皮膚科王修含醫師

王修含醫師演講公告：針劑注射部位之組織構造與施打應注意技巧詳解

【王修含醫師：演講公告】
日期：2018年05月20日(星期日)
時間：11:00~12:30 (90min)
主題：針劑注射部位之組織構造與施打應注意技巧詳解
講師：王修含醫師王修含皮膚科診所
主辦單位：中華民國美容醫學醫學會
課程名稱：2018年微整形(手術)療法教育訓練
上課地點：文化大學大新館4樓數位演講廳(台北市延平南路127號)-捷運板南線-西門捷運站3號出口
人數：80人(僅開放本會醫師報名，座位有限，請勿攜伴)

課程目的：
增進微整形治療醫師對針劑注射部位組織與解剖學構造更深層的瞭解，藉由施打應注意技巧詳解，學習高階微整形治療技術，並避免針劑注射副作用與併發症的發生。
例如：課程中將提及筆者(王修含醫師)利用解剖學與組織學原理，研發的新式治療術式，可應用於眼袋與淚溝之創新性治療，稱為「淚溝靭帶調整填充術」，合併解剖學概念，經由淚溝靭帶張力調整術式，配合注射填充玻尿酸或膠原蛋白，可同時改善眼袋與淚溝的狀況。

實際治療中，除了調整淚溝靭帶(tear trough ligament)的張力，需視每個人略有差異的解剖學構造，同時處理顴骨隔膜(又稱為「臉頰間隔」malar septum)的空間限制，以及眼輪匝肌支持靭帶(orbicularis retaining ligament)與顴弓皮膚靭帶(zygomatic cutaneous ligament)造成的張力問題，才能得到最佳的美學結果。

本站QR code，感謝您的閱讀 https://www.skin168.net/

上述解剖學概念，將於本次課程中詳細說明，請參見「淚溝靭帶調整填充術-眼袋淚溝創新性治療」http://www.skin168.net/2015/07/tear-trough-eyebag.html

中華民國美容醫學醫學會「微整形(手術)療法教育訓練」課後測驗題庫

主題：針劑注射部位之組織構造與施打應注意技巧詳解

出題者：王修含醫師

1. 關於微整形治療時使用的注射填充物(injectables)，以下何者正確？

A. 影響玻尿酸填充物持久性的因素包括：濃度、顆粒大小、交聯劑

B. 常用於玻尿酸填充物的交聯鍵結劑包括：ether bonds (BDDE = 1,4- butandiol diglycdyl ether)與ester bonds (DVS = divinylsulfone)

C. 玻尿酸、氫氧磷灰石鈣(氫氧基磷酸鈣，calcium hydroxyapatite, CaHA)、膠原蛋白，都可用於注射填充物的材質

D. 注射填充物時，針頭的選擇方面，不論是鈍針和銳針，都是針頭愈細，愈容易增加血管內注射的風險

E. 以上皆是

答案：E
參考文獻：
(1) In Vivo. 2009 May-Jun;23(3):479-86.
Assessment of a new hyaluronic acid filler. double-blind, randomized, comparative study between Puragen and Captique in the treatment of nasolabial folds.
Onesti M, Toscani M, Curinga G, Chiummariello S, Scuderi N.
(2) Dermatol Surg. 2013 Dec;39(12):1758-66. doi: 10.1111/dsu.12301. Epub 2013 Aug 13.
A review of the metabolism of 1,4-butanediol diglycidyl ether-crosslinked hyaluronic acid dermal fillers. De Boulle K, Glogau R, Kono T, Nathan M, Tezel A, Roca-Martinez JX, Paliwal S, Stroumpoulis D.
(3) Aesthet Surg J. 2013 Aug 1;33(6):862-77. doi: 10.1177/1090820X13493638. Epub 2013 Jul 3.
Complications following injection of soft-tissue fillers. Ozturk CN, Li Y, Tung R, Parker L, Piliang MP, Zins JE.
(4) Clin Cosmet Investig Dermatol. 2013 Dec 12;6:295-316. doi: 0.2147/CCID.S50546.
Dermal fillers in aesthetics: an overview of adverse events and treatment approaches. Funt D, Pavicic T.

2. 關於顳部(太陽穴, temple)的組織解剖構造，下列何者正確？

A. 周圍的支持靭帶包括：上緣是(superior temporal septum, STS)，下緣是(inferior temporal septum, ITS)，STS與ITS交界處是Temporal ligamentary adhesion (TLA)

B. ITS下方有神經通過，包括temporal branches of facial nerve (TBFN)與zygomaticotemporal nerve (ZTN)

C. 顳部本身，在STS與ITS之間，完全沒有神經通過

D. 在sentinel vein(SV)附近可找到zygomaticotemporal nerve (ZTN)，此為手術時需注意的標的物

E. 以上皆是

答案：E
參考文獻：
(1) Plastic Surgery Volume 2: Aesthetic Surgery, Third edition 2013
Ch.6 Anatomy of the aging face, Bryan Mendelson and Chin-Ho Wong
(2) Aesthet Surg J. 2013 Aug 1;33(6):769-82. doi: 10.1177/1090820X13495405. Epub 2013 Jul 12. Retaining ligaments of the face: review of anatomy and clinical applications. Alghoul M, Codner MA.
(3) Rom J Morphol Embryol. 2013;54(3 Suppl):757-61. Anatomical evidence regarding the existence of sustentaculum facies. Frâncu LL, Hînganu D, Hînganu MV.
(4) Arch Facial Plast Surg. 2006 Jul-Aug;8(4):245-51. Safety and efficacy of midface-lifts with an absorbable soft tissue suspension device. Newman J.

3. 以下何者不是老化(aging)的特徵？

A. Tear trough deformity

B. Increased vertical eyelid length (elongated lower eyelid)

C. High malar fat pad without malar crescent, cheek bulging

D. Prominent nasolabial fold

E. Platysmal ptosis, prejowl Sulcus & jowl formation

答案：C，這是年輕的特徵

參考文獻：

(1) J Oral Maxillofac Surg. 2010 Jun;68(6):1420-9. doi: 10.1016/j.joms.2009.12.004. Epub 2010 Apr 9. Essentials of cheek and midface implants. Niamtu J 3rd.

(2) J Clin Aesthet Dermatol. 2011 Dec;4(12):32-6. Avoiding malar edema during midface/cheek augmentation with dermal fillers. Funt DK.

(3) Plast Reconstr Surg. 2012 Jun;129(6):1392-402. doi: 10.1097/PRS.0b013e31824ecd77. The tear trough ligament: anatomical basis for the tear trough deformity. Wong CH, Hsieh MK, Mendelson B.

(4) M.E. Hartstein et al. (eds.), Midfacial Rejuvenation, DOI 10.1007/978-1-4614-1007-2_2, © Springer Science+Business Media, LLC 2012

Ch.2 The Anatomic Basis of Midfacial Aging. Allan E. Wulc , Pooja Sharma , and Craig N. Czyz

4. 以下何者不是老化症狀(aging sign)的成因？

A. 軟組織下垂與中臉體積減少，造成下眼瞼長度增加

B. 凹下處與韌帶(ligaments)的骨質起點(osseous origins)有關

C. 膨起處與韌帶鬆弛(ligamentous attenuation)，伴隨脂肪位移有關

D. 臉部支持韌帶(retaining ligaments)在臉部會形成溝狀結構

E. 眼眶骨質增生，造成眼周老化

答案：E，應是骨質再吸收reabsorption

參考文獻：

(1) J Oral Maxillofac Surg. 2010 Jun;68(6):1420-9. doi: 10.1016/j.joms.2009.12.004. Epub 2010 Apr 9. Essentials of cheek and midface implants. Niamtu J 3rd.

(2) M.E. Hartstein et al. (eds.), Midfacial Rejuvenation, DOI 10.1007/978-1-4614-1007-2_2, © Springer Science+Business Media, LLC 2012

Ch.2 The Anatomic Basis of Midfacial Aging. Allan E. Wulc , Pooja Sharma , and Craig N. Czyz

(3) Aesthetic Plast Surg. 2012 Aug;36(4):753-60. doi: 10.1007/s00266-012-9904-3. Epub 2012 May 12. Changes in the facial skeleton with aging: implications and clinical applications in facial rejuvenation.

Mendelson B, Wong CH.

(4) Facial Plast Surg. 2013 Feb;29(1):40-5. doi: 10.1055/s-0033-1333839. Epub 2013 Feb 20. Understanding midfacial rejuvenation in the 21st century. Chaiet SR, Williams EF 3rd.

5. 從臉部表面，垂直往下進行組織解剖，以下順序何者為是？

(1) Dermis (2) Retinacular cutis (3) SMAS (4) retaining ligament (5) periosteum

A. 12345 B. 13245 C. 12435 D. 13425 E. 21435

答案：A
參考文獻：Plastic Surgery Volume 2: Aesthetic Surgery, Third edition 2013
Ch.6 Anatomy of the aging face, Bryan Mendelson and Chin-Ho Wong

6. 關於臉部支持韌帶(retaining ligaments)，以下敘述何者為非？

A. 臉部支持韌帶(retaining ligaments)有三種形態：septae, adhesions, true ligaments

B. Zygomatic ligament, masseteric ligaments, mandibular ligament是屬於true ligaments

C. 臉部支持韌帶(retaining ligaments)的形態像一棵樹，樹根在periosteum，然後樹枝往皮膚發展

D. 在骨性顱腔(bony cavities)外的支持韌帶系統，具有穩定顱腔外軟組織的作用

E. 老化時，支持韌帶較結實，而且韌帶之間的空間轉變較不可分辨

答案：E，這是年輕的特徵
參考文獻：Plastic Surgery Volume 2: Aesthetic Surgery, Third edition 2013
Ch.6 Anatomy of the aging face, by Bryan Mendelson and Chin-Ho Wong

7. 眼周老化過程中，orbicularis retaining ligament (orbitomalar ligament)的鬆弛會造成哪個組織的下垂？

A. retro-orbicularis oculus fat (ROOF)

B. sub-orbicularis oculi fat (SOOF)

C. levator palprae superioris muscle

D. pre-septal fat

E. post-septal fat

答案：B

參考文獻：G.G. Massry et al. (eds.), Master Techniques in Blepharoplasty and Periorbital Rejuvenation, DOI 10.1007/978-1-4614-0067-7_2, c Springer Science+Business Media, LLC 2011. Ch.2 Surgical Anatomy of the Forehead, Eyelids, and Midface for the Aesthetic Surgeon. Kevin S. Tan, Sang-Rog Oh, Ayelet Priel, Bobby S. Korn, and Don O. Kikkawa

8. 眼周骨骼老化過程中，會造成多種變化，以下何者為非？

A. increased prominence of the medial fat pad

B. elevation of the medial brow

C. lengthening of the lid cheek junction

D. High malar fat pad

E. Resorbing of the superomedial and inferolateral aspects of the orbit

答案：D，這是年輕的特徵

參考文獻：

(1) J Oral Maxillofac Surg. 2010 Jun;68(6):1420-9. doi: 10.1016/j.joms.2009.12.004. Epub 2010 Apr 9. Essentials of cheek and midface implants. Niamtu J 3rd.

(2) M.E. Hartstein et al. (eds.), Midfacial Rejuvenation, DOI 10.1007/978-1-4614-1007-2_2, © Springer Science+Business Media, LLC 2012

Ch.2 The Anatomic Basis of Midfacial Aging. Allan E. Wulc , Pooja Sharma , and Craig N. Czyz

Mendelson B, Wong CH.

(4) Facial Plast Surg. 2013 Feb;29(1):40-5. doi: 10.1055/s-0033-1333839. Epub 2013 Feb 20. Understanding midfacial rejuvenation in the 21st century. Chaiet SR, Williams EF 3rd.

9. 關於微整形注射併發症，以下敘述何者為非？

A. 玻尿酸注射後的臉頰水腫(malar edema)，成因與臉頰筋膜(顴骨隔膜，又稱為「臉頰間隔」malar septum)及sub-orbicularis oculi fat (SOOF)有關

B. 氫氧基磷酸鈣(calcium hydroxylapatite)不可施打於嘴唇，否則可能會出現結節(nodules)

C. 自體脂肪移植相當於大容量玻尿酸填補，可根據注射部位精準矯正

D. 由於材質特性，聚左乳酸(poly-L-lactic acid, PLLA)比玻尿酸、氫氧基磷酸鈣容易發生異物性肉芽腫(foreign body granuloma)

E. 眼周、鼻周的區域施打要非常注意，有發生血管內注射的機率，但避開這兩處區域，仍可能有這種狀況

答案：C, 由於有存活率的問題，自體脂肪移植無法精準預估最後存活的脂肪容積，也無法一次移植過多的脂肪細胞，以免不利於存活率，故可能需要多次手術。(Plast Reconstr Surg. 2015 Oct;136(4):897-912. "Serial transplantation may be more beneficial in some cases to reduce the burden of the underlying tissue to undergo angiogenesis and enhance long-term survival of fat grafts.")

參考文獻：

(1) Clin Cosmet Investig Dermatol. 2013 Dec 12;6:295-316. doi: 10.2147/CCID.S50546. Dermal fillers in aesthetics: an overview of adverse events and treatment approaches. Funt D, Pavicic T.

(2) Aesthet Surg J. 2014 Feb;34(2):235-48. doi: 10.1177/1090820X13517897. Epub 2014 Jan 15. Malar mounds and festoons: review of current management. Kpodzo DS, Nahai F, McCord CD.

(3) J Clin Aesthet Dermatol. 2011 Dec;4(12):32-6. Avoiding malar edema during midface/cheek augmentation with dermal fillers. Funt DK.

(4) J Drugs Dermatol. 2007 Aug;6(8):846-7. Radiesse nodule of the lips from a distant injection site: report of a case and consideration of etiology and management. Beer KR.

(5) Aesthet Surg J. 2013 Aug 1;33(6):862-77. doi: 10.1177/1090820X13493638. Epub 2013 Jul 3. Complications following injection of soft-tissue fillers. Ozturk CN, Li Y, Tung R, Parker L, Piliang MP, Zins JE.

(6) Plast Reconstr Surg. 2015 Oct;136(4):897-912. doi: 10.1097/PRS.0000000000001590. The Current State of Fat Grafting: A Review of Harvesting, Processing, and Injection Techniques. Strong AL, Cederna PS, Rubin JP, Coleman SR, Levi B.

(7) Dermatol Surg. 2005 Jul;31(7 Pt 1):772-6; discussion 776. NewFill for skin augmentation: a new filler or failure? Beljaards RC, de Roos KP, Bruins FG.

(8) Aesthet Surg J. 2013 Aug 1;33(6):862-77. doi: 10.1177/1090820X13493638. Epub 2013 Jul 3. Complications following injection of soft-tissue fillers. Ozturk CN, Li Y, Tung R, Parker L, Piliang MP, Zins JE.

10. 將填充物(fillers)注射至眼動脈(ophthalmic artery)的遠端分枝(distal branches)，可能造成視網膜動脈(retinal artery)阻塞，造成失明的併發症。以下何者不是眼動脈的遠端分枝？

A. angular artery

B. zygomatico temporal artery & zygomatico facial artery

C. dorsal nasal artery

D. supratrochlear artery & supraorbital artery

E. superficial temporal artery

答案：E

參考文獻：

(1) Clin Cosmet Investig Dermatol. 2013 Dec 12;6:295-316. doi: 10.2147/CCID.S50546. Dermal fillers in aesthetics: an overview of adverse events and treatment approaches. Funt D, Pavicic T.

(2) G.G. Massry et al. (eds.), Master Techniques in Blepharoplasty and Periorbital Rejuvenation, DOI 10.1007/978-1-4614-0067-7_2, c Springer Science+Business Media, LLC 2011. Ch.2 Surgical Anatomy of the Forehead, Eyelids, and Midface for the Aesthetic Surgeon. Kevin S. Tan, Sang-Rog Oh, Ayelet Priel, Bobby S. Korn, and Don O. Kikkawa

(3) Dermatol Surg. 2009 Oct;35 Suppl 2:1635-40. doi: 10.1111/j.1524-4725.2009.01342.x. The risk of alar necrosis associated with dermal filler injection. Grunebaum LD, Bogdan Allemann I, Dayan S, Mandy S, Baumann L.

11. 骨骼老化過程中，鼻部梨狀區域(pyriform area)的骨質流失，會造成下列何種變化？

A. 鼻翼軟骨外側腳(lateral crura)的支撐變弱

B. 鼻翼軟骨內側腳(medial crura)的支撐變強

C. 鼻尖定義點(tip-defining point)上移

D. 鼻唇角(nasolabial angle)變大

E. 鼻小
柱-唇角(columella-labial angle)不受影響

答案：A
參考文獻：Aesthetic Plast Surg. 2012 Aug;36(4):753-60. doi: 10.1007/s00266-012-9904-3. Epub 2012 May 12. Changes in the facial skeleton with aging: implications and clinical applications in facial rejuvenation. Mendelson B, Wong CH.

12. 骨骼老化過程中，上頜骨(maxilla)的骨質流失，會造成下列何種變化？

A. 顴骨(zygoma)與上頜骨的角度不受影響

B. 鼻唇溝(nasolabial crease)與附近上唇向後移

C. 上頜角(maxillary angle)變大

D. 梨狀角
(pyriform angle)變大

E. 眉間角(glabellar angle)變大

答案：B
參考文獻：
(1) Aesthetic Plast Surg. 2012 Aug;36(4):753-60. doi: 10.1007/s00266-012-9904-3. Epub 2012 May 12. Changes in the facial skeleton with aging: implications and clinical applications in facial rejuvenation. Mendelson B, Wong CH.
(2) M.E. Hartstein et al. (eds.), Midfacial Rejuvenation, DOI 10.1007/978-1-4614-1007-2_2, © Springer Science+Business Media, LLC 2012. Ch.2 The Anatomic Basis of Midfacial Aging.Allan E. Wulc , Pooja Sharma , and Craig N. Czyz

13.      關於肉毒桿菌素的臉部治療與肌肉的關係，下列何者正確？
    A. 抬頭紋-frontalis muscle
    B. 皺眉紋-corrugator & procerus muscles
    C. 魚尾紋-orbicularis oculi muscle
    D. 國字臉-masseter muscle
    E. 以上皆是
        答案：E

參考文獻：

(1) Int J Oral Maxillofac Surg. 2011 Feb;40(2):127-33. doi: 10.1016/j.ijom.2010.09.014. Epub 2010 Oct 20. The use of botulinum toxin type A in cosmetic facial procedures. Jaspers GW1, Pijpe J, Jansma J.

(3) Botulinum Toxin in Aesthetic Medicine. 1st ed. 2007. Corr. 2nd printing, 2009, XX, 138 p. 151 illus. in color., Hardcover. de Maio, Mauricio, Rzany, Berthold.

14.    以下何者不是老化之後，臉部輪廓會出現的跡象？
A.    Malar crescent
B.    Cheek bulging
C.    Nasolabial fold formation
D.    Prejowl Sulcus
E.    Jowl formation
答案：B，應為Cheek depression
參考文獻：
(1) J Oral Maxillofac Surg. 2010 Jun;68(6):1420-9. doi: 10.1016/j.joms.2009.12.004. Epub 2010 Apr 9. Essentials of cheek and midface implants. Niamtu J 3rd.
(2) J Clin Aesthet Dermatol. 2011 Dec;4(12):32-6. Avoiding malar edema during midface/cheek augmentation with dermal fillers. Funt DK.
(3) Plast Reconstr Surg. 2012 Jun;129(6):1392-402. doi: 10.1097/PRS.0b013e31824ecd77. The tear trough ligament: anatomical basis for the tear trough deformity. Wong CH, Hsieh MK, Mendelson B.
(4) M.E. Hartstein et al. (eds.), Midfacial Rejuvenation, DOI 10.1007/978-1-4614-1007-2_2, © Springer Science+Business Media, LLC 2012. Ch.2 The Anatomic Basis of Midfacial Aging. Allan E. Wulc , Pooja Sharma , and Craig N. Czyz

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議程表
2018 年微整形(手術)療法教育訓練-基礎課程
(因可能有各種不可抗拒因素產生，故主辦單位保留各項活動、講題及講師異動權利，請見諒！)

時間/講題/講師/內容
2018 年 05 月 20 日(日)
＊美容醫學停看聽

美容醫學總論及應用
莊德揚醫師
立悅皮膚科診所
1.微整入門的第一堂課
2.醫學美容的過去、現在與未來
3.如何切入醫美市場-技術為本

美容醫學常見法律問題及案例解析
許朝程副局長
新北市政府衛生局
1.美容醫學醫療法令規定
2.美容醫學糾紛之主要原因及案例分享
3.醫療糾紛的處理方及與案例分享

針劑注射部位之組織構造與施打應注意技巧詳解
王修含醫師
王修含皮膚專科診所
1.臉部詳細解剖構造依照頭/眉/
眼/鼻/雙頰/唇/頸各部位紋理
2.血管走向之解剖學變異 (variations)


＊微整形(手術)療法填充物系列-上
微整形(手術)療法填充物系列-Ellanse S
1.Ellanse S 介紹與臨床應用
2.Ellanse S 治療注射技巧治療注意事項與臨床案例
林上立醫師
上立皮膚醫美診所

微整形(手術)療法填充物系列-玻尿酸的醫療美學應用
1.玻尿酸種類
2.各種玻尿酸治療技巧與臨床應用
3.玻尿酸治療注射技巧治療注意事項與臨床案例
于曉恩醫師
米蘭時尚診所

微整形(手術)療法填充物系列-3D 聚左旋乳酸(Sculptra)
1. Sculptra 特性介紹與臨床應用
2. Sculptra 注射技巧治療注意事項與臨床案例
張光正醫師
立新美學診所

1.美容醫學美學評估
2.產品治療合併使用
黃耀立醫師
長庚醫院桃園分院美容醫學中心
1.如何掌握美學在美容醫學的應用
2.產品治療合併使用案例探討

2018 年 05 月 27 日(日)
＊微整形(手術)療法填充物系列-下

「Silhoutte soft＆ Silhoutte suture 大小聚左旋乳酸鈴鐺線」臨床應用
索南多杰醫師
索南醫美中心
1.Silhoutte soft＆ Silhoutte suture 臨床應用
2 Silhoutte soft＆ Silhoutte suture 注射技巧治療注意事項

微整形(手術)療法填充物系列-晶亮瓷 CaHA
陳美齡醫師
美麗爾醫學美容機構
1.CaHA 晶亮瓷介紹與臨床應用
2.CaHA 晶亮瓷治療注射技巧治療注意事項與臨床案例

微整形(手術)療法填充物系列-肉毒桿菌
黃金財醫師
佑美診所
1.肉毒桿菌特性介紹與臨床應用
2.正確的溝通及施打評估、過量施打及術後因應之方法
3.肉毒桿菌的注射技巧治療注意事項與臨床案例

尖針與鈍針的施打技巧與經驗分享
莊堅文醫師
都市麗人美醫診所
1.尖針與鈍針簡介及使用技巧
2.尖針與鈍針應用經驗分享

＊微整型-你不可不知道的事
微整型併發症處理
孫孝先醫師
維昕診所
1.微整風險與問題處理
2.治療特殊案例探討
3.降解酶產品說明
4.玻尿酸降解酶經驗分享
5.技術為本溝通為輔的經營之道

美醫會結訓考試

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王修含醫師AMWC Asia-TDAC演講：超音波影像、光電治療

演講資訊

共計兩場
第一場
時間：2018年5月5日 10:10-10:25
題目：Applications of ultrasound imaging in the dermatology & aesthetic medicine
講師：Dr. Shiou-Han Wang, 王修含醫師
地點：台北國際會議中心(TICC)

第二場
時間：2018年5月5日 17:30-17:45
題目：Can we and should we use energy-based devices for young people?
講師：Dr. Shiou-Han Wang, 王修含醫師
地點：台北國際會議中心(TICC)

會議名稱：AMWC ASIA 2018 | Aesthetic & Anti-aging Medicine World Congress Asia
                  AMWC Asia-TDAC
                  6th Taiwan Dermatology Aesthetics Conference
                 第一屆世界美容醫學高峰會亞洲大會
                 第六屆臺灣皮膚科美容醫學學術研討會
                 臺灣皮膚科醫學會春季學術研討會
                 台灣皮膚暨美容外科醫學會年會
Official language: English
主辦單位：Aesthetic & Anti-aging Medicine World Congress & Taiwan Dermatology Aesthetic Conference

感謝主辦單位台灣皮膚科醫學會與AMWC的用心，本次國際會議相當盛大，且圓滿成功。

Abstract

Applications of ultrasound imaging in the dermatology & aesthetic medicine

Dr. WANG, Shiou-Han

In recent years, with the development of high-frequency transducer, dermatologic diagnostic ultrasound have begun to receive attention. Frequencies for general ultrasound devices are usually between 2-15 MHz. The higher the frequency, the higher the resolution, but the penetration depth would be shallower. Therefore, high-frequency ultrasound is suitable for medical and aesthetic dermatology. The transducer requires at least 10 MHz, even up to 20MHz or 50MHz.

We can apply ultrasound not only for the diagnosis of skin diseases but also for aesthetic purposes to improve the effectiveness and safety of the treatment. For example, in cosmetic medicine:

1. During radiotherapy, the thickness of the dermal layer and subcutaneous tissue can be measured by ultrasound to estimate the thermal relaxation time to avoid soft tissue burns and determine the best timing for overlapping energy to improve the therapeutic effect.

2. Before firing microfocused ultrasound, the depth of periosteum can be measured to avoid energy reflection to cause burns or other complications. It also allows the therapist to select the best depth of focus.

3. For fractional laser treatment, the data of dermal thickness can help the physician to select appropriate energy parameters to achieve better results.

4. Ultrasound can evaluate the complications of injectables, such as the range, size, and quantity of foreign body granulomata after PLLA injection. For vascular embolism caused by the hyaluronic acid injection, we can observe the location of the affected blood vessels that can provide a reference point for the injection of hyaluronidase.

5. When targeting the axillae with microwave therapy for hyperhidrosis, ultrasound can evaluate the depth of brachial plexus to avoid nerve injury.

On the scenario of medical dermatology, ultrasound can assist the management of diseases. It can differentiate multiple skin tumors. We can apply ultrasound to assess the extent and depth of severe skin infections (e.g., cellulitis). Besides, ultrasound can help to evaluate and treat many skin disorders. We will discuss the details in the speech.

Can we and should we use energy-based devices for young people?

Dr. WANG, Shiou-Han

"Prevention is better than cure," said Desiderius Erasmus (1466–1536). The aging process is always going, and prevention is the best solution. The energy-based devices (EBD) can provide some aspects of the preventive procedures. For example, UV related pigmentation plays an essential role in the photoaging. Evidence showed solar lentigines(SL) may develop into seborrheic keratoses(SK). We can use EBD to remove the new SL to prevent further SK. Melasma is related to multiple factors, such as epidermal pigmentation and increased vascularization that can be treated with EBD in the first stage to slow down the progress of melasma. Radiofrequency can facilitate the neocollagenesis for the anti-aging purpose. Atrophic and hypertrophic acne scars were revealed to have a negative impact on the quality of life, and we can improve the acne scars with the assistance of EBD.

However, "First, Do No Harm" is always the top priority in the treatment of EBD. If an EBD procedure shows the possibility of a health threat to the young people, we had better postpone the EBD treatment. We will also discuss the possible "debate conditions" that may not be suitable for the young people in the speech.

王修含醫師演講公告：針劑注射部位之組織構造與施打應注意技巧詳解(2018年)

王修含醫師AMWC Asia-TDAC演講：超音波影像、光電治療

演講資訊

Abstract

Applications of ultrasound imaging in the dermatology & aesthetic medicine

Can we and should we use energy-based devices for young people?