Objectives: underline the dangers of using needles in medical rhinoplasty

Introduction: medical rhinoplasty is a very cool technique used more and more for nasal reshape. Use of needles can be dangerous

Materials / method: The authors present a case report on an ischemical complication around the tip of the nose after a filler injection with a needle. All different passages until final recovery are outlined. The anatomical details will be underlined.

Results: The recovery after ischemical complications for a Hyaluronic acid filler injection is quit always the "restitutio ad integrum", but the time needed can vary from 3 month until 5-6.

Conclusion: The use of needles in danger areas like the nose can lead to dramatic consequences and would be avoided. Cannulas 25 or 22G can provide the same results all over the nose with only one entry point, are quit painless and reduce to a very low rate the possibility of an ischemical complication.

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Objectives: To provide clinicians with valuable information on BoNT/A and immunogenecity to enable safe and effective treatment with BoNT/A.

Introduction: All protein-based therapeutics, such as botulinum neurotoxin type A (BoNT/A),
are potentially immunogenic and can lead to anaphylaxis, autoimmunity, or diminished or complete absence of therapeutic efficacy, especially if administered repeatedly. Therefore, the protein quantity in BoNT/A products is an important consideration when selecting products for treatment. However, essential formulation data are not always publicly accessible.

Materials / method: The neurotoxin protein content of products newly introduced in
Asia, such as (listed alphabetically) Botulax®, Meditoxin®, Nabota®, and Relatox®, was measured by sandwich enzyme-linked immunosorbent assay with antisera directed against BoNT/A compared to Xeomin®.

Results: Botulax and Nabota contained 844 and 754 pg of neurotoxin protein, with inactive neurotoxin calculated to be 103% and 81% and the potency per pg of neurotoxin was 0.118 and 0.133 U, respectively. Meditoxin and Relatox had 575 and 578 pg of neurotoxins with inactive neurotoxins of 38% and 33% and the potency per pg of neurotoxin was 0.174 and 0.173 U, respectively. However, Xeomin, which has 416 pg/vial of purified neurotoxin and 0.240 U of efficacy per pg of neurotoxin, has the lowest neurotoxin protein content and consequently the highest specific
potency compared to the four Asian BoNT/A

Conclusion: Although Botulax and Nabota had more neurotoxin than Xeomin in an equivalent
volume, they contained greater amounts of inactive neurotoxin. In addition, although Meditoxin and Relatox had slightly more neurotoxin than Xeomin, both contained greater amounts of inactive neurotoxin.

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Objectives: The goal of this study is to assess the outcomes, the longevity of results and the patients’ satisfaction using microrhinofiller technique with Hyaluronic acid dermal filler.

Introduction: The nose plays a crucial role in the global facial beauty and non-surgical rhinoplasty is one of the most requested procedures in the field of aesthetic medicine. So far, several techniques have been proposed in literature and fearsome complications are reported especially in Asian individuals. For this reason, in the last years, I modified my approach to nose remodeling in selected cases by mainly choosing microrhinofiller, that prevents patients from the risks of major complications by injecting a minimum quantity of hyaluronic acid fillers to augment selected areas of the nose.

Materials / method: Microrhinofiller technique was performed using HA dermal fillers with specific rheological characteristics: shape and projection of the nose must be maintained while resisting degradation as well as the forces of compression. Moreover, the surface implant with microneedles enables for a better performance of the injectable, which will be a medium-density hyaluronic acid in less quantity than the standard approach. The improvements in the remodelling of the nose were evaluated by pre- and post-treatment images and the patients’ satisfaction was assessed using a questionnaire.

Results: 118 patients were included in the study and treated for 2 years. Almost all of them underwent a touch-up one month after treatment. The correction is stable and the results are maintained within 4 to 24 months. The 95% of the patients referred to be completely satisfied at four months or later. Positive evaluation was mainly due to the technique (microrhinofiller) and a preliminary discussion about achievable realistic results with patients before treatment. Severe complications were not encountered.

Conclusion: Non-surgical rhinoplasty with HA fillers represents a safe and effective alternative to surgery. Especially, microrhinofiller is an ideal technique to modify the nose and correct minor nasal irregularities. This innovative technique is minimally invasive and avoids severe collateral effects.

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Objectives: Full lips afre strongly associated with youth and beauty.
Because of this, lip enhancement is one of the most frequently requested procedures in a cosmetic practice. While there is no single prescription for a “perfect” lip, a correct technique for lip augmentation must provide a global approach including the perioral area treatment, in order to achieve a natural look.

Introduction: For more comprehensive and global approach to lips and perioral rejuvenation, filler technique can be combined with the injection of derma-restructuring agents, such as antioxidants, minerals, amino-acids.
Treatment of this area must take into account the age, anatomical differences, aging severity for achieving a customised and natural effect.

Materials / method: Female patients were treated; inclusion criteria: age> 30 years; exclusion criteria: dermatological or systemic diseases, infections or traumas at the injection site.
Injection treatments were performed using an electronic device, with needle or microcannula, using a dynamic filler and a redensifying agent composed of non cross-linked hyaluronic acid (15 mg / ml) and a derma-restructuring complex containing amino acids, minerals, vitamins and antioxidants.

Results: The results showed a natural effect especially in face dynamics, a marked improvement with regard to skin tropism, hydration, turgidity of the lips and the perioral area.

Conclusion: The combined treatment of the lips and the perioral region with dynamic filler and redensifying agents was safe, effective, well tolerated and had positive feedback in all patients.

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Objectives: Rhinoplasty gives possibilities to change the shape of nose. But if patient has some small imperfection and doesn’t have absolute indications to the surgery or also had made rhinoplasty I can offer nonsurgical rhinoplasty. I called my conception of nose correction “Baby” nose

Introduction: With the ages the indentation at the nose becomes more visible, the tip of nose starts to sink. We see nasal lumps and protuberances, sunken tip of nose. it happens because of bone’s changes, muscles activities and cartilage growth

Materials / method: I use the botulinum toxin in depressor septi nasi to lift the top of the nose the botulinum toxin in levator labii superioris alaeque nasi to reduce sinking of nose in actions. For shaping I use HA fillers to strengthen columella and make accent on new tip

Results: We should be especially careful with the patients after rhinoplasty not to lead to ischemic complications because of changes of vessels after surgery

Conclusion: “Baby” nose, when the tip of the nose looks up and length of the nose reduces, changing nasolabial angle

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Objectives: *obtaining a natural looking lip through proper diagnosis and injection of different peri-oral muscles using botulinum toxin type A and dermal fillers
*how to determine the exact cause of excessive gingival display
*using different approaches to recreate and enhance the normal anatomy of the lips during both resting and smiling positions.

Introduction: *excessive gingival display can be very challenging due to the complex anatomy of the lower face region as well as the variety of reasons that may cause such problem.
*gummy smile can result from different reasons, either dental, gingival, skeletal or muscular.
* Proper diagnosis for the specific etiology of the condition is key to a more natural results
*Multiple reasons can participate to cause the same condition of the gummy smile
But treating only one of the reasons will give incomplete results
* Some definitive treatments can be very aggressive so patients may prefer camouflage

Materials / method: *Adult patients (males &females) are interviewed
*careful examination
*proper planning of the case according to the defect
*complete aseptic condition
*accurate marking of the targeted muscles through palpation and mimicking the action of every muscle on the facial expression

Results: *injection of grade A botolinium toxin in the landmarks accordingly allows the muscles to relax camouflaging the defect giving the patient a more natural and more aesthetic appearance.
*there are multiple areas that could be injected accordingly to help achieving the desired natural appearance during rest and function, and they are;
• Yonsei point
• Orbicularis oris muscle(vermillion border, upper lip)
• Depressor anguli oris
*complementary lip fillers can be used whenever needed.

Conclusion: Meticulous injection of BX-A is an effective treatment option for patients with excessive gingival display and lip inversion caused by different peri-oral muscles
For the most natural results, BXA is the first treatment option in patients with excessive gingival display who have optimum clinical crowns

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