e c o g n i z e t h e n e e d l e u n d e r t h e s k i n s u r f a c e .
• Injection techniqueT h e i n j e c t i o n t e c h n i q u e i s r e t r o g r a d e f a n n i n g t e c h n i q u e ; w h e r e t h e p h y s i c i a n i n j e c t t h e m a t e r i a l w h i l e w i t h d r a w t h e n e e d l e b a c k w a r d l y .
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9. AQUALYX protocol of injection cont.,
• Infiltration rate T h e i n f i l t r a t i o n r a t e o f t h e i n j e c t i o n i s 0 . 3 m l i n e a c h s i n g l e p a s s o f t h e n e e d l e i n s i d e t h e
f a t t i s s u e ; w h e r e t h e p h y s i c i a n s h o u l d d o 2 4 p a s s e s a p p r o x i m a t e l y p e r e a c h v i a l .
• Lidocaine anesthesiaA d d 0 . 3 m l o f l i d o c a i n e 2 % f o r e a c h A Q U A LY X v i a l “ 8 m l ” , i m m e d i a t e l y b e f o r e t h e
p r o c e d u r e a n d w e l l m i x t h e c o m b i n a t i o n .
• Sessions intervalT h e r e c o m m e n d e d s e s s i o n ’ s i n t e r v a l i s 2 1 d a y s .
• Sessions interval for a new treated areaT h e r e c o m m e n d e d s e s s i o n ’ s i n t e r v a l i s 1 0 d a y s .
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9. AQUALYX protocol of injection cont.,
• Required number of treatment sessions T h e n u m b e r o f t r e a t m e n t s e s s i o n s i n t h e s a m e t r e a t m e n t a r e a d e p e n d s o n t h e f a t v o l u m e . To a c h i e v e t h e d e s i r a b l e r e s u l t s 4 t r e a t m e n t s a r e r e q u i r e d .
• Result evaluationT h e f i r s t r e s u l t e v a l u a t i o n c a n b e c a r r i e d o u t a f t e r 4 2 d a y s f r o m t h e f i r s t t r e a t m e n t ;
“ o n t h e d a y o f t h e t h i r d s e s s i o n ”.
• After treatment symptomsT h e t y p i c a l s y m p t o m s o f t h e t r e a t m e n t a r e e d e m a a n d l i g h t b r u i s i n g , t h e s e s y m p t o m s
w i l l s u b s i d e i n l e s s t h a n 5 d a y s , h o w e v e r , t h e p a t i e n t s c a n r e t u r n t o t h e i r d a i l y r o u t i n e
j u s t a f t e r t h e t r e a t m e n t s e s s i o n w i t h z e r o d o w n t i m e .
• Aqualyx side effectsI n c a s e t h e t r e a t m e n t i s n o t p e r f o r m e d c o r r e c t l y , a n d t h e i n i n f i l t r a t i o n i s s u p e r f i c i a l a
p a i n s e n s a t i o n a n d e r y t h e m a w i l l o c c u r. H o w e v e r n e c r o s i s h a s n e v e r o c c u r r e d .
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9. AQUALYX protocol of injection cont.,
• Recommendations• P r e s s - t h e r a p y• Ly m p h a t i c d r a i n a g e• C a r b o x i - t h e r a p y
• Recommended supplements• A m i n o a c i d s• C a r n i t i n e
• Contra- indicated procedures “4 days after treatment”• R a d i o - f r e q u e n c y• C r y o - l i p o l y s i s• O t h e r k i n d s o f m a s s a g e• P h y s i c a l i n t e n s e a c t i v i t y
• Expected results• I n d o u b l e c h i n , e x c e l l e n t r e s u l t s o b t a i n e d f r o m o n l y o n e s e s s i o n .• I n s m a l l a r e a s , e x c e l l e n t r e s u l t s o b t a i n e d q u i c k l y f r o m f e w s e s s i o n s .• I n l a r g e a r e a s , s a t i s f a c t o r y r e s u l t s “ 2 _ 5 c m r e d u c t i o n ” w i t h t h e f i r s t s e s s i o n , h o w e v e r , t h e
p a t i e n t s h o u l d c o m p l e t e t h e t r e a t m e n t c o u r s e ( 4 _ 6 s e s s i o n s ) t o o b t a i n e x c e l l e n t r e s u l t s .
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9. AQUALYX protocol of injection cont.,
• Injecting needle “ lipoinject”
• Specifically designed for intralipotherapy technique. made of top
quality German steel, guarantee a painless and easy penetration and
size defined by a specific study of flows to a selective and
homogeneous infiltration.
• Available in two versions for the treatment of small and large areas of
the body “25G/70mm” & “25G/100mm” respectively.
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10. AQUALYX pricing recommendations ,
• t h e p r i c i ng s ys t em s h oul d be on t h e ba s i s of t h e s i ze of t h e t r ea t ed
a r ea n o t t h e n umber o f t h e i n ject ed v i a l s .
Double chin
• The session charge : 350 _ 450 dollar # 1250_1600 aed / session.
• The clinic cost : (½ _ 1 vial) (1 _2 sessions) = 20_40 dollar # 70 _150 aed /session
Small areas
• The session charge: 400_500 dollar # 1500_ 1800 aed /session.
• The clinic cost : (1_3 vials) (2_4 sessions) = 40_120 dollar _ 150_450 aed / session.
Large areas
• The session charge: 550_700 dollar # 2000_ 2500 aed / session.
• The clinic cost : (3_6 vials) (4_6 sessions) = 160_240 dollar # 575 _ 860 aed / session.
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AQUALYX Photo-Gallery
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ABDOMEN 3 SESSIONS _ 4 VIALS / SESSION
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ABDOMEN 3 SESSIONS _ 4 VIALS / SESSION
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ABDOMEN 3 SESSIONS _ 4 VIALS / SESSION
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ABDOMEN 5 SESSIONS _ 4 VIALS / SESSION
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ABDOMEN 5 SESSIONS _ 4 VIALS / SESSION
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ABDOMEN 5 SESSIONS _ 4 VIALS / SESSION
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Bananas 3 SESSIONS _ 3 VIALS / SESSION
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Pseudo-gynecomastia 3 SESSIONS _ 3 VIALS / SESSION
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Back rolls 2 SESSIONS _ 6VIALS / SESSION
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Back rolls 2 SESSIONS _ 6VIALS / SESSION
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Back rolls 4 SESSIONS _ 4VIALS / SESSION
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Back rolls 4 SESSIONS _ 3VIALS / SESSION
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Thighs 4 SESSIONS _ 4VIALS / SESSION
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Thighs 3 SESSIONS _ 6 VIALS / SESSION
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Thighs 5 SESSIONS _ 4 VIALS / SESSION
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Thighs 5 SESSIONS _ 4 VIALS / SESSION
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Thighs 6 SESSIONS _ 4 VIALS / SESSION
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Thighs 5 SESSIONS _ 4 VIALS / SESSION
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Thighs 5 SESSIONS _ 4 VIALS / SESSION
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Thighs 4 SESSIONS _ 4 VIALS / SESSION
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Thighs 1 SESSION _ 4 VIALS / SESSION
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Thighs 6 SESSIONS _ 4 VIALS / SESSION
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Double chin 3 SESSIONS _ 1 VIAL / SESSION
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Double chin 3 SESSIONS _ 1 VIAL / SESSION
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AQUALYX
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AQUALYX
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AQUALYXThe Medical Advisor and Trainer
Dr. Gkritzalas konstantinos• Dermatologist, University of Bologna, Italy.
• Opinion Leader & Certified Trainer Greece, Turkey, ΕΜΕΑ,Russia , GCC.
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AQUALYX
THANKS !