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Objectives: Understanding and Managing Facial Overfilled Syndrome, Focus on Cheeks.

Introduction: The shifting natural appearance of one's face can be confirmed because it has a soft, fluid consistency when palpated. Once identified, it is prudent to administer hyaluronidase injections straight away, the earlier the better, to reduce the chances of the patient looking unnatural longer and without being aware of it.

Materials / method: Here I present the case report of a 56-year-old woman who developed features of FOS on her cheeks as a result of previous injecting of hyaluronic acid fillers to her nasolabial and infraorbital areas 6 years ago. It is important to inject the detectable lumps with multiple puncures of 30G sharp needle because the lumps are usually covered by a biofilm or fibrous cage. Once it flattened the treated side looked more lifted than untreated side because of weight loss. I continued injecting hyaluronidase with 23G blunt needle to minimize any distortion to the surrounding cheek and infraorbital area

Results: Performing hyaluronidase injections just once probably won't be enough to recontour the patient's face. Step by step action is generally more beneficial and should create a better outcome for patients everytime they finish having hyaluronidase treatment.

Conclusion: In the end, it is not just hyaluronidase which helps patients with FOS return to their natural appearance. What is required is an approach that combines treatments with different modalities to combat aging to five key tissues in the face. This will enhance the results leaving a more pleasingly attractive and stable look and at the same time be longer lasting.

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请注明日期: successful
和审阅情况: 19 April 2019

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Objectives: A special technique to make a better result in natural shape of chin and reduce the opportunity of granuloma recurrence caused by silicone injection

Introduction: Silicone liquid injection have been used for cosmetic for more than 40 years. Many complications have been reported such as granulomatous, inflammatory responses, migration, and discoloration of the tissue. In 1992, the FDA has banned silicone liquid  injection for cosmetic uses. However, silicone injection is still being practiced illegally. Liquid silicone injected to chin cause granuloma, inflammation, and a witch looked like face.

Materials / method: Many methods has been used to remove the granuloma but excision were the best among all. We used knife to do the excision, only to the granuloma without damaging the skin.The Incision from under the skin in submental area and then we cut the excess skin for make better shape of chin. Using a knife to remove silicone granuloma is better that curretation, and for the inflammation we use corticosteroid injection.

Results: Combination knife with special technique and corticosteroid injection can make a better result in natural shape of chin and reduce the opportunity of silicone granuloma recurrence.

Conclusion: Granuloma on the chin can be removed by excision with special technique which result in aesthetic and low recurrence of granuloma.

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Objectives: A case report of neurotoxin injection complication

Introduction: Currently injection of neurotoxins is widely used in the aesthetic field, although there are safe, side effects can occur after the injection of neurotoxins. The neurotoxin injection has local effect on the targeted muscle, but the toxin can spread to areas or muscles that are not targeted for therapy. The spread of toxins will cause side effects or complications, so it is very important to understand the location of injection of neurotoxins on the face.

Materials / method: Eiektktkcikrr

Results: A 47-year-old woman presents with right eyelid ptosis and photophobia. The right eyelid drops to pupil height after 1week injection of neurotoxin. Neurotoxin injections are performed to reduce hyperdynamic wrinkles in the glabellar region, forehead and around the eyes by a doctor. Total cumulative dose of botox A was 52 IU. Botox A was injected bilaterally into the muscles of orbicularis oculi, corrugator supercilii, procerus and frontalis. On examination there were 2 mm ptosis in the right eye. The patient received Pyridostigmine bromide 3 x 60 mg for 10 days and tetrahydrozoline HCL ED.

Conclusion: Discussion
Complications of neurotoxins injections are divided into two groups related to procedures and pharmacology. Complications related to procedures are local. Eyelid ptosis occurs when injection is carried out around the eyelids and the migration of neurotoxins through the septum orbital fascia to the levator palpebrae superioris muscle and will cause a decrease in muscle activity. Pyridostigmine bromide is an anticholinesterase agent, preventing the breakdown of acetylcholine in the nerve and muscle joints thereby reducing muscle weakness.

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