IMCAS

Preservation rhinoplasty: simplified approach

Objectives: In preservation rhinoplasty subdorsal hump resection without clear visualization, may leave a subdorsal cartilaginous stump. This stump is a frequent cause of residual and/or, hump recurrence duo to natural cartilage convexity. Also, inaccurate blind resection of subdorsal perpendicular plate of ethmoid (PPE) could be other cause of residual or recurrent hump. The modified dorsal split technique with bilateral septal T incisions may cause keystone area disruption.

Introduction: Subdorsal cartilage and bone (PPE) resection under vision with total preservation of osseocartilaginous interconnection at the dorsal keystone area.

Materials / method: One side component separation of septal T, controlled accurate resection of subdorsal cartilage strip and wedge of ethmoid bone under direct vision in a series of 53 patients with follow up of one year.

Results: All patients presented favorable outcomes with natural looking dorsum. Fine tuning of septum deviation and upper lateral cartilage adjustment were possible

Conclusion: Disrupting the keystone area is a fraught complication that may require secondary revision. One side component separation of septal T is a safe method that protect against keystone area separation. Also, it is an accurate method to do controlled subdorsal cartilage and bone resection.

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Fillers vs. threads the battle for the perfect face lift

Objectives: Primary
To discuss the benefits and limitations of fillers and threads in anti-aging treatments.
To compare and contrast fillers and threads as effective solutions for facial rejuvenation.
To provide insight into the latest advancements and trends in non surgical and anti-aging treatments.
Specific objectives
To understand the indications and contraindications for fillers and threads.
Recognise the advantages and disadvantages of each treatment modality.
Learn about the potential complications associated with fillers and threads.
Appreciate the role of combination therapy for best results.

Introduction: We are discussing crucial part of modern aesthetics, the quest for a youthful and radiant appearance.
As we navigate the vast array of non surgical cosmetic treatments available two most popular options stand out, threads and fillers.Both promise to revitalise our looks but which is the best choice?
Let us delve into the world of threads and fillers exploring their differences, benefits and limitations.
The choice between fillers and threads depends upon individual concerns, skin condition,sagging,and desired outcomes.
Threads are used to lift facial ptosis whereas fillers volumize and reshape

Materials / method: Thirty subjects were designated aging between 30 to 60 years.
10 subjects were treated with fillers (3mls)
10 subjects were treated with a box of threads containing 10 threads in each box.
10 subjects were treated with a combination of both fillers and threads.
Materials used were 20 boxes of threads ,60 mls of fillers with cannulas.
Consent forms were signed ,before and after pictures were taken.
The procedures were performed maintaining aseptic measures.
The subjects were advised post care like antibiotics, and anti inflammatory medications.The subjects were given ice packs right after .

Results: Fillers
10 subjects who were treated with filers experienced a reduction in lines and hollowness.
4 subjects did not get the lifted appearance.
5 out of 10 subjects were satisfied with the treatment.
Threads
10 subjects who were treated with threads experienced a reduction in lines ,hollowness and sagging .
8 out of 10 were satisfied with the results.
Combination of fillers and threads
9 out of 10 subjects were satisfied with the results
10 out of 10 saw an improvement in quality of skin.
10 subjects saw a lift,improved contour and sagging.
9 subjects saw an improvement in hollowness.

Conclusion: Two treatments are better than one.
One must avoid over promising results and wrong selection of patients.
Over using products which are not designed to achieve a specific look must be avoided.
Threads and fillers when used together offer a comprehensive and harmonious approach.
By combining the power of two procedures volumizing effect of fillers and lifting power of threads used together we get a harmonious effect.Let us embrace the synergy of these two treatments and discover a more radiant ,confident and beautiful result.

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Este trabalho foi realizado com o patrocínio de: none

Balancing and Optimizing Neuromodulation of the Forehead – Introducing a novel and reproducible injection algorithm for the frontalis muscle

Objectives: Signs of aging in the upper face arise from multimodal changes in facial anatomy, leading to concerns such as eyebrow ptosis and forehead lines. Neurotoxin injections are commonly used to ameliorate these lines, but the complex anatomy of the frontalis muscle poses challenges.

Introduction: To introduce and assess the efficacy of a novel injection algorithm for treating forehead lines, focusing on the anatomy and biomechanics of the upper facial musculature.

Materials / method: A retrospective analysis was conducted on 20 patients (mean age 41.6 ± 5.5 years) treated with a new injection pattern. The injection scheme involved identifying the line of convergence, injecting at specific points to avoid eyebrow ptosis, and targeting areas of high muscular activity. Forehead line severity was assessed at rest and dynamically. Three-dimensional surface imaging was utilized to measure skin displacement.

Results: At baseline, 85% of subjects had severe dynamic forehead lines, and 25% had severe static lines. After two weeks, 65% showed no dynamic lines, and 40% had no static lines. All subjects showed at least a one-point improvement in line severity, with 90% showing a ≥ 2-point improvement for dynamic lines. The mean dosage was 17.70 ± 0.7 U, and no adverse events were reported. 2 patients required a touch – up.

Conclusion: The newly introduced injection scheme provides an effective, structured approach to treating forehead lines, accounting for anatomical variability and patient preferences. The results indicate significant improvements in both dynamic and static forehead lines, with a low touch-up rate and no reported adverse events. Further research with larger populations is needed to validate these findings.

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The use of botulinum toxin for the temporary cancellation of post-traumatic facial spasms

Objectives: cancellation of facial spasms in post-traumatic patients through the use of botulinum toxin

Introduction: I had a specific request from a patient who asked me for a consultation for a major trauma to her eyelid immediately after a moped accident, as a result of which she had permanent facial damage with trembling eye, difficulty in closing, and involuntary spasms. The patient also reported to me that she often felt the need to close and re-open her eye.
I therefore took into account both the rationale of using the toxin for the therapeutic aspect and the aesthetic treatment of signs of skin ageing, in order to treat the patient in question.

Materials / method: I used the ready-to-use liquid AbobotulinumtoxinA formulation (60 speywood units along the entire course of the zygomatic nerve)

Results: I observed an excellent speed of action with a significant reduction in spasms already after 4 days and with an effect that was maintained for more than six months.

Conclusion: This personal clinical case shows how effective botulinum toxin treatment can be for both aesthetic and functional problems And a significantly increasing the patient's quality of life.

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USE OF A 15MG/ML RESILIENT, HIGH-STRETCH HYALURONIC ACID FILLER FOR THE IMPROVEMENT OF RADIAL CHEEK LINES

Objectives: -Evaluate the efficacy of a novel, less-rigidly crosslinked, 15 mg/mL resilient, high-stretch HA filler injected subdermally for improving facial fine lines of the cheek.
-Address concerns related to fine lines of the cheek, which develop due to ultraviolet exposure, dynamic expression, and aging.
-Analyze existing treatments for static and dynamic facial fine lines, including laser resurfacing, retinoids, chemical peels, and fillers.
-Investigate the potential of dynamic, adaptive HA fillers to improve skin quality and reduce fine lines while minimizing risks.

Introduction: Fine lines on the cheeks develop due to UV exposure, facial expressions, aging-related loss of skin elasticity, and superficial fat depletion. These concerns are increasingly common among patients, especially as cosmetic treatments gain popularity. Current options, including laser resurfacing, retinoids, chemical peels, and fillers, improve skin texture but often lack dynamic properties for natural results. Our study evaluates a novel, 15 mg/mL resilient, high-stretch HA filler injected subdermally for improving radial cheek lines, aiming to enhance patient satisfaction.

Materials / method: Subjects were enrolled from a cosmetic dermatology practice. Outcomes were assessed using photographs, Allergan Fine Lines Scale (AFLS) ratings (0-4) for facial lines, and FACE-Q Appraisal of Lines: Satisfaction of Skin (0-4). Total score improvements for skin quality were compared between baseline, 4 weeks, and 8 weeks post-treatment. The dynamic HA-based filler was injected in a grid pattern with 0.025-0.05cc administered subdermally at 0.5-1cm intervals across the malar and nasolabial cheek areas. Treatment occurred in two visits, 4-6 weeks apart, with final follow-up at 8 weeks.

Results: Twenty subjects met inclusion and exclusion criteria. The average injection volume was 1.8±0.18 cc. AFLS scores showed significant improvement from baseline to 4 weeks after one treatment (3.4±0.2 vs. 3.2±0.2, p=0.049) and from baseline to 8 weeks after two treatments (3.4±0.2 vs. 2.35±0.1, p<0.01). FACE-Q scores improved significantly from baseline to 4 weeks (45.9±3 vs. 67.4±4.2, p=0.0004) and from baseline to 8 weeks (45.9±3 vs. 62±4.0, p=0.0034). No long-term adverse events were reported.

Conclusion: In conclusion: Microdroplet injections using a 15 mg/mL resilient, high-stretch hyaluronic acid (HA) filler significantly enhance both patient-reported (FACE-Q) and physician-reported outcomes for radial cheek lines. The use of this dynamic HA filler leads to marked improvements in facial appearance and skin radiance with minimal side effects. This treatment approach has the potential to boost patient self-assurance and overall quality of life by effectively replenishing superficial support, reducing the visibility of radial cheek lines, and enhancing skin attractiveness.

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Glabellar dynamics decoded to refine precision in botulinum toxin treatment

Objectives: This presentation introduces a novel approach to analysing glabellar line contraction patterns and proposes a new injection technique for botulinum toxin. Attendees will gain insights into tailoring treatment protocols that minimise complications such as blepharoptosis and optimise aesthetic outcomes by understanding individual muscle dynamics.

Introduction: Glabellar lines are commonly treated without considering the specific contraction patterns unique to each individual. This study identifies and categorises two distinct glabellar contraction patterns—oblique and vertical—and introduces a corresponding injection technique that enhances precision and safety in botulinum toxin treatments.

Materials / method: We conducted a detailed anatomical analysis, identifying oblique and vertical glabellar contraction patterns. Based on these patterns, we developed a new injection protocol that adjusts depth and site targeting to align with individual muscle dynamics. Clinical observations were conducted across multiple sessions to evaluate efficacy.

Results: The new injection protocol led to improved patient outcomes, with a significant reduction in blepharoptosis and more natural aesthetic results. Tailoring the injections to specific contraction patterns resulted in high patient satisfaction and fewer adverse effects compared to conventional methods.

Conclusion: Our study proposes a new perspective on glabellar line contraction patterns and introduces a corresponding injection technique for botulinum toxin. This approach not only improves precision but also mitigates risks, offering a refined standard for practitioners. Further research is encouraged to validate these findings across diverse populations.

Reference: Wan J, Wu R, Kim HJ, Yi KH. Glabellar dynamics decoded to refine precision in botulinum toxin treatment. J Cosmet Dermatol. 2024;23(9):2816-2820.

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Complications with hyaluronic acid fillers - vascular compression - from tissue suffering to a complete necrosis

Objectives: to recognize, treat and monitor an ischemic tissue

Introduction: how to assess a suffering tissue from pending ischemia to a complete necrosis of the tissue. the management of a patient in different stages of ischemiafrom vascular congestion, tissue pallor and obvious necrosis. the role of hyaluronidase and other treatment

Materials / method: 15 patients with pending ischemia in the chin area - tissue congestion, redness and pain, tip of the nose and nasolabial folds
all treated with hyaluronidase in different doses in correlation to the ischemic stage (congestion, pallor and necrosis)

Results: complete resolution of tissue damage in all cases and in all stages of the ischemia, treated with 500 to 4500 units of HYALASE and complementary treatment

Conclusion: although the treatment with hyalase demonstrated good results, the importance of prompt diagnosis and treatment is crucial in saving the tissue
pending ischemia should be treated with high doses of hyalase

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Lip beautification by gummy smile treatment with: mechanical myomodulation with HA fillers

Objectives: Muscle imperfections used to be treated only through chemical myomodulation, or neuromodulation. Currently, we also have specific techniques to treat the muscle with mechanical myomodulation. While neuromodulation refers to the use of botulinum toxin, mechanical myomodulation is performed with cross-linked hyaluronic acid. This study will show specific techniques in order to treat muscle imperfections that lead to severe cases of gummy smile by mechanical myomodulation with a new 25 mg/ml cross-linked HA.

Introduction: Gingival smile is a multifactorial, non-pathological condition responsible for a described disharmony between the components of the smile (lips, teeth and gingiva) by exposing more than 2 mm of coronal gingiva to the maxillary incisors, encompassing both the static and dynamic frame. According to Mercado-Rosso gingival smile classification, type 1 gummy smile is characterised by lack of structural support due to bone deficiency, type 2 by an imbalance of the length-tension relationship and type 3 by an excessive mechanical action. There are certain advantages for using physical myomodulation a

Materials / method: 25 mg/ml cross-linked HA was administered at different depths depending on the amount of muscle activity aimed. For hypokinetic muscle, HA was placed under the muscle, at periosteal or submuscular level. For hyperkinetic muscle, HA was placed on the surface of the muscle. 3 bolus of 0.5-0.7 mm depth were performed at the zygomaticus major at each side, as this area does not have important vascular elements, the injection was performed directly with needle. At orbicularis oris, around 0.5-0.7 ml of HA was injected below the muscle, at the supraperiostic level, in this case a 22G cannula was use

Results: We obtained positive results with high level of patient satisfaction as muscle alterations were immediately corrected improving all patient smiles. Analysing the underlying anatomy of the muscle problem at the initial diagnosis was key to obtain optimal results, therefore, identifying the agonist and antagonist muscles of the treating area is essential in order to maintain both functional and aesthetic balance and give the patient a natural result. In vitro studies have demonstrated that succinic acid stimulates human fibroblasts increasing antiaging markers which help to provide an improvemen

Conclusion: We have proven that the specific techniques proposed in this lecture are safe and effective for correcting severe cases of gummy smile by mechanicall myomodulation. The cross-linked HA used are new products that also produced cell biostimulation due to succinic acid.

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Clinical Testing of Injectables: Challenges and Solutions

Objectives: The use of injectables such as botulinum toxin and dermal fillers has become increasingly popular in aesthetic dermatology. In response, EU regulations relating to these products have evolved to safeguard patient safety. In this talk we will delve into the regulatory framework surrounding various types of injectables, as well as the methods used to evaluate their effectiveness and safety.

Results: The following questions will be addressed:
• What is scope of injectables in aesthetic dermatology?
• Which regulations are in place?
• How does the legal framework impact the clinical testing?
• What are the safety aspects one need to consider?
• How is product efficacy evaluated?
• Which technologies can complement subjective assessments of treatment effectiveness?

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Este trabalho foi realizado com o patrocínio de: The authors are employees of the SGS family of companies, a provider of clinical testing services

The botulinum toxin therapy and injecting Hydroxylapatite - “smart” gibrid techniques

Objectives: To demonstrate the author's technique for managing muscle tone by achieving balance between the levator and depressor muscles: devolumetric and pseudovolumetric lifting techniques.

Introduction: For the last two decades, the usage of botulinum toxin has increased for 621%. Compared to traditional facial cosmetic surgery, non-surgical methods provide more natural, non-surgical, and smooth results with less traumatic period and shorter recovery period, that makes it more preferable for patients.
The aim of the technique to correct various facial parts such as wrinkles and fine lines, asymmetry and excess fat, nose lifting.

Materials / method: Case reports of some patients. Demonstrations of the procedure, before and after effects with regard to muscle tone

Results: This technique has achieved the effect of facial rejuvenation and harmonization of the face, with consideration of muscle tone, and elevation of the nasal tip. In patients with persistent edema, elimination of muscle hypertonus promoted lymphatic drainage in the face and neck area

Conclusion: This technique allows you to achieve a balance of the levator and depressor muscles, returns the face to a more youthful shape, lifts the nose. It is aimed towards correction of asymmetry, treatment of wrinkles, masking of excess fatty tissue, as well as lymphatic drainage effect

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A polyrevitalizing solution mixed with CaHA as a novel therapeutic approach for cellulite

Objectives: We hypothesized that a thinner and weaker ECM plays a significant role in the formation of cellulite. The combination of CaHA with polymicronutrients addresses directly the pathophysiology of fragile ECM and perhaps can ameliorate cellulite. Secondarily, this is a proof-of-concept case series study to evaluate efficacy and safety of the combination of CaHA with polymicronutrients for the aesthetic improvement of the cellulitic skin.

Introduction: Cellulite is a common aesthetic concern, primarily affecting the buttocks, hips and thighs mostly of young women. It is a multifactorial process, characterized by dimpled contour alteration of the skin, while it imposes a significant psychosocial distress in affected patients. There are various treatments of cellulite targeting either the fat, dermis or fibrous septae, yet with a wide variability in response and longevity of results

Materials / method: We compared clinical and photographic characteristics of 11, otherwise healthy, patients, 10 female (mean age 44,9 ± 13,37) and 1 male of 58 yrs, with medium to severe cellulite. Patients were injected in the buttocks and thighs, using a dilute mixture of CaHa:NCTF HA, in a dilution of 1:4; 7,5 ml of total mixture was injected in a retrograde manner, in each leg. A 25G, 50mm, TSK cannula was used, to place the mixture subcutaneously. Subcision of the fibrous septae was performed with the cannula prior to the injection of the mixture. Photographic documentation of before and after was recorded

Results: GAIS scores improved by at least one scale point. CSS scores improved by at least 6 points, while cellulite dimples improved by at least 2 points, at rest and dynamic scales. Celluqol scores were reduced by a mean of 25 points, by the end of the study. The most frequently reported AE (85%) was bruising at the injection site which resolved with a couple of days from treatment.

Conclusion: Improvement of cellulite is possible with a single treatment of the combination of polymicronutrients and CaHA. Results show significant improvement of skin appearance as well as a long-lasting effect of this treatment. Limitations include a small number of study subjects.

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Study on the Effectiveness of Anti-Aging Intervention: Comprehensive Transformation of the Face and Complete Elimination of Signs of Fatigue

Objectives: Upon completion, participants will be able to recognize the signs of a tired face and learn how to correct them.

- participants will be able to develop their knowledge and skills related to the full face approach to the patient.

Participants will be able to discuss possible difficulties they may encounter during combined treatments to remove the signs of a tired face.

Introduction: Facial aging results from the normal wear of facial skin, adipose tissue, muscles, ligaments, and bones. Combining different minimally invasive techniques aims to achieve the most harmonious and natural-looking facial rejuvenation as effectively and safely as possible. It is common to see the use of different combinations of injections or energy devices along with other modalities. As the demand for non-invasive facial rejuvenation continues to grow, plastic surgeons must maintain a mastery of nonsurgical techniques for restoring a youthful facial appearance.

Materials / method: We conducted an extensive study on 250 patients, evaluating the effects of anti-aging treatments aimed at achieving comprehensive facial rejuvenation and removing signs of fatigue. Interventions included precisely dosed application of botulinum toxin in the upper third of the face, hyaluronic fillers in the middle third, and botulinum toxin in the lower third of the face to achieve a lifting effect in the mid face. For additional shaping of the lower third of the face and the chin,Morpheus8 device was used, with repeated treatments after 4-8 weeks in patients with more pronounced fat deposits.

Results: Results were monitored on days 14, 30, 60, and 90 when final results were achieved. Drastic facial rejuvenation was noted in all patients, with a significant improvement in skin texture, face lifting, complete elimination of signs of fatigue, and achievement of a fresh, rejuvenated appearance. Statistical analysis showed that over 90% of patients expressed full satisfaction with the results achieved, and their longevity further confirms the effectiveness, considering that patients reported a preserved rejuvenated appearance up to 18 months after treatment.

Conclusion: Our results irrefutably prove the extraordinary power of the synergy of botulinum toxin, hyaluronic fillers, and the Morpheus8 device in facial transformation. Combined treatments allowed patients to regain their youthful appearance and permanently eliminate signs of fatigue, achieving a refreshed and rejuvenated appearance. This raised the level of self-confidence and satisfaction of our patients with their appearance. We concluded that an integrated approach to anti-aging is key to achieving superior results in aesthetic medicine, setting new standards in this field.

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Hair Restoration and Medical Tourism

Objectives: The outcome of this presentation is highly important for doctors and clinics involved in hair restoration and medical tourism, offering crucial insights that can drive business success. Attendees will gain a comprehensive understanding of global market trends, patient motivations, and innovative strategies that will enable clinics to attract and retain international clients. Additionally, actionable solutions to overcome key challenges, along with future innovations like stem cell therapy and AI diagnostics, will equip clinics with the tools they need to stay competitive.

Introduction: This presentation explores the rapidly expanding field of hair restoration within medical tourism, providing doctors and clinics with valuable insights into the market’s growth and emerging trends. From understanding why patients are increasingly choosing international clinics to exploring future innovations like stem cell therapy and AI-driven diagnostics, this session will equip healthcare professionals with the knowledge and strategies needed to attract and retain global clientele while staying ahead of industry changes.

Materials / method: The presentation draws on data from industry associations like ABHRS, ESHRS, and AAHRS, as well as reputable sources such as Patients Beyond Borders and ISHRS practice census results. The methods include a detailed analysis of global hair restoration market growth, patient motivations for choosing medical tourism, and a case study approach examining clinics that excel in providing international patient care. Trends in technology adoption, marketing strategies, and patient outcomes are also assessed.

Results: The analysis shows that the global hair transplant market is expected to grow at a CAGR of 21.05%, with regions like Asia Pacific leading the way. Clinics in countries such as Turkey, India, and Thailand have become top destinations due to cost savings, advanced treatments, and luxurious recovery options. Patient satisfaction remains high in clinics that emphasize quality and safety, while strategies like digital marketing and all-inclusive packages are key in attracting and retaining international clients.

Conclusion: The presentation concludes that medical tourism in hair restoration is set for significant growth, driven by innovations such as stem cell therapy and AI-based treatment planning. Clinics that adopt forward-thinking strategies, ensure safety standards, and leverage digital platforms will be better positioned to capitalize on this trend. By focusing on patient experience and offering personalized, cutting-edge treatments, clinics can build a strong reputation and attract a global clientele in the years to come.

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Risk and Variability And Arterial Depth Distribution Across BAP Points: Findings from 450 Ultrasound-Assisted Cases

Objectives: The primary objective of this study is to investigate the depth of arteries in five standardized injection points of the BAP technique, using ultrasound. The goal is to assess the variability in arterial depth to aid in optimizing safe injection practices in aesthetic procedures.

Introduction: In aesthetic procedures, precise knowledge of arterial depth is essential for minimizing risks of vascular complications. This study evaluates arterial depths at key points of the Bio Aesthetic Points (BAP) technique using ultrasound. We examined 450 cases to better understand the variations in arterial depth across different injection points, aiming to enhance safety and efficacy in aesthetic treatments.

Materials / method: This prospective study included 450 cases where arterial depths were measured using ultrasound. The arterial depths were assessed at five specific BAP points: zygomatic arch (Point 1), nasojugal fold (Point 2), pre-auricular area (Point 3), chin (Point 4), and mandibular angle (Point 5). The results were categorized based on the arterial depths observed at each point, specifically between 2-3 mm, 3-4 mm, over 4 mm, and instances where arteries were not visualized.

Results: Point 1: Arteries were 2-3 mm deep in 8%, 3-4 mm in 14%, not visible in 14%, and deeper than 4 mm in the rest.
Point 2: Arteries were 2-3 mm deep in 14%, 3-4 mm in 16%, not visible in 17.5%, and deeper than 4 mm in the rest.
Point 3: Arteries were 2-3 mm deep in 11%, 3-4 mm in 14%, not visible in 7%, and deeper than 4 mm in the rest.
Point 4: Arteries were 2-3 mm deep in 26%, 3-4 mm in 28%, not visible in 12.5%, and deeper than 4 mm in the rest.
Point 5: Arteries were not visible in 92%, and deeper than 4 mm in the rest.

Conclusion: This study highlights significant variability in arterial depth across the BAP points, with most arteries deeper than 4 mm, particularly at the mandibular angle (Point 5). Ultrasound proves vital for identifying areas with superficial arteries, ensuring safer injections. The chin (Point 4) poses the highest risk due to greater variability in depth, necessitating extra caution. Points 1 and 2 also require moderate caution, while Point 5 poses the least risk, making it the safest for injections.

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