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102 O FFICE -B ASED C OSMETIC P ROCEDURES using none tomake none in web,windows application Microsoft Office Official Website T ECHNIQUES FIGURE 24.1: Long -lasting ef cacy of liquid silicone for nasolabial and melolabial folds: A, pretreatment; B, ten years posttreatment (estimated volume 2.5 cc).

. sitting varies wi none none th the extent and type of the defects to be injected (Figures 24.1 24.3).

In terms of short-term outcomes, cumulative volume is not as important as the volume per injection site. However, larger total volumes of ILS are more likely to cause problems. For treatment of nasolabial or melolabial folds, volumes employed typically vary between 0.

25 and 0.75 cc. For facial hemiatrophy, 2 or 3 cc per session has been safely employed.

A second pass, injecting more ILS above or below previously treated areas, may lead to droplet coalescence and excessive broplasia. Treatments are carried out at one- to two-month intervals. for the rst several treatments, and at two- to six-month intervals as the process progresses. INSTRUMENTATION AND PERSONAL PREFERENCES Using an 18-gauge needle, 0.4 cc of Silikon is drawn up into a 1-cc leur lock syringe, tted with an assist device that is ordinarily employed for Zyplast. Injections are carried out using a 26- or 27-gauge, 1/2-inch needle.

Two weeks before treatment, anticoagulant drugs, such as aspirin, Coumadin,. FIGURE 24.2: Resu none for none lts following the injection of approximately 1 cc of liquid silicone over several months: A, pretreatment; B, six months posttreatment..

24 . Silicone 103 FIGURE 24.3: Plia ble scars located on the temple are an ideal indication for liquid silicone: A, pretreatment; B, two years after implantation of an estimated 4 cc of liquid silicone injected over several months..

or heparin, are d none none iscontinued. Patients are advised not to undergo dental procedures, run marathons, or consume signi cant amounts of alcohol for at least two weeks after treatment. On the morning of treatment, patients wear no makeup, are carefully cleansed, and are given nerve block anesthesia, which does not distort the areas to be treated.

Although topical anesthetics can be employed, their use makes careful marking of the areas to be treated more dif cult. With the patient seated under overhead lights, sites to be treated are outlined using an eyebrow pencil. Treatment is administered with the patient in the seated position.

Flash and side-lighted pretreatment and posttreatment photographs are taken, using both digital and silver halide photography. Surgical lights, although not color corrected, are used to silhouette the contours of the areas injected. Some physicians prefer to use insulin syringes (Becton Dickenson).

These 0.3-cc syringes must be lled with the plunger out. This type of syringe, with a permanently attached needle, is particularly useful for extremely small volume injections.

. COMPLICATIONS Treatment with IL none for none S can provoke the same spectrum of minor complications and certain major complications associated with other types of soft tissue llers. Complications can be minor or major, temporary or permanent, immediate or delayed, in ammatory or nonin ammatory, and technique or nontechnique related. Most complications speci c to ILS are technique related.

It is unforgiving. Problems often arise when ILS is injected too super cially. These include overcorrection; brosis; dyschromia (brown or yellow discoloration of the skin); a peau d ange appearance sometimes attributed to lymphatic blockage; and bluish discoloration, which follows the treatment of patients with very thin, translucent skin.

Telangiectasias occasionally occur. Super cial ILS implants can become visible years after treatment. When small super cial foreign body granulomas occur, they can be treated using dermabrasion, ablative lasers, or electrocautery.

Minor overcorrections often atten with intralesional corticosteroids. There is general agreement that horri c sequelae,. 104 O FFICE -B ASED C OSMETIC P ROCEDURES T ECHNIQUES including migrati on, ulceration, stulation, embolic phenomena, and collagen vascular disease, have not occurred following the use of small volumes of pure liquid silicone by skilled physicians treating properly selected patients.. DISPLACEMENT PHENOMENA Occasionally, pat ients who have undergone glabellar or nasolabial augmentation develop excessive, ridgelike fullness adjacent to the injection site. This may be due to muscular movement induced displacement of ILS or to excessive collagen deposition..

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