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Objectives: The anatomy, evaluation, and diagnosis of unwanted fat location, and the injection techniques for treating submental fullness.

Introduction: Submental fullness is one of the signs of an aging face, and one of the most desired treatment areas for patients.

Materials / method: The US FDA approved the use of deoxycholic acid injection to treat unwanted superficial submental neck fat. A 5-year follow-up study of this treatment showed long lasting effects after injection.

Results: Deoxycholic acid injection can treat moderate to severe submental fullness in 2-4 sessions spaced throughout 4-8 weeks; some severe cases may need up to 6 sessions.
Aside from the submental area, some off label areas could also be treated, given careful evaluation and treatment planning.

Conclusion: In this presentation, I will present the clinical experience on injectable lipolysis with deoxycholic acid in Asian patients

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Objectives: Paradoxical masseteric bulging is a rare sequela, clinical trials focused on its anatomical clarification need to be performed. The aim of this study
was to determine the detailed anatomical structures of the superficial part of the masseter and to elucidate the boundaries and locations of the deep tendon structure within the superficial part of the masseter.

Introduction: Various anatomical studies have attempted to determine the most effective BoNT-A injection points and obtain optimal results while minimizing complications. Several of these studies have investigated the intramuscular nerve distribution, the motor nerve entry point of the masseteric nerve into the masseter, and the relationship between the parotid gland and the marginal mandibular branch
of the facial nerve. However, the rare side effect of paradoxical masseteric bulging after BoNT-A treatment for masseteric hypertrophy has not been investigated in any recent anatomical or clinical studies.

Materials / method: Forty-four hemifaces from Korean (21 hemifaces, 10 left and 11 right; mean age 79.9 years) and Thai (23 hemifaces, 11 left and 12 right; mean age 68.6 years) embalmed cadavers were dissected to analyze the morphological patterns, with 30 of them used to measure the detailed location of the deep tendon structure of the masseter. The skin of the midface was carefully removed, and the superficial musculoaponeurotic system (SMAS), parotid gland, and masseteric fascia were dissected to reveal the entire masseter.

Results: The relationship between the masseter and DIT could be classified into three
types according to the coverage pattern: Type A, in which areas IV and V were covered by the DIT (27%, 12/44); Type B, in which areas V and VI were covered by the DIT (23%, 10/44); and Type C, in which areas IV, V, and VI were covered by the DIT (50%, 22/44). The superficial part of the masseter consists of not only the muscle belly but also the deep tendon structure.

Conclusion: Based on the results obtained in this morphological study, we recommend performing layer-by-layer retrograde injections into the superficial and deep muscle bellies of the masseter.

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Objectives: Dr Shahid Jamil -
Aesthetic Surgeon - Australia

How to master the art of creating mathematically precise , proportionate and natural lips that vary depending on the age bracket as well as sex of the patient.

Introduction: Too much stigma remains around poor lip outcomes and the cosmetic industry is often misjudged by the abundance of the over done aesthetic work that misrepresents the broader intentions of experienced physicians. For me, the Lips are like a cherry on a cake. There has to be some proportion, convexity, concavity and natural harmony bewteen the pillows and cushions that we create.

Materials / method: What exactly are these proportions which we aim to create in order to resemble enhanced yet embryologically natural contours. Both for females as well as men, for young and the aging lips.

Results: This is an advance session on how to create signature celebrity lips that rejuvenate the over all face and go beyond lips and address peri-oral refinement . Techniques targeting a multimodality approach to create the perfect pout in both animation as well static repose.

Conclusion: A discussion of the sculptors eye for what really means to craft natural lips, which add to beautiful features across the face and no merely feel done in isolation . Good lips should bring out other more importnat aestehtic subunits on a persons face.

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