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Objectives: Lower face shape and contour is very important for facial shape and younger and beautiful looking. Square lower face is very common in Asian. Sagging is an ageing sign make the lower face look rectangular. Minimal invasive way in combination of filler and toxin could have synergistic effect in reshaping the lower face in Asian.

Introduction: Aging signs on the lower face include the loss of the V-shaped lower face contour, the loss of a well-defined jawline, the formation of nasolabial folds and marionette lines, increased sagging, and jowl formation.

Materials / method: The application of botulinum toxin to the lower face can reduce the activity of facial depressor muscles, and reshape the lower face through the induction of masseter and parotid gland atrophy.

Results: The application of fillers into the lower face can reverse many aging signs and achieve a “lifting” effect. This is done through reshaping the chin, revolumzation over sunken areas, and improvement of overall facial contour.
Energy based devices with tightening effects play a role in reshaping and tightening the lower face , ncek , jawline with minimal downtime.
Injection lipolysis or cryolipolysis showed beneficial effects on submental fullness by reduction the preplatysmal fat.

Conclusion: In this session, I will present a rational and combination treatment using different modality to maximize synergistic reshaping and recontouring effects.

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Objectives: Nasal reshape is a well known indication for injectables. In the presentation the pioneer of the technique revises last details for good indications in different ethnicities and safe results. The technical details are showed live to let all doctors understand practically technical details.

Introduction: nasal reshape is a well known indication for injectables with different details in different ethnicities

Materials / method: Anatomical ethical differences are revised.
BoNT-A is used to inject mimetic muscles of the nose and perferical regions, to improve nasal tip projection and nasal perioral areas.
HA fillers are used to improve nasal bridge.
The far east ethnicities are revised to check best techniques to have good results and avoid complications.

Results: the technique is practically showed and immediate results are visible. Also delaied results are showed to assess best technical details

Conclusion: Medical rhinoplasty is a safe and very effective technique. Results are immediate and very impressive. If all steps are followed, complications are very few and can be solved immediately in the most part of cases.

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Objectives: 1. Understand the role of injectable collagenase combined with PC/DC and energy based devices in treating aging skin of thighs and knees.
2. Increase accuracy of injections with the use of a portable high resolution ultrasound unit
3. Understand who is a candidate for which combination
4. Know the limitations of these combinations

Introduction: Skin contour deformities of the thighs and knees accelerate in visibility as patients age. Volumetric loss of muscle, sun damage, and genetically programmed aging result in dimples, bulges, wrinkles, and crepey skin. . Current there are few good solutions for this type of deformity. Because most patients seek noninvasive or minimally invasive solutions, the recent release of injectable collagenase for cellulite has generated much interest for patients with these age related concerns. Injectable enzymatic degradation of fibrotic bands plus fat reduction clinically improves the region.

Materials / method: Female patients were first treated with subcutaneous injection of collagenase, followed by microinjections of dilute PC/DC. In patients with severe cellulite dimpling, energy based devices were also used. External RF/TPS was used to generate skin tightening as well as IPL. Three treatments were utilized. In patients with significant skin laxity plus lipodystrophy, RFAL was also used as a one time treatment. In order to boost the accuracy of targeting collagen bands for severe dimples, a high resolution ultrasound device was used to visualize the fibrotic bands.

Results: Postinjection ultrasound exam showed dissolution of fibrotic bands within 30 minutes. Patients achieved strong improvement of skin contour irregularities including dimpling, bulges, and crepey skin in 85% of patients treated. Limitations were noted in patients over age 70, in massive weight loss patients, and in patients with unrealistic expectations.

Conclusion: Treating poor skin quality in aging thighs and knees is a challenge without a good solution. Combination therapy using injectables combined with EBDs can generate moderate improvement in patients who are willing to undergo three sequential treatments. Collagenase offers a good solution for depressed dimples or fibrotic bands. When combined with dilute PC/DC and EBDs, skin smoothing is visible at 1 month post-treatment.

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Objectives: The primary objective of the study is to determine the efficacy of combination treatment of autologous PRP and ablative carbon dioxide laser in patients with SG.

Introduction: Striae gravidarum (SG) is a connective tissue disorder seen commonly in primigravidas. It is associated with impairment in the quality of life. To date, there have been limited published trials of PRP in SG. In recent years, PRP has been used as an adjunct treatment in various dermatological procedures. It contains growth factors that stimulate fibroblast production and enhance extracellular matrix components. In addition, trials using the combined treatment of ablative fractional CO2 laser and PRP, have not been reported previously in the literature.

Materials / method: The study was a randomized controlled trial, conducted in 16 patients. The abdomen was divided into two sides and was randomly assigned to the PRP and the control sides. They received fractional CO2 laser. After each procedure, the PRP side received PRP, while the control side received a placebo (pNSS). It was done for three sessions, every 4 weeks. An independent assessor used the photos taken at weeks 6, 10, 14 and 16 to assess the clinical improvement.A quartile grading scale was used to measure both the clinical improvement and patient satisfaction.Histopathology was done before and after.

Results: The combination of ablative fractional CO2 laser and autologous PRP had better clinical improvement and patients’ satisfaction compared to ablative fractional CO2 laser and placebo. However, both outcome measures were not statistically significant.

Conclusion: Ablative fractional CO2 laser combined with autologous PRP appears to be an effective treatment in SG.

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Objectives: Dr. TSENG would like to share his minimally-invasive approach to treat difficult periorbital cases.

Introduction: The periorbital area is challenging and prone to unsatisfactory results because of its complex anatomy, dynamic features, and thin skin.

Materials / method: It is not an area where one single recipe would satisfy the needs of different patients presenting with either tear troughs, eye bags, wrinkles, upper eyelid hollowing, eyebrow ptosis, or a combination of the above.

Results: Proper pre-treatment assessment to identify the underlying anatomical changes and tailoring treatments with fillers of suitable rheology, neuromodulation, and customized tissue tightening is crucial to natural results. 

Conclusion: Dr. TSENG would like to share his minimally-invasive approach to treat difficult periorbital cases.

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Objectives: Discussion of combined injectables treatments with the upper face as a paradigm

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