Objectives: The aim was to choose the unique technique with the usage of just one product for the ligament liquid lifting including the correction of "target lifting areas" and to evaluate the methods' effective possibilities and restrictions.

Introduction: 20 patients of different ages and morphotypes were invited for the increasing the strength of their true ligament tissues so to reach an ideal possible face lifting effect.

Materials / method: 3D images of each patient were made Before & After the injections. Six face true ligaments were taken for strengthening. Key injection locations were defined, the essential quantity of filler to each point was estimated (0.1-0.3 ml).

Results: The injection scheme was the following: lateral temporal points were injected first, then orbital retaining ligaments, then zygomatic retaining ligaments and zygomatic cutaneous ligaments, maxillary ligament, mandibular ligament. The result was assessed, the portrait of the "ideal patient" for the ligament lifting was identified.

Conclusion: The results of such correction have shown that injections of target points minimized the invasive intervention for the patient and reduced filler volume needed to reach considerable lifting effect.

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Objectives: More detailed understanding of the biological mechanism of action of poly-L-lactic acid in human skin.

Introduction: Injectable poly-L-lactic acid is indicated for use in people with healthy immune systems for the correction of shallow to deep nasolabial fold contour deficiencies and other facial wrinkles. In our present study, we first studied in detail the molecular effects of poly-L-lactic acid (PLLA) injections on human full-thickness 3D skin models comprising fibroblasts and keratinocytes.

Materials / method: Using gene expression profiling, we detected a significant effect of PLLA on day 5 after injection not only on epidermal proliferation (highly significant effect on epidermal thickness), but also a stimulatory effect on integrins (ITGA5/ITGB3) and laminins (LAMB3/LAMC2), which were essential components of the dermal-epidermal junction responsible for skin integrity and resistance to external mechanical forces.

Results: Interestingly, on day 14 and 28 after PLLA injection, immunohistochemical analyses exhibited a stimulated collagen I production in these models, whereas expression of collagen III was not affected, which correlates to previous clinical findings. These effects could be attributed at least in part to the upregulation of IL-1b and subsequently of CXCL6 which is capable to chemoattract neutrophils and to stimulate collagen I synthesis in fibroblasts as we could demonstrate using a pro-collagen type I peptide α1 ELISA.

Conclusion: Taken together, our data provide for the first time molecular insights into the stimulatory effects of PLLA injections on collagen I production in novel human long-term 3D skin models comprising macrophages.

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Por favor indique a entidade (pessoa ou empresa): In vitro research study at dept. of dermatology, RWTH Aachen University, was supported in part by Galderma

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Objectives: To describe the author's 16-year experience with the use of long-lasting fillers (polymethylmethacrylate) at muscle level. An update of more than 900.000 cc of product.

Introduction: demand for gluteal volumetry in clinics has been increasing, and invasive techniques such as liposuction and silicone prosthesis are not always possible. Filling can promote a natural, minimally invasive and safe gain. Its intramuscular use is essential to support and not "weigh".

Materials / method: Multicentric study carried out in Brazil (Sao Paulo, Rio de Janeiro and Porto Alegre). There were 16 years of follow-up and completion of filling at the intramuscular level aiming at the volumetry of the gluteus.

Results: More than 900,000 cc of long-lasting product (polymethylmethacrylate) were applied aiming at a volumetric gain at the intramuscular level with surprising results in volumetric gain where the product stays in the muscle supporting and not in the skin "weighing".

Conclusion: Conclusion - the results were considered very satisfactory and natural by the medical team and by the patients themselves, as we will demonstrate with the images and videos. Adverse effects were minimal and compared to established techniques such as liposuction and silicone prosthesis.
Filling seems to be the most natural, safe and promising technique for gluteal volumetric gain

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Objectives: Lip fill with hyaluronic acid (HÁ) is one of the most sought after injectable procedures for face beautification. However, due to the complicated and variable anatomical and vascular characteristics of the lips, the procedure carries great risks in relation to unsightly results and vascular complications.

In the last year we made 20 lip fillers (LF), using a systematization that we call K.I.S.S. technique through which the injection is made through cannulas with a blunt tip, using specific anatomical labial parameters, with good results and keeping the injections simple and safe.

Introduction: The attractiveness of the lips is determined by a combination of three factors:
1 - proportion between upper (UL) and lower lips (LL);
2 - definition of filter columns (FC), ccupid's bow (CB) and lip contour;
3 - volume.

To facilitate our evaluation, knowing that the measurements of lips components are variable, we used the following parameters:
- FC longer than 1.5 cm are considered long and should not be filled in;
- UL smaller than 0.8 cm and LL than 0.9 cm are considered thin and are candidates for filling;
- UL should be more anteriorly projected (2mm), while LL should be 20% larger.

Materials / method: In the last year, we performed lip fillers on 20 women between the ages of 25 and 45, following the K.I.S.S. technique characterized by the use of a 25 G cannula with a blunt tip to inject 1ml of HA 20mg/ml by retroinjection in the subcutaneous tissue of the vermilion of the lips, always respecting the vascular safety margin of 5mm above the red mucosal junction, where the presence of the supplying arteries is rarer.

The entry ports with a 22G needle were performed in the FC in the UL, 5.0mm above the Glogau Klein point and in points parallel to the nasal wings in the contour of LL.

Results: We named 3 anatomical sites of injection in UL as Kiss 1, 2 and 3 and 2 sites in LL Kiss 4 and 5.
- K1: diagonal vector (DV) directed to the medial tubercle (TB): improves UL projection and the contour of the CB - it is the area with the highest vascular risk;
- K2: 2 almost perpendicular vectors, directed to the lateral TB: increase projection and the vertical diameter, support CB;
- K3: DV directed to the lateral area of UL, improves volume but mainly contour;
- K4: 2 medially directed DV, one for the TB and other inferior for contour;
- K5: directed to comissure, for supporting.

Conclusion: All 20 injected patients had undergone previous lip filling with conventional needle techniques and 19 reported satisfaction with the results and a more pleasant post-procedure, with less swelling and bruising. One of them told she did prefer needle injection.

Although we can't achieve with cannulas, the precision we achieve when using needles, we could with K.I.S.S. tecnique to improve the proportion, definition and volume of the lips, in order to leave the injector and patients satisfied and in a simple, safe and reproducible way.

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Objectives: Tje aim of this study was to investigate the safety and efficacy profile of the 3-point injection technique and compare it to the 5-point injection technique.

Introduction: Glabella lines treatment with neuromodulators relies on a 5-point injection technique which is by far the most popular pattern for this area. Most feared side effects when using botulinum toxin in the glabella region are brow and eyelid ptosis. These side effects might be caused by a non controlled injection of the corrugators in the lateral point chasing the muscle on his length. The recently proposed 3-point injection technique is alleged to be safer and with same results.

Materials / method: Our study included 53 patients treated with botulinum toxin A for glabella lines. Patients were divided into 3 groups : first group was treated using the 5-point injection technique, second group using the 3-point injection technique and the third group with split face design using the 5-point injection on one side and the 3-point inejction technique on the controlateral side (using the same total of units on each side). Careful analyse using standardized photos and videos were used to assess the static and dynamic results of both the two techniques before and 14 days after the treatment.

Results: No significant difference between the two techniques in term of safety was noted but this conclusion is limited by the number of patients included. Though there is no absolute superiority of one technique to the other on the efficacy profile, the results were more interesting to analyse in a qualitative way as there were significant differences in the results obtained, regarding the anatomical variant of the corrugators (shape, length and distribution of the strength of the muscle), the natural aspect desired (or not) by the patient and the experience of the injector.

Conclusion: In our experience, the 3-point injection technique appears to be a safe and efficient option for the treatment of glabella frown lines especially for novice injectors, medium strength corrugators and when patients claim residual movement after treatment ; but this technique can show lack of efficacy in some anatomical variants of the corrugators described in this study or when the natural effect is not needed. A simplified algorithm is proposed to help practitionners integrate this technique in their daily practice.

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Objectives: There is significant variation in treatment parameters when treating the infraorbital region. Altough in this presentation i will share my own experience & method i am using to avoid immediate & long term complications. The choice of the optimal filling material, and proper understanding of the anatomy of this delicated region & a proper technique will contribute to a safe, effective, and natural result. i have used a Hyaluronic Acid filler with low g prime low bdde , and low risk for the possible post injection edema. I use always a 25 or 23 g cannula (never thinner to avoid any vascular risk

Introduction: 6 also to avoid bruising), I inject with retrograde linear threading technique very slowly a small quantity never more than 0,4 ml per side. i inject the filler pre-periosteally, deep to orbicularis oculi muscle, anterior to the inferior orbital rim to avoid the tyndall effect. Topical anesthetic is not commonly used. Side effects were generally mild and included very rarely bruising (because of the use of the cannula) , edema, and contour irregularities, imperfect correction. Non surgical correction of the tear trough deformity with soft tissue filler is a minimally invasive procedure with

Materials / method: ong-lasting effects. It is essential to have a fundamental understanding of the relevant anatomy and ideal injection technique to provide excellent patient outcomes and prevent serious complications. However i had in my experience some cases of a chronic eyelids edema even 1 year after the procedure probably because of the lymphatic circulation compression in this area. I am considering to use always more autologous gel platelet rich growth factors to treat the tear trough deformity to avoid any type of complications in future.

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Este trabalho não recebeu nenhum patrocínio direto ou indireto. O mesmo está sob a própria responsabilidade do seu autor.

Objectives: 1. To review the development of meso- and hyalu-botox techniques.
2. To provide scientifically based evidence of meso-botox aesthetic indications and effects.
3. To explain the personal technique of combined injections of hyaluronic acid (HA) with botulinum neuroprotein (BoNT-A).
4. To explain the possible undesirable effects in case of contravention of technique and ways to avoid them.
5. To show before/after photos and patient cases, to discuss the aesthetic benefits of combined injections of BoNT-A with non-cross-linked HA and cluster of amino acids (AA) in one syringe in one session.

Introduction: The micro-botox method was developed by Wu in 2000, aimed to provide more natural-looking effects for patients. Method involves systematic injections of multiple papules of highly diluted BoNT-A (mainly ONA) at 0,8 to 1,0 cm into the dermis. It is proven that meso-botox helps to smooth and tighten the skin by inducing bulk atrophy of the sweat and sebaceous glands, and by weakening the superficial muscle fibers that insert into the skin, which helps to reduce pulling effects of facial muscles that result in formation of lines. Meso-botox also helps to reduce skin erythema and rosacea.

Materials / method: This technique has been developed to supplement traditional injections, such as conventional dilution of BoNT-A in the areas of deep muscles, for example corrugators. Meso-toxin technique targets only superficial muscle fibers where they insert into the dermis with a sense of small, highly diluted microdroplet injections. We use 50 units of any registered botulinum toxin diluted with 1 ml of unpreserved normal saline and 3 ml of low-molecular weight non-cross-linked HA with a cluster of lyophilized amino acids, which makes 4 ml of hyalu-toxin solution. 0,5 ml per each periorbital area.

Results: The precise placement of small amounts of neurotoxin into the deep dermis targets only the most superficial muscle fibers inserting into dermis and is less likely to lead to diffusion of BoNT-A into untargeted muscle and cause undesirable side effects. The hyalu-toxin technique thus allows to treat the areas of the face that are generally avoided with conventional injection techniques: periorbital area, cheeks, smile lines, barcode lines, neck and decolletage. We use the grid with injection points about 5 mm apart, avoiding injections above the eyebrow, lower eyelid, area above the DAO.

Conclusion: This technique provides 3 benefits in 1 injection: promoting skin hydration and regeneration with low molecular weight HA; increasing skin thickness and elasticity and giving positive stimulation to fibroblasts with AA cluster; and affecting superficial muscle fibers, which insert into the skin, sweat and sebaceous glands to improve skin texture and reduce fine lines. Also, we observed the erythema improvement, which may be due to the neurotoxin mediated inhibition of the release of vasodilating neuropeptides. The hyalu-toxin effects last for 3 to 4 months, in some cases up to 6 months.

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Objectives: The purpose of this study was to assess patient-reported outcomes after one treatment of incobotulinumtoxinA, hyaluronic acid 22.5mg/mL, and calcium hydroxyapatite.

Introduction: Facial rejuvenation using injectables are increasingly popular in the United States. Products such as incobotulinumtoxinA, hyaluronic acid 22.5mg/mL, and calcium hydroxyapatite are commonly used to treat rhytides, restore volume-deficient areas, and improve skin quality.

Materials / method: Patients with facial and neck photoaging (Glogau facial aging scale ≥2) were treated with calcium hydroxyapatite, hyaluronic acid 22.5mg/ml, and incobutolinumtoxinA injections for full facial rejuvenation, with no touch-up treatments. Patients completed the FACE-Q Satisfaction with Facial Appearance survey at baseline, and 1- and 3-months post-treatment. The treating physician completed the Global Aesthetic Improvement Scale at 1- and 3-months post-treatment.

Results: Twenty-two patients were enrolled in the study, with one patient lost to follow-up. There was significant improvement in mean FACE-Q scores at 1-month (80.1, p=.01) and 3-month (77.9, p=.02) compared to baseline (71.4). Mean Global Aesthetic Improvement Scale scores at 1-month (2.1) and 3-month (2.2) also showed sustained improvement compared to baseline (p<.01). The amount of product used per patient varied and was not correlated with either score.

Conclusion: Global full facial rejuvenation using one treatment of calcium hydroxyapatite, hyaluronic acid 22.5mg/ml, and incobotulinumtoxinA provides a sustained patient-reported satisfaction for 3-months.

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Este trabalho foi realizado com o patrocínio de: MERZ AESTHETICS, Galderma, Acclaro, Softwave, Skinceuticals

Objectives: The aim of this study is to analyze two different cases in female subjects for neck, décolleté and hands rejuvenation. The proposed protocol includes hyaluronic acid fillers and hyaluronic acid stable hybrid cooperative complexes (HA-HCC).

Introduction: Not only the contours and youthfulness of the face, but also of the neck, décolleté and hands have a surprisingly important effect on the overall appearance. When evaluating the aging of this areas, a few characteristics must be taken into consideration: laxity of the skin, volume loss and pigment alterations.

As many factors contribute to the aging of this areas, a comprehensive approach is essential for its rejuvenation. In nonsurgical rejuvenation nowadays, treatment with hyaluronic acid (HA) has become the standard regimen.

Materials / method: The treatment performed was in the first step on three areas 2 doses of HA-HCC were injected at day 0 and day 30. One month later a touch up was done with 1 mL of HA filler on the neck, 1mL on the décolleté and on the hands 1mL per hand was injected.

Results: Results show a visibly smoother skin, improved texture and barely any lines left, also it is observed a clear improvement of the necklace lines without any contour irregularities or tissue bulking.

Conclusion: Combination treatments are a quick and generally safe option, the results will not be permanent and the effects will last for around 12 months. It is wise to advise the patient to have a top-up session every six to eight months in order to achieve continuous results. It is also important to make patients aware that a younger looking skin will help to give a more harmonious rejuvenation.

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