WEBVTT 00:00:02.560 --> 00:00:12.980 More than 20 years, so you may talk about the market also, because your markets are different from each other, so fashion. 00:00:14.260 --> 00:00:22.660 I want to talk about the cognitive [?] procedures, if you have questions you can ask here. 00:00:23.620 --> 00:00:27.520 We will start with the corporate profile. 00:00:27.820 --> 00:00:41.080 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. 00:01:17.650 --> 00:01:25.630 Yeah, when we look at the operating locations, we have a global company, so we have located in different countries. 00:01:25.950 --> 00:01:30.690 Our sales distribution office is Bogota, Colombia, for Latin America. 00:01:31.910 --> 00:01:41.690 Also, our sales distribution office is in Istanbul, that's why we are making these workshops held here in Istanbul. 00:03:26.950 --> 00:03:28.750 We are very proud to work with you. 00:03:32.740 --> 00:03:35.420 Because I don't know Arabic, excuse me for that. 00:03:35.600 --> 00:03:36.720 And you don't know Turkish. 00:03:37.120 --> 00:03:39.000 So I'm Dr. 00:03:39.080 --> 00:03:39.760 Sinan Akyurek. 00:03:40.700 --> 00:03:42.040 I'm working here. 00:03:42.180 --> 00:03:43.000 This is my clinic. 00:03:43.800 --> 00:03:48.060 I've been in the medical aesthetic sector since 2004. 00:03:48.620 --> 00:03:51.040 I've been a doctor since 2004. 00:03:51.440 --> 00:03:55.180 And with this clinic we are having our fifth year. 00:03:55.320 --> 00:04:00.340 But before that I had another clinic at the upper side of Nişantaşı again. 00:04:00.620 --> 00:04:13.940 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. 00:04:14.680 --> 00:04:18.080 So, with Gloderm, our journey started. 00:04:19.300 --> 00:04:23.920 [ad]'s mother, she is forced here to come to have lip fillers. 00:04:24.040 --> 00:04:33.280 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. 00:04:33.500 --> 00:04:41.220 So, we are going to numb her with nerve blockage, then do the injection [?]. 00:04:44.180 --> 00:04:46.060 I'm also curious about that too. 00:04:46.060 --> 00:04:51.000 So this is 00:04:54.200 --> 00:05:06.860 the first time I'm seeing this presentation so let's speak and we have dermatologists here, dentists and any other specification? 00:05:07.900 --> 00:05:08.860 Sorry? 00:05:09.040 --> 00:05:10.300 Family medicine. 00:05:10.320 --> 00:05:13.820 So everybody is in medical aesthetics right? 00:05:14.820 --> 00:05:18.740 So how much experience Do you have six 00:05:20.500 --> 00:05:24.000 years of experience and three years? 00:05:24.760 --> 00:05:27.380 So there's not a new start, right? 00:05:27.540 --> 00:05:29.960 So everybody has some experience here. 00:05:30.100 --> 00:05:30.620 All right, then. 00:05:31.180 --> 00:05:35.400 So you know that hyaluronic acid is our first need when, 00:05:37.920 --> 00:05:42.460 if you're speaking about the fillers, we are mostly speaking about hyaluronic acid fillers. 00:05:42.560 --> 00:06:03.160 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 00:06:05.500 --> 00:06:15.900 dense hyaluronic acid formation for all over the market no other brand has 30 milligram in one milliliter so when 00:06:19.000 --> 00:06:41.940 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. 00:06:42.080 --> 00:07:04.400 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. 00:07:04.980 --> 00:07:19.500 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. 00:07:19.740 --> 00:07:24.620 So replacing that is the best choice of anti-aging. 00:07:25.260 --> 00:07:32.580 So fillers, when we are in our 20s, nothing is visible seriously. 00:07:33.060 --> 00:07:39.020 But as we age and come to 30, 35, something happens to be visible. 00:07:39.260 --> 00:07:41.460 Our face goes down with gravity. 00:07:41.460 --> 00:07:43.520 The gravity pulls us constantly. 00:07:44.120 --> 00:07:49.080 And in daytime, we are 15 or 16 hours vertical. 00:07:49.260 --> 00:07:52.640 So it presses our temples, our cheeks. 00:07:53.020 --> 00:07:59.720 And also, because of that pressure, the fat pads under our skin shrinks. 00:08:00.360 --> 00:08:03.220 Also, the bones change the shape. 00:08:04.000 --> 00:08:12.260 As we work on the cadavers who died younger [?], the orbital socket is like a circle. 00:08:12.940 --> 00:08:23.380 But when we work on the cadavers who died at the 50s, 60s, it goes back down like a water drop going down. 00:08:23.620 --> 00:08:27.280 And also, the zygoma gets thinner and gets lower. 00:08:27.600 --> 00:09:17.900 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 00:09:51.620 --> 00:10:31.460 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 00:10:35.320 --> 00:11:14.780 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. 00:11:15.560 --> 00:11:28.860 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. 00:11:29.760 --> 00:12:09.680 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, 00:12:11.420 --> 00:12:12.920 if you compare with other brands. 00:12:13.100 --> 00:12:15.000 So it's a different type. 00:12:15.200 --> 00:12:24.060 So that's why we first tried 20L when it was 20 milligrams of filler. 00:12:24.540 --> 00:12:26.140 It's a softer gel. 00:12:26.340 --> 00:12:35.440 So we first tried it for the lips, as we are used to use fillers with 20 milligrams for lips. 00:12:35.440 --> 00:13:09.820 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. 00:13:10.280 --> 00:13:12.180 But 30L is like a joker. 00:13:12.580 --> 00:13:14.100 You can use it everywhere. 00:13:14.400 --> 00:13:16.440 You can use on the 00:13:18.970 --> 00:13:25.390 temples, zygoma, jawline you may use, maybe nasolabial folds. 00:13:25.590 --> 00:13:28.390 Also you can do some lips if you want to. 00:13:28.390 --> 00:13:40.690 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. 00:13:42.860 --> 00:13:45.560 You'll see that injecting. 00:13:45.680 --> 00:13:46.720 It's an interesting filler. 00:13:47.080 --> 00:13:53.080 So the volume loss is our serious first approach at anti-aging procedures. 00:13:53.080 --> 00:14:08.940 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. 00:14:09.260 --> 00:14:09.860 I'm 00:14:15.330 --> 00:14:17.110 not losing our time with these. 00:14:18.230 --> 00:14:25.390 So with cross-linking, as you know, we improve the durability of the gel in the skin. 00:14:25.390 --> 00:14:27.290 So, as 00:14:28.890 --> 00:14:34.750 we mentioned, with 20L, we have 20 milligrams of cross-linked hyaluronic acid. 00:14:36.070 --> 00:14:44.250 They tell that lip reshaping is done with 20Ls, but patient satisfaction is something else. 00:14:44.350 --> 00:14:54.730 Because in Turkey, when patients ask for lip filling, they say that I want the most natural lips ever, ever, forever stuff. 00:14:54.730 --> 00:14:58.530 stuff, but when you give the natural results, they are not satisfied with that. 00:14:58.670 --> 00:15:03.690 So they try to tell that I want full lips, but not looking ridiculous. 00:15:05.090 --> 00:15:22.430 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. 00:15:22.430 --> 00:15:24.810 So for lips, for example, I use 30L. 00:15:29.490 --> 00:15:31.730 Maybe in England, for example. 00:15:31.730 --> 00:15:32.830 So it's cultural. 00:15:32.930 --> 00:15:39.610 Maybe German people might like it, because European understanding is something else. 00:15:39.810 --> 00:15:46.970 But as we go to the Middle East, so we are all working in the Middle East area, people love to see bold results. 00:15:51.820 --> 00:15:55.440 And with 30L, as I said, it's like my joker. 00:15:55.440 --> 00:16:15.840 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 00:16:18.140 --> 00:16:23.620 are all the technical data about it so 00:16:25.320 --> 00:17:01.580 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. 00:17:03.100 --> 00:17:11.800 For example, when you use Korean brands, especially that DVS [?] technology, that beading, you don't have that chance. 00:17:12.040 --> 00:17:17.020 You need to use 25-gauge, otherwise it tires [?]. 00:17:24.790 --> 00:17:42.190 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. 00:17:42.330 --> 00:17:42.850 And 00:17:50.560 --> 00:17:54.240 these are all obtained by Turkish doctors. 00:17:59.060 --> 00:18:00.060 Nose filler, 00:18:02.910 --> 00:18:04.550 lips with 30. 00:18:15.830 --> 00:18:19.550 Again, lip and also asymmetry correction. 00:18:25.960 --> 00:18:31.750 Full face reshaping, both the upper and mid face and also jawline. 00:18:31.750 --> 00:18:34.390 lips, nose. 00:18:34.830 --> 00:18:35.630 Thank 00:18:40.850 --> 00:18:40.970 you. 00:18:43.490 --> 00:18:45.130 Anything you want to ask? 00:19:28.410 --> 00:19:40.370 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. 00:19:40.630 --> 00:19:42.430 So you don't need more. 00:19:42.590 --> 00:19:43.170 Am I right? 00:19:43.950 --> 00:19:51.710 Especially I'll ask you not to do massage at first because the gel is when you inject you'll understand what I mean. 00:19:51.710 --> 00:20:04.930 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. 00:20:05.390 --> 00:20:13.470 So when you inject and then after that press, you change the shape of the filler, then you lose the lifting. 00:20:13.830 --> 00:20:21.010 So especially when doing massage she said, but I don't do massage at all. 00:20:21.710 --> 00:20:39.130 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. 00:20:43.590 --> 00:20:44.170 Sorry? 00:20:46.560 --> 00:20:47.140 Yes. 00:20:48.100 --> 00:20:49.380 You'll see very well. 00:20:49.500 --> 00:20:52.640 For example, the first patient is a very heavy-faced lady. 00:20:52.880 --> 00:20:54.060 You'll see what happens. 00:21:02.790 --> 00:21:28.450 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? 00:21:28.710 --> 00:21:31.530 Amount and injection point. 00:21:32.130 --> 00:21:38.630 If you do one milliliter exactly on the same point, you get an unnatural result eventually. 00:21:39.050 --> 00:21:45.730 But the filler acts like standard hyaluronic acid, cross-linked hyaluronic acid filler. 00:21:45.950 --> 00:21:51.270 But the specs are, it's not hard to inject. 00:21:51.270 --> 00:22:18.070 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. 00:22:18.110 --> 00:22:19.190 I don't understand anything. 00:22:19.630 --> 00:22:21.630 15 days later, maybe 20 days later. 00:22:21.950 --> 00:22:27.690 But when we take a look at the photos before the injection, you see what happens. 00:22:36.710 --> 00:22:37.670 Of course. 00:22:38.710 --> 00:22:40.310 But that depends on you, doctor. 00:22:41.690 --> 00:22:43.590 That depends on what you do. 00:22:43.950 --> 00:22:45.730 Because the filler is a good filler. 00:22:45.910 --> 00:22:50.750 But if you do overcorrection, it's not about the filler. 00:22:58.010 --> 00:23:00.990 And also, 30 00:23:08.870 --> 00:23:15.190 mg means it will attract more water and it will give more volume. 00:23:16.110 --> 00:23:26.330 When you try the injections [?], you will see that you will use less product for having the same effect with the other when 00:23:28.020 --> 00:23:28.940 you compare with it. 00:23:29.150 --> 00:23:34.310 So serious [?], but she has normal aging properties. 00:23:34.690 --> 00:23:35.750 And she is skinny also. 00:23:36.350 --> 00:23:37.190 She's not skinny. 00:23:37.550 --> 00:23:39.210 Not skinny, but her face is. 00:23:41.270 --> 00:23:48.490 So when we look at the patient, we have jawline and sagginess on the skin especially. 00:23:48.790 --> 00:23:56.010 And as usual, we lose volume with the mid-face area and also temples. 00:23:56.010 --> 00:24:22.810 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. 00:24:22.810 --> 00:24:57.450 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. 00:24:58.250 --> 00:25:01.170 So then you have less Tyndall effect. 00:25:01.730 --> 00:25:04.550 Can you inject the temple then, this? 00:25:04.590 --> 00:25:05.410 Yeah, yeah. 00:25:05.890 --> 00:25:15.270 So when speaking about the retaining ligaments around the eye, I have three important retaining ligaments there. 00:25:15.410 --> 00:25:16.670 One is orbicular. 00:25:17.230 --> 00:25:18.430 One is zygomatic. 00:25:18.790 --> 00:25:19.950 The other is temporal. 00:25:19.950 --> 00:25:29.410 First, lifting the temporal and zygomatic lifts the orbital, then I point to under-eye, right? 00:25:33.580 --> 00:25:40.660 Then temporal, pre-auricular fascia is an important one. 00:25:40.740 --> 00:25:48.500 Also lifting the fascia will give us another lifting point, so that will be the best I would do. 00:26:17.360 --> 00:26:17.440 Okay. 00:26:18.080 --> 00:26:20.120 Now, I'm planning to do something like this for you. 00:26:20.880 --> 00:26:23.480 Previously, I did not inform the patient about what I will do. 00:26:24.680 --> 00:26:28.360 We will perform the procedure that we call lifting with facial fillings. 00:26:28.580 --> 00:26:35.360 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. 00:26:36.260 --> 00:26:37.640 But my main job is to fix them. 00:26:37.640 --> 00:26:39.680 There are bonds that hold your skin tight here. 00:26:40.060 --> 00:26:43.280 They are a little loose in your case, they are stiff below. 00:26:43.280 --> 00:26:48.060 I will fix them with my hands and place them as if I were placing a wedge [?] under their fillings. 00:26:49.240 --> 00:26:53.220 When you look at it from the outside, it does not look strange, but it will be a nice correction. 00:26:55.410 --> 00:26:57.890 She had numbing cream on her face. 00:26:59.090 --> 00:27:32.150 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 00:27:34.110 --> 00:27:45.210 when I'm injecting on the temple I go find the crest from the temporal crest then the orbital limb and 00:27:46.610 --> 00:27:48.330 palpate 00:27:50.000 --> 00:27:56.760 the softness here so just on the corner then Then I 00:27:58.900 --> 00:28:07.660 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. 00:28:07.900 --> 00:28:15.220 So giving one milliliter of filler here would create serious headache. 00:28:16.130 --> 00:28:20.280 So I'll do two injections, half a milliliter here and half a milliliter. 00:28:20.680 --> 00:28:24.160 You know, MD codes, have you been watching? 00:28:25.040 --> 00:28:30.280 All right, so I'll inject according to the MD codes, T1 and T2. 00:28:36.160 --> 00:28:40.600 When opening the mouth, we are relaxing the temporal muscle here. 00:28:40.760 --> 00:28:43.420 And also it shows where to inject itself. 00:28:43.840 --> 00:28:46.240 So temporal muscle leaves the way. 00:28:46.340 --> 00:28:49.860 So I lift the skin. 00:28:49.860 --> 00:28:53.000 Also lift the retaining ligament here. 00:28:54.760 --> 00:28:57.620 Palpate again, go down to the bone, 00:28:59.540 --> 00:29:01.760 aspirate, then 00:29:07.810 --> 00:29:08.270 inject. 00:29:09.030 --> 00:29:15.290 Aspiration is really important here because sometimes you catch a vessel. 00:29:28.970 --> 00:29:32.690 0.5 here, and 00:29:34.710 --> 00:29:35.850 one 00:29:37.550 --> 00:29:40.090 centimeter behind that. 00:29:40.090 --> 00:29:41.010 again 00:29:45.230 --> 00:29:50.670 aspirate temporal artery is under my finger I'm 00:29:52.330 --> 00:29:57.430 holding it which is good for the patient and me slow 00:30:09.660 --> 00:30:20.920 injection is the trick so I'm not forcing even if I'm in a vein or artery just 00:30:27.700 --> 00:30:33.140 a small correction I don't do a strong massage You can close your mouth. 00:30:33.560 --> 00:30:35.840 What I did here caused some pressure increase. 00:30:36.660 --> 00:30:37.500 Don't be afraid. 00:30:37.580 --> 00:30:39.480 It takes a few days and then it goes away. 00:30:39.540 --> 00:30:43.320 Especially when you eat something, you feel the fullness there. 00:30:43.880 --> 00:30:45.420 It took a day when it was done to me. 00:30:45.420 --> 00:30:47.460 Some patients say that it makes them uncomfortable for 3-4 days. 00:30:48.940 --> 00:30:50.200 It's nothing to be afraid of. 00:30:50.480 --> 00:30:52.240 After 3 days, it goes away by itself anyway. 00:30:52.840 --> 00:30:53.360 There is an interesting implant. 00:30:54.180 --> 00:30:56.100 The implant is also entering right now. 00:30:56.100 --> 00:30:58.740 Because we have one thing there. 00:30:58.780 --> 00:30:59.320 There is a muscle. 00:31:27.930 --> 00:31:31.370 It starts from the jaw and goes up all the way. 00:31:31.390 --> 00:31:31.990 It's like a band. 00:31:32.210 --> 00:31:38.950 So she's now feeling the pressure, the stretching, on her implant, dental implant. 00:31:39.830 --> 00:31:40.770 Do you want to sit? 00:31:43.390 --> 00:31:45.950 Regarding the safety of injection of your needle, 00:31:47.670 --> 00:31:52.510 doing aspirations are not making us safe [?], but there is false negative aspirations. 00:31:52.890 --> 00:31:53.810 How we can avoid this? 00:31:53.970 --> 00:31:56.450 For that, I count to 10. 00:32:00.170 --> 00:32:05.210 Not too quick, slowly, then count to ten inside. 00:32:07.620 --> 00:32:10.700 Take a look at the needle hole there, he said. 00:32:11.540 --> 00:32:14.400 But that's what I had. 00:32:15.720 --> 00:32:20.040 Believing in my cannula and I was forcing the subcision. 00:32:21.060 --> 00:32:22.640 So the cannula failed me. 00:32:23.520 --> 00:32:24.680 Cannula is a risky thing. 00:32:25.360 --> 00:32:27.880 So sometimes when you force with the cannula... 00:32:34.050 --> 00:32:40.910 Again, I'm going on MD codes, Ck1 points, again on the bone. 00:32:41.950 --> 00:32:46.470 Then I'll go with the zygomatic eminence here. 00:32:49.260 --> 00:32:54.940 Then there's the infraorbital artery and nerve here. 00:32:55.820 --> 00:33:02.460 Just next to that, for the deep fat, I'll inject again on the bone. 00:33:08.860 --> 00:33:17.280 In total, it will be 0.1, 0.1, 0.1, 0.3, 0.3, and 0.2. 00:33:17.320 --> 00:33:19.080 It will make 0.8. 00:33:22.320 --> 00:33:24.240 But let's see what happens. 00:33:24.360 --> 00:33:27.680 Maybe she might have a little more volumization here. 00:33:27.680 --> 00:33:32.560 here, if I need that, I will go superficial with half a milliliter. 00:33:33.740 --> 00:33:35.220 Let's see after the lifting. 00:33:35.400 --> 00:33:36.740 You use the needle lifting? 00:33:40.790 --> 00:33:41.270 Sorry? 00:33:41.650 --> 00:33:45.310 You use the needle, and you say, can you look because you want to lift it? 00:33:45.470 --> 00:33:45.650 Yes. 00:33:45.810 --> 00:33:48.230 I'm going at the deep fat beds. 00:33:49.390 --> 00:33:52.570 And when injecting, I hold. 00:33:53.830 --> 00:34:08.190 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 00:34:09.670 --> 00:34:16.050 I put it here like a pillar like a support leave 00:34:20.530 --> 00:34:24.270 it as it is it was like the 00:34:27.150 --> 00:34:44.010 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 00:34:46.540 --> 00:34:51.660 me for my air conditioner it's broken I think I think we also call the, 00:34:53.680 --> 00:34:56.300 now you see, I have the filler here on the bone. 00:34:57.640 --> 00:34:59.680 I don't do much of a massage. 00:35:00.160 --> 00:35:03.200 Sometimes I just slightly push it upward. 00:35:03.480 --> 00:35:06.140 Not press over it, but just giving shape. 00:35:06.840 --> 00:35:07.520 All right? 00:35:08.480 --> 00:35:11.260 Again, I'm going to the bone. 00:35:12.540 --> 00:35:13.060 And 00:35:22.410 --> 00:35:23.510 here, this 00:35:26.450 --> 00:35:28.030 is the worst part for the patient. 00:35:28.230 --> 00:35:30.010 She hears the cracking noise now. 00:35:37.910 --> 00:35:41.770 Again, it's one of the most risky areas I'm injecting. 00:35:42.010 --> 00:35:44.030 Here I found an artery once. 00:35:45.210 --> 00:35:47.710 So I'm aspirating and counting to 10. 00:35:48.970 --> 00:35:49.930 I'm on the bone. 00:35:50.030 --> 00:35:52.070 I'm nearly inside the periosteum. 00:35:54.430 --> 00:35:54.950 So 00:35:56.450 --> 00:35:59.130 that gives me the courage to inject. 00:35:59.130 --> 00:36:01.590 otherwise so 00:36:07.450 --> 00:36:09.390 it's 00:36:13.770 --> 00:36:15.750 0.3 lifting 00:36:17.390 --> 00:36:42.350 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. 00:36:54.850 --> 00:36:55.290 You 00:36:58.840 --> 00:37:02.560 see, when she smiles, everything goes up and her face is lifted. 00:37:02.780 --> 00:37:04.960 So, I'm doing the same thing to her. 00:37:09.400 --> 00:37:19.480 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? 00:37:19.660 --> 00:37:23.860 It goes up, so I go down, check, 00:37:27.980 --> 00:37:38.740 again, aspirates, and slowly, 0. 00:37:50.180 --> 00:37:51.660 My filler is here. 00:37:52.580 --> 00:38:00.540 When I lift, the skin moves there, so that's why you see the new hole there. 00:38:01.000 --> 00:38:02.540 But I inject it here. 00:38:03.740 --> 00:38:05.980 When you touch, you feel the filler here. 00:38:05.980 --> 00:38:15.100 here and now 00:38:18.330 --> 00:38:37.550 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 00:38:40.810 --> 00:38:43.110 yes 00:38:50.720 --> 00:38:51.780 Let's see what happens. 00:39:23.920 --> 00:39:27.860 The real volume will be here with 0.3 again. 00:39:28.240 --> 00:39:33.800 I will just support the area with 0.1, 0.1 and give the weight here. 00:39:33.980 --> 00:39:38.820 But first, I want to do the lifting again, even superficially. 00:39:49.370 --> 00:39:50.170 I am using the cannula. 00:39:51.050 --> 00:39:53.990 Now I am informing my patient, too, because it is her first time. 00:39:54.510 --> 00:39:57.430 She doesn't know what I am doing at the moment. 00:39:57.590 --> 00:39:58.850 But she is so confident. 00:40:00.010 --> 00:40:01.110 Yes, she is confident. 00:40:02.650 --> 00:40:05.330 Also, if there is zero pain. 00:40:07.730 --> 00:40:08.290 Canınız acıyor mu? [?] 00:40:10.890 --> 00:40:12.510 Very lightly, she says. 00:40:13.950 --> 00:40:19.550 And the thing I like about Gloderm, again, it doesn't contain lidocaine in it. 00:40:21.990 --> 00:40:26.930 So there are patients who are allergic to lidocaine for themselves. 00:40:27.650 --> 00:40:29.290 Gloderm is the only option for me. 00:40:30.410 --> 00:40:46.410 so now I came back then went under the fat pad and I will do 0.3 here because 00:40:50.790 --> 00:40:58.850 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. 00:40:59.900 --> 00:41:04.140 I want her to contract the masseter muscle, to bite. 00:41:04.460 --> 00:41:05.660 This is the scar [?]. 00:41:06.260 --> 00:41:09.000 This is the front end of masseter. 00:41:09.680 --> 00:41:10.000 Alright? 00:41:10.960 --> 00:41:12.300 Here's my zygoma. 00:41:17.260 --> 00:41:22.860 And from tragus, I keep one centimeter of distance. 00:41:23.460 --> 00:41:24.100 And 00:41:27.360 --> 00:41:28.520 here's the masseter venter. 00:41:29.740 --> 00:41:32.000 So this is the area where I will inject. 00:41:32.000 --> 00:41:36.680 right and also I 00:41:38.700 --> 00:41:41.940 can also do Jw2 here 00:41:44.120 --> 00:42:07.980 we have the facial artery and nerve yeah so I have to use the cannula that's about 00:42:12.650 --> 00:42:47.490 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 [?]. 00:42:47.950 --> 00:42:52.010 When you press, when you inject here, it gives a better lifting. 00:42:54.750 --> 00:43:18.850 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 00:43:38.760 --> 00:43:40.960 I won't force, for example, you see. 00:43:42.000 --> 00:43:45.060 I found the empty area there. 00:43:45.240 --> 00:43:45.680 So 00:43:47.090 --> 00:43:49.510 I start with the one milliliter. 00:43:49.870 --> 00:44:02.670 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. 00:44:02.670 --> 00:44:21.390 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 00:44:36.670 --> 00:44:41.670 I use a 25-gauge cannula, not a very thick one. 00:45:11.210 --> 00:45:17.090 0.5 milliliter, then I again do 00:45:18.630 --> 00:45:25.150 a small massage and do the lifting, you see 00:45:29.850 --> 00:45:41.790 when I inject the Ck4 there's a serious volume like here so i should inject it i found the mandible angle 00:45:45.720 --> 00:45:48.680 enter with my needle i'm 00:46:06.470 --> 00:46:07.330 here yeah 00:46:11.910 --> 00:46:12.770 i'm gonna lift it 00:46:20.280 --> 00:46:23.520 So, the jawline is really improved. 00:46:25.060 --> 00:46:51.300 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. 00:46:51.800 --> 00:46:57.860 She wants very natural, unrecognizable results, so I won't touch her chin because of that. 00:46:59.020 --> 00:47:01.600 You will have a very good result if you touch this. 00:47:02.600 --> 00:47:03.380 Not now. 00:47:03.440 --> 00:47:04.140 Not now. 00:47:06.180 --> 00:47:12.680 Because everybody is bringing their children to the registrations of the school. 00:47:12.680 --> 00:47:16.680 So, she has to stay strict, right? 00:47:18.060 --> 00:47:18.960 So, now...