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Objectives: We suggest a structured safe approach for lip filling injection. We also describe 4 vascular adverse events associated with dermal fillers and their successful resolution without scarring.

Introduction: Vascular complications though rare, are disastrous consequences post dermal filler injections. Safe approaches for dermal filler injections have been described for several anatomical areas, including the lips.
We present a case series of 500 consecutive cases, injected by 6 physicians, over a 3-year period.

Materials / method: Following seeing 4 cases of vascular complications of the lip, that were salvaged, (will be presented), presenting to our group practice, we follow a structured approach for lip filling. A strict adherence to 2 anatomical injection techniques was implemented. A linear approach along the vermillion border away from the labial arteries was followed for lip lining and mild volume restoration. A perpendicular approach was adopted for further volume enhancement, if needed.
The anatomical rational and video illustrations of the techniques will be presented.

Results: No vascular complications occurred during the study period. Mild to Minimal bruising was occasionally seen.

Conclusion: Knowledge of the position of the labial arteries and its variations, and following an anatomically safe and structured approach appear, to be safe effective in avoiding vascular complications of dermal filler injections in the lip.

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Objectives: Report a case of the complication from the filler injection to the region of the nasal dorsum, nasolabial folds and columella

Introduction: Fillers are the most frequently used beautifying products. Use of dermal fillers for soft tissue augmentation has become an integral part of aesthetic practice. They are generally well tolerated. However some complications can occur, even among the most experienced cosmetologists in the field of injections. The complications may vary from mild bruising to severe injection necrosis. At the same time, there is a little data on how to prevent their occurrence among the patients have undergone the plastic surgery.

Materials / method: . A 34-year-old young woman who previously underwent the surgery for correction the shape and size of the nose and nasal septum was not satisfied with the results of surgical intervention. The hyaluronic acid was injected in the region of the nasal dorsum, nasolabial folds and columella.

Results: The following medications were injected: desinfiltral into the correction zone, dexamethasone, mexidol, cytoflavin, as well as other physiotherapeutic methods were used. The complication fully reduced after 2 weeks of treatment.

Conclusion: Early diagnosis and correct treatment can reduce the severity of complications from injected filler. Doctors must consider the previous surgical history of patient before the filler injection. Preliminary patient preparation for intervention can reduce the number of complications.

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Objectives: The aim of this study is to review these delayed complications of mild intensity, discuss their management and preventive measures to avoid them.

Introduction: Aesthetic treatments with Hyaluronic acid (HA) dermal filler has become a common cosmetic procedure to obtain a rejuvenated and improved look. The results are comparable to those achieved by plastic surgery while being minimally invasive. Although the safety profile of new generation HA dermal fillers is favourable, marked increase of fillers procedures is associated with a great number of adverse events (AE). Complications associated with filler injections ranging from mild to severe intensity and might have early onset (within days) or late onset (after weeks to years). Delayed complications

Materials / method: This is a retrospective study of patients with delayed complications following HA dermal filler injection. Photographs were performed before and after treatment.

Results: The author presents subjects with delayed filler complications. In this study is analysed for each case its clinical history, AE features, moreover, it is discussed its management and presented the treatment performed to its resolution.

Conclusion: The number of aesthetic medicine procedures have been increasing as well as the number of side effects, especially those of mild entity. It’s important for physicians to be aware of the potential side effects that can appear after HA filler injections, recognize their presentations and understand how to manage them.

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Objectives: Is „baby skin” possible in a mature face?

The SMART Anti-Aging NetworkTM technique is a new comprehensive approach to full-face rejuvenation, and a fast & long-lasting anti-aging and technique works on all skin layers and deep levels of the facial tissue.
Synergistic double power combination of HMAWHA and Succinic Acid
for visible and long lasting effects

Introduction: • Clinical trials carried out on 20 patients, age 40-65 years with visible signs of skin aging, saging and wrinkled skin and dischromias.
The purpose of the fan technique is to create a subcutaneous net of crossing long-linear deposits for an optimal, even distribution of HMWHA and SA.
There are no small isolated intradermal deposits, as in the classic mezotherapy technique, but rather a subcutaneous network that gives short & long-lasting anti-aging treatment from the subcutaneous to the all levels of skin and deep levels of the facial tissues.

Materials / method: • For optimal result was used mixture of HMWHA 1,8 % and SA 1,6 % - 4 ml was injected using 25G x 50 mm microcanula, using special combination of entry points.
• Selected entry points was located away from the main vessels and nerves, in the fan technique to create a subcutaneous network of crossing long linear deposits for an optimal even distribution of HMWHA and SA under main part of the face and recreate a natural foundation liner for the skin.

Results: The aim of the study is to demonstrate the effectiveness of SMART
Anti-Aging NetworkTM technique as a usefull treatment in the fast and long-term improvement of skin quality, restoration of subcutaneous undercoat, reduction of hyperpigmentation, reduction of wrinkles and redness, and finaly faceline reshaping, with minimal risk of complications and short recovery time. In study was using ultrasound analysis and 3D dermatoscopy in 15 and 30 days after the treatment.

Conclusion: Numerous clinical studies show that a compound of HMWHA (high molecular weight HA) and succinic acid with a physiological pH value of 7.5 inhibits destructive tissue enzymes (hyaluronidase, tyrosinase) and stimulates fibroblasts.
It improves microcirculation and tissue oxygenation, supplements natural HA levels in the skin and increases hydration.

SMART Anti-Aging NetworkTM technique guarantee an amazing „baby-face” effect with the shorter recovery time and reduced discomfort.

Baby Skin in Possible!

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Objectives: Orbital filler migration and foreign body reaction to dermal filler can develop years after the injection; therefore, physicians should be aware of this, and histologic examination is the gold standard to confirm the diagnosis.

Introduction: Filler injections, specifically hyaluronic acid, are continuing to increase in popularity worldwide as a means of soft tissue augmentation and contour enhancement, and have become one of the most commonly performed nonsurgical cosmetic procedures. Filler migration and immediate or delayed foreign body granulomatous reactions are among the possible complications.

Materials / method: Case report of orbital filler migration and delayed foreign body reaction to hyaluronic acid dermal filler with clinical, CT imaging ,ultrasound, and histologic correlation.

Results: A 63-year-old female patient presented with a four week history of slowly progressive nonpainful, two masses in the right anterior upper orbit, almost one year after dermal filler injection. Anterior orbitotomy was performed and the excised masses were diagnosed histologically as migrated dermal filler causing a foreign body reaction.

Conclusion: Patients who present with new orbital masses, past history of injections should be considered in the differential diagnosis. Moreover, effects from dermal filler injections may persist even years after the procedure.

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Objectives: To evaluate the efficacy of the new SHAPE protocols (Smart Hyaluronic Acid Protocols for Enhancing Beauty)

Introduction: We evaluate the efficacy of the new SHAPE protocols using an innovative electronic, cordless, motorized system device for the injection of any kind of Hyaluronic Acids (HA).

Materials / method: This ongoing study evaluate the results of the SHAPE protocols based on three levels of photoaging:
- SHAPE protocol 1 (2 vials of HA) for 25-40 years-old patients with mild-moderate photoaging with reduction of skin radiance and superficial wrinkles;
- SHAPE protocol 2 (3 vials of HA) for 45-60 years-old patients with advanced photoaging with middle wrinkles, dull tone and thinning of derma;
- SHAPE protocol 3 (4 vials of HA) for over 60 years-old patients with advanced photoaging with deep wrinkles associated to widespread roughness, dull tone, severe thinning of derma and laxity.

Results: We present the results of the 3 different week-end protocols created for patients that desire take care of their beauty in a short time and everywhere they are.

Conclusion: The new SHAPE protocol combined with the HA injector device represents an innovative weekend approach to the beauty in all areas of the face and the neck.

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