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IMCAS Asia 2023
Program

FOCUS ON S108

CONTRIBUTING LECTURES - Facial injection techniques

Room: Room 5
Date: Sunday 11 June 2023 at 14:00 to 15:00
Format: CONTRIBUTED TALKS > session made up of abstract submissions that were carefully reviewed and selected by the Scientific Board

Chairs

Dr Simone MAY

Austria

Dr Maria Cristina PUYAT

Dermatologist

Philippines

Lectures of the session

Hours	Speakers	Lecture title	Abstract	Number
14:00	Dr Ahmad NAZARI	Unilateral masseter hypertrophy and its effect on assymetry before and after treatment by ultrasound-guided injection	View	124038
14:10	Dr Galina SAVELYEVA	Management of rare complications after “Russian Lip” augmentation: nodules, hypertrophic scarring, and fast-growing capillary hemangioma	View	124037
14:20	Dr Miray AL MUSTAFA	How to succeed with tear trough injections	View	124036
14:30	Dr Rongying ZHOU	Comparative study of stamp-type multi-needle injector injections vs single sharp needle injection for NLF and facial pore correction by small particle HA	View	125846
14:40	Dr Michelle SLATENSEK	Patient selection strategies for choosing between HA filler and PDO powder filler for periorbital rejuvenation among diverse ethnicities	View	124035
14:50		Q&A		124040

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Fillers: HA (hyaluronic acid)

Anatomy for injections

Complications

Tear trough (non-surgical)

Anatomy

Dr Ahmad NAZARI

Iran

Other author(s) :

Unilateral masseter hypertrophy and its effect on assymetry before and after treatment by ultrasound-guided injection

Objectives: Investigating the prevalence of unilateral hypertrophy of the masseter muscle, its effect on the asymmetry of the lower face and the effect of reducing its thickness on the symmetry of the face using botulinum toxin with ultrasound and investigating its consequences with the help of eye tracking in 18 patients

Introduction: Asymmetry in the face is one of the things that can have a destructive effect on people's attractiveness. symmetry has been proposed as a ‘‘certiﬁcate of health’’ in a mating perspective. Lower face asymmetry can be influenced by factors such as Size of the bony mandible , Mass of the masseter muscle , Volume of subcutaneous fat tissue.
The volume and width of masseter muscle is determined especially by the biting force, chewing habits, diet and etc. so far, there has been no study on the prevalence of unilateral hypertrophy of the master muscle among patients.

Materials / method: 435 clients of a beauty clinic were randomly examined for bilateral and unilateral hypertrophy of the master muscle with ultrasound. The distance of the mandibular gonion to the oral commissure was investigated before and 4, 8 and 16 weeks after botulonium toxin injection. The effect of asymmetry reduction on eye tracking patterns was evaluated.

Results: The prevalence of bilateral and unilateral hypertrophy was 35 and 8%, respectively. The distance between the oral commissure(OC) and the mandibular gonion(MG) was significantly higher on the dominant side than other side. The amount of observer's gaze on the lower face area was significantly reduced in 60% of cases. The noteworthy point is that the decrease in the distance between OC and MG was more than the decrease in muscle thickness, which indicates that the jaw deviates in the direction where there is hypertrophy.

Conclusion: This study, by examining the prevalence of bilateral and unilateral hypertrophy of the master muscle, the effect of unilateral muscle hypertrophy on asymmetry, and the change in the fixing eye pattern before and after botulinum toxin injection, provides new evidence to aesthetic doctors in the approach to lower face asymmetry.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Dr Galina SAVELYEVA

Dermatologist

Russia

Other author(s) :

Management of rare complications after “Russian Lip” augmentation: nodules, hypertrophic scarring, and fast-growing capillary hemangioma

Objectives: 1. Rare late complications after “Russian Lips” augmentation in an exaggerated way.
2. Ultrasound pictures and treatment for each clinical case (non-inflammatory nodules formation, hypertrophic scarring, capillary haemangioma)
3. Tips and tricks that can help clinicians avoid these problems successfully

Introduction: As most women desire to have flat, sensual lips, there is an increasing trend to give large volume injections in the soft tissue. Fillers are among the most frequently used beautifying products, and young doctors, nurses, and dentists usually start their professional career with this face area. We will not talk about common side effects like swelling, bruising, ischemia, and migration of the product. We present a few rare cases of complications after “Russian Lips” augmentation in an exaggerated way.

Materials / method: We present three different cases of rare late complications after lip augmentation. All cases were associated with the “Russian Lip” technique. Too much HA product, short-term multiple sessions with different types of fillers, and superficial injections can cause all these problems. The complications reviewed included the formation of non-inflammatory nodules, hypertrophic scarring, and fast growth capillary hemangioma.

Results: Our first case is the formation of nodules in the upper lip after the third injection session of filler to achieve a flat, well-defined upper lip shape. The nodule was injected with hyaluronidase 8 months after its formation, and near-complete resolution was not seen. Complete disappearance of the nodule was found after mechanical removal with ultrasound control. Granulomas are rare and occur as a result of a hypersensitivity IV-type reaction to a foreign body. The inflammatory reaction may be triggered by systemic infection, excessive sun exposure, impurity of dermal fillers.

Conclusion: Filler injection for soft tissue augmentation is a satisfactory procedure with very modest results despite high expectations. However, as the number of indications and performance increases, the number of complications also increases. It is important for physicians to know facial anatomy and high-risk regions. The experts of filler injection must be familiar with each filler material, the injection techniques, and the potential complications. We summarized rare complications after lip augmentation that can help clinicians avoid these problems successfully.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Dr Miray AL MUSTAFA

Dermatologist

Norway

Other author(s) :

How to succeed with tear trough injections

Objectives: The under eye area is delicate, and performing filler procedures with good results here is not surprisingly perceived as challenging.
Five cases, four female and one male, with good results after filler injections in the tear trough area, will be presented.

Four cases with complications, all female, will be presented and the learning outcomes of what might have led to the complications, will be discussed, to provide a better fundament for future treatments.

Introduction: Filler procedures are a common aesthetic request, and with increasing numbers of injectors, both experienced and less experienced, more complications are being reported.
The under eye area is anatomically challenging, and good results require a comprehensive understanding of the anatomy, correct injection technique, and choice of the right hyaluronic acid filler, which will be discussed by the author.

Furthermore, necessary evaluations that need to be done in every patient before proceeding with injections in this area, will also be presented.

Materials / method: Four female and one male patient received TT injections by the author. Sharp needles were used for the palpebromalar groove, and cannulas were used for the tear trough area. The male patient was followed up for 18 months.

Evaluation of the results were based on the patients´ and author´s examination, pictures taken before and after, and the Tear Trough Rating Scale.

Four other cases with different types of tear trough complications were treated, one with migrated filler, one with incapsulated filler (verified by biopsy) and one with filler placed in the wrong anatomical layer.

Results: Visible improvement in hollowness and and skin quality, also according to the Tear Trough Rating Scale, was accomplished in all of the five patients that was injected by the author. The male patient was followed up for 18 months with no need for touch ups.

Three of the four patients with complications were treated with with successful results. The patient with incapsulated filler received several treatments, with good, but not complete resolving of the complication.
No serious adverse reactions were reported.

Conclusion: A comprehensive understanding of the anatomy, correct injection technique, and choice of the right hyaluronic acid filler are three mandatory pillars for successful, long term injection results of the tear trough area. If one of the pillars are missing, the fundament will be weak, and complications might occur, like migration, nodules and under eye bags. Correct injection knowledge and updated complication management are crucial for high quality results and a safe outcome.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Dr Rongying ZHOU

Dermatologist

China

Other author(s) :

Comparative study of stamp-type multi-needle injector injections vs single sharp needle injection for NLF and facial pore correction by small particle HA

Objectives: -Observed the efficacy and maintenance time of Stamp Type Multineedle Injector for NLF and facial pores correction in injecting small particles of hyaluronic acid.

-The difference in efficacy between Stamp Type Multineedle injection and traditional single sharp needle injection was compared for the first time

-For the first time, we observed the both methods of adverse effects that occurred during and after treatment.

Introduction: Small particle cross-linked hyaluronic acid has been widely used in skin beauty. It is often used to the wrinkle correction ,or to supplement the superficial volume.However, it is more common to be used by single sharp needle or blunt needle to inject into the deep dermis or subcutaneous layer. But adverse events, were the most complaints from the patient and the provider.In addition to curative effects, the search for more comfortable treatment methods for patients has become one of the future important clinical work needs to focus on.

Materials / method: A study was conducted from January 2022 to February 2023. A total of 42 patients were included in the study and completed the entire observation, of which 22 used the Stamp Type Multineedle Injector and 20 used the single sharp needle for injecting into the deep facial dermis respectively. Wrinkle Severity Rating Scale (WSRS) and Global Aesthetic Improvement Scale (GAIS) were used to assess NLF and facial pores. Effective endpoints were 3 and 6 months from baseline. And recorded adverse events.

Results: WSRS and GAIS scores in NLF correction and GAIS scores in facial pore correction within 6 months are both improved, there was no significant difference in efficacy between the two groups. For the two methods, the efficacy of single injection at 6 months was lower than that at 3 months, and the GAIS score was statistically significant. Among the adverse effects, the pain complain in treatment was significantly different between the two groups. Early and late after treatment, adverse effects types were different, the difference was statistically significant.

Conclusion: -Stamp Type Multineedle Injector and single sharp needled injection can correct NLF and facial pores in a period of time. The Stamp Type Multi-needle Injector provides the same magnitude and duration of correction as a single sharp needle injection, while it is more comfortable and safer.It can be widely applied to the dermis of the skin.
-The adverse effects caused by Stamp Type Multineedle Injector can be reduced by adjusting the needle length, the injection volume and dosage, and the skills of syringe application in the treatment process.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Dr Michelle SLATENSEK

Cosmetic Surgeon

Philippines

Other author(s) :

Patient selection strategies for choosing between HA filler and PDO powder filler for periorbital rejuvenation among diverse ethnicities

Objectives: 1.Evaluate the advantages and disadvantages of hyaluronic acid filler and PDO powder filler for periorbital rejuvenation among different ethnicities.
2.Develop patient selection strategies that consider ethnic differences in facial anatomy and skin type.
3.Provide guidance on managing potential complications and adverse reactions associated with periorbital fillers in patients of diverse ethnicities.
4.Enhance practitioners' understanding of patient selection strategies for periorbital rejuvenation among diverse ethnicities to achieve optimal outcomes.

Introduction: Facial aging is a natural process that affects individuals of all ethnicities. The periorbital region is particularly susceptible to the effects of leading to wrinkles, sagging skin, and hollowness. Hyaluronic acid and PDO powder fillers have become increasingly popular options for non-invasive periorbital rejuvenation. However, selecting the appropriate filler type for patients of diverse ethnicities requires a nuanced approach, considering differences in facial anatomy and skin type.

Materials / method: In this study, two types of fillers - cross-linked hyaluronic acid at 15 mg/ml and PDO powder filler at 200mg/vial - were used in a clinic setting to assess patient preferences. A patient experience survey was conducted among 10 patients who had received their first filler treatment 5-6 months and another survey after the second treatment. The survey took into account various factors such as age, sex, weight, skin type, body type, and ethnicity, in order to evaluate which filler type was preferred.

Results: Both hyaluronic acid and PDO powder fillers are effective for periorbital rejuvenation among diverse ethnicities with significant outcomes. Hyaluronic acid fillers are preferred by patients with more subcutaneous fat or thicker skin in the periorbital area while PDO powder fillers were much preferred for those with thin skin in the periorbital area with less subcutaneous fat. There is some evidence to suggest that Asians may have thicker subcutaneous tissue in the periorbital area compared to Caucasians.Adverse reactions were more slightly observed in patients with darker skin tones.

Conclusion: The selection of filler type for periorbital rejuvenation among diverse ethnicities should be approached carefully, taking into account the unique characteristics of each patient's facial anatomy and skin type. This lecture highlights the differences between hyaluronic acid and PDO powder fillers, as well as their respective advantages and disadvantages in different ethnicities. Both hyaluronic acid and PDO powder fillers are effective for periorbital rejuvenation. It is essential to manage patient goals and expectations for using these two types of fillers.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

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IMCAS Asia 2023 Program

FOCUS ON S108

CONTRIBUTING LECTURES - Facial injection techniques

Chairs

Lectures of the session

Recommended sessions

IMCAS Asia 2023
Program