THE FOREHEAD in Java Develop 39 barcode in Java THE FOREHEAD

THE FOREHEAD using barcode generating for none control to generate, create none image in none applications. ASP.NET Web Form Project Other than smal none for none l amounts of HA llers for deep glabellar frown lines, always in conjunction with the use of neurotoxin, I do not routinely use llers on the forehead. Particular care must be taken when injecting the glabella to avoid intravascular injections. Neurotoxin alone, or in combination with resurfacing, yields excellent and predictable results on the forehead.

Fat can be used very conservatively in the brow area for the most volume-depleted cases. Great care must be taken to prevent placement or migration of the fat under the thin upper lid skin..

UPPER EYELIDS I think the llers should be avoided here. page 133 134 O FFICE -B ASED C OSMETIC P ROCEDURES T ECHNIQUES FIGURE 31.1: Te none for none ar-trough deformity: A, pretreatment; B, after 0.2 cc Restylane on each side, placed on the periosteum.

. LOWER LIDS AND CROW S FEET I used to injec none for none t Zyderm/Cosmoderm for deep crow s feet, but the use of BOTOX and the availability of fractional resurfacing have largely eliminated the need for llers in this area.. INFERIOR ORBITAL RIM AND TEAR-TROUGH DEFORMITY FIGURE 31.2: Ch none none eek augmentation with Radiesse: A, pretreatment; B, after 0.7 cc Radiesse on each side, 0.

5 cc to malar area, 0.2 cc to tear-trough area..

Fillers do very well here. Restylane, Perlane, Juv derm e Ultra (U), Juv derm UltraPlus (UP), and Radiesse can all e be used with excellent results (Figure 31.1).

Since ecchymoses can be a problem here, for most patients, I prefer Restylane or Juv derm-U, which can be injected through e a smaller needle. I place the product in the subperiosteal plane or at least under the orbicularis muscle, 0.2 0.

4 cc per side. A nger from the noninjecting hand is always kept on the orbital rim margin to protect the eye. Gentle pressure is applied for two to three minutes.

Excellent anesthesia, without any distortion of the area, is provided by an infraorbital (IO) nerve block.. THE CHEEKS Radiesse here, as it lasts the longest of the three. At least 0.5 0.

7 cc of product is injected subperiosteally in a crisscross fashion (Figure 31.2). Fat is also an excellent choice for malar augmentation and would be my choice when larger volumes are needed and multiple other areas are being treated.

Again, the IO nerve block can provide good anesthesia for most of the malar area. If I want to go further laterally, I painlessly inject a little lidocaine subperiosteally from a medial injection port, which is already numb from the IO nerve block..

THE NOSE Radiesse is an excellent ller choice to correct small dorsal nasal contour irregularities. THE LIPS, NASOLABIAL FOLD, AND PERIORAL AREA Surprisingly li ttle Perlane, Juv derm-UP, or Radiesse can e provide a good degree of malar augmentation. I prefer. The HA products none none are great for the lips (Figure 31.3). Radiesse and ArteFill should be avoided due to nodule formation.

Fat is tricky for the lip proper. With fat, very small amounts have to be injected, and there is far more downtime. 31 . Choosing a Filler 135 FIGURE 31.3: Li p augmentation with HAs: A, pretreatment; B, after subtle augmentation of the vermilion border with 0.3 cc Restylane; C, after additional augmentation of the lip proper to give a full, voluptuous lip look.

. than with HA l none none lers. On the upper lip, restoring the white roll is essential 0.2 0.

3 cc of HA ller is usually enough (Figure 31.3B). Excessive ller will give the duck lip effect.

The vertical lines do not do as well but can be injected with very small amounts. The philtrum lines can also be accentuated. The mucosal surface can be injected to increase overall volume (Figure 31.

3C). Care must be taken to maintain good balance between the upper and lower lips. The vertical dimension of the upper lip should be at least 0.

6 of the lower lip, preferably more. With age, the upper lip tends to invert, and the lower lip everts. One of the best uses of ller is the triangle that forms when the corner of the mouth sags down.

Filling that triangle brings the corners of the mouth up and greatly improves the sad line appearance of the lateral commissural folds (marionette lines). It takes 0.15 0.

25 cc of HA ller, on average. Fat is also good here, and I have not had problems with Radiesse either..

The nasolabial folds proper are the bread and butter of ller treatments. My ve-year experience with Restylane has been excellent. I inject it in serial puncture fashion, relatively high in the dermis, using 2.

5 power loupes. Because I always use IO nerve blocks, there is no distortion whatsoever from anesthetic, and the injections are painless. This allows for very precise placement of the ller and a smooth contour elevation.

Since all the HA ller is placed intradermally, I get a lot of lling with relatively small amounts of ller (Figure 31.4). The distension of the dermis appears to trigger new collagen formation.

In my hands, using Restylane, the initial results last eight to ten months. However, with repeated treatments, nasolabial fold correction lasts at least ten to eighteen months. In a retrospective chart review, it was clearly apparent that in a signi cant number of patients, with repeated treatments at nine- to twelve-month intervals, when the interval between treatments remained relatively constant, the amount of ller used for the nasolabial folds decreased over time.

When patients scheduled the appointments for retreatment based on perceived loss of correction in the nasolabial folds only, the interval between treatments increased over time. This effect was largely limited to the nasolabial folds. Interestingly, Radiesse did not seem to induce the same effect, with volume of ller needed or patient-controlled intervals between treatments remaining relatively constant.

Juv derm-U appears equally, but cere tainly no more, effective or longer lasting than Restylane. Juv derm ows easier than Restylane, but to me, that is e more of a disadvantage as it is harder to control, and easier to overcorrect. Perlane and Juv derm-UP are also about equivalent.

e They must be injected with a 27-gauge needle. If a 30gauge needle is used for these larger-particle, more viscous products, they break down in the injection process, and the bene ts of their use are lost. Occasionally, for patients with very deep folds for which two syringes are needed, it may be advantageous to layer the smaller-particle, less viscous product (e.

g., Restylane) over the larger-particle, more viscous product (e.g.

, Perlane). Radiesse is a good choice for men and for women with relatively thick skin and deep nasolabial and lateral commissural folds. Many of these ethnic women do not need lip augmentation.

I inject Radiesse with a 25- or 27-gauge, 1 1/2 inch needle, using the multiple threading technique as I withdraw the needle. The cost of Radiesse has dropped signi cantly since it was introduced, and the usual 1.4-cc syringes provide at least as much, if not more, correction than 1.

6 cc of Juv derm, at a lower cost. Initial claims that e Radiesse lasted two to three years were grossly exaggerated for these areas; the average is nine to ten months. The incidence of signi cant ecchymoses is much greater with Radiesse, which is another drawback for its super cial use.

Evolence requires a 27-gauge needle. It remains to be seen if the longer initial duration will translate into cumulative longevity increases with repeated use..

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