IMCAS

Importance of enhancing collagen in retinacula cutis: new scientific data and techniques

Objectives: - Understand retinacular cutis (RC) anatomy and physiology
- Recognize Treatment Goals
- Discuss different types of injectable solutions used for facial treatments, and understand how they interact with the skin's layers
- Perform facial assessment: learn how to perform skin assessment, including hydration, elasticity, TEWL, color and skin thickness
- Apply Injection Techniques with regards to facial ligaments and RC
- Conduct Safety Assessments: monitor and assess potential adverse reactions that may arise from injectable treatments
- Evaluate Treatment Outcomes, show before/after photos

Introduction: RC is a complex network of loosely interlaced collagen fibers that lies just beneath the skin: it is an extension of connective tissue from superficial fascia to the dermis, that connects the skin to the deeper layers of tissue, including muscles and bones, effectively suspending the skin, and allowing it to move in tandem with the body's movements. As we age, RC undergoes changes, which can contribute to visible signs of aging, such as sagging, and loss of skin firmness. Purpose: to assess safety, efficacy and the impact of proposed injection technique on skin and RC biophysical parameters.

Materials / method: Objective evaluation of skin properties (skin hydration, transepidermal water loss (TEWL), skin color (degree of melanin and erythema), elasticity, skin thickness and collagen density with the DermaLab Combo skin analyzing device (Cortex Technology, Denmark) was performed before the injection of HA based solution, 30- and 120- days after the injection, on 28 healthy female volunteers with consent form (age range 25-65 y.o). Each bolus was injected with regards to a specific ligament (lateral orbital thickening, zygomatic-cutaneous ligament, upper masseteric ligament, mandibular ligament, etc)

Results: We have registered the effectiveness and safety of injection technique with regards to facial ligaments, aimed to improve the quality of facial connective tissue, including the RC with HA-based injectable solution. The objective evaluation has proven the significant increase of skin hydration - by 18%, elasticity (by 20%) and collagen density (with ultrasound probe) - by 12%, compared to parameters taken before the injection. The TEWL hasn't changed, which proves the safety of the technique, which left the epidermal barrier intact. Skin color (degree of melanin and erythema) didn't change.

Conclusion: The skin analysis by Derma lab combo device proves the significant effectiveness of Ligaments technique with HA-based solution. The data recorded on the skin hydration, elasticity and density improvement is very encouraging, especially considering the minimal invasiveness of the procedure and the limited number of sessions required. The improvement of skin quality on the vast majority of cases occurs after the first treatment, and as the treatment protocol progresses, patients feelings and their individual assessment of skin quality also gradually improve. No adverse effects were encountered

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Non-surgical profiloplasty: how to harmonize the sinuosity of the face profile using fillers with different G prime and molecular weights

Objectives: This paper aims to illustrate how, exclusively with the use of dermal fillers of
hyaluronic acid (HA), it is possible to harmonize the sinuosity of the face and improve the Ricketts’line.

Introduction: The beauty of a face is based on aesthetic principles that emphasize the
importance of the ideal ratio of proportions between the various areas of the face. The ideal aesthetic approach to improve the overall appearance of the face profile is to
proceed with an overall profile assessment.

Materials / method: 143 patients (127 women 16 men) with an average age of 27
years were treated. The areas treated were: nose, lips and chin. The treatment was
performed using Hyaluronic Acid (HA) dermal fillers with specific rheological properties. In particular: for the rhinofiller was used a filler based on HA with high G prime and medium-high percentage of crosslinking with BDDE, injected with needle; for the lips and chin was used a filler based on HA (25mg/ml) characterized by high cohesiveness and good projection capacity, which was injected with personal technique, particularly effective and safe.

Results: Author illustrates his personal technique to non-surgical profiloplasty and shows
the excellent results obtained. Patient satisfaction exceeds 85% and gives a harmonization of the profile with minimal effort and maximum effectiveness.

Conclusion: Non-surgical profiloplasty is a valid and safe solution for facial harmonization
that leads to maximizing everyone’s beauty. In particular, the technique used is able to
achieve a high degree of patients’satisfaction, considering also the safety of the treatment but especially the duration of the results obtained.

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Ultrasound in non-surgical rhinoplasty: practical approach

Objectives: For Non-US users: to demonstrate the potential value of using ultrasound as a risk mitigation strategy of aesthetic complications including VOs and blindness, and also to demonstrate how pre-scanning can also potentially improve aesthetics outcome for our patients.
For US users: I will provide a practical imaging sequence that can potentially improve accuracy of scanning, and provide summary of the best up to date research data that can help us interpret our findings and translate them into sound clinical decision.

Introduction: Most filler-induced blindness cases been associated with NSR, although the subject of using ultrasound has been controversial, I will discuss and demonstrate an imaging sequence that can be utilised to assess the nose in an effective way that potentially can delineate the delicate anatomy and blood supply of the nose.

Materials / method: The complex anatomy of the nose and its blood supply has been the subject of many publications, I have attempted to summarise these findings and demonstrate their appearance on ultrasound.

I will cover as well the range of complications and how to assess/treat them with the use of US, including vascular compression and occlusion.

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Five-point liquid rhinoplasty: results from a retrospective analysis of a novel standardized technique and considerations on safety

Objectives: Background: Nonsurgical aesthetic improvement of the nose with hyaluronic acid (HA) fillers is becoming increasingly popular but comes with important safety considerations

Conclusions: The “five-point liquid rhinoplasty” is a simple and effective method de- signed to maximize safety. It offers a good alternative to surgery in selected patients.

Introduction: The use of minimally invasive aesthetic procedures continues to in-
crease across the world—including in Germany.
This trend is driven primarily by the growing popularity of injectable hyaluronic acid (HA) fillers and botulinum neurotoxin type A formulations. However, the nose remains an area of the face that is often considered to be more amenable to surgery rather than nonsurgical approaches. Indeed, an estimate from the International Society of Aesthetic Plastic Surgery
suggested that the number of surgical rhinoplasties performed
across the world increased by 13% in 2019 relative to 2018.

Materials / method: This was a retrospective, single-center analysis of consecutive eli- gible patients undergoing nonsurgical aesthetic treatment of the nose using HA fillers between April 2018 and October 2020. All were injected based on the standardized “five-point liquid rhino- plasty” technique. The study was conducted in accordance with the Declaration of Helsinki and subjects were required to provide writ- ten informed consent ahead of treatment.
Included patients were healthy females and males aged ≥18 years. All were assessed as having one of the following three main indica- tions for HA filler injection

Results: Twenty patients were included in the present analysis, of whom 15 (75%) were female and 5 (25%) were male (Table 1). The mean age was 37.8 ± 11.7 years (range: 23–62 years). All were Caucasian.
The main indications for treatment of the nose were: insufficient nasal projection, n = 11 (55%); nasal hump, n = 8 (40%); or deep gla- bella, n = 1 (5%). Most patients were treated using Juvéderm Voluma (n = 13; 65%) or Juvéderm Volux (n = 6; 30%), although 1 individual (5%) received Belotero Volume.

Conclusion: Increasing numbers of patients are presenting in clinic requesting
nonsurgical aesthetic improvement of their nose. The advent of novel HA fillers with optimized rheological properties has made these procedures more feasible for more patients than ever before. Our data suggest that the “five-point liquid rhinoplasty” technique offers an effective and simple-to-use method designed to maximize safety, with high levels of resulting patient satisfaction. It therefore provides a good alternative to surgical rhinoplasty in carefully se- lected individuals.

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Smart fillers: the new generation of dermal fillers (educational grant from AQ Skin Solutions)

Objectives: explain HA fillers and history
Explain new technology of smart filers
advantages and disadvantages of the new technology Vs old

Introduction: Dermal fillers made their first debut in medical aesthetics in the 1800s by using autologous fat. Then paraffin in the early 1900s until 1920 when it got abandon because of safety concerns and lack of long-term safety studies. In the late 1900s bovine collagen was used until the discovery of hyaluronic acid (HA) filler which first was under the name if Restalyne. Shortly followed by Juvaderm in 2003. Since then, many dermal fillers companies have entered the market with the same hyaluronic acid-based fillers. New smart dermal filler

Materials / method: Smart HA dermal filler
patients before and after
follow up results after 3 and 6 months

Results: Smart fillers showed improved over all appearance and less complications
Also, improve skin texture and elasticity

Conclusion: Smart filler provide new approach to dermal fillers as they provide comfort and lasting results. The complications were minimum and less amount of swelling and Odema after injection

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"Malar bags": etiology, classification, pathogenesis, and modern non-surgical treatment

Objectives: Report has detailed anatomic reasoning for «malar bags» formation as well as methods of nonsurgical correction of this aesthetic defect taking into account the proposed classification.

Introduction: «Malar bags» are anatomic lumps under eyes which pose a big problem not only to the majority of our patients but also to the doctors who set their hearts on harmonic rejuvenation and complex appearance correction.

Materials / method: Treatment. In the therapeutic correction of true «malar bags». We used HI-FU of 80 crosswise lines for SOOF area; hyaluronic acid 24 mg for ligament line and so biostimulating peptides. Peptides are very popular in aesthetic medicine and are actively used in the complex correction of «Malar bags». «False malar» bags are more often caused by the presence of hydrophilic substance (unstabilized and stabilized hyaluronic acid). More often we face a problem of the inadequate technique of hyaluronic acid administrationor aministartion into superficial fat pad or drug migration

Results: The proposed treatment regimens demonstrate a satisfactory result of the correction of paint bags. Аlso demonstrates a high degree of patient satisfaction with the treatment.

Conclusion: 1. Knowing anatomy and physiology of "malar bags" allows us to choose a method of complex correction. 2. It's important to differentiate false and true "malar bags". 3. The method of treatment is chosen after some diagnostic. 4. The method might be surgical as well as cosmetological.

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Unveiling post-filler nodules: ultrasound evaluation prior to management

Objectives: The main objective of this lecture is to review the sonographic aspects of different types of filler-related nodules, aiding physicians in selecting the most appropriate treatment.

Introduction: Dermal filler injections are generally regarded as safe; however, they may lead to adverse events, one of which is the development of nodules. The inherent characteristics of nodules result in various sonographic features that, when properly interpreted, enable the diagnosis and guide physicians in choosing the most suitable treatment for filler-related nodules.

Materials / method: High frequency ultrasound (18-24 MHz) was used to obtain sonographic images of filler and collagen stimulator nodules of patients who came for ultrasound examination in our clinics. The images were compiled and reviewed retrospectively by the authors.

Results: Filler-related nodules were subjected to ultrasound scanning and systematically examined. Ultrasound could assist in discerning the nature of various types of nodules, including overcorrection of different types of fillers, superficial filler placement, abscesses, granulomatous reactions, panniculitis and recurrent edema, with the authors documenting them as a series of cases.

Conclusion: Ultrasound plays a critical role in providing differential diagnoses of various types of nodules and in assisting injectors in identifying potential complications to ensure effective treatment.

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Real-world patient experience with prabotulinumtoxinA integration into clinical practice in the UK

Objectives: Objectives: To understand the real-world patient experience and patient perceptions of prabotulinumtoxinA performance for treatment of the glabellar region.

Introduction: Background- Botulinum Toxin Type A [BoNT-A] injection is the most widely performed nonsurgical cosmetic procedure in the United Kingdom [UK].PrabotulinumtoxinA is the new BoNT-A, recently licensed in the UK for treating moderate to severe glabellar lines in adults under 65. Though clinical trials have established safety and efficacy, real-world data can help clinicians translate study findings into practice and support PrabotulinumtoxinA use in a more diverse patient population.

Materials / method: Methods - In this real-world, single-centre survey study, a single injector administered PrabotulinumtoxinA for treatment of glabellar lines. Two weeks after treatment, patients received surveys asking about their experience by email. There were no incentives for participation. Responses returned within five weeks of treatment were included.

Results: Results - From February 2023 to June 2023, 457 patients received PrabotulinumtoxinA injections for glabellar line treatment. Survey response rate was 56% [254/457 patients]. For most patients, treatment onset was 2 to 3 days following injection, and peak response occurred after 7 to 10 days. Adverse effects were minimal, with 67% of patients experiencing none. Among survey respondents, 83% rated their treatment positively on a 5-point satisfaction scale, and 72% would choose PrabotulinumtoxinA again.

Conclusion: Conclusions: These real-world data validate the safety and effectiveness of prabotulinumtoxinA in a diverse, real-world population, confirm a high level of patient satisfaction among more experienced BoNT-A patients, and suggest a rapid time to onset and peak effect.

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New term in aesthetic medicine: "the dancing chin"

Objectives: I'd like to present a new term in Aesthetic Medicine: 'The Dancing Chin' to patients, physicians, dermatologists, aesthetic doctors and plastic surgeons to aware people of this phenomenon, and to get an early treatment.

Introduction: The term dancing chin" refers to an over-the-top movement of the three muscles in the chin (namely the mentalis, depressor labii inferior, and depressor annuli oris) and the primary neck muscle known as the platysma, which can occur both intentionally and involuntarily, such as in the case of a tic. The pathology is known on the skin as orange skin or golf ball deformity. Dancing Chin is the phenomenon leading to this pathology.

Materials / method: While examining many of my patients' faces, I noticed that their chins were moving while they spoke to me. It was difficult for me to convince them of the importance of identifying this condition, because dancing chin is often ignored by patients themselves, (because they do not speak usually in front of a mirror) but it may be noticed by their surroundings. To address this, I requested permission from some of my patients to film their lips, chin, and neck while they speak, and they agreed.

Results: After examining and comparing multiple videos and merging them into one frame, I discovered that the chin moves in a "dancing" manner.

Conclusion: As "Dancing chin" is a phenomenon if ignored can lead to chin deformity and facial disharmony, to avoid this problem plastic surgeons, aesthetic doctors, dermatologists, medical professionals, and patients should be aware of its aesthetic implications.
Dancing chin must be popular as “orange skin”, “marionette lines”, “lion wrinkles” or “crow’s feet” (etc..) to be aware of this pathology and treat it before it leads to orange skin, golf ball deformity , marionette lines and facial ptosis.

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Fe-male: transgendering injections

Objectives: In the modern world, there is a need to review standard injection protocols and usual work protocols. Because in the freedom of choice, transgender and non-binary individuals are increasingly turning to us for services. And medical aesthetic care should be provided to them individually, and not according to the gender of birth.

Introduction: In my speech, I want to pay attention to the proportions, anatomical landmarks and geometric structures of the face in patients when changing gender from male to female with the help of injections of fillers, toxin on a real example of patient with a delayed result in 5 years

Materials / method: HA fillers, Calcium hydroxiapatatite, botulotoxin type A, threads, mesococtails

Results: Including to clear calculations and analysis of the peculiarities of working with a gender-male face and bones, it was possible to achieve excellent aesthetic results and maintain them for 5 years

Conclusion: Modern requests from patients require doctors of aesthetic medicine to review standard protocols and develop new ones. My experience of working with transgender patients for 5 years shows its effectiveness and lack of complications with proper planning

And I`m want to share this experience with my colleges

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New concepts of superficial injection approach in filler facial rejuvenation

Objectives: By strategically targeting injection points, we can improve skin quality and refine superficial contours, all while providing a more accessible technique for operators and a more comfortable experience for patient.

Introduction: Skin rejuvenation through fillers is a multiplanar process. In addition to the conventional approach of rehydration, advancements in our understanding of skin structure and anatomy, along with improved properties of injected hyaluronic acids, enable us to elevate facial rejuvenation to the next level. By strategically targeting injection points, we can improve skin quality and refine superficial contours, all while providing a more accessible technique for operators and a more comfortable experience for patient.

Materials / method: We have done 15 pilot cases for analysis to conclude the improvement of the skin quality in terms of hydration, elasticity, firmness etc.

Results: The skin quality of the measure parameters have improved.

Conclusion: By strategically targeting injection points, we can improve skin quality and refine superficial contours, all while providing a more accessible technique for operators and a more comfortable experience for patient.

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Worldwide clinical program of an innovative HA technology

Objectives: Symatese is pleased to present its new technology, used in the therapeutic as well as in the aesthetic field. Especially, the HA filler range based on this technology has been assessed through a strong international clinical program, in Europe, US, and China.

Introduction: All five reference products of this range have been clinically assessed in Europe (total number of patients: 317) and are now undergoing clinical trials in the US and China.

Materials / method: LIFT Filler allows a durable result in the treatment of nasolabial folds, with a gain of 3 months in terms of WSRS score vs the Control.
In a second study, LIPS Filler showed a natural and long-lasting effect in lips augmentation and/or contouring (12 months without touch-up). This result has been reinforced by the use of SMOOTH Filler in perioral lines and nasolabial folds. The range is completed by the SCULPT Filler, the most projecting filler of the range and a last product dedicated to infraorbital hollows.

Results: This program is expanding with 2 ongoing US clinical investigations, with SMOOTH and LIFT in the nasolabial folds vs Control (6 centers, 140 patients), and SCULPT vs Control (11 centers - 308 patients) to restore the volume of the cheeks. 2 studies are planned in 2024 for eye and lips indications with LIPS and EYE.
China is also a major territory for this program, with a clinical study underway on the LIFT vs Control in nasolabial folds (6 centers – 314 patients).

Conclusion: Two other clinical studies have been launched to assess the SCULPT (6 centers – 356 patients) to restore midface volume and contouring, and SMOOTH (8 centers – 138 patients) in perioral lines treatment in Chinese population. The two other products of the range, dedicated to lips and eye, are also planned to be evaluated in China within the next months.

The new Symatese’s technology has been evaluated though a large-scale international clinical program. This is a unique schedule in the industry involving 1 435 patients worldwide to date.

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请注明名称（个人，公司，学会等等）: Research income from Symatase

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请注明名称（个人，公司，学会等等）: Abbvie, Galderma, Merz, Teoxane

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Targeting the depressor anguli oris and neighboring muscles in fresh-frozen cadavers with ultrasound-guided techniques: preliminary results

Objectives: This research aims to evaluate the effectiveness of using high-frequency ultrasound to enhance the accuracy of BoNT-A injections in the DAO muscle

Introduction: The precision of Botulinum toxin type A (BoNT-A) injections in facial muscles, particularly in the depressor anguli oris (DAO) and depressor labii inferioris (DLI), is crucial due to their close anatomical proximity. Incorrect injection sites can lead to undesirable facial expressions. This study investigates the accuracy of injections in the DAO muscle under high-frequency ultrasound guidance compared to traditional methods.

Materials / method: Four fresh frozen cadavers were subjected to BoNT-A injections at the P5 region (DAO) on the left side of the face and under high-frequency ultrasound on the right side. Subsequent dissection examined the precision of these injections in targeting the DAO muscle

Results: Among the injections performed without ultrasound guidance on the left facial side, only one accurately targeted the interface between the DLI and DAO, while the others directly hit the DAO. In contrast, all injections on the right side under ultrasound guidance accurately reached the DAO muscle (4/4). This demonstrates a significantly higher precision rate with the use of ultrasound.

Conclusion: High-frequency ultrasound guidance in administering BoNT-A injections significantly improves the accuracy of targeting the DAO muscle, minimizing the risk of inadvertently affecting the DLI. This technique promises to enhance the safety and efficacy of facial aesthetic and therapeutic procedures involving muscle-specific BoNT-A injections.

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小时	讲者	演讲标题	讲稿摘要	数字
16:00	Evgeniya SHELEMBA 医师	Importance of enhancing collagen in retinacula cutis: new scientific data and techniques	查看	130402
16:08	Gennaro BARBUTO 医师	Non-surgical profiloplasty: how to harmonize the sinuosity of the face profile using fillers with different G prime and molecular weights	查看	130404
16:16	Ryan SHANNAN 医师	Ultrasound in non-surgical rhinoplasty: practical approach	查看	130405
16:24	Leonard JOSIPOVIC 医师	Five-point liquid rhinoplasty: results from a retrospective analysis of a novel standardized technique and considerations on safety	查看	130407
16:32	Ahmed AL QAHTANI 医师	Smart fillers: the new generation of dermal fillers (educational grant from AQ Skin Solutions)	查看	130403
16:44	Ekaterina KRUGLIK 医师	"Malar bags": etiology, classification, pathogenesis, and modern non-surgical treatment	查看	130406
16:52	Rosa Maria SIGRIST 医师	Unveiling post-filler nodules: ultrasound evaluation prior to management	查看	130408
17:00	Kathryn TAYLOR BARNES 医师	Real-world patient experience with prabotulinumtoxinA integration into clinical practice in the UK	查看	130409
17:08	Ibrahim EL ACHKAR 医师	New term in aesthetic medicine: "the dancing chin"	查看	133375
17:16	Yana TOKAR 医师	Fe-male: transgendering injections	查看	133571
17:24	黃天厚医师	New concepts of superficial injection approach in filler facial rejuvenation	查看	130401
17:32	Amir MORADI 医师	Worldwide clinical program of an innovative HA technology	查看	130411
17:40	Nihat MUSTAFAYEV 医师	Targeting the depressor anguli oris and neighboring muscles in fresh-frozen cadavers with ultrasound-guided techniques: preliminary results	查看	133376
17:48		Q&A		130412

IMCAS World Congress 2024
大会日程

聚焦 146, 147

Injectables - Contributed talks

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IMCAS World Congress 2024 大会日程

聚焦 146, 147

Injectables - Contributed talks

主席

本场演讲内容

推荐会议

IMCAS World Congress 2024
大会日程

本场演讲内容