Objectives: 'Periorbital hyperchromia' – a technical name for dark circles around the eyes
Dark circles may be considered cosmetically unappealing, but they are rarely a medical concern.
and it is needing deferent treatment.

Introduction: How to examine the patient?
How to diagnose the reason of dark circles?
How to choose the procedure exactly what the patient needs?

Materials / method: real pictures of my patient

Results: Explain how to choose the procedure exactly what the patient needs to get rid his dark circles.

Conclusion: A variety of differing aesthetic treatments are available for non-surgical Periorbital rejuvenation, but one procedure or technique alone is usually insufficient. The most popular treatments presently are filler + carboxytherapy + peeling + prp + mesotherapy + laser and plasmage

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Objectives: A lot of modalities can be used while treating acne scars. It is important to choose a single mono treatment or a combination and to determine its sequence according to the type, severity and location of acne scar. In my presentation I describe methods of diagnosing, followed by constituting a treatment plan utilizing a combination of different types of subcision and energy based devices (lasers and RF)

Introduction: Atrophic acne scars are a very common condition which leads to insecurity and difficulties in communication. The distribution and types of acne scars are unique in each face. Their visualization is different under various sources of light. During the consultation it is important to simulate the worst possible light to mark the areas of skin depression of rolling scars and to consider the treatment plan and modalities to achieve the best possible result. Depending on the severity and predominant acne type the decision to use one modality or combination is made.

Materials / method: After taking the patient’s history I mark the areas of depression using either polarized light source or phone’s flash positioned above patient’s face. Once the areas of depression are marked the decision on what type of subcision is preferable is made. I use both cannula (with or without filler) and also pneumatic jet remodeling with HA. Cannula with calcium hydroxyapatite is preferable for larger volume loss on the cheek area. While jet remodeling is the best solution for temples. My next step is energy based devices. I use full field, fractional erbium laser or RF.

Results: It is extremely important to take photos and use other diagnostic devices on each step of the acne treatment road (before, after the first step, final). The percentage of overall improvement depends on the severity of acne scars and the modality used. The first result is evident on the 2 months mark after the subcision- the time it takes for skin remodeling. The final result takes from 2 to 6 months depending on the used modality. Every patient notes the improvement from 30 up to 70% . All patients have better quality of life and higher self esteem.

Conclusion: It is known that acne scarring can cause depression, lower quality of life, make patients feel embarrassed and less self confident.
Treating acne patients with multi modal approach is very gratifying. They no longer need to hide or cover their faces. Are more confident under different sources of light, can make selfies in the elevators.

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Objectives: The combination of 3 treatments has been evaluated (PRP, fractional ablative laser and subcision with hyaluronic acid injection) for the treatment of acne scars.

Introduction: Acne vulgaris has a global prevalence of about 10% (Global Burden of Disease Study 2010), with a peak in adolescence (35-80% depends on the ethnicity).
Many of this patients will develop scarring the may have a strong sociorelational impact on their lives.

Materials / method: Protocol has been structured in 4 sessions: the first 3 were scheduled 1 month apart and included the combined application of fractional ablative laser (1064nm Q-Switched - 13J/cm2 - 9x9px/cm2 spot, 2-6 passes, depends on the severity of scars); the last one was a scar subcision with 22G 50mm cannula and subsequent injection of long chain resilient hyaluronic acid with elevated stretch capacity (23mg/mL, 4% BDDE crosslink, G’ 298Pa).
10 patients were treated following this protocol.

Results: All treated patients shows improvements. 2 quit the protocol after 2 sessions because already satisfied, 6 were satisfied and 2 requested further treatments.

Conclusion: Combination of regenerative medicine, laser treatment and mechanical stimulation associated with hyaluronic acid is a great solution to improves acne scars.

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Objectives: 1- Introduce the novel innovative technique of mixing calcium and non cross-linked hyaluronic acid.
2- Explain the tailored injection technique according to each patient
3- Manage skin sagging with less complications.

Introduction: Fillers based on crosslinked hyaluronic acid (HA) are becoming increasingly important in the field of aesthetic medicine. Calcium hydroxylapatite (CaHA) is a fully biodegradable filler, dissolved in a gel that have been on the market for a very long time. After understanding the market’s direction due to the increased number of patients aiming for a more natural look, and a longer duration of the improved skin quality and glow, I tried this mix to create a hyperdiluted form of calcium biostimulator, by diluting it with non-cross linked HA instead of saline.

Materials / method: A total of 30 patients were included, all females with age ranging between 35 and 60 years. Mixing of the CaHA (0.8 or 1.5 ml) with one ampoule of non cross-linked HA is done using a connector for one minute until mixed well (at least 30 times). Then marking the landmarks of the face of the patient then marking the injection points. Injection is done using a 25 or 22 gauge cannula after puncturing the skin with a needle tip, to inject in the subcutaneous plane using slow retrograde together with microdroplet injection technique.

Results: After 1 month, patients were assessed in follow up visit. Improvement in skin laxity, tone and fine lines was noticed. Also face lifting was noted, proven by improvement in the nasolabial folds, and elevation of the level of the outer canthus of the eyes and corners of the mouth. Lateral eye brows elevation was also achieved in patients injected in the temporal area and the adjacent hairline area.
Patients felt improvement in skin hydration, fine wrinkles, looseness of the skin and whole face rejuvenation, resulting in high satisfaction rate.

Conclusion: This is by far the first study to document the use of this novel combination in skin rejuvenation. In conclusion, this new combination of CaHA and non crosslinked HA showed great results in improvement of skin quality, lifting and hydration and is considered a safe and effective option in treatment of sagging and facial wrinkles.. This mixture provides the fibroblasts with the amino acids, which are considered to be the raw material to synthesize collagen after biostimulation with the CaHA. Non cross-linked HA is also safer, more economic, and with less possibility of migration.

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Objectives: Our study aimed to evaluate the efficacy and safety of lower face correction in combination with bidirectional barbed P(LA/CL) threads in double needles form and a collagen-stimulating (poly caprolactone based) dermal filler through an innovative technique including two sessions,(Placement of thread like a frame to engage Mandibular retaining ligament, septum of mandible, Platysma auricular ligament and McGregor's patch, and after 6 weeks, infiltration of collagen stimulating filler for creating a plexus of fibrotic bundles to fix replaced superficial fat pockets to the frame of thread).

Introduction: Regarding safety and efficacy of thread in intensifying of retaining ligaments’ function and replacing superficial fat pockets, seemingly, combination therapy with Collagen-stimulating dermal filler, could be effective and safer than common minimally invasive treatments related to facial rejuvenation, with long lasting results. Our study might be considered one of the effective and safe combination therapies.

Materials / method: we conducted a study with 50 volunteers from different countries,4 men and 46 women, between 33 to75 years old (Range:42years). Based on availability of material at the time of admission and safety of product, bidirectional barbed P(LA/CL) thread in double needles form was used to create a farm in superficial fat to engage Mandibular retaining ligament, septum of mandible, Platysma auricular ligament and McGregor's patch. Six weeks after placing threads, in every side,1cc of collagen stimulating (poly caprolactone based) filler, in superficial fat, in fanning technique, became infiltrated.

Results: For every patient, photos were taken before procedure, in the end of 6th and 12th months to assess improvement rate based on Global Aesthetic Improvement Scales (GAIS).
Regarding analysis of data, with valuable P value and Cohen's kappa Coefficient, we found out acceptable agreement for improvement degree of patients between surgeon and independent surgeon in the end of 6th month. Also, with valuable P values and Cohen's kappa Coefficients, we found out acceptable to strong agreement between patients and surgeons in the end of 12th month.

Conclusion: Regarding data of our study, seemingly, combination therapy with P(LA/CL) threads and collagen-stimulating dermal fillers could be effective in correction of jawline, jaw angle, marionette line, curvature between midface and lower face and regarding to boosting effect of thread on the function of the transvers facial septum, the technique might be effective on projection of mid face in the position of rest and smile. With a low rate of side effects and long-lasting results our simple combination therapy might be considered as a alternative for correcting the mentioned areas.

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Objectives: The treatment of abdominal loosening and striae in postpartum mothers is often distressing and requires multiple sessions, leading to compliance issues. Mental concerns may also be overlooked. This lecture introduces an innovative treatment strategy for the first visit, combining microfocused ultrasound, hybrid CaHA / biomodulators, botulinum toxin, and vascular laser. It aims to help clinicians choose the most effective treatment strategy, improving patient satisfaction rates and subsequent compliance.

Introduction: This presentation aims to showcase the effectiveness of a proposed innovative treatment for post-delivery abdomen, which combines microfocused-ultrasound (MIFU), hybrid diluted calcium hydroxylapatite (CaHA) / biomodulator and Incobotulinum-toxin-A (IncoBTX-A), and the use of vascular laser. By integrating these techniques, the presentation highlights the holistic nature of the approach, which considers both the physical and psychological well-being of postnatal mothers.

Materials / method: Our study examined 8 cases of abdominal skin laxity treated with a single session of combination therapy. Various combinations and dosages of treatments involving microfocused-ultrasound (MFU), botulinum toxin, and different biostimulators/biomodulators were utilized. Before and after photos were taken, with evaluations conducted 4 weeks post-treatment. The objective of the study was to identify the most effective combination treatment tailored to the individual needs of patients.

Results: The case series showed significant improvements in abdominal skin laxity using the triple/quintuple therapy approach. Quintuple therapy, including vascular laser for red striae or scars, was effective. The combination of MFU, diluted CaHA/biomodulator, botulinum toxin, and optional vascular laser enhanced abdominal skin appearance, boosting mothers' confidence. Additionally, this approach increased patients' compliance with ongoing treatments to refine tummy skin quality. Positive early outcomes with the initial therapy fostered commitment to subsequent treatments, leading to better results.

Conclusion: By introducing an innovative treatment strategy during the first visit involving the innovative treatment protocol, doctors can confidently improve satisfaction rates in postpartum mothers with abdominal loosening and striae. Considering treatment effectiveness, cost, and addressing mental concerns ensures comprehensive care and a positive treatment experience.

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Objectives: Understanding the facial ageing in Indians
Addressing the specific challenges in this population
Devising treatment algorithm

Introduction: The idea non surgical face rejuvenation has now captured the imagination of the Indian subcontinent. With increasing disposable income, changing lifestyles, Indians face the twin challenges of obesity and accelerated ageing. The Indian patients tend to age with facial hypertrophy and sagging. Combined with a propensity of a genetic small chin, the face loses its jawline and starts to look round. Current treatments around the world look at fillers and energy based devices as the first line of treatment. However, the Indian patient needs an approach to help reduce the bulky lower face.

Materials / method: We discuss our combined experience in designing treatments for the Indian population over the last 20 physician-years. There are many challenges unique to this population. The skin is thick and pigmented, and laser rejuvenation especially with ablative lasers may often result in post inflammatory hyperpigmentation. The chin and lower jaw are small, contributing to early development of a double chin and jowls. The masseter and parotid are hypertrophied and contribute to the lower face looking more square and bulky. The predominantly carbohydrate rich diet makes obesity a common health problem.

Results: Our treatment approach is to reduce the bulk using HIFU to tighten and toxin to reduce masseter/parotid size. Injection lipolysis for the submandibular region and cheeks, if indicated, comes in as the next treatment. Then, we support and lift the tissues with thread lift before adding fillers to the chin and jawline. The treatments are planned at monthly intervals to allow adequate improvement and to allow budgeting of treatment.

Conclusion: Non surgical anti ageing is gaining popularity, however, treatment options need to be tailored to individual population needs. Collective experience sharing will help guide and design treatment algorithms in budget restricted populations.

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Objectives: Neck laxity after weight loos and aging are one of the most difficult areas to treat specially when it comes to minimally invasive methods

Neck lift using minimally invasive methods as threads lift with power assisted liposuction for better outcome and results longevity creates a perfect combination for loge results

Introduction: The little shadows we see on a face reveal crucial depth , perception characteristics and make the face appear angular , lean ( even if your not necessary lean in-terms of body fat ) , sharp , prominent and well developed ,Shadows change jaw line definition Neck bulk causes:Skin *Subcutaneous fat, plastesma ( smas)*Sub platesmal fat,Digastric muscle ,Submandebular glands
Goal is to create acute cervecal mental angle 105 to 120
Examination 1.Skin laxity 2.Degree of superficial and deep platesmal fat3.Submandibular glands enlargement and ptosis 5.Chin projection 4.Hyoid bone ideal posit

Materials / method: Barbed threads of PLA/CL and ultrasound assisted liposuction to the neck area

Results: Results and follow up of neck lift for 2 years are present

Conclusion: Combining threads and liposuction at the same session increase the results longevity and promises superior out come to a very challenging area as the neck

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Objectives: The purpose of this study is to confirm the regenerative and lifting effect of the combined procedure endo-radiofrequency & Platelet rich plasma. The neocollagenesis & neoelastogenesis stimulation generated by the heat produced by the endo-radiofrequency is amplified by the intracutaneous PRP injection. The perfect temperature control on the subdermal layer is indispensable to ensure a total safety of the procedure.

Introduction: The regenerative effect of the growth factors contained in the PRP on the dermal fibroblasts is well approved since many years in the field of anti-aging medicine.
The thermo-regulated endo-radiofrequency is a new technology which allows to reach a temperature of 57 degrees on the deeper dermal layer using a thermo cannula. Combining both procedures during the same session allows us to improve the skin texture and to obtain a medical lifting improving the jaw-line defintion.

Materials / method: I have treated 2 female patients aged 45 & 55 years.The treatment was performed on the middle & lower face with thermoregulated endo-radiofrequency using a thermo-cannula introduced in the subdermal layer reaching a temperature of 55 degrees.Immediately after the endo-radiofrequency, I drawed 20 ml of blood that i spined for 3 minutes 3000 rpm (1500G), i obtained 13 ml of pure PRP.Then i obtained 6 ml of autologous filler gel plasma rich in growth factors that i have used to improve the volume of the mandibular angle, for chin and cheek augmentation.

Results: No medication was prescrived after the treatment, no side effects as edema swelling or bruising was observed. I controlled the patients twice after 1 month & 3 months. The immediate result was a remarkable lifting effect with an immediate skin tightening improving the jawline definition. The improvement of the skin texture was more evident after 1 month. The best result was obvious on the third month as the maximum dermal neocollagenesis & neoelastogenesis is noticed 3 months after fibroblast stimulation.

Conclusion: The combined procedure using both the lifting effect of the endo-radiofrequency & the regenerative effect of the platelet rich plasma is extremely effective to obtain a medical lifting improving the jawline definition & the skin texture at the same time.
The procedure is absolutely painless very safe and doesn't cause any side effects. The result is immediately visible because of the immediate skin tightening due to the endo-radiofrequency tissue heating, although the skin texture improves drastically thanks to the growth factors as VEGF, iGF, FGF contained in the platelet rich plasma

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请注明名称（个人，公司，学会等等）: technolux

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Objectives: Radiofrequency microneedling (RFMN) treatment is the latest generation of fractional skin rejuvenation methods.However, the efficacy and safety of RFMN, and how it combines with other collagen stimulation methods remains unclear.Hyperdiluted PLLA was shown to be effective in tightening skin in the under chin/neck/décolleté areas. The benefits of combining treatments was long-lasting biostimulatory properties. But it is important to note, that the skin of this areas is thin, and sometimes following the rules can not help you to avoid complications like hyperstimulation and tissue fibrosis

Introduction: Radiofrequency (RF) works to uniformly heat the skin for immediate heat-related skin shrinkage.1. Poly -L-Lactic Acid (PLLA) is a soft-tissue injectable bio-stimulatory agent approved for the treatment of wrinkles that acts by stimulating the skin to produce collagen. PLLA is a biocompatible, biodegradable and bioresorbable polymer. It is an alpha hydroxy acid polymer of the lactic acid L-enantiomeric structure that has been safely used in many applications and in medicine for more than 30 years.The purpose of our report is to evaluate the efficacy of combination RFMN treatment +PLLA lifting

Materials / method: 15w subjects with mild to moderate skin laxity received RFMN and bio stimulation with PLLA at the same time. Subjects were followed for 6 months.One vial of PLLA was prepared by adding 6 cc of Bacteriostatic 0.9% Sodium Chloride 72 hours prior to planned injections. On the day of planned injections, an additional 2 cc of 2% Lidocaine HLC was added to the vial. The total mixture was a dilution of 16 cc/vial. Microcannula (25 g) injections along the inner area of each patient were performed till 1 vial was completely infiltrated. Massage for 5 minutes was performed

Results: All 15 patients have easy rehabilitaion after combined treatment (mild redness, xerosis and small bruisers during 3-5 days)
85% were extremly satisfied with results (skin tightening, amazing collagen production, reducing wrinkles and fat in the submental areas. The best result we can realise after 8 weeks. But 26% (4 patients) notice the non-inflamated nodules after 4 months (the areas of hypercollagen stimulation or hypercorrection ). All these patients with delay complications were treated with intralesion dexametazone and Natrium Chloride injections and 2 sessions of mild RFMN

Conclusion: Combination therapy with PLLA and Microneedling RF device give excellent improvement in the appearance of wrinkles , but can cause the hyper stimulation of collagen production and hypercorrection. The combination synergistically promotes collagen synthesis and subsequently improves wrinkling, but better do not combine this methods in one session in the areas with thin subcutaneous fat layer. The best results (reducing fat compartments, skin tightening, amazing collagen production) we receive after combined treatment with 3-4 months interval between sessions.

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Objectives: 1.The causes and the aspect of the facial aging
2. presentation of the mechanism of action of the radiofrequency microneedling and the HIFU
3.presentation of the Poly-L-lactic / Polycaprolactone threads
4. combination of the radio frequency microneedling , HIFU and threads in a tailored and individual approach in face lifting

Introduction: Skin aging is a complex mutli -factor biological process influenced by endogenous and exogenous factors.To treat efficiently the sagging of the face,combining anti-aging procedures is necessary.In this presentation, I will expose the combination of energy based devices: High intensity focalised ultrasound and radiofrequency microneedling with Poly-L-lactic / Polycaprolactone thread

Materials / method: Six patients aged from 52 to 68 year old have undergone this protocole.Through precise ultrasound visualization, the SMAS (muscle and connective tissue) is targeted with HIFU to lift and tighten this deep facial plane. Radiofrequency microneedling remodels the overlying layers giving a tightening and contouring effect boosting neocollagenesis. Poly-L-lactic / Polycaprolactone threads inserted in the subcutaneous layers provide a lifting effect with volume repositioning.

Results: Most of the patients have noticed a better skin quality, less fine wrinkles, a thicker skin, lifting of the saggy tissues and volume repositionning 2 months after the hole procedure

Conclusion: The combination of the three non invasive procedures,tailored to each individual patient’s anatomy targets the multiple layers of the face and provides a non surgical face lift without a prolonged downtime.

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Objectives: To estimate the combination of CaHa and microfocused ultrasound for young patients with low to mild noticeable age-related changes of face tissue, taking into account their morphotypes of ageing.

Introduction: More and more of young patients deal to preventive care to postpone ageing before the real visual tissue ageing start to reveal the age.

Materials / method: Prophylactic and treatment protocols were developed in our clinic in order to stimulate collagen synthesis depending on results of genetic testing of patients and on data of laboratory methods.

Results: 30 patients "with" and "without" having the disturbance of synthesis and degradation of collagen have taken the individual protocols of CaHa (diluted and not) plus microfocused ultrasound simultaneously within one day. Age of patients: 25 –35 years old. Stable effect in three months.

Conclusion: Though both groups of patients have shown positive results, the earlier collagen stimulation procedure (preceding correct preparation and following rehabilitation steps) is highly and specifically recommended for patients with the disturbance of collagen synthesis and degradation. The detailed protocols and results will be given during the presentation.

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Objectives: In this presentation, we will provide a practical method to address heavy faces. We will combine neuromodulators, fillers, and High Intensity Focused Ultrasound (HIFU) to transform an aging, rounded face into a youthful and attractive appearance. Our goal is to highlight the benefits of combining technologies and injectables, even in challenging cases. We will also clarify the sequence of application of these procedures and address common doubts faced by aesthetic professionals. This approach is based on scientific evidence and professional experience.

Introduction: Many techniques are available to improve the appearance of a rounded face. These range from surgical procedures such as removing buccal fat and facial liposuction to non-surgical approaches that enhance facial aesthetics. One such approach is to change the facial shape from rounded to an inverted triangle using minimally invasive procedures. This requires the use of several technologies including HIFU (High-Intensity Focused Ultrasound), botulinum toxin, dermal fillers, and collagen biostimulators.

Materials / method: Participants will learn HIFU-specific tips for fat reduction and addressing sagging in heavier faces. The use of biostimulators like poly L lactic acid or Calcium Hydroxyapatite in temporal areas for a lifting effect without adding volume will be emphasized. Additionally, the use of hyaluronic acid filling techniques using cannulas will be discussed, with a focus on the zygomatic arch and chin. Lastly, a safe method of applying botulinum toxin to the masseter and temporal regions will be explored.

Results: The application of macro-focused HIFU tips helps reduce facial fat and improve sagging in overweight faces. Botulinum toxin applied to the masseter and temporal muscles can reduce bigonial and bitemporal dimensions, respectively. Moreover, it can enhance the projection of the chin and zygomatic arch, resulting in a more aesthetically pleasing and triangular facial shape. Lastly, collagen bio-stimulators used in the temporal and pre-auricular region provide a lifting effect and reduce sagging in the central region of the face.

Conclusion: In conclusion, we want to highlight how effective it is to combine neuromodulators, fillers, biostimulators, and HIFU to transform heavy faces into more youthful and attractive ones. It's crucial to do a careful assessment based on scientific evidence and choose the appropriate sequence of procedures to achieve the best results. This approach is a significant breakthrough in aesthetic dermatology, providing effective solutions to meet the demands of patients who seek non-surgical enhancements to their facial appearance.

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