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IMCAS World Congress 2024
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FOCUS ON 142

Injectables - Contributed talks

Room: Room 342 - Level 3
Date: Friday 2 February 2024 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 Brunilda BARDHI

Dermatologist

Albania

Dr Todd SCHLESINGER

Dermatologist

United States

Lectures of the session

Hours	Speakers	Lecture title	Abstract	Number
08:30	Dr Alina SALMAN	“Don’t forget the hands”: what’s new in hand rejuvenation	View	130391
08:38	Dr Noury ADEL	Gummy smile treatment with neurotoxins: smile pattern analysis approach	View	130390
08:46	Dr Manuela JORGE	Lip filling performed with two products with different rheological properties: an advanced approach to facial beautification	View	130393
08:54	Dr Meryem Ozlem OZTURK	Complication management with HA dermal fillers in patients with previous rhinoplasty	View	130394
09:02	Dr Nadine HAMADA	Tear trough filler correction tips - The ongoing challenge	View	130396
09:10	Prof Hussein GHANEM	Forehead botulinum toxin injection patterns: benefits, indications, and side effects	View	133280
09:18	Prof Giuseppe SITO	Nose, lips and chin: tips and tricks to the combined treatment in order to enhance the facial profile	View	133510
09:26	Dr Amir MORADI	Revitalizing the depressor anguli oris and marionette lines: toxin treatment - Anatomical insights, techniques, and clinical study outcomes	View	134810
09:34	Dr Jani VAN LOGHEM	Using PEGylated HA in global facial rejuvenation, an anatomy-based approach (educational grant from Neauvia)	View	130395
09:46	Dr Mauricio Orlando MENDEZ ESPANA	Management of ultrasound and hyaluronidase complications	View	130392
09:54		Q&A		130398

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Recommended sessions

Fillers: HA (hyaluronic acid)

Complications

Anatomy for injections

Botulinum toxins

Lips & perioral (non-surgical)

Dr Alina SALMAN

Dermatologist

Jordan

Other author(s) :

“Don’t forget the hands”: what’s new in hand rejuvenation

Objectives: -Familiarize ourselves with aging process in the hands.
- Aknowledge out patients’ needs and concerns.
- Learn to use different approaches, techniques, injectables and devices to rejuvenate the hands.
Boosters, fillers (HA, Ca hydroxyapatite, hybrid fillers) energy based devices .. etc

Introduction: It’s not a secret aesthetic medicine and skin rejuvenation has developed a lot these past years, but all the focus was turned into treating the face. Hands should not be neglected. It’s time to address out patients concerns.

Materials / method: I used an inductive approach, by searching the literature for published, evidence based studies that researched the subject.
And discuss my experience and approach in my private clinic for best results.

Results: Many techniques and tools are available these days to rejuvenate the hands and help our patients age gracefully. It’s our job to familiarize ourselves with different approaches.

Conclusion: More and more our patients are becoming aware of the aging changes happening in their hands and asking us for solutions. We have many different tools to help achieve satisfactory results. We should always focus on combining treatments.

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 Noury ADEL

Facial Plastic Surgeon

Egypt

Other author(s) :

Gummy smile treatment with neurotoxins: smile pattern analysis approach

Objectives: * To gain the ability to assess different smile patterns and different types of gummy smile.
* To be able to customize your injection points depending on the type of gummy smile.
* To use a standardized approach for the dosage when you treat the gummy smile

Introduction: The present study was performed to evaluate the effect of repeated botulinum toxin
injections and their long-term effects, using a customized injection point and dosage
technique in the treatment of excessive gingival display.

Materials / method: Twenty women who had gummy smile due to hypermobility of the upper lip or gingival display, ranging from 4 to 6 mm‚ were included in the study. All patients were injected with Botox injections at different injection points according to the type of smile. Pre- and postoperative measurements were taken by measuring digitally the gingival display at smiling, using Adobe Photoshop software via standardized digital photographs. Patients were followed up at 14 days, 4 months, 8 months, and 12 months.

Results: Postoperative measurements showed marked improvement at 14-day follow-up,
with a significant reduction in the amount of gingival display. Relapse, however,
occurred at 4 months and later.

Conclusion: For excessive gingival display, Botox is an effective treatment that lasts for 2–3 months, with almost complete relapse at 4 months. We concluded from the results of our study that, despite repeated Botox injections at two follow-up intervals (4 and 8 months), the theory that repeated Botox injections may offer a permanent effect is still questionable.

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 Manuela JORGE

Dermatologist

Brazil

Other author(s) :

Lip filling performed with two products with different rheological properties: an advanced approach to facial beautification

Objectives: This work aims to explore an advanced lip filling technique using two types of hyaluronic acid, with different rheological properties, and to discuss its benefits, limitations and relevant clinical considerations. In addition, aspects related to safety, patient satisfaction and consistent aesthetic results that can be achieved with this approach will be addressed.

Introduction: Lip beautification has become increasingly popular in contemporary society, with a growing search for aesthetic procedures that improve facial appearance and enhance the natural beauty of the lips. Among the techniques used for this purpose, lip filling stands out, a minimally invasive and highly effective approach to provide more voluminous, defined and harmonious lips.

Materials / method: Two different types of hyaluronic acid were used: more cohesive and more rigid gel less cohesive and less rigid gel.
The technique involves using the most cohesive and rigid hyaluronic acid gel to contour, and the least cohesive and rigid to generate volume in lips that do not have a structured contour and very thin lips.
To finish the upper lip, insert the needle into the central v of the cupid's bow. Microbolus on labial center and 2 bolus on vermillion.
In the lower lip, the entry point is made in the central region of the contour, and retro-injection.

Results: This technique has the advantage of better precision in the lip contour, making it more defined and preventing the formation of nodules in the vermillion region of the mouth. Thus, we have a more beautiful and harmonic result when the two rheologies of different hyaluronic acids are associated.

Conclusion: An advanced lip filling technique using two types of hyaluronic acid, with different rheological properties, aimed at improving the lip contour, making it more defined and preventing the formation of nodules in the vermilion region of the mouth. The benefits, limitation and clinical considerations are relevant in this article.

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 Meryem Ozlem OZTURK

Dermatologist

Turkey

Other author(s) : Dr. Ilker Yoruk

Complication management with HA dermal fillers in patients with previous rhinoplasty

Objectives: Addressing complications with hyaluronic acid dermal fillers after rhinoplasty. Highlighting liquid rhinoplasty as non-surgical global trend. Evaluating rare risks like blindness and necrosis, particularly in prior rhinoplasty. Introducing innovative filler technique used in 10,000+ cases, focusing on injection sequencing to maintain nasal profiles. Presenting outcomes of liquid rhinoplasty in prior surgery. Emphasizing technique's suitability for such cases.

Introduction: Nasal augmentation is a global trend, including our country. Liquid rhinoplasty offers a surgery-free solution for patients to address aesthetic concerns and resume their routine quickly. Despite rare complications, caution is exercised due to risks like blindness and necrosis, especially in patients with a rhinoplasty history.

Our new filler technique, used in 10,000 cases over 14 years, has notably lower complications in prior rhinoplasty patients. Among approximately 1,500 previous rhinoplasty cases, only 47 experienced minor complications using our method.

Materials / method: We present an application on a patient with a 3-year-old rhinoplasty. Initial filler (0.1 cc) was administered to the columellar area, followed by a 0.05 cc injection to the supratip. Avoiding over 0.1 cc in the tip-supratip is vital to prevent compression issues. Addressing cartilage collapses post-rhinoplasty, a microdroplet technique with 0.1 cc was applied at six points. In the radix, 0.05 cc achieved a better angle, totaling 0.35 cc.

Results: Blindness from fillers is rare; necrosis is more common due to arterial issues. Treating embolization is challenging, while circulation issues due to compression are relieved by removing it.

During rhinoplasty, neovascularization results in thinner yet branched vessels, reducing embolization risks. However, thinner vessels are more susceptible to compression. Minimizing compression risks involves releasing compressed filler, applying hyaluronidase, and gentle massaging.

Conclusion: In summary, contrary to what was assumed previously, the decrease in complication rates in patients with previous rhinoplasty is attributed to this mechanism. Intra-arterial embolization risks decrease, and in cases of compression, rapid diagnosis and treatment have been observed to lead to lower complication rates. This technique can readily be applied to patients who have previously undergone rhinoplasty.

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 Nadine HAMADA

Dermatologist

Egypt

Other author(s) :

Tear trough filler correction tips - The ongoing challenge

Objectives: Tear trough area correction has always been an ongoing challenge, the aim of this review is to get a proper guide for the proper tear trough correction that shall keep good results and avoid complications.

Introduction: The eye is one of the most attractive aesthetic units at the same time its one of the areas that shows early sings of aging after over 8 years treating this area I can conclude that the key for proper treatment lies in the TT cause identification and proper patient selection for this procedure. Also more important than the type of HA fillers used the amounts and technique of injection to obtain the best results.

Materials / method: Proper Patient examination ( snap test for the skin quality, pigmentation , make sure of having HA filler ( medium cross link) , an average amount of 0.2-0.4 cc is maximally used per side.
25G, 50 mm long canula is used .
Injection must be placed deep (supra periosteaum).
under correction is recommended with only 70-80% maximum correction.
Re-consultation after 2 weeks is recommended.
Correction of the cheek defect is a must before TT treatment.
It's crucial to avoid any harsh motion or struggle with the canula to void edema.
The treatment is recommended not to be repeated before 6 months.

Results: Improvement of the tear trough with overall satisfactory results.
Complications reports were minimal (out of the 7 presented cases only 2 reported mild edema and only one of them reported tenderness that disappeared after 1 week).

Conclusion: With proper patient selection, proper injection technique TT can be safely corrected.
Filler migration can be avoided by under-correction , avoiding too much material injection, avoiding harsh massage and the use of a light to maximum medium cross linked filler.
Avoiding patients with massive edema and patients with massive laxity is important to avoid complications.

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) : Heba Darwish, Dina Farouk

Forehead botulinum toxin injection patterns: benefits, indications, and side effects

Objectives: This work aims to evaluate the various patterns for injecting Botulinum Toxin (BTX) into the Frontalis muscle and present evidence-based data related to each approach, assessing their scientific validity, safety, and indications.
Learning Outcomes:
• Gain an in-depth knowledge of the different injection patterns for Botulinum toxin injection into the forehead.
• Understand the indications, effectiveness, and safety for each injection pattern.

Introduction: Several patterns for injecting Botulinum Toxin (BTX) into the Frontalis muscle have been described, including the M-shaped pattern, the Horizontal pattern, the V-shaped pattern, the 2-row pattern, and the C-line related pattern (1). Patterns that emphasize brow lifting often aim to preserve the lateral Frontalis muscle or focus on the upper frontalis above the C-line, as described by Cotofana et al (2020).

Materials / method: An extensive literature review pertaining to BTX injection in the forehead was conducted. Search terms included "Botulinum Toxin," “Frontalis muscle,” "Forehead," "Forehead injection patterns," " Frontalis muscle injection patterns," "Botulinum toxin injection patterns" and “complications”.

Results: The M-shaped injection pattern seems to be commonly adopted. The C-line related pattern is promoted for its enhanced safety. The Horizontal pattern is believed to preserve the brow shape. Limited information exists regarding the V-shaped pattern, which is posited to reduce the incidence of brow ptosis.

Conclusion: The current emphasis on safety favours the C-line related pattern to prevent ptosis. Nevertheless, injectors should familiarize themselves with the various patterns, understanding their respective advantages and disadvantages, as they might be beneficial in particular scenarios, such as resistant forehead lines or brows prone to ptosis.

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 Giuseppe SITO

Plastic Surgeon

Italy

Other author(s) :

Nose, lips and chin: tips and tricks to the combined treatment in order to enhance the facial profile

Objectives: From the patient assessment to the main strategies to safely harmonize some focal points of beauty through the use of dermal fillers of hyaluronic acid (HA).

Introduction: Profiloplasty is the combined treatment aimed at improving the appearance of a face by enhancing the profile. It is well known, in fact, that Beauty includes convexity and concavity. How to do it, where to start, what to avoid, are the main questions to wonder.

Materials / method: Three specific areas were considered: nose, lips and chin. Once the right proportions were defined, each area was treated with Hyaluronic Acid (HA) dermal fillers with different rheological properties. For the nose and chin, a filler of HA 25 mg/ml with classical rheology, with high G prime and MoD 8%, was used by elongated bolus technique. For the lips, a filler based on dynamic HA (23mg/ml) was used, with high cohesiveness and injected with a combined technique.

Results: The author illustrates how to carry out the correct assessment of the patient, where to start and the main tips and tricks for a safe and effective treatment of the different areas.

Conclusion: A repeatable and safe combined approach that allowed a harmonious and lasting redefinition of nose, lips and chin in the same session.

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 Amir MORADI

Facial Plastic Surgeon

United States

Other author(s) :

Revitalizing the depressor anguli oris and marionette lines: toxin treatment - Anatomical insights, techniques, and clinical study outcomes

Objectives: This talk aims to explore the revitalization of the depressor anguli oris (DAO) muscle and the treatment of marionette lines through the use of toxin injections. The objectives of this presentation are to provide anatomical insights into the DAO muscle, demonstrate effective injection techniques, and present the outcomes of a clinical study. By understanding the underlying anatomy, refining injection techniques, and examining clinical results, practitioners can achieve successful outcomes in addressing DAO-related concerns and rejuvenating the marionette lines.

Introduction: The depressor anguli oris muscle and marionette lines are common concerns in facial aesthetics, as they contribute to a tired and aged appearance. Toxin injections targeting the DAO muscle have shown promise in rejuvenating the lower face, providing a non-surgical solution to address marionette lines and oral commissure downturn. This talk aims to provide a comprehensive introduction to the anatomical insights of the DAO muscle, effective injection techniques, and the clinical study outcomes highlighting the success of toxin treatments in revitalizing the DAO and treating marionette lines.

Materials / method: The talk will utilize a combination of didactic lectures, anatomical illustrations, and clinical study data to convey the methods employed in understanding the anatomy of the DAO muscle, perfecting injection techniques, and presenting clinical study outcomes. Attendees will be guided through the intricate anatomy of the DAO muscle, including its origin, insertion, and functional implications. Injection techniques targeting the DAO muscle and marionette lines will be demonstrated, emphasizing accurate needle placement, dosage, and injection depth for optimal outcomes.

Results: By the end of the talk, attendees will gain a comprehensive understanding of the anatomical insights of the DAO muscle and its role in facial aesthetics. They will learn effective injection techniques to address DAO-related concerns and revitalize the marionette lines. The presentation of clinical study outcomes will showcase successful results achieved through toxin treatments, demonstrating improvements in oral commissure downturn and marionette lines.

Conclusion: Revitalizing the depressor anguli oris muscle and treating marionette lines through toxin injections offers a non-surgical approach to lower face rejuvenation. By understanding the underlying anatomy, refining injection techniques, and examining clinical study outcomes, practitioners can confidently and effectively address DAO-related concerns.

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 Jani VAN LOGHEM

Netherlands

Other author(s) :

Using PEGylated HA in global facial rejuvenation, an anatomy-based approach (educational grant from Neauvia)

Objectives: To reverse signs of aging using PEGylated HA

Introduction: Age related anatomical changes include deep volume loss (bone, fat) and sagging of soft tissues. Retaining ligaments play an important role when the goal is to naturally rejuvenate and lift the cheeks

Materials / method: Various PEGylated HA products (Neauvia, Italy) are used in a global facial approach. High focus is on injection safety and prevention of especially vascular complications. Due to the limited duration of the presentation, a link is shared to view the full 1 hour and 48 minute live demonstration. The video is hosted on the website of UMA Academy (academy.uma-institute.com)

Results: Beautification and rejuvenation are the result of this treatment

Conclusion: PEGylated HA fillers pose a promising addition to the armamentarium of the aesthetic physician in the field of nonsurgical facial rejuvenation

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 Mauricio Orlando MENDEZ ESPANA

Mexico

Other author(s) :

Management of ultrasound and hyaluronidase complications

Objectives: Management of complications: Ultrasound and Hilauronidase

The objective of the following presentation is the correct use of ultrasound and hyaluronidase when presenting complications secondary to the use of injectables regardless of the injection material, as well as demonstrating the behaviors carried out by endodermal fillers.

In most cases, the patients themselves are unaware of the type of material that has infiltrated them. For the doctor it is important to know its origin and characteristics, since even if there are no problems, with the passage of time new injections of other material

Introduction: Ultrasound is a non-invasive, reproducible technique that makes it possible to follow the evolution over time of these materials and classify them according to identifiable patterns.
ultrasound the persistence over time of injectable filler materials, to know their degree of reabsorption when they are resorbable to decide their replacement with new injections and finally, to identify the product when the patient comes to the office for a new treatment but ignores the type of material that was injected. The identification of the infiltrated product is of great help to decide the composition

Materials / method: In this case we will use an ultrasound greater than 15Hz to better detect facial structures, the different layers that we have and the behavior that fillers carry out in the leather over time.

Likewise, also know the use of the ultrasound Doppler system to perform a review before and after the application of endodermal fillers; in case of detecting vascular complications, know how to use and know the protocol for the use of hyaluronidase for complications

images of before and after placement of fillers and doppler for detection will be shown

Results: As results we were able to find in our patients that the protocol was carried out, how to locate the vascularization, the injection site, the immediate reactions to the application as well as, in case of suspicion, apply a personalized hyaluronidase protocol and what factors does ultrasound by the type of sharing thereof; we were able to distinguish a patient with previous placement of CaHa and some filler materials placed we were able to identify which endermic filler is the most common that forms granulomas, vacuolar patterns or patterns with acoustic reinforcements

Conclusion: Ultrasound is a basic instrument for locating filler materials, for diagnosis and forecasting of behavior over time. Faced with possible adverse reactions, ultrasound is a technically useful instrument for effective action, either to objectify the therapeutic attitude or as a diagnostic imaging technique and indication to assess the suitability of a product with respect to the treated area and the patient

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 2024 Program

FOCUS ON 142

Injectables - Contributed talks

Chairs

Lectures of the session

Recommended sessions

IMCAS World Congress 2024
Program