Objectives: Botulinum toxin is wildly used in an aesthetic office. Here I pretend to give some tips and tricks in a day-by-day base, in a private office.

Introduction: Since botulinum toxin injection remain the number one technique in aesthetic field world wile is not surprising that a huge amount of guidelines, books, papers and lectures have been published or presented in conferences and congresses. Solid scientifical background is needed but in real practice keep it simple is also important.

Materials / method: Botulinum toxin injection it is an excellent tool in the treatment of wrinkles caused by muscular contractions and his application, although not complicated, requires an in-deep knowledge of the anatomy and function of the facial muscles as much as a good clinical evaluation, photographic record skills, precise technical administration and further clinical supervision in order to have a satisfied patient and a confident doctor.

Results: I will show in a day-by-day base the routine used in my clinical practice since the patient arrive until the end of a botulinum toxin treatment. The important points to not be missed and common mistakes to be avoided. Tips and tricks that make the treatment easier, safer and more professional.

Conclusion: Implementing a routine of good practices in a private office is essential to the success of a clinic and could be crucial in case of conflict. To have a standard procedure of botulinum toxin injections administration is a good start to that goal.

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

Objectives: Advantages and pratical use of new BoNTA injection procedures

Introduction: 3D syringes (click) – advantages
No dead space (hub), audible and tactile feedbacks (vs hardly visible graduations), precise, accurate for high and low volume/dose, accurate for customized treatments (1-2-3-4-5-6... UA /2.5-5-7.5-10… US), predictable, repeatable (thumb’s strength is more variable), designed to adapt very thin needles 33 -34 G ‘’nano’’-needles (less painful, less hematomas, interchangeable (no ‘’crac’’, no pain)

Materials / method: 3D syringes (click) - pratical use
aboBoNTA - 0.63 ml / 125 US : Green syringe, green graduation – 1 click = 2.5 US
inco and onaBoNTA - 1 ml / 50 UA : Orange syringe, black graduation – 1 click = 1 UA
inco and onaBoNTA - 1.25 ml / 50 UA : Green syringe, black graduation – 1 click = 1 UA

Results: Electronical pen – advantages
Exactly the same advantages as 3D syringes, plus : more accurate tactile feedback, no risk of double-clicking, slow diffusion

Conclusion: Electronical pen – practical use
Specific self-breaking with hub syringes (no dead space)
aboBoNTA – 0.63 ml / 125 US: 4 graduations (1) – 0.05 ml (10US) - 0.025 ml (5US) & 0.0125 ml (2.5 US)
inco and onaBoNTA 1ml or 1.2 ml …

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

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

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

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

Objectives: While the number of filler treatments increased by more than 300 % from 2000 to 2017 in the USA, the number of adverse events also increased at the same time. The inadvertent injection of filler in the arteries that supply the facial tissues and its consequences are the most serious of these complications.

Introduction: What happens when an arterial filler embolism occurs?
- If it is a low-volume bolus (0.1 ml or less) injected slowly under low pressure, the embolism moves with the blood flow towards the distal arterioles, causing ischemia with the risk of local tissue necrosis.
- If it is a high-volume bolus injected quickly under high pressure, the embolism is displaced in a retrograde manner to a larger proximal artery. This is especially dangerous in the naso-glabellar zone, where the embolism can reach the ophthalmic artery through one of its collaterals (nasal, supra-trochlear, supra-orbital), and then the central retinal artery with the risk of definitive blindness.
The main recommendations to prevent these vascular accidents are a good knowledge of the three-dimensional anatomy especially in potential danger areas, the use of low-volume bolus injected slowly under low pressure, and the preferential use of hyaluronic acid, because treatment with hyaluronidase is possible if there is a vascular adverse event.

Conclusion: Hyaluronidase has represented a major step forward in avoiding cutaneous necrosis due to the embolization of fillers. Nowadays, the use of hyaluronidase precludes the necrotic accidents of the past. Necrosis occurs the most frequently when the injection is delivered in the upper third of the nasolabial fold or in the glabella, but other facial locations are possible. Wide and deep necrosis can leave scars for life.
Treatment with hyaluronidase should begin as soon as possible in order to avoid necrosis, and vigilance is required to recognize vascular compromise, the first symptom of inadvertent filler placement. The new high-dose pulsed hyaluronidase protocol developed by Lorenzi has the advantage of simplicity without ancillary treatments and provides a significant improvement in the quality of results.
Is the protocol applicable in the event of visual loss due to the embolism of a filler? Theoretically, it is, but the retina is more fragile than the skin. Irreversible damage occurs after 90 minutes of ischemia, so the hyaluronidase must be placed closely by retrobulbar injection to be effective. In practice, these conditions are rarely met, so avoiding blindness remains a challenge. However, two cases with a successful outcome have been published to date.

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

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

Disclosures

Did you receive any funding to support your research for this TOPIC?
Yes
Please specify entities (individual, company, society): Merz

Were you provided with any honoraria, payment or other compensation for your work on this study?
Yes
Please specify entities (individual, company, society): Merz

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
Yes
Please specify entities (individual, company, society): Merz

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

Objectives: Introduce ultrasound technology for anatomic evaluation.
Understand facial anatomical relationships using ultrasound.
Understand the benefits of using ultrasound for evaluating prior filler injections.
To be able to determine age and composition of prior filler injections.
To see the value of using ultrasound in evaluating and treating filler complications such as granulomas, nodules, and vascular occlusion.

Introduction: Ultrasound guided injections is standard of care for Orthopedics and Anesthesia injections. Ultrasound offers real time evaluation of anatomy including skin, muscle, fascia, fat, bone, and vascular structures. For optimal filler safety and cosmetic results, a full understanding of facial anatomy and its variants must be mastered. Ultrasound can be used to evaluate an individual's unique anatomy and determine presence of prior injections. Unique ultrasound characteristics can help diagnose the composition and the age of prior filler injections. Ultrasound can be used to assist in placement of f

Materials / method: Ultrasound was used for treating and evaluating patients in Dr. Weiner's private practice.

Results: Dr. Weiner will discuss his personal experience with using ultrasound in evaluation and treatment of his filler patients.

Conclusion: Ultrasound offers a quick, noninvasive, painless method to evaluate a patient's soft tissue and vascular facial anatomy. Ultrasound can be used to determine diagnosis of filler complication and assist in their mitigation. Ultrasound guided injections can be helpful in areas of high risk for vascular complications and blindness. Filler placement and tissue plane can be accurately guided using ultrasound.

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