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Objectives: to improve the treatment outcome after an vascular adverse event of hyaluronic acid filler treatments

Introduction: Hyaluronic acid fillers are known for a reliable safety profile, but complications do occur, even serious vascular adverse events .

Materials / method: duplex ultrasound is used to detect the hyaluronic acid filler causing the intra-arterial obstruction

Results: If treated in time, one single treatment of ultrasound guided injections of hyaluronidase into the filler deposit will prevent skin necrosis.

Conclusion: As the use of duplex / ultrasound adds extra essential information, its use may become an integral part of the prevention and treatment of injection adverse events.

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请注明名称（个人，公司，学会等等）: trainer for cutaneous, duplex ultrasound courses

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Objectives: The presentation will show usefulness and feasibility of ultrasound and how to apply ultrasonography for botulinum toxin injection

Introduction: Botulinum toxin injection is number one procedure among all aesthetic procedures including surgery all over the world. However, injection guideline has not been changed for the last 15 years since botulinum toxin was firstly used in aesthetic purposes. Moreover it is mostly performed blindly. Ultrasonography can help exact targeting and identification of muscles for safe and effective botulinum toxin injection.

Materials / method: Before botulinum toxin injection, ultrasonography was used to target facial muscles to be injected in advance. After that, botulinum toxin injection was performed under ultrasound guidance.

Results: Target muscles for botulinum toxin was exactly identified from ultrasound images. Precise botulinum toxin injection to the target muscles was performed under ultrasound guidance.

Conclusion: Ultrasonography is useful for identification of facial muscles in real time and for accurate botulinum toxin injection under ultrasound guidance.

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Objectives: Doppler ultrasound detecting
1. supratrochlear artery
2. superficial temporal artery
3. facial artery
4. dorsal nasal artery
to prevent vascular complications of filler injection

Introduction: Vascular complications such as skin necrosis and blindness are the most tragic complication of soft tissue filler injection. To prevent these complications, thre are multiple guidelines and among them the most important is to have knowledge about vascular anatomy. But arteries of the face have many variation on their pathway and layers so it is almost impossible to know every variations of the arteries of face. Authors used doppler ultrasound to detect the arteries of the face and injected hyaluronic acid filler bypassing the arteries.

Materials / method: Doppler ultrasound hockey stick probe were used to detect supratrochlear artery to inject hyaluronic acid filler at glabella area. The probe were used to detec superficial temporal artery to inject filler at temple area and to insert cogged thread at the hairline. Facial artery is as detected to prevent complication when inject filler at nasolabial fold area. Dorsal nasal artery is detected the pathway and the layer to prevent vascular complication when inject filler to augment the nose.

Results: Supratrochlear artery pathway is very much related with glabellar frown wrinkle lines but about 60% are not the same location so were safe to correct wrinkles. Superficial temporal artery pathway were inside hairlines but also at the hairline and medial from hairlines. Facial artery were detected at the nasolabial fold area but some there were no artery at nasolabial fold area so were safe to inject at nasolabial fold. Among the detected faical artery at nasolabial fold were mostly located at subcutaneous layer. Dorsal nasal artery also detected at subcutaneous layer but not all the time.

Conclusion: The facial vascular anatomy is extremely important for hyaluronic acid filler injection but there are man variations of pathway and depth. So it is almost impossible to know all the variations. To use doppler ultrasound could help to detect arteries of the face and could be safer method to perform hyaluronic acid filler injection

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