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Dr. Swift and Prof. Cotofana discuss anatomical considerations in a COVID world. Is it possible to predict the contour changes for different depths of injection (surface volume coefficient)? Is there an injection sequence in the face that will economize on product (less is more)? (Episode 1 of 2) Related
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    • #4462
      Swift Beauty

      Is it possible to predict the contour changes for different depths of injection (surface volume coefficient)? Is there an injection sequence in the face that will economize on product (less is more)? [See the full post at: Conversation with Professor Sebastian Cotofana: Anatomical Concepts]

    • #4463
      Mathew Mosher

      when brilliant people have more spare time we all benefit! Thanks Stefano and Arturo
      Mat

    • #4464
      Yehia Elgarem

      Dr. Arthur, Dr Sebastian: thank you soo much for this mind chess conversation.
      My question is do you think that we should change the strategy of temple injection to a more superficial plane than the deep approach in all cases? Or we can combine both approaches in patients with marked temple hollowness so we can start with deep injection and then to the superficial injection ( like a sandwich technique) that might give more support to temple structure especially if the aim of injection is to lift the tail of the eyebrow

      • #4484
        Dr. Arthur Swift

        Excellent question, and I like the way you think. More and more, we are realizing that one size fits none. Each patient is a snowflake, and requires individual approach and treatment. I am also still learning (we never stop learning that is why it is called the practice of medicine) to apply approaches that I have found efficacious in other regions of the face. For example, I changed the way I inject nasolabial folds years ago, but addressing the issues in layers (deep on the periosteum of the pyriform region, and intradermal over top and along the fold. When I struggle with a mid cheek groove due to a “tight” zygomaticocutanous ligament doing its job of supporting the overlying skin envelope, I find that layered approach is again the best alternative in my hands, injecting on periosteum with a high G’ product, then into the overlying fat pads with intermediate G’ products, and finally with an intradermal lower G’ product. So to modify this approach for the temple makes perfect sense in the way that I inject. But to me, there are only two “S.A.F.E.R.” layers of the temple where I would employ this stacking of product: On bone high up near the temporal crest (the one up one over) with an angled approach and bevel down on the bone (thank you Sebastian for this modification), or with a cannula in the subdermal/subcutaneous plane (with the cannula PERPENDICULAR to the direction of the superficial vessels). I do believe the deep injection can very often elevate the tail of the brow (not always) through a process of which I am still not perfectly clear, but am doing research to elucidate).

        • #4485
          Yehia Elgarem

          Thank you dr Arthur for your reply. Hope i can have the chance soon to discuss with you my technique to correct mid cheek groove that i called “Ligament weakening” technique.

    • #4465
      Olivia De Tezanos Pinto

      Great job! Thank you so much

    • #4466
      Connie Brennan

      Thank you, both Dr. Swift and Prof Cotofana, for sharing your brilliance with all of us. In times like these, we are all doing what we can to make each other’s lives better by staying at home. This stillness brings creativity and thoughtful design. You both have contributed so much to the aesthetic space, and I am a big fan of you both. Thank you, again, for designing this platform so that we can hear more from you! Connie Brennan, RN, BSN, CPSN, CANS, CPC

    • #4467
      Karen Michelson

      This is fascinating! Thank you so much!

    • #4468
      Michelle O’Neill

      Absolutely love listening to these two masterminds!!

    • #4469
      Corina Johnson

      Wow, great concepts to consider! Should we check CRP and adrenal function prior to injecting? Are we going to see a rise in PDO thread procedures if fillers should reduce in a post-pandemic, “autoimmune” patient population? What is your thought about laser energy, RF, and alternative non-HA facial revolumization? Can’t wait for more to come! Cheers & thank you Doctor Swift and Doctor Cotofana, was a lovely, informal chat between two experts in the field.
      Respectfully, Corina Johnson, RN

      • #4483
        Dr. Arthur Swift

        Great questions, Corina, to which I do not have the scientific answers. I personally will not check C reactive protein nor adrenal function prior to injecting. Somewhat overkill and alarming to the patient in my opinion. This was just some banter between Sebastian and myself regarding the “new normal”, and alerting our colleagues to the potential of an increased incidence of inflammatory reactions. I still do not expect the numbers of these events to be overwhelming. I certainly, as I mentioned in the podcast, have injected patients in the past with HA filler and toxin who had background autoimmune issues… and without incident. Pure luck? Maybe, but if you adhere to super clean technique, judicious but limited amount of foreign material, and conscientious follow-up (as for all patients), I am sure adverse events will be few and far between. I will say that given the choice between injecting a cheek superficially or deep to obtain the same result, I would feel more comfortable putting the product on periosteum (as I usually do anyway) and try to avoid depositing any significant quantity intramuscular or intradermal where oedema or immune modulators may trigger the inflammatory cascade. Again, just my opinion, and not based on scientific rigour.

    • #4470
      Ashish Bhola

      Excellent Insight!!! These times provide us opportunity and it kind of reaffirms the need to inject in safer zones with required product !!

    • #4471
      Anusha Dahanayake

      Much food for thought by two great minds. In gratitude.

    • #4472
      Suad Helena Quessep

      I am grateful you have opened this window to all of us around the world to share your knowledge and perpspective of what is to come in our industry,and to all the brilliant colleages you invite to do so too.

    • #4473
      Carolina Fleishman

      Would this still apply when injecting collagen stimulating products like Scuptra Radiesse and Bellafill or just your HA injectables? Thank you for such an important information.
      As Dr Swift would say Stay smart and Stay safe! ⤴️❤️🙏🏻

      • #4482
        Dr. Arthur Swift

        Thanks for the question. Again, what I am about to say is pure conjecture. I feel any foreign body, collagen stimulatory or not, introduced into a heightened immune organism, can trigger an inflammatory response, early or late. Simple question to ask yourself: If a patient came to your office having a cold, or classic flu, or from the dentist’s office where gum surgery was just performed, would you inject that patient with filler or a collagen stimulatory agent? Probably not, even though there is only anecdotal evidence that risk of an eventual inflammatory adverse event is increased. Granted, that is a temporally limited situation, which makes it different because if you are hesitant to inject, you would probably wait two weeks or so to perform the elective procedure with less risk. Now, we may not have that luxury for the next months, so be smart, be safe, use a modicum of foreign material product, and make sure you provide your patient with the information of what to look for and how to contact you in the event a problem occurs.

    • #4474
      Tricia Henry

      Amazing and educational conversation !!!!! Absolutely beneficial to me when I start injecting again !!! ❤️

    • #4475
      Olga Zilberstein

      Thank you so much! It is a pleasure to see you both!

    • #4476
      Elizabeth Lavoie

      “when the anatomist starts writing about rheology” … you know the world will never be the same. Thank you for keeping and sharing your sharp edge while showing a great sense of humour. Such a fabulous idea to have these discussions in that format.

    • #4477
      Yaniv Bigo

      It’s an honor to listen to both of you, but I think the discussion is mainly theoretical and it has no real clinical relevance.

      1. Will you tell patients: “Hi, today we’re going to get less improvement because I’m going to inject your superficial fat pads and not the deep ones”? who will accept that..?

      2. Dermal fillers (why is it even called dermal if it is placed supre-periostly / sub-smas most of the time?) are not a crazy reservior of COVID 19. The volume of filler injected might, maybe, contribute to the formation of granuloma, abscesses, nodules, etc, not contamination with a virus.

      3. Disinfecting is always 99% of the answer, not changing the plane of injection.

      4. Actually, if COVID19 kills someone, it’s mainly due to cytokine storm. So do you want a lot of vasculature/perfusion.. or less? I think you want less.

      5. In macro-view, a virus that increases mortality by how much.. 10%? 30%? than the ‘normal’/seasonal mortality, is not a reason to change your injection technique.

      6. This is mostly a discussion caused by panic and infodemia. I don’t think you would discuss it if instead of corona we had a more aggressive form of the ‘typical’ flu.

    • #4478
      Jennifer Upitis

      Great to hear from two world experts. Thank you for providing thoughtful insights. Look forward to reading your 2 papers a week Dr Cotofana. Any concerns re neurotoxin?

      • #4481
        Dr. Arthur Swift

        I assume you mean any theoretical concerns with respect to injecting neurotoxin in this heightened immune environment? Good question, to which there is no scientific answer. However, my opinion is that I have no untoward concerns. In fact, after speaking with several colleagues across the globe who are released from lockdown and are slowly opening their offices this week, the feeling was that they are starting with neurotoxin treatments only, as they are quick to perform, minimizing the hovering over patients during treatment.

    • #4479
      Katia Paskova

      Thanks for nice presentation.Can you show us superficial temple injection with canula next time.
      After Covid time.

    • #4480
      Ann Hampson

      Thank you for taking the time to video this great learning.

    • #4486
      Anne-Marie Humniski

      Thank you so much for making this available to a wide audience. Some food for thought, much to think about. SO interesting

    • #4487
      Bhavjit Kaur

      These are really good sessions and actually grasp the attention really well . Thank you for sparing your time and sharing your knowledge

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