0:03 welcome to the beginner dermal filler
0:07 course this is Dr J park with cosmetic
0:10 medical training this is a shortened
0:13 version of our paid online course the
0:16 paid online course is much more detailed
0:19 and goes over the following the history
0:21 of dermal fillers the differences of
0:25 honic acid dermal fillers warnings
0:28 precautions consultation steps injection
0:31 techniques we'll go over how to inject
0:34 areas such as nasol laal folds oral
0:39 commer mental lip augmentation perioral
0:47 started hyaluronic acid as a principal
0:50 polysaccharide in The extracellular
0:53 Matrix honic acid is instrumental in
0:56 maintaining skin elasticity and fullness
0:59 age Associated ha loss results in skin
1:02 lack aity and volume deficit cross
1:05 length ha forms the basis of most
1:08 contemporary dermal fillers which are
1:10 predominantly produced by gr positive
1:13 bacteria this Innovative development has
1:16 led to the creation of non-animal sour hyaluronic
1:18 hyaluronic
1:22 acid cross-link ha is characterized by
1:23 its remarkable
1:25 versatility facilitating the
1:29 customization of its physical properties
1:30 such as hardening
1:34 lift duration of survival and resistance
1:37 to heat and degrading enzymes it is a
1:40 stable cost effective safe tissue compatible
1:41 compatible
1:44 biomaterial furthermore ha's tissue
1:46 residency is significantly prolonged due
1:48 to its
1:50 cross-linking G Prime is a measure of
1:53 the viscosity and elasticity of a dermal
1:56 filler it is a dimensionless quantity
1:58 that is calculated using the following
2:01 formula G Prime equals sheer stress
2:04 divided by sheer rate sheer stress is a
2:07 force that is applied to the filler to
2:10 make it flow sheer rate is the rate at
2:14 which the filler flows a higher G Prime
2:16 value indicates a more viscous and
2:19 elastic filler this means that the
2:21 filler will be more difficult to inject
2:23 and will more likely to hold the shape
2:25 once it is
2:27 injected G Prime is an important factor
2:29 to consider when choosing a dermal filler
2:30 filler
2:32 the G Prime value will affect the way
2:35 the filler flows and how it holds its
2:38 shape for example a filler with high G
2:40 Prime would be most suitable for
2:43 volumizing and lifting while a filler
2:46 with low G Prime value would be more
2:50 suitable for filling fine lines and
2:53 wrinkles the G Prime value for dermal
2:55 fillers vary depending on the type of
2:57 filler and the brand in general
3:00 hyaluronic acid based thermal filler
3:02 have a lower G Prime than calcium
3:05 hydroxy appetite based dermal
3:08 fillers the G Prime value of a dermal
3:10 filler can affect the results of
3:13 injections in a number of ways for
3:16 example a filler with ti G Prime value
3:18 will be more difficult to inject and may
3:21 cause more pain conversely a filler with
3:24 low G Prime value will be easier to
3:27 inject and may cause less pain a filler
3:29 with high G Prime value will be more
3:32 like lik ly to hold its shape which can
3:35 lead to longer results conversely a
3:37 filler with low G Prime value will be
3:39 less likely to hold shape which can lead
3:48 results wrestlin is a comprehensive line
3:50 of hyaluronic acid based terop fillers
3:53 developed by galderma each with this
3:55 unique properties to address different cosmetic
3:56 cosmetic
3:58 concerns understanding these differences
4:00 allows you to choose the most
4:02 appropriate product for each patient's
4:05 unique needs below is a comparative
4:08 exploration of wrestlin products rlin
4:14 rlin L silk lift refine Define kiss
4:16 contour and
4:19 highight wrestling is a flagship product
4:22 with 20 milligrams per ml ha and a
4:26 moderate G Prime it's versatile suitable
4:29 for moderate to severe wrinkles facial
4:32 contact touring and lip enhancement the
4:34 moderate particle size provides both
4:36 lifting and smoothing
4:38 properties rlin L is similar to the
4:41 original rlin but includes the 3%
4:44 lidocaine a local anesthetic for
4:46 improved patient Comfort during the
4:48 injection the inclusion of Lidocaine
4:51 doesn't alter the ha concentration or
4:52 the G
4:55 prom wrestling still contains smaller
4:59 smoother particles around 500 microns
5:01 than it's count counterparts making it
5:03 perfect for subtle lip augmentation
5:06 smoothing Fine Lines especially around
5:09 the mouth it has a 20 milligrams per ml
5:12 ha but a lower G Prime due to its smoother
5:14 smoother
5:17 consistency resin lift formerly known as
5:21 perlan has larger gel particles and a
5:24 higher G Prime offering more substantial
5:27 volumizing and lifting capacity it's
5:29 excellent for enhancing cheeks and correcting
5:30 correcting
5:32 volume loss in the midphase ha
5:36 concentration is 20 milligrams per
5:40 ml wrestlin refine uses expression
5:44 technology refine has a flexible gel
5:46 consistency providing subtle correction
5:48 of laugh lines while maintaining natural
5:52 expression it has 20 milligrams per mlha
5:54 but the G Prime varies due to the Cross
5:57 thinkinking process enhancing
6:00 flexibility wrestlin d Define also uses
6:03 the expression technology Define has
6:06 more cross-linking than refine offering
6:08 more support for deeper laugh lines
6:10 while still allowing natural facial
6:13 movement it also contains 20 milligrams
6:16 per ml
6:19 ha resellin kiss is tailored for lip
6:21 augmentation and smoothing of upper
6:24 perioral lines kiss also uses the
6:27 expression technology for flexibility
6:30 and naturalness it has 20 milligrams per
6:33 mL of ha but it unique cross thinkinking
6:35 gives it a different G Prime ensuring
6:39 longevity and a softer feel Contour is
6:41 designed specifically for the cheek and
6:44 Chin augmentation it uses the novel
6:45 cross thinkinking method of the
6:48 expression technology creating a product
6:50 with variable G Prime allowing for
6:53 excellent lift and Longevity it also has
6:55 20 Mig per mL of
6:59 ha resellin iight is a specific filler
7:01 design for tear trough with a lower ha
7:05 concentration of 15 mg per ML and lower
7:08 G Prime its softer gel consistency is
7:10 ideal for delicate areas like under the
7:14 eyes it also contains lioc for added
7:15 Comfort during the
7:18 injection each resin product is tailored
7:20 for different needs with variations in
7:24 ha concentrations G Prime particle size
7:27 and the presence of lioc cane some newer
7:29 products leverage the expression techn
7:31 techology for different cross-linking
7:33 levels affecting their consistency and
7:35 allowing for more natural look while
7:38 maintaining volume and lift knowledge of
7:40 these will enable you to optimize the treatment
7:46 outcomes the juven ranger dermal fillers
7:49 developed by Allergan is a well regarded
7:51 for its specialized product each
7:53 addressing different aesthetic needs a
7:56 deep understanding of their individual
7:58 characteristics enables you to select
8:01 the best suited filler for the patient
8:03 the discussion below explores juvaderm
8:08 Ultra Ultra XC Ultra Plus XC voluma
8:12 Bella bour volux and skin
8:16 viiv juviderm Ultra with 24 milligrams
8:20 per mL of ha Ultra provides versatility
8:22 in treating moderate to severe wrinkles
8:25 and folds particularly the nasol laal
8:28 fold its moderate G Prime and high
8:30 Lacross technology which provides High
8:32 degree of cross linking offers a balance
8:34 between volume and
8:38 spreadability juven Ultra XC like Ultra
8:41 Ultra XC offers 24 milligrams per mL of
8:44 ha the same degree of cross-linking the
8:46 difference lies in the inclusion of the
8:48 3% lidocaine intended to increase
8:51 patient Comfort during and after
8:55 injection duven Ultra Plus XC has a
8:59 higher G Prime than Ultra and Ultra XC
9:02 do due to more robust cross thinkinking
9:04 process resulting a more substantial
9:08 lift and higher viscosity it's ideal for
9:10 addressing more severe wrinkles and
9:14 folds juven voluma is tailored for the
9:16 Deep injection into the cheeks to
9:19 correct age related volume loss it has a
9:24 high G Prime due to proprietary vross
9:26 technology which involves cross
9:28 thinkinking low and high molecular
9:31 weight ha and offers 20 milligrams per
9:33 mL of
9:37 ha juven Vella is designed for lip
9:39 augmentation and correction of the par
9:42 oral lines it uses the vross technology
9:45 and has a low concentration 15 mgrs per
9:48 ML and a lower gep Prime for smooth
9:50 consistency suitable for delicate
9:54 areas juvenon vour uses a bcross
9:55 technology and offers an ha
9:59 concentration of 17.5 milligrams per ml
10:00 the moderate G Prime makes it an
10:02 excellent option for moderate to severe
10:04 facial wrinkles and
10:07 folds juven volu designed for the lower
10:10 face volu is used to sculpt chin and
10:13 jawline it uses the vross technology and
10:15 has a high G Prime and an ha
10:18 concentration of 25 milligrams per ml
10:21 ensuring longevity and a significant
10:25 lift juviderm skin VI is designed for
10:27 superficial dermal injections to improve
10:31 skin quality texture and icity its ha
10:33 concentration is lower in summary
10:35 difference among the juven filler range
10:38 from variation in ha concentration G
10:41 Prime inclusion of Liane through the use
10:45 of proprietary technology like hros and
10:47 viacross the specific characteristic of
10:49 each product is designed to optimize
10:52 outcome for different cosmetic needs and
10:53 a detail understanding of these is
11:01 patients developed by to oxin
11:05 Laboratories resilient honic acid or
11:08 RHA fillers are the first thermal
11:10 fillers designed for dynamic areas of
11:13 the face adapting and stretching to work
11:15 with facial movements the family
11:17 consists of RHA
11:22 redensity rha2 rha3 and four the
11:24 specific details and key differences are explored
11:26 explored
11:30 below RHA reden it has a concentration
11:34 of 15 mg per ml its low G Prime makes it
11:37 ideal for injection into the dermis and
11:39 superficial dermis of the face for the
11:42 correction of moderate to severe dynamic
11:46 perioral rids in adults age 22 years or older
11:47 older
11:51 rha2 has an ha concentration of 23
11:54 milligram per ML and is intended to fill
11:56 moderate facial wrinkles it has a
11:58 moderate G Prime allowing it to balance
12:00 between firmness and
12:03 flexibility the ha and rha2 is
12:06 cross-link which increases its viscosity and
12:07 and
12:11 Longevity rha3 also has an ha
12:14 concentration of 23 milligrams per ml
12:18 but has a higher G Prime than rha2
12:20 making it firmer and more suitable for
12:22 filling severe facial wrinkles and fold
12:24 such as nasal labial folds
12:26 folds
12:30 rh4 also has 23 milligrams per ML and
12:33 has the highest G Prime in the RHA
12:35 series and is tailored for correction of
12:38 severe wrinkles and facial
12:41 Contours typically used for volumizing
12:49 jawlines a key feature of the RHA series
12:53 is its preserved Network technology
12:55 unlike other fillers that can lose their
12:58 structural Integrity upon injection the
13:01 RH series preserves a native ha
13:03 structure resulting in a more natural
13:05 look and
13:08 feel the vers a line of hyaluronic acid
13:10 based thermal fillers are each known for
13:13 their unique manufacturing processes and
13:17 properties Versa manufactured by prenium
13:19 is a homogeneous monophasic dermal
13:22 filler that contains 24 milligrams per
13:25 mL of ha the product is created using a
13:28 proprietary wet Milling technology which
13:31 produces spherical and uniform particles
13:34 these particles result in high quality
13:37 ha reducing inflammation and
13:40 Longevity Versa has a relatively high G
13:42 Prime giving it a good lifting
13:46 capacity Versa plus is also part of the
13:48 same perenium portfolio it's similar to
13:51 the original Versa but includes lioc
13:53 cane for enhanced patient Comfort during the
13:55 the
13:58 procedure lips plus is specifically
14:00 designed design for lip augmentation
14:03 lips plus is another penum product with
14:06 24 mg per mL of
14:09 ha here we'll explore the specific
14:11 details and key differences between
14:16 belloto balance and bellal balance
14:20 plus bellotero balance is manufactured
14:24 by Ms Aesthetics bellot teral balance is
14:26 unique due to its cohesive poly
14:29 densified Matrix technology
14:32 which produces a smooth flexible gel
14:37 Bello balance has a 22.5 mg per ml ha
14:40 and a moderate G Prime that offers
14:42 balance between lift and spread this
14:44 filler is suitable for moderate lines and
14:45 and
14:49 wrinkles bellaro balance plus is similar
14:52 to bellaro balance but contains 3%
15:00 injection combined list of
15:02 contraindications dermal fillers are
15:04 contraindicated for patients with severe
15:07 allergies manifested by a history of
15:10 anaphylaxis or history or presence of
15:12 multiple severe
15:14 allergies dermal fillers which contain
15:16 Trace Amounts of gr positive bacterial
15:18 proteins are contraindicated for
15:20 patients with a history of allergy to such
15:21 such
15:23 material dermal filler should not be
15:25 used in patients with previous hypers
15:28 sensitivity to local anesthetics of the
15:30 Ami type such as
15:32 Lane dermal fillers should not be used
15:34 in patients with bleeding disorders
15:37 dermal fillers are contraindicated for
15:40 use by anyone with skin infection or a
15:43 susceptibility to choid formation or
15:45 hypertrophic scarring dermal fillers
15:47 should not be used by pregnant women or nursing
15:49 nursing
15:52 mothers patients under the age of 22
15:53 should not be treated with certain types
15:56 of dermal fillers patients with evidence
15:58 of scars at the intended treatment cite
16:00 should not be treated with dermal
16:02 fillers patients with acne or other
16:04 inflammatory disease of the skin should
16:06 not be treated with dermal fillers
16:08 patients with unattainable expectations
16:10 should not be treated with dermal
16:12 fillers dermal fillers should not be
16:15 used in patients who have plans to go
16:18 undergo desensitization
16:21 therapy dermal fillers should not be
16:23 used in patients with acute or chronic
16:25 skin disease in or near the injection
16:29 sites or with any infection or un healed
16:32 wounds of the face patients under
16:34 anti-coagulant therapy antiplatelet
16:37 therapy or with a history of coagulation
16:40 defects or connective tissue disorder
16:42 should not use dermal fillers dermal
16:44 fillers are not intended for
16:46 intravascular use and must not be
16:49 injected into blood vessels as
16:51 implantation into dermal vessels may
16:54 cause vascular inclusion infarction or embolic
16:56 embolic
16:58 phenomenon dermal filler should not be
17:01 used in conjunction with laser IPL
17:03 chemical peeling Derm bration treatment
17:05 or with over-the-counter wrinkle
17:07 products or prescription wrinkle
17:10 treatments within four weeks prior to
17:13 treatment please note that this list is
17:15 a combination of all Contra indications
17:17 from each products and each individual
17:20 products may not have every listed
17:22 contraindication always refer to the
17:25 specific products package insert this is
17:27 a combined list of all the specific warnings
17:30 warnings
17:32 avoid injecting dermal fillers directly
17:34 into blood vessels as this may cause a
17:37 vessel occlusion embolization or
17:39 infarction rare but serious Adverse
17:41 Events associated with the intravascular
17:43 injections of soft tissue fillers in the
17:45 face have been reported to include
17:46 temporary and permanent Vision
17:50 impairment blindness cerebral esea or
17:53 cerebral hemorrhage leading to stroke
17:55 skin necrosis and damage to underlying
17:58 facial structures use of these products
17:59 on patients who are pregnant
18:02 breastfeeding or under age 18 years old
18:04 have not been studied and therefore not
18:07 recommended the safety and effectiveness
18:08 of these products for the treatment of
18:11 areas other than those specified in the
18:13 respective FDA approved labeling has not
18:16 been established do not over correct or
18:19 overfill a contour deficiency because
18:21 the depression should gradually improve
18:24 as the treatment continues do not mix
18:25 these products with any other products before
18:26 before
18:29 implantation as with all skin injection
18:32 procedures there is a risk of infection
18:35 injections greater than 1.5 ml per lip
18:38 upper or lower per treatment session
18:40 significantly increases the occurrence
18:43 of a severity of lip
18:46 swelling Dillers should not be used in
18:48 areas that have high vascularity as
18:51 there is a risk of vascular
18:53 embolization injection site reaction
18:55 such as redness temporary swelling
18:57 tenderness and pain have been observed
19:00 in our short-term in duration less than
19:03 7 Days any reaction in excess of this
19:05 anticipated reaction should be reported
19:07 to their health care
19:09 professional this product should only be
19:11 used by Healthcare practitioners who
19:13 have appropriate training experience and
19:15 knowledgeable about the anatomy at and
19:16 around the S of
19:18 injection patients with adverse
19:21 inflammatory reactions that pers persist
19:23 more than one week should report this
19:26 immediately to their physician healthc
19:27 care practitioners are encouraged to
19:29 discuss all potential risk of soft
19:32 tissue injection with the patient prior
19:34 to treatment ensure that the patient are
19:37 aware of signs and symptoms of potential
19:39 complications serious Adverse Events
19:40 have been reported relate to the use of
19:43 dermal fillers in the areas of the eye
19:45 localized superficial necrosis scarring
19:48 may occur after injection in or near
19:51 vessel such as the lip nose and Gellar
19:54 area it is thought to result from injury
19:56 obstruction or compromise of blood
19:59 vessels the laate on set inflammatory
20:01 papules have been reported following the
20:04 use of dermal fillers inflammatory
20:06 papules that may occur rarely should be
20:09 considered and treated as a soft tissue
20:11 infection These Warnings provide
20:13 important information for safe and
20:15 effective use of dermal fillers and
20:17 should be carefully considered by Health
20:20 Care Providers and patients alike it is
20:22 essential to reach out to respective
20:24 product manufacturers or healthc care
20:26 providers for additional
20:29 information pre precaution dermal
20:32 fillers are intended for single use only
20:34 they should not be sterilized or used if
20:37 the package is open damage or past its
20:40 expiration date the product should be
20:42 used with caution in patients undergoing
20:44 immunosuppressive therapy or patients
20:47 who are using substances that reduce
20:49 coagulation the injection of dermal
20:51 fillers into patients with history of
20:53 herpetic eruptions may lead to
20:55 reactivation of the
20:57 herpes the patient should be informed
20:59 that they they should minimize exposure
21:02 of the treated area to excessive sun or
21:07 heat UV lamp exposure saunas and extreme
21:09 cold weather until any initial swelling
21:12 and redness has resolved and puncture
21:13 site have
21:16 healed any syringe that shows signs of
21:19 content separation or appears cloudy
21:22 should not be used if nodule or
21:25 persistent papules occur consider
21:28 appropriate treatments such as high idas
21:30 injection or surgical
21:32 removal prior to treatment patients
21:36 should avoid taking aspirin Neds St
21:39 John's wart or high does vitamin E
21:42 supplements as these agents may increase
21:44 bruising and bleeding at the injection
21:48 site injection thermal filler injections
21:50 require a meticulous technique to
21:53 achieve optimal results and minimize
21:56 complications always insert the needle
21:58 into the mid to Deep dermis for
22:01 appropriate product placement you can
22:03 gently stretch the skin to Aid the
22:05 needle insertion which can also help
22:08 visualize the treatment area better the
22:09 Contour of the needle should be barely
22:12 visible or not at all depending on the
22:13 type of filler use and the severity of
22:16 the wrinkle being treated if utilizing a
22:19 Threading technique apply even pressure
22:21 on the syringe plunger while slowly
22:24 retracting the needle ensure you stop
22:26 the injection before completely removing
22:28 the needle to prevent the products from
22:30 booing out superficial injection can
22:33 cause a bluish Hue on the skin due to
22:36 the Tindle effect if this occurs
22:38 consider massaging the product deeper
22:40 into the tissue expressing it out or
22:42 dissolving with higher
22:45 onidas in the Fanning technique keep the
22:48 needle inside the skin while angling the
22:50 syringe and reasserting the needle to
22:52 the hub be aware of potential for
22:55 intravascular injection if blanching
22:57 occurs immediately stop injecting
23:00 massage area until normal skin color
23:02 returns throughout the procedure you
23:04 should always feel the resistance of the
23:06 dermis indicating the correct plane of
23:09 injection if you encounter too much or
23:11 too Little Resistance you may be in the
23:14 wrong plane at the end of the treatment
23:16 the injected wrinkle should be visibly
23:17 lifted and
23:20 filled the level resistance that you may
23:23 feel depending on the area that you are
23:27 injecting injection in the periole space
23:30 may have very Little Resistance versus
23:32 injecting into the Derma
23:35 space post injection after administering
23:38 the dermal filler a careful evaluation
23:41 is critical to ensure an optimal result
23:43 the treated area should feel smooth with
23:46 no detectable empty spaces or lumps
23:50 strive for a precise correction neither
23:53 under nor over corrected gently massage
23:55 the injection site to blend the product
23:57 with the surrounding tissue if you feel
23:59 feel any bumps or lumps massage them
24:02 until they flatten in most cases any
24:05 protrusions will resolve naturally but
24:07 reassure the patient and schedule a
24:09 follow-up appointment within a week if a
24:11 lump persists at this followup consider
24:14 using higher onidas to dissolve the
24:17 filler symmetry assessment immediately
24:19 post injections can be challenging due
24:21 to localized swelling and bruising
24:23 invite the patient back after a week for
24:26 re-evaluation once the swelling has
24:28 subsided lastly any post injection
24:30 swelling or internal bruising should
24:33 resolve in a few days to minimize these
24:35 side effects provide your patient with
24:37 an ice pack which can also help to
24:39 reduce potential
24:42 bleeding injection technique the success
24:45 of dermal fillers is not only dependent
24:48 on the type of product used but also on
24:50 the injection technique there are
24:53 various injection techniques each with
24:56 its own set of advantages and potential
24:59 pitfalls serial puncture the serial
25:01 puncture technique involves multiple
25:03 closely spaced injections along a
25:06 wrinkle the key to this technique is the
25:08 precise placement of the filler if the
25:11 filler is not accurately placed gaps may
25:13 be found between the injection sites
25:16 this technique is less desirable due to
25:18 multiple puncture wounds it generates
25:20 however it can be effective for treating
25:22 fine lines and wrinkles provided that
25:25 the practitioner has a steady hand and a
25:26 keen eye for
25:30 detail linear threading linear threading
25:32 is a technique where the needle is fully
25:35 inserted into the wrinkle up to the hub
25:36 and the product is injected along the
25:38 tract as the needle is gradually
25:40 withdrawn this technique requires
25:43 continual pressure and even distribution
25:45 of the product this requires a certain
25:47 level of skill and dexterity as
25:50 practitioners must simultaneously push
25:52 the plunger of the syringe while pulling
25:54 back the syringe from the
25:57 skin it is crucial to stop the injection
25:59 several millimeters before completely
26:02 removing the needle from the skin to
26:04 avoid superficial placement or leakage
26:06 of the product above the
26:08 skin some practitioners prefer the push
26:10 ahead technique where the product is
26:12 injected as the needle is being Advanced
26:15 through the skin with practice this
26:17 technique can be mastered and can
26:19 provide a smooth even distribution of the
26:20 the filler
26:22 filler
26:24 cross-hatching cross-hatching is a
26:26 technique that involves injecting a
26:29 series of par parallel linear threads at
26:32 5 to 10 mm apart followed by a
26:34 perpendicular series of parallel linear
26:37 threads at the same distance this
26:40 creates a grid-like pattern and is
26:42 particularly useful for adding volume to
26:45 a larger area or when multiple wrinkles
26:47 are close in proximity the
26:50 cross-hatching technique allows for a
26:52 more uniform distribution of the filler
26:54 resulting in a more natural looking
26:57 result Fanning the Fanning technique
27:00 involves puncturing the epidermis once
27:03 as in the linear threading technique and
27:04 before the needle is completely removed
27:07 from the skin the needle is moved in a
27:09 fanlike pattern to create a triangular
27:12 shape additional evenly spaced Fanning
27:14 injections may be performed without
27:16 removing the needle from the skin
27:18 depending on the sides of the Triangular
27:21 area to be filled care must be taken to
27:24 avoid over injecting at the proximal end
27:27 of each fan as this can result in an
27:30 overlap a product in one region
27:31 region
27:34 ferning ferning or fencing is a
27:36 technique that involves short linear
27:38 threading perpendicular to the fold
27:41 followed by advancing a few millimeters
27:44 away from the fold in either direction
27:46 this technique is typically used on
27:48 Dynamic facial lines that require
27:51 stiffness of the skin on either side of
27:53 the wrinkle the ferning technique can
27:56 provide a more structured support to the
27:58 skin helping to smooth without Dynamic
28:00 lines and
28:03 wrinkles nasal labial
28:06 folds the nasal laal fold is a
28:08 noticeable line or crease that extends
28:11 from the lateral borders of the nostril
28:14 to the corner of the mouth a signifier
28:16 of facial aging the formation of the
28:19 nasal laal fold occurs due to several
28:22 anatomical changes with age such as the
28:24 gradual medial and inferior movement of
28:28 the maer fat pad caused by collagen loss
28:31 and diminish skin elasticity a heavy mid
28:34 face as seen with aging or obesity might
28:36 amplify the depth of these
28:39 lines for the provider it's essential to
28:41 understand the intricate anatomy of the
28:44 nasal labial fold area it consists of
28:48 five layers skin subcutaneous fat
28:51 superficial muscular aponeurotic system
28:55 facial muscles and the per oium of the
28:58 Magilla the vascular structure around
29:00 this area include the facial artery
29:04 angular artery and infraorbital artery
29:06 as the facial artery runs near the nasal
29:09 labial fold always aspirate before
29:11 injecting to avoid intravascular
29:14 injection and subsequent complications
29:16 when treating nasolabial folds the
29:18 choice of dermal filler is critical
29:20 older patients with deeper folds might
29:23 need a higher G Prime filler G Prime
29:25 refers to the elasticity or firmness of
29:28 a filler higher G Prime fillers can
29:31 create lift and sustain their form under
29:33 pressure which is beneficial in the
29:35 areas where a more substantial
29:37 correction is required injection
29:39 technique varies depending on the folds
29:42 depth for shallow and medium folds
29:44 linear threading with Fanning is
29:46 typically used this involves a
29:48 retrograde injection technique where in
29:50 the needle is inserted at the lower part
29:53 of the nasal labial fold and Advance
29:55 superiorly towards the nose depositing
30:00 05 to .1 mL of the filler per injection
30:02 Fanning a technique where injections are
30:05 administered in a starburst or radial
30:08 pattern it's particularly useful at the
30:11 upper y-shaped area beneath the Nars and
30:14 the lateral area to the
30:17 Alla however when progressing fly
30:19 towards the oral commissure the
30:21 correction duration tends to decrease
30:25 due to increased muscular activity also
30:27 the correction here may be challenging
30:29 due to the lack of underlying bone and
30:32 the gravitational effect on the cheek
30:34 tissue following the injection the
30:36 provider should mold the filler to
30:38 ensure optimal distribution and
30:40 smoothness this is accomplished by
30:42 placing a glove thumb on top of the
30:45 treated fold and one or two fingers
30:47 inside the mouth then gently molding
30:49 along the injection site to check for
30:52 nodules or lumps ha fillers are
30:54 particularly amenable to molding due to their
30:55 their
30:57 malleability however while while
31:00 treating the nasol labial folds multiple
31:02 superficial lines lateral to the folds
31:05 might tempt an injector these lines are
31:07 often a result of dynamic facial
31:09 expression and should be addressed
31:11 cautiously as treating these might lead
31:14 to a visible filler implantation during
31:16 facial movement which may appear like
31:18 cordlike structures on the
31:21 face post-procedural monitoring is
31:23 crucial and patients should be educated
31:25 about potential complications such as
31:28 swelling redness pain bruising lump skin
31:31 necrosis and even rarer complications
31:33 like blindness due to Accidental
31:36 intraarterial injection additionally
31:38 patients should avoid vigorous physical
31:41 activities exposure to intense heat or
31:44 cold and alcohol for the first 24 hours
31:46 postprocedure to minimize risk and
31:49 enhance recovery remember while
31:50 hyaluronic acid fillers provide an
31:53 effective minimally invasive approach to
31:55 correcting the nasal laal fold patient
31:57 safety and aesthetic results should
31:59 always be the primary concern therefore
32:01 a thorough understanding of the facial
32:04 Anatomy injection techniques and product
32:06 characteristics are prerequisites to
32:10 performing these procedures safely and
32:13 effectively lip augmentation the art of
32:16 balance and precision the lips reaching
32:19 their Peak volume by the mid-30s
32:21 represent a Hallmark of beauty and
32:24 usefulness however with age features
32:27 such as the Vermilion border fital Ridge
32:29 and Cupid's bow undergo changes
32:32 including thinning drooping and
32:35 flattening the upper lip often becomes
32:37 thin and elongated whereas the lower lip
32:41 Thins and rolls inwards simultaneously
32:43 the orbicularis orus muscle activity
32:46 contributes to radiating perioral lines
32:50 commonly referred to as lipstick lines
32:52 achieving a Natural Balance augmentation
32:55 of the lip is a complex task requiring a
32:57 thorough understanding of facial
33:00 proportions anatomy and the unique
33:02 characteristics of dermal fillers when
33:04 discussing proportions it's generally
33:06 accepted that the lower lip should be
33:09 Fuller than the upper lip with an ideal
33:14 ratio of 1 to 1.5 according to the foni
33:16 sequence the clinician's approach must
33:18 be nuanced according to the patient's
33:21 age younger individuals seek to enhance
33:23 the size and shape while even small
33:27 volumes of filler 0.1 to3 ml can
33:29 significantly enhance the lips
33:31 appearance caution should be exercised
33:34 to prevent the undesirable duck lip
33:37 appearance older patients in contrast
33:39 generally wish to restore the lips to
33:41 their previous state rather than
33:44 increasing size such patients may not
33:47 desire a lip diversion or an unnatural
33:49 appearance and might require adjunctive
33:52 treatments like laser resurfacing or
33:55 chemical peels for perioral wrinkling or
33:58 deep lipstick bleeding P pain during the
34:01 procedure can be managed by using ha
34:03 products containing leaine nerve block
34:05 or topical
34:07 anesthetics however if nerve blocks are
34:10 used it's crucial to work promptly as a
34:12 numbing can distort the lip
34:14 position in terms of injection
34:17 techniques threading is recommended for
34:19 minimizing puncture sites the Vermilion
34:21 border and the wet dry Junction are
34:23 common targets for lip volume
34:25 enhancement to increase lip size and
34:28 provide lifts and cont tour the needle
34:31 should be inserted 1 to 2 mm from the
34:33 Vermilion border towards the mucosal
34:36 border creating a ski jump appearance
34:38 however overfilling near the Vermilion
34:40 border should be avoided to prevent the duck-like
34:41 duck-like
34:44 appearance when focusing on volume
34:45 enhancement the needle should be
34:48 inserted 3 to 5 mm from the Vermilion
34:50 border near the wet dry border which
34:52 will plump up the lips without inverting
34:56 the edges for enhancing the filal column
34:57 the needle should be inserted at the
34:59 junction of the Cupid's bow and the
35:02 fital column advancing
35:05 superiorly vertical lip line can be
35:07 managed by direct injection of the lines
35:10 or along the Vermilion border care
35:11 should be taken to use minimal amounts
35:14 to prevent overcorrection and unnatural
35:17 bulging as lips are a focal point of the
35:20 face Precision is Paramount over
35:23 correction or asymmetry can be glaringly
35:26 apparent in addition lips Rich
35:27 vascularity make them prone to
35:29 complications such as bruising and
35:32 swelling it's recommended to apply ice
35:34 post procedure to mitigate these
35:37 immediate side effects and to ensure
35:38 equal amounts of fillers are
35:40 administered additionally due to their
35:43 high G Prime fillers such as juviderm
35:45 voluma or resellin lifts are generally
35:49 avoided in lips favoring softer fillers
35:52 such as juviderm Vella or reslin silk to
35:55 avoid lumpiness and provide a smoother
35:57 softer feel
35:59 potential complication include not only
36:01 the immediate post treatment swelling
36:03 and bruising but also longer term
36:05 problems such as lumps bumps asymmetry
36:08 and more seriously vascular cusion in
36:11 the case of vascular clusion immediate
36:13 management with honas is
36:16 critical in conclusion ha dermophil
36:18 injection and the lips require a deep
36:20 understanding of the lip Anatomy precise
36:22 injection techniques and careful patient
36:25 selection and counseling a conservative
36:27 approach with a focus on balance
36:29 proportion can yield the most satisfying
36:31 and natural
36:34 results high Al urones is an enzyme that
36:37 hydrolyzes and breaks down hyaluronic
36:39 acid facilitating the successful
36:42 elimination of unwanted ha
36:44 implantation it's been utilized
36:46 effectively to correct a symmetry
36:49 overcorrection tndo effect and Vascular
36:53 occlusion honas dissolves the filler and
36:55 reduces edema thereby helping to
36:59 minimize uded vessel pressure for use
37:01 higher Rodas is eluded with saline in a
37:04 1:1 ratio mandatory skin testing
37:06 involves injecting 3 to five units
37:09 intradermally a wheel formation within 5
37:12 minutes persisting for 20 to 30 minutes
37:15 with localized itching indicates a
37:18 positive skin test a total of 10 to 30
37:21 units should be injected per 2x 2 cm
37:25 area of impending necrosis it's crucial
37:27 to check the package insert for for any
37:30 honas product for complete instructions
37:33 and information regarding warnings and
37:35 contraindications attempts should be
37:37 made to dissolve or eliminate the
37:40 injected product in the case of
37:43 hyaluronic acidbase fillers Huron should
37:46 be injected all over the affected area
37:49 flooding the area with honas as soon as
37:51 possible and a dose applicable to the
37:54 product to be reversed for example 10 to
37:57 20 units per injection point
38:00 honas injection should be repeated on a
38:02 daily basis where appropriate and
38:05 continued for at least four days as long
38:07 as there are signs of esea an
38:09 anti-coagulant such as low molecular
38:13 rate Hein aspirin or Plavix could also
38:15 be prescribed to increase blood flow to
38:18 the wound other authors have suggested
38:21 the use of Viagra to dilate the compromised
38:27 vasculature this is Dr J park with
38:30 cosmetic medical training thank you for
38:33 watching or listening if you have any
38:36 questions please contact us at email
38:40 cosmetic medtraining
