More than 20 years, so you may talk about the market also, because your markets are different from each other, so fashion.
I want to talk about the cognitive [?] procedures, if you have questions you can ask here.
We will start with the corporate profile.
It's a group of companies that have presence in the healthcare industry since 1999, and with their state of art manufacturing facilities in different countries.
Yeah, when we look at the operating locations, we have a global company, so we have located in different countries.
Our sales distribution office is Bogota, Colombia, for Latin America.
Also, our sales distribution office is in Istanbul, that's why we are making these workshops held here in Istanbul.
We are very proud to work with you.
Because I don't know Arabic, excuse me for that.
And you don't know Turkish.
So I'm Dr.
Sinan Akyurek.
I'm working here.
This is my clinic.
I've been in the medical aesthetic sector since 2004.
I've been a doctor since 2004.
And with this clinic we are having our fifth year.
But before that I had another clinic at the upper side of Nişantaşı again.
I worked there for like three years and before that different areas of Istanbul, but I've been working in Istanbul since I started doctorship, except my military obligation.
So, with Gloderm, our journey started.
[ad]'s mother, she is forced here to come to have lip fillers.
She is very afraid because before, I think, two or three years ago, she had another lip filler and she had serious pain when she was having that.
So, we are going to numb her with nerve blockage, then do the injection [?].
I'm also curious about that too.
So this is
the first time I'm seeing this presentation so let's speak and we have dermatologists here, dentists and any other specification?
Sorry?
Family medicine.
So everybody is in medical aesthetics right?
So how much experience Do you have six
years of experience and three years?
So there's not a new start, right?
So everybody has some experience here.
All right, then.
So you know that hyaluronic acid is our first need when,
if you're speaking about the fillers, we are mostly speaking about hyaluronic acid fillers.
And also, the hyaluronic acid, as you know, is necessary for keeping the water, keeping them moist in our skin so Gloderm has a serious advantage there because with the 30L form we have 30 milligrams of hyaluronic acid and this is the most
dense hyaluronic acid formation for all over the market no other brand has 30 milligram in one milliliter so when
we are in aging starts It starts with our 20s, as said, but in my opinion, it starts with the puberty, because our body weight gets higher when we get tall, and our body weight keeps making pressure and micro traumas on our ankles, knees, and all the joints.
So the collagen produced and the hyaluronic acid produced by the body is used to check those micro traumas and fix those micro traumas and as we have a constant capacity of producing collagen and hyaluronic acid, our body steals the hyaluronic acid and collagen from our skin and works for the joints.
So especially when I say that the aging starts with 15s, people are shocked but during that that time, every year we lose 1% of collagen and 1% of hyaluronic acid from our skin.
So replacing that is the best choice of anti-aging.
So fillers, when we are in our 20s, nothing is visible seriously.
But as we age and come to 30, 35, something happens to be visible.
Our face goes down with gravity.
The gravity pulls us constantly.
And in daytime, we are 15 or 16 hours vertical.
So it presses our temples, our cheeks.
And also, because of that pressure, the fat pads under our skin shrinks.
Also, the bones change the shape.
As we work on the cadavers who died younger [?], the orbital socket is like a circle.
But when we work on the cadavers who died at the 50s, 60s, it goes back down like a water drop going down.
And also, the zygoma gets thinner and gets lower.
So because of those structural changes, the retaining ligaments, which are holding our skin down to the bone gets by the collagen loss they get loose and also because of the bone structure and fat that structures shrinking they go losing their support and go down so because of that our skin gets saggy and also the skin loses collagen and the structure of the skin gets loose so that way we're getting our our ages and as we age at 35 we start to see what's happening and 40s 50s it goes on so today's patients one is I think at the end of her 40s but the other lady
you may say that you need some surgery but usually when they come to you for some injections they don't want surgery that's why they come to you so sometimes we offer but when they refuse us I say that no heartbreakings but I can do this on that only so maybe if we can work on other structures we can get better results but for now that's the way it is right so we are going to work on the ladies and hala ürünlerin olduğu slide'e gelemedim ya bu slide setini ilk kez görüyorum
okay with Gloderm fillers now we have two types and there are some other products which are on the pipeline and you know we are going to use one of them with 30L form we have 30 milligrams of hyaluronic acid and 20L form we have 20 milligrams of hyaluronic acid but the structure you all use cross-linked hyaluronic acids as fillers the structural behavior of the cross-linking they have have a different golden ratio technology, as they call it.
The cross-linking amount is so well-balanced that with 30 milligrams form, you also can have lifting, but also you have a soft gel.
It was very hard for me to understand the filler technology [?], because, for example, when you are working with Restylane, you have Nasha and the other with Nasha you only have lifting [?] but no softness it's only pushes up the tissue but you if you need some soft filler effect you need to use other technologies or other brands so with 30 L especially it does both of them surprisingly so you may do both lips for for example, with 30L, but also lift the temple with 30L, too,
if you compare with other brands.
So it's a different type.
So that's why we first tried 20L when it was 20 milligrams of filler.
It's a softer gel.
So we first tried it for the lips, as we are used to use fillers with 20 milligrams for lips.
that was good with the other brands but the patient satisfaction was not enough because it was softer than we expected and with the lips it didn't work it only stayed there like five or six months so people didn't like it so for my experience I only used 20L [?] with under eye formation, under eye hollowness, that teardrop deformation, and also maybe with the fine wrinkles and thin lines, so superficial injections.
But 30L is like a joker.
You can use it everywhere.
You can use on the
temples, zygoma, jawline you may use, maybe nasolabial folds.
Also you can do some lips if you want to.
And I didn't try yet, but if there's so serious hollowness in the tear trough area, maybe you can also use it under the eye if you have a fine patient with that.
You'll see that injecting.
It's an interesting filler.
So the volume loss is our serious first approach at anti-aging procedures.
So in my practice, I first correct the volume loss and sagginess with that, then go on with the skin products like mesotherapies and skin boosters, maybe profiler, whatever it is.
I'm
not losing our time with these.
So with cross-linking, as you know, we improve the durability of the gel in the skin.
So, as
we mentioned, with 20L, we have 20 milligrams of cross-linked hyaluronic acid.
They tell that lip reshaping is done with 20Ls, but patient satisfaction is something else.
Because in Turkey, when patients ask for lip filling, they say that I want the most natural lips ever, ever, forever stuff.
stuff, but when you give the natural results, they are not satisfied with that.
So they try to tell that I want full lips, but not looking ridiculous.
So 20L gives moist, loses the wrinkles on the lips, for example, not too much volume, gives hydration and slight fullness, but Turkish patients is not satisfied with that.
So for lips, for example, I use 30L.
Maybe in England, for example.
So it's cultural.
Maybe German people might like it, because European understanding is something else.
But as we go to the Middle East, so we are all working in the Middle East area, people love to see bold results.
And with 30L, as I said, it's like my joker.
I use it everywhere on the skin so if you do in the correct area it does the lifting but if you use it for example superficially it only volumizes so it's about the technique so the filler gives you good results anywhere you use these
are all the technical data about it so
osmolarities and everything is equal the difference is one is 30 milligram the other is 20 milligram and interestingly 30 milligram of hyaluronic acid filler you can inject it easily with 27 gauge needle so yeah for example with a 27 for 20 I use you may use but But sometimes, if I need to work very thin areas, I use 30-gauge needle too.
For example, when you use Korean brands, especially that DVS [?] technology, that beading, you don't have that chance.
You need to use 25-gauge, otherwise it tires [?].
So again, marionette lines, nasolabial folds, you may use 20-gauge [?], 20L form but only for the My experience, if you go under the subcutaneous areas, I use 30L all the time.
And
these are all obtained by Turkish doctors.
Nose filler,
lips with 30.
Again, lip and also asymmetry correction.
Full face reshaping, both the upper and mid face and also jawline.
lips, nose.
Thank
you.
Anything you want to ask?
you need more massage after the injection because when you massage because it's in the area after the injection and it gives pain if you do more massage to the area.
So you don't need more.
Am I right?
Especially I'll ask you not to do massage at first because the gel is when you inject you'll understand what I mean.
is a soft gel that you inject, but in the tissue when it gets integrated, it gives volume and also inflates the skin, under the skin also fat pads and the collagen structures.
So when you inject and then after that press, you change the shape of the filler, then you lose the lifting.
So especially when doing massage she said, but I don't do massage at all.
I just, sometimes if I inject, or sometimes the patient's skin is very thin, and when you take a look, you see droplets clearly, so maybe that time I give a little bit shaping, but I don't touch them at all.
Sorry?
Yes.
You'll see very well.
For example, the first patient is a very heavy-faced lady.
You'll see what happens.
that depends on you doctor that depends on what you do yes of course if you do a natural planning so it does but if you do over feeling you lose the naturalness So, but the result of the, sorry?
Amount and injection point.
If you do one milliliter exactly on the same point, you get an unnatural result eventually.
But the filler acts like standard hyaluronic acid, cross-linked hyaluronic acid filler.
But the specs are, it's not hard to inject.
it's a soft gel form but when you inject under the skin it starts to work there with holding water and gets integrated in the tissue so maybe one week or ten days later when you touch you won't even feel the filler there it gets integrated very well so that's a result I want sometimes patients come here and And it tells that the effect is gone.
I don't understand anything.
15 days later, maybe 20 days later.
But when we take a look at the photos before the injection, you see what happens.
Of course.
But that depends on you, doctor.
That depends on what you do.
Because the filler is a good filler.
But if you do overcorrection, it's not about the filler.
And also, 30
mg means it will attract more water and it will give more volume.
When you try the injections [?], you will see that you will use less product for having the same effect with the other when
you compare with it.
So serious [?], but she has normal aging properties.
And she is skinny also.
She's not skinny.
Not skinny, but her face is.
So when we look at the patient, we have jawline and sagginess on the skin especially.
And as usual, we lose volume with the mid-face area and also temples.
So when I inject for this type of a patient, I usually start with the temples, then zygoma, then a little volumization here on the cheeks, and when we have serious jawline, I also like to support the pre-auricular area to lift the face laterally, also losing the marionette lines and jawline.
so when we do that the under eye deformation will be seen clearly it was like since five years ago we were directly going to point the tear trough deformity but today I'm not doing that when I'm doing the injection you'll see I again inject laterally the other eye too so when we you lift the area, the tear trough deformity loses itself automatically.
So then you have less Tyndall effect.
Can you inject the temple then, this?
Yeah, yeah.
So when speaking about the retaining ligaments around the eye, I have three important retaining ligaments there.
One is orbicular.
One is zygomatic.
The other is temporal.
First, lifting the temporal and zygomatic lifts the orbital, then I point to under-eye, right?
Then temporal, pre-auricular fascia is an important one.
Also lifting the fascia will give us another lifting point, so that will be the best I would do.
Okay.
Now, I'm planning to do something like this for you.
Previously, I did not inform the patient about what I will do.
We will perform the procedure that we call lifting with facial fillings.
In other words, I will add a little filling to the areas where your face loses volume in order to recover the stiff areas below, along with the age.
But my main job is to fix them.
There are bonds that hold your skin tight here.
They are a little loose in your case, they are stiff below.
I will fix them with my hands and place them as if I were placing a wedge [?] under their fillings.
When you look at it from the outside, it does not look strange, but it will be a nice correction.
She had numbing cream on her face.
Numbing the skin [?] so I use a special cream I make it especially for a format to a brand [?] it contains 24% of lidocaine and it's also supported with tetracaine and benzocaine so it's a strong one so but when you when you use the cream numbing you numb only one millimeter thickness of the skin when you go down to the bone you have nothing right so
when I'm injecting on the temple I go find the crest from the temporal crest then the orbital limb and
palpate
the softness here so just on the corner then Then I
have to be careful about the temporal artery because we have a serious volume loss here and I'll inject one milliliter total injected here.
So giving one milliliter of filler here would create serious headache.
So I'll do two injections, half a milliliter here and half a milliliter.
You know, MD codes, have you been watching?
All right, so I'll inject according to the MD codes, T1 and T2.
When opening the mouth, we are relaxing the temporal muscle here.
And also it shows where to inject itself.
So temporal muscle leaves the way.
So I lift the skin.
Also lift the retaining ligament here.
Palpate again, go down to the bone,
aspirate, then
inject.
Aspiration is really important here because sometimes you catch a vessel.
0.5 here, and
one
centimeter behind that.
again
aspirate temporal artery is under my finger I'm
holding it which is good for the patient and me slow
injection is the trick so I'm not forcing even if I'm in a vein or artery just
a small correction I don't do a strong massage You can close your mouth.
What I did here caused some pressure increase.
Don't be afraid.
It takes a few days and then it goes away.
Especially when you eat something, you feel the fullness there.
It took a day when it was done to me.
Some patients say that it makes them uncomfortable for 3-4 days.
It's nothing to be afraid of.
After 3 days, it goes away by itself anyway.
There is an interesting implant.
The implant is also entering right now.
Because we have one thing there.
There is a muscle.
It starts from the jaw and goes up all the way.
It's like a band.
So she's now feeling the pressure, the stretching, on her implant, dental implant.
Do you want to sit?
Regarding the safety of injection of your needle,
doing aspirations are not making us safe [?], but there is false negative aspirations.
How we can avoid this?
For that, I count to 10.
Not too quick, slowly, then count to ten inside.
Take a look at the needle hole there, he said.
But that's what I had.
Believing in my cannula and I was forcing the subcision.
So the cannula failed me.
Cannula is a risky thing.
So sometimes when you force with the cannula...
Again, I'm going on MD codes, Ck1 points, again on the bone.
Then I'll go with the zygomatic eminence here.
Then there's the infraorbital artery and nerve here.
Just next to that, for the deep fat, I'll inject again on the bone.
In total, it will be 0.1, 0.1, 0.1, 0.3, 0.3, and 0.2.
It will make 0.8.
But let's see what happens.
Maybe she might have a little more volumization here.
here, if I need that, I will go superficial with half a milliliter.
Let's see after the lifting.
You use the needle lifting?
Sorry?
You use the needle, and you say, can you look because you want to lift it?
Yes.
I'm going at the deep fat beds.
And when injecting, I hold.
I put the target on my mind, then lift the skin, but do the injection where the point was before to lift the retaining ligament so
I put it here like a pillar like a support leave
it as it is it was like the
retaining ligament was saying here I hold the skin lifted up then took the filler under that like a support then when you leave it it doesn't drop back okay I use a small amount excuse
me for my air conditioner it's broken I think I think we also call the,
now you see, I have the filler here on the bone.
I don't do much of a massage.
Sometimes I just slightly push it upward.
Not press over it, but just giving shape.
All right?
Again, I'm going to the bone.
And
here, this
is the worst part for the patient.
She hears the cracking noise now.
Again, it's one of the most risky areas I'm injecting.
Here I found an artery once.
So I'm aspirating and counting to 10.
I'm on the bone.
I'm nearly inside the periosteum.
So
that gives me the courage to inject.
otherwise so
it's
0.3 lifting
started yes yes so because for the zygomatic retaining ligament we hold it up and laterally so which holds the orbital retaining ligament to it was down with temporal lift and lifted here and now And now, it went like that, so I'm stretching the retaining ligaments at the moment.
You
see, when she smiles, everything goes up and her face is lifted.
So, I'm doing the same thing to her.
On the zygomatic eminence, so I will inject there, but first I'm lifting it because when I lift, can you see the zygomatic ligament?
It goes up, so I go down, check,
again, aspirates, and slowly, 0.
My filler is here.
When I lift, the skin moves there, so that's why you see the new hole there.
But I inject it here.
When you touch, you feel the filler here.
here and now
the most dangerous part again I lift a little enter down to the bone yes I felt the bone do the aspiration and 0.3
yes
Let's see what happens.
The real volume will be here with 0.3 again.
I will just support the area with 0.1, 0.1 and give the weight here.
But first, I want to do the lifting again, even superficially.
I am using the cannula.
Now I am informing my patient, too, because it is her first time.
She doesn't know what I am doing at the moment.
But she is so confident.
Yes, she is confident.
Also, if there is zero pain.
Canınız acıyor mu? [?]
Very lightly, she says.
And the thing I like about Gloderm, again, it doesn't contain lidocaine in it.
So there are patients who are allergic to lidocaine for themselves.
Gloderm is the only option for me.
so now I came back then went under the fat pad and I will do 0.3 here because
of that story I'm very careful about that I don't want my cannula like a needle at the moment because I'm over the the infraorbital artery.
I want her to contract the masseter muscle, to bite.
This is the scar [?].
This is the front end of masseter.
Alright?
Here's my zygoma.
And from tragus, I keep one centimeter of distance.
And
here's the masseter venter.
So this is the area where I will inject.
right and also I
can also do Jw2 here
we have the facial artery and nerve yeah so I have to use the cannula that's about
the patient if you have a bone structure you need to support the area if you lose volume you need to support here that's about the choice you also give a shape like the bone you see mandible it comes here and the ramus goes up yeah so when you have volume loss of the bone or volume lack of the wall [?].
When you press, when you inject here, it gives a better lifting.
And actually it's easier for me and to the patient from entering the lower part because when you inject, when you enter from here with the cannula, you have a lot of collagen lines there, you have the fascia there, so it's painful for the patient they cause the move [?] so you have to be very kind for the about the patient about that area
I won't force, for example, you see.
I found the empty area there.
So
I start with the one milliliter.
Again, I lift the skin with my hand because, you know, we are speaking about the real retaining ligaments, but there are retaining ligaments everywhere around the skin.
so they are like small nails all from the skin not down to the bone but down to the deeper tissues but here we directly connect the skin to the bone all right so don't forget that and we have collagen structures here
I use a 25-gauge cannula, not a very thick one.
0.5 milliliter, then I again do
a small massage and do the lifting, you see
when I inject the Ck4 there's a serious volume like here so i should inject it i found the mandible angle
enter with my needle i'm
here yeah
i'm gonna lift it
So, the jawline is really improved.
Actually, a jawline might be done for this patient, especially keeping the chin a little bit pointy and a little bit support here on the angle would give a very good result, but our patient is a teacher, she's a manager in a school, and changing the shape The shape of the jaw is a very serious change, so she doesn't want something like that.
She wants very natural, unrecognizable results, so I won't touch her chin because of that.
You will have a very good result if you touch this.
Not now.
Because everybody is bringing their children to the registrations of the school.
So, she has to stay strict, right?
So, now...