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Objectives: To analyse whether the treatment outcome of acne scars improves when we combine multiple modalities like laser, EBD and injectable.

Introduction: Acne scarring is a dreaded sequelae of acne. It causes emotional trauma and lowers self esteem. Acne scars can be skin coloured,red,brown and white.As per texture scars are depressed scars for e.g ice pick, boxcar, rolling or elevated scars for i.e hypertrophic or keloidal.In current trends lot of options in EBD'S are available for treating acne scars.They work best as stand alone and in many cases in combination with injectables.

Materials / method: We categorise the patients coming to us with acne scars into those with hypertrophic or depressed scars;scars associated with hyperpigmentation or skin coloured scars,and provided solutions accordingly.For raised scars we use Erbium/CO2 Fractional lasers and micro needling RF.We treated hyper pigmented scars with Qswitched 1064nm & 1064nm LP laser. For depressed scar we use micro needling RF with filler injections.

Results: Depending on the type of scars we can choose the line of treatment.EBD'S used are lasers like Ndyag 1064nm long pulse laser,Fractional 1320nm and 1440nm laser,Qsw ndyag 1064nm and Erbium Yag 2094nm laser.Non Laser modalities like Radiofrequency with microneedling delivers really good results.Other than EBD's we used Dermaroller,PRP, Subsicion & fillers.

Conclusion: EBD and injectables in combination can tackle the most difficult acne scars.

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Objectives: The tear trough should be slightly under filled to get a more pleasing aesthetic outcome. Also, excessive filling in this area causes many problems that are difficult to treat. Anatomy knowledge of the area alongwith a good understanding of the physical characteristics helps in preventing as well as dealing with the complications

Introduction: Hollowness around the eyes gives the impression of big eyes. Indians , in general have a more recessed infraorbital rim than other ethnic groups. However, the obsession with under eye grooves and the eagerness of most injectors to flatten out all grooves has given rise to an aesthetically apparent and unpleasant impression of the infraorbital region.
Also, this has resulted in excessive filler deposition, and excessive attempts to mould and massage the infraorbital region has resulted in filler migrating to areas where we never intended them to go.

Materials / method: The detailed anatomy of the tear trough region was reviewed , patients opinion was noted. Techniques were reviewed regarding whether the tear trough was either minimally filled or fully filled. Also, HA fillers which were initially available were quite hygroscopic, and a satisfactory correction was found to be bulging after 4 weeks of injection. Also, Tyndall effect was commonly seen.

Results: The overfilled ones were partially hyalased, and a better understanding of the anatomy as well as behavior of the filler helped us deal with the complications associated with overfilling viz. malar edema, migration into the orbit & lower eyelid .
The tendency to completely efface the infraorbital region does not produce an aesthetic outcome.
The infraorbital region is particularly known to retain HA filler for years altogether, and therefore can still be treated effectively years later.
Also complications resulting from excessive filling in this region is fraught with complications.

Conclusion: To obtain an aesthetic result , the tear trough should be filled very conservatively. A detailed knowledge of anatomy of the tear tough area, as well as good knowledge of the filler characteristics is necessary to minimise / treat complications.

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Objectives: The aim of study was to analyze the perforating branch pattern of the accessory nerve in the descending part of the trapezius muscle with the aim of describing the most efficient and reproducible botulinum toxin(BoNT) injection sites for aesthetic treatment of shoulder contouring.

Introduction: The descending part of the trapezius muscle is clinically associated with neck pain and aesthetic applications. The innervation of the trapezius muscle is not well described in the medical literature for clinicians.

Materials / method: Twenty-six specimens (five male and eight female) from embalmed Korean cadavers were used in this study. The trapezius muscle was dissected scrupulously and then reflected to enable examination of the locations of the perforating points. The thickness of trapezius muscle was measured in 13 volunteers using a diagnostic ultrasonography system. BoNT was injected into the trapezius muscle bilaterally. Injections were performed at 6 points separated by 2 cm. The muscle thicknesses were measured three times using ultrasonography: before the injection and at 4 and 12 weeks after the injection.

Results: The dense arborization of the perforating accessory nerve branches was confined mostly to section b (66.7%, 54/81) and section c (33.3%, 27/81). The mean muscle thickness at 4 and 12 weeks consistently decreased 0.68–0.63 cm in conventional method and 0.65–0.61 cm in new method (NDM) respectively (right and left).

Conclusion: To optimize the outcome of BoNT injection, we recommended injecting into six points separated by 2 cm in sections b and c of the upper trapezius muscle. It is significant that it is easier to apply to anyone than to apply unstructured techniques.

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请注明名称（个人，公司，学会等等）: Daewoong Phamaceutical Co.

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Objectives: Facial attractiveness and youthful appearance play important roles in human social interactions. Previous research has shown tremendous social and economic benefits to being attractive. Full face treatments with minimally invasive procedures to volumize and better contour male faces together with toxins to relax negative mimic acticity offer a wide range of options to increase facial attractiveness and achieve a more youthful appearance. However, so far, there is no data available about the effect of minimally invasive treatments on perceived male attractiveness and age.

Introduction: The aim of this study was to assess the effect of a full face treatment with Incobotulinumtoxin A and filler treatment with Calciumhydroxylapaptite and stabilized hyaluronic acid on perceived male attractiveness and age.

Materials / method: To evaluate male attractiveness and age after minimally invasive treatments, naïve, blinded male and female raters were recruited to judge randomised before and after treatment images and videos. Age was judged by writing the corresponding number, whereas attractiveness was rated on a 7-point Likert scale ranging from 1 (very unattractive) to 7 (very attractive). Moreover an eye tracking system was used to gain data about most important areas of interest within the male face. Prior to the rating study, standardised digital images were taken before, and 4 weeks after, treatment.

Results: There was a statistically significant difference (p < 0.001) in male attractiveness ratings before and after full face treatment. Post-treatment images were associated with a significant reduction (p < 0.001) in perceived age and a significant increase (p < 0.001) in perceived attractiveness compared with pre-treatment images.

Conclusion: Injections with BoNTA and application of calcium hydroxylapatite and stabilised hyaluronic acid increase perceived attractiveness in male patients and decrease social perception of age. Full face treatment with BoNTA and fillers not only convey a high therapeutic index in terms of wrinkle reduction, but also improve male facial attractiveness, which might be accompanied with consequential socioeconomic benefits. More research is needed to gain a deeper insight into socioeconomic benefits of minimally invasive treatments in male patients.

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Objectives: Mastering Peri-orbital Injections.

The Eyes are perhaps the Most Eminent aspect of a person's facial aesthetics. They are "the window to the soul" and lie at the centre of the axis of communication. An algorithm to establish the correct approach for analysing the aging changes that surround the occular orbit complex and the various step by step strategies to combat a safe and sytematic plan to treat patients.

Introduction: The dogma of treating tear troughs in isolation is challenged and a detail insight into the methods on how to get the most natural refreshing changes based on scientific structural correction of the various tissue planes and surrounding ligament. Further consideration is also taken of rheological properties of the ebst products to use for a safer profile of side effects.

Materials / method: I discuss my journey of treating high end faces where preservation of character and ability to look undetectably natural is achieved via non surgical intervention.
Perhaps challenging the notion of wether our patients may achieve satisfactory outcomes with injectibles as compared to surgery alone.

Results: Comparison is made between various techniques to rejuvenate the peri-orbital region and it is proposed that in order to achieve subtle natural outcomes and preserve the contours of the occular orbit, we must pay attention to detail to adress the various components that collectively combine to present as aging.

Conclusion: Peri-occular rejuvenation should not be trivialized and must be reserved for advance level treatments. Primarily as the region lends itself to a hazardous risk prifile as well as challenging outcomes even in the most experienced hands. We must refrain from the temptation to merely inject any product into the peri occular region without first systematically analysing the various components that lead to the ageing appearnace. Selectively addressimg these beginig with the deepest planes ensures the results are natural, long lasting and subtle on animation. Technique and experience are paramount.

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