Objectives: To investigate the safety and efficacy of multisource phase control focused RF energy treatment combined with ablative fractional RF for periorbital areas.

Introduction: The periorbital area is one of the first areas to show the signs of ageing such as laxity, fine lines and wrinkles. Treatment options are limited, due to the delicate nature of the skin in this area and safety concerns related to proximity to the eyeball. RF has been found to be effective in the safe delivery of energy into the skin, independent of skin color. This study utilizes a sophisticated Multisource phase-controlled RF technology which allows the creation of multiple heating fields for deep penetration together with ablative fractional RF.

Materials / method: 10 patients completed a course of 3 combined sessions using a multisource RF designed for periorbital areas and an ablative fractional RF handpieces. 4 weeks interval was set for the treatments. Each session included 30 minutes of RF energy delivery (15 minutes per side) followed by ablative fractional RF pulses around the eyes. Power range for multisource RF was 4W below lower eyelid, 3W above upper eyelid and 5W above the eyebrow. Surface temperature was indicated by an infrared thermometer and maintained at least 40°C. Ablative fractional RF parameters were 5W and pulse width of 30msec. All

Results: All the subjects recruited for study completed the treatment protocol.
Patients reported the treatment was comfortable and painless. Mild edema and erythema were observed up to 24 hours post treatment. Most patients reacted with crusts to the ablative treatments due to high intensity of parameters. No severe adverse events were reported during and after the treatments. Patients’ before and after photos, were graded according to Quantitative Comprehensive Grading Scale of Rhytids, Laxity, and Photoaging and according to it over 75% of patients had significant clinical improvement.

Conclusion: Effective non-surgical periorbital skin rejuvenation and wrinkle reduction is a big concern of many patients, who are looking for a short treatment sessions with minimal downtime. Combined protocol of multisource RF with ablative fractional RF was safe and effective treatment option for the periorbital area.

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Objectives: This case study aims to present and illustrate the results of using a new tissue debridement method based on applying selective innovative enzymatic concentrate made of proteolytic enzymes enriched with bromelain.

Introduction: Excisional surgical debridement (SD) is still the gold standard in the treatment of deep burns, even though we know it is not selective, and it can lead to certain complications. The enzymatic methods were introduced to the markets a long time ago.However still, most of them are slow, and they require multiple applications, which will increase the risk of burn management complications.On the other hand, the newly enzymatic substance made of proteolytic enzymes enriched in bromelain can be applied only for 4 hours resulting in selective debridement of necrotic tissue.

Materials / method: The administration of concentrate of proteolytic enzymes enriched in bromelain substance for four hours, which caused necrolysis of intracellular connection between the intact and necrotic tissue.

Results: In the present clinical case, we observed significant complete selective necrolysis followed by the closure of the wound injury. The patient was released home after staying in the hospital for 17 days. On day 14 all burns were healed. The scars were pink, flat, and there was no movement limitation. The healing was spontaneous without the need for autografting or any further surgical interventions.We consider this method safe and effective.

Conclusion: Following our modified treatment algorithm, we found this novel treatment product in deep burns is an effective, fast, and cost-efficient way of necrotic tissue debridement. Moreover, it decreases the further need for skin-grafts and surgical interventions. Promising results were evaluated regarding the efficiency and selectivity of debridement.

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Objectives: Efficacy and safety of the combination of 523 nm KTP picosecond with 1064 nm Nd-YAG nanosecond laser in the treatment of different causes of hyperpigmentation

Introduction: The new emerging role of Pico technology in clinical dermatology in the Middle East. Efficacy and safety of the combination of 523 nm KTP picosecond with 1064 nm Nd-YAG nanosecond safety of picosecond laser in the treatment of post-inflammatory hyperpigmentation, melasma, post-burn pigmented scars and pigmented surgical scars.

Materials / method: A clinical case series enrolled 10 patient who were selected randomly.
Two cases were treated for melasma, two cases for pigmented surgical scars, two cases for post burn scars, three case for post-inflammatory hyperpigmentation and one case for nine specific pigmentation
A photographs were taken for all patient prior to starting treatment and one month after third and last treatment session .
All subject were treated with 1064 nm nanoseconds (10mm, 1-1.5 J/cm2, 10 Hz) followed by 532 nm picoseconds ( 9mm, 0.1-0.2 J/cm2, 10Hz) every 3-4 weeks for three sessions.

Results: All enrolled cases completed the study, including three treatment sessions and follow-ups. was measured by comparing before and after pictures, which were taken before the start of the first treatment session and 1 month after the third session. The intensity and extend of the pigmentation were assessed. The clinical analysis performed by the two operating dermatologists and by a third independent dermatologist

Conclusion: The combination of 532 nm KTP picosecond with 1064 nm Nd-YAG nanosecond laser is safe and effective in treating post-inflammatory hyperpigmentation, melasma, post-burn pigmented scars and pigmented surgical scars.

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Objectives: The aim of this study was to assess after 4 weeks of daily use the efficacy and tolerability of M89 in adult subjects having undergone dermatologic procedures.
The skin exposome comprises several external and internal factors including UV radiation, climatic conditions (heat and humidity), medications, pollution, stress, and dermatologic procedures that may damage the skin barrier, induce skin diseases or accelerate skin ageing.1-5

Introduction: Mineral 89 (M89, Vichy Laboratoires), containing 89% Vichy volcanic water and hyaluronic acid in a minimalist formulation, was developed to reinforce the skin barrier and to protect against exposome factors.6-9
Recent study results from 1630 subjects with inflammatory dermatoses or having undergone dermatologic procedures confirmed the benefit and excellent tolerance of M89.

Materials / method: In an international, multicenter observational study, subjects having undergone dermatologic procedures applied for 4 weeks once or twice daily M89. Data about dermatologic procedures (including acne, scars, skin ageing, spots), subject information, skin characteristics compliance, subject perception of efficacy, tolerance, as well as investigator satisfaction were collected after 4 weeks. Subject satisfaction was assessed after 1 and 4 weeks of use.

Results: Data from 1101 subjects were analyzed. Peeling accounted for 23.3% and Laser/IPL for 22.1% of dermatologic procedures. At baseline, subjects had mainly dry (47.6%) and sensitive skin (60.5%). 50.3% presented with some degree of erythema, 54.0% with desquamation and 63.8% with irritation. A total of 56.2% had dry or very dry skin; while 64.8% considered that their skin was insufficiently hydrated. Mean scores for dryness, burning, itching and stinging/tingling sensation assessed by subjects were 5.3±2.8, 2.4±2.6, 1.5±2.2 and 2.3±2.6, respectively. Refer to the poster

Conclusion: Daily use of M89 for 4 weeks in subjects having undergone dermatologic procedures, including aggressive lasers resulted in very high user satisfaction along with objective and subjective skin improvement. M89 is an effective and well tolerated adjunct in post-procedure skin care.

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Objectives: Likewise, palpebral positions such as ectropion, which in turn would produce an alteration in the drainage of the tear, can also occur in association with aging.

Introduction: The cosmetic surgery of the eyelids is performed in adults of all ages, some patients are operated on to correct problems of aging at an early age such as 20 or 30 years in both sexes.
Blepharoplasty is the surgery that seeks to rejuvenate the eyelids by remodeling the periocular tissues. It is performed mainly for aesthetic reasons, but in some cases only for visual reasons (functional blepharoplasty) since the skin drop of the upper eyelids can cause a reduction of the visual field.
The aging process causes several changes in the periocular area.

Materials / method: The upper and lower blepharoplasty procedure was performed 20 years ago with a CO2 laser cut, either with the titanium tip or with the diamond blade and the CO2 laser.
Blepharoplasty of the upper eyelid consists of the removal of excess skin and in some cases of a part of the underlying orbicularis muscle. Some cases also require eliminating part of the internal fat package, but always conservatively. For this surgery, we make incisions with the CO2 laser in the natural folds of the eyelid, which avoid the visibility of the scars. The technique allows us to remove excess skin, fat and sometime

Results: The goal of blepharoplasty is to restore a more youthful appearance to the eyelid, maintaining the features of each person, providing a natural appearance, avoiding visible scars and protecting eye health.

Conclusion: Blepharoplasty is usually done with local anesthesia, and in many cases intravenous sedation is also used for greater patient comfort. General anesthesia is used when at the same time we perform other more invasive surgeries. The duration of the surgery is very variable, from 30 minutes to 1 hour generally. The recovery after surgery is characterized by the appearance of a little edema that improves with the application of cold during the first week. It is a usually painless process. The complete recovery can take between 3 and 6 days and the scars improve during 4 to 6 months.

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Objectives: 3873 cases have been done with this procedure since 1994, minimal complications have been observed. The facelift and skin resurfacing techniques are carried out during the same surgical procedure, in order to save time and improve the patient recovery. Perioral and orbital wrinkles, photo aging sings such as pigmentations and changes in skin color are treated with the skin Resurfacing technique. Many surgeons for neck and cheeks is performed as usually have mentioned the face-lift technique. By using these two techniques, a full-face rejuvenation is obtained with only one surgical procedure.

Introduction: We start performing the facial rejuvenation with surgical procedure, SMAS plication and skin resurfacing in one surgical stage in 1997. However, it is needed between 6 to 8 weeks to recovery from the skin Resurfacing with CO2 laser. This procedure takes more recovery time and produces more edema, redness and patient discomfort. For that reason, we started in 2000 to perform the facial rejuvenation and the skin resurfacing with Erbium: Yag and CO2 Lasers

Materials / method: Once the patient is marked in the places to be corrected, the procedure is started making the endovenus anesthesia combined with the local anesthesia (tumescent technique). Some patients ask for general anesthesia, in those cases special laser endo tracheal cannulas are used to ensure a more safety procedure. When local anesthesia has been placed in the neck, cheeks and the forehead, the cutting of pre and post-auricular zone is started with the CO2 laser in the cut mode at a level of 6 Watts. The skin undermining is done using scissors, from the zygomatic arch to the nasolabial folds

Results: As it was mentioned above, it is important to understand that the laser should be deeper in the central part of the face and lightly in the area were the surgical procedure was performed. In the cheeks were the SMAS plication and skin undermining was done. Employing the CO2 laser at 5 watts on the skin flap there is no different skin color; texture or border remains by the change of laser. With this method the redness and changes in color pigmentation disappear at the same time in both areas, taking only 2 or 3 weeks for patient with skin type 3, 4 and 5 to get the same skin color and texture

Conclusion: We have seen that performing this procedure, the patient results are much better. If face lifting is carried out at the same surgical time with the skin resurfacing patients recovery takes less time and discomfort. In 20 days patient skin color is in the same tone. The skin looks much younger, smooth and facial rejuvenation is highly satisfactory. It is possible to perform different facial techniques at the same time such as fat graft, Gore-Tex implant, chin implant, endoscopic forehead, etc.

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Objectives: The aim is to select the proper combination of modern hardware and injection techniques for periorbital zone correction in case of tired and deformation morphotypes of aging, providing the best results with the minimum side effects.

Introduction: Women with Slavic appearance are prevailing among the patients of our clinics, for whom the most common is a deformation and tired morphotype of aging with a pronounced pastosity and edema propensity. Separately, injection and hardware methods of correction of the periorbital zone do not allow such patients to achieve the desired result.

Materials / method: To study the issue, the following steps were taken:
● a comparison of already existing treatment protocols,
● case analysis of their effectiveness
● selection / construction of algorithm / sequence of using manipulations in a practical way
The study examined the effects of:
● Drainage preparations
● Preparations aimed at reducing lipid tissue and the adipocyte
● Lipomodificators
● Devices that allow non-surgical eyelid lifting
● Technique of hyaluronic acid injection into periorbital zone with the patient's edema propensity

Results: The results of the study showed that in case of deformation and tired morphotype of aging it is necessary to prepare the periorbital zone for manipulations in order to achieve quality results. First of all, it is necessary to prepare the target tissues: to make drainage, to reduce the expressed lipid deposits as much as possible, improve skin elasticity in this area, and finally inject hyaluronic acid exclusively in the periosteum area to avoid excessive edema of the area and the appearance of the Tyndall effect.

Conclusion: The following conclusions can be drawn from this study:
Firstly, according to the data of medical clinical studies, the most difficult zone for non-surgical correction in case of aging morphotypes that tend to be pasty and edematous, is the periorbital zone.
Secondly, as a result of the conducted studies, the optimal sequence of correction of the periorbital zone in patients prone to edema and pastuosity was revealed.
Thirdly, our study showed that the proposed algorithms of periorbital zone correction increase the satisfaction of patients with the result of manipulation by 90%.

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Objectives: To conduct a clinical study to evaluate the effect of subcutaneous injection of a polycaprolactone (PCL)-based dermal filler on skin quality in the mid-face through a comprehensive range of well established, quantitative, skin assessment methods.

Introduction: As skin ages many physiological changes occur: dermal thickness & density are reduced, elasticity is diminished, skin cell activity decreases and collagen & elastin levels decline. Both clinicians & patients have reported that treatment with a PCL-based filler results in a marked improvement in skin appearance, vigour & quality. A number of contributing physiological & anatomical factors can combine to produce good skin quality. A study was conducted to investigate whether the subjective improvement in skin quality, could be confirmed through a range of quantitative skin assessment methods.

Materials / method: A total of 24 subjects (35-65 years) were injected in the subcutaneous layer of the mid-face with a PCL-based filler; the study was open to all Fitzpatrick skin types. At follow-up visits (3, 6, 9, 12, 18 & 24m) a range of skin quality parameters were measured & compared with baseline values. Skin density & thickness was measured using a Dermascan high frequency echograph. Skin biomechanical parameters, including measures of skin extensibility and elasticity, were tested with a Cutometer. Skin relief (roughness) measurements were performed using the fringe projection system DermaTOP.

Results: Echographic analysis revealed a stat. sign. increase in skin density at all time points in comparison with baseline following treatment with a PCL-based filler. Subject echographs clearly displayed a substantial increase in tissue density in the dermis. Skin biomechanical parameters were also enhanced; skin firmness & tonicity were stat. sign. improved at all time points through to 18m (except tonicity at 9m). Skin elasticity was stat. sign. improved at all time points through to 9m. DermaTOP analysis demonstrated that skin roughness was stat. sign. reduced for 3 & 6m post-treatment.

Conclusion: A comprehensive range of well-established, quantitative, skin assessment methods demonstrate that subcutaneous injection of polycaprolactone-based dermal filler has a long–term rejuvenating effect on critical skin quality characteristics.

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Objectives: Acne conglobata is characterized by numerous comedones and large abscesses with interconnecting sinuses, cysts, and grouped inflammatory nodules. Permanent scarring remains after healing. Acne has effects that affect the patient's quality of life such as a depression and social isolation (Gieler et al., 2015). Adolescents are the one group of patients with high dissatisfaction rates (Isaacsson et al., 2014).

Introduction: In 02.01.2019. a 16-year-old male presented with severe acne nodosa on face without involvement of the back, which lasted for approximately six months. Local treatment with Azelaic Acid 10% was received, but no clinical improvement was seen. Local Clindamycin and Tretinoin gel was assigned once a day. Laboratory tests showed normal levels of liver enzymes and lipid levels, but elevated bilirubin levels (Unconjugated -24.1 μmol/L, conjugated 9.7). At the next appointment on 08.02.2019. a systemic isotretinoin was initiated with dosage 30mg/day and local treatment of local skincare products.

Materials / method: After a month in the next check-up acne conglobata was diagnosed with formation of cystic and ulcerous elements on both cheeks. Patient admitted having a social anxiety due to his looks. Local incision was made in right cheek and hemorrhagic content with pus was eliminated. Oral clindamycin 150mg twice a day for seven days and local Fusidic acid once a day was added, and isotretinoin dose was reduced to 20 mg/day. In 20.02.19. Gilbert syndrome was revealed.Laboratory tests performed on 23.03.2019 were in normal ranges. Isotretionin dose was elevated to 30mg/day which continued till 01.10.19

Results: No improvement was seen in clinical condition, so oral methylprednisolone 32mg once a day for a week was assigned for 8 days, after that 16mg once a day in the morning for 14 days, furthermore 8 mg/day for one week and then 4mg once a day for 7 days. Cystic and nodose lesions disappeared and erythema, papules, some pustules and small ulcerous region on right cheek remained. Till this moment (06.12.2019.) – clinical remission is achieved with no new nodous or cystic elements on skin. Patient is on local skincare therapy. He has also admitted that his social anxiety has been reduced.

Conclusion: Acne conglobata is a disease which occurs almost exclusively in males after puberty. Isotretinoin, often in conjunction with prednisone, is the preferred treatment for severe acne conglobata (Patterson, 2016). Topical retinoids are not as effective as oral retinoids. Many patients with acne conglobate especially on face experience a social anxiety. Sometimes it is a necessary to add a systemic steroids to treatment to improve the local status. Dermatologists should educate the patient on skin hygiene and be a support for patients while the clinical improvement is seen (Hafsi, et al., 2019).

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Objectives: This study want to illustrate how modulation of muscle movement with injectable fillers can address structural deficient , rebalance abnormal muscle activity , and restore facial appearance

Introduction: We are living and witnessing era of aesthetic medicine , new advanced techniques of injecting HA , the presence of new injectable results that were simply not attainable in the recent past.Mechanical myomodulation (RC face project) represents an innovative treatment scheme. This treatment is not only indicated for the reharmonization of the face but through a mechanical myomodulation it is possible to selectively intervene on some muscles of the face responsible for the excessive muscle tension and sometimes painful for the patient.

Materials / method: HA plants in different skin layers , with different device : needle or cannula

Results: My clinical experience has allowed me to highlight , in an important and incisive way , what with the new method of treating the full face, we can achieve .
In addiction to the desired and expected improvement as far as aging in my pattens has been achieved , there has also been a significant change in the contraction status of some muscles go the face and neck , resulting in changes of the position of the jaw and head with obvious and evident improvements to the general health of the patient treated

Conclusion: Today , with the new rejuvenation concept face project , we can achieve :
-a very important improvement in aging
-a impoverente of the state of mind of the patients after the treatment.
They became more confident and happier.This is a very important result for their life.

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Objectives: We investigated the effect of AA on pregnancy rate using data from the National Health Insurance Service-National Sample Cohort (NHIS-NSC).

Introduction: Alopecia areata (AA) is thought to be a cell-mediated autoimmune disease. To date, it is known that many autoimmune diseases are related to pregnancy outcomes. However, there has been no previous study of how AA affects subsequent chance of pregnancy.

Materials / method: A retrospective cohort study of 1,382 fertile female patients with AA and 6,910 1:5 index date-, age group-, sex-, and income level-matched control subjects was performed from 2002 to 2013 using the NHIS-NSC. We defined severe AA patients as those having alopecia totalis, alopecia universalis or ophiasis; others were defined as mild AA, and longstanding AA patients as those having 12 or more diagnostic codes for AA and over a year of the disease duration.

Results: The 5-year cumulative probability of first pregnancy in the AA group was significantly lower than that in the control group (log-rank p-value <0.001). The chance of first pregnancy in the mild AA group (adjusted HR 0.79; 95% CI 0.70-0.90) and longstanding AA group (adjusted HR 0.62; 95% CI 0.43-0.87) were significantly lower than that in the control group. The impact of AA on subsequent pregnancy was significant for patients diagnosed in all age groups except those in the youngest age group.

Conclusion: AA could delay the subsequent pregnancy, especially in patients with more longstanding AA. Therefore, clinicians should consider factors influencing subsequent pregnancy when managing women patients with AA, especially in patients with longer duration of disease.

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Objectives: PDT has been used for more than 15 years in the treatment of inflammatory acne. ALA was approved by the FDA in 1999 and since that date numerous studies have shown its effectiveness (1) (2). The concentration of 20% was used in the first trials. Lower concentrations of 3.6 to 5% have shown the same effectiveness with fewer side effects (3). At the same time, the high fluences used previously have been revised downwards. Today they are around 25 joules / cm2.

Introduction: The mechanism of PDT in acne is based on:
An optimal concentration of Protoporphyrins IX (PPIX) in the sebaceous glands
An increase in PPIX in C. acnes (4) (5)
An inhibition of innate immunity, by the action on Toll Like receptors (6)

Materials / method: ALAfast®, a recent formulation of ALA in a thermosensitive gel (Thermogel®) has shown its effectiveness and good tolerance. This excipient, whose viscosity increases at a temperature >25°, allows an easy application on the skin, and a release of ALA 5 times superior to a cream form. It allows a controlled and sustained release of ALA without occlusion.
The illumination is done with red light (630nm) which penetrates down to the sebaceous glands level. The PPIX concentration is thus obtained in approximately 90 minutes. The presence of PPIX can be objectified by highlighting the fluorescence.

Results: A “proof of concept” study in 39 patients shows a reduction in the GAG score (Global Acne Grade System) of 70% after 3 PDT sessions. The result is stable at 6 months (7). A poster published during Milan World Congress of Dermatology in 2019 involving 150 patients, shows similar results (8).

Conclusion: The tolerance of PDT with ALAfast® is good. We observe an erythema for 48 hours which can however be quite intense and last longer, which is the proof of a photodynamic reaction of good quality. More rarely, a pustular inflammatory reaction can be observed for a few days. These reactions are followed by a very significant improvement in acne. During the session, the pain is most often moderate.
PDT with ALAfast is an effective and well-tolerated treatment of inflammatory acne, in adolescents and adults.

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Objectives: The objective of the present study was to evaluate the efficacy of second medical intervention with hyaluronic acid (HA) fillers to restore adequate volume and natural appearance of previously treated lips with asymmetries in the upper/lower lip, lumps and bumps and disproportion regarding volume and/or projection.

Introduction: Augmentation of the lips with HA fillers has become increasingly common and its popularity has grown due to cultural trends and association of lip appearance with both youth and beauty. An appreciation of perioral anatomy as well as the structural characteristics that define the aging face is critical to achieve optimal results. Some surveys report that up to 70% of expert injectors corrects erroneous treatment of lips’ augmentation.

Materials / method: 46 pts (F, age 44-62 yrs) were treated with resilient HA filler in order to correct erroneous lip fillers’ treatment in order to create a higher degree of harmonious lip features, to rebalance Phi ratio between upper and lower lip and to restablish adequate distances between lips and E-Rickett line. All patients were evaluated with photographic assessment, tridimensional camera (Vectra) and GAIS before procedure (T0), immediately after (T1) and at 4 months (T2). Vectra allowed to measure distances in mm between upper and lower lip and E-Rickett’s line and upper and lower lip’s height in mm.

Results: Patients were divided according to the issue to correct: asymmetries (18/46), lumps and bumps (6/46) and disproportion (22/46). In all the patients resilient HA filler (25 mg/ml) was injected with a 30 G needle with different G’ and several techniques. Full correction according to ideal proportions was obtained in 59% of patients. GAIS was +1 (improved) in 12/46 and in 14/46 pts, +2 (much improved) in 13/46 and in 18/46 pts and +3 (very much improved) in 21/46 and in 14/46 pts at T1 and T2 respectively.

Conclusion: Erroneous outcomes of cosmetic dermal lip fillers are becoming increasingly more common. Corrections performed with resilient HA filler with proper technique can obtain significant improvement of the outcome and to a good level of patients’ satisfaction. Expert knowledge of anatomy, aesthetic rules and techniques of correction is essential.

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Objectives: This clinical study was conducted to provide insights into whether lay people could perceive natural outcomes and positive first impressions following treatment of moderate to severe facial wrinkles and folds in the lower face using two HA fillers, HA-RR and HA-RD, The primary endpoint was raters’ level of agreement with the statement “Face looks natural” using a 10-point Likert-type scale (1-Disagree; 10-Agree). Secondary endpoints included level of agreement with this statement by geographic area and first impressions using an 8-item questionnaire and Likert scale.

Introduction: Assessments of improvement in aesthetic outcomes are generally rated by treating physicians or investigators in a study, or by the subjects themselves. It is not known if the aesthetic outcome is perceived similarly by the general public, or lay people. First impressions after aesthetic treatments by lay people are equally important as they influence the everyday life and attitudes, judgements, and behaviours.

Materials / method: This was a blinded, lay-rater, image evaluation study. In a prior study, 30 subjects were treated bilaterally in their nasolabial folds and marionette lines and Baseline (pre-treatment) and Day 42 (post-treatment) 2D videos of an open smile expression were collected. In this study lay raters across 5 geographic regions were randomly presented 2-minute video clips and completed nine assessments for each video, capturing their perception of naturalness and first impressions. Raters were limited to assessing 10 videos (five baseline and five Day 42).

Results: A total of 3004 lay raters participated and the majority were between the ages of 26 and 40 (53.3%), female (62.9%), and White (79.4%). Naturalness of facial appearance was non-inferior at Day 42 compared to baseline. The proportion of subjects that had improved attractiveness also had a natural outcome. Additionally, lay rater assessments of first impression demonstrated statistically significant changes from baseline (p<0.05) in 5 of 9 categories including overall first impression score, social skills, dating success, attractiveness, and athletic success.

Conclusion: Treatment with HA-RR and HA-RD resulted in a natural-looking outcome and improved overall first impression as assessed by lay raters. This suggests that aesthetic treatment outcomes are assessed favorably by lay people and are perceived by the everyday public similarly as by treated subjects and treating physicians.

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Objectives: To evaluate the results of the automatic artificial hair implant system.

Introduction: The problem of alopecia affects both sexes at all ages, with sometimes significant psychological sequelae. Along with androgenetic alopecia, there are forms of alopecia which have various origin as traumatic, surgical, pharmacological and others. In 1993 the first biocompatible fiber was developed in Italy.

Materials / method: Artificial hair are similar to natural hair and they are available in 13 different colors, that can be washed and dried with moderate heat as normal hair, but they cannot be bleached. The fibers can go from a length between 15cm and 45 cm. Besides straight fibers, there are also tight curl, soft curl and waves. A high density variant, that allows to use 3 hairs with the same graft, is also available. The new device allows to implant up to 800 hair/hour reducing scalp trauma. The procedure is performed under local anesthesia and enables an immediate aesthetic result without pain or any scar.

Results: With this modern technique of hair restoration we have successfully treated diffuse hair loss or hair thinning, both considered for men and for women. Conditions for success are a suitable patient with healthy scalp, a well trained and qualified physician, having respect of implant protocols, after care applications, a correct  identification and a treatment of possible skin reactions.

Conclusion: Nowadays automatic artificial hair implant is a well proved surgical technique that can be also used singularly or in combination with FUE to provide the best final results.

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Objectives: To evaluate the results of micro-focused ultrasound for the acne scars.

Introduction: In our practice we offer different treatments for acne scars, considering the type. Micro-focused ultrasound are considered nowadays as one of the energies with more aesthetic possibilities, but on the other side the treatment on acne scars is one of the benefits which is less investigated.

Materials / method: We report our experience on 85 patients with moderate-to-severe acne scars on the cheeks. The patients have been treated with a single micro-focused ultrasound session using the 1.5 mm transducer. The scars treated have to be distensible with tension applied to skin, mainly rolling or boxcar type, they have to show few to no icepick scars and no hypertrophic or keloid scars. Follow-up visits will occur after 90 and 180 days. After the treatment, patients can return promptly to their normal life.

Results: Results are determined by a photographic assessment after 180 days, compared to baseline with a Clinician Global Aesthetic Improvement Scale and Subject Global Aesthetic Improvement Scale evaluation.

Conclusion: Although micro-focused ultrasound are not yet considered to be the best treatment for acne scars compared to lasers, micro-needling, fillers, chemical peels, subcision etc. the micro-focused ultrasound certainly don’t have the contraindications of these and they are able to minimize any complications.

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Objectives: Aim of this study is to evaluate the efficacy of this innovative electronic, cordless, motorized system device for the injection of any kind of Hyaluronic Acids (HA).

Introduction: This innovative hyaluronic acid injector device, represents an innovative technique which has been growing in popularity within the global market largely based on the fact that is a relatively simple and safe procedure that helps to produces immediately visible results whilst also being reproducible and repeatable

Materials / method: This ongoing study started at the end of April 2015. Inclusive criteria is that patients received at least one treatment with HA based filler in the last 12 months. No patient received any anesthetic injection or anesthetic cream. After treatment was asked to each patient to answer 4 questions regarding the treatment.

Results: Overall the results collected to date corroborate the findings recorded in the European Study (Kantar Health, 2014) for patient satisfaction (90.6%) and pain reduction (70.9%), demonstrating the efficacy of this HA injection device in reducing the treatment discomfort.

Conclusion: This specific HA injector device represents an innovative system for the injection of several types of HA (with different cross-linking) in all areas of the face where is able to offer more precision and control respect the classical injection.

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Objectives: To evaluate the results of this innovative intradermal injective device, inspired from vaccine techniques, a truly revolution in aesthetic medicine.

Introduction: The signs of aging that appear particularly in some areas such as the lower and upper eyelids, around the mouth and the neck, are often the most felt by patients. The skin in these areas is very thin and needs more specific and less aggressive treatments.

Materials / method: The new intradermal injection device has 3 pyramid-shaped microneedles of 0.6 mm pure microcrystallized silicone, with a caliber of about 36G and guarantees the correct injection into the superficial dermis and is applicable to any syringe. The only precautions to be taken are: always have in front the blue line that is drawn on the micro-needle, maintain an angle of 45° during the injection and make a small but simple movement with the hand. Histological studies shows that at a distance of 24h the product remains localized in the superficial dermis without dispersion in the depth.

Results: Before being placed on the market, I was involved among the 19 European doctors who carried out the clinical trial with this device and the answers were certainly beyond expectations with 72% of doctors reporting a painless treatment by the patient, 87% who prefer to continue to use the new micro-needle, and 94% who report that their patients have chosen to repeat the treatment with the intradermal device. The device certainly represents a unique and innovative solution especially in the treatment of the most delicate areas such as the lower eyelids but mainly the upper eyelids.

Conclusion: The treatment of the eyelids, especially the upper, is always a challenge, but thanks to the intradermal injection device the procedure becomes simple, effective and non-aggressive, reducing to the minimum possible the pain, bruise or hematoma that is common in these areas when the normal needle is used. Patients also feel safer from a more comfortable and effective approach with an immediate return to the social and working life.

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Objectives: The primary objective of the study was to evaluate effectiveness of HARL versus no-treatment control in shaping the nasal dorsum and root, by blinded evaluation of change in volume of the nasal dorsum and root at Month 6 after injection. Secondary objectives were to evaluate effectiveness and safety of HARL in shaping the nasal dorsum and root up to Month 12 after injection.

Introduction: Injectable dermal fillers, such as hyaluronic acid gel fillers, are commonly used for minimally invasive non-surgical rhinoplasty to shape the contour of the nose, especially in Asia.

Materials / method: Assignment to HARL or no-treatment control was randomized (3:1) in this multi-centre, 12-month study (NCT02216851). Subjects in the HARL group were injected with ≤1 mL HARL on Day 1; subjects in the control group were offered ≤1 mL HARL at Month 6. Outcome assessments included blinded evaluation of 3D photography measurements of change in volume (primary endpoint; Month 6) and elevation of the nasal dorsum and root, adverse events and subject diary entries of local tolerability symptoms.

Results: 132 subjects participated in the study. The primary objective was met; increase in volume of the nasal dorsum and root at Month 6 was greater with HARL than in the no-treatment control group. Elevation of the nasal dorsum and root was also greater with HARL than in the control group. The increases in volume and elevation were sustained at Month 12 after injection. Treatment-related adverse events and local tolerability symptoms were non-serious, transient and of mild-to-moderate intensity. Implant-site pain was most commonly reported. No cases of necrosis were reported.

Conclusion: Injection of HARL was well tolerated and effective for increasing the volume and elevation of the nasal dorsum and root, with results lasting for up to 12 months after injection.

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Objectives: To investigate the physicochemical properties of an injectable device containing poly-L-lactic acid (PLLA), using alternative methods for reconstitution.

Introduction: Changes in PLLA reconstitution have been proposed to avoid unnecessary standing time. According to current instructions for use, for a PLLA-containing injectable implant used for correction of nasolabial fold contour deficiencies and other facial wrinkles, the product should be reconstituted by adding sterile water for injection and left for at least 2 hours before shaking to form a uniform suspension. Physicochemical analyses were made to investigate if stability and homogeneity of the reconstituted product was affected by alternative methods to reconstitute the product.

Materials / method: The PLLA product was reconstituted to a total volume of 9 mL, including 1 mL 2% lidocaine, followed by vigorous shaking for one minute by hand, or for five minutes using vortex mixer equipment. Measurements included viscosity of eluent after filtration, concentration of excipients, pH, particle size distribution, and lidocaine stability for standing times 0h (immediate use), 2h, 24h, and 72h after reconstitution. Visualization of PLLA particles was performed using microscopy, and vials were inspected in connection with sample preparation to inspect formation of bubbles or foam.

Results: Standing time and vigorous shaking had no impact on the studied parameters; the physicochemical properties of the PLLA suspension were similar if shaken immediately or if left standing after reconstitution. Vigorous shaking up to 5 minutes did not affect PLLA particle shape or size distribution, and no difference was observed regarding foam in the upper layer of the samples. Lidocaine content was equivalent between measurements and no degradation products above the quantitation limit were observed.

Conclusion: The proposed reconstitution procedure of PLLA, using vigorous shaking followed by immediate use resulted in a homogenous suspension, as shown from physicochemical analyses. Shaking vigorously for 1 minute dissolved the excipients properly without standing time and with no impact on the PLLA particles. Implications in a clinical setting could be a more flexible reconstitution process and the possibility to use lidocaine for a better patient experience. Clinical studies are ongoing to corroborate these results.

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Objectives: Report the erythroderma psoriasis as a possible side effect of the association of antivirals :sofosbuvir and daclatsvir

Introduction: Psoriasis is an inflammatory dermatosis that affects about 2% of the world's population. The exacerbation of skin lesions can be triggered by a variety of exogenous factors, including drugs. The most frequently reported are beta-blockers, antimalarials, lithium, , nonsteroidal anti-inflammatory drugs, and interferon IFN-α . We describe here one of the rare cases of erythroderma psoriasis in a patient with hepatitis C treated with the combination of Daclatsvir (DCV) and Sofosbuvir (SOF).

Materials / method: 66 year old patient with a 2 years history of psoriasis, and a viral hepatitis C , a treatment based on Sofosbuvir 400mg/ day and Dacltasvir 60mg/day was initiated. 20 days after treatment, the patient presented a dry erythroderma requiring hospitalization. His general condition was altered ,a scarlatiniform erythema, topped with dry scales, PASI at 59, We decided to continue the antiviral treatment with a close monitoring we notified the exacerbation of psoriasis as a side effect to the pharmacovigilance center ,the acitretin 35mg/day was initiated, with the improvement of the PASi (1,8)

Results: The combination of daclatasvir and sofosbuvir is better tolerated, with a better rate of virological response thus reducing the duration of treatment, however, these drugs may have several side effects, such as anemia, severe skin lesions (3- 8%)
According to our literature research only two cases of antiviral-exacerbation of psoriasis have been described: 1st case was due to association ledipasvir / sofosbuvir. 2nd case : psoriasis erythroderma associated with erythema multiforme secondary to Daclatsvir / Sofosbuvir.

Conclusion: It is obvious that these two drugs (SOF and DCV) have revolutionized the treatment of viral hepatitis C. However, other cohort studies and histopathological investigations are needed to define their dermatological side effects. It should therefore remain vigilant when prescribing these antivirals especially if the patient has a pre-existing dermatosis

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Objectives: Our goal was to highlight the clinical histological , the evolution and therapeutic features of primary cutaneous B cell lymphoma in Morocco in order to establish a national registry
Compare our results to the main series of the literature;
Evaluate our diagnostic and therapeutic management to improve them.

Introduction: Primary cutaneous B-cell lymphomas (PCBCL) represent 20-25% of cutaneous lymphomas. They are entities with clinical, histological and evolutionary presentations, different from systemic lymphomas, which justified the creation of the WHO classification in 2008, revised by the EORTC in 2017 and the WHO-EORTC in 2018.

Materials / method: The study was conducted at the Departement of Dermatology, from January 2010 to December 2016. This was a retrospective study approved by the institutional commitee. 8 patients with clinical lesions confirmed at the histopathology examination were included. Exclusion criteria were: systemic lymphoma with cutaneous involvment.
Patients were followed from the date of diagnosis to the date of the last consultation

Results: we identified 4 patients with CBCL leg type, 2 CBCL marginal zone , 1 centrofollicular, and 1 PCBCL intravascular type, the mean age was 55 years, sex ratio H / F: 6/2, papular and nodular lesions were the most frequent lesions 37 % of the patiens, the back was the most common location (50%). Osteomedullar biopsy was normal (75% cases), medullary infiltration in 2 cases of CBCL leg type. 40% of cases benefited from the R-CHOP protocol. cutaneous recurrences were noted (1ZM), 1 patient with CBCL leg type died 2 months after diagnosis, the rest of the patient were lost to follow up.

Conclusion: PCBCL have a more indolent clinical course and a more favorable prognosis than their nodal counterparts.
Overall survival rate in 5 years for PCMZL and PCFCL is higher than 90%. In contrast, for PCLBCL, particularly leg type, the survival rate in 5 years lower than 60%.

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Objectives: The objective of these clinical studies was to evaluate, by clinical assessments and subjective evaluations, the effectiveness on wrinkles and radiance of a topical treatment containing peptides and vitamin C. Learning outcomes include understanding the importance of the composition of topical formulations to achieve effective results since peptides and vitamin C are well-known anti-aging ingredients but the formulation is critical for delivery across the stratum corneum.

Introduction: An anti-aging formula has been developed containing peptides, a high concentration of vitamin C (10%), hyaluronic acid, and Vichy mineralizing water recognized to be a volcanic mineralizing water (Peptide-C). It is formulated in daily-dose amber glass ampoules at optimal pH for maximum bioavailability of vitamin C and with a minimalist formula that requires no preservatives due to the low pH.

Materials / method: Dansyl chloride patches were placed on both forearms of 32 subjects for 24 h. Peptide-C was applied twice-daily on one designated forearm for 3 weeks while the remaining fluorescence was measured daily on both forearms.
In a second study, investigator clinical scoring of wrinkle severity based on Dynamical Atlas visual assessment (n=40) and subject questionnaires (n=47) were completed after 28 days of Peptide-C application.
In a third study, the number of wrinkles were measured by instrumental scoring (quantification software and 3D fringe projection analysis; n=40) after 30 days Peptide-C.

Results: Mean fluorescence at day 22 was lower for Peptide-C treated skin than untreated skin (59.6 vs 64.9; p<.0001) and mean cell turnover was faster (17.1 vs 19.2 days; p<.0001).
Crow’s feet wrinkles, forehead wrinkles and nasolabial folds decreased by 9%, 11%, and 5%, respectively, after 28 days of Peptide-C compared to baseline (all p<.05). After 28 days, 79% of subjects indicated their skin complexion was more radiant and 64% indicated the fine lines were less visible.
The number of wrinkles decreased 11.5% after 30 days application of Peptide-C compared to baseline (p<.05).

Conclusion: In three clinical studies, this formula of Peptide-C topical serum (containing peptides and vitamin C) in innovative packaging was consistently shown to be effective in improving facial wrinkles and radiance.

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这项工作的完成感谢以下机构的支持： These studies were funded by L'Oreal but I personally received no support and have no conflict of interests to declare.

Objectives: The objectives were to evaluate the effectiveness, by clinical assessments and subjective evaluations, of a topical treatment containing a glycolic acid complex and vitamin C derivative on visible signs of photoaging in Caucasian and Asian facial skin. Learning outcomes include understanding the importance of the composition of topical formulations containing glycolic acid.

Introduction: Middle-aged individuals, especially those living in urban areas, often have dull complexions with solar lentigines caused by the exposome, especially chronic UV exposure and potentially pollution. Ampoules (Glyco-C) have been developed with a minimalist highly effective formula including: a glycolic acid complex of 4% glycolic acid, 1% citric acid, and 5% HEPES, for the peeling effect; natural vitamin CG for the correction and prevention of dark spots; hyaluronic acid; and Vichy mineralizing water, recognized to be a volcanic mineralizing water.

Materials / method: In two open studies conducted in spring, Glyco-C was applied once daily (evening) for 8 weeks. One study in Causcasian subjects included investigator-assessed lower face pigmentation (n=41) and subject questionnaires (n=51). In a second study, Asian subjects with at least 1 well defined designated spot ≥ 3mm were assessed by investigator and subject (n=40).
In a 12-week study in 60 subjects (30 Caucasian, 10 African American, 10 Asian, 10 Hispanic) conducted from January to May, overall appearance and intensity of dark spots and skin tone were assessed by investigator.

Results: In Caucasian women, dark spots were 36.8% less dense at week 8 vs. baseline (P<.05). At end of study, 90%, 73%, and 69% of subjects noticed a reduction in the color, size and number of dark spots, respectively, and 94% agreed that their skin tone looked more even.
In Asian women, the designated spot decreased in size by 11% by week 8 (P<.001), and subject self-assessment of number of spots decreased 33% (P<.001).
In the third study, appearance and intensity of dark spots decreased 38.36% (P<0.0001) and skin tone decreased 35.65% (P<0.0001) after 12 weeks’ treatment.

Conclusion: In three studies, Glyco-C topical serum (containing glycolic acid complex and natural vitamin CG in amber glass ampoules) was shown to be effective in improving dark spots and uneven skin tone of facial skin in both Caucasian and Asian women.

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这项工作的完成感谢以下机构的支持： These studies were funded by L'Oreal but I personally received no support and have no conflicts of interest to declare.

Objectives: 1. Macroscopic assay of the Hyaluronic acid (HA)-based filler mechanical resistance: beyond G’
2. The linear viscoelastic region (LVER) as a key indicator of the gel behavior in dynamic areas
3. A higher adaptability for a natural-looking outcomes

Introduction: The rheological study of HA-based fillers is a substantial characterization to predict their mechanical behaviors once implanted. Traditionally, the elastic modulus G’ has often been regarded as the gold standard used to sort fillers by clinical indications. G’ (and other related parameters alike) is a key structural parameter of the gel, but it is measured at very low stresses or deformations which are not representative of most facial movements in vivo. Here, we show that further rheological parameters need to be considered especially to characterize a gel implanted in dynamic facial areas.

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Objectives: Fat transfer is currently an important treatment method for volume replacement in different areas of the face. Understanding fat processing and facial anatomy through deep and superficial fat compartments allows more accurate treatment of lost volumes. The benefits of replacing volume in aging areas with biologically active and autologous tissue ensures natural results and additionally improves the quality of surrounding tissues.

Introduction: Fat transfer techniques have evolved and their applications have been expanded in the treatment of the face. The indications cover facial symmetrization in reconstructive cases and wide applications for aesthetic purposes that are beyond replacement of lost volumes related to the aging process.

Materials / method: This study presents a series of cases of surgeries performed in a private clinic, demonstrating the versatility of applying fat transfer in facial treatment. The fat was collected from the abdominal region by liposuction using 3.0 mm cannulas with 60 ml syringes and was decanted. Then the fat was transferred to 20 ml syringes and subjected to mechanical fragmentation using 1.4 and 1.2 mm diameter transfer devices. The fat was transferred to the face with 1.4 and 1.2 mm microcannulas. The volume transferred were defined by the facial volume deficit in the deep and superficial fat compartments.

Results: Case report demonstrating treatment of facial hemi-atrophy caused by facial paralysis and treatment with fat transfer for facial symmetrization. Clinical cases demonstrating facial rejuvenation surgeries performed exclusively with fat transfer structuring and volumizing the face. Clinical cases demonstrating facial rejuvenation surgeries associating fat transfer with eyelid, facelift and neck surgeries. The benefits of replacing volume in aging areas with biologically active and autologous tissue ensures natural results and additionally improves the quality of surrounding tissues.

Conclusion: Current fat processing and transfer techniques allow fat transfer, either alone or in conjunction with other surgical procedures, to restructure the face, provide volume and improve the quality of the facial issues, including skin properties.

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Objectives: Demonstrate the efficacy of micrografts obtained by Rigenera Technology® in skin rejuvenation.

Materials / method: Autologous micrografts were
obtained by 3 skin punch biopsy that were mechanically disaggregate using
Rigeneracons medical device. Celi suspension was injected by 30G needle on face and neck area, 7-2 mm apart. 0.7 mi material is injected in each points and finalized with a soft massage.

Results: Patients were evaluated and followed by VAS questionary and photography. Use of dermis autologous micrografts in the treatment of Skin rejuvenation in a total of9 patients which has been reported a skin improvements after 6 months from micrografts application.

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Objectives: The aim of this paper is to introduce the concept of injectable filler treatment to modulate facial muscle action and to present a case that illustrates the use of this approach. Check in the national and international scientific literature articles that address the results of myomodulation and also report case of patient treated with hyaluronic acid filling with excellent results.

Introduction: Myomodulation is a relatively new procedure that is performed under the skin and affects the activity of adjacent muscles. That is, it is the ability to control muscle contraction through fillers. The underlying mechanism of myomodulation is not fully understood but can be used to good effect with facial harmonization. It is suitable for men and women who already have wrinkles and fine lines, as well as mild to moderate sagging. And areas like drooping eyebrows can benefit.

Materials / method: 54 year old S.P. patient with main complaint directed to the difficulty of closing the mouth at rest. She arrived at my office and a protocol was made to minimize his complaint. The methodology used was a systematic review of the literature published by PUBMED from 2014 to 2019. A case report was also presented by way of illustration. The literature selection criteria were full texts that provided data related to the theme to meet the proposed objectives. It can be seen that when structural support is missing or lost, muscle action is altered, affecting the balance of activity between muscles.

Results: The case presented provided support for the use of myomodulation, addressing muscle movement with injectable loads in the treatment of facial structural deficiencies.

Conclusion: Injectable treatment can be used to support muscle movement or block overcoming, regardless of whether the imbalance is caused by a structural deficiency or a loss of volume in aging.

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Objectives: Several methods for delineating the FTB trajectory exist, the most widely known being Pitanguy’s Line, which is defined as running from 0.5 cm below the tragus to 1.5 cm above the lateral eyebrow. However, variations in eyebrow location, often affected by modern-day cosmetic trends, complicate the accuracy of this approach. The aim of this study was to develop a surgical landmark to identify FTB location without relying on soft tissue structures.

Introduction: The seventh cranial nerve (CN VII), also known as the facial nerve, is an anatomically intricate structure the branches of which serve several physiologic functions. CN VII innervates the muscles of facial expression which are crucial for eye protection, oral competence, and social inter- action. The temporal branch, clinically referred to as the frontotemporal branch (FTB), is the most superior of the 5 branches and is at risk during cutaneous surgery of the parotid gland and in the temporal region.

Materials / method: To minimize variation, we chose landmarks that were both consistent and easy to locate based on simple surface anatomy. Twenty-one cadaver hemifaces were dissected in order to locate the FTB in relation to the inferior border of the zygomatic arch and the apex of the tragus.

Results: We found that the mean ± SEM distance from the apex of the tragus to the point where the FTB crossed the inferior border of the zygomatic arch was 3.21 ± 0.05 cm.

Conclusion: Through the use of this measurement, we aim to avoid the pitfalls of previous techniques by providing a widely applicable clinical tool based on landmarks easily found on any patient.

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Objectives: In this 6 months analysis of “Mother and daughter” study (M&D), we aimed to present patient satisfaction, after MFU, Calcium Hydroxyapatite (CaHA) and Hyaluronic Acid (HA) CPM fillers, -injection of incobotulinumtoxinA (incoBoNT-A) for the face and neck rejuvenation.

Introduction: The efficacy of combination MFU, CaHA and HA CPM fillers, incoBoNT-A for Full Face and neck treating is not well established in clinical studies. However, real-practice data regarding patient beliefs and attitudes following combination of MFU and HA CPM fillers injection treatment well known.

Materials / method: The “M&D” Study was prospective, observational, multicentre, open-label, non-controlled study in patients with face ageing. The Mothers group patients (gr.‘’M”) received MFU full face correction, CaHA 3 ml(in 8 ml dilution), 100U incoBoNT-A, CPM HA filler 2-4 ml injections. The decision treatment face ageing for the Daughters group patients (gr.”D”) with incoBoNT-A and CPM HA filler in the study depends on patients motivation and wrinkles. Patient satisfaction (aesthetic outcome, self-perceived age, complements, natural looks, self-esteem) were assessed at W03, M02, M04, M06 using a satis

Results: 46 patients (23 pare M&D) were enrolled: Daughters (18-30 yo, mean age 29.4±7.54), BMI 22.2±3.15, Mothers (40-65 yo, mean age 53.2±7.01), 25.1±4.52. At M06 1 patient not reported satisfaction with treatment. In gr.”D” the assessment of the effectiveness of the injection procedures (incoBoNT-A, HA CPM fillers) aimed at rejuvenating the face turned out to be slightly higher than in gr.”M”, with positive dynamics W03 - М03 in both groups. In gr. ”D”: GAISD from 2.3±0.72 to 2.6 ±0.59 and GAISP 2.1±0.79 to 2.3±0.58), gr.”M” (GAISD from 2.2±0.7 to 2.5 ±0.51 и GAIS P from 2.3±0.47 to 2.5±0.51). At

Conclusion: MFU in combination with simultaneous subcutaneous injections of CaHA (8 ml dilution) in face and neck demonstrated safety and efficacy of combined face and neck rejuvenation therapy in women aged 40–65 years. Efficacy of injections was higher in gr.”D” with its maximum on M03, self-esteem remained high up to M06 for both group.
This result of “M&D” study shows high levels of patient satisfaction after combine therapy with MFU, incoBoNT-A , CaHA and CHV HA-filler injections for Face and neck treatment.

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这项工作的完成感谢以下机构的支持： Merz-sponsored study

Objectives: The problems in the non-surgical cosmetic sector in the United Kingdom have historically been a lack of regulation, independent information to the public, misrepresentation of the benefits of treatment, substandard training and lack of accountability when things go wrong. These issues needed to be addressed.

Introduction: In the United Kingdom there has historically been a lack of regulation in the non-surgical cosmetic sector. In April 2013 Prof Sir Bruce Keogh addressed the need for recommendations in a review into cosmetic practice published by the Department of Health in the wake of the PIP Implant scandal. In response to this, two bodies were founded, the CPSA and the JCCP.

Materials / method: The CPSA (Cosmetic Practice Standards Authority), through open consultation with stakeholders and professional bodies created a set of standards across the main disciplines: Laser and Light-Based Energy Devices; Hair; Toxin and Fillers; Skin Rejuvenation. Our sister organisation JCCP (Joint Council of Cosmetic Practice) manages a register of practitioners who meet the requirements set out in the CPSA standards, and approve education and training providers with a view for patient safety. Patients are able to check the credentials of practitioners on the website, providing reassurance.

Results: The register went live in April 2018 and includes those who are registered with a Professional Regulated Statutory Body (Doctors, dentists, nurses, Pharmacists) and those who are not (Beauticians and Aestheticians) who require clinical oversight for certain procedures.

Conclusion: The JCCP Practitioner Register is not currently mandatory but the aim is to promote its use as a central register, a benchmark for safe and high-quality care, demonstrated by outcomes through data submission.

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Objectives: To determine distribution of hyaluronic acid (HA) filler CPM®-HA26 using a novel histological staining procedure and software-assisted analysis.

Introduction: The viscoelastic properties of HA dermal fillers have direct influence on their distribution in the skin. To characterize the behavior of HA filler CPM®-HA26 in skin after injection, a modified histological staining procedure was combined with software-assisted analysis. This novel technique can be used in the development of HA fillers and improve understanding of properties of currently available HA fillers.

Materials / method: CPM®-HA26 was injected intradermally with a 30 G x 1/2" needle into human ex-vivo skin models. After injection the skin models were cryo-sectioned directly or after 7 days in culture with a cryotome. Skin sections were stained using a modified histological staining procedure. Software-assisted analysis was used to determine HA distribution, lateral spread, vertical spread, area, volume, form and intensity.

Results: The modified histological staining method can distinguish between HA filler and tissue. It was possible to generate a 3D projection of the injected filler for each skin specimen. Besides the 3D visualization, the method facilitated full characterization of the stained area, volume, vertical spread and lateral spread of the HA in the skin. The values of vertical and lateral spread did not change over time, indicating three-dimensional stability of CPM®-HA26.

Conclusion: The combination of modified histological staining procedure and software-assisted analysis gave a complete visualization of the filler distribution parameters and its 3D interaction with human skin. This method is a potentially important tool in the analysis of HA filler distribution. The work shows that CPM®-HA26 was homogenously distributed after injection and that the filler has preserved three-dimensional stability in the human skin model.

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请注明名称（个人，公司，学会等等）: Merz Pharmaceuticals GmBH, employment

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Objectives: To investigate the potential of CaHA microspheres to remodel collagen fibers, producing a new, organized network typical of a younger skin phenotype. This mechanism may contribute to skin attractiveness, rejuvenation and overall skin quality improvement.

Introduction: Calcium hydroxylapatite (CaHA; Merz North America) microspheres suspended in a gel carrier of sodium carboxymethylcellulose (CMC) have demonstrated restoration of volume and biostimulation leading to skin quality improvement. This skin quality improvement is mostly driven by neocollagenesis of collagen type III and collagen type I. Disrupting unorganized collagens and creating a new organized collagen network may also contribute to improvement of skin attractiveness and possibly rejuvenation of the skin.

Materials / method: Cell culture: Primary normal human dermal fibroblasts (NHDF) were cultured in growth medium (including serum). For all experiments NHDF were incubated with a defined amount of CaHA microspheres for 7 days after collagen I network was already formed.

Read-out: Collagen I expression, collagen I fibers and collagen I network formation were analysed after immunofluorescent staining of collagen I.

Device: INCell 2200 analyzer (GE Healthcare) was used to quantify collagen I signal in the whole 96-well plate. Fiji was used to analyse and calculate fluorescent signal values extracted from images.

Results: Collagen I expression is increased after incubation with CaHA microspheres. Fiber formation and collagen I expression is increased in proximity to CaHA microspheres. These collagen I fibers are thicker and more compact, representative of a more youthful skin phenotype. Clearly defined collagen I strands arise from single fibers exclusively around CaHA microspheres, indicating a higher organized collagen I pattern and strengthening the collagen I network.

Conclusion: CaHA microspheres can reorganize collagen I fibers resulting in a firm and denser collagen network similar to that of younger skin. Therefore, CaHA microspheres may be able to rejuvenate aging skin comprising of unorganized thin collagen I fibers into skin with a highly organized and firm collagen I network and more youthful characteristics. This may in turn lead to increased skin attractiveness by tightening, increasing skin surface regularity and more uniform skin pigmentation.

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Objectives: 1.To demonstrate narrow hole extrusion technique for removal of a large sebaceous cyst
2.To demonstrate that this technique can give a cosmetically elegant scar superior to the conventional surgical method used for removing such cysts.

Introduction: Large sebaceous cysts or lipomas are a common occurance in a dermatologist’s and plastic surgeon’s clinic which need surgical excision demanding a cosmetically elegant scar. Narrow hole extrusion technique i.e. NHET is a procedure of removing these large cysts through a narrow hole placed along the resting skin tension lines. This presentation demonstrates how this technique can minimise the size of the scar and also improve the cosmetic appeal of the scar.

Materials / method: The margins of a large sebaceous cyst were marked with a marker. The punctum was located. Resting skin tension lines were visualized by pinching the skin. Then a small 4 mm Incision was made using a 26G needle. The contents of the cyst were drained through the hole. The sac was dissected with the undermining forceps and was removed through the hole. Haemostasis was achieved. Incision was closed by approximating the edges and applying wound closure tapes. Dressing was changed after 24hrs on 3rd day and was removed on 8th day.

Results: As the incision was small and was aligned with the resting skin tension lines, there was a small cosmetically elegant scar after 2 weeks. This scar remodelled and became even more inconspicuous after 3 months.

Conclusion: NHET-narrow hole extrusion technique is an excellent surgical method for removal of large sebaceous cysts and lipomas through a very narrow incision giving a superior quality cosmetically well accepted scar.

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Objectives: The primary goal of the study was to evaluate the effectiveness of mixture of amino acids and sodium hyaluronate in combined therapy measured by improving facial skin quality using the 5-grade WSRS, improving facial volume measured using the 4-stage MERZ scale, and assessment of patient satisfaction using the GAIS Scale.
Secondary goals included subjective assessment of skin tone improvement, reduction of skin erythema, assessment of healing after treatment, assessment of the level of treatment recommendation by the patient and assessment of the safety profile.

Introduction: The skin aging is a multidirectional process, caused by endogenous and exogenous factors. Intrinsic aging is associated with the passage of time and its course is individual. UVB and UVA radiation has a significant impact on the extrinsic aging process of the skin, resulting in increased epidermal stem cell apoptosis at the epidermis level. In the dermis, however, there is a decrease in the type I collagen content in the extracellular matrix of the skin.

Materials / method: From July to September 2019, an observational study was conducted to assess the efficacy and safety of mixture of amino acids (glycine, L-proline, L-lysine and L-leucine) and a solution of sodium hyaluronate in combined therapy of skin aging treatment. A total of 10 patients (9 women and 1 man) aged 46.3 (SD ± 6.2) participated in the study. All patients underwent 4 treatment procedures carried out every 3 weeks (on average every 18.9 days). A follow-up visit was made one month after the last procedure (30.9 days on average).

Results: Four weeks after the last procedure, 85% reduction of wrinkles on the WSRS scale and restoration of facial volume by 65% on the Merz volumetric scale were obtained. 90% of patients assessed the effects of treatment as at least a significant improvement (≥4 points) and in 40% of patients the optimal aesthetic effect (5 points on the GAIS scale) was obtained 4 weeks after the last treatment. 100% of patients participating in this clinical observation strongly recommend this procedure to other patients. No significant adverse effects were observed during the study.

Conclusion: In conclusion, it should be emphasized that the results of the study can confirm that combination therapy with amino acids is safe and efficient. Patients noted the spectacular effects around the eye and the improvement of skin tone and reconstruction of the volume of 2/3 of the lower face.

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请注明名称（个人，公司，学会等等）: Product used in this study was provided by SkinSolution Poland

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Objectives: In present study the efficacy of various treatment modalities such as subcision, skin microneedling, fractional C02 laser with or without Platelet rich plasma (PRP) have been evaluated for the management of atrophic post acne scars.

Introduction: Acne vulgaris is a common disorder of pilosebaceous unit with high prevalence among adolescents. Severely inflamed lesions often results in permanent scars, which are associated with severe psychological distress and low self-esteem.

Materials / method: Present study conducted at tertiary care centre in Amritsar comprised of a total of forty patients having grade III and IV acne scars. Most of the patients belonged to Fitzpatrick skin type IV followed by Fitzaptrick skin type V. Patients in group I-IV were treated with fractional C02 laser(FCL) alone, FCL in combination with Platelet rich plasma(PRP), microneedling in combination with PRP and subcision respectively. Total of 4 sittings were given at an interval of 4 weeks. Efficacy of treatment was assessed using scar quartile grading scale (SQGS) and patient’s subjective score (PSS).

Results: Patients in group I treated with FCL alone showed lesser mean percentage change in SQGS and PSS in comparison to FCL in combination with PRP(Group II) with P value<0.05. Combination of FCL with PRP was associated with lesser side effects and shorter downtime. Group III patients treated with microneedling along with PRP showed mean percentage change of 52.8% in PSS in comparison to group IV patients where mean percentage change in PSS was only 26.6%.

Conclusion: No single treatment modality can effectively treat various types of atrophic acne scars. Newer adjuvant treatments like PRP in combination with time tested modalities like FCL are often required for enhancing the degree of improvement and decreasing the side effects.

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Objectives: This study introduces a) the DALA treatment for asymmetry lips by using acupuncture only and b) its clinical effects with statistical significance.

Introduction: This study aims to verify the effect of Dam-Ahn-Line Acupuncture (DALA), a non-surgical acupuncture technique to improve facial soft tissue asymmetry. This study is one of a series of studies verifying the effect of the DALA on the asymmetric treatment of each face part. The previous research has found the statistical significance of DALA for volumetric asymmetry treatment of the middle face, including the cheeks and nose. This study addresses lip asymmetry treatment through the DALA.

Materials / method: This study has collected data from randomly selected 15 patients in Clinic Kimdamhui from January 2019 to November 2019. The patients had no experience taking any acupunctural treatment on their faces before Clinic Kimdamhui. Clinic Kimdamhui has treated them with 0.14mm diameter x 30mm length and 0.16mm diameter x 30mm length needles produced by Serin. The patients have been treated five times according to individual a) levels of asymmetry and b) strengths of facial tissues. In each treatment, the patients were treated with an average of 20 needles for the soft tissues around the lips in the

Results: Before the DALA treatments, the patients had 7.18 degrees as the mean difference between the left and right upper lip and 4.68 degrees as the mean difference between the left and right lower lip. After the DALA treatments, the average difference between the left and right upper lip of the patients decreased to 2.5467 degrees (p = 0.001), and the average difference between the left and right lower lip of the patients decreased to 2.4133 degrees (p = 0.053).

Conclusion: Comparing the changes in the mean differences before and after DALA treatment with the Wilcoxon Signed Rank Test, the study shows the effect of DALA treatment to relieve asymmetric upper and lower lip. In particular, the collected data shows statistical significance (p = 0.001) for DALA treatment for the upper lips.

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Objectives: “EZ Fan” is specifically designed to satisfy the needs of the surgeons who look for a clear alternative to traditional finger insertion techniques for a low friction insertion method for breast, calf gluteal and pectoral shaped silicon gel implantation procedures. It allows for minimizing the contact of the breast implant, surrounding tissue and
the incision by the way of easier insertion.

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Objectives: We report a rare case of acquired dermal melanocytosis associated with imatinib mesylate. If acquired dermal melanocytosis develops in adults, clinicians may need to consider the side effect associated imatinib.

Introduction: Imatinib mesylate is a tyrosine kinase inhibitor (TKI) that interferes with basic molecular pathways of neoplastic cells. It is used to treat diverse oncological conditions such as chronic myeloid leukemia (CML), myeloproliferative disorder, and gastrointestinal stromal tumor. The most frequent cutaneous side effect is hypopigmentation. However, the paradoxical pigmentation also have been rarely reported. This phenomenon is presumed to be the result of different target effect on precursor and mature melanocytes.

Materials / method: A 48-year-old woman suffering from CML presented with bluish to grayish macules and patches on face, shoulder, and buttock. She had been treated with imatinib mesylate for 9 years. She reported the hyperpigmentation of the face 3 years after using imatinib mesylate to treat CML. Moreover, the patient reported diffuse bluish to brownish hyperpigmentation like Mongolian spot on the upper trunk and buttock presented for approximately 2 years.

Results: Histologic examination showed the dendritic and stellate-shaped cells with brownish pigment in the dermis at Hematoxylin-Eosin staining. The immunohistochemical staining revealed that these cells were dermal melanocyte, positive for S-100, Melan-A, and HMB-45 (Figure2, 3). Based on these clinical and pathologic findings with considering temporal relationship, the diagnosis of imatinib-induced acquired dermal melanocytosis was made.

Conclusion: In our case, the patient showed facial and extrafacial hyperpigmentation on typical locations of congenitally appearing nevi such as Ota nevus, Mongolian spots and nevus of Ito. The KIT/SCF-dependent blockade from the imatinib generally cause epidermal depigmentation in mature melanocytes. On the other hand, it can promote differentiation and melanin production increased pigmentation of immature melanocytes. This case may infer that immature melanocytes were predominantly distributed in specific locations and the dermal melanocytosis can be expressed in adults by external factors.

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Objectives: Genital cosmetic surgery has the goal of enhancing female appearance and modifying sexual functioning. Cosmetic gynecology should include both surgical interventions and topical genital cosmetic products. The vulvar region has received scant attention in the cosmetic industry. This abstract will demonstrate that the literature supports that cosmetic gynecological is surgically based and medical condition focused. There is a lack of medical publications concerning noninvasive topically genital cosmetic products that could act as a frontline treatment for both aesthetic/functional concerns.

Introduction: The vulva is a sexual organ and the vulvar epithelium of labia minora is highly innervated and sensitive. During sexual arousal, the labia evert and contribute to erotic sensation and pleasure. Incision to any part of the genitalia could compromise this sensitivity and its sexual importance and surgical complications like neuroma-like hypersensitivity have been reported. The initial treatment for vulvar enhancement, and cosmesis maybe best served by a non-invasive topically cosmetic approach.

Materials / method: Comprehensive PubMed literature search was conducted with key terms “vulvar bleaching”, “vulvar cosmetics”, “vulvar cosmetic creams”, “vulvar non-surgical cosmetic”, “vulvar enhancement” and Vulvar cosmetic gynecology were considered. The search terms were limited to PubMed publications in peer reviewed articles and in the English language

Results: A total of 197 English articles were retrieved and reviewed. 24/197 or 12% were excluded leaving 173 in the analysis. 81 percent dealt with medical management of vulvar disease (43% dealing with cancer and 19% dealing with vulvar allergy, itchiness or dermatitis. 14 articles or 8% were reviews or society guidelines related to aesthetic gynecology including vulvar surgery. 6% of the article (n=6) in the medical category dealt with vulvar deodorant sprays. Surgical topics of management were discussed in 31/173 or 18% of the articles. Laser was mentioned in 6% of the articles n=10.

Conclusion: Genital cosmetic products including a vulvar cream that improves cosmesis and soothes irritate areas has been created and manufactured. This product maybe a frontline treatment for women who desire comprehensive genital anti-aging. Vulvar aesthetic surgery is commonplace however remains invasive and may have surgical complications. Conservative, non-aggressive topical interventions may be worthwhile as initial steps to help improve vulvar aesthetics. Many topical creams exist primarily for medical conditions, the literature is rather sparse for topical genital aesthetics products.

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请注明名称（个人，公司，学会等等）: Michael Krychman is a consultant for revision skincare

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Objectives: To examine protocols and or medications that may be used post genital laser or radiofrequency to enhance healing and provide a soothing post procedure recovery period. The introduction of vaginal treatment and care a novel post procedure or stand-alone genital product that enhances recovery, mitigate inflammation and promotes a soothing process during the recovery period.

Introduction: Laser/radiofrequency procedures dominate non-invasive gynecological procedures for cosmetic or functional reasons. Providers now glean a better understanding of the technological mechanism of action. Trends in this field include pre-treatment (to enhance results) and post-treatment (to enhance recovery) adjunctive therapeutics. FFP or to use topical hormones is occurring as a priming, before a procedure. Little attention has been focused on post procedure or treatment with specific formulated products, to enhance (outcomes) and patient comfort during the recovery phase.

Materials / method: An English pub med search was conducted to discover if there were any published articles on post laser or post radiofrequency recovery treatment paradigm. While there was an abundant number of articles on laser (L) and radiofrequency (RF), illustrating specific procedure protocols, patient selection, and complications there was none specifically that focused on post procedure recovery phase. The scientific literature is remiss in addressing the post procedure recovery phase and what optimal interventions may support recovery and decreased inflammation (irritation).

Results: Vaginal Restorative GF Complex, is a targeted formula that rejuvenates the vaginal wall lining. hydrates the vaginal wall, relieves vaginal dryness, soothes irritation, while promoting collagen/elastin health. it has targeted ingredients of key signaling proteins: TGFb and peptides are associated anti inflammation and collagen/ elastin production. This product is used by over 300 providers for post genital L/RF therapy and has increased over 25% in the last few years. Patient reports an immediate soothing, comfortable post procedure experience.

Conclusion: Cosmetic gynecology is a dynamic subspecialty and there remain increased demands by patients for safe effective treatments for both aesthetic and function gynecological considerations. While the focus has been primarily on the procedure, post procedure recovery remains paramount and critical for patient satisfaction. Newer products like Vtac offer excellent promise in the post treatment recovery phase. Further study and feedback is currently underway.

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请注明名称（个人，公司，学会等等）: Michael Krychman is a paid consultant for Omni Bioceuticals

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Objectives: Background: Wound healing mechanisms is believed to
have effects similar to wound healing disorders in diabetic
patients, including abnormal inflammatory cells, angiogenesis
disorders, and reduced collagen synthesis. Therefore,
reestablishment of structural and promoted angiogenesis
could be beneficial to promote wound healing
process. Objective: Therefore, we investigated whether the
polydeoxyribonucleotide (PDRN) that was self-production
in Korea, could be useful as an intradermal injection for promoting
wound healing. Also, we validate for wound healing
effect of PDRN using healing-impaired

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Objectives: Polydeoxyribonucleotides (PDRN), a mixture of short
dexoribonucleotide polymers (non-toxic agonist and no antigenic properties
[1]) is a well-known stimulator of cell growth that accelerates
cell proliferation and can help with the regeneration of skin and tissue.
Several studies have reported on the in vivo and in vitro
wound-healing ability of PDRN which was extracted from either
human placenta [2,3] or from the sperm of trout or salmon [4,5].
Studies also have reported on extensive PDRN research and application
in the following areas: human skin fibroblasts [2,3], peripheral
artery/varicoce

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Objectives: Laser interventions
Skin tightening and collagen stimulation.
Laser treatment of veins around the eyes
Peri ocular lesions removal

Introduction: The eye area is important in contact between individuals, with eye to eye communication occurring in 80% of all interactions.

Materials / method: Eryag 2940nm is used in smooth Eye (rejuvenation)
NDyag 1064nm in treatment of peri ocular veins.
Xanthlasma,Milia and skin tags

Results: Safe and a very good result with patient satisfaction.

Conclusion: Laser can use safely around the eyes when we can choose the cases.

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Objectives: The objective of this study was to comparatively evaluate the efficacy of two vacuum associated RF devices on the buttocks area.

Introduction: Ageing and weight changes, among other factors, may weaken the connective tissue, leading to flaccidity and uneven skin texture. There is a growing patient demand for noninvasive techniques in order to achieve a better body shape and contour. Radiofrequency (RF) is a form of high‐frequency electromagnetic energy that provokes the increase of cellular metabolism and subsequent induction of neocollagenesis and tissue tightening.The combination of the RF and pulsed vacuum improves the results.

Materials / method: 10 female patients, aged between 19 and 57 years, were treated with two RF devices. On the right side, a multipolar RF associated with vacuum (A) was used, and on the left side, a bipolar RF associated with vacuum and infrared light (B). For technology A, 10 weekly sessions were done, and for an equivalent treatment on the left side, 6 weekly sessions using technology B, with the same protocol. The evaluation was done using anthropometric measures of the patients (before and after), as well as photographs taken by a 360° 3D camera, skin biopsies and a satisfaction questionnaire

Results: After the end of the treatment, adipometer measurements showed an average decrease of 3,5% of pre and post treatment in both machines. Thigh circumference showed no variation at both tips, indicating that was not a good parameter to evaluate the buttocks area. There was no statistically significant difference between the percentage variation of the two treatments. All patients had a decrease in the absolute volume of the region after the treatment, with an average loss of 99,44 ml with technology A and 95,89 ml with techology B.

Conclusion: RF triggers an inflammatory reaction in the dermis and protein denaturation. Along with the healing process, there is a significant increase in the activity of the fibroblasts in the dermis, increasing collagen synthesis, as demonstrated by the biopsies. Technology A uniquely uses six generators to deliver energy deep into the skin without overheating, achieving a volumetric heating of dermis and hypodermis with comfort and safety.
There was an overall improvement in both cellulite and body contour of all patients, which were sucessfully demonstrated by photos and measurements.

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Objectives: In modern social community our patients ask the aesthetical correction of their visual disadvantages not on the face only, but with increase of period of sexual activity on their body too. With increasing of the volume of gluteal area, they ask for increase of quality of skin. There are a lot of biomechanical, chemical and injection methods for better quality of skin, but the injection of PLA is able in the same procedure to create some volume of threated area and treat skin atrophy, what can secondary help for better quality of skin.

Introduction: The acceptation of some anatomical can guarantee to achieve good results and minimization of risks of procedure of implanting of filler. The PLA is famous collagen stimulator which with creating of the volume of soft tissue regenerating and tightening of skin and subcutaneous soft tissue without more invasive plastic surgery operation. Great bonuses of treatment for our patients are short rehabilitation period, absence of operation wounds and postoperation scars. Of course, the results of this mini-invasive procedure are in area of corrective dermatology and aesthetic surgery.

Materials / method: In this presentation we would like to present the method of aesthetical correction of gluteal area PLA fillers. There are PLA of second generation with stabilizing agent of carboxy-methyl-cellulose. We would like to show you some anatomical concepts for filler implantation in gluteal area. For these cases we realized the 4 dissections of female cadavers in Medical Faculty Department of Anatomy and Pathology of Comenius University in Bratislava. Were 15 patients were treated with presented method.

Results: After anatomical researches we create some rules for implantation of PLA filler for safe implantation and for achieving of better result. The choice of layer of implantation can make the implantation more or less safe.
We were threated 15 female patients with our presented method with injection of PLA filler. The patients were photographed, the questionary of satisfied with result of procedure were filled. The 11 from 15 patients were full satisfied with result and would like to repeat the procedure, 2 from 15 were satisfied with results, 2 from 15 will not satisfied with result.

Conclusion: Good knowledge of anatomy helps to choice adequate of mini-invasive procedure and decrease of risks of procedure.
Regarding to achieving results we can recommended the method of PLA filler implantation in gluteal area.
Good of chemical composition of material guarantee to choice the best universal material for create of volume and increasing of skin quality of gluteal area as mini-invasive method.

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Objectives: The purpose of my presentation is to demonstrate the most striking clinical cases with natural asymmetry of the face and a scheme for its correction.

Introduction: Natural asymmetry of the face is found in all people, but in some it reaches a significant degree. This creates an aesthetic flaw and generates dissatisfaction with their appearance. With the exclusion of a neurological pathology, the patient gets an appointment with a cosmetologist. The main task of a cosmetologist is an individual approach to the correction and selection of special doses of botulinum toxin.

Materials / method: The most common complaint of patients about the asymmetry of eyebrows. Correction of such asymmetry should affect not only the m.frontalis, but also the m.orbicularis oculi, the muscles of the glabella, scalp muscles. The second most common complaint is smile asymmetry. With this asymmetry, it is necessary to work with the m. DAO, m. platysma, m.orbicularis oris, m.risorius. The third most common complaint is the asymmetry of the corners of the mouth in the absence of facial expression. In this case, the doses and techniques for administering botulinum toxin differ from the smile asymmetry.

Results: The presentation containts a clinical analysis of individuals with detailed prescriptions, doses and injection points, and the results of treatment are demonstrated.

Conclusion: Working with non-standard dilutions of botulinum toxin, individualization of doses and points of injection allows to successfully adjust individuals with natural asymmetry, increasing patient satisfaction with their appearance.

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Objectives: Ex. to the title of the lecture "Pigmentation - myths and reality: new treatment protocols"
1. study the various types of pigmentation
2. classify treatment regimens depending on the type of pigmentation
3. choose the optimal treatment regimen and preparation for it, depending on the nature of pigmentation

Introduction: The problem of pigmentation is relevant for representatives of any phototypes and age groups. Many cosmetic rejuvenation procedures carry the risk of pigmentation. Prevention is the key to its absence. But often therapeutic measures aimed at combating pigmentation cause its stronger development. When prescribing aggressive bleaching techniques, we must first prescribe procedures to prevent pigmentation.

Materials / method: The study was carried out on 50 volunteers who were offered different schemes of pigmentation treatment: without preparation, with preparation, monotherapy, complex treatment, control group. Conventionally, all patients with pigmentation were divided into 4 groups depending on the nature of pigmentation:
1. Large pigment spots on fair skin like coffee drops
2. Fine pigment spots on fair skin like chocolate chips
3. Giant spots covering approximately 1/5 of the face
4. Mixed pigment spots

Results: The best results were obtained in the group of patients with large age spots like coffee drops when prescribing the preparation in the form of injections of combined tyrosinase blockers. A group of patients with pigment spots like chocolate chips noted an improvement in the clinical picture by 75%. Giant pigment spots responded to treatment by 50%. And patients with mixed pigmentation received an improvement of 40%. The analysis of the severity of pigmentation was evaluated by the instrumental method for comparing skin scans before and after the procedures. Comparison occurs automatically.

Conclusion: The success of pigmentation treatment depends on the nature of the age spots, as well as the age of pigmentation. A very important point in whitening procedures is the prevention of pigmentation in the initial stages of treatment. The best treatment results are obtained with preliminary preparation for treatment, a combination type of therapy and the appointment of tyrosinase blockers.

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Objectives: The aim of this study was to assess the efficacy of a new product with a mix of actives contained in an ampoule format (10% vitamin C + peptides + hyaluronic acid + mineralizing water) on the different factors involved in skin ageing, by evaluating the following aspects:
1. Potential antioxidant and derived effects.
2. Protection against global oxidative stress.
3. Effect on collagen synthesis.

Introduction: Oxidative stress in skin plays a major role in the aging process. Homeostasis of the skin can be negatively influenced by the presence of reactive molecules (“Reactive Molecular Species”, RMS), including ROS, which are the most abundant, RNS and (RCS). The increase in ROS induces oxidative stress, responsible for damage to membranes (lipid peroxidation), to proteins (protein glycosylation or activation of MMPs). On the other hand, two complementary processes are involved in the formation of wrinkles: degradation and the novo synthesis of matrix proteins, among which collagen stands out.

Materials / method: For the screening of the potential antioxidant and derived effects, In-tube assays were performed (INVITOOLS kit).
To evaluate the protection against global oxidative stress, human keratinocyte culture were exposed to the different factors (pollution, UVA and combined factors). MMT assay were performed for cell viability and 2’,7’-dichlorodihydrofluorescein diacetate (H2DCF-DA) fluorescent probe were used to calculate free radicals level.
Collagen neosynthesis was analysed in RHE-treated fibroblasts culture and human co-cultures by quantification (INVITOOLS kit) and immunolocation (Col. VII).

Results: 1. Very high direct antioxidant capacity and efficacy on derived effects: lipid peroxidation, protein glycosylation, inhibition of hyaluronidase, elastase and collagenase activities. The product shows a protective effect against the different processes in all cases. It highlights its general anti-oxidant power over positive control.
2. Protective effect against damage by global oxidative stress (RMS). Clear protective effect against damage caused by the increase in oxidative stress by ROS and RMS.
3. Collagen neosynthesis from fibroblast stimulated by keratinocytes.

Conclusion: 1. The product (5%) presents: A. High antioxidant level, blocking oxidation. B. Protection against damage caused by oxidative stress processes: decreases lipid peroxidation and protein glycosylation; inhibits the action of hyaluronidase, the action of elastase and collagenase.
2. The active mix at 0.025%: C. Protects against cell damage by reducing oxidative stress by ROS. D. Protects against damage by reducing global oxidative stress.
3. The product and the active-mix (0.01%) induce collagen neosynthesis throught keratinocyte stimulation.

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请注明名称（个人，公司，学会等等）: Vichy (L'Oreal).

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请注明名称（个人，公司，学会等等）: Vichy (L'Oreal).

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Objectives: A diagnosis of Mucha-Habermann disease is made based upon,patient history,a clinical evaluation showing red patches that evolve into papules reddish-purple to reddish-brown and may progress to develop a blackish-brown crust ,necrosis and bleeding.The lesions may blister, often causing temporary discoloration.It occurs on the trunk and extremities may also be diffuse.Fever may be associated .The differential diagnosis includes erythema multiforme,steven Johnson syndrome,lymphomatoid papulosis ,arthropod bite reactions, varicella,Gianotti-Crosti syndrome,vasculitis,syphilis,pityriasis rosea...

Introduction: Pityriasis lichenoides(PL)a spectrum of rare, inflammatory skin diseases.It can range from a relatively mild pityriasis lichenoides chronica(PLC) to a more severe acute eruption includes pityriasis lichenoides et varioliformis acuta (PLEVA) and febrile ulceronecrotic MuchaHabermann disease ;a severe presentation of PLEVA.The precise incidence and prevalence are not known.It may occur at any age but most frequently in children,young adults and a male predominance has been detected.The pathology is distinctive .We report a case of Pleva which was difficult to distinguish.

Materials / method: 39 years old woman developed over 2weeks a burning polymorphous and generalized eruption with fever.No personal,family histories.No
medications.Erythematous/purpuric macules,papules with peripheral scaling,vesicopustules and hemorrhagic crusts .Lesions in different age ,on the trunk/extremities.Mucous membranes were spared.No Pruritus.Biological inflammatory syndrome,positive ANA and bloodculture k.pneumoniae,p.aeruginosa,s.epidermidis .ANCAs,viral serologies,Toxoplasmosis,syphilis were negative. PLEVA on the histopathology. Treated by Cefepime iv 2g/d for 21d and oral doxycycline 200mg/d

Results: PLEVA is a rare disease.The cause is not yet known but three theories exist:an inflammatory reaction triggered by infectious agents,relatively benign form ofT-cell lymphoproliferative disorder or an immune complex-mediated hypersensitivity vasculitis.Infectious agents have been associated as,Toxoplasma gondii ,EBV, HIV, CMV,HHV8 ,HSV2,parvovirus,staphylococcus aureus,GroupA β-haemolytic streptococci.This condition responses well to topical corticosteroids ,erythromycin, cycline and UV therapy. The immunosuppressant agents were used for severe cases .

Conclusion: PL may persist for some years with relapses and frequent auto-resolution.It is generally relatively harmless. Although there have been rare reports of malignant transformation.So regular follow-up is recommended. The clinical management is difficult due to its uncertain etiology and a lack of high level of evidence studies on PL.We want to remind of this rare entity which may present difficulties in diagnosis.Antibiotherapy was effective in this patient, even though we can't exclude the possibility of a spontaneous resolution.

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Objectives: Pyoderma gangrenosum (PG) is a rare, chronic, often destructive, inflammatory skin disease. It is characterized by a painful nodule or pustule which breaks down to form a progressively enlarging ulcer with a raised, tender, undermined border. It can occur by itself or with an underlying systemic disorder. PG most commonly occurs on the lower extremities and trunk of adults aged 40-60 years. Penile PG and pustular presentation are more uncommon and can mislead the diagnosis. By this case we want to remind this clinical presentation to doctors .

Introduction: Penile pyoderma gangrenosum (PPG) is non-infectious and idiopathic skin disease commonly associated with systemic diseases such as inflammatory bowel disease, rheumatoid arthritis and hematological malignancies Therapeutic options include topical or systemic corticosteroids or other systemically administered immunomodulatory drugs . We described a pustular PPG that was difficult to diagnose .

Materials / method: A healthy 60 year-old morrocan man was referred with an erythematous vesiculo-pustular and erosive , sharply demarcated lesions , located on the glans penis .The lesions have developed 2 years ago. The patient denied extramarital sex during the preceding years. Further physical examination was unremarkable. The lesions were unresponsive to topical antibiotics. The biopsy showed features of pyoderma gangrenosum and tissue cultures were negative for bacteria, mycobacteria and fungus. Full blood screening revealed normal.

Results: Four clinical variants of pyoderma gangrenosum have been described: ulcerative, bullous,vegetative and pustular.The last is a relatively uncommon variant showing vesiculo-pustular lesions that do not ulcerate and it is most commonly observed in patients with active colitis ulcerosa . Only 15 pustular PPG cases were reported some, were associated with hyperglycaemia and hyperlipidaemia.Topical tacrolimus therapy is effective and it is recommended as first-line modality. Surgical debridement is not recommended in the acute stage due to risk of tissue progression.

Conclusion: This case is reported for its extreme rarity. There are only very few reports of penile pustular PG. Highlighting this clinical presentation may help to early diagnosis.

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Objectives: Acquired fibrokeratoma (AFK) was first described in 1968 by Bart et al, initially at fingers but also on the palm, toes, and sole. A rare variant known as multibranched AFK was first described in a case report by Moriue et al in 2014. To our knowledge, our observation is the first case of multibranched transungual acquired fibrokeratoma.

Introduction: AFK is a rare benign skin tumor that usually manifests as a slow-growing solitary nodular lesion of the digits. It can occur on fingers, toes, palm or sole.The main differential diagnosis are common wart, superficial acral fibromyxoma,
supernumerary digit, Koenen’s tumor, and cutaneous horn.
We report an atypical acquired fibrokeratoma characterized by its transungual evolution and double branched form.

Materials / method: 60years old man developed over 1year ,two slow-growing , asymptomatic lesions after a trauma on the first toenail.The examination revealed 2 branching longitudinal and flesh-colored cones arising from the nail bed.Firm
consistency,smooth surface and keratotic materials at the tip of the cones.Both cones seemed to have the same emergence.No signs of tuberous sclerosis of Bourneville syndrome.Dermoscopy found 2 filiform structures,2mm thick, emerging from the nail plate with whitish-yellow and erythematous areas.We realized a complete excision of the lesion.Histopathology confirmed the diagnosis

Results: The etiology of AFK is presumed to be trauma or repetitive irritation, It may occur after a staphylococcal infection or during treatment by cyclosporin. FactorXIIIa positive dermal dendrocytes has also been suggested as a possible causal factor.Depending on the location of origin, the tumor has been classified into three subtypes:periungual, subungual and intraungual (or dissecting ungual).Urbina proposed the term“transungual” as another subtype that fits more properly our case as ,the lesion doesn’t develop in the whole thickness along the nail plate besides of the multibranched form.

Conclusion: Acquired ungual fibrokeratomas do not spontaneously regress. First line treatment is
surgical excision, the tumor has to be completely resected along with the basal attachment. Local recurrence is rare, but could occur when partial excision or curettage is performed .We report this case for its originality and rarity.

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Objectives: The breast represents an area of considerable medical and cosmetic concern to patients. Moreover, the threat of malignancy in this location is an ever-present
source of anxiety. However, often physicians and patients avoid examination of the breast because of modesty or embarrassment. The physician who is
familiar with the spectrum of disease in this unique area can assume a valuable role in ensuring early diagnosis of worrisome lesions, avoiding incorrect or
overzealous treatment, and allaying anxiety.

Introduction: Nipple/areola skin is commonly affected by various inflammatory and neoplastic processes. many physicians are unaware of the spectrum of diseases that can involve this area. Because breast and nipple skin represents a cosmetically, sexually, and functionally important entity to most patients, awareness
of these disease entities is invaluable.We report a case of unilateral nipple lesion that was secondary to a crusted scabies .

Materials / method: 19years women has presented 2months ago an itchy,painful,irritated rash
erythematous,crusted,erosive lesion localised in the right nipple/areola,no history of breastfeeding,eczema,atopic dermatitis,no irritation from articles of clothing, soaps,laundry detergents,lotions,no piercing,breast examination was normal,no other lesion on the body .Normal breast Ultrasound .She reported scabies that was poorly treated 4 months ago and she is still scratching at night.She received fusidic acid ointment ,then scabies treatment ;benzyl peroxide with good evolution. Actually she is applying a scar cream

Results: Non-specific dermatitis of the nipple are represented by atopicdermatitis,contact eczema andfriction.Fox-Fordyce and Verneuil’s disease can rarely occur in this region rich in apocrineglands.Specific dermatitis are areolar sebaceous hyperplasia,galactophoric ectasia,hyperkeratosis of the nipple.These can be secondary to(epidermotropic lymphoma,Norwegian scabies,epidermal hamartoma) orbeiatrogenic(vemurafenib).Benign tumors which are quite rare as erosive adenomatosis ofthe nipple,cutaneou lymphocytoma,solitary leiomyoma.The infiltrating syringoadenoma should be classified as malignant tumor.

Conclusion: At the conclusion of this learning activity, We 'd to emphasize on this clinical presentation which can be alarming , the importance of the medical history that avoided an unwanted biopsy of this important region .However in front of any unilateral/recent lesion , it is necessary to evoke the diagnosis of Paget's disease of the nipple and do a biopsy right away. The search for an intraductal carcinoma must be systematic given its almost systematic association with the mammary form of Paget's disease unlike the extramammary forms.

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Objectives: (1) Know different nose and chin parameters contributing to the facial profile harmony. (2) Detect the specific facial imbalance of the nose and chin in any patient who is seeking correction of the facial profile. (3) Apply different surgical techniques for chin advancement with the least complications and best results.

Introduction: Personal experience on horizontal osteoplastic chin advancement in patients undergoing rhinoplasty: The chin like the nose is in a prominent position on the face and plays a very important role in the facial profile. The important relationship between the nose and chin may be underestimated by plastic surgeons who perform rhinoplasty.

Materials / method: 74 patients underwent genioplasty and rhinoplasty. The age of patients ranged from 17 to 44. The patients were included in three groups in which the genioplasty was done before, after or at the single-stage with rhinoplasty. All procedures were performed under general anesthesia with the intraoral incision. After exposing the mentum, horizontal osteotomy was performed and the advanced segment was fixed in place. Five different methods for fixation were utilized including 3 screws, 5 screws, one prebent mini-plates, two parallel mini-plates or combination of prebent mini-plates and screws.

Results: Patients were followed 6 months to 10 years after the operation. Improvement of facial parameters was observed in all patients. There was no significant difference between the three groups of patients and between different methods of fixation. No permanent complication occurred. Three had prolonged hypoesthesia up to 3, 9 and 18 months after surgery.

Conclusion: Advancement genioplasty by osteotomy could be performed in patients with chin problems during or after rhinoplasty to improve the facial profile. Our experience with horizontal osteotomy showed satisfactory results with no important complication.

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Objectives: To acknowledge a practical technique for aesthetic correction of nasal alar concavity and collapse.

Introduction: Extreme concavities of the lower lateral crura can cause severe aesthetic and functional problems. This study presents the experience using lateral crural reversing with or without different lateral crural grafts for the treatment of patients with severe concavities leading to the collapse of the nasal valve.

Materials / method: This retrospective study was directed on twenty-three primary rhinoplasty patients. After transcolumellar and marginal incisions, the skin flap was elevated in a supraperichondrial plane, exposing the lower lateral cartilages and cartilaginous dorsum. Then the mucosa was detached from the posterior surface of the lower lateral crura. The cartilages were released, excised, reversed and fixed in place. Different lateral crural grafts were used in some of the patients.

Results: All patients were improved in form and function. There was no difference in the patient with the use of grafts or without them. Postoperative swelling was slightly longer in our patients. However, there were no complications and all patients were satisfied with the long-term aesthetic and functional results.

Conclusion: Lateral crural reversing can contour the shape, reconstruct lateral crus completely and correct concavity and valve collapse by a simple technique. It could be done with or without reinforcing grafts.

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Objectives: To be familiar with a simple technique of graft harvesting and insertion for management of the radix in rhinoplasty:
Various grafting materials have been described to augment the radix area. All of these materials have potential problems such as visibilities, irregularities, unwanted reactions and inflammations, considerable resorption and donor site morbidities. I have used intrinsic nasal fibro-fat as a graft material for radix augmentation.

Introduction: Aesthetic radix augmentation is a popularized procedure to minimize reduction, balance the nasal proportions, preserve adequate dorsal height for better function and make a natural nose. Various grafting materials have been described to augment the radix area including bone, solid cartilage, crushed cartilage, diced cartilage-fascia, diced cartilage-glue, diced cartilage-surgicel, fascia, dermal graft, and alloplasts. All of these materials have potential problems such as visibilities and irregularities, unwanted reactions and inflammations and considerable resorption. The increased operation

Materials / method: 42 patients underwent open and closed approaches for primary rhinoplasty. After elevating the skin flap in a supraperichondrial plane, the lower lateral cartilages and cartilaginous dorsum were exposed. The fibro-fatty tissue over the lateral crura and between the medial crura was harvested with sharp scissors. One to three pieces of fat were usually obtained. Using a 6-0 PDS suture, all fat compartments were attached in a bead fashion, preserving the needle for passing through the skin.

Results: Fibro-fat grafts were fixed in the radix area with suture. An overestimated size was preferred to compensate slight absorption over time. The patients were followed up to three years after surgery with satisfactory results in all of them. No complications have been noted with this type of radix graft. There was no case of visibility, displacement or recurrence.

Conclusion: The nasal fibro-fat graft is a suitable and easy harvested graft material with no morbidity for correction of radix hypoplasia. It could fit the place with no visibility problem.

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Objectives: 1) know the anatomic characteristics of deviated noses. 2) Identify risk factors and pitfalls in the correction of deviated noses. 3) Select the best technique for each type of deviated and crooked noses.

Introduction: Deviated nose is defined as a deviation of the external nasal framework, which is almost always accompanied by deviations in the nasal septum. Most patients have problems both in form and function. Establishing stable and long-term results has been a nightmare even for experienced surgeons.

Materials / method: Analyzing the underlying anatomy in each case is important to establish the plan of treatment which differs in every case. Deviation could be noted in the bony upper third part of the nose, cartilaginous middle third or combination of both and may extend to the lower third or lobule. All types of deviated noses are operated in one stage with the correction of pyramid and septum. Correction of form and function includes restoration of the straight dorsum, reducing asymmetries and providing functionally patent nasal valve.

Results: Wide exposure and extensive release of deviated cartilages would help to minimize extrinsic forces over the deviated pyramid and septum. It is especially important in the case of deviation of cartilaginous septum. Proper cuts and resections of cartilage and insertion of resected materials as different types of grafts are the basis of the most techniques which were described in this problem.

Conclusion: Deviated nose is a complex deformity extending from the radix to the tip. Of course, the successful surgery is not possible without correction of tip deformities and asymmetries as an important part of the procedure. A systematic approach including various methods in septorhinoplasty for deviated and crooked noses is addressed.

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Objectives: 1) Know different factors contributing to the nasal tip ptosis. 2) Acknowledge different methods for correction of the drooping nose with the advantages of augmentation. 3) Learn and apply efficient augmentation techniques for prevention of tip ptosis during rhinoplasty

Introduction: Maintaining long term results in rhinoplasty is the state of art in nasal plastic surgery. Numerous parameters in nasal wound healing and nasal support mechanisms have made rhinoplasty as the most difficult plastic surgery.

Materials / method: Five hundred fifty rhinoplasty cases with at least two years follow up were analyzed at different intervals before and after surgery. The patients underwent spring augmentation techniques rather than conventional techniques. In this technique, the columellar strut has been designed by consideration of intrinsic forces to make more stability over time. The intrinsic intracartilage forces have been overlooked in conventional techniques but our new method which was based on the Euler equation of springs has considered these forces.

Results: Multiple aesthetic parameters were assessed at different intervals before and after surgery. More than two to ten years follow up revealed that there was significant stability in this group of patients. Nasolabial angle and tip location are affected by different factors. These factors include the cartilaginous framework of the lower third of the nose and the motor unity of this portion consists of levator labii superioris alaeque nasi and depressor septi nasi.

Conclusion: There are different methods for the correction of tip position in rhinoplasty. We have emphasized a technique with augmentation of the base. We pronounced the role of intrinsic intracartilage forces acting as a spring for achieving the most stable results and prevent unfavorable long term effects in appearance and function.

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Objectives: Understand possible indications for non-surgical rhinoplasty; learn the proper technique and prevention of possible complications; know indications, advantages, and disadvantages of non-surgical rhinoplasty.

Introduction: Nonsurgical correction of the nose shape is an exciting procedure that is considered as an alternative to traditional rhinoplasty procedures in some cases ranging from minimal to severe nasal shape and breathing problems. Besides the time and cost-effectiveness, these procedures are very flexible, repeatable and have fewer complications if meticulous techniques applied.

Materials / method: One hundred eighty-five selected patients underwent simple but delicate techniques to change the shape of the nose by means of needles and a wide range of non-permanent dermal fillers. Various conditions which were the candidate of primary and revision rhinoplasty underwent non-surgical nasal reconstruction through a wide range of techniques to improve form and function. Non-surgical rhinoplasty could be used to camouflage defects or irregularities, correct deviations and adjust proportions such as upward tip rotation and adjusting the nasofacial angle.

Results: Many patients were excited by observing the new shape of their noses in just less than fifteen minutes. Some cases had improvement in function other than form. The duration of each procedure was less than fifteen minutes in most of the cases. Outcomes were satisfactory and there was no after procedure care and the patient could attend the work just the day after the procedure.

Conclusion: Non-surgical rhinoplasty procedures are an easy, safe and cost-effective method for improving nasal form and function in primary and revision cases. However, it should be done very cautiously by an expert surgeon with ample experiences on non-surgical correction of the nose to make this alternative technique in selected patients, mimicking the results which could be obtained by a complete surgical procedure.

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Objectives: 1) Know the anatomic characteristics of the Middle Eastern noses. 2) Identify risk factors and pitfalls in Middle Eastern rhinoplasty to avoid aesthetic and functional problems 3) Select the best technique for each type of Middle Eastern nose.

Introduction: Middle Eastern rhinoplasty has been considered as one of the most difficult primary rhinoplasty procedures. Heavy, thick skin and weak structural support are important parameters in the noses of this region of the world.

Materials / method: Middle Eastern anatomic factors make noses to show characteristics such as wide and large nose, long and drooping nose, acute nose-lip angle, deep nasal root angle, and prominent arching nose. This is very important for surgeons to avoid making unnatural looks and negative influences of the operated appearance of the nose on the other parts of the face. One of the principles to avoid complications in the Middle Eastern noses is a structural augmentation and making support, especially in the base of the nose.

Results: Indeed, most patients with Middle East noses have a deficiency in structural support. By the exact evaluation and facial analysis, it will be revealed that many humps are the result of a combination of excessiveness of the osseocartilaginous framework in a part and deficiency of the structural support on the other part. So some part of the hump is evident because of the deficiency in the root and base of the nose. The false effect of inadequate projection of the nasal base is a common cause of surgical mistakes in the Middle East noses.

Conclusion: Pitfalls in Middle Eastern rhinoplasty could be prevented by the exact preoperative analysis, restoring structural stability, starting the correction of the nose from the base and continuing to the other parts of the nose. In this presentation, special anatomic considerations, common pitfalls and preventive measures in the surgery of the Middle Eastern noses will be discussed.

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Objectives: The primary objective was to evaluate the degree of aesthetic improvement in managing lip fullness, assessed by subjects using the Global Aesthetic Improvement Scale (GAIS), 8 weeks following their last treatment with HARK when compared to pre-treatment baseline. The primary endpoint evaluated degree of response, i.e., subjects assessed as ‘improved’, ‘much improved’, or ‘very much improved’, calculated with a 95% confidence interval. Secondary objectives included partner and subject satisfaction, aesthetic improvement (assessed by treating investigators) and adverse events.

Introduction: HARK is a hyaluronic acid filler that is approved in Canada and the EU and in many other countries outside of the US for augmentation and/or restoration of lip volume. In this post-marketing study, apart from the conventional assessments by subjects and treating investigators, we also asked the subjects’ partners to complete a kissability questionnaire to evaluate their own satisfaction with treatment.

Materials / method: This was an open-label, multi-centre study (NCT03967444) in which subjects received either HARK in the lips or HARK in the lips and HARR and/or HARD in facial wrinkles and folds surrounding the lips. A touch-up visit was offered at Week 4; with follow-up at Week 8 after last treatment. Assessments included aesthetic improvement (GAIS; rated by subjects and treating investigators), satisfaction with lips (FACE-Q questionnaire completed by subjects) and kissability (questionnaires completed by subjects and partners), and adverse events.

Results: Forty subjects received HARK as well as HARR and/or HARD; 19 received only HARK. The primary objective was met; all subjects rated themselves as at least ‘improved’ on the GAIS at Week 8 after their last treatment. Furthermore, 96% of subjects were satisfied with their lip appearance when smiling, and with the size of their lips. One-hundred percent of subjects were satisfied with the result of their lip treatment, 96% agreed that their lips had a natural look and 73% of partners agreed that subjects’ lips had a more kissable and natural feel after treatment. Treatments were well tolerated.

Conclusion: Subjects agreed that lip treatment with HARK successfully achieved aesthetic improvement with respect to lip fullness. In addition to the subjects, partners were also satisfied with the subjects’ lips following treatment. HARK alone or in combination with HARR and/or HARD was well tolerated and effectively improved lip fullness while maintaining a natural appearance at rest and with animation following treatment.

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请注明名称（个人，公司，学会等等）: Galderma sponsored the study

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Objectives: The objective of this investigation was to study the physical properties flexibility and firmness of commercial HA fillers from two major brands, comparing how firmness and flexibility is balanced for the NASHA/OBT and the Hylacross/Vycross technologies.

Introduction: Many studies on HA fillers have been aimed at their firmness, typically expressed as their rheological G’ value, to estimate their ability to lift and project. However, investigations aimed at the flexibility of HA gels, i.e. their ability to recover after a larger deformation are few. To study HA fillers in the dynamic mode related to natural animation, a recent rheological method to measure gel flexibility was employed.
While soft gels must be flexible to tolerate deformation, firm gels resist deformation, which makes the balance of firmness and flexibility clinically important.

Materials / method: The rheology measurement included a relaxation time of 30 min, a frequency sweep (FS) from 10 to 0.01 Hz at 0.1% strain, followed by an amplitude sweep (AS) from 0.1% to 10000% (0.001 to 100) strain at 1 Hz. The gap was 1 mm using a PP25 measuring system at 25˚C.
The FS was evaluated for G’ at 0.1 Hz as a measure of gel firmness. The AS was evaluated for strain at the cross-over point where G’ and G’’ have the same value (xStrain), as a measure of gel flexibility.
From each technology, two NASHA, five OBT, two Hylacross and five Vycross products were studied.

Results: The range of firmness and flexibility differed between technologies. The NASHA/OBT technologies displayed a G’ ratio of 83 from firmest to softest, and an xStrain ratio of 431, while the Hylacross/Vycross technologies showed a G’ ratio of 9 and an xStrain ratio of 46.
In addition, the balance between firmness and flexibility differed between technologies. For OBT, the softer the product, the more flexible. For Vycross, the trend was the opposite, the softer the product, the less flexible, except for the most concentrated 25 mg/ml Vycross product, reaching higher G’ than other Vycross products.

Conclusion: The products from the NASHA/OBT technologies were found to cover a significantly larger range in firmness as well as in flexibility compared to the products from the Hylacross/Vycross technologies.
For OBT products, increased softness was balanced by an increase in flexibility. For Vycross products, softer products showed less flexibility. The difference was attributed to the different technologies. While OBT products differ in crosslinking level, Vycross products differ in HA concentration.

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Objectives: The aim of the study was to increase the safe and effectiveness of the temporal brow lift with the very short scar. to minimise the rehabilitation period with the adequate tissue mobilisation and lifting.

Introduction: The periorbital and temporal areas rejuvenation remains one of the most popular facial aesthetic surgery today. This part of the face reveals age-related changes most quickly. A lot of technics have been proposed in these areas today with different invasive trauma and effectiveness. The minimally invasive, short-time rehabilitation, minimizing scars, safety are the most popular requirements nowaday.

Materials / method: The 36 patients have been underwent periorbital and temporal similar combined surgeries at the clinic since 2018.The surgical complex in the studied group of patients had ncluded cutaneous temporal lifting, the Fogli modificated technique. Some patients had been underwent additional upper blepharoplasty, lipofilling, procerus muscle resection. All the surgeries had been performed by one team of surgeons, under sedation. The hospital staying had been not more than 1 day.

Results: All the patients are satisfied with the results of the surgeries that were performed. The effective long-term result have been observed no long than 2 years. The observed complications were: hematoma-1, sutures insufficiency-1, the skin epidermolysis of the forehead-3, transient anesthesia of the forehead - 13.

Conclusion: To shorten postoperative scars, to reduce the trauma and the less rehabilitation period are the requirements that guide surgeons to search for improvements of the surgery technique. The proper incisions planning allows us to avoid hair follicles damage and to have invisible scars.
The adequate using of the subperostal and the subgaleal tissue mobilization in combination with the skin temporal underlying made it possible to minimize the surgical approaches to 10mm with the proper tissue lifting displacement.The wide usage of the lipofilling always allows us to emphasize the rejuvenation effect

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Objectives: The aim of the study was to increase the facelift long-term results with the modern regenerative products in the combinationwith the laser. To study the possibilities of the regenerative products in the aesthetic medicine

Introduction: The Multipotent stromal cells, Growth factors, Exosomes have been widely used by specialists of regenerative laboratories nowadays. The aesthetic surgery can significantly rejuvenate the contours of the face, neck and other parts of the body today. But the age-related skin changes remain of less rejuvenation, especially at the areas where surgery is not very effective, like neck, décolleté, hands. The modern possibilities of the regenerative medicine help us to solve the items and to treat the scars.

Materials / method: The team of the aesthetic medicine and regenerative laboratory specialists tries to study the skin rejuvenation possibilities of the the MSCs, exosomes, growth factors combinations (5 cases) .The CO2 laser with growth factors and exosomes combination have been studied in a separate group of patients with scars, striae, and skin aging.Postnatal multipotent stem cells derived from the neural crest were isolated from a skin biopsy.Cells of stromal vascular fraction (SVF) were isolated from lipoaspirate. The exosomes — by combination of precipitation and chromatography.

Results: The skin tests were performed under standard conditions (t: 20.2°, H 52%).Ultrasound high frequency (22 MHz),digital dermatoscopy, histology have been used. These findings had been showed the skin rejuvenation and the normal fiber structure tendency, with slight increase in skin density. The sebumetry, Corneomety, Skin-pH-Metry, Tewametry tests had been improved to the normal index after superficial skin intradermal exosomes introduction with the CO2 laser treatment. The control areas was of less effect after the only CO2 laser ablation. No complication had been observed.

Conclusion: The exosomes, MSC, growth factors in combination with fractional laser is the less alternative method of skin rejuvenation, treatment of scars and striae. We have to accumulate and analyze the findings from these methods to develop a protocol for the procedures.

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Objectives: 1. Discuss PRP as a therapeutic alternative for androgenetic or areata alopecia cases.
2. Describe the methodology used in three patients with alopecia treated with monthly sessions of intradermal injection of autologous PRP into their scalp for six months.
3. Present the results obtained with referred patients.

Introduction: For approximately 3 decades, Platelet Rich Plasma (PRP) has been used for therapeutic purposes, for example, in Oral Surgeries and Teeth Implants. In aesthetic medicine, it is established as a more current alternative, on the rise in hair restoration therapies, skin rejuvenation, among other purposes. This is because platelets contain growth factors that stimulate angiogenesis and cell division, with consequent cell regeneration, increased collagen production and acceleration of tissue metabolism in the treated area.

Materials / method: This is a case report using data provided by the medical records of three alopecia patients treated at a plastic surgery and aesthetic medicine clinic in Brasilia, Brazil, as well as information on the protocols used in this clinic regarding the preparation of autologous PRP for injection in these patients. A search was conducted on Pubmed, searching for the terms “Platelet Rich Plasma” and “alopecia” in English and Portuguese.

Results: Twenty milliliters of peripheral venous blood were collected from the patients in 3.2% sodium citrate test tubes, and subsequently inserted into the centrifuge for the centrifugation of three thousand revolutions per minute during ten minutes. From this centrifuged material, only the lower plasma level was aspirated, which contains a higher concentration of platelets. After centrifugation, 10% Calcium gluconate is added to the aspirated material for the purpose of platelet degranulation by activation. This preparation is injected into the scalp of patients, obtaining satisfactory results.

Conclusion: This procedure is based on the regeneration of hair bulb cells stimulated by PRP and is safe because there is no risk of allergies or disease transmission through infused plasma. Therefore, there are few contraindications, such as active skin infections, cancer, chemotherapy, severe metabolic and systemic disorders, abnormal platelet function, among others. In addition, this procedure has the benefit of little or none downtime associated with the treatment, in that way, normal activity can be resumed immediately.

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Objectives: 1. Introduce a didactic and simple classification of aesthetic and functional procedures in gynecology.
2. Propose an objective script for the aesthetic gynecologic clinical examination.

Introduction: Gynecological complaints currently make up a large part of the demand for aesthetic and functional procedures. These complaints range from the patient’s private sexual life to their self-esteem, setting up an important theme within plastic surgery and gynecology. In this paper, different approaches will be discussed, from less invasive procedures to surgical techniques. Important stages of the consultation will also be highlighted, as indications and contraindications for the procedures and the patient selection by the physician, considering the themes previously mentioned.

Materials / method: The authors, based on clinical experience and the difficulty of approach in some cases, created an objective form of clinical evaluation of the patient and a consequent classification of the procedures. Also, a research utilizing the terms “functional gynecologic procedures”, “intime plastic surgery” and “aesthetic gynecology” was performed on the Pubmed platform in English and Portuguese.

Results: A new classification was proposed, separating the methods into functional and aesthetic, and into them surgical and non-surgical approaches. Allied to this, a script was elaborated based on the most common complaints of the patients, which aims to conduct the gynecological consultation objectively.

Conclusion: The standardization of procedure nomenclature is of great importance for proper communication, both between doctors and between doctor and patient. By enabling a more accurate diagnosis, this script directs the treatment in such a way that generates greater patient satisfaction regarding the results of the chosen approach.

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Objectives: 1.Define xanthelasma
2.Discuss two cases of patients with xanthelasma
3.Discuss the Plasma Technology used in this case for the treatment of xanthelasma

Introduction: Xanthelasma is a benign tumor originating from xanthomatous cells which infiltrate the eyelid dermis and its presence may or may not be associated with hypercholesterolemia. Besides the drug treatments for underlying disease, plasma technology currently presents as a noninvasive blepharoplasty for lesions. Plasma technology is an innovative treatment technique that blends principles of physics and biology demonstrating applicability in various aesthetic and functional procedures.

Materials / method: Case report of two patients, using evolution data after procedure, both performed in a clinic in
Brasilia, Brazil by a certified plastic surgeon. A search was performed on Scielo and PubMed, searching for the term
“plama technology” and “xanthelasma” in English and Portuguese.

Results: In this study, we describe the use of this technology for the treatment of xanthelasma in two patients who had
lesions mainly in the upper and lower medial region of the eyelids, bilaterally. Plasma technology was applied, which
has as its principle the emission of electrons from the helium gas, which generates warming and consequent selective destruction of certain cell types. After the treatment, satisfactory results were obtained with almost complete remission of the lesions without any adverse reaction or complications.

Conclusion: Plasma technology proves to be an innovative form of treatment for xanthelasma, providing a noninvasive
option with less risk to patient health. As it is a recently developed technique, further studies are needed to
demonstrate its use, results, benefits and specific indications in the aesthetic and functional medicine.

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Objectives: 1. Demonstrate the technical resource of cell therapy using the Micrografting Technology Device (MTD) in a case of idiopathic frontal alopecia

Introduction: The Micrografting Technology Device (MTD) consists in the use of a hair follicles cell population rich in progenitor cells capable of improving tissue repair. This study suggests that the regions encompassed by the treatment suffered increased metabolic activity, corroborated by hair growth in the region. Scalp tissue was removed in the occipital region in which there is the least ultraviolet cellular damage.

Materials / method: Scientific articles obtained from the Pubmed and Scielo platforms were selected with the proposal of adressing Micrografting Technology Device (MTD) cell therapy in cases of alopecia. The keywords "alopecia", "idiopathic alopecia" and "micrografting" were used in english and portuguese. Articles relating the use of MTD in alopecia were analyzed. A case of female patient with frontal alopecia after the use of the aforementioned technological device was also analyzed.

Results: The patient in the present study demosntrated effective hair growth after MTD session, having the alopecia area filled with new hair follicles, a result that was corroborated with the literature review, demonstrating effective and promising hair growth in regions of alopecia area after the use of the device.

Conclusion: The MTD has been shown to be promising in the treatment of alopecias and a therapeutic option that does not replace hair transplantation. Nevertheless, MTD represents an option of not only lower rates of morbidity, pain, but also less invasive with no downtime.

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Objectives: •More than 5.4 million cases of NMSC were treated in over 3.3 million people in the US in 2012*.

Introduction: •The accuracy of skin cancer screening prior to biopsy is ~70% (including GPs), individual-dependent.
•There have been several in vivo skin cancer screening devices based on non-invasive techniques. (e.g, multi-spectral imaging, Raman spectroscopy and electrical impedance spectroscopy (EIS)), but their diagnostic accuracies were not sufficient for clinical use.
•We developed a novel skin cancer diagnostic device based on laser spectroscopy and machine learning algorithms with superior diagnostic ac

Materials / method: 1) The light is collected from the micro-plasma induced onto the skin by a Q-switched Nd:YAG laser.
2) Chemical information including ionic, atomic and molecular composition of the irradiated skin lesion is extracted from the emission spectra.
3) Raw emission spectra is processed through intensity normalization and principal component analysis to extract the effective wavelength features
4) A DNN (deep neural network) is trained with the spectral data set labelled with biopsy results to construct the classification model. The algorithm determines the probability

Results: •The cancer cell proliferation and apoptosis are significantly related to the changes in cytosolic ion concentration.
•Ionic and molecular spectral features of tissues combined with machine learning algorithms can act as unique criteria for discriminating malignant lesions from benign ones.
•Multi-site studies at Newcastle Skin Check, Charlestown, Eastern Suburbs Dermatology, Bondi Junction and The Skin Cancer and Cosmetic Clinic, Neutral Bay, all in NSW, Australia were designed to evaluate the effectiveness and safety of the device.
•Total 364 patients were recruited in three different sites.

Conclusion: • Pathologic diagnosis-based cancer detection is considered to be time- and labor-consuming, individual-dependent sometimes.
•This real time, non-invasive, in vivo skin cancer detection device based on non-discrete molecular LIPS and machine learning algorithms demonstrated high sensitivity (~98%) and specificity (~86%) for discriminating skin cancers from benign lesions.
•The device showed promising results which could be helpful in an office-based cancer screening and real-time on-site cancer detection during skin cancer surgeries.

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Objectives: The scientific clinical work aims at elaborating on the treatment method for chronic acquired hypermelanosis skin disorders in patients with Fitzpatrick skin. types IV & V with more efficacy, no side effects, and no downtime.
The work further aims at decreasing the number of treatment sessions needed to achieve full elimination of hypermelanosis.

Introduction: Chronic hypermelanosis skin disorders are frequent among people of colored skin, especially Fitzpatrick skin types IV - V, though theoretically, any skin type may get affected as such. A chronic acquired skin hypermelanosis, such as facial melasma affecting mainly women, especially during the premenopausal period (some 5 - 10 years before menopause) and as chloasma during pregnancy. Due to frequent facial and neck involvement, hypermelanosis has a significant impact on the quality of life of patients.

Materials / method: Pixelated Q-Switched Nd: YAG 1064 nm laser treatment was applied at the level of various skin layers with different tips that differ in focal depth, delivering the laser as stacked and short but powerful microscopic beams of light into the dermis and epidermis without harming the latter.
The microscopic laser beams parallelly create short microscopic channels at various skin layer levels under the epidermal surface for stimulating collagen regeneration and convert into photo-acoustic energy that breaks the pigmentation granules into microparticles for consequent evacuation.

Results: Cases of melasma, dark eye circles, various forms of acanthosis nigricans, hyperpigmentation due to sun damage, and other types of hypermelanosis were successfully treated without any pain, side effects or downtime.
The number of treatment sessions was significantly decreased by around 50 % compared to traditional Q-Switched Nd YAG 1064 nm laser treatments for various types of hypermelanosis.

Conclusion: By avoiding damage to the skin surface, the stratum-oriented stacked & pixelated Q-Switched Nd: YAG laser treatment gives instantaneous results of hypermelanosis clearing without any pain, side effects, and downtime.
All hypermelanosis cases were epidermo-dermal.
The stacked & pixelated laser treatment is highly effective for hypermelanosis in patients of skin types IV & V with the multistrata-oriented approach.
The stratum-oriented, stacked & pixelated Q-Switched Nd: YAG laser treatment is safe for skin types IV & V, including the problematic and sensitive ones.

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Objectives: To propose a safe gluteal augmentation technique with polycaprolactone

Introduction: Gluteal augmentation is desired by many patients worldwide. Former non-surgical techniques with fillers have thrived, mainly in the submuscular plane, currently deemed unsafe by some authors. We present a safe hypodermis technique for gluteal projection and volume remodeling, using polycaprolactone (PCL) filler/ stimulator of collagen.

Materials / method: A total of 72 patients underwent gluteal augmentation with PCL in our private setting from January 2019 to December 2019. Data collected included demographics, previous procedures, volume and technique data, and postoperative outcomes. Klein Solution was used as anesthetic. Minor side effects, such as pain, ecchymosis and discomfort were common (70.5% of subjects), but short-lived and easily tolerated.

Results: 100% of patients (all female) underwent the procedure with at least 7ml PCL for lateral augmentation (trochanteric fossa) and at least 15 ml PCL for posterior gluteal projection. The patients’ mean age was 35 years, and the mean volume injected per first session was 20ml. The only late onset adverse effect was post-inflammatory hyperchromia, with resolution after topical heparin and depigmenting agents, compressive shorts and oral pycnogenol use.

Conclusion: We hereby demonstrate that hypodermic use of PCL for gluteal augmentation is safe and satisfactory when used up to 20 ml per session in hypodermis. In addition, the product’s longevity may be chosen for this treatment, from 1 to 4 years. We suggest that PCL may be safely used in other body remodeling treatments.

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Objectives: Evaluate the use of high power radiofrequency in the remodeling and elimination of abdominal fat

Introduction: INTRODUCTION.- The radiofrequency devices are an ideal option in treatment of non-invasive fats and body sculpture, they use electrical conductance and oscillating movements of energy, it`s transmitted to polar structures in cells that are in the electrical path, increasing intermolecular movement. Alternately, the molecular collisions, creating thermal energy. RF, uses the resistance (impedance) of the tissue itself generating heat instead of transferring it directly and changes in membrane polarity, trigger of cascades and signaling. Adipocytes have high tissue resistance

Materials / method: SUBJECTS AND METHODS.- 10 Women with an average age 56 ± 9.08 years, the procedure was explained and signed their consent. 15 RF sessions with a CPENERGY C200, with a periodicity of 2 times per week, the frequency was 1,2 mHz during 15 mts automatic plate, 15 mts capacitive and resistive at the same time, and 15 mts of lymphatic drainage were applied. Measurements of Abdominal Circumference, Body weight were performed and % of body fat was measured using Inbody impedance equipment.

Results: RESULTS AND DISCUSSION.- The measurements of the abdominal diameters decrease after RF 99.23 cm before and 95, 79 after p = 0.021 the measurement of the abdominal fat by ECO also decreased p = 0.016 which allows to affirm that the RF is an effective method Non-invasive for the decrease of body fat and the appearance of the skin of the abdomen.

Conclusion: CONCLUSIONS.- The use of high power radiofrequency is a harmless and effective harmless procedure for the reduction of abdominal fat and its remodeling

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Objectives: To share an interesting novel approach to treat hyaluronic acid filler complications using a high dose bolus of a less immunogenic hyaluronidase.
To demonstrate the efficacy of using high dose hyaluronidase.
To share photographic evidence of the fast onset of action of bacterial recombinant hyaluronidase.

Introduction: Hyaluronidase is perhaps the most important enzyme in the medical aesthetics field. The relevance behind this enzyme lay within its ability to be the direct antidote of exogenous hyaluronic acid.
The first type of hyaluronidase available was animal origin, followed by human hyaluronidase. Nevertheless, in recent years a new type of hyaluronidase has taken relevance: the bacterial recombinant hyaluronidase.
Bacterial Hyaluronidase has a less immunogenic profile due to its lack of glycosylation. All of this takes relevance when a complication needs large amounts of hyaluronidase to be solved.

Materials / method: We present the case of a 43-year-old woman who came into the clinic 7 days after a bilateral zygomatic filler procedure.
During the physical examination, 2 painful nodules of 3cm were observed on each zygomatic process. After explaining to the patient that the filler needed to be diluted to relief the pain and correct the nodules, she gave consent to be treated with bacterial hyaluronidase. After disinfection, a bolus of 1ml of saline solution containing 25 microkatals of bacterial hyaluronidase was injected per side. Serial pictures were taken after 1, 15 and 30 minutes postinjection.

Results: As the photographic sequence can show, the enzymatic activity onset is immediate. The first picture was taken 60 seconds after the injection showing partial dilution and collapse of the nodule. The second picture shows the nodule with almost 50% of its content collapsed while the third picture, taken 60 minutes after the injection presents the affected area with a 90% reversal.
Control pictures taken 7 days after the reversal procedure shows the patient without any residue of the hyaluronic acid nodules.

Conclusion: In conclusion, this successful resolution was achieved using a high dose bolus of bacterial hyaluronidase, without having any secondary effects such as an allergic reaction or immune response. This translates to therapeutic success in the treatment of all kinds of complications especially in vascular occlusions or impending necrosis cases were each minute is vital to solving the situation without further complications.

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Objectives: This clinical study was conducted to evaluate subject satisfaction with a twice-yearly re-treatment period with AbobotulinumtoxinA (ABO). Interim results from the first six months are presented here. The primary endpoint is subject satisfaction at 12 months, assessed by direct questioning of the subject. Secondary objectives include subject satisfaction, subject-reported FACE-Q scores, and glabellar line severity scores (GLSS) among others. Adverse events were recorded.

Introduction: Real-world re-treatment intervals of abobotulinumtoxinA (ABO) are frequently longer than the manufacturer-recommended minimum interval (3 months). Studies with ABO have shown that median re-treatment periods range from 5 to 6.5 months and subject satisfaction with treatment remains high through six months, suggesting this may be the preferred treatment interval for ABO.

Materials / method: This open-label, multi-center, interventional study evaluated subject satisfaction following on-label injections of 50 U of ABO at baseline and 6 months. An optional re-treatment will be performed at 12 months. 120 subjects were included from 6 centers in the US. Assessments included subject satisfaction by questionnaires, FACE-Q appraisal of psychological well-being, glabellar line severity scores (GLSS), time to onset of treatment effect, and adverse events.

Results: Subjects remained satisfied with their first treatment through 6 months and were ‘satisfied’ or ‘very satisfied’ with the aesthetic outcome at 1 (98%), 3 (86%) and 6 months (75%). Improved psychological well-being at 1 month compared to baseline was shown (Rasch mean total score 83.3±19.2 vs 31.6±18.2) and results continued to be improved at 6 months. Subjects reported a median onset of effect of 2 days and 37.2% of subjects had at least a 1-grade improvement from baseline in investigator-assessed GLSS at 6 months. Only one treatment-related AE was reported.

Conclusion: In this twice-yearly re-treatment study with ABO subjects were satisfied through 6 months after a single 50 U injection of ABO and there were no safety concerns. Treatment resulted in high subject satisfaction scores, improved overall psychological well-being and at 6 months approximately 37% of subjects still had at least a 1-grade improvement in GLSS.

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请注明名称（个人，公司，学会等等）: This was a Galderma sponsored study

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Objectives: Objective
To demonstrate the effectiveness of minimally invasive procedures in the treatment of cervicofacial contour according to the main clinical indication.

Introduction: Cervicofacial flaccidity affects both males and females, but for women with advancing age, worry about appearance makes them feel uncomfortable, their self-esteem affected and, consequently, having negative influences on biopsychosocial aspects. With the advancement of techniques, the demand for minimally invasive procedures has increased significantly, and it is a challenge to properly treat this region that classically requires surgical methods.

Materials / method: Material and Methods.
Retrospective analysis of all patients treated at a private clinic from 2017 to 2018, complaining of loss of cervico facial contour, undergoing minimally invasive treatments, stratifying the reason for indication and treatment outcome. The clinical characteristics analyzed were presence of hypomentonism and degree of skin laxity (soft, moderate, intense), associated with treatment efficacy after photo analysis and report of patient satisfaction (excelent, regular, poor).
Patients without adequate photographic documentation and submitted to surgical treatment were excluded

Results: 30 patients with avarage age of 47 years (27 - 70), all women, were included in the study (Table 1). Among the clinical characteristics, 60% had moderate flaccidty, and 36% had hypomentonism.
Among the treatments performed, the most common were threads (43%), followed by fillers (40%), and microfocus MFU ultrasound (16.7%). Results were rated excellent at 53.3%, regular at 36.6%, and poor at 10.1%.

Conclusion: The well-defined cervicofacial contour is synonymous with beauty and youth, and is directly affected as first signs of aging start to occour. Bone, fat pads, and elastin degradation, with consequent tissue ptosis are the main factors that alter the facial contour. Among the clinical factors studied, hypomentonism associated with soft skin laxity were the main predictors for an excellent result.
Minimally invasive procedures are effective in treating cervicofacial contour, especially in patients with soft skin laxity associated with hypomentonism, when treatment is directed to both.

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Objectives: Psoriasis, a common, chronic, relapsing, inflammatory skin disease characterized by multiple erythematous papules and plaques with silvery scales, affects 0.5% - 3% of the world’s population. Topical treatment remains important but, unfortunately, are not often very successful because of limited penetration of the active ingredient through the stratum corneum.

Three cases are presented in which was evaluated the effect of an injectable treatment based on hybrid stable cooperative complexes of high and low molecular weight hyaluronic acid (HCC) in adult patients affected by psoriasis.

Introduction: Psoriasis is characterized by excessive proliferation and abnormal differentiation and apoptosis of keratinocytes. Hyperproliferation of keratinocytes is associated with the induction of a variety of cytokines, such as TNF-α, IL-22, and IL-17, while causing keratinocytes to produce chemokines, cytokines, and antimicrobial peptides, thereby aggravating the inflammatory response.

HCC can provide wound healing capacity, anti-inflammatory and biostimulating effect, and can also activate other signaling pathways through the interaction with cell membrane receptors such as CD44, TLR-4, and RHAMM.

Materials / method: Two females aged 37 and 55 years old, and a male aged 45, with frequent recurrence of psoriasis plaques not adequately controlled with topical treatment underwent the HCC procedure.

The injectable method used was intra and perilesional deep-dermal bolus for 2 cm2 of treated area with 0,2 mL per bolus.

We used this technique to improve spreadability of the products and to reduce possible side effects.

No serious side effects were observed, with the exception of a single bruising in one session, which healed without scarring or complications within 48 hours.

Results: The injection of HCC produced a continuous, gradual therapeutic effect with significant improvements consistently decreased in a dose-time-dependent manner, with reduction in redness, desquamation, scaling and reduction in pruritus. Also, there is a macroscopic improvement on skin texture.

Conclusion: This report sought to demonstrate that HCC treatment was effective in attenuating inflammation and maintaining the skin barrier in psoriasis.
These results imply that HCC may alleviate the symptom of psoriasis through the wound healing activity, modulation of keratinocytes, the maintenance of lipid barrier in epidermis, the regulation of mast cells activation and downregulation of inflammation. In conclusion, HCC could be used as an alternative therapeutic approach in the management of psoriasis. Further studies about detailed mechanism of these protective immune responses are needed.

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请注明名称（个人，公司，学会等等）: GS has received advisory/speaker honoraria and/or research funding from IBSA.

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请注明名称（个人，公司，学会等等）: GS has received advisory/speaker honoraria and/or research funding from IBSA.

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Objectives: Assessment of the possibilities of diagnosis and surgical correction of the consequences of introducing vaseline oil into soft tissues for aesthetic purposes.

Introduction: Recently a category of patients undergoes injection of considerable quantities of vaseline oil in soft tissues with the aim of correcting the volume and shape of organs, has been appeared. Nowadays, soft-tissue augmentation with large amounts of any foreign material and these types of procedures have been abandoned by health professionals and plastic surgeons all over the world. The administration of small doses (from 1 to 5 ml) of injectable preparations, mainly absorbed within 6-12 months, is permitted and widely used to correct minor contour defects of the face, wrinkles, and soft tissue.

Materials / method: This is our experience of surgical treatment of 15 patients who applied to us at various times with the consequences of the soft tissue augmentation with vaseline oil in mammary glands, buttocks and lower legs. There were 9 (60.0%) patients with vaseline oil introduced into one zone, into two zones - 5 (33.3%), and one woman (6.7%) into three zones. During the examination, all patients underwent ultrasound, MSCT - 14 patients, MRI - 11 patients. Migration of vaseline oil to adjacent anatomical areas was observed in 10 out of 14 patients.

Results: Multiple-stages surgical treatment was performed (1-8). In addition to excision of tissues affected by fibrosis and oleogranulomas, reconstructive surgeries to restore the volume and contours of the organs were performed. Overall 47 operations were performed with 7 (14.6%) complications: divergence of the wound edges (2), regional ischemia (2) and regional necrosis (2) of the skin graft, infection with the subcutaneous (over the displaced muscle flap) seromas (1).
Good and satisfactory treatment outcomes were in 5 patients, 10 patients still require mostly reconstructive interventions.

Conclusion: The complexity and multiple-stage of surgical treatment for those patients were associated with a large volume of tissue damage in several anatomical areas, the migration of vaseline oil to neighboring areas, the impossibility of single-stage elimination of the lesion and one-stage reconstruction. The most effective examination volume for such patients is ultrasound + MRI (without contrast enhancement, no radiation exposure). Intraoperatively, after preliminary preoperative navigation when combining ultrasound+MRI (if it’s necessary), the ultrasound help to more accurately localize the lesion.

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Objectives: The greatest cosmetic effect of the correction of complications after lip augmentation and ‎contour correction is achieved with a clear preoperative assessment of the situation and revealing the true volume of the lesion.
Currently, the US research method using various modalities allows non-invasively, without radiation exposure and with minimal financial costs to assess the condition of superficially located soft tissues of a person, including after plastic surgery.
We present the possibilities of US in identifying complications after lip augmentation and ‎contour correction.

Introduction: Lip augmentation and ‎contour correction is one of the most popular and effective methods of rejuvenating and eliminating cosmetic defects. This method implies the introduction of special preparations under the skin in problem areas that fill the voids, saturating the skin with moisture, making it elastic and elastic. Contour correction of the face soft tissues is ubiquitous, you can sign up for it in almost every second cosmetology salon, as a result of which the question of helping patients with complications is the introduction of various types of drugs is currently relevant.

Materials / method: In the period from October 2013 to the present, 212 patients aged 24 to 65 years were examined and treated with complications after lip augmentation and ‎contour correction. Patients were divided into three groups: Group 1 (N = 152; 71.7%) after introduction of the biopolymer gel; Group 2 (N = 16; 7.5%) - after the introduction of a polyacrylamide gel; Group 3 (N = 44; 20.8%) - after introduction of hyaluronic acid preparations. US was performed on all patients in the preoperative period and then either in the postoperative period or with dynamic monitoring of the patients' condition.

Results: Group I: the lips soft tissues were replaced by hyperechoic diffuse masses with the effect of suppressing the echo signal to the periphery of the image.
II group: in the lips soft tissues visualized delimited an- and hypoechoic round or polycyclic avascular structures (geleomas) of varying severity, around these tissue structures were expressed densified, increased echogenicity.
III group: the US-image depended on the prescription of the drug. The vascular pattern of the lips has been preserved. The introduction of hyaluronic acid may in some cases be accompanied by an inflammatory reaction.

Conclusion: The patients were treated in the following volume: conservative - 40 (18.9%); surgical - 137 (64.6%); combined - 35 (16.5%).
US-studies of the condition of the soft tissues of the lips and nasolabial folds after contour correction can effectively assess the situation, identify the complications that have arisen, and correct or eliminate them. If necessary, US-monitoring of the state of soft tissues is possible.

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Objectives: Due to the rather rare frequency of occurrence of soft tissue sarcomas, there is a problem of the lack of alertness of doctors in their regard, there are no screening programs. The disease clinical picture is non-specific and often erased. As a rule, patients independently palpate the lesion of some part of the body, or pay attention to a change in the skin. In this case, before the appearance of any clinical symptoms, the tumor performs intermuscular spaces, interfascial and intersynovial sheets, perivascular and perineural spaces. We present dermatofibrosarcoma diagnosis and treatment datas.

Introduction: Dermatofibrosarcoma is a rather rare tumor related to soft tissue sarcomas (2-6% of soft tissue tumors). This type of tumor is characterized by a slow growth rate, a recurring course of the process, and rare metastasis. Treatment of patients with soft tissue sarcomas is one of the problems of modern oncology, which surgeons, radiologists and chemotherapists are working to solve. To prevent recurrence of tumors in surgery, these tumors follow the principles of radicalism, which entails the formation of extensive wound defects, requiring a number of plastic surgical interventions.

Materials / method: We consider a clinical case of a man (37 years old) diagnosed with the recurrence of soft tissue tumor. In January 2014, the patient noted the tumor-like lesion in the left inguinal region with a transition to the anterior abdominal wall; he turned to a medical clinic in March, where the tumor was excised (histology: fibroma). Six months later, the tumor reappeared in the same area, a second tumor was excised (histology: benign fibrous histiocytoma). Six months later, in the area of the postoperative scar, tumor appeared for the third time.

Results: After MSCT and MRI, surgery was performed: tumor wide excision with a part of the sartorius muscle, inguinal ligament, resection of the large saphenous vein, fascia, lymph nodes, tumor bed cryosurgery, plastic reconstruction of the defect with musculus tensor fasciae latae. The morphology: dermatofibrosarcoma. The tumor penetrated the subcutaneous fatty tissue, involved the lymph nodes, grew under the fascia, sprouts the dermis with ulceration, into the skeletal muscle. Tumor elements wasn't at the edges of the resection. The patient was discharged in satisfactory condition for chemotherapy.

Conclusion: Dermatofibrosarcoma initially appears on the skin as a plaque without clinic, which, as a rule, isn’t paid attention to. Rapid growth rates with the formation of several tumors nodes protruding above the surface of the skin are observed in the future (infiltrative type of growth). The tactics of treatment of such patients should, first of all, be based on radicalism, as well as subsequent plastic surgeries to close soft tissue defects. The given clinical case shows low alertness of doctors in terms of soft tissue sarcoma and the absence of the principle of radicalism when performing surgery.

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Objectives: 1. To demonstrate the superiority of a crosslinked hyaluronic acid filler designed for superficial dynamic wrinkles (RHA1, TEOXANE S.A. Geneva, Switzerland) versus a No-Treatment control at Week 8 for the correction of moderate-to-severe dynamic perioral rhytids, based on the validated Perioral Rythids Severity Rating Scale (PR-SRS) as rated by a Blinded Live Evaluator (BLE).

2. To evaluate the safety of RHA1 for up to 52 weeks following the last treatment.

Introduction: Lips and the perioral area are of outstanding importance in youthful appearance, attractiveness, and beauty. Perioral rhytids affect more than 90% of women throughout their lives, and the impact on patients' self-esteem affect quality of life in psychological and sociocultural assessments.

A range of resilient hyaluronic acid (RHA) fillers for aesthetic treatments has been developed specifically to treat rhytids while respecting facial dynamics. The perioral region may be considered the most dynamic facial area.

Materials / method: Randomized, blinded, no-treatment control, multicenter, prospective clinical trial (ClinicalTrials.gov NCT03092219) in 6 US and 2 Canadian sites.
Target population : Male or female, ≥22 yrs old with moderate-to-severe perioral rhytids (PR-SRS grade 2 or 3 on a 4-grade scale [0-3])

Subject randomization: 3:1 treatment :control group
RHA1 injections: Initial (Day 0) + optional touch-up (D14)
No-Treatment control group crossed over to treatment at Week 8.

Safety and effectiveness evaluations conducted at Weeks 4, 8, 12, 16, 24, 36, and 52 after last treatment and 4 weeks after final treatment

Results: Primary Endpoint: PR-SRS responder rate at 8 wks for RHA1 ≥ 70 %, statistically superior to the No-Treatment control responder rate, difference ≥ 50 points.
Responder = subject with ≥1-grade improvement on PR-SRS at Wk 8 after final treatment. Two-sided 95% Confidence Interval on responder rates.

Secondary Endpoint: Aesthetic improvement significantly higher for RHA1 treated (92.5%) compared to no-treatment group (8.3%) at wk 8.

Exploratory Endpoint: Marked durability of RHA 1 with PR-SRS responder rates (BLE assessment) ≥ 66% up to 52 wks.

Safety Analyses: Treatment safe and well tolerated

Conclusion: Study primary endpoint was met: RHA1 was superior (P<0.0001) to No-Treatment control for correction of perioral rhytids. All secondary outcome assessments (FACE-Q, GAI, and Subject Satisfaction) supported primary outcome assessment.

Effects of RHA1 were robust and durable throughout the evaluation period of 52 wks.
RHA1 was safe and well tolerated. Higher Fitzpatrick skin phototype was not associated with higher rates of TRAEs.

TRAEs: mild to moderate self-resolving injection site bruising (10.5%) and contour irregularities (17%). No late onset TRAEs, nodules or intravascular injection.

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请注明名称（个人，公司，学会等等）: Principal Investigator, US FDA Phase III study, Teoxane Laboratories

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请注明名称（个人，公司，学会等等）: Research Grant, Teoxane Laboratories

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Objectives: report the case of a female patient with a rare case of an sclerosing desease with an unusual genital presentation, and the treatment used with fat grafting with great post operative results.

Introduction: Localized scleroderma, also known as morphea is considered as a chronic and inflammatory disease which consists of vascular and dermis damage leading to a sclerotic condition of the skin, soft tissues, and even bone structures. It is considered a rare disease with an incidence of 0.3 to 3 cases per 100.000 habitants/year . About 50% of cases go into remission in 2.7 years (2). Several treatment options have been proposed with varying results. The use of fillers have been described with the use of substances like hyaluronic acid, collagen, silicon and fat transfers

Materials / method: for the presentation of this paper, we chose an e poster of a clinical case.

Results: great immediate post operative and mediate results were obtaines after the injection of 200 cc of fat and 45 cc of microfat in afected area.

Conclusion: Autologous fat transfers have been used for several years as a surgical approach to deformity repair after different types of sclerodermic diseases. This technique has been used for local volume restoration with satisfactory results. Some studies indicate that almost 45% of the volume of fatty tissue inserted can be reabsorbed after one year, this is why a strict following of the clinical aspect must be performed every 3 to 4 months to decide the need of future procedures. At the end of the surgery not only has the aesthetic aspect of the skin improved, and the quality of life of the patient

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Objectives: The study was established to objectively assess the effects and to evaluate the efficacy and safety of BIOHAIR® 5% & 2% in male & female hair loss.

Introduction: Hair loss usually develops gradually and may be patchy or generalized (diffuse) as shown in FIG. 1. A person loses about 100 hairs from his head every day. The average scalp contains about 150 000 hairs. Each individual hair survives for an average of 3 to 5 years. Generally, the hair falls in its fifth year and is replaced within 6 months by a new one.

Materials / method: A phase 2 before and after trial was carried out on 50 patients with hair loss for 46 months at the Aesthetics Clinic Geneva, Switzerland. Inclusion criteria were men with (MPHL) between 30 and 70 years old, the female with (FPHL) between 20-50 years with normal health status, and providing written informed consent.
Exclusion criteria were sensitivity to BIOHAIR®, using any topical OTC or prescription medication for hair growth within the past 3 months, using 5-a reductase inhibitors within the past year, using isotretinoin within the past year, chemotherapy within the past year....

Results: 50 volunteers were enrolled in this study for 16 weeks, and 10 continued up to 24 weeks to assess the treatment response, showed a 78.6% improvement in treatment response. This outcome confirms the result. In our study, an expert panel review by global photographic assessment, which is a useful follow up tool. Our results showed that the participants were satisfied with the drug efficacy at week 16 (50.2%) satisfied and week 24 (78.6%) very satisfied....

Conclusion: Hair loss is one of the most prevalent dermatological illnesses that cause patients to seek treatment. There are limited options for treating it effectively. This is why hair loss remains an important area for further research to obtain more information regarding its pathogenesis and newer therapeutic options that are now being developed. The study indicates that BIOHAIR® is highly effective treatment for Alopecia in men and women it can increase the growth of new hairs count and density. The study indicates that BIOHAIR® is safe in men and women.

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这项工作的完成感谢以下机构的支持： Qatar Pharma

Objectives: 1. Introduce the technology of Cold Machine as an innovation for slimming
2. Discuss how Cold Machine burns calories in the form of Subcutaneous Fat & Visceral Fat
3. Show the average results of Fat Loss, Inch Loss, & improved Health Risk Factor

Introduction: Many studies have been done to show that Cold Exposure increases Calorie Burning thru increased Non-Shivering Thermogenesis (NST), increased putative Brown Adipose Tissue (BAT) activation, and increasing the Resting Metabolic Rate (RMR). But there has been no documentation on its end result of producing weight loss (gross), inch loss (decreased waist circumference), as well as decreased fat mass (fat reduction). Cold Wraps have been used by slimming centers since the 1960’s to lose weight by thermogenesis and recently, they have converted to Cold Machine treatments.

Materials / method: A chronologic sample of 41,098 slimming treatments of 1,859 patients coming from 11 aesthetic centers in the Philippines with Cold Machine slimming programs consisting of 13,638 Cold Machine treatments were collated from November 4, 2014 to July 29, 2015. A random sample of 10 patients per center that fit the Inclusion & Exclusion Criteria was then used. After applying the Inclusion & Exclusion Criteria together with the Random Sampling, only 1,028 Cold Machine treatments of 106 patients remained.

Results: The average weight loss per Cold Machine treatment is 0.5 lb (median), 0.5 lb (mode), & 0.4 lb (mean). After completing 8-12 Cold Machine Treatments, the average Body Mass Index decreased by almost one (0.77338 kg/m2) with 13% changing their BMI classification. The average Inch loss is more than 1 ½” (1.518 inches). Health Risk Factor was lowered in 32%. Using a Body Composition Analysis machine (Impedance Method), it was noted that 77% decreased their Total Body Fat Percentage, 31% lowered their Visceral Fat Rating, while 77% decreased the Subcutaneous Fat volume in their Tummy Area.

Conclusion: Cold Treatment using the “new” Cold Machine mimics the same approximate weight loss result of the “old” Cold Wraps (0.5091 lb vs. 0.5195 lb, respectively). It is an effective treatment for Fat Reduction and decreasing Waist Circumference, as well as lowering of Health Risk Factor.

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Objectives: 1. Discuss the step-by-step process on how excess fat deposits under the skin (Deep SC, Superficial SC, Dermis)
2. Theorize on pressure gradient produced locally that surpasses venous drainage but still lower than arterial pressure where cellular leakage produces lymph
3. Learn about Skin Fold as a pre-requisite in Positive/Negative pressure used by vacuum/suction in combination with metal/plastic, bearings/rollers to hit fatty tissue & drain the lymphatics
4. Emphasize on centrifugal vs. centripetal techniques in pathways towards Lymph Nodes, down the Cysterna chyli, ascending Thoracic Duct

Introduction: Visceral Fat can be decreased thru proper diet and correct exercise. Take note that some diets can make you gain more fat while some exercises can make you gain more weight. Deep Reserve Fat Layers of the Subcutaneous is typically removed by liposuction. On top is the Superficial Fat Layer of the Subcutaneous specifically removed by EBDs including LASERs. At the surface is the damaged Dermis & Epidermis which protrude outwards causing the orange-peel cellulite appearance. This is where Skin Curving machine treatments where lymphatic drainage is the mechanism of action come into play.

Materials / method: The Reserve Fat Layer has fat cells wide apart w/ good lymphatic spaces in between. The venous drainage is also patent & dilated. When you over-eat & don’t do any physical exercises, fat will deposit here initially. When this fills up & continues to deposit fat, it will now be deposited in the Superficial Fat Layer where fat cells are well-organized into groups. There are lymphatic spaces in between cells and lymphatic spaces in between each group of fat cells. They will grow and impinge on each other (hypertrophy in deep & hyperplasia in superficial) causing constriction of venous drainage.

Results: To address cellulites, the liquid fat inside fat cells has to be drained via the lymphatics. Any pressure towards the body or towards the heart is Positive Pressure while any pressure away from the body or away from the heart is Negative Pressure. This is what happens when you produce a Skinfold and drain it naturally via the Lymphatic Pathway. Within the skinfold is the epidermis, dermis, and subcutaneous fat. The technique is to move the skinfold (glide/slide) to the nearest lymph nodes locally. This can be done systemically using pneumatic machines simulating normal lymphatic drainage.

Conclusion: The abnormal anatomical changes and histopathology of cellulites is multifactorial. Lymphatic drainage to relieve the local inflammation due to buildup of pressure secondary to excess fat deposition genetically dictated by estrogen (post pubertal women) is just one solution. Adding any energy (RF, IR, RL, EMF, DMA, TENS) for Subdermal Heating will help in collagen remodeling (collagen contraction, neocollagenesis, neovascularization) but only after the fat cells and surrounding lymph around them is addressed first. The best is actually a combination for synergy of their individual strengths.

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Objectives: Objective: to evaluate the impact of melanoidins as an adjuvant to sun protection.

Introduction: Introduction: Bloom syndrome (BS) is a rare autossomic recessive genetic disorder. Patients present with telangiectatic, painful, photosensitive facial rash, "café au lait" macules and skin hyperpigmentation and require a careful sun protection in order to avoid cumulative skin damage and malignancies.

Materials / method: Materials and Methods: coffee beans were grown in Guaxupé and the melanoidins were obtained by subcritical extraction in water, in which the variation of dielectric constant with temperature optimizes the process. These melanoidins were generated in a condition rich in chlorogenic acid and have a large spectrum of protection, for UVA and UVB and an extended half-life (10 hours).
The family enrolled for this study consisted of 5 siblings, 4 males and 1 female, aged between 12 and 24 years, with BS and multiple skin abnormalities exacerbated by sunlight (photo 1). In the first 90 days, they rece

Results: Results: pigmentation and erythema improved significantly 90 days after melanoidins were introduced (p = 0.001). Additionally, quality of life was improved by reduction of social stigmata and physical pain associated to photosensitivity.

Conclusion: Conclusions: melanoidins confirmed its potential as adjuvant in rigorous and long lasting sun protection. Besides, although the melanoidins used here were produced under specific conditions, it is worth noting that melanoidins are a ubiquitous waste in coffee and sugar cane industry and its re-use in sun protection would represent an ecologic initiative ("upciclying").

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Objectives: The primary objective was to demonstrate non-inferiority of the injectable hyaluronic acid gel filler HARK versus a control in lip fullness augmentation at Week 8 after last injection (blinded evaluation). Secondary objectives were to evaluate the effectiveness and safety of HARK in lip fullness augmentation and correction of upper perioral rhytids.

Introduction: HARK is designed with technology that allows for natural, flexible movement in dynamic areas, and is approved in the EU for restoration or augmentation of lip volume. Among the injectable hyaluronic acid gel fillers that are available for lip augmentation and correction of perioral rhytids in the US, HAJV was selected as the control as it was most recently approved at the time of the study.

Materials / method: Treatment with HARK or control (randomized 2:1) was administered on Day 1 in this 48-week, controlled, evaluator-blinded multi-center study (NCT03320824). Optional touch-up was offered at Week 4. Primary endpoint was change from baseline to Week 8 in Medicis Lip Fullness Scale (MLFS) score. Secondary endpoints included lip fullness (MLFS), wrinkle severity (Wrinkle Assessment Scale), aesthetic improvement (Global Aesthetic Improvement Scale), subject satisfaction (FACE-Q scales) and adverse events throughout the study, and 30-day subject diary entries of local tolerability symptoms.

Results: The total mean volume of HARK injected in lips and upper perioral rhytids was approximately 20% lower than control. HARK was found non-inferior to control in lip fullness augmentation at Week 8; thus fulfilling the primary objective. Lip fullness improvement and correction of upper perioral rhytids persisted in ≥60% of subjects at Week 48 after HARK injection, and was accompanied by high aesthetic improvement and subject satisfaction scores. Treatment-related adverse events and local tolerability symptoms were predominantly transient and of mild intensity.

Conclusion: HARK was non-inferior to control in lip fullness augmentation at Week 8. HARK effectiveness was sustained throughout the study to Week 48 based on lip fullness improvement, correction of upper perioral rhytids, aesthetic improvement and subject satisfaction data. In terms of safety findings, HARK was well-tolerated. Considering both effectiveness and safety data, HARK was well-suited for lip fullness augmentation and correction of upper perioral rhytids.

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请注明名称（个人，公司，学会等等）: Galderma sponsored the study

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这项工作的完成感谢以下机构的支持： Galderma Aesthetics

Objectives: Strategic Implementation of Minimally Invasive Treatments for the Management of Facial Asymmetry

Introduction: Individuals who have asymmetrical appearance either in-born or acquired suffer from several self-esteem issues. This condition not just impairs ones psychological and emotional perception, but also in building of social relationships. Minimally invasive treatments have been great adjunct therapies for this condition and serves as an alternative when conventional surgical interventions were exhausted and results are not satisfactory. The role of aesthetic on this aspect is to improve the appearance and boost the self-value of an individual with facial asymmetry.

Materials / method: Eight subjects with dynamic facial asymmetry for more than a year have undergone combination treatments of minimally invasive procedures such as thread lifting, Botulinum Toxin A and fillers. Assessments were made through patient history, physical examination and 3D imaging. Physicians who have blindly evaluated results were shown the before, immediately after, after 2 weeks, a month and 3 months through the Global Aesthetic Improvement Scale.

Results: Depressed and atrophic areas have immediately benefited from the volumizing effect of fillers. Botulinum Toxin A on significantly improved facial muscles synkinesis after 2 weeks. The lifting effect of threads greatly improved facial asymmetry immediately after the procedure. 75% of the patients were evaluated as “improved” (3) immediately after the procedures. After 3 months, per the GAIS, 6 out 8 subjects noted “much improvement” (4) while the other 2 were evaluated as “very much improved” patients (5).

Conclusion: Facial Asymmetry as a common issue became an aesthetic issue in overall population and minimally invasive treatments would be great adjunct for the improvement of this condition. The goal of maintaining client dignity and preservation of self-value will always be something to focus on. The author hopes to further a study with more subjects on the efficacy of such minimally invasive procedures and come-up with more detailed and informative recommendations.

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