Objectives: This work presents and explores an advanced lip filling technique with two types
distinct from hyaluronic acid, discussing benefits, limitations and clinical considerations. Aspects related to safety, patient satisfaction and consistent aesthetic results are addressed, highlighting the effectiveness of this procedure.

Introduction: Among the techniques used for this purpose, lip filling stands out, an approach minimally invasive and highly effective to provide fuller, more defined lips harmonious.
Lip filler emerges as an innovative and versatile solution to these concerns aesthetics, with significant advances in recent decades in terms of materials and techniques.
Individualized approaches are essential to avoid artificial or disproportionate results.

Materials / method: Two types of hyaluronic acid with different rheological properties were used, the first being denser hyaluronic acid (which we named AH1) and the second less dense (which we named AH2).
The technique involves injecting the highest density hyaluronic acid (AH1) to create the contour, and the lowest density hyaluronic acid (AH2) to generate volume in lips that do not have a structured contour and very thin lips. For lips that need an increase in volume, and that already have a defined contour, we use the low-density product for the contour and the high-density product for the vermilion.

Results: When we use this technique with two fillers with different rheologies, we have several benefits, which combine aesthetics and function. We have greater safety through the use of the cannula, and the use of these different fillers can avoid palpable nodules resulting from the accumulation of hyaluronic acid. This way, we also avoid an inflated appearance, which would not be natural. And when we distribute properly filler material, we avoid asymmetries in the lips, leading to a more regular, more harmonious and elegant.

Conclusion: This technique has the advantages of better precision in the lip contour, leaving it more defined and preventing nodules from forming in the vermillion region of the mouth, minimizing the risks problems related to the procedure. Through this technique, we combine aesthetics and function optimized. This way, we have a safer, more beautiful and harmonious result when associated with the two rheologies of different hyaluronic acids.

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Objectives: The primary objective was to assess the effectiveness and safety of polymethylmethacrylate filler injections at the muscle level for buttock augmentation.

Introduction: This study presents a 17-year experience using long-lasting polymethylmethacrylate fillers for intramuscular buttock volume augmentation. With over 1.000,000 cc of product applied, we aimed to achieve natural, minimally invasive, and safe volumetric gains. A multicentric study conducted in Brazil (Sao Paulo, Rio de Janeiro, and Porto Alegre) examined the intramuscular approach for gluteal volumetry.

Materials / method: The study included over .1.000,000 cc of long-lasting polymethylmethacrylate fillers, applied intramuscularly, to support and enhance gluteal volume.

Results: The results were considered highly satisfactory and natural by both the medical team and the patients. The volumetric gains achieved with this intramuscular approach were significant, and the product remained within the muscle, providing support without adding weight to the skin. Adverse effects were minimal in comparison to established techniques such as liposuction and silicone prosthesis.

Conclusion: In conclusion, this study demonstrates that intramuscular polymethylmethacrylate filler injections provide a natural, safe, and promising method for buttock volume enhancement. The technique offers excellent results with minimal adverse effects, making it a valuable alternative to conventional procedures like liposuction and silicone prosthesis in the quest for gluteal volumetric improvement.

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Objectives: The aim is to highlight the importance of customized global gluteal treatment, which encompasses not only the gluteal region but also adjacent areas. We will discuss the strategic application of products, such as dermal fillers, biostimulators, emptiers and the integration of technologies to optimize aesthetic outcomes. The focus will be on tailoring this treatment to meet the individual needs of each patient, aiming for overall enhancement of the gluteal region.

Introduction: With the growing interest in minimally invasive aesthetics, gluteal augmentation procedures have gained prominence. However, isolated approaches to gluteal enhancement often fall short of expectations. There arises the need for an integrated approach: global gluteal treatment. This encompasses not only the treatments of products in the gluteal region but also in adjacent areas. The strategic combination of different approach aims to improve volume, projection, contour, firmness, and skin texture.

Materials / method: We conducted assessment and global gluteal treatment in a group of patients, considering not only the gluteal region but also adjacent areas such as flanks, cleft, and "banana fold”. A variety of techniques and products were used, including hyaluronic acid fillers, collagen biostimulatory agents, emptiers, along with specific technologies to optimize outcomes. These interventions were strategically applied to enhance contour, volume, projection, skin firmness, and address skin texture and fat distribution.

Results: The approach of global gluteal treatment resulted in significant improvements in the aesthetics and overall appearance of the treated region. Patients expressed high satisfaction with the outcomes, reporting improvements in contour, volume, and skin firmness, as well as smoother and more uniform skin texture.

Conclusion: The strategic application of a combination therapy enabled achieving natural and harmonious results, considering the individual needs of each patient. We emphasize the importance of comprehensive assessment and personalized treatment plan to achieve superior and satisfactory aesthetic outcomes in gluteal and adjacent areas.

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Objectives: To access long -term durability and tissue integration of gluteal augmentation performed with a multilayered hyaluronic acid (HA) dermal filler in a small group of patients, through ultrasonographic follow-up. Also, follow-up occurrence of any adverse events, aiming to assess the long-term safety of this gluteal augmentation method.

Introduction: Gluteal augmentation with hyaluronic acid (HA) dermal fillers is an emerging practice reflecting the increasing demand for aesthetic procedures beyond the face. However, assessing the durability and safety of this procedure is essential. This case series aims to investigate the long-term durability of gluteal augmentation using ultrasound, emphasizing the importance of follow-up to assess proper integration, absorption.

Materials / method: Three patients underwent gluteal augmentation using a multiphase hyaluronic acid (HA) dermal filler with high G prime. Follow-up imaging through ultrasound was performed at 6, 12 and 20-months, after procedure. Injected HA was monitored overtime, including product topography, echogenicity, tissue integration, characteristics and distribution. Surrounding tissue characteristics were also assessed. A multifrequency linear transducer (8–18 MHz) from LOGIQTM Pro (GE Healthcare, USA) was used with presets adjusted for skin ultrasound evaluation.

Results: The ultrasonographic follow-up revealed the presence of the filler in all patients throughout the follow-up period and can be used as a toll to monitor it. No signs of migration to adjacent areas were observed. In the 12 and 20-month follow-ups, performed on the same patient, the largest pocket found measured 14.9x 1.7x 6.6mm and 10.2x1.7x7.2mm, respectively. Color Doppler studies did not characterize anomalous flows. At 20-month FUP, some interspersed in the subcutaneous cellular tissue, with slight surrounding hyperechogenicity, In this follow-up, patients did not report any adverse events.

Conclusion: Although this assessment involved a small number of patients, ultrasonographic evaluation demonstrated to be an important tool to monitor body fillers. It can show the durability of HA over time. These findings may indicate the durability and safety of hyaluronic acid filler for gluteal enhancement, becoming a long-term treatment option for aesthetic improvement of the buttocks.

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Objectives: The objective of this paper is to demonstrate the effectiveness of applying intramuscular fillers, in
4725 cases, to correct deformities, volume losses, asymmetry and irregularities.
With the demonstration of the correct application plans, adequate volume, correct technique for the desired results with 2,1% of complications

Introduction: Between 2009 and 2022 we performed a total of 4725 buttocks filling procedures with filler intramuscularly.
Almost 1 million ml of filler was used in these 4,725 procedures, administered through an atraumatic cannula, under local anesthesia with the patient monitoring the procedure in real time.

Materials / method: Intramuscular filler was used, with a cannula, between the years 2009 and 2024, almost 5 thousand filling
procedures with almost 1 million filler used.

Results: We show the complications observed in this sample, 2.1% of complications, no serious complications observed in this
sample. Nodules and seroma were the most common complications, both with a rate of 0.5%, followed by hemtama and pain,
both treated and eliminated in less than 30 days.

Conclusion: By applying the correct technique, adequate volume and manual skill, it is possible to successfully perform body
corrections in the gluteal area. With this procedure that I have been carrying out daily for over 10 years, I can restore
self-esteem, promote quality of life and make women feel more confident and happy with themselves.

Objectives: This presentation aims to introduce a clinical method that differentiates various complaints related to the lower eyelid, such as infra palpebral bags, deep dark circles, lower eyelid sagging, orbicular muscle hypertrophy, changes in lower eyelid pigmentation, and cases with multiple conditions combined. Discusses various therapeutic options for the lower eyelid, such as botulinum toxin, phenol-croton peel, TCA and lactic acid peel, HIFU, and hyaluronic acid fillers. This presentation does not teach how to perform the techniques but rather how to select the most appropriate approach.

Introduction: According to recent studies using eye-tracking technology, the periorbital region shows the most signs of facial aging. Doctors are constantly challenged to evaluate and treat a range of aesthetic concerns related to the lower eyelid. These can range from infra palpebral bags to deep dark circles, sagging of the lower eyelid, hypertrophy of the orbicularis muscle, changes in lower eyelid pigmentation, and cases involving multiple conditions in a single patient. Furthermore, the literature presents confusing nomenclatures and inadequate differentiation of these aesthetic complaints

Materials / method: During the presentation, the audience will receive a detailed anatomical overview of facial features. The speaker will also discuss different aesthetic conditions of the lower eyelid. Additionally, non-invasive therapeutic options will be presented, along with real case studies to demonstrate the practical application of clinical methods in diagnosing aesthetic issues.

Results: By the end of the class, participants will be able to identify various aesthetic conditions of the lower eyelid. They will also learn to personalize treatment plans for individual patients and immediately apply this knowledge to improve diagnoses and care, resulting in better patient satisfaction and aesthetic results. The goal is to equip participants with a practical understanding of how to address lower eyelid aesthetic challenges and contribute significantly to the field of medical aesthetics.

Conclusion: I aim to equip all the participants of this class with the comprehensive and practical knowledge necessary to tackle the aesthetic obstacles of the lower eyelid. This will lead to enhanced care for their patients.

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Objectives: To use fillers and botulinum toxin to treat facial asymmetries of neurological patients

Introduction: The art of treating facial deformities due to accidents, neurological conditions, burns, or other conditions is an evolving field of medicine since these deformities have a negative impact on the quality of life, work life, and social life. Those conditions can receive non-surgical treatments with the collaboration of different multidisciplinary healthcare professionals. A combination of pharmacological treatments such as botulinum toxin and fillers or polynucleotides seems like an optimal solution, taking into consideration both the static and dynamic aspects of facial expression.

Materials / method: A 41-year-old female patient with a traumatic peripheral facial nerve palsy after an operation on her right ear during her childhood came to our outpatient clinic. She had a dynamic asymmetry, especially when she was smiling. Her medical history revealed that she has undergone, over the last 15 years, several BONT-A treatments and filler applications. The patient was treated with injections of BoNTA-ABO (230 units) and with 2 ml of hyaluronic acid dermal filler in order to restore the asymmetries of her face.

Results: The patient was assessed 5 weeks after the injections, and she had a remarkable improvement in her dynamic asymmetry, especially when smiling. The patient readmitted 7 weeks after the first treatment, and she was injected with 3 ml of hyaluronic acid dermal filler in order to further restore the midface volume of her face.

Conclusion: The combination of injectables could be a safe and effective therapy for the restoration of asymmetries due to facial nerve palsy. Long and frequent sessions of treatment are suggested. We hope our case report will prompt other clinicians to use the proposed combination of injectables.

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Objectives: Introducing the Spiderweb Technique, our aim is to highlight facial rejuvenation by harnessing the natural regenerative potential of the body. We seek to demonstrate its efficacy in promoting collagen synthesis, improving skin texture, and achieving long-lasting aesthetic outcomes through the innovative combination of non-barbed and barbed PDO threads using an innovative technique.

Introduction: Innovative and minimally invasive, the Spiderweb Technique offers a paradigm shift in facial rejuvenation. By strategically placing polydioxanone (PDO) sutures via thin needles to knit and support subcutaneous tissue, this technique stimulates collagen production, compensating for decreased collagen in aging skin. Threads woven into the problematic area provide a strong lifting and tightening effect, resulting in rejuvenated, tightened, and smoother skin.

Materials / method: Utilizing the Spiderweb Technique, we treated a cohort of patients with varying degrees of facial aging. Combining SVF and fat extract with PDO threads strategically injected, targeting key facial areas. Patient demographics, treatment protocols, and post-procedural assessments were meticulously documented.

Results: The Spiderweb Technique yielded remarkable outcomes in our patient cohort. Significant improvements in skin laxity, texture, and overall rejuvenation were observed. Patient satisfaction scores were high, with minimal adverse effects reported. Quantitative analysis revealed increased collagen synthesis and sustained aesthetic enhancements over time.

Conclusion: The Spiderweb Technique emerges as a promising approach in facial rejuvenation, offering natural-looking results and minimal downtime. With its ability to stimulate collagen production and improve skin quality, this innovative method holds immense potential in the realm of aesthetic medicine and plastic surgery, changing the way we approach facial aging.

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Objectives: The large portfolio of marketed fillers, varying application techniques, and expanding medical literature create a challenging environment for healthcare professionals (HCPs) to identify appropriate products, apply them safely, and obtain consistent, predictable natural looking lip augmentation. The aim of his paper is to provide a standardized methodology, based upon foundational anatomical and aesthetic principles to deliver consistent lip augmentation.

Introduction: A global consensus panel of 5 dermatologists/ aesthetic physicians served to develop a universal lip augmentation injection method, appropriate for injectors of all levels, and adaptable to a great variety of individuals regardless of age, gender, and ethnicity. Through the round-table discussion format, panel members identified eight universal focus injection sites for lip augmentation. To create a standardized method, specific techniques, injection plane, product, and application tools were agreed upon for each treatment site.

Materials / method: Based upon discussion of correct procedure to assess patients desires and appropriate treatments available, two pathways of treatment were devised. First, Beautification, incorporating four injection sites, selected for individuals with good lip structure seeking natural looking augmentation through lift and volumization, and second, Restoration, incorporating four distinct structural injection sites and three Beautification injection sites, designed for individuals requiring restructuring of the natural looking lip shape that further serves to support subsequent optional Beautification.

Results: This consensus is not intended to be a systematic review, but to be the core treatment guide for natural looking lip augmentation with CPM-HA injectable fillers supported by the research literature and the consensus panels’ clinical experience. The consensus has been prepared to guide HCPs in the assessment of patient lips, selection of products, administration of techniques, and safe effect depths, with the aim of establishing a reproducible, seamless lip augmentation protocol to achieve consistent, natural looking results, with enhanced safety and patient satisfaction.

Conclusion: It is anticipated that HCP injectors will use the consensus knowledge to provide individualized treatment plans for their patients and achieve the desired lip augmentation outcomes.

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