19 & 20 November 2022 SUPPORTED BY
IET London: 2 Savoy Place London WC2R 0BL 19 & 20 November 2022 Contents CMAC are proud be to an Accredited CPD Provider CMAC.WORLD 5 6 10 16 18 22 50 52 53 Introduction Agenda Speakers Venue map Exhibitors Lectures and notes Clarius feature Vision Loss Algorithm Vascular Occlusion Algorithm SUPPORTED BY
5 CMAC.WORLD Welcome The Complications in Medical Aesthetics Collaborative (CMAC) was formed in 2020 to promote and facilitate peer to peer collaborative learning and reflection, across the world. WITH A DECADE IN FACIAL AESTHETICS, AWARD WINNING DR ZAINAB ALMUKHTAR BRINGS TOGETHER HOW TO LEARN AND MASTER THE ART OF FACIAL CONTOURING, WITH SAFETY, AND EVIDENCE BASE AS KEY CORNERSTONES DESIGNED TO DEVELOP YOUR AESTHETIC EYE IN FACIAL ASSESSMENT AND BUILD INDIVIDUALISED TREATMENT PLANS, TO PRODUCE BEAUTIFUL NATURAL PATIENT TRANSFORMATIONS FOCUS ON FACIAL RESTRUCTURING PROFILE BALANCING, FEMINISATION, AND MASCULINISATION E - LEARNING & HANDS ON INJECTING LONDON LOCATIONS FACIAL CONTOURING MASTERCLASS BOOK NOW FOR 2023 AWARD WINNING TRAINING ACADEMY, ACQUISITION AESTHETICS INTRODUCES THE in collaboration with The Collaborative is committed to making expert experience and knowledge more accessible across the membership with regular expert discussion, panel discussions and case presentations available to membership, in addition to a range of guidance documents and open access published guidelines. CMAC aims to elevate members’ knowledge, understanding and confidence in the avoidance, diagnosis and management of known complications, and provides peer support via a helpline, via email and on our closed Facebook group. CMAC is proud to be holding its inaugural conference at the Institute of Engineering Technology (IET), a superb venue in the heart of London. “ Two days of CPD of exceptional quality and value” This first conference is titled ‘New Frontiers’ and has been curated to bring new thinking and new technologies to the attention of delegates, with panel discussions to review and share perspectives on present experiences and practices and what changes the future may bring. We are very pleased to be able to offer independently accredited CPD points. We welcome our speakers, of international renown, some not usually seen on the UK circuit, some being introduced for the first time. Many of them form part of our expert International Board, collaborating, supporting and sharing knowledge with our membership, always there to turn to when complex complications present and consensus is needed. “ In the UK we just don’t get to see these International stars, all of whom walk the walk in successful practices and will be sharing experience as well as knowledge. There is no other conference or training that so comprehensively covers all the main complications and will bring the latest evidence and research into the mix, plus real case presentations.” The topics and presentations are free from commercial remit or bias - we have packed a great deal in! (See the agenda on page 6) - and each session will be rounded up with a panel discussion to ensure the broadest perspectives and to answer audience questions. Unlike larger conferences, we do hope delegates will take advantage of the opportunity to interact with speakers and for those attending the drinks reception, there will be further Q and A opportunities. “ Discussion is such a valuable part of learning, opinions and experiences differ but having the differences dissected and challenged elevates learning.” Because the speakers and their presentations are not sponsored we have a very limited number of stands to visit, we are very grateful for the support these companies have provided and hope you will take the time to say hello to each of them and learn something from them too. We are so pleased you are here to share this learning experience in person, meet fellow collaborators and make new friends. Lee Walker CMAC Chair
CMAC CONFERENCE 2022 – NEW FRONTIERS: 19 & 20 NOVEMBER 2022 7 6 CMAC.WORLD Agenda: Saturday Why Ultrasound? A practitioners perspective – Zainab Al-Mukhtar BDS Ultrasound of Upper Third – Steve Weiner MD Mid Third – MJ Rowland-Warmann BDS Lower Third – Steve Harris MD Introduction What lies beneath – Leonie Schelke MD Pathophysiology of ischaemia – Danny Soares MD Stages of progression – Gillian Murray MPharm Case presentation – Jair Mauricio Cerón Bohórquez MD Introduction Overview of filler complications and soft tissue filler – Peter Velthius MD The role of biofilm, immune response and immunogenetics in soft tissue filler complications – Tom Decates MD Nodules and post injection oedema – Leonie Schelke MD Case presentation – Jonathan Hopkirk MD Hyaluronidase: an overview (risks, dose and dilution) – Gillian Murray MPharm The elective use of hyaluronidase – Karim Sayed MD Using hyaluronidase in an emergency – Steve Harris MD Panel Discussion/Q&A Panel Discussion/Q&A Panel Discussion/Q&A Panel Discussion/Q&A Registration and coffee Ultrasound Session Vascular adverse events DONS Hyaluronidase Refreshments and Exhibition Lunch and Exhibition Refreshments and Exhibition END Introduction and welcome – Dr Lee Walker 09:05 09:20 09:35 09:50 10:45 10:50 11:10 11:30 11:45 14:00 14:05 14:25 14:45 15:00 16:00 16:15 16:25 10:05 12:05 15:20 16:40 08:00 10:15 12:30 15:30 17:00 09:00 Agenda: Sunday Introduction Periorbital complications related to soft tissue filler – Sabrina Shah Desai MD Pathophysiology of blindness related to soft tissue filler – Lee Walker BDS Management of blindness related to soft tissue filler – Steve Weiner MD Introduction Why we get neuromodulator complications – Nicola Lowrey PA Avoiding complications with neuromodulator in the lower third – Lee Walker BDS Avoiding complications with neuromodulator in the upper third – Jake Sloane MD Diagnosis and management of eye-lid ptosis – Brittony Croasdell APRN Introduction Adverse events caused by devices – Cormac Convery MD Using devices to treat complications – Emil Henningsen MD Case presentation – Cormac Convery MD Introduction Pathophysiology of soft tissue filler infection – Devan Vaghela MD Antibiotics or steroids in the management of soft tissue filler infection – Gillian Murray MPharm Investigations and testing soft tissue filler infections – Cormac Convery MD Panel Discussion/Q&A Panel Discussion/Q&A Panel Discussion/Q&A Panel Discussion/Q&A Registration and coffee Blindness and periorbital adverse events Adverse events with neuromodulators Complications related to Energy Based Devices Infection Refreshments and Exhibition Lunch and Exhibition Lunch and Exhibition END 09:00 09:05 09:25 09:45 11:00 11:05 11:25 11:40 11:55 14:00 14:05 14:20 14:35 15:30 15:35 16:00 16:25 10:05 12:05 14:50 16:45 08:30 10:30 12:30 15:00 17:00
8 Bacteriostatic saline solution for injection For intramuscular/intradermal injection Sodium Chloride 0.9% w/v Benzyl Alcohol 0.9% w/v www.tor-generics.com Tel: 07785-311873 Tor-Bac® 10 ampoules with 5 ml solution for injection 5ml
CMAC CONFERENCE 2022 – NEW FRONTIERS: 19 & 20 NOVEMBER 2022 11 10 CMAC.WORLD Pathophysiology of ischaemia Alastair Clarke MD Q&A PANELLIST Complications related to Energy Based Devices....................................................SUNDAY 14:50 Owner and Medical Director of Sandton Aesthetic Institute in Johannesburg, South Africa. He designs and delivers courses in the disciplines of filler volumisation, neuromuscular manipulation with botulinum neurotoxin, nonsurgical thread lifts, IPL and laser, chemical peels, as well as physical treatments of the skin. Dr Clark has presented and given live demonstrations at numerous international congresses in Europe, Asia and South Africa. He is an Executive Committee member of the Aesthetic and Anti-Ageing Medicine Society of South Africa. He is currently the Head National Key Opinion Leader for Teosyal of Teoxane Laboratories. He also served as International Key Opinion Leader and Trainer for Restylane. Dr Clark has presented on the local and international stage for the following aesthetic companies: Q Med, Restylane – Galderma, Restylane – Sinclair, Silhouette Softlift – National Head KOL Myoscience, Iovera – Genop Healthcare – Palomar Medical Technologies Inc. – Filorga Laboratories – Syneron/Candela Medical Ltd – Radiant Healthcare. Emma Davies RN Q&A PANELLIST Vascular Adverse Events...............................................................................................SATURDAY 12:05 Emma has specialised in Aesthetic Medicine since 1998. In addition to her private clinical practice in Somerset, she has contributed to numerous publications, professional bodies and project groups relating to clinical standards, regulation and education. Emma was a Committee Member RCN Aesthetic Nurses Forum 2000-2010; Founding Member and Secretary British Association of Sclerotherapists 2003-2010; Founding Member and Chair British Association of Cosmetic Nurses 2010-2014; Clinical Director Save Face 2014-present; Founding member The Aesthetic Complications Expert Group 2010-2020. She also received cosmetic awards: Services to Industry and Cosmetic Nurse of The Year 2013, Association of the year (BACN) 2011, 2012, 2013, 2014 and Initiative of the Year (ACE Group) 2018. Brittony Croasdell APRN SUNDAY, 11:55 Diagnosis and management of eye-lid ptosis Designing her injection philosophy on a foundation of integrity and trust, Brittony Croasdell is a renowned aesthetic medicine Nurse Practitioner whose underlying mission is to empower and instill confidence within every patient that she serves. As the current Medical Director at The Fitz, Brittony offers over a decade of experience across the aesthetic and plastic surgery specialties. Brittony specializes in neurotoxins, complication management of neurotoxins, dermal fillers and complication management of dermal fillers, lasers, BBL, IPL, CoolSculpting, radio frequency, chemical peels, microneedling, and kybella injections. Brittony belongs to a group of highly selective and elite international injectors that proactively train other MD, NP, PA, and RN injectors with Allergan (AMI) and Galderma (GAIN). National Certifications American Nurses Credentialing Center (ANCC) Certified Aesthetic Nurse Specialist (CANS) from the Plastic Surgical Nursing Certification Board Additional Affiliations National Trainer for Allergan Medical Institute National Trainer for Galderma Aesthetic Injector Network Member of the International Society of Plastic Surgery Nurses (ISPSN) Board Member of the Illinois Society of Advanced Practice Nursing (ISAPN) Member of American Nurses Credentialing Center (ANCC) Danny Soares MD SATURDAY, 11:10 Dr. Soares is a double-board certified facial plastic & reconstructive surgeon and assistant professor at the University of Central Florida, College of Medicine. He is the co-founder and president of the American Foundation for Aesthetic Medicine (AFFAM), a non-profit organization dedicated to the fellowship-training of non-physician practitioners in aesthetics. His active areas of interest & research include the ligamentous and vascular anatomy of the face and the pathophysiology of filler-induced vascular occlusion. He is the host and content creator for the YouTube channel Aesthetic Minutes, which provides educational content in facial plastic surgery for the general public. Dr. Soares serves as the medical director of the Village institute of Plastic Surgery, and as program director for the facility’s aesthetic medicine fellowship. Emil Henningsen MD SUNDAY, 14:20 Using devices to treat complications Emil Henningsen is a Board Certified Dermatologist, licensed in Denmark. He trained at the University Hospital of Odense and Aarhus. In 2019 he founded Cutis Clinic, a chain of Aesthetic Clinics, he is the Clinical Director and consults international clients daily. He has several years of international experiences as an Aesthetic Doctor and Procedural Dermatologist in the UK and Scandinavia. Emil Henningsen is an experienced injector in areas of lipoinjection, bio-filling with prolonged PRF, and semi- and non-permanent fillers. His area of expertise is acne scar revision, whereby he combines tailormade procedures to treat the clients requests. These procedures are for example Taylor Liberator Subcision, punch excision, laser resurfacing, RFM, and many more. He is also a renowned KOL for Merz & Lutronic Lasers performing live talks and treatments at international conferences throughout Europe. Emil Henningsen is proud to represent CMAC in his country and to spread out the visions of our wonderful CMAC community. Pathophysiology of soft tissue filler infection Devan Vaghela MD SUNDAY, 15:35 Dr Devan Vaghela has been practicing medicine since 2009. He has worked in many NHS trusts across the United Kingdom as well as abroad and is a Specialist Registrar in Infectious Diseases and Microbiology. He has been working in Aesthetics for 3 years, is a trainer with Derma Medical and has his own practice in west london. We are very fortunate to have Dev as part of the team. Cormac Convery MD SUNDAY, 14:05 SUNDAY, 14:35 SUNDAY, 16:25 Adverse events caused by devices Adverse events caused by devices – case study Investigations and testing soft tissue filler infections Dr Cormac Convery MB ChB MSc MASLMS, CMAC Vice Chair is dedicated to the field of Aesthetic Medicine. A GMC registered doctor with a background in General Practice, he specialised in minor surgery. In 2013 he founded The Bloomfield Clinic in Ayrshire and Ever Clinic in Glasgow in 2017. He has also worked in London Victoria and Harley Street clinics and is an honorary senior lecturer at Queen Mary University of London, where he achieved his MSc in Aesthetic Medicine with distinction. He also sat on the expert panel for the Aesthetic Complications group (ACE) UK from 2016-2020. With a focus and specialisation in laser practice he is now one of a few doctors in the UK to offer fully ablative laser skin resurfacing in the treatment of rejuvenation and scarring. A member of the American Society for Laser Medicine & Surgery, Cormac is passionate about the inclusion of energy-based devices in his clinical practice, research and training interests
CMAC CONFERENCE 2022 – NEW FRONTIERS: 19 & 20 NOVEMBER 2022 13 12 CMAC.WORLD Gillian Murray MPharm SATURDAY, 11:30 SATURDAY, 16:00 SUNDAY, 16:00 Vascular adverse events – Stages of progression Hyaluronidase : an overview (risks, dose and dilution) Antibiotics or steroids in the management of soft tissue filler infection Gillian Murray is a clinical prescribing pharmacist specialising in aesthetics medicine and holds a clinical academic position at Kings College London (KCL) University. At the university she is working towards her PhD in hyaluronidase. Pharmacists in the UK can undertake clinical training to work autonomously as prescribing clinicians. She is a senior lecturer in advanced clinical practice, rheology and pharmacokinetics, and has published several papers supporting the management of complications in aesthetic practice and dermal filler rheology. Gillian has 18 years’ experience of working in acute trusts within the NHS predominately in her area of speciality - Surgery. She has held the positions of directorate pharmacist to many surgical disciplines including plastics, burns, ICU, vascular and to medical disciplines such as acute medicine, infection, dermatology and rheumatology. Passionate about using medicines safely and understanding co morbidities to inform treatment decisions, she set up the group ‘medicine in aesthetics’ which supports aesthetic practitioners. She has worked extensively to support complications and is a founding board member of the Complications in Medical Aesthetic Collaborative (CMAC UK) Further to her PhD research she has an interest hypersensitivity reactions in aesthetics, HA gel chemistry, rheology and behaviours. Jair Mauricio Cerón Bohórquez MD SATURDAY, 11:45 Vascular adverse events – case presentation Board certified abdominal surgeon with emphasis on aesthetics, anti-aging medicine and cosmetic surgery. Trained at University Hospital Eppendorf in Hamburg/Germany, Asklepios Medical School Hamburg/Germany and Hannover Medical School Germany, where last 2 years of plastic, aesthtetic and reconstructive surgery training took place. Guided Dissection Anatomy by Dr. Kestemont and mentored by Arthur Swift, Mauricio de Maio and Gerhard Sattler in Filler- & Neuromodulators Therapy and Liposuction. National and International Speaker for Lutronic Medical Systems Germany GmbH. Owner and Clinic Director of Medical Contour in Hamburg and cooperation partner of Cosmopolitan Aesthetics Hannover GmbH. Member of the German Society of Surgeons, German Society of Botulinum- and FillerTherapy, American Academy of Aesthetic Medicine and International Society of Aesthetic Medicine. My love, passion and dedication to my work are the drive to satisfy my patients with the best possible treatments. SUNDAY, 11:40* Avoiding complications with neuromodulator in the upper third Originally from London, Dr Jake Sloane emigrated to Australia in 2015. He trained as a general surgeon for over a decade before dedicating his time to aesthetic medicine. With 14 years of experience, he’s established himself as one of the country’s most dynamic and progressive injectors. He is a KOL for Allergan Aesthetics. Having been identified as a globally outstanding injector and teacher, he has been mentored by Dr Mauricio De Maio since 2020. He is a seen as Australia’s most experienced user of Belkyra and has previously been invited by Professor Greg Goodman to teach masterclass courses on the product. He is also a Belkyra complications expert for www.aestheticmet.com In 2022, Dr Jake has taken on two additional roles. He has partnered with Cutaneous Facial Ultrasound, founded by Dr Leonie Schelke & Dr Peter Velthuis. This is the world’s leading facial aesthetic ultrasound course and in August 2022, Dr Jake hosted Australia’s first course. He has also recently been appointed as a trainer for Profhilo that just launched in Australia. Lastly, Dr Jake is the co-founder and co-host of Inside Aesthetics (IA), the world’s most downloaded aesthetic podcast. With over 179 episodes and 730,000 listens to date, IA has become a leading educational channel for injectors in over 100 countries. Jake Sloane MD *via remote link from Australia Jonathan Hopkirk MD SATURDAY, 15:00 DONs Case Presentation A passionate and empathetic Australian trained medical doctor, with a special interest in aesthetic medicine. Working as the Laser Clinics Global Medical Director and company ambassador as well as a leader in the companies ‘Centre Of Excellence’ team. Enthusiastically committed to ensuring the company and industry at large is functioning at the highest level and with the safest standards supported by empirical evidence. Qualifications include a Bachelor in Human Anatomy, and Structural Biology where he was invited to complete an honors program (University of Otago, New Zealand) a Bachelor of Medicine and Bachelor of Surgery (University of Wollongong, Australia), and full certification in non-surgical cosmetic injectable treatments. A self-imposed mission is to lift the overall standard of treatments and care offered within the aesthetic medical field, through applying general medical principles that guide overall clinical and ethical excellence. Sabrina Shah Desai MD SUNDAY, 09:05 Periorbital complications related to soft tissue filler Mrs. Sabrina Shah Desai, is a leading UK expert in surgical & technologically advanced cosmetic facial treatments, recognised by her peers and industry experts as a peri-orbital specialist with surgical, dermatological and aesthetic experience. She has pioneered a much sought-after tear trough filler treatment Eye-boost™ to naturally restore the delicate peri-orbital area and founded a highly effective and topical dark circle corrector eye serum & SPF. Her special interest lies in 3-Dimensional aesthetic restoration of the eyes, face, and neck, using surgery, energy-based devices, fillers & toxin to create natural harmonious results, which she calls the Perfect 360 ™. Passionate about education and safe aesthetic treatments, she founded the Oculo-Facial Aesthetic Academy (OFAA) in 2016 to improve training standards in Aesthetic Medicine and runs Cadaveric Anatomy and Aesthetic Ultrasonography courses. Karim Sayed MD SATURDAY, 16:15 The elective use of hyaluronidase Dr Karim Sayed graduated from University of Oslo Medical School in 2003 and is a KOL in the Nordics. Dr Sayed is aesthetic doctor with 13 years of experience in aesthetic medicine and in addition to running his own clinic in downtown Oslo, he is a lecturer at the University of Southeast Norway where he teaches in the field of aesthetic medicine. He has 8 years of experience as a trainer, and hosts multiple trainings masterclasses yearly, on subjects like Botulinum Toxin type A, advanced filler treatments and laser treatments. He has a particular interest in complications and sees patients with complications from all over Norway, and is Allergan´s official complications consultant in Norway. He is also a part of Allergan´s European complications group. Dr Sayed is famous in Norway for both his teaching and his skills as an aesthetic practitioner, and has treated thousands of patients there. He is also the co-founder and current chairman of NORFEM (the Association of Aesthetic Practitioners in Norway). Lee Walker BDS SUNDAY, 09:25 Pathophysiology of blindness related to soft tissue filler Dr Lee Walker is Director and Clinical Lead at the multi-award winning BCity Clinics, Liverpool and has over 18 years experience in the field of Medical Aesthetics. He has been awarded memberships to the prestigious Royal College of Surgeons in both Scotland and England. He also holds a postgraduate qualification in Clinical Education from the Royal College of Surgeons and Physicians Glasgow. As part of his commitment to medical safety, Dr Walker sat on the expert panel for the Aesthetic Complications group (ACE) UK to provide guidance and advice on complications related to non-surgical treatments 2016-2020. A renowned global KOL sharing his knowledge internationally and teaching medical professionals, he is also Co-lead for medical education Teoxane UK faculty. He has produced and internationally published peer reviewed publications on blindness and vascular occlusion, co-authored several chapters in medical aesthetic literature and published a book on injection anatomy and facial aging. SUNDAY, 11:25 Avoiding complications with neuromodulator in the lower third
CMAC CONFERENCE 2022 – NEW FRONTIERS: 19 & 20 NOVEMBER 2022 15 14 CMAC.WORLD Steve Harris MD SATURDAY, 09:50 SATURDAY, 16:25 Ultrasound – lower-third facial anatomy Using hyaluronidase in an emergency Dr Steve Harris MB BCh, MSc, MBCAM completed his medical studies in Johannesburg in 1997. After working as a General Practitioner for 10 years and completing a further Masters degree in Cognitive Behavioural Therapy, he decided to pursue his passion for Art and Aesthetics. Dr Harris has been practicing Aesthetic Medicine at his clinic in North London since 2004 and has gained an international reputation for his ethical and artistic approach. He is also a trainer and educator; his regular educational posts may be viewed on Instagram @drharrisclinic. Steve Weiner MD SATURDAY, 09:20 SUNDAY, 09:45 Ultrasound – upper-third facial anatomy Management of blindness related to soft tissue filler Steve is a Board Certified, Head, Neck, and Facial Plastic Surgeon. He interned and completed his residency at The Johns Hopkins Hospital where he became an instructor for two years. In mid 2005 he “laid down his scalpel” and began concentrating 100% of his efforts in non-invasive and minimally invasive cosmetic procedures, creating The Aesthetic Clinique. Dr. Weiner divides his time between his practice, physician trainings, and lectures. He has served on multiple advisory boards, participated in FDA trials, and authored several clinical papers and textbook chapters. He is world renown for his filler techniques using cannulas and his reJAWvenation™ procedure, which he performed on The Doctors Show. He was awarded the Best Aesthetic Practice in US in 2018 at The Aesthetic Show. His newest interest is applying ultrasound imaging to assist in evaluating facial anatomy and fillers to ultimately lead to better and safer patient treatments and outcomes. Zainab AlMukhtar BDS SATURDAY, 09:05 Why Ultrasound? A practitioners perspective Dr Zainab Al-Mukhtar, (BDS, MFDS RCS Ed, MJDF RCS Eng) qualified as a dentist in 2010, before pursuing a career in facial aesthetics in 2013. She is the co-owner and medical director of a highly reputable practice that attracts national and international patients, Harrow On The Hill Dental & Facial Aesthetics Clinic in London (shortlisted ‘Best Facial Aesthetics Practice’). She is known for her exceptionally high standards and passion for patient safety. An advocate for continuing development and evidence based practice, Dr Zainab was amongst the earliest adopters of facial ultrasound in the UK, for anatomical assessment and vascular mapping before the high risk injectable procedures. A regular trainer of injectables since 2014, she is committed to sharing with colleagues and is now co-creator and lead trainer of the Facial Contouring Masterclass with UK’s No.1 training provider Acquisition Aesthetics. Dr Zainab has been awarded ‘Highly Commended’ for the ‘Facial Aesthetics – Full Facial Treatment’ award in 2020, and has been widely published in national and professional press. Tom Decates MD SUNDAY, 14:25 The role of biofilm, immune response and immunogenetics in soft tissue filler complications Dr Tom Decates received his medical degree at the Academic Medical Center, affiliated with the University of Amsterdam, before pursuing plastic surgery and specialising in aesthetic medicine in 2010. Since 2016 he has been conducting research into the complications of fillers at the Amsterdam UMC and the ErasmusMC in Rotterdam. In 2021 he received his PhD on the thesis: ‘The Origin of Soft Tissue Filler Adverse Events’. He is the head of the SOCG (Cosmetic Medicine Training Foundation), the training institute affiliated with the Dutch Association of Cosmetic Medicine (NVCG). Leonie Schelke MD SUNDAY, 10:50 SATURDAY, 14:45 Vascular adverse events – what lies beneath Nodules and post-injection oedema Leonie Schelke is a Dutch certified cosmetic physician. She has a private practice in Amsterdam for more than 20 years. Since 2010 she and her colleagues run a policlinic for filler complications at the Department of Dermatology, Erasmus MC, Rotterdam the Netherlands (2 days per week, 500 new patients per year). She received her PhD in the use of duplex ultrasound and the management of filler complications. She is a teacher in the Dutch certified educational program for cosmetic medicine. She is co-founder and trainer of CutaneoUS, an organization for ultrasound courses in cosmetic medicine and dermatology MJ Rowland- Warmann BDS SATURDAY, 09:35 Ultrasound – mid-third facial anatomy Dr Rowland-Warmann, BDS, BSc, MSc, Aes. Med, MClin, Dent Orthod, PGDip Endod, PGCert MedEd, Dip.MJDF, is the founder and lead clinician at Smileworks Liverpool. Initially qualifying as a dentist, she has subsequently completed Masters degrees in Orthodontics and Aesthetic Medicine. Her practice is limited to non-surgical aesthetics where her special area of interest is the management of dermal filler complications using ultrasound. Dr Rowland-Warmann is a trainer for Sinclair Pharma, and a member of their vigilance team, accepting referrals from UK-wide practices for the resolution of filler-related incidents. She is also founder of the Smileworks HUB, a training academy for medical professionals to advance their skills in aesthetic medicine and ultrasound. Dr Rowland-Warmann is an advocate for better safety standards in aesthetics and has been widely published in industry and national media. Nicola Lowrey PA SUNDAY, 11:05 Why we get neuromodulator complications Nicola graduated from USC’s Keck School of Medicine in 2003. She is an advanced aesthetic injector with over 17 years of experience in the industry. Her work focuses on an artistic, natural, and clinically safe approach with the goal of enhancing her patient’s in the most undetectable, yet powerful way. Splitting her time between her very busy practice in Manhattan Beach, CA and traveling across the country to train other injectors, it is apparent that education is one of her greatest passions. Nicola is one of the most requested Allergan Speakes/Trainers in the US. This is greatly due to her training model having such a strong emphasis on anatomy and safety with injectable treatments. Nicola consistently and eagerly attends advanced trainings all over the world to make sure that what she shares with her students encompasses the most up to date and highest quality education, to truly advance her trainees practice. “I share everything I know with my students. I don’t hold back. If we elevate each other, this industry only gets better for us all!” NIcola has a soon to be published book on the horizon, “AnatomySunday, a Manual for Injectors.” A comprehensive textbook focusing on injector specific anatomy and some of Nicola’s favorite treatment pearls. Peter Velthius MD SUNDAY, 14:05 Overview of filler complications and soft tissue filler Peter Velthuis (born 1954) is a dermatologist since 1986. He worked as a general dermatologist up to 2011. In a partnership with his friend Jak Dekker, he started Velthuis Clinic in 1995 (Eindhoven, The Netherlands). At first this clinic was active in the field of cosmetic medicine only, but from 2007 onwards the clinic included other areas of specialized care such as hand surgery (later orthopedic in general), phlebology, dermato-oncology and others. Currently, these services are offered under different brand names: Xpert Clinic and Helder kliniek. The holding company was renamed into Equipe Zorgbedrijven. Under the direction of Velthuis/Dekker the company grew into a chain of clinics comprising more than 15 affiliates. Together Leonie Schelke and Peter Velthuis form CUTANEOUS, a company for education in facial ultrasound imaging. Cutaneous provides courses, and e-learnings. www.cutaneous.org.
CMAC CONFERENCE 2022 – NEW FRONTIERS: 19 & 20 NOVEMBER 2022 17 16 CMAC.WORLD Venue map B e l l e For a life more beautiful... Blumlein room Staff/green room Marconi room Cloakroom (unattended) Haslett room Kelvin Lecture Theatre Flowers room Lovelace room Watson-Watt room REGISTRATION
CMAC CONFERENCE 2022 – NEW FRONTIERS: 19 & 20 NOVEMBER 2022 19 18 CMAC.WORLD Exhibitors Belle is a leading supplier to the medical aesthetic market and is proud to represent Clarius ultrasound, Aerolase, Dermadrop and Tulip Medical Products. Clarius is a leading ultrasound company providing portable devices for all applications. The L20HD3 is the world’s only 20 MHz portable ultrasound and is first choice for facial aesthetics due to its unmatched resolution. Aerolase Lasers are innovative, short-pulse Nd:YAG and Er:YAG lasers. With over 36 FDA approved indications, Aerolase lasers are safe and effective on all skin tones; all year round. Dermadrop is a unique, needle-free system for treating skin concerns quickly and painlessly. Dermadrop’s new BIOBTX range is inspired by Botox treatments and allows for needle-free treatment of wrinkles. Church Pharmacy is a multi-award-winning distributor specialising in medical aesthetics. We provide a wide and curated choice of only the most reputable, safest aesthetic injectables as well as everything required for a clinic from syringes to skincare. Renowned for our award-winning customer service, innovative logistics and ordering technologies, our aim is for everything aesthetics to be easier, by choosing Church Pharmacy. With exceptional superficial imaging and the new advanced aesthetic preset, the Clarius L20 HD3 is the popular choice for facial aesthetics. It’s the only specialtydesigned handheld ultrasound with ultra-high frequency to 20 MHz. Wireless and affordable, it delivers exceptional superficial imaging to 4 cm with an easy-to-use app for your iOS or Android device. • Perform facial mapping to avoid vascular occlusions • Visualize safe cannula placement prior to injection • Confirm filler placement and vessel flow after injections • Visualize your needle and nodules to dissolve fillers • Measure dermal thickness prior to microneedling • Visualize vessels for reconstructive/cosmetic facial surgery Cosmetic Insure is a specialist provider of insurance products and services specifically designed for the aesthetics industry, using a panel of insurers to ensure flexiblity. In addition, Cosmetic Insure provides a suite of exclusive benefits to clients which not only protects their business but provides business support, for example, free medicolegal helplines and advice on business practice. Whether an individual practitioner, national clinic chain or product supplier, our experienced team can offer free advice on all of your insurance requirements. Building a world that works GE Healthcare is a leading global medical technology and digital solutions innovator, GE Healthcare enables clinicians to make faster, more informed decisions through intelligent devices, data analytics, applications and services, supported by its Edison intelligence platform. With over 100 years of healthcare industry experience and around 50,000 employees globally, the company operates at the center of an ecosystem working toward precision health, digitizing healthcare, helping drive productivity and improve outcomes for patients, providers, health systems and researchers around the world. www.gehealthcare.co.uk Twitter: @GEHealthcare Facebook: /GEHealthcare Email Richard Justin: Richard.Justin@ge.com Bsure Medical is a social enterprise focused on personal medicine and active in the fields of medical science, DNA research and implants. All Bsure’s activities are aimed at enabling the safe and knowledgeable use of implants for both clinicians and implant users. Founded in Barcelona, January 2021, as a spin-off of the research institute of the university hospital Vall D’Hebron in Barcelona (VHIR). In July 2021, the Dutch subsidiary Bsure Medical B.V. was founded in Amsterdam. The founders are doctors and researchers Prof. dr. Jaume Alijotas, Dr. Simo Schwartz (Vall D’Hebron University Hospital, Barcelona), Dr. Frank Niessen (AUMC, Amsterdam) and Dr. Tom Decates (Erasmus MC, Rotterdam). All four passionate doctors and researchers, renowned worldwide for their findings in the field of complications with implants. The knowledge of the 4 doctors is complemented by 2 experienced entrepreneurs (the Netherlands) and Fagron (the Netherlands), a listed multinational focused on personalized pharmaceutical care. First DNA test for fillers The first product is a DNA test to predict the risk of filler complications. The patented test is based on scientific research of which an article was published in PUBMED in January 2021. (https://pubmed.ncbi.nlm.nih.gov/33300274/). Medical complications that can occur include chronic and/or localized inflammation that may require months or years of medical treatment and can cause lifelong symptoms. Market launch and expansion Since its market launch in the Netherlands in November 2021, Bsure has signed an agreement with Fagron UK and Wigmore Medical, the biggest distributor of cosmetic products in the UK. The filler test was launched in the UK in August 2022. By the end of 2022 and beginning of 2023 Bsure is planning to launch the test in Spain and other European markets. New DNA test for breast implants. In the first quarter of 2023 Bsure expects to launch a new DNA test for the detection of increased risk of serious complications with breast implants. Further research will be carried out for predicting the risk of complications with other foreign body implants, starting in 2023. B e l l e For a life more beautiful...
Safety means ultrasound. Discover the remarkable new ultrasound courses exciting practitioners in 2023. Learn to plan treatments, reduce complications and inject safely so your practice can thrive. Our mission is to bring affordable ultrasound training to everyone. Because we believe ultrasound will dramatically improve patient safety. Best value for 2023 Call to book: 0151 315 1221 "I flew in from Canada and spent three days with Dr. MJ for 1:1 training in ultrasound guided fillers, advanced botox and complications. It was absolutely amazing! The amount of knowledge Dr. MJ has - just confirms why she's a leader worldwide. I hope to be half the clinician and educator she is!" - Fahad A 2022 www.smileworks-hub.co.uk Online only £450 Online & hands on £1,050 One to one mentoring £2,500
CMAC CONFERENCE 2022 – NEW FRONTIERS: 19 & 20 NOVEMBER 2022 23 22 CMAC.WORLD Why Ultrasound? A practitioners perspective – Zainab Al-Mukhtar BDS Ultrasound of Upper Third – Steve Weiner MD SATURDAY—09:05 SATURDAY—09:20 Dr Zainab, an early adopter of facial ultrasound in aesthetics, will speak about her perspectives around it having introduced ultrasound into her clinical practice. She will cover her motivations for adopting it early on, the basic and advanced applications in aesthetic medicine, and the overall value it can add to clinical practice, in the prevention and treatment of complications as well as being a valuable diagnostic and educational tool that is now adding to the evidence base in aesthetic medicine. Dr Zainab will outline her suggestions around steps in training, getting started with ultrasound and how to integrate it into day to day practice. A thorough discussion of the pertinent injection anatomy of the temple, forehead, and glabellar area using ultrasound. The various levels of injection of the temple will be explained. A safe ultrasound guided injection of the interfascial plane will be demonstrated. Lecture notes Lecture notes
CMAC CONFERENCE 2022 – NEW FRONTIERS: 19 & 20 NOVEMBER 2022 25 24 CMAC.WORLD Mid Third – MJ Rowland-Warmann BDS Lower Third – Steve Harris MD SATURDAY—09:35 SATURDAY—09:50 The highest risk dermal filler treatment areas for vascular events are the nose and nasolabial fold. Not only ischaemia and necrosis, but blindness due to filler embolus to the ophthalmic circulation can occur. Without visualisation of what lies beneath the skin, even experienced practitioners cause complications due to unexpected anatomy. Reviewing cases from my practice and the scientific literature, I will share with you how deviations from what we assume to be the “norm” can present hazards for injectors. We will appraise how ultrasound can mitigate the risk in nose and nasolabial treatments to improve safety and predictability in these high risk areas. We are in the midst of an epidemic of overfilled faces characterised by anatomical distortions (alienisation) and filler spread (migration). Ultrasound can play a key role in the normalisation of aesthetic results, especially relating to lips where we appear to have ‘lost the plot.’ It allows us to visualise real time individual anatomy not only as a guide for preventing and dealing with complications, but for ensuring normal looking aesthetic results. In this session, the use of ultrasound will be demonstrated with specific examples involving Botulinum Toxin and soft tissue filler treatments of the lower face. Lecture notes Lecture notes
CMAC CONFERENCE 2022 – NEW FRONTIERS: 19 & 20 NOVEMBER 2022 27 26 CMAC.WORLD Pathophysiology of ischaemia – Danny Soares MD SATURDAY—11:10 SATURDAY—10:50 Lecture notes Lecture notes What lies beneath – Leonie Schelke MD Our hospital runs an out-patient clinic for filler complications for more than twelve years. Difficult and persistent cases are being referred. In the last years we were able to build up experience in vascular adverse events ( vascular occlusion). More than hundred cases were treated. To diagnose and manage complications, facial ultrasound imaging is considered the primary complementary technique and is incorporated in our patient care. With duplex ultrasound, the blood flow pattern before, during and after a vascular adverse events was observed. We think that vasospasm is one the mchanisms to consider. The popularity of injectable HA fillers has brought an increase in the incidence of once-rare iatrogenic vaso-occlusive injuries ranging from disfiguring facial skin necrosis to disabling neuro-ophthalmological sequelae. As our understanding of the pathophysiology of these injuries has evolved, the formulation of novel therapeutic and preventative strategies has permitted the amelioration of this burdensome complication. In this presentation, we review the relevant mechanisms underlying HA filler-induced vascular occlusion (FIVO), with particular emphasis on the rheo-mechanical aspects of vascular blockade, the thromboembolic potential of HA mixtures, and the tissue-specific ischemic susceptibility of microvascular networks leading to injury.
CMAC CONFERENCE 2022 – NEW FRONTIERS: 19 & 20 NOVEMBER 2022 29 28 CMAC.WORLD Stages of progression – Gillian Murray MPharm Case presentation – Jair Mauricio Cerón Bohórquez MD SATURDAY—11:30 SATURDAY—11:45 It can be difficult to ascertain worsening ischaemia, and whether the use of hyaluronidase has been successful. Applying the concept of ‘stages’ allows the clinician to monitor any further decline in the tissue. Further understanding of the ‘stages’ of ischaemia allows prediction of wound formation, and whether further methods should be deployed to support tissue healing. It is also useful to understand the time frame and appreciate when necrosis is likely to develop, this can alleviate panic and allow formation of a more ordered management plan. In this session we share our understanding from practice with our conference delegates to allow them to take control of these unfortunate events. A 41 y old female patient Fitzpatrick photo type V – VI presented 3 days after chin augmentation with hyaluronic acid-based filler with a stage 3 vascular occlusion. One day after injection quarantine was obligatory due to COVID 19 infection with severe symptoms. A watch and wait approach, 1g of aspirin and tissue warming was decided due to impossibility to asses. Assessment took place 5 days after treatment and negative COVID test, a stage 5 vascular oclusion was diagnosed with local vasospasm of the superficial chin fibrofatty layer via ultrasound. Dissolving via us-guided low-dose hyaluronidase injection released the vasospasm as well as the pain and pressure immediately, the blood flow was increased in the us-duplex imaging. An early-induced multimodal scar therapy was performed. After all, the patient shows minimal scarring and hyperpigmentation, the outcome of the chin augmentation was not influenced, no re-treatment was needed. Lecture notes Lecture notes
CMAC CONFERENCE 2022 – NEW FRONTIERS: 19 & 20 NOVEMBER 2022 31 30 CMAC.WORLD SATURDAY—14:05 SATURDAY—14:25 Lecture notes Overview of filler complications and soft tissue filler – Peter Velthius MD From the 2000+ patients that we have seen in our hospital, we now use this stratification: (1) Inflammatory reactions, either acute or late-onset; (2) Non-inflammatory nodules; (3) Vascular adverse events; (4) Regional edema; (5) Miscellaneous, e.g. pain, generalized edema, Tyndall phenomenon, etc. Each has its own etiology, some of which we are beginning to understand, others such as inflammatory reactions still elude us. However, primarily based on knowledge gained by the use of ultrasound imaging, we have new insight how to avoid some of these complications. Lecture notes The role of biofilm, immune response and immunogenetics in soft tissue filler complications – Tom Decates MD The treatment algorithm in late-onset inflammatory adverse events on soft tissue fillers depends primarily on the assumed causative factor, being either immunological or bacterial. 29 patients, of whom 13 experienced adverse events and 16 who did not. We acquired biopsies from both groups. We used a new and very sensitive method to detect microbiota, the IS-pro method.
CMAC CONFERENCE 2022 – NEW FRONTIERS: 19 & 20 NOVEMBER 2022 33 32 CMAC.WORLD Case presentation – Jonathan Hopkirk MD SATURDAY—14:45 SATURDAY—15:00 Delayed Onset Nodules (DON) are fortunately an uncommon adverse event to encounter with dermal fillers. However, they can take you and your patient on a turbulent journey if not managed well. With many synonyms for the entities that fall under the umbrella diagnosis of DON, it can be challenging to determine exactly ‘what’ you are dealing with and ‘how’ to resolve it. This session showcases a lengthy DON case that spanned a two-year period and had a myriad of treatment methods employed by numerous healthcare professionals. With an opportunity to review 30 plus cases annually, from a global network over the last seven years, I will share with you the valuable lessons I have learnt during this time. l will also discuss the preventative measures, ‘red-flag’ checkpoints and safety buffers you can consider implementing in your practice, to enable you to have a better chance of tackling this insidious complication. Lecture notes Nodules and post injection oedema – Leonie Schelke MD Our hospital runs an out-patient clinic for filler complications for more than twelve years. Difficult and persistent cases are being referred. To diagnose and manage complications, facial ultrasound imaging is considered the primary complementary technique and is incorporated in our patient care. For nodules and malar oedema, recently, we are more focused on the layer the filler is injected in and the vascular involvement. All nodules seen at our policlinic were located In the SMAS or fascia. For malar edema after by filler treatments in the peri-ocular region, venous compression by filler deposits may be involved. Lecture notes
CMAC CONFERENCE 2022 – NEW FRONTIERS: 19 & 20 NOVEMBER 2022 35 34 CMAC.WORLD The elective use of hyaluronidase – Karim Sayed MD SATURDAY—16:15 A key features of hyaluronic acid (HA) dermal fillers underlying their success is reversibility. The injectable enzyme hyaluronidase (HYAL) cleaves the HA chains present in HA gel fillers, permitting diffusion and further degradation by native hyaluronidases. In contrast to high-dose protocols for vascular compromise where the goal is rapid an complete dissolution of product, elective use of HYAL requires a more tailored and/or targeted approach. This presentation details elective uses of HYAL, including management of misplaced product, micro doses for reduction of product volume, as well as the resolution of early and late-onset nodules. The talk will also review ultrasound guided management of these issues. Lecture notes Hyaluronidase: an overview (risks, dose and dilution) – Gillian Murray MPharm SATURDAY—16:00 ‘The devil you know, or the devil you don’t know’ Hyaluronidase use has exploded in aesthetic medicines, but its use remains unlicensed. How much do we really know about this enzyme? This session introduces some of the things we know, and don’t know. We will discuss allergy testing, swelling reactions, and apply some evidence to the dogma that surrounds this drug. Lecture notes
CMAC CONFERENCE 2022 – NEW FRONTIERS: 19 & 20 NOVEMBER 2022 36 37 CMAC.WORLD SUNDAY—09:05 Using hyaluronidase in an emergency – Steve Harris MD SATURDAY—16:25 Our hospital runs an out-patient clinic for filler complications for more than twelve years. Difficult and persistent cases are being referred. To diagnose and manage complications, facial ultrasound imaging is considered the primary complementary technique and is incorporated in our patient care. For nodules and malar oedema, recently, we are more focused on the layer the filler is injected in and the vascular involvement. All nodules seen at our policlinic were located In the SMAS or fascia. For malar edema after by filler treatments in the peri-ocular region, venous compression by filler deposits may be involved. Lecture notes Periorbital complications related to soft tissue filler – Sabrina Shah Desai MD The periorbital area is challenging to treat, given its unforgiving anatomy and the risk of lymphatic compromise. Malar edema and subsequent festoons/malar bags are a common early and delayed adverse event of under eye dermal fillers. An overview of common & rare periorbital complications will be presented, with a brief overview of malar edema/ bags management. Lecture notes
CMAC CONFERENCE 2022 – NEW FRONTIERS: 19 & 20 NOVEMBER 2022 39 38 CMAC.WORLD Pathophysiology of blindness related to soft tissue filler – Lee Walker BDS Management of blindness related to soft tissue filler – Steve Weiner MD SUNDAY—09:25 SUNDAY—09:45 Lecture notes The presentation will cover the incidence, demographics, and most common injection sites of this complication from the literature. A discussion of the etiology (included choke vessels) associated signs and symptoms, and prognosis. The pros and cons of retrobulbar and “external” approaches for hyaluronidase will be debated. A “NO VISION” protocol will be proposed. Vision loss is a rare but catastrophic complication associated with soft tissue filler injection. Cases are often under reported and there is a steady increase of new publications identifying this growing problem. This presentation will concentrate on the pathophysiology of blindness , including the unique vascular anatomy, retrograde embolism directly linked to pressure, presentation of signs and symptoms, management strategies and risk mitigation. Lecture notes
CMAC CONFERENCE 2022 – NEW FRONTIERS: 19 & 20 NOVEMBER 2022 41 40 CMAC.WORLD Why we get neuromodulator complications – Nicola Lowrey PA SUNDAY—11:05 SUNDAY—11:25 Lecture notes All drugs, whether therapeutic or cosmetic, have the potential to cause complications. When it comes to neuromodulators, very rarely the complication is secondary to the drug itself. Most neuromodulator complications are caused by provider error. Toxin administration is an easy skill to acquire, yet a difficult one to perfect. The most important thing to consider for the prevention of unwanted outcomes with all neuromodulators is muscular anatomy. An intimate understanding of the facial muscles including location, depth, action, and synergistic/antagonistic pairing can help you achieve consistent and beautiful results! Lecture notes Avoiding complications with neuromodulator in the lower third – Lee Walker BDS Lower face muscular anatomy is intimately linked and is often misunderstood. There are both depressors and elevators in the lower face which contribute to facial expression and the masticatory process. Clinicians often inject these areas without a deep knowledge of muscular dynamics and their relationship with bony and cutaneous landmarks. This presentation will focus on the regional anatomy and Injection strategies to avoid unwanted complications.