Objectives: Objectives:

Understand the Normal Erection Process
Understand that ED is a systemic Disease
Understand the Basics of Stem Cells
Able to understand the Potential of Stem cells in the Treatment of ED (Erectile Dysfunction) and Early Treatment for new onset Diabetes Mellitus Type 2
Stem cells as possible Treatment for ED in the setting of Radical Prostatectomy and Radiation and Diabetes and Peyronie’s Disease
Understanding of the Technique for Intracavernosal Injection with Stem cells

Introduction: Abstract:

ED(Erectile Dysfunction) affects 10 percent of the population worldwide. In 1995 152 million were affected by ED. It is estimated that by 2025 352 million of the population worldwide will be affected. Currently there is not available treatment that can restore or regenerate the tissues in the corpus cavernous or arterial system that will cure the ED. a 20 Percent Failure rate with present therapies and high rate of Drop out in patients with ED due to Radical Prostatectomy and Post Radiation.

Materials / method: Adipose tissue is abundant and easy to collect from a mini liposuction. The procedure consists in collecting a lipoaspirate of 60 ml. No general Anesthesia is required. Outpatient procedure. Adipose Tissue is processed using collagenase enzyme. SVF (Stromal Vascular Fraction) is isolated. Blood is obtained through a venipuncture. PRP (Platelet Rich-Plasma) is obtained. The SVF is suspended in PRP. The mixture is injected into the Corpus Cavernosum using our designed protocol for injection point

Results: Two types of patients: 1- DM 2- ED due to Prostatectomy and Radiation. Patients filled out the Intensity score Questionnaire before and after the procedure. Both reported better erections in the morning, firmer, with better response to PDI5 inhibitors for which they were not responders prior to the treatment. This might be due to Stem cells to regenerate Corpus Nerve and Endothelial cells enhancing the Nitric Oxide production and then have the PDI5 inhibitors to work.

Conclusion: The IC injection of a suspension of SVF in PRP appears promising in ED patients due to DM and Prostatectomy and Radiation in which at present there is no a CURE and they have a high rate of Failure to PDI5 inhibitors. The Procedure is done as outpatient and requires no general anesthesia. The potential to treat diabetes as early as diagnosed might be a possibility since lower Fasting glucose levels and improvement in HbA1C were noticed. More studies are needed.

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请注明日期: PATENT IS PENDING
和审阅情况: 2016

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Objectives: To assess possible interferences in the ultrasonographic evaluation of thyroid after application of hyperdiluted CaHa on the neck region.

Introduction: Sagging neck skin is a common complaint and the use of calcium hydroxyapatite injection is a traditional treatment approach for this region. The published literature is limited regarding the possible interference in imaging exams of hyperdiluted product, which presents radiopaque features, for the assessment of deep structures to the application.

Materials / method: This was a prospective, blinded, and controlled study. Ten patients had their cervical regions treated with diluted CaHa (1:4). Ultrasonographic evaluations of thyroid were conducted in D0 (pre-procedure), D15, and D60 by two blinded radiologists to assess the application.

Results: In D0 no exclusion criteria were observed. In D15 technical artifacts that difficulted, but did not unable the complete assessment of thyroid, were seen. In D60 the artifacts of posterior acoustic shadowing considerably reduced and they didn’t cause any difficult for evaluation of the gland.

Conclusion: Treatment of sagging neck skin with diluted CaHa in 1:4 did not negatively impact the ultrasonography evaluation of thyroid as early as 15 days, and particularly from the 60 days after the procedure. These results refute possible criticisms related to this treatment and support the safety of calcium hydroxyapatite in this region. Patients who need ultrasonographic monitoring of the thyroid, therefore, do not have a contraindication for treatment.

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Objectives: OVER 2,000 WOMEN SUBMITTED TO AN INCREASED BUTTONS IN THE INTRAMUSCULAR PLATE WITH POLIMETILMETACRILATE (PMMA).
VERY LOW INDICES OF COMPLICATIONS, PRESENTED IN STATISTICAL DATA AND WHEN THEY OCCURRED, ALL TREATED WITHOUT ANY AESTHETIC DAMAGE TO THE PATIENT. HIGH SATISFACTION INDEX CAN BE OBSERVED THROUGH BEFORE/AFTER PHOTOS

Introduction: THE PURPOSE OF THIS WORK IS TO PRESENT THE HIGH NUMBER OF PROCEDURES PERFORMED OVER 13 YEARS.
I WILL PRESENT RESULTS WITH HIGH SATISFACTION RESULTS
AND THE VERY LOW RATE OF COMPLICATIONS WHICH, WHEN THEY OCCURRED, WERE TREATED WITHOUT AESTHETIC DAMAGE TO THE PATIENT.
OVER THE YEARS WE HAVE DEVELOPED SAFE TECHNIQUES TO INCREASE GLUTEO,
USING RELEASED PRODUCT THAT REACHES THE PATIENT'S OUTCOME EXPECTATION.

Materials / method: OVER 2,000 WOMEN SUBMITTED TO AN INCREASED BUTTONS IN THE INTRAMUSCULAR PLATE WITH PMMA. SIDE EFFECTS WERE CALCULATED, PICTURES REVIEW BEFORE E AFTER TO PROVE THE EFFECTIVENESS OF RESULTS. MONITORING TIME OF 13 YEARS, WE WILL PRESENT AVERAGE OF THE NUMBER OF SESSIONS REQUIRED FOR THE DESIRED RESULTS AND THE AVERAGE OF THE QUANTITY OF PRODUCT USED.

Results: PRESENTING A LOW RATE OF COMPLICATIONS, A GREAT DIFERENCE IN VOLUME AND SHAPE. A HIGH SATISFACTION RATE.
WOMEN BEING FOLLOWED OVER 13 YEARS WITH OVER 2,000 WOMEN.

Conclusion: GLUTEAL AUGMENTATION WITH PMMA IS A SAFE PROCEDURE IN A LONG FOLLOW UP YEARS.

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Objectives: Collagen represent about 70-85% of dermis dry-weight giving to the skin specific characteristics of greater or lesser extensibility. This indicates that the extracellular matrix is the most important tissue in skin quality.Plateles rich plasma(PRP)therapies have been used for various indications with promising results for the regenerative capacity.Collagen replacement with its PRP activation effect is a logical approach in skin rejuvenation.

Introduction: As an autologous method, PRP is used for the healing of autologous enhancement of the tissues by secreting the growth factors inside from the platelet cells. Collagen is known as a powerful activator of platelets therefore, application with prp shows a double effect of activating platelets and compensating for collagen lost associated with skin aging. The infiltration of collagen into the extra-cellular matrix has a dual action:replace and increasing the conditions of anisotropy and capable of stimulating fibroblast for the synthesis of autologous collagen.

Materials / method: Prospective trial included 30 healthy female volunteers (average age 38) randomly assigned to three groups of 10 volunteers each administered three time an interval of three weeks 8ml intradermal 30-gauge needle injections administered on whole face. A group–PRP treatment;B group–collagen treatment and C group– combined PRP and collagen tretament. Participants were asked to grade on a scale from 0 to 5 for general appearance, skin firmness–sagging, wrinkle state and pigmentation disorder of their own face before each PRP procedure and 6 months after the last procedure.

Results: In all groups improved clinical outcome scores were registered at second and third sesion while there was a statistically significant difference for skin firmness – relaxation after 6 months in group of combined PRP and collagen tretament in relation to groups treated only with prp or collagen.

Conclusion: The study shows that combined prp and collagen administration have benefitial long-term effects in the treatment of for general appearance, skin firmness–sagging, wrinkle state and pigmentation disorder.

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Objectives: Facial aging involves bone, ligaments, muscles and skin changes over the years.. We propose laser for ligaments’ assessment and skins' treatment; injectable PLLA in areas of bone reabsorption and neuromodulation with botulinum toxin as
a NEW APPROACH FOR REGENERATIVE REJUVENATION.

Introduction: Facial aging is a complex and dynamic alteration of balance and proportion characterized by a Myriad of features involving bone, ligaments, and muscles and skin changes over the years.
New studies about ligaments allowed us to think about new possibilities. There is a decrease of about 1 % of collagen production by year, from 30 years old and as ligaments are composed mainly of collagen, LASER can stimulate ligaments. PLLA stimulates bones and botulinum toxin modulates muscles

Materials / method: The patient underwent one session of 2940 nm Er: YAG laser smooth mode, using the intra-oral technique followed by transcutaneous ligaments assessment. The ligaments assessed were: orbital retaining ligament, zygomatic cutaneous ligament, zygomatic ligaments, lateral orbital thickening, parotid masseteric ligament, mandibular retaining ligament, and mental ligaments . Bones were stimulated by the use of PLLA and muscles were modulated by use of botulinum toxin

Results: Results can be seen 3 months after the first session

Conclusion: As Facial aging is a complex and dynamic alteration of balance and proportion characterized by a Myriad of features involving bone, ligaments, and muscles and skin changes over the years, the use of LASER for ligaments assessment, Poli L lactic Acid ( PLLA)for bone's regeneration and botulinum toxin for neuromodulation can be a NEW APPROACH FOR REGENERATIVE REJUVENATION

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Objectives: Objective: The aim of this study is to analyse the efficacy and safety of the combined medical-aesthetic treatment with HIFU and Hyaluronic Acid dermal fillers in facial rejuvenation.

Introduction: ntroduction: Ageing affects every cell in the body, but the skin shows the most obvious signs of the passage of time. During the aging process the skin becomes gradually thinner, drier with the loss of elasticity with the appearance of line and wrinkles. Combined treatment of Micro- and Macro-Focused Ultrasound (HIFU) and Hyaluronic Acid (HA) anti-ageing injections, may be an effective and safe treatment to refresh the appearance.

Materials / method: Materials and Methods: From March 2018 to March 2020 over one hundred patients have undergone to this combined protocol for facial rejuvenation. This medical-aesthetic treatment was performed using HIFU technology, Micro- and Macro-Focused Ultrasound in the SMAS area (Superficial Muscular-Aponeurotic System) and HA with these features: a mix of cross-linked and non-crosslinked Resilient HA (RHA), 15 mg/ml concentration in total, 1.9% of BDDE and 0.3% of lidocaine; a 15 mg/ml non-crosslinked HA supplemented with a Dermo-Restructuring Complex (DRC) and 0.3% of lidocaine. Moreover, photographs of

Results: Results: In this study was evaluated the efficacy and safety of HIFU and HA in facial rejuvenation. The author discusses her personal applications of these combined procedures and shows of the results obtained using this combined medical-aesthetic treatments.

Conclusion: Conclusions: The combined treatment of HIFU and HA dermal fillers has proved to be an efficacy and safety option of aesthetic treatment. This combination approach produces a skin rejuvenation with an overall facial improvement appearance.

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Objectives: Background
The current treatments of Facial hyperhidrosis (FH) are often limited.
Objective
Was to study the efficacy, safety and tolerability of microneedling delivery of botulinum toxin-A (BTX-A) versus its intradermal injection in treatment of FH.
Methods
Forty-two patients with FH were subjected to microneedling followed by topical application of BTX-A on one side of the face and an intradermal injection of BTX-A on the other side. Two sessions were done at 2weeks apart. Assessment tools were Hyperhidrosis Disease Severity Scale (HDSS), Dermatology Life Quality Index (DLQI), and

Introduction: Hyperhidrosis (HH) is characterized by excessive sweating that exceeds the amount necessary to meet the body's thermal regulation. Hyperhidrosis often interferes with daily activities and is associated with low self-esteem. Hyperhidrosis is classified into primary or secondary. The primary type has unknown etiology and is characterized by bilateral and symmetrical distribution. Secondary HH may be caused by endocrinal, neurological diseases, infections, or malignancy. The focal type can affect the face, axillae, hands, or feet (1-3). Treatments of HH are often limited. Topical antiperspirants

Materials / method: Iodine starch test was performed before each session and 2 weeks after. The face was cleansed by alcohol and cotton soaked with iodine was applied to the skin. After drying, starch flour was sprinkled on the face. Then, standardized photographs were taken, and the patients were instructed to wash their faces. Then each patient received an intradermal BTX-A injection on one side and microneedling on the other side followed by an application of BTX-A.

Results: After the treatment, group I showed a highly significant decrease in HDSS; 85.7% of patients achieved a score of 1 versus 83.3% of the patients in group II (Table2).
- DLQI, decreased to1.3±0.3 in group I versus 1.7±0.2 in group II with no significant difference between both groups.
-Patients’ satisfaction was significantly higher in group II compared to group I (p<0.03) (Table3).
-There was a significant increase in the frequency of pain in group I (intradermal Injection). Mild erythema and slight edema were noted in group II(microneedling)

Conclusion: Both intradermal injections of diluted BTX-A or its microneedling delivery could be the first therapeutic option for FH owing to their safety and efficacy particularly if the patient was not satisfied with the topical treatment. Microneedling delivery of BTX-A was less painful and had greater patient satisfaction.

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Objectives: The goal of this presentation is to show the great utility of hyaluronidase in avoiding complications and unaesthetic results due to hematomas. We propose early drainage of hematomas even in its gelatinous or organization phases by being dissolved with hyaluronidase. Also, hyaluronidase can dissolve and facilitate the absorption of large traumatic hematomas after filler injections that may compress vessels. Reference: Almeida ART, Monteiro RSTD. Hematoma in aesthetic surgery: tips to avoid unaesthetic results. Hyaluronidase and hematoma drainage. Surg Cosmet Dermatol. 2021;13:e202100

Introduction: Hematomas are usually reabsorbed spontaneously. In some cases, they may induce poor aesthetic results like flap necrosis after face-lift surgeries, resulting in unaesthetic scars. They may jeopardize the flap viability, leading to knots, necrosis, skin irregularities, hyperpigmentation and prolonged healing time. One of subcision's adverse effects are residual indurations that can be due to unrecognized hematomas. Early drainage can prevent nodule formation. Hyaluronidase is useful to help absorption of large hematomas due to needle trauma after injecting fillers causing vassels compresssion

Materials / method: Case 1.Subcision for marionette lines: treatment of residual firm local bumps with puncture and drainage of residual hematoma. Case 2.Hematoma, partial scar dehiscence and necrosis after face-lift surgery: drainage of coagulated hematoma pre dissolved with hyaluronidase. Case 3.Lip hematoma causing vascular compression: after filler injection on the lower lip, a blanching area was observed and treated with hyaluronidase injected with a needle. This led to a large hematoma, causing new vascular compression. In order to dissolve the hematoma hyaluronidase was injected with a cannula.

Results: Case 1. Within 6 weeks, there were no more nodules and local improvement of wrinkles and laxity could be observed. Case 2. Immediately after treatment, the patient felt less discomfort. The wound started to heal on the following days. Two
weeks later, small areas of localized blue-colored skin indurations were punctured again. Immediately after the procedure, the bluish color disappeared as well as the indurations.Case 3. One hour after the hyaluronidase injection, the purple
color on the patient's lower lip cleared and 24 hours later, almost complete resolution of the hematoma occurred

Conclusion: Hematoma is a frequent occurrence following surgical procedures. Observation is often adopted. But, in some cases, they may course with complications. The authors propose early drainage when in the liquefaction phase or by hyaluronidase injection when consolidated in order to reduce patient discomfort, downtime and to prevent poor aesthetic outcomes. Although the property of hyaluronidase of making tissues more permeable to fluids and its capacity to dissolve hematomas is reported in other specialties such as anesthesiology and orthopedics, such use is still little known by aesthetic doctors

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Objectives: In the achievement of an aesthetic result often you have to deal with patients requests. which are dictated by the fashion of the moment and which are in contrast with our idea of naturalness.
Our aim is to demonstrate how the respecting of the peculiarities of the face and its intrinsic harmony determine a more satisfactory and appreciated response compared to a stereotypical result

Introduction: To obtain it our working group used the technique "Middle-Lower Face&Lip With Single Entry Point”, that is a treatment with hyaluronic acid that involves several districts of the face with a unique entry point going to restore lost volumes and making patients younger but never different and artifact.

Materials / method: The technique used by our group is characterized by the injection a hyaluronic acid with specific rheological properties (stable and long lasting but at the same time dynamic) through electronic device associated to a cannula 6o mm length 25 Gauge with needle 21 Gauge or specific device to define the entry point.
With a single-entry point for each hemiface through the cannula you got the volume restoration or volume creation of these anatomical districts. This volume restoration and creation affected harmoniously also chin and lips through a linear retrograde injection

Results: Analysing the total sample of 526 patients treated between 2015-2022 and composed by 348 women and 178 men, we obtained a degree of satisfaction of the 98% and the occurrence of 76 minor complications such as oedema of the lips or mild haematomas in the entry points.
No patient encountered serious complications

Conclusion: With our technique we can administer the right amount of hyaluronic acid in all the districts in order not to create a block of the segments of the face but rather a movement and a connection among them which is really harmonious and dynamic and respects the naturalness and harmony of the face itself.
This study demonstrated how an innovative technique associated to a proper preliminary analysis of the patient and to the proper product, leads to a desired aesthetic result without subverting the basic features rather exalting and bringing them in balance between them.

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Objectives: The purpose of the study: to find optimal protocols of the LLLT (low level laser therapy) in wound healing and regeneration.

Introduction: After review of articles describing the studies of scar formation, it is possible to conclude that angiogenesis is one of the main processes in the second and third phases of the wound healing process. Typically Nd:Yag lasers (L) are used to work with vascular formations in medicine. L have a small absorption in melanin and expressed in hemoglobin, but in low energy L provide healing effect on deep and superficial wounds, helping to avoid rude scars formation throw regeneration process

Materials / method: Methods: we treated a group of 20 patients who previously underwent surgical intervention with usual wound suturing. The patients were divided into 2 groups: 1st group: underwent LLLT after operations, 2nd group: who were followed up after operations by traditional method of wound healing.

Results: Results: in the 1st group we observe a faster resolution of postoperative edema in the suture area, as well as lesser severity of erythema. Within a month, sessions of LLLT of the suture area were performed, which made it possible to reduce the area of scars in both groups revealed that its structure and dimensions in the 1st group is closer to intact skin, compared to the results in the control group.

Conclusion: Conclusion. The data obtained during this trial can show the direct correlation between early LLLT and the process of regeneration and car formation, as well as the possibility of controlling this process by local impact on the wound with a L. The advantage of the proposed method is its availability, ease of use, lack of systemic and side effects, as well as high efficiency and relatively low cost.

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Objectives: Nowadays young patients are seeking the fox eye procedure which focuses on lifting the tail of the eyebrow, even though this procedure is a trend that is performed by many clinicians, the longevity of the procedure is questionable. the question remains is it worth doing it.

Introduction: Eyebrows have a huge impact on eye beauty, where low brows can make the eyes look heavy, sad, and aged, on the other hand, high brows reverse all the latter features. Numerous procedures for eyebrow lifting have been advocated those of which involve surgical and non-surgical procedures, the latter includes neurotoxins, fillers, and threads. millennial patients tend to seek a special type of lift for their eyebrows where they focus on a lift for the tail of the eyebrows which is commonly knowns in the market as the fox/cat eyes.

Materials / method: Thirty female patients aged between 22 - 35 years old had a fox eye procedure, by lifting the tail of the eyebrow using PDO barbed threads through different techniques of thread insertion.

Results: None of the patients reported paresthesia, hematoma, bruising, or any adverse events. However the main outcome of the procedure which is achieving a marked lift for the tail of the eyebrow was not maintained after the treatment on the follow-up sessions, Relapse is inevitable.

Conclusion: The longevity of the procedure is questionable.

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Objectives: For a dermatologic or esthetic surgeon it is essential to know how to properly use high amounts of local anesthetics. For already a few decades we use the tumescence technic where a high diluted local anesthetic solution is used to perform the surgeries in an outpatient setting.
We are presenting different concentrations of the solution for the different intervention and we are proving in our own studies that the usage of high volume tumescence solution is safe for the patient and for example in liposuction the outcome is superior to the results in general anesthesia.

Introduction: Tumescence Local Anesthesia has changed the way we perform dermatologic surgery. With the right mixture it is possible to perform high volume liposuctions, body contouring surgeries, vein surgeries and classic dermatologic surgery in an uncomplicated outpatient setting.
For the different interventions we use different concentrations of the solutions.
Since we can perform all these surgeries in local anesthesia they can be done in an outpatient setting.

Materials / method: We are performing high volume liposuctions and body contouring surgeries in either pure local anesthesia or in combination with a light sedoanalgesia. In a study we investigated the blood levels of Lidocaine in our patients and proved that even when using high amounts of local anesthetics there is no intoxication, if the concentration of the solution is chosen appropriately.

Results: Our studies showed no intoxications and there were no severe incidences in the last 1000 Liposuctions which were used to treat Lipedema.

Conclusion: Surgeries like liposuctions or body contouring surgeries are safe when performed in local anesthesia using the tumescence technique.

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Objectives: The Latest Advances in Prescribing Hydroquinone Safely and Effectively Long-Term

Introduction: Hydroquinone (HQ) remains the gold-standard when treating conditions of pigmentation. For decades, it has been widely uncontrolled and available for sale in varying formulations and concentrations online, over the counter and via prescription. This has led to widespread misuse, poor long-term results, grave complications as well as frustrated patients and physicians.

Materials / method: These latest HQ guidelines aim to maximise its efficacy and mitigate any unwanted side-effects. Because it cannot be used indefinitely, time frames for maximum usage are now clearly defined. This includes pulsed therapy, cycling and a “HQ holiday”, during which time advanced non-HQ topical alternatives are employed to reduce the melanocyte’s output. Gradual weaning of HQ should also occur in order to prevent rebound pigmentation. HQ dosage must also be strongly considered as well as frequency of application in darker skin tones in order to avoid excessive lightening of the skin.

Results: It is further important when selecting the correct HQ topical that physicians consider modern formulations with advanced delivery mechanisms for dermal pigment improvement, added keratinocyte exfoliation systems to hasten results, potent anti-inflammatories and antioxidants to reduce inflammation as well as barrier-replenishing agents to moisten newly exposed skin. The pH of the HQ topical is also important to contemplate as this determines its overall mechanism of action: “Bleaching” vs “Blending” effect.

Conclusion: HQ’s efficacy for managing pigment disorders is unmatched. Together, these current and comprehensive guidelines will help enhance its results potential and mitigate any side-effects.

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Objectives: 1. Gender equality in sexuality
2. Promotion of self-knowledge and self-discovery (exploration-masturbation)
3. Anorgasmia and lack of sexual desire
4. High rate of divorces, marital breakdowns
5. Quality of LIFE

Introduction: Science had not expressed interest in the female pacer, until the 60s, Masters and Johnson discovered that between 14 and 16% of women recognized themselves as multiorgasmic; but the most serious studies on female orgasm came with Barry Komisaruk.
It is said that the orgasm caused by vaginal stimulation involves the whole body, while the one that results from the stimulation of the clitoris is more focused on this region (NEED TO PROMOTE PRESSOTHERAPY FOR STIMULATION OF THE G-SPOT DRGSPOT).

Materials / method: DrGSpot

Results: 1. Physical Factors (surgical trauma, fibrosis, scarring, dryness, atrophies, calcifications, malformations)
2. Emotional Factors: (rapes, fears, taboos, childhood traumas, self-esteem) generate in the individual reactions of anxiety, insecurity, fear of failure, fears of all kinds that not only affect individually but also affect the couple and society.
3. Social Factors (taboos, prejudices, unfounded fears, economy, religion, routine lives) Sensitize society about female sexuality, its empowerment and integration.

Conclusion: It is important that both men and women have a healthy self-exploration in order to have orgasms that are not only for fun, but also help your body to be in optimal conditions to combat both physical and psychological diseases.

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请注明日期: Patented - Program Woman and Men Multiorgasmic Dr Gspot
和审阅情况: 2015

这项工作没有任何直接或间接的资金支持。由作者自己承担责任。

Objectives: 1. Elucidate the labial anatomical variations described in the scientific literature
2. Understand and justify the lip fill technique using the 4mm needle as safe
3. Signal needle anglees to the properor in order to avoid serious intercursives.

Introduction: Currently several lip filling techniques are described in the literature and the concern of the injector professional is growing increasingly in relation to the safety of the procedure.
The lips have anatomy with high vascularization. Walker and Cetto 2021 advocate the use of the 4 mm needle as a safe option to perform the technique. The labial anatomy has great vascularity and its occlusion may evolve to severe complications. The technique in addition to the safety mentioned in the study also emphasizes patient comfort.

Materials / method: To achieve the proposed objectives of the study, a thorough research of the scientific literature was carried out through the PubMed website between 2004 and 2022 relating articles involving lip filling techniques, anatomy and the Walker and Cetto technique, 2021.

Results: Scientific findings show the range of anatomical variation mainly among the arterial branches that irrigate the lips. The Walker and Cetto technique has demonstrated patient safety and comfort when compared to other injection techniques. Although it is not yet considered as a standard another in safety can be an alternative that requires more studies.

Conclusion: Although the studies suggest an approach on a superficial plane as safe, more studies need to be performed with the 4mm needle technique to guide as another standard in the safety of the procedure.

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Objectives: Aging brings unsightly changes in the female genitalia, closely associated with the gradual loss of collagen and the reduction of fat pad that fills the region, making labia majora ( LM ) shriveled, looser and pendulous, a fact that bothers many women.

Filling the LM with hyaluronic acid (HA) has been shown to be a safe and effective alternative for the treatment of laxity, with a high rate of patient satisfaction.

Our objective is to propose a systematization that helps doctors to plan and execute the procedure with anatomical, aesthetic and functional criteria.

Introduction: In addition to aging, fat loss from the LM occurs due to large weight losses, in high-performance athletes with very low percentages of body fat or in sports practitioners with a lot of impact in the region, such as equestrian and cycling.

Filling the LM with HA can be desired even by young women whose labia minora protrude not because they are big, but because the LM are not big or close enough to contain them.

So, before injecting the fíler, it is important to analyze the anatomy and what you want to achieve with the procedure, whether volumization, lifting or closing the vulva.

Materials / method: After an intense anatomical study of the vulva and numerous LM fillings, we concluded that our challenge is precisely understanding whose therapeutic target we want to achieve, that could be divided into 3 goals:
1- volumization itself, for withered LM, not extensively pendulous
2- closing the vulva for LM away from the midline that allow the exposure of the labia minora
3- lifting for LM withered and drooping lips, cases in which threads and biostimulators should be considered

We propose 4 anatomic vectors for injection of HA, that we named Vulvar Anatomy VA1, VA2, VA3 e VA4.

Results: We systematized the fillers injection of LM according to the vectors:
- VA1: medial border of LM
- VA2: 1cm lateral to V1, 1cm shorter than V1
- VA3: 2cm lateral to V1, 2cm shorter than V1
- VA4: transition between the labium and the pubic mound

Fillers in VA1 promotes closure of the vulva, with better accommodation of the labia minora. In VA2 and VA3 promote volumization in loose LM, but should be performed with caution if they are pendolous. In the VA4 fillers promotes lifting but requires caution if there is suprapubic fat accumulation.

Conclusion: Following the proposed systematization, we have obtained excellent results with a high degree of patient satisfaction.

In most cases, the injection of VA1 precedes the VA2 and VA3, to prevent the lateral volumization from exposing the labia minora.

In general, I use products with greater definition power such as Restylane Defyne for VA1 and VA4, while for VA2 and VA3 I prefer volumizing products such as Restylane Volyme. I usually use a maximum of 2ml of HA per LM per session.

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