Pretreatment assessment for botulinum toxin and filler injection

서구일 ( Kyle Koo-il Seo ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.2

During the patient consultation, items to be evaluated can be separated into the following categories: subjective, objective, sociocultural, financial and previous history of cosmetic procedures. True ‘custom-tailored’ treatment is only possible when the treatment plan fully takes into account the results of a comprehensive evaluation covering various aspects along with an understanding of individual characteristics. Since beauty is a subjective concept, it is important to know which points a patient is primarily concerned about. Patients are usually not satisfied unless they receive the improvements they want even if their needs are met in other areas. Once you feel that you have truly grasped a patient’s needs, you should evaluate their expected results in the next step. If the expectation level is too high, it will be extremely difficult to satisfy a patient despite what you feel may be a successful outcome. The objective evaluation is a summary of the patient’s physiological characteristics such as age, gender, facial shapes and facial aging features: wrinkle characteristics, follicular pores, depression, sagging, skin thickness, elasticity, et al. Botulinum toxin type A(BoNT-A) dose and injection sites vary by age and gender. Accurately grasping your patients’ problems is the first step towards the effective treatment of any disease and cosmetic treatment is no exception. Once you have gathered information about patients’ characteristics and general aging state, it is important to assess the appropriate indications and potential adverse effects of treating them with BoNT-A and fillers. For example, fillers are required as a supplement to BoNT-A for deep wrinkles in the glabellar area and fractional lasers for infraorbital lines. Patients with ptosis may experience difficulties to open their eyes after injection of BoNT-A into forehead unless dose of BoNT-A is lowered. Developing an acute sense of ‘doctor’s insight’ to grasp patients’ problems before treatment is essential for providing successful care. It is helpful to develop meticulous observation skills for examining patients from the forehead to the neck when they are at rest and while giving forced facial expressions. As prolonged staring at patient’s face may be a bit uncomfortable, ‘diagnosis with mirror’, allowing patients to observe themselves through a mirror is a good alternative for doctors to find their problems. ‘Mirror diagnosis’ is not only helpful for catching problems in detail, but also allows patients to find new problems that may have been unnoticed previously, which motivates patients to receive treatments for new problems. It is also important to observe patients’ facial expressions during consultations, including their involuntary habits. It can be helpful to naturally observe all of a patient’s habitual movements such as lifting of the eyebrows, twitching of the nose, glabellar frowning, applying force to the anterior jaw, peculiar expressions accompanied by tics, and to also watch for periorbital lines and nasolabial folds that appear while smiling or speaking and the shape of lines around the lips. Among sociocultural aspects, it is helpful to know the profession, marital status, nationality and ethnicity of your patients. You should also determine to what extent bruising or edema may interfere with their daily lives in case they occur. For male CEOs in their 60s, the procedure should be without social down time. As people of different races and ethnicities have their own preferred facial shapes and treatment goals, treatments should be adjusted as necessary according to these factors. For example, BoNT-A treatment for masseter hypertrophy is not popular in western countries since most Caucasians do not care much about square jaw with mandibular angles and masseter hypertrophy. Volumization using filler for sunken lower cheek which is popular in Asians is not performed since Caucasians prefer sunken cheeks. It is important to check your patients’ previous history of cosmetic treatments such as the removal of infraorbital lines, nose surgery, fat transplantation, BoNT-A injections and filler injections. With regards to fillers, it is helpful to know which products were used and how satisfied they were with the treatment. If a patient has received prior treatments with BoNT-A, it is important to find out if they had experienced any adverse effects after the injections, particularly eyebrow drooping or change of facial expressions. Finally, financial situation is one of the most important, yet often overlooked, aspects of a patient evaluation. Budgetary constraint is an important factor in customer purchase decisions. Most patients need to weigh up the cost and benefits of a given treatment. If there is true financial burden, it is better to initially recommend the best cost-benefit options with the most noticeable results in order of priority. It is with this in mind that practitioners assist patients prioritize the necessary treatments they need to receive. For example, upon assessing a patients’ face, I would suggest they start with treatment of the glabellar wrinkle and anterior malar depression as their first priority. I would then suggest they could do with a nose filler and chin augmentation later to add more definition to the face, but for now their priority should be the glabellar wrinkle and malar depression treatments for the younger appearance. Or it can be a good idea to drop patients who come in with unrealistically low cost estimations. Patients who are under cost pressure tend to have disproportionately higher expectations about the results, and will most likely end up being an unhappy customer.

Hyperhidrosis: Optimized toxin injection technique

서구일 ( Kyle Koo-il Seo ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1

FCT 2-7 Evaluating the longevity of filler rhinoplasty via anthropometric analysis

( Sung Hwan Youn ),( Kyle Koo-il Seo ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.2

Background: Filler rhinoplasty is a simple and effective treatment modality producing outcomes comparable to surgical augmentation rhinoplasty. There are no reports of objectively evaluating the longevity of filler rhinoplasty using anthropometric techniques. Objectives: To objectively evaluate the longevity of filler rhinoplasty via anthropometric analysis. Methods: We retrospectively reviewed the medical records of the patients who received the filler rhinoplasty in Modelo clinic from 2006 to 2014. We included the 76 Korean patients who revisited the clinic after the hyaluronic acid filler rhinoplasty and dividable by follow-up duration as 3months, 6months, 9months 12months and 18months subgroup. We compared the anthropometry between before and follow-up by paired t-test. Results: Until 18months, nasofrontal angle, modified nasofacial angle and radix height increment showed statistical difference between before and follow-up. But, nasolabial angle start to lost efficacy between 12months and 18months after filler rhinoplasty. Conclusion: Nasal dorsum, especially nasal root is more stable area for filler rhinoplasty than nasolabial angle in terms of longevity. But nasolabial angle also showed at least over 12months longevity. More data will be needed to conclude the longevity at the nasal dorsum.

FCT 8 : Forehead augmentation with filler in 103 Koreans

( Sung Hwan Youn ),( Kyle Koo Il Seo ) 대한피부과학회 2014 대한피부과학회 학술발표대회집 Vol.66 No.2

Background: Filler augmentation for younger appearance is usual procedure in facial rejuvenation including forehead augmentation. Objectives: To evaluate the duration of forehead augmentation with filler. Methods: We retrospectively reviewed the medical records of the patients who received the forehead augmentation with filler from 2006 to 2014. And we included the 104 patients who used more than 1ml of hyaluronic acid filler. The injection was done by cannula after the nerve block and anesthesia of the entry points. The treatment was performed to a visual endpoint of optimal correction. We divided into two groups according to the follow up periods. Results: 93.2% of patients were female. 71.9% were in twenties to thirties in their age. 84.5% were received on various area of the face and 15.5% were received only at the forehead. Average dose for the whole forehead augmentation is 3.78ml. And 1.22ml for the right side of the forehead, 1.5ml for the central part and 1.15ml for the left side. 20.4% of patients were followed up at least after 8months to 18months. Conclusion: Forehead augmentation with filler is the treatment of choice to the patients who wanted less invasive techniques, no downtimes, high degree of satisfaction and have the fear of the operation. We assumed that the volume of hyaluronic acid filler at the forehead was preserved at least 6months to 12months.

FCT 12 : Filler rhinoplasty in 74 Koreans

( Sung Hwan Youn ),( Kyle Koo Il Seo ) 대한피부과학회 2013 대한피부과학회 학술발표대회집 Vol.65 No.2

Background: Filler augmentation is usual procedure in facial rejuvenation including rhinoplasty. The nasal augmentation has long been wanted among Asians who have relatively smaller nose than Caucasians. Objectives: To review the clinical experience of the hyaluronic acid filler rhinoplasty in our clinic and to objectively measure the effectiveness of filler rhinoplasty . Methods: We retrospectively reviewed the medical records of the 357 patients who received the filler rhinoplasty from 2006 to 2012. And we included the 74 patients who followed up at least after 6 months. Whole cases were treated with hyaluronic acid fillers. The injection was done by cannula after the anesthesia of the entry points. And we compared the ratio of the sellion nasolabial angle and nasofacial angle before and after at least 6 months of treatment. Results: 95% of patients were female. 76% were in twenties to thirties in their age. 51% were received on their nasal dorsum and 41% were received totally as nasal dorsum nasal tip and collumla. Average dose for the nasal dorsum augmentation is 0.87ml. And 1.61ml for the total correction. 63% of patients were followed up at least after 6months to 18months. 37% were followed up until 2years to 4years. There were 3 cases of complications recovered without any severe sequelles. Conclusion: Filler rhinoplasty is the treatment of choice to the patients who wanted less invasive techniques no downtimes high degree of satisfaction and have the fear of the operation.

Anthropometric analysis on filler rhinoplasty in 360 Koreans

( Sung Hwan Youn ),( Kyle Koo Il Seo ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1

Background: Filler augmentation is usual procedure in facial rejuvenation including rhinoplasty. The nasal augmentation has long been wanted among Asians, who have relatively smaller nose than Caucasians. Objective: To objectively measure the effectiveness of filler rhinoplasty and to review the clinical experience of the hyaluronic acid filler rhinoplasty in our clinic. Methods: We retrospectively reviewed the medical records of the patients who received the filler rhinoplasty in our clinic from 2006 to 2014. And we included the 360 Korean patients who treated with hyaluronic acid fillers. In majority of the cases, the injection was done by cannula after the anesthesia of the entry points. We checked the site and the amount of the injected filler, and measure the anthropometric factors. Results: 92% of patients were female. 78% were in twenties to thirties in their age. 50% were received on their nasal dorsum and 47% were received totally as nasal dorsum, nasal tip and collumla. Average dose for the nasal dorsum augmentation is 1ml. And 1.50ml for the total correction. There were 6 cases of complications recovered without any severe sequelles. The height of the nasal root, nasofrontal angle and nasolabial angle is increased after injection. Conclusion: Filler rhinoplasty is the treatment of choice to the patients who wanted less invasive techniques, no downtimes, high degree ofsatisfaction and have the fear of the operation