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IMCAS World Congress 2022
Program

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FOCUS ON S026

Contributing lectures - Injectables

Room: Room 242 AB - Level 2
Date: Friday 3 June 2022 at 08:30 to 10:00
Format: CONTRIBUTED TALKS > session made up of abstract submissions that were carefully reviewed and selected by the Scientific Board

Chairs

Dr Marcin AMBROZIAK

Dermatologist

Poland

Dr Sahar Foad GHANNAM

Dermatologist

Kuwait

Lectures of the session

Hours	Speakers	Lecture title	Abstract	Number
08:30		Introduction		114311
08:32	Dr Roberta VASCONCELOS BERG	Ultrasound Guided Filler and Biostimulator Injections: Useful tips to integrate the sonography in daily practice	View	114387
08:41	Dr Rosa Maria SIGRIST	Ultrasound evaluation of the nose: anatomy, cosmetic fillers, threads, and its complications	View	113981
08:50	Dr Kahina BETROUNE	The growing role of duplex ultrasound in facial aesthetic injections	View	114681
08:59	Dr Amelia K HAUSAUER	Botulinum toxin type A in aesthetics: A 20-year systematic review, assessment of unmet needs in the US FDA trials, a discussion of global implications	View	113992
09:08	Prof Hussein GHANEM	Pitfalls, prevention, and management with botulinum toxin injections in the face and neck	View	113949
09:17	Dr Paola MOLINARI	Full-face combined aesthetic treatment, with hyaluronic acid fillers for volume and beauty booster for redensification	View	114304
09:26	Dr Jason RIVERS	Incidence and treatment of delayed-onset nodules after VYC filler injections (2139 patients at a single Canadian clinic)	View	112778
09:35	Dr Fabio MARINI	Tear trough: agarose gel treatment	View	113995
09:44	Dr Grasiela Cassia MONTEIRO	Chin strategy differences male and female patients using injectable fillers	View	115051
09:53		Q&A		114312

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Recommended sessions

Fillers: HA (hyaluronic acid)

Anatomy for injections

Ultrasonography

Botulinum toxins

Upper face & forehead (non-surgical)

Introduction

Dr Roberta VASCONCELOS BERG

Dermatologist

Switzerland

Other author(s) : Juliana Favaro Izidoro, Alina Müller, Francisca Wenz, Rosa Sigrist

Ultrasound Guided Filler and Biostimulator Injections: Useful tips to integrate the sonography in daily practice

Objectives: Guide the audience on practical ways to integrate sonography to guide the application of fillers and biostimulators on a daily basis.
Show the necessary equipment and material to perform the procedure and discuss its vantages and disadvantages.
Discuss the possible positions of the device and technical personal to assure a more comfortable environment.
Discuss two possibilities of guided fillers, with the ultrasound being performed right before or during the injection

Introduction: Real-time monitoring the anatomy of the face during the application of injectables potentially prevents complications such as vascular occlusions and injections into noble structures. The injectors who are starting out in the practice of ultrasound-guided injections are commonly faced with practical questions about the use of the equipment, positioning of professionals, materials and better management of the cannula and the device simultaneously. In addition, they are usually in doubt about the best time to use the device during the procedure and which structures should be identified.

Materials / method: The authors summarize the steps for the injecting physician to start the use of ultrasound to guide injectable aesthetic procedures, such as fillers and biostimulators.

Results: We will first approach factors related to the equipment and the ideal ultrasound transducers. Next, we discuss practical issues: material used, aseptic options, substances to promote contact of the skin with the transducer and ways of marking the skin during ultrasound. Then, we approach forms of positioning the professionals and equipments in the treatment field. We close with two methods to guide injectable procedures: 1) See before Inject: ultrasound is done immediately before the procedure 2) See while Inject: consists of identifing the vascular structures simultaneously to the injection.

Conclusion: Doppler ultrasound is a tool that provides safety for aesthetic injectable procedures and more and more professionals are seeking to qualify in this field to offer guided procedures. For professionals who are starting out in this area, it is important to know the details of the procedure for the treatment to occur in a fluid and safe way.

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 Rosa Maria SIGRIST

Radiologist

Brazil

Other author(s) : Luciana M Lourenço, Maria Gabriela O de Noronha, Lara A Colla, Thomaz R Izzo, Claudia Fontan, Giselle de Goes, Paula Colpas

Ultrasound evaluation of the nose: anatomy, cosmetic fillers, threads, and its complications

Objectives: The main objective of this lecture is to demonstrate the sonographic anatomy of the nose, as well as the sonographic characteristics of the most common fillers and threads found by the authors in distinct anatomical planes in the nose and the major complications of non-surgical nose procedures.

Introduction: The popularity of non-surgical nose procedures inevitably results in an increasing incidence of aesthetic complications in the nose. The authors emphasise the importance of continuous learning of nose anatomy, recognition of the sonographic characteristics of cosmetic fillers and threads, specially the recognition of complications

Materials / method: Ultrasonographic images of the nose of patients who underwent filler injection rhinoplasty or thread insertion in the last year were reviewed retrospectively by the authors.

Results: The sonographic anatomy of the nose was systematically reviewed based on the anatomical layers: skin, subcutaneous tissue, superficial muscle-aponeurotic system, deep fatty layer, periosteum and perichondrium. The main vessels of the nose were recognized and its possible positions were described. The planes which the most common cosmetic fillers, such as hyaluronic acid and polymethyl methacrylate were injected were also recognized, as well as absorbable polydioxanone (PDO) threads. Complications such as vascular occlusion and a thread extrusion were also described.

Conclusion: The recognition of the sonographic anatomy of the nose, sonographic characteristics of cosmetic fillers and threads used in the nose and its possible complications is of utmost importance for doctors and sonographers who scan the face.

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 Kahina BETROUNE

Phlebologist

France

Other author(s) :

The growing role of duplex ultrasound in facial aesthetic injections

Objectives: Given the explosive growth of aesthetics treatments worldwide, the use of duplex ultrasound should be the gold standard in the management of aesthetics procedures for optimal results and increased safety.

Results: However, the performance of duplex ultrasound is dependent on the operator’s training and understanding of basic ultrasound principles as well as their expertise in facial and vascular anatomy.

Handheld high frequency ultrasound devices are now available in the market. Ultrasound applications are growing due to their precision, optimal results, and increased safety. Duplex ultrasound is used to identify facial anatomy and facial vascular mapping before aesthetic treatments. It is ideal for guided filler injection, evaluating previous facial fillers, or treating complications.

Conclusion: The use of duplex ultrasound is becoming an essential method in all phases of facial aesthetics treatments. Its growth has been possible due to the accessibility of training, easy use and convenient size.

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 Amelia K HAUSAUER

Dermatologist

United States

Other author(s) : Hema Sundaram, MA, MD, FAAD

Botulinum toxin type A in aesthetics: A 20-year systematic review, assessment of unmet needs in the US FDA trials, a discussion of global implications

Objectives: This presentation is co-authored by two United States (US) dermatologists with experience as a Principal Investigator and Sub-Investigator on pivotal FDA randomized controlled clinical trials of Botulinum toxin type A (BoNTA). It provides the first systematic review and analysis of the research conducted in the US for toxin approvals and for post-approval surveillance. The high-yield evidence-based analysis highlights unmet needs and/or limitations to study designs and data capture.

Introduction: BoNTA injection represents the most popular nonsurgical cosmetic procedure performed worldwide with an increasing number of available products. Those that are approved by the US FDA have undergone rigorous, multi-phase Evidence Level I clinical trials to determine appropriate dosing and quantitatively evaluate safety, efficacy and tolerability. With rising demand for botulinum toxins comes a greater diversity of patient populations seeking treatment with respect to age, Fitzpatrick skin phototype, ethnicity, sociocultural considerations, and gender.

Materials / method: A primary literature search for phase 2 and 3 pivotal trials of botulinum toxin type A for cosmetic indications was conducted according to the PRISMA reporting guidelines.

Results: Comparisons of study design, participant characteristics, experimental variable(s), outcome metrics and adverse events were performed, tabulated and analyzed.

Conclusion: This first-of-its-kind retrospective analysis serves as a new resource for direct comparison of the robust trials conducted to obtain FDA approval of cosmetic neuromodulators. It also highlights the need for more ethnoculturally diverse data that matches the evolving demographics of patients seeking toxin treatments, requisite standardization of meaningful outcome metrics, limits of extrapolation, and potential failure to capture full dose-response effects. This research may stimulate discussion re study design while raising the evidence level for aesthetic applications of BoNTA globally.

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

Prof Hussein GHANEM

Dermatologist

Egypt

Other author(s) : Hussein Ghanem, Heba Darwish, Dina Farouk

Pitfalls, prevention, and management with botulinum toxin injections in the face and neck

Objectives: • Understanding pertinent anatomy related to botulinum toxin injections in the face and neck.
• Understanding various complications with approaches to prevent and manage their occurrence.

Introduction: Botulinum toxin is one of the most commonly performed cosmetic procedures. However, undesirable effects are common and may be preventable to a significant degree. Side-effects may be related to technique, anatomy or product used. Ptosis of eyebrows or eyelids, excessive elevation of the eyebrows, transient diplopia, a “chip-monk” look, are examples of side effects noted with upper face injections. An uneven smile and rarely difficulty swallowing are among complications reported with lower face and neck injections.

Materials / method: This is a retrospective study and review of literature regarding side effects of botulinum toxin injections. Five hundred and thirty cases were injected by 3 dermatologists over a 5-year period. Pertinent anatomy and related techniques will be presented. Cases were reviewed regarding side-effects and injection techniques.

Results: Transient ptosis of eyebrows or eyelids, or excessive elevation of the eyebrows may occur with forehead and glabellar injections. Techniques to avoid and manage them will be discussed. Transient diplopia was seen in one case with injections beneath the orbit. The so-called “chip-monk” look, or complete erasing of the lateral canthal lines were seen with high doses lateral to the orbit. An uneven smile was rarely seen with Depressor Anguli Oris and masseter injections. Temporary difficulty swallowing was not seen but has been reported in the literature with neck injections and could be material

Conclusion: Though botulinum toxin is one of the most commonly performed cosmetic procedures, yet full understanding of the anatomy and nature of the products are necessary to avoid undesirable side effects.

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 Paola MOLINARI

Cosmetic Surgeon

Italy

Other author(s) :

Full-face combined aesthetic treatment, with hyaluronic acid fillers for volume and beauty booster for redensification

Objectives: This study aimed to present a new approach for the full-face volumizing with the multilayer technique combined with skin redensification

Introduction: The use of hyaluronic acid (HA) dermal fillers for the full-face reshaping is growing in popularity. Moreover, newer understanding about the anatomical fad pads and the causes of facial volume loss have led to a development of new treatment techniques with a gender different approach.

Materials / method: The Multilayer is an injective technique that takes into account both anatomy of cutaneous layers and gender facial features. This technique was performed using different HA dermal fillers that were injected in a specific depth based on their rheologic properties. Facial volume was restored starting from the deeper to the more superficial and dynamic layers with static and dynamic HA dermal fillers respectively. The full-face volumizing approach is completed with a beauty booster redensification.

Results: The Author explains the anatomy of the various facial compartments and shows the full-face volumizing technique with the results obtained from this new approach.

Conclusion: The combined full-face volume approach is a technique of aesthetic medicine to reshape the facial volume respecting the dynamism of the face. This is an anatomical approach that takes into account various cutaneous layers and gender differences. The practitioners should have a deep knowledge of facial anatomy to choose the ideal HA fillers based on the plane of injection and their rheology properties to achieve the desired results.

Disclosures

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

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?
Yes
Please specify entities (individual, company, society): teoxane

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 Jason RIVERS

Dermatologist

Canada

Other author(s) : Jason K Rivers

Incidence and treatment of delayed-onset nodules after VYC filler injections (2139 patients at a single Canadian clinic)

Objectives: 1) Appreciate the incidence of delayed onset nodule formation from Vycross HA filler
2) Develop an approach to minimize the occurrence of these nodules
3) Formulate a management strategy to deal with delayed nodules

Introduction: Delayed-onset complications from dermal fillers can occur weeks to months after the injection but are uncommon. The incidence of delayed-onset hypersensitivity reactions to earlier nonanimal stabilized HA (NASHA) fillers has been estimated at 0.02% to 0.4%. However, there are reports of higher incidences of delayed-onset nodule development with HA filler products using Vycross (VYC) technology. Prior studies were based on data from sites with multiple injectors, different injection techniques and methods of skin preparation, and dilution of HA fillers prior to injection.

Materials / method: Patients with delayed-onset nodules after injections with VYC-20L , VYC-17.5L, and VYC-15L were identified by retrospective chart review.

Results: Since 2010, 2139 patients received injections from the same physician with combinations of VYC-20L (57.6% of patients; 2.4 syringes/patient), VYC-17.5L (23.9%; 1.5), or VYC-15L (18.5%; 1.5). Seven female patients (mean age, 62 years) developed delayed-onset nodules for an overall incidence of 0.33%. A potential inflammatory trigger (reported by 6 patients) occurred 1 to 168 days prior to nodule development. Nodule biopsy in 1 patient confirmed a foreign-body granuloma. The most effective treatment incorporated prednisone with or without hyaluronidase.

Conclusion: VYC-associated incidence of delayed-onset nodules (0.33%) was lower than earlier estimates from previous studies. In the current analysis, VYC-15L had a rate of delayed reactions comparable to non-VYC products. The data suggest that a standardized injection protocol may be associated with the lower incidence of VYC product delayed-onset nodule development observed in the current analysis, that an inflammatory trigger may play a significant role in subsequent nodule development, and that reactive nodule treatment strategies are associated with successful resolution in affected patients.

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 is presented thanks to the support of: Abbvie via an educational grant for publication of the manuscript

Dr Fabio MARINI

Cosmetic Surgeon

Italy

Other author(s) :

Tear trough: agarose gel treatment

Objectives: Tear trough: agarose gel treatment
To report safety and patient satisfaction outcomes of AGAROSE GEL 1% for correction of tear trough

Introduction: The tear trough deformity is commonly requested for correction, most often by filler injections. However, the tear trough remains difficult to treat due to its complex anatomy, a variety of other concurrent deformities, and the high risk of complications.
AGAROSE GEL filler can be safely used as a soft-tissue filler for correction of infraorbital hollowing. It has a high overall patient satisfaction profile among patients.

Materials / method: This was a retrospective observational study performed at a private ambulatory of aesthetic medicine and surgery practice. Participants were all patients 21 to 85 years old who presented to our practice and underwent agarose gel 1 % treatment for correction of tear trough as a singular intervention from February 2019 to July 2021.
Interventions: Injection of Agarose gel 1% to the tear trough, nasojugal fold, and/or palpebromalar groove.
Main outcomes and measures: Primary outcome measures include the number of recorded short- and long-term adverse events, need for additional treatment, and

Results: Results: A total of 202 eyes were treated in 101 patients with a mean follow-up of 12 months. Patients were principally female (90 [89%]) with an average age of 54 years (range, 21-85 years). Most patients (99) had Fitzpatrick grade 1 to 4 skin type (98%) and had an infraorbital hollows score of 2 to 4 (89 [88%]). The average initial treatment volume was 0,5 mL with 18 patients (18%) requiring additional treatment within 3 months. The average time until additional treatment was 35.7 days. Adverse effects include bruising (in 10 [10%], contour irregularities (2 [2%]),swelling (7[7%]),
Tyndal 0

Conclusion: Hyaluronidase never was required . Forty-one patients completed the FACE-Q Satisfaction With Eyes survey, and 42 patients completed the FACE-Q Satisfaction With Decision survey (41% and 42%). Overall mean (SD) patient satisfaction (based on FACE-Q scores) was 71.1% (27.3) and 65.6% (31.3), respectively
Conclusions and relevance: agarose gel 1% has a high patient satisfaction profile and and good safety profile for the correction of tear trough.

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 Grasiela Cassia MONTEIRO

Dermatologist

Brazil

Other author(s) :

Chin strategy differences male and female patients using injectable fillers

Objectives: - Evaluate the most common chin deformities
- Describe the differences when treating chin area in male compared with female patients
- Review of the anatomy of the chin, special gender considerations for assessment and filler treatments
- A video showing special tips to use cannula in the mental area.

Introduction: The use of injectables in the chin area is growing in the last decades. This minimally invasive facial aesthetic treatment is more popular than surgery in many recessed cases. Gender differences in the male face include a wider and larger chin and broader jawbones compared with females. The male face, in general, is squarer compared to the heart- shaped face of a woman. The male chin is also squarer compared to the female which is more pointed.

Materials / method: A review of the scientific literature in Pub Med in the past 10 years using as keywords: chin, male patient, female patient, fillers .

Results: It is very crucial for the correct assessment before the filler treatments in the male and female patients of the chin area to avoid undesired masculinization or feminization of the face.

Conclusion: Chin deformities are the most common bony abnormality of the face and the majority of them can be treated with fillers. the fillers in the chin can be used for beautification and /or rejuvenation. A beautiful face, in general, means the harmonious proportions of the facial horizontal thirds and vertical fifths. The chin is of great importance for a beautiful face in both men and women patients.

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 World Congress 2022 Program

FOCUS ON S026

Contributing lectures - Injectables

Chairs

Lectures of the session

Recommended sessions

IMCAS World Congress 2022
Program