Objectives: How to achieve symmetry in the upper face with botulinum therapy? We are well aware of the principles of synergy and antagonism of various facial muscles. When we correct the upper face, we can also observe a good example of portional synergy of the muscle within. We have to pay attention to partial work of muscles when we are correcting asymmetry.

Introduction: The upper face is the area of most commonly therapy with botulinum toxin. With seeming simplicity, working with asymmetry in this zone can lead to a number of undesirable phenomena, including pseudoptosis of the upper eyelid. This problem can occur even though when we have done everything properly. Long denervation of the orbital portion of the orbicularis oculi muscle inevitably leads to increase in the activity of its palpebral portion. Antagonism between the palpebral portion and the levator muscle of the upper eyelid favors much stronger depression and can induce pseudoptosis.

Materials / method: A review and analysis of 12 own clinical cases have been conducted. Botulinum therapy was carried out in order to correct asymmetry of upper face.The technique for treating pseudoptosis is the same as that of true ptosis. The main difference in the treatment of eyelid ptosis and pseudoptosis is in dosage of toxin. Dosage can be much higher in true eyelid ptosis and minimal – with pseudoptosis.

Results: Partial denervation of the palpebral portion of the orbicularis oculi muscle will enable increase in the activity of the levator palpebrae superioris muscle. In managing conditions of the upper eyelids, consideration of the synergy and antagonism of the muscles of upper face and their portions guarantee safe aesthetic correction of the periorbital zone. Patients with asymmetry and symptoms unilateral pseudoptosis had been injected toxin in palpebral portion of the orbicularis oculi muscle. In all clinical cases this therapy was successful.

Conclusion: Eyebrow asymmetry should be corrected in view of eyelid asymmetry. Unilateral pseudoptosis have good correction when palpebral portion of orbicularis oculi muscle is injected with a small dose of toxin.

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Objectives: How to attend to male beauty in HA-treatments and neuromodulators

Introduction: Lower face is one of the most important areas of beautification and rejuvenation. It´s most often where the first signs of aging can be seen as the jawline starts to descend, which is the most common reason to midface lifts. With the understanding of the aging anatomy and change of morphology we can use nonsurgical injectable treatments such as fillers, neuromodulators and deoxycholic acid to both rejuvenate and beautify the face by attending to the lower third.

Materials / method: Male-female patients have different preferences. Some main different characteristics need to be considered treating male patients to create balance and harmony for each and every patient. The understanding of the strength of the jawline and the chin is important. Together not only beautify the paitent but also masculinize him.

To create male facial shape some areas are of more importance. The strength of the lower third of the face is directly connected to presumed testosterone levels and a strong chin and mandible line gives signals of a strong and attractive man. The mid face is important i

Results: With the right guidelines we can avoid feminizing our male patients and achieve higher satisfaction

Conclusion: Male market for fillers and neuromodulators is growing it is of great importance to treat male patients from a male beauty perspective

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Objectives: What do our patients want for facial rejuvenation? They want the least invasive option, but with the best results, an easy follow-up, an undetectable result, a safe and effective technique with the newest products. They often prefer no risk associated to surgery.
With fillers injections, we can restore facial volumes, recreate a "V" shape and fix the wrinkles but sometimes the sagging is very important and only a facelift can reduce the excess of skin and fix the SMAS with plication. Also for some periorbital indications, the upper and lower lid surgery cannot be replaced by injectables.

Conclusion: We have to be safe in the selection of the good cases with realistic expectations.
A good combination between surgical and non surgical options is possible.

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Objectives: The webcast will address the fact that the change in shape observable over time, named “aging”, is related to progressive muscle reactions to stress and trauma (shortening of flexors), and not to a sort of intrinsic decay of the body’s constitution. In order to address the topic the notion of “enteroception” and “body awareness” will briefly be characterised. Relaxation, a synonym of anti-inflammation, is brought by activating the vagus nerve or tools able to transduce physical waves into electromagnetic modifications in the body.

Introduction: Enteroception is defined as the sense of the internal state of the body, encompassing the brain's process of integrating signals relayed from numerous external and internal sensors allowing for a representation of the physiological state of the body. Still, anxiety, depression, posttraumatic stress disorder (PTSD), obsessive compulsive disorder (OCD) and sickness disease can be responsible for misrepresentations of internal states. The most important interoceptive signals are driven by the vagus nerve and somatosensory pathways from the skin.

Materials / method: Body awareness is the sense that we have of our own bodies and develops from the largely reflexive movements of the newborn. The most important item in body awareness is the development of one’s relationship towards gravity, making balance a major feature. Therefore “an emotional response,” (Oschman), “immediately precipitates the contraction of the flexor muscles and movement away from structural balance.” This point is important because gravity “pulls the structure downward, making the body shorter”.

Results: One of the most important contributions to aging is chronic low-grade inflammation. This undeniably enhances the tensional status through activation of the ortho-sympathetic system. “Recovery from an emotional shock requires flexibility and resiliency of the musculoskeletal system, an ability to return the body toward the ideal pattern of relationship with gravity.” Vagal tonus, principal tool of the para-sympathetic system, based essentially on relaxation of the contractures, governing healing, secretions and the reversal from tension to relaxation, allowing alertness, without freezing.

Conclusion: Obviously, within an anti-aging logic, reversibility becomes an issue. Would aging thus be the aerodynamic consequence of the choice to stay vulnerable, defining a certain availability of man to be exposed to risks, conditions rich in evolutionary perspectives ?

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Objectives: Describe a systematic approach to refine surgical planning and provide more natural, long lasting, and safe results to breast surgery using silicone implants.

Introduction: Mammaplasty using silicone implants is the most common surgery performed worldwide. Considering 2017 ASPS reports, breast augmentation and breast lifts are responsible for 22,6% of the total aesthetic plastic surgeries in the US. Different sizes and implant shapes, the evolution of surgical techniques, including skin resection and breast fat grafting are important refinements to surgical planning. Individualisation of surgical planning and use breast fat grafting as a complementary treatment are valuable tools to obtain more natural surgical results.

Materials / method: Methods:
I. Breast Landmarks:
1) Main Architecture
2) Grade of Ptosis
3) Nipple-Areola Complex displacement
4) Contain and Continent Relation
II. Patient Examination and Assessment:
1) Evaluate breast volume and the symmetry
2) Evaluate superior and medial quadrants breast density
3 )Evaluate upper and lower pole proportions
4) Evaluate patient perception and expectations

III. Surgical Planning:
1) Incisions and skin resections based on grade of ptosis.
2) Inclusion plan based on patients anatomy.
3) Implant size and shape based on anatomy and patient expectations
4) Breast fat grafting

Results: The use of inclusion plans respecting the density of breast parenchyma, and the implant choice based on anthropometric and volumetric measurements provide more satisfactory results to patients. Skin resections are well accepted and well understood by the patients to achieve long lasting natural result. Use of fat grafting as a complementary treatment respect individual indications and is desired by most patients after knowing the natural touch and texture the fat can provide to the breast.

Conclusion: These surgical planning refinements provide more attractive results to patients and decrease of unfavorable results and complications. Carefull and individualized surgical planning provide natural, long lasting, and safe results.

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Objectives: Stem cell therapy has been set back in the US due to the FDA's ruling that individual stem cell extracts, when chemically processed, become a drug and therefore FDA approval is needed for re-injection. In this webinar, viewers will learn about alternatives to traditional stem cell therapies, including cadaver tissue, nanofat, amplified growth factors, and mechanically produced stem cells. A new regenerative product is introduced. Patient selection, processing of these injectables, and indications for use are discussed. Techniques of injection including enhancement of uptake are reviewed.

Introduction: PRP has maintained strong popularity in many branches of medicine, especially in the aesthetic field. Results are mixed, and cost conscious consumers are looking for alternatives that work. The process with PRP can be time consuming. These injections, especially in the scalp, can be quite painful. Increased efficacy, a decrease in processing complexity, new methods of delivery, and improved cost effectiveness are top goals in stem cell type therapies.

Materials / method: New alternative materials include allografts of stromal/vascular tissue , adipose free. The performance is enhanced when mixed with nanofat. A topical targeted peptide, combined with needling, stimulates the body's own quiescent stem cells. Other formulations can be injected or applied topically following thermal or nonthermal microneedling. A new method of extracting stem cells mechanically with no chemical processing adds a cost effective way to enhance injected fat, especially with difficult recipient areas. A new regenerative product can grow skin, fat and hair in nonhealing areas.

Results: Results of treatments are promising, though these techniques are quite new. A large series of patients is needed to prove value over time. Allograft SVF plus nanofat is a good middle ground choice for patients with filler fatigue. Targeted peptides stimulate existing banks of stem cells that already exist in the body. Topical concentrated growth factors combined with microneedling can favorably compete with PRP as the viscosity is lower. Mechanical extraction of stem cells is a new innovation, and offers an effective alternative that is proven to work well in a number of situations.

Conclusion: The rapid development of a variety of injectable or topical growth factors, targeted peptides, and mechanically processed stem cells offer the aesthetic physician new treatment options. Applications include nonsurgical hair restoration, skin rejuvenation, volume enhancement, wound healing applications, and regeneration of full thickness skin, hair, and fat in regions of open wounds or scars.

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