The blue hue after hyaluronic acid injection is a well known complication. It is commonly referred to as the Tyndall effect. But does the Tyndall effect really describe this phenomenon? Considered from a  scientific point of view this appearance is examind and reasons are shown, why this is not in any means related to what Tyndall did describe. The reasons for this are beeing presented as well the management of the complications and the avoidance of it.

Background Our gynecology department operates on the basis of the largest private plastic surgery center in Russia where more than 8,000 surgical procedures including facial rejuvenation are performed per year. To optimize the aesthetic outcomes of plastic surgery, comprehensive approach and synergistic cooperation between physicians of different specialties involved in Anti-Ageing program is required. As gynecologists we are interested in the role of hormone replacement therapy (HRT) and its impact on aesthetic surgery outcomes.

The value of HRT in the Anti-Ageing program is confirmed by multiple studies. HRT offers the following benefits in aesthetic surgery:

1. It tends to slow down the typical thinning of the skin that occurs after menopause.

2. HRT containing progesterone derivates with anti-androgen effects reduces hirsutism and alopecia signs in menopause, which may be a source of psychological distress.

3. It is well known, that the muscle mass decreases and fat deposits increase with age. Several studies have shown that there is not just a spontaneous weight gain during the menopausal transition but primarily fat accumulation in visceral abdominal area. In addition to aesthetic concerns of women, weight gain also has important health effects as it increases CVD risk. Timely initiation of HRT contributes to weight stabilization and prevents fat redistribution.

4. Another aspect of the quality of life for postmenopausal women is urinary dysfunction due to urogenital atrophy.

5. Many studies suggest that estrogen therapy has a positive impact on the appearance and mechanical properties of the vulvar skin. HRT may improve the sensorimotor response of the vulvar vestibule.

6. Moreover, recent studies suggest a role of HRT in faster wound healing. This should be taken into account when vaginoplasty is performed and necessitates the use of HRT postoperatively.

We also attract patients’ attention to the general long-term goals – i.e. health and longevity.

Surgical component of the comprehensive Anti-Ageing program gives an opportunity to perform face and body aesthetic treatment in combination with treatment of other age-related problems, such as genital prolapse, stress incontinence, varicose veins and so on.

Objective Our study was aimed to assess the efficacy of HRT in comprehensive rehabilitation after aesthetic surgery and develop an algorithm of clinical and hormonal monitoring.

Methods The study included 92 women aged 37 to 69 years examined before face and neck lift and followed up for 18 months postoperatively (January 2013 – January 2015).

Preoperative clinical laboratory tests were complemented by assessment of hormonal profile, aging markers, oncology markers, bone resorption rate, lipoproteid fractions and coagulogram, as well as pelvic ultrasonography, oncocolpocytology, x-ray densitometry and mammography.

Additional consultations were provided depending on existing comorbidities. Three groups of patients were followed up:

Group 1 (n=63) receiving HRT perioperatively; Group 2 (n=21) without HRT due to contraindications; Group 3 (n=8) not requiring HRT according to preoperative findings (controls)

Postoperatively, a rehabilitation therapist analyzed 4 parameters: the extent of tissue edema, complications, sensitivity recovery and subjective facial assessment by patients.

Each parameter was scored 1 to 5; the first two parameters had negative scores. The total score of 4 parameters was recorded for each patient at 1, 3, and 9 months postoperatively.

At 1 month, parameters in all groups had similar scores (- 7.3 to -7.9).

At 3 months, Groups 1 and 3 had higher scores than Group 2. At 9 months, the difference in score between Groups 1 and 2 was 2.8. Group 1 had fewer subjective complaints and rehabilitation treatments between 3 and 9 months, while Group 2 complained of skin tightness and dryness, paresthesia and loss of sensitivity.

Conclusions Adequate HRT is an important component of rehabilitation that helps maintain the achieved aesthetic results. The use of HRT in conjunction with aesthetic surgery in perimenopausal women is pathogenetically grounded. It reduces the extent of rehabilitation treatments, decreases patients’ anxiety and depression and improves their mood, as well as reduces the number of complaints and improves their subjective assessment of the outcomes.

Background.  Revision reconstructive rhinoplasty after unsatisfactory and destructive surgeries is still one of the most complex challenges for all plastic surgeons. Patients seeking for revisions after previous destructive rhinoplasty often have serious aesthetic, functional and psychological problems: an unnatural nose shape due to excessive resection of the nasal structures and tissues, breathing problems etc. Today, many plastic surgeons tend to use open rhinoplasty technique as the only approach to correct such complicated cases, especially if previous surgeries at other clinics were performed with open methods application. Many specialists believe that only open technique allows them to see in detail, estimate and correct the defects and failures of the previous operations, achieving the best optimal results of the revision.

Objective. We would like to review the surgical methods we use in closed revision reconstructive rhinoplasty after unsuccessful open and destructive nasal surgeries.

Patients and methods. From 1998 to 2016 we operated more than 2,000 noses. 292 of them were revision rhinoplasties after operations performed somewhere else at other clinics, 186 cases were revisions after our own previous surgeries. We carried out most revision operations using the endonasal methods. In our presentation we would like to review the following subjects:

1) Advanced surgical endonasal techniques in revision reconstructive rhinoplasty

2) Nasal skin peculiarities and their impact on the rhinoplasty outcomes

3) Osteotomy of an injured nose

4) Airway dysfunction management in reconstructive rhinoplasty

5) Modifying thick nostrils using various cut out patterns

6) Cartilaginous tip grafts

7) Anthropometrical compensations

8) Nasal base reduction in revisions

9) Suture techniques for a boxy injured nasal tip

10) Diprospan (Betamethasone) in rhinoplasty: the prons and cons

11) Complications of a revision reconstructive rhinoplasty

Conclusions. Closed techniques have many significant and important possibilities and advantages in revision reconstructive rhinoplasty as they allow achieving good satisfactory results in revisions of traditionally complex previously injured noses. At the same time, after endonasal surgeries the postoperative scars are not as much visible, patients satisfaction is much higher and rehabilitation period is shorter. https://cloud.mail.ru/public/GMz7/ZSiWKCMpo

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Introduction: Surgical corrections of the nose in reconstructive surgery are important as well as in aesthetic surgery. In the past years a trend towards non-surgical procedures for an aesthetic improvement of the nose could be noticed.

Methods: Also for filler injections anatomical knowledge is crucial to provide a safe and aesthetic outcome. At the department of Anatomy we dissected 20 noses to show the basis for exact filler treatment for the back, the tip and the angles of the nose.

Results: knowing the different spaces and layers, as well as the proper shape of the cartilages, the vascular supply and the bony structures of the nose are important for a satisfying result.

Conclusion: On the one hand we find surgical procedures more effective due to the long lasting effect. Nevertheless exact filler placement in the right hand and the right knowledge provides also a perfect result that might be satisfying over several months

Background:Beside the face,first signs of aging are clearly shown in the hands. Due to the high demand,different techniques for hand rejuvination using either structural fat grafts or injectable fillers to restore the volume have been performed. Mesotherapy, lasers, chemical peelings or sclerotherapy help to treat the superficial signs of aging. We wanted to demonstrate the right plane of injection for safe volumetric restoration.

Methods: Having dissected 12 cadaveric hands, evaluation clearly showed the best placement of volumetric fillers.

Results: Histologic examination showed 3 fatty laminae which are separated by thin fascias. No structures transversing the subcutaneus, superficial fatty lamina could be found. Dorsal veins and dorsal sensory nerves could be found within the intermediate lamina. The extensor tendons were found within the deep lamina.

Conclusions: Following anatomical dissection we could demonstrate the safe approach injecting into the intermediate lamina with minimal risk of adverse events.

The ageing of our patients is suggested not only by the face’s changes but buy the hand too.

The importance to choose the most correct technique to fill the hand dorsum is fundamental to obtain the best results.

The author have compared 4 different techniques (four videos are presented), two with needle and two with cannula, single and multiple injecting points. In the last 100 treatments the author have injected calcium hydroxilapatite restored with 5% of lidocaine 2%.  Difficulties, adverse events, patient’s pain and filler distribution are analyzed.

Treatments by cannulas allows an easily distribution of the filler but induce more local edema.

On the contrary treatments by needle needs more skill by physician but with a faster result.

In conclusion great results can be obtained with all the 4 techniques and physicians can choose his preferred technique  considering his personal skill and experience

Technical progress in the field of soft-tissue simulations and augmented reality throughout the past decade enables an easy implementation of virtual planning workflows in clinical routine. The additional utilization of optical coherence tomography in preoperative planning can contribute to the optimization of hair restoration surgery by means of follicular unit extraction, helping to avoid follicle damage or dissection during harvesting. Our approach presented in this lecture is to consider geometry, proportions and harmony of the whole face, even if surgical procedures are scheduled at different times respectively by various specialists. Consequently, a full integration of hair restoration surgery, cranio-maxillofacial surgery (e.g. genioplasty, midface augmentation) and dental implantology should become possible.

Currently established software for planning and simulation in facial surgery does not sufficiently consider hairline design, although this has an outstanding impact on the esthetics of the whole face. Without consideration of hairline design, which means realistic visualization, the impression of the face is substantially impeded and consequently the quality of any preoperative simulation reduced. Nevertheless, neither the merge of a conventional 2D-photo showing the actual hairline (including eyelashes and eyebrows) with a 3D rendering based on computed tomography data of the skull, nor a pure “illustration” of a planned newly generated hairline by the hair transplant surgeon can provide a realistic prognosis of the postoperative look. For this purpose the extraction of information e.g. from trichodensitometry and the use of specific image processing algorithms could found the base for realistic simulations.

The full integration of all these aspects in one and the same computer based workflow is what we call “Facial Esthetics Engineering”. This lecture gives a survey of the most recent technical and medical developments with special focus on future perspectives of virtual planning in facial surgery and hair restoration surgery.